Spreadsheet: 04b7f01c-7525-4350-90f0-55a97b8be73c
Sheet: Sheet1

Procedure Code | Procedure Code Description | Price [NAME] | Allowed Amount  (If $0.00 indicates a Manual Priced Code) | PA Required | HC Req | Technical Component Amount | Professional Component Amount
01996 | DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN | 2008-01-01 00:00:00 | 46.13 | N | N | N/A | N/A
01999 | ANESTHESIA-UNLISTED ANESTHESIA | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
10021 | FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE | 2011-07-01 00:00:00 | 120.54 | N | Y | N/A | N/A
10022 | FINE NEEDLE ASPIRATION WITH IMAGING GUIDANCE | 2011-07-01 00:00:00 | 116.54 | N | Y | N/A | N/A
10030 | IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE | 2014-01-01 00:00:00 | 644.64 | N | Y | N/A | N/A
10040 | ACNE SURGERY | 2011-07-01 00:00:00 | 86 | N | Y | N/A | N/A
10060 | INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | 2011-07-01 00:00:00 | 93.04 | N | Y | N/A | N/A
10061 | INCISION&DRAINAGE ABSCESS COMPLICATED/MULTIPLE | 2011-07-01 00:00:00 | 154.85 | N | Y | N/A | N/A
10080 | INCISION & DRAINAGE PILONIDAL CYST SIMPLE | 2011-07-01 00:00:00 | 141.16 | N | Y | N/A | N/A
10081 | INCISION & DRAINAGE PILONIDAL CYST COMPLICATED | 2011-07-01 00:00:00 | 217.25 | N | Y | N/A | N/A
10120 | INCISION&REMOVAL FOREIGN BODY SUBQ TISS SIMPLE | 2011-07-01 00:00:00 | 114.26 | N | Y | N/A | N/A
10121 | INCISION&REMOVAL FOREIGN BODY SUBQ TISS COMPL | 2011-07-01 00:00:00 | 221.29 | N | Y | N/A | N/A
10140 | I&D HEMATOMA SEROMA/FLUID COLLECTION | 2011-07-01 00:00:00 | 131.11 | N | Y | N/A | N/A
10160 | PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST | 2011-07-01 00:00:00 | 106.19 | N | Y | N/A | N/A
10180 | INCISION&DRAINAGE COMPLEX PO WOUND INFECTION | 2011-07-01 00:00:00 | 197.24 | N | Y | N/A | N/A
11000 | DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF | 2011-07-01 00:00:00 | 44.6 | N | Y | N/A | N/A
11001 | DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10% BDY SURF | 2011-07-01 00:00:00 | 18.06 | N | Y | N/A | N/A
11004 | DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT&PR | 2011-07-01 00:00:00 | 493.94 | N | Y | N/A | N/A
11005 | DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL | 2011-07-01 00:00:00 | 656.66 | N | Y | N/A | N/A
11006 | DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT/ABDL | 2011-07-01 00:00:00 | 602.13 | N | Y | N/A | N/A
11008 | REMOVAL PROSTHETIC MATRL ABDL WALL FOR INFECTION | 2011-07-01 00:00:00 | 230.66 | N | Y | N/A | N/A
11010 | DBRDMT W/RMVL FM FX&/DISLC SKN&SUBQ TISS | 2011-07-01 00:00:00 | 398.35 | N | Y | N/A | N/A
11011 | DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC | 2011-07-01 00:00:00 | 436.09 | N | Y | N/A | N/A
11012 | DBRDMT FX&/DISLC SUBQ T/M/F BONE | 2011-07-01 00:00:00 | 585.65 | N | Y | N/A | N/A
11042 | DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/LT | 2011-07-01 00:00:00 | 73.79 | N | Y | N/A | N/A
11043 | DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/LT | 2011-07-01 00:00:00 | 161.51 | N | Y | N/A | N/A
11044 | DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/LT | 2011-07-01 00:00:00 | 245.96 | N | Y | N/A | N/A
11045 | DBRDMT [NAME] TISSUE EA ADDL 20 SQ CMLT | 2011-07-01 00:00:00 | 26.02 | N | Y | N/A | N/A
11046 | DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM | 2011-07-01 00:00:00 | 45.42 | N | Y | N/A | N/A
11047 | DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM/LT | 2011-07-01 00:00:00 | 74.57 | N | Y | N/A | N/A
11055 | PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1 | 2011-07-01 00:00:00 | 41.07 | N | Y | N/A | N/A
11056 | PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4 | 2011-07-01 00:00:00 | 49.34 | N | Y | N/A | N/A
11057 | PARING/CUTTING BENIGN HYPERKERATOTIC LESION GT4 | 2011-07-01 00:00:00 | 58.48 | N | Y | N/A | N/A
11100 | BX SKIN SUBCUTANEOUS&/MUCOUS MEMBRANE 1 LESION | 2011-07-01 00:00:00 | 86.96 | N | Y | N/A | N/A
11101 | BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESION | 2011-07-01 00:00:00 | 27.83 | N | Y | N/A | N/A
11200 | REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UP&W/15 | 2011-07-01 00:00:00 | 71.12 | N | Y | N/A | N/A
11201 | REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10LT | 2011-07-01 00:00:00 | 15.91 | N | Y | N/A | N/A
11300 | SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/LT | 2011-07-01 00:00:00 | 57.47 | N | Y | N/A | N/A
11301 | SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM | 2011-07-01 00:00:00 | 78.09 | N | Y | N/A | N/A
11302 | SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM | 2011-07-01 00:00:00 | 93.38 | N | Y | N/A | N/A
11303 | SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM GT2.0 CM | 2011-07-01 00:00:00 | 109.98 | N | Y | N/A | N/A
11305 | SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/LT | 2011-07-01 00:00:00 | 57.99 | N | Y | N/A | N/A
11306 | SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM | 2011-07-01 00:00:00 | 80.06 | N | Y | N/A | N/A
11307 | SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM | 2011-07-01 00:00:00 | 94.69 | N | Y | N/A | N/A
11308 | SHAVING SKIN LESION 1 S/N/H/F/G DIAM GT2.0 CM | 2011-07-01 00:00:00 | 105.26 | N | Y | N/A | N/A
11310 | SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/LT | 2011-07-01 00:00:00 | 71.07 | N | Y | N/A | N/A
11311 | SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM | 2011-07-01 00:00:00 | 89.63 | N | Y | N/A | N/A
11312 | SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM | 2011-07-01 00:00:00 | 104.15 | N | Y | N/A | N/A
11313 | SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM GT2.0 CM | 2011-07-01 00:00:00 | 129.29 | N | Y | N/A | N/A
11400 | EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/LT | 2011-07-01 00:00:00 | 99.41 | N | Y | N/A | N/A
11401 | EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM | 2011-07-01 00:00:00 | 121.37 | N | Y | N/A | N/A
11402 | EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM | 2011-07-01 00:00:00 | 135.05 | N | Y | N/A | N/A
11403 | EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/GT | 2011-07-01 00:00:00 | 155.12 | N | Y | N/A | N/A
11404 | EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM | 2011-07-01 00:00:00 | 176.25 | N | Y | N/A | N/A
11406 | EXC B9 LES MRGN XCP SK TG T/A/L GT 4.0 CM | 2011-07-01 00:00:00 | 250.56 | N | Y | N/A | N/A
11420 | EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/LT | 2011-07-01 00:00:00 | 99.34 | N | Y | N/A | N/A
11421 | EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM | 2011-07-01 00:00:00 | 128.67 | N | Y | N/A | N/A
11422 | EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM | 2011-07-01 00:00:00 | 143.29 | N | Y | N/A | N/A
11423 | EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM | 2011-07-01 00:00:00 | 165.94 | N | Y | N/A | N/A
11424 | EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM | 2011-07-01 00:00:00 | 190.57 | N | Y | N/A | N/A
11426 | EXC B9 LES MRGN XCP SK TG S/N/H/F/G GT 4.0CM | 2011-07-01 00:00:00 | 272.15 | N | Y | N/A | N/A
11440 | EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/LT | 2011-07-01 00:00:00 | 109.31 | N | Y | N/A | N/A
11441 | EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM | 2011-07-01 00:00:00 | 137.49 | N | Y | N/A | N/A
11442 | EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM | 2011-07-01 00:00:00 | 154.94 | N | Y | N/A | N/A
11443 | EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM | 2011-07-01 00:00:00 | 184.61 | N | Y | N/A | N/A
11444 | EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM | 2011-07-01 00:00:00 | 232.07 | N | Y | N/A | N/A
11446 | EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M GT 4.0CM | 2011-07-01 00:00:00 | 319.37 | N | Y | N/A | N/A
11450 | EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR | 2011-07-01 00:00:00 | 301.01 | N | Y | N/A | N/A
11451 | EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR | 2011-07-01 00:00:00 | 384.49 | N | Y | N/A | N/A
11462 | EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR | 2011-07-01 00:00:00 | 295.72 | N | Y | N/A | N/A
11463 | [NAME] | 2011-07-01 00:00:00 | 392.79 | N | Y | N/A | N/A
11470 | EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR | 2011-07-01 00:00:00 | 329.5 | N | Y | N/A | N/A
11471 | EXCISION H/P/P/U COMPLEX REPAIR | 2011-07-01 00:00:00 | 407.66 | N | Y | N/A | N/A
11600 | EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/LT | 2011-07-01 00:00:00 | 154.45 | N | Y | N/A | N/A
11601 | EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM | 2011-07-01 00:00:00 | 188.1 | N | Y | N/A | N/A
11602 | EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM | 2011-07-01 00:00:00 | 205.7 | N | Y | N/A | N/A
11603 | EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/GT | 2011-07-01 00:00:00 | 233.72 | N | Y | N/A | N/A
11604 | EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM | 2011-07-01 00:00:00 | 258.57 | N | Y | N/A | N/A
11606 | EXCISION MALIGNANT LESION TRUNK/ARM/LEG GT4.0 CM | 2011-07-01 00:00:00 | 365.55 | N | Y | N/A | N/A
11620 | EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/LT | 2011-07-01 00:00:00 | 157.36 | N | Y | N/A | N/A
11621 | EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM | 2011-07-01 00:00:00 | 189.56 | N | Y | N/A | N/A
11622 | EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM | 2011-07-01 00:00:00 | 213.39 | N | Y | N/A | N/A
11623 | EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/GT | 2011-07-01 00:00:00 | 249.29 | N | Y | N/A | N/A
11624 | EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM | 2011-07-01 00:00:00 | 279.78 | N | Y | N/A | N/A
11626 | EXCISION MALIGNANT LESION S/N/H/F/G GT 4.0 CM | 2011-07-01 00:00:00 | 337.49 | N | Y | N/A | N/A
11640 | EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/LT | 2011-07-01 00:00:00 | 163.46 | N | Y | N/A | N/A
11641 | EXCISION MALIGNANT LES F/E/E/N/L 0.6-1.0 CM | 2011-07-01 00:00:00 | 197.86 | N | Y | N/A | N/A
11642 | EXCISION MALIGNANT LES F/E/E/N/L 1.1-2.0 CM | 2011-07-01 00:00:00 | 226.79 | N | Y | N/A | N/A
11643 | EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/GT | 2011-07-01 00:00:00 | 266.85 | N | Y | N/A | N/A
11644 | EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM | 2011-07-01 00:00:00 | 328.53 | N | Y | N/A | N/A
11646 | EXCISION MALIGNANT LESION F/E/E/N/L GT 4.0 CM | 2011-07-01 00:00:00 | 429.8 | N | Y | N/A | N/A
11719 | TRIMMING NONDYSTROPHIC NAILS ANY NUMBER | 2011-07-01 00:00:00 | 18.06 | N | Y | N/A | N/A
11720 | DEBRIDEMENT NAIL ANY METHOD 1-5 | 2011-07-01 00:00:00 | 26.17 | N | Y | N/A | N/A
11721 | DEBRIDEMENT NAIL ANY METHOD 6/GT | 2011-07-01 00:00:00 | 35.96 | N | Y | N/A | N/A
11730 | AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 | 2011-07-01 00:00:00 | 80.6 | N | Y | N/A | N/A
11732 | AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL | 2011-07-01 00:00:00 | 36.87 | N | Y | N/A | N/A
11740 | EVACUATION SUBUNGUAL HEMATOMA | 2011-07-01 00:00:00 | 38.94 | N | Y | N/A | N/A
11750 | EXCISION NAIL MATRIX PERMANENT REMOVAL | 2011-07-01 00:00:00 | 181.8 | N | Y | N/A | N/A
11752 | EXC NAIL MATRIX PRM RMVL W/AMP TUFT DSTL PHALANX | 2011-07-01 00:00:00 | 261.42 | N | Y | N/A | N/A
11755 | BIOPSY NAIL UNIT SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 110.9 | N | Y | N/A | N/A
11760 | REPAIR NAIL BED | 2011-07-01 00:00:00 | 178.39 | N | Y | N/A | N/A
11762 | RECONSTRUCTION NAIL BED W/GRAFT | 2011-07-01 00:00:00 | 226.24 | N | Y | N/A | N/A
11765 | WEDGE EXCISION SKIN NAIL FOLD | 2011-07-01 00:00:00 | 114.05 | N | Y | N/A | N/A
11770 | EXCISION PILONIDAL CYST/SINUS SIMPLE | 2011-07-01 00:00:00 | 219.91 | N | Y | N/A | N/A
11771 | EXCISION PILONIDAL CYST/SINUS EXTENSIVE | 2011-07-01 00:00:00 | 455.33 | N | Y | N/A | N/A
11772 | EXCISION PILONIDAL CYST/SINUS COMPLICATED | 2011-07-01 00:00:00 | 546.03 | N | Y | N/A | N/A
11900 | INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS | 2011-07-01 00:00:00 | 47.12 | N | Y | N/A | N/A
11901 | INJECTION INTRALESIONAL GT7 LESIONS | 2011-07-01 00:00:00 | 59.54 | N | Y | N/A | N/A
11920 | TATTOOING INCL MICROPIGMENTATION 6.0 CM/LT | 2011-07-01 00:00:00 | 146.93 | Y | Y | N/A | N/A
11921 | TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM | 2011-07-01 00:00:00 | 169.3 | Y | Y | N/A | N/A
11960 | INSERTION TISSUE EXPANDER INCL SBSQ XPNSJ | 2011-07-01 00:00:00 | 758.98 | N | Y | N/A | N/A
11970 | REPLACEMENT TISS EXPANDER PERMANENT PROSTHESIS | 2011-07-01 00:00:00 | 512.31 | Y | Y | N/A | N/A
11971 | REMOVAL TISS EXPANDER W/O INSERTION PROSTHESIS | 2011-07-01 00:00:00 | 387.68 | N | Y | N/A | N/A
11976 | REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES | 2011-07-01 00:00:00 | 121.96 | N | N | N/A | N/A
11980 | SUBCUTANEOUS HORMONE PELLET IMPLANTATION | 2011-07-01 00:00:00 | 87.63 | N | Y | N/A | N/A
11981 | INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT | 2011-07-01 00:00:00 | 113.18 | N | Y | N/A | N/A
11982 | REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT | 2011-07-01 00:00:00 | 126.68 | N | Y | N/A | N/A
11983 | RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT | 2011-07-01 00:00:00 | 189.5 | N | Y | N/A | N/A
12001 | SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/LT | 2011-07-01 00:00:00 | 80.9 | N | Y | N/A | N/A
12002 | SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM | 2011-07-01 00:00:00 | 94.99 | N | Y | N/A | N/A
12004 | SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM | 2011-07-01 00:00:00 | 112.82 | N | Y | N/A | N/A
12005 | SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM | 2011-07-01 00:00:00 | 145.31 | N | Y | N/A | N/A
12006 | SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM | 2011-07-01 00:00:00 | 175.41 | N | Y | N/A | N/A
12007 | SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK GT30.0CM | 2011-07-01 00:00:00 | 204.41 | N | Y | N/A | N/A
12011 | SIMPLE REPAIR F/E/E/N/L/M 2.5CM/LT | 2011-07-01 00:00:00 | 96.89 | N | Y | N/A | N/A
12013 | SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0CM | 2011-07-01 00:00:00 | 104.25 | N | Y | N/A | N/A
12014 | SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5CM | 2011-07-01 00:00:00 | 123.49 | N | Y | N/A | N/A
12015 | SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5CM | 2011-07-01 00:00:00 | 151.38 | N | Y | N/A | N/A
12016 | SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0CM | 2011-07-01 00:00:00 | 189.19 | N | Y | N/A | N/A
12017 | SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0CM | 2011-07-01 00:00:00 | 145.67 | N | Y | N/A | N/A
12018 | SIMPLE REPAIR F/E/E/N/L/M GT30.0CM | 2011-07-01 00:00:00 | 172.62 | N | Y | N/A | N/A
12020 | [NAME] CLOSURE | 2011-07-01 00:00:00 | 224.81 | N | Y | N/A | N/A
12021 | [NAME] | 2011-07-01 00:00:00 | 133.58 | N | Y | N/A | N/A
12031 | REPAIR INTERMEDIATE S/A/T/E 2.5 CM/LT | 2011-07-01 00:00:00 | 203.45 | N | Y | N/A | N/A
12032 | REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM | 2011-07-01 00:00:00 | 256.43 | N | Y | N/A | N/A
12034 | REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM | 2011-07-01 00:00:00 | 255.28 | N | Y | N/A | N/A
12035 | REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM | 2011-07-01 00:00:00 | 309.06 | N | Y | N/A | N/A
12036 | REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM | 2011-07-01 00:00:00 | 337.39 | N | Y | N/A | N/A
12037 | REPAIR INTERMEDIATE S/A/T/E GT 30.0 CM | 2011-07-01 00:00:00 | 378.05 | N | Y | N/A | N/A
12041 | REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/LT | 2011-07-01 00:00:00 | 212.54 | N | Y | N/A | N/A
12042 | REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM | 2011-07-01 00:00:00 | 243.59 | N | Y | N/A | N/A
12044 | REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM | 2011-07-01 00:00:00 | 288.02 | N | Y | N/A | N/A
12045 | REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM | 2011-07-01 00:00:00 | 308.39 | N | Y | N/A | N/A
12046 | RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM | 2011-07-01 00:00:00 | 364.74 | N | Y | N/A | N/A
12047 | REPAIR INTERMEDIATE N/H/F/XTRNL GENT GT30.0 CM | 2011-07-01 00:00:00 | 396.07 | N | Y | N/A | N/A
12051 | REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/LT | 2011-07-01 00:00:00 | 224.88 | N | Y | N/A | N/A
12052 | REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-53.0 CM/GT | 2011-07-01 00:00:00 | 256.88 | N | Y | N/A | N/A
12053 | REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM | 2011-07-01 00:00:00 | 283.31 | N | Y | N/A | N/A
12054 | REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM | 2011-07-01 00:00:00 | 300.17 | N | Y | N/A | N/A
12055 | REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM | 2011-07-01 00:00:00 | 360.53 | N | Y | N/A | N/A
12056 | REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30.0CM | 2011-07-01 00:00:00 | 432.41 | N | Y | N/A | N/A
12057 | REPAIR INTERMEDIATE F/E/E/N/L&/MUC GT 30.0 CM | 2011-07-01 00:00:00 | 493.2 | N | Y | N/A | N/A
13100 | REPAIR COMPLEX TRUNK 1.1 CM-2.5 CM | 2011-07-01 00:00:00 | 262.55 | N | Y | N/A | N/A
13101 | REPAIR COMPLEX TRUNK 2.6 CM-7.5 CM | 2011-07-01 00:00:00 | 333.9 | N | Y | N/A | N/A
13102 | REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/LT | 2011-07-01 00:00:00 | 90.39 | N | Y | N/A | N/A
13120 | REPAIR COMPLEX SCALP/ARM/LEG 1.1 CM-2.5 CM | 2011-07-01 00:00:00 | 273.3 | N | Y | N/A | N/A
13121 | REPAIR COMPLEX SCALP/ARM/LEG 2.6 CM-7.5 CM | 2011-07-01 00:00:00 | 372.38 | N | Y | N/A | N/A
13122 | REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/LT | 2011-07-01 00:00:00 | 99.91 | N | Y | N/A | N/A
13131 | REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1 CM-2.5 CM | 2011-07-01 00:00:00 | 301.9 | N | Y | N/A | N/A
13132 | REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6 CM-7.5 CM | 2011-07-01 00:00:00 | 489.4 | N | Y | N/A | N/A
13133 | REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/LT | 2011-07-01 00:00:00 | 141.83 | N | Y | N/A | N/A
13151 | REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM | 2011-07-01 00:00:00 | 342.22 | N | Y | N/A | N/A
13152 | REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM | 2011-07-01 00:00:00 | 473.23 | N | Y | N/A | N/A
13153 | REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/LT | 2011-07-01 00:00:00 | 155.55 | N | Y | N/A | N/A
13160 | [NAME] EXTSV/COMPLIC | 2011-07-01 00:00:00 | 678.52 | N | Y | N/A | N/A
14000 | ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 CM/LT | 2011-07-01 00:00:00 | 521.36 | N | Y | N/A | N/A
14001 | [NAME]/REARRANGE TRUNK 10.1-30.0 SQCM | 2011-07-01 00:00:00 | 673.45 | N | Y | N/A | N/A
14020 | ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/LT | 2011-07-01 00:00:00 | 586.24 | N | Y | N/A | N/A
14021 | ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM | 2011-07-01 00:00:00 | 737.55 | N | Y | N/A | N/A
14040 | ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/LT | 2011-07-01 00:00:00 | 647.67 | N | Y | N/A | N/A
14041 | ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM | 2011-07-01 00:00:00 | 803.29 | N | Y | N/A | N/A
14060 | ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/LT | 2011-07-01 00:00:00 | 658.3 | N | Y | N/A | N/A
14061 | ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM | 2011-07-01 00:00:00 | 862.23 | N | Y | N/A | N/A
14301 | ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM | 2011-07-01 00:00:00 | 928.02 | N | Y | N/A | N/A
14302 | ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/LT | 2011-07-01 00:00:00 | 198.32 | N | Y | N/A | N/A
14350 | FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE | 2011-07-01 00:00:00 | 612.41 | N | Y | N/A | N/A
15002 | PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT | 2011-07-01 00:00:00 | 281 | N | Y | N/A | N/A
15003 | PREP SITE T/A/L ADDL 100 SQ CM/1PCT | 2011-07-01 00:00:00 | 61 | N | Y | N/A | N/A
15004 | PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT | 2011-07-01 00:00:00 | 331.99 | N | Y | N/A | N/A
15005 | PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT | 2011-07-01 00:00:00 | 101.06 | N | Y | N/A | N/A
15040 | HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/LT | 2011-07-01 00:00:00 | 211.52 | N | Y | N/A | N/A
15050 | PINCH GRAFT 1/MLT CGT SM ULCER TIP/OTH AREA 2CM | 2011-07-01 00:00:00 | 467.79 | N | Y | N/A | N/A
15100 | SPLIT AGRFT T/A/L 1ST 100 CM/ LE OR 1% BDY INFT/CHLD | 2011-07-01 00:00:00 | 718.62 | N | Y | N/A | N/A
15101 | SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD | 2011-07-01 00:00:00 | 155.43 | N | Y | N/A | N/A
15110 | EPIDRM AGRFT T/A/L 1ST 100 CM/ LE OR 1% BDY INFT/CHLD | 2011-07-01 00:00:00 | 708.42 | N | Y | N/A | N/A
15111 | EPIDRM AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD | 2011-07-01 00:00:00 | 98.69 | N | Y | N/A | N/A
15115 | EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/LT | 2011-07-01 00:00:00 | 723.6 | N | Y | N/A | N/A
15116 | EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/LT | 2011-07-01 00:00:00 | 142.11 | N | Y | N/A | N/A
15120 | [NAME] 1ST 100 CMLT1 % | 2011-07-01 00:00:00 | 796.89 | N | Y | N/A | N/A
15121 | [NAME] 1 % | 2011-07-01 00:00:00 | 222.46 | N | Y | N/A | N/A
15130 | DERMAL AUTOGRAFT TRUNK/ARM/LEG 1ST 100 CM | 2011-07-01 00:00:00 | 562.38 | N | Y | N/A | N/A
15131 | DERMAL AUTOGRAFT TRUNK/ARM/LEG EA 100 CM/EA | 2011-07-01 00:00:00 | 84.74 | N | Y | N/A | N/A
15135 | DERMAL AUTOGRAFT F/S/N/H/F/G/M/D GT 1ST 100 | 2011-07-01 00:00:00 | 728.02 | N | Y | N/A | N/A
15136 | DERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA | 2011-07-01 00:00:00 | 75.88 | N | Y | N/A | N/A
15150 | CLTR SKIN AUTOGRAFT T/A/L 1ST 25 CM/LT | 2011-07-01 00:00:00 | 575.98 | N | Y | N/A | N/A
15151 | [NAME] AGRFT T/A/L ADDL 1 CM-75 CM | 2011-07-01 00:00:00 | 110.31 | N | Y | N/A | N/A
15152 | [NAME] AGRFT T/A/L EA 100 CM/EA 1%BODY AREA | 2011-07-01 00:00:00 | 130.01 | N | Y | N/A | N/A
15155 | [NAME] 1ST 25CM/LT | 2011-07-01 00:00:00 | 551.16 | N | Y | N/A | N/A
15156 | [NAME] GT ADDL 1-75CM | 2011-07-01 00:00:00 | 141.13 | N | Y | N/A | N/A
15157 | [NAME] 100 EA | 2011-07-01 00:00:00 | 141.72 | N | Y | N/A | N/A
15200 | FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 CM/LT | 2011-07-01 00:00:00 | 684.68 | N | Y | N/A | N/A
15201 | FTH/GFT FR W/DIR CLSR TRNK EA ADDL 20 CMLT | 2011-07-01 00:00:00 | 123.92 | N | Y | N/A | N/A
15220 | FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 CM/LT | 2011-07-01 00:00:00 | 645.41 | N | Y | N/A | N/A
15221 | FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 CMLT | 2011-07-01 00:00:00 | 114.8 | N | Y | N/A | N/A
15240 | FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/LT | 2011-07-01 00:00:00 | 781.17 | N | Y | N/A | N/A
15241 | FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/LT | 2011-07-01 00:00:00 | 154.93 | N | Y | N/A | N/A
15260 | FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/LT | 2011-07-01 00:00:00 | 848.56 | N | Y | N/A | N/A
15261 | FTH/GFT FREE W/DIR CLSR N/E/E/L EA 20 SQ CM/LT | 2011-07-01 00:00:00 | 181.06 | N | Y | N/A | N/A
15271 | [NAME] T/A/L AREA/LT100SCM /LT1ST 25 SCM | 2012-01-01 00:00:00 | 118.76 | N | N | N/A | N/A
15272 | [NAME] T/A/L AREA/LT100SCM EA ADL 25SCM | 2012-01-01 00:00:00 | 22.63 | N | N | N/A | N/A
15273 | [NAME] T/A/L AREA/GT100SCM 1ST 100SCM | 2012-01-01 00:00:00 | 244.38 | N | N | N/A | N/A
15274 | [NAME] T/A/L AREA/GT100SCM ADL 100SCM | 2012-01-01 00:00:00 | 57.85 | N | N | N/A | N/A
15275 | SUB GRFT F/S/N/H/F/G/M/D /LT100SCM /LT1ST 25 SCM | 2012-01-01 00:00:00 | 127.79 | N | N | N/A | N/A
15276 | SUB GRFT F/S/N/H/F/G/M/D /LT100SCM EA ADL 25SCM | 2012-01-01 00:00:00 | 28.21 | N | N | N/A | N/A
15277 | SUB GRFT F/S/N/H/F/G/M/D /GT100SCM 1ST 100SCM | 2012-01-01 00:00:00 | 247.64 | N | N | N/A | N/A
15278 | SUB GRFT F/S/N/H/F/G/M/D /GT100SCM ADL 100SCM | 2012-01-01 00:00:00 | 68.09 | N | N | N/A | N/A
15570 | FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK | 2011-07-01 00:00:00 | 744.04 | N | Y | N/A | N/A
15572 | FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS | 2011-07-01 00:00:00 | 727.69 | N | Y | N/A | N/A
15574 | FRMJ DIR/TUBE PEDCL W/WOTR FT/CH/CH/M/N/AX/G/H/F | 2011-07-01 00:00:00 | 762.15 | N | Y | N/A | N/A
15576 | FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL | 2011-07-01 00:00:00 | 677.66 | N | Y | N/A | N/A
15600 | DELAY FLAP/SECTIONING FLAP TRUNK | 2011-07-01 00:00:00 | 271.12 | N | Y | N/A | N/A
15610 | DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS | 2011-07-01 00:00:00 | 284.76 | N | Y | N/A | N/A
15620 | DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F | 2011-07-01 00:00:00 | 366.7 | N | Y | N/A | N/A
15630 | DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS | 2011-07-01 00:00:00 | 387.86 | N | Y | N/A | N/A
15650 | TRANSFER ANY PEDICLE FLAP ANY LOCATION | 2011-07-01 00:00:00 | 428.54 | N | Y | N/A | N/A
15731 | FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE | 2011-07-01 00:00:00 | 961.13 | N | Y | N/A | N/A
15732 | MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP HEAD&NCK | 2011-07-01 00:00:00 | 1263.02 | N | Y | N/A | N/A
15734 | MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK | 2011-07-01 00:00:00 | 1278.59 | N | Y | N/A | N/A
15736 | MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR | 2011-07-01 00:00:00 | 1125.98 | N | Y | N/A | N/A
15738 | MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR | 2011-07-01 00:00:00 | 1197.6 | N | Y | N/A | N/A
15740 | FLAP ISLAND PEDICLE | 2011-07-01 00:00:00 | 864.98 | N | Y | N/A | N/A
15750 | FLAP NEUROVASCULAR PEDICLE | 2011-07-01 00:00:00 | 774.02 | N | Y | N/A | N/A
15756 | [NAME] ANAST | 2011-07-01 00:00:00 | 2005.55 | N | Y | N/A | N/A
15757 | FREE SKIN FLAP W/MICROVASCULAR ANASTOMOSIS | 2011-07-01 00:00:00 | 1990.72 | N | Y | N/A | N/A
15758 | FREE FASCIAL FLAP W/MICROVASCULAR ANASTOMOSIS | 2011-07-01 00:00:00 | 1981.63 | N | Y | N/A | N/A
15760 | GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA | 2011-07-01 00:00:00 | 716.7 | N | Y | N/A | N/A
15770 | GRAFT DERMA-FAT-FASCIA | 2011-07-01 00:00:00 | 563.46 | N | Y | N/A | N/A
15777 | IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT | 2012-01-01 00:00:00 | 177.25 | Y | N | N/A | N/A
15820 | BLEPHAROPLASTY LOWER EYELID | 2011-07-01 00:00:00 | 467.46 | N | Y | N/A | N/A
15821 | BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD | 2011-07-01 00:00:00 | 498.86 | N | Y | N/A | N/A
15822 | BLEPHAROPLASTY UPPER EYELID | 2011-07-01 00:00:00 | 363.52 | N | Y | N/A | N/A
15823 | BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN | 2011-07-01 00:00:00 | 511.61 | N | Y | N/A | N/A
15829 | RHYTIDECTOMY SMAS FLAP | 2008-07-01 00:00:00 | 536.88 | Y | Y | N/A | N/A
15830 | EXCISION SKIN ABD INFRAUMBILICAL PANNICULECTOMY | 2011-07-01 00:00:00 | 979.28 | Y | Y | N/A | N/A
15833 | EXCISION EXCESSIVE SKIN&SUBQ TISSUE LEG | 2011-07-01 00:00:00 | 728.76 | Y | Y | N/A | N/A
15836 | EXCISION EXCESSIVE SKIN&SUBQ TISSUE ARM | 2011-07-01 00:00:00 | 605.64 | Y | Y | N/A | N/A
15840 | GRAFT FACIAL NERVE PARALYSIS FREE FASCIAL GRAFT | 2011-07-01 00:00:00 | 866.57 | N | Y | N/A | N/A
15841 | GRAFT FACIAL NERVE PARALYSIS FREE MUSCLE GRAFT | 2011-07-01 00:00:00 | 1440.03 | N | Y | N/A | N/A
15842 | GRF FACIAL NRV PALYSS FR MUSCLE FLAP MICROSURG | 2011-07-01 00:00:00 | 2161.29 | N | Y | N/A | N/A
15845 | [NAME] REGIONAL MUSCLE TR | 2011-07-01 00:00:00 | 832.82 | N | Y | N/A | N/A
15847 | EXCISION EXCESSIVE SKIN & SUBQ TISSUE ABDOMEN | 2008-07-01 00:00:00 | 796.67 | Y | Y | N/A | N/A
15850 | REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON | 2008-07-01 00:00:00 | 54.03 | N | Y | N/A | N/A
15851 | REMOVAL SUTURES UNDER ANESTHESIA OTHER SURGEON | 2011-07-01 00:00:00 | 79.43 | N | Y | N/A | N/A
15852 | DRESSING CHANGE UNDER ANESTHESIA | 2011-07-01 00:00:00 | 39.71 | N | Y | N/A | N/A
15860 | IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT | 2011-07-01 00:00:00 | 91.94 | N | Y | N/A | N/A
15877 | SUCTION ASSISTED LIPECTOMY; TRUNK | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
15920 | EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/PRIM SUTR | 2011-07-01 00:00:00 | 500.83 | N | Y | N/A | N/A
15922 | EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/FLAP CLSR | 2011-07-01 00:00:00 | 646.46 | N | Y | N/A | N/A
15931 | EXCISION SACRAL PRESSURE ULCER W/PRIMARY SUTURE | 2011-07-01 00:00:00 | 560.12 | N | Y | N/A | N/A
15933 | EXC SACRAL PRESSURE ULC W/PRIM SUTR W/OSTECTOMY | 2011-07-01 00:00:00 | 694.46 | N | Y | N/A | N/A
15934 | EXCISION SACRAL PRESSURE ULCER W/SKIN FLAP CLSR | 2011-07-01 00:00:00 | 771.74 | N | Y | N/A | N/A
15935 | EXC SACRAL PR ULCER W/SKN FLAP CLSR W/OSTECTOMY | 2011-07-01 00:00:00 | 914.18 | N | Y | N/A | N/A
15936 | EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR | 2011-07-01 00:00:00 | 744.98 | N | Y | N/A | N/A
15937 | EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC | 2011-07-01 00:00:00 | 872.03 | N | Y | N/A | N/A
15940 | EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE | 2011-07-01 00:00:00 | 577.65 | N | Y | N/A | N/A
15941 | EXC ISCHIAL PR ULC W/PRIM SUTR W/OSTC ISCHIECT | 2011-07-01 00:00:00 | 749.86 | N | Y | N/A | N/A
15944 | EXC ISCHIAL PRESSURE ULCER W/SKIN FLAP CLOSURE | 2011-07-01 00:00:00 | 745.65 | N | Y | N/A | N/A
15945 | EXC ISCHIAL PR ULC W/SKN FLAP CLSR W/OSTECTOMY | 2011-07-01 00:00:00 | 827.96 | N | Y | N/A | N/A
15946 | EXC ISCHIAL PR ULCER W/OSTC MUSC/MYOQ FLAP/SKIN | 2011-07-01 00:00:00 | 1375.8 | N | Y | N/A | N/A
15950 | EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR | 2011-07-01 00:00:00 | 475.5 | N | Y | N/A | N/A
15951 | EXC TRCHNTRIC PR ULCER W/PRIM SUTR W/OSTECTOMY | 2011-07-01 00:00:00 | 716.77 | N | Y | N/A | N/A
15952 | EXC TROCHANTERIC PR ULCER W/SKIN FLAP CLOSURE | 2011-07-01 00:00:00 | 697.52 | N | Y | N/A | N/A
15953 | EXC TRCHNTRIC PR ULC W/SKN FLAP CLSR W/OSTECTOMY | 2011-07-01 00:00:00 | 767.89 | N | Y | N/A | N/A
15956 | EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN | 2011-07-01 00:00:00 | 966.27 | N | Y | N/A | N/A
15958 | EXC TRCHNTRIC PR ULC MUSC/MYOQ FLAP/SKIN W/OSTC | 2011-07-01 00:00:00 | 986.44 | N | Y | N/A | N/A
15999 | EXCISION PRESSURE ULCER | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
16000 | INITIAL TX 1ST DEGREE BURN LOCAL TX | 2011-07-01 00:00:00 | 57.29 | N | Y | N/A | N/A
16020 | DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL | 2011-07-01 00:00:00 | 69.07 | N | Y | N/A | N/A
16025 | DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM | 2011-07-01 00:00:00 | 123.42 | N | Y | N/A | N/A
16030 | DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE | 2011-07-01 00:00:00 | 148.22 | N | Y | N/A | N/A
16035 | ESCHAROTOMY FIRST INCISION | 2011-07-01 00:00:00 | 172.1 | N | Y | N/A | N/A
16036 | ESCHAROTOMY EACH ADDITIONAL INCISION | 2011-07-01 00:00:00 | 69.34 | N | Y | N/A | N/A
17000 | DESTRUCTION PREMALIGNANT LESION 1ST | 2011-07-01 00:00:00 | 67.7 | N | Y | N/A | N/A
17003 | DESTRUCTION PREMALIGNANT LESION 2-14 EA | 2011-07-01 00:00:00 | 6.07 | N | Y | N/A | N/A
17004 | DESTRUCTION PREMALIGNANT LESION 15/GT | 2011-07-01 00:00:00 | 146.07 | N | Y | N/A | N/A
17106 | DESTRUCTION CUTANEOUS VASC PROLIFERATIVE LT10CM | 2011-07-01 00:00:00 | 288.2 | Y | Y | N/A | N/A
17107 | DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM | 2011-07-01 00:00:00 | 373.49 | Y | Y | N/A | N/A
17108 | DSTRJ CUTANEOUS VASCULAR LESIONS GT50.0 SQ CM | 2011-07-01 00:00:00 | 531.66 | Y | Y | N/A | N/A
17110 | DESTRUCTION BENIGN LESIONS UP TO 14 | 2011-07-01 00:00:00 | 92.3 | N | Y | N/A | N/A
17111 | DESTRUCTION BENIGN LESIONS 15/GT | 2011-07-01 00:00:00 | 109.91 | N | Y | N/A | N/A
17250 | CHEMICAL CAUTERIZATION GRANULATION TISSUE | 2011-07-01 00:00:00 | 63.51 | N | Y | N/A | N/A
17260 | DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/LT | 2011-07-01 00:00:00 | 79.9 | N | Y | N/A | N/A
17261 | DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM | 2011-07-01 00:00:00 | 120.33 | N | Y | N/A | N/A
17262 | DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM | 2011-07-01 00:00:00 | 146.14 | N | Y | N/A | N/A
17263 | DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM | 2011-07-01 00:00:00 | 160.88 | N | Y | N/A | N/A
17264 | DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM | 2011-07-01 00:00:00 | 172.33 | N | Y | N/A | N/A
17266 | DESTRUCTION MAL LESION TRUNK/ARM/LEG GT 4.0 CM | 2011-07-01 00:00:00 | 195.53 | N | Y | N/A | N/A
17270 | DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/LT | 2011-07-01 00:00:00 | 125.56 | N | Y | N/A | N/A
17271 | DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM | 2011-07-01 00:00:00 | 137.91 | N | Y | N/A | N/A
17272 | DESTRUCTION MALIGNANT LESION S/N/H/F/G 1.1-2.0CM | 2011-07-01 00:00:00 | 157.37 | N | Y | N/A | N/A
17273 | DESTRUCTION MALIGNANT LESION S/N/H/F/G 2.1-3.0CM | 2011-07-01 00:00:00 | 175.29 | N | Y | N/A | N/A
17274 | DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM | 2011-07-01 00:00:00 | 206.87 | N | Y | N/A | N/A
17276 | DSTRJ MAL LES S/N/H/F/G LES DIAM GT 4.0 CM | 2011-07-01 00:00:00 | 239.27 | N | Y | N/A | N/A
17280 | DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/LT | 2011-07-01 00:00:00 | 117.74 | N | Y | N/A | N/A
17281 | DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM | 2011-07-01 00:00:00 | 149.22 | N | Y | N/A | N/A
17282 | DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM | 2011-07-01 00:00:00 | 172.96 | N | Y | N/A | N/A
17283 | DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM | 2011-07-01 00:00:00 | 208 | N | Y | N/A | N/A
17284 | DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM | 2011-07-01 00:00:00 | 241.35 | N | Y | N/A | N/A
17286 | DESTRUCTION MAL LESION F/E/E/N/L/M GT 4.0 CM | 2011-07-01 00:00:00 | 305 | N | Y | N/A | N/A
17311 | MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS | 2011-07-01 00:00:00 | 567.85 | N | Y | N/A | N/A
17312 | MOHS MICROGRAPHIC H/N/H/F/G EACH ADDL STAGE | 2011-07-01 00:00:00 | 338.89 | N | Y | N/A | N/A
17313 | MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS | 2011-07-01 00:00:00 | 517.87 | N | Y | N/A | N/A
17314 | MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE | 2011-07-01 00:00:00 | 314.3 | N | Y | N/A | N/A
17315 | MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE | 2011-07-01 00:00:00 | 68.32 | N | Y | N/A | N/A
17999 | UNLISTED PROCEDURE, SKIN | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
19000 | PUNCTURE ASPIRATION CYST BREAST | 2011-07-01 00:00:00 | 92.49 | N | Y | N/A | N/A
19001 | PUNCTURE ASPIRATION BREAST EACH ADDITIONAL CYST | 2011-07-01 00:00:00 | 22.65 | N | Y | N/A | N/A
19020 | MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP | 2011-07-01 00:00:00 | 373.55 | N | Y | N/A | N/A
19030 | INJECTION MAMMARY DUCTOGRAM/GALACTOGRAM | 2011-07-01 00:00:00 | 138.05 | N | Y | N/A | N/A
19081 | BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE | 2014-01-01 00:00:00 | 553.05 | N | Y | N/A | N/A
19082 | BX BREAST W DEVICE ADDL LESION STEREOTACT GUIDE | 2014-01-01 00:00:00 | 447.19 | N | Y | N/A | N/A
19083 | BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE | 2014-01-01 00:00:00 | 549.42 | N | Y | N/A | N/A
19084 | BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE | 2014-01-01 00:00:00 | 441.01 | N | Y | N/A | N/A
19085 | BX BREAST W DEVICE 1ST LESION MAGNETIC RES GUIDE | 2014-01-01 00:00:00 | 830.75 | N | Y | N/A | N/A
19086 | BX BREAST W DEVICE ADDL LESION MAGNET RES GUIDE | 2014-01-01 00:00:00 | 664.37 | N | Y | N/A | N/A
19100 | BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX | 2011-07-01 00:00:00 | 119.8 | N | Y | N/A | N/A
19101 | BIOPSY BREAST OPEN INCISIONAL | 2011-07-01 00:00:00 | 272.84 | N | Y | N/A | N/A
19105 | ABLTJ CRYOSURGICAL W/US GID EA FIBROADENOMA | 2011-07-01 00:00:00 | 1729.27 | N | Y | N/A | N/A
19110 | NIPPLE EXPLORATION | 2011-07-01 00:00:00 | 387.33 | N | Y | N/A | N/A
19112 | [NAME] FISTULA | 2011-07-01 00:00:00 | 363.78 | N | Y | N/A | N/A
19120 | [NAME]/ABERRANT BREAST TISSUE OPEN 1/GT LESIONS | 2011-07-01 00:00:00 | 393.79 | N | Y | N/A | N/A
19125 | [NAME] PREOP PLMT RAD [NAME] OPEN 1 LES | 2011-07-01 00:00:00 | 437.03 | N | Y | N/A | N/A
19126 | EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL | 2011-07-01 00:00:00 | 134.06 | N | Y | N/A | N/A
19260 | EXCISION CHEST WALL TUMOR INCLUDING RIBS | 2011-07-01 00:00:00 | 1003.97 | N | Y | N/A | N/A
19271 | EXC CHEST TUMOR W/RCNSTJ W/O MEDSTNL LMPHADEC | 2011-07-01 00:00:00 | 1362.04 | N | Y | N/A | N/A
19272 | EXC CHEST TUMOR W/RCNSTJ W/MEDSTNL LMPHADEC | 2011-07-01 00:00:00 | 1505.13 | N | Y | N/A | N/A
19281 | PERQ DEVICE PLACEMT BREAST LOC 1ST LES W GUIDNCE | 2014-01-01 00:00:00 | 202.79 | N | Y | N/A | N/A
19282 | PERQ DEVICE PLACEMT BREAST LOC EA LES W GUIDNCE | 2014-01-01 00:00:00 | 140.53 | N | Y | N/A | N/A
19283 | PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GUID | 2014-01-01 00:00:00 | 229.65 | N | Y | N/A | N/A
19284 | PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC | 2014-01-01 00:00:00 | 167.98 | N | Y | N/A | N/A
19285 | PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG | 2014-01-01 00:00:00 | 384.69 | N | Y | N/A | N/A
19286 | PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE | 2014-01-01 00:00:00 | 321.73 | N | Y | N/A | N/A
19287 | PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID | 2014-01-01 00:00:00 | 707.96 | N | Y | N/A | N/A
19288 | PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID | 2014-01-01 00:00:00 | 565.43 | N | Y | N/A | N/A
19296 | PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST | 2011-07-01 00:00:00 | 3349.34 | N | Y | N/A | N/A
19297 | PLMT EXPANDABLE CATH BRST CONCURRENT PRTL MAST | 2011-07-01 00:00:00 | 78.62 | N | Y | N/A | N/A
19298 | PLMT RADTHX BRACHYTX BRST FOLLOWING PRTL MAST | 2011-07-01 00:00:00 | 1030.12 | N | Y | N/A | N/A
19300 | MASTECTOMY GYNECOMASTIA | 2011-07-01 00:00:00 | 418.3 | Y | Y | N/A | N/A
19301 | MASTECTOMY PARTIAL | 2011-07-01 00:00:00 | 527.01 | N | Y | N/A | N/A
19302 | MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY | 2011-07-01 00:00:00 | 726.75 | N | Y | N/A | N/A
19303 | MASTECTOMY SIMPLE COMPLETE | 2011-07-01 00:00:00 | 815.72 | N | Y | N/A | N/A
19304 | MASTECTOMY SUBCUTANEOUS | 2011-07-01 00:00:00 | 464.93 | N | Y | N/A | N/A
19305 | MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES | 2011-07-01 00:00:00 | 921.82 | N | Y | N/A | N/A
19306 | MAST RAD W/PECTORAL MUSC AX INT MAM LYMPH NODES | 2011-07-01 00:00:00 | 971.28 | N | Y | N/A | N/A
19307 | MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN | 2011-07-01 00:00:00 | 971.75 | N | Y | N/A | N/A
19316 | MASTOPEXY | 2011-07-01 00:00:00 | 650.21 | Y | Y | N/A | N/A
19318 | REDUCTION MAMMAPLASTY | 2011-07-01 00:00:00 | 943.96 | Y | Y | N/A | N/A
19324 | MAMMAPLASTY AUGMENTATION W/O PROSTHETIC IMPLANT | 2011-07-01 00:00:00 | 401.88 | Y | Y | N/A | N/A
19325 | MAMMAPLASTY AUGMENTATION W/PROSTHETIC IMPLANT | 2011-07-01 00:00:00 | 544.92 | Y | Y | N/A | N/A
19328 | REMOVAL INTACT MAMMARY IMPLANT | 2011-07-01 00:00:00 | 415.47 | Y | Y | N/A | N/A
19330 | REMOVAL MAMMARY IMPLANT MATERIAL | 2011-07-01 00:00:00 | 530.96 | Y | Y | N/A | N/A
19340 | [NAME] BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ | 2011-07-01 00:00:00 | 733.69 | Y | Y | N/A | N/A
19342 | DLYD INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ | 2011-07-01 00:00:00 | 780.4 | Y | Y | N/A | N/A
19350 | NIPPLE/AREOLA RECONSTRUCTION | 2011-07-01 00:00:00 | 700.43 | Y | Y | N/A | N/A
19357 | BRST RCNSTJ IMMT/DLYD W/TISS EXPANDER SBSQ XPNSJ | 2011-07-01 00:00:00 | 1247.84 | Y | Y | N/A | N/A
19361 | BRST RCNSTJ W/LATSMS D/SI FLAP WO PRSTHC IMPL | 2011-07-01 00:00:00 | 1426.86 | Y | Y | N/A | N/A
19364 | BREAST RECONSTRUCTION FREE FLAP | 2011-07-01 00:00:00 | 2356.4 | Y | Y | N/A | N/A
19366 | BREAST RECONSTRUCTION OTHER TECHNIQUE | 2011-07-01 00:00:00 | 1159.64 | Y | Y | N/A | N/A
19367 | BREAST RECONSTRUCTION TRAM FLAP 1 PEDICLE | 2011-07-01 00:00:00 | 1528.78 | Y | Y | N/A | N/A
19368 | BREAST RECONSTRUCTION TRAM 1 PEDCL MVASC ANAST | 2011-07-01 00:00:00 | 1889.46 | Y | Y | N/A | N/A
19369 | BREAST RECONSTRUCTION TRAM FLAP DOUBLE PEDICLE | 2011-07-01 00:00:00 | 1744.36 | Y | Y | N/A | N/A
19370 | OPEN PERIPROSTHETIC CAPSULOTOMY BREAST | 2011-07-01 00:00:00 | 578.33 | Y | Y | N/A | N/A
19371 | PERIPROSTHETIC CAPSULECTOMY BREAST | 2011-07-01 00:00:00 | 662.86 | Y | Y | N/A | N/A
19380 | REVISION RECONSTRUCTED BREAST | 2011-07-01 00:00:00 | 651.71 | Y | Y | N/A | N/A
19499 | UNLISTED PROCEDURE, BREAST | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
20005 | I&D SOFT TISSUE ABSCESS SUBFASC | 2011-07-01 00:00:00 | 250.42 | N | Y | N/A | N/A
20100 | EXPLORATION PENETRATING WOUND SPX NECK | 2011-07-01 00:00:00 | 499.62 | N | Y | N/A | N/A
20101 | EXPLORATION PENETRATING WOUND SPX CHEST | 2011-07-01 00:00:00 | 333.16 | N | Y | N/A | N/A
20102 | EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK | 2011-07-01 00:00:00 | 393.49 | N | Y | N/A | N/A
20103 | EXPLORATION PENETRATING WOUND SPX EXTREMITY | 2011-07-01 00:00:00 | 473.87 | N | Y | N/A | N/A
20150 | EXCISION EPIPHYSEAL BAR | 2011-07-01 00:00:00 | 826.69 | N | Y | N/A | N/A
20200 | [NAME] | 2011-07-01 00:00:00 | 164.03 | N | Y | N/A | N/A
20205 | [NAME] DEEP | 2011-07-01 00:00:00 | 225.26 | N | Y | N/A | N/A
20206 | [NAME] NEEDLE | 2011-07-01 00:00:00 | 210.23 | N | Y | N/A | N/A
20220 | BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL | 2011-07-01 00:00:00 | 138.8 | N | Y | N/A | N/A
20225 | BIOPSY BONE TROCAR/NEEDLE DEEP | 2011-07-01 00:00:00 | 517.38 | N | Y | N/A | N/A
20240 | BIOPSY BONE OPEN SUPERFICIAL | 2011-07-01 00:00:00 | 188.98 | N | Y | N/A | N/A
20245 | BIOPSY BONE OPEN DEEP | 2011-07-01 00:00:00 | 528.62 | N | Y | N/A | N/A
20250 | BIOPSY VERTEBRAL BODY OPEN THORACIC | 2011-07-01 00:00:00 | 314.99 | N | Y | N/A | N/A
20251 | BIOPSY VERTEBRAL BODY OPEN LUMBAR/CERVICAL | 2011-07-01 00:00:00 | 344.48 | N | Y | N/A | N/A
20500 | INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC | 2011-07-01 00:00:00 | 92.85 | N | Y | N/A | N/A
20501 | INJECTION SINUS TRACT DIAGNOSTIC | 2011-07-01 00:00:00 | 104.91 | N | Y | N/A | N/A
20520 | REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE | 2011-07-01 00:00:00 | 162.25 | N | Y | N/A | N/A
20525 | RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP | 2011-07-01 00:00:00 | 392.23 | N | Y | N/A | N/A
20526 | [NAME] TUNNEL | 2011-07-01 00:00:00 | 62.62 | N | Y | N/A | N/A
20527 | INJECTION ENZYME PALMAR FASCIAL CORD | 2012-01-01 00:00:00 | 62.98 | N | N | N/A | N/A
20550 | INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS | 2011-07-01 00:00:00 | 47.98 | N | Y | N/A | N/A
20551 | INJECTION SINGLE TENDON ORIGIN/INSERTION | 2011-07-01 00:00:00 | 48.84 | N | Y | N/A | N/A
20552 | INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES | 2011-07-01 00:00:00 | 44.77 | N | Y | N/A | N/A
20553 | INJECTION SINGLE/MLT TRIGGER POINT 3/GT MUSCLES | 2011-07-01 00:00:00 | 50.69 | N | Y | N/A | N/A
20555 | PLACEMENT NEEDLES MUSCLE SUBSEQUENT RADIOELEMENT | 2011-07-01 00:00:00 | 280.12 | N | Y | N/A | N/A
20600 | ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA | 2011-07-01 00:00:00 | 45.34 | N | Y | N/A | N/A
20605 | ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURSA | 2011-07-01 00:00:00 | 49.3 | N | Y | N/A | N/A
20610 | ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA | 2011-07-01 00:00:00 | 65.19 | N | Y | N/A | N/A
20612 | ASPIRATION&/INJECTION GANGLION CYST ANY LOCATION | 2011-07-01 00:00:00 | 49.04 | N | Y | N/A | N/A
20615 | ASPIRATION&INJECTION TREATMENT BONE CYST | 2011-07-01 00:00:00 | 182.44 | N | Y | N/A | N/A
20650 | INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX | 2011-07-01 00:00:00 | 165.05 | N | Y | N/A | N/A
20660 | APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX | 2011-07-01 00:00:00 | 201.83 | N | Y | N/A | N/A
20661 | [NAME] INCLUDING REMOVAL | 2011-07-01 00:00:00 | 401.07 | N | Y | N/A | N/A
20662 | APPLICATION HALO PELVIC INCLUDING REMOVAL | 2011-07-01 00:00:00 | 366.96 | N | Y | N/A | N/A
20663 | APPLICATION HALO FEMORAL INCLUDING REMOVAL | 2011-07-01 00:00:00 | 380.88 | N | Y | N/A | N/A
20664 | APPL HALO 6/GT PINS THIN SKULL OSTEOLOGY | 2011-07-01 00:00:00 | 662.58 | N | Y | N/A | N/A
20665 | REMOVAL TONG/HALO APPLIED BY ANOTHER PHYSICIAN | 2011-07-01 00:00:00 | 93.39 | N | Y | N/A | N/A
20670 | REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 322.97 | N | Y | N/A | N/A
20680 | REMOVAL IMPLANT DEEP | 2011-07-01 00:00:00 | 507.31 | N | Y | N/A | N/A
20690 | APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM | 2011-07-01 00:00:00 | 481.08 | N | Y | N/A | N/A
20692 | APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM | 2011-07-01 00:00:00 | 906.36 | N | Y | N/A | N/A
20693 | ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES | 2011-07-01 00:00:00 | 381.25 | N | Y | N/A | N/A
20694 | REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES | 2011-07-01 00:00:00 | 352.66 | N | Y | N/A | N/A
20696 | XTRNL FIXJ W/STEREOTACTIC ADJUSTMENT 1ST&SUBQ | 2011-07-01 00:00:00 | 923.31 | N | Y | N/A | N/A
20697 | XTRNL FIXJ W/STRTCTC ADJUSTMENT EXCHANGE STRUT | 2011-07-01 00:00:00 | 1420.91 | N | Y | N/A | N/A
20802 | REPLANTATION ARM COMPLETE AMPUTATION | 2011-07-01 00:00:00 | 1992.16 | N | Y | N/A | N/A
20805 | REPLANTATION FOREARM COMPLETE AMPUTATION | 2011-07-01 00:00:00 | 2390.23 | N | Y | N/A | N/A
20808 | REPLANTATION HAND COMPLETE AMPUTATION | 2011-07-01 00:00:00 | 3502.77 | N | Y | N/A | N/A
20816 | RPLJ DGT EXCEPT THMB MTCARPHLNGL JT COMPL AMP | 2011-07-01 00:00:00 | 1828.52 | N | Y | N/A | N/A
20822 | RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP | 2011-07-01 00:00:00 | 1593.7 | N | Y | N/A | N/A
20824 | RPLJ THMB CARP/MTCRPL JT MP JT COMPL AMPUTATION | 2011-07-01 00:00:00 | 1822.9 | N | Y | N/A | N/A
20827 | RPLJ THUMB DISTAL TIP MP JOINT COMPL AMPUTATION | 2011-07-01 00:00:00 | 1655.14 | N | Y | N/A | N/A
20838 | REPLANTATION FOOT COMPLETE AMPUTATION | 2011-07-01 00:00:00 | 2044.4 | N | Y | N/A | N/A
20900 | BONE GRAFT ANY DONOR AREA MINOR/SMALL | 2011-07-01 00:00:00 | 345.48 | N | Y | N/A | N/A
20902 | BONE GRAFT ANY DONOR AREA MAJOR/LARGE | 2011-07-01 00:00:00 | 274.93 | N | Y | N/A | N/A
20910 | CARTILAGE GRAFT COSTOCHONDRAL | 2011-07-01 00:00:00 | 358.28 | N | Y | N/A | N/A
20912 | CARTILAGE GRAFT NASAL SEPTUM | 2011-07-01 00:00:00 | 413.1 | N | Y | N/A | N/A
20920 | FASCIA LATA GRAFT BY STRIPPER | 2011-07-01 00:00:00 | 341.46 | N | Y | N/A | N/A
20922 | FASCIA LATA GRAFT INCISION & AREA EXPOSURE | 2011-07-01 00:00:00 | 500.74 | N | Y | N/A | N/A
20924 | TENDON GRAFT FROM A DISTANCE | 2011-07-01 00:00:00 | 422.78 | N | Y | N/A | N/A
20926 | TISSUE GRAFTS OTHER | 2011-07-01 00:00:00 | 364.76 | N | Y | N/A | N/A
20930 | ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED | 2008-07-01 00:00:00 | 171.62 | N | Y | N/A | N/A
20931 | ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL | 2011-07-01 00:00:00 | 93.69 | N | Y | N/A | N/A
20936 | AUTOGRAFT FOR SPINE SURGERY ONLY; (INCL HARVEST) LOCAL FROM SAME INCISION-(SP) | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
20937 | AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION | 2011-07-01 00:00:00 | 142.19 | N | Y | N/A | N/A
20938 | AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC | 2011-07-01 00:00:00 | 155.03 | N | Y | N/A | N/A
20950 | [NAME] INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME | 2011-07-01 00:00:00 | 205.47 | N | Y | N/A | N/A
20955 | BONE GRAFT MICROVASCULAR ANASTOMOSIS FIBULA | 2011-07-01 00:00:00 | 2168.43 | N | Y | N/A | N/A
20956 | BONE GRAFT MICROVASCULAR ANAST ILIAC CREST | 2011-07-01 00:00:00 | 2226.43 | N | Y | N/A | N/A
20957 | BONE GRAFT MICROVASCULAR ANAST METATARSAL | 2011-07-01 00:00:00 | 2166.06 | N | Y | N/A | N/A
20962 | BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR | 2011-07-01 00:00:00 | 2208.21 | N | Y | N/A | N/A
20969 | FREE OSTQ FLAP W/MVASC ANAST METAR/GREAT TOE | 2011-07-01 00:00:00 | 2400.92 | N | Y | N/A | N/A
20970 | FREE OSTQ FLAP W/MVASC ANASTOMOSIS ILIAC CREST | 2011-07-01 00:00:00 | 2377.47 | N | Y | N/A | N/A
20972 | FREE OSTQ FLAP W/MVASC ANASTOMOSIS METATARSAL | 2011-07-01 00:00:00 | 1987.68 | N | Y | N/A | N/A
20973 | FR OSTQ FLAP W/MVASC ANAST GRT TOE W/WEB SPACE | 2011-07-01 00:00:00 | 2322.94 | N | Y | N/A | N/A
20974 | ELECTRICAL STIMULATION BONE HEALING NONINVASIVE | 2011-07-01 00:00:00 | 57.97 | N | Y | N/A | N/A
20975 | ELECTRICAL STIMULATION BONE HEALING INVASIVE | 2011-07-01 00:00:00 | 147.78 | N | Y | N/A | N/A
20979 | LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE | 2011-07-01 00:00:00 | 44 | N | Y | N/A | N/A
20982 | ABLATION BONE TUMOR RF PERCUTANEOUS CT GUIDANCE | 2011-07-01 00:00:00 | 3036.26 | N | Y | N/A | N/A
20985 | CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS | 2011-07-01 00:00:00 | 125.1 | N | Y | N/A | N/A
20999 | REPAIR, MUSCLE WOUND | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
21010 | [NAME] JOINT | 2011-07-01 00:00:00 | 615.02 | N | Y | N/A | N/A
21011 | AMB SURG CTR -ARTHRO TEMPOROM | 2011-07-01 00:00:00 | 278.95 | N | Y | N/A | N/A
21012 | EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/GT | 2011-07-01 00:00:00 | 293.43 | N | Y | N/A | N/A
21013 | EXC FACE TUM DEEP LT 2 CM | 2011-07-01 00:00:00 | 430.95 | N | Y | N/A | N/A
21014 | EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/GT | 2011-07-01 00:00:00 | 452.57 | N | Y | N/A | N/A
21015 | RAD RESECTION TUMOR SOFT TISS FACE/SCALP LT 2CM | 2011-07-01 00:00:00 | 552.96 | N | Y | N/A | N/A
21016 | RAD RESECTION TUMOR SOFT TISS FACE/SCALP 2 CM/GT | 2011-07-01 00:00:00 | 892.68 | N | Y | N/A | N/A
21025 | EXCISION BONE MANDIBLE | 2011-07-01 00:00:00 | 745.97 | N | Y | N/A | N/A
21026 | EXCISION FACIAL BONE | 2011-07-01 00:00:00 | 508.61 | N | Y | N/A | N/A
21029 | REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE | 2011-07-01 00:00:00 | 643.84 | N | Y | N/A | N/A
21030 | [NAME]CYST MAXL/ZYGOMA ENCL & CURTG | 2011-07-01 00:00:00 | 425.84 | N | Y | N/A | N/A
21031 | EXCISION TORUS MANDIBULARIS | 2011-07-01 00:00:00 | 321.75 | N | Y | N/A | N/A
21032 | EXCISION [NAME] PALATINUS | 2011-07-01 00:00:00 | 327.19 | N | Y | N/A | N/A
21034 | EXCISION MALIGNANT TUMOR MAXILLA/ZYGOMA | 2011-07-01 00:00:00 | 1128.36 | N | Y | N/A | N/A
21040 | EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL&/CURTG | 2011-07-01 00:00:00 | 429.13 | N | Y | N/A | N/A
21044 | EXCISION MALIGNANT TUMOR MANDIBLE | 2011-07-01 00:00:00 | 751.85 | N | Y | N/A | N/A
21045 | EXCISION MALIGNANT TUMOR MANDIBLE RADICAL | 2011-07-01 00:00:00 | 1048.15 | N | Y | N/A | N/A
21046 | [NAME]CYST MNDBL INTRA-ORAL OSTEOT | 2011-07-01 00:00:00 | 926.58 | N | Y | N/A | N/A
21047 | EXC B9 TUM/CST MNDBL XTR-ORAL OSTEOT&PRTL MNDBLC | 2011-07-01 00:00:00 | 1108.57 | N | Y | N/A | N/A
21048 | [NAME]CYST MAXL INTRA-ORAL OSTEOT | 2011-07-01 00:00:00 | 947.41 | N | Y | N/A | N/A
21049 | EXC B9 TUM/CST MAXL XTR-ORAL OSTEOT&PRTL MAXLCT | 2011-07-01 00:00:00 | 1063.47 | N | Y | N/A | N/A
21050 | CONDYLECTOMY TEMPOROMANDIBULAR JOINT SPX | 2011-07-01 00:00:00 | 738.66 | N | Y | N/A | N/A
21060 | MENISCECTOMY PRTL/COMPL TEMPOROMANDIBULAR JT SPX | 2011-07-01 00:00:00 | 686.54 | N | Y | N/A | N/A
21070 | CORONOIDECTOMY SPX | 2011-07-01 00:00:00 | 531.4 | N | Y | N/A | N/A
21073 | MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA | 2011-07-01 00:00:00 | 322.7 | N | Y | N/A | N/A
21076 | IMPRESSION&PREPARATION SURG OBTURATOR PROSTHESIS | 2011-07-01 00:00:00 | 821.85 | N | Y | N/A | N/A
21079 | IMPRESSION&PREPARATION INTERIM OBTURATOR PROSTH | 2011-07-01 00:00:00 | 1390.16 | N | Y | N/A | N/A
21080 | IMPRESSION&PREPJ DEFINITIVE OBTURATOR PROSTHESIS | 2011-07-01 00:00:00 | 1569.65 | N | Y | N/A | N/A
21081 | IMPRESSION&PREPJ [NAME] | 2011-07-01 00:00:00 | 1440.36 | Y | Y | N/A | N/A
21082 | IMPRESSION&PREPJ PALATAL AUGMENTATION PROSTHESIS | 2011-07-01 00:00:00 | 1351.22 | Y | Y | N/A | N/A
21083 | IMPRESSION&PREPARATION PALATAL LIFT PROSTHESIS | 2011-07-01 00:00:00 | 1266.63 | N | Y | N/A | N/A
21084 | IMPRESSION&PREPARATION SPEECH AID PROSTHESIS | 2011-07-01 00:00:00 | 1479.5 | Y | Y | N/A | N/A
21085 | IMPRESSION&PREPARATION ORAL SURGICAL SPLINT | 2011-07-01 00:00:00 | 645.5 | N | Y | N/A | N/A
21086 | IMPRESSION&PREPARATION AURICULAR PROSTHESIS | 2011-07-01 00:00:00 | 1503.64 | Y | Y | N/A | N/A
21087 | IMPRESSION&PREPARATION NASAL PROSTHESIS | 2011-07-01 00:00:00 | 1500.76 | N | Y | N/A | N/A
21088 | FACIAL PROSTHESIS (DESIGNED PREPARED BY PHYSICIAN) | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
21089 | UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
21100 | APPL HALO APPLIANCE MAXILLOFACIAL FIXATION SPX | 2011-07-01 00:00:00 | 548.87 | N | Y | N/A | N/A
21110 | APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC | 2011-07-01 00:00:00 | 650.04 | N | Y | N/A | N/A
21116 | [NAME] ARTHROGRAPHY | 2011-07-01 00:00:00 | 123.98 | N | Y | N/A | N/A
21120 | GENIOPLASTY AUGMENTATION | 2011-07-01 00:00:00 | 534.93 | N | Y | N/A | N/A
21121 | GENIOPLASTY SLIDING OSTEOTOMY SINGLE PIECE | 2011-07-01 00:00:00 | 653.41 | N | Y | N/A | N/A
21122 | GENIOPLASTY 2/GT SLIDING OSTEOTOMIES | 2011-07-01 00:00:00 | 597.66 | N | Y | N/A | N/A
21123 | [NAME]/INTERPOSAL BONE GRAFTS | 2011-07-01 00:00:00 | 747.44 | N | Y | N/A | N/A
21125 | AGMNTJ MNDBLR BODY/ANGLE PROSTHETIC MATERIAL | 2011-07-01 00:00:00 | 2556.89 | N | Y | N/A | N/A
21127 | AGMNTJ MNDBLR BDY/ANGL W/B1 GRF ONLAY/INTERPOSAL | 2011-07-01 00:00:00 | 3132.9 | N | Y | N/A | N/A
21138 | RDCTJ FHD CNTRG&PROSTHETIC MATRL/BONE GRAFT | 2011-07-01 00:00:00 | 753.82 | Y | Y | N/A | N/A
21141 | RCNSTJ MIDFACE LEFORT I 1 PIECE W/O BONE GRAFT | 2011-07-01 00:00:00 | 1156.27 | N | Y | N/A | N/A
21142 | RCNSTJ MIDFACE LEFORT I 2 PIECES W/O BONE GRAFT | 2011-07-01 00:00:00 | 1165.31 | N | Y | N/A | N/A
21143 | RCNSTJ MIDFACE LEFORT I 3/GTPIECE W/O BONE GRAFT | 2011-07-01 00:00:00 | 1231.46 | N | Y | N/A | N/A
21145 | RCNSTJ MIDFACE LEFORT I 1 PIECE W/BONE GRAFTS | 2011-07-01 00:00:00 | 1288.45 | N | Y | N/A | N/A
21146 | RCNSTJ MIDFACE LEFORT I 2 PIECES W/BONE GRAFTS | 2011-07-01 00:00:00 | 1441.37 | N | Y | N/A | N/A
21147 | RCNSTJ MIDFACE LEFORT I 3/GTPIECE W/BONE GRAFTS | 2011-07-01 00:00:00 | 1412.39 | N | Y | N/A | N/A
21150 | RCNSTJ MIDFACE LEFORT II ANTERIOR INTRUSION | 2011-07-01 00:00:00 | 1414.26 | N | Y | N/A | N/A
21151 | RCNSTJ MIDFACE LEFORT II W/BONE GRAFTS | 2011-07-01 00:00:00 | 1672.55 | N | Y | N/A | N/A
21154 | RCNSTJ MIDFACE LEFORT III W/O LEFORT I | 2011-07-01 00:00:00 | 1812.73 | N | Y | N/A | N/A
21155 | RCNSTJ MIDFACE LEFORT III W/LEFORT I | 2011-07-01 00:00:00 | 1870.44 | N | Y | N/A | N/A
21159 | RCNSTJ MIDFACE LEFORT III W/FHD W/O LEFORT I | 2011-07-01 00:00:00 | 2387.37 | Y | Y | N/A | N/A
21160 | RCNSTJ MIDFACE LEFORT III W/FHD W/LEFORT I | 2011-07-01 00:00:00 | 2322.74 | N | Y | N/A | N/A
21172 | RCNSTJ SUPERIOR-LATERAL ORBITAL RIM&LOWER FHD | 2011-07-01 00:00:00 | 1523.98 | N | Y | N/A | N/A
21175 | RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS&LWR FHD | 2011-07-01 00:00:00 | 1959.84 | N | Y | N/A | N/A
21179 | RCNSTJ FOREHEAD&/SUPRAORB RIMS W/ALGRF/PROSTC | 2011-07-01 00:00:00 | 1285.05 | N | Y | N/A | N/A
21180 | RCNSTJ FOREHEAD&/SUPRAORBITAL RIMS W/AUTOGRAFT | 2011-07-01 00:00:00 | 1418.19 | N | Y | N/A | N/A
21181 | RCNSTJ CONTOURING BENIGN TUMOR CRNL BONES XTRC | 2011-07-01 00:00:00 | 606.88 | N | Y | N/A | N/A
21182 | RCNSTJ ORBIT/FHD/[NAME] TUM GRF LT40SQCM | 2011-07-01 00:00:00 | 1696.26 | N | Y | N/A | N/A
21183 | RCNSTJ ORBIT/FHD/[NAME] GT40 [NAME] | 2011-07-01 00:00:00 | 1900.74 | N | Y | N/A | N/A
21184 | RCNSTJ ORBIT/FHD/[NAME] | 2011-07-01 00:00:00 | 2092.8 | N | Y | N/A | N/A
21188 | RCNSTJ MDFC OTH/THN LEFORT OSTEOT&BONE GRAFTS | 2011-07-01 00:00:00 | 1374.8 | N | Y | N/A | N/A
21193 | [NAME]VER/C/L OSTEOT W/O GRF | 2011-07-01 00:00:00 | 1101.32 | N | Y | N/A | N/A
21194 | [NAME]VER/C/L OSTEOT W/GRAFT | 2011-07-01 00:00:00 | 1192.28 | N | Y | N/A | N/A
21195 | RCNSTJ MNDBLR RAMI&/BODY SGTL SPLT W/O INT RGD | 2011-07-01 00:00:00 | 1146.06 | N | Y | N/A | N/A
21196 | RCNSTJ MNDBLR RAMI&/BDY SGTL SPLT W/INT RGD FIXJ | 2011-07-01 00:00:00 | 1254.02 | N | Y | N/A | N/A
21198 | OSTEOTOMY MANDIBLE SEGMENTAL | 2011-07-01 00:00:00 | 988.54 | N | Y | N/A | N/A
21199 | OSTEOTOMY MANDIBLE SGMTL W/GENIOGLOSSUS ADVMNT | 2011-07-01 00:00:00 | 873.59 | N | Y | N/A | N/A
21206 | OSTEOTOMY MAXILLA SEGMENTAL | 2011-07-01 00:00:00 | 1024.44 | N | Y | N/A | N/A
21208 | OSTEOPLASTY FACIAL BONES AUGMENTATION | 2011-07-01 00:00:00 | 1518.64 | N | Y | N/A | N/A
21209 | OSTEOPLASTY FACIAL BONES REDUCTION | 2011-07-01 00:00:00 | 701.78 | N | Y | N/A | N/A
21210 | GRAFT BONE NASAL/MAXILLARY/MALAR AREAS | 2011-07-01 00:00:00 | 1826.24 | N | Y | N/A | N/A
21215 | GRAFT BONE MANDIBLE | 2011-07-01 00:00:00 | 3173.81 | N | Y | N/A | N/A
21230 | GRAFT [NAME] | 2011-07-01 00:00:00 | 654.97 | N | Y | N/A | N/A
21235 | GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR | 2011-07-01 00:00:00 | 617.97 | N | Y | N/A | N/A
21240 | [NAME] W/WO AUTOGRAFT | 2011-07-01 00:00:00 | 936.26 | N | Y | N/A | N/A
21242 | ARTHROPLASTY TEMPOROMANDIBULAR JT W/ALLOGRAFT | 2011-07-01 00:00:00 | 858.51 | N | Y | N/A | N/A
21243 | [NAME] | 2011-07-01 00:00:00 | 1413.23 | N | Y | N/A | N/A
21244 | RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE | 2011-07-01 00:00:00 | 900.66 | N | Y | N/A | N/A
21245 | RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT PARTIAL | 2011-07-01 00:00:00 | 958.96 | N | Y | N/A | N/A
21246 | RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT COMPLETE | 2011-07-01 00:00:00 | 714.31 | N | Y | N/A | N/A
21247 | [NAME]/BONE CARTLG AUTOGRAFTS | 2011-07-01 00:00:00 | 1370.47 | N | Y | N/A | N/A
21248 | RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT PARTIAL | 2011-07-01 00:00:00 | 912.91 | N | Y | N/A | N/A
21249 | RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT COMPLETE | 2011-07-01 00:00:00 | 1256.38 | N | Y | N/A | N/A
21255 | [NAME]/GLENOID FOSSA W/BONE CARTLG | 2011-07-01 00:00:00 | 1176.25 | N | Y | N/A | N/A
21256 | RECONSTRUCTION ORBIT W/OSTEOTOMIES&BONE GRAFTS | 2011-07-01 00:00:00 | 1009.21 | N | Y | N/A | N/A
21260 | PERIORBITAL OSTEOTOMIES BONE GRAFTS EXTRACRANIAL | 2011-07-01 00:00:00 | 1142.25 | N | Y | N/A | N/A
21261 | PERIORBITAL OSTEOTOMIES W/BONE GRAFTS ICRA&XTRC | 2011-07-01 00:00:00 | 1857.47 | N | Y | N/A | N/A
21263 | PERIORBITAL OSTEOTOMIES W/BONE GRAFTS W/FOREHEAD | 2011-07-01 00:00:00 | 1629.48 | N | Y | N/A | N/A
21267 | ORBITAL REPOSITIONING W/BONE GRAFTS EXTRACRANIAL | 2011-07-01 00:00:00 | 1351.4 | N | Y | N/A | N/A
21268 | ORBITAL REPOSITIONING W/BONE GRAFTS ICRA&XTRC | 2011-07-01 00:00:00 | 1545.17 | N | Y | N/A | N/A
21270 | MALAR AUGMENTATION PROSTHETIC MATERIAL | 2011-07-01 00:00:00 | 802.17 | N | Y | N/A | N/A
21275 | SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ | 2011-07-01 00:00:00 | 704.92 | N | Y | N/A | N/A
21280 | MEDIAL CANTHOPEXY SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 473.2 | N | Y | N/A | N/A
21282 | [NAME] CANTHOPEXY | 2011-07-01 00:00:00 | 312.33 | N | Y | N/A | N/A
21295 | REDUCTION MASSETER MUSCLE&BONE EXTRAORAL | 2011-07-01 00:00:00 | 148.48 | N | Y | N/A | N/A
21296 | REDUCTION MASSETER MUSCLE&BONE INTRAORAL | 2011-07-01 00:00:00 | 340.52 | N | Y | N/A | N/A
21299 | UNLISTED CRANIOFACIAL AND MAXILLOFACIAL PROCEDURE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
21310 | CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION | 2011-07-01 00:00:00 | 94.17 | N | Y | N/A | N/A
21315 | CLOSED TX NASAL FRACTURE W/O STABILIZATION | 2011-07-01 00:00:00 | 227.41 | N | Y | N/A | N/A
21320 | CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION | 2011-07-01 00:00:00 | 214.75 | N | Y | N/A | N/A
21325 | OPEN TREATMENT NASAL FRACTURE UNCOMPLICATED | 2011-07-01 00:00:00 | 399.64 | N | Y | N/A | N/A
21330 | OPEN TX NASAL FX COMP W/INT&/XTRNL SKELETAL FIXJ | 2011-07-01 00:00:00 | 484.52 | N | Y | N/A | N/A
21335 | OPEN TX NASAL FX W/CONCOMITANT OPTX FXD SEPTUM | 2011-07-01 00:00:00 | 624.16 | N | Y | N/A | N/A
21336 | OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION | 2011-07-01 00:00:00 | 551.38 | N | Y | N/A | N/A
21337 | CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION | 2011-07-01 00:00:00 | 337.1 | N | Y | N/A | N/A
21338 | OPEN TX NASOETHMOID FX W/O EXTERNAL FIXATION | 2011-07-01 00:00:00 | 630.06 | N | Y | N/A | N/A
21339 | OPEN TX NASOETHMOID FX W/EXTERNAL FIXATION | 2011-07-01 00:00:00 | 678.53 | N | Y | N/A | N/A
21340 | PERCUTANEOUS TX NASOETHMOID COMPLEX FRACTURE | 2011-07-01 00:00:00 | 663.58 | N | Y | N/A | N/A
21343 | OPEN TX DEPRESSED FRONTAL SINUS FRACTURE | 2011-07-01 00:00:00 | 970.97 | N | Y | N/A | N/A
21344 | OPEN TX COMPLICATED FRONTAL SINUS FRACTURE | 2011-07-01 00:00:00 | 1368.22 | N | Y | N/A | N/A
21345 | CLOSED TX NASOMAXILLARY COMPLEX FRACTURE | 2011-07-01 00:00:00 | 666.89 | N | Y | N/A | N/A
21346 | OPTX NASOMAX CPLX FX LEFT II TYPE W/WIRG&FIXJ | 2011-07-01 00:00:00 | 792.98 | N | Y | N/A | N/A
21347 | OPTX NASOMAX CPLX FX LEFT II TYPE REQ MLT OPN | 2011-07-01 00:00:00 | 939.91 | N | Y | N/A | N/A
21348 | OPTX NASOMAX CPLX FX LEFT II TYPE W/BONE GRAFT | 2011-07-01 00:00:00 | 990.33 | N | Y | N/A | N/A
