[Federal Register Volume 65, Number 219 (Monday, November 13, 2000)]
[Rules and Regulations]
[Pages 67798-68020]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-28475]



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Part II





Department of Health and Human Services





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Health Care Financing Administration



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42 CFR Part 419



Medicare Program; Prospective Payment System for Hospital Outpatient 
Services; Interim Final Rule

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / 
Rules and Regulations

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Part 419

[HCFA-1005-IFC]
RIN 0938-A156


Medicare Program; Prospective Payment System for Hospital 
Outpatient Services

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Interim final rule with comment period.

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SUMMARY: This interim final rule with comment period provides for the 
annual update to the Medicare hospital outpatient prospective payment 
system conversion factor that is used to calculate the payment amount 
for each payment group, effective January 1, 2001. It also updates the 
wage index values and incorporates the year 2001 changes in the 
procedure codes that are used to make payments under this system. In 
this rule, we are also responding to public comments received on those 
portions of the April 7, 2000 final rule with comment period (which 
established the hospital outpatient prospective payment system) that 
implemented related provisions of the Balanced Budget Refinement Act 
(BBRA) of 1999. In addition, we are responding to public comments on 
the August 3, 2000 interim final rule with comment period that modified 
the April 7, 2000 final rule with comment period by revising the 
criteria used to define new or innovative medical devices, drugs, and 
biologicals eligible for transitional pass-through payments and 
correcting the criteria for grandfathering provider-based Federally 
Qualified Health Centers (FQHC) into the prospective payment system.

DATES:   
    Effective Date: These regulations are effective on January 1, 2001.
    Comment Period: We will consider comments if we receive them at the 
appropriate address, as provided below, no later than 5 p.m. on January 
12, 2001.

ADDRESSES: Mail written comments (1 original and 3 copies) to the 
following address:

Health Care Financing Administration, Department of Health and Human 
Services, Attention: HCFA-1005-IFC, P.O. Box 8013, Baltimore, MD 21244-
8013.

    To ensure that mailed comments are received in time for us to 
consider them, please allow for possible delays in delivering them.
    If you prefer, you may deliver your written comments (1 original 
and 3 copies) to one of the following addresses:

Room 443-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., 
Washington, DC 20201, or

Room C5-14-03, 7500 Security Boulevard, Baltimore, MD 21244-1850.

    Comments mailed to the above addresses may be delayed and received 
too late for us to consider them. Because of staff and resource 
limitations, we cannot accept comments by facsimile (FAX) transmission. 
In commenting, please refer to file code HCFA-1005-IFC. of the received 
timely will be available for public inspection as they are received, 
generally beginning approximately 3 weeks after publication of a 
document, in Room 443-G of the Department's office at 200 Independence 
Avenue, SW., Washington, DC, on Monday through Friday of each week from 
8:30 to 5 p.m. (phone: (202) 690-7890).

FOR FURTHER INFORMATION CONTACT:
Janet Wellham (410) 786-4510, Chuck Braver, (410) 786-6719, or Jana 
Petze (410) 786-9374, (for general information).
Kity Ahern, (410) 786-4515 (for information related to ambulatory 
payment classification groups and transitional pass-through payments 
related to drugs and biologicals).
Majorie Baldo, (410) 786-4617 or Barry Levi, (410) 786-4529 (for 
information related to transitional pass-through payments for medical 
devices).
George Morey (410) 786-4653 (for information related to the criteria 
for grandfathering provider-based FQHCs into the prospective payment 
system).

SUPPLEMENTARY INFORMATION:

Availability of Copies and Electronic Access

    Copies: To order copies of the Federal Register containing this 
document, send your request to: New Orders, Superintendent of 
Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date 
of the issue requested and enclose a check or money order payable to 
the Superintendent of Documents, or enclose your Visa or Master Card 
number and expiration date. Credit card orders can also be placed by 
calling the order desk at (202) 512-1800 or by faxing to (202) 512-
2250. The cost for each copy is $8. As an alternative, you can view and 
photocopy the Federal Register document at most libraries designated as 
Federal Depository Libraries and at many other public and academic 
libraries throughout the country that receive the Federal Register.
    This Federal Register document is also available from the Federal 
Register online database through GPO Access, a service of the U.S. 
Government Printing Office. The Website address is http://www.access.gpo.gov /nara/index.html.
    To assist readers in referencing sections contained in this 
document, we are providing the following table of contents:

Table of Contents

I. Background

A. General Summary of April 7, 2000 Final Rule With Comment Period 
that Implemented Amendments Enacted by the Balanced Budget Act of 
1997 and the Balanced Budget Refinement Act of 1999
B. June 30, 2000 Notice of Delay of Effective Date for the April 7, 
2000 Final Rule with Comment Period
C. August 3, 2000 Interim Final Rule with Comment Period
D. Summary of This Interim Final Rule with Comment Period

II. Analysis of, and Responses to, Public Comments on the BBRA 1999 
Provisions and the August 3, 2000 Interim Final Rule with Comment 
Period

A. April 7, 2000 BBRA 1999 Provisions
    1. Outlier Adjustment
    2. Transitional Pass-Through for Additional Costs of Innovative 
Medical Devices, Drugs, and Biologicals
    a. Definition of a device
    b. Eligibility criteria
    c. Investigational device exemption (IDE) device
    d. Removing cost of predicate item
    e. Excluded costs
    f. Effect on conversion factor
    g. Cost significance tests
    h. Brand-specific versus categorization approaches
    i. Issues pertaining to specific items
    j. Pass-through applications process
    k. Payment for pass-through items
    l. Focus medical review
    3. Budget Neutrality Applied to New Adjustments
    4. Limitation on Judicial Review
    5. Inclusion in the Hospital Outpatient Prospective Payment 
System of Certain Implantable Items
    6. Payment Weights Based on Median or Mean Hospital Costs
    7. Limitation on Variation of Costs of Services Classified 
Within a Group
    8. Annual Review of the Components of the Hospital Outpatient 
Prospective Payment System
    9. Copayment Amounts Not Affected by Pass-Throughs
    10. Extension of Cost Reductions
    11. Clarification of Congressional Intent Regarding Base Amounts 
Used in Determining the Hospital Outpatient Prospective Payment 
System

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    12. Transitional Corridors for Application of Outpatient 
Prospective Payment System
    a. Interim payment versus final settlement
    b. Payment-to-cost ratios
    c. Cost-to-charge ratios
    d. Interim payments limited to 85 percent of the estimated 
transitional corridor payment
    e. Providers having more than one 1996 cost report
    f. Providers having no 1996 cost report
    g. Prospective payment system delay and transitional corridor 
payments
    h. Rural hold-harmless provision
    i. Covered charges
    j. Cancer hospitals and transitional corridor payments
    k. Teaching hospitals and transitional corridor payments
    13. Limitation on Coinsurance for a Procedure
    14. Reclassification of Certain Hospitals
B. August 3, 2000 Interim Final Rule With Comment Period
    1. Transitional Pass-Through Provisions
    a. ``Not insignificant'' cost criteria
    b. Definition of medical device
    2. Revision to Grandfather Provision for Certain FQHCs and 
``Look-Alikes''
    3. Clarification of Notice of Beneficiary Cost-Sharing Liability
    4. Clarification of Protocols for Off-Campus Departments
    5. Typographical Errors in the Provider-Based Regulations

III. Provisions of This Interim Final Rule With Comment Period

A. Changes Relating to the BBRA 1999 Public Comments
B. Annual Updates to Components of the Hospital Outpatient 
Prospective Payment System
    1. APC Groups
a. New codes
b. Deleted codes
c. Revisions to correct errors or inconsistencies
d. Device-related codes
e. Inpatient codes moved to the outpatient setting
f. ``Two-times'' rule
g. Inpatient codes moved to outpatient and affected by device
h. Newly covered codes
i. Pass-through requests for drugs
2. Inpatient Procedures List Update
3. Wage Index Adjustment
4. Conversion Factor Update

IV. Waiver of Notice of Proposed Rulemaking

V. Collection of Information Requirements

VI. Regulatory Impact

      A. General
      B. Analysis for Changes in this Interim Final Rule with 
Comment Period
      C. Federalism
      D. Executive Order 12866 and 5 U.S.C. 804(2) Regulation Text
      Addenda
Note to the Addenda
Addendum A--List of Hospital Outpatient Ambulatory Payment 
Classifications with Status Indicators, Relative Weights, Payment 
Rates, and Coinsurance Amounts--Calendar Year 2001
Addendum B--Hospital Outpatient Department (HOPD) Payment Status by 
HCPCS Code and Related Information--Calendar Year 2001
Addendum C--[Reserved]
Addendum D--Status Indicators: How Various Services Are Treated 
under the Hospital Outpatient Prospective Payment System
Addendum E--CPT Codes Which Will Be Paid Only As Inpatient 
Procedures--Calendar Year 2001
Addendum F--Wage Index for Urban Areas
Addendum G--Wage Index for Rural Areas
Addendum H--Wage Index for Hospitals That Are Reclassified

Alphabetical List of Acronyms Appearing in the Interim Final Rule With 
Comment Period

APC  Ambulatory payment classification
APG  Ambulatory patient group
ASC  Ambulatory surgical center
AWP  Average wholesale price
BBA  1997 Balanced Budget Act of 1997
BBRA  1999 Balanced Budget Refinement Act of 1999
CAT  Computerized axial tomography
CCI  [HCFA's] Correct Coding Initiative
CCR  Cost center specific cost-to-charge ratio
CMHC  Community mental health center
CORF  Comprehensive outpatient rehabilitation facility
CPI  Consumer Price Index
CPT  [Physicians'] Current Procedural Terminology, 4th Edition, 
2000, copyrighted by the American Medical Association
DME  Durable medical equipment
DMEPOS  DME, prosthetics (which include prosthetic devices and 
implants) orthotics, and supplies
DRG  Diagnosis-related group
FDA  Food and Drug Administration
FQHC  Federally qualified health center
HCPCS  HCFA Common Procedure Coding System
HHA  Home health agency
ICD-9-CM  International Classification of Diseases, Ninth Edition, 
Clinical Modification
IME  Indirect medical education
JCAHO  Joint Commission on Accreditation of Healthcare Organizations
MRI  Magnetic resonance imaging
MSA  Metropolitan statistical area
NECMA  New England County Metropolitan Area
PPS  Prospective payment system
RFA  Regulatory Flexibility Act
RHC Rural health clinic
RRC Rural referral center
SCH Sole community hospital
SNF Skilled nursing facility

I. Background

A. General Summary of April 7, 2000 Final Rule With Comment Period That 
Implemented Amendments Enacted by the Balanced Budget Act of 1997 and 
the Balanced Budget Refinement Act of 1999

    On April 7, 2000, we published in the Federal Register (65 FR 
18434) a final rule with comment period to implement a new prospective 
payment system for hospital outpatient services. This new system 
establishes prospective payment rates for covered outpatient hospital 
services using ambulatory payment classification (APC) groups. The 
April 7, 2000 final rule with comment period implemented section 4523 
of the Balanced Budget Act of 1997 (the BBA 1997), Public Law 105-33, 
and related sections of the Balanced Budget Refinement Act of 1999 (the 
BBRA 1999), Public Law 106-113. Section 4523 of the BBA 1997 amended 
section 1833 of the Social Security Act (the Act) by adding subsection 
(t) to provide for implementation of a prospective payment system for 
hospital outpatient services furnished to Medicare beneficiaries. 
Section 1833(t) of the Act, as added by the BBA 1997--
    <bullet> Authorizes the Secretary to designate the hospital 
outpatient services that would be paid under the prospective payment 
system and requires that the hospital outpatient prospective payment 
system include hospital inpatient services designated by the Secretary 
that are covered under Medicare Part B for beneficiaries who are 
entitled to Part A benefits but who have exhausted them or are 
otherwise entitled to them.
    <bullet> Sets forth certain requirements for the hospital 
outpatient prospective payment system, including the requirement that a 
classification system for covered outpatient services be developed that 
may consist of groups arranged so that the services within each group 
are comparable clinically and with respect to the use of resources.
    <bullet> Specifies data requirements for establishing relative 
payment weights. The weights are to be based on the median hospital 
costs determined by 1996 claims data and data from the most recent 
available cost reports. (This provision has subsequently been changed 
by the BBRA 1999, as discussed later in this preamble.)
    <bullet> Requires that the portion of the Medicare payment and the 
beneficiary coinsurance that are attributable to labor and labor-
related costs be adjusted for geographic wage differences in a budget 
neutral manner.
    <bullet> Authorizes the Secretary under section 1833(t)(2)(E) of 
the Act to establish, in a budget neutral manner, other adjustments, 
such as outlier adjustments or adjustments for certain classes of 
hospitals, that the Secretary determines to be necessary to ensure 
equitable payments.
    <bullet> Requires the Secretary to develop a method for controlling 
unnecessary

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increases in the volume of covered outpatient services.
    <bullet> Specifies how beneficiary deductibles are to be treated 
when calculating the Medicare payment and beneficiary coinsurance 
amounts and requires that rules be established regarding determination 
of coinsurance amounts for covered services that were not furnished in 
1996. The statute freezes beneficiary coinsurance at 20 percent of the 
national median charges for covered services (or a group of covered 
services) furnished during 1996 and updated to 1999 using the 
Secretary's estimated charge growth from 1996 to 1999.
    <bullet> Prescribes the formula for calculating the initial 
conversion factor used to determine 1999 Medicare payment amounts and 
the method for updating the conversion factor in subsequent years.
    <bullet> Describes the method for determining the Medicare payment 
amount and the beneficiary coinsurance amount for services covered 
under the outpatient prospective payment system. (This section was 
amended by the BBRA 1999, as discussed later in this preamble.)
    <bullet> Requires the Secretary to establish a procedure whereby 
hospitals may voluntarily elect to reduce beneficiary copayment for 
some or all covered services to an amount no less than 20 percent of 
the Medicare payment amount. Hospitals are further allowed to 
disseminate information on any such reductions of copayment amounts. 
Section 4451 of the BBA 1997 added section 1861(v)(1)(T) to the Act, 
which provides that any reduction in copayment, must not be treated as 
a bad debt.
    <bullet> Authorizes periodic review and revision of the payment 
groups, relative payment weights, wage index, and conversion factor. 
(This section was amended by the BBRA 1999, as discussed later in this 
preamble.)
    <bullet> Describes how payment is to be made for ambulance 
services, which are specifically excluded from the hospital outpatient 
prospective payment system under section 1833(t)(1)(B) of the Act.
    <bullet> Provides that the Secretary may establish a separate 
conversion factor for services furnished by cancer hospitals that are 
excluded from the hospital inpatient prospective payment system.
    <bullet> Prohibits administrative or judicial review of the 
hospital outpatient prospective payment system classification system, 
the payment groups, relative payment weights, wage adjustment factors, 
other adjustments, calculation of base amounts, periodic adjustments, 
and the establishment of a separate conversion factor for those cancer 
hospitals excluded from hospital inpatient prospective payment system. 
(This section was expanded by the BBRA 1999, as discussed later in this 
preamble.)
    Section 4523(d) of the BBA 1997 made a conforming amendment to 
section 1833(a)(2)(B) of the Act to provide for payment under the 
hospital outpatient prospective payment system for some services 
described in section 1832(a)(2) of the Act that are currently paid on a 
cost basis and furnished by providers of services, such as 
comprehensive outpatient rehabilitation facilities (CORFs), home health 
agencies (HHAs), hospices, and community mental health centers (CMHCs). 
This amendment provides that partial hospitalization services furnished 
by CMHCs be paid under the hospital outpatient prospective payment 
system.
    Before enactment of section 4521(b) of the BBA 1997, the blended 
payment formulas for ambulatory surgery centers (ASC) procedures, 
radiology, and other diagnostic services, the ASC or physician fee 
schedule portion were calculated as if the beneficiary paid 20 percent 
of the ASC rate or physician fee schedule amount instead of the actual 
amount paid, which was 20 percent of the hospital's billed charges. 
Section 4521(b) of the BBA 1997, which amended sections 
1833(i)(3)(B)(i)(II) and 1833(n)(1)(B)(i) of the Act, corrected this 
anomaly by changing the blended calculations so that all amounts paid 
by the beneficiary are subtracted from the total payment in the 
calculation to determine the amount due from the program. Effective for 
services furnished on or after October 1, 1997, payment for ASC 
surgery, radiology, and other diagnostic services calculated by blended 
payment methods is now calculated by subtracting the full amount of 
coinsurance due from the beneficiary (based on 20 percent of the 
hospital's billed charges).
    Section 1861(v)(1)(S)(ii) of the Act was amended by section 4522 of 
the BBA 1997 to require that the amounts otherwise payable for hospital 
outpatient operating costs and capital costs be reduced by 5.8 percent 
and 10 percent, respectively, through December 31, 1999. (This section 
was further amended by the BBRA 1999.)
    (Refer to the April 7, 2000 hospital outpatient prospective payment 
system final rule with comment period for a more in-depth description 
of how the changes made by the BBA 1997 and the BBRA 1999 were 
implemented.)
    On November 29, 1999, after we had published a proposed rule to 
implement section 4253 of the BBA 1997, the BBRA 1999 was enacted. The 
BBRA 1999 made major changes that affected the hospital outpatient 
prospective payment system that was established by the BBA 1997 and 
implemented in the April 7, 2000 final rule with comment period. 
Therefore, in the April 7, 2000 final rule with comment period, we also 
implemented 14 provisions of the BBRA 1999 that affected the hospital 
outpatient prospective payment system and solicited public comments on 
those provisions. The BBRA 1999 provisions on which we solicited 
comments included the following:
1. Outlier Adjustment
    Section 201(a) of the BBRA 1999 amended section 1833(t) of the Act 
by adding a new paragraph (5) to provide that the Secretary must make 
payment adjustments (that is, an outlier payment) for covered services 
whose costs exceed a threshold determined by the Secretary. This 
section describes how the additional payments are to be calculated and 
caps the projected outlier payments at no more than 2.5 percent of the 
total projected payments (sum of both Medicare and beneficiary payments 
to the hospital) made under the hospital outpatient prospective payment 
system for years before 2004 and 3.0 percent of the total projected 
payments for 2004 and subsequent years.
2. Transitional Pass-Through for Additional Costs of Innovative Medical 
Devices, Drugs, and Biologicals
    Section 201(b) of the BBRA 1999 added new section 1833(t)(6) to the 
Act, establishing transitional pass-through payments for certain 
medical devices, drugs, and biologicals. This provision specifies the 
types of items for which additional payments must be made; describes 
the amount of the additional payments; limits these payments to at 
least 2, but not more than 3 years; and caps the projected payment 
adjustments annually at 2.5 percent of the total projected payments for 
hospital outpatient services each year before 2004 and no more than 2.0 
percent in subsequent years. Under this provision, the Secretary must 
reduce pro rata the amount of the additional payments if, before the 
beginning of a year, he or she estimates that these payments would 
otherwise exceed the caps.
3. Budget Neutrality Applied to New Adjustments
    Section 201(c) of the BBRA 1999 amended section 1833(t)(2)(E) of 
the Act to require that the establishment of outlier and transitional 
pass-through payment adjustments be made in a budget neutral manner.

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4. Limitation on Judicial Review
    Section 201(d) of the BBRA 1999 amended redesignated section 
1833(t)(11) of the Act by extending the prohibition of administrative 
or judicial review to include the factors for determining outlier 
payments (that is, the fixed multiple, or a fixed dollar cutoff amount, 
the marginal cost of care, or applicable total payment percentage), and 
the determination of additional payments for certain medical devices, 
drugs, and biologicals, the insignificant cost determination for these 
items, the duration of the additional payment or portion of the 
prospective payment system payment amount associated with particular 
devices, drugs, or biologicals, and any pro rata reduction.
5. Inclusion in the Hospital Outpatient Prospective Payment System of 
Certain Implantable Items
    Section 201(e) of the BBRA 1999 amended section 1833(t)(1)(B) of 
the Act to include as covered hospital outpatient services implantable 
prosthetics, durable medical equipment (DME), diagnostic x-ray, 
laboratory, and other tests associated with those implantable items.
6. Payment Weights Based on Median or Mean Hospital Costs
    Section 201(f) of the BBRA 1999 amended section 1833(t)(2)(C) of 
the Act, which specifies data requirements for establishing relative 
payment weights, to allow the Secretary the discretion to base the 
weights on either the median or mean hospital costs determined by data 
from the most recent available cost reports.
7. Limitation on Variation of Costs of Services Classified Within a 
Group
    Section 201(g) of the BBRA 1999 amended section 1833(t)(2) of the 
Act to limit the variation of costs of services within each payment 
classification group by providing that the highest median cost (or mean 
cost, if elected by the Secretary) for an item or service within the 
group cannot be more than 2 times greater than the lowest median (or 
mean) cost for an item or service within the group. The provision 
allows the Secretary to make exceptions in unusual cases, such as for 
low volume items and services.
8. Annual Review of the Hospital Outpatient Prospective Payment System 
Components
    Section 201(h) of the BBRA 1999 amended redesignated section 
1833(t)(8) of the Act to require at least an annual review of the 
payment groups, relative payment weights, and the wage and other 
adjustments made by the Secretary to take into account changes in 
medical practice, the addition of new services, new cost data, and 
other relevant information and factors. Section 201(h)(2) provides that 
the first annual review must be conducted in 2001 for application in 
2002. The section was further amended to require the Secretary to 
consult with an expert outside advisory panel composed of an 
appropriate selection of provider representatives who will review the 
clinical integrity of the groups and weights and advise the Secretary 
accordingly. The panel may use data other than those collected or 
developed by the Department of Health and Human Services (HHS) for 
review and advisory purposes.
9. Coinsurance Not Affected by Pass-Throughs
    Section 201(i) of the BBRA 1999 amended redesignated section 
1833(t)(7) of the Act to provide that the beneficiary coinsurance 
amount will be calculated as if the outlier and transitional pass-
throughs had not occurred; that is, there will be no additional 
coinsurance collected from beneficiaries for the additional payments 
made to hospitals by Medicare for these adjustments.
10. Extension of Cost Reductions
    Section 201(k) of the BBRA 1999 amended section 1861(v)(1)(S)(ii) 
of the Act to extend, until the first date that the hospital outpatient 
prospective payment system is implemented, the 5.8 and 10 percent 
reductions for hospital operating and capital costs, respectively.
11. Clarification of Congressional Intent Regarding Base Amounts Used 
in Determining the Hospital Outpatient Prospective Payment System
    Section 201(l) of the BBRA 1999 provided that, ``With respect to 
determining the amount of copayments described in paragraph (3)(A)(ii) 
of section 1833(t) of the Social Security Act, as added by section 
4523(a) of BBA, Congress finds that such amount should be determined 
without regard to such section, in a budget neutral manner with respect 
to aggregate payments to hospitals, and that the Secretary of Health 
and Human Services has the authority to determine such amount without 
regard to such section.''
12. Transitional Corridors for Application of Outpatient Prospective 
Payment System
    Section 202 of the BBRA 1999 amended section 1833(t) of the Act by 
redesignating paragraphs (7) through (11) as paragraphs (8) through 
(12), respectively, and adding a new paragraph (7), which provides for 
a transitional adjustment to limit payment reductions under the 
hospital outpatient prospective payment system. More specifically, from 
the date the prospective payment system is implemented through 2003, a 
provider, including a CMHC, will receive an adjustment if its 
prospective payment system payments for outpatient services furnished 
during the year is less than a set percentage of its ``pre-BBA'' amount 
for that year. The pre-BBA amount is the product of the reasonable 
costs the hospital incurs for prospective payment system services 
during the year and the payment-to-cost ratio for covered prospective 
payment system services furnished during the cost report period ending 
during 1996. Two categories of hospitals, rural hospitals with 100 or 
fewer beds and cancer hospitals, will be held harmless under this 
provision. Small rural hospitals will be held harmless for services 
furnished before January 1, 2004. The hold-harmless provision applies 
permanently to cancer centers. Section 202 also requires the Secretary 
to make interim payments to affected hospitals subject to retrospective 
adjustments and requires that the provisions of this section do not 
affect beneficiary coinsurance. Finally, this provision is not subject 
to budget neutrality.
13. Limitation on Coinsurance for a Procedure
    Section 204 of the BBRA 1999 amended redesignated section 
1833(t)(8) of the Act to provide that the copayment amount for a 
procedure performed in a year cannot exceed the hospital inpatient 
deductible for that year.
14. Reclassification of Certain Hospitals
    Section 401 of the BBRA 1999 added section 1886(d)(8)(E) to the Act 
to permit reclassification of certain urban hospitals as rural 
hospitals for purposes of section 1886(d) of the Act. Section 401 added 
section 1833(t)(13) to the Act to provide that a hospital being treated 
as a rural hospital under section 1886(d)(8)(E) is also to be treated 
as a rural hospital under the hospital outpatient prospective payment 
system.
    A discussion of how each of these BBRA 1999 provisions was 
implemented in the April 7, 2000 final rule with comment period appears 
in section II of this preamble preceding our summary of the public 
comments received and our responses to those comments.

[[Page 67802]]

B. June 30, 2000 Notice of Delay of Effective Date for the April 7, 
2000 Final Rule With Comment Period

    On June 30, 2000, we published a notice in the Federal Register (65 
FR 40535) announcing a delay in the effective date of the April 7, 2000 
hospital outpatient prospective payment system final rule with comment 
period from July 1, 2000 to August 1, 2000. This delay was based on our 
determination that the appropriate claims processing changes could not 
feasibly be made to our computer systems and properly tested in time to 
ensure that proper payments would be made for Medicare hospital 
outpatient services under the new prospective payment system by the 
original July 1, 2000 effective date.

C. August 3, 2000 Interim Final Rule With Comment Period

    On August 3, 2000, we published an interim final rule with comment 
period in the Federal Register (65 FR 47670) that changed one criterion 
and postponed the effective date for two other criteria that a new 
device, drug, or biological must meet in order for its cost to be 
considered ``not insignificant'' for purposes of determining its 
eligibility for transitional pass-through payments from the hospital 
outpatient prospective payment system. It also changed the transitional 
pass-through payment policy to include new single use medical devices 
that come in contact with human tissue and are surgically implanted or 
inserted into patients, whether or not the devices remain with the 
patients following their release. These policies were a departure from 
those presented in the April 7, 2000 final rule with comment period.
    The August 3, 2000 rule also corrected a trigger date for 
grandfathering of provider-based FQHCs to conform with the intent not 
to disrupt existing FQHCs with longstanding provider-based treatment 
that we discussed in the April 7, 2000 rule. Under the criteria in the 
April 7, 2000 final rule with comment period, FQHCs would have been 
treated as departments of a provider without regard to the criteria for 
provider-based status if they continued to qualify as FQHCs and were 
designated as FQHCs before 1995. In accordance with the August 3, 2000 
interim final rule with comment period and this interim final rule with 
comment period, facilities that continue to qualify as FQHCs and were 
designated as FQHCs or ``look-alikes'' on or before April 7, 2000 would 
continue to be treated as provider-based facilities. In addition, we 
clarified how the requirement for prior notices to beneficiaries is to 
be applied in emergency situations. We also clarified the protocols for 
off-campus departments in emergency situations.
D. Summary of This Interim Final Rule With Comment Period
    In section II of this preamble, we--
    <bullet> Respond to public comments received timely on the 14 BBRA 
1999 provisions that were included in the April 7, 2000 final rule with 
comment period. (We received numerous public comments on other aspects 
of the April 7, 2000 final rule with comment period that were not open 
for comment. We will not address those comments in this rule.)
    <bullet> Respond to public comments on the August 3, 2000 interim 
final rule with comment period that revised the criteria for defining 
new or innovative medical devices, drugs, and biologicals eligible for 
pass-through payments and corrected the criteria for the grandfathering 
provision for certain FQHCs as provider-based.
    In section III of this preamble, we are updating, for services 
furnished during calendar year 2001, the wage index values and the 
conversion factor, and revising the APCs to reflect new codes for 2001 
effective January 1, 2001. As required under section 1833(t)(8)(A) of 
the Act, in 2001, we will begin our annual review process of the APC 
groups, relative weights, and the wage and other adjustments for the 
prospective payment systems payments that will become effective on 
January 1, 2002. The statute requires the Secretary to consult with an 
expert outside advisory panel composed of an appropriate selection of 
representatives of providers to review (and advise the Secretary 
concerning) the clinical integrity of the groups and weights. This 
provision allows these experts to use data other than those collected 
or developed by us during our review of the APC groups and weights.

II. Analysis of, and Responses to, Public Comments on the BBRA 1999 
Provisions and the August 3, 2000 Interim Final Rule With Comment 
Period

    We received a total of 747 pieces of timely correspondence 
containing public comments on the April 7, 2000 final rule with comment 
period. In addition to receiving comments from various organizations 
throughout the hospital industry, we also received comments from 
beneficiaries and their families, physicians, health care workers, 
individual hospitals, professional associations and societies, legal 
and nonlegal representatives and spokespersons for beneficiaries and 
hospitals, members of the Congress, and other interested citizens. The 
majority of the comments addressed the BBRA 1999 provisions relating to 
the limitation on variation of costs of services classified within a 
group, the transitional pass-through provision for devices, drugs, and 
biologicals, and the inclusion of implantable items.
    We received 13 comments in response to the August 3, 2000 interim 
final rule with comment period. These comments were submitted by major 
associations, drug and device manufacturers, providers, a private 
citizen, and a law firm. More than half of the comments addressed 
issues for which we did not solicit comments in the August 3, 2000 
interim final rule with comment period. Those comments specifically 
addressed payment policy and typographical errors present in the April 
7, 2000 final rule with comment period. The remaining commenters 
addressed the revisions to the criteria to define new or innovative 
medical devices, drugs, and biologicals eligible for pass-through 
payments and corrections to the criteria for the grandfathering 
provision for certain FQHCs. These commenters took issue with some of 
the provisions and raised additional concerns regarding our actions. A 
summary of the public comments and our responses to them appears 
following the discussion of the April 7, 2000 final rule with comment 
period.
    We have carefully reviewed and considered all comments received 
timely. The modifications that we are making in response to commenters' 
suggestions and recommendations are summarized in section III.A of this 
preamble and, as appropriate, reflected in the regulation text.

A. April 7, 2000 BBRA 1999 Provisions

    Below we discuss the implementation of the BBRA 1999 provisions 
addressed in the April 7, 2000 final rule with comment period and 
modified in the August 3, 2000 interim final rule with comment period, 
the public comments received on each provision, and our response to 
those comments.
1. Outlier Adjustment
    Section 1833(t)(5) of the Act, as added by section 201(a) of the 
BBRA 1999, required that the Secretary make an additional payment (that 
is, an outlier adjustment) for outpatient services for which a 
hospital's charges, adjusted to cost, exceed a fixed multiple of the 
sum of the outpatient prospective payment system payment and the 
transitional pass-through payments. The Secretary is

[[Page 67803]]

authorized to determine the amount of this fixed multiple and the 
percent of costs above the threshold that is to be paid under this 
outlier provision. Under the statute, projected outlier payments may 
not exceed an ``applicable percentage'' of projected total program 
payments. The applicable percentage means a percentage specified by the 
Secretary (projected percentage of outlier payments relative to total 
payments), subject to the following limits: For years before 2004, the 
projected percentage that the Secretary specifies cannot exceed 2.5 
percent; for 2004 and later, the projected percentage cannot exceed 3.0 
percent. Section 1833(t)(2)(E) of the Act requires that these payments 
be budget neutral.
    Section 1833(t)(5)(D) of the Act grants the Secretary authority 
until 2002 to identify outliers on a bill basis rather than on a 
specific service basis and to use an overall hospital cost-to-charge 
ratio (CCR) to calculate costs on the bill rather than using 
department-specific CCRs for each hospital.
    In the April 7, 2000 final rule with comment period, in accordance 
with the statute, we presented how the additional outlier payments are 
to be calculated.
    To set the threshold or fixed multiple and the payment percentage 
of costs above that multiple for which an outlier payment would be 
made, we first had to determine what specified percentage of total 
program payment, up to 2.5 percent, we should select. We decided to set 
the outlier target at 2.0 percent. In order to set the fixed multiple 
outlier threshold and payment percentage, we simulated the prospective 
payment system payments. We calibrated the threshold and the payment 
percentage applying an iterative process so that the simulated outlier 
payments were 2.5 percent of simulated total payments. For purposes of 
the simulation, we set a ``target'' of 2.5 percent (rather than 2.0 
percent), because we believed that a given set of numerical criteria 
would result in a higher percentage of outlier payments under the 
simulation using 1996 data than under the prospective payment system. 
This is because we believe that the 1996 data reflects undercoding of 
services, which means simulated total payments would likely be 
understated and, in turn, the percentage of outlier payments would be 
overstated. In addition, we were not able to fully estimate the amount 
and distribution of pass-through payments using the 1996 data. Our 
inability to make these estimates further understated the total 
payments under the simulation. We believe that a set of numerical 
criteria that results in simulated outlier payments of 2.5 percent 
using the 1996 data would result in outlier payments of 2.0 percent 
under the prospective payment system. The difference arises from the 
effect of undercoding in the historical data and the payment of pass-
throughs under prospective payment system. We set the outlier threshold 
at 2.5 times the prospective payment system payments.
    Comment: Several commenters asked us to clarify how series bills 
for services such as chemotherapy that are billed monthly for multiple 
sessions are treated in determining outlier payments. They also asked 
that we clarify how bills for multiple clinic visits on the same day 
are treated in calculating the outlier payment.
    Response: In accordance with section 1833(t)(5)(D) of the Act, 
until 2002, outliers will be determined on a bill basis rather than on 
a specific service basis. Therefore, the charges (converted to costs) 
associated with all services under the hospital outpatient prospective 
payment system reported on series bills or all payable multiple clinic 
visits billed on a single claim would be used to determine whether the 
outlier threshold is exceeded and to calculate the outlier payment.
    Comment: One commenter suggested that we prospectively adjust the 
conversion factor if we determine that the actual outlier expenditures 
are less than estimated in a given year.
    Response: Consistent with our outlier policies in other prospective 
payment systems, we will not adjust the conversion factor for a given 
year to account for an underestimation (or overestimation) of outlier 
payments in a previous year. The statute does not provide for such an 
adjustment to the conversion factor. We set outlier policies 
prospectively, using the best available data. Outlier payments, like 
many aspects of a prospective payment system, reflect estimates, and we 
believe it would be inappropriate to adjust the conversion factor 
(upward or downward) for a given year simply because an estimate for a 
previous year ultimately turned out to be inaccurate. If we 
underestimate or overestimate the percentage of outlier payments, the 
divergence of our estimate from actual experience might provide 
information that might help us improve estimates in the future, but it 
would have no direct effect on the conversion factor for any following 
year.
    Comment: One commenter urged us to provide additional information 
about the cost-to-charge ratios that will be used to determine whether 
a claim exceeds the outlier threshold for payment. The commenter stated 
that the preamble language on page 18498 of our April 7, 2000 final 
rule with comment period conflicts with statements contained in Program 
Memorandum Transmittal No. A-00-23 regarding which cost-to-charge ratio 
would be used to determine whether a claim meets the outlier threshold 
requirements for payment. According to the commenter, we stated in the 
final rule with comment period that we will use a hospital's overall 
cost-to-charge ratio to make this determination, but stated in the 
program memorandum that we will use an outpatient cost-to-charge ratio. 
The commenter asked us to clarify the conflicting statements.
    Response: On September 8, 2000, we issued Program Memorandum 
Transmittal No. A-00-63, titled ``Cost-to-Charge Ratios (CCRs) for 
Calculating Certain Payments Under the Hospital Outpatient Prospective 
Payment System'' which describes how we calculated the cost-to-charge 
ratios that are used to determine payments for outliers, interim 
transitional corridors, and device pass-throughs for calendar year 
2000. That program memorandum defined the cost-to-charge ratio that is 
used to calculate these payments as the overall hospital outpatient 
cost-to-charge ratio. This is consistent with what we stated in our 
April 7, 2000 final rule with comment period. The September program 
memorandum contains the latest and most complete information available 
on cost-to-charge ratio calculation for the hospital outpatient 
prospective payment system.
    Comment: One commenter assumed that we will use department level 
cost-to-charge ratios after 2002 to determine if a particular 
outpatient service qualifies for outlier payment. The commenter asked 
if we will use a ``national cost-to-charge mapping procedure'' to 
determine the appropriate department cost-to-charge ratios to use. The 
commenter expressed concern about the appropriateness of that approach 
because of the variability among providers in assigning costs to 
departments. For this reason, the commenter recommended, if we use a 
national cost-to-charge mapping procedure, we permit providers to 
request outlier payments if they can demonstrate that the actual 
department cost-to-charge ratio to which they assign costs for a 
service results in a cost calculation that meets the outlier threshold.
    Response: We plan to address this issue and seek comments on it in 
the rulemaking process for the annual update for 2002.
    Comment: One commenter urged us to publish annually the ``cost 
reporting

[[Page 67804]]

year'' used to determine the cost-to-charge ratios that will be used in 
determining outlier payments. The commenter also asked that we explain 
how we computed cost-to-charge ratios for hospitals that have merged or 
been acquired.
    Response: On September 8, 2000, we issued Program Memorandum 
Transmittal No. A-00-63 that describes the specific criteria we used 
and provides detailed instructions for calculating the cost-to-charge 
ratios for hospitals that have merged or been acquired. It also 
identifies the specific cost reporting year end that was used to 
calculate each provider's cost-to-charge ratio.
    Comment: One commenter asked that we lower the outlier threshold 
from 2.5 to 2.0. The commenter strongly recommended that we permanently 
retain the lowered threshold to ensure appropriate patient care and 
adequate provider reimbursement.
    Response: We oppose lowering the outlier threshold to 2.0. As 
discussed in our April 7, 2000 final rule with comment period, we set 
the outlier threshold at 2.5 by simulating total prospective payment 
system payments (using 1996 hospital outpatient data) and using an 
iterative process to calculate a threshold under which outlier payments 
are projected to equal 2.0 percent of total payments. If we lowered the 
threshold as the commenter suggests, then the projected percentage of 
outlier payments would increase and we would have to reduce the 
conversion factor correspondingly (thus reducing the payment for all 
non-outlier cases.)
2. Transitional Pass-Through for Additional Costs of Innovative Medical 
Devices, Drugs, and Biologicals
    Section 1833(t)(6) of the Act, as added by section 201(b) of the 
BBRA 1999, requires the Secretary to make additional payments to 
hospitals, outside the hospital outpatient prospective payment system 
for a period of 2 to 3 years for specific items. The items designated 
by the law are the following: Current orphan drugs, as designated under 
section 526 of the Federal Food, Drug, and Cosmetic Act; current drugs, 
biologic agents, and brachytherapy devices used for treatment of 
cancer; current radiopharmaceutical drugs and biological products; and 
new medical devices, drugs, and biologic agents, in instances where the 
item was not being paid as a hospital outpatient service as of December 
31, 1996, and where the cost of the item is ``not insignificant'' in 
relation to the hospital outpatient prospective payment system payment 
amount. In this context, ``current'' refers to those items for which 
hospital outpatient payment is being made on the first date the new 
prospective payment system is implemented.
    Section 1833(t)(6)(C)(i) of the Act sets the additional payment 
amounts for the drugs and biologicals as the amount by which the amount 
determined under section 1842(o) of the Act (95 percent of the average 
wholesale price (AWP)) exceeds the portion of the otherwise applicable 
hospital outpatient department fee schedule amount that the Secretary 
determines to be associated with the drug or biological. Section 
1833(t)(6)(C)(ii) of the Act provides that the additional payment for 
medical devices be the amount by which the hospital's charges for the 
device, adjusted to cost, exceed the portion of the otherwise 
applicable hospital outpatient department fee schedule amount 
determined by the Secretary to be associated with the device. Under 
section 1833(t)(6)(D), the total amount of pass-through payments for a 
given year cannot be projected to exceed an ``applicable percentage'' 
of total payments. For a year (or a portion of a year) before 2004, the 
applicable percentage is 2.5 percent; for 2004 and subsequent years, 
the applicable percentage is 2.0 percent. If the Secretary estimates 
that total pass-through payments would exceed the caps, the statute 
requires the Secretary to reduce the additional payments uniformly to 
ensure the ceiling is not exceeded.
    These pass-through payments must be made in a budget neutral 
manner. In addition, these additional payments do not affect the 
computation of the beneficiary coinsurance amount.
    In the April 7, 2000 final rule with comment period, we specified 
the types of items for which additional payments would be made; 
described the amount of the additional payments; announced that these 
payments would be limited to at least 2 years but not more than 3 
years; and announced a cap of the projected payment adjustments 
annually at 2.5 percent of the total projected payments for hospital 
outpatient services each year before 2004 and no more than 2.0 percent 
in subsequent years.
a. Definition of a Device
    Comment: Some commenters argued that we have adopted a very narrow 
definition of a device that restricts pass-through payments to 
prosthetic devices and excludes valuable new nonprosthetics from pass-
through consideration. They asserted that the definition of a device 
should mirror the definition set forth in the Federal Food, Drug, and 
Cosmetic Act. They agreed that such a definition should exclude capital 
equipment, reusable items, and incidental supplies. However, they 
argued that we should clarify and revise our definition of devices to 
those that are ``implanted or inserted'' and ``remain with the patient 
after the patient is released from the hospital outpatient 
department.''
    Response: The definition of a device under the Food, Drug, and 
Cosmetic Act is extremely broad. In summary, it refers to a device as 
an instrument, apparatus, implement, machine, contrivance, implant, in 
vitro reagent, or other similar or related article, including any 
component, part, or accessory, which is--
    <bullet> Recognized in the official national formulary, or the U.S. 
Pharmacopeia, or any supplement to them;
    <bullet> Intended for the use of the diagnosis of conditions other 
than diseases such as pregnancy;
    <bullet> Intended to affect the structure or any function of the 
body of man or other animals; or
    <bullet> Considered an in vitro diagnostic product, including those 
previously regulated as drugs, and which does not achieve any of its 
principal intended purposes through chemical action within or on the 
body of man or other animals and which is not dependent upon being 
metabolized for the achievement of any of its principal intended 
purposes.
    This definition is inappropriate for use in the context of the 
transitional pass-through payments for several reasons: It would 
include (as the commenters noted) items that are treated as supplies, 
reusable items, or capital equipment by Medicare payment systems, 
including the outpatient prospective payment system. It has a number of 
inappropriate elements, including reference to pharmaceuticals and to 
use in animals. Further, it is insufficiently specific for Medicare 
purposes, as it does not mention medical necessity or the test of 
whether the cost of a device is ``not insignificant'' relative to the 
associated APC.
    We have instead provided a definition of a device specific to the 
purposes of the transitional pass-through provision. This definition 
was presented in the preamble to the April 7, 2000 final rule with 
comment period and revised in the August 3, 2000 interim final rule 
with comment period, which added Sec. 413.43(e)(4).
    In the August 3, 2000 interim final rule with comment period, we 
revised the criteria that we had set forth in the

[[Page 67805]]

April 7, 2000 final rule with comment period to define a device. Among 
the changes included is a revision of the criterion relating to whether 
a device must remain with the patient. The new criterion 
(Sec. 419.43(e)(4)(iv)) includes devices that are surgically implanted 
or inserted in a patient ``whether or not they remain with the patient 
when the patient is released from the hospital outpatient department.'' 
This change allows pass-through payments for devices that are 
surgically implanted or inserted even temporarily in a patient 
providing the devices meet all other requirements for pass-through 
payments. As a result, nonprosthetic devices, such as cardiac 
catheters, guidewires, or stents that commenters noted would be 
excluded, may be eligible for pass-through status.
    In Sec. 419.43(e)(4)(iv), we have retained the limitation to 
devices that are surgically implanted or inserted because we believe 
this offers the best interpretation of section 201(e) of the BBRA 1999, 
which indicates that implantable devices are to be included in the 
APCs. To further clarify how we interpret Sec. 419.43(e)(4)(iv), we 
consider that a device is surgically implanted or inserted if it is 
introduced into the human body through a surgically created incision. 
We do not consider an item used to cut or otherwise create a surgical 
opening to be a device that is surgically implanted or inserted. We 
consider items used to create incisions, such as scalpels, 
electrocautery units, biopsy apparatuses, or other commonly used 
operating room instruments, to be supplies or capital equipment, and 
hence, in accordance with Sec. 419.43(e)(4)(vi) or (vii), we consider 
these items not eligible for transitional pass-through payments. We 
believe the function of these items is different and distinct from that 
of devices that are used for surgical implantation or insertion. 
Generally, we would expect that surgical implantation or insertion of a 
device occurs after the surgeon uses certain primary tools, supplies, 
or instruments to create the surgical path or site for implanting the 
device.
    We have discovered some items that do not meet the requirement of 
being surgically implanted or inserted were erroneously approved for 
pass-through payments. Consequently, we will eliminate these items from 
the list of items eligible for pass-through payments, effective January 
1, 2001.
    Comment: One commenter claimed that it was inappropriate for us to 
change the definition of devices through letters to manufacturers. The 
commenter believed that this was done outside the rulemaking process.
    Response: We did not make a change to our policy through a letter. 
As we began to evaluate the hundreds of applications for approval of 
numerous devices, it was apparent that our definition for new medical 
devices as published in our April 7, 2000 final rule with comment 
period would have resulted in denials for items that we believe might 
warrant pass-through payments. Examples of such potential denials are 
many types of general and specialty catheters. Based on our experience 
in reviewing these applications, we decided to change three of the 
eight specific criteria that a new device must meet in order to be 
eligible for pass-through payments. We published these changes in our 
August 3, 2000 interim final rule with comment period.
b. Eligibility Criteria
    Comment: Some commenters believed that we should accept and process 
applications for items while they are undergoing the FDA review 
process.
    Response: We have accepted and begun processing all applications, 
including those for which items are pending FDA approval or clearance. 
However, in those instances where the FDA approval or clearance 
documentation is missing, the application is considered incomplete. In 
order for an item to be eligible for transitional pass-through 
payments, it must have been approved or cleared by the FDA for 
marketing. We will not make a final determination on any applications 
that are pending FDA approval or clearance until all the required 
documentation is submitted. Resources permitting, we will commence 
preliminary processing of the applications when received. The applying 
party is responsible for providing us with proper evidence of FDA 
approval or clearance for any item, once approval or clearance has been 
obtained. Once we receive documentation of FDA approval or clearance 
and determine the item is determined to be eligible for transitional 
pass-through payments, payment for the item will commence at the start 
of the next quarterly update of pass-through items.
    Comment: Some commenters asked that we clarify that items must meet 
Medicare coverage requirements in order to qualify for pass-through 
status.
    Response: As stated in both our April 7, 2000 final rule with 
comment period and our August 3, 2000 interim final rule with comment, 
items that qualify for pass-through payments must be covered by 
Medicare. They must have been determined to be reasonable and necessary 
for the diagnosis or treatment of an illness or injury or to improve 
the functioning of a malformed body part, as required by section 
1862(a)(1)(A) of the Act. (See Sec. 419.43(e)(4)(iii).)
c. Investigational Device Exemption (IDE) Devices
    Comment: Some commenters recommended that we automatically define 
as ``new'' any device that receives an investigational device exemption 
(IDE) from the FDA, with a Category B designation. They believed that 
we should pay for IDE devices through the pass-through payment 
methodology rather than limit the payment to no more than what is 
currently paid for an equivalent device.
    Response: As stated in our August 3, 2000 interim final rule with 
comment period, we have changed the payment methodology for eligible 
IDE Category B devices so that they will be paid using the transitional 
pass-through methodology. Since these noninvestigational devices are 
required to meet the same eligibility criteria as other devices, we 
determined that they should be paid in a similar manner. However, we do 
not accept the commenter's recommendation that all IDE Category B 
devices ``automatically'' be considered as new. The statute defines 
``new'' medical device on the basis of a date certain (that is, payment 
for the device was not being made as an hospital outpatient service as 
of December 31, 1996) rather than based on a class of devices (such as 
IDEs).
d. Removing Cost of Predicate Item
    Comment: Some commenters stated that we did not have adequate data 
to ensure appropriate removal of the costs for predecessor items 
(particularly radiopharmaceuticals and devices) from their relevant 
APCs. They advocated that we reevaluate this provision as soon as 
possible after implementation of our new system and make necessary 
changes.
    Response: We will be continuously evaluating our data to remove the 
costs of predecessor items from the pass-through payments. As of 
January 1, 2001, a specific dollar amount will be deducted from 
selected devices (see explanation below). Over time, such deductions 
will be made, as we are able to make appropriate estimates from the 
data.
e. Excluded Costs
    Comment: A number of commenters stated that the APC construction 
excluded costs for implantable devices billed with revenue codes 274, 
275 and 278. The commenters recommended

[[Page 67806]]

that implantable devices associated with these revenue codes be 
included on the pass-through list until data is collected to adequately 
reflect the cost of such devices. In addition to claims that revenue 
codes 274, 275 and 278 were not represented in the data, some 
commenters alleged that implant procedures were infrequently performed 
on an outpatient basis prior to 1997 and therefore the costs associated 
with them were not represented in the data used to develop the APC 
rates. Some commenters recommended, on that basis, that all implantable 
devices be included for pass-through payment regardless of FDA approval 
dates.
    Response: Following enactment of the BBRA of 1999, we did not have 
sufficient time to re-run our data to package the costs of implantable 
device revenue centers into the APC weights and still be able to 
publish a final rule in time to implement the prospective payment 
system by July 1, 2000.
    As of January 1, 2001, the APC rates will reflect the inclusion of 
revenue codes 274, 275 and 278. While the aggregate amount of these 
revenue centers is small (0.3 percent of total charges in 1996), the 
costs of certain procedures such as implantation of cardiac pacemakers 
did increase substantially. As detailed in section III.B.1 of this 
interim final rule, some APC groups were modified because of the 
inclusion of these revenue centers, and rates for some procedures will 
increase to reflect these costs. A reduction in an amount equal to the 
increase in the APC rates will be deducted from the relevant devices 
that are either eligible for pass-through payments or that can be 
billed for additional payment through the new technology APCs.
f. Effect on Conversion Factor
    Comment: Some commenters believed that lowering the outpatient 
prospective payment system conversion factor to reflect the 2.5 percent 
transitional pass-through adjustment could affect hospitals' financial 
health. They asserted that any risks to the financial health of 
hospitals resulting from reducing the conversion factor should be 
balanced against any benefits that would be gained from higher payments 
for new drugs and devices. Another commenter advocated that we increase 
the conversion factor if we find that the transitional pass-through 
payments do not comprise 2.5 percent of the total outpatient 
prospective payment system payments.
    Response: Section 1833(t)(2)(E), as amended by section 201(c) of 
the BBRA 1999, requires that transitional pass-through payments be 
implemented in a budget neutral manner. We set prospective payment 
system rates prospectively and, consistent with our policies in other 
aspects of the prospective payment system, we will not adjust (upward 
or downward) the conversion factor for a given year to account for the 
difference between 2.5 percent and the actual percentage of pass-
through payments in a previous year.
g. Cost Significance Tests
    Comment: Some commenters asserted that we could preclude some 
worthwhile technologies from achieving pass-through status if we set 
the ``not insignificant'' cost threshold at 25 percent of the APC 
payment rate for the relevant procedure with which it is used. They 
contend that technologies associated with higher payment APCs would be 
more likely to be disqualified.
    Response: We have lowered the cost threshold from 25 percent to 10 
percent of the applicable fee schedule amount for the service 
associated with the item. This change is effective for services 
furnished on or after August 1, 2000.
    Comment: A hospital association asked that we clarify how the ``not 
insignificant'' criteria will be applied when a new device, drug, or 
biological is associated with more than one APC. The commenter stated 
that, under the current provisions of the rule, an item could be 
determined to be eligible for pass-through payment when used in 
performing a procedure in one APC, but not another. The commenter 
suggested that an item that meets the criteria for one APC be treated 
as a pass-through item for all APCs in which it is used.
    Response: We agree with the stated approach. This has been the 
policy that we have applied in processing applications.
    Comment: One manufacturer stated that we did not make information 
available on the ``not insignificant'' rule in sufficient time for 
applicants to take the criteria into account in preparing applications 
for payment effective August 1, 2000. The commenter alleged that the 
term ``not insignificant'' can be interpreted widely and caused 
manufacturers not to apply for all potentially eligible pass-through 
items. The commenter recommended that we review applications submitted 
for the following HCPCS codes to be certain that they meet the 
published cost criteria and remove them from the pass-through list if 
they do not. The commenter also advocated that we allow other 
manufacturers to submit applications retroactive to July 1, 2000, to 
assure that we are not promoting a competitive disadvantage for some 
companies.

HCPCS Codes

C1029
C1034
C1061
C1072
C1073
C1074
C1100
C1101
C1155

    Response: In order for a device to be included on the pass-through 
list, it must meet the criteria for transitional pass-through payments. 
These criteria include a test of whether the cost of a device is ``not 
insignificant'' relative to the payment for the associated APC. This 
test was first put forth in the April 7, 2000 final rule with comment 
period, and subsequently revised in the August 3, 2000 interim final 
rule with comment period. All the devices denoted by the HCPCS codes 
listed above were tested and met the 10-percent ``not insignificant'' 
test as well as the other applicable criteria. The ``not 
insignificant'' test was applied uniformly to all applications that had 
been received timely. We believe that permitting retroactive 
applications is unwarranted (and would be inconsistent with principles 
of prospectivity); moreover, resource and systems constraints would 
make it infeasible to give retroactive effect to determinations of 
eligibility for pass-through payments.
h. Brand-Specific Versus Categorization Approaches
    Comment: Many commenters criticized us for implementing a brand-
specific approach to items on the pass-through list. Device 
manufacturers in particular recommended a category scheme to classify 
pass-through devices. Representatives of the device industry also 
offered to assist us in creating the categories. They argued that a 
category system would allow devices to be added immediately upon FDA 
approval. They stated that under a category approach manufacturers 
would only approach us to obtain new pass-through categories and codes 
when items reflect a technological advance and are significantly more 
costly than existing payment amounts.
    Response: We adopted a trade-name specific approach for several 
reasons. First, such an approach provides better information. Codes 
that are largely item-specific allow us to track what procedures the 
items are used with and costs of the items. When the pass-through 
payments for an item ends, we would expect to have good information

[[Page 67807]]

for assigning it to relevant APCs and ensuring appropriate payment for 
these APCs. Adopting a scheme with a significant degree of 
categorization would require use of averages in making assignments and 
setting payment rates. Decisions based on these more limited data would 
be likely to lead to intensified concerns about the appropriateness of 
APC assignment and payment.
    Second, this approach permits finer discrimination in eligibility 
decisions. An item-by-item approach allows us to be sure individual 
items in fact meet the criteria for eligibility. Of major concern in 
this instance is whether a device is ``new'' using the standard of the 
statute. Section 1833(t)(6)(A) of the Act limits transitional pass-
through payment to those devices for which ``* * * payment for the 
device * * * as an outpatient hospital service under this part was not 
being made as of December 31, 1996.'' Adopting categories would in some 
cases mix ``old'' and ``new'' devices. In these instances, either some 
old devices would get special treatment that they would not be eligible 
for if they were examined on an item-specific basis, or an entire 
category could be considered old, thus depriving some new devices from 
special treatment they would be eligible for if they were examined on 
an item-specific basis.
    Third, an item-specific scheme avoids issues associated with the 
design of categories needed for purposes of transitional pass-through 
payments. It largely avoids concerns about what items should be in what 
category or whether new categories should be created to accommodate 
items that may appear to be little different from those in existing 
categories.
    Fourth, an item-specific approach allows us to assure that a newly 
arriving device can obtain the full period of pass-through status it is 
arguably eligible for under the statute. A categorization approach 
would likely lead to latecomers being eligible for pass-through 
payments for a shorter period. Insofar as revision to APC payment rates 
reflected the costs of items in the category by the time the category 
was terminated, the shorter period would be of little consequence. 
However, if the costs of the late-coming item were significantly 
higher, this procedure could appear objectionable. A solution in this 
case would be to create a new code, which could be specific to that 
item, thus departing from a categorization approach.
    We recognize that a category approach would lessen concerns about 
competitive disadvantages that may have been inadvertently created by 
an item specific approach and about access to specific items by 
hospitals and their patients. However, we found no satisfactory way of 
establishing categories that would not run into difficulty regarding 
the test of whether a device is ``new'' as described above. 
Consequently, we are making no change in our approach.
    Comment: Many commenters argued that competitive advantages have 
resulted and will continue to result from using a brand-specific 
approach to implementing transitional pass-through payments for 
devices. Some commenters alleged that our use of the FDA approval date 
as a proxy for determining payment in concert with the brand-specific 
approach causes further competitive disadvantages. Some hospitals 
claimed that the brand-specific approach would create winners and 
losers if a device that one hospital uses obtains pass-through status, 
but one that another hospital uses does not. A number of commenters 
asserted that a category approach would decrease the administrative 
burden on hospitals, manufacturers, and us that a brand-specific 
approach for application and approval of new devices now incurs.
    Response: It was never our intent to competitively disadvantage 
anyone or any product. To the maximum extent possible, given the 
limitations under the BBRA 1999 and our resource constraints, we have 
worked closely with the pharmaceutical and medical device industries to 
identify and resolve such issues. By October 1, 2000, we had determined 
that more than 700 devices are eligible for pass-through payments. 
Therefore, we believe that hospitals will receive additional payments 
for many of the devices they use.
i. Issues Pertaining to Specific Items
    Comment: A medical association advocated pass-through status for 
the following devices: new pacemakers, implantable cardioverter 
defibrillators, insertable loop recorders, electrophysiology catheters 
(ablation and diagnostic), intracardiac echocardiography ultrasound 
catheters, and advanced three-dimensional mapping system catheters.
    Response: All of these items are already on the pass-through list. 
For a complete list of items approved on the pass-through list, refer 
to Addendum B of this rule for short descriptions of the items. Refer 
to Program Memoranda Transmittals Nos. A-00-42, A-00-61 and A-00-72 for 
the long descriptors for each of the C-codes listed in Addendum B. We 
are developing an additional program memorandum that we expect to issue 
shortly. This additional program memorandum will contain a list of 
additional devices, drugs, and new technology services that will be 
effective January 1, 2001.
    Comment: Several device manufacturers alleged that the following 
devices were not included on the pass-through list:

PALMAZ Balloon-Expandable Stent
Corinthian IQ Biliary Stent
SMART Cordis Nitinol Stent
CARTO EP Navigation System Catheters
HYDROLYSER Catheter
Indigo Prostate Seeding Needle
Lioresal Intrathecal
SynchroMed and SynchroMed EL infusion pumps

    Response: All of these devices have been approved for pass-through 
payments and assigned C-codes. They have been assigned the following 
codes: the PALMAZ Balloon-Expandable Stent, C8522; Corinthian IQ 
Biliary Stent, C5004; SMART Cordis Nitinol Stent, C1372; CARTO EP 
Navigation System Catheters, C1047; HYDROLYSER Catheter, C1054; Indigo 
Prostate Seeding Needle, C1706; Lioresal Intrathecal, C9007, C9008, 
C9009, and C9010; SynchroMed and SynchroMed EL infusion pumps, C8505 
and C3800, respectively.
    Comment: Another device manufacturer claimed that the following 
devices were not included on the pass-through list:

Mitek Bone Anchors
Innovasive Bone Anchors
VAPR and VAPR Thermal T Electrode
Gynecare TVT Tension-Free Support for Incontinence System (TVT)
Gynecare Thermachoice Uterine Balloon Therapy System

    Response: Many of the items above have been approved for pass-
through status and assigned C-codes. The Mitek and Innovasive Bone 
Anchors have been assigned to C1109; VAPR and VAPR Thermal T Electrode, 
to C1323; TVT Single-Use Tension-Free Vaginal Tape, to C1370; and the 
Gynecare Thermachoice II Catheter, to C1056. However, some of the items 
included in the Gynecare TVT Tension-Free Support for Incontinence 
System and the Gynecare Thermachoice Uterine Balloon Therapy System did 
not meet the criteria for pass-through status and, therefore, are 
ineligible for additional payments. The eligible pass-through items are 
listed in Addendum B.
    Comment: A device manufacturer believed that we should have 
approved the Targis System, which provides prostatic microwave 
thermotherapy, for pass-through payments.
    Response: We assigned the prostatic microwave thermotherapy 
procedure to

[[Page 67808]]

a new technology APC, that is, APC 0980. In making this assignment, we 
took into account the costs associated with performing this procedure, 
including the cost of the Targis system. Therefore, we would not also 
make a pass-through payment for the system.
    Comment: A number of commenters contended that only 39 of the more 
than 70 eligible radiopharmaceuticals have been given pass-through 
status. They recommended that we approve the following 
radiopharmaceuticals for pass-through payments:

Strontium Sr 82 Rubidium Rb 82 Generator
Sodium Chromate Cr-51
Co 57 Cobaltous Chloride
Co 57 Cyanocobalamin
Ferrous Citrate Fe59
Fludeoxyglucose F 18
Intrinsic Factor Concentrate Capsules
In 111 Imciromab (Myoscint)
In 111 Labeled WBCs, Platelets
I 123 and I 131 Hippurate
Iodinated I 131 Albumin (I 131 Albumin)
Iodinated I 125 Albumin (I 125 Albumin)
Iothalamate Sodium I 125 Albumin (I125 Iothalamate)
Technetium Tc 99m Pertechnetate
Technetium Tc 99m Albumin Colloid
Technetium Tc 99m Lidofenin
Technetium Tc 99m Tebroxime
Technetium Tc 99m Nofetumomab (Verluma)
Technetium Tc 99m HMPAO labeled WBCs
Technetium Tc 99m Human Serum Albumin
Technetium Tc 99m Serum Albumin (Tc 99m HSA kit)
Xenon XE 127 Gas

    Response: While a number of radiopharmaceuticals are already on the 
pass-through list, we are unable to add some of the ones listed above 
because we do not have AWPs for them. The AWPs are the basis for 
payment for these items and without the AWPs we cannot approve them for 
pass-through payments. As soon as the AWPs are made available to us, we 
will complete our review to determine their pass-through status. If 
eligible, they will be added to the pass-through list during the 
appropriate quarterly update cycle.
    Comment: One commenter stated that our transitional pass-through 
policy for devices precludes pass-through eligibility for capital 
equipment and therefore does not provide a mechanism under our new 
system for recognizing the incremental costs associated with capital 
equipment. The commenter recommended that we recognize capital-
equipment costs through our new technology APCs.
    Response: Under our new outpatient prospective payment system, 
capital costs are not paid separately. Payment for these costs are 
included in the total APC payment amount for each procedure or medical 
visit and will be updated through our annual updating process. 
Therefore, the new technology APCs will not be used to make separate 
payments for capital related costs.
    Comment: A number of commenters claimed that we denied pass-through 
status for the contrast agents.
    Response: As clarified in our August 3, 2000 interim final rule 
with comment, contrast agents other than radiopharmaceuticals are 
considered supplies and are not eligible for pass-through payments. 
(See Sec. 419.43(e)(4)(vii).)
    Comment: A medical association claimed that we denied pass-through 
status requests for high dose rate brachytherapy. Another industry 
group alleged that many brachytherapy related items that manufacturers 
applied for were excluded from the pass-through list.
    Response: Since publishing our initial list of potentially eligible 
pass-through items to our website on March 9, 2000, we have added 38 
brachytherapy items to our pass-through list. High-dose rate 
brachytherapy will be eligible for pass-through payment effective for 
services furnished on or after January 1, 2001.
j. Pass-Through Applications Process
    Comment: Some commenters urged that we process transitional pass-
through applications in a more timely manner. A few other commenters 
believed that we should have chosen a date later than July 14, 2000 as 
the application deadline for the October 1, 2000 quarterly update for 
pass-through items.
    Response: We have committed considerable resources to process pass-
through applications in a timely manner. Since publication of our 
preliminary list of 149 potentially eligible pass-through items on our 
website on March 9, 2000, we have approved nearly 1000 additional items 
for pass-through payments. We have instituted a coding strategy that 
allows us to assign a temporary HCPCS code immediately to an eligible 
pass-through item if a national HCPCS code has not been assigned. We 
have committed to making quarterly updates to the pass-through list, a 
commitment that is unprecedented in Medicare's history. We have 
reviewed all applications timely submitted for each update cycle. 
Unfortunately, however, we have had to defer items with significantly 
unclear applications or for which sufficient information was not 
included to determine that the item meets the statutory criteria. We 
have endeavored to work closely with the applicants to obtain this 
information and respond timely to their questions.
    Regarding objections to setting a July 14, 2000 deadline for 
receipt of pass-through applications for the October 1 update, this 
deadline was established in order to evaluate the applications and make 
the necessary systems modifications in time for the October release to 
our fiscal intermediaries and standard systems maintainers.
    Comment: One commenter believed that we should update our 
transitional pass-through list more frequently than quarterly. Some 
other commenters were concerned that the quarterly updating process 
could potentially create systems problems for both HCFA and hospitals 
that would delay payments. They believed that such a delay would, in 
turn, create cash flow difficulties for hospitals. They urged that we 
develop contingency plans to address cash flow problems resulting from 
the transitional pass-through process.
    Response: Because of the complexity of our new system, we cannot 
institute systems changes more frequently than quarterly for pass-
through payments. While we believe that making quarterly updates to the 
pass-through list will present challenges both for HCFA and the 
hospital industry, we have not been advised that any hospital is 
experiencing cash flow problems attributable to the transitional pass-
through process.
    Comment: One commenter urged us to issue guidelines that detail the 
planned methodologies, data sources, and associated timelines for 
updating the pass-through list.
    Response: Since March 10, 2000, we have published information on 
our website which provides detailed instructions and deadlines for 
submitting transitional pass-through applications. These instructions 
have been revised as needed in order to clarify and update information 
and may be found on the following HCFA website: http://www.hcfa.gov /
medlearn/refopps.htm.
    Comment: One commenter claimed that our method and timing of 
assigning HCPCS codes to eligible transitional pass-through items would 
preclude Medicare beneficiaries from receiving appropriate treatment. 
The commenter also alleged that hospitals will not always be adequately 
reimbursed for their costs for such items and that they will have an 
incentive to switch to more invasive treatment options with higher 
costs.

[[Page 67809]]

    Response: We have expedited the process of assigning HCPCS codes to 
pass-through items. When an item is determined eligible for pass-
through status, a temporary HCPCS code is assigned immediately in order 
that hospitals may begin billing the item as soon as it is effective 
for payment.
    In addition, section 1833(t)(6)(C)(i) of the Act requires that the 
hospital's additional payment for drugs and biologicals be determined 
as the difference between the amount determined under section 1842(o) 
of the Act (95 percent of AWP) and the portion of the hospital 
outpatient department fee schedule amount determined by the Secretary 
to be associated with those items. For devices, the additional payment 
is the difference between the hospitals' charges adjusted to costs and 
the portion of the applicable hospital outpatient department fee 
schedule amount associated with the device. We believe that this 
payment method will appropriately reimburse hospitals for eligible 
pass-through items and that hospitals will act in a prudent manner and 
not compromise their patients' safety and care.
k. Payment for Pass-Through Items
    Comment: Several commenters questioned how payment would be made 
when a pass-through item is included on an outpatient claim. Another 
commenter stated that our April 7, 2000 final rule with comment period 
does not state the actual payment amount that will be made for each 
pass-through item, or provide a good reason for not updating drug and 
biological average wholesale prices quarterly, or pledge timely 
correction of payment amount errors. The latter commenter believed that 
we should make available the actual APC payment rates for pass-through 
items and institute quarterly pricing-updates for drug and biological 
APCs.
    Response: Transitional pass-through payments for devices are 
established by taking the hospital charges for each billed item (on an 
item-by-item basis), reducing them to cost by use of the hospital's 
cost-to-charge ratio, and subtracting an amount representing the device 
cost contained in the APC payments for procedures involving that 
device. Note that for services furnished prior to January 1, 2001, we 
have not subtracted an amount for the predicate device that is packaged 
in the relevant APC. However, we will implement this policy beginning 
with services furnished on or after January 1, 2001. These calculations 
are all done in the outpatient prospective payment system pricer. 
Because there are no predetermined APC payment rates for eligible pass-
through devices, we cannot publish them in the same manner as we 
publish the APC payment rates for other services.
    For drugs and biologicals, pass-through payments are determined 
based on 95 percent of the AWP for the eligible drug or biological. We 
described in our April 7, 2000 final rule (65 FR 18481) the process we 
used to subtract the cost of the eligible drug or biological contained 
in the APC payments for procedures involving that drug, 
radiopharmaceutical or biological. The year 2000 AWPs for pass-through 
drugs and biologicals on which payments are currently based will be 
updated annually at the beginning of the next quarter following 
publication of the updated values. Due to the complexity of our new 
system, we cannot update AWPs quarterly as requested.
    Comment: A number of commenters stated that the codes for drugs in 
Addendum K of our April 2000 final rule are specific to the dosage 
amount dispensed and asked what happens if the dosage dispensed to a 
patient is not equal to the amount associated with the eligible codes. 
The commenters requested additional information about how providers 
should account for these situations. They asked if we would allow 
providers to bill for the product amount associated with the container 
opened to treat the patient and round up to the nearest whole billing 
unit.
    Response: The APC payment amount for drugs and biologicals is 
established at the lowest dosage level for the specific drug or 
biological. If the dosage required in treating the patient exceeds the 
lowest level specified in the HCPCS code descriptor for the drug or 
biological, providers may bill the number of units necessary to treat 
the patient and round them up to the nearest unit. To determine the 
payment for the drug or biological, multiply the number of billed units 
by the APC payment amount.
    Comment: One commenter stated that the APC payment amount for 
Eptifibatide, a drug on the pass-through list, does not equal 95 
percent of the average wholesale price ($6.28 per 5-mg. service unit). 
The commenter claimed that the APC payment is 42 percent lower than 95 
percent of the AWP. The commenter asked that we correct the payment 
immediately.
    Response: The correct APC payment amount for Eptifibatide 
injection, 5 mg. is $12.57, of which $1.68 is the minimum unadjusted 
coinsurance.
    Comment: One commenter stated that the APC payment amount for 
Quadramet, a pass-through drug, is incorrect. The commenter claimed the 
AWP for this drug is $2,975 rather than $2,875, which the commenter 
believed is the basis for our APC payment amount. The commenter stated 
that the pass-through payment should be $942.08 instead of $910.42.
    Response: The correct APC payment amount for Quadramet is $942.09. 
Of this amount, $134.87 is the minimum unadjusted coinsurance.
    Comment: A commenter stated that the APC payment amount for 
Thyrogen, a pass-through drug, should be $494.00 rather than $404.18 
per vial.
    Response: The APC payment amount of $404.18 is for 0.9 mg. units of 
Thyrogen rather than 1.1 mg., which appears to be the standard vial 
dosage. However, because Thyrogen is not available in a vial dosage 
less than 1.1 mg., we are eliminating the APC payment for 0.9 mg. units 
(HCPCS code J3240) effective for outpatient prospective payment system 
services furnished on or after January 1, 2001. We have established a 
new code, C9108, for Thyrogen, 1.1 mg. with an APC payment amount of 
$494.00. This new code is effective for outpatient prospective payment 
system services furnished on or after January 1, 2001.
    Comment: A medical association acknowledged our short lead-time for 
implementing the transitional pass-through provision and urged that we 
hold a series of face-to-face meetings with physicians and suppliers to 
clarify and revise our pass-through policies.
    Response: Since publishing our April 7, 2000 final rule with 
comment period, we have met on numerous occasions with physicians and 
representatives of hospitals, pharmaceutical companies and device 
manufacturers. During these meetings, we have discussed our 
transitional pass-through policies and clarified information regarding 
the pass-through applications process.
    Comment: One commenter stated that the April 7, 2000 final rule 
with comment period requiring the submittal of applications for 
national HCPCS codes to bill eligible transitional pass-through was 
published after the application deadline had passed. The commenter 
alleged that some manufacturers obtained information about the pass-
through provisions prior to publication of the final rule, submitted 
their applications timely, and thus dominated the hospital outpatient 
market.
    Response: On March 9, 2000, we posted information on our website 
similar to that contained in the April 7, 2000 final rule with comment 
period about applying for national HCPCS codes for pass-through items. 
We also

[[Page 67810]]

discussed the coding deadline with representatives of the 
pharmaceutical and device manufacturers associations as well as with 
hospital industry representatives through conference calls, meetings, 
and e-mails. We note that the instructions and deadline for submitting 
applications for a national HCPCS code are well established and were 
published on HCFA's website (http://www.hcfa.gov /medicare/hcpcs.htm) 
more than a year prior to publication of our April 7, 2000 final rule 
with comment period. Subsequent to these publications, we adopted a new 
system for assigning codes exclusively for pass-through items to 
expedite their availability to the hospital industry and Medicare 
beneficiaries. Therefore, interested parties applying for pass-through 
status for items have not been required to obtain national HCPCS codes 
for these items unless they want to bill other payment systems in 
addition to the hospital outpatient prospective payment system.
l. Focus Medical Review
    Comment: One commenter asked that we clarify why we intend to 
conduct focused medical review of pass-through eligible drugs, 
biologicals and medical devices.
    Response: Our goal is to identify inappropriate billing for these 
services and to ensure that payment is not made for noncovered 
services.
3. Budget Neutrality Applied to New Adjustments
    In the April 7, 2000 final rule with comment period, in accordance 
with section 1833(t)(2)(E) of the Act, as amended by section 201(c) of 
the BBRA 1999, we made the outlier and transitional pass-through 
payment adjustments under section 1833(t)(5) and section 1833(t)(6) of 
the Act, respectively, budget neutral. We did not receive any public 
comments on this provision.
4. Limitation on Judicial Review
    In the April 7, 2000 final rule with comment period (65 FR 18503-
18504), in accordance with section 1833(t)(12) of the Act (as amended 
by section 201(d) of the BBRA 1999 and redesignated by section 202(a) 
of the BBRA 1999), we implemented the extension of the prohibition of 
administrative or judicial review to include the factors for 
determining outlier payments (that is, the fixed multiple, or a fixed 
dollar cutoff amount, the marginal cost of care, or applicable total 
payment percentage), and the factors used to determine additional 
payments for certain medical devices, drugs, and biologicals, the 
insignificant cost determination for these items, the duration of the 
additional payment or portion of the prospective payment system payment 
amount associated with particular devices, drugs, or biologicals, and 
any pro rata reduction.
    We did not receive any public comments on this provision.
5. Inclusion in the Hospital Outpatient Prospective Payment System of 
Certain Implantable Items
    In the April 7, 2000 final rule with comment period, we specified 
that section 1833(t)(1)(B) of the Act, as amended by section 201(e) of 
the BBRA 1999, provides that ``covered OPD services'' include 
implantable items described in section 1861(s)(3), (6), or (8) of the 
Act.
    The conference report accompanying the BBRA 1999, H.R. Rept. No. 
479, 106th Cong., 1st Sess. at 869-870, (1999), expresses the belief of 
the conferees that the current DMEPOS fee schedule is not appropriate 
for certain implantable medical items such as pacemakers, 
defibrillators, cardiac sensors, venous grafts, drug pumps, stents, 
neurostimulators, and orthopedic implants as well as items that come 
into contact with internal human tissue during invasive medical 
procedures, but are not permanently implanted. In the conference report 
agreement, the conferees state their intention that payment for these 
items be made through the hospital outpatient prospective payment 
system, regardless of how they might be classified on current HCFA fee 
schedules.
    In the April 7, 2000 final rule with comment period, we included 
the following in the list of items and services whose costs are 
included in hospital outpatient prospective payment rates: Prosthetic 
implants (other than dental) that replace all or part of an internal 
body organ (including colostomy bags and supplies directly related to 
colostomy care), and including replacement of these devices; 
implantable DME; and implantable items used in performing diagnostic x-
rays, diagnostic laboratory tests, and other diagnostic tests. In 
accordance with the BBRA 1999 provision, we require that an implantable 
item be classified to the group that includes the service to which the 
item relates. We indicated that we would continue to review the impact 
of packaging implantables in future updates. For more detailed 
information on this provision, refer to the April 7, 2000 final rule 
with comment period (65 FR 18443-18444).
    Comment: Two commenters (hospitals) expressed concern that the APC 
for the Cyberonics-NeuroCybernetic Prosthesis (NCP) System, an 
implantable device used to treat epilepsy patients with partial-onset 
seizures, will not adequately reimburse hospitals for the cost of the 
device and the implantation procedure cost. The hospitals recommended 
that HCFA create a separate APC group for the NCP System implantation.
    Response: The NCP System was approved for pass-through status 
effective for services furnished on or after August 1, 2000 (see 
Program Memorandum Transmittal No. A-00-42 issued on July 26, 2000). 
The two components of this system, the NeuroCybernetic Prosthesis 
Generator and the NeuroCybernetic Prosthesis Lead, will be paid based 
on the hospital's charges that are converted to cost using the 
hospital's assigned cost-to-charge ratio. These devices have been 
assigned to two separate pass-through APCs (1048 and 1306, 
respectively) and should be billed using HCPCS code C1048 for the 
generator and C1306 for each lead.
    Comment: Several commenters from physician practices and a device 
manufacturer raised concerns that the APC payment level for the 
Contigen Implant procedure is inadequate to cover the facility costs 
and the Contigen Implant supplies. According to the commenters, the APC 
reimbursement amount only covers the 2-3 Contigen Implant syringes used 
per procedure. The commenters recommended that we map the Contigen 
Implant procedure and the collagen skin test to higher paying 
completely new APCs, to more adequately reflect reasonable costs for 
syringes and skin tests used in the procedure, in addition to 
appropriate facility fees.
    Other commenters raised concerns that the separate APC 
reimbursement for the pre-Contigen Implant procedure testing is 
inadequate to reimburse for the reasonable cost of the supply. They 
recommended that we allow payment of Contigen Implant syringes 
according to the DMEPOS fee schedule.
    One commenter recommended that we create a special ancillary APC to 
cover Contigen Implant syringes and the collagen skin test.
    Response: While we understand the commenters' concerns, Contigen 
Implant syringes do not qualify for transitional pass-through status 
because they do not meet all of the device criteria set forth in 
Sec. 419.43(e)(4). Specifically, they are not items that are surgically 
implanted or inserted in a patient. However, both collagen implant

[[Page 67811]]

material and the collagen skin test are paid as APCs (that is, APCs 
6012 through 6016 and 343, respectively). We will examine data after 
the first year of billing under the prospective payment system to 
determine if we are adequately capturing the cost of performing these 
procedures.
    As stated in our April 7, 2000 final rule with comment period, we 
will initiate the annual review process for the various components of 
our system, including the APC groupings, in calendar year 2001 for 
services furnished on or after January 1, 2002. We expect to publish 
our proposed rule for 2002 in the spring of 2001.
    Comment: A device manufacturer inquired as to what will happen when 
devices are taken off the transitional pass-through list after 2 to 3 
years. The commenter stated that the additional expense of these 
implantable devices will require that HCFA reassign these CPT codes to 
an APC that is comparable clinically and in terms of resources used at 
the close of the transition period. If this does not occur, the 
commenter indicated that hospitals would be seriously underpaid for the 
use of these technologies and other technologies in similar 
circumstances.
    Response: As stated above, the BBRA 1999 allows for 2 to 3 years of 
transitional pass-through payments to be made for new devices, drugs, 
and biologicals. After the temporary payment period expires for any 
item, its cost will be packaged with the relative procedure code or 
medical visit and assigned to the APC group that is clinically related 
and comparable in resources used. Thus, the APC groupings, weights, and 
payments will be updated in a subsequent year to include costs 
associated with former pass-through items.
    Comment: A coalition of health care providers and insurers 
indicated that providers should be allowed to report all DME, 
orthotics, and prosthetic devices, both implantable and nonimplantable, 
on the UB-92 to the fiscal intermediary. The fiscal intermediary should 
be able to either pay for the item via the DMEPOS fee schedule or 
through the APC. This also would allow a tracking system for future 
ratesetting, and consolidate the billing into one claim. This would 
consolidate all charges on one bill per encounter, which simplifies 
processing and is consistent with other third party payer claims 
processing as well as Medicare inpatient claims processing.
    Response: Section 201(e) of the BBRA 1999 amended section 
1833(t)(1)(B) of the Act to require that covered outpatient prospective 
payment system services include implantable medical items, described in 
section 1861(s)(3), (6), or (8) of the Act. These items were formerly 
paid under the DMEPOS fee schedule. The statute is explicit in defining 
which DME items are payable under the hospital outpatient prospective 
payment system.
    Also, we cannot adopt the suggested billing changes for DME as the 
commenter suggested. All services that are billed through the fiscal 
intermediaries, whether they are paid under the hospital outpatient 
prospective payment system or DMEPOS, may be submitted on the UB-92 (or 
the equivalent electronic transaction). However, there are numerous, 
very exacting, specific criteria and rules that govern Medicare 
coverage and payment for nonimplantable DME and oxygen. The DME 
regional carriers are exclusively qualified to deal with these issues. 
Therefore, claims for nonimplantable DME and oxygen cannot be billed to 
the fiscal intermediaries. Instead, providers must continue to submit 
claims for nonimplantable DME and oxygen to the DME regional carriers 
using form HCFA-1500 (or the equivalent electronic transaction).
    It should be noted that if a health care provider submits an 
electronic claim for these services, the transaction must comply with 
the standards adopted by the Secretary in the August 17, 2000 final 
rule (65 FR 50312) Standards for Electronic Transactions. The 
compliance date of that rule is October 16, 2002.
    Comment: A device manufacturer expressed concern about how the new 
system will change the payment mechanism for cochlear implants. Under 
the DMEPOS fee schedule, payments were fixed and unrelated to hospital 
charges. Now, under the new system, hospitals must properly establish 
charges that, when multiplied by the ratio of cost to charges, provide 
an accurate reflection of cost. This manufacturer was concerned that 
they will have to collect data to determine the charges hospitals have 
set for these devices and the applicable ratio of cost to charges. They 
believe the charges may not have been set appropriately to be 
consistent with the ratio of cost to charges. If not, pass-through 
payments might be substantially less than the actual cost for these 
medical devices.
    This manufacturer indicated that it is working to obtain the 
required charge and cost report data from providers of cochlear implant 
procedures and will report back to us once it has these data. The 
manufacturer requested that we agree to work with them in setting any 
future update to the payment allowance recognizing the short timeframe 
available to collect the data.
    Response: We appreciate the commenter's offer to assist us in 
collecting cost and charge data on cochlear implants billed by 
hospitals. However, for purposes of making transitional pass-through 
payments for new medical devices such as cochlear implants, it is not 
necessary for manufacturers to obtain cost report data from hospitals 
to assist us in developing hospital-specific, cost-to-charge ratios to 
calculate these payments. We have already calculated these ratios and 
assigned them to providers. Each provider is responsible for accurately 
reporting its charges in order that we may calculate the appropriate 
payment for the pass-through device.
6. Payment Weights Based on Median or Mean Hospital Costs
    Section 1833(t)(2)(C) of the Act requires the Secretary to 
establish relative payment weights for covered hospital outpatient 
services. This section requires that the weights be developed using 
data on claims from 1996 and data from the most recent available 
hospital cost reports.
    As specified in the April 7, 2000 final rule with comment period 
(65 FR 18482), section 201(f) of the BBRA 1999 amended section 
1833(t)(2)(C) of the Act to authorize the Secretary to base the 
relative payments weights on median or mean hospital costs. In 
implementing the BBRA 1999 provision, we decided to adopt as final our 
previously proposed policy to base the relative payment weights on 
median (as opposed to mean) costs. We had already used median costs to 
reconstruct our database for the outpatient prospective payment system 
group weights and conversion factors in a proposed rule and we believe 
that this method is still valid, especially considering the time 
constraints for implementation of the BBRA 1999 provision. We indicated 
that, among other things, reconstructing our database to evaluate the 
impact of using mean costs after the BBRA 1999 was enacted would have 
delayed implementation of the hospital outpatient prospective payment 
system rule.
    Comment: A group of hospitals urged us to adopt a mean-based APC 
relative weight system to implement section 201(f) of the BBRA 1999, 
which authorizes, but does not require, the Secretary to use mean 
(rather than median) costs in determining the APC payment weights. The 
commenters contend that use of the geometric mean is standard in the 
industry as the basis

[[Page 67812]]

for calculating payment weights for prospective payment systems. They 
pointed out that the geometric mean is used because costs are not 
distributed ``normally'' (that is, there are no negative costs) and 
that for APCs that include low volume, high costs procedures, the 
geometric mean is preferable for adequately accounting for these costs. 
The commenters believed that our use of median costs also forced us to 
select an arbitrary value for relative weight 1.0, because finding the 
median of medians is meaningless. The commenters believed that, given 
the Congress' clarification in section 201(f) of the BBRA 1999, we 
should at least evaluate the impact of a mean-based system in our 
system review for 2001.
    Response: We plan to further evaluate the feasibility of using mean 
rather than median costs for calculating APC payment weights in future 
updates. In order to make a decision about whether we should change the 
basis we are using for determining payment weights, we have to analyze 
and rerun claims data and conduct extensive impact analyses to assess 
the impact such a change would have on different types of providers and 
different types of services.
7. Limitation on Variation of Costs of Services Classified Within a 
Group
    Section 1833(t)(2) of the Act was amended by section 201(g) of the 
BBRA 1999 to limit the variation in resource use among the procedures 
or services within an APC group. Specifically, section 1833(t)(2) of 
the Act provides that the items and services within a group cannot be 
considered comparable with respect to the use of resources if the 
highest cost item or service within a group is more than 2 times 
greater than the lowest cost item or service within the same group. The 
Secretary is to use either the mean or median cost of the item or 
service.
    Section 1833(t)(2) of the Act, as amended, also allows the 
Secretary to make exceptions to this limit on the variation of costs 
within each group in unusual cases such as low volume items and 
services, although we may not make such an exception in the case of a 
drug or biological that has been designated as an orphan drug under 
section 526 of the Federal Food, Drug, and Cosmetic Act.
    In the April 7, 2000 final rule with comment period, we elected to 
use the median cost because we have continued to set the relative 
payment weights for each APC based on median hospital costs. We 
modified the composition of the APC groups and then made additional 
changes to the APC in response to public comments on individual or 
serial APCs.
    In determining whether or not to accept changes recommended by 
commenters, we focused on five criteria that are fundamental to the 
definition of a group within the APC system. The decision to accept or 
decline a modification to an APC group was determined based on whether 
the change enhanced, detracted from, or had no effect on the integrity 
of an APC group within the context of the following five criteria:
    <bullet> Resource homogeneity;
    <bullet> Clinical homogeneity;
    <bullet> Provider concentration;
    <bullet> Frequency of services; and
    <bullet> Minimal opportunity for upcoding and code fragmentation.
    For a full explanation of these criteria, refer to the April 7, 
2000 final rule with comment period (65 FR 18457).
    After we modified the composition of the APC groups based on the 
recommendations of commenters, we applied the median cost variation 
limit required by section 201(g) of the BBRA 1999 to the revised APC 
groups. As a result of our analysis of the array of median costs within 
the revised APC groups, we had to split some otherwise clinically 
homogeneous APC groups into smaller groups. We listed the APC groups 
that we had designated as exceptions to the ``two times'' requirement 
and our reasons for granting the exception. We based the exceptions on 
factors such as low procedure volume, suspect or incomplete cost data, 
concerns about inaccurate or incorrect coding, or compelling clinical 
arguments. We indicated that we would be examining the extent to which 
the APC reorganization due to the ``two times'' rule results in 
upcoding (refer to the April 7, 2000 final rule with comment period (65 
FR 18458-18475)).
    Comment: We received requests to examine 51 APCs that commenters 
alleged violated the ``two times'' rule.
    Response: We reevaluated the APCs listed below, upon which we 
received comments, and found that most of them did not warrant 
revision. We received no new information about these APC groups that 
would alter our previous decision. These APCs are identified below 
under numbers 1 and 2.
    Our review also revealed that a few APC groups did warrant revision 
and we have reconfigured these APCs accordingly. We have listed these 
APCs under number 3. In addition, our review identified some APCs that 
are additional exceptions to the ``two times'' requirement. These APC 
groups and our reasons for the exception are listed below under number 
4.
    In reviewing the APC groups for conformance to the ``two times'' 
requirement, we exempted from the analysis codes for unlisted services 
and procedures and those codes that represent less than 2 percent of 
the claims in the APC (our test for low volume).
    1. Taking into account the exemptions mentioned above, the 
following APC groups that we reviewed based on comments have not been 
reconfigured:

0005  Level II Needle Biopsy/Aspiration Except Bone Marrow
0076  Endoscopy Lower Airway
0088  Thrombectomy
0090  Level II Implantation/Removal/Revision of Pacemaker, AICD or 
Vascular Device
0111  Blood Product Exchange
0112  Extracorporeal Photopheresis
0121  Level I Tube changes and Repositioning
0143  Lower GI Endoscopy
0146  Level I Sigmoidoscopy
0149  Level II Anal/Rectal Procedure
0150  Level III Anal/Rectal Procedure
0151  Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
0162  Level III Cystourethroscopy and other Genitourinary Procedures
0260  Level I Plain Film Except Teeth
0262  Plain Film of Teeth
0265  Level I Diagnostic Ultrasound Except Vascular
0268  Guidance Under Ultrasound
0269  Echocardiogram Except Transesophageal
0278  Diagnostic Urography
0280  Level II Diagnostic Angiography and Venography Except Extremity
0282  Level I Computerized Axial Tomography
0283  Level II Computerized Axial Tomography
0284  Magnetic Resonance Imaging
0286  Myocardial Scans
0290  Standard Non-Imaging Nuclear Medicine
0291  Level I Diagnostic Nuclear Medicine Excluding Myocardial Scans
0292  Level II Diagnostic Nuclear Medicine Excluding Myocardial Scans
0294  Level I Therapeutic Nuclear Medicine
0297  Level II Therapeutic Radiologic Procedures
0301  Level II Radiation Therapy
0303  Treatment Device Construction
0304  Level I Therapeutic Radiation Treatment Preparation
0305  Level II Therapeutic Radiation Treatment Preparation

    2. The following APC groups were listed in the April 7, 2000 final 
rule

[[Page 67813]]

with comment period as exceptions to the ``two times'' rule and our 
review found no factual basis for modifying our decision:

0030  Breast Reconstruction/Mastectomy
0264  Level II Miscellaneous Radiology Procedures
0274  Myelography
0279  Level I Diagnostic Angiography and Venography Except Extremity
0311  Radiation Physics Services
0371  Allergy Injections

    3. We have reconstructed the four APCs shown below as a result of 
adding the cost of certain devices used in performing procedures 
included in these APCs. We discuss this change in section III.B. of 
this preamble.

0080  Diagnostic Cardiac Catheterization
0081  Non-Coronary Angioplasty or Atherectomy
0082  Coronary Atherectomy
0083  Athrectomy

    4. Following are additional exceptions to the ``two times'' rule 
and our reasons for the exceptions. We are excepting these APCs from 
the ``two times limit'' on an interim basis, until we can review data 
from the first year of billing under the hospital outpatient 
prospective payment system.
    0142  Small Intestine Endoscopy: The codes in APC 0142 are 
clinically similar and should show a relative progression of cost with 
slight increases in complexity. This effect does not occur, presumably 
due to low volume (although exceeding our low volume threshold) or 
inconsistent coding. Splitting this APC into two, based on current 
data, would be unjustified.
    0145  Therapeutic Anoscopy: The costs of the codes in this APC are 
aberrant, with several of them exceeding the costs of more extensive 
procedures such as sigmoidoscopy and colonoscopy.
    0152  Percutaneous Biliary Endoscopic Procedures: The codes in this 
APC have so few occurrences that we cannot justify splitting the group. 
Several of the codes call for the use of devices such as stents that 
may be paid for separately.
    0161  Level II Cystourethroscopy and other Genitourinary 
Procedures: The costs of the codes in this APC are aberrant, with more 
comprehensive codes costing less than the base codes.
    0195  Level V Female Reproductive Procedures: This is a low volume 
APC, with aberrant cost data. In several instances, codes that are more 
comprehensive cost less than the related, simpler code.
    0296  Level I Therapeutic Radiologic Procedures: We believe the 
codes at the lower end of the median cost in this APC would be 
underpaid if we were to move them to a lower-paying APC.
    0300  Level I Radiation Therapy: We believe we would underpay codes 
at the lower end of median cost in this APC if we were to move them to 
a lower-paying APC.
    0312  Radioelement Applications: We believe the costs in this very 
low volume APC are aberrant. However, the group is completely coherent 
clinically. The radioactive elements related to these codes would 
receive separate payment.
    0313  Brachytherapy: We believe the costs in this very low volume 
APC are aberrant. The group is coherent clinically. The radioactive 
elements related to these codes would receive separate payment.
    0314  Hyperthermic Therapies: This APC has an extremely low volume, 
with aberrant costs.
8. Annual Review of the Components of the Hospital Outpatient 
Prospective Payment System
    In the April 7, 2000 final rule with comment period (65 FR 18501-
18502), we indicated that, in accordance with section 1833(t)(9) (as 
redesignated and revised by sections 201(h) and 202(a) of the BBRA 
1999), we would review and update annually, for implementation 
effective January 1 of each year, the APC groups, the relative payment 
weights, and the wage and other adjustments that are components of the 
hospital outpatient prospective payment system. In accordance with 
section 201(h)(2) of the BBRA 1999, an annual review process will begin 
in calendar year 2001 for the hospital outpatient prospective payments 
that would take effect for services furnished on or after January 1, 
2002. This review process will involve consultation with an expert 
advisory panel. We will provide notice of the formation of the expert 
advisory panel in the Federal Register. The expert outside advisory 
panel will review and make recommendations to us on the clinical 
integrity of the groups and weights and may use data other than those 
collected or developed by us for their review and advisory functions.
    We note that in section III of this preamble, we are updating the 
wage index values and the conversion factor under the hospital 
outpatient prospective payment system effective for calendar year 2001. 
We also are making appropriate changes to the APC groups to reflect 
additions and deletions of CPT codes and changes to a limited number of 
APCs to incorporate the cost of certain devices used in performing 
those procedures that were excluded from our initial ratesetting 
methodology.
    Comment: One commenter stated that the wage index for the 
Hattiesburg, Mississippi Metropolitan Statistical Area (MSA), .7306, 
was printed incorrectly in our April 7, 2000 final rule with comment 
period. The commenter stated that use of this value would result in an 
underpayment for that area. The commenter further stated that, ``the 
appropriate wage index for the Hattiesburg, Mississippi MSA for the 
fiscal year 2000 is .7634.'' The commenter was concerned that we had 
previously acknowledged this error and promised to correct it via a 
program memorandum to fiscal intermediaries dated April 2000 
(Transmittal Number A-00-17), but had failed to do so in our April 7, 
2000 final rule with comment period.
    Response: We apologize for the confusion. The fiscal year 2000 
hospital inpatient prospective payment system wage index value for the 
Hattiesburg, Mississippi (MSA) was changed from .7306 to .7634 in 
accordance with section 153 of the BBRA 1999 that required us to 
include wage data from Wesley Medical Center in calculating the wage 
index for this MSA. On August 1, 2000, we published in the Federal 
Register an interim final rule with comment period (65 FR 47026) that 
included Hattiesburg's new hospital inpatient prospective payment 
system wage index. For services paid under the hospital outpatient 
prospective payment system, the new wage index value is effective for 
services furnished on or after August 1, 2000.
9. Copayment Amounts Not Affected by Pass-Throughs
    Section 1833(t) of the Act, as established by the BBA of 1997, 
includes a mechanism designed to achieve a beneficiary coinsurance 
level equal to 20 percent of the prospectively determined payment rate 
established for the service. In the April 7, 2000 final rule with 
comment period, we specified how a copayment amount is calculated 
annually for each APC group under the hospital outpatient prospective 
payment system.
    We also explained that sections 201(a) and (b) of the BBRA 1999 
amended section 1833(t) of the Act to provide for additional payments 
to hospitals for outlier cases and for certain medical devices, drugs, 
and biologicals and that these additional payments to hospitals will 
not affect copayment amounts. Redesignated section 1833(t)(8)(D) of the 
Act, as amended by section 201(i) of the BBRA 1999, provides that the 
copayment amount is to be computed as

[[Page 67814]]

if outlier adjustments, adjustments for certain medical devices, drugs, 
and biologicals, as well as any other adjustments we may establish 
under section 1833(t)(2)(E) of the Act, had not occurred.
    In addition, we specified that section 202 of the BBRA 1999 added a 
new section 1833(t)(7) to the Act to provide transitional corridor 
payments to certain hospitals through calendar year 2003 and 
indefinitely for certain cancer centers. Section 1833(t)(7)(H) of the 
Act provides that the transitional corridor payment provisions will 
have no effect on determining copayment amounts.
    We specified that copayment from beneficiaries will not be 
collected for the additional payments made to hospitals (outlier and 
transitional pass-throughs) by Medicare. Beneficiary copayment amounts 
will be calculated as if the outlier and transitional pass-throughs had 
not occurred (65 FR 18487-18488).
    When a drug or device pass-through payment is reduced by the 
otherwise applicable APC payment amount that is associated with the 
drug or device, it is only the portion of the payment that represents 
an additional pass-through payment that is not subject to copayment. 
The portion that does not represent an additional pass-through payment 
will be subject to copayment.
    We did not receive any public comments on this provision.
10. Extension of Cost Reductions
    In the April 7, 2000 final rule with comment period (65 FR 18439), 
we announced that, in accordance with section 1861(v)(1)(S)(ii) of the 
Act (as amended by section 201(k) of the BBRA 1999), the 5.8 and 10 
percent reductions for hospital operating and capital costs, 
respectively, would extend until the first date that the hospital 
outpatient prospective payment system is implemented (which was August 
1, 2000).
    We did not receive any public comments on this provision.
11. Clarification of Congressional Intent Regarding Base Amounts Used 
in Determining the Hospital Outpatient Prospective Payment System
    Section 201(l) of the BBRA 1999 provided that, ``With respect to 
determining the amount of copayments described in paragraph (3)(A)(ii) 
of section 1833(t) of the Act, as added by section 4523(a) of BBA, 
Congress finds that such amount should be determined without regard to 
such section, in a budget neutral manner with respect to aggregate 
payments to hospitals, and that the Secretary of Health and Human 
Services has the authority to determine such amount without regard to 
such section.'' In accordance with this provision, in the April 7, 2000 
final rule with comment period (65 FR 18482-18493), we explained how we 
determined APC group weights, calculated an outpatient prospective 
payment system conversion factor, and determined national prospective 
payment rates, standardized for area wage variations, for the APC 
groups. We then explained how we calculated the aggregate hospital 
outpatient prospective payment to hospitals in a budget neutral manner 
and how we calculated beneficiary coinsurance amounts for each APC 
group.
    We did not receive any public comments on this provision.
12. Transitional Corridors for Application of Outpatient Prospective 
Payment System
    Section 1833(t)(7) of the Act, as added by section 202(a)(3) of the 
BBRA 1999, provides for payment adjustments during a transition period 
to limit the decline in payments under the outpatient prospective 
payment system for hospitals. These additional payments are to be 
implemented without regard to budget neutrality and are in effect 
through 2003.
    In the April 7, 2000 final rule with comment period (65 FR 18499-
18500), we specified that, from the date the prospective payment system 
is implemented through 2003, a provider, including a CMHC, will receive 
an adjustment if its prospective payment system payments for outpatient 
services furnished during the year is less than a set percentage of its 
pre-BBA amount for that year. The pre-BBA amount is the product of the 
reasonable cost the hospital incurs for prospective payment system 
services furnished during the year and the payment-to-cost ratio for 
covered prospective payment system services furnished during the cost 
reporting period ending in calendar year 1996. Additionally, we 
provided that small rural hospitals with 100 or fewer beds and cancer 
hospitals will be held harmless under this provision. Small rural 
hospitals will be held harmless for services furnished before January 
1, 2004. The hold-harmless provision applies permanently to cancer 
centers. We announced that we will make interim payments to the 
affected hospitals subject to retrospective adjustments and that these 
provisions do not affect beneficiary coinsurance. Finally, we specified 
that this provision is not subject to budget neutrality.
a. Interim Payment Versus Final Settlement
    Comment: One commenter recommended that we make retroactive 
payments to hospitals in those ``situations where underpayments have 
been made between the prospective payment system payments as compared 
to the pre-prospective payment system amounts.'' Another commenter 
asked that we set forth the process that would be used to determine 
retroactive payment adjustments if the hospital's interim payments are 
higher or lower than its actual experience. The commenter further asks 
that we state whether the interim payments will be compared to 
outpatient payments shown on settled or audited cost reports.
    Response: Final transitional corridor payments are determined based 
on a provider's settled cost report. At the time the cost report is 
settled, the reasonable costs incurred by the provider to furnish 
outpatient prospective payment system services during the calendar year 
are known and that amount is then multiplied by the provider's 1996 
payment-to-cost ratio to calculate the pre-BBA amount. The pre-BBA 
amount for a calendar year is compared to the actual prospective 
payment system payments the provider received to determine whether the 
provider may be entitled to a transitional corridor payment. Although 
the final transitional corridor payment is based on a settled cost 
report, beginning in October 2000, we have been making monthly interim 
payments to providers based on estimates of what their transitional 
corridor payments should be based on the monthly bills the provider 
submits. The monthly payments are designed to maintain some additional 
cash flow to providers that may otherwise realize significant losses on 
services that are being paid under the prospective payment system.
b. Payment-to-Cost Ratios
    Comment: One commenter argued that our formula for calculating the 
base payment-to-cost ratio for the transitional corridor payments does 
not comport with the statutory requirements. The commenter stated that 
we define the denominator of the base payment-to-cost ratio to be 
``[the] reasonable cost of these services for the period, without 
applying the cost reductions under section 1861(v)(1)(S) of the Act.'' 
The commenter contends that the phrase ``without applying the cost 
reductions under section 1861(v)(1)(S) of the Act'' is not included in 
section 1833(t)(7)(F)(ii)(II) of the Act, as

[[Page 67815]]

amended by section 212 of the BBRA 1999. The commenter claimed that by 
defining the denominator in this manner, the payment-to-cost ratio is 
understated and transitional corridors payments to hospitals would be 
reduced. The commenter stated that such a reduction is contrary to 
Congressional intent and urged us to modify our base payment-to-cost 
denominator set forth in Sec. 419.70(f)(2)(ii) to exclude the phrase 
``without applying the cost reduction under section 1861(v)(1)(S) of 
the Act.''
    Response: The phrase ``without applying the cost reductions under 
section 1861(v)(1)(S) of the Act'' was intended to make clear that a 
hospital's 1996 ``reasonable costs'' do not include the effects of the 
reductions in section 1861(v)(1)(S) of the Act. We did not mean to 
suggest that we were taking the hospital's 1996 ``reasonable costs'' 
and then adding back the reductions for purposes of determining the 
denominator of the base payment-to-cost ratio. We view the hospital's 
1996 reasonable costs as the unreduced amount; thus, the denominator of 
the hospital's base payment-to-cost ratio (1996 reasonable costs) does 
not reflect the reductions. We believe that our policy is consistent 
with the purpose of the transitional corridor provision. Under this 
policy, if a hospital incurs the same amount of costs during the 
transitional corridor as in 1996, then its pre-BBA amount (the amount 
that estimates what the hospital would have received in the current 
year if payments were calculated under the pre-prospective payment 
system) would be the same as the payments the hospital received in 
1996. Under the methodology suggested by the commenter, if a hospital 
incurs the same amount of costs during the transitional corridor as in 
1996, then its pre-BBA amount would be higher than the payments the 
hospital received in 1996. The language in Sec. 419.70(f)(2)(ii) as set 
forth in the April 7, 2000 final rule with comment period was intended 
to clarify, not revise, the definition of 1996 reasonable costs, but we 
recognize that the phrase at issue may have inadvertently caused 
confusion to the extent it is redundant; accordingly, we are revising 
that section to remove the phrase.
    Comment: One commenter asked us to clarify the term ``payment-to-
cost ratio'' and the data that will be used to compute the ratio. 
Several commenters asked why we did not give the 1996 outpatient 
prospective payment system-specific amounts required to compute the 
payment-to-cost ratio and the methodology for calculating it.
    Response: The statutory definition of base ``payment-to-cost 
ratio'' is fairly straightforward. Under section 1833(t)(7)(F) of the 
Act, the base payment-to-cost ratio for a given hospital is the ratio 
of (1) the hospital's Medicare Part B reimbursement for covered OPD 
services for the cost reporting period ending during 1996, to (2) the 
hospital's reasonable costs for that period. We are in the process of 
developing program instructions for fiscal intermediaries (for 
notification to providers) to provide detailed information on how 
payment-to-cost ratios are calculated. These instructions will be made 
available as soon as possible.
    Comment: One hospital association recommended that we revise our 
regulations to explicitly state that we will adjust the provider's 1996 
payment-to-cost ratio ``whenever subsequent developments occur that 
affect the data used in the calculation.'' The commenter cited final 
audit adjustments and appeal determinations as examples of adjustments 
that would warrant changing the 1996 cost data used to calculate the 
provider's payment-to-cost ratio. The commenter stated that this policy 
is consistent with similar adjustments made under the prospective 
payment systems for both inpatient operating and capital-related costs.
    Response: We agree with the commenter. In the event final audit 
adjustments or appeals result in a change in outpatient costs or 
payments for the provider's 1996 cost report, the provider's payment-
to-cost ratio would be recalculated.
    Comment: One commenter asked for clarification on the treatment of 
direct graduate medical education costs and education costs for nursing 
and allied health programs in calculating the payment-to-cost ratio. 
The commenter assumed that such costs are excluded from the pre-BBA 
amount because they will continue to be paid on a cost pass-through 
basis.
    Response: The commenter is correct that direct graduate medical 
education costs and certain costs of nursing and allied health programs 
are paid on a cost pass-through basis and will not be included in 
calculating a provider's pre-BBA amount.
    Comment: One commenter asked that we explain our reasons for basing 
the transitional corridor interim payments on a 0.8 payment-to-cost 
ratio. The commenter suggested that a provider be allowed to modify its 
interim transitional corridor payment if it can show that its payment-
to-cost ratio is higher or lower than the 0.8 level.
    Several commenters questioned why we chose to use a standard 0.8 
payment-to-cost ratio for all providers in calculating the interim 
payment if provider-specific payment-to-cost ratios were available. 
They stated that 9 of the 10 cancer centers have payment-to-cost ratios 
that exceed 0.8.
    Response: The standard payment-to-cost ratio of 80 percent is an 
average value that we calculated for payment-to-cost ratios across all 
hospitals. We decided to use 80 percent for all providers to permit us 
to make interim payments as soon as possible following the 
implementation of the outpatient prospective payment system. If we had 
attempted to calculate individual payment-to-cost ratios for all 
providers, it would have delayed, perhaps for several months, the 
introduction of interim payments. Final transitional corridor payments 
will be calculated using each provider's payment-to-cost ratio for the 
relevant year at the time of settlement of the cost report. In the 
future, as we gain more experience with interim payments, we will 
consider permitting modification of payment-to-cost ratios to reflect 
particular circumstances.
c. Cost-to-Charge Ratios
    Comment: One commenter stated that the April 7, 2000 final rule 
with comment period did not explain how the transitional corridor 
payments would be implemented for the 10 cancer hospitals. The 
commenter noted that while Program Memorandum Transmittal No. A-00-23 
issued by us on April 7, 2000, does describe how these payments are to 
be calculated it does not clarify how we derived the hospital-specific 
cost-to-charge ratios used to compute the transitional corridor 
payments.
    Several commenters representing the 10 cancer centers stated that 
the cost-to-charge ratios for their centers that will be used in 
calculating their transitional corridor, outlier, and transitional 
pass-through payments are significantly lower than their estimates. 
They requested that we explain how we determined their ratios and 
comment on the appropriateness of our methodology. They also asked that 
we respond to a number of specific questions to allow hospitals to 
determine whether the cost-to-charge ratios accurately reflect the 
hospital's cost and provide a fair base for calculating their 
transitional corridor payments.
    Response: On September 8, 2000, we issued a Program Memorandum 
Transmittal No. A-00-63, which provides a detailed explanation of how 
hospital cost-to-charge ratios were

[[Page 67816]]

calculated. This program memorandum is available on HCFA's internet 
website at www.hcfa.gov/Medicare.
d. Interim Payments Limited to 85 Percent of the Estimated Transitional 
Corridor Payment
    Comment: One commenter asked why we will only pay 85 percent of the 
estimated transitional corridor payment as an interim payment. Another 
commenter recommended that we reconsider our policy to pay providers 
only 85 percent of their transitional corridor payments on the interim 
basis. The commenter stated that our policy to withhold 15 percent of 
each provider's payment until the fiscal intermediary finalizes the 
provider's cost report is contrary to Congressional intent to preserve 
hospitals' cash flow and ensure them of an ability to provide 
outpatient services to beneficiaries, especially those in rural areas. 
Another commenter stated that retaining 15 percent of each provider's 
estimated transitional corridor payments until the provider's cost 
report is settled is contrary to Congressional intent and defers relief 
provided by statute for several years.
    Response: We limited the interim payment to less than 100 percent 
of the estimated payment in order to minimize the risk of overpayment. 
If interim payments exceed the final settled amounts, we would need to 
initiate recoupment procedures that place additional burden both on the 
agency and on providers. Eighty-five percent was chosen as a reasonable 
percentage that prudently balances the cash flow needs of some 
providers with concerns regarding possible difficulties in the recovery 
of overpayments. We have used comparable figures in other situations in 
which we make interim or advance payments. One example where we 
specified 85 percent for advance payments is in the contingency plan 
that we published to address the possibility that either our 
contractors or individual providers would be unable to process claims 
at the initiation of the outpatient prospective payment system. In the 
future, as cost reports are settled and we are able to determine how 
well interim transitional corridor payments relate to final 
transitional corridor payments, we will reevaluate this aspect of our 
interim payment policy.
e. Providers Having More Than One 1996 Cost Report
    Comment: Several commenters stated that we did not discuss in our 
final rule how we would calculate the 1996 payment-to-cost ratio in 
cases where a provider has more than one cost report that is less than 
12 full months during the fiscal year ending in 1996. The commenters 
asked which would be the appropriate cost report to use in calculating 
the transitional corridor payments. One commenter explained that this 
situation may occur if ownership changed during the provider's fiscal 
year ending in 1996.
    Response: The 1996 cost report that will be used to calculate a 
payment-to-cost ratio is the cost report period that ends in calendar 
year 1996. If a provider has two cost reports that end in 1996, we will 
make a decision about which cost report to use on a case-by-case basis, 
depending on which appeared to be the most representative of the 
provider's experience in 1996. For example, if one cost report covers a 
longer period, we would likely use that one.
f. Providers Having No 1996 Cost Report
    Comment: One commenter expressed concern about insufficient 
guidance from us about how transitional corridor payments would be 
determined for providers that did not file cost reports during 1996. 
The commenter believed that because the statute is silent on this 
issue, we have the discretion to develop such policy. The commenter 
strongly opposed any decisions by us to preclude providers without 1996 
cost reports from being eligible to receive transitional corridor 
payments.
    Another commenter requested that we treat new hospitals that did 
not file a 1996 cost report the same as rural hospitals. The commenter 
contended that the pre-BBA payment level for these hospitals should be 
based on the hospital's first full cost reporting period, and would be 
guaranteed at that level through December 31, 2003. Another commenter 
suggested as an option that we assign a regional average payment-to-
cost ratio for existing providers to providers without a 1996 cost 
report.
    Response: Under the statute, the amount of transitional payments to 
providers depends on the provider's reimbursement for the 1996 cost 
reporting period. We intend to monitor the adequacy of payments to 
providers not having a 1996 cost report, but we believe that a 
statutory change is required in order to provide transitional payments 
to providers that did not have a 1996 cost report.
g. Prospective Payment System Delay and Transitional Corridor Payments
    Comment: One commenter expressed concern about the potential effect 
of delaying implementation of the hospital outpatient prospective 
payment system on the duration of the transitional corridor payments as 
provided by law. The commenter stated that our decision to delay 
implementation of the prospective payment system for 1 month, from July 
1, 2000 to August 1, 2000, should not result in a 1-month loss of 
transitional corridor payments for providers. The commenter believed 
that the 3\1/2\ years of corridor payments required by law for non-
cancer hospitals paid under the outpatient prospective payment system 
should not be reduced due to delayed implementation of the prospective 
payment system. The commenter urged us to seek a legislative change if 
we determine the 3\1/2\ year period for transitional corridor payments 
must coincide with the first 3\1/2\ years of actual prospective payment 
system implementation.
    Response: For hospitals that do not qualify for the permanent hold-
harmless provision applicable to cancer hospitals, the statute provides 
for transitional corridor payments through the end of calendar year 
2003. We will monitor and evaluate prospective payment system payments 
and will consider whether it would be appropriate to recommend that 
Congress legislate an extension of transitional corridor payments.
h. Rural Hold-Harmless Provision
    Comment: One commenter suggested that we reevaluate the definition 
of rural outpatient hospitals eligible for the hold-harmless provision 
and consider including rural hospitals that have 100 to 200 beds, ``but 
whose outpatient volumes are not sufficient to maintain the facilities' 
finances.''
    Response: The bed size for hospitals to qualify for the rural 
hospital hold-harmless provision is limited by statute, under section 
1833(t)(7)(D)(i) of the Act, to hospitals that have no more than 100 
beds.
    Comment: One commenter stated that on page 18501 of the April 7, 
2000 final rule with comment period, we state that bed size under the 
rural hospital hold-harmless provision will be determined in the same 
manner as it is for the hospital inpatient prospective payment system 
indirect medical education adjustment. The commenter contended that we 
have not provided these instructions to fiscal intermediaries. The 
commenter questioned whether the fiscal intermediaries are using the 
number of beds reported on the hospital cost reports to determine the 
bed size. Still another commenter stated that we failed to specify how 
beds are to be counted under the hospital outpatient prospective 
payment system. The commenter further stated that our impact analysis 
published in the April 7, 2000 final rule with comment period

[[Page 67817]]

suggests that available bed counts shown on the HCFA-2552 cost report 
S-3 Worksheet are used to determine if a hospital has 100 or fewer beds 
to qualify for the rural hold-harmless transitional corridor payment 
provision. The commenter urged us to clarify this issue.
    Response: In Program Memorandum Transmittal No. A-00-23, later 
revised in June 2000 as Program Memorandum Transmittal No. A-00-36, we 
provided instructions to fiscal intermediaries concerning how to 
calculate interim transitional corridor payments. As indicated in the 
April 7, 2000 final rule with comment period, the bed size used for 
transitional corridor payments will be the same bed size defined in and 
used to calculate indirect medical education costs and disproportionate 
share adjustments under the hospital inpatient prospective payment 
system. Fiscal intermediaries are instructed to obtain certain 
provider-specific information needed to make the calculation from the 
outpatient provider-specific file that they maintain. Certain items on 
the outpatient provider-specific file, including bed size, are taken 
directly from the provider file used in processing inpatient claims.
    Comment: One commenter urged that we revise policy for determining 
bed size for purposes of defining rural providers eligible for the 
hold-harmless provision. The commenter advocated that we adjust a 
provider's count of acute inpatient days to account for observation 
patients occupying acute inpatient beds.
    Response: The commenter did not provide a rationale for their 
recommendation. We believe that it is appropriate to adopt a policy for 
purposes of the outpatient prospective payment system that is 
consistent with the policy for purposes of the inpatient prospective 
payment system; therefore, we are not making a change at this time.
    Comment: A commenter specifically asked that, for purposes of 
determining bed size for rural providers, we clarify what year is used 
to determine bed size. The commenter also asked what our policy is 
regarding providers that changed their inpatient capacity prior to July 
1, 2000, and those that may change this capacity during the 3\1/2\ year 
transition period. The commenter suggested that we permit hospitals to 
downsize capacity without affecting their eligibility for hold-harmless 
status.
    Response: Under Sec. 412.105(b), to determine bed size for the 
rural hold-harmless provision, we calculated bed size on the basis of 
the provider's cost reporting period. A rural hospital's bed size and, 
therefore, its eligibility for hold-harmless treatment may change from 
one cost reporting period to the next.
    Comment: Several commenters asked us to clarify whether a 
hospital's reclassification for either the wage index area or 
standardized amount affects its eligibility for the rural hold-harmless 
payment. The commenter believed that, because the BBRA 1999 statutory 
provision relevant to the rural hold-harmless provision refers to 
providers ``located in a rural area'' rather than the provider's 
payment status, a provider's geographic reclassification for wages or 
standardized amount has no bearing on its rural hold-harmless status. A 
few commenters argued that a geographic reclassification under 
inpatient prospective payment system for the wage index or the 
standardized amount is not relevant for purposes of the hold-harmless 
rural payment provision and that these reclassified hospitals should be 
included in the rural hold-harmless payment.
    Response: If a hospital is located in a rural area, it will not 
lose its eligibility for hold-harmless payments if it obtains a 
geographic reclassification under the inpatient prospective payment 
system for purposes of determining its wage index or standardized 
amount.
    Comment: A number of commenters expressed concern about the various 
aspects of the hold-harmless provision, referring to sections 
1886(d)(8)(E) and 1833(t)(13) under section 401 of the BBRA 1999, and 
asked about a hospital's eligibility for the rural hold-harmless 
provision.
    Response: Under section 1886(d)(8)(E) of the Act, as added by 
section 401 of the BBRA 1999, if a hospital submits an application and 
meets certain criteria, the Secretary treats the hospital as being 
located in a rural area for purposes of section 1886(d) of the Act. 
Under section 1833(t)(13) of the Act, as added by section 401(b) of the 
BBRA 1999, if a hospital is treated as being located in a rural area 
under section 1886(d)(8)(E) of the Act, then the Secretary shall treat 
the hospital as being located in a rural area for purposes of the 
outpatient prospective payment system. Therefore, if a hospital is 
treated as being located in a rural area under section 1886(d)(8)(E) of 
the Act, then the hospital is treated as a rural hospital for purposes 
of the hold-harmless provision.
    Comment: One commenter stated that the 2-month waiting period for 
interim transitional payments may adversely affect a large number of 
small rural hospitals. The commenter also believed these hospitals will 
require a higher interim payment than planned. The commenter asked that 
we use a hospital-specific impact analyses to create a process for 
interim payments for these small rural hospitals that would begin 
concurrently with the start of the prospective payment system.
    Response: In order to calculate interim transitional corridor 
payments for any hospital, we needed to have some amount of claims that 
had been processed under the prospective payment system. For this 
reason, we were not able to begin transitional corridor payments 
concurrently with the implementation of the prospective payment system. 
Because of our concerns discussed earlier about having to initiate 
recoupment procedures in cases of overpayments, we are not increasing 
interim payments at this time. However, as cost reports are settled and 
we are able to determine how well interim payments predict final 
transitional corridor payments, we will be able to reevaluate this 
policy.
i. Covered Charges
    Comment: Several commenters asked that we clarify the definition of 
``covered charges'' used to compute the rural hold-harmless 
transitional corridor payment. One commenter stated that total 
procedures and thus the hold-harmless payment will be understated 
should we eliminate from these calculations the charges for incidental 
procedures or procedures that the Outpatient Code Editor consolidates 
into the main procedures.
    Response: In the preamble and the regulation text of the April 7, 
2000 final rule with comment period, we refer to ``covered hospital 
outpatient services'' to describe the services that are paid under the 
prospective payment system and, therefore, subject to the transitional 
corridor provision. To determine a provider's costs for purposes of 
calculating the pre-BBA amount for both interim payments and for final 
cost report settlement, we will take into account all costs encompassed 
under the prospective payment system, including the cost of incidental 
services that are packaged into the APC rate. These services are 
identified as those having HCPCS codes with a status indicator of ``N'' 
(as listed in Addendum B) and incidental services that may not be 
billed with HCPCS codes, but which are billed under revenue codes that 
indicate a packaged service such as observation services, recovery 
room, supplies and many drugs.
    Comment: One commenter asked us to clarify how charges for packaged 
services, for example observation services, should be billed when they 
are

[[Page 67818]]

the only service provided. The commenter stated that inclusion of 
charges for these packaged services in the total bill charges are 
necessary to calculate the proper transitional corridor payment.
    Response: Packaged services will not be the only items that appear 
on a bill. Packaged services will appear on a bill with the service to 
which they are incidental. For example, observation services are 
properly billed with the clinic visit, emergency room visit, surgery, 
etc., that results in the need for the incidental observation service.
j. Cancer Hospitals and Transitional Corridor Payments
    Comment: Several commenters believed that the process described in 
Program Memorandum Transmittal No. A-00-23 for calculating the hold-
harmless transitional corridor payments should be revised because it 
does not reflect Congressional intent and will not provide the relief 
to the 10 cancer centers that the Congress intended. These commenters 
contended that the method described in the program memorandum for 
calculating the transitional corridor payments will result in a 22 
percent loss in outpatient patient revenues for the cancer centers 
compared to those received in 1998. The commenters further claimed that 
their revenue losses under the new outpatient prospective payment 
system may increase an additional 2 percent, or 24 percent in total, 
because we will not pay claims for any medical visits that are billed 
in conjunction with related significant procedures.
    In addition, these commenters urged us to:
    <bullet> Establish an appeal process for providers with cash flow 
problems that would permit fiscal intermediaries to adjust a provider's 
cost-to-charge ratio ``to rectify ongoing OPPS losses prior to 
reconciliation.''
    <bullet> Reduce interim payments to the 10 cancer centers by only 5 
percent rather than 15 percent. (The commenters contended that this 
approach would be consistent with the method currently used to 
determine their inpatient interim payments under the TEFRA cost limits 
system.)
    <bullet> Pay the 10 cancer centers the balance of the hold-harmless 
payments due at the time the cost report is subjected to desk review 
rather than at the time it is settled. (The commenters stated that 
settlement of the centers' cost reports is completed within 2 to 4 
years after a completed cost report is filed, whereas the cost report 
desk review is generally completed 90 days after it is filed.)
    Response: Medical visits may be billed with significant procedures 
as long as the medical visit is a separate and distinct service from 
the significant procedure, even though the significant procedure is 
related to the medical visit. For example, as a result of an 
examination performed as part of a clinic or emergency room visit, a 
patient is determined to need a CT scan or MRI, or as a result of a 
dermatology examination performed as a clinic visit, a patient also has 
a surgical procedure to remove a mole. In these types of situations, 
payment will be made for both a medical visit and a significant 
procedure.
    Program Memorandum Transmittal No. A-00-63 provides for adjustment 
of a provider's cost-to-charge ratio in certain specific situations. In 
the future, in order to reflect changes in hospital costs and charges, 
we will allow fiscal intermediaries to make additional updates of a 
provider's cost-to-charge ratio to ensure that interim payments 
accurately reflect our best estimates of final transitional corridor 
payments.
    Although we limited the interim payment to 85 percent of the 
estimated payment in order to minimize the risk of overpayment, in the 
future, as cost reports are settled and we are able to determine how 
well interim payments predict final transitional corridor payments, we 
will be able to reevaluate this aspect of our interim payment policy 
and we will consider permitting modification of payment-to-cost ratios 
to reflect particular circumstances.
    The statute indicates that interim payments are made subject to 
retrospective adjustments based on settled cost reports. However, it is 
current practice that, depending on the provider's specific situation, 
a fiscal intermediary may make additional payments as part of a 
tentative settlement action prior to final settlement of the cost 
report.
k. Teaching Hospitals and Transitional Corridor Payments
    Comment: One commenter urged that we retain the transitional 
corridor payments permanently for major teaching hospitals.
    Response: Section 1833(t)(7) of the Act provides permanent 
transitional corridor payments only for cancer hospitals described in 
section 1886(d)(1)(B)(v) of the Act. As indicated earlier, we will 
monitor and evaluate the prospective payment system payments and will 
consider whether it would be appropriate to recommend that Congress 
extend transitional corridor payments.
    Comment: One commenter stated that while the transitional corridor 
payments will mitigate some of the losses to teaching hospitals under 
the prospective payment system compared to the former cost-based 
payment system, these payments are temporary. The commenter believed 
that we underestimated the losses that some teaching hospitals will 
experience. Another commenter urged us to monitor closely the impact of 
the prospective payment system on major teaching hospitals during the 
3\1/2\ year transitional corridor payments. The commenter believed that 
these hospitals will require a payment adjustment after the 
transitional corridor payment period expires to mitigate their 
potential financial losses under the prospective payment system.
    Response: As we stated in the preamble of the April 7, 2000 final 
rule with comment period, we will perform further comprehensive 
analyses of cost and payment differences between different classes of 
hospitals as soon as there is a sufficient amount of claims data 
submitted under the prospective payment system. We will use data from 
the initial years of the prospective payment system to conduct 
regression and simulation analyses. In addition, we will carefully 
track and analyze the additional payments made to hospitals under the 
transitional corridor provision. These analyses will be used to 
consider and possibly propose adjustments in the system, particularly 
beginning in 2004 when the transitional corridor provisions expire.
13. Limitation on Coinsurance for a Procedure
    In the April 7, 2000 final rule with comment period (65 FR 18488), 
we specified that, in accordance with section 1833(t)(8) of the Act (as 
amended by section 204(a) of the BBRA 1999), the coinsurance amount for 
a procedure performed in a year cannot exceed the hospital inpatient 
deductible for that year. We specified that we would apply the 
limitation to the wage-adjusted coinsurance amount (not the unadjusted 
coinsurance amount) after any Part B deductible amounts are taken into 
account. Therefore, although the unadjusted coinsurance amount for any 
APC may be higher or lower than the inpatient hospital deductible, the 
actual coinsurance amount for an APC, determined after any deductible 
amounts and adjustments for variations in geographic areas are taken 
into account, will be limited to the Medicare inpatient hospital 
deductible. Any reduction in coinsurance that occurs in applying the 
limitation will be paid to

[[Page 67819]]

hospitals as additional program payments.
    Comment: One commenter disagreed with our interpretation of the 
BBRA 1999 provision that amended section 1833(t)(8) of the Act to limit 
the coinsurance amount for a procedure to the amount of the inpatient 
hospital deductible. The commenter believed that our interpretation 
that applies the limitation to coinsurance on an APC by the APC basis 
is too narrow.
    The commenter concluded that, at a minimum, the limitation should 
be more broadly interpreted to apply to the total coinsurance incurred 
by a beneficiary in connection with an outpatient visit, that is, from 
the time the beneficiary walks into an outpatient department until he 
or she is released. However, to implement the provision as envisioned 
by the Congress, the commenter suggested that we also consider 
developing a service period unit for outpatient procedures that is 
similar to the ``spell of illness'' concept used to define the set of 
services to which a single inpatient hospital deductible applies. 
Therefore, when a patient comes to an outpatient department for 
treatment of a particular condition, his or her coinsurance liability 
for all the services required for that condition should not exceed the 
inpatient hospital deductible. The commenter recommended that we apply 
the limitation regardless of how many or which APCs are billed or the 
number of visits required for such treatment.
    Response: APCs are based on CPT codes. We believe that the most 
plausible meaning for ``procedure'' in this context is a CPT code or, 
by extension, an APC. Thus we interpret the limitation of coinsurance 
for a procedure in section 1833(t)(8)(C) of the Act as added by section 
204 of the BBRA 1999 to apply in general to APCs.
    We do not believe that it was the intent of the Congress to apply 
the coinsurance limitation to the beneficiary's aggregate coinsurance 
amounts for all outpatient services received during the entire service 
period for a specific condition or even to the services a beneficiary 
receives in one day. During the Congressional committee deliberations 
on this provision before it was enacted, we held technical discussions 
with committee staff. At their request, we identified the specific 10 
APCs in the September 1998 proposed rule that would be likely to have a 
coinsurance that exceeded the inpatient hospital deductible. The 
Congressional Budget Office also used that information to project the 
cost of this statutory provision. Therefore, we believe that our 
interpretation in the April 7, 2000 final rule with comment period of 
how the coinsurance limitation is to be applied is consistent with the 
intent of Congress.
    Comment: Several commenters pointed out that because APCs for drugs 
and biologicals are defined based on HCPCS codes for the lowest unit of 
the drug or biological, if we intend to apply the inpatient deductible 
limit at the APC level, we might disadvantage beneficiaries who receive 
multiple units. For example, the coinsurance for a specific drug APC 
may not exceed the inpatient deductible amount. However, if multiple 
units of the same drug are administered, the coinsurance based on the 
multiple APCs may, in fact, exceed the inpatient deductible. The 
commenters believed that the total coinsurance amount for a drug or 
biological based on the amount administered should be subjected to the 
inpatient deductible limit. The commenters believed that constructing 
APCs for drugs based on the lowest unit of the drug is solely a payment 
convention and does not mean that each dose is a separate 
``procedure.'' Therefore, the commenters contended, a better reading of 
the statute is that the administration of a drug or biological, 
regardless of the dose, is one procedure for purposes of applying the 
hospital outpatient prospective payment system and it would be 
inappropriate to compare the inpatient deductible limit to anything but 
the total coinsurance amounts.
    Response: In the case of services that involve the administration 
of drugs and biologicals in separate APCs, we have concluded that we 
should apply the limitation on coinsurance to include both the drug or 
biological (in whatever units it is administered) and the service that 
leads to its administration. We constructed separate APCs for drugs and 
biologicals, and established pricing on the basis of the lowest dose, 
not to reflect CPT codes, but solely as a matter of convenience in 
administering the payment system. Consequently, we think that the 
interpretation with the most clinical relevance in this instance is to 
treat a drug or biological and the service that leads to its 
administration as a single procedure. We had not proposed separate APCs 
for drugs and biologicals in the proposed rule for the outpatient 
prospective payment system and the Congress did not know we would 
segment APCs at the time it passed the BBRA 1997.
    Effective for drugs and biologicals furnished on or after January 
1, 2001, when multiple units of a drug or biological are furnished to a 
beneficiary during one day, resulting in multiple APC payments for the 
same drug, we will aggregate the total coinsurance applicable to the 
drug or biological, and the aggregated amount cannot exceed the 
inpatient hospital deductible for the calendar year. In order to 
accomplish this change in our bill processing systems, we are assigning 
a new status indicator designated as ``K'' to APCs for nonpass-through 
drugs and biologicals (as reflected in Addendum D of this interim final 
rule with comment period). Effective for services furnished on or after 
July 1, 2001, in the same circumstances, we will aggregate the total 
coinsurance applicable to the drug or biological and to the service 
that resulted in the administration of the drug, and the aggregated 
amount cannot exceed the inpatient hospital deductible for the calendar 
year. We are unable to make the latter provision effective earlier 
because of systems constraints.
    Comment: One commenter stated that the BBRA 1999 requirement that 
coinsurance for a procedure cannot exceed the inpatient hospital 
deductible for that year adds confusion to an already complicated 
formula for determining coinsurance. The commenter stated that the 
monitoring of coinsurance needed to ensure the limitation is being 
applied on a procedure basis will add undue burden and increase a 
provider's costs. To make the hospital outpatient prospective payment 
system less complicated, the commenter believed that we should consider 
eliminating the threshold.
    Response: The coinsurance limitation is required by statute. 
Therefore, a statutory change would be required to eliminate this 
provision.
14. Reclassification of Certain Hospitals
    In the August 1, 2000 Federal Register (65 FR 47029), we 
implemented section 401 of the BBRA 1999 for the hospital inpatient 
prospective payment system. Section 401(a) of the BBRA 1999, which 
amended section 1886(d)(8) of the Act by adding a new paragraph (E), 
directs the Secretary to treat any subsection (d) hospital located in 
an urban area as being located in the rural area of the State in which 
the hospital is located if the hospital files an application (in the 
form and manner determined by the Secretary) and meets certain 
statutorily specified criteria. Additionally, section 401(a) of the 
BBRA 1999 includes hospitals ``* * * located in an area designated by 
any law or regulation of such State as a rural area (or is designated 
by such State as a rural hospital).'' A hospital also may seek to 
qualify for reclassification premised on the fact that, had it been 
located in a

[[Page 67820]]

rural area, it would have qualified as a rural referral center or as a 
sole community hospital.
    Section 401(b) of the BBRA 1999 made a conforming change to section 
1833(t) of the Act. Specifically, section 401(b) added section 
1833(t)(13) to the Act which provides that if a hospital is being 
treated as being located in a rural area under section 1886(d)(8)(E) of 
the Act (for purposes of section 1886(d) of the Act), the hospital will 
also be treated under section 1833(t)(13) of the Act as being located 
in a rural area.
    In the April 7, 2000 final rule with comment period, we explained 
that we use the same yearly version of the hospital inpatient 
prospective payment system wage index (which takes effect each October 
1) to adjust the portion of the outpatient prospective payment system 
payment rate and the coinsurance amount that is attributable to labor-
related costs for relative differences in labor and labor-related costs 
across geographic areas (and that will be applied effective each 
January 1). This wage index reflects the effects of hospital 
designations under section 1886(d)(8)(B) of the Act and hospital 
reclassifications under section 1886(d)(10) of the Act.
    We did not receive any comments on this conforming change.

B. August 3, 2000 Interim Final Rule With Comment Period

    Following are the issues addressed in the August 3, 2000 interim 
final rule with comment period, the public comments received on each 
issue, and our response to those comments. In that interim final rule, 
we--
    <bullet> Revised the regulation at Sec. 419.43(e)(1)(iv) to change 
one criterion and postpone the effective date for two other criteria 
that a new device, drug, or biological must meet in order for its cost 
to be considered ``not insignificant'' for purposes of determining its 
eligibility for transitional pass-through payments;
    <bullet> Changed our interpretation for three of the eight criteria 
set forth in the April 7, 2000 final rule with comment period for 
defining a new medical device that would be eligible for transitional 
pass-through payments and amended Sec. 419.43 by adding new paragraph 
(e)(4) to include all eight criteria;
    <bullet> Clarified the assignment of ``C'' codes to eligible pass-
through items;
    <bullet> Corrected a trigger date for grandfathering of provider-
based FQHCs; and
    <bullet> Clarified our intent regarding prior notice of beneficiary 
cost-sharing liability in emergency situations.
1. Transitional Pass-Through Provisions
a. ``Not Insignificant'' Cost Criteria
    Section 1833(t)(6) of the Act, as added by section 201(b) of the 
BBRA 1999, requires the Secretary to make transitional pass-through 
payments for post-1996 new drugs, biologicals, and devices for at least 
2 but no more than 3 years when the cost of the item is ``not 
insignificant'' in relation to the hospital outpatient prospective 
payment system payment amount. In the April 7, 2000 final rule with 
comment period, we established three criteria that a new device, drug, 
or biological must meet to determine whether its costs are not 
insignificant relative to the APC payment with which the item is 
associated (65 FR 18480-81). We stated that all of the following cost 
criteria must be satisfied in order for a new device, drug, or 
biological to be eligible for transitional pass-through payments:
    <bullet> Its expected reasonable cost exceeds the applicable fee 
schedule amount determined to be associated with the drug, biological, 
or device by 25 percent.
    <bullet> The expected reasonable cost of the new drug, biological, 
or device exceeds the portion of the fee schedule amount determined to 
be associated with the drug, biological, or device by 25 percent.
    <bullet> The difference between the expected, reasonable cost of 
the item and the portion of the hospital outpatient department fee 
schedule amount determined to be associated with the item exceeds 10 
percent of the applicable hospital outpatient fee schedule amount.
    After we published the April 7, 2000 final rule with comment 
period, we gained considerable experience from reviewing applications 
for transitional pass-through payments. Based on that experience, we 
concluded that the 25-percent limitation was too restrictive and could 
result in limiting Medicare beneficiaries' access to new products. 
Therefore, in the August 3, 2000 interim final rule with comment 
period, we changed that criterion to ensure that Medicare beneficiaries 
would continue to have access to the latest technologies. We now 
require that the expected reasonable cost of a new drug, biological, or 
device must exceed 10 percent of the applicable fee schedule amount for 
the associated service. In addition, we also postponed the effective 
date of the other two criteria applying to a new device, biologicals, 
or drugs for which a transitional pass-through payment is first made to 
on or after January 1, 2003. As stated in the August 3, 2000 interim 
final rule with comment period, the delay in the effective date for 
these two criteria is necessary so that we will have sufficient time to 
gather and analyze data needed to determine the current portion of the 
fee schedule amounts associated with a device, drug, or biological, 
which is an essential factor in applying these criteria.
    Comment: Several commenters commended us for revising the one ``not 
insignificant'' criterion and postponing the other two criteria until 
after December 31, 2002. However, some argued that we created an uneven 
playing field by changing our policies after we published our April 7, 
2000 final rule and announced pass-through application deadlines. They 
claimed that our untimely lowering of the cost threshold from 25 
percent to 10 percent unfairly disadvantaged companies that did not 
submit pass-through applications by the deadline for our August 1, 2000 
payments because they believed that their products would not qualify 
for payment. One commenter recommended that we rapidly process 
applications submitted for our January 1, 2001 update and change the 
effective date of that update to November 1, 2000. Another commenter 
advocated that we apply the 10-percent cost threshold retroactively to 
all device pass-through applications to ensure equitable treatment for 
all manufacturers.
    Response: Based on our review of transitional pass-through 
applications, we believe that we have not applied our policy change 
inconsistently to applications that we received. The change to the 
lower cost threshold is effective for services furnished on or after 
August 1, 2000. If an applicant's product was denied pass-through 
status because its cost was considered to be ``not insignificant'' and 
that applicant can show that our decision was not based on the 10-
percent criterion, the applicant may request that we reevaluate the 
application. In addition, we encourage other interested parties who 
withheld applications because they believed that their products would 
not qualify for pass-through status to submit them. Further, we cannot 
update the pass-through payments effective November 1, 2000 as 
requested. Adding new pass-through items to our outpatient prospective 
payment system requires changes to our complex Medicare computerized 
claims processing systems that we can make only at the beginning of a 
calendar quarter.
    Comment: One commenter believed that reducing the cost threshold to 
10 percent for new devices may be too low. The commenter stated that 
the lower

[[Page 67821]]

cost threshold would expose hospitals to financial risk created by the 
use of new and expensive technology furnished in providing patient 
care. The commenter advocated that we consider as an option 
``establishing * * * a floor--or a variable percentage that is higher 
for low-cost cases and lower for high-cost cases.''
    Response: We believe that this option will require time to evaluate 
its merits, assess its impact on our systems and determine systems 
changes that would be required to implement it. Therefore, we will 
consider this request for possible inclusion in our future proposed 
rule for outpatient prospective payment system updating that we expect 
to publish in the spring of 2001.
    Comment: One commenter urged that we grant the public another 
opportunity to evaluate and comment on all three ``not insignificant'' 
cost criteria before implementing them.
    Response: Before we implement all three of these criteria, we plan 
to provide notice and opportunity for public comment. Since we do not 
expect to implement two of these criteria before January 1, 2003, we 
would not expect to publish a proposed rulemaking until the spring of 
2002.
    Comment: One commenter asked how we would apply the three ``not 
insignificant'' cost criteria in instances when multiple units of a new 
device are used in performing a procedure. The commenter recommended 
that we use the ``weighted average cost of the product, based on the 
average number of unit used in a procedure.''
    Response: We plan to fully describe our approach to implementing 
these three criteria in a future proposed rule. As previously stated, 
we will not implement two of these criteria before January 1, 2003. 
Therefore, we do not expect to publish a proposed rulemaking until the 
spring of 2002.
    Comment: One commenter asked that we clarify how transitional pass-
through payments will be incorporated into the APC payments at the end 
of the 2- to 3-year transitional period for a given device. The 
commenter also asked how we would prevent the cost for the pass-through 
items from being diluted significantly by the median cost of other 
procedures grouped in the same APC.
    Response: We plan to use a methodology similar to that currently 
used to construct the APC groups to incorporate payment for pass-
through items into the APC payments once their pass-through status 
expires. That is, we have assigned a unique HCPCS code to each eligible 
pass-through item that will allow us to track its payments and 
utilization over the 2 to 3 years that it is eligible for pass-through 
status. The codes will allow us to match the pass-through items to the 
specific procedures or medical visits with which they are used. After 
we gain appropriate information about the actual costs a hospital 
incurs to provide a pass-through item, we will package the cost for the 
pass-through with that for the relevant procedure or medical visit with 
which it is used and assign the packaged service to a clinically 
related APC group with comparable resources. We will limit the cost 
variation within each group as required by section 1833(t)(2) of the 
Act, as amended by section 201(g) of the BBRA 1999. In accordance with 
this provision, the items and services within a group cannot be 
considered comparable with respect to the use of resources if the 
highest median cost item or service within a group is more than two 
times greater than the lowest median cost item or service within the 
same group. By law, the Secretary is allowed certain exceptions to this 
requirement, that is, for low volume items and services.
    Comment: One commenter asked if we would provide adequate 
recognition for multiple devices used in a procedure ``if multiple 
procedure discounting is allowed to cut the pass-through generated 
recognition of these costs in half.''
    Response: Under the hospital outpatient prospective payment system, 
devices eligible for pass-through payments are paid separately and not 
subject to the multiple procedure discounting policy. This policy 
applies only to the actual surgical procedure that is performed to 
implant the pass-through device. These procedures are denoted by a 
status indicator ``T'' and listed in Addendum B of this rule.
    Comment: One commenter urged us to correct erroneous APC groupings 
more frequently than during our scheduled quarterly or annual update 
cycles until we stabilize the hospital outpatient prospective payment 
system.
    Response: We understand the importance of paying appropriately for 
services billed under our new outpatient system and are committed to 
resolving problems that would preclude us from making appropriate 
payments in a timely manner. However, because of the complexity of our 
system we cannot commit to making changes other than during the 
scheduled updating cycles.
b. Definition of Medical Device
    In the April 7, 2000 final rule with comment period, we established 
eight specific criteria that new or innovative medical devices must 
meet to be considered eligible for pass-through payments under section 
1833(t)(6) of the Act. We stated in that rule that new or innovative 
medical devices must meet all of the following criteria to be 
considered eligible for transitional pass-through payments:
    (1) They were not recognized for payment as a hospital outpatient 
service prior to 1997.
    (2) They have been approved or cleared for use by the FDA.
    (3) They are determined to be reasonable and necessary for the 
diagnosis or treatment of an illness or injury or to improve the 
functioning of a malformed body part, as required by section 
1862(a)(1)(A) of the Act. We recognize that some investigational 
devices are refinements of existing technologies or replications of 
existing technologies and may be considered reasonable and necessary. 
Therefore, we indicated that we will consider devices for coverage 
under the hospital outpatient prospective payment system if they have 
received an FDA investigational device exemption (IDE) and are 
classified by the FDA as Category B devices. However, in accordance 
with regulations at Sec. 405.209, payment for a nonexperimental 
investigation device is based on, and may not exceed, the amount that 
would have been paid for a currently used device serving the same 
medical purpose that has been approved or cleared for marketing by the 
FDA.
    (4) They are an integral and subordinate part of the procedure 
performed, are used for one patient only, are surgically implanted or 
inserted, and remain with that patient after the patient is released 
from the hospital outpatient department.
    (5) The associated cost is not insignificant in relation to the APC 
payment for the service in which the innovative medical equipment is 
packaged.
    (6) They are not equipment, instruments, apparatuses, implements, 
or items for which depreciation and financing expenses are recovered as 
depreciable assets as defined in Chapter 1 of the Medicare Provider 
Reimbursement Manual (HCFA Pub. 15-1).
    (7) They are not materials and supplies such as sutures, clips, or 
customized surgical kits furnished incident to a service or procedure.
    (8) They are not materials such as biologicals or synthetics that 
may be used to replace human skin.
    In the August 3, 2000 rule, we revised criteria (3), (4), and (7) 
and amended Sec. 419.43(e)(4) to include all eight criteria. We stated 
in that rule that our change in policies reflects experience

[[Page 67822]]

gained in reviewing and processing transitional pass-through 
applications for devices since publishing our April 7, 2000 final rule 
with comment period. With regard to criteria (3), we revised it by 
removing the cost limitation provision for IDE Category B devices that 
qualify for transitional pass-through payments. We explained in the 
August 3, 2000 interim final rule that on review of our policy for such 
new devices, we believed that it would be more appropriate to remove 
the cost limitation because they are subjected to the same eligibility 
requirements as any other device applying for pass-through status and 
because pass-through payments for a specific device are temporary.
    For criteria (4), we modified our interpretation of which devices 
are eligible for transition pass-through payments to include new 
medical devices that are used for one patient only, are single use, 
come in contact with human tissue, and are surgically implanted or 
inserted in a patient during a procedure but may also be removed during 
that procedure so that the patient leaves the hospital without the 
device. Our revised interpretation also includes clips that are used as 
radiological site or tissue markers.
    As explained in the August 3, 2000 interim final rule, it became 
apparent, based on experience gained in processing a large number of 
applications for new medical device pass-through status, that our 
attempt to distinguish implantable devices using the criteria we had 
outlined in our April 7, 2000 final rule with comment period had some 
practical limitations. We also explained that, in some instances, the 
new medical device is implanted temporarily rather than permanently as 
indicated in our original policy published in the April 7, 2000 final 
rule with comment period. However, we did not intend for our policy to 
exclude new medical devices that are implanted or inserted during a 
procedure but also may be removed during that procedure so that the 
patient leaves the hospital without the device. Rather, we believed 
that these devices should be considered for pass-through payments 
because they also are implantables. We further stated in the August 3, 
2000 interim final rule with comment period that it had become apparent 
that some implantable clips are expensive and function other than as 
tools or supplies necessary for a surgeon to perform a surgical 
procedure. We did not intend to exclude such clips from consideration 
for pass-through payments. Therefore, we revised our interpretation of 
which devices are eligible for transitional pass-through status to 
include also new single use medical devices that may be temporarily 
implanted or inserted in a patient.
    Finally, in criterion (7), we became aware of the need, based on 
our review of pass-through applications, to clarify that supplies 
include pharmacological imaging and stressing agents, including 
contrast media but excluding radiopharmaceuticals (for which payment 
under the transitional pass-through provision is established by section 
1833(t)(6)(A) of the Act).
    Comment: One commenter urged that we issue detailed guidelines that 
clarify whether an IDE Category B device with pass-through status will 
be assigned only one ``C-code'' for both its clinical investigation and 
commercialization.
    Response: Our general policy is to assign only one code to an 
eligible pass-through item.
    Comment: One commenter asked how we would reconcile differences in 
pass-through payment differences (over 2 to 3 years) that are made for 
an eligible IDE Category B device during its clinical investigation 
phase versus those paid once the device is commercialized.
    Response: Policy decisions regarding the analytical treatment of 
costs associated with specific items that will be included in our 
database for constructing APCs will be made in the context of the 
methodology that we use to derive updated APC weights and payments. 
This methodology will be fully described in a subsequent proposed rule 
prior to incorporating the cost for pass-through devices such as 
eligible IDE Category B devices into our APC payments.
    Comment: One commenter asked that we clarify when the definition of 
a device includes or excludes all of a device's components. The 
commenter also asked whether we assigned separate codes for the 
device's components.
    Response: If a device can be separated into distinct components and 
such components are considered integral to the functioning of that 
device, we evaluate the device and all its component parts to determine 
whether any or all would qualify for transitional pass-through payment. 
For example, we have approved several implantable neurostimulator 
systems for pass-through payment. These systems usually include at 
least two or three separate components such as a generator, leads, and 
receiver/transmitter. In this case, we have assigned separate HCPCS 
codes to each of the eligible components. However, if an eligible pass-
through item is considered a component of a non-eligible item, such as 
a piece of capital equipment, only the eligible item will receive a 
HCPCS code to bill for pass-through payments.
    Comment: One commenter warned us about medical devices that we have 
approved for pass-through payments such as electrophysiology catheters 
that the commenter alleges are not single use items. The commenter 
stated that hospitals use them more than once. The commenter advocated 
that we advise hospitals not to request additional payments for any 
approved pass-through item if they reprocess or reuse them.
    Response: In the August 3, 2000 interim final rule with comment 
period, we revised criterion ``d'' of the eight medical device 
eligibility criteria to explicitly preclude pass-through payments for 
new medical devices other than those that are single use. Therefore, 
additional payments will not be made for devices that are reprocessed 
or reused. Hospitals that bill these devices might be considered to be 
engaging in fraudulent billing practices.
    Comment: A number of the commenters urged that we abandon the use 
of an individual or brand-specific approach to approving devices for 
transitional pass-through payments and adopt an approach that 
distinguishes devices based on categories. The commenters argued that a 
category approach is more appropriate and more efficient to implement 
than an individual, item-specific approach. They alleged that the 
latter approach creates winners and losers and delays timely approval 
of new technologies.
    Response: As previously stated, we adopted a trade-name specific 
approach for several reasons. First, such an approach provides better 
information. Codes that are largely item-specific allow us to track 
what procedures the items are used with and costs of the items. When 
the pass-through payments for an item ends, we would expect to have 
good information for assigning it to relevant APCs and ensuring 
appropriate payment for these APCs. Adopting a scheme with a 
significant degree of categorization would require use of averages in 
making assignments and setting payment rates. Decisions based on these 
more limited data would likely lead to intensified concerns about the 
appropriateness of APC assignment and payment.
    Second, this approach permits finer discrimination in eligibility 
decisions. An item-by-item approach allows us to be sure individual 
items in fact meet the criteria for eligibility. Of major concern in 
this instance is whether a device is ``new'' using the standard of the 
statute. Section 1833(t)(6)(A) of the Act limits

[[Page 67823]]

transitional pass-through payment to those devices for which `` * * * 
payment for the device * * * as an outpatient hospital service under 
this part was not being made as of December 31, 1996.'' Adopting 
categories would in some cases mix ``old'' and ``new'' devices. In 
these instances, either some old devices would get special treatment 
that they would not be eligible for if they were examined on an item-
specific basis, or an entire category could be considered old, thus 
depriving some new devices from special treatment they would be 
eligible for if they were examined on an item-specific basis.
    Third, an item-specific scheme avoids issues associated with the 
design of categories needed for purposes of transitional pass-through 
payments. It largely avoids concerns about what items should be in what 
category or whether new categories should be created to accommodate 
items that may appear to be little different from those in existing 
categories.
    Fourth, an item-specific approach allows us to assure that a newly 
arriving device can obtain the full period of pass-through status it is 
arguably eligible for under the statute. A categorization approach 
would likely lead to latecomers being eligible for pass-through 
payments only for a shorter period. Insofar as revision to APC payment 
rates reflected the costs of items in the category by the time the 
category was terminated, the shorter period would be of little 
consequence. However, if the costs of the late-coming item were 
significantly higher, this procedure could appear objectionable. A 
solution in this case would be to create a new code, which could be 
specific to that item, thus departing from a categorization approach.
    We recognize that a category approach would lessen concerns about 
competitive disadvantages that may have been inadvertently created by 
an item specific approach and about access to specific items by 
hospitals and their patients. However, we found no satisfactory way of 
establishing categories that would not run into difficulty regarding 
the test of whether a device is ``new'' as described above. 
Consequently, we are making no change in our approach in response to 
comments.
2. Revision to Grandfather Provision for Certain FQHCs and ``Look-
Alikes''
    In the April 7, 2000 final rule with comment period, which 
discussed the provider-based status criteria and requirements, we 
grandfathered FQHCs or ``look-alikes'' that were designated as such 
before 1995 in order to assure the continuity of care and access to 
care for patients of some of these facilities. To meet our original 
policy intent of helping to ensure that the new criteria do not disrupt 
the delivery of services to patients of these facilities, in the August 
3, 2000 interim final rule with comment period (65 FR 47674), we 
corrected Sec. 413.65(m) to state that a facility that has since April 
7, 1995 furnished only services that were billed as if they had been 
furnished by a department of a provider will continue to be considered 
as a department of a provider, without regard to compliance with the 
provider-based criteria, if the facility--
    (1) Received a grant on or before April 7, 2000 under section 330 
of the Public Health Service Act and continues to receive funding under 
such a grant, or is receiving funding from a grant made on or before 
April 7, 2000 under section 330 of the Public Health Service Act under 
a contract with recipient of such a grant, and continues to meet the 
requirements to receive a grant under section 330 of the Public Health 
Service Act; or
    (2) Based on the recommendation of the Public Health Service, was 
determined by HCFA on or before April 7, 2000 to meet the requirements 
for receiving a grant under section 330 of the Public Health Service 
Act, and continues to meet such requirements. We made this change to 
clarify that grandfathering under Sec. 413.65 is based on continued 
status as a section 330 of the Public Health Service Act grantee or a 
``look-alike'' facility. We received no comments on this change.
3. Clarification of Notice of Beneficiary Cost-Sharing Liability
    In the August 3, 2000 interim final rule with comment, we also 
addressed whether hospitals could reasonably be expected to furnish an 
exact statement of the patient's financial liability, since the exact 
scope of services needed may not be known at the time notice must be 
given. Specifically, we stated that when the extent of care needed is 
not known before the patient is admitted, the hospital may furnish a 
written notice to the patient that explains the general fact that the 
beneficiary will incur a coinsurance liability to the hospital that he 
or she would not incur if the facility were not provider based. 
Furthermore, we clarified that the estimate of ``potential financial 
liability'' in this written notice may be based on typical or average 
charges for visits to the facility or organization, while stating that 
the patient's actual liability will depend upon the actual services 
furnished by the hospital.
    Comment: One commenter stated that our clarification regarding the 
notice of beneficiary cost sharing liability was helpful, but 
recommended that we amend or modify the regulations at 
Sec. 413.65(g)(7) to reflect such clarification since the wording of 
the existing regulations states twice that the notice must be given 
``prior to the delivery of services'' without an exclusion for 
emergency medical conditions. In addition, the regulation states that 
the hospital has an obligation to notify the beneficiary of the 
``potential financial liability'' not just to provide the beneficiary 
with ``an estimate based upon typical or average charges'' in the event 
that the exact type and extent of care is not known.
    The commenter also recommended that we require hospitals to only 
notify the beneficiary of the fact that the beneficiary will incur a 
coinsurance liability for hospital outpatient services without giving a 
dollar amount of beneficiary copayment. Such a notice could include a 
statement that the copayment liability will be determined by us and the 
beneficiary will be notified of the exact amount once the hospital is 
notified of the amount determined by us. The commenter believes that an 
estimate based on charges would ``miss the point'' of this provision 
since beneficiary copayment amounts are now determined by HCFA using an 
APC grouper, not charges.
    Response: We appreciate the commenter's concerns and agree that a 
change in the regulations is needed to reflect the clarification 
provided in the August 3, 2000 interim final rule with comment period 
in a future proposed rule. As we stated in the August 3, 2000 interim 
final rule with comment period (65 FR 47675), we are developing a 
proposed rule that will further revise and clarify the notice 
requirements. We are doing this to allow the public a full opportunity 
to comment on the changes and to ensure that we have the benefit of all 
relevant comments.
    We disagree with the commenter's statement that an estimate based 
on charges would ``miss the point'' of this provision since such a 
notice is required only to give the beneficiary an idea or an example 
of their ``potential financial liability''. As stated in the August 3, 
2000 interim final rule with comment period (65 FR 47675), the estimate 
should state that the beneficiary's ``actual liability will depend upon 
actual services furnished by the hospital.'' Also, with the delay in 
the effective date of the provider-based status regulations until 
January 10, 2001, hospitals will have at least five months of 
experience with APC

[[Page 67824]]

payments under outpatient prospective payment system and should be able 
to develop an appropriate estimate of a copayment amount based on APCs 
rather than charges.
4. Clarification of Protocols for Off-Campus Departments
    In the April 7, 2000 final rule, under new Sec. 489.24(i)(2) we 
require hospitals to establish protocols for handling individuals with 
potential emergency conditions who arrive at hospital off-campus 
departments. Section 489.24(i)(2)(ii) further requires that if the off-
campus department is a physical therapy, radiology, or other facility 
not routinely staffed with physicians, RNs, or LPNs, the department 
personnel must be given protocols that direct them to contact emergency 
personnel at the main hospital campus.
    In the August 3, 2000 interim final rule with comment period, we 
clarified that Sec. 489.24(i)(2) does not require a delay of an 
appropriate transfer when the main hospital campus does not have the 
specialized capability or facilities required by the individual or when 
the individual's condition is deteriorating so rapidly that the time 
needed to move the individual to the main hospital campus would 
significantly jeopardize the individual's life or health. We also 
stated that the contact with emergency personnel at the main hospital 
campus should be made either after, or concurrently with, the actions 
needed to arrange an appropriate transfer under Sec. 489.24(i)(3)(ii), 
if doing otherwise would significantly jeopardize the individual's life 
or health. We noted that this clarification does not relieve the off-
site department of the responsibility for making this contact, but only 
clarifies that the contact may be delayed in specific cases when doing 
otherwise would endanger a patient subject to EMTALA protection. We 
received no comments on this clarification.
5. Typographical Errors in the Provider-Based Regulations
    Comment: One commenter questioned whether the provider-based 
regulations in Secs. 413.65 and 489.24, as they appeared in the April 
7, 2000 final rule with comment period (65 FR 18538), contained 
typographical errors.
    Response: We are aware of typographical errors in the provider-
based regulations as published in the April 7, 2000 final rule with 
comment period (65 FR 18538) and will be publishing a correction notice 
(HCFA-1005-CN) to make these corrections.

III. Provisions of This Interim Final Rule With Comment Period

A. Changes Relating to the BBRA 1999 Public Comments

    Except for the changes discussed in the preamble, we are adopting 
the BBRA 1999 provisions implemented in the April 7, 2000 final rule 
with comment period and the August 3, 2000 interim final rule with 
comment period, described in section II of this preamble, as final 
without modification. We are making the following changes to the 
regulation text as a result of the public comments received:
    We are revising Sec. 419.41(c)(4)(i) to provide that, effective 
January 1, 2001, when multiple APCs for a single drug or biological are 
furnished to a beneficiary on the same day, the inpatient hospital 
deductible limitation on coinsurance will be applied to the aggregate 
coinsurance for the drug or biological. The section is further revised 
to provide that, effective July 1, 2001, the coinsurance amount for the 
procedure or service that resulted in the administration of the drug or 
biological will be aggregated with the coinsurance for the drug or 
biological in applying the limit.
    We are revising Sec. 419.70(f)(2)(ii) to remove the phrase 
``without applying the cost reductions under section 1861(v)(1)(S) of 
the Act''. We recognize that the phase may have inadvertently caused 
confusion to the extent it is redundant, as pointed out by a commenter.

B. Annual Updates to Components of the Hospital Outpatient Prospective 
Payment System

    In this interim final rule with comment period, for calendar year 
2001, we are updating the wage index and the conversion factor 
adjustment for covered hospital outpatient services furnished beginning 
January 1, 2001. We also are updating the existing APC groups to 
reflect new codes that have been assigned. In accordance with section 
1833(t)(9)(A) of the Act and section 201(h)(2) of the BBRA 1999, we 
will undertake a complete system update in 2001 for hospital outpatient 
prospective payments. That update will take effect on January 1, 2002. 
We will consult with an expert outside advisory panel composed of 
appropriate representatives of providers. This panel will review and 
advise us concerning the clinical integrity of the APC groups and 
relative weights. The panel will be allowed to use data other than 
those we have collected or developed during our review of the APC 
groups and relative weights.
1. APC Groups
    We are updating the existing APC groups effective January 1, 2001 
to reflect the addition of new CPT and alpha-numeric codes, the 
deletion of invalid codes, changes to the list of procedures we pay for 
only in an inpatient setting (the ``inpatient list''), the creation of 
a new status indicator, newly covered procedures, reconfigurations due 
to the inclusion of device costs, and revisions to correct errors and 
provide consistency in the placement of codes.
a. New Codes
    There are 936 new codes, 645 of which are ``C'' codes. ``New'' in 
this context means new since the April 7, 2000 final rule with comment 
period was published. Many of the ``C'' codes were published in program 
memoranda over the intervening months. New codes are shown in Addendum 
B with an asterisk in the column preceding the code.
b. Deleted Codes
    With the exception of ``C'' codes, codes deleted effective January 
1 of each year are given a 3-month grace period in which they will 
still be recognized. ``C'' codes are temporary codes used exclusively 
to bill pass-through items and new technology services and items paid 
under the hospital prospective payment system. We will retire these 
codes prospectively at the start of a new calendar quarter based on 
specific service dates and are not extending the same 3-month grace 
period to them. We will drop all non ``C'' codes from APCs effective 
April l. Deleted codes are shown in Addendum B. They are followed by 
the letter D. The AMA's CPT books also list deleted codes.
c. Revisions to Correct Errors or Inconsistencies
    We are revising the APCs in order to correct errors and to provide 
greater consistency in the placement of codes. For example, we had 
assigned various types of cardiovascular diagnostic tests to four APCs, 
with rates based on data that, on subsequent review, appeared limited. 
We are recategorizing these APCs. This recategorization results in 
three APCs with greater clinical coherence.
    Medicare covers influenza, pneumococcal, and hepatitis B 
immunizations routinely, with no copayment or deductible due for flu 
and pneumonia vaccines or their administration. Other vaccines may be 
covered in certain circumstances, but are, in fact, given so 
infrequently that our cost data are limited. We are

[[Page 67825]]

rearranging the preventive vaccines and assigning the less frequently 
furnished vaccines based on their reported costs, but within a smaller 
range. We expect very few immunizations other than influenza and 
pneumonia to be billed, but if they are billed, we will update our 
data.
    We also are changing the APCs to which bone density studies are 
assigned. The codes used in 1996 captured both central and peripheral 
bone density studies. Coding changes since that time have separated the 
two types of studies, but this distinction was not reflected in the 
1996 data. In order to better reflect these differences, we are 
separating the various codes and assigning central dual energy x-ray 
absorptiometry (DEXA) bone density studies to a new technology APC.
    We did not include the codes for transfusion laboratory services 
(for example, typing and crossmatching) in APCs in the April 7, 2000 
final rule with comment period. We are now creating three APCs to 
capture these codes, and an additional APC to capture fertility 
procedures.
d. Device-Related Codes
    As described in the April 7, 2000 final rule with comment period, 
revenue centers 274, 275, and 278 were not included for purposes of 
calculating the APC rates because prior to the BBRA 1999, we 
anticipated paying for durable medical equipment and prosthetics 
(including implantable devices) outside of the outpatient prospective 
payment system and it was unfeasible to revise our database to reflect 
the revenue centers in time to publish a final rule and implement the 
prospective payment system by July 1, 2000. To reflect the inclusion of 
implantable devices as required under the BBRA 1999, we have 
recalculated APC rates with these revenue centers included. As a 
result, the median cost for certain procedures such as inserting 
pacemakers, replacing leads, and providing neurostimulators increased 
significantly.
    In order to recognize these cost increases, which are attributable 
to the devices, and to aid in the assignment of devices to APCs at the 
end of the pass-through period, we are reconfiguring certain APCs. That 
is, we are creating APC groups for the insertion of pacemakers, the 
replacement of pacemaker electrodes, the implantation of a pacemaker 
and electrodes, and the removal of a pacemaker. These changes reflect 
our basic criteria that procedures within an APC group be clinically 
similar and comparable in terms of resources, with the highest cost 
item or service within a group being no more than 2 times greater than 
the lowest cost item or service within the same group.
e. Inpatient Codes Moved to the Outpatient Setting
    In response to numerous requests, we reviewed the composition of 
the inpatient list. While we continue to believe that we have the 
majority of the codes assigned properly, for the reasons discussed in 
section III.B.2. we are persuaded to move a number of codes to the 
outpatient setting. We are able to place most codes into closely 
related APCs.
f. ``Two-times'' Rule
    The BBRA 1999 required us to ensure that no APC contains codes such 
that the highest median cost in the APC exceed twice the lowest median 
cost. We undertook an analysis of APCs in relation to this requirement 
as part of the 2001 update. (Note that the law provides for exceptions 
based on low volume and other reasons. We consider a code that captures 
fewer than 2 percent of the services within an APC to be low volume, 
and we disregard codes for unlisted services or procedures, since we do 
not know what service or procedure was billed.) For example, moving a 
radical mastectomy code from the inpatient list to a breast procedure 
APC caused the group to fail the two-times test. In another instance, 
as described above, we packaged costs associated with implantable 
devices into the relevant procedure codes. This change would also cause 
device-related APCs to fail the two-times test. For these situations 
and others that failed the two-times test, we are reconfiguring the 
APCs appropriately.
g. Inpatient Codes Moved to Outpatient and Affected by Device
    Seven codes related to vascular and neurological procedures were 
moved from the inpatient list into APCs, that were then split according 
to device use, in response to comments.
h. Newly Covered Codes
    The updated APCs reflect recent HCFA decisions to provide Medicare 
coverage for an electrical bioimpedance procedure and three magnetic 
resonance angiography services. The codes for these newly covered 
services are M0302 and 71555, 73725, and 74185, respectively.
i. Pass-Through Requests for Drugs
    Since publication of the April 7, 2000 final rule with comment 
period, we have received additional requests for pass-through status 
for a number of drugs. The codes for the additional eligible pass-
through drugs are shown in Addendum B.
    The following table contains a listing of the changes in the APC 
groups discussed above.

                                                               Summary of Changes to APCs
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   Changes to APC Placement of Existing Codes
                       ---------------------------------------------------------------------------------------------------------------------------------
                                                                                                     Inpatient codes
       New Codes           Revisions or                                                                 moved to                          Pass-through
                          corrections of     Device-related    Inpatient moved     ``Two-times''     outpatient and     Newly covered     requests for
                              errors             codes          to outpatient           rule           affected by          codes             drugs
                                                                                                         device
--------------------------------------------------------------------------------------------------------------------------------------------------------
936 codes added, 645    111 codes changed  87 codes changed.  56 codes changed   25 codes changed.  7 codes changed.  4 codes changed.  4 codes changed
 of which are ``C''.                                           (12 as of 8/1/
                                                               2000).

[[Page 67826]]

 
Denoted by asterisk in  APCs--0004, 0087,  APCs--0082, 0083,  APCs--0005, 0020,  APCs--0028 and     HCPCS--37620,     HCPCS--71555,     HCPCS--J1650,
 Addendum B.             0099, 0100,        0089, 0091,        0021, 0029,        0029.              35011, 36834,     73725, 74185,     J2770, J1810,
                         0102, 0123,        0093, 0103,        0046, 0050,                           61880, 61888,     M0302.            J7315
                         0282, 0340,        0104, 0105,        0081, 0114,                           33284, 63741.
                         0342, 0346,        0106, 0107,        0115, 0120,
                         0347, 0348,        0108, 0109,        0121, 0162,
                         0349, 0354,        0115, 0119,        0165, 0194,
                         0356, 0602,        0124, 0185,        0195, 0198 ,
                         0761, 0970,        0224, 0225,        0216, 0254,
                         0971, 0974,        0226, 0227,        0256, 0263,
                         0976, 1044,        0228, 0229,        0264, 0279,
                         1401, 1402,        0256, and 1002.    0280, 0970,
                         1403, 1404,                           0974, and 0981..
                         1405, 1406,
                         1407, and 1409.
--------------------------------------------------------------------------------------------------------------------------------------------------------

    Addenda A and B reflect changes to the APC groups, effective 
January 1, 2001. Addendum C, entitled ``Hospital Outpatient Department 
(HOPD) Payment for Procedures by APC, Calendar Year 2001,'' is not 
published in this interim final rule with comment period, but will be 
posted on our website at http://www.hcfa.gov /medlearn/refopps.htm. 
Addendum C will display data similar to those contained in Addenda A 
and B, but sorted by APCs with each procedure code listed that is 
assigned to the APC.
2. Inpatient Procedures List Update
    In the preamble to the April 7, 2000 final rule with comment 
period, we indicated that, as part of our annual update process, we 
would update the procedures on the inpatient list. The first annual 
revision of this list is effective on January 1, 2001. We are removing 
44 procedures from the list and placing them in APCs. (Several 
procedures that were inadvertently left on the inpatient list in the 
April 7, 2000 final rule with comment period were removed from the list 
and placed in APCs in August 2000.) The revised list is included in 
Addendum E.
    We have attempted to limit the inpatient only list to those 
procedures that, in current medical practice as understood by our 
clinical staff, require inpatient care, such as those that are highly 
invasive, result in major blood loss or temporary deficits of organ 
systems (such as neurological impairment or respiratory insufficiency), 
or otherwise require intensive or extensive postoperative care. Insofar 
as advances in medical practice mitigate concerns about these 
procedures being performed on an outpatient basis, we will be prepared 
to remove them from the inpatient list and provide for payment under 
the hospital outpatient prospective payment system. Since the April 7, 
2000 final rule with comment period was published, we have received 
requests to move a number of procedures from the inpatient list 
because, based on medical evidence, the procedures can be performed 
safely in a hospital outpatient setting. These included breast and 
other cancer procedures, repairs of facial trauma, many orthopedic 
procedures, several vascular procedures, and some genito-urinary 
procedures.
    Among the procedures we are removing from the inpatient list and 
placing in APCs as a result of these requests are excision of chest 
wall tumors, several orthopedic repairs, vascular procedures, and 
ureteral endoscopies. We are moving overnight pulse oximetry from the 
inpatient list to packaged status. We also are moving several 
comparable procedures, for example, related ureteral endoscopies.
    At this time, we are not removing from the inpatient list various 
spinal procedures, including osteotomies and laminectomies. We also are 
not removing several open abdominal and retroperitoneal procedures from 
the inpatient list because many of these procedures involve prolonged 
invasion of the thoracic cavity, the peritoneum, or the retroperitoneal 
space. Patients undergoing these procedures typically require prolonged 
postoperative monitoring. Moreover, the information provided to us by 
requesters did not provide convincing evidence that these procedures 
are currently being performed or can be safely performed in an 
outpatient setting. However, we are aware that, with advances in 
technology and surgical techniques, many of these procedures may 
eventually be performed safely in a hospital outpatient setting. We 
will continue to review all the procedures on the inpatient list and 
will consider additional requests to move specific procedures to the 
outpatient setting. We ask that these requests contain detailed 
rationale along with medical evidence that the procedure may be 
performed safely in an outpatient setting.
    We note that, in some instances, requests for removing a particular 
procedure from the inpatient list may have resulted from a 
misunderstanding about appropriate coding. Less invasive versions of 
the procedure on the inpatient list may be in an APC. The presence of 
certain thoracoscopies on the inpatient list, for example, does not 
mean that no thoracoscopy will be paid under the outpatient prospective 
payment system.
    We also were asked to move several procedures from APCs to the 
inpatient list. Because of the rapid advance in technology and surgical 
techniques mentioned above, we believe that if procedures have been 
assigned APCs, we should not reverse that status unless it becomes 
obvious that we have made an error. Thus, we are moving to the 
inpatient setting only one of the codes for which we received a request 
(open treatment of a knee dislocation, which requires more than 
outpatient

[[Page 67827]]

postoperative monitoring), and two other codes (for nephrectomy with 
total ureterectomy and for escharotomy) that had been assigned APCs in 
error.
    Beginning in April 2001, we will, if warranted, revise the 
inpatient list at least quarterly to better reflect changes in medical 
practice that permit procedures that were previously performed only in 
an inpatient setting to be safely and effectively performed in an 
outpatient setting. In the April 7, 2000 final rule with comment 
period, we discussed our intent to revise the list as part of the 
annual update of APCs and asked that interested parties advise us of 
procedures that can be performed in an outpatient setting. Since we 
will be making quarterly updates to the outpatient prospective payment 
system for other purposes, we will also change the inpatient list 
quarterly, if warranted. Generally, because of systems limitations, 3 
months or more are required after a decision is made before we can 
implement a change.
    The inpatient list was not a result of a provision of the BBRA 
1999; it was included in the September 1998 proposed rule and we 
responded to comments and made the provision final in the April 7, 2000 
final rule with comment. Accordingly, we did not request comments on 
our policy on the establishment of the inpatient list at that time. 
Nonetheless, we received a number of comments concerning the existence 
of this list, the provisions for updating it, and its implications for 
other Medicare payment systems. We will consider these comments and 
expect to discuss the matter further in the proposed rule updating the 
hospital outpatient prospective payment system for 2002, which we will 
publish in the spring of 2001.
3. Wage Index Adjustment
    Under section 1833(t)(2)(D) of the Act, we are required to 
determine a wage adjustment factor to adjust, in a budget neutral 
manner, the portion of the payment rate and the coinsurance amount that 
is attributable to labor-related costs for relative differences in 
labor and labor-related costs across geographic regions under the 
hospital outpatient prospective payment system.
    In the April 7, 2000 final rule with comment period, we specified, 
in regulations at Sec. 419.43(c), that each year we use the hospital 
inpatient prospective payment system wage index established in 
accordance with 42 CFR Part 412 to make a wage adjustment for relative 
differences in labor and labor-related costs across geographic areas 
under the hospital outpatient prospective payment system. We note that, 
by statute, we implement the annual update of the hospital inpatient 
prospective payment system on a fiscal year basis. However, we update 
the hospital outpatient prospective payment system on a calendar year 
basis. Therefore, the hospital inpatient prospective payment system 
wage index values established for urban and rural areas and for 
reclassified hospitals published in the Federal Register on August 1, 
2000 (65 FR 47149 through 47157) are being applied for wage adjustments 
under the hospital outpatient prospective payment system, effective 
January 1, 2001. The fiscal year 2001 hospital inpatient wage index 
reflects the effects of hospitals redesignated under section 
1886(d)(8)(B) of the Act and hospital reclassifications under section 
1886(d)(10) of the Act. After publication of the hospital inpatient 
wage index values for fiscal year 2001 on August 1, 2000, we discovered 
several errors in the values for several geographic areas. The correct 
wage index values for all areas are republished in Addenda F, G, and H 
of this interim final rule with comment period.
    In this interim final rule with comment period, we are establishing 
the methodology that we will use in making adjustments for area wage 
differences for services furnished in the Virgin Islands. We note that 
a hospital inpatient prospective payment system wage index value is not 
calculated for the Virgin Islands because there are no hospitals 
located in that area that are paid under the inpatient hospital 
prospective payment system. Because the wage index that we adopted in 
our April 7, 2000 final rule with comment period does not include a 
value for adjusting wage differences for the Virgin Islands, we will 
use the wage index for the Virgin Islands as calculated for the skilled 
nursing facilities prospective payment system to make this adjustment. 
The skilled nursing facilities prospective payment system uses the 
inpatient hospital wage index data to adjust its prospective payment 
rates for the same fiscal year (that is effective October 1, 2000) as 
covered by the hospital inpatient prospective payment system wage index 
values. As stated in the July 31, 2000 skilled nursing facilities 
prospective payment system final rule (65 FR 46770), ``The computation 
of the wage index * * * incorporate[s] the latest data and methodology 
used to construct the hospital wage index. For these reasons, the wage 
index adjustment that we will apply to the Virgin Islands for services 
furnished on or after January 1, 2001 is 0.6306.
    Although the wage index for skilled nursing facilities is based on 
a fiscal year beginning October 1, we will apply the wage index factor 
for the Virgin Islands that goes into effect on October 1 of each year 
to the hospital outpatient prospective payment system services 
furnished during the following calendar year. This is consistent with 
how we apply the hospital inpatient prospective payment system wage 
index values to the hospital outpatient prospective payment system 
services.
    Consistent with the methodology applicable for services furnished 
in 2000 (on or after August 1, 2000), in making adjustments for area 
wage differences for services furnished in 2001, we will recognize 60 
percent of the hospital's costs as labor-related costs that are 
standardized for geographic wage differences.

4. Conversion Factor Update

    Section 1833(t)(3)(C)(ii) of the Act requires us to update annually 
the conversion factor used to determine APC payment rates. Section 
1833(t)(3)(C)(iii) of the Act provides that the update be equal to the 
hospital inpatient market basket percentage increase applicable to 
hospital discharges under section 1886(b)(3)(B)(iii) of the Act, 
reduced by one percentage point for the years 2000, 2001, and 2002. 
Thus, the update to the outpatient hospital prospective payment system 
conversion factor for 2001 is 2.4 percent (3.4 percent minus 1 
percent).
    In accordance with section 1833(t)(9)(B) of the Act, the conversion 
factor for 2001 also has been adjusted to ensure that the revisions we 
made to update the wage index are made on a budget-neutral basis. A 
budget neutrality factor of .9989 was calculated for wage index changes 
by comparing total payments from our simulation model using the wage 
index values that will be effective January 1, 2001.
    The market basket increase of 2.4 percent for 2001 and the required 
budget neutrality adjustment calculated to be .9989 result in a 
conversion factor for 2001 of $49.596.

IV. Waiver of Notice of Proposed Rulemaking

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register and invite public comments on the proposed rule. The 
notice of proposed rulemaking includes a reference to the legal 
authority under which the rule is proposed, and the terms and substance 
of the proposed rule or a description of the subjects and

[[Page 67828]]

issues involved. This procedure can be waived, however, if an agency 
finds good cause that a notice-and-comment procedure is impracticable, 
unnecessary, or contrary to the public interest, and incorporates a 
statement of the finding and its reasons in the rule. For the reasons 
set forth below, we find that the circumstances surrounding this 
interim final rule with comment period make it either unnecessary or 
impracticable to pursue a notice-and-comment procedure before the 
provisions of this interim final rule with comment period take effect.
    As discussed earlier in this interim final rule with comment 
period, we implemented the hospital outpatient prospective payment 
system on August 1, 2000 in accordance with the methodology that we set 
forth in the April 7, 2000 final rule with comment period (65 FR 
18434). In section III.I. of the April 7, 2000 final rule with comment 
period (65 FR 18501), we discuss how we will update the outpatient 
prospective payment system on an annual basis. We are required under 
section 1833(t)(3)(C)(ii) of the Act to update annually the conversion 
factor used to determine the APC payment rates. Under the regulations, 
42 CFR 419.43, the wage adjustment under outpatient prospective payment 
system is based on the hospital inpatient wage index, and we updated 
the hospital inpatient wage index after the publication of the April 7, 
2000 final rule with comment period. Accordingly, in this interim final 
rule with comment period, we are updating the conversion factor and the 
wage index adjustment for covered hospital outpatient services 
furnished beginning January 1, 2001, using the methodology published in 
the April 7, 2000 final rule with comment period, for which we had 
previously received comments. We also are updating the existing APC 
groups to reflect new and deleted CPT codes for 2001 and reconfiguring 
certain APC groups using more recent data to ensure clinical integrity 
and consideration of resource use as required by section 1833(t)(8)(A) 
of the Act and as described in the April 7, 2000 final rule with 
comment period (65 FR 18456 and 18501). Because these various 
adjustments are being made in accordance with existing methodology as 
set forth in the April 7, 2000 final rule with comment period, we 
believe it is unnecessary to address them further through the notice-
and-comment procedure.
    In addition, we find good cause to waive prior notice-and-comment 
procedures with respect to the Virgin Islands wage index methodology 
because it would have been impracticable to undertake and complete 
notice-and-comment procedures on this issue in time for the Virgin 
Islands outpatient prospective payment system wage index value to be 
effective at the same time as the updated outpatient prospective 
payment system wage index values for all other areas.
    Accordingly, we find good cause to waive the notice-and-comment 
procedure with respect to the annual update of the wage index values, 
conversion factor, and the APC groups. However, we are providing for a 
60-day comment period as specified in the ``Dates'' section of this 
preamble.

II. Collection of Information Requirements

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995.

VI. Regulatory Impact

A. General

    We have examined the impacts of this interim final with comment 
period rule as required by Executive Order 12866, the Unfunded Mandates 
Reform Act of 1965, and the Regulatory Flexibility Act (RFA) (Public 
Law 96-354). Executive Order 12866 directs agencies to assess all costs 
and benefits of available regulatory alternatives and, if regulation is 
necessary, to select regulatory approaches that maximize net benefits 
(including potential economic, environmental, public health and safety 
effects, distributive impacts, and equity). A regulatory impact 
analysis (RIA) must be prepared for major rules with economically 
significant effects ($100 million or more annually).
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule that may result in an expenditure in any one year by 
State, local, or tribal governments, in the aggregate, or by the 
private sector, of $100 million. This final rule does not mandate any 
requirements for State, local, or tribal governments.
    The RFA requires agencies to analyze options for regulatory relief 
of small businesses. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations and government agencies. For 
purposes of the RFA, we consider all hospitals to be small entities. 
Individuals and States are not included in the definition of a small 
entity.
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis if a rule may have a significant impact on 
the operations of a substantial number of small rural hospitals. This 
analysis must conform to the provisions of section 604 of the RFA. With 
the exception of hospitals located in certain New England counties, for 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital that is located outside of a Metropolitan 
Statistical Area (MSA) or New England County Metropolitan Area (NECMA). 
Section 601(g) of the Social Security Amendments of 1983 (Public Law 
98-21) designated hospitals in certain New England counties as 
belonging to the adjacent NECMA. Thus, for purposes of the hospital 
outpatient prospective payment system, we classify these hospitals as 
urban hospitals.

B. Analysis for Changes in this Interim Final Rule with Comment Period

    We implemented the outpatient prospective payment system on August 
1, 2000 in accordance with the methodology published in the April 7, 
2000 final rule with comment period. In section III.I. of the April 7, 
2000 final rule with comment period (65 FR 18501), we discuss how we 
will update the outpatient prospective payment system on an annual 
basis. We are required under section 1833(t)(3)(C)(ii) of the Act to 
update annually the conversion factor used to determine the APC payment 
rates. We are required under section 1833(t)(8)(A) of the Act to revise 
not less often than annually the wage and other adjustments. 
Accordingly, in this interim final rule with comment period, we are 
updating the conversion factor and the wage index adjustment for 
covered hospital outpatient services furnished beginning January 1, 
2001, using the methodology published in the April 7, 2000 final rule 
with comment period, for which we had previously received comments.
    In section IX.B. of the preamble of the April 7, 2000 final rule 
with comment period, we gave our Office of the Actuary's projection of 
the additional benefit expenditures from the Medicare Part B Trust Fund 
resulting from implementation of the hospital outpatient prospective 
payment system and the hospital outpatient provisions enacted by the 
BBRA 1999. The impact of implementing the hospital outpatient 
prospective payment system on the Medicare program is reflected in the 
table below, which is republished from the April 7, 2000 final rule 
with

[[Page 67829]]

comment period (65 FR 18530). The calendar year 2001 increase in total 
payments to hospitals, which results primarily from the updated 
conversion factor, is already included as part of HCFA's current law 
baseline expenditures for hospital outpatient services under the 
outpatient prospective payment system.

------------------------------------------------------------------------
                                                              Impact (in
                        Fiscal year                           millions)
------------------------------------------------------------------------
2001.......................................................       $3,030
2002.......................................................        3,520
2003.......................................................        4,230
2004.......................................................        4,670
------------------------------------------------------------------------

    We also are updating the existing APC groups to reflect new and 
deleted CPT codes for 2001 and adjusting the groups to reflect more 
recent data as we described in the April 7, 2000 final rule with 
comment period. The provisions of this interim final rule with comment 
period do not measurably alter the effect of the outpatient prospective 
payment system on the groups of hospitals or geographic areas as 
projected in Table 2 of the April 7, 2000 final rule with comment 
period (65 FR 18533-18534).

C. Federalism

    We have examined this interim rule with comment period in 
accordance with Executive Order 13132, Federalism, and have determined 
that it will not have any negative impact on the rights, roles, and 
responsibilities of State, local or Tribal governments.

D. Executive Order 12866 and 5 U.S.C. 804(2)

    The statutory effects of the provisions that are being implemented 
by this interim final rule with comment period result in expenditures 
exceeding $100 million per year. Therefore, this interim final rule 
with comment period is an economically significant rule under Executive 
Order 12866, and a major rule under 5 U.S.C. 804(2).
    In accordance with the provisions of Executive Order 12866, this 
interim final rule with comment period was reviewed by the Office of 
Management and Budget.

List of Subjects in 42 CFR Part 419

    Health facilities, Hospitals, Medicare.


    For the reasons set forth in the preamble, 42 CFR Part 419 is 
amended as set forth below:

PART 419--PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT 
DEPARTMENT SERVICES

    1. The authority citation for Part 419 continues to read as 
follows:

    Authority: Secs. 1102, 1833(t), and 187l of the Social Security 
Act (42 U.S.C. 1302, 1395l(t), and 1395hh).

    2. Section 419.41 is amended by revising paragraph (c)(4)(i) to 
read as follows:


Sec. 419.41  Calculation of national beneficiary coinsurance amounts 
and national Medicare program payment amounts.

* * * * *
    (c) * * *
    (4) * * *
    (i) The coinsurance amount for an APC cannot exceed the amount of 
the inpatient hospital deductible, established in accordance with 
Sec. 409.82 of this chapter, for that year. For purposes of this 
paragraph (c)--
    (A) Effective for drugs and biologicals furnished on or after 
January 1, 2001, the coinsurance amount for multiple APCs for a single 
drug or biological furnished on the same day will be aggregated and 
treated as the coinsurance amount for one APC.
    (B) Effective for drugs and biologicals furnished on or after July 
1, 2001, the coinsurance amount for the APC or APCs for a drug or 
biological furnished on the same day will be aggregated with the 
coinsurance amount for the APC that reflects the administration of the 
drug or biological furnished on that day and treated as the coinsurance 
amount for one APC.
* * * * *

    3. Section 419.70 is amended by revising paragraph (f)(2)(ii) to 
read as follows:


Sec. 419.70  Transitional adjustment to limit decline in payment.

* * * * *
    (f) * * *
    (2) * * *
    (ii) The reasonable cost of these services for this period.
* * * * *

(Catalog of Federal Domestic Assistance Program No. 93.774, 
Medicare'Supplementary Medical Insurance Program)

    Dated: November 1, 2000.
Michael M. Hash,
Acting Administrator, Health Care Financing Administration.
    Approved: November 1, 2000.
Donna E. Shalala,
Secretary.

    Note to the Addenda: The following Addenda A through H will not 
appear in the Code of Federal Regulations.

    Addenda A through H provide various data pertaining to the 
Medicare hospital outpatient prospective payment system. Addendum A 
contains the APCs with title, status indicators, relative weight, 
payment rate, national unadjusted coinsurance, and minimum 
unadjusted coinsurance. Addendum B differs from Addendum A in that 
the APC titles are not listed and both HCPCS codes and descriptions 
appear. Addendum C, entitled ``Hospital Outpatient Department (HOPD) 
Payment for Procedures by APC, Calendar Year 2001,'' is not 
published in this interim final rule with comment period, but will 
be posted on our website at (http://www.hcfa.gov /medlearn/
refopps.htm). Addendum C will display data similar to those 
contained in Addenda A and B, but sorted by APCs with each procedure 
code listed that is assigned to the APC. Addendum D lists the status 
indicators for how various services are treated under the hospital 
outpatient prospective payment system. Addendum E lists the 
procedures that we pay for only in an inpatient setting. Addendum F 
lists the wage index for urban areas, Addendum G lists the wage 
index for rural areas, and Addendum H lists the wage index for 
hospitals that are reclassified.

Addendum A.--List of Hospital Outpatient Ambulatory Payment 
Classification Groups with Status Indicators, Relative Weights, Payment 
Rates, and Coinsurance Amounts

    The payment rate (once wage adjusted) is the total payment to 
the hospital. The coinsurance amount is part of the total payment 
rate.
    Those APCs with status indicators ``G'' or ``J'' denote the 
inclusion of drugs that are eligible for pass-through payments. The 
relative weight column for these drug APCs is empty since payment 
for pass-through drugs/biologicals is calculated using the average 
wholesale price for the drug/biological rather than the relative 
weight. Note also that the only coinsurance column that has been 
filled is the minimum unadjusted coinsurance column. The coinsurance 
is applied to the nonpass-through portion of the payment rate for 
the drug/biological.
    Those APCs with status indicator ``H'' denote the inclusion of 
devices that are eligible for pass-through payments. The relative 
weight, payment rate, and coinsurance columns are not filled for 
these APCs. The relative weight and payment rate columns are empty 
because payment for pass-through devices is determined based on the 
hospital's submitted charges adjusted to cost using the hospital's 
cost-to-charge ratio. This calculation is done in the PRICER. The 
coinsurance columns for these APCs are not filled since the 
coinsurance is applied to the APC that contains the procedure with 
which the pass-through device is used rather than to the device APC.

Addendum B.--Hospital Outpatient Department (HOPD) Payment Status by 
HCPCS Code and Related Information

    The codes listed in this addendum include the 2001 CPT codes as 
published in CPT 2001 by the American Medical Association. Also 
listed are the codes that have been deleted for 2001. These codes 
are denoted in the CPT column with the subscript letter ``D''. These 
codes are billable through March 31, 2001 for services occurring 
before January 1, 2001. Deleted codes billed after March 31,

[[Page 67830]]

2001 will be rejected. CPT codes appearing for the first time in 
2001 are denoted in the CPT column with bolded print. These codes 
are new for 2001 and are billable effective January 1, 2001.
    All CPT codes that are paid only as inpatient procedures are 
denoted by the status indicator ``C''. A number of procedures that 
appeared on the inpatient list in the April 7, 2000 final rule with 
comment period are now payable under the hospital outpatient 
prospective payment system. The status indicators for these codes 
have been updated to reflect their current payment status.

  Addendum A.--List of Hospital Outpatient Ambulatory Payment Classifications With Status Indicators, Relative
                       Weights, Payment Rates, and Coinsurance Amounts, Calendar Year 2001
----------------------------------------------------------------------------------------------------------------
                                                                                          National     Minimum
  APC            Group title             Status  indicator      Relative     Payment     unadjusted   unadjusted
                                                                 weight        rate     coinsurance  coinsurance
----------------------------------------------------------------------------------------------------------------
   0001  Photochemotherapy..........  S                              0.47       $23.31        $8.49        $4.66
   0002  Fine needle Biopsy/          T                              0.62       $30.75       $17.66        $6.15
          Aspiration.
   0003  Bone Marrow Biopsy/          T                              0.98       $48.61       $27.99        $9.72
          Aspiration.
   0004  Level I Needle Biopsy/       T                              1.84       $91.26       $32.57       $18.25
          Aspiration Except Bone
          Marrow.
   0005  Level II Needle Biopsy /     T                              5.41      $268.32      $119.75       $53.66
          Aspiration Except Bone
          Marrow.
   0006  Level I Incision & Drainage  T                              2.00       $99.19       $33.95       $19.84
   0007  Level II Incision &          T                              3.68      $182.51       $72.03       $36.50
          Drainage.
   0008  Level III Incision &         T                              6.15      $305.02      $113.67       $61.00
          Drainage.
   0009  Nail Procedures............  T                              0.74       $36.70        $9.63        $7.34
   0010  Level I Destruction of       T                              0.55       $27.28        $9.86        $5.46
          Lesion.
   0011  Level II Destruction of      T                              2.72      $134.90       $50.01       $26.98
          Lesion.
   0012  Level I Debridement &        T                              0.53       $26.29        $9.18        $5.26
          Destruction.
   0013  Level II Debridement &       T                              0.91       $45.13       $17.66        $9.03
          Destruction.
   0014  Level III Debridement &      T                              1.50       $74.39       $24.55       $14.88
          Destruction.
   0015  Level IV Debridement &       T                              1.77       $87.78       $31.20       $17.56
          Destruction.
   0016  Level V Debridement &        T                              3.53      $175.07       $74.67       $35.01
          Destruction.
   0017  Level VI Debridement &       T                             12.45      $617.47      $289.16      $123.49
          Destruction.
   0018  Biopsy Skin, Subcutaneous    T                              0.94       $46.62       $17.66        $9.32
          Tissue or Mucous Membrane.
   0019  Level I Excision/ Biopsy...  T                              4.00      $198.39       $78.91       $39.68
   0020  Level II Excision/ Biopsy..  T                              6.51      $322.87      $130.53       $64.57
   0021  Level III Excision/ Biopsy.  T                             10.49      $520.26      $236.51      $104.05
   0022  Level IV Excision/ Biopsy..  T                             12.49      $619.45      $292.94      $123.89
   0023  Exploration Penetrating      T                              1.98       $98.20       $40.37       $19.64
          Wound.
   0024  Level I Skin Repair........  T                              2.43      $120.51       $44.50       $24.10
   0025  Level II Skin Repair.......  T                              3.74      $185.49       $70.66       $37.10
   0026  Level III Skin Repair......  T                             12.11      $600.61      $277.92      $120.12
   0027  Level IV Skin Repair.......  T                             15.80      $783.62      $383.10      $156.72
   0028  Level I Incision/Excision    T                             12.37      $613.52      $303.74      $122.70
          Breast.
   0029  Level II Incision/Excision   T                             31.39    $1,557.05      $820.79      $311.41
          Breast.
   0030  Breast Reconstruction......  T                             31.11    $1,543.16      $763.55      $308.63
   0032  Placement Transvenous        T                              5.40      $267.82      $119.52       $53.56
          Catheters/Arterial Cutdown.
   0033  Partial Hospitalization....  P                              4.17      $206.82       $48.17       $41.36
   0040  Arthrocentesis & Ligament/   T                              2.11      $104.65       $40.60       $20.93
          Tendon Injection.
   0041  Arthroscopy................  T                             24.57    $1,218.58      $592.08      $243.72
   0042  Arthroscopically-Aided       T                             29.22    $1,449.19      $804.74      $289.84
          Procedures.
   0043  Closed Treatment Fracture    T                              1.64       $81.34       $25.46       $16.27
          Finger/Toe/Trunk.
   0044  Closed Treatment Fracture/   T                              2.17      $107.63       $38.08       $21.53
          Dislocation Except Finger/
          Toe/Trunk.
   0045  Bone/Joint Manipulation      T                             11.02      $546.55      $277.12      $109.31
          Under Anesthesia.
   0046  Open/Percutaneous Treatment  T                             22.29    $1,105.50      $535.76      $221.10
          Fracture or Dislocation.
   0047  Arthroplasty without         T                             22.09    $1,095.58      $537.03      $219.12
          Prosthesis.
   0048  Arthroplasty with            T                             29.06    $1,441.26      $725.94      $288.25
          Prosthesis.
   0049  Level I Musculoskeletal      T                             15.04      $745.93      $356.95      $149.19
          Procedures Except Hand and
          Foot.
   0050  Level II Musculoskeletal     T                             21.13    $1,047.96      $513.86      $209.59
          Procedures Except Hand and
          Foot.
   0051  Level III Musculoskeletal    T                             27.76    $1,376.79      $675.24      $275.36
          Procedures Except Hand and
          Foot.
   0052  Level IV Musculoskeletal     T                             36.16    $1,793.39      $930.91      $358.68
          Procedures Except Hand and
          Foot.
   0053  Level I Hand                 T                             11.32      $561.42      $253.49      $112.28
          Musculoskeletal Procedures.
   0054  Level II Hand                T                             19.66      $975.06      $472.33      $195.01
          Musculoskeletal Procedures.
   0055  Level I Foot                 T                             15.47      $767.26      $355.34      $153.45
          Musculoskeletal Procedures.
   0056  Level II Foot                T                             17.30      $858.02      $405.81      $171.60
          Musculoskeletal Procedures.
   0057  Bunion Procedures..........  T                             21.00    $1,041.52      $496.65      $208.30
   0058  Level I Strapping and Cast   S                              1.09       $54.06       $19.27       $10.81
          Application.
   0059  Level II Strapping and Cast  S                              1.74       $86.30       $29.59       $17.26
          Application.
   0060  Manipulation Therapy.......  S                              0.77       $38.19        $7.80        $7.64
   0070  Thoracentesis/Lavage         T                              3.64      $180.53       $79.60       $36.11
          Procedures.
   0071  Level I Endoscopy Upper      T                              0.55       $27.28       $14.22        $5.46
          Airway.
   0072  Level II Endoscopy Upper     T                              1.26       $62.49       $41.52       $12.50
          Airway.
   0073  Level III Endoscopy Upper    T                              4.11      $203.84       $91.07       $40.77
          Airway.
   0074  Level IV Endoscopy Upper     T                             13.61      $675.00      $347.54      $135.00
          Airway.
   0075  Level V Endoscopy Upper      T                             18.55      $920.01      $467.29      $184.00
          Airway.
   0076  Endoscopy Lower Airway.....  T                              8.06      $399.75      $197.05       $79.95
   0077  Level I Pulmonary Treatment  S                              0.43       $21.33       $12.62        $4.27
   0078  Level II Pulmonary           S                              1.34       $66.46       $29.13       $13.29
          Treatment.
   0079  Ventilation Initiation and   S                              3.18      $157.72      $107.70       $31.54
          Management.
   0080  Diagnostic Cardiac           T                             31.55    $1,564.75      $838.92      $312.95
          Catheterization.
   0081  Non-Coronary Angioplasty or  T                             28.81    $1,428.86      $710.91      $285.77
          Atherectomy.
   0082  Coronary Atherectomy.......  T                             51.01    $2,529.89    $1,351.74      $505.98
   0083  Coronary Angioplasty.......  T                             29.70    $1,473.00      $794.30      $294.60
   0084  Level I Electrophysiologic   S                             10.70      $530.68      $177.79      $106.14
          Evaluation.
   0085  Level II Electrophysiologic  S                             27.06    $1,342.07      $654.48      $268.41
          Evaluation.
   0086  Ablate Heart Dysrhythm       S                             47.62    $2,361.76    $1,265.37      $472.35
          Focus.
   0087  Cardiac Electrophysiologic   S                              9.53      $472.65      $214.72       $94.53
          Recording/Mapping.
   0088  Thrombectomy...............  T                             26.49    $1,313.80      $678.68      $262.76

[[Page 67831]]

 
   0089  Insertion/Replacement of     T                             78.45    $3,890.81    $2,275.19      $778.16
          Permanent Pacemaker and
          Electrodes.
   0090  Insertion/Replacement of     T                             78.28    $3,882.37    $2,133.88      $776.47
          Pacemaker Pulse Generator.
   0091  Level I Vascular Ligation..  T                             14.79      $733.52      $348.23      $146.70
   0092  Level II Vascular Ligation.  T                             20.21    $1,002.34      $505.37      $200.47
   0093  Vascular Repair/Fistula      T                             12.82      $635.82      $277.34      $127.16
          Construction.
   0094  Resuscitation and            S                              4.51      $223.68      $105.29       $44.74
          Cardioversion.
   0095  Cardiac Rehabilitation.....  S                              0.64       $31.74       $16.98        $6.35
   0096  Non-Invasive Vascular        S                              2.06      $102.16       $61.48       $20.43
          Studies.
   0097  Cardiac Monitoring for 30    X                              1.62       $80.35       $62.40       $16.07
          days.
   0098  Injection of Sclerosing      T                              1.19       $59.02       $20.88       $11.80
          Solution.
   0099  Electrocardiograms.........  S                              0.38       $18.85       $14.68        $3.77
   0100  Stress Tests and Continuous  X                              1.70       $84.32       $71.57       $16.86
          ECG.
   0101  Tilt Table Evaluation......  S                              4.47      $221.70      $128.84       $44.34
   0102  Electronic Analysis of       S                              0.45       $22.32       $12.62        $4.46
          Pacemakers/other Devices.
   0103  Miscellaneous Vascular       T                             13.09      $649.21      $295.70      $129.84
          Procedures.
   0104  Transcatheter Placement of   T                             14.94      $740.96      $339.51      $148.19
          Intracoronary Stents.
   0105  Revision/Removal of          T                             15.06      $746.92      $372.32      $149.38
          Pacemakers, AICD, or
          Vascular Device.
   0106  Insertion/Replacement/       T                             18.96      $940.34      $503.07      $188.07
          Repair of Pacemaker
          Electrodes.
   0107  Insertion of Cardioverter-   T                            147.51    $7,315.91    $5,086.37    $1,463.18
          Defibrillator.
   0108  Insertion/Replacement/       T                            210.84   $10,456.84    $5,484.72    $2,091.37
          Repair of Cardioverter-
          Defibrillator Leads.
   0109  Removal of Implanted         T                              6.53      $323.86      $133.51       $64.77
          Devices.
   0110  Transfusion................  S                              5.83      $289.15      $122.73       $57.83
   0111  Blood Product Exchange.....  S                             14.17      $702.77      $300.74      $140.55
   0112  Extracorporeal               S                             39.60    $1,964.01      $663.65      $392.80
          Photopheresis.
   0113  Excision Lymphatic System..  T                             13.89      $688.89      $326.55      $137.78
   0114  Thyroid/Lymphadenectomy      T                             19.56      $970.10      $493.78      $194.02
          Procedures.
   0115  Cannula/Access Device        T                             19.34      $959.19      $506.74      $191.84
          Procedures.
   0116  Chemotherapy Administration  S                              2.34      $116.06       $23.21       $23.21
          by Other Technique Except
          Infusion.
   0117  Chemotherapy Administration  S                              1.84       $91.26       $71.80       $18.25
          by Infusion Only.
   0118  Chemotherapy Administration  S                              2.90      $143.83       $72.03       $28.77
          by Both Infusion and Other
          Technique.
   0119  Implantation of Devices....  T                              9.87      $489.59      $161.50       $97.92
   0120  Infusion Therapy Except      T                              1.66       $82.33       $42.67       $16.47
          Chemotherapy.
   0121  Level I Tube changes and     T                              2.36      $117.05       $52.53       $23.41
          Repositioning.
   0122  Level II Tube changes and    T                              5.04      $249.96      $114.93       $49.99
          Repositioning.
   0123  Bone Marrow Harvesting and   S                              4.13      $204.83       $40.97       $40.97
          Bone Marrow/Stem Cell
          Transplant.
   0124  Revision of Implanted        T                              2.55      $126.64       $81.36       $25.33
          Infusion Pump.
   0130  Level I Laparoscopy........  T                             25.36    $1,257.75      $659.53      $251.55
   0131  Level II Laparoscopy.......  T                             41.81    $2,073.61    $1,089.88      $414.72
   0132  Level III Laparoscopy......  T                             48.91    $2,425.74    $1,239.22      $485.15
   0140  Esophageal Dilation without  T                              4.74      $235.09      $107.24       $47.02
          Endoscopy.
   0141  Upper GI Procedures........  T                              7.15      $354.61      $184.67       $70.92
   0142  Small Intestine Endoscopy..  T                              7.45      $369.49      $162.42       $73.90
   0143  Lower GI Endoscopy.........  T                              7.98      $395.78      $199.12       $79.16
   0144  Diagnostic Anoscopy........  T                              2.23      $110.60       $49.32       $22.12
   0145  Therapeutic Anoscopy.......  T                              7.46      $369.98      $179.39       $74.00
   0146  Level I Sigmoidoscopy......  T                              2.83      $140.36       $65.15       $28.07
   0147  Level II Sigmoidoscopy.....  T                              6.26      $310.47      $149.11       $62.09
   0148  Level I Anal/Rectal          T                              2.34      $116.06       $43.59       $23.21
          Procedure.
   0149  Level II Anal/Rectal         T                             12.86      $637.80      $293.06      $127.56
          Procedure.
   0150  Level III Anal/Rectal        T                             17.68      $876.86      $437.12      $175.37
          Procedure.
   0151  Endoscopic Retrograde        T                             10.53      $522.25      $245.46      $104.45
          Cholangio-Pancreatography
          (ERCP).
   0152  Percutaneous Biliary         T                              8.22      $407.68      $207.38       $81.54
          Endoscopic Procedures.
   0153  Peritoneal and Abdominal     T                             19.62      $973.08      $496.31      $194.62
          Procedures.
   0154  Hernia/Hydrocele Procedures  T                             22.43    $1,112.45      $556.98      $222.49
   0157  Colorectal Cancer            S                              1.79       $88.78  ...........       $22.19
          Screening: Barium Enema.
   0158  Colorectal Cancer            S                              7.98      $395.78  ...........       $98.94
          Screening: Colonoscopy.
   0159  Colorectal Cancer            S                              2.83      $140.36  ...........       $35.09
          Screening: Flexible
          Sigmoidoscopy.
   0160  Level I Cystourethroscopy    T                              5.43      $269.30      $110.11       $53.86
          and other Genitourinary
          Procedures.
   0161  Level II Cystourethroscopy   T                             10.94      $542.58      $249.36      $108.52
          and other Genitourinary
          Procedures.
   0162  Level III Cystourethroscopy  T                             17.49      $867.44      $427.49      $173.49
          and other Genitourinary
          Procedures.
   0163  Level IV Cystourethroscopy   T                             28.98    $1,437.30      $792.58      $287.46
          and other Genitourinary
          Procedures.
   0164  Level I Urinary and Anal     T                              2.17      $107.64       $33.03       $21.53
          Procedures.
   0165  Level II Urinary and Anal    T                              3.89      $192.92       $91.76       $38.58
          Procedures.
   0166  Level I Urethral Procedures  T                             10.17      $504.39      $218.73      $100.88
   0167  Level II Urethral            T                             21.06    $1,044.50      $555.84      $208.90
          Procedures.
   0168  Level III Urethral           T                             24.94    $1,236.93      $536.11      $247.39
          Procedures.
   0169  Lithotripsy................  T                             46.72    $2,317.13    $1,384.20      $463.43
   0170  Dialysis for Other Than      S                              6.68      $331.30       $72.26       $66.26
          ESRD Patients.
   0180  Circumcision...............  T                             13.62      $675.49      $304.87      $135.10
   0181  Penile Procedures..........  T                             32.37    $1,605.43      $906.36      $321.09
   0182  Insertion of Penile          T                             52.11    $2,584.45    $1,525.05      $516.89
          Prosthesis.
   0183  Testes/Epididymis            T                             18.26      $905.62      $448.94      $181.12
          Procedures.
   0184  Prostate Biopsy............  T                              4.94      $245.01      $122.96       $49.00
   0185  Removal or Repair of Penile  T                             32.37    $1,605.43      $906.36      $321.09
          Prosthesis.
   0190  Surgical Hysteroscopy......  T                             17.85      $885.29      $443.89      $177.06
   0191  Level I Female Reproductive  T                              1.19       $59.02       $17.43       $11.80
          Procedures.
   0192  Level II Female              T                              2.38      $118.04       $35.33       $23.61
          Reproductive Procedures.
   0193  Level III Female             T                              8.93      $442.89      $171.13       $88.58
          Reproductive Procedures.

[[Page 67832]]

 
   0194  Level IV Female              T                             16.21      $803.96      $395.94      $160.79
          Reproductive Procedures.
   0195  Level V Female Reproductive  T                             18.68      $926.46      $483.80      $185.29
          Procedures.
   0196  Dilatation & Curettage.....  T                             14.47      $717.66      $357.98      $143.53
   0197  Infertility Procedures.....  T                              2.40      $119.03       $49.55       $23.81
   0198  Pregnancy and Neonatal Care  T                              1.34       $66.46       $33.03       $13.29
          Procedures.
   0199  Vaginal Delivery...........  T                             11.20      $555.48      $157.83      $111.10
   0200  Therapeutic Abortion.......  T                             13.89      $688.89      $373.23      $137.78
   0201  Spontaneous Abortion.......  T                             13.00      $644.75      $329.65      $128.95
   0210  Spinal Tap.................  T                              3.00      $148.79       $62.40       $29.76
   0211  Level I Nervous System       T                              3.32      $164.66       $74.78       $32.93
          Injections.
   0212  Level II Nervous System      T                              3.64      $180.53       $88.78       $36.11
          Injections.
   0213  Extended EEG Studies and     S                             11.15      $553.00      $290.42      $110.60
          Sleep Studies.
   0214  Electroencephalogram.......  S                              2.32      $115.06       $58.50       $23.01
   0215  Level I Nerve and Muscle     S                              1.15       $57.04       $30.05       $11.41
          Tests.
   0216  Level II Nerve and Muscle    S                              2.87      $142.34       $64.69       $28.47
          Tests.
   0217  Level III Nerve and Muscle   S                              5.87      $291.13      $156.68       $58.23
          Tests.
   0220  Level I Nerve Procedures...  T                             13.96      $692.36      $326.21      $138.47
   0221  Level II Nerve Procedures..  T                             18.36      $910.58      $463.62      $182.12
   0222  Implantation of              T                            124.43    $6,171.23    $2,955.13    $1,234.25
          Neurological Device.
   0223  Implantation of Pain         T                              7.05      $349.65      $154.27       $69.93
          Management Device.
   0224  Implantation of Reservoir/   T                             17.89      $887.27      $453.41      $177.45
          Pump/Shunt.
   0225  Implantation of              T                             17.72      $878.84      $408.33      $175.77
          Neurostimulator Electrodes.
   0226  Implantation of Drug         T                              5.62      $278.73      $109.42       $55.75
          Infusion Reservoir.
   0227  Implantation of Drug         T                             11.17      $553.99      $330.11      $110.80
          Infusion Device.
   0228  Creation of Lumbar           T                             25.06    $1,242.88      $696.46      $248.58
          Subarachnoid Shunt.
   0229  Transcatherter Placement of  T                             34.81    $1,726.44    $1,030.12      $345.29
          Intravascular Shunts.
   0230  Level I Eye Tests..........  S                              0.98       $48.61       $22.48        $9.72
   0231  Level II Eye Tests.........  S                              2.64      $130.94       $59.87       $26.19
   0232  Level I Anterior Segment     T                              6.04      $299.56      $134.66       $59.91
          Eye.
   0233  Level II Anterior Segment    T                             13.79      $683.93      $331.60      $136.79
          Eye.
   0234  Level III Anterior Segment   T                             20.64    $1,023.66      $502.16      $204.73
          Eye Procedures.
   0235  Level I Posterior Segment    T                              2.94      $145.81       $78.91       $29.16
          Eye Procedures.
   0236  Level II Posterior Segment   T                              6.70      $332.29      $147.96       $66.46
          Eye Procedures.
   0237  Level III Posterior Segment  T                             33.96    $1,684.28      $852.68      $336.86
          Eye Procedures.
   0238  Level I Repair and Plastic   T                              2.80      $138.87       $58.96       $27.77
          Eye Procedures.
   0239  Level II Repair and Plastic  T                              6.26      $310.47      $123.42       $62.09
          Eye Procedures.
   0240  Level III Repair and         T                             13.47      $668.06      $315.31      $133.61
          Plastic Eye Procedures.
   0241  Level IV Repair and Plastic  T                             16.60      $823.30      $384.47      $164.66
          Eye Procedures.
   0242  Level V Repair and Plastic   T                             23.70    $1,175.42      $597.36      $235.08
          Eye Procedures.
   0243  Strabismus/Muscle            T                             17.99      $892.23      $431.39      $178.45
          Procedures.
   0244  Corneal Transplant.........  T                             32.88    $1,630.72      $851.42      $326.14
   0245  Cataract Procedures without  T                             26.55    $1,316.77      $623.85      $263.35
          IOL Insert.
   0246  Cataract Procedures with     T                             26.55    $1,316.77      $623.85      $263.35
          IOL Insert.
   0247  Laser Eye Procedures Except  T                              4.89      $242.52      $112.86       $48.50
          Retinal.
   0248  Laser Retinal Procedures...  T                              4.19      $207.81       $94.05       $41.56
   0250  Nasal Cauterization/Packing  T                              2.21      $109.61       $38.54       $21.92
   0251  Level I ENT Procedures.....  T                              1.68       $83.32       $27.99       $16.66
   0252  Level II ENT Procedures....  T                              5.18      $256.90      $114.24       $51.38
   0253  Level III ENT Procedures...  T                             12.02      $596.14      $284.00      $119.23
   0254  Level IV ENT Procedures....  T                             12.45      $617.47      $272.41      $123.49
   0256  Level V ENT Procedures.....  T                             25.40    $1,259.74      $623.05      $251.95
   0258  Tonsil and Adenoid           T                             18.62      $923.48      $462.81      $184.70
          Procedures.
   0260  Level I Plain Film Except    X                              0.79       $39.18       $22.02        $7.84
          Teeth.
   0261  Level II Plain Film Except   X                              1.38       $68.44       $38.77       $13.69
          Teeth Including Bone
          Density Measurement.
   0262  Plain Film of Teeth........  X                              0.40       $19.83       $10.90        $3.97
   0263  Level I Miscellaneous        X                              1.68       $83.32       $45.88       $16.66
          Radiology Procedures.
   0264  Level II Miscellaneous       X                              3.83      $189.96      $108.97       $37.99
          Radiology Procedures.
   0265  Level I Diagnostic           S                              1.17       $58.03       $38.08       $11.61
          Ultrasound Except Vascular.
   0266  Level II Diagnostic          S                              1.79       $88.78       $57.35       $17.76
          Ultrasound Except Vascular.
   0267  Vascular Ultrasound........  S                              2.72      $134.90       $80.06       $26.98
   0268  Guidance Under Ultrasound..  X                              2.23      $110.60       $69.51       $22.12
   0269  Echocardiogram Except        S                              4.40      $218.22      $114.01       $43.64
          Transesophageal.
   0270  Transesophageal              S                              5.55      $275.25      $150.26       $55.05
          Echocardiogram.
   0271  Mammography................  S                              0.70       $34.72       $19.50        $6.94
   0272  Level I Fluoroscopy........  X                              1.40       $69.43       $39.00       $13.89
   0273  Level II Fluoroscopy.......  X                              2.49      $123.49       $61.02       $24.70
   0274  Myelography................  S                              4.83      $239.55      $128.12       $47.91
   0275  Arthrography...............  S                              2.74      $135.89       $72.26       $27.18
   0276  Level I Digestive Radiology  S                              1.79       $88.78       $49.78       $17.76
   0277  Level II Digestive           S                              2.47      $122.50       $69.28       $24.50
          Radiology.
   0278  Diagnostic Urography.......  S                              2.85      $141.35       $81.67       $28.27
   0279  Level I Angiography and      S                              6.30      $312.46      $174.57       $62.49
          Venography except
          Extremity.
   0280  Level II Angiography and     S                             14.98      $742.95      $380.12      $148.59
          Venography except
          Extremity.
   0281  Venography of Extremity....  S                              4.40      $218.22      $115.16       $43.64
   0282  Level I Computerized Axial   S                              2.38      $118.04       $94.51       $23.61
          Tomography.
   0283  Level II Computerized Axial  S                              4.89      $242.52      $179.39       $48.50
          Tomography.
   0284  Magnetic Resonance Imaging.  S                              8.02      $397.76      $257.39       $79.55
   0285  Positron Emission            S                             15.06      $746.92      $415.21      $149.38
          Tomography (PET).

[[Page 67833]]

 
   0286  Myocardial Scans...........  S                              7.28      $361.06      $200.04       $72.21
   0290  Standard Non-Imaging         S                              1.94       $96.21       $55.51       $19.24
          Nuclear Medicine.
   0291  Level I Diagnostic Nuclear   S                              3.15      $156.22       $93.14       $31.24
          Medicine Excluding
          Myocardial Scans.
   0292  Level II Diagnostic Nuclear  S                              4.36      $216.24      $126.63       $43.25
          Medicine Excluding
          Myocardial Scans.
   0294  Level I Therapeutic Nuclear  S                              5.13      $254.43      $144.06       $50.89
          Medicine.
   0295  Level II Therapeutic         S                             19.85      $984.48      $609.17      $196.90
          Nuclear Medicine.
   0296  Level I Therapeutic          S                              3.57      $177.06      $100.25       $35.41
          Radiologic Procedures.
   0297  Level II Therapeutic         S                              6.13      $304.03      $172.51       $60.81
          Radiologic Procedures.
   0300  Level I Radiation Therapy..  S                              1.98       $98.20       $47.72       $19.64
   0301  Level II Radiation Therapy.  S                              2.21      $109.61       $52.53       $21.92
   0302  Level III Radiation Therapy  S                              8.21      $407.18      $216.55       $81.44
   0303  Treatment Device             X                              2.83      $140.36       $69.28       $28.07
          Construction.
   0304  Level I Therapeutic          X                              1.49       $73.90       $41.52       $14.78
          Radiation Treatment
          Preparation.
   0305  Level II Therapeutic         X                              4.06      $201.36       $97.50       $40.27
          Radiation Treatment
          Preparation.
   0310  Level III Therapeutic        X                             13.98      $693.35      $339.05      $138.67
          Radiation Treatment
          Preparation.
   0311  Radiation Physics Services.  X                              1.32       $65.46       $31.66       $13.09
   0312  Radioelement Applications..  S                              4.09      $202.85      $109.65       $40.57
   0313  Brachytherapy..............  S                              7.89      $391.31      $164.02       $78.26
   0314  Hyperthermic Therapies.....  S                              5.88      $291.62      $150.95       $58.32
   0320  Electroconvulsive Therapy..  S                              3.68      $182.51       $80.06       $36.50
   0321  Biofeedback and Other        S                              1.26       $62.49       $29.25       $12.50
          Training.
   0322  Brief Individual             S                              1.32       $65.46       $14.22       $13.09
          Psychotherapy.
   0323  Extended Individual          S                              1.85       $91.75       $22.48       $18.35
          Psychotherapy.
   0324  Family Psychotherapy.......  S                              1.87       $92.74       $20.19       $18.55
   0325  Group Psychotherapy........  S                              1.55       $76.88       $19.96       $15.38
   0330  Dental Procedures..........  S                              1.51       $74.89       $14.98       $14.98
   0340  Minor Ancillary Procedures.  X                              1.04       $51.58       $12.85       $10.32
   0341  Immunology Tests...........  X                              0.13        $6.44        $3.67        $1.29
   0342  Level I Pathology..........  X                              0.26       $12.90        $8.03        $2.58
   0343  Level II Pathology.........  X                              0.45       $22.32       $12.16        $4.46
   0344  Level III Pathology........  X                              0.79       $39.18       $23.63        $7.84
   0345  Transfusion Laboratory       X                              0.22       $10.92        $5.37        $2.18
          Procedures Level I.
   0346  Transfusion Laboratory       X                              0.51       $25.49       $12.03        $5.10
          Procedures Level II.
   0347  Transfusion Laboratory       X                              0.84       $41.90       $20.13        $8.38
          Procedures Level III.
   0348  Fertility Laboratory         X                              0.52       $25.57        $5.11        $5.11
          Procedures.
   0349  Miscellaneous Laboratory     X                              0.48       $23.65        $4.73        $4.73
          Procedures.
   0354  Administration of Influenza/ K                              0.13        $6.33  ...........  ...........
          Pneumonia Vaccine.
   0355  Level I Immunizations......  K                              0.19        $9.42        $5.05        $1.88
   0356  Level II Immunizations.....  K                              0.36       $17.86        $4.82        $3.57
   0359  Injections.................  X                              0.96       $47.61        $9.52        $9.52
   0360  Level I Alimentary Tests...  X                              1.38       $68.44       $34.75       $13.69
   0361  Level II Alimentary Tests..  X                              3.53      $175.07       $88.09       $35.01
   0362  Fitting of Vision Aids.....  X                              0.51       $25.30        $9.63        $5.06
   0363  Otorhinolaryngologic         X                              2.83      $140.36       $53.22       $28.07
          Function Tests.
   0364  Level I Audiometry.........  X                              0.68       $33.72       $13.31        $6.74
   0365  Level II Audiometry........  X                              1.47       $72.91       $22.48       $14.58
   0367  Level I Pulmonary Test.....  X                              0.83       $41.16       $20.65        $8.23
   0368  Level II Pulmonary Tests...  X                              1.66       $82.33       $42.44       $16.47
   0369  Level III Pulmonary Tests..  X                              2.34      $116.06       $58.50       $23.21
   0370  Allergy Tests..............  X                              0.57       $28.27       $11.81        $5.65
   0371  Allergy Injections.........  X                              0.32       $15.87        $3.67        $3.17
   0372  Therapeutic Phlebotomy.....  X                              0.43       $21.33       $10.09        $4.27
   0373  Neuropsychological Testing.  X                              3.21      $159.20       $44.96       $31.84
   0374  Monitoring Psychiatric       X                              1.17       $58.03       $13.08       $11.61
          Drugs.
   0600  Low Level Clinic Visits....  V                              0.98       $48.61        $9.72        $9.72
   0601  Mid Level Clinic Visits....  V                              1.00       $49.60        $9.92        $9.92
   0602  High Level Clinic Visits...  V                              1.66       $82.33       $16.47       $16.47
   0610  Low Level Emergency Visits.  V                              1.34       $66.46       $20.65       $13.29
   0611  Mid Level Emergency Visits.  V                              2.11      $104.65       $36.47       $20.93
   0612  High Level Emergency Visits  V                              3.19      $158.21       $54.14       $31.64
   0620  Critical Care..............  S                              8.60      $426.53      $152.78       $85.31
   0701  SR 89 chloride, per mCi....  G                       ...........      $783.75  ...........       $95.62
   0702  SM 153 lexidronam, 50 mCi..  G                       ...........      $942.09  ...........      $134.87
   0704  IN 111 Satumomab pendetide   G                       ...........      $712.50  ...........       $86.93
          per dose.
   0705  TC 99M tetrofosmin, per      G                       ...........      $136.80  ...........       $16.69
          dose.
   0725  Leucovorin calcium inj, 50   G                       ...........       $49.73  ...........        $6.66
          mg.
   0726  Dexrazoxane hcl injection,   G                       ...........      $161.11  ...........       $21.59
          250 mg.
   0727  Etidronate disodium inj 300  G                       ...........       $63.65  ...........        $8.53
          mg.
   0728  Filgrastim 300 mcg           G                       ...........      $171.38  ...........       $22.96
          injection.
   0730  Pamidronate disodium, 30 mg  G                       ...........      $232.51  ...........       $31.16
   0731  Sargramostim injection 50    G                       ...........       $27.42  ...........        $3.67
          mcg.
   0732  Mesna injection 200 mg.....  G                       ...........       $36.51  ...........        $4.89
   0733  Non esrd epoetin alpha inj,  G                       ...........       $11.40  ...........        $1.53
          1000 u.
   0750  Dolasetron mesylate, 10 mg.  G                       ...........       $14.81  ...........        $1.98
   0754  Metoclopramide hcl           G                       ...........        $2.00  ...........        $0.27
          injection up to 10 mg.
   0755  Thiethylperazine maleate     G                       ...........        $5.02  ...........        $0.67
          inj up to 10 mg.
   0761  Unspecified oral anti-       G                       ...........        $0.60  ...........        $0.08
          emetic.
   0762  Dronabinol 2.5mg oral......  G                       ...........        $3.20  ...........        $0.48

[[Page 67834]]

 
   0763  Dolasetron mesylate oral,    G                       ...........       $65.21  ...........        $8.74
          100 mg.
   0764  Granisetron hcl injection    G                       ...........        $1.85  ...........        $0.25
          100 mcg.
   0765  Granisetron hcl 1 mg oral..  G                       ...........       $44.70  ...........        $5.99
   0768  Ondansetron hcl injection 1  G                       ...........        $6.09  ...........        $0.82
          mg.
   0769  Ondansetron hcl 8mg oral...  G                       ...........       $25.15  ...........        $3.37
   0800  Leuprolide acetate, 3.75 mg  G                       ...........      $492.71  ...........       $63.27
   0801  Cyclophosphamide oral 25 mg  G                       ...........        $2.12  ...........        $0.28
   0802  Etoposide oral 50 mg.......  G                       ...........       $45.95  ...........        $6.16
   0803  Melphalan oral 2 mg........  G                       ...........        $2.07  ...........        $0.28
   0807  Aldesleukin/single use vial  G                       ...........      $569.76  ...........       $76.35
   0809  Bcg live intravesical vac..  G                       ...........      $159.39  ...........       $19.45
   0810  Goserelin acetate implant    G                       ...........      $446.49  ...........       $59.83
          3.6 mg.
   0811  Carboplatin injection 50 mg  G                       ...........       $98.90  ...........       $13.25
   0812  Carmus bischl nitro inj 100  G                       ...........      $103.27  ...........       $13.84
          mg.
   0813  Cisplatin 10 mg injection..  G                       ...........       $42.18  ...........        $5.65
   0814  Asparaginase injection       G                       ...........       $57.41  ...........        $7.69
          10,000 u.
   0815  Cyclophosphamide 100 mg inj  G                       ...........        $6.13  ...........        $0.82
   0816  Cyclophosphamide             G                       ...........        $6.13  ...........        $0.82
          lyophilized 100 mg.
   0817  Cytarabine hcl 100 mg inj..  G                       ...........        $5.94  ...........        $0.80
   0818  Dactinomycin 0.5 mg........  G                       ...........       $12.73  ...........        $1.71
   0819  Dacarbazine 10 mg inj......  G                       ...........        $1.13  ...........        $0.15
   0820  Daunorubicin 10 mg.........  G                       ...........       $80.04  ...........       $10.73
   0821  Daunorubicin citrate         G                       ...........       $64.60  ...........        $8.66
          liposom 10 mg.
   0822  Diethylstilbestrol           G                       ...........        $4.20  ...........        $0.56
          injection 250 mg.
   0823  Docetaxel, 20 mg...........  G                       ...........      $283.65  ...........       $38.01
   0824  Etoposide 10 mg inj........  G                       ...........        $4.06  ...........        $0.54
   0826  Methotrexate Oral 2.5 mg...  G                       ...........        $2.92  ...........        $0.39
   0827  Floxuridine injection 500    G                       ...........      $129.56  ...........       $17.36
          mg.
   0828  Gemcitabine HCL 200 mg.....  G                       ...........       $88.46  ...........       $11.85
   0830  Irinotecan injection 20 mg.  G                       ...........      $117.81  ...........       $15.79
   0831  Ifosfomide injection 1 gm..  G                       ...........      $141.50  ...........       $18.96
   0832  Idarubicin hcl injection 5   G                       ...........      $341.38  ...........       $45.75
          mg.
   0833  Interferon alfacon-1, 1 mcg  G                       ...........        $3.91  ...........        $0.52
   0834  Interferon alfa-2a inj       G                       ...........       $33.22  ...........        $4.45
          recombinant 3 million u.
   0836  Interferon alfa-2b inj       G                       ...........       $11.28  ...........        $1.51
          recombinant, 1 million.
   0838  Interferon gamma 1-b inj, 3  G                       ...........      $199.50  ...........       $26.73
          million u.
   0839  Mechlorethamine hcl inj 10   G                       ...........       $11.01  ...........        $1.48
          mg.
   0840  Melphalan hydrochl 50 mg...  G                       ...........      $363.48  ...........       $48.71
   0841  Methotrexate sodium inj 5    G                       ...........        $0.45  ...........        $0.06
          mg.
   0842  Fludarabine phosphate inj    G                       ...........      $237.03  ...........       $31.76
          50 mg.
   0843  Pegaspargase, singl dose     G                       ...........    $1,321.65  ...........      $177.10
          vial.
   0844  Pentostatin injection, 10    G                       ...........    $1,562.75  ...........      $209.41
          mg.
   0847  Doxorubicin hcl 10 mg vl     G                       ...........       $15.79  ...........        $2.12
          chemo.
   0849  Rituximab, 100 mg..........  G                       ...........      $420.29  ...........       $56.32
   0850  Streptozocin injection, 1    G                       ...........       $65.79  ...........        $8.82
          gm.
   0851  Thiotepa injection, 15 mg..  G                       ...........      $100.30  ...........       $13.44
   0852  Topotecan, 4 mg............  G                       ...........      $573.75  ...........       $76.88
   0853  Vinblastine sulfate inj, 1   G                       ...........        $4.11  ...........        $0.55
          mg.
   0854  Vincristine sulfate 1 mg     G                       ...........       $30.16  ...........        $4.04
          inj.
   0855  Vinorelbine tartrate, 10 mg  G                       ...........       $75.51  ...........       $10.12
   0856  Porfimer sodium, 75 mg.....  G                       ...........    $2,603.67  ...........      $348.89
   0857  Bleomycin sulfate injection  G                       ...........      $294.48  ...........       $39.46
          15 u.
   0858  Cladribine, 1mg............  G                       ...........       $53.47  ...........        $7.16
   0859  Fluorouracil injection 500   G                       ...........        $2.75  ...........        $0.37
          mg.
   0860  Plicamycin (mithramycin)     G                       ...........       $93.80  ...........       $12.57
          inj 2.5 mg.
   0861  Leuprolide acetate           G                       ...........       $22.90  ...........        $3.07
          injection 1 mg.
   0862  Mitomycin 5 mg inj.........  G                       ...........      $121.65  ...........       $16.30
   0863  Paclitaxel injection, 30 mg  G                       ...........      $173.50  ...........       $23.25
   0864  Mitoxantrone hcl, 5 mg.....  G                       ...........      $223.02  ...........       $29.88
   0865  Interferon alfa-n3 inj,      G                       ...........        $7.86  ...........        $1.05
          human leukocyte derived,
          250,000 iu.
   0884  Rho d immune globulin inj,   G                       ...........       $35.91  ...........        $4.38
          1 dose pkg.
   0886  Azathioprine oral 50mg.....  G                       ...........        $1.24  ...........        $0.17
   0887  Azathioprine parenteral 100  G                       ...........       $67.88  ...........        $9.10
          mg.
   0888  Cyclosporine oral 100 mg...  G                       ...........        $5.80  ...........        $0.78
   0889  Cyclosporin parenteral       G                       ...........       $15.81  ...........        $2.12
          250mg.
   0890  Lymphocyte immune globulin   G                       ...........      $249.13  ...........       $30.39
          250 mg.
   0891  Tacrolimus oral per 1 mg...  G                       ...........        $2.66  ...........        $0.36
   0900  Alglucerase injection, per   G                       ...........       $37.53  ...........        $5.03
          10 u.
   0901  Alpha 1 proteinase           G                       ...........        $2.09  ...........        $0.28
          inhibitor, 10 mg.
   0902  Botulinum toxin a, per unit  G                       ...........        $4.39  ...........        $0.59
   0903  Cytomegalovirus imm IV,      G                       ...........      $370.50  ...........       $49.65
          vial.
   0905  Immune globulin 500 mg.....  G                       ...........       $27.28  ...........        $3.33
   0906  RSV-ivig, 50 mg............  G                       ...........      $427.73  ...........       $57.32
   0907  Ganciclovir Sodium 500 mg    K                              0.45       $22.26  ...........        $4.45
          injection.
   0908  Tetanus immune globulin inj  G                       ...........      $102.60  ...........       $13.75
          up to 250 u.
   0909  Interferon beta-1a, 33 mcg.  G                       ...........      $204.73  ...........       $27.43
   0910  Interferon beta-1b, .25 mg.  G                       ...........       $57.00  ...........        $7.64
   0911  Streptokinase per 250,000    K                              1.76       $87.25  ...........       $17.45
          iu.

[[Page 67835]]

 
   0913  Ganciclovir long act         G                       ...........    $4,750.00  ...........      $636.50
          implant 4.5 mg.
   0914  Reteplase, per 37.6mg......  G                       ...........    $2,612.50  ...........      $350.08
   0915  Alteplase inj rec, per 10    K                              3.80      $188.46  ...........       $37.69
          mg.
   0916  Imiglucerase, unit.........  G                       ...........        $3.75  ...........        $0.50
   0917  Pharmacologic stressors....  K                              0.36       $17.86  ...........        $3.57
   0918  Brachytherapy Seeds, Any     H                       ...........  ...........  ...........  ...........
          type, Each.
   0925  Factor viii per iu.........  G                       ...........        $0.88  ...........        $0.12
   0926  Factor VIII (porcine) per    G                       ...........        $2.09  ...........        $0.28
          iu.
   0927  Factor viii recombinant per  G                       ...........        $1.17  ...........        $0.16
          iu.
   0928  Factor ix complex per iu...  G                       ...........         $.71  ...........        $0.10
   0929  Anti-inhibitor per iu......  G                       ...........        $1.43  ...........        $0.19
   0930  Antithrombin iii injection   G                       ...........         $.82  ...........        $0.11
          per iu.
   0931  Factor IX non-recombinant,   G                       ...........        $0.72  ...........        $0.10
          per iu.
   0932  Factor IX recombinant, per   G                       ...........        $1.12  ...........        $0.10
          iu.
   0949  Plasma, Pooled Multiple      K                              2.94      $145.76  ...........       $29.15
          Donor, Solvent/Detergent
          Treated, Frozen.
   0950  Blood (Whole) For            K                              2.08      $103.33  ...........       $20.67
          Transfusion.
   0952  Cryoprecipitate............  K                              0.70       $34.70  ...........        $6.94
   0953  Fibrinogen Unit............  K                              0.48       $23.80  ...........        $4.76
   0954  RBC Leukocytes Reduced.....  K                              2.83      $140.35  ...........       $28.07
   0955  Plasma, Fresh Frozen.......  K                              2.26      $111.85  ...........       $22.37
   0956  Plasma Protein Fraction....  K                              1.26       $62.49  ...........       $12.50
   0957  Platelet Concentrate.......  K                              0.98       $48.55  ...........        $9.71
   0958  Platelet Rich Plasma.......  K                              1.16       $57.54  ...........       $11.51
   0959  Red Blood Cells............  K                              2.04      $101.31  ...........       $20.26
   0960  Washed Red Blood Cells.....  K                              3.81      $188.75  ...........       $37.75
   0961  Infusion, Albumin (Human)    K                              2.77      $137.38  ...........       $27.48
          5%, 500 ml.
   0962  Infusion, Albumin (Human)    K                              1.38       $68.44  ...........       $13.69
          25%, 50 ml.
   0970  New Technology-- I ($0-$50)  T                              0.52       $25.79  ...........        $5.16
   0971  New Technology-- II ($50-    S                              1.55       $76.88  ...........       $15.38
          $100).
   0972  New Technology-- III ($100-  T                              3.09      $153.26  ...........       $30.65
          $200).
   0973  New Technology-- IV ($200-   T                              5.16      $255.91  ...........       $51.18
          $300).
   0974  New Technology-- V ($300-    S                              8.25      $409.17  ...........       $81.83
          $500).
   0975  New Technology-- VI ($500-   T                             12.90      $639.79  ...........      $127.96
          $750).
   0976  New Technology-- VII ($750-  S                             18.05      $895.21  ...........      $179.04
          $1000).
   0977  New Technology-- VIII        T                             23.20    $1,150.63  ...........      $230.13
          ($1000-$1250).
   0978  New Technology-- IX ($1250-  T                             28.36    $1,406.54  ...........      $281.31
          $1500).
   0979  New Technology-- X ($1500-   T                             33.51    $1,661.96  ...........      $332.39
          $1750).
   0980  New Technology-- XI ($1750-  T                             38.67    $1,917.89  ...........      $383.58
          $2000).
   0981  New Technology-- XII ($2000- S                             46.40    $2,301.26  ...........      $460.25
          $2500).
   0982  New Technology-- XIII        T                             61.87    $3,068.50  ...........      $613.70
          ($2500-$3500).
   0983  New Technology-- XIV ($3500- T                             87.65    $4,347.09  ...........      $869.42
          $5000).
   0984  New Technology-- XV ($5000-  T                            113.43    $5,625.67  ...........    $1,125.13
          $6000).
   0987  New Device Technology-- I    X                       ...........      $127.86  ...........       $25.57
          ($0-$250).
   0988  New Device Technology-- II   X                       ...........      $383.58  ...........       $76.72
          ($250-$500).
   0989  New Device Technology-- III  X                       ...........      $639.30  ...........      $127.86
          ($500-$750).
   0990  New Device Technology-- IV   X                       ...........      $895.01  ...........      $179.00
          ($750-$1000).
   0991  New Device Technology-- V    X                       ...........    $1,278.59  ...........      $255.72
          ($1000-$1500).
   0992  New Device Technology-- VI   X                       ...........    $1,790.03  ...........      $358.01
          ($1500-$2000).
   0993  New Device Technology-- VII  X                       ...........    $2,557.18  ...........      $511.44
          ($2000-$3000).
   0994  New Device Technology--      X                       ...........    $3,580.05  ...........      $716.01
          VIII ($3000-$4000).
   0995  New Device Technology-- IX   X                       ...........    $4,602.92  ...........      $920.58
          ($4000-$5000).
   0996  New Device Technology-- X    X                       ...........    $6,137.23  ...........    $1,227.45
          ($5000-$7000).
   0997  New Device Technology-- XI   X                       ...........    $8,182.98  ...........    $1,636.60
          ($7000-$9000).
   1000  Perclose Closer Prostar      H                       ...........  ...........  ...........  ...........
          Arterial Vascular Closure.
   1001  AcuNav-diagnstic ultrsnd ca  H                       ...........  ...........  ...........  ...........
   1002  Cochlear Implant System....  H                       ...........  ...........  ...........  ...........
   1003  Cath, ablation, Livewire TC  H                       ...........  ...........  ...........  ...........
   1004  Fast-Cath,Swartz,SAFL,CSTA.  H                       ...........  ...........  ...........  ...........
   1006  ARRAY post chamb IOL.......  H                       ...........  ...........  ...........  ...........
   1007  Ams 700 penile prosthesis..  H                       ...........  ...........  ...........  ...........
   1008  Urolume-implt urethral       H                       ...........  ...........  ...........  ...........
          stent.
   1009  Plasma, cryoprecipitate-     K                              0.86       $42.76  ...........        $8.55
          reduced, unit.
   1010  Blood, L/R, CMV-neg........  K                              2.88      $142.84  ...........       $28.57
   1011  Platelets, L/R, CMV-neg,     K                             11.86      $588.15  ...........      $117.63
          unit.
   1012  Platelet concentrate, L/R,   K                              1.92       $95.23  ...........       $19.05
          irradiated, unit.
   1013  Platelet concentrate, L/R,   K                              1.18       $58.30  ...........       $11.66
          unit.
   1014  Platelets, aph/pher, L/R,    K                              8.93      $443.11  ...........       $88.62
          unit.
   1016  Blood, L/R, froz/deglycerol/ K                              7.15      $354.68  ...........       $70.94
          washed.
   1017  Platelets, aph/pher, L/R,    K                              9.33      $462.54  ...........       $92.51
          CMV-neg, unit.
   1018  Blood, L/R, irradiated.....  K                              3.13      $155.48  ...........       $31.10
   1019  Platelets, aph/pher, L/R,    K                              9.64      $478.09  ...........       $95.62
          irradiated, unit.
   1024  Quinupristin 150 mg/         J                       ...........      $102.05  ...........       $13.67
          dalfopriston 350 mg.
   1025  Marinr CS catheter.........  H                       ...........  ...........  ...........  ...........
   1026  RF Perfrmr cath 5F RF        H                       ...........  ...........  ...........  ...........
          Marinr.
   1027  Magic x/short, Radius14mm..  H                       ...........  ...........  ...........  ...........
   1028  Prcis Twst trnsvg anch sys.  H                       ...........  ...........  ...........  ...........
   1029  CRE guided balloon dil cath  H                       ...........  ...........  ...........  ...........
   1030  Cthtr:Mrshal,Blu Max Utr     H                       ...........  ...........  ...........  ...........
          Dmnd.

[[Page 67836]]

 
   1033  Sonicath mdl 37-410........  H                       ...........  ...........  ...........  ...........
   1034  SURPASS, Long30 SURPASS-     H                       ...........  ...........  ...........  ...........
          cath.
   1035  Cath, Ultra ICE............  H                       ...........  ...........  ...........  ...........
   1036  R port/reservoir impl dev..  H                       ...........  ...........  ...........  ...........
   1037  Vaxcelchronic dialysis cath  H                       ...........  ...........  ...........  ...........
   1038  UltraCross Imaging Cath....  H                       ...........  ...........  ...........  ...........
   1039  Wallstent/RP: Trach........  H                       ...........  ...........  ...........  ...........
   1040  Wallstent/RP TIPS--20/40/60  H                       ...........  ...........  ...........  ...........
   1042  Wallstent, UltraFlex: Bil..  H                       ...........  ...........  ...........  ...........
   1043  Atherectomy sys, coronary..  H                       ...........  ...........  ...........  ...........
   1045  I-131 MIBG (ioben-sulfate)   G                       ...........    $1,140.00  ...........      $139.08
          O.5mCi.
   1047  Navi-Star, Noga-Star cath..  H                       ...........  ...........  ...........  ...........
   1048  NeuroCyberneticPros: gen...  H                       ...........  ...........  ...........  ...........
   1051  Oasis Thrombectomy Cath....  H                       ...........  ...........  ...........  ...........
   1053  EnSite 3000 catheter.......  H                       ...........  ...........  ...........  ...........
   1054  Hydrolyser Thromb Cath 6/7F  H                       ...........  ...........  ...........  ...........
   1055  Transesoph 210, 210-S Cath.  H                       ...........  ...........  ...........  ...........
   1056  Thermachoice II Cath.......  H                       ...........  ...........  ...........  ...........
   1057  Micromark Tissue Marker....  H                       ...........  ...........  ...........  ...........
   1059  Carticel,auto cult-chndr     G                       ...........   $14,250.00  ...........    $2,010.00
          cyte.
   1060  ACS multi-link tristor       H                       ...........  ...........  ...........  ...........
          stent.
   1061  ACS Viking Guiding cath....  H                       ...........  ...........  ...........  ...........
   1063  EndoTak Endurance EZ, RX     H                       ...........  ...........  ...........  ...........
          leads.
   1067  Megalink biliary stent.....  H                       ...........  ...........  ...........  ...........
   1068  Pulsar DDD pmkr............  H                       ...........  ...........  ...........  ...........
   1069  Discovery DR, pmaker.......  H                       ...........  ...........  ...........  ...........
   1071  Pulsar Max, Pulsar SR pmkr.  H                       ...........  ...........  ...........  ...........
   1072  Guidant: blln dil cath.....  H                       ...........  ...........  ...........  ...........
   1073  Gynecare Morcellator.......  H                       ...........  ...........  ...........  ...........
   1074  RX/OTW Viatrac-peri dil      H                       ...........  ...........  ...........  ...........
          cath.
   1075  Guidant: lead..............  H                       ...........  ...........  ...........  ...........
   1076  Ventak mini sc defib.......  H                       ...........  ...........  ...........  ...........
   1077  Ventak VR Prizm VR, sc       H                       ...........  ...........  ...........  ...........
          defib.
   1078  Ventak: Prizm, AVIIIDR       H                       ...........  ...........  ...........  ...........
          defib.
   1079  CO 57/58 0.5 mCi...........  G                       ...........      $264.10  ...........       $32.22
   1084  Denileukin diftitox, 300     G                       ...........      $942.88  ...........      $126.35
          mcg.
   1086  Temozolomide, 5 mg.........  G                       ...........        $5.70  ...........        $0.76
   1087  I-123 per uCi capsule......  G                       ...........        $0.84  ...........        $0.10
   1089  CO 57, 0.5 mCi.............  G                       ...........       $91.20  ...........       $11.13
   1090  IN 111 Chloride, per mCi...  G                       ...........      $152.00  ...........       $18.54
   1091  IN 111 Oxyquinoline, per 5   G                       ...........      $508.25  ...........       $62.01
          mCi.
   1092  IN 111 Pentetate, per 1.5    G                       ...........      $769.50  ...........       $93.88
          mCi.
   1094  TC 99M Albumin aggr, per     J                       ...........       $34.20  ...........        $4.17
          vial.
   1095  TC 99M Depreotide, per vial  G                       ...........      $760.00  ...........      $101.84
   1096  TC 99M Exametazime, per      G                       ...........      $445.31  ...........       $63.75
          dose.
   1097  TC 99M Mebrofenin, per vial  G                       ...........       $46.76  ...........        $5.71
   1098  TC 99M Pentetate, per vial.  G                       ...........       $22.80  ...........        $2.78
   1099  TC 99M Pyrophosphate, per    J                       ...........       $42.75  ...........        $5.22
          vial.
   1100  Medtronic AVE GT1 guidewire  H                       ...........  ...........  ...........  ...........
   1101  Medtronic AVE, AVE Z2 cath.  H                       ...........  ...........  ...........  ...........
   1102  Synergy Neurostim Genrtr...  H                       ...........  ...........  ...........  ...........
   1103  Micro Jewel Defibrillator..  H                       ...........  ...........  ...........  ...........
   1104  RF Conductor Ablative Cath.  H                       ...........  ...........  ...........  ...........
   1105  Sigma 300VDD pacmker.......  H                       ...........  ...........  ...........  ...........
   1106  SynergyEZ Pt Progrmr.......  H                       ...........  ...........  ...........  ...........
   1107  Torqr, Solist cath.........  H                       ...........  ...........  ...........  ...........
   1108  Reveal Cardiac Recorder....  H                       ...........  ...........  ...........  ...........
   1109  Implantable anchor: Ethicon  H                       ...........  ...........  ...........  ...........
   1110  Stable Mapper, cath electrd  H                       ...........  ...........  ...........  ...........
   1111  AneuRxAort-Uni-              H                       ...........  ...........  ...........  ...........
          Ilicstnt&cath.
   1112  AneuRx Stent graft/del.cath  H                       ...........  ...........  ...........  ...........
   1113  Tlnt Endo Sprng Stnt Grft    H                       ...........  ...........  ...........  ...........
          Sys.
   1114  TalntSprgStnt+Graf endo      H                       ...........  ...........  ...........  ...........
          pros.
   1115  5038S,5038,5038L pace lead.  H                       ...........  ...........  ...........  ...........
   1116  CapSureSP pacing Lead......  H                       ...........  ...........  ...........  ...........
   1117  Ancure Endograft Del Sys...  H                       ...........  ...........  ...........  ...........
   1118  Sigma300DR LegIIDR,pacemkr.  H                       ...........  ...........  ...........  ...........
   1119  Sprint6932,6943 defib lead.  H                       ...........  ...........  ...........  ...........
   1120  Sprint6942,6945 defib lead.  H                       ...........  ...........  ...........  ...........
   1121  Gem defibrillator..........  H                       ...........  ...........  ...........  ...........
   1122  TC 99M arcitumomab per dose  G                       ...........      $926.25  ...........      $124.12
   1123  Gem II VR defibrillator....  H                       ...........  ...........  ...........  ...........
   1124  InterStim Test Stim Kit....  H                       ...........  ...........  ...........  ...........
   1125  Kappa 400SR,Ttopaz II SR     H                       ...........  ...........  ...........  ...........
          pmkr.
   1126  Kappa 700 DR pacemakr......  H                       ...........  ...........  ...........  ...........
   1127  Kappa 700SR,pmkr sgl         H                       ...........  ...........  ...........  ...........
          chamber.
   1128  Kappa 700D,Ruby IID pmkr...  H                       ...........  ...........  ...........  ...........
   1129  Kappa 700VDD,pacmkr........  H                       ...........  ...........  ...........  ...........

[[Page 67837]]

 
   1130  Sigma 200D,LGCY IID sc pmkr  H                       ...........  ...........  ...........  ...........
   1131  Sigma 200DR, pmker.........  H                       ...........  ...........  ...........  ...........
   1132  Sigma 200SR Leg II:sc pac..  H                       ...........  ...........  ...........  ...........
   1133  Sigma SR, Vita SR, pmaker..  H                       ...........  ...........  ...........  ...........
   1134  Sigma 300D pmker...........  H                       ...........  ...........  ...........  ...........
   1135  Entity DR 5326L/R, DC, pmkr  H                       ...........  ...........  ...........  ...........
   1136  Affinity DR 5330L/R, DC,     H                       ...........  ...........  ...........  ...........
          pmkr.
   1137  CardioSEAL implant syst....  H                       ...........  ...........  ...........  ...........
   1143  AddVent mod 2060BL,VDD.....  H                       ...........  ...........  ...........  ...........
   1144  Afnty SP 5130,Integrity      H                       ...........  ...........  ...........  ...........
          SR,pmkr.
   1145  Angio-Seal 6fr, 8fr........  H                       ...........  ...........  ...........  ...........
   1147  AV Plus DX 1368: lead......  H                       ...........  ...........  ...........  ...........
   1148  Contour MD sc defib........  H                       ...........  ...........  ...........  ...........
   1149  Entity DC 5226R-pmker......  H                       ...........  ...........  ...........  ...........
   1151  Passiveplus DX lead, 10mdls  H                       ...........  ...........  ...........  ...........
   1152  LifeSite Access System.....  H                       ...........  ...........  ...........  ...........
   1153  Regency SC+ 2402L pmker....  H                       ...........  ...........  ...........  ...........
   1154  SPL:SPOI,02,04- defib lead.  H                       ...........  ...........  ...........  ...........
   1155  Repliform 8 sq cm..........  H                       ...........  ...........  ...........  ...........
   1156  Tr 1102TrSR+                 H                       ...........  ...........  ...........  ...........
          2260L,2264L,5131.
   1157  Trilogy DCT 23/8L pmkr.....  H                       ...........  ...........  ...........  ...........
   1158  TVL lead SV01,SV02,SV04....  H                       ...........  ...........  ...........  ...........
   1159  TVL RV02,RV06,RV07: lead...  H                       ...........  ...........  ...........  ...........
   1160  TVL-ADX 1559: lead.........  H                       ...........  ...........  ...........  ...........
   1161  Tendril DX, 1388 pacing      H                       ...........  ...........  ...........  ...........
          lead.
   1162  TempoDr, TrilogyDR+DC pmkr.  H                       ...........  ...........  ...........  ...........
   1163  Tendril SDX, 1488T pacing    H                       ...........  ...........  ...........  ...........
          lead.
   1164  Iodine-125 brachytx seed...  H                       ...........  ...........  ...........  ...........
   1166  Cytarabine liposomal, 10 mg  G                       ...........      $371.45  ...........       $49.77
   1167  Epirubicin hcl, 2 mg.......  J                       ...........       $24.94  ...........        $3.34
   1171  Autosuture site marker       H                       ...........  ...........  ...........  ...........
          stple.
   1172  Spacemaker dissect ballon..  H                       ...........  ...........  ...........  ...........
   1173  Cor stntS540,S670,o-wire     H                       ...........  ...........  ...........  ...........
          stn.
   1174  Bard brachytx needle.......  H                       ...........  ...........  ...........  ...........
   1178  Busulfan IV, 6 mg..........  G                       ...........       $26.48  ...........        $3.55
   1180  Vigor SR, SC, pmkr.........  H                       ...........  ...........  ...........  ...........
   1181  Meridian SSI, SC, pmkr.....  H                       ...........  ...........  ...........  ...........
   1182  Pulsar SSI, SC, pmkr.......  H                       ...........  ...........  ...........  ...........
   1183  Jade IIS, Sigma 300S,SC,     H                       ...........  ...........  ...........  ...........
          pmkr.
   1184  Sigma 200S, SC, pmkr.......  H                       ...........  ...........  ...........  ...........
   1188  I 131, per mCi.............  G                       ...........        $5.86  ...........        $0.75
   1200  TC 99M Sodium                G                       ...........      $113.05  ...........       $13.79
          Glucoheptonate, per vial.
   1201  TC 99M succimer, per vial..  G                       ...........      $135.66  ...........       $16.55
   1202  TC 99M Sulfur Colloid, per   G                       ...........       $38.00  ...........        $4.64
          dose.
   1203  Verteporfin for Injection..  G                       ...........    $1,458.25  ...........      $195.41
   1205  TC 99M Disofenin, per vial.  G                       ...........      $427.50  ...........       $57.29
   1207  Octreotide acetate depot     G                       ...........      $135.10  ...........       $16.48
          1mg.
   1302  SQ01: lead.................  H                       ...........  ...........  ...........  ...........
   1303  CapSure Fix 6940/4068-110,   H                       ...........  ...........  ...........  ...........
          lead.
   1304  Sonicath mdl 37-416,-418...  H                       ...........  ...........  ...........  ...........
   1305  Apligraf...................  G                       ...........    $1,157.81  ...........      $163.31
   1306  NeuroCyberneticPros: lead..  H                       ...........  ...........  ...........  ...........
   1311  Trilogy DR+/DAO pmkr.......  H                       ...........  ...........  ...........  ...........
   1312  Magic WALLSTENT stent-Mini.  H                       ...........  ...........  ...........  ...........
   1313  Magic medium, Radius 31mm..  H                       ...........  ...........  ...........  ...........
   1314  Magic WALLSTENT stent-Long.  H                       ...........  ...........  ...........  ...........
   1315  Vigor DR, Meridian DR pmkr.  H                       ...........  ...........  ...........  ...........
   1316  Meridian DDD pmkr..........  H                       ...........  ...........  ...........  ...........
   1317  Discovery SR, pmkr.........  H                       ...........  ...........  ...........  ...........
   1318  Meridian SR pmakr..........  H                       ...........  ...........  ...........  ...........
   1319  Wallstent/RP Enteral--60mm.  H                       ...........  ...........  ...........  ...........
   1320  Wallstent/RP Iliac Del Sys.  H                       ...........  ...........  ...........  ...........
   1325  Pallidium -103 seed........  H                       ...........  ...........  ...........  ...........
   1326  Angio-jet rheolytic thromb   H                       ...........  ...........  ...........  ...........
          cath.
   1328  ANS Renew NS trnsmtr.......  H                       ...........  ...........  ...........  ...........
   1333  PALMZA Corinthian bill       H                       ...........  ...........  ...........  ...........
          stent.
   1334  Crown,Mini-crown,CrossLC...  H                       ...........  ...........  ...........  ...........
   1335  Mesh, Prolene..............  H                       ...........  ...........  ...........  ...........
   1336  Constant Flow Imp Pump.....  H                       ...........  ...........  ...........  ...........
   1337  IsoMed 8472-20/35/60.......  H                       ...........  ...........  ...........  ...........
   1348  I 131 per mCi solution.....  G                       ...........      $146.57  ...........       $17.88
   1350  Prosta/OncoSeed, RAPID       H                       ...........  ...........  ...........  ...........
          strand, I-125.
   1351  CapSure(Fix)pacing lead....  H                       ...........  ...........  ...........  ...........
   1352  Gem II defib...............  H                       ...........  ...........  ...........  ...........
   1353  Itrel Interstm               H                       ...........  ...........  ...........  ...........
          neurostim+ext.
   1354  Kappa 400DR,Diamond II       H                       ...........  ...........  ...........  ...........
          820DR.
   1355  Kappa 600DR, Vita DR.......  H                       ...........  ...........  ...........  ...........
   1356  Profile MD V-186HV3 sc       H                       ...........  ...........  ...........  ...........
          defib.

[[Page 67838]]

 
   1357  Angstrom MD V-190HV3 sc      H                       ...........  ...........  ...........  ...........
          defib.
   1358  Affinity DC 5230R-Pacemaker  H                       ...........  ...........  ...........  ...........
   1359  Pulsar,Pulsar Max DR,pmkr..  H                       ...........  ...........  ...........  ...........
   1363  Gem DR, DC, defib..........  H                       ...........  ...........  ...........  ...........
   1364  Photon DR V-230HV3 DC defib  H                       ...........  ...........  ...........  ...........
   1365  Guidewire, Hi-Torque14/18/   H                       ...........  ...........  ...........  ...........
          35.
   1366  Guidewire,PTCA, Hi-Torque..  H                       ...........  ...........  ...........  ...........
   1367  Guidewire, Hi-Torque         H                       ...........  ...........  ...........  ...........
          CrossIt.
   1369  ANS Renew Stim Sys recvr...  H                       ...........  ...........  ...........  ...........
   1370  Tension-Free Vaginal Tape..  H                       ...........  ...........  ...........  ...........
   1371  Symp Nitinol Transhep Bil    H                       ...........  ...........  ...........  ...........
          Sys.
   1372  Cordis Nitinol bil stent...  H                       ...........  ...........  ...........  ...........
   1375  Stent, coronary, NIR.......  H                       ...........  ...........  ...........  ...........
   1376  ANS Renew Stim Sys lead....  H                       ...........  ...........  ...........  ...........
   1377  Specify 3988 neuro lead....  H                       ...........  ...........  ...........  ...........
   1378  InterStim Tx 3080/3886 lead  H                       ...........  ...........  ...........  ...........
   1379  Pisces-Quad 3887 lead......  H                       ...........  ...........  ...........  ...........
   1400  Diphenhydramine hcl 50mg...  G                       ...........        $1.18  ...........         $.16
   1401  Prochlorperazine maleate     G                       ...........        $1.31  ...........         $.18
          5mg.
   1402  Promethazine hcl 12.5mg      G                       ...........         $.03  ...........         $.00
          oral.
   1403  Chlorpromazine hcl 10mg      G                       ...........         $.55  ...........         $.07
          oral.
   1404  Trimethobenzamide hcl 250mg  G                       ...........         $.36  ...........         $.05
   1405  Thiethylperazine             G                       ...........         $.69  ...........         $.09
          maleate10mg.
   1406  Perphenazine 4mg oral......  G                       ...........         $.71  ...........         $.10
   1407  Hydroxyzine pamoate 25mg...  G                       ...........         $.20  ...........         $.03
   1409  Factor viia recombinant,     G                       ...........    $1,596.00  ...........      $213.86
          per 1.2 mg.
   1410  Prosorba column............  H                       ...........  ...........  ...........  ...........
   1411  Herculink,OTW SDS bil stent  H                       ...........  ...........  ...........  ...........
   1420  StapleTac2 Bone w/Dermis...  H                       ...........  ...........  ...........  ...........
   1421  StapleTac2 Bone wo Dermis..  H                       ...........  ...........  ...........  ...........
   1450  Orthosphere Arthroplasty...  H                       ...........  ...........  ...........  ...........
   1451  Orthosphere Arthroplasty     H                       ...........  ...........  ...........  ...........
          Kit.
   1500  Atherectomy sys, peripheral  H                       ...........  ...........  ...........  ...........
   1600  TC 99M sestamibi, per        G                       ...........      $109.25  ...........       $13.33
          syringe.
   1601  TC 99M medronate, per dose.  G                       ...........       $38.38  ...........        $4.68
   1602  TC 99M apcitide, per vial..  G                       ...........       $47.50  ...........        $5.80
   1603  TL 201, mCi................  G                       ...........       $28.50  ...........        $3.48
   1604  IN 111 capromab pendetide,   G                       ...........    $1,008.90  ...........      $135.19
          per dose.
   1605  Abciximab injection, 10 mg.  G                       ...........      $513.02  ...........       $68.74
   1606  Anistreplase, 30 u.........  G                       ...........    $2,693.80  ...........      $360.97
   1607  Eptifibatide injection, 5    G                       ...........       $12.57  ...........        $1.68
          mg.
   1608  Etanercept injection, 25 mg  G                       ...........      $134.42  ...........       $18.01
   1609  Rho(D) immune globulin h,    G                       ...........       $20.55  ...........        $2.51
          sd, 100 iu.
   1611  Hylan G-F 20 injection, 16   G                       ...........      $204.87  ...........       $27.45
          mg.
   1612  Daclizumab, parenteral, 25   G                       ...........      $397.29  ...........       $53.24
          mg.
   1613  Trastuzumab, 10 mg.........  G                       ...........       $48.85  ...........        $6.55
   1614  Valrubicin, 200 mg.........  G                       ...........      $423.23  ...........       $56.71
   1615  Basiliximab, 20 mg.........  G                       ...........    $1,250.01  ...........      $167.50
   1616  Histrelin Acetate, 0.5 mg..  G                       ...........       $14.91  ...........        $2.00
   1617  Lepirdin, 50 mg............  G                       ...........      $124.49  ...........       $16.68
   1618  Von Willebrand factor, per   G                       ...........         $.95  ...........         $.13
          iu.
   1619  Ga 67, per mCi.............  G                       ...........       $25.97  ...........        $3.17
   1620  TC 99M Bicisate, per vial..  G                       ...........      $417.53  ...........       $55.95
   1621  Xe 133, per mCi............  G                       ...........       $28.50  ...........        $3.66
   1622  TC 99M Mertiatide, per vial  G                       ...........      $185.82  ...........       $24.90
   1623  TC 99M Gluceptate..........  G                       ...........       $22.61  ...........        $2.76
   1624  P32 sodium, per mCi........  G                       ...........       $74.10  ...........        $9.04
   1625  IN 111 Pentetreotide, per    G                       ...........      $283.42  ...........       $37.98
          mCi.
   1626  TC 99M Oxidronate, per vial  G                       ...........       $38.38  ...........        $4.68
   1627  TC-99 labeled red blood      G                       ...........       $38.95  ...........        $4.75
          cell, per test.
   1628  P32 phosphate chromic, per   G                       ...........      $137.12  ...........       $16.73
          mCi.
   1700  Authen Mick TP brachy        H                       ...........  ...........  ...........  ...........
          needle.
   1701  Medtec MT-BT-5201-25 ndl...  H                       ...........  ...........  ...........  ...........
   1702  WWMT brachytx needle.......  H                       ...........  ...........  ...........  ...........
   1703  Mentor Prostate Brachy.....  H                       ...........  ...........  ...........  ...........
   1704  MT-BT-5001-25/5051-25......  H                       ...........  ...........  ...........  ...........
   1705  Best Flexi Brachy Needle...  H                       ...........  ...........  ...........  ...........
   1706  Indigo Prostate Seeding Ndl  H                       ...........  ...........  ...........  ...........
   1707  Varisource Implt Ndl.......  H                       ...........  ...........  ...........  ...........
   1708  UroMed Prostate Seed Ndl...  H                       ...........  ...........  ...........  ...........
   1709  Remington Brachytx Needle..  H                       ...........  ...........  ...........  ...........
   1710  US Biopsy Prostate Needle..  H                       ...........  ...........  ...........  ...........
   1711  MD Tech brachytx needle....  H                       ...........  ...........  ...........  ...........
   1712  Imagyn brachytx needle.....  H                       ...........  ...........  ...........  ...........
   1790  Iridium 192 HDR............  H                       ...........  ...........  ...........  ...........
   1791  OncoSeed, Rapid Strand I-    H                       ...........  ...........  ...........  ...........
          125.
   1792  UroMed I-125 Brachy seed...  H                       ...........  ...........  ...........  ...........
   1793  Bard InterSource P-103 seed  H                       ...........  ...........  ...........  ...........

[[Page 67839]]

 
   1794  Bard IsoSeed P-103 seed....  H                       ...........  ...........  ...........  ...........
   1795  Bard BrachySource I-125....  H                       ...........  ...........  ...........  ...........
   1796  SourceTech Med I-125.......  H                       ...........  ...........  ...........  ...........
   1797  Draximage I-125 seed.......  H                       ...........  ...........  ...........  ...........
   1798  Syncor I-125 PharmaSeed....  H                       ...........  ...........  ...........  ...........
   1799  I-Plant I-125 Brachytx seed  H                       ...........  ...........  ...........  ...........
   1800  Pd-103 brachytx seed.......  H                       ...........  ...........  ...........  ...........
   1801  IoGold I-125 brachytx seed.  H                       ...........  ...........  ...........  ...........
   1802  Iridium 192 brachytx seeds.  H                       ...........  ...........  ...........  ...........
   1803  Best Iodine 125 brachytx     H                       ...........  ...........  ...........  ...........
          sds.
   1804  Best Palladium 103 seeds...  H                       ...........  ...........  ...........  ...........
   1805  IsoStar Iodine-125 seeds...  H                       ...........  ...........  ...........  ...........
   1806  Gold 198...................  H                       ...........  ...........  ...........  ...........
   1810  D114S Dilatation Cath......  H                       ...........  ...........  ...........  ...........
   1811  Surgical Dynamics Anchors..  H                       ...........  ...........  ...........  ...........
   1812  OBL Anchors................  H                       ...........  ...........  ...........  ...........
   1850  Repliform 14/21 sq cm......  H                       ...........  ...........  ...........  ...........
   1851  Repliform 24/28 sq cm......  H                       ...........  ...........  ...........  ...........
   1852  TransCyte, per 247 sq cm...  H                       ...........  ...........  ...........  ...........
   1853  Suspend, per 8/14 sq cm....  H                       ...........  ...........  ...........  ...........
   1854  Suspend, per 24/28 sq cm...  H                       ...........  ...........  ...........  ...........
   1855  Suspend, per 36 sq cm......  H                       ...........  ...........  ...........  ...........
   1856  Suspend, per 48 sq cm......  H                       ...........  ...........  ...........  ...........
   1857  Suspend, per 84 sq cm......  H                       ...........  ...........  ...........  ...........
   1858  DuraDerm, per 8/14 sq cm...  H                       ...........  ...........  ...........  ...........
   1859  DuraDerm, per 21/24/28 sq    H                       ...........  ...........  ...........  ...........
          cm.
   1860  DuraDerm, per 48 sq cm.....  H                       ...........  ...........  ...........  ...........
   1861  DuraDerm, per 36 sq cm.....  H                       ...........  ...........  ...........  ...........
   1862  DuraDerm, per 72 sq cm.....  H                       ...........  ...........  ...........  ...........
   1863  DuraDerm, per 84 sq cm.....  H                       ...........  ...........  ...........  ...........
   1864  SpermaTex, per 13.44 sq cm.  H                       ...........  ...........  ...........  ...........
   1865  FasLata, per 8/14 sq cm....  H                       ...........  ...........  ...........  ...........
   1866  FasLata, per 24/28 sq cm...  H                       ...........  ...........  ...........  ...........
   1867  FasLata, per 36/48 sq cm...  H                       ...........  ...........  ...........  ...........
   1868  FasLata, per 96 sq cm......  H                       ...........  ...........  ...........  ...........
   1869  Gore Thyroplasty Dev.......  H                       ...........  ...........  ...........  ...........
   1870  DermMatrix, per 16 sq cm...  H                       ...........  ...........  ...........  ...........
   1871  DermMatrix, 32 or 64 sq cm.  H                       ...........  ...........  ...........  ...........
   1872  Dermagraft, per 37.5 sq cm.  H                       ...........  ...........  ...........  ...........
   1873  Bard 3DMax Mesh............  H                       ...........  ...........  ...........  ...........
   1929  Maverick PTCA Cath.........  H                       ...........  ...........  ...........  ...........
   1930  Coyote Dil Cath, 20/30/40mm  H                       ...........  ...........  ...........  ...........
   1931  Talon Dil Cath.............  H                       ...........  ...........  ...........  ...........
   1932  Scimed Remedy Dil Cath.....  H                       ...........  ...........  ...........  ...........
   1933  Opti-Plast XL/Centurion      H                       ...........  ...........  ...........  ...........
          Cath.
   1934  Ultraverse 3.5F Bal Dil      H                       ...........  ...........  ...........  ...........
          Cath.
   1935  Workhorse PTA Bal Cath.....  H                       ...........  ...........  ...........  ...........
   1936  Uromax Ultra Bal Dil Cath..  H                       ...........  ...........  ...........  ...........
   1937  Synergy Balloon Dil Cath...  H                       ...........  ...........  ...........  ...........
   1938  UroForce Bal Dil Cath......  H                       ...........  ...........  ...........  ...........
   1939  Raptur, Ninja PTCA Dil Cath  H                       ...........  ...........  ...........  ...........
   1940  PowerFlex,OPTA 5/LP Bal      H                       ...........  ...........  ...........  ...........
          Cath.
   1941  Jupiter PTA Dil Cath.......  H                       ...........  ...........  ...........  ...........
   1942  Cordis Maxi LD PTA Bal Cath  H                       ...........  ...........  ...........  ...........
   1943  RXCrossSail OTW OpenSail...  H                       ...........  ...........  ...........  ...........
   1944  Rapid Exchange Bil Dil Cath  H                       ...........  ...........  ...........  ...........
   1945  Savvy PTA Dil Cath.........  H                       ...........  ...........  ...........  ...........
   1946  R1s Rapid Dil Cath.........  H                       ...........  ...........  ...........  ...........
   1947  Gazelle Bal Dil Cath.......  H                       ...........  ...........  ...........  ...........
   1948  Pursuit Balloon Cath.......  H                       ...........  ...........  ...........  ...........
   1949  Oracle Megasonics Cath.....  H                       ...........  ...........  ...........  ...........
   1979  Visions PV/Avanar US Cath..  H                       ...........  ...........  ...........  ...........
   1980  Atlantis SR Coronary Cath..  H                       ...........  ...........  ...........  ...........
   1981  PTCA Catheters.............  H                       ...........  ...........  ...........  ...........
   2000  Orbiter ST Steerable Cath..  H                       ...........  ...........  ...........  ...........
   2001  Constellation Diag Cath....  H                       ...........  ...........  ...........  ...........
   2002  Irvine 5F Inquiry Diag EP    H                       ...........  ...........  ...........  ...........
          Cath.
   2003  Irvine 6F Inquiry Diag EP    H                       ...........  ...........  ...........  ...........
          Cath.
   2004  Biosense EP Cath--Octapolar  H                       ...........  ...........  ...........  ...........
   2005  Biosense EP Cath--Hexapolar  H                       ...........  ...........  ...........  ...........
   2006  Biosense EP Cath--Decapolar  H                       ...........  ...........  ...........  ...........
   2007  Irvine 6F Luma-Cath EP Cath  H                       ...........  ...........  ...........  ...........
   2008  7F Luma-Cath EP Cath 81910-  H                       ...........  ...........  ...........  ...........
          15.
   2009  Irvine 7F Luma-Cath EP Cath  H                       ...........  ...........  ...........  ...........
   2010  Fixed Curve EP Cath........  H                       ...........  ...........  ...........  ...........
   2011  Deflectable Tip Cath--Quad.  H                       ...........  ...........  ...........  ...........
   2012  Celsius Abln Cath..........  H                       ...........  ...........  ...........  ...........
   2013  Celsius Large Abln Cath....  H                       ...........  ...........  ...........  ...........

[[Page 67840]]

 
   2014  Celsius II Asym Abln Cath..  H                       ...........  ...........  ...........  ...........
   2015  Celsius II Sym Abln Cath...  H                       ...........  ...........  ...........  ...........
   2016  Navi-Star DS, Navi-Star      H                       ...........  ...........  ...........  ...........
          Ther.
   2017  Navi-Star Abln Cath........  H                       ...........  ...........  ...........  ...........
   2018  Polaris T Ablation Cath....  H                       ...........  ...........  ...........  ...........
   2019  EP Deflectable Cath........  H                       ...........  ...........  ...........  ...........
   2020  Blazer II XP Abln Cath.....  H                       ...........  ...........  ...........  ...........
   2021  SilverFlex EP Cath.........  H                       ...........  ...........  ...........  ...........
   2022  CP Chilli Cooled Abln Cath.  H                       ...........  ...........  ...........  ...........
   2023  Chilli Cld AblnCath-std, lg  H                       ...........  ...........  ...........  ...........
   2100  CP CS Reference Cath.......  H                       ...........  ...........  ...........  ...........
   2101  CP RV Reference Cath.......  H                       ...........  ...........  ...........  ...........
   2102  CP Radii 7F EP Cath........  H                       ...........  ...........  ...........  ...........
   2103  CP Radii 7F EP Cath w/Track  H                       ...........  ...........  ...........  ...........
   2104  Lasso Deflectable Cath.....  H                       ...........  ...........  ...........  ...........
   2151  Veripath Guiding Cath......  H                       ...........  ...........  ...........  ...........
   2152  Cordis Vista Brite Tip Cath  H                       ...........  ...........  ...........  ...........
   2153  Bard Viking Cath...........  H                       ...........  ...........  ...........  ...........
   2200  Arrow-Trerotola PTD Cath...  H                       ...........  ...........  ...........  ...........
   2300  Varisource Stnd Catheters..  H                       ...........  ...........  ...........  ...........
   2597  CliniCath/kit 16/18 sgl/dbl  H                       ...........  ...........  ...........  ...........
   2598  CliniCath 18/20/24G-single.  H                       ...........  ...........  ...........  ...........
   2599  CliniCath 16/18G-double....  H                       ...........  ...........  ...........  ...........
   2601  Bard DL Ureteral Cath......  H                       ...........  ...........  ...........  ...........
   2602  Vitesse Laser Cath 1.4/      H                       ...........  ...........  ...........  ...........
          1.7mm.
   2603  Vitesse Laser Cath 2.0mm...  H                       ...........  ...........  ...........  ...........
   2604  Vitesse E Laser Cath 2.0mm.  H                       ...........  ...........  ...........  ...........
   2605  Extreme Laser Catheter.....  H                       ...........  ...........  ...........  ...........
   2606  SpineCath XL Catheter......  H                       ...........  ...........  ...........  ...........
   2607  SpineCath Intradiscal Cath.  H                       ...........  ...........  ...........  ...........
   2608  Scimed 6F Wiseguide Cath...  H                       ...........  ...........  ...........  ...........
   2609  Flexima Bil Drainage Cath..  H                       ...........  ...........  ...........  ...........
   2610  FlexTipPlus Intraspinal      H                       ...........  ...........  ...........  ...........
          Cath.
   2611  AlgoLine Intraspinal Cath..  H                       ...........  ...........  ...........  ...........
   2612  InDura Catheter............  H                       ...........  ...........  ...........  ...........
   2700  MycroPhylax Plus SC defib..  H                       ...........  ...........  ...........  ...........
   2701  Phylax XM SC defib.........  H                       ...........  ...........  ...........  ...........
   2702  Ventak Prizm 2 VR Defib....  H                       ...........  ...........  ...........  ...........
   2703  Ventak Prizm VR HE Defib...  H                       ...........  ...........  ...........  ...........
   2704  Ventak Mini IV+ Defib......  H                       ...........  ...........  ...........  ...........
   2801  Defender IV DR 612 DC defib  H                       ...........  ...........  ...........  ...........
   2802  Phylax AV DC defib.........  H                       ...........  ...........  ...........  ...........
   2803  Ventak Prizm DR HE Defib...  H                       ...........  ...........  ...........  ...........
   2804  Ventak Prizm 2 DR Defib....  H                       ...........  ...........  ...........  ...........
   2805  Jewel AF 7250 Defib........  H                       ...........  ...........  ...........  ...........
   2806  GEM VR 7227 Defib..........  H                       ...........  ...........  ...........  ...........
   2807  Contak CD 1823.............  H                       ...........  ...........  ...........  ...........
   2808  Contak TR 1241.............  H                       ...........  ...........  ...........  ...........
   3002  EasyTrak Defib Lead........  H                       ...........  ...........  ...........  ...........
   3001  Kainox SL/RV defib lead....  H                       ...........  ...........  ...........  ...........
   3003  Endotak SQ Array XP lead...  H                       ...........  ...........  ...........  ...........
   3004  Intervene Defib Lead.......  H                       ...........  ...........  ...........  ...........
   3400  Siltex Spectrum, Contour     H                       ...........  ...........  ...........  ...........
          Prof.
   3401  Saline-Filled Spectrum.....  H                       ...........  ...........  ...........  ...........
   3500  Mentor Alpha I Inf Penile    H                       ...........  ...........  ...........  ...........
          Pros.
   3510  AMS 800 Urinary Pros.......  H                       ...........  ...........  ...........  ...........
   3551  Choice/PT Graphix/Luge/      H                       ...........  ...........  ...........  ...........
          Trooper.
   3552  Hi-Torque Whisper..........  H                       ...........  ...........  ...........  ...........
   3553  Cordis guidewires..........  H                       ...........  ...........  ...........  ...........
   3554  Jindo guidewire............  H                       ...........  ...........  ...........  ...........
   3555  Wholey Hi-Torque Plus GW...  H                       ...........  ...........  ...........  ...........
   3556  Wave/FlowWire Guidewire....  H                       ...........  ...........  ...........  ...........
   3557  HyTek guidewire............  H                       ...........  ...........  ...........  ...........
   3800  SynchroMed EL infusion pump  H                       ...........  ...........  ...........  ...........
   3801  Arrow/MicroJect PCA Sys....  H                       ...........  ...........  ...........  ...........
   3851  Elastic UV IOL AA-4203T/TF/  H                       ...........  ...........  ...........  ...........
          TL.
   4000  Opus G 4621, 4624 SC pmkr..  H                       ...........  ...........  ...........  ...........
   4001  Opus S 4121/4124 SC pmkr...  H                       ...........  ...........  ...........  ...........
   4002  Talent 113 SC pmkr.........  H                       ...........  ...........  ...........  ...........
   4003  Kairos SR SC pmkr..........  H                       ...........  ...........  ...........  ...........
   4004  Actros SR, Actros SLR SC     H                       ...........  ...........  ...........  ...........
          pmkr.
   4005  Philos SR/SR-B SC pmkr.....  H                       ...........  ...........  ...........  ...........
   4006  Pulsar Max II SR pmkr......  H                       ...........  ...........  ...........  ...........
   4007  Marathon SR pmkr...........  H                       ...........  ...........  ...........  ...........
   4008  Discovery II SSI pmkr......  H                       ...........  ...........  ...........  ...........
   4009  Discovery II SR pmkr.......  H                       ...........  ...........  ...........  ...........
   4300  Integrity AFx DR 5342 pmkr.  H                       ...........  ...........  ...........  ...........
   4301  Integrity AFx DR 5346 pmkr.  H                       ...........  ...........  ...........  ...........

[[Page 67841]]

 
   4302  Affinity VDR 5430 pmkr.....  H                       ...........  ...........  ...........  ...........
   4303  Brio 112 DC pmkr...........  H                       ...........  ...........  ...........  ...........
   4304  Brio 212, Talent 213/223 DC  H                       ...........  ...........  ...........  ...........
          pmkr.
   4305  Brio 222 DC pmkr...........  H                       ...........  ...........  ...........  ...........
   4306  Brio 220 DC pmkr...........  H                       ...........  ...........  ...........  ...........
   4307  Kairos DR DC pmkr..........  H                       ...........  ...........  ...........  ...........
   4308  Inos2, Inos2+ DC pmkr......  H                       ...........  ...........  ...........  ...........
   4309  Actros DR,D,DR-A,SLR DC      H                       ...........  ...........  ...........  ...........
          pmkr.
   4310  Actros DR-B DC pmkr........  H                       ...........  ...........  ...........  ...........
   4311  Philos DR/DR-B/SLR DC pmkr.  H                       ...........  ...........  ...........  ...........
   4312  Pulsar Max II DR pmkr......  H                       ...........  ...........  ...........  ...........
   4313  Marathon DR pmkr...........  H                       ...........  ...........  ...........  ...........
   4314  Momentum DR pmkr...........  H                       ...........  ...........  ...........  ...........
   4315  Selection AFm pmkr.........  H                       ...........  ...........  ...........  ...........
   4316  Discovery II DR............  H                       ...........  ...........  ...........  ...........
   4317  Discovery II DDD...........  H                       ...........  ...........  ...........  ...........
   4600  Snynox,Polyrox,Elox,Retrox.  H                       ...........  ...........  ...........  ...........
   4602  Tendril SDX, 1488K pmkr      H                       ...........  ...........  ...........  ...........
          lead.
   4603  Oscor/Flexion pmkr lead....  H                       ...........  ...........  ...........  ...........
   4604  CrystallineActFix,CapsureFi  H                       ...........  ...........  ...........  ...........
          x.
   4605  CapSure Epi pmkr lead......  H                       ...........  ...........  ...........  ...........
   4606  Flextend pmkr lead.........  H                       ...........  ...........  ...........  ...........
   4607  FinelineII/EZ, ThinlineII/   H                       ...........  ...........  ...........  ...........
          EZ.
   5000  BX Velocity w/Hepacoat.....  H                       ...........  ...........  ...........  ...........
   5001  Memotherm Bil Stent, sm,     H                       ...........  ...........  ...........  ...........
          med.
   5002  Memotherm Bil Stent, large.  H                       ...........  ...........  ...........  ...........
   5003  Memotherm Bil Stent, x-      H                       ...........  ...........  ...........  ...........
          large.
   5004  PalmazCorinthian IQ Bil      H                       ...........  ...........  ...........  ...........
          Stent.
   5005  PalmazCorinthian IQ Trans/   H                       ...........  ...........  ...........  ...........
          Bil.
   5006  PalmazTrans Bil Stent Sys-   H                       ...........  ...........  ...........  ...........
          Med.
   5007  PalmazTrans XL Bil Stent--   H                       ...........  ...........  ...........  ...........
          40mm.
   5008  PalmazTrans XL Bil Stent--   H                       ...........  ...........  ...........  ...........
          50mm.
   5009  VistaFlex Biliary Stent....  H                       ...........  ...........  ...........  ...........
   5010  Rapid Exchange Bil Stent     H                       ...........  ...........  ...........  ...........
          Sys.
   5011  IntraStent, IntraStent LP..  H                       ...........  ...........  ...........  ...........
   5012  IntraStent DoubleStrut LD..  H                       ...........  ...........  ...........  ...........
   5013  IntraStent DoubleStrut, XS.  H                       ...........  ...........  ...........  ...........
   5014  AVE Bridge Stent Sys-10/17/  H                       ...........  ...........  ...........  ...........
          28.
   5015  AVE/X3 Bridge Sys, 40-100..  H                       ...........  ...........  ...........  ...........
   5016  Biliary stent single use     H                       ...........  ...........  ...........  ...........
          cov.
   5017  WallstentRP Bil--20/40/60/   H                       ...........  ...........  ...........  ...........
          68mm.
   5018  WallstentRP Bil--80/94mm...  H                       ...........  ...........  ...........  ...........
   5019  Flexima Bil Stent Sys......  H                       ...........  ...........  ...........  ...........
   5020  Smart Nitinol Stent--20mm..  H                       ...........  ...........  ...........  ...........
   5021  Smart Nitinol Stent--40/     H                       ...........  ...........  ...........  ...........
          60mm.
   5022  Smart Nitinol Stent--80mm..  H                       ...........  ...........  ...........  ...........
   5023  BX Velocity Stent--8/13mm..  H                       ...........  ...........  ...........  ...........
   5024  BX Velocity Stent--18mm....  H                       ...........  ...........  ...........  ...........
   5025  BX Velocity Stent--23mm....  H                       ...........  ...........  ...........  ...........
   5026  BX Velocity Stent--28/33mm.  H                       ...........  ...........  ...........  ...........
   5027  BX Velocity w/Hep--8/13mm..  H                       ...........  ...........  ...........  ...........
   5028  BX Velocity w/Hep--18mm....  H                       ...........  ...........  ...........  ...........
   5029  BX Velocity w/Hep--23mm....  H                       ...........  ...........  ...........  ...........
   5030  Stent, coronary, S660 9/     H                       ...........  ...........  ...........  ...........
          12mm.
   5031  Stent,coronary, S660 15/     H                       ...........  ...........  ...........  ...........
          18mm.
   5032  Stent,coronary, S660 24/     H                       ...........  ...........  ...........  ...........
          30mm.
   5033  Niroyal Stent Sys, 9mm.....  H                       ...........  ...........  ...........  ...........
   5034  Niroyal Stent Sys, 12/15mm.  H                       ...........  ...........  ...........  ...........
   5035  Niroyal Stent Sys, 18mm....  H                       ...........  ...........  ...........  ...........
   5036  Niroyal Stent Sys, 25mm....  H                       ...........  ...........  ...........  ...........
   5037  Niroyal Stent Sys, 31mm....  H                       ...........  ...........  ...........  ...........
   5038  BX Velocity Stent w/Raptor.  H                       ...........  ...........  ...........  ...........
   5039  IntraCoil Periph Stent--     H                       ...........  ...........  ...........  ...........
          40mm.
   5040  IntraCoil Periph Stent--     H                       ...........  ...........  ...........  ...........
          60mm.
   5041  BeStent Over-the-Wire 24/    H                       ...........  ...........  ...........  ...........
          30mm.
   5042  BeStent Over-the-Wire 18mm.  H                       ...........  ...........  ...........  ...........
   5043  BeStent Over-the-Wire 15mm.  H                       ...........  ...........  ...........  ...........
   5044  BeStent Over-the-Wire 9/     H                       ...........  ...........  ...........  ...........
          12mm.
   5045  Multilink Tetra Cor Stent    H                       ...........  ...........  ...........  ...........
          Sys.
   5046  Radius 20mm cor stent......  H                       ...........  ...........  ...........  ...........
   5047  Niroyal Elite Cor Stent Sys  H                       ...........  ...........  ...........  ...........
   5048  GR II Coronary Stent.......  H                       ...........  ...........  ...........  ...........
   5130  Wilson-Cook Colonic Z-Stent  H                       ...........  ...........  ...........  ...........
   5131  Bard Colorectal Stent-60mm.  H                       ...........  ...........  ...........  ...........
   5132  Bard Colorectal Stent-80mm.  H                       ...........  ...........  ...........  ...........
   5133  Bard Colorectal Stent-100mm  H                       ...........  ...........  ...........  ...........
   5134  Enteral Wallstent--90mm....  H                       ...........  ...........  ...........  ...........
   5279  Contour/Percuflex Stent....  H                       ...........  ...........  ...........  ...........

[[Page 67842]]

 
   5280  Inlay Dbl Ureteral Stent...  H                       ...........  ...........  ...........  ...........
   5281  Wallgraft Trach Sys 70mm...  H                       ...........  ...........  ...........  ...........
   5282  Wallgraft Trach Sys 20/30/   H                       ...........  ...........  ...........  ...........
          50.
   5283  Wallstent/RP TIPS--80mm....  H                       ...........  ...........  ...........  ...........
   5284  Wallstent TrachUltraFlex...  H                       ...........  ...........  ...........  ...........
   5600  Closure dev, VasoSeal ES...  H                       ...........  ...........  ...........  ...........
   5601  VasoSeal Model 1000........  H                       ...........  ...........  ...........  ...........
   6001  Composix Mesh 8/21 in......  H                       ...........  ...........  ...........  ...........
   6002   Composix Mesh 32 in.......  H                       ...........  ...........  ...........  ...........
   6003  Composix Mesh 48 in........  H                       ...........  ...........  ...........  ...........
   6004  Composix Mesh 80 in........  H                       ...........  ...........  ...........  ...........
   6005  Composix Mesh 140 in.......  H                       ...........  ...........  ...........  ...........
   6006  Composix Mesh 144 in.......  H                       ...........  ...........  ...........  ...........
   6012  Pelvicol Collagen 8/14 sq    H                       ...........  ...........  ...........  ...........
          cm.
   6013  Pelvicol Collagen 21/24/28   H                       ...........  ...........  ...........  ...........
          sq cm.
   6014  Pelvicol Collagen 36 sq cm.  H                       ...........  ...........  ...........  ...........
   6015  Pelvicol Collagen 48 sq cm.  H                       ...........  ...........  ...........  ...........
   6016  Pelvicol Collagen 96 sq cm.  H                       ...........  ...........  ...........  ...........
   6017  Gore-Tex DualMesh 75/96 sq   H                       ...........  ...........  ...........  ...........
          cm.
   6018  Gore-Tex DualMesh 150 sq cm  H                       ...........  ...........  ...........  ...........
   6019  Gore-Tex DualMesh 285 sq cm  H                       ...........  ...........  ...........  ...........
   6020  Gore-Tex DualMesh 432 sq cm  H                       ...........  ...........  ...........  ...........
   6021  Gore-Tex DualMesh 600 sq cm  H                       ...........  ...........  ...........  ...........
   6022  Gore-Tex DualMesh 884 sq cm  H                       ...........  ...........  ...........  ...........
   6023  Gore-TexPlus 1mm, 75/96sq    H                       ...........  ...........  ...........  ...........
          cm.
   6024  Gore-TexPlus 1mm, 150sq cm.  H                       ...........  ...........  ...........  ...........
   6025  Gore-TexPlus 1mm, 285sq cm.  H                       ...........  ...........  ...........  ...........
   6026  Gore-TexPlus 1mm, 432sq cm.  H                       ...........  ...........  ...........  ...........
   6027  Gore-TexPlus 1mm, 600sq cm.  H                       ...........  ...........  ...........  ...........
   6028  Gore-TexPlus 1mm, 884 sq cm  H                       ...........  ...........  ...........  ...........
   6029  Gore-TexPlus 2mm, 150 sq cm  H                       ...........  ...........  ...........  ...........
   6030  Gore-TexPlus 2mm, 285 sq cm  H                       ...........  ...........  ...........  ...........
   6031  Gore-TexPlus 2mm, 432 sq cm  H                       ...........  ...........  ...........  ...........
   6032  Gore-TexPlus 2mm, 600 sq cm  H                       ...........  ...........  ...........  ...........
   6033  Gore-TexPlus 2mm, 884 sq cm  H                       ...........  ...........  ...........  ...........
   6034  Bard ePTFE: 150 sq cm--2mm.  H                       ...........  ...........  ...........  ...........
   6035  Bard ePTFE 150 sqcm-1mm,75-  H                       ...........  ...........  ...........  ...........
          2mm.
   6036  Bard ePTFE: 50/75 sqcm-      H                       ...........  ...........  ...........  ...........
          1,2mm.
   6037  Bard ePTFE: 300 sq cm-1,2mm  H                       ...........  ...........  ...........  ...........
   6038  Bard ePTFE: 600 sq cm-1mm..  H                       ...........  ...........  ...........  ...........
   6039  Bard ePTFE: 884 sq cm-1mm..  H                       ...........  ...........  ...........  ...........
   6040  Bard ePTFE: 600 sq cm-2mm..  H                       ...........  ...........  ...........  ...........
   6041  Bard ePTFE: 884 sq cm-2mm..  H                       ...........  ...........  ...........  ...........
   6050  Female Sling Sys w/wo Matrl  H                       ...........  ...........  ...........  ...........
   6051  Stratasis Sling, 20/40 cm..  H                       ...........  ...........  ...........  ...........
   6052  Stratasis Sling, 60 cm.....  H                       ...........  ...........  ...........  ...........
   6053  Surgisis Soft Graft........  H                       ...........  ...........  ...........  ...........
   6054  Surgisis Enhanced Graft....  H                       ...........  ...........  ...........  ...........
   6055  Surgisis Enhanced Tissue...  H                       ...........  ...........  ...........  ...........
   6056  Surgisis Soft Tissue Graft.  H                       ...........  ...........  ...........  ...........
   6057  Surgisis Hernia Graft......  H                       ...........  ...........  ...........  ...........
   6058  SurgiPro Hernia Plug, med/   H                       ...........  ...........  ...........  ...........
          lg.
   6080  Male Sling Sys w/wo Matrl..  H                       ...........  ...........  ...........  ...........
   6200  Exxcel Sft ePTFE vas graft.  H                       ...........  ...........  ...........  ...........
   6201  Impra Venaflo--10/20cm.....  H                       ...........  ...........  ...........  ...........
   6202  Impra Venaflo-30/40cm......  H                       ...........  ...........  ...........  ...........
   6203  Impra Venaflo-50cm,vt45....  H                       ...........  ...........  ...........  ...........
   6204  Impra Venaflo-stepped......  H                       ...........  ...........  ...........  ...........
   6205  Impra Carboflo--10cm.......  H                       ...........  ...........  ...........  ...........
   6206  Impra Carboflo--20cm.......  H                       ...........  ...........  ...........  ...........
   6207  Impra Carboflo--30/35/40cm.  H                       ...........  ...........  ...........  ...........
   6208  Impra Carboflo--40/50cm....  H                       ...........  ...........  ...........  ...........
   6209  Impra Carboflo--ctrflex....  H                       ...........  ...........  ...........  ...........
   6210  Exxcel ePTFE vas graft.....  H                       ...........  ...........  ...........  ...........
   6300  Vanguard III Endovas Graft.  H                       ...........  ...........  ...........  ...........
   6500  Preface Guiding Sheath.....  H                       ...........  ...........  ...........  ...........
   6501  Soft Tip Sheaths...........  H                       ...........  ...........  ...........  ...........
   6502  Perry Exchange Dilator.....  H                       ...........  ...........  ...........  ...........
   6525  Spectranetics Laser Sheath.  H                       ...........  ...........  ...........  ...........
   6600  Micro Litho Flex Probes....  H                       ...........  ...........  ...........  ...........
   6650  Fast-Cath Guiding            H                       ...........  ...........  ...........  ...........
          Introducer.
   6651  Seal-AwayGuiding Introducer  H                       ...........  ...........  ...........  ...........
   6652  Bard Excalibur Introducer..  H                       ...........  ...........  ...........  ...........
   6700  Focal Seal-L...............  H                       ...........  ...........  ...........  ...........
   7000  Amifostine, 500 mg.........  G                       ...........      $350.31  ...........       $46.94
   7001  Amphotericin B lipid         G                       ...........       $95.00  ...........       $12.73
          complex, 50 mg.
   7003  Epoprostenol injection 0.5   G                       ...........       $16.53  ...........        $2.22
          mg.
   7004  Immune globulin 5 gms......  G                       ...........      $272.80  ...........       $33.28

[[Page 67843]]

 
   7005  Gonadorelin hydroch, 100     G                       ...........       $14.80  ...........        $1.98
          mcg.
   7007  Milrinone lactate, per 5     K                              0.47       $23.31  ...........        $4.66
          ml, inj.
   7010  Morphine sulfate             G                       ...........        $7.41  ...........         $.99
          (preservative free) 10 mg.
   7011  Oprelvekin injection, 5 mg.  G                       ...........      $236.31  ...........       $31.67
   7014  Fentanyl citrate inj up 2    G                       ...........        $0.98  ...........        $0.13
          ml.
   7015  Busulfan, oral, 2 mg.......  G                       ...........        $1.73  ...........        $0.23
   7019  Aprotinin, 10,000 kiu......  G                       ...........      $196.35  ...........       $26.31
   7022  Elliot's B solution, per ml  G                       ...........       $14.25  ...........        $1.91
   7023  Treatment for bladder        G                       ...........       $23.54  ...........        $3.15
          calculi, per 500 ml.
   7024  Corticorelin ovine           G                       ...........      $353.88  ...........       $45.77
          triflutate, per 0.1 mg.
   7025  Digoxin immune FAB (Ovine),  G                       ...........      $530.44  ...........       $64.71
          40 mg vial.
   7026  Ethanolamine oleate, 100 mg  G                       ...........       $27.21  ...........        $3.65
   7027  Fomepizole, 1.5 mg.........  G                       ...........      $728.33  ...........       $97.60
   7028  Fosphenytoin, 50 mg........  G                       ...........        $8.55  ...........        $1.15
   7029  Glatiramer acetate, 20 mg..  G                       ...........       $27.40  ...........        $3.67
   7030  Hemin, 1 mg................  G                       ...........        $0.90  ...........        $0.12
   7031  Octreotide acetate           G                       ...........      $115.34  ...........       $15.46
          injection 1mg.
   7032  Sermorelin acetate, 0.5 mg.  G                       ...........       $15.78  ...........        $2.11
   7033  Somatrem, 5 mg.............  G                       ...........      $199.50  ...........       $26.73
   7034  Somatropin, 1 mg (any        G                       ...........       $39.90  ...........        $5.35
          derivation).
   7035  Teniposide, 50 mg..........  G                       ...........      $195.28  ...........       $26.17
   7036  Urokinase, inj, IV, 250,000  K                              6.78      $336.29  ...........       $67.26
          I.U..
   7037  Urofollitropin, 75 I.U.....  G                       ...........       $69.73  ...........        $9.34
   7038  Muromonab-CD3, 5 mg........  G                       ...........      $741.00  ...........       $99.29
   7039  Pegademase bovine inj 25     G                       ...........      $139.33  ...........       $18.67
          I.U.
   7040  Pentastarch 10% inj, 100 ml  G                       ...........       $15.11  ...........        $2.04
   7041  Tirofiban hydrochloride      G                       ...........      $399.00  ...........       $53.47
          12.5 mg.
   7042  Capecitabine, oral, 150 mg.  G                       ...........        $1.94  ...........        $0.26
   7043  Infliximab injection 10 mg.  G                       ...........       $58.08  ...........        $7.78
   7045  Trimetrexate glucoronate 25  G                       ...........       $69.83  ...........        $9.36
          mg.
   7046  Doxorubicin hcl liposome     G                       ...........      $311.72  ...........       $41.77
          inj 10 mg.
   7047  Droperidol/fentanyl inj....  G                       ...........        $7.02  ...........        $0.90
   7048  Alteplase, 1 mg............  K                              0.38       $18.70  ...........        $3.74
   7049  Filgrastim 480 mcg           G                       ...........      $273.03  ...........       $35.06
          injection.
   7315  Sodium hyaluronate, 20 mg..  G                       ...........      $125.59  ...........       $16.83
   8099  Spectranetics Lead Lock Dev  H                       ...........  ...........  ...........  ...........
   8100  Adhesion barrier, ADCON-L..  H                       ...........  ...........  ...........  ...........
   8102  SurgiVision Esoph Coil.....  H                       ...........  ...........  ...........  ...........
   9000  Na chromate Cr51, per        G                       ...........      $259.36  ...........       $34.75
          0.25mCi.
   9001  Linezolid inj, 200mg.......  J                       ...........       $34.14  ...........        $4.57
   9002  Tenecteplase, 50mg/vial....  J                       ...........    $2,612.50  ...........      $350.08
   9003  Palivizumab, per 50mg......  J                       ...........      $664.49  ...........       $89.04
   9004  Gemtuzumab ozogamicin        J                       ...........    $1,929.69  ...........      $258.58
          inj,5mg.
   9005  Reteplase inj, half-kit,     G                       ...........    $1,306.25  ...........      $175.04
          18.8 mg/vial.
   9006  Tacrolimus inj, per 5mg (1   J                       ...........      $109.83  ...........       $14.72
          amp).
   9007  Baclofen Intrathecal kit-    G                       ...........       $79.80  ...........       $10.69
          1amp.
   9008  Baclofen Refill Kit--500mcg  G                       ...........      $222.30  ...........       $29.79
   9009  Baclofen Refill Kit--        G                       ...........      $467.40  ...........       $62.63
          2000mcg.
   9010  Baclofen Refill Kit--        G                       ...........      $820.80  ...........      $109.99
          4000mcg.
   9011  Caffeine Citrate, inj, 1ml.  G                       ...........       $12.22  ...........        $1.57
   9100  Iodinated I-131 Albumin....  G                       ...........      $246.05  ...........       $30.02
   9102  51 Na chromate, 50mCi......  G                       ...........      $216.60  ...........       $26.43
   9103  Na Iothalamate I-125, 10uCi  G                       ...........       $12.27  ...........        $1.50
   9104  Anti-thymocyte               G                       ...........      $251.75  ...........       $33.73
          globulin,25mg.
   9105  Hep B imm glob, per 1 ml...  G                       ...........      $152.00  ...........       $20.37
   9106  Sirolimus 1mg/ml...........  J                       ...........        $6.51  ...........         $.87
   9107  Tinzaparin sodium, 2ml vial  J                       ...........      $159.60  ...........       $20.50
   9108  Thyrotropin Alfa,1.1 mg....  G                       ...........      $494.00  ...........       $70.72
   9109  Tirofiban hydrochloride      G                       ...........      $199.50  ...........       $28.56
          6.25 mg.
   9217  Leuprolide acetate for       G                       ...........      $592.60  ...........       $79.40
          depot suspension, 7.5 mg.
   9500  Platelets, irrad, ea unit..  K                              1.77       $87.97  ...........       $17.59
   9501  Platelets, pheresis, ea      K                              9.69      $480.75  ...........       $96.15
          unit.
   9502  Platelets, pher/irrad, ea    K                             10.52      $521.66  ...........      $104.33
          unit.
   9503  Fresh frozen plasma, ea      K                              1.65       $81.83  ...........       $16.37
          unit.
   9504  RBC, deglycerolized, ea      K                              4.35      $215.83  ...........       $43.17
          unit.
 
 

[[Page 67844]]

 
   9505  RBC, irradiated, ea unit...  K                              2.58      $127.86  ...........       $25.57
   9998  Enoxaparin.................  G                       ...........        $5.53  ...........        $0.79
----------------------------------------------------------------------------------------------------------------

    --------------------
CPT codes and descriptions only are copyright American Medical 
Association. All Rights Reserved. Applicable FARS/DFARS Apply.

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

[[Page 67844]]



     Addendum B.--Hospital Outpatient Department (HOPD) Payment Status by HCPCS Code and Related Information
----------------------------------------------------------------------------------------------------------------
                                                                                          National     Minimum
   CPT/      HOPD  Status       Description          APC        Relative     Payment     Unadjusted   Unadjusted
  HCPCS       Indicator                                          Weight        Rate     Coinsurance  Coinsurance
----------------------------------------------------------------------------------------------------------------
    00100  N                Anesth, salivary     ...........  ...........  ...........  ...........  ...........
                             gland.
    00102  N                Anesth, repair of    ...........  ...........  ...........  ...........  ...........
                             cleft lip.
    00103  N                Anesth,              ...........  ...........  ...........  ...........  ...........
                             blepharoplasty.
    00104  N                Anesth,              ...........  ...........  ...........  ...........  ...........
                             electroshock.
    00120  N                Anesth, ear surgery  ...........  ...........  ...........  ...........  ...........
    00124  N                Anesth, ear exam...  ...........  ...........  ...........  ...........  ...........
    00126  N                Anesth, tympanotomy  ...........  ...........  ...........  ...........  ...........
    00140  N                Anesth, procedures   ...........  ...........  ...........  ...........  ...........
                             on eye.
    00142  N                Anesth, lens         ...........  ...........  ...........  ...........  ...........
                             surgery.
    00144  N                Anesth, corneal      ...........  ...........  ...........  ...........  ...........
                             transplant.
    00145  N                Anesth, vitrectomy.  ...........  ...........  ...........  ...........  ...........
    00147  N                Anesth, iridectomy.  ...........  ...........  ...........  ...........  ...........
    00148  N                Anesth, eye exam...  ...........  ...........  ...........  ...........  ...........
    00160  N                Anesth, nose/sinus   ...........  ...........  ...........  ...........  ...........
                             surgery.
    00162  N                Anesth, nose/sinus   ...........  ...........  ...........  ...........  ...........
                             surgery.
    00164  N                Anesth, biopsy of    ...........  ...........  ...........  ...........  ...........
                             nose.
    00170  N                Anesth, procedure    ...........  ...........  ...........  ...........  ...........
                             on mouth.
    00172  N                Anesth, cleft        ...........  ...........  ...........  ...........  ...........
                             palate repair.
    00174  N                Anesth, pharyngeal   ...........  ...........  ...........  ...........  ...........
                             surgery.
    00176  N                Anesth, pharyngeal   ...........  ...........  ...........  ...........  ...........
                             surgery.
    00190  N                Anesth, facial bone  ...........  ...........  ...........  ...........  ...........
                             surgery.
    00192  N                Anesth, facial bone  ...........  ...........  ...........  ...........  ...........
                             surgery.
    00210  N                Anesth, open head    ...........  ...........  ...........  ...........  ...........
                             surgery.
    00212  N                Anesth, skull        ...........  ...........  ...........  ...........  ...........
                             drainage.
    00214  N                Anesth, skull        ...........  ...........  ...........  ...........  ...........
                             drainage.
    00215  N                Anesth, skull        ...........  ...........  ...........  ...........  ...........
                             fracture.
    00216  N                Anesth, head vessel  ...........  ...........  ...........  ...........  ...........
                             surgery.
    00218  N                Anesth, special      ...........  ...........  ...........  ...........  ...........
                             head surgery.
    00220  N                Anesth, spinal       ...........  ...........  ...........  ...........  ...........
                             fluid shunt.
    00222  N                Anesth, head nerve   ...........  ...........  ...........  ...........  ...........
                             surgery.
    00300  N                Anesth, head/neck/   ...........  ...........  ...........  ...........  ...........
                             ptrunk.
    00320  N                Anesth, neck organ   ...........  ...........  ...........  ...........  ...........
                             surgery.
    00322  N                Anesth, biopsy of    ...........  ...........  ...........  ...........  ...........
                             thyroid.
    00350  N                Anesth, neck vessel  ...........  ...........  ...........  ...........  ...........
                             surgery.
    00352  N                Anesth, neck vessel  ...........  ...........  ...........  ...........  ...........
                             surgery.
    00400  N                Anesth, skin, ext/   ...........  ...........  ...........  ...........  ...........
                             per/atrunk.
    00402  N                Anesth, surgery of   ...........  ...........  ...........  ...........  ...........
                             breast.
    00404  N                Anesth, surgery of   ...........  ...........  ...........  ...........  ...........
                             breast.
    00406  N                Anesth, surgery of   ...........  ...........  ...........  ...........  ...........
                             breast.
    00410  N                Anesth, correct      ...........  ...........  ...........  ...........  ...........
                             heart rhythm.
    00420  N                Anesth, skin         ...........  ...........  ...........  ...........  ...........
                             surgery, back.
    00450  N                Anesth, surgery of   ...........  ...........  ...........  ...........  ...........
                             shoulder.
    00452  N                Anesth, surgery of   ...........  ...........  ...........  ...........  ...........
                             shoulder.
    00454  N                Anesth, collar bone  ...........  ...........  ...........  ...........  ...........
                             biopsy.
    00470  N                Anesth, removal of   ...........  ...........  ...........  ...........  ...........
                             rib.
    00472  N                Anesth, chest wall   ...........  ...........  ...........  ...........  ...........
                             repair.
    00474  N                Anesth, surgery of   ...........  ...........  ...........  ...........  ...........
                             rib(s).
    00500  N                Anesth, esophageal   ...........  ...........  ...........  ...........  ...........
                             surgery.
    00520  N                Anesth, chest        ...........  ...........  ...........  ...........  ...........
                             procedure.
    00522  N                Anesth, chest        ...........  ...........  ...........  ...........  ...........
                             lining biopsy.
    00524  N                Anesth, chest        ...........  ...........  ...........  ...........  ...........
                             drainage.
    00528  N                Anesth, chest        ...........  ...........  ...........  ...........  ...........
                             partition view.
    00530  N                Anesth, pacemaker    ...........  ...........  ...........  ...........  ...........
                             insertion.
    00532  N                Anesth, vascular     ...........  ...........  ...........  ...........  ...........
                             access.
    00534  N                Anesth,              ...........  ...........  ...........  ...........  ...........
                             cardioverter/defib.
   *00537  N                Anesth, cardiac      ...........  ...........  ...........  ...........  ...........
                             electrophys.
    00540  N                Anesth, chest        ...........  ...........  ...........  ...........  ...........
                             surgery.
    00542  N                Anesth, release of   ...........  ...........  ...........  ...........  ...........
                             lung.
    00544  N                Anesth, chest        ...........  ...........  ...........  ...........  ...........
                             lining removal.
    00546  N                Anesth, lung,chest   ...........  ...........  ...........  ...........  ...........
                             wall surg.
    00548  N                Anesth,              ...........  ...........  ...........  ...........  ...........
                             trachea,bronchi
                             surg.
   *00550  N                Anesth, sternal      ...........  ...........  ...........  ...........  ...........
                             debridement.
    00560  N                Anesth, open heart   ...........  ...........  ...........  ...........  ...........
                             surgery.
    00562  N                Anesth, open heart   ...........  ...........  ...........  ...........  ...........
                             surgery.

[[Page 67845]]

 
   *00563  N                Anesth, openproc w/  ...........  ...........  ...........  ...........  ...........
                             pump.
   *00566  N                Anesth CABG w/o      ...........  ...........  ...........  ...........  ...........
                             pump.
    00580  N                Anesth heart/lung    ...........  ...........  ...........  ...........  ...........
                             transplant.
    00600  N                Anesth, spine, cord  ...........  ...........  ...........  ...........  ...........
                             surgery.
    00604  N                Anesth, surgery of   ...........  ...........  ...........  ...........  ...........
                             vertebra.
    00620  N                Anesth, spine, cord  ...........  ...........  ...........  ...........  ...........
                             surgery.
    00622  N                Anesth, removal of   ...........  ...........  ...........  ...........  ...........
                             nerves.
    00630  N                Anesth, spine, cord  ...........  ...........  ...........  ...........  ...........
                             surgery.
    00632  N                Anesth, removal of   ...........  ...........  ...........  ...........  ...........
                             nerves.
    00634  N                Anesth for           ...........  ...........  ...........  ...........  ...........
                             chemonucleolysis.
   *00635  N                Anesth, lumbar       ...........  ...........  ...........  ...........  ...........
                             puncture.
    00670  N                Anesth, spine, cord  ...........  ...........  ...........  ...........  ...........
                             surgery.
    00700  N                Anesth, abdominal    ...........  ...........  ...........  ...........  ...........
                             wall surg.
    00702  N                Anesth, for liver    ...........  ...........  ...........  ...........  ...........
                             biopsy.
    00730  N                Anesth, abdominal    ...........  ...........  ...........  ...........  ...........
                             wall surg.
    00740  N                Anesth, upper gi     ...........  ...........  ...........  ...........  ...........
                             visualize.
    00750  N                Anesth, repair of    ...........  ...........  ...........  ...........  ...........
                             hernia.
    00752  N                Anesth, repair of    ...........  ...........  ...........  ...........  ...........
                             hernia.
    00754  N                Anesth, repair of    ...........  ...........  ...........  ...........  ...........
                             hernia.
    00756  N                Anesth, repair of    ...........  ...........  ...........  ...........  ...........
                             hernia.
    00770  N                Anesth, blood        ...........  ...........  ...........  ...........  ...........
                             vessel repair.
    00790  N                Anesth, surg upper   ...........  ...........  ...........  ...........  ...........
                             abdomen.
    00792  N                Anesth, part liver   ...........  ...........  ...........  ...........  ...........
                             removal.
    00794  N                Anesth, pancreas     ...........  ...........  ...........  ...........  ...........
                             removal.
    00796  N                Anesth, for liver    ...........  ...........  ...........  ...........  ...........
                             transplant.
    00800  N                Anesth, abdominal    ...........  ...........  ...........  ...........  ...........
                             wall surg.
    00802  N                Anesth, fat layer    ...........  ...........  ...........  ...........  ...........
                             removal.
    00810  N                Anesth, low          ...........  ...........  ...........  ...........  ...........
                             intestine scope.
    00820  N                Anesth, abdominal    ...........  ...........  ...........  ...........  ...........
                             wall surg.
    00830  N                Anesth, repair of    ...........  ...........  ...........  ...........  ...........
                             hernia.
    00832  N                Anesth, repair of    ...........  ...........  ...........  ...........  ...........
                             hernia.
    00840  N                Anesth, surg lower   ...........  ...........  ...........  ...........  ...........
                             abdomen.
    00842  N                Anesth,              ...........  ...........  ...........  ...........  ...........
                             amniocentesis.
    00844  N                Anesth, pelvis       ...........  ...........  ...........  ...........  ...........
                             surgery.
    00846  N                Anesth,              ...........  ...........  ...........  ...........  ...........
                             hysterectomy.
    00848  N                Anesth, pelvic       ...........  ...........  ...........  ...........  ...........
                             organ surg.
    00850  N                Anesth, cesarean     ...........  ...........  ...........  ...........  ...........
                             section.
    00855  N                Anesth,              ...........  ...........  ...........  ...........  ...........
                             hysterectomy.
    00857  N                Analgesia, labor &   ...........  ...........  ...........  ...........  ...........
                             c-section.
    00860  N                Anesth, surgery of   ...........  ...........  ...........  ...........  ...........
                             abdomen.
    00862  N                Anesth, kidney/      ...........  ...........  ...........  ...........  ...........
                             ureter surg.
    00864  N                Anesth, removal of   ...........  ...........  ...........  ...........  ...........
                             bladder.
    00865  N                Anesth, removal of   ...........  ...........  ...........  ...........  ...........
                             prostate.
    00866  N                Anesth, removal of   ...........  ...........  ...........  ...........  ...........
                             adrenal.
    00868  N                Anesth, kidney       ...........  ...........  ...........  ...........  ...........
                             transplant.
    00870  N                Anesth, bladder      ...........  ...........  ...........  ...........  ...........
                             stone surg.
    00872  N                Anesth kidney stone  ...........  ...........  ...........  ...........  ...........
                             destruct.
    00873  N                Anesth kidney stone  ...........  ...........  ...........  ...........  ...........
                             destruct.
    00880  N                Anesth, abdomen      ...........  ...........  ...........  ...........  ...........
                             vessel surg.
    00882  N                Anesth, major vein   ...........  ...........  ...........  ...........  ...........
                             ligation.
    00884  N                Anesth, major vein   ...........  ...........  ...........  ...........  ...........
                             revision.
   00900D  N                Anesth, perineal     ...........  ...........  ...........  ...........  ...........
                             procedure.
    00902  N                Anesth, anorectal    ...........  ...........  ...........  ...........  ...........
                             surgery.
    00904  N                Anesth, perineal     ...........  ...........  ...........  ...........  ...........
                             surgery.
    00906  N                Anesth, removal of   ...........  ...........  ...........  ...........  ...........
                             vulva.
    00908  N                Anesth, removal of   ...........  ...........  ...........  ...........  ...........
                             prostate.
    00910  N                Anesth, bladder      ...........  ...........  ...........  ...........  ...........
                             surgery.
    00912  N                Anesth, bladder      ...........  ...........  ...........  ...........  ...........
                             tumor surg.
    00914  N                Anesth, removal of   ...........  ...........  ...........  ...........  ...........
                             prostate.
    00916  N                Anesth, bleeding     ...........  ...........  ...........  ...........  ...........
                             control.
    00918  N                Anesth, stone        ...........  ...........  ...........  ...........  ...........
                             removal.
    00920  N                Anesth, genitalia    ...........  ...........  ...........  ...........  ...........
                             surgery.
    00922  N                Anesth, sperm duct   ...........  ...........  ...........  ...........  ...........
                             surgery.
    27280  C                Fusion of            ...........  ...........  ...........  ...........  ...........
                             sacroiliac joint.
    27282  C                Fusion of pubic      ...........  ...........  ...........  ...........  ...........
                             bones.
    27284  C                Fusion of hip joint  ...........  ...........  ...........  ...........  ...........
    27286  C                Fusion of hip joint  ...........  ...........  ...........  ...........  ...........
    27290  C                Amputation of leg    ...........  ...........  ...........  ...........  ...........
                             at hip.
    27295  C                Amputation of leg    ...........  ...........  ...........  ...........  ...........
                             at hip.
    27299  T                Pelvis/hip joint            0043         1.64       $81.34       $25.46       $16.27
                             surgery.
    27301  T                Drain thigh/knee            0008         6.15      $305.02      $113.67       $61.00
                             lesion.
    27303  C                Drainage of bone     ...........  ...........  ...........  ...........  ...........
                             lesion.
    27305  T                Incise thigh tendon         0049        15.04      $745.93      $356.95      $149.19
                             & fascia.
    27306  T                Incision of thigh           0049        15.04      $745.93      $356.95      $149.19
                             tendon.

[[Page 67846]]

 
    27307  T                Incision of thigh           0049        15.04      $745.93      $356.95      $149.19
                             tendons.
    27310  T                Exploration of knee         0050        21.13    $1,047.96      $513.86      $209.59
                             joint.
    27315  T                Partial removal,            0220        13.96      $692.36      $326.21      $138.47
                             thigh nerve.
    27320  T                Partial removal,            0220        13.96      $692.36      $326.21      $138.47
                             thigh nerve.
    27323  T                Biopsy, thigh soft          0021        10.49      $520.26      $236.51      $104.05
                             tissues.
    27324  T                Biopsy, thigh soft          0022        12.49      $619.45      $292.94      $123.89
                             tissues.
    27327  T                Removal of thigh            0022        12.49      $619.45      $292.94      $123.89
                             lesion.
    27328  T                Removal of thigh            0022        12.49      $619.45      $292.94      $123.89
                             lesion.
    27329  T                Remove tumor, thigh/        0022        12.49      $619.45      $292.94      $123.89
                             knee.
    27330  T                Biopsy, knee joint          0050        21.13    $1,047.96      $513.86      $209.59
                             lining.
    27331  T                Explore/treat knee          0050        21.13    $1,047.96      $513.86      $209.59
                             joint.
    27332  T                Removal of knee             0050        21.13    $1,047.96      $513.86      $209.59
                             cartilage.
    27333  T                Removal of knee             0050        21.13    $1,047.96      $513.86      $209.59
                             cartilage.
    27334  T                Remove knee joint           0050        21.13    $1,047.96      $513.86      $209.59
                             lining.
    27335  T                Remove knee joint           0050        21.13    $1,047.96      $513.86      $209.59
                             lining.
    27340  T                Removal of kneecap          0049        15.04      $745.93      $356.95      $149.19
                             bursa.
    27345  T                Removal of knee             0049        15.04      $745.93      $356.95      $149.19
                             cyst.
    27347  T                Remove knee cyst...         0049        15.04      $745.93      $356.95      $149.19
    27350  T                Removal of kneecap.         0050        21.13    $1,047.96      $513.86      $209.59
    27355  T                Remove femur lesion         0050        21.13    $1,047.96      $513.86      $209.59
    27356  T                Remove femur lesion/        0050        21.13    $1,047.96      $513.86      $209.59
                             graft.
    27357  T                Remove femur lesion/        0050        21.13    $1,047.96      $513.86      $209.59
                             graft.
    27358  T                Remove femur lesion/        0050        21.13    $1,047.96      $513.86      $209.59
                             fixation.
    27360  T                Partial removal,            0050        21.13    $1,047.96      $513.86      $209.59
                             leg bone(s).
    27365  C                Extensive leg        ...........  ...........  ...........  ...........  ...........
                             surgery.
    27370  N                Injection for knee   ...........  ...........  ...........  ...........  ...........
                             x-ray.
    27372  T                Removal of foreign          0022        12.49      $619.45      $292.94      $123.89
                             body.
    27380  T                Repair of kneecap           0049        15.04      $745.93      $356.95      $149.19
                             tendon.
    27381  T                Repair/graft                0049        15.04      $745.93      $356.95      $149.19
                             kneecap tendon.
    27385  T                Repair of thigh             0049        15.04      $745.93      $356.95      $149.19
                             muscle.
    27386  T                Repair/graft of             0049        15.04      $745.93      $356.95      $149.19
                             thigh muscle.
    27390  T                Incision of thigh           0049        15.04      $745.93      $356.95      $149.19
                             tendon.
    27391  T                Incision of thigh           0049        15.04      $745.93      $356.95      $149.19
                             tendons.
    27392  T                Incision of thigh           0049        15.04      $745.93      $356.95      $149.19
                             tendons.
    27393  T                Lengthening of              0050        21.13    $1,047.96      $513.86      $209.59
                             thigh tendon.
    27394  T                Lengthening of              0050        21.13    $1,047.96      $513.86      $209.59
                             thigh tendons.
    27395  T                Lengthening of              0051        27.76    $1,376.79      $675.24      $275.36
                             thigh tendons.
    27396  T                Transplant of thigh         0050        21.13    $1,047.96      $513.86      $209.59
                             tendon.
    27397  T                Transplants of              0051        27.76    $1,376.79      $675.24      $275.36
                             thigh tendons.
    27400  T                Revise thigh                0051        27.76    $1,376.79      $675.24      $275.36
                             muscles/tendons.
    27403  T                Repair of knee              0050        21.13    $1,047.96      $513.86      $209.59
                             cartilage.
    27405  T                Repair of knee              0051        27.76    $1,376.79      $675.24      $275.36
                             ligament.
    27407  T                Repair of knee              0051        27.76    $1,376.79      $675.24      $275.36
                             ligament.
    27409  T                Repair of knee              0051        27.76    $1,376.79      $675.24      $275.36
                             ligaments.
    27418  T                Repair degenerated          0051        27.76    $1,376.79      $675.24      $275.36
                             kneecap.
    27420  T                Revision of                 0051        27.76    $1,376.79      $675.24      $275.36
                             unstable kneecap.
    27422  T                Revision of                 0051        27.76    $1,376.79      $675.24      $275.36
                             unstable kneecap.
    27424  T                Revision/removal of         0051        27.76    $1,376.79      $675.24      $275.36
                             kneecap.
    27425  T                Lateral retinacular         0050        21.13    $1,047.96      $513.86      $209.59
                             release.
    27427  T                Reconstruction,             0052        36.16    $1,793.39      $930.91      $358.68
                             knee.
    27428  T                Reconstruction,             0052        36.16    $1,793.39      $930.91      $358.68
                             knee.
    27429  T                Reconstruction,             0052        36.16    $1,793.39      $930.91      $358.68
                             knee.
    27430  T                Revision of thigh           0051        27.76    $1,376.79      $675.24      $275.36
                             muscles.
    27435  T                Incision of knee            0051        27.76    $1,376.79      $675.24      $275.36
                             joint.
    27437  T                Revise kneecap.....         0047        22.09    $1,095.58      $537.03      $219.12
    27438  T                Revise kneecap with         0048        29.06    $1,441.26      $725.94      $288.25
                             implant.
    27440  T                Revision of knee            0047        22.09    $1,095.58      $537.03      $219.12
                             joint.
    27441  T                Revision of knee            0047        22.09    $1,095.58      $537.03      $219.12
                             joint.
    27442  T                Revision of knee            0047        22.09    $1,095.58      $537.03      $219.12
                             joint.
    27443  T                Revision of knee            0047        22.09    $1,095.58      $537.03      $219.12
                             joint.
    27445  C                Revision of knee     ...........  ...........  ...........  ...........  ...........
                             joint.
    27446  C                Revision of knee     ...........  ...........  ...........  ...........  ...........
                             joint.
    27447  C                Total knee           ...........  ...........  ...........  ...........  ...........
                             replacement.
    27448  C                Incision of thigh..  ...........  ...........  ...........  ...........  ...........
    27450  C                Incision of thigh..  ...........  ...........  ...........  ...........  ...........
    27454  C                Realignment of       ...........  ...........  ...........  ...........  ...........
                             thigh bone.
    27455  C                Realignment of knee  ...........  ...........  ...........  ...........  ...........
    27457  C                Realignment of knee  ...........  ...........  ...........  ...........  ...........
    27465  C                Shortening of thigh  ...........  ...........  ...........  ...........  ...........
                             bone.
    27466  C                Lengthening of       ...........  ...........  ...........  ...........  ...........
                             thigh bone.
    27468  C                Shorten/lengthen     ...........  ...........  ...........  ...........  ...........
                             thighs.
    27470  C                Repair of thigh....  ...........  ...........  ...........  ...........  ...........
    27472  C                Repair/graft of      ...........  ...........  ...........  ...........  ...........
                             thigh.
    27475  C                Surgery to stop leg  ...........  ...........  ...........  ...........  ...........
                             growth.

[[Page 67847]]

 
    27477  C                Surgery to stop leg  ...........  ...........  ...........  ...........  ...........
                             growth.
    27479  C                Surgery to stop leg  ...........  ...........  ...........  ...........  ...........
                             growth.
    27485  C                Surgery to stop leg  ...........  ...........  ...........  ...........  ...........
                             growth.
    27486  C                Revise/replace knee  ...........  ...........  ...........  ...........  ...........
                             joint.
    27487  C                Revise/replace knee  ...........  ...........  ...........  ...........  ...........
                             joint.
    27488  C                Removal of knee      ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    27495  C                Reinforce thigh....  ...........  ...........  ...........  ...........  ...........
    27496  T                Decompression of            0049        15.04      $745.93      $356.95      $149.19
                             thigh/knee.
    27497  T                Decompression of            0049        15.04      $745.93      $356.95      $149.19
                             thigh/knee.
    27498  T                Decompression of            0049        15.04      $745.93      $356.95      $149.19
                             thigh/knee.
    27499  T                Decompression of            0049        15.04      $745.93      $356.95      $149.19
                             thigh/knee.
    27500  T                Treatment of thigh          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27501  T                Treatment of thigh          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27502  T                Treatment of thigh          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27503  T                Treatment of thigh          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27506  C                Treatment of thigh   ...........  ...........  ...........  ...........  ...........
                             fracture.
    27507  C                Treatment of thigh   ...........  ...........  ...........  ...........  ...........
                             fracture.
    27508  T                Treatment of thigh          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27509  T                Treatment of thigh          0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    27510  T                Treatment of thigh          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27511  C                Treatment of thigh   ...........  ...........  ...........  ...........  ...........
                             fracture.
    27513  C                Treatment of thigh   ...........  ...........  ...........  ...........  ...........
                             fracture.
    27514  C                Treatment of thigh   ...........  ...........  ...........  ...........  ...........
                             fracture.
    27516  T                Treat thigh fx              0044         2.17      $107.63       $38.08       $21.53
                             growth plate.
    27517  T                Treat thigh fx              0044         2.17      $107.63       $38.08       $21.53
                             growth plate.
    27519  C                Treat thigh fx       ...........  ...........  ...........  ...........  ...........
                             growth plate.
    27520  T                Treat kneecap               0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27524  T                Treat kneecap               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    27530  T                Treat knee fracture         0044         2.17      $107.63       $38.08       $21.53
    27532  T                Treat knee fracture         0044         2.17      $107.63       $38.08       $21.53
    27535  C                Treat knee fracture  ...........  ...........  ...........  ...........  ...........
    27536  C                Treat knee fracture  ...........  ...........  ...........  ...........  ...........
    27538  T                Treat knee                  0044         2.17      $107.63       $38.08       $21.53
                             fracture(s).
    27540  C                Treat knee fracture  ...........  ...........  ...........  ...........  ...........
    27550  T                Treat knee                  0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    27552  T                Treat knee                  0045        11.02      $546.55      $277.12      $109.31
                             dislocation.
    27556  C                Treat knee           ...........  ...........  ...........  ...........  ...........
                             dislocation.
    27557  C                Treat knee           ...........  ...........  ...........  ...........  ...........
                             dislocation.
    27558  C                Treat knee           ...........  ...........  ...........  ...........  ...........
                             dislocation.
    27560  T                Treat kneecap               0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    27562  T                Treat kneecap               0045        11.02      $546.55      $277.12      $109.31
                             dislocation.
    27566  T                Treat kneecap               0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    27570  T                Fixation of knee            0045        11.02      $546.55      $277.12      $109.31
                             joint.
    27580  C                Fusion of knee.....  ...........  ...........  ...........  ...........  ...........
    27590  C                Amputate leg at      ...........  ...........  ...........  ...........  ...........
                             thigh.
    27591  C                Amputate leg at      ...........  ...........  ...........  ...........  ...........
                             thigh.
    27592  C                Amputate leg at      ...........  ...........  ...........  ...........  ...........
                             thigh.
    27594  T                Amputation follow-          0049        15.04      $745.93      $356.95      $149.19
                             up surgery.
    27596  C                Amputation follow-   ...........  ...........  ...........  ...........  ...........
                             up surgery.
    27598  C                Amputate lower leg   ...........  ...........  ...........  ...........  ...........
                             at knee.
    27599  T                Leg surgery                 0044         2.17      $107.63       $38.08       $21.53
                             procedure.
    27600  T                Decompression of            0049        15.04      $745.93      $356.95      $149.19
                             lower leg.
    27601  T                Decompression of            0049        15.04      $745.93      $356.95      $149.19
                             lower leg.
    27602  T                Decompression of            0049        15.04      $745.93      $356.95      $149.19
                             lower leg.
    27603  T                Drain lower leg             0008         6.15      $305.02      $113.67       $61.00
                             lesion.
    27604  T                Drain lower leg             0049        15.04      $745.93      $356.95      $149.19
                             bursa.
    27605  T                Incision of                 0055        15.47      $767.26      $355.34      $153.45
                             achilles tendon.
    00924  N                Anesth, testis       ...........  ...........  ...........  ...........  ...........
                             exploration.
    00926  N                Anesth, removal of   ...........  ...........  ...........  ...........  ...........
                             testis.
    00928  N                Anesth, removal of   ...........  ...........  ...........  ...........  ...........
                             testis.
    00930  N                Anesth, testis       ...........  ...........  ...........  ...........  ...........
                             suspension.
    00932  N                Anesth, amputation   ...........  ...........  ...........  ...........  ...........
                             of penis.
    00934  N                Anesth, penis,       ...........  ...........  ...........  ...........  ...........
                             nodes removal.
    00936  N                Anesth, penis,       ...........  ...........  ...........  ...........  ...........
                             nodes removal.
    00938  N                Anesth, insert       ...........  ...........  ...........  ...........  ...........
                             penis device.
    00940  N                Anesth, vaginal      ...........  ...........  ...........  ...........  ...........
                             procedures.
    00942  N                Anesth, surgery on   ...........  ...........  ...........  ...........  ...........
                             vagina.
    00944  N                Anesth, vaginal      ...........  ...........  ...........  ...........  ...........
                             hysterectomy.
    00946  N                Anesth, vaginal      ...........  ...........  ...........  ...........  ...........
                             delivery.
    00948  N                Anesth, repair of    ...........  ...........  ...........  ...........  ...........
                             cervix.
    00950  N                Anesth, vaginal      ...........  ...........  ...........  ...........  ...........
                             endoscopy.
    00952  N                Anesth,              ...........  ...........  ...........  ...........  ...........
                             hysteroscope/graph.
    00955  N                Analgesia, vaginal   ...........  ...........  ...........  ...........  ...........
                             delivery.
    01000  N                Anesth, skin         ...........  ...........  ...........  ...........  ...........
                             surgery, pelvis.

[[Page 67848]]

 
    01110  N                Anesth, skin         ...........  ...........  ...........  ...........  ...........
                             surgery, pelvis.
   *01112  N                Anesth, bone         ...........  ...........  ...........  ...........  ...........
                             aspirate/bx.
    01120  N                Anesth, pelvis       ...........  ...........  ...........  ...........  ...........
                             surgery.
    01130  N                Anesth, body cast    ...........  ...........  ...........  ...........  ...........
                             procedure.
    01140  N                Anesth, amputation   ...........  ...........  ...........  ...........  ...........
                             at pelvis.
    01150  N                Anesth, pelvic       ...........  ...........  ...........  ...........  ...........
                             tumor surgery.
    01160  N                Anesth, pelvis       ...........  ...........  ...........  ...........  ...........
                             procedure.
    01170  N                Anesth, pelvis       ...........  ...........  ...........  ...........  ...........
                             surgery.
    01180  N                Anesth, pelvis       ...........  ...........  ...........  ...........  ...........
                             nerve removal.
    01190  N                Anesth, pelvis       ...........  ...........  ...........  ...........  ...........
                             nerve removal.
    01200  N                Anesth, hip joint    ...........  ...........  ...........  ...........  ...........
                             procedure.
    01202  N                Anesth, arthroscopy  ...........  ...........  ...........  ...........  ...........
                             of hip.
    01210  N                Anesth, hip joint    ...........  ...........  ...........  ...........  ...........
                             surgery.
    01212  N                Anesth, hip          ...........  ...........  ...........  ...........  ...........
                             disarticulation.
    01214  N                Anesth, replacement  ...........  ...........  ...........  ...........  ...........
                             of hip.
   *01215  N                Anesth, revise hip   ...........  ...........  ...........  ...........  ...........
                             repair.
    01220  N                Anesth, procedure    ...........  ...........  ...........  ...........  ...........
                             on femur.
    01230  N                Anesth, surgery of   ...........  ...........  ...........  ...........  ...........
                             femur.
    01232  N                Anesth, amputation   ...........  ...........  ...........  ...........  ...........
                             of femur.
    01234  N                Anesth, radical      ...........  ...........  ...........  ...........  ...........
                             femur surg.
    01240  N                Anesth, upper leg    ...........  ...........  ...........  ...........  ...........
                             skin surg.
    01250  N                Anesth, upper leg    ...........  ...........  ...........  ...........  ...........
                             surgery.
    01260  N                Anesth, upper leg    ...........  ...........  ...........  ...........  ...........
                             veins surg.
    01270  N                Anesth, thigh        ...........  ...........  ...........  ...........  ...........
                             arteries surg.
    01272  N                Anesth, femoral      ...........  ...........  ...........  ...........  ...........
                             artery surg.
    01274  N                Anesth, femoral      ...........  ...........  ...........  ...........  ...........
                             embolectomy.
    01300  N                Anesth, skin         ...........  ...........  ...........  ...........  ...........
                             surgery, knee.
    01320  N                Anesth, knee area    ...........  ...........  ...........  ...........  ...........
                             surgery.
    01340  N                Anesth, knee area    ...........  ...........  ...........  ...........  ...........
                             procedure.
    01360  N                Anesth, knee area    ...........  ...........  ...........  ...........  ...........
                             surgery.
    01380  N                Anesth, knee joint   ...........  ...........  ...........  ...........  ...........
                             procedure.
    01382  N                Anesth, knee         ...........  ...........  ...........  ...........  ...........
                             arthroscopy.
    01390  N                Anesth, knee area    ...........  ...........  ...........  ...........  ...........
                             procedure.
    01392  N                Anesth, knee area    ...........  ...........  ...........  ...........  ...........
                             surgery.
    01400  N                Anesth, knee joint   ...........  ...........  ...........  ...........  ...........
                             surgery.
    01402  N                Anesth, replacement  ...........  ...........  ...........  ...........  ...........
                             of knee.
    01404  N                Anesth, amputation   ...........  ...........  ...........  ...........  ...........
                             at knee.
    01420  N                Anesth, knee joint   ...........  ...........  ...........  ...........  ...........
                             casting.
    01430  N                Anesth, knee veins   ...........  ...........  ...........  ...........  ...........
                             surgery.
    01432  N                Anesth, knee vessel  ...........  ...........  ...........  ...........  ...........
                             surg.
    01440  N                Anesth, knee         ...........  ...........  ...........  ...........  ...........
                             arteries surg.
    01442  N                Anesth, knee artery  ...........  ...........  ...........  ...........  ...........
                             surg.
    01444  N                Anesth, knee artery  ...........  ...........  ...........  ...........  ...........
                             repair.
    01460  N                Anesth, lower leg    ...........  ...........  ...........  ...........  ...........
                             skin surg.
    01462  N                Anesth, lower leg    ...........  ...........  ...........  ...........  ...........
                             procedure.
    01464  N                Anesth, ankle        ...........  ...........  ...........  ...........  ...........
                             arthroscopy.
    01470  N                Anesth, lower leg    ...........  ...........  ...........  ...........  ...........
                             surgery.
    01472  N                Anesth, achilles     ...........  ...........  ...........  ...........  ...........
                             tendon surg.
    01474  N                Anesth, lower leg    ...........  ...........  ...........  ...........  ...........
                             surgery.
    01480  N                Anesth, lower leg    ...........  ...........  ...........  ...........  ...........
                             bone surg.
    01482  N                Anesth, radical leg  ...........  ...........  ...........  ...........  ...........
                             surgery.
    01484  N                Anesth, lower leg    ...........  ...........  ...........  ...........  ...........
                             revision.
    01486  N                Anesth, ankle        ...........  ...........  ...........  ...........  ...........
                             replacement.
    01490  N                Anesth, lower leg    ...........  ...........  ...........  ...........  ...........
                             casting.
    01500  N                Anesth, leg          ...........  ...........  ...........  ...........  ...........
                             arteries surg.
    01502  N                Anesth, lwr leg      ...........  ...........  ...........  ...........  ...........
                             embolectomy.
    01520  N                Anesth, lower leg    ...........  ...........  ...........  ...........  ...........
                             vein surg.
    01522  N                Anesth, lower leg    ...........  ...........  ...........  ...........  ...........
                             vein surg.
    01600  N                Anesth, shoulder     ...........  ...........  ...........  ...........  ...........
                             skin surg.
    01610  N                Anesth, surgery of   ...........  ...........  ...........  ...........  ...........
                             shoulder.
    01620  N                Anesth, shoulder     ...........  ...........  ...........  ...........  ...........
                             procedure.
    01622  N                Anesth, shoulder     ...........  ...........  ...........  ...........  ...........
                             arthroscopy.
    01630  N                Anesth, surgery of   ...........  ...........  ...........  ...........  ...........
                             shoulder.
    01632  N                Anesth, surgery of   ...........  ...........  ...........  ...........  ...........
                             shoulder.
    01634  N                Anesth, shoulder     ...........  ...........  ...........  ...........  ...........
                             joint amput.
    01636  N                Anesth, forequarter  ...........  ...........  ...........  ...........  ...........
                             amput.
    01638  N                Anesth, shoulder     ...........  ...........  ...........  ...........  ...........
                             replacement.
    01650  N                Anesth, shoulder     ...........  ...........  ...........  ...........  ...........
                             artery surg.
    01652  N                Anesth, shoulder     ...........  ...........  ...........  ...........  ...........
                             vessel surg.
    01654  N                Anesth, shoulder     ...........  ...........  ...........  ...........  ...........
                             vessel surg.
    01656  N                Anesth, arm-leg      ...........  ...........  ...........  ...........  ...........
                             vessel surg.
    01670  N                Anesth, shoulder     ...........  ...........  ...........  ...........  ...........
                             vein surg.
    01680  N                Anesth, shoulder     ...........  ...........  ...........  ...........  ...........
                             casting.
    01682  N                Anesth, airplane     ...........  ...........  ...........  ...........  ...........
                             cast.

[[Page 67849]]

 
    01700  N                Anesth, elbow area   ...........  ...........  ...........  ...........  ...........
                             skin surg.
    01710  N                Anesth, elbow area   ...........  ...........  ...........  ...........  ...........
                             surgery.
    01712  N                Anesth, uppr arm     ...........  ...........  ...........  ...........  ...........
                             tendon surg.
    01714  N                Anesth, uppr arm     ...........  ...........  ...........  ...........  ...........
                             tendon surg.
    01716  N                Anesth, biceps       ...........  ...........  ...........  ...........  ...........
                             tendon repair.
    01730  N                Anesth, uppr arm     ...........  ...........  ...........  ...........  ...........
                             procedure.
    01732  N                Anesth, elbow        ...........  ...........  ...........  ...........  ...........
                             arthroscopy.
    01740  N                Anesth, upper arm    ...........  ...........  ...........  ...........  ...........
                             surgery.
    01742  N                Anesth, humerus      ...........  ...........  ...........  ...........  ...........
                             surgery.
    01744  N                Anesth, humerus      ...........  ...........  ...........  ...........  ...........
                             repair.
    01756  N                Anesth, radical      ...........  ...........  ...........  ...........  ...........
                             humerus surg.
    01758  N                Anesth, humeral      ...........  ...........  ...........  ...........  ...........
                             lesion surg.
    01760  N                Anesth, elbow        ...........  ...........  ...........  ...........  ...........
                             replacement.
    01770  N                Anesth, uppr arm     ...........  ...........  ...........  ...........  ...........
                             artery surg.
    01772  N                Anesth, uppr arm     ...........  ...........  ...........  ...........  ...........
                             embolectomy.
    01780  N                Anesth, upper arm    ...........  ...........  ...........  ...........  ...........
                             vein surg.
    01782  N                Anesth, uppr arm     ...........  ...........  ...........  ...........  ...........
                             vein repair.
   01784D  N                Anesth, av fistula   ...........  ...........  ...........  ...........  ...........
                             repair.
    01800  N                Anesth, lower arm    ...........  ...........  ...........  ...........  ...........
                             skin surg.
    01810  N                Anesth, lower arm    ...........  ...........  ...........  ...........  ...........
                             surgery.
    01820  N                Anesth, lower arm    ...........  ...........  ...........  ...........  ...........
                             procedure.
    01830  N                Anesth, lower arm    ...........  ...........  ...........  ...........  ...........
                             surgery.
    01832  N                Anesth, wrist        ...........  ...........  ...........  ...........  ...........
                             replacement.
    01840  N                Anesth, lwr arm      ...........  ...........  ...........  ...........  ...........
                             artery surg.
    01842  N                Anesth, lwr arm      ...........  ...........  ...........  ...........  ...........
                             embolectomy.
    01844  N                Anesth, vascular     ...........  ...........  ...........  ...........  ...........
                             shunt surg.
    01850  N                Anesth, lower arm    ...........  ...........  ...........  ...........  ...........
                             vein surg.
    01852  N                Anesth, lwr arm      ...........  ...........  ...........  ...........  ...........
                             vein repair.
    01860  N                Anesth, lower arm    ...........  ...........  ...........  ...........  ...........
                             casting.
    01900  N                Anesth, uterus/tube  ...........  ...........  ...........  ...........  ...........
                             inject.
    01902  N                Anesth, burr holes,  ...........  ...........  ...........  ...........  ...........
                             skull.
    01904  N                Anesth, skull x-ray  ...........  ...........  ...........  ...........  ...........
                             inject.
    01906  N                Anesth, lumbar       ...........  ...........  ...........  ...........  ...........
                             myelography.
    01908  N                Anesth, cervical     ...........  ...........  ...........  ...........  ...........
                             myelography.
    01910  N                Anesth, skull        ...........  ...........  ...........  ...........  ...........
                             myelography.
    01912  N                Anesth, lumbar       ...........  ...........  ...........  ...........  ...........
                             diskography.
    01914  N                Anesth, cervical     ...........  ...........  ...........  ...........  ...........
                             diskography.
    01916  N                Anesth, head         ...........  ...........  ...........  ...........  ...........
                             arteriogram.
    01918  N                Anesth, limb         ...........  ...........  ...........  ...........  ...........
                             arteriogram.
    01920  N                Anesth, catheterize  ...........  ...........  ...........  ...........  ...........
                             heart.
    01921  N                Anesth, vessel       ...........  ...........  ...........  ...........  ...........
                             surgery.
    01922  N                Anesth, cat or MRI   ...........  ...........  ...........  ...........  ...........
                             scan.
   *01951  N                Anesth, burn, less   ...........  ...........  ...........  ...........  ...........
                             1 percent.
   *01952  N                Anesth, burn, 1-9    ...........  ...........  ...........  ...........  ...........
                             percent.
   *01953  N                Anesth, burn, each   ...........  ...........  ...........  ...........  ...........
                             9 percent.
    01990  N                Support for organ    ...........  ...........  ...........  ...........  ...........
                             donor.
    01995  N                Regional             ...........  ...........  ...........  ...........  ...........
                             anesthesia, limb.
    01996  N                Manage daily drug    ...........  ...........  ...........  ...........  ...........
                             therapy.
    01999  N                Unlisted anesth      ...........  ...........  ...........  ...........  ...........
                             procedure.
    10040  T                Acne surgery of             0006         2.00       $99.19       $33.95       $19.84
                             skin abscess.
    10060  T                Drainage of skin            0006         2.00       $99.19       $33.95       $19.84
                             abscess.
    10061  T                Drainage of skin            0006         2.00       $99.19       $33.95       $19.84
                             abscess.
    10080  T                Drainage of                 0006         2.00       $99.19       $33.95       $19.84
                             pilonidal cyst.
    10081  T                Drainage of                 0007         3.68      $182.51       $72.03       $36.50
                             pilonidal cyst.
    10120  T                Remove foreign body         0006         2.00       $99.19       $33.95       $19.84
    10121  T                Remove foreign body         0020         6.51      $322.87      $130.53       $64.57
    10140  T                Drainage of                 0007         3.68      $182.51       $72.03       $36.50
                             hematoma/fluid.
    10160  T                Puncture drainage           0006         2.00       $99.19       $33.95       $19.84
                             of lesion.
    10180  T                Complex drainage,           0007         3.68      $182.51       $72.03       $36.50
                             wound.
    11000  T                Debride infected            0015         1.77       $87.78       $31.20       $17.56
                             skin.
    11001  T                Debride infected            0015         1.77       $87.78       $31.20       $17.56
                             skin add-on.
    11010  T                Debride skin, fx...         0022        12.49      $619.45      $292.94      $123.89
    11011  T                Debride skin/               0022        12.49      $619.45      $292.94      $123.89
                             muscle, fx.
    11012  T                Debride skin/muscle/        0022        12.49      $619.45      $292.94      $123.89
                             bone, fx.
    11040  T                Debride skin,               0015         1.77       $87.78       $31.20       $17.56
                             partial.
    11041  T                Debride skin, full.         0015         1.77       $87.78       $31.20       $17.56
    11042  T                Debride skin/tissue         0016         3.53      $175.07       $74.67       $35.01
    11043  T                Debride tissue/             0016         3.53      $175.07       $74.67       $35.01
                             muscle.
    11044  T                Debride tissue/             0017        12.45      $617.47      $289.16      $123.49
                             muscle/bone.
    11055  T                Trim skin lesion...         0015         1.77       $87.78       $31.20       $17.56
    11056  T                Trim skin lesions,          0015         1.77       $87.78       $31.20       $17.56
                             2 to 4.
    11057  T                Trim skin lesions,          0015         1.77       $87.78       $31.20       $17.56
                             over 4.
    11100  T                Biopsy of skin              0018         0.94       $46.62       $17.66        $9.32
                             lesion.
    11101  T                Biopsy, skin add-on         0018         0.94       $46.62       $17.66        $9.32

[[Page 67850]]

 
    11200  T                Removal of skin             0015         1.77       $87.78       $31.20       $17.56
                             tags.
    11201  T                Remove skin tags            0015         1.77       $87.78       $31.20       $17.56
                             add-on.
    11300  T                Shave skin lesion..         0013         0.91       $45.13       $17.66        $9.03
    11301  T                Shave skin lesion..         0013         0.91       $45.13       $17.66        $9.03
    11302  T                Shave skin lesion..         0014         1.50       $74.39       $24.55       $14.88
    11303  T                Shave skin lesion..         0015         1.77       $87.78       $31.20       $17.56
    11305  T                Shave skin lesion..         0013         0.91       $45.13       $17.66        $9.03
    11306  T                Shave skin lesion..         0013         0.91       $45.13       $17.66        $9.03
    11307  T                Shave skin lesion..         0014         1.50       $74.39       $24.55       $14.88
    11308  T                Shave skin lesion..         0015         1.77       $87.78       $31.20       $17.56
    11310  T                Shave skin lesion..         0013         0.91       $45.13       $17.66        $9.03
    11311  T                Shave skin lesion..         0013         0.91       $45.13       $17.66        $9.03
    11312  T                Shave skin lesion..         0015         1.77       $87.78       $31.20       $17.56
    11313  T                Shave skin lesion..         0016         3.53      $175.07       $74.67       $35.01
    11400  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11401  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11402  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11403  T                Removal of skin             0020         6.51      $322.87      $130.53       $64.57
                             lesion.
    11404  T                Removal of skin             0020         6.51      $322.87      $130.53       $64.57
                             lesion.
    11406  T                Removal of skin             0020         6.51      $322.87      $130.53       $64.57
                             lesion.
    11420  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11421  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11422  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11423  T                Removal of skin             0020         6.51      $322.87      $130.53       $64.57
                             lesion.
    11424  T                Removal of skin             0020         6.51      $322.87      $130.53       $64.57
                             lesion.
    11426  T                Removal of skin             0022        12.49      $619.45      $292.94      $123.89
                             lesion.
    11440  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11441  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11442  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11443  T                Removal of skin             0020         6.51      $322.87      $130.53       $64.57
                             lesion.
    11444  T                Removal of skin             0020         6.51      $322.87      $130.53       $64.57
                             lesion.
    11446  T                Removal of skin             0022        12.49      $619.45      $292.94      $123.89
                             lesion.
    11450  T                Removal, sweat              0022        12.49      $619.45      $292.94      $123.89
                             gland lesion.
    11451  T                Removal, sweat              0022        12.49      $619.45      $292.94      $123.89
                             gland lesion.
    11462  T                Removal, sweat              0022        12.49      $619.45      $292.94      $123.89
                             gland lesion.
    11463  T                Removal, sweat              0022        12.49      $619.45      $292.94      $123.89
                             gland lesion.
    11470  T                Removal, sweat              0022        12.49      $619.45      $292.94      $123.89
                             gland lesion.
    11471  T                Removal, sweat              0022        12.49      $619.45      $292.94      $123.89
                             gland lesion.
    11600  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11601  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11602  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11603  T                Removal of skin             0020         6.51      $322.87      $130.53       $64.57
                             lesion.
    11604  T                Removal of skin             0020         6.51      $322.87      $130.53       $64.57
                             lesion.
    11606  T                Removal of skin             0021        10.49      $520.26      $236.51      $104.05
                             lesion.
    11620  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11621  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11622  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11623  T                Removal of skin             0020         6.51      $322.87      $130.53       $64.57
                             lesion.
    11624  T                Removal of skin             0020         6.51      $322.87      $130.53       $64.57
                             lesion.
    11626  T                Removal of skin             0022        12.49      $619.45      $292.94      $123.89
                             lesion.
    11640  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11641  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11642  T                Removal of skin             0019         4.00      $198.39       $78.91       $39.68
                             lesion.
    11643  T                Removal of skin             0020         6.51      $322.87      $130.53       $64.57
                             lesion.
    11644  T                Removal of skin             0020         6.51      $322.87      $130.53       $64.57
                             lesion.
    11646  T                Removal of skin             0022        12.49      $619.45      $292.94      $123.89
                             lesion.
    11719  T                Trim nail(s).......         0009         0.74       $36.70        $9.63        $7.34
    11720  T                Debride nail, 1-5..         0009         0.74       $36.70        $9.63        $7.34
    11721  T                Debride nail, 6 or          0009         0.74       $36.70        $9.63        $7.34
                             more.
    11730  T                Removal of nail             0013         0.91       $45.13       $17.66        $9.03
                             plate.
    11732  T                Remove nail plate,          0012         0.53       $26.29        $9.18        $5.26
                             add-on.
    11740  T                Drain blood from            0009         0.74       $36.70        $9.63        $7.34
                             under nail.
    11750  T                Removal of nail bed         0019         4.00      $198.39       $78.91       $39.68
    11752  T                Remove nail bed/            0022        12.49      $619.45      $292.94      $123.89
                             finger tip.
    11755  T                Biopsy, nail unit..         0019         4.00      $198.39       $78.91       $39.68
    11760  T                Repair of nail bed.         0024         2.43      $120.51       $44.50       $24.10
    11762  T                Reconstruction of           0024         2.43      $120.51       $44.50       $24.10
                             nail bed.
    11765  T                Excision of nail            0015         1.77       $87.78       $31.20       $17.56
                             fold, toe.
    11770  T                Removal of                  0021        10.49      $520.26      $236.51      $104.05
                             pilonidal lesion.
    11771  T                Removal of                  0022        12.49      $619.45      $292.94      $123.89
                             pilonidal lesion.
    11772  T                Removal of                  0022        12.49      $619.45      $292.94      $123.89
                             pilonidal lesion.
    11900  T                Injection into skin         0012         0.53       $26.29        $9.18        $5.26
                             lesions.
    11901  T                Added skin lesions          0013         0.91       $45.13       $17.66        $9.03
                             injection.
    11920  T                Correct skin color          0024         2.43      $120.51       $44.50       $24.10
                             defects.

[[Page 67851]]

 
    11921  T                Correct skin color          0024         2.43      $120.51       $44.50       $24.10
                             defects.
    11922  T                Correct skin color          0024         2.43      $120.51       $44.50       $24.10
                             defects.
    11950  T                Therapy for contour         0024         2.43      $120.51       $44.50       $24.10
                             defects.
    11951  T                Therapy for contour         0024         2.43      $120.51       $44.50       $24.10
                             defects.
    11952  T                Therapy for contour         0024         2.43      $120.51       $44.50       $24.10
                             defects.
    11954  T                Therapy for contour         0024         2.43      $120.51       $44.50       $24.10
                             defects.
    11960  T                Insert tissue               0026        12.11      $600.61      $277.92      $120.12
                             expander(s).
    11970  T                Replace tissue              0026        12.11      $600.61      $277.92      $120.12
                             expander.
    11971  T                Remove tissue               0022        12.49      $619.45      $292.94      $123.89
                             expander(s).
    11975  E                Insert               ...........  ...........  ...........  ...........  ...........
                             contraceptive cap.
    11976  T                Removal of                  0019         4.00      $198.39       $78.91       $39.68
                             contraceptive cap.
    11977  E                Removal/reinsert     ...........  ...........  ...........  ...........  ...........
                             contra cap.
    11980  X                Implant hormone             0340         1.04       $51.58       $12.85       $10.32
                             pellet(s).
    12001  T                Repair superficial          0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12002  T                Repair superficial          0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12004  T                Repair superficial          0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12005  T                Repair superficial          0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12006  T                Repair superficial          0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12007  T                Repair superficial          0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12011  T                Repair superficial          0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12013  T                Repair superficial          0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12014  T                Repair superficial          0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12015  T                Repair superficial          0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12016  T                Repair superficial          0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12017  T                Repair superficial          0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12018  T                Repair superficial          0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12020  T                Closure of split            0024         2.43      $120.51       $44.50       $24.10
                             wound.
    12021  T                Closure of split            0024         2.43      $120.51       $44.50       $24.10
                             wound.
    12031  T                Layer closure of            0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12032  T                Layer closure of            0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12034  T                Layer closure of            0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12035  T                Layer closure of            0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12036  T                Layer closure of            0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12037  T                Layer closure of            0026        12.11      $600.61      $277.92      $120.12
                             wound(s).
    12041  T                Layer closure of            0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12042  T                Layer closure of            0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12044  T                Layer closure of            0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12045  T                Layer closure of            0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12046  T                Layer closure of            0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12047  T                Layer closure of            0026        12.11      $600.61      $277.92      $120.12
                             wound(s).
    12051  T                Layer closure of            0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12052  T                Layer closure of            0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12053  T                Layer closure of            0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12054  T                Layer closure of            0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12055  T                Layer closure of            0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12056  T                Layer closure of            0024         2.43      $120.51       $44.50       $24.10
                             wound(s).
    12057  T                Layer closure of            0026        12.11      $600.61      $277.92      $120.12
                             wound(s).
    13100  T                Repair of wound or          0025         3.74      $185.49       $70.66       $37.10
                             lesion.
    13101  T                Repair of wound or          0025         3.74      $185.49       $70.66       $37.10
                             lesion.
    13102  T                Repair wound/lesion         0025         3.74      $185.49       $70.66       $37.10
                             add-on.
    13120  T                Repair of wound or          0025         3.74      $185.49       $70.66       $37.10
                             lesion.
    13121  T                Repair of wound or          0025         3.74      $185.49       $70.66       $37.10
                             lesion.
    13122  T                Repair wound/lesion         0025         3.74      $185.49       $70.66       $37.10
                             add-on.
    13131  T                Repair of wound or          0025         3.74      $185.49       $70.66       $37.10
                             lesion.
    13132  T                Repair of wound or          0025         3.74      $185.49       $70.66       $37.10
                             lesion.
    13133  T                Repair wound/lesion         0025         3.74      $185.49       $70.66       $37.10
                             add-on.
    13150  T                Repair of wound or          0026        12.11      $600.61      $277.92      $120.12
                             lesion.
    13151  T                Repair of wound or          0025         3.74      $185.49       $70.66       $37.10
                             lesion.
    13152  T                Repair of wound or          0025         3.74      $185.49       $70.66       $37.10
                             lesion.
    13153  T                Repair wound/lesion         0025         3.74      $185.49       $70.66       $37.10
                             add-on.
    13160  T                Late closure of             0026        12.11      $600.61      $277.92      $120.12
                             wound.
    14000  T                Skin tissue                 0026        12.11      $600.61      $277.92      $120.12
                             rearrangement.
    14001  T                Skin tissue                 0026        12.11      $600.61      $277.92      $120.12
                             rearrangement.
    14020  T                Skin tissue                 0026        12.11      $600.61      $277.92      $120.12
                             rearrangement.
    14021  T                Skin tissue                 0026        12.11      $600.61      $277.92      $120.12
                             rearrangement.
    14040  T                Skin tissue                 0026        12.11      $600.61      $277.92      $120.12
                             rearrangement.
    14041  T                Skin tissue                 0026        12.11      $600.61      $277.92      $120.12
                             rearrangement.
    14060  T                Skin tissue                 0026        12.11      $600.61      $277.92      $120.12
                             rearrangement.
    14061  T                Skin tissue                 0026        12.11      $600.61      $277.92      $120.12
                             rearrangement.
    14300  T                Skin tissue                 0026        12.11      $600.61      $277.92      $120.12
                             rearrangement.
    14350  T                Skin tissue                 0026        12.11      $600.61      $277.92      $120.12
                             rearrangement.
    15000  T                Skin graft.........         0026        12.11      $600.61      $277.92      $120.12
    15001  T                Skin graft add-on..         0026        12.11      $600.61      $277.92      $120.12
    15050  T                Skin pinch graft...         0026        12.11      $600.61      $277.92      $120.12

[[Page 67852]]

 
    15100  T                Skin split graft...         0026        12.11      $600.61      $277.92      $120.12
    15101  T                Skin split graft            0026        12.11      $600.61      $277.92      $120.12
                             add-on.
    15120  T                Skin split graft...         0026        12.11      $600.61      $277.92      $120.12
    15121  T                Skin split graft            0026        12.11      $600.61      $277.92      $120.12
                             add-on.
    15200  T                Skin full graft....         0026        12.11      $600.61      $277.92      $120.12
    15201  T                Skin full graft add-        0026        12.11      $600.61      $277.92      $120.12
                             on.
    15220  T                Skin full graft....         0026        12.11      $600.61      $277.92      $120.12
    15221  T                Skin full graft add-        0026        12.11      $600.61      $277.92      $120.12
                             on.
    15240  T                Skin full graft....         0026        12.11      $600.61      $277.92      $120.12
    15241  T                Skin full graft add-        0026        12.11      $600.61      $277.92      $120.12
                             on.
    15260  T                Skin full graft....         0026        12.11      $600.61      $277.92      $120.12
    15261  T                Skin full graft add-        0026        12.11      $600.61      $277.92      $120.12
                             on.
   *15342  T                Cultured skin               0025         3.74      $185.49       $70.66       $37.10
                             graft, 25 cm.
   *15343  T                Culture skin graft          0025         3.74      $185.49       $70.66       $37.10
                             addl 25 cm.
    15350  T                Skin homograft.....         0026        12.11      $600.61      $277.92      $120.12
    15351  T                Skin homograft add-         0026        12.11      $600.61      $277.92      $120.12
                             on.
    15400  T                Skin heterograft...         0026        12.11      $600.61      $277.92      $120.12
    15401  T                Skin heterograft            0026        12.11      $600.61      $277.92      $120.12
                             add-on.
    15570  T                Form skin pedicle           0026        12.11      $600.61      $277.92      $120.12
                             flap.
    15572  T                Form skin pedicle           0026        12.11      $600.61      $277.92      $120.12
                             flap.
    15574  T                Form skin pedicle           0026        12.11      $600.61      $277.92      $120.12
                             flap.
    15576  T                Form skin pedicle           0026        12.11      $600.61      $277.92      $120.12
                             flap.
    15600  T                Skin graft.........         0026        12.11      $600.61      $277.92      $120.12
    15610  T                Skin graft.........         0026        12.11      $600.61      $277.92      $120.12
    15620  T                Skin graft.........         0026        12.11      $600.61      $277.92      $120.12
    15630  T                Skin graft.........         0026        12.11      $600.61      $277.92      $120.12
    15650  T                Transfer skin               0026        12.11      $600.61      $277.92      $120.12
                             pedicle flap.
    15732  T                Muscle-skin graft,          0027        15.80      $783.62      $383.10      $156.72
                             head/neck.
    15734  T                Muscle-skin graft,          0027        15.80      $783.62      $383.10      $156.72
                             trunk.
    15736  T                Muscle-skin graft,          0027        15.80      $783.62      $383.10      $156.72
                             arm.
    15738  T                Muscle-skin graft,          0027        15.80      $783.62      $383.10      $156.72
                             leg.
    15740  T                Island pedicle flap         0027        15.80      $783.62      $383.10      $156.72
                             graft.
    15750  T                Neurovascular               0027        15.80      $783.62      $383.10      $156.72
                             pedicle graft.
    15756  C                Free muscle flap,    ...........  ...........  ...........  ...........  ...........
                             microvasc.
    15757  C                Free skin flap,      ...........  ...........  ...........  ...........  ...........
                             microvasc.
    15758  C                Free fascial flap,   ...........  ...........  ...........  ...........  ...........
                             microvasc.
    15760  T                Composite skin              0027        15.80      $783.62      $383.10      $156.72
                             graft.
    15770  T                Derma-fat-fascia            0027        15.80      $783.62      $383.10      $156.72
                             graft.
    15775  T                Hair transplant             0026        12.11      $600.61      $277.92      $120.12
                             punch grafts.
    15776  T                Hair transplant             0026        12.11      $600.61      $277.92      $120.12
                             punch grafts.
    15780  T                Abrasion treatment          0022        12.49      $619.45      $292.94      $123.89
                             of skin.
    15781  T                Abrasion treatment          0022        12.49      $619.45      $292.94      $123.89
                             of skin.
    15782  T                Abrasion treatment          0022        12.49      $619.45      $292.94      $123.89
                             of skin.
    15783  T                Abrasion treatment          0015         1.77       $87.78       $31.20       $17.56
                             of skin.
    15786  T                Abrasion, lesion,           0013         0.91       $45.13       $17.66        $9.03
                             single.
    15787  T                Abrasion, lesions,          0016         3.53      $175.07       $74.67       $35.01
                             add-on.
    15788  T                Chemical peel,              0013         0.91       $45.13       $17.66        $9.03
                             face, epiderm.
    15789  T                Chemical peel,              0015         1.77       $87.78       $31.20       $17.56
                             face, dermal.
    15792  T                Chemical peel,              0016         3.53      $175.07       $74.67       $35.01
                             nonfacial.
    15793  T                Chemical peel,              0016         3.53      $175.07       $74.67       $35.01
                             nonfacial.
    15810  T                Salabrasion........         0016         3.53      $175.07       $74.67       $35.01
    15811  T                Salabrasion........         0022        12.49      $619.45      $292.94      $123.89
    15819  T                Plastic surgery,            0026        12.11      $600.61      $277.92      $120.12
                             neck.
    15820  T                Revision of lower           0026        12.11      $600.61      $277.92      $120.12
                             eyelid.
    15821  T                Revision of lower           0026        12.11      $600.61      $277.92      $120.12
                             eyelid.
    15822  T                Revision of upper           0026        12.11      $600.61      $277.92      $120.12
                             eyelid.
    15823  T                Revision of upper           0026        12.11      $600.61      $277.92      $120.12
                             eyelid.
    15824  T                Removal of forehead         0027        15.80      $783.62      $383.10      $156.72
                             wrinkles.
    15825  T                Removal of neck             0026        12.11      $600.61      $277.92      $120.12
                             wrinkles.
    15826  T                Removal of brow             0027        15.80      $783.62      $383.10      $156.72
                             wrinkles.
    15828  T                Removal of face             0027        15.80      $783.62      $383.10      $156.72
                             wrinkles.
    15829  T                Removal of skin             0026        12.11      $600.61      $277.92      $120.12
                             wrinkles.
    15831  T                Excise excessive            0027        15.80      $783.62      $383.10      $156.72
                             skin tissue.
    15832  T                Excise excessive            0027        15.80      $783.62      $383.10      $156.72
                             skin tissue.
    15833  T                Excise excessive            0027        15.80      $783.62      $383.10      $156.72
                             skin tissue.
    15834  T                Excise excessive            0027        15.80      $783.62      $383.10      $156.72
                             skin tissue.
    15835  T                Excise excessive            0026        12.11      $600.61      $277.92      $120.12
                             skin tissue.
    15836  T                Excise excessive            0027        15.80      $783.62      $383.10      $156.72
                             skin tissue.
    15837  T                Excise excessive            0027        15.80      $783.62      $383.10      $156.72
                             skin tissue.
    15838  T                Excise excessive            0022        12.49      $619.45      $292.94      $123.89
                             skin tissue.
    15839  T                Excise excessive            0027        15.80      $783.62      $383.10      $156.72
                             skin tissue.
    15840  T                Graft for face              0027        15.80      $783.62      $383.10      $156.72
                             nerve palsy.
    15841  T                Graft for face              0027        15.80      $783.62      $383.10      $156.72
                             nerve palsy.
    15842  T                Graft for face              0027        15.80      $783.62      $383.10      $156.72
                             nerve palsy.

[[Page 67853]]

 
    15845  T                Skin and muscle             0027        15.80      $783.62      $383.10      $156.72
                             repair, face.
    15850  T                Removal of sutures.         0013         0.91       $45.13       $17.66        $9.03
    15851  T                Removal of sutures.         0013         0.91       $45.13       $17.66        $9.03
    15852  T                Dressing change,not         0012         0.53       $26.29        $9.18        $5.26
                             for burn.
    15860  N                Test for blood flow  ...........  ...........  ...........  ...........  ...........
                             in graft.
    15876  T                Suction assisted            0027        15.80      $783.62      $383.10      $156.72
                             lipectomy.
    15877  T                Suction assisted            0027        15.80      $783.62      $383.10      $156.72
                             lipectomy.
    15878  T                Suction assisted            0027        15.80      $783.62      $383.10      $156.72
                             lipectomy.
    15879  T                Suction assisted            0027        15.80      $783.62      $383.10      $156.72
                             lipectomy.
    15920  T                Removal of tail             0022        12.49      $619.45      $292.94      $123.89
                             bone ulcer.
    15922  T                Removal of tail             0027        15.80      $783.62      $383.10      $156.72
                             bone ulcer.
    15931  T                Remove sacrum               0022        12.49      $619.45      $292.94      $123.89
                             pressure sore.
    15933  T                Remove sacrum               0022        12.49      $619.45      $292.94      $123.89
                             pressure sore.
    15934  T                Remove sacrum               0027        15.80      $783.62      $383.10      $156.72
                             pressure sore.
    15935  T                Remove sacrum               0027        15.80      $783.62      $383.10      $156.72
                             pressure sore.
    15936  T                Remove sacrum               0027        15.80      $783.62      $383.10      $156.72
                             pressure sore.
    15937  T                Remove sacrum               0027        15.80      $783.62      $383.10      $156.72
                             pressure sore.
    15940  T                Remove hip pressure         0022        12.49      $619.45      $292.94      $123.89
                             sore.
    15941  T                Remove hip pressure         0022        12.49      $619.45      $292.94      $123.89
                             sore.
    15944  T                Remove hip pressure         0027        15.80      $783.62      $383.10      $156.72
                             sore.
    15945  T                Remove hip pressure         0027        15.80      $783.62      $383.10      $156.72
                             sore.
    15946  T                Remove hip pressure         0027        15.80      $783.62      $383.10      $156.72
                             sore.
    15950  T                Remove thigh                0022        12.49      $619.45      $292.94      $123.89
                             pressure sore.
    15951  T                Remove thigh                0022        12.49      $619.45      $292.94      $123.89
                             pressure sore.
    15952  T                Remove thigh                0027        15.80      $783.62      $383.10      $156.72
                             pressure sore.
    15953  T                Remove thigh                0027        15.80      $783.62      $383.10      $156.72
                             pressure sore.
    15956  T                Remove thigh                0027        15.80      $783.62      $383.10      $156.72
                             pressure sore.
    15958  T                Remove thigh                0027        15.80      $783.62      $383.10      $156.72
                             pressure sore.
    15999  T                Removal of pressure         0022        12.49      $619.45      $292.94      $123.89
                             sore.
    16000  T                Initial treatment           0015         1.77       $87.78       $31.20       $17.56
                             of burn(s).
    16010  T                Treatment of                0015         1.77       $87.78       $31.20       $17.56
                             burn(s).
    16015  T                Treatment of                0017        12.45      $617.47      $289.16      $123.49
                             burn(s).
    16020  T                Treatment of                0015         1.77       $87.78       $31.20       $17.56
                             burn(s).
    16025  T                Treatment of                0014         1.50       $74.39       $24.55       $14.88
                             burn(s).
    16030  T                Treatment of                0015         1.77       $87.78       $31.20       $17.56
                             burn(s).
    16035  C                Incision of burn     ...........  ...........  ...........  ...........  ...........
                             scab, initl.
   *16036  C                Incise burn scab,    ...........  ...........  ...........  ...........  ...........
                             addl incis.
    17000  T                Destroy benign/             0010         0.55       $27.28        $9.86        $5.46
                             premal lesion.
    17003  T                Destroy lesions, 2-         0010         0.55       $27.28        $9.86        $5.46
                             14.
    17004  T                Destroy lesions, 15         0011         2.72      $134.90       $50.01       $26.98
                             or more.
    17106  T                Destruction of skin         0011         2.72      $134.90       $50.01       $26.98
                             lesions.
    17107  T                Destruction of skin         0011         2.72      $134.90       $50.01       $26.98
                             lesions.
    17108  T                Destruction of skin         0011         2.72      $134.90       $50.01       $26.98
                             lesions.
    17110  T                Destruct lesion, 1-         0010         0.55       $27.28        $9.86        $5.46
                             14.
    17111  T                Destruct lesion, 15         0011         2.72      $134.90       $50.01       $26.98
                             or more.
    17250  T                Chemical cautery,           0014         1.50       $74.39       $24.55       $14.88
                             tissue.
    17260  T                Destruction of skin         0013         0.91       $45.13       $17.66        $9.03
                             lesions.
    17261  T                Destruction of skin         0013         0.91       $45.13       $17.66        $9.03
                             lesions.
    17262  T                Destruction of skin         0013         0.91       $45.13       $17.66        $9.03
                             lesions.
    17263  T                Destruction of skin         0013         0.91       $45.13       $17.66        $9.03
                             lesions.
    17264  T                Destruction of skin         0015         1.77       $87.78       $31.20       $17.56
                             lesions.
    17266  T                Destruction of skin         0016         3.53      $175.07       $74.67       $35.01
                             lesions.
    17270  T                Destruction of skin         0015         1.77       $87.78       $31.20       $17.56
                             lesions.
    17271  T                Destruction of skin         0013         0.91       $45.13       $17.66        $9.03
                             lesions.
    17272  T                Destruction of skin         0013         0.91       $45.13       $17.66        $9.03
                             lesions.
    17273  T                Destruction of skin         0015         1.77       $87.78       $31.20       $17.56
                             lesions.
    17274  T                Destruction of skin         0015         1.77       $87.78       $31.20       $17.56
                             lesions.
    17276  T                Destruction of skin         0015         1.77       $87.78       $31.20       $17.56
                             lesions.
    17280  T                Destruction of skin         0015         1.77       $87.78       $31.20       $17.56
                             lesions.
    17281  T                Destruction of skin         0015         1.77       $87.78       $31.20       $17.56
                             lesions.
    17282  T                Destruction of skin         0015         1.77       $87.78       $31.20       $17.56
                             lesions.
    17283  T                Destruction of skin         0015         1.77       $87.78       $31.20       $17.56
                             lesions.
    17284  T                Destruction of skin         0016         3.53      $175.07       $74.67       $35.01
                             lesions.
    17286  T                Destruction of skin         0016         3.53      $175.07       $74.67       $35.01
                             lesions.
    17304  T                Chemosurgery of             0020         6.51      $322.87      $130.53       $64.57
                             skin lesion.
    17305  T                2nd stage                   0020         6.51      $322.87      $130.53       $64.57
                             chemosurgery.
    17306  T                3rd stage                   0020         6.51      $322.87      $130.53       $64.57
                             chemosurgery.
    17307  T                Followup skin               0020         6.51      $322.87      $130.53       $64.57
                             lesion therapy.
    17310  T                Extensive skin              0020         6.51      $322.87      $130.53       $64.57
                             chemosurgery.
    17340  T                Cryotherapy of skin         0012         0.53       $26.29        $9.18        $5.26
    17360  T                Skin peel therapy..         0016         3.53      $175.07       $74.67       $35.01
    17380  T                Hair removal by             0016         3.53      $175.07       $74.67       $35.01
                             electrolysis.
    17999  T                Skin tissue                 0004         1.84       $91.26       $32.57       $18.25
                             procedure.
    19000  T                Drainage of breast          0004         1.84       $91.26       $32.57       $18.25
                             lesion.

[[Page 67854]]

 
    19001  T                Drain breast lesion         0004         1.84       $91.26       $32.57       $18.25
                             add-on.
    19020  T                Incision of breast          0008         6.15      $305.02      $113.67       $61.00
                             lesion.
    19030  N                Injection for        ...........  ...........  ...........  ...........  ...........
                             breast x-ray.
    19100  T                Bx breast percut w/         0005         5.41      $268.32      $119.75       $53.66
                             o image.
    19101  T                Biopsy of breast,           0028        12.37      $613.52      $303.74      $122.70
                             open.
   *19102  T                Bx breast percut w/         0005         5.41      $268.32      $119.75       $53.66
                             image.
   *19103  S                Bx breast percut w/         0974         8.25      $409.17  ...........       $81.83
                             device.
    19110  T                Nipple exploration.         0028        12.37      $613.52      $303.74      $122.70
    19112  T                Excise breast duct          0028        12.37      $613.52      $303.74      $122.70
                             fistula.
    19120  T                Removal of breast           0028        12.37      $613.52      $303.74      $122.70
                             lesion.
    19125  T                Excision, breast            0028        12.37      $613.52      $303.74      $122.70
                             lesion.
    19126  T                Excision, addl              0028        12.37      $613.52      $303.74      $122.70
                             breast lesion.
    19140  T                Removal of breast           0028        12.37      $613.52      $303.74      $122.70
                             tissue.
    19160  T                Removal of breast           0028        12.37      $613.52      $303.74      $122.70
                             tissue.
    19162  T                Remove breast               0029        31.39    $1,557.05      $820.79      $311.41
                             tissue, nodes.
    19180  T                Removal of breast..         0029        31.39    $1,557.05      $820.79      $311.41
    19182  T                Removal of breast..         0028        12.37      $613.52      $303.74      $122.70
    19200  C                Removal of breast..  ...........  ...........  ...........  ...........  ...........
    19220  C                Removal of breast..  ...........  ...........  ...........  ...........  ...........
    19240  T                Removal of breast..         0029        31.39    $1,557.05      $820.79      $311.41
    19260  T                Removal of chest            0021        10.49      $520.26      $236.51      $104.05
                             wall lesion.
    19271  C                Revision of chest    ...........  ...........  ...........  ...........  ...........
                             wall.
    19272  C                Extensive chest      ...........  ...........  ...........  ...........  ...........
                             wall surgery.
    19290  T                Place needle wire,          0028        12.37      $613.52      $303.74      $122.70
                             breast.
    19291  T                Place needle wire,          0028        12.37      $613.52      $303.74      $122.70
                             breast.
   *19295  S                Place breast clip,          0971         1.55       $76.88  ...........       $15.38
                             percut.
    19316  T                Suspension of               0029        31.39    $1,557.05      $820.79      $311.41
                             breast.
    19318  T                Reduction of large          0029        31.39    $1,557.05      $820.79      $311.41
                             breast.
    19324  T                Enlarge breast.....         0029        31.39    $1,557.05      $820.79      $311.41
    19325  T                Enlarge breast with         0030        31.11    $1,543.16      $763.55      $308.63
                             implant.
    19328  T                Removal of breast           0028        12.37      $613.52      $303.74      $122.70
                             implant.
    19330  T                Removal of implant          0028        12.37      $613.52      $303.74      $122.70
                             material.
    19340  T                Immediate breast            0030        31.11    $1,543.16      $763.55      $308.63
                             prosthesis.
    19342  T                Delayed breast              0030        31.11    $1,543.16      $763.55      $308.63
                             prosthesis.
    19350  T                Breast                      0028        12.37      $613.52      $303.74      $122.70
                             reconstruction.
    19355  T                Correct inverted            0028        12.37      $613.52      $303.74      $122.70
                             nipple(s).
    19357  T                Breast                      0030        31.11    $1,543.16      $763.55      $308.63
                             reconstruction.
    19361  C                Breast               ...........  ...........  ...........  ...........  ...........
                             reconstruction.
    19364  C                Breast               ...........  ...........  ...........  ...........  ...........
                             reconstruction.
    19366  T                Breast                      0029        31.39    $1,557.05      $820.79      $311.41
                             reconstruction.
    19367  C                Breast               ...........  ...........  ...........  ...........  ...........
                             reconstruction.
    19368  C                Breast               ...........  ...........  ...........  ...........  ...........
                             reconstruction.
    19369  C                Breast               ...........  ...........  ...........  ...........  ...........
                             reconstruction.
    19370  T                Surgery of breast           0028        12.37      $613.52      $303.74      $122.70
                             capsule.
    19371  T                Removal of breast           0029        31.39    $1,557.05      $820.79      $311.41
                             capsule.
    19380  T                Revise breast               0029        31.39    $1,557.05      $820.79      $311.41
                             reconstruction.
    19396  T                Design custom               0028        12.37      $613.52      $303.74      $122.70
                             breast implant.
    19499  T                Breast surgery              0004         1.84       $91.26       $32.57       $18.25
                             procedure.
    20000  T                Incision of abscess         0006         2.00       $99.19       $33.95       $19.84
    20005  T                Incision of deep            0049        15.04      $745.93      $356.95      $149.19
                             abscess.
    20100  T                Explore wound, neck         0023         1.98       $98.20       $40.37       $19.64
    20101  T                Explore wound,              0026        12.11      $600.61      $277.92      $120.12
                             chest.
    20102  T                Explore wound,              0026        12.11      $600.61      $277.92      $120.12
                             abdomen.
    20103  T                Explore wound,              0023         1.98       $98.20       $40.37       $19.64
                             extremity.
    20150  T                Excise epiphyseal           0051        27.76    $1,376.79      $675.24      $275.36
                             bar.
    20200  T                Muscle biopsy......         0020         6.51      $322.87      $130.53       $64.57
    20205  T                Deep muscle biopsy.         0021        10.49      $520.26      $236.51      $104.05
    20206  T                Needle biopsy,              0005         5.41      $268.32      $119.75       $53.66
                             muscle.
    20220  T                Bone biopsy, trocar/        0019         4.00      $198.39       $78.91       $39.68
                             needle.
    20225  T                Bone biopsy, trocar/        0020         6.51      $322.87      $130.53       $64.57
                             needle.
    20240  T                Bone biopsy,                0022        12.49      $619.45      $292.94      $123.89
                             excisional.
    20245  T                Bone biopsy,                0022        12.49      $619.45      $292.94      $123.89
                             excisional.
    20250  T                Open bone biopsy...         0049        15.04      $745.93      $356.95      $149.19
    20251  T                Open bone biopsy...         0049        15.04      $745.93      $356.95      $149.19
    20500  T                Injection of sinus          0252         5.18      $256.90      $114.24       $51.38
                             tract.
    20501  N                Inject sinus tract   ...........  ...........  ...........  ...........  ...........
                             for x-ray.
    20520  T                Removal of foreign          0019         4.00      $198.39       $78.91       $39.68
                             body.
    20525  T                Removal of foreign          0022        12.49      $619.45      $292.94      $123.89
                             body.
    20550  T                Inject tendon/              0040         2.11      $104.65       $40.60       $20.93
                             ligament/cyst.
    20600  T                Drain/inject, joint/        0040         2.11      $104.65       $40.60       $20.93
                             bursa.
    20605  T                Drain/inject, joint/        0040         2.11      $104.65       $40.60       $20.93
                             bursa.
    20610  T                Drain/inject, joint/        0040         2.11      $104.65       $40.60       $20.93
                             bursa.
    20615  T                Treatment of bone           0004         1.84       $91.26       $32.57       $18.25
                             cyst.
    20650  T                Insert and remove           0049        15.04      $745.93      $356.95      $149.19
                             bone pin.

[[Page 67855]]

 
    20660  C                Apply,remove         ...........  ...........  ...........  ...........  ...........
                             fixation device.
    20661  C                Application of head  ...........  ...........  ...........  ...........  ...........
                             brace.
    20662  C                Application of       ...........  ...........  ...........  ...........  ...........
                             pelvis brace.
    20663  C                Application of       ...........  ...........  ...........  ...........  ...........
                             thigh brace.
    20664  C                Halo brace           ...........  ...........  ...........  ...........  ...........
                             application.
    20665  N                Removal of fixation  ...........  ...........  ...........  ...........  ...........
                             device.
    20670  T                Removal of support          0021        10.49      $520.26      $236.51      $104.05
                             implant.
    20680  T                Removal of support          0022        12.49      $619.45      $292.94      $123.89
                             implant.
    20690  T                Apply bone fixation         0050        21.13    $1,047.96      $513.86      $209.59
                             device.
    20692  T                Apply bone fixation         0050        21.13    $1,047.96      $513.86      $209.59
                             device.
    20693  T                Adjust bone                 0049        15.04      $745.93      $356.95      $149.19
                             fixation device.
    20694  T                Remove bone                 0049        15.04      $745.93      $356.95      $149.19
                             fixation device.
    20802  C                Replantation, arm,   ...........  ...........  ...........  ...........  ...........
                             complete.
    20805  C                Replant, forearm,    ...........  ...........  ...........  ...........  ...........
                             complete.
    20808  C                Replantation hand,   ...........  ...........  ...........  ...........  ...........
                             complete.
    20816  C                Replantation digit,  ...........  ...........  ...........  ...........  ...........
                             complete.
    20822  C                Replantation digit,  ...........  ...........  ...........  ...........  ...........
                             complete.
    20824  C                Replantation thumb,  ...........  ...........  ...........  ...........  ...........
                             complete.
    20827  C                Replantation thumb,  ...........  ...........  ...........  ...........  ...........
                             complete.
    20838  C                Replantation foot,   ...........  ...........  ...........  ...........  ...........
                             complete.
    20900  T                Removal of bone for         0050        21.13    $1,047.96      $513.86      $209.59
                             graft.
    20902  T                Removal of bone for         0050        21.13    $1,047.96      $513.86      $209.59
                             graft.
    20910  T                Remove cartilage            0026        12.11      $600.61      $277.92      $120.12
                             for graft.
    20912  T                Remove cartilage            0026        12.11      $600.61      $277.92      $120.12
                             for graft.
    20920  T                Removal of fascia           0026        12.11      $600.61      $277.92      $120.12
                             for graft.
    20922  T                Removal of fascia           0026        12.11      $600.61      $277.92      $120.12
                             for graft.
    20924  T                Removal of tendon           0050        21.13    $1,047.96      $513.86      $209.59
                             for graft.
    20926  T                Removal of tissue           0026        12.11      $600.61      $277.92      $120.12
                             for graft.
    20930  C                Spinal bone          ...........  ...........  ...........  ...........  ...........
                             allograft.
    20931  C                Spinal bone          ...........  ...........  ...........  ...........  ...........
                             allograft.
    20936  C                Spinal bone          ...........  ...........  ...........  ...........  ...........
                             autograft.
    20937  C                Spinal bone          ...........  ...........  ...........  ...........  ...........
                             autograft.
    20938  C                Spinal bone          ...........  ...........  ...........  ...........  ...........
                             autograft.
    20950  T                Fluid pressure,             0008         6.15      $305.02      $113.67       $61.00
                             muscle.
    20955  C                Fibula bone graft,   ...........  ...........  ...........  ...........  ...........
                             microvasc.
    20956  C                Iliac bone graft,    ...........  ...........  ...........  ...........  ...........
                             microvasc.
    20957  C                Mt bone graft,       ...........  ...........  ...........  ...........  ...........
                             microvasc.
    20962  C                Other bone graft,    ...........  ...........  ...........  ...........  ...........
                             microvasc.
    20969  C                Bone/skin graft,     ...........  ...........  ...........  ...........  ...........
                             microvasc.
    20970  C                Bone/skin graft,     ...........  ...........  ...........  ...........  ...........
                             iliac crest.
    20972  C                Bone/skin graft,     ...........  ...........  ...........  ...........  ...........
                             metatarsal.
    20973  C                Bone/skin graft,     ...........  ...........  ...........  ...........  ...........
                             great toe.
    20974  A                Electrical bone      ...........  ...........  ...........  ...........  ...........
                             stimulation.
    20975  T                Electrical bone             0049        15.04      $745.93      $356.95      $149.19
                             stimulation.
    20979  E                Us bone stimulation  ...........  ...........  ...........  ...........  ...........
    20999  N                Musculoskeletal      ...........  ...........  ...........  ...........  ...........
                             surgery.
    21010  T                Incision of jaw             0254        12.45      $617.47      $272.41      $123.49
                             joint.
    21015  T                Resection of facial         0254        12.45      $617.47      $272.41      $123.49
                             tumor.
    21025  T                Excision of bone,           0256        25.40    $1,259.74      $623.05      $251.95
                             lower jaw.
    21026  T                Excision of facial          0256        25.40    $1,259.74      $623.05      $251.95
                             bone(s).
    21029  T                Contour of face             0256        25.40    $1,259.74      $623.05      $251.95
                             bone lesion.
    21030  T                Removal of face             0254        12.45      $617.47      $272.41      $123.49
                             bone lesion.
    21031  T                Remove exostosis,           0253        12.02      $596.14      $284.00      $119.23
                             mandible.
    21032  T                Remove exostosis,           0253        12.02      $596.14      $284.00      $119.23
                             maxilla.
    21034  T                Removal of face             0256        25.40    $1,259.74      $623.05      $251.95
                             bone lesion.
    21040  T                Removal of jaw bone         0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    21041  T                Removal of jaw bone         0256        25.40    $1,259.74      $623.05      $251.95
                             lesion.
    21044  T                Removal of jaw bone         0256        25.40    $1,259.74      $623.05      $251.95
                             lesion.
    21045  C                Extensive jaw        ...........  ...........  ...........  ...........  ...........
                             surgery.
    21050  T                Removal of jaw              0256        25.40    $1,259.74      $623.05      $251.95
                             joint.
    21060  T                Remove jaw joint            0256        25.40    $1,259.74      $623.05      $251.95
                             cartilage.
    21070  T                Remove coronoid             0256        25.40    $1,259.74      $623.05      $251.95
                             process.
    21076  T                Prepare face/oral           0254        12.45      $617.47      $272.41      $123.49
                             prosthesis.
    21077  T                Prepare face/oral           0256        25.40    $1,259.74      $623.05      $251.95
                             prosthesis.
    21079  T                Prepare face/oral           0256        25.40    $1,259.74      $623.05      $251.95
                             prosthesis.
    21080  T                Prepare face/oral           0256        25.40    $1,259.74      $623.05      $251.95
                             prosthesis.
    21081  T                Prepare face/oral           0256        25.40    $1,259.74      $623.05      $251.95
                             prosthesis.
    21082  T                Prepare face/oral           0256        25.40    $1,259.74      $623.05      $251.95
                             prosthesis.
    21083  T                Prepare face/oral           0256        25.40    $1,259.74      $623.05      $251.95
                             prosthesis.
    21084  T                Prepare face/oral           0256        25.40    $1,259.74      $623.05      $251.95
                             prosthesis.
    21085  T                Prepare face/oral           0253        12.02      $596.14      $284.00      $119.23
                             prosthesis.
    21086  T                Prepare face/oral           0256        25.40    $1,259.74      $623.05      $251.95
                             prosthesis.
    21087  T                Prepare face/oral           0256        25.40    $1,259.74      $623.05      $251.95
                             prosthesis.
    21088  T                Prepare face/oral           0256        25.40    $1,259.74      $623.05      $251.95
                             prosthesis.

[[Page 67856]]

 
    21089  T                Prepare face/oral           0253        12.02      $596.14      $284.00      $119.23
                             prosthesis.
    21100  T                Maxillofacial               0256        25.40    $1,259.74      $623.05      $251.95
                             fixation.
    21110  T                Interdental                 0254        12.45      $617.47      $272.41      $123.49
                             fixation.
    21116  N                Injection, jaw       ...........  ...........  ...........  ...........  ...........
                             joint x-ray.
    21120  T                Reconstruction of           0254        12.45      $617.47      $272.41      $123.49
                             chin.
    21121  T                Reconstruction of           0254        12.45      $617.47      $272.41      $123.49
                             chin.
    21122  T                Reconstruction of           0254        12.45      $617.47      $272.41      $123.49
                             chin.
    21123  T                Reconstruction of           0254        12.45      $617.47      $272.41      $123.49
                             chin.
    21125  T                Augmentation, lower         0254        12.45      $617.47      $272.41      $123.49
                             jaw bone.
    21127  T                Augmentation, lower         0256        25.40    $1,259.74      $623.05      $251.95
                             jaw bone.
    21137  T                Reduction of                0254        12.45      $617.47      $272.41      $123.49
                             forehead.
    21138  T                Reduction of                0256        25.40    $1,259.74      $623.05      $251.95
                             forehead.
    21139  T                Reduction of                0256        25.40    $1,259.74      $623.05      $251.95
                             forehead.
    21141  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             midface, lefort.
    21142  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             midface, lefort.
    21143  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             midface, lefort.
    21145  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             midface, lefort.
    21146  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             midface, lefort.
    21147  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             midface, lefort.
    21150  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             midface, lefort.
    21151  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             midface, lefort.
    21154  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             midface, lefort.
    21155  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             midface, lefort.
    21159  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             midface, lefort.
    21160  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             midface, lefort.
    21172  C                Reconstruct orbit/   ...........  ...........  ...........  ...........  ...........
                             forehead.
    21175  C                Reconstruct orbit/   ...........  ...........  ...........  ...........  ...........
                             forehead.
    21179  C                Reconstruct entire   ...........  ...........  ...........  ...........  ...........
                             forehead.
    21180  C                Reconstruct entire   ...........  ...........  ...........  ...........  ...........
                             forehead.
    21181  T                Contour cranial             0254        12.45      $617.47      $272.41      $123.49
                             bone lesion.
    21182  C                Reconstruct cranial  ...........  ...........  ...........  ...........  ...........
                             bone.
    21183  C                Reconstruct cranial  ...........  ...........  ...........  ...........  ...........
                             bone.
    21184  C                Reconstruct cranial  ...........  ...........  ...........  ...........  ...........
                             bone.
    21188  C                Reconstruction of    ...........  ...........  ...........  ...........  ...........
                             midface.
    21193  C                Reconst lwr jaw w/o  ...........  ...........  ...........  ...........  ...........
                             graft.
    21194  C                Reconst lwr jaw w/   ...........  ...........  ...........  ...........  ...........
                             graft.
    21195  C                Reconst lwr jaw w/o  ...........  ...........  ...........  ...........  ...........
                             fixation.
    21196  C                Reconst lwr jaw w/   ...........  ...........  ...........  ...........  ...........
                             fixation.
    21198  T                Reconst lwr jaw             0256        25.40    $1,259.74      $623.05      $251.95
                             segment.
   *21199  T                Reconst lwr jaw w/          0256        25.40    $1,259.74      $623.05      $251.95
                             advance.
    21206  T                Reconstruct upper           0256        25.40    $1,259.74      $623.05      $251.95
                             jaw bone.
    21208  T                Augmentation of             0256        25.40    $1,259.74      $623.05      $251.95
                             facial bones.
    21209  T                Reduction of facial         0256        25.40    $1,259.74      $623.05      $251.95
                             bones.
    21210  T                Face bone graft....         0256        25.40    $1,259.74      $623.05      $251.95
    21215  T                Lower jaw bone              0256        25.40    $1,259.74      $623.05      $251.95
                             graft.
    21230  T                Rib cartilage graft         0256        25.40    $1,259.74      $623.05      $251.95
    21235  T                Ear cartilage graft         0254        12.45      $617.47      $272.41      $123.49
    21240  T                Reconstruction of           0256        25.40    $1,259.74      $623.05      $251.95
                             jaw joint.
    21242  T                Reconstruction of           0256        25.40    $1,259.74      $623.05      $251.95
                             jaw joint.
    21243  T                Reconstruction of           0256        25.40    $1,259.74      $623.05      $251.95
                             jaw joint.
    21244  T                Reconstruction of           0256        25.40    $1,259.74      $623.05      $251.95
                             lower jaw.
    21245  T                Reconstruction of           0256        25.40    $1,259.74      $623.05      $251.95
                             jaw.
    21246  T                Reconstruction of           0256        25.40    $1,259.74      $623.05      $251.95
                             jaw.
    21247  C                Reconstruct lower    ...........  ...........  ...........  ...........  ...........
                             jaw bone.
    21248  T                Reconstruction of           0256        25.40    $1,259.74      $623.05      $251.95
                             jaw.
    21249  T                Reconstruction of           0256        25.40    $1,259.74      $623.05      $251.95
                             jaw.
    21255  C                Reconstruct lower    ...........  ...........  ...........  ...........  ...........
                             jaw bone.
    21256  C                Reconstruction of    ...........  ...........  ...........  ...........  ...........
                             orbit.
    21260  T                Revise eye sockets.         0256        25.40    $1,259.74      $623.05      $251.95
    21261  T                Revise eye sockets.         0256        25.40    $1,259.74      $623.05      $251.95
    21263  T                Revise eye sockets.         0256        25.40    $1,259.74      $623.05      $251.95
    21267  T                Revise eye sockets.         0256        25.40    $1,259.74      $623.05      $251.95
    21268  C                Revise eye sockets.  ...........  ...........  ...........  ...........  ...........
    21270  T                Augmentation, cheek         0256        25.40    $1,259.74      $623.05      $251.95
                             bone.
    21275  T                Revision,                   0256        25.40    $1,259.74      $623.05      $251.95
                             orbitofacial bones.
    21280  T                Revision of eyelid.         0256        25.40    $1,259.74      $623.05      $251.95
    21282  T                Revision of eyelid.         0253        12.02      $596.14      $284.00      $119.23
    21295  T                Revision of jaw             0253        12.02      $596.14      $284.00      $119.23
                             muscle/bone.
    21296  T                Revision of jaw             0254        12.45      $617.47      $272.41      $123.49
                             muscle/bone.
    21299  T                Cranio/                     0253        12.02      $596.14      $284.00      $119.23
                             maxillofacial
                             surgery.
    21300  T                Treatment of skull          0253        12.02      $596.14      $284.00      $119.23
                             fracture.
    21310  T                Treatment of nose           0253        12.02      $596.14      $284.00      $119.23
                             fracture.
    21315  T                Treatment of nose           0253        12.02      $596.14      $284.00      $119.23
                             fracture.
    21320  T                Treatment of nose           0253        12.02      $596.14      $284.00      $119.23
                             fracture.

[[Page 67857]]

 
    21325  T                Treatment of nose           0253        12.02      $596.14      $284.00      $119.23
                             fracture.
    21330  T                Treatment of nose           0254        12.45      $617.47      $272.41      $123.49
                             fracture.
    21335  T                Treatment of nose           0254        12.45      $617.47      $272.41      $123.49
                             fracture.
    21336  T                Treat nasal septal          0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    21337  T                Treat nasal septal          0253        12.02      $596.14      $284.00      $119.23
                             fracture.
    21338  T                Treat nasoethmoid           0254        12.45      $617.47      $272.41      $123.49
                             fracture.
    21339  T                Treat nasoethmoid           0254        12.45      $617.47      $272.41      $123.49
                             fracture.
    21340  T                Treatment of nose           0256        25.40    $1,259.74      $623.05      $251.95
                             fracture.
    21343  C                Treatment of sinus   ...........  ...........  ...........  ...........  ...........
                             fracture.
    21344  C                Treatment of sinus   ...........  ...........  ...........  ...........  ...........
                             fracture.
    21345  T                Treat nose/jaw              0254        12.45      $617.47      $272.41      $123.49
                             fracture.
    21346  C                Treat nose/jaw       ...........  ...........  ...........  ...........  ...........
                             fracture.
    21347  C                Treat nose/jaw       ...........  ...........  ...........  ...........  ...........
                             fracture.
    21348  C                Treat nose/jaw       ...........  ...........  ...........  ...........  ...........
                             fracture.
    21355  T                Treat cheek bone            0256        25.40    $1,259.74      $623.05      $251.95
                             fracture.
    21356  C                Treat cheek bone     ...........  ...........  ...........  ...........  ...........
                             fracture.
    21360  C                Treat cheek bone     ...........  ...........  ...........  ...........  ...........
                             fracture.
    21365  C                Treat cheek bone     ...........  ...........  ...........  ...........  ...........
                             fracture.
    21366  C                Treat cheek bone     ...........  ...........  ...........  ...........  ...........
                             fracture.
    21385  C                Treat eye socket     ...........  ...........  ...........  ...........  ...........
                             fracture.
    21386  C                Treat eye socket     ...........  ...........  ...........  ...........  ...........
                             fracture.
    21387  C                Treat eye socket     ...........  ...........  ...........  ...........  ...........
                             fracture.
    21390  C                Treat eye socket     ...........  ...........  ...........  ...........  ...........
                             fracture.
    21395  C                Treat eye socket     ...........  ...........  ...........  ...........  ...........
                             fracture.
    21400  T                Treat eye socket            0252         5.18      $256.90      $114.24       $51.38
                             fracture.
    21401  T                Treat eye socket            0253        12.02      $596.14      $284.00      $119.23
                             fracture.
    21406  T                Treat eye socket            0256        25.40    $1,259.74      $623.05      $251.95
                             fracture.
    21407  T                Treat eye socket            0256        25.40    $1,259.74      $623.05      $251.95
                             fracture.
    21408  C                Treat eye socket     ...........  ...........  ...........  ...........  ...........
                             fracture.
    21421  T                Treat mouth roof            0254        12.45      $617.47      $272.41      $123.49
                             fracture.
    21422  C                Treat mouth roof     ...........  ...........  ...........  ...........  ...........
                             fracture.
    21423  C                Treat mouth roof     ...........  ...........  ...........  ...........  ...........
                             fracture.
    21431  C                Treat craniofacial   ...........  ...........  ...........  ...........  ...........
                             fracture.
    21432  C                Treat craniofacial   ...........  ...........  ...........  ...........  ...........
                             fracture.
    21433  C                Treat craniofacial   ...........  ...........  ...........  ...........  ...........
                             fracture.
    21435  C                Treat craniofacial   ...........  ...........  ...........  ...........  ...........
                             fracture.
    21436  C                Treat craniofacial   ...........  ...........  ...........  ...........  ...........
                             fracture.
    21440  T                Treat dental ridge          0253        12.02      $596.14      $284.00      $119.23
                             fracture.
    21445  T                Treat dental ridge          0254        12.45      $617.47      $272.41      $123.49
                             fracture.
    21450  T                Treat lower jaw             0251         1.68       $83.32       $27.99       $16.66
                             fracture.
    21451  T                Treat lower jaw             0254        12.45      $617.47      $272.41      $123.49
                             fracture.
    21452  T                Treat lower jaw             0253        12.02      $596.14      $284.00      $119.23
                             fracture.
    21453  T                Treat lower jaw             0256        25.40    $1,259.74      $623.05      $251.95
                             fracture.
    21454  T                Treat lower jaw             0254        12.45      $617.47      $272.41      $123.49
                             fracture.
    21461  T                Treat lower jaw             0256        25.40    $1,259.74      $623.05      $251.95
                             fracture.
    21462  T                Treat lower jaw             0256        25.40    $1,259.74      $623.05      $251.95
                             fracture.
    21465  T                Treat lower jaw             0256        25.40    $1,259.74      $623.05      $251.95
                             fracture.
    21470  T                Treat lower jaw             0256        25.40    $1,259.74      $623.05      $251.95
                             fracture.
    21480  T                Reset dislocated            0251         1.68       $83.32       $27.99       $16.66
                             jaw.
    21485  T                Reset dislocated            0253        12.02      $596.14      $284.00      $119.23
                             jaw.
    21490  T                Repair dislocated           0256        25.40    $1,259.74      $623.05      $251.95
                             jaw.
    21493  T                Treat hyoid bone            0252         5.18      $256.90      $114.24       $51.38
                             fracture.
    21494  T                Treat hyoid bone            0252         5.18      $256.90      $114.24       $51.38
                             fracture.
    21495  C                Treat hyoid bone     ...........  ...........  ...........  ...........  ...........
                             fracture.
    21497  T                Interdental wiring.         0253        12.02      $596.14      $284.00      $119.23
    21499  T                Head surgery                0253        12.02      $596.14      $284.00      $119.23
                             procedure.
    21501  T                Drain neck/chest            0008         6.15      $305.02      $113.67       $61.00
                             lesion.
    21502  T                Drain chest lesion.         0050        21.13    $1,047.96      $513.86      $209.59
    21510  C                Drainage of bone     ...........  ...........  ...........  ...........  ...........
                             lesion.
    21550  T                Biopsy of neck/             0019         4.00      $198.39       $78.91       $39.68
                             chest.
    21555  T                Remove lesion, neck/        0022        12.49      $619.45      $292.94      $123.89
                             chest.
    21556  T                Remove lesion, neck/        0022        12.49      $619.45      $292.94      $123.89
                             chest.
    21557  C                Remove tumor, neck/  ...........  ...........  ...........  ...........  ...........
                             chest.
    21600  T                Partial removal of          0050        21.13    $1,047.96      $513.86      $209.59
                             rib.
    21610  T                Partial removal of          0050        21.13    $1,047.96      $513.86      $209.59
                             rib.
    21615  C                Removal of rib.....  ...........  ...........  ...........  ...........  ...........
    21616  C                Removal of rib and   ...........  ...........  ...........  ...........  ...........
                             nerves.
    21620  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             sternum.
    21627  C                Sternal debridement  ...........  ...........  ...........  ...........  ...........
    21630  C                Extensive sternum    ...........  ...........  ...........  ...........  ...........
                             surgery.
    21632  C                Extensive sternum    ...........  ...........  ...........  ...........  ...........
                             surgery.
    21700  T                Revision of neck            0008         6.15      $305.02      $113.67       $61.00
                             muscle.
    21705  C                Revision of neck     ...........  ...........  ...........  ...........  ...........
                             muscle/rib.
    21720  T                Revision of neck            0008         6.15      $305.02      $113.67       $61.00
                             muscle.