21355 | [NAME] FRACTURE | 2011-07-01 00:00:00 | 376.85 | N | Y | N/A | N/A
21356 | OPEN TX DEPRESSED ZYGOMATIC ARCH FRACTURE | 2011-07-01 00:00:00 | 417.62 | N | Y | N/A | N/A
21360 | OPEN TX DEPRESSED MALAR FRACTURE | 2011-07-01 00:00:00 | 452.04 | N | Y | N/A | N/A
21365 | OPEN TX COMP FX MALAR W/INTERNAL FX&MULT SURG | 2011-07-01 00:00:00 | 946.45 | N | Y | N/A | N/A
21366 | OPEN TX COMP FRACTURE MALAR AREA W/BONE GRAFT | 2011-07-01 00:00:00 | 1067.51 | N | Y | N/A | N/A
21385 | OPEN TX ORBITAL FLOOR BLOWOUT FX TRANSANTRAL | 2011-07-01 00:00:00 | 594.84 | N | Y | N/A | N/A
21386 | OPEN TX ORBITAL FLOOR BLOWOUT FX PERIORBITAL | 2011-07-01 00:00:00 | 560.83 | N | Y | N/A | N/A
21387 | OPEN TX ORBITAL FLOOR BLOWOUT FX COMBINED APPR | 2011-07-01 00:00:00 | 631.67 | N | Y | N/A | N/A
21390 | OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC | 2011-07-01 00:00:00 | 670.87 | N | Y | N/A | N/A
21395 | OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/BONE GRF | 2011-07-01 00:00:00 | 830.73 | N | Y | N/A | N/A
21400 | CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIPULATION | 2011-07-01 00:00:00 | 154.4 | N | Y | N/A | N/A
21401 | CLOSED TX FX ORBIT EXCEPT BLOWOUT W/MANIPULATION | 2011-07-01 00:00:00 | 398.2 | N | Y | N/A | N/A
21406 | OPEN TX FX ORBIT EXCEPT BLOWOUT W/O IMPLANT | 2011-07-01 00:00:00 | 468.14 | N | Y | N/A | N/A
21407 | OPEN TX FX ORBIT EXCEPT BLOWOUT W/IMPLANT | 2011-07-01 00:00:00 | 547.87 | N | Y | N/A | N/A
21408 | OPEN TX FX ORBIT EXCEPT BLOWOUT W/BONE GRAFT | 2011-07-01 00:00:00 | 760.72 | N | Y | N/A | N/A
21421 | CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT | 2011-07-01 00:00:00 | 627.45 | N | Y | N/A | N/A
21422 | OPEN TREATMENT PALATAL/MAXILLARY FRACTURE | 2011-07-01 00:00:00 | 564.41 | N | Y | N/A | N/A
21423 | OPEN TX PALATAL/MAXILLARY FX COMP MULTIPLE APPR | 2011-07-01 00:00:00 | 692.17 | N | Y | N/A | N/A
21431 | CLOSED [NAME] SEPARATION | 2011-07-01 00:00:00 | 625.1 | N | Y | N/A | N/A
21432 | OPEN TX CRANIOFACIAL SEP W/WIRING&/INT FIXJ | 2011-07-01 00:00:00 | 591.44 | N | Y | N/A | N/A
21433 | OPEN TX CRANIOFACIAL SEP COMPLICATED MLT APPR | 2011-07-01 00:00:00 | 1422.68 | N | Y | N/A | N/A
21435 | OPEN TX CRANIOFACIAL SEP COMP W/INT&/XTRNL FIXJ | 2011-07-01 00:00:00 | 1112.82 | N | Y | N/A | N/A
21436 | OPTX CRNFCL SEP LFT III TYP COMP INT FIXJ W/BONE | 2011-07-01 00:00:00 | 1729.36 | N | Y | N/A | N/A
21440 | [NAME] FX SPX | 2011-07-01 00:00:00 | 464.09 | N | Y | N/A | N/A
21445 | [NAME] | 2011-07-01 00:00:00 | 637.67 | N | Y | N/A | N/A
21450 | CLOSED [NAME] MANIPULATION | 2011-07-01 00:00:00 | 487.28 | N | Y | N/A | N/A
21451 | CLOSED [NAME] | 2011-07-01 00:00:00 | 634.91 | N | Y | N/A | N/A
21452 | [NAME] | 2011-07-01 00:00:00 | 489.23 | N | Y | N/A | N/A
21453 | CLOSED [NAME] | 2011-07-01 00:00:00 | 739.3 | N | Y | N/A | N/A
21454 | OPEN TX MANDIBULAR FX W/EXTERNAL FIXATION | 2011-07-01 00:00:00 | 472.88 | N | Y | N/A | N/A
21461 | OPEN TX MANDIBULAR FX W/O INTERDENTAL FIXATION | 2011-07-01 00:00:00 | 1708.29 | N | Y | N/A | N/A
21462 | OPEN TX MANDIBULAR FX W/INTERDENTAL FIXATION | 2011-07-01 00:00:00 | 1814.83 | N | Y | N/A | N/A
21465 | OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE | 2011-07-01 00:00:00 | 800.02 | N | Y | N/A | N/A
21470 | OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION | 2011-07-01 00:00:00 | 1022.21 | N | Y | N/A | N/A
21480 | CLOSED [NAME] DISLOCATION 1ST/SBSQ | 2011-07-01 00:00:00 | 77.21 | N | Y | N/A | N/A
21485 | CLOSED [NAME] DISLC COMP 1ST/SBSQ | 2011-07-01 00:00:00 | 570.61 | N | Y | N/A | N/A
21490 | OPEN TREATMENT TEMPOROMANDIBULAR DISLOCATION | 2011-07-01 00:00:00 | 784.49 | N | Y | N/A | N/A
21495 | OPEN TREATMENT HYOID FRACTURE | 2011-07-01 00:00:00 | 596.96 | N | Y | N/A | N/A
21497 | INTERDENTAL WIRING OTHER THAN FRACTURE | 2011-07-01 00:00:00 | 568.54 | N | Y | N/A | N/A
21499 | UNLISTED MUSCULOSKELETAL PROCEDURE, HEAD | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
21501 | I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX | 2011-07-01 00:00:00 | 373.58 | N | Y | N/A | N/A
21502 | I&D DP ABSC/HMTMA SOFT TISS NCK/THORAX PRTL RIB | 2011-07-01 00:00:00 | 427.72 | N | Y | N/A | N/A
21510 | INCISION DEEP OPENING BONE CORTEX THORAX | 2011-07-01 00:00:00 | 392.75 | N | Y | N/A | N/A
21550 | BIOPSY SOFT TISSUE NECK/THORAX | 2011-07-01 00:00:00 | 216.54 | N | Y | N/A | N/A
21552 | EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/GT | 2011-07-01 00:00:00 | 382.62 | N | Y | N/A | N/A
21554 | EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/GT | 2011-07-01 00:00:00 | 629.04 | N | Y | N/A | N/A
21555 | EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ LT3CM | 2011-07-01 00:00:00 | 342.93 | N | Y | N/A | N/A
21556 | EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL LT5CM | 2011-07-01 00:00:00 | 433.01 | N | Y | N/A | N/A
21557 | RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX LT5CM | 2011-07-01 00:00:00 | 750.42 | N | Y | N/A | N/A
21558 | RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/GT | 2011-07-01 00:00:00 | 1168.98 | N | Y | N/A | N/A
21600 | [NAME] PARTIAL | 2011-07-01 00:00:00 | 470.64 | N | Y | N/A | N/A
21610 | COSTOTRANSVERSECTOMY SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 945.27 | N | Y | N/A | N/A
21615 | [NAME] RIB | 2011-07-01 00:00:00 | 554.05 | N | Y | N/A | N/A
21616 | [NAME] | 2011-07-01 00:00:00 | 676.52 | N | Y | N/A | N/A
21620 | OSTECTOMY STERNUM PARTIAL | 2011-07-01 00:00:00 | 439.82 | N | Y | N/A | N/A
21627 | STERNAL DEBRIDEMENT | 2011-07-01 00:00:00 | 460.85 | N | Y | N/A | N/A
21630 | [NAME] | 2011-07-01 00:00:00 | 1067.5 | N | Y | N/A | N/A
21632 | [NAME] | 2011-07-01 00:00:00 | 1052.96 | N | Y | N/A | N/A
21685 | HYOID MYOTOMY & SUSPENSION | 2011-07-01 00:00:00 | 859.35 | N | Y | N/A | N/A
21700 | DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB | 2011-07-01 00:00:00 | 359.33 | N | Y | N/A | N/A
21705 | DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB | 2011-07-01 00:00:00 | 507.77 | N | Y | N/A | N/A
21720 | DIVISION STERNOCLEIDOMASTOID OPEN W/O CAST | 2011-07-01 00:00:00 | 366.39 | N | Y | N/A | N/A
21725 | DIVISION STERNOCLEIDOMASTOID OPEN W/CAST | 2011-07-01 00:00:00 | 446.27 | N | Y | N/A | N/A
21740 | REPAIR PECTUS EXCAVATUM/CARINATUM OPEN | 2011-07-01 00:00:00 | 879.4 | N | Y | N/A | N/A
21742 | RECONSTRUCTIVE REPAIR OF PECTUS EXCAVATUM OR CARINATUM; MIN. INVASIVE APPROACH | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
21743 | RECONSTRUCTIVE REPAIR OF PECTUS EXCAVATUM/CARINATUM MINIMAL INVASIVE APPROACH | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
21750 | CLOSE MEDIAN STERNOTOMY SEP W/WO DEBRIDEMENT SPX | 2011-07-01 00:00:00 | 592.95 | N | Y | N/A | N/A
21800 | CLOSED [NAME] UNCOMPLICATED EACH | 2011-07-01 00:00:00 | 85.37 | N | Y | N/A | N/A
21805 | OPEN TX RIB FRACTURE W/O FIXATION EACH | 2011-07-01 00:00:00 | 219.17 | N | Y | N/A | N/A
21810 | TX RIB FRACTURE EXTERNAL FIXATION FLAIL CHEST | 2011-07-01 00:00:00 | 434.38 | N | Y | N/A | N/A
21820 | CLOSED TREATMENT STERNUM FRACTURE | 2011-07-01 00:00:00 | 113.03 | N | Y | N/A | N/A
21825 | OPEN TX STERNUM FRACTURE W/WO SKELETAL FIXATION | 2011-07-01 00:00:00 | 473 | N | Y | N/A | N/A
21899 | UNLISTED PROC, NECK, THORAX | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
21920 | BIOPSY SOFT TISSUE BACK/FLANK SUPERFICIAL | 2011-07-01 00:00:00 | 216.38 | N | Y | N/A | N/A
21925 | BIOPSY SOFT TISSUE BACK/FLANK DEEP | 2011-07-01 00:00:00 | 357.97 | N | Y | N/A | N/A
21930 | EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ LT3CM | 2011-07-01 00:00:00 | 386.04 | N | Y | N/A | N/A
21931 | EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/GT | 2011-07-01 00:00:00 | 399.01 | N | Y | N/A | N/A
21932 | EXC BACK TUM DEEP LT 5 CM | 2011-07-01 00:00:00 | 568.79 | N | Y | N/A | N/A
21933 | EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/GT | 2011-07-01 00:00:00 | 626.55 | N | Y | N/A | N/A
21935 | RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK LT5CM | 2011-07-01 00:00:00 | 864.42 | N | Y | N/A | N/A
21936 | RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/GT | 2011-07-01 00:00:00 | 1214.95 | N | Y | N/A | N/A
22010 | I&D DEEP ABSCESS PST SPINE CRV THRC/CERVICOTHRC | 2011-07-01 00:00:00 | 773.56 | N | Y | N/A | N/A
22015 | I&D DEEP ABSCESS PST SPINE LUMBAR SAC/LUMBOSAC | 2011-07-01 00:00:00 | 763.35 | N | Y | N/A | N/A
22100 | PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV | 2011-07-01 00:00:00 | 710.42 | N | Y | N/A | N/A
22101 | PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC | 2011-07-01 00:00:00 | 694.88 | N | Y | N/A | N/A
22102 | PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR | 2011-07-01 00:00:00 | 681.37 | N | Y | N/A | N/A
22103 | PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA | 2011-07-01 00:00:00 | 120.52 | N | Y | N/A | N/A
22110 | [NAME] [NAME] LES W/O SPI CORD 1 SGM CRV | 2011-07-01 00:00:00 | 872.67 | N | Y | N/A | N/A
22112 | [NAME] [NAME] LES W/O SPI CORD 1 SGM THRC | 2011-07-01 00:00:00 | 859.99 | N | Y | N/A | N/A
22114 | [NAME] [NAME] LES W/O SPI CORD 1 SGM LMBR | 2011-07-01 00:00:00 | 828.07 | N | Y | N/A | N/A
22116 | [NAME] [NAME] LES W/O SPI CORD 1 SGM EA | 2011-07-01 00:00:00 | 118.06 | N | Y | N/A | N/A
22206 | OSTEOTOMY SPINE POSTERIOR 3 COLUMN THORACIC | 2011-07-01 00:00:00 | 1974.31 | N | Y | N/A | N/A
22207 | OSTEOTOMY SPINE POSTERIOR 3 COLUMN LUMBAR | 2011-07-01 00:00:00 | 1984.41 | N | Y | N/A | N/A
22208 | OSTEOTOMY SPINE POSTERIOR 3 COLUMN EA ADDL SGM | 2011-07-01 00:00:00 | 492.08 | N | Y | N/A | N/A
22210 | OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM CRV | 2011-07-01 00:00:00 | 1460.77 | N | Y | N/A | N/A
22212 | OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM THRC | 2011-07-01 00:00:00 | 1217.84 | N | Y | N/A | N/A
22214 | OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM LMBR | 2011-07-01 00:00:00 | 1224.26 | N | Y | N/A | N/A
22216 | OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM | 2011-07-01 00:00:00 | 308.27 | N | Y | N/A | N/A
22220 | OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM CRV | 2011-07-01 00:00:00 | 1326.18 | N | Y | N/A | N/A
22222 | OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM THRC | 2011-07-01 00:00:00 | 1249.61 | N | Y | N/A | N/A
22224 | OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM LMBR | 2011-07-01 00:00:00 | 1310.85 | N | Y | N/A | N/A
22226 | OSTEOT SPI W/DSKC ANT APPR 1 VRT SGM EA VRT SGM | 2011-07-01 00:00:00 | 308.34 | N | Y | N/A | N/A
22305 | CLOSED TX VERTEBRAL PROCESS FRACTURE | 2011-07-01 00:00:00 | 155.35 | N | Y | N/A | N/A
22310 | CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING | 2011-07-01 00:00:00 | 248.23 | N | Y | N/A | N/A
22315 | CLTX VRT FX&/DISLC CSTING/BRACING MANJ/TRCJ | 2011-07-01 00:00:00 | 721.7 | N | Y | N/A | N/A
22318 | OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRFG | 2011-07-01 00:00:00 | 1329.67 | N | Y | N/A | N/A
22319 | OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ GRF | 2011-07-01 00:00:00 | 1474.87 | N | Y | N/A | N/A
22325 | OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LMBR | 2011-07-01 00:00:00 | 1173.69 | N | Y | N/A | N/A
22326 | OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CRV | 2011-07-01 00:00:00 | 1215.17 | N | Y | N/A | N/A
22327 | OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM THRC | 2011-07-01 00:00:00 | 1214.11 | N | Y | N/A | N/A
22328 | OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA SGM | 2011-07-01 00:00:00 | 236.83 | N | Y | N/A | N/A
22505 | MANIPULATION SPINE REQUIRING ANESTHESIA | 2011-07-01 00:00:00 | 99.74 | N | Y | N/A | N/A
22520 | PERCUTANEOUS VERTEBROPLSTY THORACIC W/WO BONE BX | 2011-07-01 00:00:00 | 1896.25 | N | Y | N/A | N/A
22521 | PERCUTANEOUS VERTEBROPLASTY LUMBAR W/WO BNE BX | 2011-07-01 00:00:00 | 1860.07 | N | Y | N/A | N/A
22522 | PERCUTANEOUS VERTEBROPLASTY EA ADDL THRC/LMBR | 2011-07-01 00:00:00 | 197.45 | N | Y | N/A | N/A
22523 | PERCUTANEOUS VERTEBRAL AUGMENTATION THORACIC | 2011-07-01 00:00:00 | 493.78 | N | Y | N/A | N/A
22524 | PERCUTANEOUS VERTEBRAL AUGMENTATION LUMBAR | 2011-07-01 00:00:00 | 474.67 | N | Y | N/A | N/A
22525 | PERQ VERTEBRAL AUGMENTATION EA ADDL THRC/LMBR | 2011-07-01 00:00:00 | 220.78 | N | Y | N/A | N/A
22532 | ARTHRODESIS [NAME] EXTRACAVITARY THORACIC | 2011-07-01 00:00:00 | 1467.82 | Y | Y | N/A | N/A
22533 | ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR | 2011-07-01 00:00:00 | 1391.86 | Y | Y | N/A | N/A
22534 | ARTHRODESIS LAT EXTRACAVITARY EA ADDL THRC/LMBR | 2011-07-01 00:00:00 | 306.14 | Y | Y | N/A | N/A
22548 | ARTHRD ANT TRANSORAL/XTRORAL C1-C2 W/WOEXC ODNTD | 2011-07-01 00:00:00 | 1581.69 | Y | Y | N/A | N/A
22551 | ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2 | 2011-07-01 00:00:00 | 1432.36 | Y | Y | N/A | N/A
22552 | [NAME] ADDL NTRSPC | 2011-07-01 00:00:00 | 334.85 | Y | Y | N/A | N/A
22554 | [NAME] DISCECT INTERBODY CERV BELOW C2 | 2011-07-01 00:00:00 | 1046.66 | Y | Y | N/A | N/A
22556 | [NAME] DISCECTOMY INTERBODY THORACIC | 2011-07-01 00:00:00 | 1381.65 | Y | Y | N/A | N/A
22558 | ARTHRODESIS ANTERIOR INTERBODY LUMBAR | 2011-07-01 00:00:00 | 1283.35 | Y | Y | N/A | N/A
22585 | ARTHRODESIS ANTERIOR INTERBODY EA ADDL NTRSPC | 2011-07-01 00:00:00 | 282.54 | Y | Y | N/A | N/A
22586 | ARTHRODESIS PRESACRAL INTRBDY W/INSTRUMENT L5/S1 | 2013-01-01 00:00:00 | 1269.75 | N | N | N/A | N/A
22590 | ARTHRODESIS POSTERIOR CRANIOCERVICAL | 2011-07-01 00:00:00 | 1287.57 | Y | Y | N/A | N/A
22595 | ARTHRODESIS POSTERIOR ATLAS-AXIS C1-C2 | 2011-07-01 00:00:00 | 1225.31 | Y | Y | N/A | N/A
22600 | ARTHRODESIS PST/PSTLAT CERVICAL BELW C2 SGM | 2011-07-01 00:00:00 | 1049.3 | Y | Y | N/A | N/A
22610 | ARTHRODESIS POSTERIOR/POSTEROLATERAL THORACIC | 2011-07-01 00:00:00 | 1032.39 | Y | Y | N/A | N/A
22612 | ARTHRODESIS POSTERIOR/POSTEROLATERAL LUMBAR | 2011-07-01 00:00:00 | 1323.02 | Y | Y | N/A | N/A
22614 | ARTHRODESIS POSTERIOR/POSTEROLATERAL EA ADDL | 2011-07-01 00:00:00 | 330.24 | Y | Y | N/A | N/A
22630 | ARTHRODESIS POSTERIOR INTERBODY LUMBAR | 2011-07-01 00:00:00 | 1270.75 | Y | Y | N/A | N/A
22632 | ARTHRODESIS POSTERIOR INTERBODY EA ADDL | 2011-07-01 00:00:00 | 268.61 | Y | Y | N/A | N/A
22633 | ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR | 2012-01-01 00:00:00 | 1525.1 | Y | N | N/A | N/A
22634 | ARTHDSIS POST/POSTERLATRL/POSTINTRBDYADL SPC/SEG | 2012-01-01 00:00:00 | 411.21 | Y | N | N/A | N/A
22800 | ARTHRODESIS POSTERIOR SPINAL DFRM UP 6 VRT SEG | 2011-07-01 00:00:00 | 1123.18 | Y | Y | N/A | N/A
22802 | ARTHRODESIS POSTERIOR SPINAL DFRM 7-12 VRT SEG | 2011-07-01 00:00:00 | 1763.49 | Y | Y | N/A | N/A
22804 | ARTHRODESIS POSTERIOR SPINAL [NAME] 13/GT VRT SEG | 2011-07-01 00:00:00 | 2034.96 | Y | Y | N/A | N/A
22808 | ARTHRODESIS ANTERIOR SPINAL [NAME] 2-3 VRT SEG | 2011-07-01 00:00:00 | 1524.05 | Y | Y | N/A | N/A
22810 | ARTHRODESIS ANTERIOR SPINAL [NAME] 4-7 VRT SEG | 2011-07-01 00:00:00 | 1698.54 | Y | Y | N/A | N/A
22812 | ARTHRODESIS POSTERIOR SPINAL DFRM 8/GT VRT SEG | 2011-07-01 00:00:00 | 1857.16 | Y | Y | N/A | N/A
22818 | KYPHECTOMY SINGLE OR TWO SEGMENTS | 2011-07-01 00:00:00 | 1836.14 | N | Y | N/A | N/A
22819 | KYPHECTOMY 3 OR MORE SEGMENTS | 2011-07-01 00:00:00 | 2223.62 | N | Y | N/A | N/A
22830 | EXPLORATION SPINAL FUSION | 2011-07-01 00:00:00 | 668.91 | Y | Y | N/A | N/A
22840 | POSTERIOR NON-SEGMENTAL INSTRUMENTATION | 2011-07-01 00:00:00 | 642.97 | Y | Y | N/A | N/A
22841 | INTERNAL SPINAL FIXATION BY WIRING OF SPINOUS PROCESSES-(SP) | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
22842 | POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG | 2011-07-01 00:00:00 | 644.64 | Y | Y | N/A | N/A
22843 | POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG | 2011-07-01 00:00:00 | 686.45 | Y | Y | N/A | N/A
22844 | POSTERIOR SEGMENTAL INSTRUMENTATION 13/GT VRT SEG | 2011-07-01 00:00:00 | 835.11 | Y | Y | N/A | N/A
22845 | ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS | 2011-07-01 00:00:00 | 616.56 | Y | Y | N/A | N/A
22846 | ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS | 2011-07-01 00:00:00 | 640.04 | Y | Y | N/A | N/A
22847 | ANTERIOR INSTRUMENTATION 8/GT VERTEBRAL SEGMENTS | 2011-07-01 00:00:00 | 723.65 | Y | Y | N/A | N/A
22848 | PELVIC FIXATION OTHER THAN SACRUM | 2011-07-01 00:00:00 | 305.52 | Y | Y | N/A | N/A
22849 | REINSERTION SPINAL FIXATION DEVICE | 2011-07-01 00:00:00 | 1079.51 | Y | Y | N/A | N/A
22850 | REMOVAL POSTERIOR NONSEGMENTAL INSTRUMENTATION | 2011-07-01 00:00:00 | 593.34 | N | Y | N/A | N/A
22851 | APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE | 2011-07-01 00:00:00 | 343.76 | Y | Y | N/A | N/A
22852 | REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION | 2011-07-01 00:00:00 | 568.02 | N | Y | N/A | N/A
22855 | REMOVAL ANTERIOR INSTRUMENTATION | 2011-07-01 00:00:00 | 919.57 | N | Y | N/A | N/A
22856 | TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC CRV | 2011-07-01 00:00:00 | 1364.5 | N | Y | N/A | N/A
22861 | REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC CRV | 2011-07-01 00:00:00 | 1668.97 | N | Y | N/A | N/A
22864 | RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE CERVICAL | 2011-07-01 00:00:00 | 1569.36 | N | Y | N/A | N/A
22899 | UNLISTED PROCEDURE, SPINE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
22900 | EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL LT5CM | 2011-07-01 00:00:00 | 441.77 | N | Y | N/A | N/A
22901 | EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/GT | 2011-07-01 00:00:00 | 558.12 | N | Y | N/A | N/A
22902 | EXC ABD LES SC LT 3 CM | 2011-07-01 00:00:00 | 370.19 | N | Y | N/A | N/A
22903 | EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/GT | 2011-07-01 00:00:00 | 376.32 | N | Y | N/A | N/A
22904 | [NAME] 5 CM | 2011-07-01 00:00:00 | 871.19 | N | Y | N/A | N/A
22905 | RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5 CM/GT | 2011-07-01 00:00:00 | 1133.09 | N | Y | N/A | N/A
22999 | UNLISTED PROCEDURE, ABDOMEN | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
23000 | REMOVAL SUBDELTOID CALCAREOUS DEPOSITS OPEN | 2011-07-01 00:00:00 | 458.27 | N | Y | N/A | N/A
23020 | CAPSULAR CONTRACTURE RELEASE | 2011-07-01 00:00:00 | 572.32 | N | Y | N/A | N/A
23030 | I&D SHOULDER DEEP ABSCESS/HEMATOMA | 2011-07-01 00:00:00 | 356.47 | N | Y | N/A | N/A
23031 | I&D SHOULDER INFECTED BURSA | 2011-07-01 00:00:00 | 332.19 | N | Y | N/A | N/A
23035 | INCISION BONE CORTEX SHOULDER AREA | 2011-07-01 00:00:00 | 567.65 | N | Y | N/A | N/A
23040 | ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL FB | 2011-07-01 00:00:00 | 598.28 | N | Y | N/A | N/A
23044 | ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB | 2011-07-01 00:00:00 | 474.31 | N | Y | N/A | N/A
23065 | BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL | 2011-07-01 00:00:00 | 180.21 | N | Y | N/A | N/A
23066 | BIOPSY SOFT TISSUE SHOULDER DEEP | 2011-07-01 00:00:00 | 432.81 | N | Y | N/A | N/A
23071 | EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/GT | 2011-07-01 00:00:00 | 355.87 | N | Y | N/A | N/A
23073 | EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/GT | 2011-07-01 00:00:00 | 589.68 | N | Y | N/A | N/A
23075 | EXCISION TUMOR SOFT TISSUE SHOULDER [NAME] | 2011-07-01 00:00:00 | 331.5 | N | Y | N/A | N/A
23076 | EXC TUMOR SOFT TISS SHOULDER [NAME] | 2011-07-01 00:00:00 | 449.66 | N | Y | N/A | N/A
23077 | RAD RESECTION TUMOR SOFT TISSUE SHOULDER LT5CM | 2011-07-01 00:00:00 | 967.88 | N | Y | N/A | N/A
23078 | RAD RESECTION TUMOR SOFT TISSUE SHOULDER 5 CM/GT | 2011-07-01 00:00:00 | 1178.71 | N | Y | N/A | N/A
23100 | ARTHROTOMY GLENOHUMERAL JOINT W/BIOPSY | 2011-07-01 00:00:00 | 410.18 | N | Y | N/A | N/A
23101 | ARTHRT ACROMCLAV/STRNCLAV JT W/BX&/EXC CRTLG | 2011-07-01 00:00:00 | 372.59 | N | Y | N/A | N/A
23105 | ARTHRT GLENOHUMRL JT W/SYNOVECTOMY W/WO BIOPSY | 2011-07-01 00:00:00 | 529.12 | N | Y | N/A | N/A
23106 | ARTHRT GLENOHUMRL JT STRNCLAV JT W/SYNVCT W/WOBX | 2011-07-01 00:00:00 | 403.83 | N | Y | N/A | N/A
23107 | ARTHRT GLENOHUMRL JT W/JT EXPL W/WORMVL LOOSE/FB | 2011-07-01 00:00:00 | 548.85 | N | Y | N/A | N/A
23120 | CLAVICULECTOMY PARTIAL | 2011-07-01 00:00:00 | 481.63 | N | Y | N/A | N/A
23125 | CLAVICULECTOMY TOTAL | 2011-07-01 00:00:00 | 586.78 | N | Y | N/A | N/A
23130 | PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE | 2011-07-01 00:00:00 | 503.81 | N | Y | N/A | N/A
23140 | EXC/CURTG BONE CYST/BENIGN TUMOR CLAV/SCAPULA | 2011-07-01 00:00:00 | 431.43 | N | Y | N/A | N/A
23145 | EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/AGRFT | 2011-07-01 00:00:00 | 576.73 | N | Y | N/A | N/A
23146 | EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/ALGRFT | 2011-07-01 00:00:00 | 507.3 | N | Y | N/A | N/A
23150 | EXC/CURTG BONE CYST/BENIGN TUMOR PROX HUMERUS | 2011-07-01 00:00:00 | 546.32 | N | Y | N/A | N/A
23155 | EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/AGRFT | 2011-07-01 00:00:00 | 659.03 | N | Y | N/A | N/A
23156 | EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT | 2011-07-01 00:00:00 | 561.79 | N | Y | N/A | N/A
23170 | SEQUESTRECTOMY CLAVICLE | 2011-07-01 00:00:00 | 453.21 | N | Y | N/A | N/A
23172 | SEQUESTRECTOMY SCAPULA | 2011-07-01 00:00:00 | 463.32 | N | Y | N/A | N/A
23174 | SEQUESTRECTOMY HUMERAL HEAD SURGERY NECK | 2011-07-01 00:00:00 | 628.69 | N | Y | N/A | N/A
23180 | PARTIAL EXCISION BONE CLAVICLE | 2011-07-01 00:00:00 | 564.35 | N | Y | N/A | N/A
23182 | PARTIAL EXCISION BONE SCAPULA | 2011-07-01 00:00:00 | 552.08 | N | Y | N/A | N/A
23184 | PARTIAL EXCISION BONE PROXIMAL HUMERUS | 2011-07-01 00:00:00 | 615.27 | N | Y | N/A | N/A
23190 | OSTECTOMY SCAPULA PARTIAL | 2011-07-01 00:00:00 | 469.42 | N | Y | N/A | N/A
23195 | [NAME] | 2011-07-01 00:00:00 | 627.11 | N | Y | N/A | N/A
23200 | RADICAL RESECTION TUMOR CLAVICLE | 2011-07-01 00:00:00 | 1181.98 | N | Y | N/A | N/A
23210 | RADICAL RESECTION TUMOR SCAPULA | 2011-07-01 00:00:00 | 1382.85 | N | Y | N/A | N/A
23220 | RADICAL RESECTION BONE TUMOR PROXIMAL HUMERUS | 2011-07-01 00:00:00 | 1526.6 | N | Y | N/A | N/A
23330 | REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS | 2011-07-01 00:00:00 | 189.95 | N | Y | N/A | N/A
23333 | REMOVAL SHOULDER FOREIGN BODY DEEP SUBFASCIAL/IM | 2014-01-01 00:00:00 | 383.67 | N | Y | N/A | N/A
23334 | PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT | 2014-01-01 00:00:00 | 907.32 | N | Y | N/A | N/A
23335 | PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT | 2014-01-01 00:00:00 | 1082.66 | N | Y | N/A | N/A
23350 | INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG | 2011-07-01 00:00:00 | 126.33 | N | Y | N/A | N/A
23395 | MUSCLE TRANSFER SHOULDER/UPPER ARM SINGLE | 2011-07-01 00:00:00 | 1074.95 | N | Y | N/A | N/A
23397 | MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE | 2011-07-01 00:00:00 | 957.38 | N | Y | N/A | N/A
23400 | SCAPULOPEXY | 2011-07-01 00:00:00 | 812.89 | N | Y | N/A | N/A
23405 | TENOTOMY SHOULDER AREA 1 TENDON | 2011-07-01 00:00:00 | 522.59 | N | Y | N/A | N/A
23406 | TENOTOMY SHOULDER MULTIPLE THRU SAME INCISION | 2011-07-01 00:00:00 | 650.7 | N | Y | N/A | N/A
23410 | OPEN REPAIR OF ROTATOR CUFF ACUTE | 2011-07-01 00:00:00 | 687.59 | N | Y | N/A | N/A
23412 | OPEN REPAIR OF ROTATOR CUFF CHRONIC | 2011-07-01 00:00:00 | 715.48 | N | Y | N/A | N/A
23415 | CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY | 2011-07-01 00:00:00 | 578.32 | N | Y | N/A | N/A
23420 | RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC | 2011-07-01 00:00:00 | 811.32 | N | Y | N/A | N/A
23430 | TENODESIS LONG TENDON BICEPS | 2011-07-01 00:00:00 | 618.52 | N | Y | N/A | N/A
23440 | RESECTION/TRANSPLANTATION LONG TENDON BICEPS | 2011-07-01 00:00:00 | 631.18 | N | Y | N/A | N/A
23450 | CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON | 2011-07-01 00:00:00 | 792.75 | N | Y | N/A | N/A
23455 | CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR | 2011-07-01 00:00:00 | 842.63 | N | Y | N/A | N/A
23460 | CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK | 2011-07-01 00:00:00 | 914.81 | N | Y | N/A | N/A
23462 | CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR | 2011-07-01 00:00:00 | 898.89 | N | Y | N/A | N/A
23465 | CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK | 2011-07-01 00:00:00 | 935.51 | N | Y | N/A | N/A
23466 | CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS | 2011-07-01 00:00:00 | 934.5 | N | Y | N/A | N/A
23470 | ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY | 2011-07-01 00:00:00 | 1015.61 | N | Y | N/A | N/A
23472 | ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER | 2011-07-01 00:00:00 | 1258.4 | N | Y | N/A | N/A
23473 | REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT | 2013-01-01 00:00:00 | 1359.05 | N | N | N/A | N/A
23474 | REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT | 2013-01-01 00:00:00 | 1468.16 | N | N | N/A | N/A
23480 | OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION | 2011-07-01 00:00:00 | 684.51 | N | Y | N/A | N/A
23485 | OSTEOTOMY CLAV W/WO INT FIXJ W/B1 GRF NON/MAL | 2011-07-01 00:00:00 | 803.96 | N | Y | N/A | N/A
23490 | PROPH TX W/WO METHYLMETHACRYLATE CLAVICLE | 2011-07-01 00:00:00 | 728.99 | N | Y | N/A | N/A
23491 | PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS | 2011-07-01 00:00:00 | 848.05 | N | Y | N/A | N/A
23500 | CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION | 2011-07-01 00:00:00 | 175.1 | N | Y | N/A | N/A
23505 | CLSD TX CLAVICULAR FRACTURE W/MANIPULATION | 2011-07-01 00:00:00 | 284.27 | N | Y | N/A | N/A
23515 | OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION | 2011-07-01 00:00:00 | 599.27 | N | Y | N/A | N/A
23520 | CLSD TX STERNOCLAVICULAR DISLC W/O MANIPULATION | 2011-07-01 00:00:00 | 183.83 | N | Y | N/A | N/A
23525 | CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION | 2011-07-01 00:00:00 | 301.1 | N | Y | N/A | N/A
23530 | OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC | 2011-07-01 00:00:00 | 461.94 | N | Y | N/A | N/A
23532 | OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF | 2011-07-01 00:00:00 | 516.8 | N | Y | N/A | N/A
23540 | CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION | 2011-07-01 00:00:00 | 178.7 | N | Y | N/A | N/A
23545 | CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION | 2011-07-01 00:00:00 | 261.86 | N | Y | N/A | N/A
23550 | OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC | 2011-07-01 00:00:00 | 474.65 | N | Y | N/A | N/A
23552 | OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF | 2011-07-01 00:00:00 | 547.14 | N | Y | N/A | N/A
23570 | CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION | 2011-07-01 00:00:00 | 186.26 | N | Y | N/A | N/A
23575 | CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION | 2011-07-01 00:00:00 | 321.79 | N | Y | N/A | N/A
23585 | OPEN TX SCAPULAR FX W/INTERNAL FIXATION IF PFRMD | 2011-07-01 00:00:00 | 813.01 | N | Y | N/A | N/A
23600 | CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION | 2011-07-01 00:00:00 | 261.31 | N | Y | N/A | N/A
23605 | CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ | 2011-07-01 00:00:00 | 379.49 | N | Y | N/A | N/A
23615 | OPEN TREATMENT PROXIMAL HUMERAL FRACTURE | 2011-07-01 00:00:00 | 736.16 | N | Y | N/A | N/A
23616 | OPEN PROX HUMERAL FRACTURE PROSTHETIC RPLCMT | 2011-07-01 00:00:00 | 1051.12 | N | Y | N/A | N/A
23620 | [NAME]/O MANJ | 2011-07-01 00:00:00 | 216.02 | N | Y | N/A | N/A
23625 | CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION | 2011-07-01 00:00:00 | 308.86 | N | Y | N/A | N/A
23630 | OPEN TREATMENT GRTER HUMERAL TUBEROSITY FRACTURE | 2011-07-01 00:00:00 | 643.17 | N | Y | N/A | N/A
23650 | CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES | 2011-07-01 00:00:00 | 243.76 | N | Y | N/A | N/A
23655 | CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES | 2011-07-01 00:00:00 | 321.56 | N | Y | N/A | N/A
23660 | OPEN TX ACUTE SHOULDER DISLOCATION | 2011-07-01 00:00:00 | 483.08 | N | Y | N/A | N/A
23665 | CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ | 2011-07-01 00:00:00 | 344.46 | N | Y | N/A | N/A
23670 | OPEN TX SHOULDER DISLC W/HUMERAL TUBEROSITY FX | 2011-07-01 00:00:00 | 721.13 | N | Y | N/A | N/A
23675 | CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ | 2011-07-01 00:00:00 | 448.31 | N | Y | N/A | N/A
23680 | OPEN TX SHOULDER DISLOCATION W/NECK FRACTURE | 2011-07-01 00:00:00 | 769.45 | N | Y | N/A | N/A
23700 | MANJ W/ANES SHOULDER JOINT W/FIXATION APPARATUS | 2011-07-01 00:00:00 | 161.26 | N | Y | N/A | N/A
23800 | ARTHRODESIS GLENOHUMERAL JOINT | 2011-07-01 00:00:00 | 858.09 | N | Y | N/A | N/A
23802 | ARTHRODESIS GLENOHUMERAL JT W/AUTOGENOUS GRAFT | 2011-07-01 00:00:00 | 1061.42 | N | Y | N/A | N/A
23900 | INTERTHORACOSCAPULAR AMPUTATION | 2011-07-01 00:00:00 | 1136.69 | N | Y | N/A | N/A
23920 | DISARTICULATION SHOULDER | 2011-07-01 00:00:00 | 923.38 | N | Y | N/A | N/A
23921 | DISRTCJ SHOULDER SECONDARY CLSR/SCAR REVISION | 2011-07-01 00:00:00 | 363.92 | N | Y | N/A | N/A
23929 | UNLISTED PROCEDURE, SHOULDER | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
23930 | I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA | 2011-07-01 00:00:00 | 292.13 | N | Y | N/A | N/A
23931 | INCISION&DRAINAGE UPPER ARM/ELBOW BURSA | 2011-07-01 00:00:00 | 231.77 | N | Y | N/A | N/A
23935 | INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW | 2011-07-01 00:00:00 | 416.9 | N | Y | N/A | N/A
24000 | ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB | 2011-07-01 00:00:00 | 394.39 | N | Y | N/A | N/A
24006 | ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX | 2011-07-01 00:00:00 | 592.65 | N | Y | N/A | N/A
24065 | BIOPSY SOFT TISSUE UPPER ARM/ELBOW SUPERFICIAL | 2011-07-01 00:00:00 | 212.66 | N | Y | N/A | N/A
24066 | BIOPSY SOFT TISSUE UPPER ARM/ELBOW AREA DEEP | 2011-07-01 00:00:00 | 495.64 | N | Y | N/A | N/A
24071 | EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/GT | 2011-07-01 00:00:00 | 347.13 | N | Y | N/A | N/A
24073 | EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/GT | 2011-07-01 00:00:00 | 592.04 | N | Y | N/A | N/A
24075 | EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ LT3CM | 2011-07-01 00:00:00 | 402.71 | N | Y | N/A | N/A
24076 | EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC LT5CM | 2011-07-01 00:00:00 | 439.05 | N | Y | N/A | N/A
24077 | RAD [NAME] TISS UPPER ARM/ELBOW LT5CM | 2011-07-01 00:00:00 | 838.23 | N | Y | N/A | N/A
24079 | RAD [NAME] TISS UPPER ARM/ELBOW 5CM/GT | 2011-07-01 00:00:00 | 1087.47 | N | Y | N/A | N/A
24100 | ARTHROTOMY ELBOW W/SYNOVIAL BIOPSY ONLY | 2011-07-01 00:00:00 | 340.24 | N | Y | N/A | N/A
24101 | ARTHRT ELBOW W/JNT EXPL W/WOBX W/WORMVL LOOSE/FB | 2011-07-01 00:00:00 | 413.93 | N | Y | N/A | N/A
24102 | ARTHROTOMY ELBOW W/SYNOVECTOMY | 2011-07-01 00:00:00 | 510.67 | N | Y | N/A | N/A
24105 | EXCISION OLECRANON BURSA | 2011-07-01 00:00:00 | 284.18 | N | Y | N/A | N/A
24110 | EXCISION/CURTG BONE CYST/BENIGN TUMOR HUMERUS | 2011-07-01 00:00:00 | 485.25 | N | Y | N/A | N/A
24115 | EXC/CURTG BONE CYST/BENIGN TUMOR HUMERUS W/AGRFT | 2011-07-01 00:00:00 | 610.7 | N | Y | N/A | N/A
24116 | EXC/CURTG BONE CYST/BENIGN TUM HUMERUS W/ALGRFT | 2011-07-01 00:00:00 | 719.2 | N | Y | N/A | N/A
24120 | EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN | 2011-07-01 00:00:00 | 435.84 | N | Y | N/A | N/A
24125 | EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/AGRFT | 2011-07-01 00:00:00 | 510.29 | N | Y | N/A | N/A
24126 | EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/ALGRT | 2011-07-01 00:00:00 | 537.39 | N | Y | N/A | N/A
24130 | [NAME] HEAD | 2011-07-01 00:00:00 | 419.73 | N | Y | N/A | N/A
24134 | SEQUESTRECTOMY SHAFT/DISTAL HUMERUS | 2011-07-01 00:00:00 | 624.32 | N | Y | N/A | N/A
24136 | SEQUESTRECTOMY RADIAL HEAD OR NECK | 2011-07-01 00:00:00 | 509.49 | N | Y | N/A | N/A
24138 | SEQUESTRECTOMY OLECRANON PROCESS | 2011-07-01 00:00:00 | 555.69 | N | Y | N/A | N/A
24140 | PARTIAL EXCISION BONE HUMERUS | 2011-07-01 00:00:00 | 591.91 | N | Y | N/A | N/A
24145 | PARTIAL EXCISION BONE RADIAL HEAD/NECK | 2011-07-01 00:00:00 | 497.02 | N | Y | N/A | N/A
24147 | PARTIAL EXCISION BONE OLECRANON PROCESS | 2011-07-01 00:00:00 | 520.19 | N | Y | N/A | N/A
24149 | RAD RESCJ CAPSL TISS&HTRTPC BONE ELBW CONTRCT | 2011-07-01 00:00:00 | 976.03 | N | Y | N/A | N/A
24150 | RADICAL RESECTION TUMOR SHAFT/DISTAL HUMERUS | 2011-07-01 00:00:00 | 1230.03 | N | Y | N/A | N/A
24152 | RADICAL RESECTION TUMOR RADIAL HEAD/NECK | 2011-07-01 00:00:00 | 1046.22 | N | Y | N/A | N/A
24155 | RESECTION ELBOW JOINT ARTHRECTOMY | 2011-07-01 00:00:00 | 710.06 | N | Y | N/A | N/A
24160 | IMPLANT REMOVAL ELBOW JOINT | 2011-07-01 00:00:00 | 503.57 | N | Y | N/A | N/A
24164 | IMPLANT REMOVAL RADIAL HEAD | 2011-07-01 00:00:00 | 412.33 | N | Y | N/A | N/A
24200 | RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS | 2011-07-01 00:00:00 | 166.6 | N | Y | N/A | N/A
24201 | REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP | 2011-07-01 00:00:00 | 456.99 | N | Y | N/A | N/A
24220 | INJECTION ELBOW ARTHROGRAPHY | 2011-07-01 00:00:00 | 137.6 | N | Y | N/A | N/A
24300 | MANIPULATION ELBOW UNDER ANESTHESIA | 2011-07-01 00:00:00 | 333.37 | N | Y | N/A | N/A
24301 | [NAME]/TENDON TRANSFER UPPER ARM/ELBOW SINGLE | 2011-07-01 00:00:00 | 625.99 | N | Y | N/A | N/A
24305 | TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON | 2011-07-01 00:00:00 | 482 | N | Y | N/A | N/A
24310 | TENOTOMY OPEN ELBOW TO SHOULDER EACH TENDON | 2011-07-01 00:00:00 | 394.93 | N | Y | N/A | N/A
24320 | TENOPLASTY ELBOW TO SHOULDER SINGLE | 2011-07-01 00:00:00 | 648.36 | N | Y | N/A | N/A
24330 | FLEXOR-PLASTY ELBOW | 2011-07-01 00:00:00 | 596.8 | N | Y | N/A | N/A
24331 | FLEXOR-PLASTY ELBOW W/EXTENSOR ADVANCEMENT | 2011-07-01 00:00:00 | 670.49 | N | Y | N/A | N/A
24332 | TENOLYSIS TRICEPS | 2011-07-01 00:00:00 | 506.02 | N | Y | N/A | N/A
24340 | TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 509.44 | N | Y | N/A | N/A
24341 | REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA | 2011-07-01 00:00:00 | 614.66 | N | Y | N/A | N/A
24342 | [NAME] | 2011-07-01 00:00:00 | 650.3 | N | Y | N/A | N/A
24343 | REPAIR LATERAL COLLATERAL LIGAMENT ELBOW | 2011-07-01 00:00:00 | 585.56 | N | Y | N/A | N/A
24344 | RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT | 2011-07-01 00:00:00 | 913.66 | N | Y | N/A | N/A
24345 | REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW | 2011-07-01 00:00:00 | 582.1 | N | Y | N/A | N/A
24346 | RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF | 2011-07-01 00:00:00 | 915.11 | N | Y | N/A | N/A
24357 | TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS | 2011-07-01 00:00:00 | 368.91 | N | Y | N/A | N/A
24358 | TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN | 2011-07-01 00:00:00 | 434.29 | N | Y | N/A | N/A
24359 | TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR | 2011-07-01 00:00:00 | 546.32 | N | Y | N/A | N/A
24360 | ARTHROPLASTY ELBOW W/MEMBRANE | 2011-07-01 00:00:00 | 751.18 | N | Y | N/A | N/A
24361 | ARTHROPLASTY ELBOW W/DISTAL HUMRL PROSTC RPLCMT | 2011-07-01 00:00:00 | 843.26 | N | Y | N/A | N/A
24362 | ARTHRP ELBOW W/IMPLT&FSCA LATA LIGAMENT RCNSTJ | 2011-07-01 00:00:00 | 887.27 | N | Y | N/A | N/A
24363 | ARTHRP ELBOW W/DISTAL HUM&PROX UR PROSTC RPLCMT | 2011-07-01 00:00:00 | 1257.32 | N | Y | N/A | N/A
24365 | ARTHROPLASTY RADIAL HEAD | 2011-07-01 00:00:00 | 531.91 | N | Y | N/A | N/A
24366 | ARTHROPLASTY RADIAL HEAD W/IMPLANT | 2011-07-01 00:00:00 | 568.92 | N | Y | N/A | N/A
24370 | REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT | 2013-01-01 00:00:00 | 1286.25 | N | N | N/A | N/A
24371 | REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT | 2013-01-01 00:00:00 | 1482.55 | N | N | N/A | N/A
24400 | OSTEOTOMY HUMERUS W/WO INTERNAL FIXATION | 2011-07-01 00:00:00 | 683.79 | N | Y | N/A | N/A
24410 | MLT OSTEOT W/RELIGNMT IMED ROD HUMERAL SHAFT | 2011-07-01 00:00:00 | 878.25 | N | Y | N/A | N/A
24420 | OSTEOPLASTY HUMERUS | 2011-07-01 00:00:00 | 826.25 | N | Y | N/A | N/A
24430 | REPAIR NON/MALUNION HUMERUS W/O GRAFT | 2011-07-01 00:00:00 | 882.99 | N | Y | N/A | N/A
24435 | REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT | 2011-07-01 00:00:00 | 898.04 | N | Y | N/A | N/A
24470 | HEMIEPIPHYSEAL ARREST | 2011-07-01 00:00:00 | 540.77 | N | Y | N/A | N/A
24495 | [NAME] | 2011-07-01 00:00:00 | 546.44 | N | Y | N/A | N/A
24498 | PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT | 2011-07-01 00:00:00 | 725.05 | N | Y | N/A | N/A
24500 | CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION | 2011-07-01 00:00:00 | 285.31 | N | Y | N/A | N/A
24505 | CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ | 2011-07-01 00:00:00 | 407.24 | N | Y | N/A | N/A
24515 | OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE | 2011-07-01 00:00:00 | 730.76 | N | Y | N/A | N/A
24516 | TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE | 2011-07-01 00:00:00 | 719.47 | N | Y | N/A | N/A
24530 | CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ | 2011-07-01 00:00:00 | 305.7 | N | Y | N/A | N/A
24535 | CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ | 2011-07-01 00:00:00 | 505.51 | N | Y | N/A | N/A
24538 | PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX | 2011-07-01 00:00:00 | 618.39 | N | Y | N/A | N/A
24545 | OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN | 2011-07-01 00:00:00 | 771.87 | N | Y | N/A | N/A
24546 | OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/XTN | 2011-07-01 00:00:00 | 873.44 | N | Y | N/A | N/A
24560 | CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ | 2011-07-01 00:00:00 | 256.35 | N | Y | N/A | N/A
24565 | CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ | 2011-07-01 00:00:00 | 427.09 | N | Y | N/A | N/A
24566 | PRQ SKEL FIXJ HUMRL EPCNDYLR FX MEDIAL/LAT MANJ | 2011-07-01 00:00:00 | 591.41 | N | Y | N/A | N/A
24575 | OPEN TX HUMERAL EPICONDYLAR FRACTURE | 2011-07-01 00:00:00 | 609.51 | N | Y | N/A | N/A
24576 | CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ | 2011-07-01 00:00:00 | 271.72 | N | Y | N/A | N/A
24577 | CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ | 2011-07-01 00:00:00 | 442.03 | N | Y | N/A | N/A
24579 | OPEN TREATMENT HUMERAL CONDYLAR FRACTURE | 2011-07-01 00:00:00 | 695.12 | N | Y | N/A | N/A
24582 | PRQ SKEL FIXJ HUMRL CNDYLR FX MEDIAL/LAT W/MANJ | 2011-07-01 00:00:00 | 662.93 | N | Y | N/A | N/A
24586 | OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBOW | 2011-07-01 00:00:00 | 911.32 | N | Y | N/A | N/A
24587 | OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHRP | 2011-07-01 00:00:00 | 910.97 | N | Y | N/A | N/A
24600 | TREATMENT CLOSED ELBOW DISLOCATION W/O ANES | 2011-07-01 00:00:00 | 293.41 | N | Y | N/A | N/A
24605 | TREATMENT CLOSED ELBOW DISLOCATION REQ ANES | 2011-07-01 00:00:00 | 382.71 | N | Y | N/A | N/A
24615 | OPEN TX ACUTE/CHRONIC ELBOW DISLOCATION | 2011-07-01 00:00:00 | 594.32 | N | Y | N/A | N/A
24620 | CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ | 2011-07-01 00:00:00 | 457.66 | N | Y | N/A | N/A
24635 | OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW | 2011-07-01 00:00:00 | 586.08 | N | Y | N/A | N/A
24640 | CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ | 2011-07-01 00:00:00 | 103.67 | N | Y | N/A | N/A
24650 | CLOSED [NAME] HEAD/NECK FX W/O MANIPULATION | 2011-07-01 00:00:00 | 208.61 | N | Y | N/A | N/A
24655 | CLOSED [NAME] HEAD/NECK FX W/MANIPULATION | 2011-07-01 00:00:00 | 353.27 | N | Y | N/A | N/A
24665 | OPEN TX RADIAL HEAD/NECK FRACTURE | 2011-07-01 00:00:00 | 540.09 | N | Y | N/A | N/A
24666 | OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC | 2011-07-01 00:00:00 | 609.71 | N | Y | N/A | N/A
24670 | CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ | 2011-07-01 00:00:00 | 233.16 | N | Y | N/A | N/A
24675 | CLOSED TX ULNAR FRACTURE PROXIMAL END W MANJ | 2011-07-01 00:00:00 | 372.01 | N | Y | N/A | N/A
24685 | OPEN TREATMENT ULNAR FRACTURE PROXIMAL END | 2011-07-01 00:00:00 | 540.92 | N | Y | N/A | N/A
24800 | ARTHRODESIS ELBOW JOINT LOCAL | 2011-07-01 00:00:00 | 678.64 | N | Y | N/A | N/A
24802 | ARTHRODESIS ELBOW JOINT W/AUTOGENOUS GRAFT | 2011-07-01 00:00:00 | 835.72 | N | Y | N/A | N/A
24900 | AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE | 2011-07-01 00:00:00 | 605.11 | N | Y | N/A | N/A
24920 | AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR | 2011-07-01 00:00:00 | 602.07 | N | Y | N/A | N/A
24925 | AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ | 2011-07-01 00:00:00 | 466.7 | N | Y | N/A | N/A
24930 | AMPUTATION ARM THRU HUMERUS RE-AMPUTATION | 2011-07-01 00:00:00 | 637.93 | N | Y | N/A | N/A
24931 | AMPUTATION ARM THRU HUMERUS W/IMPLANT | 2011-07-01 00:00:00 | 662.32 | N | Y | N/A | N/A
24935 | STUMP ELONGATION UPPER EXTREMITY | 2011-07-01 00:00:00 | 805.66 | N | Y | N/A | N/A
24940 | CINEPLASTY UPPER EXTREMITY COMPLETE PROCEDURE | 2008-07-01 00:00:00 | 998.38 | N | Y | N/A | N/A
24999 | UNLISTED PROCEDURE, HUMERUS OR ELBOW | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
25000 | INCISION EXTENSOR TENDON SHEATH WRIST | 2011-07-01 00:00:00 | 284.98 | N | Y | N/A | N/A
25001 | INCISION FLEXOR TENDON SHEATH WRIST | 2011-07-01 00:00:00 | 280.73 | N | Y | N/A | N/A
25020 | DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT | 2011-07-01 00:00:00 | 479.52 | N | Y | N/A | N/A
25023 | DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT | 2011-07-01 00:00:00 | 918.94 | N | Y | N/A | N/A
25024 | DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DBRDMT | 2011-07-01 00:00:00 | 647.31 | N | Y | N/A | N/A
25025 | DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT NV | 2011-07-01 00:00:00 | 1013.34 | N | Y | N/A | N/A
25028 | I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA | 2011-07-01 00:00:00 | 429.09 | N | Y | N/A | N/A
25031 | INCISION & DRAINAGE FOREARM&/WRIST BURSA | 2011-07-01 00:00:00 | 300.79 | N | Y | N/A | N/A
25035 | INCISION DEEP BONE CORTEX FOREARM&/WRIST | 2011-07-01 00:00:00 | 512.42 | N | Y | N/A | N/A
25040 | ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB | 2011-07-01 00:00:00 | 471.71 | N | Y | N/A | N/A
25065 | BIOPSY SOFT TISSUE FOREARM&/WRIST SUPERFICIAL | 2011-07-01 00:00:00 | 211.75 | N | Y | N/A | N/A
25066 | BIOPSY SOFT TISSUE FOREARM&/WRIST DEEP | 2011-07-01 00:00:00 | 305.76 | N | Y | N/A | N/A
25071 | EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/GT | 2011-07-01 00:00:00 | 365.27 | N | Y | N/A | N/A
25073 | EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3CM/GT | 2011-07-01 00:00:00 | 457.22 | N | Y | N/A | N/A
25075 | EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ LT3CM | 2011-07-01 00:00:00 | 398.52 | N | Y | N/A | N/A
25076 | EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC LT3CM | 2011-07-01 00:00:00 | 430.63 | N | Y | N/A | N/A
25077 | RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST LT3CM | 2011-07-01 00:00:00 | 735.16 | N | Y | N/A | N/A
25078 | RAD RESCJ TUM SOFT TISSUE FOREARM&/WRIST 3 CM/GT | 2011-07-01 00:00:00 | 951.07 | N | Y | N/A | N/A
25085 | CAPSULOTOMY WRIST | 2011-07-01 00:00:00 | 380.58 | N | Y | N/A | N/A
25100 | ARTHROTOMY WRIST JOINT WITH BIOPSY | 2011-07-01 00:00:00 | 286.8 | N | Y | N/A | N/A
25101 | ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB | 2011-07-01 00:00:00 | 336.74 | N | Y | N/A | N/A
25105 | ARTHROTOMY WRIST JOINT WITH SYNOVECTOMY | 2011-07-01 00:00:00 | 405.75 | N | Y | N/A | N/A
25107 | ARTHROTOMY DSTL RADIOULNAR JOINT RPR CARTILAGE | 2011-07-01 00:00:00 | 515.02 | N | Y | N/A | N/A
25109 | EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA | 2011-07-01 00:00:00 | 442.96 | N | Y | N/A | N/A
25110 | EXCISION LESION TENDON SHEATH FOREARM&/WRIST | 2011-07-01 00:00:00 | 291.21 | N | Y | N/A | N/A
25111 | EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY | 2011-07-01 00:00:00 | 263.56 | N | Y | N/A | N/A
25112 | EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT | 2011-07-01 00:00:00 | 319.79 | N | Y | N/A | N/A
25115 | RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS | 2011-07-01 00:00:00 | 656.93 | N | Y | N/A | N/A
25116 | RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS | 2011-07-01 00:00:00 | 524.05 | N | Y | N/A | N/A
25118 | SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT | 2011-07-01 00:00:00 | 318.57 | N | Y | N/A | N/A
25119 | SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA | 2011-07-01 00:00:00 | 417.99 | N | Y | N/A | N/A
25120 | EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA | 2011-07-01 00:00:00 | 439.42 | N | Y | N/A | N/A
25125 | EXC/CURTG CYST/TUMOR RADIUS/ULNA W/AUTOGRAFT | 2011-07-01 00:00:00 | 517.88 | N | Y | N/A | N/A
25126 | EXC/CURTG CYST/TUMOR RADIUS/ULNA W/ALLOGRAFT | 2011-07-01 00:00:00 | 519.9 | N | Y | N/A | N/A
25130 | EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES | 2011-07-01 00:00:00 | 374.83 | N | Y | N/A | N/A
25135 | EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT | 2011-07-01 00:00:00 | 465.73 | N | Y | N/A | N/A
25136 | EXC/CURTG CYST/TUMOR CARPAL BONES W/ALLOGRAFT | 2011-07-01 00:00:00 | 410.19 | N | Y | N/A | N/A
25145 | SEQUESTRECTOMY FOREARM &/WRIST | 2011-07-01 00:00:00 | 453.06 | N | Y | N/A | N/A
25150 | PARTIAL EXCISION BONE ULNA | 2011-07-01 00:00:00 | 476.69 | N | Y | N/A | N/A
25151 | PARTIAL EXCISION BONE RADIUS | 2011-07-01 00:00:00 | 511.55 | N | Y | N/A | N/A
25170 | RADICAL RESECTION TUMOR RADIUS OR ULNA | 2011-07-01 00:00:00 | 1183.22 | N | Y | N/A | N/A
25210 | CARPECTOMY 1 BONE | 2011-07-01 00:00:00 | 409.33 | N | Y | N/A | N/A
25215 | CARPECTOMY ALL BONES PROXIMAL ROW | 2011-07-01 00:00:00 | 521.68 | N | Y | N/A | N/A
25230 | RADICAL STYLOIDECTOMY SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 361.32 | N | Y | N/A | N/A
25240 | EXCISION DISTAL ULNA PARTIAL/COMPLETE | 2011-07-01 00:00:00 | 361.97 | N | Y | N/A | N/A
25246 | INJECTION WRIST ARTHROGRAPHY | 2011-07-01 00:00:00 | 139.92 | N | Y | N/A | N/A
25248 | EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST | 2011-07-01 00:00:00 | 355.77 | N | Y | N/A | N/A
25250 | REMOVAL WRIST PROSTHESIS SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 437.72 | N | Y | N/A | N/A
25251 | REMOVAL WRIST PROSTH COMPLICATED W/TOTAL WRIST | 2011-07-01 00:00:00 | 598.46 | N | Y | N/A | N/A
25259 | MANIPULATION WRIST UNDER ANESTHESIA | 2011-07-01 00:00:00 | 335.39 | N | Y | N/A | N/A
25260 | RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MUSC | 2011-07-01 00:00:00 | 548.86 | N | Y | N/A | N/A
25263 | RPR TDN/MUSC FLXR F/ARM&/WRST SEC 1 EA TDN/MUSC | 2011-07-01 00:00:00 | 545.7 | N | Y | N/A | N/A
25265 | RPR TDN/MUSC FLXR F/ARM&/WRST SEC FR GRF EA | 2011-07-01 00:00:00 | 648.68 | N | Y | N/A | N/A
25270 | RPR TDN/MUSC XTNSR F/ARM&/WRST PRIM 1 EA TDN | 2011-07-01 00:00:00 | 434.17 | N | Y | N/A | N/A
25272 | RPR TDN/MUSC XTNSR F/ARM&/WRST SEC 1 EA TDN/MUSC | 2011-07-01 00:00:00 | 487.8 | N | Y | N/A | N/A
25274 | RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN | 2011-07-01 00:00:00 | 582.6 | N | Y | N/A | N/A
25275 | RPR TENDON SHEATH EXTENSOR F/ARM&/WRST W/GRAFT | 2011-07-01 00:00:00 | 561.29 | N | Y | N/A | N/A
25280 | LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRST 1 EA TDN | 2011-07-01 00:00:00 | 495.49 | N | Y | N/A | N/A
25290 | TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA | 2011-07-01 00:00:00 | 403.49 | N | Y | N/A | N/A
25295 | TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA | 2011-07-01 00:00:00 | 461.14 | N | Y | N/A | N/A
25300 | TENODESIS WRIST FLEXORS FINGERS | 2011-07-01 00:00:00 | 571.38 | N | Y | N/A | N/A
25301 | TENODESIS WRIST EXTENSORS FINGERS | 2011-07-01 00:00:00 | 539.56 | N | Y | N/A | N/A
25310 | TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN | 2011-07-01 00:00:00 | 540.14 | N | Y | N/A | N/A
25312 | TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GRF | 2011-07-01 00:00:00 | 626.12 | N | Y | N/A | N/A
25315 | FLEXOR ORIGIN SLIDE FOREARM &/WRIST | 2011-07-01 00:00:00 | 670.41 | N | Y | N/A | N/A
25316 | FLEXOR ORIGIN SLIDE F/ARM&/WRST TENDON TRANSFER | 2011-07-01 00:00:00 | 770.09 | N | Y | N/A | N/A
25320 | CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS | 2011-07-01 00:00:00 | 821 | N | Y | N/A | N/A
25332 | ARTHRP WRST W/WO INTERPOS W/WO XTRNL/INT FIXJ | 2011-07-01 00:00:00 | 705.67 | N | Y | N/A | N/A
25335 | CENTRALIZATION WRST ULNA | 2011-07-01 00:00:00 | 714.42 | N | Y | N/A | N/A
25337 | RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ | 2011-07-01 00:00:00 | 744.78 | N | Y | N/A | N/A
25350 | OSTEOTOMY RADIUS DISTAL THIRD | 2011-07-01 00:00:00 | 589.29 | N | Y | N/A | N/A
25355 | OSTEOTOMY RADIUS MIDDLE/PROXIMAL THIRD | 2011-07-01 00:00:00 | 665.59 | N | Y | N/A | N/A
25360 | OSTEOTOMY ULNA | 2011-07-01 00:00:00 | 572.08 | N | Y | N/A | N/A
25365 | OSTEOTOMY RADIUS & ULNA | 2011-07-01 00:00:00 | 787.71 | N | Y | N/A | N/A
25370 | MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS/ULNA | 2011-07-01 00:00:00 | 863.3 | N | Y | N/A | N/A
25375 | MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS&ULNA | 2011-07-01 00:00:00 | 794.29 | N | Y | N/A | N/A
25390 | OSTEOPLASTY RADIUS/ULNA SHORTENING | 2011-07-01 00:00:00 | 670.64 | N | Y | N/A | N/A
25391 | OSTEOPLASTY RADIUS/ULNA LENGTHENING W/AUTOGRAFT | 2011-07-01 00:00:00 | 859.01 | N | Y | N/A | N/A
25392 | OSTEOPLASTY RADIUS & ULNA SHORTENING | 2011-07-01 00:00:00 | 874.89 | N | Y | N/A | N/A
25393 | OSTEOPLASTY RADIUS&ULNA LENGTHENING W/AUTOGRAFT | 2011-07-01 00:00:00 | 996 | N | Y | N/A | N/A
25394 | OSTEOPLASTY CARPAL BONE SHORTENING | 2011-07-01 00:00:00 | 651.8 | N | Y | N/A | N/A
25400 | RPIR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT | 2011-07-01 00:00:00 | 700.63 | N | Y | N/A | N/A
25405 | RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT | 2011-07-01 00:00:00 | 896.77 | N | Y | N/A | N/A
25415 | RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAFT | 2011-07-01 00:00:00 | 847.89 | N | Y | N/A | N/A
25420 | RPR NONUNION/MALUNION RADIUS&ULNA W/AUTOGRAFT | 2011-07-01 00:00:00 | 1008.11 | N | Y | N/A | N/A
25425 | REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA | 2011-07-01 00:00:00 | 853.06 | N | Y | N/A | N/A
25426 | REPAIR DEFECT W/AUTOGRAFT RADIUS&ULNA | 2011-07-01 00:00:00 | 938.3 | N | Y | N/A | N/A
25430 | INSERTION VASCULAR PEDICLE CARPAL BONE | 2011-07-01 00:00:00 | 590.87 | N | Y | N/A | N/A
25431 | REPAIR NONUNION CARPAL BONE EACH BONE | 2011-07-01 00:00:00 | 653.78 | N | Y | N/A | N/A
25440 | RPR NONUNION SCAPHOID CARPAL BNE W/WO RDL STYLEC | 2011-07-01 00:00:00 | 644.82 | N | Y | N/A | N/A
25441 | ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL RADIUS | 2011-07-01 00:00:00 | 783.87 | N | Y | N/A | N/A
25442 | ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL ULNA | 2011-07-01 00:00:00 | 665.97 | N | Y | N/A | N/A
25443 | ARTHROPLASTY W/PROSTHETIC RPLCMT SCAPHOID CARPAL | 2011-07-01 00:00:00 | 651.35 | N | Y | N/A | N/A
25444 | ARTHROPLASTY W/PROSTHETIC REPLACEMENT LUNATE | 2011-07-01 00:00:00 | 676.94 | N | Y | N/A | N/A
25445 | ARTHROPLASTY W/PROSTHETIC REPLACEMENT TRAPEZIUM | 2011-07-01 00:00:00 | 601.49 | N | Y | N/A | N/A
25446 | ARTHRP W/PROSTC RPLCMT DSTL RDS&PRTL/CARPUS | 2011-07-01 00:00:00 | 985.46 | N | Y | N/A | N/A
25447 | ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS | 2011-07-01 00:00:00 | 687.22 | N | Y | N/A | N/A
25449 | REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT | 2011-07-01 00:00:00 | 872.93 | N | Y | N/A | N/A
25450 | EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/U | 2011-07-01 00:00:00 | 470.19 | N | Y | N/A | N/A
25455 | EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS&U | 2011-07-01 00:00:00 | 531.42 | N | Y | N/A | N/A
25490 | PROPH TX N/P/PLTWR W/WO METHYLACRYLATE RADIUS | 2011-07-01 00:00:00 | 593.62 | N | Y | N/A | N/A
25491 | PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE ULNA | 2011-07-01 00:00:00 | 643.64 | N | Y | N/A | N/A
25492 | PROPH TX N/P/PLTWR W/WO METHYLMECRYLATE RAD&ULNA | 2011-07-01 00:00:00 | 778.84 | N | Y | N/A | N/A
25500 | CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION | 2011-07-01 00:00:00 | 215.12 | N | Y | N/A | N/A
25505 | CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION | 2011-07-01 00:00:00 | 408.15 | N | Y | N/A | N/A
25515 | OPEN TREATMENT RADIAL SHAFT FRACTURE | 2011-07-01 00:00:00 | 554.36 | N | Y | N/A | N/A
25520 | CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT | 2011-07-01 00:00:00 | 456.74 | N | Y | N/A | N/A
25525 | OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE | 2011-07-01 00:00:00 | 657.95 | N | Y | N/A | N/A
25526 | OPEN RDL SHAFT FX OPEN RAD/ULN JT DISLOCATE | 2011-07-01 00:00:00 | 809.48 | N | Y | N/A | N/A
25530 | CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION | 2011-07-01 00:00:00 | 208.31 | N | Y | N/A | N/A
25535 | CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION | 2011-07-01 00:00:00 | 397.14 | N | Y | N/A | N/A
25545 | OPEN TREATMENT OF ULNAR SHAFT FRACTURE | 2011-07-01 00:00:00 | 516.91 | N | Y | N/A | N/A
25560 | CLOSED TX RADIAL&ULNAR [NAME] FRACTURES W/O MANJ | 2011-07-01 00:00:00 | 218.22 | N | Y | N/A | N/A
25565 | CLOSED TX RADIAL&ULNAR [NAME] FRACTURES W/MANJ | 2011-07-01 00:00:00 | 426.21 | N | Y | N/A | N/A
25574 | OPEN TX RADIAL & ULNAR SHAFT FX FIXJ RADIUS/ULNA | 2011-07-01 00:00:00 | 555.46 | N | Y | N/A | N/A
25575 | OPEN TX RDL& ULNAR SHAFT FX FIXJ RADIUS &ULNA | 2011-07-01 00:00:00 | 747.49 | N | Y | N/A | N/A
25600 | CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ | 2011-07-01 00:00:00 | 234.82 | N | Y | N/A | N/A
25605 | CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF | 2011-07-01 00:00:00 | 508.41 | N | Y | N/A | N/A
25606 | PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP | 2011-07-01 00:00:00 | 551.89 | N | Y | N/A | N/A
25607 | OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP | 2011-07-01 00:00:00 | 604.74 | N | Y | N/A | N/A
25608 | OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG | 2011-07-01 00:00:00 | 679.8 | N | Y | N/A | N/A
25609 | OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG | 2011-07-01 00:00:00 | 866.83 | N | Y | N/A | N/A
25622 | CLOSED [NAME] | 2011-07-01 00:00:00 | 242.91 | N | Y | N/A | N/A
25624 | CLOSED [NAME] | 2011-07-01 00:00:00 | 375.21 | N | Y | N/A | N/A
25628 | OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE | 2011-07-01 00:00:00 | 598.91 | N | Y | N/A | N/A
25630 | CLTX CARPAL BONE FX W/O MANJ EACH BONE | 2011-07-01 00:00:00 | 246.05 | N | Y | N/A | N/A
25635 | CLTX CARPAL BONE FX W/MANJ EACH BONE | 2011-07-01 00:00:00 | 363.47 | N | Y | N/A | N/A
25645 | OPEN TX CARPAL BONE FRACTURE OTH/THN SCAPHOID EA | 2011-07-01 00:00:00 | 470.89 | N | Y | N/A | N/A
25650 | CLOSED TREATMENT ULNAR STYLOID FRACTURE | 2011-07-01 00:00:00 | 258.06 | N | Y | N/A | N/A
25651 | PRQ SKELETAL FIXATION ULNAR STYLOID FRACTURE | 2011-07-01 00:00:00 | 398.2 | N | Y | N/A | N/A
25652 | OPEN TREATMENT ULNAR STYLOID FRACTURE | 2011-07-01 00:00:00 | 515.84 | N | Y | N/A | N/A
25660 | CLTX RDCRPL/INTERCARPL DISLC 1/GT BONES W/MANJ | 2011-07-01 00:00:00 | 331.52 | N | Y | N/A | N/A
25670 | OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/GT BONES | 2011-07-01 00:00:00 | 503.44 | N | Y | N/A | N/A
25671 | PRQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION | 2011-07-01 00:00:00 | 436.31 | N | Y | N/A | N/A
25675 | CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ | 2011-07-01 00:00:00 | 352.18 | N | Y | N/A | N/A
25676 | OPEN TX DISTAL RADIOULNAR DISLC ACUTE/CHRONIC | 2011-07-01 00:00:00 | 524.67 | N | Y | N/A | N/A
25680 | CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MANJ | 2011-07-01 00:00:00 | 381.26 | N | Y | N/A | N/A
25685 | OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC | 2011-07-01 00:00:00 | 610.02 | N | Y | N/A | N/A
25690 | CLOSED [NAME] DISLOCATION W/MANIPULATION | 2011-07-01 00:00:00 | 390.07 | N | Y | N/A | N/A
25695 | OPEN TREATMENT LUNATE DISLOCATION | 2011-07-01 00:00:00 | 526.01 | N | Y | N/A | N/A
25800 | ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT | 2011-07-01 00:00:00 | 615.55 | N | Y | N/A | N/A
25805 | ARTHRODESIS WRIST W/SLIDING GRAFT | 2011-07-01 00:00:00 | 710.06 | N | Y | N/A | N/A
25810 | ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT | 2011-07-01 00:00:00 | 726.62 | N | Y | N/A | N/A
25820 | ARTHRODESIS WRIST LIMITED W/O BONE GRAFT | 2011-07-01 00:00:00 | 510.18 | N | Y | N/A | N/A
25825 | ARTHRODESIS WRIST LIMITED W/AUTOGRAFT | 2011-07-01 00:00:00 | 630.38 | N | Y | N/A | N/A
25830 | ARTHRD DSTL RAD/ULN JT SGMTL RESCJ ULNA W/WOBONE | 2011-07-01 00:00:00 | 791.31 | N | Y | N/A | N/A
25900 | AMPUTATION FOREARM THROUGH RADIUS & ULNA | 2011-07-01 00:00:00 | 611.75 | N | Y | N/A | N/A
25905 | AMP FOREARM THRU RADIUS&ULNA OPEN CIRCULAR | 2011-07-01 00:00:00 | 601.97 | N | Y | N/A | N/A
25907 | AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR REVJ | 2011-07-01 00:00:00 | 526.93 | N | Y | N/A | N/A
25909 | AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION | 2011-07-01 00:00:00 | 589.37 | N | Y | N/A | N/A
25920 | DISARTICULATION THROUGH WRIST | 2011-07-01 00:00:00 | 575.43 | N | Y | N/A | N/A
25922 | DISARTICULATION THRU WRIST SEC CLOSURE/SCAR REVJ | 2011-07-01 00:00:00 | 439.57 | N | Y | N/A | N/A
25924 | DISARTICULATION THRU WRIST RE-AMPUTATION | 2011-07-01 00:00:00 | 532.88 | N | Y | N/A | N/A
25927 | TRANSMETACARPAL AMPUTATION | 2011-07-01 00:00:00 | 662.68 | N | Y | N/A | N/A
25929 | TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ | 2011-07-01 00:00:00 | 490.69 | N | Y | N/A | N/A
25931 | TRANSMETACARPAL AMPUTATION RE-AMPUTATION | 2011-07-01 00:00:00 | 576.34 | N | Y | N/A | N/A
25999 | UNLISTED PROCEDURE, FOREARM/WRIST | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
26010 | DRAINAGE FINGER ABSCESS SIMPLE | 2011-07-01 00:00:00 | 210.21 | N | Y | N/A | N/A
26011 | DRAINAGE FINGER ABSCESS COMPLICATED | 2011-07-01 00:00:00 | 318.4 | N | Y | N/A | N/A
26020 | DRAINAGE TENDON SHEATH DIGIT&/PALM EACH | 2011-07-01 00:00:00 | 357.31 | N | Y | N/A | N/A
26025 | DRAINAGE OF PALMAR BURSA SINGLE BURSA | 2011-07-01 00:00:00 | 346.87 | N | Y | N/A | N/A
26030 | DRAINAGE OF PALMAR BURSA MULTIPLE BURSA | 2011-07-01 00:00:00 | 408.07 | N | Y | N/A | N/A
26034 | INCISION BONE CORTEX HAND/FINGER | 2011-07-01 00:00:00 | 443.52 | N | Y | N/A | N/A
26035 | DECOMPRESSION FINGERS&/HAND INJECTION INJURY | 2011-07-01 00:00:00 | 701.57 | N | Y | N/A | N/A
26037 | DECOMPRESSIVE FASCIOTOMY HAND | 2011-07-01 00:00:00 | 474.38 | N | Y | N/A | N/A
26040 | FASCIOTOMY PALMAR PERCUTANEOUS | 2011-07-01 00:00:00 | 255.74 | N | Y | N/A | N/A
26045 | FASCIOTOMY PALMAR OPEN PARTIAL | 2011-07-01 00:00:00 | 385.75 | N | Y | N/A | N/A
26055 | TENDON SHEATH INCISION | 2011-07-01 00:00:00 | 463.03 | N | Y | N/A | N/A
26060 | TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT | 2011-07-01 00:00:00 | 219.54 | N | Y | N/A | N/A
26070 | ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRPL JT | 2011-07-01 00:00:00 | 252.15 | N | Y | N/A | N/A
26075 | ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA | 2011-07-01 00:00:00 | 264.79 | N | Y | N/A | N/A
26080 | ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA | 2011-07-01 00:00:00 | 319.6 | N | Y | N/A | N/A
26100 | ARTHROTOMY BIOPSY CARP/MTCRPL JOINT EACH | 2011-07-01 00:00:00 | 270.82 | N | Y | N/A | N/A
26105 | ARTHROTOMY BIOPSY MTCARPHLNGL JOINT EACH | 2011-07-01 00:00:00 | 274.7 | N | Y | N/A | N/A
26110 | ARTHROTOMY BIOPSY INTERPHALANGEAL JOINT EACH | 2011-07-01 00:00:00 | 263.82 | N | Y | N/A | N/A
26111 | EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/GT | 2011-07-01 00:00:00 | 357.8 | N | Y | N/A | N/A
26113 | EX TUM/VASC MAL SFT [NAME] SUBFSC 1.5CM/GT | 2011-07-01 00:00:00 | 469.42 | N | Y | N/A | N/A
26115 | EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LT1.5CM | 2011-07-01 00:00:00 | 461.66 | N | Y | N/A | N/A
26116 | EXC TUM/VAS MAL SFT [NAME] SUBFASCLT1.5CM | 2011-07-01 00:00:00 | 436.44 | N | Y | N/A | N/A
26117 | RAD RESECT TUMOR SOFT TISSUE HAND/FINGER LT3CM | 2011-07-01 00:00:00 | 608.85 | N | Y | N/A | N/A
26118 | RAD RESCJ TUM SOFT TISSUE HAND/FINGER 3 CM/GT | 2011-07-01 00:00:00 | 914.34 | N | Y | N/A | N/A
26121 | FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT | 2011-07-01 00:00:00 | 496.45 | N | Y | N/A | N/A
26123 | FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR | 2011-07-01 00:00:00 | 690.39 | N | Y | N/A | N/A
26125 | FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR | 2011-07-01 00:00:00 | 234.88 | N | Y | N/A | N/A
26130 | SYNOVECTOMY CARPOMETACARPAL JOINT | 2011-07-01 00:00:00 | 379.5 | N | Y | N/A | N/A
26135 | SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD | 2011-07-01 00:00:00 | 457.95 | N | Y | N/A | N/A
26140 | SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT | 2011-07-01 00:00:00 | 418.55 | N | Y | N/A | N/A
26145 | SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN | 2011-07-01 00:00:00 | 424.69 | N | Y | N/A | N/A
26160 | [NAME] TDN SHTH/JT CAPSL HAND/FNGR | 2011-07-01 00:00:00 | 469.45 | N | Y | N/A | N/A
26170 | EXCISION TENDON PALM FLEXOR/EXTENSOR SINGLE EACH | 2011-07-01 00:00:00 | 335.89 | N | Y | N/A | N/A