[[Page 67858]]

 
    21725  T                Revision of neck            0008         6.15      $305.02      $113.67       $61.00
                             muscle.
    21740  C                Reconstruction of    ...........  ...........  ...........  ...........  ...........
                             sternum.
    21750  C                Repair of sternum    ...........  ...........  ...........  ...........  ...........
                             separation.
    21800  T                Treatment of rib            0043         1.64       $81.34       $25.46       $16.27
                             fracture.
    21805  T                Treatment of rib            0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    21810  C                Treatment of rib     ...........  ...........  ...........  ...........  ...........
                             fracture(s).
    21820  T                Treat sternum               0043         1.64       $81.34       $25.46       $16.27
                             fracture.
    21825  C                Treat sternum        ...........  ...........  ...........  ...........  ...........
                             fracture.
    21899  T                Neck/chest surgery          0252         5.18      $256.90      $114.24       $51.38
                             procedure.
    21920  T                Biopsy soft tissue          0020         6.51      $322.87      $130.53       $64.57
                             of back.
    21925  T                Biopsy soft tissue          0022        12.49      $619.45      $292.94      $123.89
                             of back.
    21930  T                Remove lesion, back         0022        12.49      $619.45      $292.94      $123.89
                             or flank.
    21935  T                Remove tumor, back.         0022        12.49      $619.45      $292.94      $123.89
    22100  C                Remove part of neck  ...........  ...........  ...........  ...........  ...........
                             vertebra.
    22101  C                Remove part, thorax  ...........  ...........  ...........  ...........  ...........
                             vertebra.
    22102  C                Remove part, lumbar  ...........  ...........  ...........  ...........  ...........
                             vertebra.
    22103  C                Remove extra spine   ...........  ...........  ...........  ...........  ...........
                             segment.
    22110  C                Remove part of neck  ...........  ...........  ...........  ...........  ...........
                             vertebra.
    22112  C                Remove part, thorax  ...........  ...........  ...........  ...........  ...........
                             vertebra.
    22114  C                Remove part, lumbar  ...........  ...........  ...........  ...........  ...........
                             vertebra.
    22116  C                Remove extra spine   ...........  ...........  ...........  ...........  ...........
                             segment.
    22210  C                Revision of neck     ...........  ...........  ...........  ...........  ...........
                             spine.
    22212  C                Revision of thorax   ...........  ...........  ...........  ...........  ...........
                             spine.
    22214  C                Revision of lumbar   ...........  ...........  ...........  ...........  ...........
                             spine.
    22216  C                Revise, extra spine  ...........  ...........  ...........  ...........  ...........
                             segment.
    22220  C                Revision of neck     ...........  ...........  ...........  ...........  ...........
                             spine.
    22222  C                Revision of thorax   ...........  ...........  ...........  ...........  ...........
                             spine.
    22224  C                Revision of lumbar   ...........  ...........  ...........  ...........  ...........
                             spine.
    22226  C                Revise, extra spine  ...........  ...........  ...........  ...........  ...........
                             segment.
    22305  T                Treat spine process         0043         1.64       $81.34       $25.46       $16.27
                             fracture.
    22310  T                Treat spine                 0043         1.64       $81.34       $25.46       $16.27
                             fracture.
    22315  T                Treat spine                 0043         1.64       $81.34       $25.46       $16.27
                             fracture.
    22318  C                Treat odontoid fx w/ ...........  ...........  ...........  ...........  ...........
                             o graft.
    22319  C                Treat odontoid fx w/ ...........  ...........  ...........  ...........  ...........
                             graft.
    22325  C                Treat spine          ...........  ...........  ...........  ...........  ...........
                             fracture.
    22326  C                Treat neck spine     ...........  ...........  ...........  ...........  ...........
                             fracture.
    22327  C                Treat thorax spine   ...........  ...........  ...........  ...........  ...........
                             fracture.
    22328  C                Treat each add       ...........  ...........  ...........  ...........  ...........
                             spine fx.
    22505  T                Manipulation of             0045        11.02      $546.55      $277.12      $109.31
                             spine.
   *22520  T                Percut                      0049        15.04      $745.93      $356.95      $149.19
                             vertebroplasty
                             thor.
   *22521  T                Percut                      0049        15.04      $745.93      $356.95      $149.19
                             vertebroplasty
                             lumb.
   *22522  T                Percut                      0049        15.04      $745.93      $356.95      $149.19
                             vertebroplasty
                             addl.
    22548  C                Neck spine fusion..  ...........  ...........  ...........  ...........  ...........
    22554  C                Neck spine fusion..  ...........  ...........  ...........  ...........  ...........
    22556  C                Thorax spine fusion  ...........  ...........  ...........  ...........  ...........
    22558  C                Lumbar spine fusion  ...........  ...........  ...........  ...........  ...........
    22585  C                Additional spinal    ...........  ...........  ...........  ...........  ...........
                             fusion.
    22590  C                Spine & skull        ...........  ...........  ...........  ...........  ...........
                             spinal fusion.
    22595  C                Neck spinal fusion.  ...........  ...........  ...........  ...........  ...........
    22600  C                Neck spine fusion..  ...........  ...........  ...........  ...........  ...........
    22610  C                Thorax spine fusion  ...........  ...........  ...........  ...........  ...........
    22612  C                Lumbar spine fusion  ...........  ...........  ...........  ...........  ...........
    22614  C                Spine fusion, extra  ...........  ...........  ...........  ...........  ...........
                             segment.
    22630  C                Lumbar spine fusion  ...........  ...........  ...........  ...........  ...........
    22632  C                Spine fusion, extra  ...........  ...........  ...........  ...........  ...........
                             segment.
    22800  C                Fusion of spine....  ...........  ...........  ...........  ...........  ...........
    22802  C                Fusion of spine....  ...........  ...........  ...........  ...........  ...........
    22804  C                Fusion of spine....  ...........  ...........  ...........  ...........  ...........
    22808  C                Fusion of spine....  ...........  ...........  ...........  ...........  ...........
    22810  C                Fusion of spine....  ...........  ...........  ...........  ...........  ...........
    22812  C                Fusion of spine....  ...........  ...........  ...........  ...........  ...........
    22818  C                Kyphectomy, 1-2      ...........  ...........  ...........  ...........  ...........
                             segments.
    22819  C                Kyphectomy, 3 or     ...........  ...........  ...........  ...........  ...........
                             more.
    22830  C                Exploration of       ...........  ...........  ...........  ...........  ...........
                             spinal fusion.
    22840  C                Insert spine         ...........  ...........  ...........  ...........  ...........
                             fixation device.
    22841  C                Insert spine         ...........  ...........  ...........  ...........  ...........
                             fixation device.
    22842  C                Insert spine         ...........  ...........  ...........  ...........  ...........
                             fixation device.
    22843  C                Insert spine         ...........  ...........  ...........  ...........  ...........
                             fixation device.
    22844  C                Insert spine         ...........  ...........  ...........  ...........  ...........
                             fixation device.
    22845  C                Insert spine         ...........  ...........  ...........  ...........  ...........
                             fixation device.
    22846  C                Insert spine         ...........  ...........  ...........  ...........  ...........
                             fixation device.
    22847  C                Insert spine         ...........  ...........  ...........  ...........  ...........
                             fixation device.
    22848  C                Insert pelv          ...........  ...........  ...........  ...........  ...........
                             fixation device.
    22849  C                Reinsert spinal      ...........  ...........  ...........  ...........  ...........
                             fixation.

[[Page 67859]]

 
    22850  C                Remove spine         ...........  ...........  ...........  ...........  ...........
                             fixation device.
    22851  C                Apply spine prosth   ...........  ...........  ...........  ...........  ...........
                             device.
    22852  C                Remove spine         ...........  ...........  ...........  ...........  ...........
                             fixation device.
    22855  C                Remove spine         ...........  ...........  ...........  ...........  ...........
                             fixation device.
    22899  T                Spine surgery               0043         1.64       $81.34       $25.46       $16.27
                             procedure.
    22900  T                Remove abdominal            0022        12.49      $619.45      $292.94      $123.89
                             wall lesion.
    22999  T                Abdomen surgery             0022        12.49      $619.45      $292.94      $123.89
                             procedure.
    23000  T                Removal of calcium          0021        10.49      $520.26      $236.51      $104.05
                             deposits.
    23020  T                Release shoulder            0051        27.76    $1,376.79      $675.24      $275.36
                             joint.
    23030  T                Drain shoulder              0008         6.15      $305.02      $113.67       $61.00
                             lesion.
    23031  T                Drain shoulder              0008         6.15      $305.02      $113.67       $61.00
                             bursa.
    23035  C                Drain shoulder bone  ...........  ...........  ...........  ...........  ...........
                             lesion.
    23040  T                Exploratory                 0050        21.13    $1,047.96      $513.86      $209.59
                             shoulder surgery.
    23044  T                Exploratory                 0050        21.13    $1,047.96      $513.86      $209.59
                             shoulder surgery.
    23065  T                Biopsy shoulder             0021        10.49      $520.26      $236.51      $104.05
                             tissues.
    23066  T                Biopsy shoulder             0022        12.49      $619.45      $292.94      $123.89
                             tissues.
    23075  T                Removal of shoulder         0021        10.49      $520.26      $236.51      $104.05
                             lesion.
    23076  T                Removal of shoulder         0022        12.49      $619.45      $292.94      $123.89
                             lesion.
    23077  T                Remove tumor of             0022        12.49      $619.45      $292.94      $123.89
                             shoulder.
    23100  T                Biopsy of shoulder          0049        15.04      $745.93      $356.95      $149.19
                             joint.
    23101  T                Shoulder joint              0050        21.13    $1,047.96      $513.86      $209.59
                             surgery.
    23105  T                Remove shoulder             0050        21.13    $1,047.96      $513.86      $209.59
                             joint lining.
    23106  T                Incision of                 0050        21.13    $1,047.96      $513.86      $209.59
                             collarbone joint.
    23107  T                Explore treat               0050        21.13    $1,047.96      $513.86      $209.59
                             shoulder joint.
    23120  T                Partial removal,            0051        27.76    $1,376.79      $675.24      $275.36
                             collar bone.
    23125  C                Removal of collar    ...........  ...........  ...........  ...........  ...........
                             bone.
    23130  T                Remove shoulder             0051        27.76    $1,376.79      $675.24      $275.36
                             bone, part.
    23140  T                Removal of bone             0049        15.04      $745.93      $356.95      $149.19
                             lesion.
    23145  T                Removal of bone             0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    23146  T                Removal of bone             0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    23150  T                Removal of humerus          0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    23155  T                Removal of humerus          0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    23156  T                Removal of humerus          0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    23170  T                Remove collar bone          0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    23172  T                Remove shoulder             0050        21.13    $1,047.96      $513.86      $209.59
                             blade lesion.
    23174  T                Remove humerus              0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    23180  T                Remove collar bone          0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    23182  T                Remove shoulder             0050        21.13    $1,047.96      $513.86      $209.59
                             blade lesion.
    23184  T                Remove humerus              0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    23190  T                Partial removal of          0050        21.13    $1,047.96      $513.86      $209.59
                             scapula.
    23195  C                Removal of head of   ...........  ...........  ...........  ...........  ...........
                             humerus.
    23200  C                Removal of collar    ...........  ...........  ...........  ...........  ...........
                             bone.
    23210  C                Removal of shoulder  ...........  ...........  ...........  ...........  ...........
                             blade.
    23220  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             humerus.
    23221  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             humerus.
    23222  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             humerus.
    23330  T                Remove shoulder             0019         4.00      $198.39       $78.91       $39.68
                             foreign body.
    23331  T                Remove shoulder             0022        12.49      $619.45      $292.94      $123.89
                             foreign body.
    23332  C                Remove shoulder      ...........  ...........  ...........  ...........  ...........
                             foreign body.
    23350  N                Injection for        ...........  ...........  ...........  ...........  ...........
                             shoulder x-ray.
    23395  C                Muscle               ...........  ...........  ...........  ...........  ...........
                             transfer,shoulder/
                             arm.
    23397  C                Muscle transfers...  ...........  ...........  ...........  ...........  ...........
    23400  C                Fixation of          ...........  ...........  ...........  ...........  ...........
                             shoulder blade.
    23405  T                Incision of tendon          0050        21.13    $1,047.96      $513.86      $209.59
                             & muscle.
    23406  T                Incise tendon(s) &          0050        21.13    $1,047.96      $513.86      $209.59
                             muscle(s).
    23410  T                Repair of tendon(s)         0052        36.16    $1,793.39      $930.91      $358.68
    23412  T                Repair of tendon(s)         0052        36.16    $1,793.39      $930.91      $358.68
    23415  T                Release of shoulder         0051        27.76    $1,376.79      $675.24      $275.36
                             ligament.
    23420  T                Repair of shoulder.         0052        36.16    $1,793.39      $930.91      $358.68
    23430  T                Repair biceps               0052        36.16    $1,793.39      $930.91      $358.68
                             tendon.
    23440  C                Remove/transplant    ...........  ...........  ...........  ...........  ...........
                             tendon.
    23450  T                Repair shoulder             0052        36.16    $1,793.39      $930.91      $358.68
                             capsule.
    23455  T                Repair shoulder             0052        36.16    $1,793.39      $930.91      $358.68
                             capsule.
    23460  T                Repair shoulder             0052        36.16    $1,793.39      $930.91      $358.68
                             capsule.
    23462  T                Repair shoulder             0052        36.16    $1,793.39      $930.91      $358.68
                             capsule.
    23465  T                Repair shoulder             0052        36.16    $1,793.39      $930.91      $358.68
                             capsule.
    23466  T                Repair shoulder             0052        36.16    $1,793.39      $930.91      $358.68
                             capsule.
    23470  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             shoulder joint.
    23472  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             shoulder joint.
    23480  T                Revision of collar          0051        27.76    $1,376.79      $675.24      $275.36
                             bone.
    23485  T                Revision of collar          0051        27.76    $1,376.79      $675.24      $275.36
                             bone.
    23490  T                Reinforce clavicle.         0051        27.76    $1,376.79      $675.24      $275.36
    23491  T                Reinforce shoulder          0051        27.76    $1,376.79      $675.24      $275.36
                             bones.
    23500  T                Treat clavicle              0043         1.64       $81.34       $25.46       $16.27
                             fracture.

[[Page 67860]]

 
    23505  T                Treat clavicle              0043         1.64       $81.34       $25.46       $16.27
                             fracture.
    23515  T                Treat clavicle              0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    23520  T                Treat clavicle              0043         1.64       $81.34       $25.46       $16.27
                             dislocation.
    23525  T                Treat clavicle              0043         1.64       $81.34       $25.46       $16.27
                             dislocation.
    23530  T                Treat clavicle              0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    23532  T                Treat clavicle              0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    23540  T                Treat clavicle              0043         1.64       $81.34       $25.46       $16.27
                             dislocation.
    23545  T                Treat clavicle              0043         1.64       $81.34       $25.46       $16.27
                             dislocation.
    23550  T                Treat clavicle              0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    23552  T                Treat clavicle              0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    23570  T                Treat shoulder              0043         1.64       $81.34       $25.46       $16.27
                             blade fx.
    23575  T                Treat shoulder              0043         1.64       $81.34       $25.46       $16.27
                             blade fx.
    23585  T                Treat scapula               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    23600  T                Treat humerus               0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    23605  T                Treat humerus               0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    23615  T                Treat humerus               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    23616  T                Treat humerus               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    23620  T                Treat humerus               0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    23625  T                Treat humerus               0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    23630  T                Treat humerus               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    23650  T                Treat shoulder              0043         1.64       $81.34       $25.46       $16.27
                             dislocation.
    23655  T                Treat shoulder              0045        11.02      $546.55      $277.12      $109.31
                             dislocation.
    23660  T                Treat shoulder              0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    23665  T                Treat dislocation/          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    23670  T                Treat dislocation/          0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    23675  T                Treat dislocation/          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    23680  T                Treat dislocation/          0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    23700  T                Fixation of                 0045        11.02      $546.55      $277.12      $109.31
                             shoulder.
    23800  T                Fusion of shoulder          0051        27.76    $1,376.79      $675.24      $275.36
                             joint.
    23802  T                Fusion of shoulder          0051        27.76    $1,376.79      $675.24      $275.36
                             joint.
    23900  C                Amputation of arm &  ...........  ...........  ...........  ...........  ...........
                             girdle.
    23920  C                Amputation at        ...........  ...........  ...........  ...........  ...........
                             shoulder joint.
    23921  T                Amputation follow-          0026        12.11      $600.61      $277.92      $120.12
                             up surgery.
    23929  T                Shoulder surgery            0043         1.64       $81.34       $25.46       $16.27
                             procedure.
    23930  T                Drainage of arm             0008         6.15      $305.02      $113.67       $61.00
                             lesion.
    23931  T                Drainage of arm             0008         6.15      $305.02      $113.67       $61.00
                             bursa.
    23935  T                Drain arm/elbow             0049        15.04      $745.93      $356.95      $149.19
                             bone lesion.
    24000  T                Exploratory elbow           0050        21.13    $1,047.96      $513.86      $209.59
                             surgery.
    24006  T                Release elbow joint         0050        21.13    $1,047.96      $513.86      $209.59
    24065  T                Biopsy arm/elbow            0020         6.51      $322.87      $130.53       $64.57
                             soft tissue.
    24066  T                Biopsy arm/elbow            0020         6.51      $322.87      $130.53       $64.57
                             soft tissue.
    24075  T                Remove arm/elbow            0021        10.49      $520.26      $236.51      $104.05
                             lesion.
    24076  T                Remove arm/elbow            0022        12.49      $619.45      $292.94      $123.89
                             lesion.
    24077  T                Remove tumor of arm/        0022        12.49      $619.45      $292.94      $123.89
                             elbow.
    24100  T                Biopsy elbow joint          0049        15.04      $745.93      $356.95      $149.19
                             lining.
    24101  T                Explore/treat elbow         0050        21.13    $1,047.96      $513.86      $209.59
                             joint.
    24102  T                Remove elbow joint          0050        21.13    $1,047.96      $513.86      $209.59
                             lining.
    24105  T                Removal of elbow            0049        15.04      $745.93      $356.95      $149.19
                             bursa.
    24110  T                Remove humerus              0049        15.04      $745.93      $356.95      $149.19
                             lesion.
    24115  T                Remove/graft bone           0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    24116  T                Remove/graft bone           0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    24120  T                Remove elbow lesion         0049        15.04      $745.93      $356.95      $149.19
    24125  T                Remove/graft bone           0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    24126  T                Remove/graft bone           0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    24130  T                Removal of head of          0050        21.13    $1,047.96      $513.86      $209.59
                             radius.
    24134  T                Removal of arm bone         0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    24136  T                Remove radius bone          0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    24138  T                Remove elbow bone           0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    24140  T                Partial removal of          0050        21.13    $1,047.96      $513.86      $209.59
                             arm bone.
    24145  T                Partial removal of          0050        21.13    $1,047.96      $513.86      $209.59
                             radius.
    24147  T                Partial removal of          0050        21.13    $1,047.96      $513.86      $209.59
                             elbow.
    24149  C                Radical resection    ...........  ...........  ...........  ...........  ...........
                             of elbow.
    24150  C                Extensive humerus    ...........  ...........  ...........  ...........  ...........
                             surgery.
    24151  C                Extensive humerus    ...........  ...........  ...........  ...........  ...........
                             surgery.
    24152  C                Extensive radius     ...........  ...........  ...........  ...........  ...........
                             surgery.
    24153  C                Extensive radius     ...........  ...........  ...........  ...........  ...........
                             surgery.
    24155  T                Removal of elbow            0051        27.76    $1,376.79      $675.24      $275.36
                             joint.
    24160  T                Remove elbow joint          0050        21.13    $1,047.96      $513.86      $209.59
                             implant.
    24164  T                Remove radius head          0050        21.13    $1,047.96      $513.86      $209.59
                             implant.
    24200  T                Removal of arm              0019         4.00      $198.39       $78.91       $39.68
                             foreign body.
    24201  T                Removal of arm              0021        10.49      $520.26      $236.51      $104.05
                             foreign body.
    24220  N                Injection for elbow  ...........  ...........  ...........  ...........  ...........
                             x-ray.
    24301  T                Muscle/tendon               0050        21.13    $1,047.96      $513.86      $209.59
                             transfer.
    24305  T                Arm tendon                  0050        21.13    $1,047.96      $513.86      $209.59
                             lengthening.

[[Page 67861]]

 
    24310  T                Revision of arm             0049        15.04      $745.93      $356.95      $149.19
                             tendon.
    24320  T                Repair of arm               0051        27.76    $1,376.79      $675.24      $275.36
                             tendon.
    24330  T                Revision of arm             0051        27.76    $1,376.79      $675.24      $275.36
                             muscles.
    24331  T                Revision of arm             0051        27.76    $1,376.79      $675.24      $275.36
                             muscles.
    24340  T                Repair of biceps            0051        27.76    $1,376.79      $675.24      $275.36
                             tendon.
    24341  T                Repair arm tendon/          0051        27.76    $1,376.79      $675.24      $275.36
                             muscle.
    24342  T                Repair of ruptured          0051        27.76    $1,376.79      $675.24      $275.36
                             tendon.
    24350  T                Repair of tennis            0050        21.13    $1,047.96      $513.86      $209.59
                             elbow.
    24351  T                Repair of tennis            0050        21.13    $1,047.96      $513.86      $209.59
                             elbow.
    24352  T                Repair of tennis            0050        21.13    $1,047.96      $513.86      $209.59
                             elbow.
    24354  T                Repair of tennis            0050        21.13    $1,047.96      $513.86      $209.59
                             elbow.
    24356  T                Revision of tennis          0050        21.13    $1,047.96      $513.86      $209.59
                             elbow.
    24360  T                Reconstruct elbow           0047        22.09    $1,095.58      $537.03      $219.12
                             joint.
    24361  T                Reconstruct elbow           0048        29.06    $1,441.26      $725.94      $288.25
                             joint.
    24362  T                Reconstruct elbow           0048        29.06    $1,441.26      $725.94      $288.25
                             joint.
    24363  T                Replace elbow joint         0048        29.06    $1,441.26      $725.94      $288.25
    24365  T                Reconstruct head of         0047        22.09    $1,095.58      $537.03      $219.12
                             radius.
    24366  T                Reconstruct head of         0048        29.06    $1,441.26      $725.94      $288.25
                             radius.
    24400  T                Revision of humerus         0050        21.13    $1,047.96      $513.86      $209.59
    24410  T                Revision of humerus         0050        21.13    $1,047.96      $513.86      $209.59
    24420  T                Revision of humerus         0051        27.76    $1,376.79      $675.24      $275.36
    24430  T                Repair of humerus..         0051        27.76    $1,376.79      $675.24      $275.36
    24435  T                Repair humerus with         0051        27.76    $1,376.79      $675.24      $275.36
                             graft.
    24470  T                Revision of elbow           0051        27.76    $1,376.79      $675.24      $275.36
                             joint.
    24495  T                Decompression of            0050        21.13    $1,047.96      $513.86      $209.59
                             forearm.
    24498  T                Reinforce humerus..         0051        27.76    $1,376.79      $675.24      $275.36
    24500  T                Treat humerus               0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    24505  T                Treat humerus               0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    24515  T                Treat humerus               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    24516  T                Treat humerus               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    24530  T                Treat humerus               0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    24535  T                Treat humerus               0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    24538  T                Treat humerus               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    24545  T                Treat humerus               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    24546  T                Treat humerus               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    24560  T                Treat humerus               0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    24565  T                Treat humerus               0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    24566  T                Treat humerus               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    24575  T                Treat humerus               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    24576  T                Treat humerus               0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    24577  T                Treat humerus               0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    24579  T                Treat humerus               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    24582  T                Treat humerus               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    24586  T                Treat elbow                 0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    24587  T                Treat elbow                 0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    24600  T                Treat elbow                 0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    24605  T                Treat elbow                 0045        11.02      $546.55      $277.12      $109.31
                             dislocation.
    24615  T                Treat elbow                 0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    24620  T                Treat elbow                 0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    24635  T                Treat elbow                 0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    24640  T                Treat elbow                 0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    24650  T                Treat radius                0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    24655  T                Treat radius                0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    24665  T                Treat radius                0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    24666  T                Treat radius                0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    24670  T                Treat ulnar                 0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    24675  T                Treat ulnar                 0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    24685  T                Treat ulnar                 0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    24800  T                Fusion of elbow             0051        27.76    $1,376.79      $675.24      $275.36
                             joint.
    24802  T                Fusion/graft of             0051        27.76    $1,376.79      $675.24      $275.36
                             elbow joint.
    24900  C                Amputation of upper  ...........  ...........  ...........  ...........  ...........
                             arm.
    24920  C                Amputation of upper  ...........  ...........  ...........  ...........  ...........
                             arm.
    24925  T                Amputation follow-          0049        15.04      $745.93      $356.95      $149.19
                             up surgery.
    24930  C                Amputation follow-   ...........  ...........  ...........  ...........  ...........
                             up surgery.
    24931  C                Amputate upper arm   ...........  ...........  ...........  ...........  ...........
                             & implant.
    24935  T                Revision of                 0052        36.16    $1,793.39      $930.91      $358.68
                             amputation.
    24940  C                Revision of upper    ...........  ...........  ...........  ...........  ...........
                             arm.
    24999  T                Upper arm/elbow             0044         2.17      $107.63       $38.08       $21.53
                             surgery.
    25000  T                Incision of tendon          0049        15.04      $745.93      $356.95      $149.19
                             sheath.
    25020  T                Decompression of            0049        15.04      $745.93      $356.95      $149.19
                             forearm.
    25023  T                Decompression of            0050        21.13    $1,047.96      $513.86      $209.59
                             forearm.
    25028  T                Drainage of forearm         0049        15.04      $745.93      $356.95      $149.19
                             lesion.
    25031  T                Drainage of forearm         0049        15.04      $745.93      $356.95      $149.19
                             bursa.
    25035  T                Treat forearm bone          0049        15.04      $745.93      $356.95      $149.19
                             lesion.

[[Page 67862]]

 
    25040  T                Explore/treat wrist         0050        21.13    $1,047.96      $513.86      $209.59
                             joint.
    25065  T                Biopsy forearm soft         0020         6.51      $322.87      $130.53       $64.57
                             tissues.
    25066  T                Biopsy forearm soft         0022        12.49      $619.45      $292.94      $123.89
                             tissues.
    25075  T                Removal of forearm          0020         6.51      $322.87      $130.53       $64.57
                             lesion.
    25076  T                Removal of forearm          0022        12.49      $619.45      $292.94      $123.89
                             lesion.
    25077  T                Remove tumor,               0022        12.49      $619.45      $292.94      $123.89
                             forearm/wrist.
    25085  T                Incision of wrist           0049        15.04      $745.93      $356.95      $149.19
                             capsule.
    25100  T                Biopsy of wrist             0049        15.04      $745.93      $356.95      $149.19
                             joint.
    25101  T                Explore/treat wrist         0050        21.13    $1,047.96      $513.86      $209.59
                             joint.
    25105  T                Remove wrist joint          0050        21.13    $1,047.96      $513.86      $209.59
                             lining.
    25107  T                Remove wrist joint          0050        21.13    $1,047.96      $513.86      $209.59
                             cartilage.
    25110  T                Remove wrist tendon         0049        15.04      $745.93      $356.95      $149.19
                             lesion.
    25111  T                Remove wrist tendon         0053        11.32      $561.42      $253.49      $112.28
                             lesion.
    25112  T                Reremove wrist              0053        11.32      $561.42      $253.49      $112.28
                             tendon lesion.
    25115  T                Remove wrist/               0049        15.04      $745.93      $356.95      $149.19
                             forearm lesion.
    25116  T                Remove wrist/               0049        15.04      $745.93      $356.95      $149.19
                             forearm lesion.
    25118  T                Excise wrist tendon         0050        21.13    $1,047.96      $513.86      $209.59
                             sheath.
    25119  T                Partial removal of          0050        21.13    $1,047.96      $513.86      $209.59
                             ulna.
    25120  T                Removal of forearm          0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    25125  T                Remove/graft                0050        21.13    $1,047.96      $513.86      $209.59
                             forearm lesion.
    25126  T                Remove/graft                0050        21.13    $1,047.96      $513.86      $209.59
                             forearm lesion.
    25130  T                Removal of wrist            0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    25135  T                Remove & graft              0050        21.13    $1,047.96      $513.86      $209.59
                             wrist lesion.
    25136  T                Remove & graft              0050        21.13    $1,047.96      $513.86      $209.59
                             wrist lesion.
    25145  T                Remove forearm bone         0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    25150  T                Partial removal of          0050        21.13    $1,047.96      $513.86      $209.59
                             ulna.
    25151  T                Partial removal of          0050        21.13    $1,047.96      $513.86      $209.59
                             radius.
    25170  C                Extensive forearm    ...........  ...........  ...........  ...........  ...........
                             surgery.
    25210  T                Removal of wrist            0054        19.66      $975.06      $472.33      $195.01
                             bone.
    25215  T                Removal of wrist            0054        19.66      $975.06      $472.33      $195.01
                             bones.
    25230  T                Partial removal of          0050        21.13    $1,047.96      $513.86      $209.59
                             radius.
    25240  T                Partial removal of          0050        21.13    $1,047.96      $513.86      $209.59
                             ulna.
    25246  N                Injection for wrist  ...........  ...........  ...........  ...........  ...........
                             x-ray.
    25248  T                Remove forearm              0049        15.04      $745.93      $356.95      $149.19
                             foreign body.
    25250  T                Removal of wrist            0050        21.13    $1,047.96      $513.86      $209.59
                             prosthesis.
    25251  T                Removal of wrist            0050        21.13    $1,047.96      $513.86      $209.59
                             prosthesis.
    25260  T                Repair forearm              0050        21.13    $1,047.96      $513.86      $209.59
                             tendon/muscle.
    25263  T                Repair forearm              0050        21.13    $1,047.96      $513.86      $209.59
                             tendon/muscle.
    25265  T                Repair forearm              0050        21.13    $1,047.96      $513.86      $209.59
                             tendon/muscle.
    25270  T                Repair forearm              0050        21.13    $1,047.96      $513.86      $209.59
                             tendon/muscle.
    25272  T                Repair forearm              0050        21.13    $1,047.96      $513.86      $209.59
                             tendon/muscle.
    25274  T                Repair forearm              0050        21.13    $1,047.96      $513.86      $209.59
                             tendon/muscle.
    25280  T                Revise wrist/               0050        21.13    $1,047.96      $513.86      $209.59
                             forearm tendon.
    25290  T                Incise wrist/               0050        21.13    $1,047.96      $513.86      $209.59
                             forearm tendon.
    25295  T                Release wrist/              0049        15.04      $745.93      $356.95      $149.19
                             forearm tendon.
    25300  T                Fusion of tendons           0050        21.13    $1,047.96      $513.86      $209.59
                             at wrist.
    25301  T                Fusion of tendons           0050        21.13    $1,047.96      $513.86      $209.59
                             at wrist.
    27606  T                Incision of                 0049        15.04      $745.93      $356.95      $149.19
                             achilles tendon.
    27607  T                Treat lower leg             0049        15.04      $745.93      $356.95      $149.19
                             bone lesion.
    27610  T                Explore/treat ankle         0050        21.13    $1,047.96      $513.86      $209.59
                             joint.
    27612  T                Exploration of              0050        21.13    $1,047.96      $513.86      $209.59
                             ankle joint.
    27613  T                Biopsy lower leg            0020         6.51      $322.87      $130.53       $64.57
                             soft tissue.
    27614  T                Biopsy lower leg            0022        12.49      $619.45      $292.94      $123.89
                             soft tissue.
    27615  T                Remove tumor, lower         0046        22.29    $1,105.50      $535.76      $221.10
                             leg.
    27618  T                Remove lower leg            0021        10.49      $520.26      $236.51      $104.05
                             lesion.
    27619  T                Remove lower leg            0022        12.49      $619.45      $292.94      $123.89
                             lesion.
    27620  T                Explore/treat ankle         0050        21.13    $1,047.96      $513.86      $209.59
                             joint.
    27625  T                Remove ankle joint          0050        21.13    $1,047.96      $513.86      $209.59
                             lining.
    27626  T                Remove ankle joint          0050        21.13    $1,047.96      $513.86      $209.59
                             lining.
    27630  T                Removal of tendon           0049        15.04      $745.93      $356.95      $149.19
                             lesion.
    27635  T                Remove lower leg            0050        21.13    $1,047.96      $513.86      $209.59
                             bone lesion.
    27637  T                Remove/graft leg            0050        21.13    $1,047.96      $513.86      $209.59
                             bone lesion.
    27638  T                Remove/graft leg            0050        21.13    $1,047.96      $513.86      $209.59
                             bone lesion.
    27640  T                Partial removal of          0051        27.76    $1,376.79      $675.24      $275.36
                             tibia.
    27641  T                Partial removal of          0050        21.13    $1,047.96      $513.86      $209.59
                             fibula.
    27645  C                Extensive lower leg  ...........  ...........  ...........  ...........  ...........
                             surgery.
    27646  C                Extensive lower leg  ...........  ...........  ...........  ...........  ...........
                             surgery.
    27647  T                Extensive ankle/            0051        27.76    $1,376.79      $675.24      $275.36
                             heel surgery.
    27648  N                Injection for ankle  ...........  ...........  ...........  ...........  ...........
                             x-ray.
    27650  T                Repair achilles             0051        27.76    $1,376.79      $675.24      $275.36
                             tendon.
    27652  T                Repair/graft                0051        27.76    $1,376.79      $675.24      $275.36
                             achilles tendon.
    27654  T                Repair of achilles          0051        27.76    $1,376.79      $675.24      $275.36
                             tendon.
    27656  T                Repair leg fascia           0049        15.04      $745.93      $356.95      $149.19
                             defect.
    27658  T                Repair of leg               0049        15.04      $745.93      $356.95      $149.19
                             tendon, each.

[[Page 67863]]

 
    27659  T                Repair of leg               0049        15.04      $745.93      $356.95      $149.19
                             tendon, each.
    27664  T                Repair of leg               0049        15.04      $745.93      $356.95      $149.19
                             tendon, each.
    27665  T                Repair of leg               0050        21.13    $1,047.96      $513.86      $209.59
                             tendon, each.
    27675  T                Repair lower leg            0049        15.04      $745.93      $356.95      $149.19
                             tendons.
    27676  T                Repair lower leg            0050        21.13    $1,047.96      $513.86      $209.59
                             tendons.
    27680  T                Release of lower            0050        21.13    $1,047.96      $513.86      $209.59
                             leg tendon.
    27681  T                Release of lower            0050        21.13    $1,047.96      $513.86      $209.59
                             leg tendons.
    27685  T                Revision of lower           0050        21.13    $1,047.96      $513.86      $209.59
                             leg tendon.
    27686  T                Revise lower leg            0050        21.13    $1,047.96      $513.86      $209.59
                             tendons.
    27687  T                Revision of calf            0050        21.13    $1,047.96      $513.86      $209.59
                             tendon.
    27690  T                Revise lower leg            0051        27.76    $1,376.79      $675.24      $275.36
                             tendon.
    27691  T                Revise lower leg            0051        27.76    $1,376.79      $675.24      $275.36
                             tendon.
    27692  T                Revise additional           0051        27.76    $1,376.79      $675.24      $275.36
                             leg tendon.
    27695  T                Repair of ankle             0050        21.13    $1,047.96      $513.86      $209.59
                             ligament.
    27696  T                Repair of ankle             0050        21.13    $1,047.96      $513.86      $209.59
                             ligaments.
    27698  T                Repair of ankle             0050        21.13    $1,047.96      $513.86      $209.59
                             ligament.
    27700  T                Revision of ankle           0047        22.09    $1,095.58      $537.03      $219.12
                             joint.
    27702  C                Reconstruct ankle    ...........  ...........  ...........  ...........  ...........
                             joint.
    27703  C                Reconstruction,      ...........  ...........  ...........  ...........  ...........
                             ankle joint.
    27704  T                Removal of ankle            0049        15.04      $745.93      $356.95      $149.19
                             implant.
    27705  T                Incision of tibia..         0051        27.76    $1,376.79      $675.24      $275.36
    27707  T                Incision of fibula.         0049        15.04      $745.93      $356.95      $149.19
    27709  T                Incision of tibia &         0050        21.13    $1,047.96      $513.86      $209.59
                             fibula.
    27712  C                Realignment of       ...........  ...........  ...........  ...........  ...........
                             lower leg.
    27715  C                Revision of lower    ...........  ...........  ...........  ...........  ...........
                             leg.
    27720  C                Repair of tibia....  ...........  ...........  ...........  ...........  ...........
    27722  C                Repair/graft of      ...........  ...........  ...........  ...........  ...........
                             tibia.
    27724  C                Repair/graft of      ...........  ...........  ...........  ...........  ...........
                             tibia.
    27725  C                Repair of lower leg  ...........  ...........  ...........  ...........  ...........
    27727  C                Repair of lower leg  ...........  ...........  ...........  ...........  ...........
    27730  T                Repair of tibia             0050        21.13    $1,047.96      $513.86      $209.59
                             epiphysis.
    27732  T                Repair of fibula            0050        21.13    $1,047.96      $513.86      $209.59
                             epiphysis.
    27734  T                Repair lower leg            0050        21.13    $1,047.96      $513.86      $209.59
                             epiphyses.
    27740  T                Repair of leg               0050        21.13    $1,047.96      $513.86      $209.59
                             epiphyses.
    27742  T                Repair of leg               0051        27.76    $1,376.79      $675.24      $275.36
                             epiphyses.
    27745  T                Reinforce tibia....         0051        27.76    $1,376.79      $675.24      $275.36
    27750  T                Treatment of tibia          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27752  T                Treatment of tibia          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27756  T                Treatment of tibia          0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    27758  T                Treatment of tibia          0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    27759  T                Treatment of tibia          0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    27760  T                Treatment of ankle          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27762  T                Treatment of ankle          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27766  T                Treatment of ankle          0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    27780  T                Treatment of fibula         0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27781  T                Treatment of fibula         0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27784  T                Treatment of fibula         0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    27786  T                Treatment of ankle          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27788  T                Treatment of ankle          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27792  T                Treatment of ankle          0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    27808  T                Treatment of ankle          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27810  T                Treatment of ankle          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27814  T                Treatment of ankle          0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    27816  T                Treatment of ankle          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27818  T                Treatment of ankle          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27822  T                Treatment of ankle          0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    27823  T                Treatment of ankle          0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    27824  T                Treat lower leg             0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27825  T                Treat lower leg             0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27826  T                Treat lower leg             0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    27827  T                Treat lower leg             0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    27828  T                Treat lower leg             0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    27829  T                Treat lower leg             0046        22.29    $1,105.50      $535.76      $221.10
                             joint.
    27830  T                Treat lower leg             0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    27831  T                Treat lower leg             0045        11.02      $546.55      $277.12      $109.31
                             dislocation.
    27832  T                Treat lower leg             0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    27840  T                Treat ankle                 0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    27842  T                Treat ankle                 0045        11.02      $546.55      $277.12      $109.31
                             dislocation.
    27846  T                Treat ankle                 0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    27848  T                Treat ankle                 0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    27860  T                Fixation of ankle           0045        11.02      $546.55      $277.12      $109.31
                             joint.
    27870  T                Fusion of ankle             0051        27.76    $1,376.79      $675.24      $275.36
                             joint.
    27871  T                Fusion of                   0051        27.76    $1,376.79      $675.24      $275.36
                             tibiofibular joint.
    27880  C                Amputation of lower  ...........  ...........  ...........  ...........  ...........
                             leg.

[[Page 67864]]

 
    27881  C                Amputation of lower  ...........  ...........  ...........  ...........  ...........
                             leg.
    27882  C                Amputation of lower  ...........  ...........  ...........  ...........  ...........
                             leg.
    27884  T                Amputation follow-          0049        15.04      $745.93      $356.95      $149.19
                             up surgery.
    27886  C                Amputation follow-   ...........  ...........  ...........  ...........  ...........
                             up surgery.
    27888  C                Amputation of foot   ...........  ...........  ...........  ...........  ...........
                             at ankle.
    27889  T                Amputation of foot          0050        21.13    $1,047.96      $513.86      $209.59
                             at ankle.
    27892  T                Decompression of            0049        15.04      $745.93      $356.95      $149.19
                             leg.
    27893  T                Decompression of            0049        15.04      $745.93      $356.95      $149.19
                             leg.
    27894  T                Decompression of            0049        15.04      $745.93      $356.95      $149.19
                             leg.
    27899  T                Leg/ankle surgery           0044         2.17      $107.63       $38.08       $21.53
                             procedure.
    28001  T                Drainage of bursa           0008         6.15      $305.02      $113.67       $61.00
                             of foot.
    28002  T                Treatment of foot           0049        15.04      $745.93      $356.95      $149.19
                             infection.
    28003  T                Treatment of foot           0049        15.04      $745.93      $356.95      $149.19
                             infection.
    28005  T                Treat foot bone             0055        15.47      $767.26      $355.34      $153.45
                             lesion.
    28008  T                Incision of foot            0055        15.47      $767.26      $355.34      $153.45
                             fascia.
    28010  T                Incision of toe             0055        15.47      $767.26      $355.34      $153.45
                             tendon.
    28011  T                Incision of toe             0055        15.47      $767.26      $355.34      $153.45
                             tendons.
    28020  T                Exploration of foot         0055        15.47      $767.26      $355.34      $153.45
                             joint.
    28022  T                Exploration of foot         0055        15.47      $767.26      $355.34      $153.45
                             joint.
    28024  T                Exploration of toe          0055        15.47      $767.26      $355.34      $153.45
                             joint.
    28030  T                Removal of foot             0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    28035  T                Decompression of            0220        13.96      $692.36      $326.21      $138.47
                             tibia nerve.
    28043  T                Excision of foot            0021        10.49      $520.26      $236.51      $104.05
                             lesion.
    28045  T                Excision of foot            0055        15.47      $767.26      $355.34      $153.45
                             lesion.
    28046  T                Resection of tumor,         0055        15.47      $767.26      $355.34      $153.45
                             foot.
    28050  T                Biopsy of foot              0055        15.47      $767.26      $355.34      $153.45
                             joint lining.
    28052  T                Biopsy of foot              0055        15.47      $767.26      $355.34      $153.45
                             joint lining.
    28054  T                Biopsy of toe joint         0055        15.47      $767.26      $355.34      $153.45
                             lining.
    28060  T                Partial removal,            0056        17.30      $858.02      $405.81      $171.60
                             foot fascia.
    28062  T                Removal of foot             0056        17.30      $858.02      $405.81      $171.60
                             fascia.
    28070  T                Removal of foot             0056        17.30      $858.02      $405.81      $171.60
                             joint lining.
    28072  T                Removal of foot             0056        17.30      $858.02      $405.81      $171.60
                             joint lining.
    28080  T                Removal of foot             0055        15.47      $767.26      $355.34      $153.45
                             lesion.
    28086  T                Excise foot tendon          0055        15.47      $767.26      $355.34      $153.45
                             sheath.
    28088  T                Excise foot tendon          0055        15.47      $767.26      $355.34      $153.45
                             sheath.
    28090  T                Removal of foot             0055        15.47      $767.26      $355.34      $153.45
                             lesion.
    28092  T                Removal of toe              0055        15.47      $767.26      $355.34      $153.45
                             lesions.
    28100  T                Removal of ankle/           0055        15.47      $767.26      $355.34      $153.45
                             heel lesion.
    28102  T                Remove/graft foot           0056        17.30      $858.02      $405.81      $171.60
                             lesion.
    28103  T                Remove/graft foot           0056        17.30      $858.02      $405.81      $171.60
                             lesion.
    28104  T                Removal of foot             0055        15.47      $767.26      $355.34      $153.45
                             lesion.
    28106  T                Remove/graft foot           0056        17.30      $858.02      $405.81      $171.60
                             lesion.
    28107  T                Remove/graft foot           0056        17.30      $858.02      $405.81      $171.60
                             lesion.
    28108  T                Removal of toe              0055        15.47      $767.26      $355.34      $153.45
                             lesions.
    28110  T                Part removal of             0057        21.00    $1,041.52      $496.65      $208.30
                             metatarsal.
    28111  T                Part removal of             0055        15.47      $767.26      $355.34      $153.45
                             metatarsal.
    28112  T                Part removal of             0055        15.47      $767.26      $355.34      $153.45
                             metatarsal.
    28113  T                Part removal of             0055        15.47      $767.26      $355.34      $153.45
                             metatarsal.
    28114  T                Removal of                  0055        15.47      $767.26      $355.34      $153.45
                             metatarsal heads.
    28116  T                Revision of foot...         0055        15.47      $767.26      $355.34      $153.45
    28118  T                Removal of heel             0055        15.47      $767.26      $355.34      $153.45
                             bone.
    28119  T                Removal of heel             0055        15.47      $767.26      $355.34      $153.45
                             spur.
    28120  T                Part removal of             0055        15.47      $767.26      $355.34      $153.45
                             ankle/heel.
    28122  T                Partial removal of          0055        15.47      $767.26      $355.34      $153.45
                             foot bone.
    28124  T                Partial removal of          0055        15.47      $767.26      $355.34      $153.45
                             toe.
    28126  T                Partial removal of          0055        15.47      $767.26      $355.34      $153.45
                             toe.
    28130  T                Removal of ankle            0055        15.47      $767.26      $355.34      $153.45
                             bone.
    28140  T                Removal of                  0055        15.47      $767.26      $355.34      $153.45
                             metatarsal.
    28150  T                Removal of toe.....         0055        15.47      $767.26      $355.34      $153.45
    28153  T                Partial removal of          0055        15.47      $767.26      $355.34      $153.45
                             toe.
    28160  T                Partial removal of          0055        15.47      $767.26      $355.34      $153.45
                             toe.
    28171  T                Extensive foot              0055        15.47      $767.26      $355.34      $153.45
                             surgery.
    28173  T                Extensive foot              0055        15.47      $767.26      $355.34      $153.45
                             surgery.
    28175  T                Extensive foot              0055        15.47      $767.26      $355.34      $153.45
                             surgery.
    28190  T                Removal of foot             0019         4.00      $198.39       $78.91       $39.68
                             foreign body.
    28192  T                Removal of foot             0021        10.49      $520.26      $236.51      $104.05
                             foreign body.
    28193  T                Removal of foot             0020         6.51      $322.87      $130.53       $64.57
                             foreign body.
    28200  T                Repair of foot              0055        15.47      $767.26      $355.34      $153.45
                             tendon.
    28202  T                Repair/graft of             0056        17.30      $858.02      $405.81      $171.60
                             foot tendon.
    28208  T                Repair of foot              0055        15.47      $767.26      $355.34      $153.45
                             tendon.
    28210  T                Repair/graft of             0055        15.47      $767.26      $355.34      $153.45
                             foot tendon.
    28220  T                Release of foot             0055        15.47      $767.26      $355.34      $153.45
                             tendon.
    28222  T                Release of foot             0055        15.47      $767.26      $355.34      $153.45
                             tendons.
    28225  T                Release of foot             0055        15.47      $767.26      $355.34      $153.45
                             tendon.

[[Page 67865]]

 
    28226  T                Release of foot             0055        15.47      $767.26      $355.34      $153.45
                             tendons.
    28230  T                Incision of foot            0055        15.47      $767.26      $355.34      $153.45
                             tendon(s).
    28232  T                Incision of toe             0055        15.47      $767.26      $355.34      $153.45
                             tendon.
    28234  T                Incision of foot            0055        15.47      $767.26      $355.34      $153.45
                             tendon.
    28238  T                Revision of foot            0056        17.30      $858.02      $405.81      $171.60
                             tendon.
    28240  T                Release of big toe.         0055        15.47      $767.26      $355.34      $153.45
    28250  T                Revision of foot            0056        17.30      $858.02      $405.81      $171.60
                             fascia.
    28260  T                Release of midfoot          0056        17.30      $858.02      $405.81      $171.60
                             joint.
    28261  T                Revision of foot            0056        17.30      $858.02      $405.81      $171.60
                             tendon.
    28262  T                Revision of foot            0056        17.30      $858.02      $405.81      $171.60
                             and ankle.
    28264  T                Release of midfoot          0056        17.30      $858.02      $405.81      $171.60
                             joint.
    28270  T                Release of foot             0055        15.47      $767.26      $355.34      $153.45
                             contracture.
    28272  T                Release of toe              0055        15.47      $767.26      $355.34      $153.45
                             joint, each.
    28280  T                Fusion of toes.....         0055        15.47      $767.26      $355.34      $153.45
    28285  T                Repair of hammertoe         0055        15.47      $767.26      $355.34      $153.45
    28286  T                Repair of hammertoe         0055        15.47      $767.26      $355.34      $153.45
    28288  T                Partial removal of          0056        17.30      $858.02      $405.81      $171.60
                             foot bone.
    28289  T                Repair hallux               0056        17.30      $858.02      $405.81      $171.60
                             rigidus.
    28290  T                Correction of               0057        21.00    $1,041.52      $496.65      $208.30
                             bunion.
    28292  T                Correction of               0057        21.00    $1,041.52      $496.65      $208.30
                             bunion.
    28293  T                Correction of               0057        21.00    $1,041.52      $496.65      $208.30
                             bunion.
    28294  T                Correction of               0057        21.00    $1,041.52      $496.65      $208.30
                             bunion.
    28296  T                Correction of               0057        21.00    $1,041.52      $496.65      $208.30
                             bunion.
    28297  T                Correction of               0057        21.00    $1,041.52      $496.65      $208.30
                             bunion.
    28298  T                Correction of               0057        21.00    $1,041.52      $496.65      $208.30
                             bunion.
    28299  T                Correction of               0057        21.00    $1,041.52      $496.65      $208.30
                             bunion.
    28300  T                Incision of heel            0056        17.30      $858.02      $405.81      $171.60
                             bone.
    28302  T                Incision of ankle           0056        17.30      $858.02      $405.81      $171.60
                             bone.
    28304  T                Incision of midfoot         0056        17.30      $858.02      $405.81      $171.60
                             bones.
    28305  T                Incise/graft                0056        17.30      $858.02      $405.81      $171.60
                             midfoot bones.
    28306  T                Incision of                 0056        17.30      $858.02      $405.81      $171.60
                             metatarsal.
    28307  T                Incision of                 0056        17.30      $858.02      $405.81      $171.60
                             metatarsal.
    28308  T                Incision of                 0056        17.30      $858.02      $405.81      $171.60
                             metatarsal.
    28309  T                Incision of                 0056        17.30      $858.02      $405.81      $171.60
                             metatarsals.
    28310  T                Revision of big toe         0055        15.47      $767.26      $355.34      $153.45
    28312  T                Revision of toe....         0055        15.47      $767.26      $355.34      $153.45
    28313  T                Repair deformity of         0055        15.47      $767.26      $355.34      $153.45
                             toe.
    28315  T                Removal of sesamoid         0055        15.47      $767.26      $355.34      $153.45
                             bone.
    28320  T                Repair of foot              0056        17.30      $858.02      $405.81      $171.60
                             bones.
    28322  T                Repair of                   0056        17.30      $858.02      $405.81      $171.60
                             metatarsals.
    28340  T                Resect enlarged toe         0055        15.47      $767.26      $355.34      $153.45
                             tissue.
    28341  T                Resect enlarged toe         0055        15.47      $767.26      $355.34      $153.45
    28344  T                Repair extra toe(s)         0056        17.30      $858.02      $405.81      $171.60
    28345  T                Repair webbed               0056        17.30      $858.02      $405.81      $171.60
                             toe(s).
    28360  T                Reconstruct cleft           0056        17.30      $858.02      $405.81      $171.60
                             foot.
    28400  T                Treatment of heel           0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    28405  T                Treatment of heel           0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    28406  T                Treatment of heel           0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    28415  T                Treat heel fracture         0046        22.29    $1,105.50      $535.76      $221.10
    28420  T                Treat/graft heel            0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    28430  T                Treatment of ankle          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    28435  T                Treatment of ankle          0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    28436  T                Treatment of ankle          0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    28445  T                Treat ankle                 0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    28450  T                Treat midfoot               0044         2.17      $107.63       $38.08       $21.53
                             fracture, each.
    28455  T                Treat midfoot               0044         2.17      $107.63       $38.08       $21.53
                             fracture, each.
    28456  T                Treat midfoot               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    28465  T                Treat midfoot               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture, each.
    28470  T                Treat metatarsal            0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    28475  T                Treat metatarsal            0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    28476  T                Treat metatarsal            0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    28485  T                Treat metatarsal            0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    28490  T                Treat big toe               0043         1.64       $81.34       $25.46       $16.27
                             fracture.
    28495  T                Treat big toe               0043         1.64       $81.34       $25.46       $16.27
                             fracture.
    28496  T                Treat big toe               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    28505  T                Treat big toe               0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    28510  T                Treatment of toe            0043         1.64       $81.34       $25.46       $16.27
                             fracture.
    28515  T                Treatment of toe            0043         1.64       $81.34       $25.46       $16.27
                             fracture.
    28525  T                Treat toe fracture.         0046        22.29    $1,105.50      $535.76      $221.10
    28530  T                Treat sesamoid bone         0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    28531  T                Treat sesamoid bone         0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    28540  T                Treat foot                  0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    28545  T                Treat foot                  0045        11.02      $546.55      $277.12      $109.31
                             dislocation.
    28546  T                Treat foot                  0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.

[[Page 67866]]

 
    28555  T                Repair foot                 0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    28570  T                Treat foot                  0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    28575  T                Treat foot                  0045        11.02      $546.55      $277.12      $109.31
                             dislocation.
    28576  T                Treat foot                  0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    28585  T                Repair foot                 0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    28600  T                Treat foot                  0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    28605  T                Treat foot                  0045        11.02      $546.55      $277.12      $109.31
                             dislocation.
    28606  T                Treat foot                  0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    28615  T                Repair foot                 0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    28630  T                Treat toe                   0043         1.64       $81.34       $25.46       $16.27
                             dislocation.
    28635  T                Treat toe                   0045        11.02      $546.55      $277.12      $109.31
                             dislocation.
    28636  T                Treat toe                   0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    28645  T                Repair toe                  0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    28660  T                Treat toe                   0043         1.64       $81.34       $25.46       $16.27
                             dislocation.
    28665  T                Treat toe                   0045        11.02      $546.55      $277.12      $109.31
                             dislocation.
    28666  T                Treat toe                   0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    28675  T                Repair of toe               0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    28705  T                Fusion of foot              0056        17.30      $858.02      $405.81      $171.60
                             bones.
    28715  T                Fusion of foot              0056        17.30      $858.02      $405.81      $171.60
                             bones.
    28725  T                Fusion of foot              0056        17.30      $858.02      $405.81      $171.60
                             bones.
    28730  T                Fusion of foot              0056        17.30      $858.02      $405.81      $171.60
                             bones.
    28735  T                Fusion of foot              0056        17.30      $858.02      $405.81      $171.60
                             bones.
    28737  T                Revision of foot            0055        15.47      $767.26      $355.34      $153.45
                             bones.
    28740  T                Fusion of foot              0056        17.30      $858.02      $405.81      $171.60
                             bones.
    28750  T                Fusion of big toe           0055        15.47      $767.26      $355.34      $153.45
                             joint.
    28755  T                Fusion of big toe           0055        15.47      $767.26      $355.34      $153.45
                             joint.
    28760  T                Fusion of big toe           0056        17.30      $858.02      $405.81      $171.60
                             joint.
    28800  C                Amputation of        ...........  ...........  ...........  ...........  ...........
                             midfoot.
    28805  C                Amputation thru      ...........  ...........  ...........  ...........  ...........
                             metatarsal.
    28810  T                Amputation toe &            0055        15.47      $767.26      $355.34      $153.45
                             metatarsal.
    28820  T                Amputation of toe..         0055        15.47      $767.26      $355.34      $153.45
    28825  T                Partial amputation          0055        15.47      $767.26      $355.34      $153.45
                             of toe.
    28899  T                Foot/toes surgery           0043         1.64       $81.34       $25.46       $16.27
                             procedure.
    29000  S                Application of body         0059         1.74       $86.30       $29.59       $17.26
                             cast.
    29010  S                Application of body         0059         1.74       $86.30       $29.59       $17.26
                             cast.
    29015  S                Application of body         0059         1.74       $86.30       $29.59       $17.26
                             cast.
    29020  S                Application of body         0059         1.74       $86.30       $29.59       $17.26
                             cast.
    29025  S                Application of body         0059         1.74       $86.30       $29.59       $17.26
                             cast.
    29035  S                Application of body         0059         1.74       $86.30       $29.59       $17.26
                             cast.
    29040  S                Application of body         0059         1.74       $86.30       $29.59       $17.26
                             cast.
    29044  S                Application of body         0059         1.74       $86.30       $29.59       $17.26
                             cast.
    29046  S                Application of body         0059         1.74       $86.30       $29.59       $17.26
                             cast.
    29049  S                Application of              0059         1.74       $86.30       $29.59       $17.26
                             figure eight.
    29055  S                Application of              0059         1.74       $86.30       $29.59       $17.26
                             shoulder cast.
    29058  S                Application of              0059         1.74       $86.30       $29.59       $17.26
                             shoulder cast.
    29065  S                Application of long         0059         1.74       $86.30       $29.59       $17.26
                             arm cast.
    29075  S                Application of              0059         1.74       $86.30       $29.59       $17.26
                             forearm cast.
    29085  S                Apply hand/wrist            0059         1.74       $86.30       $29.59       $17.26
                             cast.
    29105  S                Apply long arm              0059         1.74       $86.30       $29.59       $17.26
                             splint.
    29125  S                Apply forearm               0059         1.74       $86.30       $29.59       $17.26
                             splint.
    29126  S                Apply forearm               0059         1.74       $86.30       $29.59       $17.26
                             splint.
    29130  S                Application of              0059         1.74       $86.30       $29.59       $17.26
                             finger splint.
    29131  S                Application of              0059         1.74       $86.30       $29.59       $17.26
                             finger splint.
    29200  S                Strapping of chest.         0059         1.74       $86.30       $29.59       $17.26
    29220  S                Strapping of low            0059         1.74       $86.30       $29.59       $17.26
                             back.
    29240  S                Strapping of                0059         1.74       $86.30       $29.59       $17.26
                             shoulder.
    29260  S                Strapping of elbow          0059         1.74       $86.30       $29.59       $17.26
                             or wrist.
    29280  S                Strapping of hand           0059         1.74       $86.30       $29.59       $17.26
                             or finger.
    29305  S                Application of hip          0059         1.74       $86.30       $29.59       $17.26
                             cast.
    29325  S                Application of hip          0059         1.74       $86.30       $29.59       $17.26
                             casts.
    29345  S                Application of long         0059         1.74       $86.30       $29.59       $17.26
                             leg cast.
    29355  S                Application of long         0059         1.74       $86.30       $29.59       $17.26
                             leg cast.
    29358  S                Apply long leg cast         0059         1.74       $86.30       $29.59       $17.26
                             brace.
    29365  S                Application of long         0059         1.74       $86.30       $29.59       $17.26
                             leg cast.
    29405  S                Apply short leg             0059         1.74       $86.30       $29.59       $17.26
                             cast.
    29425  S                Apply short leg             0059         1.74       $86.30       $29.59       $17.26
                             cast.
    29435  S                Apply short leg             0059         1.74       $86.30       $29.59       $17.26
                             cast.
    29440  S                Addition of walker          0059         1.74       $86.30       $29.59       $17.26
                             to cast.
    29445  S                Apply rigid leg             0059         1.74       $86.30       $29.59       $17.26
                             cast.
    29450  S                Application of leg          0059         1.74       $86.30       $29.59       $17.26
                             cast.
    29505  S                Application, long           0058         1.09       $54.06       $19.27       $10.81
                             leg splint.
    29515  S                Application lower           0058         1.09       $54.06       $19.27       $10.81
                             leg splint.
    29520  S                Strapping of hip...         0058         1.09       $54.06       $19.27       $10.81
    29530  S                Strapping of knee..         0058         1.09       $54.06       $19.27       $10.81

[[Page 67867]]

 
    29540  S                Strapping of ankle.         0058         1.09       $54.06       $19.27       $10.81
    29550  S                Strapping of toes..         0058         1.09       $54.06       $19.27       $10.81
    29580  S                Application of              0058         1.09       $54.06       $19.27       $10.81
                             paste boot.
    29590  S                Application of foot         0058         1.09       $54.06       $19.27       $10.81
                             splint.
    29700  S                Removal/revision of         0058         1.09       $54.06       $19.27       $10.81
                             cast.
    29705  S                Removal/revision of         0058         1.09       $54.06       $19.27       $10.81
                             cast.
    29710  S                Removal/revision of         0058         1.09       $54.06       $19.27       $10.81
                             cast.
    29715  S                Removal/revision of         0058         1.09       $54.06       $19.27       $10.81
                             cast.
    29720  S                Repair of body cast         0058         1.09       $54.06       $19.27       $10.81
    29730  S                Windowing of cast..         0058         1.09       $54.06       $19.27       $10.81
    29740  S                Wedging of cast....         0058         1.09       $54.06       $19.27       $10.81
    29750  S                Wedging of clubfoot         0058         1.09       $54.06       $19.27       $10.81
                             cast.
    29799  S                Casting/strapping           0058         1.09       $54.06       $19.27       $10.81
                             procedure.
    29800  T                Jaw arthroscopy/            0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29804  T                Jaw arthroscopy/            0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29815  T                Shoulder                    0041        24.57    $1,218.58      $592.08      $243.72
                             arthroscopy.
    29819  T                Shoulder                    0041        24.57    $1,218.58      $592.08      $243.72
                             arthroscopy/
                             surgery.
    29820  T                Shoulder                    0041        24.57    $1,218.58      $592.08      $243.72
                             arthroscopy/
                             surgery.
    29821  T                Shoulder                    0041        24.57    $1,218.58      $592.08      $243.72
                             arthroscopy/
                             surgery.
    29822  T                Shoulder                    0041        24.57    $1,218.58      $592.08      $243.72
                             arthroscopy/
                             surgery.
    29823  T                Shoulder                    0041        24.57    $1,218.58      $592.08      $243.72
                             arthroscopy/
                             surgery.
    29825  T                Shoulder                    0041        24.57    $1,218.58      $592.08      $243.72
                             arthroscopy/
                             surgery.
    29826  T                Shoulder                    0041        24.57    $1,218.58      $592.08      $243.72
                             arthroscopy/
                             surgery.
    29830  T                Elbow arthroscopy..         0041        24.57    $1,218.58      $592.08      $243.72
    29834  T                Elbow arthroscopy/          0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29835  T                Elbow arthroscopy/          0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29836  T                Elbow arthroscopy/          0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29837  T                Elbow arthroscopy/          0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29838  T                Elbow arthroscopy/          0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29840  T                Wrist arthroscopy..         0041        24.57    $1,218.58      $592.08      $243.72
    29843  T                Wrist arthroscopy/          0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29844  T                Wrist arthroscopy/          0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29845  T                Wrist arthroscopy/          0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29846  T                Wrist arthroscopy/          0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29847  T                Wrist arthroscopy/          0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29848  T                Wrist endoscopy/            0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29850  T                Knee arthroscopy/           0042        29.22    $1,449.19      $804.74      $289.84
                             surgery.
    29851  T                Knee arthroscopy/           0042        29.22    $1,449.19      $804.74      $289.84
                             surgery.
    29855  T                Tibial arthroscopy/         0042        29.22    $1,449.19      $804.74      $289.84
                             surgery.
    29856  T                Tibial arthroscopy/         0042        29.22    $1,449.19      $804.74      $289.84
                             surgery.
    29860  T                Hip arthroscopy, dx         0041        24.57    $1,218.58      $592.08      $243.72
    29861  T                Hip arthroscopy/            0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29862  T                Hip arthroscopy/            0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29863  T                Hip arthroscopy/            0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29870  T                Knee arthroscopy,           0041        24.57    $1,218.58      $592.08      $243.72
                             dx.
    29871  T                Knee arthroscopy/           0041        24.57    $1,218.58      $592.08      $243.72
                             drainage.
    29874  T                Knee arthroscopy/           0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29875  T                Knee arthroscopy/           0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29876  T                Knee arthroscopy/           0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29877  T                Knee arthroscopy/           0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29879  T                Knee arthroscopy/           0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29880  T                Knee arthroscopy/           0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29881  T                Knee arthroscopy/           0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29882  T                Knee arthroscopy/           0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29883  T                Knee arthroscopy/           0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29884  T                Knee arthroscopy/           0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29885  T                Knee arthroscopy/           0042        29.22    $1,449.19      $804.74      $289.84
                             surgery.
    29886  T                Knee arthroscopy/           0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29887  T                Knee arthroscopy/           0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29888  T                Knee arthroscopy/           0042        29.22    $1,449.19      $804.74      $289.84
                             surgery.
    29889  T                Knee arthroscopy/           0042        29.22    $1,449.19      $804.74      $289.84
                             surgery.
    29891  T                Ankle arthroscopy/          0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29892  T                Ankle arthroscopy/          0042        29.22    $1,449.19      $804.74      $289.84
                             surgery.
    29893  T                Scope, plantar              0055        15.47      $767.26      $355.34      $153.45
                             fasciotomy.
    29894  T                Ankle arthroscopy/          0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29895  T                Ankle arthroscopy/          0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29897  T                Ankle arthroscopy/          0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29898  T                Ankle arthroscopy/          0041        24.57    $1,218.58      $592.08      $243.72
                             surgery.
    29909  T                Arthroscopy of              0041        24.57    $1,218.58      $592.08      $243.72
                             joint.
    30000  T                Drainage of nose            0251         1.68       $83.32       $27.99       $16.66
                             lesion.
    30020  T                Drainage of nose            0251         1.68       $83.32       $27.99       $16.66
                             lesion.
    30100  T                Intranasal biopsy..         0252         5.18      $256.90      $114.24       $51.38
    30110  T                Removal of nose             0253        12.02      $596.14      $284.00      $119.23
                             polyp(s).
    30115  T                Removal of nose             0253        12.02      $596.14      $284.00      $119.23
                             polyp(s).

[[Page 67868]]

 
    30117  T                Removal of                  0253        12.02      $596.14      $284.00      $119.23
                             intranasal lesion.
    30118  T                Removal of                  0254        12.45      $617.47      $272.41      $123.49
                             intranasal lesion.
    30120  T                Revision of nose...         0253        12.02      $596.14      $284.00      $119.23
    30124  T                Removal of nose             0252         5.18      $256.90      $114.24       $51.38
                             lesion.
    30125  T                Removal of nose             0256        25.40    $1,259.74      $623.05      $251.95
                             lesion.
    30130  T                Removal of                  0253        12.02      $596.14      $284.00      $119.23
                             turbinate bones.
    30140  T                Removal of                  0253        12.02      $596.14      $284.00      $119.23
                             turbinate bones.
    30150  T                Partial removal of          0256        25.40    $1,259.74      $623.05      $251.95
                             nose.
    30160  T                Removal of nose....         0256        25.40    $1,259.74      $623.05      $251.95
    30200  T                Injection treatment         0253        12.02      $596.14      $284.00      $119.23
                             of nose.
    30210  T                Nasal sinus therapy         0252         5.18      $256.90      $114.24       $51.38
    30220  T                Insert nasal septal         0252         5.18      $256.90      $114.24       $51.38
                             button.
    30300  T                Remove nasal                0251         1.68       $83.32       $27.99       $16.66
                             foreign body.
    30310  T                Remove nasal                0253        12.02      $596.14      $284.00      $119.23
                             foreign body.
    30320  T                Remove nasal                0253        12.02      $596.14      $284.00      $119.23
                             foreign body.
    30400  T                Reconstruction of           0256        25.40    $1,259.74      $623.05      $251.95
                             nose.
    30410  T                Reconstruction of           0256        25.40    $1,259.74      $623.05      $251.95
                             nose.
    30420  T                Reconstruction of           0256        25.40    $1,259.74      $623.05      $251.95
                             nose.
    30430  T                Revision of nose...         0254        12.45      $617.47      $272.41      $123.49
    30435  T                Revision of nose...         0256        25.40    $1,259.74      $623.05      $251.95
    30450  T                Revision of nose...         0256        25.40    $1,259.74      $623.05      $251.95
    30460  T                Revision of nose...         0256        25.40    $1,259.74      $623.05      $251.95
    30462  T                Revision of nose...         0256        25.40    $1,259.74      $623.05      $251.95
   *30465  T                Repair nasal                0256        25.40    $1,259.74      $623.05      $251.95
                             stenosis.
    30520  T                Repair of nasal             0256        25.40    $1,259.74      $623.05      $251.95
                             septum.
    30540  T                Repair nasal defect         0256        25.40    $1,259.74      $623.05      $251.95
    30545  T                Repair nasal defect         0256        25.40    $1,259.74      $623.05      $251.95
    30560  T                Release of nasal            0251         1.68       $83.32       $27.99       $16.66
                             adhesions.
    30580  T                Repair upper jaw            0256        25.40    $1,259.74      $623.05      $251.95
                             fistula.
    30600  T                Repair mouth/nose           0256        25.40    $1,259.74      $623.05      $251.95
                             fistula.
    30620  T                Intranasal                  0256        25.40    $1,259.74      $623.05      $251.95
                             reconstruction.
    30630  T                Repair nasal septum         0254        12.45      $617.47      $272.41      $123.49
                             defect.
    30801  T                Cauterization,              0252         5.18      $256.90      $114.24       $51.38
                             inner nose.
    30802  T                Cauterization,              0253        12.02      $596.14      $284.00      $119.23
                             inner nose.
    30901  T                Control of                  0250         2.21      $109.61       $38.54       $21.92
                             nosebleed.
    30903  T                Control of                  0250         2.21      $109.61       $38.54       $21.92
                             nosebleed.
    30905  T                Control of                  0250         2.21      $109.61       $38.54       $21.92
                             nosebleed.
    30906  T                Repeat control of           0250         2.21      $109.61       $38.54       $21.92
                             nosebleed.
    30915  T                Ligation, nasal             0091        14.79      $733.52      $348.23      $146.70
                             sinus artery.
    30920  T                Ligation, upper jaw         0092        20.21    $1,002.34      $505.37      $200.47
                             artery.
    30930  T                Therapy, fracture           0253        12.02      $596.14      $284.00      $119.23
                             of nose.
    30999  T                Nasal surgery               0251         1.68       $83.32       $27.99       $16.66
                             procedure.
    31000  T                Irrigation,                 0251         1.68       $83.32       $27.99       $16.66
                             maxillary sinus.
    31002  T                Irrigation,                 0252         5.18      $256.90      $114.24       $51.38
                             sphenoid sinus.
    31020  T                Exploration,                0253        12.02      $596.14      $284.00      $119.23
                             maxillary sinus.
    31030  T                Exploration,                0256        25.40    $1,259.74      $623.05      $251.95
                             maxillary sinus.
    31032  T                Explore                     0256        25.40    $1,259.74      $623.05      $251.95
                             sinus,remove
                             polyps.
    31040  T                Exploration behind          0254        12.45      $617.47      $272.41      $123.49
                             upper jaw.
    31050  T                Exploration,                0256        25.40    $1,259.74      $623.05      $251.95
                             sphenoid sinus.
    31051  T                Sphenoid sinus              0256        25.40    $1,259.74      $623.05      $251.95
                             surgery.
    31070  T                Exploration of              0254        12.45      $617.47      $272.41      $123.49
                             frontal sinus.
    31075  T                Exploration of              0256        25.40    $1,259.74      $623.05      $251.95
                             frontal sinus.
    31080  T                Removal of frontal          0256        25.40    $1,259.74      $623.05      $251.95
                             sinus.
    31081  T                Removal of frontal          0256        25.40    $1,259.74      $623.05      $251.95
                             sinus.
    31084  T                Removal of frontal          0256        25.40    $1,259.74      $623.05      $251.95
                             sinus.
    31085  T                Removal of frontal          0256        25.40    $1,259.74      $623.05      $251.95
                             sinus.
    31086  T                Removal of frontal          0256        25.40    $1,259.74      $623.05      $251.95
                             sinus.
    31087  T                Removal of frontal          0256        25.40    $1,259.74      $623.05      $251.95
                             sinus.
    31090  T                Exploration of              0256        25.40    $1,259.74      $623.05      $251.95
                             sinuses.
    31200  T                Removal of ethmoid          0256        25.40    $1,259.74      $623.05      $251.95
                             sinus.
    31201  T                Removal of ethmoid          0256        25.40    $1,259.74      $623.05      $251.95
                             sinus.
    31205  T                Removal of ethmoid          0256        25.40    $1,259.74      $623.05      $251.95
                             sinus.
    31225  C                Removal of upper     ...........  ...........  ...........  ...........  ...........
                             jaw.
    31230  C                Removal of upper     ...........  ...........  ...........  ...........  ...........
                             jaw.
    31231  T                Nasal endoscopy, dx         0071         0.55       $27.28       $14.22        $5.46
    31233  T                Nasal/sinus                 0072         1.26       $62.49       $41.52       $12.50
                             endoscopy, dx.
    31235  T                Nasal/sinus                 0074        13.61      $675.00      $347.54      $135.00
                             endoscopy, dx.
    31237  T                Nasal/sinus                 0074        13.61      $675.00      $347.54      $135.00
                             endoscopy, surg.
    31238  T                Nasal/sinus                 0074        13.61      $675.00      $347.54      $135.00
                             endoscopy, surg.
    31239  T                Nasal/sinus                 0075        18.55      $920.01      $467.29      $184.00
                             endoscopy, surg.
    31240  T                Nasal/sinus                 0074        13.61      $675.00      $347.54      $135.00
                             endoscopy, surg.
    31254  T                Revision of ethmoid         0075        18.55      $920.01      $467.29      $184.00
                             sinus.
    31255  T                Removal of ethmoid          0075        18.55      $920.01      $467.29      $184.00
                             sinus.
    31256  T                Exploration                 0075        18.55      $920.01      $467.29      $184.00
                             maxillary sinus.

[[Page 67869]]

 
    31267  T                Endoscopy,                  0075        18.55      $920.01      $467.29      $184.00
                             maxillary sinus.
    31276  T                Sinus endoscopy,            0075        18.55      $920.01      $467.29      $184.00
                             surgical.
    31287  T                Nasal/sinus                 0075        18.55      $920.01      $467.29      $184.00
                             endoscopy, surg.
    31288  T                Nasal/sinus                 0075        18.55      $920.01      $467.29      $184.00
                             endoscopy, surg.
    31290  C                Nasal/sinus          ...........  ...........  ...........  ...........  ...........
                             endoscopy, surg.
    31291  C                Nasal/sinus          ...........  ...........  ...........  ...........  ...........
                             endoscopy, surg.
    31292  C                Nasal/sinus          ...........  ...........  ...........  ...........  ...........
                             endoscopy, surg.
    31293  C                Nasal/sinus          ...........  ...........  ...........  ...........  ...........
                             endoscopy, surg.
    31294  C                Nasal/sinus          ...........  ...........  ...........  ...........  ...........
                             endoscopy, surg.
    31299  T                Sinus surgery               0252         5.18      $256.90      $114.24       $51.38
                             procedure.
    31300  T                Removal of larynx           0256        25.40    $1,259.74      $623.05      $251.95
                             lesion.
    31320  T                Diagnostic                  0256        25.40    $1,259.74      $623.05      $251.95
                             incision, larynx.
    31360  C                Removal of larynx..  ...........  ...........  ...........  ...........  ...........
    31365  C                Removal of larynx..  ...........  ...........  ...........  ...........  ...........
    31367  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             larynx.
    31368  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             larynx.
    31370  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             larynx.
    31375  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             larynx.
    31380  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             larynx.
    31382  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             larynx.
    31390  C                Removal of larynx &  ...........  ...........  ...........  ...........  ...........
                             pharynx.
    31395  C                Reconstruct larynx   ...........  ...........  ...........  ...........  ...........
                             & pharynx.
    31400  T                Revision of larynx.         0256        25.40    $1,259.74      $623.05      $251.95
    31420  T                Removal of                  0256        25.40    $1,259.74      $623.05      $251.95
                             epiglottis.
    31500  S                Insert emergency            0094         4.51      $223.68      $105.29       $44.74
                             airway.
    31502  T                Change of windpipe          0121         2.36      $117.05       $52.53       $23.41
                             airway.
    31505  T                Diagnostic                  0072         1.26       $62.49       $41.52       $12.50
                             laryngoscopy.
    31510  T                Laryngoscopy with           0074        13.61      $675.00      $347.54      $135.00
                             biopsy.
    31511  T                Remove foreign              0072         1.26       $62.49       $41.52       $12.50
                             body, larynx.
    31512  T                Removal of larynx           0074        13.61      $675.00      $347.54      $135.00
                             lesion.
    31513  T                Injection into              0073         4.11      $203.84       $91.07       $40.77
                             vocal cord.
    31515  T                Laryngoscopy for            0074        13.61      $675.00      $347.54      $135.00
                             aspiration.
    31520  T                Diagnostic                  0072         1.26       $62.49       $41.52       $12.50
                             laryngoscopy.
    31525  T                Diagnostic                  0074        13.61      $675.00      $347.54      $135.00
                             laryngoscopy.
    31526  T                Diagnostic                  0074        13.61      $675.00      $347.54      $135.00
                             laryngoscopy.
    31527  T                Laryngoscopy for            0075        18.55      $920.01      $467.29      $184.00
                             treatment.
    31528  T                Laryngoscopy and            0074        13.61      $675.00      $347.54      $135.00
                             dilatation.
    31529  T                Laryngoscopy and            0074        13.61      $675.00      $347.54      $135.00
                             dilatation.
    31530  T                Operative                   0075        18.55      $920.01      $467.29      $184.00
                             laryngoscopy.
    31531  T                Operative                   0075        18.55      $920.01      $467.29      $184.00
                             laryngoscopy.
    31535  T                Operative                   0075        18.55      $920.01      $467.29      $184.00
                             laryngoscopy.
    31536  T                Operative                   0075        18.55      $920.01      $467.29      $184.00
                             laryngoscopy.
    31540  T                Operative                   0075        18.55      $920.01      $467.29      $184.00
                             laryngoscopy.
    31541  T                Operative                   0075        18.55      $920.01      $467.29      $184.00
                             laryngoscopy.
    31560  T                Operative                   0075        18.55      $920.01      $467.29      $184.00
                             laryngoscopy.
    31561  T                Operative                   0075        18.55      $920.01      $467.29      $184.00
                             laryngoscopy.
    31570  T                Laryngoscopy with           0075        18.55      $920.01      $467.29      $184.00
                             injection.
    31571  T                Laryngoscopy with           0075        18.55      $920.01      $467.29      $184.00
                             injection.
    31575  T                Diagnostic                  0071         0.55       $27.28       $14.22        $5.46
                             laryngoscopy.
    31576  T                Laryngoscopy with           0074        13.61      $675.00      $347.54      $135.00
                             biopsy.
    31577  T                Remove foreign              0073         4.11      $203.84       $91.07       $40.77
                             body, larynx.
    31578  T                Removal of larynx           0074        13.61      $675.00      $347.54      $135.00
                             lesion.
    31579  T                Diagnostic                  0073         4.11      $203.84       $91.07       $40.77
                             laryngoscopy.
    31580  T                Revision of larynx.         0256        25.40    $1,259.74      $623.05      $251.95
    31582  C                Revision of larynx.  ...........  ...........  ...........  ...........  ...........
    31584  C                Treat larynx         ...........  ...........  ...........  ...........  ...........
                             fracture.
    31585  T                Treat larynx                0253        12.02      $596.14      $284.00      $119.23
                             fracture.
    31586  T                Treat larynx                0256        25.40    $1,259.74      $623.05      $251.95
                             fracture.
    31587  C                Revision of larynx.  ...........  ...........  ...........  ...........  ...........
    31588  T                Revision of larynx.         0256        25.40    $1,259.74      $623.05      $251.95
    31590  T                Reinnervate larynx.         0256        25.40    $1,259.74      $623.05      $251.95
    31595  T                Larynx nerve                0256        25.40    $1,259.74      $623.05      $251.95
                             surgery.
    31599  T                Larynx surgery              0253        12.02      $596.14      $284.00      $119.23
                             procedure.
    31600  T                Incision of                 0254        12.45      $617.47      $272.41      $123.49
                             windpipe.
    31601  T                Incision of                 0254        12.45      $617.47      $272.41      $123.49
                             windpipe.
    31603  T                Incision of                 0254        12.45      $617.47      $272.41      $123.49
                             windpipe.
    31605  T                Incision of                 0254        12.45      $617.47      $272.41      $123.49
                             windpipe.
    31610  T                Incision of                 0254        12.45      $617.47      $272.41      $123.49
                             windpipe.
    31611  T                Surgery/speech              0254        12.45      $617.47      $272.41      $123.49
                             prosthesis.
    31612  T                Puncture/clear              0253        12.02      $596.14      $284.00      $119.23
                             windpipe.
    31613  T                Repair windpipe             0254        12.45      $617.47      $272.41      $123.49
                             opening.
    31614  T                Repair windpipe             0256        25.40    $1,259.74      $623.05      $251.95
                             opening.
    31615  T                Visualization of            0076         8.06      $399.75      $197.05       $79.95
                             windpipe.
    31622  T                Dx bronchoscope/            0076         8.06      $399.75      $197.05       $79.95
                             wash.

[[Page 67870]]

 
    31623  T                Dx bronchoscope/            0076         8.06      $399.75      $197.05       $79.95
                             brush.
    31624  T                Dx bronchoscope/            0076         8.06      $399.75      $197.05       $79.95
                             lavage.
    31625  T                Bronchoscopy with           0076         8.06      $399.75      $197.05       $79.95
                             biopsy.
    31628  T                Bronchoscopy with           0076         8.06      $399.75      $197.05       $79.95
                             biopsy.
    31629  T                Bronchoscopy with           0076         8.06      $399.75      $197.05       $79.95
                             biopsy.
    31630  T                Bronchoscopy with           0076         8.06      $399.75      $197.05       $79.95
                             repair.
    31631  T                Bronchoscopy with           0076         8.06      $399.75      $197.05       $79.95
                             dilation.
    31635  T                Remove foreign              0076         8.06      $399.75      $197.05       $79.95
                             body, airway.
    31640  T                Bronchoscopy &              0076         8.06      $399.75      $197.05       $79.95
                             remove lesion.
    31641  T                Bronchoscopy, treat         0076         8.06      $399.75      $197.05       $79.95
                             blockage.
    31643  T                Diag bronchoscope/          0076         8.06      $399.75      $197.05       $79.95
                             catheter.
    31645  T                Bronchoscopy, clear         0076         8.06      $399.75      $197.05       $79.95
                             airways.
    31646  T                Bronchoscopy,               0076         8.06      $399.75      $197.05       $79.95
                             reclear airway.
    31656  T                Bronchoscopy, inj           0076         8.06      $399.75      $197.05       $79.95
                             for xray.
    31700  T                Insertion of airway         0072         1.26       $62.49       $41.52       $12.50
                             catheter.
    31708  N                Instill airway       ...........  ...........  ...........  ...........  ...........
                             contrast dye.
    31710  N                Insertion of airway  ...........  ...........  ...........  ...........  ...........
                             catheter.
    31715  N                Injection for        ...........  ...........  ...........  ...........  ...........
                             bronchus x-ray.
    31717  T                Bronchial brush             0073         4.11      $203.84       $91.07       $40.77
                             biopsy.
    31720  T                Clearance of                0072         1.26       $62.49       $41.52       $12.50
                             airways.
    31725  C                Clearance of         ...........  ...........  ...........  ...........  ...........
                             airways.
    31730  T                Intro, windpipe             0073         4.11      $203.84       $91.07       $40.77
                             wire/tube.
    31750  T                Repair of windpipe.         0256        25.40    $1,259.74      $623.05      $251.95
    31755  T                Repair of windpipe.         0256        25.40    $1,259.74      $623.05      $251.95
    31760  C                Repair of windpipe.  ...........  ...........  ...........  ...........  ...........
    31766  C                Reconstruction of    ...........  ...........  ...........  ...........  ...........
                             windpipe.
    31770  C                Repair/graft of      ...........  ...........  ...........  ...........  ...........
                             bronchus.
    31775  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             bronchus.
    31780  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             windpipe.
    31781  C                Reconstruct          ...........  ...........  ...........  ...........  ...........
                             windpipe.
    31785  C                Remove windpipe      ...........  ...........  ...........  ...........  ...........
                             lesion.
    31786  C                Remove windpipe      ...........  ...........  ...........  ...........  ...........
                             lesion.
    31800  C                Repair of windpipe   ...........  ...........  ...........  ...........  ...........
                             injury.
    31805  C                Repair of windpipe   ...........  ...........  ...........  ...........  ...........
                             injury.
    31820  T                Closure of windpipe         0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    31825  T                Repair of windpipe          0254        12.45      $617.47      $272.41      $123.49
                             defect.
    31830  T                Revise windpipe             0254        12.45      $617.47      $272.41      $123.49
                             scar.
    31899  T                Airways surgical            0076         8.06      $399.75      $197.05       $79.95
                             procedure.
    32000  T                Drainage of chest..         0070         3.64      $180.53       $79.60       $36.11
    32002  T                Treatment of                0070         3.64      $180.53       $79.60       $36.11
                             collapsed lung.
    32005  T                Treat lung lining           0070         3.64      $180.53       $79.60       $36.11
                             chemically.
    32020  T                Insertion of chest          0070         3.64      $180.53       $79.60       $36.11
                             tube.
    32035  C                Exploration of       ...........  ...........  ...........  ...........  ...........
                             chest.
    32036  C                Exploration of       ...........  ...........  ...........  ...........  ...........
                             chest.
    32095  C                Biopsy through       ...........  ...........  ...........  ...........  ...........
                             chest wall.
    32100  C                Exploration/biopsy   ...........  ...........  ...........  ...........  ...........
                             of chest.
    32110  C                Explore/repair       ...........  ...........  ...........  ...........  ...........
                             chest.
    32120  C                Re-exploration of    ...........  ...........  ...........  ...........  ...........
                             chest.
    32124  C                Explore chest free   ...........  ...........  ...........  ...........  ...........
                             adhesions.
    32140  C                Removal of lung      ...........  ...........  ...........  ...........  ...........
                             lesion(s).
    32141  C                Remove/treat lung    ...........  ...........  ...........  ...........  ...........
                             lesions.
    32150  C                Removal of lung      ...........  ...........  ...........  ...........  ...........
                             lesion(s).
    32151  C                Remove lung foreign  ...........  ...........  ...........  ...........  ...........
                             body.
    32160  C                Open chest heart     ...........  ...........  ...........  ...........  ...........
                             massage.
    32200  C                Drain, open, lung    ...........  ...........  ...........  ...........  ...........
                             lesion.
    32201  C                Drain, percut, lung  ...........  ...........  ...........  ...........  ...........
                             lesion.
    32215  C                Treat chest lining.  ...........  ...........  ...........  ...........  ...........
    32220  C                Release of lung....  ...........  ...........  ...........  ...........  ...........
    32225  C                Partial release of   ...........  ...........  ...........  ...........  ...........
                             lung.
    32310  C                Removal of chest     ...........  ...........  ...........  ...........  ...........
                             lining.
    32320  C                Free/remove chest    ...........  ...........  ...........  ...........  ...........
                             lining.
    32400  T                Needle biopsy chest         0005         5.41      $268.32      $119.75       $53.66
                             lining.
    32402  C                Open biopsy chest    ...........  ...........  ...........  ...........  ...........
                             lining.
    32405  T                Biopsy, lung or             0005         5.41      $268.32      $119.75       $53.66
                             mediastinum.
    32420  T                Puncture/clear lung         0070         3.64      $180.53       $79.60       $36.11
    32440  C                Removal of lung....  ...........  ...........  ...........  ...........  ...........
    32442  C                Sleeve               ...........  ...........  ...........  ...........  ...........
                             pneumonectomy.
    32445  C                Removal of lung....  ...........  ...........  ...........  ...........  ...........
    32480  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             lung.
    32482  C                Bilobectomy........  ...........  ...........  ...........  ...........  ...........
    32484  C                Segmentectomy......  ...........  ...........  ...........  ...........  ...........
    32486  C                Sleeve lobectomy...  ...........  ...........  ...........  ...........  ...........
    32488  C                Completion           ...........  ...........  ...........  ...........  ...........
                             pneumonectomy.
    32491  C                Lung volume          ...........  ...........  ...........  ...........  ...........
                             reduction.

[[Page 67871]]

 
    32500  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             lung.
    32501  C                Repair bronchus add- ...........  ...........  ...........  ...........  ...........
                             on.
    32520  C                Remove lung &        ...........  ...........  ...........  ...........  ...........
                             revise chest.
    32522  C                Remove lung &        ...........  ...........  ...........  ...........  ...........
                             revise chest.
    32525  C                Remove lung &        ...........  ...........  ...........  ...........  ...........
                             revise chest.
    32540  C                Removal of lung      ...........  ...........  ...........  ...........  ...........
                             lesion.
    32601  T                Thoracoscopy,               0076         8.06      $399.75      $197.05       $79.95
                             diagnostic.
    32602  T                Thoracoscopy,               0076         8.06      $399.75      $197.05       $79.95
                             diagnostic.
    32603  T                Thoracoscopy,               0076         8.06      $399.75      $197.05       $79.95
                             diagnostic.
    32604  T                Thoracoscopy,               0076         8.06      $399.75      $197.05       $79.95
                             diagnostic.
    32605  T                Thoracoscopy,               0076         8.06      $399.75      $197.05       $79.95
                             diagnostic.
    32606  T                Thoracoscopy,               0076         8.06      $399.75      $197.05       $79.95
                             diagnostic.
    32650  C                Thoracoscopy,        ...........  ...........  ...........  ...........  ...........
                             surgical.
    32651  C                Thoracoscopy,        ...........  ...........  ...........  ...........  ...........
                             surgical.
    32652  C                Thoracoscopy,        ...........  ...........  ...........  ...........  ...........
                             surgical.
    32653  C                Thoracoscopy,        ...........  ...........  ...........  ...........  ...........
                             surgical.
    32654  C                Thoracoscopy,        ...........  ...........  ...........  ...........  ...........
                             surgical.
    32655  C                Thoracoscopy,        ...........  ...........  ...........  ...........  ...........
                             surgical.
    32656  C                Thoracoscopy,        ...........  ...........  ...........  ...........  ...........
                             surgical.
    32657  C                Thoracoscopy,        ...........  ...........  ...........  ...........  ...........
                             surgical.
    32658  C                Thoracoscopy,        ...........  ...........  ...........  ...........  ...........
                             surgical.
    32659  C                Thoracoscopy,        ...........  ...........  ...........  ...........  ...........
                             surgical.
    32660  C                Thoracoscopy,        ...........  ...........  ...........  ...........  ...........
                             surgical.
    32661  C                Thoracoscopy,        ...........  ...........  ...........  ...........  ...........
                             surgical.
    32662  C                Thoracoscopy,        ...........  ...........  ...........  ...........  ...........
                             surgical.
    32663  C                Thoracoscopy,        ...........  ...........  ...........  ...........  ...........
                             surgical.
    32664  C                Thoracoscopy,        ...........  ...........  ...........  ...........  ...........
                             surgical.
    32665  C                Thoracoscopy,        ...........  ...........  ...........  ...........  ...........
                             surgical.
    32800  C                Repair lung hernia.  ...........  ...........  ...........  ...........  ...........
    32810  C                Close chest after    ...........  ...........  ...........  ...........  ...........
                             drainage.
    32815  C                Close bronchial      ...........  ...........  ...........  ...........  ...........
                             fistula.
    32820  C                Reconstruct injured  ...........  ...........  ...........  ...........  ...........
                             chest.
    32850  C                Donor pneumonectomy  ...........  ...........  ...........  ...........  ...........
    32851  C                Lung transplant,     ...........  ...........  ...........  ...........  ...........
                             single.
    32852  C                Lung transplant      ...........  ...........  ...........  ...........  ...........
                             with bypass.
    32853  C                Lung transplant,     ...........  ...........  ...........  ...........  ...........
                             double.
    32854  C                Lung transplant      ...........  ...........  ...........  ...........  ...........
                             with bypass.
    32900  C                Removal of rib(s)..  ...........  ...........  ...........  ...........  ...........
    32905  C                Revise & repair      ...........  ...........  ...........  ...........  ...........
                             chest wall.
    32906  C                Revise & repair      ...........  ...........  ...........  ...........  ...........
                             chest wall.
    32940  C                Revision of lung...  ...........  ...........  ...........  ...........  ...........
    32960  T                Therapeutic                 0070         3.64      $180.53       $79.60       $36.11
                             pneumothorax.
    32997  C                Total lung lavage..  ...........  ...........  ...........  ...........  ...........
    32999  T                Chest surgery               0070         3.64      $180.53       $79.60       $36.11
                             procedure.
    33010  T                Drainage of heart           0070         3.64      $180.53       $79.60       $36.11
                             sac.
    33011  T                Repeat drainage of          0070         3.64      $180.53       $79.60       $36.11
                             heart sac.
    33015  C                Incision of heart    ...........  ...........  ...........  ...........  ...........
                             sac.
    33020  C                Incision of heart    ...........  ...........  ...........  ...........  ...........
                             sac.
    33025  C                Incision of heart    ...........  ...........  ...........  ...........  ...........
                             sac.
    33030  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             heart sac.
    33031  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             heart sac.
    33050  C                Removal of heart     ...........  ...........  ...........  ...........  ...........
                             sac lesion.
    33120  C                Removal of heart     ...........  ...........  ...........  ...........  ...........
                             lesion.
    33130  C                Removal of heart     ...........  ...........  ...........  ...........  ...........
                             lesion.
    33140  C                Heart revascularize  ...........  ...........  ...........  ...........  ...........
                             (tmr).
   *33141  C                Heart TMR w/ other   ...........  ...........  ...........  ...........  ...........
                             procedure.
    33200  C                Insertion of heart   ...........  ...........  ...........  ...........  ...........
                             pacemaker.
    33201  C                Insertion of heart   ...........  ...........  ...........  ...........  ...........
                             pacemaker.
    33206  T                Insertion of heart          0089        78.45    $3,890.81    $2,275.19      $778.16
                             pacemaker.
    33207  T                Insertion of heart          0089        78.45    $3,890.81    $2,275.19      $778.16
                             pacemaker.
    33208  T                Insertion of heart          0089        78.45    $3,890.81    $2,275.19      $778.16
                             pacemaker.
    33210  T                Insertion of heart          0106        18.96      $940.34      $503.07      $188.07
                             electrode.
    33211  T                Insertion of heart          0106        18.96      $940.34      $503.07      $188.07
                             electrode.
    33212  T                Insertion of pulse          0090        78.28    $3,882.37    $2,133.88      $776.47
                             generator.
    33213  T                Insertion of pulse          0090        78.28    $3,882.37    $2,133.88      $776.47
                             generator.
    33214  T                Upgrade of                  0089        78.45    $3,890.81    $2,275.19      $778.16
                             pacemaker system.
    33216  T                Revise eltrd pacing-        0106        18.96      $940.34      $503.07      $188.07
                             defib.
    33217  T                Revise eltrd pacing-        0106        18.96      $940.34      $503.07      $188.07
                             defib.
    33218  T                Revise eltrd pacing-        0106        18.96      $940.34      $503.07      $188.07
                             defib.
    33220  T                Revise eltrd pacing-        0106        18.96      $940.34      $503.07      $188.07
                             defib.
    33222  T                Revise pocket,              0026        12.11      $600.61      $277.92      $120.12
                             pacemaker.
    33223  T                Revise pocket,              0026        12.11      $600.61      $277.92      $120.12
                             pacing-defib.
    33233  T                Removal of                  0105        15.06      $746.92      $372.32      $149.38
                             pacemaker system.
    33234  T                Removal of                  0105        15.06      $746.92      $372.32      $149.38
                             pacemaker system.

[[Page 67872]]

 
    33235  T                Removal pacemaker           0105        15.06      $746.92      $372.32      $149.38
                             electrode.
    33236  C                Remove electrode/    ...........  ...........  ...........  ...........  ...........
                             thoracotomy.
    33237  C                Remove electrode/    ...........  ...........  ...........  ...........  ...........
                             thoracotomy.
    33238  C                Remove electrode/    ...........  ...........  ...........  ...........  ...........
                             thoracotomy.
    33240  T                Insert pulse                0107       147.51    $7,315.91    $5,086.37    $1,463.18
                             generator.
    33241  T                Remove pulse                0105        15.06      $746.92      $372.32      $149.38
                             generator.
    33243  C                Remove eltrd/        ...........  ...........  ...........  ...........  ...........
                             thoracotomy.
    33244  T                Remove eltrd,               0105        15.06      $746.92      $372.32      $149.38
                             transven.
    33245  C                Insert epic eltrd    ...........  ...........  ...........  ...........  ...........
                             pace-defib.
    33246  C                Insert epic eltrd/   ...........  ...........  ...........  ...........  ...........
                             generator.
    33249  T                Eltrd/insert pace-          0108       210.84   $10,456.84    $5,484.72    $2,091.37
                             defib.
    33250  C                Ablate heart         ...........  ...........  ...........  ...........  ...........
                             dysrhythm focus.
    33251  C                Ablate heart         ...........  ...........  ...........  ...........  ...........
                             dysrhythm focus.
    33253  C                Reconstruct atria..  ...........  ...........  ...........  ...........  ...........
    33261  C                Ablate heart         ...........  ...........  ...........  ...........  ...........
                             dysrhythm focus.
    33282  S                Implant pat-active          0974         8.25      $409.17  ...........       $81.83
                             ht record.
    33284  T                Remove pat-active           0109         6.53      $323.86      $133.51       $64.77
                             ht record.
    33300  C                Repair of heart      ...........  ...........  ...........  ...........  ...........
                             wound.
    33305  C                Repair of heart      ...........  ...........  ...........  ...........  ...........
                             wound.
    33310  C                Exploratory heart    ...........  ...........  ...........  ...........  ...........
                             surgery.
    33315  C                Exploratory heart    ...........  ...........  ...........  ...........  ...........
                             surgery.
    33320  C                Repair major blood   ...........  ...........  ...........  ...........  ...........
                             vessel(s).
    33321  C                Repair major vessel  ...........  ...........  ...........  ...........  ...........
    33322  C                Repair major blood   ...........  ...........  ...........  ...........  ...........
                             vessel(s).
    33330  C                Insert major vessel  ...........  ...........  ...........  ...........  ...........
                             graft.
    33332  C                Insert major vessel  ...........  ...........  ...........  ...........  ...........
                             graft.
    33335  C                Insert major vessel  ...........  ...........  ...........  ...........  ...........
                             graft.
    33400  C                Repair of aortic     ...........  ...........  ...........  ...........  ...........
                             valve.
    33401  C                Valvuloplasty, open  ...........  ...........  ...........  ...........  ...........
    33403  C                Valvuloplasty, w/cp  ...........  ...........  ...........  ...........  ...........
                             bypass.
    33404  C                Prepare heart-aorta  ...........  ...........  ...........  ...........  ...........
                             conduit.
    33405  C                Replacement of       ...........  ...........  ...........  ...........  ...........
                             aortic valve.
    33406  C                Replacement of       ...........  ...........  ...........  ...........  ...........
                             aortic valve.
    33410  C                Replacement of       ...........  ...........  ...........  ...........  ...........
                             aortic valve.
    33411  C                Replacement of       ...........  ...........  ...........  ...........  ...........
                             aortic valve.
    33412  C                Replacement of       ...........  ...........  ...........  ...........  ...........
                             aortic valve.
    33413  C                Replacement of       ...........  ...........  ...........  ...........  ...........
                             aortic valve.
    33414  C                Repair of aortic     ...........  ...........  ...........  ...........  ...........
                             valve.
    33415  C                Revision,            ...........  ...........  ...........  ...........  ...........
                             subvalvular tissue.
    33416  C                Revise ventricle     ...........  ...........  ...........  ...........  ...........
                             muscle.
    33417  C                Repair of aortic     ...........  ...........  ...........  ...........  ...........
                             valve.
    33420  C                Revision of mitral   ...........  ...........  ...........  ...........  ...........
                             valve.
    33422  C                Revision of mitral   ...........  ...........  ...........  ...........  ...........
                             valve.
    33425  C                Repair of mitral     ...........  ...........  ...........  ...........  ...........
                             valve.
    33426  C                Repair of mitral     ...........  ...........  ...........  ...........  ...........
                             valve.
    33427  C                Repair of mitral     ...........  ...........  ...........  ...........  ...........
                             valve.
    33430  C                Replacement of       ...........  ...........  ...........  ...........  ...........
                             mitral valve.
    33460  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             tricuspid valve.
    33463  C                Valvuloplasty,       ...........  ...........  ...........  ...........  ...........
                             tricuspid.
    33464  C                Valvuloplasty,       ...........  ...........  ...........  ...........  ...........
                             tricuspid.
    33465  C                Replace tricuspid    ...........  ...........  ...........  ...........  ...........
                             valve.
    33468  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             tricuspid valve.
    33470  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             pulmonary valve.
    33471  C                Valvotomy,           ...........  ...........  ...........  ...........  ...........
                             pulmonary valve.
    33472  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             pulmonary valve.
    33474  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             pulmonary valve.
    33475  C                Replacement,         ...........  ...........  ...........  ...........  ...........
                             pulmonary valve.
    33476  C                Revision of heart    ...........  ...........  ...........  ...........  ...........
                             chamber.
    33478  C                Revision of heart    ...........  ...........  ...........  ...........  ...........
                             chamber.
    33496  C                Repair, prosth       ...........  ...........  ...........  ...........  ...........
                             valve clot.
    33500  C                Repair heart vessel  ...........  ...........  ...........  ...........  ...........
                             fistula.
    33501  C                Repair heart vessel  ...........  ...........  ...........  ...........  ...........
                             fistula.
    33502  C                Coronary artery      ...........  ...........  ...........  ...........  ...........
                             correction.
    33503  C                Coronary artery      ...........  ...........  ...........  ...........  ...........
                             graft.
    33504  C                Coronary artery      ...........  ...........  ...........  ...........  ...........
                             graft.
    33505  C                Repair artery w/     ...........  ...........  ...........  ...........  ...........
                             tunnel.
    33506  C                Repair artery,       ...........  ...........  ...........  ...........  ...........
                             translocation.
    33510  C                CABG, vein, single.  ...........  ...........  ...........  ...........  ...........
    33511  C                CABG, vein, two....  ...........  ...........  ...........  ...........  ...........
    33512  C                CABG, vein, three..  ...........  ...........  ...........  ...........  ...........
    33513  C                CABG, vein, four...  ...........  ...........  ...........  ...........  ...........
    33514  C                CABG, vein, five...  ...........  ...........  ...........  ...........  ...........
    33516  C                Cabg, vein, six or   ...........  ...........  ...........  ...........  ...........
                             more.
    33517  C                CABG, artery-vein,   ...........  ...........  ...........  ...........  ...........
                             single.

[[Page 67873]]

 
    33518  C                CABG, artery-vein,   ...........  ...........  ...........  ...........  ...........
                             two.
    33519  C                CABG, artery-vein,   ...........  ...........  ...........  ...........  ...........
                             three.
    33521  C                CABG, artery-vein,   ...........  ...........  ...........  ...........  ...........
                             four.
    33522  C                CABG, artery-vein,   ...........  ...........  ...........  ...........  ...........
                             five.
    33523  C                Cabg, art-vein, six  ...........  ...........  ...........  ...........  ...........
                             or more.
    33530  C                Coronary artery,     ...........  ...........  ...........  ...........  ...........
                             bypass/reop.
    33533  C                CABG, arterial,      ...........  ...........  ...........  ...........  ...........
                             single.
    33534  C                CABG, arterial, two  ...........  ...........  ...........  ...........  ...........
    33535  C                CABG, arterial,      ...........  ...........  ...........  ...........  ...........
                             three.
    33536  C                Cabg, arterial,      ...........  ...........  ...........  ...........  ...........
                             four or more.
    33542  C                Removal of heart     ...........  ...........  ...........  ...........  ...........
                             lesion.
    33545  C                Repair of heart      ...........  ...........  ...........  ...........  ...........
                             damage.
    33572  C                Open coronary        ...........  ...........  ...........  ...........  ...........
                             endarterectomy.
    33600  C                Closure of valve...  ...........  ...........  ...........  ...........  ...........
    33602  C                Closure of valve...  ...........  ...........  ...........  ...........  ...........
    33606  C                Anastomosis/artery-  ...........  ...........  ...........  ...........  ...........
                             aorta.
    33608  C                Repair anomaly w/    ...........  ...........  ...........  ...........  ...........
                             conduit.
    33610  C                Repair by            ...........  ...........  ...........  ...........  ...........
                             enlargement.
    33611  C                Repair double        ...........  ...........  ...........  ...........  ...........
                             ventricle.
    33612  C                Repair double        ...........  ...........  ...........  ...........  ...........
                             ventricle.
    33615  C                Repair, simple       ...........  ...........  ...........  ...........  ...........
                             fontan.
    33617  C                Repair, modified     ...........  ...........  ...........  ...........  ...........
                             fontan.
    33619  C                Repair single        ...........  ...........  ...........  ...........  ...........
                             ventricle.
    33641  C                Repair heart septum  ...........  ...........  ...........  ...........  ...........
                             defect.
    33645  C                Revision of heart    ...........  ...........  ...........  ...........  ...........
                             veins.
    33647  C                Repair heart septum  ...........  ...........  ...........  ...........  ...........
                             defects.
    33660  C                Repair of heart      ...........  ...........  ...........  ...........  ...........
                             defects.
    33665  C                Repair of heart      ...........  ...........  ...........  ...........  ...........
                             defects.
    33670  C                Repair of heart      ...........  ...........  ...........  ...........  ...........
                             chambers.
    33681  C                Repair heart septum  ...........  ...........  ...........  ...........  ...........
                             defect.
    33684  C                Repair heart septum  ...........  ...........  ...........  ...........  ...........
                             defect.
    33688  C                Repair heart septum  ...........  ...........  ...........  ...........  ...........
                             defect.
    33690  C                Reinforce pulmonary  ...........  ...........  ...........  ...........  ...........
                             artery.
    33692  C                Repair of heart      ...........  ...........  ...........  ...........  ...........
                             defects.
    33694  C                Repair of heart      ...........  ...........  ...........  ...........  ...........
                             defects.
    33697  C                Repair of heart      ...........  ...........  ...........  ...........  ...........
                             defects.
    33702  C                Repair of heart      ...........  ...........  ...........  ...........  ...........
                             defects.
    33710  C                Repair of heart      ...........  ...........  ...........  ...........  ...........
                             defects.
    33720  C                Repair of heart      ...........  ...........  ...........  ...........  ...........
                             defect.
    33722  C                Repair of heart      ...........  ...........  ...........  ...........  ...........
                             defect.
    33730  C                Repair heart-vein    ...........  ...........  ...........  ...........  ...........
                             defect(s).
    33732  C                Repair heart-vein    ...........  ...........  ...........  ...........  ...........
                             defect.
    33735  C                Revision of heart    ...........  ...........  ...........  ...........  ...........
                             chamber.
    33736  C                Revision of heart    ...........  ...........  ...........  ...........  ...........
                             chamber.
    33737  C                Revision of heart    ...........  ...........  ...........  ...........  ...........
                             chamber.
    33750  C                Major vessel shunt.  ...........  ...........  ...........  ...........  ...........
    33755  C                Major vessel shunt.  ...........  ...........  ...........  ...........  ...........
    33762  C                Major vessel shunt.  ...........  ...........  ...........  ...........  ...........
    33764  C                Major vessel shunt   ...........  ...........  ...........  ...........  ...........
                             & graft.
    33766  C                Major vessel shunt.  ...........  ...........  ...........  ...........  ...........
    33767  C                Major vessel shunt.  ...........  ...........  ...........  ...........  ...........
    33770  C                Repair great         ...........  ...........  ...........  ...........  ...........
                             vessels defect.
    33771  C                Repair great         ...........  ...........  ...........  ...........  ...........
                             vessels defect.
    33774  C                Repair great         ...........  ...........  ...........  ...........  ...........
                             vessels defect.
    33775  C                Repair great         ...........  ...........  ...........  ...........  ...........
                             vessels defect.
    33776  C                Repair great         ...........  ...........  ...........  ...........  ...........
                             vessels defect.
    33777  C                Repair great         ...........  ...........  ...........  ...........  ...........
                             vessels defect.
    33778  C                Repair great         ...........  ...........  ...........  ...........  ...........
                             vessels defect.
    33779  C                Repair great         ...........  ...........  ...........  ...........  ...........
                             vessels defect.
    33780  C                Repair great         ...........  ...........  ...........  ...........  ...........
                             vessels defect.
    33781  C                Repair great         ...........  ...........  ...........  ...........  ...........
                             vessels defect.
    33786  C                Repair arterial      ...........  ...........  ...........  ...........  ...........
                             trunk.
    33788  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             pulmonary artery.
    33800  C                Aortic suspension..  ...........  ...........  ...........  ...........  ...........
    33802  C                Repair vessel        ...........  ...........  ...........  ...........  ...........
                             defect.
    33803  C                Repair vessel        ...........  ...........  ...........  ...........  ...........
                             defect.
    33813  C                Repair septal        ...........  ...........  ...........  ...........  ...........
                             defect.
    33814  C                Repair septal        ...........  ...........  ...........  ...........  ...........
                             defect.
    33820  C                Revise major vessel  ...........  ...........  ...........  ...........  ...........
    33822  C                Revise major vessel  ...........  ...........  ...........  ...........  ...........
    33824  C                Revise major vessel  ...........  ...........  ...........  ...........  ...........
    33840  C                Remove aorta         ...........  ...........  ...........  ...........  ...........
                             constriction.
    33845  C                Remove aorta         ...........  ...........  ...........  ...........  ...........
                             constriction.
    33851  C                Remove aorta         ...........  ...........  ...........  ...........  ...........
                             constriction.

[[Page 67874]]

 
    33852  C                Repair septal        ...........  ...........  ...........  ...........  ...........
                             defect.
    33853  C                Repair septal        ...........  ...........  ...........  ...........  ...........
                             defect.
    33860  C                Ascending aortic     ...........  ...........  ...........  ...........  ...........
                             graft.
    33861  C                Ascending aortic     ...........  ...........  ...........  ...........  ...........
                             graft.
    33863  C                Ascending aortic     ...........  ...........  ...........  ...........  ...........
                             graft.
    33870  C                Transverse aortic    ...........  ...........  ...........  ...........  ...........
                             arch graft.
    33875  C                Thoracic aortic      ...........  ...........  ...........  ...........  ...........
                             graft.
    33877  C                Thoracoabdominal     ...........  ...........  ...........  ...........  ...........
                             graft.
    33910  C                Remove lung artery   ...........  ...........  ...........  ...........  ...........
                             emboli.
    33915  C                Remove lung artery   ...........  ...........  ...........  ...........  ...........
                             emboli.
    33916  C                Surgery of great     ...........  ...........  ...........  ...........  ...........
                             vessel.
    33917  C                Repair pulmonary     ...........  ...........  ...........  ...........  ...........
                             artery.
    33918  C                Repair pulmonary     ...........  ...........  ...........  ...........  ...........
                             atresia.
    33919  C                Repair pulmonary     ...........  ...........  ...........  ...........  ...........
                             atresia.
    33920  C                Repair pulmonary     ...........  ...........  ...........  ...........  ...........
                             atresia.
    33922  C                Transect pulmonary   ...........  ...........  ...........  ...........  ...........
                             artery.
    33924  C                Remove pulmonary     ...........  ...........  ...........  ...........  ...........
                             shunt.
    33930  C                Removal of donor     ...........  ...........  ...........  ...........  ...........
                             heart/lung.
    33935  C                Transplantation,     ...........  ...........  ...........  ...........  ...........
                             heart/lung.
    33940  C                Removal of donor     ...........  ...........  ...........  ...........  ...........
                             heart.
    33945  C                Transplantation of   ...........  ...........  ...........  ...........  ...........
                             heart.
    33960  C                External             ...........  ...........  ...........  ...........  ...........
                             circulation assist.
    33961  C                External             ...........  ...........  ...........  ...........  ...........
                             circulation assist.
    33968  C                Remove aortic        ...........  ...........  ...........  ...........  ...........
                             assist device.
    33970  C                Aortic circulation   ...........  ...........  ...........  ...........  ...........
                             assist.
    33971  C                Aortic circulation   ...........  ...........  ...........  ...........  ...........
                             assist.
    33973  C                Insert balloon       ...........  ...........  ...........  ...........  ...........
                             device.
    33974  C                Remove intra-aortic  ...........  ...........  ...........  ...........  ...........
                             balloon.
    33975  C                Implant ventricular  ...........  ...........  ...........  ...........  ...........
                             device.
    33976  C                Implant ventricular  ...........  ...........  ...........  ...........  ...........
                             device.
    33977  C                Remove ventricular   ...........  ...........  ...........  ...........  ...........
                             device.
    33978  C                Remove ventricular   ...........  ...........  ...........  ...........  ...........
                             device.
    33999  T                Cardiac surgery             0070         3.64      $180.53       $79.60       $36.11
                             procedure.
    34001  C                Removal of artery    ...........  ...........  ...........  ...........  ...........
                             clot.
    34051  C                Removal of artery    ...........  ...........  ...........  ...........  ...........
                             clot.
    34101  T                Removal of artery           0088        26.49    $1,313.80      $678.68      $262.76
                             clot.
    34111  T                Removal of arm              0088        26.49    $1,313.80      $678.68      $262.76
                             artery clot.
    34151  C                Removal of artery    ...........  ...........  ...........  ...........  ...........
                             clot.
    34201  T                Removal of artery           0088        26.49    $1,313.80      $678.68      $262.76
                             clot.
    34203  T                Removal of leg              0088        26.49    $1,313.80      $678.68      $262.76
                             artery clot.
    34401  C                Removal of vein      ...........  ...........  ...........  ...........  ...........
                             clot.
    34421  T                Removal of vein             0088        26.49    $1,313.80      $678.68      $262.76
                             clot.
    34451  C                Removal of vein      ...........  ...........  ...........  ...........  ...........
                             clot.
    34471  T                Removal of vein             0088        26.49    $1,313.80      $678.68      $262.76
                             clot.
    34490  T                Removal of vein             0088        26.49    $1,313.80      $678.68      $262.76
                             clot.
    34501  T                Repair valve,               0088        26.49    $1,313.80      $678.68      $262.76
                             femoral vein.
    34502  C                Reconstruct vena     ...........  ...........  ...........  ...........  ...........
                             cava.
    34510  T                Transposition of            0088        26.49    $1,313.80      $678.68      $262.76
                             vein valve.
    34520  T                Cross-over vein             0088        26.49    $1,313.80      $678.68      $262.76
                             graft.
    34530  T                Leg vein fusion....         0088        26.49    $1,313.80      $678.68      $262.76
   *34800  C                Endovasc abdo        ...........  ...........  ...........  ...........  ...........
                             repair w/tube.
   *34802  C                Endovasc abdo repr   ...........  ...........  ...........  ...........  ...........
                             w/device.
   *34804  C                Endovasc abdo repr   ...........  ...........  ...........  ...........  ...........
                             w/device.
   *34808  C                Endovasc abdo        ...........  ...........  ...........  ...........  ...........
                             occlud device.
   *34812  C                xpose for            ...........  ...........  ...........  ...........  ...........
                             endoprosth, aortic.
   *34813  C                xpose for            ...........  ...........  ...........  ...........  ...........
                             endoprosth,
                             femoral.
   *34820  C                xpose for            ...........  ...........  ...........  ...........  ...........
                             endoprosth, iliac.
   *34825  C                endovasc extend      ...........  ...........  ...........  ...........  ...........
                             prosth, init.
   *34826  C                endovasc extend      ...........  ...........  ...........  ...........  ...........
                             prosth,addl.
   *34830  C                open aortic tube     ...........  ...........  ...........  ...........  ...........
                             prosth repr.
   *34831  C                open aortoiliac      ...........  ...........  ...........  ...........  ...........
                             prosth repr.
   *34832  C                open aortofemor      ...........  ...........  ...........  ...........  ...........
                             prosth repr.
    35001  C                Repair defect of     ...........  ...........  ...........  ...........  ...........
                             artery.
    35002  C                Repair artery        ...........  ...........  ...........  ...........  ...........
                             rupture, neck.
    35005  C                Repair defect of     ...........  ...........  ...........  ...........  ...........
                             artery.
    35011  T                Repair defect of            0093        12.82      $635.82      $277.34      $127.16
                             artery.
    35013  C                Repair artery        ...........  ...........  ...........  ...........  ...........
                             rupture, arm.
    35021  C                Repair defect of     ...........  ...........  ...........  ...........  ...........
                             artery.
    35022  C                Repair artery        ...........  ...........  ...........  ...........  ...........
                             rupture, chest.
    35045  C                Repair defect of     ...........  ...........  ...........  ...........  ...........
                             arm artery.
    35081  C                Repair defect of     ...........  ...........  ...........  ...........  ...........
                             artery.
    35082  C                Repair artery        ...........  ...........  ...........  ...........  ...........
                             rupture, aorta.
    35091  C                Repair defect of     ...........  ...........  ...........  ...........  ...........
                             artery.
    35092  C                Repair artery        ...........  ...........  ...........  ...........  ...........
                             rupture, aorta.

[[Page 67875]]

 
    35102  C                Repair defect of     ...........  ...........  ...........  ...........  ...........
                             artery.
    35103  C                Repair artery        ...........  ...........  ...........  ...........  ...........
                             rupture, groin.
    35111  C                Repair defect of     ...........  ...........  ...........  ...........  ...........
                             artery.
    35112  C                Repair artery        ...........  ...........  ...........  ...........  ...........
                             rupture,spleen.
    35121  C                Repair defect of     ...........  ...........  ...........  ...........  ...........
                             artery.
    35122  C                Repair artery        ...........  ...........  ...........  ...........  ...........
                             rupture, belly.
    35131  C                Repair defect of     ...........  ...........  ...........  ...........  ...........
                             artery.
    35132  C                Repair artery        ...........  ...........  ...........  ...........  ...........
                             rupture, groin.
    35141  C                Repair defect of     ...........  ...........  ...........  ...........  ...........
                             artery.
    35142  C                Repair artery        ...........  ...........  ...........  ...........  ...........
                             rupture, thigh.
    35151  C                Repair defect of     ...........  ...........  ...........  ...........  ...........
                             artery.
    35152  C                Repair artery        ...........  ...........  ...........  ...........  ...........
                             rupture, knee.
    35161  C                Repair defect of     ...........  ...........  ...........  ...........  ...........
                             artery.
    35162  C                Repair artery        ...........  ...........  ...........  ...........  ...........
                             rupture.
    35180  T                Repair blood vessel         0093        12.82      $635.82      $277.34      $127.16
                             lesion.
    35182  C                Repair blood vessel  ...........  ...........  ...........  ...........  ...........
                             lesion.
    35184  T                Repair blood vessel         0093        12.82      $635.82      $277.34      $127.16
                             lesion.
    35188  T                Repair blood vessel         0088        26.49    $1,313.80      $678.68      $262.76
                             lesion.
    35189  C                Repair blood vessel  ...........  ...........  ...........  ...........  ...........
                             lesion.
    35190  T                Repair blood vessel         0093        12.82      $635.82      $277.34      $127.16
                             lesion.
    35201  T                Repair blood vessel         0093        12.82      $635.82      $277.34      $127.16
                             lesion.
    35206  T                Repair blood vessel         0093        12.82      $635.82      $277.34      $127.16
                             lesion.
    35207  T                Repair blood vessel         0088        26.49    $1,313.80      $678.68      $262.76
                             lesion.
    35211  C                Repair blood vessel  ...........  ...........  ...........  ...........  ...........
                             lesion.
    35216  C                Repair blood vessel  ...........  ...........  ...........  ...........  ...........
                             lesion.
    35221  C                Repair blood vessel  ...........  ...........  ...........  ...........  ...........
                             lesion.
    35226  T                Repair blood vessel         0093        12.82      $635.82      $277.34      $127.16
                             lesion.
    35231  T                Repair blood vessel         0093        12.82      $635.82      $277.34      $127.16
                             lesion.
    35236  T                Repair blood vessel         0093        12.82      $635.82      $277.34      $127.16
                             lesion.
    35241  C                Repair blood vessel  ...........  ...........  ...........  ...........  ...........
                             lesion.
    35246  C                Repair blood vessel  ...........  ...........  ...........  ...........  ...........
                             lesion.
    35251  C                Repair blood vessel  ...........  ...........  ...........  ...........  ...........
                             lesion.
    35256  T                Repair blood vessel         0093        12.82      $635.82      $277.34      $127.16
                             lesion.
    35261  T                Repair blood vessel         0093        12.82      $635.82      $277.34      $127.16
                             lesion.
    35266  T                Repair blood vessel         0093        12.82      $635.82      $277.34      $127.16
                             lesion.
    35271  C                Repair blood vessel  ...........  ...........  ...........  ...........  ...........
                             lesion.
    35276  C                Repair blood vessel  ...........  ...........  ...........  ...........  ...........
                             lesion.
    35281  C                Repair blood vessel  ...........  ...........  ...........  ...........  ...........
                             lesion.
    35286  T                Repair blood vessel         0093        12.82      $635.82      $277.34      $127.16
                             lesion.
    35301  C                Rechanneling of      ...........  ...........  ...........  ...........  ...........
                             artery.
    35311  C                Rechanneling of      ...........  ...........  ...........  ...........  ...........
                             artery.
    35321  T                Rechanneling of             0093        12.82      $635.82      $277.34      $127.16
                             artery.
    35331  C                Rechanneling of      ...........  ...........  ...........  ...........  ...........
                             artery.
    35341  C                Rechanneling of      ...........  ...........  ...........  ...........  ...........
                             artery.
    35351  C                Rechanneling of      ...........  ...........  ...........  ...........  ...........
                             artery.
    35355  C                Rechanneling of      ...........  ...........  ...........  ...........  ...........
                             artery.
    35361  C                Rechanneling of      ...........  ...........  ...........  ...........  ...........
                             artery.
    35363  C                Rechanneling of      ...........  ...........  ...........  ...........  ...........
                             artery.
    35371  C                Rechanneling of      ...........  ...........  ...........  ...........  ...........
                             artery.
    35372  C                Rechanneling of      ...........  ...........  ...........  ...........  ...........
                             artery.
    35381  C                Rechanneling of      ...........  ...........  ...........  ...........  ...........
                             artery.
    35390  C                Reoperation,         ...........  ...........  ...........  ...........  ...........
                             carotid add-on.
    35400  C                Angioscopy.........  ...........  ...........  ...........  ...........  ...........
    35450  C                Repair arterial      ...........  ...........  ...........  ...........  ...........
                             blockage.
    35452  C                Repair arterial      ...........  ...........  ...........  ...........  ...........
                             blockage.
    35454  C                Repair arterial      ...........  ...........  ...........  ...........  ...........
                             blockage.
    35456  C                Repair arterial      ...........  ...........  ...........  ...........  ...........
                             blockage.
    35458  T                Repair arterial             0081        28.81    $1,428.86      $710.91      $285.77
                             blockage.
    35459  T                Repair arterial             0081        28.81    $1,428.86      $710.91      $285.77
                             blockage.
    35460  T                Repair venous               0081        28.81    $1,428.86      $710.91      $285.77
                             blockage.
    35470  T                Repair arterial             0081        28.81    $1,428.86      $710.91      $285.77
                             blockage.
    35471  T                Repair arterial             0081        28.81    $1,428.86      $710.91      $285.77
                             blockage.
    35472  T                Repair arterial             0081        28.81    $1,428.86      $710.91      $285.77
                             blockage.
    35473  T                Repair arterial             0081        28.81    $1,428.86      $710.91      $285.77
                             blockage.
    35474  T                Repair arterial             0081        28.81    $1,428.86      $710.91      $285.77
                             blockage.
    35475  T                Repair arterial             0081        28.81    $1,428.86      $710.91      $285.77
                             blockage.
    35476  T                Repair venous               0081        28.81    $1,428.86      $710.91      $285.77
                             blockage.
    35480  C                Atherectomy, open..  ...........  ...........  ...........  ...........  ...........
    35481  T                Atherectomy, open..         0081        28.81    $1,428.86      $710.91      $285.77
    35482  C                Atherectomy, open..  ...........  ...........  ...........  ...........  ...........
    35483  C                Atherectomy, open..  ...........  ...........  ...........  ...........  ...........
    35484  T                Atherectomy, open..         0081        28.81    $1,428.86      $710.91      $285.77
    35485  T                Atherectomy, open..         0081        28.81    $1,428.86      $710.91      $285.77
    35490  T                Atherectomy,                0081        28.81    $1,428.86      $710.91      $285.77
                             percutaneous.

[[Page 67876]]

 
    35491  T                Atherectomy,                0081        28.81    $1,428.86      $710.91      $285.77
                             percutaneous.
    35492  T                Atherectomy,                0081        28.81    $1,428.86      $710.91      $285.77
                             percutaneous.
    35493  T                Atherectomy,                0081        28.81    $1,428.86      $710.91      $285.77
                             percutaneous.
    35494  T                Atherectomy,                0081        28.81    $1,428.86      $710.91      $285.77
                             percutaneous.
    35495  T                Atherectomy,                0081        28.81    $1,428.86      $710.91      $285.77
                             percutaneous.
    35500  T                Harvest vein for            0091        14.79      $733.52      $348.23      $146.70
                             bypass.
    35501  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35506  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35507  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35508  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35509  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35511  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35515  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35516  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35518  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35521  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35526  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35531  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35533  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35536  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35541  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35546  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35548  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35549  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35551  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35556  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35558  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35560  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35563  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35565  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35566  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35571  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35582  C                Vein bypass graft..  ...........  ...........  ...........  ...........  ...........
    35583  C                Vein bypass graft..  ...........  ...........  ...........  ...........  ...........
    35585  C                Vein bypass graft..  ...........  ...........  ...........  ...........  ...........
    35587  C                Vein bypass graft..  ...........  ...........  ...........  ...........  ...........
   *35600  C                Harvest artery for   ...........  ...........  ...........  ...........  ...........
                             CABG.
    35601  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35606  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35612  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35616  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35621  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35623  C                Bypass graft, not    ...........  ...........  ...........  ...........  ...........
                             vein.
    35626  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35631  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35636  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35641  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35642  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35645  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35646  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35650  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35651  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35654  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35656  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35661  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35663  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35665  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35666  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35671  C                Artery bypass graft  ...........  ...........  ...........  ...........  ...........
    35681  C                Composite bypass     ...........  ...........  ...........  ...........  ...........
                             graft.
    35682  C                Composite bypass     ...........  ...........  ...........  ...........  ...........
                             graft.
    35683  C                Composite bypass     ...........  ...........  ...........  ...........  ...........
                             graft.
    35691  C                Arterial             ...........  ...........  ...........  ...........  ...........
                             transposition.
    35693  C                Arterial             ...........  ...........  ...........  ...........  ...........
                             transposition.
    35694  C                Arterial             ...........  ...........  ...........  ...........  ...........
                             transposition.
    35695  C                Arterial             ...........  ...........  ...........  ...........  ...........
                             transposition.
    35700  C                Reoperation, bypass  ...........  ...........  ...........  ...........  ...........
                             graft.
    35701  C                Exploration,         ...........  ...........  ...........  ...........  ...........
                             carotid artery.
    35721  C                Exploration,         ...........  ...........  ...........  ...........  ...........
                             femoral artery.
    35741  C                Exploration          ...........  ...........  ...........  ...........  ...........
                             popliteal artery.
    35761  T                Exploration of              0115        19.34      $959.19      $506.74      $191.84
                             artery/vein.
    35800  C                Explore neck         ...........  ...........  ...........  ...........  ...........
                             vessels.
    35820  C                Explore chest        ...........  ...........  ...........  ...........  ...........
                             vessels.
    35840  C                Explore abdominal    ...........  ...........  ...........  ...........  ...........
                             vessels.

[[Page 67877]]

 
    35860  T                Explore limb                0115        19.34      $959.19      $506.74      $191.84
                             vessels.
    35870  C                Repair vessel graft  ...........  ...........  ...........  ...........  ...........
                             defect.
    35875  T                Removal of clot in          0088        26.49    $1,313.80      $678.68      $262.76
                             graft.
    35876  T                Removal of clot in          0088        26.49    $1,313.80      $678.68      $262.76
                             graft.
    35879  T                Revise graft w/vein         0088        26.49    $1,313.80      $678.68      $262.76
    35881  T                Revise graft w/vein         0088        26.49    $1,313.80      $678.68      $262.76
    35901  C                Excision, graft,     ...........  ...........  ...........  ...........  ...........
                             neck.
    35903  T                Excision, graft,            0115        19.34      $959.19      $506.74      $191.84
                             extremity.
    35905  C                Excision, graft,     ...........  ...........  ...........  ...........  ...........
                             thorax.
    35907  C                Excision, graft,     ...........  ...........  ...........  ...........  ...........
                             abdomen.
    36000  N                Place needle in      ...........  ...........  ...........  ...........  ...........
                             vein.
    36005  N                Injection,           ...........  ...........  ...........  ...........  ...........
                             venography.
    36010  N                Place catheter in    ...........  ...........  ...........  ...........  ...........
                             vein.
    36011  N                Place catheter in    ...........  ...........  ...........  ...........  ...........
                             vein.
    36012  N                Place catheter in    ...........  ...........  ...........  ...........  ...........
                             vein.
    36013  N                Place catheter in    ...........  ...........  ...........  ...........  ...........
                             artery.
    36014  N                Place catheter in    ...........  ...........  ...........  ...........  ...........
                             artery.
    36015  N                Place catheter in    ...........  ...........  ...........  ...........  ...........
                             artery.
    36100  N                Establish access to  ...........  ...........  ...........  ...........  ...........
                             artery.
    36120  N                Establish access to  ...........  ...........  ...........  ...........  ...........
                             artery.
    36140  N                Establish access to  ...........  ...........  ...........  ...........  ...........
                             artery.
    36145  N                Artery to vein       ...........  ...........  ...........  ...........  ...........
                             shunt.
    36160  N                Establish access to  ...........  ...........  ...........  ...........  ...........
                             aorta.
    36200  N                Place catheter in    ...........  ...........  ...........  ...........  ...........
                             aorta.
    36215  N                Place catheter in    ...........  ...........  ...........  ...........  ...........
                             artery.
    36216  N                Place catheter in    ...........  ...........  ...........  ...........  ...........
                             artery.
    36217  N                Place catheter in    ...........  ...........  ...........  ...........  ...........
                             artery.
    36218  N                Place catheter in    ...........  ...........  ...........  ...........  ...........
                             artery.
    36245  N                Place catheter in    ...........  ...........  ...........  ...........  ...........
                             artery.
    36246  N                Place catheter in    ...........  ...........  ...........  ...........  ...........
                             artery.
    36247  N                Place catheter in    ...........  ...........  ...........  ...........  ...........
                             artery.
    36248  N                Place catheter in    ...........  ...........  ...........  ...........  ...........
                             artery.
    36260  T                Insertion of                0119         9.87      $489.59      $161.50       $97.92
                             infusion pump.
    36261  T                Revision of                 0124         2.55      $126.64       $81.36       $25.33
                             infusion pump.
    36262  T                Removal of infusion         0109         6.53      $323.86      $133.51       $64.77
                             pump.
    36299  T                Vessel injection            0089        78.45    $3,890.81    $2,275.19      $778.16
                             procedure.
    36400  N                Drawing blood......  ...........  ...........  ...........  ...........  ...........
    36405  N                Drawing blood......  ...........  ...........  ...........  ...........  ...........
    36406  N                Drawing blood......  ...........  ...........  ...........  ...........  ...........
    36410  N                Drawing blood......  ...........  ...........  ...........  ...........  ...........
    36415  E                Drawing blood......  ...........  ...........  ...........  ...........  ...........
    36420  T                Establish access to         0032         5.40      $267.82      $119.52       $53.56
                             vein.
    36425  T                Establish access to         0032         5.40      $267.82      $119.52       $53.56
                             vein.
    36430  S                Blood transfusion           0110         5.83      $289.15      $122.73       $57.83
                             service.
    36440  S                Blood transfusion           0110         5.83      $289.15      $122.73       $57.83
                             service.
    36450  S                Exchange                    0110         5.83      $289.15      $122.73       $57.83
                             transfusion
                             service.
    36455  S                Exchange                    0110         5.83      $289.15      $122.73       $57.83
                             transfusion
                             service.
    36460  S                Transfusion                 0110         5.83      $289.15      $122.73       $57.83
                             service, fetal.
    36468  T                Injection(s),               0098         1.19       $59.02       $20.88       $11.80
                             spider veins.
    36469  T                Injection(s),               0098         1.19       $59.02       $20.88       $11.80
                             spider veins.
    36470  T                Injection therapy           0098         1.19       $59.02       $20.88       $11.80
                             of vein.
    36471  T                Injection therapy           0098         1.19       $59.02       $20.88       $11.80
                             of veins.
    36481  N                Insertion of         ...........  ...........  ...........  ...........  ...........
                             catheter, vein.
    36488  T                Insertion of                0032         5.40      $267.82      $119.52       $53.56
                             catheter, vein.
    36489  T                Insertion of                0032         5.40      $267.82      $119.52       $53.56
                             catheter, vein.
    36490  T                Insertion of                0032         5.40      $267.82      $119.52       $53.56
                             catheter, vein.
    36491  T                Insertion of                0032         5.40      $267.82      $119.52       $53.56
                             catheter, vein.
    36493  T                Repositioning of            0032         5.40      $267.82      $119.52       $53.56
                             cvc.
    36500  N                Insertion of         ...........  ...........  ...........  ...........  ...........
                             catheter, vein.
    36510  C                Insertion of         ...........  ...........  ...........  ...........  ...........
                             catheter, vein.
    36520  S                Plasma and/or cell          0111        14.17      $702.77      $300.74      $140.55
                             exchange.
    36521  S                Apheresis w/ adsorp/        0111        14.17      $702.77      $300.74      $140.55
                             reinfuse.
    36522  S                Photopheresis......         0112        39.60    $1,964.01      $663.65      $392.80
    36530  T                Insertion of                0119         9.87      $489.59      $161.50       $97.92
                             infusion pump.
    36531  T                Revision of                 0124         2.55      $126.64       $81.36       $25.33
                             infusion pump.
    36532  T                Removal of infusion         0109         6.53      $323.86      $133.51       $64.77
                             pump.
    36533  T                Insertion of access         0115        19.34      $959.19      $506.74      $191.84
                             device.
    36534  T                Revision of access          0103        13.09      $649.21      $295.70      $129.84
                             device.
    36535  T                Removal of access           0109         6.53      $323.86      $133.51       $64.77
                             device.
   *36540  N                Collect blood        ...........  ...........  ...........  ...........  ...........
                             venous device.
    36550  T                Declot vascular             0970         0.52       $25.79  ...........        $5.16
                             device.
    36600  N                Withdrawal of        ...........  ...........  ...........  ...........  ...........
                             arterial blood.
    36620  N                Insertion catheter,  ...........  ...........  ...........  ...........  ...........
                             artery.
    36625  N                Insertion catheter,  ...........  ...........  ...........  ...........  ...........
                             artery.

[[Page 67878]]

 
    36640  T                Insertion catheter,         0032         5.40      $267.82      $119.52       $53.56
                             artery.
    36660  C                Insertion catheter,  ...........  ...........  ...........  ...........  ...........
                             artery.
    36680  T                Insert needle, bone         0120         1.66       $82.33       $42.67       $16.47
                             cavity.
    36800  T                Insertion of                0115        19.34      $959.19      $506.74      $191.84
                             cannula.
    36810  T                Insertion of                0115        19.34      $959.19      $506.74      $191.84
                             cannula.
    36815  T                Insertion of                0115        19.34      $959.19      $506.74      $191.84
                             cannula.
    36819  T                Av fusion by                0093        12.82      $635.82      $277.34      $127.16
                             basilic vein.
    36821  T                Av fusion direct            0088        26.49    $1,313.80      $678.68      $262.76
                             any site.
    36822  C                Insertion of         ...........  ...........  ...........  ...........  ...........
                             cannula(s).
    36823  C                Insertion of         ...........  ...........  ...........  ...........  ...........
                             cannula(s).
    36825  T                Artery-vein graft..         0088        26.49    $1,313.80      $678.68      $262.76
    36830  T                Artery-vein graft..         0088        26.49    $1,313.80      $678.68      $262.76
    36831  T                Av fistula excision         0088        26.49    $1,313.80      $678.68      $262.76
    36832  T                Av fistula revision         0088        26.49    $1,313.80      $678.68      $262.76
    36833  T                Av fistula revision         0088        26.49    $1,313.80      $678.68      $262.76
    36834  T                Repair A-V aneurysm         0093        12.82      $635.82      $277.34      $127.16
    36835  T                Artery to vein              0115        19.34      $959.19      $506.74      $191.84
                             shunt.
    36860  T                External cannula            0115        19.34      $959.19      $506.74      $191.84
                             declotting.
    36861  T                Cannula declotting.         0115        19.34      $959.19      $506.74      $191.84
   *36870  T                AV fistula                  0093        12.82      $635.82      $277.34      $127.16
                             revision, open.
    37140  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             circulation.
    37145  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             circulation.
    37160  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             circulation.
    37180  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             circulation.
    37181  C                Splice spleen/       ...........  ...........  ...........  ...........  ...........
                             kidney veins.
    37195  C                Thrombolytic         ...........  ...........  ...........  ...........  ...........
                             therapy, stroke.
    37200  T                Transcatheter               0005         5.41      $268.32      $119.75       $53.66
                             biopsy.
    37201  T                Transcatheter               0120         1.66       $82.33       $42.67       $16.47
                             therapy infuse.
    37202  T                Transcatheter               0120         1.66       $82.33       $42.67       $16.47
                             therapy infuse.
    37203  T                Transcatheter               0103        13.09      $649.21      $295.70      $129.84
                             retrieval.
    37204  T                Transcatheter               0103        13.09      $649.21      $295.70      $129.84
                             occlusion.
    37205  T                Transcatheter stent         0229        34.81    $1,726.44    $1,030.12      $345.29
    37206  T                Transcatheter stent         0229        34.81    $1,726.44    $1,030.12      $345.29
                             add-on.
    37207  T                Transcatheter stent         0229        34.81    $1,726.44    $1,030.12      $345.29
    37208  T                Transcatheter stent         0229        34.81    $1,726.44    $1,030.12      $345.29
                             add-on.
    37209  T                Exchange arterial           0103        13.09      $649.21      $295.70      $129.84
                             catheter.
    37250  T                Iv us first vessel          0103        13.09      $649.21      $295.70      $129.84
                             add-on.
    37251  T                Iv us each add              0103        13.09      $649.21      $295.70      $129.84
                             vessel add-on.
    37565  T                Ligation of neck            0093        12.82      $635.82      $277.34      $127.16
                             vein.
    37600  T                Ligation of neck            0093        12.82      $635.82      $277.34      $127.16
                             artery.
    37605  T                Ligation of neck            0091        14.79      $733.52      $348.23      $146.70
                             artery.
    37606  T                Ligation of neck            0091        14.79      $733.52      $348.23      $146.70
                             artery.
    37607  T                Ligation of a-v             0092        20.21    $1,002.34      $505.37      $200.47
                             fistula.
    37609  T                Temporal artery             0020         6.51      $322.87      $130.53       $64.57
                             procedure.
    37615  T                Ligation of neck            0091        14.79      $733.52      $348.23      $146.70
                             artery.
    37616  C                Ligation of chest    ...........  ...........  ...........  ...........  ...........
                             artery.
    37617  C                Ligation of abdomen  ...........  ...........  ...........  ...........  ...........
                             artery.
    37618  C                Ligation of          ...........  ...........  ...........  ...........  ...........
                             extremity artery.
    37620  T                Revision of major           0091        14.79      $733.52      $348.23      $146.70
                             vein.
    37650  T                Revision of major           0091        14.79      $733.52      $348.23      $146.70
                             vein.
    37660  C                Revision of major    ...........  ...........  ...........  ...........  ...........
                             vein.
    37700  T                Revise leg vein....         0091        14.79      $733.52      $348.23      $146.70
    37720  T                Removal of leg vein         0092        20.21    $1,002.34      $505.37      $200.47
    37730  T                Removal of leg              0092        20.21    $1,002.34      $505.37      $200.47
                             veins.
    37735  T                Removal of leg              0092        20.21    $1,002.34      $505.37      $200.47
                             veins/lesion.
    37760  T                Revision of leg             0091        14.79      $733.52      $348.23      $146.70
                             veins.
    37780  T                Revision of leg             0091        14.79      $733.52      $348.23      $146.70
                             vein.
    37785  T                Revise secondary            0091        14.79      $733.52      $348.23      $146.70
                             varicosity.
    37788  C                Revascularization,   ...........  ...........  ...........  ...........  ...........
                             penis.
    37790  T                Penile venous               0181        32.37    $1,605.43      $906.36      $321.09
                             occlusion.
    37799  T                Vascular surgery            0020         6.51      $322.87      $130.53       $64.57
                             procedure.
    38100  C                Removal of spleen,   ...........  ...........  ...........  ...........  ...........
                             total.
    38101  C                Removal of spleen,   ...........  ...........  ...........  ...........  ...........
                             partial.
    38102  C                Removal of spleen,   ...........  ...........  ...........  ...........  ...........
                             total.
    38115  C                Repair of ruptured   ...........  ...........  ...........  ...........  ...........
                             spleen.
    38120  T                Laparoscopy,                0131        41.81    $2,073.61    $1,089.88      $414.72
                             splenectomy.
    38129  T                Laparoscope proc,           0130        25.36    $1,257.75      $659.53      $251.55
                             spleen.
    38200  N                Injection for        ...........  ...........  ...........  ...........  ...........
                             spleen x-ray.
    38230  S                Bone marrow                 0123         4.13      $204.83       $40.97       $40.97
                             collection.
    38231  S                Stem cell                   0111        14.17      $702.77      $300.74      $140.55
                             collection.
    38240  S                Bone marrow/stem            0123         4.13      $204.83       $40.97       $40.97
                             transplant.
    38241  S                Bone marrow/stem            0123         4.13      $204.83       $40.97       $40.97
                             transplant.
    38300  T                Drainage, lymph             0008         6.15      $305.02      $113.67       $61.00
                             node lesion.
    38305  T                Drainage, lymph             0008         6.15      $305.02      $113.67       $61.00
                             node lesion.

[[Page 67879]]

 
    38308  T                Incision of lymph           0113        13.89      $688.89      $326.55      $137.78
                             channels.
    38380  C                Thoracic duct        ...........  ...........  ...........  ...........  ...........
                             procedure.
    38381  C                Thoracic duct        ...........  ...........  ...........  ...........  ...........
                             procedure.
    38382  C                Thoracic duct        ...........  ...........  ...........  ...........  ...........
                             procedure.
    38500  T                Biopsy/removal,             0113        13.89      $688.89      $326.55      $137.78
                             lymph nodes.
    38505  T                Needle biopsy,              0005         5.41      $268.32      $119.75       $53.66
                             lymph nodes.
    38510  T                Biopsy/removal,             0113        13.89      $688.89      $326.55      $137.78
                             lymph nodes.
    38520  T                Biopsy/removal,             0113        13.89      $688.89      $326.55      $137.78
                             lymph nodes.
    38525  T                Biopsy/removal,             0113        13.89      $688.89      $326.55      $137.78
                             lymph nodes.
    38530  T                Biopsy/removal,             0113        13.89      $688.89      $326.55      $137.78
                             lymph nodes.
    38542  T                Explore deep                0114        19.56      $970.10      $493.78      $194.02
                             node(s), neck.
    38550  T                Removal, neck/              0113        13.89      $688.89      $326.55      $137.78
                             armpit lesion.
    38555  T                Removal, neck/              0114        19.56      $970.10      $493.78      $194.02
                             armpit lesion.
    38562  C                Removal, pelvic      ...........  ...........  ...........  ...........  ...........
                             lymph nodes.
    38564  C                Removal, abdomen     ...........  ...........  ...........  ...........  ...........
                             lymph nodes.
    38570  T                Laparoscopy, lymph          0131        41.81    $2,073.61    $1,089.88      $414.72
                             node biop.
    38571  T                Laparoscopy,                0132        48.91    $2,425.74    $1,239.22      $485.15
                             lymphadenectomy.
    38572  T                Laparoscopy,                0131        41.81    $2,073.61    $1,089.88      $414.72
                             lymphadenectomy.
    38589  T                Laparoscope proc,           0130        25.36    $1,257.75      $659.53      $251.55
                             lymphatic.
    38700  C                Removal of lymph     ...........  ...........  ...........  ...........  ...........
                             nodes, neck.
    38720  T                Removal of lymph            0114        19.56      $970.10      $493.78      $194.02
                             nodes, neck.
    38724  C                Removal of lymph     ...........  ...........  ...........  ...........  ...........
                             nodes, neck.
    38740  T                Remove armpit lymph         0114        19.56      $970.10      $493.78      $194.02
                             nodes.
    38745  T                Remove armpit lymph         0114        19.56      $970.10      $493.78      $194.02
                             nodes.
    38746  C                Remove thoracic      ...........  ...........  ...........  ...........  ...........
                             lymph nodes.
    38747  C                Remove abdominal     ...........  ...........  ...........  ...........  ...........
                             lymph nodes.
    38760  T                Remove groin lymph          0114        19.56      $970.10      $493.78      $194.02
                             nodes.
    38765  C                Remove groin lymph   ...........  ...........  ...........  ...........  ...........
                             nodes.
    38770  C                Remove pelvis lymph  ...........  ...........  ...........  ...........  ...........
                             nodes.
    38780  C                Remove abdomen       ...........  ...........  ...........  ...........  ...........
                             lymph nodes.
    38790  N                Inject for           ...........  ...........  ...........  ...........  ...........
                             lymphatic x-ray.
    38792  N                Identify sentinel    ...........  ...........  ...........  ...........  ...........
                             node.
    38794  N                Access thoracic      ...........  ...........  ...........  ...........  ...........
                             lymph duct.
    38999  T                Blood/lymph system          0008         6.15      $305.02      $113.67       $61.00
                             procedure.
    39000  C                Exploration of       ...........  ...........  ...........  ...........  ...........
                             chest.
    39010  C                Exploration of       ...........  ...........  ...........  ...........  ...........
                             chest.
    39200  C                Removal chest        ...........  ...........  ...........  ...........  ...........
                             lesion.
    39220  C                Removal chest        ...........  ...........  ...........  ...........  ...........
                             lesion.
    39400  T                Visualization of            0076         8.06      $399.75      $197.05       $79.95
                             chest.
    39499  C                Chest procedure....  ...........  ...........  ...........  ...........  ...........
    39501  C                Repair diaphragm     ...........  ...........  ...........  ...........  ...........
                             laceration.
    39502  C                Repair               ...........  ...........  ...........  ...........  ...........
                             paraesophageal
                             hernia.
    39503  C                Repair of diaphragm  ...........  ...........  ...........  ...........  ...........
                             hernia.
    39520  C                Repair of diaphragm  ...........  ...........  ...........  ...........  ...........
                             hernia.
    39530  C                Repair of diaphragm  ...........  ...........  ...........  ...........  ...........
                             hernia.
    39531  C                Repair of diaphragm  ...........  ...........  ...........  ...........  ...........
                             hernia.
    39540  C                Repair of diaphragm  ...........  ...........  ...........  ...........  ...........
                             hernia.
    39541  C                Repair of diaphragm  ...........  ...........  ...........  ...........  ...........
                             hernia.
    39545  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             diaphragm.
    39560  C                Resect diaphragm,    ...........  ...........  ...........  ...........  ...........
                             simple.
    39561  C                Resect diaphragm,    ...........  ...........  ...........  ...........  ...........
                             complex.
    39599  C                Diaphragm surgery    ...........  ...........  ...........  ...........  ...........
                             procedure.
    40490  T                Biopsy of lip......         0252         5.18      $256.90      $114.24       $51.38
    40500  T                Partial excision of         0253        12.02      $596.14      $284.00      $119.23
                             lip.
    40510  T                Partial excision of         0254        12.45      $617.47      $272.41      $123.49
                             lip.
    40520  T                Partial excision of         0253        12.02      $596.14      $284.00      $119.23
                             lip.
    40525  T                Reconstruct lip             0254        12.45      $617.47      $272.41      $123.49
                             with flap.
    40527  T                Reconstruct lip             0254        12.45      $617.47      $272.41      $123.49
                             with flap.
    40530  T                Partial removal of          0254        12.45      $617.47      $272.41      $123.49
                             lip.
    40650  T                Repair lip.........         0253        12.02      $596.14      $284.00      $119.23
    40652  T                Repair lip.........         0253        12.02      $596.14      $284.00      $119.23
    40654  T                Repair lip.........         0254        12.45      $617.47      $272.41      $123.49
    40700  T                Repair cleft lip/           0256        25.40    $1,259.74      $623.05      $251.95
                             nasal.
    40701  T                Repair cleft lip/           0256        25.40    $1,259.74      $623.05      $251.95
                             nasal.
    40702  T                Repair cleft lip/           0256        25.40    $1,259.74      $623.05      $251.95
                             nasal.
    40720  T                Repair cleft lip/           0256        25.40    $1,259.74      $623.05      $251.95
                             nasal.
    40761  T                Repair cleft lip/           0256        25.40    $1,259.74      $623.05      $251.95
                             nasal.
    40799  T                Lip surgery                 0253        12.02      $596.14      $284.00      $119.23
                             procedure.
    40800  T                Drainage of mouth           0251         1.68       $83.32       $27.99       $16.66
                             lesion.
    40801  T                Drainage of mouth           0252         5.18      $256.90      $114.24       $51.38
                             lesion.
    40804  T                Removal, foreign            0251         1.68       $83.32       $27.99       $16.66
                             body, mouth.
    40805  T                Removal, foreign            0252         5.18      $256.90      $114.24       $51.38
                             body, mouth.
    40806  T                Incision of lip             0251         1.68       $83.32       $27.99       $16.66
                             fold.
    40808  T                Biopsy of mouth             0251         1.68       $83.32       $27.99       $16.66
                             lesion.

[[Page 67880]]

 
    40810  T                Excision of mouth           0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    40812  T                Excise/repair mouth         0252         5.18      $256.90      $114.24       $51.38
                             lesion.
    40814  T                Excise/repair mouth         0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    40816  T                Excision of mouth           0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    40818  T                Excise oral mucosa          0251         1.68       $83.32       $27.99       $16.66
                             for graft.
    40819  T                Excise lip or cheek         0252         5.18      $256.90      $114.24       $51.38
                             fold.
    40820  T                Treatment of mouth          0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    40830  T                Repair mouth                0251         1.68       $83.32       $27.99       $16.66
                             laceration.
    40831  T                Repair mouth                0253        12.02      $596.14      $284.00      $119.23
                             laceration.
    40840  T                Reconstruction of           0254        12.45      $617.47      $272.41      $123.49
                             mouth.
    40842  T                Reconstruction of           0254        12.45      $617.47      $272.41      $123.49
                             mouth.
    40843  T                Reconstruction of           0254        12.45      $617.47      $272.41      $123.49
                             mouth.
    40844  T                Reconstruction of           0256        25.40    $1,259.74      $623.05      $251.95
                             mouth.
    40845  T                Reconstruction of           0256        25.40    $1,259.74      $623.05      $251.95
                             mouth.
    40899  T                Mouth surgery               0252         5.18      $256.90      $114.24       $51.38
                             procedure.
    41000  T                Drainage of mouth           0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41005  T                Drainage of mouth           0251         1.68       $83.32       $27.99       $16.66
                             lesion.
    41006  T                Drainage of mouth           0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41007  T                Drainage of mouth           0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41008  T                Drainage of mouth           0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41009  T                Drainage of mouth           0251         1.68       $83.32       $27.99       $16.66
                             lesion.
    41010  T                Incision of tongue          0253        12.02      $596.14      $284.00      $119.23
                             fold.
    41015  T                Drainage of mouth           0252         5.18      $256.90      $114.24       $51.38
                             lesion.
    41016  T                Drainage of mouth           0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41017  T                Drainage of mouth           0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41018  T                Drainage of mouth           0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41100  T                Biopsy of tongue...         0252         5.18      $256.90      $114.24       $51.38
    41105  T                Biopsy of tongue...         0253        12.02      $596.14      $284.00      $119.23
    41108  T                Biopsy of floor of          0252         5.18      $256.90      $114.24       $51.38
                             mouth.
    41110  T                Excision of tongue          0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41112  T                Excision of tongue          0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41113  T                Excision of tongue          0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41114  T                Excision of tongue          0254        12.45      $617.47      $272.41      $123.49
                             lesion.
    41115  T                Excision of tongue          0253        12.02      $596.14      $284.00      $119.23
                             fold.
    41116  T                Excision of mouth           0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41120  T                Partial removal of          0256        25.40    $1,259.74      $623.05      $251.95
                             tongue.
    41130  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             tongue.
    41135  C                Tongue and neck      ...........  ...........  ...........  ...........  ...........
                             surgery.
    41140  C                Removal of tongue..  ...........  ...........  ...........  ...........  ...........
    41145  C                Tongue removal,      ...........  ...........  ...........  ...........  ...........
                             neck surgery.
    41150  C                Tongue, mouth, jaw   ...........  ...........  ...........  ...........  ...........
                             surgery.
    41153  C                Tongue, mouth, neck  ...........  ...........  ...........  ...........  ...........
                             surgery.
    41155  C                Tongue, jaw, & neck  ...........  ...........  ...........  ...........  ...........
                             surgery.
    41250  T                Repair tongue               0251         1.68       $83.32       $27.99       $16.66
                             laceration.
    41251  T                Repair tongue               0253        12.02      $596.14      $284.00      $119.23
                             laceration.
    41252  T                Repair tongue               0253        12.02      $596.14      $284.00      $119.23
                             laceration.
    41500  T                Fixation of tongue.         0253        12.02      $596.14      $284.00      $119.23
    41510  T                Tongue to lip               0253        12.02      $596.14      $284.00      $119.23
                             surgery.
    41520  T                Reconstruction,             0253        12.02      $596.14      $284.00      $119.23
                             tongue fold.
    41599  T                Tongue and mouth            0251         1.68       $83.32       $27.99       $16.66
                             surgery.
    41800  T                Drainage of gum             0251         1.68       $83.32       $27.99       $16.66
                             lesion.
    41805  T                Removal foreign             0253        12.02      $596.14      $284.00      $119.23
                             body, gum.
    41806  T                Removal foreign             0253        12.02      $596.14      $284.00      $119.23
                             body,jawbone.
    41820  T                Excision, gum, each         0252         5.18      $256.90      $114.24       $51.38
                             quadrant.
    41821  T                Excision of gum             0252         5.18      $256.90      $114.24       $51.38
                             flap.
    41822  T                Excision of gum             0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41823  T                Excision of gum             0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41825  T                Excision of gum             0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41826  T                Excision of gum             0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41827  T                Excision of gum             0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41828  T                Excision of gum             0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41830  T                Removal of gum              0253        12.02      $596.14      $284.00      $119.23
                             tissue.
    41850  T                Treatment of gum            0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    41870  T                Gum graft..........         0253        12.02      $596.14      $284.00      $119.23
    41872  T                Repair gum.........         0253        12.02      $596.14      $284.00      $119.23
    41874  T                Repair tooth socket         0253        12.02      $596.14      $284.00      $119.23
    41899  T                Dental surgery              0253        12.02      $596.14      $284.00      $119.23
                             procedure.
    42000  T                Drainage mouth roof         0251         1.68       $83.32       $27.99       $16.66
                             lesion.
    42100  T                Biopsy roof of              0252         5.18      $256.90      $114.24       $51.38
                             mouth.
    42104  T                Excision lesion,            0253        12.02      $596.14      $284.00      $119.23
                             mouth roof.
    42106  T                Excision lesion,            0253        12.02      $596.14      $284.00      $119.23
                             mouth roof.
    42107  T                Excision lesion,            0254        12.45      $617.47      $272.41      $123.49
                             mouth roof.
    42120  T                Remove palate/              0256        25.40    $1,259.74      $623.05      $251.95
                             lesion.
    42140  T                Excision of uvula..         0252         5.18      $256.90      $114.24       $51.38

[[Page 67881]]

 
    42145  T                Repair palate,              0254        12.45      $617.47      $272.41      $123.49
                             pharynx/uvula.
    42160  T                Treatment mouth             0253        12.02      $596.14      $284.00      $119.23
                             roof lesion.
    42180  T                Repair palate......         0251         1.68       $83.32       $27.99       $16.66
    42182  T                Repair palate......         0256        25.40    $1,259.74      $623.05      $251.95
    42200  T                Reconstruct cleft           0256        25.40    $1,259.74      $623.05      $251.95
                             palate.
    42205  T                Reconstruct cleft           0256        25.40    $1,259.74      $623.05      $251.95
                             palate.
    42210  T                Reconstruct cleft           0256        25.40    $1,259.74      $623.05      $251.95
                             palate.
    42215  T                Reconstruct cleft           0256        25.40    $1,259.74      $623.05      $251.95
                             palate.
    42220  T                Reconstruct cleft           0256        25.40    $1,259.74      $623.05      $251.95
                             palate.
    42225  T                Reconstruct cleft           0256        25.40    $1,259.74      $623.05      $251.95
                             palate.
    42226  T                Lengthening of              0256        25.40    $1,259.74      $623.05      $251.95
                             palate.
    42227  T                Lengthening of              0256        25.40    $1,259.74      $623.05      $251.95
                             palate.
    42235  T                Repair palate......         0254        12.45      $617.47      $272.41      $123.49
    42260  T                Repair nose to lip          0253        12.02      $596.14      $284.00      $119.23
                             fistula.
    42280  T                Preparation, palate         0251         1.68       $83.32       $27.99       $16.66
                             mold.
    42281  T                Insertion, palate           0253        12.02      $596.14      $284.00      $119.23
                             prosthesis.
    42299  T                Palate/uvula                0251         1.68       $83.32       $27.99       $16.66
                             surgery.
    42300  T                Drainage of                 0253        12.02      $596.14      $284.00      $119.23
                             salivary gland.
    42305  T                Drainage of                 0253        12.02      $596.14      $284.00      $119.23
                             salivary gland.
    42310  T                Drainage of                 0251         1.68       $83.32       $27.99       $16.66
                             salivary gland.
    42320  T                Drainage of                 0251         1.68       $83.32       $27.99       $16.66
                             salivary gland.
    42325  T                Create salivary             0252         5.18      $256.90      $114.24       $51.38
                             cyst drain.
    42326  T                Create salivary             0252         5.18      $256.90      $114.24       $51.38
                             cyst drain.
    42330  T                Removal of salivary         0252         5.18      $256.90      $114.24       $51.38
                             stone.
    42335  T                Removal of salivary         0253        12.02      $596.14      $284.00      $119.23
                             stone.
    42340  T                Removal of salivary         0253        12.02      $596.14      $284.00      $119.23
                             stone.
    42400  T                Biopsy of salivary          0004         1.84       $91.26       $32.57       $18.25
                             gland.
    42405  T                Biopsy of salivary          0253        12.02      $596.14      $284.00      $119.23
                             gland.
    42408  T                Excision of                 0253        12.02      $596.14      $284.00      $119.23
                             salivary cyst.
    42409  T                Drainage of                 0253        12.02      $596.14      $284.00      $119.23
                             salivary cyst.
    42410  T                Excise parotid              0256        25.40    $1,259.74      $623.05      $251.95
                             gland/lesion.
    42415  T                Excise parotid              0256        25.40    $1,259.74      $623.05      $251.95
                             gland/lesion.
    42420  T                Excise parotid              0256        25.40    $1,259.74      $623.05      $251.95
                             gland/lesion.
    42425  T                Excise parotid              0256        25.40    $1,259.74      $623.05      $251.95
                             gland/lesion.
    42426  C                Excise parotid       ...........  ...........  ...........  ...........  ...........
                             gland/lesion.
    42440  T                Excise submaxillary         0256        25.40    $1,259.74      $623.05      $251.95
                             gland.
    42450  T                Excise sublingual           0253        12.02      $596.14      $284.00      $119.23
                             gland.
    42500  T                Repair salivary             0254        12.45      $617.47      $272.41      $123.49
                             duct.
    42505  T                Repair salivary             0256        25.40    $1,259.74      $623.05      $251.95
                             duct.
    42507  T                Parotid duct                0256        25.40    $1,259.74      $623.05      $251.95
                             diversion.
    42508  T                Parotid duct                0256        25.40    $1,259.74      $623.05      $251.95
                             diversion.
    42509  T                Parotid duct                0256        25.40    $1,259.74      $623.05      $251.95
                             diversion.
    42510  T                Parotid duct                0256        25.40    $1,259.74      $623.05      $251.95
                             diversion.
    42550  N                Injection for        ...........  ...........  ...........  ...........  ...........
                             salivary x-ray.
    42600  T                Closure of salivary         0253        12.02      $596.14      $284.00      $119.23
                             fistula.
    42650  T                Dilation of                 0252         5.18      $256.90      $114.24       $51.38
                             salivary duct.
    42660  T                Dilation of                 0252         5.18      $256.90      $114.24       $51.38
                             salivary duct.
    42665  T                Ligation of                 0253        12.02      $596.14      $284.00      $119.23
                             salivary duct.
    42699  T                Salivary surgery            0253        12.02      $596.14      $284.00      $119.23
                             procedure.
    42700  T                Drainage of tonsil          0251         1.68       $83.32       $27.99       $16.66
                             abscess.
    42720  T                Drainage of throat          0253        12.02      $596.14      $284.00      $119.23
                             abscess.
    42725  T                Drainage of throat          0256        25.40    $1,259.74      $623.05      $251.95
                             abscess.
    42800  T                Biopsy of throat...         0252         5.18      $256.90      $114.24       $51.38
    42802  T                Biopsy of throat...         0253        12.02      $596.14      $284.00      $119.23
    42804  T                Biopsy of upper             0253        12.02      $596.14      $284.00      $119.23
                             nose/throat.
    42806  T                Biopsy of upper             0253        12.02      $596.14      $284.00      $119.23
                             nose/throat.
    42808  T                Excise pharynx              0253        12.02      $596.14      $284.00      $119.23
                             lesion.
    42809  T                Remove pharynx              0251         1.68       $83.32       $27.99       $16.66
                             foreign body.
    42810  T                Excision of neck            0253        12.02      $596.14      $284.00      $119.23
                             cyst.
    42815  T                Excision of neck            0256        25.40    $1,259.74      $623.05      $251.95
                             cyst.
    42820  T                Remove tonsils and          0258        18.62      $923.48      $462.81      $184.70
                             adenoids.
    42821  T                Remove tonsils and          0258        18.62      $923.48      $462.81      $184.70
                             adenoids.
    42825  T                Removal of tonsils.         0258        18.62      $923.48      $462.81      $184.70
    42826  T                Removal of tonsils.         0258        18.62      $923.48      $462.81      $184.70
    42830  T                Removal of adenoids         0258        18.62      $923.48      $462.81      $184.70
    42831  T                Removal of adenoids         0258        18.62      $923.48      $462.81      $184.70
    42835  T                Removal of adenoids         0258        18.62      $923.48      $462.81      $184.70
    42836  T                Removal of adenoids         0258        18.62      $923.48      $462.81      $184.70
    42842  C                Extensive surgery    ...........  ...........  ...........  ...........  ...........
                             of throat.
    42844  T                Extensive surgery           0256        25.40    $1,259.74      $623.05      $251.95
                             of throat.
    42845  C                Extensive surgery    ...........  ...........  ...........  ...........  ...........
                             of throat.
    42860  T                Excision of tonsil          0258        18.62      $923.48      $462.81      $184.70
                             tags.
    42870  T                Excision of lingual         0258        18.62      $923.48      $462.81      $184.70
                             tonsil.
    42890  T                Partial removal of          0256        25.40    $1,259.74      $623.05      $251.95
                             pharynx.

[[Page 67882]]

 
    42892  T                Revision of                 0256        25.40    $1,259.74      $623.05      $251.95
                             pharyngeal walls.
    42894  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             pharyngeal walls.
    42900  T                Repair throat wound         0253        12.02      $596.14      $284.00      $119.23
    42950  T                Reconstruction of           0254        12.45      $617.47      $272.41      $123.49
                             throat.
    42953  C                Repair throat,       ...........  ...........  ...........  ...........  ...........
                             esophagus.
    42955  T                Surgical opening of         0254        12.45      $617.47      $272.41      $123.49
                             throat.
    42960  T                Control throat              0250         2.21      $109.61       $38.54       $21.92
                             bleeding.
    42961  C                Control throat       ...........  ...........  ...........  ...........  ...........
                             bleeding.
    42962  T                Control throat              0256        25.40    $1,259.74      $623.05      $251.95
                             bleeding.
    42970  T                Control nose/throat         0250         2.21      $109.61       $38.54       $21.92
                             bleeding.
    42971  C                Control nose/throat  ...........  ...........  ...........  ...........  ...........
                             bleeding.
    42972  T                Control nose/throat         0253        12.02      $596.14      $284.00      $119.23
                             bleeding.
    42999  T                Throat surgery              0252         5.18      $256.90      $114.24       $51.38
                             procedure.
    43020  T                Incision of                 0254        12.45      $617.47      $272.41      $123.49
                             esophagus.
    43030  C                Throat muscle        ...........  ...........  ...........  ...........  ...........
                             surgery.
    43045  C                Incision of          ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43100  C                Excision of          ...........  ...........  ...........  ...........  ...........
                             esophagus lesion.
    43101  C                Excision of          ...........  ...........  ...........  ...........  ...........
                             esophagus lesion.
    43107  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43108  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43112  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43113  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43116  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43117  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43118  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43121  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43122  C                Parital removal of   ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43123  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43124  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43130  T                Removal of                  0254        12.45      $617.47      $272.41      $123.49
                             esophagus pouch.
    43135  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             esophagus pouch.
    43200  T                Esophagus endoscopy         0141         7.15      $354.61      $184.67       $70.92
    43202  T                Esophagus                   0141         7.15      $354.61      $184.67       $70.92
                             endoscopy, biopsy.
    43204  T                Esophagus endoscopy         0141         7.15      $354.61      $184.67       $70.92
                             & inject.
    43205  T                Esophagus endoscopy/        0141         7.15      $354.61      $184.67       $70.92
                             ligation.
    43215  T                Esophagus endoscopy         0141         7.15      $354.61      $184.67       $70.92
    43216  T                Esophagus endoscopy/        0141         7.15      $354.61      $184.67       $70.92
                             lesion.
    43217  T                Esophagus endoscopy         0141         7.15      $354.61      $184.67       $70.92
    43219  T                Esophagus endoscopy         0141         7.15      $354.61      $184.67       $70.92
    43220  T                Esoph endoscopy,            0141         7.15      $354.61      $184.67       $70.92
                             dilation.
    43226  T                Esoph endoscopy,            0141         7.15      $354.61      $184.67       $70.92
                             dilation.
    43227  T                Esoph endoscopy,            0141         7.15      $354.61      $184.67       $70.92
                             repair.
    43228  T                Esoph endoscopy,            0141         7.15      $354.61      $184.67       $70.92
                             ablation.
   *43231  T                Esoph endoscopy w/          0141         7.15      $354.61      $184.67       $70.92
                             US exam.
   *43232  T                Esoph endoscopy w/          0141         7.15      $354.61      $184.67       $70.92
                             US fn bx.
    43234  T                Upper GI endoscopy,         0141         7.15      $354.61      $184.67       $70.92
                             exam.
    43235  T                Uppr gi endoscopy,          0141         7.15      $354.61      $184.67       $70.92
                             diagnosis.
    43239  T                Upper GI endoscopy,         0141         7.15      $354.61      $184.67       $70.92
                             biopsy.
   *43240  T                Esoph endoscopy w/          0141         7.15      $354.61      $184.67       $70.92
                             drain cyst.
    43241  T                Upper GI endoscopy          0141         7.15      $354.61      $184.67       $70.92
                             with tube.
   *43242  T                Uppr GI endoscopy w/        0141         7.15      $354.61      $184.67       $70.92
                              US fn bx.
    43243  T                Upper GI endoscopy          0141         7.15      $354.61      $184.67       $70.92
                             & inject.
    43244  T                Upper GI endoscopy/         0141         7.15      $354.61      $184.67       $70.92
                             ligation.
    43245  T                Operative upper GI          0141         7.15      $354.61      $184.67       $70.92
                             endoscopy.
    43246  T                Place gastrostomy           0141         7.15      $354.61      $184.67       $70.92
                             tube.
    43247  T                Operative upper GI          0141         7.15      $354.61      $184.67       $70.92
                             endoscopy.
    43248  T                Uppr gi endoscopy/          0141         7.15      $354.61      $184.67       $70.92
                             guide wire.
    43249  T                Esoph endoscopy,            0141         7.15      $354.61      $184.67       $70.92
                             dilation.
    43250  T                Upper GI endoscopy/         0141         7.15      $354.61      $184.67       $70.92
                             tumor.
    43251  T                Operative upper GI          0141         7.15      $354.61      $184.67       $70.92
                             endoscopy.
    43255  T                Operative upper GI          0141         7.15      $354.61      $184.67       $70.92
                             endoscopy.
   *43256  T                Uppr GI endoscopy w/        0141         7.15      $354.61      $184.67       $70.92
                              stent.
    43258  T                Operative upper GI          0141         7.15      $354.61      $184.67       $70.92
                             endoscopy.
    43259  T                Endoscopic                  0141         7.15      $354.61      $184.67       $70.92
                             ultrasound exam.
    43260  T                Endo                        0151        10.53      $522.25      $245.46      $104.45
                             cholangiopancreato
                             graph.
    43261  T                Endo                        0151        10.53      $522.25      $245.46      $104.45
                             cholangiopancreato
                             graph.
    43262  T                Endo                        0151        10.53      $522.25      $245.46      $104.45
                             cholangiopancreato
                             graph.
    43263  T                Endo                        0151        10.53      $522.25      $245.46      $104.45
                             cholangiopancreato
                             graph.
    43264  T                Endo                        0151        10.53      $522.25      $245.46      $104.45
                             cholangiopancreato
                             graph.
    43265  T                Endo                        0151        10.53      $522.25      $245.46      $104.45
                             cholangiopancreato
                             graph.
    43267  T                Endo                        0151        10.53      $522.25      $245.46      $104.45
                             cholangiopancreato
                             graph.
    43268  T                Endo                        0151        10.53      $522.25      $245.46      $104.45
                             cholangiopancreato
                             graph.
    43269  T                Endo                        0151        10.53      $522.25      $245.46      $104.45
                             cholangiopancreato
                             graph.
    43271  T                Endo                        0151        10.53      $522.25      $245.46      $104.45
                             cholangiopancreato
                             graph.

[[Page 67883]]

 
    43272  T                Endo                        0151        10.53      $522.25      $245.46      $104.45
                             cholangiopancreato
                             graph.
    43280  T                Laparoscopy,                0132        48.91    $2,425.74    $1,239.22      $485.15
                             fundoplasty.
    43289  T                Laparoscope proc,           0130        25.36    $1,257.75      $659.53      $251.55
                             esoph.
    43300  C                Repair of esophagus  ...........  ...........  ...........  ...........  ...........
    43305  C                Repair esophagus     ...........  ...........  ...........  ...........  ...........
                             and fistula.
    43310  C                Repair of esophagus  ...........  ...........  ...........  ...........  ...........
    43312  C                Repair esophagus     ...........  ...........  ...........  ...........  ...........
                             and fistula.
    43320  C                Fuse esophagus &     ...........  ...........  ...........  ...........  ...........
                             stomach.
    43324  C                Revise esophagus &   ...........  ...........  ...........  ...........  ...........
                             stomach.
    43325  C                Revise esophagus &   ...........  ...........  ...........  ...........  ...........
                             stomach.
    43326  C                Revise esophagus &   ...........  ...........  ...........  ...........  ...........
                             stomach.
    43330  C                Repair of esophagus  ...........  ...........  ...........  ...........  ...........
    43331  C                Repair of esophagus  ...........  ...........  ...........  ...........  ...........
    43340  C                Fuse esophagus &     ...........  ...........  ...........  ...........  ...........
                             intestine.
    43341  C                Fuse esophagus &     ...........  ...........  ...........  ...........  ...........
                             intestine.
    43350  C                Surgical opening,    ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43351  C                Surgical opening,    ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43352  C                Surgical opening,    ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43360  C                Gastrointestinal     ...........  ...........  ...........  ...........  ...........
                             repair.
    43361  C                Gastrointestinal     ...........  ...........  ...........  ...........  ...........
                             repair.
   *44383  T                Ileoscopy through           0142         7.45      $369.49      $162.42       $73.90
                             stoma w/stent.
    43400  C                Ligate esophagus     ...........  ...........  ...........  ...........  ...........
                             veins.
    43401  C                Esophagus surgery    ...........  ...........  ...........  ...........  ...........
                             for veins.
    43405  C                Ligate/staple        ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43410  C                Repair esophagus     ...........  ...........  ...........  ...........  ...........
                             wound.
    43415  C                Repair esophagus     ...........  ...........  ...........  ...........  ...........
                             wound.
    43420  C                Repair esophagus     ...........  ...........  ...........  ...........  ...........
                             opening.
    43425  C                Repair esophagus     ...........  ...........  ...........  ...........  ...........
                             opening.
    43450  T                Dilate esophagus...         0140         4.74      $235.09      $107.24       $47.02
    43453  T                Dilate esophagus...         0140         4.74      $235.09      $107.24       $47.02
    43456  T                Dilate esophagus...         0140         4.74      $235.09      $107.24       $47.02
    43458  T                Dilate esophagus...         0140         4.74      $235.09      $107.24       $47.02
    43460  C                Pressure treatment   ...........  ...........  ...........  ...........  ...........
                             esophagus.
    43496  C                Free jejunum flap,   ...........  ...........  ...........  ...........  ...........
                             microvasc.
    43499  T                Esophagus surgery           0140         4.74      $235.09      $107.24       $47.02
                             procedure.
    43500  C                Surgical opening of  ...........  ...........  ...........  ...........  ...........
                             stomach.
    43501  C                Surgical repair of   ...........  ...........  ...........  ...........  ...........
                             stomach.
    43502  C                Surgical repair of   ...........  ...........  ...........  ...........  ...........
                             stomach.
    43510  C                Surgical opening of  ...........  ...........  ...........  ...........  ...........
                             stomach.
    43520  C                Incision of pyloric  ...........  ...........  ...........  ...........  ...........
                             muscle.
    43600  T                Biopsy of stomach..         0141         7.15      $354.61      $184.67       $70.92
    43605  C                Biopsy of stomach..  ...........  ...........  ...........  ...........  ...........
    43610  C                Excision of stomach  ...........  ...........  ...........  ...........  ...........
                             lesion.
    43611  C                Excision of stomach  ...........  ...........  ...........  ...........  ...........
                             lesion.
    43620  C                Removal of stomach.  ...........  ...........  ...........  ...........  ...........
    43621  C                Removal of stomach.  ...........  ...........  ...........  ...........  ...........
    43622  C                Removal of stomach.  ...........  ...........  ...........  ...........  ...........
    43631  C                Removal of stomach,  ...........  ...........  ...........  ...........  ...........
                             partial.
    43632  C                Removal of stomach,  ...........  ...........  ...........  ...........  ...........
                             partial.
    43633  C                Removal of stomach,  ...........  ...........  ...........  ...........  ...........
                             partial.
    43634  C                Removal of stomach,  ...........  ...........  ...........  ...........  ...........
                             partial.
    43635  C                Removal of stomach,  ...........  ...........  ...........  ...........  ...........
                             partial.
    43638  C                Removal of stomach,  ...........  ...........  ...........  ...........  ...........
                             partial.
    43639  C                Removal of stomach,  ...........  ...........  ...........  ...........  ...........
                             partial.
    43640  C                Vagotomy & pylorus   ...........  ...........  ...........  ...........  ...........
                             repair.
    43641  C                Vagotomy & pylorus   ...........  ...........  ...........  ...........  ...........
                             repair.
    43651  T                Laparoscopy, vagus          0132        48.91    $2,425.74    $1,239.22      $485.15
                             nerve.
    43652  T                Laparoscopy, vagus          0132        48.91    $2,425.74    $1,239.22      $485.15
                             nerve.
    43653  T                Laparoscopy,                0131        41.81    $2,073.61    $1,089.88      $414.72
                             gastrostomy.
    43659  T                Laparoscope proc,           0130        25.36    $1,257.75      $659.53      $251.55
                             stom.
   *43752  E                Nasal/orogastric w/  ...........  ...........  ...........  ...........  ...........
                             stent.
    43750  T                Place gastrostomy           0141         7.15      $354.61      $184.67       $70.92
                             tube.
    43760  T                Change gastrostomy          0121         2.36      $117.05       $52.53       $23.41
                             tube.
    43761  T                Reposition                  0121         2.36      $117.05       $52.53       $23.41
                             gastrostomy tube.
    43800  C                Reconstruction of    ...........  ...........  ...........  ...........  ...........
                             pylorus.
    43810  C                Fusion of stomach    ...........  ...........  ...........  ...........  ...........
                             and bowel.
    43820  C                Fusion of stomach    ...........  ...........  ...........  ...........  ...........
                             and bowel.
    43825  C                Fusion of stomach    ...........  ...........  ...........  ...........  ...........
                             and bowel.
    43830  T                Place gastrostomy           0141         7.15      $354.61      $184.67       $70.92
                             tube.
    43831  T                Place gastrostomy           0141         7.15      $354.61      $184.67       $70.92
                             tube.
    43832  C                Place gastrostomy    ...........  ...........  ...........  ...........  ...........
                             tube.
    43840  C                Repair of stomach    ...........  ...........  ...........  ...........  ...........
                             lesion.
    43842  C                Gastroplasty for     ...........  ...........  ...........  ...........  ...........
                             obesity.
    43843  C                Gastroplasty for     ...........  ...........  ...........  ...........  ...........
                             obesity.

[[Page 67884]]

 
    43846  C                Gastric bypass for   ...........  ...........  ...........  ...........  ...........
                             obesity.
    43847  C                Gastric bypass for   ...........  ...........  ...........  ...........  ...........
                             obesity.
    43848  C                Revision             ...........  ...........  ...........  ...........  ...........
                             gastroplasty.
    43850  C                Revise stomach-      ...........  ...........  ...........  ...........  ...........
                             bowel fusion.
    43855  C                Revise stomach-      ...........  ...........  ...........  ...........  ...........
                             bowel fusion.
    43860  C                Revise stomach-      ...........  ...........  ...........  ...........  ...........
                             bowel fusion.
    43865  C                Revise stomach-      ...........  ...........  ...........  ...........  ...........
                             bowel fusion.
    43870  T                Repair stomach              0025         3.74      $185.49       $70.66       $37.10
                             opening.
    43880  C                Repair stomach-      ...........  ...........  ...........  ...........  ...........
                             bowel fistula.
    43999  T                Stomach surgery             0121         2.36      $117.05       $52.53       $23.41
                             procedure.
    44005  C                Freeing of bowel     ...........  ...........  ...........  ...........  ...........
                             adhesion.
    44010  C                Incision of small    ...........  ...........  ...........  ...........  ...........
                             bowel.
    44015  C                Insert needle cath   ...........  ...........  ...........  ...........  ...........
                             bowel.
    44020  C                Exploration of       ...........  ...........  ...........  ...........  ...........
                             small bowel.
    44021  C                Decompress small     ...........  ...........  ...........  ...........  ...........
                             bowel.
    44025  C                Incision of large    ...........  ...........  ...........  ...........  ...........
                             bowel.
    44050  C                Reduce bowel         ...........  ...........  ...........  ...........  ...........
                             obstruction.
    44055  C                Correct malrotation  ...........  ...........  ...........  ...........  ...........
                             of bowel.
    44100  T                Biopsy of bowel....         0141         7.15      $354.61      $184.67       $70.92
    44110  C                Excision of bowel    ...........  ...........  ...........  ...........  ...........
                             lesion(s).
    44111  C                Excision of bowel    ...........  ...........  ...........  ...........  ...........
                             lesion(s).
    44120  C                Removal of small     ...........  ...........  ...........  ...........  ...........
                             intestine.
    44121  C                Removal of small     ...........  ...........  ...........  ...........  ...........
                             intestine.
    44125  C                Removal of small     ...........  ...........  ...........  ...........  ...........
                             intestine.
    44130  C                Bowel to bowel       ...........  ...........  ...........  ...........  ...........
                             fusion.
   *44132  C                Enterectomy,         ...........  ...........  ...........  ...........  ...........
                             cadaver donor.
   *44133  C                Enterectomy, live    ...........  ...........  ...........  ...........  ...........
                             donor.
   *44135  C                Intestine            ...........  ...........  ...........  ...........  ...........
                             transplnt, cadaver.
   *44136  C                Intestine            ...........  ...........  ...........  ...........  ...........
                             transplnt, live.
    44139  C                Mobilization of      ...........  ...........  ...........  ...........  ...........
                             colon.
    44140  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             colon.
    44141  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             colon.
    44143  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             colon.
    44144  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             colon.
    44145  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             colon.
    44146  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             colon.
    44147  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             colon.
    44150  C                Removal of colon...  ...........  ...........  ...........  ...........  ...........
    44151  C                Removal of colon/    ...........  ...........  ...........  ...........  ...........
                             ileostomy.
    44152  C                Removal of colon/    ...........  ...........  ...........  ...........  ...........
                             ileostomy.
    44153  C                Removal of colon/    ...........  ...........  ...........  ...........  ...........
                             ileostomy.
    44155  C                Removal of colon/    ...........  ...........  ...........  ...........  ...........
                             ileostomy.
    44156  C                Removal of colon/    ...........  ...........  ...........  ...........  ...........
                             ileostomy.
    44160  C                Removal of colon...  ...........  ...........  ...........  ...........  ...........
    44200  T                Laparoscopy,                0131        41.81    $2,073.61    $1,089.88      $414.72
                             enterolysis.
    44201  T                Laparoscopy,                0131        41.81    $2,073.61    $1,089.88      $414.72
                             jejunostomy.
    44202  C                Laparo, resect       ...........  ...........  ...........  ...........  ...........
                             intestine.
    44209  T                Laparoscope proc,           0130        25.36    $1,257.75      $659.53      $251.55
                             intestine.
    44300  C                Open bowel to skin.  ...........  ...........  ...........  ...........  ...........
    44310  C                Ileostomy/           ...........  ...........  ...........  ...........  ...........
                             jejunostomy.
    44312  T                Revision of                 0026        12.11      $600.61      $277.92      $120.12
                             ileostomy.
    44314  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             ileostomy.
    44316  C                Devise bowel pouch.  ...........  ...........  ...........  ...........  ...........
    44320  C                Colostomy..........  ...........  ...........  ...........  ...........  ...........
    44322  C                Colostomy with       ...........  ...........  ...........  ...........  ...........
                             biopsies.
    44340  T                Revision of                 0026        12.11      $600.61      $277.92      $120.12
                             colostomy.
    44345  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             colostomy.
    44346  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             colostomy.
    44360  T                Small bowel                 0142         7.45      $369.49      $162.42       $73.90
                             endoscopy.
    44361  T                Small bowel                 0142         7.45      $369.49      $162.42       $73.90
                             endoscopy/biopsy.
    44363  T                Small bowel                 0142         7.45      $369.49      $162.42       $73.90
                             endoscopy.
    44364  T                Small bowel                 0142         7.45      $369.49      $162.42       $73.90
                             endoscopy.
    44365  T                Small bowel                 0142         7.45      $369.49      $162.42       $73.90
                             endoscopy.
    44366  T                Small bowel                 0142         7.45      $369.49      $162.42       $73.90
                             endoscopy.
    44369  T                Small bowel                 0142         7.45      $369.49      $162.42       $73.90
                             endoscopy.
   *44370  T                Small bowel                 0142         7.45      $369.49      $162.42       $73.90
                             endoscopy/stent.
    44372  T                Small bowel                 0142         7.45      $369.49      $162.42       $73.90
                             endoscopy.
    44373  T                Small bowel                 0142         7.45      $369.49      $162.42       $73.90
                             endoscopy.
    44376  T                Small bowel                 0142         7.45      $369.49      $162.42       $73.90
                             endoscopy.
    44377  T                Small bowel                 0142         7.45      $369.49      $162.42       $73.90
                             endoscopy/biopsy.
    44378  T                Small bowel                 0142         7.45      $369.49      $162.42       $73.90
                             endoscopy.
   *44379  T                Small bowel                 0142         7.45      $369.49      $162.42       $73.90
                             endoscopy/stent.
    44380  T                Small bowel                 0142         7.45      $369.49      $162.42       $73.90
                             endoscopy.
    44382  T                Small bowel                 0142         7.45      $369.49      $162.42       $73.90
                             endoscopy.

[[Page 67885]]

 
    44385  T                Endoscopy of bowel          0143         7.98      $395.78      $199.12       $79.16
                             pouch.
    44386  T                Endoscopy, bowel            0143         7.98      $395.78      $199.12       $79.16
                             pouch/biop.
    44388  T                Colon endoscopy....         0143         7.98      $395.78      $199.12       $79.16
    44389  T                Colonoscopy with            0143         7.98      $395.78      $199.12       $79.16
                             biopsy.
    44390  T                Colonoscopy for             0143         7.98      $395.78      $199.12       $79.16
                             foreign body.
    44391  T                Colonoscopy for             0143         7.98      $395.78      $199.12       $79.16
                             bleeding.
    44392  T                Colonoscopy &               0143         7.98      $395.78      $199.12       $79.16
                             polypectomy.
    44393  T                Colonoscopy, lesion         0143         7.98      $395.78      $199.12       $79.16
                             removal.
    44394  T                Colonoscopy w/snare         0143         7.98      $395.78      $199.12       $79.16
   *44397  T                Colonoscopy w/stent         0143         7.98      $395.78      $199.12       $79.16
    44500  T                Intro,                      0121         2.36      $117.05       $52.53       $23.41
                             gastrointestinal
                             tube.
    44602  C                Suture, small        ...........  ...........  ...........  ...........  ...........
                             intestine.
    44603  C                Suture, small        ...........  ...........  ...........  ...........  ...........
                             intestine.
    44604  C                Suture, large        ...........  ...........  ...........  ...........  ...........
                             intestine.
    44605  C                Repair of bowel      ...........  ...........  ...........  ...........  ...........
                             lesion.
    44615  C                Intestinal           ...........  ...........  ...........  ...........  ...........
                             stricturoplasty.
    44620  C                Repair bowel         ...........  ...........  ...........  ...........  ...........
                             opening.
    44625  C                Repair bowel         ...........  ...........  ...........  ...........  ...........
                             opening.
    44626  C                Repair bowel         ...........  ...........  ...........  ...........  ...........
                             opening.
    44640  C                Repair bowel-skin    ...........  ...........  ...........  ...........  ...........
                             fistula.
    44650  C                Repair bowel         ...........  ...........  ...........  ...........  ...........
                             fistula.
    44660  C                Repair bowel-        ...........  ...........  ...........  ...........  ...........
                             bladder fistula.
    44661  C                Repair bowel-        ...........  ...........  ...........  ...........  ...........
                             bladder fistula.
    44680  C                Surgical revision,   ...........  ...........  ...........  ...........  ...........
                             intestine.
    44700  C                Suspend bowel w/     ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    44799  T                Intestine surgery           0142         7.45      $369.49      $162.42       $73.90
                             procedure.
    44800  C                Excision of bowel    ...........  ...........  ...........  ...........  ...........
                             pouch.
    44820  C                Excision of          ...........  ...........  ...........  ...........  ...........
                             mesentery lesion.
    44850  C                Repair of mesentery  ...........  ...........  ...........  ...........  ...........
    44899  C                Bowel surgery        ...........  ...........  ...........  ...........  ...........
                             procedure.
    44900  C                Drain app abscess,   ...........  ...........  ...........  ...........  ...........
                             open.
    44901  C                Drain app abscess,   ...........  ...........  ...........  ...........  ...........
                             percut.
    44950  C                Appendectomy.......  ...........  ...........  ...........  ...........  ...........
    44955  C                Appendectomy add-on  ...........  ...........  ...........  ...........  ...........
    44960  C                Appendectomy.......  ...........  ...........  ...........  ...........  ...........
    44970  T                Laparoscopy,                0130        25.36    $1,257.75      $659.53      $251.55
                             appendectomy.
    44979  T                Laparoscope proc,           0130        25.36    $1,257.75      $659.53      $251.55
                             app.
    45000  T                Drainage of pelvic          0149        12.86      $637.80      $293.06      $127.56
                             abscess.
    45005  T                Drainage of rectal          0148         2.34      $116.06       $43.59       $23.21
                             abscess.
    45020  T                Drainage of rectal          0149        12.86      $637.80      $293.06      $127.56
                             abscess.
    45100  T                Biopsy of rectum...         0149        12.86      $637.80      $293.06      $127.56
    45108  T                Removal of                  0150        17.68      $876.86      $437.12      $175.37
                             anorectal lesion.
    45110  C                Removal of rectum..  ...........  ...........  ...........  ...........  ...........
    45111  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             rectum.
    45112  C                Removal of rectum..  ...........  ...........  ...........  ...........  ...........
    45113  C                Partial proctectomy  ...........  ...........  ...........  ...........  ...........
    45114  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             rectum.
    45116  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             rectum.
    45119  C                Remove rectum w/     ...........  ...........  ...........  ...........  ...........
                             reservoir.
    45120  C                Removal of rectum..  ...........  ...........  ...........  ...........  ...........
    45121  C                Removal of rectum    ...........  ...........  ...........  ...........  ...........
                             and colon.
    45123  C                Partial proctectomy  ...........  ...........  ...........  ...........  ...........
    45126  C                Pelvic exenteration  ...........  ...........  ...........  ...........  ...........
    45130  C                Excision of rectal   ...........  ...........  ...........  ...........  ...........
                             prolapse.
    45135  C                Excision of rectal   ...........  ...........  ...........  ...........  ...........
                             prolapse.
    45150  T                Excision of rectal          0150        17.68      $876.86      $437.12      $175.37
                             stricture.
    45160  T                Excision of rectal          0150        17.68      $876.86      $437.12      $175.37
                             lesion.
    45170  T                Excision of rectal          0150        17.68      $876.86      $437.12      $175.37
                             lesion.
    45190  T                Destruction, rectal         0150        17.68      $876.86      $437.12      $175.37
                             tumor.
    45300  T                Proctosigmoidoscopy         0146         2.83      $140.36       $65.15       $28.07
    45303  T                Proctosigmoidoscopy         0146         2.83      $140.36       $65.15       $28.07
    45305  T                Proctosigmoidoscopy         0146         2.83      $140.36       $65.15       $28.07
                             & biopsy.
    45307  T                Proctosigmoidoscopy         0146         2.83      $140.36       $65.15       $28.07
    45308  T                Proctosigmoidoscopy         0147         6.26      $310.47      $149.11       $62.09
    45309  T                Proctosigmoidoscopy         0147         6.26      $310.47      $149.11       $62.09
    45315  T                Proctosigmoidoscopy         0147         6.26      $310.47      $149.11       $62.09
    45317  T                Proctosigmoidoscopy         0146         2.83      $140.36       $65.15       $28.07
    45320  T                Proctosigmoidoscopy         0147         6.26      $310.47      $149.11       $62.09
    45321  T                Proctosigmoidoscopy         0147         6.26      $310.47      $149.11       $62.09
   *45327  T                Proctosigmoidoscopy         0147         6.26      $310.47      $149.11       $62.09
                             w/stent.
    45330  T                Diagnostic                  0146         2.83      $140.36       $65.15       $28.07
                             sigmoidoscopy.
    45331  T                Sigmoidoscopy and           0146         2.83      $140.36       $65.15       $28.07
                             biopsy.
    45332  T                Sigmoidoscopy w/fb          0146         2.83      $140.36       $65.15       $28.07
                             removal.
    45333  T                Sigmoidoscopy &             0147         6.26      $310.47      $149.11       $62.09
                             polypectomy.

[[Page 67886]]

 
    45334  T                Sigmoidoscopy for           0147         6.26      $310.47      $149.11       $62.09
                             bleeding.
    45337  T                Sigmoidoscopy &             0147         6.26      $310.47      $149.11       $62.09
                             decompress.
    45338  T                Sigmoidoscopy w/            0147         6.26      $310.47      $149.11       $62.09
                             tumr remove.
    45339  T                Sigmoidoscopy w/            0147         6.26      $310.47      $149.11       $62.09
                             ablate tumr.
   *45341  T                Sigmoidoscopy w/            0147         6.26      $310.47      $149.11       $62.09
                             ultrasound.
   *45342  T                Sigmoidoscopy w/ US         0147         6.26      $310.47      $149.11       $62.09
                             guide bx.
   *45345  T                Sigmoidoscopy w/            0147         6.26      $310.47      $149.11       $62.09
                             stent.
    45355  T                Surgical                    0143         7.98      $395.78      $199.12       $79.16
                             colonoscopy.
    45378  T                Diagnostic                  0143         7.98      $395.78      $199.12       $79.16
                             colonoscopy.
    45379  T                Colonoscopy........         0143         7.98      $395.78      $199.12       $79.16
    45380  T                Colonoscopy and             0143         7.98      $395.78      $199.12       $79.16
                             biopsy.
    45382  T                Colonoscopy/control         0143         7.98      $395.78      $199.12       $79.16
                             bleeding.
    45383  T                Lesion removal              0143         7.98      $395.78      $199.12       $79.16
                             colonoscopy.
    45384  T                Colonoscopy........         0143         7.98      $395.78      $199.12       $79.16
    45385  T                Lesion removal              0143         7.98      $395.78      $199.12       $79.16
                             colonoscopy.
   *45387  T                Colonoscopy w/stent         0143         7.98      $395.78      $199.12       $79.16
    45500  T                Repair of rectum...         0150        17.68      $876.86      $437.12      $175.37
    45505  T                Repair of rectum...         0150        17.68      $876.86      $437.12      $175.37
    45520  T                Treatment of rectal         0098         1.19       $59.02       $20.88       $11.80
                             prolapse.
    45540  C                Correct rectal       ...........  ...........  ...........  ...........  ...........
                             prolapse.
    45541  C                Correct rectal       ...........  ...........  ...........  ...........  ...........
                             prolapse.
    45550  C                Repair rectum/       ...........  ...........  ...........  ...........  ...........
                             remove sigmoid.
    45560  T                Repair of rectocele         0150        17.68      $876.86      $437.12      $175.37
    45562  C                Exploration/repair   ...........  ...........  ...........  ...........  ...........
                             of rectum.
    45563  C                Exploration/repair   ...........  ...........  ...........  ...........  ...........
                             of rectum.
    45800  C                Repair rect/bladder  ...........  ...........  ...........  ...........  ...........
                             fistula.
    45805  C                Repair fistula w/    ...........  ...........  ...........  ...........  ...........
                             colostomy.
    45820  C                Repair               ...........  ...........  ...........  ...........  ...........
                             rectourethral
                             fistula.
    45825  C                Repair fistula w/    ...........  ...........  ...........  ...........  ...........
                             colostomy.
    45900  T                Reduction of rectal         0148         2.34      $116.06       $43.59       $23.21
                             prolapse.
    45905  T                Dilation of anal            0149        12.86      $637.80      $293.06      $127.56
                             sphincter.
    45910  T                Dilation of rectal          0149        12.86      $637.80      $293.06      $127.56
                             narrowing.
    45915  T                Remove rectal               0148         2.34      $116.06       $43.59       $23.21
                             obstruction.
    45999  T                Rectum surgery              0148         2.34      $116.06       $43.59       $23.21
                             procedure.
    46030  T                Removal of rectal           0149        12.86      $637.80      $293.06      $127.56
                             marker.
    46040  T                Incision of rectal          0148         2.34      $116.06       $43.59       $23.21
                             abscess.
    46045  T                Incision of rectal          0150        17.68      $876.86      $437.12      $175.37
                             abscess.
    46050  T                Incision of anal            0148         2.34      $116.06       $43.59       $23.21
                             abscess.
    46060  T                Incision of rectal          0150        17.68      $876.86      $437.12      $175.37
                             abscess.
    46070  T                Incision of anal            0148         2.34      $116.06       $43.59       $23.21
                             septum.
    46080  T                Incision of anal            0149        12.86      $637.80      $293.06      $127.56
                             sphincter.
    46083  T                Incise external             0148         2.34      $116.06       $43.59       $23.21
                             hemorrhoid.
    46200  T                Removal of anal             0150        17.68      $876.86      $437.12      $175.37
                             fissure.
    46210  T                Removal of anal             0149        12.86      $637.80      $293.06      $127.56
                             crypt.
    46211  T                Removal of anal             0150        17.68      $876.86      $437.12      $175.37
                             crypts.
    46220  T                Removal of anal tab         0149        12.86      $637.80      $293.06      $127.56
    46221  T                Ligation of                 0148         2.34      $116.06       $43.59       $23.21
                             hemorrhoid(s).
    46230  T                Removal of anal             0149        12.86      $637.80      $293.06      $127.56
                             tabs.
    46250  T                Hemorrhoidectomy...         0150        17.68      $876.86      $437.12      $175.37
    46255  T                Hemorrhoidectomy...         0150        17.68      $876.86      $437.12      $175.37
    46257  T                Remove hemorrhoids          0150        17.68      $876.86      $437.12      $175.37
                             & fissure.
    46258  T                Remove hemorrhoids          0150        17.68      $876.86      $437.12      $175.37
                             & fistula.
    46260  T                Hemorrhoidectomy...         0150        17.68      $876.86      $437.12      $175.37
    46261  T                Remove hemorrhoids          0150        17.68      $876.86      $437.12      $175.37
                             & fissure.
    46262  T                Remove hemorrhoids          0150        17.68      $876.86      $437.12      $175.37
                             & fistula.
    46270  T                Removal of anal             0150        17.68      $876.86      $437.12      $175.37
                             fistula.
    46275  T                Removal of anal             0150        17.68      $876.86      $437.12      $175.37
                             fistula.
    46280  T                Removal of anal             0150        17.68      $876.86      $437.12      $175.37
                             fistula.
    46285  T                Removal of anal             0150        17.68      $876.86      $437.12      $175.37
                             fistula.
    46288  T                Repair anal fistula         0150        17.68      $876.86      $437.12      $175.37
    46320  T                Removal of                  0148         2.34      $116.06       $43.59       $23.21
                             hemorrhoid clot.
    46500  T                Injection into              0148         2.34      $116.06       $43.59       $23.21
                             hemorrhoids.
    46600  N                Diagnostic anoscopy  ...........  ...........  ...........  ...........  ...........
    46604  T                Anoscopy and                0144         2.23      $110.60       $49.32       $22.12
                             dilation.
    46606  T                Anoscopy and biopsy         0145         7.46      $369.98      $179.39       $74.00
    46608  T                Anoscopy/ remove            0144         2.23      $110.60       $49.32       $22.12
                             for body.
    46610  T                Anoscopy/remove             0145         7.46      $369.98      $179.39       $74.00
                             lesion.
    46611  T                Anoscopy...........         0145         7.46      $369.98      $179.39       $74.00
    46612  T                Anoscopy/ remove            0145         7.46      $369.98      $179.39       $74.00
                             lesions.
    46614  T                Anoscopy/control            0145         7.46      $369.98      $179.39       $74.00
                             bleeding.
    46615  T                Anoscopy...........         0145         7.46      $369.98      $179.39       $74.00
    46700  T                Repair of anal              0150        17.68      $876.86      $437.12      $175.37
                             stricture.
    46705  C                Repair of anal       ...........  ...........  ...........  ...........  ...........
                             stricture.
    46715  C                Repair of            ...........  ...........  ...........  ...........  ...........
                             anovaginal fistula.

[[Page 67887]]

 
    46716  C                Repair of            ...........  ...........  ...........  ...........  ...........
                             anovaginal fistula.
    46730  C                Construction of      ...........  ...........  ...........  ...........  ...........
                             absent anus.
    46735  C                Construction of      ...........  ...........  ...........  ...........  ...........
                             absent anus.
    46740  C                Construction of      ...........  ...........  ...........  ...........  ...........
                             absent anus.
    46742  C                Repair of            ...........  ...........  ...........  ...........  ...........
                             imperforated anus.
    46744  C                Repair of cloacal    ...........  ...........  ...........  ...........  ...........
                             anomaly.
    46746  C                Repair of cloacal    ...........  ...........  ...........  ...........  ...........
                             anomaly.
    46748  C                Repair of cloacal    ...........  ...........  ...........  ...........  ...........
                             anomaly.
    46750  T                Repair of anal              0150        17.68      $876.86      $437.12      $175.37
                             sphincter.
    46751  C                Repair of anal       ...........  ...........  ...........  ...........  ...........
                             sphincter.
    46753  T                Reconstruction of           0150        17.68      $876.86      $437.12      $175.37
                             anus.
    46754  T                Removal of suture           0149        12.86      $637.80      $293.06      $127.56
                             from anus.
    46760  T                Repair of anal              0150        17.68      $876.86      $437.12      $175.37
                             sphincter.
    46761  T                Repair of anal              0150        17.68      $876.86      $437.12      $175.37
                             sphincter.
    46762  T                Implant artificial          0150        17.68      $876.86      $437.12      $175.37
                             sphincter.
    46900  T                Destruction, anal           0016         3.53      $175.07       $74.67       $35.01
                             lesion(s).
    46910  T                Destruction, anal           0016         3.53      $175.07       $74.67       $35.01
                             lesion(s).
    46916  T                Cryosurgery, anal           0016         3.53      $175.07       $74.67       $35.01
                             lesion(s).
    46917  T                Laser surgery, anal         0014         1.50       $74.39       $24.55       $14.88
                             lesions.
    46922  T                Excision of anal            0017        12.45      $617.47      $289.16      $123.49
                             lesion(s).
    46924  T                Destruction, anal           0017        12.45      $617.47      $289.16      $123.49
                             lesion(s).
    46934  T                Destruction of              0148         2.34      $116.06       $43.59       $23.21
                             hemorrhoids.
    46935  T                Destruction of              0148         2.34      $116.06       $43.59       $23.21
                             hemorrhoids.
    46936  T                Destruction of              0149        12.86      $637.80      $293.06      $127.56
                             hemorrhoids.
    46937  T                Cryotherapy of              0150        17.68      $876.86      $437.12      $175.37
                             rectal lesion.
    46938  T                Cryotherapy of              0150        17.68      $876.86      $437.12      $175.37
                             rectal lesion.
    46940  T                Treatment of anal           0149        12.86      $637.80      $293.06      $127.56
                             fissure.
    46942  T                Treatment of anal           0149        12.86      $637.80      $293.06      $127.56
                             fissure.
    46945  T                Ligation of                 0148         2.34      $116.06       $43.59       $23.21
                             hemorrhoids.
    46946  T                Ligation of                 0148         2.34      $116.06       $43.59       $23.21
                             hemorrhoids.
    46999  T                Anus surgery                0149        12.86      $637.80      $293.06      $127.56
                             procedure.
    47000  T                Needle biopsy of            0005         5.41      $268.32      $119.75       $53.66
                             liver.
    47001  C                Needle biopsy,       ...........  ...........  ...........  ...........  ...........
                             liver add-on.
    47010  C                Open drainage,       ...........  ...........  ...........  ...........  ...........
                             liver lesion.
    47011  C                Percut drain, liver  ...........  ...........  ...........  ...........  ...........
                             lesion.
    47015  C                Inject/aspirate      ...........  ...........  ...........  ...........  ...........
                             liver cyst.
    47100  C                Wedge biopsy of      ...........  ...........  ...........  ...........  ...........
                             liver.
    47120  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             liver.
    47122  C                Extensive removal    ...........  ...........  ...........  ...........  ...........
                             of liver.
    47125  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             liver.
    47130  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             liver.
    47133  C                Removal of donor     ...........  ...........  ...........  ...........  ...........
                             liver.
    47134  C                Partial removal,     ...........  ...........  ...........  ...........  ...........
                             donor liver.
    47135  C                Transplantation of   ...........  ...........  ...........  ...........  ...........
                             liver.
    47136  C                Transplantation of   ...........  ...........  ...........  ...........  ...........
                             liver.
    47300  C                Surgery for liver    ...........  ...........  ...........  ...........  ...........
                             lesion.
    47350  C                Repair liver wound.  ...........  ...........  ...........  ...........  ...........
    47360  C                Repair liver wound.  ...........  ...........  ...........  ...........  ...........
    47361  C                Repair liver wound.  ...........  ...........  ...........  ...........  ...........
    47362  C                Repair liver wound.  ...........  ...........  ...........  ...........  ...........
   *47379  T                Laparoscope                 0130        25.36    $1,257.75      $659.53      $251.55
                             procedure, liver.
    47399  T                Liver surgery               0005         5.41      $268.32      $119.75       $53.66
                             procedure.
    47400  C                Incision of liver    ...........  ...........  ...........  ...........  ...........
                             duct.
    47420  C                Incision of bile     ...........  ...........  ...........  ...........  ...........
                             duct.
    47425  C                Incision of bile     ...........  ...........  ...........  ...........  ...........
                             duct.
    47460  C                Incise bile duct     ...........  ...........  ...........  ...........  ...........
                             sphincter.
    47480  C                Incision of          ...........  ...........  ...........  ...........  ...........
                             gallbladder.
    47490  C                Incision of          ...........  ...........  ...........  ...........  ...........
                             gallbladder.
    47500  N                Injection for liver  ...........  ...........  ...........  ...........  ...........
                             x-rays.
    47505  N                Injection for liver  ...........  ...........  ...........  ...........  ...........
                             x-rays.
    47510  T                Insert catheter,            0152         8.22      $407.68      $207.38       $81.54
                             bile duct.
    47511  T                Insert bile duct            0152         8.22      $407.68      $207.38       $81.54
                             drain.
    47525  T                Change bile duct            0122         5.04      $249.96      $114.93       $49.99
                             catheter.
    47530  T                Revise/reinsert             0121         2.36      $117.05       $52.53       $23.41
                             bile tube.
    47550  C                Bile duct endoscopy  ...........  ...........  ...........  ...........  ...........
                             add-on.
    47552  T                Biliary endoscopy           0152         8.22      $407.68      $207.38       $81.54
                             thru skin.
    47553  T                Biliary endoscopy           0152         8.22      $407.68      $207.38       $81.54
                             thru skin.
    47554  T                Biliary endoscopy           0152         8.22      $407.68      $207.38       $81.54
                             thru skin.
    47555  T                Biliary endoscopy           0152         8.22      $407.68      $207.38       $81.54
                             thru skin.
    47556  T                Biliary endoscopy           0152         8.22      $407.68      $207.38       $81.54
                             thru skin.
    47560  T                Laparoscopy w/              0130        25.36    $1,257.75      $659.53      $251.55
                             cholangio.
    47561  T                Laparo w/cholangio/         0130        25.36    $1,257.75      $659.53      $251.55
                             biopsy.
    47562  T                Laparoscopic                0131        41.81    $2,073.61    $1,089.88      $414.72
                             cholecystectomy.
    47563  T                Laparo                      0131        41.81    $2,073.61    $1,089.88      $414.72
                             cholecystectomy/
                             graph.

[[Page 67888]]

 
    47564  T                Laparo                      0131        41.81    $2,073.61    $1,089.88      $414.72
                             cholecystectomy/
                             explr.
    47570  C                Laparo               ...........  ...........  ...........  ...........  ...........
                             cholecystoenterost
                             omy.
    47579  T                Laparoscope proc,           0130        25.36    $1,257.75      $659.53      $251.55
                             biliary.
    47600  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             gallbladder.
    47605  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             gallbladder.
    47610  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             gallbladder.
    47612  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             gallbladder.
    47620  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             gallbladder.
    47630  T                Remove bile duct            0152         8.22      $407.68      $207.38       $81.54
                             stone.
    47700  C                Exploration of bile  ...........  ...........  ...........  ...........  ...........
                             ducts.
    47701  C                Bile duct revision.  ...........  ...........  ...........  ...........  ...........
    47711  C                Excision of bile     ...........  ...........  ...........  ...........  ...........
                             duct tumor.
    47712  C                Excision of bile     ...........  ...........  ...........  ...........  ...........
                             duct tumor.
    47715  C                Excision of bile     ...........  ...........  ...........  ...........  ...........
                             duct cyst.
    47716  C                Fusion of bile duct  ...........  ...........  ...........  ...........  ...........
                             cyst.
    47720  C                Fuse gallbladder &   ...........  ...........  ...........  ...........  ...........
                             bowel.
    47721  C                Fuse upper gi        ...........  ...........  ...........  ...........  ...........
                             structures.
    47740  C                Fuse gallbladder &   ...........  ...........  ...........  ...........  ...........
                             bowel.
    47741  C                Fuse gallbladder &   ...........  ...........  ...........  ...........  ...........
                             bowel.
    47760  C                Fuse bile ducts and  ...........  ...........  ...........  ...........  ...........
                             bowel.
    47765  C                Fuse liver ducts &   ...........  ...........  ...........  ...........  ...........
                             bowel.
    47780  C                Fuse bile ducts and  ...........  ...........  ...........  ...........  ...........
                             bowel.
    47785  C                Fuse bile ducts and  ...........  ...........  ...........  ...........  ...........
                             bowel.
    47800  C                Reconstruction of    ...........  ...........  ...........  ...........  ...........
                             bile ducts.
    47801  C                Placement, bile      ...........  ...........  ...........  ...........  ...........
                             duct support.
    47802  C                Fuse liver duct &    ...........  ...........  ...........  ...........  ...........
                             intestine.
    47900  C                Suture bile duct     ...........  ...........  ...........  ...........  ...........
                             injury.
    47999  T                Bile tract surgery          0121         2.36      $117.05       $52.53       $23.41
                             procedure.
    48000  C                Drainage of abdomen  ...........  ...........  ...........  ...........  ...........
    48001  C                Placement of drain,  ...........  ...........  ...........  ...........  ...........
                             pancreas.
    48005  C                Resect/debride       ...........  ...........  ...........  ...........  ...........
                             pancreas.
    48020  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             pancreatic stone.
    48100  C                Biopsy of pancreas.  ...........  ...........  ...........  ...........  ...........
    48102  T                Needle biopsy,              0005         5.41      $268.32      $119.75       $53.66
                             pancreas.
    48120  C                Removal of pancreas  ...........  ...........  ...........  ...........  ...........
                             lesion.
    48140  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             pancreas.
    48145  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             pancreas.
    48146  C                Pancreatectomy.....  ...........  ...........  ...........  ...........  ...........
    48148  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             pancreatic duct.
    48150  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             pancreas.
    48152  C                Pancreatectomy.....  ...........  ...........  ...........  ...........  ...........
    48153  C                Pancreatectomy.....  ...........  ...........  ...........  ...........  ...........
    48154  C                Pancreatectomy.....  ...........  ...........  ...........  ...........  ...........
    48155  C                Removal of pancreas  ...........  ...........  ...........  ...........  ...........
    48160  E                Pancreas removal/    ...........  ...........  ...........  ...........  ...........
                             transplant.
    48180  C                Fuse pancreas and    ...........  ...........  ...........  ...........  ...........
                             bowel.
    48400  C                Injection, intraop   ...........  ...........  ...........  ...........  ...........
                             add-on.
    48500  C                Surgery of pancreas  ...........  ...........  ...........  ...........  ...........
                             cyst.
    48510  C                Drain pancreatic     ...........  ...........  ...........  ...........  ...........
                             pseudocyst.
    48511  C                Drain pancreatic     ...........  ...........  ...........  ...........  ...........
                             pseudocyst.
    48520  C                Fuse pancreas cyst   ...........  ...........  ...........  ...........  ...........
                             and bowel.
    48540  C                Fuse pancreas cyst   ...........  ...........  ...........  ...........  ...........
                             and bowel.
    48545  C                Pancreatorrhaphy...  ...........  ...........  ...........  ...........  ...........
    48547  C                Duodenal exclusion.  ...........  ...........  ...........  ...........  ...........
    48550  E                Donor                ...........  ...........  ...........  ...........  ...........
                             pancreatectomy.
    48554  E                Transpl allograft    ...........  ...........  ...........  ...........  ...........
                             pancreas.
    48556  C                Removal, allograft   ...........  ...........  ...........  ...........  ...........
                             pancreas.
    48999  T                Pancreas surgery            0005         5.41      $268.32      $119.75       $53.66
                             procedure.
    49000  C                Exploration of       ...........  ...........  ...........  ...........  ...........
                             abdomen.
    49002  C                Reopening of         ...........  ...........  ...........  ...........  ...........
                             abdomen.
    49010  C                Exploration behind   ...........  ...........  ...........  ...........  ...........
                             abdomen.
    49020  C                Drain abdominal      ...........  ...........  ...........  ...........  ...........
                             abscess.
    49021  C                Drain abdominal      ...........  ...........  ...........  ...........  ...........
                             abscess.
    49040  C                Drain, open, abdom   ...........  ...........  ...........  ...........  ...........
                             abscess.
    49041  C                Drain, percut,       ...........  ...........  ...........  ...........  ...........
                             abdom abscess.
    49060  C                Drain, open, retrop  ...........  ...........  ...........  ...........  ...........
                             abscess.
    49061  C                Drain, percut,       ...........  ...........  ...........  ...........  ...........
                             retroper absc.
    49062  C                Drain to peritoneal  ...........  ...........  ...........  ...........  ...........
                             cavity.
    49080  T                Puncture,                   0070         3.64      $180.53       $79.60       $36.11
                             peritoneal cavity.
    49081  T                Removal of                  0070         3.64      $180.53       $79.60       $36.11
                             abdominal fluid.
    49085  T                Remove abdomen              0153        19.62      $973.08      $496.31      $194.62
                             foreign body.
    49180  T                Biopsy, abdominal           0005         5.41      $268.32      $119.75       $53.66
                             mass.
    49200  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             abdominal lesion.
    49201  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             abdominal lesion.

[[Page 67889]]

 
    49215  C                Excise sacral spine  ...........  ...........  ...........  ...........  ...........
                             tumor.
    49220  C                Multiple surgery,    ...........  ...........  ...........  ...........  ...........
                             abdomen.
    49250  T                Excision of                 0153        19.62      $973.08      $496.31      $194.62
                             umbilicus.
    49255  C                Removal of omentum.  ...........  ...........  ...........  ...........  ...........
    49320  T                Diag laparo                 0130        25.36    $1,257.75      $659.53      $251.55
                             separate proc.
    49321  T                Laparoscopy, biopsy         0130        25.36    $1,257.75      $659.53      $251.55
    49322  T                Laparoscopy,                0130        25.36    $1,257.75      $659.53      $251.55
                             aspiration.
    49323  T                Laparo drain                0130        25.36    $1,257.75      $659.53      $251.55
                             lymphocele.
    49329  T                Laparo proc, abdm/          0130        25.36    $1,257.75      $659.53      $251.55
                             per/oment.
    49400  N                Air injection into   ...........  ...........  ...........  ...........  ...........
                             abdomen.
    49420  T                Insert abdominal            0153        19.62      $973.08      $496.31      $194.62
                             drain.
    49421  T                Insert abdominal            0153        19.62      $973.08      $496.31      $194.62
                             drain.
    49422  T                Remove perm cannula/        0105        15.06      $746.92      $372.32      $149.38
                             catheter.
    49423  T                Exchange drainage           0153        19.62      $973.08      $496.31      $194.62
                             catheter.
    49424  N                Assess cyst,         ...........  ...........  ...........  ...........  ...........
                             contrast inject.
    49425  C                Insert abdomen-      ...........  ...........  ...........  ...........  ...........
                             venous drain.
    49426  T                Revise abdomen-             0153        19.62      $973.08      $496.31      $194.62
                             venous shunt.
    49427  N                Injection,           ...........  ...........  ...........  ...........  ...........
                             abdominal shunt.
    49428  C                Ligation of shunt..  ...........  ...........  ...........  ...........  ...........
    49429  T                Removal of shunt...         0105        15.06      $746.92      $372.32      $149.38
    49495  T                Repair inguinal             0154        22.43    $1,112.45      $556.98      $222.49
                             hernia, init.
    49496  T                Repair inguinal             0154        22.43    $1,112.45      $556.98      $222.49
                             hernia, init.
    49500  T                Repair inguinal             0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49501  T                Repair inguinal             0154        22.43    $1,112.45      $556.98      $222.49
                             hernia, init.
    49505  T                Repair inguinal             0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49507  T                Repair inguinal             0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49520  T                Rerepair inguinal           0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49521  T                Repair inguinal             0154        22.43    $1,112.45      $556.98      $222.49
                             hernia, rec.
    49525  T                Repair inguinal             0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49540  T                Repair lumbar               0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49550  T                Repair femoral              0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49553  T                Repair femoral              0154        22.43    $1,112.45      $556.98      $222.49
                             hernia, init.
    49555  T                Repair femoral              0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49557  T                Repair femoral              0154        22.43    $1,112.45      $556.98      $222.49
                             hernia, recur.
    49560  T                Repair abdominal            0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49561  T                Repair incisional           0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49565  T                Rerepair abdominal          0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49566  T                Repair incisional           0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49568  T                Hernia repair w/            0154        22.43    $1,112.45      $556.98      $222.49
                             mesh.
    49570  T                Repair epigastric           0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49572  T                Repair epigastric           0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49580  T                Repair umbilical            0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49582  T                Repair umbilical            0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49585  T                Repair umbilical            0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49587  T                Repair umbilical            0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49590  T                Repair abdominal            0154        22.43    $1,112.45      $556.98      $222.49
                             hernia.
    49600  T                Repair umbilical            0154        22.43    $1,112.45      $556.98      $222.49
                             lesion.
    49605  C                Repair umbilical     ...........  ...........  ...........  ...........  ...........
                             lesion.
    49606  C                Repair umbilical     ...........  ...........  ...........  ...........  ...........
                             lesion.
    49610  C                Repair umbilical     ...........  ...........  ...........  ...........  ...........
                             lesion.
    49611  C                Repair umbilical     ...........  ...........  ...........  ...........  ...........
                             lesion.
    49650  T                Laparo hernia               0131        41.81    $2,073.61    $1,089.88      $414.72
                             repair initial.
    49651  T                Laparo hernia               0131        41.81    $2,073.61    $1,089.88      $414.72
                             repair recur.
    49659  T                Laparo proc, hernia         0131        41.81    $2,073.61    $1,089.88      $414.72
                             repair.
    49900  C                Repair of abdominal  ...........  ...........  ...........  ...........  ...........
                             wall.
    49905  C                Omental flap.......  ...........  ...........  ...........  ...........  ...........
    49906  C                Free omental flap,   ...........  ...........  ...........  ...........  ...........
                             microvasc.
    49999  T                Abdomen surgery             0121         2.36      $117.05       $52.53       $23.41
                             procedure.
    50010  C                Exploration of       ...........  ...........  ...........  ...........  ...........
                             kidney.
    50020  C                Renal abscess, open  ...........  ...........  ...........  ...........  ...........
                             drain.
    50021  C                Renal abscess,       ...........  ...........  ...........  ...........  ...........
                             percut drain.
    50040  C                Drainage of kidney.  ...........  ...........  ...........  ...........  ...........
    50045  C                Exploration of       ...........  ...........  ...........  ...........  ...........
                             kidney.
    50060  C                Removal of kidney    ...........  ...........  ...........  ...........  ...........
                             stone.
    50065  C                Incision of kidney.  ...........  ...........  ...........  ...........  ...........
    50070  C                Incision of kidney.  ...........  ...........  ...........  ...........  ...........
    50075  C                Removal of kidney    ...........  ...........  ...........  ...........  ...........
                             stone.
    50080  T                Removal of kidney           0163        28.98    $1,437.30      $792.58      $287.46
                             stone.
    50081  T                Removal of kidney           0163        28.98    $1,437.30      $792.58      $287.46
                             stone.
    50100  C                Revise kidney blood  ...........  ...........  ...........  ...........  ...........
                             vessels.
    50120  C                Exploration of       ...........  ...........  ...........  ...........  ...........
                             kidney.
    50125  C                Explore and drain    ...........  ...........  ...........  ...........  ...........
                             kidney.
    50130  C                Removal of kidney    ...........  ...........  ...........  ...........  ...........
                             stone.
    50135  C                Exploration of       ...........  ...........  ...........  ...........  ...........
                             kidney.

[[Page 67890]]

 
    50200  T                Biopsy of kidney...         0005         5.41      $268.32      $119.75       $53.66
    50205  C                Biopsy of kidney...  ...........  ...........  ...........  ...........  ...........
    50220  C                Removal of kidney..  ...........  ...........  ...........  ...........  ...........
    50225  C                Removal of kidney..  ...........  ...........  ...........  ...........  ...........
    50230  C                Removal of kidney..  ...........  ...........  ...........  ...........  ...........
    50234  C                Removal of kidney &  ...........  ...........  ...........  ...........  ...........
                             ureter.
    50236  C                Removal of kidney &  ...........  ...........  ...........  ...........  ...........
                             ureter.
    50240  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             kidney.
    50280  C                Removal of kidney    ...........  ...........  ...........  ...........  ...........
                             lesion.
    50290  C                Removal of kidney    ...........  ...........  ...........  ...........  ...........
                             lesion.
    50300  C                Removal of donor     ...........  ...........  ...........  ...........  ...........
                             kidney.
    50320  C                Removal of donor     ...........  ...........  ...........  ...........  ...........
                             kidney.
    50340  C                Removal of kidney..  ...........  ...........  ...........  ...........  ...........
    50360  C                Transplantation of   ...........  ...........  ...........  ...........  ...........
                             kidney.
    50365  C                Transplantation of   ...........  ...........  ...........  ...........  ...........
                             kidney.
    50370  C                Remove transplanted  ...........  ...........  ...........  ...........  ...........
                             kidney.
    50380  C                Reimplantation of    ...........  ...........  ...........  ...........  ...........
                             kidney.
    50390  T                Drainage of kidney          0005         5.41      $268.32      $119.75       $53.66
                             lesion.
    50392  T                Insert kidney drain         0160         5.43      $269.30      $110.11       $53.86
    50393  T                Insert ureteral             0160         5.43      $269.30      $110.11       $53.86
                             tube.
    50394  N                Injection for        ...........  ...........  ...........  ...........  ...........
                             kidney x-ray.
    50395  T                Create passage to           0160         5.43      $269.30      $110.11       $53.86
                             kidney.
    50396  T                Measure kidney              0165         3.89      $192.92       $91.76       $38.58
                             pressure.
    50398  T                Change kidney tube.         0122         5.04      $249.96      $114.93       $49.99
    50400  C                Revision of kidney/  ...........  ...........  ...........  ...........  ...........
                             ureter.
    50405  C                Revision of kidney/  ...........  ...........  ...........  ...........  ...........
                             ureter.
    50500  C                Repair of kidney     ...........  ...........  ...........  ...........  ...........
                             wound.
    50520  C                Close kidney-skin    ...........  ...........  ...........  ...........  ...........
                             fistula.
    50525  C                Repair renal-        ...........  ...........  ...........  ...........  ...........
                             abdomen fistula.
    50526  C                Repair renal-        ...........  ...........  ...........  ...........  ...........
                             abdomen fistula.
    50540  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             horseshoe kidney.
    50541  T                Laparo ablate renal         0131        41.81    $2,073.61    $1,089.88      $414.72
                             cyst.
    50544  T                Laparoscopy,                0131        41.81    $2,073.61    $1,089.88      $414.72
                             pyeloplasty.
   *50545  C                Laparo radical       ...........  ...........  ...........  ...........  ...........
                             nephrectomy.
    50546  C                Laparoscopic         ...........  ...........  ...........  ...........  ...........
                             nephrectomy.
    50547  C                Laparo removal       ...........  ...........  ...........  ...........  ...........
                             donor kidney.
    50548  C                Laparo-asst remove   ...........  ...........  ...........  ...........  ...........
                             k/ureter.
    50549  T                Laparoscope proc,           0130        25.36    $1,257.75      $659.53      $251.55
                             renal.
    50551  T                Kidney endoscopy...         0161        10.94      $542.58      $249.36      $108.52
    50553  T                Kidney endoscopy...         0161        10.94      $542.58      $249.36      $108.52
    50555  T                Kidney endoscopy &          0161        10.94      $542.58      $249.36      $108.52
                             biopsy.
    50557  T                Kidney endoscopy &          0161        10.94      $542.58      $249.36      $108.52
                             treatment.
    50559  T                Renal endoscopy/            0161        10.94      $542.58      $249.36      $108.52
                             radiotracer.
    50561  T                Kidney endoscopy &          0161        10.94      $542.58      $249.36      $108.52
                             treatment.
    50570  C                Kidney endoscopy...  ...........  ...........  ...........  ...........  ...........
    50572  C                Kidney endoscopy...  ...........  ...........  ...........  ...........  ...........
    50574  C                Kidney endoscopy &   ...........  ...........  ...........  ...........  ...........
                             biopsy.
    50575  C                Kidney endoscopy...  ...........  ...........  ...........  ...........  ...........
    50576  C                Kidney endoscopy &   ...........  ...........  ...........  ...........  ...........
                             treatment.
    50578  C                Renal endoscopy/     ...........  ...........  ...........  ...........  ...........
                             radiotracer.
    50580  C                Kidney endoscopy &   ...........  ...........  ...........  ...........  ...........
                             treatment.
    50590  T                Fragmenting of              0169        46.72    $2,317.13    $1,384.20      $463.43
                             kidney stone.
    50600  C                Exploration of       ...........  ...........  ...........  ...........  ...........
                             ureter.
    50605  C                Insert ureteral      ...........  ...........  ...........  ...........  ...........
                             support.
    50610  C                Removal of ureter    ...........  ...........  ...........  ...........  ...........
                             stone.
    50620  C                Removal of ureter    ...........  ...........  ...........  ...........  ...........
                             stone.
    50630  C                Removal of ureter    ...........  ...........  ...........  ...........  ...........
                             stone.
    50650  C                Removal of ureter..  ...........  ...........  ...........  ...........  ...........
    50660  C                Removal of ureter..  ...........  ...........  ...........  ...........  ...........
    50684  N                Injection for        ...........  ...........  ...........  ...........  ...........
                             ureter x-ray.
    50686  T                Measure ureter              0165         3.89      $192.92       $91.76       $38.58
                             pressure.
    50688  T                Change of ureter            0121         2.36      $117.05       $52.53       $23.41
                             tube.
    50690  N                Injection for        ...........  ...........  ...........  ...........  ...........
                             ureter x-ray.
    50700  C                Revision of ureter.  ...........  ...........  ...........  ...........  ...........
    50715  C                Release of ureter..  ...........  ...........  ...........  ...........  ...........
    50722  C                Release of ureter..  ...........  ...........  ...........  ...........  ...........
    50725  C                Release/revise       ...........  ...........  ...........  ...........  ...........
                             ureter.
    50727  C                Revise ureter......  ...........  ...........  ...........  ...........  ...........
    50728  C                Revise ureter......  ...........  ...........  ...........  ...........  ...........
    50740  C                Fusion of ureter &   ...........  ...........  ...........  ...........  ...........
                             kidney.
    50750  C                Fusion of ureter &   ...........  ...........  ...........  ...........  ...........
                             kidney.
    50760  C                Fusion of ureters..  ...........  ...........  ...........  ...........  ...........
    50770  C                Splicing of ureters  ...........  ...........  ...........  ...........  ...........
    50780  C                Reimplant ureter in  ...........  ...........  ...........  ...........  ...........
                             bladder.

[[Page 67891]]

 
    50782  C                Reimplant ureter in  ...........  ...........  ...........  ...........  ...........
                             bladder.
    50783  C                Reimplant ureter in  ...........  ...........  ...........  ...........  ...........
                             bladder.
    50785  C                Reimplant ureter in  ...........  ...........  ...........  ...........  ...........
                             bladder.
    50800  C                Implant ureter in    ...........  ...........  ...........  ...........  ...........
                             bowel.
    50810  C                Fusion of ureter &   ...........  ...........  ...........  ...........  ...........
                             bowel.
    50815  C                Urine shunt to       ...........  ...........  ...........  ...........  ...........
                             bowel.
    50820  C                Construct bowel      ...........  ...........  ...........  ...........  ...........
                             bladder.
    50825  C                Construct bowel      ...........  ...........  ...........  ...........  ...........
                             bladder.
    50830  C                Revise urine flow..  ...........  ...........  ...........  ...........  ...........
    50840  C                Replace ureter by    ...........  ...........  ...........  ...........  ...........
                             bowel.
    50845  C                Appendico-           ...........  ...........  ...........  ...........  ...........
                             vesicostomy.
    50860  C                Transplant ureter    ...........  ...........  ...........  ...........  ...........
                             to skin.
    50900  C                Repair of ureter...  ...........  ...........  ...........  ...........  ...........
    50920  C                Closure ureter/skin  ...........  ...........  ...........  ...........  ...........
                             fistula.
    50930  C                Closure ureter/      ...........  ...........  ...........  ...........  ...........
                             bowel fistula.
    50940  C                Release of ureter..  ...........  ...........  ...........  ...........  ...........
    50945  T                Laparoscopy                 0131        41.81    $2,073.61    $1,089.88      $414.72
                             ureterolithotomy.
   *50947  T                Laparoscopy new             0130        25.36    $1,257.75      $659.53      $251.55
                             ureter/bladder.
   *50948  T                Laparoscopy new             0130        25.36    $1,257.75      $659.53      $251.55
                             ureter/bladder.
   *50949  T                Laparoscope proc,           0130        25.36    $1,257.75      $659.53      $251.55
                             ureter.
    50951  T                Endoscopy of ureter         0162        17.49      $867.44      $427.49      $173.49
    50953  T                Endoscopy of ureter         0162        17.49      $867.44      $427.49      $173.49
    50955  T                Ureter endoscopy &          0162        17.49      $867.44      $427.49      $173.49
                             biopsy.
    50957  T                Ureter endoscopy &          0162        17.49      $867.44      $427.49      $173.49
                             treatment.
    50959  T                Ureter endoscopy &          0162        17.49      $867.44      $427.49      $173.49
                             tracer.
    50961  T                Ureter endoscopy &          0162        17.49      $867.44      $427.49      $173.49
                             treatment.
    50970  T                Ureter endoscopy...         0162        17.49      $867.44      $427.49      $173.49
    50972  T                Ureter endoscopy &          0162        17.49      $867.44      $427.49      $173.49
                             catheter.
    50974  T                Ureter endoscopy &          0162        17.49      $867.44      $427.49      $173.49
                             biopsy.
    50976  T                Ureter endoscopy &          0162        17.49      $867.44      $427.49      $173.49
                             treatment.
    50978  T                Ureter endoscopy &          0162        17.49      $867.44      $427.49      $173.49
                             tracer.
    50980  T                Ureter endoscopy &          0162        17.49      $867.44      $427.49      $173.49
                             treatment.
    51000  T                Drainage of bladder         0165         3.89      $192.92       $91.76       $38.58
    51005  T                Drainage of bladder         0164         2.17      $107.64       $33.03       $21.53
    51010  T                Drainage of bladder         0165         3.89      $192.92       $91.76       $38.58
    51020  T                Incise & treat              0162        17.49      $867.44      $427.49      $173.49
                             bladder.
    51030  T                Incise & treat              0162        17.49      $867.44      $427.49      $173.49
                             bladder.
    51040  T                Incise & drain              0162        17.49      $867.44      $427.49      $173.49
                             bladder.
    51045  T                Incise bladder/             0162        17.49      $867.44      $427.49      $173.49
                             drain ureter.
    51050  T                Removal of bladder          0162        17.49      $867.44      $427.49      $173.49
                             stone.
    51060  C                Removal of ureter    ...........  ...........  ...........  ...........  ...........
                             stone.
    51065  T                Removal of ureter           0162        17.49      $867.44      $427.49      $173.49
                             stone.
    51080  T                Drainage of bladder         0008         6.15      $305.02      $113.67       $61.00
                             abscess.
    51500  T                Removal of bladder          0154        22.43    $1,112.45      $556.98      $222.49
                             cyst.
    51520  T                Removal of bladder          0162        17.49      $867.44      $427.49      $173.49
                             lesion.
    51525  C                Removal of bladder   ...........  ...........  ...........  ...........  ...........
                             lesion.
    51530  C                Removal of bladder   ...........  ...........  ...........  ...........  ...........
                             lesion.
    51535  C                Repair of ureter     ...........  ...........  ...........  ...........  ...........
                             lesion.
    51550  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             bladder.
    51555  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             bladder.
    51565  C                Revise bladder &     ...........  ...........  ...........  ...........  ...........
                             ureter(s).
    51570  C                Removal of bladder.  ...........  ...........  ...........  ...........  ...........
    51575  C                Removal of bladder   ...........  ...........  ...........  ...........  ...........
                             & nodes.
    51580  C                Remove bladder/      ...........  ...........  ...........  ...........  ...........
                             revise tract.
    51585  C                Removal of bladder   ...........  ...........  ...........  ...........  ...........
                             & nodes.
    51590  C                Remove bladder/      ...........  ...........  ...........  ...........  ...........
                             revise tract.
    51595  C                Remove bladder/      ...........  ...........  ...........  ...........  ...........
                             revise tract.
    51596  C                Remove bladder/      ...........  ...........  ...........  ...........  ...........
                             create pouch.
    51597  C                Removal of pelvic    ...........  ...........  ...........  ...........  ...........
                             structures.
    51600  N                Injection for        ...........  ...........  ...........  ...........  ...........
                             bladder x-ray.
    51605  N                Preparation for      ...........  ...........  ...........  ...........  ...........
                             bladder xray.
    51610  N                Injection for        ...........  ...........  ...........  ...........  ...........
                             bladder x-ray.
    51700  T                Irrigation of               0164         2.17      $107.64       $33.03       $21.53
                             bladder.
    51705  T                Change of bladder           0121         2.36      $117.05       $52.53       $23.41
                             tube.
    51710  T                Change of bladder           0121         2.36      $117.05       $52.53       $23.41
                             tube.
    51715  T                Endoscopic                  0167        21.06    $1,044.50      $555.84      $208.90
                             injection/implant.
    51720  T                Treatment of                0165         3.89      $192.92       $91.76       $38.58
                             bladder lesion.
    51725  T                Simple                      0165         3.89      $192.92       $91.76       $38.58
                             cystometrogram.
    51726  T                Complex                     0165         3.89      $192.92       $91.76       $38.58
                             cystometrogram.
    51736  T                Urine flow                  0164         2.17      $107.64       $33.03       $21.53
                             measurement.
    51741  T                Electro-                    0164         2.17      $107.64       $33.03       $21.53
                             uroflowmetry,
                             first.
    51772  T                Urethra pressure            0165         3.89      $192.92       $91.76       $38.58
                             profile.
    51784  T                Anal/urinary muscle         0164         2.17      $107.64       $33.03       $21.53
                             study.
    51785  T                Anal/urinary muscle         0164         2.17      $107.64       $33.03       $21.53
                             study.

[[Page 67892]]

 
    51792  T                Urinary reflex              0165         3.89      $192.92       $91.76       $38.58
                             study.
    51795  T                Urine voiding               0164         2.17      $107.64       $33.03       $21.53
                             pressure study.
    51797  T                Intraabdominal              0164         2.17      $107.64       $33.03       $21.53
                             pressure test.
    51800  C                Revision of bladder/ ...........  ...........  ...........  ...........  ...........
                             urethra.
    51820  C                Revision of urinary  ...........  ...........  ...........  ...........  ...........
                             tract.
    51840  C                Attach bladder/      ...........  ...........  ...........  ...........  ...........
                             urethra.
    51841  C                Attach bladder/      ...........  ...........  ...........  ...........  ...........
                             urethra.
    51845  C                Repair bladder neck  ...........  ...........  ...........  ...........  ...........
    51860  C                Repair of bladder    ...........  ...........  ...........  ...........  ...........
                             wound.
    51865  C                Repair of bladder    ...........  ...........  ...........  ...........  ...........
                             wound.
    51880  T                Repair of bladder           0162        17.49      $867.44      $427.49      $173.49
                             opening.
    51900  C                Repair bladder/      ...........  ...........  ...........  ...........  ...........
                             vagina lesion.
    51920  C                Close bladder-       ...........  ...........  ...........  ...........  ...........
                             uterus fistula.
    51925  C                Hysterectomy/        ...........  ...........  ...........  ...........  ...........
                             bladder repair.
    51940  C                Correction of        ...........  ...........  ...........  ...........  ...........
                             bladder defect.
    51960  C                Revision of bladder  ...........  ...........  ...........  ...........  ...........
                             & bowel.
    51980  C                Construct bladder    ...........  ...........  ...........  ...........  ...........
                             opening.
    51990  T                Laparo urethral             0131        41.81    $2,073.61    $1,089.88      $414.72
                             suspension.
    51992  T                Laparo sling                0132        48.91    $2,425.74    $1,239.22      $485.15
                             operation.
    52000  T                Cystoscopy.........         0160         5.43      $269.30      $110.11       $53.86
    52005  T                Cystoscopy & ureter         0161        10.94      $542.58      $249.36      $108.52
                             catheter.
    52007  T                Cystoscopy and              0161        10.94      $542.58      $249.36      $108.52
                             biopsy.
    52010  T                Cystoscopy & duct           0161        10.94      $542.58      $249.36      $108.52
                             catheter.
    52204  T                Cystoscopy.........         0161        10.94      $542.58      $249.36      $108.52
    52214  T                Cystoscopy and              0161        10.94      $542.58      $249.36      $108.52
                             treatment.
    52224  T                Cystoscopy and              0161        10.94      $542.58      $249.36      $108.52
                             treatment.
    52234  T                Cystoscopy and              0162        17.49      $867.44      $427.49      $173.49
                             treatment.
    52235  T                Cystoscopy and              0162        17.49      $867.44      $427.49      $173.49
                             treatment.
    52240  T                Cystoscopy and              0163        28.98    $1,437.30      $792.58      $287.46
                             treatment.
    52250  T                Cystoscopy and              0162        17.49      $867.44      $427.49      $173.49
                             radiotracer.
    52260  T                Cystoscopy and              0161        10.94      $542.58      $249.36      $108.52
                             treatment.
    52265  T                Cystoscopy and              0160         5.43      $269.30      $110.11       $53.86
                             treatment.
    52270  T                Cystoscopy & revise         0161        10.94      $542.58      $249.36      $108.52
                             urethra.
    52275  T                Cystoscopy & revise         0161        10.94      $542.58      $249.36      $108.52
                             urethra.
    52276  T                Cystoscopy and              0161        10.94      $542.58      $249.36      $108.52
                             treatment.
    52277  T                Cystoscopy and              0162        17.49      $867.44      $427.49      $173.49
                             treatment.
    52281  T                Cystoscopy and              0161        10.94      $542.58      $249.36      $108.52
                             treatment.
    52282  T                Cystoscopy, implant         0162        17.49      $867.44      $427.49      $173.49
                             stent.
    52283  T                Cystoscopy and              0161        10.94      $542.58      $249.36      $108.52
                             treatment.
    52285  T                Cystoscopy and              0161        10.94      $542.58      $249.36      $108.52
                             treatment.
    52290  T                Cystoscopy and              0161        10.94      $542.58      $249.36      $108.52
                             treatment.
    52300  T                Cystoscopy and              0161        10.94      $542.58      $249.36      $108.52
                             treatment.
    52301  T                Cystoscopy and              0161        10.94      $542.58      $249.36      $108.52
                             treatment.
    52305  T                Cystoscopy and              0161        10.94      $542.58      $249.36      $108.52
                             treatment.
    52310  T                Cystoscopy and              0161        10.94      $542.58      $249.36      $108.52
                             treatment.
    52315  T                Cystoscopy and              0161        10.94      $542.58      $249.36      $108.52
                             treatment.
    52317  T                Remove bladder              0162        17.49      $867.44      $427.49      $173.49
                             stone.
    52318  T                Remove bladder              0162        17.49      $867.44      $427.49      $173.49
                             stone.
    52320  T                Cystoscopy and              0162        17.49      $867.44      $427.49      $173.49
                             treatment.
    52325  T                Cystoscopy, stone           0162        17.49      $867.44      $427.49      $173.49
                             removal.
    52327  T                Cystoscopy, inject          0161        10.94      $542.58      $249.36      $108.52
                             material.
    52330  T                Cystoscopy and              0162        17.49      $867.44      $427.49      $173.49
                             treatment.
    52332  T                Cystoscopy and              0162        17.49      $867.44      $427.49      $173.49
                             treatment.
    52334  T                Create passage to           0162        17.49      $867.44      $427.49      $173.49
                             kidney.
   52335D  T                Endoscopy of                0162        17.49      $867.44      $427.49      $173.49
                             urinary tract.
   52336D  T                Cystoscopy, stone           0162        17.49      $867.44      $427.49      $173.49
                             removal.
   52337D  T                Cystoscopy, stone           0162        17.49      $867.44      $427.49      $173.49
                             removal.
   52338D  T                Cystoscopy and              0162        17.49      $867.44      $427.49      $173.49
                             treatment.
   52339D  T                Cystoscopy and              0162        17.49      $867.44      $427.49      $173.49
                             treatment.
   52340D  T                Cystoscopy and              0162        17.49      $867.44      $427.49      $173.49
                             treatment.
   *52341  T                Cysto w/ureter              0162        17.49      $867.44      $427.49      $173.49
                             stricture
                             treatment.
   *52342  T                Cysto w/up                  0162        17.49      $867.44      $427.49      $173.49
                             stricture
                             treatment.
   *52343  T                Cysto w/renal               0162        17.49      $867.44      $427.49      $173.49
                             stricture
                             treatment.
   *52344  T                Cysto/uretero,              0162        17.49      $867.44      $427.49      $173.49
                             stone removal.
   *52345  T                Cysto/uretero w/up          0162        17.49      $867.44      $427.49      $173.49
                             stricture.
   *52346  T                Cystouretero w/             0162        17.49      $867.44      $427.49      $173.49
                             renal strict.
   *52351  T                Cystouretero &/or           0161        10.94      $542.58      $249.36      $108.52
                             pyeloscope.
   *52352  T                Cystouretero w/             0162        17.49      $867.44      $427.49      $173.49
                             stone removal.
   *52353  T                Cystouretero w/             0162        17.49      $867.44      $427.49      $173.49
                             lithotripsy.
   *52354  T                Cystouretero w/             0162        17.49      $867.44      $427.49      $173.49
                             biopsy.
   *52355  T                Cystouretero w/             0162        17.49      $867.44      $427.49      $173.49
                             excise tumor.
   *52400  T                Cystouretero w/             0162        17.49      $867.44      $427.49      $173.49
                             congen repr.
    52450  T                Incision of                 0162        17.49      $867.44      $427.49      $173.49
                             prostate.
    52500  T                Revision of bladder         0162        17.49      $867.44      $427.49      $173.49
                             neck.

[[Page 67893]]

 
    52510  T                Dilation prostatic          0161        10.94      $542.58      $249.36      $108.52
                             urethra.
    52601  T                Prostatectomy               0163        28.98    $1,437.30      $792.58      $287.46
                             (TURP).
    52606  T                Control postop              0162        17.49      $867.44      $427.49      $173.49
                             bleeding.
    52612  T                Prostatectomy,              0163        28.98    $1,437.30      $792.58      $287.46
                             first stage.
    52614  T                Prostatectomy,              0163        28.98    $1,437.30      $792.58      $287.46
                             second stage.
    52620  T                Remove residual             0163        28.98    $1,437.30      $792.58      $287.46
                             prostate.
    52630  T                Remove prostate             0163        28.98    $1,437.30      $792.58      $287.46
                             regrowth.
    52640  T                Relieve bladder             0162        17.49      $867.44      $427.49      $173.49
                             contracture.
    52647  T                Laser surgery of            0163        28.98    $1,437.30      $792.58      $287.46
                             prostate.
    52648  T                Laser surgery of            0163        28.98    $1,437.30      $792.58      $287.46
                             prostate.
    52700  T                Drainage of                 0162        17.49      $867.44      $427.49      $173.49
                             prostate abscess.
    53000  T                Incision of urethra         0166        10.17      $504.39      $218.73      $100.88
    53010  T                Incision of urethra         0166        10.17      $504.39      $218.73      $100.88
    53020  T                Incision of urethra         0166        10.17      $504.39      $218.73      $100.88
    53025  T                Incision of urethra         0166        10.17      $504.39      $218.73      $100.88
    53040  T                Drainage of urethra         0166        10.17      $504.39      $218.73      $100.88
                             abscess.
    53060  T                Drainage of urethra         0166        10.17      $504.39      $218.73      $100.88
                             abscess.
    53080  T                Drainage of urinary         0166        10.17      $504.39      $218.73      $100.88
                             leakage.
    53085  C                Drainage of urinary  ...........  ...........  ...........  ...........  ...........
                             leakage.
    53200  T                Biopsy of urethra..         0166        10.17      $504.39      $218.73      $100.88
    53210  T                Removal of urethra.         0168        24.94    $1,236.93      $536.11      $247.39
    53215  T                Removal of urethra.         0168        24.94    $1,236.93      $536.11      $247.39
    53220  T                Treatment of                0168        24.94    $1,236.93      $536.11      $247.39
                             urethra lesion.
    53230  T                Removal of urethra          0168        24.94    $1,236.93      $536.11      $247.39
                             lesion.
    53235  T                Removal of urethra          0168        24.94    $1,236.93      $536.11      $247.39
                             lesion.
    53240  T                Surgery for urethra         0168        24.94    $1,236.93      $536.11      $247.39
                             pouch.
    53250  T                Removal of urethra          0166        10.17      $504.39      $218.73      $100.88
                             gland.
    53260  T                Treatment of                0166        10.17      $504.39      $218.73      $100.88
                             urethra lesion.
    53265  T                Treatment of                0166        10.17      $504.39      $218.73      $100.88
                             urethra lesion.
    53270  T                Removal of urethra          0167        21.06    $1,044.50      $555.84      $208.90
                             gland.
    53275  T                Repair of urethra           0166        10.17      $504.39      $218.73      $100.88
                             defect.
    53400  T                Revise urethra,             0168        24.94    $1,236.93      $536.11      $247.39
                             stage 1.
    53405  T                Revise urethra,             0168        24.94    $1,236.93      $536.11      $247.39
                             stage 2.
    53410  T                Reconstruction of           0168        24.94    $1,236.93      $536.11      $247.39
                             urethra.
    53415  C                Reconstruction of    ...........  ...........  ...........  ...........  ...........
                             urethra.
    53420  T                Reconstruct                 0168        24.94    $1,236.93      $536.11      $247.39
                             urethra, stage 1.
    53425  T                Reconstruct                 0168        24.94    $1,236.93      $536.11      $247.39
                             urethra, stage 2.
    53430  T                Reconstruction of           0168        24.94    $1,236.93      $536.11      $247.39
                             urethra.
    53440  T                Correct bladder             0182        52.11    $2,584.45    $1,525.05      $516.89
                             function.
    53442  T                Remove perineal             0166        10.17      $504.39      $218.73      $100.88
                             prosthesis.
    53443  C                Reconstruction of    ...........  ...........  ...........  ...........  ...........
                             urethra.
    53445  T                Correct urine flow          0182        52.11    $2,584.45    $1,525.05      $516.89
                             control.
    53447  T                Remove artificial           0168        24.94    $1,236.93      $536.11      $247.39
                             sphincter.
    53449  T                Correct artificial          0168        24.94    $1,236.93      $536.11      $247.39
                             sphincter.
    53450  T                Revision of urethra         0168        24.94    $1,236.93      $536.11      $247.39
    53460  T                Revision of urethra         0168        24.94    $1,236.93      $536.11      $247.39
    53502  T                Repair of urethra           0166        10.17      $504.39      $218.73      $100.88
                             injury.
    53505  T                Repair of urethra           0167        21.06    $1,044.50      $555.84      $208.90
                             injury.
    53510  T                Repair of urethra           0166        10.17      $504.39      $218.73      $100.88
                             injury.
    53515  T                Repair of urethra           0168        24.94    $1,236.93      $536.11      $247.39
                             injury.
    53520  T                Repair of urethra           0168        24.94    $1,236.93      $536.11      $247.39
                             defect.
    53600  T                Dilate urethra              0164         2.17      $107.64       $33.03       $21.53
                             stricture.
    53601  T                Dilate urethra              0164         2.17      $107.64       $33.03       $21.53
                             stricture.
    53605  T                Dilate urethra              0161        10.94      $542.58      $249.36      $108.52
                             stricture.
    53620  T                Dilate urethra              0165         3.89      $192.92       $91.76       $38.58
                             stricture.
    53621  T                Dilate urethra              0164         2.17      $107.64       $33.03       $21.53
                             stricture.
    53660  T                Dilation of urethra         0164         2.17      $107.64       $33.03       $21.53
    53661  T                Dilation of urethra         0164         2.17      $107.64       $33.03       $21.53
    53665  T                Dilation of urethra         0166        10.17      $504.39      $218.73      $100.88
    53670  N                Insert urinary       ...........  ...........  ...........  ...........  ...........
                             catheter.
    53675  T                Insert urinary              0164         2.17      $107.64       $33.03       $21.53
                             catheter.
    53850  T                Prostatic microwave         0980        38.67    $1,917.89  ...........      $383.58
                             thermotx.
    53852  T                Prostatic rf                0980        38.67    $1,917.89  ...........      $383.58
                             thermotx.
    53899  T                Urology surgery             0165         3.89      $192.92       $91.76       $38.58
                             procedure.
    54000  T                Slitting of prepuce         0166        10.17      $504.39      $218.73      $100.88
    54001  T                Slitting of prepuce         0166        10.17      $504.39      $218.73      $100.88
    54015  T                Drain penis lesion.         0008         6.15      $305.02      $113.67       $61.00
    54050  T                Destruction, penis          0013         0.91       $45.13       $17.66        $9.03
                             lesion(s).
    54055  T                Destruction, penis          0016         3.53      $175.07       $74.67       $35.01
                             lesion(s).
    54056  T                Cryosurgery, penis          0013         0.91       $45.13       $17.66        $9.03
                             lesion(s).
    54057  T                Laser surg, penis           0017        12.45      $617.47      $289.16      $123.49
                             lesion(s).
    54060  T                Excision of penis           0017        12.45      $617.47      $289.16      $123.49
                             lesion(s).
    54065  T                Destruction, penis          0017        12.45      $617.47      $289.16      $123.49
                             lesion(s).
    54100  T                Biopsy of penis....         0020         6.51      $322.87      $130.53       $64.57

[[Page 67894]]

 
    54105  T                Biopsy of penis....         0021        10.49      $520.26      $236.51      $104.05
    54110  T                Treatment of penis          0181        32.37    $1,605.43      $906.36      $321.09
                             lesion.
    54111  T                Treat penis lesion,         0181        32.37    $1,605.43      $906.36      $321.09
                             graft.
    54112  T                Treat penis lesion,         0181        32.37    $1,605.43      $906.36      $321.09
                             graft.
    54115  T                Treatment of penis          0008         6.15      $305.02      $113.67       $61.00
                             lesion.
    54120  T                Partial removal of          0181        32.37    $1,605.43      $906.36      $321.09
                             penis.
    54125  C                Removal of penis...  ...........  ...........  ...........  ...........  ...........
    54130  C                Remove penis &       ...........  ...........  ...........  ...........  ...........
                             nodes.
    54135  C                Remove penis &       ...........  ...........  ...........  ...........  ...........
                             nodes.
    54150  T                Circumcision.......         0180        13.62      $675.49      $304.87      $135.10
    54152  T                Circumcision.......         0180        13.62      $675.49      $304.87      $135.10
    54160  T                Circumcision.......         0180        13.62      $675.49      $304.87      $135.10
    54161  T                Circumcision.......         0180        13.62      $675.49      $304.87      $135.10
    54200  T                Treatment of penis          0165         3.89      $192.92       $91.76       $38.58
                             lesion.
    54205  T                Treatment of penis          0181        32.37    $1,605.43      $906.36      $321.09
                             lesion.
    54220  T                Treatment of penis          0165         3.89      $192.92       $91.76       $38.58
                             lesion.
    54230  N                Prepare penis study  ...........  ...........  ...........  ...........  ...........
    54231  T                Dynamic                     0165         3.89      $192.92       $91.76       $38.58
                             cavernosometry.
    54235  T                Penile injection...         0164         2.17      $107.64       $33.03       $21.53
    54240  T                Penis study........         0164         2.17      $107.64       $33.03       $21.53
    54250  T                Penis study........         0165         3.89      $192.92       $91.76       $38.58
    54300  T                Revision of penis..         0181        32.37    $1,605.43      $906.36      $321.09
    54304  T                Revision of penis..         0181        32.37    $1,605.43      $906.36      $321.09
    54308  T                Reconstruction of           0181        32.37    $1,605.43      $906.36      $321.09
                             urethra.
    54312  T                Reconstruction of           0181        32.37    $1,605.43      $906.36      $321.09
                             urethra.
    54316  T                Reconstruction of           0181        32.37    $1,605.43      $906.36      $321.09
                             urethra.
    54318  T                Reconstruction of           0181        32.37    $1,605.43      $906.36      $321.09
                             urethra.
    54322  T                Reconstruction of           0181        32.37    $1,605.43      $906.36      $321.09
                             urethra.
    54324  T                Reconstruction of           0181        32.37    $1,605.43      $906.36      $321.09
                             urethra.
    54326  T                Reconstruction of           0181        32.37    $1,605.43      $906.36      $321.09
                             urethra.
    54328  T                Revise penis/               0181        32.37    $1,605.43      $906.36      $321.09
                             urethra.
    54332  C                Revise penis/        ...........  ...........  ...........  ...........  ...........
                             urethra.
    54336  C                Revise penis/        ...........  ...........  ...........  ...........  ...........
                             urethra.
    54340  T                Secondary urethral          0181        32.37    $1,605.43      $906.36      $321.09
                             surgery.
    54344  T                Secondary urethral          0181        32.37    $1,605.43      $906.36      $321.09
                             surgery.
    54348  T                Secondary urethral          0181        32.37    $1,605.43      $906.36      $321.09
                             surgery.
    54352  T                Reconstruct urethra/        0181        32.37    $1,605.43      $906.36      $321.09
                             penis.
    54360  T                Penis plastic               0181        32.37    $1,605.43      $906.36      $321.09
                             surgery.
    54380  T                Repair penis.......         0181        32.37    $1,605.43      $906.36      $321.09
    54385  T                Repair penis.......         0181        32.37    $1,605.43      $906.36      $321.09
    54390  C                Repair penis and     ...........  ...........  ...........  ...........  ...........
                             bladder.
    54400  T                Insert semi-rigid           0182        52.11    $2,584.45    $1,525.05      $516.89
                             prosthesis.
    54401  T                Insert self-contd           0182        52.11    $2,584.45    $1,525.05      $516.89
                             prosthesis.
    54402  T                Remove penis                0185        32.37    $1,605.43      $906.36      $321.09
                             prosthesis.
    54405  T                Insert multi-comp           0182        52.11    $2,584.45    $1,525.05      $516.89
                             prosthesis.
    54407  T                Remove multi-comp           0185        32.37    $1,605.43      $906.36      $321.09
                             prosthesis.
    54409  T                Revise penis                0185        32.37    $1,605.43      $906.36      $321.09
                             prosthesis.
    54420  T                Revision of penis..         0181        32.37    $1,605.43      $906.36      $321.09
    54430  C                Revision of penis..  ...........  ...........  ...........  ...........  ...........
    54435  T                Revision of penis..         0181        32.37    $1,605.43      $906.36      $321.09
    54440  T                Repair of penis....         0181        32.37    $1,605.43      $906.36      $321.09
    54450  T                Preputial                   0165         3.89      $192.92       $91.76       $38.58
                             stretching.
    54500  T                Biopsy of testis...         0005         5.41      $268.32      $119.75       $53.66
    54505  T                Biopsy of testis...         0183        18.26      $905.62      $448.94      $181.12
    54510  T                Removal of testis           0183        18.26      $905.62      $448.94      $181.12
                             lesion.
   *54512  T                Excise lesion               0183        18.26      $905.62      $448.94      $181.12
                             testis.
    54520  T                Removal of testis..         0183        18.26      $905.62      $448.94      $181.12
   *54522  T                Orchiectomy,                0183        18.26      $905.62      $448.94      $181.12
                             partial.
    54530  T                Removal of testis..         0154        22.43    $1,112.45      $556.98      $222.49
    54535  C                Extensive testis     ...........  ...........  ...........  ...........  ...........
                             surgery.
    54550  T                Exploration for             0154        22.43    $1,112.45      $556.98      $222.49
                             testis.
    54560  C                Exploration for      ...........  ...........  ...........  ...........  ...........
                             testis.
    54600  T                Reduce testis               0183        18.26      $905.62      $448.94      $181.12
                             torsion.
    54620  T                Suspension of               0183        18.26      $905.62      $448.94      $181.12
                             testis.
    54640  T                Suspension of               0154        22.43    $1,112.45      $556.98      $222.49
                             testis.
    54650  C                Orchiopexy (Fowler-  ...........  ...........  ...........  ...........  ...........
                             Stephens).
    54660  T                Revision of testis.         0183        18.26      $905.62      $448.94      $181.12
    54670  T                Repair testis               0183        18.26      $905.62      $448.94      $181.12
                             injury.
    54680  T                Relocation of               0183        18.26      $905.62      $448.94      $181.12
                             testis(es).
    54690  T                Laparoscopy,                0131        41.81    $2,073.61    $1,089.88      $414.72
                             orchiectomy.
    54692  T                Laparoscopy,                0132        48.91    $2,425.74    $1,239.22      $485.15
                             orchiopexy.
    54699  T                Laparoscope proc,           0130        25.36    $1,257.75      $659.53      $251.55
                             testis.
    54700  T                Drainage of scrotum         0183        18.26      $905.62      $448.94      $181.12
    54800  T                Biopsy of                   0004         1.84       $91.26       $32.57       $18.25
                             epididymis.

[[Page 67895]]

 
    54820  T                Exploration of              0183        18.26      $905.62      $448.94      $181.12
                             epididymis.
    54830  T                Remove epididymis           0183        18.26      $905.62      $448.94      $181.12
                             lesion.
    54840  T                Remove epididymis           0183        18.26      $905.62      $448.94      $181.12
                             lesion.
    54860  T                Removal of                  0183        18.26      $905.62      $448.94      $181.12
                             epididymis.
    54861  T                Removal of                  0183        18.26      $905.62      $448.94      $181.12
                             epididymis.
    54900  T                Fusion of spermatic         0183        18.26      $905.62      $448.94      $181.12
                             ducts.
    54901  T                Fusion of spermatic         0183        18.26      $905.62      $448.94      $181.12
                             ducts.
    55000  T                Drainage of                 0004         1.84       $91.26       $32.57       $18.25
                             hydrocele.
    55040  T                Removal of                  0154        22.43    $1,112.45      $556.98      $222.49
                             hydrocele.
    55041  T                Removal of                  0154        22.43    $1,112.45      $556.98      $222.49
                             hydroceles.
    55060  T                Repair of hydrocele         0183        18.26      $905.62      $448.94      $181.12
    55100  T                Drainage of scrotum         0008         6.15      $305.02      $113.67       $61.00
                             abscess.
    55110  T                Explore scrotum....         0183        18.26      $905.62      $448.94      $181.12
    55120  T                Removal of scrotum          0183        18.26      $905.62      $448.94      $181.12
                             lesion.
    55150  T                Removal of scrotum.         0183        18.26      $905.62      $448.94      $181.12
    55175  T                Revision of scrotum         0183        18.26      $905.62      $448.94      $181.12
    55180  T                Revision of scrotum         0183        18.26      $905.62      $448.94      $181.12
    55200  T                Incision of sperm           0183        18.26      $905.62      $448.94      $181.12
                             duct.
    55250  T                Removal of sperm            0183        18.26      $905.62      $448.94      $181.12
                             duct(s).
    55300  N                Prepare, sperm duct  ...........  ...........  ...........  ...........  ...........
                             x-ray.
    55400  T                Repair of sperm             0183        18.26      $905.62      $448.94      $181.12
                             duct.
    55450  T                Ligation of sperm           0183        18.26      $905.62      $448.94      $181.12
                             duct.
    55500  T                Removal of                  0183        18.26      $905.62      $448.94      $181.12
                             hydrocele.
    55520  T                Removal of sperm            0183        18.26      $905.62      $448.94      $181.12
                             cord lesion.
    55530  T                Revise spermatic            0183        18.26      $905.62      $448.94      $181.12
                             cord veins.
    55535  T                Revise spermatic            0154        22.43    $1,112.45      $556.98      $222.49
                             cord veins.
    55540  T                Revise hernia &             0154        22.43    $1,112.45      $556.98      $222.49
                             sperm veins.
    55550  T                Laparo ligate               0131        41.81    $2,073.61    $1,089.88      $414.72
                             spermatic vein.
    55559  T                Laparo proc,                0130        25.36    $1,257.75      $659.53      $251.55
                             spermatic cord.
    55600  C                Incise sperm duct    ...........  ...........  ...........  ...........  ...........
                             pouch.
    55605  C                Incise sperm duct    ...........  ...........  ...........  ...........  ...........
                             pouch.
    55650  C                Remove sperm duct    ...........  ...........  ...........  ...........  ...........
                             pouch.
    55680  T                Remove sperm pouch          0183        18.26      $905.62      $448.94      $181.12
                             lesion.
    55700  T                Biopsy of prostate.         0184         4.94      $245.01      $122.96       $49.00
    55705  T                Biopsy of prostate.         0184         4.94      $245.01      $122.96       $49.00
    55720  T                Drainage of                 0162        17.49      $867.44      $427.49      $173.49
                             prostate abscess.
    55725  T                Drainage of                 0162        17.49      $867.44      $427.49      $173.49
                             prostate abscess.
    55801  C                Removal of prostate  ...........  ...........  ...........  ...........  ...........
    55810  C                Extensive prostate   ...........  ...........  ...........  ...........  ...........
                             surgery.
    55812  C                Extensive prostate   ...........  ...........  ...........  ...........  ...........
                             surgery.
    55815  C                Extensive prostate   ...........  ...........  ...........  ...........  ...........
                             surgery.
    55821  C                Removal of prostate  ...........  ...........  ...........  ...........  ...........
    55831  C                Removal of prostate  ...........  ...........  ...........  ...........  ...........
    55840  C                Extensive prostate   ...........  ...........  ...........  ...........  ...........
                             surgery.
    55842  C                Extensive prostate   ...........  ...........  ...........  ...........  ...........
                             surgery.
    55845  C                Extensive prostate   ...........  ...........  ...........  ...........  ...........
                             surgery.
    55859  T                Percut/needle               0162        17.49      $867.44      $427.49      $173.49
                             insert, pros.
    55860  T                Surgical exposure,          0165         3.89      $192.92       $91.76       $38.58
                             prostate.
    55862  C                Extensive prostate   ...........  ...........  ...........  ...........  ...........
                             surgery.
    55865  C                Extensive prostate   ...........  ...........  ...........  ...........  ...........
                             surgery.
    55870  T                Electroejaculation.         0197         2.40      $119.03       $49.55       $23.81
   *55873  T                Cryoablate prostate         0980        38.67    $1,917.89  ...........      $383.58
    55899  T                Genital surgery             0164         2.17      $107.64       $33.03       $21.53
                             procedure.
    55970  E                Sex transformation,  ...........  ...........  ...........  ...........  ...........
                             M to F.
    55980  E                Sex transformation,  ...........  ...........  ...........  ...........  ...........
                             F to M.
    56405  T                I & D of vulva/             0192         2.38      $118.04       $35.33       $23.61
                             perineum.
    56420  T                Drainage of gland           0192         2.38      $118.04       $35.33       $23.61
                             abscess.
    56440  T                Surgery for vulva           0194        16.21      $803.96      $395.94      $160.79
                             lesion.
    56441  T                Lysis of labial             0193         8.93      $442.89      $171.13       $88.58
                             lesion(s).
    56501  T                Destruction, vulva          0016         3.53      $175.07       $74.67       $35.01
                             lesion(s).
    56515  T                Destruction, vulva          0017        12.45      $617.47      $289.16      $123.49
                             lesion(s).
    56605  T                Biopsy of vulva/            0019         4.00      $198.39       $78.91       $39.68
                             perineum.
    56606  T                Biopsy of vulva/            0019         4.00      $198.39       $78.91       $39.68
                             perineum.
    56620  T                Partial removal of          0195        18.68      $926.46      $483.80      $185.29
                             vulva.
    56625  T                Complete removal of         0195        18.68      $926.46      $483.80      $185.29
                             vulva.
    56630  C                Extensive vulva      ...........  ...........  ...........  ...........  ...........
                             surgery.
    56631  C                Extensive vulva      ...........  ...........  ...........  ...........  ...........
                             surgery.
    56632  C                Extensive vulva      ...........  ...........  ...........  ...........  ...........
                             surgery.
    56633  C                Extensive vulva      ...........  ...........  ...........  ...........  ...........
                             surgery.
    56634  C                Extensive vulva      ...........  ...........  ...........  ...........  ...........
                             surgery.
    56637  C                Extensive vulva      ...........  ...........  ...........  ...........  ...........
                             surgery.
    56640  C                Extensive vulva      ...........  ...........  ...........  ...........  ...........
                             surgery.
    56700  T                Partial removal of          0194        16.21      $803.96      $395.94      $160.79
                             hymen.
    56720  T                Incision of hymen..         0193         8.93      $442.89      $171.13       $88.58

[[Page 67896]]

 
    56740  T                Remove vagina gland         0194        16.21      $803.96      $395.94      $160.79
                             lesion.
    56800  T                Repair of vagina...         0194        16.21      $803.96      $395.94      $160.79
    56805  T                Repair clitoris....         0194        16.21      $803.96      $395.94      $160.79
    56810  T                Repair of perineum.         0194        16.21      $803.96      $395.94      $160.79
    57000  T                Exploration of              0194        16.21      $803.96      $395.94      $160.79
                             vagina.
    57010  T                Drainage of pelvic          0194        16.21      $803.96      $395.94      $160.79
                             abscess.
    57020  T                Drainage of pelvic          0193         8.93      $442.89      $171.13       $88.58
                             fluid.
   *57022  T                I & D vaginal               0007         3.68      $182.51       $72.03       $36.50
                             hematoma, OB.
   *57023  T                I & D vaginal               0007         3.68      $182.51       $72.03       $36.50
                             hematoma, trauma.
    57061  T                Destruction vagina          0194        16.21      $803.96      $395.94      $160.79
                             lesion(s).
    57065  T                Destruction vagina          0194        16.21      $803.96      $395.94      $160.79
                             lesion(s).
    57100  T                Biopsy of vagina...         0192         2.38      $118.04       $35.33       $23.61
    57105  T                Biopsy of vagina...         0194        16.21      $803.96      $395.94      $160.79
    57106  T                Remove vagina wall,         0194        16.21      $803.96      $395.94      $160.79
                             partial.
    57107  T                Remove vagina               0194        16.21      $803.96      $395.94      $160.79
                             tissue, part.
    57109  T                Vaginectomy partial         0194        16.21      $803.96      $395.94      $160.79
                             w/nodes.
    57110  C                Remove vagina wall,  ...........  ...........  ...........  ...........  ...........
                             complete.
    57111  C                Remove vagina        ...........  ...........  ...........  ...........  ...........
                             tissue, compl.
    57112  C                Vaginectomy w/       ...........  ...........  ...........  ...........  ...........
                             nodes, compl.
    57120  T                Closure of vagina..         0194        16.21      $803.96      $395.94      $160.79
    57130  T                Remove vagina               0194        16.21      $803.96      $395.94      $160.79
                             lesion.
    57135  T                Remove vagina               0194        16.21      $803.96      $395.94      $160.79
                             lesion.
    57150  T                Treat vagina                0192         2.38      $118.04       $35.33       $23.61
                             infection.
    57160  T                Insert pessary/             0191         1.19       $59.02       $17.43       $11.80
                             other device.
    57170  T                Fitting of                  0191         1.19       $59.02       $17.43       $11.80
                             diaphragm/cap.
    57180  T                Treat vaginal               0192         2.38      $118.04       $35.33       $23.61
                             bleeding.
    57200  T                Repair of vagina...         0194        16.21      $803.96      $395.94      $160.79
    57210  T                Repair vagina/              0194        16.21      $803.96      $395.94      $160.79
                             perineum.
    57220  T                Revision of urethra         0195        18.68      $926.46      $483.80      $185.29
    57230  T                Repair of urethral          0194        16.21      $803.96      $395.94      $160.79
                             lesion.
    57240  T                Repair bladder &            0195        18.68      $926.46      $483.80      $185.29
                             vagina.
    57250  T                Repair rectum &             0195        18.68      $926.46      $483.80      $185.29
                             vagina.
    57260  T                Repair of vagina...         0195        18.68      $926.46      $483.80      $185.29
    57265  T                Extensive repair of         0195        18.68      $926.46      $483.80      $185.29
                             vagina.
    57268  T                Repair of bowel             0195        18.68      $926.46      $483.80      $185.29
                             bulge.
    57270  C                Repair of bowel      ...........  ...........  ...........  ...........  ...........
                             pouch.
    57280  C                Suspension of        ...........  ...........  ...........  ...........  ...........
                             vagina.
    57282  C                Repair of vaginal    ...........  ...........  ...........  ...........  ...........
                             prolapse.
    57284  T                Repair paravaginal          0195        18.68      $926.46      $483.80      $185.29
                             defect.
   *57287  T                Revise/remove sling         0195        18.68      $926.46      $483.80      $185.29
                             repair.
    57288  T                Repair bladder              0195        18.68      $926.46      $483.80      $185.29
                             defect.
    57289  T                Repair bladder &            0195        18.68      $926.46      $483.80      $185.29
                             vagina.
    57291  T                Construction of             0195        18.68      $926.46      $483.80      $185.29
                             vagina.
    57292  C                Construct vagina     ...........  ...........  ...........  ...........  ...........
                             with graft.
    57300  T                Repair rectum-              0195        18.68      $926.46      $483.80      $185.29
                             vagina fistula.
    57305  C                Repair rectum-       ...........  ...........  ...........  ...........  ...........
                             vagina fistula.
    57307  C                Fistula repair &     ...........  ...........  ...........  ...........  ...........
                             colostomy.
    57308  C                Fistula repair,      ...........  ...........  ...........  ...........  ...........
                             transperine.
    57310  T                Repair                      0195        18.68      $926.46      $483.80      $185.29
                             urethrovaginal
                             lesion.
    57311  C                Repair               ...........  ...........  ...........  ...........  ...........
                             urethrovaginal
                             lesion.
    57320  T                Repair bladder-             0195        18.68      $926.46      $483.80      $185.29
                             vagina lesion.
    57330  T                Repair bladder-             0195        18.68      $926.46      $483.80      $185.29
                             vagina lesion.
    57335  C                Repair vagina......  ...........  ...........  ...........  ...........  ...........
    57400  T                Dilation of vagina.         0194        16.21      $803.96      $395.94      $160.79
    57410  T                Pelvic examination.         0194        16.21      $803.96      $395.94      $160.79
    57415  T                Remove vaginal              0194        16.21      $803.96      $395.94      $160.79
                             foreign body.
    57452  T                Examination of              0191         1.19       $59.02       $17.43       $11.80
                             vagina.
    57454  T                Vagina examination          0192         2.38      $118.04       $35.33       $23.61
                             & biopsy.
    57460  T                Cervix excision....         0193         8.93      $442.89      $171.13       $88.58
    57500  T                Biopsy of cervix...         0193         8.93      $442.89      $171.13       $88.58
    57505  T                Endocervical                0192         2.38      $118.04       $35.33       $23.61
                             curettage.
    57510  T                Cauterization of            0193         8.93      $442.89      $171.13       $88.58
                             cervix.
    57511  T                Cryocautery of              0192         2.38      $118.04       $35.33       $23.61
                             cervix.
    57513  T                Laser surgery of            0193         8.93      $442.89      $171.13       $88.58
                             cervix.
    57520  T                Conization of               0194        16.21      $803.96      $395.94      $160.79
                             cervix.
    57522  T                Conization of               0195        18.68      $926.46      $483.80      $185.29
                             cervix.
    57530  T                Removal of cervix..         0195        18.68      $926.46      $483.80      $185.29
    57531  C                Removal of cervix,   ...........  ...........  ...........  ...........  ...........
                             radical.
    57540  C                Removal of residual  ...........  ...........  ...........  ...........  ...........
                             cervix.
    57545  C                Remove cervix/       ...........  ...........  ...........  ...........  ...........
                             repair pelvis.
    57550  T                Removal of residual         0195        18.68      $926.46      $483.80      $185.29
                             cervix.
    57555  T                Remove cervix/              0195        18.68      $926.46      $483.80      $185.29
                             repair vagina.
    57556  T                Remove cervix,              0195        18.68      $926.46      $483.80      $185.29
                             repair bowel.
    57700  T                Revision of cervix.         0194        16.21      $803.96      $395.94      $160.79

[[Page 67897]]

 
    57720  T                Revision of cervix.         0194        16.21      $803.96      $395.94      $160.79
    57800  T                Dilation of                 0193         8.93      $442.89      $171.13       $88.58
                             cervical canal.
    57820  T                D & c of residual           0196        14.47      $717.66      $357.98      $143.53
                             cervix.
    58100  T                Biopsy of uterus            0191         1.19       $59.02       $17.43       $11.80
                             lining.
    58120  T                Dilation and                0196        14.47      $717.66      $357.98      $143.53
                             curettage.
    58140  C                Removal of uterus    ...........  ...........  ...........  ...........  ...........
                             lesion.
    58145  T                Removal of uterus           0195        18.68      $926.46      $483.80      $185.29
                             lesion.
    58150  C                Total hysterectomy.  ...........  ...........  ...........  ...........  ...........
    58152  C                Total hysterectomy.  ...........  ...........  ...........  ...........  ...........
    58180  C                Partial              ...........  ...........  ...........  ...........  ...........
                             hysterectomy.
    58200  C                Extensive            ...........  ...........  ...........  ...........  ...........
                             hysterectomy.
    58210  C                Extensive            ...........  ...........  ...........  ...........  ...........
                             hysterectomy.
    58240  C                Removal of pelvis    ...........  ...........  ...........  ...........  ...........
                             contents.
    58260  C                Vaginal              ...........  ...........  ...........  ...........  ...........
                             hysterectomy.
    58262  C                Vaginal              ...........  ...........  ...........  ...........  ...........
                             hysterectomy.
    58263  C                Vaginal              ...........  ...........  ...........  ...........  ...........
                             hysterectomy.
    58267  C                Hysterectomy &       ...........  ...........  ...........  ...........  ...........
                             vagina repair.
    58270  C                Hysterectomy &       ...........  ...........  ...........  ...........  ...........
                             vagina repair.
    58275  C                Hysterectomy/revise  ...........  ...........  ...........  ...........  ...........
                             vagina.
    58280  C                Hysterectomy/revise  ...........  ...........  ...........  ...........  ...........
                             vagina.
    58285  C                Extensive            ...........  ...........  ...........  ...........  ...........
                             hysterectomy.
    58300  E                Insert intrauterine  ...........  ...........  ...........  ...........  ...........
                             device.
    58301  T                Remove intrauterine         0191         1.19       $59.02       $17.43       $11.80
                             device.
    58321  T                Artificial                  0197         2.40      $119.03       $49.55       $23.81
                             insemination.
    58322  T                Artificial                  0197         2.40      $119.03       $49.55       $23.81
                             insemination.
    58323  T                Sperm washing......         0197         2.40      $119.03       $49.55       $23.81
    58340  N                Catheter for         ...........  ...........  ...........  ...........  ...........
                             hysterography.
    58345  T                Reopen fallopian            0194        16.21      $803.96      $395.94      $160.79
                             tube.
    58350  T                Reopen fallopian            0194        16.21      $803.96      $395.94      $160.79
                             tube.
   *58353  T                Endometr ablate,            0193         8.93      $442.89      $171.13       $88.58
                             thermal.
    58400  C                Suspension of        ...........  ...........  ...........  ...........  ...........
                             uterus.
    58410  C                Suspension of        ...........  ...........  ...........  ...........  ...........
                             uterus.
    58520  C                Repair of ruptured   ...........  ...........  ...........  ...........  ...........
                             uterus.
    58540  C                Revision of uterus.  ...........  ...........  ...........  ...........  ...........
    58550  T                Laparo-asst vag             0132        48.91    $2,425.74    $1,239.22      $485.15
                             hysterectomy.
    58551  T                Laparoscopy, remove         0131        41.81    $2,073.61    $1,089.88      $414.72
                             myoma.
    58555  T                Hysteroscopy, dx,           0191         1.19       $59.02       $17.43       $11.80
                             sep proc.
    58558  T                Hysteroscopy,               0190        17.85      $885.29      $443.89      $177.06
                             biopsy.
    58559  T                Hysteroscopy, lysis         0190        17.85      $885.29      $443.89      $177.06
    58560  T                Hysteroscopy,               0190        17.85      $885.29      $443.89      $177.06
                             resect septum.
    58561  T                Hysteroscopy,               0190        17.85      $885.29      $443.89      $177.06
                             remove myoma.
    58562  T                Hysteroscopy,               0190        17.85      $885.29      $443.89      $177.06
                             remove fb.
    58563  T                Hysteroscopy,               0190        17.85      $885.29      $443.89      $177.06
                             ablation.
    58578  T                Laparo proc, uterus         0190        17.85      $885.29      $443.89      $177.06
    58579  T                Hysteroscope                0190        17.85      $885.29      $443.89      $177.06
                             procedure.
    58600  T                Division of                 0194        16.21      $803.96      $395.94      $160.79
                             fallopian tube.
    58605  C                Division of          ...........  ...........  ...........  ...........  ...........
                             fallopian tube.
    58611  C                Ligate oviduct(s)    ...........  ...........  ...........  ...........  ...........
                             add-on.
    58615  T                Occlude fallopian           0194        16.21      $803.96      $395.94      $160.79
                             tube(s).
    58660  T                Laparoscopy, lysis.         0131        41.81    $2,073.61    $1,089.88      $414.72
    58661  T                Laparoscopy, remove         0131        41.81    $2,073.61    $1,089.88      $414.72
                             adnexa.
    58662  T                Laparoscopy, excise         0131        41.81    $2,073.61    $1,089.88      $414.72
                             lesions.
    58670  T                Laparoscopy, tubal          0131        41.81    $2,073.61    $1,089.88      $414.72
                             cautery.
    58671  T                Laparoscopy, tubal          0131        41.81    $2,073.61    $1,089.88      $414.72
                             block.
    58672  T                Laparoscopy,                0131        41.81    $2,073.61    $1,089.88      $414.72
                             fimbrioplasty.
    58673  T                Laparoscopy,                0131        41.81    $2,073.61    $1,089.88      $414.72
                             salpingostomy.
    58679  T                Laparo proc,                0130        25.36    $1,257.75      $659.53      $251.55
                             oviduct-ovary.
    58700  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             fallopian tube.
    58720  C                Removal of ovary/    ...........  ...........  ...........  ...........  ...........
                             tube(s).
    58740  C                Revise fallopian     ...........  ...........  ...........  ...........  ...........
                             tube(s).
    58750  C                Repair oviduct.....  ...........  ...........  ...........  ...........  ...........
    58752  C                Revise ovarian       ...........  ...........  ...........  ...........  ...........
                             tube(s).
    58760  C                Remove tubal         ...........  ...........  ...........  ...........  ...........
                             obstruction.
    58770  C                Create new tubal     ...........  ...........  ...........  ...........  ...........
                             opening.
    58800  T                Drainage of ovarian         0195        18.68      $926.46      $483.80      $185.29
                             cyst(s).
    58805  C                Drainage of ovarian  ...........  ...........  ...........  ...........  ...........
                             cyst(s).
    58820  T                Drain ovary                 0195        18.68      $926.46      $483.80      $185.29
                             abscess, open.
    58822  C                Drain ovary          ...........  ...........  ...........  ...........  ...........
                             abscess, percut.
    58823  C                Drain pelvic         ...........  ...........  ...........  ...........  ...........
                             abscess, percut.
    58825  C                Transposition,       ...........  ...........  ...........  ...........  ...........
                             ovary(s).
    58900  T                Biopsy of ovary(s).         0195        18.68      $926.46      $483.80      $185.29
    58920  T                Partial removal of          0195        18.68      $926.46      $483.80      $185.29
                             ovary(s).
    58925  T                Removal of ovarian          0195        18.68      $926.46      $483.80      $185.29
                             cyst(s).
    58940  C                Removal of ovary(s)  ...........  ...........  ...........  ...........  ...........

[[Page 67898]]

 
    58943  C                Removal of ovary(s)  ...........  ...........  ...........  ...........  ...........
    58950  C                Resect ovarian       ...........  ...........  ...........  ...........  ...........
                             malignancy.
    58951  C                Resect ovarian       ...........  ...........  ...........  ...........  ...........
                             malignancy.
    58952  C                Resect ovarian       ...........  ...........  ...........  ...........  ...........
                             malignancy.
    58960  C                Exploration of       ...........  ...........  ...........  ...........  ...........
                             abdomen.
    58970  T                Retrieval of oocyte         0194        16.21      $803.96      $395.94      $160.79
    58974  T                Transfer of embryo.         0197         2.40      $119.03       $49.55       $23.81
    58976  T                Transfer of embryo.         0197         2.40      $119.03       $49.55       $23.81
    58999  T                Genital surgery             0019         4.00      $198.39       $78.91       $39.68
                             procedure.
    59000  T                Amniocentesis......         0198         1.34       $66.46       $33.03       $13.29
    59012  T                Fetal cord                  0198         1.34       $66.46       $33.03       $13.29
                             puncture,prenatal.
    59015  T                Chorion biopsy.....         0198         1.34       $66.46       $33.03       $13.29
    59020  T                Fetal contract              0198         1.34       $66.46       $33.03       $13.29
                             stress test.
    59025  T                Fetal non-stress            0198         1.34       $66.46       $33.03       $13.29
                             test.
    59030  T                Fetal scalp blood           0198         1.34       $66.46       $33.03       $13.29
                             sample.
    59050  T                Fetal monitor w/            0198         1.34       $66.46       $33.03       $13.29
                             report.
    59051  E                Fetal monitor/       ...........  ...........  ...........  ...........  ...........
                             interpret only.
    59100  C                Remove uterus        ...........  ...........  ...........  ...........  ...........
                             lesion.
    59120  C                Treat ectopic        ...........  ...........  ...........  ...........  ...........
                             pregnancy.
    59121  C                Treat ectopic        ...........  ...........  ...........  ...........  ...........
                             pregnancy.
    59130  C                Treat ectopic        ...........  ...........  ...........  ...........  ...........
                             pregnancy.
    59135  C                Treat ectopic        ...........  ...........  ...........  ...........  ...........
                             pregnancy.
    59136  C                Treat ectopic        ...........  ...........  ...........  ...........  ...........
                             pregnancy.
    59140  C                Treat ectopic        ...........  ...........  ...........  ...........  ...........
                             pregnancy.
    59150  T                Treat ectopic               0131        41.81    $2,073.61    $1,089.88      $414.72
                             pregnancy.
    59151  T                Treat ectopic               0131        41.81    $2,073.61    $1,089.88      $414.72
                             pregnancy.
    59160  T                D & c after                 0196        14.47      $717.66      $357.98      $143.53
                             delivery.
    59200  T                Insert cervical             0191         1.19       $59.02       $17.43       $11.80
                             dilator.
    59300  T                Episiotomy or               0194        16.21      $803.96      $395.94      $160.79
                             vaginal repair.
    59320  T                Revision of cervix.         0194        16.21      $803.96      $395.94      $160.79
    59325  C                Revision of cervix.  ...........  ...........  ...........  ...........  ...........
    59350  C                Repair of uterus...  ...........  ...........  ...........  ...........  ...........
    59400  E                Obstetrical care...  ...........  ...........  ...........  ...........  ...........
    59409  T                Obstetrical care...         0199        11.20      $555.48      $157.83      $111.10
    59410  E                Obstetrical care...  ...........  ...........  ...........  ...........  ...........
    59412  T                Antepartum                  0199        11.20      $555.48      $157.83      $111.10
                             manipulation.
    59414  T                Deliver placenta...         0199        11.20      $555.48      $157.83      $111.10
    59425  E                Antepartum care      ...........  ...........  ...........  ...........  ...........
                             only.
    59426  E                Antepartum care      ...........  ...........  ...........  ...........  ...........
                             only.
    59430  E                Care after delivery  ...........  ...........  ...........  ...........  ...........
    59510  E                Cesarean delivery..  ...........  ...........  ...........  ...........  ...........
    59514  C                Cesarean delivery    ...........  ...........  ...........  ...........  ...........
                             only.
    59515  E                Cesarean delivery..  ...........  ...........  ...........  ...........  ...........
    59525  C                Remove uterus after  ...........  ...........  ...........  ...........  ...........
                             cesarean.
    59610  E                Vbac delivery......  ...........  ...........  ...........  ...........  ...........
    59612  T                Vbac delivery only.         0199        11.20      $555.48      $157.83      $111.10
    59614  E                Vbac care after      ...........  ...........  ...........  ...........  ...........
                             delivery.
    59618  E                Attempted vbac       ...........  ...........  ...........  ...........  ...........
                             delivery.
    59620  C                Attempted vbac       ...........  ...........  ...........  ...........  ...........
                             delivery only.
    59622  E                Attempted vbac       ...........  ...........  ...........  ...........  ...........
                             after care.
    59812  T                Treatment of                0201        13.00      $644.75      $329.65      $128.95
                             miscarriage.
    59820  T                Care of miscarriage         0201        13.00      $644.75      $329.65      $128.95
    59821  T                Treatment of                0201        13.00      $644.75      $329.65      $128.95
                             miscarriage.
    59830  C                Treat uterus         ...........  ...........  ...........  ...........  ...........
                             infection.
    59840  T                Abortion...........         0200        13.89      $688.89      $373.23      $137.78
    59841  T                Abortion...........         0200        13.89      $688.89      $373.23      $137.78
    59850  C                Abortion...........  ...........  ...........  ...........  ...........  ...........
    59851  C                Abortion...........  ...........  ...........  ...........  ...........  ...........
    59852  C                Abortion...........  ...........  ...........  ...........  ...........  ...........
    59855  C                Abortion...........  ...........  ...........  ...........  ...........  ...........
    59856  C                Abortion...........  ...........  ...........  ...........  ...........  ...........
    59857  C                Abortion...........  ...........  ...........  ...........  ...........  ...........
    59866  T                Abortion (mpr).....         0198         1.34       $66.46       $33.03       $13.29
    59870  T                Evacuate mole of            0201        13.00      $644.75      $329.65      $128.95
                             uterus.
    59871  T                Remove cerclage             0194        16.21      $803.96      $395.94      $160.79
                             suture.
    59898  T                Laparo proc, ob             0130        25.36    $1,257.75      $659.53      $251.55
                             care/deliver.
    59899  T                Maternity care              0198         1.34       $66.46       $33.03       $13.29
                             procedure.
    60000  T                Drain thyroid/              0253        12.02      $596.14      $284.00      $119.23
                             tongue cyst.
    60001  T                Aspirate/inject             0002         0.62       $30.75       $17.66        $6.15
                             thyriod cyst.
    60100  T                Biopsy of thyroid..         0004         1.84       $91.26       $32.57       $18.25
    60200  T                Remove thyroid              0114        19.56      $970.10      $493.78      $194.02
                             lesion.
    60210  T                Partial thyroid             0114        19.56      $970.10      $493.78      $194.02
                             excision.
    60212  T                Parital thyroid             0114        19.56      $970.10      $493.78      $194.02
                             excision.
    60220  T                Partial removal of          0114        19.56      $970.10      $493.78      $194.02
                             thyroid.

[[Page 67899]]

 
    60225  T                Partial removal of          0114        19.56      $970.10      $493.78      $194.02
                             thyroid.
    60240  T                Removal of thyroid.         0114        19.56      $970.10      $493.78      $194.02
    60252  T                Removal of thyroid.         0256        25.40    $1,259.74      $623.05      $251.95
    60254  C                Extensive thyroid    ...........  ...........  ...........  ...........  ...........
                             surgery.
    60260  T                Repeat thyroid              0256        25.40    $1,259.74      $623.05      $251.95
                             surgery.
    60270  C                Removal of thyroid.  ...........  ...........  ...........  ...........  ...........
    60271  C                Removal of thyroid.  ...........  ...........  ...........  ...........  ...........
    60280  T                Remove thyroid duct         0114        19.56      $970.10      $493.78      $194.02
                             lesion.
    60281  T                Remove thyroid duct         0114        19.56      $970.10      $493.78      $194.02
                             lesion.
    60500  T                Explore parathyroid         0256        25.40    $1,259.74      $623.05      $251.95
                             glands.
    60502  C                Re-explore           ...........  ...........  ...........  ...........  ...........
                             parathyroids.
    60505  C                Explore parathyroid  ...........  ...........  ...........  ...........  ...........
                             glands.
    60512  T                Autotransplant              0020         6.51      $322.87      $130.53       $64.57
                             parathyroid.
    60520  C                Removal of thymus    ...........  ...........  ...........  ...........  ...........
                             gland.
    60521  C                Removal of thymus    ...........  ...........  ...........  ...........  ...........
                             gland.
    60522  C                Removal of thymus    ...........  ...........  ...........  ...........  ...........
                             gland.
    60540  C                Explore adrenal      ...........  ...........  ...........  ...........  ...........
                             gland.
    60545  C                Explore adrenal      ...........  ...........  ...........  ...........  ...........
                             gland.
    60600  C                Remove carotid body  ...........  ...........  ...........  ...........  ...........
                             lesion.
    60605  C                Remove carotid body  ...........  ...........  ...........  ...........  ...........
                             lesion.
    60650  C                Laparoscopy          ...........  ...........  ...........  ...........  ...........
                             adrenalectomy.
    60659  T                Laparo proc,                0130        25.36    $1,257.75      $659.53      $251.55
                             endocrine.
    60699  T                Endocrine surgery           0004         1.84       $91.26       $32.57       $18.25
                             procedure.
    61000  T                Remove cranial              0212         3.64      $180.53       $88.78       $36.11
                             cavity fluid.
    61001  T                Remove cranial              0212         3.64      $180.53       $88.78       $36.11
                             cavity fluid.
    61020  T                Remove brain cavity         0212         3.64      $180.53       $88.78       $36.11
                             fluid.
    61026  T                Injection into              0212         3.64      $180.53       $88.78       $36.11
                             brain canal.
    61050  T                Remove brain canal          0212         3.64      $180.53       $88.78       $36.11
                             fluid.
    61055  T                Injection into              0212         3.64      $180.53       $88.78       $36.11
                             brain canal.
    61070  T                Brain canal shunt           0212         3.64      $180.53       $88.78       $36.11
                             procedure.
    61105  C                Twist drill hole...  ...........  ...........  ...........  ...........  ...........
    61107  C                Drill skull for      ...........  ...........  ...........  ...........  ...........
                             implantation.
    61108  C                Drill skull for      ...........  ...........  ...........  ...........  ...........
                             drainage.
    61120  C                Burr hole for        ...........  ...........  ...........  ...........  ...........
                             puncture.
    61140  C                Pierce skull for     ...........  ...........  ...........  ...........  ...........
                             biopsy.
    61150  C                Pierce skull for     ...........  ...........  ...........  ...........  ...........
                             drainage.
    61151  C                Pierce skull for     ...........  ...........  ...........  ...........  ...........
                             drainage.
    61154  C                Pierce skull &       ...........  ...........  ...........  ...........  ...........
                             remove clot.
    61156  C                Pierce skull for     ...........  ...........  ...........  ...........  ...........
                             drainage.
    61210  C                Pierce skull,        ...........  ...........  ...........  ...........  ...........
                             implant device.
    61215  T                Insert brain-fluid          0224        17.89      $887.27      $453.41      $177.45
                             device.
    61250  C                Pierce skull &       ...........  ...........  ...........  ...........  ...........
                             explore.
    61253  C                Pierce skull &       ...........  ...........  ...........  ...........  ...........
                             explore.
    61304  C                Open skull for       ...........  ...........  ...........  ...........  ...........
                             exploration.
    61305  C                Open skull for       ...........  ...........  ...........  ...........  ...........
                             exploration.
    61312  C                Open skull for       ...........  ...........  ...........  ...........  ...........
                             drainage.
    61313  C                Open skull for       ...........  ...........  ...........  ...........  ...........
                             drainage.
    61314  C                Open skull for       ...........  ...........  ...........  ...........  ...........
                             drainage.
    61315  C                Open skull for       ...........  ...........  ...........  ...........  ...........
                             drainage.
    61320  C                Open skull for       ...........  ...........  ...........  ...........  ...........
                             drainage.
    61321  C                Open skull for       ...........  ...........  ...........  ...........  ...........
                             drainage.
    61330  T                Decompress eye              0256        25.40    $1,259.74      $623.05      $251.95
                             socket.
    61332  C                Explore/biopsy eye   ...........  ...........  ...........  ...........  ...........
                             socket.
    61333  C                Explore orbit/       ...........  ...........  ...........  ...........  ...........
                             remove lesion.
    61334  C                Explore orbit/       ...........  ...........  ...........  ...........  ...........
                             remove object.
    61340  C                Relieve cranial      ...........  ...........  ...........  ...........  ...........
                             pressure.
    61343  C                Incise skull (press  ...........  ...........  ...........  ...........  ...........
                             relief).
    61345  C                Relieve cranial      ...........  ...........  ...........  ...........  ...........
                             pressure.
    61440  C                Incise skull for     ...........  ...........  ...........  ...........  ...........
                             surgery.
    61450  C                Incise skull for     ...........  ...........  ...........  ...........  ...........
                             surgery.
    61458  C                Incise skull for     ...........  ...........  ...........  ...........  ...........
                             brain wound.
    61460  C                Incise skull for     ...........  ...........  ...........  ...........  ...........
                             surgery.
    61470  C                Incise skull for     ...........  ...........  ...........  ...........  ...........
                             surgery.
    61480  C                Incise skull for     ...........  ...........  ...........  ...........  ...........
                             surgery.
    61490  C                Incise skull for     ...........  ...........  ...........  ...........  ...........
                             surgery.
    61500  C                Removal of skull     ...........  ...........  ...........  ...........  ...........
                             lesion.
    61501  C                Remove infected      ...........  ...........  ...........  ...........  ...........
                             skull bone.
    61510  C                Removal of brain     ...........  ...........  ...........  ...........  ...........
                             lesion.
    61512  C                Remove brain lining  ...........  ...........  ...........  ...........  ...........
                             lesion.
    61514  C                Removal of brain     ...........  ...........  ...........  ...........  ...........
                             abscess.
    61516  C                Removal of brain     ...........  ...........  ...........  ...........  ...........
                             lesion.
    61518  C                Removal of brain     ...........  ...........  ...........  ...........  ...........
                             lesion.
    61519  C                Remove brain lining  ...........  ...........  ...........  ...........  ...........
                             lesion.
    61520  C                Removal of brain     ...........  ...........  ...........  ...........  ...........
                             lesion.

[[Page 67900]]

 
    61521  C                Removal of brain     ...........  ...........  ...........  ...........  ...........
                             lesion.
    61522  C                Removal of brain     ...........  ...........  ...........  ...........  ...........
                             abscess.
    61524  C                Removal of brain     ...........  ...........  ...........  ...........  ...........
                             lesion.
    61526  C                Removal of brain     ...........  ...........  ...........  ...........  ...........
                             lesion.
    61530  C                Removal of brain     ...........  ...........  ...........  ...........  ...........
                             lesion.
    61531  C                Implant brain        ...........  ...........  ...........  ...........  ...........
                             electrodes.
    61533  C                Implant brain        ...........  ...........  ...........  ...........  ...........
                             electrodes.
    61534  C                Removal of brain     ...........  ...........  ...........  ...........  ...........
                             lesion.
    61535  C                Remove brain         ...........  ...........  ...........  ...........  ...........
                             electrodes.
    61536  C                Removal of brain     ...........  ...........  ...........  ...........  ...........
                             lesion.
    61538  C                Removal of brain     ...........  ...........  ...........  ...........  ...........
                             tissue.
    61539  C                Removal of brain     ...........  ...........  ...........  ...........  ...........
                             tissue.
    61541  C                Incision of brain    ...........  ...........  ...........  ...........  ...........
                             tissue.
    61542  C                Removal of brain     ...........  ...........  ...........  ...........  ...........
                             tissue.
    61543  C                Removal of brain     ...........  ...........  ...........  ...........  ...........
                             tissue.
    61544  C                Remove & treat       ...........  ...........  ...........  ...........  ...........
                             brain lesion.
    61545  C                Excision of brain    ...........  ...........  ...........  ...........  ...........
                             tumor.
    61546  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             pituitary gland.
    61548  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             pituitary gland.
    61550  C                Release of skull     ...........  ...........  ...........  ...........  ...........
                             seams.
    61552  C                Release of skull     ...........  ...........  ...........  ...........  ...........
                             seams.
    61556  C                Incise skull/        ...........  ...........  ...........  ...........  ...........
                             sutures.
    61557  C                Incise skull/        ...........  ...........  ...........  ...........  ...........
                             sutures.
    61558  C                Excision of skull/   ...........  ...........  ...........  ...........  ...........
                             sutures.
    61559  C                Excision of skull/   ...........  ...........  ...........  ...........  ...........
                             sutures.
    61563  C                Excision of skull    ...........  ...........  ...........  ...........  ...........
                             tumor.
    61564  C                Excision of skull    ...........  ...........  ...........  ...........  ...........
                             tumor.
    61570  C                Remove foreign       ...........  ...........  ...........  ...........  ...........
                             body, brain.
    61571  C                Incise skull for     ...........  ...........  ...........  ...........  ...........
                             brain wound.
    61575  C                Skull base/          ...........  ...........  ...........  ...........  ...........
                             brainstem surgery.
    61576  C                Skull base/          ...........  ...........  ...........  ...........  ...........
                             brainstem surgery.
    61580  C                Craniofacial         ...........  ...........  ...........  ...........  ...........
                             approach, skull.
    61581  C                Craniofacial         ...........  ...........  ...........  ...........  ...........
                             approach, skull.
    61582  C                Craniofacial         ...........  ...........  ...........  ...........  ...........
                             approach, skull.
    61583  C                Craniofacial         ...........  ...........  ...........  ...........  ...........
                             approach, skull.
    61584  C                Orbitocranial        ...........  ...........  ...........  ...........  ...........
                             approach/skull.
    61585  C                Orbitocranial        ...........  ...........  ...........  ...........  ...........
                             approach/skull.
    61586  C                Resect nasopharynx,  ...........  ...........  ...........  ...........  ...........
                             skull.
    61590  C                Infratemporal        ...........  ...........  ...........  ...........  ...........
                             approach/skull.
    61591  C                Infratemporal        ...........  ...........  ...........  ...........  ...........
                             approach/skull.
    61592  C                Orbitocranial        ...........  ...........  ...........  ...........  ...........
                             approach/skull.
    61595  C                Transtemporal        ...........  ...........  ...........  ...........  ...........
                             approach/skull.
    61596  C                Transcochlear        ...........  ...........  ...........  ...........  ...........
                             approach/skull.
    61597  C                Transcondylar        ...........  ...........  ...........  ...........  ...........
                             approach/skull.
    61598  C                Transpetrosal        ...........  ...........  ...........  ...........  ...........
                             approach/skull.
    61600  C                Resect/excise        ...........  ...........  ...........  ...........  ...........
                             cranial lesion.
    61601  C                Resect/excise        ...........  ...........  ...........  ...........  ...........
                             cranial lesion.
    61605  C                Resect/excise        ...........  ...........  ...........  ...........  ...........
                             cranial lesion.
    61606  C                Resect/excise        ...........  ...........  ...........  ...........  ...........
                             cranial lesion.
    61607  C                Resect/excise        ...........  ...........  ...........  ...........  ...........
                             cranial lesion.
    61608  C                Resect/excise        ...........  ...........  ...........  ...........  ...........
                             cranial lesion.
    61609  C                Transect artery,     ...........  ...........  ...........  ...........  ...........
                             sinus.
    61610  C                Transect artery,     ...........  ...........  ...........  ...........  ...........
                             sinus.
    61611  C                Transect artery,     ...........  ...........  ...........  ...........  ...........
                             sinus.
    61612  C                Transect artery,     ...........  ...........  ...........  ...........  ...........
                             sinus.
    61613  C                Remove aneurysm,     ...........  ...........  ...........  ...........  ...........
                             sinus.
    61615  C                Resect/excise        ...........  ...........  ...........  ...........  ...........
                             lesion, skull.
    61616  C                Resect/excise        ...........  ...........  ...........  ...........  ...........
                             lesion, skull.
    61618  C                Repair dura........  ...........  ...........  ...........  ...........  ...........
    61619  C                Repair dura........  ...........  ...........  ...........  ...........  ...........
    61624  C                Occlusion/           ...........  ...........  ...........  ...........  ...........
                             embolization cath.
    61626  C                Occlusion/           ...........  ...........  ...........  ...........  ...........
                             embolization cath.
    61680  C                Intracranial vessel  ...........  ...........  ...........  ...........  ...........
                             surgery.
    61682  C                Intracranial vessel  ...........  ...........  ...........  ...........  ...........
                             surgery.
    61684  C                Intracranial vessel  ...........  ...........  ...........  ...........  ...........
                             surgery.
    61686  C                Intracranial vessel  ...........  ...........  ...........  ...........  ...........
                             surgery.
    61690  C                Intracranial vessel  ...........  ...........  ...........  ...........  ...........
                             surgery.
    61692  C                Intracranial vessel  ...........  ...........  ...........  ...........  ...........
                             surgery.
   *61697  C                Brain aneurysm       ...........  ...........  ...........  ...........  ...........
                             repair, complex.
   *61698  C                Brain aneurysm       ...........  ...........  ...........  ...........  ...........
                             repair, complex.
    61700  C                Inner skull vessel   ...........  ...........  ...........  ...........  ...........
                             surgery.
    61702  C                Inner skull vessel   ...........  ...........  ...........  ...........  ...........
                             surgery.
    61703  C                Clamp neck artery..  ...........  ...........  ...........  ...........  ...........
    61705  C                Revise circulation   ...........  ...........  ...........  ...........  ...........
                             to head.

[[Page 67901]]

 
    61708  C                Revise circulation   ...........  ...........  ...........  ...........  ...........
                             to head.
    61710  C                Revise circulation   ...........  ...........  ...........  ...........  ...........
                             to head.
    61711  C                Fusion of skull      ...........  ...........  ...........  ...........  ...........
                             arteries.
    61720  C                Incise skull/brain   ...........  ...........  ...........  ...........  ...........
                             surgery.
    61735  C                Incise skull/brain   ...........  ...........  ...........  ...........  ...........
                             surgery.
    61750  C                Incise skull/brain   ...........  ...........  ...........  ...........  ...........
                             biopsy.
    61751  C                Brain biopsy w/ ct/  ...........  ...........  ...........  ...........  ...........
                             mr guide.
    61760  C                Implant brain        ...........  ...........  ...........  ...........  ...........
                             electrodes.
    61770  C                Incise skull for     ...........  ...........  ...........  ...........  ...........
                             treatment.
    61790  T                Treat trigeminal            0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    61791  C                Treat trigeminal     ...........  ...........  ...........  ...........  ...........
                             tract.
    61793  E                Focus radiation      ...........  ...........  ...........  ...........  ...........
                             beam.
    61795  S                Brain surgery using         0302         8.21      $407.18      $216.55       $81.44
                             computer.
    61850  C                Implant              ...........  ...........  ...........  ...........  ...........
                             neuroelectrodes.
    61860  C                Implant              ...........  ...........  ...........  ...........  ...........
                             neuroelectrodes.
    61862  C                Implant              ...........  ...........  ...........  ...........  ...........
                             neurostimul,
                             subcort.
    61870  C                Implant              ...........  ...........  ...........  ...........  ...........
                             neuroelectrodes.
    61875  C                Implant              ...........  ...........  ...........  ...........  ...........
                             neuroelectrodes.
    61880  T                Revise/remove               0105        15.06      $746.92      $372.32      $149.38
                             neuroelectrode.
    61885  T                Implant neurostim           0222       124.43    $6,171.23    $2,955.13    $1,234.25
                             one array.
    61886  T                Implant neurostim           0222       124.43    $6,171.23    $2,955.13    $1,234.25
                             arrays.
    61888  T                Revise/remove               0105        15.06      $746.92      $372.32      $149.38
                             neuroreceiver.
    62000  C                Treat skull          ...........  ...........  ...........  ...........  ...........
                             fracture.
    62005  C                Treat skull          ...........  ...........  ...........  ...........  ...........
                             fracture.
    62010  C                Treatment of head    ...........  ...........  ...........  ...........  ...........
                             injury.
    62100  C                Repair brain fluid   ...........  ...........  ...........  ...........  ...........
                             leakage.
    62115  C                Reduction of skull   ...........  ...........  ...........  ...........  ...........
                             defect.
    62116  C                Reduction of skull   ...........  ...........  ...........  ...........  ...........
                             defect.
    62117  C                Reduction of skull   ...........  ...........  ...........  ...........  ...........
                             defect.
    62120  C                Repair skull cavity  ...........  ...........  ...........  ...........  ...........
                             lesion.
    62121  C                Incise skull repair  ...........  ...........  ...........  ...........  ...........
    62140  C                Repair of skull      ...........  ...........  ...........  ...........  ...........
                             defect.
    62141  C                Repair of skull      ...........  ...........  ...........  ...........  ...........
                             defect.
    62142  C                Remove skull plate/  ...........  ...........  ...........  ...........  ...........
                             flap.
    62143  C                Replace skull plate/ ...........  ...........  ...........  ...........  ...........
                             flap.
    62145  C                Repair of skull &    ...........  ...........  ...........  ...........  ...........
                             brain.
    62146  C                Repair of skull      ...........  ...........  ...........  ...........  ...........
                             with graft.
    62147  C                Repair of skull      ...........  ...........  ...........  ...........  ...........
                             with graft.
    62180  C                Establish brain      ...........  ...........  ...........  ...........  ...........
                             cavity shunt.
    62190  C                Establish brain      ...........  ...........  ...........  ...........  ...........
                             cavity shunt.
    62192  C                Establish brain      ...........  ...........  ...........  ...........  ...........
                             cavity shunt.
    62194  T                Replace/irrigate            0121         2.36      $117.05       $52.53       $23.41
                             catheter.
    62200  C                Establish brain      ...........  ...........  ...........  ...........  ...........
                             cavity shunt.
    62201  C                Establish brain      ...........  ...........  ...........  ...........  ...........
                             cavity shunt.
    62220  C                Establish brain      ...........  ...........  ...........  ...........  ...........
                             cavity shunt.
    62223  C                Establish brain      ...........  ...........  ...........  ...........  ...........
                             cavity shunt.
    62225  T                Replace/irrigate            0121         2.36      $117.05       $52.53       $23.41
                             catheter.
    62230  T                Replace/revise              0224        17.89      $887.27      $453.41      $177.45
                             brain shunt.
   *62252  S                CSF shunt reprogram         0102         0.45       $22.32       $12.62        $4.46
    62256  C                Remove brain cavity  ...........  ...........  ...........  ...........  ...........
                             shunt.
    62258  C                Replace brain        ...........  ...........  ...........  ...........  ...........
                             cavity shunt.
    62263  T                Lysis epidural              0212         3.64      $180.53       $88.78       $36.11
                             adhesions.
    62268  T                Drain spinal cord           0212         3.64      $180.53       $88.78       $36.11
                             cyst.
    62269  T                Needle biopsy,              0005         5.41      $268.32      $119.75       $53.66
                             spinal cord.
    62270  T                Spinal fluid tap,           0210         3.00      $148.79       $62.40       $29.76
                             diagnostic.
    62272  T                Drain spinal fluid.         0210         3.00      $148.79       $62.40       $29.76
    62273  T                Treat epidural              0212         3.64      $180.53       $88.78       $36.11
                             spine lesion.
    62280  T                Treat spinal cord           0212         3.64      $180.53       $88.78       $36.11
                             lesion.
    62281  T                Treat spinal cord           0212         3.64      $180.53       $88.78       $36.11
                             lesion.
    62282  T                Treat spinal canal          0212         3.64      $180.53       $88.78       $36.11
                             lesion.
    62284  N                Injection for        ...........  ...........  ...........  ...........  ...........
                             myelogram.
    62287  T                Percutaneous                0220        13.96      $692.36      $326.21      $138.47
                             diskectomy.
    62290  N                Inject for spine     ...........  ...........  ...........  ...........  ...........
                             disk x-ray.
    62291  N                Inject for spine     ...........  ...........  ...........  ...........  ...........
                             disk x-ray.
    62292  T                Injection into disk         0212         3.64      $180.53       $88.78       $36.11
                             lesion.
    62294  T                Injection into              0212         3.64      $180.53       $88.78       $36.11
                             spinal artery.
    62310  T                Inject spine c/t...         0212         3.64      $180.53       $88.78       $36.11
    62311  T                Inject spine l/s            0212         3.64      $180.53       $88.78       $36.11
                             (cd).
    62318  T                Inject spine w/             0212         3.64      $180.53       $88.78       $36.11
                             cath, c/t.
    62319  T                Inject spine w/cath         0212         3.64      $180.53       $88.78       $36.11
                             l/s (cd).
    62350  T                Implant spinal              0223         7.05      $349.65      $154.27       $69.93
                             canal cath.
    62351  C                Implant spinal       ...........  ...........  ...........  ...........  ...........
                             canal cath.
    62355  T                Remove spinal canal         0105        15.06      $746.92      $372.32      $149.38
                             catheter.
    62360  T                Insert spine                0226         5.62      $278.73      $109.42       $55.75
                             infusion device.

[[Page 67902]]

 
    62361  T                Implant spine               0227        11.17      $553.99      $330.11      $110.80
                             infusion pump.
    62362  T                Implant spine               0227        11.17      $553.99      $330.11      $110.80
                             infusion pump.
    62365  T                Remove spine                0105        15.06      $746.92      $372.32      $149.38
                             infusion device.
    62367  S                Analyze spine               0102         0.45       $22.32       $12.62        $4.46
                             infusion pump.
    62368  S                Analyze spine               0102         0.45       $22.32       $12.62        $4.46
                             infusion pump.
    63001  C                Removal of spinal    ...........  ...........  ...........  ...........  ...........
                             lamina.
    63003  C                Removal of spinal    ...........  ...........  ...........  ...........  ...........
                             lamina.
    63005  C                Removal of spinal    ...........  ...........  ...........  ...........  ...........
                             lamina.
    63011  C                Removal of spinal    ...........  ...........  ...........  ...........  ...........
                             lamina.
    63012  C                Removal of spinal    ...........  ...........  ...........  ...........  ...........
                             lamina.
    63015  C                Removal of spinal    ...........  ...........  ...........  ...........  ...........
                             lamina.
    63016  C                Removal of spinal    ...........  ...........  ...........  ...........  ...........
                             lamina.
    63017  C                Removal of spinal    ...........  ...........  ...........  ...........  ...........
                             lamina.
    63020  C                Neck spine disk      ...........  ...........  ...........  ...........  ...........
                             surgery.
    63030  C                Low back disk        ...........  ...........  ...........  ...........  ...........
                             surgery.
    63035  C                Spinal disk surgery  ...........  ...........  ...........  ...........  ...........
                             add-on.
    63040  C                Neck spine disk      ...........  ...........  ...........  ...........  ...........
                             surgery.
    63042  C                Low back disk        ...........  ...........  ...........  ...........  ...........
                             surgery.
   *63043  C                Laminotomy, addl     ...........  ...........  ...........  ...........  ...........
                             cervical.
   *63044  C                Laminotomy, addl     ...........  ...........  ...........  ...........  ...........
                             lumbar.
    63045  C                Removal of spinal    ...........  ...........  ...........  ...........  ...........
                             lamina.
    63046  C                Removal of spinal    ...........  ...........  ...........  ...........  ...........
                             lamina.
    63047  C                Removal of spinal    ...........  ...........  ...........  ...........  ...........
                             lamina.
    63048  C                Remove spinal        ...........  ...........  ...........  ...........  ...........
                             lamina add-on.
    63055  C                Decompress spinal    ...........  ...........  ...........  ...........  ...........
                             cord.
    63056  C                Decompress spinal    ...........  ...........  ...........  ...........  ...........
                             cord.
    63057  C                Decompress spine     ...........  ...........  ...........  ...........  ...........
                             cord add-on.
    63064  C                Decompress spinal    ...........  ...........  ...........  ...........  ...........
                             cord.
    63066  C                Decompress spine     ...........  ...........  ...........  ...........  ...........
                             cord add-on.
    63075  C                Neck spine disk      ...........  ...........  ...........  ...........  ...........
                             surgery.
    63076  C                Neck spine disk      ...........  ...........  ...........  ...........  ...........
                             surgery.
    63077  C                Spine disk surgery,  ...........  ...........  ...........  ...........  ...........
                             thorax.
    63078  C                Spine disk surgery,  ...........  ...........  ...........  ...........  ...........
                             thorax.
    63081  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             vertebral body.
    63082  C                Remove vertebral     ...........  ...........  ...........  ...........  ...........
                             body add-on.
    63085  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             vertebral body.
    63086  C                Remove vertebral     ...........  ...........  ...........  ...........  ...........
                             body add-on.
    63087  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             vertebral body.
    63088  C                Remove vertebral     ...........  ...........  ...........  ...........  ...........
                             body add-on.
    63090  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             vertebral body.
    63091  C                Remove vertebral     ...........  ...........  ...........  ...........  ...........
                             body add-on.
    63170  C                Incise spinal cord   ...........  ...........  ...........  ...........  ...........
                             tract(s).
    63172  C                Drainage of spinal   ...........  ...........  ...........  ...........  ...........
                             cyst.
    63173  C                Drainage of spinal   ...........  ...........  ...........  ...........  ...........
                             cyst.
    63180  C                Revise spinal cord   ...........  ...........  ...........  ...........  ...........
                             ligaments.
    63182  C                Revise spinal cord   ...........  ...........  ...........  ...........  ...........
                             ligaments.
    63185  C                Incise spinal        ...........  ...........  ...........  ...........  ...........
                             column/nerves.
    63190  C                Incise spinal        ...........  ...........  ...........  ...........  ...........
                             column/nerves.
    63191  C                Incise spinal        ...........  ...........  ...........  ...........  ...........
                             column/nerves.
    63194  C                Incise spinal        ...........  ...........  ...........  ...........  ...........
                             column & cord.
    63195  C                Incise spinal        ...........  ...........  ...........  ...........  ...........
                             column & cord.
    63196  C                Incise spinal        ...........  ...........  ...........  ...........  ...........
                             column & cord.
    63197  C                Incise spinal        ...........  ...........  ...........  ...........  ...........
                             column & cord.
    63198  C                Incise spinal        ...........  ...........  ...........  ...........  ...........
                             column & cord.
    63199  C                Incise spinal        ...........  ...........  ...........  ...........  ...........
                             column & cord.
    63200  C                Release of spinal    ...........  ...........  ...........  ...........  ...........
                             cord.
    63250  C                Revise spinal cord   ...........  ...........  ...........  ...........  ...........
                             vessels.
    63251  C                Revise spinal cord   ...........  ...........  ...........  ...........  ...........
                             vessels.
    63252  C                Revise spinal cord   ...........  ...........  ...........  ...........  ...........
                             vessels.
    63265  C                Excise intraspinal   ...........  ...........  ...........  ...........  ...........
                             lesion.
    63266  C                Excise intraspinal   ...........  ...........  ...........  ...........  ...........
                             lesion.
    63267  C                Excise intraspinal   ...........  ...........  ...........  ...........  ...........
                             lesion.
    63268  C                Excise intraspinal   ...........  ...........  ...........  ...........  ...........
                             lesion.
    63270  C                Excise intraspinal   ...........  ...........  ...........  ...........  ...........
                             lesion.
    63271  C                Excise intraspinal   ...........  ...........  ...........  ...........  ...........
                             lesion.
    63272  C                Excise intraspinal   ...........  ...........  ...........  ...........  ...........
                             lesion.
    63273  C                Excise intraspinal   ...........  ...........  ...........  ...........  ...........
                             lesion.
    63275  C                Biopsy/excise        ...........  ...........  ...........  ...........  ...........
                             spinal tumor.
    63276  C                Biopsy/excise        ...........  ...........  ...........  ...........  ...........
                             spinal tumor.
    63277  C                Biopsy/excise        ...........  ...........  ...........  ...........  ...........
                             spinal tumor.
    63278  C                Biopsy/excise        ...........  ...........  ...........  ...........  ...........
                             spinal tumor.
    63280  C                Biopsy/excise        ...........  ...........  ...........  ...........  ...........
                             spinal tumor.
    63281  C                Biopsy/excise        ...........  ...........  ...........  ...........  ...........
                             spinal tumor.
    63282  C                Biopsy/excise        ...........  ...........  ...........  ...........  ...........
                             spinal tumor.

[[Page 67903]]

 
    63283  C                Biopsy/excise        ...........  ...........  ...........  ...........  ...........
                             spinal tumor.
    63285  C                Biopsy/excise        ...........  ...........  ...........  ...........  ...........
                             spinal tumor.
    63286  C                Biopsy/excise        ...........  ...........  ...........  ...........  ...........
                             spinal tumor.
    63287  C                Biopsy/excise        ...........  ...........  ...........  ...........  ...........
                             spinal tumor.
    63290  C                Biopsy/excise        ...........  ...........  ...........  ...........  ...........
                             spinal tumor.
    63300  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             vertebral body.
    63301  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             vertebral body.
    63302  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             vertebral body.
    63303  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             vertebral body.
    63304  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             vertebral body.
    63305  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             vertebral body.
    63306  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             vertebral body.
    63307  C                Removal of           ...........  ...........  ...........  ...........  ...........
                             vertebral body.
    63308  C                Remove vertebral     ...........  ...........  ...........  ...........  ...........
                             body add-on.
    63600  T                Remove spinal cord          0220        13.96      $692.36      $326.21      $138.47
                             lesion.
    63610  T                Stimulation of              0220        13.96      $692.36      $326.21      $138.47
                             spinal cord.
    63615  T                Remove lesion of            0220        13.96      $692.36      $326.21      $138.47
                             spinal cord.
    63650  T                Implant                     0225        17.72      $878.84      $408.33      $175.77
                             neuroelectrodes.
    63655  C                Implant              ...........  ...........  ...........  ...........  ...........
                             neuroelectrodes.
    63660  T                Revise/remove               0105        15.06      $746.92      $372.32      $149.38
                             neuroelectrode.
    63685  T                Implant                     0222       124.43    $6,171.23    $2,955.13    $1,234.25
                             neuroreceiver.
    63688  T                Revise/remove               0105        15.06      $746.92      $372.32      $149.38
                             neuroreceiver.
    63700  C                Repair of spinal     ...........  ...........  ...........  ...........  ...........
                             herniation.
    63702  C                Repair of spinal     ...........  ...........  ...........  ...........  ...........
                             herniation.
    63704  C                Repair of spinal     ...........  ...........  ...........  ...........  ...........
                             herniation.
    63706  C                Repair of spinal     ...........  ...........  ...........  ...........  ...........
                             herniation.
    63707  C                Repair spinal fluid  ...........  ...........  ...........  ...........  ...........
                             leakage.
    63709  C                Repair spinal fluid  ...........  ...........  ...........  ...........  ...........
                             leakage.
    63710  C                Graft repair of      ...........  ...........  ...........  ...........  ...........
                             spine defect.
    63740  C                Install spinal       ...........  ...........  ...........  ...........  ...........
                             shunt.
    63741  T                Install spinal              0228        25.06    $1,242.88      $696.46      $248.58
                             shunt.
    63744  T                Revision of spinal          0228        25.06    $1,242.88      $696.46      $248.58
                             shunt.
    63746  T                Removal of spinal           0109         6.53      $323.86      $133.51       $64.77
                             shunt.
    64400  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64402  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64405  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64408  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64410  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64412  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64413  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64415  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64417  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64418  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64420  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64421  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64425  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64430  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64435  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64445  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64450  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64470  T                Inj paravertebral c/        0211         3.32      $164.66       $74.78       $32.93
                             t.
    64472  T                Inj paravertebral c/        0211         3.32      $164.66       $74.78       $32.93
                             t add-on.
    64475  T                Inj paravertebral l/        0211         3.32      $164.66       $74.78       $32.93
                             s.
    64476  T                Inj paravertebral l/        0211         3.32      $164.66       $74.78       $32.93
                             s add-on.
    64479  T                Inj foramen                 0211         3.32      $164.66       $74.78       $32.93
                             epidural c/t.
    64480  T                Inj foramen                 0211         3.32      $164.66       $74.78       $32.93
                             epidural add-on.
    64483  T                Inj foramen                 0211         3.32      $164.66       $74.78       $32.93
                             epidural l/s.
    64484  T                Inj foramen                 0211         3.32      $164.66       $74.78       $32.93
                             epidural add-on.
    64505  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64508  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64510  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64520  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64530  T                Injection for nerve         0211         3.32      $164.66       $74.78       $32.93
                             block.
    64550  A                Apply                ...........  ...........  ...........  ...........  ...........
                             neurostimulator.
    64553  T                Implant                     0225        17.72      $878.84      $408.33      $175.77
                             neuroelectrodes.
    64555  T                Implant                     0225        17.72      $878.84      $408.33      $175.77
                             neuroelectrodes.
    64560  T                Implant                     0225        17.72      $878.84      $408.33      $175.77
                             neuroelectrodes.
    64565  T                Implant                     0225        17.72      $878.84      $408.33      $175.77
                             neuroelectrodes.
    64573  T                Implant                     0225        17.72      $878.84      $408.33      $175.77
                             neuroelectrodes.
    64575  T                Implant                     0225        17.72      $878.84      $408.33      $175.77
                             neuroelectrodes.
    64577  T                Implant                     0225        17.72      $878.84      $408.33      $175.77
                             neuroelectrodes.
    64580  T                Implant                     0225        17.72      $878.84      $408.33      $175.77
                             neuroelectrodes.
    64585  T                Revise/remove               0105        15.06      $746.92      $372.32      $149.38
                             neuroelectrode.
    64590  T                Implant                     0222       124.43    $6,171.23    $2,955.13    $1,234.25
                             neuroreceiver.

[[Page 67904]]

 
    64595  T                Revise/remove               0105        15.06      $746.92      $372.32      $149.38
                             neuroreceiver.
    64600  T                Injection treatment         0211         3.32      $164.66       $74.78       $32.93
                             of nerve.
    64605  T                Injection treatment         0211         3.32      $164.66       $74.78       $32.93
                             of nerve.
    64610  T                Injection treatment         0211         3.32      $164.66       $74.78       $32.93
                             of nerve.
    64612  T                Destroy nerve, face         0211         3.32      $164.66       $74.78       $32.93
                             muscle.
    64613  T                Destroy nerve,              0211         3.32      $164.66       $74.78       $32.93
                             spine muscle.
   *64614  S                Desrtoy nerve,              0971         1.55       $76.88  ...........       $15.38
                             extrem musc.
    64620  T                Injection treatment         0211         3.32      $164.66       $74.78       $32.93
                             of nerve.
    64622  T                Destr paravertebrl          0211         3.32      $164.66       $74.78       $32.93
                             nerve l/s.
    64623  T                Destr paravertebral         0211         3.32      $164.66       $74.78       $32.93
                             n add-on.
    64626  T                Destr paravertebrl          0211         3.32      $164.66       $74.78       $32.93
                             nerve c/t.
    64627  T                Destr paravertebral         0211         3.32      $164.66       $74.78       $32.93
                             n add-on.
    64630  T                Injection treatment         0211         3.32      $164.66       $74.78       $32.93
                             of nerve.
    64640  T                Injection treatment         0211         3.32      $164.66       $74.78       $32.93
                             of nerve.
    64680  T                Injection treatment         0211         3.32      $164.66       $74.78       $32.93
                             of nerve.
    64702  T                Revise finger/toe           0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    64704  T                Revise hand/foot            0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    64708  T                Revise arm/leg              0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    64712  T                Revision of sciatic         0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    64713  T                Revision of arm             0220        13.96      $692.36      $326.21      $138.47
                             nerve(s).
    64714  T                Revise low back             0220        13.96      $692.36      $326.21      $138.47
                             nerve(s).
    64716  T                Revision of cranial         0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    64718  T                Revise ulnar nerve          0220        13.96      $692.36      $326.21      $138.47
                             at elbow.
    64719  T                Revise ulnar nerve          0220        13.96      $692.36      $326.21      $138.47
                             at wrist.
    64721  T                Carpal tunnel               0220        13.96      $692.36      $326.21      $138.47
                             surgery.
    64722  T                Relieve pressure on         0220        13.96      $692.36      $326.21      $138.47
                             nerve(s).
    64726  T                Release foot/toe            0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    64727  T                Internal nerve              0220        13.96      $692.36      $326.21      $138.47
                             revision.
    64732  T                Incision of brow            0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    64734  T                Incision of cheek           0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    64736  T                Incision of chin            0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    64738  T                Incision of jaw             0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    64740  T                Incision of tongue          0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    64742  T                Incision of facial          0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    64744  T                Incise nerve, back          0220        13.96      $692.36      $326.21      $138.47
                             of head.
    64746  T                Incise diaphragm            0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    64752  C                Incision of vagus    ...........  ...........  ...........  ...........  ...........
                             nerve.
    64755  C                Incision of stomach  ...........  ...........  ...........  ...........  ...........
                             nerves.
    64760  C                Incision of vagus    ...........  ...........  ...........  ...........  ...........
                             nerve.
    64761  T                Incision of pelvis          0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    64763  C                Incise hip/thigh     ...........  ...........  ...........  ...........  ...........
                             nerve.
    64766  C                Incise hip/thigh     ...........  ...........  ...........  ...........  ...........
                             nerve.
    64771  T                Sever cranial nerve         0220        13.96      $692.36      $326.21      $138.47
    64772  T                Incision of spinal          0220        13.96      $692.36      $326.21      $138.47
                             nerve.
    64774  T                Remove skin nerve           0220        13.96      $692.36      $326.21      $138.47
                             lesion.
    64776  T                Remove digit nerve          0220        13.96      $692.36      $326.21      $138.47
                             lesion.
    64778  T                Digit nerve surgery         0220        13.96      $692.36      $326.21      $138.47
                             add-on.
    64782  T                Remove limb nerve           0220        13.96      $692.36      $326.21      $138.47
                             lesion.
    64783  T                Limb nerve surgery          0220        13.96      $692.36      $326.21      $138.47
                             add-on.
    64784  T                Remove nerve lesion         0220        13.96      $692.36      $326.21      $138.47
    64786  T                Remove sciatic              0221        18.36      $910.58      $463.62      $182.12
                             nerve lesion.
    64787  T                Implant nerve end..         0220        13.96      $692.36      $326.21      $138.47
    64788  T                Remove skin nerve           0220        13.96      $692.36      $326.21      $138.47
                             lesion.
    64790  T                Removal of nerve            0220        13.96      $692.36      $326.21      $138.47
                             lesion.
    64792  T                Removal of nerve            0221        18.36      $910.58      $463.62      $182.12
                             lesion.
    64795  T                Biopsy of nerve....         0220        13.96      $692.36      $326.21      $138.47
    64802  C                Remove sympathetic   ...........  ...........  ...........  ...........  ...........
                             nerves.
    64804  C                Remove sympathetic   ...........  ...........  ...........  ...........  ...........
                             nerves.
    64809  C                Remove sympathetic   ...........  ...........  ...........  ...........  ...........
                             nerves.
    64818  C                Remove sympathetic   ...........  ...........  ...........  ...........  ...........
                             nerves.
    64820  C                Remove sympathetic   ...........  ...........  ...........  ...........  ...........
                             nerves.
    64831  T                Repair of digit             0221        18.36      $910.58      $463.62      $182.12
                             nerve.
    64832  T                Repair nerve add-on         0221        18.36      $910.58      $463.62      $182.12
    64834  T                Repair of hand or           0221        18.36      $910.58      $463.62      $182.12
                             foot nerve.
    64835  T                Repair of hand or           0221        18.36      $910.58      $463.62      $182.12
                             foot nerve.
    64836  T                Repair of hand or           0221        18.36      $910.58      $463.62      $182.12
                             foot nerve.
    64837  T                Repair nerve add-on         0221        18.36      $910.58      $463.62      $182.12
    64840  T                Repair of leg nerve         0221        18.36      $910.58      $463.62      $182.12
    64856  T                Repair/transpose            0221        18.36      $910.58      $463.62      $182.12
                             nerve.
    64857  T                Repair arm/leg              0221        18.36      $910.58      $463.62      $182.12
                             nerve.
    64858  T                Repair sciatic              0221        18.36      $910.58      $463.62      $182.12
                             nerve.
    64859  T                Nerve surgery......         0221        18.36      $910.58      $463.62      $182.12
    64861  T                Repair of arm               0221        18.36      $910.58      $463.62      $182.12
                             nerves.
    64862  T                Repair of low back          0221        18.36      $910.58      $463.62      $182.12
                             nerves.

[[Page 67905]]

 
    64864  T                Repair of facial            0221        18.36      $910.58      $463.62      $182.12
                             nerve.
    64865  T                Repair of facial            0221        18.36      $910.58      $463.62      $182.12
                             nerve.
    64866  C                Fusion of facial/    ...........  ...........  ...........  ...........  ...........
                             other nerve.
    64868  C                Fusion of facial/    ...........  ...........  ...........  ...........  ...........
                             other nerve.
    64870  T                Fusion of facial/           0221        18.36      $910.58      $463.62      $182.12
                             other nerve.
    64872  T                Subsequent repair           0221        18.36      $910.58      $463.62      $182.12
                             of nerve.
    64874  T                Repair & revise             0221        18.36      $910.58      $463.62      $182.12
                             nerve add-on.
    64876  T                Repair nerve/               0221        18.36      $910.58      $463.62      $182.12
                             shorten bone.
    64885  T                Nerve graft, head           0221        18.36      $910.58      $463.62      $182.12
                             or neck.
    64886  T                Nerve graft, head           0221        18.36      $910.58      $463.62      $182.12
                             or neck.
    64890  T                Nerve graft, hand           0221        18.36      $910.58      $463.62      $182.12
                             or foot.
    64891  T                Nerve graft, hand           0221        18.36      $910.58      $463.62      $182.12
                             or foot.
    64892  T                Nerve graft, arm or         0221        18.36      $910.58      $463.62      $182.12
                             leg.
    64893  T                Nerve graft, arm or         0221        18.36      $910.58      $463.62      $182.12
                             leg.
    64895  T                Nerve graft, hand           0221        18.36      $910.58      $463.62      $182.12
                             or foot.
    64896  T                Nerve graft, hand           0221        18.36      $910.58      $463.62      $182.12
                             or foot.
    64897  T                Nerve graft, arm or         0221        18.36      $910.58      $463.62      $182.12
                             leg.
    64898  T                Nerve graft, arm or         0221        18.36      $910.58      $463.62      $182.12
                             leg.
    64901  T                Nerve graft add-on.         0221        18.36      $910.58      $463.62      $182.12
    64902  T                Nerve graft add-on.         0221        18.36      $910.58      $463.62      $182.12
    64905  T                Nerve pedicle               0221        18.36      $910.58      $463.62      $182.12
                             transfer.
    64907  T                Nerve pedicle               0221        18.36      $910.58      $463.62      $182.12
                             transfer.
    64999  T                Nervous system              0211         3.32      $164.66       $74.78       $32.93
                             surgery.
    65091  T                Revise eye.........         0242        23.70    $1,175.42      $597.36      $235.08
    65093  T                Revise eye with             0241        16.60      $823.30      $384.47      $164.66
                             implant.
    65101  T                Removal of eye.....         0242        23.70    $1,175.42      $597.36      $235.08
    65103  T                Remove eye/insert           0242        23.70    $1,175.42      $597.36      $235.08
                             implant.
    65105  T                Remove eye/attach           0242        23.70    $1,175.42      $597.36      $235.08
                             implant.
    65110  T                Removal of eye.....         0242        23.70    $1,175.42      $597.36      $235.08
    65112  T                Remove eye/revise           0242        23.70    $1,175.42      $597.36      $235.08
                             socket.
    65114  T                Remove eye/revise           0242        23.70    $1,175.42      $597.36      $235.08
                             socket.
    65125  T                Revise ocular               0240        13.47      $668.06      $315.31      $133.61
                             implant.
    65130  T                Insert ocular               0241        16.60      $823.30      $384.47      $164.66
                             implant.
    65135  T                Insert ocular               0241        16.60      $823.30      $384.47      $164.66
                             implant.
    65140  T                Attach ocular               0242        23.70    $1,175.42      $597.36      $235.08
                             implant.
    65150  T                Revise ocular               0241        16.60      $823.30      $384.47      $164.66
                             implant.
    65155  T                Reinsert ocular             0242        23.70    $1,175.42      $597.36      $235.08
                             implant.
    65175  T                Removal of ocular           0240        13.47      $668.06      $315.31      $133.61
                             implant.
    65205  S                Remove foreign body         0231         2.64      $130.94       $59.87       $26.19
                             from eye.
    65210  S                Remove foreign body         0231         2.64      $130.94       $59.87       $26.19
                             from eye.
    65220  S                Remove foreign body         0231         2.64      $130.94       $59.87       $26.19
                             from eye.
    65222  S                Remove foreign body         0231         2.64      $130.94       $59.87       $26.19
                             from eye.
    65235  T                Remove foreign body         0232         6.04      $299.56      $134.66       $59.91
                             from eye.
    65260  T                Remove foreign body         0237        33.96    $1,684.28      $852.68      $336.86
                             from eye.
    65265  T                Remove foreign body         0237        33.96    $1,684.28      $852.68      $336.86
                             from eye.
    65270  T                Repair of eye wound         0240        13.47      $668.06      $315.31      $133.61
    65272  T                Repair of eye wound         0232         6.04      $299.56      $134.66       $59.91
    65273  C                Repair of eye wound  ...........  ...........  ...........  ...........  ...........
    65275  T                Repair of eye wound         0233        13.79      $683.93      $331.60      $136.79
    65280  T                Repair of eye wound         0233        13.79      $683.93      $331.60      $136.79
    65285  T                Repair of eye wound         0234        20.64    $1,023.66      $502.16      $204.73
    65286  T                Repair of eye wound         0232         6.04      $299.56      $134.66       $59.91
    65290  T                Repair of eye               0243        17.99      $892.23      $431.39      $178.45
                             socket wound.
    65400  T                Removal of eye              0232         6.04      $299.56      $134.66       $59.91
                             lesion.
    65410  T                Biopsy of cornea...         0233        13.79      $683.93      $331.60      $136.79
    65420  T                Removal of eye              0233        13.79      $683.93      $331.60      $136.79
                             lesion.
    65426  T                Removal of eye              0233        13.79      $683.93      $331.60      $136.79
                             lesion.
    65430  S                Corneal smear......         0231         2.64      $130.94       $59.87       $26.19
    65435  T                Curette/treat               0239         6.26      $310.47      $123.42       $62.09
                             cornea.
    65436  T                Curette/treat               0232         6.04      $299.56      $134.66       $59.91
                             cornea.
    65450  T                Treatment of                0232         6.04      $299.56      $134.66       $59.91
                             corneal lesion.
    65600  T                Revision of cornea.         0240        13.47      $668.06      $315.31      $133.61
    65710  T                Corneal transplant.         0244        32.88    $1,630.72      $851.42      $326.14
    65730  T                Corneal transplant.         0244        32.88    $1,630.72      $851.42      $326.14
    65750  T                Corneal transplant.         0244        32.88    $1,630.72      $851.42      $326.14
    65755  T                Corneal transplant.         0244        32.88    $1,630.72      $851.42      $326.14
    65760  E                Revision of cornea.  ...........  ...........  ...........  ...........  ...........
    65765  E                Revision of cornea.  ...........  ...........  ...........  ...........  ...........
    65767  E                Corneal tissue       ...........  ...........  ...........  ...........  ...........
                             transplant.
    65770  T                Revise cornea with          0244        32.88    $1,630.72      $851.42      $326.14
                             implant.
    65771  E                Radial keratotomy..  ...........  ...........  ...........  ...........  ...........
    65772  T                Correction of               0232         6.04      $299.56      $134.66       $59.91
                             astigmatism.
    65775  T                Correction of               0233        13.79      $683.93      $331.60      $136.79
                             astigmatism.
    65800  T                Drainage of eye....         0232         6.04      $299.56      $134.66       $59.91

[[Page 67906]]

 
    65805  T                Drainage of eye....         0233        13.79      $683.93      $331.60      $136.79
    65810  T                Drainage of eye....         0233        13.79      $683.93      $331.60      $136.79
    65815  T                Drainage of eye....         0233        13.79      $683.93      $331.60      $136.79
    65820  T                Relieve inner eye           0232         6.04      $299.56      $134.66       $59.91
                             pressure.
    65850  T                Incision of eye....         0234        20.64    $1,023.66      $502.16      $204.73
    65855  T                Laser surgery of            0247         4.89      $242.52      $112.86       $48.50
                             eye.
    65860  T                Incise inner eye            0247         4.89      $242.52      $112.86       $48.50
                             adhesions.
    65865  T                Incise inner eye            0233        13.79      $683.93      $331.60      $136.79
                             adhesions.
    65870  T                Incise inner eye            0233        13.79      $683.93      $331.60      $136.79
                             adhesions.
    65875  T                Incise inner eye            0233        13.79      $683.93      $331.60      $136.79
                             adhesions.
    65880  T                Incise inner eye            0232         6.04      $299.56      $134.66       $59.91
                             adhesions.
    65900  T                Remove eye lesion..         0232         6.04      $299.56      $134.66       $59.91
    65920  T                Remove implant from         0233        13.79      $683.93      $331.60      $136.79
                             eye.
    65930  T                Remove blood clot           0233        13.79      $683.93      $331.60      $136.79
                             from eye.
    66020  T                Injection treatment         0232         6.04      $299.56      $134.66       $59.91
                             of eye.
    66030  T                Injection treatment         0232         6.04      $299.56      $134.66       $59.91
                             of eye.
    66130  T                Remove eye lesion..         0233        13.79      $683.93      $331.60      $136.79
    66150  T                Glaucoma surgery...         0233        13.79      $683.93      $331.60      $136.79
    66155  T                Glaucoma surgery...         0234        20.64    $1,023.66      $502.16      $204.73
    66160  T                Glaucoma surgery...         0234        20.64    $1,023.66      $502.16      $204.73
    66165  T                Glaucoma surgery...         0234        20.64    $1,023.66      $502.16      $204.73
    66170  T                Glaucoma surgery...         0234        20.64    $1,023.66      $502.16      $204.73
    66172  T                Incision of eye....         0234        20.64    $1,023.66      $502.16      $204.73
    66180  T                Implant eye shunt..         0234        20.64    $1,023.66      $502.16      $204.73
    66185  T                Revise eye shunt...         0234        20.64    $1,023.66      $502.16      $204.73
    66220  T                Repair eye lesion..         0236         6.70      $332.29      $147.96       $66.46
    66225  T                Repair/graft eye            0234        20.64    $1,023.66      $502.16      $204.73
                             lesion.
    66250  T                Follow-up surgery           0233        13.79      $683.93      $331.60      $136.79
                             of eye.
    66500  T                Incision of iris...         0232         6.04      $299.56      $134.66       $59.91
    66505  T                Incision of iris...         0232         6.04      $299.56      $134.66       $59.91
    66600  T                Remove iris and             0233        13.79      $683.93      $331.60      $136.79
                             lesion.
    66605  T                Removal of iris....         0233        13.79      $683.93      $331.60      $136.79
    66625  T                Removal of iris....         0232         6.04      $299.56      $134.66       $59.91
    66630  T                Removal of iris....         0233        13.79      $683.93      $331.60      $136.79
    66635  T                Removal of iris....         0233        13.79      $683.93      $331.60      $136.79
    66680  T                Repair iris &               0233        13.79      $683.93      $331.60      $136.79
                             ciliary body.
    66682  T                Repair iris &               0233        13.79      $683.93      $331.60      $136.79
                             ciliary body.
    66700  T                Destruction,                0232         6.04      $299.56      $134.66       $59.91
                             ciliary body.
    66710  T                Destruction,                0232         6.04      $299.56      $134.66       $59.91
                             ciliary body.
    66720  T                Destruction,                0232         6.04      $299.56      $134.66       $59.91
                             ciliary body.
    66740  T                Destruction,                0233        13.79      $683.93      $331.60      $136.79
                             ciliary body.
    66761  T                Revision of iris...         0247         4.89      $242.52      $112.86       $48.50
    66762  T                Revision of iris...         0247         4.89      $242.52      $112.86       $48.50
    66770  T                Removal of inner            0247         4.89      $242.52      $112.86       $48.50
                             eye lesion.
    66820  T                Incision, secondary         0232         6.04      $299.56      $134.66       $59.91
                             cataract.
    66821  T                After cataract              0247         4.89      $242.52      $112.86       $48.50
                             laser surgery.
    66825  T                Reposition                  0233        13.79      $683.93      $331.60      $136.79
                             intraocular lens.
    66830  T                Removal of lens             0232         6.04      $299.56      $134.66       $59.91
                             lesion.
    66840  T                Removal of lens             0245        26.55    $1,316.77      $623.85      $263.35
                             material.
    66850  T                Removal of lens             0245        26.55    $1,316.77      $623.85      $263.35
                             material.
    66852  T                Removal of lens             0245        26.55    $1,316.77      $623.85      $263.35
                             material.
    66920  T                Extraction of lens.         0245        26.55    $1,316.77      $623.85      $263.35
    66930  T                Extraction of lens.         0245        26.55    $1,316.77      $623.85      $263.35
    66940  T                Extraction of lens.         0245        26.55    $1,316.77      $623.85      $263.35
   *66982  T                Cataract surgery,           0246        26.55    $1,316.77      $623.85      $263.35
                             complex.
    66983  T                Remove cataract/            0246        26.55    $1,316.77      $623.85      $263.35
                             insert lens.
    66984  T                Remove cataract/            0246        26.55    $1,316.77      $623.85      $263.35
                             insert lens.
    66985  T                Insert lens                 0246        26.55    $1,316.77      $623.85      $263.35
                             prosthesis.
    66986  T                Exchange lens               0246        26.55    $1,316.77      $623.85      $263.35
                             prosthesis.
    66999  T                Eye surgery                 0247         4.89      $242.52      $112.86       $48.50
                             procedure.
    67005  T                Partial removal of          0237        33.96    $1,684.28      $852.68      $336.86
                             eye fluid.
    67010  T                Partial removal of          0237        33.96    $1,684.28      $852.68      $336.86
                             eye fluid.
    67015  T                Release of eye              0237        33.96    $1,684.28      $852.68      $336.86
                             fluid.
    67025  T                Replace eye fluid..         0237        33.96    $1,684.28      $852.68      $336.86
    67027  T                Implant eye drug            0237        33.96    $1,684.28      $852.68      $336.86
                             system.
    67028  T                Injection eye drug.         0236         6.70      $332.29      $147.96       $66.46
    67030  T                Incise inner eye            0236         6.70      $332.29      $147.96       $66.46
                             strands.
    67031  T                Laser surgery, eye          0247         4.89      $242.52      $112.86       $48.50
                             strands.
    67036  T                Removal of inner            0237        33.96    $1,684.28      $852.68      $336.86
                             eye fluid.
    67038  T                Strip retinal               0237        33.96    $1,684.28      $852.68      $336.86
                             membrane.
    67039  T                Laser treatment of          0237        33.96    $1,684.28      $852.68      $336.86
                             retina.
    67040  T                Laser treatment of          0237        33.96    $1,684.28      $852.68      $336.86
                             retina.
    67101  T                Repair detached             0236         6.70      $332.29      $147.96       $66.46
                             retina.
    67105  T                Repair detached             0248         4.19      $207.81       $94.05       $41.56
                             retina.

[[Page 67907]]

 
    67107  T                Repair detached             0237        33.96    $1,684.28      $852.68      $336.86
                             retina.
    67108  T                Repair detached             0237        33.96    $1,684.28      $852.68      $336.86
                             retina.
    67110  T                Repair detached             0236         6.70      $332.29      $147.96       $66.46
                             retina.
    67112  T                Rerepair detached           0237        33.96    $1,684.28      $852.68      $336.86
                             retina.
    67115  T                Release encircling          0236         6.70      $332.29      $147.96       $66.46
                             material.
    67120  T                Remove eye implant          0236         6.70      $332.29      $147.96       $66.46
                             material.
    67121  T                Remove eye implant          0237        33.96    $1,684.28      $852.68      $336.86
                             material.
    67141  T                Treatment of retina         0235         2.94      $145.81       $78.91       $29.16
    67145  T                Treatment of retina         0248         4.19      $207.81       $94.05       $41.56
    67208  T                Treatment of                0235         2.94      $145.81       $78.91       $29.16
                             retinal lesion.
    67210  T                Treatment of                0248         4.19      $207.81       $94.05       $41.56
                             retinal lesion.
    67218  T                Treatment of                0237        33.96    $1,684.28      $852.68      $336.86
                             retinal lesion.
    67220  T                Treatment of                0237        33.96    $1,684.28      $852.68      $336.86
                             choroid lesion.
   *67221  T                Treatment of                0235         2.94      $145.81       $78.91       $29.16
                             choroid lesion.
    67227  T                Treatment of                0235         2.94      $145.81       $78.91       $29.16
                             retinal lesion.
    67228  T                Treatment of                0248         4.19      $207.81       $94.05       $41.56
                             retinal lesion.
    67250  T                Reinforce eye wall.         0240        13.47      $668.06      $315.31      $133.61
    67255  T                Reinforce/graft eye         0237        33.96    $1,684.28      $852.68      $336.86
                             wall.
    67299  T                Eye surgery                 0248         4.19      $207.81       $94.05       $41.56
                             procedure.
    67311  T                Revise eye muscle..         0243        17.99      $892.23      $431.39      $178.45
    67312  T                Revise two eye              0243        17.99      $892.23      $431.39      $178.45
                             muscles.
    67314  T                Revise eye muscle..         0243        17.99      $892.23      $431.39      $178.45
    67316  T                Revise two eye              0243        17.99      $892.23      $431.39      $178.45
                             muscles.
    67318  T                Revise eye                  0243        17.99      $892.23      $431.39      $178.45
                             muscle(s).
    67320  T                Revise eye                  0243        17.99      $892.23      $431.39      $178.45
                             muscle(s) add-on.
    67331  T                Eye surgery follow-         0243        17.99      $892.23      $431.39      $178.45
                             up add-on.
    67332  T                Rerevise eye                0243        17.99      $892.23      $431.39      $178.45
                             muscles add-on.
    67334  T                Revise eye muscle w/        0243        17.99      $892.23      $431.39      $178.45
                             suture.
    67335  T                Eye suture during           0243        17.99      $892.23      $431.39      $178.45
                             surgery.
    67340  T                Revise eye muscle           0243        17.99      $892.23      $431.39      $178.45
                             add-on.
    67343  T                Release eye tissue.         0243        17.99      $892.23      $431.39      $178.45
    67345  T                Destroy nerve of            0238         2.80      $138.87       $58.96       $27.77
                             eye muscle.
    67350  S                Biopsy eye muscle..         0231         2.64      $130.94       $59.87       $26.19
    67399  T                Eye muscle surgery          0243        17.99      $892.23      $431.39      $178.45
                             procedure.
    67400  T                Explore/biopsy eye          0241        16.60      $823.30      $384.47      $164.66
                             socket.
    67405  T                Explore/drain eye           0241        16.60      $823.30      $384.47      $164.66
                             socket.
    67412  T                Explore/treat eye           0241        16.60      $823.30      $384.47      $164.66
                             socket.
    67413  T                Explore/treat eye           0241        16.60      $823.30      $384.47      $164.66
                             socket.
    67414  T                Explr/decompress            0242        23.70    $1,175.42      $597.36      $235.08
                             eye socket.
    67415  T                Aspiration, orbital         0239         6.26      $310.47      $123.42       $62.09
                             contents.
    67420  T                Explore/treat eye           0242        23.70    $1,175.42      $597.36      $235.08
                             socket.
    67430  T                Explore/treat eye           0242        23.70    $1,175.42      $597.36      $235.08
                             socket.
    67440  T                Explore/drain eye           0242        23.70    $1,175.42      $597.36      $235.08
                             socket.
    67445  T                Explr/decompress            0242        23.70    $1,175.42      $597.36      $235.08
                             eye socket.
    67450  T                Explore/biopsy eye          0242        23.70    $1,175.42      $597.36      $235.08
                             socket.
    67500  S                Inject/treat eye            0231         2.64      $130.94       $59.87       $26.19
                             socket.
    67505  T                Inject/treat eye            0238         2.80      $138.87       $58.96       $27.77
                             socket.
    67515  T                Inject/treat eye            0239         6.26      $310.47      $123.42       $62.09
                             socket.
    67550  T                Insert eye socket           0242        23.70    $1,175.42      $597.36      $235.08
                             implant.
    67560  T                Revise eye socket           0241        16.60      $823.30      $384.47      $164.66
                             implant.
    67570  T                Decompress optic            0242        23.70    $1,175.42      $597.36      $235.08
                             nerve.
    67599  T                Orbit surgery               0239         6.26      $310.47      $123.42       $62.09
                             procedure.
    67700  T                Drainage of eyelid          0238         2.80      $138.87       $58.96       $27.77
                             abscess.
    67710  T                Incision of eyelid.         0239         6.26      $310.47      $123.42       $62.09
    67715  T                Incision of eyelid          0240        13.47      $668.06      $315.31      $133.61
                             fold.
    67800  T                Remove eyelid               0238         2.80      $138.87       $58.96       $27.77
                             lesion.
    67801  T                Remove eyelid               0239         6.26      $310.47      $123.42       $62.09
                             lesions.
    67805  T                Remove eyelid               0238         2.80      $138.87       $58.96       $27.77
                             lesions.
    67808  T                Remove eyelid               0240        13.47      $668.06      $315.31      $133.61
                             lesion(s).
    67810  T                Biopsy of eyelid...         0238         2.80      $138.87       $58.96       $27.77
    67820  T                Revise eyelashes...         0238         2.80      $138.87       $58.96       $27.77
    67825  T                Revise eyelashes...         0238         2.80      $138.87       $58.96       $27.77
    67830  T                Revise eyelashes...         0239         6.26      $310.47      $123.42       $62.09
    67835  T                Revise eyelashes...         0240        13.47      $668.06      $315.31      $133.61
    67840  T                Remove eyelid               0239         6.26      $310.47      $123.42       $62.09
                             lesion.
    67850  T                Treat eyelid lesion         0239         6.26      $310.47      $123.42       $62.09
    67875  T                Closure of eyelid           0239         6.26      $310.47      $123.42       $62.09
                             by suture.
    67880  T                Revision of eyelid.         0232         6.04      $299.56      $134.66       $59.91
    67882  T                Revision of eyelid.         0240        13.47      $668.06      $315.31      $133.61
    67900  T                Repair brow defect.         0240        13.47      $668.06      $315.31      $133.61
    67901  T                Repair eyelid               0240        13.47      $668.06      $315.31      $133.61
                             defect.
    67902  T                Repair eyelid               0240        13.47      $668.06      $315.31      $133.61
                             defect.
    67903  T                Repair eyelid               0240        13.47      $668.06      $315.31      $133.61
                             defect.
    67904  T                Repair eyelid               0240        13.47      $668.06      $315.31      $133.61
                             defect.

[[Page 67908]]

 
    67906  T                Repair eyelid               0240        13.47      $668.06      $315.31      $133.61
                             defect.
    67908  T                Repair eyelid               0240        13.47      $668.06      $315.31      $133.61
                             defect.
    67909  T                Revise eyelid               0240        13.47      $668.06      $315.31      $133.61
                             defect.
    67911  T                Revise eyelid               0240        13.47      $668.06      $315.31      $133.61
                             defect.
    67914  T                Repair eyelid               0240        13.47      $668.06      $315.31      $133.61
                             defect.
    67915  T                Repair eyelid               0239         6.26      $310.47      $123.42       $62.09
                             defect.
    67916  T                Repair eyelid               0240        13.47      $668.06      $315.31      $133.61
                             defect.
    67917  T                Repair eyelid               0240        13.47      $668.06      $315.31      $133.61
                             defect.
    67921  T                Repair eyelid               0240        13.47      $668.06      $315.31      $133.61
                             defect.
    67922  T                Repair eyelid               0239         6.26      $310.47      $123.42       $62.09
                             defect.
    67923  T                Repair eyelid               0240        13.47      $668.06      $315.31      $133.61
                             defect.
    67924  T                Repair eyelid               0240        13.47      $668.06      $315.31      $133.61
                             defect.
    67930  T                Repair eyelid wound         0240        13.47      $668.06      $315.31      $133.61
    67935  T                Repair eyelid wound         0240        13.47      $668.06      $315.31      $133.61
    67938  T                Remove eyelid               0238         2.80      $138.87       $58.96       $27.77
                             foreign body.
    67950  T                Revision of eyelid.         0240        13.47      $668.06      $315.31      $133.61
    67961  T                Revision of eyelid.         0240        13.47      $668.06      $315.31      $133.61
    67966  T                Revision of eyelid.         0240        13.47      $668.06      $315.31      $133.61
    67971  T                Reconstruction of           0241        16.60      $823.30      $384.47      $164.66
                             eyelid.
    67973  T                Reconstruction of           0241        16.60      $823.30      $384.47      $164.66
                             eyelid.
    67974  T                Reconstruction of           0241        16.60      $823.30      $384.47      $164.66
                             eyelid.
    67975  T                Reconstruction of           0240        13.47      $668.06      $315.31      $133.61
                             eyelid.
    67999  T                Revision of eyelid.         0240        13.47      $668.06      $315.31      $133.61
    68020  T                Incise/drain eyelid         0240        13.47      $668.06      $315.31      $133.61
                             lining.
    68040  T                Treatment of eyelid         0239         6.26      $310.47      $123.42       $62.09
                             lesions.
    68100  T                Biopsy of eyelid            0232         6.04      $299.56      $134.66       $59.91
                             lining.
    68110  S                Remove eyelid               0231         2.64      $130.94       $59.87       $26.19
                             lining lesion.
    68115  T                Remove eyelid               0239         6.26      $310.47      $123.42       $62.09
                             lining lesion.
    68130  T                Remove eyelid               0233        13.79      $683.93      $331.60      $136.79
                             lining lesion.
    68135  T                Remove eyelid               0239         6.26      $310.47      $123.42       $62.09
                             lining lesion.
    68200  S                Treat eyelid by             0230         0.98       $48.61       $22.48        $9.72
                             injection.
    68320  T                Revise/graft eyelid         0240        13.47      $668.06      $315.31      $133.61
                             lining.
    68325  T                Revise/graft eyelid         0242        23.70    $1,175.42      $597.36      $235.08
                             lining.
    68326  T                Revise/graft eyelid         0241        16.60      $823.30      $384.47      $164.66
                             lining.
    68328  T                Revise/graft eyelid         0241        16.60      $823.30      $384.47      $164.66
                             lining.
    68330  T                Revise eyelid               0233        13.79      $683.93      $331.60      $136.79
                             lining.
    68335  T                Revise/graft eyelid         0241        16.60      $823.30      $384.47      $164.66
                             lining.
    68340  T                Separate eyelid             0240        13.47      $668.06      $315.31      $133.61
                             adhesions.
    68360  T                Revise eyelid               0234        20.64    $1,023.66      $502.16      $204.73
                             lining.
    68362  T                Revise eyelid               0234        20.64    $1,023.66      $502.16      $204.73
                             lining.
    68399  T                Eyelid lining               0239         6.26      $310.47      $123.42       $62.09
                             surgery.
    68400  T                Incise/drain tear           0238         2.80      $138.87       $58.96       $27.77
                             gland.
    68420  T                Incise/drain tear           0240        13.47      $668.06      $315.31      $133.61
                             sac.
    68440  T                Incise tear duct            0238         2.80      $138.87       $58.96       $27.77
                             opening.
    68500  T                Removal of tear             0241        16.60      $823.30      $384.47      $164.66
                             gland.
    68505  T                Partial removal,            0241        16.60      $823.30      $384.47      $164.66
                             tear gland.
    68510  T                Biopsy of tear              0240        13.47      $668.06      $315.31      $133.61
                             gland.
    68520  T                Removal of tear sac         0241        16.60      $823.30      $384.47      $164.66
    68525  T                Biopsy of tear sac.         0240        13.47      $668.06      $315.31      $133.61
    68530  T                Clearance of tear           0240        13.47      $668.06      $315.31      $133.61
                             duct.
    68540  T                Remove tear gland           0241        16.60      $823.30      $384.47      $164.66
                             lesion.
    68550  T                Remove tear gland           0242        23.70    $1,175.42      $597.36      $235.08
                             lesion.
    68700  T                Repair tear ducts..         0241        16.60      $823.30      $384.47      $164.66
    68705  T                Revise tear duct            0238         2.80      $138.87       $58.96       $27.77
                             opening.
    68720  T                Create tear sac             0242        23.70    $1,175.42      $597.36      $235.08
                             drain.
    68745  T                Create tear duct            0241        16.60      $823.30      $384.47      $164.66
                             drain.
    68750  T                Create tear duct            0242        23.70    $1,175.42      $597.36      $235.08
                             drain.
    68760  T                Close tear duct             0238         2.80      $138.87       $58.96       $27.77
                             opening.
    68761  S                Close tear duct             0231         2.64      $130.94       $59.87       $26.19
                             opening.
    68770  T                Close tear system           0240        13.47      $668.06      $315.31      $133.61
                             fistula.
    68801  S                Dilate tear duct            0231         2.64      $130.94       $59.87       $26.19
                             opening.
    68810  S                Probe nasolacrimal          0231         2.64      $130.94       $59.87       $26.19
                             duct.
    68811  T                Probe nasolacrimal          0240        13.47      $668.06      $315.31      $133.61
                             duct.
    68815  T                Probe nasolacrimal          0240        13.47      $668.06      $315.31      $133.61
                             duct.
    68840  S                Explore/irrigate            0231         2.64      $130.94       $59.87       $26.19
                             tear ducts.
    68850  N                Injection for tear   ...........  ...........  ...........  ...........  ...........
                             sac x-ray.
    68899  S                Tear duct system            0231         2.64      $130.94       $59.87       $26.19
                             surgery.
    69000  T                Drain external ear          0006         2.00       $99.19       $33.95       $19.84
                             lesion.
    69005  T                Drain external ear          0007         3.68      $182.51       $72.03       $36.50
                             lesion.
    69020  T                Drain outer ear             0006         2.00       $99.19       $33.95       $19.84
                             canal lesion.
    69090  E                Pierce earlobes....  ...........  ...........  ...........  ...........  ...........
    69100  T                Biopsy of external          0019         4.00      $198.39       $78.91       $39.68
                             ear.
    69105  T                Biopsy of external          0253        12.02      $596.14      $284.00      $119.23
                             ear canal.
    69110  T                Remove external             0020         6.51      $322.87      $130.53       $64.57
                             ear, partial.

[[Page 67909]]

 
    69120  T                Removal of external         0253        12.02      $596.14      $284.00      $119.23
                             ear.
    69140  T                Remove ear canal            0254        12.45      $617.47      $272.41      $123.49
                             lesion(s).
    69145  T                Remove ear canal            0020         6.51      $322.87      $130.53       $64.57
                             lesion(s).
    69150  C                Extensive ear canal  ...........  ...........  ...........  ...........  ...........
                             surgery.
    69155  C                Extensive ear/neck   ...........  ...........  ...........  ...........  ...........
                             surgery.
    69200  X                Clear outer ear             0340         1.04       $51.58       $12.85       $10.32
                             canal.
    69205  T                Clear outer ear             0022        12.49      $619.45      $292.94      $123.89
                             canal.
    69210  X                Remove impacted ear         0340         1.04       $51.58       $12.85       $10.32
                             wax.
    69220  T                Clean out mastoid           0012         0.53       $26.29        $9.18        $5.26
                             cavity.
    69222  T                Clean out mastoid           0253        12.02      $596.14      $284.00      $119.23
                             cavity.
    69300  T                Revise external ear         0254        12.45      $617.47      $272.41      $123.49
    69310  T                Rebuild outer ear           0256        25.40    $1,259.74      $623.05      $251.95
                             canal.
    69320  T                Rebuild outer ear           0256        25.40    $1,259.74      $623.05      $251.95
                             canal.
    69399  T                Outer ear surgery           0252         5.18      $256.90      $114.24       $51.38
                             procedure.
    69400  T                Inflate middle ear          0251         1.68       $83.32       $27.99       $16.66
                             canal.
    69401  N                Inflate middle ear   ...........  ...........  ...........  ...........  ...........
                             canal.
    69405  T                Catheterize middle          0252         5.18      $256.90      $114.24       $51.38
                             ear canal.
    69410  T                Inset middle ear            0252         5.18      $256.90      $114.24       $51.38
                             (baffle).
    69420  T                Incision of eardrum         0252         5.18      $256.90      $114.24       $51.38
    69421  T                Incision of eardrum         0253        12.02      $596.14      $284.00      $119.23
    69424  T                Remove ventilating          0252         5.18      $256.90      $114.24       $51.38
                             tube.
    69433  T                Create eardrum              0252         5.18      $256.90      $114.24       $51.38
                             opening.
    69436  T                Create eardrum              0253        12.02      $596.14      $284.00      $119.23
                             opening.
    69440  T                Exploration of              0253        12.02      $596.14      $284.00      $119.23
                             middle ear.
    69450  T                Eardrum revision...         0256        25.40    $1,259.74      $623.05      $251.95
    69501  T                Mastoidectomy......         0256        25.40    $1,259.74      $623.05      $251.95
    69502  C                Mastoidectomy......  ...........  ...........  ...........  ...........  ...........
    69505  T                Remove mastoid              0256        25.40    $1,259.74      $623.05      $251.95
                             structures.
    69511  T                Extensive mastoid           0256        25.40    $1,259.74      $623.05      $251.95
                             surgery.
    69530  T                Extensive mastoid           0256        25.40    $1,259.74      $623.05      $251.95
                             surgery.
    69535  C                Remove part of       ...........  ...........  ...........  ...........  ...........
                             temporal bone.
    69540  T                Remove ear lesion..         0253        12.02      $596.14      $284.00      $119.23
    69550  T                Remove ear lesion..         0256        25.40    $1,259.74      $623.05      $251.95
    69552  T                Remove ear lesion..         0256        25.40    $1,259.74      $623.05      $251.95
    69554  C                Remove ear lesion..  ...........  ...........  ...........  ...........  ...........
    69601  T                Mastoid surgery             0256        25.40    $1,259.74      $623.05      $251.95
                             revision.
    69602  T                Mastoid surgery             0256        25.40    $1,259.74      $623.05      $251.95
                             revision.
    69603  T                Mastoid surgery             0256        25.40    $1,259.74      $623.05      $251.95
                             revision.
    69604  T                Mastoid surgery             0256        25.40    $1,259.74      $623.05      $251.95
                             revision.
    69605  T                Mastoid surgery             0256        25.40    $1,259.74      $623.05      $251.95
                             revision.
    69610  T                Repair of eardrum..         0253        12.02      $596.14      $284.00      $119.23
    69620  T                Repair of eardrum..         0253        12.02      $596.14      $284.00      $119.23
    69631  T                Repair eardrum              0256        25.40    $1,259.74      $623.05      $251.95
                             structures.
    69632  T                Rebuild eardrum             0256        25.40    $1,259.74      $623.05      $251.95
                             structures.
    69633  T                Rebuild eardrum             0256        25.40    $1,259.74      $623.05      $251.95
                             structures.
    69635  T                Repair eardrum              0256        25.40    $1,259.74      $623.05      $251.95
                             structures.
    69636  T                Rebuild eardrum             0256        25.40    $1,259.74      $623.05      $251.95
                             structures.
    69637  T                Rebuild eardrum             0256        25.40    $1,259.74      $623.05      $251.95
                             structures.
    69641  T                Revise middle ear &         0256        25.40    $1,259.74      $623.05      $251.95
                             mastoid.
    69642  T                Revise middle ear &         0256        25.40    $1,259.74      $623.05      $251.95
                             mastoid.
    69643  T                Revise middle ear &         0256        25.40    $1,259.74      $623.05      $251.95
                             mastoid.
    69644  T                Revise middle ear &         0256        25.40    $1,259.74      $623.05      $251.95
                             mastoid.
    69645  T                Revise middle ear &         0256        25.40    $1,259.74      $623.05      $251.95
                             mastoid.
    69646  T                Revise middle ear &         0256        25.40    $1,259.74      $623.05      $251.95
                             mastoid.
    69650  T                Release middle ear          0254        12.45      $617.47      $272.41      $123.49
                             bone.
    69660  T                Revise middle ear           0256        25.40    $1,259.74      $623.05      $251.95
                             bone.
    69661  T                Revise middle ear           0256        25.40    $1,259.74      $623.05      $251.95
                             bone.
    69662  T                Revise middle ear           0256        25.40    $1,259.74      $623.05      $251.95
                             bone.
    69666  T                Repair middle ear           0256        25.40    $1,259.74      $623.05      $251.95
                             structures.
    69667  T                Repair middle ear           0256        25.40    $1,259.74      $623.05      $251.95
                             structures.
    69670  T                Remove mastoid air          0256        25.40    $1,259.74      $623.05      $251.95
                             cells.
    69676  T                Remove middle ear           0256        25.40    $1,259.74      $623.05      $251.95
                             nerve.
    69700  T                Close mastoid               0256        25.40    $1,259.74      $623.05      $251.95
                             fistula.
    69710  E                Implant/replace      ...........  ...........  ...........  ...........  ...........
                             hearing aid.
    69711  T                Remove/repair               0256        25.40    $1,259.74      $623.05      $251.95
                             hearing aid.
   *69714  T                Implant temple bone         0256        25.40    $1,259.74      $623.05      $251.95
                             w/stimul.
   *69715  T                Temple bne implnt w/        0256        25.40    $1,259.74      $623.05      $251.95
                             stimulat.
   *69717  T                Temple bone implant         0256        25.40    $1,259.74      $623.05      $251.95
                             revision.
   *69718  T                Revise temple bone          0256        25.40    $1,259.74      $623.05      $251.95
                             implant.
    69720  T                Release facial              0256        25.40    $1,259.74      $623.05      $251.95
                             nerve.
    69725  T                Release facial              0256        25.40    $1,259.74      $623.05      $251.95
                             nerve.
    69740  T                Repair facial nerve         0256        25.40    $1,259.74      $623.05      $251.95
    69745  T                Repair facial nerve         0256        25.40    $1,259.74      $623.05      $251.95
    69799  T                Middle ear surgery          0253        12.02      $596.14      $284.00      $119.23
                             procedure.

[[Page 67910]]

 
    69801  T                Incise inner ear...         0256        25.40    $1,259.74      $623.05      $251.95
    69802  T                Incise inner ear...         0256        25.40    $1,259.74      $623.05      $251.95
    69805  T                Explore inner ear..         0256        25.40    $1,259.74      $623.05      $251.95
    69806  T                Explore inner ear..         0256        25.40    $1,259.74      $623.05      $251.95
    69820  T                Establish inner ear         0256        25.40    $1,259.74      $623.05      $251.95
                             window.
    69840  T                Revise inner ear            0256        25.40    $1,259.74      $623.05      $251.95
                             window.
    69905  T                Remove inner ear...         0256        25.40    $1,259.74      $623.05      $251.95
    69910  T                Remove inner ear &          0256        25.40    $1,259.74      $623.05      $251.95
                             mastoid.
    69915  T                Incise inner ear            0256        25.40    $1,259.74      $623.05      $251.95
                             nerve.
    69930  T                Implant cochlear            0256        25.40    $1,259.74      $623.05      $251.95
                             device.
    69949  T                Inner ear surgery           0253        12.02      $596.14      $284.00      $119.23
                             procedure.
    69950  C                Incise inner ear     ...........  ...........  ...........  ...........  ...........
                             nerve.
    69955  T                Release facial              0256        25.40    $1,259.74      $623.05      $251.95
                             nerve.
    69960  T                Release inner ear           0256        25.40    $1,259.74      $623.05      $251.95
                             canal.
    69970  C                Remove inner ear     ...........  ...........  ...........  ...........  ...........
                             lesion.
    69979  T                Temporal bone               0252         5.18      $256.90      $114.24       $51.38
                             surgery.
    69990  N                Microsurgery add-on  ...........  ...........  ...........  ...........  ...........
    70010  S                Contrast x-ray of           0274         4.83      $239.55      $128.12       $47.91
                             brain.
    70015  S                Contrast x-ray of           0274         4.83      $239.55      $128.12       $47.91
                             brain.
    70030  X                X-ray eye for               0260         0.79       $39.18       $22.02        $7.84
                             foreign body.
    70100  X                X-ray exam of jaw..         0260         0.79       $39.18       $22.02        $7.84
    70110  X                X-ray exam of jaw..         0260         0.79       $39.18       $22.02        $7.84
    70120  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             mastoids.
    70130  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             mastoids.
    70134  X                X-ray exam of               0261         1.38       $68.44       $38.77       $13.69
                             middle ear.
    70140  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             facial bones.
    70150  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             facial bones.
    70160  X                X-ray exam of nasal         0260         0.79       $39.18       $22.02        $7.84
                             bones.
    70170  X                X-ray exam of tear          0263         1.68       $83.32       $45.88       $16.66
                             duct.
    70190  X                X-ray exam of eye           0260         0.79       $39.18       $22.02        $7.84
                             sockets.
    70200  X                X-ray exam of eye           0260         0.79       $39.18       $22.02        $7.84
                             sockets.
    70210  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             sinuses.
    70220  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             sinuses.
    70240  X                X-ray exam,                 0260         0.79       $39.18       $22.02        $7.84
                             pituitary saddle.
    70250  X                X-ray exam of skull         0260         0.79       $39.18       $22.02        $7.84
    70260  X                X-ray exam of skull         0261         1.38       $68.44       $38.77       $13.69
    70300  X                X-ray exam of teeth         0262         0.40       $19.83       $10.90        $3.97
    70310  X                X-ray exam of teeth         0262         0.40       $19.83       $10.90        $3.97
    70320  X                Full mouth x-ray of         0262         0.40       $19.83       $10.90        $3.97
                             teeth.
    70328  X                X-ray exam of jaw           0260         0.79       $39.18       $22.02        $7.84
                             joint.
    70330  X                X-ray exam of jaw           0260         0.79       $39.18       $22.02        $7.84
                             joints.
    70332  S                X-ray exam of jaw           0275         2.74      $135.89       $72.26       $27.18
                             joint.
    70336  S                Magnetic image, jaw         0284         8.02      $397.76      $257.39       $79.55
                             joint.
    70350  X                X-ray head for              0260         0.79       $39.18       $22.02        $7.84
                             orthodontia.
    70355  X                Panoramic x-ray of          0260         0.79       $39.18       $22.02        $7.84
                             jaws.
    70360  X                X-ray exam of neck.         0260         0.79       $39.18       $22.02        $7.84
    70370  X                Throat x-ray &              0273         2.49      $123.49       $61.02       $24.70
                             fluoroscopy.
    70371  X                Speech evaluation,          0272         1.40       $69.43       $39.00       $13.89
                             complex.
    70373  X                Contrast x-ray of           0263         1.68       $83.32       $45.88       $16.66
                             larynx.
    70380  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             salivary gland.
    70390  X                X-ray exam of               0263         1.68       $83.32       $45.88       $16.66
                             salivary duct.
    70450  S                CAT scan of head or         0283         4.89      $242.52      $179.39       $48.50
                             brain.
    70460  S                Contrast CAT scan           0283         4.89      $242.52      $179.39       $48.50
                             of head.
    70470  S                Contrast CAT scans          0283         4.89      $242.52      $179.39       $48.50
                             of head.
    70480  S                CAT scan of skull..         0283         4.89      $242.52      $179.39       $48.50
    70481  S                Contrast CAT scan           0283         4.89      $242.52      $179.39       $48.50
                             of skull.
    70482  S                Contrast CAT scans          0283         4.89      $242.52      $179.39       $48.50
                             of skull.
    70486  S                Cat scan of face/           0282         2.38      $118.04       $94.51       $23.61
                             jaw.
    70487  S                Contrast CAT scan,          0283         4.89      $242.52      $179.39       $48.50
                             face/jaw.
    70488  S                Contrast cat scans,         0283         4.89      $242.52      $179.39       $48.50
                             face/jaw.
    70490  S                CAT scan of neck            0283         4.89      $242.52      $179.39       $48.50
                             tissue.
    70491  S                Contrast CAT of             0283         4.89      $242.52      $179.39       $48.50
                             neck tissue.
    70492  S                Contrast CAT of             0283         4.89      $242.52      $179.39       $48.50
                             neck tissue.
   *70496  S                Ct angiography,             0283         4.89      $242.52      $179.39       $48.50
                             head.
   *70498  S                Ct angiography,             0283         4.89      $242.52      $179.39       $48.50
                             neck.
    70540  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             face/neck.
   70541D  S                MR angiography.....         0284         8.02      $397.76      $257.39       $79.55
   *70542  S                MR (eg, proton)             0284         8.02      $397.76      $257.39       $79.55
                             imaging.
   *70543  S                MR (eg, proton)             0284         8.02      $397.76      $257.39       $79.55
                             imaging.
   *70544  S                MR angiography.....         0284         8.02      $397.76      $257.39       $79.55
   *70545  S                MR angiography.....         0284         8.02      $397.76      $257.39       $79.55
   *70546  S                MR angiography.....         0284         8.02      $397.76      $257.39       $79.55
   *70547  S                MR angiography.....         0284         8.02      $397.76      $257.39       $79.55
   *70548  S                MR angiography.....         0284         8.02      $397.76      $257.39       $79.55

[[Page 67911]]

 
   *70549  S                MR angiography.....         0284         8.02      $397.76      $257.39       $79.55
    70551  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             brain (MRI).
    70552  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             brain (MRI).
    70553  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             brain (mri).
    71010  X                Chest x-ray........         0260         0.79       $39.18       $22.02        $7.84
    71015  X                Chest x-ray........         0260         0.79       $39.18       $22.02        $7.84
    71020  X                Chest x-ray........         0260         0.79       $39.18       $22.02        $7.84
    71021  X                Chest x-ray........         0260         0.79       $39.18       $22.02        $7.84
    71022  X                Chest x-ray........         0260         0.79       $39.18       $22.02        $7.84
    71023  X                Chest x-ray and             0272         1.40       $69.43       $39.00       $13.89
                             fluoroscopy.
    71030  X                Chest x-ray........         0260         0.79       $39.18       $22.02        $7.84
    71034  X                Chest x-ray and             0272         1.40       $69.43       $39.00       $13.89
                             fluoroscopy.
    71035  X                Chest x-ray........         0260         0.79       $39.18       $22.02        $7.84
   71036D  X                X-ray guidance for          0273         2.49      $123.49       $61.02       $24.70
                             biopsy.
    71040  X                Contrast x-ray of           0263         1.68       $83.32       $45.88       $16.66
                             bronchi.
    71060  X                Contrast x-ray of           0263         1.68       $83.32       $45.88       $16.66
                             bronchi.
    71090  X                X-ray & pacemaker           0273         2.49      $123.49       $61.02       $24.70
                             insertion.
    71100  X                X-ray exam of ribs.         0260         0.79       $39.18       $22.02        $7.84
    71101  X                X-ray exam of ribs/         0260         0.79       $39.18       $22.02        $7.84
                             chest.
    71110  X                X-ray exam of ribs.         0260         0.79       $39.18       $22.02        $7.84
    71111  X                X-ray exam of ribs/         0261         1.38       $68.44       $38.77       $13.69
                             chest.
    71120  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             breastbone.
    71130  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             breastbone.
    71250  S                Cat scan of chest..         0283         4.89      $242.52      $179.39       $48.50
    71260  S                Contrast CAT scan           0283         4.89      $242.52      $179.39       $48.50
                             of chest.
    71270  S                Contrast CAT scans          0283         4.89      $242.52      $179.39       $48.50
                             of chest.
   *71275  S                CT angiography,             0283         4.89      $242.52      $179.39       $48.50
                             chest.
    71550  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             chest (mri).
   *71551  S                MRI chest w/ dye...         0284         8.02      $397.76      $257.39       $79.55
   *71552  S                MRI chest w/o dye..         0284         8.02      $397.76      $257.39       $79.55
    71555  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             chest (mra).
    72010  X                X-ray exam of spine         0261         1.38       $68.44       $38.77       $13.69
    72020  X                X-ray exam of spine         0260         0.79       $39.18       $22.02        $7.84
    72040  X                X-ray exam of neck          0260         0.79       $39.18       $22.02        $7.84
                             spine.
    72050  X                X-ray exam of neck          0261         1.38       $68.44       $38.77       $13.69
                             spine.
    72052  X                X-ray exam of neck          0261         1.38       $68.44       $38.77       $13.69
                             spine.
    72069  X                X-ray exam of trunk         0260         0.79       $39.18       $22.02        $7.84
                             spine.
    72070  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             thoracic spine.
    72072  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             thoracic spine.
    72074  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             thoracic spine.
    72080  X                X-ray exam of trunk         0260         0.79       $39.18       $22.02        $7.84
                             spine.
    72090  X                X-ray exam of trunk         0260         0.79       $39.18       $22.02        $7.84
                             spine.
    72100  X                X-ray exam of lower         0260         0.79       $39.18       $22.02        $7.84
                             spine.
    72110  X                X-ray exam of lower         0261         1.38       $68.44       $38.77       $13.69
                             spine.
    72114  X                X-ray exam of lower         0261         1.38       $68.44       $38.77       $13.69
                             spine.
    72120  X                X-ray exam of lower         0260         0.79       $39.18       $22.02        $7.84
                             spine.
    72125  S                CAT scan of neck            0283         4.89      $242.52      $179.39       $48.50
                             spine.
    72126  S                Contrast CAT scan           0283         4.89      $242.52      $179.39       $48.50
                             of neck.
    72127  S                Contrast CAT scans          0283         4.89      $242.52      $179.39       $48.50
                             of neck.
    72128  S                CAT scan of thorax          0283         4.89      $242.52      $179.39       $48.50
                             spine.
    72129  S                Contrast CAT scan           0283         4.89      $242.52      $179.39       $48.50
                             of thorax.
    72130  S                Contrast CAT scans          0283         4.89      $242.52      $179.39       $48.50
                             of thorax.
    72131  S                CAT scan of lower           0283         4.89      $242.52      $179.39       $48.50
                             spine.
    72132  S                Contrast CAT of             0283         4.89      $242.52      $179.39       $48.50
                             lower spine.
    72133  S                Contrst cat scans,          0283         4.89      $242.52      $179.39       $48.50
                             low spine.
    72141  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             neck spine.
    72142  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             neck spine.
    72146  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             chest spine.
    72147  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             chest spine.
    72148  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             lumbar spine.
    72149  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             lumbar spine.
    72156  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             neck spine.
    72157  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             chest spine.
    72158  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             lumbar spine.
    72159  E                Magnetic image,      ...........  ...........  ...........  ...........  ...........
                             spine (mra).
    72170  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             pelvis.
    72190  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             pelvis.
   *72191  S                CT angiograph pelv          0283         4.89      $242.52      $179.39       $48.50
                             w/o & w/ dye.
    72192  S                CAT scan of pelvis.         0283         4.89      $242.52      $179.39       $48.50
    72193  S                Contrast CAT scan           0283         4.89      $242.52      $179.39       $48.50
                             of pelvis.
    72194  S                Contrast CAT scans          0283         4.89      $242.52      $179.39       $48.50
                             of pelvis.
   *72195  S                MRI pelvis w/o dye.         0284         8.02      $397.76      $257.39       $79.55
    72196  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             pelvis.
   *72197  S                MRI pelvis w/o & w/         0284         8.02      $397.76      $257.39       $79.55
                             dye.

[[Page 67912]]

 
    72198  E                Magnetic image,      ...........  ...........  ...........  ...........  ...........
                             pelvis (mra).
    72200  X                X-ray exam                  0260         0.79       $39.18       $22.02        $7.84
                             sacroiliac joints.
    72202  X                X-ray exam                  0260         0.79       $39.18       $22.02        $7.84
                             sacroiliac joints.
    72220  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             tailbone.
    72240  S                Contrast x-ray of           0274         4.83      $239.55      $128.12       $47.91
                             neck spine.
    72255  S                Contrast x-ray,             0274         4.83      $239.55      $128.12       $47.91
                             thorax spine.
    72265  S                Contrast x-ray,             0274         4.83      $239.55      $128.12       $47.91
                             lower spine.
    72270  S                Contrast x-ray of           0274         4.83      $239.55      $128.12       $47.91
                             spine.
    72275  S                Epidurography......         0274         4.83      $239.55      $128.12       $47.91
    72285  S                X-ray c/t spine             0274         4.83      $239.55      $128.12       $47.91
                             disk.
    72295  S                X-ray of lower              0274         4.83      $239.55      $128.12       $47.91
                             spine disk.
    73000  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             collar bone.
    73010  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             shoulder blade.
    73020  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             shoulder.
    73030  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             shoulder.
    73040  S                Contrast x-ray of           0275         2.74      $135.89       $72.26       $27.18
                             shoulder.
    73050  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             shoulders.
    73060  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             humerus.
    73070  X                X-ray exam of elbow         0260         0.79       $39.18       $22.02        $7.84
    73080  X                X-ray exam of elbow         0260         0.79       $39.18       $22.02        $7.84
    73085  S                Contrast x-ray of           0275         2.74      $135.89       $72.26       $27.18
                             elbow.
    73090  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             forearm.
    73092  X                X-ray exam of arm,          0260         0.79       $39.18       $22.02        $7.84
                             infant.
    73100  X                X-ray exam of wrist         0260         0.79       $39.18       $22.02        $7.84
    73110  X                X-ray exam of wrist         0260         0.79       $39.18       $22.02        $7.84
    73115  S                Contrast x-ray of           0275         2.74      $135.89       $72.26       $27.18
                             wrist.
    73120  X                X-ray exam of hand.         0260         0.79       $39.18       $22.02        $7.84
    73130  X                X-ray exam of hand.         0260         0.79       $39.18       $22.02        $7.84
    73140  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             finger(s).
    73200  S                CAT scan of arm....         0283         4.89      $242.52      $179.39       $48.50
    73201  S                Contrast CAT scan           0283         4.89      $242.52      $179.39       $48.50
                             of arm.
    73202  S                Contrast CAT scans          0283         4.89      $242.52      $179.39       $48.50
                             of arm.
   *73206  S                CT angio upr extrm          0283         4.89      $242.52      $179.39       $48.50
                             w/o & w/ dye.
   *73218  S                MRI upper extrm w/o         0284         8.02      $397.76      $257.39       $79.55
                             dye.
   *73219  S                MRI upper extrm w/          0284         8.02      $397.76      $257.39       $79.55
                             dye.
    73220  S                Magnetic image, arm/        0284         8.02      $397.76      $257.39       $79.55
                             hand.
    73221  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             joint of arm.
   *73222  S                MRI joint upr extrm         0284         8.02      $397.76      $257.39       $79.55
                             w/ dye.
   *73223  S                MRI joint upr extrm         0284         8.02      $397.76      $257.39       $79.55
                             w/o & w/ dye.
    73225  E                Magnetic image,      ...........  ...........  ...........  ...........  ...........
                             upper (mra).
    73500  X                X-ray exam of hip..         0260         0.79       $39.18       $22.02        $7.84
    73510  X                X-ray exam of hip..         0260         0.79       $39.18       $22.02        $7.84
    73520  X                X-ray exam of hips.         0260         0.79       $39.18       $22.02        $7.84
    73525  S                Contrast x-ray of           0275         2.74      $135.89       $72.26       $27.18
                             hip.
    73530  X                X-ray exam of hip..         0261         1.38       $68.44       $38.77       $13.69
    73540  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             pelvis & hips.
    73542  S                X-ray exam,                 0275         2.74      $135.89       $72.26       $27.18
                             sacroiliac joint.
    73550  X                X-ray exam of thigh         0260         0.79       $39.18       $22.02        $7.84
    73560  X                X-ray exam of knee,         0260         0.79       $39.18       $22.02        $7.84
                             1 or 2.
    73562  X                X-ray exam of knee,         0260         0.79       $39.18       $22.02        $7.84
                             3.
    73564  X                X-ray exam, knee, 4         0260         0.79       $39.18       $22.02        $7.84
                             or more.
    73565  X                X-ray exam of knees         0260         0.79       $39.18       $22.02        $7.84
    73580  S                Contrast x-ray of           0275         2.74      $135.89       $72.26       $27.18
                             knee joint.
    73590  X                X-ray exam of lower         0260         0.79       $39.18       $22.02        $7.84
                             leg.
    73592  X                X-ray exam of leg,          0261         1.38       $68.44       $38.77       $13.69
                             infant.
    73600  X                X-ray exam of ankle         0260         0.79       $39.18       $22.02        $7.84
    73610  X                X-ray exam of ankle         0260         0.79       $39.18       $22.02        $7.84
    73615  S                Contrast x-ray of           0275         2.74      $135.89       $72.26       $27.18
                             ankle.
    73620  X                X-ray exam of foot.         0260         0.79       $39.18       $22.02        $7.84
    73630  X                X-ray exam of foot.         0260         0.79       $39.18       $22.02        $7.84
    73650  X                X-ray exam of heel.         0260         0.79       $39.18       $22.02        $7.84
    73660  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             toe(s).
    73700  S                CAT scan of leg....         0283         4.89      $242.52      $179.39       $48.50
    73701  S                Contrast CAT scan           0283         4.89      $242.52      $179.39       $48.50
                             of leg.
    73702  S                Contrast CAT scans          0283         4.89      $242.52      $179.39       $48.50
                             of leg.
   *73706  S                CT angio lwr extr w/        0283         4.89      $242.52      $179.39       $48.50
                             o & w/ dye.
   *73718  S                MRI lower extrem w/         0284         8.02      $397.76      $257.39       $79.55
                             o dye.
   *73719  S                MRI lower extrem w/         0284         8.02      $397.76      $257.39       $79.55
                             dye.
    73720  S                Magnetic image, leg/        0284         8.02      $397.76      $257.39       $79.55
                             foot.
    73721  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             joint of leg.
   *73722  S                MRI joint lwr extrm         0284         8.02      $397.76      $257.39       $79.55
                             w/ dye.
   *73723  S                MRI joint lwr extrm         0284         8.02      $397.76      $257.39       $79.55
                             w/o & w/ dye.
    73725  S                Magnetic image/             0284         8.02      $397.76      $257.39       $79.55
                             lower (mra).
    74000  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             abdomen.

[[Page 67913]]

 
    74010  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             abdomen.
    74020  X                X-ray exam of               0260         0.79       $39.18       $22.02        $7.84
                             abdomen.
    74022  X                X-ray exam series,          0261         1.38       $68.44       $38.77       $13.69
                             abdomen.
    74150  S                CAT scan of abdomen         0283         4.89      $242.52      $179.39       $48.50
    74160  S                Contrast CAT scan           0283         4.89      $242.52      $179.39       $48.50
                             of abdomen.
    74170  S                Contrast CAT scans,         0283         4.89      $242.52      $179.39       $48.50
                             abdomen.
   *74175  S                CT angio abdom w/o          0283         4.89      $242.52      $179.39       $48.50
                             & w/ dye.
    74181  S                Magnetic image/             0284         8.02      $397.76      $257.39       $79.55
                             abdomen (mri).
   *74182  S                MRI abdomen w/ dye.         0284         8.02      $397.76      $257.39       $79.55
   *74183  S                MRI abdomen w/o & w/        0284         8.02      $397.76      $257.39       $79.55
                              dye.
    74185  S                Magnetic image/             0284         8.02      $397.76      $257.39       $79.55
                             abdomen (MRA).
    74190  X                X-ray exam of               0263         1.68       $83.32       $45.88       $16.66
                             peritoneum.
    74210  S                Contrst x-ray exam          0276         1.79       $88.78       $49.78       $17.76
                             of throat.
    74220  S                Contrast x-ray,             0276         1.79       $88.78       $49.78       $17.76
                             esophagus.
    74230  S                Cinema x-ray,               0276         1.79       $88.78       $49.78       $17.76
                             throat/esoph.
    74235  S                Remove esophagus            0296         3.57      $177.06      $100.25       $35.41
                             obstruction.
    74240  S                X-ray exam, upper           0276         1.79       $88.78       $49.78       $17.76
                             gi tract.
    74241  S                X-ray exam, upper           0276         1.79       $88.78       $49.78       $17.76
                             gi tract.
    74245  S                X-ray exam, upper           0277         2.47      $122.50       $69.28       $24.50
                             gi tract.
    74246  S                Contrst x-ray uppr          0276         1.79       $88.78       $49.78       $17.76
                             gi tract.
    74247  S                Contrst x-ray uppr          0276         1.79       $88.78       $49.78       $17.76
                             gi tract.
    74249  S                Contrst x-ray uppr          0277         2.47      $122.50       $69.28       $24.50
                             gi tract.
    74250  S                X-ray exam of small         0276         1.79       $88.78       $49.78       $17.76
                             bowel.
    74251  S                X-ray exam of small         0277         2.47      $122.50       $69.28       $24.50
                             bowel.
    74260  S                X-ray exam of small         0277         2.47      $122.50       $69.28       $24.50
                             bowel.
    74270  S                Contrast x-ray exam         0276         1.79       $88.78       $49.78       $17.76
                             of colon.
    74280  S                Contrast x-ray exam         0277         2.47      $122.50       $69.28       $24.50
                             of colon.
    74283  S                Contrast x-ray exam         0276         1.79       $88.78       $49.78       $17.76
                             of colon.
    74290  S                Contrast x-ray,             0276         1.79       $88.78       $49.78       $17.76
                             gallbladder.
    74291  S                Contrast x-rays,            0276         1.79       $88.78       $49.78       $17.76
                             gallbladder.
    74300  X                X-ray bile ducts/           0263         1.68       $83.32       $45.88       $16.66
                             pancreas.
    74301  X                X-rays at surgery           0263         1.68       $83.32       $45.88       $16.66
                             add-on.
    74305  X                X-ray bile ducts/           0263         1.68       $83.32       $45.88       $16.66
                             pancreas.
    74320  X                Contrast x-ray of           0264         3.83      $189.96      $108.97       $37.99
                             bile ducts.
    74327  S                X-ray bile stone            0296         3.57      $177.06      $100.25       $35.41
                             removal.
    74328  X                Xray bile duct              0264         3.83      $189.96      $108.97       $37.99
                             endoscopy.
    74329  X                X-ray for pancreas          0264         3.83      $189.96      $108.97       $37.99
                             endoscopy.
    74330  X                X-ray bile/panc             0264         3.83      $189.96      $108.97       $37.99
                             endoscopy.
    74340  X                X-ray guide for GI          0272         1.40       $69.43       $39.00       $13.89
                             tube.
    74350  X                X-ray guide,                0264         3.83      $189.96      $108.97       $37.99
                             stomach tube.
    74355  X                X-ray guide,                0264         3.83      $189.96      $108.97       $37.99
                             intestinal tube.
    74360  S                X-ray guide, GI             0296         3.57      $177.06      $100.25       $35.41
                             dilation.
    74363  S                X-ray, bile duct            0297         6.13      $304.03      $172.51       $60.81
                             dilation.
    74400  S                Contrst x-ray,              0278         2.85      $141.35       $81.67       $28.27
                             urinary tract.
    74410  S                Contrst x-ray,              0278         2.85      $141.35       $81.67       $28.27
                             urinary tract.
    74415  S                Contrst x-ray,              0278         2.85      $141.35       $81.67       $28.27
                             urinary tract.
    74420  S                Contrst x-ray,              0278         2.85      $141.35       $81.67       $28.27
                             urinary tract.
    74425  S                Contrst x-ray,              0278         2.85      $141.35       $81.67       $28.27
                             urinary tract.
    74430  S                Contrast x-ray,             0278         2.85      $141.35       $81.67       $28.27
                             bladder.
    74440  S                X-ray, male genital         0278         2.85      $141.35       $81.67       $28.27
                             tract.
    74445  S                X-ray exam of penis         0278         2.85      $141.35       $81.67       $28.27
    74450  S                X-ray, urethra/             0278         2.85      $141.35       $81.67       $28.27
                             bladder.
    74455  S                X-ray, urethra/             0278         2.85      $141.35       $81.67       $28.27
                             bladder.
    74470  X                X-ray exam of               0264         3.83      $189.96      $108.97       $37.99
                             kidney lesion.
    74475  S                X-ray control, cath         0297         6.13      $304.03      $172.51       $60.81
                             insert.
    74480  S                X-ray control, cath         0297         6.13      $304.03      $172.51       $60.81
                             insert.
    74485  S                X-ray guide, GU             0296         3.57      $177.06      $100.25       $35.41
                             dilation.
    74710  X                X-ray measurement           0260         0.79       $39.18       $22.02        $7.84
                             of pelvis.
    74740  X                X-ray, female               0264         3.83      $189.96      $108.97       $37.99
                             genital tract.
    74742  X                X-ray, fallopian            0264         3.83      $189.96      $108.97       $37.99
                             tube.
    74775  S                X-ray exam of               0278         2.85      $141.35       $81.67       $28.27
                             perineum.
    75552  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             myocardium.
    75553  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             myocardium.
    75554  S                Cardiac MRI/                0284         8.02      $397.76      $257.39       $79.55
                             function.
    75555  S                Cardiac MRI/limited         0284         8.02      $397.76      $257.39       $79.55
                             study.
    75556  E                Cardiac MRI/flow     ...........  ...........  ...........  ...........  ...........
                             mapping.
    75600  S                Contrast x-ray exam         0280        14.98      $742.95      $380.12      $148.59
                             of aorta.
    75605  S                Contrast x-ray exam         0280        14.98      $742.95      $380.12      $148.59
                             of aorta.
    75625  S                Contrast x-ray exam         0280        14.98      $742.95      $380.12      $148.59
                             of aorta.
    75630  S                X-ray aorta, leg            0280        14.98      $742.95      $380.12      $148.59
                             arteries.
   *75635  S                CT angio abdominal          0283         4.89      $242.52      $179.39       $48.50
                             arteries.
    75650  S                Artery x-rays, head         0280        14.98      $742.95      $380.12      $148.59
                             & neck.
    75658  S                Artery x-rays, arm.         0280        14.98      $742.95      $380.12      $148.59
    75660  S                Artery x-rays, head         0279         6.30      $312.46      $174.57       $62.49
                             & neck.

[[Page 67914]]

 
    75662  S                Artery x-rays, head         0279         6.30      $312.46      $174.57       $62.49
                             & neck.
    75665  S                Artery x-rays, head         0280        14.98      $742.95      $380.12      $148.59
                             & neck.
    75671  S                Artery x-rays, head         0280        14.98      $742.95      $380.12      $148.59
                             & neck.
    75676  S                Artery x-rays, neck         0280        14.98      $742.95      $380.12      $148.59
    75680  S                Artery x-rays, neck         0280        14.98      $742.95      $380.12      $148.59
    75685  S                Artery x-rays,              0279         6.30      $312.46      $174.57       $62.49
                             spine.
    75705  S                Artery x-rays,              0279         6.30      $312.46      $174.57       $62.49
                             spine.
    75710  S                Artery x-rays, arm/         0280        14.98      $742.95      $380.12      $148.59
                             leg.
    75716  S                Artery x-rays, arms/        0280        14.98      $742.95      $380.12      $148.59
                             legs.
    75722  S                Artery x-rays,              0280        14.98      $742.95      $380.12      $148.59
                             kidney.
    75724  S                Artery x-rays,              0280        14.98      $742.95      $380.12      $148.59
                             kidneys.
    75726  S                Artery x-rays,              0280        14.98      $742.95      $380.12      $148.59
                             abdomen.
    75731  S                Artery x-rays,              0280        14.98      $742.95      $380.12      $148.59
                             adrenal gland.
    75733  S                Artery x-rays,              0280        14.98      $742.95      $380.12      $148.59
                             adrenals.
    75736  S                Artery x-rays,              0280        14.98      $742.95      $380.12      $148.59
                             pelvis.
    75741  S                Artery x-rays, lung         0279         6.30      $312.46      $174.57       $62.49
    75743  S                Artery x-rays,              0280        14.98      $742.95      $380.12      $148.59
                             lungs.
    75746  S                Artery x-rays, lung         0279         6.30      $312.46      $174.57       $62.49
    75756  S                Artery x-rays,              0279         6.30      $312.46      $174.57       $62.49
                             chest.
    75774  S                Artery x-ray, each          0280        14.98      $742.95      $380.12      $148.59
                             vessel.
    75790  S                Visualize A-V shunt         0281         4.40      $218.22      $115.16       $43.64
    75801  X                Lymph vessel x-ray,         0264         3.83      $189.96      $108.97       $37.99
                             arm/leg.
    75803  X                Lymph vessel x-             0264         3.83      $189.96      $108.97       $37.99
                             ray,arms/legs.
    75805  X                Lymph vessel x-ray,         0264         3.83      $189.96      $108.97       $37.99
                             trunk.
    75807  X                Lymph vessel x-ray,         0264         3.83      $189.96      $108.97       $37.99
                             trunk.
    75809  X                Nonvascular shunt,          0264         3.83      $189.96      $108.97       $37.99
                             x-ray.
    75810  S                Vein x-ray, spleen/         0279         6.30      $312.46      $174.57       $62.49
                             liver.
    75820  S                Vein x-ray, arm/leg         0281         4.40      $218.22      $115.16       $43.64
    75822  S                Vein x-ray, arms/           0281         4.40      $218.22      $115.16       $43.64
                             legs.
    75825  S                Vein x-ray, trunk..         0279         6.30      $312.46      $174.57       $62.49
    75827  S                Vein x-ray, chest..         0279         6.30      $312.46      $174.57       $62.49
    75831  S                Vein x-ray, kidney.         0279         6.30      $312.46      $174.57       $62.49
    75833  S                Vein x-ray, kidneys         0279         6.30      $312.46      $174.57       $62.49
    75840  S                Vein x-ray, adrenal         0279         6.30      $312.46      $174.57       $62.49
                             gland.
    75842  S                Vein x-ray, adrenal         0279         6.30      $312.46      $174.57       $62.49
                             glands.
    75860  S                Vein x-ray, neck...         0279         6.30      $312.46      $174.57       $62.49
    75870  S                Vein x-ray, skull..         0279         6.30      $312.46      $174.57       $62.49
    75872  S                Vein x-ray, skull..         0279         6.30      $312.46      $174.57       $62.49
    75880  S                Vein x-ray, eye             0279         6.30      $312.46      $174.57       $62.49
                             socket.
    75885  S                Vein x-ray, liver..         0279         6.30      $312.46      $174.57       $62.49
    75887  S                Vein x-ray, liver..         0280        14.98      $742.95      $380.12      $148.59
    75889  S                Vein x-ray, liver..         0279         6.30      $312.46      $174.57       $62.49
    75891  S                Vein x-ray, liver..         0279         6.30      $312.46      $174.57       $62.49
    75893  N                Venous sampling by   ...........  ...........  ...........  ...........  ...........
                             catheter.
    75894  S                X-rays, transcath           0297         6.13      $304.03      $172.51       $60.81
                             therapy.
    75896  S                X-rays, transcath           0297         6.13      $304.03      $172.51       $60.81
                             therapy.
    75898  X                Follow-up angiogram         0264         3.83      $189.96      $108.97       $37.99
    75900  C                Arterial catheter    ...........  ...........  ...........  ...........  ...........
                             exchange.
    75940  X                X-ray placement,            0264         3.83      $189.96      $108.97       $37.99
                             vein filter.
    75945  S                Intravascular us...         0267         2.72      $134.90       $80.06       $26.98
    75946  S                Intravascular us            0267         2.72      $134.90       $80.06       $26.98
                             add-on.
   *75952  C                Abdom aneurysm       ...........  ...........  ...........  ...........  ...........
                             endovas repr.
   *75953  C                Abdom aneurysm       ...........  ...........  ...........  ...........  ...........
                             endovas repr.
    75960  S                Transcatheter               0279         6.30      $312.46      $174.57       $62.49
                             intro, stent.
    75961  S                Retrieval, broken           0279         6.30      $312.46      $174.57       $62.49
                             catheter.
    75962  S                Repair arterial             0280        14.98      $742.95      $380.12      $148.59
                             blockage.
    75964  S                Repair artery               0279         6.30      $312.46      $174.57       $62.49
                             blockage, each.
    75966  S                Repair arterial             0280        14.98      $742.95      $380.12      $148.59
                             blockage.
    75968  S                Repair artery               0279         6.30      $312.46      $174.57       $62.49
                             blockage, each.
    75970  S                Vascular biopsy....         0279         6.30      $312.46      $174.57       $62.49
    75978  S                Repair venous               0279         6.30      $312.46      $174.57       $62.49
                             blockage.
    75980  S                Contrast xray exam          0297         6.13      $304.03      $172.51       $60.81
                             bile duct.
    75982  S                Contrast xray exam          0297         6.13      $304.03      $172.51       $60.81
                             bile duct.
    75984  S                Xray control                0296         3.57      $177.06      $100.25       $35.41
                             catheter change.
    75989  X                Abscess drainage            0273         2.49      $123.49       $61.02       $24.70
                             under x-ray.
    75992  S                Atherectomy, x-ray          0279         6.30      $312.46      $174.57       $62.49
                             exam.
    75993  T                Atherectomy, x-ray          0081        28.81    $1,428.86      $710.91      $285.77
                             exam.
    75994  T                Atherectomy, x-ray          0081        28.81    $1,428.86      $710.91      $285.77
                             exam.
    75995  S                Atherectomy, x-ray          0279         6.30      $312.46      $174.57       $62.49
                             exam.
    75996  T                Atherectomy, x-ray          0081        28.81    $1,428.86      $710.91      $285.77
                             exam.
    76000  X                Fluoroscope                 0272         1.40       $69.43       $39.00       $13.89
                             examination.
    76001  X                Fluoroscope exam,           0273         2.49      $123.49       $61.02       $24.70
                             extensive.
    76003  X                Needle localization         0272         1.40       $69.43       $39.00       $13.89
                             by x-ray.
    76005  X                Fluoroguide for             0273         2.49      $123.49       $61.02       $24.70
                             spine inject.