26180 | EXCISION TENDON FINGER FLEXOR/EXTENSOR EACH | 2011-07-01 00:00:00 | 365.04 | N | Y | N/A | N/A
26185 | SESAMOIDECTOMY THUMB/FINGER SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 448.7 | N | Y | N/A | N/A
26200 | EXCISION/CURETTAGE CYST/TUMOR METACARPAL | 2011-07-01 00:00:00 | 373.32 | N | Y | N/A | N/A
26205 | EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT | 2011-07-01 00:00:00 | 500.06 | N | Y | N/A | N/A
26210 | EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER | 2011-07-01 00:00:00 | 365.28 | N | Y | N/A | N/A
26215 | EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT | 2011-07-01 00:00:00 | 464.34 | N | Y | N/A | N/A
26230 | PARTIAL EXCISION BONE METACARPAL | 2011-07-01 00:00:00 | 415.13 | N | Y | N/A | N/A
26235 | PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER | 2011-07-01 00:00:00 | 410.62 | N | Y | N/A | N/A
26236 | PARTIAL EXCISION DISTAL PHALANX FINGER | 2011-07-01 00:00:00 | 365.19 | N | Y | N/A | N/A
26250 | RADICAL RESECTION TUMOR METACARPAL | 2011-07-01 00:00:00 | 823.99 | N | Y | N/A | N/A
26260 | RAD [NAME] | 2011-07-01 00:00:00 | 646.3 | N | Y | N/A | N/A
26262 | RADICAL RESECTION TUMOR DISTAL PHALANX FINGER | 2011-07-01 00:00:00 | 496.94 | N | Y | N/A | N/A
26320 | REMOVAL IMPLANT FROM FINGER/HAND | 2011-07-01 00:00:00 | 286.59 | N | Y | N/A | N/A
26340 | MANIPULATION FINGER JOINT UNDER ANES EACH JOINT | 2011-07-01 00:00:00 | 269.17 | N | Y | N/A | N/A
26341 | MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD | 2012-01-01 00:00:00 | 81.13 | N | N | N/A | N/A
26350 | RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDON | 2011-07-01 00:00:00 | 587.99 | N | Y | N/A | N/A
26352 | RPR/ADVMNT FLXR TDN N/Z/2 W/FR GRAFT EA TENDON | 2011-07-01 00:00:00 | 670.02 | N | Y | N/A | N/A
26356 | RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON | 2011-07-01 00:00:00 | 896.99 | N | Y | N/A | N/A
26357 | RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON | 2011-07-01 00:00:00 | 715.63 | N | Y | N/A | N/A
26358 | RPR/ADVMNT FLXR TDN ZONE 2 W/FR GRAFT EA TENDON | 2011-07-01 00:00:00 | 764.09 | N | Y | N/A | N/A
26370 | RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN | 2011-07-01 00:00:00 | 632.51 | N | Y | N/A | N/A
26372 | RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/FREE GRAFT EA | 2011-07-01 00:00:00 | 731.69 | N | Y | N/A | N/A
26373 | RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/O FREE GRF EA | 2011-07-01 00:00:00 | 699.25 | N | Y | N/A | N/A
26390 | EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F | 2011-07-01 00:00:00 | 687.39 | N | Y | N/A | N/A
26392 | RMVL SYNTH ROD&INSJ FLXR TDN GRF H/F EA ROD | 2011-07-01 00:00:00 | 801.93 | N | Y | N/A | N/A
26410 | REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH | 2011-07-01 00:00:00 | 466.74 | N | Y | N/A | N/A
26412 | REPAIR EXTENSOR TENDON HAND W/GRAFT EACH | 2011-07-01 00:00:00 | 565.91 | N | Y | N/A | N/A
26415 | EXC XTNSR TDN W/IMPLTJ SYNTH ROD DLYD GRF H/F EA | 2011-07-01 00:00:00 | 580.87 | N | Y | N/A | N/A
26416 | RMVL SYNTH ROD&INSJ XTNSR TDN GRF H/F EA ROD | 2011-07-01 00:00:00 | 691.15 | N | Y | N/A | N/A
26418 | REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH | 2011-07-01 00:00:00 | 473.71 | N | Y | N/A | N/A
26420 | REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH | 2011-07-01 00:00:00 | 585.67 | N | Y | N/A | N/A
26426 | RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR | 2011-07-01 00:00:00 | 447.35 | N | Y | N/A | N/A
26428 | RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER | 2011-07-01 00:00:00 | 620.8 | N | Y | N/A | N/A
26432 | CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING | 2011-07-01 00:00:00 | 409.88 | N | Y | N/A | N/A
26433 | REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF | 2011-07-01 00:00:00 | 438.18 | N | Y | N/A | N/A
26434 | REPAIR EXTENSOR TENDON DISTAL INSERTION W/GRAFT | 2011-07-01 00:00:00 | 528.87 | N | Y | N/A | N/A
26437 | REALIGNMENT EXTENSOR TENDON HAND EACH TENDON | 2011-07-01 00:00:00 | 512.9 | N | Y | N/A | N/A
26440 | TENOLYSIS FLEXOR TENDON PALM/FINGER EACH TENDON | 2011-07-01 00:00:00 | 513.79 | N | Y | N/A | N/A
26442 | TENOLYSIS FLEXOR TENDON PALM&FINGER EACH TENDON | 2011-07-01 00:00:00 | 793.41 | N | Y | N/A | N/A
26445 | TENOLYSIS EXTENSOR TENDON HAND/FINGER EACH | 2011-07-01 00:00:00 | 477.87 | N | Y | N/A | N/A
26449 | TENOLYSIS CPLX XTNSR TENDON FINGER W/FOREARM EA | 2011-07-01 00:00:00 | 610.61 | N | Y | N/A | N/A
26450 | TENOTOMY FLEXOR PALM OPEN EACH TENDON | 2011-07-01 00:00:00 | 332.52 | N | Y | N/A | N/A
26455 | TENOTOMY FLEXOR FINGER OPEN EACH TENDON | 2011-07-01 00:00:00 | 331.2 | N | Y | N/A | N/A
26460 | TENOTOMY EXTENSOR HAND/FINGER OPEN EACH TENDON | 2011-07-01 00:00:00 | 322.63 | N | Y | N/A | N/A
26471 | TENODESIS PROXIMAL INTERPHALANGEAL JOINT EACH | 2011-07-01 00:00:00 | 506.68 | N | Y | N/A | N/A
26474 | TENODESIS DISTAL JOINT EACH | 2011-07-01 00:00:00 | 493 | N | Y | N/A | N/A
26476 | LENGTHENING TENDON EXTENSOR HAND/FINGER EACH | 2011-07-01 00:00:00 | 482.61 | N | Y | N/A | N/A
26477 | SHORTENING TENDON EXTENSOR HAND/FINGER EACH | 2011-07-01 00:00:00 | 479.26 | N | Y | N/A | N/A
26478 | LENGTHENING TENDON FLEXOR HAND/FINGER EACH | 2011-07-01 00:00:00 | 514.77 | N | Y | N/A | N/A
26479 | SHORTENING TENDON FLEXOR HAND/FINGER EACH | 2011-07-01 00:00:00 | 512.33 | N | Y | N/A | N/A
26480 | TR/TRNSPL TDN CARP/MTCRPL HAND W/O FR GRF EA TDN | 2011-07-01 00:00:00 | 621.73 | N | Y | N/A | N/A
26483 | TENDON TRANSFER TRANSPLANT CARP/MTCRPL GRAFT | 2011-07-01 00:00:00 | 697.97 | N | Y | N/A | N/A
26485 | TRANSFER/TRANSPLANT TENDON PALMAR W/O GRAFT EACH | 2011-07-01 00:00:00 | 669.17 | N | Y | N/A | N/A
26489 | TRANSFER/TRANSPLANT TENDON PALMAR W/GRAFT EACH | 2011-07-01 00:00:00 | 749.06 | N | Y | N/A | N/A
26490 | OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN | 2011-07-01 00:00:00 | 654.71 | N | Y | N/A | N/A
26492 | OPPONENSPLASTY TDN TR W/GRF EA TDN | 2011-07-01 00:00:00 | 725.09 | N | Y | N/A | N/A
26494 | OPPONENSPLASTY HYPOTHENAR MUSC TR | 2011-07-01 00:00:00 | 657.13 | N | Y | N/A | N/A
26496 | OPPONENSPLASTY OTHER METHODS | 2011-07-01 00:00:00 | 709.13 | N | Y | N/A | N/A
26497 | TR TDN RESTORE INTRNSC FUNCJ RING&SM FNGR | 2011-07-01 00:00:00 | 712.67 | N | Y | N/A | N/A
26498 | TR TDN RESTORE INTRNSC FUNCJ ALL 4 FNGRS | 2011-07-01 00:00:00 | 946.31 | N | Y | N/A | N/A
26499 | CORRECTION CLAW FINGER OTHER METHODS | 2011-07-01 00:00:00 | 682.03 | N | Y | N/A | N/A
26500 | RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX | 2011-07-01 00:00:00 | 517.37 | N | Y | N/A | N/A
26502 | RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX | 2011-07-01 00:00:00 | 588.18 | N | Y | N/A | N/A
26508 | RELEASE THENAR MUSCLE | 2011-07-01 00:00:00 | 520.22 | N | Y | N/A | N/A
26510 | CROSS INTRINSIC TRANSFER EACH TENDON | 2011-07-01 00:00:00 | 491.73 | N | Y | N/A | N/A
26516 | CAPSULODESIS MTCARPHLNGL JOINT SINGLE [NAME] | 2011-07-01 00:00:00 | 578.3 | N | Y | N/A | N/A
26517 | CAPSULODESIS MTCARPHLNGL JOINT 2 DIGITS | 2011-07-01 00:00:00 | 679.97 | N | Y | N/A | N/A
26518 | CAPSULODESIS MTCARPHLNGL JOINT 3/4 DIGITS | 2011-07-01 00:00:00 | 691.89 | N | Y | N/A | N/A
26520 | CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH | 2011-07-01 00:00:00 | 538.97 | N | Y | N/A | N/A
26525 | CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH | 2011-07-01 00:00:00 | 539.77 | N | Y | N/A | N/A
26530 | ARTHROPLASTY METACARPOPHALANGEAL JOINT EACH | 2011-07-01 00:00:00 | 444.82 | N | Y | N/A | N/A
26531 | [NAME] IMPLT EA JT | 2011-07-01 00:00:00 | 518.31 | N | Y | N/A | N/A
26535 | ARTHROPLASTY INTERPHALANGEAL JOINT EACH | 2011-07-01 00:00:00 | 339.41 | N | Y | N/A | N/A
26536 | ARTHROPLASTY INTERPHALANGEAL JT W/PROSTHETIC EA | 2011-07-01 00:00:00 | 571.29 | N | Y | N/A | N/A
26540 | RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT | 2011-07-01 00:00:00 | 543.98 | N | Y | N/A | N/A
26541 | RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF | 2011-07-01 00:00:00 | 660.76 | N | Y | N/A | N/A
26542 | RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS | 2011-07-01 00:00:00 | 562.82 | N | Y | N/A | N/A
26545 | RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT | 2011-07-01 00:00:00 | 574.99 | N | Y | N/A | N/A
26546 | RPR NON-UNION MTCRPL/PHALANX | 2011-07-01 00:00:00 | 815.09 | N | Y | N/A | N/A
26548 | RPR&RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL JT | 2011-07-01 00:00:00 | 631.41 | N | Y | N/A | N/A
26550 | POLLICIZATION DIGIT | 2011-07-01 00:00:00 | 1304.08 | N | Y | N/A | N/A
26551 | TR TOE-TO-HAND W/MVASC ANAST GRT TOE WRP/ARND | 2011-07-01 00:00:00 | 2536.2 | N | Y | N/A | N/A
26553 | TR TOE-TO-HAND W/MVASC ANAST OTH/THN GRT TOE 1 | 2011-07-01 00:00:00 | 2545.97 | N | Y | N/A | N/A
26554 | TR TOE-TO-HAND W/MVASC ANAST OTH/THN GRT TOE 2 | 2011-07-01 00:00:00 | 2796.74 | N | Y | N/A | N/A
26555 | TR FNGR AXH POS W/O MVASC ANAST | 2011-07-01 00:00:00 | 1135.92 | N | Y | N/A | N/A
26556 | TRANSFER FREE TOE JOINT W/MVASC ANASTOMOSIS | 2011-07-01 00:00:00 | 2437.17 | N | Y | N/A | N/A
26560 | REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS | 2011-07-01 00:00:00 | 479.97 | N | Y | N/A | N/A
26561 | REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS&GRAFTS | 2011-07-01 00:00:00 | 780.19 | N | Y | N/A | N/A
26562 | REPAIR SYNDACTYLY EACH SPACE COMPLEX | 2011-07-01 00:00:00 | 1067.62 | N | Y | N/A | N/A
26565 | OSTEOTOMY METACARPAL EACH | 2011-07-01 00:00:00 | 559.49 | N | Y | N/A | N/A
26567 | OSTEOTOMY PHALANX FINGER EACH | 2011-07-01 00:00:00 | 561.56 | N | Y | N/A | N/A
26568 | OSTEOPLASTY LENGTHENING METACARPAL/PHALANX | 2011-07-01 00:00:00 | 739.48 | N | Y | N/A | N/A
26580 | REPAIR CLEFT HAND | 2011-07-01 00:00:00 | 1128.15 | N | Y | N/A | N/A
26587 | RCNSTJ POLYDACTYLOUS DGT SOFT TISS&B1 | 2011-07-01 00:00:00 | 857.2 | N | Y | N/A | N/A
26590 | REPAIR MACRODACTYLIA EACH DIGIT | 2011-07-01 00:00:00 | 1049.13 | N | Y | N/A | N/A
26591 | REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE | 2011-07-01 00:00:00 | 360.28 | N | Y | N/A | N/A
26593 | RELEASE INTRINSIC MUSCLES HAND EACH MUSCLE | 2011-07-01 00:00:00 | 493.28 | N | Y | N/A | N/A
26596 | EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES | 2011-07-01 00:00:00 | 616.81 | N | Y | N/A | N/A
26600 | CLTX METACARPAL FX W/O MANIPULATION EACH BONE | 2011-07-01 00:00:00 | 231.8 | N | Y | N/A | N/A
26605 | CLTX METACARPAL FX W/MANIPULATION EACH BONE | 2011-07-01 00:00:00 | 259.03 | N | Y | N/A | N/A
26607 | CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE | 2011-07-01 00:00:00 | 369.22 | N | Y | N/A | N/A
26608 | PRQ SKELETAL FIXJ METACARPAL FX EACH BONE | 2011-07-01 00:00:00 | 393.62 | N | Y | N/A | N/A
26615 | OPEN TX METACARPAL FRACTURE SINGLE EA BONE | 2011-07-01 00:00:00 | 469.44 | N | Y | N/A | N/A
26641 | CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ | 2011-07-01 00:00:00 | 292.58 | N | Y | N/A | N/A
26645 | CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ | 2011-07-01 00:00:00 | 342.01 | N | Y | N/A | N/A
26650 | PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB | 2011-07-01 00:00:00 | 393.96 | N | Y | N/A | N/A
26665 | OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB | 2011-07-01 00:00:00 | 515.63 | N | Y | N/A | N/A
26670 | CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES | 2011-07-01 00:00:00 | 267.25 | N | Y | N/A | N/A
26675 | CLTX CARPO/MTCRPL DISLC THUMB [NAME] JT W/ANES | 2011-07-01 00:00:00 | 363.85 | N | Y | N/A | N/A
26676 | PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB [NAME] | 2011-07-01 00:00:00 | 412.35 | N | Y | N/A | N/A
26685 | OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB | 2011-07-01 00:00:00 | 473.21 | N | Y | N/A | N/A
26686 | OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ | 2011-07-01 00:00:00 | 515.59 | N | Y | N/A | N/A
26700 | CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES | 2011-07-01 00:00:00 | 255.65 | N | Y | N/A | N/A
26705 | CLTX METACARPOPHALANGEAL DISLC W/MANJ W/ANES | 2011-07-01 00:00:00 | 335.71 | N | Y | N/A | N/A
26706 | PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ | 2011-07-01 00:00:00 | 361.23 | N | Y | N/A | N/A
26715 | OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION | 2011-07-01 00:00:00 | 467.13 | N | Y | N/A | N/A
26720 | CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA | 2011-07-01 00:00:00 | 157.06 | N | Y | N/A | N/A
26725 | CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA | 2011-07-01 00:00:00 | 274.47 | N | Y | N/A | N/A
26727 | PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T | 2011-07-01 00:00:00 | 387.78 | N | Y | N/A | N/A
26735 | OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA | 2011-07-01 00:00:00 | 487.31 | N | Y | N/A | N/A
26740 | CLTX ARTICULAR FX INVG MTCARPHLNGL/IPHAL JT W/O | 2011-07-01 00:00:00 | 183.03 | N | Y | N/A | N/A
26742 | CLTX ARTICULAR FX INVG MTCARPHLNGL/IPHAL JT W/ | 2011-07-01 00:00:00 | 298.67 | N | Y | N/A | N/A
26746 | OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA | 2011-07-01 00:00:00 | 605.03 | N | Y | N/A | N/A
26750 | CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA | 2011-07-01 00:00:00 | 146.17 | N | Y | N/A | N/A
26755 | CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA | 2011-07-01 00:00:00 | 252.69 | N | Y | N/A | N/A
26756 | PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA | 2011-07-01 00:00:00 | 343.44 | N | Y | N/A | N/A
26765 | OPEN TX DISTAL PHALANGEAL FRACTURE EACH | 2011-07-01 00:00:00 | 404.72 | N | Y | N/A | N/A
26770 | CLTX IPHAL JT DISLC W/MANJ W/O ANES | 2011-07-01 00:00:00 | 217.65 | N | Y | N/A | N/A
26775 | CLTX IPHAL JT DISLC W/MANJ REQ ANES | 2011-07-01 00:00:00 | 308.95 | N | Y | N/A | N/A
26776 | PRQ SKEL FIXJ IPHAL JT DISLC W/MANJ | 2011-07-01 00:00:00 | 364.3 | N | Y | N/A | N/A
26785 | OPEN TX INTERPHALANGEAL JOINT DISLOCATION | 2011-07-01 00:00:00 | 441.56 | N | Y | N/A | N/A
26820 | FUSION OPPOSITION THUMB W/AUTOGENOUS GRAFT | 2011-07-01 00:00:00 | 648.16 | N | Y | N/A | N/A
26841 | ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ | 2011-07-01 00:00:00 | 601.44 | N | Y | N/A | N/A
26842 | ARTHRD CRP/MTACRPL JT THMB W/WO INT FIXJ W/AGRFT | 2011-07-01 00:00:00 | 651.4 | N | Y | N/A | N/A
26843 | ARTHRD CARP/MTCRPL JT DGT OTHER THAN THUMB EACH | 2011-07-01 00:00:00 | 606.26 | N | Y | N/A | N/A
26844 | ARTHRD CARP/MTCRPL JT DGT OTH/THN THMB W/AGRFT | 2011-07-01 00:00:00 | 674.54 | N | Y | N/A | N/A
26850 | ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ | 2011-07-01 00:00:00 | 572.5 | N | Y | N/A | N/A
26852 | [NAME] FIXJ W/AGRFT | 2011-07-01 00:00:00 | 657.41 | N | Y | N/A | N/A
26860 | [NAME] | 2011-07-01 00:00:00 | 463.52 | N | Y | N/A | N/A
26861 | [NAME] FIXJ EA IPHAL JT | 2011-07-01 00:00:00 | 88.33 | N | Y | N/A | N/A
26862 | [NAME] FIXJ W/AGRFT | 2011-07-01 00:00:00 | 598.97 | N | Y | N/A | N/A
26863 | [NAME] FIXJ W/AGRFT EA JT | 2011-07-01 00:00:00 | 196.95 | N | Y | N/A | N/A
26910 | AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER | 2011-07-01 00:00:00 | 590.87 | N | Y | N/A | N/A
26951 | AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR | 2011-07-01 00:00:00 | 527.89 | N | Y | N/A | N/A
26952 | AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP | 2011-07-01 00:00:00 | 534.78 | N | Y | N/A | N/A
26989 | DERMODESIS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
26990 | I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA | 2011-07-01 00:00:00 | 515.56 | N | Y | N/A | N/A
26991 | I&D PELVIS/HIP JOINT AREA INFECTED BURSA | 2011-07-01 00:00:00 | 580.75 | N | Y | N/A | N/A
26992 | INCISION BONE CORTEX PELVIS&/HIP JOINT | 2011-07-01 00:00:00 | 801.47 | N | Y | N/A | N/A
27000 | [NAME] SPX | 2011-07-01 00:00:00 | 365.41 | N | Y | N/A | N/A
27001 | [NAME] OPEN | 2011-07-01 00:00:00 | 448.42 | N | Y | N/A | N/A
27003 | TX ADDUXOR SUBQ OPN W/OBTURATOR NEURECTOMY | 2011-07-01 00:00:00 | 490.97 | N | Y | N/A | N/A
27005 | TENOTOMY HIP FLEXOR OPEN SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 605.66 | N | Y | N/A | N/A
27006 | TENOTOMY ABDUCTORS&/EXTENSOR HIP OPEN SPX | 2011-07-01 00:00:00 | 613.92 | N | Y | N/A | N/A
27025 | FASCIOTOMY HIP/THIGH ANY TYPE | 2011-07-01 00:00:00 | 756.88 | N | Y | N/A | N/A
27027 | DECOMPRESSION FASCIOTOMY PELVIC COMPARTMENT UNI | 2011-07-01 00:00:00 | 713.12 | N | Y | N/A | N/A
27030 | ARTHROTOMY HIP W/DRAINAGE | 2011-07-01 00:00:00 | 783.89 | N | Y | N/A | N/A
27033 | ARTHROTOMY HIP EXPLORATION/REMOVAL FOREIGN BODY | 2011-07-01 00:00:00 | 815.74 | N | Y | N/A | N/A
27035 | DNRVTJ HIP JT INTRAPEL/XTRPEL INTRA-ARTCLR BRNCH | 2011-07-01 00:00:00 | 956.78 | N | Y | N/A | N/A
27036 | CAPSLCTOMY/CAPSUL HIP W/RLS HIP FLXR MUSC | 2011-07-01 00:00:00 | 840.9 | N | Y | N/A | N/A
27040 | BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL | 2011-07-01 00:00:00 | 281.94 | N | Y | N/A | N/A
27041 | BIOPSY SOFT TISSUE PELVIS&HIP DEEP/SUBFSCAL/IM | 2011-07-01 00:00:00 | 567.3 | N | Y | N/A | N/A
27043 | EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3CM/GT | 2011-07-01 00:00:00 | 399.01 | N | Y | N/A | N/A
27045 | EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5CM/GT | 2011-07-01 00:00:00 | 633.34 | N | Y | N/A | N/A
27047 | EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ LT3CM | 2011-07-01 00:00:00 | 404.2 | N | Y | N/A | N/A
27048 | EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC LT5CM | 2011-07-01 00:00:00 | 494.33 | N | Y | N/A | N/A
27049 | RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP LT5CM | 2011-07-01 00:00:00 | 1098.61 | N | Y | N/A | N/A
27050 | ARTHROTOMY W/BIOPSY SACROILIAC JOINT | 2011-07-01 00:00:00 | 313.17 | N | Y | N/A | N/A
27052 | ARTHROTOMY W/BIOPSY HIP JOINT | 2011-07-01 00:00:00 | 472.05 | N | Y | N/A | N/A
27054 | ARTHROTOMY W/SYNOVECTOMY HIP JOINT | 2011-07-01 00:00:00 | 568.2 | N | Y | N/A | N/A
27057 | DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI | 2011-07-01 00:00:00 | 802.33 | N | Y | N/A | N/A
27059 | RAD RESECTION TUMOR SOFT TISS PELVIS&HIP 5 CM/GT | 2011-07-01 00:00:00 | 1551.37 | N | Y | N/A | N/A
27060 | EXCISION ISCHIAL BURSA | 2011-07-01 00:00:00 | 373.27 | N | Y | N/A | N/A
27062 | EXCISION TROCHANTERIC BURSA/CALCIFICATION | 2011-07-01 00:00:00 | 376.39 | N | Y | N/A | N/A
27065 | EXCISION BONE CYST/B9 TUMOR SUPERFICIAL | 2011-07-01 00:00:00 | 418.47 | N | Y | N/A | N/A
27066 | EXCISION BONE CYST/B9 TUMOR DEEP | 2011-07-01 00:00:00 | 675.67 | N | Y | N/A | N/A
27067 | EXC B1 CST/B9 TUM W/AGRFT REQ SEP INC | 2011-07-01 00:00:00 | 864.64 | N | Y | N/A | N/A
27070 | PARTIAL EXCISION SUPERFICIAL PELVIS | 2011-07-01 00:00:00 | 708.95 | N | Y | N/A | N/A
27071 | PARTIAL EXCISION DEEP PELVIS | 2011-07-01 00:00:00 | 759.21 | N | Y | N/A | N/A
27075 | RAD RESCT TUMOR WING OF ILIUM 1 PUBIC/ISCHIAL | 2011-07-01 00:00:00 | 1761.97 | N | Y | N/A | N/A
27076 | RAD RESCT TUMOR ILIUM ACETABULUM BOTH PUBIC | 2011-07-01 00:00:00 | 2015.35 | N | Y | N/A | N/A
27077 | [NAME] INNOMINATE BONE TOTAL | 2011-07-01 00:00:00 | 2363.3 | N | Y | N/A | N/A
27078 | RAD RESCT TUMOR ISCHIAL TUBEROSITY&GRT TRCHNTR | 2011-07-01 00:00:00 | 1609.69 | N | Y | N/A | N/A
27080 | COCCYGECTOMY PRIMARY | 2011-07-01 00:00:00 | 418.92 | N | Y | N/A | N/A
27086 | RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS | 2011-07-01 00:00:00 | 203.7 | N | Y | N/A | N/A
27087 | REMOVAL FOREIGN BODY PELVIS/HIP DEEP | 2011-07-01 00:00:00 | 524.66 | N | Y | N/A | N/A
27090 | REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 693.09 | N | Y | N/A | N/A
27091 | RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA | 2011-07-01 00:00:00 | 1342.12 | N | Y | N/A | N/A
27093 | INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA | 2011-07-01 00:00:00 | 161.29 | N | Y | N/A | N/A
27095 | INJECTION HIP ARTHROGRAPHY W/ANESTHESIA | 2011-07-01 00:00:00 | 197.24 | N | Y | N/A | N/A
27096 | INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMAGE | 2011-07-01 00:00:00 | 157.65 | N | Y | N/A | N/A
27097 | RELEASE/RECESSION HAMSTRING PROXIMAL | 2011-07-01 00:00:00 | 560.69 | N | Y | N/A | N/A
27098 | TRANSFER [NAME] | 2011-07-01 00:00:00 | 553.92 | N | Y | N/A | N/A
27100 | [NAME] MUSC TRCHNTR W/FSCAL/TDN XTN GRF | 2011-07-01 00:00:00 | 686.55 | N | Y | N/A | N/A
27105 | TR PARASPI MUSC HIP FASC/TDN XTN GRF | 2011-07-01 00:00:00 | 721.85 | N | Y | N/A | N/A
27110 | TRANSFER ILIOPSOAS GREATER TROCHANTER FEMUR | 2011-07-01 00:00:00 | 804.58 | N | Y | N/A | N/A
27111 | TRANSFER ILIOPSOAS FEMORAL NECK | 2011-07-01 00:00:00 | 732.25 | N | Y | N/A | N/A
27120 | ACETABULOPLASTY | 2011-07-01 00:00:00 | 1085.05 | N | Y | N/A | N/A
27122 | [NAME] FEMORAL HEAD | 2011-07-01 00:00:00 | 923.88 | N | Y | N/A | N/A
27125 | HEMIARTHROPLASTY HIP PARTIAL | 2011-07-01 00:00:00 | 947.99 | Y | Y | N/A | N/A
27130 | ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT | 2011-07-01 00:00:00 | 1211.66 | Y | Y | N/A | N/A
27132 | CONV PREV HIP TOT HIP [NAME] | 2011-07-01 00:00:00 | 1414.46 | Y | Y | N/A | N/A
27134 | REVJ TOT HIP [NAME] | 2011-07-01 00:00:00 | 1626.5 | Y | Y | N/A | N/A
27137 | REVJ TOT HIP [NAME] | 2011-07-01 00:00:00 | 1245.34 | Y | Y | N/A | N/A
27138 | REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT | 2011-07-01 00:00:00 | 1295.74 | Y | Y | N/A | N/A
27140 | OSTEOTOMY&TRANSFER GREATER TROCHANTER SPX | 2011-07-01 00:00:00 | 748.9 | N | Y | N/A | N/A
27146 | OSTEOTOMY ILIAC ACETABULAR/INNOMINATE BONE | 2011-07-01 00:00:00 | 1069.88 | N | Y | N/A | N/A
27147 | OSTEOTOMY ILIAC ACETABULAR/INNOMINATE HIP RDCTJ | 2011-07-01 00:00:00 | 1233.78 | N | Y | N/A | N/A
27151 | OSTEOTOMY ILIAC ACETABULAR/INNOMINATE FEM OSTEOT | 2011-07-01 00:00:00 | 1309.01 | N | Y | N/A | N/A
27156 | OSTEOT ILIAC ACTBLR/INNOMINATE B1 OSTEOT RDCTJ | 2011-07-01 00:00:00 | 1439.64 | N | Y | N/A | N/A
27158 | OSTEOTOMY PELVIS BILATERAL | 2011-07-01 00:00:00 | 1168.4 | N | Y | N/A | N/A
27161 | OSTEOTOMY FEMORAL NECK SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 1019.93 | N | Y | N/A | N/A
27165 | OSTEOT INTERTRCHNTRIC/SUBTRCHNTRIC W/INT/XTRNL | 2011-07-01 00:00:00 | 1151.32 | N | Y | N/A | N/A
27170 | B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA | 2011-07-01 00:00:00 | 989.33 | N | Y | N/A | N/A
27175 | TX SLP FEMORAL EPIPHYSIS TRCJ W/O REDUCTION | 2011-07-01 00:00:00 | 555.35 | N | Y | N/A | N/A
27176 | TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU | 2011-07-01 00:00:00 | 764.25 | N | Y | N/A | N/A
27177 | OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT | 2011-07-01 00:00:00 | 931.55 | N | Y | N/A | N/A
27178 | OPTX SLP FEM EPIPHYSIS CLSD [NAME]/MLTPL PIN | 2011-07-01 00:00:00 | 761.66 | N | Y | N/A | N/A
27179 | OPTX SLP FEM EPIPHYSIS OSTPL FEM NCK HEYMAN PX | 2011-07-01 00:00:00 | 814.97 | N | Y | N/A | N/A
27181 | OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ | 2011-07-01 00:00:00 | 935.41 | N | Y | N/A | N/A
27185 | EPIPHYSL ARRST EPIPHYSIOD/STAPLING TRCHNTR FEMUR | 2011-07-01 00:00:00 | 514.73 | N | Y | N/A | N/A
27187 | PROPH TX N/P/PLTWR +-MMA FEM NCK&PROX FEMUR | 2011-07-01 00:00:00 | 830.43 | N | Y | N/A | N/A
27193 | CLTX PEL RING FX DISLC DIAST/SUBLXTJ W/O MANJ | 2011-07-01 00:00:00 | 388.31 | N | Y | N/A | N/A
27194 | CLTX PEL RING FX DISLC DIAST/SUBLXTJ W/MANJ ANES | 2011-07-01 00:00:00 | 581.43 | N | Y | N/A | N/A
27200 | CLOSED TREATMENT COCCYGEAL FRACTURE | 2011-07-01 00:00:00 | 144.71 | N | Y | N/A | N/A
27202 | OPEN TREATMENT COCCYGEAL FRACTURE | 2011-07-01 00:00:00 | 501.38 | N | Y | N/A | N/A
27215 | [NAME] TUBRST AVLS/WING FX FIXJ IF PRFRMD | 2008-07-01 00:00:00 | 615.65 | N | Y | N/A | N/A
27216 | PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DISLC | 2008-07-01 00:00:00 | 890.4 | N | Y | N/A | N/A
27217 | OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFRMD | 2008-07-01 00:00:00 | 850.7 | N | Y | N/A | N/A
27218 | OPTX POST PEL BONE FX&/DISLC INT FIXJ IF PFRMD | 2008-07-01 00:00:00 | 1147.76 | N | Y | N/A | N/A
27220 | CLTX ACETABULUM HIP/SOCKT FX W/O MANJ | 2011-07-01 00:00:00 | 437.14 | N | Y | N/A | N/A
27222 | CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ | 2011-07-01 00:00:00 | 816.54 | N | Y | N/A | N/A
27226 | OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ | 2011-07-01 00:00:00 | 878.32 | N | Y | N/A | N/A
27227 | OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT | 2011-07-01 00:00:00 | 1401.85 | N | Y | N/A | N/A
27228 | OPTX ACTBLR FX INVG ANT&PST 2 COLUMNS FX W/INT | 2011-07-01 00:00:00 | 1600.35 | N | Y | N/A | N/A
27230 | CLTX FEM FX PROX END NCK W/O MANJ | 2011-07-01 00:00:00 | 389.65 | N | Y | N/A | N/A
27232 | CLTX FEM FX PROX END NCK W/MANJ W/WO SKEL TRACJ | 2011-07-01 00:00:00 | 641.69 | N | Y | N/A | N/A
27235 | PRQ SKEL FIXJ FEMORAL FX PROX END NECK | 2011-07-01 00:00:00 | 761.81 | N | Y | N/A | N/A
27236 | OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT | 2011-07-01 00:00:00 | 1001.45 | N | Y | N/A | N/A
27238 | CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ | 2011-07-01 00:00:00 | 377.26 | N | Y | N/A | N/A
27240 | CLTX INTR/PERI/SBTRCHNTC FEMORAL FX W/MANJ | 2011-07-01 00:00:00 | 798.36 | N | Y | N/A | N/A
27244 | TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT | 2011-07-01 00:00:00 | 1030.43 | N | Y | N/A | N/A
27245 | TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW | 2011-07-01 00:00:00 | 1041.68 | N | Y | N/A | N/A
27246 | CLTX GREATER TROCHANTERIC FX W/O MANJ | 2011-07-01 00:00:00 | 317.08 | N | Y | N/A | N/A
27248 | OPEN TREATMENT GREATER TROCHANTERIC FRACTURE | 2011-07-01 00:00:00 | 625.37 | N | Y | N/A | N/A
27250 | CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA | 2011-07-01 00:00:00 | 172.65 | N | Y | N/A | N/A
27252 | CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA | 2011-07-01 00:00:00 | 630.77 | N | Y | N/A | N/A
27253 | OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ | 2011-07-01 00:00:00 | 788.96 | N | Y | N/A | N/A
27254 | OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD FX | 2011-07-01 00:00:00 | 1063.1 | N | Y | N/A | N/A
27256 | TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES | 2011-07-01 00:00:00 | 242.61 | N | Y | N/A | N/A
27257 | TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES | 2011-07-01 00:00:00 | 279.41 | N | Y | N/A | N/A
27258 | OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM | 2011-07-01 00:00:00 | 928.77 | N | Y | N/A | N/A
27259 | OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM SHRT | 2011-07-01 00:00:00 | 1302.45 | N | Y | N/A | N/A
27265 | CLTX POST HIP [NAME] | 2011-07-01 00:00:00 | 324.71 | N | Y | N/A | N/A
27266 | CLTX POST HIP [NAME] | 2011-07-01 00:00:00 | 482.49 | N | Y | N/A | N/A
27267 | CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANJ | 2011-07-01 00:00:00 | 352.76 | N | Y | N/A | N/A
27268 | CLOSED TX FEMORAL FRACTURE PROX HEAD W MANJ | 2011-07-01 00:00:00 | 436.85 | N | Y | N/A | N/A
27269 | OPEN TX FEMORAL FRACTURE PROXIMAL END HEAD | 2011-07-01 00:00:00 | 1027.02 | N | Y | N/A | N/A
27275 | MANIPULATION HIP JOINT GENERAL ANESTHESIA | 2011-07-01 00:00:00 | 148.12 | N | Y | N/A | N/A
27280 | ARTHRODESIS SACROILIAC JOINT W/OBTAINING GRAFT | 2011-07-01 00:00:00 | 858.99 | Y | Y | N/A | N/A
27282 | ARTHRODESIS SYMPHYSIS PUBIS W/OBTAINING GRAFT | 2011-07-01 00:00:00 | 694.01 | N | Y | N/A | N/A
27284 | ARTHRODESIS HIP JOINT W/OBTAINING GRAFT | 2011-07-01 00:00:00 | 1331.56 | N | Y | N/A | N/A
27286 | [NAME] HIP JT W/OBTG GRF W/SUBTRCHNTRIC OSTEOT | 2011-07-01 00:00:00 | 1394.1 | N | Y | N/A | N/A
27290 | INTERPELVIABDOMINAL AMPUTATION | 2011-07-01 00:00:00 | 1345.07 | N | Y | N/A | N/A
27295 | DISARTICULATION HIP | 2011-07-01 00:00:00 | 1064.64 | N | Y | N/A | N/A
27299 | UNLISTED PROCEDURE, PELVIS OR HIP JOINT | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
27301 | I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION | 2011-07-01 00:00:00 | 549.34 | N | Y | N/A | N/A
27303 | INC DEEP W/OPNG BONE CORTEX FEMUR/KNEE | 2011-07-01 00:00:00 | 531.35 | N | Y | N/A | N/A
27305 | FASCIOTOMY ILIOTIBIAL OPEN | 2011-07-01 00:00:00 | 392.85 | N | Y | N/A | N/A
27306 | TENOTOMY PRQ ADDUCTOR/HAMSTRING 1 TENDON SPX | 2011-07-01 00:00:00 | 311.16 | N | Y | N/A | N/A
27307 | TENOTOMY PRQ ADDUCTOR/HAMSTRING MULTIPLE TENDON | 2011-07-01 00:00:00 | 392 | N | Y | N/A | N/A
27310 | ARTHRT KNE W/EXPL DRG/RMVL FB | 2011-07-01 00:00:00 | 607.37 | N | Y | N/A | N/A
27323 | BIOPSY SOFT TISSUE THIGH/KNEE AREA SUPERFICIAL | 2011-07-01 00:00:00 | 224.33 | N | Y | N/A | N/A
27324 | BIOPSY SOFT TISSUE THIGH/KNEE AREA DEEP | 2011-07-01 00:00:00 | 322.43 | N | Y | N/A | N/A
27325 | NEURECTOMY HAMSTRING MUSCLE | 2011-07-01 00:00:00 | 451.18 | N | Y | N/A | N/A
27326 | NEURECTOMY POPLITEAL | 2011-07-01 00:00:00 | 415.28 | N | Y | N/A | N/A
27327 | EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ LT3CM | 2011-07-01 00:00:00 | 363.47 | N | Y | N/A | N/A
27328 | EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC LT5CM | 2011-07-01 00:00:00 | 489.14 | N | Y | N/A | N/A
27329 | RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE LT5CM | 2011-07-01 00:00:00 | 869.66 | N | Y | N/A | N/A
27330 | ARTHROTOMY KNEE W/SYNOVIAL BIOPSY ONLY | 2011-07-01 00:00:00 | 336.66 | N | Y | N/A | N/A
27331 | ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB | 2011-07-01 00:00:00 | 393.02 | N | Y | N/A | N/A
27332 | ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL/LAT | 2011-07-01 00:00:00 | 531.5 | N | Y | N/A | N/A
27333 | ARTHRT W/EXC SEMILUNAR [NAME] | 2011-07-01 00:00:00 | 484.05 | N | Y | N/A | N/A
27334 | ARTHROTOMY W/SYNOVECTOMY KNEE ANTERIOR/POSTERIOR | 2011-07-01 00:00:00 | 567.01 | N | Y | N/A | N/A
27335 | ARTHRT W/SYNVCT KNE ANT&PST W/POP AREA | 2011-07-01 00:00:00 | 636.5 | N | Y | N/A | N/A
27337 | EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/GT | 2011-07-01 00:00:00 | 357.02 | N | Y | N/A | N/A
27339 | EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5 CM/GT | 2011-07-01 00:00:00 | 641.99 | N | Y | N/A | N/A
27340 | EXCISION PREPATELLAR BURSA | 2011-07-01 00:00:00 | 304.52 | N | Y | N/A | N/A
27345 | EXCISION SYNOVIAL CYST POPLITEAL SPACE | 2011-07-01 00:00:00 | 398.11 | N | Y | N/A | N/A
27347 | EXCISION LESION [NAME]/CAPSULE KNEE | 2011-07-01 00:00:00 | 434.2 | N | Y | N/A | N/A
27350 | PATELLECTOMY/HEMIPATELLECTOMY | 2011-07-01 00:00:00 | 541.21 | N | Y | N/A | N/A
27355 | EXCISION/CURETTAGE CYST/TUMOR FEMUR | 2011-07-01 00:00:00 | 500.64 | N | Y | N/A | N/A
27356 | EXCISION/CURETTAGE CYST/TUMOR FEMUR W/ALLOGRAFT | 2011-07-01 00:00:00 | 612.9 | N | Y | N/A | N/A
27357 | EXCISION/CURETTAGE CYST/TUMOR FEMUR W/AUTOGRAFT | 2011-07-01 00:00:00 | 677.61 | N | Y | N/A | N/A
27358 | EXCISION/CURETTAGE CYST/TUMOR FEMUR INT FIXATION | 2011-07-01 00:00:00 | 238.99 | N | Y | N/A | N/A
27360 | PRTL EXC B1 FEMUR PROX TIBIA&/FIBULA | 2011-07-01 00:00:00 | 708.31 | N | Y | N/A | N/A
27364 | RAD RESECTION TUMOR SOFT TIS THIGH/KNEE 5 CM/GT | 2011-07-01 00:00:00 | 1332.65 | N | Y | N/A | N/A
27365 | RADICAL RESECTION TUMOR FEMOR OR KNEE | 2011-07-01 00:00:00 | 1635.99 | N | Y | N/A | N/A
27370 | [NAME] ARTHROGRAPHY | 2011-07-01 00:00:00 | 142.18 | N | Y | N/A | N/A
27372 | REMOVAL FOREIGN BODY DEEP THIGH/KNEE | 2011-07-01 00:00:00 | 496.25 | N | Y | N/A | N/A
27380 | SUTURE INFRAPATELLAR TENDON PRIMARY | 2011-07-01 00:00:00 | 491.42 | N | Y | N/A | N/A
27381 | SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF | 2011-07-01 00:00:00 | 665.14 | N | Y | N/A | N/A
27385 | SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY | 2011-07-01 00:00:00 | 525.23 | N | Y | N/A | N/A
27386 | SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ | 2011-07-01 00:00:00 | 691.8 | N | Y | N/A | N/A
27390 | TENOTOMY OPEN HAMSTRING KNEE HIP SINGLE TENDON | 2011-07-01 00:00:00 | 368.1 | N | Y | N/A | N/A
27391 | TENOTOMY OPN HAMSTRING KNEE HIP MULTIPLE 1 LEG | 2011-07-01 00:00:00 | 476.67 | N | Y | N/A | N/A
27392 | TENOTOMY OPEN HAMSTRING KNEE HIP MULTIPLE BI | 2011-07-01 00:00:00 | 588.2 | N | Y | N/A | N/A
27393 | LENGTHENING HAMSTRING TENDON SINGLE | 2011-07-01 00:00:00 | 419.58 | N | Y | N/A | N/A
27394 | LENGTHENING HAMSTRING TENDON MULTIPLE 1 LEG | 2011-07-01 00:00:00 | 540.16 | N | Y | N/A | N/A
27395 | LENGTHENING HAMSTRING TENDON MULTIPLE BILATERAL | 2011-07-01 00:00:00 | 732.76 | N | Y | N/A | N/A
27396 | TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR 1 TENDON | 2011-07-01 00:00:00 | 511.24 | N | Y | N/A | N/A
27397 | TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR MULT TDN | 2011-07-01 00:00:00 | 760.67 | N | Y | N/A | N/A
27400 | TRANSFER TENDON/MUSCLE HAMSTRINGS FEMUR | 2011-07-01 00:00:00 | 575.57 | N | Y | N/A | N/A
27403 | ARTHROTOMY W/MENISCUS REPAIR KNEE | 2011-07-01 00:00:00 | 532.71 | N | Y | N/A | N/A
27405 | RPR PRIMARY TORN LIGM&/CAPSULE KNEE COLLATERAL | 2011-07-01 00:00:00 | 562.9 | N | Y | N/A | N/A
27407 | REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIATE | 2011-07-01 00:00:00 | 650.93 | N | Y | N/A | N/A
27409 | RPR 1 TORN LIGM&/CAPSL KNE COLTRL&CRUCIATE LIGMS | 2011-07-01 00:00:00 | 806.03 | N | Y | N/A | N/A
27415 | OSTEOCHONDRAL ALLOGRAFT KNEE OPEN | 2011-07-01 00:00:00 | 1147.17 | N | Y | N/A | N/A
27416 | OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY | 2011-07-01 00:00:00 | 813.41 | N | Y | N/A | N/A
27418 | ANTERIOR TIBIAL TUBERCLEPLASTY | 2011-07-01 00:00:00 | 694.42 | N | Y | N/A | N/A
27420 | RCNSTJ DISLOCATING PATELLA | 2011-07-01 00:00:00 | 621.79 | N | Y | N/A | N/A
27422 | [NAME] RLS | 2011-07-01 00:00:00 | 619.23 | N | Y | N/A | N/A
27424 | [NAME] | 2011-07-01 00:00:00 | 620.03 | N | Y | N/A | N/A
27425 | LATERAL RETINACULAR RELEASE OPEN | 2011-07-01 00:00:00 | 368.49 | N | Y | N/A | N/A
27427 | LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR | 2011-07-01 00:00:00 | 597.38 | N | Y | N/A | N/A
27428 | LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR | 2011-07-01 00:00:00 | 927.53 | N | Y | N/A | N/A
27429 | [NAME] INTRA-ARTICULAR XTR | 2011-07-01 00:00:00 | 1037.66 | N | Y | N/A | N/A
27430 | QUADRICEPSPLASTY | 2011-07-01 00:00:00 | 616.26 | N | Y | N/A | N/A
27435 | CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE | 2011-07-01 00:00:00 | 669.04 | N | Y | N/A | N/A
27437 | ARTHROPLASTY PATELLA W/O PROSTHESIS | 2011-07-01 00:00:00 | 549.71 | N | Y | N/A | N/A
27438 | ARTHROPLASTY PATELLA W/PROSTHESIS | 2011-07-01 00:00:00 | 701.34 | N | Y | N/A | N/A
27440 | ARTHROPLASTY KNEE TIBIAL PLATEAU | 2011-07-01 00:00:00 | 653.21 | N | Y | N/A | N/A
27441 | [NAME] DBRDMT&PRTL SYNVCT | 2011-07-01 00:00:00 | 674.42 | N | Y | N/A | N/A
27442 | ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE | 2011-07-01 00:00:00 | 725.38 | N | Y | N/A | N/A
27443 | [NAME] PLATU KNE DBRDMT&PRTL | 2011-07-01 00:00:00 | 680.94 | N | Y | N/A | N/A
27445 | ARTHROPLASTY KNEE HINGE PROSTHESIS | 2011-07-01 00:00:00 | 1053.14 | Y | Y | N/A | N/A
27446 | [NAME] CMPRT | 2011-07-01 00:00:00 | 930.22 | Y | Y | N/A | N/A
27447 | [NAME] | 2011-07-01 00:00:00 | 1295.23 | Y | Y | N/A | N/A
27448 | OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/O FIXATION | 2011-07-01 00:00:00 | 683.7 | N | Y | N/A | N/A
27450 | OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/FIXATION | 2011-07-01 00:00:00 | 849.85 | N | Y | N/A | N/A
27454 | OSTEOT MLT W/RELIGNMT IMED ROD FEM SHFT | 2011-07-01 00:00:00 | 1083.11 | N | Y | N/A | N/A
27455 | OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL | 2011-07-01 00:00:00 | 787.3 | N | Y | N/A | N/A
27457 | OSTEOT PROX TIBIA FIB EXC/OSTEOT AFTER EPIPHYSL | 2011-07-01 00:00:00 | 808.04 | N | Y | N/A | N/A
27465 | OSTEOPLASTY FEMUR SHORTENING EXCLUDING 64876 | 2011-07-01 00:00:00 | 1042.49 | N | Y | N/A | N/A
27466 | OSTEOPLASTY FEMUR LENGTHENING | 2011-07-01 00:00:00 | 988.17 | N | Y | N/A | N/A
27468 | OSTPL FEMUR CMBN LNGTH&SHRT W/FEM SGM TR | 2011-07-01 00:00:00 | 1123.18 | N | Y | N/A | N/A
27470 | RPR NON/MAL FEMUR DSTL H/N W/O GRF | 2011-07-01 00:00:00 | 988.56 | N | Y | N/A | N/A
27472 | RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG BONE | 2011-07-01 00:00:00 | 1063.63 | N | Y | N/A | N/A
27475 | ARREST EPIPHYSEAL DISTAL FEMUR | 2011-07-01 00:00:00 | 511.07 | N | Y | N/A | N/A
27477 | ARREST EPIPHYSEAL TIBIA&FIBULA PROXIMAL | 2011-07-01 00:00:00 | 610.45 | N | Y | N/A | N/A
27479 | ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB | 2011-07-01 00:00:00 | 741.36 | N | Y | N/A | N/A
27485 | ARRST HEMIEPIPHYSL DSTL FEMUR/PROX TIBIA/FIBULA | 2011-07-01 00:00:00 | 558.54 | N | Y | N/A | N/A
27486 | REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT | 2011-07-01 00:00:00 | 1184.4 | Y | Y | N/A | N/A
27487 | REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONENT | 2011-07-01 00:00:00 | 1486.42 | Y | Y | N/A | N/A
27488 | RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER | 2011-07-01 00:00:00 | 1007.2 | N | Y | N/A | N/A
27495 | PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR | 2011-07-01 00:00:00 | 947.29 | N | Y | N/A | N/A
27496 | DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT | 2011-07-01 00:00:00 | 435.9 | N | Y | N/A | N/A
27497 | DCMPRN FASCT THIGH&/KNEE DBRDMT MUSCLE&/NERVE | 2011-07-01 00:00:00 | 469.59 | N | Y | N/A | N/A
27498 | DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS | 2011-07-01 00:00:00 | 520.44 | N | Y | N/A | N/A
27499 | DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&/NRV | 2011-07-01 00:00:00 | 565.7 | N | Y | N/A | N/A
27500 | CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION | 2011-07-01 00:00:00 | 425.35 | N | Y | N/A | N/A
27501 | CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ | 2011-07-01 00:00:00 | 416.68 | N | Y | N/A | N/A
27502 | CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ | 2011-07-01 00:00:00 | 652.99 | N | Y | N/A | N/A
27503 | CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ | 2011-07-01 00:00:00 | 670.02 | N | Y | N/A | N/A
27506 | OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW | 2011-07-01 00:00:00 | 1121.57 | N | Y | N/A | N/A
27507 | OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE | 2011-07-01 00:00:00 | 819.8 | N | Y | N/A | N/A
27508 | CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ | 2011-07-01 00:00:00 | 430.31 | N | Y | N/A | N/A
27509 | PRQ SKELETAL FIXJ FEMORAL FX DISTAL END | 2011-07-01 00:00:00 | 535.96 | N | Y | N/A | N/A
27510 | CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ | 2011-07-01 00:00:00 | 577.94 | N | Y | N/A | N/A
27511 | OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/O XTN | 2011-07-01 00:00:00 | 847.8 | N | Y | N/A | N/A
27513 | OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W XTN | 2011-07-01 00:00:00 | 1059.38 | N | Y | N/A | N/A
27514 | OPEN TX FEMORAL FRACTURE DISTAL MED/LAT CONDYLE | 2011-07-01 00:00:00 | 832.01 | N | Y | N/A | N/A
27516 | CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ | 2011-07-01 00:00:00 | 411.35 | N | Y | N/A | N/A
27517 | CLTX DSTL FEM EPIPHYSL SEP W/MANJ W/WO SKIN/SKEL | 2011-07-01 00:00:00 | 568.44 | N | Y | N/A | N/A
27519 | OPEN TX DISTAL FEMORAL EPIPHYSEAL SEPARATION | 2011-07-01 00:00:00 | 761.38 | N | Y | N/A | N/A
27520 | CLOSED [NAME] | 2011-07-01 00:00:00 | 259.86 | N | Y | N/A | N/A
27524 | OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR | 2011-07-01 00:00:00 | 627.99 | N | Y | N/A | N/A
27530 | CLTX TIBIAL FX PROXIMAL W/O MANIPULATION | 2011-07-01 00:00:00 | 323.26 | N | Y | N/A | N/A
27532 | CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ | 2011-07-01 00:00:00 | 507.92 | N | Y | N/A | N/A
27535 | OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR | 2011-07-01 00:00:00 | 760.86 | N | Y | N/A | N/A
27536 | OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ | 2011-07-01 00:00:00 | 998.34 | N | Y | N/A | N/A
27538 | CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MANJ | 2011-07-01 00:00:00 | 385.19 | N | Y | N/A | N/A
27540 | OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE | 2011-07-01 00:00:00 | 683.11 | N | Y | N/A | N/A
27550 | CLOSED [NAME] | 2011-07-01 00:00:00 | 406.84 | N | Y | N/A | N/A
27552 | CLOSED [NAME] | 2011-07-01 00:00:00 | 518.5 | N | Y | N/A | N/A
27556 | OPEN [NAME]/O LIGAMENTOUS REPAIR | 2011-07-01 00:00:00 | 748.71 | N | Y | N/A | N/A
27557 | OPEN [NAME] LIGAMENTOUS REPAIR | 2011-07-01 00:00:00 | 896.09 | N | Y | N/A | N/A
27558 | OPEN [NAME] | 2011-07-01 00:00:00 | 1016.68 | N | Y | N/A | N/A
27560 | CLOSED [NAME] | 2011-07-01 00:00:00 | 306.87 | N | Y | N/A | N/A
27562 | CLOSED [NAME] | 2011-07-01 00:00:00 | 391.8 | N | Y | N/A | N/A
27566 | [NAME] PATELLECTOMY | 2011-07-01 00:00:00 | 745.25 | N | Y | N/A | N/A
27570 | MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA | 2011-07-01 00:00:00 | 123.54 | N | Y | N/A | N/A
27580 | [NAME] TECHNIQUE | 2011-07-01 00:00:00 | 1209.16 | N | Y | N/A | N/A
27590 | AMPUTATION THIGH THROUGH FEMUR ANY LEVEL | 2011-07-01 00:00:00 | 696.49 | N | Y | N/A | N/A
27591 | [NAME] FEMUR LVL IMMT FITG TQ W/1ST CST | 2011-07-01 00:00:00 | 762.93 | N | Y | N/A | N/A
27592 | AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR | 2011-07-01 00:00:00 | 592.37 | N | Y | N/A | N/A
27594 | AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION | 2011-07-01 00:00:00 | 429.68 | N | Y | N/A | N/A
27596 | AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION | 2011-07-01 00:00:00 | 619.06 | N | Y | N/A | N/A
27598 | [NAME] | 2011-07-01 00:00:00 | 628.37 | N | Y | N/A | N/A
27599 | UNLISTED PROCEDURE, FEMUR OR KNEE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
27600 | DCMPRN FASCT LEG ANT&/LAT CMPRTS ONLY | 2011-07-01 00:00:00 | 352.8 | N | Y | N/A | N/A
27601 | DCMPRN FASCT LEG PST CMPRT ONLY | 2011-07-01 00:00:00 | 373.31 | N | Y | N/A | N/A
27602 | DCMPRN FASCT LEG ANT&/LAT&PST CMPRT | 2011-07-01 00:00:00 | 431.91 | N | Y | N/A | N/A
27603 | INCISION&DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA | 2011-07-01 00:00:00 | 442.02 | N | Y | N/A | N/A
27604 | INCISION&DRAINAGE LEG/ANKLE INFECTED BURSA | 2011-07-01 00:00:00 | 387.86 | N | Y | N/A | N/A
27605 | TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES | 2011-07-01 00:00:00 | 290.75 | N | Y | N/A | N/A
27606 | TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES | 2011-07-01 00:00:00 | 243.65 | N | Y | N/A | N/A
27607 | INCISION LEG/ANKLE | 2011-07-01 00:00:00 | 513.84 | N | Y | N/A | N/A
27610 | ARTHROTOMY ANKLE W/EXPL DRAINAGE/REMOVAL FB | 2011-07-01 00:00:00 | 547.61 | N | Y | N/A | N/A
27612 | ARTHRT PST CAPSUL RLS ANKLE W/WO ACHLL TDN LNGTH | 2011-07-01 00:00:00 | 473.37 | N | Y | N/A | N/A
27613 | BIOPSY SOFT TISSUE LEG/ANKLE AREA SUPERFICIAL | 2011-07-01 00:00:00 | 210.28 | N | Y | N/A | N/A
27614 | BIOPSY SOFT TISSUE LEG/ANKLE AREA DEEP | 2011-07-01 00:00:00 | 472.77 | N | Y | N/A | N/A
27615 | RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE LT5CM | 2011-07-01 00:00:00 | 852.24 | N | Y | N/A | N/A
27616 | RAD RESCJ TUM SOFT TISSUE LEG/ANKLE 5 CM/GT | 2011-07-01 00:00:00 | 1089.66 | N | Y | N/A | N/A
27618 | EXC TUMOR SOFT TISSUE LEG/ANKLE [NAME] | 2011-07-01 00:00:00 | 365.7 | N | Y | N/A | N/A
27619 | EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL LT5CM | 2011-07-01 00:00:00 | 419.78 | N | Y | N/A | N/A
27620 | ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB | 2011-07-01 00:00:00 | 384.63 | N | Y | N/A | N/A
27625 | ARTHROTOMY W/SYNOVECTOMY ANKLE | 2011-07-01 00:00:00 | 488.01 | N | Y | N/A | N/A
27626 | ARTHROTOMY W/SYNOVECTOMY ANKLE TENOSYNOVECTOMY | 2011-07-01 00:00:00 | 530.35 | N | Y | N/A | N/A
27630 | EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANKLE | 2011-07-01 00:00:00 | 454.21 | N | Y | N/A | N/A
27632 | EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/GT | 2011-07-01 00:00:00 | 354.18 | N | Y | N/A | N/A
27634 | EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5 CM/GT | 2011-07-01 00:00:00 | 575.69 | N | Y | N/A | N/A
27635 | EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA | 2011-07-01 00:00:00 | 496.13 | N | Y | N/A | N/A
27637 | EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/AGRAFT | 2011-07-01 00:00:00 | 633.59 | N | Y | N/A | N/A
27638 | EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/ALGRAFT | 2011-07-01 00:00:00 | 649.51 | N | Y | N/A | N/A
27640 | PARTIAL EXCISION BONE TIBIA | 2011-07-01 00:00:00 | 714.96 | N | Y | N/A | N/A
27641 | PARTIAL EXCISION BONE FIBULA | 2011-07-01 00:00:00 | 570.59 | N | Y | N/A | N/A
27645 | RADICAL RESECTION OF TUMOR TIBIA | 2011-07-01 00:00:00 | 1407.07 | N | Y | N/A | N/A
27646 | RADICAL RESECTION TUMOR BONE FIBULA | 2011-07-01 00:00:00 | 1214.42 | N | Y | N/A | N/A
27647 | RADICAL RESECTION OF TUMOR TALUS OR CALCANEUS | 2011-07-01 00:00:00 | 928.68 | N | Y | N/A | N/A
27648 | INJECTION ANKLE ARTHROGRAPHY | 2011-07-01 00:00:00 | 136.41 | N | Y | N/A | N/A
27650 | REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON | 2011-07-01 00:00:00 | 561.8 | N | Y | N/A | N/A
27652 | RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT | 2011-07-01 00:00:00 | 601.16 | N | Y | N/A | N/A
27654 | REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT | 2011-07-01 00:00:00 | 601.59 | N | Y | N/A | N/A
27656 | REPAIR FASCIAL DEFECT LEG | 2011-07-01 00:00:00 | 485.21 | N | Y | N/A | N/A
27658 | REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH | 2011-07-01 00:00:00 | 318.13 | N | Y | N/A | N/A
27659 | RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH | 2011-07-01 00:00:00 | 414.07 | N | Y | N/A | N/A
27664 | RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH | 2011-07-01 00:00:00 | 306.26 | N | Y | N/A | N/A
27665 | RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH | 2011-07-01 00:00:00 | 346.62 | N | Y | N/A | N/A
27675 | RPR DISLOC PERONEAL TENDON W/O FIBULAR OSTEOTOMY | 2011-07-01 00:00:00 | 417.92 | N | Y | N/A | N/A
27676 | REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT | 2011-07-01 00:00:00 | 521.6 | N | Y | N/A | N/A
27680 | TENOLYSIS FLXR/XTNSR TENDON LEG&/ANKLE 1 EACH | 2011-07-01 00:00:00 | 363.33 | N | Y | N/A | N/A
27681 | TNOLS FLXR/XTNSR TDN LEG&/ANKLE MLT TDN | 2011-07-01 00:00:00 | 444.92 | N | Y | N/A | N/A
27685 | LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX | 2011-07-01 00:00:00 | 537.98 | N | Y | N/A | N/A
27686 | LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA | 2011-07-01 00:00:00 | 468.03 | N | Y | N/A | N/A
27687 | GASTROCNEMIUS RECESSION | 2011-07-01 00:00:00 | 385.77 | N | Y | N/A | N/A
27690 | TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC | 2011-07-01 00:00:00 | 536.49 | N | Y | N/A | N/A
27691 | TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP | 2011-07-01 00:00:00 | 631.16 | N | Y | N/A | N/A
27692 | TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING EA TDN | 2011-07-01 00:00:00 | 92.25 | N | Y | N/A | N/A
27695 | RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL | 2011-07-01 00:00:00 | 408.03 | N | Y | N/A | N/A
27696 | RPR PRIM DISRUPTED LIGM ANKLE [NAME] | 2011-07-01 00:00:00 | 481.04 | N | Y | N/A | N/A
27698 | REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL | 2011-07-01 00:00:00 | 546.06 | N | Y | N/A | N/A
27700 | ARTHROPLASTY ANKLE | 2011-07-01 00:00:00 | 508.72 | N | Y | N/A | N/A
27702 | ARTHROPLASTY ANKLE W/IMPLANT | 2011-07-01 00:00:00 | 826.7 | N | Y | N/A | N/A
27703 | ARTHROPLASTY ANKLE REVISION TOTAL ANKLE | 2011-07-01 00:00:00 | 956.85 | N | Y | N/A | N/A
27704 | REMOVAL ANKLE IMPLANT | 2011-07-01 00:00:00 | 479.64 | N | Y | N/A | N/A
27705 | OSTEOTOMY TIBIA | 2011-07-01 00:00:00 | 640.31 | N | Y | N/A | N/A
27707 | OSTEOTOMY FIBULA | 2011-07-01 00:00:00 | 334.93 | N | Y | N/A | N/A
27709 | OSTEOTOMY TIBIA&FIBULA | 2011-07-01 00:00:00 | 976.28 | N | Y | N/A | N/A
27712 | OSTEOT MLT W/RELIGNMT IMED ROD | 2011-07-01 00:00:00 | 923.72 | N | Y | N/A | N/A
27715 | OSTEOPLASTY TIBIA&FIBULA LENGTHENING/SHORTENING | 2011-07-01 00:00:00 | 889.44 | N | Y | N/A | N/A
27720 | REPAIR NONUNION/MALUNION TIBIA W/O GRAFT | 2011-07-01 00:00:00 | 734.53 | N | Y | N/A | N/A
27722 | REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT | 2011-07-01 00:00:00 | 739.42 | N | Y | N/A | N/A
27724 | RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT | 2011-07-01 00:00:00 | 1071.89 | N | Y | N/A | N/A
27725 | RPR NON/MAL TIBIA SYNOSTOSIS W/FIBULA ANY METH | 2011-07-01 00:00:00 | 1017.01 | N | Y | N/A | N/A
27726 | REPAIR FIBULA NONUNION/MALUNION W INT FIXATION | 2011-07-01 00:00:00 | 800.86 | N | Y | N/A | N/A
27727 | REPAIR CONGENITAL PSEUDARTHROSIS TIBIA | 2011-07-01 00:00:00 | 841.44 | N | Y | N/A | N/A
27730 | ARREST EPIPHYSEAL OPEN DISTAL TIBIA | 2011-07-01 00:00:00 | 485.24 | N | Y | N/A | N/A
27732 | ARREST EPIPHYSEAL OPEN DISTAL FIBULA | 2011-07-01 00:00:00 | 354.54 | N | Y | N/A | N/A
27734 | ARREST EPIPHYSEAL OPEN DISTAL TIBIA&FIBULA | 2011-07-01 00:00:00 | 504.79 | N | Y | N/A | N/A
27740 | ARREST EPIPHYSEAL ANY METHOD TIBIA & FIBULA | 2011-07-01 00:00:00 | 531.08 | N | Y | N/A | N/A
27742 | ARRST EPIPHYSL ANY METH TIBFIB&DSTL FEMUR | 2011-07-01 00:00:00 | 594.14 | N | Y | N/A | N/A
27745 | PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA | 2011-07-01 00:00:00 | 630.11 | N | Y | N/A | N/A
27750 | CLTX TIBIAL SHAFT FX W/O MANIPULATION | 2011-07-01 00:00:00 | 279.19 | N | Y | N/A | N/A
27752 | CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ | 2011-07-01 00:00:00 | 442.42 | N | Y | N/A | N/A
27756 | PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE | 2011-07-01 00:00:00 | 476.25 | N | Y | N/A | N/A
27758 | OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE | 2011-07-01 00:00:00 | 744.37 | N | Y | N/A | N/A
27759 | TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLAGE | 2011-07-01 00:00:00 | 838.43 | N | Y | N/A | N/A
27760 | CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION | 2011-07-01 00:00:00 | 269.96 | N | Y | N/A | N/A
27762 | CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ | 2011-07-01 00:00:00 | 395.43 | N | Y | N/A | N/A
27766 | OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE | 2011-07-01 00:00:00 | 508.46 | N | Y | N/A | N/A
27767 | CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ | 2011-07-01 00:00:00 | 223.56 | N | Y | N/A | N/A
27768 | CLOSED TREATMENT PST MALLEOLUS FRACTURE W MANJ | 2011-07-01 00:00:00 | 350.91 | N | Y | N/A | N/A
27769 | OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE | 2011-07-01 00:00:00 | 598.64 | N | Y | N/A | N/A
27780 | CLTX PROX FIBULA/SHFT FX W/O MANJ | 2011-07-01 00:00:00 | 244.31 | N | Y | N/A | N/A
27781 | CLTX PROX FIBULA/SHFT FX W/MANJ | 2011-07-01 00:00:00 | 346.18 | N | Y | N/A | N/A
27784 | OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE | 2011-07-01 00:00:00 | 592.43 | N | Y | N/A | N/A
27786 | CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ | 2011-07-01 00:00:00 | 255.49 | N | Y | N/A | N/A
27788 | CLTX DSTL FIBULAR FX LAT MALLS W/MANJ | 2011-07-01 00:00:00 | 346.32 | N | Y | N/A | N/A
27792 | OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS | 2011-07-01 00:00:00 | 593.24 | N | Y | N/A | N/A
27808 | CLOSED [NAME] | 2011-07-01 00:00:00 | 268.83 | N | Y | N/A | N/A
27810 | CLOSED [NAME] FRACTURE W MANJ | 2011-07-01 00:00:00 | 386.81 | N | Y | N/A | N/A
27814 | OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE | 2011-07-01 00:00:00 | 647.06 | N | Y | N/A | N/A
27816 | CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION | 2011-07-01 00:00:00 | 255.57 | N | Y | N/A | N/A
27818 | CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION | 2011-07-01 00:00:00 | 396.8 | N | Y | N/A | N/A
27822 | OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP | 2011-07-01 00:00:00 | 708.15 | N | Y | N/A | N/A
27823 | OPEN TX TRIMALLEOLAR ANKLE FX W FIXJ PST LIP | 2011-07-01 00:00:00 | 805.16 | N | Y | N/A | N/A
27824 | CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ | 2011-07-01 00:00:00 | 254.04 | N | Y | N/A | N/A
27825 | CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ | 2011-07-01 00:00:00 | 451.59 | N | Y | N/A | N/A
27826 | OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA | 2011-07-01 00:00:00 | 696.36 | N | Y | N/A | N/A
27827 | OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY | 2011-07-01 00:00:00 | 909.86 | N | Y | N/A | N/A
27828 | OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA | 2011-07-01 00:00:00 | 1089.46 | N | Y | N/A | N/A
27829 | OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION | 2011-07-01 00:00:00 | 565.09 | N | Y | N/A | N/A
27830 | CLTX PROX TIBFIB JT DISLC W/O ANES | 2011-07-01 00:00:00 | 302.5 | N | Y | N/A | N/A
27831 | CLTX PROX TIBFIB JT DISLC REQ ANES | 2011-07-01 00:00:00 | 322.61 | N | Y | N/A | N/A
27832 | OPEN TX PROX TIBFIB JOINT DISLOCATE EXC PROX FIB | 2011-07-01 00:00:00 | 615.99 | N | Y | N/A | N/A
27840 | CLOSED [NAME] DISLOCATION W/O ANESTHESIA | 2011-07-01 00:00:00 | 295.33 | N | Y | N/A | N/A
27842 | CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ | 2011-07-01 00:00:00 | 408.44 | N | Y | N/A | N/A
27846 | [NAME] DISLOCATION W/O REPAIR/INTERNAL FIXJ | 2011-07-01 00:00:00 | 615.47 | N | Y | N/A | N/A
27848 | [NAME] DISLOCATION W/REPAIR/INT/XTRNL FIXJ | 2011-07-01 00:00:00 | 691.79 | N | Y | N/A | N/A
27860 | MANIPULATION ANKLE UNDER GENERAL ANESTHESIA | 2011-07-01 00:00:00 | 146.81 | N | Y | N/A | N/A
27870 | ARTHRODESIS ANKLE OPEN | 2011-07-01 00:00:00 | 877.76 | N | Y | N/A | N/A
27871 | [NAME] PROXIMAL/DISTAL | 2011-07-01 00:00:00 | 579.85 | N | Y | N/A | N/A
27880 | [NAME] | 2011-07-01 00:00:00 | 788.45 | N | Y | N/A | N/A
27881 | AMP LEG THRU TIBFIB W/IMMT FITG TQ W/1ST CST | 2011-07-01 00:00:00 | 748.36 | N | Y | N/A | N/A
27882 | AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR | 2011-07-01 00:00:00 | 528.16 | N | Y | N/A | N/A
27884 | AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REVJ | 2011-07-01 00:00:00 | 495.62 | N | Y | N/A | N/A
27886 | AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION | 2011-07-01 00:00:00 | 564.71 | N | Y | N/A | N/A
27888 | [NAME]/PLSTC CLSR&RESCJ NRV | 2011-07-01 00:00:00 | 584.72 | N | Y | N/A | N/A
27889 | ANKLE DISARTICULATION | 2011-07-01 00:00:00 | 576.67 | N | Y | N/A | N/A
27892 | DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NRV | 2011-07-01 00:00:00 | 462.77 | N | Y | N/A | N/A
27893 | DCMPRN FASCT LEG PST W/DBRDMT MUSC&/NRV | 2011-07-01 00:00:00 | 489.36 | N | Y | N/A | N/A
27894 | DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUSC&/NRV | 2011-07-01 00:00:00 | 721.63 | N | Y | N/A | N/A
27899 | UNLISTED PROCEDURE, LEG/ANKLE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
28001 | INCISION&DRAINAGE BURSA FOOT | 2011-07-01 00:00:00 | 225.42 | N | Y | N/A | N/A
28002 | I&D BELOW FASCIA FOOT 1 BURSAL SPACE | 2011-07-01 00:00:00 | 425.18 | N | Y | N/A | N/A
28003 | I&D BELOW FASCIA FOOT MULTIPLE AREAS | 2011-07-01 00:00:00 | 566.35 | N | Y | N/A | N/A
28005 | INCISION BONE CORTEX FOOT | 2011-07-01 00:00:00 | 509.22 | N | Y | N/A | N/A
28008 | FASCIOTOMY FOOT&/TOE | 2011-07-01 00:00:00 | 356.3 | N | Y | N/A | N/A
28010 | TENOTOMY PERCUTANEOUS TOE SINGLE TENDON | 2011-07-01 00:00:00 | 195.61 | N | Y | N/A | N/A
28011 | TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDON | 2011-07-01 00:00:00 | 276.99 | N | Y | N/A | N/A
28020 | ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT | 2011-07-01 00:00:00 | 433.04 | N | Y | N/A | N/A
28022 | ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT | 2011-07-01 00:00:00 | 393.55 | N | Y | N/A | N/A
28024 | ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT | 2011-07-01 00:00:00 | 372.21 | N | Y | N/A | N/A
28035 | RELEASE TARSAL TUNNEL | 2011-07-01 00:00:00 | 429.67 | N | Y | N/A | N/A
28039 | EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/GT | 2011-07-01 00:00:00 | 415.67 | N | Y | N/A | N/A
28041 | EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/GT | 2011-07-01 00:00:00 | 382.76 | N | Y | N/A | N/A
28043 | EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ LT1.5CM | 2011-07-01 00:00:00 | 315.05 | N | Y | N/A | N/A
28045 | EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC LT1.5CM | 2011-07-01 00:00:00 | 419.25 | N | Y | N/A | N/A
28046 | RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE LT3CM | 2011-07-01 00:00:00 | 635.69 | N | Y | N/A | N/A
28047 | RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE 3 CM/GT | 2011-07-01 00:00:00 | 802.54 | N | Y | N/A | N/A
28050 | ARTHRT W/BX INTERTARSAL/TARSOMETATARSAL JOINT | 2011-07-01 00:00:00 | 362.81 | N | Y | N/A | N/A
28052 | ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT | 2011-07-01 00:00:00 | 351.01 | N | Y | N/A | N/A
28054 | ARTHRTOMY W/BX INTERPHALANGEAL JOINT | 2011-07-01 00:00:00 | 317.18 | N | Y | N/A | N/A
28055 | NEURECTOMY INTRINSIC MUSCULATURE OF FOOT | 2011-07-01 00:00:00 | 327.34 | N | Y | N/A | N/A
28060 | FASCIECTOMY PLANTAR FASCIA PARTIAL SPX | 2011-07-01 00:00:00 | 422.85 | N | Y | N/A | N/A
28062 | FASCIOTOMY PLANTAR FASCIA RADICAL SPX | 2011-07-01 00:00:00 | 488.43 | N | Y | N/A | N/A
28070 | SYNVCT INTERTARSAL/TARSOMETATARSAL JT EA SPX | 2011-07-01 00:00:00 | 429.26 | N | Y | N/A | N/A
28072 | SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH | 2011-07-01 00:00:00 | 419.66 | N | Y | N/A | N/A
28080 | EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH | 2011-07-01 00:00:00 | 420.28 | N | Y | N/A | N/A
28086 | SYNOVECTOMY TENDON SHEATH FOOT FLEXOR | 2011-07-01 00:00:00 | 444.77 | N | Y | N/A | N/A
28088 | SYNOVECTOMY TENDON SHEATH FOOT EXTENSOR | 2011-07-01 00:00:00 | 390.67 | N | Y | N/A | N/A
28090 | EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT | 2011-07-01 00:00:00 | 383.12 | N | Y | N/A | N/A
28092 | EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA | 2011-07-01 00:00:00 | 348.19 | N | Y | N/A | N/A
28100 | EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS | 2011-07-01 00:00:00 | 489.15 | N | Y | N/A | N/A
28102 | EXC/CURTG CST/B9 TUM TALUS/CLCNS W/ILIAC/AGRFT | 2011-07-01 00:00:00 | 477.2 | N | Y | N/A | N/A
28103 | EXC/CURETTAGE CYST/TUMOR TALUS/CALCANEUS ALGRFT | 2011-07-01 00:00:00 | 354 | N | Y | N/A | N/A
28104 | EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL | 2011-07-01 00:00:00 | 420 | N | Y | N/A | N/A
28106 | EXC/CURTG CST/B9 TUM TARSAL/METAR W/ILIAC/AGRFT | 2011-07-01 00:00:00 | 380.17 | N | Y | N/A | N/A
28107 | EXC/CURTG CST/B9 TUM TARSAL/METAR W/ALGRFT | 2011-07-01 00:00:00 | 444.11 | N | Y | N/A | N/A
28108 | EXC/CURTG CST/B9 TUM PHALANGES FOOT | 2011-07-01 00:00:00 | 356.71 | N | Y | N/A | N/A
28110 | OSTECTOMY PRTL 5TH METAR HEAD SPX | 2011-07-01 00:00:00 | 375.84 | N | Y | N/A | N/A
28111 | OSTECTOMY COMPLETE 1ST [NAME] HEAD | 2011-07-01 00:00:00 | 421.16 | N | Y | N/A | N/A
28112 | OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4 | 2011-07-01 00:00:00 | 403.57 | N | Y | N/A | N/A
28113 | OSTECTOMY COMPLETE 5TH METATARSAL HEAD | 2011-07-01 00:00:00 | 488.52 | N | Y | N/A | N/A
28114 | OSTC COMPL ALL METAR HEADS W/PRTL PROX PHALANGC | 2011-07-01 00:00:00 | 881.69 | N | Y | N/A | N/A
28116 | OSTECTOMY TARSAL COALITION | 2011-07-01 00:00:00 | 622.24 | N | Y | N/A | N/A
28118 | OSTECTOMY CALCANEUS | 2011-07-01 00:00:00 | 483.44 | N | Y | N/A | N/A
28119 | OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS | 2011-07-01 00:00:00 | 429.58 | N | Y | N/A | N/A
28120 | PARTIAL EXCISION BONE TALUS/CALCANEUS | 2011-07-01 00:00:00 | 583.97 | N | Y | N/A | N/A
28122 | PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS | 2011-07-01 00:00:00 | 544.82 | N | Y | N/A | N/A
28124 | PARTICAL EXCISION BONE PHALANX TOE | 2011-07-01 00:00:00 | 392.65 | N | Y | N/A | N/A
28126 | RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH | 2011-07-01 00:00:00 | 321.7 | N | Y | N/A | N/A
28130 | TALECTOMY ASTRAGALECTOMY | 2011-07-01 00:00:00 | 579.96 | N | Y | N/A | N/A
28140 | METATARSECTOMY | 2011-07-01 00:00:00 | 509.74 | N | Y | N/A | N/A
28150 | PHALANGECTOMY TOE EACH TOE | 2011-07-01 00:00:00 | 356.72 | N | Y | N/A | N/A
28153 | [NAME] PHALANX EACH TOE | 2011-07-01 00:00:00 | 336.64 | N | Y | N/A | N/A
28160 | HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXC TOE | 2011-07-01 00:00:00 | 344.16 | N | Y | N/A | N/A
28171 | RAD RESCJ TUMOR TARSAL EXCEPT TALUS/CALCANEUS | 2011-07-01 00:00:00 | 726.96 | N | Y | N/A | N/A
28173 | RADICAL RESECTION TUMOR METATARSAL | 2011-07-01 00:00:00 | 652.21 | N | Y | N/A | N/A
28175 | RADICAL RESECTION TUMOR PHALANX OR TOE | 2011-07-01 00:00:00 | 411.67 | N | Y | N/A | N/A
28190 | REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS | 2011-07-01 00:00:00 | 206.84 | N | Y | N/A | N/A
28192 | REMOVAL FOREIGN BODY FOOT DEEP | 2011-07-01 00:00:00 | 388.88 | N | Y | N/A | N/A
28193 | REMOVAL FOREIGN BODY FOOT COMPLICATED | 2011-07-01 00:00:00 | 441.95 | N | Y | N/A | N/A
28200 | RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON | 2011-07-01 00:00:00 | 390.42 | N | Y | N/A | N/A
28202 | RPR TENDON FLXR FOOT SEC W/FREE GRAFT EA TENDON | 2011-07-01 00:00:00 | 496.71 | N | Y | N/A | N/A
28208 | REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON | 2011-07-01 00:00:00 | 380.63 | N | Y | N/A | N/A
28210 | RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON | 2011-07-01 00:00:00 | 474.71 | N | Y | N/A | N/A
28220 | TENOLYSIS FLEXOR FOOT SINGLE TENDON | 2011-07-01 00:00:00 | 369.13 | N | Y | N/A | N/A
28222 | TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS | 2011-07-01 00:00:00 | 423.06 | N | Y | N/A | N/A