[[Page 67915]]

 
    76006  X                X-ray stress view..         0261         1.38       $68.44       $38.77       $13.69
    76010  X                X-ray, nose to              0260         0.79       $39.18       $22.02        $7.84
                             rectum.
   *76012  S                Percut                      0274         4.83      $239.55      $128.12       $47.91
                             vertebroplasty
                             fluor.
   *76013  S                Percut                      0274         4.83      $239.55      $128.12       $47.91
                             vertebroplasty CT.
    76020  X                X-rays for bone age         0261         1.38       $68.44       $38.77       $13.69
    76040  X                X-rays, bone                0260         0.79       $39.18       $22.02        $7.84
                             evaluation.
    76061  X                X-rays, bone survey         0261         1.38       $68.44       $38.77       $13.69
    76062  X                X-rays, bone survey         0261         1.38       $68.44       $38.77       $13.69
    76065  X                X-rays, bone                0261         1.38       $68.44       $38.77       $13.69
                             evaluation.
    76066  X                Joint(s) survey,            0260         0.79       $39.18       $22.02        $7.84
                             single film.
    76070  E                CT scan, bone        ...........  ...........  ...........  ...........  ...........
                             density study.
    76075  S                Dual energy x-ray           0971         1.55       $76.88  ...........       $15.38
                             study.
    76076  T                Dual energy x-ray           0970         0.52       $25.79  ...........        $5.16
                             study.
    76078  X                Photodensitometry..         0261         1.38       $68.44       $38.77       $13.69
    76080  X                X-ray exam of               0263         1.68       $83.32       $45.88       $16.66
                             fistula.
    76086  X                X-ray of mammary            0263         1.68       $83.32       $45.88       $16.66
                             duct.
    76088  X                X-ray of mammary            0263         1.68       $83.32       $45.88       $16.66
                             ducts.
    76090  S                Mammogram, one              0271         0.70       $34.72       $19.50        $6.94
                             breast.
    76091  S                Mammogram, both             0271         0.70       $34.72       $19.50        $6.94
                             breasts.
    76092  A                Mammogram,           ...........  ...........  ...........  ...........  ...........
                             screening.
    76093  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             breast.
    76094  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             both breasts.
    76095  X                Stereotactic breast         0264         3.83      $189.96      $108.97       $37.99
                             biopsy.
    76096  X                X-ray of needle             0263         1.68       $83.32       $45.88       $16.66
                             wire, breast.
    76098  X                X-ray exam, breast          0260         0.79       $39.18       $22.02        $7.84
                             specimen.
    76100  X                X-ray exam of body          0261         1.38       $68.44       $38.77       $13.69
                             section.
    76101  X                Complex body                0263         1.68       $83.32       $45.88       $16.66
                             section x-ray.
    76102  X                Complex body                0264         3.83      $189.96      $108.97       $37.99
                             section x-rays.
    76120  X                Cinematic x-rays...         0261         1.38       $68.44       $38.77       $13.69
    76125  X                Cinematic x-rays            0261         1.38       $68.44       $38.77       $13.69
                             add-on.
    76140  E                X-ray consultation.  ...........  ...........  ...........  ...........  ...........
    76150  X                X-ray exam, dry             0260         0.79       $39.18       $22.02        $7.84
                             process.
    76350  N                Special x-ray        ...........  ...........  ...........  ...........  ...........
                             contrast study.
    76355  S                CAT scan for                0283         4.89      $242.52      $179.39       $48.50
                             localization.
    76360  S                CAT scan for needle         0283         4.89      $242.52      $179.39       $48.50
                             biopsy.
   76365D  S                CAT scan for cyst           0283         4.89      $242.52      $179.39       $48.50
                             aspiration.
    76370  S                CAT scan for                0282         2.38      $118.04       $94.51       $23.61
                             therapy guide.
    76375  S                3d/holograph                0282         2.38      $118.04       $94.51       $23.61
                             reconstr add-on.
    76380  S                CAT scan follow-up          0282         2.38      $118.04       $94.51       $23.61
                             study.
    76390  S                Mr spectroscopy....         0284         8.02      $397.76      $257.39       $79.55
   *76393  X                MR guidance for             0273         2.49      $123.49       $61.02       $24.70
                             needle place.
    76400  S                Magnetic image,             0284         8.02      $397.76      $257.39       $79.55
                             bone marrow.
    76499  X                Radiographic                0260         0.79       $39.18       $22.02        $7.84
                             procedure.
    76506  S                Echo exam of head..         0266         1.79       $88.78       $57.35       $17.76
    76511  S                Echo exam of eye...         0266         1.79       $88.78       $57.35       $17.76
    76512  S                Echo exam of eye...         0266         1.79       $88.78       $57.35       $17.76
    76513  S                Echo exam of eye,           0265         1.17       $58.03       $38.08       $11.61
                             water bath.
    76516  S                Echo exam of eye...         0266         1.79       $88.78       $57.35       $17.76
    76519  S                Echo exam of eye...         0266         1.79       $88.78       $57.35       $17.76
    76529  S                Echo exam of eye...         0265         1.17       $58.03       $38.08       $11.61
    76536  S                Echo exam of head           0265         1.17       $58.03       $38.08       $11.61
                             and neck.
    76604  S                Echo exam of chest.         0266         1.79       $88.78       $57.35       $17.76
    76645  S                Echo exam of                0265         1.17       $58.03       $38.08       $11.61
                             breast(s).
    76700  S                Echo exam of                0266         1.79       $88.78       $57.35       $17.76
                             abdomen.
    76705  S                Echo exam of                0266         1.79       $88.78       $57.35       $17.76
                             abdomen.
    76770  S                Echo exam abdomen           0266         1.79       $88.78       $57.35       $17.76
                             back wall.
    76775  S                Echo exam abdomen           0266         1.79       $88.78       $57.35       $17.76
                             back wall.
    76778  S                Echo exam kidney            0266         1.79       $88.78       $57.35       $17.76
                             transplant.
    76800  S                Echo exam spinal            0266         1.79       $88.78       $57.35       $17.76
                             canal.
    76805  S                Echo exam of                0266         1.79       $88.78       $57.35       $17.76
                             pregnant uterus.
    76810  S                Echo exam of                0265         1.17       $58.03       $38.08       $11.61
                             pregnant uterus.
    76815  S                Echo exam of                0265         1.17       $58.03       $38.08       $11.61
                             pregnant uterus.
    76816  S                Echo exam follow-up/        0265         1.17       $58.03       $38.08       $11.61
                             repeat.
    76818  S                Fetal biophysical           0266         1.79       $88.78       $57.35       $17.76
                             profile.
   *76819  S                Fetl biophys profil         0266         1.79       $88.78       $57.35       $17.76
                             w/o stress.
    76825  S                Echo exam of fetal          0269         4.40      $218.22      $114.01       $43.64
                             heart.
    76826  S                Echo exam of fetal          0269         4.40      $218.22      $114.01       $43.64
                             heart.
    76827  S                Echo exam of fetal          0269         4.40      $218.22      $114.01       $43.64
                             heart.
    76828  S                Echo exam of fetal          0269         4.40      $218.22      $114.01       $43.64
                             heart.
    76830  S                Echo exam,                  0266         1.79       $88.78       $57.35       $17.76
                             transvaginal.
    76831  S                Echo exam, uterus..         0266         1.79       $88.78       $57.35       $17.76
    76856  S                Echo exam of pelvis         0266         1.79       $88.78       $57.35       $17.76
    76857  S                Echo exam of pelvis         0265         1.17       $58.03       $38.08       $11.61
    76870  S                Echo exam of                0266         1.79       $88.78       $57.35       $17.76
                             scrotum.

[[Page 67916]]

 
    76872  S                Echo exam,                  0266         1.79       $88.78       $57.35       $17.76
                             transrectal.
    76873  S                Echograp trans r,           0266         1.79       $88.78       $57.35       $17.76
                             pros study.
    76880  S                Echo exam of                0266         1.79       $88.78       $57.35       $17.76
                             extremity.
    76885  S                Echo exam, infant           0266         1.79       $88.78       $57.35       $17.76
                             hips.
    76886  S                Echo exam, infant           0266         1.79       $88.78       $57.35       $17.76
                             hips.
    76930  X                Echo guide for              0268         2.23      $110.60       $69.51       $22.12
                             heart sac tap.
    76932  X                Echo guide for              0268         2.23      $110.60       $69.51       $22.12
                             heart biopsy.
   76934D  X                Echo guide for              0268         2.23      $110.60       $69.51       $22.12
                             chest tap.
    76936  X                Echo guide for              0268         2.23      $110.60       $69.51       $22.12
                             artery repair.
   76938D  X                Echo exam for               0268         2.23      $110.60       $69.51       $22.12
                             drainage.
    76941  X                Echo guide for              0268         2.23      $110.60       $69.51       $22.12
                             transfusion.
    76942  X                Echo guide for              0268         2.23      $110.60       $69.51       $22.12
                             biopsy.
    76945  X                Echo guide, villus          0268         2.23      $110.60       $69.51       $22.12
                             sampling.
    76946  X                Echo guide for              0268         2.23      $110.60       $69.51       $22.12
                             amniocentesis.
    76948  X                Echo guide, ova             0268         2.23      $110.60       $69.51       $22.12
                             aspiration.
    76950  X                Echo guidance               0268         2.23      $110.60       $69.51       $22.12
                             radiotherapy.
   76960D  X                Echo guidance               0268         2.23      $110.60       $69.51       $22.12
                             radiotherapy.
    76965  X                Echo guidance               0268         2.23      $110.60       $69.51       $22.12
                             radiotherapy.
    76970  S                Ultrasound exam             0265         1.17       $58.03       $38.08       $11.61
                             follow-up.
    76975  S                GI endoscopic               0266         1.79       $88.78       $57.35       $17.76
                             ultrasound.
    76977  S                Us bone density             0265         1.17       $58.03       $38.08       $11.61
                             measure.
    76986  S                Echo exam at                0266         1.79       $88.78       $57.35       $17.76
                             surgery.
    76999  S                Echo examination            0266         1.79       $88.78       $57.35       $17.76
                             procedure.
    77261  E                Radiation therapy    ...........  ...........  ...........  ...........  ...........
                             planning.
    77262  E                Radiation therapy    ...........  ...........  ...........  ...........  ...........
                             planning.
    77263  E                Radiation therapy    ...........  ...........  ...........  ...........  ...........
                             planning.
    77280  X                Set radiation               0304         1.49       $73.90       $41.52       $14.78
                             therapy field.
    77285  X                Set radiation               0305         4.06      $201.36       $97.50       $40.27
                             therapy field.
    77290  X                Set radiation               0305         4.06      $201.36       $97.50       $40.27
                             therapy field.
    77295  X                Set radiation               0310        13.98      $693.35      $339.05      $138.67
                             therapy field.
    77299  E                Radiation therapy    ...........  ...........  ...........  ...........  ...........
                             planning.
    77300  X                Radiation therapy           0304         1.49       $73.90       $41.52       $14.78
                             dose plan.
    77305  X                Radiation therapy           0304         1.49       $73.90       $41.52       $14.78
                             dose plan.
    77310  X                Radiation therapy           0304         1.49       $73.90       $41.52       $14.78
                             dose plan.
    77315  X                Radiation therapy           0305         4.06      $201.36       $97.50       $40.27
                             dose plan.
    77321  X                Radiation therapy           0305         4.06      $201.36       $97.50       $40.27
                             port plan.
    77326  X                Radiation therapy           0305         4.06      $201.36       $97.50       $40.27
                             dose plan.
    77327  X                Radiation therapy           0305         4.06      $201.36       $97.50       $40.27
                             dose plan.
    77328  X                Radiation therapy           0305         4.06      $201.36       $97.50       $40.27
                             dose plan.
    77331  X                Special radiation           0304         1.49       $73.90       $41.52       $14.78
                             dosimetry.
    77332  X                Radiation treatment         0303         2.83      $140.36       $69.28       $28.07
                             aid(s).
    77333  X                Radiation treatment         0303         2.83      $140.36       $69.28       $28.07
                             aid(s).
    77334  X                Radiation treatment         0303         2.83      $140.36       $69.28       $28.07
                             aid(s).
    77336  X                Radiation physics           0311         1.32       $65.46       $31.66       $13.09
                             consult.
    77370  X                Radiation physics           0311         1.32       $65.46       $31.66       $13.09
                             consult.
    77399  X                External radiation          0311         1.32       $65.46       $31.66       $13.09
                             dosimetry.
    77401  S                Radiation treatment         0300         1.98       $98.20       $47.72       $19.64
                             delivery.
    77402  S                Radiation treatment         0300         1.98       $98.20       $47.72       $19.64
                             delivery.
    77403  S                Radiation treatment         0300         1.98       $98.20       $47.72       $19.64
                             delivery.
    77404  S                Radiation treatment         0300         1.98       $98.20       $47.72       $19.64
                             delivery.
    77406  S                Radiation treatment         0300         1.98       $98.20       $47.72       $19.64
                             delivery.
    77407  S                Radiation treatment         0300         1.98       $98.20       $47.72       $19.64
                             delivery.
    77408  S                Radiation treatment         0300         1.98       $98.20       $47.72       $19.64
                             delivery.
    77409  S                Radiation treatment         0300         1.98       $98.20       $47.72       $19.64
                             delivery.
    77411  S                Radiation treatment         0301         2.21      $109.61       $52.53       $21.92
                             delivery.
    77412  S                Radiation treatment         0301         2.21      $109.61       $52.53       $21.92
                             delivery.
    77413  S                Radiation treatment         0301         2.21      $109.61       $52.53       $21.92
                             delivery.
    77414  S                Radiation treatment         0300         1.98       $98.20       $47.72       $19.64
                             delivery.
    77416  S                Radiation treatment         0301         2.21      $109.61       $52.53       $21.92
                             delivery.
    77417  X                Radiology port              0260         0.79       $39.18       $22.02        $7.84
                             film(s).
    77427  E                Radiation tx         ...........  ...........  ...........  ...........  ...........
                             management, x5.
    77431  E                Radiation therapy    ...........  ...........  ...........  ...........  ...........
                             management.
    77432  E                Stereotactic         ...........  ...........  ...........  ...........  ...........
                             radiation trmt.
    77470  S                Special radiation           0302         8.21      $407.18      $216.55       $81.44
                             treatment.
    77499  E                Radiation therapy    ...........  ...........  ...........  ...........  ...........
                             management.
    77520  S                Proton beam                 0974         8.25      $409.17  ...........       $81.83
                             delivery.
   *77522  S                Proton trmt, simple         0974         8.25      $409.17  ...........       $81.83
                             w/ comp.
    77523  S                Proton beam                 0976        18.05      $895.21  ...........      $179.04
                             delivery.
   *77525  S                Proton treatment,           0976        18.05      $895.21  ...........      $179.04
                             complex.
    77600  S                Hyperthermia                0314         5.88      $291.62      $150.95       $58.32
                             treatment.
    77605  S                Hyperthermia                0314         5.88      $291.62      $150.95       $58.32
                             treatment.
    77610  S                Hyperthermia                0314         5.88      $291.62      $150.95       $58.32
                             treatment.
    77615  S                Hyperthermia                0314         5.88      $291.62      $150.95       $58.32
                             treatment.
    77620  S                Hyperthermia                0314         5.88      $291.62      $150.95       $58.32
                             treatment.

[[Page 67917]]

 
    77750  S                Infuse radioactive          0301         2.21      $109.61       $52.53       $21.92
                             materials.
    77761  S                Radioelement                0312         4.09      $202.85      $109.65       $40.57
                             application.
    77762  S                Radioelement                0312         4.09      $202.85      $109.65       $40.57
                             application.
    77763  S                Radioelement                0312         4.09      $202.85      $109.65       $40.57
                             application.
    77776  S                Radioelement                0312         4.09      $202.85      $109.65       $40.57
                             application.
    77777  S                Radioelement                0312         4.09      $202.85      $109.65       $40.57
                             application.
    77778  S                Radioelement                0312         4.09      $202.85      $109.65       $40.57
                             application.
    77781  S                High intensity              0313         7.89      $391.31      $164.02       $78.26
                             brachytherapy.
    77782  S                High intensity              0313         7.89      $391.31      $164.02       $78.26
                             brachytherapy.
    77783  S                High intensity              0313         7.89      $391.31      $164.02       $78.26
                             brachytherapy.
    77784  S                High intensity              0313         7.89      $391.31      $164.02       $78.26
                             brachytherapy.
    77789  S                Radioelement                0300         1.98       $98.20       $47.72       $19.64
                             application.
    77790  N                Radioelement         ...........  ...........  ...........  ...........  ...........
                             handling.
    77799  S                Radium/radioisotope         0313         7.89      $391.31      $164.02       $78.26
                             therapy.
    78000  S                Thyroid, single             0290         1.94       $96.21       $55.51       $19.24
                             uptake.
    78001  S                Thyroid, multiple           0290         1.94       $96.21       $55.51       $19.24
                             uptakes.
    78003  S                Thyroid suppress/           0290         1.94       $96.21       $55.51       $19.24
                             stimul.
    78006  S                Thyroid imaging             0291         3.15      $156.22       $93.14       $31.24
                             with uptake.
    78007  S                Thyroid image, mult         0291         3.15      $156.22       $93.14       $31.24
                             uptakes.
    78010  S                Thyroid imaging....         0290         1.94       $96.21       $55.51       $19.24
    78011  S                Thyroid imaging             0290         1.94       $96.21       $55.51       $19.24
                             with flow.
    78015  S                Thyroid met imaging         0291         3.15      $156.22       $93.14       $31.24
    78016  S                Thyroid met imaging/        0292         4.36      $216.24      $126.63       $43.25
                             studies.
    78018  S                Thyroid met                 0292         4.36      $216.24      $126.63       $43.25
                             imaging, body.
    78020  S                Thyroid met uptake.         0292         4.36      $216.24      $126.63       $43.25
    78070  S                Parathyroid nuclear         0292         4.36      $216.24      $126.63       $43.25
                             imaging.
    78075  S                Adrenal nuclear             0292         4.36      $216.24      $126.63       $43.25
                             imaging.
    78099  S                Endocrine nuclear           0290         1.94       $96.21       $55.51       $19.24
                             procedure.
    78102  S                Bone marrow                 0291         3.15      $156.22       $93.14       $31.24
                             imaging, ltd.
    78103  S                Bone marrow                 0292         4.36      $216.24      $126.63       $43.25
                             imaging, mult.
    78104  S                Bone marrow                 0292         4.36      $216.24      $126.63       $43.25
                             imaging, body.
    78110  S                Plasma volume,              0291         3.15      $156.22       $93.14       $31.24
                             single.
    78111  S                Plasma volume,              0291         3.15      $156.22       $93.14       $31.24
                             multiple.
    78120  S                Red cell mass,              0291         3.15      $156.22       $93.14       $31.24
                             single.
    78121  S                Red cell mass,              0291         3.15      $156.22       $93.14       $31.24
                             multiple.
    78122  S                Blood volume.......         0292         4.36      $216.24      $126.63       $43.25
    78130  S                Red cell survival           0292         4.36      $216.24      $126.63       $43.25
                             study.
    78135  S                Red cell survival           0292         4.36      $216.24      $126.63       $43.25
                             kinetics.
    78140  S                Red cell                    0292         4.36      $216.24      $126.63       $43.25
                             sequestration.
    78160  S                Plasma iron                 0292         4.36      $216.24      $126.63       $43.25
                             turnover.
    78162  S                Iron absorption             0292         4.36      $216.24      $126.63       $43.25
                             exam.
    78170  S                Red cell iron               0292         4.36      $216.24      $126.63       $43.25
                             utilization.
    78172  S                Total body iron             0292         4.36      $216.24      $126.63       $43.25
                             estimation.
    78185  S                Spleen imaging.....         0291         3.15      $156.22       $93.14       $31.24
    78190  S                Platelet survival,          0291         3.15      $156.22       $93.14       $31.24
                             kinetics.
    78191  S                Platelet survival..         0291         3.15      $156.22       $93.14       $31.24
    78195  S                Lymph system                0292         4.36      $216.24      $126.63       $43.25
                             imaging.
    78199  S                Blood/lymph nuclear         0290         1.94       $96.21       $55.51       $19.24
                             exam.
    78201  S                Liver imaging......         0291         3.15      $156.22       $93.14       $31.24
    78202  S                Liver imaging with          0291         3.15      $156.22       $93.14       $31.24
                             flow.
    78205  S                Liver imaging (3D).         0292         4.36      $216.24      $126.63       $43.25
    78206  S                Liver image (3d) w/         0292         4.36      $216.24      $126.63       $43.25
                             flow.
    78215  S                Liver and spleen            0291         3.15      $156.22       $93.14       $31.24
                             imaging.
    78216  S                Liver & spleen              0291         3.15      $156.22       $93.14       $31.24
                             image/flow.
    78220  S                Liver function              0292         4.36      $216.24      $126.63       $43.25
                             study.
    78223  S                Hepatobiliary               0292         4.36      $216.24      $126.63       $43.25
                             imaging.
    78230  S                Salivary gland              0291         3.15      $156.22       $93.14       $31.24
                             imaging.
    78231  S                Serial salivary             0291         3.15      $156.22       $93.14       $31.24
                             imaging.
    78232  S                Salivary gland              0291         3.15      $156.22       $93.14       $31.24
                             function exam.
    78258  S                Esophageal motility         0291         3.15      $156.22       $93.14       $31.24
                             study.
    78261  S                Gastric mucosa              0291         3.15      $156.22       $93.14       $31.24
                             imaging.
    78262  S                Gastroesophageal            0291         3.15      $156.22       $93.14       $31.24
                             reflux exam.
    78264  S                Gastric emptying            0292         4.36      $216.24      $126.63       $43.25
                             study.
    78267  A                Breath tst attain/   ...........  ...........  ...........  ...........  ...........
                             anal c-14.
    78268  A                Breath test          ...........  ...........  ...........  ...........  ...........
                             analysis, c-14.
    78270  S                Vit B-12 absorption         0290         1.94       $96.21       $55.51       $19.24
                             exam.
    78271  S                Vit B-12 absorp             0290         1.94       $96.21       $55.51       $19.24
                             exam, IF.
    78272  S                Vit B-12 absorp,            0291         3.15      $156.22       $93.14       $31.24
                             combined.
    78278  S                Acute GI blood loss         0292         4.36      $216.24      $126.63       $43.25
                             imaging.
    78282  S                GI protein loss             0290         1.94       $96.21       $55.51       $19.24
                             exam.
    78290  S                Meckel's divert             0291         3.15      $156.22       $93.14       $31.24
                             exam.
    78291  S                Leveen/shunt                0292         4.36      $216.24      $126.63       $43.25
                             patency exam.
    78299  S                GI nuclear                  0290         1.94       $96.21       $55.51       $19.24
                             procedure.
    78300  S                Bone imaging,               0291         3.15      $156.22       $93.14       $31.24
                             limited area.

[[Page 67918]]

 
    78305  S                Bone imaging,               0292         4.36      $216.24      $126.63       $43.25
                             multiple areas.
    78306  S                Bone imaging, whole         0292         4.36      $216.24      $126.63       $43.25
                             body.
    78315  S                Bone imaging, 3             0292         4.36      $216.24      $126.63       $43.25
                             phase.
    78320  S                Bone imaging (3D)..         0292         4.36      $216.24      $126.63       $43.25
    78350  X                Bone mineral,               0261         1.38       $68.44       $38.77       $13.69
                             single photon.
    78351  E                Bone mineral, dual   ...........  ...........  ...........  ...........  ...........
                             photon.
    78399  S                Musculoskeletal             0290         1.94       $96.21       $55.51       $19.24
                             nuclear exam.
    78414  S                Non-imaging heart           0292         4.36      $216.24      $126.63       $43.25
                             function.
    78428  S                Cardiac shunt               0292         4.36      $216.24      $126.63       $43.25
                             imaging.
    78445  S                Vascular flow               0291         3.15      $156.22       $93.14       $31.24
                             imaging.
    78455  S                Venous thrombosis           0291         3.15      $156.22       $93.14       $31.24
                             study.
    78456  S                Acute venous                0291         3.15      $156.22       $93.14       $31.24
                             thrombus image.
    78457  S                Venous thrombosis           0291         3.15      $156.22       $93.14       $31.24
                             imaging.
    78458  S                Ven thrombosis              0291         3.15      $156.22       $93.14       $31.24
                             images, bilat.
    78459  E                Heart muscle         ...........  ...........  ...........  ...........  ...........
                             imaging (PET).
    78460  S                Heart muscle blood,         0286         7.28      $361.06      $200.04       $72.21
                             single.
    78461  S                Heart muscle blood,         0286         7.28      $361.06      $200.04       $72.21
                             multiple.
    78464  S                Heart image (3d),           0286         7.28      $361.06      $200.04       $72.21
                             single.
    78465  S                Heart image (3d),           0286         7.28      $361.06      $200.04       $72.21
                             multiple.
    78466  S                Heart infarct image         0292         4.36      $216.24      $126.63       $43.25
    78468  S                Heart infarct image         0292         4.36      $216.24      $126.63       $43.25
                             (ef).
    78469  S                Heart infarct image         0292         4.36      $216.24      $126.63       $43.25
                             (3D).
    78472  S                Gated heart,                0286         7.28      $361.06      $200.04       $72.21
                             planar, single.
    78473  S                Gated heart,                0286         7.28      $361.06      $200.04       $72.21
                             multiple.
    78478  S                Heart wall motion           0286         7.28      $361.06      $200.04       $72.21
                             add-on.
    78480  S                Heart function add-         0286         7.28      $361.06      $200.04       $72.21
                             on.
    78481  S                Heart first pass,           0286         7.28      $361.06      $200.04       $72.21
                             single.
    78483  S                Heart first pass,           0286         7.28      $361.06      $200.04       $72.21
                             multiple.
    78491  E                Heart image (pet),   ...........  ...........  ...........  ...........  ...........
                             single.
    78492  E                Heart image (pet),   ...........  ...........  ...........  ...........  ...........
                             multiple.
    78494  S                Heart image, spect.         0296         3.57      $177.06      $100.25       $35.41
    78496  S                Heart first pass            0296         3.57      $177.06      $100.25       $35.41
                             add-on.
    78499  S                Cardiovascular              0292         4.36      $216.24      $126.63       $43.25
                             nuclear exam.
    78580  S                Lung perfusion              0291         3.15      $156.22       $93.14       $31.24
                             imaging.
    78584  S                Lung V/Q image              0292         4.36      $216.24      $126.63       $43.25
                             single breath.
    78585  S                Lung V/Q imaging...         0292         4.36      $216.24      $126.63       $43.25
    78586  S                Aerosol lung image,         0292         4.36      $216.24      $126.63       $43.25
                             single.
    78587  S                Aerosol lung image,         0292         4.36      $216.24      $126.63       $43.25
                             multiple.
    78588  S                Perfusion lung              0292         4.36      $216.24      $126.63       $43.25
                             image.
    78591  S                Vent image, 1               0291         3.15      $156.22       $93.14       $31.24
                             breath, 1 proj.
    78593  S                Vent image, 1 proj,         0292         4.36      $216.24      $126.63       $43.25
                             gas.
    78594  S                Vent image, mult            0292         4.36      $216.24      $126.63       $43.25
                             proj, gas.
    78596  S                Lung differential           0292         4.36      $216.24      $126.63       $43.25
                             function.
    78599  S                Respiratory nuclear         0291         3.15      $156.22       $93.14       $31.24
                             exam.
    78600  S                Brain imaging, ltd          0292         4.36      $216.24      $126.63       $43.25
                             static.
    78601  S                Brain imaging, ltd          0292         4.36      $216.24      $126.63       $43.25
                             w/ flow.
    78605  S                Brain imaging,              0291         3.15      $156.22       $93.14       $31.24
                             complete.
    78606  S                Brain imaging,              0292         4.36      $216.24      $126.63       $43.25
                             compl w/flow.
    78607  S                Brain imaging (3D).         0292         4.36      $216.24      $126.63       $43.25
    78608  E                Brain imaging (PET)  ...........  ...........  ...........  ...........  ...........
    78609  E                Brain imaging (PET)  ...........  ...........  ...........  ...........  ...........
    78610  S                Brain flow imaging          0291         3.15      $156.22       $93.14       $31.24
                             only.
    78615  S                Cerebral blood flow         0292         4.36      $216.24      $126.63       $43.25
                             imaging.
    78630  S                Cerebrospinal fluid         0292         4.36      $216.24      $126.63       $43.25
                             scan.
    78635  S                CSF                         0292         4.36      $216.24      $126.63       $43.25
                             ventriculography.
    78645  S                CSF shunt                   0292         4.36      $216.24      $126.63       $43.25
                             evaluation.
    78647  S                Cerebrospinal fluid         0292         4.36      $216.24      $126.63       $43.25
                             scan.
    78650  S                CSF leakage imaging         0292         4.36      $216.24      $126.63       $43.25
    78660  S                Nuclear exam of             0291         3.15      $156.22       $93.14       $31.24
                             tear flow.
    78699  S                Nervous system              0292         4.36      $216.24      $126.63       $43.25
                             nuclear exam.
    78700  S                Kidney imaging,             0291         3.15      $156.22       $93.14       $31.24
                             static.
    78701  S                Kidney imaging with         0291         3.15      $156.22       $93.14       $31.24
                             flow.
    78704  S                Imaging renogram...         0292         4.36      $216.24      $126.63       $43.25
    78707  S                Kidney flow/                0292         4.36      $216.24      $126.63       $43.25
                             function image.
    78708  S                Kidney flow/                0292         4.36      $216.24      $126.63       $43.25
                             function image.
    78709  S                Kidney flow/                0292         4.36      $216.24      $126.63       $43.25
                             function image.
    78710  S                Kidney imaging (3D)         0292         4.36      $216.24      $126.63       $43.25
    78715  S                Renal vascular flow         0291         3.15      $156.22       $93.14       $31.24
                             exam.
    78725  S                Kidney function             0291         3.15      $156.22       $93.14       $31.24
                             study.
    78730  S                Urinary bladder             0291         3.15      $156.22       $93.14       $31.24
                             retention.
    78740  S                Ureteral reflux             0291         3.15      $156.22       $93.14       $31.24
                             study.
    78760  S                Testicular imaging.         0291         3.15      $156.22       $93.14       $31.24
    78761  S                Testicular imaging/         0291         3.15      $156.22       $93.14       $31.24
                             flow.
    78799  S                Genitourinary               0292         4.36      $216.24      $126.63       $43.25
                             nuclear exam.

[[Page 67919]]

 
    78800  S                Tumor imaging,              0292         4.36      $216.24      $126.63       $43.25
                             limited area.
    78801  S                Tumor imaging, mult         0292         4.36      $216.24      $126.63       $43.25
                             areas.
    78802  S                Tumor imaging,              0292         4.36      $216.24      $126.63       $43.25
                             whole body.
    78803  S                Tumor imaging (3D).         0292         4.36      $216.24      $126.63       $43.25
    78805  S                Abscess imaging,            0292         4.36      $216.24      $126.63       $43.25
                             ltd area.
    78806  S                Abscess imaging,            0292         4.36      $216.24      $126.63       $43.25
                             whole body.
    78807  S                Nuclear                     0292         4.36      $216.24      $126.63       $43.25
                             localization/
                             abscess.
    78810  E                Tumor imaging (PET)  ...........  ...........  ...........  ...........  ...........
    78890  N                Nuclear medicine     ...........  ...........  ...........  ...........  ...........
                             data proc.
    78891  N                Nuclear med data     ...........  ...........  ...........  ...........  ...........
                             proc.
    78990  N                Provide diag         ...........  ...........  ...........  ...........  ...........
                             radionuclide(s).
    78999  S                Nuclear diagnostic          0291         3.15      $156.22       $93.14       $31.24
                             exam.
    79000  S                Init hyperthyroid           0294         5.13      $254.43      $144.06       $50.89
                             therapy.
    79001  S                Repeat hyperthyroid         0294         5.13      $254.43      $144.06       $50.89
                             therapy.
    79020  S                Thyroid ablation...         0294         5.13      $254.43      $144.06       $50.89
    79030  S                Thyroid ablation,           0294         5.13      $254.43      $144.06       $50.89
                             carcinoma.
    79035  S                Thyroid metastatic          0294         5.13      $254.43      $144.06       $50.89
                             therapy.
    79100  S                Hematopoetic                0294         5.13      $254.43      $144.06       $50.89
                             nuclear therapy.
    79200  S                Intracavitary               0295        19.85      $984.48      $609.17      $196.90
                             nuclear trmt.
    79300  S                Interstitial                0294         5.13      $254.43      $144.06       $50.89
                             nuclear therapy.
    79400  S                Nonhemato nuclear           0295        19.85      $984.48      $609.17      $196.90
                             therapy.
    79420  S                Intravascular               0295        19.85      $984.48      $609.17      $196.90
                             nuclear ther.
    79440  S                Nuclear joint               0294         5.13      $254.43      $144.06       $50.89
                             therapy.
    79900  N                Provide ther         ...........  ...........  ...........  ...........  ...........
                             radiopharm(s).
    79999  S                Nuclear medicine            0294         5.13      $254.43      $144.06       $50.89
                             therapy.
    80048  A                Basic metabolic      ...........  ...........  ...........  ...........  ...........
                             panel.
    80050  A                General health       ...........  ...........  ...........  ...........  ...........
                             panel.
    80051  A                Electrolyte panel..  ...........  ...........  ...........  ...........  ...........
    80053  A                Comprehen metabolic  ...........  ...........  ...........  ...........  ...........
                             panel.
    80055  A                Obstetric panel....  ...........  ...........  ...........  ...........  ...........
    80061  A                Lipid panel........  ...........  ...........  ...........  ...........  ...........
    80069  A                Renal function       ...........  ...........  ...........  ...........  ...........
                             panel.
    80072  A                Arthritis panel....  ...........  ...........  ...........  ...........  ...........
    80074  A                Acute hepatitis      ...........  ...........  ...........  ...........  ...........
                             panel.
    80076  A                Hepatic function     ...........  ...........  ...........  ...........  ...........
                             panel.
    80090  A                Torch antibody       ...........  ...........  ...........  ...........  ...........
                             panel.
    80100  A                Drug screen........  ...........  ...........  ...........  ...........  ...........
    80101  A                Drug screen........  ...........  ...........  ...........  ...........  ...........
    80102  A                Drug confirmation..  ...........  ...........  ...........  ...........  ...........
    80103  N                Drug analysis,       ...........  ...........  ...........  ...........  ...........
                             tissue prep.
    80150  A                Assay of amikacin..  ...........  ...........  ...........  ...........  ...........
    80152  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             amitriptyline.
    80154  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             benzodiazepines.
    80156  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             carbamazepine.
   *80157  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             carbamazepine,
                             free.
    80158  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             cyclosporine.
    80160  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             desipramine.
    80162  A                Assay of digoxin...  ...........  ...........  ...........  ...........  ...........
    80164  A                Assay,               ...........  ...........  ...........  ...........  ...........
                             dipropylacetic
                             acid.
    80166  A                Assay of doxepin...  ...........  ...........  ...........  ...........  ...........
    80168  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             ethosuximide.
    80170  A                Assay of gentamicin  ...........  ...........  ...........  ...........  ...........
    80172  A                Assay of gold......  ...........  ...........  ...........  ...........  ...........
   *80173  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             haloperidol.
    80174  A                Assay of imipramine  ...........  ...........  ...........  ...........  ...........
    80176  A                Assay of lidocaine.  ...........  ...........  ...........  ...........  ...........
    80178  A                Assay of lithium...  ...........  ...........  ...........  ...........  ...........
    80182  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             nortriptyline.
    80184  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             phenobarbital.
    80185  A                Assay of phenytoin,  ...........  ...........  ...........  ...........  ...........
                             total.
    80186  A                Assay of phenytoin,  ...........  ...........  ...........  ...........  ...........
                             free.
    80188  A                Assay of primidone.  ...........  ...........  ...........  ...........  ...........
    80190  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             procainamide.
    80192  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             procainamide.
    80194  A                Assay of quinidine.  ...........  ...........  ...........  ...........  ...........
    80196  A                Assay of salicylate  ...........  ...........  ...........  ...........  ...........
    80197  A                Assay of tacrolimus  ...........  ...........  ...........  ...........  ...........
    80198  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             theophylline.
    80200  A                Assay of tobramycin  ...........  ...........  ...........  ...........  ...........
    80201  A                Assay of topiramate  ...........  ...........  ...........  ...........  ...........
    80202  A                Assay of vancomycin  ...........  ...........  ...........  ...........  ...........
    80299  A                Quantitative assay,  ...........  ...........  ...........  ...........  ...........
                             drug.
    80400  A                Acth stimulation     ...........  ...........  ...........  ...........  ...........
                             panel.
    80402  A                Acth stimulation     ...........  ...........  ...........  ...........  ...........
                             panel.

[[Page 67920]]

 
    80406  A                Acth stimulation     ...........  ...........  ...........  ...........  ...........
                             panel.
    80408  A                Aldosterone          ...........  ...........  ...........  ...........  ...........
                             suppression eval.
    80410  A                Calcitonin stimul    ...........  ...........  ...........  ...........  ...........
                             panel.
    80412  A                CRH stimulation      ...........  ...........  ...........  ...........  ...........
                             panel.
    80414  A                Testosterone         ...........  ...........  ...........  ...........  ...........
                             response.
    80415  A                Estradiol response   ...........  ...........  ...........  ...........  ...........
                             panel.
    80416  A                Renin stimulation    ...........  ...........  ...........  ...........  ...........
                             panel.
    80417  A                Renin stimulation    ...........  ...........  ...........  ...........  ...........
                             panel.
    80418  A                Pituitary            ...........  ...........  ...........  ...........  ...........
                             evaluation panel.
    80420  A                Dexamethasone panel  ...........  ...........  ...........  ...........  ...........
    80422  A                Glucagon tolerance   ...........  ...........  ...........  ...........  ...........
                             panel.
    80424  A                Glucagon tolerance   ...........  ...........  ...........  ...........  ...........
                             panel.
    80426  A                Gonadotropin         ...........  ...........  ...........  ...........  ...........
                             hormone panel.
    80428  A                Growth hormone       ...........  ...........  ...........  ...........  ...........
                             panel.
    80430  A                Growth hormone       ...........  ...........  ...........  ...........  ...........
                             panel.
    80432  A                Insulin suppression  ...........  ...........  ...........  ...........  ...........
                             panel.
    80434  A                Insulin tolerance    ...........  ...........  ...........  ...........  ...........
                             panel.
    80435  A                Insulin tolerance    ...........  ...........  ...........  ...........  ...........
                             panel.
    80436  A                Metyrapone panel...  ...........  ...........  ...........  ...........  ...........
    80438  A                TRH stimulation      ...........  ...........  ...........  ...........  ...........
                             panel.
    80439  A                TRH stimulation      ...........  ...........  ...........  ...........  ...........
                             panel.
    80440  A                TRH stimulation      ...........  ...........  ...........  ...........  ...........
                             panel.
    80500  X                Lab pathology               0343         0.45       $22.32       $12.16        $4.46
                             consultation.
    80502  X                Lab pathology               0343         0.45       $22.32       $12.16        $4.46
                             consultation.
    81000  A                Urinalysis, nonauto  ...........  ...........  ...........  ...........  ...........
                             w/scope.
    81001  A                Urinalysis, auto w/  ...........  ...........  ...........  ...........  ...........
                             scope.
    81002  A                Urinalysis nonauto   ...........  ...........  ...........  ...........  ...........
                             w/o scope.
    81003  A                Urinalysis, auto, w/ ...........  ...........  ...........  ...........  ...........
                             o scope.
    81005  A                Urinalysis.........  ...........  ...........  ...........  ...........  ...........
    81007  A                Urine screen for     ...........  ...........  ...........  ...........  ...........
                             bacteria.
    81015  A                Microscopic exam of  ...........  ...........  ...........  ...........  ...........
                             urine.
    81020  A                Urinalysis, glass    ...........  ...........  ...........  ...........  ...........
                             test.
    81025  A                Urine pregnancy      ...........  ...........  ...........  ...........  ...........
                             test.
    81050  A                Urinalysis, volume   ...........  ...........  ...........  ...........  ...........
                             measure.
    81099  X                Urinalysis test             0349         0.48       $23.65        $4.73        $4.73
                             procedure.
    82000  A                Assay of blood       ...........  ...........  ...........  ...........  ...........
                             acetaldehyde.
    82003  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             acetaminophen.
    82009  A                Test for acetone/    ...........  ...........  ...........  ...........  ...........
                             ketones.
    82010  A                Acetone assay......  ...........  ...........  ...........  ...........  ...........
    82013  A                Acetylcholinesteras  ...........  ...........  ...........  ...........  ...........
                             e assay.
    82016  A                Acylcarnitines,      ...........  ...........  ...........  ...........  ...........
                             qual.
    82017  A                Acylcarnitines,      ...........  ...........  ...........  ...........  ...........
                             quant.
    82024  A                Assay of acth......  ...........  ...........  ...........  ...........  ...........
    82030  A                Assay of adp & amp.  ...........  ...........  ...........  ...........  ...........
    82040  A                Assay of serum       ...........  ...........  ...........  ...........  ...........
                             albumin.
    82042  A                Assay of urine       ...........  ...........  ...........  ...........  ...........
                             albumin.
    82043  A                Microalbumin,        ...........  ...........  ...........  ...........  ...........
                             quantitative.
    82044  A                Microalbumin,        ...........  ...........  ...........  ...........  ...........
                             semiquant.
    82055  A                Assay of ethanol...  ...........  ...........  ...........  ...........  ...........
    82075  A                Assay of breath      ...........  ...........  ...........  ...........  ...........
                             ethanol.
    82085  A                Assay of aldolase..  ...........  ...........  ...........  ...........  ...........
    82088  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             aldosterone.
    82101  A                Assay of urine       ...........  ...........  ...........  ...........  ...........
                             alkaloids.
    82103  A                Alpha-1-             ...........  ...........  ...........  ...........  ...........
                             antitrypsin, total.
    82104  A                Alpha-1-             ...........  ...........  ...........  ...........  ...........
                             antitrypsin, pheno.
    82105  A                Alpha-fetoprotein,   ...........  ...........  ...........  ...........  ...........
                             serum.
    82106  A                Alpha-fetoprotein,   ...........  ...........  ...........  ...........  ...........
                             amniotic.
    82108  A                Assay of aluminum..  ...........  ...........  ...........  ...........  ...........
    82120  A                Amines, vaginal      ...........  ...........  ...........  ...........  ...........
                             fluid qual.
    82127  A                Amino acid, single   ...........  ...........  ...........  ...........  ...........
                             qual.
    82128  A                Amino acids, mult    ...........  ...........  ...........  ...........  ...........
                             qual.
    82131  A                Amino acids, single  ...........  ...........  ...........  ...........  ...........
                             quant.
    82135  A                Assay,               ...........  ...........  ...........  ...........  ...........
                             aminolevulinic
                             acid.
    82136  A                Amino acids, quant,  ...........  ...........  ...........  ...........  ...........
                             2-5.
    82139  A                Amino acids, quan,   ...........  ...........  ...........  ...........  ...........
                             6 or more.
    82140  A                Assay of ammonia...  ...........  ...........  ...........  ...........  ...........
    82143  A                Amniotic fluid scan  ...........  ...........  ...........  ...........  ...........
    82145  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             amphetamines.
    82150  A                Assay of amylase...  ...........  ...........  ...........  ...........  ...........
    82154  A                Androstanediol       ...........  ...........  ...........  ...........  ...........
                             glucuronide.
    82157  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             androstenedione.
    82160  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             androsterone.
    82163  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             angiotensin II.
    82164  A                Angiotensin I        ...........  ...........  ...........  ...........  ...........
                             enzyme test.

[[Page 67921]]

 
    82172  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             apolipoprotein.
    82175  A                Assay of arsenic...  ...........  ...........  ...........  ...........  ...........
    82180  A                Assay of ascorbic    ...........  ...........  ...........  ...........  ...........
                             acid.
    82190  A                Atomic absorption..  ...........  ...........  ...........  ...........  ...........
    82205  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             barbiturates.
    82232  A                Assay of beta-2      ...........  ...........  ...........  ...........  ...........
                             protein.
    82239  A                Bile acids, total..  ...........  ...........  ...........  ...........  ...........
    82240  A                Bile acids,          ...........  ...........  ...........  ...........  ...........
                             cholylglycine.
    82247  A                Bilirubin, total...  ...........  ...........  ...........  ...........  ...........
    82248  A                Bilirubin, direct..  ...........  ...........  ...........  ...........  ...........
   82251D  A                Assay of bilirubin.  ...........  ...........  ...........  ...........  ...........
    82252  A                Fecal bilirubin      ...........  ...........  ...........  ...........  ...........
                             test.
    82261  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             biotinidase.
    82270  A                Test for blood,      ...........  ...........  ...........  ...........  ...........
                             feces.
    82273  A                Test for blood,      ...........  ...........  ...........  ...........  ...........
                             other source.
    82286  A                Assay of bradykinin  ...........  ...........  ...........  ...........  ...........
    82300  A                Assay of cadmium...  ...........  ...........  ...........  ...........  ...........
    82306  A                Assay of vitamin D.  ...........  ...........  ...........  ...........  ...........
    82307  A                Assay of vitamin D.  ...........  ...........  ...........  ...........  ...........
    82308  A                Assay of calcitonin  ...........  ...........  ...........  ...........  ...........
    82310  A                Assay of calcium...  ...........  ...........  ...........  ...........  ...........
    82330  A                Assay of calcium...  ...........  ...........  ...........  ...........  ...........
    82331  A                Calcium infusion     ...........  ...........  ...........  ...........  ...........
                             test.
    82340  A                Assay of calcium in  ...........  ...........  ...........  ...........  ...........
                             urine.
    82355  A                Calculus (stone)     ...........  ...........  ...........  ...........  ...........
                             analysis.
    82360  A                Calculus (stone)     ...........  ...........  ...........  ...........  ...........
                             assay.
    82365  A                Calculus (stone)     ...........  ...........  ...........  ...........  ...........
                             assay.
    82370  A                X-ray assay,         ...........  ...........  ...........  ...........  ...........
                             calculus.
   *82373  A                Carb deficient       ...........  ...........  ...........  ...........  ...........
                             transferrin.
    82374  A                Assay, blood carbon  ...........  ...........  ...........  ...........  ...........
                             dioxide.
    82375  A                Assay, blood carbon  ...........  ...........  ...........  ...........  ...........
                             monoxide.
    82376  A                Test for carbon      ...........  ...........  ...........  ...........  ...........
                             monoxide.
    82378  A                Carcinoembryonic     ...........  ...........  ...........  ...........  ...........
                             antigen.
    82379  A                Assay of carnitine.  ...........  ...........  ...........  ...........  ...........
    82380  A                Assay of carotene..  ...........  ...........  ...........  ...........  ...........
    82382  A                Assay, urine         ...........  ...........  ...........  ...........  ...........
                             catecholamines.
    82383  A                Assay, blood         ...........  ...........  ...........  ...........  ...........
                             catecholamines.
    82384  A                Assay, three         ...........  ...........  ...........  ...........  ...........
                             catecholamines.
    82387  A                Assay of cathepsin-  ...........  ...........  ...........  ...........  ...........
                             d.
    82390  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             ceruloplasmin.
    82397  A                Chemiluminescent     ...........  ...........  ...........  ...........  ...........
                             assay.
    82415  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             chloramphenicol.
    82435  A                Assay of blood       ...........  ...........  ...........  ...........  ...........
                             chloride.
    82436  A                Assay of urine       ...........  ...........  ...........  ...........  ...........
                             chloride.
    82438  A                Assay, other fluid   ...........  ...........  ...........  ...........  ...........
                             chlorides.
    82441  A                Test for             ...........  ...........  ...........  ...........  ...........
                             chlorohydrocarbons.
    82465  A                Assay of serum       ...........  ...........  ...........  ...........  ...........
                             cholesterol.
    82480  A                Assay, serum         ...........  ...........  ...........  ...........  ...........
                             cholinesterase.
    82482  A                Assay, rbc           ...........  ...........  ...........  ...........  ...........
                             cholinesterase.
    82485  A                Assay, chondroitin   ...........  ...........  ...........  ...........  ...........
                             sulfate.
    82486  A                Gas/liquid           ...........  ...........  ...........  ...........  ...........
                             chromatography.
    82487  A                Paper                ...........  ...........  ...........  ...........  ...........
                             chromatography.
    82488  A                Paper                ...........  ...........  ...........  ...........  ...........
                             chromatography.
    82489  A                Thin layer           ...........  ...........  ...........  ...........  ...........
                             chromatography.
    82491  A                Chromotography,      ...........  ...........  ...........  ...........  ...........
                             quant, sing.
    82492  A                Chromotography,      ...........  ...........  ...........  ...........  ...........
                             quant, mult.
    82495  A                Assay of chromium..  ...........  ...........  ...........  ...........  ...........
    82507  A                Assay of citrate...  ...........  ...........  ...........  ...........  ...........
    82520  A                Assay of cocaine...  ...........  ...........  ...........  ...........  ...........
    82523  A                Collagen crosslinks  ...........  ...........  ...........  ...........  ...........
    82525  A                Assay of copper....  ...........  ...........  ...........  ...........  ...........
    82528  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             corticosterone.
    82530  A                Cortisol, free.....  ...........  ...........  ...........  ...........  ...........
    82533  A                Total cortisol.....  ...........  ...........  ...........  ...........  ...........
    82540  A                Assay of creatine..  ...........  ...........  ...........  ...........  ...........
    82541  A                Column               ...........  ...........  ...........  ...........  ...........
                             chromotography,
                             qual.
    82542  A                Column               ...........  ...........  ...........  ...........  ...........
                             chromotography,
                             quant.
    82543  A                Column               ...........  ...........  ...........  ...........  ...........
                             chromotograph/
                             isotope.
    82544  A                Column               ...........  ...........  ...........  ...........  ...........
                             chromotograph/
                             isotope.
    82550  A                Assay of ck (cpk)..  ...........  ...........  ...........  ...........  ...........
    82552  A                Assay of cpk in      ...........  ...........  ...........  ...........  ...........
                             blood.
    82553  A                Creatine, MB         ...........  ...........  ...........  ...........  ...........
                             fraction.
    82554  A                Creatine, isoforms.  ...........  ...........  ...........  ...........  ...........
    82565  A                Assay of creatinine  ...........  ...........  ...........  ...........  ...........

[[Page 67922]]

 
    82570  A                Assay of urine       ...........  ...........  ...........  ...........  ...........
                             creatinine.
    82575  A                Creatinine           ...........  ...........  ...........  ...........  ...........
                             clearance test.
    82585  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             cryofibrinogen.
    82595  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             cryoglobulin.
    82600  A                Assay of cyanide...  ...........  ...........  ...........  ...........  ...........
    82607  A                Vitamin B-12.......  ...........  ...........  ...........  ...........  ...........
    82608  A                B-12 binding         ...........  ...........  ...........  ...........  ...........
                             capacity.
    82615  A                Test for urine       ...........  ...........  ...........  ...........  ...........
                             cystines.
    82626  A                Dehydroepiandroster  ...........  ...........  ...........  ...........  ...........
                             one.
    82627  A                Dehydroepiandroster  ...........  ...........  ...........  ...........  ...........
                             one.
    82633  A                Desoxycorticosteron  ...........  ...........  ...........  ...........  ...........
                             e.
    82634  A                Deoxycortisol......  ...........  ...........  ...........  ...........  ...........
    82638  A                Assay of dibucaine   ...........  ...........  ...........  ...........  ...........
                             number.
    82646  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             dihydrocodeinone.
    82649  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             dihydromorphinone.
    82651  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             dihydrotestosteron
                             e.
    82652  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             dihydroxyvitamin d.
    82654  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             dimethadione.
    82657  A                Enzyme cell          ...........  ...........  ...........  ...........  ...........
                             activity.
    82658  A                Enzyme cell          ...........  ...........  ...........  ...........  ...........
                             activity, ra.
    82664  A                Electrophoretic      ...........  ...........  ...........  ...........  ...........
                             test.
    82666  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             epiandrosterone.
    82668  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             erythropoietin.
    82670  A                Assay of estradiol.  ...........  ...........  ...........  ...........  ...........
    82671  A                Assay of estrogens.  ...........  ...........  ...........  ...........  ...........
    82672  A                Assay of estrogen..  ...........  ...........  ...........  ...........  ...........
    82677  A                Assay of estriol...  ...........  ...........  ...........  ...........  ...........
    82679  A                Assay of estrone...  ...........  ...........  ...........  ...........  ...........
    82690  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             ethchlorvynol.
    82693  A                Assay of ethylene    ...........  ...........  ...........  ...........  ...........
                             glycol.
    82696  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             etiocholanolone.
    82705  A                Fats/lipids, feces,  ...........  ...........  ...........  ...........  ...........
                             qual.
    82710  A                Fats/lipids, feces,  ...........  ...........  ...........  ...........  ...........
                             quant.
    82715  A                Assay of fecal fat.  ...........  ...........  ...........  ...........  ...........
    82725  A                Assay of blood       ...........  ...........  ...........  ...........  ...........
                             fatty acids.
    82726  A                Long chain fatty     ...........  ...........  ...........  ...........  ...........
                             acids.
    82728  A                Assay of ferritin..  ...........  ...........  ...........  ...........  ...........
    82731  A                Assay of fetal       ...........  ...........  ...........  ...........  ...........
                             fibronectin.
    82735  A                Assay of fluoride..  ...........  ...........  ...........  ...........  ...........
    82742  A                Assay of flurazepam  ...........  ...........  ...........  ...........  ...........
    82746  A                Blood folic acid     ...........  ...........  ...........  ...........  ...........
                             serum.
    82747  A                Assay of folic       ...........  ...........  ...........  ...........  ...........
                             acid, rbc.
    82757  A                Assay of semen       ...........  ...........  ...........  ...........  ...........
                             fructose.
    82759  A                Assay of rbc         ...........  ...........  ...........  ...........  ...........
                             galactokinase.
    82760  A                Assay of galactose.  ...........  ...........  ...........  ...........  ...........
    82775  A                Assay galactose      ...........  ...........  ...........  ...........  ...........
                             transferase.
    82776  A                Galactose            ...........  ...........  ...........  ...........  ...........
                             transferase test.
    82784  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             gammaglobulin igm.
    82785  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             gammaglobulin ige.
    82787  A                Igg 1, 2, 3 and 4..  ...........  ...........  ...........  ...........  ...........
    82800  A                Blood pH...........  ...........  ...........  ...........  ...........  ...........
    82803  A                Blood gases: pH,     ...........  ...........  ...........  ...........  ...........
                             pO2 & pCO2.
    82805  A                Blood gases W/O2     ...........  ...........  ...........  ...........  ...........
                             saturation.
    82810  A                Blood gases, O2 sat  ...........  ...........  ...........  ...........  ...........
                             only.
    82820  A                Hemoglobin-oxygen    ...........  ...........  ...........  ...........  ...........
                             affinity.
    82926  A                Assay of gastric     ...........  ...........  ...........  ...........  ...........
                             acid.
    82928  A                Assay of gastric     ...........  ...........  ...........  ...........  ...........
                             acid.
    82938  A                Gastrin test.......  ...........  ...........  ...........  ...........  ...........
    82941  A                Assay of gastrin...  ...........  ...........  ...........  ...........  ...........
    82943  A                Assay of glucagon..  ...........  ...........  ...........  ...........  ...........
   *82945  A                Glucose, body fluid  ...........  ...........  ...........  ...........  ...........
                             other than blood.
    82946  A                Glucagon tolerance   ...........  ...........  ...........  ...........  ...........
                             test.
    82947  A                Assay of glucose,    ...........  ...........  ...........  ...........  ...........
                             quant.
    82948  A                Reagent strip/blood  ...........  ...........  ...........  ...........  ...........
                             glucose.
    82950  A                Glucose test.......  ...........  ...........  ...........  ...........  ...........
    82951  A                Glucose tolerance    ...........  ...........  ...........  ...........  ...........
                             test (GTT).
    82952  A                GTT-added samples..  ...........  ...........  ...........  ...........  ...........
    82953  A                Glucose-tolbutamide  ...........  ...........  ...........  ...........  ...........
                             test.
    82955  A                Assay of g6pd        ...........  ...........  ...........  ...........  ...........
                             enzyme.
    82960  A                Test for G6PD        ...........  ...........  ...........  ...........  ...........
                             enzyme.
    82962  A                Glucose blood test.  ...........  ...........  ...........  ...........  ...........
    82963  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             glucosidase.
    82965  A                Assay of gdh enzyme  ...........  ...........  ...........  ...........  ...........
    82975  A                Assay of glutamine.  ...........  ...........  ...........  ...........  ...........

[[Page 67923]]

 
    82977  A                Assay of GGT.......  ...........  ...........  ...........  ...........  ...........
    82978  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             glutathione.
    82979  A                Assay, rbc           ...........  ...........  ...........  ...........  ...........
                             glutathione.
    82980  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             glutethimide.
    82985  A                Glycated protein...  ...........  ...........  ...........  ...........  ...........
    83001  A                Gonadotropin (FSH).  ...........  ...........  ...........  ...........  ...........
    83002  A                Gonadotropin (LH)..  ...........  ...........  ...........  ...........  ...........
    83003  A                Assay, growth        ...........  ...........  ...........  ...........  ...........
                             hormone (hgh).
    83008  A                Assay of guanosine.  ...........  ...........  ...........  ...........  ...........
    83010  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             haptoglobin, quant.
    83012  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             haptoglobins.
    83013  A                H pylori breath tst  ...........  ...........  ...........  ...........  ...........
                             analysis.
    83014  A                H pylori drug admin/ ...........  ...........  ...........  ...........  ...........
                             collect.
    83015  A                Heavy metal screen.  ...........  ...........  ...........  ...........  ...........
    83018  A                Quantitative         ...........  ...........  ...........  ...........  ...........
                             screen, metals.
    83020  A                Hemoglobin           ...........  ...........  ...........  ...........  ...........
                             electrophoresis.
    83021  A                Hemoglobin           ...........  ...........  ...........  ...........  ...........
                             chromotography.
    83026  A                Hemoglobin, copper   ...........  ...........  ...........  ...........  ...........
                             sulfate.
    83030  A                Fetal hemoglobin     ...........  ...........  ...........  ...........  ...........
                             assay.
    83033  A                Fetal fecal          ...........  ...........  ...........  ...........  ...........
                             hemoglobin assay.
    83036  A                Glycated hemoglobin  ...........  ...........  ...........  ...........  ...........
                             test.
    83045  A                Blood methemoglobin  ...........  ...........  ...........  ...........  ...........
                             test.
    83050  A                Blood methemoglobin  ...........  ...........  ...........  ...........  ...........
                             assay.
    83051  A                Assay of plasma      ...........  ...........  ...........  ...........  ...........
                             hemoglobin.
    83055  A                Blood                ...........  ...........  ...........  ...........  ...........
                             sulfhemoglobin
                             test.
    83060  A                Blood                ...........  ...........  ...........  ...........  ...........
                             sulfhemoglobin
                             assay.
    83065  A                Assay of hemoglobin  ...........  ...........  ...........  ...........  ...........
                             heat.
    83068  A                Hemoglobin           ...........  ...........  ...........  ...........  ...........
                             stability screen.
    83069  A                Assay of urine       ...........  ...........  ...........  ...........  ...........
                             hemoglobin.
    83070  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             hemosiderin, qual.
    83071  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             hemosiderin, quant.
    83080  A                Assay of b           ...........  ...........  ...........  ...........  ...........
                             hexosaminidase.
    83088  A                Assay of histamine.  ...........  ...........  ...........  ...........  ...........
   *83090  A                Homocystine........  ...........  ...........  ...........  ...........  ...........
    83150  A                Assay of for hva...  ...........  ...........  ...........  ...........  ...........
    83491  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             corticosteroids.
    83497  A                Assay of 5-hiaa....  ...........  ...........  ...........  ...........  ...........
    83498  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             progesterone.
    83499  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             progesterone.
    83500  A                Assay, free          ...........  ...........  ...........  ...........  ...........
                             hydroxyproline.
    83505  A                Assay, total         ...........  ...........  ...........  ...........  ...........
                             hydroxyproline.
    83516  A                Immunoassay,         ...........  ...........  ...........  ...........  ...........
                             nonantibody.
    83518  A                Immunoassay,         ...........  ...........  ...........  ...........  ...........
                             dipstick.
    83519  A                Immunoassay,         ...........  ...........  ...........  ...........  ...........
                             nonantibody.
    83520  A                Immunoassay, RIA...  ...........  ...........  ...........  ...........  ...........
    83525  A                Assay of insulin...  ...........  ...........  ...........  ...........  ...........
    83527  A                Assay of insulin...  ...........  ...........  ...........  ...........  ...........
    83528  A                Assay of intrinsic   ...........  ...........  ...........  ...........  ...........
                             factor.
    83540  A                Assay of iron......  ...........  ...........  ...........  ...........  ...........
    83550  A                Iron binding test..  ...........  ...........  ...........  ...........  ...........
    83570  A                Assay of idh enzyme  ...........  ...........  ...........  ...........  ...........
    83582  A                Assay of ketogenic   ...........  ...........  ...........  ...........  ...........
                             steroids.
    83586  A                Assay 17-            ...........  ...........  ...........  ...........  ...........
                             ketosteroids.
    83593  A                Fractionation,       ...........  ...........  ...........  ...........  ...........
                             ketosteroids.
    83605  A                Assay of lactic      ...........  ...........  ...........  ...........  ...........
                             acid.
    83615  A                Lactate (LD) (LDH)   ...........  ...........  ...........  ...........  ...........
                             enzyme.
    83625  A                Assay of ldh         ...........  ...........  ...........  ...........  ...........
                             enzymes.
    83632  A                Placental lactogen.  ...........  ...........  ...........  ...........  ...........
    83633  A                Test urine for       ...........  ...........  ...........  ...........  ...........
                             lactose.
    83634  A                Assay of urine for   ...........  ...........  ...........  ...........  ...........
                             lactose.
    83655  A                Assay of lead......  ...........  ...........  ...........  ...........  ...........
    83661  A                Assay of l/s ratio.  ...........  ...........  ...........  ...........  ...........
    83662  A                L/S ratio, foam      ...........  ...........  ...........  ...........  ...........
                             stability.
   *83663  A                Fetal lung           ...........  ...........  ...........  ...........  ...........
                             maturity, fluor
                             polar.
   *83664  A                Fetal lung           ...........  ...........  ...........  ...........  ...........
                             maturity, lam body
                             dens.
    83670  A                Assay of lap enzyme  ...........  ...........  ...........  ...........  ...........
    83690  A                Assay of lipase....  ...........  ...........  ...........  ...........  ...........
    83715  A                Assay of blood       ...........  ...........  ...........  ...........  ...........
                             lipoproteins.
    83716  A                Assay of blood       ...........  ...........  ...........  ...........  ...........
                             lipoproteins.
    83718  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             lipoprotein.
    83719  A                Assay of blood       ...........  ...........  ...........  ...........  ...........
                             lipoprotein.
    83721  A                Assay of blood       ...........  ...........  ...........  ...........  ...........
                             lipoprotein.
    83727  A                Assay of lrh         ...........  ...........  ...........  ...........  ...........
                             hormone.
    83735  A                Assay of magnesium.  ...........  ...........  ...........  ...........  ...........

[[Page 67924]]

 
    83775  A                Assay of md enzyme.  ...........  ...........  ...........  ...........  ...........
    83785  A                Assay of manganese.  ...........  ...........  ...........  ...........  ...........
    83788  A                Mass spectrometry    ...........  ...........  ...........  ...........  ...........
                             qual.
    83789  A                Mass spectrometry    ...........  ...........  ...........  ...........  ...........
                             quant.
    83805  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             meprobamate.
    83825  A                Assay of mercury...  ...........  ...........  ...........  ...........  ...........
    83835  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             metanephrines.
    83840  A                Assay of methadone.  ...........  ...........  ...........  ...........  ...........
    83857  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             methemalbumin.
    83858  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             methsuximide.
    83864  A                Mucopolysaccharides  ...........  ...........  ...........  ...........  ...........
    83866  A                Mucopolysaccharides  ...........  ...........  ...........  ...........  ...........
                             screen.
    83872  A                Assay synovial       ...........  ...........  ...........  ...........  ...........
                             fluid mucin.
    83873  A                Assay of csf         ...........  ...........  ...........  ...........  ...........
                             protein.
    83874  A                Assay of myoglobin.  ...........  ...........  ...........  ...........  ...........
    83883  A                Assay, nephelometry  ...........  ...........  ...........  ...........  ...........
                             not spec.
    83885  A                Assay of nickel....  ...........  ...........  ...........  ...........  ...........
    83887  A                Assay of nicotine..  ...........  ...........  ...........  ...........  ...........
    83890  A                Molecule isolate...  ...........  ...........  ...........  ...........  ...........
    83891  A                Molecule isolate     ...........  ...........  ...........  ...........  ...........
                             nucleic.
    83892  A                Molecular            ...........  ...........  ...........  ...........  ...........
                             diagnostics.
    83893  A                Molecule dot/slot/   ...........  ...........  ...........  ...........  ...........
                             blot.
    83894  A                Molecule gel         ...........  ...........  ...........  ...........  ...........
                             electrophor.
    83896  A                Molecular            ...........  ...........  ...........  ...........  ...........
                             diagnostics.
    83897  A                Molecule nucleic     ...........  ...........  ...........  ...........  ...........
                             transfer.
    83898  A                Molecule nucleic     ...........  ...........  ...........  ...........  ...........
                             ampli.
    83901  A                Molecule nucleic     ...........  ...........  ...........  ...........  ...........
                             ampli.
    83902  A                Molecular            ...........  ...........  ...........  ...........  ...........
                             diagnostics.
    83903  A                Molecule mutation    ...........  ...........  ...........  ...........  ...........
                             scan.
    83904  A                Molecule mutation    ...........  ...........  ...........  ...........  ...........
                             identify.
    83905  A                Molecule mutation    ...........  ...........  ...........  ...........  ...........
                             identify.
    83906  A                Molecule mutation    ...........  ...........  ...........  ...........  ...........
                             identify.
    83912  A                Genetic examination  ...........  ...........  ...........  ...........  ...........
    83915  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             nucleotidase.
    83916  A                Oligoclonal bands..  ...........  ...........  ...........  ...........  ...........
    83918  A                Assay, organic       ...........  ...........  ...........  ...........  ...........
                             acids quant.
    83919  A                Assay, organic       ...........  ...........  ...........  ...........  ...........
                             acids qual.
   *83921  A                Assay, organic       ...........  ...........  ...........  ...........  ...........
                             acid, single,
                             quant.
    83925  A                Assay of opiates...  ...........  ...........  ...........  ...........  ...........
    83930  A                Assay of blood       ...........  ...........  ...........  ...........  ...........
                             osmolality.
    83935  A                Assay of urine       ...........  ...........  ...........  ...........  ...........
                             osmolality.
    83937  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             osteocalcin.
    83945  A                Assay of oxalate...  ...........  ...........  ...........  ...........  ...........
    83970  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             parathormone.
    83986  A                Assay of body fluid  ...........  ...........  ...........  ...........  ...........
                             acidity.
    83992  A                Assay for            ...........  ...........  ...........  ...........  ...........
                             phencyclidine.
    84022  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             phenothiazine.
    84030  A                Assay of blood pku.  ...........  ...........  ...........  ...........  ...........
    84035  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             phenylketones.
    84060  A                Assay acid           ...........  ...........  ...........  ...........  ...........
                             phosphatase.
    84061  A                Phosphatase,         ...........  ...........  ...........  ...........  ...........
                             forensic exam.
    84066  A                Assay prostate       ...........  ...........  ...........  ...........  ...........
                             phosphatase.
    84075  A                Assay alkaline       ...........  ...........  ...........  ...........  ...........
                             phosphatase.
    84078  A                Assay alkaline       ...........  ...........  ...........  ...........  ...........
                             phosphatase.
    84080  A                Assay alkaline       ...........  ...........  ...........  ...........  ...........
                             phosphatases.
    84081  A                Amniotic fluid       ...........  ...........  ...........  ...........  ...........
                             enzyme test.
    84085  A                Assay of rbc pg6d    ...........  ...........  ...........  ...........  ...........
                             enzyme.
    84087  A                Assay phosphohexose  ...........  ...........  ...........  ...........  ...........
                             enzymes.
    84100  A                Assay of phosphorus  ...........  ...........  ...........  ...........  ...........
    84105  A                Assay of urine       ...........  ...........  ...........  ...........  ...........
                             phosphorus.
    84106  A                Test for             ...........  ...........  ...........  ...........  ...........
                             porphobilinogen.
    84110  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             porphobilinogen.
    84119  A                Test urine for       ...........  ...........  ...........  ...........  ...........
                             porphyrins.
    84120  A                Assay of urine       ...........  ...........  ...........  ...........  ...........
                             porphyrins.
    84126  A                Assay of feces       ...........  ...........  ...........  ...........  ...........
                             porphyrins.
    84127  A                Assay of feces       ...........  ...........  ...........  ...........  ...........
                             porphyrins.
    84132  A                Assay of serum       ...........  ...........  ...........  ...........  ...........
                             potassium.
    84133  A                Assay of urine       ...........  ...........  ...........  ...........  ...........
                             potassium.
    84134  A                Assay of prealbumin  ...........  ...........  ...........  ...........  ...........
    84135  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             pregnanediol.
    84138  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             pregnanetriol.
    84140  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             pregnenolone.
    84143  A                Assay of 17-         ...........  ...........  ...........  ...........  ...........
                             hydroxypregneno.
    84144  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             progesterone.

[[Page 67925]]

 
    84146  A                Assay of prolactin.  ...........  ...........  ...........  ...........  ...........
    84150  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             prostaglandin.
   *84152  A                PSA, complexed.....  ...........  ...........  ...........  ...........  ...........
    84153  A                Assay of psa, total  ...........  ...........  ...........  ...........  ...........
    84154  A                Assay of psa, free.  ...........  ...........  ...........  ...........  ...........
    84155  A                Assay of protein...  ...........  ...........  ...........  ...........  ...........
    84160  A                Assay of serum       ...........  ...........  ...........  ...........  ...........
                             protein.
    84165  A                Assay of serum       ...........  ...........  ...........  ...........  ...........
                             proteins.
    84181  A                Western blot test..  ...........  ...........  ...........  ...........  ...........
    84182  A                Protein, western     ...........  ...........  ...........  ...........  ...........
                             blot test.
    84202  A                Assay RBC            ...........  ...........  ...........  ...........  ...........
                             protoporphyrin.
    84203  A                Test RBC             ...........  ...........  ...........  ...........  ...........
                             protoporphyrin.
    84206  A                Assay of proinsulin  ...........  ...........  ...........  ...........  ...........
    84207  A                Assay of vitamin b-  ...........  ...........  ...........  ...........  ...........
                             6.
    84210  A                Assay of pyruvate..  ...........  ...........  ...........  ...........  ...........
    84220  A                Assay of pyruvate    ...........  ...........  ...........  ...........  ...........
                             kinase.
    84228  A                Assay of quinine...  ...........  ...........  ...........  ...........  ...........
    84233  A                Assay of estrogen..  ...........  ...........  ...........  ...........  ...........
    84234  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             progesterone.
    84235  A                Assay of endocrine   ...........  ...........  ...........  ...........  ...........
                             hormone.
    84238  A                Assay, nonendocrine  ...........  ...........  ...........  ...........  ...........
                             receptor.
    84244  A                Assay of renin.....  ...........  ...........  ...........  ...........  ...........
    84252  A                Assay of vitamin b-  ...........  ...........  ...........  ...........  ...........
                             2.
    84255  A                Assay of selenium..  ...........  ...........  ...........  ...........  ...........
    84260  A                Assay of serotonin.  ...........  ...........  ...........  ...........  ...........
    84270  A                Assay of sex         ...........  ...........  ...........  ...........  ...........
                             hormone globul.
    84275  A                Assay of sialic      ...........  ...........  ...........  ...........  ...........
                             acid.
    84285  A                Assay of silica....  ...........  ...........  ...........  ...........  ...........
    84295  A                Assay of serum       ...........  ...........  ...........  ...........  ...........
                             sodium.
    84300  A                Assay of urine       ...........  ...........  ...........  ...........  ...........
                             sodium.
    84305  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             somatomedin.
    84307  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             somatostatin.
    84311  A                Spectrophotometry..  ...........  ...........  ...........  ...........  ...........
    84315  A                Body fluid specific  ...........  ...........  ...........  ...........  ...........
                             gravity.
    84375  A                Chromatogram assay,  ...........  ...........  ...........  ...........  ...........
                             sugars.
    84376  A                Sugars, single,      ...........  ...........  ...........  ...........  ...........
                             qual.
    84377  A                Sugars, multiple,    ...........  ...........  ...........  ...........  ...........
                             qual.
    84378  A                Sugars single quant  ...........  ...........  ...........  ...........  ...........
    84379  A                Sugars multiple      ...........  ...........  ...........  ...........  ...........
                             quant.
    84392  A                Assay of urine       ...........  ...........  ...........  ...........  ...........
                             sulfate.
    84402  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             testosterone.
    84403  A                Assay of total       ...........  ...........  ...........  ...........  ...........
                             testosterone.
    84425  A                Assay of vitamin b-  ...........  ...........  ...........  ...........  ...........
                             1.
    84430  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             thiocyanate.
    84432  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             thyroglobulin.
    84436  A                Assay of total       ...........  ...........  ...........  ...........  ...........
                             thyroxine.
    84437  A                Assay of neonatal    ...........  ...........  ...........  ...........  ...........
                             thyroxine.
    84439  A                Assay of free        ...........  ...........  ...........  ...........  ...........
                             thyroxine.
    84442  A                Assay of thyroid     ...........  ...........  ...........  ...........  ...........
                             activity.
    84443  A                Assay thyroid stim   ...........  ...........  ...........  ...........  ...........
                             hormone.
    84445  A                Assay of tsi.......  ...........  ...........  ...........  ...........  ...........
    84446  A                Assay of vitamin e.  ...........  ...........  ...........  ...........  ...........
    84449  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             transcortin.
    84450  A                Transferase (AST)    ...........  ...........  ...........  ...........  ...........
                             (SGOT).
    84460  A                Alanine amino (ALT)  ...........  ...........  ...........  ...........  ...........
                             (SGPT).
    84466  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             transferrin.
    84478  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             triglycerides.
    84479  A                Assay of thyroid     ...........  ...........  ...........  ...........  ...........
                             (t3 or t4).
    84480  A                Assay,               ...........  ...........  ...........  ...........  ...........
                             triiodothyronine
                             (t3).
    84481  A                Free assay (FT-3)..  ...........  ...........  ...........  ...........  ...........
    84482  A                T3 reverse.........  ...........  ...........  ...........  ...........  ...........
    84484  A                Assay of troponin,   ...........  ...........  ...........  ...........  ...........
                             quant.
    84485  A                Assay duodenal       ...........  ...........  ...........  ...........  ...........
                             fluid trypsin.
    84488  A                Test feces for       ...........  ...........  ...........  ...........  ...........
                             trypsin.
    84490  A                Assay of feces for   ...........  ...........  ...........  ...........  ...........
                             trypsin.
    84510  A                Assay of tyrosine..  ...........  ...........  ...........  ...........  ...........
    84512  A                Assay of troponin,   ...........  ...........  ...........  ...........  ...........
                             qual.
    84520  A                Assay of urea        ...........  ...........  ...........  ...........  ...........
                             nitrogen.
    84525  A                Urea nitrogen semi-  ...........  ...........  ...........  ...........  ...........
                             quant.
    84540  A                Assay of urine/urea- ...........  ...........  ...........  ...........  ...........
                             n.
    84545  A                Urea-N clearance     ...........  ...........  ...........  ...........  ...........
                             test.
    84550  A                Assay of blood/uric  ...........  ...........  ...........  ...........  ...........
                             acid.
    84560  A                Assay of urine/uric  ...........  ...........  ...........  ...........  ...........
                             acid.
    84577  A                Assay of feces/      ...........  ...........  ...........  ...........  ...........
                             urobilinogen.

[[Page 67926]]

 
    84578  A                Test urine           ...........  ...........  ...........  ...........  ...........
                             urobilinogen.
    84580  A                Assay of urine       ...........  ...........  ...........  ...........  ...........
                             urobilinogen.
    84583  A                Assay of urine       ...........  ...........  ...........  ...........  ...........
                             urobilinogen.
    84585  A                Assay of urine vma.  ...........  ...........  ...........  ...........  ...........
    84586  A                Assay of vip.......  ...........  ...........  ...........  ...........  ...........
    84588  A                Assay of             ...........  ...........  ...........  ...........  ...........
                             vasopressin.
    84590  A                Assay of vitamin a.  ...........  ...........  ...........  ...........  ...........
   *84591  A                Vitamin, NOS.......  ...........  ...........  ...........  ...........  ...........
    84597  A                Assay of vitamin k.  ...........  ...........  ...........  ...........  ...........
    84600  A                Assay of volatiles.  ...........  ...........  ...........  ...........  ...........
    84620  A                Xylose tolerance     ...........  ...........  ...........  ...........  ...........
                             test.
    84630  A                Assay of zinc......  ...........  ...........  ...........  ...........  ...........
    84681  A                Assay of c-peptide.  ...........  ...........  ...........  ...........  ...........
    84702  A                Chorionic            ...........  ...........  ...........  ...........  ...........
                             gonadotropin test.
    84703  A                Chorionic            ...........  ...........  ...........  ...........  ...........
                             gonadotropin assay.
    84830  A                Ovulation tests....  ...........  ...........  ...........  ...........  ...........
    84999  X                Clinical chemistry          0349         0.48       $23.65        $4.73        $4.73
                             test.
    85002  A                Bleeding time test.  ...........  ...........  ...........  ...........  ...........
    85007  A                Differential WBC     ...........  ...........  ...........  ...........  ...........
                             count.
    85008  A                Nondifferential WBC  ...........  ...........  ...........  ...........  ...........
                             count.
    85009  A                Differential WBC     ...........  ...........  ...........  ...........  ...........
                             count.
    85013  A                Hematocrit.........  ...........  ...........  ...........  ...........  ...........
    85014  A                Hematocrit.........  ...........  ...........  ...........  ...........  ...........
    85018  A                Hemoglobin.........  ...........  ...........  ...........  ...........  ...........
    85021  A                Automated hemogram.  ...........  ...........  ...........  ...........  ...........
    85022  A                Automated hemogram.  ...........  ...........  ...........  ...........  ...........
    85023  A                Automated hemogram.  ...........  ...........  ...........  ...........  ...........
    85024  A                Automated hemogram.  ...........  ...........  ...........  ...........  ...........
    85025  A                Automated hemogram.  ...........  ...........  ...........  ...........  ...........
    85027  A                Automated hemogram.  ...........  ...........  ...........  ...........  ...........
    85031  A                Manual hemogram,     ...........  ...........  ...........  ...........  ...........
                             cbc.
    85041  A                Red blood cell       ...........  ...........  ...........  ...........  ...........
                             (RBC) count.
    85044  A                Reticulocyte count.  ...........  ...........  ...........  ...........  ...........
    85045  A                Reticulocyte count.  ...........  ...........  ...........  ...........  ...........
    85046  A                Reticyte/hgb         ...........  ...........  ...........  ...........  ...........
                             concentrate.
    85048  A                White blood cell     ...........  ...........  ...........  ...........  ...........
                             (WBC) count.
    85060  X                Blood smear                 0342         0.26       $12.90        $8.03        $2.58
                             interpretation.
    85095  T                Bone marrow                 0003         0.98       $48.61       $27.99        $9.72
                             aspiration.
    85097  X                Bone marrow                 0344         0.79       $39.18       $23.63        $7.84
                             interpretation.
    85102  T                Bone marrow biopsy.         0003         0.98       $48.61       $27.99        $9.72
    85130  A                Chromogenic          ...........  ...........  ...........  ...........  ...........
                             substrate assay.
    85170  A                Blood clot           ...........  ...........  ...........  ...........  ...........
                             retraction.
    85175  A                Blood clot lysis     ...........  ...........  ...........  ...........  ...........
                             time.
    85210  A                Blood clot factor    ...........  ...........  ...........  ...........  ...........
                             II test.
    85220  A                Blood clot factor V  ...........  ...........  ...........  ...........  ...........
                             test.
    85230  A                Blood clot factor    ...........  ...........  ...........  ...........  ...........
                             VII test.
    85240  A                Blood clot factor    ...........  ...........  ...........  ...........  ...........
                             VIII test.
    85244  A                Blood clot factor    ...........  ...........  ...........  ...........  ...........
                             VIII test.
    85245  A                Blood clot factor    ...........  ...........  ...........  ...........  ...........
                             VIII test.
    85246  A                Blood clot factor    ...........  ...........  ...........  ...........  ...........
                             VIII test.
    85247  A                Blood clot factor    ...........  ...........  ...........  ...........  ...........
                             VIII test.
    85250  A                Blood clot factor    ...........  ...........  ...........  ...........  ...........
                             IX test.
    85260  A                Blood clot factor X  ...........  ...........  ...........  ...........  ...........
                             test.
    85270  A                Blood clot factor    ...........  ...........  ...........  ...........  ...........
                             XI test.
    85280  A                Blood clot factor    ...........  ...........  ...........  ...........  ...........
                             XII test.
    85290  A                Blood clot factor    ...........  ...........  ...........  ...........  ...........
                             XIII test.
    85291  A                Blood clot factor    ...........  ...........  ...........  ...........  ...........
                             XIII test.
    85292  A                Blood clot factor    ...........  ...........  ...........  ...........  ...........
                             assay.
    85293  A                Blood clot factor    ...........  ...........  ...........  ...........  ...........
                             assay.
    85300  A                Antithrombin III     ...........  ...........  ...........  ...........  ...........
                             test.
    85301  A                Antithrombin III     ...........  ...........  ...........  ...........  ...........
                             test.
    85302  A                Blood clot           ...........  ...........  ...........  ...........  ...........
                             inhibitor antigen.
    85303  A                Blood clot           ...........  ...........  ...........  ...........  ...........
                             inhibitor test.
    85305  A                Blood clot           ...........  ...........  ...........  ...........  ...........
                             inhibitor assay.
    85306  A                Blood clot           ...........  ...........  ...........  ...........  ...........
                             inhibitor test.
   *85307  A                Activated protein C  ...........  ...........  ...........  ...........  ...........
                             resistance.
    85335  A                Factor inhibitor     ...........  ...........  ...........  ...........  ...........
                             test.
    85337  A                Thrombomodulin.....  ...........  ...........  ...........  ...........  ...........
    85345  A                Coagulation time...  ...........  ...........  ...........  ...........  ...........
    85347  A                Coagulation time...  ...........  ...........  ...........  ...........  ...........
    85348  A                Coagulation time...  ...........  ...........  ...........  ...........  ...........
    85360  A                Euglobulin lysis...  ...........  ...........  ...........  ...........  ...........
    85362  A                Fibrin degradation   ...........  ...........  ...........  ...........  ...........
                             products.
    85366  A                Fibrinogen test....  ...........  ...........  ...........  ...........  ...........

[[Page 67927]]

 
    85370  A                Fibrinogen test....  ...........  ...........  ...........  ...........  ...........
    85378  A                Fibrin degradation.  ...........  ...........  ...........  ...........  ...........
    85379  A                Fibrin degradation.  ...........  ...........  ...........  ...........  ...........
    85384  A                Fibrinogen.........  ...........  ...........  ...........  ...........  ...........
    85385  A                Fibrinogen.........  ...........  ...........  ...........  ...........  ...........
    85390  A                Fibrinolysins        ...........  ...........  ...........  ...........  ...........
                             screen.
    85400  A                Fibrinolytic         ...........  ...........  ...........  ...........  ...........
                             plasmin.
    85410  A                Fibrinolytic         ...........  ...........  ...........  ...........  ...........
                             antiplasmin.
    85415  A                Fibrinolytic         ...........  ...........  ...........  ...........  ...........
                             plasminogen.
    85420  A                Fibrinolytic         ...........  ...........  ...........  ...........  ...........
                             plasminogen.
    85421  A                Fibrinolytic         ...........  ...........  ...........  ...........  ...........
                             plasminogen.
    85441  A                Heinz bodies,        ...........  ...........  ...........  ...........  ...........
                             direct.
    85445  A                Heinz bodies,        ...........  ...........  ...........  ...........  ...........
                             induced.
    85460  A                Hemoglobin, fetal..  ...........  ...........  ...........  ...........  ...........
    85461  A                Hemoglobin, fetal..  ...........  ...........  ...........  ...........  ...........
    85475  A                Hemolysin..........  ...........  ...........  ...........  ...........  ...........
    85520  A                Heparin assay......  ...........  ...........  ...........  ...........  ...........
    85525  A                Heparin............  ...........  ...........  ...........  ...........  ...........
    85530  A                Heparin-protamine    ...........  ...........  ...........  ...........  ...........
                             tolerance.
    85535  A                Iron stain, blood    ...........  ...........  ...........  ...........  ...........
                             cells.
   *85536  A                Iron stain,          ...........  ...........  ...........  ...........  ...........
                             peripheral blood.
    85540  A                Wbc alkaline         ...........  ...........  ...........  ...........  ...........
                             phosphatase.
    85547  A                RBC mechanical       ...........  ...........  ...........  ...........  ...........
                             fragility.
    85549  A                Muramidase.........  ...........  ...........  ...........  ...........  ...........
    85555  A                RBC osmotic          ...........  ...........  ...........  ...........  ...........
                             fragility.
    85557  A                RBC osmotic          ...........  ...........  ...........  ...........  ...........
                             fragility.
    85576  A                Blood platelet       ...........  ...........  ...........  ...........  ...........
                             aggregation.
    85585  A                Blood platelet       ...........  ...........  ...........  ...........  ...........
                             estimation.
    85590  A                Platelet count,      ...........  ...........  ...........  ...........  ...........
                             manual.
    85595  A                Platelet count,      ...........  ...........  ...........  ...........  ...........
                             automated.
    85597  A                Platelet             ...........  ...........  ...........  ...........  ...........
                             neutralization.
    85610  A                Prothrombin time...  ...........  ...........  ...........  ...........  ...........
    85611  A                Prothrombin test...  ...........  ...........  ...........  ...........  ...........
    85612  A                Viper venom          ...........  ...........  ...........  ...........  ...........
                             prothrombin time.
    85613  A                Russell viper        ...........  ...........  ...........  ...........  ...........
                             venom, diluted.
    85635  A                Reptilase test.....  ...........  ...........  ...........  ...........  ...........
    85651  A                Rbc sed rate,        ...........  ...........  ...........  ...........  ...........
                             nonautomated.
    85652  A                Rbc sed rate,        ...........  ...........  ...........  ...........  ...........
                             automated.
    85660  A                RBC sickle cell      ...........  ...........  ...........  ...........  ...........
                             test.
    85670  A                Thrombin time,       ...........  ...........  ...........  ...........  ...........
                             plasma.
    85675  A                Thrombin time,       ...........  ...........  ...........  ...........  ...........
                             titer.
    85705  A                Thromboplastin       ...........  ...........  ...........  ...........  ...........
                             inhibition.
    85730  A                Thromboplastin       ...........  ...........  ...........  ...........  ...........
                             time, partial.
    85732  A                Thromboplastin       ...........  ...........  ...........  ...........  ...........
                             time, partial.
    85810  A                Blood viscosity      ...........  ...........  ...........  ...........  ...........
                             examination.
    85999  X                Hematology                  0349         0.48       $23.65        $4.73        $4.73
                             procedure.
    86000  A                Agglutinins,         ...........  ...........  ...........  ...........  ...........
                             febrile.
   *86001  A                Allergen specific    ...........  ...........  ...........  ...........  ...........
                             IgE, quant/
                             semiquant.
    86003  A                Allergen specific    ...........  ...........  ...........  ...........  ...........
                             IgE.
    86005  A                Allergen specific    ...........  ...........  ...........  ...........  ...........
                             IgE.
    86021  A                WBC antibody         ...........  ...........  ...........  ...........  ...........
                             identification.
    86022  A                Platelet antibodies  ...........  ...........  ...........  ...........  ...........
    86023  A                Immunoglobulin       ...........  ...........  ...........  ...........  ...........
                             assay.
    86038  A                Antinuclear          ...........  ...........  ...........  ...........  ...........
                             antibodies.
    86039  A                Antinuclear          ...........  ...........  ...........  ...........  ...........
                             antibodies (ANA).
    86060  A                Antistreptolysin o,  ...........  ...........  ...........  ...........  ...........
                             titer.
    86063  A                Antistreptolysin o,  ...........  ...........  ...........  ...........  ...........
                             screen.
    86077  X                Physician blood             0343         0.45       $22.32       $12.16        $4.46
                             bank service.
    86078  X                Physician blood             0344         0.79       $39.18       $23.63        $7.84
                             bank service.
    86079  X                Physician blood             0344         0.79       $39.18       $23.63        $7.84
                             bank service.
    86140  A                C-reactive protein.  ...........  ...........  ...........  ...........  ...........
   *86146  A                Beta 2 glycoprotein  ...........  ...........  ...........  ...........  ...........
                             I antibody.
    86147  A                Cardiolipin          ...........  ...........  ...........  ...........  ...........
                             antibody.
    86148  A                Phospholipid         ...........  ...........  ...........  ...........  ...........
                             antibody.
    86155  A                Chemotaxis assay...  ...........  ...........  ...........  ...........  ...........
    86156  A                Cold agglutinin,     ...........  ...........  ...........  ...........  ...........
                             screen.
    86157  A                Cold agglutinin,     ...........  ...........  ...........  ...........  ...........
                             titer.
    86160  A                Complement, antigen  ...........  ...........  ...........  ...........  ...........
    86161  A                Complement/function  ...........  ...........  ...........  ...........  ...........
                             activity.
    86162  A                Complement, total    ...........  ...........  ...........  ...........  ...........
                             (CH50).
    86171  A                Complement           ...........  ...........  ...........  ...........  ...........
                             fixation, each.
    86185  A                Counterimmunoelectr  ...........  ...........  ...........  ...........  ...........
                             ophoresis.
    86215  A                Deoxyribonuclease,   ...........  ...........  ...........  ...........  ...........
                             antibody.
    86225  A                DNA antibody.......  ...........  ...........  ...........  ...........  ...........

[[Page 67928]]

 
    86226  A                DNA antibody,        ...........  ...........  ...........  ...........  ...........
                             single strand.
    86235  A                Nuclear antigen      ...........  ...........  ...........  ...........  ...........
                             antibody.
    86243  A                Fc receptor........  ...........  ...........  ...........  ...........  ...........
    86255  A                Fluorescent          ...........  ...........  ...........  ...........  ...........
                             antibody, screen.
    86256  A                Fluorescent          ...........  ...........  ...........  ...........  ...........
                             antibody, titer.
    86277  A                Growth hormone       ...........  ...........  ...........  ...........  ...........
                             antibody.
    86280  A                Hemagglutination     ...........  ...........  ...........  ...........  ...........
                             inhibition.
   *86294  A                Tumor antigen, qual  ...........  ...........  ...........  ...........  ...........
                             or semiquant.
   *86300  A                Tumor antigen,       ...........  ...........  ...........  ...........  ...........
                             quant; CA 15-3.
   *86301  A                Tumor antigen,       ...........  ...........  ...........  ...........  ...........
                             quant; CA 19-9.
   *86304  A                Tumor antigen,       ...........  ...........  ...........  ...........  ...........
                             quant; CA 125.
    86308  A                Heterophile          ...........  ...........  ...........  ...........  ...........
                             antibodies.
    86309  A                Heterophile          ...........  ...........  ...........  ...........  ...........
                             antibodies.
    86310  A                Heterophile          ...........  ...........  ...........  ...........  ...........
                             antibodies.
    86316  A                Immunoassay, tumor   ...........  ...........  ...........  ...........  ...........
                             antigen.
    86317  A                Immunoassay,infecti  ...........  ...........  ...........  ...........  ...........
                             ous agent.
    86318  A                Immunoassay,infecti  ...........  ...........  ...........  ...........  ...........
                             ous agent.
    86320  A                Serum                ...........  ...........  ...........  ...........  ...........
                             immunoelectrophore
                             sis.
    86325  A                Other                ...........  ...........  ...........  ...........  ...........
                             immunoelectrophore
                             sis.
    86327  A                Immunoelectrophores  ...........  ...........  ...........  ...........  ...........
                             is assay.
    86329  A                Immunodiffusion....  ...........  ...........  ...........  ...........  ...........
    86331  A                Immunodiffusion      ...........  ...........  ...........  ...........  ...........
                             ouchterlony.
    86332  A                Immune complex       ...........  ...........  ...........  ...........  ...........
                             assay.
    86334  A                Immunofixation       ...........  ...........  ...........  ...........  ...........
                             procedure.
    86337  A                Insulin antibodies.  ...........  ...........  ...........  ...........  ...........
    86340  A                Intrinsic factor     ...........  ...........  ...........  ...........  ...........
                             antibody.
    86341  A                Islet cell antibody  ...........  ...........  ...........  ...........  ...........
    86343  A                Leukocyte histamine  ...........  ...........  ...........  ...........  ...........
                             release.
    86344  A                Leukocyte            ...........  ...........  ...........  ...........  ...........
                             phagocytosis.
    86353  A                Lymphocyte           ...........  ...........  ...........  ...........  ...........
                             transformation.
    86359  A                T cells, total       ...........  ...........  ...........  ...........  ...........
                             count.
    86360  A                T cell, absolute     ...........  ...........  ...........  ...........  ...........
                             count/ratio.
    86361  A                T cell, absolute     ...........  ...........  ...........  ...........  ...........
                             count.
    86376  A                Microsomal antibody  ...........  ...........  ...........  ...........  ...........
    86378  A                Migration            ...........  ...........  ...........  ...........  ...........
                             inhibitory factor.
    86382  A                Neutralization       ...........  ...........  ...........  ...........  ...........
                             test, viral.
    86384  A                Nitroblue            ...........  ...........  ...........  ...........  ...........
                             tetrazolium dye.
    86403  A                Particle             ...........  ...........  ...........  ...........  ...........
                             agglutination test.
    86406  A                Particle             ...........  ...........  ...........  ...........  ...........
                             agglutination test.
    86430  A                Rheumatoid factor    ...........  ...........  ...........  ...........  ...........
                             test.
    86431  A                Rheumatoid factor,   ...........  ...........  ...........  ...........  ...........
                             quant.
    86485  X                Skin test, candida.         0341         0.13        $6.44        $3.67        $1.29
    86490  X                Coccidioidomycosis          0341         0.13        $6.44        $3.67        $1.29
                             skin test.
    86510  X                Histoplasmosis skin         0341         0.13        $6.44        $3.67        $1.29
                             test.
    86580  X                TB intradermal test         0341         0.13        $6.44        $3.67        $1.29
    86585  X                TB tine test.......         0341         0.13        $6.44        $3.67        $1.29
    86586  X                Skin test, unlisted         0341         0.13        $6.44        $3.67        $1.29
    86590  A                Streptokinase,       ...........  ...........  ...........  ...........  ...........
                             antibody.
    86592  A                Blood serology,      ...........  ...........  ...........  ...........  ...........
                             qualitative.
    86593  A                Blood serology,      ...........  ...........  ...........  ...........  ...........
                             quantitative.
    86602  A                Antinomyces          ...........  ...........  ...........  ...........  ...........
                             antibody.
    86603  A                Adenovirus antibody  ...........  ...........  ...........  ...........  ...........
    86606  A                Aspergillus          ...........  ...........  ...........  ...........  ...........
                             antibody.
    86609  A                Bacterium antibody.  ...........  ...........  ...........  ...........  ...........
   *86611  A                Bartonella antibody  ...........  ...........  ...........  ...........  ...........
    86612  A                Blastomyces          ...........  ...........  ...........  ...........  ...........
                             antibody.
    86615  A                Bordetella antibody  ...........  ...........  ...........  ...........  ...........
    86617  A                Lyme disease         ...........  ...........  ...........  ...........  ...........
                             antibody.
    86618  A                Lyme disease         ...........  ...........  ...........  ...........  ...........
                             antibody.
    86619  A                Borrelia antibody..  ...........  ...........  ...........  ...........  ...........
    86622  A                Brucella antibody..  ...........  ...........  ...........  ...........  ...........
    86625  A                Campylobacter        ...........  ...........  ...........  ...........  ...........
                             antibody.
    86628  A                Candida antibody...  ...........  ...........  ...........  ...........  ...........
    86631  A                Chlamydia antibody.  ...........  ...........  ...........  ...........  ...........
    86632  A                Chlamydia igm        ...........  ...........  ...........  ...........  ...........
                             antibody.
    86635  A                Coccidioides         ...........  ...........  ...........  ...........  ...........
                             antibody.
    86638  A                Q fever antibody...  ...........  ...........  ...........  ...........  ...........
    86641  A                Cryptococcus         ...........  ...........  ...........  ...........  ...........
                             antibody.
    86644  A                CMV antibody.......  ...........  ...........  ...........  ...........  ...........
    86645  A                CMV antibody, IgM..  ...........  ...........  ...........  ...........  ...........
    86648  A                Diphtheria antibody  ...........  ...........  ...........  ...........  ...........
    86651  A                Encephalitis         ...........  ...........  ...........  ...........  ...........
                             antibody.
    86652  A                Encephalitis         ...........  ...........  ...........  ...........  ...........
                             antibody.
    86653  A                Encephalitis         ...........  ...........  ...........  ...........  ...........
                             antibody.

[[Page 67929]]

 
    86654  A                Encephalitis         ...........  ...........  ...........  ...........  ...........
                             antibody.
    86658  A                Enterovirus          ...........  ...........  ...........  ...........  ...........
                             antibody.
    86663  A                Epstein-barr         ...........  ...........  ...........  ...........  ...........
                             antibody.
    86664  A                Epstein-barr         ...........  ...........  ...........  ...........  ...........
                             antibody.
    86665  A                Epstein-barr         ...........  ...........  ...........  ...........  ...........
                             antibody.
   *86666  A                Erlichia antibody..  ...........  ...........  ...........  ...........  ...........
    86668  A                Francisella          ...........  ...........  ...........  ...........  ...........
                             tularensis.
    86671  A                Fungus antibody....  ...........  ...........  ...........  ...........  ...........
    86674  A                Giardia lamblia      ...........  ...........  ...........  ...........  ...........
                             antibody.
    86677  A                Helicobacter pylori  ...........  ...........  ...........  ...........  ...........
    86682  A                Helminth antibody..  ...........  ...........  ...........  ...........  ...........
   *86683  A                Fecal hgb antibody.  ...........  ...........  ...........  ...........  ...........
    86684  A                Hemophilus           ...........  ...........  ...........  ...........  ...........
                             influenza.
    86687  A                Htlv-i antibody....  ...........  ...........  ...........  ...........  ...........
    86688  A                Htlv-ii antibody...  ...........  ...........  ...........  ...........  ...........
    86689  A                HTLV/HIV             ...........  ...........  ...........  ...........  ...........
                             confirmatory test.
    86692  A                Hepatitis, delta     ...........  ...........  ...........  ...........  ...........
                             agent.
   *86696  A                Herpes simplex type  ...........  ...........  ...........  ...........  ...........
                             2 antibody.
    86694  A                Herpes simplex test  ...........  ...........  ...........  ...........  ...........
    86695  A                Herpes simplex test  ...........  ...........  ...........  ...........  ...........
    86698  A                Histoplasma........  ...........  ...........  ...........  ...........  ...........
    86701  A                HIV-1..............  ...........  ...........  ...........  ...........  ...........
    86702  A                HIV-2..............  ...........  ...........  ...........  ...........  ...........
    86703  A                HIV-1/HIV-2, single  ...........  ...........  ...........  ...........  ...........
                             assay.
    86704  A                Hep b core           ...........  ...........  ...........  ...........  ...........
                             antibody, igg/igm.
    86705  A                Hep b core           ...........  ...........  ...........  ...........  ...........
                             antibody, igm.
    86706  A                Hep b surface        ...........  ...........  ...........  ...........  ...........
                             antibody.
    86707  A                Hep be antibody....  ...........  ...........  ...........  ...........  ...........
    86708  A                Hep a antibody, igg/ ...........  ...........  ...........  ...........  ...........
                             igm.
    86709  A                Hep a antibody, igm  ...........  ...........  ...........  ...........  ...........
    86710  A                Influenza virus      ...........  ...........  ...........  ...........  ...........
                             antibody.
    86713  A                Legionella antibody  ...........  ...........  ...........  ...........  ...........
    86717  A                Leishmania antibody  ...........  ...........  ...........  ...........  ...........
    86720  A                Leptospira antibody  ...........  ...........  ...........  ...........  ...........
    86723  A                Listeria             ...........  ...........  ...........  ...........  ...........
                             monocytogenes ab.
    86727  A                Lymph                ...........  ...........  ...........  ...........  ...........
                             choriomeningitis
                             ab.
    86729  A                Lympho venereum      ...........  ...........  ...........  ...........  ...........
                             antibody.
    86732  A                Mucormycosis         ...........  ...........  ...........  ...........  ...........
                             antibody.
    86735  A                Mumps antibody.....  ...........  ...........  ...........  ...........  ...........
    86738  A                Mycoplasma antibody  ...........  ...........  ...........  ...........  ...........
    86741  A                Neisseria            ...........  ...........  ...........  ...........  ...........
                             meningitidis.
    86744  A                Nocardia antibody..  ...........  ...........  ...........  ...........  ...........
    86747  A                Parvovirus antibody  ...........  ...........  ...........  ...........  ...........
    86750  A                Malaria antibody...  ...........  ...........  ...........  ...........  ...........
    86753  A                Protozoa antibody    ...........  ...........  ...........  ...........  ...........
                             nos.
    86756  A                Respiratory virus    ...........  ...........  ...........  ...........  ...........
                             antibody.
   *86757  A                Rickettsia antibody  ...........  ...........  ...........  ...........  ...........
    86759  A                Rotavirus antibody.  ...........  ...........  ...........  ...........  ...........
    86762  A                Rubella antibody...  ...........  ...........  ...........  ...........  ...........
    86765  A                Rubeola antibody...  ...........  ...........  ...........  ...........  ...........
    86768  A                Salmonella antibody  ...........  ...........  ...........  ...........  ...........
    86771  A                Shigella antibody..  ...........  ...........  ...........  ...........  ...........
    86774  A                Tetanus antibody...  ...........  ...........  ...........  ...........  ...........
    86777  A                Toxoplasma antibody  ...........  ...........  ...........  ...........  ...........
    86778  A                Toxoplasma           ...........  ...........  ...........  ...........  ...........
                             antibody, igm.
    86781  A                Treponema pallidum,  ...........  ...........  ...........  ...........  ...........
                             confirm.
    86784  A                Trichinella          ...........  ...........  ...........  ...........  ...........
                             antibody.
    86787  A                Varicella-zoster     ...........  ...........  ...........  ...........  ...........
                             antibody.
    86790  A                Virus antibody nos.  ...........  ...........  ...........  ...........  ...........
    86793  A                Yersinia antibody..  ...........  ...........  ...........  ...........  ...........
    86800  A                Thyroglobulin        ...........  ...........  ...........  ...........  ...........
                             antibody.
    86803  A                Hepatitis c ab test  ...........  ...........  ...........  ...........  ...........
    86804  A                Hep c ab test,       ...........  ...........  ...........  ...........  ...........
                             confirm.
    86805  A                Lymphocytotoxicity   ...........  ...........  ...........  ...........  ...........
                             assay.
    86806  A                Lymphocytotoxicity   ...........  ...........  ...........  ...........  ...........
                             assay.
    86807  A                Cytotoxic antibody   ...........  ...........  ...........  ...........  ...........
                             screening.
    86808  A                Cytotoxic antibody   ...........  ...........  ...........  ...........  ...........
                             screening.
    86812  A                HLA typing, A, B,    ...........  ...........  ...........  ...........  ...........
                             or C.
    86813  A                HLA typing, A, B,    ...........  ...........  ...........  ...........  ...........
                             or C.
    86816  A                HLA typing, DR/DQ..  ...........  ...........  ...........  ...........  ...........
    86817  A                HLA typing, DR/DQ..  ...........  ...........  ...........  ...........  ...........
    86821  A                Lymphocyte culture,  ...........  ...........  ...........  ...........  ...........
                             mixed.
    86822  A                Lymphocyte culture,  ...........  ...........  ...........  ...........  ...........
                             primed.
    86849  X                Immunology                  0349         0.48       $23.65        $4.73        $4.73
                             procedure.

[[Page 67930]]

 
    86850  X                RBC antibody screen         0346         0.51       $25.49       $12.03        $5.10
    86860  X                RBC antibody                0345         0.22       $10.92        $5.37        $2.18
                             elution.
    86870  X                RBC antibody                0347         0.84       $41.90       $20.13        $8.38
                             identification.
    86880  A                Coombs test........  ...........  ...........  ...........  ...........  ...........
    86885  A                Coombs test........  ...........  ...........  ...........  ...........  ...........
    86886  A                Coombs test........  ...........  ...........  ...........  ...........  ...........
    86890  X                Autologous blood            0347         0.84       $41.90       $20.13        $8.38
                             process.
    86891  X                Autologous blood,           0345         0.22       $10.92        $5.37        $2.18
                             op salvage.
    86900  A                Blood typing, ABO..  ...........  ...........  ...........  ...........  ...........
    86901  X                Blood typing, Rh            0345         0.22       $10.92        $5.37        $2.18
                             (D).
    86903  A                Blood typing,        ...........  ...........  ...........  ...........  ...........
                             antigen screen.
    86904  A                Blood typing,        ...........  ...........  ...........  ...........  ...........
                             patient serum.
    86905  A                Blood typing, RBC    ...........  ...........  ...........  ...........  ...........
                             antigens.
    86906  A                Blood typing, Rh     ...........  ...........  ...........  ...........  ...........
                             phenotype.
    86910  E                Blood typing,        ...........  ...........  ...........  ...........  ...........
                             paternity test.
    86911  E                Blood typing,        ...........  ...........  ...........  ...........  ...........
                             antigen system.
    86915  X                Bone marrow/stem            0347         0.84       $41.90       $20.13        $8.38
                             cell prep.
    86920  X                Compatibility test.         0346         0.51       $25.49       $12.03        $5.10
    86921  X                Compatibility test.         0346         0.51       $25.49       $12.03        $5.10
    86922  X                Compatibility test.         0346         0.51       $25.49       $12.03        $5.10
    86927  X                Plasma, fresh               0347         0.84       $41.90       $20.13        $8.38
                             frozen.
    86930  X                Frozen blood prep..         0347         0.84       $41.90       $20.13        $8.38
    86931  X                Frozen blood thaw..         0347         0.84       $41.90       $20.13        $8.38
    86932  X                Frozen blood freeze/        0347         0.84       $41.90       $20.13        $8.38
                             thaw.
    86940  A                Hemolysins/          ...........  ...........  ...........  ...........  ...........
                             agglutinins, auto.
    86941  A                Hemolysins/          ...........  ...........  ...........  ...........  ...........
                             agglutinins.
    86945  X                Blood product/              0346         0.51       $25.49       $12.03        $5.10
                             irradiation.
    86950  X                Leukacyte                   0347         0.84       $41.90       $20.13        $8.38
                             transfusion.
    86965  X                Pooling blood               0346         0.51       $25.49       $12.03        $5.10
                             platelets.
    86970  X                RBC pretreatment...         0345         0.22       $10.92        $5.37        $2.18
    86971  X                RBC pretreatment...         0346         0.51       $25.49       $12.03        $5.10
    86972  X                RBC pretreatment...         0345         0.22       $10.92        $5.37        $2.18
    86975  X                RBC pretreatment,           0346         0.51       $25.49       $12.03        $5.10
                             serum.
    86976  X                RBC pretreatment,           0347         0.84       $41.90       $20.13        $8.38
                             serum.
    86977  X                RBC pretreatment,           0346         0.51       $25.49       $12.03        $5.10
                             serum.
    86978  X                RBC pretreatment,           0345         0.22       $10.92        $5.37        $2.18
                             serum.
    86985  X                Split blood or              0347         0.84       $41.90       $20.13        $8.38
                             products.
    86999  X                Transfusion                 0346         0.51       $25.49       $12.03        $5.10
                             procedure.
    87001  A                Small animal         ...........  ...........  ...........  ...........  ...........
                             inoculation.
    87003  A                Small animal         ...........  ...........  ...........  ...........  ...........
                             inoculation.
    87015  A                Specimen             ...........  ...........  ...........  ...........  ...........
                             concentration.
    87040  A                Blood culture for    ...........  ...........  ...........  ...........  ...........
                             bacteria.
    87045  A                Stool culture for    ...........  ...........  ...........  ...........  ...........
                             bacteria.
   *87046  A                Stool culture for    ...........  ...........  ...........  ...........  ...........
                             bacteria.
   87060D  A                Nose/throat          ...........  ...........  ...........  ...........  ...........
                             culture, bact.
    87070  A                Culture specimen,    ...........  ...........  ...........  ...........  ...........
                             bacteria.
   *87071  A                Culture specimen,    ...........  ...........  ...........  ...........  ...........
                             bacteria.
   87072D  A                Culture of specimen  ...........  ...........  ...........  ...........  ...........
                             by kit.
   *87073  A                Culture specimen,    ...........  ...........  ...........  ...........  ...........
                             bacteria.
    87075  A                Culture specimen,    ...........  ...........  ...........  ...........  ...........
                             bacteria.
    87076  A                Bacteria             ...........  ...........  ...........  ...........  ...........
                             identification.
   *87077  A                Culture specimen,    ...........  ...........  ...........  ...........  ...........
                             bacteria.
    87081  A                Bacteria culture     ...........  ...........  ...........  ...........  ...........
                             screen.
    87082  A                Culture of specimen  ...........  ...........  ...........  ...........  ...........
                             by kit.
   87083D  A                Culture of specimen  ...........  ...........  ...........  ...........  ...........
                             by kit.
    87084  A                Culture of specimen  ...........  ...........  ...........  ...........  ...........
                             by kit.
   87085D  A                Culture of specimen  ...........  ...........  ...........  ...........  ...........
                             by kit.
    87086  A                Urine culture/       ...........  ...........  ...........  ...........  ...........
                             colony count.
   87087D  A                Urine bacteria       ...........  ...........  ...........  ...........  ...........
                             culture.
    87088  A                Urine bacteria       ...........  ...........  ...........  ...........  ...........
                             culture.
    87101  A                Skin fungus culture  ...........  ...........  ...........  ...........  ...........
    87102  A                Fungus isolation     ...........  ...........  ...........  ...........  ...........
                             culture.
    87103  A                Blood fungus         ...........  ...........  ...........  ...........  ...........
                             culture.
    87106  A                Fungus               ...........  ...........  ...........  ...........  ...........
                             identification.
   *87107  A                Culture specimen,    ...........  ...........  ...........  ...........  ...........
                             fungi.
    87109  A                Mycoplasma culture.  ...........  ...........  ...........  ...........  ...........
    87110  A                Culture, chlamydia.  ...........  ...........  ...........  ...........  ...........
    87116  A                Mycobacteria         ...........  ...........  ...........  ...........  ...........
                             culture.
   87117D  A                Mycobacteria         ...........  ...........  ...........  ...........  ...........
                             culture.
    87118  A                Mycobacteria         ...........  ...........  ...........  ...........  ...........
                             identification.
    87140  A                Culture typing,      ...........  ...........  ...........  ...........  ...........
                             fluorescent.
    87143  A                Culture typing, GLC  ...........  ...........  ...........  ...........  ...........
                             method.
   87145D  A                Culture typing,      ...........  ...........  ...........  ...........  ...........
                             phage method.
    87147  A                Culture typing,      ...........  ...........  ...........  ...........  ...........
                             serologic.

[[Page 67931]]

 
   *87149  A                Culture typing.....  ...........  ...........  ...........  ...........  ...........
   87151D  A                Culture typing,      ...........  ...........  ...........  ...........  ...........
                             serologic.
   *87152  A                Culture typing.....  ...........  ...........  ...........  ...........  ...........
   87155D  A                Culture typing,      ...........  ...........  ...........  ...........  ...........
                             precipitin.
    87158  A                Culture typing,      ...........  ...........  ...........  ...........  ...........
                             added method.
   87163D  A                Special              ...........  ...........  ...........  ...........  ...........
                             microbiology
                             culture.
    87164  A                Dark field           ...........  ...........  ...........  ...........  ...........
                             examination.
    87166  A                Dark field           ...........  ...........  ...........  ...........  ...........
                             examination.
   *87168  A                Macroscopic exam,    ...........  ...........  ...........  ...........  ...........
                             arthropod.
   *87169  A                Macroscopic exam,    ...........  ...........  ...........  ...........  ...........
                             arthropod.
   *87172  A                Pinworm exam.......  ...........  ...........  ...........  ...........  ...........
   87174D  A                Endotoxin,           ...........  ...........  ...........  ...........  ...........
                             bacterial.
   87175D  A                Assay, endotoxin,    ...........  ...........  ...........  ...........  ...........
                             bacterial.
    87176  A                Endotoxin,           ...........  ...........  ...........  ...........  ...........
                             bacterial.
    87177  A                Ova and parasites    ...........  ...........  ...........  ...........  ...........
                             smears.
    87181  A                Antibiotic           ...........  ...........  ...........  ...........  ...........
                             sensitivity, each.
    87184  A                Antibiotic           ...........  ...........  ...........  ...........  ...........
                             sensitivity, each.
   *87185  A                Susceptibility       ...........  ...........  ...........  ...........  ...........
                             study.
    87186  A                Antibiotic           ...........  ...........  ...........  ...........  ...........
                             sensitivity, MIC.
    87187  A                Antibiotic           ...........  ...........  ...........  ...........  ...........
                             sensitivity, MBC.
    87188  A                Antibiotic           ...........  ...........  ...........  ...........  ...........
                             sensitivity, each.
    87190  A                TB antibiotic        ...........  ...........  ...........  ...........  ...........
                             sensitivity.
   87192D  A                Antibiotic           ...........  ...........  ...........  ...........  ...........
                             sensitivity, each.
    87197  A                Bactericidal level,  ...........  ...........  ...........  ...........  ...........
                             serum.
    87205  A                Smear, stain &       ...........  ...........  ...........  ...........  ...........
                             interpret.
    87206  A                Smear, stain &       ...........  ...........  ...........  ...........  ...........
                             interpret.
    87207  A                Smear, stain &       ...........  ...........  ...........  ...........  ...........
                             interpret.
   87208D  A                Smear, stain &       ...........  ...........  ...........  ...........  ...........
                             interpret.
    87210  A                Smear, stain &       ...........  ...........  ...........  ...........  ...........
                             interpret.
   87211D  A                Smear, stain &       ...........  ...........  ...........  ...........  ...........
                             interpret.
    87220  A                Tissue exam for      ...........  ...........  ...........  ...........  ...........
                             fungi.
    87230  A                Assay, toxin or      ...........  ...........  ...........  ...........  ...........
                             antitoxin.
    87250  A                Virus inoculation    ...........  ...........  ...........  ...........  ...........
                             for test.
    87252  A                Virus inoculation    ...........  ...........  ...........  ...........  ...........
                             for test.
    87253  A                Virus inoculation    ...........  ...........  ...........  ...........  ...........
                             for test.
   *87254  A                Virus isolation....  ...........  ...........  ...........  ...........  ...........
    87260  A                Adenovirus ag, dfa.  ...........  ...........  ...........  ...........  ...........
    87265  A                Pertussis ag, dfa..  ...........  ...........  ...........  ...........  ...........
    87270  A                Chylmd trach ag,     ...........  ...........  ...........  ...........  ...........
                             dfa.
    87272  A                Cryptosporidum ag,   ...........  ...........  ...........  ...........  ...........
                             dfa.
   *87273  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
    87274  A                Herpes simplex ag,   ...........  ...........  ...........  ...........  ...........
                             dfa.
   *87275  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
    87276  A                Influenza ag, dfa..  ...........  ...........  ...........  ...........  ...........
   *87277  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
    87278  A                Legion pneumo ag,    ...........  ...........  ...........  ...........  ...........
                             dfa.
   *87279  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
    87280  A                Resp syncytial ag,   ...........  ...........  ...........  ...........  ...........
                             dfa.
   *87281  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
   *87283  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
    87285  A                Trepon pallidum ag,  ...........  ...........  ...........  ...........  ...........
                             dfa.
    87290  A                Varicella ag, dfa..  ...........  ...........  ...........  ...........  ...........
    87299  A                Ag detection nos,    ...........  ...........  ...........  ...........  ...........
                             dfa.
   *87300  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
    87301  A                Adenovirus ag, eia.  ...........  ...........  ...........  ...........  ...........
    87320  A                Chylmd trach ag,     ...........  ...........  ...........  ...........  ...........
                             eia.
    87324  A                Clostridium ag, eia  ...........  ...........  ...........  ...........  ...........
   *87327  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
    87328  A                Cryptospor ag, eia.  ...........  ...........  ...........  ...........  ...........
    87332  A                Cytomegalovirus ag,  ...........  ...........  ...........  ...........  ...........
                             eia.
    87335  A                E coli 0157 ag, eia  ...........  ...........  ...........  ...........  ...........
   *87336  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
   *87337  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
    87338  A                Hpylori, stool, eia  ...........  ...........  ...........  ...........  ...........
   *87339  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
    87340  A                Hepatitis b surface  ...........  ...........  ...........  ...........  ...........
                             ag, eia.
   *87341  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
    87350  A                Hepatitis be ag,     ...........  ...........  ...........  ...........  ...........
                             eia.
    87380  A                Hepatitis delta ag,  ...........  ...........  ...........  ...........  ...........
                             eia.
    87385  A                Histoplasma capsul   ...........  ...........  ...........  ...........  ...........
                             ag, eia.
    87390  A                Hiv-1 ag, eia......  ...........  ...........  ...........  ...........  ...........
    87391  A                Hiv-2 ag, eia......  ...........  ...........  ...........  ...........  ...........
   *87400  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
    87420  A                Resp syncytial ag,   ...........  ...........  ...........  ...........  ...........
                             eia.

[[Page 67932]]

 
    87425  A                Rotavirus ag, eia..  ...........  ...........  ...........  ...........  ...........
   *87427  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
    87430  A                Strep a ag, eia....  ...........  ...........  ...........  ...........  ...........
    87449  A                Ag detect nos, eia,  ...........  ...........  ...........  ...........  ...........
                             mult.
    87450  A                Ag detect nos, eia,  ...........  ...........  ...........  ...........  ...........
                             single.
   *87451  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
    87470  A                Bartonella, dna,     ...........  ...........  ...........  ...........  ...........
                             dir probe.
    87471  A                Bartonella, dna,     ...........  ...........  ...........  ...........  ...........
                             amp probe.
    87472  A                Bartonella, dna,     ...........  ...........  ...........  ...........  ...........
                             quant.
    87475  A                Lyme dis, dna, dir   ...........  ...........  ...........  ...........  ...........
                             probe.
    87476  A                Lyme dis, dna, amp   ...........  ...........  ...........  ...........  ...........
                             probe.
    87477  A                Lyme dis, dna,       ...........  ...........  ...........  ...........  ...........
                             quant.
    87480  A                Candida, dna, dir    ...........  ...........  ...........  ...........  ...........
                             probe.
    87481  A                Candida, dna, amp    ...........  ...........  ...........  ...........  ...........
                             probe.
    87482  A                Candida, dna, quant  ...........  ...........  ...........  ...........  ...........
    87485  A                Chylmd pneum, dna,   ...........  ...........  ...........  ...........  ...........
                             dir probe.
    87486  A                Chylmd pneum, dna,   ...........  ...........  ...........  ...........  ...........
                             amp probe.
    87487  A                Chylmd pneum, dna,   ...........  ...........  ...........  ...........  ...........
                             quant.
    87490  A                Chylmd trach, dna,   ...........  ...........  ...........  ...........  ...........
                             dir probe.
    87491  A                Chylmd trach, dna,   ...........  ...........  ...........  ...........  ...........
                             amp probe.
    87492  A                Chylmd trach, dna,   ...........  ...........  ...........  ...........  ...........
                             quant.
    87495  A                Cytomeg, dna, dir    ...........  ...........  ...........  ...........  ...........
                             probe.
    87496  A                Cytomeg, dna, amp    ...........  ...........  ...........  ...........  ...........
                             probe.
    87497  A                Cytomeg, dna, quant  ...........  ...........  ...........  ...........  ...........
    87510  A                Gardner vag, dna,    ...........  ...........  ...........  ...........  ...........
                             dir probe.
    87511  A                Gardner vag, dna,    ...........  ...........  ...........  ...........  ...........
                             amp probe.
    87512  A                Gardner vag, dna,    ...........  ...........  ...........  ...........  ...........
                             quant.
    87515  A                Hepatitis b, dna,    ...........  ...........  ...........  ...........  ...........
                             dir probe.
    87516  A                Hepatitis b , dna,   ...........  ...........  ...........  ...........  ...........
                             amp probe.
    87517  A                Hepatitis b , dna,   ...........  ...........  ...........  ...........  ...........
                             quant.
    87520  A                Hepatitis c , rna,   ...........  ...........  ...........  ...........  ...........
                             dir probe.
    87521  A                Hepatitis c , rna,   ...........  ...........  ...........  ...........  ...........
                             amp probe.
    87522  A                Hepatitis c, rna,    ...........  ...........  ...........  ...........  ...........
                             quant.
    87525  A                Hepatitis g , dna,   ...........  ...........  ...........  ...........  ...........
                             dir probe.
    87526  A                Hepatitis g, dna,    ...........  ...........  ...........  ...........  ...........
                             amp probe.
    87527  A                Hepatitis g, dna,    ...........  ...........  ...........  ...........  ...........
                             quant.
    87528  A                Hsv, dna, dir probe  ...........  ...........  ...........  ...........  ...........
    87529  A                Hsv, dna, amp probe  ...........  ...........  ...........  ...........  ...........
    87530  A                Hsv, dna, quant....  ...........  ...........  ...........  ...........  ...........
    87531  A                Hhv-6, dna, dir      ...........  ...........  ...........  ...........  ...........
                             probe.
    87532  A                Hhv-6, dna, amp      ...........  ...........  ...........  ...........  ...........
                             probe.
    87533  A                Hhv-6, dna, quant..  ...........  ...........  ...........  ...........  ...........
    87534  A                Hiv-1, dna, dir      ...........  ...........  ...........  ...........  ...........
                             probe.
    87535  A                Hiv-1, dna, amp      ...........  ...........  ...........  ...........  ...........
                             probe.
    87536  A                Hiv-1, dna, quant..  ...........  ...........  ...........  ...........  ...........
    87537  A                Hiv-2, dna, dir      ...........  ...........  ...........  ...........  ...........
                             probe.
    87538  A                Hiv-2, dna, amp      ...........  ...........  ...........  ...........  ...........
                             probe.
    87539  A                Hiv-2, dna, quant..  ...........  ...........  ...........  ...........  ...........
    87540  A                Legion pneumo, dna,  ...........  ...........  ...........  ...........  ...........
                             dir prob.
    87541  A                Legion pneumo, dna,  ...........  ...........  ...........  ...........  ...........
                             amp prob.
    87542  A                Legion pneumo, dna,  ...........  ...........  ...........  ...........  ...........
                             quant.
    87550  A                Mycobacteria, dna,   ...........  ...........  ...........  ...........  ...........
                             dir probe.
    87551  A                Mycobacteria, dna,   ...........  ...........  ...........  ...........  ...........
                             amp probe.
    87552  A                Mycobacteria, dna,   ...........  ...........  ...........  ...........  ...........
                             quant.
    87555  A                M.tuberculo, dna,    ...........  ...........  ...........  ...........  ...........
                             dir probe.
    87556  A                M.tuberculo, dna,    ...........  ...........  ...........  ...........  ...........
                             amp probe.
    87557  A                M.tuberculo, dna,    ...........  ...........  ...........  ...........  ...........
                             quant.
    87560  A                M.avium-intra, dna,  ...........  ...........  ...........  ...........  ...........
                             dir prob.
    87561  A                M.avium-intra, dna,  ...........  ...........  ...........  ...........  ...........
                             amp prob.
    87562  A                M.avium-intra, dna,  ...........  ...........  ...........  ...........  ...........
                             quant.
    87580  A                M.pneumon, dna, dir  ...........  ...........  ...........  ...........  ...........
                             probe.
    87581  A                M.pneumon, dna, amp  ...........  ...........  ...........  ...........  ...........
                             probe.
    87582  A                M.pneumon, dna,      ...........  ...........  ...........  ...........  ...........
                             quant.
    87590  A                N.gonorrhoeae, dna,  ...........  ...........  ...........  ...........  ...........
                             dir prob.
    87591  A                N.gonorrhoeae, dna,  ...........  ...........  ...........  ...........  ...........
                             amp prob.
    87592  A                N.gonorrhoeae, dna,  ...........  ...........  ...........  ...........  ...........
                             quant.
    87620  A                Hpv, dna, dir probe  ...........  ...........  ...........  ...........  ...........
    87621  A                Hpv, dna, amp probe  ...........  ...........  ...........  ...........  ...........
    87622  A                Hpv, dna, quant....  ...........  ...........  ...........  ...........  ...........
    87650  A                Strep a, dna, dir    ...........  ...........  ...........  ...........  ...........
                             probe.
    87651  A                Strep a, dna, amp    ...........  ...........  ...........  ...........  ...........
                             probe.
    87652  A                Strep a, dna, quant  ...........  ...........  ...........  ...........  ...........
    87797  A                Detect agent nos,    ...........  ...........  ...........  ...........  ...........
                             dna, dir.
    87798  A                Detect agent nos,    ...........  ...........  ...........  ...........  ...........
                             dna, amp.

[[Page 67933]]

 
    87799  A                Detect agent nos,    ...........  ...........  ...........  ...........  ...........
                             dna, quant.
   *87800  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
   *87801  A                Identify infectious  ...........  ...........  ...........  ...........  ...........
                             agent.
    87810  A                Chylmd trach assay   ...........  ...........  ...........  ...........  ...........
                             w/optic.
    87850  A                N. gonorrhoeae       ...........  ...........  ...........  ...........  ...........
                             assay w/optic.
    87880  A                Strep a assay w/     ...........  ...........  ...........  ...........  ...........
                             optic.
    87899  A                Agent nos assay w/   ...........  ...........  ...........  ...........  ...........
                             optic.
   *87901  A                Infectious agent     ...........  ...........  ...........  ...........  ...........
                             genotype.
   *87903  A                Infectious agent     ...........  ...........  ...........  ...........  ...........
                             phenotype.
   *87904  A                Infectious agent     ...........  ...........  ...........  ...........  ...........
                             phenotype.
    87999  X                Microbiology                0349         0.48       $23.65        $4.73        $4.73
                             procedure.
    88000  E                Autopsy (necropsy),  ...........  ...........  ...........  ...........  ...........
                             gross.
    88005  E                Autopsy (necropsy),  ...........  ...........  ...........  ...........  ...........
                             gross.
    88007  E                Autopsy (necropsy),  ...........  ...........  ...........  ...........  ...........
                             gross.
    88012  E                Autopsy (necropsy),  ...........  ...........  ...........  ...........  ...........
                             gross.
    88014  E                Autopsy (necropsy),  ...........  ...........  ...........  ...........  ...........
                             gross.
    88016  E                Autopsy (necropsy),  ...........  ...........  ...........  ...........  ...........
                             gross.
    88020  E                Autopsy (necropsy),  ...........  ...........  ...........  ...........  ...........
                             complete.
    88025  E                Autopsy (necropsy),  ...........  ...........  ...........  ...........  ...........
                             complete.
    88027  E                Autopsy (necropsy),  ...........  ...........  ...........  ...........  ...........
                             complete.
    88028  E                Autopsy (necropsy),  ...........  ...........  ...........  ...........  ...........
                             complete.
    88029  E                Autopsy (necropsy),  ...........  ...........  ...........  ...........  ...........
                             complete.
    88036  E                Limited autopsy....  ...........  ...........  ...........  ...........  ...........
    88037  E                Limited autopsy....  ...........  ...........  ...........  ...........  ...........
    88040  E                Forensic autopsy     ...........  ...........  ...........  ...........  ...........
                             (necropsy).
    88045  E                Coroner's autopsy    ...........  ...........  ...........  ...........  ...........
                             (necropsy).
    88099  E                Necropsy (autopsy)   ...........  ...........  ...........  ...........  ...........
                             procedure.
    88104  X                Cytopathology,              0343         0.45       $22.32       $12.16        $4.46
                             fluids.
    88106  X                Cytopathology,              0343         0.45       $22.32       $12.16        $4.46
                             fluids.
    88107  X                Cytopathology,              0343         0.45       $22.32       $12.16        $4.46
                             fluids.
    88108  X                Cytopath,                   0343         0.45       $22.32       $12.16        $4.46
                             concentrate tech.
    88125  X                Forensic                    0343         0.45       $22.32       $12.16        $4.46
                             cytopathology.
    88130  A                Sex chromatin        ...........  ...........  ...........  ...........  ...........
                             identification.
    88140  A                Sex chromatin        ...........  ...........  ...........  ...........  ...........
                             identification.
    88141  N                Cytopath, c/v,       ...........  ...........  ...........  ...........  ...........
                             interpret.
    88142  A                Cytopath, c/v, thin  ...........  ...........  ...........  ...........  ...........
                             layer.
    88143  A                Cytopath c/v thin    ...........  ...........  ...........  ...........  ...........
                             layer redo.
    88144  A                Cytopath, c/v thin   ...........  ...........  ...........  ...........  ...........
                             lyr redo.
    88145  A                Cytopath, c/v thin   ...........  ...........  ...........  ...........  ...........
                             lyr sel.
    88147  A                Cytopath, c/v,       ...........  ...........  ...........  ...........  ...........
                             automated.
    88148  A                Cytopath, c/v, auto  ...........  ...........  ...........  ...........  ...........
                             rescreen.
    88150  A                Cytopath, c/v,       ...........  ...........  ...........  ...........  ...........
                             manual.
    88152  A                Cytopath, c/v, auto  ...........  ...........  ...........  ...........  ...........
                             redo.
    88153  A                Cytopath, c/v, redo  ...........  ...........  ...........  ...........  ...........
    88154  A                Cytopath, c/v,       ...........  ...........  ...........  ...........  ...........
                             select.
    88155  A                Cytopath, c/v,       ...........  ...........  ...........  ...........  ...........
                             index add-on.
    88160  X                Cytopath smear,             0342         0.26       $12.90        $8.03        $2.58
                             other source.
    88161  X                Cytopath smear,             0343         0.45       $22.32       $12.16        $4.46
                             other source.
    88162  X                Cytopath smear,             0343         0.45       $22.32       $12.16        $4.46
                             other source.
    88164  A                Cytopath tbs, c/v,   ...........  ...........  ...........  ...........  ...........
                             manual.
    88165  A                Cytopath tbs, c/v,   ...........  ...........  ...........  ...........  ...........
                             redo.
    88166  A                Cytopath tbs, c/v,   ...........  ...........  ...........  ...........  ...........
                             auto redo.
    88167  A                Cytopath tbs, c/v,   ...........  ...........  ...........  ...........  ...........
                             select.
    88170  T                Fine needle                 0002         0.62       $30.75       $17.66        $6.15
                             aspiration.
    88171  T                Fine needle                 0002         0.62       $30.75       $17.66        $6.15
                             aspiration.
    88172  X                Evaluation of smear         0343         0.45       $22.32       $12.16        $4.46
    88173  X                Interpretation of           0343         0.45       $22.32       $12.16        $4.46
                             smear.
    88180  X                Cell marker study..         0344         0.79       $39.18       $23.63        $7.84
    88182  X                Cell marker study..         0344         0.79       $39.18       $23.63        $7.84
    88199  X                Cytopathology               0349         0.48       $23.65        $4.73        $4.73
                             procedure.
    88230  A                Tissue culture,      ...........  ...........  ...........  ...........  ...........
                             lymphocyte.
    88233  A                Tissue culture,      ...........  ...........  ...........  ...........  ...........
                             skin/biopsy.
    88235  A                Tissue culture,      ...........  ...........  ...........  ...........  ...........
                             placenta.
    88237  A                Tissue culture,      ...........  ...........  ...........  ...........  ...........
                             bone marrow.
    88239  A                Tissue culture,      ...........  ...........  ...........  ...........  ...........
                             tumor.
    88240  A                Cell cryopreserve/   ...........  ...........  ...........  ...........  ...........
                             storage.
    88241  A                Frozen cell          ...........  ...........  ...........  ...........  ...........
                             preparation.
    88245  A                Chromosome           ...........  ...........  ...........  ...........  ...........
                             analysis, 20-25.
    88248  A                Chromosome           ...........  ...........  ...........  ...........  ...........
                             analysis, 50-100.
    88249  A                Chromosome           ...........  ...........  ...........  ...........  ...........
                             analysis, 100.
    88261  A                Chromosome           ...........  ...........  ...........  ...........  ...........
                             analysis, 5.
    88262  A                Chromosome           ...........  ...........  ...........  ...........  ...........
                             analysis, 15-20.
    88263  A                Chromosome           ...........  ...........  ...........  ...........  ...........
                             analysis, 45.
    88264  A                Chromosome           ...........  ...........  ...........  ...........  ...........
                             analysis, 20-25.

[[Page 67934]]

 
    88267  A                Chromosome analys,   ...........  ...........  ...........  ...........  ...........
                             placenta.
    88269  A                Chromosome analys,   ...........  ...........  ...........  ...........  ...........
                             amniotic.
    88271  A                Cytogenetics, dna    ...........  ...........  ...........  ...........  ...........
                             probe.
    88272  A                Cytogenetics, 3-5..  ...........  ...........  ...........  ...........  ...........
    88273  A                Cytogenetics, 10-30  ...........  ...........  ...........  ...........  ...........
    88274  A                Cytogenetics, 25-99  ...........  ...........  ...........  ...........  ...........
    88275  A                Cytogenetics, 100-   ...........  ...........  ...........  ...........  ...........
                             300.
    88280  A                Chromosome           ...........  ...........  ...........  ...........  ...........
                             karyotype study.
    88283  A                Chromosome banding   ...........  ...........  ...........  ...........  ...........
                             study.
    88285  A                Chromosome count,    ...........  ...........  ...........  ...........  ...........
                             additional.
    88289  A                Chromosome study,    ...........  ...........  ...........  ...........  ...........
                             additional.
    88291  A                Cyto/molecular       ...........  ...........  ...........  ...........  ...........
                             report.
    88299  X                Cytogenetic study..         0342         0.26       $12.90        $8.03        $2.58
    88300  X                Surgical path,              0342         0.26       $12.90        $8.03        $2.58
                             gross.
    88302  X                Tissue exam by              0342         0.26       $12.90        $8.03        $2.58
                             pathologist.
    88304  X                Tissue exam by              0343         0.45       $22.32       $12.16        $4.46
                             pathologist.
    88305  X                Tissue exam by              0343         0.45       $22.32       $12.16        $4.46
                             pathologist.
    88307  X                Tissue exam by              0344         0.79       $39.18       $23.63        $7.84
                             pathologist.
    88309  X                Tissue exam by              0344         0.79       $39.18       $23.63        $7.84
                             pathologist.
    88311  X                Decalcify tissue...         0342         0.26       $12.90        $8.03        $2.58
    88312  X                Special stains.....         0343         0.45       $22.32       $12.16        $4.46
    88313  X                Special stains.....         0342         0.26       $12.90        $8.03        $2.58
    88314  X                Histochemical stain         0343         0.45       $22.32       $12.16        $4.46
    88318  X                Chemical                    0343         0.45       $22.32       $12.16        $4.46
                             histochemistry.
    88319  X                Enzyme                      0342         0.26       $12.90        $8.03        $2.58
                             histochemistry.
    88321  X                Microslide                  0342         0.26       $12.90        $8.03        $2.58
                             consultation.
    88323  X                Microslide                  0343         0.45       $22.32       $12.16        $4.46
                             consultation.
    88325  X                Comprehensive               0343         0.45       $22.32       $12.16        $4.46
                             review of data.
    88329  X                Pathology consult           0343         0.45       $22.32       $12.16        $4.46
                             in surgery.
    88331  X                Pathology consult           0343         0.45       $22.32       $12.16        $4.46
                             in surgery.
    88332  X                Pathology consult           0343         0.45       $22.32       $12.16        $4.46
                             in surgery.
    88342  X                Immunocytochemistry         0344         0.79       $39.18       $23.63        $7.84
    88346  X                Immunofluorescent           0343         0.45       $22.32       $12.16        $4.46
                             study.
    88347  X                Immunofluorescent           0344         0.79       $39.18       $23.63        $7.84
                             study.
    88348  X                Electron microscopy         0344         0.79       $39.18       $23.63        $7.84
    88349  X                Scanning electron           0344         0.79       $39.18       $23.63        $7.84
                             microscopy.
    88355  X                Analysis, skeletal          0344         0.79       $39.18       $23.63        $7.84
                             muscle.
    88356  X                Analysis, nerve....         0344         0.79       $39.18       $23.63        $7.84
    88358  X                Analysis, tumor....         0344         0.79       $39.18       $23.63        $7.84
    88362  X                Nerve teasing               0343         0.45       $22.32       $12.16        $4.46
                             preparations.
    88365  X                Tissue                      0344         0.79       $39.18       $23.63        $7.84
                             hybridization.
    88371  A                Protein, western     ...........  ...........  ...........  ...........  ...........
                             blot tissue.
    88372  A                Protein analysis w/  ...........  ...........  ...........  ...........  ...........
                             probe.
    88399  X                Surgical pathology          0349         0.48       $23.65        $4.73        $4.73
                             procedure.
   *88400  A                Bilirubin total,     ...........  ...........  ...........  ...........  ...........
                             trascutaneous.
    89050  A                Body fluid cell      ...........  ...........  ...........  ...........  ...........
                             count.
    89051  A                Body fluid cell      ...........  ...........  ...........  ...........  ...........
                             count.
    89060  A                Exam,synovial fluid  ...........  ...........  ...........  ...........  ...........
                             crystals.
    89100  X                Sample intestinal           0361         3.53      $175.07       $88.09       $35.01
                             contents.
    89105  X                Sample intestinal           0360         1.38       $68.44       $34.75       $13.69
                             contents.
    89125  A                Specimen fat stain.  ...........  ...........  ...........  ...........  ...........
    89130  X                Sample stomach              0360         1.38       $68.44       $34.75       $13.69
                             contents.
    89132  X                Sample stomach              0360         1.38       $68.44       $34.75       $13.69
                             contents.
    89135  X                Sample stomach              0360         1.38       $68.44       $34.75       $13.69
                             contents.
    89136  X                Sample stomach              0360         1.38       $68.44       $34.75       $13.69
                             contents.
    89140  X                Sample stomach              0360         1.38       $68.44       $34.75       $13.69
                             contents.
    89141  X                Sample stomach              0361         3.53      $175.07       $88.09       $35.01
                             contents.
    89160  A                Exam feces for meat  ...........  ...........  ...........  ...........  ...........
                             fibers.
    89190  A                Nasal smear for      ...........  ...........  ...........  ...........  ...........
                             eosinophils.
    89250  X                Fertilization of            0348         0.52       $25.57        $5.11        $5.11
                             oocyte.
    89251  X                Culture oocyte w/           0348         0.52       $25.57        $5.11        $5.11
                             embryos.
    89252  X                Assist oocyte               0348         0.52       $25.57        $5.11        $5.11
                             fertilization.
    89253  X                Embryo hatching....         0348         0.52       $25.57        $5.11        $5.11
    89254  X                Oocyte                      0348         0.52       $25.57        $5.11        $5.11
                             identification.
    89255  X                Prepare embryo for          0348         0.52       $25.57        $5.11        $5.11
                             transfer.
    89256  X                Prepare                     0348         0.52       $25.57        $5.11        $5.11
                             cryopreserved
                             embryo.
    89257  X                Sperm                       0348         0.52       $25.57        $5.11        $5.11
                             identification.
    89258  X                Cryopreservation,           0348         0.52       $25.57        $5.11        $5.11
                             embryo.
    89259  X                Cryopreservation,           0348         0.52       $25.57        $5.11        $5.11
                             sperm.
    89260  X                Sperm isolation,            0348         0.52       $25.57        $5.11        $5.11
                             simple.
    89261  X                Sperm isolation,            0348         0.52       $25.57        $5.11        $5.11
                             complex.
    89264  X                Identify sperm              0348         0.52       $25.57        $5.11        $5.11
                             tissue.
    89300  A                Semen analysis.....  ...........  ...........  ...........  ...........  ...........
    89310  A                Semen analysis.....  ...........  ...........  ...........  ...........  ...........

[[Page 67935]]

 
    89320  A                Semen analysis.....  ...........  ...........  ...........  ...........  ...........
   *89321  A                Semen analysis.....  ...........  ...........  ...........  ...........  ...........
    89325  A                Sperm antibody test  ...........  ...........  ...........  ...........  ...........
    89329  A                Sperm evaluation     ...........  ...........  ...........  ...........  ...........
                             test.
    89330  A                Evaluation,          ...........  ...........  ...........  ...........  ...........
                             cervical mucus.
    89350  X                Sputum specimen             0344         0.79       $39.18       $23.63        $7.84
                             collection.
    89355  A                Exam feces for       ...........  ...........  ...........  ...........  ...........
                             starch.
    89360  X                Collect sweat for           0344         0.79       $39.18       $23.63        $7.84
                             test.
    89365  A                Water load test....  ...........  ...........  ...........  ...........  ...........
    89399  X                Pathology lab               0349         0.48       $23.65        $4.73        $4.73
                             procedure.
    90281  E                Human ig, im.......  ...........  ...........  ...........  ...........  ...........
    90283  E                Human ig, iv.......  ...........  ...........  ...........  ...........  ...........
    90287  E                Botulinum antitoxin  ...........  ...........  ...........  ...........  ...........
    90288  E                Botulism ig, iv....  ...........  ...........  ...........  ...........  ...........
    90291  E                Cmv ig, iv.........  ...........  ...........  ...........  ...........  ...........
    90296  K                Diphtheria                  0356         0.36       $17.86        $4.82        $3.57
                             antitoxin.
    90371  K                Hep b ig, im.......         0356         0.36       $17.86        $4.82        $3.57
    90375  K                Rabies ig, im/sc...         0356         0.36       $17.86        $4.82        $3.57
    90376  K                Rabies ig, heat             0356         0.36       $17.86        $4.82        $3.57
                             treated.
    90378  K                Rsv ig, im.........         0356         0.36       $17.86        $4.82        $3.57
    90379  K                Rsv ig, iv.........         0356         0.36       $17.86        $4.82        $3.57
    90384  E                Rh ig, full-dose,    ...........  ...........  ...........  ...........  ...........
                             im.
    90385  K                Rh ig, minidose, im         0356         0.36       $17.86        $4.82        $3.57
    90386  E                Rh ig, iv..........  ...........  ...........  ...........  ...........  ...........
    90389  K                Tetanus ig, im.....         0356         0.36       $17.86        $4.82        $3.57
    90393  K                Vaccina ig, im.....         0356         0.36       $17.86        $4.82        $3.57
    90396  K                Varicella-zoster            0356         0.36       $17.86        $4.82        $3.57
                             ig, im.
    90399  E                Immune globulin....  ...........  ...........  ...........  ...........  ...........
    90471  N                Immunization admin.  ...........  ...........  ...........  ...........  ...........
    90472  N                Immunization admin,  ...........  ...........  ...........  ...........  ...........
                             each add.
    90476  K                Adenovirus vaccine,         0356         0.36       $17.86        $4.82        $3.57
                             type 4.
    90477  K                Adenovirus vaccine,         0356         0.36       $17.86        $4.82        $3.57
                             type 7.
    90581  K                Anthrax vaccine, sc         0356         0.36       $17.86        $4.82        $3.57
    90585  K                Bcg vaccine, percut         0356         0.36       $17.86        $4.82        $3.57
    90586  K                Bcg vaccine,                0356         0.36       $17.86        $4.82        $3.57
                             intravesical.
    90632  K                Hep a vaccine,              0356         0.36       $17.86        $4.82        $3.57
                             adult im.
    90633  K                Hep a vacc, ped/            0356         0.36       $17.86        $4.82        $3.57
                             adol, 2 dose.
    90634  K                Hep a vacc, ped/            0356         0.36       $17.86        $4.82        $3.57
                             adol, 3 dose.
    90636  K                Hep a/hep b vacc,           0356         0.36       $17.86        $4.82        $3.57
                             adult im.
    90645  K                Hib vaccine, hboc,          0355         0.19        $9.42        $5.05        $1.88
                             im.
    90646  K                Hib vaccine, prp-d,         0355         0.19        $9.42        $5.05        $1.88
                             im.
    90647  K                Hib vaccine, prp-           0355         0.19        $9.42        $5.05        $1.88
                             omp, im.
    90648  K                Hib vaccine, prp-t,         0355         0.19        $9.42        $5.05        $1.88
                             im.
    90657  K                Flu vaccine, 6-35           0354         0.13        $6.33  ...........  ...........
                             mo, im.
    90658  K                Flu vaccine, 3 yrs,         0354         0.13        $6.33  ...........  ...........
                             im.
    90659  K                Flu vaccine, whole,         0354         0.13        $6.33  ...........  ...........
                             im.
    90660  K                Flu vaccine, nasal.         0354         0.13        $6.33  ...........  ...........
    90665  K                Lyme disease                0356         0.36       $17.86        $4.82        $3.57
                             vaccine, im.
    90669  K                Pneumococcal                0356         0.36       $17.86        $4.82        $3.57
                             vaccine, ped.
    90675  K                Rabies vaccine, im.         0356         0.36       $17.86        $4.82        $3.57
    90676  K                Rabies vaccine, id.         0356         0.36       $17.86        $4.82        $3.57
    90680  K                Rotovirus vaccine,          0356         0.36       $17.86        $4.82        $3.57
                             oral.
    90690  K                Typhoid vaccine,            0356         0.36       $17.86        $4.82        $3.57
                             oral.
    90691  K                Typhoid vaccine, im         0356         0.36       $17.86        $4.82        $3.57
    90692  K                Typhoid vaccine, h-         0356         0.36       $17.86        $4.82        $3.57
                             p, sc/id.
    90693  K                Typhoid vaccine,            0356         0.36       $17.86        $4.82        $3.57
                             akd, sc.
    90700  K                Dtap vaccine, im...         0355         0.19        $9.42        $5.05        $1.88
    90701  K                Dtp vaccine, im....         0356         0.36       $17.86        $4.82        $3.57
    90702  K                Dt vaccine, im.....         0355         0.19        $9.42        $5.05        $1.88
    90703  K                Tetanus vaccine, im         0356         0.36       $17.86        $4.82        $3.57
    90704  K                Mumps vaccine, sc..         0355         0.19        $9.42        $5.05        $1.88
    90705  K                Measles vaccine, sc         0356         0.36       $17.86        $4.82        $3.57
    90706  K                Rubella vaccine, sc         0356         0.36       $17.86        $4.82        $3.57
    90707  K                Mmr vaccine, sc....         0356         0.36       $17.86        $4.82        $3.57
    90708  K                Measles-rubella             0356         0.36       $17.86        $4.82        $3.57
                             vaccine, sc.
    90709  K                Rubella & mumps             0356         0.36       $17.86        $4.82        $3.57
                             vaccine, sc.
    90710  K                Mmrv vaccine, sc...         0356         0.36       $17.86        $4.82        $3.57
    90712  K                Oral poliovirus             0356         0.36       $17.86        $4.82        $3.57
                             vaccine.
    90713  K                Poliovirus, ipv, sc         0355         0.19        $9.42        $5.05        $1.88
    90716  K                Chicken pox                 0355         0.19        $9.42        $5.05        $1.88
                             vaccine, sc.
    90717  K                Yellow fever                0356         0.36       $17.86        $4.82        $3.57
                             vaccine, sc.
    90718  K                Td vaccine, im.....         0356         0.36       $17.86        $4.82        $3.57
    90719  K                Diphtheria vaccine,         0356         0.36       $17.86        $4.82        $3.57
                             im.
    90720  K                Dtp/hib vaccine, im         0355         0.19        $9.42        $5.05        $1.88

[[Page 67936]]

 
    90721  K                Dtap/hib vaccine,           0355         0.19        $9.42        $5.05        $1.88
                             im.
   *90723  K                DTAP-HepB-IPV               0356         0.36       $17.86        $4.82        $3.57
                             vaccine.
    90725  K                Cholera vaccine,            0356         0.36       $17.86        $4.82        $3.57
                             injectable.
    90727  K                Plague vaccine, im.         0355         0.19        $9.42        $5.05        $1.88
    90732  K                Pneumococcal                0354         0.13        $6.33  ...........  ...........
                             vaccine, adult.
    90733  K                Meningococcal               0356         0.36       $17.86        $4.82        $3.57
                             vaccine, sc.
    90735  K                Encephalitis                0356         0.36       $17.86        $4.82        $3.57
                             vaccine, sc.
   *90740  K                Hep B vaccine, 3            0356         0.36       $17.86        $4.82        $3.57
                             dose sched.
   *90743  K                Hep B vaccine, 2            0356         0.36       $17.86        $4.82        $3.57
                             dose sched.
    90744  K                Hep b vaccine, ped/         0356         0.36       $17.86        $4.82        $3.57
                             adol, im.
    90746  K                Hep b vaccine,              0356         0.36       $17.86        $4.82        $3.57
                             adult, im.
    90747  K                Hep b vaccine, ill          0356         0.36       $17.86        $4.82        $3.57
                             pat, im.
    90748  K                Hep b/hib vaccine,          0356         0.36       $17.86        $4.82        $3.57
                             im.
    90749  K                Vaccine toxoid.....         0355         0.19        $9.42        $5.05        $1.88
    90780  E                IV infusion          ...........  ...........  ...........  ...........  ...........
                             therapy, 1 hour.
    90781  E                IV infusion,         ...........  ...........  ...........  ...........  ...........
                             additional hour.
    90782  X                Injection, sc/im...         0359         0.96       $47.61        $9.52        $9.52
    90783  X                Injection, ia......         0359         0.96       $47.61        $9.52        $9.52
    90784  X                Injection, iv......         0359         0.96       $47.61        $9.52        $9.52
    90788  X                Injection of                0359         0.96       $47.61        $9.52        $9.52
                             antibiotic.
    90799  X                Ther/prophylactic/          0359         0.96       $47.61        $9.52        $9.52
                             dx inject.
    90801  S                Psy dx interview...         0323         1.85       $91.75       $22.48       $18.35
    90802  S                Intac psy dx                0323         1.85       $91.75       $22.48       $18.35
                             interview.
    90804  S                Psytx, office, 20-          0322         1.32       $65.46       $14.22       $13.09
                             30 min.
    90805  S                Psytx, off, 20-30           0322         1.32       $65.46       $14.22       $13.09
                             min w/e&m.
    90806  S                Psytx, off, 45-50           0323         1.85       $91.75       $22.48       $18.35
                             min.
    90807  S                Psytx, off, 45-50           0323         1.85       $91.75       $22.48       $18.35
                             min w/e&m.
    90808  S                Psytx, office, 75-          0323         1.85       $91.75       $22.48       $18.35
                             80 min.
    90809  S                Psytx, off, 75-80,          0323         1.85       $91.75       $22.48       $18.35
                             w/e&m.
    90810  S                Intac psytx, off,           0322         1.32       $65.46       $14.22       $13.09
                             20-30 min.
    90811  S                Intac psytx, 20-30,         0322         1.32       $65.46       $14.22       $13.09
                             w/e&m.
    90812  S                Intac psytx, off,           0323         1.85       $91.75       $22.48       $18.35
                             45-50 min.
    90813  S                Intac psytx, 45-50          0323         1.85       $91.75       $22.48       $18.35
                             min w/e&m.
    90814  S                Intac psytx, off,           0323         1.85       $91.75       $22.48       $18.35
                             75-80 min.
    90815  S                Intac psytx, 75-80          0323         1.85       $91.75       $22.48       $18.35
                             w/e&m.
    90816  S                Psytx, hosp, 20-30          0322         1.32       $65.46       $14.22       $13.09
                             min.
    90817  S                Psytx, hosp, 20-30          0322         1.32       $65.46       $14.22       $13.09
                             min w/e&m.
    90818  S                Psytx, hosp, 45-50          0323         1.85       $91.75       $22.48       $18.35
                             min.
    90819  S                Psytx, hosp, 45-50          0323         1.85       $91.75       $22.48       $18.35
                             min w/e&m.
    90821  S                Psytx, hosp, 75-80          0323         1.85       $91.75       $22.48       $18.35
                             min.
    90822  S                Psytx, hosp, 75-80          0323         1.85       $91.75       $22.48       $18.35
                             min w/e&m.
    90823  S                Intac psytx, hosp,          0322         1.32       $65.46       $14.22       $13.09
                             20-30 min.
    90824  S                Intac psytx, hsp 20-        0322         1.32       $65.46       $14.22       $13.09
                             30 w/e&m.
    90826  S                Intac psytx, hosp,          0323         1.85       $91.75       $22.48       $18.35
                             45-50 min.
    90827  S                Intac psytx, hsp 45-        0323         1.85       $91.75       $22.48       $18.35
                             50 w/e&m.
    90828  S                Intac psytx, hosp,          0323         1.85       $91.75       $22.48       $18.35
                             75-80 min.
    90829  S                Intac psytx, hsp 75-        0323         1.85       $91.75       $22.48       $18.35
                             80 w/e&m.
    90845  S                Psychoanalysis.....         0323         1.85       $91.75       $22.48       $18.35
    90846  S                Family psytx w/o            0324         1.87       $92.74       $20.19       $18.55
                             patient.
    90847  S                Family psytx w/             0324         1.87       $92.74       $20.19       $18.55
                             patient.
    90849  S                Multiple family             0325         1.55       $76.88       $19.96       $15.38
                             group psytx.
    90853  S                Group psychotherapy         0325         1.55       $76.88       $19.96       $15.38
    90857  S                Intac group psytx..         0325         1.55       $76.88       $19.96       $15.38
    90862  X                Medication                  0374         1.17       $58.03       $13.08       $11.61
                             management.
    90865  S                Narcosynthesis.....         0323         1.85       $91.75       $22.48       $18.35
    90870  S                Electroconvulsive           0320         3.68      $182.51       $80.06       $36.50
                             therapy.
    90871  S                Electroconvulsive           0320         3.68      $182.51       $80.06       $36.50
                             therapy.
    90875  E                Psychophysiological  ...........  ...........  ...........  ...........  ...........
                             therapy.
    90876  E                Psychophysiological  ...........  ...........  ...........  ...........  ...........
                             therapy.
    90880  S                Hypnotherapy.......         0323         1.85       $91.75       $22.48       $18.35
    90882  E                Environmental        ...........  ...........  ...........  ...........  ...........
                             manipulation.
    90885  N                Psy evaluation of    ...........  ...........  ...........  ...........  ...........
                             records.
    90887  N                Consultation with    ...........  ...........  ...........  ...........  ...........
                             family.
    90889  N                Preparation of       ...........  ...........  ...........  ...........  ...........
                             report.
    90899  S                Psychiatric service/        0322         1.32       $65.46       $14.22       $13.09
                             therapy.
    90901  S                Biofeedback train,          0321         1.26       $62.49       $29.25       $12.50
                             any meth.
    90911  S                Biofeedback peri/           0321         1.26       $62.49       $29.25       $12.50
                             uro/rectal.
    90918  A                ESRD related         ...........  ...........  ...........  ...........  ...........
                             services, month.
    90919  A                ESRD related         ...........  ...........  ...........  ...........  ...........
                             services, month.
    90920  A                ESRD related         ...........  ...........  ...........  ...........  ...........
                             services, month.
    90921  A                ESRD related         ...........  ...........  ...........  ...........  ...........
                             services, month.
    90922  A                ESRD related         ...........  ...........  ...........  ...........  ...........
                             services, day.
    90923  A                Esrd related         ...........  ...........  ...........  ...........  ...........
                             services, day.
    90924  A                Esrd related         ...........  ...........  ...........  ...........  ...........
                             services, day.

[[Page 67937]]

 
    90925  A                Esrd related         ...........  ...........  ...........  ...........  ...........
                             services, day.
    90935  S                Hemodialysis, one           0170         6.68      $331.30       $72.26       $66.26
                             evaluation.
    90937  E                Hemodialysis,        ...........  ...........  ...........  ...........  ...........
                             repeated eval.
   *90940  N                Hemodyalysis access  ...........  ...........  ...........  ...........  ...........
                             study.
    90945  S                Dialysis, one               0170         6.68      $331.30       $72.26       $66.26
                             evaluation.
    90947  E                Dialysis, repeated   ...........  ...........  ...........  ...........  ...........
                             eval.
    90989  E                Dialysis training,   ...........  ...........  ...........  ...........  ...........
                             complete.
    90993  E                Dialysis training,   ...........  ...........  ...........  ...........  ...........
                             incompl.
    90997  E                Hemoperfusion......  ...........  ...........  ...........  ...........  ...........
    90999  E                Dialysis procedure.  ...........  ...........  ...........  ...........  ...........
    91000  X                Esophageal                  0361         3.53      $175.07       $88.09       $35.01
                             intubation.
    91010  X                Esophagus motility          0361         3.53      $175.07       $88.09       $35.01
                             study.
    91011  X                Esophagus motility          0361         3.53      $175.07       $88.09       $35.01
                             study.
    91012  X                Esophagus motility          0361         3.53      $175.07       $88.09       $35.01
                             study.
    91020  X                Gastric motility...         0361         3.53      $175.07       $88.09       $35.01
    91030  X                Acid perfusion of           0360         1.38       $68.44       $34.75       $13.69
                             esophagus.
    91032  X                Esophagus, acid             0361         3.53      $175.07       $88.09       $35.01
                             reflux test.
    91033  X                Prolonged acid              0361         3.53      $175.07       $88.09       $35.01
                             reflux test.
    91052  X                Gastric analysis            0361         3.53      $175.07       $88.09       $35.01
                             test.
    91055  X                Gastric intubation          0360         1.38       $68.44       $34.75       $13.69
                             for smear.
    91060  X                Gastric saline load         0361         3.53      $175.07       $88.09       $35.01
                             test.
    91065  X                Breath hydrogen             0360         1.38       $68.44       $34.75       $13.69
                             test.
    91100  X                Pass intestine              0360         1.38       $68.44       $34.75       $13.69
                             bleeding tube.
    91105  X                Gastric intubation          0360         1.38       $68.44       $34.75       $13.69
                             treatment.
    91122  T                Anal pressure               0165         3.89      $192.92       $91.76       $38.58
                             record.
   *91132  X                Electrogastrography         0360         1.38       $68.44       $34.75       $13.69
   *91133  X                Electrogastrography         0360         1.38       $68.44       $34.75       $13.69
    91299  X                Gastroenterology            0360         1.38       $68.44       $34.75       $13.69
                             procedure.
    92002  V                Eye exam, new               0601         1.00       $49.60        $9.92        $9.92
                             patient.
    92004  V                Eye exam, new               0602         1.66       $82.33       $16.47       $16.47
                             patient.
    92012  V                Eye exam                    0601         1.00       $49.60        $9.92        $9.92
                             established pat.
    92014  V                Eye exam &                  0602         1.66       $82.33       $16.47       $16.47
                             treatment.
    92015  E                Refraction.........  ...........  ...........  ...........  ...........  ...........
    92018  S                New eye exam &              0231         2.64      $130.94       $59.87       $26.19
                             treatment.
    92019  S                Eye exam &                  0231         2.64      $130.94       $59.87       $26.19
                             treatment.
    92020  S                Special eye                 0230         0.98       $48.61       $22.48        $9.72
                             evaluation.
    92060  S                Special eye                 0230         0.98       $48.61       $22.48        $9.72
                             evaluation.
    92065  S                Orthoptic/pleoptic          0230         0.98       $48.61       $22.48        $9.72
                             training.
    92070  N                Fitting of contact   ...........  ...........  ...........  ...........  ...........
                             lens.
    92081  S                Visual field                0230         0.98       $48.61       $22.48        $9.72
                             examination(s).
    92082  S                Visual field                0230         0.98       $48.61       $22.48        $9.72
                             examination(s).
    92083  S                Visual field                0230         0.98       $48.61       $22.48        $9.72
                             examination(s).
    92100  N                Serial tonometry     ...........  ...........  ...........  ...........  ...........
                             exam(s).
    92120  S                Tonography & eye            0230         0.98       $48.61       $22.48        $9.72
                             evaluation.
    92130  S                Water provocation           0230         0.98       $48.61       $22.48        $9.72
                             tonography.
    92135  S                Opthalmic dx                0231         2.64      $130.94       $59.87       $26.19
                             imaging.
    92140  S                Glaucoma                    0231         2.64      $130.94       $59.87       $26.19
                             provocative tests.
    92225  S                Special eye exam,           0230         0.98       $48.61       $22.48        $9.72
                             initial.
    92226  S                Special eye exam,           0231         2.64      $130.94       $59.87       $26.19
                             subsequent.
    92230  S                Eye exam with               0231         2.64      $130.94       $59.87       $26.19
                             photos.
    92235  S                Eye exam with               0231         2.64      $130.94       $59.87       $26.19
                             photos.
    92240  S                Icg angiography....         0231         2.64      $130.94       $59.87       $26.19
    92250  S                Eye exam with               0230         0.98       $48.61       $22.48        $9.72
                             photos.
    92260  S                Ophthalmoscopy/             0230         0.98       $48.61       $22.48        $9.72
                             dynamometry.
    92265  S                Eye muscle                  0230         0.98       $48.61       $22.48        $9.72
                             evaluation.
    92270  S                Electro-oculography         0230         0.98       $48.61       $22.48        $9.72
    92275  S                Electroretinography         0216         2.87      $142.34       $64.69       $28.47
    92283  S                Color vision                0230         0.98       $48.61       $22.48        $9.72
                             examination.
    92284  S                Dark adaptation eye         0231         2.64      $130.94       $59.87       $26.19
                             exam.
    92285  S                Eye photography....         0230         0.98       $48.61       $22.48        $9.72
    92286  S                Internal eye                0231         2.64      $130.94       $59.87       $26.19
                             photography.
    92287  S                Internal eye                0231         2.64      $130.94       $59.87       $26.19
                             photography.
    92310  E                Contact lens         ...........  ...........  ...........  ...........  ...........
                             fitting.
    92311  X                Contact lens                0362         0.51       $25.30        $9.63        $5.06
                             fitting.
    92312  X                Contact lens                0362         0.51       $25.30        $9.63        $5.06
                             fitting.
    92313  X                Contact lens                0362         0.51       $25.30        $9.63        $5.06
                             fitting.
    92314  E                Prescription of      ...........  ...........  ...........  ...........  ...........
                             contact lens.
    92315  X                Prescription of             0362         0.51       $25.30        $9.63        $5.06
                             contact lens.
    92316  X                Prescription of             0362         0.51       $25.30        $9.63        $5.06
                             contact lens.
    92317  X                Prescription of             0362         0.51       $25.30        $9.63        $5.06
                             contact lens.
    92325  X                Modification of             0362         0.51       $25.30        $9.63        $5.06
                             contact lens.
    92326  X                Replacement of              0362         0.51       $25.30        $9.63        $5.06
                             contact lens.
    92330  S                Fitting of                  0230         0.98       $48.61       $22.48        $9.72
                             artificial eye.
    92335  N                Fitting of           ...........  ...........  ...........  ...........  ...........
                             artificial eye.

[[Page 67938]]

 
    92340  E                Fitting of           ...........  ...........  ...........  ...........  ...........
                             spectacles.
    92341  E                Fitting of           ...........  ...........  ...........  ...........  ...........
                             spectacles.
    92342  E                Fitting of           ...........  ...........  ...........  ...........  ...........
                             spectacles.
    92352  X                Special spectacles          0362         0.51       $25.30        $9.63        $5.06
                             fitting.
    92353  X                Special spectacles          0362         0.51       $25.30        $9.63        $5.06
                             fitting.
    92354  X                Special spectacles          0362         0.51       $25.30        $9.63        $5.06
                             fitting.
    92355  X                Special spectacles          0362         0.51       $25.30        $9.63        $5.06
                             fitting.
    92358  X                Eye prosthesis              0362         0.51       $25.30        $9.63        $5.06
                             service.
    92370  E                Repair & adjust      ...........  ...........  ...........  ...........  ...........
                             spectacles.
    92371  X                Repair & adjust             0362         0.51       $25.30        $9.63        $5.06
                             spectacles.
    92390  E                Supply of            ...........  ...........  ...........  ...........  ...........
                             spectacles.
    92391  E                Supply of contact    ...........  ...........  ...........  ...........  ...........
                             lenses.
    92392  E                Supply of low        ...........  ...........  ...........  ...........  ...........
                             vision aids.
    92393  E                Supply of            ...........  ...........  ...........  ...........  ...........
                             artificial eye.
    92395  E                Supply of            ...........  ...........  ...........  ...........  ...........
                             spectacles.
    92396  E                Supply of contact    ...........  ...........  ...........  ...........  ...........
                             lenses.
    92499  S                Eye service or              0230         0.98       $48.61       $22.48        $9.72
                             procedure.
    92502  T                Ear and throat              0251         1.68       $83.32       $27.99       $16.66
                             examination.
    92504  N                Ear microscopy       ...........  ...........  ...........  ...........  ...........
                             examination.
    92506  A                Speech/hearing       ...........  ...........  ...........  ...........  ...........
                             evaluation.
    92507  A                Speech/hearing       ...........  ...........  ...........  ...........  ...........
                             therapy.
    92508  A                Speech/hearing       ...........  ...........  ...........  ...........  ...........
                             therapy.
    92510  A                Rehab for ear        ...........  ...........  ...........  ...........  ...........
                             implant.
    92511  T                Nasopharyngoscopy..         0071         0.55       $27.28       $14.22        $5.46
    92512  X                Nasal function              0363         2.83      $140.36       $53.22       $28.07
                             studies.
    92516  X                Facial nerve                0363         2.83      $140.36       $53.22       $28.07
                             function test.
    92520  X                Laryngeal function          0363         2.83      $140.36       $53.22       $28.07
                             studies.
    92525  E                Oral function        ...........  ...........  ...........  ...........  ...........
                             evaluation.
    92526  A                Oral function        ...........  ...........  ...........  ...........  ...........
                             therapy.
    92531  N                Spontaneous          ...........  ...........  ...........  ...........  ...........
                             nystagmus study.
    92532  N                Positional           ...........  ...........  ...........  ...........  ...........
                             nystagmus study.
    92533  N                Caloric vestibular   ...........  ...........  ...........  ...........  ...........
                             test.
    92534  N                Optokinetic          ...........  ...........  ...........  ...........  ...........
                             nystagmus.
    92541  X                Spontaneous                 0363         2.83      $140.36       $53.22       $28.07
                             nystagmus test.
    92542  X                Positional                  0363         2.83      $140.36       $53.22       $28.07
                             nystagmus test.
    92543  X                Caloric vestibular          0363         2.83      $140.36       $53.22       $28.07
                             test.
    92544  X                Optokinetic                 0363         2.83      $140.36       $53.22       $28.07
                             nystagmus test.
    92545  X                Oscillating                 0363         2.83      $140.36       $53.22       $28.07
                             tracking test.
    92546  X                Sinusoidal                  0363         2.83      $140.36       $53.22       $28.07
                             rotational test.
    92547  X                Supplemental                0363         2.83      $140.36       $53.22       $28.07
                             electrical test.
    92548  X                Posturography......         0363         2.83      $140.36       $53.22       $28.07
    92551  E                Pure tone hearing    ...........  ...........  ...........  ...........  ...........
                             test, air.
    92552  X                Pure tone                   0364         0.68       $33.72       $13.31        $6.74
                             audiometry, air.
    92553  X                Audiometry, air &           0364         0.68       $33.72       $13.31        $6.74
                             bone.
    92555  X                Speech threshold            0364         0.68       $33.72       $13.31        $6.74
                             audiometry.
    92556  X                Speech audiometry,          0364         0.68       $33.72       $13.31        $6.74
                             complete.
    92557  X                Comprehensive               0365         1.47       $72.91       $22.48       $14.58
                             hearing test.
    92559  E                Group audiometric    ...........  ...........  ...........  ...........  ...........
                             testing.
    92560  E                Bekesy audiometry,   ...........  ...........  ...........  ...........  ...........
                             screen.
    92561  X                Bekesy audiometry,          0365         1.47       $72.91       $22.48       $14.58
                             diagnosis.
    92562  X                Loudness balance            0365         1.47       $72.91       $22.48       $14.58
                             test.
    92563  X                Tone decay hearing          0365         1.47       $72.91       $22.48       $14.58
                             test.
    92564  X                Sisi hearing test..         0365         1.47       $72.91       $22.48       $14.58
    92565  X                Stenger test, pure          0365         1.47       $72.91       $22.48       $14.58
                             tone.
    92567  X                Tympanometry.......         0364         0.68       $33.72       $13.31        $6.74
    92568  X                Acoustic reflex             0365         1.47       $72.91       $22.48       $14.58
                             testing.
    92569  X                Acoustic reflex             0365         1.47       $72.91       $22.48       $14.58
                             decay test.
    92571  X                Filtered speech             0365         1.47       $72.91       $22.48       $14.58
                             hearing test.
    92572  X                Staggered spondaic          0365         1.47       $72.91       $22.48       $14.58
                             word test.
    92573  X                Lombard test.......         0365         1.47       $72.91       $22.48       $14.58
    92575  X                Sensorineural               0365         1.47       $72.91       $22.48       $14.58
                             acuity test.
    92576  X                Synthetic sentence          0365         1.47       $72.91       $22.48       $14.58
                             test.
    92577  X                Stenger test,               0365         1.47       $72.91       $22.48       $14.58
                             speech.
    92579  X                Visual audiometry           0365         1.47       $72.91       $22.48       $14.58
                             (vra).
    92582  X                Conditioning play           0365         1.47       $72.91       $22.48       $14.58
                             audiometry.
    92583  X                Select picture              0365         1.47       $72.91       $22.48       $14.58
                             audiometry.
    92584  X                Electrocochleograph         0363         2.83      $140.36       $53.22       $28.07
                             y.
    92585  S                Auditory evoked             0216         2.87      $142.34       $64.69       $28.47
                             potential.
   *92586  S                Auditory evoked             0971         1.55       $76.88  ...........       $15.38
                             potentials, ltd.
    92587  X                Evoked auditory             0363         2.83      $140.36       $53.22       $28.07
                             test.
    92588  X                Evoked auditory             0363         2.83      $140.36       $53.22       $28.07
                             test.
    92589  X                Auditory function           0365         1.47       $72.91       $22.48       $14.58
                             test(s).
    92590  E                Hearing aid exam,    ...........  ...........  ...........  ...........  ...........
                             one ear.
    92591  E                Hearing aid exam,    ...........  ...........  ...........  ...........  ...........
                             both ears.

[[Page 67939]]

 
    92592  E                Hearing aid check,   ...........  ...........  ...........  ...........  ...........
                             one ear.
    92593  E                Hearing aid check,   ...........  ...........  ...........  ...........  ...........
                             both ears.
    92594  E                Electro hearng aid   ...........  ...........  ...........  ...........  ...........
                             test, one.
    92595  E                Electro hearng aid   ...........  ...........  ...........  ...........  ...........
                             tst, both.
    92596  X                Ear protector               0365         1.47       $72.91       $22.48       $14.58
                             evaluation.
   92597D  E                Voice prosthetic     ...........  ...........  ...........  ...........  ...........
                             evaluation.
   92598D  E                Voice prosthetic     ...........  ...........  ...........  ...........  ...........
                             modification.
    92599  X                ENT procedure/              0364         0.68       $33.72       $13.31        $6.74
                             service.
    92950  S                Heart/lung                  0094         4.51      $223.68      $105.29       $44.74
                             resuscitation cpr.
    92953  S                Temporary external          0094         4.51      $223.68      $105.29       $44.74
                             pacing.
    92960  S                Cardioversion               0094         4.51      $223.68      $105.29       $44.74
                             electric, ext.
    92961  S                Cardioversion,              0094         4.51      $223.68      $105.29       $44.74
                             electric, int.
    92970  C                Cardioassist,        ...........  ...........  ...........  ...........  ...........
                             internal.
    92971  C                Cardioassist,        ...........  ...........  ...........  ...........  ...........
                             external.
    92975  C                Dissolve clot,       ...........  ...........  ...........  ...........  ...........
                             heart vessel.
    92977  T                Dissolve clot,              0120         1.66       $82.33       $42.67       $16.47
                             heart vessel.
    92978  S                Intravasc us, heart         0267         2.72      $134.90       $80.06       $26.98
                             add-on.
    92979  S                Intravasc us, heart         0267         2.72      $134.90       $80.06       $26.98
                             add-on.
    92980  T                Insert                      0104        14.94      $740.96      $339.51      $148.19
                             intracoronary
                             stent.
    92981  T                Insert                      0104        14.94      $740.96      $339.51      $148.19
                             intracoronary
                             stent.
    92982  T                Coronary artery             0082        51.01    $2,529.89    $1,351.74      $505.98
                             dilation.
    92984  T                Coronary artery             0082        51.01    $2,529.89    $1,351.74      $505.98
                             dilation.
    92986  C                Revision of aortic   ...........  ...........  ...........  ...........  ...........
                             valve.
    92987  C                Revision of mitral   ...........  ...........  ...........  ...........  ...........
                             valve.
    92990  C                Revision of          ...........  ...........  ...........  ...........  ...........
                             pulmonary valve.
    92992  C                Revision of heart    ...........  ...........  ...........  ...........  ...........
                             chamber.
    92993  C                Revision of heart    ...........  ...........  ...........  ...........  ...........
                             chamber.
    92995  T                Coronary                    0083        29.70    $1,473.00      $794.30      $294.60
                             atherectomy.
    92996  T                Coronary                    0083        29.70    $1,473.00      $794.30      $294.60
                             atherectomy add-on.
    92997  C                Pul art balloon      ...........  ...........  ...........  ...........  ...........
                             repr, percut.
    92998  C                Pul art balloon      ...........  ...........  ...........  ...........  ...........
                             repr, percut.
    93000  E                Electrocardiogram,   ...........  ...........  ...........  ...........  ...........
                             complete.
    93005  X                Electrocardiogram,          0099         0.38       $18.85       $14.68        $3.77
                             tracing.
    93010  E                Electrocardiogram    ...........  ...........  ...........  ...........  ...........
                             report.
    93012  X                Transmission of ecg         0097         1.62       $80.35       $62.40       $16.07
    93014  E                Report on            ...........  ...........  ...........  ...........  ...........
                             transmitted ecg.
    93015  E                Cardiovascular       ...........  ...........  ...........  ...........  ...........
                             stress test.
    93016  E                Cardiovascular       ...........  ...........  ...........  ...........  ...........
                             stress test.
    93017  X                Cardiovascular              0100         1.70       $84.32       $71.57       $16.86
                             stress test.
    93018  E                Cardiovascular       ...........  ...........  ...........  ...........  ...........
                             stress test.
    93024  X                Cardiac drug stress         0100         1.70       $84.32       $71.57       $16.86
                             test.
    93040  E                Rhythm ECG with      ...........  ...........  ...........  ...........  ...........
                             report.
    93041  X                Rhythm ECG, tracing         0099         0.38       $18.85       $14.68        $3.77
    93042  E                Rhythm ECG, report.  ...........  ...........  ...........  ...........  ...........
    93224  E                ECG monitor/report,  ...........  ...........  ...........  ...........  ...........
                             24 hrs.
    93225  X                ECG monitor/record,         0100         1.70       $84.32       $71.57       $16.86
                             24 hrs.
    93226  X                ECG monitor/report,         0100         1.70       $84.32       $71.57       $16.86
                             24 hrs.
    93227  E                ECG monitor/review,  ...........  ...........  ...........  ...........  ...........
                             24 hrs.
    93230  E                ECG monitor/report,  ...........  ...........  ...........  ...........  ...........
                             24 hrs.
    93231  X                Ecg monitor/record,         0100         1.70       $84.32       $71.57       $16.86
                             24 hrs.
    93232  X                ECG monitor/report,         0100         1.70       $84.32       $71.57       $16.86
                             24 hrs.
    93233  E                ECG monitor/review,  ...........  ...........  ...........  ...........  ...........
                             24 hrs.
    93235  E                ECG monitor/report,  ...........  ...........  ...........  ...........  ...........
                             24 hrs.
    93236  X                ECG monitor/report,         0100         1.70       $84.32       $71.57       $16.86
                             24 hrs.
    93237  E                ECG monitor/review,  ...........  ...........  ...........  ...........  ...........
                             24 hrs.
    93268  E                ECG record/review..  ...........  ...........  ...........  ...........  ...........
    93270  X                ECG recording......         0097         1.62       $80.35       $62.40       $16.07
    93271  X                Ecg/monitoring and          0097         1.62       $80.35       $62.40       $16.07
                             analysis.
    93272  E                Ecg/                 ...........  ...........  ...........  ...........  ...........
                             review,interpret
                             only.
    93278  X                ECG/signal-averaged         0099         0.38       $18.85       $14.68        $3.77
    93303  S                Echo transthoracic.         0269         4.40      $218.22      $114.01       $43.64
    93304  S                Echo transthoracic.         0269         4.40      $218.22      $114.01       $43.64
    93307  S                Echo exam of heart.         0269         4.40      $218.22      $114.01       $43.64
    93308  S                Echo exam of heart.         0269         4.40      $218.22      $114.01       $43.64
    93312  S                Echo                        0270         5.55      $275.25      $150.26       $55.05
                             transesophageal.
    93313  S                Echo                        0270         5.55      $275.25      $150.26       $55.05
                             transesophageal.
    93314  N                Echo                 ...........  ...........  ...........  ...........  ...........
                             transesophageal.
    93315  S                Echo                        0270         5.55      $275.25      $150.26       $55.05
                             transesophageal.
    93316  S                Echo                        0270         5.55      $275.25      $150.26       $55.05
                             transesophageal.
    93317  N                Echo                 ...........  ...........  ...........  ...........  ...........
                             transesophageal.
   *93318  S                Echo                        0270         5.55      $275.25      $150.26       $55.05
                             transesophageal.
    93320  S                Doppler echo exam,          0269         4.40      $218.22      $114.01       $43.64
                             heart.
    93321  S                Doppler echo exam,          0269         4.40      $218.22      $114.01       $43.64
                             heart.
    93325  S                Doppler color flow          0269         4.40      $218.22      $114.01       $43.64
                             add-on.

[[Page 67940]]

 
    93350  S                Echo transthoracic.         0269         4.40      $218.22      $114.01       $43.64
    93501  T                Right heart                 0080        31.55    $1,564.75      $838.92      $312.95
                             catheterization.
    93503  T                Insert/place heart          0103        13.09      $649.21      $295.70      $129.84
                             catheter.
    93505  T                Biopsy of heart             0103        13.09      $649.21      $295.70      $129.84
                             lining.
    93508  N                Cath placement,      ...........  ...........  ...........  ...........  ...........
                             angiography.
    93510  T                Left heart                  0080        31.55    $1,564.75      $838.92      $312.95
                             catheterization.
    93511  T                Left heart                  0080        31.55    $1,564.75      $838.92      $312.95
                             catheterization.
    93514  T                Left heart                  0080        31.55    $1,564.75      $838.92      $312.95
                             catheterization.
    93524  T                Left heart                  0080        31.55    $1,564.75      $838.92      $312.95
                             catheterization.
    93526  T                Rt & Lt heart               0080        31.55    $1,564.75      $838.92      $312.95
                             catheters.
    93527  T                Rt & Lt heart               0080        31.55    $1,564.75      $838.92      $312.95
                             catheters.
    93528  T                Rt & Lt heart               0080        31.55    $1,564.75      $838.92      $312.95
                             catheters.
    93529  T                Rt, Lt heart                0080        31.55    $1,564.75      $838.92      $312.95
                             catheterization.
    93530  T                Rt heart cath,              0080        31.55    $1,564.75      $838.92      $312.95
                             congenital.
    93531  T                R & l heart cath,           0080        31.55    $1,564.75      $838.92      $312.95
                             congenital.
    93532  T                R & l heart cath,           0080        31.55    $1,564.75      $838.92      $312.95
                             congenital.
    93533  T                R & l heart cath,           0080        31.55    $1,564.75      $838.92      $312.95
                             congenital.
    93536  T                Insert circulation          0103        13.09      $649.21      $295.70      $129.84
                             assi.
    93539  N                Injection, cardiac   ...........  ...........  ...........  ...........  ...........
                             cath.
    93540  N                Injection, cardiac   ...........  ...........  ...........  ...........  ...........
                             cath.
    93541  N                Injection for lung   ...........  ...........  ...........  ...........  ...........
                             angiogram.
    93542  N                Injection for heart  ...........  ...........  ...........  ...........  ...........
                             x-rays.
    93543  N                Injection for heart  ...........  ...........  ...........  ...........  ...........
                             x-rays.
    93544  N                Injection for        ...........  ...........  ...........  ...........  ...........
                             aortography.
    93545  N                Inject for coronary  ...........  ...........  ...........  ...........  ...........
                             x-rays.
    93555  N                Imaging, cardiac     ...........  ...........  ...........  ...........  ...........
                             cath.
    93556  N                Imaging, cardiac     ...........  ...........  ...........  ...........  ...........
                             cath.
    93561  N                Cardiac output       ...........  ...........  ...........  ...........  ...........
                             measurement.
    93562  N                Cardiac output       ...........  ...........  ...........  ...........  ...........
                             measurement.
    93571  N                Heart flow reserve   ...........  ...........  ...........  ...........  ...........
                             measure.
    93572  N                Heart flow reserve   ...........  ...........  ...........  ...........  ...........
                             measure.
    93600  S                Bundle of His               0087         9.53      $472.65      $214.72       $94.53
                             recording.
    93602  S                Intra-atrial                0087         9.53      $472.65      $214.72       $94.53
                             recording.
    93603  S                Right ventricular           0087         9.53      $472.65      $214.72       $94.53
                             recording.
    93607  S                Left ventricular            0087         9.53      $472.65      $214.72       $94.53
                             recording.
    93609  S                Mapping of                  0087         9.53      $472.65      $214.72       $94.53
                             tachycardia.
    93610  S                Intra-atrial pacing         0087         9.53      $472.65      $214.72       $94.53
    93612  S                Intraventricular            0087         9.53      $472.65      $214.72       $94.53
                             pacing.
    93615  S                Esophageal                  0087         9.53      $472.65      $214.72       $94.53
                             recording.
    93616  S                Esophageal                  0087         9.53      $472.65      $214.72       $94.53
                             recording.
    93618  S                Heart rhythm pacing         0087         9.53      $472.65      $214.72       $94.53
    93619  S                Electrophysiology           0085        27.06    $1,342.07      $654.48      $268.41
                             evaluation.
    93620  S                Electrophysiology           0085        27.06    $1,342.07      $654.48      $268.41
                             evaluation.
    93621  S                Electrophysiology           0085        27.06    $1,342.07      $654.48      $268.41
                             evaluation.
    93622  S                Electrophysiology           0085        27.06    $1,342.07      $654.48      $268.41
                             evaluation.
    93623  S                Stimulation, pacing         0087         9.53      $472.65      $214.72       $94.53
                             heart.
    93624  S                Electrophysiologic          0087         9.53      $472.65      $214.72       $94.53
                             study.
    93631  S                Heart pacing,               0087         9.53      $472.65      $214.72       $94.53
                             mapping.
    93640  S                Evaluation heart            0084        10.70      $530.68      $177.79      $106.14
                             device.
    93641  S                Electrophysiology           0084        10.70      $530.68      $177.79      $106.14
                             evaluation.
    93642  S                Electrophysiology           0084        10.70      $530.68      $177.79      $106.14
                             evaluation.
    93650  S                Ablate heart                0086        47.62    $2,361.76    $1,265.37      $472.35
                             dysrhythm focus.
    93651  S                Ablate heart                0086        47.62    $2,361.76    $1,265.37      $472.35
                             dysrhythm focus.
    93652  S                Ablate heart                0086        47.62    $2,361.76    $1,265.37      $472.35
                             dysrhythm focus.
    93660  S                Tilt table                  0101         4.47      $221.70      $128.84       $44.34
                             evaluation.
   *93662  S                Intracardiac ECG...         0270         5.55      $275.25      $150.26       $55.05
   *93668  E                Peripheral vascular  ...........  ...........  ...........  ...........  ...........
                             rehab.
    93720  E                Total body           ...........  ...........  ...........  ...........  ...........
                             plethysmography.
    93721  S                Plethysmography             0096         2.06      $102.16       $61.48       $20.43
                             tracing.
    93722  E                Plethysmography      ...........  ...........  ...........  ...........  ...........
                             report.
    93724  S                Analyze pacemaker           0102         0.45       $22.32       $12.62        $4.46
                             system.
    93727  S                Analyze ilr system.         0102         0.45       $22.32       $12.62        $4.46
    93731  S                Analyze pacemaker           0102         0.45       $22.32       $12.62        $4.46
                             system.
    93732  S                Analyze pacemaker           0102         0.45       $22.32       $12.62        $4.46
                             system.
    93733  S                Telephone analy,            0102         0.45       $22.32       $12.62        $4.46
                             pacemaker.
    93734  S                Analyze pacemaker           0102         0.45       $22.32       $12.62        $4.46
                             system.
    93735  S                Analyze pacemaker           0102         0.45       $22.32       $12.62        $4.46
                             system.
    93736  S                Telephone analy,            0102         0.45       $22.32       $12.62        $4.46
                             pacemaker.
    93737  S                Analyze cardio/             0102         0.45       $22.32       $12.62        $4.46
                             defibrillator.
    93738  S                Analyze cardio/             0102         0.45       $22.32       $12.62        $4.46
                             defibrillator.
    93740  S                Temperature                 0096         2.06      $102.16       $61.48       $20.43
                             gradient studies.
    93741  S                Analyze ht pace             0102         0.45       $22.32       $12.62        $4.46
                             device sngl.
    93742  S                Analyze ht pace             0102         0.45       $22.32       $12.62        $4.46
                             device sngl.
    93743  S                Analyze ht pace             0102         0.45       $22.32       $12.62        $4.46
                             device dual.

[[Page 67941]]

 
    93744  S                Analyze ht pace             0102         0.45       $22.32       $12.62        $4.46
                             device dual.
    93760  E                Cephalic thermogram  ...........  ...........  ...........  ...........  ...........
    93762  E                Peripheral           ...........  ...........  ...........  ...........  ...........
                             thermogram.
    93770  N                Measure venous       ...........  ...........  ...........  ...........  ...........
                             pressure.
    93784  E                Ambulatory BP        ...........  ...........  ...........  ...........  ...........
                             monitoring.
    93786  E                Ambulatory BP        ...........  ...........  ...........  ...........  ...........
                             recording.
    93788  E                Ambulatory BP        ...........  ...........  ...........  ...........  ...........
                             analysis.
    93790  E                Review/report BP     ...........  ...........  ...........  ...........  ...........
                             recording.
    93797  S                Cardiac rehab......         0095         0.64       $31.74       $16.98        $6.35
    93798  S                Cardiac rehab/              0095         0.64       $31.74       $16.98        $6.35
                             monitor.
    93799  S                Cardiovascular              0096         2.06      $102.16       $61.48       $20.43
                             procedure.
    93875  S                Extracranial study.         0096         2.06      $102.16       $61.48       $20.43
    93880  S                Extracranial study.         0267         2.72      $134.90       $80.06       $26.98
    93882  S                Extracranial study.         0267         2.72      $134.90       $80.06       $26.98
    93886  S                Intracranial study.         0267         2.72      $134.90       $80.06       $26.98
    93888  S                Intracranial study.         0267         2.72      $134.90       $80.06       $26.98
    93922  S                Extremity study....         0096         2.06      $102.16       $61.48       $20.43
    93923  S                Extremity study....         0096         2.06      $102.16       $61.48       $20.43
    93924  S                Extremity study....         0096         2.06      $102.16       $61.48       $20.43
    93925  S                Lower extremity             0267         2.72      $134.90       $80.06       $26.98
                             study.
    93926  S                Lower extremity             0267         2.72      $134.90       $80.06       $26.98
                             study.
    93930  S                Upper extremity             0267         2.72      $134.90       $80.06       $26.98
                             study.
    93931  S                Upper extremity             0267         2.72      $134.90       $80.06       $26.98
                             study.
    93965  S                Extremity study....         0096         2.06      $102.16       $61.48       $20.43
    93970  S                Extremity study....         0267         2.72      $134.90       $80.06       $26.98
    93971  S                Extremity study....         0267         2.72      $134.90       $80.06       $26.98
    93975  S                Vascular study.....         0267         2.72      $134.90       $80.06       $26.98
    93976  S                Vascular study.....         0267         2.72      $134.90       $80.06       $26.98
    93978  S                Vascular study.....         0267         2.72      $134.90       $80.06       $26.98
    93979  S                Vascular study.....         0267         2.72      $134.90       $80.06       $26.98
    93980  S                Penile vascular             0267         2.72      $134.90       $80.06       $26.98
                             study.
    93981  S                Penile vascular             0267         2.72      $134.90       $80.06       $26.98
                             study.
    93990  S                Doppler flow                0267         2.72      $134.90       $80.06       $26.98
                             testing.
    94010  X                Breathing capacity          0367         0.83       $41.16       $20.65        $8.23
                             test.
    94014  X                Patient recorded            0369         2.34      $116.06       $58.50       $23.21
                             spirometry.
    94015  X                Patient recorded            0369         2.34      $116.06       $58.50       $23.21
                             spirometry.
    94016  X                Review patient              0369         2.34      $116.06       $58.50       $23.21
                             spirometry.
    94060  X                Evaluation of               0368         1.66       $82.33       $42.44       $16.47
                             wheezing.
    94070  X                Evaluation of               0369         2.34      $116.06       $58.50       $23.21
                             wheezing.
    94150  N                Vital capacity test  ...........  ...........  ...........  ...........  ...........
    94200  X                Lung function test          0367         0.83       $41.16       $20.65        $8.23
                             (MBC/MVV).
    94240  X                Residual lung               0368         1.66       $82.33       $42.44       $16.47
                             capacity.
    94250  X                Expired gas                 0367         0.83       $41.16       $20.65        $8.23
                             collection.
    94260  X                Thoracic gas volume         0368         1.66       $82.33       $42.44       $16.47
    94350  X                Lung nitrogen               0368         1.66       $82.33       $42.44       $16.47
                             washout curve.
    94360  X                Measure airflow             0368         1.66       $82.33       $42.44       $16.47
                             resistance.
    94370  X                Breath airway               0368         1.66       $82.33       $42.44       $16.47
                             closing volume.
    94375  X                Respiratory flow            0367         0.83       $41.16       $20.65        $8.23
                             volume loop.
    94400  X                CO2 breathing               0367         0.83       $41.16       $20.65        $8.23
                             response curve.
    94450  X                Hypoxia response            0367         0.83       $41.16       $20.65        $8.23
                             curve.
    94620  X                Pulmonary stress            0368         1.66       $82.33       $42.44       $16.47
                             test/simple.
    94621  X                Pulm stress test/           0369         2.34      $116.06       $58.50       $23.21
                             complex.
    94640  S                Airway inhalation           0077         0.43       $21.33       $12.62        $4.27
                             treatment.
    94642  S                Aerosol inhalation          0078         1.34       $66.46       $29.13       $13.29
                             treatment.
    94650  S                Pressure breathing          0077         0.43       $21.33       $12.62        $4.27
                             (IPPB).
    94651  S                Pressure breathing          0077         0.43       $21.33       $12.62        $4.27
                             (IPPB).
    94652  C                Pressure breathing   ...........  ...........  ...........  ...........  ...........
                             (IPPB).
    94656  S                Initial ventilator          0079         3.18      $157.72      $107.70       $31.54
                             mgmt.
    94657  S                Continued                   0079         3.18      $157.72      $107.70       $31.54
                             ventilator mgmt.
    94660  S                Pos airway                  0079         3.18      $157.72      $107.70       $31.54
                             pressure, CPAP.
    94662  S                Neg press                   0079         3.18      $157.72      $107.70       $31.54
                             ventilation, cnp.
    94664  S                Aerosol or vapor            0077         0.43       $21.33       $12.62        $4.27
                             inhalations.
    94665  S                Aerosol or vapor            0077         0.43       $21.33       $12.62        $4.27
                             inhalations.
    94667  S                Chest wall                  0077         0.43       $21.33       $12.62        $4.27
                             manipulation.
    94668  S                Chest wall                  0077         0.43       $21.33       $12.62        $4.27
                             manipulation.
    94680  X                Exhaled air                 0367         0.83       $41.16       $20.65        $8.23
                             analysis, o2.
    94681  X                Exhaled air                 0368         1.66       $82.33       $42.44       $16.47
                             analysis, o2/co2.
    94690  X                Exhaled air                 0367         0.83       $41.16       $20.65        $8.23
                             analysis.
    94720  X                Monoxide diffusing          0367         0.83       $41.16       $20.65        $8.23
                             capacity.
    94725  X                Membrane diffusion          0368         1.66       $82.33       $42.44       $16.47
                             capacity.
    94750  X                Pulmonary                   0368         1.66       $82.33       $42.44       $16.47
                             compliance study.
    94760  N                Measure blood        ...........  ...........  ...........  ...........  ...........
                             oxygen level.
    94761  N                Measure blood        ...........  ...........  ...........  ...........  ...........
                             oxygen level.
    94762  N                Measure blood        ...........  ...........  ...........  ...........  ...........
                             oxygen level.

[[Page 67942]]

 
    94770  X                Exhaled carbon              0367         0.83       $41.16       $20.65        $8.23
                             dioxide test.
    94772  X                Breath recording,           0369         2.34      $116.06       $58.50       $23.21
                             infant.
    94799  X                Pulmonary service/          0367         0.83       $41.16       $20.65        $8.23
                             procedure.
    95004  X                Allergy skin tests.         0370         0.57       $28.27       $11.81        $5.65
    95010  X                Sensitivity skin            0370         0.57       $28.27       $11.81        $5.65
                             tests.
    95015  X                Sensitivity skin            0370         0.57       $28.27       $11.81        $5.65
                             tests.
    95024  X                Allergy skin tests.         0370         0.57       $28.27       $11.81        $5.65
    95027  X                Skin end point              0370         0.57       $28.27       $11.81        $5.65
                             titration.
    95028  X                Allergy skin tests.         0370         0.57       $28.27       $11.81        $5.65
    95044  X                Allergy patch tests         0370         0.57       $28.27       $11.81        $5.65
    95052  X                Photo patch test...         0370         0.57       $28.27       $11.81        $5.65
    95056  X                Photosensitivity            0370         0.57       $28.27       $11.81        $5.65
                             tests.
    95060  X                Eye allergy tests..         0370         0.57       $28.27       $11.81        $5.65
    95065  X                Nose allergy test..         0370         0.57       $28.27       $11.81        $5.65
    95070  X                Bronchial allergy           0369         2.34      $116.06       $58.50       $23.21
                             tests.
    95071  X                Bronchial allergy           0369         2.34      $116.06       $58.50       $23.21
                             tests.
    95075  X                Ingestion challenge         0361         3.53      $175.07       $88.09       $35.01
                             test.
    95078  X                Provocative testing         0370         0.57       $28.27       $11.81        $5.65
    95115  X                Immunotherapy, one          0371         0.32       $15.87        $3.67        $3.17
                             injection.
    95117  X                Immunotherapy               0371         0.32       $15.87        $3.67        $3.17
                             injections.
    95120  E                Immunotherapy, one   ...........  ...........  ...........  ...........  ...........
                             injection.
    95125  E                Immunotherapy, many  ...........  ...........  ...........  ...........  ...........
                             antigens.
    95130  E                Immunotherapy,       ...........  ...........  ...........  ...........  ...........
                             insect venom.
    95131  E                Immunotherapy,       ...........  ...........  ...........  ...........  ...........
                             insect venoms.
    95132  E                Immunotherapy,       ...........  ...........  ...........  ...........  ...........
                             insect venoms.
    95133  E                Immunotherapy,       ...........  ...........  ...........  ...........  ...........
                             insect venoms.
    95134  E                Immunotherapy,       ...........  ...........  ...........  ...........  ...........
                             insect venoms.
    95144  X                Antigen therapy             0371         0.32       $15.87        $3.67        $3.17
                             services.
    95145  X                Antigen therapy             0371         0.32       $15.87        $3.67        $3.17
                             services.
    95146  X                Antigen therapy             0371         0.32       $15.87        $3.67        $3.17
                             services.
    95147  X                Antigen therapy             0371         0.32       $15.87        $3.67        $3.17
                             services.
    95148  X                Antigen therapy             0371         0.32       $15.87        $3.67        $3.17
                             services.
    95149  X                Antigen therapy             0371         0.32       $15.87        $3.67        $3.17
                             services.
    95165  X                Antigen therapy             0371         0.32       $15.87        $3.67        $3.17
                             services.
    95170  X                Antigen therapy             0371         0.32       $15.87        $3.67        $3.17
                             services.
    95180  X                Rapid                       0370         0.57       $28.27       $11.81        $5.65
                             desensitization.
    95199  X                Allergy immunology          0370         0.57       $28.27       $11.81        $5.65
                             services.
    95805  S                Multiple sleep              0213        11.15      $553.00      $290.42      $110.60
                             latency test.
    95806  S                Sleep study,                0213        11.15      $553.00      $290.42      $110.60
                             unattended.
    95807  S                Sleep study,                0213        11.15      $553.00      $290.42      $110.60
                             attended.
    95808  S                Polysomnography, 1-         0213        11.15      $553.00      $290.42      $110.60
                             3.
    95810  S                Polysomnography, 4          0213        11.15      $553.00      $290.42      $110.60
                             or more.
    95811  S                Polysomnography w/          0213        11.15      $553.00      $290.42      $110.60
                             cpap.
    95812  S                Electroencephalogra         0213        11.15      $553.00      $290.42      $110.60
                             m (EEG).
    95813  S                Electroencephalogra         0213        11.15      $553.00      $290.42      $110.60
                             m (EEG).
    95816  S                Electroencephalogra         0214         2.32      $115.06       $58.50       $23.01
                             m (EEG).
    95819  S                Electroencephalogra         0214         2.32      $115.06       $58.50       $23.01
                             m (EEG).
    95822  S                Sleep                       0214         2.32      $115.06       $58.50       $23.01
                             electroencephalogr
                             am.
    95824  S                Electroencephalogra         0214         2.32      $115.06       $58.50       $23.01
                             phy.
    95827  S                Night                       0213        11.15      $553.00      $290.42      $110.60
                             electroencephalogr
                             am.
    95829  S                Surgery                     0214         2.32      $115.06       $58.50       $23.01
                             electrocorticogram.
    95830  E                Insert electrodes    ...........  ...........  ...........  ...........  ...........
                             for EEG.
    95831  N                Limb muscle          ...........  ...........  ...........  ...........  ...........
                             testing, manual.
    95832  N                Hand muscle          ...........  ...........  ...........  ...........  ...........
                             testing, manual.
    95833  N                Body muscle          ...........  ...........  ...........  ...........  ...........
                             testing, manual.
    95834  N                Body muscle          ...........  ...........  ...........  ...........  ...........
                             testing, manual.
    95851  N                Range of motion      ...........  ...........  ...........  ...........  ...........
                             measurements.
    95852  N                Range of motion      ...........  ...........  ...........  ...........  ...........
                             measurements.
    95857  S                Tensilon test......         0215         1.15       $57.04       $30.05       $11.41
    95858  S                Tensilon test &             0215         1.15       $57.04       $30.05       $11.41
                             myogram.
    95860  S                Muscle test, one            0215         1.15       $57.04       $30.05       $11.41
                             limb.
    95861  S                Muscle test, two            0215         1.15       $57.04       $30.05       $11.41
                             limbs.
    95863  S                Muscle test, 3              0216         2.87      $142.34       $64.69       $28.47
                             limbs.
    95864  S                Muscle test, 4              0215         1.15       $57.04       $30.05       $11.41
                             limbs.
    95867  S                Muscle test, head           0216         2.87      $142.34       $64.69       $28.47
                             or neck.
    95868  S                Muscle test, head           0216         2.87      $142.34       $64.69       $28.47
                             or neck.
    95869  S                Muscle test, thor           0215         1.15       $57.04       $30.05       $11.41
                             paraspinal.
    95870  S                Muscle test,                0215         1.15       $57.04       $30.05       $11.41
                             nonparaspinal.
    95872  S                Muscle test, one            0215         1.15       $57.04       $30.05       $11.41
                             fiber.
    95875  S                Limb exercise test.         0217         5.87      $291.13      $156.68       $58.23
    95900  S                Motor nerve                 0215         1.15       $57.04       $30.05       $11.41
                             conduction test.
    95903  S                Motor nerve                 0215         1.15       $57.04       $30.05       $11.41
                             conduction test.
    95904  S                Sense/mixed n               0215         1.15       $57.04       $30.05       $11.41
                             conduction tst.
    95920  S                Intraop nerve test          0216         2.87      $142.34       $64.69       $28.47
                             add-on.