28225 | TENOLYSIS EXTENSOR FOOT SINGLE TENDON | 2011-07-01 00:00:00 | 325.29 | N | Y | N/A | N/A
28226 | TENOLYSIS EXTENSOR FOOT MULTIPLE TENDON | 2011-07-01 00:00:00 | 388.55 | N | Y | N/A | N/A
28230 | TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX | 2011-07-01 00:00:00 | 354.68 | N | Y | N/A | N/A
28232 | TX OPEN TENDON FLEXOR TOE 1 TENDON SPX | 2011-07-01 00:00:00 | 319.46 | N | Y | N/A | N/A
28234 | TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON | 2011-07-01 00:00:00 | 334.96 | N | Y | N/A | N/A
28238 | RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR | 2011-07-01 00:00:00 | 559.49 | N | Y | N/A | N/A
28240 | TENOTOMY LENGTHENING/RLS ABDUCTOR HALLUCIS MUSC | 2011-07-01 00:00:00 | 363.27 | N | Y | N/A | N/A
28250 | DIVISION PLANTAR FASCIA&MUSCLE SPX | 2011-07-01 00:00:00 | 468.79 | N | Y | N/A | N/A
28260 | CAPSULOTOMY MIDFOOT MEDIAL RELEASE ONLY SPX | 2011-07-01 00:00:00 | 570.94 | N | Y | N/A | N/A
28261 | CAPSULOTOMY MIDFOOT W/TENDON LENGTHENING | 2011-07-01 00:00:00 | 804.48 | N | Y | N/A | N/A
28262 | CAPSUL MIDFOOT W/PST TALOTIBL CAPSUL&TDN LNGTH | 2011-07-01 00:00:00 | 1144.67 | N | Y | N/A | N/A
28264 | CAPSULOTOMY MIDTARSAL | 2011-07-01 00:00:00 | 760.72 | N | Y | N/A | N/A
28270 | CAPSUL MTTARPHLNGL JT W/WO TENORRHAPHY EA JT SPX | 2011-07-01 00:00:00 | 401.43 | N | Y | N/A | N/A
28272 | CAPSULOTOMY IPHAL JOINT EACH JOINT SPX | 2011-07-01 00:00:00 | 323.4 | N | Y | N/A | N/A
28280 | SYNDACTYLIZATION TOES | 2011-07-01 00:00:00 | 430.12 | N | Y | N/A | N/A
28285 | CORRECTION HAMMERTOE | 2011-07-01 00:00:00 | 386.42 | N | Y | N/A | N/A
28286 | [NAME] 5TH TOE W/PLASTIC CLOSURE | 2011-07-01 00:00:00 | 374.89 | N | Y | N/A | N/A
28288 | OSTC PRTL EXOSTC/CONDYLC METAR HEAD | 2011-07-01 00:00:00 | 495.69 | N | Y | N/A | N/A
28289 | HALLUX RIGIDUS CORRECT W/CHEILECTOMY 1ST MP JT | 2011-07-01 00:00:00 | 608 | N | Y | N/A | N/A
28290 | CORRJ HALLUX VALGUS W/WO SESMDC SMPL EXOSTECTOMY | 2011-07-01 00:00:00 | 478.99 | N | Y | N/A | N/A
28292 | KELLER/MCBRIDE/MAYO PROCEDURE | 2011-07-01 00:00:00 | 652.11 | N | Y | N/A | N/A
28293 | CORRJ HALLUX VALGUS W/WO SESMDC RESCJ JT W/IMPLT | 2011-07-01 00:00:00 | 863.64 | N | Y | N/A | N/A
28294 | CORRJ HALLUX VALGUS W/WO SESMDC W/TDN TRNSPLS | 2011-07-01 00:00:00 | 606.79 | N | Y | N/A | N/A
28296 | CORRJ HALLUX VALGUS W/WO SESMDC W/METAR OSTEOT | 2011-07-01 00:00:00 | 596.49 | N | Y | N/A | N/A
28297 | CORRJ HALLUX VALGUS W/WO SESMDC LAPIDUS-TYP PX | 2011-07-01 00:00:00 | 680.69 | N | Y | N/A | N/A
28298 | CORRJ HALLUX VALGUS W/WO SESMDC PHALANX OSTEOT | 2011-07-01 00:00:00 | 593.42 | N | Y | N/A | N/A
28299 | CORRJ HALLUX VALGUS W/WO SESMDC 2 OSTEOT | 2011-07-01 00:00:00 | 748.31 | N | Y | N/A | N/A
28300 | OSTEOTOMY CALCANEUS +-INTERNAL FIXATION | 2011-07-01 00:00:00 | 559.84 | N | Y | N/A | N/A
28302 | OSTEOTOMY TALUS | 2011-07-01 00:00:00 | 581.72 | N | Y | N/A | N/A
28304 | OSTEOTOMY TARSAL BONES OTH/THN CALCANEUS/TALUS | 2011-07-01 00:00:00 | 661.86 | N | Y | N/A | N/A
28305 | OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT | 2011-07-01 00:00:00 | 565.43 | N | Y | N/A | N/A
28306 | OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR | 2011-07-01 00:00:00 | 503.36 | N | Y | N/A | N/A
28307 | OSTEOT W/WO LNGTH SHRT/CORRJ [NAME] 1ST TOE | 2011-07-01 00:00:00 | 579.01 | N | Y | N/A | N/A
28308 | OSTEOT W/WO LNGTH SHRT/CORRJ [NAME] 1ST EA | 2011-07-01 00:00:00 | 457.08 | N | Y | N/A | N/A
28309 | OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT | 2011-07-01 00:00:00 | 756.93 | N | Y | N/A | N/A
28310 | OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE | 2011-07-01 00:00:00 | 443.91 | N | Y | N/A | N/A
28312 | OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE | 2011-07-01 00:00:00 | 410.53 | N | Y | N/A | N/A
28313 | [NAME] TOE SOFT TISS PX ONLY | 2011-07-01 00:00:00 | 431.96 | N | Y | N/A | N/A
28315 | SESAMOIDECTOMY FIRST TOE SPX | 2011-07-01 00:00:00 | 391 | N | Y | N/A | N/A
28320 | REPAIR NONUNION/MALUNION TARSAL BONES | 2011-07-01 00:00:00 | 522.49 | N | Y | N/A | N/A
28322 | RPR NON/MALUNION METARSAL W/WO BONE GRAFT | 2011-07-01 00:00:00 | 644.49 | N | Y | N/A | N/A
28340 | RCNSTJ TOE MACRODACTYLY SOFT TISSUE RESECTION | 2011-07-01 00:00:00 | 492.51 | N | Y | N/A | N/A
28341 | RCNSTJ TOE MACRODACTYLY REQUIRING BONE RESECTION | 2011-07-01 00:00:00 | 569.03 | N | Y | N/A | N/A
28344 | RECONSTRUCTION TOE POLYDACTYLY | 2011-07-01 00:00:00 | 373.49 | N | Y | N/A | N/A
28345 | RCNSTJ TOE SYNDACTYLY W/WO SKIN GRAFT EACH WEB | 2011-07-01 00:00:00 | 450.45 | N | Y | N/A | N/A
28400 | CLOSED [NAME] | 2011-07-01 00:00:00 | 202.26 | N | Y | N/A | N/A
28405 | CLOSED [NAME] | 2011-07-01 00:00:00 | 324.14 | N | Y | N/A | N/A
28406 | PRQ SKELETAL FIXJ CALCANEAL FRACTURE W/MANJ | 2011-07-01 00:00:00 | 438.48 | N | Y | N/A | N/A
28415 | OPEN TREATMENT CALCANEAL FRACTURE | 2011-07-01 00:00:00 | 947.69 | N | Y | N/A | N/A
28420 | OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT | 2011-07-01 00:00:00 | 1031.68 | N | Y | N/A | N/A
28430 | CLOSED TX TALUS FRACTURE W/O MANIPULATION | 2011-07-01 00:00:00 | 190.5 | N | Y | N/A | N/A
28435 | CLOSED TX TALUS FRACTURE W/MANIPULATION | 2011-07-01 00:00:00 | 280.07 | N | Y | N/A | N/A
28436 | PRQ SKELETAL FIXATION TALUS FRACTURE W/MANJ | 2011-07-01 00:00:00 | 364.21 | N | Y | N/A | N/A
28445 | OPEN TREATMENT TALUS FRACTURE | 2011-07-01 00:00:00 | 894.46 | N | Y | N/A | N/A
28446 | OPEN OSTEOCHONDRAL AUTOGRAFT TALUS | 2011-07-01 00:00:00 | 1013.97 | N | Y | N/A | N/A
28450 | TX TARSAL B1 FX XCP TALUS&CALCN W/O MANJ | 2011-07-01 00:00:00 | 175.46 | N | Y | N/A | N/A
28455 | TX TARSAL B1 FX XCP TALUS&CALCN W/MANJ | 2011-07-01 00:00:00 | 241.72 | N | Y | N/A | N/A
28456 | PRQ SKEL FIXJ TARSL FX XCP TALUS&CALCNS W/MANJ | 2011-07-01 00:00:00 | 250.66 | N | Y | N/A | N/A
28465 | OPEN TX TARSAL FRACTURE XCP TALUS &CALCANEUS EA | 2011-07-01 00:00:00 | 514.78 | N | Y | N/A | N/A
28470 | CLOSED TX METATARSAL FRACTURE W/O MANIPULATION | 2011-07-01 00:00:00 | 173.1 | N | Y | N/A | N/A
28475 | CLTX METAR FX W/MANJ | 2011-07-01 00:00:00 | 213.74 | N | Y | N/A | N/A
28476 | PRQ SKEL FIXJ METAR FX W/MANJ | 2011-07-01 00:00:00 | 286.61 | N | Y | N/A | N/A
28485 | OPEN TREATMENT METATARSAL FRACTURE EACH | 2011-07-01 00:00:00 | 448.28 | N | Y | N/A | N/A
28490 | CLTX FX GRT TOE PHLX/PHLG W/O MANJ | 2011-07-01 00:00:00 | 115.28 | N | Y | N/A | N/A
28495 | CLTX FX GRT TOE PHLX/PHLG W/MANJ | 2011-07-01 00:00:00 | 144.26 | N | Y | N/A | N/A
28496 | PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ | 2011-07-01 00:00:00 | 353.88 | N | Y | N/A | N/A
28505 | OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES | 2011-07-01 00:00:00 | 553.76 | N | Y | N/A | N/A
28510 | CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ | 2011-07-01 00:00:00 | 99.07 | N | Y | N/A | N/A
28515 | CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ | 2011-07-01 00:00:00 | 130.15 | N | Y | N/A | N/A
28525 | OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE | 2011-07-01 00:00:00 | 469.46 | N | Y | N/A | N/A
28530 | CLOSED TREATMENT SESAMOID FRACTURE | 2011-07-01 00:00:00 | 94.4 | N | Y | N/A | N/A
28531 | OPEN TX SESAMOID FRACTURE W/WO INTERNAL FIXATION | 2011-07-01 00:00:00 | 298.41 | N | Y | N/A | N/A
28540 | CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES | 2011-07-01 00:00:00 | 166.84 | N | Y | N/A | N/A
28545 | CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES | 2011-07-01 00:00:00 | 223.78 | N | Y | N/A | N/A
28546 | PRQ SKEL FIXJ TARSL DISLC XCP TALOTARSAL W/MANJ | 2011-07-01 00:00:00 | 431.15 | N | Y | N/A | N/A
28555 | OPEN TREATMENT TARSAL BONE DISLOCATION | 2011-07-01 00:00:00 | 722.33 | N | Y | N/A | N/A
28570 | CLOSED TX TALOTARSAL JOINT DISLC W/O ANES | 2011-07-01 00:00:00 | 137.81 | N | Y | N/A | N/A
28575 | CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES | 2011-07-01 00:00:00 | 287.02 | N | Y | N/A | N/A
28576 | PRQ SKEL FIXJ TALOTARSAL JT DISLC W/MANJ | 2011-07-01 00:00:00 | 312.98 | N | Y | N/A | N/A
28585 | OPEN TREATMENT TALOTARSAL JOINT DISLOCATION | 2011-07-01 00:00:00 | 763.1 | N | Y | N/A | N/A
28600 | CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES | 2011-07-01 00:00:00 | 177.86 | N | Y | N/A | N/A
28605 | CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES | 2011-07-01 00:00:00 | 231.1 | N | Y | N/A | N/A
28606 | PRQ SKEL FIXJ TARS JT DISLC W/MANJ | 2011-07-01 00:00:00 | 326.63 | N | Y | N/A | N/A
28615 | OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION | 2011-07-01 00:00:00 | 660.92 | N | Y | N/A | N/A
28630 | CLTX METATARSOPHLNGL JT DISLC W/O ANES | 2011-07-01 00:00:00 | 125.01 | N | Y | N/A | N/A
28635 | CLTX METATARSOPHLNGL JT DISLC REQ ANES | 2011-07-01 00:00:00 | 147.11 | N | Y | N/A | N/A
28636 | PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ | 2011-07-01 00:00:00 | 226.19 | N | Y | N/A | N/A
28645 | OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION | 2011-07-01 00:00:00 | 528.71 | N | Y | N/A | N/A
28660 | CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES | 2011-07-01 00:00:00 | 91.66 | N | Y | N/A | N/A
28665 | CLTX INTERPHALANGEAL JOINT DISLOCATION REQ ANES | 2011-07-01 00:00:00 | 129.03 | N | Y | N/A | N/A
28666 | PRQ SKEL FIXJ INTERPHALANGEAL JOINT DISLC W/MANJ | 2011-07-01 00:00:00 | 170.31 | N | Y | N/A | N/A
28675 | OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION | 2011-07-01 00:00:00 | 479.39 | N | Y | N/A | N/A
28705 | ARTHRODESIS PANTALAR | 2011-07-01 00:00:00 | 1097.42 | N | Y | N/A | N/A
28715 | ARTHRODESIS TRIPLE | 2011-07-01 00:00:00 | 820.86 | N | Y | N/A | N/A
28725 | [NAME] | 2011-07-01 00:00:00 | 670.91 | N | Y | N/A | N/A
28730 | [NAME]/TARSOMETATARSAL MULT/TRANSVRS | 2011-07-01 00:00:00 | 711.82 | N | Y | N/A | N/A
28735 | [NAME]TRANSVRS W/OSTEOT | 2011-07-01 00:00:00 | 673.57 | N | Y | N/A | N/A
28737 | [NAME] LNGTH&ADVMNT TARSL NVCLR-CUNEIFORM | 2011-07-01 00:00:00 | 582.86 | N | Y | N/A | N/A
28740 | ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT | 2011-07-01 00:00:00 | 708.68 | N | Y | N/A | N/A
28750 | ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT | 2011-07-01 00:00:00 | 688.38 | N | Y | N/A | N/A
28755 | ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT | 2011-07-01 00:00:00 | 414.95 | N | Y | N/A | N/A
28760 | [NAME] TR 1ST METAR NCK | 2011-07-01 00:00:00 | 656.28 | N | Y | N/A | N/A
28800 | AMPUTATION FOOT MIDTARSAL | 2011-07-01 00:00:00 | 478.27 | N | Y | N/A | N/A
28805 | AMPUTATION FOOT TRANSMETARSAL | 2011-07-01 00:00:00 | 643.22 | N | Y | N/A | N/A
28810 | AMPUTATION METATARSAL W/TOE SINGLE | 2011-07-01 00:00:00 | 374.78 | N | Y | N/A | N/A
28820 | AMPUTATION TOE METATARSOPHALANGEAL JOINT | 2011-07-01 00:00:00 | 437.29 | N | Y | N/A | N/A
28825 | AMPUTATION TOE INTERPHALANGEAL JOINT | 2011-07-01 00:00:00 | 482.8 | N | Y | N/A | N/A
28890 | ESWT HI NRG PFRMD PHYS W/US GDN INVG PLNTAR FSCA | 2011-07-01 00:00:00 | 285.79 | N | Y | N/A | N/A
28899 | UNLISTED PROCEDURE, FOOT OR TOES | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
29000 | APPLICATION HALO TYPE BODY CAST | 2011-07-01 00:00:00 | 243.23 | N | Y | N/A | N/A
29010 | APPLICATION RISSER JACKET LOCALIZER BODY ONLY | 2011-07-01 00:00:00 | 232.45 | N | Y | N/A | N/A
29015 | APPLICATION RISSER JACKET LOCALIZER BODY W/HEAD | 2011-07-01 00:00:00 | 195.92 | N | Y | N/A | N/A
29020 | APPLICATION TURNBUCKLE JACKET BODY ONLY | 2011-07-01 00:00:00 | 178.67 | N | Y | N/A | N/A
29025 | APPLICATION TURNBUCKLE JACKET BODY W/HEAD | 2011-07-01 00:00:00 | 205.78 | N | Y | N/A | N/A
29035 | APPLICATION BODY CAST SHOULDER HIPS | 2011-07-01 00:00:00 | 203.09 | N | Y | N/A | N/A
29040 | APPLICATION BODY CAST SHOULDER HIPS HEAD MINERVA | 2011-07-01 00:00:00 | 194.32 | N | Y | N/A | N/A
29044 | APPLICATION BODY CAST SHOULDER HIPS W/ONE THIGH | 2011-07-01 00:00:00 | 223.97 | N | Y | N/A | N/A
29046 | APPLICATION BODY CAST SHOULDER HIPS BOTH THIGHS | 2011-07-01 00:00:00 | 220.79 | N | Y | N/A | N/A
29049 | APPLICATION CAST FIGURE-OF-8 | 2011-07-01 00:00:00 | 75.92 | N | Y | N/A | N/A
29055 | APPLICATION CAST SHOULDER SPICA | 2011-07-01 00:00:00 | 175.32 | N | Y | N/A | N/A
29058 | APPLICATION CAST PLASTER VELPEAU | 2011-07-01 00:00:00 | 83.87 | N | Y | N/A | N/A
29065 | APPLICATION CAST SHOULDER HAND LONG ARM | 2011-07-01 00:00:00 | 77.27 | N | Y | N/A | N/A
29075 | APPLICATION CAST ELBOW FINGER SHORT ARM | 2011-07-01 00:00:00 | 72.14 | N | Y | N/A | N/A
29085 | APPLICATION CAST HAND&LOWER FOREARM GAUNTLET | 2011-07-01 00:00:00 | 76.64 | N | Y | N/A | N/A
29086 | APPLICATION CAST FINGER | 2011-07-01 00:00:00 | 61.02 | N | Y | N/A | N/A
29105 | APPLICATION LONG ARM SPLINT SHOULDER HAND | 2011-07-01 00:00:00 | 70.29 | N | Y | N/A | N/A
29125 | APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC | 2011-07-01 00:00:00 | 56.12 | N | Y | N/A | N/A
29126 | APPLICATION SHORT ARM SPLINT [NAME] | 2011-07-01 00:00:00 | 64.11 | N | Y | N/A | N/A
29130 | APPLICATION FINGER SPLINT STATIC | 2011-07-01 00:00:00 | 33.24 | N | Y | N/A | N/A
29131 | APPLICATION FINGER SPLINT [NAME] | 2011-07-01 00:00:00 | 42.15 | N | Y | N/A | N/A
29200 | STRAPPING THORAX | 2011-07-01 00:00:00 | 44.11 | N | Y | N/A | N/A
29240 | STRAPPING SHOULDER | 2011-07-01 00:00:00 | 47.67 | N | Y | N/A | N/A
29260 | STRAPPING ELBOW/WRIST | 2011-07-01 00:00:00 | 42.49 | N | Y | N/A | N/A
29280 | STRAPPING HAND/FINGER | 2011-07-01 00:00:00 | 41.38 | N | Y | N/A | N/A
29305 | APPLICATION HIP SPICA CAST 1 LEG | 2011-07-01 00:00:00 | 196.07 | N | Y | N/A | N/A
29325 | APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS | 2011-07-01 00:00:00 | 217.8 | N | Y | N/A | N/A
29345 | APPLICATION LONG LEG CAST THIGH-TOE | 2011-07-01 00:00:00 | 110.39 | N | Y | N/A | N/A
29355 | APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE | 2011-07-01 00:00:00 | 114.72 | N | Y | N/A | N/A
29358 | APPLICATION LONG LEG CAST BRACE | 2011-07-01 00:00:00 | 127.52 | N | Y | N/A | N/A
29365 | APPLICATION CYLINDER CAST THIGH ANKLE | 2011-07-01 00:00:00 | 99.5 | N | Y | N/A | N/A
29405 | APPLICATION SHORT LEG CAST BELOW KNEE-TOE | 2011-07-01 00:00:00 | 72.51 | N | Y | N/A | N/A
29425 | APPLICATION SHORT LEG CAST WALKING/AMBULATORY | 2011-07-01 00:00:00 | 77.68 | N | Y | N/A | N/A
29435 | APPLICATION PATELLAR TENDON BEARING CAST | 2011-07-01 00:00:00 | 96.62 | N | Y | N/A | N/A
29440 | ADDING WALKER PREVIOUSLY APPLIED CAST | 2011-07-01 00:00:00 | 39.88 | N | Y | N/A | N/A
29445 | APPLICATION RIGID TOTAL CONTACT LEG CAST | 2011-07-01 00:00:00 | 116.87 | N | Y | N/A | N/A
29450 | APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG | 2011-07-01 00:00:00 | 121.66 | N | Y | N/A | N/A
29505 | APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES | 2011-07-01 00:00:00 | 63.11 | N | Y | N/A | N/A
29515 | APPLICATION SHORT LEG SPLINT CALF FOOT | 2011-07-01 00:00:00 | 58.96 | N | Y | N/A | N/A
29520 | STRAPPING HIP | 2011-07-01 00:00:00 | 41.15 | N | Y | N/A | N/A
29530 | STRAPPING KNEE | 2011-07-01 00:00:00 | 43.1 | N | Y | N/A | N/A
29540 | STRAPPING ANKLE &/FOOT | 2011-07-01 00:00:00 | 28.19 | N | Y | N/A | N/A
29550 | STRAPPING TOES | 2011-07-01 00:00:00 | 22.64 | N | Y | N/A | N/A
29580 | STRAPPING UNNA BOOT | 2011-07-01 00:00:00 | 43.42 | N | Y | N/A | N/A
29581 | APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT | 2011-07-01 00:00:00 | 78.11 | N | Y | N/A | N/A
29582 | APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE | 2012-01-01 00:00:00 | 57.19 | N | N | N/A | N/A
29583 | APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM | 2012-01-01 00:00:00 | 35.51 | N | N | N/A | N/A
29584 | APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FINGER | 2012-01-01 00:00:00 | 57.19 | N | N | N/A | N/A
29700 | REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST | 2011-07-01 00:00:00 | 53.5 | N | Y | N/A | N/A
29705 | REMOVAL/BIVALVING FULL ARM/FULL LEG CAST | 2011-07-01 00:00:00 | 54.75 | N | Y | N/A | N/A
29710 | RMVL/BIVALV SHO/HIP SPICA MINERVA/RISSER JACKET | 2011-07-01 00:00:00 | 99.33 | N | Y | N/A | N/A
29715 | REMOVAL/BIVALVING TURNBUCKLE JACKET | 2011-07-01 00:00:00 | 70.63 | N | Y | N/A | N/A
29720 | REPAIR SPICA BODY CAST/JACKET | 2011-07-01 00:00:00 | 66.44 | N | Y | N/A | N/A
29730 | WINDOWING CAST | 2011-07-01 00:00:00 | 53.12 | N | Y | N/A | N/A
29740 | WEDGING CAST EXCEPT CLUBFOOT CASTS | 2011-07-01 00:00:00 | 74.59 | N | Y | N/A | N/A
29750 | WEDGING CLUBFOOT CAST | 2011-07-01 00:00:00 | 83.45 | N | Y | N/A | N/A
29799 | BODY STRAPPING | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
29800 | ARTHRS TEMPOROMANDIBULR JT DX W/WO SYNVAL BX SPX | 2011-07-01 00:00:00 | 436.87 | N | Y | N/A | N/A
29804 | [NAME] | 2011-07-01 00:00:00 | 545.9 | N | Y | N/A | N/A
29805 | ARTHROSCOPY SHOULDER DX W/WO SYNOVIAL BIOPSY SPX | 2011-07-01 00:00:00 | 391.6 | N | Y | N/A | N/A
29806 | ARTHROSCOPY SHOULDER SURGICAL CAPSULORRHAPHY | 2011-07-01 00:00:00 | 888.8 | N | Y | N/A | N/A
29807 | ARTHROSCOPY SHOULDER SURGICAL REPAIR SLAP LESION | 2011-07-01 00:00:00 | 867.6 | N | Y | N/A | N/A
29819 | ARTHROSCOPY SHOULDER SURGICAL REMOVAL LOOSE/FB | 2011-07-01 00:00:00 | 489.14 | N | Y | N/A | N/A
29820 | ARTHROSCOPY SHOULDER SURG SYNOVECTOMY PARTIAL | 2011-07-01 00:00:00 | 450.27 | N | Y | N/A | N/A
29821 | ARTHROSCOPY SHOULDER SURG SYNOVECTOMY COMPLETE | 2011-07-01 00:00:00 | 492.72 | N | Y | N/A | N/A
29822 | [NAME] LIMITED | 2011-07-01 00:00:00 | 478.94 | N | Y | N/A | N/A
29823 | [NAME] EXTENSIVE | 2011-07-01 00:00:00 | 522.91 | N | Y | N/A | N/A
29824 | ARTHROSCOPY SHOULDER DISTAL CLAVICULECTOMY | 2011-07-01 00:00:00 | 562.19 | N | Y | N/A | N/A
29825 | ARTHROSCOPY SHOULDER LYSIS&RESCJ ADHESION +-MANJ | 2011-07-01 00:00:00 | 487.98 | N | Y | N/A | N/A
29826 | SHOULDER SCOPE BONE SHAVING | 2011-07-01 00:00:00 | 557.26 | N | Y | N/A | N/A
29827 | [NAME] REPAIR | 2011-07-01 00:00:00 | 904.89 | N | Y | N/A | N/A
29828 | ARTHROSCOPY SHOULDER BICEPS TENODESIS | 2011-07-01 00:00:00 | 767.51 | N | Y | N/A | N/A
29830 | ARTHROSCOPY ELBOW DIAG W/WO SYNOVIAL BIOPSY SPX | 2011-07-01 00:00:00 | 377.89 | N | Y | N/A | N/A
29834 | ARTHROSCOPY ELBOW SURGICAL W/REMOVAL LOOSE/FB | 2011-07-01 00:00:00 | 410.27 | N | Y | N/A | N/A
29835 | ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY PARTIAL | 2011-07-01 00:00:00 | 421.66 | N | Y | N/A | N/A
29836 | ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY COMPLETE | 2011-07-01 00:00:00 | 486.14 | N | Y | N/A | N/A
29837 | ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT LIMITED | 2011-07-01 00:00:00 | 441.15 | N | Y | N/A | N/A
29838 | ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT EXTENSIVE | 2011-07-01 00:00:00 | 493.85 | N | Y | N/A | N/A
29840 | ARTHROSCOPY WRIST DIAG W/WO SYNOVIAL BIOPSY SPX | 2011-07-01 00:00:00 | 374.54 | N | Y | N/A | N/A
29843 | ARTHROSCOPY WRIST INFECTION LAVAGE&DRAINAGE | 2011-07-01 00:00:00 | 401.27 | N | Y | N/A | N/A
29844 | ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY PARTIAL | 2011-07-01 00:00:00 | 414.93 | N | Y | N/A | N/A
29845 | ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY COMPLETE | 2011-07-01 00:00:00 | 479.42 | N | Y | N/A | N/A
29846 | ARTHRS WRST EXC&/RPR TRIANG FIBROCART&/JT DBRDMT | 2011-07-01 00:00:00 | 435.61 | N | Y | N/A | N/A
29847 | ARTHROSCOPY WRIST SURG INT FIXJ FX/INSTABILITY | 2011-07-01 00:00:00 | 452.66 | N | Y | N/A | N/A
29848 | NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM | 2011-07-01 00:00:00 | 422.33 | N | Y | N/A | N/A
29850 | ARTHROSCOPY AID TX SPINE&/FX KNEE W/O FIXJ | 2011-07-01 00:00:00 | 498.93 | N | Y | N/A | N/A
29851 | ARTHROSCOPY AID TX SPINE&/FX KNEE W/FIXJ | 2011-07-01 00:00:00 | 780.44 | N | Y | N/A | N/A
29855 | ARTHRS AID TIBIAL FRACTURE PROXIMAL UNICONDYLAR | 2011-07-01 00:00:00 | 656.78 | N | Y | N/A | N/A
29856 | ARTHRS AID TIBIAL FX PROX UNICONDYLAR BICONDYLAR | 2011-07-01 00:00:00 | 836.52 | N | Y | N/A | N/A
29860 | ARTHROSCOPY HIP DIAGNOSTIC +-SYNOVIAL BIOPSY SPX | 2011-07-01 00:00:00 | 551.16 | N | Y | N/A | N/A
29861 | ARTHROSCOPY HIP SURGICAL W/REMOVAL LOOSE/FB | 2011-07-01 00:00:00 | 606.86 | N | Y | N/A | N/A
29862 | ARTHRS HIP DEBRIDEMENT/SHAVING ARTICULAR CRTLG | 2011-07-01 00:00:00 | 680.91 | N | Y | N/A | N/A
29863 | ARTHROSCOPY HIP SURGICAL W/SYNOVECTOMY | 2011-07-01 00:00:00 | 678.78 | N | Y | N/A | N/A
29866 | [NAME] | 2011-07-01 00:00:00 | 876.38 | N | Y | N/A | N/A
29867 | [NAME] | 2011-07-01 00:00:00 | 1066.85 | N | Y | N/A | N/A
29868 | [NAME] TRNSPLJ MED/LAT | 2011-07-01 00:00:00 | 1405.45 | N | Y | N/A | N/A
29870 | ARTHROSCOPY KNEE DIAGNOSTIC W/WO SYNOVIAL BX SPX | 2011-07-01 00:00:00 | 487.68 | N | Y | N/A | N/A
29871 | ARTHROSCOPY KNEE INFECTION LAVAGE & DRAINAGE | 2011-07-01 00:00:00 | 427.03 | N | Y | N/A | N/A
29873 | [NAME] RELEASE | 2011-07-01 00:00:00 | 432.46 | N | Y | N/A | N/A
29874 | ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY | 2011-07-01 00:00:00 | 449.08 | N | Y | N/A | N/A
29875 | [NAME] SPX | 2011-07-01 00:00:00 | 412.65 | N | Y | N/A | N/A
29876 | [NAME] | 2011-07-01 00:00:00 | 546.77 | N | Y | N/A | N/A
29877 | [NAME]/SHAVING ARTCLR CRTLG | 2011-07-01 00:00:00 | 518.01 | N | Y | N/A | N/A
29879 | [NAME]/MICROFX | 2011-07-01 00:00:00 | 552.7 | N | Y | N/A | N/A
29880 | ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING | 2011-07-01 00:00:00 | 576.23 | N | Y | N/A | N/A
29881 | [NAME]/LAT W/SHVG | 2011-07-01 00:00:00 | 538.59 | N | Y | N/A | N/A
29882 | ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL | 2011-07-01 00:00:00 | 582.1 | N | Y | N/A | N/A
29883 | ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL | 2011-07-01 00:00:00 | 702.92 | N | Y | N/A | N/A
29884 | ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX | 2011-07-01 00:00:00 | 516.54 | N | Y | N/A | N/A
29885 | ARTHRS KNEE DRILL OSTEOCHONDRITIS DISSECANS GRFG | 2011-07-01 00:00:00 | 625.74 | N | Y | N/A | N/A
29886 | [NAME] DISSECANS LESION | 2011-07-01 00:00:00 | 528.27 | N | Y | N/A | N/A
29887 | [NAME] OSTEOCHOND DISSECANS INT FIXJ | 2011-07-01 00:00:00 | 621.74 | N | Y | N/A | N/A
29888 | ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ | 2011-07-01 00:00:00 | 829.4 | N | Y | N/A | N/A
29889 | ARTHRS AIDED PST CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ | 2011-07-01 00:00:00 | 1020.7 | N | Y | N/A | N/A
29891 | ARTHRS ANKLE EXC OSTCHNDRL DFCT W/DRLG DFCT | 2011-07-01 00:00:00 | 580.62 | N | Y | N/A | N/A
29892 | ARTHRS AID RPR LES/TALAR DOME FX/TIBL PLAFOND FX | 2011-07-01 00:00:00 | 556.25 | N | Y | N/A | N/A
29893 | ENDOSCOPIC PLANTAR FASCIOTOMY | 2011-07-01 00:00:00 | 501.61 | N | Y | N/A | N/A
29894 | ARTHROSCOPY ANKLE W/REMOVAL LOOSE/FOREIGN BODY | 2011-07-01 00:00:00 | 433.52 | N | Y | N/A | N/A
29895 | ARTHROSCOPY ANKLE SURGICAL SYNOVECTOMY PARTIAL | 2011-07-01 00:00:00 | 415.13 | N | Y | N/A | N/A
29897 | ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT LIMITED | 2011-07-01 00:00:00 | 434.12 | N | Y | N/A | N/A
29898 | ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE | 2011-07-01 00:00:00 | 484.03 | N | Y | N/A | N/A
29899 | ARTHROSCOPY ANKLE SURGICAL W/ANKLE ARTHRODESIS | 2011-07-01 00:00:00 | 879.56 | N | Y | N/A | N/A
29900 | [NAME] | 2011-07-01 00:00:00 | 383.92 | N | Y | N/A | N/A
29901 | ARTHRS METACARPOPHALANGEAL JOINT DEBRIDEMENT | 2011-07-01 00:00:00 | 430.83 | N | Y | N/A | N/A
29902 | ARTHRS MTCARPHLNGL JT W/RDCTJ UR COLTRL LIGM | 2011-07-01 00:00:00 | 443.84 | N | Y | N/A | N/A
29904 | [NAME]FOREIGN BODY | 2011-07-01 00:00:00 | 526.19 | N | Y | N/A | N/A
29905 | [NAME] WITH SYNOVECTOMY | 2011-07-01 00:00:00 | 568.72 | N | Y | N/A | N/A
29906 | [NAME] WITH DEBRIDEMENT | 2011-07-01 00:00:00 | 598.63 | N | Y | N/A | N/A
29907 | [NAME] | 2011-07-01 00:00:00 | 725.56 | N | Y | N/A | N/A
29914 | ARTHROSCOPY HIP W/FEMOROPLASTY | 2011-07-01 00:00:00 | 866.85 | N | Y | N/A | N/A
29915 | ARTHROSCOPY HIP W/ACETABULOPLASTY | 2011-07-01 00:00:00 | 883.41 | N | Y | N/A | N/A
29916 | ARTHROSCOPY HIP W/LABRAL REPAIR | 2011-07-01 00:00:00 | 883.41 | N | Y | N/A | N/A
29999 | UNLISTED PROCEDURE, ARTHROSCOPY | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
30000 | DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH | 2011-07-01 00:00:00 | 194.44 | N | Y | N/A | N/A
30020 | DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM | 2011-07-01 00:00:00 | 192.65 | N | Y | N/A | N/A
30100 | BIOPSY INTRANASAL | 2011-07-01 00:00:00 | 118.91 | N | Y | N/A | N/A
30110 | EXCISION NASAL POLYP SIMPLE | 2011-07-01 00:00:00 | 192.65 | N | Y | N/A | N/A
30115 | EXCISION NASAL POLYP EXTENSIVE | 2011-07-01 00:00:00 | 365.29 | N | Y | N/A | N/A
30117 | EXCISION/DESTRUCTION INTRANASAL LESION INT APPR | 2011-07-01 00:00:00 | 719.62 | N | Y | N/A | N/A
30118 | EXCISION/DESTRUCTION INTRANASAL LESION XTRNL | 2011-07-01 00:00:00 | 654.41 | N | Y | N/A | N/A
30120 | EXCISION/SURGICAL PLANING SKIN NOSE RHINOPHYMA | 2011-07-01 00:00:00 | 438.17 | N | Y | N/A | N/A
30124 | EXCISION DERMOID CYST NOSE SIMPLE SUBCUTANEOUS | 2011-07-01 00:00:00 | 232.19 | N | Y | N/A | N/A
30125 | EXC DERMOID CYST NOSE COMPLEX UNDER BONE/CRTLG | 2011-07-01 00:00:00 | 520.64 | N | Y | N/A | N/A
30130 | EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE | 2011-07-01 00:00:00 | 320.55 | N | Y | N/A | N/A
30140 | SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL | 2011-07-01 00:00:00 | 369.35 | N | Y | N/A | N/A
30150 | RHINECTOMY PARTIAL | 2011-07-01 00:00:00 | 662.32 | N | Y | N/A | N/A
30160 | RHINECTOMY TOTAL | 2011-07-01 00:00:00 | 666.69 | N | Y | N/A | N/A
30200 | INJECTION TURBINATE THERAPEUTIC | 2011-07-01 00:00:00 | 95.38 | N | Y | N/A | N/A
30210 | [NAME] TYPE | 2011-07-01 00:00:00 | 125.82 | N | Y | N/A | N/A
30220 | INSERTION NASAL SEPTAL PROSTHESIS BUTTON | 2011-07-01 00:00:00 | 251.15 | N | Y | N/A | N/A
30300 | REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE | 2011-07-01 00:00:00 | 191.78 | N | Y | N/A | N/A
30310 | REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES | 2011-07-01 00:00:00 | 174.14 | N | Y | N/A | N/A
30320 | RMVL FOREIGN BODY INTRANASAL LATERAL RHINOTOMY | 2011-07-01 00:00:00 | 383.93 | N | Y | N/A | N/A
30400 | RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TIP | 2011-07-01 00:00:00 | 870.83 | Y | Y | N/A | N/A
30410 | RHINP PRIM [NAME] PARTS | 2011-07-01 00:00:00 | 1024.48 | Y | Y | N/A | N/A
30420 | RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR | 2011-07-01 00:00:00 | 1170.08 | Y | Y | N/A | N/A
30430 | RHINOPLASTY SECONDARY MINOR REVISION | 2011-07-01 00:00:00 | 765.04 | Y | Y | N/A | N/A
30435 | RHINOPLASTY SECONDARY INTERMEDIATE REVISION | 2011-07-01 00:00:00 | 1025.64 | Y | Y | N/A | N/A
30450 | RHINOPLASTY SECONDARY MAJOR REVISION | 2011-07-01 00:00:00 | 1308.48 | Y | Y | N/A | N/A
30460 | RHINP DFRM W/COLUM LNGTH TIP ONLY | 2011-07-01 00:00:00 | 646.01 | Y | Y | N/A | N/A
30462 | RHINP DFRM COLUM LNGTH TIP SEPTUM OSTEOT | 2011-07-01 00:00:00 | 1317.56 | Y | Y | N/A | N/A
30465 | REPAIR NASAL VESTIBULAR STENOSIS | 2011-07-01 00:00:00 | 836.02 | Y | Y | N/A | N/A
30520 | SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF | 2011-07-01 00:00:00 | 524.51 | Y | Y | N/A | N/A
30540 | REPAIR CHOANAL ATRESIA INTRANASAL | 2011-07-01 00:00:00 | 578.66 | N | Y | N/A | N/A
30545 | REPAIR CHOANAL ATRESIA TRANSPALATINE | 2011-07-01 00:00:00 | 746.55 | N | Y | N/A | N/A
30560 | LYSIS INTRANASAL SYNECHIA | 2011-07-01 00:00:00 | 227.47 | N | Y | N/A | N/A
30580 | REPAIR FISTULA OROMAXILLARY | 2011-07-01 00:00:00 | 533.85 | N | Y | N/A | N/A
30600 | REPAIR FISTULA ORONASAL | 2011-07-01 00:00:00 | 487.2 | N | Y | N/A | N/A
30620 | SEPTAL/OTHER INTRANASAL DERMATOPLASTY | 2011-07-01 00:00:00 | 525.85 | N | Y | N/A | N/A
30630 | REPAIR NASAL SEPTAL PERFORATIONS | 2011-07-01 00:00:00 | 531.77 | N | Y | N/A | N/A
30801 | ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC | 2011-07-01 00:00:00 | 190.72 | N | Y | N/A | N/A
30802 | ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL | 2011-07-01 00:00:00 | 244.8 | N | Y | N/A | N/A
30901 | CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE | 2011-07-01 00:00:00 | 81.42 | N | Y | N/A | N/A
30903 | CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX | 2011-07-01 00:00:00 | 166.46 | N | Y | N/A | N/A
30905 | CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST | 2011-07-01 00:00:00 | 206.5 | N | Y | N/A | N/A
30906 | CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ | 2011-07-01 00:00:00 | 234.39 | N | Y | N/A | N/A
30915 | LIGATION ARTERIES ETHMOIDAL | 2011-07-01 00:00:00 | 491.95 | N | Y | N/A | N/A
30920 | LIGATION ARTERIES INT MAXILLARY TRANSANTRAL | 2011-07-01 00:00:00 | 710.2 | N | Y | N/A | N/A
30930 | FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC | 2011-07-01 00:00:00 | 104.34 | N | Y | N/A | N/A
30999 | UNLISTED PROCEDURE, NOSE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
31000 | LAVAGE [NAME] | 2011-07-01 00:00:00 | 151.89 | N | Y | N/A | N/A
31002 | LAVAGE CANNULATION SPHENOID SINUS | 2011-07-01 00:00:00 | 170.31 | N | Y | N/A | N/A
31020 | SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL | 2011-07-01 00:00:00 | 406.36 | N | Y | N/A | N/A
31030 | SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS | 2011-07-01 00:00:00 | 583.01 | N | Y | N/A | N/A
31032 | SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS | 2011-07-01 00:00:00 | 485.08 | N | Y | N/A | N/A
31040 | PTERYGOMAXILLARY FOSSA SURGERY ANY APPROACH | 2011-07-01 00:00:00 | 636.52 | N | Y | N/A | N/A
31050 | SINUSOTOMY SPHENOID W/WO BIOPSY | 2011-07-01 00:00:00 | 415.15 | N | Y | N/A | N/A
31051 | SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP | 2011-07-01 00:00:00 | 547.88 | N | Y | N/A | N/A
31070 | SINUSOTOMY FRONTAL EXTERNAL SIMPLE | 2011-07-01 00:00:00 | 371.51 | N | Y | N/A | N/A
31075 | SINUSOTOMY FRONTAL TRANSORBITAL UNILATERAL | 2011-07-01 00:00:00 | 667.11 | N | Y | N/A | N/A
31080 | SINUSOTOMY FRNT OBLITERATIVE W/O FLAP BROW INC | 2011-07-01 00:00:00 | 868.79 | N | Y | N/A | N/A
31081 | SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC | 2011-07-01 00:00:00 | 1137.14 | N | Y | N/A | N/A
31084 | SINUSOT FRNT OBLIT W/OSTPL FLAP BROW INC | 2011-07-01 00:00:00 | 995.65 | N | Y | N/A | N/A
31085 | SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC | 2011-07-01 00:00:00 | 1098.48 | N | Y | N/A | N/A
31086 | SINUSOT FRNT NONOBLIT W/OSTPL FLAP BROW INC | 2011-07-01 00:00:00 | 955.62 | N | Y | N/A | N/A
31087 | SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC | 2011-07-01 00:00:00 | 929.64 | N | Y | N/A | N/A
31090 | SINUSOT UNI 3/GT PARANSL SINUSES | 2011-07-01 00:00:00 | 863.25 | N | Y | N/A | N/A
31200 | ETHMOIDECTOMY INTRANASAL ANTERIOR | 2011-07-01 00:00:00 | 462.63 | N | Y | N/A | N/A
31201 | ETHMOIDECTOMY INTRANASAL TOTAL | 2011-07-01 00:00:00 | 623.47 | N | Y | N/A | N/A
31205 | ETHMOIDECTOMY EXTRANASAL TOTAL | 2011-07-01 00:00:00 | 743.79 | N | Y | N/A | N/A
31225 | MAXILLECTOMY W/O ORBITAL EXENTERATION | 2011-07-01 00:00:00 | 1586.47 | N | Y | N/A | N/A
31230 | MAXILLECTOMY W/ORBITAL EXENTERATION | 2011-07-01 00:00:00 | 1772.1 | N | Y | N/A | N/A
31231 | NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX | 2011-07-01 00:00:00 | 161.75 | N | Y | N/A | N/A
31233 | NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY | 2011-07-01 00:00:00 | 225.72 | N | Y | N/A | N/A
31235 | NASAL/SINUS ENDOSCOPY DX SPHENOID SINUSOSCOPY | 2011-07-01 00:00:00 | 256.05 | N | Y | N/A | N/A
31237 | NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX | 2011-07-01 00:00:00 | 277.13 | N | Y | N/A | N/A
31238 | NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG | 2011-07-01 00:00:00 | 285.35 | N | Y | N/A | N/A
31239 | NASAL/SINUS NDSC SURG W/DACRYOCSTORHINOSTOMY | 2011-07-01 00:00:00 | 576.03 | N | Y | N/A | N/A
31240 | NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION | 2011-07-01 00:00:00 | 139.97 | N | Y | N/A | N/A
31254 | NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY PARTIAL | 2011-07-01 00:00:00 | 238.6 | N | Y | N/A | N/A
31255 | NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY TOTAL | 2011-07-01 00:00:00 | 349.89 | N | Y | N/A | N/A
31256 | NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY | 2011-07-01 00:00:00 | 172.66 | N | Y | N/A | N/A
31267 | NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS | 2011-07-01 00:00:00 | 277.34 | N | Y | N/A | N/A
31276 | NASAL/SINUS NDSC W/FRONTAL SINUS EXPLORATION | 2011-07-01 00:00:00 | 441.35 | N | Y | N/A | N/A
31287 | NASAL/SINUS ENDOSCOPY W/SPHENOIDECTOMY | 2011-07-01 00:00:00 | 202.71 | N | Y | N/A | N/A
31288 | NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS | 2011-07-01 00:00:00 | 235.31 | N | Y | N/A | N/A
31290 | NASAL/SINUS NDSC RPR CEREBRSP FLUID LEAK ETHMOID | 2011-07-01 00:00:00 | 1001.65 | N | Y | N/A | N/A
31291 | NASAL/SINUS NDSC RPR CEREBSP FLUID LEAK SPHENOID | 2011-07-01 00:00:00 | 1057.9 | N | Y | N/A | N/A
31292 | NSL/SINUS NDSC SURG W/MEDIAL/INF ORB WALL DCMPRN | 2011-07-01 00:00:00 | 864.45 | N | Y | N/A | N/A
31293 | NASAL/SINUS NDSC MEDIAL ORB&INF ORB WALL DCMPRN | 2011-07-01 00:00:00 | 942.02 | N | Y | N/A | N/A
31294 | NASAL/SINUS NDSC SURG W/OPTIC NERVE DCMPRN | 2011-07-01 00:00:00 | 1079.34 | N | Y | N/A | N/A
31295 | NASAL/SINUS NDSC SURG W/DILAT MAXILLARY SINUS | 2011-07-01 00:00:00 | 1725.98 | N | Y | N/A | N/A
31296 | NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS | 2011-07-01 00:00:00 | 3231.15 | N | Y | N/A | N/A
31297 | NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS | 2011-07-01 00:00:00 | 3200.65 | N | N | N/A | N/A
31299 | UNLISTED SINUS PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
31300 | LARYNGOTOMY W/RMVL TUMOR/LARYNGOCELE CORDECTOMY | 2011-07-01 00:00:00 | 1080.28 | N | Y | N/A | N/A
31320 | LARYNGOTOMY THYROTOMY LARYNGOFISSURE DX | 2011-07-01 00:00:00 | 556.05 | N | Y | N/A | N/A
31360 | LARYNGECTOMY TOTAL W/O RADICAL NECK DISSECTION | 2011-07-01 00:00:00 | 1759.15 | N | Y | N/A | N/A
31365 | LARYNGECTOMY TOTAL W/RADICAL NECK DISSECTION | 2011-07-01 00:00:00 | 2184.8 | N | Y | N/A | N/A
31367 | LARYNGECTOMY STOT SUPRAGLOTTIC W/O RAD NECK DSJ | 2011-07-01 00:00:00 | 1878.25 | N | Y | N/A | N/A
31368 | LARYNGECTOMY STOT SUPRAGLOTTIC W/RAD NCK DSJ | 2011-07-01 00:00:00 | 2086.66 | N | Y | N/A | N/A
31370 | PARTIAL LARYNGECTOMY HEMILARYGECTOMY HORIZONTAL | 2011-07-01 00:00:00 | 1764.57 | N | Y | N/A | N/A
31375 | PARTIAL LARYNGECTOMY HEMILARYNG LATEROVERTICAL | 2011-07-01 00:00:00 | 1672.88 | N | Y | N/A | N/A
31380 | PARTIAL LARYNGECTOMY HEMILARYNG ANTEROVERTICAL | 2011-07-01 00:00:00 | 1647.71 | N | Y | N/A | N/A
31382 | PARTIAL LARYNG HEMILARYNG ANTERO-LATERO-VERTICAL | 2011-07-01 00:00:00 | 1808.15 | N | Y | N/A | N/A
31390 | PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/O RCNSTJ | 2011-07-01 00:00:00 | 2425.14 | N | Y | N/A | N/A
31395 | PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/RCNSTJ | 2011-07-01 00:00:00 | 2564.44 | N | Y | N/A | N/A
31400 | ARYTENOIDECTOMY/ARYTENOIDOPEXY XTRNL APPROACH | 2011-07-01 00:00:00 | 855.87 | N | Y | N/A | N/A
31420 | EPIGLOTTIDECTOMY | 2011-07-01 00:00:00 | 716.64 | N | Y | N/A | N/A
31500 | INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE | 2011-07-01 00:00:00 | 93.97 | N | Y | N/A | N/A
31502 | TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT | 2011-07-01 00:00:00 | 30.33 | N | Y | N/A | N/A
31505 | LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX | 2011-07-01 00:00:00 | 70.63 | N | Y | N/A | N/A
31510 | LARYNGOSCOPY INDIRECT W/BIOPSY | 2011-07-01 00:00:00 | 180.05 | N | Y | N/A | N/A
31511 | LARYNGOSCOPY INDIRECT W/REMOVAL FOREIGN BODY | 2011-07-01 00:00:00 | 179.6 | N | Y | N/A | N/A
31512 | LARYNGOSCOPY INDIRECT W/REMOVAL LESION | 2011-07-01 00:00:00 | 178.17 | N | Y | N/A | N/A
31513 | LARYNGOSCOPY INDIRECT W/VOCAL CORD INJECTION | 2011-07-01 00:00:00 | 115.07 | N | Y | N/A | N/A
31515 | LARYNGOSCOPY W/WO TRACHEOSCOPY ASPIRATION | 2011-07-01 00:00:00 | 177.46 | N | Y | N/A | N/A
31520 | LARYNGOSCOPY W/WO TRACHEOSCOPY DX NEWBORN | 2011-07-01 00:00:00 | 135.67 | N | Y | N/A | N/A
31525 | LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN | 2011-07-01 00:00:00 | 214.4 | N | Y | N/A | N/A
31526 | LARYNGOSCOPY W/WO TRACHEOSCOPY W/MICRO/TELESCOPE | 2011-07-01 00:00:00 | 138 | N | Y | N/A | N/A
31527 | LARYNGOSCOPY W/WO TRACHEOSCOPY INSERT OBTURATOR | 2011-07-01 00:00:00 | 170.03 | N | Y | N/A | N/A
31528 | LARYNGOSCOPY W/WO TRACHEOSCOPY W/DILATION IN | 2011-07-01 00:00:00 | 126.34 | N | Y | N/A | N/A
31529 | LARYNGOSCOPY W/WO TRACHEOSCOPY DILATION SUBSQ | 2011-07-01 00:00:00 | 141.53 | N | Y | N/A | N/A
31530 | LARYNGOSCOPY W/FOREIGN BODY REMOVAL | 2011-07-01 00:00:00 | 173.05 | N | Y | N/A | N/A
31531 | LARYNGOSCOPY FOREIGN BODY RMVL MICRO/TELESCOPE | 2011-07-01 00:00:00 | 186.26 | N | Y | N/A | N/A
31535 | LARYNGOSCOPY DIRECT OPERATIVE W/BIOPSY | 2011-07-01 00:00:00 | 166.09 | N | Y | N/A | N/A
31536 | LARYNGOSCOPY W/BIOPSY MICROSCOPE/TELESCOPE | 2011-07-01 00:00:00 | 185.35 | N | Y | N/A | N/A
31540 | [NAME] TUM&/STRIPPING CORDS/EPIGLOTTIS | 2011-07-01 00:00:00 | 212.82 | N | Y | N/A | N/A
31541 | LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP | 2011-07-01 00:00:00 | 232.45 | N | Y | N/A | N/A
31545 | LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD FLAP | 2011-07-01 00:00:00 | 318.23 | N | Y | N/A | N/A
31546 | LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD GRAFT | 2011-07-01 00:00:00 | 482.03 | N | Y | N/A | N/A
31560 | LARYNGOSCOPY DIRECT OPERATIVE W/ARYTENOIDECTOMY | 2011-07-01 00:00:00 | 275.61 | N | Y | N/A | N/A
31561 | LARGSC ARYTENOIDECTOMY MICROSCOPE/TELESCOPE | 2011-07-01 00:00:00 | 301.42 | N | Y | N/A | N/A
31570 | LARYNGOSCOPE [NAME] CORD THERAPEUTIC | 2011-07-01 00:00:00 | 293.98 | N | Y | N/A | N/A
31571 | LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE | 2011-07-01 00:00:00 | 219.29 | N | Y | N/A | N/A
31575 | LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC | 2011-07-01 00:00:00 | 98.31 | N | Y | N/A | N/A
31576 | LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY | 2011-07-01 00:00:00 | 192.18 | N | Y | N/A | N/A
31577 | LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY | 2011-07-01 00:00:00 | 207.32 | N | Y | N/A | N/A
31578 | LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION | 2011-07-01 00:00:00 | 240.89 | N | Y | N/A | N/A
31579 | LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY | 2011-07-01 00:00:00 | 184.22 | N | Y | N/A | N/A
31580 | LARYNGOPLASTY LARYN WEB 2 STG W/KEEL INSJ&RMVL | 2011-07-01 00:00:00 | 1039.43 | N | Y | N/A | N/A
31582 | LARYNGP LARYN STENOSIS GRF/CORE MOLD W/TRACHT | 2011-07-01 00:00:00 | 1630.87 | N | Y | N/A | N/A
31584 | LARYNGOPLASTY W/OPEN REDUCTION FRACTURE | 2011-07-01 00:00:00 | 1295.96 | N | Y | N/A | N/A
31587 | LARYNGOPLASTY CRICOID SPLIT | 2011-07-01 00:00:00 | 858.03 | N | Y | N/A | N/A
31588 | LARYNGOPLASTY NOT OTHERWISE SPECIFIED | 2011-07-01 00:00:00 | 978.3 | N | Y | N/A | N/A
31590 | LARYNGEAL REINNERVATION NEUROMUSCULAR PEDICLE | 2011-07-01 00:00:00 | 761.36 | N | Y | N/A | N/A
31595 | SECTION RECURRENT LARYNGEAL NERVE THER UNI SPX | 2011-07-01 00:00:00 | 655.03 | N | Y | N/A | N/A
31599 | UNLISTED PROC, LARYNX | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
31600 | TRACHEOSTOMY PLANNED SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 340.37 | N | Y | N/A | N/A
31601 | TRACHEOSTOMY PLANNED UNDER 2 YEARS SPX | 2011-07-01 00:00:00 | 226.88 | N | Y | N/A | N/A
31603 | TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL | 2011-07-01 00:00:00 | 192.3 | N | Y | N/A | N/A
31605 | TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE | 2011-07-01 00:00:00 | 156.52 | N | Y | N/A | N/A
31610 | TRACHEOSTOMY FENESTRATION W/SKIN FLAPS | 2011-07-01 00:00:00 | 608.08 | N | Y | N/A | N/A
31611 | [NAME] PROSTH | 2011-07-01 00:00:00 | 459.75 | N | Y | N/A | N/A
31612 | TRACHEAL PNXR PRQ W/TRANSTRACHEAL ASPIR&/NJX | 2011-07-01 00:00:00 | 69.26 | N | Y | N/A | N/A
31613 | TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION | 2011-07-01 00:00:00 | 381.83 | N | Y | N/A | N/A
31614 | TRACHEOSTOMA REVJ CPLX W/FLAP ROTATION | 2011-07-01 00:00:00 | 639.22 | N | Y | N/A | N/A
31615 | TRACHEOBRNCHSC THRU EST TRACHS INC | 2011-07-01 00:00:00 | 156.11 | N | Y | N/A | N/A
31620 | ENDOBRNCL US BRONCHOSCOPIC DX/THER IVNTJ | 2011-07-01 00:00:00 | 236.95 | N | Y | N/A | N/A
31622 | BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX | 2011-07-01 00:00:00 | 267.44 | N | Y | N/A | N/A
31623 | BRNCHSC BRUSHING/PROTECTED BRUSHINGS | 2011-07-01 00:00:00 | 287.83 | N | Y | N/A | N/A
31624 | BRNCHSC W/BRNCL ALVEOLAR LAVAGE | 2011-07-01 00:00:00 | 269.09 | N | Y | N/A | N/A
31625 | BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES | 2011-07-01 00:00:00 | 289.25 | N | Y | N/A | N/A
31626 | BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT | 2011-07-01 00:00:00 | 379.47 | N | Y | N/A | N/A
31627 | BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION | 2011-07-01 00:00:00 | 1080.94 | N | Y | N/A | N/A
31628 | BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE | 2011-07-01 00:00:00 | 339.16 | N | Y | N/A | N/A
31629 | BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRONCH | 2011-07-01 00:00:00 | 525.48 | N | Y | N/A | N/A
31630 | BRNCHSC W/TRACHEAL/BRONCHIAL DILAT/CLSD RDCTJ FX | 2011-07-01 00:00:00 | 175.54 | N | Y | N/A | N/A
31631 | BRONCHOSCOPY W/PLACEMENT TRACHEAL STENT | 2011-07-01 00:00:00 | 199.76 | N | Y | N/A | N/A
31632 | BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE | 2011-07-01 00:00:00 | 61.56 | N | Y | N/A | N/A
31633 | BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA LOBE | 2011-07-01 00:00:00 | 75.28 | N | Y | N/A | N/A
31634 | BRONCHOSCOPY BALLOON OCCLUSION | 2011-07-01 00:00:00 | 1534.12 | N | Y | N/A | N/A
31635 | BRONCHOSCOPY W/REMOVAL FOREIGN BODY | 2011-07-01 00:00:00 | 296.39 | N | Y | N/A | N/A
31636 | BRNCHSC W/PLACEMENT BRNCL STENT 1ST BRONCHUS | 2011-07-01 00:00:00 | 193.76 | N | Y | N/A | N/A
31637 | BRONCHOSCOPY EACH MAJOR BRONCHUS STENTED | 2011-07-01 00:00:00 | 67.25 | N | Y | N/A | N/A
31638 | BRNCHSC REVJ TRACHEAL/BRNCL STENT INS PREV SESS | 2011-07-01 00:00:00 | 221.44 | N | Y | N/A | N/A
31640 | BRONCHOSCOPY W/EXCISION TUMOR | 2011-07-01 00:00:00 | 223.66 | N | Y | N/A | N/A
31641 | BRNCHSC W/DSTRJ TUM RELIEF STENOSIS OTH/THN EXC | 2011-07-01 00:00:00 | 223.8 | N | Y | N/A | N/A
31643 | BRNCHSC W/PLMT CATH INTRCV RADIOELMNT APPL | 2011-07-01 00:00:00 | 152.16 | N | Y | N/A | N/A
31645 | BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST | 2011-07-01 00:00:00 | 259.43 | N | Y | N/A | N/A
31646 | BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ | 2011-07-01 00:00:00 | 236.22 | N | Y | N/A | N/A
31647 | BRNCHSC OCCLUSION&INSERT BRONCH VALVE INIT LOBE | 2013-01-01 00:00:00 | 190.97 | N | N | N/A | N/A
31648 | BRNCHSC REMOVAL BRONCHIAL VALVE INITIAL | 2013-01-01 00:00:00 | 198.62 | N | N | N/A | N/A
31649 | BRNCHSC REMOVAL BRONCHIAL VALVE EA ADDL | 2013-01-01 00:00:00 | 63.46 | N | N | N/A | N/A
31651 | BRNCHSC OCCLUSION&INSERT BRONCH VALVE ADDL LOBE | 2013-01-01 00:00:00 | 67.38 | N | N | N/A | N/A
31660 | BRONCHOSCOPIC THERMOPLASTY ONE LOBE | 2013-01-01 00:00:00 | 191.21 | N | N | N/A | N/A
31661 | BRONCHOSCOPIC THERMOPLASTY 2/> LOBES | 2013-01-01 00:00:00 | 201.71 | N | N | N/A | N/A
31717 | CATHETERIZATION W/BRONCHIAL BRUSH BIOPSY | 2011-07-01 00:00:00 | 244.1 | N | Y | N/A | N/A
31720 | CATHETER ASPIRATION NASOTRACHEAL SPX | 2011-07-01 00:00:00 | 44.77 | N | Y | N/A | N/A
31725 | CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX | 2011-07-01 00:00:00 | 82.18 | N | Y | N/A | N/A
31730 | TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER | 2011-07-01 00:00:00 | 863.78 | N | Y | N/A | N/A
31750 | TRACHEOPLASTY CERVICAL | 2011-07-01 00:00:00 | 1161.42 | N | Y | N/A | N/A
31755 | TRACHEOPLASTY TRACHEOPHARYNGEAL FSTLJ EA STG | 2011-07-01 00:00:00 | 1471.35 | N | Y | N/A | N/A
31760 | TRACHEOPLASTY INTRATHORACIC | 2011-07-01 00:00:00 | 1181.21 | N | Y | N/A | N/A
31766 | CARINAL RECONSTRUCTION | 2011-07-01 00:00:00 | 1528.96 | N | Y | N/A | N/A
31770 | BRONCHOPLASTY GRAFT REPAIR | 2011-07-01 00:00:00 | 1144.76 | N | Y | N/A | N/A
31775 | BRONCHOPLASTY EXCISION STENOSIS & ANASTOMOSIS | 2011-07-01 00:00:00 | 1171.6 | N | Y | N/A | N/A
31780 | EXCISION TRACHEAL STENOSIS&ANASTOMOSIS CERVICAL | 2011-07-01 00:00:00 | 1029.11 | N | Y | N/A | N/A
31781 | EXC TRACHEAL STENOSIS&ANAST CERVICOTHORACIC | 2011-07-01 00:00:00 | 1211 | N | Y | N/A | N/A
31785 | EXCISION TRACHEAL TUMOR/CARCINOMA CERVICAL | 2011-07-01 00:00:00 | 933.48 | N | Y | N/A | N/A
31786 | EXCISION TRACHEAL TUMOR/CARCINOMA THORACIC | 2011-07-01 00:00:00 | 1255.85 | N | Y | N/A | N/A
31800 | SUTURE TRACHEAL WOUND/INJURY CERVICAL | 2011-07-01 00:00:00 | 598.38 | N | Y | N/A | N/A
31805 | SUTURE TRACHEAL WOUND/INJURY INTRATHORACIC | 2011-07-01 00:00:00 | 700.65 | N | Y | N/A | N/A
31820 | SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR | 2011-07-01 00:00:00 | 369.59 | N | Y | N/A | N/A
31825 | SURG CLSR TRACHEOSTOMY/FISTULA W/PLASTIC RPR | 2011-07-01 00:00:00 | 514.66 | N | Y | N/A | N/A
31830 | REVISION TRACHEOSTOMY SCAR | 2011-07-01 00:00:00 | 372.84 | N | Y | N/A | N/A
31899 | UNLISTED PROC TRACHEA/BRONCHI | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
32035 | THORACOSTOMY W/RIB RESECTION EMPYEMA | 2011-07-01 00:00:00 | 614.53 | N | Y | N/A | N/A
32036 | THORACOSTOMY OPEN FLAP DRAINAGE EMPYEMA | 2011-07-01 00:00:00 | 662.72 | N | Y | N/A | N/A
32096 | THORACTOMY W/DX BX LUNG INFILTRATE UNILATERAL | 2012-01-01 00:00:00 | 680.07 | N | N | N/A | N/A
32097 | THORACTOMY W/DX BX LUNG NODULE/MASS UNILATERAL | 2012-01-01 00:00:00 | 680.07 | N | N | N/A | N/A
32098 | THORACOTOMY W/BIOPSY OF PLEURA | 2012-01-01 00:00:00 | 639.23 | N | N | N/A | N/A
32100 | THORACOTOMY WITH EXPLORATION | 2011-07-01 00:00:00 | 821.58 | N | Y | N/A | N/A
32110 | THORCOM CTRL TRAUMTC HEMRRG&/RPR LNG TEAR | 2011-07-01 00:00:00 | 1249.74 | N | Y | N/A | N/A
32120 | THORACOTOMY POSTOPERATIVE COMPLICATIONS | 2011-07-01 00:00:00 | 749.5 | N | Y | N/A | N/A
32124 | THORACOTOMY OPN INTRAPLEURAL PNEUMONOLYSIS | 2011-07-01 00:00:00 | 795.29 | N | Y | N/A | N/A
32140 | THORCOM W/REMOVAL OF CYST | 2011-07-01 00:00:00 | 848.25 | N | Y | N/A | N/A
32141 | THORACOTOMY W/RESECTION BULLAE | 2011-07-01 00:00:00 | 1309.28 | N | Y | N/A | N/A
32150 | [NAME] | 2011-07-01 00:00:00 | 857.3 | N | Y | N/A | N/A
32151 | [NAME] | 2011-07-01 00:00:00 | 867.15 | N | Y | N/A | N/A
32160 | THORACOTOMY W/CARDIAC MASSAGE | 2011-07-01 00:00:00 | 665.11 | N | Y | N/A | N/A
32200 | PNEUMONOSTOMY W/OPEN DRAINAGE ABSCESS/CYST | 2011-07-01 00:00:00 | 970.07 | N | Y | N/A | N/A
32215 | PLEURAL SCARIFICATION REPEAT PNEUMOTHORAX | 2011-07-01 00:00:00 | 686.55 | N | Y | N/A | N/A
32220 | [NAME] TOTAL SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 1367.46 | N | Y | N/A | N/A
32225 | [NAME] PARTIAL SEPARATE PROC | 2011-07-01 00:00:00 | 854.99 | N | Y | N/A | N/A
32310 | PLEURECTOMY PARIETAL SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 786.33 | N | Y | N/A | N/A
32320 | DECORTICATION & PARIETAL PLEURECTOMY | 2011-07-01 00:00:00 | 1373.36 | N | Y | N/A | N/A
32400 | BIOPSY PLEURA PERCUTANEOUS NEEDLE | 2011-07-01 00:00:00 | 128.48 | N | Y | N/A | N/A
32405 | BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE | 2011-07-01 00:00:00 | 85.52 | N | Y | N/A | N/A
32440 | REMOVAL OF LUNG PNEUMONECTOMY | 2011-07-01 00:00:00 | 1355.18 | N | Y | N/A | N/A
32442 | REMOVAL LUNG PNEUMONECTOMY RESXN SGMNT TRACHEA | 2011-07-01 00:00:00 | 2455.7 | N | Y | N/A | N/A
32445 | REMOVAL LUNG PNEUMONECTOMY EXTRAPLEURAL | 2011-07-01 00:00:00 | 2999.82 | N | Y | N/A | N/A
32480 | RMVL LUNG OTHER THAN PNEUMONECTOMY 1 LOBE LOBECT | 2011-07-01 00:00:00 | 1281.65 | N | Y | N/A | N/A
32482 | RMVL LUNG OTHER THAN PNEUMONECT 2 LOBES BILOBEC | 2011-07-01 00:00:00 | 1370.36 | N | Y | N/A | N/A
32484 | RMVL LUNG OTHER THAN PNEUMONECT 1 SEGMENTECTOMY | 2011-07-01 00:00:00 | 1242.5 | N | Y | N/A | N/A
32486 | RMVL LUNG XCP TOT PNEUMONECTOMY SLEEVE LOBECTOMY | 2011-07-01 00:00:00 | 2024.06 | N | Y | N/A | N/A
32488 | RMVL LUNG OTHER/THAN PNUMEC COMPLETION PNUMEC | 2011-07-01 00:00:00 | 2054.29 | N | Y | N/A | N/A
32501 | RESCJ&BRONCHOPLASTY PFRMD TM LOBEC/SGMECTOMY | 2011-07-01 00:00:00 | 212.92 | N | Y | N/A | N/A
32503 | RESCJ APICAL LUNG TUMOR W/O CHEST WALL RCNSTJ | 2011-07-01 00:00:00 | 1561.1 | N | Y | N/A | N/A
32504 | RESCJ APICAL LUNG TUMOR W/CHEST WALL RCNSTJ | 2011-07-01 00:00:00 | 1775.9 | N | Y | N/A | N/A
32505 | THORACOTOMY W/THERAPEUTIC WEDGE RESEXN INITIAL | 2012-01-01 00:00:00 | 784.97 | N | N | N/A | N/A
32506 | THORACOTOMY W/THERAP WEDGE RESEXN ADDL IPSILATRL | 2012-01-01 00:00:00 | 132.68 | N | N | N/A | N/A
32507 | THORACOTOMY W/DX WEDGE RESEXN &ANTOM LUNG RESEXN | 2012-01-01 00:00:00 | 132.68 | N | N | N/A | N/A
32540 | EXTRAPLEURAL ENUCLEATION EMPYEMA EMPYEMECTOMY | 2011-07-01 00:00:00 | 1474.98 | N | Y | N/A | N/A
32550 | INSERTION INDWELLING TUNNELED PLEURAL CATHETER | 2011-07-01 00:00:00 | 675.35 | N | Y | N/A | N/A
32551 | TUBE THORACOSTOMY INCLUDES WATER SEAL | 2011-07-01 00:00:00 | 148.34 | N | Y | N/A | N/A
32552 | RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF | 2011-07-01 00:00:00 | 157.64 | N | Y | N/A | N/A
32553 | INS MARK THOR FOR RT PERQ | 2011-07-01 00:00:00 | 522.89 | N | Y | N/A | N/A
32554 | THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING | 2013-01-01 00:00:00 | 460.19 | N | N | N/A | N/A
32555 | THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING | 2013-01-01 00:00:00 | 530.92 | N | N | N/A | N/A
32556 | PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING | 2013-01-01 00:00:00 | 486.32 | N | N | N/A | N/A
32557 | PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING | 2013-01-01 00:00:00 | 783.89 | N | N | N/A | N/A
32560 | INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS | 2011-07-01 00:00:00 | 220.79 | N | Y | N/A | N/A
32561 | LYSE CHEST FIBRIN INIT DAY | 2011-07-01 00:00:00 | 81.59 | N | Y | N/A | N/A
32562 | LYSE CHEST FIBRIN SUBQ DAY | 2011-07-01 00:00:00 | 72.79 | N | Y | N/A | N/A
32601 | THORSC DX LUNGS/PERICAR/MED/PLEURAL SPACE W/O BX | 2011-07-01 00:00:00 | 266.44 | N | Y | N/A | N/A
32604 | THORACOSCOPY DX PERICARDIAL SAC W/BIOPSY SPX | 2011-07-01 00:00:00 | 417.76 | N | Y | N/A | N/A
32606 | THORACOSCOPY DX MEDIASTINAL SPACE W/BIOPSY SPX | 2011-07-01 00:00:00 | 400.46 | N | Y | N/A | N/A
32607 | THORACOSCOPY W/DX BX OF LUNG INFILTRATE UNILATRL | 2012-01-01 00:00:00 | 260.87 | N | N | N/A | N/A
32608 | THORACOSCOPY W/DX BX OF LUNG NODULES UNILATRL | 2012-01-01 00:00:00 | 320.43 | N | N | N/A | N/A
32609 | THORACOSCOPY WITH BIOPSYIES OF PLEURA | 2012-01-01 00:00:00 | 221.06 | N | N | N/A | N/A
32650 | THORACOSCOPY W/PLEURODESIS | 2011-07-01 00:00:00 | 574.67 | N | Y | N/A | N/A
32651 | THORACOSCOPY W/PARTIAL PULMONARY DECORTICATION | 2011-07-01 00:00:00 | 933.69 | N | Y | N/A | N/A
32652 | THRSC TOT PULM DCRTCTJ INTRAPLEURAL PNEUMONOLSS | 2011-07-01 00:00:00 | 1416.91 | N | Y | N/A | N/A
32653 | THORACOSCOPY RMVL INTRAPLEURAL FB/FIBRIN DEPOSIT | 2011-07-01 00:00:00 | 900.18 | N | Y | N/A | N/A
32654 | THORACOSCOPY CONTROL TRAUMATIC HEMORRHAGE | 2011-07-01 00:00:00 | 1004.95 | N | Y | N/A | N/A
32655 | THORACOSCOPY W/RESECTION BULLAE W/WO PLEURAL PX | 2011-07-01 00:00:00 | 818.19 | N | Y | N/A | N/A
32656 | THORACOSCOPY W/PARIETAL PLEURECTOMY | 2011-07-01 00:00:00 | 687.94 | N | Y | N/A | N/A
32658 | THORACOSCOPY W/RMVL CLOT/FB FROM PERICARDIAL SAC | 2011-07-01 00:00:00 | 617.26 | N | Y | N/A | N/A
32659 | THRSC CRTJ PRCRD WINDOW/PRTL RESCJ PRCRD SAC | 2011-07-01 00:00:00 | 632.66 | N | Y | N/A | N/A
32661 | THORACOSCOPY W/EXC PERICARDIAL CYST TUMOR/MASS | 2011-07-01 00:00:00 | 689.59 | N | Y | N/A | N/A
32662 | THORACOSCOPY W/EXC MEDIASTINAL CYST TUMOR/MASS | 2011-07-01 00:00:00 | 773.06 | N | Y | N/A | N/A
32663 | THORACOSCOPY W/LOBECTOMY SINGLE LOBE | 2011-07-01 00:00:00 | 1206.81 | N | Y | N/A | N/A
32664 | THORACOSCOPY W/THORACIC SYMPATHECTOMY | 2011-07-01 00:00:00 | 729.59 | N | Y | N/A | N/A
32665 | THORACOSCOPY W/ESOPHAGOMYOTOMY HELLER TYPE | 2011-07-01 00:00:00 | 1047.37 | N | Y | N/A | N/A
32666 | THORACOSCOPY W/THERA WEDGE RESEXN INITIAL UNILAT | 2012-01-01 00:00:00 | 733.3 | N | N | N/A | N/A
32667 | THORACOSCOPY W/THERA WEDGE RESEXN ADDL IPSILATRL | 2012-01-01 00:00:00 | 132.68 | N | N | N/A | N/A
32668 | THORACOSCOPY W/DX WEDGE RESEXN ANATO LUNG RESEXN | 2012-01-01 00:00:00 | 133.32 | N | N | N/A | N/A
32669 | THORACOSCOPY W/SEGMENTECTOMY | 2012-01-01 00:00:00 | 1131.24 | N | N | N/A | N/A
32670 | THORACOSCOPY W/BILOBECTOMY | 2012-01-01 00:00:00 | 1350.98 | N | N | N/A | N/A
32671 | THORACOSCOPY W/PNEUMONECTOMY | 2012-01-01 00:00:00 | 1498.61 | N | N | N/A | N/A
32672 | THORACOSCOPY W/RESEXN-PLICAJ EMPHYSEMA LUNG UNIL | 2012-01-01 00:00:00 | 1281.73 | N | N | N/A | N/A
32673 | THORACOSCOPY RESEXN THYMUS UNI/BILATERAL | 2012-01-01 00:00:00 | 1014.06 | N | N | N/A | N/A
32674 | THORCOSCPY W/MEDIASTINL &REGIONL LYMPHADENECTOMY | 2012-01-01 00:00:00 | 182.02 | N | N | N/A | N/A
32701 | THORAX STEREOTACTIC RADIATION TARGET W/TX COURSE | 2013-01-01 00:00:00 | 183.52 | N | N | N/A | N/A
32800 | REPAIR LUNG HERNIA THROUGH CHEST WALL | 2011-07-01 00:00:00 | 804.74 | N | Y | N/A | N/A
32810 | CLSR CH WALL FLWG OPN FLAP DRG EMPYEMA | 2011-07-01 00:00:00 | 773.74 | N | Y | N/A | N/A
32815 | OPEN CLOSURE MAJOR BRONCHIAL FISTULA | 2011-07-01 00:00:00 | 2382.19 | N | Y | N/A | N/A
32820 | MAJOR RECONSTRUCTION CHEST WALL POSTTRAUMATIC | 2011-07-01 00:00:00 | 1151.79 | N | Y | N/A | N/A
32850 | DONOR PNEUMONECTOMY (INCLUDING COLD [NAME]) FROM CADAVER DONER | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
32851 | LUNG TRANSPLANT 1 W/O CARDIOPULMONARY BYPASS | 2011-07-01 00:00:00 | 2228.99 | Y | Y | N/A | N/A
32852 | LUNG TRANSPLANT 1 W/CARDIOPULMONARY BYPASS | 2011-07-01 00:00:00 | 2467.34 | Y | Y | N/A | N/A
32853 | LUNG TRANSPLANT 2 W/O CARDIOPULMONARY BYPASS | 2011-07-01 00:00:00 | 2649.16 | Y | Y | N/A | N/A
32854 | LUNG TRANSPLANT 2 W/CARDIOPULMONARY BYPASS | 2011-07-01 00:00:00 | 2899.54 | Y | Y | N/A | N/A
32855 | BKBENCH PREPJ CADAVER DONOR LUNG ALLOGRAFT UNI | 2011-07-01 00:00:00 | 151.72 | Y | Y | N/A | N/A
32856 | BKBENCH PREPJ CADAVER DONOR LUNG ALLOGRAFT BI | 2011-07-01 00:00:00 | 151.72 | Y | Y | N/A | N/A
32900 | RESECTION RIBS EXTRAPLEURAL ALL STAGES | 2011-07-01 00:00:00 | 1190.14 | N | Y | N/A | N/A
32905 | THORACOPLASTY SCHEDE TYPE/EXTRAPLEURAL | 2011-07-01 00:00:00 | 1150.19 | N | Y | N/A | N/A
32906 | THORACOP SCHEDE TYP/XTRPLEURAL CLSR BRNCPLR FSTL | 2011-07-01 00:00:00 | 1423.86 | N | Y | N/A | N/A
32940 | [NAME] | 2011-07-01 00:00:00 | 1059.97 | N | Y | N/A | N/A
32960 | [NAME] INJECTION AIR | 2011-07-01 00:00:00 | 118.68 | N | Y | N/A | N/A
32997 | TOTAL LUNG LAVAGE UNILATERAL | 2011-07-01 00:00:00 | 307.22 | N | Y | N/A | N/A
32998 | ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI | 2011-07-01 00:00:00 | 2453.84 | N | Y | N/A | N/A
32999 | UNLISTED PROCEDURE, LUNGS AND PLEURA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
33010 | PERICARDIOCENTESIS INITIAL | 2011-07-01 00:00:00 | 106.07 | N | Y | N/A | N/A
33011 | PERICARDIOCENTESIS SUBSEQUENT | 2011-07-01 00:00:00 | 105.62 | N | Y | N/A | N/A
33015 | TUBE PERICARDIOSTOMY | 2011-07-01 00:00:00 | 451.8 | N | Y | N/A | N/A
33020 | PERICARDIOTOMY REMOVAL CLOT/FOREIGN BODY PRIMARY | 2011-07-01 00:00:00 | 756.15 | N | Y | N/A | N/A
33025 | CRTJ PERICARDIAL WINDOW/PRTL RESECJ W/DRG/BX | 2011-07-01 00:00:00 | 691.76 | N | Y | N/A | N/A
33030 | PRICARDIECTOMY STOT/COMPL W/O CARDPULM BYPASS | 2011-07-01 00:00:00 | 1113.94 | N | Y | N/A | N/A
33031 | PRICARDIECTOMY STOT/COMPL W/CARDPULM BYPASS | 2011-07-01 00:00:00 | 1239.08 | N | Y | N/A | N/A
33050 | RESECTION PERICARDIAL CYST/TUMOR | 2011-07-01 00:00:00 | 865.19 | N | Y | N/A | N/A
33120 | [NAME] TUMOR RESCJ CARDIOPULMONARY BYP | 2011-07-01 00:00:00 | 1347.34 | N | Y | N/A | N/A
33130 | RESECTION EXTERNAL CARDIAC TUMOR | 2011-07-01 00:00:00 | 1197.11 | N | Y | N/A | N/A
33140 | TRANSMYOCARDIAL LASER REVASCULAR THORACOTOMY SPX | 2011-07-01 00:00:00 | 1376.55 | N | Y | N/A | N/A
33141 | TRANSMYOCRD LASER REVSC PFRMD TM OTH OPN CAR PX | 2011-07-01 00:00:00 | 119.77 | N | Y | N/A | N/A
33202 | INSERTION EPICARDIAL ELECTRODE OPEN | 2011-07-01 00:00:00 | 672.3 | N | Y | N/A | N/A
33203 | INSERTION EPICARDIAL ELECTRODE ENDOSCOPIC | 2011-07-01 00:00:00 | 706.01 | N | Y | N/A | N/A
33206 | INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL | 2011-07-01 00:00:00 | 404.26 | N | Y | N/A | N/A
33207 | INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR | 2011-07-01 00:00:00 | 430.52 | N | Y | N/A | N/A
33208 | INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT | 2011-07-01 00:00:00 | 464.97 | N | Y | N/A | N/A
33210 | INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH | 2011-07-01 00:00:00 | 159.46 | N | Y | N/A | N/A
33211 | INSJ/RPLCMT TEMP TRANSVNS 2CHMBR PACG ELTRDS SPX | 2011-07-01 00:00:00 | 161.77 | N | Y | N/A | N/A
33212 | INS PM PLS GEN W/EXIST SINGLE LEAD | 2011-07-01 00:00:00 | 299.54 | N | Y | N/A | N/A
33213 | INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS | 2011-07-01 00:00:00 | 341.54 | N | Y | N/A | N/A
33214 | UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS | 2011-07-01 00:00:00 | 426.63 | N | Y | N/A | N/A
33215 | RPSG PREV IMPLTED PM/CVDFB R ATR/R VENTR ELTRD | 2011-07-01 00:00:00 | 270.55 | N | Y | N/A | N/A
33216 | INSJ 1 TRANSVNS ELTRD PERM PACEMAKER OR CVDFB | 2011-07-01 00:00:00 | 334.24 | N | Y | N/A | N/A
33217 | INSJ 2 TRANSVNS ELTRD PERM PACEMAKER OR CVDFB | 2011-07-01 00:00:00 | 332.17 | N | Y | N/A | N/A
33218 | RPR 1 ELTRD PRM PM/PACING CVDFB | 2011-07-01 00:00:00 | 348.55 | N | Y | N/A | N/A
33220 | RPR 2 ELTRDS PRM PM/PACING CVDFB | 2011-07-01 00:00:00 | 351.47 | N | Y | N/A | N/A
33221 | INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS | 2012-01-01 00:00:00 | 295.44 | N | N | N/A | N/A
33222 | REVISION/RELOCATION SKIN POCKET PACEMAKER | 2011-07-01 00:00:00 | 306.52 | N | Y | N/A | N/A
33223 | REVJ SKN POCKET FOR CARDIOVERTER-DEFIBRILLATOR | 2011-07-01 00:00:00 | 367.7 | N | Y | N/A | N/A
33224 | INSJ ELTRD CAR VEN SYS ATTCH PM/CVDFB PLS GEN | 2011-07-01 00:00:00 | 449.94 | N | Y | N/A | N/A
33225 | INSJ ELTRD CAR [NAME]/PM PLS GEN | 2011-07-01 00:00:00 | 405.65 | N | Y | N/A | N/A
33226 | RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD | 2011-07-01 00:00:00 | 433.21 | N | Y | N/A | N/A
33227 | REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD | 2012-01-01 00:00:00 | 281.85 | N | N | N/A | N/A
33228 | REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS | 2012-01-01 00:00:00 | 293.98 | N | N | N/A | N/A
33229 | REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD | 2012-01-01 00:00:00 | 306.09 | N | N | N/A | N/A
33230 | INS PACNG CVDFB PLS GEN ONLY W/EXIST DUAL LEADS | 2012-01-01 00:00:00 | 317.97 | N | N | N/A | N/A
33231 | INS PACNG CVDFB PLS GEN ONLY W/EXIST MULTI LEADS | 2012-01-01 00:00:00 | 330.08 | N | N | N/A | N/A
33233 | REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY | 2011-07-01 00:00:00 | 212.17 | N | Y | N/A | N/A
33234 | RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR | 2011-07-01 00:00:00 | 431.49 | N | Y | N/A | N/A
33235 | RMVL TRANSVNS PM ELTRD DUAL LEAD SYS | 2011-07-01 00:00:00 | 563.11 | N | Y | N/A | N/A
33236 | RMVL PRM EPICAR PM&ELTRDS [NAME] LEAD SYS | 2011-07-01 00:00:00 | 679.91 | N | Y | N/A | N/A
33237 | RMVL PRM EPICAR PM&ELTRDS THORCOM DUAL LEAD SYS | 2011-07-01 00:00:00 | 730.47 | N | Y | N/A | N/A
33238 | RMVL PRM TRANSVENOUS ELECTRODE THORACOTOMY | 2011-07-01 00:00:00 | 811.41 | N | Y | N/A | N/A
33240 | INSJ 1/2 CHMBR PACING CARDIOVERTERDEFIB PLS GEN | 2011-07-01 00:00:00 | 411.17 | N | Y | N/A | N/A
33241 | REMVL PAC CVDFB PLS GEN ONLY | 2011-07-01 00:00:00 | 199.82 | N | Y | N/A | N/A
33243 | RMVL 1/2CHMBR PACG CARDIOVTERDEFIB ELTRD THORCOM | 2011-07-01 00:00:00 | 1193.32 | N | Y | N/A | N/A
33244 | RMVL 1/2CHMBR PACG CVDFB ELTRD TRANSVNS XTRJ | 2011-07-01 00:00:00 | 757.98 | N | Y | N/A | N/A
33249 | INS/REP PAC PERM CVDFB TRNSVEN LEADS 1/2 CHAMBER | 2011-07-01 00:00:00 | 805.7 | N | Y | N/A | N/A
33250 | [NAME] | 2011-07-01 00:00:00 | 1277.25 | N | Y | N/A | N/A
33251 | [NAME] | 2011-07-01 00:00:00 | 1418.44 | N | Y | N/A | N/A
33254 | ABLATION & RECONSTRUCTION ATRIA LIMITED | 2011-07-01 00:00:00 | 1187.58 | N | Y | N/A | N/A
33255 | ABLATION & RCNSTJ ATRIA X10SV W/O BYPASS | 2011-07-01 00:00:00 | 1440.72 | N | Y | N/A | N/A
33256 | ABLATION & RCNSTJ ATRIA X10SV W/BYPASS | 2011-07-01 00:00:00 | 1711.61 | N | Y | N/A | N/A
33257 | ATRIA ABLATE & RCNSTJ W OTHER PROCEDURE LIMITED | 2011-07-01 00:00:00 | 507.89 | N | Y | N/A | N/A
33258 | ATRIA ABLTJ &RCNSTJ W OTHER PX EXTENSIVE W/O BYP | 2011-07-01 00:00:00 | 571.24 | N | Y | N/A | N/A
33259 | ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTEN W/BYPASS | 2011-07-01 00:00:00 | 737.19 | N | Y | N/A | N/A
33261 | OPRATIVE ABLTJ VENTR ARRHYTHMOGENIC FOC W/BYPASS | 2011-07-01 00:00:00 | 1410.17 | N | Y | N/A | N/A
33262 | REM PAC CVDFB PLSE GEN &REPL PLSE GEN SNGL LEAD | 2012-01-01 00:00:00 | 306.43 | N | N | N/A | N/A