[[Page 67943]]

 
    95921  S                Autonomic nerv              0216         2.87      $142.34       $64.69       $28.47
                             function test.
    95922  S                Autonomic nerv              0216         2.87      $142.34       $64.69       $28.47
                             function test.
    95923  S                Autonomic nerv              0216         2.87      $142.34       $64.69       $28.47
                             function test.
    95925  S                Somatosensory               0216         2.87      $142.34       $64.69       $28.47
                             testing.
    95926  S                Somatosensory               0216         2.87      $142.34       $64.69       $28.47
                             testing.
    95927  S                Somatosensory               0216         2.87      $142.34       $64.69       $28.47
                             testing.
    95930  S                Visual evoked               0216         2.87      $142.34       $64.69       $28.47
                             potential test.
    95933  S                Blink reflex test..         0215         1.15       $57.04       $30.05       $11.41
    95934  S                H-reflex test......         0215         1.15       $57.04       $30.05       $11.41
    95936  S                H-reflex test......         0216         2.87      $142.34       $64.69       $28.47
    95937  S                Neuromuscular               0215         1.15       $57.04       $30.05       $11.41
                             junction test.
    95950  S                Ambulatory eeg              0217         5.87      $291.13      $156.68       $58.23
                             monitoring.
    95951  S                EEG monitoring/             0213        11.15      $553.00      $290.42      $110.60
                             videorecord.
    95953  S                EEG monitoring/             0213        11.15      $553.00      $290.42      $110.60
                             computer.
    95954  S                EEG monitoring/             0213        11.15      $553.00      $290.42      $110.60
                             giving drugs.
    95955  S                EEG during surgery.         0214         2.32      $115.06       $58.50       $23.01
    95956  N                Eeg monitoring,      ...........  ...........  ...........  ...........  ...........
                             cable/radio.
    95957  N                EEG digital          ...........  ...........  ...........  ...........  ...........
                             analysis.
    95958  S                EEG monitoring/             0213        11.15      $553.00      $290.42      $110.60
                             function test.
    95961  S                Electrode                   0216         2.87      $142.34       $64.69       $28.47
                             stimulation, brain.
    95962  S                Electrode stim,             0216         2.87      $142.34       $64.69       $28.47
                             brain add-on.
    95970  S                Analyze neurostim,          0102         0.45       $22.32       $12.62        $4.46
                             no prog.
    95971  S                Analyze neurostim,          0102         0.45       $22.32       $12.62        $4.46
                             simple.
    95972  S                Analyze neurostim,          0102         0.45       $22.32       $12.62        $4.46
                             complex.
    95973  S                Analyze neurostim,          0102         0.45       $22.32       $12.62        $4.46
                             complex.
    95974  S                Cranial neurostim,          0102         0.45       $22.32       $12.62        $4.46
                             complex.
    95975  S                Cranial neurostim,          0102         0.45       $22.32       $12.62        $4.46
                             complex.
    95999  N                Neurological         ...........  ...........  ...........  ...........  ...........
                             procedure.
    96100  X                Psychological               0373         3.21      $159.20       $44.96       $31.84
                             testing.
    96105  X                Assessment of               0373         3.21      $159.20       $44.96       $31.84
                             aphasia.
    96110  X                Developmental test,         0373         3.21      $159.20       $44.96       $31.84
                             lim.
    96111  X                Developmental test,         0373         3.21      $159.20       $44.96       $31.84
                             extend.
    96115  X                Neurobehavior               0373         3.21      $159.20       $44.96       $31.84
                             status exam.
    96117  X                Neuropsych test             0373         3.21      $159.20       $44.96       $31.84
                             battery.
    96400  E                Chemotherapy, sc/im  ...........  ...........  ...........  ...........  ...........
    96405  E                Intralesional chemo  ...........  ...........  ...........  ...........  ...........
                             admin.
    96406  E                Intralesional chemo  ...........  ...........  ...........  ...........  ...........
                             admin.
    96408  E                Chemotherapy, push   ...........  ...........  ...........  ...........  ...........
                             technique.
    96410  E                Chemotherapy,infusi  ...........  ...........  ...........  ...........  ...........
                             on method.
    96412  E                Chemo, infuse        ...........  ...........  ...........  ...........  ...........
                             method add-on.
    96414  E                Chemo, infuse        ...........  ...........  ...........  ...........  ...........
                             method add-on.
    96420  E                Chemotherapy, push   ...........  ...........  ...........  ...........  ...........
                             technique.
    96422  E                Chemotherapy,infusi  ...........  ...........  ...........  ...........  ...........
                             on method.
    96423  E                Chemo, infuse        ...........  ...........  ...........  ...........  ...........
                             method add-on.
    96425  E                Chemotherapy,infusi  ...........  ...........  ...........  ...........  ...........
                             on method.
    96440  E                Chemotherapy,        ...........  ...........  ...........  ...........  ...........
                             intracavitary.
    96445  E                Chemotherapy,        ...........  ...........  ...........  ...........  ...........
                             intracavitary.
    96450  E                Chemotherapy, into   ...........  ...........  ...........  ...........  ...........
                             CNS.
    96520  E                Pump refilling,      ...........  ...........  ...........  ...........  ...........
                             maintenance.
    96530  E                Pump refilling,      ...........  ...........  ...........  ...........  ...........
                             maintenance.
    96542  E                Chemotherapy         ...........  ...........  ...........  ...........  ...........
                             injection.
    96545  E                Provide              ...........  ...........  ...........  ...........  ...........
                             chemotherapy agent.
    96549  E                Chemotherapy,        ...........  ...........  ...........  ...........  ...........
                             unspecified.
    96570  T                Photodynamic tx, 30         0973         5.16      $255.91  ...........       $51.18
                             min.
    96571  T                Photodynamic tx,            0973         5.16      $255.91  ...........       $51.18
                             addl 15 min.
    96900  S                Ultraviolet light           0001         0.47       $23.31        $8.49        $4.66
                             therapy.
    96902  N                Trichogram.........  ...........  ...........  ...........  ...........  ...........
    96910  S                Photochemotherapy           0001         0.47       $23.31        $8.49        $4.66
                             with UV-B.
    96912  S                Photochemotherapy           0001         0.47       $23.31        $8.49        $4.66
                             with UV-A.
    96913  S                Photochemotherapy,          0001         0.47       $23.31        $8.49        $4.66
                             UV-A or B.
    96999  S                Dermatological              0001         0.47       $23.31        $8.49        $4.66
                             procedure.
    97001  A                Pt evaluation......  ...........  ...........  ...........  ...........  ...........
    97002  A                Pt re-evaluation...  ...........  ...........  ...........  ...........  ...........
    97003  A                Ot evaluation......  ...........  ...........  ...........  ...........  ...........
    97004  A                Ot re-evaluation...  ...........  ...........  ...........  ...........  ...........
    97010  A                Hot or cold packs    ...........  ...........  ...........  ...........  ...........
                             therapy.
    97012  A                Mechanical traction  ...........  ...........  ...........  ...........  ...........
                             therapy.
    97014  A                Electric             ...........  ...........  ...........  ...........  ...........
                             stimulation
                             therapy.
    97016  A                Vasopneumatic        ...........  ...........  ...........  ...........  ...........
                             device therapy.
    97018  A                Paraffin bath        ...........  ...........  ...........  ...........  ...........
                             therapy.
    97020  A                Microwave therapy..  ...........  ...........  ...........  ...........  ...........
    97022  A                Whirlpool therapy..  ...........  ...........  ...........  ...........  ...........
    97024  A                Diathermy treatment  ...........  ...........  ...........  ...........  ...........
    97026  A                Infrared therapy...  ...........  ...........  ...........  ...........  ...........

[[Page 67944]]

 
    97028  A                Ultraviolet therapy  ...........  ...........  ...........  ...........  ...........
    97032  A                Electrical           ...........  ...........  ...........  ...........  ...........
                             stimulation.
    97033  A                Electric current     ...........  ...........  ...........  ...........  ...........
                             therapy.
    97034  A                Contrast bath        ...........  ...........  ...........  ...........  ...........
                             therapy.
    97035  A                Ultrasound therapy.  ...........  ...........  ...........  ...........  ...........
    97036  A                Hydrotherapy.......  ...........  ...........  ...........  ...........  ...........
    97039  A                Physical therapy     ...........  ...........  ...........  ...........  ...........
                             treatment.
    97110  A                Therapeutic          ...........  ...........  ...........  ...........  ...........
                             exercises.
    97112  A                Neuromuscular        ...........  ...........  ...........  ...........  ...........
                             reeducation.
    97113  A                Aquatic therapy/     ...........  ...........  ...........  ...........  ...........
                             exercises.
    97116  A                Gait training        ...........  ...........  ...........  ...........  ...........
                             therapy.
    97124  A                Massage therapy....  ...........  ...........  ...........  ...........  ...........
    97139  A                Physical medicine    ...........  ...........  ...........  ...........  ...........
                             procedure.
    97140  A                Manual therapy.....  ...........  ...........  ...........  ...........  ...........
    97150  A                Group therapeutic    ...........  ...........  ...........  ...........  ...........
                             procedures.
    97504  A                Orthotic training..  ...........  ...........  ...........  ...........  ...........
    97520  A                Prosthetic training  ...........  ...........  ...........  ...........  ...........
    97530  A                Therapeutic          ...........  ...........  ...........  ...........  ...........
                             activities.
   *97532  A                Cognitive skills     ...........  ...........  ...........  ...........  ...........
                             development.
   *97533  A                Sensory integration  ...........  ...........  ...........  ...........  ...........
    97535  A                Self care mngment    ...........  ...........  ...........  ...........  ...........
                             training.
    97537  A                Community/work       ...........  ...........  ...........  ...........  ...........
                             reintegration.
    97542  A                Wheelchair mngment   ...........  ...........  ...........  ...........  ...........
                             training.
    97545  A                Work hardening.....  ...........  ...........  ...........  ...........  ...........
    97546  A                Work hardening add-  ...........  ...........  ...........  ...........  ...........
                             on.
   *97601  A                Wound care           ...........  ...........  ...........  ...........  ...........
                             selective.
   *97602  N                Wound care non-      ...........  ...........  ...........  ...........  ...........
                             selective.
    97703  A                Prosthetic checkout  ...........  ...........  ...........  ...........  ...........
    97750  A                Physical             ...........  ...........  ...........  ...........  ...........
                             performance test.
   97770D  A                Cognitive skills     ...........  ...........  ...........  ...........  ...........
                             development.
    97780  E                Acupuncture w/o      ...........  ...........  ...........  ...........  ...........
                             stimul.
    97781  E                Acupuncture w/       ...........  ...........  ...........  ...........  ...........
                             stimul.
    97799  A                Physical medicine    ...........  ...........  ...........  ...........  ...........
                             procedure.
   *97802  E                Medical nutrition..  ...........  ...........  ...........  ...........  ...........
   *97803  E                Medical nutrition..  ...........  ...........  ...........  ...........  ...........
   *97804  E                Medical nutrition..  ...........  ...........  ...........  ...........  ...........
    98925  S                Osteopathic                 0060         0.77       $38.19        $7.80        $7.64
                             manipulation.
    98926  S                Osteopathic                 0060         0.77       $38.19        $7.80        $7.64
                             manipulation.
    98927  S                Osteopathic                 0060         0.77       $38.19        $7.80        $7.64
                             manipulation.
    98928  S                Osteopathic                 0060         0.77       $38.19        $7.80        $7.64
                             manipulation.
    98929  S                Osteopathic                 0060         0.77       $38.19        $7.80        $7.64
                             manipulation.
    98940  S                Chiropractic                0060         0.77       $38.19        $7.80        $7.64
                             manipulation.
    98941  S                Chiropractic                0060         0.77       $38.19        $7.80        $7.64
                             manipulation.
    98942  S                Chiropractic                0060         0.77       $38.19        $7.80        $7.64
                             manipulation.
    98943  E                Chiropractic         ...........  ...........  ...........  ...........  ...........
                             manipulation.
    99000  E                Specimen handling..  ...........  ...........  ...........  ...........  ...........
    99001  E                Specimen handling..  ...........  ...........  ...........  ...........  ...........
    99002  E                Device handling....  ...........  ...........  ...........  ...........  ...........
    99024  E                Postop follow-up     ...........  ...........  ...........  ...........  ...........
                             visit.
    99025  E                Initial surgical     ...........  ...........  ...........  ...........  ...........
                             evaluation.
    99050  E                Medical services     ...........  ...........  ...........  ...........  ...........
                             after hrs.
    99052  E                Medical services at  ...........  ...........  ...........  ...........  ...........
                             night.
    99054  E                Medical servcs,      ...........  ...........  ...........  ...........  ...........
                             unusual hrs.
    99056  E                Non-office medical   ...........  ...........  ...........  ...........  ...........
                             services.
    99058  E                Office emergency     ...........  ...........  ...........  ...........  ...........
                             care.
    99070  E                Special supplies...  ...........  ...........  ...........  ...........  ...........
    99071  E                Patient education    ...........  ...........  ...........  ...........  ...........
                             materials.
    99075  E                Medical testimony..  ...........  ...........  ...........  ...........  ...........
    99078  E                Group health         ...........  ...........  ...........  ...........  ...........
                             education.
    99080  E                Special reports or   ...........  ...........  ...........  ...........  ...........
                             forms.
    99082  E                Unusual physician    ...........  ...........  ...........  ...........  ...........
                             travel.
    99090  E                Computer data        ...........  ...........  ...........  ...........  ...........
                             analysis.
    99100  E                Special anesthesia   ...........  ...........  ...........  ...........  ...........
                             service.
    99116  E                Anesthesia with      ...........  ...........  ...........  ...........  ...........
                             hypothermia.
    99135  E                Special anesthesia   ...........  ...........  ...........  ...........  ...........
                             procedure.
    99140  E                Emergency            ...........  ...........  ...........  ...........  ...........
                             anesthesia.
    99141  N                Sedation, iv/im or   ...........  ...........  ...........  ...........  ...........
                             inhalant.
    99142  N                Sedation, oral/      ...........  ...........  ...........  ...........  ...........
                             rectal/nasal.
    99170  T                Anogenital exam,            0192         2.38      $118.04       $35.33       $23.61
                             child.
   *99172  E                Visual function      ...........  ...........  ...........  ...........  ...........
                             screening.
    99173  E                Visual screening     ...........  ...........  ...........  ...........  ...........
                             test.
    99175  N                Induction of         ...........  ...........  ...........  ...........  ...........
                             vomiting.
    99183  E                Hyperbaric oxygen    ...........  ...........  ...........  ...........  ...........
                             therapy.
    99185  N                Regional             ...........  ...........  ...........  ...........  ...........
                             hypothermia.

[[Page 67945]]

 
    99186  N                Total body           ...........  ...........  ...........  ...........  ...........
                             hypothermia.
    99190  C                Special pump         ...........  ...........  ...........  ...........  ...........
                             services.
    99191  C                Special pump         ...........  ...........  ...........  ...........  ...........
                             services.
    99192  C                Special pump         ...........  ...........  ...........  ...........  ...........
                             services.
    99195  X                Phlebotomy.........         0372         0.43       $21.33       $10.09        $4.27
    99199  E                Special service/     ...........  ...........  ...........  ...........  ...........
                             proc/report.
    99201  V                Office/outpatient           0600         0.98       $48.61        $9.72        $9.72
                             visit, new.
    99202  V                Office/outpatient           0600         0.98       $48.61        $9.72        $9.72
                             visit, new.
    99203  V                Office/outpatient           0601         1.00       $49.60        $9.92        $9.92
                             visit, new.
    99204  V                Office/outpatient           0602         1.66       $82.33       $16.47       $16.47
                             visit, new.
    99205  V                Office/outpatient           0602         1.66       $82.33       $16.47       $16.47
                             visit, new.
    99211  V                Office/outpatient           0600         0.98       $48.61        $9.72        $9.72
                             visit, est.
    99212  V                Office/outpatient           0600         0.98       $48.61        $9.72        $9.72
                             visit, est.
    99213  V                Office/outpatient           0601         1.00       $49.60        $9.92        $9.92
                             visit, est.
    99214  V                Office/outpatient           0602         1.66       $82.33       $16.47       $16.47
                             visit, est.
    99215  V                Office/outpatient           0602         1.66       $82.33       $16.47       $16.47
                             visit, est.
    99217  N                Observation care     ...........  ...........  ...........  ...........  ...........
                             discharge.
    99218  N                Observation care...  ...........  ...........  ...........  ...........  ...........
    99219  N                Observation care...  ...........  ...........  ...........  ...........  ...........
    99220  N                Observation care...  ...........  ...........  ...........  ...........  ...........
    99221  E                Initial hospital     ...........  ...........  ...........  ...........  ...........
                             care.
    99222  E                Initial hospital     ...........  ...........  ...........  ...........  ...........
                             care.
    99223  E                Initial hospital     ...........  ...........  ...........  ...........  ...........
                             care.
    99231  E                Subsequent hospital  ...........  ...........  ...........  ...........  ...........
                             care.
    99232  E                Subsequent hospital  ...........  ...........  ...........  ...........  ...........
                             care.
    99233  E                Subsequent hospital  ...........  ...........  ...........  ...........  ...........
                             care.
    99234  N                Observ/hosp same     ...........  ...........  ...........  ...........  ...........
                             date.
    99235  N                Observ/hosp same     ...........  ...........  ...........  ...........  ...........
                             date.
    99236  N                Observ/hosp same     ...........  ...........  ...........  ...........  ...........
                             date.
    99238  E                Hospital discharge   ...........  ...........  ...........  ...........  ...........
                             day.
    99239  E                Hospital discharge   ...........  ...........  ...........  ...........  ...........
                             day.
    99241  V                Office consultation         0600         0.98       $48.61        $9.72        $9.72
    99242  V                Office consultation         0600         0.98       $48.61        $9.72        $9.72
    99243  V                Office consultation         0601         1.00       $49.60        $9.92        $9.92
    99244  V                Office consultation         0602         1.66       $82.33       $16.47       $16.47
    99245  V                Office consultation         0602         1.66       $82.33       $16.47       $16.47
    99251  C                Initial inpatient    ...........  ...........  ...........  ...........  ...........
                             consult.
    99252  C                Initial inpatient    ...........  ...........  ...........  ...........  ...........
                             consult.
    99253  C                Initial inpatient    ...........  ...........  ...........  ...........  ...........
                             consult.
    99254  C                Initial inpatient    ...........  ...........  ...........  ...........  ...........
                             consult.
    99255  C                Initial inpatient    ...........  ...........  ...........  ...........  ...........
                             consult.
    99261  C                Follow-up inpatient  ...........  ...........  ...........  ...........  ...........
                             consult.
    99262  C                Follow-up inpatient  ...........  ...........  ...........  ...........  ...........
                             consult.
    99263  C                Follow-up inpatient  ...........  ...........  ...........  ...........  ...........
                             consult.
    99271  V                Confirmatory                0600         0.98       $48.61        $9.72        $9.72
                             consultation.
    99272  V                Confirmatory                0600         0.98       $48.61        $9.72        $9.72
                             consultation.
    99273  V                Confirmatory                0601         1.00       $49.60        $9.92        $9.92
                             consultation.
    99274  V                Confirmatory                0602         1.66       $82.33       $16.47       $16.47
                             consultation.
    99275  V                Confirmatory                0602         1.66       $82.33       $16.47       $16.47
                             consultation.
    99281  V                Emergency dept              0610         1.34       $66.46       $20.65       $13.29
                             visit.
    99282  V                Emergency dept              0610         1.34       $66.46       $20.65       $13.29
                             visit.
    99283  V                Emergency dept              0611         2.11      $104.65       $36.47       $20.93
                             visit.
    99284  V                Emergency dept              0612         3.19      $158.21       $54.14       $31.64
                             visit.
    99285  V                Emergency dept              0612         3.19      $158.21       $54.14       $31.64
                             visit.
    99288  E                Direct advanced      ...........  ...........  ...........  ...........  ...........
                             life support.
    99291  S                Critical care,              0620         8.60      $426.53      $152.78       $85.31
                             first hour.
    99292  N                Critical care, addl  ...........  ...........  ...........  ...........  ...........
                             30 min.
    99295  C                Neonatal critical    ...........  ...........  ...........  ...........  ...........
                             care.
    99296  C                Neonatal critical    ...........  ...........  ...........  ...........  ...........
                             care.
    99297  C                Neonatal critical    ...........  ...........  ...........  ...........  ...........
                             care.
    99298  C                Neonatal critical    ...........  ...........  ...........  ...........  ...........
                             care.
    99301  E                Nursing facility     ...........  ...........  ...........  ...........  ...........
                             care.
    99302  E                Nursing facility     ...........  ...........  ...........  ...........  ...........
                             care.
    99303  E                Nursing facility     ...........  ...........  ...........  ...........  ...........
                             care.
    99311  E                Nursing fac care,    ...........  ...........  ...........  ...........  ...........
                             subseq.
    99312  E                Nursing fac care,    ...........  ...........  ...........  ...........  ...........
                             subseq.
    99313  E                Nursing fac care,    ...........  ...........  ...........  ...........  ...........
                             subseq.
    99315  E                Nursing fac          ...........  ...........  ...........  ...........  ...........
                             discharge day.
    99316  E                Nursing fac          ...........  ...........  ...........  ...........  ...........
                             discharge day.
    99321  E                Rest home visit,     ...........  ...........  ...........  ...........  ...........
                             new patient.
    99322  E                Rest home visit,     ...........  ...........  ...........  ...........  ...........
                             new patient.
    99323  E                Rest home visit,     ...........  ...........  ...........  ...........  ...........
                             new patient.
    99331  E                Rest home visit,     ...........  ...........  ...........  ...........  ...........
                             est pat.
    99332  E                Rest home visit,     ...........  ...........  ...........  ...........  ...........
                             est pat.

[[Page 67946]]

 
    99333  E                Rest home visit,     ...........  ...........  ...........  ...........  ...........
                             est pat.
    99341  E                Home visit, new      ...........  ...........  ...........  ...........  ...........
                             patient.
    99342  E                Home visit, new      ...........  ...........  ...........  ...........  ...........
                             patient.
    99343  E                Home visit, new      ...........  ...........  ...........  ...........  ...........
                             patient.
    99344  E                Home visit, new      ...........  ...........  ...........  ...........  ...........
                             patient.
    99345  E                Home visit, new      ...........  ...........  ...........  ...........  ...........
                             patient.
    99347  E                Home visit, est      ...........  ...........  ...........  ...........  ...........
                             patient.
    99348  E                Home visit, est      ...........  ...........  ...........  ...........  ...........
                             patient.
    99349  E                Home visit, est      ...........  ...........  ...........  ...........  ...........
                             patient.
    99350  E                Home visit, est      ...........  ...........  ...........  ...........  ...........
                             patient.
    99354  N                Prolonged service,   ...........  ...........  ...........  ...........  ...........
                             office.
    99355  N                Prolonged service,   ...........  ...........  ...........  ...........  ...........
                             office.
    99356  C                Prolonged service,   ...........  ...........  ...........  ...........  ...........
                             inpatient.
    99357  C                Prolonged service,   ...........  ...........  ...........  ...........  ...........
                             inpatient.
    99358  N                Prolonged serv, w/o  ...........  ...........  ...........  ...........  ...........
                             contact.
    99359  N                Prolonged serv, w/o  ...........  ...........  ...........  ...........  ...........
                             contact.
    99360  E                Physician standby    ...........  ...........  ...........  ...........  ...........
                             services.
    99361  E                Physician/team       ...........  ...........  ...........  ...........  ...........
                             conference.
    99362  E                Physician/team       ...........  ...........  ...........  ...........  ...........
                             conference.
    99371  E                Physician phone      ...........  ...........  ...........  ...........  ...........
                             consultation.
    99372  E                Physician phone      ...........  ...........  ...........  ...........  ...........
                             consultation.
    99373  E                Physician phone      ...........  ...........  ...........  ...........  ...........
                             consultation.
    99374  E                Home health care     ...........  ...........  ...........  ...........  ...........
                             supervision.
   99375D  E                Home health care     ...........  ...........  ...........  ...........  ...........
                             supervision.
    99377  E                Hospice care         ...........  ...........  ...........  ...........  ...........
                             supervision.
   99378D  E                Hospice care         ...........  ...........  ...........  ...........  ...........
                             supervision.
    99379  E                Nursing fac care     ...........  ...........  ...........  ...........  ...........
                             supervision.
    99380  E                Nursing fac care     ...........  ...........  ...........  ...........  ...........
                             supervision.
    99381  E                Prev visit, new,     ...........  ...........  ...........  ...........  ...........
                             infant.
    99382  E                Prev visit, new,     ...........  ...........  ...........  ...........  ...........
                             age 1-4.
    99383  E                Prev visit, new,     ...........  ...........  ...........  ...........  ...........
                             age 5-11.
    99384  E                Prev visit, new,     ...........  ...........  ...........  ...........  ...........
                             age 12-17.
    99385  E                Prev visit, new,     ...........  ...........  ...........  ...........  ...........
                             age 18-39.
    99386  E                Prev visit, new,     ...........  ...........  ...........  ...........  ...........
                             age 40-64.
    99387  E                Prev visit, new, 65  ...........  ...........  ...........  ...........  ...........
                             & over.
    99391  E                Prev visit, est,     ...........  ...........  ...........  ...........  ...........
                             infant.
    99392  E                Prev visit, est,     ...........  ...........  ...........  ...........  ...........
                             age 1-4.
    99393  E                Prev visit, est,     ...........  ...........  ...........  ...........  ...........
                             age 5-11.
    99394  E                Prev visit, est,     ...........  ...........  ...........  ...........  ...........
                             age 12-17.
    99395  E                Prev visit, est,     ...........  ...........  ...........  ...........  ...........
                             age 18-39.
    99396  E                Prev visit, est,     ...........  ...........  ...........  ...........  ...........
                             age 40-64.
    99397  E                Prev visit, est, 65  ...........  ...........  ...........  ...........  ...........
                             & over.
    99401  E                Preventive           ...........  ...........  ...........  ...........  ...........
                             counseling, indiv.
    99402  E                Preventive           ...........  ...........  ...........  ...........  ...........
                             counseling, indiv.
    99403  E                Preventive           ...........  ...........  ...........  ...........  ...........
                             counseling, indiv.
    99404  E                Preventive           ...........  ...........  ...........  ...........  ...........
                             counseling, indiv.
    99411  E                Preventive           ...........  ...........  ...........  ...........  ...........
                             counseling, group.
    99412  E                Preventive           ...........  ...........  ...........  ...........  ...........
                             counseling, group.
    99420  E                Health risk          ...........  ...........  ...........  ...........  ...........
                             assessment test.
    99429  E                Unlisted preventive  ...........  ...........  ...........  ...........  ...........
                             service.
    99431  N                Initial care,        ...........  ...........  ...........  ...........  ...........
                             normal newborn.
    99432  N                Newborn care, not    ...........  ...........  ...........  ...........  ...........
                             in hosp.
    99433  C                Normal newborn care/ ...........  ...........  ...........  ...........  ...........
                             hospital.
    99435  E                Newborn discharge    ...........  ...........  ...........  ...........  ...........
                             day hosp.
    99436  N                Attendance, birth..  ...........  ...........  ...........  ...........  ...........
    99440  S                Newborn                     0094         4.51      $223.68      $105.29       $44.74
                             resuscitation.
    99450  E                Life/disability      ...........  ...........  ...........  ...........  ...........
                             evaluation.
    99455  E                Disability           ...........  ...........  ...........  ...........  ...........
                             examination.
    99456  E                Disability           ...........  ...........  ...........  ...........  ...........
                             examination.
    99499  E                Unlisted e&m         ...........  ...........  ...........  ...........  ...........
                             service.
    A0021  E                Outside state        ...........  ...........  ...........  ...........  ...........
                             ambulance serv.
   A0030D  A                Air ambulance        ...........  ...........  ...........  ...........  ...........
                             service.
   A0040D  A                Helicopter           ...........  ...........  ...........  ...........  ...........
                             ambulance service.
   A0050D  A                Water amb service    ...........  ...........  ...........  ...........  ...........
                             emergency.
    A0080  E                Noninterest escort   ...........  ...........  ...........  ...........  ...........
                             in non er.
    A0090  E                Interest escort in   ...........  ...........  ...........  ...........  ...........
                             non er.
    A0100  E                Nonemergency         ...........  ...........  ...........  ...........  ...........
                             transport taxi.
    A0110  E                Nonemergency         ...........  ...........  ...........  ...........  ...........
                             transport bus.
    A0120  E                Noner transport      ...........  ...........  ...........  ...........  ...........
                             mini-bus.
    A0130  E                Noner transport      ...........  ...........  ...........  ...........  ...........
                             wheelch van.
    A0140  E                Nonemergency         ...........  ...........  ...........  ...........  ...........
                             transport air.
    A0160  E                Noner transport      ...........  ...........  ...........  ...........  ...........
                             case worker.
    A0170  E                Noner transport      ...........  ...........  ...........  ...........  ...........
                             parking fees.
    A0180  E                Noner transport      ...........  ...........  ...........  ...........  ...........
                             lodgng recip.

[[Page 67947]]

 
    A0190  E                Noner transport      ...........  ...........  ...........  ...........  ...........
                             meals recip.
    A0200  E                Noner transport      ...........  ...........  ...........  ...........  ...........
                             lodgng escrt.
    A0210  E                Noner transport      ...........  ...........  ...........  ...........  ...........
                             meals escort.
    A0225  A                Neonatal emergency   ...........  ...........  ...........  ...........  ...........
                             transport.
   A0300D  A                Ambulance basic non- ...........  ...........  ...........  ...........  ...........
                             emer all.
   A0302D  A                Ambulance basic      ...........  ...........  ...........  ...........  ...........
                             emergeny all.
   A0304D  A                Amb adv non-er no    ...........  ...........  ...........  ...........  ...........
                             serv all.
   A0306D  A                Amb adv non-er spec  ...........  ...........  ...........  ...........  ...........
                             serv all.
   A0308D  A                Amb adv er no spec   ...........  ...........  ...........  ...........  ...........
                             serv all.
   A0310D  A                Amb adv er spec      ...........  ...........  ...........  ...........  ...........
                             serv all.
   A0320D  A                Amb basic non-er +   ...........  ...........  ...........  ...........  ...........
                             supplies.
   A0322D  A                Amb basic emerg +    ...........  ...........  ...........  ...........  ...........
                             supplies.
   A0324D  A                Adv non-er serv sep  ...........  ...........  ...........  ...........  ...........
                             mileage.
   A0326D  A                Adv non-er no serv   ...........  ...........  ...........  ...........  ...........
                             sep mile.
   A0328D  A                Adv er no serv sep   ...........  ...........  ...........  ...........  ...........
                             mileage.
   A0330D  A                Adv er spec serv     ...........  ...........  ...........  ...........  ...........
                             sep mile.
   A0340D  A                Amb basic non-er +   ...........  ...........  ...........  ...........  ...........
                             mileage.
   A0342D  A                Ambul basic emer +   ...........  ...........  ...........  ...........  ...........
                             mileage.
   A0344D  A                Amb adv non-er no    ...........  ...........  ...........  ...........  ...........
                             serv +mile.
   A0346D  A                Amb adv non-er serv  ...........  ...........  ...........  ...........  ...........
                             + mile.
   A0348D  A                Adv emer no spec     ...........  ...........  ...........  ...........  ...........
                             serv + mile.
   A0350D  A                Adv emer spec serv   ...........  ...........  ...........  ...........  ...........
                             + mileage.
   A0360D  A                Basic non-er sep     ...........  ...........  ...........  ...........  ...........
                             mile & supp.
   A0362D  A                Basic emer sep mile  ...........  ...........  ...........  ...........  ...........
                             & supply.
   A0364D  A                Adv non-er no serv   ...........  ...........  ...........  ...........  ...........
                             sep mi&su.
   A0366D  A                Adv non-er serv sep  ...........  ...........  ...........  ...........  ...........
                             mil&supp.
    A0368  A                Adv er no serv sep   ...........  ...........  ...........  ...........  ...........
                             mile&supp.
   A0370D  A                Adv er spec serv     ...........  ...........  ...........  ...........  ...........
                             sep mi&supp.
   A0380D  A                Basic life support   ...........  ...........  ...........  ...........  ...........
                             mileage.
    A0382  A                Basic support        ...........  ...........  ...........  ...........  ...........
                             routine suppls.
    A0384  A                Bls defibrillation   ...........  ...........  ...........  ...........  ...........
                             supplies.
   A0390D  A                Advanced life        ...........  ...........  ...........  ...........  ...........
                             support mileag.
    A0392  A                Als defibrillation   ...........  ...........  ...........  ...........  ...........
                             supplies.
    A0394  A                Als IV drug therapy  ...........  ...........  ...........  ...........  ...........
                             supplies.
    A0396  A                Als esophageal       ...........  ...........  ...........  ...........  ...........
                             intub suppls.
    A0398  A                Als routine          ...........  ...........  ...........  ...........  ...........
                             disposble suppls.
    A0420  A                Ambulance waiting 1/ ...........  ...........  ...........  ...........  ...........
                             2 hr.
    A0422  A                Ambulance O2 life    ...........  ...........  ...........  ...........  ...........
                             sustaining.
    A0424  A                Extra ambulance      ...........  ...........  ...........  ...........  ...........
                             attendant.
    A0425  A                Ground mileage.....  ...........  ...........  ...........  ...........  ...........
    A0426  A                Als 1..............  ...........  ...........  ...........  ...........  ...........
    A0427  A                ALS1-emergency.....  ...........  ...........  ...........  ...........  ...........
    A0428  A                bls................  ...........  ...........  ...........  ...........  ...........
    A0429  A                BLS-emergency......  ...........  ...........  ...........  ...........  ...........
    A0430  A                Fixed wing air       ...........  ...........  ...........  ...........  ...........
                             transport.
    A0431  A                Rotary wing air      ...........  ...........  ...........  ...........  ...........
                             transport.
    A0432  A                PI volunteer         ...........  ...........  ...........  ...........  ...........
                             ambulance co.
    A0433  A                als 2..............  ...........  ...........  ...........  ...........  ...........
    A0434  A                Specialty care       ...........  ...........  ...........  ...........  ...........
                             transport.
    A0435  A                Fixed wing air       ...........  ...........  ...........  ...........  ...........
                             mileage.
    A0436  A                Rotary wing air      ...........  ...........  ...........  ...........  ...........
                             mileage.
    A0888  E                Noncovered           ...........  ...........  ...........  ...........  ...........
                             ambulance mileage.
    A0999  A                Unlisted ambulance   ...........  ...........  ...........  ...........  ...........
                             service.
    A4206  E                1 CC sterile         ...........  ...........  ...........  ...........  ...........
                             syringe&needle.
    A4207  E                2 CC sterile         ...........  ...........  ...........  ...........  ...........
                             syringe&needle.
    A4208  E                3 CC sterile         ...........  ...........  ...........  ...........  ...........
                             syringe&needle.
    A4209  E                5+ CC sterile        ...........  ...........  ...........  ...........  ...........
                             syringe&needle.
    A4210  E                Nonneedle injection  ...........  ...........  ...........  ...........  ...........
                             device.
    A4211  E                Supp for self-adm    ...........  ...........  ...........  ...........  ...........
                             injections.
    A4212  E                Non coring needle    ...........  ...........  ...........  ...........  ...........
                             or stylet.
    A4213  E                20+ CC syringe only  ...........  ...........  ...........  ...........  ...........
    A4214  A                30 CC sterile water/ ...........  ...........  ...........  ...........  ...........
                             saline.
    A4215  E                Sterile needle.....  ...........  ...........  ...........  ...........  ...........
    A4220  E                Infusion pump        ...........  ...........  ...........  ...........  ...........
                             refill kit.
    A4221  A                Maint drug infus     ...........  ...........  ...........  ...........  ...........
                             cath per wk.
    A4222  A                Drug infusion pump   ...........  ...........  ...........  ...........  ...........
                             supplies.
    A4230  A                Infus insulin pump   ...........  ...........  ...........  ...........  ...........
                             non needl.
    A4231  A                Infusion insulin     ...........  ...........  ...........  ...........  ...........
                             pump needle.
    A4232  A                Syringe w/needle     ...........  ...........  ...........  ...........  ...........
                             insulin 3cc.
    A4244  E                Alcohol or peroxide  ...........  ...........  ...........  ...........  ...........
                             per pint.
    A4245  E                Alcohol wipes per    ...........  ...........  ...........  ...........  ...........
                             box.
    A4246  E                Betadine/phisohex    ...........  ...........  ...........  ...........  ...........
                             solution.
    A4247  E                Betadine/iodine      ...........  ...........  ...........  ...........  ...........
                             swabs/wipes.
    A4250  E                Urine reagent        ...........  ...........  ...........  ...........  ...........
                             strips/tablets.

[[Page 67948]]

 
    A4253  A                Blood glucose/       ...........  ...........  ...........  ...........  ...........
                             reagent strips.
    A4254  A                Battery for glucose  ...........  ...........  ...........  ...........  ...........
                             monitor.
    A4255  A                Glucose monitor      ...........  ...........  ...........  ...........  ...........
                             platforms.
    A4256  A                Calibrator solution/ ...........  ...........  ...........  ...........  ...........
                             chips.
    A4258  A                Lancet device each.  ...........  ...........  ...........  ...........  ...........
    A4259  A                Lancets per box....  ...........  ...........  ...........  ...........  ...........
    A4260  E                Levonorgestrel       ...........  ...........  ...........  ...........  ...........
                             implant.
    A4261  E                Cervical cap         ...........  ...........  ...........  ...........  ...........
                             contraceptive.
    A4262  N                Temporary tear duct  ...........  ...........  ...........  ...........  ...........
                             plug.
    A4263  N                Permanent tear duct  ...........  ...........  ...........  ...........  ...........
                             plug.
    A4265  A                Paraffin...........  ...........  ...........  ...........  ...........  ...........
    A4270  A                Disposable           ...........  ...........  ...........  ...........  ...........
                             endoscope sheath.
    A4280  A                Brst prsths adhsv    ...........  ...........  ...........  ...........  ...........
                             attchmnt.
    A4290  N                Sacral nerve stim    ...........  ...........  ...........  ...........  ...........
                             test lead.
    A4300  A                Cath impl vasc       ...........  ...........  ...........  ...........  ...........
                             access portal.
    A4301  A                Implantable access   ...........  ...........  ...........  ...........  ...........
                             syst perc.
    A4305  A                Drug delivery        ...........  ...........  ...........  ...........  ...........
                             system >=50 ML.
    A4306  A                Drug delivery        ...........  ...........  ...........  ...........  ...........
                             system =5 ML.
    A4310  A                Insert tray w/o bag/ ...........  ...........  ...........  ...........  ...........
                             cath.
    A4311  A                Catheter w/o bag 2-  ...........  ...........  ...........  ...........  ...........
                             way latex.
    A4312  A                Cath w/o bag 2-way   ...........  ...........  ...........  ...........  ...........
                             silicone.
    A4313  A                Catheter w/bag 3-    ...........  ...........  ...........  ...........  ...........
                             way.
    A4314  A                Cath w/drainage 2-   ...........  ...........  ...........  ...........  ...........
                             way latex.
    A4315  A                Cath w/drainage 2-   ...........  ...........  ...........  ...........  ...........
                             way silcne.
    A4316  A                Cath w/drainage 3-   ...........  ...........  ...........  ...........  ...........
                             way.
    A4319  A                Sterile H2O          ...........  ...........  ...........  ...........  ...........
                             irrigation solut.
    A4320  A                Irrigation tray....  ...........  ...........  ...........  ...........  ...........
    A4321  A                Cath therapeutic     ...........  ...........  ...........  ...........  ...........
                             irrig agent.
    A4322  A                Irrigation syringe.  ...........  ...........  ...........  ...........  ...........
    A4323  A                Saline irrigation    ...........  ...........  ...........  ...........  ...........
                             solution.
    A4324  A                Male ext cath w/adh  ...........  ...........  ...........  ...........  ...........
                             coating.
    A4325  A                Male ext cath w/adh  ...........  ...........  ...........  ...........  ...........
                             strip.
    A4326  A                Male external        ...........  ...........  ...........  ...........  ...........
                             catheter.
    A4327  A                Fem urinary collect  ...........  ...........  ...........  ...........  ...........
                             dev cup.
    A4328  A                Fem urinary collect  ...........  ...........  ...........  ...........  ...........
                             pouch.
    A4329  A                External catheter    ...........  ...........  ...........  ...........  ...........
                             start set.
    A4330  A                Stool collection     ...........  ...........  ...........  ...........  ...........
                             pouch.
    A4331  A                Extension drainage   ...........  ...........  ...........  ...........  ...........
                             tubing.
    A4332  A                Lubricant for cath   ...........  ...........  ...........  ...........  ...........
                             insertion.
    A4333  A                Urinary cath anchor  ...........  ...........  ...........  ...........  ...........
                             device.
    A4334  A                Urinary cath leg     ...........  ...........  ...........  ...........  ...........
                             strap.
    A4335  A                Incontinence supply  ...........  ...........  ...........  ...........  ...........
    A4338  A                Indwelling catheter  ...........  ...........  ...........  ...........  ...........
                             latex.
    A4340  A                Indwelling catheter  ...........  ...........  ...........  ...........  ...........
                             special.
    A4344  A                Cath indw foley 2    ...........  ...........  ...........  ...........  ...........
                             way silicn.
    A4346  A                Cath indw foley 3    ...........  ...........  ...........  ...........  ...........
                             way.
    A4347  A                Male external        ...........  ...........  ...........  ...........  ...........
                             catheter.
    A4348  A                Male ext cath        ...........  ...........  ...........  ...........  ...........
                             extended wear.
    A4351  A                Straight tip urine   ...........  ...........  ...........  ...........  ...........
                             catheter.
    A4352  A                Coude tip urinary    ...........  ...........  ...........  ...........  ...........
                             catheter.
    A4353  A                Intermittent         ...........  ...........  ...........  ...........  ...........
                             urinary cath.
    A4354  A                Cath insertion tray  ...........  ...........  ...........  ...........  ...........
                             w/bag.
    A4355  A                Bladder irrigation   ...........  ...........  ...........  ...........  ...........
                             tubing.
    A4356  A                Ext ureth clmp or    ...........  ...........  ...........  ...........  ...........
                             compr dvc.
    A4357  A                Bedside drainage     ...........  ...........  ...........  ...........  ...........
                             bag.
    A4358  A                Urinary leg bag....  ...........  ...........  ...........  ...........  ...........
    A4359  A                Urinary suspensory   ...........  ...........  ...........  ...........  ...........
                             w/o leg b.
    A4361  A                Ostomy face plate..  ...........  ...........  ...........  ...........  ...........
    A4362  A                Solid skin barrier.  ...........  ...........  ...........  ...........  ...........
    A4364  A                Ostomy/cath          ...........  ...........  ...........  ...........  ...........
                             adhesive.
    A4365  A                Ostomy adhesive      ...........  ...........  ...........  ...........  ...........
                             remover wipe.
    A4367  A                Ostomy belt........  ...........  ...........  ...........  ...........  ...........
    A4368  A                Ostomy filter......  ...........  ...........  ...........  ...........  ...........
    A4369  A                Skin barrier liquid  ...........  ...........  ...........  ...........  ...........
                             per oz.
    A4370  A                Skin barrier paste   ...........  ...........  ...........  ...........  ...........
                             per oz.
    A4371  A                Skin barrier powder  ...........  ...........  ...........  ...........  ...........
                             per oz.
    A4372  A                Skin barrier solid   ...........  ...........  ...........  ...........  ...........
                             4x4 equiv.
    A4373  A                Skin barrier with    ...........  ...........  ...........  ...........  ...........
                             flange.
    A4374  A                Skin barrier         ...........  ...........  ...........  ...........  ...........
                             extended wear.
    A4375  A                Drainable plastic    ...........  ...........  ...........  ...........  ...........
                             pch w fcpl.
    A4376  A                Drainable rubber     ...........  ...........  ...........  ...........  ...........
                             pch w fcplt.
    A4377  A                Drainable plstic     ...........  ...........  ...........  ...........  ...........
                             pch w/o fp.
    A4378  A                Drainable rubber     ...........  ...........  ...........  ...........  ...........
                             pch w/o fp.
    A4379  A                Urinary plastic      ...........  ...........  ...........  ...........  ...........
                             pouch w fcpl.

[[Page 67949]]

 
    A4380  A                Urinary rubber       ...........  ...........  ...........  ...........  ...........
                             pouch w fcplt.
    A4381  A                Urinary plastic      ...........  ...........  ...........  ...........  ...........
                             pouch w/o fp.
    A4382  A                Urinary hvy plstc    ...........  ...........  ...........  ...........  ...........
                             pch w/o fp.
    A4383  A                Urinary rubber       ...........  ...........  ...........  ...........  ...........
                             pouch w/o fp.
    A4384  A                Ostomy faceplt/      ...........  ...........  ...........  ...........  ...........
                             silicone ring.
    A4385  A                Ost skn barrier sld  ...........  ...........  ...........  ...........  ...........
                             ext wear.
    A4386  A                Ost skn barrier w    ...........  ...........  ...........  ...........  ...........
                             flng ex wr.
    A4387  A                Ost clsd pouch w     ...........  ...........  ...........  ...........  ...........
                             att st barr.
    A4388  A                Drainable pch w ex   ...........  ...........  ...........  ...........  ...........
                             wear barr.
    A4389  A                Drainable pch w st   ...........  ...........  ...........  ...........  ...........
                             wear barr.
    A4390  A                Drainable pch ex     ...........  ...........  ...........  ...........  ...........
                             wear convex.
    A4391  A                Urinary pouch w ex   ...........  ...........  ...........  ...........  ...........
                             wear barr.
    A4392  A                Urinary pouch w st   ...........  ...........  ...........  ...........  ...........
                             wear barr.
    A4393  A                Urine pch w ex wear  ...........  ...........  ...........  ...........  ...........
                             bar conv.
    A4394  A                Ostomy pouch liq     ...........  ...........  ...........  ...........  ...........
                             deodorant.
    A4395  A                Ostomy pouch solid   ...........  ...........  ...........  ...........  ...........
                             deodorant.
    A4396  A                Peristomal hernia    ...........  ...........  ...........  ...........  ...........
                             supprt blt.
    A4397  A                Irrigation supply    ...........  ...........  ...........  ...........  ...........
                             sleeve.
    A4398  A                Ostomy irrigation    ...........  ...........  ...........  ...........  ...........
                             bag.
    A4399  A                Ostomy irrig cone/   ...........  ...........  ...........  ...........  ...........
                             cath w brs.
    A4400  A                Ostomy irrigation    ...........  ...........  ...........  ...........  ...........
                             set.
    A4402  A                Lubricant per ounce  ...........  ...........  ...........  ...........  ...........
    A4404  A                Ostomy ring each...  ...........  ...........  ...........  ...........  ...........
    A4421  A                Ostomy supply misc.  ...........  ...........  ...........  ...........  ...........
    A4454  A                Tape all types all   ...........  ...........  ...........  ...........  ...........
                             sizes.
    A4455  A                Adhesive remover     ...........  ...........  ...........  ...........  ...........
                             per ounce.
    A4460  A                Elastic compression  ...........  ...........  ...........  ...........  ...........
                             bandage.
    A4462  A                Abdmnl drssng        ...........  ...........  ...........  ...........  ...........
                             holder/binder.
    A4464  A                Joint support        ...........  ...........  ...........  ...........  ...........
                             device/garment.
    A4465  A                Non-elastic          ...........  ...........  ...........  ...........  ...........
                             extremity binder.
    A4470  A                Gravlee jet washer.  ...........  ...........  ...........  ...........  ...........
    A4480  A                Vabra aspirator....  ...........  ...........  ...........  ...........  ...........
    A4481  A                Tracheostoma filter  ...........  ...........  ...........  ...........  ...........
    A4483  A                Moisture exchanger.  ...........  ...........  ...........  ...........  ...........
    A4490  E                Above knee surgical  ...........  ...........  ...........  ...........  ...........
                             stocking.
    A4495  E                Thigh length surg    ...........  ...........  ...........  ...........  ...........
                             stocking.
    A4500  E                Below knee surgical  ...........  ...........  ...........  ...........  ...........
                             stocking.
    A4510  E                Full length surg     ...........  ...........  ...........  ...........  ...........
                             stocking.
    A4550  E                Surgical trays.....  ...........  ...........  ...........  ...........  ...........
    A4554  E                Disposable           ...........  ...........  ...........  ...........  ...........
                             underpads.
    A4556  A                Electrodes, pair...  ...........  ...........  ...........  ...........  ...........
    A4557  A                Lead wires, pair...  ...........  ...........  ...........  ...........  ...........
    A4558  A                Conductive paste or  ...........  ...........  ...........  ...........  ...........
                             gel.
   A4560D  A                Pessary............  ...........  ...........  ...........  ...........  ...........
    A4561  N                Pessary rubber, any  ...........  ...........  ...........  ...........  ...........
                             type.
    A4562  N                Pessary, non         ...........  ...........  ...........  ...........  ...........
                             rubber,any type.
    A4565  A                Slings.............  ...........  ...........  ...........  ...........  ...........
    A4570  N                Splint.............  ...........  ...........  ...........  ...........  ...........
    A4572  A                Rib belt...........  ...........  ...........  ...........  ...........  ...........
    A4575  E                Hyperbaric o2        ...........  ...........  ...........  ...........  ...........
                             chamber disps.
    A4580  N                Cast supplies        ...........  ...........  ...........  ...........  ...........
                             (plaster).
    A4590  N                Special casting      ...........  ...........  ...........  ...........  ...........
                             material.
    A4595  A                TENS suppl 2 lead    ...........  ...........  ...........  ...........  ...........
                             per month.
    A4608  A                Transtracheal        ...........  ...........  ...........  ...........  ...........
                             oxygen cath.
    A4611  A                Heavy duty battery.  ...........  ...........  ...........  ...........  ...........
    A4612  A                Battery cables.....  ...........  ...........  ...........  ...........  ...........
    A4613  A                Battery charger....  ...........  ...........  ...........  ...........  ...........
    A4614  A                Hand-held PEFR       ...........  ...........  ...........  ...........  ...........
                             meter.
    A4615  A                Cannula nasal......  ...........  ...........  ...........  ...........  ...........
    A4616  A                Tubing (oxygen) per  ...........  ...........  ...........  ...........  ...........
                             foot.
    A4617  A                Mouth piece........  ...........  ...........  ...........  ...........  ...........
    A4618  A                Breathing circuits.  ...........  ...........  ...........  ...........  ...........
    A4619  A                Face tent..........  ...........  ...........  ...........  ...........  ...........
    A4620  A                Variable             ...........  ...........  ...........  ...........  ...........
                             concentration mask.
    A4621  A                Tracheotomy mask or  ...........  ...........  ...........  ...........  ...........
                             collar.
    A4622  A                Tracheostomy or      ...........  ...........  ...........  ...........  ...........
                             larngectomy.
    A4623  A                Tracheostomy inner   ...........  ...........  ...........  ...........  ...........
                             cannula.
    A4624  A                Tracheal suction     ...........  ...........  ...........  ...........  ...........
                             tube.
    A4625  A                Trach care kit for   ...........  ...........  ...........  ...........  ...........
                             new trach.
    A4626  A                Tracheostomy         ...........  ...........  ...........  ...........  ...........
                             cleaning brush.
    A4627  E                Spacer bag/          ...........  ...........  ...........  ...........  ...........
                             reservoir.
    A4628  A                Oropharyngeal        ...........  ...........  ...........  ...........  ...........
                             suction cath.
    A4629  A                Tracheostomy care    ...........  ...........  ...........  ...........  ...........
                             kit.
    A4630  A                Repl bat t.e.n.s.    ...........  ...........  ...........  ...........  ...........
                             own by pt.

[[Page 67950]]

 
    A4631  A                Wheelchair battery.  ...........  ...........  ...........  ...........  ...........
    A4635  A                Underarm crutch pad  ...........  ...........  ...........  ...........  ...........
    A4636  A                Handgrip for cane    ...........  ...........  ...........  ...........  ...........
                             etc.
    A4637  A                Repl tip cane/       ...........  ...........  ...........  ...........  ...........
                             crutch/walker.
    A4640  A                Alternating          ...........  ...........  ...........  ...........  ...........
                             pressure pad.
    A4641  N                Diagnostic imaging   ...........  ...........  ...........  ...........  ...........
                             agent.
    A4642  G                Satumomab pendetide         0704  ...........      $712.50  ...........       $86.93
                             per dose.
    A4643  N                High dose contrast   ...........  ...........  ...........  ...........  ...........
                             MRI.
    A4644  N                Contrast 100-199     ...........  ...........  ...........  ...........  ...........
                             MGs iodine.
    A4645  N                Contrast 200-299     ...........  ...........  ...........  ...........  ...........
                             MGs iodine.
    A4646  N                Contrast 300-399     ...........  ...........  ...........  ...........  ...........
                             MGs iodine.
    A4647  N                Supp- paramagnetic   ...........  ...........  ...........  ...........  ...........
                             contr mat.
    A4649  A                Surgical supplies..  ...........  ...........  ...........  ...........  ...........
    A4650  A                Supp esrd            ...........  ...........  ...........  ...........  ...........
                             centrifuge.
    A4655  A                Esrd syringe/needle  ...........  ...........  ...........  ...........  ...........
    A4660  A                Esrd blood pressure  ...........  ...........  ...........  ...........  ...........
                             device.
    A4663  A                Esrd blood pressure  ...........  ...........  ...........  ...........  ...........
                             cuff.
    A4670  E                Auto blood pressure  ...........  ...........  ...........  ...........  ...........
                             monitor.
    A4680  A                Activated carbon     ...........  ...........  ...........  ...........  ...........
                             filters.
    A4690  A                Dialyzers..........  ...........  ...........  ...........  ...........  ...........
    A4700  A                Standard dialysate   ...........  ...........  ...........  ...........  ...........
                             solution.
    A4705  A                Bicarb dialysate     ...........  ...........  ...........  ...........  ...........
                             solution.
    A4712  A                Sterile water......  ...........  ...........  ...........  ...........  ...........
    A4714  A                Treated water for    ...........  ...........  ...........  ...........  ...........
                             dialysis.
    A4730  A                Fistula cannulation  ...........  ...........  ...........  ...........  ...........
                             set dial.
    A4735  A                Local/topical        ...........  ...........  ...........  ...........  ...........
                             anesthetics.
    A4740  A                Esrd shunt           ...........  ...........  ...........  ...........  ...........
                             accessory.
    A4750  A                Arterial or venous   ...........  ...........  ...........  ...........  ...........
                             tubing.
    A4755  A                Arterial and venous  ...........  ...........  ...........  ...........  ...........
                             tubing.
    A4760  A                Standard testing     ...........  ...........  ...........  ...........  ...........
                             solution.
    A4765  A                Dialysate            ...........  ...........  ...........  ...........  ...........
                             concentrate.
    A4770  A                Blood testing        ...........  ...........  ...........  ...........  ...........
                             supplies.
    A4771  A                Blood clotting time  ...........  ...........  ...........  ...........  ...........
                             tube.
    A4772  A                Dextrostick/glucose  ...........  ...........  ...........  ...........  ...........
                             strips.
    A4773  A                Hemostix...........  ...........  ...........  ...........  ...........  ...........
    A4774  A                Ammonia test paper.  ...........  ...........  ...........  ...........  ...........
    A4780  A                Esrd sterilizing     ...........  ...........  ...........  ...........  ...........
                             agent.
    A4790  A                Esrd cleansing       ...........  ...........  ...........  ...........  ...........
                             agents.
    A4800  A                Heparin/antidote     ...........  ...........  ...........  ...........  ...........
                             dialysis.
    A4820  A                Supplies             ...........  ...........  ...........  ...........  ...........
                             hemodialysis kit.
    A4850  A                Rubber tipped        ...........  ...........  ...........  ...........  ...........
                             hemostats.
    A4860  A                Disposable catheter  ...........  ...........  ...........  ...........  ...........
                             caps.
    A4870  A                Plumbing/electrical  ...........  ...........  ...........  ...........  ...........
                             work.
    A4880  A                Water storage tanks  ...........  ...........  ...........  ...........  ...........
    A4890  A                Contracts/repair/    ...........  ...........  ...........  ...........  ...........
                             maintenance.
    A4900  A                Capd supply kit....  ...........  ...........  ...........  ...........  ...........
    A4901  A                Ccpd supply kit....  ...........  ...........  ...........  ...........  ...........
    A4905  A                Ipd supply kit.....  ...........  ...........  ...........  ...........  ...........
    A4910  A                Esrd nonmedical      ...........  ...........  ...........  ...........  ...........
                             supplies.
    A4912  A                Gomco drain bottle.  ...........  ...........  ...........  ...........  ...........
    A4913  A                Esrd supply........  ...........  ...........  ...........  ...........  ...........
    A4914  A                Preparation kit....  ...........  ...........  ...........  ...........  ...........
    A4918  A                Venous pressure      ...........  ...........  ...........  ...........  ...........
                             clamp.
    A4919  A                Supp dialysis        ...........  ...........  ...........  ...........  ...........
                             dialyzer holde.
    A4920  A                Harvard pressure     ...........  ...........  ...........  ...........  ...........
                             clamp.
    A4921  A                Measuring cylinder.  ...........  ...........  ...........  ...........  ...........
    A4927  A                Gloves.............  ...........  ...........  ...........  ...........  ...........
    A5051  A                Pouch clsd w barr    ...........  ...........  ...........  ...........  ...........
                             attached.
    A5052  A                Clsd ostomy pouch w/ ...........  ...........  ...........  ...........  ...........
                             o barr.
    A5053  A                Clsd ostomy pouch    ...........  ...........  ...........  ...........  ...........
                             faceplate.
    A5054  A                Clsd ostomy pouch w/ ...........  ...........  ...........  ...........  ...........
                             flange.
    A5055  A                Stoma cap..........  ...........  ...........  ...........  ...........  ...........
    A5061  A                Pouch drainable w    ...........  ...........  ...........  ...........  ...........
                             barrier at.
    A5062  A                Drnble ostomy pouch  ...........  ...........  ...........  ...........  ...........
                             w/o barr.
    A5063  A                Drain ostomy pouch   ...........  ...........  ...........  ...........  ...........
                             w/flange.
    A5064  E                Drain ostomy pouch   ...........  ...........  ...........  ...........  ...........
                             w/fceplte.
   A5065D  E                Drain ostomy pouch   ...........  ...........  ...........  ...........  ...........
                             w/fceplte.
    A5071  A                Urinary pouch w/     ...........  ...........  ...........  ...........  ...........
                             barrier.
    A5072  A                Urinary pouch w/o    ...........  ...........  ...........  ...........  ...........
                             barrier.
    A5073  A                Urinary pouch on     ...........  ...........  ...........  ...........  ...........
                             barr w/flng.
    A5074  E                Urinary pouch w/     ...........  ...........  ...........  ...........  ...........
                             faceplate.
    A5075  E                Urinary pouch on     ...........  ...........  ...........  ...........  ...........
                             faceplate.
    A5081  A                Continent stoma      ...........  ...........  ...........  ...........  ...........
                             plug.
    A5082  A                Continent stoma      ...........  ...........  ...........  ...........  ...........
                             catheter.

[[Page 67951]]

 
    A5093  A                Ostomy accessory     ...........  ...........  ...........  ...........  ...........
                             convex inse.
    A5102  A                Bedside drain btl w/ ...........  ...........  ...........  ...........  ...........
                             wo tube.
    A5105  A                Urinary suspensory.  ...........  ...........  ...........  ...........  ...........
    A5112  A                Urinary leg bag....  ...........  ...........  ...........  ...........  ...........
    A5113  A                Latex leg strap....  ...........  ...........  ...........  ...........  ...........
    A5114  A                Foam/fabric leg      ...........  ...........  ...........  ...........  ...........
                             strap.
    A5119  A                Skin barrier wipes   ...........  ...........  ...........  ...........  ...........
                             box pr 50.
    A5121  A                Solid skin barrier   ...........  ...........  ...........  ...........  ...........
                             6x6.
    A5122  A                Solid skin barrier   ...........  ...........  ...........  ...........  ...........
                             8x8.
    A5123  A                Skin barrier with    ...........  ...........  ...........  ...........  ...........
                             flange.
    A5126  A                Disk/foam pad +or-   ...........  ...........  ...........  ...........  ...........
                             adhesive.
    A5131  A                Appliance cleaner..  ...........  ...........  ...........  ...........  ...........
   A5149D  A                Incontinence/ostomy  ...........  ...........  ...........  ...........  ...........
                             supply.
    A5200  A                Percutaneous         ...........  ...........  ...........  ...........  ...........
                             catheter anchor.
    A5500  A                Diab shoe for        ...........  ...........  ...........  ...........  ...........
                             density insert.
    A5501  A                Diabetic custom      ...........  ...........  ...........  ...........  ...........
                             molded shoe.
    A5502  A                Diabetic shoe        ...........  ...........  ...........  ...........  ...........
                             density insert.
    A5503  A                Diabetic shoe w/     ...........  ...........  ...........  ...........  ...........
                             roller/rockr.
    A5504  A                Diabetic shoe with   ...........  ...........  ...........  ...........  ...........
                             wedge.
    A5505  A                Diab shoe w/         ...........  ...........  ...........  ...........  ...........
                             metatarsal bar.
    A5506  A                Diabetic shoe w/off  ...........  ...........  ...........  ...........  ...........
                             set heel.
    A5507  A                Modification         ...........  ...........  ...........  ...........  ...........
                             diabetic shoe.
    A5508  A                Diabetic deluxe      ...........  ...........  ...........  ...........  ...........
                             shoe.
    A6020  A                Collagen wound       ...........  ...........  ...........  ...........  ...........
                             dressing.
    A6021  A                Collagen dressing    ...........  ...........  ...........  ...........  ...........
                             =16 sq in.
    A6022  A                Collagen drsg>6=48   ...........  ...........  ...........  ...........  ...........
                             sq in.
    A6023  A                Collagen dressing    ...........  ...........  ...........  ...........  ...........
                             >48 sq in.
    A6024  A                Collagen dsg wound   ...........  ...........  ...........  ...........  ...........
                             filler.
    A6025  E                Silicone gel sheet,  ...........  ...........  ...........  ...........  ...........
                             each.
    A6154  A                Wound pouch each...  ...........  ...........  ...........  ...........  ...........
    A6196  A                Alginate dressing    ...........  ...........  ...........  ...........  ...........
                             =16 sq in.
    A6197  A                Alginate drsg >16    ...........  ...........  ...........  ...........  ...........
                             =48 sq in.
    A6198  A                alginate dressing >  ...........  ...........  ...........  ...........  ...........
                             48 sq in.
    A6199  A                Alginate drsg wound  ...........  ...........  ...........  ...........  ...........
                             filler.
    A6200  A                Compos drsg =16 no   ...........  ...........  ...........  ...........  ...........
                             border.
    A6201  A                Compos drsg >16=48   ...........  ...........  ...........  ...........  ...........
                             no bdr.
    A6202  A                Compos drsg >48 no   ...........  ...........  ...........  ...........  ...........
                             border.
    A6203  A                Composite drsg = 16  ...........  ...........  ...........  ...........  ...........
                             sq in.
    A6204  A                Composite drsg       ...........  ...........  ...........  ...........  ...........
                             >16=48 sq in.
    A6205  A                Composite drsg > 48  ...........  ...........  ...........  ...........  ...........
                             sq in.
    A6206  A                Contact layer = 16   ...........  ...........  ...........  ...........  ...........
                             sq in.
    A6207  A                Contact layer >16=   ...........  ...........  ...........  ...........  ...........
                             48 sq in.
    A6208  A                Contact layer > 48   ...........  ...........  ...........  ...........  ...........
                             sq in.
    A6209  A                Foam drsg =16 sq in  ...........  ...........  ...........  ...........  ...........
                             w/o bdr.
    A6210  A                Foam drg >16=48 sq   ...........  ...........  ...........  ...........  ...........
                             in w/o b.
    A6211  A                Foam drg > 48 sq in  ...........  ...........  ...........  ...........  ...........
                             w/o brdr.
    A6212  A                Foam drg =16 sq in   ...........  ...........  ...........  ...........  ...........
                             w/border.
    A6213  A                Foam drg >16=48 sq   ...........  ...........  ...........  ...........  ...........
                             in w/bdr.
    A6214  A                Foam drg > 48 sq in  ...........  ...........  ...........  ...........  ...........
                             w/border.
    A6215  A                Foam dressing wound  ...........  ...........  ...........  ...........  ...........
                             filler.
    A6216  A                Non-sterile          ...........  ...........  ...........  ...........  ...........
                             gauze=16 sq in.
    A6217  A                Non-sterile          ...........  ...........  ...........  ...........  ...........
                             gauze>16=48 sq.
    A6218  A                Non-sterile gauze >  ...........  ...........  ...........  ...........  ...........
                             48 sq in.
    A6219  A                Gauze = 16 sq in w/  ...........  ...........  ...........  ...........  ...........
                             border.
    A6220  A                Gauze >16 =48 sq in  ...........  ...........  ...........  ...........  ...........
                             w/bordr.
    A6221  A                Gauze > 48 sq in w/  ...........  ...........  ...........  ...........  ...........
                             border.
    A6222  A                Gauze =16 in no w/   ...........  ...........  ...........  ...........  ...........
                             sal w/o b.
    A6223  A                Gauze >16=48 no w/   ...........  ...........  ...........  ...........  ...........
                             sal w/o b.
    A6224  A                Gauze > 48 in no w/  ...........  ...........  ...........  ...........  ...........
                             sal w/o b.
    A6228  A                Gauze = 16 sq in     ...........  ...........  ...........  ...........  ...........
                             water/sal.
    A6229  A                Gauze >16=48 sq in   ...........  ...........  ...........  ...........  ...........
                             watr/sal.
    A6230  A                Gauze > 48 sq in     ...........  ...........  ...........  ...........  ...........
                             water/salne.
    A6231  A                Hydrogel dsg=16 sq   ...........  ...........  ...........  ...........  ...........
                             in.
    A6232  A                Hydrogel dsg>16=48   ...........  ...........  ...........  ...........  ...........
                             sq in.
    A6233  A                Hydrogel dressing    ...........  ...........  ...........  ...........  ...........
                             >48 sq in.
    A6234  A                Hydrocolld drg =16   ...........  ...........  ...........  ...........  ...........
                             w/o bdr.
    A6235  A                Hydrocolld drg       ...........  ...........  ...........  ...........  ...........
                             >16=48 w/o b.
    A6236  A                Hydrocolld drg > 48  ...........  ...........  ...........  ...........  ...........
                             in w/o b.
    A6237  A                Hydrocolld drg =16   ...........  ...........  ...........  ...........  ...........
                             in w/bdr.
    A6238  A                Hydrocolld drg       ...........  ...........  ...........  ...........  ...........
                             >16=48 w/bdr.
    A6239  A                Hydrocolld drg > 48  ...........  ...........  ...........  ...........  ...........
                             in w/bdr.
    A6240  A                Hydrocolld drg       ...........  ...........  ...........  ...........  ...........
                             filler paste.
    A6241  A                Hydrocolloid drg     ...........  ...........  ...........  ...........  ...........
                             filler dry.
    A6242  A                Hydrogel drg =16 in  ...........  ...........  ...........  ...........  ...........
                             w/o bdr.

[[Page 67952]]

 
    A6243  A                Hydrogel drg >16=48  ...........  ...........  ...........  ...........  ...........
                             w/o bdr.
    A6244  A                Hydrogel drg >48 in  ...........  ...........  ...........  ...........  ...........
                             w/o bdr.
    A6245  A                Hydrogel drg = 16    ...........  ...........  ...........  ...........  ...........
                             in w/bdr.
    A6246  A                Hydrogel drg >16=48  ...........  ...........  ...........  ...........  ...........
                             in w/b.
    A6247  A                Hydrogel drg > 48    ...........  ...........  ...........  ...........  ...........
                             sq in w/b.
    A6248  A                Hydrogel drsg gel    ...........  ...........  ...........  ...........  ...........
                             filler.
    A6250  A                Skin seal protect    ...........  ...........  ...........  ...........  ...........
                             moisturizr.
    A6251  A                Absorpt drg =16 sq   ...........  ...........  ...........  ...........  ...........
                             in w/o b.
    A6252  A                Absorpt drg >16 =48  ...........  ...........  ...........  ...........  ...........
                             w/o bdr.
    A6253  A                Absorpt drg > 48 sq  ...........  ...........  ...........  ...........  ...........
                             in w/o b.
    A6254  A                Absorpt drg =16 sq   ...........  ...........  ...........  ...........  ...........
                             in w/bdr.
    A6255  A                Absorpt drg >16=48   ...........  ...........  ...........  ...........  ...........
                             in w/bdr.
    A6256  A                Absorpt drg > 48 sq  ...........  ...........  ...........  ...........  ...........
                             in w/bdr.
    A6257  A                Transparent film =   ...........  ...........  ...........  ...........  ...........
                             16 sq in.
    A6258  A                Transparent film     ...........  ...........  ...........  ...........  ...........
                             >16=48 in.
    A6259  A                Transparent film >   ...........  ...........  ...........  ...........  ...........
                             48 sq in.
    A6260  A                Wound cleanser any   ...........  ...........  ...........  ...........  ...........
                             type/size.
    A6261  A                Wound filler gel/    ...........  ...........  ...........  ...........  ...........
                             paste /oz.
    A6262  A                Wound filler dry     ...........  ...........  ...........  ...........  ...........
                             form / gram.
    A6263  A                Non-sterile elastic  ...........  ...........  ...........  ...........  ...........
                             gauze/yd.
    A6264  A                Non-sterile no       ...........  ...........  ...........  ...........  ...........
                             elastic gauze.
    A6265  A                Tape per 18 sq       ...........  ...........  ...........  ...........  ...........
                             inches.
    A6266  A                Impreg gauze no h2O/ ...........  ...........  ...........  ...........  ...........
                             sal/yard.
    A6402  A                Sterile gauze = 16   ...........  ...........  ...........  ...........  ...........
                             sq in.
    A6403  A                Sterile gauze>16 =   ...........  ...........  ...........  ...........  ...........
                             48 sq in.
    A6404  A                Sterile gauze > 48   ...........  ...........  ...........  ...........  ...........
                             sq in.
    A6405  A                Sterile elastic      ...........  ...........  ...........  ...........  ...........
                             gauze /yd.
    A6406  A                Sterile non-elastic  ...........  ...........  ...........  ...........  ...........
                             gauze/yd.
    A7000  A                Disposable canister  ...........  ...........  ...........  ...........  ...........
                             for pump.
    A7001  A                Nondisposable pump   ...........  ...........  ...........  ...........  ...........
                             canister.
    A7002  A                Tubing used w        ...........  ...........  ...........  ...........  ...........
                             suction pump.
    A7003  A                Nebulizer            ...........  ...........  ...........  ...........  ...........
                             administration set.
    A7004  A                Disposable           ...........  ...........  ...........  ...........  ...........
                             nebulizer sml vol.
    A7005  A                Nondisposable        ...........  ...........  ...........  ...........  ...........
                             nebulizer set.
    A7006  A                Filtered nebulizer   ...........  ...........  ...........  ...........  ...........
                             admin set.
    A7007  A                Lg vol nebulizer     ...........  ...........  ...........  ...........  ...........
                             disposable.
    A7008  A                Disposable           ...........  ...........  ...........  ...........  ...........
                             nebulizer prefill.
    A7009  A                Nebulizer reservoir  ...........  ...........  ...........  ...........  ...........
                             bottle.
    A7010  A                Disposable           ...........  ...........  ...........  ...........  ...........
                             corrugated tubing.
    A7011  A                Nondispos            ...........  ...........  ...........  ...........  ...........
                             corrugated tubing.
    A7012  A                Nebulizer water      ...........  ...........  ...........  ...........  ...........
                             collec devic.
    A7013  A                Disposable           ...........  ...........  ...........  ...........  ...........
                             compressor filter.
    A7014  A                Compressor           ...........  ...........  ...........  ...........  ...........
                             nondispos filter.
    A7015  A                Aerosol mask used w  ...........  ...........  ...........  ...........  ...........
                             nebulize.
    A7016  A                Nebulizer dome &     ...........  ...........  ...........  ...........  ...........
                             mouthpiece.
    A7017  A                Nebulizer not used   ...........  ...........  ...........  ...........  ...........
                             w oxygen.
    A7018  A                Water distilled w/   ...........  ...........  ...........  ...........  ...........
                             nebulizer.
    A7019  A                Saline solution      ...........  ...........  ...........  ...........  ...........
                             dispenser.
    A7020  A                Sterile H2O or NSS   ...........  ...........  ...........  ...........  ...........
                             w lgv neb.
    A7501  A                Tracheostoma valve   ...........  ...........  ...........  ...........  ...........
                             w diaphra.
    A7502  A                Replacement          ...........  ...........  ...........  ...........  ...........
                             diaphragm/fplate.
    A7503  A                HMES filter holder   ...........  ...........  ...........  ...........  ...........
                             or cap.
    A7504  A                Tracheostoma HMES    ...........  ...........  ...........  ...........  ...........
                             filter.
    A7505  A                HMES or trach valve  ...........  ...........  ...........  ...........  ...........
                             housing.
    A7506  A                HMES/trachvalve      ...........  ...........  ...........  ...........  ...........
                             adhesivedisk.
    A7507  A                Integrated filter &  ...........  ...........  ...........  ...........  ...........
                             holder.
    A7508  A                Housing &            ...........  ...........  ...........  ...........  ...........
                             Integrated Adhesiv.
    A7509  A                Heat & moisture      ...........  ...........  ...........  ...........  ...........
                             exchange sys.
    A9150  E                Misc/exper non-      ...........  ...........  ...........  ...........  ...........
                             prescript dru.
    A9160  E                Podiatrist non-      ...........  ...........  ...........  ...........  ...........
                             covered servi.
    A9170  E                Chiropractor non-    ...........  ...........  ...........  ...........  ...........
                             covered ser.
    A9190  E                Misc/expe personal   ...........  ...........  ...........  ...........  ...........
                             comfort i.
    A9270  E                Non-covered item or  ...........  ...........  ...........  ...........  ...........
                             service.
    A9300  E                Exercise equipment.  ...........  ...........  ...........  ...........  ...........
   *A9500  G                Technetium TC 99m           1600  ...........      $109.25  ...........       $13.33
                             sestamibi.
    A9502  G                Technetium TC99M            0705  ...........      $136.80  ...........       $16.69
                             tetrofosmin.
   *A9503  G                Technetium TC 99m           1601  ...........       $38.38  ...........        $4.68
                             medronate.
   *A9504  G                Technetium tc 99m           1602  ...........       $47.50  ...........        $5.80
                             apcitide.
   *A9505  G                Thallous chloride           1603  ...........       $28.50  ...........        $3.48
                             TL 201/mci.
   *A9507  G                Indium/111 capromab         1604  ...........    $1,008.90  ...........      $135.19
                             pendetid.
    A9508  G                Iobenguane sulfate          1045  ...........    $1,140.00  ...........      $139.08
                             I-131.
    A9510  G                Technetium TC99m            1205  ...........      $427.50  ...........       $57.29
                             Disofenin.
    A9600  G                Strontium-89                0701  ...........      $783.75  ...........       $95.62
                             chloride.
    A9605  G                Samarium sm153              0702  ...........      $942.09  ...........      $134.87
                             lexidronamm.

[[Page 67953]]

 
    A9700  N                Echocardiography     ...........  ...........  ...........  ...........  ...........
                             Contrast.
    A9900  E                Supply/accessory/    ...........  ...........  ...........  ...........  ...........
                             service.
    A9901  E                Delivery/set up/     ...........  ...........  ...........  ...........  ...........
                             dispensing.
    B4034  A                Enter feed supkit    ...........  ...........  ...........  ...........  ...........
                             syr by day.
    B4035  A                Enteral feed supp    ...........  ...........  ...........  ...........  ...........
                             pump per d.
    B4036  A                Enteral feed sup     ...........  ...........  ...........  ...........  ...........
                             kit grav by.
    B4081  A                Enteral ng tubing w/ ...........  ...........  ...........  ...........  ...........
                              stylet.
    B4082  A                Enteral ng tubing w/ ...........  ...........  ...........  ...........  ...........
                             o stylet.
    B4083  A                Enteral stomach      ...........  ...........  ...........  ...........  ...........
                             tube levine.
    B4084  A                Gastrostomy/         ...........  ...........  ...........  ...........  ...........
                             jejunostomy tubi.
    B4085  A                Gastrostomy tube w/  ...........  ...........  ...........  ...........  ...........
                             ring each.
    B4150  A                Enteral formulae     ...........  ...........  ...........  ...........  ...........
                             category i.
    B4151  A                Enteral formulae     ...........  ...........  ...........  ...........  ...........
                             category i-.
    B4152  A                Enteral formulae     ...........  ...........  ...........  ...........  ...........
                             category ii.
    B4153  A                Enteral formulae     ...........  ...........  ...........  ...........  ...........
                             category ii.
    B4154  A                Enteral formulae     ...........  ...........  ...........  ...........  ...........
                             category IV.
    B4155  A                Enteral formulae     ...........  ...........  ...........  ...........  ...........
                             category v.
    B4156  A                Enteral formulae     ...........  ...........  ...........  ...........  ...........
                             category vi.
    B4164  A                Parenteral 50%       ...........  ...........  ...........  ...........  ...........
                             dextrose solu.
    B4168  A                Parenteral sol       ...........  ...........  ...........  ...........  ...........
                             amino acid 3..
    B4172  A                Parenteral sol       ...........  ...........  ...........  ...........  ...........
                             amino acid 5..
    B4176  A                Parenteral sol       ...........  ...........  ...........  ...........  ...........
                             amino acid 7-.
    B4178  A                Parenteral sol       ...........  ...........  ...........  ...........  ...........
                             amino acid >.
    B4180  A                Parenteral sol carb  ...........  ...........  ...........  ...........  ...........
                             > 50%.
    B4184  A                Parenteral sol       ...........  ...........  ...........  ...........  ...........
                             lipids 10%.
    B4186  A                Parenteral sol       ...........  ...........  ...........  ...........  ...........
                             lipids 20%.
    B4189  A                Parenteral sol       ...........  ...........  ...........  ...........  ...........
                             amino acid &.
    B4193  A                Parenteral sol 52-   ...........  ...........  ...........  ...........  ...........
                             73 gm prot.
    B4197  A                Parenteral sol 74-   ...........  ...........  ...........  ...........  ...........
                             100 gm pro.
    B4199  A                Parenteral sol >     ...........  ...........  ...........  ...........  ...........
                             100gm prote.
    B4216  A                Parenteral           ...........  ...........  ...........  ...........  ...........
                             nutrition additiv.
    B4220  A                Parenteral supply    ...........  ...........  ...........  ...........  ...........
                             kit premix.
    B4222  A                Parenteral supply    ...........  ...........  ...........  ...........  ...........
                             kit homemi.
    B4224  A                Parenteral           ...........  ...........  ...........  ...........  ...........
                             administration ki.
    B5000  A                Parenteral sol       ...........  ...........  ...........  ...........  ...........
                             renal-amirosy.
    B5100  A                Parenteral sol       ...........  ...........  ...........  ...........  ...........
                             hepatic-fream.
    B5200  A                Parenteral sol       ...........  ...........  ...........  ...........  ...........
                             stres-brnch c.
    B9000  A                Enter infusion pump  ...........  ...........  ...........  ...........  ...........
                             w/o alrm.
    B9002  A                Enteral infusion     ...........  ...........  ...........  ...........  ...........
                             pump w/ ala.
    B9004  A                Parenteral infus     ...........  ...........  ...........  ...........  ...........
                             pump portab.
    B9006  A                Parenteral infus     ...........  ...........  ...........  ...........  ...........
                             pump statio.
    B9998  A                Enteral supp not     ...........  ...........  ...........  ...........  ...........
                             otherwise c.
    B9999  A                Parenteral supp not  ...........  ...........  ...........  ...........  ...........
                             othrws c.
    C1000  H                 PerclosClosr               1000  ...........  ...........  ...........  ...........
                             ProstarArt Vas.
    C1001  H                 AcuNav-diagnstic           1001  ...........  ...........  ...........  ...........
                             ultrsnd ca.
    C1003  H                Cath, ablation,             1003  ...........  ...........  ...........  ...........
                             Livewire TC.
    C1004  H                Fast-                       1004  ...........  ...........  ...........  ...........
                             Cath,Swartz,SAFL,C
                             STA.
   C1005D  E                Sensar IOL.........  ...........  ...........  ...........  ...........  ...........
    C1006  H                ARRAY post chamb            1006  ...........  ...........  ...........  ...........
                             IOL.
    C1007  H                Ams 700 penile              1007  ...........  ...........  ...........  ...........
                             prosthesis.
    C1008  H                Urolume-implt               1008  ...........  ...........  ...........  ...........
                             uretheral stent.
    C1009  K                Plasma,                     1009         0.86       $42.76  ...........        $8.55
                             cryoprecipitate-
                             reduced, unit.
    C1010  K                Blood, L/R, CMV-neg         1010         2.88      $142.84  ...........       $28.57
    C1011  K                Platelets, L/R, CMV-        1011        11.86      $588.15  ...........      $117.63
                             neg, unit.
    C1012  K                Platelet                    1012         1.92       $95.23  ...........       $19.05
                             concentrate, L/R,
                             irradiated, unit.
    C1013  K                Platelet                    1013         1.18       $58.30  ...........       $11.66
                             concentrate, L/R,
                             unit.
    C1014  K                Platelets, aph/             1014         8.93      $443.11  ...........       $88.62
                             pher, L/R, unit.
    C1016  K                Blood, L/R, froz/           1016         7.15      $354.68  ...........       $70.94
                             deglycerol/washed.
    C1017  K                Platelets, aph/             1017         9.33      $462.54  ...........       $92.51
                             pher, L/R, CMV-
                             neg, unit.
    C1018  K                Blood, L/R,                 1018         3.13      $155.48  ...........       $31.10
                             irradiated.
    C1019  K                Platelets, aph/             1019         9.64      $478.09  ...........       $95.62
                             pher, L/R,
                             irradiated, unit.
    C1024  J                Quinupristin 150 mg/        1024  ...........      $159.60  ...........       $20.50
                             dalfopriston 350
                             mg.
    C1025  H                Marinr CS Cath.....         1025  ...........  ...........  ...........  ...........
    C1026  H                RF Perfrmr cath 5F          1026  ...........  ...........  ...........  ...........
                             RF Marinr.
    C1027  H                 Magic x/short,             1027  ...........  ...........  ...........  ...........
                             Radius14mm.
    C1028  H                Prcis Twst trnsvg           1028  ...........  ...........  ...........  ...........
                             anch sys.
    C1029  H                CRE guided balloon          1029  ...........  ...........  ...........  ...........
                             dil cath.
    C1030  H                Cthtr:Mrshal,Blu            1030  ...........  ...........  ...........  ...........
                             Max Utr Dmnd.
   C1031D  E                 MR Comp/mod LeVeen  ...........  ...........  ...........  ...........  ...........
                             ned elect.
    C1033  H                Sonicath mdl 37-410         1033  ...........  ...........  ...........  ...........
    C1034  H                SURPASS, Long30             1034  ...........  ...........  ...........  ...........
                             SURPASS-cath.
    C1035  H                Cath, Ultra ICE....         1035  ...........  ...........  ...........  ...........
    C1036  H                R port/reservoir            1036  ...........  ...........  ...........  ...........
                             impl dev.
    C1037  H                 Vaxcelchronic              1037  ...........  ...........  ...........  ...........
                             dialysis cath.

[[Page 67954]]

 
    C1038  H                UltraCross Imaging          1038  ...........  ...........  ...........  ...........
                             Cath.
    C1039  H                 Wallstent,                 1039  ...........  ...........  ...........  ...........
                             tracheobronchial.
    C1040  H                 WALLSTENT: TIPS            1040  ...........  ...........  ...........  ...........
                             (shunt).
    C1042  H                 Wallstent, biliary         1042  ...........  ...........  ...........  ...........
    C1043  H                 Atherectomy sys,           1043  ...........  ...........  ...........  ...........
                             coronary.
    C1045  G                I-131 MIBG (ioben-          1045  ...........    $1,140.00  ...........      $139.08
                             sulfate) O.5mCi.
    C1047  H                 Noga/Navi-Star             1047  ...........  ...........  ...........  ...........
                             cath.
    C1048  H                NeuroCyberneticPros         1048  ...........  ...........  ...........  ...........
                             : gen.
    C1050  H                 Prosorba column...         1410  ...........  ...........  ...........  ...........
    C1051  H                Oasis Thrombectomy          1051  ...........  ...........  ...........  ...........
                             Cath.
    C1053  H                EnSite 3000                 1053  ...........  ...........  ...........  ...........
                             catheter.
    C1054  H                Hydrolyser Thromb           1054  ...........  ...........  ...........  ...........
                             Cath 6/7F.
    C1055  H                Transesoph 210, 210-        1055  ...........  ...........  ...........  ...........
                             S Cath.
    C1056  H                Thermachoice II             1056  ...........  ...........  ...........  ...........
                             Cath.
    C1057  H                Micromark Tissue            1057  ...........  ...........  ...........  ...........
                             Marker.
    C1059  G                Carticel,auto cult-         1059  ...........   $14,250.00  ...........    $2,010.00
                             chndr cyte.
    C1060  H                ACS multi-link              1060  ...........  ...........  ...........  ...........
                             tristor/ultra.
   *C1061  H                ACS Viking Guiding          1061  ...........  ...........  ...........  ...........
                             cath.
   *C1063  H                EndoTak Endurance           1063  ...........  ...........  ...........  ...........
                             EZ, RX lead.
   *C1067  H                Megalink biliary            1067  ...........  ...........  ...........  ...........
                             stent.
   *C1068  H                Pulsar DDD pmkr....         1068  ...........  ...........  ...........  ...........
   *C1069  H                Discovery DR,               1069  ...........  ...........  ...........  ...........
                             pmaker.
   *C1071  H                Pulsar Max, Pulsar          1071  ...........  ...........  ...........  ...........
                             SR pmkr.
   *C1072  H                 Guidant: blln dil          1072  ...........  ...........  ...........  ...........
                             cath.
   *C1073  H                 Morcellator.......         1073  ...........  ...........  ...........  ...........
   *C1074  H                RX/OTW Viatrac-peri         1074  ...........  ...........  ...........  ...........
                             dil cath.
   *C1075  H                Guidant: lead......         1075  ...........  ...........  ...........  ...........
   *C1076  H                Ventak mini sc              1076  ...........  ...........  ...........  ...........
                             defib.
   *C1077  H                 Ventak VR Prizm            1077  ...........  ...........  ...........  ...........
                             VR, sc defib.
   *C1078  H                 Ventak: Prizm,             1078  ...........  ...........  ...........  ...........
                             AVIIIDR defib.
   *C1079  G                CO 57/58 0.5 mCi...         1079  ...........      $264.10  ...........       $32.22
   *C1084  G                Denileukin                  1084  ...........      $942.88  ...........      $126.35
                             diftitox, 300 mcg.
   *C1086  G                Temozolomide, 5 mg.         1086  ...........        $5.70  ...........         $.76
   *C1087  G                I-123 per uCi               1087  ...........         $.84  ...........         $.10
                             capsule.
   *C1088  T                LaserOptic tx sys..         0980        38.67    $1,917.89  ...........      $383.58
   *C1089  G                CO 57, 0.5 mCi.....         1089  ...........       $91.20  ...........       $11.13
   *C1090  G                IN 111 Chloride,            1090  ...........      $152.00  ...........       $18.54
                             per mCi.
   *C1091  G                IN 111                      1091  ...........      $508.25  ...........       $62.01
                             Oxyquinoline, per
                             5 mCi.
   *C1092  G                IN 111 Pentetate,           1092  ...........      $769.50  ...........       $93.88
                             per 1.5 mCi.
   *C1094  J                TC 99M Albumin              1094  ...........      $102.05  ...........       $13.67
                             aggr, per vial.
   *C1095  G                TC 99M Depreotide,          1095  ...........      $760.00  ...........      $101.84
                             per vial.
   *C1096  G                TC 99M Exametazime,         1096  ...........       $34.20  ...........        $4.17
                             per dose.
   *C1097  G                TC 99M Mebrofenin,          1097  ...........      $445.31  ...........       $63.75
                             per vial.
   *C1098  G                TC 99M Pentetate,           1098  ...........       $46.76  ...........        $5.71
                             per vial.
   *C1099  J                TC 99M                      1099  ...........       $42.75  ...........        $5.22
                             Pyrophosphate, per
                             vial.
   *C1100  H                Medtronic AVE GT1           1100  ...........  ...........  ...........  ...........
                             guidewire.
   *C1101  H                 MedtronicAVE Zuma          1101  ...........  ...........  ...........  ...........
                             guidecath.
   *C1102  H                Syngergy Neurostim          1102  ...........  ...........  ...........  ...........
                             Genrtr.
   *C1103  H                Micro Jewel                 1103  ...........  ...........  ...........  ...........
                             Defibrillator.
   *C1104  H                RF Conductor                1104  ...........  ...........  ...........  ...........
                             Ablative Cath.
   *C1105  H                Sigma 300VDD                1105  ...........  ...........  ...........  ...........
                             pacmker.
   *C1106  H                SynergyEZ Pt                1106  ...........  ...........  ...........  ...........
                             Progrmr.
   *C1107  H                Torqr, Solist cath.         1107  ...........  ...........  ...........  ...........
   *C1109  H                 Implantable                1109  ...........  ...........  ...........  ...........
                             anchor: Ethicon.
   *C1110  H                Stable Mapper, cath         1110  ...........  ...........  ...........  ...........
                             electrd.
   *C1111  H                AneuRxAort-Uni-             1111  ...........  ...........  ...........  ...........
                             Ilicstnt&cath.
   *C1112  H                AneuRx Stent graft/         1112  ...........  ...........  ...........  ...........
                             del.cath.
   *C1113  H                Tlnt Endo Sprng             1113  ...........  ...........  ...........  ...........
                             Stnt Grft Sys.
   *C1114  H                TalntSprgStnt+Graf          1114  ...........  ...........  ...........  ...........
                             endo pros.
   *C1115  H                5038S,5038,5038L            1115  ...........  ...........  ...........  ...........
                             pace lead.
   *C1116  H                CapSureSP pacing            1116  ...........  ...........  ...........  ...........
                             Lead.
   *C1117  H                Ancure Endograft            1117  ...........  ...........  ...........  ...........
                             Del Sys.
   *C1118  H                Sigma300DR                  1118  ...........  ...........  ...........  ...........
                             LegIIDR,pacemkr.
   *C1119  H                Sprint6932,6943             1119  ...........  ...........  ...........  ...........
                             defib lead.
   *C1120  H                Sprint6942,6945             1120  ...........  ...........  ...........  ...........
                             defib lead.
   *C1121  H                Gem defibrillator..         1121  ...........  ...........  ...........  ...........
   *C1122  G                TC 99M arcitumomab          1122  ...........       $22.80  ...........        $2.78
                             per dose.
   *C1123  H                Gem II VR                   1123  ...........  ...........  ...........  ...........
                             defibrillator.
   *C1124  H                InterStim Test Stim         1124  ...........  ...........  ...........  ...........
                             Kit.
   *C1125  H                Kappa 400SR,Ttopaz          1125  ...........  ...........  ...........  ...........
                             II SR pmkr.
   *C1126  H                Kappa 700 DR                1126  ...........  ...........  ...........  ...........
                             pacemakr.
   *C1127  H                Kappa 700SR,pmkr            1127  ...........  ...........  ...........  ...........
                             sgl chamber.
   *C1128  H                Kappa 700D,Ruby IID         1128  ...........  ...........  ...........  ...........
                             pmkr.
   *C1129  H                Kappa 700VDD,pacmkr         1129  ...........  ...........  ...........  ...........

[[Page 67955]]

 
   *C1130  H                Sigm200D,LGCY IID           1130  ...........  ...........  ...........  ...........
                             sc pmkr.
   *C1131  H                Sigma 200DR, pmker.         1131  ...........  ...........  ...........  ...........
   *C1132  H                Sigma300,200SR Leg          1132  ...........  ...........  ...........  ...........
                             II:sc pac.
   *C1133  H                Sigma SR, Vita SR,          1133  ...........  ...........  ...........  ...........
                             pmaker.
   *C1134  H                Sigma 300D pmker...         1134  ...........  ...........  ...........  ...........
   *C1135  H                Entity DR 5326L/R..         1135  ...........  ...........  ...........  ...........
   *C1136  H                Affinity DR 5330L/R         1136  ...........  ...........  ...........  ...........
   *C1137  H                CardioSEAL implant          1137  ...........  ...........  ...........  ...........
                             syst.
   *C1143  H                AddVent mod                 1143  ...........  ...........  ...........  ...........
                             2060BL,VDD.
   *C1144  H                Afnty SR                    1144  ...........  ...........  ...........  ...........
                             5130,Integrity
                             SR,pmkr.
   *C1145  H                Angio-Seal 6fr, 8fr         1145  ...........  ...........  ...........  ...........
   C1146D  E                 VETT tube.........  ...........  ...........  ...........  ...........  ...........
   *C1147  H                AV Plus DX 1368:            1147  ...........  ...........  ...........  ...........
                             lead.
   *C1148  H                Contour MD sc defib         1148  ...........  ...........  ...........  ...........
   *C1149  H                Entity DC 5226R,            1149  ...........  ...........  ...........  ...........
                             5226 pmkr.
   *C1151  H                 Passiveplus DX             1151  ...........  ...........  ...........  ...........
                             lead, 10mdls.
   *C1152  H                 LifeSite Access            1152  ...........  ...........  ...........  ...........
                             System.
   *C1153  H                Regency SC+ 2402L           1153  ...........  ...........  ...........  ...........
                             pmker.
   *C1154  H                SPL:SPOI,02,04-             1154  ...........  ...........  ...........  ...........
                             defib lead.
   *C1155  H                 Repliform 8 sq cm.         1155  ...........  ...........  ...........  ...........
   *C1156  H                Tr 1102TrSR+                1156  ...........  ...........  ...........  ...........
                             2260L,2264L,5131.
   *C1157  H                Trilogy DCT 2318L           1157  ...........  ...........  ...........  ...........
                             pmkr.
   *C1158  H                TVL lead                    1158  ...........  ...........  ...........  ...........
                             SV01,SV02,SV04.
   *C1159  H                TVL RV02,RV06,RV07:         1159  ...........  ...........  ...........  ...........
                             lead.
   *C1160  H                TVL-ADX 1559: lead.         1160  ...........  ...........  ...........  ...........
   *C1161  H                Tendril DX, 1388            1161  ...........  ...........  ...........  ...........
                             pacing lead.
   *C1162  H                TempoDr,                    1162  ...........  ...........  ...........  ...........
                             TrilogyDR+DC pmkr.
   *C1163  H                Tendril SDX, 1488T          1163  ...........  ...........  ...........  ...........
                             pacing lead.
   *C1164  H                Iodine-125 brachytx         1164  ...........  ...........  ...........  ...........
                             seed.
   *C1166  G                Cytarabine                  1166  ...........      $371.45  ...........       $49.77
                             liposomal, 10 mg.
   *C1167  J                Epirubicin hcl, 2           1167  ...........       $24.94  ...........        $3.34
                             mg.
   C1170D  E                ABBI disp biopsy     ...........  ...........  ...........  ...........  ...........
                             device.
   *C1171  H                Autosuture site             1171  ...........  ...........  ...........  ...........
                             marker stple.
   *C1172  H                Spacemaker dissect          1172  ...........  ...........  ...........  ...........
                             ballon.
   *C1173  H                Cor stnt S540,              1173  ...........  ...........  ...........  ...........
                             S670, o-wire stn.
   *C1174  H                Bard brachytx               1174  ...........  ...........  ...........  ...........
                             needle.
   C1175D  E                Biopsy device, MIBB  ...........  ...........  ...........  ...........  ...........
                             Device.
   C1176D  E                Mammotome HH Probe   ...........  ...........  ...........  ...........  ...........
                             w/Vac Sys.
   C1177D  E                11-G Mammotome       ...........  ...........  ...........  ...........  ...........
                             Probe.
   *C1178  G                Busulfan IV, 6 mg..         1178  ...........       $26.48  ...........        $3.55
   C1179D  E                14-G Mammotome       ...........  ...........  ...........  ...........  ...........
                             Probe.
   *C1180  H                Vigor SR, SC, pmkr.         1180  ...........  ...........  ...........  ...........
   *C1181  H                Meridian SSI, SC,           1181  ...........  ...........  ...........  ...........
                             pmkr.
   *C1182  H                Pulsar SSI, SC,             1182  ...........  ...........  ...........  ...........
                             pmkr.
   *C1183  H                Jade IIS, Sigma             1183  ...........  ...........  ...........  ...........
                             300S,SC, pmkr.
   *C1184  H                Sigma 200S, SC,             1184  ...........  ...........  ...........  ...........
                             pmkr.
   *C1188  G                I 131, per mCi.....         1188  ...........        $5.86  ...........         $.75
   *C1200  G                TC 99M Sodium               1200  ...........      $113.05  ...........       $13.79
                             Glucoheptonate,
                             per vial.
   *C1201  G                TC 99M succimer,            1201  ...........      $135.66  ...........       $16.55
                             per vial.
   *C1202  G                TC 99M Sulfur               1202  ...........       $38.00  ...........        $4.64
                             Colloid, per dose.
   *C1203  G                Verteporfin for             1203  ...........    $1,458.25  ...........      $195.41
                             Injection.
   *C1205  G                TC 99M Disofenin,           1205  ...........      $427.50  ...........       $57.29
                             per vial.
   *C1207  G                Octreotide acetate          1207  ...........      $135.10  ...........       $16.48
                             depot 1mg.
   *C1300  S                Hyperbaric O2 per           0971         1.55       $76.88  ...........       $15.38
                             30 min under
                             pressure.
   *C1302  H                Lead,                       1302  ...........  ...........  ...........  ...........
                             defibrillator, TVL
                             SQ01.
   *C1303  H                CapSure Fix 6940/           1303  ...........  ...........  ...........  ...........
                             4068-110, lead.
   *C1304  H                Sonicath mdl 37-            1304  ...........  ...........  ...........  ...........
                             416,-418.
   *C1305  G                Apligraf...........         1305  ...........    $1,157.81  ...........      $163.31
   *C1306  H                NeuroCyberneticPros         1306  ...........  ...........  ...........  ...........
                             : lead.
   *C1311  H                Trilogy DR+/DAO             1311  ...........  ...........  ...........  ...........
                             pmkr.
   *C1312  H                Magic                       1312  ...........  ...........  ...........  ...........
                             WALLSTENTstent-
                             Mini.
   *C1313  H                 Magic medium,              1313  ...........  ...........  ...........  ...........
                             Radius 31mm.
   *C1314  H                Magic WALLSTENT             1314  ...........  ...........  ...........  ...........
                             stent-Long.
   *C1315  H                Vigor DR, Meridian          1315  ...........  ...........  ...........  ...........
                             DR pmkr.
   *C1316  H                Meridian DDD pmkr..         1316  ...........  ...........  ...........  ...........
   *C1317  H                Discovery SR, pmkr.         1317  ...........  ...........  ...........  ...........
   *C1318  H                Meridian SR pmakr..         1318  ...........  ...........  ...........  ...........
   *C1319  H                 WALLSTENT: enteral         1319  ...........  ...........  ...........  ...........
   *C1320  H                 WALLSTENT:iliac...         1320  ...........  ...........  ...........  ...........
   C1321D  E                Palate/Base of       ...........  ...........  ...........  ...........  ...........
                             Tongue electr.
   C1322D  E                Turbinate            ...........  ...........  ...........  ...........  ...........
                             Somnoplasty electr.
   C1323D  E                VAPR/T disp          ...........  ...........  ...........  ...........  ...........
                             electrode.
   C1324D  E                Ligasure disposable  ...........  ...........  ...........  ...........  ...........
                             electrode.
   *C1325  H                Pallidium -103 seed         1325  ...........  ...........  ...........  ...........

[[Page 67956]]

 
   *C1326  H                Angio-jet rheolytic         1326  ...........  ...........  ...........  ...........
                             thromb cath.
   *C1328  H                 ANS Renew NS               1328  ...........  ...........  ...........  ...........
                             trnsmtr.
   C1329D  E                Versapoint disp      ...........  ...........  ...........  ...........  ...........
                             electrode.
   *C1333  H                PALMAZ Corinthian           1333  ...........  ...........  ...........  ...........
                             bill stent.
   *C1334  H                 Crown,Mini-                1334  ...........  ...........  ...........  ...........
                             crown,CrossLC.
   *C1335  H                 Mesh, Prolene.....         1335  ...........  ...........  ...........  ...........
   *C1336  H                 Constant Flow Imp          1336  ...........  ...........  ...........  ...........
                             Pump.
   *C1337  H                IsoMed 8472-20/35/          1337  ...........  ...........  ...........  ...........
                             60.
   *C1348  G                I 131 per mCi               1348  ...........      $146.57  ...........       $17.88
                             solution.
   *C1350  H                ProstaSeed, I125,           1350  ...........  ...........  ...........  ...........
                             per source.
   *C1351  H                 CapSure Fix lead..         1351  ...........  ...........  ...........  ...........
   *C1352  H                Gem II defib.......         1352  ...........  ...........  ...........  ...........
   *C1353  H                Itrel Interstm              1353  ...........  ...........  ...........  ...........
                             neurostim+ext.
   *C1354  H                Kappa 400DR,Diamond         1354  ...........  ...........  ...........  ...........
                             II 820DR.
   *C1355  H                Kappa 600DR, Vita           1355  ...........  ...........  ...........  ...........
                             DR.
   *C1356  H                Profile MD V-186HV3         1356  ...........  ...........  ...........  ...........
                             sc defib.
   *C1357  H                Angstrom MD V-              1357  ...........  ...........  ...........  ...........
                             190HV3 sc defib.
   *C1358  H                Affinity DC 5230R,          1358  ...........  ...........  ...........  ...........
                             5230 pmkr.
   *C1359  H                Pulsar,Pulsar Max           1359  ...........  ...........  ...........  ...........
                             DR,pmkr.
  *C1360D  T                Ocular photodynamic         0235         2.94      $145.81       $78.91       $29.16
                             therapy.
   *C1361  H                Reveal Cardiac              1108  ...........  ...........  ...........  ...........
                             Recorder.
   *C1362  H                Herculink,OTW SDS           1411  ...........  ...........  ...........  ...........
                             bil stent.
   *C1363  H                Gem DR, DC, defib..         1363  ...........  ...........  ...........  ...........
   *C1364  H                Photon DR V-230HV3          1364  ...........  ...........  ...........  ...........
                             DC defib.
   *C1365  H                Guidewire, Hi-              1365  ...........  ...........  ...........  ...........
                             Torque14/18/35.
   *C1366  H                Guidewire,PTCA, Hi-         1366  ...........  ...........  ...........  ...........
                             Torque.
   *C1367  H                Guidewire, Hi-              1367  ...........  ...........  ...........  ...........
                             Torque CrossIt.
   C1368D  E                On-Q Pain Mgt Sys..  ...........  ...........  ...........  ...........  ...........
   *C1369  H                ANS Renew Stim Sys          1369  ...........  ...........  ...........  ...........
                             recvr.
   *C1370  H                Tension-Free                1370  ...........  ...........  ...........  ...........
                             Vaginal Tape.
   *C1371  H                Symp Nitinol                1371  ...........  ...........  ...........  ...........
                             Transhep Bil Sys.
   *C1372  H                Cordis Nitinol bil          1372  ...........  ...........  ...........  ...........
                             stent.
   *C1375  H                Stent, coronary,            1375  ...........  ...........  ...........  ...........
                             NIR.
   *C1376  H                ANS Renew Stim Sys          1376  ...........  ...........  ...........  ...........
                             lead/ex.
   *C1377  H                Specify 3988 neuro          1377  ...........  ...........  ...........  ...........
                             lead.
   *C1378  H                InterStim Tx 3080/          1378  ...........  ...........  ...........  ...........
                             3886 lead.
   *C1379  H                Pisces-Quad 3887            1379  ...........  ...........  ...........  ...........
                             lead.
   *C1420  H                StapleTac2 Bone w/          1420  ...........  ...........  ...........  ...........
                             Dermis.
   *C1421  H                StapleTac2 Bone wo          1421  ...........  ...........  ...........  ...........
                             Dermis.
   *C1450  H                Orthosphere                 1450  ...........  ...........  ...........  ...........
                             Arthroplasty.
   *C1451  H                Orthosphere                 1451  ...........  ...........  ...........  ...........
                             Arthroplasty Kit.
   *C1500  H                Atherectomy sys,            1500  ...........  ...........  ...........  ...........
                             peripheral.
   *C1700  H                Authen Mick TP              1700  ...........  ...........  ...........  ...........
                             brachy needle.
   *C1701  H                Medtec MT-BT-5201 -         1701  ...........  ...........  ...........  ...........
                             25 ndl.
   *C1702  H                WWMT brachytx               1702  ...........  ...........  ...........  ...........
                             needle.
   *C1703  H                Mentor Prostate             1703  ...........  ...........  ...........  ...........
                             Brachy.
   *C1704  H                MT-BT-5001-25/5051-         1704  ...........  ...........  ...........  ...........
                             25.
   *C1705  H                Best Flexi Brachy           1705  ...........  ...........  ...........  ...........
                             Needle.
   *C1706  H                Indigo Prostate             1706  ...........  ...........  ...........  ...........
                             Seeding Ndl.
   *C1707  H                Varisource Implt            1707  ...........  ...........  ...........  ...........
                             Ndl.
   *C1708  H                UroMed Prostate             1708  ...........  ...........  ...........  ...........
                             Seed Ndl.
   *C1709  H                Remington Brachytx          1709  ...........  ...........  ...........  ...........
                             Needle.
   *C1710  H                US Biopsy Prostate          1710  ...........  ...........  ...........  ...........
                             Needle.
   *C1711  H                MD Tech brachytx            1711  ...........  ...........  ...........  ...........
                             needle.
   *C1712  H                Imagyn brachytx             1712  ...........  ...........  ...........  ...........
                             needle.
   *C1790  H                Iridium 192 HDR....         1790  ...........  ...........  ...........  ...........
   *C1791  H                OncoSeed, Rapid             1791  ...........  ...........  ...........  ...........
                             Strand I-125.
   *C1792  H                UroMed I-125 Brachy         1792  ...........  ...........  ...........  ...........
                             seed.
   *C1793  H                Bard InterSource P-         1793  ...........  ...........  ...........  ...........
                             103 seed.
   *C1794  H                Bard IsoSeed P-103          1794  ...........  ...........  ...........  ...........
                             seed.
   *C1795  H                Bard BrachySource I-        1795  ...........  ...........  ...........  ...........
                             125.
   *C1796  H                SourceTech Med I-           1796  ...........  ...........  ...........  ...........
                             125.
   *C1797  H                Draximage I-125             1797  ...........  ...........  ...........  ...........
                             seed.
   *C1798  H                Syncor I-125                1798  ...........  ...........  ...........  ...........
                             PharmaSeed.
   *C1799  H                I-Plant I-125               1799  ...........  ...........  ...........  ...........
                             Brachytx seed.
   *C1800  H                Pd-103 brachytx             1800  ...........  ...........  ...........  ...........
                             seed.
   *C1801  H                IoGold I-125                1801  ...........  ...........  ...........  ...........
                             brachytx seed.
   *C1802  H                Brachytherapy seed,         1802  ...........  ...........  ...........  ...........
                             Iridium 192.
   *C1803  H                Best Iodine 125             1803  ...........  ...........  ...........  ...........
                             brachytx sds.
   *C1804  H                Best Palladium 103          1804  ...........  ...........  ...........  ...........
                             seeds.
   *C1805  H                IsoStar Iodine-125          1805  ...........  ...........  ...........  ...........
                             seeds.
   *C1806  H                Gold 198 brachy             1806  ...........  ...........  ...........  ...........
                             seeds.
   *C1810  H                D114S Dilatation            1810  ...........  ...........  ...........  ...........
                             Cath.
   *C1811  H                Surgical Dynamics           1811  ...........  ...........  ...........  ...........
                             Anchors.

[[Page 67957]]

 
   *C1812  H                OBL Anchors........         1812  ...........  ...........  ...........  ...........
   *C1850  H                Repliform 14/21 sq          1850  ...........  ...........  ...........  ...........
                             cm.
   *C1851  H                Repliform 24/28 sq          1851  ...........  ...........  ...........  ...........
                             cm.
   *C1852  H                TransCyte, per 247          1852  ...........  ...........  ...........  ...........
                             sq cm.
   *C1853  H                Suspend, per 8/14           1853  ...........  ...........  ...........  ...........
                             sq cm.
   *C1854  H                Suspend, per 24/28          1854  ...........  ...........  ...........  ...........
                             sq cm.
   *C1855  H                Suspend, per 36 sq          1855  ...........  ...........  ...........  ...........
                             cm.
   *C1856  H                Suspend, per 48 sq          1856  ...........  ...........  ...........  ...........
                             cm.
   *C1857  H                Suspend, per 84 sq          1857  ...........  ...........  ...........  ...........
                             cm.
   *C1858  H                DuraDerm, per 8/14          1858  ...........  ...........  ...........  ...........
                             sq cm.
   *C1859  H                DuraDerm, per 21/24/        1859  ...........  ...........  ...........  ...........
                             28 sq cm.
   *C1860  H                DuraDerm, per 48 sq         1860  ...........  ...........  ...........  ...........
                             cm.
   *C1861  H                DuraDerm, per 36 sq         1861  ...........  ...........  ...........  ...........
                             cm.
   *C1862  H                DuraDerm, per 72 sq         1862  ...........  ...........  ...........  ...........
                             cm.
   *C1863  H                DuraDerm, per 84 sq         1863  ...........  ...........  ...........  ...........
                             cm.
   *C1864  H                SpermaTex,per 13.44         1864  ...........  ...........  ...........  ...........
                             sq cm.
   *C1865  H                FasLata, per 8/14           1865  ...........  ...........  ...........  ...........
                             sq cm.
   *C1866  H                FasLata, per 24/28          1866  ...........  ...........  ...........  ...........
                             sq cm.
   *C1867  H                FasLata, per 36/48          1867  ...........  ...........  ...........  ...........
                             sq cm.
   *C1868  H                FasLata, per 96 sq          1868  ...........  ...........  ...........  ...........
                             cm.
   *C1869  H                Gore Thyroplasty            1869  ...........  ...........  ...........  ...........
                             Dev.
   *C1870  H                DermMatrix, per 16          1870  ...........  ...........  ...........  ...........
                             sq cm.
   *C1871  H                DermMatrix, 32 or           1871  ...........  ...........  ...........  ...........
                             64 sq cm.
   *C1872  H                Dermagraft, per             1872  ...........  ...........  ...........  ...........
                             37.5 sq cm.
   *C1873  H                Bard 3DMax Mesh....         1873  ...........  ...........  ...........  ...........
   *C1929  H                Maverick PTCA Cath.         1929  ...........  ...........  ...........  ...........
   *C1930  H                Coyote Dil Cath,20/         1930  ...........  ...........  ...........  ...........
                             30/40mm.
   *C1931  H                Talon Dil Cath.....         1931  ...........  ...........  ...........  ...........
   *C1932  H                Scimed Remedy Dil           1932  ...........  ...........  ...........  ...........
                             Cath.
   *C1933  H                Opti-Plast XL/              1933  ...........  ...........  ...........  ...........
                             Centurion Cath.
   *C1934  H                Ultraverse 3.5F Bal         1934  ...........  ...........  ...........  ...........
                             Dil Cath.
   *C1935  H                Workhorse PTA Bal           1935  ...........  ...........  ...........  ...........
                             Cath.
   *C1936  H                Uromax Ultra Bal            1936  ...........  ...........  ...........  ...........
                             Dil Cath.
   *C1937  H                Synergy Balloon Dil         1937  ...........  ...........  ...........  ...........
                             Cath.
   *C1938  H                UroForce Bal Dil            1938  ...........  ...........  ...........  ...........
                             Cath.
   *C1939  H                Raptor, Ninja PTCA          1939  ...........  ...........  ...........  ...........
                             Dil Cath.
   *C1940  H                PowerFlex,OPTA 5/LP         1940  ...........  ...........  ...........  ...........
                             Bal Cath.
   *C1941  H                Jupiter PTA Dil             1941  ...........  ...........  ...........  ...........
                             Cath.
   *C1942  H                Cordis Maxi LD PTA          1942  ...........  ...........  ...........  ...........
                             Bal Cath.
   *C1943  H                RXCrossSail OTW             1943  ...........  ...........  ...........  ...........
                             OpenSail.
   *C1944  H                Rapid Exchange Bil          1944  ...........  ...........  ...........  ...........
                             Dil Cath.
   *C1945  H                Savvy PTA Dil Cath.         1945  ...........  ...........  ...........  ...........
   *C1946  H                R1s Rapid Dil Cath.         1946  ...........  ...........  ...........  ...........
   *C1947  H                Gazelle Bal Dil             1947  ...........  ...........  ...........  ...........
                             Cath.
   *C1948  H                Pursuit Balloon             1948  ...........  ...........  ...........  ...........
                             Cath.
   *C1949  H                Oracle Megasonics           1949  ...........  ...........  ...........  ...........
                             Cath.
   *C1979  H                Visions PV/Avanar           1979  ...........  ...........  ...........  ...........
                             US Cath.
   *C1980  H                Atlantis SR                 1980  ...........  ...........  ...........  ...........
                             Coronary Cath.
   *C1981  H                PTCA Catheters.....         1981  ...........  ...........  ...........  ...........
   *C2000  H                Orbiter ST                  2000  ...........  ...........  ...........  ...........
                             Steerable Cath.
   *C2001  H                Constellation Diag          2001  ...........  ...........  ...........  ...........
                             Cath.
   *C2002  H                Irvine 5F Inquiry           2002  ...........  ...........  ...........  ...........
                             Diag EP Cath.
   *C2003  H                Irvine 6F Inquiry           2003  ...........  ...........  ...........  ...........
                             Diag EP Cath.
   *C2004  H                Biosense EP Cath--          2004  ...........  ...........  ...........  ...........
                             Octapolar.
   *C2005  H                Biosense EP Cath--          2005  ...........  ...........  ...........  ...........
                             Hexapolar.
   *C2006  H                Biosense EP Cath--          2006  ...........  ...........  ...........  ...........
                             Decapolar.
   *C2007  H                Irvine 6F Luma-Cath         2007  ...........  ...........  ...........  ...........
                             EP Cath.
   *C2008  H                Luma-Cath EP Cath           2008  ...........  ...........  ...........  ...........
                             81910-15.
   *C2009  H                Irvine 7F Luma-Cath         2009  ...........  ...........  ...........  ...........
                             EP Cath.
   *C2010  H                Fixed Curve EP Cath         2010  ...........  ...........  ...........  ...........
   *C2011  H                Deflectable Tip             2011  ...........  ...........  ...........  ...........
                             Cath--Quad.
   *C2012  H                Celsius Abln Cath..         2012  ...........  ...........  ...........  ...........
   *C2013  H                Celsius Large Abln          2013  ...........  ...........  ...........  ...........
                             Cath.
   *C2014  H                Celsius II Asym             2014  ...........  ...........  ...........  ...........
                             Abln Cath.
   *C2015  H                Celsius II Sym Abln         2015  ...........  ...........  ...........  ...........
                             Cath.
   *C2016  H                Navi-Star DS, Navi-         2016  ...........  ...........  ...........  ...........
                             Star Ther.
   *C2017  H                Navi-Star Abln Cath         2017  ...........  ...........  ...........  ...........
   *C2018  H                Polaris T Ablation          2018  ...........  ...........  ...........  ...........
                             Cath.
   *C2019  H                EP Deflectable Cath         2019  ...........  ...........  ...........  ...........
   *C2020  H                Catheter, ablation,         2020  ...........  ...........  ...........  ...........
                             Blazer II XP.
   *C2021  H                SilverFlex EP Cath.         2021  ...........  ...........  ...........  ...........
   *C2022  H                CP Chilli Cooled            2022  ...........  ...........  ...........  ...........
                             Abln Cath.
   *C2023  H                Chilli Cld AblnCath-        2023  ...........  ...........  ...........  ...........
                             std, lg.
   *C2100  H                CP CS Reference             2100  ...........  ...........  ...........  ...........
                             Cath.

[[Page 67958]]

 
   *C2101  H                CP RV Reference             2101  ...........  ...........  ...........  ...........
                             Cath.
   *C2102  H                CP Radii 7F EP Cath         2102  ...........  ...........  ...........  ...........
   *C2103  H                CP Radii 7F EP Cath         2103  ...........  ...........  ...........  ...........
                             w/Track.
   *C2104  H                Lasso Deflectable           2104  ...........  ...........  ...........  ...........
                             Cath.
   *C2151  H                Veripath Guiding            2151  ...........  ...........  ...........  ...........
                             Cath.
   *C2152  H                Cordis Vista Brite          2152  ...........  ...........  ...........  ...........
                             Tip Cath.
   *C2153  H                Bard Viking Cath...         2153  ...........  ...........  ...........  ...........
   *C2200  H                Arrow-Trerotola PTD         2200  ...........  ...........  ...........  ...........
                             Cath.
   *C2300  H                Varisource Stnd             2300  ...........  ...........  ...........  ...........
                             Catheters.
   *C2597  H                CliniCath/kit 16/18         2597  ...........  ...........  ...........  ...........
                             sgl/dbl.
   *C2598  H                CliniCath 18/20/24G-        2598  ...........  ...........  ...........  ...........
                             single.
   *C2599  H                CliniCath 16/18G-           2599  ...........  ...........  ...........  ...........
                             double.
   C2600D  E                Gold Probe Catheter  ...........  ...........  ...........  ...........  ...........
   *C2601  H                Bard DL Ureteral            2601  ...........  ...........  ...........  ...........
                             Cath.
   *C2602  H                Vitesse Laser Cath          2602  ...........  ...........  ...........  ...........
                             1.4/1.7mm.
   *C2603  H                Vitesse Laser Cath          2603  ...........  ...........  ...........  ...........
                             2.0mm.
   *C2604  H                Vitesse E Laser             2604  ...........  ...........  ...........  ...........
                             Cath 2.0mm.
   *C2605  H                Extreme Laser               2605  ...........  ...........  ...........  ...........
                             Catheter.
   *C2606  H                SpineCath XL                2606  ...........  ...........  ...........  ...........
                             Catheter.
   *C2607  H                SpineCath                   2607  ...........  ...........  ...........  ...........
                             Intradiscal Cath.
   *C2608  H                Scimed 6F Wiseguide         2608  ...........  ...........  ...........  ...........
                             Cath.
   *C2609  H                Flexima Bil                 2609  ...........  ...........  ...........  ...........
                             Drainage Cath.
   *C2610  H                FlexTipPlus                 2610  ...........  ...........  ...........  ...........
                             Intraspinal Cath.
   *C2611  H                AlgoLine                    2611  ...........  ...........  ...........  ...........
                             Intraspinal Cath.
   *C2612  H                InDura Catheter....         2612  ...........  ...........  ...........  ...........
   *C2676  E                Response CV          ...........  ...........  ...........  ...........  ...........
                             Catheter.
   *C2700  H                MycroPhylax Plus SC         2700  ...........  ...........  ...........  ...........
                             defib.
   *C2701  H                Phylax XM SC defib.         2701  ...........  ...........  ...........  ...........
   *C2702  H                Ventak Prizm 2 VR           2702  ...........  ...........  ...........  ...........
                             Defib.
   *C2703  H                Ventak Prizm VR HE          2703  ...........  ...........  ...........  ...........
                             Defib.
   *C2704  H                Ventak Mini IV+             2704  ...........  ...........  ...........  ...........
                             Defib.
   *C2801  H                Defender IV DR 612          2801  ...........  ...........  ...........  ...........
                             DC defib.
   *C2802  H                Phylax AV DC defib.         2802  ...........  ...........  ...........  ...........
   *C2803  H                Ventak Prizm DR HE          2803  ...........  ...........  ...........  ...........
                             Defib.
   *C2804  H                Ventak Prizm 2 DR           2804  ...........  ...........  ...........  ...........
                             Defib.
   *C2805  H                Jewel AF 7250 Defib         2805  ...........  ...........  ...........  ...........
   *C2806  H                GEM VR 7227 Defib..         2806  ...........  ...........  ...........  ...........
   *C2807  H                Contak CD 1823.....         2807  ...........  ...........  ...........  ...........
   *C2808  H                Contak TR 1241.....         2808  ...........  ...........  ...........  ...........
   *C3001  H                Kainox SL/RV defib          3001  ...........  ...........  ...........  ...........
                             lead.
   *C3002  H                EasyTrak Defib Lead         3002  ...........  ...........  ...........  ...........
   *C3003  H                Endotak SQ Array XP         3003  ...........  ...........  ...........  ...........
                             lead.
   *C3004  H                Intervene Defib             3004  ...........  ...........  ...........  ...........
                             Lead.
   *C3400  H                Siltex                      3400  ...........  ...........  ...........  ...........
                             Spectrum,Contour
                             Prof.
   *C3401  H                Saline-Filled               3401  ...........  ...........  ...........  ...........
                             Spectrum.
   *C3500  H                Mentor Alpha I Inf          3500  ...........  ...........  ...........  ...........
                             Penile Pros.
   *C3510  H                AMS 800 Urinary             3510  ...........  ...........  ...........  ...........
                             Pros.
   *C3551  H                Choice/PT Graphix/          3551  ...........  ...........  ...........  ...........
                             Luge/Trooper.
   *C3552  H                Hi-Torque Whisper..         3552  ...........  ...........  ...........  ...........
   *C3553  H                Cordis guidewires..         3553  ...........  ...........  ...........  ...........
   *C3554  H                Jindo guidewire....         3554  ...........  ...........  ...........  ...........
   *C3555  H                Wholey Hi-Torque            3555  ...........  ...........  ...........  ...........
                             Plus GW.
   *C3556  H                Wave/FlowWire               3556  ...........  ...........  ...........  ...........
                             Guidewire.
   *C3557  H                HyTek guidewire....         3557  ...........  ...........  ...........  ...........
   *C3800  H                SynchroMed EL               3800  ...........  ...........  ...........  ...........
                             infusion pump.
   *C3801  H                Arrow/MicroJect PCA         3801  ...........  ...........  ...........  ...........
                             Sys.
   *C3851  H                Elastic UV IOL AA-          3851  ...........  ...........  ...........  ...........
                             4203T/TF/TL.
   *C4000  H                Opus G 4621, 4624           4000  ...........  ...........  ...........  ...........
                             SC pmkr.
   *C4001  H                Opus S 4121/4124 SC         4001  ...........  ...........  ...........  ...........
                             pmkr.
   *C4002  H                Talent 113 SC pmkr.         4002  ...........  ...........  ...........  ...........
   *C4003  H                Kairos SR SC pmkr..         4003  ...........  ...........  ...........  ...........
   *C4004  H                Actros SR, Actros           4004  ...........  ...........  ...........  ...........
                             SLR SC pmkr.
   *C4005  H                Philos SR/SR-B SC           4005  ...........  ...........  ...........  ...........
                             pmkr.
   *C4006  H                Pulsar Max II SR            4006  ...........  ...........  ...........  ...........
                             pmkr.
   *C4007  H                Marathon SR pmkr...         4007  ...........  ...........  ...........  ...........
   *C4008  H                Discovery II SSI            4008  ...........  ...........  ...........  ...........
                             pmkr.
   *C4009  H                Discovery II SR             4009  ...........  ...........  ...........  ...........
                             pmkr.
   *C4300  H                Integrity AFx DR            4300  ...........  ...........  ...........  ...........
                             5342 pmkr.
   *C4301  H                Integrity AFx DR            4301  ...........  ...........  ...........  ...........
                             5346 pmkr.
   *C4302  H                Affinity VDR 5430           4302  ...........  ...........  ...........  ...........
                             pmkr.
   *C4303  H                Brio 112 DC pmkr...         4303  ...........  ...........  ...........  ...........
   *C4304  H                Brio 212, Talent            4304  ...........  ...........  ...........  ...........
                             213/223 DC pmkr.
   *C4305  H                Brio 222 DC pmkr...         4305  ...........  ...........  ...........  ...........
   *C4306  H                Brio 220 DC pmkr...         4306  ...........  ...........  ...........  ...........

[[Page 67959]]

 
   *C4307  H                Kairos DR DC pmkr..         4307  ...........  ...........  ...........  ...........
   *C4308  H                Inos2, Inos2+ DC            4308  ...........  ...........  ...........  ...........
                             pmkr.
   *C4309  H                Actros DR,D,DR-             4309  ...........  ...........  ...........  ...........
                             A,SLR DC pmkr.
   *C4310  H                Actros DR-B DC pmkr         4310  ...........  ...........  ...........  ...........
   *C4311  H                Philos DR/DR-B/SLR          4311  ...........  ...........  ...........  ...........
                             DC pmkr.
   *C4312  H                Pulsar Max II DR            4312  ...........  ...........  ...........  ...........
                             pmkr.
   *C4313  H                Marathon DR pmkr...         4313  ...........  ...........  ...........  ...........
   *C4314  H                Momentum DR pmkr...         4314  ...........  ...........  ...........  ...........
   *C4315  H                Selection AFm pmkr.         4315  ...........  ...........  ...........  ...........
   *C4316  H                Discovery II DR....         4316  ...........  ...........  ...........  ...........
   *C4317  H                Discovery II DDD...         4317  ...........  ...........  ...........  ...........
   *C4600  H                Snynox,Polyrox,Elox         4600  ...........  ...........  ...........  ...........
                             ,Retrox.
   *C4601  E                Aescula LV pmkr      ...........  ...........  ...........  ...........  ...........
                             lead.
   *C4602  H                Tendril SDX, 1488K          4602  ...........  ...........  ...........  ...........
                             pmkr lead.
   *C4603  H                Oscor/Flexion pmkr          4603  ...........  ...........  ...........  ...........
                             lead.
   *C4604  H                CrystallineActFix,C         4604  ...........  ...........  ...........  ...........
                             apsureFix.
   *C4605  H                CapSure Epi pmkr            4605  ...........  ...........  ...........  ...........
                             lead.
   *C4606  H                Flextend pmkr lead.         4606  ...........  ...........  ...........  ...........
   *C4607  H                FinelineII/EZ,              4607  ...........  ...........  ...........  ...........
                             ThinlineII/EZ.
   *C5000  H                BX Velocity w/              5000  ...........  ...........  ...........  ...........
                             Hepacoat.
   *C5001  H                Memotherm Bil               5001  ...........  ...........  ...........  ...........
                             Stent, sm, med.
   *C5002  H                Memotherm Bil               5002  ...........  ...........  ...........  ...........
                             Stent, large.
   *C5003  H                Memotherm Bil               5003  ...........  ...........  ...........  ...........
                             Stent, x-large.
   *C5004  H                PalmazCorinthian IQ         5004  ...........  ...........  ...........  ...........
                             Bil Stent.
   *C5005  H                PalmazCorinthian IQ         5005  ...........  ...........  ...........  ...........
                             Trans/Bil.
   *C5006  H                PalmazTrans Bil             5006  ...........  ...........  ...........  ...........
                             Stent Sys-Med.
   *C5007  H                PalmazTrans XL Bil          5007  ...........  ...........  ...........  ...........
                             Stent--40mm.
   *C5008  H                PalmazTrans XL Bil          5008  ...........  ...........  ...........  ...........
                             Stent--50mm.
   *C5009  H                Stent, biliary,             5009  ...........  ...........  ...........  ...........
                             Biliary VistaFlex
                             Stent.
   *C5010  H                Rapid Exchange Bil          5010  ...........  ...........  ...........  ...........
                             Stent Sys.
   *C5011  H                Stent, biliary,             5011  ...........  ...........  ...........  ...........
                             IntraStent,
                             IntraStent LP.
   *C5012  H                Stent, biliary,             5012  ...........  ...........  ...........  ...........
                             IntraStent
                             DoubleStrut LD.
   *C5013  H                IntraStent                  5013  ...........  ...........  ...........  ...........
                             DoubleStrut, XS.
   *C5014  H                AVE Bridge Stent            5014  ...........  ...........  ...........  ...........
                             Sys-10/17/28.
   *C5015  H                AVE/X3 Bridge Sys,          5015  ...........  ...........  ...........  ...........
                             40-100.
   *C5016  H                Biliary stent               5016  ...........  ...........  ...........  ...........
                             single use cov.
   *C5017  H                WallstentRP Bil--20/        5017  ...........  ...........  ...........  ...........
                             40/60/68mm.
   *C5018  H                WallstentRP Bil--80/        5018  ...........  ...........  ...........  ...........
                             94mm.
   *C5019  H                Flexima Bil Stent           5019  ...........  ...........  ...........  ...........
                             Sys.
   *C5020  H                Smart Nitinol Stent-        5020  ...........  ...........  ...........  ...........
                             -20mm.
   *C5021  H                Smart Nitinol Stent-        5021  ...........  ...........  ...........  ...........
                             -40/60mm.
   *C5022  H                Smart Nitinol Stent-        5022  ...........  ...........  ...........  ...........
                             -80mm.
   *C5023  H                BX Velocity Stent--         5023  ...........  ...........  ...........  ...........
                             8/13mm.
   *C5024  H                BX Velocity Stent--         5024  ...........  ...........  ...........  ...........
                             18mm.
   *C5025  H                BX Velocity Stent--         5025  ...........  ...........  ...........  ...........
                             23mm.
   *C5026  H                BX Velocity Stent--         5026  ...........  ...........  ...........  ...........
                             28/33mm.
   *C5027  H                BX Velocity w/Hep--         5027  ...........  ...........  ...........  ...........
                             8/13mm.
   *C5028  H                BX Velocity w/Hep--         5028  ...........  ...........  ...........  ...........
                             18mm.
   *C5029  H                BX Velocity w/Hep--         5029  ...........  ...........  ...........  ...........
                             23mm.
   *C5030  H                Stent, coronary,            5030  ...........  ...........  ...........  ...........
                             S660 9/12mm.
   *C5031  H                Stent,coronary,             5031  ...........  ...........  ...........  ...........
                             S660 15/18mm.
   *C5032  H                Stent,coronary,             5032  ...........  ...........  ...........  ...........
                             S660 24/30mm.
   *C5033  H                Niroyal Stent Sys,          5033  ...........  ...........  ...........  ...........
                             9mm.
   *C5034  H                Niroyal Stent Sys,          5034  ...........  ...........  ...........  ...........
                             12/15mm.
   *C5035  H                Niroyal Stent Sys,          5035  ...........  ...........  ...........  ...........
                             18mm.
   *C5036  H                Niroyal Stent Sys,          5036  ...........  ...........  ...........  ...........
                             25mm.
   *C5037  H                Niroyal Stent Sys,          5037  ...........  ...........  ...........  ...........
                             31mm.
   *C5038  H                BX Velocity Stent w/        5038  ...........  ...........  ...........  ...........
                             Raptor.
   *C5039  H                IntraCoil Periph            5039  ...........  ...........  ...........  ...........
                             Stent--40mm.
   *C5040  H                IntraCoil Periph            5040  ...........  ...........  ...........  ...........
                             Stent--60mm.
   *C5041  H                BeStent Over-the-           5041  ...........  ...........  ...........  ...........
                             Wire 24/30mm.
   *C5042  H                BeStent Over-the-           5042  ...........  ...........  ...........  ...........
                             Wire 18mm.
   *C5043  H                BeStent Over-the-           5043  ...........  ...........  ...........  ...........
                             Wire 15mm.
   *C5044  H                BeStent Over-the-           5044  ...........  ...........  ...........  ...........
                             Wire 9/12mm.
   *C5045  H                Multilink Tetra Cor         5045  ...........  ...........  ...........  ...........
                             Stent Sys.
   *C5046  H                Radius 20mm cor             5046  ...........  ...........  ...........  ...........
                             stent.
   *C5047  H                Niroyal Elite Cor           5047  ...........  ...........  ...........  ...........
                             Stent Sys.
   *C5048  H                GR II Coronary              5048  ...........  ...........  ...........  ...........
                             Stent.
   *C5130  H                Wilson-Cook Colonic         5130  ...........  ...........  ...........  ...........
                             Z-Stent.
   *C5131  H                Bard Colorectal             5131  ...........  ...........  ...........  ...........
                             Stent-60mm.
   *C5132  H                Bard Colorectal             5132  ...........  ...........  ...........  ...........
                             Stent-80mm.
   *C5133  H                Bard Colorectal             5133  ...........  ...........  ...........  ...........
                             Stent-100mm.
   *C5134  H                Enteral Wallstent--         5134  ...........  ...........  ...........  ...........
                             90mm.
   *C5279  H                Contour/Percuflex           5279  ...........  ...........  ...........  ...........
                             Stent.

[[Page 67960]]

 
   *C5280  H                Inlay Dbl Ureteral          5280  ...........  ...........  ...........  ...........
                             Stent.
   *C5281  H                Wallgraft Trach Sys         5281  ...........  ...........  ...........  ...........
                             70mm.
   *C5282  H                Wallgraft Trach Sys         5282  ...........  ...........  ...........  ...........
                             20/30/50.
   *C5283  H                Wallstent/RP TIPS --        5283  ...........  ...........  ...........  ...........
                             80mm.
   *C5284  H                Wallstent                   5284  ...........  ...........  ...........  ...........
                             TrachUltraFlex.
   *C5600  H                Closure dev,                5600  ...........  ...........  ...........  ...........
                             VasoSeal ES.
   *C5601  H                VasoSeal Model 1000         5601  ...........  ...........  ...........  ...........
   *C6001  H                Composix Mesh 8/21          6001  ...........  ...........  ...........  ...........
                             in.
   *C6002  H                 Composix Mesh 32           6002  ...........  ...........  ...........  ...........
                             in.
   *C6003  H                Composix Mesh 48 in         6003  ...........  ...........  ...........  ...........
   *C6004  H                Composix Mesh 80 in         6004  ...........  ...........  ...........  ...........
   *C6005  H                Composix Mesh 140           6005  ...........  ...........  ...........  ...........
                             in.
   *C6006  H                Composix Mesh 144           6006  ...........  ...........  ...........  ...........
                             in.
   *C6012  H                Pelvicol Collagen 8/        6012  ...........  ...........  ...........  ...........
                             14 sq cm.
   *C6013  H                Pelvicol Collagen           6013  ...........  ...........  ...........  ...........
                             21/24/28 sq cm.
   *C6014  H                Pelvicol Collagen           6014  ...........  ...........  ...........  ...........
                             40sq cm.
   *C6015  H                Pelvicol Collagen           6015  ...........  ...........  ...........  ...........
                             48 sq cm.
   *C6016  H                Pelvicol Collagen           6016  ...........  ...........  ...........  ...........
                             96 sq cm.
   *C6017  H                Gore-Tex DualMesh           6017  ...........  ...........  ...........  ...........
                             75/96 sq cm.
   *C6018  H                Gore-Tex DualMesh           6018  ...........  ...........  ...........  ...........
                             150 sq cm.
   *C6019  H                Gore-Tex DualMesh           6019  ...........  ...........  ...........  ...........
                             285 sq cm.
   *C6020  H                Gore-Tex DualMesh           6020  ...........  ...........  ...........  ...........
                             432 sq cm.
   *C6021  H                Gore-Tex DualMesh           6021  ...........  ...........  ...........  ...........
                             600 sq cm.
   *C6022  H                Gore-Tex DualMesh           6022  ...........  ...........  ...........  ...........
                             884 sq cm.
   *C6023  H                Gore-TexPlus 1mm,           6023  ...........  ...........  ...........  ...........
                             75/96sq cm.
   *C6024  H                Gore-TexPlus 1mm,           6024  ...........  ...........  ...........  ...........
                             150sq cm.
   *C6025  H                Gore-TexPlus 1mm,           6025  ...........  ...........  ...........  ...........
                             285sq cm.
   *C6026  H                Gore-TexPlus 1mm,           6026  ...........  ...........  ...........  ...........
                             432sq cm.
   *C6027  H                Gore-TexPlus 1mm,           6027  ...........  ...........  ...........  ...........
                             600sq cm.
   *C6028  H                Gore-TexPlus 1mm,           6028  ...........  ...........  ...........  ...........
                             884 sq cm.
   *C6029  H                Gore-TexPlus 2mm,           6029  ...........  ...........  ...........  ...........
                             150 sq cm.
   *C6030  H                Gore-TexPlus 2mm,           6030  ...........  ...........  ...........  ...........
                             285 sq cm.
   *C6031  H                Gore-TexPlus 2mm,           6031  ...........  ...........  ...........  ...........
                             432 sq cm.
   *C6032  H                Gore-TexPlus 2mm,           6032  ...........  ...........  ...........  ...........
                             600 sq cm.
   *C6033  H                Gore-TexPlus 2mm,           6033  ...........  ...........  ...........  ...........
                             884 sq cm.
   *C6034  H                Bard ePTFE: 15 sq           6034  ...........  ...........  ...........  ...........
                             cm--2mm.
   *C6035  H                Bard ePTFE150sqcm-          6035  ...........  ...........  ...........  ...........
                             1mm,75-2mm.
   *C6036  H                Bard ePTFE: 50/             6036  ...........  ...........  ...........  ...........
                             75sqcm-1,2mm.
   *C6037  H                Bard ePTFE: 300sq           6037  ...........  ...........  ...........  ...........
                             cm-1,2mm.
   *C6038  H                Bard ePTFE: 600sq           6038  ...........  ...........  ...........  ...........
                             cm-1mm.
   *C6039  H                Bard ePTFE: 884sq           6039  ...........  ...........  ...........  ...........
                             cm-1mm.
   *C6040  H                Bard ePTFE: 600sq           6040  ...........  ...........  ...........  ...........
                             cm-2mm.
   *C6041  H                Bard ePTFE: 884sq           6041  ...........  ...........  ...........  ...........
                             cm-2mm.
   *C6050  H                Female Sling Sys w/         6050  ...........  ...........  ...........  ...........
                             wo Matrl.
   *C6051  H                Stratasis Urethral          6051  ...........  ...........  ...........  ...........
                             Sling, 20/40 cm.
   *C6052  H                Stratasis Urethral          6052  ...........  ...........  ...........  ...........
                             Sling, 60 cm.
   *C6053  H                Surgisis Soft Graft         6053  ...........  ...........  ...........  ...........
   *C6054  H                Surgisis Enhanced           6054  ...........  ...........  ...........  ...........
                             Graft.
   *C6055  H                Surgisis Enhanced           6055  ...........  ...........  ...........  ...........
                             Tissue.
   *C6056  H                Surgisis Soft               6056  ...........  ...........  ...........  ...........
                             Tissue Graft.
   *C6057  H                Surgisis Hernia             6057  ...........  ...........  ...........  ...........
                             Graft.
   *C6058  H                SurgiPro Hernia             6058  ...........  ...........  ...........  ...........
                             Plug, med/lg.
   *C6080  H                Male Sling Sys w/wo         6080  ...........  ...........  ...........  ...........
                             Matrl.
   *C6200  H                Exxcel Sft ePTFE            6200  ...........  ...........  ...........  ...........
                             vas graft.
   *C6201  H                Impra Venaflo--10/          6201  ...........  ...........  ...........  ...........
                             20cm.
   *C6202  H                Impra Venaflo-30/           6202  ...........  ...........  ...........  ...........
                             40cm.
   *C6203  H                Impra Venaflo-              6203  ...........  ...........  ...........  ...........
                             50cm,vt45.
   *C6204  H                Impra Venaflo-              6204  ...........  ...........  ...........  ...........
                             stepped.
   *C6205  H                Impra Carboflo--            6205  ...........  ...........  ...........  ...........
                             10cm.
   *C6206  H                Impra Carboflo--            6206  ...........  ...........  ...........  ...........
                             20cm.
   *C6207  H                Impra Carboflo--30/         6207  ...........  ...........  ...........  ...........
                             35/40cm.
   *C6208  H                Impra Carboflo--40/         6208  ...........  ...........  ...........  ...........
                             50cm.
   *C6209  H                Impra Carboflo--            6209  ...........  ...........  ...........  ...........
                             ctrflex.
   *C6210  H                Exxcel ePTFE vas            6210  ...........  ...........  ...........  ...........
                             graft.
   *C6300  H                Vanguard III                6300  ...........  ...........  ...........  ...........
                             Endovas Graft.
   *C6500  H                Preface Guiding             6500  ...........  ...........  ...........  ...........
                             Sheath.
   *C6501  H                Sheath, Soft Tip            6501  ...........  ...........  ...........  ...........
                             Sheaths.
   *C6502  H                Perry Exchange              6502  ...........  ...........  ...........  ...........
                             Dilator.
   *C6525  H                Spectranetics Laser         6525  ...........  ...........  ...........  ...........
                             Sheath.
   *C6600  H                Micro Litho Flex            6600  ...........  ...........  ...........  ...........
                             Probes.
   *C6650  H                Fast-Cath Guiding           6650  ...........  ...........  ...........  ...........
                             Introducer.
   *C6651  H                Seal-AwayGuiding            6651  ...........  ...........  ...........  ...........
                             Introducer.
   *C6652  H                Bard Excalibur              6652  ...........  ...........  ...........  ...........
                             Introducer.
   *C6700  H                Focal Seal-L.......         6700  ...........  ...........  ...........  ...........

[[Page 67961]]

 
   *C8099  H                Spectranetics Lead          8099  ...........  ...........  ...........  ...........
                             Lock Dev.
    C8100  H                Adhesion barrier,           8100  ...........  ...........  ...........  ...........
                             ADCON-L.
   *C8102  H                SurgiVision Esoph           8102  ...........  ...........  ...........  ...........
                             Coil.
   C8103D  E                Capio Capturing Dev  ...........  ...........  ...........  ...........  ...........
   *C8500  X                Atherocath-GTO.....         0991  ...........    $1,278.59  ...........      $255.72
   *C8501  X                Pacemaker, single           0992  ...........    $1,790.03  ...........      $358.01
                             chamber, Vigor SSI.
   *C8502  X                Livewire Steerable          0988  ...........      $383.58  ...........       $76.72
                             EP Cath.
   *C8503  X                SyncroMed Vas Cath.         0988  ...........      $383.58  ...........       $76.72
   *C8504  X                VasoSeal Hemostasis         0987  ...........      $127.86  ...........       $25.57
                             Dev.
   *C8505  X                SynchroMed Infusion         0997  ...........    $8,182.98  ...........    $1,636.60
                             Pump.
   *C8506  X                Pmkr leads                  0990  ...........      $895.01  ...........      $179.00
                             4057M,4058M.
   *C8507  X                6721L/M/S,6939 lead         0990  ...........      $895.01  ...........      $179.00
   *C8508  X                Lead,                       0990  ...........      $895.01  ...........      $179.00
                             defibrillator,
                             CapSure 4965.
   *C8509  X                Transvene 6933/6937         0990  ...........      $895.01  ...........      $179.00
                             lead.
   *C8510  X                Lead,                       0990  ...........      $895.01  ...........      $179.00
                             defibrillator, DP-
                             3238.
   *C8511  X                Lead,                       0996  ...........    $6,137.23  ...........    $1,227.45
                             defibrillator,
                             EndoTak DSP.
   *C8512  X                On-Point,Pisces-            0990  ...........      $895.01  ...........      $179.00
                             Quad lead.
   *C8513  X                Pisces,Resume II            0990  ...........      $895.01  ...........      $179.00
                             lead.
   *C8514  X                Dura II Penile Pros         0993  ...........    $2,557.18  ...........      $511.44
  *C8515D  X                Alpha 1 narrow base         0995  ...........    $4,602.92  ...........      $920.58
                             prosthesis.
   *C8516  X                Mentor Acu-Form/Mal         0992  ...........    $1,790.03  ...........      $358.01
                             Pros.
  *C8517D  X                Ambicor prosthesis.         0994  ...........    $3,580.05  ...........      $716.01
   *C8518  X                Pacemaker, dual             0994  ...........    $3,580.05  ...........      $716.01
                             chamber, Vigor DDD.
   *C8519  X                Pacemaker, dual             0994  ...........    $3,580.05  ...........      $716.01
                             chamber, Vista DDD.
   *C8520  X                Pacemaker, single           0992  ...........    $1,790.03  ...........      $358.01
                             chamber, Legacy II
                             S.
   *C8521  X                Medtronic Mattrix           0997  ...........    $8,182.98  ...........    $1,636.60
                             rcvr/trmr.
   *C8522  X                Palmaz Bal Stent...         0990  ...........      $895.01  ...........      $179.00
   *C8523  X                Wallstent Trans Bil         0991  ...........    $1,278.59  ...........      $255.72
   *C8524  X                Wallstent Esop.....         0991  ...........    $1,278.59  ...........      $255.72
   *C8525  X                Esoph stent--double         0992  ...........    $1,790.03  ...........      $358.01
   *C8526  X                 OptiPlast XT 5F            0987  ...........      $127.86  ...........       $25.57
                             PTA Cath.
   *C8528  X                MS Classique                0987  ...........      $127.86  ...........       $25.57
                             Balloon Dilation
                             Catheter.
   *C8529  X                Crista Cath II Def          0990  ...........      $895.01  ...........      $179.00
                             20-Pole.
   *C8530  X                Gel-Filled/Smooth           0989  ...........      $639.30  ...........      $127.86
                             Mammary Pros.
   *C8531  X                Wilson-Cook Esoph Z-        0989  ...........      $639.30  ...........      $127.86
                             Stent.
   *C8532  X                UltraFlex Esoph....         0991  ...........    $1,278.59  ...........      $255.72
   *C8533  X                SynchroMed Vas Cath         0988  ...........      $383.58  ...........       $76.72
                             8700A/V.
   *C8534  X                AMS Malleable 650           0992  ...........    $1,790.03  ...........      $358.01
                             Penile Prosthesis.
   *C8535  X                Za/Spiral Z Bil             0990  ...........      $895.01  ...........      $179.00
                             Stent.
   *C8536  X                Esoph Z Metal Stent         0991  ...........    $1,278.59  ...........      $255.72
   *C8539  X                Quantum Dil Balloon         0987  ...........      $127.86  ...........       $25.57
   *C8540  X                Flex-EZ Bal Dilator         0988  ...........      $383.58  ...........       $76.72
   *C8541  X                Carson/Passprt Dil.         0988  ...........      $383.58  ...........       $76.72
   *C8542  X                UrethraMax Dil Cath         0987  ...........      $127.86  ...........       $25.57
   *C8543  X                Amplatz Renal Dil..         0987  ...........      $127.86  ...........       $25.57
   *C8550  X                Livewire 5F, 7F EP          0989  ...........      $639.30  ...........      $127.86
                             Cath.
   *C8551  X                Livewire 7F Duo-            0990  ...........      $895.01  ...........      $179.00
                             Decapolar.
   *C8552  X                Santuro Fixed Curve         0989  ...........      $639.30  ...........      $127.86
                             Cath.
   *C8597  X                Wisdom ST guidewire         0987  ...........      $127.86  ...........       $25.57
   *C8598  X                SV Guidewire-5/8/           0987  ...........      $127.86  ...........       $25.57
                             14cm.
   *C8599  X                Stabilizer XS               0987  ...........      $127.86  ...........       $25.57
                             guidewire.
   *C8600  X                Shinobi Plus                0987  ...........      $127.86  ...........       $25.57
                             guidewire.
   *C8650  X                XL Check-Flo                0987  ...........      $127.86  ...........       $25.57
                             Introducer.
   *C8724  X                Octad neuro lead...         0991  ...........    $1,278.59  ...........      $255.72
   *C8725  X                SymMix neuro lead..         0990  ...........      $895.01  ...........      $179.00
   *C8748  X                Endotak SQ Patch            0990  ...........      $895.01  ...........      $179.00
                             defib lead.
   *C8749  X                Endotak SQ Array            0993  ...........    $2,557.18  ...........      $511.44
                             defib lead.
   *C8750  X                Unity VDDR dc pmkr.         0994  ...........    $3,580.05  ...........      $716.01
   *C8775  X                2188 Cor pmkr lead.         0991  ...........    $1,278.59  ...........      $255.72
   *C8776  X                Innomedica pmkr             0990  ...........      $895.01  ...........      $179.00
                             lead.
   *C8777  X                Unipass pmkr lead..         0991  ...........    $1,278.59  ...........      $255.72
   *C8800  X                Lg Palmaz Bil Stent         0990  ...........      $895.01  ...........      $179.00
   *C8801  X                Gianturco Bil Z             0989  ...........      $639.30  ...........      $127.86
                             Stent.
   *C8802  X                Oasis Stent Intro           0987  ...........      $127.86  ...........       $25.57
                             Sys.
   *C8830  X                Gianturco-Roubin            0991  ...........    $1,278.59  ...........      $255.72
                             Cor Snt.
   *C8890  X                Perfluoron, per 2ml         0987  ...........      $127.86  ...........       $25.57
   *C8891  X                Perfluoron, per 5/          0988  ...........      $383.58  ...........       $76.72
                             7ml.
    C9000  G                Na chromate Cr51,           9000  ...........      $259.36  ...........       $34.75
                             per 0.25mCi.
    C9001  J                Linezolid inj,              9001  ...........       $34.14  ...........        $4.57
                             200mg.
    C9002  J                Tenecteplase, 50mg/         9002  ...........    $2,612.50  ...........      $350.08
                             vial.
    C9003  J                Palivizumab, per            9003  ...........      $664.49  ...........       $89.04
                             50mg.
    C9004  J                Gemtuzumab                  9004  ...........    $1,929.69  ...........      $258.58
                             ozogamicin inj,5mg.
    C9005  G                reteplase, 18.1 mg          9005  ...........    $1,306.25  ...........      $175.04
                             (one single-use
                             vial).
    C9006  J                Tacrolimus inj, per         9006  ...........      $109.83  ...........       $14.72
                             5mg (1 amp).

[[Page 67962]]

 
    C9007  G                Baclofen                    9007  ...........       $79.80  ...........       $10.69
                             Intrathecal kit-
                             1amp.
    C9008  G                Baclofen Refill Kit-        9008  ...........      $222.30  ...........       $29.79
                             -500mcg.
    C9009  G                Baclofen Refill Kit-        9009  ...........      $467.40  ...........       $62.63
                             -2000mcg.
    C9010  G                Baclofen Refill Kit-        9010  ...........      $820.80  ...........      $109.99
                             -4000mcg.
    C9011  G                Caffeine Citrate,           9011  ...........       $12.22  ...........        $1.57
                             inj, 1ml.
   *C9100  G                Iodinated I-131             9100  ...........      $246.05  ...........       $30.02
                             Albumin.
    C9102  G                51 Na chromate,             9102  ...........      $216.60  ...........       $26.43
                             50uCi.
    C9103  G                Na Iothalamate I-           9103  ...........       $12.27  ...........        $1.50
                             125, 10uCi.
    C9104  G                Anti-thymocyte              9104  ...........      $251.75  ...........       $33.73
                             globulin,25mg.
    C9105  G                Hep B imm glob, per         9105  ...........      $152.00  ...........       $20.37
                             1 ml.
    C9106  J                Sirolimus 1mg/ml...         9106  ...........        $6.51  ...........         $.87
   *C9107  J                Tinzaparin sodium,          9107  ...........      $159.60  ...........       $20.50
                             2ml vial.
    C9108  G                Thyrotropin alfa,           9108  ...........      $494.00  ...........       $70.72
                             1.1 mg.
    C9109  G                Tirofiban hcl, 6.25         9109  ...........      $199.50  ...........       $28.56
                             mg.
    C9500  K                Platelets,                  9500         1.77       $87.97  ...........       $17.59
                             irradiated, each
                             unit.
    C9501  K                Platelets,                  9501         9.69      $480.75  ...........       $96.15
                             pheresis, each
                             unit.
    C9502  K                Platelets,                  9502        10.52      $521.66  ...........      $104.33
                             pheresis,
                             irradiated, each
                             unit.
    C9503  K                Fresh frzn plasma,          9503         1.65       $81.83  ...........       $16.37
                             donor retested,
                             unit.
    C9504  K                Red blood cells,            9504         4.35      $215.83  ...........       $43.17
                             deglycerolized,
                             unit.
    C9505  K                Red blood cells,            9505         2.58      $127.86  ...........       $25.57
                             irradiated, each
                             unit.
   *C9700  T                Water-induced               0977        23.20    $1,150.63  ...........      $230.13
                             thermotherapy.
   *C9701  S                Stretta Procedure..         0976        18.05      $895.21  ...........      $179.04
   *C9702  S                Chkmate Intra               0981        46.40    $2,301.26  ...........      $460.25
                             Brachytx Sys.
    D0120  E                Periodic oral        ...........  ...........  ...........  ...........  ...........
                             evaluation.
    D0140  E                Limit oral eval      ...........  ...........  ...........  ...........  ...........
                             problm focus.
    D0150  S                Comprehensve oral           0330         1.51       $74.89       $14.98       $14.98
                             evaluation.
    D0160  E                Extensv oral eval    ...........  ...........  ...........  ...........  ...........
                             prob focus.
    D0170  E                Re-eval,est          ...........  ...........  ...........  ...........  ...........
                             pt,problem focus.
    D0210  E                Intraor complete     ...........  ...........  ...........  ...........  ...........
                             film series.
    D0220  E                Intraoral            ...........  ...........  ...........  ...........  ...........
                             periapical first f.
    D0230  E                Intraoral            ...........  ...........  ...........  ...........  ...........
                             periapical ea add.
    D0240  S                Intraoral occlusal          0330         1.51       $74.89       $14.98       $14.98
                             film.
    D0250  S                Extraoral first             0330         1.51       $74.89       $14.98       $14.98
                             film.
    D0260  S                Extraoral ea                0330         1.51       $74.89       $14.98       $14.98
                             additional film.
    D0270  S                Dental bitewing             0330         1.51       $74.89       $14.98       $14.98
                             single film.
    D0272  S                Dental bitewings            0330         1.51       $74.89       $14.98       $14.98
                             two films.
    D0274  S                Dental bitewings            0330         1.51       $74.89       $14.98       $14.98
                             four films.
    D0277  S                Vert bitewings-sev          0330         1.51       $74.89       $14.98       $14.98
                             to eight.
    D0290  E                Dental film skull/   ...........  ...........  ...........  ...........  ...........
                             facial bon.
    D0310  E                Dental saliography.  ...........  ...........  ...........  ...........  ...........
    D0320  E                Dental tmj           ...........  ...........  ...........  ...........  ...........
                             arthrogram incl i.
    D0321  E                Dental other tmj     ...........  ...........  ...........  ...........  ...........
                             films.
    D0322  E                Dental tomographic   ...........  ...........  ...........  ...........  ...........
                             survey.
    D0330  E                Dental panoramic     ...........  ...........  ...........  ...........  ...........
                             film.
    D0340  E                Dental               ...........  ...........  ...........  ...........  ...........
                             cephalometric film.
    D0350  E                Oral/facial images.  ...........  ...........  ...........  ...........  ...........
    D0415  E                Bacteriologic study  ...........  ...........  ...........  ...........  ...........
    D0425  E                Caries               ...........  ...........  ...........  ...........  ...........
                             susceptibility
                             test.
    D0460  S                Pulp vitality test.         0330         1.51       $74.89       $14.98       $14.98
    D0470  E                Diagnostic casts...  ...........  ...........  ...........  ...........  ...........
    D0472  S                Gross exam, prep &          0330         1.51       $74.89       $14.98       $14.98
                             report.
    D0473  S                Micro exam, prep &          0330         1.51       $74.89       $14.98       $14.98
                             report.
    D0474  S                Micro w exam of             0330         1.51       $74.89       $14.98       $14.98
                             surg margins.
    D0480  S                Cytopath smear prep         0330         1.51       $74.89       $14.98       $14.98
                             & report.
    D0501  S                Histopathologic             0330         1.51       $74.89       $14.98       $14.98
                             examinations.
    D0502  S                Other oral                  0330         1.51       $74.89       $14.98       $14.98
                             pathology procedu.
    D0999  S                Unspecified                 0330         1.51       $74.89       $14.98       $14.98
                             diagnostic proce.
    D1110  E                Dental prophylaxis   ...........  ...........  ...........  ...........  ...........
                             adult.
    D1120  E                Dental prophylaxis   ...........  ...........  ...........  ...........  ...........
                             child.
    D1201  E                Topical fluor w      ...........  ...........  ...........  ...........  ...........
                             prophy child.
    D1203  E                Topical fluor w/o    ...........  ...........  ...........  ...........  ...........
                             prophy chi.
    D1204  E                Topical fluor w/o    ...........  ...........  ...........  ...........  ...........
                             prophy adu.
    D1205  E                Topical fluoride w/  ...........  ...........  ...........  ...........  ...........
                             prophy a.
    D1310  E                Nutri counsel-       ...........  ...........  ...........  ...........  ...........
                             control caries.
    D1320  E                Tobacco counseling.  ...........  ...........  ...........  ...........  ...........
    D1330  E                Oral hygiene         ...........  ...........  ...........  ...........  ...........
                             instruction.
    D1351  E                Dental sealant per   ...........  ...........  ...........  ...........  ...........
                             tooth.
    D1510  S                Space maintainer            0330         1.51       $74.89       $14.98       $14.98
                             fxd unilat.
    D1515  S                Fixed bilat space           0330         1.51       $74.89       $14.98       $14.98
                             maintainer.
    D1520  S                Remove unilat space         0330         1.51       $74.89       $14.98       $14.98
                             maintain.
    D1525  S                Remove bilat space          0330         1.51       $74.89       $14.98       $14.98
                             maintain.
    D1550  S                Recement space              0330         1.51       $74.89       $14.98       $14.98
                             maintainer.
    D2110  E                Amalgam one surface  ...........  ...........  ...........  ...........  ...........
                             primary.
    D2120  E                Amalgam two          ...........  ...........  ...........  ...........  ...........
                             surfaces primary.

[[Page 67963]]

 
    D2130  E                Amalgam three        ...........  ...........  ...........  ...........  ...........
                             surfaces prima.
    D2131  E                Amalgam four/more    ...........  ...........  ...........  ...........  ...........
                             surf prima.
    D2140  E                Amalgam one surface  ...........  ...........  ...........  ...........  ...........
                             permanen.
    D2150  E                Amalgam two          ...........  ...........  ...........  ...........  ...........
                             surfaces permane.
    D2160  E                Amalgam three        ...........  ...........  ...........  ...........  ...........
                             surfaces perma.
    D2161  E                Amalgam 4 or >       ...........  ...........  ...........  ...........  ...........
                             surfaces perm.
    D2330  E                Resin one surface-   ...........  ...........  ...........  ...........  ...........
                             anterior.
    D2331  E                Resin two surfaces-  ...........  ...........  ...........  ...........  ...........
                             anterior.
    D2332  E                Resin three          ...........  ...........  ...........  ...........  ...........
                             surfaces-anterio.
    D2335  E                Resin 4/> surf or w  ...........  ...........  ...........  ...........  ...........
                             incis an.
    D2336  E                Composite resin      ...........  ...........  ...........  ...........  ...........
                             crown.
    D2337  E                Compo resin crown    ...........  ...........  ...........  ...........  ...........
                             ant-perm.
    D2380  E                Resin one surf       ...........  ...........  ...........  ...........  ...........
                             poster primar.
    D2381  E                Resin two surf       ...........  ...........  ...........  ...........  ...........
                             poster primar.
    D2382  E                Resin three/more     ...........  ...........  ...........  ...........  ...........
                             surf post p.
    D2385  E                Resin one surf       ...........  ...........  ...........  ...........  ...........
                             poster perman.
    D2386  E                Resin two surf       ...........  ...........  ...........  ...........  ...........
                             poster perman.
    D2387  E                Resin three/more     ...........  ...........  ...........  ...........  ...........
                             surf post p.
    D2388  E                Resin four/more,     ...........  ...........  ...........  ...........  ...........
                             post perm.
    D2410  E                Dental gold foil     ...........  ...........  ...........  ...........  ...........
                             one surface.
    D2420  E                Dental gold foil     ...........  ...........  ...........  ...........  ...........
                             two surface.
    D2430  E                Dental gold foil     ...........  ...........  ...........  ...........  ...........
                             three surfa.
    D2510  E                Dental inlay         ...........  ...........  ...........  ...........  ...........
                             metalic 1 surf.
    D2520  E                Dental inlay         ...........  ...........  ...........  ...........  ...........
                             metallic 2 surf.
    D2530  E                Dental inlay metl 3/ ...........  ...........  ...........  ...........  ...........
                             more sur.
    D2542  E                Dental onlay         ...........  ...........  ...........  ...........  ...........
                             metallic 2 surf.
    D2543  E                Dental onlay         ...........  ...........  ...........  ...........  ...........
                             metallic 3 surf.
    D2544  E                Dental onlay metl 4/ ...........  ...........  ...........  ...........  ...........
                             more sur.
    D2610  E                Inlay porcelain/     ...........  ...........  ...........  ...........  ...........
                             ceramic 1 su.
    D2620  E                Inlay porcelain/     ...........  ...........  ...........  ...........  ...........
                             ceramic 2 su.
    D2630  E                Dental onlay porc 3/ ...........  ...........  ...........  ...........  ...........
                             more sur.
    D2642  E                Dental onlay         ...........  ...........  ...........  ...........  ...........
                             porcelin 2 surf.
    D2643  E                Dental onlay         ...........  ...........  ...........  ...........  ...........
                             porcelin 3 surf.
    D2644  E                Dental onlay porc 4/ ...........  ...........  ...........  ...........  ...........
                             more sur.
    D2650  E                Inlay composite/     ...........  ...........  ...........  ...........  ...........
                             resin one su.
    D2651  E                Inlay composite/     ...........  ...........  ...........  ...........  ...........
                             resin two su.
    D2652  E                Dental inlay resin   ...........  ...........  ...........  ...........  ...........
                             3/mre sur.
    D2662  E                Dental onlay resin   ...........  ...........  ...........  ...........  ...........
                             2 surface.
    D2663  E                Dental onlay resin   ...........  ...........  ...........  ...........  ...........
                             3 surface.
    D2664  E                Dental onlay resin   ...........  ...........  ...........  ...........  ...........
                             4/mre sur.
    D2710  E                Crown resin          ...........  ...........  ...........  ...........  ...........
                             laboratory.
    D2720  E                Crown resin w/ high  ...........  ...........  ...........  ...........  ...........
                             noble me.
    D2721  E                Crown resin w/ base  ...........  ...........  ...........  ...........  ...........
                             metal.
    D2722  E                Crown resin w/       ...........  ...........  ...........  ...........  ...........
                             noble metal.
    D2740  E                Crown porcelain/     ...........  ...........  ...........  ...........  ...........
                             ceramic subs.
    D2750  E                Crown porcelain w/   ...........  ...........  ...........  ...........  ...........
                             h noble m.
    D2751  E                Crown porcelain      ...........  ...........  ...........  ...........  ...........
                             fused base m.
    D2752  E                Crown porcelain w/   ...........  ...........  ...........  ...........  ...........
                             noble met.
    D2780  E                Crown 3/4 cast hi    ...........  ...........  ...........  ...........  ...........
                             noble met.
    D2781  E                Crown 3/4 cast base  ...........  ...........  ...........  ...........  ...........
                             metal.
    D2782  E                Crown 3/4 cast       ...........  ...........  ...........  ...........  ...........
                             noble metal.
    D2783  E                Crown 3/4 porcelain/ ...........  ...........  ...........  ...........  ...........
                             ceramic.
    D2790  E                Crown full cast      ...........  ...........  ...........  ...........  ...........
                             high noble m.
    D2791  E                Crown full cast      ...........  ...........  ...........  ...........  ...........
                             base metal.
    D2792  E                Crown full cast      ...........  ...........  ...........  ...........  ...........
                             noble metal.
    D2799  E                Provisional crown..  ...........  ...........  ...........  ...........  ...........
    D2910  E                Dental recement      ...........  ...........  ...........  ...........  ...........
                             inlay.
    D2920  E                Dental recement      ...........  ...........  ...........  ...........  ...........
                             crown.
    D2930  E                Prefab stnlss steel  ...........  ...........  ...........  ...........  ...........
                             crwn pri.
    D2931  E                Prefab stnlss steel  ...........  ...........  ...........  ...........  ...........
                             crown pe.
    D2932  E                Prefabricated resin  ...........  ...........  ...........  ...........  ...........
                             crown.
    D2933  E                Prefab stainless     ...........  ...........  ...........  ...........  ...........
                             steel crown.
    D2940  E                Dental sedative      ...........  ...........  ...........  ...........  ...........
                             filling.
    D2950  E                Core build-up incl   ...........  ...........  ...........  ...........  ...........
                             any pins.
    D2951  E                Tooth pin retention  ...........  ...........  ...........  ...........  ...........
    D2952  E                Post and core cast   ...........  ...........  ...........  ...........  ...........
                             + crown.
    D2953  E                Each addtnl cast     ...........  ...........  ...........  ...........  ...........
                             post.
    D2954  E                Prefab post/core +   ...........  ...........  ...........  ...........  ...........
                             crown.
    D2955  E                Post removal.......  ...........  ...........  ...........  ...........  ...........
    D2957  E                Each addtnl prefab   ...........  ...........  ...........  ...........  ...........
                             post.
    D2960  E                Laminate labial      ...........  ...........  ...........  ...........  ...........
                             veneer.
    D2961  E                Lab labial veneer    ...........  ...........  ...........  ...........  ...........
                             resin.
    D2962  E                Lab labial veneer    ...........  ...........  ...........  ...........  ...........
                             porcelain.
    D2970  S                Temporary-                  0330         1.51       $74.89       $14.98       $14.98
                             fractured tooth.

[[Page 67964]]

 
    D2980  E                Crown repair.......  ...........  ...........  ...........  ...........  ...........
    D2999  S                Dental unspec               0330         1.51       $74.89       $14.98       $14.98
                             restorative pr.
    D3110  E                Pulp cap direct....  ...........  ...........  ...........  ...........  ...........
    D3120  E                Pulp cap indirect..  ...........  ...........  ...........  ...........  ...........
    D3220  E                Therapeutic          ...........  ...........  ...........  ...........  ...........
                             pulpotomy.
    D3221  E                Gross pulpal         ...........  ...........  ...........  ...........  ...........
                             debridement.
    D3230  E                Pulpal therapy       ...........  ...........  ...........  ...........  ...........
                             anterior prim.
    D3240  E                Pulpal therapy       ...........  ...........  ...........  ...........  ...........
                             posterior pri.
    D3310  E                Anterior...........  ...........  ...........  ...........  ...........  ...........
    D3320  E                Root canal therapy   ...........  ...........  ...........  ...........  ...........
                             2 canals.
    D3330  E                Root canal therapy   ...........  ...........  ...........  ...........  ...........
                             3 canals.
    D3331  E                Non-surg tx root     ...........  ...........  ...........  ...........  ...........
                             canal obs.
    D3332  E                Incomplete           ...........  ...........  ...........  ...........  ...........
                             endodontic tx.
    D3333  E                Internal root        ...........  ...........  ...........  ...........  ...........
                             repair.
    D3346  E                Retreat root canal   ...........  ...........  ...........  ...........  ...........
                             anterior.
    D3347  E                Retreat root canal   ...........  ...........  ...........  ...........  ...........
                             bicuspid.
    D3348  E                Retreat root canal   ...........  ...........  ...........  ...........  ...........
                             molar.
    D3351  E                Apexification/       ...........  ...........  ...........  ...........  ...........
                             recalc initial.
    D3352  E                Apexification/       ...........  ...........  ...........  ...........  ...........
                             recalc interim.
    D3353  E                Apexification/       ...........  ...........  ...........  ...........  ...........
                             recalc final.
    D3410  E                Apicoect/perirad     ...........  ...........  ...........  ...........  ...........
                             surg anter.
    D3421  E                Root surgery         ...........  ...........  ...........  ...........  ...........
                             bicuspid.
    D3425  E                Root surgery molar.  ...........  ...........  ...........  ...........  ...........
    D3426  E                Root surgery ea add  ...........  ...........  ...........  ...........  ...........
                             root.
    D3430  E                Retrograde filling.  ...........  ...........  ...........  ...........  ...........
    D3450  E                Root amputation....  ...........  ...........  ...........  ...........  ...........
    D3460  S                Endodontic                  0330         1.51       $74.89       $14.98       $14.98
                             endosseous implan.
    D3470  E                Intentional          ...........  ...........  ...........  ...........  ...........
                             replantation.
    D3910  E                Isolation- tooth w   ...........  ...........  ...........  ...........  ...........
                             rubb dam.
    D3920  E                Tooth splitting....  ...........  ...........  ...........  ...........  ...........
    D3950  E                Canal prep/fitting   ...........  ...........  ...........  ...........  ...........
                             of dowel.
    D3999  S                Endodontic                  0330         1.51       $74.89       $14.98       $14.98
                             procedure.
    D4210  E                Gingivectomy/plasty  ...........  ...........  ...........  ...........  ...........
                             per quad.
    D4211  E                Gingivectomy/plasty  ...........  ...........  ...........  ...........  ...........
                             per toot.
    D4220  E                Gingival curettage   ...........  ...........  ...........  ...........  ...........
                             per quadr.
    D4240  E                Gingival flap proc   ...........  ...........  ...........  ...........  ...........
                             w/ planin.
    D4245  E                Apically positioned  ...........  ...........  ...........  ...........  ...........
                             flap.
    D4249  E                Crown lengthen hard  ...........  ...........  ...........  ...........  ...........
                             tissue.
    D4260  S                Osseous surgery per         0330         1.51       $74.89       $14.98       $14.98
                             quadrant.
    D4263  S                Bone replce graft           0330         1.51       $74.89       $14.98       $14.98
                             first site.
    D4264  S                Bone replce graft           0330         1.51       $74.89       $14.98       $14.98
                             each add.
    D4266  E                Guided tiss regen    ...........  ...........  ...........  ...........  ...........
                             resorble.
    D4267  E                Guided tiss regen    ...........  ...........  ...........  ...........  ...........
                             nonresorb.
    D4268  S                Surgical revision           0330         1.51       $74.89       $14.98       $14.98
                             procedure.
    D4270  S                Pedicle soft tissue         0330         1.51       $74.89       $14.98       $14.98
                             graft pr.
    D4271  S                Free soft tissue            0330         1.51       $74.89       $14.98       $14.98
                             graft proc.
    D4273  S                Subepithelial               0330         1.51       $74.89       $14.98       $14.98
                             tissue graft.
    D4274  E                Distal/proximal      ...........  ...........  ...........  ...........  ...........
                             wedge proc.
    D4320  E                Provision splnt      ...........  ...........  ...........  ...........  ...........
                             intracoronal.
    D4321  E                Provisional splint   ...........  ...........  ...........  ...........  ...........
                             extracoro.
    D4341  E                Periodontal scaling  ...........  ...........  ...........  ...........  ...........
                             & root.
    D4355  S                Full mouth                  0330         1.51       $74.89       $14.98       $14.98
                             debridement.
    D4381  S                Localized chemo             0330         1.51       $74.89       $14.98       $14.98
                             delivery.
    D4910  E                Periodontal maint    ...........  ...........  ...........  ...........  ...........
                             procedures.
    D4920  E                Unscheduled          ...........  ...........  ...........  ...........  ...........
                             dressing change.
    D4999  E                Unspecified          ...........  ...........  ...........  ...........  ...........
                             periodontal proc.
    D5110  E                Dentures complete    ...........  ...........  ...........  ...........  ...........
                             maxillary.
    D5120  E                Dentures complete    ...........  ...........  ...........  ...........  ...........
                             mandible.
    D5130  E                Dentures immediat    ...........  ...........  ...........  ...........  ...........
                             maxillary.
    D5140  E                Dentures immediat    ...........  ...........  ...........  ...........  ...........
                             mandible.
    D5211  E                Dentures maxill      ...........  ...........  ...........  ...........  ...........
                             part resin.
    D5212  E                Dentures mand part   ...........  ...........  ...........  ...........  ...........
                             resin.
    D5213  E                Dentures maxill      ...........  ...........  ...........  ...........  ...........
                             part metal.
    D5214  E                Dentures mandibl     ...........  ...........  ...........  ...........  ...........
                             part metal.
    D5281  E                Removable partial    ...........  ...........  ...........  ...........  ...........
                             denture.
    D5410  E                Dentures adjust      ...........  ...........  ...........  ...........  ...........
                             cmplt maxil.
    D5411  E                Dentures adjust      ...........  ...........  ...........  ...........  ...........
                             cmplt mand.
    D5421  E                Dentures adjust      ...........  ...........  ...........  ...........  ...........
                             part maxill.
    D5422  E                Dentures adjust      ...........  ...........  ...........  ...........  ...........
                             part mandbl.
    D5510  E                Dentur repr broken   ...........  ...........  ...........  ...........  ...........
                             compl bas.
    D5520  E                Replace denture      ...........  ...........  ...........  ...........  ...........
                             teeth complt.
    D5610  E                Dentures repair      ...........  ...........  ...........  ...........  ...........
                             resin base.
    D5620  E                Rep part denture     ...........  ...........  ...........  ...........  ...........
                             cast frame.
    D5630  E                Rep partial denture  ...........  ...........  ...........  ...........  ...........
                             clasp.

[[Page 67965]]

 
    D5640  E                Replace part         ...........  ...........  ...........  ...........  ...........
                             denture teeth.
    D5650  E                Add tooth to         ...........  ...........  ...........  ...........  ...........
                             partial denture.
    D5660  E                Add clasp to         ...........  ...........  ...........  ...........  ...........
                             partial denture.
    D5710  E                Dentures rebase      ...........  ...........  ...........  ...........  ...........
                             cmplt maxil.
    D5711  E                Dentures rebase      ...........  ...........  ...........  ...........  ...........
                             cmplt mand.
    D5720  E                Dentures rebase      ...........  ...........  ...........  ...........  ...........
                             part maxill.
    D5721  E                Dentures rebase      ...........  ...........  ...........  ...........  ...........
                             part mandbl.
    D5730  E                Denture reln cmplt   ...........  ...........  ...........  ...........  ...........
                             maxil ch.
    D5731  E                Denture reln cmplt   ...........  ...........  ...........  ...........  ...........
                             mand chr.
    D5740  E                Denture reln part    ...........  ...........  ...........  ...........  ...........
                             maxil chr.
    D5741  E                Denture reln part    ...........  ...........  ...........  ...........  ...........
                             mand chr.
    D5750  E                Denture reln cmplt   ...........  ...........  ...........  ...........  ...........
                             max lab.
    D5751  E                Denture reln cmplt   ...........  ...........  ...........  ...........  ...........
                             mand lab.
    D5760  E                Denture reln part    ...........  ...........  ...........  ...........  ...........
                             maxil lab.
    D5761  E                Denture reln part    ...........  ...........  ...........  ...........  ...........
                             mand lab.
    D5810  E                Denture interm       ...........  ...........  ...........  ...........  ...........
                             cmplt maxill.
    D5811  E                Denture interm       ...........  ...........  ...........  ...........  ...........
                             cmplt mandbl.
    D5820  E                Denture interm part  ...........  ...........  ...........  ...........  ...........
                             maxill.
    D5821  E                Denture interm part  ...........  ...........  ...........  ...........  ...........
                             mandbl.
    D5850  E                Denture tiss         ...........  ...........  ...........  ...........  ...........
                             conditn maxill.
    D5851  E                Denture tiss         ...........  ...........  ...........  ...........  ...........
                             condtin mandbl.
    D5860  E                Overdenture          ...........  ...........  ...........  ...........  ...........
                             complete.
    D5861  E                Overdenture partial  ...........  ...........  ...........  ...........  ...........
    D5862  E                Precision            ...........  ...........  ...........  ...........  ...........
                             attachment.
    D5867  E                Replacement of       ...........  ...........  ...........  ...........  ...........
                             precision att.
    D5875  E                Prosthesis           ...........  ...........  ...........  ...........  ...........
                             modification.
    D5899  E                Removable            ...........  ...........  ...........  ...........  ...........
                             prosthodontic proc.
    D5911  S                Facial moulage              0330         1.51       $74.89       $14.98       $14.98
                             sectional.
    D5912  S                Facial moulage              0330         1.51       $74.89       $14.98       $14.98
                             complete.
    D5913  E                Nasal prosthesis...  ...........  ...........  ...........  ...........  ...........
    D5914  E                Auricular            ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    D5915  E                Orbital prosthesis.  ...........  ...........  ...........  ...........  ...........
    D5916  E                Ocular prosthesis..  ...........  ...........  ...........  ...........  ...........
    D5919  E                Facial prosthesis..  ...........  ...........  ...........  ...........  ...........
    D5922  E                Nasal septal         ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    D5923  E                Ocular prosthesis    ...........  ...........  ...........  ...........  ...........
                             interim.
    D5924  E                Cranial prosthesis.  ...........  ...........  ...........  ...........  ...........
    D5925  E                Facial augmentation  ...........  ...........  ...........  ...........  ...........
                             implant.
    D5926  E                Replacement nasal    ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    D5927  E                Auricular            ...........  ...........  ...........  ...........  ...........
                             replacement.
    D5928  E                Orbital replacement  ...........  ...........  ...........  ...........  ...........
    D5929  E                Facial replacement.  ...........  ...........  ...........  ...........  ...........
    D5931  E                Surgical obturator.  ...........  ...........  ...........  ...........  ...........
    D5932  E                Postsurgical         ...........  ...........  ...........  ...........  ...........
                             obturator.
    D5933  E                Refitting of         ...........  ...........  ...........  ...........  ...........
                             obturator.
    D5934  E                Mandibular flange    ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    D5935  E                Mandibular denture   ...........  ...........  ...........  ...........  ...........
                             prosth.
    D5936  E                Temp obturator       ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    D5937  E                Trismus appliance..  ...........  ...........  ...........  ...........  ...........
    D5951  E                Feeding aid........  ...........  ...........  ...........  ...........  ...........
    D5952  E                Pediatric speech     ...........  ...........  ...........  ...........  ...........
                             aid.
    D5953  E                Adult speech aid...  ...........  ...........  ...........  ...........  ...........
    D5954  E                Superimposed         ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    D5955  E                Palatal lift         ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    D5958  E                Intraoral con def    ...........  ...........  ...........  ...........  ...........
                             inter plt.
    D5959  E                Intraoral con def    ...........  ...........  ...........  ...........  ...........
                             mod palat.
    D5960  E                Modify speech aid    ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    D5982  E                Surgical stent.....  ...........  ...........  ...........  ...........  ...........
    D5983  S                Radiation                   0330         1.51       $74.89       $14.98       $14.98
                             applicator.
    D5984  S                Radiation shield...         0330         1.51       $74.89       $14.98       $14.98
    D5985  S                Radiation cone              0330         1.51       $74.89       $14.98       $14.98
                             locator.
    D5986  E                Fluoride applicator  ...........  ...........  ...........  ...........  ...........
    D5987  S                Commissure splint..         0330         1.51       $74.89       $14.98       $14.98
    D5988  E                Surgical splint....  ...........  ...........  ...........  ...........  ...........
    D5999  E                Maxillofacial        ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    D6010  E                Odontics endosteal   ...........  ...........  ...........  ...........  ...........
                             implant.
    D6020  E                Odontics abutment    ...........  ...........  ...........  ...........  ...........
                             placement.
    D6040  E                Odontics eposteal    ...........  ...........  ...........  ...........  ...........
                             implant.
    D6050  E                Odontics             ...........  ...........  ...........  ...........  ...........
                             transosteal implnt.
    D6055  E                Implant connecting   ...........  ...........  ...........  ...........  ...........
                             bar.
    D6056  E                Prefabricated        ...........  ...........  ...........  ...........  ...........
                             abutment.
    D6057  E                Custom abutment....  ...........  ...........  ...........  ...........  ...........
    D6058  E                Abutment supported   ...........  ...........  ...........  ...........  ...........
                             crown.
    D6059  E                Abutment supported   ...........  ...........  ...........  ...........  ...........
                             mtl crown.

[[Page 67966]]

 
    D6060  E                Abutment supported   ...........  ...........  ...........  ...........  ...........
                             mtl crown.
    D6061  E                Abutment supported   ...........  ...........  ...........  ...........  ...........
                             mtl crown.
    D6062  E                Abutment supported   ...........  ...........  ...........  ...........  ...........
                             mtl crown.
    D6063  E                Abutment supported   ...........  ...........  ...........  ...........  ...........
                             mtl crown.
    D6064  E                Abutment supported   ...........  ...........  ...........  ...........  ...........
                             mtl crown.
    D6065  E                Implant supported    ...........  ...........  ...........  ...........  ...........
                             crown.
    D6066  E                Implant supported    ...........  ...........  ...........  ...........  ...........
                             mtl crown.
    D6067  E                Implant supported    ...........  ...........  ...........  ...........  ...........
                             mtl crown.
    D6068  E                Abutment supported   ...........  ...........  ...........  ...........  ...........
                             retainer.
    D6069  E                Abutment supported   ...........  ...........  ...........  ...........  ...........
                             retainer.
    D6070  E                Abutment supported   ...........  ...........  ...........  ...........  ...........
                             retainer.
    D6071  E                Abutment supported   ...........  ...........  ...........  ...........  ...........
                             retainer.
    D6072  E                Abutment supported   ...........  ...........  ...........  ...........  ...........
                             retainer.
    D6073  E                Abutment supported   ...........  ...........  ...........  ...........  ...........
                             retainer.
    D6074  E                Abutment supported   ...........  ...........  ...........  ...........  ...........
                             retainer.
    D6075  E                Implant supported    ...........  ...........  ...........  ...........  ...........
                             retainer.
    D6076  E                Implant supported    ...........  ...........  ...........  ...........  ...........
                             retainer.
    D6077  E                Implant supported    ...........  ...........  ...........  ...........  ...........
                             retainer.
    D6078  E                Implnt/abut suprtd   ...........  ...........  ...........  ...........  ...........
                             fixd dent.
    D6079  E                Implnt/abut suprtd   ...........  ...........  ...........  ...........  ...........
                             fixd dent.
    D6080  E                Implant maintenance  ...........  ...........  ...........  ...........  ...........
    D6090  E                Repair implant.....  ...........  ...........  ...........  ...........  ...........
    D6095  E                Odontics repr        ...........  ...........  ...........  ...........  ...........
                             abutment.
    D6100  E                Removal of implant.  ...........  ...........  ...........  ...........  ...........
    D6199  E                Implant procedure..  ...........  ...........  ...........  ...........  ...........
    D6210  E                Prosthodont high     ...........  ...........  ...........  ...........  ...........
                             noble metal.
    D6211  E                Bridge base metal    ...........  ...........  ...........  ...........  ...........
                             cast.
    D6212  E                Bridge noble metal   ...........  ...........  ...........  ...........  ...........
                             cast.
    D6240  E                Bridge porcelain     ...........  ...........  ...........  ...........  ...........
                             high noble.
    D6241  E                Bridge porcelain     ...........  ...........  ...........  ...........  ...........
                             base metal.
    D6242  E                Bridge porcelain     ...........  ...........  ...........  ...........  ...........
                             nobel metal.
    D6245  E                Bridge porcelain/    ...........  ...........  ...........  ...........  ...........
                             ceramic.
    D6250  E                Bridge resin w/high  ...........  ...........  ...........  ...........  ...........
                             noble.
    D6251  E                Bridge resin base    ...........  ...........  ...........  ...........  ...........
                             metal.
    D6252  E                Bridge resin w/      ...........  ...........  ...........  ...........  ...........
                             noble metal.
    D6519  E                Inlay/onlay porce/   ...........  ...........  ...........  ...........  ...........
                             ceramic.
    D6520  E                Dental retainer two  ...........  ...........  ...........  ...........  ...........
                             surfaces.
    D6530  E                Retainer metallic    ...........  ...........  ...........  ...........  ...........
                             3+ surface.
    D6543  E                Dental retainr       ...........  ...........  ...........  ...........  ...........
                             onlay 3 surf.
    D6544  E                Dental retainr       ...........  ...........  ...........  ...........  ...........
                             onlay 4/more.
    D6545  E                Dental retainr cast  ...........  ...........  ...........  ...........  ...........
                             metl.
    D6548  E                Porcelain/ceramic    ...........  ...........  ...........  ...........  ...........
                             retainer.
    D6720  E                Retain crown resin   ...........  ...........  ...........  ...........  ...........
                             w hi nble.
    D6721  E                Crown resin w/base   ...........  ...........  ...........  ...........  ...........
                             metal.
    D6722  E                Crown resin w/noble  ...........  ...........  ...........  ...........  ...........
                             metal.
    D6740  E                Crown porcelain/     ...........  ...........  ...........  ...........  ...........
                             ceramic.
    D6750  E                Crown porcelain      ...........  ...........  ...........  ...........  ...........
                             high noble.
    D6751  E                Crown porcelain      ...........  ...........  ...........  ...........  ...........
                             base metal.
    D6752  E                Crown porcelain      ...........  ...........  ...........  ...........  ...........
                             noble metal.
    D6780  E                Crown 3/4 high       ...........  ...........  ...........  ...........  ...........
                             noble metal.
    D6781  E                Crown 3/4 cast       ...........  ...........  ...........  ...........  ...........
                             based metal.
    D6782  E                Crown 3/4 cast       ...........  ...........  ...........  ...........  ...........
                             noble metal.
    D6783  E                Crown 3/4 porcelain/ ...........  ...........  ...........  ...........  ...........
                             ceramic.
    D6790  E                Crown full high      ...........  ...........  ...........  ...........  ...........
                             noble metal.
    D6791  E                Crown full base      ...........  ...........  ...........  ...........  ...........
                             metal cast.
    D6792  E                Crown full noble     ...........  ...........  ...........  ...........  ...........
                             metal cast.
    D6920  S                Dental connector            0330         1.51       $74.89       $14.98       $14.98
                             bar.
    D6930  E                Dental recement      ...........  ...........  ...........  ...........  ...........
                             bridge.
    D6940  E                Stress breaker.....  ...........  ...........  ...........  ...........  ...........
    D6950  E                Precision            ...........  ...........  ...........  ...........  ...........
                             attachment.
    D6970  E                Post & core plus     ...........  ...........  ...........  ...........  ...........
                             retainer.
    D6971  E                Cast post bridge     ...........  ...........  ...........  ...........  ...........
                             retainer.
    D6972  E                Prefab post & core   ...........  ...........  ...........  ...........  ...........
                             plus reta.
    D6973  E                Core build up for    ...........  ...........  ...........  ...........  ...........
                             retainer.
    D6975  E                Coping metal.......  ...........  ...........  ...........  ...........  ...........
    D6976  E                Each addtnl cast     ...........  ...........  ...........  ...........  ...........
                             post.
    D6977  E                Each addtl prefab    ...........  ...........  ...........  ...........  ...........
                             post.
    D6980  E                Bridge repair......  ...........  ...........  ...........  ...........  ...........
    D6999  E                Fixed prosthodontic  ...........  ...........  ...........  ...........  ...........
                             proc.
    D7110  S                Oral surgery single         0330         1.51       $74.89       $14.98       $14.98
                             tooth.
    D7120  S                Each add tooth              0330         1.51       $74.89       $14.98       $14.98
                             extraction.
    D7130  S                Tooth root removal.         0330         1.51       $74.89       $14.98       $14.98
    D7210  S                Rem imp tooth w             0330         1.51       $74.89       $14.98       $14.98
                             mucoper flp.
    D7220  S                Impact tooth remov          0330         1.51       $74.89       $14.98       $14.98
                             soft tiss.

[[Page 67967]]

 
    D7230  S                Impact tooth remov          0330         1.51       $74.89       $14.98       $14.98
                             part bony.
    D7240  S                Impact tooth remov          0330         1.51       $74.89       $14.98       $14.98
                             comp bony.
    D7241  S                Impact tooth rem            0330         1.51       $74.89       $14.98       $14.98
                             bony w/comp.
    D7250  S                Tooth root removal.         0330         1.51       $74.89       $14.98       $14.98
    D7260  S                Oral antral fistula         0330         1.51       $74.89       $14.98       $14.98
                             closure.
    D7270  E                Tooth                ...........  ...........  ...........  ...........  ...........
                             reimplantation.
    D7272  E                Tooth                ...........  ...........  ...........  ...........  ...........
                             transplantation.
    D7280  E                Exposure impact      ...........  ...........  ...........  ...........  ...........
                             tooth orthod.
    D7281  E                Exposure tooth aid   ...........  ...........  ...........  ...........  ...........
                             eruption.
    D7285  E                Biopsy of oral       ...........  ...........  ...........  ...........  ...........
                             tissue hard.
    D7286  E                Biopsy of oral       ...........  ...........  ...........  ...........  ...........
                             tissue soft.
    D7290  E                Repositioning of     ...........  ...........  ...........  ...........  ...........
                             teeth.
    D7291  S                Transseptal                 0330         1.51       $74.89       $14.98       $14.98
                             fiberotomy.
    D7310  E                Alveoplasty w/       ...........  ...........  ...........  ...........  ...........
                             extraction.
    D7320  E                Alveoplasty w/o      ...........  ...........  ...........  ...........  ...........
                             extraction.
    D7340  E                Vestibuloplasty      ...........  ...........  ...........  ...........  ...........
                             ridge extens.
    D7350  E                Vestibuloplasty      ...........  ...........  ...........  ...........  ...........
                             exten graft.
    D7410  E                Rad exc lesion up    ...........  ...........  ...........  ...........  ...........
                             to 1.25 cm.
    D7420  E                Lesion > 1.25 cm...  ...........  ...........  ...........  ...........  ...........
    D7430  E                Exc benign tumor to  ...........  ...........  ...........  ...........  ...........
                             1.25 cm.
    D7431  E                Benign tumor exc >   ...........  ...........  ...........  ...........  ...........
                             1.25 cm.
    D7440  E                Malig tumor exc to   ...........  ...........  ...........  ...........  ...........
                             1.25 cm.
    D7441  E                Malig tumor > 1.25   ...........  ...........  ...........  ...........  ...........
                             cm.
    D7450  E                Rem odontogen cyst   ...........  ...........  ...........  ...........  ...........
                             to 1.25cm.
    D7451  E                Rem odontogen cyst   ...........  ...........  ...........  ...........  ...........
                             > 1.25 cm.
    D7460  E                Rem nonodonto cyst   ...........  ...........  ...........  ...........  ...........
                             to 1.25cm.
    D7461  E                Rem nonodonto cyst   ...........  ...........  ...........  ...........  ...........
                             > 1.25 cm.
    D7465  E                Lesion destruction.  ...........  ...........  ...........  ...........  ...........
    D7471  E                Rem exostosis any    ...........  ...........  ...........  ...........  ...........
                             site.
    D7480  E                Partial ostectomy..  ...........  ...........  ...........  ...........  ...........
    D7490  E                Mandible resection.  ...........  ...........  ...........  ...........  ...........
    D7510  E                I&d absc intraoral   ...........  ...........  ...........  ...........  ...........
                             soft tiss.
    D7520  E                I&d abscess          ...........  ...........  ...........  ...........  ...........
                             extraoral.
    D7530  E                Removal fb skin/     ...........  ...........  ...........  ...........  ...........
                             areolar tiss.
    D7540  E                Removal of fb        ...........  ...........  ...........  ...........  ...........
                             reaction.
    D7550  E                Removal of sloughed  ...........  ...........  ...........  ...........  ...........
                             off bone.
    D7560  E                Maxillary            ...........  ...........  ...........  ...........  ...........
                             sinusotomy.
    D7610  E                Maxilla open reduct  ...........  ...........  ...........  ...........  ...........
                             simple.
    D7620  E                Clsd reduct simpl    ...........  ...........  ...........  ...........  ...........
                             maxilla fx.
    D7630  E                Open red simpl       ...........  ...........  ...........  ...........  ...........
                             mandible fx.
    D7640  E                Clsd red simpl       ...........  ...........  ...........  ...........  ...........
                             mandible fx.
    D7650  E                Open red simp malar/ ...........  ...........  ...........  ...........  ...........
                             zygom fx.
    D7660  E                Clsd red simp malar/ ...........  ...........  ...........  ...........  ...........
                             zygom fx.
    D7670  E                Closd rductn splint  ...........  ...........  ...........  ...........  ...........
                             alveolus.
    D7680  E                Reduct simple        ...........  ...........  ...........  ...........  ...........
                             facial bone fx.
    D7710  E                Maxilla open reduct  ...........  ...........  ...........  ...........  ...........
                             compound.
    D7720  E                Clsd reduct compd    ...........  ...........  ...........  ...........  ...........
                             maxilla fx.
    D7730  E                Open reduct compd    ...........  ...........  ...........  ...........  ...........
                             mandble fx.
    D7740  E                Clsd reduct compd    ...........  ...........  ...........  ...........  ...........
                             mandble fx.
    D7750  E                Open red comp malar/ ...........  ...........  ...........  ...........  ...........
                             zygma fx.
    D7760  E                Clsd red comp malar/ ...........  ...........  ...........  ...........  ...........
                             zygma fx.
    D7770  E                Open reduc compd     ...........  ...........  ...........  ...........  ...........
                             alveolus fx.
    D7780  E                Reduct compnd        ...........  ...........  ...........  ...........  ...........
                             facial bone fx.
    D7810  E                Tmj open reduct-     ...........  ...........  ...........  ...........  ...........
                             dislocation.
    D7820  E                Closed tmp           ...........  ...........  ...........  ...........  ...........
                             manipulation.
    D7830  E                Tmj manipulation     ...........  ...........  ...........  ...........  ...........
                             under anest.
    D7840  E                Removal of tmj       ...........  ...........  ...........  ...........  ...........
                             condyle.
    D7850  E                Tmj meniscectomy...  ...........  ...........  ...........  ...........  ...........
    D7852  E                Tmj repair of joint  ...........  ...........  ...........  ...........  ...........
                             disc.
    D7854  E                Tmj excisn of joint  ...........  ...........  ...........  ...........  ...........
                             membrane.
    D7856  E                Tmj cutting of a     ...........  ...........  ...........  ...........  ...........
                             muscle.
    D7858  E                Tmj reconstruction.  ...........  ...........  ...........  ...........  ...........
    D7860  E                Tmj cutting into     ...........  ...........  ...........  ...........  ...........
                             joint.
    D7865  E                Tmj reshaping        ...........  ...........  ...........  ...........  ...........
                             components.
    D7870  E                Tmj aspiration       ...........  ...........  ...........  ...........  ...........
                             joint fluid.
    D7871  E                Lysis + lavage w     ...........  ...........  ...........  ...........  ...........
                             catheters.
    D7872  E                Tmj diagnostic       ...........  ...........  ...........  ...........  ...........
                             arthroscopy.
    D7873  E                Tmj arthroscopy      ...........  ...........  ...........  ...........  ...........
                             lysis adhesn.
    D7874  E                Tmj arthroscopy      ...........  ...........  ...........  ...........  ...........
                             disc reposit.
    D7875  E                Tmj arthroscopy      ...........  ...........  ...........  ...........  ...........
                             synovectomy.
    D7876  E                Tmj arthroscopy      ...........  ...........  ...........  ...........  ...........
                             discectomy.
    D7877  E                Tmj arthroscopy      ...........  ...........  ...........  ...........  ...........
                             debridement.
    D7880  E                Occlusal orthotic    ...........  ...........  ...........  ...........  ...........
                             appliance.
    D7899  E                Tmj unspecified      ...........  ...........  ...........  ...........  ...........
                             therapy.

[[Page 67968]]

 
    D7910  E                Dent sutur recent    ...........  ...........  ...........  ...........  ...........
                             wnd to 5cm.
    D7911  E                Dental suture wound  ...........  ...........  ...........  ...........  ...........
                             to 5 cm.
    D7912  E                Suture complicate    ...........  ...........  ...........  ...........  ...........
                             wnd > 5 cm.
    D7920  E                Dental skin graft..  ...........  ...........  ...........  ...........  ...........
    D7940  S                Reshaping bone              0330         1.51       $74.89       $14.98       $14.98
                             orthognathic.
    D7941  E                Bone cutting ramus   ...........  ...........  ...........  ...........  ...........
                             closed.
    D7943  E                Cutting ramus open   ...........  ...........  ...........  ...........  ...........
                             w/graft.
    D7944  E                Bone cutting         ...........  ...........  ...........  ...........  ...........
                             segmented.
    D7945  E                Bone cutting body    ...........  ...........  ...........  ...........  ...........
                             mandible.
    D7946  E                Reconstruction       ...........  ...........  ...........  ...........  ...........
                             maxilla total.
    D7947  E                Reconstruct maxilla  ...........  ...........  ...........  ...........  ...........
                             segment.
    D7948  E                Reconstruct midface  ...........  ...........  ...........  ...........  ...........
                             no graft.
    D7949  E                Reconstruct midface  ...........  ...........  ...........  ...........  ...........
                             w/graft.
    D7950  E                Mandible graft.....  ...........  ...........  ...........  ...........  ...........
    D7955  E                Repair               ...........  ...........  ...........  ...........  ...........
                             maxillofacial
                             defects.
    D7960  E                Frenulectomy/        ...........  ...........  ...........  ...........  ...........
                             frenulotomy.
    D7970  E                Excision             ...........  ...........  ...........  ...........  ...........
                             hyperplastic
                             tissue.
    D7971  E                Excision             ...........  ...........  ...........  ...........  ...........
                             pericoronal
                             gingiva.
    D7980  E                Sialolithotomy.....  ...........  ...........  ...........  ...........  ...........
    D7981  E                Excision of          ...........  ...........  ...........  ...........  ...........
                             salivary gland.
    D7982  E                Sialodochoplasty...  ...........  ...........  ...........  ...........  ...........
    D7983  E                Closure of salivary  ...........  ...........  ...........  ...........  ...........
                             fistula.
    D7990  E                Emergency            ...........  ...........  ...........  ...........  ...........
                             tracheotomy.
    D7991  E                Dental               ...........  ...........  ...........  ...........  ...........
                             coronoidectomy.
    D7995  E                Synthetic graft      ...........  ...........  ...........  ...........  ...........
                             facial bones.
    D7996  E                Implant mandible     ...........  ...........  ...........  ...........  ...........
                             for augment.
    D7997  E                Appliance removal..  ...........  ...........  ...........  ...........  ...........
    D7999  E                Oral surgery         ...........  ...........  ...........  ...........  ...........
                             procedure.
    D8010  E                Limited dental tx    ...........  ...........  ...........  ...........  ...........
                             primary.
    D8020  E                Limited dental tx    ...........  ...........  ...........  ...........  ...........
                             transition.
    D8030  E                Limited dental tx    ...........  ...........  ...........  ...........  ...........
                             adolescent.
    D8040  E                Limited dental tx    ...........  ...........  ...........  ...........  ...........
                             adult.
    D8050  E                Intercep dental tx   ...........  ...........  ...........  ...........  ...........
                             primary.
    D8060  E                Intercep dental tx   ...........  ...........  ...........  ...........  ...........
                             transitn.
    D8070  E                Compre dental tx     ...........  ...........  ...........  ...........  ...........
                             transition.
    D8080  E                Compre dental tx     ...........  ...........  ...........  ...........  ...........
                             adolescent.
    D8090  E                Compre dental tx     ...........  ...........  ...........  ...........  ...........
                             adult.
    D8210  E                Orthodontic rem      ...........  ...........  ...........  ...........  ...........
                             appliance tx.
    D8220  E                Fixed appliance      ...........  ...........  ...........  ...........  ...........
                             therapy habt.
    D8660  E                Preorthodontic tx    ...........  ...........  ...........  ...........  ...........
                             visit.
    D8670  E                Periodic orthodontc  ...........  ...........  ...........  ...........  ...........
                             tx visit.
    D8680  E                Orthodontic          ...........  ...........  ...........  ...........  ...........
                             retention.
    D8690  E                Orthodontic          ...........  ...........  ...........  ...........  ...........
                             treatment.
    D8691  E                Repair ortho         ...........  ...........  ...........  ...........  ...........
                             appliance.
    D8692  E                Replacement          ...........  ...........  ...........  ...........  ...........
                             retainer.
    D8999  E                Orthodontic          ...........  ...........  ...........  ...........  ...........
                             procedure.
    D9110  N                Tx dental pain       ...........  ...........  ...........  ...........  ...........
                             minor proc.
    D9210  E                Dent anesthesia w/o  ...........  ...........  ...........  ...........  ...........
                             surgery.
    D9211  E                Regional block       ...........  ...........  ...........  ...........  ...........
                             anesthesia.
    D9212  E                Trigeminal block     ...........  ...........  ...........  ...........  ...........
                             anesthesia.
    D9215  E                Local anesthesia...  ...........  ...........  ...........  ...........  ...........
    D9220  E                General anesthesia.  ...........  ...........  ...........  ...........  ...........
    D9221  E                General anesthesia   ...........  ...........  ...........  ...........  ...........
                             ea ad 15m.
    D9230  N                Analgesia..........  ...........  ...........  ...........  ...........  ...........
    D9241  E                Intravenous          ...........  ...........  ...........  ...........  ...........
                             sedation.
    D9242  E                IV sedation ea ad    ...........  ...........  ...........  ...........  ...........
                             30 m.
    D9248  N                Sedation (non-iv)..  ...........  ...........  ...........  ...........  ...........
    D9310  E                Dental consultation  ...........  ...........  ...........  ...........  ...........
    D9410  E                Dental house call..  ...........  ...........  ...........  ...........  ...........
    D9420  E                Hospital call......  ...........  ...........  ...........  ...........  ...........
    D9430  E                Office visit during  ...........  ...........  ...........  ...........  ...........
                             hours.
    D9440  E                Office visit after   ...........  ...........  ...........  ...........  ...........
                             hours.
    D9610  E                Dent therapeutic     ...........  ...........  ...........  ...........  ...........
                             drug inject.
    D9630  S                Other drugs/                0330         1.51       $74.89       $14.98       $14.98
                             medicaments.
    D9910  E                Dent appl            ...........  ...........  ...........  ...........  ...........
                             desensitizing med.
    D9911  E                Appl desensitizing   ...........  ...........  ...........  ...........  ...........
                             resin.
    D9920  E                Behavior management  ...........  ...........  ...........  ...........  ...........
    D9930  S                Treatment of                0330         1.51       $74.89       $14.98       $14.98
                             complications.
    D9940  S                Dental occlusal             0330         1.51       $74.89       $14.98       $14.98
                             guard.
    D9941  E                Fabrication          ...........  ...........  ...........  ...........  ...........
                             athletic guard.
    D9950  S                Occlusion analysis.         0330         1.51       $74.89       $14.98       $14.98
    D9951  S                Limited occlusal            0330         1.51       $74.89       $14.98       $14.98
                             adjustment.
    D9952  S                Complete occlusal           0330         1.51       $74.89       $14.98       $14.98
                             adjustment.
    D9970  E                Enamel               ...........  ...........  ...........  ...........  ...........
                             microabrasion.

[[Page 67969]]

 
    D9971  E                Odontoplasty 1-2     ...........  ...........  ...........  ...........  ...........
                             teeth.
    D9972  E                Extrnl bleaching     ...........  ...........  ...........  ...........  ...........
                             per arch.
    D9973  E                Extrnl bleaching     ...........  ...........  ...........  ...........  ...........
                             per tooth.
    D9974  E                Intrnl bleaching     ...........  ...........  ...........  ...........  ...........
                             per tooth.
    D9999  E                Adjunctive           ...........  ...........  ...........  ...........  ...........
                             procedure.
    E0100  A                Cane adjust/fixed    ...........  ...........  ...........  ...........  ...........
                             with tip.
    E0105  A                Cane adjust/fixed    ...........  ...........  ...........  ...........  ...........
                             quad/3 pro.
    E0110  A                Crutch forearm pair  ...........  ...........  ...........  ...........  ...........
    E0111  A                Crutch forearm each  ...........  ...........  ...........  ...........  ...........
    E0112  A                Crutch underarm      ...........  ...........  ...........  ...........  ...........
                             pair wood.
    E0113  A                Crutch underarm      ...........  ...........  ...........  ...........  ...........
                             each wood.
    E0114  A                Crutch underarm      ...........  ...........  ...........  ...........  ...........
                             pair no wood.
    E0116  A                Crutch underarm      ...........  ...........  ...........  ...........  ...........
                             each no wood.
    E0130  A                Walker rigid adjust/ ...........  ...........  ...........  ...........  ...........
                             fixed ht.
    E0135  A                Walker folding       ...........  ...........  ...........  ...........  ...........
                             adjust/fixed.
    E0141  A                Rigid walker         ...........  ...........  ...........  ...........  ...........
                             wheeled wo seat.
    E0142  A                Walker rigid         ...........  ...........  ...........  ...........  ...........
                             wheeled with se.
    E0143  A                Walker folding       ...........  ...........  ...........  ...........  ...........
                             wheeled w/o s.
    E0144  A                Enclosed walker w    ...........  ...........  ...........  ...........  ...........
                             rear seat.
    E0145  A                Walker whled seat/   ...........  ...........  ...........  ...........  ...........
                             crutch att.
    E0146  A                Folding walker       ...........  ...........  ...........  ...........  ...........
                             wheels w seat.
    E0147  A                Walker variable      ...........  ...........  ...........  ...........  ...........
                             wheel resist.
    E0148  A                Heavyduty walker no  ...........  ...........  ...........  ...........  ...........
                             wheels.
    E0149  A                Heavy duty wheeled   ...........  ...........  ...........  ...........  ...........
                             walker.
    E0153  A                Forearm crutch       ...........  ...........  ...........  ...........  ...........
                             platform atta.
    E0154  A                Walker platform      ...........  ...........  ...........  ...........  ...........
                             attachment.
    E0155  A                Walker wheel         ...........  ...........  ...........  ...........  ...........
                             attachment,pair.
    E0156  A                Walker seat          ...........  ...........  ...........  ...........  ...........
                             attachment.
    E0157  A                Walker crutch        ...........  ...........  ...........  ...........  ...........
                             attachment.
    E0158  A                Walker leg           ...........  ...........  ...........  ...........  ...........
                             extenders set of4.
    E0159  A                Brake for wheeled    ...........  ...........  ...........  ...........  ...........
                             walker.
    E0160  A                Sitz type bath or    ...........  ...........  ...........  ...........  ...........
                             equipment.
    E0161  A                Sitz bath/equipment  ...........  ...........  ...........  ...........  ...........
                             w/faucet.
    E0162  A                Sitz bath chair....  ...........  ...........  ...........  ...........  ...........
    E0163  A                Commode chair        ...........  ...........  ...........  ...........  ...........
                             stationry fxd.
    E0164  A                Commode chair        ...........  ...........  ...........  ...........  ...........
                             mobile fixed a.
    E0165  A                Commode chair        ...........  ...........  ...........  ...........  ...........
                             stationry det.
    E0166  A                Commode chair        ...........  ...........  ...........  ...........  ...........
                             mobile detach.
    E0167  A                Commode chair pail   ...........  ...........  ...........  ...........  ...........
                             or pan.
    E0168  A                Heavyduty/wide       ...........  ...........  ...........  ...........  ...........
                             commode chair.
    E0175  A                Commode chair foot   ...........  ...........  ...........  ...........  ...........
                             rest.
    E0176  A                Air pressre pad/     ...........  ...........  ...........  ...........  ...........
                             cushion nonp.
    E0177  A                Water press pad/     ...........  ...........  ...........  ...........  ...........
                             cushion nonp.
    E0178  A                Gel pressre pad/     ...........  ...........  ...........  ...........  ...........
                             cushion nonp.
    E0179  A                Dry pressre pad/     ...........  ...........  ...........  ...........  ...........
                             cushion nonp.
    E0180  A                Press pad            ...........  ...........  ...........  ...........  ...........
                             alternating w pump.
    E0181  A                Press pad            ...........  ...........  ...........  ...........  ...........
                             alternating w/ pum.
    E0182  A                Pressure pad         ...........  ...........  ...........  ...........  ...........
                             alternating pum.
    E0184  A                Dry pressure         ...........  ...........  ...........  ...........  ...........
                             mattress.
    E0185  A                Gel pressure         ...........  ...........  ...........  ...........  ...........
                             mattress pad.
    E0186  A                Air pressure         ...........  ...........  ...........  ...........  ...........
                             mattress.
    E0187  A                Water pressure       ...........  ...........  ...........  ...........  ...........
                             mattress.
    E0188  E                Synthetic sheepskin  ...........  ...........  ...........  ...........  ...........
                             pad.
    E0189  E                Lambswool sheepskin  ...........  ...........  ...........  ...........  ...........
                             pad.
    E0191  A                Protector heel or    ...........  ...........  ...........  ...........  ...........
                             elbow.
    E0192  A                Pad wheelchr low     ...........  ...........  ...........  ...........  ...........
                             press/posit.
    E0193  A                Powered air          ...........  ...........  ...........  ...........  ...........
                             flotation bed.
    E0194  A                Air fluidized bed..  ...........  ...........  ...........  ...........  ...........
    E0196  A                Gel pressure         ...........  ...........  ...........  ...........  ...........
                             mattress.
    E0197  A                Air pressure pad     ...........  ...........  ...........  ...........  ...........
                             for mattres.
    E0198  A                Water pressure pad   ...........  ...........  ...........  ...........  ...........
                             for mattr.
    E0199  A                Dry pressure pad     ...........  ...........  ...........  ...........  ...........
                             for mattres.
    E0200  A                Heat lamp without    ...........  ...........  ...........  ...........  ...........
                             stand.
    E0202  A                Phototherapy light   ...........  ...........  ...........  ...........  ...........
                             w/ photom.
    E0205  A                Heat lamp with       ...........  ...........  ...........  ...........  ...........
                             stand.
    E0210  A                Electric heat pad    ...........  ...........  ...........  ...........  ...........
                             standard.
    E0215  A                Electric heat pad    ...........  ...........  ...........  ...........  ...........
                             moist.
    E0217  A                Water circ heat pad  ...........  ...........  ...........  ...........  ...........
                             w pump.
    E0218  E                Water circ cold pad  ...........  ...........  ...........  ...........  ...........
                             w pump.
    E0220  A                Hot water bottle...  ...........  ...........  ...........  ...........  ...........
    E0225  A                Hydrocollator unit.  ...........  ...........  ...........  ...........  ...........
    E0230  A                Ice cap or collar..  ...........  ...........  ...........  ...........  ...........
    E0235  A                Paraffin bath unit   ...........  ...........  ...........  ...........  ...........
                             portable.
    E0236  A                Pump for water       ...........  ...........  ...........  ...........  ...........
                             circulating p.

[[Page 67970]]

 
    E0238  A                Heat pad non-        ...........  ...........  ...........  ...........  ...........
                             electric moist.
    E0239  A                Hydrocollator unit   ...........  ...........  ...........  ...........  ...........
                             portable.
    E0241  E                Bath tub wall rail.  ...........  ...........  ...........  ...........  ...........
    E0242  E                Bath tub rail floor  ...........  ...........  ...........  ...........  ...........
    E0243  E                Toilet rail........  ...........  ...........  ...........  ...........  ...........
    E0244  E                Toilet seat raised.  ...........  ...........  ...........  ...........  ...........
    E0245  E                Tub stool or bench.  ...........  ...........  ...........  ...........  ...........
    E0246  E                Transfer tub rail    ...........  ...........  ...........  ...........  ...........
                             attachment.
    E0249  A                Pad water            ...........  ...........  ...........  ...........  ...........
                             circulating heat u.
    E0250  A                Hosp bed fixed ht w/ ...........  ...........  ...........  ...........  ...........
                              mattres.
    E0251  A                Hosp bed fixd ht w/  ...........  ...........  ...........  ...........  ...........
                             o mattres.
    E0255  A                Hospital bed var ht  ...........  ...........  ...........  ...........  ...........
                             w/ mattr.
    E0256  A                Hospital bed var ht  ...........  ...........  ...........  ...........  ...........
                             w/o matt.
    E0260  A                Hosp bed semi-       ...........  ...........  ...........  ...........  ...........
                             electr w/ matt.
    E0261  A                Hosp bed semi-       ...........  ...........  ...........  ...........  ...........
                             electr w/o mat.
    E0265  A                Hosp bed total       ...........  ...........  ...........  ...........  ...........
                             electr w/ mat.
    E0266  A                Hosp bed total elec  ...........  ...........  ...........  ...........  ...........
                             w/o matt.
    E0270  E                Hospital bed         ...........  ...........  ...........  ...........  ...........
                             institutional t.
    E0271  A                Mattress             ...........  ...........  ...........  ...........  ...........
                             innerspring.
    E0272  A                Mattress foam        ...........  ...........  ...........  ...........  ...........
                             rubber.
    E0273  E                Bed board..........  ...........  ...........  ...........  ...........  ...........
    E0274  E                Over-bed table.....  ...........  ...........  ...........  ...........  ...........
    E0275  A                Bed pan standard...  ...........  ...........  ...........  ...........  ...........
    E0276  A                Bed pan fracture...  ...........  ...........  ...........  ...........  ...........
    E0277  A                Powered pres-redu    ...........  ...........  ...........  ...........  ...........
                             air mattrs.
    E0280  A                Bed cradle.........  ...........  ...........  ...........  ...........  ...........
    E0290  A                Hosp bed fx ht w/o   ...........  ...........  ...........  ...........  ...........
                             rails w/m.
    E0291  A                Hosp bed fx ht w/o   ...........  ...........  ...........  ...........  ...........
                             rail w/o.
    E0292  A                Hosp bed var ht w/o  ...........  ...........  ...........  ...........  ...........
                             rail w/o.
    E0293  A                Hosp bed var ht w/o  ...........  ...........  ...........  ...........  ...........
                             rail w/.
    E0294  A                Hosp bed semi-elect  ...........  ...........  ...........  ...........  ...........
                             w/ mattr.
    E0295  A                Hosp bed semi-elect  ...........  ...........  ...........  ...........  ...........
                             w/o matt.
    E0296  A                Hosp bed total       ...........  ...........  ...........  ...........  ...........
                             elect w/ matt.
    E0297  A                Hosp bed total       ...........  ...........  ...........  ...........  ...........
                             elect w/o mat.
    E0298  A                Heavyduty/xtra wide  ...........  ...........  ...........  ...........  ...........
                             hosp bed.
    E0305  A                Rails bed side half  ...........  ...........  ...........  ...........  ...........
                             length.
    E0310  A                Rails bed side full  ...........  ...........  ...........  ...........  ...........
                             length.
    E0315  E                Bed accessory brd/   ...........  ...........  ...........  ...........  ...........
                             tbl/supprt.
    E0325  A                Urinal male jug-     ...........  ...........  ...........  ...........  ...........
                             type.
    E0326  A                Urinal female jug-   ...........  ...........  ...........  ...........  ...........
                             type.
    E0350  E                Control unit bowel   ...........  ...........  ...........  ...........  ...........
                             system.
    E0352  E                Disposable pack w/   ...........  ...........  ...........  ...........  ...........
                             bowel syst.
    E0370  E                Air elevator for     ...........  ...........  ...........  ...........  ...........
                             heel.
    E0371  A                Nonpower mattress    ...........  ...........  ...........  ...........  ...........
                             overlay.
    E0372  A                Powered air          ...........  ...........  ...........  ...........  ...........
                             mattress overlay.
    E0373  A                Nonpowered pressure  ...........  ...........  ...........  ...........  ...........
                             mattress.
    E0424  A                Stationary           ...........  ...........  ...........  ...........  ...........
                             compressed gas O2.
    E0425  E                Gas system           ...........  ...........  ...........  ...........  ...........
                             stationary compre.
    E0430  E                Oxygen system gas    ...........  ...........  ...........  ...........  ...........
                             portable.
    E0431  A                Portable gaseous O2  ...........  ...........  ...........  ...........  ...........
    E0434  A                Portable liquid O2.  ...........  ...........  ...........  ...........  ...........
    E0435  E                Oxygen system        ...........  ...........  ...........  ...........  ...........
                             liquid portabl.
    E0439  A                Stationary liquid    ...........  ...........  ...........  ...........  ...........
                             O2.
    E0440  E                Oxygen system        ...........  ...........  ...........  ...........  ...........
                             liquid station.
    E0441  A                Oxygen contents gas  ...........  ...........  ...........  ...........  ...........
                             per/unit.
    E0442  A                Oxygen contents liq  ...........  ...........  ...........  ...........  ...........
                             per/unit.
    E0443  A                Port O2 contents     ...........  ...........  ...........  ...........  ...........
                             gas/unit.
    E0444  A                Port O2 contents     ...........  ...........  ...........  ...........  ...........
                             liq/unit.
    E0450  A                Volume vent          ...........  ...........  ...........  ...........  ...........
                             stationary/porta.
    E0455  A                Oxygen tent excl     ...........  ...........  ...........  ...........  ...........
                             croup/ped t.
    E0457  A                Chest shell........  ...........  ...........  ...........  ...........  ...........
    E0459  A                Chest wrap.........  ...........  ...........  ...........  ...........  ...........
    E0460  A                Neg press vent       ...........  ...........  ...........  ...........  ...........
                             portabl/statn.
    E0462  A                Rocking bed w/ or w/ ...........  ...........  ...........  ...........  ...........
                             o side r.
    E0480  A                Percussor elect/     ...........  ...........  ...........  ...........  ...........
                             pneum home m.
    E0500  A                Ippb all types.....  ...........  ...........  ...........  ...........  ...........
    E0550  A                Humidif extens       ...........  ...........  ...........  ...........  ...........
                             supple w ippb.
    E0555  A                Humidifier for use   ...........  ...........  ...........  ...........  ...........
                             w/ regula.
    E0560  A                Humidifier           ...........  ...........  ...........  ...........  ...........
                             supplemental w/ i.
    E0565  A                Compressor air       ...........  ...........  ...........  ...........  ...........
                             power source.
    E0570  A                Nebulizer with       ...........  ...........  ...........  ...........  ...........
                             compression.
    E0571  A                Aerosol compressor   ...........  ...........  ...........  ...........  ...........
                             for svneb.
    E0572  A                Aerosol compressor   ...........  ...........  ...........  ...........  ...........
                             adjust pr.
    E0574  A                Ultrasonic           ...........  ...........  ...........  ...........  ...........
                             generator w svneb.

[[Page 67971]]

 
    E0575  A                Nebulizer            ...........  ...........  ...........  ...........  ...........
                             ultrasonic.
    E0580  A                Nebulizer for use w/ ...........  ...........  ...........  ...........  ...........
                              regulat.
    E0585  A                Nebulizer w/         ...........  ...........  ...........  ...........  ...........
                             compressor & he.
    E0590  A                Dispensing fee dme   ...........  ...........  ...........  ...........  ...........
                             neb drug.
    E0600  A                Suction pump portab  ...........  ...........  ...........  ...........  ...........
                             hom modl.
    E0601  A                Cont airway          ...........  ...........  ...........  ...........  ...........
                             pressure device.
    E0602  E                Breast pump........  ...........  ...........  ...........  ...........  ...........
    E0605  A                Vaporizer room type  ...........  ...........  ...........  ...........  ...........
    E0606  A                Drainage board       ...........  ...........  ...........  ...........  ...........
                             postural.
    E0607  A                Blood glucose        ...........  ...........  ...........  ...........  ...........
                             monitor home.
    E0608  A                Apnea monitor......  ...........  ...........  ...........  ...........  ...........
    E0609  A                Blood gluc mon w/    ...........  ...........  ...........  ...........  ...........
                             special fea.
    E0610  A                Pacemaker monitr     ...........  ...........  ...........  ...........  ...........
                             audible/vis.
    E0615  A                Pacemaker monitr     ...........  ...........  ...........  ...........  ...........
                             digital/vis.
    E0616  N                Cardiac event        ...........  ...........  ...........  ...........  ...........
                             recorder.
    E0617  A                Automatic ext        ...........  ...........  ...........  ...........  ...........
                             defibrillator.
    E0621  A                Patient lift sling   ...........  ...........  ...........  ...........  ...........
                             or seat.
    E0625  E                Patient lift         ...........  ...........  ...........  ...........  ...........
                             bathroom or toi.
    E0627  A                Seat lift incorp     ...........  ...........  ...........  ...........  ...........
                             lift-chair.
    E0628  A                Seat lift for pt     ...........  ...........  ...........  ...........  ...........
                             furn-electr.
    E0629  A                Seat lift for pt     ...........  ...........  ...........  ...........  ...........
                             furn-non-el.
    E0630  A                Patient lift         ...........  ...........  ...........  ...........  ...........
                             hydraulic.
    E0635  A                Patient lift         ...........  ...........  ...........  ...........  ...........
                             electric.
    E0650  A                Pneuma compresor     ...........  ...........  ...........  ...........  ...........
                             non-segment.
    E0651  A                Pneum compressor     ...........  ...........  ...........  ...........  ...........
                             segmental.
    E0652  A                Pneum compres w/cal  ...........  ...........  ...........  ...........  ...........
                             pressure.
    E0655  A                Pneumatic appliance  ...........  ...........  ...........  ...........  ...........
                             half arm.
    E0660  A                Pneumatic appliance  ...........  ...........  ...........  ...........  ...........
                             full leg.
    E0665  A                Pneumatic appliance  ...........  ...........  ...........  ...........  ...........
                             full arm.
    E0666  A                Pneumatic appliance  ...........  ...........  ...........  ...........  ...........
                             half leg.
    E0667  A                Seg pneumatic appl   ...........  ...........  ...........  ...........  ...........
                             full leg.
    E0668  A                Seg pneumatic appl   ...........  ...........  ...........  ...........  ...........
                             full arm.
    E0669  A                Seg pneumatic appli  ...........  ...........  ...........  ...........  ...........
                             half leg.
    E0671  A                Pressure pneum appl  ...........  ...........  ...........  ...........  ...........
                             full leg.
    E0672  A                Pressure pneum appl  ...........  ...........  ...........  ...........  ...........
                             full arm.
    E0673  A                Pressure pneum appl  ...........  ...........  ...........  ...........  ...........
                             half leg.
    E0690  A                Ultraviolet cabinet  ...........  ...........  ...........  ...........  ...........
    E0700  E                Safety equipment...  ...........  ...........  ...........  ...........  ...........
    E0710  E                Restraints any type  ...........  ...........  ...........  ...........  ...........
    E0720  A                Tens two lead......  ...........  ...........  ...........  ...........  ...........
    E0730  A                Tens four lead.....  ...........  ...........  ...........  ...........  ...........
    E0731  A                Conductive garment   ...........  ...........  ...........  ...........  ...........
                             for tens/.
    E0740  E                Incontinence         ...........  ...........  ...........  ...........  ...........
                             treatment systm.
    E0744  A                Neuromuscular stim   ...........  ...........  ...........  ...........  ...........
                             for scoli.
    E0745  A                Neuromuscular stim   ...........  ...........  ...........  ...........  ...........
                             for shock.
    E0746  E                Electromyograph      ...........  ...........  ...........  ...........  ...........
                             biofeedback.
    E0747  A                Elec osteogen stim   ...........  ...........  ...........  ...........  ...........
                             not spine.
    E0748  A                Elec osteogen stim   ...........  ...........  ...........  ...........  ...........
                             spinal.
    E0749  N                Elec osteogen stim   ...........  ...........  ...........  ...........  ...........
                             implanted.
   E0751D  N                Pulse generator or   ...........  ...........  ...........  ...........  ...........
                             receiver.
    E0753  N                Neurostimulator      ...........  ...........  ...........  ...........  ...........
                             electrodes.
    E0755  E                Electronic salivary  ...........  ...........  ...........  ...........  ...........
                             reflex s.
    E0756  N                Implantable pulse    ...........  ...........  ...........  ...........  ...........
                             generator.
    E0757  N                Implantable RF       ...........  ...........  ...........  ...........  ...........
                             receiver.
    E0758  A                External RF          ...........  ...........  ...........  ...........  ...........
                             transmitter.
    E0760  E                Osteogen ultrasound  ...........  ...........  ...........  ...........  ...........
                             stimltor.
    E0765  A                Nerve stimulator     ...........  ...........  ...........  ...........  ...........
                             for tx n&v.
    E0776  A                Iv pole............  ...........  ...........  ...........  ...........  ...........
    E0779  A                Amb infusion pump    ...........  ...........  ...........  ...........  ...........
                             mechanical.
    E0780  A                Mech amb infusion    ...........  ...........  ...........  ...........  ...........
                             pump 8hrs.
    E0781  A                External ambulatory  ...........  ...........  ...........  ...........  ...........
                             infus pu.
    E0782  N                Non-programble       ...........  ...........  ...........  ...........  ...........
                             infusion pump.
    E0783  N                Programmable         ...........  ...........  ...........  ...........  ...........
                             infusion pump.
    E0784  A                Ext amb infusn pump  ...........  ...........  ...........  ...........  ...........
                             insulin.
    E0785  N                Replacement impl     ...........  ...........  ...........  ...........  ...........
                             pump cathet.
    E0786  N                Implantable pump     ...........  ...........  ...........  ...........  ...........
                             replacement.
    E0791  A                Parenteral infusion  ...........  ...........  ...........  ...........  ...........
                             pump sta.
    E0830  A                Ambulatory traction  ...........  ...........  ...........  ...........  ...........
                             device.
    E0840  A                Tract frame attach   ...........  ...........  ...........  ...........  ...........
                             headboard.
    E0850  A                Traction stand free  ...........  ...........  ...........  ...........  ...........
                             standing.
    E0855  A                Cervical traction    ...........  ...........  ...........  ...........  ...........
                             equipment.
    E0860  A                Tract equip          ...........  ...........  ...........  ...........  ...........
                             cervical tract.
    E0870  A                Tract frame attach   ...........  ...........  ...........  ...........  ...........
                             footboard.
    E0880  A                Trac stand free      ...........  ...........  ...........  ...........  ...........
                             stand extrem.

[[Page 67972]]

 
    E0890  A                Traction frame       ...........  ...........  ...........  ...........  ...........
                             attach pelvic.
    E0900  A                Trac stand free      ...........  ...........  ...........  ...........  ...........
                             stand pelvic.
    E0910  A                Trapeze bar          ...........  ...........  ...........  ...........  ...........
                             attached to bed.
    E0920  A                Fracture frame       ...........  ...........  ...........  ...........  ...........
                             attached to b.
    E0930  A                Fracture frame free  ...........  ...........  ...........  ...........  ...........
                             standing.
    E0935  A                Exercise device      ...........  ...........  ...........  ...........  ...........
                             passive moti.
    E0940  A                Trapeze bar free     ...........  ...........  ...........  ...........  ...........
                             standing.
    E0941  A                Gravity assisted     ...........  ...........  ...........  ...........  ...........
                             traction de.
    E0942  A                Cervical head        ...........  ...........  ...........  ...........  ...........
                             harness/halter.
    E0943  A                Cervical pillow....  ...........  ...........  ...........  ...........  ...........
    E0944  A                Pelvic belt/harness/ ...........  ...........  ...........  ...........  ...........
                             boot.
    E0945  A                Belt/harness         ...........  ...........  ...........  ...........  ...........
                             extremity.
    E0946  A                Fracture frame dual  ...........  ...........  ...........  ...........  ...........
                             w cross.
    E0947  A                Fracture frame       ...........  ...........  ...........  ...........  ...........
                             attachmnts pe.
    E0948  A                Fracture frame       ...........  ...........  ...........  ...........  ...........
                             attachmnts ce.
    E0950  E                Tray...............  ...........  ...........  ...........  ...........  ...........
    E0951  E                Loop heel..........  ...........  ...........  ...........  ...........  ...........
    E0952  E                Loop tie...........  ...........  ...........  ...........  ...........  ...........
    E0953  E                Pneumatic tire.....  ...........  ...........  ...........  ...........  ...........
    E0954  E                Wheelchair semi-     ...........  ...........  ...........  ...........  ...........
                             pneumatic ca.
    E0958  E                Whlchr att- conv 1   ...........  ...........  ...........  ...........  ...........
                             arm drive.
    E0959  E                Amputee adapter....  ...........  ...........  ...........  ...........  ...........
    E0961  E                Wheelchair brake     ...........  ...........  ...........  ...........  ...........
                             extension.
    E0962  A                Wheelchair 1 inch    ...........  ...........  ...........  ...........  ...........
                             cushion.
    E0963  A                Wheelchair 2 inch    ...........  ...........  ...........  ...........  ...........
                             cushion.
    E0964  A                Wheelchair 3 inch    ...........  ...........  ...........  ...........  ...........
                             cushion.
    E0965  A                Wheelchair 4 inch    ...........  ...........  ...........  ...........  ...........
                             cushion.
    E0966  E                Wheelchair head      ...........  ...........  ...........  ...........  ...........
                             rest extensi.
    E0967  E                Wheelchair hand      ...........  ...........  ...........  ...........  ...........
                             rims.
    E0968  E                Wheelchair commode   ...........  ...........  ...........  ...........  ...........
                             seat.
    E0969  E                Wheelchair           ...........  ...........  ...........  ...........  ...........
                             narrowing device.
    E0970  E                Wheelchair no. 2     ...........  ...........  ...........  ...........  ...........
                             footplates.
    E0971  E                Wheelchair anti-     ...........  ...........  ...........  ...........  ...........
                             tipping devi.
    E0972  A                Transfer board or    ...........  ...........  ...........  ...........  ...........
                             device.
    E0973  E                Wheelchair           ...........  ...........  ...........  ...........  ...........
                             adjustabl height.
    E0974  E                Wheelchair grade-    ...........  ...........  ...........  ...........  ...........
                             aid.
    E0975  E                Wheelchair           ...........  ...........  ...........  ...........  ...........
                             reinforced seat u.
    E0976  E                Wheelchair           ...........  ...........  ...........  ...........  ...........
                             reinforced back u.
    E0977  E                Wheelchair wedge     ...........  ...........  ...........  ...........  ...........
                             cushion.
    E0978  E                Wheelchair belt w/   ...........  ...........  ...........  ...........  ...........
                             airplane b.
    E0979  E                Wheelchair belt      ...........  ...........  ...........  ...........  ...........
                             with velcro.
    E0980  E                Wheelchair safety    ...........  ...........  ...........  ...........  ...........
                             vest.
    E0990  E                Whellchair           ...........  ...........  ...........  ...........  ...........
                             elevating leg res.
    E0991  E                Wheelchair           ...........  ...........  ...........  ...........  ...........
                             upholstry seat.
    E0992  E                Wheelchair solid     ...........  ...........  ...........  ...........  ...........
                             seat insert.
    E0993  E                Wheelchair back      ...........  ...........  ...........  ...........  ...........
                             upholstery.
    E0994  E                Wheelchair arm rest  ...........  ...........  ...........  ...........  ...........
    E0995  E                Wheelchair calf      ...........  ...........  ...........  ...........  ...........
                             rest.
    E0996  E                Wheelchair tire      ...........  ...........  ...........  ...........  ...........
                             solid.
    E0997  E                Wheelchair caster w/ ...........  ...........  ...........  ...........  ...........
                              a fork.
    E0998  E                Wheelchair caster w/ ...........  ...........  ...........  ...........  ...........
                             o a fork.
    E0999  E                Wheelchr pneumatic   ...........  ...........  ...........  ...........  ...........
                             tire w/wh.
    E1000  E                Wheelchair tire      ...........  ...........  ...........  ...........  ...........
                             pneumatic ca.
    E1001  E                Wheelchair wheel...  ...........  ...........  ...........  ...........  ...........
    E1031  A                Rollabout chair      ...........  ...........  ...........  ...........  ...........
                             with casters.
    E1035  A                Patient transfer     ...........  ...........  ...........  ...........  ...........
                             system.
    E1050  E                Whelchr fxd full     ...........  ...........  ...........  ...........  ...........
                             length arms.
    E1060  E                Wheelchair           ...........  ...........  ...........  ...........  ...........
                             detachable arms.
    E1065  E                Wheelchair power     ...........  ...........  ...........  ...........  ...........
                             attachment.
    E1066  E                Wheelchair battery   ...........  ...........  ...........  ...........  ...........
                             charger.
    E1069  E                Wheelchair deep      ...........  ...........  ...........  ...........  ...........
                             cycle batter.
    E1070  E                Wheelchair           ...........  ...........  ...........  ...........  ...........
                             detachable foot r.
    E1083  E                Hemi-wheelchair      ...........  ...........  ...........  ...........  ...........
                             fixed arms.
    E1084  E                Hemi-wheelchair      ...........  ...........  ...........  ...........  ...........
                             detachable a.
    E1085  E                Hemi-wheelchair      ...........  ...........  ...........  ...........  ...........
                             fixed arms.
    E1086  E                Hemi-wheelchair      ...........  ...........  ...........  ...........  ...........
                             detachable a.
    E1087  E                Wheelchair lightwt   ...........  ...........  ...........  ...........  ...........
                             fixed arm.
    E1088  E                Wheelchair           ...........  ...........  ...........  ...........  ...........
                             lightweight det a.
    E1089  E                Wheelchair lightwt   ...........  ...........  ...........  ...........  ...........
                             fixed arm.
    E1090  E                Wheelchair           ...........  ...........  ...........  ...........  ...........
                             lightweight det a.
    E1091  E                Wheelchair youth...  ...........  ...........  ...........  ...........  ...........
    E1092  E                Wheelchair wide w/   ...........  ...........  ...........  ...........  ...........
                             leg rests.
    E1093  E                Wheelchair wide w/   ...........  ...........  ...........  ...........  ...........
                             foot rest.
    E1100  E                Whchr s-recl fxd     ...........  ...........  ...........  ...........  ...........
                             arm leg res.

[[Page 67973]]

 
    E1110  E                Wheelchair semi-     ...........  ...........  ...........  ...........  ...........
                             recl detach.
    E1130  E                Whlchr stand fxd     ...........  ...........  ...........  ...........  ...........
                             arm ft rest.
    E1140  E                Wheelchair standard  ...........  ...........  ...........  ...........  ...........
                             detach a.
    E1150  E                Wheelchair standard  ...........  ...........  ...........  ...........  ...........
                             w/ leg r.
    E1160  E                Wheelchair fixed     ...........  ...........  ...........  ...........  ...........
                             arms.
    E1170  E                Whlchr ampu fxd arm  ...........  ...........  ...........  ...........  ...........
                             leg rest.
    E1171  E                Wheelchair amputee   ...........  ...........  ...........  ...........  ...........
                             w/o leg r.
    E1172  E                Wheelchair amputee   ...........  ...........  ...........  ...........  ...........
                             detach ar.
    E1180  E                Wheelchair amputee   ...........  ...........  ...........  ...........  ...........
                             w/ foot r.
    E1190  E                Wheelchair amputee   ...........  ...........  ...........  ...........  ...........
                             w/ leg re.
    E1195  E                Wheelchair amputee   ...........  ...........  ...........  ...........  ...........
                             heavy dut.
    E1200  E                Wheelchair amputee   ...........  ...........  ...........  ...........  ...........
                             fixed arm.
    E1210  E                Whlchr moto ful arm  ...........  ...........  ...........  ...........  ...........
                             leg rest.
    E1211  E                Wheelchair           ...........  ...........  ...........  ...........  ...........
                             motorized w/ det.
    E1212  E                Wheelchair           ...........  ...........  ...........  ...........  ...........
                             motorized w full.
    E1213  E                Wheelchair           ...........  ...........  ...........  ...........  ...........
                             motorized w/ det.
    E1220  E                Whlchr special size/ ...........  ...........  ...........  ...........  ...........
                             constrc.
    E1221  E                Wheelchair spec      ...........  ...........  ...........  ...........  ...........
                             size w foot.
    E1222  E                Wheelchair spec      ...........  ...........  ...........  ...........  ...........
                             size w/ leg.
    E1223  E                Wheelchair spec      ...........  ...........  ...........  ...........  ...........
                             size w foot.
    E1224  E                Wheelchair spec      ...........  ...........  ...........  ...........  ...........
                             size w/ leg.
    E1225  E                Wheelchair spec sz   ...........  ...........  ...........  ...........  ...........
                             semi-recl.
    E1226  E                Wheelchair spec sz   ...........  ...........  ...........  ...........  ...........
                             full-recl.
    E1227  E                Wheelchair spec sz   ...........  ...........  ...........  ...........  ...........
                             spec ht a.
    E1228  E                Wheelchair spec sz   ...........  ...........  ...........  ...........  ...........
                             spec ht b.
    E1230  A                Power operated       ...........  ...........  ...........  ...........  ...........
                             vehicle.
    E1240  E                Whchr litwt det arm  ...........  ...........  ...........  ...........  ...........
                             leg rest.
    E1250  E                Wheelchair lightwt   ...........  ...........  ...........  ...........  ...........
                             fixed arm.
    E1260  E                Wheelchair lightwt   ...........  ...........  ...........  ...........  ...........
                             foot rest.
    E1270  E                Wheelchair           ...........  ...........  ...........  ...........  ...........
                             lightweight leg r.
    E1280  E                Whchr h-duty det     ...........  ...........  ...........  ...........  ...........
                             arm leg res.
    E1285  E                Wheelchair heavy     ...........  ...........  ...........  ...........  ...........
                             duty fixed.
    E1290  E                Wheelchair hvy duty  ...........  ...........  ...........  ...........  ...........
                             detach a.
    E1295  E                Wheelchair heavy     ...........  ...........  ...........  ...........  ...........
                             duty fixed.
    E1296  E                Wheelchair special   ...........  ...........  ...........  ...........  ...........
                             seat heig.
    E1297  E                Wheelchair special   ...........  ...........  ...........  ...........  ...........
                             seat dept.
    E1298  E                Wheelchair spec      ...........  ...........  ...........  ...........  ...........
                             seat depth/w.
    E1300  E                Whirlpool portable.  ...........  ...........  ...........  ...........  ...........
    E1310  A                Whirlpool non-       ...........  ...........  ...........  ...........  ...........
                             portable.
    E1340  A                Repair for DME, per  ...........  ...........  ...........  ...........  ...........
                             15 min.
    E1353  A                Oxygen supplies      ...........  ...........  ...........  ...........  ...........
                             regulator.
    E1355  A                Oxygen supplies      ...........  ...........  ...........  ...........  ...........
                             stand/rack.
    E1372  A                Oxy suppl heater     ...........  ...........  ...........  ...........  ...........
                             for nebuliz.
   E1375D  A                Oxygen suppl         ...........  ...........  ...........  ...........  ...........
                             nebulizer porta.
   E1377D  E                Oxygen concentrator  ...........  ...........  ...........  ...........  ...........
                             to 244 c.
   E1378D  E                Oxygen concentrator  ...........  ...........  ...........  ...........  ...........
                             to 488 c.
   E1379D  E                Oxygen concentrator  ...........  ...........  ...........  ...........  ...........
                             to 732 c.
   E1380D  E                Oxygen concentrator  ...........  ...........  ...........  ...........  ...........
                             to 976 c.
   E1381D  E                Oxygen concentrat    ...........  ...........  ...........  ...........  ...........
                             to 1220 cu.
   E1382D  E                Oxygen concentrat    ...........  ...........  ...........  ...........  ...........
                             to 1464 cu.
   E1383D  E                Oxygen concentrat    ...........  ...........  ...........  ...........  ...........
                             to 1708 cu.
   E1384D  E                Oxygen concentrat    ...........  ...........  ...........  ...........  ...........
                             to 1952 cu.
   E1385D  E                Oxygen concentrator  ...........  ...........  ...........  ...........  ...........
                             > 1952 c.
    E1390  A                Oxygen concentrator  ...........  ...........  ...........  ...........  ...........
    E1399  A                Durable medical      ...........  ...........  ...........  ...........  ...........
                             equipment mi.
    E1405  A                O2/water vapor       ...........  ...........  ...........  ...........  ...........
                             enrich w/heat.
    E1406  A                O2/water vapor       ...........  ...........  ...........  ...........  ...........
                             enrich w/o he.
    E1510  A                Kidney dialysate     ...........  ...........  ...........  ...........  ...........
                             delivry sys.
    E1520  A                Heparin infusion     ...........  ...........  ...........  ...........  ...........
                             pump for di.
    E1530  A                Air bubble detector  ...........  ...........  ...........  ...........  ...........
                             for dial.
    E1540  A                Pressure alarm for   ...........  ...........  ...........  ...........  ...........
                             dialysis.
    E1550  A                Bath conductivity    ...........  ...........  ...........  ...........  ...........
                             meter.
    E1560  A                Blood leak detector  ...........  ...........  ...........  ...........  ...........
                             for dial.
    E1570  A                Adjustable chair     ...........  ...........  ...........  ...........  ...........
                             for esrd pt.
    E1575  A                Transducer           ...........  ...........  ...........  ...........  ...........
                             protector/fluid b.
    E1580  A                Unipuncture control  ...........  ...........  ...........  ...........  ...........
                             system.
    E1590  A                Hemodialysis         ...........  ...........  ...........  ...........  ...........
                             machine.
    E1592  A                Auto interm          ...........  ...........  ...........  ...........  ...........
                             peritoneal dialy.
    E1594  A                Cycler dialysis      ...........  ...........  ...........  ...........  ...........
                             machine.
    E1600  A                Deliv/install equip  ...........  ...........  ...........  ...........  ...........
                             for dial.
    E1610  A                Reverse osmosis      ...........  ...........  ...........  ...........  ...........
                             water purifi.
    E1615  A                Deionizer water      ...........  ...........  ...........  ...........  ...........
                             purification.
    E1620  A                Blood pump for       ...........  ...........  ...........  ...........  ...........
                             dialysis.
    E1625  A                Water softening      ...........  ...........  ...........  ...........  ...........
                             system.

[[Page 67974]]

 
    E1630  A                Reciprocating        ...........  ...........  ...........  ...........  ...........
                             peritoneal dia.
    E1632  A                Wearable artificial  ...........  ...........  ...........  ...........  ...........
                             kidney.
    E1635  A                Compact travel       ...........  ...........  ...........  ...........  ...........
                             hemodialyzer.
    E1636  A                Sorbent cartridges   ...........  ...........  ...........  ...........  ...........
                             for dialy.
    E1640  A                Replacement          ...........  ...........  ...........  ...........  ...........
                             components for d.
    E1699  A                Dialysis equipment   ...........  ...........  ...........  ...........  ...........
                             unspecifi.
    E1700  A                Jaw motion rehab     ...........  ...........  ...........  ...........  ...........
                             system.
    E1701  A                Repl cushions for    ...........  ...........  ...........  ...........  ...........
                             jaw motion.
    E1702  A                Repl measr scales    ...........  ...........  ...........  ...........  ...........
                             jaw motion.
    E1800  A                Adjust elbow ext/    ...........  ...........  ...........  ...........  ...........
                             flex device.
    E1805  A                Adjust wrist ext/    ...........  ...........  ...........  ...........  ...........
                             flex device.
    E1810  A                Adjust knee ext/     ...........  ...........  ...........  ...........  ...........
                             flex device.
    E1815  A                Adjust ankle ext/    ...........  ...........  ...........  ...........  ...........
                             flex device.
    E1820  A                Soft interface       ...........  ...........  ...........  ...........  ...........
                             material.
    E1825  A                Adjust finger ext/   ...........  ...........  ...........  ...........  ...........
                             flex devc.
    E1830  A                Adjust toe ext/flex  ...........  ...........  ...........  ...........  ...........
                             device.
    E1900  A                Speech               ...........  ...........  ...........  ...........  ...........
                             communication
                             device.
    G0001  A                Drawing blood for    ...........  ...........  ...........  ...........  ...........
                             specimen.
    G0002  N                Temporary urinary    ...........  ...........  ...........  ...........  ...........
                             catheter.
    G0004  E                ECG transm phys      ...........  ...........  ...........  ...........  ...........
                             review & int.
    G0005  X                ECG 24 hour                 0097         1.62       $80.35       $62.40       $16.07
                             recording.
    G0006  X                ECG transmission &          0097         1.62       $80.35       $62.40       $16.07
                             analysis.
    G0007  N                ECG phy review &     ...........  ...........  ...........  ...........  ...........
                             interpret.
    G0008  K                Admin influenza             0354         0.13        $6.33  ...........  ...........
                             virus vac.
    G0009  K                Admin pneumococcal          0354         0.13        $6.33  ...........  ...........
                             vaccine.
    G0010  N                Admin hepatitis b    ...........  ...........  ...........  ...........  ...........
                             vaccine.
    G0015  X                Post symptom ECG            0097         1.62       $80.35       $62.40       $16.07
                             tracing.
    G0016  E                Post symptom ECG md  ...........  ...........  ...........  ...........  ...........
                             review.
    G0025  X                Collagen skin test          0343         0.45       $22.32       $12.16        $4.46
                             kit.
    G0026  A                Fecal leukocyte      ...........  ...........  ...........  ...........  ...........
                             examination.
    G0027  A                Semen analysis.....  ...........  ...........  ...........  ...........  ...........
    G0030  S                PET imaging prev            0285        15.06      $746.92      $415.21      $149.38
                             PET single.
    G0031  S                PET imaging prev            0285        15.06      $746.92      $415.21      $149.38
                             PET multple.
    G0032  S                PET follow SPECT            0285        15.06      $746.92      $415.21      $149.38
                             78464 singl.
    G0033  S                PET follow SPECT            0285        15.06      $746.92      $415.21      $149.38
                             78464 mult.
    G0034  S                PET follow SPECT            0285        15.06      $746.92      $415.21      $149.38
                             76865 singl.
    G0035  S                PET follow SPECT            0285        15.06      $746.92      $415.21      $149.38
                             78465 mult.
    G0036  S                PET follow cornry           0285        15.06      $746.92      $415.21      $149.38
                             angio sing.
    G0037  S                PET follow cornry           0285        15.06      $746.92      $415.21      $149.38
                             angio mult.
    G0038  S                PET follow myocard          0285        15.06      $746.92      $415.21      $149.38
                             perf sing.
    G0039  S                PET follow myocard          0285        15.06      $746.92      $415.21      $149.38
                             perf mult.
    G0040  S                PET follow stress           0285        15.06      $746.92      $415.21      $149.38
                             echo singl.
    G0041  S                PET follow stress           0285        15.06      $746.92      $415.21      $149.38
                             echo mult.
    G0042  S                PET follow                  0285        15.06      $746.92      $415.21      $149.38
                             ventriculogm sing.
    G0043  S                PET follow                  0285        15.06      $746.92      $415.21      $149.38
                             ventriculogm mult.
    G0044  S                PET following rest          0285        15.06      $746.92      $415.21      $149.38
                             ECG singl.
    G0045  S                PET following rest          0285        15.06      $746.92      $415.21      $149.38
                             ECG mult.
    G0046  S                PET follow stress           0285        15.06      $746.92      $415.21      $149.38
                             ECG singl.
    G0047  S                PET follow stress           0285        15.06      $746.92      $415.21      $149.38
                             ECG mult.
    G0050  S                Residual urine by           0265         1.17       $58.03       $38.08       $11.61
                             ultrasound.
    G0101  V                CA screen;pelvic/           0601         1.00       $49.60        $9.92        $9.92
                             breast exam.
    G0102  N                Prostate ca          ...........  ...........  ...........  ...........  ...........
                             screening; dre.
    G0103  A                Psa, total           ...........  ...........  ...........  ...........  ...........
                             screening.
    G0104  S                CA screen;flexi             0159         2.83      $140.36  ...........       $35.09
                             sigmoidscope.
    G0105  S                Colorectal scrn; hi         0158         7.98      $395.78  ...........       $98.94
                             risk ind.
    G0106  S                Colon CA                    0157         1.79       $88.78  ...........       $22.19
                             screen;barium
                             enema.
    G0107  A                CA screen; fecal     ...........  ...........  ...........  ...........  ...........
                             blood test.
    G0108  A                Diab manage trn per  ...........  ...........  ...........  ...........  ...........
                             indiv.
    G0109  A                Diab manage trn ind/ ...........  ...........  ...........  ...........  ...........
                             group.
    G0110  A                Nett pulm-rehab      ...........  ...........  ...........  ...........  ...........
                             educ; ind.
    G0111  A                Nett pulm-rehab      ...........  ...........  ...........  ...........  ...........
                             educ; group.
    G0112  A                Nett;nutrition       ...........  ...........  ...........  ...........  ...........
                             guid, initial.
    G0113  A                Nett;nutrition       ...........  ...........  ...........  ...........  ...........
                             guid,subseqnt.
    G0114  A                Nett; psychosocial   ...........  ...........  ...........  ...........  ...........
                             consult.
    G0115  A                Nett; psychological  ...........  ...........  ...........  ...........  ...........
                             testing.
    G0116  A                Nett; psychosocial   ...........  ...........  ...........  ...........  ...........
                             counsel.
    G0120  S                Colon ca scrn;              0157         1.79       $88.78  ...........       $22.19
                             barium enema.
    G0121  E                Colon ca scrn not    ...........  ...........  ...........  ...........  ...........
                             hi rsk ind.
    G0122  S                Colon ca scrn;              0157         1.79       $88.78  ...........       $22.19
                             barium enema.
    G0123  A                Screen cerv/vag      ...........  ...........  ...........  ...........  ...........
                             thin layer.
    G0124  A                Screen c/v thin      ...........  ...........  ...........  ...........  ...........
                             layer by MD.
    G0125  S                Lung image (PET)...         0981        46.40    $2,301.26  ...........      $460.25
    G0126  S                Lung image (PET)            0981        46.40    $2,301.26  ...........      $460.25
                             staging.
    G0127  T                Trim nail(s).......         0009         0.74       $36.70        $9.63        $7.34

[[Page 67975]]

 
    G0128  E                CORF skilled         ...........  ...........  ...........  ...........  ...........
                             nursing service.
    G0129  P                Partial hosp prog           0033         4.17      $206.82       $48.17       $41.36
                             service.
    G0130  X                Single energy x-ray         0261         1.38       $68.44       $38.77       $13.69
                             study.
    G0131  S                CT scan, bone               0282         2.38      $118.04       $94.51       $23.61
                             density study.
    G0132  S                CT scan, bone               0282         2.38      $118.04       $94.51       $23.61
                             density study.
    G0141  E                Scr c/v              ...........  ...........  ...........  ...........  ...........
                             cyto,autosys and
                             md.
    G0143  A                Scr c/v              ...........  ...........  ...........  ...........  ...........
                             cyto,thinlayer,res
                             cr.
    G0144  A                Scr c/v              ...........  ...........  ...........  ...........  ...........
                             cyto,thinlayer,res
                             cr.
    G0145  A                Scr c/v              ...........  ...........  ...........  ...........  ...........
                             cyto,thinlayer,res
                             cr.
    G0147  A                Scr c/v cyto,        ...........  ...........  ...........  ...........  ...........
                             automated sys.
    G0148  A                Scr c/v cyto,        ...........  ...........  ...........  ...........  ...........
                             autosys, rescr.
    G0151  E                HHCP-serv of pt,ea   ...........  ...........  ...........  ...........  ...........
                             15 min.
    G0152  E                HHCP-serv of ot,ea   ...........  ...........  ...........  ...........  ...........
                             15 min.
    G0153  E                HHCP-svs of s/l      ...........  ...........  ...........  ...........  ...........
                             path,ea 15mn.
    G0154  E                HHCP-svs of rn,ea    ...........  ...........  ...........  ...........  ...........
                             15 min.
    G0155  E                HHCP-svs of csw,ea   ...........  ...........  ...........  ...........  ...........
                             15 min.
    G0156  E                HHCP-svs of aide,ea  ...........  ...........  ...........  ...........  ...........
                             15 min.
   G0159D  T                Perc declot                 0103        13.09      $649.21      $295.70      $129.84
                             dialysis graft.
  *G0160D  S                Cryo. ablation,             0981        46.40    $2,301.26  ...........      $460.25
                             prostate.
   G0161D  X                Echo guide for cryo         0268         2.23      $110.60       $69.51       $22.12
                             probes.
    G0163  S                Pet for rec of              0981        46.40    $2,301.26  ...........      $460.25
                             colorectal ca.
    G0164  S                Pet for lymphoma            0981        46.40    $2,301.26  ...........      $460.25
                             staging.
    G0165  S                Pet,rec of melanoma/        0981        46.40    $2,301.26  ...........      $460.25
                             met ca.
    G0166  T                Extrnl                      0972         3.09      $153.26  ...........       $30.65
                             counterpulse, per
                             tx.
    G0167  E                Hyperbaric oz tx;no  ...........  ...........  ...........  ...........  ...........
                             md reqrd.
    G0168  T                Wound closure by            0970         0.52       $25.79  ...........        $5.16
                             adhesive.
   G0169D  T                Removal tissue; no          0013         0.91       $45.13       $17.66        $9.03
                             anesthsia.
   G0170D  T                Skin biograft......         0025         3.74      $185.49       $70.66       $37.10
   G0171D  T                Skin biograft add-          0025         3.74      $185.49       $70.66       $37.10
                             on.
   G0172D  P                Partial hosp prog           0033         4.17      $206.82       $48.17       $41.36
                             service.
    G0173  S                Stereotactic                0302         8.21      $407.18      $216.55       $81.44
                             radiosurgery.
    G0174  S                IMRT , per session.         0302         8.21      $407.18      $216.55       $81.44
    G0175  V                Interdisciplinary           0602         1.66       $82.33       $16.47       $16.47
                             team conf.
   *G0176  P                OPPS/PHP;activity           0033         4.17      $206.82       $48.17       $41.36
                             therapy.
   *G0177  P                OPPS/PHP; train &           0033         4.17      $206.82       $48.17       $41.36
                             educ serv.
   *G0178  S                Intensity modulated         0302         8.21      $407.18      $216.55       $81.44
                             radiation.
   *G0179  E                Phys                 ...........  ...........  ...........  ...........  ...........
                             recertification,
                             HHA pt.
   *G0180  E                Phys certification,  ...........  ...........  ...........  ...........  ...........
                             HHA pt.
   *G0181  E                Home health care     ...........  ...........  ...........  ...........  ...........
                             supervision.
   *G0182  E                Hospice care         ...........  ...........  ...........  ...........  ...........
                             supervision.
   *G0183  T                Ocular photodynamic         0235         2.94      $145.81       $78.91       $29.16
                             therapy.
   *G0184  T                Ocular                      0235        33.96    $1,684.28      $852.68      $336.86
                             photocoagulation.
   *G0185  T                Transpuppillary             0235         6.70      $332.29      $147.96       $66.46
                             thermotx.
   *G0186  T                Dstry eye lesn,fdr          0235         6.70      $332.29      $147.96       $66.46
                             vssl tech.
   *G0187  T                Dstry mclr                  0235        33.96    $1,684.28      $852.68      $336.86
                             drusen,photocoag.
   *G0188  X                Xray lwr extrmty-    ...........         1.38       $68.44       $38.77       $13.69
                             full lngth.
   *G0190  N                Immunization         ...........  ...........  ...........  ...........  ...........
                             administration.
   *G0191  N                Immunization         ...........  ...........  ...........  ...........  ...........
                             admin,each add.
   *G0192  N                Immunization oral/   ...........  ...........  ...........  ...........  ...........
                             intranasal.
   *G0195  A                Clinical eval,       ...........  ...........  ...........  ...........  ...........
                             swallowing.
   *G0196  A                Radioisotope eval,   ...........  ...........  ...........  ...........  ...........
                             swallowing.
   *G0197  A                Eval, speech         ...........  ...........  ...........  ...........  ...........
                             generating device.
   *G0198  A                Trng, speech         ...........  ...........  ...........  ...........  ...........
                             generating device.
   *G0199  A                Re-evaluation,       ...........  ...........  ...........  ...........  ...........
                             speech device.
   *G0200  A                Eval, voice          ...........  ...........  ...........  ...........  ...........
                             prosthetic.
   *G0201  A                Trng, voice          ...........  ...........  ...........  ...........  ...........
                             prosthetic.
   *G9001  E                Coordinated care     ...........  ...........  ...........  ...........  ...........
                             fee.
   *G9002  E                Coordinated care     ...........  ...........  ...........  ...........  ...........
                             fee.
   *G9003  E                Coordinated care     ...........  ...........  ...........  ...........  ...........
                             fee.
   *G9004  E                Coordinated care     ...........  ...........  ...........  ...........  ...........
                             fee.
   *G9005  E                Coordinated care     ...........  ...........  ...........  ...........  ...........
                             fee.
   *G9006  E                Coordinated care     ...........  ...........  ...........  ...........  ...........
                             fee.
   *G9007  E                Coordinated care     ...........  ...........  ...........  ...........  ...........
                             fee.
   *G9008  E                Coordinated care     ...........  ...........  ...........  ...........  ...........
                             fee.
   *G9016  A                Demo-smoking         ...........  ...........  ...........  ...........  ...........
                             cessation coun.
    J0120  N                Tetracyclin          ...........  ...........  ...........  ...........  ...........
                             injection.
   *J0130  G                Abciximab injection         1605  ...........      $513.02  ...........       $68.74
    J0150  K                Injection adenosine         0917         0.36       $17.86  ...........        $3.57
                             6 MG.
    J0151  E                Adenosine injection  ...........  ...........  ...........  ...........  ...........
    J0170  N                Adrenalin            ...........  ...........  ...........  ...........  ...........
                             epinephrin inject.
    J0190  N                Inj biperiden        ...........  ...........  ...........  ...........  ...........
                             lactate/5 mg.
    J0200  N                Alatrofloxacin       ...........  ...........  ...........  ...........  ...........
                             mesylate.
    J0205  G                Alglucerase                 0900  ...........       $37.53  ...........        $5.03
                             injection.
    J0207  G                Amifostine.........         7000  ...........      $350.31  ...........       $46.94

[[Page 67976]]

 
    J0210  N                Methyldopate hcl     ...........  ...........  ...........  ...........  ...........
                             injection.
    J0256  G                Alpha 1 proteinase          0901  ...........        $2.09  ...........         $.28
                             inhibitor.
    J0270  E                Alprostadil for      ...........  ...........  ...........  ...........  ...........
                             injection.
    J0275  E                Alprostadil          ...........  ...........  ...........  ...........  ...........
                             urethral suppos.
    J0280  N                Aminophyllin 250 MG  ...........  ...........  ...........  ...........  ...........
                             inj.
    J0282  N                Amiodarone HCl.....  ...........  ...........  ...........  ...........  ...........
    J0285  N                Amphotericin B.....  ...........  ...........  ...........  ...........  ...........
    J0286  G                Amphotericin B              7001  ...........       $95.00  ...........       $12.73
                             lipid complex.
    J0290  N                Ampicillin 500 MG    ...........  ...........  ...........  ...........  ...........
                             inj.
    J0295  N                Ampicillin sodium    ...........  ...........  ...........  ...........  ...........
                             per 1.5 gm.
    J0300  N                Amobarbital 125 MG   ...........  ...........  ...........  ...........  ...........
                             inj.
    J0330  N                Succinycholine       ...........  ...........  ...........  ...........  ...........
                             chloride inj.
    J0340  N                Nandrolon            ...........  ...........  ...........  ...........  ...........
                             phenpropionate inj.
   *J0350  G                Injection                   1606  ...........    $2,693.80  ...........      $360.97
                             anistreplase 30 u.
    J0360  N                Hydralazine hcl      ...........  ...........  ...........  ...........  ...........
                             injection.
    J0380  N                Inj metaraminol      ...........  ...........  ...........  ...........  ...........
                             bitartrate.
    J0390  N                Chloroquine          ...........  ...........  ...........  ...........  ...........
                             injection.
    J0395  N                Arbutamine HCl       ...........  ...........  ...........  ...........  ...........
                             injection.
    J0400  N                Inj trimethaphan     ...........  ...........  ...........  ...........  ...........
                             camsylate.
    J0456  N                Azithromycin.......  ...........  ...........  ...........  ...........  ...........
    J0460  N                Atropine sulfate     ...........  ...........  ...........  ...........  ...........
                             injection.
    J0470  N                Dimecaprol           ...........  ...........  ...........  ...........  ...........
                             injection.
    J0475  N                Baclofen 10 MG       ...........  ...........  ...........  ...........  ...........
                             injection.
    J0476  E                Baclofen 50 mcg      ...........  ...........  ...........  ...........  ...........
                             intrathecal trial.
    J0500  N                Dicyclomine          ...........  ...........  ...........  ...........  ...........
                             injection.
    J0510  N                Benzquinamide        ...........  ...........  ...........  ...........  ...........
                             injection.
    J0515  N                Inj benztropine      ...........  ...........  ...........  ...........  ...........
                             mesylate.
    J0520  N                Bethanechol          ...........  ...........  ...........  ...........  ...........
                             chloride inject.
    J0530  N                Penicillin g         ...........  ...........  ...........  ...........  ...........
                             benzathine inj.
    J0540  N                Penicillin g         ...........  ...........  ...........  ...........  ...........
                             benzathine inj.
    J0550  N                Penicillin g         ...........  ...........  ...........  ...........  ...........
                             benzathine inj.
    J0560  N                Penicillin g         ...........  ...........  ...........  ...........  ...........
                             benzathine inj.
    J0570  N                Penicillin g         ...........  ...........  ...........  ...........  ...........
                             benzathine inj.
    J0580  N                Penicillin g         ...........  ...........  ...........  ...........  ...........
                             benzathine inj.
    J0585  G                Botulinum toxin a           0902  ...........        $4.39  ...........         $.59
                             per unit.
    J0590  N                Ethylnorepinephrine  ...........  ...........  ...........  ...........  ...........
                             hcl inj.
    J0600  N                Edetate calcium      ...........  ...........  ...........  ...........  ...........
                             disodium inj.
    J0610  N                Calcium gluconate    ...........  ...........  ...........  ...........  ...........
                             injection.
    J0620  N                Calcium glycer &     ...........  ...........  ...........  ...........  ...........
                             lact/10 ML.
    J0630  N                Calcitonin salmon    ...........  ...........  ...........  ...........  ...........
                             injection.
    J0635  N                Calcitriol           ...........  ...........  ...........  ...........  ...........
                             injection.
    J0640  G                Leucovorin calcium          0725  ...........       $49.73  ...........        $6.66
                             injection.
    J0670  N                Inj mepivacaine HCL/ ...........  ...........  ...........  ...........  ...........
                             10 ml.
    J0690  N                Cefazolin sodium     ...........  ...........  ...........  ...........  ...........
                             injection.
    J0694  N                Cefoxitin sodium     ...........  ...........  ...........  ...........  ...........
                             injection.
    J0695  N                Cefonocid sodium     ...........  ...........  ...........  ...........  ...........
                             injection.
    J0696  N                Ceftriaxone sodium   ...........  ...........  ...........  ...........  ...........
                             injection.
    J0697  N                Sterile cefuroxime   ...........  ...........  ...........  ...........  ...........
                             injection.
    J0698  N                Cefotaxime sodium    ...........  ...........  ...........  ...........  ...........
                             injection.
    J0702  N                Betamethasone        ...........  ...........  ...........  ...........  ...........
                             acet&sod phosp.
    J0704  N                Betamethasone sod    ...........  ...........  ...........  ...........  ...........
                             phosp/4 MG.
    J0710  N                Cephapirin sodium    ...........  ...........  ...........  ...........  ...........
                             injection.
    J0713  N                Inj ceftazidime per  ...........  ...........  ...........  ...........  ...........
                             500 mg.
    J0715  N                Ceftizoxime sodium / ...........  ...........  ...........  ...........  ...........
                              500 MG.
    J0720  N                Chloramphenicol      ...........  ...........  ...........  ...........  ...........
                             sodium injec.
    J0725  N                Chorionic            ...........  ...........  ...........  ...........  ...........
                             gonadotropin/1000u.
    J0730  N                Chlorpheniramin      ...........  ...........  ...........  ...........  ...........
                             maleate inj.
    J0735  N                Clonidine            ...........  ...........  ...........  ...........  ...........
                             hydrochloride.
    J0740  N                Cidofovir injection  ...........  ...........  ...........  ...........  ...........
    J0743  N                Cilastatin sodium    ...........  ...........  ...........  ...........  ...........
                             injection.
    J0745  N                Inj codeine          ...........  ...........  ...........  ...........  ...........
                             phosphate /30 MG.
    J0760  N                Colchicine           ...........  ...........  ...........  ...........  ...........
                             injection.
    J0770  N                Colistimethate       ...........  ...........  ...........  ...........  ...........
                             sodium inj.
    J0780  N                Prochlorperazine     ...........  ...........  ...........  ...........  ...........
                             injection.
    J0800  N                Corticotropin        ...........  ...........  ...........  ...........  ...........
                             injection.
    J0810  N                Cortisone injection  ...........  ...........  ...........  ...........  ...........
    J0835  N                Inj cosyntropin per  ...........  ...........  ...........  ...........  ...........
                             0.25 MG.
    J0850  G                Cytomegalovirus imm         0903  ...........      $370.50  ...........       $49.65
                             IV /vial.
    J0895  N                Deferoxamine         ...........  ...........  ...........  ...........  ...........
                             mesylate inj.
    J0900  N                Testosterone         ...........  ...........  ...........  ...........  ...........
                             enanthate inj.
    J0945  N                Brompheniramine      ...........  ...........  ...........  ...........  ...........
                             maleate inj.
    J0970  N                Estradiol valerate   ...........  ...........  ...........  ...........  ...........
                             injection.
    J1000  N                Depo-estradiol       ...........  ...........  ...........  ...........  ...........
                             cypionate inj.
    J1020  N                Methylprednisolone   ...........  ...........  ...........  ...........  ...........
                             20 MG inj.

[[Page 67977]]

 
    J1030  N                Methylprednisolone   ...........  ...........  ...........  ...........  ...........
                             40 MG inj.
    J1040  N                Methylprednisolone   ...........  ...........  ...........  ...........  ...........
                             80 MG inj.
    J1050  N                Medroxyprogesterone  ...........  ...........  ...........  ...........  ...........
                             inj.
    J1055  E                Medrxyprogester      ...........  ...........  ...........  ...........  ...........
                             acetate inj.
    J1060  N                Testosterone         ...........  ...........  ...........  ...........  ...........
                             cypionate 1 ML.
    J1070  N                Testosterone         ...........  ...........  ...........  ...........  ...........
                             cypionat 100 MG.
    J1080  N                Testosterone         ...........  ...........  ...........  ...........  ...........
                             cypionat 200 MG.
    J1090  N                Testosterone         ...........  ...........  ...........  ...........  ...........
                             cypionate 50 MG.
    J1095  N                Inj dexamethasone    ...........  ...........  ...........  ...........  ...........
                             acetate.
    J1100  N                Dexamethasone        ...........  ...........  ...........  ...........  ...........
                             sodium phos.
    J1110  N                Inj                  ...........  ...........  ...........  ...........  ...........
                             dihydroergotamine
                             mesylt.
    J1120  N                Acetazolamid sodium  ...........  ...........  ...........  ...........  ...........
                             injectio.
    J1160  N                Digoxin injection..  ...........  ...........  ...........  ...........  ...........
    J1165  N                Phenytoin sodium     ...........  ...........  ...........  ...........  ...........
                             injection.
    J1170  N                Hydromorphone        ...........  ...........  ...........  ...........  ...........
                             injection.
    J1180  N                Dyphylline           ...........  ...........  ...........  ...........  ...........
                             injection.
    J1190  G                Dexrazoxane HCl             0726  ...........      $161.11  ...........       $21.59
                             injection.
    J1200  N                Diphenhydramine hcl  ...........  ...........  ...........  ...........  ...........
                             injectio.
    J1205  N                Chlorothiazide       ...........  ...........  ...........  ...........  ...........
                             sodium inj.
    J1212  N                Dimethyl sulfoxide   ...........  ...........  ...........  ...........  ...........
                             50% 50 ML.
    J1230  N                Methadone injection  ...........  ...........  ...........  ...........  ...........
    J1240  N                Dimenhydrinate       ...........  ...........  ...........  ...........  ...........
                             injection.
    J1245  K                Dipyridamole                0917         0.36       $17.86  ...........        $3.57
                             injection.
    J1250  N                Inj dobutamine HCL/  ...........  ...........  ...........  ...........  ...........
                             250 mg.
    J1260  G                Dolasetron mesylate         0750  ...........       $14.81  ...........        $1.98
    J1320  N                Amitriptyline        ...........  ...........  ...........  ...........  ...........
                             injection.
    J1325  G                Epoprostenol                7003  ...........       $16.53  ...........        $2.22
                             injection.
   *J1327  G                Eptifibatide                1607  ...........       $12.57  ...........        $1.68
                             injection.
    J1330  N                Ergonovine maleate   ...........  ...........  ...........  ...........  ...........
                             injection.
    J1362  N                Erythromycin glucep  ...........  ...........  ...........  ...........  ...........
                             / 250 MG.
    J1364  N                Erythro              ...........  ...........  ...........  ...........  ...........
                             lactobionate /500
                             MG.
    J1380  N                Estradiol valerate   ...........  ...........  ...........  ...........  ...........
                             10 MG inj.
    J1390  N                Estradiol valerate   ...........  ...........  ...........  ...........  ...........
                             20 MG inj.
    J1410  N                Inj estrogen         ...........  ...........  ...........  ...........  ...........
                             conjugate 25 MG.
    J1435  N                Injection estrone    ...........  ...........  ...........  ...........  ...........
                             per 1 MG.
    J1436  G                Etidronate disodium         0727  ...........       $63.65  ...........        $8.53
                             inj.
   *J1438  G                Etanercept                  1608  ...........      $134.42  ...........       $18.01
                             injection.
    J1440  G                Filgrastim 300 mcg          0728  ...........      $171.38  ...........       $22.96
                             injection.
    J1441  G                Filgrastim 480 mcg          7049  ...........      $273.03  ...........       $35.06
                             injection.
    J1450  N                Fluconazole........  ...........  ...........  ...........  ...........  ...........
    J1452  N                Intraocular          ...........  ...........  ...........  ...........  ...........
                             Fomivirsen na 1.65
                             MG.
    J1455  N                Foscarnet sodium     ...........  ...........  ...........  ...........  ...........
                             injection.
    J1460  N                Gamma globulin 1 CC  ...........  ...........  ...........  ...........  ...........
                             inj.
    J1470  E                Gamma globulin 2 CC  ...........  ...........  ...........  ...........  ...........
                             inj.
    J1480  E                Gamma globulin 3 CC  ...........  ...........  ...........  ...........  ...........
                             inj.
    J1490  E                Gamma globulin 4 CC  ...........  ...........  ...........  ...........  ...........
                             inj.
    J1500  E                Gamma globulin 5 CC  ...........  ...........  ...........  ...........  ...........
                             inj.
    J1510  E                Gamma globulin 6 CC  ...........  ...........  ...........  ...........  ...........
                             inj.
    J1520  E                Gamma globulin 7 CC  ...........  ...........  ...........  ...........  ...........
                             inj.
    J1530  E                Gamma globulin 8 CC  ...........  ...........  ...........  ...........  ...........
                             inj.
    J1540  E                Gamma globulin 9 CC  ...........  ...........  ...........  ...........  ...........
                             inj.
    J1550  E                Gamma globulin 10    ...........  ...........  ...........  ...........  ...........
                             CC inj.
    J1560  E                Gamma globulin > 10  ...........  ...........  ...........  ...........  ...........
                             CC inj.
    J1561  G                Immune globulin 500         0905  ...........       $27.28  ...........        $3.33
                             mg.
   J1562D  G                Immune globulin 5           7004  ...........      $272.80  ...........       $33.28
                             gms.
   J1563D  N                IV immune globulin   ...........  ...........  ...........  ...........  ...........
                             1 GM.
    J1565  G                RSV-ivig...........         0906  ...........      $427.73  ...........       $57.32
    J1570  K                Ganciclovir sodium          0907         0.45       $22.26  ...........        $4.45
                             injection.
    J1580  N                Garamycin            ...........  ...........  ...........  ...........  ...........
                             gentamicin inj.
    J1600  N                Gold sodium          ...........  ...........  ...........  ...........  ...........
                             thiomaleate inj.
    J1610  N                Glucagon             ...........  ...........  ...........  ...........  ...........
                             hydrochloride/1 MG.
    J1620  G                Gonadorelin hydroch/        7005  ...........       $14.80  ...........        $1.98
                              100 mcg.
    J1626  G                Granisetron HCl             0764  ...........        $1.85  ...........         $.25
                             injection.
    J1630  N                Haloperidol          ...........  ...........  ...........  ...........  ...........
                             injection.
    J1631  N                Haloperidol          ...........  ...........  ...........  ...........  ...........
                             decanoate inj.
    J1642  N                Inj heparin sodium   ...........  ...........  ...........  ...........  ...........
                             per 10 u.
    J1644  N                Inj heparin sodium   ...........  ...........  ...........  ...........  ...........
                             per 1000u.
    J1645  N                Dalteparin sodium..  ...........  ...........  ...........  ...........  ...........
    J1650  G                Enoxaparin sodium           9998  ...........        $5.53  ...........         $.79
                             10 mg.
    J1670  G                Tetanus immune              0908  ...........      $102.60  ...........       $13.75
                             globulin inj.
    J1690  N                Prednisolone         ...........  ...........  ...........  ...........  ...........
                             tebutate inj.
    J1700  N                Hydrocortisone       ...........  ...........  ...........  ...........  ...........
                             acetate inj.
    J1710  N                Hydrocortisone       ...........  ...........  ...........  ...........  ...........
                             sodium ph inj.
    J1720  N                Hydrocortisone       ...........  ...........  ...........  ...........  ...........
                             sodium succ i.

[[Page 67978]]

 
    J1730  N                Diazoxide injection  ...........  ...........  ...........  ...........  ...........
    J1739  N                Hydroxyprogesterone  ...........  ...........  ...........  ...........  ...........
                             cap 125.
    J1741  N                Hydroxyprogesterone  ...........  ...........  ...........  ...........  ...........
                             cap 250.
    J1742  N                Ibutilide fumarate   ...........  ...........  ...........  ...........  ...........
                             injection.
    J1745  G                Infliximab                  7043  ...........       $58.08  ...........        $7.78
                             injection.
    J1750  N                Iron dextran.......  ...........  ...........  ...........  ...........  ...........
    J1785  G                Injection                   0916  ...........        $3.75  ...........         $.50
                             imiglucerase /unit.
    J1790  N                Droperidol           ...........  ...........  ...........  ...........  ...........
                             injection.
    J1800  N                Propranolol          ...........  ...........  ...........  ...........  ...........
                             injection.
    J1810  G                Droperidol/fentanyl         7047  ...........        $7.02  ...........         $.90
                             inj.
    J1820  N                Insulin injection..  ...........  ...........  ...........  ...........  ...........
    J1825  G                Interferon beta-1a.         0909  ...........      $204.73  ...........       $27.43
    J1830  G                Interferon beta-1b /        0910  ...........       $57.00  ...........        $7.64
                              .25 MG.
    J1840  N                Kanamycin sulfate    ...........  ...........  ...........  ...........  ...........
                             500 MG inj.
    J1850  N                Kanamycin sulfate    ...........  ...........  ...........  ...........  ...........
                             75 MG inj.
    J1885  N                Ketorolac            ...........  ...........  ...........  ...........  ...........
                             tromethamine inj.
    J1890  N                Cephalothin sodium   ...........  ...........  ...........  ...........  ...........
                             injection.
    J1910  N                Kutapressin          ...........  ...........  ...........  ...........  ...........
                             injection.
    J1930  N                Propiomazine         ...........  ...........  ...........  ...........  ...........
                             injection.
    J1940  N                Furosemide           ...........  ...........  ...........  ...........  ...........
                             injection.
    J1950  G                Leuprolide acetate /        0800  ...........      $492.71  ...........       $63.27
                             3.75 MG.
    J1955  N                Inj levocarnitine    ...........  ...........  ...........  ...........  ...........
                             per 1 gm.
    J1956  N                Levofloxacin         ...........  ...........  ...........  ...........  ...........
                             injection.
    J1960  N                Levorphanol          ...........  ...........  ...........  ...........  ...........
                             tartrate inj.
    J1970  N                Methotrimeprazine    ...........  ...........  ...........  ...........  ...........
                             injection.
    J1980  N                Hyoscyamine sulfate  ...........  ...........  ...........  ...........  ...........
                             inj.
    J1990  N                Chlordiazepoxide     ...........  ...........  ...........  ...........  ...........
                             injection.
    J2000  N                Lidocaine injection  ...........  ...........  ...........  ...........  ...........
    J2010  N                Lincomycin           ...........  ...........  ...........  ...........  ...........
                             injection.
    J2060  N                Lorazepam injection  ...........  ...........  ...........  ...........  ...........
    J2150  N                Mannitol injection.  ...........  ...........  ...........  ...........  ...........
    J2175  N                Meperidine hydrochl  ...........  ...........  ...........  ...........  ...........
                             /100 MG.
    J2180  N                Meperidine/          ...........  ...........  ...........  ...........  ...........
                             promethazine inj.
    J2210  N                Methylergonovin      ...........  ...........  ...........  ...........  ...........
                             maleate inj.
    J2240  N                Metocurine iodide    ...........  ...........  ...........  ...........  ...........
                             injection.
    J2250  N                Inj midazolam        ...........  ...........  ...........  ...........  ...........
                             hydrochloride.
    J2260  K                Inj milrinone               7007         0.47       $23.31  ...........        $4.66
                             lactate / 5 ML.
    J2270  N                Morphine sulfate     ...........  ...........  ...........  ...........  ...........
                             injection.
    J2271  N                Morphine so4         ...........  ...........  ...........  ...........  ...........
                             injection 100mg.
    J2275  G                Morphine sulfate            7010  ...........        $7.41  ...........         $.99
                             injection.
    J2300  N                Inj nalbuphine       ...........  ...........  ...........  ...........  ...........
                             hydrochloride.
    J2310  N                Inj naloxone         ...........  ...........  ...........  ...........  ...........
                             hydrochloride.
    J2320  N                Nandrolone           ...........  ...........  ...........  ...........  ...........
                             decanoate 50 MG.
    J2321  N                Nandrolone           ...........  ...........  ...........  ...........  ...........
                             decanoate 100 MG.
    J2322  N                Nandrolone           ...........  ...........  ...........  ...........  ...........
                             decanoate 200 MG.
    J2330  N                Thiothixene          ...........  ...........  ...........  ...........  ...........
                             injection.
    J2350  N                Niacinamide/niacin   ...........  ...........  ...........  ...........  ...........
                             injection.
    J2352  G                Octreotide acetate          7031  ...........      $115.34  ...........       $15.46
                             injection.
    J2355  G                Oprelvekin                  7011  ...........      $236.31  ...........       $31.67
                             injection.
    J2360  N                Orphenadrine         ...........  ...........  ...........  ...........  ...........
                             injection.
    J2370  N                Phenylephrine hcl    ...........  ...........  ...........  ...........  ...........
                             injection.
    J2400  N                Chloroprocaine hcl   ...........  ...........  ...........  ...........  ...........
                             injection.
    J2405  G                Ondansetron hcl             0768  ...........        $6.09  ...........         $.82
                             injection.
    J2410  N                Oxymorphone hcl      ...........  ...........  ...........  ...........  ...........
                             injection.
    J2430  G                Pamidronate                 0730  ...........      $232.51  ...........       $31.16
                             disodium /30 MG.
    J2440  N                Papaverin hcl        ...........  ...........  ...........  ...........  ...........
                             injection.
    J2460  N                Oxytetracycline      ...........  ...........  ...........  ...........  ...........
                             injection.
    J2480  N                Hydrochlorides of    ...........  ...........  ...........  ...........  ...........
                             opium inj.
    J2500  N                Paricalcitol.......  ...........  ...........  ...........  ...........  ...........
    J2510  N                Penicillin g         ...........  ...........  ...........  ...........  ...........
                             procaine inj.
    J2512  N                Inj pentagastrin     ...........  ...........  ...........  ...........  ...........
                             per 2 ML.
    J2515  N                Pentobarbital        ...........  ...........  ...........  ...........  ...........
                             sodium inj.
    J2540  N                Penicillin g         ...........  ...........  ...........  ...........  ...........
                             potassium inj.
    J2543  N                Piperacillin/        ...........  ...........  ...........  ...........  ...........
                             tazobactam.
    J2545  A                Pentamidine          ...........  ...........  ...........  ...........  ...........
                             isethionte/300mg.
    J2550  N                Promethazine hcl     ...........  ...........  ...........  ...........  ...........
                             injection.
    J2560  N                Phenobarbital        ...........  ...........  ...........  ...........  ...........
                             sodium inj.
    J2590  N                Oxytocin injection.  ...........  ...........  ...........  ...........  ...........
    J2597  E                Inj desmopressin     ...........  ...........  ...........  ...........  ...........
                             acetate.
    J2640  N                Prednisolone sodium  ...........  ...........  ...........  ...........  ...........
                             ph inj.
    J2650  N                Prednisolone         ...........  ...........  ...........  ...........  ...........
                             acetate inj.
    J2670  N                Totazoline hcl       ...........  ...........  ...........  ...........  ...........
                             injection.
    J2675  N                Inj progesterone     ...........  ...........  ...........  ...........  ...........
                             per 50 MG.
    J2680  N                Fluphenazine         ...........  ...........  ...........  ...........  ...........
                             decanoate 25 MG.

[[Page 67979]]

 
    J2690  N                Procainamide hcl     ...........  ...........  ...........  ...........  ...........
                             injection.
    J2700  N                Oxacillin sodium     ...........  ...........  ...........  ...........  ...........
                             injection.
    J2710  N                Neostigmine          ...........  ...........  ...........  ...........  ...........
                             methylslfte inj.
    J2720  N                Inj protamine        ...........  ...........  ...........  ...........  ...........
                             sulfate/10 MG.
    J2725  N                Inj protirelin per   ...........  ...........  ...........  ...........  ...........
                             250 mcg.
    J2730  N                Pralidoxime          ...........  ...........  ...........  ...........  ...........
                             chloride inj.
    J2760  N                Phentolaine          ...........  ...........  ...........  ...........  ...........
                             mesylate inj.
    J2765  G                Metoclopramide hcl          0754  ...........        $2.00  ...........         $.27
                             injection.
    J2770  G                Quinupristin/               1024  ...........      $102.05  ...........       $13.67
                             dalfopristin.
    J2780  N                Ranitidine           ...........  ...........  ...........  ...........  ...........
                             hydrochloride inj.
    J2790  G                Rho d immune                0884  ...........       $35.91  ...........        $4.38
                             globulin inj.
   *J2792  G                Rho(D) immune               1609  ...........       $20.55  ...........        $2.51
                             globulin h, sd.
    J2795  N                Ropivacaine HCl      ...........  ...........  ...........  ...........  ...........
                             injection.
    J2800  N                Methocarbamol        ...........  ...........  ...........  ...........  ...........
                             injection.
    J2810  N                Inj theophylline     ...........  ...........  ...........  ...........  ...........
                             per 40 MG.
    J2820  G                Sargramostim                0731  ...........       $27.42  ...........        $3.67
                             injection.
    J2860  N                Secobarbital sodium  ...........  ...........  ...........  ...........  ...........
                             inj.
    J2910  N                Aurothioglucose      ...........  ...........  ...........  ...........  ...........
                             injection.
    J2912  N                Sodium chloride      ...........  ...........  ...........  ...........  ...........
                             injection.
    J2915  N                NA Ferric Gluconate  ...........  ...........  ...........  ...........  ...........
                             Complex.
    J2920  N                Methylprednisolone   ...........  ...........  ...........  ...........  ...........
                             injection.
    J2930  N                Methylprednisolone   ...........  ...........  ...........  ...........  ...........
                             injection.
    J2950  N                Promazine hcl        ...........  ...........  ...........  ...........  ...........
                             injection.
    J2970  N                Methicillin sodium   ...........  ...........  ...........  ...........  ...........
                             injection.
    J2993  G                Reteplase injection         9005  ...........    $1,306.25  ...........      $175.04
   J2994D  G                Reteplase double            0914  ...........    $2,612.50  ...........      $350.08
                             bolus.
    J2995  K                Inj streptokinase /         0911         1.76       $87.25  ...........       $17.45
                             250000 IU.
   J2996D  K                Alteplase                   0915         3.80      $188.46  ...........       $37.69
                             recombinant inj.
    J2997  G                Alteplase                   7048         0.38       $18.70  ...........        $3.74
                             recombinant, 1 mg.
    J3000  N                Streptomycin         ...........  ...........  ...........  ...........  ...........
                             injection.
    J3010  G                Fentanyl citrate            7014  ...........         $.98  ...........         $.13
                             injection.
    J3030  N                Sumatriptan          ...........  ...........  ...........  ...........  ...........
                             succinate / 6 MG.
    J3070  N                Pentazocine hcl      ...........  ...........  ...........  ...........  ...........
                             injection.
    J3080  N                Chlorprothixene      ...........  ...........  ...........  ...........  ...........
                             injection.
    J3105  N                Terbutaline sulfate  ...........  ...........  ...........  ...........  ...........
                             inj.
    J3120  N                Testosterone         ...........  ...........  ...........  ...........  ...........
                             enanthate inj.
    J3130  N                Testosterone         ...........  ...........  ...........  ...........  ...........
                             enanthate inj.
    J3140  N                Testosterone         ...........  ...........  ...........  ...........  ...........
                             suspension inj.
    J3150  N                Testosteron          ...........  ...........  ...........  ...........  ...........
                             propionate inj.
    J3230  N                Chlorpromazine hcl   ...........  ...........  ...........  ...........  ...........
                             injection.
   *J3240  E                Thyrotropin          ...........  ...........  ...........  ...........  ...........
                             injection.
    J3245  G                Tirofiban                   7041  ...........      $399.00  ...........       $53.47
                             hydrochloride.
    J3250  N                Trimethobenzamide    ...........  ...........  ...........  ...........  ...........
                             hcl inj.
    J3260  N                Tobramycin sulfate   ...........  ...........  ...........  ...........  ...........
                             injection.
    J3265  N                Injection torsemide  ...........  ...........  ...........  ...........  ...........
                             10 mg/ml.
    J3270  N                Imipramine hcl       ...........  ...........  ...........  ...........  ...........
                             injection.
    J3280  G                Thiethylperazine            0755  ...........        $5.02  ...........         $.67
                             maleate inj.
    J3301  N                Triamcinolone        ...........  ...........  ...........  ...........  ...........
                             acetonide inj.
    J3302  N                Triamcinolone        ...........  ...........  ...........  ...........  ...........
                             diacetate inj.
    J3303  N                Triamcinolone        ...........  ...........  ...........  ...........  ...........
                             hexacetonl inj.
    J3305  G                Inj trimetrexate            7045  ...........       $69.83  ...........        $9.36
                             glucoronate.
    J3310  N                Perphenazine         ...........  ...........  ...........  ...........  ...........
                             injection.
    J3320  N                Spectinomycn di-hcl  ...........  ...........  ...........  ...........  ...........
                             inj.
    J3350  N                Urea injection.....  ...........  ...........  ...........  ...........  ...........
    J3360  N                Diazepam injection.  ...........  ...........  ...........  ...........  ...........
    J3364  N                Urokinase 5000 IU    ...........  ...........  ...........  ...........  ...........
                             injection.
    J3365  K                Urokinase 250,000           7036         6.78      $336.29  ...........       $67.26
                             IU inj.
    J3370  N                Vancomycin hcl       ...........  ...........  ...........  ...........  ...........
                             injection.
    J3390  N                Methoxamine          ...........  ...........  ...........  ...........  ...........
                             injection.
    J3400  N                Triflupromazine hcl  ...........  ...........  ...........  ...........  ...........
                             inj.
    J3410  N                Hydroxyzine hcl      ...........  ...........  ...........  ...........  ...........
                             injection.
    J3420  N                Vitamin b12          ...........  ...........  ...........  ...........  ...........
                             injection.
    J3430  N                Vitamin k            ...........  ...........  ...........  ...........  ...........
                             phytonadione inj.
    J3450  N                Mephentermine        ...........  ...........  ...........  ...........  ...........
                             sulfate inj.
    J3470  N                Hyaluronidase        ...........  ...........  ...........  ...........  ...........
                             injection.
    J3475  N                Inj magnesium        ...........  ...........  ...........  ...........  ...........
                             sulfate.
    J3480  N                Inj potassium        ...........  ...........  ...........  ...........  ...........
                             chloride.
    J3485  N                Zidovudine.........  ...........  ...........  ...........  ...........  ...........
    J3490  N                Drugs unclassified   ...........  ...........  ...........  ...........  ...........
                             injection.
    J3520  E                Edetate disodium     ...........  ...........  ...........  ...........  ...........
                             per 150 mg.
    J3530  N                Nasal vaccine        ...........  ...........  ...........  ...........  ...........
                             inhalation.
    J3535  E                Metered dose         ...........  ...........  ...........  ...........  ...........
                             inhaler drug.
    J3570  E                Laetrile amygdalin   ...........  ...........  ...........  ...........  ...........
                             vit B17.
    J7030  N                Normal saline        ...........  ...........  ...........  ...........  ...........
                             solution infus.

[[Page 67980]]

 
    J7040  N                Normal saline        ...........  ...........  ...........  ...........  ...........
                             solution infus.
    J7042  N                5% dextrose/normal   ...........  ...........  ...........  ...........  ...........
                             saline.
    J7050  N                Normal saline        ...........  ...........  ...........  ...........  ...........
                             solution infus.
    J7051  N                Sterile saline/      ...........  ...........  ...........  ...........  ...........
                             water.
    J7060  N                5% dextrose/water..  ...........  ...........  ...........  ...........  ...........
    J7070  N                D5w infusion.......  ...........  ...........  ...........  ...........  ...........
    J7100  N                Dextran 40 infusion  ...........  ...........  ...........  ...........  ...........
    J7110  N                Dextran 75 infusion  ...........  ...........  ...........  ...........  ...........
    J7120  N                Ringers lactate      ...........  ...........  ...........  ...........  ...........
                             infusion.
    J7130  N                Hypertonic saline    ...........  ...........  ...........  ...........  ...........
                             solution.
    J7190  G                Factor viii........         0925  ...........         $.88  ...........         $.12
    J7191  G                Factor VIII                 0926  ...........        $2.09  ...........         $.28
                             (porcine).
    J7192  G                Factor viii                 0927  ...........        $1.17  ...........         $.16
                             recombinant.
    J7194  G                Factor ix complex..         0928  ...........         $.71  ...........         $.10
    J7197  G                Antithrombin iii            0930  ...........         $.82  ...........         $.11
                             injection.
    J7198  G                Anti-inhibitor.....         0929  ...........        $1.43  ...........         $.19
    J7199  E                Hemophilia clot      ...........  ...........  ...........  ...........  ...........
                             factor noc.
    J7300  E                Intraut copper       ...........  ...........  ...........  ...........  ...........
                             contraceptive.
    J7310  G                Ganciclovir long            0913  ...........    $4,750.00  ...........      $636.50
                             act implant.
    J7315  G                Sodium hyaluronate          7315  ...........      $125.59  ...........       $16.83
                             injection.
   *J7320  G                Hylan G-F 20                1611  ...........      $204.87  ...........       $27.45
                             injection.
    J7330  G                Cultured                    1059  ...........   $14,250.00  ...........    $2,010.00
                             chondrocytes
                             implnt.
    J7500  G                Azathioprine oral           0886  ...........        $1.24  ...........         $.17
                             50mg.
    J7501  G                Azathioprine                0887  ...........       $67.88  ...........        $9.10
                             parenteral.
    J7502  G                Cyclosporine oral           0888  ...........        $5.80  ...........         $.78
                             100 mg.
    J7504  G                Lymphocyte immune           0890  ...........      $249.13  ...........       $30.39
                             globulin.
    J7505  G                Muromonab-CD3, 5 mg         7038  ...........      $741.00  ...........       $99.29
    J7506  N                Prednisone oral....  ...........  ...........  ...........  ...........  ...........
    J7507  G                Tacrolimus oral per         0891  ...........        $2.66  ...........         $.36
                             1 MG.
    J7508  E                Tacrolimus oral per  ...........  ...........  ...........  ...........  ...........
                             5 MG.
    J7509  N                Methylprednisolone   ...........  ...........  ...........  ...........  ...........
                             oral.
    J7510  N                Prednisolone oral    ...........  ...........  ...........  ...........  ...........
                             per 5 mg.
   *J7513  G                Daclizumab,                 1612  ...........      $397.29  ...........       $53.24
                             parenteral.
    J7515  N                Cyclosporine oral    ...........  ...........  ...........  ...........  ...........
                             25 mg.
    J7516  G                Cyclosporin                 0889  ...........       $15.81  ...........        $2.12
                             parenteral 250mg.
    J7517  N                Mycophenolate        ...........  ...........  ...........  ...........  ...........
                             mofetil oral.
    J7520  G                Sirolimus, oral....         9106  ...........        $6.51  ...........         $.87
    J7525  E                Tacrolimus           ...........  ...........  ...........  ...........  ...........
                             injection.
    J7599  E                Immunosuppressive    ...........  ...........  ...........  ...........  ...........
                             drug noc.
    J7608  A                Acetylcysteine inh   ...........  ...........  ...........  ...........  ...........
                             sol u d.
   J7610D  A                Acetylcysteine 10%   ...........  ...........  ...........  ...........  ...........
                             injection.
   J7615D  A                Acetylcysteine 20%   ...........  ...........  ...........  ...........  ...........
                             injection.
    J7618  A                Albuterol inh sol    ...........  ...........  ...........  ...........  ...........
                             con.
    J7619  A                Albuterol inh sol u  ...........  ...........  ...........  ...........  ...........
                             d.
   J7620D  A                Albuterol sulfate    ...........  ...........  ...........  ...........  ...........
                             .083%/ml.
   J7625D  A                Albuterol sulfate    ...........  ...........  ...........  ...........  ...........
                             .5% inj.
   J7627D  A                Bitolterolmesylate   ...........  ...........  ...........  ...........  ...........
                             inhal sol.
    J7628  A                Bitolterol mes       ...........  ...........  ...........  ...........  ...........
                             inhal sol con.
    J7629  A                Bitolterol mes inh   ...........  ...........  ...........  ...........  ...........
                             sol u d.
   J7630D  A                Cromolyn sodium      ...........  ...........  ...........  ...........  ...........
                             injection.
    J7631  A                Cromolyn sodium inh  ...........  ...........  ...........  ...........  ...........
                             sol u d.
    J7635  A                Atropine inhal sol   ...........  ...........  ...........  ...........  ...........
                             con.
    J7636  A                Atropine inhal sol   ...........  ...........  ...........  ...........  ...........
                             unit dose.
    J7637  A                Dexamethasone inhal  ...........  ...........  ...........  ...........  ...........
                             sol con.
    J7638  A                Dexamethasone inhal  ...........  ...........  ...........  ...........  ...........
                             sol u d.
    J7639  A                Dornase alpha inhal  ...........  ...........  ...........  ...........  ...........
                             sol u d.
   J7640D  A                Epinephrine          ...........  ...........  ...........  ...........  ...........
                             injection.
    J7642  A                Glycopyrrolate       ...........  ...........  ...........  ...........  ...........
                             inhal sol con.
    J7643  A                Glycopyrrolate       ...........  ...........  ...........  ...........  ...........
                             inhal sol u d.
    J7644  A                Ipratropium brom     ...........  ...........  ...........  ...........  ...........
                             inh sol u d.
   J7645D  A                Ipratropium bromide  ...........  ...........  ...........  ...........  ...........
                             .02%/ml.
    J7648  A                Isoetharine hcl inh  ...........  ...........  ...........  ...........  ...........
                             sol con.
    J7649  A                Isoetharine hcl inh  ...........  ...........  ...........  ...........  ...........
                             sol u d.
   J7650D  A                Isoetharine hcl .1%  ...........  ...........  ...........  ...........  ...........
                             inj.
   J7651D  A                Isoetharine hcl      ...........  ...........  ...........  ...........  ...........
                             .125% inj.
   J7652D  A                Isoetharine hcl      ...........  ...........  ...........  ...........  ...........
                             .167% inj.
   J7653D  A                Isoetharine hcl .2%/ ...........  ...........  ...........  ...........  ...........
                              inj.
   J7654D  A                Isoetharine hcl      ...........  ...........  ...........  ...........  ...........
                             .25% inj.
   J7655D  A                Isoetharine hcl 1%   ...........  ...........  ...........  ...........  ...........
                             inj.
    J7658  A                Isoproterenolhcl     ...........  ...........  ...........  ...........  ...........
                             inh sol con.
    J7659  A                Isoproterenol hcl    ...........  ...........  ...........  ...........  ...........
                             inh sol ud.
   J7660D  A                Isoproterenol hcl    ...........  ...........  ...........  ...........  ...........
                             .5% inj.
   J7665D  A                Isoproterenol hcl    ...........  ...........  ...........  ...........  ...........
                             1% inj.
    J7668  A                Metaproterenol inh   ...........  ...........  ...........  ...........  ...........
                             sol con.

[[Page 67981]]

 
    J7669  A                Metaproterenol inh   ...........  ...........  ...........  ...........  ...........
                             sol u d.
   J7670D  A                Metaproterenol       ...........  ...........  ...........  ...........  ...........
                             sulfate .4%.
   J7672D  A                Metaproterenol       ...........  ...........  ...........  ...........  ...........
                             sulfate .6%.
   J7675D  A                Metaproterenol       ...........  ...........  ...........  ...........  ...........
                             sulfate 5%.
    J7680  A                Terbutaline so4 inh  ...........  ...........  ...........  ...........  ...........
                             sol con.
    J7681  A                Terbutaline so4 inh  ...........  ...........  ...........  ...........  ...........
                             sol u d.
    J7682  A                Tobramycin           ...........  ...........  ...........  ...........  ...........
                             inhalation sol.
    J7683  A                Triamcinolone inh    ...........  ...........  ...........  ...........  ...........
                             sol con.
    J7684  A                Triamcinolone inh    ...........  ...........  ...........  ...........  ...........
                             sol u d.
    J7699  A                Inhalation solution  ...........  ...........  ...........  ...........  ...........
                             for DME.
    J7799  A                Non-inhalation drug  ...........  ...........  ...........  ...........  ...........
                             for DME.
    J8499  E                Oral prescrip drug   ...........  ...........  ...........  ...........  ...........
                             non chemo.
    J8510  G                Oral busulfan......         7015  ...........        $1.73  ...........         $.23
    J8520  G                Capecitabine, oral,         7042  ...........        $1.94  ...........         $.26
                             150 mg.
    J8521  N                Capecitabine, oral,  ...........  ...........  ...........  ...........  ...........
                             500 mg.
    J8530  G                Cyclophosphamide            0801  ...........        $2.12  ...........         $.28
                             oral 25 MG.
    J8560  G                Etoposide oral 50           0802  ...........       $45.95  ...........        $6.16
                             MG.
    J8600  G                Melphalan oral 2 MG         0803  ...........        $2.07  ...........         $.30
    J8610  G                Methotrexate oral           0826  ...........        $2.92  ...........         $.39
                             2.5 MG.
    J8700  G                Temozolmide, oral 5         1086  ...........        $5.70  ...........         $.76
                             mg.
    J8999  E                Oral prescription    ...........  ...........  ...........  ...........  ...........
                             drug chemo.
    J9000  G                Doxorubic hcl 10 MG         0847  ...........       $15.79  ...........        $2.12
                             vl chemo.
    J9001  G                Doxorubicin hcl             7046  ...........      $311.72  ...........       $41.77
                             liposome inj.
    J9015  G                Aldesleukin/single          0807  ...........      $569.76  ...........       $76.35
                             use vial.
    J9020  G                Asparaginase                0814  ...........       $57.41  ...........        $7.69
                             injection.
    J9031  G                Bcg live                    0809  ...........      $159.39  ...........       $19.45
                             intravesical vac.
    J9040  G                Bleomycin sulfate           0857  ...........      $294.48  ...........       $39.46
                             injection.
    J9045  G                Carboplatin                 0811  ...........       $98.90  ...........       $13.25
                             injection.
    J9050  G                Carmus bischl nitro         0812  ...........      $103.27  ...........       $13.84
                             inj.
    J9060  G                Cisplatin 10 MG             0813  ...........       $42.18  ...........        $5.65
                             injection.
    J9062  E                Cisplatin 50 MG      ...........  ...........  ...........  ...........  ...........
                             injection.
    J9065  G                Inj cladribine per          0858  ...........       $53.47  ...........        $7.16
                             1 MG.
    J9070  G                Cyclophosphamide            0815  ...........        $6.13  ...........         $.82
                             100 MG inj.
    J9080  E                Cyclophosphamide     ...........  ...........  ...........  ...........  ...........
                             200 MG inj.
    J9090  E                Cyclophosphamide     ...........  ...........  ...........  ...........  ...........
                             500 MG inj.
    J9091  E                Cyclophosphamide     ...........  ...........  ...........  ...........  ...........
                             1.0 grm inj.
    J9092  E                Cyclophosphamide     ...........  ...........  ...........  ...........  ...........
                             2.0 grm inj.
    J9093  G                Cyclophosphamide            0816  ...........        $6.13  ...........         $.82
                             lyophilized.
    J9094  E                Cyclophosphamide     ...........  ...........  ...........  ...........  ...........
                             lyophilized.
    J9095  E                Cyclophosphamide     ...........  ...........  ...........  ...........  ...........
                             lyophilized.
    J9096  E                Cyclophosphamide     ...........  ...........  ...........  ...........  ...........
                             lyophilized.
    J9097  E                Cyclophosphamide     ...........  ...........  ...........  ...........  ...........
                             lyophilized.
    J9100  G                Cytarabine hcl 100          0817  ...........        $5.94  ...........         $.80
                             MG inj.
    J9110  E                Cytarabine hcl 500   ...........  ...........  ...........  ...........  ...........
                             MG inj.
    J9120  G                Dactinomycin                0818  ...........       $12.73  ...........        $1.71
                             actinomycin d.
    J9130  G                Dacarbazine 10 MG           0819  ...........        $1.13  ...........         $.15
                             inj.
    J9140  E                Dacarbazine 200 MG   ...........  ...........  ...........  ...........  ...........
                             inj.
    J9150  G                Daunorubicin.......         0820  ...........       $80.04  ...........       $10.73
    J9151  G                Daunorubicin                0821  ...........       $64.60  ...........        $8.66
                             citrate liposom.
    J9160  G                Denileukin                  1084  ...........      $942.88  ...........      $126.35
                             diftitox, 300 mcg.
    J9165  G                Diethylstilbestrol          0822  ...........        $4.20  ...........         $.56
                             injection.
    J9170  G                Docetaxel..........         0823  ...........      $283.65  ...........       $38.01
    J9180  E                Epirubicin HCl       ...........  ...........  ...........  ...........  ...........
                             injection.
    J9181  G                Etoposide 10 MG inj         0824  ...........        $4.06  ...........         $.54
    J9182  E                Etoposide 100 MG     ...........  ...........  ...........  ...........  ...........
                             inj.
    J9185  G                Fludarabine                 0842  ...........      $237.03  ...........       $31.76
                             phosphate inj.
    J9190  G                Fluorouracil                0859  ...........        $2.75  ...........         $.37
                             injection.
    J9200  G                Floxuridine                 0827  ...........      $129.56  ...........       $17.36
                             injection.
    J9201  G                Gemcitabine HCl....         0828  ...........       $88.46  ...........       $11.85
    J9202  G                Goserelin acetate           0810  ...........      $446.49  ...........       $59.83
                             implant.
    J9206  G                Irinotecan                  0830  ...........      $117.81  ...........       $15.79
                             injection.
    J9208  G                Ifosfomide                  0831  ...........      $141.50  ...........       $18.96
                             injection.
    J9209  G                Mesna injection....         0732  ...........       $36.51  ...........        $4.89
    J9211  G                Idarubicin hcl              0832  ...........      $341.38  ...........       $45.75
                             injection.
    J9212  G                Interferon alfacon-         0833  ...........        $3.91  ...........         $.52
                             1.
    J9213  G                Interferon alfa-2a          0834  ...........       $33.22  ...........        $4.45
                             inj.
    J9214  G                Interferon alfa-2b          0836  ...........       $11.28  ...........        $1.51
                             inj.
    J9215  G                Interferon alfa-n3          0865  ...........        $7.86  ...........        $1.05
                             inj.
    J9216  G                Interferon gamma 1-         0838  ...........      $199.50  ...........       $26.73
                             b inj.
    J9217  G                Leuprolide acetate          9217  ...........      $592.60  ...........       $79.40
                             suspnsion.
    J9218  G                Leuprolide acetate          0861  ...........       $22.90  ...........        $3.07
                             injection.
    J9219  N                Leuprolide acetate   ...........  ...........  ...........  ...........  ...........
                             implant.
    J9230  G                Mechlorethamine hcl         0839  ...........       $11.01  ...........        $1.48
                             inj.
    J9245  G                Inj melphalan               0840  ...........      $363.48  ...........       $48.71
                             hydrochl 50 MG.

[[Page 67982]]

 
    J9250  G                Methotrexate sodium         0841  ...........         $.45  ...........         $.06
                             inj.
    J9260  E                Methotrexate sodium  ...........  ...........  ...........  ...........  ...........
                             inj.
    J9265  G                Paclitaxel                  0863  ...........      $173.50  ...........       $23.25
                             injection.
    J9266  G                Pegaspargase/singl          0843  ...........    $1,321.65  ...........      $177.10
                             dose vial.
    J9268  G                Pentostatin                 0844  ...........    $1,562.75  ...........      $209.41
                             injection.
    J9270  G                Plicamycin                  0860  ...........       $93.80  ...........       $12.57
                             (mithramycin) inj.
    J9280  G                Mitomycin 5 MG inj.         0862  ...........      $121.65  ...........       $16.30
    J9290  E                Mitomycin 20 MG inj  ...........  ...........  ...........  ...........  ...........
    J9291  E                Mitomycin 40 MG inj  ...........  ...........  ...........  ...........  ...........
    J9293  G                Mitoxantrone                0864  ...........      $223.02  ...........       $29.88
                             hydrochl / 5 MG.
    J9310  G                Rituximab cancer            0849  ...........      $420.29  ...........       $56.32
                             treatment.
    J9320  G                Streptozocin                0850  ...........       $65.79  ...........        $8.82
                             injection.
    J9340  G                Thiotepa injection.         0851  ...........      $100.30  ...........       $13.44
    J9350  G                Topotecan..........         0852  ...........      $573.75  ...........       $76.88
   *J9355  G                Trastuzumab........         1613  ...........       $48.85  ...........        $6.55
   *J9357  G                Valrubicin, 200 mg.         1614  ...........      $423.23  ...........       $56.71
    J9360  G                Vinblastine sulfate         0853  ...........        $4.11  ...........         $.55
                             inj.
    J9370  G                Vincristine sulfate         0854  ...........       $30.16  ...........        $4.04
                             1 MG inj.
    J9375  E                Vincristine sulfate  ...........  ...........  ...........  ...........  ...........
                             2 MG inj.
    J9380  E                Vincristine sulfate  ...........  ...........  ...........  ...........  ...........
                             5 MG inj.
    J9390  G                Vinorelbine                 0855  ...........       $75.51  ...........       $10.12
                             tartrate/10 mg.
    J9600  G                Porfimer sodium....         0856  ...........    $2,603.67  ...........      $348.89
    J9999  E                Chemotherapy drug..  ...........  ...........  ...........  ...........  ...........
    K0001  A                Standard wheelchair  ...........  ...........  ...........  ...........  ...........
    K0002  A                Stnd hemi (low       ...........  ...........  ...........  ...........  ...........
                             seat) whlchr.
    K0003  A                Lightweight          ...........  ...........  ...........  ...........  ...........
                             wheelchair.
    K0004  A                High strength ltwt   ...........  ...........  ...........  ...........  ...........
                             whlchr.
    K0005  A                Ultralightweight     ...........  ...........  ...........  ...........  ...........
                             wheelchair.
    K0006  A                Heavy duty           ...........  ...........  ...........  ...........  ...........
                             wheelchair.
    K0007  A                Extra heavy duty     ...........  ...........  ...........  ...........  ...........
                             wheelchair.
    K0008  A                Cstm manual          ...........  ...........  ...........  ...........  ...........
                             wheelchair/base.
    K0009  A                Other manual         ...........  ...........  ...........  ...........  ...........
                             wheelchair/base.
    K0010  A                Stnd wt frame power  ...........  ...........  ...........  ...........  ...........
                             whlchr.
    K0011  A                Stnd wt pwr whlchr   ...........  ...........  ...........  ...........  ...........
                             w control.
    K0012  A                Ltwt portbl power    ...........  ...........  ...........  ...........  ...........
                             whlchr.
    K0013  A                Custom power whlchr  ...........  ...........  ...........  ...........  ...........
                             base.
    K0014  A                Other power whlchr   ...........  ...........  ...........  ...........  ...........
                             base.
    K0015  A                Detach non-adjus     ...........  ...........  ...........  ...........  ...........
                             hght armrst.
    K0016  A                Detach adjust        ...........  ...........  ...........  ...........  ...........
                             armrst cmplete.
    K0017  A                Detach adjust        ...........  ...........  ...........  ...........  ...........
                             armrest base.
    K0018  A                Detach adjust        ...........  ...........  ...........  ...........  ...........
                             armrst upper.
    K0019  A                Arm pad each.......  ...........  ...........  ...........  ...........  ...........
    K0020  A                Fixed adjust         ...........  ...........  ...........  ...........  ...........
                             armrest pair.
    K0021  A                Anti-tipping device  ...........  ...........  ...........  ...........  ...........
                             each.
    K0022  A                Reinforced back      ...........  ...........  ...........  ...........  ...........
                             upholstery.
    K0023  A                Planr back insrt     ...........  ...........  ...........  ...........  ...........
                             foam w/strp.
    K0024  A                Plnr back insrt      ...........  ...........  ...........  ...........  ...........
                             foam w/hrdwr.
    K0025  A                Hook-on headrest     ...........  ...........  ...........  ...........  ...........
                             extension.
    K0026  A                Back upholst lgtwt   ...........  ...........  ...........  ...........  ...........
                             whlchr.
    K0027  A                Back upholst other   ...........  ...........  ...........  ...........  ...........
                             whlchr.
    K0028  A                Manual fully         ...........  ...........  ...........  ...........  ...........
                             reclining back.
    K0029  A                Reinforced seat      ...........  ...........  ...........  ...........  ...........
                             upholstery.
    K0030  A                Solid plnr seat      ...........  ...........  ...........  ...........  ...........
                             sngl dnsfoam.
    K0031  A                Safety belt/pelvic   ...........  ...........  ...........  ...........  ...........
                             strap.
    K0032  A                Seat uphols lgtwt    ...........  ...........  ...........  ...........  ...........
                             whlchr.
    K0033  A                Seat upholstery      ...........  ...........  ...........  ...........  ...........
                             other whlchr.
    K0034  A                Heel loop each.....  ...........  ...........  ...........  ...........  ...........
    K0035  A                Heel loop with       ...........  ...........  ...........  ...........  ...........
                             ankle strap.
    K0036  A                Toe loop each......  ...........  ...........  ...........  ...........  ...........
    K0037  A                High mount flip-up   ...........  ...........  ...........  ...........  ...........
                             footrest.
    K0038  A                Leg strap each.....  ...........  ...........  ...........  ...........  ...........
    K0039  A                Leg strap h style    ...........  ...........  ...........  ...........  ...........
                             each.
    K0040  A                Adjustable angle     ...........  ...........  ...........  ...........  ...........
                             footplate.
    K0041  A                Large size           ...........  ...........  ...........  ...........  ...........
                             footplate each.
    K0042  A                Standard size        ...........  ...........  ...........  ...........  ...........
                             footplate each.
    K0043  A                Ftrst lower          ...........  ...........  ...........  ...........  ...........
                             extension tube.
    K0044  A                Ftrst upper hanger   ...........  ...........  ...........  ...........  ...........
                             bracket.
    K0045  A                Footrest complete    ...........  ...........  ...........  ...........  ...........
                             assembly.
    K0046  A                Elevat legrst low    ...........  ...........  ...........  ...........  ...........
                             extension.
    K0047  A                Elevat legrst up     ...........  ...........  ...........  ...........  ...........
                             hangr brack.
    K0048  A                Elevate legrest      ...........  ...........  ...........  ...........  ...........
                             complete.
    K0049  A                Calf pad each......  ...........  ...........  ...........  ...........  ...........
    K0050  A                Ratchet assembly...  ...........  ...........  ...........  ...........  ...........
    K0051  A                Cam relese assem     ...........  ...........  ...........  ...........  ...........
                             ftrst/lgrst.

[[Page 67983]]

 
    K0052  A                Swingaway detach     ...........  ...........  ...........  ...........  ...........
                             footrest.
    K0053  A                Elevate footrest     ...........  ...........  ...........  ...........  ...........
                             articulate.
    K0054  A                Seat wdth 10-12/15/  ...........  ...........  ...........  ...........  ...........
                             17/20 wc.
    K0055  A                Seat dpth 15/17/18   ...........  ...........  ...........  ...........  ...........
                             ltwt wc.
    K0056  A                Seat ht 17 or >=21   ...........  ...........  ...........  ...........  ...........
                             ltwt wc.
    K0057  A                Seat wdth 19/20 hvy  ...........  ...........  ...........  ...........  ...........
                             dty wc.
    K0058  A                Seat dpth 17/18      ...........  ...........  ...........  ...........  ...........
                             power wc.
    K0059  A                Plastic coated       ...........  ...........  ...........  ...........  ...........
                             handrim each.
    K0060  A                Steel handrim each.  ...........  ...........  ...........  ...........  ...........
    K0061  A                Aluminum handrim     ...........  ...........  ...........  ...........  ...........
                             each.
    K0062  A                Handrim 8-10 vert/   ...........  ...........  ...........  ...........  ...........
                             obliq proj.
    K0063  A                Hndrm 12-16 vert/    ...........  ...........  ...........  ...........  ...........
                             obliq proj.
    K0064  A                Zero pressure tube   ...........  ...........  ...........  ...........  ...........
                             flat free.
    K0065  A                Spoke protectors...  ...........  ...........  ...........  ...........  ...........
    K0066  A                Solid tire any size  ...........  ...........  ...........  ...........  ...........
                             each.
    K0067  A                Pneumatic tire any   ...........  ...........  ...........  ...........  ...........
                             size each.
    K0068  A                Pneumatic tire tube  ...........  ...........  ...........  ...........  ...........
                             each.
    K0069  A                Rear whl complete    ...........  ...........  ...........  ...........  ...........
                             solid tire.
    K0070  A                Rear whl compl       ...........  ...........  ...........  ...........  ...........
                             pneum tire.
    K0071  A                Front castr compl    ...........  ...........  ...........  ...........  ...........
                             pneum tire.
    K0072  A                Frnt cstr cmpl sem-  ...........  ...........  ...........  ...........  ...........
                             pneum tir.
    K0073  A                Caster pin lock      ...........  ...........  ...........  ...........  ...........
                             each.
    K0074  A                Pneumatic caster     ...........  ...........  ...........  ...........  ...........
                             tire each.
    K0075  A                Semi-pneumatic       ...........  ...........  ...........  ...........  ...........
                             caster tire.
    K0076  A                Solid caster tire    ...........  ...........  ...........  ...........  ...........
                             each.
    K0077  A                Front caster assem   ...........  ...........  ...........  ...........  ...........
                             complete.
    K0078  A                Pneumatic caster     ...........  ...........  ...........  ...........  ...........
                             tire tube.
    K0079  A                Wheel lock           ...........  ...........  ...........  ...........  ...........
                             extension pair.
    K0080  A                Anti-rollback        ...........  ...........  ...........  ...........  ...........
                             device pair.
    K0081  A                Wheel lock assembly  ...........  ...........  ...........  ...........  ...........
                             complete.
    K0082  A                22 nf deep cycl      ...........  ...........  ...........  ...........  ...........
                             acid battery.
    K0083  A                22 nf gel cell       ...........  ...........  ...........  ...........  ...........
                             battery each.
    K0084  A                Grp 24 deep cycl     ...........  ...........  ...........  ...........  ...........
                             acid battry.
    K0085  A                Group 24 gel cell    ...........  ...........  ...........  ...........  ...........
                             battery.
    K0086  A                U-1 lead acid        ...........  ...........  ...........  ...........  ...........
                             battery each.
    K0087  A                U-1 gel cell         ...........  ...........  ...........  ...........  ...........
                             battery each.
    K0088  A                Battry chrgr acid/   ...........  ...........  ...........  ...........  ...........
                             gel cell.
    K0089  A                Battery charger      ...........  ...........  ...........  ...........  ...........
                             dual mode.
    K0090  A                Rear tire power      ...........  ...........  ...........  ...........  ...........
                             wheelchair.
    K0091  A                Rear tire tube       ...........  ...........  ...........  ...........  ...........
                             power whlchr.
    K0092  A                Rear assem cmplt     ...........  ...........  ...........  ...........  ...........
                             powr whlchr.
    K0093  A                Rear zero pressure   ...........  ...........  ...........  ...........  ...........
                             tire tube.
    K0094  A                Wheel tire for       ...........  ...........  ...........  ...........  ...........
                             power base.
    K0095  A                Wheel tire tube      ...........  ...........  ...........  ...........  ...........
                             each base.
    K0096  A                Wheel assem powr     ...........  ...........  ...........  ...........  ...........
                             base complt.
    K0097  A                Wheel zero presure   ...........  ...........  ...........  ...........  ...........
                             tire tube.
    K0098  A                Drive belt power     ...........  ...........  ...........  ...........  ...........
                             wheelchair.
    K0099  A                Pwr wheelchair       ...........  ...........  ...........  ...........  ...........
                             front caster.
    K0100  A                Amputee adapter      ...........  ...........  ...........  ...........  ...........
                             pair.
    K0101  A                One-arm drive        ...........  ...........  ...........  ...........  ...........
                             attachment.
    K0102  A                Crutch and cane      ...........  ...........  ...........  ...........  ...........
                             holder.
    K0103  A                Transfer board  25"  ...........  ...........  ...........  ...........  ...........
    K0104  A                Cylinder tank        ...........  ...........  ...........  ...........  ...........
                             carrier.
    K0105  A                Iv hanger..........  ...........  ...........  ...........  ...........  ...........
    K0106  A                Arm trough each....  ...........  ...........  ...........  ...........  ...........
    K0107  A                Wheelchair tray....  ...........  ...........  ...........  ...........  ...........
    K0108  A                W/c component-       ...........  ...........  ...........  ...........  ...........
                             accessory NOS.
    K0112  A                Trunk vest supprt    ...........  ...........  ...........  ...........  ...........
                             innr frame.
    K0113  A                Trunk vest suprt w/  ...........  ...........  ...........  ...........  ...........
                             o inr frm.
    K0114  A                Whlchr back suprt    ...........  ...........  ...........  ...........  ...........
                             inr frame.
    K0115  A                Back module          ...........  ...........  ...........  ...........  ...........
                             orthotic system.
    K0116  A                Back & seat modul    ...........  ...........  ...........  ...........  ...........
                             orthot sys.
   K0182D  A                Water distilled w/   ...........  ...........  ...........  ...........  ...........
                             nebulizer.
    K0183  A                Nasal application    ...........  ...........  ...........  ...........  ...........
                             device.
    K0184  A                Nasal pillows/seals  ...........  ...........  ...........  ...........  ...........
                             pair.
    K0185  A                Pos airway pressure  ...........  ...........  ...........  ...........  ...........
                             headgear.
    K0186  A                Pos airway prssure   ...........  ...........  ...........  ...........  ...........
                             chinstrap.
    K0187  A                Pos airway pressure  ...........  ...........  ...........  ...........  ...........
                             tubing.
    K0188  A                Pos airway pressure  ...........  ...........  ...........  ...........  ...........
                             filter.
    K0189  A                Filter               ...........  ...........  ...........  ...........  ...........
                             nondisposable w
                             PAP.
    K0195  A                Elevating whlchair   ...........  ...........  ...........  ...........  ...........
                             leg rests.
    K0268  A                Humidifier           ...........  ...........  ...........  ...........  ...........
                             nonheated w PAP.
   K0269D  A                Aerosol compressor   ...........  ...........  ...........  ...........  ...........
                             cpap dev.
   K0270D  A                Ultrasonic           ...........  ...........  ...........  ...........  ...........
                             generator w nebul.

[[Page 67984]]

 
   K0280D  A                Extension drainage   ...........  ...........  ...........  ...........  ...........
                             tubing.
   K0281D  A                Lubricant catheter   ...........  ...........  ...........  ...........  ...........
                             insertion.
   K0283D  A                Saline solution      ...........  ...........  ...........  ...........  ...........
                             dispenser.
   K0407D  A                Urinary cath skin    ...........  ...........  ...........  ...........  ...........
                             attachment.
   K0408D  A                Urinary cath leg     ...........  ...........  ...........  ...........  ...........
                             strap.
   K0409D  A                Sterile H2O          ...........  ...........  ...........  ...........  ...........
                             irrigation solut.
   K0410D  A                Male ext cath w/adh  ...........  ...........  ...........  ...........  ...........
                             coating.
   K0411D  A                Male ext cath w/adh  ...........  ...........  ...........  ...........  ...........
                             strip.
    K0415  E                RX antiemetic drg,   ...........  ...........  ...........  ...........  ...........
                             oral NOS.
    K0416  E                Rx antiemetic        ...........  ...........  ...........  ...........  ...........
                             drg,rectal NOS.
   K0440D  A                Nasal prosthesis...  ...........  ...........  ...........  ...........  ...........
   K0441D  A                Midfacial            ...........  ...........  ...........  ...........  ...........
                             prosthesis.
   K0442D  A                Orbital prosthesis.  ...........  ...........  ...........  ...........  ...........
   K0443D  A                Upper facial         ...........  ...........  ...........  ...........  ...........
                             prosthesis.
   K0444D  A                Hemi-facial          ...........  ...........  ...........  ...........  ...........
                             prosthesis.
   K0445D  A                Auricular            ...........  ...........  ...........  ...........  ...........
                             prosthesis.
   K0446D  A                Partial facial       ...........  ...........  ...........  ...........  ...........
                             prosthesis.
   K0447D  A                Nasal septal         ...........  ...........  ...........  ...........  ...........
                             prosthesis.
   K0448D  A                Unspec               ...........  ...........  ...........  ...........  ...........
                             maxillofacial
                             prosth.
   K0449D  A                Repair               ...........  ...........  ...........  ...........  ...........
                             maxillofacial
                             prosth.
   K0450D  A                Liq adhes for        ...........  ...........  ...........  ...........  ...........
                             facial prosth.
   K0451D  A                Adhesive remover     ...........  ...........  ...........  ...........  ...........
                             wipes.
    K0452  A                Wheelchair bearings  ...........  ...........  ...........  ...........  ...........
    K0455  A                Pump uninterrupted   ...........  ...........  ...........  ...........  ...........
                             infusion.
   K0456D  A                Heavyduty/xtra wide  ...........  ...........  ...........  ...........  ...........
                             hosp bed.
   K0457D  A                Heavyduty/wide       ...........  ...........  ...........  ...........  ...........
                             commode chair.
   K0458D  A                Heavyduty walker no  ...........  ...........  ...........  ...........  ...........
                             wheels.
   K0459D  A                Heavy duty wheeled   ...........  ...........  ...........  ...........  ...........
                             walker.
    K0460  A                WC power add-on      ...........  ...........  ...........  ...........  ...........
                             joystick.
    K0461  A                WC power add-on      ...........  ...........  ...........  ...........  ...........
                             tiller cntrl.
    K0462  A                Temporary            ...........  ...........  ...........  ...........  ...........
                             replacement eqpmnt.
   K0501D  A                Aerosol compressor   ...........  ...........  ...........  ...........  ...........
                             for svneb.
   K0529D  A                Sterile H20 or nss   ...........  ...........  ...........  ...........  ...........
                             w lv neb.
    K0531  A                Heated humidifier    ...........  ...........  ...........  ...........  ...........
                             used w pap.
    K0532  A                Noninvasive assist   ...........  ...........  ...........  ...........  ...........
                             wo backup.
    K0533  A                Noninvasive assist   ...........  ...........  ...........  ...........  ...........
                             w backup.
    K0534  A                Invasive assist w    ...........  ...........  ...........  ...........  ...........
                             backup.
   K0535D  A                Gauze, impregnated   ...........  ...........  ...........  ...........  ...........
                             hydrogel.
   K0536D  A                Gauze, impregnated   ...........  ...........  ...........  ...........  ...........
                             hydrogel.
   K0537D  A                Gauze, impregnated   ...........  ...........  ...........  ...........  ...........
                             hydrogel.
    K0541  A                Speech generating    ...........  ...........  ...........  ...........  ...........
                             device.
    K0542  A                Speech generating    ...........  ...........  ...........  ...........  ...........
                             device.
    K0543  A                Speech generating    ...........  ...........  ...........  ...........  ...........
                             device.
    K0544  A                Speech generating    ...........  ...........  ...........  ...........  ...........
                             device.
    K0545  A                Speech generating    ...........  ...........  ...........  ...........  ...........
                             software.
    K0546  A                Accessory for        ...........  ...........  ...........  ...........  ...........
                             sgd,mntng syst.
    K0547  A                Accessory for        ...........  ...........  ...........  ...........  ...........
                             sgd,not clasfd.
    L0100  A                Cerv craniosten      ...........  ...........  ...........  ...........  ...........
                             helmet mold.
    L0110  A                Cerv craniostenosis  ...........  ...........  ...........  ...........  ...........
                             hel non-.
    L0120  A                Cerv flexible non-   ...........  ...........  ...........  ...........  ...........
                             adjustable.
    L0130  A                Flex thermoplastic   ...........  ...........  ...........  ...........  ...........
                             collar mo.
    L0140  A                Cervical semi-rigid  ...........  ...........  ...........  ...........  ...........
                             adjustab.
    L0150  A                Cerv semi-rig adj    ...........  ...........  ...........  ...........  ...........
                             molded chn.
    L0160  A                Cerv semi-rig wire   ...........  ...........  ...........  ...........  ...........
                             occ/mand.
    L0170  A                Cervical collar      ...........  ...........  ...........  ...........  ...........
                             molded to pt.
    L0172  A                Cerv col thermplas   ...........  ...........  ...........  ...........  ...........
                             foam 2 pi.
    L0174  A                Cerv col foam 2      ...........  ...........  ...........  ...........  ...........
                             piece w thor.
    L0180  A                Cer post col occ/    ...........  ...........  ...........  ...........  ...........
                             man sup adj.
    L0190  A                Cerv collar supp     ...........  ...........  ...........  ...........  ...........
                             adj cerv ba.
    L0200  A                Cerv col supp adj    ...........  ...........  ...........  ...........  ...........
                             bar & thor.
    L0210  A                Thoracic rib belt..  ...........  ...........  ...........  ...........  ...........
    L0220  A                Thor rib belt        ...........  ...........  ...........  ...........  ...........
                             custom fabrica.
    L0300  A                TLSO flex surgical   ...........  ...........  ...........  ...........  ...........
                             support.
    L0310  A                Tlso flexible        ...........  ...........  ...........  ...........  ...........
                             custom fabrica.
    L0315  A                Tlso flex elas       ...........  ...........  ...........  ...........  ...........
                             rigid post pa.
    L0317  A                Tlso flex hypext     ...........  ...........  ...........  ...........  ...........
                             elas post p.
    L0320  A                Tlso a-p contrl w    ...........  ...........  ...........  ...........  ...........
                             apron frnt.
    L0330  A                Tlso ant-pos-        ...........  ...........  ...........  ...........  ...........
                             lateral control.
    L0340  A                Tlso a-p-l-rotary    ...........  ...........  ...........  ...........  ...........
                             with apron.
    L0350  A                Tlso flex compress   ...........  ...........  ...........  ...........  ...........
                             jacket cu.
    L0360  A                Tlso flex compress   ...........  ...........  ...........  ...........  ...........
                             jacket mo.
    L0370  A                Tlso a-p-l-rotary    ...........  ...........  ...........  ...........  ...........
                             hyperexten.
    L0380  A                Tlso a-p-l-rot w/    ...........  ...........  ...........  ...........  ...........
                             pos extens.
    L0390  A                Tlso a-p-l control   ...........  ...........  ...........  ...........  ...........
                             molded.

[[Page 67985]]

 
    L0400  A                Tlso a-p-l w         ...........  ...........  ...........  ...........  ...........
                             interface mater.
    L0410  A                Tlso a-p-l two       ...........  ...........  ...........  ...........  ...........
                             piece constr.
    L0420  A                Tlso a-p-l 2 piece   ...........  ...........  ...........  ...........  ...........
                             w interfa.
    L0430  A                Tlso a-p-l w         ...........  ...........  ...........  ...........  ...........
                             interface custm.
    L0440  A                Tlso a-p-l overlap   ...........  ...........  ...........  ...........  ...........
                             frnt cust.
    L0500  A                Lso flex surgical    ...........  ...........  ...........  ...........  ...........
                             support.
    L0510  A                Lso flexible custom  ...........  ...........  ...........  ...........  ...........
                             fabricat.
    L0515  A                Lso flex elas w/     ...........  ...........  ...........  ...........  ...........
                             rig post pa.
    L0520  A                Lso a-p-l control    ...........  ...........  ...........  ...........  ...........
                             with apron.
    L0530  A                Lso ant-pos control  ...........  ...........  ...........  ...........  ...........
                             w apron.
    L0540  A                Lso lumbar flexion   ...........  ...........  ...........  ...........  ...........
                             a-p-l.
    L0550  A                Lso a-p-l control    ...........  ...........  ...........  ...........  ...........
                             molded.
    L0560  A                Lso a-p-l w          ...........  ...........  ...........  ...........  ...........
                             interface.
    L0565  A                Lso a-p-l control    ...........  ...........  ...........  ...........  ...........
                             custom.
    L0600  A                Sacroiliac flex      ...........  ...........  ...........  ...........  ...........
                             surg support.
    L0610  A                Sacroiliac flexible  ...........  ...........  ...........  ...........  ...........
                             custm fa.
    L0620  A                Sacroiliac semi-rig  ...........  ...........  ...........  ...........  ...........
                             w apron.
    L0700  A                Ctlso a-p-l control  ...........  ...........  ...........  ...........  ...........
                             molded.
    L0710  A                Ctlso a-p-l control  ...........  ...........  ...........  ...........  ...........
                             w/ inter.
    L0810  A                Halo cervical into   ...........  ...........  ...........  ...........  ...........
                             jckt vest.
    L0820  A                Halo cervical into   ...........  ...........  ...........  ...........  ...........
                             body jack.
    L0830  A                Halo cerv into       ...........  ...........  ...........  ...........  ...........
                             milwaukee typ.
    L0860  A                Magnetic resonanc    ...........  ...........  ...........  ...........  ...........
                             image comp.
    L0900  A                Torso/ptosis         ...........  ...........  ...........  ...........  ...........
                             support.
    L0910  A                Torso & ptosis supp  ...........  ...........  ...........  ...........  ...........
                             custm fa.
    L0920  A                Torso/pendulous abd  ...........  ...........  ...........  ...........  ...........
                             support.
    L0930  A                Pendulous abdomen    ...........  ...........  ...........  ...........  ...........
                             supp custm.
    L0940  A                Torso/postsurgical   ...........  ...........  ...........  ...........  ...........
                             support.
    L0950  A                Post surg support    ...........  ...........  ...........  ...........  ...........
                             custom fab.
    L0960  A                Post surgical        ...........  ...........  ...........  ...........  ...........
                             support pads.
    L0970  A                Tlso corset front..  ...........  ...........  ...........  ...........  ...........
    L0972  A                Lso corset front...  ...........  ...........  ...........  ...........  ...........
    L0974  A                Tlso full corset...  ...........  ...........  ...........  ...........  ...........
    L0976  A                Lso full corset....  ...........  ...........  ...........  ...........  ...........
    L0978  A                Axillary crutch      ...........  ...........  ...........  ...........  ...........
                             extension.
    L0980  A                Peroneal straps      ...........  ...........  ...........  ...........  ...........
                             pair.
    L0982  A                Stocking supp grips  ...........  ...........  ...........  ...........  ...........
                             set of f.
    L0984  A                Protective body      ...........  ...........  ...........  ...........  ...........
                             sock each.
    L0999  A                Add to spinal        ...........  ...........  ...........  ...........  ...........
                             orthosis NOS.
    L1000  A                Ctlso milwauke       ...........  ...........  ...........  ...........  ...........
                             initial model.
    L1010  A                Ctlso axilla sling.  ...........  ...........  ...........  ...........  ...........
    L1020  A                Kyphosis pad.......  ...........  ...........  ...........  ...........  ...........
    L1025  A                Kyphosis pad         ...........  ...........  ...........  ...........  ...........
                             floating.
    L1030  A                Lumbar bolster pad.  ...........  ...........  ...........  ...........  ...........
    L1040  A                Lumbar or lumbar     ...........  ...........  ...........  ...........  ...........
                             rib pad.
    L1050  A                Sternal pad........  ...........  ...........  ...........  ...........  ...........
    L1060  A                Thoracic pad.......  ...........  ...........  ...........  ...........  ...........
    L1070  A                Trapezius sling....  ...........  ...........  ...........  ...........  ...........
    L1080  A                Outrigger..........  ...........  ...........  ...........  ...........  ...........
    L1085  A                Outrigger bil w/     ...........  ...........  ...........  ...........  ...........
                             vert extens.
    L1090  A                Lumbar sling.......  ...........  ...........  ...........  ...........  ...........
    L1100  A                Ring flange plastic/ ...........  ...........  ...........  ...........  ...........
                             leather.
    L1110  A                Ring flange plas/    ...........  ...........  ...........  ...........  ...........
                             leather mol.
    L1120  A                Covers for upright   ...........  ...........  ...........  ...........  ...........
                             each.
    L1200  A                Furnsh initial       ...........  ...........  ...........  ...........  ...........
                             orthosis only.
    L1210  A                Lateral thoracic     ...........  ...........  ...........  ...........  ...........
                             extension.
    L1220  A                Anterior thoracic    ...........  ...........  ...........  ...........  ...........
                             extension.
    L1230  A                Milwaukee type       ...........  ...........  ...........  ...........  ...........
                             superstructur.
    L1240  A                Lumbar derotation    ...........  ...........  ...........  ...........  ...........
                             pad.
    L1250  A                Anterior asis pad..  ...........  ...........  ...........  ...........  ...........
    L1260  A                Anterior thoracic    ...........  ...........  ...........  ...........  ...........
                             derotation.
    L1270  A                Abdominal pad......  ...........  ...........  ...........  ...........  ...........
    L1280  A                Rib gusset           ...........  ...........  ...........  ...........  ...........
                             (elastic) each.
    L1290  A                Lateral              ...........  ...........  ...........  ...........  ...........
                             trochanteric pad.
    L1300  A                Body jacket mold to  ...........  ...........  ...........  ...........  ...........
                             patient.
    L1310  A                Post-operative body  ...........  ...........  ...........  ...........  ...........
                             jacket.
    L1499  A                Spinal orthosis NOS  ...........  ...........  ...........  ...........  ...........
    L1500  A                Thkao mobility       ...........  ...........  ...........  ...........  ...........
                             frame.
    L1510  A                Thkao standing       ...........  ...........  ...........  ...........  ...........
                             frame.
    L1520  A                Thkao swivel walker  ...........  ...........  ...........  ...........  ...........
    L1600  A                Abduct hip flex      ...........  ...........  ...........  ...........  ...........
                             frejka w cvr.
    L1610  A                Abduct hip flex      ...........  ...........  ...........  ...........  ...........
                             frejka covr.
    L1620  A                Abduct hip flex      ...........  ...........  ...........  ...........  ...........
                             pavlik harne.
    L1630  A                Abduct control hip   ...........  ...........  ...........  ...........  ...........
                             semi-flex.

[[Page 67986]]

 
    L1640  A                Pelv band/spread     ...........  ...........  ...........  ...........  ...........
                             bar thigh c.
    L1650  A                HO abduction hip     ...........  ...........  ...........  ...........  ...........
                             adjustable.
    L1660  A                HO abduction static  ...........  ...........  ...........  ...........  ...........
                             plastic.
    L1680  A                Pelvic & hip         ...........  ...........  ...........  ...........  ...........
                             control thigh c.
    L1685  A                Post-op hip abduct   ...........  ...........  ...........  ...........  ...........
                             custom fa.
    L1686  A                HO post-op hip       ...........  ...........  ...........  ...........  ...........
                             abduction.
    L1690  A                Combination          ...........  ...........  ...........  ...........  ...........
                             bilateral HO.
    L1700  A                Leg perthes orth     ...........  ...........  ...........  ...........  ...........
                             toronto typ.
    L1710  A                Legg perthes orth    ...........  ...........  ...........  ...........  ...........
                             newington.
    L1720  A                Legg perthes         ...........  ...........  ...........  ...........  ...........
                             orthosis trilat.
    L1730  A                Legg perthes orth    ...........  ...........  ...........  ...........  ...........
                             scottish r.
    L1750  A                Legg perthes sling.  ...........  ...........  ...........  ...........  ...........
    L1755  A                Legg perthes patten  ...........  ...........  ...........  ...........  ...........
                             bottom t.
    L1800  A                Knee orthoses elas   ...........  ...........  ...........  ...........  ...........
                             w stays.
    L1810  A                Ko elastic with      ...........  ...........  ...........  ...........  ...........
                             joints.
    L1815  A                Elastic with         ...........  ...........  ...........  ...........  ...........
                             condylar pads.
    L1820  A                Ko elas w/ condyle   ...........  ...........  ...........  ...........  ...........
                             pads & jo.
    L1825  A                Ko elastic knee cap  ...........  ...........  ...........  ...........  ...........
    L1830  A                Ko immobilizer       ...........  ...........  ...........  ...........  ...........
                             canvas longit.
    L1832  A                KO adj jnt pos       ...........  ...........  ...........  ...........  ...........
                             rigid support.
    L1834  A                Ko w/0 joint rigid   ...........  ...........  ...........  ...........  ...........
                             molded to.
    L1840  A                Ko derot ant         ...........  ...........  ...........  ...........  ...........
                             cruciate custom.
    L1843  A                KO single upright    ...........  ...........  ...........  ...........  ...........
                             custom fit.
    L1844  A                Ko w/adj jt rot      ...........  ...........  ...........  ...........  ...........
                             cntrl molded.
    L1845  A                Ko w/ adj flex/ext   ...........  ...........  ...........  ...........  ...........
                             rotat cus.
    L1846  A                Ko w adj flex/ext    ...........  ...........  ...........  ...........  ...........
                             rotat mold.
    L1847  A                KO adjustable w air  ...........  ...........  ...........  ...........  ...........
                             chambers.
    L1850  A                Ko swedish type....  ...........  ...........  ...........  ...........  ...........
    L1855  A                Ko plas doub         ...........  ...........  ...........  ...........  ...........
                             upright jnt mol.
    L1858  A                Ko polycentric       ...........  ...........  ...........  ...........  ...........
                             pneumatic pad.
    L1860  A                Ko supracondylar     ...........  ...........  ...........  ...........  ...........
                             socket mold.
    L1870  A                Ko doub upright      ...........  ...........  ...........  ...........  ...........
                             lacers molde.
    L1880  A                Ko doub upright      ...........  ...........  ...........  ...........  ...........
                             cuffs/lacers.
    L1885  A                Knee upright w/      ...........  ...........  ...........  ...........  ...........
                             resistance.
    L1900  A                Afo sprng wir        ...........  ...........  ...........  ...........  ...........
                             drsflx calf bd.
    L1902  A                Afo ankle gauntlet.  ...........  ...........  ...........  ...........  ...........
    L1904  A                Afo molded ankle     ...........  ...........  ...........  ...........  ...........
                             gauntlet.
    L1906  A                Afo multiligamentus  ...........  ...........  ...........  ...........  ...........
                             ankle su.
    L1910  A                Afo sing bar clasp   ...........  ...........  ...........  ...........  ...........
                             attach sh.
    L1920  A                Afo sing upright w/  ...........  ...........  ...........  ...........  ...........
                             adjust s.
    L1930  A                Afo plastic........  ...........  ...........  ...........  ...........  ...........
    L1940  A                Afo molded to        ...........  ...........  ...........  ...........  ...........
                             patient plasti.
    L1945  A                Afo molded plas rig  ...........  ...........  ...........  ...........  ...........
                             ant tib.
    L1950  A                Afo spiral molded    ...........  ...........  ...........  ...........  ...........
                             to pt plas.
    L1960  A                Afo pos solid ank    ...........  ...........  ...........  ...........  ...........
                             plastic mo.
    L1970  A                Afo plastic molded   ...........  ...........  ...........  ...........  ...........
                             w/ankle j.
    L1980  A                Afo sing solid       ...........  ...........  ...........  ...........  ...........
                             stirrup calf.
    L1990  A                Afo doub solid       ...........  ...........  ...........  ...........  ...........
                             stirrup calf.
    L2000  A                Kafo sing fre stirr  ...........  ...........  ...........  ...........  ...........
                             thi/calf.
    L2010  A                Kafo sng solid       ...........  ...........  ...........  ...........  ...........
                             stirrup w/o j.
    L2020  A                Kafo dbl solid       ...........  ...........  ...........  ...........  ...........
                             stirrup band/.
    L2030  A                Kafo dbl solid       ...........  ...........  ...........  ...........  ...........
                             stirrup w/o j.
    L2035  A                KAFO plastic         ...........  ...........  ...........  ...........  ...........
                             pediatric size.
    L2036  A                Kafo plas doub free  ...........  ...........  ...........  ...........  ...........
                             knee mol.
    L2037  A                Kafo plas sing free  ...........  ...........  ...........  ...........  ...........
                             knee mol.
    L2038  A                Kafo w/o joint       ...........  ...........  ...........  ...........  ...........
                             multi-axis an.
    L2039  A                KAFO,plstic,medlat   ...........  ...........  ...........  ...........  ...........
                             rotat con.
    L2040  A                Hkafo torsion bil    ...........  ...........  ...........  ...........  ...........
                             rot straps.
    L2050  A                Hkafo torsion cable  ...........  ...........  ...........  ...........  ...........
                             hip pelv.
    L2060  A                Hkafo torsion ball   ...........  ...........  ...........  ...........  ...........
                             bearing j.
    L2070  A                Hkafo torsion        ...........  ...........  ...........  ...........  ...........
                             unilat rot str.
    L2080  A                Hkafo unilat         ...........  ...........  ...........  ...........  ...........
                             torsion cable.
    L2090  A                Hkafo unilat         ...........  ...........  ...........  ...........  ...........
                             torsion ball br.
    L2102  A                Afo tibial fx cast   ...........  ...........  ...........  ...........  ...........
                             plstr mol.
    L2104  A                Afo tib fx cast      ...........  ...........  ...........  ...........  ...........
                             synthetic mo.
    L2106  A                Afo tib fx cast      ...........  ...........  ...........  ...........  ...........
                             plaster mold.
    L2108  A                Afo tib fx cast      ...........  ...........  ...........  ...........  ...........
                             molded to pt.
    L2112  A                Afo tibial fracture  ...........  ...........  ...........  ...........  ...........
                             soft.
    L2114  A                Afo tib fx semi-     ...........  ...........  ...........  ...........  ...........
                             rigid.
    L2116  A                Afo tibial fracture  ...........  ...........  ...........  ...........  ...........
                             rigid.
    L2122  A                Kafo fem fx cast     ...........  ...........  ...........  ...........  ...........
                             plaster mol.
    L2124  A                Kafo fem fx cast     ...........  ...........  ...........  ...........  ...........
                             synthet mol.
    L2126  A                Kafo fem fx cast     ...........  ...........  ...........  ...........  ...........
                             thermoplas.
    L2128  A                Kafo fem fx cast     ...........  ...........  ...........  ...........  ...........
                             molded to p.

[[Page 67987]]

 
    L2132  A                Kafo femoral fx      ...........  ...........  ...........  ...........  ...........
                             cast soft.
    L2134  A                Kafo fem fx cast     ...........  ...........  ...........  ...........  ...........
                             semi-rigid.
    L2136  A                Kafo femoral fx      ...........  ...........  ...........  ...........  ...........
                             cast rigid.
    L2180  A                Plas shoe insert w   ...........  ...........  ...........  ...........  ...........
                             ank joint.
    L2182  A                Drop lock knee.....  ...........  ...........  ...........  ...........  ...........
    L2184  A                Limited motion knee  ...........  ...........  ...........  ...........  ...........
                             joint.
    L2186  A                Adj motion knee jnt  ...........  ...........  ...........  ...........  ...........
                             lerman t.
    L2188  A                Quadrilateral brim.  ...........  ...........  ...........  ...........  ...........
    L2190  A                Waist belt.........  ...........  ...........  ...........  ...........  ...........
    L2192  A                Pelvic band & belt   ...........  ...........  ...........  ...........  ...........
                             thigh fla.
    L2200  A                Limited ankle        ...........  ...........  ...........  ...........  ...........
                             motion ea jnt.
    L2210  A                Dorsiflexion assist  ...........  ...........  ...........  ...........  ...........
                             each joi.
    L2220  A                Dorsi & plantar      ...........  ...........  ...........  ...........  ...........
                             flex ass/res.
    L2230  A                Split flat caliper   ...........  ...........  ...........  ...........  ...........
                             stirr & p.
    L2240  A                Round caliper and    ...........  ...........  ...........  ...........  ...........
                             plate atta.
    L2250  A                Foot plate molded    ...........  ...........  ...........  ...........  ...........
                             stirrup at.
    L2260  A                Reinforced solid     ...........  ...........  ...........  ...........  ...........
                             stirrup.
    L2265  A                Long tongue stirrup  ...........  ...........  ...........  ...........  ...........
    L2270  A                Varus/valgus strap   ...........  ...........  ...........  ...........  ...........
                             padded/li.
    L2275  A                Plastic mod low ext  ...........  ...........  ...........  ...........  ...........
                             pad/line.
    L2280  A                Molded inner boot..  ...........  ...........  ...........  ...........  ...........
    L2300  A                Abduction bar        ...........  ...........  ...........  ...........  ...........
                             jointed adjust.
    L2310  A                Abduction bar-       ...........  ...........  ...........  ...........  ...........
                             straight.
    L2320  A                Non-molded lacer...  ...........  ...........  ...........  ...........  ...........
    L2330  A                Lacer molded to      ...........  ...........  ...........  ...........  ...........
                             patient mode.
    L2335  A                Anterior swing band  ...........  ...........  ...........  ...........  ...........
    L2340  A                Pre-tibial shell     ...........  ...........  ...........  ...........  ...........
                             molded to p.
    L2350  A                Prosthetic type      ...........  ...........  ...........  ...........  ...........
                             socket molde.
    L2360  A                Extended steel       ...........  ...........  ...........  ...........  ...........
                             shank.
    L2370  A                Patten bottom......  ...........  ...........  ...........  ...........  ...........
    L2375  A                Torsion ank & half   ...........  ...........  ...........  ...........  ...........
                             solid sti.
    L2380  A                Torsion straight     ...........  ...........  ...........  ...........  ...........
                             knee joint.
    L2385  A                Straight knee joint  ...........  ...........  ...........  ...........  ...........
                             heavy du.
    L2390  A                Offset knee joint    ...........  ...........  ...........  ...........  ...........
                             each.
    L2395  A                Offset knee joint    ...........  ...........  ...........  ...........  ...........
                             heavy duty.
    L2397  A                Suspension sleeve    ...........  ...........  ...........  ...........  ...........
                             lower ext.
    L2405  A                Knee joint drop      ...........  ...........  ...........  ...........  ...........
                             lock ea jnt.
    L2415  A                Knee joint cam lock  ...........  ...........  ...........  ...........  ...........
                             each joi.
    L2425  A                Knee disc/dial lock/ ...........  ...........  ...........  ...........  ...........
                             adj flex.
    L2430  A                Knee jnt ratchet     ...........  ...........  ...........  ...........  ...........
                             lock ea jnt.
    L2435  A                Knee joint           ...........  ...........  ...........  ...........  ...........
                             polycentric joint.
    L2492  A                Knee lift loop drop  ...........  ...........  ...........  ...........  ...........
                             lock rin.
    L2500  A                Thi/glut/ischia wgt  ...........  ...........  ...........  ...........  ...........
                             bearing.
    L2510  A                Th/wght bear quad-   ...........  ...........  ...........  ...........  ...........
                             lat brim m.
    L2520  A                Th/wght bear quad-   ...........  ...........  ...........  ...........  ...........
                             lat brim c.
    L2525  A                Th/wght bear nar m-  ...........  ...........  ...........  ...........  ...........
                             l brim mo.
    L2526  A                Th/wght bear nar m-  ...........  ...........  ...........  ...........  ...........
                             l brim cu.
    L2530  A                Thigh/wght bear      ...........  ...........  ...........  ...........  ...........
                             lacer non-mo.
    L2540  A                Thigh/wght bear      ...........  ...........  ...........  ...........  ...........
                             lacer molded.
    L2550  A                Thigh/wght bear      ...........  ...........  ...........  ...........  ...........
                             high roll cu.
    L2570  A                Hip clevis type 2    ...........  ...........  ...........  ...........  ...........
                             posit jnt.
    L2580  A                Pelvic control       ...........  ...........  ...........  ...........  ...........
                             pelvic sling.
    L2600  A                Hip clevis/thrust    ...........  ...........  ...........  ...........  ...........
                             bearing fr.
    L2610  A                Hip clevis/thrust    ...........  ...........  ...........  ...........  ...........
                             bearing lo.
    L2620  A                Pelvic control hip   ...........  ...........  ...........  ...........  ...........
                             heavy dut.
    L2622  A                Hip joint            ...........  ...........  ...........  ...........  ...........
                             adjustable flexion.
    L2624  A                Hip adj flex ext     ...........  ...........  ...........  ...........  ...........
                             abduct cont.
    L2627  A                Plastic mold         ...........  ...........  ...........  ...........  ...........
                             recipro hip & c.
    L2628  A                Metal frame recipro  ...........  ...........  ...........  ...........  ...........
                             hip & ca.
    L2630  A                Pelvic control band  ...........  ...........  ...........  ...........  ...........
                             & belt u.
    L2640  A                Pelvic control band  ...........  ...........  ...........  ...........  ...........
                             & belt b.
    L2650  A                Pelv & thor control  ...........  ...........  ...........  ...........  ...........
                             gluteal.
    L2660  A                Thoracic control     ...........  ...........  ...........  ...........  ...........
                             thoracic ba.
    L2670  A                Thorac cont          ...........  ...........  ...........  ...........  ...........
                             paraspinal uprig.
    L2680  A                Thorac cont lat      ...........  ...........  ...........  ...........  ...........
                             support upri.
    L2750  A                Plating chrome/      ...........  ...........  ...........  ...........  ...........
                             nickel pr bar.
    L2755  A                Carbon graphite      ...........  ...........  ...........  ...........  ...........
                             lamination.
    L2760  A                Extension per        ...........  ...........  ...........  ...........  ...........
                             extension per.
    L2770  A                Low ext orthosis     ...........  ...........  ...........  ...........  ...........
                             per bar/jnt.
    L2780  A                Non-corrosive        ...........  ...........  ...........  ...........  ...........
                             finish.
    L2785  A                Drop lock retainer   ...........  ...........  ...........  ...........  ...........
                             each.
    L2795  A                Knee control full    ...........  ...........  ...........  ...........  ...........
                             kneecap.
    L2800  A                Knee cap medial or   ...........  ...........  ...........  ...........  ...........
                             lateral p.
    L2810  A                Knee control         ...........  ...........  ...........  ...........  ...........
                             condylar pad.

[[Page 67988]]

 
    L2820  A                Soft interface       ...........  ...........  ...........  ...........  ...........
                             below knee se.
    L2830  A                Soft interface       ...........  ...........  ...........  ...........  ...........
                             above knee se.
    L2840  A                Tibial length sock   ...........  ...........  ...........  ...........  ...........
                             fx or equ.
    L2850  A                Femoral lgth sock    ...........  ...........  ...........  ...........  ...........
                             fx or equa.
    L2860  A                Torsion mechanism    ...........  ...........  ...........  ...........  ...........
                             knee/ankle.
    L2999  A                Lower extremity      ...........  ...........  ...........  ...........  ...........
                             orthosis NOS.
    L3000  E                Ft insert ucb        ...........  ...........  ...........  ...........  ...........
                             berkeley shell.
    L3001  E                Foot insert remov    ...........  ...........  ...........  ...........  ...........
                             molded spe.
    L3002  E                Foot insert          ...........  ...........  ...........  ...........  ...........
                             plastazote or eq.
    L3003  E                Foot insert          ...........  ...........  ...........  ...........  ...........
                             silicone gel eac.
    L3010  E                Foot longitudinal    ...........  ...........  ...........  ...........  ...........
                             arch suppo.
    L3020  E                Foot longitud/       ...........  ...........  ...........  ...........  ...........
                             metatarsal sup.
    L3030  E                Foot arch support    ...........  ...........  ...........  ...........  ...........
                             remov prem.
    L3040  E                Ft arch suprt        ...........  ...........  ...........  ...........  ...........
                             premold longit.
    L3050  E                Foot arch supp       ...........  ...........  ...........  ...........  ...........
                             premold metat.
    L3060  E                Foot arch supp       ...........  ...........  ...........  ...........  ...........
                             longitud/meta.
    L3070  E                Arch suprt att to    ...........  ...........  ...........  ...........  ...........
                             sho longit.
    L3080  E                Arch supp att to     ...........  ...........  ...........  ...........  ...........
                             shoe metata.
    L3090  E                Arch supp att to     ...........  ...........  ...........  ...........  ...........
                             shoe long/m.
    L3100  E                Hallus-valgus nght   ...........  ...........  ...........  ...........  ...........
                             dynamic s.
    L3140  E                Abduction rotation   ...........  ...........  ...........  ...........  ...........
                             bar shoe.
    L3150  E                Abduct rotation bar  ...........  ...........  ...........  ...........  ...........
                             w/o shoe.
    L3160  E                Shoe styled          ...........  ...........  ...........  ...........  ...........
                             positioning dev.
    L3170  E                Foot plastic heel    ...........  ...........  ...........  ...........  ...........
                             stabilizer.
    L3201  E                Oxford w supinat/    ...........  ...........  ...........  ...........  ...........
                             pronat inf.
    L3202  E                Oxford w/ supinat/   ...........  ...........  ...........  ...........  ...........
                             pronator c.
    L3203  E                Oxford w/ supinator/ ...........  ...........  ...........  ...........  ...........
                             pronator.
    L3204  E                Hightop w/ supp/     ...........  ...........  ...........  ...........  ...........
                             pronator inf.
    L3206  E                Hightop w/ supp/     ...........  ...........  ...........  ...........  ...........
                             pronator chi.
    L3207  E                Hightop w/ supp/     ...........  ...........  ...........  ...........  ...........
                             pronator jun.
    L3208  E                Surgical boot each   ...........  ...........  ...........  ...........  ...........
                             infant.
    L3209  E                Surgical boot each   ...........  ...........  ...........  ...........  ...........
                             child.
    L3211  E                Surgical boot each   ...........  ...........  ...........  ...........  ...........
                             junior.
    L3212  E                Benesch boot pair    ...........  ...........  ...........  ...........  ...........
                             infant.
    L3213  E                Benesch boot pair    ...........  ...........  ...........  ...........  ...........
                             child.
    L3214  E                Benesch boot pair    ...........  ...........  ...........  ...........  ...........
                             junior.
    L3215  E                Orthopedic ftwear    ...........  ...........  ...........  ...........  ...........
                             ladies oxf.
    L3216  E                Orthoped ladies      ...........  ...........  ...........  ...........  ...........
                             shoes dpth i.
    L3217  E                Ladies shoes         ...........  ...........  ...........  ...........  ...........
                             hightop depth i.
    L3218  E                Ladies surgical      ...........  ...........  ...........  ...........  ...........
                             boot each.
    L3219  E                Orthopedic mens      ...........  ...........  ...........  ...........  ...........
                             shoes oxford.
    L3221  E                Orthopedic mens      ...........  ...........  ...........  ...........  ...........
                             shoes dpth i.
    L3222  E                Mens shoes hightop   ...........  ...........  ...........  ...........  ...........
                             depth inl.
    L3223  E                Mens surgical boot   ...........  ...........  ...........  ...........  ...........
                             each.
    L3224  A                Woman's shoe oxford  ...........  ...........  ...........  ...........  ...........
                             brace.
    L3225  A                Man's shoe oxford    ...........  ...........  ...........  ...........  ...........
                             brace.
    L3230  E                Custom shoes depth   ...........  ...........  ...........  ...........  ...........
                             inlay.
    L3250  E                Custom mold shoe     ...........  ...........  ...........  ...........  ...........
                             remov prost.
    L3251  E                Shoe molded to pt    ...........  ...........  ...........  ...........  ...........
                             silicone s.
    L3252  E                Shoe molded          ...........  ...........  ...........  ...........  ...........
                             plastazote cust.
    L3253  E                Shoe molded          ...........  ...........  ...........  ...........  ...........
                             plastazote cust.
    L3254  E                Orth foot non-       ...........  ...........  ...........  ...........  ...........
                             stndard size/w.
    L3255  E                Orth foot non-       ...........  ...........  ...........  ...........  ...........
                             standard size/.
    L3257  E                Orth foot add        ...........  ...........  ...........  ...........  ...........
                             charge split s.
    L3260  E                Ambulatory surgical  ...........  ...........  ...........  ...........  ...........
                             boot eac.
    L3265  E                Plastazote sandal    ...........  ...........  ...........  ...........  ...........
                             each.
    L3300  E                Sho lift taper to    ...........  ...........  ...........  ...........  ...........
                             metatarsal.
    L3310  E                Shoe lift elev heel/ ...........  ...........  ...........  ...........  ...........
                             sole neo.
    L3320  E                Shoe lift elev heel/ ...........  ...........  ...........  ...........  ...........
                             sole cor.
    L3330  E                Lifts elevation      ...........  ...........  ...........  ...........  ...........
                             metal extens.
    L3332  E                Shoe lifts tapered   ...........  ...........  ...........  ...........  ...........
                             to one-ha.
    L3334  E                Shoe lifts           ...........  ...........  ...........  ...........  ...........
                             elevation heel /i.
    L3340  E                Shoe wedge sach....  ...........  ...........  ...........  ...........  ...........
    L3350  E                Shoe heel wedge....  ...........  ...........  ...........  ...........  ...........
    L3360  E                Shoe sole wedge      ...........  ...........  ...........  ...........  ...........
                             outside sole.
    L3370  E                Shoe sole wedge      ...........  ...........  ...........  ...........  ...........
                             between sole.
    L3380  E                Shoe clubfoot wedge  ...........  ...........  ...........  ...........  ...........
    L3390  E                Shoe outflare wedge  ...........  ...........  ...........  ...........  ...........
    L3400  E                Shoe metatarsal bar  ...........  ...........  ...........  ...........  ...........
                             wedge ro.
    L3410  E                Shoe metatarsal bar  ...........  ...........  ...........  ...........  ...........
                             between.
    L3420  E                Full sole/heel       ...........  ...........  ...........  ...........  ...........
                             wedge btween.
    L3430  E                Sho heel count       ...........  ...........  ...........  ...........  ...........
                             plast reinfor.
    L3440  E                Heel leather         ...........  ...........  ...........  ...........  ...........
                             reinforced.
    L3450  E                Shoe heel sach       ...........  ...........  ...........  ...........  ...........
                             cushion type.

[[Page 67989]]

 
    L3455  E                Shoe heel new        ...........  ...........  ...........  ...........  ...........
                             leather standa.
    L3460  E                Shoe heel new        ...........  ...........  ...........  ...........  ...........
                             rubber standar.
    L3465  E                Shoe heel thomas     ...........  ...........  ...........  ...........  ...........
                             with wedge.
    L3470  E                Shoe heel thomas     ...........  ...........  ...........  ...........  ...........
                             extend to b.
    L3480  E                Shoe heel pad &      ...........  ...........  ...........  ...........  ...........
                             depress for.
    L3485  E                Shoe heel pad        ...........  ...........  ...........  ...........  ...........
                             removable for.
    L3500  E                Ortho shoe add       ...........  ...........  ...........  ...........  ...........
                             leather insol.
    L3510  E                Orthopedic shoe add  ...........  ...........  ...........  ...........  ...........
                             rub insl.
    L3520  E                O shoe add felt w    ...........  ...........  ...........  ...........  ...........
                             leath insl.
    L3530  E                Ortho shoe add half  ...........  ...........  ...........  ...........  ...........
                             sole.
    L3540  E                Ortho shoe add full  ...........  ...........  ...........  ...........  ...........
                             sole.
    L3550  E                O shoe add standard  ...........  ...........  ...........  ...........  ...........
                             toe tap.
    L3560  E                O shoe add           ...........  ...........  ...........  ...........  ...........
                             horseshoe toe tap.
    L3570  E                O shoe add instep    ...........  ...........  ...........  ...........  ...........
                             extension.
    L3580  E                O shoe add instep    ...........  ...........  ...........  ...........  ...........
                             velcro clo.
    L3590  E                O shoe convert to    ...........  ...........  ...........  ...........  ...........
                             sof counte.
    L3595  E                Ortho shoe add       ...........  ...........  ...........  ...........  ...........
                             march bar.
    L3600  E                Trans shoe calip     ...........  ...........  ...........  ...........  ...........
                             plate exist.
    L3610  E                Trans shoe caliper   ...........  ...........  ...........  ...........  ...........
                             plate new.
    L3620  E                Trans shoe solid     ...........  ...........  ...........  ...........  ...........
                             stirrup exi.
    L3630  E                Trans shoe solid     ...........  ...........  ...........  ...........  ...........
                             stirrup new.
    L3640  E                Shoe dennis browne   ...........  ...........  ...........  ...........  ...........
                             splint bo.
    L3649  E                Orthopedic shoe      ...........  ...........  ...........  ...........  ...........
                             modifica NOS.
    L3650  A                Shlder fig 8 abduct  ...........  ...........  ...........  ...........  ...........
                             restrain.
    L3660  A                Abduct restrainer    ...........  ...........  ...........  ...........  ...........
                             canvas&web.
    L3670  A                Acromio/clavicular   ...........  ...........  ...........  ...........  ...........
                             canvas&we.
    L3675  A                Canvas vest SO.....  ...........  ...........  ...........  ...........  ...........
    L3700  A                Elbow orthoses elas  ...........  ...........  ...........  ...........  ...........
                             w stays.
    L3710  A                Elbow elastic with   ...........  ...........  ...........  ...........  ...........
                             metal joi.
    L3720  A                Forearm/arm cuffs    ...........  ...........  ...........  ...........  ...........
                             free motio.
    L3730  A                Forearm/arm cuffs    ...........  ...........  ...........  ...........  ...........
                             ext/flex a.
    L3740  A                Cuffs adj lock w/    ...........  ...........  ...........  ...........  ...........
                             active con.
    L3760  A                EO withjoint,        ...........  ...........  ...........  ...........  ...........
                             Prefabricated.
    L3800  A                Whfo short opponen   ...........  ...........  ...........  ...........  ...........
                             no attach.
    L3805  A                Whfo long opponens   ...........  ...........  ...........  ...........  ...........
                             no attach.
    L3807  A                Whfo w inflatable    ...........  ...........  ...........  ...........  ...........
                             airchamber.
    L3810  A                Whfo thumb           ...........  ...........  ...........  ...........  ...........
                             abduction bar.
    L3815  A                Whfo second m.p.     ...........  ...........  ...........  ...........  ...........
                             abduction a.
    L3820  A                Whfo ip ext asst w/  ...........  ...........  ...........  ...........  ...........
                             mp ext s.
    L3825  A                Whfo m.p. extension  ...........  ...........  ...........  ...........  ...........
                             stop.
    L3830  A                Whfo m.p. extension  ...........  ...........  ...........  ...........  ...........
                             assist.
    L3835  A                Whfo m.p. spring     ...........  ...........  ...........  ...........  ...........
                             extension a.
    L3840  A                Whfo spring swivel   ...........  ...........  ...........  ...........  ...........
                             thumb.
    L3845  A                Whfo thumb ip ext    ...........  ...........  ...........  ...........  ...........
                             ass w/ mp.
    L3850  A                Action wrist w/      ...........  ...........  ...........  ...........  ...........
                             dorsiflex as.
    L3855  A                Whfo adj m.p.        ...........  ...........  ...........  ...........  ...........
                             flexion contro.
    L3860  A                Whfo adj m.p. flex   ...........  ...........  ...........  ...........  ...........
                             ctrl & i..
    L3890  E                Torsion mechanism    ...........  ...........  ...........  ...........  ...........
                             wrist/elbo.
    L3900  A                Hinge extension/     ...........  ...........  ...........  ...........  ...........
                             flex wrist/f.
    L3901  A                Hinge ext/flex       ...........  ...........  ...........  ...........  ...........
                             wrist finger.
    L3902  A                Whfo ext power       ...........  ...........  ...........  ...........  ...........
                             compress gas.
    L3904  A                Whfo electric        ...........  ...........  ...........  ...........  ...........
                             custom fitted.
    L3906  A                Wrist gauntlet       ...........  ...........  ...........  ...........  ...........
                             molded to pt.
    L3907  A                Whfo wrst gauntlt    ...........  ...........  ...........  ...........  ...........
                             thmb spica.
    L3908  A                Wrist cock-up non-   ...........  ...........  ...........  ...........  ...........
                             molded.
    L3910  A                Whfo swanson design  ...........  ...........  ...........  ...........  ...........
    L3912  A                Flex glove w/        ...........  ...........  ...........  ...........  ...........
                             elastic finger.
    L3914  A                WHO wrist extension  ...........  ...........  ...........  ...........  ...........
                             cock-up.
    L3916  A                Whfo wrist extens w/ ...........  ...........  ...........  ...........  ...........
                              outrigg.
    L3918  A                HFO knuckle bender.  ...........  ...........  ...........  ...........  ...........
    L3920  A                Knuckle bender with  ...........  ...........  ...........  ...........  ...........
                             outrigge.
    L3922  A                Knuckle bend 2 seg   ...........  ...........  ...........  ...........  ...........
                             to flex j.
    L3923  A                HFO, no joint,       ...........  ...........  ...........  ...........  ...........
                             prefabricated.
    L3924  A                Oppenheimer........  ...........  ...........  ...........  ...........  ...........
    L3926  A                Thomas suspension..  ...........  ...........  ...........  ...........  ...........
    L3928  A                Finger extension w/  ...........  ...........  ...........  ...........  ...........
                             clock sp.
    L3930  A                Finger extension     ...........  ...........  ...........  ...........  ...........
                             with wrist.
    L3932  A                Safety pin spring    ...........  ...........  ...........  ...........  ...........
                             wire.
    L3934  A                Safety pin modified  ...........  ...........  ...........  ...........  ...........
    L3936  A                Palmer.............  ...........  ...........  ...........  ...........  ...........
    L3938  A                Dorsal wrist.......  ...........  ...........  ...........  ...........  ...........
    L3940  A                Dorsal wrist w/      ...........  ...........  ...........  ...........  ...........
                             outrigger at.
    L3942  A                Reverse knuckle      ...........  ...........  ...........  ...........  ...........
                             bender.
    L3944  A                Reverse knuckle      ...........  ...........  ...........  ...........  ...........
                             bend w/ outr.

[[Page 67990]]

 
    L3946  A                HFO composite        ...........  ...........  ...........  ...........  ...........
                             elastic.
    L3948  A                Finger knuckle       ...........  ...........  ...........  ...........  ...........
                             bender.
    L3950  A                Oppenheimer w/       ...........  ...........  ...........  ...........  ...........
                             knuckle bend.
    L3952  A                Oppenheimer w/ rev   ...........  ...........  ...........  ...........  ...........
                             knuckle 2.
    L3954  A                Spreading hand.....  ...........  ...........  ...........  ...........  ...........
    L3956  A                Add joint upper ext  ...........  ...........  ...........  ...........  ...........
                             orthosis.
    L3960  A                Sewho airplan desig  ...........  ...........  ...........  ...........  ...........
                             abdu pos.
    L3962  A                Sewho erbs palsey    ...........  ...........  ...........  ...........  ...........
                             design abd.
    L3963  A                Molded w/            ...........  ...........  ...........  ...........  ...........
                             articulating elbow.
    L3964  A                Seo mobile arm sup   ...........  ...........  ...........  ...........  ...........
                             att to wc.
    L3965  A                Arm supp att to wc   ...........  ...........  ...........  ...........  ...........
                             rancho ty.
    L3966  A                Mobile arm supports  ...........  ...........  ...........  ...........  ...........
                             reclinin.
    L3968  A                Friction dampening   ...........  ...........  ...........  ...........  ...........
                             arm supp.
    L3969  A                Monosuspension arm/  ...........  ...........  ...........  ...........  ...........
                             hand supp.
    L3970  A                Elevat proximal arm  ...........  ...........  ...........  ...........  ...........
                             support.
    L3972  A                Offset/lat rocker    ...........  ...........  ...........  ...........  ...........
                             arm w/ ela.
    L3974  A                Mobile arm support   ...........  ...........  ...........  ...........  ...........
                             supinator.
    L3980  A                Upp ext fx orthosis  ...........  ...........  ...........  ...........  ...........
                             humeral.
    L3982  A                Upper ext fx         ...........  ...........  ...........  ...........  ...........
                             orthosis rad/ul.
    L3984  A                Upper ext fx         ...........  ...........  ...........  ...........  ...........
                             orthosis wrist.
    L3985  A                Forearm hand fx      ...........  ...........  ...........  ...........  ...........
                             orth w/ wr h.
    L3986  A                Humeral rad/ulna     ...........  ...........  ...........  ...........  ...........
                             wrist fx or.
    L3995  A                Sock fracture or     ...........  ...........  ...........  ...........  ...........
                             equal each.
    L3999  A                Upper limb orthosis  ...........  ...........  ...........  ...........  ...........
                             NOS.
    L4000  A                Repl girdle          ...........  ...........  ...........  ...........  ...........
                             milwaukee orth.
    L4010  A                Replace trilateral   ...........  ...........  ...........  ...........  ...........
                             socket br.
    L4020  A                Replace quadlat      ...........  ...........  ...........  ...........  ...........
                             socket brim.
    L4030  A                Replace socket brim  ...........  ...........  ...........  ...........  ...........
                             cust fit.
    L4040  A                Replace molded       ...........  ...........  ...........  ...........  ...........
                             thigh lacer.
    L4045  A                Replace non-molded   ...........  ...........  ...........  ...........  ...........
                             thigh lac.
    L4050  A                Replace molded calf  ...........  ...........  ...........  ...........  ...........
                             lacer.
    L4055  A                Replace non-molded   ...........  ...........  ...........  ...........  ...........
                             calf lace.
    L4060  A                Replace high roll    ...........  ...........  ...........  ...........  ...........
                             cuff.
    L4070  A                Replace prox & dist  ...........  ...........  ...........  ...........  ...........
                             upright.
    L4080  A                Repl met band kafo-  ...........  ...........  ...........  ...........  ...........
                             afo prox.
    L4090  A                Repl met band kafo-  ...........  ...........  ...........  ...........  ...........
                             afo calf/.
    L4100  A                Repl leath cuff      ...........  ...........  ...........  ...........  ...........
                             kafo prox th.
    L4110  A                Repl leath cuff      ...........  ...........  ...........  ...........  ...........
                             kafo-afo cal.
    L4130  A                Replace pretibial    ...........  ...........  ...........  ...........  ...........
                             shell.
    L4205  A                Ortho dvc repair     ...........  ...........  ...........  ...........  ...........
                             per 15 min.
    L4210  A                Orth dev repair/     ...........  ...........  ...........  ...........  ...........
                             repl minor p.
    L4350  A                Pneumatic ankle      ...........  ...........  ...........  ...........  ...........
                             cntrl splint.
    L4360  A                Pneumatic walking    ...........  ...........  ...........  ...........  ...........
                             splint.
    L4370  A                Pneumatic full leg   ...........  ...........  ...........  ...........  ...........
                             splint.
    L4380  A                Pneumatic knee       ...........  ...........  ...........  ...........  ...........
                             splint.
    L4392  A                Replace AFO soft     ...........  ...........  ...........  ...........  ...........
                             interface.
    L4394  A                Replace foot drop    ...........  ...........  ...........  ...........  ...........
                             spint.
    L4396  A                Static AFO.........  ...........  ...........  ...........  ...........  ...........
    L4398  A                Foot drop splint     ...........  ...........  ...........  ...........  ...........
                             recumbent.
    L5000  A                Sho insert w arch    ...........  ...........  ...........  ...........  ...........
                             toe filler.
    L5010  A                Mold socket ank hgt  ...........  ...........  ...........  ...........  ...........
                             w/ toe f.
    L5020  A                Tibial tubercle hgt  ...........  ...........  ...........  ...........  ...........
                             w/ toe f.
    L5050  A                Ank symes mold sckt  ...........  ...........  ...........  ...........  ...........
                             sach ft.
    L5060  A                Symes met fr leath   ...........  ...........  ...........  ...........  ...........
                             socket ar.
    L5100  A                Molded socket shin   ...........  ...........  ...........  ...........  ...........
                             sach foot.
    L5105  A                Plast socket jts/    ...........  ...........  ...........  ...........  ...........
                             thgh lacer.
    L5150  A                Mold sckt ext knee   ...........  ...........  ...........  ...........  ...........
                             shin sach.
    L5160  A                Mold socket bent     ...........  ...........  ...........  ...........  ...........
                             knee shin s.
    L5200  A                Kne sing axis fric   ...........  ...........  ...........  ...........  ...........
                             shin sach.
    L5210  A                No knee/ankle        ...........  ...........  ...........  ...........  ...........
                             joints w/ ft b.
    L5220  A                No knee joint with   ...........  ...........  ...........  ...........  ...........
                             artic ali.
    L5230  A                Fem focal defic      ...........  ...........  ...........  ...........  ...........
                             constant fri.
    L5250  A                Hip canad sing axi   ...........  ...........  ...........  ...........  ...........
                             cons fric.
    L5270  A                Tilt table locking   ...........  ...........  ...........  ...........  ...........
                             hip sing.
    L5280  A                Hemipelvect canad    ...........  ...........  ...........  ...........  ...........
                             sing axis.
    L5300  A                Bk sach soft cover   ...........  ...........  ...........  ...........  ...........
                             & finish.
    L5310  A                Knee disart sach     ...........  ...........  ...........  ...........  ...........
                             soft cv/fin.
    L5320  A                Ak open end sach     ...........  ...........  ...........  ...........  ...........
                             soft cv/fin.
    L5330  A                Hip canadian sach    ...........  ...........  ...........  ...........  ...........
                             sft cv/fin.
    L5340  A                Hemipelvectomy       ...........  ...........  ...........  ...........  ...........
                             canad cv/fin.
    L5400  A                Postop dress & 1     ...........  ...........  ...........  ...........  ...........
                             cast chg bk.
    L5410  A                Postop dsg bk ea     ...........  ...........  ...........  ...........  ...........
                             add cast ch.
    L5420  A                Postop dsg & 1 cast  ...........  ...........  ...........  ...........  ...........
                             chg ak/d.
    L5430  A                Postop dsg ak ea     ...........  ...........  ...........  ...........  ...........
                             add cast ch.

[[Page 67991]]

 
    L5450  A                Postop app non-wgt   ...........  ...........  ...........  ...........  ...........
                             bear dsg.
    L5460  A                Postop app non-wgt   ...........  ...........  ...........  ...........  ...........
                             bear dsg.
    L5500  A                Init bk ptb plaster  ...........  ...........  ...........  ...........  ...........
                             direct.
    L5505  A                Init ak ischal       ...........  ...........  ...........  ...........  ...........
                             plstr direct.
    L5510  A                Prep BK ptb plaster  ...........  ...........  ...........  ...........  ...........
                             molded.
    L5520  A                Perp BK ptb          ...........  ...........  ...........  ...........  ...........
                             thermopls direct.
    L5530  A                Prep BK ptb          ...........  ...........  ...........  ...........  ...........
                             thermopls molded.
    L5535  A                Prep BK ptb open     ...........  ...........  ...........  ...........  ...........
                             end socket.
    L5540  A                Prep BK ptb          ...........  ...........  ...........  ...........  ...........
                             laminated socket.
    L5560  A                Prep AK ischial      ...........  ...........  ...........  ...........  ...........
                             plast molded.
    L5570  A                Prep AK ischial      ...........  ...........  ...........  ...........  ...........
                             direct form.
    L5580  A                Prep AK ischial      ...........  ...........  ...........  ...........  ...........
                             thermo mold.
    L5585  A                Prep AK ischial      ...........  ...........  ...........  ...........  ...........
                             open end.
    L5590  A                Prep AK ischial      ...........  ...........  ...........  ...........  ...........
                             laminated.
    L5595  A                Hip disartic sach    ...........  ...........  ...........  ...........  ...........
                             thermopls.
    L5600  A                Hip disart sach      ...........  ...........  ...........  ...........  ...........
                             laminat mold.
    L5610  A                Above knee           ...........  ...........  ...........  ...........  ...........
                             hydracadence.
    L5611  A                Ak 4 bar link w/     ...........  ...........  ...........  ...........  ...........
                             fric swing.
    L5613  A                Ak 4 bar ling w/     ...........  ...........  ...........  ...........  ...........
                             hydraul swig.
    L5614  A                4-bar link above     ...........  ...........  ...........  ...........  ...........
                             knee w/swng.
    L5616  A                Ak univ multiplex    ...........  ...........  ...........  ...........  ...........
                             sys frict.
    L5617  A                AK/BK self-aligning  ...........  ...........  ...........  ...........  ...........
                             unit ea.
    L5618  A                Test socket symes..  ...........  ...........  ...........  ...........  ...........
    L5620  A                Test socket below    ...........  ...........  ...........  ...........  ...........
                             knee.
    L5622  A                Test socket knee     ...........  ...........  ...........  ...........  ...........
                             disarticula.
    L5624  A                Test socket above    ...........  ...........  ...........  ...........  ...........
                             knee.
    L5626  A                Test socket hip      ...........  ...........  ...........  ...........  ...........
                             disarticulat.
    L5628  A                Test socket          ...........  ...........  ...........  ...........  ...........
                             hemipelvectomy.
    L5629  A                Below knee acrylic   ...........  ...........  ...........  ...........  ...........
                             socket.
    L5630  A                Syme typ expandabl   ...........  ...........  ...........  ...........  ...........
                             wall sckt.
    L5631  A                Ak/knee disartic     ...........  ...........  ...........  ...........  ...........
                             acrylic soc.
    L5632  A                Symes type ptb brim  ...........  ...........  ...........  ...........  ...........
                             design s.
    L5634  A                Symes type poster    ...........  ...........  ...........  ...........  ...........
                             opening so.
    L5636  A                Symes type medial    ...........  ...........  ...........  ...........  ...........
                             opening so.
    L5637  A                Below knee total     ...........  ...........  ...........  ...........  ...........
                             contact.
    L5638  A                Below knee leather   ...........  ...........  ...........  ...........  ...........
                             socket.
    L5639  A                Below knee wood      ...........  ...........  ...........  ...........  ...........
                             socket.
    L5640  A                Knee disarticulat    ...........  ...........  ...........  ...........  ...........
                             leather so.
    L5642  A                Above knee leather   ...........  ...........  ...........  ...........  ...........
                             socket.
    L5643  A                Hip flex inner       ...........  ...........  ...........  ...........  ...........
                             socket ext fr.
    L5644  A                Above knee wood      ...........  ...........  ...........  ...........  ...........
                             socket.
    L5645  A                Ak flexibl inner     ...........  ...........  ...........  ...........  ...........
                             socket ext.
    L5646  A                Below knee air       ...........  ...........  ...........  ...........  ...........
                             cushion socke.
    L5647  A                Below knee suction   ...........  ...........  ...........  ...........  ...........
                             socket.
    L5648  A                Above knee air       ...........  ...........  ...........  ...........  ...........
                             cushion socke.
    L5649  A                Isch containmt/      ...........  ...........  ...........  ...........  ...........
                             narrow m-l so.
    L5650  A                Tot contact ak/knee  ...........  ...........  ...........  ...........  ...........
                             disart s.
    L5651  A                Ak flex inner        ...........  ...........  ...........  ...........  ...........
                             socket ext fra.
    L5652  A                Suction susp ak/     ...........  ...........  ...........  ...........  ...........
                             knee disart.
    L5653  A                Knee disart expand   ...........  ...........  ...........  ...........  ...........
                             wall sock.
    L5654  A                Socket insert symes  ...........  ...........  ...........  ...........  ...........
    L5655  A                Socket insert below  ...........  ...........  ...........  ...........  ...........
                             knee.
    L5656  A                Socket insert knee   ...........  ...........  ...........  ...........  ...........
                             articulat.
    L5658  A                Socket insert above  ...........  ...........  ...........  ...........  ...........
                             knee.
    L5660  A                Sock insrt syme      ...........  ...........  ...........  ...........  ...........
                             silicone gel.
    L5661  A                Multi-durometer      ...........  ...........  ...........  ...........  ...........
                             symes.
    L5662  A                Socket insert bk     ...........  ...........  ...........  ...........  ...........
                             silicone ge.
    L5663  A                Sock knee disartic   ...........  ...........  ...........  ...........  ...........
                             silicone.
    L5664  A                Socket insert ak     ...........  ...........  ...........  ...........  ...........
                             silicone ge.
    L5665  A                Multi-durometer      ...........  ...........  ...........  ...........  ...........
                             below knee.
    L5666  A                Below knee cuff      ...........  ...........  ...........  ...........  ...........
                             suspension.
    L5667  A                Socket insert w      ...........  ...........  ...........  ...........  ...........
                             lock lower.
    L5668  A                Socket insert w/o    ...........  ...........  ...........  ...........  ...........
                             lock lower.
    L5669  A                Below knee socket w/ ...........  ...........  ...........  ...........  ...........
                             o lock.
    L5670  A                Bk molded            ...........  ...........  ...........  ...........  ...........
                             supracondylar susp.
    L5672  A                Bk removable medial  ...........  ...........  ...........  ...........  ...........
                             brim sus.
    L5674  A                Bk latex sleeve      ...........  ...........  ...........  ...........  ...........
                             suspension/e.
    L5675  A                Bk latex sleeve      ...........  ...........  ...........  ...........  ...........
                             susp/eq hvy.
    L5676  A                Bk knee joints       ...........  ...........  ...........  ...........  ...........
                             single axis p.
    L5677  A                Bk knee joints       ...........  ...........  ...........  ...........  ...........
                             polycentric p.
    L5678  A                Bk joint covers      ...........  ...........  ...........  ...........  ...........
                             pair.
    L5680  A                Bk thigh lacer non-  ...........  ...........  ...........  ...........  ...........
                             molded.
    L5682  A                Bk thigh lacer glut/ ...........  ...........  ...........  ...........  ...........
                             ischia m.
    L5684  A                Bk fork strap......  ...........  ...........  ...........  ...........  ...........

[[Page 67992]]

 
    L5686  A                Bk back check......  ...........  ...........  ...........  ...........  ...........
    L5688  A                Bk waist belt        ...........  ...........  ...........  ...........  ...........
                             webbing.
    L5690  A                Bk waist belt        ...........  ...........  ...........  ...........  ...........
                             padded and lin.
    L5692  A                Ak pelvic control    ...........  ...........  ...........  ...........  ...........
                             belt light.
    L5694  A                Ak pelvic control    ...........  ...........  ...........  ...........  ...........
                             belt pad/l.
    L5695  A                Ak sleeve susp       ...........  ...........  ...........  ...........  ...........
                             neoprene/equa.
    L5696  A                Ak/knee disartic     ...........  ...........  ...........  ...........  ...........
                             pelvic join.
    L5697  A                Ak/knee disartic     ...........  ...........  ...........  ...........  ...........
                             pelvic band.
    L5698  A                Ak/knee disartic     ...........  ...........  ...........  ...........  ...........
                             silesian ba.
    L5699  A                Shoulder harness...  ...........  ...........  ...........  ...........  ...........
    L5700  A                Replace socket       ...........  ...........  ...........  ...........  ...........
                             below knee.
    L5701  A                Replace socket       ...........  ...........  ...........  ...........  ...........
                             above knee.
    L5702  A                Replace socket hip.  ...........  ...........  ...........  ...........  ...........
    L5704  A                Custom shape covr    ...........  ...........  ...........  ...........  ...........
                             below knee.
    L5705  A                Custm shape cover    ...........  ...........  ...........  ...........  ...........
                             above knee.
    L5706  A                Custm shape cvr      ...........  ...........  ...........  ...........  ...........
                             knee disart.
    L5707  A                Custm shape cover    ...........  ...........  ...........  ...........  ...........
                             hip disart.
    L5710  A                Kne-shin exo sng     ...........  ...........  ...........  ...........  ...........
                             axi mnl loc.
    L5711  A                Knee-shin exo mnl    ...........  ...........  ...........  ...........  ...........
                             lock ultra.
    L5712  A                Knee-shin exo frict  ...........  ...........  ...........  ...........  ...........
                             swg & st.
    L5714  A                Knee-shin exo        ...........  ...........  ...........  ...........  ...........
                             variable frict.
    L5716  A                Knee-shin exo mech   ...........  ...........  ...........  ...........  ...........
                             stance ph.
    L5718  A                Knee-shin exo frct   ...........  ...........  ...........  ...........  ...........
                             swg & sta.
    L5722  A                Knee-shin pneum swg  ...........  ...........  ...........  ...........  ...........
                             frct exo.
    L5724  A                Knee-shin exo fluid  ...........  ...........  ...........  ...........  ...........
                             swing ph.
    L5726  A                Knee-shin ext jnts   ...........  ...........  ...........  ...........  ...........
                             fld swg e.
    L5728  A                Knee-shin fluid swg  ...........  ...........  ...........  ...........  ...........
                             & stance.
    L5780  A                Knee-shin pneum/     ...........  ...........  ...........  ...........  ...........
                             hydra pneum.
    L5785  A                Exoskeletal bk       ...........  ...........  ...........  ...........  ...........
                             ultralt mater.
    L5790  A                Exoskeletal ak       ...........  ...........  ...........  ...........  ...........
                             ultra-light m.
    L5795  A                Exoskel hip ultra-   ...........  ...........  ...........  ...........  ...........
                             light mate.
    L5810  A                Endoskel knee-shin   ...........  ...........  ...........  ...........  ...........
                             mnl lock.
    L5811  A                Endo knee-shin mnl   ...........  ...........  ...........  ...........  ...........
                             lck ultra.
    L5812  A                Endo knee-shin frct  ...........  ...........  ...........  ...........  ...........
                             swg & st.
    L5814  A                Endo knee-shin       ...........  ...........  ...........  ...........  ...........
                             hydral swg ph.
    L5816  A                Endo knee-shin       ...........  ...........  ...........  ...........  ...........
                             polyc mch sta.
    L5818  A                Endo knee-shin frct  ...........  ...........  ...........  ...........  ...........
                             swg & st.
    L5822  A                Endo knee-shin       ...........  ...........  ...........  ...........  ...........
                             pneum swg frc.
    L5824  A                Endo knee-shin       ...........  ...........  ...........  ...........  ...........
                             fluid swing p.
    L5826  A                Miniature knee       ...........  ...........  ...........  ...........  ...........
                             joint.
    L5828  A                Endo knee-shin       ...........  ...........  ...........  ...........  ...........
                             fluid swg/sta.
    L5830  A                Endo knee-shin       ...........  ...........  ...........  ...........  ...........
                             pneum/swg pha.
    L5840  A                Multi-axial knee/    ...........  ...........  ...........  ...........  ...........
                             shin system.
    L5845  A                Knee-shin sys        ...........  ...........  ...........  ...........  ...........
                             stance flexion.
    L5846  A                Knee-shin sys        ...........  ...........  ...........  ...........  ...........
                             microprocessor.
    L5850  A                Endo ak/hip knee     ...........  ...........  ...........  ...........  ...........
                             extens assi.
    L5855  A                Mech hip extension   ...........  ...........  ...........  ...........  ...........
                             assist.
    L5910  A                Endo below knee      ...........  ...........  ...........  ...........  ...........
                             alignable sy.
    L5920  A                Endo ak/hip          ...........  ...........  ...........  ...........  ...........
                             alignable system.
    L5925  A                Above knee manual    ...........  ...........  ...........  ...........  ...........
                             lock.
    L5930  A                High activity knee   ...........  ...........  ...........  ...........  ...........
                             frame.
    L5940  A                Endo bk ultra-light  ...........  ...........  ...........  ...........  ...........
                             material.
    L5950  A                Endo ak ultra-light  ...........  ...........  ...........  ...........  ...........
                             material.
    L5960  A                Endo hip ultra-      ...........  ...........  ...........  ...........  ...........
                             light materia.
    L5962  A                Below knee flex      ...........  ...........  ...........  ...........  ...........
                             cover system.
    L5964  A                Above knee flex      ...........  ...........  ...........  ...........  ...........
                             cover system.
    L5966  A                Hip flexible cover   ...........  ...........  ...........  ...........  ...........
                             system.
    L5968  A                Multiaxial ankle w   ...........  ...........  ...........  ...........  ...........
                             dorsiflex.
    L5970  A                Foot external keel   ...........  ...........  ...........  ...........  ...........
                             sach foot.
    L5972  A                Flexible keel foot.  ...........  ...........  ...........  ...........  ...........
    L5974  A                Foot single axis     ...........  ...........  ...........  ...........  ...........
                             ankle/foot.
    L5975  A                Combo ankle/foot     ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    L5976  A                Energy storing foot  ...........  ...........  ...........  ...........  ...........
    L5978  A                Ft prosth            ...........  ...........  ...........  ...........  ...........
                             multiaxial ankl/ft.
    L5979  A                Multi-axial ankle/   ...........  ...........  ...........  ...........  ...........
                             ft prosth.
    L5980  A                Flex foot system...  ...........  ...........  ...........  ...........  ...........
    L5981  A                Flex-walk sys low    ...........  ...........  ...........  ...........  ...........
                             ext prosth.
    L5982  A                Exoskeletal axial    ...........  ...........  ...........  ...........  ...........
                             rotation u.
    L5984  A                Endoskeletal axial   ...........  ...........  ...........  ...........  ...........
                             rotation.
    L5985  A                Lwr ext dynamic      ...........  ...........  ...........  ...........  ...........
                             prosth pylon.
    L5986  A                Multi-axial          ...........  ...........  ...........  ...........  ...........
                             rotation unit.
    L5987  A                Shank ft w vert      ...........  ...........  ...........  ...........  ...........
                             load pylon.
    L5988  A                Vertical shock       ...........  ...........  ...........  ...........  ...........
                             reducing pylo.
    L5999  A                Lowr extremity       ...........  ...........  ...........  ...........  ...........
                             prosthes NOS.

[[Page 67993]]

 
    L6000  A                Par hand robin-aids  ...........  ...........  ...........  ...........  ...........
                             thum rem.
    L6010  A                Hand robin-aids      ...........  ...........  ...........  ...........  ...........
                             little/ring.
    L6020  A                Part hand robin-     ...........  ...........  ...........  ...........  ...........
                             aids no fing.
    L6050  A                Wrst MLd sck flx     ...........  ...........  ...........  ...........  ...........
                             hng tri pad.
    L6055  A                Wrst mold sock w/    ...........  ...........  ...........  ...........  ...........
                             exp interfa.
    L6100  A                Elb mold sock flex   ...........  ...........  ...........  ...........  ...........
                             hinge pad.
    L6110  A                Elbow mold sock      ...........  ...........  ...........  ...........  ...........
                             suspension t.
    L6120  A                Elbow mold doub      ...........  ...........  ...........  ...........  ...........
                             splt soc ste.
    L6130  A                Elbow stump          ...........  ...........  ...........  ...........  ...........
                             activated lock h.
    L6200  A                Elbow mold outsid    ...........  ...........  ...........  ...........  ...........
                             lock hinge.
    L6205  A                Elbow molded w/      ...........  ...........  ...........  ...........  ...........
                             expand inter.
    L6250  A                Elbow inter loc      ...........  ...........  ...........  ...........  ...........
                             elbow forarm.
    L6300  A                Shlder disart int    ...........  ...........  ...........  ...........  ...........
                             lock elbow.
    L6310  A                Shoulder passive     ...........  ...........  ...........  ...........  ...........
                             restor comp.
    L6320  A                Shoulder passive     ...........  ...........  ...........  ...........  ...........
                             restor cap.
    L6350  A                Thoracic intern      ...........  ...........  ...........  ...........  ...........
                             lock elbow.
    L6360  A                Thoracic passive     ...........  ...........  ...........  ...........  ...........
                             restor comp.
    L6370  A                Thoracic passive     ...........  ...........  ...........  ...........  ...........
                             restor cap.
    L6380  A                Postop dsg cast chg  ...........  ...........  ...........  ...........  ...........
                             wrst/elb.
    L6382  A                Postop dsg cast chg  ...........  ...........  ...........  ...........  ...........
                             elb dis/.
    L6384  A                Postop dsg cast chg  ...........  ...........  ...........  ...........  ...........
                             shlder/t.
    L6386  A                Postop ea cast chg   ...........  ...........  ...........  ...........  ...........
                             & realign.
    L6388  A                Postop applicat      ...........  ...........  ...........  ...........  ...........
                             rigid dsg on.
    L6400  A                Below elbow prosth   ...........  ...........  ...........  ...........  ...........
                             tiss shap.
    L6450  A                Elb disart prosth    ...........  ...........  ...........  ...........  ...........
                             tiss shap.
    L6500  A                Above elbow prosth   ...........  ...........  ...........  ...........  ...........
                             tiss shap.
    L6550  A                Shldr disar prosth   ...........  ...........  ...........  ...........  ...........
                             tiss shap.
    L6570  A                Scap thorac prosth   ...........  ...........  ...........  ...........  ...........
                             tiss shap.
    L6580  A                Wrist/elbow bowden   ...........  ...........  ...........  ...........  ...........
                             cable mol.
    L6582  A                Wrist/elbow bowden   ...........  ...........  ...........  ...........  ...........
                             cbl dir f.
    L6584  A                Elbow fair lead      ...........  ...........  ...........  ...........  ...........
                             cable molded.
    L6586  A                Elbow fair lead      ...........  ...........  ...........  ...........  ...........
                             cable dir fo.
    L6588  A                Shdr fair lead       ...........  ...........  ...........  ...........  ...........
                             cable molded.
    L6590  A                Shdr fair lead       ...........  ...........  ...........  ...........  ...........
                             cable direct.
    L6600  A                Polycentric hinge    ...........  ...........  ...........  ...........  ...........
                             pair.
    L6605  A                Single pivot hinge   ...........  ...........  ...........  ...........  ...........
                             pair.
    L6610  A                Flexible metal       ...........  ...........  ...........  ...........  ...........
                             hinge pair.
    L6615  A                Disconnect locking   ...........  ...........  ...........  ...........  ...........
                             wrist uni.
    L6616  A                Disconnect insert    ...........  ...........  ...........  ...........  ...........
                             locking wr.
    L6620  A                Flexion-friction     ...........  ...........  ...........  ...........  ...........
                             wrist unit.
    L6623  A                Spring-ass rot wrst  ...........  ...........  ...........  ...........  ...........
                             w/ latch.
    L6625  A                Rotation wrst w/     ...........  ...........  ...........  ...........  ...........
                             cable lock.
    L6628  A                Quick disconn hook   ...........  ...........  ...........  ...........  ...........
                             adapter o.
    L6629  A                Lamination collar w/ ...........  ...........  ...........  ...........  ...........
                              couplin.
    L6630  A                Stainless steel any  ...........  ...........  ...........  ...........  ...........
                             wrist.
    L6632  A                Latex suspension     ...........  ...........  ...........  ...........  ...........
                             sleeve each.
    L6635  A                Lift assist for      ...........  ...........  ...........  ...........  ...........
                             elbow.
    L6637  A                Nudge control elbow  ...........  ...........  ...........  ...........  ...........
                             lock.
    L6640  A                Shoulder abduction   ...........  ...........  ...........  ...........  ...........
                             joint pai.
    L6641  A                Excursion amplifier  ...........  ...........  ...........  ...........  ...........
                             pulley t.
    L6642  A                Excursion amplifier  ...........  ...........  ...........  ...........  ...........
                             lever ty.
    L6645  A                Shoulder flexion-    ...........  ...........  ...........  ...........  ...........
                             abduction j.
    L6650  A                Shoulder universal   ...........  ...........  ...........  ...........  ...........
                             joint.
    L6655  A                Standard control     ...........  ...........  ...........  ...........  ...........
                             cable extra.
    L6660  A                Heavy duty control   ...........  ...........  ...........  ...........  ...........
                             cable.
    L6665  A                Teflon or equal      ...........  ...........  ...........  ...........  ...........
                             cable lining.
    L6670  A                Hook to hand cable   ...........  ...........  ...........  ...........  ...........
                             adapter.
    L6672  A                Harness chest/       ...........  ...........  ...........  ...........  ...........
                             shlder saddle.
    L6675  A                Harness figure of 8  ...........  ...........  ...........  ...........  ...........
                             sing con.
    L6676  A                Harness figure of 8  ...........  ...........  ...........  ...........  ...........
                             dual con.
    L6680  A                Test sock wrist      ...........  ...........  ...........  ...........  ...........
                             disart/bel e.
    L6682  A                Test sock elbw       ...........  ...........  ...........  ...........  ...........
                             disart/above.
    L6684  A                Test socket shldr    ...........  ...........  ...........  ...........  ...........
                             disart/tho.
    L6686  A                Suction socket.....  ...........  ...........  ...........  ...........  ...........
    L6687  A                Frame typ socket     ...........  ...........  ...........  ...........  ...........
                             bel elbow/w.
    L6688  A                Frame typ sock       ...........  ...........  ...........  ...........  ...........
                             above elb/dis.
    L6689  A                Frame typ socket     ...........  ...........  ...........  ...........  ...........
                             shoulder di.
    L6690  A                Frame typ sock       ...........  ...........  ...........  ...........  ...........
                             interscap-tho.
    L6691  A                Removable insert     ...........  ...........  ...........  ...........  ...........
                             each.
    L6692  A                Silicone gel insert  ...........  ...........  ...........  ...........  ...........
                             or equal.
    L6693  A                Lockingelbow         ...........  ...........  ...........  ...........  ...........
                             forearm cntrbal.
    L6700  A                Terminal device      ...........  ...........  ...........  ...........  ...........
                             model #3.
    L6705  A                Terminal device      ...........  ...........  ...........  ...........  ...........
                             model #5.
    L6710  A                Terminal device      ...........  ...........  ...........  ...........  ...........
                             model #5x.

[[Page 67994]]

 
    L6715  A                Terminal device      ...........  ...........  ...........  ...........  ...........
                             model #5xa.
    L6720  A                Terminal device      ...........  ...........  ...........  ...........  ...........
                             model #6.
    L6725  A                Terminal device      ...........  ...........  ...........  ...........  ...........
                             model #7.
    L6730  A                Terminal device      ...........  ...........  ...........  ...........  ...........
                             model #7lo.
    L6735  A                Terminal device      ...........  ...........  ...........  ...........  ...........
                             model #8.
    L6740  A                Terminal device      ...........  ...........  ...........  ...........  ...........
                             model #8x.
    L6745  A                Terminal device      ...........  ...........  ...........  ...........  ...........
                             model #88x.
    L6750  A                Terminal device      ...........  ...........  ...........  ...........  ...........
                             model #10p.
    L6755  A                Terminal device      ...........  ...........  ...........  ...........  ...........
                             model #10x.
    L6765  A                Terminal device      ...........  ...........  ...........  ...........  ...........
                             model #12p.
    L6770  A                Terminal device      ...........  ...........  ...........  ...........  ...........
                             model #99x.
    L6775  A                Terminal device      ...........  ...........  ...........  ...........  ...........
                             model #555.
    L6780  A                Terminal device      ...........  ...........  ...........  ...........  ...........
                             model #ss555.
    L6790  A                Hooks-accu hook or   ...........  ...........  ...........  ...........  ...........
                             equal.
    L6795  A                Hooks-2 load or      ...........  ...........  ...........  ...........  ...........
                             equal.
    L6800  A                Hooks-aprl vc or     ...........  ...........  ...........  ...........  ...........
                             equal.
    L6805  A                Modifier wrist       ...........  ...........  ...........  ...........  ...........
                             flexion unit.
    L6806  A                Trs grip vc or       ...........  ...........  ...........  ...........  ...........
                             equal.
    L6807  A                Term device grip1/2  ...........  ...........  ...........  ...........  ...........
                             or equal.
    L6808  A                Term device infant   ...........  ...........  ...........  ...........  ...........
                             or child.
    L6809  A                Trs super sport      ...........  ...........  ...........  ...........  ...........
                             passive.
    L6810  A                Pincher tool otto    ...........  ...........  ...........  ...........  ...........
                             bock or eq.
    L6825  A                Hands dorrance vo..  ...........  ...........  ...........  ...........  ...........
    L6830  A                Hand aprl vc.......  ...........  ...........  ...........  ...........  ...........
    L6835  A                Hand sierra vo.....  ...........  ...........  ...........  ...........  ...........
    L6840  A                Hand becker          ...........  ...........  ...........  ...........  ...........
                             imperial.
    L6845  A                Hand becker lock     ...........  ...........  ...........  ...........  ...........
                             grip.
    L6850  A                Term dvc-hand        ...........  ...........  ...........  ...........  ...........
                             becker plylite.
    L6855  A                Hand robin-aids vo.  ...........  ...........  ...........  ...........  ...........
    L6860  A                Hand robin-aids vo   ...........  ...........  ...........  ...........  ...........
                             soft.
    L6865  A                Hand passive hand..  ...........  ...........  ...........  ...........  ...........
    L6867  A                Hand detroit infant  ...........  ...........  ...........  ...........  ...........
                             hand.
    L6868  A                Passive inf hand     ...........  ...........  ...........  ...........  ...........
                             steeper/hos.
    L6870  A                Hand child mitt....  ...........  ...........  ...........  ...........  ...........
    L6872  A                Hand nyu child hand  ...........  ...........  ...........  ...........  ...........
    L6873  A                Hand mech inf        ...........  ...........  ...........  ...........  ...........
                             steeper or equ.
    L6875  A                Hand bock vc.......  ...........  ...........  ...........  ...........  ...........
    L6880  A                Hand bock vo.......  ...........  ...........  ...........  ...........  ...........
    L6890  A                Production glove...  ...........  ...........  ...........  ...........  ...........
    L6895  A                Custom glove.......  ...........  ...........  ...........  ...........  ...........
    L6900  A                Hand restorat thumb/ ...........  ...........  ...........  ...........  ...........
                             1 finger.
    L6905  A                Hand restoration     ...........  ...........  ...........  ...........  ...........
                             multiple fi.
    L6910  A                Hand restoration no  ...........  ...........  ...........  ...........  ...........
                             fingers.
    L6915  A                Hand restoration     ...........  ...........  ...........  ...........  ...........
                             replacmnt g.
    L6920  A                Wrist disarticul     ...........  ...........  ...........  ...........  ...........
                             switch ctrl.
    L6925  A                Wrist disart         ...........  ...........  ...........  ...........  ...........
                             myoelectronic c.
    L6930  A                Below elbow switch   ...........  ...........  ...........  ...........  ...........
                             control.
    L6935  A                Below elbow          ...........  ...........  ...........  ...........  ...........
                             myoelectronic ct.
    L6940  A                Elbow                ...........  ...........  ...........  ...........  ...........
                             disarticulation
                             switch.
    L6945  A                Elbow disart         ...........  ...........  ...........  ...........  ...........
                             myoelectronic c.
    L6950  A                Above elbow switch   ...........  ...........  ...........  ...........  ...........
                             control.
    L6955  A                Above elbow          ...........  ...........  ...........  ...........  ...........
                             myoelectronic ct.
    L6960  A                Shldr disartic       ...........  ...........  ...........  ...........  ...........
                             switch contro.
    L6965  A                Shldr disartic       ...........  ...........  ...........  ...........  ...........
                             myoelectronic.
    L6970  A                Interscapular-thor   ...........  ...........  ...........  ...........  ...........
                             switch ct.
    L6975  A                Interscap-thor       ...........  ...........  ...........  ...........  ...........
                             myoelectronic.
    L7010  A                Hand otto back       ...........  ...........  ...........  ...........  ...........
                             steeper/eq sw.
    L7015  A                Hand sys teknik      ...........  ...........  ...........  ...........  ...........
                             village swit.
    L7020  A                Electronic greifer   ...........  ...........  ...........  ...........  ...........
                             switch ct.
    L7025  A                Electron hand        ...........  ...........  ...........  ...........  ...........
                             myoelectronic.
    L7030  A                Hand sys teknik      ...........  ...........  ...........  ...........  ...........
                             vill myoelec.
    L7035  A                Electron greifer     ...........  ...........  ...........  ...........  ...........
                             myoelectro.
    L7040  A                Prehensile actuator  ...........  ...........  ...........  ...........  ...........
                             hosmer s.
    L7045  A                Electron hook child  ...........  ...........  ...........  ...........  ...........
                             michigan.
    L7170  A                Electronic elbow     ...........  ...........  ...........  ...........  ...........
                             hosmer swit.
    L7180  A                Electronic elbow     ...........  ...........  ...........  ...........  ...........
                             utah myoele.
    L7185  A                Electron elbow       ...........  ...........  ...........  ...........  ...........
                             adolescent sw.
    L7186  A                Electron elbow       ...........  ...........  ...........  ...........  ...........
                             child switch.
    L7190  A                Elbow adolescent     ...........  ...........  ...........  ...........  ...........
                             myoelectron.
    L7191  A                Elbow child          ...........  ...........  ...........  ...........  ...........
                             myoelectronic ct.
    L7260  A                Electron wrist       ...........  ...........  ...........  ...........  ...........
                             rotator otto.
    L7261  A                Electron wrist       ...........  ...........  ...........  ...........  ...........
                             rotator utah.
    L7266  A                Servo control        ...........  ...........  ...........  ...........  ...........
                             steeper or equ.
    L7272  A                Analogue control     ...........  ...........  ...........  ...........  ...........
                             unb or equa.