33263 | REM PAC CVDFB PLSE GEN &REPL PLSE GEN DUAL LEAD | 2012-01-01 00:00:00 | 318.55 | N | N | N/A | N/A
33264 | REM PAC CVDFB PLS GEN &REPL PLSE GEN MULTI LEAD | 2012-01-01 00:00:00 | 330.67 | N | N | N/A | N/A
33265 | NDSC ABLATION & RCNSTJ ATRIA LIMITED W/O BYPASS | 2011-07-01 00:00:00 | 1176.22 | N | Y | N/A | N/A
33266 | NDSC ABLATION & RCNSTJ ATRIA EXTEN W/O BYPASS | 2011-07-01 00:00:00 | 1606.37 | N | Y | N/A | N/A
33282 | IMPLANTATION PT-ACTIVATED CARDIAC EVENT RECORDER | 2011-07-01 00:00:00 | 287.41 | Y | Y | N/A | N/A
33284 | RMVL IMPLANTABLE PT-ACTIVATED CAR EVENT RECORDER | 2011-07-01 00:00:00 | 207.11 | N | Y | N/A | N/A
33300 | REPAIR CARDIAC WOUND W/O BYPASS | 2011-07-01 00:00:00 | 2097.31 | N | Y | N/A | N/A
33305 | REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS | 2011-07-01 00:00:00 | 3525.15 | N | Y | N/A | N/A
33310 | CARDIOT EXPL W/RMVL FB ATR/VENTR THRMB W/O BYP | 2011-07-01 00:00:00 | 1009.92 | N | Y | N/A | N/A
33315 | CARDIOT EXPL RMVL FB ATR/VENTR THRMB CARD BYP | 2011-07-01 00:00:00 | 1289.17 | N | Y | N/A | N/A
33320 | SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP | 2011-07-01 00:00:00 | 924.16 | N | Y | N/A | N/A
33321 | SUTR RPR AORTA/GREAT VESSEL W/SHUNT BYPASS | 2011-07-01 00:00:00 | 1032.37 | N | Y | N/A | N/A
33322 | SUTURE REPAIR AORTA/GREAT VESSEL W/BYPASS | 2011-07-01 00:00:00 | 1211.87 | N | Y | N/A | N/A
33330 | INSJ GRAFT AORTA/GREAT VESSEL W/O SHUNT/BYPASS | 2011-07-01 00:00:00 | 1236.43 | N | Y | N/A | N/A
33332 | INSJ GRAFT AORTA/GREAT VESSEL W/SHUN | 2011-07-01 00:00:00 | 1213.61 | N | Y | N/A | N/A
33335 | INSJ GRAFT AORTA/GREAT VESSEL W/BYPASS | 2011-07-01 00:00:00 | 1640.22 | N | Y | N/A | N/A
33361 | REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH | 2013-01-01 00:00:00 | 1119.74 | N | N | N/A | N/A
33362 | REPLACE AORTIC VALVE OPENFEMORAL ARTERY APPROACH | 2013-01-01 00:00:00 | 1225.15 | N | N | N/A | N/A
33363 | REPLACE AORTIC VALVE OPEN AXILLRY ARTRY APPROACH | 2013-01-01 00:00:00 | 1268.52 | N | N | N/A | N/A
33364 | REPLACE AORTIC VALVE OPEN ILIAC ARTERY APPROACH | 2013-01-01 00:00:00 | 1349.21 | N | N | N/A | N/A
33365 | REPLACE AORTIC VALVE OPEN TRANSAORTIC APPROACH | 2013-01-01 00:00:00 | 1475.12 | N | N | N/A | N/A
33366 | TRANSCATHETER TRANSAPICAL REPLACEMT AORTIC VALVE | 2014-01-01 00:00:00 | 1639.05 | N | Y | N/A | N/A
33367 | REPLACE AORTIC VALVE W/BYP PRQ ART/VENOUS APPRCH | 2013-01-01 00:00:00 | 518.32 | N | N | N/A | N/A
33368 | REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS APRCH | 2013-01-01 00:00:00 | 628.07 | N | N | N/A | N/A
33369 | REPLACE AORTA VALVE W/BYP CNTRL ART/VENOUS APRCH | 2013-01-01 00:00:00 | 829.23 | N | N | N/A | N/A
33400 | VALVULOPLASTY AORTIC VALVE OPEN W/BYPASS | 2011-07-01 00:00:00 | 1993.35 | N | Y | N/A | N/A
33401 | VALVULOPLASTY AORTIC VALVE OPEN W/INFLOW OCCLUS | 2011-07-01 00:00:00 | 1255 | N | Y | N/A | N/A
33403 | VLVP AORTIC VALVE W/TRANSVENTR DILAT W/CARD BYP | 2011-07-01 00:00:00 | 1302.52 | N | Y | N/A | N/A
33404 | [NAME] CONDUIT | 2011-07-01 00:00:00 | 1534.01 | N | Y | N/A | N/A
33405 | RPLCMT PROST AORTIC VALVE XCP HOMOGRF/STENT | 2011-07-01 00:00:00 | 2003.65 | N | Y | N/A | N/A
33406 | RPLCMT AORTIC VALVE ALLOGRAFT VALVE FREEHAND | 2011-07-01 00:00:00 | 2507.85 | N | Y | N/A | N/A
33410 | RPLCMT AORTIC VALVE W/STENTLESS TISSUE VALVE | 2011-07-01 00:00:00 | 2220.89 | N | Y | N/A | N/A
33411 | RPLCMT AORTIC VALVE ANNULUS ENLGMENT NONC SINUS | 2011-07-01 00:00:00 | 2922.44 | N | Y | N/A | N/A
33412 | REPLACEMENT AORTIC VALVE KONNO PROCEDURE | 2011-07-01 00:00:00 | 2149.66 | N | Y | N/A | N/A
33413 | REPLACEMENT AORTIC&PULMON VALVES ROSS PROCEDURE | 2011-07-01 00:00:00 | 2825.13 | N | Y | N/A | N/A
33414 | RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC | 2011-07-01 00:00:00 | 1889.27 | N | Y | N/A | N/A
33415 | RESECTION/INCISION SUBVALVULAR TISSUE | 2011-07-01 00:00:00 | 1760.73 | N | Y | N/A | N/A
33416 | VENTRICULOMYOTOMY-MYECTOMY | 2011-07-01 00:00:00 | 1768.03 | N | Y | N/A | N/A
33417 | [NAME] | 2011-07-01 00:00:00 | 1456.3 | N | Y | N/A | N/A
33420 | VALVOTOMY MITRAL VALVE CLOSED HEART | 2011-07-01 00:00:00 | 1243.86 | N | Y | N/A | N/A
33422 | [NAME] OPEN HEART W/BYPASS | 2011-07-01 00:00:00 | 1469.99 | N | Y | N/A | N/A
33425 | VALVULOPLASTY MITRAL VALVE W/CARDIAC BYPASS | 2011-07-01 00:00:00 | 2361.15 | N | Y | N/A | N/A
33426 | VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING | 2011-07-01 00:00:00 | 2088.01 | N | Y | N/A | N/A
33427 | VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING | 2011-07-01 00:00:00 | 2149.38 | N | Y | N/A | N/A
33430 | REPLACEMENT MITRAL VALVE W/CARDIOPULMONARY BYP | 2011-07-01 00:00:00 | 2444.84 | N | Y | N/A | N/A
33460 | VALVECTOMY TRICUSPID VALVE W/CARDIOPULMONARY BYP | 2011-07-01 00:00:00 | 2096.87 | N | Y | N/A | N/A
33463 | VALVULOPLASTY TRICUSPID VALVE W/O RING INSERTION | 2011-07-01 00:00:00 | 2672.64 | N | Y | N/A | N/A
33464 | VALVULOPLASTY TRICUSPID VALVE W/RING INSERTION | 2011-07-01 00:00:00 | 2124.95 | N | Y | N/A | N/A
33465 | REPLACEMENT TRICUSPID VALVE W/CARD BYPASS | 2011-07-01 00:00:00 | 2387.04 | N | Y | N/A | N/A
33468 | TRICUSPID VALVE RPSG&PLCTJ EBSTEIN ANOMALY | 2011-07-01 00:00:00 | 1623.9 | N | Y | N/A | N/A
33470 | [NAME] CLSD HEART TRANSVENTR | 2011-07-01 00:00:00 | 1096.2 | N | Y | N/A | N/A
33471 | VALVOTOMY PULM VALVE CLSD HEART VIA PULM ARTERY | 2011-07-01 00:00:00 | 1098.08 | N | Y | N/A | N/A
33472 | VALVOTOMY PULM VALVE OPEN HRT W/INFLOW OCCLUSION | 2011-07-01 00:00:00 | 1075.07 | N | Y | N/A | N/A
33474 | [NAME] VALVE OPEN HEART W/BYPASS | 2011-07-01 00:00:00 | 1847.8 | N | Y | N/A | N/A
33475 | [NAME] VALVE | 2011-07-01 00:00:00 | 2033.28 | N | Y | N/A | N/A
33476 | R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY | 2011-07-01 00:00:00 | 1312.71 | N | Y | N/A | N/A
33478 | OUTFLOW TRACT AGMNTJ W/WO COMMISSUR/INFUND RESCJ | 2011-07-01 00:00:00 | 1366.93 | N | Y | N/A | N/A
33496 | RPR NON-STRUCT PROSTC VALVE DYSFUNCTION W/BYPASS | 2011-07-01 00:00:00 | 1456.14 | N | Y | N/A | N/A
33500 | RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/BYPASS | 2011-07-01 00:00:00 | 1372.37 | N | Y | N/A | N/A
33501 | RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/O BYPASS | 2011-07-01 00:00:00 | 973.66 | N | Y | N/A | N/A
33502 | RPR ANOM CORONARY ART PULM ART ORIGIN LIGATION | 2011-07-01 00:00:00 | 1106.22 | N | Y | N/A | N/A
33503 | RPR ANOM CORONARY ARTERY PULM ART ORIGIN GRAFT | 2011-07-01 00:00:00 | 1163.56 | N | Y | N/A | N/A
33504 | RPR ANOM CORONARY ART PULM ART ORIGIN GRF W/BYP | 2011-07-01 00:00:00 | 1267.24 | N | Y | N/A | N/A
33505 | RPR ANOM CORON ART W/CONSTJ INTRAPULM ART TUNNEL | 2011-07-01 00:00:00 | 1793.42 | N | Y | N/A | N/A
33506 | RPR ANOM CORONARY ART FROM PULM ART TO AORTA | 2011-07-01 00:00:00 | 1889.56 | N | Y | N/A | N/A
33507 | RPR ANOM AORTIC ORIGIN CORONARY ART UNROOF/TLCJ | 2011-07-01 00:00:00 | 1499.93 | N | Y | N/A | N/A
33508 | NDSC SURG W/VIDEO-ASSISTED HARVEST VEIN CABG | 2011-07-01 00:00:00 | 14.17 | N | Y | N/A | N/A
33510 | CORONARY ARTERY BYPASS 1 CORONARY VENOUS GRAFT | 2011-07-01 00:00:00 | 1706.09 | N | Y | N/A | N/A
33511 | CORONARY ARTERY BYPASS 2 CORONARY VENOUS GRAFTS | 2011-07-01 00:00:00 | 1868.99 | N | Y | N/A | N/A
33512 | CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS | 2011-07-01 00:00:00 | 2119.37 | N | Y | N/A | N/A
33513 | CORONARY ARTERY BYPASS 4 CORONARY VENOUS GRAFTS | 2011-07-01 00:00:00 | 2171.23 | N | Y | N/A | N/A
33514 | CORONARY ARTERY BYPASS 5 CORONARY VENOUS GRAFTS | 2011-07-01 00:00:00 | 2299.25 | N | Y | N/A | N/A
33516 | CORONARY ARTERY BYPASS 6/+ CORONARY VENOUS GRAFT | 2011-07-01 00:00:00 | 2391.28 | N | Y | N/A | N/A
33517 | CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 1 VEIN | 2011-07-01 00:00:00 | 163.78 | N | Y | N/A | N/A
33518 | CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 2 VEINS | 2011-07-01 00:00:00 | 358.95 | N | Y | N/A | N/A
33519 | CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 3 VEINS | 2011-07-01 00:00:00 | 475.87 | N | Y | N/A | N/A
33521 | CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 4 VEINS | 2011-07-01 00:00:00 | 572.99 | N | Y | N/A | N/A
33522 | CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 5 VEINS | 2011-07-01 00:00:00 | 645.21 | N | Y | N/A | N/A
33523 | CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 6 VEINS | 2011-07-01 00:00:00 | 732.7 | N | Y | N/A | N/A
33530 | ROPRTJ CAB/VALVE PX GT 1 MO AFTER ORIGINAL [NAME] | 2011-07-01 00:00:00 | 457.34 | N | Y | N/A | N/A
33533 | CABG W/ARTERIAL GRAFT SINGLE ARTERIAL GRAFT | 2011-07-01 00:00:00 | 1650.6 | N | Y | N/A | N/A
33534 | CABG W/ARTERIAL GRAFT TWO ARTERIAL GRAFTS | 2011-07-01 00:00:00 | 1936.66 | N | Y | N/A | N/A
33535 | CABG W/ARTERIAL GRAFT THREE ARTERIAL GRAFTS | 2011-07-01 00:00:00 | 2156.79 | N | Y | N/A | N/A
33536 | CABG W/ARTERIAL GRAFT FOUR/GTARTERIAL GRAFTS | 2011-07-01 00:00:00 | 2318.81 | N | Y | N/A | N/A
33542 | [NAME] | 2011-07-01 00:00:00 | 2278.45 | N | Y | N/A | N/A
33545 | RPR POSTINFRCJ VENTRICULAR SEPTAL DEFECT | 2011-07-01 00:00:00 | 2678.46 | N | Y | N/A | N/A
33548 | SURG VENTRICULAR RSTRJ PX W/PROSTC PATCH PFRMD | 2011-07-01 00:00:00 | 2598.81 | N | Y | N/A | N/A
33572 | CORONARY ENDARTERCOMY OPEN ANY METHOD | 2011-07-01 00:00:00 | 203.39 | N | Y | N/A | N/A
33600 | [NAME] ATRIOVENTRICULAR VALVE SUTURE/PATCH | 2011-07-01 00:00:00 | 1482.07 | N | Y | N/A | N/A
33602 | CLOSURE SEMILUNAR VALVE AORTIC/PULM SUTURE/PATCH | 2011-07-01 00:00:00 | 1419.14 | N | Y | N/A | N/A
33606 | ANAST PULMONARY ART AORTA DAMUS-KAYE-STANSEL PX | 2011-07-01 00:00:00 | 1556.33 | N | Y | N/A | N/A
33608 | RPR CAR ANOMAL XCP PULM ATRESIA VENTR SEPTL DFCT | 2011-07-01 00:00:00 | 1566.13 | N | Y | N/A | N/A
33610 | RPR CAR ANOMAL SURG ENLGMENT VENTR SEPTL DFCT | 2011-07-01 00:00:00 | 1534.54 | N | Y | N/A | N/A
33611 | RPR 2 OUTLET R VNTRC W/INTRAVENTR TUNNEL RPR | 2011-07-01 00:00:00 | 1705.89 | N | Y | N/A | N/A
33612 | RPR 2 OUTLET R VNTRC RPR R VENTR O/F TRC OBSTRCJ | 2011-07-01 00:00:00 | 1724.41 | N | Y | N/A | N/A
33615 | RPR CAR ANOMAL CLSR SEPTL DFCT SMPL FONTAN PX | 2011-07-01 00:00:00 | 1742.27 | N | Y | N/A | N/A
33617 | RPR COMPLEX CARDIAC ANOMALY MODIFIED FONTAN PX | 2011-07-01 00:00:00 | 1866.8 | N | Y | N/A | N/A
33619 | RPR 1 VNTRC W/O/F OBSTRCJ&AORTIC ARCH HYPOPLASIA | 2011-07-01 00:00:00 | 2372.16 | N | Y | N/A | N/A
33620 | APPLICATION RIGHT & LEFT PULMONARY ARTERY BANDS | 2011-07-01 00:00:00 | 1434.94 | N | Y | N/A | N/A
33621 | TRANSTHORACIC CATHETER INSERTION FOR STENT PLMT | 2011-07-01 00:00:00 | 773.63 | N | Y | N/A | N/A
33622 | RECONSTRUCTION COMPLEX CARDIAC ANOMALY | 2011-07-01 00:00:00 | 3032.23 | N | Y | N/A | N/A
33641 | RPR ATRIAL SEPTAL DFCT SECUNDUM W/BYP W/WO PATCH | 2011-07-01 00:00:00 | 1424.11 | N | Y | N/A | N/A
33645 | DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG | 2011-07-01 00:00:00 | 1377.96 | N | Y | N/A | N/A
33647 | RPR ATRIAL & VENTRIC SEPTAL DFCT DIR/PATCH CLSR | 2011-07-01 00:00:00 | 1473.55 | N | Y | N/A | N/A
33660 | RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR | 2011-07-01 00:00:00 | 1618.91 | N | Y | N/A | N/A
33665 | RPR INTRM/TRANSJ AV CANAL W/WO AV VALVE RPR | 2011-07-01 00:00:00 | 1672.7 | N | Y | N/A | N/A
33670 | RPR COMPL AV CANAL W/WO PROSTC VALVE | 2011-07-01 00:00:00 | 1726 | N | Y | N/A | N/A
33675 | [NAME] MULTIPLE VENTRICULAR SEPTAL DEFECTS | 2011-07-01 00:00:00 | 1717.75 | N | Y | N/A | N/A
33676 | CLOSURE MULTIPLE VSD W/RESECTION | 2011-07-01 00:00:00 | 1698.39 | N | Y | N/A | N/A
33677 | CLOSURE MULTIPLE VSD W/REMOVAL ARTERY BAND | 2011-07-01 00:00:00 | 1678.71 | N | Y | N/A | N/A
33681 | CLSR 1 VENTRICULAR SEPTAL DEFECT W/WO PATCH | 2011-07-01 00:00:00 | 1599.98 | N | Y | N/A | N/A
33684 | CLSR V-SEPTL DFCT W/PULM VLVT/INFUND RESCJ | 2011-07-01 00:00:00 | 1650.38 | N | Y | N/A | N/A
33688 | CLSR V-SEPTAL DFCT W/RMVL P-ART BAND W/WO GUSSET | 2011-07-01 00:00:00 | 1634.63 | N | Y | N/A | N/A
33690 | BANDING PULMONARY ARTERY | 2011-07-01 00:00:00 | 1060.24 | N | Y | N/A | N/A
33692 | COMPL RPR TETRALOGY FALLOT W/O PULM ATRESIA | 2011-07-01 00:00:00 | 1461.95 | N | Y | N/A | N/A
33694 | COMPL RPR T-FALLOT W/O PULM ATRESIA TANULR PATCH | 2011-07-01 00:00:00 | 1709.92 | N | Y | N/A | N/A
33697 | COMPL RPR T-FALLOT W/PULM ATRESIA | 2011-07-01 00:00:00 | 1826.42 | N | Y | N/A | N/A
33702 | RPR SINUS VALSALVA FISTULA | 2011-07-01 00:00:00 | 1341.94 | N | Y | N/A | N/A
33710 | RPR SINUS VALSALVA FISTULA W/RPR V-SEPTAL DEFECT | 2011-07-01 00:00:00 | 1545.51 | N | Y | N/A | N/A
33720 | RPR SINUS VALSALVA ANEURYSM | 2011-07-01 00:00:00 | 1340.51 | N | Y | N/A | N/A
33722 | CLOSURE AORTICO-LEFT VENTRICULAR TUNNEL | 2011-07-01 00:00:00 | 1439.7 | N | Y | N/A | N/A
33724 | REPAIR ISOLATED PARTIAL PULM VENOUS RETURN | 2011-07-01 00:00:00 | 1346.71 | N | Y | N/A | N/A
33726 | [NAME] | 2011-07-01 00:00:00 | 1832.01 | N | Y | N/A | N/A
33730 | COMPLETE RPR [NAME] | 2011-07-01 00:00:00 | 1722.76 | N | Y | N/A | N/A
33732 | RPR COR TRIATM/SUPVALVR RING RESCJ L ATRIAL MEMB | 2011-07-01 00:00:00 | 1435.51 | N | Y | N/A | N/A
33735 | ATRIAL SEPTECTOMY/SEPTOSTOMY CLOSED HEART | 2011-07-01 00:00:00 | 1120 | N | Y | N/A | N/A
33736 | ATRIAL SEPTECTOMY/SEPTOSTOMY OPEN HEART W/BYPASS | 2011-07-01 00:00:00 | 1220.67 | N | Y | N/A | N/A
33737 | ATRIAL SEPTECT/SEPTOST OPN HRT W/INFL OCCLUSION | 2011-07-01 00:00:00 | 1122.14 | N | Y | N/A | N/A
33750 | SHUNT SUBCLAVIAN PULMONARY ARTERY | 2011-07-01 00:00:00 | 1167.66 | N | Y | N/A | N/A
33755 | SHUNT ASCENDING AORTA PULMONARY ARTERY | 2011-07-01 00:00:00 | 1122.36 | N | Y | N/A | N/A
33762 | SHUNT DESCENDING AORTA PULMONARY ARTERY | 2011-07-01 00:00:00 | 1070.75 | N | Y | N/A | N/A
33764 | SHUNT CENTRAL W/PROSTHETIC GRAFT | 2011-07-01 00:00:00 | 1131.4 | N | Y | N/A | N/A
33766 | SHUNT SUPERIOR VENA CAVA PULMONARY ART 1 LUNG | 2011-07-01 00:00:00 | 1172.36 | N | Y | N/A | N/A
33767 | SHUNT SUPERIOR VENA CAVA PULM ARTERY BOTH LUNGS | 2011-07-01 00:00:00 | 1231.83 | N | Y | N/A | N/A
33768 | ANASTOMOSIS CAVOPULMARY 2ND SUPRIOR VENA CAVA | 2011-07-01 00:00:00 | 352.47 | N | Y | N/A | N/A
33770 | RPR TRPOS GREAT VSLS W/O ENLGMNT V-SEPTL DFCT | 2011-07-01 00:00:00 | 1838.79 | N | Y | N/A | N/A
33771 | RPR TRPOS GREAT VSLS W/ENLGMNT V-SEPTL DFCT | 2011-07-01 00:00:00 | 1824 | N | Y | N/A | N/A
33774 | RPR TRPOS GREAT VSLS ATRIAL BAFFLE PX W/BYPASS | 2011-07-01 00:00:00 | 1567.17 | N | Y | N/A | N/A
33775 | RPR TRPOS GREAT VSLS ATR BAFFLE W/RMVL PULM BAND | 2011-07-01 00:00:00 | 1552.73 | N | Y | N/A | N/A
33776 | RPR TRPOS GRT VSL ATR BAFFLE W/CLSR V-SEPTL DFCT | 2011-07-01 00:00:00 | 1639.79 | N | Y | N/A | N/A
33777 | RPR TRPOS GRT VSL ATR BAFFLE W/BYP SBPULM OBSTRC | 2011-07-01 00:00:00 | 1513.97 | N | Y | N/A | N/A
33778 | RPR TRPOS GRT VESSEL AORTIC [NAME] | 2011-07-01 00:00:00 | 1970.18 | N | Y | N/A | N/A
33779 | RPR TGV AORTIC PULM ART RCNSTJ W/RMVL PULM BAND | 2011-07-01 00:00:00 | 1954.99 | N | Y | N/A | N/A
33780 | RPR TGV AORTIC P-ART RCNSTJ W/CLSR V-SEPTL DFCT | 2011-07-01 00:00:00 | 2004.72 | N | Y | N/A | N/A
33781 | RPR TGV AORTIC P-ART RCNSTJ RPR SBPULMC OBSTRCJ | 2011-07-01 00:00:00 | 1938.23 | N | Y | N/A | N/A
33782 | ATRIAL BAFFLE PROCEDURE | 2011-07-01 00:00:00 | 2776.19 | N | Y | N/A | N/A
33783 | A-ROOT TLCJ VSD PULM STNS RPR W/RIMPLTJ C OSTIA | 2011-07-01 00:00:00 | 3000.3 | N | Y | N/A | N/A
33786 | TOTAL REPAIR TRUNCUS ARTERIOSUS | 2011-07-01 00:00:00 | 1859.28 | N | Y | N/A | N/A
33788 | REIMPLANTATION [NAME] ARTERY | 2011-07-01 00:00:00 | 1254.59 | N | Y | N/A | N/A
33800 | AORTIC SUSPENSION TRACHEAL DECOMPRESSION SPX | 2011-07-01 00:00:00 | 851.49 | N | Y | N/A | N/A
33802 | DIVISION ABERRANT VESSEL VASCULAR RING | 2011-07-01 00:00:00 | 959.67 | N | Y | N/A | N/A
33803 | DIVISION ABERRANT VESSEL W/REANASTOMOSIS | 2011-07-01 00:00:00 | 991.93 | N | Y | N/A | N/A
33813 | OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS | 2011-07-01 00:00:00 | 1116.23 | N | Y | N/A | N/A
33814 | OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/BYPASS | 2011-07-01 00:00:00 | 1324.24 | N | Y | N/A | N/A
33820 | REPAIR PATENT DUCTUS ARTERIOSUS LIGATION | 2011-07-01 00:00:00 | 847.61 | N | Y | N/A | N/A
33822 | RPR PATENT DUXUS ARTERIOSUS DIV UNDER 18 YR | 2011-07-01 00:00:00 | 854.08 | N | Y | N/A | N/A
33824 | RPR PATENT DUXUS ARTERIOSUS DIV 18 YR&OLDER | 2011-07-01 00:00:00 | 1034.86 | N | Y | N/A | N/A
33840 | EXC COARCJ AORTA W/WO PDA W/DIRECT ANASTOMOSIS | 2011-07-01 00:00:00 | 1094.87 | N | Y | N/A | N/A
33845 | EXCISION COARCTATION AORTA W/WO PDA W/GRAFT | 2011-07-01 00:00:00 | 1176.84 | N | Y | N/A | N/A
33851 | EXC COARCJ AORTA W/L SUBCLAV ART/PROSTC GUSSET | 2011-07-01 00:00:00 | 1203.68 | N | Y | N/A | N/A
33852 | RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/O BYPASS | 2011-07-01 00:00:00 | 1210.98 | N | Y | N/A | N/A
33853 | RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/BYPASS | 2011-07-01 00:00:00 | 1618.34 | N | Y | N/A | N/A
33860 | ASCENDING AORTA GRF W/CARD BYP & VALVE SSP | 2011-07-01 00:00:00 | 2790.08 | N | Y | N/A | N/A
33863 | AS-AORT GRF W/CARD BYP & AORTIC ROOT RPLCMT | 2011-07-01 00:00:00 | 2751.17 | N | Y | N/A | N/A
33864 | ASCENDING AORTA GRF VALVE SPARE ROOT REMODEL | 2011-07-01 00:00:00 | 2817.19 | N | Y | N/A | N/A
33870 | TRANSVERSE ARCH GRAFT W/CARDIOPULMONARY BYPASS | 2011-07-01 00:00:00 | 2202.66 | N | Y | N/A | N/A
33875 | DESCENDING THORACIC AORTA GRAFT W/WO BYPASS | 2011-07-01 00:00:00 | 1736.17 | N | Y | N/A | N/A
33877 | RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS | 2011-07-01 00:00:00 | 3151.76 | N | Y | N/A | N/A
33880 | EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH | 2011-07-01 00:00:00 | 1605.38 | N | Y | N/A | N/A
33881 | EVASC RPR DTA EXP COVERAGE W/O ART ORIGIN | 2011-07-01 00:00:00 | 1381.28 | N | Y | N/A | N/A
33883 | PLMT PROX XTN PROSTH EVASC RPR DTA 1ST XTN | 2011-07-01 00:00:00 | 1001.63 | N | Y | N/A | N/A
33884 | PLMT PROX XTN PROSTH EVASC RPR DTA EA PROX XTN | 2011-07-01 00:00:00 | 364.54 | N | Y | N/A | N/A
33886 | PLMT DSTL XTN PROSTH DLYD AFTER EVASC RPR DTA | 2011-07-01 00:00:00 | 866.57 | N | Y | N/A | N/A
33889 | OPN SUBCLA CRTD ART TRPOS NCK INC ULAT | 2011-07-01 00:00:00 | 711.23 | N | Y | N/A | N/A
33891 | BYP GRF W/DESCENDING THORACIC AORTA RPR NECK INC | 2011-07-01 00:00:00 | 878.05 | N | Y | N/A | N/A
33910 | [NAME] ARTERY EMBOLECTOMY W/CARD BYPASS | 2011-07-01 00:00:00 | 1458.99 | N | Y | N/A | N/A
33915 | [NAME] ARTERY EMBOLECTOMY W/O CARD BYPASS | 2011-07-01 00:00:00 | 1186.82 | N | Y | N/A | N/A
33916 | [NAME] EMBOLECTOMY W/BYPASS | 2011-07-01 00:00:00 | 1423.76 | N | Y | N/A | N/A
33917 | RPR [NAME] | 2011-07-01 00:00:00 | 1283.78 | N | Y | N/A | N/A
33920 | RPR PULMONARY ATRESIA W/CONSTJ/RPLCMT CONDUIT | 2011-07-01 00:00:00 | 1581.08 | N | Y | N/A | N/A
33922 | TRANSECTION PULMONARY ARTERY W/CARD BYPASS | 2011-07-01 00:00:00 | 1204.76 | N | Y | N/A | N/A
33924 | [NAME] SHUNT W/CGEN HEART PX | 2011-07-01 00:00:00 | 247.65 | N | Y | N/A | N/A
33925 | RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/O BYPASS | 2011-07-01 00:00:00 | 1506.15 | N | Y | N/A | N/A
33926 | RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/BYPASS | 2011-07-01 00:00:00 | 2194.96 | N | Y | N/A | N/A
33935 | HEART-LUNG TRNSPL W/RECIPIENT CARDIECTOMY-PNUMEC | 2011-07-01 00:00:00 | 3010.46 | Y | Y | N/A | N/A
33940 | DONOR CARDIECTOMY | 2008-07-01 00:00:00 | 1651.15 | N | Y | N/A | N/A
33944 | BACKBENCH STANDARD PREP OF CADAVER DONOR HEART ALLOGRAFT PRIOR TO TRANSPLANT | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
33945 | HEART TRANSPLANT W/WO RECIPIENT CARDIECTOMY | 2011-07-01 00:00:00 | 4177.56 | Y | Y | N/A | N/A
33960 | PROLONGED EXTRACORPOREAL CIRCULATION INIT DAY | 2011-07-01 00:00:00 | 862.07 | N | Y | N/A | N/A
33961 | PROLONGED EXTRACORPOREAL CIRCULATION EA ADDL DAY | 2011-07-01 00:00:00 | 481.74 | N | Y | N/A | N/A
33967 | INSERTION INTRA-AORTIC BALLOON ASSIST DEV PRQ | 2011-07-01 00:00:00 | 234.37 | N | Y | N/A | N/A
33968 | REMOVAL INTRA-AORTIC BALLOON ASSIST DEVICE PRQ | 2011-07-01 00:00:00 | 30.1 | N | Y | N/A | N/A
33970 | [NAME] BALO ASSIST DEV VIA FEM ART OPEN | 2011-07-01 00:00:00 | 315.46 | N | Y | N/A | N/A
33971 | RMVL I-AORT BALO ASST DEV W/RPR FEM ART W/WO GRF | 2011-07-01 00:00:00 | 623.23 | N | Y | N/A | N/A
33973 | INSJ I-AORT BALO ASSIST DEV VIA ASCENDING AORTA | 2011-07-01 00:00:00 | 457.92 | N | Y | N/A | N/A
33974 | RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA | 2011-07-01 00:00:00 | 783.33 | N | Y | N/A | N/A
33975 | INSJ VENTRIC ASSIST [NAME] SINGLE VENTRICLE | 2011-07-01 00:00:00 | 958.91 | N | Y | N/A | N/A
33976 | INSJ VENTRIC ASSIST [NAME] | 2011-07-01 00:00:00 | 1061.16 | N | Y | N/A | N/A
33977 | REMOVAL VENTR ASSIST DEVICE XTRCORP 1 VENTRICLE | 2011-07-01 00:00:00 | 1048.46 | N | Y | N/A | N/A
33978 | REMOVAL VENTR ASSIST [NAME] | 2011-07-01 00:00:00 | 1161.93 | N | Y | N/A | N/A
33979 | INSJ VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC | 2011-07-01 00:00:00 | 2096.03 | N | Y | N/A | N/A
33980 | RMVL VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC | 2011-07-01 00:00:00 | 3150.38 | N | Y | N/A | N/A
33981 | REPLAC OF EXTRACORPOREAL VENTRICULAR DEVICE, [NAME] OR BIVENTRICULAR, PUMP(S) | 2012-07-01 00:00:00 | 711.82 | Y | Y | N/A | N/A
33982 | REPLACEMENT OF VENTRICULAR PUMP(S); IMPLANTABLE ,W/O CARDIOPULMONARY BYPASS | 2012-07-01 00:00:00 | 1169.12 | Y | Y | N/A | N/A
33983 | IMPLANTABLE INTRACORPOREAL, SINGLE VENTRICLE, WITH CARDIOPULMONARY BYPASS | 2012-07-01 00:00:00 | 1959.73 | Y | Y | N/A | N/A
33990 | INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY | 2013-01-01 00:00:00 | 364.19 | N | N | N/A | N/A
33991 | INSJ PERQ VAD TRNSPTAL W/IMAGE ART&VENOUS ACCESS | 2013-01-01 00:00:00 | 530.69 | N | N | N/A | N/A
33992 | REMOVAL PERCUTANEOUS VAD DIFFERENT SESSION | 2013-01-01 00:00:00 | 173.41 | N | N | N/A | N/A
33993 | REPOSITION VAD W/IMAGING DIFFERENT SESSION | 2013-01-01 00:00:00 | 152.27 | N | N | N/A | N/A
33999 | UNLISTED CARDIAC PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
34001 | EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART | 2011-07-01 00:00:00 | 865.93 | N | Y | N/A | N/A
34051 | EMBLC/THRMBC INNOMINATE SUBCLAVIAN ARTERY | 2011-07-01 00:00:00 | 858.01 | N | Y | N/A | N/A
34101 | EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART | 2011-07-01 00:00:00 | 541.33 | N | Y | N/A | N/A
34111 | EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC | 2011-07-01 00:00:00 | 541.27 | N | Y | N/A | N/A
34151 | EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART | 2011-07-01 00:00:00 | 1249.29 | N | Y | N/A | N/A
34201 | EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART | 2011-07-01 00:00:00 | 915.1 | N | Y | N/A | N/A
34203 | EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC | 2011-07-01 00:00:00 | 863.42 | N | Y | N/A | N/A
34401 | THRMBC DIR/W/CATH VENA CAVA ILIAC VEIN ABDL INC | 2011-07-01 00:00:00 | 1310.77 | N | Y | N/A | N/A
34421 | THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN LEG INC | 2011-07-01 00:00:00 | 658.6 | N | Y | N/A | N/A
34451 | THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN ABDL&LEG | 2011-07-01 00:00:00 | 1318.55 | N | Y | N/A | N/A
34471 | THRMBC DIR/W/CATH SUBCLAVIAN VEIN NECK INC | 2011-07-01 00:00:00 | 1024.41 | N | Y | N/A | N/A
34490 | THRMBC DIR/W/CATH AXILL&SUBCLAVIAN VEIN ARM INC | 2011-07-01 00:00:00 | 547.52 | N | Y | N/A | N/A
34501 | VALVULOPLASTY FEMORAL VEIN | 2011-07-01 00:00:00 | 822.83 | N | Y | N/A | N/A
34502 | RECONSTRUCTION VENA CAVA ANY METHOD | 2011-07-01 00:00:00 | 1349.21 | N | Y | N/A | N/A
34510 | VENOUS VALVE TRANSPOSITION ANY VEIN DONOR | 2011-07-01 00:00:00 | 989.05 | N | Y | N/A | N/A
34520 | CROSS-OVER VEIN GRAFT VENOUS SYSTEM | 2011-07-01 00:00:00 | 906.87 | N | Y | N/A | N/A
34530 | SAPHENOPOPLITEAL VEIN ANASTOMOSIS | 2011-07-01 00:00:00 | 854.43 | N | Y | N/A | N/A
34800 | EVASC RPR AAA W/AORTO-AORTIC TUBE PROSTH | 2011-07-01 00:00:00 | 1013.12 | N | Y | N/A | N/A
34802 | EVASC RPR AAA W/MDLR BFRC PROSTH 1 LIMB | 2011-07-01 00:00:00 | 1119.28 | N | Y | N/A | N/A
34803 | EVASC RPR AAA W/MDLR BFRC PROSTH 2 LIMBS | 2011-07-01 00:00:00 | 1156.01 | Y | Y | N/A | N/A
34804 | EVASC RPR AAA W/UNIBDY BFRC PROSTH | 2011-07-01 00:00:00 | 1119.86 | N | Y | N/A | N/A
34805 | EVASC RPR AAA AORTO-UNIILIAC/AORTO-UNIFEM PROSTH | 2011-07-01 00:00:00 | 1063.1 | N | Y | N/A | N/A
34806 | TCAT PLACEMENT PHYSIOLOGIC SENSOR ANEURYSMAL SAC | 2011-07-01 00:00:00 | 92.21 | N | Y | N/A | N/A
34808 | EVASC PLACEMENT ILIAC ARTERY OCCLUSION DEVICE | 2011-07-01 00:00:00 | 183.25 | N | Y | N/A | N/A
34812 | OPN FEM ART EXPOS DLVR EVASC PROSTH UNI | 2011-07-01 00:00:00 | 300.4 | N | Y | N/A | N/A
34813 | PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR | 2011-07-01 00:00:00 | 212.14 | N | Y | N/A | N/A
34820 | ILIAC ART EXPOS PROSTH/ILIAC OCCLS EVASC UNI | 2011-07-01 00:00:00 | 433.72 | N | Y | N/A | N/A
34825 | PLMT XTN PROSTH EVASC RPR ARYSM/DSJ 1ST VSL | 2011-07-01 00:00:00 | 628.09 | N | Y | N/A | N/A
34826 | PLMT XTN PROSTH EVASC RPR ARYSM/DSJ EA VSL | 2011-07-01 00:00:00 | 184.05 | N | Y | N/A | N/A
34830 | OPN RPR ARYSM RPR [NAME] PROSTH | 2011-07-01 00:00:00 | 1611.36 | N | Y | N/A | N/A
34831 | OPN RPR ARYSM RPR [NAME] AORTOBIILIAC PROSTH | 2011-07-01 00:00:00 | 1718.81 | N | Y | N/A | N/A
34832 | OPN RPR ARYSM RPR [NAME] PROSTH | 2011-07-01 00:00:00 | 1732.37 | N | Y | N/A | N/A
34833 | ILIAC ART EXPOS W/CRTJ CONDUIT UNI | 2011-07-01 00:00:00 | 544.32 | N | Y | N/A | N/A
34834 | BRACH ART EXPOS DPLMNT AORTIC/ILIAC PROSTH UNI | 2011-07-01 00:00:00 | 246.11 | N | Y | N/A | N/A
34841 | ENDOVASC VISCER AORTA REPAIR FENEST 1 ENDOGRAFT | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
34842 | ENDOVASC VISCER AORTA REPAIR FENEST 2 ENDOGRAFT | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
34843 | ENDOVASC VISCER AORTA REPAIR FENEST 3 ENDOGRAFT | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
34844 | ENDOVASC VISCER AORTA REPR FENEST 4+ ENDOGRAFT | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
34845 | VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
34846 | VISCER AND INFRARENAL ABDOM AORTA 2 PROSTHESIS | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
34847 | VISCER AND INFRARENAL ABDOM AORTA 3 PROSTHESIS | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
34848 | VISCER AND INFRARENAL ABDOM AORTA 4+ PROSTHESIS | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
34900 | EVASC RPR ILIAC ART ILIO-ILIAC PROSTHESIS | 2011-07-01 00:00:00 | 806.54 | N | Y | N/A | N/A
35001 | DIR RPR ARYSM/&GRF INSJ CAROTID SUBCLAVIAN ART | 2011-07-01 00:00:00 | 1009.01 | N | Y | N/A | N/A
35002 | DIR RPR ARYSM&GRF INSJ RPTD ARYSM CRTD SUBCLA | 2011-07-01 00:00:00 | 1037.37 | N | Y | N/A | N/A
35005 | DIR RPR ANEURYSM & GRAFT INSJ VERTEBRAL ARTERY | 2011-07-01 00:00:00 | 979.79 | N | Y | N/A | N/A
35011 | DIR RPR ANEURYSM & GRAFT INSJ AX-BRACHIAL ARTERY | 2011-07-01 00:00:00 | 890.53 | N | Y | N/A | N/A
35013 | DIR RPR ARYSM&GRF INSJ RPTD AX-BRACHIAL ART | 2011-07-01 00:00:00 | 1114.42 | N | Y | N/A | N/A
35021 | DIR RPR ARYSM&GRF INSJ INNOMINATE SUBCLA ART | 2011-07-01 00:00:00 | 1055.22 | N | Y | N/A | N/A
35022 | DIR RPR ARYSM&GRF RPTD ARYSM INNOM SUBCLA ART | 2011-07-01 00:00:00 | 1236.92 | N | Y | N/A | N/A
35045 | DIR RPR ARYSM&GRF INSJ RADIAL/ULNAR ART | 2011-07-01 00:00:00 | 874.44 | N | Y | N/A | N/A
35081 | DIR RPR ARYSM&GRF INSJ ABDL AORTA | 2011-07-01 00:00:00 | 1568.95 | N | Y | N/A | N/A
35082 | DIR RPR ARYSM&GRF INSJ RPTD ARYSM ABDL AORTA | 2011-07-01 00:00:00 | 1957.48 | N | Y | N/A | N/A
35091 | DIR RPR ARYSM&GRF INSJ ABDL AORTA VISC VSL | 2011-07-01 00:00:00 | 1616.96 | N | Y | N/A | N/A
35092 | DIR RPR ARYSM&GRF RPTD ARYSM ABDL AORTA VISC VSL | 2011-07-01 00:00:00 | 2330.58 | N | Y | N/A | N/A
35102 | DIR RPR ARYSM&GRF INSJ ABDL AORTA ILIAC VSL | 2011-07-01 00:00:00 | 1694.49 | N | Y | N/A | N/A
35103 | DIR RPR ARYSM&GRF RPTD ARYSM ABDL AORTA ILIAC | 2011-07-01 00:00:00 | 2008.02 | N | Y | N/A | N/A
35111 | DIR RPR ARYSM&GRF INSJ SPLENIC ART | 2011-07-01 00:00:00 | 1276.88 | N | Y | N/A | N/A
35112 | DIR RPR ARYSM&GRF INSJ RPTD ARYSM SPLENIC ART | 2011-07-01 00:00:00 | 1567.18 | N | Y | N/A | N/A
35121 | DIR RPR ARYSM&GRF [NAME] RNL/MSN ART | 2011-07-01 00:00:00 | 1475.9 | N | Y | N/A | N/A
35122 | DIR RPR ARYSM&GRF RPTD ARYSM HEPATC CEL RNL/MSN | 2011-07-01 00:00:00 | 1718.07 | N | Y | N/A | N/A
35131 | DIR RPR ARYSM&GRF INSJ ILIAC ART | 2011-07-01 00:00:00 | 1249.34 | N | Y | N/A | N/A
35132 | DIR RPR ARYSM&GRF INSJ RPTD ARYSM ILIAC ART | 2011-07-01 00:00:00 | 1488.55 | N | Y | N/A | N/A
35141 | DIR RPR ARYSM&GRF INSJ COMMON FEM ART | 2011-07-01 00:00:00 | 993.5 | N | Y | N/A | N/A
35142 | DIR RPR ARYSM&GRF INSJ RPTD ARYSM COMMON FEM ART | 2011-07-01 00:00:00 | 1190.25 | N | Y | N/A | N/A
35151 | DIR RPR ARYSM&GRF INSJ POP ART | 2011-07-01 00:00:00 | 1121.47 | N | Y | N/A | N/A
35152 | DIR RPR ARYSM&GRF INSJ RPTD ARYSM POP ART | 2011-07-01 00:00:00 | 1281.95 | N | Y | N/A | N/A
35180 | REPAIR CONGENITAL ARTERIOVENOUS FISTULA HEAD&NCK | 2011-07-01 00:00:00 | 815.02 | N | Y | N/A | N/A
35182 | RPR CONGENITAL ARTERIOVENOUS FISTULA THORAX&ABD | 2011-07-01 00:00:00 | 1519.27 | N | Y | N/A | N/A
35184 | RPR CONGENITAL ARTERIOVENOUS FISTULA EXTREMITIES | 2011-07-01 00:00:00 | 907.17 | N | Y | N/A | N/A
35188 | RPR/TRAUMATIC ARTERIOVENOUS FISTULA HEAD & NECK | 2011-07-01 00:00:00 | 730.75 | N | Y | N/A | N/A
35189 | RPR/TRAUMATIC ARTERIOVENOUS FISTULA THORAX & ABD | 2011-07-01 00:00:00 | 1471.54 | N | Y | N/A | N/A
35190 | RPR/TRAUMATIC ARTERIOVENOUS FISTULA EXTREMITIES | 2011-07-01 00:00:00 | 667.18 | N | Y | N/A | N/A
35201 | REPAIR BLOOD VESSEL DIRECT NECK | 2011-07-01 00:00:00 | 833.18 | N | Y | N/A | N/A
35206 | REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY | 2011-07-01 00:00:00 | 684.35 | N | Y | N/A | N/A
35207 | REPAIR BLOOD VESSEL DIRECT HAND FINGER | 2011-07-01 00:00:00 | 633.29 | N | Y | N/A | N/A
35211 | RPR BLOOD VESSEL DIRECT INTRATHORACIC W/BYPASS | 2011-07-01 00:00:00 | 1208.53 | N | Y | N/A | N/A
35216 | RPR BLOOD VESSEL DIRECT INTRATHORACIC W/O BYPASS | 2011-07-01 00:00:00 | 1758.51 | N | Y | N/A | N/A
35221 | RPR BLOOD VESSEL DIRECT INTRA-ABDOMINAL | 2011-07-01 00:00:00 | 1253.93 | N | Y | N/A | N/A
35226 | RPR BLOOD VESSEL DIRECT LOWER EXTREMITY | 2011-07-01 00:00:00 | 747.42 | N | Y | N/A | N/A
35231 | REPAIR BLOOD VESSEL W/VEIN GRAFT NECK | 2011-07-01 00:00:00 | 1041.33 | N | Y | N/A | N/A
35236 | REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY | 2011-07-01 00:00:00 | 869.38 | N | Y | N/A | N/A
35241 | RPR BLOOD VESSEL VEIN GRAFT INTRATHORACIC W/BYP | 2011-07-01 00:00:00 | 1271.02 | N | Y | N/A | N/A
35246 | RPR BLOOD VESSEL VEIN GRF INTRATHORACIC W/O BYP | 2011-07-01 00:00:00 | 1326.74 | N | Y | N/A | N/A
35251 | REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL | 2011-07-01 00:00:00 | 1484.89 | N | Y | N/A | N/A
35256 | REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY | 2011-07-01 00:00:00 | 909.39 | N | Y | N/A | N/A
35261 | REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK | 2011-07-01 00:00:00 | 931.99 | N | Y | N/A | N/A
35266 | RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY | 2011-07-01 00:00:00 | 768.55 | N | Y | N/A | N/A
35271 | RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/BYP | 2011-07-01 00:00:00 | 1211.97 | N | Y | N/A | N/A
35276 | RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/O BYP | 2011-07-01 00:00:00 | 1263.15 | N | Y | N/A | N/A
35281 | RPR BLVSL W/GRFT OTHER/THAN VEIN INTRA-ABDOMINAL | 2011-07-01 00:00:00 | 1421.19 | N | Y | N/A | N/A
35286 | RPR BLVSL W/GRF OTHER/THAN VEIN LOWER EXTREMITY | 2011-07-01 00:00:00 | 839.15 | N | Y | N/A | N/A
35301 | TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC | 2011-07-01 00:00:00 | 940.37 | N | Y | N/A | N/A
35302 | TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY | 2011-07-01 00:00:00 | 1002.93 | N | Y | N/A | N/A
35303 | TEAEC W/GRAFT POPLITEAL ARTERY | 2011-07-01 00:00:00 | 1106.43 | N | Y | N/A | N/A
35304 | TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY | 2011-07-01 00:00:00 | 1145.76 | N | Y | N/A | N/A
35305 | TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL | 2011-07-01 00:00:00 | 1103.84 | N | Y | N/A | N/A
35306 | TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART | 2011-07-01 00:00:00 | 422.08 | N | Y | N/A | N/A
35311 | TEAEC W/WO PATCH GRF SUBCLAV INNOM THORACIC INC | 2011-07-01 00:00:00 | 1350.75 | N | Y | N/A | N/A
35321 | TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL | 2011-07-01 00:00:00 | 799.32 | N | Y | N/A | N/A
35331 | TEAEC W/WO PATCH GRAFT ABDOMINAL AORTA | 2011-07-01 00:00:00 | 1314.1 | N | Y | N/A | N/A
35341 | TEAEC W/WO PATCH GRAFT MESENTERIC CELIAC/RENAL | 2011-07-01 00:00:00 | 1228.7 | N | Y | N/A | N/A
35351 | TEAEC W/WO PATCH GRAFT ILIAC | 2011-07-01 00:00:00 | 1152.7 | N | Y | N/A | N/A
35355 | TEAEC W/WO PATCH GRAFT ILIOFEMORAL | 2011-07-01 00:00:00 | 935.04 | N | Y | N/A | N/A
35361 | TEAEC W/WO PATCH GRAFT COMBINED AORTOILIAC | 2011-07-01 00:00:00 | 1393.32 | N | Y | N/A | N/A
35363 | TEAEC W/WO PATCH GRAFT COMBINED AORTOILIOFEMORAL | 2011-07-01 00:00:00 | 1541.76 | N | Y | N/A | N/A
35371 | TEAEC W/WO PATCH GRAFT COMMON FEMORAL | 2011-07-01 00:00:00 | 738.5 | N | Y | N/A | N/A
35372 | TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL | 2011-07-01 00:00:00 | 882.58 | N | Y | N/A | N/A
35390 | ROPRTJ CRTD TEAEC GT 1 MO AFTER ORIGINAL OPRATION | 2011-07-01 00:00:00 | 142.61 | N | Y | N/A | N/A
35400 | [NAME] VESSEL/GRAFTS THER IVNTJ | 2011-07-01 00:00:00 | 133.91 | N | Y | N/A | N/A
35450 | [NAME] ANGIOPL OPN RENAL/OTH VISCERAL ART | 2011-07-01 00:00:00 | 459.42 | N | Y | N/A | N/A
35452 | TRLUML BALLOON ANGIOPLASTY OPEN AORTIC | 2011-07-01 00:00:00 | 319.37 | N | Y | N/A | N/A
35458 | TRLUML BALO ANGIOP OPN BRCH/CPHLC TRNK/BRNCH EA | 2011-07-01 00:00:00 | 436.32 | N | Y | N/A | N/A
35460 | TRLUML BALLOON ANGIOPLASTY OPEN VENOUS | 2011-07-01 00:00:00 | 278.7 | N | Y | N/A | N/A
35471 | TRLUML BALLOON ANGIOP PRQ RENAL/VISCERAL ART | 2011-07-01 00:00:00 | 2502.5 | N | Y | N/A | N/A
35472 | TRLUML BALLOON ANGIOPLASTY PERCUTANEOUS AORTIC | 2011-07-01 00:00:00 | 1811.48 | N | Y | N/A | N/A
35475 | TRLUML BALO ANGIOP PRQ BRCH/CPHLC TRNK/BRNCH EA | 2011-07-01 00:00:00 | 1969.92 | N | Y | N/A | N/A
35476 | TRLUML BALLOON ANGIOPLASTY PERCUTANEOUS VENOUS | 2011-07-01 00:00:00 | 1490.18 | N | Y | N/A | N/A
35500 | HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX | 2011-07-01 00:00:00 | 286.89 | N | Y | N/A | N/A
35501 | BYPASS W/VEIN COMMON-IPSILATERAL CAROTID | 2011-07-01 00:00:00 | 1407.26 | N | Y | N/A | N/A
35506 | BYPASS W/VEIN CAROTID-SUBCLV/SUBCLAVIAN CAROTID | 2011-07-01 00:00:00 | 1197.05 | N | Y | N/A | N/A
35508 | BYPASS W/VEIN CAROTID-VERTEBRAL | 2011-07-01 00:00:00 | 1261.04 | N | Y | N/A | N/A
35509 | BYPASS W/VEIN CAROTID-CONTRALATERAL CAROTID | 2011-07-01 00:00:00 | 1333.76 | N | Y | N/A | N/A
35511 | BYPASS W/VEIN SUBCLAVIAN-SUBCLAVIAN | 2011-07-01 00:00:00 | 1106.27 | N | Y | N/A | N/A
35512 | BYPASS W/VEIN SUBCLAVIAN-BRACHIAL | 2011-07-01 00:00:00 | 1104.68 | N | Y | N/A | N/A
35515 | BYPASS W/VEIN SUBCLAVIAN-VERTEBRAL | 2011-07-01 00:00:00 | 1198.18 | N | Y | N/A | N/A
35516 | BYPASS W/VEIN SUBCLAVIAN-AXILLARY | 2011-07-01 00:00:00 | 1101.1 | N | Y | N/A | N/A
35518 | BYPASS W/VEIN AXILLARY-AXILLARY | 2011-07-01 00:00:00 | 1054.59 | N | Y | N/A | N/A
35521 | BYPASS W/VEIN AXILLARY-FEMORAL | 2011-07-01 00:00:00 | 1188.44 | N | Y | N/A | N/A
35522 | BYPASS W/VEIN AXILLARY-BRACHIAL | 2011-07-01 00:00:00 | 1097.87 | N | Y | N/A | N/A
35523 | BYPASS W/VEIN BRACHIAL-ULNAR/-RADIAL | 2011-07-01 00:00:00 | 1154.94 | N | Y | N/A | N/A
35525 | BYPASS W/VEIN BRACHIAL-BRACHIAL | 2011-07-01 00:00:00 | 1026.58 | N | Y | N/A | N/A
35526 | BYPASS W/VEIN AORTOSUBCLAV/CAROTID/INNOMINATE | 2011-07-01 00:00:00 | 1470.71 | N | Y | N/A | N/A
35531 | BYPASS W/VEIN AORTOCELIAC/AORTOMESENTERIC | 2011-07-01 00:00:00 | 1815.17 | N | Y | N/A | N/A
35533 | BYPASS W/VEIN AXILLARY-FEMORAL-FEMORAL | 2011-07-01 00:00:00 | 1460.11 | N | Y | N/A | N/A
35535 | BYPASS W/VEIN HEPATORENAL | 2011-07-01 00:00:00 | 1644.17 | N | Y | N/A | N/A
35536 | BYPASS W/VEIN SPLENORENAL | 2011-07-01 00:00:00 | 1540.8 | N | Y | N/A | N/A
35537 | BYPASS W/VEIN AORTOILIAC | 2011-07-01 00:00:00 | 2008.43 | N | Y | N/A | N/A
35538 | BYPASS W/VEIN AORTOBI-ILIAC | 2011-07-01 00:00:00 | 2251.27 | N | Y | N/A | N/A
35539 | BYPASS W/VEIN AORTOFEMORAL | 2011-07-01 00:00:00 | 1992.36 | N | Y | N/A | N/A
35540 | BYPASS W/VEIN AORTOBIFEMORAL | 2011-07-01 00:00:00 | 2281.67 | N | Y | N/A | N/A
35556 | BYPASS W/VEIN FEMORAL-POPLITEAL | 2011-07-01 00:00:00 | 1255.83 | N | Y | N/A | N/A
35558 | BYPASS W/VEIN FEMORAL-FEMORAL | 2011-07-01 00:00:00 | 1108.08 | N | Y | N/A | N/A
35560 | BYPASS W/VEIN AORTORENAL | 2011-07-01 00:00:00 | 1563.13 | N | Y | N/A | N/A
35563 | BYPASS W/VEIN ILIOILIAC | 2011-07-01 00:00:00 | 1207.17 | N | Y | N/A | N/A
35565 | BYPASS W/VEIN ILIOFEMORAL | 2011-07-01 00:00:00 | 1187.77 | N | Y | N/A | N/A
35566 | BYP FEM-ANT TIBL PST TIBL PRONEAL ART/OTH DSTL | 2011-07-01 00:00:00 | 1503.92 | N | Y | N/A | N/A
35570 | BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL | 2011-07-01 00:00:00 | 1275.05 | N | Y | N/A | N/A
35571 | BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL | 2011-07-01 00:00:00 | 1202.03 | N | Y | N/A | N/A
35572 | HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX | 2011-07-01 00:00:00 | 309.29 | N | Y | N/A | N/A
35583 | IN-SITU VEIN BYPASS FEMORAL-POPLITEAL | 2011-07-01 00:00:00 | 1298.92 | N | Y | N/A | N/A
35585 | IN-SITU FEM-ANT TIBL PST TIBL/PRONEAL ART | 2011-07-01 00:00:00 | 1510.53 | N | Y | N/A | N/A
35587 | IN-SITU VEIN BYP POP-TIBL PRONEAL | 2011-07-01 00:00:00 | 1243.63 | N | Y | N/A | N/A
35600 | HARVEST UPPER EXTREMITY ARTERY 1 SEGMENT CABG | 2011-07-01 00:00:00 | 227.41 | N | Y | N/A | N/A
35601 | BYP OTH/THN VEIN COMMON-IPSILATERAL CAROTID | 2011-07-01 00:00:00 | 1307.79 | N | Y | N/A | N/A
35606 | BYP OTH/THN VEIN CAROTID-SUBCLAVIAN | 2011-07-01 00:00:00 | 1058.34 | N | Y | N/A | N/A
35612 | BYP OTH/THN VEIN SUBCLAVIAN-SUBCLAVIAN | 2011-07-01 00:00:00 | 808.93 | N | Y | N/A | N/A
35616 | BYP OTH/THN VEIN SUBCLAVIAN-AXILLARY | 2011-07-01 00:00:00 | 1056.24 | N | Y | N/A | N/A
35621 | BYP OTH/THN VEIN AXILLARY-FEMORAL | 2011-07-01 00:00:00 | 991.52 | N | Y | N/A | N/A
35623 | BYP OTH/THN VEIN AXILLARY-POPLITEAL/-TIBIAL | 2011-07-01 00:00:00 | 1271.4 | N | Y | N/A | N/A
35626 | BYPASS NOT VEIN AORTOSUBCLA/CAROTID/INNOMINATE | 2011-07-01 00:00:00 | 1393.79 | N | Y | N/A | N/A
35631 | BYP OTH/THN VEIN AORTOCELIAC AORTOMSN AORTORNL | 2011-07-01 00:00:00 | 1661.09 | N | Y | N/A | N/A
35632 | BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC | 2011-07-01 00:00:00 | 1561.25 | N | Y | N/A | N/A
35633 | BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC | 2011-07-01 00:00:00 | 1705.64 | N | Y | N/A | N/A
35634 | BYPASS GRAFT W/OTHER THAN VEIN ILIORENAL | 2011-07-01 00:00:00 | 1543.35 | N | Y | N/A | N/A
35636 | BYP OTH/THN VEIN SPLENORENAL | 2011-07-01 00:00:00 | 1541.64 | N | Y | N/A | N/A
35637 | BYP OTH/THN VEIN AORTOILIAC | 2011-07-01 00:00:00 | 1540.35 | N | Y | N/A | N/A
35638 | BYP OTH/THN VEIN AORTOBI-ILIAC | 2011-07-01 00:00:00 | 1574.15 | N | Y | N/A | N/A
35642 | BYP OTH/THN VEIN CAROTID-VERTEBRAL | 2011-07-01 00:00:00 | 971.43 | N | Y | N/A | N/A
35645 | BYP OTH/THN VEIN SUBCLAVIAN-VERTEBRAL | 2011-07-01 00:00:00 | 923.33 | N | Y | N/A | N/A
35646 | BYP OTH/THN VEIN AORTOBIFEMORAL | 2011-07-01 00:00:00 | 1544.37 | N | Y | N/A | N/A
35647 | BYP OTH/THN VEIN AORTOFEMORAL | 2011-07-01 00:00:00 | 1402.07 | N | Y | N/A | N/A
35650 | BYP OTH/THN VEIN AXILLARY-AXILLARY | 2011-07-01 00:00:00 | 961.07 | N | Y | N/A | N/A
35654 | BYP OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL | 2011-07-01 00:00:00 | 1236.49 | N | Y | N/A | N/A
35656 | BYP OTH/THN VEIN FEMORAL-POPLITEAL | 2011-07-01 00:00:00 | 974.48 | N | Y | N/A | N/A
35661 | BYP OTH/THN VEIN FEMORAL-FEMORAL | 2011-07-01 00:00:00 | 978.71 | N | Y | N/A | N/A
35663 | BYP OTH/THN VEIN ILIOILIAC | 2011-07-01 00:00:00 | 1128.47 | N | Y | N/A | N/A
35665 | BYP OTH/THN VEIN ILIOFEMORAL | 2011-07-01 00:00:00 | 1058.75 | N | Y | N/A | N/A
35666 | BYP OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRONEAL | 2011-07-01 00:00:00 | 1145.07 | N | Y | N/A | N/A
35671 | BYP OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART | 2011-07-01 00:00:00 | 1008.82 | N | Y | N/A | N/A
35681 | BYPASS COMPOSITE GRAFT PROSTHETIC & VEIN | 2011-07-01 00:00:00 | 71.55 | N | Y | N/A | N/A
35682 | BYP AUTOG COMPOSIT 2 SEG VEINS FROM 2 LOCATIONS | 2011-07-01 00:00:00 | 318.39 | N | Y | N/A | N/A
35683 | BYP AUTOG COMPOSIT 3/GT SEG FROM 2/GT LOCATIONS | 2011-07-01 00:00:00 | 372.46 | N | Y | N/A | N/A
35685 | PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT | 2011-07-01 00:00:00 | 179.31 | N | Y | N/A | N/A
35686 | CRTJ DSTL ARVEN FSTL LXTR BYP SURG NON-HEMO | 2011-07-01 00:00:00 | 148.99 | N | Y | N/A | N/A
35691 | TRPOS&/RIMPLTJ VERTEBRAL CAROTID ART | 2011-07-01 00:00:00 | 868.35 | N | Y | N/A | N/A
35693 | TRPOS&/RIMPLTJ VERTEBRAL SUBCLAVIAN ART | 2011-07-01 00:00:00 | 769.9 | N | Y | N/A | N/A
35694 | TRPOS&/RIMPLTJ SUBCLAVIAN CAROTID ART | 2011-07-01 00:00:00 | 916.9 | N | Y | N/A | N/A
35695 | TRPOS&/RIMPLTJ CAROTID SUBCLAVIAN ART | 2011-07-01 00:00:00 | 938.6 | N | Y | N/A | N/A
35697 | RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART | 2011-07-01 00:00:00 | 133.51 | N | Y | N/A | N/A
35700 | ROPRTJ GT 1 MO AFTER ORIGINAL OPRATION | 2011-07-01 00:00:00 | 137.46 | N | Y | N/A | N/A
35701 | EXPL N/FLWD SURG RPR W/WO LYSIS CAROTID ARTERY | 2011-07-01 00:00:00 | 489.84 | N | Y | N/A | N/A
35721 | EXPL N/FLWD SURG RPR W/WO LYSIS FEMORAL ARTERY | 2011-07-01 00:00:00 | 405.5 | N | Y | N/A | N/A
35741 | EXPL N/FLWD SURG RPR W/WO LYSIS POPLITEAL ARTERY | 2011-07-01 00:00:00 | 449.72 | N | Y | N/A | N/A
35761 | EXPL N/FLWD SURG RPR W/WO LYSIS OTHER ARTERY | 2011-07-01 00:00:00 | 337.99 | N | Y | N/A | N/A
35800 | EXPL PO HEMRRG THROMBOSIS/INFCTJ NCK | 2011-07-01 00:00:00 | 431.64 | N | Y | N/A | N/A
35820 | EXPL PO HEMRRG THROMBOSIS/INFCTJ CH | 2011-07-01 00:00:00 | 1728.3 | N | Y | N/A | N/A
35840 | EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD | 2011-07-01 00:00:00 | 562.53 | N | Y | N/A | N/A
35860 | EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR | 2011-07-01 00:00:00 | 362.79 | N | Y | N/A | N/A
35870 | RPR GRF-ENTERIC FSTL | 2011-07-01 00:00:00 | 1204.33 | N | Y | N/A | N/A
35875 | THRMBC ARTL/VEN GRF OTH/THN HEMO GRF/FSTL | 2011-07-01 00:00:00 | 534.27 | N | Y | N/A | N/A
35876 | THRMBC ARTL/VEN GRF XCP HEMO GRF/FSTL W/REVJ GRF | 2011-07-01 00:00:00 | 849.56 | N | Y | N/A | N/A
35879 | REVJ LXTR ARTL BYP OPN VEIN PATCH [NAME] | 2011-07-01 00:00:00 | 834.64 | N | Y | N/A | N/A
35881 | REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS | 2011-07-01 00:00:00 | 923.7 | N | Y | N/A | N/A
35883 | REVISION FEMORAL ANAST OPEN NONAUTOG GRAFT | 2011-07-01 00:00:00 | 1081.3 | N | Y | N/A | N/A
35884 | REVISION FEMORAL ANAST OPEN W/AUTOG GRAFT | 2011-07-01 00:00:00 | 1122.93 | N | Y | N/A | N/A
35901 | EXCISION INFECTED NECK GRAFT | 2011-07-01 00:00:00 | 451.13 | N | Y | N/A | N/A
35903 | EXCISION INFECTED GRAFT EXTREMITY | 2011-07-01 00:00:00 | 507.22 | N | Y | N/A | N/A
35905 | EXCISION INFECTED GRAFT THORAX | 2011-07-01 00:00:00 | 1537.07 | N | Y | N/A | N/A
35907 | EXCISION INFECTED GRAFT ABDOMEN | 2011-07-01 00:00:00 | 1724.47 | N | Y | N/A | N/A
36000 | INTRODUCTION NEEDLE/INTRACATHETER VEIN | 2011-07-01 00:00:00 | 21.31 | N | Y | N/A | N/A
36002 | INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM | 2011-07-01 00:00:00 | 143.04 | N | Y | N/A | N/A
36005 | NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH | 2011-07-01 00:00:00 | 296.5 | N | Y | N/A | N/A
36010 | INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA | 2011-07-01 00:00:00 | 482.11 | N | Y | N/A | N/A
36011 | SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH | 2011-07-01 00:00:00 | 790.58 | N | Y | N/A | N/A
36012 | SLCTV CATH PLMT VEN SYS 2ND ORDER/GT SLCTV BRANCH | 2011-07-01 00:00:00 | 766.39 | N | Y | N/A | N/A
36013 | INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY | 2011-07-01 00:00:00 | 696.83 | N | Y | N/A | N/A
36014 | SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY | 2011-07-01 00:00:00 | 732.8 | N | Y | N/A | N/A
36015 | SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART | 2011-07-01 00:00:00 | 796.64 | N | Y | N/A | N/A
36100 | INTRO NEEDLE/INTRACATH CAROTID/VERTEBRAL ARTERY | 2011-07-01 00:00:00 | 454.13 | N | Y | N/A | N/A
36120 | INTRO NEEDLE/INTRACATH RETROGRADE BRACHIAL ART | 2011-07-01 00:00:00 | 387.32 | N | Y | N/A | N/A
36140 | INTRO NEEDLE/INTRACATH EXTREMITY ARTERY | 2011-07-01 00:00:00 | 412.88 | N | Y | N/A | N/A
36147 | ACCESS AV DIAL GRFT FOR EVAL | 2011-07-01 00:00:00 | 702.39 | N | Y | N/A | N/A
36148 | ACCESS AV DIAL GRFT FOR PROC | 2011-07-01 00:00:00 | 221.55 | N | Y | N/A | N/A
36160 | INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR | 2011-07-01 00:00:00 | 448.19 | N | Y | N/A | N/A
36200 | INTRODUCTION CATHETER AORTA | 2011-07-01 00:00:00 | 558.45 | N | Y | N/A | N/A
36215 | SLCTV CATHJ EA 1ST [NAME] BRNCH | 2011-07-01 00:00:00 | 993.38 | N | Y | N/A | N/A
36216 | SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH | 2011-07-01 00:00:00 | 1092.95 | N | Y | N/A | N/A
36217 | SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH | 2011-07-01 00:00:00 | 1785.89 | N | Y | N/A | N/A
36218 | SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH | 2011-07-01 00:00:00 | 165.47 | N | Y | N/A | N/A
36221 | NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART | 2013-01-01 00:00:00 | 944.28 | N | N | N/A | N/A
36222 | SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART | 2013-01-01 00:00:00 | 1171.01 | N | N | N/A | N/A
36223 | SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART | 2013-01-01 00:00:00 | 1281.04 | N | N | N/A | N/A
36224 | SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART | 2013-01-01 00:00:00 | 1391.81 | N | N | N/A | N/A
36225 | SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY | 2013-01-01 00:00:00 | 1271.83 | N | N | N/A | N/A
36226 | SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY | 2013-01-01 00:00:00 | 1418.64 | N | N | N/A | N/A
36227 | SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC | 2013-01-01 00:00:00 | 206.42 | N | N | N/A | N/A
36228 | SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT | 2013-01-01 00:00:00 | 973.88 | N | N | N/A | N/A
36245 | SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH | 2011-07-01 00:00:00 | 1047.6 | N | Y | N/A | N/A
36246 | SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH | 2011-07-01 00:00:00 | 1058.07 | N | Y | N/A | N/A
36247 | SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH | 2011-07-01 00:00:00 | 1663.99 | N | Y | N/A | N/A
36248 | SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH | 2011-07-01 00:00:00 | 138.93 | N | Y | N/A | N/A
36251 | SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UNI | 2012-01-01 00:00:00 | 1385.15 | N | N | N/A | N/A
36252 | SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BILAT | 2012-01-01 00:00:00 | 1309.79 | N | N | N/A | N/A
36253 | SUPSLCTV CATH 2ND+ORD RENL&ACCES ARTERY/S&I UNI | 2012-01-01 00:00:00 | 1821.93 | N | N | N/A | N/A
36254 | SUPSLCTV CATH 2ND+ORD RENL&ACCES ARTER/S&I BILAT | 2012-01-01 00:00:00 | 1896.02 | N | N | N/A | N/A
36260 | INSJ IMPLANTABLE INTRA-ARTERIAL INFUSION PUM | 2011-07-01 00:00:00 | 528.13 | N | Y | N/A | N/A
36261 | REVJ IMPLANTED INTRA-ARTERIAL INFUSION PUMP | 2011-07-01 00:00:00 | 327.78 | N | Y | N/A | N/A
36262 | REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP | 2011-07-01 00:00:00 | 248.45 | N | Y | N/A | N/A
36299 | UNLISTED VASCULAR INJECTION | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
36400 | VNPNXR LT3 YEARS PHYS SKILL FEMORAL/JUGULAR VEIN | 2011-07-01 00:00:00 | 24.89 | N | Y | N/A | N/A
36405 | VNPNXR LT3 YEARS PHYS SKILL SCALP VEIN | 2011-07-01 00:00:00 | 20.45 | N | Y | N/A | N/A
36406 | VNPNXR LT3 YEARS PHYS SKILL OTHER VEIN | 2011-07-01 00:00:00 | 14.68 | N | Y | N/A | N/A
36410 | VNPNXR 3 YEARS/GT PHYS [NAME] | 2011-07-01 00:00:00 | 15.54 | N | Y | N/A | N/A
36415 | [NAME] BLOOD VENIPUNCTURE | 2011-07-01 00:00:00 | 2.7 | N | N | N/A | N/A
36416 | COLLECTION CAPILLARY BLOOD SPECIMEN | 2008-07-01 00:00:00 | 3 | N | N | N/A | N/A
36420 | VENIPUNCTURE CUTDOWN UNDER AGE 1 YR | 2011-07-01 00:00:00 | 40.77 | N | Y | N/A | N/A
36425 | VENIPUNCTURE CUTDOWN AGE 1 YR/GT | 2011-07-01 00:00:00 | 34.1 | N | Y | N/A | N/A
36430 | TRANSFUSION BLOOD/BLOOD COMPONENTS | 2011-07-01 00:00:00 | 29.58 | N | Y | N/A | N/A
36440 | PUSH TRANSFUSION BLOOD 2 YR/UNDER | 2011-07-01 00:00:00 | 47.81 | N | Y | N/A | N/A
36450 | EXCHNG TRANSFUSION BLOOD NEWBORN | 2011-07-01 00:00:00 | 99.82 | N | Y | N/A | N/A
36455 | EXCHNG TRANSFUSION BLOOD OTHER/THAN NEW BORN | 2011-07-01 00:00:00 | 105.3 | N | Y | N/A | N/A
36460 | TRANSFUSION INTRAUTERINE FETAL | 2011-07-01 00:00:00 | 303.84 | N | Y | N/A | N/A
36468 | 1/MLT NJXS SCLRSG SLNS SPIDER VEINS LIMB/TRUNK | 2008-07-01 00:00:00 | 27 | N | Y | N/A | N/A
36469 | 1/MLT NJXS SCLRSG SLNS SPIDER VEINS FACE | 2008-07-01 00:00:00 | 54.03 | N | Y | N/A | N/A
36470 | NJX SCLEROSING SOLUTION SINGLE VEIN | 2011-07-01 00:00:00 | 122.27 | Y | Y | N/A | N/A
36471 | NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG | 2011-07-01 00:00:00 | 150.23 | Y | Y | N/A | N/A
36475 | ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN | 2011-07-01 00:00:00 | 1566 | Y | Y | N/A | N/A
36476 | ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS | 2011-07-01 00:00:00 | 340.87 | Y | Y | N/A | N/A
36478 | ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN | 2011-07-01 00:00:00 | 1238.12 | Y | Y | N/A | N/A
36479 | ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS | 2011-07-01 00:00:00 | 351.76 | Y | Y | N/A | N/A
36481 | PRQ PORTAL VEIN CATHETERIZATION ANY METHOD | 2011-07-01 00:00:00 | 1078.91 | N | Y | N/A | N/A
36500 | VEN CATHJ SLCTV ORGAN BLD SAMPLING | 2011-07-01 00:00:00 | 159.28 | N | Y | N/A | N/A
36510 | CATHJ UMBILICAL VEIN DX/THER NB | 2011-07-01 00:00:00 | 89.72 | N | Y | N/A | N/A
36511 | THERAPEUTIC APHERESIS WHITE BLOOD CELLS | 2011-07-01 00:00:00 | 81.58 | N | Y | N/A | N/A
36512 | THERAPEUTIC APHERESIS RED BLOOD CELLS | 2011-07-01 00:00:00 | 80.23 | N | Y | N/A | N/A
36513 | THERAPEUTIC APHERESIS PLATELETS | 2011-07-01 00:00:00 | 85.39 | N | Y | N/A | N/A
36514 | THERAPEUTIC [NAME] | 2011-07-01 00:00:00 | 442.31 | N | Y | N/A | N/A
36515 | THER APHERESIS W/XTRCORP IMMUNODSPTJ&PLSM RENFS | 2011-07-01 00:00:00 | 1648.28 | N | Y | N/A | N/A
36516 | [NAME] ADSRPJ/FILTRJ&RENFS | 2011-07-01 00:00:00 | 1819.71 | N | Y | N/A | N/A
36522 | PHOTOPHERESIS EXTRACORPOREAL | 2011-07-01 00:00:00 | 1160 | N | Y | N/A | N/A
36555 | INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE LT 5 YR | 2011-07-01 00:00:00 | 231.99 | N | Y | N/A | N/A
36556 | INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/GT | 2011-07-01 00:00:00 | 200.96 | N | Y | N/A | N/A
36557 | INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGELT5 YR | 2011-07-01 00:00:00 | 798.8 | N | Y | N/A | N/A
36558 | INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/GT | 2011-07-01 00:00:00 | 690.89 | N | Y | N/A | N/A
36560 | INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR | 2011-07-01 00:00:00 | 1085.03 | N | Y | N/A | N/A
36561 | INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/GT | 2011-07-01 00:00:00 | 1009.9 | N | Y | N/A | N/A
36563 | INSJ TUNNELED CTR VAD W/SUBQ PUMP | 2011-07-01 00:00:00 | 1071.87 | N | Y | N/A | N/A
36565 | INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP | 2011-07-01 00:00:00 | 855.49 | N | Y | N/A | N/A
36566 | INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT | 2011-07-01 00:00:00 | 3819.75 | N | Y | N/A | N/A
36568 | INSJ PRPH CVC W/O SUBQ PORT/PMP UNDER 5 YR | 2011-07-01 00:00:00 | 255.92 | N | Y | N/A | N/A
36569 | INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/GT | 2011-07-01 00:00:00 | 221.72 | N | Y | N/A | N/A
36570 | INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR | 2011-07-01 00:00:00 | 967.19 | N | Y | N/A | N/A
36571 | INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/GT | 2011-07-01 00:00:00 | 1085.99 | N | Y | N/A | N/A
36575 | RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP | 2011-07-01 00:00:00 | 138.74 | N | Y | N/A | N/A
36576 | RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT | 2011-07-01 00:00:00 | 319.95 | N | Y | N/A | N/A
36578 | RPLCMT CATH CTR VAD SUBQ PORT/PMP | 2011-07-01 00:00:00 | 438.46 | N | Y | N/A | N/A
36580 | RPLCMT COMPL NON-TUN CVC W/O SUBQ PORT/PMP | 2011-07-01 00:00:00 | 191.65 | N | Y | N/A | N/A
36581 | RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP | 2011-07-01 00:00:00 | 656.8 | N | Y | N/A | N/A
36582 | RPLCMT COMPL TUN CTR VAD W/SUBQ PORT | 2011-07-01 00:00:00 | 941.79 | N | Y | N/A | N/A
36583 | RPLCMT COMPL TUN CTR VAD W/SUBQ PMP | 2011-07-01 00:00:00 | 1047.06 | N | Y | N/A | N/A
36584 | RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP | 2011-07-01 00:00:00 | 184.24 | N | Y | N/A | N/A
36585 | RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT | 2011-07-01 00:00:00 | 948.09 | N | Y | N/A | N/A
36589 | RMVL TUN CVC W/O SUBQ PORT/PMP | 2011-07-01 00:00:00 | 143.96 | N | Y | N/A | N/A
36590 | RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ | 2011-07-01 00:00:00 | 243.79 | N | Y | N/A | N/A
36591 | COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE | 2011-07-01 00:00:00 | 19.49 | N | Y | N/A | N/A
36592 | COLLECT BLOOD FROM CATHETER VENOUS NOS | 2011-07-01 00:00:00 | 21.8 | N | Y | N/A | N/A
36593 | DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH | 2011-07-01 00:00:00 | 24.4 | N | Y | N/A | N/A
36595 | MCHNL RMVL PRICATH OBSTR CV DEV VIA VEN ACCESS | 2011-07-01 00:00:00 | 506.46 | N | Y | N/A | N/A
36596 | MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN | 2011-07-01 00:00:00 | 116.38 | N | Y | N/A | N/A
36597 | RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDN | 2011-07-01 00:00:00 | 108.42 | N | Y | N/A | N/A
36598 | CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT | 2011-07-01 00:00:00 | 97.38 | N | Y | N/A | N/A
36600 | ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX | 2011-07-01 00:00:00 | 26.46 | N | Y | N/A | N/A
36620 | ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ | 2011-07-01 00:00:00 | 44.13 | N | Y | N/A | N/A
36625 | ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX CUTDOWN | 2011-07-01 00:00:00 | 92.05 | N | Y | N/A | N/A
36640 | ARTL CATHJ PROLNG NFS THER CHEMOTX CUTDOWN | 2011-07-01 00:00:00 | 108.76 | N | Y | N/A | N/A
36660 | CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY | 2011-07-01 00:00:00 | 64.04 | N | Y | N/A | N/A
36680 | PLACEMENT NEEDLE INTRAOSSEOUS INFUSION | 2011-07-01 00:00:00 | 51.21 | N | Y | N/A | N/A
36800 | [NAME] PURPOSE SPX VEIN VEIN | 2011-07-01 00:00:00 | 139.32 | N | Y | N/A | N/A
36810 | [NAME] PURPOSE SPX ARVEN XTRNL | 2011-07-01 00:00:00 | 184.03 | N | Y | N/A | N/A
36815 | [NAME] REVJ/CLSR | 2011-07-01 00:00:00 | 130.86 | N | Y | N/A | N/A
36818 | ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS | 2011-07-01 00:00:00 | 590.45 | N | Y | N/A | N/A
36819 | ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS | 2011-07-01 00:00:00 | 702.61 | N | Y | N/A | N/A
36820 | ARVEN ANAST OPN F/ARM VEIN TRPOS | 2011-07-01 00:00:00 | 707.91 | N | Y | N/A | N/A
36821 | ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT | 2011-07-01 00:00:00 | 603.13 | N | Y | N/A | N/A
36822 | [NAME] ECMO SPX | 2011-07-01 00:00:00 | 331.01 | N | Y | N/A | N/A
36823 | INSJ CNULA ISLTD XC-CIRCJ REG CHEMOTX XTR RMVL | 2011-07-01 00:00:00 | 1133.77 | N | Y | N/A | N/A
36825 | CRTJ ARVEN FSTL XCP DIR ARVEN ANAST [NAME] | 2011-07-01 00:00:00 | 715.27 | N | Y | N/A | N/A
36830 | CRTJ ARVEN FSTL XCP DIR ARVEN ANAST [NAME] | 2011-07-01 00:00:00 | 579.05 | N | Y | N/A | N/A
36831 | THRMBC OPN ARVEN FSTL W/O REVJ DIAL GRF | 2011-07-01 00:00:00 | 402.48 | N | Y | N/A | N/A
36832 | REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF | 2011-07-01 00:00:00 | 511.43 | N | Y | N/A | N/A
36833 | REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF | 2011-07-01 00:00:00 | 577.75 | N | Y | N/A | N/A
36835 | INSERTION THOMAS SHUNT SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 419.67 | N | Y | N/A | N/A
36838 | DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS | 2011-07-01 00:00:00 | 1024.17 | N | Y | N/A | N/A
36860 | XTRNL CANNULA DECLTNG SPX W/O BALO CATH | 2011-07-01 00:00:00 | 172.99 | N | Y | N/A | N/A
36861 | XTRNL CANNULA DECLTNG SPX W/BALO CATH | 2011-07-01 00:00:00 | 132.17 | N | Y | N/A | N/A
36870 | THRMBC PRQ ARVEN FSTL AUTOG/[NAME] | 2011-07-01 00:00:00 | 1605.77 | N | Y | N/A | N/A
37140 | [NAME] OPEN PORTOCAVAL | 2011-07-01 00:00:00 | 1237.01 | N | Y | N/A | N/A
37145 | [NAME] OPEN RENOPORTAL | 2011-07-01 00:00:00 | 1296.62 | N | Y | N/A | N/A
37160 | [NAME] OPEN CAVAL-MESENTERIC | 2011-07-01 00:00:00 | 1143.32 | N | Y | N/A | N/A
37180 | [NAME] OPEN SPLENORENAL PROXIMAL | 2011-07-01 00:00:00 | 1277.4 | N | Y | N/A | N/A
37181 | [NAME] OPEN SPLENORENAL DISTAL | 2011-07-01 00:00:00 | 1379.17 | N | Y | N/A | N/A
37182 | INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT | 2011-07-01 00:00:00 | 758.04 | N | Y | N/A | N/A
37183 | REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT | 2011-07-01 00:00:00 | 4628.59 | N | Y | N/A | N/A
37184 | PRIM PRQ TRLUML MCHNL THRMBC 1ST VSL | 2011-07-01 00:00:00 | 2050.21 | N | Y | N/A | N/A
37185 | PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL | 2011-07-01 00:00:00 | 676.44 | N | Y | N/A | N/A
37186 | SEC PRQ TRANSLUMINAL THROMBECTOMY NONCORONARY | 2011-07-01 00:00:00 | 1333.18 | N | Y | N/A | N/A
37187 | PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN | 2011-07-01 00:00:00 | 1954.51 | N | Y | N/A | N/A
37188 | PRQ TRLUML MCHNL THRMBC VEIN REPEAT [NAME] | 2011-07-01 00:00:00 | 1649.51 | N | Y | N/A | N/A
37191 | INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I | 2012-01-01 00:00:00 | 2159.82 | N | N | N/A | N/A
37192 | REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I | 2012-01-01 00:00:00 | 1456.7 | N | N | N/A | N/A
37193 | RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I | 2012-01-01 00:00:00 | 1390.97 | N | N | N/A | N/A
37195 | THROMBOLYSIS CEREBRAL IV INFUSION | 2008-07-01 00:00:00 | 279.89 | N | Y | N/A | N/A
37197 | PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING | 2013-01-01 00:00:00 | 1290.19 | N | N | N/A | N/A
37200 | TRANSCATHETER BIOPSY | 2011-07-01 00:00:00 | 200.98 | N | Y | N/A | N/A
37202 | TCAT THER INFUSION OTH/THN THROMBOLYSIS ANY TYPE | 2011-07-01 00:00:00 | 294.66 | N | Y | N/A | N/A
37211 | THROMBOLYSIS ARTERIAL INFUSION W/IMAGING INIT TX | 2013-01-01 00:00:00 | 340.71 | N | N | N/A | N/A
37212 | THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX | 2013-01-01 00:00:00 | 300.76 | N | N | N/A | N/A
37213 | THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX | 2013-01-01 00:00:00 | 210.23 | N | N | N/A | N/A
37214 | CESSATION THROMBOLYTIC THRPY W/CATHETER REMOVAL | 2013-01-01 00:00:00 | 123.15 | N | N | N/A | N/A
37215 | [NAME] CRTD ART EMBOLIC PROTECJ | 2011-07-01 00:00:00 | 976.99 | N | Y | N/A | N/A
37216 | [NAME] CRTD ART W/O EMBOLIC PROTECJ | 2008-07-01 00:00:00 | 1082.96 | N | Y | N/A | N/A
37217 | [NAME] STENT PLACEMT RETROGRAD CAROTID/INNOMINATE | 2014-01-01 00:00:00 | 961.69 | N | Y | N/A | N/A
37220 | [NAME] ARTERY [NAME] VSL | 2011-07-01 00:00:00 | 2687.08 | N | Y | N/A | N/A
37221 | REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOP UNI | 2011-07-01 00:00:00 | 3973.3 | N | Y | N/A | N/A
37222 | [NAME] | 2011-07-01 00:00:00 | 774.14 | N | Y | N/A | N/A
37223 | REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSI VSL | 2011-07-01 00:00:00 | 2188.24 | N | Y | N/A | N/A
37224 | REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI | 2011-07-01 00:00:00 | 3229.08 | N | Y | N/A | N/A
37225 | REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL | 2011-07-01 00:00:00 | 9122.02 | N | Y | N/A | N/A
37226 | REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL | 2011-07-01 00:00:00 | 7645.42 | N | Y | N/A | N/A
37227 | REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL | 2011-07-01 00:00:00 | 12333.25 | N | Y | N/A | N/A
37228 | REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI | 2011-07-01 00:00:00 | 4596.88 | N | Y | N/A | N/A
37229 | REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL | 2011-07-01 00:00:00 | 9042.52 | N | Y | N/A | N/A
37230 | REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL | 2011-07-01 00:00:00 | 7106.21 | N | Y | N/A | N/A
37231 | REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL | 2011-07-01 00:00:00 | 11404.82 | N | Y | N/A | N/A
37232 | REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL | 2011-07-01 00:00:00 | 1031.72 | N | Y | N/A | N/A