[[Page 67995]]

 
    L7274  A                Proportional ctl 12  ...........  ...........  ...........  ...........  ...........
                             volt uta.
    L7360  A                Six volt bat otto    ...........  ...........  ...........  ...........  ...........
                             bock/eq ea.
    L7362  A                Battery chrgr six    ...........  ...........  ...........  ...........  ...........
                             volt otto.
    L7364  A                Twelve volt battery  ...........  ...........  ...........  ...........  ...........
                             utah/equ.
    L7366  A                Battery chrgr 12     ...........  ...........  ...........  ...........  ...........
                             volt utah/e.
    L7499  A                Upper extremity      ...........  ...........  ...........  ...........  ...........
                             prosthes NOS.
    L7500  A                Prosthetic dvc       ...........  ...........  ...........  ...........  ...........
                             repair hourly.
    L7510  A                Prosthetic device    ...........  ...........  ...........  ...........  ...........
                             repair rep.
    L7520  A                Repair prosthesis    ...........  ...........  ...........  ...........  ...........
                             per 15 min.
    L7900  A                Vacuum erection      ...........  ...........  ...........  ...........  ...........
                             system.
    L8000  A                Mastectomy bra.....  ...........  ...........  ...........  ...........  ...........
    L8010  A                Mastectomy sleeve..  ...........  ...........  ...........  ...........  ...........
    L8015  A                Ext                  ...........  ...........  ...........  ...........  ...........
                             breastprosthesis
                             garment.
    L8020  A                Mastectomy form....  ...........  ...........  ...........  ...........  ...........
    L8030  A                Breast prosthesis    ...........  ...........  ...........  ...........  ...........
                             silicone/e.
    L8035  A                Custom breast        ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    L8039  A                Breast prosthesis    ...........  ...........  ...........  ...........  ...........
                             NOS.
    L8040  A                Nasal prosthesis...  ...........  ...........  ...........  ...........  ...........
    L8041  A                Midfacial            ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    L8042  A                Orbital prosthesis.  ...........  ...........  ...........  ...........  ...........
    L8043  A                Upper facial         ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    L8044  A                Hemi-facial          ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    L8045  A                Auricular            ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    L8046  A                Partial facial       ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    L8047  A                Nasal septal         ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    L8048  A                Unspec               ...........  ...........  ...........  ...........  ...........
                             maxillofacial
                             prosth.
    L8049  A                Repair               ...........  ...........  ...........  ...........  ...........
                             maxillofacial
                             prosth.
    L8100  E                Compression          ...........  ...........  ...........  ...........  ...........
                             stocking BK18-30.
    L8110  E                Compression          ...........  ...........  ...........  ...........  ...........
                             stocking BK30-40.
    L8120  E                Compression          ...........  ...........  ...........  ...........  ...........
                             stocking BK40-50.
    L8130  E                Gc stocking          ...........  ...........  ...........  ...........  ...........
                             thighlngth 18-30.
    L8140  E                Gc stocking          ...........  ...........  ...........  ...........  ...........
                             thighlngth 30-40.
    L8150  E                Gc stocking          ...........  ...........  ...........  ...........  ...........
                             thighlngth 40-50.
    L8160  E                Gc stocking full     ...........  ...........  ...........  ...........  ...........
                             lngth 18-30.
    L8170  E                Gc stocking full     ...........  ...........  ...........  ...........  ...........
                             lngth 30-40.
    L8180  E                Gc stocking full     ...........  ...........  ...........  ...........  ...........
                             lngth 40-50.
    L8190  E                Gc stocking          ...........  ...........  ...........  ...........  ...........
                             waistlngth 18-30.
    L8195  E                Gc stocking          ...........  ...........  ...........  ...........  ...........
                             waistlngth 30-40.
    L8200  E                Gc stocking          ...........  ...........  ...........  ...........  ...........
                             waistlngth 40-50.
    L8210  E                Gc stocking custom   ...........  ...........  ...........  ...........  ...........
                             made.
    L8220  E                Gc stocking          ...........  ...........  ...........  ...........  ...........
                             lymphedema.
    L8230  E                Gc stocking garter   ...........  ...........  ...........  ...........  ...........
                             belt.
    L8239  E                G compression        ...........  ...........  ...........  ...........  ...........
                             stocking NOS.
    L8300  A                Truss single w/      ...........  ...........  ...........  ...........  ...........
                             standard pad.
    L8310  A                Truss double w/      ...........  ...........  ...........  ...........  ...........
                             standard pad.
    L8320  A                Truss addition to    ...........  ...........  ...........  ...........  ...........
                             std pad wa.
    L8330  A                Truss add to std     ...........  ...........  ...........  ...........  ...........
                             pad scrotal.
    L8400  A                Sheath below knee..  ...........  ...........  ...........  ...........  ...........
    L8410  A                Sheath above knee..  ...........  ...........  ...........  ...........  ...........
    L8415  A                Sheath upper limb..  ...........  ...........  ...........  ...........  ...........
    L8417  A                Pros sheath/sock w   ...........  ...........  ...........  ...........  ...........
                             gel cushn.
    L8420  A                Prosthetic sock      ...........  ...........  ...........  ...........  ...........
                             multi ply BK.
    L8430  A                Prosthetic sock      ...........  ...........  ...........  ...........  ...........
                             multi ply AK.
    L8435  A                Pros sock multi ply  ...........  ...........  ...........  ...........  ...........
                             upper lm.
    L8440  A                Shrinker below knee  ...........  ...........  ...........  ...........  ...........
    L8460  A                Shrinker above knee  ...........  ...........  ...........  ...........  ...........
    L8465  A                Shrinker upper limb  ...........  ...........  ...........  ...........  ...........
    L8470  A                Pros sock single     ...........  ...........  ...........  ...........  ...........
                             ply BK.
    L8480  A                Pros sock single     ...........  ...........  ...........  ...........  ...........
                             ply AK.
    L8485  A                Pros sock single     ...........  ...........  ...........  ...........  ...........
                             ply upper l.
    L8490  A                Air seal suction     ...........  ...........  ...........  ...........  ...........
                             reten systm.
    L8499  A                Unlisted misc        ...........  ...........  ...........  ...........  ...........
                             prosthetic ser.
    L8500  A                Artificial larynx..  ...........  ...........  ...........  ...........  ...........
    L8501  A                Tracheostomy         ...........  ...........  ...........  ...........  ...........
                             speaking valve.
    L8600  N                Implant breast       ...........  ...........  ...........  ...........  ...........
                             silicone/eq.
    L8603  N                Collagen imp         ...........  ...........  ...........  ...........  ...........
                             urinary 2.5 CC.
    L8606  N                Synthetic implnt     ...........  ...........  ...........  ...........  ...........
                             urinary 1ml.
    L8610  N                Ocular implant.....  ...........  ...........  ...........  ...........  ...........
    L8612  N                Aqueous shunt        ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    L8613  N                Ossicular implant..  ...........  ...........  ...........  ...........  ...........
   *L8614  H                Cochlear device/            1002  ...........  ...........  ...........  ...........
                             system.
    L8619  A                Replace cochlear     ...........  ...........  ...........  ...........  ...........
                             processor.
    L8630  N                Metacarpophalangeal  ...........  ...........  ...........  ...........  ...........
                             implant.
    L8641  N                Metatarsal joint     ...........  ...........  ...........  ...........  ...........
                             implant.

[[Page 67996]]

 
    L8642  N                Hallux implant.....  ...........  ...........  ...........  ...........  ...........
    L8658  N                Interphalangeal      ...........  ...........  ...........  ...........  ...........
                             joint implnt.
    L8670  N                Vascular graft,      ...........  ...........  ...........  ...........  ...........
                             synthetic.
    L8699  N                Prosthetic implant   ...........  ...........  ...........  ...........  ...........
                             NOS.
    L9900  A                O&P supply/          ...........  ...........  ...........  ...........  ...........
                             accessory/service.
    M0064  X                Visit for drug              0374         1.17       $58.03       $13.08       $11.61
                             monitoring.
    M0075  E                Cellular therapy...  ...........  ...........  ...........  ...........  ...........
    M0076  E                Prolotherapy.......  ...........  ...........  ...........  ...........  ...........
    M0100  E                Intragastric         ...........  ...........  ...........  ...........  ...........
                             hypothermia.
    M0300  E                IV chelationtherapy  ...........  ...........  ...........  ...........  ...........
    M0301  E                Fabric wrapping of   ...........  ...........  ...........  ...........  ...........
                             aneurysm.
    M0302  T                Assessment of               0970         0.52       $25.79  ...........        $5.16
                             cardiac output.
    P2028  A                Cephalin             ...........  ...........  ...........  ...........  ...........
                             floculation test.
    P2029  A                Congo red blood      ...........  ...........  ...........  ...........  ...........
                             test.
    P2031  E                Hair analysis......  ...........  ...........  ...........  ...........  ...........
    P2033  A                Blood thymol         ...........  ...........  ...........  ...........  ...........
                             turbidity.
    P2038  A                Blood mucoprotein..  ...........  ...........  ...........  ...........  ...........
    P3000  A                Screen pap by tech   ...........  ...........  ...........  ...........  ...........
                             w md supv.
    P3001  E                Screening pap smear  ...........  ...........  ...........  ...........  ...........
                             by phys.
    P7001  E                Culture bacterial    ...........  ...........  ...........  ...........  ...........
                             urine.
    P9010  K                Whole blood for             0950         2.08      $103.33  ...........       $20.67
                             transfusion.
    P9011  E                Blood split unit...  ...........  ...........  ...........  ...........  ...........
    P9012  K                Cryoprecipitate             0952         0.70       $34.70  ...........        $6.94
                             each unit.
   P9013D  K                Unit/s blood                0953         0.48       $23.80  ...........        $4.76
                             fibrinogen.
    P9016  K                Leukocyte poor              0954         2.83      $140.35  ...........       $28.07
                             blood, unit.
    P9017  K                One donor fresh             0955         2.26      $111.85  ...........       $22.37
                             frozn plasma.
   P9018D  K                Plasma protein              0956         1.26       $62.49  ...........       $12.50
                             fract, unit.
    P9019  K                Platelet                    0957         0.98       $48.55  ...........        $9.71
                             concentrate unit.
    P9020  K                Plaelet rich plasma         0958         1.16       $57.54  ...........       $11.51
                             unit.
    P9021  K                Red blood cells             0959         2.04      $101.31  ...........       $20.26
                             unit.
    P9022  K                Washed red blood            0960         3.81      $188.75  ...........       $37.75
                             cells unit.
    P9023  K                Frozen plasma,              0949         2.94      $145.76  ...........       $29.15
                             pooled, sd.
    P9031  K                Platelets                   0954         2.83      $140.35  ...........       $28.07
                             leukocytes reduced.
    P9032  K                Platelets,                  9500         1.77       $87.97  ...........       $17.59
                             irradiated.
    P9033  K                Platelets                   0954         2.83      $140.35  ...........       $28.07
                             leukoreduced irrad.
    P9034  K                Platelets, pheresis         9501         9.69      $480.75  ...........       $96.15
    P9035  K                Platelet pheres             9501         9.69      $480.75  ...........       $96.15
                             leukoreduced.
    P9036  K                Platelet pheresis           9502        10.52      $521.66  ...........      $104.33
                             irradiated.
    P9037  K                Plate pheres                9501         9.69      $480.75  ...........       $96.15
                             leukoredu irrad.
    P9038  K                RBC irradiated.....         9505         2.58      $127.86  ...........       $25.57
    P9039  K                RBC deglycerolized.         9504         4.35      $215.83  ...........       $43.17
    P9040  K                RBC leukoreduced            9504         4.35      $215.83  ...........       $43.17
                             irradiated.
    P9041  K                Albumin(human), 5%,         0961         2.77      $137.38  ...........       $27.48
                             500 ML.
    P9042  K                Albumin (human),            0962         1.38       $68.44  ...........       $13.69
                             25%, 50 ML.
    P9043  K                Plasma protein              0956         1.26       $62.49  ...........       $12.50
                             fraction.
    P9044  K                Cryoprecipitate             1009         0.86       $42.76  ...........        $8.55
                             reduced plasma.
    P9603  A                One-way allow        ...........  ...........  ...........  ...........  ...........
                             prorated miles.
    P9604  A                One-way allow        ...........  ...........  ...........  ...........  ...........
                             prorated trip.
    P9612  N                Catheterize for      ...........  ...........  ...........  ...........  ...........
                             urine spec.
    P9615  N                Urine specimen       ...........  ...........  ...........  ...........  ...........
                             collect mult.
   Q0034D  K                Admin of influenza          0354         0.13        $6.33  ...........  ...........
                             vaccine.
    Q0035  X                Cardiokymography...         0100         1.70       $84.32       $71.57       $16.86
    Q0081  T                Infusion ther other         0120         1.66       $82.33       $42.67       $16.47
                             than che.
   Q0082D  P                Activity therapy w/         0033         4.17      $206.82       $48.17       $41.36
                             partial h.
    Q0083  S                Chemo by other than         0116         2.34      $116.06       $23.21       $23.21
                             infusion.
    Q0084  S                Chemotherapy by             0117         1.84       $91.26       $71.80       $18.25
                             infusion.
    Q0085  S                Chemo by both               0118         2.90      $143.83       $72.03       $28.77
                             infusion and o.
    Q0086  A                Physical therapy     ...........  ...........  ...........  ...........  ...........
                             evaluation/.
    Q0091  T                Obtaining screen            0191         1.19       $59.02       $17.43       $11.80
                             pap smear.
    Q0092  N                Set up port xray     ...........  ...........  ...........  ...........  ...........
                             equipment.
    Q0111  A                Wet mounts/ w        ...........  ...........  ...........  ...........  ...........
                             preparations.
    Q0112  A                Potassium hydroxide  ...........  ...........  ...........  ...........  ...........
                             preps.
    Q0113  A                Pinworm              ...........  ...........  ...........  ...........  ...........
                             examinations.
    Q0114  A                Fern test..........  ...........  ...........  ...........  ...........  ...........
    Q0115  A                Post-coital mucous   ...........  ...........  ...........  ...........  ...........
                             exam.
    Q0136  G                Non esrd epoetin            0733  ...........       $11.40  ...........        $1.53
                             alpha inj.
    Q0144  E                Azithromycin         ...........  ...........  ...........  ...........  ...........
                             dihydrate, oral.
   Q0156D  K                Human albumin 5%...         0961         2.77      $137.38  ...........       $27.48
   Q0157D  K                Human albumin 25%..         0962         1.38       $68.44  ...........       $13.69
    Q0160  G                Factor IX non-              0931  ...........         $.72  ...........         $.10
                             recombinant.
    Q0161  G                Factor IX                   0932  ...........        $1.12  ...........         $.10
                             recombinant.
    Q0163  G                Diphenhydramine HCl         1400  ...........        $1.18  ...........         $.16
                             50mg.
    Q0164  G                Prochlorperazine            1401  ...........        $1.31  ...........         $.18
                             maleate 5mg.
    Q0165  E                Prochlorperazine     ...........  ...........  ...........  ...........  ...........
                             maleate10mg.

[[Page 67997]]

 
    Q0166  G                Granisetron HCl 1           0765  ...........       $44.70  ...........        $5.99
                             mg oral.
    Q0167  G                Dronabinol 2.5mg            0762  ...........        $3.20  ...........         $.48
                             oral.
    Q0168  E                Dronabinol 5mg oral  ...........  ...........  ...........  ...........  ...........
    Q0169  G                Promethazine HCl            1402  ...........         $.03  ...........  ...........
                             12.5mg oral.
    Q0170  E                Promethazine HCl 25  ...........  ...........  ...........  ...........  ...........
                             mg oral.
    Q0171  G                Chlorpromazine HCl          1403  ...........         $.55  ...........         $.07
                             10mg oral.
    Q0172  E                Chlorpromazine HCl   ...........  ...........  ...........  ...........  ...........
                             25mg oral.
    Q0173  G                Trimethobenzamide           1404  ...........         $.36  ...........         $.05
                             HCl 250mg.
    Q0174  G                Thiethylperazine            1405  ...........         $.69  ...........         $.09
                             maleate10mg.
    Q0175  G                Perphenazine 4mg            1406  ...........         $.71  ...........         $.10
                             oral.
    Q0176  E                Perphenazine 8mg     ...........  ...........  ...........  ...........  ...........
                             oral.
    Q0177  G                Hydroxyzine pamoate         1407  ...........         $.20  ...........         $.03
                             25mg.
    Q0178  E                Hydroxyzine pamoate  ...........  ...........  ...........  ...........  ...........
                             50mg.
    Q0179  G                Ondansetron HCl 8mg         0769  ...........       $25.15  ...........        $3.37
                             oral.
    Q0180  G                Dolasetron mesylate         0763  ...........       $65.21  ...........        $8.74
                             oral.
    Q0181  G                Unspecified oral            0761  ...........         $.60  ...........         $.08
                             anti-emetic.
    Q0183  N                Nonmetabolic active  ...........  ...........  ...........  ...........  ...........
                             tissue.
    Q0184  N                Metabolically        ...........  ...........  ...........  ...........  ...........
                             active tissue.
    Q0185  N                Metabolic active D/  ...........  ...........  ...........  ...........  ...........
                             E tissue.
   Q0186D  E                Paramedic            ...........  ...........  ...........  ...........  ...........
                             intercept, rural.
    Q0187  G                Factor viia                 1409  ...........    $1,596.00  ...........      $213.86
                             recombinant.
   Q0188D  N                Contrast medium....  ...........  ...........  ...........  ...........  ...........
    Q1001  E                Ntiol category 1...  ...........  ...........  ...........  ...........  ...........
    Q1002  E                Ntiol category 2...  ...........  ...........  ...........  ...........  ...........
    Q1003  E                Ntiol category 3...  ...........  ...........  ...........  ...........  ...........
    Q1004  E                Ntiol category 4...  ...........  ...........  ...........  ...........  ...........
    Q1005  E                Ntiol category 5...  ...........  ...........  ...........  ...........  ...........
    Q2001  N                Cabergoline, 0.5     ...........  ...........  ...........  ...........  ...........
                             mg, oral.
    Q2002  G                Elliot's B                  7022  ...........       $14.25  ...........        $1.91
                             solution, per ml.
    Q2003  G                Aprotinin, 10,000           7019  ...........      $196.35  ...........       $26.31
                             kiu.
    Q2004  G                Treatment for               7023  ...........       $23.54  ...........        $3.15
                             bladder calculi,
                             per 500 ml.
    Q2005  G                Corticorelin ovine          7024  ...........      $353.88  ...........       $45.77
                             triflutate, per
                             0.1 mg.
    Q2006  G                Digoxin immune FAB          7025  ...........      $530.44  ...........       $64.71
                             (Ovine), 40 mg
                             vial.
    Q2007  G                Ethanolamine                7026  ...........       $27.21  ...........        $3.65
                             oleate, 100 mg.
    Q2008  G                Fomepizole, 1.5 mg.         7027  ...........      $728.33  ...........       $97.60
    Q2009  G                Fosphenytoin, 50 mg         7028  ...........        $8.55  ...........        $1.15
    Q2010  G                Glatiramer acetate,         7029  ...........       $27.40  ...........        $3.67
                             20 mg.
    Q2011  G                Hemin, 1 mg........         7030  ...........         $.90  ...........         $.12
    Q2012  G                Pegademase bovine           7039  ...........      $139.33  ...........       $18.67
                             inj 25 I.U.
    Q2013  G                Pentastarch 10%             7040  ...........       $15.11  ...........        $2.04
                             inj, 100 ml.
    Q2014  G                Sermorelin acetate,         7032  ...........       $15.78  ...........        $2.11
                             0.5 mg.
    Q2015  G                Somatrem, 5 mg.....         7033  ...........      $199.50  ...........       $26.73
    Q2016  G                Somatropin, 1 mg            7034  ...........       $39.90  ...........        $5.35
                             (any derivation).
    Q2017  G                Teniposide, 50 mg..         7035  ...........      $195.28  ...........       $26.17
    Q2018  G                Urofollitropin, 75          7037  ...........       $69.73  ...........        $9.34
                             I.U..
   *Q2019  G                Basiliximab, 20 mg.         1615  ...........    $1,250.01  ...........      $167.50
   *Q2020  G                Histrelin Acetate,          1616  ...........       $14.91  ...........        $2.00
                             0.5 mg.
   *Q2021  G                Lepirdin, 50 mg....         1617  ...........      $124.49  ...........       $16.68
   *Q2022  G                Von Willebrand              1618  ...........         $.95  ...........         $.13
                             factor, per iu.
    Q3001  H                Brachytherapy Seeds         0918  ...........  ...........  ...........  ...........
   *Q3002  G                Ga 67, per mCi.....         1619  ...........       $25.97  ...........        $3.17
   *Q3003  G                TC 99M Bicisate,            1620  ...........      $417.53  ...........       $55.95
                             per vial.
   *Q3004  G                Xe 133, per mCi....         1621  ...........       $28.50  ...........        $3.66
   *Q3005  G                TC 99M Mertiatide,          1622  ...........      $185.82  ...........       $24.90
                             per vial.
   *Q3006  G                TC 99M Gluceptate..         1623  ...........       $22.61  ...........        $2.76
   *Q3007  G                P32 sodium, per mCi         1624  ...........       $74.10  ...........        $9.04
   *Q3008  G                IN 111                      1625  ...........      $283.42  ...........       $37.98
                             Pentetreotide, per
                             mCi.
   *Q3009  G                TC 99M Oxidronate,          1626  ...........       $38.38  ...........        $4.68
                             per vial.
   *Q3010  G                TC-99 labeled red           1627  ...........       $38.95  ...........        $4.75
                             blood cell, per
                             test.
   *Q3011  G                P32 phosphate               1628  ...........      $137.12  ...........       $16.73
                             chromic, per mCi.
    Q9920  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             20.
    Q9921  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             21.
    Q9922  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             22.
    Q9923  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             23.
    Q9924  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             24.
    Q9925  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             25.
    Q9926  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             26.
    Q9927  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             27.
    Q9928  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             28.
    Q9929  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             29.
    Q9930  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             30.
    Q9931  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             31.
    Q9932  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             32.
    Q9933  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             33.

[[Page 67998]]

 
    Q9934  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             34.
    Q9935  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             35.
    Q9936  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             36.
    Q9937  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             37.
    Q9938  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             38.
    Q9939  A                Epoetin with hct =   ...........  ...........  ...........  ...........  ...........
                             39.
    Q9940  A                Epoetin with hct >=  ...........  ...........  ...........  ...........  ...........
                             40.
    R0070  N                Transport portable   ...........  ...........  ...........  ...........  ...........
                             x-ray.
    R0075  N                Transport port x-    ...........  ...........  ...........  ...........  ...........
                             ray multipl.
    R0076  N                Transport portable   ...........  ...........  ...........  ...........  ...........
                             EKG.
    V2020  A                Vision svcs frames   ...........  ...........  ...........  ...........  ...........
                             purchases.
    V2025  E                Eyeglasses delux     ...........  ...........  ...........  ...........  ...........
                             frames.
    V2100  A                Lens spher single    ...........  ...........  ...........  ...........  ...........
                             plano 4.00.
    V2101  A                Single visn sphere   ...........  ...........  ...........  ...........  ...........
                             4.12-7.00.
    V2102  A                Singl visn sphere    ...........  ...........  ...........  ...........  ...........
                             7.12-20.00.
    V2103  A                Spherocylindr 4.00d/ ...........  ...........  ...........  ...........  ...........
                             12-2.00d.
    V2104  A                Spherocylindr 4.00d/ ...........  ...........  ...........  ...........  ...........
                             2.12-4d.
    V2105  A                Spherocylinder       ...........  ...........  ...........  ...........  ...........
                             4.00d/4.25-6d.
    V2106  A                Spherocylinder       ...........  ...........  ...........  ...........  ...........
                             4.00d/>6.00d.
    V2107  A                Spherocylinder       ...........  ...........  ...........  ...........  ...........
                             4.25d/12-2d.
    V2108  A                Spherocylinder       ...........  ...........  ...........  ...........  ...........
                             4.25d/2.12-4d.
    V2109  A                Spherocylinder       ...........  ...........  ...........  ...........  ...........
                             4.25d/4.25-6d.
    V2110  A                Spherocylinder       ...........  ...........  ...........  ...........  ...........
                             4.25d/over 6d.
    V2111  A                Spherocylindr 7.25d/ ...........  ...........  ...........  ...........  ...........
                             .25-2.25.
    V2112  A                Spherocylindr 7.25d/ ...........  ...........  ...........  ...........  ...........
                             2.25-4d.
    V2113  A                Spherocylindr 7.25d/ ...........  ...........  ...........  ...........  ...........
                             4.25-6d.
    V2114  A                Spherocylinder over  ...........  ...........  ...........  ...........  ...........
                             12.00d.
    V2115  A                Lens lenticular      ...........  ...........  ...........  ...........  ...........
                             bifocal.
    V2116  A                Nonaspheric lens     ...........  ...........  ...........  ...........  ...........
                             bifocal.
    V2117  A                Aspheric lens        ...........  ...........  ...........  ...........  ...........
                             bifocal.
    V2118  A                Lens aniseikonic     ...........  ...........  ...........  ...........  ...........
                             single.
    V2199  A                Lens single vision   ...........  ...........  ...........  ...........  ...........
                             not oth c.
    V2200  A                Lens spher bifoc     ...........  ...........  ...........  ...........  ...........
                             plano 4.00d.
    V2201  A                Lens sphere bifocal  ...........  ...........  ...........  ...........  ...........
                             4.12-7.0.
    V2202  A                Lens sphere bifocal  ...........  ...........  ...........  ...........  ...........
                             7.12-20..
    V2203  A                Lens sphcyl bifocal  ...........  ...........  ...........  ...........  ...........
                             4.00d/.1.
    V2204  A                Lens sphcy bifocal   ...........  ...........  ...........  ...........  ...........
                             4.00d/2.1.
    V2205  A                Lens sphcy bifocal   ...........  ...........  ...........  ...........  ...........
                             4.00d/4.2.
    V2206  A                Lens sphcy bifocal   ...........  ...........  ...........  ...........  ...........
                             4.00d/ove.
    V2207  A                Lens sphcy bifocal   ...........  ...........  ...........  ...........  ...........
                             4.25-7d/..
    V2208  A                Lens sphcy bifocal   ...........  ...........  ...........  ...........  ...........
                             4.25-7/2..
    V2209  A                Lens sphcy bifocal   ...........  ...........  ...........  ...........  ...........
                             4.25-7/4..
    V2210  A                Lens sphcy bifocal   ...........  ...........  ...........  ...........  ...........
                             4.25-7/ov.
    V2211  A                Lens sphcy bifo      ...........  ...........  ...........  ...........  ...........
                             7.25-12/.25-.
    V2212  A                Lens sphcyl bifo     ...........  ...........  ...........  ...........  ...........
                             7.25-12/2.2.
    V2213  A                Lens sphcyl bifo     ...........  ...........  ...........  ...........  ...........
                             7.25-12/4.2.
    V2214  A                Lens sphcyl bifocal  ...........  ...........  ...........  ...........  ...........
                             over 12..
    V2215  A                Lens lenticular      ...........  ...........  ...........  ...........  ...........
                             bifocal.
    V2216  A                Lens lenticular      ...........  ...........  ...........  ...........  ...........
                             nonaspheric.
    V2217  A                Lens lenticular      ...........  ...........  ...........  ...........  ...........
                             aspheric bif.
    V2218  A                Lens aniseikonic     ...........  ...........  ...........  ...........  ...........
                             bifocal.
    V2219  A                Lens bifocal seg     ...........  ...........  ...........  ...........  ...........
                             width over.
    V2220  A                Lens bifocal add     ...........  ...........  ...........  ...........  ...........
                             over 3.25d.
    V2299  A                Lens bifocal         ...........  ...........  ...........  ...........  ...........
                             speciality.
    V2300  A                Lens sphere          ...........  ...........  ...........  ...........  ...........
                             trifocal 4.00d.
    V2301  A                Lens sphere          ...........  ...........  ...........  ...........  ...........
                             trifocal 4.12-7..
    V2302  A                Lens sphere          ...........  ...........  ...........  ...........  ...........
                             trifocal 7.12-20.
    V2303  A                Lens sphcy trifocal  ...........  ...........  ...........  ...........  ...........
                             4.0/.12-.
    V2304  A                Lens sphcy trifocal  ...........  ...........  ...........  ...........  ...........
                             4.0/2.25.
    V2305  A                Lens sphcy trifocal  ...........  ...........  ...........  ...........  ...........
                             4.0/4.25.
    V2306  A                Lens sphcyl          ...........  ...........  ...........  ...........  ...........
                             trifocal 4.00/>6.
    V2307  A                Lens sphcy trifocal  ...........  ...........  ...........  ...........  ...........
                             4.25-7/..
    V2308  A                Lens sphc trifocal   ...........  ...........  ...........  ...........  ...........
                             4.25-7/2..
    V2309  A                Lens sphc trifocal   ...........  ...........  ...........  ...........  ...........
                             4.25-7/4..
    V2310  A                Lens sphc trifocal   ...........  ...........  ...........  ...........  ...........
                             4.25-7/>6.
    V2311  A                Lens sphc trifo      ...........  ...........  ...........  ...........  ...........
                             7.25-12/.25-.
    V2312  A                Lens sphc trifo      ...........  ...........  ...........  ...........  ...........
                             7.25-12/2.25.
    V2313  A                Lens sphc trifo      ...........  ...........  ...........  ...........  ...........
                             7.25-12/4.25.
    V2314  A                Lens sphcyl          ...........  ...........  ...........  ...........  ...........
                             trifocal over 12.
    V2315  A                Lens lenticular      ...........  ...........  ...........  ...........  ...........
                             trifocal.
    V2316  A                Lens lenticular      ...........  ...........  ...........  ...........  ...........
                             nonaspheric.
    V2317  A                Lens lenticular      ...........  ...........  ...........  ...........  ...........
                             aspheric tri.
    V2318  A                Lens aniseikonic     ...........  ...........  ...........  ...........  ...........
                             trifocal.
    V2319  A                Lens trifocal seg    ...........  ...........  ...........  ...........  ...........
                             width > 28.

[[Page 67999]]

 
    V2320  A                Lens trifocal add    ...........  ...........  ...........  ...........  ...........
                             over 3.25d.
    V2399  A                Lens trifocal        ...........  ...........  ...........  ...........  ...........
                             speciality.
    V2410  A                Lens variab          ...........  ...........  ...........  ...........  ...........
                             asphericity sing.
    V2430  A                Lens variable        ...........  ...........  ...........  ...........  ...........
                             asphericity bi.
    V2499  A                Variable             ...........  ...........  ...........  ...........  ...........
                             asphericity lens.
    V2500  A                Contact lens pmma    ...........  ...........  ...........  ...........  ...........
                             spherical.
    V2501  A                Cntct lens pmma-     ...........  ...........  ...........  ...........  ...........
                             toric/prism.
    V2502  A                Contact lens pmma    ...........  ...........  ...........  ...........  ...........
                             bifocal.
    V2503  A                Cntct lens pmma      ...........  ...........  ...........  ...........  ...........
                             color vision.
    V2510  A                Cntct gas permeable  ...........  ...........  ...........  ...........  ...........
                             sphericl.
    V2511  A                Cntct toric prism    ...........  ...........  ...........  ...........  ...........
                             ballast.
    V2512  A                Cntct lens gas       ...........  ...........  ...........  ...........  ...........
                             permbl bifocl.
    V2513  A                Contact lens         ...........  ...........  ...........  ...........  ...........
                             extended wear.
    V2520  A                Contact lens         ...........  ...........  ...........  ...........  ...........
                             hydrophilic.
    V2521  A                Cntct lens           ...........  ...........  ...........  ...........  ...........
                             hydrophilic toric.
    V2522  A                Cntct lens           ...........  ...........  ...........  ...........  ...........
                             hydrophil bifocl.
    V2523  A                Cntct lens           ...........  ...........  ...........  ...........  ...........
                             hydrophil extend.
    V2530  A                Contact lens gas     ...........  ...........  ...........  ...........  ...........
                             impermeable.
    V2531  A                Contact lens gas     ...........  ...........  ...........  ...........  ...........
                             permeable.
    V2599  A                Contact lens/es      ...........  ...........  ...........  ...........  ...........
                             other type.
    V2600  A                Hand held low        ...........  ...........  ...........  ...........  ...........
                             vision aids.
    V2610  A                Single lens          ...........  ...........  ...........  ...........  ...........
                             spectacle mount.
    V2615  A                Telescop/othr        ...........  ...........  ...........  ...........  ...........
                             compound lens.
    V2623  A                Plastic eye prosth   ...........  ...........  ...........  ...........  ...........
                             custom.
    V2624  A                Polishing artifical  ...........  ...........  ...........  ...........  ...........
                             eye.
    V2625  A                Enlargemnt of eye    ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    V2626  A                Reduction of eye     ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    V2627  A                Scleral cover shell  ...........  ...........  ...........  ...........  ...........
    V2628  A                Fabrication &        ...........  ...........  ...........  ...........  ...........
                             fitting.
    V2629  A                Prosthetic eye       ...........  ...........  ...........  ...........  ...........
                             other type.
    V2630  N                Anter chamber        ...........  ...........  ...........  ...........  ...........
                             intraocul lens.
    V2631  N                Iris support         ...........  ...........  ...........  ...........  ...........
                             intraoclr lens.
    V2632  N                Post chmbr           ...........  ...........  ...........  ...........  ...........
                             intraocular lens.
    V2700  A                Balance lens.......  ...........  ...........  ...........  ...........  ...........
    V2710  A                Glass/plastic slab   ...........  ...........  ...........  ...........  ...........
                             off prism.
    V2715  A                Prism lens/es......  ...........  ...........  ...........  ...........  ...........
    V2718  A                Fresnell prism       ...........  ...........  ...........  ...........  ...........
                             press-on lens.
    V2730  A                Special base curve.  ...........  ...........  ...........  ...........  ...........
    V2740  A                Rose tint plastic..  ...........  ...........  ...........  ...........  ...........
    V2741  A                Non-rose tint        ...........  ...........  ...........  ...........  ...........
                             plastic.
    V2742  A                Rose tint glass....  ...........  ...........  ...........  ...........  ...........
    V2743  A                Non-rose tint glass  ...........  ...........  ...........  ...........  ...........
    V2744  A                Tint photochromatic  ...........  ...........  ...........  ...........  ...........
                             lens/es.
    V2750  A                Anti-reflective      ...........  ...........  ...........  ...........  ...........
                             coating.
    V2755  A                UV lens/es.........  ...........  ...........  ...........  ...........  ...........
    V2760  A                Scratch resistant    ...........  ...........  ...........  ...........  ...........
                             coating.
    V2770  A                Occluder lens/es...  ...........  ...........  ...........  ...........  ...........
    V2780  A                Oversize lens/es...  ...........  ...........  ...........  ...........  ...........
    V2781  E                Progressive lens     ...........  ...........  ...........  ...........  ...........
                             per lens.
    V2785  F                Corneal tissue       ...........  ...........  ...........  ...........  ...........
                             processing.
    V2790  N                Amniotic membrane..  ...........  ...........  ...........  ...........  ...........
    V2799  A                Miscellaneous        ...........  ...........  ...........  ...........  ...........
                             vision service.
    V5008  E                Hearing screening..  ...........  ...........  ...........  ...........  ...........
    V5010  E                Assessment for       ...........  ...........  ...........  ...........  ...........
                             hearing aid.
    V5011  E                Hearing aid fitting/ ...........  ...........  ...........  ...........  ...........
                             checking.
    V5014  E                Hearing aid repair/  ...........  ...........  ...........  ...........  ...........
                             modifying.
    V5020  E                Conformity           ...........  ...........  ...........  ...........  ...........
                             evaluation.
    V5030  E                Body-worn hearing    ...........  ...........  ...........  ...........  ...........
                             aid air.
    V5040  E                Body-worn hearing    ...........  ...........  ...........  ...........  ...........
                             aid bone.
    V5050  E                Body-worn hearing    ...........  ...........  ...........  ...........  ...........
                             aid in ear.
    V5060  E                Behind ear hearing   ...........  ...........  ...........  ...........  ...........
                             aid.
    V5070  E                Glasses air          ...........  ...........  ...........  ...........  ...........
                             conduction.
    V5080  E                Glasses bone         ...........  ...........  ...........  ...........  ...........
                             conduction.
    V5090  E                Hearing aid          ...........  ...........  ...........  ...........  ...........
                             dispensing fee.
    V5100  E                Body-worn bilat      ...........  ...........  ...........  ...........  ...........
                             hearing aid.
    V5110  E                Hearing aid          ...........  ...........  ...........  ...........  ...........
                             dispensing fee.
    V5120  E                Body-worn binaur     ...........  ...........  ...........  ...........  ...........
                             hearing aid.
    V5130  E                In ear binaural      ...........  ...........  ...........  ...........  ...........
                             hearing aid.
    V5140  E                Behind ear binaur    ...........  ...........  ...........  ...........  ...........
                             hearing ai.
    V5150  E                Glasses binaural     ...........  ...........  ...........  ...........  ...........
                             hearing aid.
    V5160  E                Dispensing fee       ...........  ...........  ...........  ...........  ...........
                             binaural.
    V5170  E                Within ear cros      ...........  ...........  ...........  ...........  ...........
                             hearing aid.
    V5180  E                Behind ear cros      ...........  ...........  ...........  ...........  ...........
                             hearing aid.
    V5190  E                Glasses cros         ...........  ...........  ...........  ...........  ...........
                             hearing aid.

[[Page 68000]]

 
    V5200  E                Cros hearing aid     ...........  ...........  ...........  ...........  ...........
                             dispens fee.
    V5210  E                In ear bicros        ...........  ...........  ...........  ...........  ...........
                             hearing aid.
    V5220  E                Behind ear bicros    ...........  ...........  ...........  ...........  ...........
                             hearing ai.
    V5230  E                Glasses bicros       ...........  ...........  ...........  ...........  ...........
                             hearing aid.
    V5240  E                Dispensing fee       ...........  ...........  ...........  ...........  ...........
                             bicros.
    V5299  E                Hearing service....  ...........  ...........  ...........  ...........  ...........
    V5336  E                Repair               ...........  ...........  ...........  ...........  ...........
                             communication
                             device.
    V5362  A                Speech screening...  ...........  ...........  ...........  ...........  ...........
    V5363  A                Language screening.  ...........  ...........  ...........  ...........  ...........
    V5364  A                Dysphagia screening  ...........  ...........  ...........  ...........  ...........
    25310  T                Transplant forearm          0051        27.76    $1,376.79      $675.24      $275.36
                             tendon.
    25312  T                Transplant forearm          0051        27.76    $1,376.79      $675.24      $275.36
                             tendon.
    25315  T                Revise palsy hand           0051        27.76    $1,376.79      $675.24      $275.36
                             tendon(s).
    25316  T                Revise palsy hand           0051        27.76    $1,376.79      $675.24      $275.36
                             tendon(s).
    25320  T                Repair/revise wrist         0051        27.76    $1,376.79      $675.24      $275.36
                             joint.
    25332  T                Revise wrist joint.         0047        22.09    $1,095.58      $537.03      $219.12
    25335  T                Realignment of hand         0051        27.76    $1,376.79      $675.24      $275.36
    25337  T                Reconstruct ulna/           0051        27.76    $1,376.79      $675.24      $275.36
                             radioulnar.
    25350  T                Revision of radius.         0051        27.76    $1,376.79      $675.24      $275.36
    25355  T                Revision of radius.         0051        27.76    $1,376.79      $675.24      $275.36
    25360  T                Revision of ulna...         0050        21.13    $1,047.96      $513.86      $209.59
    25365  T                Revise radius &             0050        21.13    $1,047.96      $513.86      $209.59
                             ulna.
    25370  T                Revise radius or            0051        27.76    $1,376.79      $675.24      $275.36
                             ulna.
    25375  T                Revise radius &             0051        27.76    $1,376.79      $675.24      $275.36
                             ulna.
    25390  C                Shorten radius or    ...........  ...........  ...........  ...........  ...........
                             ulna.
    25391  C                Lengthen radius or   ...........  ...........  ...........  ...........  ...........
                             ulna.
    25392  C                Shorten radius &     ...........  ...........  ...........  ...........  ...........
                             ulna.
    25393  C                Lengthen radius &    ...........  ...........  ...........  ...........  ...........
                             ulna.
    25400  T                Repair radius or            0050        21.13    $1,047.96      $513.86      $209.59
                             ulna.
    25405  T                Repair/graft radius         0050        21.13    $1,047.96      $513.86      $209.59
                             or ulna.
    25415  T                Repair radius &             0050        21.13    $1,047.96      $513.86      $209.59
                             ulna.
    25420  C                Repair/graft radius  ...........  ...........  ...........  ...........  ...........
                             & ulna.
    25425  T                Repair/graft radius         0051        27.76    $1,376.79      $675.24      $275.36
                             or ulna.
    25426  T                Repair/graft radius         0051        27.76    $1,376.79      $675.24      $275.36
                             & ulna.
    25440  T                Repair/graft wrist          0051        27.76    $1,376.79      $675.24      $275.36
                             bone.
    25441  T                Reconstruct wrist           0048        29.06    $1,441.26      $725.94      $288.25
                             joint.
    25442  T                Reconstruct wrist           0048        29.06    $1,441.26      $725.94      $288.25
                             joint.
    25443  T                Reconstruct wrist           0048        29.06    $1,441.26      $725.94      $288.25
                             joint.
    25444  T                Reconstruct wrist           0048        29.06    $1,441.26      $725.94      $288.25
                             joint.
    25445  T                Reconstruct wrist           0048        29.06    $1,441.26      $725.94      $288.25
                             joint.
    25446  T                Wrist replacement..         0048        29.06    $1,441.26      $725.94      $288.25
    25447  T                Repair wrist                0047        22.09    $1,095.58      $537.03      $219.12
                             joint(s).
    25449  T                Remove wrist joint          0047        22.09    $1,095.58      $537.03      $219.12
                             implant.
    25450  T                Revision of wrist           0051        27.76    $1,376.79      $675.24      $275.36
                             joint.
    25455  T                Revision of wrist           0051        27.76    $1,376.79      $675.24      $275.36
                             joint.
    25490  T                Reinforce radius...         0051        27.76    $1,376.79      $675.24      $275.36
    25491  T                Reinforce ulna.....         0051        27.76    $1,376.79      $675.24      $275.36
    25492  T                Reinforce radius            0051        27.76    $1,376.79      $675.24      $275.36
                             and ulna.
    25500  T                Treat fracture of           0044         2.17      $107.63       $38.08       $21.53
                             radius.
    25505  T                Treat fracture of           0044         2.17      $107.63       $38.08       $21.53
                             radius.
    25515  T                Treat fracture of           0046        22.29    $1,105.50      $535.76      $221.10
                             radius.
    25520  T                Treat fracture of           0044         2.17      $107.63       $38.08       $21.53
                             radius.
    25525  T                Treat fracture of           0046        22.29    $1,105.50      $535.76      $221.10
                             radius.
    25526  T                Treat fracture of           0046        22.29    $1,105.50      $535.76      $221.10
                             radius.
    25530  T                Treat fracture of           0044         2.17      $107.63       $38.08       $21.53
                             ulna.
    25535  T                Treat fracture of           0044         2.17      $107.63       $38.08       $21.53
                             ulna.
    25545  T                Treat fracture of           0046        22.29    $1,105.50      $535.76      $221.10
                             ulna.
    25560  T                Treat fracture              0044         2.17      $107.63       $38.08       $21.53
                             radius & ulna.
    25565  T                Treat fracture              0044         2.17      $107.63       $38.08       $21.53
                             radius & ulna.
    25574  T                Treat fracture              0046        22.29    $1,105.50      $535.76      $221.10
                             radius & ulna.
    25575  T                Treat fracture              0046        22.29    $1,105.50      $535.76      $221.10
                             radius/ulna.
    25600  T                Treat fracture              0044         2.17      $107.63       $38.08       $21.53
                             radius/ulna.
    25605  T                Treat fracture              0044         2.17      $107.63       $38.08       $21.53
                             radius/ulna.
    25611  T                Treat fracture              0046        22.29    $1,105.50      $535.76      $221.10
                             radius/ulna.
    25620  T                Treat fracture              0046        22.29    $1,105.50      $535.76      $221.10
                             radius/ulna.
    25622  T                Treat wrist bone            0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    25624  T                Treat wrist bone            0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    25628  T                Treat wrist bone            0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    25630  T                Treat wrist bone            0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    25635  T                Treat wrist bone            0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    25645  T                Treat wrist bone            0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    25650  T                Treat wrist bone            0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    25660  T                Treat wrist                 0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    25670  T                Treat wrist                 0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.

[[Page 68001]]

 
    25675  T                Treat wrist                 0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    25676  T                Treat wrist                 0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    25680  T                Treat wrist                 0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    25685  T                Treat wrist                 0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    25690  T                Treat wrist                 0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    25695  T                Treat wrist                 0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    25800  T                Fusion of wrist             0051        27.76    $1,376.79      $675.24      $275.36
                             joint.
    25805  T                Fusion/graft of             0051        27.76    $1,376.79      $675.24      $275.36
                             wrist joint.
    25810  T                Fusion/graft of             0051        27.76    $1,376.79      $675.24      $275.36
                             wrist joint.
    25820  T                Fusion of hand              0053        11.32      $561.42      $253.49      $112.28
                             bones.
    25825  T                Fuse hand bones             0054        19.66      $975.06      $472.33      $195.01
                             with graft.
    25830  T                Fusion, radioulnar          0051        27.76    $1,376.79      $675.24      $275.36
                             jnt/ulna.
    25900  C                Amputation of        ...........  ...........  ...........  ...........  ...........
                             forearm.
    25905  C                Amputation of        ...........  ...........  ...........  ...........  ...........
                             forearm.
    25907  T                Amputation follow-          0049        15.04      $745.93      $356.95      $149.19
                             up surgery.
    25909  C                Amputation follow-   ...........  ...........  ...........  ...........  ...........
                             up surgery.
    25915  C                Amputation of        ...........  ...........  ...........  ...........  ...........
                             forearm.
    25920  C                Amputate hand at     ...........  ...........  ...........  ...........  ...........
                             wrist.
    25922  T                Amputate hand at            0049        15.04      $745.93      $356.95      $149.19
                             wrist.
    25924  C                Amputation follow-   ...........  ...........  ...........  ...........  ...........
                             up surgery.
    25927  C                Amputation of hand.  ...........  ...........  ...........  ...........  ...........
    25929  T                Amputation follow-          0026        12.11      $600.61      $277.92      $120.12
                             up surgery.
    25931  C                Amputation follow-   ...........  ...........  ...........  ...........  ...........
                             up surgery.
    25999  T                Forearm or wrist            0044         2.17      $107.63       $38.08       $21.53
                             surgery.
    26010  T                Drainage of finger          0006         2.00       $99.19       $33.95       $19.84
                             abscess.
    26011  T                Drainage of finger          0007         3.68      $182.51       $72.03       $36.50
                             abscess.
    26020  T                Drain hand tendon           0053        11.32      $561.42      $253.49      $112.28
                             sheath.
    26025  T                Drainage of palm            0053        11.32      $561.42      $253.49      $112.28
                             bursa.
    26030  T                Drainage of palm            0053        11.32      $561.42      $253.49      $112.28
                             bursa(s).
    26034  T                Treat hand bone             0053        11.32      $561.42      $253.49      $112.28
                             lesion.
    26035  T                Decompress fingers/         0053        11.32      $561.42      $253.49      $112.28
                             hand.
    26037  T                Decompress fingers/         0053        11.32      $561.42      $253.49      $112.28
                             hand.
    26040  T                Release palm                0054        19.66      $975.06      $472.33      $195.01
                             contracture.
    26045  T                Release palm                0054        19.66      $975.06      $472.33      $195.01
                             contracture.
    26055  T                Incise finger               0053        11.32      $561.42      $253.49      $112.28
                             tendon sheath.
    26060  T                Incision of finger          0053        11.32      $561.42      $253.49      $112.28
                             tendon.
    26070  T                Explore/treat hand          0053        11.32      $561.42      $253.49      $112.28
                             joint.
    26075  T                Explore/treat               0053        11.32      $561.42      $253.49      $112.28
                             finger joint.
    26080  T                Explore/treat               0053        11.32      $561.42      $253.49      $112.28
                             finger joint.
    26100  T                Biopsy hand joint           0053        11.32      $561.42      $253.49      $112.28
                             lining.
    26105  T                Biopsy finger joint         0053        11.32      $561.42      $253.49      $112.28
                             lining.
    26110  T                Biopsy finger joint         0053        11.32      $561.42      $253.49      $112.28
                             lining.
    26115  T                Removal of hand             0022        12.49      $619.45      $292.94      $123.89
                             lesion.
    26116  T                Removal of hand             0022        12.49      $619.45      $292.94      $123.89
                             lesion.
    26117  T                Remove tumor, hand/         0022        12.49      $619.45      $292.94      $123.89
                             finger.
    26121  T                Release palm                0054        19.66      $975.06      $472.33      $195.01
                             contracture.
    26123  T                Release palm                0054        19.66      $975.06      $472.33      $195.01
                             contracture.
    26125  T                Release palm                0054        19.66      $975.06      $472.33      $195.01
                             contracture.
    26130  T                Remove wrist joint          0053        11.32      $561.42      $253.49      $112.28
                             lining.
    26135  T                Revise finger               0054        19.66      $975.06      $472.33      $195.01
                             joint, each.
    26140  T                Revise finger               0053        11.32      $561.42      $253.49      $112.28
                             joint, each.
    26145  T                Tendon excision,            0053        11.32      $561.42      $253.49      $112.28
                             palm/finger.
    26160  T                Remove tendon               0053        11.32      $561.42      $253.49      $112.28
                             sheath lesion.
    26170  T                Removal of palm             0053        11.32      $561.42      $253.49      $112.28
                             tendon, each.
    26180  T                Removal of finger           0053        11.32      $561.42      $253.49      $112.28
                             tendon.
    26185  T                Remove finger bone.         0053        11.32      $561.42      $253.49      $112.28
    26200  T                Remove hand bone            0053        11.32      $561.42      $253.49      $112.28
                             lesion.
    26205  T                Remove/graft bone           0054        19.66      $975.06      $472.33      $195.01
                             lesion.
    26210  T                Removal of finger           0053        11.32      $561.42      $253.49      $112.28
                             lesion.
    26215  T                Remove/graft finger         0053        11.32      $561.42      $253.49      $112.28
                             lesion.
    26230  T                Partial removal of          0053        11.32      $561.42      $253.49      $112.28
                             hand bone.
    26235  T                Partial removal,            0053        11.32      $561.42      $253.49      $112.28
                             finger bone.
    26236  T                Partial removal,            0053        11.32      $561.42      $253.49      $112.28
                             finger bone.
    26250  T                Extensive hand              0053        11.32      $561.42      $253.49      $112.28
                             surgery.
    26255  T                Extensive hand              0054        19.66      $975.06      $472.33      $195.01
                             surgery.
    26260  T                Extensive finger            0053        11.32      $561.42      $253.49      $112.28
                             surgery.
    26261  T                Extensive finger            0053        11.32      $561.42      $253.49      $112.28
                             surgery.
    26262  T                Partial removal of          0053        11.32      $561.42      $253.49      $112.28
                             finger.
    26320  T                Removal of implant          0020         6.51      $322.87      $130.53       $64.57
                             from hand.
    26350  T                Repair finger/hand          0054        19.66      $975.06      $472.33      $195.01
                             tendon.
    26352  T                Repair/graft hand           0054        19.66      $975.06      $472.33      $195.01
                             tendon.
    26356  T                Repair finger/hand          0054        19.66      $975.06      $472.33      $195.01
                             tendon.
    26357  T                Repair finger/hand          0054        19.66      $975.06      $472.33      $195.01
                             tendon.
    26358  T                Repair/graft hand           0054        19.66      $975.06      $472.33      $195.01
                             tendon.

[[Page 68002]]

 
    26370  T                Repair finger/hand          0054        19.66      $975.06      $472.33      $195.01
                             tendon.
    26372  T                Repair/graft hand           0054        19.66      $975.06      $472.33      $195.01
                             tendon.
    26373  T                Repair finger/hand          0054        19.66      $975.06      $472.33      $195.01
                             tendon.
    26390  T                Revise hand/finger          0054        19.66      $975.06      $472.33      $195.01
                             tendon.
    26392  T                Repair/graft hand           0054        19.66      $975.06      $472.33      $195.01
                             tendon.
    26410  T                Repair hand tendon.         0053        11.32      $561.42      $253.49      $112.28
    26412  T                Repair/graft hand           0054        19.66      $975.06      $472.33      $195.01
                             tendon.
    26415  T                Excision, hand/             0054        19.66      $975.06      $472.33      $195.01
                             finger tendon.
    26416  T                Graft hand or               0054        19.66      $975.06      $472.33      $195.01
                             finger tendon.
    26418  T                Repair finger               0053        11.32      $561.42      $253.49      $112.28
                             tendon.
    26420  T                Repair/graft finger         0054        19.66      $975.06      $472.33      $195.01
                             tendon.
    26426  T                Repair finger/hand          0054        19.66      $975.06      $472.33      $195.01
                             tendon.
    26428  T                Repair/graft finger         0054        19.66      $975.06      $472.33      $195.01
                             tendon.
    26432  T                Repair finger               0053        11.32      $561.42      $253.49      $112.28
                             tendon.
    26433  T                Repair finger               0053        11.32      $561.42      $253.49      $112.28
                             tendon.
    26434  T                Repair/graft finger         0054        19.66      $975.06      $472.33      $195.01
                             tendon.
    26437  T                Realignment of              0053        11.32      $561.42      $253.49      $112.28
                             tendons.
    26440  T                Release palm/finger         0053        11.32      $561.42      $253.49      $112.28
                             tendon.
    26442  T                Release palm &              0054        19.66      $975.06      $472.33      $195.01
                             finger tendon.
    26445  T                Release hand/finger         0053        11.32      $561.42      $253.49      $112.28
                             tendon.
    26449  T                Release forearm/            0054        19.66      $975.06      $472.33      $195.01
                             hand tendon.
    26450  T                Incision of palm            0053        11.32      $561.42      $253.49      $112.28
                             tendon.
    26455  T                Incision of finger          0053        11.32      $561.42      $253.49      $112.28
                             tendon.
    26460  T                Incise hand/finger          0053        11.32      $561.42      $253.49      $112.28
                             tendon.
    26471  T                Fusion of finger            0053        11.32      $561.42      $253.49      $112.28
                             tendons.
    26474  T                Fusion of finger            0053        11.32      $561.42      $253.49      $112.28
                             tendons.
    26476  T                Tendon lengthening.         0053        11.32      $561.42      $253.49      $112.28
    26477  T                Tendon shortening..         0053        11.32      $561.42      $253.49      $112.28
    26478  T                Lengthening of hand         0053        11.32      $561.42      $253.49      $112.28
                             tendon.
    26479  T                Shortening of hand          0053        11.32      $561.42      $253.49      $112.28
                             tendon.
    26480  T                Transplant hand             0054        19.66      $975.06      $472.33      $195.01
                             tendon.
    26483  T                Transplant/graft            0054        19.66      $975.06      $472.33      $195.01
                             hand tendon.
    26485  T                Transplant palm             0054        19.66      $975.06      $472.33      $195.01
                             tendon.
    26489  T                Transplant/graft            0054        19.66      $975.06      $472.33      $195.01
                             palm tendon.
    26490  T                Revise thumb tendon         0054        19.66      $975.06      $472.33      $195.01
    26492  T                Tendon transfer             0054        19.66      $975.06      $472.33      $195.01
                             with graft.
    26494  T                Hand tendon/muscle          0054        19.66      $975.06      $472.33      $195.01
                             transfer.
    26496  T                Revise thumb tendon         0054        19.66      $975.06      $472.33      $195.01
    26497  T                Finger tendon               0054        19.66      $975.06      $472.33      $195.01
                             transfer.
    26498  T                Finger tendon               0054        19.66      $975.06      $472.33      $195.01
                             transfer.
    26499  T                Revision of finger.         0054        19.66      $975.06      $472.33      $195.01
    26500  T                Hand tendon                 0053        11.32      $561.42      $253.49      $112.28
                             reconstruction.
    26502  T                Hand tendon                 0054        19.66      $975.06      $472.33      $195.01
                             reconstruction.
    26504  T                Hand tendon                 0054        19.66      $975.06      $472.33      $195.01
                             reconstruction.
    26508  T                Release thumb               0053        11.32      $561.42      $253.49      $112.28
                             contracture.
    26510  T                Thumb tendon                0054        19.66      $975.06      $472.33      $195.01
                             transfer.
    26516  T                Fusion of knuckle           0054        19.66      $975.06      $472.33      $195.01
                             joint.
    26517  T                Fusion of knuckle           0054        19.66      $975.06      $472.33      $195.01
                             joints.
    26518  T                Fusion of knuckle           0054        19.66      $975.06      $472.33      $195.01
                             joints.
    26520  T                Release knuckle             0053        11.32      $561.42      $253.49      $112.28
                             contracture.
    26525  T                Release finger              0053        11.32      $561.42      $253.49      $112.28
                             contracture.
    26530  T                Revise knuckle              0047        22.09    $1,095.58      $537.03      $219.12
                             joint.
    26531  T                Revise knuckle with         0048        29.06    $1,441.26      $725.94      $288.25
                             implant.
    26535  T                Revise finger joint         0047        22.09    $1,095.58      $537.03      $219.12
    26536  T                Revise/implant              0048        29.06    $1,441.26      $725.94      $288.25
                             finger joint.
    26540  T                Repair hand joint..         0053        11.32      $561.42      $253.49      $112.28
    26541  T                Repair hand joint           0054        19.66      $975.06      $472.33      $195.01
                             with graft.
    26542  T                Repair hand joint           0053        11.32      $561.42      $253.49      $112.28
                             with graft.
    26545  T                Reconstruct finger          0054        19.66      $975.06      $472.33      $195.01
                             joint.
    26546  T                Repair nonunion             0054        19.66      $975.06      $472.33      $195.01
                             hand.
    26548  T                Reconstruct finger          0054        19.66      $975.06      $472.33      $195.01
                             joint.
    26550  T                Construct thumb             0054        19.66      $975.06      $472.33      $195.01
                             replacement.
    26551  C                Great toe-hand       ...........  ...........  ...........  ...........  ...........
                             transfer.
    26553  C                Single transfer,     ...........  ...........  ...........  ...........  ...........
                             toe-hand.
    26554  C                Double transfer,     ...........  ...........  ...........  ...........  ...........
                             toe-hand.
    26555  T                Positional change           0054        19.66      $975.06      $472.33      $195.01
                             of finger.
    26556  C                Toe joint transfer.  ...........  ...........  ...........  ...........  ...........
    26560  T                Repair of web               0053        11.32      $561.42      $253.49      $112.28
                             finger.
    26561  T                Repair of web               0054        19.66      $975.06      $472.33      $195.01
                             finger.
    26562  T                Repair of web               0054        19.66      $975.06      $472.33      $195.01
                             finger.
    26565  T                Correct metacarpal          0054        19.66      $975.06      $472.33      $195.01
                             flaw.
    26567  T                Correct finger              0054        19.66      $975.06      $472.33      $195.01
                             deformity.
    26568  T                Lengthen metacarpal/        0054        19.66      $975.06      $472.33      $195.01
                             finger.
    26580  T                Repair hand                 0054        19.66      $975.06      $472.33      $195.01
                             deformity.

[[Page 68003]]

 
    26585  T                Repair finger               0054        19.66      $975.06      $472.33      $195.01
                             deformity.
    26587  T                Reconstruct extra           0053        11.32      $561.42      $253.49      $112.28
                             finger.
    26590  T                Repair finger               0054        19.66      $975.06      $472.33      $195.01
                             deformity.
    26591  T                Repair muscles of           0054        19.66      $975.06      $472.33      $195.01
                             hand.
    26593  T                Release muscles of          0053        11.32      $561.42      $253.49      $112.28
                             hand.
    26596  T                Excision                    0054        19.66      $975.06      $472.33      $195.01
                             constricting
                             tissue.
    26597  T                Release of scar             0054        19.66      $975.06      $472.33      $195.01
                             contracture.
    26600  T                Treat metacarpal            0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    26605  T                Treat metacarpal            0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    26607  T                Treat metacarpal            0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    26608  T                Treat metacarpal            0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    26615  T                Treat metacarpal            0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    26641  T                Treat thumb                 0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    26645  T                Treat thumb                 0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    26650  T                Treat thumb                 0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    26665  T                Treat thumb                 0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    26670  T                Treat hand                  0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    26675  T                Treat hand                  0045        11.02      $546.55      $277.12      $109.31
                             dislocation.
    26676  T                Pin hand                    0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    26685  T                Treat hand                  0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    26686  T                Treat hand                  0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    26700  T                Treat knuckle               0043         1.64       $81.34       $25.46       $16.27
                             dislocation.
    26705  T                Treat knuckle               0045        11.02      $546.55      $277.12      $109.31
                             dislocation.
    26706  T                Pin knuckle                 0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    26715  T                Treat knuckle               0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    26720  T                Treat finger                0043         1.64       $81.34       $25.46       $16.27
                             fracture, each.
    26725  T                Treat finger                0043         1.64       $81.34       $25.46       $16.27
                             fracture, each.
    26727  T                Treat finger                0046        22.29    $1,105.50      $535.76      $221.10
                             fracture, each.
    26735  T                Treat finger                0046        22.29    $1,105.50      $535.76      $221.10
                             fracture, each.
    26740  T                Treat finger                0043         1.64       $81.34       $25.46       $16.27
                             fracture, each.
    26742  T                Treat finger                0044         2.17      $107.63       $38.08       $21.53
                             fracture, each.
    26746  T                Treat finger                0046        22.29    $1,105.50      $535.76      $221.10
                             fracture, each.
    26750  T                Treat finger                0043         1.64       $81.34       $25.46       $16.27
                             fracture, each.
    26755  T                Treat finger                0043         1.64       $81.34       $25.46       $16.27
                             fracture, each.
    26756  T                Pin finger                  0046        22.29    $1,105.50      $535.76      $221.10
                             fracture, each.
    26765  T                Treat finger                0046        22.29    $1,105.50      $535.76      $221.10
                             fracture, each.
    26770  T                Treat finger                0043         1.64       $81.34       $25.46       $16.27
                             dislocation.
    26775  T                Treat finger                0045        11.02      $546.55      $277.12      $109.31
                             dislocation.
    26776  T                Pin finger                  0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    26785  T                Treat finger                0046        22.29    $1,105.50      $535.76      $221.10
                             dislocation.
    26820  T                Thumb fusion with           0054        19.66      $975.06      $472.33      $195.01
                             graft.
    26841  T                Fusion of thumb....         0054        19.66      $975.06      $472.33      $195.01
    26842  T                Thumb fusion with           0054        19.66      $975.06      $472.33      $195.01
                             graft.
    26843  T                Fusion of hand              0054        19.66      $975.06      $472.33      $195.01
                             joint.
    26844  T                Fusion/graft of             0054        19.66      $975.06      $472.33      $195.01
                             hand joint.
    26850  T                Fusion of knuckle..         0054        19.66      $975.06      $472.33      $195.01
    26852  T                Fusion of knuckle           0054        19.66      $975.06      $472.33      $195.01
                             with graft.
    26860  T                Fusion of finger            0054        19.66      $975.06      $472.33      $195.01
                             joint.
    26861  T                Fusion of finger            0054        19.66      $975.06      $472.33      $195.01
                             jnt, add-on.
    26862  T                Fusion/graft of             0054        19.66      $975.06      $472.33      $195.01
                             finger joint.
    26863  T                Fuse/graft added            0054        19.66      $975.06      $472.33      $195.01
                             joint.
    26910  T                Amputate metacarpal         0054        19.66      $975.06      $472.33      $195.01
                             bone.
    26951  T                Amputation of               0053        11.32      $561.42      $253.49      $112.28
                             finger/thumb.
    26952  T                Amputation of               0053        11.32      $561.42      $253.49      $112.28
                             finger/thumb.
    26989  T                Hand/finger surgery         0043         1.64       $81.34       $25.46       $16.27
    26990  T                Drainage of pelvis          0049        15.04      $745.93      $356.95      $149.19
                             lesion.
    26991  T                Drainage of pelvis          0049        15.04      $745.93      $356.95      $149.19
                             bursa.
    26992  C                Drainage of bone     ...........  ...........  ...........  ...........  ...........
                             lesion.
    27000  T                Incision of hip             0049        15.04      $745.93      $356.95      $149.19
                             tendon.
    27001  T                Incision of hip             0050        21.13    $1,047.96      $513.86      $209.59
                             tendon.
    27003  T                Incision of hip             0050        21.13    $1,047.96      $513.86      $209.59
                             tendon.
    27005  C                Incision of hip      ...........  ...........  ...........  ...........  ...........
                             tendon.
    27006  C                Incision of hip      ...........  ...........  ...........  ...........  ...........
                             tendons.
    27025  C                Incision of hip/     ...........  ...........  ...........  ...........  ...........
                             thigh fascia.
    27030  C                Drainage of hip      ...........  ...........  ...........  ...........  ...........
                             joint.
    27033  T                Exploration of hip          0051        27.76    $1,376.79      $675.24      $275.36
                             joint.
    27035  C                Denervation of hip   ...........  ...........  ...........  ...........  ...........
                             joint.
    27036  C                Excision of hip      ...........  ...........  ...........  ...........  ...........
                             joint/muscle.
    27040  T                Biopsy of soft              0021        10.49      $520.26      $236.51      $104.05
                             tissues.
    27041  T                Biopsy of soft              0022        12.49      $619.45      $292.94      $123.89
                             tissues.
    27047  T                Remove hip/pelvis           0022        12.49      $619.45      $292.94      $123.89
                             lesion.
    27048  T                Remove hip/pelvis           0022        12.49      $619.45      $292.94      $123.89
                             lesion.
    27049  T                Remove tumor, hip/          0022        12.49      $619.45      $292.94      $123.89
                             pelvis.
    27050  T                Biopsy of                   0049        15.04      $745.93      $356.95      $149.19
                             sacroiliac joint.

[[Page 68004]]

 
    27052  T                Biopsy of hip joint         0049        15.04      $745.93      $356.95      $149.19
    27054  C                Removal of hip       ...........  ...........  ...........  ...........  ...........
                             joint lining.
    27060  T                Removal of ischial          0049        15.04      $745.93      $356.95      $149.19
                             bursa.
    27062  T                Remove femur lesion/        0049        15.04      $745.93      $356.95      $149.19
                             bursa.
    27065  T                Removal of hip bone         0049        15.04      $745.93      $356.95      $149.19
                             lesion.
    27066  T                Removal of hip bone         0050        21.13    $1,047.96      $513.86      $209.59
                             lesion.
    27067  T                Remove/graft hip            0050        21.13    $1,047.96      $513.86      $209.59
                             bone lesion.
    27070  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             hip bone.
    27071  C                Partial removal of   ...........  ...........  ...........  ...........  ...........
                             hip bone.
    27075  C                Extensive hip        ...........  ...........  ...........  ...........  ...........
                             surgery.
    27076  C                Extensive hip        ...........  ...........  ...........  ...........  ...........
                             surgery.
    27077  C                Extensive hip        ...........  ...........  ...........  ...........  ...........
                             surgery.
    27078  C                Extensive hip        ...........  ...........  ...........  ...........  ...........
                             surgery.
    27079  C                Extensive hip        ...........  ...........  ...........  ...........  ...........
                             surgery.
    27080  T                Removal of tail             0050        21.13    $1,047.96      $513.86      $209.59
                             bone.
    27086  T                Remove hip foreign          0019         4.00      $198.39       $78.91       $39.68
                             body.
    27087  T                Remove hip foreign          0049        15.04      $745.93      $356.95      $149.19
                             body.
    27090  C                Removal of hip       ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    27091  C                Removal of hip       ...........  ...........  ...........  ...........  ...........
                             prosthesis.
    27093  N                Injection for hip x- ...........  ...........  ...........  ...........  ...........
                             ray.
    27095  N                Injection for hip x- ...........  ...........  ...........  ...........  ...........
                             ray.
    27096  N                Inject sacroiliac    ...........  ...........  ...........  ...........  ...........
                             joint.
    27097  T                Revision of hip             0050        21.13    $1,047.96      $513.86      $209.59
                             tendon.
    27098  T                Transfer tendon to          0050        21.13    $1,047.96      $513.86      $209.59
                             pelvis.
    27100  T                Transfer of                 0051        27.76    $1,376.79      $675.24      $275.36
                             abdominal muscle.
    27105  T                Transfer of spinal          0051        27.76    $1,376.79      $675.24      $275.36
                             muscle.
    27110  T                Transfer of                 0051        27.76    $1,376.79      $675.24      $275.36
                             iliopsoas muscle.
    27111  T                Transfer of                 0051        27.76    $1,376.79      $675.24      $275.36
                             iliopsoas muscle.
    27120  C                Reconstruction of    ...........  ...........  ...........  ...........  ...........
                             hip socket.
    27122  C                Reconstruction of    ...........  ...........  ...........  ...........  ...........
                             hip socket.
    27125  C                Partial hip          ...........  ...........  ...........  ...........  ...........
                             replacement.
    27130  C                Total hip            ...........  ...........  ...........  ...........  ...........
                             replacement.
    27132  C                Total hip            ...........  ...........  ...........  ...........  ...........
                             replacement.
    27134  C                Revise hip joint     ...........  ...........  ...........  ...........  ...........
                             replacement.
    27137  C                Revise hip joint     ...........  ...........  ...........  ...........  ...........
                             replacement.
    27138  C                Revise hip joint     ...........  ...........  ...........  ...........  ...........
                             replacement.
    27140  C                Transplant femur     ...........  ...........  ...........  ...........  ...........
                             ridge.
    27146  C                Incision of hip      ...........  ...........  ...........  ...........  ...........
                             bone.
    27147  C                Revision of hip      ...........  ...........  ...........  ...........  ...........
                             bone.
    27151  C                Incision of hip      ...........  ...........  ...........  ...........  ...........
                             bones.
    27156  C                Revision of hip      ...........  ...........  ...........  ...........  ...........
                             bones.
    27158  C                Revision of pelvis.  ...........  ...........  ...........  ...........  ...........
    27161  C                Incision of neck of  ...........  ...........  ...........  ...........  ...........
                             femur.
    27165  C                Incision/fixation    ...........  ...........  ...........  ...........  ...........
                             of femur.
    27170  C                Repair/graft femur   ...........  ...........  ...........  ...........  ...........
                             head/neck.
    27175  C                Treat slipped        ...........  ...........  ...........  ...........  ...........
                             epiphysis.
    27176  C                Treat slipped        ...........  ...........  ...........  ...........  ...........
                             epiphysis.
    27177  C                Treat slipped        ...........  ...........  ...........  ...........  ...........
                             epiphysis.
    27178  C                Treat slipped        ...........  ...........  ...........  ...........  ...........
                             epiphysis.
    27179  C                Revise head/neck of  ...........  ...........  ...........  ...........  ...........
                             femur.
    27181  C                Treat slipped        ...........  ...........  ...........  ...........  ...........
                             epiphysis.
    27185  C                Revision of femur    ...........  ...........  ...........  ...........  ...........
                             epiphysis.
    27187  C                Reinforce hip bones  ...........  ...........  ...........  ...........  ...........
    27193  T                Treat pelvic ring           0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27194  T                Treat pelvic ring           0045        11.02      $546.55      $277.12      $109.31
                             fracture.
    27200  T                Treat tail bone             0043         1.64       $81.34       $25.46       $16.27
                             fracture.
    27202  T                Treat tail bone             0046        22.29    $1,105.50      $535.76      $221.10
                             fracture.
    27215  C                Treat pelvic         ...........  ...........  ...........  ...........  ...........
                             fracture(s).
    27216  C                Treat pelvic ring    ...........  ...........  ...........  ...........  ...........
                             fracture.
    27217  C                Treat pelvic ring    ...........  ...........  ...........  ...........  ...........
                             fracture.
    27218  C                Treat pelvic ring    ...........  ...........  ...........  ...........  ...........
                             fracture.
    27220  T                Treat hip socket            0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27222  C                Treat hip socket     ...........  ...........  ...........  ...........  ...........
                             fracture.
    27226  C                Treat hip wall       ...........  ...........  ...........  ...........  ...........
                             fracture.
    27227  C                Treat hip            ...........  ...........  ...........  ...........  ...........
                             fracture(s).
    27228  C                Treat hip            ...........  ...........  ...........  ...........  ...........
                             fracture(s).
    27230  T                Treat thigh                 0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27232  C                Treat thigh          ...........  ...........  ...........  ...........  ...........
                             fracture.
    27235  C                Treat thigh          ...........  ...........  ...........  ...........  ...........
                             fracture.
    27236  C                Treat thigh          ...........  ...........  ...........  ...........  ...........
                             fracture.
    27238  T                Treat thigh                 0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27240  C                Treat thigh          ...........  ...........  ...........  ...........  ...........
                             fracture.
    27244  C                Treat thigh          ...........  ...........  ...........  ...........  ...........
                             fracture.
    27245  C                Treat thigh          ...........  ...........  ...........  ...........  ...........
                             fracture.

[[Page 68005]]

 
    27246  T                Treat thigh                 0044         2.17      $107.63       $38.08       $21.53
                             fracture.
    27248  C                Treat thigh          ...........  ...........  ...........  ...........  ...........
                             fracture.
    27250  T                Treat hip                   0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    27252  T                Treat hip                   0045        11.02      $546.55      $277.12      $109.31
                             dislocation.
    27253  C                Treat hip            ...........  ...........  ...........  ...........  ...........
                             dislocation.
    27254  C                Treat hip            ...........  ...........  ...........  ...........  ...........
                             dislocation.
    27256  T                Treat hip                   0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    27257  T                Treat hip                   0045        11.02      $546.55      $277.12      $109.31
                             dislocation.
    27258  C                Treat hip            ...........  ...........  ...........  ...........  ...........
                             dislocation.
    27259  C                Treat hip            ...........  ...........  ...........  ...........  ...........
                             dislocation.
    27265  T                Treat hip                   0044         2.17      $107.63       $38.08       $21.53
                             dislocation.
    27266  T                Treat hip                   0047        22.09    $1,095.58      $537.03      $219.12
                             dislocation.
    27275  T                Manipulation of hip         0045        11.02      $546.55      $277.12     $109.31
                             joint.
----------------------------------------------------------------------------------------------------------------
CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/
  DFARS Apply.
Copyright American Dental Association. All rights reserved.
* Code is new in 2001.

      
  

  

  

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / 
Rules and Regulations

[[Page 68005]]



Addendum C--[Reserved]

 Addendum D.--Status Indicators: How Various Services Are Treated Under
           the Hospital Outpatient Prospective Payment System
------------------------------------------------------------------------
     Indicator               Service                     Status
------------------------------------------------------------------------
A.................  Pulmonary Rehabilitation   Not Paid Under Ourpatient
                     Clinical Trial.            PPS.
C.................  Inpatient Procedures.....  Admit Patient; Bill as
                                                Inpatient.
A.................  Durable Medical            DMEPOS Fee Schedule.
                     Equipment, Prosthetics
                     and Orthotics.
E.................  Non-Covered Items and      Not Paid Under Outpatient
                     Services.                  PPS.
A.................  Physical, Occupational     Rehabilitation Fee
                     and Speech Therapy.        Schedule.
A.................  Ambulance................  Ambulance Fee Schedule.
A.................  EPO for ESRD Patients....  National Rate.
A.................  Clinical Diagnostic        Laboratory Fee Schedule.
                     Laboratory Services.
A.................  Physician Services for     Not Paid Under Outpatient
                     ESRD Patients.             PPS.
A.................  Screening Mammography....  Lower of Charges or
                                                National Rate.
N.................  Incidental Services,       Packaged.
                     packaged into APC Rate.
P.................  Partial Hospitalization..  Paid Per Diem APC.
S.................  Significant Procedure,     Paid Under Outpatient
                     Not Discounted When        PPS.
                     Multiple.
T.................  Significant Procedure,     Paid Under Outpatient
                     Multiple Procedure         PPS.
                     Reduction Applies.
V.................  Visit to Clinic or         Paid Under Outpatient
                     Emergency Department.      PPS.
X.................  Ancillary Service........  Paid Under Outpatient
                                                PPS.
F.................  Acquisition of Corneal     Paid at Reasonable Cost.
                     Tissue.
G.................  Current Drug/Biological    Additional Payment.
                     Pass-Through.
H.................  Device Pass-Through......  Additional Payment.
J.................  New Drug/Biological Pass-  Additional Payment.
                     Through.
K.................  Non Pass-Through Drug/     Paid Under Outpatient
                     Biological.                PPS.
------------------------------------------------------------------------

    --------------------
CPT codes and descriptions only are copyright American Medical 
Association. All Rights Reserved. Applicable FARS/DFARS Apply.

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

[[Page 68005]]



 Addendum E.--CPT Codes Which Will Be Paid Only as Inpatient Procedures
                          [Calendar Year 2001]
------------------------------------------------------------------------
  CPT/
  HCPCS     HOPD  status  indicator               Description
------------------------------------------------------------------------
   15756  C                            Free muscle flap, microvasc
   15757  C                            Free skin flap, microvasc
   15758  C                            Free fascial flap, microvasc
   16035  C                            Incision of burn scab
\*\ 1603  C                            Incision of burn scab
        6
   19200  C                            Removal of breast
   19220  C                            Removal of breast
   19271  C                            Revision of chest wall
   19272  C                            Extensive chest wall surgery
   19361  C                            Breast reconstruction
   19364  C                            Breast reconstruction
   19367  C                            Breast reconstruction
   19368  C                            Breast reconstruction
   19369  C                            Breast reconstruction
   20660  C                            Apply, remove fixation device
   20661  C                            Application of head brace
   20662  C                            Application of pelvis brace
   20663  C                            Application of thigh brace
   20664  C                            Halo brace application
   20802  C                            Replantation, arm, complete
   20805  C                            Replant, forearm, complete
   20808  C                            Replantation hand, complete
   20816  C                            Replantation digit, complete
   20822  C                            Replantation digit, complete
   20824  C                            Replantation thumb, complete
   20827  C                            Replantation thumb, complete
   20838  C                            Replantation foot, complete
   20930  C                            Spinal bone allograft
   20931  C                            Spinal bone allograft
   20936  C                            Spinal bone autograft
   20937  C                            Spinal bone autograft
   20938  C                            Spinal bone autograft
   20955  C                            Fibula bone graft, microvasc
   20956  C                            Iliac bone graft, microvasc
   20957  C                            Mt bone graft, microvasc
   20962  C                            Other bone graft, microvasc
   20969  C                            Bone/skin graft, microvasc
   20970  C                            Bone/skin graft, iliac crest
   20972  C                            Bone/skin graft, metatarsal
   20973  C                            Bone/skin graft, great toe
   21045  C                            Extensive jaw surgery
   21141  C                            Reconstruct midface, lefort
   21142  C                            Reconstruct midface, lefort
   21143  C                            Reconstruct midface, lefort
   21145  C                            Reconstruct midface, lefort
   21146  C                            Reconstruct midface, lefort
   21147  C                            Reconstruct midface, lefort

[[Page 68006]]

 
   21150  C                            Reconstruct midface, lefort
   21151  C                            Reconstruct midface, lefort
   21154  C                            Reconstruct midface, lefort
   21155  C                            Reconstruct midface, lefort
   21159  C                            Reconstruct midface, lefort
   21160  C                            Reconstruct midface, lefort
   21172  C                            Reconstruct orbit/forehead
   21175  C                            Reconstruct orbit/forehead
   21179  C                            Reconstruct entire forehead
   21180  C                            Reconstruct entire forehead
   21182  C                            Reconstruct cranial bone
   21183  C                            Reconstruct cranial bone
   21184  C                            Reconstruct cranial bone
   21188  C                            Reconstruction of midface
   21193  C                            Reconstruct lower jaw bone
   21194  C                            Reconstruct lower jaw bone
   21195  C                            Reconstruct lower jaw bone
   21196  C                            Reconstruct lower jaw bone
   21247  C                            Reconstruct lower jaw bone
   21255  C                            Reconstruct lower jaw bone
   21256  C                            Reconstruction of orbit
   21268  C                            Revise eye sockets
   21343  C                            Treatment of sinus fracture
   21344  C                            Treatment of sinus fracture
   21346  C                            Treat nose/jaw fracture
   21347  C                            Treat nose/jaw fracture
   21348  C                            Treat nose/jaw fracture
   21356  C                            Treat cheek bone fracture
   21360  C                            Treat cheek bone fracture
   21365  C                            Treat cheek bone fracture
   21366  C                            Treat cheek bone fracture
   21385  C                            Treat eye socket fracture
   21386  C                            Treat eye socket fracture
   21387  C                            Treat eye socket fracture
   21390  C                            Treat eye socket fracture
   21395  C                            Treat eye socket fracture
   21408  C                            Treat eye socket fracture
   21422  C                            Treat mouth roof fracture
   21423  C                            Treat mouth roof fracture
   21431  C                            Treat craniofacial fracture
   21432  C                            Treat craniofacial fracture
   21433  C                            Treat craniofacial fracture
   21435  C                            Treat craniofacial fracture
   21436  C                            Treat craniofacial fracture
   21495  C                            Treat hyoid bone fracture
   21510  C                            Drainage of bone lesion
   21557  C                            Remove tumor, neck/chest
   21615  C                            Removal of rib
   21616  C                            Removal of rib and nerves
   21620  C                            Partial removal of sternum
   21627  C                            Sternal debridement
   21630  C                            Extensive sternum surgery
   21632  C                            Extensive sternum surgery
   21705  C                            Revision of neck muscle/rib
   21740  C                            Reconstruction of sternum
   21750  C                            Repair of sternum separation
   21810  C                            Treatment of rib fracture(s)
   21825  C                            Treat sternum fracture
   22100  C                            Remove part of neck vertebra
   22101  C                            Remove part, thorax vertebra
   22102  C                            Remove part, lumbar vertebra
   22103  C                            Remove extra spine segment
   22110  C                            Remove part of neck vertebra
   22112  C                            Remove part, thorax vertebra
   22114  C                            Remove part, lumbar vertebra
   22116  C                            Remove extra spine segment
   22210  C                            Revision of neck spine
   22212  C                            Revision of thorax spine
   22214  C                            Revision of lumbar spine
   22216  C                            Revise, extra spine segment
   22220  C                            Revision of neck spine
   22222  C                            Revision of thorax spine
   22224  C                            Revision of lumbar spine
   22226  C                            Revise, extra spine segment
   22318  C                            Treat odontoid fx w/o graft
   22319  C                            Treat odontoid fx w/graft
   22325  C                            Treat spine fracture
   22326  C                            Treat neck spine fracture
   22327  C                            Treat thorax spine fracture
   22328  C                            Treat each add spine fx
   22548  C                            Neck spine fusion
   22554  C                            Neck spine fusion
   22556  C                            Thorax spine fusion
   22558  C                            Lumbar spine fusion
   22585  C                            Additional spinal fusion
   22590  C                            Spine & skull spinal fusion
   22595  C                            Neck spinal fusion
   22600  C                            Neck spine fusion
   22610  C                            Thorax spine fusion
   22612  C                            Lumbar spine fusion
   22614  C                            Spine fusion, extra segment
   22630  C                            Lumbar spine fusion
   22632  C                            Spine fusion, extra segment
   22800  C                            Fusion of spine
   22802  C                            Fusion of spine
   22804  C                            Fusion of spine
   22808  C                            Fusion of spine
   22810  C                            Fusion of spine
   22812  C                            Fusion of spine
   22818  C                            Kyphectomy, 1-2 segments
   22819  C                            Kyphectomy, 3 or more
   22830  C                            Exploration of spinal fusion
   22840  C                            Insert spine fixation device
   22841  C                            Insert spine fixation device
   22842  C                            Insert spine fixation device
   22843  C                            Insert spine fixation device
   22844  C                            Insert spine fixation device
   22845  C                            Insert spine fixation device
   22846  C                            Insert spine fixation device
   22847  C                            Insert spine fixation device
   22848  C                            Insert pelv fixation device
   22849  C                            Reinsert spinal fixation
   22850  C                            Remove spine fixation device
   22851  C                            Apply spine prosth device
   22852  C                            Remove spine fixation device
   22855  C                            Remove spine fixation device
   23035  C                            Drain shoulder bone lesion
   23125  C                            Removal of collar bone
   23195  C                            Removal of head of humerus
   23200  C                            Removal of collar bone
   23210  C                            Removal of shoulder blade
   23220  C                            Partial removal of humerus
   23221  C                            Partial removal of humerus
   23222  C                            Partial removal of humerus
   23332  C                            Remove shoulder foreign body
   23395  C                            Muscle transfer, shoulder/arm
   23397  C                            Muscle transfers
   23400  C                            Fixation of shoulder blade
   23440  C                            Remove/transplant tendon
   23470  C                            Reconstruct shoulder joint
   23472  C                            Reconstruct shoulder joint
   23900  C                            Amputation of arm & girdle
   23920  C                            Amputation at shoulder joint
   24149  C                            Radical resection of elbow
   24150  C                            Extensive humerus surgery
   24151  C                            Extensive humerus surgery
   24152  C                            Extensive radius surgery
   24153  C                            Extensive radius surgery
   24900  C                            Amputation of upper arm
   24920  C                            Amputation of upper arm
   24930  C                            Amputation follow-up surgery
   24931  C                            Amputate upper arm & implant
   24940  C                            Revision of upper arm
   25170  C                            Extensive forearm surgery
   25390  C                            Shorten radius or ulna
   25391  C                            Lengthen radius or ulna
   25392  C                            Shorten radius & ulna
   25393  C                            Lengthen radius & ulna
   25420  C                            Repair/graft radius & ulna
   25900  C                            Amputation of forearm
   25905  C                            Amputation of forearm
   25909  C                            Amputation follow-up surgery
   25915  C                            Amputation of forearm
   25920  C                            Amputate hand at wrist
   25924  C                            Amputation follow-up surgery
   25927  C                            Amputation of hand
   25931  C                            Amputation follow-up surgery
   26551  C                            Great toe-hand transfer
   26553  C                            Single transfer, toe-hand
   26554  C                            Double transfer, toe-hand
   26556  C                            Toe joint transfer
   26992  C                            Drainage of bone lesion
   27005  C                            Incision of hip tendon
   27006  C                            Incision of hip tendons
   27025  C                            Incision of hip/thigh fascia
   27030  C                            Drainage of hip joint
   27035  C                            Denervation of hip joint
   27036  C                            Excision of hip joint/muscle
   27054  C                            Removal of hip joint lining
   27070  C                            Partial removal of hip bone
   27071  C                            Partial removal of hip bone
   27075  C                            Extensive hip surgery
   27076  C                            Extensive hip surgery
   27077  C                            Extensive hip surgery
   27078  C                            Extensive hip surgery
   27079  C                            Extensive hip surgery
   27090  C                            Removal of hip prosthesis
   27091  C                            Removal of hip prosthesis
   27120  C                            Reconstruction of hip socket
   27122  C                            Reconstruction of hip socket
   27125  C                            Partial hip replacement
   27130  C                            Total hip replacement
   27132  C                            Total hip replacement
   27134  C                            Revise hip joint replacement
   27137  C                            Revise hip joint replacement
   27138  C                            Revise hip joint replacement
   27140  C                            Transplant femur ridge
   27146  C                            Incision of hip bone
   27147  C                            Revision of hip bone
   27151  C                            Incision of hip bones
   27156  C                            Revision of hip bones
   27158  C                            Revision of pelvis
   27161  C                            Incision of neck of femur
   27165  C                            Incision/fixation of femur
   27170  C                            Repair/graft femur head/neck
   27175  C                            Treat slipped epiphysis
   27176  C                            Treat slipped epiphysis
   27177  C                            Treat slipped epiphysis
   27178  C                            Treat slipped epiphysis
   27179  C                            Revise head/neck of femur
   27181  C                            Treat slipped epiphysis
   27185  C                            Revision of femur epiphysis
   27187  C                            Reinforce hip bones
   27215  C                            Treat pelvic fracture(s)
   27216  C                            Treat pelvic ring fracture
   27217  C                            Treat pelvic ring fracture
   27218  C                            Treat pelvic ring fracture
   27222  C                            Treat hip socket fracture
   27226  C                            Treat hip wall fracture
   27227  C                            Treat hip fracture(s)
   27228  C                            Treat hip fracture(s)
   27232  C                            Treat thigh fracture
   27235  C                            Treat thigh fracture

[[Page 68007]]

 
   27236  C                            Treat thigh fracture
   27240  C                            Treat thigh fracture
   27244  C                            Treat thigh fracture
   27245  C                            Treat thigh fracture
   27248  C                            Treat thigh fracture
   27253  C                            Treat hip dislocation
   27254  C                            Treat hip dislocation
   27258  C                            Treat hip dislocation
   27259  C                            Treat hip dislocation
   27280  C                            Fusion of sacroiliac joint
   27282  C                            Fusion of pubic bones
   27284  C                            Fusion of hip joint
   27286  C                            Fusion of hip joint
   27290  C                            Amputation of leg at hip
   27295  C                            Amputation of leg at hip
   27303  C                            Drainage of bone lesion
   27365  C                            Extensive leg surgery
   27445  C                            Revision of knee joint
   27446  C                            Revision of knee joint
   27447  C                            Total knee replacement
   27448  C                            Incision of thigh
   27450  C                            Incision of thigh
   27454  C                            Realignment of thigh bone
   27455  C                            Realignment of knee
   27457  C                            Realignment of knee
   27465  C                            Shortening of thigh bone
   27466  C                            Lengthening of thigh bone
   27468  C                            Shorten/lengthen thighs
   27470  C                            Repair of thigh
   27472  C                            Repair/graft of thigh
   27475  C                            Surgery to stop leg growth
   27477  C                            Surgery to stop leg growth
   27479  C                            Surgery to stop leg growth
   27485  C                            Surgery to stop leg growth
   27486  C                            Revise/replace knee joint
   27487  C                            Revise/replace knee joint
   27488  C                            Removal of knee prosthesis
   27495  C                            Reinforce thigh
   27506  C                            Treatment of thigh fracture
   27507  C                            Treatment of thigh fracture
   27511  C                            Treatment of thigh fracture
   27513  C                            Treatment of thigh fracture
   27514  C                            Treatment of thigh fracture
   27519  C                            Treat thigh fx growth plate
   27535  C                            Treat knee fracture
   27536  C                            Treat knee fracture
   27540  C                            Treat knee fracture
   27556  C                            Treat knee dislocation
   27557  C                            Treat knee dislocation
   27558  C                            Treat knee dislocation
   27580  C                            Fusion of knee
   27590  C                            Amputate leg at thigh
   27591  C                            Amputate leg at thigh
   27592  C                            Amputate leg at thigh
   27596  C                            Amputation follow-up surgery
   27598  C                            Amputate lower leg at knee
   27645  C                            Extensive lower leg surgery
   27646  C                            Extensive lower leg surgery
   27702  C                            Reconstruct ankle joint
   27703  C                            Reconstruction, ankle joint
   27712  C                            Realignment of lower leg
   27715  C                            Revision of lower leg
   27720  C                            Repair of tibia
   27722  C                            Repair/graft of tibia
   27724  C                            Repair/graft of tibia
   27725  C                            Repair of lower leg
   27727  C                            Repair of lower leg
   27880  C                            Amputation of lower leg
   27881  C                            Amputation of lower leg
   27882  C                            Amputation of lower leg
   27886  C                            Amputation follow-up surgery
   27888  C                            Amputation of foot at ankle
   28800  C                            Amputation of midfoot
   28805  C                            Amputation thru metatarsal
   31225  C                            Removal of upper jaw
   31230  C                            Removal of upper jaw
   31290  C                            Nasal/sinus endoscopy, surg
   31291  C                            Nasal/sinus endoscopy, surg
   31292  C                            Nasal/sinus endoscopy, surg
   31293  C                            Nasal/sinus endoscopy, surg
   31294  C                            Nasal/sinus endoscopy, surg
   31360  C                            Removal of larynx
   31365  C                            Removal of larynx
   31367  C                            Partial removal of larynx
   31368  C                            Partial removal of larynx
   31370  C                            Partial removal of larynx
   31375  C                            Partial removal of larynx
   31380  C                            Partial removal of larynx
   31382  C                            Partial removal of larynx
   31390  C                            Removal of larynx & pharynx
   31395  C                            Reconstruct larynx & pharynx
   31582  C                            Revision of larynx
   31584  C                            Treat larynx fracture
   31587  C                            Revision of larynx
   31725  C                            Clearance of airways
   31760  C                            Repair of windpipe
   31766  C                            Reconstruction of windpipe
   31770  C                            Repair/graft of bronchus
   31775  C                            Reconstruct bronchus
   31780  C                            Reconstruct windpipe
   31781  C                            Reconstruct windpipe
   31785  C                            Remove windpipe lesion
   31786  C                            Remove windpipe lesion
   31800  C                            Repair of windpipe injury
   31805  C                            Repair of windpipe injury
   32035  C                            Exploration of chest
   32036  C                            Exploration of chest
   32095  C                            Biopsy through chest wall
   32100  C                            Exploration/biopsy of chest
   32110  C                            Explore/repair chest
   32120  C                            Re-exploration of chest
   32124  C                            Explore chest free adhesions
   32140  C                            Removal of lung lesion(s)
   32141  C                            Remove/treat lung lesions
   32150  C                            Removal of lung lesion(s)
   32151  C                            Remove lung foreign body
   32160  C                            Open chest heart massage
   32200  C                            Drain, open, lung lesion
   32201  C                            Drain, percut, lung lesion
   32215  C                            Treat chest lining
   32220  C                            Release of lung
   32225  C                            Partial release of lung
   32310  C                            Removal of chest lining
   32320  C                            Free/remove chest lining
   32402  C                            Open biopsy chest lining
   32440  C                            Removal of lung
   32442  C                            Sleeve pneumonectomy
   32445  C                            Removal of lung
   32480  C                            Partial removal of lung
   32482  C                            Bilobectomy
   32484  C                            Segmentectomy
   32486  C                            Sleeve lobectomy
   32488  C                            Completion pneumonectomy
   32491  C                            Lung volume reduction
   32500  C                            Partial removal of lung
   32501  C                            Repair bronchus add-on
   32520  C                            Remove lung & revise chest
   32522  C                            Remove lung & revise chest
   32525  C                            Remove lung & revise chest
   32540  C                            Removal of lung lesion
   32650  C                            Thoracoscopy, surgical
   32651  C                            Thoracoscopy, surgical
   32652  C                            Thoracoscopy, surgical
   32653  C                            Thoracoscopy, surgical
   32654  C                            Thoracoscopy, surgical
   32655  C                            Thoracoscopy, surgical
   32656  C                            Thoracoscopy, surgical
   32657  C                            Thoracoscopy, surgical
   32658  C                            Thoracoscopy, surgical
   32659  C                            Thoracoscopy, surgical
   32660  C                            Thoracoscopy, surgical
   32661  C                            Thoracoscopy, surgical
   32662  C                            Thoracoscopy, surgical
   32663  C                            Thoracoscopy, surgical
   32664  C                            Thoracoscopy, surgical
   32665  C                            Thoracoscopy, surgical
   32800  C                            Repair lung hernia
   32810  C                            Close chest after drainage
   32815  C                            Close bronchial fistula
   32820  C                            Reconstruct injured chest
   32850  C                            Donor pneumonectomy
   32851  C                            Lung transplant, single
   32852  C                            Lung transplant with bypass
   32853  C                            Lung transplant, double
   32854  C                            Lung transplant with bypass
   32900  C                            Removal of rib(s)
   32905  C                            Revise & repair chest wall
   32906  C                            Revise & repair chest wall
   32940  C                            Revision of lung
   32997  C                            Total lung lavage
   33015  C                            Incision of heart sac
   33020  C                            Incision of heart sac
   33025  C                            Incision of heart sac
   33030  C                            Partial removal of heart sac
   33031  C                            Partial removal of heart sac
   33050  C                            Removal of heart sac lesion
   33120  C                            Removal of heart lesion
   33130  C                            Removal of heart lesion
   33140  C                            Heart revascularize (tmr)
\*\ 3314  C                            Heart revascularize (tmr)
        1
   33200  C                            Insertion of heart pacemaker
   33201  C                            Insertion of heart pacemaker
   33236  C                            Remove electrode/thoracotomy
   33237  C                            Remove electrode/thoracotomy
   33238  C                            Remove electrode/thoracotomy
   33243  C                            Remove eltrd/thoracotomy
   33245  C                            Insert epic eltrd pace-defib
   33246  C                            Insert epic eltrd/generator
   33250  C                            Ablate heart dysrhythm focus
   33251  C                            Ablate heart dysrhythm focus
   33253  C                            Reconstruct atria
   33261  C                            Ablate heart dysrhythm focus
   33300  C                            Repair of heart wound
   33305  C                            Repair of heart wound
   33310  C                            Exploratory heart surgery
   33315  C                            Exploratory heart surgery
   33320  C                            Repair major blood vessel(s)
   33321  C                            Repair major vessel
   33322  C                            Repair major blood vessel(s)
   33330  C                            Insert major vessel graft
   33332  C                            Insert major vessel graft
   33335  C                            Insert major vessel graft
   33400  C                            Repair of aortic valve
   33401  C                            Valvuloplasty, open
   33403  C                            Valvuloplasty, w/cp bypass
   33404  C                            Prepare heart-aorta conduit
   33405  C                            Replacement of aortic valve
   33406  C                            Replacement of aortic valve
   33410  C                            Replacement of aortic valve
   33411  C                            Replacement of aortic valve

[[Page 68008]]

 
   33412  C                            Replacement of aortic valve
   33413  C                            Replacement of aortic valve
   33414  C                            Repair of aortic valve
   33415  C                            Revision, subvalvular tissue
   33416  C                            Revise ventricle muscle
   33417  C                            Repair of aortic valve
   33420  C                            Revision of mitral valve
   33422  C                            Revision of mitral valve
   33425  C                            Repair of mitral valve
   33426  C                            Repair of mitral valve
   33427  C                            Repair of mitral valve
   33430  C                            Replacement of mitral valve
   33460  C                            Revision of tricuspid valve
   33463  C                            Valvuloplasty, tricuspid
   33464  C                            Valvuloplasty, tricuspid
   33465  C                            Replace tricuspid valve
   33468  C                            Revision of tricuspid valve
   33470  C                            Revision of pulmonary valve
   33471  C                            Valvotomy, pulmonary valve
   33472  C                            Revision of pulmonary valve
   33474  C                            Revision of pulmonary valve
   33475  C                            Replacement, pulmonary valve
   33476  C                            Revision of heart chamber
   33478  C                            Revision of heart chamber
   33496  C                            Repair, prosth valve clot
   33500  C                            Repair heart vessel fistula
   33501  C                            Repair heart vessel fistula
   33502  C                            Coronary artery correction
   33503  C                            Coronary artery graft
   33504  C                            Coronary artery graft
   33505  C                            Repair artery w/tunnel
   33506  C                            Repair artery, translocation
   33510  C                            CABG, vein, single
   33511  C                            CABG, vein, two
   33512  C                            CABG, vein, three
   33513  C                            CABG, vein, four
   33514  C                            CABG, vein, five
   33516  C                            Cabg, vein, six or more
   33517  C                            CABG, artery-vein, single
   33518  C                            CABG, artery-vein, two
   33519  C                            CABG, artery-vein, three
   33521  C                            CABG, artery-vein, four
   33522  C                            CABG, artery-vein, five
   33523  C                            Cabg, art-vein, six or more
   33530  C                            Coronary artery, bypass/reop
   33533  C                            CABG, arterial, single
   33534  C                            CABG, arterial, two
   33535  C                            CABG, arterial, three
   33536  C                            Cabg, arterial, four or more
   33542  C                            Removal of heart lesion
   33545  C                            Repair of heart damage
   33572  C                            Open coronary endarterectomy
   33600  C                            Closure of valve
   33602  C                            Closure of valve
   33606  C                            Anastomosis/artery-aorta
   33608  C                            Repair anomaly w/conduit
   33610  C                            Repair by enlargement
   33611  C                            Repair double ventricle
   33612  C                            Repair double ventricle
   33615  C                            Repair, simple fontan
   33617  C                            Repair, modified fontan
   33619  C                            Repair single ventricle
   33641  C                            Repair heart septum defect
   33645  C                            Revision of heart veins
   33647  C                            Repair heart septum defects
   33660  C                            Repair of heart defects
   33665  C                            Repair of heart defects
   33670  C                            Repair of heart chambers
   33681  C                            Repair heart septum defect
   33684  C                            Repair heart septum defect
   33688  C                            Repair heart septum defect
   33690  C                            Reinforce pulmonary artery
   33692  C                            Repair of heart defects
   33694  C                            Repair of heart defects
   33697  C                            Repair of heart defects
   33702  C                            Repair of heart defects
   33710  C                            Repair of heart defects
   33720  C                            Repair of heart defect
   33722  C                            Repair of heart defect
   33730  C                            Repair heart-vein defect(s)
   33732  C                            Repair heart-vein defect
   33735  C                            Revision of heart chamber
   33736  C                            Revision of heart chamber
   33737  C                            Revision of heart chamber
   33750  C                            Major vessel shunt
   33755  C                            Major vessel shunt
   33762  C                            Major vessel shunt
   33764  C                            Major vessel shunt & graft
   33766  C                            Major vessel shunt
   33767  C                            Major vessel shunt
   33770  C                            Repair great vessels defect
   33771  C                            Repair great vessels defect
   33774  C                            Repair great vessels defect
   33775  C                            Repair great vessels defect
   33776  C                            Repair great vessels defect
   33777  C                            Repair great vessels defect
   33778  C                            Repair great vessels defect
   33779  C                            Repair great vessels defect
   33780  C                            Repair great vessels defect
   33781  C                            Repair great vessels defect
   33786  C                            Repair arterial trunk
   33788  C                            Revision of pulmonary artery
   33800  C                            Aortic suspension
   33802  C                            Repair vessel defect
   33803  C                            Repair vessel defect
   33813  C                            Repair septal defect
   33814  C                            Repair septal defect
   33820  C                            Revise major vessel
   33822  C                            Revise major vessel
   33824  C                            Revise major vessel
   33840  C                            Remove aorta constriction
   33845  C                            Remove aorta constriction
   33851  C                            Remove aorta constriction
   33852  C                            Repair septal defect
   33853  C                            Repair septal defect
   33860  C                            Ascending aortic graft
   33861  C                            Ascending aortic graft
   33863  C                            Ascending aortic graft
   33870  C                            Transverse aortic arch graft
   33875  C                            Thoracic aortic graft
   33877  C                            Thoracoabdominal graft
   33910  C                            Remove lung artery emboli
   33915  C                            Remove lung artery emboli
   33916  C                            Surgery of great vessel
   33917  C                            Repair pulmonary artery
   33918  C                            Repair pulmonary atresia
   33919  C                            Repair pulmonary atresia
   33920  C                            Repair pulmonary atresia
   33922  C                            Transect pulmonary artery
   33924  C                            Remove pulmonary shunt
   33930  C                            Removal of donor heart/lung
   33935  C                            Transplantation, heart/lung
   33940  C                            Removal of donor heart
   33945  C                            Transplantation of heart
   33960  C                            External circulation assist
   33961  C                            External circulation assist
   33968  C                            Remove aortic assist device
   33970  C                            Aortic circulation assist
   33971  C                            Aortic circulation assist
   33973  C                            Insert balloon device
   33974  C                            Remove intra-aortic balloon
   33975  C                            Implant ventricular device
   33976  C                            Implant ventricular device
   33977  C                            Remove ventricular device
   33978  C                            Remove ventricular device
   34001  C                            Removal of artery clot
   34051  C                            Removal of artery clot
   34151  C                            Removal of artery clot
   34401  C                            Removal of vein clot
   34451  C                            Removal of vein clot
   34502  C                            Reconstruct vena cava
\*\ 3480  C                            Repair abdominal aortic aneurysm
        0
\*\ 3480  C                            Repair abdominal aortic aneurysm
        2
\*\ 3480  C                            Repair abdominal aortic aneurysm
        4
\*\ 3480  C                            Repair abdominal aortic aneurysm
        8
\*\ 3481  C                            Repair abdominal aortic aneurysm
        2
\*\ 3481  C                            Repair abdominal aortic aneurysm
        3
\*\ 3482  C                            Repair abdominal aortic aneurysm
        0
\*\ 3482  C                            Repair abdominal aortic aneurysm
        5
\*\ 3482  C                            Repair abdominal aortic aneurysm
        6
\*\ 3483  C                            Repair abdominal aortic aneurysm
        0
\*\ 3483  C                            Repair abdominal aortic aneurysm
        1
\*\ 3483  C                            Repair abdominal aortic aneurysm
        2
   35001  C                            Repair defect of artery
   35002  C                            Repair artery rupture, neck
   35005  C                            Repair defect of artery
   35013  C                            Repair artery rupture, arm
   35021  C                            Repair defect of artery
   35022  C                            Repair artery rupture, chest
   35045  C                            Repair defect of arm artery
   35081  C                            Repair defect of artery
   35082  C                            Repair artery rupture, aorta
   35091  C                            Repair defect of artery
   35092  C                            Repair artery rupture, aorta
   35102  C                            Repair defect of artery
   35103  C                            Repair artery rupture, groin
   35111  C                            Repair defect of artery
   35112  C                            Repair artery rupture,spleen
   35121  C                            Repair defect of artery
   35122  C                            Repair artery rupture, belly
   35131  C                            Repair defect of artery
   35132  C                            Repair artery rupture, groin
   35141  C                            Repair defect of artery
   35142  C                            Repair artery rupture, thigh
   35151  C                            Repair defect of artery
   35152  C                            Repair artery rupture, knee
   35161  C                            Repair defect of artery
   35162  C                            Repair artery rupture
   35182  C                            Repair blood vessel lesion
   35189  C                            Repair blood vessel lesion
   35211  C                            Repair blood vessel lesion
   35216  C                            Repair blood vessel lesion
   35221  C                            Repair blood vessel lesion
   35241  C                            Repair blood vessel lesion
   35246  C                            Repair blood vessel lesion
   35251  C                            Repair blood vessel lesion
   35271  C                            Repair blood vessel lesion
   35276  C                            Repair blood vessel lesion
   35281  C                            Repair blood vessel lesion

[[Page 68009]]

 
   35301  C                            Rechanneling of artery
   35311  C                            Rechanneling of artery
   35331  C                            Rechanneling of artery
   35341  C                            Rechanneling of artery
   35351  C                            Rechanneling of artery
   35355  C                            Rechanneling of artery
   35361  C                            Rechanneling of artery
   35363  C                            Rechanneling of artery
   35371  C                            Rechanneling of artery
   35372  C                            Rechanneling of artery
   35381  C                            Rechanneling of artery
   35390  C                            Reoperation, carotid add-on
   35400  C                            Angioscopy
   35450  C                            Repair arterial blockage
   35452  C                            Repair arterial blockage
   35454  C                            Repair arterial blockage
   35456  C                            Repair arterial blockage
   35480  C                            Atherectomy, open
   35482  C                            Atherectomy, open
   35483  C                            Atherectomy, open
   35501  C                            Artery bypass graft
   35506  C                            Artery bypass graft
   35507  C                            Artery bypass graft
   35508  C                            Artery bypass graft
   35509  C                            Artery bypass graft
   35511  C                            Artery bypass graft
   35515  C                            Artery bypass graft
   35516  C                            Artery bypass graft
   35518  C                            Artery bypass graft
   35521  C                            Artery bypass graft
   35526  C                            Artery bypass graft
   35531  C                            Artery bypass graft
   35533  C                            Artery bypass graft
   35536  C                            Artery bypass graft
   35541  C                            Artery bypass graft
   35546  C                            Artery bypass graft
   35548  C                            Artery bypass graft
   35549  C                            Artery bypass graft
   35551  C                            Artery bypass graft
   35556  C                            Artery bypass graft
   35558  C                            Artery bypass graft
   35560  C                            Artery bypass graft
   35563  C                            Artery bypass graft
   35565  C                            Artery bypass graft
   35566  C                            Artery bypass graft
   35571  C                            Artery bypass graft
   35582  C                            Vein bypass graft
   35583  C                            Vein bypass graft
   35585  C                            Vein bypass graft
   35587  C                            Vein bypass graft
\*\ 3560  C                            Harvest artery graft
        0
   35601  C                            Artery bypass graft
   35606  C                            Artery bypass graft
   35612  C                            Artery bypass graft
   35616  C                            Artery bypass graft
   35621  C                            Artery bypass graft
   35623  C                            Bypass graft, not vein
   35626  C                            Artery bypass graft
   35631  C                            Artery bypass graft
   35636  C                            Artery bypass graft
   35641  C                            Artery bypass graft
   35642  C                            Artery bypass graft
   35645  C                            Artery bypass graft
   35646  C                            Artery bypass graft
   35650  C                            Artery bypass graft
   35651  C                            Artery bypass graft
   35654  C                            Artery bypass graft
   35656  C                            Artery bypass graft
   35661  C                            Artery bypass graft
   35663  C                            Artery bypass graft
   35665  C                            Artery bypass graft
   35666  C                            Artery bypass graft
   35671  C                            Artery bypass graft
   35681  C                            Composite bypass graft
   35682  C                            Composite bypass graft
   35683  C                            Composite bypass graft
   35691  C                            Arterial transposition
   35693  C                            Arterial transposition
   35694  C                            Arterial transposition
   35695  C                            Arterial transposition
   35700  C                            Reoperation, bypass graft
   35701  C                            Exploration, carotid artery
   35721  C                            Exploration, femoral artery
   35741  C                            Exploration popliteal artery
   35800  C                            Explore neck vessels
   35820  C                            Explore chest vessels
   35840  C                            Explore abdominal vessels
   35870  C                            Repair vessel graft defect
   35901  C                            Excision, graft, neck
   35905  C                            Excision, graft, thorax
   35907  C                            Excision, graft, abdomen
   36510  C                            Insertion of catheter, vein
   36660  C                            Insertion catheter, artery
   36822  C                            Insertion of cannula(s)
   36823  C                            Insertion of cannula(s)
   37140  C                            Revision of circulation
   37145  C                            Revision of circulation
   37160  C                            Revision of circulation
   37180  C                            Revision of circulation
   37181  C                            Splice spleen/kidney veins
   37195  C                            Thrombolytic therapy, stroke
   37616  C                            Ligation of chest artery
   37617  C                            Ligation of abdomen artery
   37618  C                            Ligation of extremity artery
   37660  C                            Revision of major vein
   37788  C                            Revascularization, penis
   38100  C                            Removal of spleen, total
   38101  C                            Removal of spleen, partial
   38102  C                            Removal of spleen, total
   38115  C                            Repair of ruptured spleen
   38380  C                            Thoracic duct procedure
   38381  C                            Thoracic duct procedure
   38382  C                            Thoracic duct procedure
   38562  C                            Removal, pelvic lymph nodes
   38564  C                            Removal, abdomen lymph nodes
   38700  C                            Removal of lymph nodes, neck
   38724  C                            Removal of lymph nodes, neck
   38746  C                            Remove thoracic lymph nodes
   38747  C                            Remove abdominal lymph nodes
   38765  C                            Remove groin lymph nodes
   38770  C                            Remove pelvis lymph nodes
   38780  C                            Remove abdomen lymph nodes
   39000  C                            Exploration of chest
   39010  C                            Exploration of chest
   39200  C                            Removal chest lesion
   39220  C                            Removal chest lesion
   39499  C                            Chest procedure
   39501  C                            Repair diaphragm laceration
   39502  C                            Repair paraesophageal hernia
   39503  C                            Repair of diaphragm hernia
   39520  C                            Repair of diaphragm hernia
   39530  C                            Repair of diaphragm hernia
   39531  C                            Repair of diaphragm hernia
   39540  C                            Repair of diaphragm hernia
   39541  C                            Repair of diaphragm hernia
   39545  C                            Revision of diaphragm
   39560  C                            Resect diaphragm, simple
   39561  C                            Resect diaphragm, complex
   39599  C                            Diaphragm surgery procedure
   41130  C                            Partial removal of tongue
   41135  C                            Tongue and neck surgery
   41140  C                            Removal of tongue
   41145  C                            Tongue removal, neck surgery
   41150  C                            Tongue, mouth, jaw surgery
   41153  C                            Tongue, mouth, neck surgery
   41155  C                            Tongue, jaw, & neck surgery
   42426  C                            Excise parotid gland/lesion
   42842  C                            Extensive surgery of throat
   42845  C                            Extensive surgery of throat
   42894  C                            Revision of pharyngeal walls
   42953  C                            Repair throat, esophagus
   42961  C                            Control throat bleeding
   42971  C                            Control nose/throat bleeding
   43030  C                            Throat muscle surgery
   43045  C                            Incision of esophagus
   43100  C                            Excision of esophagus lesion
   43101  C                            Excision of esophagus lesion
   43107  C                            Removal of esophagus
   43108  C                            Removal of esophagus
   43112  C                            Removal of esophagus
   43113  C                            Removal of esophagus
   43116  C                            Partial removal of esophagus
   43117  C                            Partial removal of esophagus
   43118  C                            Partial removal of esophagus
   43121  C                            Partial removal of esophagus
   43122  C                            Parital removal of esophagus
   43123  C                            Partial removal of esophagus
   43124  C                            Removal of esophagus
   43135  C                            Removal of esophagus pouch
   43300  C                            Repair of esophagus
   43305  C                            Repair esophagus and fistula
   43310  C                            Repair of esophagus
   43312  C                            Repair esophagus and fistula
   43320  C                            Fuse esophagus & stomach
   43324  C                            Revise esophagus & stomach
   43325  C                            Revise esophagus & stomach
   43326  C                            Revise esophagus & stomach
   43330  C                            Repair of esophagus
   43331  C                            Repair of esophagus
   43340  C                            Fuse esophagus & intestine
   43341  C                            Fuse esophagus & intestine
   43350  C                            Surgical opening, esophagus
   43351  C                            Surgical opening, esophagus
   43352  C                            Surgical opening, esophagus
   43360  C                            Gastrointestinal repair
   43361  C                            Gastrointestinal repair
   43400  C                            Ligate esophagus veins
   43401  C                            Esophagus surgery for veins
   43405  C                            Ligate/staple esophagus
   43410  C                            Repair esophagus wound
   43415  C                            Repair esophagus wound
   43420  C                            Repair esophagus opening
   43425  C                            Repair esophagus opening
   43460  C                            Pressure treatment esophagus
   43496  C                            Free jejunum flap, microvasc
   43500  C                            Surgical opening of stomach
   43501  C                            Surgical repair of stomach
   43502  C                            Surgical repair of stomach
   43510  C                            Surgical opening of stomach
   43520  C                            Incision of pyloric muscle
   43605  C                            Biopsy of stomach
   43610  C                            Excision of stomach lesion
   43611  C                            Excision of stomach lesion
   43620  C                            Removal of stomach
   43621  C                            Removal of stomach
   43622  C                            Removal of stomach
   43631  C                            Removal of stomach, partial
   43632  C                            Removal of stomach, partial

[[Page 68010]]

 
   43633  C                            Removal of stomach, partial
   43634  C                            Removal of stomach, partial
   43635  C                            Removal of stomach, partial
   43638  C                            Removal of stomach, partial
   43639  C                            Removal of stomach, partial
   43640  C                            Vagotomy & pylorus repair
   43641  C                            Vagotomy & pylorus repair
   43800  C                            Reconstruction of pylorus
   43810  C                            Fusion of stomach and bowel
   43820  C                            Fusion of stomach and bowel
   43825  C                            Fusion of stomach and bowel
   43832  C                            Place gastrostomy tube
   43840  C                            Repair of stomach lesion
   43842  C                            Gastroplasty for obesity
   43843  C                            Gastroplasty for obesity
   43846  C                            Gastric bypass for obesity
   43847  C                            Gastric bypass for obesity
   43848  C                            Revision gastroplasty
   43850  C                            Revise stomach-bowel fusion
   43855  C                            Revise stomach-bowel fusion
   43860  C                            Revise stomach-bowel fusion
   43865  C                            Revise stomach-bowel fusion
   43880  C                            Repair stomach-bowel fistula
   44005  C                            Freeing of bowel adhesion
   44010  C                            Incision of small bowel
   44015  C                            Insert needle cath bowel
   44020  C                            Exploration of small bowel
   44021  C                            Decompress small bowel
   44025  C                            Incision of large bowel
   44050  C                            Reduce bowel obstruction
   44055  C                            Correct malrotation of bowel
   44110  C                            Excision of bowel lesion(s)
   44111  C                            Excision of bowel lesion(s)
   44120  C                            Removal of small intestine
   44121  C                            Removal of small intestine
   44125  C                            Removal of small intestine
\*\ 4413  C                            Bowel to bowel fusion
        0
\*\ 4413  C                            Donor enterectomy
        2
\*\ 4413  C                            Donor enterectomy
        3
\*\ 4413  C                            Intestinal allotransplantation
        5
\*\ 4413  C                            Intestinal allotransplantation
        6
   44139  C                            Mobilization of colon
   44140  C                            Partial removal of colon
   44141  C                            Partial removal of colon
   44143  C                            Partial removal of colon
   44144  C                            Partial removal of colon
   44145  C                            Partial removal of colon
   44146  C                            Partial removal of colon
   44147  C                            Partial removal of colon
   44150  C                            Removal of colon
   44151  C                            Removal of colon/ileostomy
   44152  C                            Removal of colon/ileostomy
   44153  C                            Removal of colon/ileostomy
   44155  C                            Removal of colon/ileostomy
   44156  C                            Removal of colon/ileostomy
   44160  C                            Removal of colon
   44202  C                            Laparo, resect intestine
   44300  C                            Open bowel to skin
   44310  C                            Ileostomy/jejunostomy
   44314  C                            Revision of ileostomy
   44316  C                            Devise bowel pouch
   44320  C                            Colostomy
   44322  C                            Colostomy with biopsies
   44345  C                            Revision of colostomy
   44346  C                            Revision of colostomy
   44602  C                            Suture, small intestine
   44603  C                            Suture, small intestine
   44604  C                            Suture, large intestine
   44605  C                            Repair of bowel lesion
   44615  C                            Intestinal stricturoplasty
   44620  C                            Repair bowel opening
   44625  C                            Repair bowel opening
   44626  C                            Repair bowel opening
   44640  C                            Repair bowel-skin fistula
   44650  C                            Repair bowel fistula
   44660  C                            Repair bowel-bladder fistula
   44661  C                            Repair bowel-bladder fistula
   44680  C                            Surgical revision, intestine
   44700  C                            Suspend bowel w/prosthesis
   44800  C                            Excision of bowel pouch
   44820  C                            Excision of mesentery lesion
   44850  C                            Repair of mesentery
   44899  C                            Bowel surgery procedure
   44900  C                            Drain app abscess, open
   44901  C                            Drain app abscess, percut
   44950  C                            Appendectomy
   44955  C                            Appendectomy add-on
   44960  C                            Appendectomy
   45110  C                            Removal of rectum
   45111  C                            Partial removal of rectum
   45112  C                            Removal of rectum
   45113  C                            Partial proctectomy
   45114  C                            Partial removal of rectum
   45116  C                            Partial removal of rectum
   45119  C                            Remove rectum w/reservoir
   45120  C                            Removal of rectum
   45121  C                            Removal of rectum and colon
   45123  C                            Partial proctectomy
   45126  C                            Pelvic exenteration
   45130  C                            Excision of rectal prolapse
   45135  C                            Excision of rectal prolapse
   45540  C                            Correct rectal prolapse
   45541  C                            Correct rectal prolapse
   45550  C                            Repair rectum/remove sigmoid
   45562  C                            Exploration/repair of rectum
   45563  C                            Exploration/repair of rectum
   45800  C                            Repair rect/bladder fistula
   45805  C                            Repair fistula w/colostomy
   45820  C                            Repair rectourethral fistula
   45825  C                            Repair fistula w/colostomy
   46705  C                            Repair of anal stricture
   46715  C                            Repair of anovaginal fistula
   46716  C                            Repair of anovaginal fistula
   46730  C                            Construction of absent anus
   46735  C                            Construction of absent anus
   46740  C                            Construction of absent anus
   46742  C                            Repair of imperforated anus
   46744  C                            Repair of cloacal anomaly
   46746  C                            Repair of cloacal anomaly
   46748  C                            Repair of cloacal anomaly
   46751  C                            Repair of anal sphincter
   47001  C                            Needle biopsy, liver add-on
   47010  C                            Open drainage, liver lesion
   47011  C                            Percut drain, liver lesion
   47015  C                            Inject/aspirate liver cyst
   47100  C                            Wedge biopsy of liver
   47120  C                            Partial removal of liver
   47122  C                            Extensive removal of liver
   47125  C                            Partial removal of liver
   47130  C                            Partial removal of liver
   47133  C                            Removal of donor liver
   47134  C                            Partial removal, donor liver
   47135  C                            Transplantation of liver
   47136  C                            Transplantation of liver
   47300  C                            Surgery for liver lesion
   47350  C                            Repair liver wound
   47360  C                            Repair liver wound
   47361  C                            Repair liver wound
   47362  C                            Repair liver wound
   47400  C                            Incision of liver duct
   47420  C                            Incision of bile duct
   47425  C                            Incision of bile duct
   47460  C                            Incise bile duct sphincter
   47480  C                            Incision of gallbladder
   47490  C                            Incision of gallbladder
   47550  C                            Bile duct endoscopy add-on
   47570  C                            Laparo cholecystoenterostomy
   47600  C                            Removal of gallbladder
   47605  C                            Removal of gallbladder
   47610  C                            Removal of gallbladder
   47612  C                            Removal of gallbladder
   47620  C                            Removal of gallbladder
   47700  C                            Exploration of bile ducts
   47701  C                            Bile duct revision
   47711  C                            Excision of bile duct tumor
   47712  C                            Excision of bile duct tumor
   47715  C                            Excision of bile duct cyst
   47716  C                            Fusion of bile duct cyst
   47720  C                            Fuse gallbladder & bowel
   47721  C                            Fuse upper gi structures
   47740  C                            Fuse gallbladder & bowel
   47741  C                            Fuse gallbladder & bowel
   47760  C                            Fuse bile ducts and bowel
   47765  C                            Fuse liver ducts & bowel
   47780  C                            Fuse bile ducts and bowel
   47785  C                            Fuse bile ducts and bowel
   47800  C                            Reconstruction of bile ducts
   47801  C                            Placement, bile duct support
   47802  C                            Fuse liver duct & intestine
   47900  C                            Suture bile duct injury
   48000  C                            Drainage of abdomen
   48001  C                            Placement of drain, pancreas
   48005  C                            Resect/debride pancreas
   48020  C                            Removal of pancreatic stone
   48100  C                            Biopsy of pancreas
   48120  C                            Removal of pancreas lesion
   48140  C                            Partial removal of pancreas
   48145  C                            Partial removal of pancreas
   48146  C                            Pancreatectomy
   48148  C                            Removal of pancreatic duct
   48150  C                            Partial removal of pancreas
   48152  C                            Pancreatectomy
   48153  C                            Pancreatectomy
   48154  C                            Pancreatectomy
   48155  C                            Removal of pancreas
   48180  C                            Fuse pancreas and bowel
   48400  C                            Injection, intraop add-on
   48500  C                            Surgery of pancreas cyst
   48510  C                            Drain pancreatic pseudocyst
   48511  C                            Drain pancreatic pseudocyst
   48520  C                            Fuse pancreas cyst and bowel
   48540  C                            Fuse pancreas cyst and bowel
   48545  C                            Pancreatorrhaphy
   48547  C                            Duodenal exclusion
   48556  C                            Removal, allograft pancreas
   49000  C                            Exploration of abdomen
   49002  C                            Reopening of abdomen
   49010  C                            Exploration behind abdomen
   49020  C                            Drain abdominal abscess
   49021  C                            Drain abdominal abscess
   49040  C                            Drain, open, abdom abscess
   49041  C                            Drain, percut, abdom abscess
   49060  C                            Drain, open, retrop abscess
   49061  C                            Drain, percut, retroper absc
   49062  C                            Drain to peritoneal cavity
   49200  C                            Removal of abdominal lesion
   49201  C                            Removal of abdominal lesion
   49215  C                            Excise sacral spine tumor
   49220  C                            Multiple surgery, abdomen
   49255  C                            Removal of omentum
   49425  C                            Insert abdomen-venous drain
   49428  C                            Ligation of shunt
   49605  C                            Repair umbilical lesion

[[Page 68011]]

 
   49606  C                            Repair umbilical lesion
   49610  C                            Repair umbilical lesion
   49611  C                            Repair umbilical lesion
   49900  C                            Repair of abdominal wall
   49905  C                            Omental flap
   49906  C                            Free omental flap, microvasc
   50010  C                            Exploration of kidney
   50020  C                            Renal abscess, open drain
   50021  C                            Renal abscess, percut drain
   50040  C                            Drainage of kidney
   50045  C                            Exploration of kidney
   50060  C                            Removal of kidney stone
   50065  C                            Incision of kidney
   50070  C                            Incision of kidney
   50075  C                            Removal of kidney stone
   50100  C                            Revise kidney blood vessels
   50120  C                            Exploration of kidney
   50125  C                            Explore and drain kidney
   50130  C                            Removal of kidney stone
   50135  C                            Exploration of kidney
   50205  C                            Biopsy of kidney
   50220  C                            Removal of kidney
   50225  C                            Removal of kidney
   50230  C                            Removal of kidney
   50234  C                            Removal of kidney & ureter
   50236  C                            Removal of kidney & ureter
   50240  C                            Partial removal of kidney
   50280  C                            Removal of kidney lesion
   50290  C                            Removal of kidney lesion
   50300  C                            Removal of donor kidney
   50320  C                            Removal of donor kidney
   50340  C                            Removal of kidney
   50360  C                            Transplantation of kidney
   50365  C                            Transplantation of kidney
   50370  C                            Remove transplanted kidney
   50380  C                            Reimplantation of kidney
   50400  C                            Revision of kidney/ureter
   50405  C                            Revision of kidney/ureter
   50500  C                            Repair of kidney wound
   50520  C                            Close kidney-skin fistula
   50525  C                            Repair renal-abdomen fistula
   50526  C                            Repair renal-abdomen fistula
   50540  C                            Revision of horseshoe kidney
\*\ 5054  C                            Laparoscopic nephrectomy
        5
   50546  C                            Laparoscopic nephrectomy
   50547  C                            Laparo removal donor kidney
   50548  C                            Laparo-asst remove k/ureter
   50570  C                            Kidney endoscopy
   50572  C                            Kidney endoscopy
   50574  C                            Kidney endoscopy & biopsy
   50575  C                            Kidney endoscopy
   50576  C                            Kidney endoscopy & treatment
   50578  C                            Renal endoscopy/radiotracer
   50580  C                            Kidney endoscopy & treatment
   50600  C                            Exploration of ureter
   50605  C                            Insert ureteral support
   50610  C                            Removal of ureter stone
   50620  C                            Removal of ureter stone
   50630  C                            Removal of ureter stone
   50650  C                            Removal of ureter
   50660  C                            Removal of ureter
   50700  C                            Revision of ureter
   50715  C                            Release of ureter
   50722  C                            Release of ureter
   50725  C                            Release/revise ureter
   50727  C                            Revise ureter
   50728  C                            Revise ureter
   50740  C                            Fusion of ureter & kidney
   50750  C                            Fusion of ureter & kidney
   50760  C                            Fusion of ureters
   50770  C                            Splicing of ureters
   50780  C                            Reimplant ureter in bladder
   50782  C                            Reimplant ureter in bladder
   50783  C                            Reimplant ureter in bladder
   50785  C                            Reimplant ureter in bladder
   50800  C                            Implant ureter in bowel
   50810  C                            Fusion of ureter & bowel
   50815  C                            Urine shunt to bowel
   50820  C                            Construct bowel bladder
   50825  C                            Construct bowel bladder
   50830  C                            Revise urine flow
   50840  C                            Replace ureter by bowel
   50845  C                            Appendico-vesicostomy
   50860  C                            Transplant ureter to skin
   50900  C                            Repair of ureter
   50920  C                            Closure ureter/skin fistula
   50930  C                            Closure ureter/bowel fistula
   50940  C                            Release of ureter
   51060  C                            Removal of ureter stone
   51525  C                            Removal of bladder lesion
   51530  C                            Removal of bladder lesion
   51535  C                            Repair of ureter lesion
   51550  C                            Partial removal of bladder
   51555  C                            Partial removal of bladder
   51565  C                            Revise bladder & ureter(s)
   51570  C                            Removal of bladder
   51575  C                            Removal of bladder & nodes
   51580  C                            Remove bladder/revise tract
   51585  C                            Removal of bladder & nodes
   51590  C                            Remove bladder/revise tract
   51595  C                            Remove bladder/revise tract
   51596  C                            Remove bladder/create pouch
   51597  C                            Removal of pelvic structures
   51800  C                            Revision of bladder/urethra
   51820  C                            Revision of urinary tract
   51840  C                            Attach bladder/urethra
   51841  C                            Attach bladder/urethra
   51845  C                            Repair bladder neck
   51860  C                            Repair of bladder wound
   51865  C                            Repair of bladder wound
   51900  C                            Repair bladder/vagina lesion
   51920  C                            Close bladder-uterus fistula
   51925  C                            Hysterectomy/bladder repair
   51940  C                            Correction of bladder defect
   51960  C                            Revision of bladder & bowel
   51980  C                            Construct bladder opening
   53085  C                            Drainage of urinary leakage
   53415  C                            Reconstruction of urethra
   53443  C                            Reconstruction of urethra
   54125  C                            Removal of penis
   54130  C                            Remove penis & nodes
   54135  C                            Remove penis & nodes
   54332  C                            Revise penis/urethra
   54336  C                            Revise penis/urethra
   54390  C                            Repair penis and bladder
   54430  C                            Revision of penis
   54535  C                            Extensive testis surgery
   54560  C                            Exploration for testis
   54650  C                            Orchiopexy (Fowler-Stephens)
   55600  C                            Incise sperm duct pouch
   55605  C                            Incise sperm duct pouch
   55650  C                            Remove sperm duct pouch
   55801  C                            Removal of prostate
   55810  C                            Extensive prostate surgery
   55812  C                            Extensive prostate surgery
   55815  C                            Extensive prostate surgery
   55821  C                            Removal of prostate
   55831  C                            Removal of prostate
   55840  C                            Extensive prostate surgery
   55842  C                            Extensive prostate surgery
   55845  C                            Extensive prostate surgery
   55862  C                            Extensive prostate surgery
   55865  C                            Extensive prostate surgery
   56630  C                            Extensive vulva surgery
   56631  C                            Extensive vulva surgery
   56632  C                            Extensive vulva surgery
   56633  C                            Extensive vulva surgery
   56634  C                            Extensive vulva surgery
   56637  C                            Extensive vulva surgery
   56640  C                            Extensive vulva surgery
   57110  C                            Remove vagina wall, complete
   57111  C                            Remove vagina tissue, compl
   57112  C                            Vaginectomy w/nodes, compl
   57270  C                            Repair of bowel pouch
   57280  C                            Suspension of vagina
   57282  C                            Repair of vaginal prolapse
   57292  C                            Construct vagina with graft
   57305  C                            Repair rectum-vagina fistula
   57307  C                            Fistula repair & colostomy
   57308  C                            Fistula repair, transperine
   57311  C                            Repair urethrovaginal lesion
   57335  C                            Repair vagina
   57531  C                            Removal of cervix, radical
   57540  C                            Removal of residual cervix
   57545  C                            Remove cervix/repair pelvis
   58140  C                            Removal of uterus lesion
   58150  C                            Total hysterectomy
   58152  C                            Total hysterectomy
   58180  C                            Partial hysterectomy
   58200  C                            Extensive hysterectomy
   58210  C                            Extensive hysterectomy
   58240  C                            Removal of pelvis contents
   58260  C                            Vaginal hysterectomy
   58262  C                            Vaginal hysterectomy
   58263  C                            Vaginal hysterectomy
   58267  C                            Hysterectomy & vagina repair
   58270  C                            Hysterectomy & vagina repair
   58275  C                            Hysterectomy/revise vagina
   58280  C                            Hysterectomy/revise vagina
   58285  C                            Extensive hysterectomy
   58400  C                            Suspension of uterus
   58410  C                            Suspension of uterus
   58520  C                            Repair of ruptured uterus
   58540  C                            Revision of uterus
   58605  C                            Division of fallopian tube
   58611  C                            Ligate oviduct(s) add-on
   58700  C                            Removal of fallopian tube
   58720  C                            Removal of ovary/tube(s)
   58740  C                            Revise fallopian tube(s)
   58750  C                            Repair oviduct
   58752  C                            Revise ovarian tube(s)
   58760  C                            Remove tubal obstruction
   58770  C                            Create new tubal opening
   58805  C                            Drainage of ovarian cyst(s)
   58822  C                            Drain ovary abscess, percut
   58823  C                            Drain pelvic abscess, percut
   58825  C                            Transposition, ovary(s)
   58940  C                            Removal of ovary(s)
   58943  C                            Removal of ovary(s)
   58950  C                            Resect ovarian malignancy
   58951  C                            Resect ovarian malignancy
   58952  C                            Resect ovarian malignancy
   58960  C                            Exploration of abdomen
   59100  C                            Remove uterus lesion
   59120  C                            Treat ectopic pregnancy
   59121  C                            Treat ectopic pregnancy
   59130  C                            Treat ectopic pregnancy
   59135  C                            Treat ectopic pregnancy
   59136  C                            Treat ectopic pregnancy
   59140  C                            Treat ectopic pregnancy
   59325  C                            Revision of cervix
   59350  C                            Repair of uterus
   59514  C                            Cesarean delivery only

[[Page 68012]]

 
   59525  C                            Remove uterus after cesarean
   59620  C                            Attempted vbac delivery only
   59830  C                            Treat uterus infection
   59850  C                            Abortion
   59851  C                            Abortion
   59852  C                            Abortion
   59855  C                            Abortion
   59856  C                            Abortion
   59857  C                            Abortion
   60254  C                            Extensive thyroid surgery
   60270  C                            Removal of thyroid
   60271  C                            Removal of thyroid
   60502  C                            Re-explore parathyroids
   60505  C                            Explore parathyroid glands
   60520  C                            Removal of thymus gland
   60521  C                            Removal of thymus gland
   60522  C                            Removal of thymus gland
   60540  C                            Explore adrenal gland
   60545  C                            Explore adrenal gland
   60600  C                            Remove carotid body lesion
   60605  C                            Remove carotid body lesion
   60650  C                            Laparoscopy adrenalectomy
   61105  C                            Twist drill hole
   61107  C                            Drill skull for implantation
   61108  C                            Drill skull for drainage
   61120  C                            Burr hole for puncture
   61140  C                            Pierce skull for biopsy
   61150  C                            Pierce skull for drainage
   61151  C                            Pierce skull for drainage
   61154  C                            Pierce skull & remove clot
   61156  C                            Pierce skull for drainage
   61210  C                            Pierce skull, implant device
   61250  C                            Pierce skull & explore
   61253  C                            Pierce skull & explore
   61304  C                            Open skull for exploration
   61305  C                            Open skull for exploration
   61312  C                            Open skull for drainage
   61313  C                            Open skull for drainage
   61314  C                            Open skull for drainage
   61315  C                            Open skull for drainage
   61320  C                            Open skull for drainage
   61321  C                            Open skull for drainage
   61332  C                            Explore/biopsy eye socket
   61333  C                            Explore orbit/remove lesion
   61334  C                            Explore orbit/remove object
   61340  C                            Relieve cranial pressure
   61343  C                            Incise skull (press relief)
   61345  C                            Relieve cranial pressure
   61440  C                            Incise skull for surgery
   61450  C                            Incise skull for surgery
   61458  C                            Incise skull for brain wound
   61460  C                            Incise skull for surgery
   61470  C                            Incise skull for surgery
   61480  C                            Incise skull for surgery
   61490  C                            Incise skull for surgery
   61500  C                            Removal of skull lesion
   61501  C                            Remove infected skull bone
   61510  C                            Removal of brain lesion
   61512  C                            Remove brain lining lesion
   61514  C                            Removal of brain abscess
   61516  C                            Removal of brain lesion
   61518  C                            Removal of brain lesion
   61519  C                            Remove brain lining lesion
   61520  C                            Removal of brain lesion
   61521  C                            Removal of brain lesion
   61522  C                            Removal of brain abscess
   61524  C                            Removal of brain lesion
   61526  C                            Removal of brain lesion
   61530  C                            Removal of brain lesion
   61531  C                            Implant brain electrodes
   61533  C                            Implant brain electrodes
   61534  C                            Removal of brain lesion
   61535  C                            Remove brain electrodes
   61536  C                            Removal of brain lesion
   61538  C                            Removal of brain tissue
   61539  C                            Removal of brain tissue
   61541  C                            Incision of brain tissue
   61542  C                            Removal of brain tissue
   61543  C                            Removal of brain tissue
   61544  C                            Remove & treat brain lesion
   61545  C                            Excision of brain tumor
   61546  C                            Removal of pituitary gland
   61548  C                            Removal of pituitary gland
   61550  C                            Release of skull seams
   61552  C                            Release of skull seams
   61556  C                            Incise skull/sutures
   61557  C                            Incise skull/sutures
   61558  C                            Excision of skull/sutures
   61559  C                            Excision of skull/sutures
   61563  C                            Excision of skull tumor
   61564  C                            Excision of skull tumor
   61570  C                            Remove foreign body, brain
   61571  C                            Incise skull for brain wound
   61575  C                            Skull base/brainstem surgery
   61576  C                            Skull base/brainstem surgery
   61580  C                            Craniofacial approach, skull
   61581  C                            Craniofacial approach, skull
   61582  C                            Craniofacial approach, skull
   61583  C                            Craniofacial approach, skull
   61584  C                            Orbitocranial approach/skull
   61585  C                            Orbitocranial approach/skull
   61586  C                            Resect nasopharynx, skull
   61590  C                            Infratemporal approach/skull
   61591  C                            Infratemporal approach/skull
   61592  C                            Orbitocranial approach/skull
   61595  C                            Transtemporal approach/skull
   61596  C                            Transcochlear approach/skull
   61597  C                            Transcondylar approach/skull
   61598  C                            Transpetrosal approach/skull
   61600  C                            Resect/excise cranial lesion
   61601  C                            Resect/excise cranial lesion
   61605  C                            Resect/excise cranial lesion
   61606  C                            Resect/excise cranial lesion
   61607  C                            Resect/excise cranial lesion
   61608  C                            Resect/excise cranial lesion
   61609  C                            Transect artery, sinus
   61610  C                            Transect artery, sinus
   61611  C                            Transect artery, sinus
   61612  C                            Transect artery, sinus
   61613  C                            Remove aneurysm, sinus
   61615  C                            Resect/excise lesion, skull
   61616  C                            Resect/excise lesion, skull
   61618  C                            Repair dura
   61619  C                            Repair dura
   61624  C                            Occlusion/embolization cath
   61626  C                            Occlusion/embolization cath
   61680  C                            Intracranial vessel surgery
   61682  C                            Intracranial vessel surgery
   61684  C                            Intracranial vessel surgery
   61686  C                            Intracranial vessel surgery
   61690  C                            Intracranial vessel surgery
   61692  C                            Intracranial vessel surgery
\*\ 6169  C                            Intracranial aneurysm surgery
        7
\*\ 6169  C                            Intracranial aneurysm surgery
        8
   61700  C                            Inner skull vessel surgery
   61702  C                            Inner skull vessel surgery
   61703  C                            Clamp neck artery
   61705  C                            Revise circulation to head
   61708  C                            Revise circulation to head
   61710  C                            Revise circulation to head
   61711  C                            Fusion of skull arteries
   61720  C                            Incise skull/brain surgery
   61735  C                            Incise skull/brain surgery
   61750  C                            Incise skull/brain biopsy
   61751  C                            Brain biopsy w/ ct/mr guide
   61760  C                            Implant brain electrodes
   61770  C                            Incise skull for treatment
   61791  C                            Treat trigeminal tract
   61850  C                            Implant neuroelectrodes
   61860  C                            Implant neuroelectrodes
   61862  C                            Implant neurostimul, subcort
   61870  C                            Implant neuroelectrodes
   61875  C                            Implant neuroelectrodes
   62000  C                            Treat skull fracture
   62005  C                            Treat skull fracture
   62010  C                            Treatment of head injury
   62100  C                            Repair brain fluid leakage
   62115  C                            Reduction of skull defect
   62116  C                            Reduction of skull defect
   62117  C                            Reduction of skull defect
   62120  C                            Repair skull cavity lesion
   62121  C                            Incise skull repair
   62140  C                            Repair of skull defect
   62141  C                            Repair of skull defect
   62142  C                            Remove skull plate/flap
   62143  C                            Replace skull plate/flap
   62145  C                            Repair of skull & brain
   62146  C                            Repair of skull with graft
   62147  C                            Repair of skull with graft
   62180  C                            Establish brain cavity shunt
   62190  C                            Establish brain cavity shunt
   62192  C                            Establish brain cavity shunt
   62200  C                            Establish brain cavity shunt
   62201  C                            Establish brain cavity shunt
   62220  C                            Establish brain cavity shunt
   62223  C                            Establish brain cavity shunt
   62256  C                            Remove brain cavity shunt
   62258  C                            Replace brain cavity shunt
   62351  C                            Implant spinal canal cath
   63001  C                            Removal of spinal lamina
   63003  C                            Removal of spinal lamina
   63005  C                            Removal of spinal lamina
   63011  C                            Removal of spinal lamina
   63012  C                            Removal of spinal lamina
   63015  C                            Removal of spinal lamina
   63016  C                            Removal of spinal lamina
   63017  C                            Removal of spinal lamina
   63020  C                            Neck spine disk surgery
   63030  C                            Low back disk surgery
   63035  C                            Spinal disk surgery add-on
   63040  C                            Neck spine disk surgery
   63042  C                            Low back disk surgery
\*\ 6304  C                            Repair of skull
        3
\*\ 6304  C                            Repair of skull
        4
   63045  C                            Removal of spinal lamina
   63046  C                            Removal of spinal lamina
   63047  C                            Removal of spinal lamina
   63048  C                            Remove spinal lamina add-on
   63055  C                            Decompress spinal cord
   63056  C                            Decompress spinal cord
   63057  C                            Decompress spine cord add-on
   63064  C                            Decompress spinal cord
   63066  C                            Decompress spine cord add-on
   63075  C                            Neck spine disk surgery
   63076  C                            Neck spine disk surgery
   63077  C                            Spine disk surgery, thorax
   63078  C                            Spine disk surgery, thorax
   63081  C                            Removal of vertebral body
   63082  C                            Remove vertebral body add-on
   63085  C                            Removal of vertebral body

[[Page 68013]]

 
   63086  C                            Remove vertebral body add-on
   63087  C                            Removal of vertebral body
   63088  C                            Remove vertebral body add-on
   63090  C                            Removal of vertebral body
   63091  C                            Remove vertebral body add-on
   63170  C                            Incise spinal cord tract(s)
   63172  C                            Drainage of spinal cyst
   63173  C                            Drainage of spinal cyst
   63180  C                            Revise spinal cord ligaments
   63182  C                            Revise spinal cord ligaments
   63185  C                            Incise spinal column/nerves
   63190  C                            Incise spinal column/nerves
   63191  C                            Incise spinal column/nerves
   63194  C                            Incise spinal column & cord
   63195  C                            Incise spinal column & cord
   63196  C                            Incise spinal column & cord
   63197  C                            Incise spinal column & cord
   63198  C                            Incise spinal column & cord
   63199  C                            Incise spinal column & cord
   63200  C                            Release of spinal cord
   63250  C                            Revise spinal cord vessels
   63251  C                            Revise spinal cord vessels
   63252  C                            Revise spinal cord vessels
   63265  C                            Excise intraspinal lesion
   63266  C                            Excise intraspinal lesion
   63267  C                            Excise intraspinal lesion
   63268  C                            Excise intraspinal lesion
   63270  C                            Excise intraspinal lesion
   63271  C                            Excise intraspinal lesion
   63272  C                            Excise intraspinal lesion
   63273  C                            Excise intraspinal lesion
   63275  C                            Biopsy/excise spinal tumor
   63276  C                            Biopsy/excise spinal tumor
   63277  C                            Biopsy/excise spinal tumor
   63278  C                            Biopsy/excise spinal tumor
   63280  C                            Biopsy/excise spinal tumor
   63281  C                            Biopsy/excise spinal tumor
   63282  C                            Biopsy/excise spinal tumor
   63283  C                            Biopsy/excise spinal tumor
   63285  C                            Biopsy/excise spinal tumor
   63286  C                            Biopsy/excise spinal tumor
   63287  C                            Biopsy/excise spinal tumor
   63290  C                            Biopsy/excise spinal tumor
   63300  C                            Removal of vertebral body
   63301  C                            Removal of vertebral body
   63302  C                            Removal of vertebral body
   63303  C                            Removal of vertebral body
   63304  C                            Removal of vertebral body
   63305  C                            Removal of vertebral body
   63306  C                            Removal of vertebral body
   63307  C                            Removal of vertebral body
   63308  C                            Remove vertebral body add-on
   63655  C                            Implant neuroelectrodes
   63700  C                            Repair of spinal herniation
   63702  C                            Repair of spinal herniation
   63704  C                            Repair of spinal herniation
   63706  C                            Repair of spinal herniation
   63707  C                            Repair spinal fluid leakage
   63709  C                            Repair spinal fluid leakage
   63710  C                            Graft repair of spine defect
   63740  C                            Install spinal shunt
   64752  C                            Incision of vagus nerve
   64755  C                            Incision of stomach nerves
   64760  C                            Incision of vagus nerve
   64763  C                            Incise hip/thigh nerve
   64766  C                            Incise hip/thigh nerve
   64802  C                            Remove sympathetic nerves
   64804  C                            Remove sympathetic nerves
   64809  C                            Remove sympathetic nerves
   64818  C                            Remove sympathetic nerves
   64820  C                            Remove sympathetic nerves
   64866  C                            Fusion of facial/other nerve
   64868  C                            Fusion of facial/other nerve
   65273  C                            Repair of eye wound
   69150  C                            Extensive ear canal surgery
   69155  C                            Extensive ear/neck surgery
   69502  C                            Mastoidectomy
   69535  C                            Remove part of temporal bone
   69554  C                            Remove ear lesion
   69950  C                            Incise inner ear nerve
   69970  C                            Remove inner ear lesion
   75900  C                            Arterial catheter exchange
\*\ 7595  C                            Abdominal aortic aneurysm repair
        2
\*\ 7595  C                            Abdominal aortic aneurysm repair
        3
   92970  C                            Cardioassist, internal
   92971  C                            Cardioassist, external
   92975  C                            Dissolve clot, heart vessel
   92986  C                            Revision of aortic valve
   92987  C                            Revision of mitral valve
   92990  C                            Revision of pulmonary valve
   92992  C                            Revision of heart chamber
   92993  C                            Revision of heart chamber
   92997  C                            Pul art balloon repr, percut
   92998  C                            Pul art balloon repr, percut
   94652  C                            Pressure breathing (IPPB)
   99190  C                            Special pump services
   99191  C                            Special pump services
   99192  C                            Special pump services
   99251  C                            Initial inpatient consult
   99252  C                            Initial inpatient consult
   99253  C                            Initial inpatient consult
   99254  C                            Initial inpatient consult
   99255  C                            Initial inpatient consult
   99261  C                            Follow-up inpatient consult
   99262  C                            Follow-up inpatient consult
   99263  C                            Follow-up inpatient consult
   99295  C                            Neonatal critical care
   99296  C                            Neonatal critical care
   99297  C                            Neonatal critical care
   99298  C                            Neonatal critical care
   99356  C                            Prolonged service, inpatient
   99357  C                            Prolonged service, inpatient
   99433  C                            Normal newborn care/hospital
------------------------------------------------------------------------
CPT codes and descriptions only are copyright American Medical
  Association. All Rights Reserved. Applicable FARS/DFARS Apply.
Copyright American Dental Association. All rights reserved.
* Code is new in 2001.

      
  

  

  

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / 
Rules and Regulations

                 Addendum F--Wage Index for Urban Areas
------------------------------------------------------------------------
                                                                   Wage
               Urban Area  (Constituent Counties)                 Index
------------------------------------------------------------------------
0040  Abilene, -+*.............................................   0.8240
  Taylor, TX
0060  Aguadilla, PR............................................   0.4391
  Aguada, PR
  Aguadilla, PR
  Moca, PR
0080  Akron, OH................................................   0.9736
  Portage, OH
  Summit, OH
0120  Albany, GA...............................................   0.9933
  Dougherty, GA
  Lee, GA
0160  Albany-Schenectady-Troy, NY..............................   0.8549
  Albany, NY
  Montgomery, NY
  Rensselaer, NY
  Saratoga, NY
  Schenectady, NY
  Schoharie, NY
0200  Albuquerque, NM..........................................   0.9136
  Bernalillo, NM
  Sandoval, NM
  Valencia, NM
0220  Alexandria, LA...........................................   0.8170
  Rapides, LA
0240  Allentown-Bethlehem-Easton, PA...........................   0.9925
  Carbon, PA
  Lehigh, PA
  Northampton, PA
0280  Altoona, PA..............................................   0.9346
  Blair, PA
0320  Amarillo, TX Potter, TX..................................   0.8715
  Randall, TX
0380  Anchorage, AK............................................   1.2865
  Anchorage, AK
0440  Ann Arbor, MI............................................   1.1254
  Lenawee, MI
  Livingston, MI
  Washtenaw, MI
0450  Anniston, AL.............................................   0.8284
  Calhoun, AL
0460  Appleton-Oshkosh-Neenah, WI..............................   0.9052
  Calumet, WI
  Outagamie, WI
  Winnebago, WI
0470  Arecibo, PR..............................................   0.4525
  Arecibo, PR
  Camuy, PR
  Hatillo, PR
0480  Asheville, NC............................................   0.9516
  Buncombe, NC
  Madison, NC
0500  Athens, GA...............................................   0.9739
  Clarke, GA
  Madison, GA
  Oconee, GA
0520  Atlanta, GA \1\..........................................   1.0096
  Barrow, GA
  Bartow, GA
  Carroll, GA
  Cherokee, GA
  Clayton, GA
  Cobb, GA
  Coweta, GA
  DeKalb, GA
  Douglas, GA
  Fayette, GA
  Forsyth, GA
  Fulton, GA
  Gwinnett, GA
  Henry, GA
  Newton, GA
  Paulding, GA
  Pickens, GA
  Rockdale, GA
  Spalding, GA
  Walton, GA
0560  Atlantic-Cape May, NJ....................................   1.1182
  Atlantic, NJ

[[Page 68014]]

 
  Cape May, NJ
0580  Auburn-Opelika, AL.......................................   0.8106
  Lee, AL
0600  Augusta-Aiken, GA-SC.....................................   0.9160
  Columbia, GA
  McDuffie, GA
  Richmond, GA
  Aiken, SC
  Edgefield, SC
0640  Austin-San Marcos, TX \1\................................   0.9577
  Bastrop, TX
  Caldwell, TX
  Hays, TX
  Travis, TX
  Williamson, TX
0680  Bakersfield, CA \2\......................................   0.9861
  Kern, CA
0720  Baltimore, MD \1\........................................   0.9365
  Anne Arundel, MD
  Baltimore County, MD
  Baltimore City, MD
  Carroll, MD
  Harford, MD
  Howard, MD
  Queen Anne's, MD
0733  Bangor, ME...............................................   0.9561
  Penobscot, ME
0743  Barnstable-Yarmouth, MA..................................   1.3839
  Barnstable, MA
0760  Baton Rouge, LA..........................................   0.8842
  Ascension, LA
  East Baton Rouge, LA
  Livingston, LA
  West Baton Rouge, LA
0840  Beaumont-Port Arthur, TX.................................   0.8744
  Hardin, TX
  Jefferson, TX
  Orange, TX
0860  Bellingham, WA...........................................   1.1439
  Whatcom, WA
0870  Benton Harbor, MI \2\....................................   0.9021
  Berrien, MI
0875  Bergen-Passaic, NJ \1\...................................   1.1605
  Bergen, NJ
  Passaic, NJ
0880  Billings, MT.............................................   0.9591
  Yellowstone, MT
0920  Biloxi-Gulfport-Pascagoula, MS...........................   0.8236
  Hancock, MS
  Harrison, MS
  Jackson, MS
0960  Binghamton, NY...........................................   0.8690
  Broome, NY
  Tioga, NY
1000  Birmingham, AL...........................................   0.8477
  Blount, AL
  Jefferson, AL
  St. Clair, AL
  Shelby, AL
1010  Bismarck, ND.............................................   0.7897
  Burleigh, ND
  Morton, ND
1020  Bloomington, IN..........................................   0.8733
  Monroe, IN
1040  Bloomington-Normal, IL...................................   0.9156
  McLean, IL
1080  Boise City, ID...........................................   0.9042
  Ada, ID
  Canyon, ID
1123  Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH (MA        1.1204
 Hospitals) \1\, \2\...........................................
  Bristol, MA
  Essex, MA
  Middlesex, MA
  Norfolk, MA
  Plymouth, MA
  Suffolk, MA
  Worcester, MA
  Hillsborough, NH
  Merrimack, NH
  Rockingham, NH
  Strafford, NH
1123  Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH (NH        1.1160
 Hospitals) \1\................................................
  Bristol, MA
  Essex, MA
  Middlesex, MA
  Norfolk, MA
  Plymouth, MA
  Suffolk, MA
  Worcester, MA
  Hillsborough, NH
  Merrimack, NH
  Rockingham, NH
  Strafford, NH
1125  Boulder-Longmont, CO.....................................   0.9731
  Boulder, CO
1145  Brazoria, TX.............................................   0.8658
  Brazoria, TX
1150  Bremerton, WA............................................   1.0975
  Kitsap, WA
1240  Brownsville-Harlingen-San Benito, TX.....................   0.8722
  Cameron, TX
1260  Bryan-College Station, TX................................   0.8237
  Brazos, TX
1280  Buffalo-Niagara Falls, NY \1\............................   0.9580
  Erie, NY
  Niagara, NY
1303  Burlington, VT...........................................   1.0735
  Chittenden, VT
  Franklin, VT
  Grand Isle, VT
1310  Caguas, PR...............................................   0.4562
  Caguas, PR
  Cayey, PR
  Cidra, PR
  Gurabo, PR
  San Lorenzo, PR
1320  Canton-Massillon, OH \2\.................................   0.8670
  Carroll, OH
  Stark, OH
1350  Casper, WY \2\...........................................   0.8817
  Natrona, WY
1360  Cedar Rapids, IA.........................................   0.8736
  Linn, IA
1400  Champaign-Urbana, IL.....................................   0.9198
  Champaign, IL
1440  Charleston-North Charleston, SC..........................   0.9067
  Berkeley, SC
  Charleston, SC
  Dorchester, SC
1480  Charleston, WV...........................................   0.9240
  Kanawha, WV
  Putnam, WV
1520  Charlotte-Gastonia-Rock Hill, NC-SC \1\..................   0.9391
  Cabarrus, NC
  Gaston, NC
  Lincoln, NC
  Mecklenburg, NC
  Rowan, NC
  Stanly, NC
  Union, NC
  York, SC
1540  Charlottesville, VA......................................   1.0789
  Albemarle, VA
  Charlottesville City, VA
  Fluvanna, VA
  Greene, VA
1560  Chattanooga, TN-GA.......................................   0.9833
  Catoosa, GA
  Dade, GA
  Walker, GA
  Hamilton, TN
  Marion, TN
1580  Cheyenne, WY \2\.........................................   0.8817
  Laramie, WY
1600  Chicago, IL \1\..........................................   1.1146
  Cook, IL
  DeKalb, IL
  DuPage, IL
  Grundy, IL
  Kane, IL
  Kendall, IL
  Lake, IL
  McHenry, IL
  Will, IL
1620  Chico-Paradise, CA.......................................   0.9918
  Butte, CA
1640  Cincinnati, OH-KY-IN \1\.................................   0.9415
  Dearborn, IN
  Ohio, IN
  Boone, KY
  Campbell, KY
  Gallatin, KY
  Grant, KY
  Kenton, KY
  Pendleton, KY
  Brown, OH
  Clermont, OH
  Hamilton, OH
  Warren, OH
1660  Clarksville-Hopkinsville, TN-KY..........................   0.8277
  Christian, KY
  Montgomery, TN
1680  Cleveland-Lorain-Elyria, OH \1\..........................   0.9593
  Ashtabula, OH
  Cuyahoga, OH
  Geauga, OH
  Lake, OH
  Lorain, OH
  Medina, OH
1720  Colorado Springs, CO.....................................   0.9697
  El Paso, CO
1740  Columbia, MO.............................................   0.8961
  Boone, MO
1760  Columbia, SC.............................................   0.9554
  Lexington, SC
  Richland, SC
1800  Columbus, GA-AL Russell, AL..............................   0.8568
  Chattahoochee, GA
  Harris, GA
  Muscogee, GA
1840  Columbus, OH \1\.........................................   0.9619
  Delaware, OH
  Fairfield, OH
  Franklin, OH
  Licking, OH
  Madison, OH
  Pickaway, OH
1880  Corpus Christi, TX.......................................   0.8726
  Nueces, TX
  San Patricio, TX
1890  Corvallis, OR............................................   1.1326
  Benton, OR
1900  Cumberland, MD-WV (MD Hospitals) \2\.....................   0.8651
  Allegany, MD
  Mineral, WV
1900  Cumberland, MD-WV (WV Hospital)..........................   0.8369
  Allegany, MD
  Mineral, WV
1920  Dallas, TX \1\...........................................   0.9913
  Collin, TX
  Dallas, TX
  Denton, TX
  Ellis, TX
  Henderson, TX
  Hunt, TX
  Kaufman, TX
  Rockwall, TX
1950  Danville, VA.............................................   0.8589
  Danville City, VA
  Pittsylvania, VA
1960  Davenport-Moline-Rock Island, IA-IL......................   0.8898

[[Page 68015]]

 
  Scott, IA
  Henry, IL
  Rock Island, IL
2000  Dayton-Springfield, OH...................................   0.9442
  Clark, OH
  Greene, OH
  Miami, OH
  Montgomery, OH
2020  Daytona Beach, FL........................................   0.9147
  Flagler, FL
  Volusia, FL
2030  Decatur, AL..............................................   0.8534
  Lawrence, AL
  Morgan, AL
2040  Decatur, IL \2\..........................................   0.8160
  Macon, IL
2080  Denver, CO \1\...........................................   1.0181
  Adams, CO
  Arapahoe, CO
  Denver, CO
  Douglas, CO
  Jefferson, CO
2120  Des Moines, IA...........................................   0.9118
  Dallas, IA
  Polk, IA
  Warren, IA
2160  Detroit, MI \1\..........................................   1.0510
  Lapeer, MI
  Macomb, MI
  Monroe, MI
  Oakland, MI
  St. Clair, MI
  Wayne, MI
2180  Dothan, AL...............................................   0.8013
  Dale, AL
  Houston, AL
2190  Dover, DE................................................   1.0078
  Kent, DE
2200  Dubuque, IA..............................................   0.8746
  Dubuque, IA
2240  Duluth-Superior, MN-WI...................................   1.0043
  St. Louis, MN
  Douglas, WI
2281  Dutchess County, NY......................................   0.9491
  Dutchess, NY
2290  Eau Claire, WI \2\.......................................   0.8880
  Chippewa, WI
  Eau Claire, WI
2320  El Paso, TX..............................................   0.9346
  El Paso, TX
2330  Elkhart-Goshen, IN.......................................   0.9145
  Elkhart, IN
2335  Elmira, NY...............................................   0.8546
  Chemung, NY
2340  Enid, OK.................................................   0.8610
  Garfield, OK
2360  Erie, PA.................................................   0.8985
  Erie, PA
2400  Eugene-Springfield, OR...................................   1.0965
  Lane, OR
2440  Evansville-Henderson, IN-KY (IN Hospitals) \2\...........   0.8602
  Posey, IN
  Vanderburgh, IN
  Warrick, IN
  Henderson, KY
2440  Evansville-Henderson, IN-KY (KY Hospitals)...............   0.8173
  Posey, IN
  Vanderburgh, IN
  Warrick, IN
  Henderson, KY
2520  Fargo-Moorhead, ND-MN....................................   0.8749
  Clay, MN
  Cass, ND
2560  Fayetteville, NC.........................................   0.8655
  Cumberland, NC
2580  Fayetteville-Springdale-Rogers, AR.......................   0.7910
  Benton, AR
  Washington, AR
2620  Flagstaff, AZ-UT.........................................   1.0686
  Coconino, AZ
  Kane, UT
2640  Flint, MI................................................   1.1205
  Genesee, MI
2650  Florence, AL.............................................   0.7652
  Colbert, AL
  Lauderdale, AL
2655  Florence, SC.............................................   0.8777
  Florence, SC
2670  Fort Collins-Loveland, CO................................   1.0647
  Larimer, CO
2680  \1\ Ft. Lauderdale, FL...................................   1.0152
  Broward, FL
2700  Fort Myers-Cape Coral, FL................................   0.9247
  Lee, FL
2710  Fort Pierce-Port St. Lucie, FL...........................   0.9622
  Martin, FL
  St. Lucie, FL
2720  Fort Smith, AR-OK........................................   0.8052
  Crawford, AR
  Sebastian, AR
  Sequoyah, OK
2750  Fort Walton Beach, FL....................................   0.9607
  Okaloosa, FL
2760  Fort Wayne, IN...........................................   0.8665
  Adams, IN
  Allen, IN
  De Kalb, IN
  Huntington, IN
  Wells, IN
  Whitley, IN
2800  Forth Worth-Arlington, TX \1\............................   0.9527
  Hood, TX
  Johnson, TX
  Parker, TX
  Tarrant, TX
2840  Fresno, CA...............................................   1.0104
  Fresno, CA
  Madera, CA
2880  Gadsden, AL..............................................   0.8423
  Etowah, AL
2900  Gainesville, FL..........................................   1.0074
  Alachua, FL
2920  Galveston-Texas City, TX.................................   0.9918
  Galveston, TX
2960  Gary, IN.................................................   0.9454
  Lake, IN
  Porter, IN
2975  Glens Falls, NY \2\......................................   0.8499
  Warren, NY
  Washington, NY
2980  Goldsboro, NC \2\........................................   0.8441
  Wayne, NC
2985  Grand Forks, ND-MN.......................................   0.8954
  Polk, MN
  Grand Forks, ND
2995  Grand Junction, CO.......................................   0.9471
  Mesa, CO
3000  Grand Rapids-Muskegon-Holland, MI \1\....................   1.0248
  Allegan, MI
  Kent, MI
  Muskegon, MI
  Ottawa, MI
3040  Great Falls, MT..........................................   0.9330
  Cascade, MT
3060  Greeley, CO..............................................   0.9814
  Weld, CO
3080  Green Bay, WI............................................   0.9308
  Brown, WI
3120  Greensboro-Winston-Salem-High Point, NC \1\..............   0.9124
  Alamance, NC
  Davidson, NC
  Davie, NC
  Forsyth, NC Guilford, NC
  Randolph, NC
  Stokes, NC
  Yadkin, NC
3150  Greenville, NC...........................................   0.9384
  Pitt, NC
3160  Greenville-Spartanburg-Anderson, SC......................   0.9003
  Anderson, SC
  Cherokee, SC
  Greenville, SC
  Pickens, SC
  Spartanburg, SC
3180  Hagerstown, MD...........................................   0.9409
  Washington, MD
3200  Hamilton-Middletown, OH..................................   0.9061
  Butler, OH
3240  Harrisburg-Lebanon-Carlisle, PA..........................   0.9386
  Cumberland, PA
  Dauphin, PA
  Lebanon, PA
  Perry, PA
3283  Hartford, CT \1\, \2\....................................   1.1715
  Hartford, CT
  Litchfield, CT
  Middlesex, CT
  Tolland, CT
3285  Hattiesburg, MS \2\......................................   0.7491
  Forrest, MS
  Lamar, MS
3290  Hickory-Morganton-Lenoir, NC.............................   0.8755
  Alexander, NC
  Burke, NC
  Caldwell, NC
  Catawba, NC
3320  Honolulu, HI.............................................   1.1866
  Honolulu, HI
3350  Houma, LA................................................   0.8086
  Lafourche, LA
  Terrebonne, LA
3360  Houston, TX \1\..........................................   0.9732
  Chambers, TX
  Fort Bend, TX
  Harris, TX
  Liberty, TX
  Montgomery, TX
  Waller, TX
3400  Huntington-Ashland, WV-KY-OH.............................   0.9876
  Boyd, KY
  Carter, KY
  Greenup, KY
  Lawrence, OH
  Cabell, WV
  Wayne, WV
3440  Huntsville, AL...........................................   0.8932
  Limestone, AL
  Madison, AL
3480  Indianapolis, IN \1\.....................................   0.9787
  Boone, IN
  Hamilton, IN
  Hancock, IN
  Hendricks, IN
  Johnson, IN
  Madison, IN
  Marion, IN
  Morgan, IN
  Shelby, IN
3500  Iowa City, IA............................................   0.9657
  Johnson, IA
3520  Jackson, MI..............................................   0.9134
  Jackson, MI
3560  Jackson, MS..............................................   0.8812
  Hinds, MS
  Madison, MS
  Rankin, MS
3580  Jackson, TN..............................................   0.8796
  Madison, TN
  Chester, TN
3600  Jacksonville, FL \1\.....................................   0.9208
  Clay, FL
  Duval, FL

[[Page 68016]]

 
  Nassau, FL
  St. Johns, FL
3605  Jacksonville, NC \2\.....................................   0.8441
  Onslow, NC
3610  Jamestown, NY \2\........................................   0.8499
  Chautauqua, NY
3620  Janesville-Beloit, WI....................................   0.9585
  Rock, WI
3640  Jersey City, NJ..........................................   1.1573
  Hudson, NJ
3660  Johnson City-Kingsport-Bristol, TN-VA....................   0.8328
  Carter, TN
  Hawkins, TN
  Sullivan, TN
  Unicoi, TN
  Washington, TN
  Bristol City, VA
  Scott, VA
  Washington, VA
3680  Johnstown, PA............................................   0.8578
  Cambria, PA
  Somerset, PA
3700  Jonesboro, AR............................................   0.7832
  Craighead, AR
3710  Joplin, MO...............................................   0.8148
  Jasper, MO
  Newton, MO
3720  Kalamazoo-Battlecreek, MI................................   1.0453
  Calhoun, MI
  Kalamazoo, MI
  Van Buren, MI
3740  Kankakee, IL.............................................   0.9902
  Kankakee, IL
3760  Kansas City, KS-MO \1\...................................   0.9661
  Johnson, KS
  Leavenworth, KS
  Miami, KS
  Wyandotte, KS
  Cass, MO
  Clay, MO
  Clinton, MO
  Jackson, MO
  Lafayette, MO
  Platte, MO
  Ray, MO
3800  Kenosha, WI..............................................   0.9611
  Kenosha, WI
3810  Killeen-Temple, TX.......................................   1.0119
  Bell, TX
  Coryell, TX
3840  Knoxville, TN............................................   0.8340
  Anderson, TN
  Blount, TN
  Knox, TN
  Loudon, TN
  Sevier, TN
  Union, TN
3850  Kokomo, IN...............................................   0.9525
  Howard, IN
  Tipton, IN
3870  La Crosse, WI-MN.........................................   0.9211
  Houston, MN
  La Crosse, WI
3880  Lafayette, LA............................................   0.8490
  Acadia, LA
  Lafayette, LA
  St. Landry, LA
  St. Martin, LA
3920  Lafayette, IN............................................   0.8834
  Clinton, IN
  Tippecanoe, IN
3960  Lake Charles, LA \2\.....................................   0.7713
  Calcasieu, LA
3980  Lakeland-Winter Haven, FL................................   0.8928
  Polk, FL
4000  Lancaster, PA............................................   0.9259
  Lancaster, PA
4040  Lansing-East Lansing, MI.................................   0.9934
  Clinton, MI
  Eaton, MI
  Ingham, MI
4080  Laredo, TX...............................................   0.8168
  Webb, TX
4100  Las Cruces, NM...........................................   0.8658
  Dona Ana, NM
4120  Las Vegas, NV-AZ \1\.....................................   1.0796
  Mohave, AZ
  Clark, NV
  Nye, NV
4150  Lawrence, KS.............................................   0.8190
  Douglas, KS
4200  Lawton, OK...............................................   0.8996
  Comanche, OK
4243  Lewiston-Auburn, ME......................................   0.9036
  Androscoggin, ME
4280  Lexington, KY............................................   0.8866
  Bourbon, KY
  Clark, KY
  Fayette, KY
  Jessamine, KY
  Madison, KY
  Scott, KY
  Woodford, KY
4320  Lima, OH.................................................   0.9320
  Allen, OH
  Auglaize, OH
4360  Lincoln, NE..............................................   0.9666
  Lancaster, NE
4400  Little Rock-North Little Rock, AR........................   0.8906
  Faulkner, AR
  Lonoke, AR
  Pulaski, AR
  Saline, AR
4420  Longview-Marshall, TX....................................   0.8922
  Gregg, TX
  Harrison, TX
  Upshur, TX
4480  Los Angeles-Long Beach, CA \1\...........................   1.2033
  Los Angeles, CA
4520  Louisville, KY-IN........................................   0.9350
  Clark, IN
  Floyd, IN
  Harrison, IN
  Scott, IN
  Bullitt, KY
  Jefferson, KY
  Oldham, KY
4600  Lubbock, TX..............................................   0.8838
  Lubbock, TX
4640  Lynchburg, VA............................................   0.8867
  Amherst, VA
  Bedford, VA
  Bedford City, VA
  Campbell, VA
  Lynchburg City, VA
4680  Macon, GA................................................   0.8974
  Bibb, GA
  Houston, GA
  Jones, GA
  Peach, GA
  Twiggs, GA
4720  Madison, WI..............................................   1.0271
  Dane, WI
4800  Mansfield, OH............................................   0.8690
  Crawford, OH
  Richland, OH
4840  Mayaguez, PR.............................................   0.4589
  Anasco, PR
  Cabo Rojo, PR
  Hormigueros, PR
  Mayaguez, PR
  Sabana Grande, PR
  San German, PR
4880  McAllen-Edinburg-Mission, TX.............................   0.8566
  Hidalgo, TX
4890  Medford-Ashland, OR......................................   1.0344
  Jackson, OR
4900  Melbourne-Titusville-Palm Bay, FL........................   0.9688
  Brevard, Fl
4920  Memphis, TN-AR-MS \1\....................................   0.8723
  Crittenden, AR
  DeSoto, MS
  Fayette, TN
  Shelby, TN
  Tipton, TN
4940  Merced, CA \2\...........................................   0.9861
  Merced, CA
5000  Miami, FL \1\............................................   1.0059
  Dade, FL
5015  Middlesex-Somerset-Hunterdon, NJ \1\.....................   1.0333
  Hunterdon, NJ
  Middlesex, NJ
  Somerset, NJ
5080  Milwaukee-Waukesha, WI \1\...............................   0.9767
  Milwaukee, WI
  Ozaukee, WI
  Washington, WI
  Waukesha, WI
5120  Minneapolis-St. Paul, MN-WI \1\..........................   1.1017
  Anoka, MN
  Carver, MN
  Chisago, MN
  Dakota, MN
  Hennepin, MN
  Isanti, MN
  Ramsey, MN
  Scott, MN
  Sherburne, MN
  Washington, MN
  Wright, MN
  Pierce, WI
  St. Croix, WI
5140  Missoula, MT.............................................   0.9332
  Missoula, MT
5160  Mobile, AL...............................................   0.8163
  Baldwin, AL
  Mobile, AL
5170  Modesto, CA..............................................   1.0396
  Stanislaus, CA
5190  Monmouth-Ocean, NJ \1\...................................   1.1283
  Monmouth, NJ
  Ocean, NJ
5200  Monroe, LA...............................................   0.8396
  Ouachita, LA
5240  Montgomery, AL...........................................   0.7653
  Autauga, AL
  Elmore, AL
  Montgomery, AL
5280  Muncie, IN...............................................   1.0969
  Delaware, IN
5330  Myrtle Beach, SC.........................................   0.8440
  Horry, SC
5345  Naples, FL...............................................   0.9661
  Collier, FL
5360  Nashville, TN \1\........................................   0.9490
  Cheatham, TN
  Davidson, TN
  Dickson, TN
  Robertson, TN
  Rutherford, TN
  Sumner, TN
  Williamson, TN
  Wilson, TN
5380  Nassau-Suffolk, NY \1\...................................   1.3932
  Nassau, NY
  Suffolk, NY
5483  New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT \1\..   1.2034
  Fairfield, CT
  New Haven, CT
5523  New London-Norwich, CT...................................   1.2063
  New London, CT
5560  New Orleans, LA \1\......................................   0.9295
  Jefferson, LA
  Orleans, LA

[[Page 68017]]

 
  Plaquemines, LA
  St. Bernard, LA
  St. Charles, LA
  St. James, LA
  St. John The Baptist, LA
  St. Tammany, LA
5600  New York, NY \1\.........................................   1.4651
  Bronx, NY
  Kings, NY
  New York, NY
  Putnam, NY
  Queens, NY
  Richmond, NY
  Rockland, NY
  Westchester, NY
5640  Newark, NJ \1\...........................................   1.0757
  Essex, NJ
  Morris, NJ
  Sussex, NJ
  Union, NJ
  Warren, NJ
5660  Newburgh, NY-PA..........................................   1.0847
  Orange, NY
  Pike, PA
5720  Norfolk-Virginia Beach-Newport News, VA-NC \1\...........   0.8422
  Currituck, NC
  Chesapeake City, VA
  Gloucester, VA
  Hampton City, VA
  Isle of Wight, VA
  James City, VA
  Mathews, VA
  Newport News City, VA
  Norfolk City, VA
  Poquoson City, VA
  Portsmouth City, VA
  Suffolk City, VA
  Virginia Beach City VA
  Williamsburg City, VA
  York, VA
5775  Oakland, CA \1\..........................................   1.4983
  Alameda, CA
  Contra Costa, CA
5790  Ocala, FL................................................   0.9243
  Marion, FL
5800  Odessa-Midland, TX.......................................   0.9205
  Ector, TX
  Midland, TX
5880  Oklahoma City, OK \1\....................................   0.8822
  Canadian, OK
  Cleveland, OK
  Logan, OK
  McClain, OK
  Oklahoma, OK
  Pottawatomie, OK
5910  Olympia, WA..............................................   1.0677
  Thurston, WA
5920  Omaha, NE-IA.............................................   0.9572
  Pottawattamie, IA
  Cass, NE
  Douglas, NE
  Sarpy, NE
  Washington, NE
5945  Orange County, CA \1\....................................   1.1411
  Orange, CA
5960  Orlando, FL \1\..........................................   0.9610
  Lake, FL
  Orange, FL
  Osceola, FL
  Seminole, FL
5990  Owensboro, KY............................................   0.8159
  Daviess, KY
6015  Panama City, FL..........................................   0.9010
  Bay, FL
6020  Parkersburg-Marietta, WV-OH (WV Hospitals)...............   0.8274
  Washington, OH
  Wood, WV
6020  Parkersburg-Marietta, WV-OH (OH Hospitals) \2\...........   0.8670
  Washington, OH
  Wood, WV
6080  Pensacola, FL \2\........................................   0.8928
  Escambia, FL
  Santa Rosa, FL
6120  Peoria-Pekin, IL.........................................   0.8646
  Peoria, IL
  Tazewell, IL
  Woodford, IL
6160  Philadelphia, PA-NJ \1\..................................   1.0937
  Burlington, NJ
  Camden, NJ
  Gloucester, NJ
  Salem, NJ
  Bucks, PA
  Chester, PA
  Delaware, PA
  Montgomery, PA
  Philadelphia, PA
6200  Phoenix-Mesa, AZ \1\.....................................   0.9669
  Maricopa, AZ
  Pinal, AZ
6240  Pine Bluff, AR...........................................   0.7791
  Jefferson, AR
6280  Pittsburgh, PA \1\.......................................   0.9741
  Allegheny, PA
  Beaver, PA
  Butler, PA
  Fayette, PA
  Washington, PA
  Westmoreland, PA
6323  Pittsfield, MA \2\.......................................   1.1204
  Berkshire, MA
6340  Pocatello, ID............................................   0.9076
  Bannock, ID
6360  Ponce, PR................................................   0.5006
  Guayanilla, PR
  Juana Diaz, PR
  Penuelas, PR
  Ponce, PR
  Villalba, PR
  Yauco, PR
6403  Portland, ME.............................................   0.9748
  Cumberland, ME
  Sagadahoc, ME
  York, ME
6440  Portland-Vancouver, \1\ OR-WA............................   1.0910
  Clackamas, OR
  Columbia, OR
  Multnomah, OR
  Washington, OR
  Yamhill, OR
  Clark, WA
6483  Providence-Warwick-Pawtucket, RI \1\.....................   1.0864
  Bristol, RI
  Kent, RI
  Newport, RI
  Providence, RI
  Washington, RI
6520  Provo-Orem, UT...........................................   1.0041
  Utah, UT
6560  Pueblo, CO \2\...........................................   0.8968
  Pueblo, CO
6580  Punta Gorda, FL..........................................   0.9613
  Charlotte, FL
6600  Racine, WI...............................................   0.9246
  Racine, WI
6640  Raleigh-Durham-Chapel Hill, NC \1\.......................   0.9646
  Chatham, NC
  Durham, NC
  Franklin, NC
  Johnston, NC
  Orange, NC
  Wake, NC
6660  Rapid City, SD...........................................   0.8865
  Pennington, SD
6680  Reading, PA..............................................   0.9152
  Berks, PA
690   Redding, CA..............................................   1.1664
  Shasta, CA
6720  Reno, NV.................................................   1.0550
  Washoe, NV
6740  Richland-Kennewick-Pasco, WA.............................   1.1460
  Benton, WA
  Franklin, WA
6760  Richmond-Petersburg, VA..................................   0.9617
  Charles City County, VA
  Chesterfield, VA
  Colonial Heights City, VA
  Dinwiddie, VA
  Goochland, VA
  Hanover, VA
  Henrico, VA
  Hopewell City, VA
  New Kent, VA
  Petersburg City, VA
  Powhatan, VA
  Prince George, VA
  Richmond City, VA
6780  Riverside-San Bernardino, CA \1\.........................   1.1115
  Riverside, CA
  San Bernardino, CA
6800  Roanoke, VA..............................................   0.8782
  Botetourt, VA
  Roanoke, VA
  Roanoke City, VA
  Salem City, VA
6820  Rochester, MN............................................   1.1315
  Olmsted, MN
6840  Rochester, NY \1\........................................   0.9182
  Genesee, NY
  Livingston, NY
  Monroe, NY
  Ontario, NY
  Orleans, NY
  Wayne, NY
6880  Rockford, IL.............................................   0.8819
  Boone, IL
  Ogle, IL
  Winnebago, IL
6895  Rocky Mount, NC..........................................   0.8849
  Edgecombe, NC
  Nash, NC
6920  Sacramento, CA \1\.......................................   1.1957
  El Dorado, CA
  Placer, CA
  Sacramento, CA
6960  Saginaw-Bay City-Midland, MI.............................   0.9575
  Bay, MI
  Midland, MI
  Saginaw, MI
6980  St. Cloud, MN............................................   1.0016
  Benton, MN
  Stearns, MN
7000  St. Joseph, MO...........................................   0.9071
  Andrew, MO
  Buchanan, MO
7040  St. Louis, MO-IL \1\.....................................   0.9049
  Clinton, IL
  Jersey, IL
  Madison, IL
  Monroe, IL
  St. Clair, IL
  Franklin, MO
  Jefferson, MO
  Lincoln, MO
  St. Charles, MO
  St. Louis, MO
  St. Louis City, MO
  Warren, MO
7080  Salem, OR................................................   1.0132
  Marion, OR
  Polk, OR
7120  Salinas, CA..............................................   1.4502
  Monterey, CA
7160  Salt Lake City-Ogden, UT \1\.............................   0.9811

[[Page 68018]]

 
  Davis, UT
  Salt Lake, UT
  Weber, UT
7200  San Angelo, TX...........................................   0.8083
  Tom Green, TX
7240  San Antonio, TX \1\......................................   0.8580
  Bexar, TX
  Comal, TX
  Guadalupe, TX
  Wilson, TX
7320  San Diego, CA \1\........................................   1.1784
  San Diego, CA
7360  San Francisco, CA \1\....................................   1.4193
  Marin, CA
  San Francisco, CA
  San Mateo, CA
7400  San Jose, CA \1\.........................................   1.3564
  Santa Clara, CA
7440  San Juan-Bayamon, PR \1\.................................   0.4690
  Aguas Buenas, PR
  Barceloneta, PR
  Bayamon, PR
  Canovanas, PR
  Carolina, PR
  Catano, PR
  Ceiba, PR
  Comerio, PR
  Corozal, PR
  Dorado, PR
  Fajardo, PR
  Florida, PR
  Guaynabo, PR
  Humacao, PR
  Juncos, PR
  Los Piedras, PR
  Loiza, PR
  Luguillo, PR
  Manati, PR
  Morovis, PR
  Naguabo, PR
  Naranjito, PR
  Rio Grande, PR
  San Juan, PR
  Toa Alta, PR
  Toa Baja, PR
  Trujillo Alto, PR
  Vega Alta, PR
  Vega Baja, PR
  Yabucoa, PR
7460  San Luis Obispo-Atascadero-Paso Robles, CA...............   1.0673
  San Luis Obispo, CA
7480  Santa Barbara-Santa Maria-Lompoc, CA.....................   1.0597
  Santa Barbara, CA
7485  Santa Cruz-Watsonville, CA...............................   1.4095
  Santa Cruz, CA
7490  Santa Fe, NM.............................................   1.0537
  Los Alamos, NM
  Santa Fe, NM
7500  Santa Rosa, CA...........................................   1.2646
  Sonoma, CA
7510  Sarasota-Bradenton, FL...................................   0.9809
  Manatee, FL
  Sarasota, FL
7520  Savannah, GA.............................................   0.9697
  Bryan, GA
  Chatham, GA
  Effingham, GA
7560  Scranton-Wilkes-Barre-Hazleton, PA \2\...................   0.8578
  Columbia, PA
  Lackawanna, PA
  Luzerne, PA
  Wyoming, PA
7600  Seattle-Bellevue-Everett, WA \1\.........................   1.1016
  Island, WA
  King, WA
  Snohomish, WA
7610  Sharon, PA \2\...........................................   0.8578
  Mercer, PA
7620  Sheboygan, WI \2\........................................   0.8880
  Sheboygan, WI
7640  Sherman-Denison, TX......................................   0.8795
  Grayson, TX
7680  Shreveport-Bossier City, LA..............................   0.8750
  Bossier, LA
  Caddo, LA
  Webster, LA
7720  Sioux City, IA-NE........................................   0.8473
  Woodbury, IA
  Dakota, NE
7760  Sioux Falls, SD..........................................   0.8790
  Lincoln, SD
  Minnehaha, SD
7800  South Bend, IN...........................................   1.0029
  St. Joseph, IN
7840  Spokane, WA..............................................   1.0513
  Spokane, WA
7880  Springfield, IL..........................................   0.8685
  Menard, IL
  Sangamon, IL
7920  Springfield, MO..........................................   0.8488
  Christian, MO
  Greene, MO
  Webster, MO
8003  Springfield, MA \2\......................................   1.1204
  Hampden, MA
  Hampshire, MA
8050  State College, PA........................................   0.9038
  Centre, PA
8080  Steubenville-Weirton, OH-WV \2\ (OH Hospitals)...........   0.8670
  Jefferson, OH
  Brooke, WV
  Hancock, WV
8080  Steubenville-Weirton, OH-WV (WV Hospitals)...............   0.8548
  Jefferson, OH
  Brooke, WV
  Hancock, WV
8120  Stockton-Lodi, CA........................................   1.0629
  San Joaquin, CA
8140  Sumter, SC \2\...........................................   0.8370
  Sumter, SC
8160  Syracuse, NY.............................................   0.9594
  Cayuga, NY
  Madison, NY
  Onondaga, NY
  Oswego, NY
8200  Tacoma, WA...............................................   1.1564
  Pierce, WA
8240  Tallahassee, FL \2\......................................   0.8928
  Gadsden, FL
  Leon, FL
8280  Tampa-St. Petersburg-Clearwater, FL \1\..................   0.9099
  Hernando, FL
  Hillsborough, FL
  Pasco, FL
  Pinellas, FL
8320  Terre Haute, IN \2\......................................   0.8602
  Clay, IN
  Vermillion, IN
  Vigo, IN
8360  Texarkana, AR-Texarkana, TX..............................   0.8427
  Miller, AR
  Bowie, TX
8400  Toledo, OH...............................................   0.9664
  Fulton, OH
  Lucas, OH
  Wood, OH
8440  Topeka, KS...............................................   0.9117
  Shawnee, KS
8480  Trenton, NJ..............................................   1.0137
  Mercer, NJ
8520  Tucson, AZ...............................................   0.8821
  Pima, AZ
8560  Tulsa, OK................................................   0.8454
  Creek, OK
  Osage, OK
  Rogers, OK
  Tulsa, OK
  Wagoner, OK
8600  Tuscaloosa, AL...........................................   0.8064
  Tuscaloosa, AL
8640  Tyler, TX................................................   0.9404
  Smith, TX
8680  Utica-Rome, NY...........................................   0.8560
  Herkimer, NY
  Oneida, NY
8720  Vallejo-Fairfield-Napa, CA...............................   1.2266
  Napa, CA
  Solano, CA
8735  Ventura, CA..............................................   1.0479
  Ventura, CA
8750  Victoria, TX.............................................   0.8154
  Victoria, TX
8760  Vineland-Millville-Bridgeton, NJ.........................   1.0501
  Cumberland, NJ
8780  Visalia-Tulare-Porterville, CA \2\.......................   0.9861
  Tulare, CA
8800  Waco, TX.................................................   0.8314
  McLennan, TX
8840  Washington, DC-MD-VA-WV \1\..............................   1.0755
  District of Columbia, DC
  Calvert, MD
  Charles, MD
  Frederick, MD
  Montgomery, MD
  Prince Georges, MD
  Alexandria City, VA
  Arlington, VA
  Clarke, VA
  Culpeper, VA
  Fairfax, VA
  Fairfax City, VA
  Falls Church City, VA
  Fauquier, VA
  Fredericksburg City, VA
  King George, VA
  Loudoun, VA
  Manassas City, VA
  Manassas Park City, VA
  Prince William, VA
  Spotsylvania, VA
  Stafford, VA
  Warren, VA
  Berkeley, WV
  Jefferson, WV
8920  Waterloo-Cedar Falls, IA.................................   0.8802
  Black Hawk, IA
8940  Wausau, WI...............................................   0.9426
  Marathon, WI
8960  \1\ West Palm Beach-Boca Raton, FL.......................   0.9615
  Palm Beach, FL
9000  Wheeling, WV-OH \2\ (WV Hospitals).......................   0.8231
  Belmont, OH
  Marshall, WV
  Ohio, WV
9000  Wheeling, WV-OH \2\ (OH Hospitals).......................   0.8670
  Belmont, OH
  Marshall, WV
  Ohio, WV
9040  Wichita, KS..............................................   0.9544
  Butler, KS
  Harvey, KS
  Sedgwick, KS
9080  Wichita Falls, TX........................................   0.7668
  Archer, TX
  Wichita, TX
9140  Williamsport, PA \2\.....................................   0.8578
  Lycoming, PA
9160  Wilmington-Newark, DE-MD.................................   1.1191
  New Castle, DE
  Cecil, MD
9200  Wilmington, NC...........................................   0.9402

[[Page 68019]]

 
  New Hanover, NC
  Brunswick, NC
9260  Yakima, WA \2\...........................................   1.0434
  Yakima, WA
9270  Yolo, CA.................................................   1.0199
  Yolo, CA
9280  York, PA.................................................   0.9264
  York, PA
9320  Youngstown-Warren, OH....................................   0.9543
  Columbiana, OH
  Mahoning, OH
  Trumbull, OH
9340  Yuba City, CA............................................   1.0706
  Sutter, CA
  Yuba, CA
9360  Yuma, AZ.................................................   0.9529
  Yuma, AZ
------------------------------------------------------------------------
\1\ Large Urban Area
\2\ Hospitals geographically located in the area are assigned the
  statewide rural wage index for FY 2001.


                 Addendum G--Wage Index for Rural Areas
------------------------------------------------------------------------
                                                                  DWage
                         Nonurban area                            index
------------------------------------------------------------------------
Alabama........................................................   0.7528
Alaska.........................................................   1.2392
Arizona........................................................   0.8317
Arkansas.......................................................   0.7445
California.....................................................   0.9861
Colorado.......................................................   0.8968
Connecticut....................................................   1.1715
Delaware.......................................................   0.9074
Florida........................................................   0.8928
Georgia........................................................   0.8329
Hawaii.........................................................   1.1059
Idaho..........................................................   0.8678
Illinois.......................................................   0.8160
Indiana........................................................   0.8602
Iowa...........................................................   0.8030
Kansas.........................................................   0.7605
Kentucky.......................................................   0.7931
Louisiana......................................................   0.7713
Maine..........................................................   0.8766
Maryland.......................................................   0.8651
Massachusetts..................................................   1.1204
Michigan.......................................................   0.9021
Minnesota......................................................   0.8881
Mississippi....................................................   0.7491
Missouri.......................................................   0.7707
Montana........................................................   0.8688
Nebraska.......................................................   0.8109
Nevada.........................................................   0.9232
New Hampshire..................................................   0.9845
New Jersey \1\.................................................  .......
New Mexico.....................................................   0.8497
New York.......................................................   0.8499
North Carolina.................................................   0.8441
North Dakota...................................................   0.7716
Ohio...........................................................   0.8670
Oklahoma.......................................................   0.7491
Oregon.........................................................   1.0132
Pennsylvania...................................................   0.8578
Puerto Rico....................................................   0.4264
Rhode Island \1\...............................................  .......
South Carolina.................................................   0.8370
South Dakota...................................................   0.7570
Tennessee......................................................   0.7838
Texas..........................................................   0.7507
Utah...........................................................   0.9037
Vermont........................................................   0.9409
Virginia.......................................................   0.8189
Washington.....................................................   1.0434
West Virginia..................................................   0.8231
Wisconsin......................................................   0.8880
Wyoming........................................................  0.8817
------------------------------------------------------------------------
\1\ All counties within the State are classified as urban.


       Addendum H--Wage Index for Hospitals That Are Reclassified
------------------------------------------------------------------------
                                                                   Wage
                              Area                                Index
------------------------------------------------------------------------
Abilene, TX....................................................   0.8240
Akron, OH......................................................   0.9736
Alexandria, LA.................................................   0.8170
Amarillo, TX...................................................   0.8715
Anchorage, AK..................................................   1.2865
Ann Arbor, MI..................................................   1.1064
Atlanta, GA....................................................   1.0096
Atlantic-Cape May, NJ..........................................   1.0822
Augusta-Aiken, GA-SC...........................................   0.9160
Barnstable-Yarmouth, MA........................................   1.3583
Baton Rouge, LA................................................   0.8734
Benton Harbor, MI..............................................   0.9021
Bergen-Passaic, NJ.............................................   1.1605
Billings, MT...................................................   0.9591
Binghamton, NY.................................................   0.8690
Birmingham, AL.................................................   0.8477
Bismarck, ND...................................................   0.7897
Bloomington-Normal, IL.........................................   0.9156
Boise City, ID.................................................   0.9042
Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH (NH, RI, and     1.1160
 VT Hospitals).................................................
Burlington, VT.................................................   1.0236
Casper, WY.....................................................   0.8817
Champaign-Urbana, IL...........................................   0.9084
Charleston-North Charleston, SC................................   0.9067
Charleston, WV.................................................   0.8904
Charlotte-Gastonia-Rock Hill, NC-SC............................   0.9391
Chattanooga, TN-GA.............................................   0.9624
Chicago, IL....................................................   1.1015
Cincinnati, OH-KY-IN...........................................   0.9415
Clarksville-Hopkinsville, TN-KY................................   0.8277
Cleveland-Lorain-Elyria, OH....................................   0.9593
Columbia, MO...................................................   0.8756
Columbia, SC...................................................   0.9433
Columbus, OH...................................................   0.9619
Dallas, TX.....................................................   0.9913
Danville, VA...................................................   0.8212
Davenport-Moline-Rock Island, IA-IL............................   0.8898
Dayton-Springfield, OH.........................................   0.9442
Denver, CO.....................................................   1.0181
Des Moines, IA.................................................   0.9011
Dothan, AL.....................................................   0.8013
Dover, DE......................................................   0.9769
Duluth-Superior, MN-WI.........................................   1.0043
Eau Claire, WI.................................................   0.8880
Erie, PA.......................................................   0.8985
Eugene-Springfield, OR.........................................   1.0965
Fargo-Moorhead, ND-MN..........................................   0.8517
Fayetteville, NC...............................................   0.8469
Flagstaff, AZ-UT...............................................   1.0525
Flint, MI......................................................   1.1058
Florence, AL...................................................   0.7652
Florence, SC...................................................   0.8777
Fort Collins-Loveland, CO......................................   1.0647
Ft. Lauderdale, FL.............................................   1.0152
Fort Pierce-Port St. Lucie, FL.................................   0.9622
Fort Smith, AR-OK..............................................   0.7947
Fort Walton Beach, FL..........................................   0.9358
Fort Wayne, IN.................................................   0.8665
Forth Worth-Arlington, TX......................................   0.9527
Gadsden, AL....................................................   0.8423
Grand Forks, ND-MN.............................................   0.8954
Grand Junction, CO.............................................   0.9471
Grand Rapids-Muskegon-Holland, MI..............................   1.0248
Great Falls, MT................................................   0.9330
Greeley, CO....................................................   0.9573
Green Bay, WI..................................................   0.9308
Greensboro-Winston-Salem-High Point, NC........................   0.9124
Greenville, NC.................................................   0.9172
Greenville-Spartanburg-Anderson, SC............................   0.9003
Harrisburg-Lebanon-Carlisle, PA................................   0.9386
Hartford, CT (MA Hospital).....................................   1.1420
Hattiesburg, MS................................................   0.7491
Hickory-Morganton-Lenoir, NC...................................   0.8577
Honolulu, HI...................................................   1.1866
Houston, TX....................................................   0.9732
Huntington-Ashland, WV-KY-OH...................................   0.9605
Huntsville, AL.................................................   0.8779
Indianapolis, IN...............................................   0.9787
Jackson, MS....................................................   0.8698
Jackson, TN....................................................   0.8796
Jacksonville, FL...............................................   0.9208
Jersey City, NJ................................................   1.1573
Johnson City-Kingsport-Bristol, TN-VA..........................   0.8328
Joplin, MO.....................................................   0.8148
Kalamazoo-Battlecreek, MI......................................   1.0291
Kansas City, KS-MO.............................................   0.9509
Knoxville, TN..................................................   0.8340
Kokomo, IN.....................................................   0.9525
Lafayette, LA..................................................   0.8490
Lansing-East Lansing, MI.......................................   0.9934
Las Cruces, NM.................................................   0.8510
Las Vegas, NV-AZ...............................................   1.0796
Lexington, KY..................................................   0.8712
Lima, OH.......................................................   0.9320
Lincoln, NE....................................................   0.9666
Little Rock-North Little Rock, AR..............................   0.8791
Longview-Marshall, TX..........................................   0.8732
Los Angeles-Long Beach, CA.....................................   1.2033
Louisville, KY-IN..............................................   0.9350
Lynchburg, VA..................................................   0.8749
Macon, GA......................................................   0.8974
Madison, WI....................................................   1.0271
Mansfield, OH..................................................   0.8690
Memphis, TN-AR-MS..............................................   0.8584
Milwaukee-Waukesha, WI.........................................   0.9767
Minneapolis-St. Paul, MN-WI....................................   1.1017
Missoula, MT...................................................   0.9332
Mobile, AL.....................................................   0.8163
Monmouth-Ocean, NJ.............................................   1.1283
Montgomery, AL.................................................   0.7653
Myrtle Beach, SC (NC Hospital).................................   0.8441
Nashville, TN..................................................   0.9301
New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT............   1.2034
New London-Norwich, CT.........................................   1.1926
New Orleans, LA................................................   0.9295
New York, NY...................................................   1.4463
Newburgh, NY-PA................................................   1.0317
Norfolk-Virginia Beach-Newport News, VA-NC.....................   0.8441
Oakland, CA....................................................   1.4983
Ocala, FL......................................................   0.9243
Odessa-Midland, TX.............................................   0.9074
Oklahoma City, OK..............................................   0.8822
Omaha, NE-IA...................................................   0.9572
Orange County, CA..............................................   1.1411
Orlando, FL....................................................   0.9610
Peoria-Pekin, IL...............................................   0.8646
Philadelphia, PA-NJ............................................   1.0937
Pine Bluff, AR.................................................   0.7680
Pittsburgh, PA.................................................   0.9575
Pittsfield, MA (VT Hospital)...................................   0.9914
Pocatello, ID..................................................   0.8715
Portland, ME...................................................   0.9629
Portland-Vancouver, OR-WA......................................   1.0910
Provo-Orem, UT.................................................   1.0041
Raleigh-Durham-Chapel Hill, NC.................................   0.9646
Rapid City, SD.................................................   0.8865
Redding, CA....................................................   1.1664
Reno, NV.......................................................   1.0438
Richland-Kennewick-Pasco, WA...................................   1.1147
Roanoke, VA....................................................   0.8782
Rochester, MN..................................................   1.1315
Rockford, IL...................................................   0.8819
Sacramento, CA.................................................   1.1957

[[Page 68020]]

 
Saginaw-Bay City-Midland, MI...................................   0.9575
St. Cloud, MN..................................................   1.0016
St. Joseph, MO.................................................   0.8848
St. Louis, MO-IL...............................................   0.9049
Salinas, CA....................................................   1.4502
Salt Lake City-Ogden, UT.......................................   0.9811
San Diego, CA..................................................   1.1784
Santa Cruz-Watsonville, CA.....................................   1.3897
Santa Fe, NM...................................................   1.0000
Santa Rosa, CA.................................................   1.2398
Seattle-Bellevue-Everett, WA...................................   1.1016
Sherman-Denison, TX............................................   0.8795
Sioux City, IA-NE..............................................   0.8473
South Bend, IN.................................................   1.0029
Spokane, WA....................................................   1.0333
Springfield, IL................................................   0.8685
Springfield, MO................................................   0.8212
Syracuse, NY...................................................   0.9594
Tampa-St. Petersburg-Clearwater, FL............................   0.9099
Texarkana, AR-Texarkana, TX....................................   0.8427
Toledo, OH.....................................................   0.9664
Topeka, KS.....................................................   0.9117
Tucson, AZ.....................................................   0.8821
Tulsa, OK......................................................   0.8454
Tuscaloosa, AL.................................................   0.8064
Tyler, TX......................................................   0.9141
Victoria, TX...................................................   0.8154
Washington, DC-MD-VA-WV........................................   1.0755
Waterloo-Cedar Falls, IA.......................................   0.8802
Wausau, WI.....................................................   0.9426
Wichita, KS....................................................   0.9262
Rural Alabama..................................................   0.7528
Rural Florida..................................................   0.8928
Rural Illinois.................................................   0.8160
Rural Louisiana................................................   0.7713
Rural Michigan.................................................   0.9021
Rural Minnesota................................................   0.8881
Rural Missouri.................................................   0.7707
Rural Montana..................................................   0.8688
Rural Oregon...................................................   1.0132
Rural Texas....................................................   0.7507
Rural Washington...............................................   1.0434
Rural West Virginia............................................   0.8231
Rural Wisconsin................................................   0.8880
Rural Wyoming (NE Hospital)....................................   0.8671
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[FR Doc. 00-28475 Filed 11-2-00; 11:43 am]
BILLING CODE 4120-01-P