37233 | REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL | 2011-07-01 00:00:00 | 1259.66 | N | Y | N/A | N/A
37234 | REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL | 2011-07-01 00:00:00 | 3289.4 | N | Y | N/A | N/A
37235 | REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP EA VSL | 2011-07-01 00:00:00 | 3513.4 | N | Y | N/A | N/A
37236 | OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL | 2014-01-01 00:00:00 | 2320.82 | N | Y | N/A | N/A
37237 | OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL | 2014-01-01 00:00:00 | 1008.16 | N | Y | N/A | N/A
37238 | OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST | 2014-01-01 00:00:00 | 3384.21 | N | Y | N/A | N/A
37239 | OPEN/PERQ PLACEMT INTRAVASC STENT SAME EA ADDL | 2014-01-01 00:00:00 | 1681.61 | N | Y | N/A | N/A
37241 | VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I | 2014-01-01 00:00:00 | 3755.56 | N | Y | N/A | N/A
37242 | VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I | 2014-01-01 00:00:00 | 6315.07 | N | Y | N/A | N/A
37243 | VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT | 2014-01-01 00:00:00 | 7970.54 | N | Y | N/A | N/A
37244 | VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE | 2014-01-01 00:00:00 | 5592.41 | N | Y | N/A | N/A
37250 | IV US NON-C VSL DX EVAL&/THER IVNTJ 1ST VSL | 2011-07-01 00:00:00 | 96.31 | N | Y | N/A | N/A
37251 | IV US NON-C VSL DX EVAL&/THER IVNTJ EA VSL | 2011-07-01 00:00:00 | 71.78 | N | Y | N/A | N/A
37500 | VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX | 2011-07-01 00:00:00 | 609.03 | N | Y | N/A | N/A
37501 | UNLISTED VASCULAR ENDOSCOPY PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
37565 | LIGATION INTERNAL JUGULAR VEIN | 2011-07-01 00:00:00 | 619.89 | N | Y | N/A | N/A
37600 | LIGATION EXTERNAL CAROTID ARTERY | 2011-07-01 00:00:00 | 622.78 | N | Y | N/A | N/A
37605 | LIGATION INTERNAL/COMMON CAROTID ARTERY | 2011-07-01 00:00:00 | 708.19 | N | Y | N/A | N/A
37606 | LIG INT/COMMON CAROTID ART W/GRADUAL OCCLUSION | 2011-07-01 00:00:00 | 442.42 | N | Y | N/A | N/A
37607 | LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA | 2011-07-01 00:00:00 | 330.71 | N | Y | N/A | N/A
37609 | LIGATION/BIOPSY TEMPORAL ARTERY | 2011-07-01 00:00:00 | 260.46 | N | Y | N/A | N/A
37615 | LIGATION MAJOR ARTERY NECK | 2011-07-01 00:00:00 | 442.12 | N | Y | N/A | N/A
37616 | LIGATION MAJOR ARTERY CHEST | 2011-07-01 00:00:00 | 946.94 | N | Y | N/A | N/A
37617 | LIGATION MAJOR ARTERY ABDOMEN | 2011-07-01 00:00:00 | 1133.91 | N | Y | N/A | N/A
37618 | LIGAMENT MAJOR ARTERY EXTREMITY | 2011-07-01 00:00:00 | 334.07 | N | Y | N/A | N/A
37619 | INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I | 2012-01-01 00:00:00 | 1372.19 | N | N | N/A | N/A
37650 | REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I | 2011-07-01 00:00:00 | 428.6 | N | Y | N/A | N/A
37660 | RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I | 2011-07-01 00:00:00 | 1084.46 | N | Y | N/A | N/A
37700 | LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ | 2011-07-01 00:00:00 | 221.18 | Y | Y | N/A | N/A
37718 | LIG DIV&STRIPPING SHORT SAPHENOUS VEIN | 2011-07-01 00:00:00 | 381.88 | Y | Y | N/A | N/A
37722 | LIG DIV&STRIP LONG SAPH SAPHFEM JUNCT KNE/BELW | 2011-07-01 00:00:00 | 424.78 | Y | Y | N/A | N/A
37735 | LIG&DIV&COMPL STRIP LONG/SHORT SAPH RAD EXC | 2011-07-01 00:00:00 | 551.76 | Y | Y | N/A | N/A
37760 | LIG PRFRATR VEIN SUBFSCAL RAD INCL SKN GRF 1 LEG | 2011-07-01 00:00:00 | 563.18 | Y | Y | N/A | N/A
37761 | LIGATE LEG VEINS OPEN | 2011-07-01 00:00:00 | 491.67 | N | Y | N/A | N/A
37765 | STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS | 2011-07-01 00:00:00 | 570.03 | N | Y | N/A | N/A
37766 | STAB PHLEBT VARICOSE VEINS 1 XTR GT 20 INCS | 2011-07-01 00:00:00 | 678.3 | N | Y | N/A | N/A
37780 | LIG&DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX | 2011-07-01 00:00:00 | 228.07 | Y | Y | N/A | N/A
37785 | LIG DIV&/EXC VARICOSE VEIN CLUSTER 1 LEG | 2011-07-01 00:00:00 | 308.52 | Y | Y | N/A | N/A
37790 | PENILE VENOUS OCCLUSIVE PROCEDURE | 2011-07-01 00:00:00 | 423.8 | N | Y | N/A | N/A
37799 | UNLISTED PROCEDURE, VASCULAR SURGERY | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
38100 | SPLENECTOMY TOTAL SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 946.86 | N | Y | N/A | N/A
38101 | SPLENECTOMY TOTAL EN BLOC W/OTHER PROCEDURE | 2011-07-01 00:00:00 | 953.46 | N | Y | N/A | N/A
38102 | SPLENC TOT EN BLOC X10SV DS CONJUNCT W/OTH PX | 2011-07-01 00:00:00 | 218.86 | N | Y | N/A | N/A
38115 | RPR RPTD SPLEEN SPLENORRHAPHY W/WO PRTL SPLENECT | 2011-07-01 00:00:00 | 1048.32 | N | Y | N/A | N/A
38120 | LAPAROSCOPIC SURGICAL SPLENECTOMY | 2011-07-01 00:00:00 | 867.13 | N | Y | N/A | N/A
38129 | [NAME], SPLEEN | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
38200 | INJECTION PROCEDURE SPLENOPORTOGRAPY | 2011-07-01 00:00:00 | 125.49 | N | Y | N/A | N/A
38204 | MANAGEMENT OF RECIPIENT HEMATOPOIETIC PROGENITOR CELL DONOR SEARCH & CELL ACQUIS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
38205 | BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC | 2011-07-01 00:00:00 | 69.47 | N | Y | N/A | N/A
38206 | BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL | 2011-07-01 00:00:00 | 69.99 | N | Y | N/A | N/A
38220 | MARROW ASPIRATION ONLY | 2011-07-01 00:00:00 | 128.95 | N | Y | N/A | N/A
38221 | BONE MARROW BIOPSY NEEDLE/TROCAR | 2011-07-01 00:00:00 | 140.18 | N | Y | N/A | N/A
38230 | BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC | 2011-07-01 00:00:00 | 287.22 | N | Y | N/A | N/A
38232 | BONE MARROW HARVEST TRANSPLANTATION AUTOLOGOUS | 2012-01-01 00:00:00 | 153.05 | N | N | N/A | N/A
38240 | MARROW/BLD-DRV PRPH STEM CELL TRNSPLJ ALLOGENEIC | 2011-07-01 00:00:00 | 108.5 | Y | Y | N/A | N/A
38241 | MARROW/BLD-DRV PRPH STEM CELL TRNSPLJ AUTOL | 2011-07-01 00:00:00 | 108.43 | Y | Y | N/A | N/A
38242 | MARROW/BLD-DRV PRPH STEM CELL TRNSPLJ ALGC DON | 2011-07-01 00:00:00 | 82.87 | Y | Y | N/A | N/A
38243 | TRNSPLJ HEMATOPOIETIC CELL BOOST | 2013-01-01 00:00:00 | 99.47 | N | N | N/A | N/A
38300 | DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL | 2011-07-01 00:00:00 | 230.44 | N | Y | N/A | N/A
38305 | DRG LYMPH NODE ABSC/LYMPHADENITIS X10SV | 2011-07-01 00:00:00 | 385.26 | N | Y | N/A | N/A
38308 | LYMPHANGIOTOMY/OTH OPRATIONS LYMPHATIC CHANNELS | 2011-07-01 00:00:00 | 372.47 | N | Y | N/A | N/A
38380 | SUTR&/LIG THORACIC DUCT CERVICAL APPROACH | 2011-07-01 00:00:00 | 487.4 | N | Y | N/A | N/A
38381 | SUTR&/LIG THORACIC DUCT THORACIC APPROACH | 2011-07-01 00:00:00 | 688.12 | N | Y | N/A | N/A
38382 | SUTR&/LIG THORACIC DUCT ABDOMINAL APPROACH | 2011-07-01 00:00:00 | 565.03 | N | Y | N/A | N/A
38500 | BX/EXC LYMPH NODE OPEN SUPERFICIAL | 2011-07-01 00:00:00 | 269.68 | N | Y | N/A | N/A
38505 | BX/EXC LYMPH NODE NEEDLE SUPERFICIAL | 2011-07-01 00:00:00 | 107.32 | N | Y | N/A | N/A
38510 | BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE | 2011-07-01 00:00:00 | 433.73 | N | Y | N/A | N/A
38520 | BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD | 2011-07-01 00:00:00 | 388.6 | N | Y | N/A | N/A
38525 | BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE | 2011-07-01 00:00:00 | 355.65 | N | Y | N/A | N/A
38530 | BX/EXC LYMPH NODE OPEN INT MAMMARY NODE | 2011-07-01 00:00:00 | 453.53 | N | Y | N/A | N/A
38542 | DISSECTION DEEP JUGULAR NODE | 2011-07-01 00:00:00 | 439.38 | N | Y | N/A | N/A
38550 | EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ | 2011-07-01 00:00:00 | 410.67 | N | Y | N/A | N/A
38555 | EXC CSTIC HYGROMA AX/CRV W/DP NEUROVASC DSJ | 2011-07-01 00:00:00 | 835.5 | N | Y | N/A | N/A
38562 | LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC | 2011-07-01 00:00:00 | 587.03 | N | Y | N/A | N/A
38564 | LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC | 2011-07-01 00:00:00 | 586.88 | N | Y | N/A | N/A
38570 | LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT | 2011-07-01 00:00:00 | 458.07 | N | Y | N/A | N/A
38571 | LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY | 2011-07-01 00:00:00 | 701.28 | N | Y | N/A | N/A
38572 | LAPS BI TOT PEL LMPHADEC&PRI-AORTIC LYMPH BX 1/+ | 2011-07-01 00:00:00 | 802.78 | N | Y | N/A | N/A
38589 | [NAME] PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
38700 | SUPRAHYOID LYMPHADENECTOMY | 2011-07-01 00:00:00 | 686.23 | N | Y | N/A | N/A
38720 | CERVICAL LYMPHADENECTOMY | 2011-07-01 00:00:00 | 1142.27 | N | Y | N/A | N/A
38724 | CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ | 2011-07-01 00:00:00 | 1240.22 | N | Y | N/A | N/A
38740 | AXILLARY LYMPHADENECTOMY SUPERFICIAL | 2011-07-01 00:00:00 | 565.97 | N | Y | N/A | N/A
38745 | AXILLARY LYMPHADENECTOMY COMPLETE | 2011-07-01 00:00:00 | 718.52 | N | Y | N/A | N/A
38746 | [NAME] | 2011-07-01 00:00:00 | 222.8 | N | Y | N/A | N/A
38747 | ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC | 2011-07-01 00:00:00 | 222.89 | N | Y | N/A | N/A
38760 | INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX | 2011-07-01 00:00:00 | 699.71 | N | Y | N/A | N/A
38765 | INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC | 2011-07-01 00:00:00 | 1078.17 | N | Y | N/A | N/A
38770 | PEL LMPHADEC W/XTRNL ILIAC HYPOGSTR&OBTURATOR | 2011-07-01 00:00:00 | 693.32 | N | Y | N/A | N/A
38780 | RPR TABDL LMPHADEC X10SV W/PEL AORTIC&RNL | 2011-07-01 00:00:00 | 883.31 | N | Y | N/A | N/A
38790 | INJECTION PROCEDURE LYMPHANGIOGRAPHY | 2011-07-01 00:00:00 | 71.04 | N | Y | N/A | N/A
38792 | INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE | 2011-07-01 00:00:00 | 34.32 | N | Y | N/A | N/A
38794 | CANNULATION THORACIC DUCT | 2011-07-01 00:00:00 | 257.62 | N | Y | N/A | N/A
38900 | INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION | 2011-07-01 00:00:00 | 114.84 | N | Y | N/A | N/A
38999 | UNLISTED PROCEDURE, HEMIC OR LYMPHATIC SYSTEM | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
39000 | MEDIAST W/EXPL DRG RMVL FB/BX CRV APPR | 2011-07-01 00:00:00 | 424.19 | N | Y | N/A | N/A
39010 | MEDIAST W/EXPL DRG RMVL FB/BX TTHRC APPR | 2011-07-01 00:00:00 | 684.73 | N | Y | N/A | N/A
39200 | RESECTION OF MEDIASTINAL CYST | 2011-07-01 00:00:00 | 758.08 | N | Y | N/A | N/A
39220 | [NAME] | 2011-07-01 00:00:00 | 979.98 | N | Y | N/A | N/A
39400 | MEDIASTINOSCOPY INCL BIOPSIES WHEN PERFORMED | 2011-07-01 00:00:00 | 434.47 | N | Y | N/A | N/A
39499 | UNLISTED MEDIASTINUM PROC | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
39501 | REPAIR LACERATION DIAPHRAGM ANY APPROACH | 2011-07-01 00:00:00 | 709.78 | N | Y | N/A | N/A
39503 | RPR NEONATAL DIPHRG HERNIA W/WO CHEST TUBE INSJ | 2011-07-01 00:00:00 | 5057.61 | N | Y | N/A | N/A
39540 | RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC AQT | 2011-07-01 00:00:00 | 727.04 | N | Y | N/A | N/A
39541 | RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC CHRNC | 2011-07-01 00:00:00 | 787.64 | N | Y | N/A | N/A
39545 | IMBRICATION DIAPHRAGM EVENTRATION | 2011-07-01 00:00:00 | 762.74 | N | Y | N/A | N/A
39560 | RESCJ DIAPHRAGM W/SIMPLE REPAIR | 2011-07-01 00:00:00 | 665.29 | N | Y | N/A | N/A
39561 | RESCJ DIAPHRAGM W/COMPLEX REPAIR | 2011-07-01 00:00:00 | 1044.86 | N | Y | N/A | N/A
39599 | UNLISTED DIAPHRAGM PROC | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
40490 | BIOPSY OF LIP | 2011-07-01 00:00:00 | 109.66 | N | Y | N/A | N/A
40500 | VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT | 2011-07-01 00:00:00 | 426.67 | N | Y | N/A | N/A
40510 | EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR | 2011-07-01 00:00:00 | 408.38 | N | Y | N/A | N/A
40520 | [NAME]/PRIM [NAME] CLSR | 2011-07-01 00:00:00 | 416.81 | N | Y | N/A | N/A
40525 | EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP | 2011-07-01 00:00:00 | 474.55 | N | Y | N/A | N/A
40527 | EXC LIP FULL THKNS RCNSTJ W/CROSS LIP FLAP | 2011-07-01 00:00:00 | 546.76 | N | Y | N/A | N/A
40530 | RESCJ LIP GT ONE-FOURTH W/O RCNSTJ | 2011-07-01 00:00:00 | 460.12 | N | Y | N/A | N/A
40650 | RPR LIP FULL THICKNESS VERMILION ONLY | 2011-07-01 00:00:00 | 350.72 | N | Y | N/A | N/A
40652 | RPR LIP FULL THICKNESS HALF/LT VERTICAL HEIGHT | 2011-07-01 00:00:00 | 408.85 | N | Y | N/A | N/A
40654 | RPR LIP FULL THKNS GTONE-HALF VERT HEIGHT/COMPLEX | 2011-07-01 00:00:00 | 481.42 | N | Y | N/A | N/A
40700 | PLSTC RPR CL LIP/NSL DFRM PRIM PRTL/COMPL UNI | 2011-07-01 00:00:00 | 825.87 | N | Y | N/A | N/A
40701 | PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 STG PX | 2011-07-01 00:00:00 | 955.5 | N | Y | N/A | N/A
40702 | PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 2 STGS | 2011-07-01 00:00:00 | 718.05 | N | Y | N/A | N/A
40720 | PLSTC RPR CL LIP/NSL DFRM SEC RECRTJ DFCT&RECLSR | 2011-07-01 00:00:00 | 834.08 | N | Y | N/A | N/A
40761 | PLSTC RPR CL LIP/NSL DFRM W/CROSS LIP PEDCL FLAP | 2011-07-01 00:00:00 | 927.53 | N | Y | N/A | N/A
40799 | UNLISTED PROCEDURE, LIP | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
40800 | DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL | 2011-07-01 00:00:00 | 173.12 | N | Y | N/A | N/A
40801 | DRG ABSC CST HMTMA VESTIBULE MOUTH COMP | 2011-07-01 00:00:00 | 261.64 | N | Y | N/A | N/A
40804 | RMVL EMBEDDED FB VESTIBULE MOUTH SMPL | 2011-07-01 00:00:00 | 177.8 | N | Y | N/A | N/A
40805 | RMVL EMBEDDED FB VESTIBULE MOUTH COMP | 2011-07-01 00:00:00 | 271.95 | N | Y | N/A | N/A
40806 | INCISION LABIAL FRENUM FRENOTOMY | 2011-07-01 00:00:00 | 88.9 | N | Y | N/A | N/A
40808 | BIOPSY VESTIBULE MOUTH | 2011-07-01 00:00:00 | 155.25 | N | Y | N/A | N/A
40810 | [NAME] MUCOSA&SBMCSL [NAME] | 2011-07-01 00:00:00 | 172.19 | N | Y | N/A | N/A
40812 | [NAME] MUCOSA&SBMCSL VESTIBULE SMPL RPR | 2011-07-01 00:00:00 | 239.37 | N | Y | N/A | N/A
40814 | [NAME] MUCOSA&SBMCSL VESTIBULE CPLX RPR | 2011-07-01 00:00:00 | 322.21 | N | Y | N/A | N/A
40816 | [NAME] MUCOSA&SBMCSL [NAME] EXC MUSC | 2011-07-01 00:00:00 | 338.91 | N | Y | N/A | N/A
40818 | EXC MUCOSA VESTIBULE MOUTH AS [NAME] | 2011-07-01 00:00:00 | 297.75 | N | Y | N/A | N/A
40819 | [NAME] | 2011-07-01 00:00:00 | 256.4 | N | Y | N/A | N/A
40820 | DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS | 2011-07-01 00:00:00 | 222.9 | N | Y | N/A | N/A
40830 | CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/LT | 2011-07-01 00:00:00 | 206.98 | N | Y | N/A | N/A
40831 | CLOSURE LACERATION VESTIBULE MOUTH GT 2.5 CM/CPLX | 2011-07-01 00:00:00 | 275.38 | N | Y | N/A | N/A
40840 | VESTIBULOPLASTY ANTERIOR | 2011-07-01 00:00:00 | 706.16 | N | Y | N/A | N/A
40842 | VESTIBULOPLASTY POSTERIOR UNILATERAL | 2011-07-01 00:00:00 | 677.03 | N | Y | N/A | N/A
40843 | VESTIBULOPLASTY POSTERIOR BILATERAL | 2011-07-01 00:00:00 | 894.83 | N | Y | N/A | N/A
40844 | VESTIBULOPLASTY ENTIRE ARCH | 2011-07-01 00:00:00 | 1175.62 | N | Y | N/A | N/A
40845 | VESTIBULOPLASTY CPLX W/RIDGE XTN MUSC RPSG | 2011-07-01 00:00:00 | 1249.59 | N | Y | N/A | N/A
40899 | UNLISTED PROCEDURE, MOUTH | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
41000 | INTRAORAL I&D TONGUE/FLOOR LINGUAL | 2011-07-01 00:00:00 | 136.13 | N | Y | N/A | N/A
41005 | INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC | 2011-07-01 00:00:00 | 188.19 | N | Y | N/A | N/A
41006 | INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD | 2011-07-01 00:00:00 | 303.83 | N | Y | N/A | N/A
41007 | INTRAORAL I&D TONGUE/FLOOR SUBMENTAL SPACE | 2011-07-01 00:00:00 | 303.13 | N | Y | N/A | N/A
41008 | INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE | 2011-07-01 00:00:00 | 313.91 | N | Y | N/A | N/A
41009 | INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE | 2011-07-01 00:00:00 | 334.07 | N | Y | N/A | N/A
41010 | INCISION LINGUAL FRENUM FRENOTOMY | 2011-07-01 00:00:00 | 173.36 | N | Y | N/A | N/A
41015 | XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL | 2011-07-01 00:00:00 | 366.56 | N | Y | N/A | N/A
41016 | XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMENTAL | 2011-07-01 00:00:00 | 366.64 | N | Y | N/A | N/A
41017 | XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDBLR | 2011-07-01 00:00:00 | 369.81 | N | Y | N/A | N/A
41018 | XTRORAL I&D FLOOR MASTICATOR SPACE | 2011-07-01 00:00:00 | 418.18 | N | Y | N/A | N/A
41019 | PLACEMENT NEEDLE HEAD/NECK RADIOELEMENT APPLICAT | 2011-07-01 00:00:00 | 406.04 | N | Y | N/A | N/A
41100 | BIOPSY TONGUE ANTERIOR TWO-THIRDS | 2011-07-01 00:00:00 | 142.66 | N | Y | N/A | N/A
41105 | BIOPSY TONGUE POSTERIOR ONE-THIRD | 2011-07-01 00:00:00 | 144.18 | N | Y | N/A | N/A
41108 | BIOPSY FLOOR MOUTH | 2011-07-01 00:00:00 | 124.33 | N | Y | N/A | N/A
41110 | EXCISION LESION TONGUE W/O CLOSURE | 2011-07-01 00:00:00 | 179.29 | N | Y | N/A | N/A
41112 | [NAME] TONGUE W/CLSR ANTERIOR TWO-THIRDS | 2011-07-01 00:00:00 | 280.73 | N | Y | N/A | N/A
41113 | [NAME] TONGUE W/CLSR POSTERIOR ONE-THIRD | 2011-07-01 00:00:00 | 306.34 | N | Y | N/A | N/A
41114 | EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP | 2011-07-01 00:00:00 | 546.8 | N | Y | N/A | N/A
41115 | EXCIISION LINGUAL FRENUM FRENECTOMY | 2011-07-01 00:00:00 | 205.82 | N | Y | N/A | N/A
41116 | EXCISION LESION [NAME] | 2011-07-01 00:00:00 | 277.36 | N | Y | N/A | N/A
41120 | GLOSSECTOMY LT ONE-HALF TONGUE | 2011-07-01 00:00:00 | 903.17 | N | Y | N/A | N/A
41130 | GLOSSECTOMY HEMIGLOSSECTOMY | 2011-07-01 00:00:00 | 1118.05 | N | Y | N/A | N/A
41135 | GLOSSECTOMY PRTL W/UNI RADICAL NECK DSJ | 2011-07-01 00:00:00 | 1850.46 | N | Y | N/A | N/A
41140 | GLSSC COMPL/TOT W/WOTRACHS W/O RAD NECK DSJ | 2011-07-01 00:00:00 | 1887.09 | N | Y | N/A | N/A
41145 | GLSSC COMPL/TOT W/WO TRACHS W/UNI RAD NECK DSJ | 2011-07-01 00:00:00 | 2376.55 | N | Y | N/A | N/A
41150 | GLSSC COMPOSIT W/RESCJ FLOOR&MNDBLR RESCJ | 2011-07-01 00:00:00 | 1880 | N | Y | N/A | N/A
41153 | GLSSC COMPOSIT RESCJ FLOOR SUPRAHYOID NCK DSJ | 2011-07-01 00:00:00 | 2043.75 | N | Y | N/A | N/A
41155 | GLSSC COMPOSIT RESCJ FLR MNDBLR RESCJ&RAD NCK | 2011-07-01 00:00:00 | 2553.66 | N | Y | N/A | N/A
41250 | RPR LAC 2.5 CM/LT MOUTH&/ANT TWO-THIRDS TONGUE | 2011-07-01 00:00:00 | 202.1 | N | Y | N/A | N/A
41251 | RPR LAC 2.5 CM/LT PST ONE-THIRD TONGUE | 2011-07-01 00:00:00 | 212.58 | N | Y | N/A | N/A
41252 | RPR LAC TONGUE FLOOR MOUTH GT 2.6 CM/CPLX | 2011-07-01 00:00:00 | 262.8 | N | Y | N/A | N/A
41500 | FIXJ TONGUE MECHANICAL OTHER/THAN SUTURE | 2011-07-01 00:00:00 | 385.44 | N | Y | N/A | N/A
41510 | SUTURE TONGUE LIP MICROGNATHIA | 2011-07-01 00:00:00 | 325.53 | N | Y | N/A | N/A
41512 | TONGUE BASE SUSPENSION PERMANENT SUTURE TQ | 2011-07-01 00:00:00 | 536.69 | N | Y | N/A | N/A
41520 | FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY | 2011-07-01 00:00:00 | 293.07 | N | Y | N/A | N/A
41599 | UNLISTED PROCEDURE, TONGUE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
41800 | DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS | 2011-07-01 00:00:00 | 205.89 | N | Y | N/A | N/A
41805 | RMVL EMBEDDED FB FROM DENTALVLR STRUXS SOFT TISS | 2011-07-01 00:00:00 | 202.43 | N | Y | N/A | N/A
41806 | RMVL EMBEDDED FB FROM DENTOALVEOLAR STRUXS BONE | 2011-07-01 00:00:00 | 299.21 | N | Y | N/A | N/A
41820 | GINGIVECTOMY | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
41821 | OPERCULECTOMY, EXCISION PERICORONAL TISSUE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
41822 | [NAME] TUBEROSITIES DENTOALVEOLAR STRUXS | 2011-07-01 00:00:00 | 241.75 | N | Y | N/A | N/A
41823 | EXC OSS TUBEROSITIES DENTOALVEOLAR STRUXS | 2011-07-01 00:00:00 | 358.97 | N | Y | N/A | N/A
41825 | EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR | 2011-07-01 00:00:00 | 175.51 | N | Y | N/A | N/A
41826 | EXC LESION/TUMOR DENTOALVEOLAR STRUX W/SMPL RPR | 2011-07-01 00:00:00 | 252.14 | N | Y | N/A | N/A
41827 | EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR | 2011-07-01 00:00:00 | 365.02 | N | Y | N/A | N/A
41828 | [NAME] ALVEOLAR MUCOSA EA QUADRANT SPEC | 2011-07-01 00:00:00 | 254.8 | N | Y | N/A | N/A
41830 | ALVEOLECTOMY W/CURTG OSTEITIS/SEQUESTRECTOMY | 2011-07-01 00:00:00 | 326 | N | Y | N/A | N/A
41850 | DSTRCTN, LESN, DENTO-ALVEOLAR | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
41870 | PERIODONTAL MUCOSAL GRAFTING | 2008-07-01 00:00:00 | 345.48 | N | Y | N/A | N/A
41872 | GINGIVOPLASTY EACH QUADRANT SPECIFY | 2011-07-01 00:00:00 | 309 | N | Y | N/A | N/A
41874 | ALVEOLOPLASTY EACH QUADRANT SPECIFY | 2011-07-01 00:00:00 | 309.11 | N | Y | N/A | N/A
41899 | UNLISTED PROC, DENTOALVEOLAR | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
42000 | DRAINAGE ABSCESS PALATE UVULA | 2011-07-01 00:00:00 | 132.77 | N | Y | N/A | N/A
42100 | BIOPSY PALATE UVULA | 2011-07-01 00:00:00 | 126.92 | N | Y | N/A | N/A
42104 | EXC LESION PALATE UVULA W/O CLOSURE | 2011-07-01 00:00:00 | 179.98 | N | Y | N/A | N/A
42106 | EXC LESION PALATE UVULA W/SMPL PRIM [NAME] | 2011-07-01 00:00:00 | 226.24 | N | Y | N/A | N/A
42107 | EXC LESION PALATE UVULA W/LOCAL FLAP CLOSURE | 2011-07-01 00:00:00 | 388.52 | N | Y | N/A | N/A
42120 | RESCJ PALATE/EXTENSIVE RESCJ LESION | 2011-07-01 00:00:00 | 850.64 | N | Y | N/A | N/A
42140 | UVULECTOMY EXCISION UVULA | 2011-07-01 00:00:00 | 215.47 | N | Y | N/A | N/A
42145 | PALATOPHARYNGOPLASTY | 2011-07-01 00:00:00 | 609.28 | N | Y | N/A | N/A
42160 | DSTRJ LES PALATE/UVULA THERMAL CRYO/CHEM | 2011-07-01 00:00:00 | 200.62 | N | Y | N/A | N/A
42180 | REPAIR LACERATION PALATE LT/2 CM | 2011-07-01 00:00:00 | 199.09 | N | Y | N/A | N/A
42182 | REPAIR LACERATION PALATE GT2 CM/COMPLEX | 2011-07-01 00:00:00 | 277.15 | N | Y | N/A | N/A
42200 | PALATOP CL PALATE SOFT&/HARD PALATE ONLY | 2011-07-01 00:00:00 | 747.83 | N | Y | N/A | N/A
42205 | PALATOPLASTY W/CLSR ALVEOLAR RIDGE SOFT TISSUE | 2011-07-01 00:00:00 | 818.92 | N | Y | N/A | N/A
42210 | PALATOP CLSR ALVEOLAR RIDGE GRF ALVEOLAR RIDGE | 2011-07-01 00:00:00 | 894.48 | N | Y | N/A | N/A
42215 | PALATOPLASTY CLEFT PALATE MAJOR REVJ | 2011-07-01 00:00:00 | 610.83 | N | Y | N/A | N/A
42220 | PALATOPLASTY CLEFT PALATE SEC LNGTH PX | 2011-07-01 00:00:00 | 456.35 | N | Y | N/A | N/A
42225 | PALATOP CL PALATE ATTACHMENT PHARYNGEAL FLAP | 2011-07-01 00:00:00 | 785.16 | N | Y | N/A | N/A
42226 | LENGTHENING PALATE & PHARYNGEAL FLAP | 2011-07-01 00:00:00 | 787.11 | N | Y | N/A | N/A
42227 | LENGTHENING PALATE W/ISLAND FLAP | 2011-07-01 00:00:00 | 751.72 | N | Y | N/A | N/A
42235 | REPAIR ANTERIOR PALATE W/VOMER FLAP | 2011-07-01 00:00:00 | 636.95 | N | Y | N/A | N/A
42260 | REPAIR NASOLABIAL FISTULA | 2011-07-01 00:00:00 | 701.93 | N | Y | N/A | N/A
42280 | MAXILLARY IMPRESJ PALATAL PROSTHESIS | 2011-07-01 00:00:00 | 137.03 | N | Y | N/A | N/A
42281 | INSJ PIN-RETAINED PALATAL PROSTHESIS | 2011-07-01 00:00:00 | 174.38 | N | Y | N/A | N/A
42299 | UNLISTED PROC, PALATE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
42300 | DRAINAGE ABSCESS PAROTID SIMPLE | 2011-07-01 00:00:00 | 178.31 | N | Y | N/A | N/A
42305 | DRAINAGE ABSCESS PAROTID COMPLICATED | 2011-07-01 00:00:00 | 371.78 | N | Y | N/A | N/A
42310 | DRG ABSC SUBMAXILLARY/SUBLINGUAL INTRAORAL | 2011-07-01 00:00:00 | 138.44 | N | Y | N/A | N/A
42320 | DRAINAGE ABSCESS SUBMAXILLARY INTRAORAL | 2011-07-01 00:00:00 | 213.76 | N | Y | N/A | N/A
42330 | SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL | 2011-07-01 00:00:00 | 198.35 | N | Y | N/A | N/A
42335 | SIALOLITHOTOMY SUBMNDBLR SUBMAX COMP INTRAORAL | 2011-07-01 00:00:00 | 318.09 | N | Y | N/A | N/A
42340 | SIALOLITHOTOMY PRTD XTRORAL/COMP INTRAORAL | 2011-07-01 00:00:00 | 396.07 | N | Y | N/A | N/A
42400 | BIOPSY SALIVARY GLAND NEEDLE | 2011-07-01 00:00:00 | 91.86 | N | Y | N/A | N/A
42405 | BIOPSY SALIVARY GLAND INCISIONAL | 2011-07-01 00:00:00 | 255.68 | N | Y | N/A | N/A
42408 | EXC SUBLINGUAL [NAME] | 2011-07-01 00:00:00 | 388.87 | N | Y | N/A | N/A
42409 | MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA | 2011-07-01 00:00:00 | 284.04 | N | Y | N/A | N/A
42410 | [NAME] LAT LOBE W/O NRV DSJ | 2011-07-01 00:00:00 | 536.4 | N | Y | N/A | N/A
42415 | [NAME] LAT DSJ&PRSRV FACIAL NRV | 2011-07-01 00:00:00 | 963.5 | N | Y | N/A | N/A
42420 | [NAME] DSJ&PRSRV FACIAL NRV | 2011-07-01 00:00:00 | 1103.43 | N | Y | N/A | N/A
42425 | EXCISION PAROTID TUMOR/GLAND TOTAL EN BLOC RMVL | 2011-07-01 00:00:00 | 727.74 | N | Y | N/A | N/A
42426 | [NAME]/UNI RAD NCK DSJ | 2011-07-01 00:00:00 | 1176.85 | N | Y | N/A | N/A
42440 | EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND | 2011-07-01 00:00:00 | 404.2 | N | Y | N/A | N/A
42450 | EXISION OF SUBLINGUAL GLAND | 2011-07-01 00:00:00 | 387.11 | N | Y | N/A | N/A
42500 | PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM | 2011-07-01 00:00:00 | 369.71 | N | Y | N/A | N/A
42505 | PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY SEC/COMP | 2011-07-01 00:00:00 | 476 | N | Y | N/A | N/A
42507 | PAROTID DUCT DIVERSION BILATERAL WILKE PX | 2011-07-01 00:00:00 | 445.31 | N | Y | N/A | N/A
42508 | PAROTID DUCT DIVERSION BI W/EXC 1 SUBMNDBLR GLND | 2011-07-01 00:00:00 | 610.51 | N | Y | N/A | N/A
42509 | PAROTID DUCT DVRJ BI W/EXC BOTH SUBMNDBLR GLANDS | 2011-07-01 00:00:00 | 700.88 | N | Y | N/A | N/A
42510 | PAROTID DUCT DVRJ BILATERAL WITH LIG BOTH DUCTS | 2011-07-01 00:00:00 | 546.15 | N | Y | N/A | N/A
42550 | INJECTION PROCEDURE SIALOGRAPHY | 2011-07-01 00:00:00 | 119.16 | N | Y | N/A | N/A
42600 | CLOSURE SALIVARY FISTULA | 2011-07-01 00:00:00 | 413.7 | N | Y | N/A | N/A
42650 | [NAME] DUCT | 2011-07-01 00:00:00 | 71.15 | N | Y | N/A | N/A
42660 | DILAT&CATHJ SALIVARY DUCT W/WO INJECTION | 2011-07-01 00:00:00 | 90.93 | N | Y | N/A | N/A
42665 | LIGATION SALIVARY DUCT INTRAORAL | 2011-07-01 00:00:00 | 267.17 | N | Y | N/A | N/A
42699 | UNLISTED PROC [NAME] | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
42700 | I&D ABSCESS PERITONSILLAR | 2011-07-01 00:00:00 | 161.5 | N | Y | N/A | N/A
42720 | [NAME] | 2011-07-01 00:00:00 | 392.02 | N | Y | N/A | N/A
42725 | [NAME] | 2011-07-01 00:00:00 | 702.86 | N | Y | N/A | N/A
42800 | BIOPSY OROPHARYNX | 2011-07-01 00:00:00 | 135.77 | N | Y | N/A | N/A
42804 | BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE | 2011-07-01 00:00:00 | 170.86 | N | Y | N/A | N/A
42806 | BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION | 2011-07-01 00:00:00 | 191.82 | N | Y | N/A | N/A
42808 | EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD | 2011-07-01 00:00:00 | 195.34 | N | Y | N/A | N/A
42809 | REMOVAL FOREIGN BODY PHARYNX | 2011-07-01 00:00:00 | 145.51 | N | Y | N/A | N/A
42810 | [NAME] TISS | 2011-07-01 00:00:00 | 332.45 | N | Y | N/A | N/A
42815 | [NAME] TISS&/PHRNX | 2011-07-01 00:00:00 | 481.11 | N | Y | N/A | N/A
42820 | TONSILLECTOMY & ADENOIDECTOMY LTAGE 12 | 2011-07-01 00:00:00 | 252.5 | N | Y | N/A | N/A
42821 | TONSILLECTOMY & ADENOIDECTOMY AGE 12/GT | 2011-07-01 00:00:00 | 262.79 | N | Y | N/A | N/A
42825 | TONSILLECTOMY ONE-HALF LTAGE 12 | 2011-07-01 00:00:00 | 227.77 | N | Y | N/A | N/A
42826 | TONSILLECTOMY ONE-HALF AGE 12/GT | 2011-07-01 00:00:00 | 218.74 | N | Y | N/A | N/A
42830 | ADENOIDECTOMY PRIMARY LTAGE 12 | 2011-07-01 00:00:00 | 179.83 | N | Y | N/A | N/A
42831 | ADENOIDECTOMY PRIMARY AGE 12/GT | 2011-07-01 00:00:00 | 193.84 | N | Y | N/A | N/A
42835 | ADENOIDECTOMY SECONDARYLTAGE 12 | 2011-07-01 00:00:00 | 154.73 | N | Y | N/A | N/A
42836 | ADENOIDECTOMY SECONDARY AGE 12/GT | 2011-07-01 00:00:00 | 209.8 | N | Y | N/A | N/A
42842 | RADICAL RESECTION TONSIL W/O CLOSURE | 2011-07-01 00:00:00 | 852.89 | N | Y | N/A | N/A
42844 | RADICAL RESCJ TONSIL CLOSURE W/LOCAL FLAP | 2011-07-01 00:00:00 | 1181.16 | N | Y | N/A | N/A
42845 | RADICAL RESCJ TONSIL CLOSURE W/OTHER FLAP | 2011-07-01 00:00:00 | 1920.56 | N | Y | N/A | N/A
42860 | EXCISION TONSIL TAGS | 2011-07-01 00:00:00 | 163.24 | N | Y | N/A | N/A
42870 | EXC/DSTRJ LINGUAL TONSIL ANY METHOD SPX | 2011-07-01 00:00:00 | 498.99 | N | Y | N/A | N/A
42890 | LIMITED PHARYNGECTOMY | 2011-07-01 00:00:00 | 1212.69 | N | Y | N/A | N/A
42892 | RESCJ LAT PHRNGL WALL/PYRIFORM SINUS DIR CLSR | 2011-07-01 00:00:00 | 1600.61 | N | Y | N/A | N/A
42894 | RESCJ PHRNGL WALL CLSR W/FLP OR FLP W/MVASC ANAS | 2011-07-01 00:00:00 | 2030.08 | N | Y | N/A | N/A
42900 | SUTURE PHARYNX WOUND/INJURY | 2011-07-01 00:00:00 | 295.92 | N | Y | N/A | N/A
42950 | PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX | 2011-07-01 00:00:00 | 684.6 | N | Y | N/A | N/A
42953 | PHARYNGOESOPHAGEAL REPAIR | 2011-07-01 00:00:00 | 831.79 | N | Y | N/A | N/A
42955 | PHARYNGOSTOMY FSTLJ PHARYNX XTRNL FEEDING | 2011-07-01 00:00:00 | 646.18 | N | Y | N/A | N/A
42960 | CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE | 2011-07-01 00:00:00 | 146.83 | N | Y | N/A | N/A
42961 | CTRL OROPHARYNGEAL HEMORRHAGE COMP REQ HOSPITJ | 2011-07-01 00:00:00 | 365.1 | N | Y | N/A | N/A
42962 | CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ | 2011-07-01 00:00:00 | 450.23 | N | Y | N/A | N/A
42970 | CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS | 2011-07-01 00:00:00 | 340.59 | N | Y | N/A | N/A
42971 | CTRL NASOPHARYNGEAL HEMRRG COMP REQ HOSPIZATION | 2011-07-01 00:00:00 | 397.31 | N | Y | N/A | N/A
42972 | CTRL NASOPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ | 2011-07-01 00:00:00 | 444.74 | N | Y | N/A | N/A
42999 | UNLISTED PROC, T/A OR PHARYNX | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
43020 | ESOPHAGOTOMY CERVICAL APPR W/RMVL FB | 2011-07-01 00:00:00 | 460.52 | N | Y | N/A | N/A
43030 | CRICOPHARYNGEAL MYOTOMY | 2011-07-01 00:00:00 | 450.5 | N | Y | N/A | N/A
43045 | ESOPHAGOTOMY THORACIC APPR W/RMVL FB | 2011-07-01 00:00:00 | 1115.03 | N | Y | N/A | N/A
43100 | EXC LESION ESOPHOGUS W/PRIM RPR CERVICAL APPR | 2011-07-01 00:00:00 | 541.42 | N | Y | N/A | N/A
43101 | EXC LESION ESOPHAGUS W/PRIM RPR THRC/ABDL APPR | 2011-07-01 00:00:00 | 862.14 | N | Y | N/A | N/A
43107 | TOT ESOPHAGECTOMY W/O THORCOM W/WO PYLOROPLASTY | 2011-07-01 00:00:00 | 2160.59 | N | Y | N/A | N/A
43108 | TOT ESOPHG W/O THORCOM COLON NTRPSTJ/INT RCNSTJ | 2011-07-01 00:00:00 | 3847.77 | N | Y | N/A | N/A
43112 | TOTAL ESOPHAGECTOMY W/THORCOM W/WO PYLORPLASTY | 2011-07-01 00:00:00 | 2289.64 | N | Y | N/A | N/A
43113 | TOT ESOPHG W/THORCOM W/COLON NTRPSTJ/INT RCNSTJ | 2011-07-01 00:00:00 | 3797.95 | N | Y | N/A | N/A
43116 | PRTL ESOPHAGECTOMY CERVICAL W/FREE INTSTINAL GRF | 2011-07-01 00:00:00 | 4418.6 | N | Y | N/A | N/A
43117 | PRTL ESOPHECT DSTL W/WO PROX GASTRECT/PYLORPLSTY | 2011-07-01 00:00:00 | 2099.98 | N | Y | N/A | N/A
43118 | PRTL ESOPH DSTL W/WO PROX GASTRC W/COLON NTRPSTJ | 2011-07-01 00:00:00 | 3143.62 | N | Y | N/A | N/A
43121 | PRTL ESOPHAGEC W/WO PROX GASTREC/PYLOROPLASTY | 2011-07-01 00:00:00 | 2429 | N | Y | N/A | N/A
43122 | PRTL ESOPHG THORACOABD W/WO PROXGASTREC/PYLOROPL | 2011-07-01 00:00:00 | 2140.99 | N | Y | N/A | N/A
43123 | PRTL ESPHG THORACOABDL/ABDL APPR NTRPSTJ/RCNSTJ | 2011-07-01 00:00:00 | 3882.64 | N | Y | N/A | N/A
43124 | TOT/PRTL ESPHG W/O RCNSTJ W/CRV ESOPHAGOSTOMY | 2011-07-01 00:00:00 | 3323.05 | N | Y | N/A | N/A
43130 | DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR | 2011-07-01 00:00:00 | 678.92 | N | Y | N/A | N/A
43135 | DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR | 2011-07-01 00:00:00 | 1268.87 | N | Y | N/A | N/A
43191 | ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH | 2014-01-01 00:00:00 | 109.56 | N | Y | N/A | N/A
43192 | ESOPHAGOSCOPY RIGID TRANSORAL INJ SUBMUCOSAL | 2014-01-01 00:00:00 | 130.73 | N | Y | N/A | N/A
43193 | ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY | 2014-01-01 00:00:00 | 155.9 | N | Y | N/A | N/A
43194 | ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY | 2014-01-01 00:00:00 | 142.04 | N | Y | N/A | N/A
43195 | ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION | 2014-01-01 00:00:00 | 156.19 | N | Y | N/A | N/A
43196 | ESOPHAGOSCOPY RIG TRANSORAL GUIDE WIRE DILATION | 2014-01-01 00:00:00 | 170.54 | N | Y | N/A | N/A
43197 | ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC | 2014-01-01 00:00:00 | 154.69 | N | Y | N/A | N/A
43198 | ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY | 2014-01-01 00:00:00 | 172.99 | N | Y | N/A | N/A
43200 | ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX | 2011-07-01 00:00:00 | 184.42 | N | Y | N/A | N/A
43201 | ESPHGSC RGD/FLX W/SUBMUCOSAL INJ ANY SBST | 2011-07-01 00:00:00 | 251.97 | N | Y | N/A | N/A
43202 | ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE | 2011-07-01 00:00:00 | 241.07 | N | Y | N/A | N/A
43204 | ESPHGSC RGD/FLX W/NJX SCLEROSIS ESOPHGL VARC | 2011-07-01 00:00:00 | 192.2 | N | Y | N/A | N/A
43205 | ESPHGSC RGD/FLX W/BAND LIGATION ESOPHGL VARICES | 2011-07-01 00:00:00 | 194.3 | N | Y | N/A | N/A
43206 | ESPHGSC W/OPTICAL ENDOMICROSCOPY | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
43211 | ESOPHAGOSCOPY FLEXIBLE TRANSORAL MUCOSAL RESEXN | 2014-01-01 00:00:00 | 211.82 | N | Y | N/A | N/A
43212 | [NAME] [NAME] | 2014-01-01 00:00:00 | 166.21 | N | Y | N/A | N/A
43213 | ESOPHAGOSCOPY RETROGRADE DILATE BALLOON/OTHER | 2014-01-01 00:00:00 | 1018.71 | N | Y | N/A | N/A
43214 | ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM | 2014-01-01 00:00:00 | 170.15 | N | Y | N/A | N/A
43215 | ESPHGSC RGD/FLX W/RMVL FOREIGN BODY | 2011-07-01 00:00:00 | 133.39 | N | Y | N/A | N/A
43216 | ESPHGSC RGD/FLX RMVL TUM HOT BX FORCEPS/CAUT | 2011-07-01 00:00:00 | 176.98 | N | Y | N/A | N/A
43217 | ESPHGSC RGD/FLX W/RMVL TUMOR SNARE TECHNIQUE | 2011-07-01 00:00:00 | 322.16 | N | Y | N/A | N/A
43220 | ESPHGSC RGD/FLX W/BALLOON DILAT LT 30 MM DIAM | 2011-07-01 00:00:00 | 110.01 | N | Y | N/A | N/A
43226 | ESPHGSC RGD/FLX W/INSJ GUIDE WIRE DILATION | 2011-07-01 00:00:00 | 122.44 | N | Y | N/A | N/A
43227 | ESPHGSC RGD/FLX W/CTRL BLEEDING | 2011-07-01 00:00:00 | 182.09 | N | Y | N/A | N/A
43229 | ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION | 2014-01-01 00:00:00 | 661.78 | N | Y | N/A | N/A
43231 | ESPHGSC RGD/FLX W/NDSC ULTRASOUND EXAMINATION | 2011-07-01 00:00:00 | 165.05 | N | Y | N/A | N/A
43232 | ESPHGSC RGD/FLX W/TNDSC US-GID FINE NDL ASPIR/BX | 2011-07-01 00:00:00 | 227.19 | N | Y | N/A | N/A
43233 | EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER | 2014-01-01 00:00:00 | 181.84 | N | Y | N/A | N/A
43235 | UPPER GI NDSC DX W/WO COLLECTION SPECIMEN | 2011-07-01 00:00:00 | 252.86 | N | Y | N/A | N/A
43236 | UPPER GI NDSC W/SUBMUCOSAL INJECTION | 2011-07-01 00:00:00 | 313.77 | N | Y | N/A | N/A
43237 | UPR GI NDSC & US NDSC EXAM LMTD ESOPHAGUS | 2011-07-01 00:00:00 | 204.29 | N | Y | N/A | N/A
43238 | UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH | 2011-07-01 00:00:00 | 254.86 | N | Y | N/A | N/A
43239 | UPPER NDSC BIOPSY SINGLE/MULTIPLE | 2011-07-01 00:00:00 | 293.21 | N | Y | N/A | N/A
43240 | UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST | 2011-07-01 00:00:00 | 343.98 | N | Y | N/A | N/A
43241 | UPR GI NDSC TNDSC INTRALUMINAL TUBE/CATH PLMT | 2011-07-01 00:00:00 | 134.76 | N | Y | N/A | N/A
43242 | UPPER GI NDSC ULTRASOUND GUIDED BIOPSY | 2011-07-01 00:00:00 | 367.55 | N | Y | N/A | N/A
43243 | UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICES | 2011-07-01 00:00:00 | 232.07 | N | Y | N/A | N/A
43244 | UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES | 2011-07-01 00:00:00 | 256.56 | N | Y | N/A | N/A
43245 | UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ | 2011-07-01 00:00:00 | 162.79 | N | Y | N/A | N/A
43246 | UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE | 2011-07-01 00:00:00 | 217.7 | N | Y | N/A | N/A
43247 | UPPER GI NDSC W/FOREIGN BODY REMOVAL | 2011-07-01 00:00:00 | 173.58 | N | Y | N/A | N/A
43248 | UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS | 2011-07-01 00:00:00 | 163.59 | N | Y | N/A | N/A
43249 | UPR GI NDSC BALLOON DILAT ESOPH LT 30 MM DIAM | 2011-07-01 00:00:00 | 150.81 | N | Y | N/A | N/A
43250 | UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY | 2011-07-01 00:00:00 | 163.18 | N | Y | N/A | N/A
43251 | UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ | 2011-07-01 00:00:00 | 188.96 | N | Y | N/A | N/A
43252 | UPR GI W/OPTICAL ENDOMICROSCOPY | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
43253 | EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER | 2014-01-01 00:00:00 | 234.36 | N | Y | N/A | N/A
43254 | EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION | 2014-01-01 00:00:00 | 243.14 | N | Y | N/A | N/A
43255 | UPR GI NDSC CONTROL BLEEDING ANY METHOD | 2011-07-01 00:00:00 | 245.14 | N | Y | N/A | N/A
43257 | UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA | 2011-07-01 00:00:00 | 276.18 | N | Y | N/A | N/A
43259 | UPPER GI NDSC W/NDSC ULTRASOUND EXAM | 2011-07-01 00:00:00 | 263.81 | N | Y | N/A | N/A
43260 | ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX | 2011-07-01 00:00:00 | 300.97 | N | Y | N/A | N/A
43261 | ERCP W/BIOPSY SINGLE/MULTIPLE | 2011-07-01 00:00:00 | 316.34 | N | Y | N/A | N/A
43262 | ERCP W/SPHINCTEROTOMY/PAPILLOTOMY | 2011-07-01 00:00:00 | 371.61 | N | Y | N/A | N/A
43263 | ERCP W/PRESSURE MEAS SPHINCTER ODDI | 2011-07-01 00:00:00 | 366.36 | N | Y | N/A | N/A
43264 | ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS | 2011-07-01 00:00:00 | 446.15 | N | Y | N/A | N/A
43265 | ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD | 2011-07-01 00:00:00 | 500.36 | N | Y | N/A | N/A
43266 | EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION | 2014-01-01 00:00:00 | 201.12 | N | Y | N/A | N/A
43270 | EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE | 2014-01-01 00:00:00 | 601.47 | N | Y | N/A | N/A
43273 | ENDOSCOPIC PAPILLA CANNULATION BILE PANCREATIC | 2011-07-01 00:00:00 | 111.18 | N | Y | N/A | N/A
43274 | ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT | 2014-01-01 00:00:00 | 417.11 | N | Y | N/A | N/A
43275 | ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT | 2014-01-01 00:00:00 | 343.83 | N | Y | N/A | N/A
43276 | ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE | 2014-01-01 00:00:00 | 434.05 | N | Y | N/A | N/A
43277 | ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA | 2014-01-01 00:00:00 | 345.98 | N | Y | N/A | N/A
43278 | ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE | 2014-01-01 00:00:00 | 354.07 | N | Y | N/A | N/A
43279 | LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED | 2011-07-01 00:00:00 | 1074.21 | N | Y | N/A | N/A
43280 | LAPS SURG ESOPG/GSTR FUNDOPLASTY | 2011-07-01 00:00:00 | 895.33 | N | Y | N/A | N/A
43281 | LAP PARAESOPHAG HERN REPAIR | 2011-07-01 00:00:00 | 1318.98 | N | Y | N/A | N/A
43282 | LAP PARAESOPH HER RPR W/MESH | 2011-07-01 00:00:00 | 1482.14 | N | Y | N/A | N/A
43283 | LAPS ESOPHAGEAL LENGTHENING ADDL | 2011-07-01 00:00:00 | 137.61 | N | Y | N/A | N/A
43289 | [NAME] ESOPHAGUS PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
43300 | ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL | 2011-07-01 00:00:00 | 532.65 | N | Y | N/A | N/A
43305 | ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL | 2011-07-01 00:00:00 | 952.02 | N | Y | N/A | N/A
43310 | ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL | 2011-07-01 00:00:00 | 1278.92 | N | Y | N/A | N/A
43312 | ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL | 2011-07-01 00:00:00 | 1394.18 | N | Y | N/A | N/A
43313 | ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL | 2011-07-01 00:00:00 | 2360.02 | N | Y | N/A | N/A
43314 | ESPHGP CGEN DFCT THRC APPR W/RPR FSTL | 2011-07-01 00:00:00 | 2468.54 | N | Y | N/A | N/A
43320 | EGST W/WO VAGOTOMY&PYLOROPLASTY TABDL/TTHRC APPR | 2011-07-01 00:00:00 | 1160.92 | N | Y | N/A | N/A
43325 | ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH | 2011-07-01 00:00:00 | 1108.61 | N | Y | N/A | N/A
43327 | ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY | 2011-07-01 00:00:00 | 692.05 | N | Y | N/A | N/A
43328 | ESOPG/GSTR FUNDOPLASTY W/THORACOTOMY | 2011-07-01 00:00:00 | 1007.93 | N | Y | N/A | N/A
43330 | ESOPHAGOMYOTOMY HELLER TYPE ABDOMINAL APPROACH | 2011-07-01 00:00:00 | 1091.75 | N | Y | N/A | N/A
43331 | ESOPHAGOMYOTOMY HELLER TYPE THORACIC APPROACH | 2011-07-01 00:00:00 | 1156.01 | N | Y | N/A | N/A
43332 | RPR PARAESOPH HIATAL HERNIA W/LAPT W/O MESH | 2011-07-01 00:00:00 | 990.84 | N | Y | N/A | N/A
43333 | LAPT RPR PARAESOPH HIATAL HERNIA W/MESH | 2011-07-01 00:00:00 | 1076.07 | N | Y | N/A | N/A
43334 | RPR PARAESOPH HIATAL HERNIA W/THORCOM W/O MESH | 2011-07-01 00:00:00 | 1087.23 | N | Y | N/A | N/A
43335 | RPR PARAESOPH HIATAL HERNIA W/THORCOM W/MESH | 2011-07-01 00:00:00 | 1171.6 | N | Y | N/A | N/A
43336 | RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/O MESH | 2011-07-01 00:00:00 | 1279.69 | N | Y | N/A | N/A
43337 | RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/MESH | 2011-07-01 00:00:00 | 1397.22 | N | Y | N/A | N/A
43338 | ESOPHAGUS LENGTHENING | 2011-07-01 00:00:00 | 113.81 | N | Y | N/A | N/A
43340 | ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT ABDL APPR | 2011-07-01 00:00:00 | 1139.64 | N | Y | N/A | N/A
43341 | ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT THRC APPR | 2011-07-01 00:00:00 | 1247.15 | N | Y | N/A | N/A
43350 | ESOPHAGOSTOMY FSTLJ ESOPH XTRNL ABDL APPR | 2011-07-01 00:00:00 | 1025.56 | N | Y | N/A | N/A
43351 | ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR | 2011-07-01 00:00:00 | 1115.74 | N | Y | N/A | N/A
43352 | ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR | 2011-07-01 00:00:00 | 913.52 | N | Y | N/A | N/A
43360 | GI RCNSTJ PREV ESPHG/EXCLUSION W/STOMACH | 2011-07-01 00:00:00 | 1937.37 | N | Y | N/A | N/A
43361 | GI RCNSTJ PREV ESPHG/EXCLUSION W/COLON SM INT | 2011-07-01 00:00:00 | 2167.85 | N | Y | N/A | N/A
43400 | LIGATION DIRECT ESOPHAGEAL VARICES | 2011-07-01 00:00:00 | 1298.88 | N | Y | N/A | N/A
43401 | TRNSXJ ESOPH W/RPR ESOPHAGEAL VARICES | 2011-07-01 00:00:00 | 1264.4 | N | Y | N/A | N/A
43405 | LIG/STAPLING G-ESOP JUNCT PRE-ESOPHGL PRF8J | 2011-07-01 00:00:00 | 1267.26 | N | Y | N/A | N/A
43410 | SUTR ESOPHGL WND/INJ CRV APPR | 2011-07-01 00:00:00 | 874.91 | N | Y | N/A | N/A
43415 | SUTR ESOPHGL WND/INJ TTHRC/TABDL APPR | 2011-07-01 00:00:00 | 1450.76 | N | Y | N/A | N/A
43420 | CLSR ESOPHAGOSTOMY/FSTL CRV APPR | 2011-07-01 00:00:00 | 873.68 | N | Y | N/A | N/A
43425 | CLSR ESOPHAGOSTOMY/FSTL TTHRC/TABDL APPR | 2011-07-01 00:00:00 | 1274.51 | N | Y | N/A | N/A
43450 | [NAME] UNGUIDED SOUND/BOUGIE 1/MULT PASS | 2011-07-01 00:00:00 | 133.7 | N | Y | N/A | N/A
43453 | DILATION ESOPHAGUS GUIDE WIRE | 2011-07-01 00:00:00 | 251.76 | N | Y | N/A | N/A
43460 | ESOPG/GSTR TAMPONADE W/BALO SENGSTAKEN TYPE | 2011-07-01 00:00:00 | 191.95 | N | Y | N/A | N/A
43496 | FREE JEJUNUM TRANSFER W/MICROVASCULAR ANASTOMOSIS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
43499 | MULTIPLE ENDOSCOPIC PROCS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
43500 | GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL | 2011-07-01 00:00:00 | 646.7 | N | Y | N/A | N/A
43501 | GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER | 2011-07-01 00:00:00 | 1107.74 | N | Y | N/A | N/A
43502 | GASTROTOMY W/SUTR RPR PRE-ESOPG/GASTRIC LAC | 2011-07-01 00:00:00 | 1253.8 | N | Y | N/A | N/A
43510 | GSTRT W/ESOPHGL DILAT&INSJ PRM INTRAL TUBE | 2011-07-01 00:00:00 | 798.52 | N | Y | N/A | N/A
43520 | PYLOROMYOTOMY CUTTING PYLORIC MUSC | 2011-07-01 00:00:00 | 576.97 | N | Y | N/A | N/A
43605 | BIOPSY STOMACH LAPAROTOMY | 2011-07-01 00:00:00 | 691.2 | N | Y | N/A | N/A
43610 | EXC LOCAL ULCER/BENIGN TUMOR STOMACH | 2011-07-01 00:00:00 | 807.88 | N | Y | N/A | N/A
43611 | EXC LOCAL MALIGNANT TUMOR STOMACH | 2011-07-01 00:00:00 | 1006.08 | N | Y | N/A | N/A
43620 | GSTRCT TOT W/ESOPHAGOENTEROSTOMY | 2011-07-01 00:00:00 | 1628.22 | N | Y | N/A | N/A
43621 | GSTRCT TOT W/ROUX-EN-Y RCNSTJ | 2011-07-01 00:00:00 | 1870.02 | N | Y | N/A | N/A
43622 | GSTRCT TOT W/FRMJ INTSTINAL POUCH ANY TYPE | 2011-07-01 00:00:00 | 1896.12 | N | Y | N/A | N/A
43631 | GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY | 2011-07-01 00:00:00 | 1196.85 | N | Y | N/A | N/A
43632 | GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY | 2011-07-01 00:00:00 | 1664.54 | N | Y | N/A | N/A
43633 | GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ | 2011-07-01 00:00:00 | 1577.3 | N | Y | N/A | N/A
43634 | GSTRCT PRTL DSTL W/FRMJ INTSTINAL POUCH | 2011-07-01 00:00:00 | 1744.05 | N | Y | N/A | N/A
43635 | VAGOTOMY PFRMD W/PRTL DSTL GSTRCT | 2011-07-01 00:00:00 | 93.41 | N | Y | N/A | N/A
43640 | VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV | 2011-07-01 00:00:00 | 969.79 | N | Y | N/A | N/A
43641 | VGTMY W/PYLOROPLASTY W/WO GASTROST PARIETAL CELL | 2011-07-01 00:00:00 | 983.21 | N | Y | N/A | N/A
43644 | LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB LT150 CM | 2011-07-01 00:00:00 | 1431.41 | Y | Y | N/A | N/A
43645 | LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ | 2011-07-01 00:00:00 | 1529.28 | Y | Y | N/A | N/A
43647 | LAPAROSCOPY, SURGICAL; IMPLANT/REPLACEMENT/GASTRIC NEUROSTIMULATOR | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
43648 | REVISION OR REMOVAL OF GASTRIC NEUROSTIMULATOR ELECTRODES, ANTRUM | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
43651 | LAPS SURG TRNSXJ VAGUS NRV TRUNCAL | 2011-07-01 00:00:00 | 535.84 | N | Y | N/A | N/A
43652 | LAPS SURG TRNSXJ VAGUS NRV SLCTV/HILY SLCTV | 2011-07-01 00:00:00 | 626.72 | N | Y | N/A | N/A
43653 | LAPS SURG GASTROSTOMY W/O CONSTJ GSTR TUBE SPX | 2011-07-01 00:00:00 | 465.71 | N | Y | N/A | N/A
43659 | [NAME] STOMACH PROCEDURE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
43752 | NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDN | 2011-07-01 00:00:00 | 35.69 | N | Y | N/A | N/A
43753 | GASTRIC INTUBAT&ASPIRA W/PHYS SKILL/LAVAGE | 2011-07-01 00:00:00 | 18.04 | N | Y | N/A | N/A
43754 | GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIMEN | 2011-07-01 00:00:00 | 67.23 | N | Y | N/A | N/A
43755 | GASTRIC INTUBATION DX & ASPIRATJ MULTIPLE SPECS | 2011-07-01 00:00:00 | 102.81 | N | Y | N/A | N/A
43756 | DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN | 2011-07-01 00:00:00 | 185.9 | N | Y | N/A | N/A
43757 | DUODENAL INTUBAT W/IMAG GUIDED MULTIPLE SPECIMEN | 2011-07-01 00:00:00 | 239.47 | N | Y | N/A | N/A
43760 | CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE | 2011-07-01 00:00:00 | 342.84 | N | Y | N/A | N/A
43761 | REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO | 2011-07-01 00:00:00 | 103.15 | N | Y | N/A | N/A
43770 | LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE | 2011-07-01 00:00:00 | 919.55 | Y | Y | N/A | N/A
43771 | LAPS GASTRIC RESTRICTIVE PX REVISION DEVICE | 2011-07-01 00:00:00 | 1047.31 | Y | Y | N/A | N/A
43772 | LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE | 2011-07-01 00:00:00 | 788.86 | Y | Y | N/A | N/A
43773 | LAPS GASTRIC RESTRICTIVE PX REMOVE&RPLCMT DEVICE | 2011-07-01 00:00:00 | 1047.31 | Y | Y | N/A | N/A
43774 | LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE &PORT | 2011-07-01 00:00:00 | 791.27 | Y | Y | N/A | N/A
43775 | LAP SLEEVE GASTRECTOMY | 2010-01-01 00:00:00 | 918.68 | Y | Y | N/A | N/A
43800 | PYLOROPLASTY | 2011-07-01 00:00:00 | 766.18 | N | Y | N/A | N/A
43810 | GASTRODUODENOSTOMY | 2011-07-01 00:00:00 | 834.16 | N | Y | N/A | N/A
43820 | GASTROJEJUNOSTOMY W/O VAGOTOMY | 2011-07-01 00:00:00 | 1096.88 | N | Y | N/A | N/A
43825 | GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE | 2011-07-01 00:00:00 | 1074.41 | N | Y | N/A | N/A
43830 | GASTROSTOMY OPN W/O CONSTJ GSTR TUBE SPX | 2011-07-01 00:00:00 | 573.79 | N | Y | N/A | N/A
43831 | GASTROSTOMY OPN NEONATAL FEEDING | 2011-07-01 00:00:00 | 484.76 | N | Y | N/A | N/A
43832 | GASTROSTOMY OPN W/CONSTJ GSTR TUBE | 2011-07-01 00:00:00 | 870.54 | N | Y | N/A | N/A
43840 | GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ | 2011-07-01 00:00:00 | 1111.73 | N | Y | N/A | N/A
43842 | GASTRIC RSTCV W/O BYP VERTICAL-BANDED GASTROPLY | 2008-07-01 00:00:00 | 1146.6 | Y | Y | N/A | N/A
43843 | GSTR RSTCV W/O BYP OTH/THN VER-BANDED GSTP | 2011-07-01 00:00:00 | 1048.87 | Y | Y | N/A | N/A
43845 | GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | 2011-07-01 00:00:00 | 1613.22 | Y | Y | N/A | N/A
43846 | GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/LT | 2011-07-01 00:00:00 | 1345.04 | Y | Y | N/A | N/A
43847 | GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ | 2011-07-01 00:00:00 | 1476.18 | Y | Y | N/A | N/A
43848 | REVISION OPEN GASTRIC RESTRICTIVE PX NOT DEVICE | 2011-07-01 00:00:00 | 1592 | Y | Y | N/A | N/A
43850 | REVJ GASTRODUOL ANAST W/RCNSTJ W/O VAGOTOMY | 2011-07-01 00:00:00 | 1336.64 | Y | Y | N/A | N/A
43855 | REVJ GASTRODUOL ANAST W/RCNSTJ W/VGTMY | 2011-07-01 00:00:00 | 1391.05 | N | Y | N/A | N/A
43860 | REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY | 2011-07-01 00:00:00 | 1349.01 | N | Y | N/A | N/A
43865 | REVJ GSTR/JJ ANAST W/RCNSTJ W/VGTMY | 2011-07-01 00:00:00 | 1406.63 | N | Y | N/A | N/A
43870 | CLOSURE GASTROSTOMY SURG | 2011-07-01 00:00:00 | 584.7 | N | Y | N/A | N/A
43880 | [NAME] GASTROCOLIC FISTULA | 2011-07-01 00:00:00 | 1317.23 | N | Y | N/A | N/A
43881 | IMPLANTATION OR REPLACEMENT OF GASTRIC NEUROSTIMULATOR ELECTRODES, ANTRUM, OPEN | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
43882 | REVISION OR REMOVAL OF GASTRIC NEUROSTIMULATOR ELECTRODES, ANTRUM, OPEN | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
43999 | UNLISTED PROCEDURE, STOMACH | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
44005 | ENTEROLSS FRING INTSTINAL ADHESION SPX | 2011-07-01 00:00:00 | 902.42 | N | Y | N/A | N/A
44010 | DUODENOTOMY EXPLORATION/BX/FOREIGN BODY REMOVAL | 2011-07-01 00:00:00 | 713.33 | N | Y | N/A | N/A
44015 | TUBE/NEEDLE CATH JEJUNOSTOMY ANY METHOD | 2011-07-01 00:00:00 | 119.61 | N | Y | N/A | N/A
44020 | ENTEROTOMY SM INT OTH/THN DUO EXPL BX/FB RMVL | 2011-07-01 00:00:00 | 801.14 | N | Y | N/A | N/A
44021 | ENTEROTOMY SM INT OTH/THN DUO DCMPRN | 2011-07-01 00:00:00 | 809.5 | N | Y | N/A | N/A
44025 | COLOTOMY EXPLORATION/BIOPSY/FOREIGN BODY REMOVAL | 2011-07-01 00:00:00 | 814.28 | N | Y | N/A | N/A
44050 | RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT | 2011-07-01 00:00:00 | 769.73 | N | Y | N/A | N/A
44055 | CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS | 2011-07-01 00:00:00 | 1232.93 | N | Y | N/A | N/A
44100 | BX INTESTINE CAPSULE TUBE PRORAL 1/GT SPECIMENS | 2011-07-01 00:00:00 | 98.32 | N | Y | N/A | N/A
44110 | EXC 1/GT SMALL/LARGE LESIONS INTESTINE ENTEROTOMY | 2011-07-01 00:00:00 | 699.49 | N | Y | N/A | N/A
44111 | EXC 1/GT SM/LG LESIONS INTESTNE MULT ENTEROTOMIES | 2011-07-01 00:00:00 | 812.17 | N | Y | N/A | N/A
44120 | ENTRC RESCJ SMALL INTESTINE 1 RESCJ&ANAST | 2011-07-01 00:00:00 | 1007.96 | N | Y | N/A | N/A
44121 | ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ&ANAST | 2011-07-01 00:00:00 | 201.98 | N | Y | N/A | N/A
44125 | ENTERECTOMY RESCJ SMALL INTESTINE W/ENTEROSTOMY | 2011-07-01 00:00:00 | 975.21 | N | Y | N/A | N/A
44126 | ENTRC RESCJ ATRESIA RESCJ&ANAST W/O TAPRING | 2011-07-01 00:00:00 | 2025.77 | N | Y | N/A | N/A
44127 | ENTRC RESCJ ATRESIA RESCJ&ANAST SGM W/TAPRING | 2011-07-01 00:00:00 | 2346.23 | N | Y | N/A | N/A
44128 | ENTRC RESCJ ATRESIA EA RESCJ&ANAST | 2011-07-01 00:00:00 | 202.79 | N | Y | N/A | N/A
44130 | ENTEROENTEROST ANAST INT W/WO CUTAN NTRSTM SPX | 2011-07-01 00:00:00 | 1075.36 | N | Y | N/A | N/A
44132 | DONOR ENTERECTOMY INCLUDING COLD PRESERVATION OPEN FROM CADAVER DONOR | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
44133 | DONOR ENTERECTOMY PARTIAL, FROM LIVING DONOR | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
44135 | INTESTINAL ALLOTRANSPLANTATION CADAVER DONOR | 2008-07-01 00:00:00 | 5526.77 | Y | Y | N/A | N/A
44136 | INTESTINAL ALLOTRANSPLANTATION LIVING DONOR | 2008-07-01 00:00:00 | 5971.6401 | Y | Y | N/A | N/A
44137 | RMVL TRNSPLED INTESTINAL ALLOGRAFT COMPL | 2008-07-01 00:00:00 | 1190.3 | Y | Y | N/A | N/A
44139 | MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT | 2011-07-01 00:00:00 | 101.26 | N | Y | N/A | N/A
44140 | COLECTOMY PARTIAL W/ANASTOMOSIS | 2011-07-01 00:00:00 | 1107.59 | N | Y | N/A | N/A
44141 | COLECTOMY PRTL W/SKIN LEVEL CECOST/COLOSTOMY | 2011-07-01 00:00:00 | 1495.9 | N | Y | N/A | N/A
44143 | COLECTOMY [NAME] COLOSTOMY&CLSR DSTL SGMT | 2011-07-01 00:00:00 | 1374.07 | N | Y | N/A | N/A
44144 | COLECTOMY PRTL W/COLOST/ILEOST & MUCOFISTULA | 2011-07-01 00:00:00 | 1456.4 | N | Y | N/A | N/A
44145 | COLECTOMY [NAME]/COLOPROCTOSTOMY | 2011-07-01 00:00:00 | 1376.06 | N | Y | N/A | N/A
44146 | COLECTOMY PRTL W/COLOPROCTOSTOMY & COLOSTOMY | 2011-07-01 00:00:00 | 1746.32 | N | Y | N/A | N/A
44147 | COLECTOMY PRTL ABDOMINAL & TRANSANAL APPR | 2011-07-01 00:00:00 | 1594.3 | N | Y | N/A | N/A
44150 | COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS | 2011-07-01 00:00:00 | 1538.58 | N | Y | N/A | N/A
44151 | COLCT TOT ABDL W/O PRCTECT W/CONTINENT ILEOST | 2011-07-01 00:00:00 | 1760.24 | N | Y | N/A | N/A
44155 | COLECTOMY TOT ABDL W/PROCTECTOMY W/ILEOSTOMY | 2011-07-01 00:00:00 | 1717.14 | N | Y | N/A | N/A
44156 | COLECTOMY TOT ABDL W/PROCTECTOMY W/CONTNT ILEOST | 2011-07-01 00:00:00 | 1894.18 | N | Y | N/A | N/A
44157 | COLECTOMY TOT ABD W/PROCTECTOMY ILEOANAL ANAST | 2011-07-01 00:00:00 | 1790.7 | N | Y | N/A | N/A
44158 | COLCT TTL ABD W/PRCTECT ILEOANAL ANAST & RSVR | 2011-07-01 00:00:00 | 1833.03 | N | Y | N/A | N/A
44160 | COLECTOMY [NAME]/RMVL TERMINAL ILEUM&ILEOCOLOST | 2011-07-01 00:00:00 | 1024.73 | N | Y | N/A | N/A
44180 | [NAME] SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 760.28 | N | Y | N/A | N/A
44186 | [NAME] JEJUNOSTOMY | 2011-07-01 00:00:00 | 538.77 | N | Y | N/A | N/A
44187 | [NAME] SURG ILEOSTOMY/JEJUNOSTOMY NON-TUBE | 2011-07-01 00:00:00 | 912.06 | N | Y | N/A | N/A
44188 | [NAME]/SKN LVL CECOSTOMY | 2011-07-01 00:00:00 | 1010.09 | N | Y | N/A | N/A
44202 | LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANAST | 2011-07-01 00:00:00 | 1145.81 | N | Y | N/A | N/A
44203 | [NAME] SMALL INTESTINE RESCJ&ANASTOMOSIS | 2011-07-01 00:00:00 | 201.92 | N | Y | N/A | N/A
44204 | [NAME] COLECTOMY PARTIAL W/ANASTOMOSIS | 2011-07-01 00:00:00 | 1276.54 | N | Y | N/A | N/A
44205 | LAPS COLECTOMY PRTL W/RMVL TERMINAL ILEUM | 2011-07-01 00:00:00 | 1111.82 | N | Y | N/A | N/A
44206 | LAPS COLECTOMY PRTL W/END CLST&CLSR DSTL SGM | 2011-07-01 00:00:00 | 1454.37 | N | Y | N/A | N/A
44207 | LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST | 2011-07-01 00:00:00 | 1519.01 | N | Y | N/A | N/A
44208 | LAPS COLECTMY PRTL W/COLOPXTSTMY LW ANAST W/CLST | 2011-07-01 00:00:00 | 1652.77 | N | Y | N/A | N/A
44210 | LAPS COLECTOMY TOT W/O PRCTECT W/ILEOST/ILEOPXTS | 2011-07-01 00:00:00 | 1487.15 | N | Y | N/A | N/A
44211 | LAPS COLCT TTL ABD W/PRCTECT ILEOANAL ANAST&RSVR | 2011-07-01 00:00:00 | 1846.8 | N | Y | N/A | N/A
44212 | LAPS COLECTOMY ABDL W/PROCTECTOMY W/ILEOSTOMY | 2011-07-01 00:00:00 | 1708.64 | N | Y | N/A | N/A
44213 | LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY | 2011-07-01 00:00:00 | 158.25 | N | Y | N/A | N/A
44227 | LAPS CLSR NTRSTM LG/SM INT W/RESCJ&ANAST | 2011-07-01 00:00:00 | 1383.32 | N | Y | N/A | N/A
44238 | [NAME], INTESTINE (EXCEPT RECTUM) | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
44300 | [NAME]/CECOSTOMY TUBE OPEN | 2011-07-01 00:00:00 | 694.55 | N | Y | N/A | N/A
44310 | ILEOSTOMY/JEJUNOSTOMY NON-TUBE | 2011-07-01 00:00:00 | 863.69 | N | Y | N/A | N/A
44312 | REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX | 2011-07-01 00:00:00 | 492.44 | N | Y | N/A | N/A
44314 | REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX | 2011-07-01 00:00:00 | 836.78 | N | Y | N/A | N/A
44316 | CONTINENT ILEOSTOMY KOCK PROCEDURE SPX | 2011-07-01 00:00:00 | 1160.44 | N | Y | N/A | N/A
44320 | [NAME]/SKIN LEVEL CECOSTOMY | 2011-07-01 00:00:00 | 990.86 | N | Y | N/A | N/A
44322 | [NAME]/SKN LVL CECOSTOMY W/MULT BXS SPX | 2011-07-01 00:00:00 | 809.65 | N | Y | N/A | N/A
44340 | REVJ [NAME] SMPL RLS SUPFC SCAR SPX | 2011-07-01 00:00:00 | 508.7 | N | Y | N/A | N/A
44345 | REVJ COLOSTOMY COMP RCNSTJ IN-DEPTH SPX | 2011-07-01 00:00:00 | 868.46 | N | Y | N/A | N/A
44346 | REVJ COLOSTOMY W/RPR PARACLST HERNIA SPX | 2011-07-01 00:00:00 | 975.81 | N | Y | N/A | N/A
44360 | ENDOSCOPY UPPER SMALL INTESTINE | 2011-07-01 00:00:00 | 136.59 | N | Y | N/A | N/A
44361 | ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY | 2011-07-01 00:00:00 | 150.3 | N | Y | N/A | N/A
44363 | ENTEROSCOPY GT 2ND PRTN W/RMVL FOREIGN BODY | 2011-07-01 00:00:00 | 178.97 | N | Y | N/A | N/A
44364 | ENTEROSCOPY GT 2ND PRTN W/RMVL LESION SNARE | 2011-07-01 00:00:00 | 191.84 | N | Y | N/A | N/A
44365 | ENTEROSCOPY GT 2ND PRTN W/RMVL LESION CAUTERY | 2011-07-01 00:00:00 | 171.21 | N | Y | N/A | N/A
44366 | ENTEROSCOPY GT 2ND PRTN W/CONTROL BLEEDING | 2011-07-01 00:00:00 | 225.61 | N | Y | N/A | N/A
44369 | ENTEROSCOPY GT 2ND PRTN ABLTJ LESION | 2011-07-01 00:00:00 | 230.6 | N | Y | N/A | N/A
44370 | ENTEROSCOPY GT 2ND PRTN TNDSC STENT PLMT | 2011-07-01 00:00:00 | 249.08 | N | Y | N/A | N/A
44372 | ENTEROSCOPY GT 2ND PRTN W/PLMT PRQ TUBE | 2011-07-01 00:00:00 | 221.01 | N | Y | N/A | N/A
44373 | ENTEROSCOPY GT 2ND PRTN CONV GSTRST TUBE | 2011-07-01 00:00:00 | 177.98 | N | Y | N/A | N/A
44376 | ENTEROSC GT2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX | 2011-07-01 00:00:00 | 263.12 | N | Y | N/A | N/A
44377 | ENTEROSC GT2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE | 2011-07-01 00:00:00 | 278.87 | N | Y | N/A | N/A
44378 | ENTEROSCOPY GT 2ND PRTN ILEUM CONTROL BLEEDING | 2011-07-01 00:00:00 | 358.07 | N | Y | N/A | N/A
44379 | ENTEROSCOPY GT 2ND PRTN W/ILEUM W/STENT PLMT | 2011-07-01 00:00:00 | 379.54 | N | Y | N/A | N/A
44380 | ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX | 2011-07-01 00:00:00 | 59.07 | N | Y | N/A | N/A
44382 | ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE | 2011-07-01 00:00:00 | 71.46 | N | Y | N/A | N/A
44383 | ILEOSCOPY STOMA W/TNDSC STENT PLMT | 2011-07-01 00:00:00 | 147 | N | Y | N/A | N/A
44385 | NDSC EVAL INTSTINAL POUCH DX W/WO COLLJ SPEC SPX | 2011-07-01 00:00:00 | 215.05 | N | Y | N/A | N/A
44386 | NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE | 2011-07-01 00:00:00 | 295.8 | N | Y | N/A | N/A
44388 | COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX | 2011-07-01 00:00:00 | 295.96 | N | Y | N/A | N/A
44389 | COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE | 2011-07-01 00:00:00 | 339 | N | Y | N/A | N/A
44390 | COLONOSCOPY STOMA W/RMVL FOREIGN BODY | 2011-07-01 00:00:00 | 394.49 | N | Y | N/A | N/A
44391 | COLONOSCOPY STOMA CONTROL BLEEDING | 2011-07-01 00:00:00 | 432.1 | N | Y | N/A | N/A
44392 | COLONOSCOPY STOMA RMVL LESION CAUTERY | 2011-07-01 00:00:00 | 371.48 | N | Y | N/A | N/A
44393 | COLONOSCOPY STOMA ABLATION LESION | 2011-07-01 00:00:00 | 430.61 | N | Y | N/A | N/A
44394 | COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE | 2011-07-01 00:00:00 | 428.95 | N | Y | N/A | N/A
44397 | COLONOSCOPY STOMA W/TNDSC STENT PLMT | 2011-07-01 00:00:00 | 238.66 | N | Y | N/A | N/A
44500 | INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 21.45 | N | Y | N/A | N/A
44602 | ENTERORRHAPHY 1PERFORATION | 2011-07-01 00:00:00 | 1157.98 | N | Y | N/A | N/A
44603 | ENTERORRHAPHY MULTIPLE PERFORATIONS | 2011-07-01 00:00:00 | 1329.21 | N | Y | N/A | N/A
44604 | SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY | 2011-07-01 00:00:00 | 873.85 | N | Y | N/A | N/A
44605 | SUTR LG INTESTINE 1/MULT PERFORAT W/COLOSTOMY | 2011-07-01 00:00:00 | 1080.78 | N | Y | N/A | N/A
44615 | INTSTINAL STRICTUROPLASTY W/WO DILAT OBSTRCJ | 2011-07-01 00:00:00 | 890.16 | N | Y | N/A | N/A
44620 | CLOSURE ENTEROSTOMY LG/SMALL INTESTINE | 2011-07-01 00:00:00 | 715.67 | N | Y | N/A | N/A
44625 | CLSR NTRSTM LG/SM RESCJ&ANAST OTH/THN CLRCT | 2011-07-01 00:00:00 | 843.81 | N | Y | N/A | N/A
44626 | CLSR NTRSTM LG/SM RESCJ&CLRCT ANAST | 2011-07-01 00:00:00 | 1330.31 | N | Y | N/A | N/A
44640 | CLOSURE INTESTINAL CUTANEOUS FISTULA | 2011-07-01 00:00:00 | 1162.34 | N | Y | N/A | N/A
44650 | CLSR ENTEROENTERIC/ENTEROCOLIC FSTL | 2011-07-01 00:00:00 | 1203.53 | N | Y | N/A | N/A
44660 | CLSR ENTEROVES FSTL W/O INTSTINAL/BLDR RESCJ | 2011-07-01 00:00:00 | 1141.05 | N | Y | N/A | N/A
44661 | CLSR ENTEROVES FSTL W/INT&/BLDR RESCJ | 2011-07-01 00:00:00 | 1300.11 | N | Y | N/A | N/A
44680 | INTESTINAL PLICATION SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 883.09 | N | Y | N/A | N/A
44700 | EXCLUSION SM INT FROM PELVIS [NAME]/PROSTH/TISS | 2011-07-01 00:00:00 | 846.05 | N | Y | N/A | N/A
44701 | [NAME] | 2011-07-01 00:00:00 | 140 | N | Y | N/A | N/A
44705 | PREPARE FECAL MICROBIOTA FOR INSTILLATION | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
44715 | BKBENCH PREP CADAVER/LIVING DONOR INTESTINE | 2008-07-01 00:00:00 | 918.45 | Y | Y | N/A | N/A
44720 | BKBENCH RCNSTJ INT ALGRFT VEN ANAST EA | 2011-07-01 00:00:00 | 220.15 | Y | Y | N/A | N/A
44721 | BKBENCH RCNSTJ INT ALGRFT ARTL ANAST EA | 2011-07-01 00:00:00 | 321.32 | Y | Y | N/A | N/A
44799 | UNLISTED PROC, INTESTINE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
44800 | EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT | 2011-07-01 00:00:00 | 628.29 | N | Y | N/A | N/A
44820 | EXCISION LESION MESENTERY SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 692.82 | N | Y | N/A | N/A
44850 | SUTURE MESENTERY SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 615.38 | N | Y | N/A | N/A
44899 | UNLISTED PROC, MESENTERY | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
44900 | I&D APPENDICEAL ABSC OPN | 2011-07-01 00:00:00 | 635 | N | Y | N/A | N/A
44950 | APPENDECTOMY | 2011-07-01 00:00:00 | 529.24 | N | Y | N/A | N/A
44955 | APPENDEC INDICATED PURPOSE OTH MAJOR PX X SPX | 2011-07-01 00:00:00 | 70.08 | N | Y | N/A | N/A
44960 | APPENDEC RPTD APPENDIX ABSC/PRITONITIS | 2011-07-01 00:00:00 | 718.72 | N | Y | N/A | N/A
44970 | LAPAROSCOPIC APPENDECTOMY | 2011-07-01 00:00:00 | 491.54 | N | Y | N/A | N/A
44979 | [NAME] PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
45000 | TRANSRECTAL DRAINAGE OF PELVIC ABSCESS | 2011-07-01 00:00:00 | 347.81 | N | Y | N/A | N/A
45005 | I&D SUBMUCOSAL ABSCESS RECTUM | 2011-07-01 00:00:00 | 214.33 | N | Y | N/A | N/A
45020 | I&D DP SUPRALEVATOR PELVIRCT/RETRORCT ABSC | 2011-07-01 00:00:00 | 462.82 | N | Y | N/A | N/A
45100 | BX ANORECTAL WALL ANAL APPROACH | 2011-07-01 00:00:00 | 243.11 | N | Y | N/A | N/A
45108 | ANORECTAL MYOMECTOMY | 2011-07-01 00:00:00 | 297.6 | N | Y | N/A | N/A
45110 | PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST | 2011-07-01 00:00:00 | 1532.49 | N | Y | N/A | N/A
45111 | PRCTECT PRTL RESCJ RECTUM TABDL APPR | 2011-07-01 00:00:00 | 900.59 | N | Y | N/A | N/A
45112 | PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX | 2011-07-01 00:00:00 | 1569.06 | N | Y | N/A | N/A
45113 | PRCTECT PRTL W/MUCOSEC ILEOANAL ANAST RSVR | 2011-07-01 00:00:00 | 1630.16 | N | Y | N/A | N/A
45114 | PRCTECT PRTL W/ANAST ABDL&TRANSSAC APPR | 2011-07-01 00:00:00 | 1489.84 | N | Y | N/A | N/A
45116 | PRCTECT PRTL W/ANAST TRANSSAC APPR ONLY | 2011-07-01 00:00:00 | 1312.53 | N | Y | N/A | N/A
45119 | PRCTECT CMBN PULL-THRU W/RSVR W/NTRSTM | 2011-07-01 00:00:00 | 1619.54 | N | Y | N/A | N/A
45120 | PRCTECT COMPL W/PULL-THRU PX&ANAST | 2011-07-01 00:00:00 | 1305.13 | N | Y | N/A | N/A
45121 | PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS | 2011-07-01 00:00:00 | 1425.71 | N | Y | N/A | N/A
45123 | PRCTECT PRTL W/O ANAST PRNL APPR | 2011-07-01 00:00:00 | 923.98 | N | Y | N/A | N/A
45126 | PELVIC EXENTERATION COLORECTAL MALIGNANCY | 2011-07-01 00:00:00 | 2401.41 | N | Y | N/A | N/A
45130 | EXC RCT PROCIDENTIA W/ANAST PRNL APPR | 2011-07-01 00:00:00 | 901.89 | N | Y | N/A | N/A
45135 | EXC RCT PROCIDENTIA W/ANAST ABDL&PRNL APPR | 2011-07-01 00:00:00 | 1121.68 | N | Y | N/A | N/A
45136 | EXC ILEOANAL RSVR W/ILEOSTOMY | 2011-07-01 00:00:00 | 1512.67 | N | Y | N/A | N/A
45150 | DIVISION STRICTURE [NAME] | 2011-07-01 00:00:00 | 329.51 | N | Y | N/A | N/A
45160 | EXC RCT TUM PROCTOTOMY TRANSSAC/TRANSCOCCYGEAL | 2011-07-01 00:00:00 | 828.97 | N | Y | N/A | N/A
45171 | EXC RECT TUM TRANSANAL PART | 2011-07-01 00:00:00 | 506.57 | N | Y | N/A | N/A
45172 | EXC RECT TUM TRANSANAL FULL | 2011-07-01 00:00:00 | 691.36 | N | Y | N/A | N/A
45190 | DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH | 2011-07-01 00:00:00 | 564.84 | N | Y | N/A | N/A
45300 | PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX | 2011-07-01 00:00:00 | 96.35 | N | Y | N/A | N/A
45303 | PROCTOSGMDSC RIGID W/DILATION | 2011-07-01 00:00:00 | 744.78 | N | Y | N/A | N/A
45305 | PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE | 2011-07-01 00:00:00 | 154.13 | N | Y | N/A | N/A
45307 | PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY | 2011-07-01 00:00:00 | 172.81 | N | Y | N/A | N/A
45308 | PROCTOSGMDSC RIGID RMVL 1 LESION CAUTERY | 2011-07-01 00:00:00 | 162.7 | N | Y | N/A | N/A
45309 | PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ | 2011-07-01 00:00:00 | 173.43 | N | Y | N/A | N/A
45315 | PROCTOSGMDSC RIGID RMVL MULT TUMOR CAUTERY/SNARE | 2011-07-01 00:00:00 | 192.02 | N | Y | N/A | N/A
45317 | PROCTOSGMDSC RIGID CONTROL BLEEDING | 2011-07-01 00:00:00 | 185.45 | N | Y | N/A | N/A
45320 | PROCTOSGMDSC RIGID ABLATION LESION | 2011-07-01 00:00:00 | 180.1 | N | Y | N/A | N/A
45321 | PROCTOSGMDSC RIGID DCMPRN VOLVULUS | 2011-07-01 00:00:00 | 90.14 | N | Y | N/A | N/A
45327 | PROCTOSGMDSC RIGID TNDSC STENT PLMT | 2011-07-01 00:00:00 | 106.28 | N | Y | N/A | N/A
45330 | SIGMOIDOSCOPY FLX DX W/WO COLLJ SPECIMENS | 2011-07-01 00:00:00 | 116.87 | N | Y | N/A | N/A
45331 | SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE | 2011-07-01 00:00:00 | 145.58 | N | Y | N/A | N/A
45332 | SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY | 2011-07-01 00:00:00 | 242.92 | N | Y | N/A | N/A
45333 | SIGMOIDOSCOPY FLX W/RMVL TUMOR CAUTERY | 2011-07-01 00:00:00 | 245.51 | N | Y | N/A | N/A
45334 | SIGMOIDOSCOPY FLX CONTROL BLEEDING | 2011-07-01 00:00:00 | 141.92 | N | Y | N/A | N/A
45335 | SGMDSC FLX DIRED SBMCSL NJX ANY SBST | 2011-07-01 00:00:00 | 214.47 | N | Y | N/A | N/A
45337 | SGMDSC FLX DCMPRN VOLVULUS ANY METHOD | 2011-07-01 00:00:00 | 122.36 | N | Y | N/A | N/A
45338 | SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ | 2011-07-01 00:00:00 | 269.43 | N | Y | N/A | N/A
45339 | SIGMOIDOSCOPY FLX ABLTJ LESION | 2011-07-01 00:00:00 | 284.06 | N | Y | N/A | N/A
45340 | SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS | 2011-07-01 00:00:00 | 385.71 | N | Y | N/A | N/A
45341 | SIGMOIDOSCOPY FLX NDSC US XM | 2011-07-01 00:00:00 | 136.04 | N | Y | N/A | N/A
45342 | SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX | 2011-07-01 00:00:00 | 207.59 | N | Y | N/A | N/A
45345 | SIGMOIDOSCOPY FLX TNDSC STENT PLMT | 2011-07-01 00:00:00 | 150.91 | N | Y | N/A | N/A
45355 | COLSC RGD/FLX TABDL VIA COLOTOMY 1/MLT | 2011-07-01 00:00:00 | 174.74 | N | Y | N/A | N/A
45378 | COLONOSCOPY FLX DX W/WO COLLJ SPECIMENS | 2011-07-01 00:00:00 | 335.67 | N | Y | N/A | N/A
45379 | [NAME] FLXR RMVL FB | 2011-07-01 00:00:00 | 428.49 | N | Y | N/A | N/A
45380 | COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE | 2011-07-01 00:00:00 | 401.52 | N | Y | N/A | N/A
45381 | [NAME] FLXR SBMCSL NJX | 2011-07-01 00:00:00 | 390.88 | N | Y | N/A | N/A
45382 | [NAME] FLXR CTRL BLD | 2011-07-01 00:00:00 | 526.05 | N | Y | N/A | N/A
45383 | [NAME] FLXR ABLTJ LES | 2011-07-01 00:00:00 | 482.02 | N | Y | N/A | N/A
45384 | [NAME] FLXR RMVL LES CAUT | 2011-07-01 00:00:00 | 397.25 | N | Y | N/A | N/A
45385 | [NAME] FLXR RMVL LES SNARE TQ | 2011-07-01 00:00:00 | 452.59 | N | Y | N/A | N/A
45386 | [NAME] FLXR DILAT BALO 1/GT STRIX | 2011-07-01 00:00:00 | 560.94 | N | Y | N/A | N/A
45387 | [NAME] FLXR TNDSC STENT PLMT | 2011-07-01 00:00:00 | 298.76 | N | Y | N/A | N/A
45391 | [NAME] FLXR NDSC US XM | 2011-07-01 00:00:00 | 256.65 | N | Y | N/A | N/A
45392 | [NAME] FLXR US GID NDL ASPIR/BX | 2011-07-01 00:00:00 | 328.84 | N | Y | N/A | N/A
45395 | LAPS PROCTECTOMY ABDOMINOPERINEAL W/COLOSTOMY | 2011-07-01 00:00:00 | 1651.66 | N | Y | N/A | N/A
45397 | LAPS PROCTECTOMY COMBINED PULL-THRU W/RESERVOIR | 2011-07-01 00:00:00 | 1788.05 | N | Y | N/A | N/A
45400 | [NAME] PROCTOPEXY PROLAPSE | 2011-07-01 00:00:00 | 955.63 | N | Y | N/A | N/A
45402 | [NAME] PROCTOPEXY PROLAPSE SIGMOID RESCJ | 2011-07-01 00:00:00 | 1271.84 | N | Y | N/A | N/A
45499 | [NAME], RECTUM | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
45500 | PROCTOPLASTY STENOSIS | 2011-07-01 00:00:00 | 428.25 | N | Y | N/A | N/A
45505 | PROCTOPLASTY PROLAPSE MUCOUS MEMBRANE | 2011-07-01 00:00:00 | 477.56 | N | Y | N/A | N/A
45520 | PERIRECTAL INJ SCLEROSING SOLUTION PROLAPSE | 2011-07-01 00:00:00 | 116.66 | N | Y | N/A | N/A
45540 | PROCTOPEXY ABDOMINAL APPROACH | 2011-07-01 00:00:00 | 877.7 | N | Y | N/A | N/A
45541 | PROCTOPEXY PERINEAL APPROACH | 2011-07-01 00:00:00 | 764.4 | N | Y | N/A | N/A
45550 | PROCTOPEXY W/SIGMOID RESCJ ABDL APPR | 2011-07-01 00:00:00 | 1212.44 | N | Y | N/A | N/A
45560 | REPAIR RECTOCELE SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 589.31 | N | Y | N/A | N/A
45562 | EXPL RPR&PRESACRAL DRG RECTAL INJURY | 2011-07-01 00:00:00 | 922.37 | N | Y | N/A | N/A
45563 | EXPL RPR&PRESACRAL DRG RECTAL INJ W/COLOSTOMY | 2011-07-01 00:00:00 | 1344.6 | N | Y | N/A | N/A
45800 | CLOSURE RECTOVESICAL FISTULA | 2011-07-01 00:00:00 | 1011.67 | N | Y | N/A | N/A
45805 | CLSR RECTOVESICAL FISTULA W/COLOSTOMY | 2011-07-01 00:00:00 | 1193.24 | N | Y | N/A | N/A
45820 | CLOSURE RECTOURETHRAL FISTULA | 2011-07-01 00:00:00 | 994.55 | N | Y | N/A | N/A
45825 | CLOSURE RECTOURETHRAL FISTULA W/COLOSTOMY | 2011-07-01 00:00:00 | 1214.85 | N | Y | N/A | N/A
45900 | RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 165.24 | N | Y | N/A | N/A
45905 | DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL | 2011-07-01 00:00:00 | 139.01 | N | Y | N/A | N/A
45910 | DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL | 2011-07-01 00:00:00 | 162.73 | N | Y | N/A | N/A
45915 | RMVL FECAL IMPACTION/FB SPX UNDER ANES | 2011-07-01 00:00:00 | 263.22 | N | Y | N/A | N/A
45990 | ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX | 2011-07-01 00:00:00 | 89.87 | N | Y | N/A | N/A
45999 | UNLISTED PROCEDURE, RECTUM | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
46020 | [NAME] | 2011-07-01 00:00:00 | 218.55 | N | Y | N/A | N/A
46030 | REMOVAL ANAL SETON OTHER MARKER | 2011-07-01 00:00:00 | 110.03 | N | Y | N/A | N/A
46040 | I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX | 2011-07-01 00:00:00 | 422.49 | N | Y | N/A | N/A
46045 | I&D INTRAMURAL IM/ABSC TRANSANAL ANES | 2011-07-01 00:00:00 | 347.89 | N | Y | N/A | N/A
46050 | I&D PERIANAL ABSCESS SUPERFICIAL | 2011-07-01 00:00:00 | 155.73 | N | Y | N/A | N/A
46060 | I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON | 2011-07-01 00:00:00 | 382.1 | N | Y | N/A | N/A
46070 | INCISION ANAL SEPTUM INFANT | 2011-07-01 00:00:00 | 189.16 | N | Y | N/A | N/A
46080 | SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX | 2011-07-01 00:00:00 | 197.23 | N | Y | N/A | N/A
46083 | INCISION THROMBOSED HEMORRHOID EXTERNAL | 2011-07-01 00:00:00 | 143.98 | N | Y | N/A | N/A
46200 | FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED | 2011-07-01 00:00:00 | 342.54 | N | Y | N/A | N/A
46220 | EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS | 2011-07-01 00:00:00 | 162.61 | N | Y | N/A | N/A
46221 | HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS | 2011-07-01 00:00:00 | 211.99 | N | Y | N/A | N/A
46230 | EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS | 2011-07-01 00:00:00 | 217.69 | N | Y | N/A | N/A
46250 | HEMORRHOIDECTOMY XTRNL 2/GT COLUMN/GROUP | 2011-07-01 00:00:00 | 365.47 | N | Y | N/A | N/A
46255 | HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP | 2011-07-01 00:00:00 | 402.15 | N | Y | N/A | N/A
46257 | HEMORRHOID NTRNL & XTRNL 1 COLUMN W/FISSURECTOMY | 2011-07-01 00:00:00 | 339.78 | N | Y | N/A | N/A
46258 | HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY | 2011-07-01 00:00:00 | 376.55 | N | Y | N/A | N/A
46260 | HEMORRHOIDECTOMY INT & XTRNL 2/GT COLUMN/GROUP | 2011-07-01 00:00:00 | 383.44 | N | Y | N/A | N/A
46261 | HRHC NTRNL & XTRNL 2/GT COLUMN/GROUP W/FISSURECT | 2011-07-01 00:00:00 | 429.43 | N | Y | N/A | N/A
46262 | HRHC 2/GT COL/GRP W/FSTULECTMY INCL FSSRECTMY | 2011-07-01 00:00:00 | 448.16 | N | Y | N/A | N/A
46270 | SURG TX ANAL FISTULA SUBQ | 2011-07-01 00:00:00 | 399.72 | N | Y | N/A | N/A
46275 | SURG TX ANAL FISTULA INTERSPHINCTERIC | 2011-07-01 00:00:00 | 422.22 | N | Y | N/A | N/A
46280 | TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON | 2011-07-01 00:00:00 | 377.22 | N | Y | N/A | N/A
46285 | SURG TX ANAL FISTULA 2ND STAGE | 2011-07-01 00:00:00 | 415.51 | N | Y | N/A | N/A
46288 | CLSR ANAL FSTL W/RCT ADVMNT FLAP | 2011-07-01 00:00:00 | 443.17 | N | Y | N/A | N/A
46320 | EXC THROMBOSED HEMORRHOID XTRNL | 2011-07-01 00:00:00 | 144.78 | N | Y | N/A | N/A
46500 | [NAME] SOLUTION HEMORRHOIDS | 2011-07-01 00:00:00 | 182.76 | N | Y | N/A | N/A
46505 | CHEMODENERVATION INTERNAL ANAL SPHINCTER | 2011-07-01 00:00:00 | 230.69 | N | Y | N/A | N/A
46600 | ANOSCOPY DX W/WO COLLJ SPEC BR/WA SPX | 2011-07-01 00:00:00 | 69.83 | N | Y | N/A | N/A
46604 | ANOSCOPY W/DILATION | 2011-07-01 00:00:00 | 463.37 | N | Y | N/A | N/A
46606 | ANOSCOPY W/BX SINGLE/MULTIPLE | 2011-07-01 00:00:00 | 179.7 | N | Y | N/A | N/A
46608 | ANOSCOPY W/RMVL FOREIGN BODY | 2011-07-01 00:00:00 | 185.54 | N | Y | N/A | N/A
46610 | ANOSCOPY W/RMVL LESION CAUTERY | 2011-07-01 00:00:00 | 182.33 | N | Y | N/A | N/A
46611 | ANOSC RMVL 1 TUM POLYP/OTH LES SNARE TQ | 2011-07-01 00:00:00 | 142.4 | N | Y | N/A | N/A
46612 | ANOSC RMVL MULT TUMORS CAUTERY/SNARE | 2011-07-01 00:00:00 | 214.79 | N | Y | N/A | N/A
46614 | ANOSCOPY CONTROL BLEEDING | 2011-07-01 00:00:00 | 104.54 | N | Y | N/A | N/A
46615 | ANOSCOPY ABLATION LESION | 2011-07-01 00:00:00 | 118.99 | N | Y | N/A | N/A
46700 | ANOPLASTY PLASTIC OPERATION STRICTURE ADULT | 2011-07-01 00:00:00 | 531.78 | N | Y | N/A | N/A
46705 | ANOPLASTY PLASTIC OPERATION STRICTURE INFANT | 2011-07-01 00:00:00 | 409.02 | N | Y | N/A | N/A
46706 | REPAIR ANAL FISTULA W/FIBRIN GLUE | 2011-07-01 00:00:00 | 137.9 | N | Y | N/A | N/A
46707 | REPAIR ANORECTAL FISTULA PLUG | 2011-07-01 00:00:00 | 398.57 | N | Y | N/A | N/A
46710 | RPR ILEOANAL POUCH FSTL/POUCH ADVMNT TPRNL APPR | 2011-07-01 00:00:00 | 898.88 | N | Y | N/A | N/A
46712 | RPR ILEOANAL POUCH FSTL/POUCH ADVMNT CMBN APPR | 2011-07-01 00:00:00 | 1734.02 | N | Y | N/A | N/A
46715 | RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK | 2011-07-01 00:00:00 | 410.68 | N | Y | N/A | N/A
46716 | RPR LW IMPERFORATE ANUS W/TRPOS FISTULA | 2011-07-01 00:00:00 | 974.72 | N | Y | N/A | N/A
46730 | RPR HI IMPRF ANUS W/O FSTL PRNL/SACROPRNL APPR | 2011-07-01 00:00:00 | 1506.53 | N | Y | N/A | N/A
46735 | RPR HI IMPRF ANUS W/O FISTULA CMBN APPR | 2011-07-01 00:00:00 | 1747.26 | N | Y | N/A | N/A
46740 | RPR HI IMPRF ANUS W/FSTL PRNL/SACROPRNL APPR | 2011-07-01 00:00:00 | 1745.56 | N | Y | N/A | N/A
46742 | RPR HI IMPRF ANUS W/FSTL TABDL&SACROPRNL | 2011-07-01 00:00:00 | 2037.2 | N | Y | N/A | N/A
46744 | RPR CLOACAL ANOMALY SACROPERINEAL | 2011-07-01 00:00:00 | 2827.93 | N | Y | N/A | N/A
46746 | RPR CLOACAL ANOMALY CMBN ABDL&SACROPRNL | 2011-07-01 00:00:00 | 3049.38 | N | Y | N/A | N/A
46748 | RPR CLOACAL ANOMALY CMBN ABDL&SACROPRNL W/GRF | 2011-07-01 00:00:00 | 3242.25 | N | Y | N/A | N/A
46750 | SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT | 2011-07-01 00:00:00 | 632.06 | N | Y | N/A | N/A
46751 | SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD | 2011-07-01 00:00:00 | 510.53 | N | Y | N/A | N/A
46753 | GRF THIERSCH RCT INCONTINENCE&/PROLAPSE | 2011-07-01 00:00:00 | 479.35 | N | Y | N/A | N/A
46754 | RMVL THIERSCH WIRE/SUTURE ANAL CANAL | 2011-07-01 00:00:00 | 239.53 | N | Y | N/A | N/A
46760 | SPHINCTEROPLASTY ANAL MUSCLE TRANSPLANT | 2011-07-01 00:00:00 | 897.63 | N | Y | N/A | N/A
46761 | SPHNCTROP ANAL LEVATOR MUSC IMBRCJ | 2011-07-01 00:00:00 | 771.99 | N | Y | N/A | N/A
46762 | SPHNCTROP ANAL IMPLTJ ARTIF SPHNCTR | 2011-07-01 00:00:00 | 761.9 | N | Y | N/A | N/A
46900 | DSTRJ LESION ANUS SIMPLE CHEMICAL | 2011-07-01 00:00:00 | 191.97 | N | Y | N/A | N/A
46910 | DSTRJ LESION ANUS SMPL ELTRDSICCATION | 2011-07-01 00:00:00 | 199.31 | N | Y | N/A | N/A
46916 | DSTRJ LESION ANUS SIMPLE CRYOSURGERY | 2011-07-01 00:00:00 | 193.18 | N | Y | N/A | N/A
46917 | DSTRJ LESION ANUS SIMPLE LASER SURG | 2011-07-01 00:00:00 | 376.76 | N | Y | N/A | N/A
46922 | DSTRJ LESION ANUS SIMPLE SURG EXCISION | 2011-07-01 00:00:00 | 210.44 | N | Y | N/A | N/A
46924 | DSTRJ LESION ANUS EXTENSIVE | 2011-07-01 00:00:00 | 430.6 | N | Y | N/A | N/A
46930 | DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY | 2011-07-01 00:00:00 | 172.58 | N | Y | N/A | N/A
46940 | CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX 1ST | 2011-07-01 00:00:00 | 181.28 | N | Y | N/A | N/A
46942 | CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX SBSQ | 2011-07-01 00:00:00 | 169.42 | N | Y | N/A | N/A
46945 | HRHC NTRNL LIG OTH THAN RBBR BAND 1 COL/GRP | 2011-07-01 00:00:00 | 239.45 | N | Y | N/A | N/A
46946 | HRHC NTRNL LIG OTH THAN RBBR BAND 2/GT COL/GRP | 2011-07-01 00:00:00 | 249.6 | N | Y | N/A | N/A
46947 | HEMORRHOIDOPEXY STAPLING | 2011-07-01 00:00:00 | 310.79 | N | Y | N/A | N/A
46999 | UNLISTED PROCEDURE ANUS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
47000 | BIOPSY LIVER NEEDLE PERCUTANEOUS | 2011-07-01 00:00:00 | 293.72 | N | Y | N/A | N/A
47001 | BX LVR NDL DONE PURPOSE TM OTH MAJOR PX | 2011-07-01 00:00:00 | 86.37 | N | Y | N/A | N/A
47010 | HEPATOTOMY OPN DRG ABSCESS/CYST 1/2 STAGES | 2011-07-01 00:00:00 | 988.62 | N | Y | N/A | N/A
47015 | LAPT W/ASPIR&/NJX HEPATC PARASITIC CYST/ABSCESS | 2011-07-01 00:00:00 | 949.91 | N | Y | N/A | N/A
47100 | BIOPSY LIVER WEDGE | 2011-07-01 00:00:00 | 690.97 | N | Y | N/A | N/A
47120 | HEPATECTOMY RESCJ PARTIAL LOBECTOMY | 2011-07-01 00:00:00 | 1918.4 | N | Y | N/A | N/A
47122 | HEPATECTOMY RESCJ TRISEGMENTECTOMY | 2011-07-01 00:00:00 | 2834.05 | N | Y | N/A | N/A
47125 | HEPATECTOMY RESCJ TOTAL LEFT LOBECTOMY | 2011-07-01 00:00:00 | 2538.41 | N | Y | N/A | N/A
47130 | HEPATECTOMY RESCJ TOTAL RIGHT LOBECTOMY | 2011-07-01 00:00:00 | 2725.27 | N | Y | N/A | N/A
47133 | DONOR HEPATECTOMY COLD PRESERVATION FROM CADAVER DONOR | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
47135 | LVR ALTRNSPLJ ORTHOTOPIC PRTL/WHL DON ANY AGE | 2011-07-01 00:00:00 | 4038.69 | Y | Y | N/A | N/A
47136 | LVR ALTRNSPLJ HTRTPC PRTL/WHL DON ANY AGE | 2011-07-01 00:00:00 | 3428.26 | Y | Y | N/A | N/A
47143 | BKBENCH PREP CADAVER DONOR | 2008-07-01 00:00:00 | 4864.8799 | Y | Y | N/A | N/A
47144 | BKBENCH PREPJ CADAVER WHOLE LIVER GRF I&IV VIII | 2008-07-01 00:00:00 | 3572.52 | Y | Y | N/A | N/A
47145 | BKBENCH PREPJ CADAVER DONOR WHL LVR GRF I&V VIII | 2008-07-01 00:00:00 | 3942.4099 | Y | Y | N/A | N/A
47146 | BKBENCH RCNSTJ LVR GRF VENOUS ANAST EA | 2011-07-01 00:00:00 | 274.2 | Y | Y | N/A | N/A
47147 | BKBENCH RCNSTJ LVR GRF ARTL ANAST EA | 2011-07-01 00:00:00 | 319.82 | Y | Y | N/A | N/A
47300 | MARSUPIALIZATION CST/ABSC LVR | 2011-07-01 00:00:00 | 929.54 | N | Y | N/A | N/A
47350 | MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ | 2011-07-01 00:00:00 | 1128.93 | N | Y | N/A | N/A
47360 | MGMT LVR HEMRRG CPLX SUTR WND/INJ | 2011-07-01 00:00:00 | 1542.09 | N | Y | N/A | N/A
47361 | MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR | 2011-07-01 00:00:00 | 2496.88 | N | Y | N/A | N/A
47362 | MGMT LVR HEMRRG RE-EXPL WND RMVL PACKING | 2011-07-01 00:00:00 | 1183.4 | N | Y | N/A | N/A
47370 | LAPS SURG ABLTJ 1/GT LVR TUM RF | 2011-07-01 00:00:00 | 1023 | N | Y | N/A | N/A
47371 | LAPS SURG ABLTJ 1 GT LVR TUM CRYOSURG | 2011-07-01 00:00:00 | 1040.99 | N | Y | N/A | N/A
47379 | UNLISTED LIVER LAPAROSCOPY | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
47380 | ABLTJ OPN 1/GT LVR TUM RF | 2011-07-01 00:00:00 | 1192.28 | N | Y | N/A | N/A
47381 | ABLTJ OPN 1/GT LVR TUM CRYOSURG | 2011-07-01 00:00:00 | 1186.16 | N | Y | N/A | N/A
47382 | ABLTJ 1/GT LVR TUM PRQ [NAME] | 2011-07-01 00:00:00 | 3940.34 | N | Y | N/A | N/A
47399 | UNLISTED PROC, [NAME] | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
47400 | HEPATCOTOMY/HEPATCOSTOMY W/EXPL DRG/RMVL ST1 | 2011-07-01 00:00:00 | 1773.77 | N | Y | N/A | N/A
47420 | CHOLEDOCHOT/OST W/O SPHNCTROTOMY/SPHNCTROP | 2011-07-01 00:00:00 | 1103.96 | N | Y | N/A | N/A
47425 | CHOLEDOCHOT/OST W/SPHNCTROTOMY/SPHNCTROP | 2011-07-01 00:00:00 | 1120.15 | N | Y | N/A | N/A
47460 | [NAME] | 2011-07-01 00:00:00 | 1051.38 | N | Y | N/A | N/A
47480 | CHOLECSTOT/CHOLECSTOST W/EXPL DRG/RMVL ST1 SPX | 2011-07-01 00:00:00 | 712.5 | N | Y | N/A | N/A
47490 | CHOLECYSTOSTOMY PRQ W/IMAGING & CATH PLMT | 2011-07-01 00:00:00 | 313.29 | N | Y | N/A | N/A
47500 | INJECTION PX PRQ TRANSHEPATIC CHOLANGIOGRAPHY | 2011-07-01 00:00:00 | 86.79 | N | Y | N/A | N/A
47505 | INJ PX CHOLANGIOGRAPHY VIA CATHETER/T-TUBE | 2011-07-01 00:00:00 | 33.4 | N | Y | N/A | N/A
47510 | INTRO PRQ TRANSHEPATC CATH BILIARY DRG | 2011-07-01 00:00:00 | 416.4 | N | Y | N/A | N/A
47511 | INTRO PRQ TRANSHEPATC STENT BILIARY DRG | 2011-07-01 00:00:00 | 516.15 | N | Y | N/A | N/A
47525 | CHANGE PRQ BILIARY DRAINAGE CATHETER | 2011-07-01 00:00:00 | 437.67 | N | Y | N/A | N/A
47530 | REVJ&/RINSJ TRANSHEPATC TUBE | 2011-07-01 00:00:00 | 1232.6 | N | Y | N/A | N/A
47550 | BILIARY NDSC INTRAOPERATIVE | 2011-07-01 00:00:00 | 138.26 | N | Y | N/A | N/A
47552 | BILIARY NDSC PRQ T-TUBE DX W/WO COLLJ SPEC SPX | 2011-07-01 00:00:00 | 279.61 | N | Y | N/A | N/A
47553 | BILIARY NDSC PRQ T-TUBE W/BX SINGLE/MULTIPLE | 2011-07-01 00:00:00 | 280.44 | N | Y | N/A | N/A
47554 | BILIARY ENDOSCOPY PRQ VIA T-TUBE W/RMVL CALCULUS | 2011-07-01 00:00:00 | 422.53 | N | Y | N/A | N/A
47555 | BILIARY NDSC PRQ T-TUBE W/DIL DUCT W/O STENT | 2011-07-01 00:00:00 | 333.54 | N | Y | N/A | N/A
47556 | BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT | 2011-07-01 00:00:00 | 378.1 | N | Y | N/A | N/A
47560 | LAPS SURG W/GID TRANSHEPATC CHOLANGRPH W/O BX | 2011-07-01 00:00:00 | 223.82 | N | Y | N/A | N/A
47561 | LAPS SURG W/GID TRANSHEPATC CHOLANGRPH W/BX | 2011-07-01 00:00:00 | 244.52 | N | Y | N/A | N/A
47562 | [NAME] | 2011-07-01 00:00:00 | 613.2 | N | Y | N/A | N/A
47563 | LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY | 2011-07-01 00:00:00 | 621.14 | N | Y | N/A | N/A
47564 | LAPS SURG CHOLECSTC W/EXPL COMMON DUCT | 2011-07-01 00:00:00 | 711.8 | N | Y | N/A | N/A
47570 | LAPAROSCOPY SURG CHOLECYSTOENETEROSTOMY | 2011-07-01 00:00:00 | 636.95 | N | Y | N/A | N/A
47579 | [NAME] TRACT PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
47600 | CHOLECYSTECTOMY | 2011-07-01 00:00:00 | 885.86 | N | Y | N/A | N/A
47605 | CHOLECYSTECTOMY W/CHOLANGIOGRAPHY | 2011-07-01 00:00:00 | 807.07 | N | Y | N/A | N/A
47610 | CHOLECYSTECTOMY W/EXPLORATION COMMON DUCT | 2011-07-01 00:00:00 | 1032.43 | N | Y | N/A | N/A
47612 | CHOLECYSTECTOMY EXPL DUCT CHOLEDOCHOENTEROSTOMY | 2011-07-01 00:00:00 | 1043.61 | N | Y | N/A | N/A
47620 | CHOLECSTC EXPL DUX SPHNCTROTOMY/SPHNCTROP | 2011-07-01 00:00:00 | 1133.56 | N | Y | N/A | N/A
47630 | BILIARY DUCT STONE XTRJ PRQ VIA BASKET/SNARE | 2011-07-01 00:00:00 | 480.32 | N | Y | N/A | N/A
47700 | EXPL CONGENITAL ATRESIA BILE DUCTS | 2011-07-01 00:00:00 | 863.13 | N | Y | N/A | N/A
47701 | PORTOENETEROSTOMY | 2011-07-01 00:00:00 | 1450.81 | N | Y | N/A | N/A
47711 | EXC BILE DUX TUM W/WO PRIM RPR XTRHEPATC | 2011-07-01 00:00:00 | 1283.47 | N | Y | N/A | N/A
47712 | EXC BILE DUX TUM W/WO PRIM RPR INTRAHEPATC | 2011-07-01 00:00:00 | 1644.08 | N | Y | N/A | N/A
47715 | EXCISION CHOLEDOCHAL CYST | 2011-07-01 00:00:00 | 1088.06 | N | Y | N/A | N/A
47720 | CHOLECYSTOENTEROSTOMY DIRECT | 2011-07-01 00:00:00 | 939.24 | N | Y | N/A | N/A
47721 | CHOLECYSTOENTEROSTOMY W/GASTROENTEROSTOMY | 2011-07-01 00:00:00 | 1108.74 | N | Y | N/A | N/A
47740 | CHOLECYSTOENTEROSTOMY ROUX-EN-Y | 2011-07-01 00:00:00 | 1072.84 | N | Y | N/A | N/A
47741 | [NAME] | 2011-07-01 00:00:00 | 1210.04 | N | Y | N/A | N/A
47760 | ANAST XTRHEPATC BILIARY DUCTS & GI TRACT | 2011-07-01 00:00:00 | 1845.65 | N | Y | N/A | N/A
47765 | ANAST INTRAHEPATC DUCTS & GI TRACT | 2011-07-01 00:00:00 | 2475.72 | N | Y | N/A | N/A
47780 | ANAST ROUX-EN-Y XTRHEPATC BILIARY DUCTS&GI | 2011-07-01 00:00:00 | 2022.98 | N | Y | N/A | N/A
47785 | ANAST ROUX-EN-Y INTRAHEPATC BILIARY DUCTS&GI | 2011-07-01 00:00:00 | 2651.43 | N | Y | N/A | N/A
47800 | RCNSTJ PLSTC BILIARY DUCTS W/END-TO-END ANAST | 2011-07-01 00:00:00 | 1299.7 | N | Y | N/A | N/A
47801 | PLACEMENT CHOLEDOCHAL STENT | 2011-07-01 00:00:00 | 879.61 | N | Y | N/A | N/A
47802 | U-TUBE HEPATICOENTEROSTOMY | 2011-07-01 00:00:00 | 1251.59 | N | Y | N/A | N/A
47900 | SUTURE EXTRAHEPATIC BILE DUCT PRE-EXIST INJURY | 2011-07-01 00:00:00 | 1121.7 | N | Y | N/A | N/A
47999 | UNLISTED BILIARY TRACT PROC | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
48000 | PLACE DRAIN PERIPANCREATIC ACUTE PANCREATITIS | 2011-07-01 00:00:00 | 1535.5 | N | Y | N/A | N/A
48001 | PLACE DRAIN PERIPANCREATIC W/CHOLECYSTOSTOMY | 2011-07-01 00:00:00 | 1904.11 | N | Y | N/A | N/A
48020 | REMOVAL PANCREATIC CALCULUS | 2011-07-01 00:00:00 | 966.25 | N | Y | N/A | N/A
48100 | BIOPSY PANCREAS OPEN | 2011-07-01 00:00:00 | 730.05 | N | Y | N/A | N/A
48102 | BIOPSY PANCREA PERCUTANEOUS NEEDLE | 2011-07-01 00:00:00 | 461.98 | N | Y | N/A | N/A
48105 | RESECJ/DBRDMT PANCREAS NECROTIZING PANCREATITIS | 2011-07-01 00:00:00 | 2352.86 | N | Y | N/A | N/A
48120 | EXCISION LESION PANCREAS | 2011-07-01 00:00:00 | 910.76 | N | Y | N/A | N/A
48140 | PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY | 2011-07-01 00:00:00 | 1286.81 | N | Y | N/A | N/A
48145 | PNCRTECT DSTL STOT W/PNCRTCOJEJUNOSTOMY | 2011-07-01 00:00:00 | 1340.63 | N | Y | N/A | N/A
48146 | PNCRTECT DSTL NR-TOT W/PRSRV DUO CHLD-TYP PX | 2011-07-01 00:00:00 | 1537.94 | N | Y | N/A | N/A
48148 | EXCISION AMPULLA VATER | 2011-07-01 00:00:00 | 1021.8 | N | Y | N/A | N/A
48150 | PNCRTECT PROX STOT W/PANCREATOJEJUNOSTOMY | 2011-07-01 00:00:00 | 2559.63 | N | Y | N/A | N/A
48152 | PNCRTECT WHIPPLE W/O PANCREATOJEJUNOSTOMY | 2011-07-01 00:00:00 | 2376.56 | N | Y | N/A | N/A
48153 | PNCRTECT W/PANCREATOJEJUNOSTOMY | 2011-07-01 00:00:00 | 2556.02 | N | Y | N/A | N/A
48154 | PNCRTECT PROX STOT W/O PANCREATOJEJUNOSTOMY | 2011-07-01 00:00:00 | 2384.46 | N | Y | N/A | N/A
48155 | PANCREATECTOMY TOTAL | 2011-07-01 00:00:00 | 1489.46 | N | Y | N/A | N/A
48160 | PANCREATECTOMY W/TRNSPLJ PANCREAS/ISLET CELLS | 2008-07-01 00:00:00 | 1821.8 | Y | Y | N/A | N/A
48400 | INJECTION INTRAOPERATIVE PANCREATOGRAPHY | 2011-07-01 00:00:00 | 89.5 | N | Y | N/A | N/A
48500 | MARSUPIALIZATION PANCREATIC CYST | 2011-07-01 00:00:00 | 939.62 | N | Y | N/A | N/A
48510 | XTRNL DRG PSEUDOCYST PANCREAS OPEN | 2011-07-01 00:00:00 | 890.64 | N | Y | N/A | N/A
48520 | INT ANAST PANCREATIC CYST GI TRACT DIRECT | 2011-07-01 00:00:00 | 899.86 | N | Y | N/A | N/A
48540 | INT ANAST PANCREATIC CYST GI TRACT ROUX-EN-Y | 2011-07-01 00:00:00 | 1067.18 | N | Y | N/A | N/A
48545 | PANCREATORRHAPHY INJURY | 2011-07-01 00:00:00 | 1100.51 | N | Y | N/A | N/A
48547 | DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ | 2011-07-01 00:00:00 | 1471.91 | N | Y | N/A | N/A
48548 | PANCREATICOJEJUNOSTOMY SIDE-TO-SIDE ANAST | 2011-07-01 00:00:00 | 1371.4 | N | Y | N/A | N/A
48999 | UNLISTED PANCREAS PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
49000 | EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX | 2011-07-01 00:00:00 | 636.89 | N | Y | N/A | N/A
49002 | REOPENING RECENT LAPAROTOMY | 2011-07-01 00:00:00 | 857.16 | N | Y | N/A | N/A
49010 | EXPL RETROPERITONEUM W/WO BX SPX | 2011-07-01 00:00:00 | 787.55 | N | Y | N/A | N/A
49020 | DRG PERITONEAL ABSCESS/LOCAL PERITONITIS OPEN | 2011-07-01 00:00:00 | 1314.04 | N | Y | N/A | N/A
49040 | DRG SUBDIAPHRAGMATIC/SUBPHRENIC ABSCESS OPEN | 2011-07-01 00:00:00 | 826.28 | N | Y | N/A | N/A
49060 | DRG RETROPERITONEAL ABSCESS OPEN | 2011-07-01 00:00:00 | 916.64 | N | Y | N/A | N/A
49062 | DRG XTRAPERITONEAL LYMPHOCELE PERITON CAVITY OPN | 2011-07-01 00:00:00 | 619.99 | N | Y | N/A | N/A
49082 | ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE | 2012-01-01 00:00:00 | 135.05 | N | N | N/A | N/A
49083 | ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE | 2012-01-01 00:00:00 | 253.84 | N | N | N/A | N/A
49084 | PERITONEAL LAVAGE W/WO IMAGING GUIDANCE | 2012-01-01 00:00:00 | 84.03 | N | N | N/A | N/A
49180 | BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE | 2011-07-01 00:00:00 | 140.48 | N | Y | N/A | N/A
49203 | EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/LT | 2011-07-01 00:00:00 | 992.84 | N | Y | N/A | N/A
49204 | EXC/DESTRUCTION OPEN ABDMNL TUMORS 5.1-10.0 CM | 2011-07-01 00:00:00 | 1264.47 | N | Y | N/A | N/A
49205 | EXC/DESTRUCTION OPEN ABDOMINAL TUMORS GT10.0 CM | 2011-07-01 00:00:00 | 1449.25 | N | Y | N/A | N/A
49215 | EXC PRESAC/SACROCOCCYGEAL TUMOR | 2011-07-01 00:00:00 | 1827.01 | N | Y | N/A | N/A
49220 | STAGING LAPAROTOMY HODGKINS DISEASE/LYMPHOMA | 2011-07-01 00:00:00 | 799.64 | N | Y | N/A | N/A
49250 | UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX | 2011-07-01 00:00:00 | 480.13 | N | Y | N/A | N/A
49255 | OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX | 2011-07-01 00:00:00 | 651 | N | Y | N/A | N/A
49320 | LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX | 2011-07-01 00:00:00 | 271.5 | N | Y | N/A | N/A
49321 | LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE | 2011-07-01 00:00:00 | 287.04 | N | Y | N/A | N/A
49322 | LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE | 2011-07-01 00:00:00 | 309.32 | N | Y | N/A | N/A
49323 | LAPS SURG W/DRG LYMPHOCELE PRTL CAVITY | 2011-07-01 00:00:00 | 533.65 | N | Y | N/A | N/A
49324 | LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER | 2011-07-01 00:00:00 | 326.39 | N | Y | N/A | N/A
49325 | LAPS W/REVISION INTRAPERITONEAL CATHETER | 2011-07-01 00:00:00 | 349.03 | N | Y | N/A | N/A
49326 | LAPAROSCOPY W/OMENTOPEXY | 2011-07-01 00:00:00 | 157.86 | N | Y | N/A | N/A
49327 | LAPS W/INSERTION NTRSTL DEV W/IMG GID 1/MLT | 2011-07-01 00:00:00 | 110.87 | N | Y | N/A | N/A
49329 | LAPAROSCOPY/PERITONEOSCOPY UNLISTED ABDOMEN | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
49400 | INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX | 2011-07-01 00:00:00 | 134.35 | N | Y | N/A | N/A
49402 | REMOVAL PERITONEAL FOREIGN BODY FROM CAVITY | 2011-07-01 00:00:00 | 705.92 | N | Y | N/A | N/A
49405 | IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ | 2014-01-01 00:00:00 | 652.38 | N | Y | N/A | N/A
49406 | IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ | 2014-01-01 00:00:00 | 724.58 | N | Y | N/A | N/A
49407 | IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL | 2014-01-01 00:00:00 | 614.46 | N | Y | N/A | N/A
49411 | INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT | 2011-07-01 00:00:00 | 445.61 | N | Y | N/A | N/A
49412 | PLMT INTRSTL DEV OPN W/IMG GID 1/MLT | 2011-07-01 00:00:00 | 69.28 | N | Y | N/A | N/A
49418 | INSJ INTRAPERITONEAL CATHETER W/IMG GID | 2011-07-01 00:00:00 | 1289.44 | N | Y | N/A | N/A
49419 | INSERTION TUNNEL INTRAPERITONEAL CATH SUBQ PORT | 2011-07-01 00:00:00 | 370.2 | N | Y | N/A | N/A
49421 | INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN | 2011-07-01 00:00:00 | 226.59 | N | Y | N/A | N/A
49422 | REMOVAL TUNNELED INTRAPERITONEAL CATHETER | 2011-07-01 00:00:00 | 319.01 | N | Y | N/A | N/A
49423 | EXCHNG ABSC/CST DRG CATH RAD GID SPX | 2011-07-01 00:00:00 | 485.33 | N | Y | N/A | N/A
49424 | CNTRST NJX ASSMT ABSC/CST VIA DRG CATH/TUBE SPX | 2011-07-01 00:00:00 | 129.72 | N | Y | N/A | N/A
49425 | INSERTION PERITONEAL-VENOUS SHUNT | 2011-07-01 00:00:00 | 627.42 | N | Y | N/A | N/A
49426 | REVIS PERITONEAL-VENOUS SHUNT | 2011-07-01 00:00:00 | 531.59 | N | Y | N/A | N/A
49427 | INJECT EVALUATE PREVIOUS PERITONEAL-VENOUS SHUNT | 2011-07-01 00:00:00 | 39.92 | N | Y | N/A | N/A
49428 | LIGATION PERITONEAL-VENOUS SHUNT | 2011-07-01 00:00:00 | 360.94 | N | Y | N/A | N/A
49429 | RMVL PERITONEAL-VENOUS SHUNT | 2011-07-01 00:00:00 | 379.6 | N | Y | N/A | N/A
49435 | INSJ SUBQ EXTENSION INTRAPERITONEAL CATHETER | 2011-07-01 00:00:00 | 100.03 | N | Y | N/A | N/A
49436 | DELAYED CREATION EXIT SITE EMBEDDED CATHETER | 2011-07-01 00:00:00 | 153.77 | N | Y | N/A | N/A
49440 | INSERT GASTROSTOMY TUBE PERCUTANEOUS | 2011-07-01 00:00:00 | 926.89 | N | Y | N/A | N/A
49441 | INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ | 2011-07-01 00:00:00 | 1027.3 | N | Y | N/A | N/A
49442 | INSERT CECOSTOMY/OTHER COLONIC TUBE PERCUTANEOUS | 2011-07-01 00:00:00 | 862.95 | N | Y | N/A | N/A
49446 | [NAME]-JEJUNOSTOMY TUBE PERQ | 2011-07-01 00:00:00 | 857.52 | N | Y | N/A | N/A
49450 | REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS | 2011-07-01 00:00:00 | 610.88 | N | Y | N/A | N/A
49451 | REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ | 2011-07-01 00:00:00 | 618.89 | N | Y | N/A | N/A
49452 | REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS | 2011-07-01 00:00:00 | 770.1 | N | Y | N/A | N/A
49460 | OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE | 2011-07-01 00:00:00 | 673.57 | N | Y | N/A | N/A
49465 | CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE | 2011-07-01 00:00:00 | 147.29 | N | Y | N/A | N/A
49491 | RPR 1ST INGUN HRNA PRETERM INFT RDC | 2011-07-01 00:00:00 | 646.98 | N | Y | N/A | N/A
49492 | RPR 1ST INGUN HRNA PRETERM INFT INCARCERATED | 2011-07-01 00:00:00 | 783.71 | N | Y | N/A | N/A
49495 | RPR 1ST INGUN HRNA FULL TERM INFTLT6 MO RDC | 2011-07-01 00:00:00 | 331.19 | N | Y | N/A | N/A
49496 | RPR 1ST INGUN HRNA FULL TERM INFTLT6 MO INCARCER | 2011-07-01 00:00:00 | 503.59 | N | Y | N/A | N/A
49500 | RPR 1ST INGUN HRNA AGE 6 MO-5 YRS REDUCIBLE | 2011-07-01 00:00:00 | 315.32 | N | Y | N/A | N/A
49501 | RPR 1ST INGUN HRNA AGE 6 MO-5 YRS INCARCERATED | 2011-07-01 00:00:00 | 493.75 | N | Y | N/A | N/A
49505 | RPR 1ST INGUN HRNA AGE 5 YRS/GT REDUCIBLE | 2011-07-01 00:00:00 | 425.56 | N | Y | N/A | N/A
49507 | RPR 1ST INGUN HRNA AGE 5 YRS/GT INCARCERATED | 2011-07-01 00:00:00 | 522.89 | N | Y | N/A | N/A
49520 | RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE | 2011-07-01 00:00:00 | 518.11 | N | Y | N/A | N/A
49521 | RPR RECRT INGUN HERNIA ANY AGE INCARCERATED | 2011-07-01 00:00:00 | 629.06 | N | Y | N/A | N/A
49525 | RPR INGUN HERNIA SLIDING ANY AGE | 2011-07-01 00:00:00 | 469.39 | N | Y | N/A | N/A
49540 | REPAIR LUMBAR HERNIA | 2011-07-01 00:00:00 | 555.09 | N | Y | N/A | N/A
49550 | RPR 1ST FEM HRNA ANY AGE REDUCIBLE | 2011-07-01 00:00:00 | 472.04 | N | Y | N/A | N/A
49553 | RPR 1ST FEM HERNIA ANY AGE INCARCERATED | 2011-07-01 00:00:00 | 517.12 | N | Y | N/A | N/A
49555 | RPR RECRT FEM HERNIA REDUCIBLE | 2011-07-01 00:00:00 | 490.28 | N | Y | N/A | N/A
49557 | RPR RECRT FEM HRNA INCARCERATED | 2011-07-01 00:00:00 | 594.55 | N | Y | N/A | N/A
49560 | REPAIR FIRST ABDOMINAL WALL HERNIA | 2011-07-01 00:00:00 | 606.27 | N | Y | N/A | N/A
49561 | RPR 1ST INCAL/VNT HERNIA INCARCERATED | 2011-07-01 00:00:00 | 765.15 | N | Y | N/A | N/A
49565 | RPR RECRT INCAL/VNT HERNIA REDUCIBLE | 2011-07-01 00:00:00 | 631.06 | N | Y | N/A | N/A
49566 | RPR RECRT INCAL/VNT HERNIA INCARCERATED | 2011-07-01 00:00:00 | 773.21 | N | Y | N/A | N/A
49568 | IMPLANT [NAME] CLOSURE | 2011-07-01 00:00:00 | 222.89 | N | Y | N/A | N/A
49570 | RPR EPIGASTRIC HERNIA REDUCIBLE SPX | 2011-07-01 00:00:00 | 338.59 | N | Y | N/A | N/A
49572 | RPR EPIGASTRIC HERNIA INCARCERATED | 2011-07-01 00:00:00 | 420.04 | N | Y | N/A | N/A
49580 | RPR UMBILICAL HERNIA LT 5 YRS REDUCIBLE | 2011-07-01 00:00:00 | 268.07 | N | Y | N/A | N/A
49582 | RPR UMBILICAL HERNIA LT5 YRS INCARCERATED | 2011-07-01 00:00:00 | 391.97 | N | Y | N/A | N/A
49585 | RPR UMBILICAL HRNA 5 YRS/GT REDUCIBLE | 2011-07-01 00:00:00 | 362.45 | N | Y | N/A | N/A
49587 | RPR UMBILICAL HERNIA AGE 5 YRS/GT INCARCERATED | 2011-07-01 00:00:00 | 428.25 | N | Y | N/A | N/A
49590 | RPR SPIGELIAN HERNIA | 2011-07-01 00:00:00 | 468.53 | N | Y | N/A | N/A
49600 | RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE | 2011-07-01 00:00:00 | 602.22 | N | Y | N/A | N/A
49605 | RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH | 2011-07-01 00:00:00 | 4113.26 | N | Y | N/A | N/A
49606 | RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH | 2011-07-01 00:00:00 | 933.44 | N | Y | N/A | N/A
49610 | RPR OMPHALOCELE GROSS TYP OPRATION 1ST STG | 2011-07-01 00:00:00 | 565.49 | N | Y | N/A | N/A
49611 | RPR OMPHALOCELE GROSS TYP OPRATION 2ND STG | 2011-07-01 00:00:00 | 473.45 | N | Y | N/A | N/A
49650 | LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA | 2011-07-01 00:00:00 | 349.24 | N | Y | N/A | N/A
49651 | LAPS SURG RPR RECURRENT INGUINAL HERNIA | 2011-07-01 00:00:00 | 454.35 | N | Y | N/A | N/A
49652 | LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE | 2011-07-01 00:00:00 | 622.69 | N | Y | N/A | N/A
49653 | LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED | 2011-07-01 00:00:00 | 780.11 | N | Y | N/A | N/A
49654 | LAPAROSCOPY REPAIR INCISIONAL HERNIA REDUCIBLE | 2011-07-01 00:00:00 | 715.74 | N | Y | N/A | N/A
49655 | LAPS RPR INCISIONAL HERNIA NCRC8/STRANGULATED | 2011-07-01 00:00:00 | 861.35 | N | Y | N/A | N/A
49656 | LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE | 2011-07-01 00:00:00 | 718.2 | N | Y | N/A | N/A
49657 | LAPS RPR RECURRENT INCAL HRNA NCRC8/STRANGULATED | 2011-07-01 00:00:00 | 1033.44 | N | Y | N/A | N/A
49659 | [NAME] HERNIA PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
49900 | SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN | 2011-07-01 00:00:00 | 671.21 | N | Y | N/A | N/A
49904 | OMENTAL FLAP EXTRA-ABDOMINAL | 2011-07-01 00:00:00 | 1221.54 | N | Y | N/A | N/A
49905 | OMENTAL FLAP INTRA-ABDOMINAL | 2011-07-01 00:00:00 | 296.36 | N | Y | N/A | N/A
49906 | FREE OMENTAL FLAP W/MICROVASCULAR ANASTOMOSIS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
49999 | UNLISTED PROC, ABDOMEN ETC. | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
50010 | RNL EXPL X NECESSITATING OTH SPEC PX | 2011-07-01 00:00:00 | 635.09 | N | Y | N/A | N/A
50020 | DRAINAGE PERIRENAL/RENAL ABSCESS OPEN | 2011-07-01 00:00:00 | 905.58 | N | Y | N/A | N/A
50040 | NEPHROSTOMY/NEPHROTOMY W/DRAINAGE | 2011-07-01 00:00:00 | 821.34 | N | Y | N/A | N/A
50045 | NEPHROTOMY W/EXPLORATION | 2011-07-01 00:00:00 | 824.69 | N | Y | N/A | N/A
50060 | NEPHROLITHOTOMY REMOVAL STAGE 1 | 2011-07-01 00:00:00 | 1013.73 | N | Y | N/A | N/A
50065 | NEPHROLITHOTOMY SECONDARY FOR CALCULUS | 2011-07-01 00:00:00 | 1068.06 | N | Y | N/A | N/A
50070 | NEPHROLITHOTOMY COMP CGEN KDN ABNORMALITY | 2011-07-01 00:00:00 | 1057.02 | N | Y | N/A | N/A
50075 | NEPHROLITHOTOMY RMVL LG STAGHORN STAGE 1 | 2011-07-01 00:00:00 | 1298.84 | N | Y | N/A | N/A
50080 | PRQ NEPHROSTOLITHOTOMY/PYELOSTOLITHOTOMY 2 CM/LT | 2011-07-01 00:00:00 | 774.58 | N | Y | N/A | N/A
50081 | PRQ NEPHROSTOLITHOTOMY/PYELOSTOLITHOTOMY GT 2 CM | 2011-07-01 00:00:00 | 1137.33 | N | Y | N/A | N/A
50100 | TRNSXJ/REPOSITIONING ABERRANT RENAL VESSEL SPX | 2011-07-01 00:00:00 | 838.76 | N | Y | N/A | N/A
50120 | PYELOTOMY W/EXPLORATION | 2011-07-01 00:00:00 | 840.77 | N | Y | N/A | N/A
50125 | PYELOTOMY W/DRAINAGE PYELOSTOMY | 2011-07-01 00:00:00 | 893.75 | N | Y | N/A | N/A
50130 | PYELOTOMY W/REMOVAL CALCULUS | 2011-07-01 00:00:00 | 919.62 | N | Y | N/A | N/A
50135 | PYELOTOMY COMPLICATED | 2011-07-01 00:00:00 | 996.33 | N | Y | N/A | N/A
50200 | RENAL BIOPSY PRQ TROCAR/NEEDLE | 2011-07-01 00:00:00 | 492.43 | N | Y | N/A | N/A
50205 | [NAME] KIDNEY | 2011-07-01 00:00:00 | 625.41 | N | Y | N/A | N/A
50220 | NEPHRECTOMY W/PRTL URETERECTOMY W/OPEN RIB RESCJ | 2011-07-01 00:00:00 | 917.67 | N | Y | N/A | N/A
50225 | NEPHRECTOMY W/PRTL URETERECT OPN RIB RESCJ COMPL | 2011-07-01 00:00:00 | 1056.72 | N | Y | N/A | N/A
50230 | NEPHRECTOMY W/PRTL URETERECT OPEN RIB RESCJ RAD | 2011-07-01 00:00:00 | 1138.01 | N | Y | N/A | N/A
50234 | NEPHRECTOMY W/TOT URETERECT&BLDR CUFF SAME INC | 2011-07-01 00:00:00 | 1155.84 | N | Y | N/A | N/A
50236 | NEPHRECTOMY TOT URETEREC&BLDR CUFF SEPARATE INC | 2011-07-01 00:00:00 | 1304.81 | N | Y | N/A | N/A
50240 | NEPHRECTOMY PARTIAL | 2011-07-01 00:00:00 | 1176.53 | N | Y | N/A | N/A
50250 | OPEN ABLATION RENAL MASS CRYOSURG ULTRASOUND | 2011-07-01 00:00:00 | 1086.4 | N | Y | N/A | N/A
50280 | EXCISION/UNROOFING CYST KIDNEY | 2011-07-01 00:00:00 | 844.34 | N | Y | N/A | N/A
50290 | EXCISION PERINEPHRIC CYST | 2011-07-01 00:00:00 | 805.34 | N | Y | N/A | N/A
50300 | DONOR NEPHRECTOMY CADAVER DONOR UNI/BILATERAL | 2008-07-01 00:00:00 | 669.95 | N | Y | N/A | N/A
50320 | DONOR NEPHRECTOMY OPEN LIVING DONOR | 2011-07-01 00:00:00 | 1195.8 | N | Y | N/A | N/A
50323 | BKBENCH PREPJ CADAVER DONOR RENAL ALLOGRAFT | 2011-07-01 00:00:00 | 151.72 | Y | Y | N/A | N/A
50325 | BKBENCH PREPJ LIVING RENAL DONOR ALLOGRAFT | 2011-07-01 00:00:00 | 151.72 | Y | Y | N/A | N/A
50327 | BKBENCH RCNSTJ RENAL ALGRFT VENOUS ANAST EA | 2011-07-01 00:00:00 | 182.1 | Y | Y | N/A | N/A
50328 | BKBENCH RCNSTJ RENAL ALLOGRAFT ARTERIAL ANAST EA | 2011-07-01 00:00:00 | 159.4 | Y | Y | N/A | N/A
50329 | BKBENCH RCNSTJ ALGRFT URETERAL ANAST EA | 2011-07-01 00:00:00 | 151.48 | Y | Y | N/A | N/A
50340 | RECIPIENT NEPHRECTOMY SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 772.07 | N | Y | N/A | N/A
50360 | RENAL ALTRNSPLJ IMPLTJ GRF W/O RCP NEPHRECTOMY | 2011-07-01 00:00:00 | 2111.55 | Y | Y | N/A | N/A
50365 | RENAL ALTRNSPLJ IMPLTJ GRF W/RCP NEPHRECTOMY | 2011-07-01 00:00:00 | 2373.1 | Y | Y | N/A | N/A
50370 | RMVL TRNSPLED RENAL ALLOGRAFT | 2011-07-01 00:00:00 | 987.1 | N | Y | N/A | N/A
50380 | RENAL AUTOTRNSPLJ REIMPLANTATION KIDNEY | 2011-07-01 00:00:00 | 1665.22 | Y | Y | N/A | N/A
50382 | RMVL&RPLCMT INTLY DWELLING URETERAL STENT | 2011-07-01 00:00:00 | 1091.09 | N | Y | N/A | N/A
50384 | REMOVAL INDWELLING URETERAL STENT PRQ | 2011-07-01 00:00:00 | 911.59 | N | Y | N/A | N/A
50385 | REMOVE & REPLACE INT DWELL URETERAL STENT TRURL | 2011-07-01 00:00:00 | 1065.29 | N | Y | N/A | N/A
50386 | REMOVE INT DWELL URETERAL STENT TRANSURETHRAL | 2011-07-01 00:00:00 | 694.58 | N | Y | N/A | N/A
50387 | RMVL&RPLCMT [NAME] URTRL STENT | 2011-07-01 00:00:00 | 505.27 | N | Y | N/A | N/A
50389 | RMVL NFROS TUBE REQ FLUORO GUIDANCE | 2011-07-01 00:00:00 | 281.07 | N | Y | N/A | N/A
50390 | ASPIR&/NJX RNL CYST/PELVIS NEEDLE PRQ | 2011-07-01 00:00:00 | 86.44 | N | Y | N/A | N/A
50391 | INSTLJ THER AGENT RENAL PELVIS&/URETER VIA TUBE | 2011-07-01 00:00:00 | 111.02 | N | Y | N/A | N/A
50392 | INTRO INTRACATH/CATH IN RNL PELVIS DRG&/NJX PRQ | 2011-07-01 00:00:00 | 159.23 | N | Y | N/A | N/A
50393 | INTRO URETER CATH/STNT RENAL PELVIS DRG&/NJX PRQ | 2011-07-01 00:00:00 | 193.82 | N | Y | N/A | N/A
50394 | INJECTION PROCEDURE PYELOGRAPHY VIA TUBE/CATH | 2011-07-01 00:00:00 | 89.63 | N | Y | N/A | N/A
50395 | INTRO GUIDE PELVIS&/URETER W/DILAT NFROS TRACT | 2011-07-01 00:00:00 | 160.73 | N | Y | N/A | N/A
50396 | [NAME] URTRL CATH | 2011-07-01 00:00:00 | 103.46 | N | Y | N/A | N/A
50398 | CHANGE NEPHROSTOMY/PYELOSTOMY TUBE | 2011-07-01 00:00:00 | 457.36 | N | Y | N/A | N/A
50400 | PYELOPLASTY SIMPLE | 2011-07-01 00:00:00 | 1027.4 | N | Y | N/A | N/A
50405 | PYELOPLASTY COMPLICATED | 2011-07-01 00:00:00 | 1240.22 | N | Y | N/A | N/A
50500 | NEPHRORRHAPHY SUTURE KIDNEY WOUND/INJURY | 2011-07-01 00:00:00 | 1062.72 | N | Y | N/A | N/A
50520 | CLOSURE NEPHROCUTANEOUS/PYELOCUTANEOUS FISTULA | 2011-07-01 00:00:00 | 916.9 | N | Y | N/A | N/A
50525 | CLSR NEPHROVISCERAL FISTULA W/VISC RPR ABDL APPR | 2011-07-01 00:00:00 | 1237.01 | N | Y | N/A | N/A
50526 | CLSR NEPHROVISCERAL FISTULA W/VISC RPR THRC APPR | 2011-07-01 00:00:00 | 1232.4 | N | Y | N/A | N/A
50540 | SYMPHYSIOTOMY HORSESHOE KDN W/WO PLOP UNI/BI | 2011-07-01 00:00:00 | 1010.6 | N | Y | N/A | N/A
50541 | [NAME] ABLATION RENAL CYSTS | 2011-07-01 00:00:00 | 818.08 | N | Y | N/A | N/A
50542 | LAPS ABLTJ RENAL MASS LESION W/INTRAOP US | 2011-07-01 00:00:00 | 1039.1 | N | Y | N/A | N/A
50543 | [NAME] PARTIAL NEPHRECTOMY | 2011-07-01 00:00:00 | 1325.2 | N | Y | N/A | N/A
50544 | LAPAROSCOPY SURG PYELOPLASTY | 2011-07-01 00:00:00 | 1111.44 | N | Y | N/A | N/A
50545 | [NAME] | 2011-07-01 00:00:00 | 1195.29 | N | Y | N/A | N/A
50546 | LAPAROSCOPY NEPHRECTOMY W/PARTIAL URETERECT | 2011-07-01 00:00:00 | 1065.39 | N | Y | N/A | N/A
50547 | [NAME] | 2011-07-01 00:00:00 | 1346.69 | N | Y | N/A | N/A
50548 | LAPAROSCOPY NEPHRECTOMY W/TOTAL URETERECTOMY | 2011-07-01 00:00:00 | 1201.86 | N | Y | N/A | N/A
50549 | LAPARSCOPY UNLISTED RENAL PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
50551 | RENAL ENDOSCOPY NEPHROSTOMY W/WO IRRIGATION | 2011-07-01 00:00:00 | 322.25 | N | Y | N/A | N/A
50553 | RENAL NDSC NEPHROST W/URETERAL CATH W/WO DILA | 2011-07-01 00:00:00 | 341.58 | N | Y | N/A | N/A
50555 | RENAL NDSC NEPHROS/PYELOSTOMY BIOPSY | 2011-07-01 00:00:00 | 368.13 | N | Y | N/A | N/A
50557 | RENAL NDSC NEPHROS/PYELOSTOMY FULG&/INC W/WO BX | 2011-07-01 00:00:00 | 374.8 | N | Y | N/A | N/A
50561 | RENAL NDSC NEPHROS/PYELOSTOMY RMVL FB/CALCULUS | 2011-07-01 00:00:00 | 425.71 | N | Y | N/A | N/A
50562 | RENAL NDSC NEPHROS/PYELOSTOMY RESCJ TUMOR | 2011-07-01 00:00:00 | 520.25 | N | Y | N/A | N/A
50570 | RENAL NDSC NEPHROTOMY W/WO IRRIGATION | 2011-07-01 00:00:00 | 439.97 | N | Y | N/A | N/A
50572 | RNL NDSC NFROT W/URTRL CATHJ W/WO DILAT URETER | 2011-07-01 00:00:00 | 476.57 | N | Y | N/A | N/A
50574 | RENAL NDSC NEPHROTOMY W/BIOPSY | 2011-07-01 00:00:00 | 506.65 | N | Y | N/A | N/A
50575 | RNL NDSC NFROT/PLOT W/ENDOPYELOTOMY | 2011-07-01 00:00:00 | 639.83 | N | Y | N/A | N/A
50576 | RNL NDSC NFROT FULGURATION&/INC W/WO BX | 2011-07-01 00:00:00 | 505.09 | N | Y | N/A | N/A
50580 | RNL NDSC NFROT/PLOT W/RMVL FB/CALCULUS | 2011-07-01 00:00:00 | 542.67 | N | Y | N/A | N/A
50590 | [NAME] | 2011-07-01 00:00:00 | 757.13 | N | Y | N/A | N/A
50592 | ABLTJ 1/GT RENAL TUMOR PRQ UNI RADIOFREQUENCY | 2011-07-01 00:00:00 | 2931.43 | N | Y | N/A | N/A
50593 | ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY | 2011-07-01 00:00:00 | 4032.78 | N | Y | N/A | N/A
50600 | URTROTOMY W/EXPL/DRG SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 832.05 | N | Y | N/A | N/A
50605 | URETEROTOMY INSERTION INDWELLING STENT ALL TYPES | 2011-07-01 00:00:00 | 833.13 | N | Y | N/A | N/A
50610 | URTROLITHOTOMY UPPER ONE-THIRD URETER | 2011-07-01 00:00:00 | 840.56 | N | Y | N/A | N/A
50620 | URTROLITHOTOMY MIDDLE ONE-THIRD URETER | 2011-07-01 00:00:00 | 803.87 | N | Y | N/A | N/A
50630 | URTROLITHOTOMY LOWER ONE-THIRD URETER | 2011-07-01 00:00:00 | 787.85 | N | Y | N/A | N/A
50650 | URETRECECTOMY W/BLADDER CUFF SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 919.4 | N | Y | N/A | N/A
50660 | URETERECTOMY TOT ECTOPIC URETER CMBN APPR | 2011-07-01 00:00:00 | 1014.21 | N | Y | N/A | N/A
50684 | INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH | 2011-07-01 00:00:00 | 128.57 | N | Y | N/A | N/A
50686 | [NAME] CATH | 2011-07-01 00:00:00 | 125.57 | N | Y | N/A | N/A
50688 | CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL | 2011-07-01 00:00:00 | 70.62 | N | Y | N/A | N/A
50690 | NJX VISUALIZATION ILEAL CONDUIT&/URTROPLOG | 2011-07-01 00:00:00 | 86.24 | N | Y | N/A | N/A
50700 | URETEROPLASTY PLASTIC OPERATION URETER | 2011-07-01 00:00:00 | 820.13 | N | Y | N/A | N/A
50715 | URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS | 2011-07-01 00:00:00 | 1008.77 | N | Y | N/A | N/A
50722 | URETEROLYSIS FOR OVARIAN VEIN SYNDROME | 2011-07-01 00:00:00 | 891.17 | N | Y | N/A | N/A
50725 | URTROLSS RETROCAVAL [NAME] | 2011-07-01 00:00:00 | 996.68 | N | Y | N/A | N/A
50727 | REVJ URINARY-CUTANEOUS ANASTAMOSIS | 2011-07-01 00:00:00 | 446.96 | N | Y | N/A | N/A
50728 | REVJ UR-CUTAN ANAST RPR FSCAL DFCT&HRNA | 2011-07-01 00:00:00 | 613.97 | N | Y | N/A | N/A
50740 | URTROPYELOSTOMY ANAST URTR&RNL PELVIS | 2011-07-01 00:00:00 | 1012.01 | N | Y | N/A | N/A
50750 | URETEROCALYCOSTOMY ANAST URETER RENAL CALYX | 2011-07-01 00:00:00 | 1028.29 | N | Y | N/A | N/A
50760 | URETEROURETEROSTOMY | 2011-07-01 00:00:00 | 983.09 | N | Y | N/A | N/A
50770 | TRANSURETEROURETEROSTOMY ANAST URETER CLAT URTR | 2011-07-01 00:00:00 | 1008.96 | N | Y | N/A | N/A
50780 | URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER | 2011-07-01 00:00:00 | 973.7 | N | Y | N/A | N/A
50782 | URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR | 2011-07-01 00:00:00 | 986.76 | N | Y | N/A | N/A
50783 | URETERONEOCYSTOSTOMY W/URETERAL TAILORING | 2011-07-01 00:00:00 | 1011.97 | N | Y | N/A | N/A
50785 | URTRONEOCSTOST W/VESICO-PSOAS HITCH/BLDR FLAP | 2011-07-01 00:00:00 | 1074.09 | N | Y | N/A | N/A
50800 | URETEROENTEROSTOMY ANAST URETER INTESTINE | 2011-07-01 00:00:00 | 819.14 | N | Y | N/A | N/A
50810 | URETEROSIGMOIDOSTOMY W/SIGMOID BLADDER&COLOSTOMY | 2011-07-01 00:00:00 | 1124.5 | N | Y | N/A | N/A
50815 | URETEROCOLON CONDUIT INTESTINE [NAME] | 2011-07-01 00:00:00 | 1084.97 | N | Y | N/A | N/A
50820 | URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS | 2011-07-01 00:00:00 | 1162.44 | N | Y | N/A | N/A
50825 | CONTINENT DVRJ W/INT ANAST W/ANY SGM SM&/LG INT | 2011-07-01 00:00:00 | 1469.68 | N | Y | N/A | N/A
50830 | [NAME] | 2011-07-01 00:00:00 | 1592.51 | N | Y | N/A | N/A
50840 | RPLCMT ALL/PART URETER INTESTINE SGM W/ANAST | 2011-07-01 00:00:00 | 1092.47 | N | Y | N/A | N/A
50845 | CUTANANEOUS APPENDICO-VESICOSTOMY | 2011-07-01 00:00:00 | 1108.74 | N | Y | N/A | N/A
50860 | URETEROSTOMY TRANSPLANTATION URETER SKIN | 2011-07-01 00:00:00 | 837.49 | N | Y | N/A | N/A
50900 | URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 746 | N | Y | N/A | N/A
50920 | CLOSURE URETEROCUTANEOUS FISTULA | 2011-07-01 00:00:00 | 782.6 | N | Y | N/A | N/A
50930 | CLOSURE URETEROCUTANEOUS FISTULA W/VISC RPR | 2011-07-01 00:00:00 | 1000.85 | N | Y | N/A | N/A
50940 | DELIGATION URETER | 2011-07-01 00:00:00 | 784.71 | N | Y | N/A | N/A
50945 | [NAME] URTROLITHOTOMY | 2011-07-01 00:00:00 | 865.41 | N | Y | N/A | N/A
50947 | LAPS URTRONEOCSTOST W/CSTSC&URTRL STENT PLMT | 2011-07-01 00:00:00 | 1225.94 | N | Y | N/A | N/A
50948 | LAPS URTRONEOCSTOST W/O CSTSC&URTRL STENT PLMT | 2011-07-01 00:00:00 | 1137.72 | N | Y | N/A | N/A
50949 | [NAME], URETER | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
50951 | URETERAL ENDOSCOPY VIA URETEROSTOMY | 2011-07-01 00:00:00 | 336.86 | N | Y | N/A | N/A
50953 | URETERAL ENDOSCOPY VIA URETEROST W/WO DIL URETER | 2011-07-01 00:00:00 | 356.31 | N | Y | N/A | N/A
50955 | URETERAL ENDOSCOPY VIA URETEROSTOMY W/BIOPSY | 2011-07-01 00:00:00 | 387.89 | N | Y | N/A | N/A
50957 | URETERAL ENDOSCOPY W/DEST&/INC W/WO BIOPSY | 2011-07-01 00:00:00 | 383.35 | N | Y | N/A | N/A
50961 | URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE | 2011-07-01 00:00:00 | 346.11 | N | Y | N/A | N/A
50970 | URETERAL ENDOSCOPY VIA URETEROTOMY W/O IMAGING | 2011-07-01 00:00:00 | 331.71 | N | Y | N/A | N/A
50972 | NDSC URETEROTOMY URTRL CATHJ W/WO DILAT URETER | 2011-07-01 00:00:00 | 320.14 | N | Y | N/A | N/A
50974 | URETERAL ENDOSCOPY VIA URETEROT W/O IMAGING W/BX | 2011-07-01 00:00:00 | 423.52 | N | Y | N/A | N/A
50976 | URETERAL ENDOSC VIA URETEROT W/DEST&/INC W/WO BX | 2011-07-01 00:00:00 | 417.07 | N | Y | N/A | N/A
50980 | NDSC URETEROTOMY RMVL FB/CALCULUS | 2011-07-01 00:00:00 | 318.86 | N | Y | N/A | N/A
51020 | CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL | 2011-07-01 00:00:00 | 415.47 | N | Y | N/A | N/A
51030 | CSTOTOMY/CSTOST CRYOSURG DSTRJ INTRAVESICAL LES | 2011-07-01 00:00:00 | 412.26 | N | Y | N/A | N/A
51040 | CYSTOSTOMY CYSTOTOMY W/DRAINAGE | 2011-07-01 00:00:00 | 257.45 | N | Y | N/A | N/A
51045 | CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX | 2011-07-01 00:00:00 | 426.05 | N | Y | N/A | N/A
51050 | CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS | 2011-07-01 00:00:00 | 419.41 | N | Y | N/A | N/A
51060 | TRANSVESICAL URETROLITHOTOMY | 2011-07-01 00:00:00 | 516.33 | N | Y | N/A | N/A
51065 | CYSTOTOMY W/CALCULUS BASKET XTRJ&/FRAGMENTATION | 2011-07-01 00:00:00 | 513.16 | N | Y | N/A | N/A
51080 | DRG PRIVESICAL/PREVESICAL SPACE ABSC | 2011-07-01 00:00:00 | 361.02 | N | Y | N/A | N/A
51100 | ASPIRATION BLADDER NEEDLE | 2011-07-01 00:00:00 | 54.67 | N | Y | N/A | N/A
51101 | ASPIRATION BLADDER TROCAR/INTRACATHETER | 2011-07-01 00:00:00 | 111.15 | N | Y | N/A | N/A
51102 | ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER | 2011-07-01 00:00:00 | 203.27 | N | Y | N/A | N/A
51500 | EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR | 2011-07-01 00:00:00 | 574.79 | N | Y | N/A | N/A
51520 | CYSTOTOMY SIMPLE EXCISION VESICAL NECK | 2011-07-01 00:00:00 | 522.73 | N | Y | N/A | N/A
51525 | CYSTOTOMY EXCISE BLADDER DIVERTICULUM 1/MULTIPLE | 2011-07-01 00:00:00 | 763.41 | N | Y | N/A | N/A
51530 | CYSTOTOMY EXCISION BLADDER TUMOR | 2011-07-01 00:00:00 | 691.76 | N | Y | N/A | N/A
51535 | CYSTOTOMY EXCISE/INCISE/REPAIR URETEROCELE | 2011-07-01 00:00:00 | 686.78 | N | Y | N/A | N/A
51550 | CYSTECTOMY PARTIAL SIMPLE | 2011-07-01 00:00:00 | 849.2 | N | Y | N/A | N/A
51555 | CYSTECTOMY PARTIAL COMPLICATED | 2011-07-01 00:00:00 | 1120.8 | N | Y | N/A | N/A
51565 | CSTC PRTL W/RIMPLTJ URTR IN BLDR URTRONEOCSTOST | 2011-07-01 00:00:00 | 1144.76 | N | Y | N/A | N/A
51570 | CYSTECTOMY COMPLETE SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 1309.67 | N | Y | N/A | N/A
51575 | CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY | 2011-07-01 00:00:00 | 1621.09 | N | Y | N/A | N/A
51580 | CYSTECTOMY W/URETEROSIGMOIDOSTOMY W/NODES | 2011-07-01 00:00:00 | 1688.75 | N | Y | N/A | N/A
51585 | CYSTECTOMY W/URETEROSIGMOID BI PELV LYMPH NODES | 2011-07-01 00:00:00 | 1880.71 | N | Y | N/A | N/A
51590 | CSTC COMPL W/URTROILEAL CONDUIT/BLDR W/INT ANAST | 2011-07-01 00:00:00 | 1718.1 | N | Y | N/A | N/A
51595 | CSTC COMPL W/CONDUIT/SIGMOID BLDR PEL LMPHADEC | 2011-07-01 00:00:00 | 1949.32 | N | Y | N/A | N/A
51596 | CSTC COMPL W/CONTINENT DVRJ OPN NEOBLDR | 2011-07-01 00:00:00 | 2095.15 | N | Y | N/A | N/A
51597 | PELVIC EXENTERATION COMPLETE MALIGNANCY | 2011-07-01 00:00:00 | 2033.16 | N | Y | N/A | N/A
51600 | NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY | 2011-07-01 00:00:00 | 167.01 | N | Y | N/A | N/A
51605 | NJX&PLMT CHAIN CONTRAST&/URETHROCSTOGRAPY | 2011-07-01 00:00:00 | 34 | N | Y | N/A | N/A
51610 | NJX RETROGRADE URETHROCSTOGRAPY | 2011-07-01 00:00:00 | 96.14 | N | Y | N/A | N/A
51700 | BLDR IRRIGATION SMPL LAVAGE&/INSTLJ | 2011-07-01 00:00:00 | 75.02 | N | Y | N/A | N/A
51701 | INSJ NON-NDWELLG BLADDER CATHETER | 2011-07-01 00:00:00 | 51.06 | N | Y | N/A | N/A
51702 | INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE | 2011-07-01 00:00:00 | 65.76 | N | Y | N/A | N/A
51703 | INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED | 2011-07-01 00:00:00 | 119.49 | N | Y | N/A | N/A
51705 | CHANGE CYSTOSTOMY TUBE SIMPLE | 2011-07-01 00:00:00 | 97.01 | N | Y | N/A | N/A
51710 | CHANGE CYSTOSTOMY TUBE COMPLICATED | 2011-07-01 00:00:00 | 135.14 | N | Y | N/A | N/A
51715 | NDSC NJX IMPLT MATRL URT&/BLDR NCK | 2011-07-01 00:00:00 | 256.99 | N | Y | N/A | N/A
51720 | BLADDER INSTILLATION ANTICARCINOGENIC AGENT | 2011-07-01 00:00:00 | 99.07 | N | Y | N/A | N/A
51725 | SIMPLE CYSTOMETROGRAM | 2011-07-01 00:00:00 | 180.23 | N | Y | 112.93 | 67.3
51726 | BLADDER PRESSURE MEASUREMENT DURING FILLING | 2011-07-01 00:00:00 | 262.59 | N | Y | 185.94 | 76.65
51727 | COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE | 2011-07-01 00:00:00 | 261.17 | N | Y | 166.85 | 94.32
51728 | CYSTOMETROGRAM W/VP | 2011-07-01 00:00:00 | 259.03 | N | Y | 166.28 | 92.75
51729 | COMPLEX CYSTOMETROGRAM WITH VO | 2011-07-01 00:00:00 | 283.55 | N | Y | 172.03 | 111.52
51736 | SIMPLE UROFLOMETRY | 2011-07-01 00:00:00 | 30.06 | N | Y | 19.49 | 10.57
51741 | COMPLEX UROFLOMETRY | 2011-07-01 00:00:00 | 36.69 | N | Y | 22.38 | 14.31
51784 | EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL | 2011-07-01 00:00:00 | 175.94 | N | Y | 107.74 | 68.2
51785 | NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ | 2011-07-01 00:00:00 | 193.24 | N | Y | 124.75 | 68.49
51792 | STIMULUS EVOKED RESPONSE | 2011-07-01 00:00:00 | 198.49 | N | Y | 148.97 | 49.52
51797 | VOID PRESSURE STUDIES INTRAABDOMINAL | 2011-07-01 00:00:00 | 115.48 | N | Y | 78.89 | 36.59
51798 | MEAS POST-VOIDING RESIDUAL URINE&/BLDR CAP | 2011-07-01 00:00:00 | 16.61 | N | Y | N/A | N/A
51800 | CSTOPLASTY/CSTOURTP PLSTC ANY | 2011-07-01 00:00:00 | 927.21 | N | Y | N/A | N/A
51820 | CSTOURTP W/UNI/BI URTRONEOCSTOST | 2011-07-01 00:00:00 | 946.12 | N | Y | N/A | N/A
51840 | ANT VESICOURETHROPEXY/URETHROPEXY SMPL | 2011-07-01 00:00:00 | 576.04 | N | Y | N/A | N/A
51841 | ANT VESICOURETHROPEXY/URETHROPEXY COMP | 2011-07-01 00:00:00 | 685.22 | N | Y | N/A | N/A
51845 | ABDOMINO-VAG VESICAL NCK SSP W/WO NDSC CTRL | 2011-07-01 00:00:00 | 519.66 | N | Y | N/A | N/A
51860 | CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE | 2011-07-01 00:00:00 | 646.61 | N | Y | N/A | N/A
51865 | CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED | 2011-07-01 00:00:00 | 787.2 | N | Y | N/A | N/A
51880 | CLOSURE CYSTOSTOMY SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 411.96 | N | Y | N/A | N/A
51900 | CLSR VESICOVAGINAL FISTUL AABDL APPROACH | 2011-07-01 00:00:00 | 727.11 | N | Y | N/A | N/A
51920 | CLOSURE VESICOUTERINE FISTULA | 2011-07-01 00:00:00 | 668.5 | N | Y | N/A | N/A
51925 | CLSR VESICOUTERINE FISTULA W/HYSTERECTOMY | 2011-07-01 00:00:00 | 913.84 | Y | Y | N/A | N/A
51940 | CLOSURE EXSTROPHY BLADDER | 2011-07-01 00:00:00 | 1436.05 | N | Y | N/A | N/A
51960 | ENTEROCYSTOPLASTY W/INTESTINAL ANASTOMOSIS | 2011-07-01 00:00:00 | 1233.96 | N | Y | N/A | N/A
51980 | CUTANEOUS VESICOSTOMY | 2011-07-01 00:00:00 | 631.49 | N | Y | N/A | N/A
51990 | [NAME] URETHRAL SUSPENSION STRESS INCONT | 2011-07-01 00:00:00 | 659.8 | N | Y | N/A | N/A
51992 | LAPAROSCOPY SLING OPERATION STRESS INCONT | 2011-07-01 00:00:00 | 735.64 | N | Y | N/A | N/A
52000 | [NAME] | 2011-07-01 00:00:00 | 182.66 | N | Y | N/A | N/A
52001 | CYSTO W/IRRG&EVAC MLT OBSTRUCTING CLOTS | 2011-07-01 00:00:00 | 333.93 | N | Y | N/A | N/A
52005 | CYSTO BLADDER W/URETERAL CATHETERIZATION | 2011-07-01 00:00:00 | 249.69 | N | Y | N/A | N/A
52007 | CYSTO W/URTRL CATHJ BRUSH BX URTR&/RNL PELVIS | 2011-07-01 00:00:00 | 447.37 | N | Y | N/A | N/A
52010 | CYSTO W/EJACULATORY DUCT CATHETERIZATION | 2011-07-01 00:00:00 | 345.58 | N | Y | N/A | N/A
52204 | CYSTOURETHROSCOPY WITH BIOPSY | 2011-07-01 00:00:00 | 361.72 | N | Y | N/A | N/A
52214 | CYSTO W/DESTRUCTION OF LESIONS | 2011-07-01 00:00:00 | 540.27 | N | Y | N/A | N/A
52224 | CYSTO W/REMOVAL OF LESIONS SMALL | 2011-07-01 00:00:00 | 644.71 | N | Y | N/A | N/A
52234 | CYSTO W/REMOVAL OF TUMORS SMALL | 2011-07-01 00:00:00 | 219.91 | N | Y | N/A | N/A
52235 | CYSTOURETHROSCOPY W/DEST&/RMVL MED BLADDER TUMOR | 2011-07-01 00:00:00 | 257.81 | N | Y | N/A | N/A
52240 | CYSTOURETHROSCOPY W/DEST&/RMVL TUMOR LARGE | 2011-07-01 00:00:00 | 450.5 | N | Y | N/A | N/A
52250 | [NAME] RADIOACT SBST W/WOBX/FULG | 2011-07-01 00:00:00 | 216.68 | N | Y | N/A | N/A
52260 | CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH | 2011-07-01 00:00:00 | 187.23 | N | Y | N/A | N/A
52265 | CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA | 2011-07-01 00:00:00 | 352.67 | N | Y | N/A | N/A
52270 | CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE | 2011-07-01 00:00:00 | 339.2 | N | Y | N/A | N/A
52275 | CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE | 2011-07-01 00:00:00 | 461.56 | N | Y | N/A | N/A
52276 | CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE | 2011-07-01 00:00:00 | 237.29 | N | Y | N/A | N/A
52277 | CYSTOURETHROSCOPY W/RESECJ EXTERNAL SPHINCTER | 2011-07-01 00:00:00 | 290.56 | N | Y | N/A | N/A
52281 | CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS | 2011-07-01 00:00:00 | 250.61 | N | Y | N/A | N/A
52282 | CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT | 2011-07-01 00:00:00 | 300.48 | N | Y | N/A | N/A
52283 | CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE | 2011-07-01 00:00:00 | 247.7 | N | Y | N/A | N/A
52285 | [NAME] | 2011-07-01 00:00:00 | 249.49 | N | Y | N/A | N/A
52287 | CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER | 2013-01-01 00:00:00 | 256.28 | N | N | N/A | N/A
52290 | CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI | 2011-07-01 00:00:00 | 218.39 | N | Y | N/A | N/A
52300 | CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI | 2011-07-01 00:00:00 | 252.6 | N | Y | N/A | N/A
52301 | CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI | 2011-07-01 00:00:00 | 261.66 | N | Y | N/A | N/A
52305 | CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT | 2011-07-01 00:00:00 | 249.02 | N | Y | N/A | N/A
52310 | CYSTO W/SIMPLE REMOVAL STONE & STENT | 2011-07-01 00:00:00 | 217.01 | N | Y | N/A | N/A
52315 | CYSTO W/COMPLEX REMOVAL STONE & STENT | 2011-07-01 00:00:00 | 380.57 | N | Y | N/A | N/A
52317 | LITHOLAPAXY SMPL/SM LT 2.5 CM | 2011-07-01 00:00:00 | 785.2 | N | Y | N/A | N/A
52318 | LITHOLAPAXY COMP/LG GT 2.5 CM | 2011-07-01 00:00:00 | 423.56 | N | Y | N/A | N/A
52320 | CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS | 2011-07-01 00:00:00 | 220.2 | N | Y | N/A | N/A
52325 | CYSTO FRAGMENTATION URETERAL STONE | 2011-07-01 00:00:00 | 286.51 | N | Y | N/A | N/A
52327 | CYSTO W/SUBURTRIC NJX IMPLT MATRL | 2011-07-01 00:00:00 | 234.4 | N | Y | N/A | N/A
52330 | CYSTO MANJ W/O RMVL URETERAL STONE | 2011-07-01 00:00:00 | 575.02 | N | Y | N/A | N/A
52332 | CYSTO W/INSERT URETERAL STENT | 2011-07-01 00:00:00 | 426.91 | N | Y | N/A | N/A
52334 | CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR | 2011-07-01 00:00:00 | 229.32 | N | Y | N/A | N/A
52341 | CYSTO W/TX URETERAL STRICTURE | 2011-07-01 00:00:00 | 258.91 | N | Y | N/A | N/A
52342 | CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE | 2011-07-01 00:00:00 | 281.53 | N | Y | N/A | N/A
52343 | CYSTO W/TX INTRA-RENAL STRICTURE | 2011-07-01 00:00:00 | 313.27 | N | Y | N/A | N/A
52344 | CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE | 2011-07-01 00:00:00 | 339.93 | N | Y | N/A | N/A
52345 | CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX | 2011-07-01 00:00:00 | 362.56 | N | Y | N/A | N/A
52346 | CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE | 2011-07-01 00:00:00 | 409.24 | N | Y | N/A | N/A
52351 | CYSTO W/URTROSCOPY&/PYELOSCOPY DX | 2011-07-01 00:00:00 | 280.38 | N | Y | N/A | N/A
52352 | CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES | 2011-07-01 00:00:00 | 329.36 | N | Y | N/A | N/A
52353 | CYSTO W/URETEROSCOPY W/LITHOTRIPSY | 2011-07-01 00:00:00 | 378.39 | N | Y | N/A | N/A
52354 | CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION | 2011-07-01 00:00:00 | 350.17 | N | Y | N/A | N/A
52355 | CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR | 2011-07-01 00:00:00 | 417.09 | N | Y | N/A | N/A
52356 | CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT | 2014-01-01 00:00:00 | 360.45 | N | Y | N/A | N/A
52400 | CYSTO INC FULG/RESCJ URTL VALVES/FOLDS | 2011-07-01 00:00:00 | 427.77 | N | Y | N/A | N/A
52402 | CSTO W/TRURL RESCJ/INC EJACULATORY DUXS | 2011-07-01 00:00:00 | 238.82 | N | Y | N/A | N/A
52450 | TRANSURETHRAL INCISION PROSTATE | 2011-07-01 00:00:00 | 416.83 | N | Y | N/A | N/A
52500 | TRANSURETHRAL RESECTION PROSTATE | 2011-07-01 00:00:00 | 433.55 | N | Y | N/A | N/A
52601 | TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE | 2011-07-01 00:00:00 | 743.17 | N | Y | N/A | N/A
52630 | TRURL RESCJ RESIDUAL/REGROWTH OBSTR PRSTATE TISS | 2011-07-01 00:00:00 | 394.25 | N | Y | N/A | N/A
52640 | TRURL RESCJ POSTOP BLADDER NECK CONTRACTURE | 2011-07-01 00:00:00 | 263.92 | Y | Y | N/A | N/A
52647 | LASER COAGULATION OF PROSTATE FOR URINE FLOW | 2011-07-01 00:00:00 | 1768.22 | N | Y | N/A | N/A
52648 | LASER VAPORIZATION OF PROSTATE FOR URINE FLOW | 2011-07-01 00:00:00 | 1811.53 | N | Y | N/A | N/A
52649 | LASER ENUCLEATION PROSTATE W/MORCELLATION | 2011-07-01 00:00:00 | 859.82 | N | Y | N/A | N/A
52700 | TRURL DRAINAGE PROSTATIC ABSCESS | 2011-07-01 00:00:00 | 388.12 | N | Y | N/A | N/A
53000 | URTT/URTS XTRNL SPX PENDULOUS URETHRA | 2011-07-01 00:00:00 | 131.97 | N | Y | N/A | N/A
53010 | URETHROTOMY/URETHROSTOMY XT SPX PERINEAL URETHRA | 2011-07-01 00:00:00 | 261.07 | N | Y | N/A | N/A
53020 | MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT | 2011-07-01 00:00:00 | 86.4 | N | Y | N/A | N/A
53025 | MEATOTOMY CUTTING MEATUS SPX INFANT | 2011-07-01 00:00:00 | 59.14 | N | Y | N/A | N/A
53040 | DRAINAGE DEEP PERIURETHRAL ABSCESS | 2011-07-01 00:00:00 | 347.88 | N | Y | N/A | N/A
53060 | DRG OF SKENE'S GLAND ABSCESS OR CYST | 2011-07-01 00:00:00 | 160 | N | Y | N/A | N/A
53080 | DRG PERINEAL URINARY XTRVASATION UNCOMP SPX | 2011-07-01 00:00:00 | 379.61 | N | Y | N/A | N/A
53085 | DRG PERINEAL URINARY XTRVASATION COMPLIC | 2011-07-01 00:00:00 | 563.78 | N | Y | N/A | N/A
53200 | BIOPSY URETHRA | 2011-07-01 00:00:00 | 137.27 | N | Y | N/A | N/A
53210 | URETHRECTOMY TOT W/CYSTOST FEMALE | 2011-07-01 00:00:00 | 685.71 | N | Y | N/A | N/A
53215 | URETHRECTOMY TOT W/CYSTOST MALE | 2011-07-01 00:00:00 | 826.64 | N | Y | N/A | N/A
53220 | EXC/FULGURATION CARCINOMA URETHRA | 2011-07-01 00:00:00 | 402.08 | N | Y | N/A | N/A
53230 | EXC URETHRAL DIVERTICULUM SPX FEMALE | 2011-07-01 00:00:00 | 537.81 | N | Y | N/A | N/A
53235 | EXC URETHRAL DIVERTICULUM SPX MALE | 2011-07-01 00:00:00 | 564.24 | N | Y | N/A | N/A
53240 | MARSUPIALIZATION URTL DIVERTICULUM MALE/FEMALE | 2011-07-01 00:00:00 | 378.63 | N | Y | N/A | N/A
53250 | EXCISION OF BULBOURETHRAL GLAND | 2011-07-01 00:00:00 | 372.43 | N | Y | N/A | N/A
53260 | EXC/FULGURATION URETHRAL POLYP DSTL URETHRA | 2011-07-01 00:00:00 | 177.5 | N | Y | N/A | N/A
53265 | EXC/FULGURATION URETHRAL CARUNCLE | 2011-07-01 00:00:00 | 194.29 | N | Y | N/A | N/A
53270 | EXCISION OR FULGURATION SKENES GLANDS | 2011-07-01 00:00:00 | 185.45 | N | Y | N/A | N/A
53275 | EXCISION/FULGURATION URETHRAL PROLAPSE | 2011-07-01 00:00:00 | 234.13 | N | Y | N/A | N/A
53400 | URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX | 2011-07-01 00:00:00 | 711.82 | N | Y | N/A | N/A
53405 | URETHROPLASTY 2ND STAGE W/URINARY DIVERSION | 2011-07-01 00:00:00 | 778.53 | N | Y | N/A | N/A
53410 | URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA | 2011-07-01 00:00:00 | 871.59 | N | Y | N/A | N/A
53415 | URTP TRANSPUBIC/PRNL 1 STG RCNSTJ/RPR URT | 2011-07-01 00:00:00 | 1004.6 | N | Y | N/A | N/A
53420 | URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 1ST STAGE | 2011-07-01 00:00:00 | 729.4 | N | Y | N/A | N/A
53425 | URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 2ND STAGE | 2011-07-01 00:00:00 | 836.03 | N | Y | N/A | N/A
53430 | URETHROPLASTY RCNSTJ FEMALE URETHRA | 2011-07-01 00:00:00 | 851.19 | N | Y | N/A | N/A
53431 | URTP W/TUBULARIZATION POST URT&/LWR BLDR | 2011-07-01 00:00:00 | 1025.91 | N | Y | N/A | N/A
53440 | SLING OPRATION CORRJ [NAME] | 2011-07-01 00:00:00 | 783.79 | N | Y | N/A | N/A
53442 | RMVL/REVJ SLING MALE URINARY INCONTINENCE | 2011-07-01 00:00:00 | 692.34 | N | Y | N/A | N/A
53444 | INSERTION TANDEM CUFF | 2011-07-01 00:00:00 | 706.44 | N | Y | N/A | N/A
53445 | INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER | 2011-07-01 00:00:00 | 781.92 | N | Y | N/A | N/A
53446 | REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER | 2011-07-01 00:00:00 | 572.31 | N | Y | N/A | N/A
53447 | RMVL&RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINCTR | 2011-07-01 00:00:00 | 721.25 | N | Y | N/A | N/A
53448 | RMVL&RPLCMT NFLTBL NCK SPHNCTR THRU INFCT FLD | 2011-07-01 00:00:00 | 1139.81 | N | Y | N/A | N/A
53449 | RPR NFLTBL URETHRAL/BLADDER NECK SPHINCTER | 2011-07-01 00:00:00 | 544.57 | N | Y | N/A | N/A
53450 | URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT | 2011-07-01 00:00:00 | 362.85 | N | Y | N/A | N/A
53460 | URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM | 2011-07-01 00:00:00 | 406.62 | N | Y | N/A | N/A
53500 | URETHROLSS TRVG SEC OPN W/CSTO | 2011-07-01 00:00:00 | 661.65 | N | Y | N/A | N/A
53502 | URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE | 2011-07-01 00:00:00 | 430.07 | N | Y | N/A | N/A
53505 | URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE | 2011-07-01 00:00:00 | 432.09 | N | Y | N/A | N/A
53510 | URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PERINEAL | 2011-07-01 00:00:00 | 561.3 | N | Y | N/A | N/A
53515 | URTORR SUTR URETHRAL WND/INJ PROSTATOMEMBRANOUS | 2011-07-01 00:00:00 | 705.92 | N | Y | N/A | N/A
53520 | CLSR URETHROSTOMY/URETHROQ FSTL MALE SPX | 2011-07-01 00:00:00 | 494.1 | N | Y | N/A | N/A
53600 | DILAT URETHRAL STRIX DILATOR MALE 1ST | 2011-07-01 00:00:00 | 74.97 | N | Y | N/A | N/A
53601 | DILAT URETHRAL STRIX DILATOR MALE SBSQ | 2011-07-01 00:00:00 | 72.89 | N | Y | N/A | N/A
53605 | DILAT URETHRAL STRIX/VESICAL NCK DILAT [NAME] | 2011-07-01 00:00:00 | 57.38 | N | Y | N/A | N/A
53620 | DILAT URETHRAL STRIX FILIFORM&FOLLWR MALE 1ST | 2011-07-01 00:00:00 | 106.26 | N | Y | N/A | N/A
53621 | DILAT URETHRAL STRIX FILIFORM&FOLLWR [NAME] | 2011-07-01 00:00:00 | 100.19 | N | Y | N/A | N/A
53660 | DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INIT | 2011-07-01 00:00:00 | 63.59 | N | Y | N/A | N/A
53661 | DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ | 2011-07-01 00:00:00 | 63.04 | N | Y | N/A | N/A
53665 | DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES | 2011-07-01 00:00:00 | 34.16 | N | Y | N/A | N/A
53850 | TRURL DSTRJ PRSTATE TISS MICROWAVE THERMOTH | 2011-07-01 00:00:00 | 2001.2 | N | Y | N/A | N/A
53852 | TRURL DSTRJ PRSTATE TISS RF THERMOTH | 2011-07-01 00:00:00 | 1930.19 | N | Y | N/A | N/A
53855 | INSERT PROST URETHRAL STENT | 2011-07-01 00:00:00 | 608.33 | N | Y | N/A | N/A
53860 | TRURL RF FEMALE BLADDER NECK STRS URIN INCONT | 2011-07-01 00:00:00 | 1238.27 | N | Y | N/A | N/A
53899 | UNLISTED PROC, URINARY SYST | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
54000 | SLITTING PREPUCE DORSAL/LATERAL SPX NEWBORN | 2011-07-01 00:00:00 | 134.98 | N | Y | N/A | N/A
54001 | SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN | 2011-07-01 00:00:00 | 167.39 | N | Y | N/A | N/A
54015 | I&D PENIS DEEP | 2011-07-01 00:00:00 | 273.75 | N | Y | N/A | N/A
54050 | DSTRJ LESION PENIS SIMPLE CHEMICAL | 2011-07-01 00:00:00 | 112.03 | N | Y | N/A | N/A
54055 | DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION | 2011-07-01 00:00:00 | 102.67 | N | Y | N/A | N/A
54056 | DSTRJ LESION PENIS SIMPLE CRYOSURGERY | 2011-07-01 00:00:00 | 119.87 | N | Y | N/A | N/A
54057 | DSTRJ LESION PENIS SIMPLE LASER | 2011-07-01 00:00:00 | 120.84 | N | Y | N/A | N/A
54060 | DSTRJ LESION PENIS SIMPLE SURG EXCISION | 2011-07-01 00:00:00 | 161.28 | N | Y | N/A | N/A
54065 | DSTRJ LESION PENIS EXTENSIVE | 2011-07-01 00:00:00 | 188.51 | N | Y | N/A | N/A
54100 | BIOPSY PENIS SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 171.01 | N | Y | N/A | N/A
54105 | BIOPSY PENIS DEEP STRUCTURES | 2011-07-01 00:00:00 | 239.81 | N | Y | N/A | N/A
54110 | EXCISION OF PENILE PLAQUE | 2011-07-01 00:00:00 | 554.31 | N | Y | N/A | N/A
54111 | EXC PENILE PLAQUE GRAFT LT/5 CM LENGTH | 2011-07-01 00:00:00 | 713.13 | N | Y | N/A | N/A
54112 | EXC PENILE PLAQUE GRAFT GT 5 CM LENGTH | 2011-07-01 00:00:00 | 836.09 | N | Y | N/A | N/A
54115 | REMOVAL FOREIGN BODY DEEP PENILE TISSUE | 2011-07-01 00:00:00 | 400.72 | N | Y | N/A | N/A
54120 | AMPUTATION PENIS PARTIAL | 2011-07-01 00:00:00 | 561.63 | N | Y | N/A | N/A
54125 | [NAME] | 2011-07-01 00:00:00 | 722.57 | N | Y | N/A | N/A
54130 | AMPUTAION PENIS RADW/BI INGUINOFEMORAL LMPHADE | 2011-07-01 00:00:00 | 1062.77 | N | Y | N/A | N/A
54135 | [NAME]/LYMPH NODES | 2011-07-01 00:00:00 | 1348.21 | N | Y | N/A | N/A
54150 | CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK | 2011-07-01 00:00:00 | 143.73 | N | Y | N/A | N/A
54160 | [NAME] | 2011-07-01 00:00:00 | 200.37 | N | Y | N/A | N/A
54161 | CIRCUMCISION AGE GT28 DAYS | 2011-07-01 00:00:00 | 174.94 | N | Y | N/A | N/A
54162 | LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS | 2011-07-01 00:00:00 | 234.75 | N | Y | N/A | N/A
54163 | REPAIR INCOMPLETE CIRCUMCISION | 2011-07-01 00:00:00 | 194.09 | N | Y | N/A | N/A
54164 | FRENULOTOMY PENIS | 2011-07-01 00:00:00 | 171.18 | N | Y | N/A | N/A
54200 | [NAME] DISEASE | 2011-07-01 00:00:00 | 96.53 | N | Y | N/A | N/A
54205 | NJX PEYRONIE W/SURG EXPOS PLAQUE | 2011-07-01 00:00:00 | 475.33 | N | Y | N/A | N/A
54220 | IRRIGATION CORPORA CAVERNOSA PRIAPISM | 2011-07-01 00:00:00 | 183.51 | N | Y | N/A | N/A
54300 | PENIS STRAIGHTENING CHORDEE | 2011-07-01 00:00:00 | 574.07 | N | Y | N/A | N/A
54304 | PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR | 2011-07-01 00:00:00 | 671.27 | N | Y | N/A | N/A
54308 | URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR LT 3 CM | 2011-07-01 00:00:00 | 650.91 | N | Y | N/A | N/A
54312 | URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR GT 3 CM | 2011-07-01 00:00:00 | 745.59 | N | Y | N/A | N/A
54316 | URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR SKIN GRF | 2011-07-01 00:00:00 | 908.23 | N | Y | N/A | N/A
54318 | URETHROPLASTY 3RD STG HYPOSPADIAS RPR RLS PENIS | 2011-07-01 00:00:00 | 640.41 | N | Y | N/A | N/A
54322 | 1 STG DSTL HYPOSPADIAS RPR W/SMPL MEATAL ADVMNT | 2011-07-01 00:00:00 | 698.98 | N | Y | N/A | N/A
54324 | 1 STG DSTL HYPOSPADIAS RPR W/URTP SKIN FLAPS | 2011-07-01 00:00:00 | 867.84 | N | Y | N/A | N/A
54326 | 1 STG DSTL HYPOSPADIAS RPR URTP SKN FLAPS&MOB | 2011-07-01 00:00:00 | 829.59 | N | Y | N/A | N/A
54328 | 1 STAGE DSTL HYPOSPADIAS RPR W/EXTENSIVE DSJ | 2011-07-01 00:00:00 | 835.07 | N | Y | N/A | N/A
54332 | 1 STAGE PROX PENILE/PENOSCROTAL HYPOSPADIAS RPR | 2011-07-01 00:00:00 | 906.02 | N | Y | N/A | N/A
54336 | 1 STG PERINEAL HYPOSPADIAS RPR W/GRF&/FLA | 2011-07-01 00:00:00 | 1052.24 | N | Y | N/A | N/A
54340 | RPR HYPOSPADIAS COMPLCTJS CLSR INC/EXC SIMPLE | 2011-07-01 00:00:00 | 503.79 | N | Y | N/A | N/A
54344 | RPR HYPOSPADIAS COMPLCTJS MOBLJ FLAPS&URTP | 2011-07-01 00:00:00 | 863.12 | N | Y | N/A | N/A
54348 | RPR HYPOSPADIAS COMPLCTJS DSJ&URTP FLAP/GRF | 2011-07-01 00:00:00 | 1004.35 | N | Y | N/A | N/A
54352 | RPR HYPOSPADIAS CRIPPLE W/DSJ&EXC&GRFS/FLAPS | 2011-07-01 00:00:00 | 1413.14 | N | Y | N/A | N/A
54360 | PLASTIC RPR PENIS CORRECT ANGULATION | 2011-07-01 00:00:00 | 644.9 | N | Y | N/A | N/A
54380 | PLASTIC RPR PENIS EPISPADIAS DSTL SPHNCTR | 2011-07-01 00:00:00 | 714.79 | N | Y | N/A | N/A
54385 | PLASTIC PENIS EPISPADIAS DSTL SPHNCTR W/INCONT | 2011-07-01 00:00:00 | 866.2 | N | Y | N/A | N/A
54390 | PLASTIC RPR PENIS EPISPADIAS W/EXSTROPHY BLADDER | 2011-07-01 00:00:00 | 1092.61 | N | Y | N/A | N/A
54420 | CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT UNI/BI | 2011-07-01 00:00:00 | 628.99 | N | Y | N/A | N/A
54430 | CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/B | 2011-07-01 00:00:00 | 571.05 | N | Y | N/A | N/A
54435 | CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM | 2011-07-01 00:00:00 | 371 | N | Y | N/A | N/A
54440 | REPAIR, PENILE INJURY | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
54450 | [NAME] | 2011-07-01 00:00:00 | 63.39 | N | Y | N/A | N/A
54500 | BIOPSY TESTIS NEEDLE SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 66.38 | N | Y | N/A | N/A
54505 | BIOPSY TESTIS INCISIONAL SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 187.66 | N | Y | N/A | N/A
54512 | [NAME] LESION TESTIS | 2011-07-01 00:00:00 | 476.6 | N | Y | N/A | N/A
54520 | ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH | 2011-07-01 00:00:00 | 288.66 | N | Y | N/A | N/A
54522 | ORCHIECTOMY PARTIAL | 2011-07-01 00:00:00 | 517.37 | N | Y | N/A | N/A
54530 | ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH | 2011-07-01 00:00:00 | 449.24 | N | Y | N/A | N/A
54535 | ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL | 2011-07-01 00:00:00 | 655.54 | N | Y | N/A | N/A
54550 | EXPL UNDESCENDED TSTIS INGUN/SCROTAL AREA | 2011-07-01 00:00:00 | 435.29 | N | Y | N/A | N/A
54560 | EXPL UNDESCENDED TESTIS W/ABDOMINAL EXPL | 2011-07-01 00:00:00 | 598.55 | N | Y | N/A | N/A
54600 | RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS | 2011-07-01 00:00:00 | 402.1 | N | Y | N/A | N/A
54620 | FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 267.54 | N | Y | N/A | N/A
54640 | ORCHIOPEXY INGUINAL APPROACH W/WO HERNIA RPR | 2011-07-01 00:00:00 | 420.57 | N | Y | N/A | N/A
54650 | ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS | 2011-07-01 00:00:00 | 628.13 | N | Y | N/A | N/A
54670 | SUTURE/REPAIR TESTICULAR INJURY | 2011-07-01 00:00:00 | 359.01 | N | Y | N/A | N/A
54680 | [NAME] TO THIGH | 2011-07-01 00:00:00 | 694.76 | N | Y | N/A | N/A
54690 | [NAME] ORCHIECTOMY | 2011-07-01 00:00:00 | 592.33 | N | Y | N/A | N/A
54692 | [NAME] ORCHIOPEXY INTRA-ABDOMINAL TESTIS | 2011-07-01 00:00:00 | 676.52 | N | Y | N/A | N/A
54699 | [NAME] PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
54700 | I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE | 2011-07-01 00:00:00 | 188.19 | N | Y | N/A | N/A
54800 | BIOPSY EPIDIDYMIS NEEDLE | 2011-07-01 00:00:00 | 129.21 | N | Y | N/A | N/A
54830 | EXCISION LOCAL LESION EPIDIDYMIS | 2011-07-01 00:00:00 | 329.75 | N | Y | N/A | N/A
54840 | EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY | 2011-07-01 00:00:00 | 285.88 | N | Y | N/A | N/A
54860 | EPIDIDYMECTOMY UNILATERAL | 2011-07-01 00:00:00 | 371.76 | N | Y | N/A | N/A
54861 | EPIDIDYMECTOMY BILATERAL | 2011-07-01 00:00:00 | 502.05 | N | Y | N/A | N/A
54865 | EXPLORATION EPIDIDYMIS W/WO BIOPSY | 2011-07-01 00:00:00 | 317.44 | N | Y | N/A | N/A
55000 | PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED | 2011-07-01 00:00:00 | 105.58 | N | Y | N/A | N/A
55040 | EXCISION HYDROCELE UNILATERAL | 2011-07-01 00:00:00 | 299.58 | N | Y | N/A | N/A
55041 | [NAME] | 2011-07-01 00:00:00 | 451.63 | N | Y | N/A | N/A
55060 | RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE | 2011-07-01 00:00:00 | 336.46 | N | Y | N/A | N/A
55100 | DRAINAGE SCROTAL WALL ABSCESS | 2011-07-01 00:00:00 | 191.48 | N | Y | N/A | N/A
55110 | SCROTAL EXPLORATION | 2011-07-01 00:00:00 | 343.3 | N | Y | N/A | N/A
55120 | REMOVAL FOREIGN BODY SCROTUM | 2011-07-01 00:00:00 | 315.05 | N | Y | N/A | N/A
55150 | [NAME] | 2011-07-01 00:00:00 | 434.38 | N | Y | N/A | N/A
55175 | SCROTOPLASTY SIMPLE | 2011-07-01 00:00:00 | 322.63 | N | Y | N/A | N/A
55180 | SCROTOPLASTY COMPLICATED | 2011-07-01 00:00:00 | 611.74 | N | Y | N/A | N/A
55200 | VASOTOMY CANNULIZATION W/WO VAS INC UNI/BI SPX | 2011-07-01 00:00:00 | 411.54 | N | Y | N/A | N/A
55250 | VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS | 2011-07-01 00:00:00 | 366.62 | N | N | N/A | N/A
55300 | VASOTOMY VASOGRAMS UNI/BI | 2011-07-01 00:00:00 | 162.57 | N | Y | N/A | N/A
55450 | LIGATION PRQ VAS DEFERENS UNI/BI SPX | 2011-07-01 00:00:00 | 328.51 | N | N | N/A | N/A
55500 | [NAME] SPRMATIC CORD UNI SPX | 2011-07-01 00:00:00 | 343.43 | N | Y | N/A | N/A
55520 | EXC LESION [NAME] SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 371.04 | N | Y | N/A | N/A
55530 | [NAME] | 2011-07-01 00:00:00 | 313.43 | Y | Y | N/A | N/A
55535 | [NAME] | 2011-07-01 00:00:00 | 380.14 | Y | Y | N/A | N/A
55540 | [NAME]/HERNIA RPR | 2011-07-01 00:00:00 | 445.88 | Y | Y | N/A | N/A
55550 | LAPS LIGATION SPERMATIC VEINS VARICOCELE | 2011-07-01 00:00:00 | 376.13 | N | Y | N/A | N/A
55559 | [NAME] SPERMATIC CORD PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
55650 | VESICULECTOMY ANY APPROACH | 2011-07-01 00:00:00 | 634.23 | N | Y | N/A | N/A
55680 | EXCISION MULLERIAN DUCT CYST | 2011-07-01 00:00:00 | 302.5 | N | Y | N/A | N/A
55700 | PROSTATE NEEDLE BIOPSY ANY APPROACH | 2011-07-01 00:00:00 | 199.65 | N | Y | N/A | N/A
55705 | BIOPSY PROSTATE INCISIONAL ANY APPROACH | 2011-07-01 00:00:00 | 237.94 | N | Y | N/A | N/A
55706 | BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID | 2011-07-01 00:00:00 | 334.4 | N | Y | N/A | N/A
55720 | PROSTATOTOMY EXTERNAL DRG ABSCESS SIMPLE | 2011-07-01 00:00:00 | 400.82 | N | Y | N/A | N/A
55725 | PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED | 2011-07-01 00:00:00 | 524.29 | N | Y | N/A | N/A
55801 | PROSTATECTOMY PERINEAL SUBTOTAL | 2011-07-01 00:00:00 | 968.63 | N | Y | N/A | N/A
55810 | PROSTATECTOMY PERINEAL RADICAL | 2011-07-01 00:00:00 | 1170.23 | N | Y | N/A | N/A
55812 | PROSTATECTOMY PERINEAL RADICAL W/LYMPH NODE BX | 2011-07-01 00:00:00 | 1432.04 | N | Y | N/A | N/A
55815 | PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC | 2011-07-01 00:00:00 | 1570.76 | N | Y | N/A | N/A
55821 | PROSTATECTOMY [NAME] 1/2 STAGES | 2011-07-01 00:00:00 | 778.07 | N | Y | N/A | N/A
55831 | PROSTATECTOMY RETROPUBIC SUBTOTAL | 2011-07-01 00:00:00 | 841.89 | N | Y | N/A | N/A
55840 | PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING | 2011-07-01 00:00:00 | 1191.51 | N | Y | N/A | N/A
55842 | PROSTECT RETROPUBIC RAD W/WO NRV SPAR W/LYMPH BX | 2011-07-01 00:00:00 | 1275.64 | N | Y | N/A | N/A
55845 | PROSTECT RETROPUB RAD W/WO NRV SPAR&BI PLV LYMPH | 2011-07-01 00:00:00 | 1457.59 | N | Y | N/A | N/A
55860 | EXPOS PROSTATE ANY APPROACH INSJ RADIOACT SUBST | 2011-07-01 00:00:00 | 778.55 | N | Y | N/A | N/A
55862 | EXPOS PROSTATE INSJ RADIOACT SBST W/LYMPH BX | 2011-07-01 00:00:00 | 978.17 | N | Y | N/A | N/A
55865 | EXPOS PROSTATE INSJ RADIOAC SBST W/BI PELV LYMPH | 2011-07-01 00:00:00 | 1189.73 | N | Y | N/A | N/A
55866 | LAPS PROSTECT RETROPUBIC RAD W/NRV SPARING ROBOT | 2011-07-01 00:00:00 | 1542.62 | N | Y | N/A | N/A
55873 | CRYOSURGICAL ABLATION PROSTATE W/US & MONITORING | 2011-07-01 00:00:00 | 5383.26 | N | Y | N/A | N/A
55875 | TRANSPERINEAL PLMT NDL/CATHS PROSTATE RADJ INSJ | 2011-07-01 00:00:00 | 677.82 | N | Y | N/A | N/A
55876 | PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT | 2011-07-01 00:00:00 | 120.87 | N | Y | N/A | N/A
55899 | UNLISTED MALE GEN PROC | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
55920 | PLACEMENT NEEDLE PELVIC ORGAN RADIOELEMENT APPL | 2011-07-01 00:00:00 | 386.61 | N | Y | N/A | N/A
55970 | INTERSEX SURGERY | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
55980 | INTERSEX SURGERY | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
56405 | I&D VULVA/PERINEAL ABSCESS | 2011-07-01 00:00:00 | 93.08 | N | Y | N/A | N/A
56420 | I&D OF BARTHOLINS GLAND ABSCESS | 2011-07-01 00:00:00 | 105.33 | N | Y | N/A | N/A
56440 | MARSUPIALIZATION BARTHOLINS GLAND CYST | 2011-07-01 00:00:00 | 156.35 | N | Y | N/A | N/A
56441 | LYSIS LABIAL ADHESIONS | 2011-07-01 00:00:00 | 125.38 | N | Y | N/A | N/A
56442 | HYMENOTOMY SIMPLE INCISION | 2011-07-01 00:00:00 | 41.18 | N | Y | N/A | N/A
56501 | DESTRUCTION LESIONS VULVA SIMPLE | 2011-07-01 00:00:00 | 111.29 | N | Y | N/A | N/A
56515 | DESTRUCTION LESIONS VULVA EXTENSIVE | 2011-07-01 00:00:00 | 190.88 | N | Y | N/A | N/A
56605 | BIOPSY VULVA/PERINEUM 1 LESION SPX | 2011-07-01 00:00:00 | 70.52 | N | Y | N/A | N/A
56606 | BIOPSY VULVA/PERINEUM EACH ADDL LESION | 2011-07-01 00:00:00 | 32.06 | N | Y | N/A | N/A
56620 | VULVECTOMY SIMPLE PARTIAL | 2011-07-01 00:00:00 | 426.35 | N | Y | N/A | N/A
56625 | VULVECTOMY SIMPLE COMPLETE | 2011-07-01 00:00:00 | 511.77 | N | Y | N/A | N/A
56630 | VULVECTOMY RADICAL PARTIAL | 2011-07-01 00:00:00 | 750.81 | N | Y | N/A | N/A
56631 | [NAME] PRTL UNI INGUINOFEM LMPHADEC | 2011-07-01 00:00:00 | 952.3 | N | Y | N/A | N/A
56632 | [NAME] PRTL BI INGUINOFEM LMPHADEC | 2011-07-01 00:00:00 | 1106.6 | N | Y | N/A | N/A
56633 | [NAME] | 2011-07-01 00:00:00 | 976.66 | N | Y | N/A | N/A
56634 | VULVECTOMY RAD COMPL UNI INGUINOFEM LMPHADEC | 2011-07-01 00:00:00 | 1032.37 | N | Y | N/A | N/A
56637 | VULVECTOMY RAD COMPL BI INGUINOFEM LMPHADEC | 2011-07-01 00:00:00 | 1215.18 | N | Y | N/A | N/A
56640 | [NAME] | 2011-07-01 00:00:00 | 1198.22 | N | Y | N/A | N/A
56700 | PRTL HYMENECTOMY/REVJ HYMENAL RING | 2011-07-01 00:00:00 | 159.83 | N | Y | N/A | N/A
56740 | [NAME] GLAND/CYST | 2011-07-01 00:00:00 | 253.71 | N | Y | N/A | N/A
56800 | PLASTIC REPAIR INTROITUS | 2011-07-01 00:00:00 | 206.63 | N | Y | N/A | N/A
56805 | CLITOROPLASTY INTERSEX STATE | 2011-07-01 00:00:00 | 978.17 | N | Y | N/A | N/A
56810 | PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX | 2011-07-01 00:00:00 | 222.26 | N | Y | N/A | N/A
56820 | COLPOSCOPY VULVA | 2011-07-01 00:00:00 | 93.96 | N | Y | N/A | N/A
56821 | COLPOSCOPY VULVA W/BIOPSY | 2011-07-01 00:00:00 | 125.15 | N | Y | N/A | N/A
57000 | COLPOTOMY W/EXPLORATION | 2011-07-01 00:00:00 | 162.51 | N | Y | N/A | N/A
57010 | COLPOTOMY W/DRAINAGE PELVIC ABSCESS | 2011-07-01 00:00:00 | 370.17 | N | Y | N/A | N/A
57020 | COLPOCENTESIS SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 80.12 | N | Y | N/A | N/A
57022 | I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM | 2011-07-01 00:00:00 | 143.25 | N | Y | N/A | N/A
57023 | I&D VAGINAL HEMATOMA NON-OBSTETRICAL | 2011-07-01 00:00:00 | 265.89 | N | Y | N/A | N/A
57061 | DESTRUCTION VAGINAL LESIONS SIMPLE | 2011-07-01 00:00:00 | 96.95 | N | Y | N/A | N/A
57065 | DESTRUCTION VAGINAL LESIONS EXTENSIVE | 2011-07-01 00:00:00 | 163.14 | N | Y | N/A | N/A
57100 | BIOPSY VAGINAL MUCOSA SIMPLE | 2011-07-01 00:00:00 | 74.8 | N | Y | N/A | N/A
57105 | BIOPSY VAGINAL MUCOSA EXTENSIVE | 2011-07-01 00:00:00 | 115.08 | N | Y | N/A | N/A
57106 | VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL | 2011-07-01 00:00:00 | 409.68 | N | Y | N/A | N/A
57107 | VAGINECTOMY PRTL RMVL VAG WALL & PARAVAGINAL TIS | 2011-07-01 00:00:00 | 1196.74 | N | Y | N/A | N/A
57109 | VAGNC PRTL RMVL VAG WALL W/BI TOT PEL LMPHADEC | 2011-07-01 00:00:00 | 1367.63 | N | Y | N/A | N/A
57110 | VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL | 2011-07-01 00:00:00 | 767.51 | N | Y | N/A | N/A
57111 | VAGINECTOMY COMPL RMVL VAG WALL & PARAVAG TISS | 2011-07-01 00:00:00 | 1375.99 | N | Y | N/A | N/A
57112 | VAGNC COMPL RMVL VAG WALL TOT PEL LMPHADEC BX | 2011-07-01 00:00:00 | 1320.47 | N | Y | N/A | N/A
57120 | COLPOCLEISIS LE FORT TYPE | 2011-07-01 00:00:00 | 437.02 | N | Y | N/A | N/A
57130 | EXCISION VAGINAL SEPTUM | 2011-07-01 00:00:00 | 152.47 | N | Y | N/A | N/A
57135 | EXCISION VAGINAL CYST/TUMOR | 2011-07-01 00:00:00 | 163.79 | N | Y | N/A | N/A
57150 | IRRIGATION VAGINA&/APPL MEDICAMENT TX DISEASE | 2011-07-01 00:00:00 | 40.71 | N | Y | N/A | N/A
57155 | INSERTION UTERINE TANDEM&/VAGINAL OVOIDS | 2011-07-01 00:00:00 | 281.03 | N | Y | N/A | N/A
57156 | INSERTION VAGINAL RADIATION DEVICE | 2011-07-01 00:00:00 | 128.61 | N | Y | N/A | N/A
57160 | FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVICE | 2011-07-01 00:00:00 | 65.42 | N | Y | N/A | N/A
57170 | DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS | 2011-07-01 00:00:00 | 55.36 | N | N | N/A | N/A
57180 | INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX | 2011-07-01 00:00:00 | 120.31 | N | Y | N/A | N/A
57200 | COLPORRHAPHY SUTURE INJURY VAGINA | 2011-07-01 00:00:00 | 254.27 | N | Y | N/A | N/A
57210 | COLPOPERINEORRHAPHY SUTURE INJ VAGINA&/PERINEUM | 2011-07-01 00:00:00 | 312.79 | N | Y | N/A | N/A
57220 | PLASTIC URETHRAL SPHINCTER VAGINAL APPROACH | 2011-07-01 00:00:00 | 273.61 | N | Y | N/A | N/A
57230 | PLASTIC REPAIR URETHROCELE | 2011-07-01 00:00:00 | 341.81 | N | Y | N/A | N/A
57240 | ANT COLPORRHAPHY CYSTOCELE W/WO RPR URETHROCELE | 2011-07-01 00:00:00 | 572.21 | N | Y | N/A | N/A
57250 | POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY | 2011-07-01 00:00:00 | 571.63 | N | Y | N/A | N/A
57260 | COMBINED ANTEROPOSTERIOR COLPORRHAPHY | 2011-07-01 00:00:00 | 706.25 | N | Y | N/A | N/A
57265 | [NAME] | 2011-07-01 00:00:00 | 778.35 | N | Y | N/A | N/A
57267 | INSJ MESH/PROSTH PELVIC FLOOR DEFECT EACH SITE | 2011-07-01 00:00:00 | 223.24 | N | Y | N/A | N/A
57268 | REPAIR ENTEROCELE VAGINAL APPROACH SPX | 2011-07-01 00:00:00 | 411.71 | N | Y | N/A | N/A
57270 | REPAIR ENTEROCELE ABDOMINAL APPROACH SPX | 2011-07-01 00:00:00 | 681.99 | N | Y | N/A | N/A
57280 | COLPOPEXY ABDOMINAL APPROACH | 2011-07-01 00:00:00 | 820.6 | N | Y | N/A | N/A
57282 | COLPOPEXY VAGINAL EXTRAPERITONEAL APPROACH | 2011-07-01 00:00:00 | 430.34 | N | Y | N/A | N/A
57283 | COLPOPEXY VAGINAL INTRAPERITONEAL APPROACH | 2011-07-01 00:00:00 | 591.12 | N | Y | N/A | N/A
57284 | PARAVAGINAL DEFECT REPAIR OPEN ABDOMINAL APPR | 2011-07-01 00:00:00 | 706.09 | N | Y | N/A | N/A
57285 | PARAVAGINAL DEFECT REPAIR VAGINAL APPROACH | 2011-07-01 00:00:00 | 580.84 | N | Y | N/A | N/A
57287 | RMVL/REVJ SLING STRESS INCONTINENCE | 2011-07-01 00:00:00 | 592.16 | N | Y | N/A | N/A
57288 | SLING OPERATION STRESS INCONTINENCE | 2011-07-01 00:00:00 | 614.71 | N | Y | N/A | N/A
57289 | PEREYRA PX W/ANTERIOR COLPORRHAPHY | 2011-07-01 00:00:00 | 634.84 | N | Y | N/A | N/A
57295 | REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP | 2011-07-01 00:00:00 | 413.81 | N | Y | N/A | N/A
57296 | REVJ W/RMVL PROSTHETIC VAGINAL GRAFT ABDML APPR | 2011-07-01 00:00:00 | 812.98 | N | Y | N/A | N/A
57300 | CLSR RECTOVAGINAL FISTULA VAGINAL/TRANSANAL APPR | 2011-07-01 00:00:00 | 466.23 | N | Y | N/A | N/A
57305 | CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH | 2011-07-01 00:00:00 | 773.65 | N | Y | N/A | N/A
57307 | CLSR RECTOVAG FSTL ABDL APPR W/CONCOMITANT CLST | 2011-07-01 00:00:00 | 874.7 | N | Y | N/A | N/A
57308 | CLSR RECTOVAG FSTL TPRNL PRNL BDY RCNSTJ | 2011-07-01 00:00:00 | 551.68 | N | Y | N/A | N/A
57310 | CLOSURE URETHROVAGINAL FISTULA | 2011-07-01 00:00:00 | 404.71 | N | Y | N/A | N/A
57311 | CLSR URETHROVAG FSTL W/BULBOCAVERNOSUS TRNSPL | 2011-07-01 00:00:00 | 460.8 | N | Y | N/A | N/A
57320 | CLOSURE VESICOVAGINAL FISTULA VAGINAL APPROACH | 2011-07-01 00:00:00 | 465.8 | N | Y | N/A | N/A
57330 | CLSR VESICOVAG FSTL TRANSVESICAL&VAG APPR | 2011-07-01 00:00:00 | 648.95 | N | Y | N/A | N/A
57335 | VAGINOPLASTY INTERSEX STATE | 2011-07-01 00:00:00 | 996.46 | N | Y | N/A | N/A
57400 | DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL | 2011-07-01 00:00:00 | 114.7 | N | Y | N/A | N/A
57410 | PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL | 2011-07-01 00:00:00 | 91.46 | N | Y | N/A | N/A
57415 | REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL | 2011-07-01 00:00:00 | 136.83 | N | Y | N/A | N/A
57420 | COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT | 2011-07-01 00:00:00 | 98.46 | N | Y | N/A | N/A
57421 | COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX | 2011-07-01 00:00:00 | 132.57 | N | Y | N/A | N/A
57423 | PARAVAGINAL DEFECT REPAIR LAPAROSCOPIC APPROACH | 2011-07-01 00:00:00 | 788.14 | N | Y | N/A | N/A
57425 | [NAME] SUSPENSION VAGINAL APEX | 2011-07-01 00:00:00 | 831.88 | N | Y | N/A | N/A
57426 | REVISE PROSTH VAG GRAFT LAP | 2011-07-01 00:00:00 | 719.34 | N | Y | N/A | N/A
57452 | COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA | 2011-07-01 00:00:00 | 92.46 | N | Y | N/A | N/A
57454 | COLPOSCOPY CERVIX BX CERVIX&ENDOCRV CURTG | 2011-07-01 00:00:00 | 130.95 | N | Y | N/A | N/A
57455 | COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX | 2011-07-01 00:00:00 | 121.7 | N | Y | N/A | N/A
57456 | COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE | 2011-07-01 00:00:00 | 115.05 | N | Y | N/A | N/A
57460 | COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX | 2011-07-01 00:00:00 | 247.76 | N | Y | N/A | N/A
57461 | COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX | 2011-07-01 00:00:00 | 278.7 | N | Y | N/A | N/A
57500 | BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX | 2011-07-01 00:00:00 | 110.84 | N | Y | N/A | N/A
57505 | ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE | 2011-07-01 00:00:00 | 86.6 | N | Y | N/A | N/A
57510 | CAUTERY CERVIX ELECTRO/THERMAL | 2011-07-01 00:00:00 | 112.26 | N | Y | N/A | N/A
57511 | CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT | 2011-07-01 00:00:00 | 123.94 | N | Y | N/A | N/A
57513 | CAUTERY CERVIX LASER ABLATION | 2011-07-01 00:00:00 | 122.5 | N | Y | N/A | N/A
57520 | CONIZATION CERVIX +-D&C RPR KNIFE/LASER | 2011-07-01 00:00:00 | 260.7 | N | Y | N/A | N/A
57522 | CONIZATION CERVIX +-D&C RPR ELTRD EXC | 2011-07-01 00:00:00 | 224.75 | N | Y | N/A | N/A
57530 | TRACHELECTOMY CERVICECTOMY AMP CERVIX SPX | 2011-07-01 00:00:00 | 293.73 | N | Y | N/A | N/A
57531 | RAD TRACHELECTOMY W/BI PEL LMPHADEC | 2011-07-01 00:00:00 | 1460.52 | N | Y | N/A | N/A
57540 | EXCISION CERVICAL STUMP ABDOMINAL APPROACH | 2011-07-01 00:00:00 | 665.13 | N | Y | N/A | N/A
57545 | EXC CERVICAL STUMP ABDL APPR W/PELVIC FLOOR RPR | 2011-07-01 00:00:00 | 702.09 | N | Y | N/A | N/A
57550 | EXCISION CERVICAL STUMP VAGINAL APPROACH | 2011-07-01 00:00:00 | 348.58 | N | Y | N/A | N/A
57555 | EXC CRV [NAME]/ANT&/POST RPR | 2011-07-01 00:00:00 | 512.63 | N | Y | N/A | N/A
57556 | EXC CRV [NAME] | 2011-07-01 00:00:00 | 485.63 | N | Y | N/A | N/A
57558 | DILATION & CURETTAGE CERVICAL STUMP | 2011-07-01 00:00:00 | 106.69 | N | Y | N/A | N/A
57700 | CERCLAGE UTERINE CERVIX NONOBSTETRICAL | 2011-07-01 00:00:00 | 265.28 | N | Y | N/A | N/A
57720 | TRACHELORRHAPHY PLSTC RPR UTERINE CERVIX VAG | 2011-07-01 00:00:00 | 262.4 | N | Y | N/A | N/A
57800 | [NAME] | 2011-07-01 00:00:00 | 51.02 | N | Y | N/A | N/A
58100 | ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX | 2011-07-01 00:00:00 | 93.43 | N | Y | N/A | N/A
58110 | ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY | 2011-07-01 00:00:00 | 41.22 | N | Y | N/A | N/A
58120 | DILATION & CURETTAGE DX&/THER NONOBSTETRICAL | 2011-07-01 00:00:00 | 216.18 | N | Y | N/A | N/A
58140 | MYOMECTOMY 1-4 MYOMAS W/250 GM/LT ABDOMINAL APPR | 2011-07-01 00:00:00 | 781.53 | N | Y | N/A | N/A
58145 | MYOMECTOMY 1-4 MYOMAS 250 GM/LT VAGINAL APPR | 2011-07-01 00:00:00 | 463.92 | N | Y | N/A | N/A
58146 | MYOMECTOMY 5/GT MYOMAS &/GT250 GM ABDOMINAL APPR | 2011-07-01 00:00:00 | 988.09 | N | Y | N/A | N/A
58150 | TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY | 2011-07-01 00:00:00 | 848.05 | Y | Y | N/A | N/A
58152 | TOT ABD HYST W/WO RMVL TUBE OVARY W/COLPURETHRXY | 2011-07-01 00:00:00 | 1064.32 | Y | Y | N/A | N/A
58180 | SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY | 2011-07-01 00:00:00 | 815.53 | Y | Y | N/A | N/A
58200 | TOT ABD HYST W/PARAORTIC&PELVIC [NAME] SAMPL | 2011-07-01 00:00:00 | 1118.13 | Y | Y | N/A | N/A
58210 | [NAME] LMPHADENECTOMY | 2011-07-01 00:00:00 | 1493.55 | Y | Y | N/A | N/A
58240 | PEL EXNTJ GYNECOLOGIC MAL | 2011-07-01 00:00:00 | 2370.72 | N | Y | N/A | N/A
58260 | VAGINAL HYSTERECTOMY UTERUS 250 GM/LT | 2011-07-01 00:00:00 | 706.45 | Y | Y | N/A | N/A
58262 | VAG HYST 250 GM/LT W/RMVL TUBE&/OVARY | 2011-07-01 00:00:00 | 787.94 | Y | Y | N/A | N/A
58263 | VAG HYST 250 GM/LT W/RMVL TUBE OVARY W/RPR NTRCL | 2011-07-01 00:00:00 | 847.67 | Y | Y | N/A | N/A
58267 | VAG HYST 250 GM/LT W/COLPO-URTCSTOPEXY | 2011-07-01 00:00:00 | 901.48 | Y | Y | N/A | N/A
58270 | VAGINAL HYSTERECTOMY 250 GM/LT W/RPR ENTEROCELE | 2011-07-01 00:00:00 | 753.59 | Y | Y | N/A | N/A
58275 | VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY | 2011-07-01 00:00:00 | 840.23 | Y | Y | N/A | N/A
58280 | VAG HYSTER W/TOT/PRTL VAGINECT W/RPR ENTEROCELE | 2011-07-01 00:00:00 | 898.99 | Y | Y | N/A | N/A
58285 | VAGINAL HYSTERECTOMY RADICAL SCHAUTA OPERATION | 2011-07-01 00:00:00 | 1121.91 | Y | Y | N/A | N/A
58290 | VAGINAL HYSTERECTOMY UTERUS GT 250 GM | 2011-07-01 00:00:00 | 984.62 | Y | Y | N/A | N/A
58291 | VAG HYST GT 250 GM RMVL TUBE&/OVARY | 2011-07-01 00:00:00 | 1067.96 | Y | Y | N/A | N/A
58292 | VAG HYST GT 250 GM RMVL TUBE&/OVARY W/RPR NTRCL | 2011-07-01 00:00:00 | 1125.61 | Y | Y | N/A | N/A
58293 | VAG HYST [NAME] COLPOURTCSTOPEXY W/WO NDSC CTRL | 2011-07-01 00:00:00 | 1169.69 | Y | Y | N/A | N/A
58294 | VAGINAL HYSTERECTOMY GT250 GM RPR ENTEROCELE | 2011-07-01 00:00:00 | 1041.91 | Y | Y | N/A | N/A
58300 | INSERTION INTRAUTERINE DEVICE IUD | 2008-07-01 00:00:00 | 59.4 | N | N | N/A | N/A
58301 | REMOVAL INTRAUTERINE DEVICE IUD | 2011-07-01 00:00:00 | 81.61 | N | N | N/A | N/A
58340 | CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPING | 2011-07-01 00:00:00 | 104.56 | N | Y | N/A | N/A
58346 | INSERTION HEYMAN CAPSULES CLINICAL BRACHYTHERAPY | 2011-07-01 00:00:00 | 378.59 | N | Y | N/A | N/A
58353 | ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GID | 2011-07-01 00:00:00 | 916.34 | N | Y | N/A | N/A
58356 | ENDOMETRIAL CRYOABLATION W/US & ENDOMETRIAL CRTG | 2011-07-01 00:00:00 | 1697.92 | N | Y | N/A | N/A
58400 | UTERINE SUSPENSION W/WO SHORTENING LIGAMENTS SPX | 2011-07-01 00:00:00 | 378.23 | N | Y | N/A | N/A
58410 | UTERINE SUSP W/WO SHORT LIGAMNTS W/SYMPATHECTOMY | 2011-07-01 00:00:00 | 686.45 | N | Y | N/A | N/A
58520 | HYSTERORRHAPHY REPAIR RUPT UTERUS NONOBSTETRICAL | 2011-07-01 00:00:00 | 681.5 | N | Y | N/A | N/A
58540 | HYSTEROPLASTY RPR UTERINE ANOMALY | 2011-07-01 00:00:00 | 775.31 | N | Y | N/A | N/A
58541 | [NAME] 250 GM/LT | 2011-07-01 00:00:00 | 734.47 | Y | Y | N/A | N/A
58542 | LAPS SUPRACRV HYSTERECT 250 GM/LT RMVL TUBE/OVARY | 2011-07-01 00:00:00 | 820.07 | Y | Y | N/A | N/A
58543 | LAPS SUPRACERVICAL HYSTERECTOMY GT250 | 2011-07-01 00:00:00 | 834.06 | Y | Y | N/A | N/A
58544 | LAPS SUPRACRV HYSTEREC [NAME] TUBE/OVARY | 2011-07-01 00:00:00 | 901.49 | Y | Y | N/A | N/A
58545 | LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/[NAME] | 2011-07-01 00:00:00 | 763.56 | N | Y | N/A | N/A
58546 | LAPS MYOMECTOMY EXC 5/GT MYOMAS [NAME] | 2011-07-01 00:00:00 | 964.03 | N | Y | N/A | N/A
58548 | LAPS W/RAD HYST W/BILAT LMPHADEC RMVL TUBE/OVARY | 2011-07-01 00:00:00 | 1524.22 | Y | Y | N/A | N/A
58550 | LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/[NAME] | 2011-07-01 00:00:00 | 753.93 | Y | Y | N/A | N/A
58552 | LAPS W/VAG HYSTERECT 250 GM/LT RMVL TUBE&/OVARY | 2011-07-01 00:00:00 | 836.33 | Y | Y | N/A | N/A
58553 | LAPS W/VAGINAL HYSTERECTOMY GT 250 GRAMS | 2011-07-01 00:00:00 | 969.89 | Y | Y | N/A | N/A
58554 | LAPS VAGINAL HYSTERECT GT 250 GM RMVL TUBE&/OVARY | 2011-07-01 00:00:00 | 1121.73 | Y | Y | N/A | N/A
58555 | HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 229.85 | N | Y | N/A | N/A
58558 | HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C | 2011-07-01 00:00:00 | 304.85 | N | Y | N/A | N/A
58559 | HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS | 2011-07-01 00:00:00 | 293.81 | N | Y | N/A | N/A
58560 | HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM | 2011-07-01 00:00:00 | 331.85 | N | Y | N/A | N/A
58561 | HYSTEROSCOPY REMOVAL LEIOMYOMATA | 2011-07-01 00:00:00 | 469.36 | N | Y | N/A | N/A
58562 | HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY | 2011-07-01 00:00:00 | 318.69 | N | Y | N/A | N/A
58563 | HYSTEROSCOPY ENDOMETRIAL ABLATION | 2011-07-01 00:00:00 | 1499.72 | N | Y | N/A | N/A
58565 | HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS | 2011-07-01 00:00:00 | 1632.63 | N | Y | N/A | N/A
58570 | [NAME] TOTAL HYSTERECTOMY UTERUS 250 GM/LT | 2011-07-01 00:00:00 | 789.28 | Y | Y | N/A | N/A
58571 | LAPS TOTAL HYSTERECT 250 GM/LT W/RMVL TUBE/OVARY | 2011-07-01 00:00:00 | 874.16 | Y | Y | N/A | N/A
58572 | [NAME] | 2011-07-01 00:00:00 | 980.9 | Y | Y | N/A | N/A
58573 | LAPAROSCOPY TOT HYSTERECTOMY [NAME]OVARY | 2011-07-01 00:00:00 | 1119.88 | Y | Y | N/A | N/A
58578 | [NAME] PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
58579 | HYSTEROSCOPY UNLISTED UTERUS PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
58600 | LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI | 2011-07-01 00:00:00 | 310.84 | N | N | N/A | N/A
58605 | LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX | 2011-07-01 00:00:00 | 281.23 | N | N | N/A | N/A
58611 | LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG | 2011-07-01 00:00:00 | 66.41 | N | N | N/A | N/A
58615 | OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR | 2011-07-01 00:00:00 | 210.35 | N | N | N/A | N/A
58660 | LAPAROSCOPY W/LYSIS OF ADHESIONS | 2011-07-01 00:00:00 | 572.62 | N | Y | N/A | N/A
58661 | LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES | 2011-07-01 00:00:00 | 548.94 | N | Y | N/A | N/A
58662 | LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE | 2011-07-01 00:00:00 | 601.52 | N | Y | N/A | N/A
58670 | [NAME] | 2011-07-01 00:00:00 | 312 | N | Y | N/A | N/A
58671 | LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS | 2011-07-01 00:00:00 | 311.72 | N | Y | N/A | N/A
58672 | [NAME] | 2011-07-01 00:00:00 | 629.27 | N | Y | N/A | N/A
58673 | [NAME] | 2011-07-01 00:00:00 | 684.68 | N | Y | N/A | N/A
58679 | [NAME] OVIDUCT/OVARY PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
58700 | SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX | 2011-07-01 00:00:00 | 656.72 | N | N | N/A | N/A
58720 | SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX | 2011-07-01 00:00:00 | 613.6 | N | Y | N/A | N/A
58740 | LYSIS OF ADHESIONS SALPINX/OVARY | 2011-07-01 00:00:00 | 745.46 | N | Y | N/A | N/A
58770 | [NAME] | 2011-07-01 00:00:00 | 722.25 | N | Y | N/A | N/A
58800 | DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR | 2011-07-01 00:00:00 | 273.37 | N | Y | N/A | N/A
58805 | DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL | 2011-07-01 00:00:00 | 343.99 | N | Y | N/A | N/A
58820 | DRAINAGE OVARIAN ABSCESS VAGINAL APPR OPEN | 2011-07-01 00:00:00 | 278.18 | N | Y | N/A | N/A
58822 | DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH | 2011-07-01 00:00:00 | 611.1 | N | Y | N/A | N/A
58825 | TRANSPOSITION OVARY | 2011-07-01 00:00:00 | 597.97 | N | Y | N/A | N/A
58900 | BIOPSY OVARY UNI/BI SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 368.74 | N | Y | N/A | N/A
58920 | WEDGE RESCJ/BISCTJ OVARY UNI/BI | 2011-07-01 00:00:00 | 596.77 | N | Y | N/A | N/A
58925 | OVARIAN CYSTECTOMY UNI/BI | 2011-07-01 00:00:00 | 628.16 | N | Y | N/A | N/A
58940 | OOPHORECTOMY PARTIAL/TOTAL UNI/BI | 2011-07-01 00:00:00 | 436.02 | N | Y | N/A | N/A
58943 | OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY | 2011-07-01 00:00:00 | 958.07 | N | Y | N/A | N/A
58950 | RESCJ OVARIAN/TUBAL/PERITONEAL MALIGNANCY W/BSO | 2011-07-01 00:00:00 | 916.16 | N | Y | N/A | N/A
58951 | RESCJ PRIM PRTL MAL W/BSO&OMNTC TAH&LMPHADEC | 2011-07-01 00:00:00 | 1178.28 | Y | Y | N/A | N/A
58952 | RESCJ PRIM PRTL MAL W/BSO&OMNTC RAD DEBULKING | 2011-07-01 00:00:00 | 1329.46 | N | Y | N/A | N/A
58953 | BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION | 2011-07-01 00:00:00 | 1645.36 | Y | Y | N/A | N/A
58954 | BSO W/OMENTECTOMY TAH DEBULKING W/LMPHADECTOMY | 2011-07-01 00:00:00 | 1783.85 | Y | Y | N/A | N/A
58956 | BSO W/TOT OMENTECTOMY & HYSTERECTOMY MALIGNANCY | 2011-07-01 00:00:00 | 1123.97 | Y | Y | N/A | N/A
58957 | RESECJ RECUR OVARIAN/TUBAL/PERITONEAL MALIGNANCY | 2011-07-01 00:00:00 | 1279.34 | N | Y | N/A | N/A
58958 | RESECTION RECRT MAL W/OMENTECTOMY PEL LMPHADEC | 2011-07-01 00:00:00 | 1411.01 | N | Y | N/A | N/A
58960 | LAPT STG/RESTG OVARIAN TUBAL/PRIM MAL 2ND LOOK | 2011-07-01 00:00:00 | 788.33 | N | Y | N/A | N/A
58999 | UNLISTED PROCEDURE, FEMALE GENITAL SYSTEM, NON OB | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
59000 | AMNIOCENTESIS DIAGNOSIC | 2011-07-01 00:00:00 | 107.35 | N | Y | N/A | N/A
59001 | AMNIOCENTESISS THER AMNIOTIC FLUID RDCTJ US GID | 2011-07-01 00:00:00 | 153.78 | N | Y | N/A | N/A
59012 | CORDOCENTESIS INTRAUTERINE | 2011-07-01 00:00:00 | 171.24 | N | Y | N/A | N/A
59015 | CHORIONIC VILLUS SAMPLING | 2011-07-01 00:00:00 | 131.06 | N | Y | N/A | N/A
59020 | FETAL CONTRACTION STRESS TEST | 2011-07-01 00:00:00 | 58.05 | N | Y | 26.99 | 31.06
59025 | FETAL NONSTRESS TEST | 2011-07-01 00:00:00 | 39.53 | N | Y | 14.59 | 24.94
59030 | FETAL SCALP BLOOD SAMPLING | 2011-07-01 00:00:00 | 86.6 | N | Y | N/A | N/A
59050 | FETAL MONITORING LABOR PHYS WRTTN REPRT S&I | 2011-07-01 00:00:00 | 42.72 | N | Y | N/A | N/A
59051 | FETAL MONITR LABOR PHYS WRTTN REPRT INTERPJ ONLY | 2011-07-01 00:00:00 | 35.42 | N | Y | N/A | N/A
59070 | TRANSABDOMINAL AMNIOINFUSION W/ULTRSND GUIDANCE | 2011-07-01 00:00:00 | 353.89 | N | Y | N/A | N/A
59072 | FETAL UMBILICAL CORD OCCLUSION W/ULTRSND GUIDNCE | 2011-07-01 00:00:00 | 441.32 | N | Y | N/A | N/A
59074 | FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE | 2011-07-01 00:00:00 | 346.97 | N | Y | N/A | N/A
59076 | FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE | 2011-07-01 00:00:00 | 436.41 | N | Y | N/A | N/A
59100 | HYSTEROTOMY ABDOMINAL | 2011-07-01 00:00:00 | 698.04 | N | Y | N/A | N/A
59120 | [NAME] | 2011-07-01 00:00:00 | 667.14 | N | Y | N/A | N/A
59121 | TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY | 2011-07-01 00:00:00 | 668.02 | N | Y | N/A | N/A
59130 | [NAME] PREGNANCY ABDL PREGNANCY | 2011-07-01 00:00:00 | 721.38 | N | Y | N/A | N/A
59135 | TX ECTOPIC PREGNANCY NTRSTL REQ TOT HYST | 2011-07-01 00:00:00 | 721.04 | Y | Y | N/A | N/A
59136 | TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER | 2011-07-01 00:00:00 | 737.28 | N | Y | N/A | N/A
59140 | TX ECTOPIC PREGNANCY CERVICAL W/EVACUATION | 2011-07-01 00:00:00 | 311.65 | N | Y | N/A | N/A
59150 | LAPS [NAME] | 2011-07-01 00:00:00 | 645.35 | N | Y | N/A | N/A
59151 | LAPS [NAME]/SALPING&/OOPHORECTOMY | 2011-07-01 00:00:00 | 629.28 | N | Y | N/A | N/A
59160 | CURETTAGE POSTPARTUM | 2011-07-01 00:00:00 | 176.18 | N | Y | N/A | N/A
59200 | INSERTION CERVICAL DILATOR SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 61.63 | N | Y | N/A | N/A
59300 | EPISIOTOMY/VAG RPR OTH/THN ATTENDING PHYS | 2011-07-01 00:00:00 | 161.71 | N | Y | N/A | N/A
59320 | CERCLAGE CERVIX PREGNANCY VAGINAL | 2011-07-01 00:00:00 | 128.28 | N | Y | N/A | N/A
59325 | CERCLAGE CERVIX PREGNANCY ABDOMINAL | 2011-07-01 00:00:00 | 189.2 | N | Y | N/A | N/A
59350 | HYSTERORRHAPHY RUPTURED UTERUS | 2011-07-01 00:00:00 | 235.01 | N | Y | N/A | N/A
59400 | OB CARE ANTEPARTUM VAG DLVR&POSTPARTUM | 2011-07-01 00:00:00 | 1574.16 | N | Y | N/A | N/A
59409 | VAGINAL DELIVERY ONLY | 2011-07-01 00:00:00 | 616.46 | N | N | N/A | N/A
59410 | VAGINAL DELIVERY ONLY W/POSTPARTUM CARE | 2011-07-01 00:00:00 | 781.76 | N | Y | N/A | N/A
59412 | EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS | 2011-07-01 00:00:00 | 79.57 | N | Y | N/A | N/A
59414 | DELIVERY PLACENTA SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 69.95 | N | Y | N/A | N/A
59425 | ANTEPARTUM CARE ONLY 4-6 VISITS | 2011-07-01 00:00:00 | 351.52 | N | Y | N/A | N/A
59426 | ANTEPARTUM CARE ONLY 7/GT VISITS | 2011-07-01 00:00:00 | 629.02 | N | Y | N/A | N/A
59430 | POSTPARTUM CARE ONLY SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 130.82 | N | Y | N/A | N/A
59510 | OB ANTEPARTUM CARE CESAREAN DLVR&POSTPARTUM | 2011-07-01 00:00:00 | 1750.84 | N | Y | N/A | N/A
59514 | CESAREAN DELIVERY ONLY | 2011-07-01 00:00:00 | 698.82 | N | N | N/A | N/A
59515 | CESAREAN DELIVERY ONLY W/POSTPARTUM CARE | 2011-07-01 00:00:00 | 946.13 | N | Y | N/A | N/A
59525 | STOT/TOT HYSTERECTOMY AFTER CESAREN DELIVERY | 2011-07-01 00:00:00 | 408.76 | Y | Y | N/A | N/A
59610 | ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VBAC | 2011-07-01 00:00:00 | 1655.58 | N | Y | N/A | N/A
59612 | VAGINAL DELIVERY AFTER CESAREAN DELIVERY | 2011-07-01 00:00:00 | 693.4 | N | N | N/A | N/A
59614 | VAGINAL DELIVERY & POSTPARTUM CARE VBAC | 2011-07-01 00:00:00 | 853.74 | N | Y | N/A | N/A
59618 | ROUTINE OBSTETRICAL CARE ATTEMPTED VBAC | 2011-07-01 00:00:00 | 1782.59 | N | Y | N/A | N/A
59620 | CESAREAN DELIVERY ATTEMPTED VBAC | 2011-07-01 00:00:00 | 727.48 | N | N | N/A | N/A
59622 | CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBAC | 2011-07-01 00:00:00 | 979.95 | N | Y | N/A | N/A
59812 | [NAME] | 2011-07-01 00:00:00 | 266.06 | N | Y | N/A | N/A
59820 | TX MISSED ABORTION FIRST TRIMESTER SURGICAL | 2011-07-01 00:00:00 | 319.09 | N | Y | N/A | N/A
59821 | TX MISSED ABORTION SECOND TRIMESTER SURGICAL | 2011-07-01 00:00:00 | 321.79 | N | Y | N/A | N/A
59830 | TX SEPTIC ABORTION SURGICAL | 2011-07-01 00:00:00 | 366.93 | N | Y | N/A | N/A
59840 | INDUCED ABORTION DILATION AND CURETTAGE | 2011-07-01 00:00:00 | 181.01 | N | Y | N/A | N/A
59841 | INDUCED ABORTION DILATION & EVAUCATION | 2011-07-01 00:00:00 | 320.19 | N | Y | N/A | N/A
59850 | INDUCED ABORTION 1/GT AMNIOTIC INJX W/D&C/EVAC | 2011-07-01 00:00:00 | 300.92 | N | Y | N/A | N/A
59851 | INDUCE ABORT 1/GT AMNIOT NJXS DLVR FETUS D&C&EVAC | 2011-07-01 00:00:00 | 335.16 | N | Y | N/A | N/A
59852 | INDUCE ABORT 1/GT AMNIOT NJXS DLVR FETUS HYSTOTMY | 2011-07-01 00:00:00 | 435.29 | N | Y | N/A | N/A
59855 | INDUCED ABORT 1/GT VAG SUPPOSITORIES DLVR FETUS | 2011-07-01 00:00:00 | 348.94 | N | Y | N/A | N/A
59856 | INDUCED ABORT 1/GT VAG SUPP DLVR FETUS D&C&/EVAC | 2011-07-01 00:00:00 | 410.15 | N | Y | N/A | N/A
59857 | INDUCED ABORT 1/GT VAG SUPPOS DLVR FETUS HYSTOT | 2011-07-01 00:00:00 | 451.52 | N | Y | N/A | N/A
59866 | MULTIFETAL PREGNANCY REDUCTION | 2011-07-01 00:00:00 | 186.77 | Y | Y | N/A | N/A
59870 | UTERINE EVACUATION&CURETTAGE HYDATIDIFORM MOLE | 2011-07-01 00:00:00 | 398.03 | N | Y | N/A | N/A
59871 | REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA | 2011-07-01 00:00:00 | 112.72 | N | Y | N/A | N/A
59897 | UNLISTED FETAL INVASIVE PROCEDURE, INCLUDING ULTRASOUND GUIDANCE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
59898 | [NAME] | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
59899 | UNLISTED MATERNITY PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
60000 | I&D THYROGLOSSAL DUCT CYST INFECTED | 2011-07-01 00:00:00 | 138.27 | N | Y | N/A | N/A
60100 | BIOPSY THYROID PERCUTANEOUS CORE NEEDLE | 2011-07-01 00:00:00 | 96.07 | N | Y | N/A | N/A
60200 | [NAME]/ADENOMA THYROID/TRANSECTION ISTHMUS | 2011-07-01 00:00:00 | 556.44 | N | Y | N/A | N/A
60210 | PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY | 2011-07-01 00:00:00 | 593.57 | N | Y | N/A | N/A
60212 | PRTL THYROID LOBEC UNI W/CONTRATLAT STOT LOBEC | 2011-07-01 00:00:00 | 851.79 | N | Y | N/A | N/A
60220 | TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY | 2011-07-01 00:00:00 | 649.43 | N | Y | N/A | N/A
60225 | TOTAL THYROID LOBEC UNI W/CONTRALAT STOT LOBEC | 2011-07-01 00:00:00 | 780.45 | N | Y | N/A | N/A
60240 | THYROIDECTOMY TOTAL/COMPLETE | 2011-07-01 00:00:00 | 818.35 | N | Y | N/A | N/A
60252 | THYROIDECTOMY TOTAL/SUBTOTAL LMTD NECK DISSECT | 2011-07-01 00:00:00 | 1111.73 | N | Y | N/A | N/A
60254 | THYROIDECTOMY TOTAL/SUBTOTAL RAD NECK DISSECT | 2011-07-01 00:00:00 | 1431.57 | N | Y | N/A | N/A
60260 | THYROIDECTOMY RMVL REMAINING TISS FLWG PRTL RMVL | 2011-07-01 00:00:00 | 925.98 | N | Y | N/A | N/A
60270 | THYROIDECT W/SUBSTERNAL SPLIT/TRANSTHORACIC | 2011-07-01 00:00:00 | 1164.08 | N | Y | N/A | N/A
60271 | THYROIDECTOMY SUBSTERNAL CERVICAL APPROACH | 2011-07-01 00:00:00 | 894.22 | N | Y | N/A | N/A
60280 | EXCISION THYROGLOSSAL DUCT CYST/SINUS | 2011-07-01 00:00:00 | 378.09 | N | Y | N/A | N/A
60281 | EXCISION THYROGLOSSAL DUCT CYST/SINUS RECURRENT | 2011-07-01 00:00:00 | 504.76 | N | Y | N/A | N/A
60300 | ASPIRATION AND/OR INJECTION THYROID CYST | 2011-07-01 00:00:00 | 94.45 | N | Y | N/A | N/A
60500 | PARATHYROIDECTOMY/EXPLORATION PARATHYROIDS | 2011-07-01 00:00:00 | 853.24 | N | Y | N/A | N/A
60502 | PARATHYROIDECTOMY/EXPLOR PARATHYROIDS RE-EXPLOR | 2011-07-01 00:00:00 | 1071.13 | N | Y | N/A | N/A
60505 | PARATHYRDEC/EXPL PARATHYR MEDSTNL STERNAL/TTHRC | 2011-07-01 00:00:00 | 1171.9 | N | Y | N/A | N/A
60512 | PARATHYROID [NAME] ADD-ON | 2011-07-01 00:00:00 | 204.79 | N | Y | N/A | N/A
60520 | THYMECTOMY PRTL/TOT TRANSCERVICAL APPR SPX | 2011-07-01 00:00:00 | 869.17 | N | Y | N/A | N/A
60521 | THYMECTOMY PRTL/TOT W/O RAD MEDSTNL DSJ SPX | 2011-07-01 00:00:00 | 971.97 | N | Y | N/A | N/A
60522 | THYMECTOMY PRTL/TOT RAD MEDSTNL DSJ SPX | 2011-07-01 00:00:00 | 1177.97 | N | Y | N/A | N/A
60540 | ADRENALECTOMY W/EXPL W/WO BX ABDL/LMBR/DRSAL SPX | 2011-07-01 00:00:00 | 898.61 | N | Y | N/A | N/A
60545 | ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR | 2011-07-01 00:00:00 | 1030.4 | N | Y | N/A | N/A
60600 | EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY | 2011-07-01 00:00:00 | 1218.82 | N | Y | N/A | N/A
60605 | EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY | 2011-07-01 00:00:00 | 1532.76 | N | Y | N/A | N/A
60650 | [NAME] ADRENALECTOMY PRTL/COMPL TABDL | 2011-07-01 00:00:00 | 1007.57 | N | Y | N/A | N/A
60659 | [NAME] ENDOCRINE PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
60699 | UNLISTED ENDOCRINE PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
61000 | SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT | 2011-07-01 00:00:00 | 92.86 | N | Y | N/A | N/A
61001 | SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI SBSQ | 2011-07-01 00:00:00 | 94.05 | N | Y | N/A | N/A
61020 | [NAME] PREVIOUS BURR HOLE W/O NJX | 2011-07-01 00:00:00 | 112.01 | N | Y | N/A | N/A
61026 | [NAME] PREVIOUS BURR HOLE W/INJ | 2011-07-01 00:00:00 | 106.48 | N | Y | N/A | N/A
61050 | CISTERNAL/LATERAL C1-C2 PUNCTURE W/O INJ SPX | 2011-07-01 00:00:00 | 89.22 | N | Y | N/A | N/A
61055 | CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION | 2011-07-01 00:00:00 | 115.71 | N | Y | N/A | N/A
61070 | PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX | 2011-07-01 00:00:00 | 69.93 | N | Y | N/A | N/A
61105 | TWIST DRILL HOLE SUBDURAL/VENTRICULAR PUNCTURE | 2011-07-01 00:00:00 | 369.79 | N | Y | N/A | N/A
61107 | TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE | 2011-07-01 00:00:00 | 260.42 | N | Y | N/A | N/A
61108 | TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA | 2011-07-01 00:00:00 | 731.41 | N | Y | N/A | N/A
61120 | BURR HOLE VENTRICULAR PUNCTURE | 2011-07-01 00:00:00 | 602.06 | N | Y | N/A | N/A
61140 | BURR HOLE/TREPHINE W/BX BRAIN/INTRACRNIAL LESION | 2011-07-01 00:00:00 | 1022.45 | N | Y | N/A | N/A
61150 | BURR HOLE/TREPHINE W/DRG BRAIN ABSCESS/CYST | 2011-07-01 00:00:00 | 1099.66 | N | Y | N/A | N/A
61151 | BURR HOLE/TREPHINE W/SBSQ TAPPING ICRA ABSC/CST | 2011-07-01 00:00:00 | 803 | N | Y | N/A | N/A
61154 | BURR HOLE W/EVAC&/DRG HEMATOMA XDRL/SDRL | 2011-07-01 00:00:00 | 1026.61 | N | Y | N/A | N/A
61156 | BURR HOLE W/ASPIR HEMATOMA/CYST INTRACEREBRAL | 2011-07-01 00:00:00 | 1014.21 | N | Y | N/A | N/A
61210 | BURR HOLE IMPLANT VENTRICULAR CATH/OTHER DEVICE | 2011-07-01 00:00:00 | 304.05 | N | Y | N/A | N/A
61215 | INSJ SUBQ RSVR PUMP/INFUSION SYSTEM VENTRIC CATH | 2011-07-01 00:00:00 | 405.12 | N | Y | N/A | N/A
61250 | BURR HOLE/TREPHINE SUPRATENTORIAL W/O OTH SURG | 2011-07-01 00:00:00 | 697.64 | N | Y | N/A | N/A
61253 | BURR HOLE/TREPHINE INFRATENTORIAL UNI/BI | 2011-07-01 00:00:00 | 718.08 | N | Y | N/A | N/A
61304 | CRANIECTOMY/CRANIOTOMY EXPL SUPRATENTORIAL | 2011-07-01 00:00:00 | 1337.94 | N | Y | N/A | N/A
61305 | CRANIECTOMY/CRANIOTOMY EXPL INFRATENTORIAL | 2011-07-01 00:00:00 | 1636.62 | N | Y | N/A | N/A
61312 | CRANIECTOMY HMTMA SUPRATENTORIAL EXTRA/SUBDURAL | 2011-07-01 00:00:00 | 1693.49 | N | Y | N/A | N/A
61313 | CRANIECTOMY HMTMA SUPRATENTORIAL INTRACEREBRAL | 2011-07-01 00:00:00 | 1612.55 | N | Y | N/A | N/A
61314 | CRANIECTOMY HMTMA INFRATENTORIAL EXTRA/SUBDURAL | 2011-07-01 00:00:00 | 1485.58 | N | Y | N/A | N/A
61315 | CRANIECTOMY HMTMA SUPRATENTORIAL INTRACEREBRAL | 2011-07-01 00:00:00 | 1685.98 | N | Y | N/A | N/A
61316 | INCISION & SUBCUTANEOUS PLMT CRANIAL BONE GRAFT | 2011-07-01 00:00:00 | 72.13 | N | Y | N/A | N/A
61320 | CRANIECTOMY/CRANIOTMY DRG ABSCESS SUPRATENTORIAL | 2011-07-01 00:00:00 | 1552.66 | N | Y | N/A | N/A
61321 | CRANIECTOMY/CRANIOTMY DRG ABSCESS INFRATENTORIAL | 2011-07-01 00:00:00 | 1726.09 | N | Y | N/A | N/A
61322 | CRANIECT/CRANIOT W/WO DURAPLASTY W/O LOBECTOMY | 2011-07-01 00:00:00 | 1923.21 | N | Y | N/A | N/A
61323 | CRANIECT/CRANIOT W/WO DURAPLASTY W/LOBECTOMY | 2011-07-01 00:00:00 | 1944.14 | N | Y | N/A | N/A
61330 | DECOMPRESSION ORBIT ONLY TRANSCRANIAL APPROACH | 2011-07-01 00:00:00 | 1436.69 | N | Y | N/A | N/A
61332 | EXPLORATION ORBIT TRANSCRANIAL APPROACH W/BIOPSY | 2011-07-01 00:00:00 | 1598.72 | N | Y | N/A | N/A
61333 | EXPL ORBIT TRANSCRANIAL APPROACH W/RMVL LESION | 2011-07-01 00:00:00 | 1668.28 | N | Y | N/A | N/A
61334 | EXPL ORBIT TRANSCRANIAL W/RMVL FOREIGN BODY | 2011-07-01 00:00:00 | 1091.52 | N | Y | N/A | N/A
61340 | SUBTEMPORAL CRANIAL DECOMPRESSION | 2011-07-01 00:00:00 | 1171.63 | N | Y | N/A | N/A
61343 | CRNEC SUBOCCIPITAL CRV LAM DCMPRN MEDULLA & CORD | 2011-07-01 00:00:00 | 1791.86 | N | Y | N/A | N/A
61345 | OTHER CRANIAL DECOMPRESSION POSTERIOR FOSSA | 2011-07-01 00:00:00 | 1663.25 | N | Y | N/A | N/A
61440 | CRANIOTOMY SECTION TENTORIUM CEREBELLI SPX | 2011-07-01 00:00:00 | 1630.89 | N | Y | N/A | N/A
61450 | CRNEC STPL SCTJ COMPRESSION/DCMPRN GANGLION | 2011-07-01 00:00:00 | 1564.14 | N | Y | N/A | N/A
61458 | CRNEC SOPL EXPL/DCMPRN CRNL NRV | 2011-07-01 00:00:00 | 1638.18 | N | Y | N/A | N/A
61460 | CRANIECTOMY SUBOCCIPITAL SECTION 1/GT CRANIAL NRV | 2011-07-01 00:00:00 | 1704.46 | N | Y | N/A | N/A
61470 | CRANIECTOMY SUBOCCIPITAL MEDULLARY TRACTOTOMY | 2011-07-01 00:00:00 | 1563.21 | N | Y | N/A | N/A
61480 | CRNEC SUBOCPTL MESENCEPHAL TRCOTOMY/PEDUNCULOTMY | 2011-07-01 00:00:00 | 1316.37 | N | Y | N/A | N/A
61490 | CRANIOTOMY LOBOTOMY W/CINGULOTOMY | 2011-07-01 00:00:00 | 1545.71 | N | Y | N/A | N/A
61500 | CRANIECTOMY W/EXCISION TUMOR/LESION SKULL | 2011-07-01 00:00:00 | 1101.39 | N | Y | N/A | N/A
61501 | CRANIECTOMY OSTEOMYELITIS | 2011-07-01 00:00:00 | 950.17 | N | Y | N/A | N/A
61510 | CRANIEC TREPHINE BONE FLP BRAIN TUMOR SUPRTENTOR | 2011-07-01 00:00:00 | 1777.2 | N | Y | N/A | N/A
61512 | CRNEC TREPHINE BONE FLAP MENINGIOMA SUPRATENTOR | 2011-07-01 00:00:00 | 2081.95 | N | Y | N/A | N/A
61514 | CRNEC TREPHINE BONE FLAP BRAIN ABSC SUPRATENTOR | 2011-07-01 00:00:00 | 1549.68 | N | Y | N/A | N/A
61516 | CRNEC TREPHINE BONE FLAP FENEST CYST SUPRATENTOR | 2011-07-01 00:00:00 | 1511.43 | N | Y | N/A | N/A
61517 | IMPLTJ BRAIN INTRACAVITARY CHEMOTHERAPY AGENT | 2011-07-01 00:00:00 | 71.82 | N | Y | N/A | N/A
61518 | CRNEC [NAME] INFRATENTORIAL/POST FOSSA | 2011-07-01 00:00:00 | 2248.18 | N | Y | N/A | N/A
61519 | CRNEC EXC TUM INFRATENTOR/POST FOSSA MENINGIOMA | 2011-07-01 00:00:00 | 2409.83 | N | Y | N/A | N/A
61520 | CRNEC TUM INFRATTL/POSTFOSSA CRBLOPNT ANGLE TUM | 2011-07-01 00:00:00 | 3097.28 | N | Y | N/A | N/A
61521 | CRNEC TUM INFRATTL/PFOSSA MIDLINE TUM BASE SKULL | 2011-07-01 00:00:00 | 2598.31 | N | Y | N/A | N/A
61522 | CRNEC INFRATNTORIAL/POST FOSSA EXC BRAIN ABSCESS | 2011-07-01 00:00:00 | 1785.02 | N | Y | N/A | N/A
61524 | CRNEC INFRATNTOR/POSTFOSSA EXC/FENESTRATION CYST | 2011-07-01 00:00:00 | 1693.28 | N | Y | N/A | N/A
61526 | CRNEC TRANSTEMPOR [NAME] ANGLE TUM | 2011-07-01 00:00:00 | 2959.2 | N | Y | N/A | N/A
61530 | CRNEC EXC CEREBELLOPNTIN ANGLE TUM MID/POSTFOSSA | 2011-07-01 00:00:00 | 2501.6 | N | Y | N/A | N/A
61531 | SUBDURAL IMPLTJ ELECTRODES SEIZURE MONITORING | 2011-07-01 00:00:00 | 991.22 | N | Y | N/A | N/A
61533 | CRANIOT SUBDURAL IMPLT [NAME] | 2011-07-01 00:00:00 | 1239.7 | N | Y | N/A | N/A
61534 | CRANIOT EPILEPTOGENIC FOC W/O ELECTRCORTICOGRPHY | 2011-07-01 00:00:00 | 1338.3 | N | Y | N/A | N/A
61535 | CRANIOT RMVL EPID/SUBDURL ELCTRD W/O EXC TIS SPX | 2011-07-01 00:00:00 | 809.07 | N | Y | N/A | N/A
61536 | CRANIOT EPILEPTOGENIC FOCUS W/ELECTROCORTCOGRPHY | 2011-07-01 00:00:00 | 2109.71 | N | Y | N/A | N/A
61537 | CRANIOT TEMPORAL LOBE W/O ELECTROCORTICOGRAPHY | 2011-07-01 00:00:00 | 1999.32 | N | Y | N/A | N/A
61538 | CRANIOT [NAME] | 2011-07-01 00:00:00 | 2161.7 | N | Y | N/A | N/A
61539 | CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/ECOG | 2011-07-01 00:00:00 | 1921.12 | N | Y | N/A | N/A
61540 | CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/O ECOG | 2011-07-01 00:00:00 | 1782.4 | N | Y | N/A | N/A
61541 | CRANIOTOMY TRANSECTION CORPUS CALLOSUM | 2011-07-01 00:00:00 | 1750.02 | N | Y | N/A | N/A
61542 | CRANIOTOMY TOTAL HEMISPHERECTOMY | 2011-07-01 00:00:00 | 1824.23 | N | Y | N/A | N/A
61543 | CRANIOTOMY PARTIAL/SUBTOTAL HEMISPHERECTOMY | 2011-07-01 00:00:00 | 1761.13 | N | Y | N/A | N/A
61544 | CRANIOTOMY EXCISION/COAGULATION CHOROID PLEXUS | 2011-07-01 00:00:00 | 1503.4 | N | Y | N/A | N/A
61545 | CRANIOTOMY EXCISION CRANIOPHARYNGIOMA | 2011-07-01 00:00:00 | 2594.7 | N | Y | N/A | N/A
61546 | CRANIOT HYPOPHYSEC/EXC PITUITARY TUMOR ICRL APPR | 2011-07-01 00:00:00 | 1879.92 | N | Y | N/A | N/A
61548 | HYPOPHYSEC/EXC PITUITARY TUM TRANSNASAL/SEPTAL | 2011-07-01 00:00:00 | 1290.07 | N | Y | N/A | N/A
61550 | CRANIECTOMY CRANIOSYNOSTOSIS 1 CRANIAL SUTURE | 2011-07-01 00:00:00 | 800.76 | N | Y | N/A | N/A
61552 | CRANIECT CRANIOSYNOSTOSIS MULT CRANIAL SUTURES | 2011-07-01 00:00:00 | 1017.29 | N | Y | N/A | N/A
61556 | CRANIEC CRANIOSYNOSTOSIS FRONT/PARIET BONE FLAP | 2011-07-01 00:00:00 | 1339.11 | N | Y | N/A | N/A
61557 | CRANIECTOMY CRANIOSYNOSTOSIS BIFRONTAL BONE FLAP | 2011-07-01 00:00:00 | 1371.6 | N | Y | N/A | N/A
61558 | XTN CRANIECT MULTIPLE SUTURE CRANIOSYNOSTOSIS | 2011-07-01 00:00:00 | 1442.95 | N | Y | N/A | N/A
61559 | [NAME] CRANIOSYNOSTOSIS W/BONE GRAFT | 2011-07-01 00:00:00 | 1783.73 | N | Y | N/A | N/A
61563 | [NAME] BENIGN TUM CRANIAL BONE W/O OPTIC NRV DCMPRN | 2011-07-01 00:00:00 | 1615.45 | N | Y | N/A | N/A
61564 | [NAME] BENIGN TUM CRANIAL BONE W/OPTIC NRV DCMPRN | 2011-07-01 00:00:00 | 1965.2 | N | Y | N/A | N/A
61566 | CRANIOTOMY SELECTIVE AMYGDALOHIPPOCAMPECTOMY | 2011-07-01 00:00:00 | 1838.92 | N | Y | N/A | N/A
61567 | CRANIOTOMY MULTIPLE SUBPIAL TRANSECTIONS W/ECOG | 2011-07-01 00:00:00 | 2098.78 | N | Y | N/A | N/A
61570 | CRANIECTOMY/CRANIOTOMY EXC FOREIGN BODY BRAIN | 2011-07-01 00:00:00 | 1513.91 | N | Y | N/A | N/A
61571 | CRANIECTOMY/CRANIOTOMY TX PENETRATNG WOUND BRAIN | 2011-07-01 00:00:00 | 1622.56 | N | Y | N/A | N/A
61575 | TRNSRAL SKULL BSE/BR STEM/CORD BX/DCOMPR/EXC LES | 2011-07-01 00:00:00 | 2025.08 | N | Y | N/A | N/A
61576 | TRNSRL SKUL BSE/BR STM/[NAME]/DCMP/ SPLT TONGUE | 2011-07-01 00:00:00 | 3029.19 | N | Y | N/A | N/A
61580 | CRANIOFACIAL ANT CRANIAL FOSSA W/O ORBITAL EXNTJ | 2011-07-01 00:00:00 | 2075.56 | N | Y | N/A | N/A
61581 | CRANIOFACIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ | 2011-07-01 00:00:00 | 2306.35 | N | Y | N/A | N/A
61582 | CRANFCL ANT CRANIAL FOSSA UNI/BI CRANIOT/OSTEOT | 2011-07-01 00:00:00 | 2437.17 | N | Y | N/A | N/A
61583 | CRANFCL ANT CRANIAL FOSSA UNI/BIFRNTL ELEV LOBE | 2011-07-01 00:00:00 | 2363.56 | N | Y | N/A | N/A
61584 | ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ | 2011-07-01 00:00:00 | 2324.23 | N | Y | N/A | N/A
61585 | ORBITOCRANIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ | 2011-07-01 00:00:00 | 2579.41 | N | Y | N/A | N/A
61586 | BICORONAL TRANSZYGMTC&/LEFORT I W/O BONE GRFT | 2011-07-01 00:00:00 | 1911.47 | N | Y | N/A | N/A
61590 | INFRATEMPORAL MID CRANIAL FOSSA W/WO DISARTICLTN | 2011-07-01 00:00:00 | 2610.47 | N | Y | N/A | N/A
61591 | INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBIL | 2011-07-01 00:00:00 | 2630.26 | N | Y | N/A | N/A
61592 | ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE | 2011-07-01 00:00:00 | 2588.17 | N | Y | N/A | N/A
61595 | TRANSTEMP APPR POST CRAN FOSSA DCOMPR SINUS/NRV | 2011-07-01 00:00:00 | 1988.13 | N | Y | N/A | N/A
61596 | TRANSCOCHLR POST CRNL FOSSA W/WO MOBIL NRV/ART | 2011-07-01 00:00:00 | 2144.88 | N | Y | N/A | N/A
61597 | TRNSCONDLR POST CRNL FOSSA DCOMPR ART W/WO MOBIL | 2011-07-01 00:00:00 | 2366.54 | N | Y | N/A | N/A
61598 | TRANSPTRSAL POST CRNL FOSSA CLIVUS/FORAMN MAGNUM | 2011-07-01 00:00:00 | 2235.07 | N | Y | N/A | N/A
61600 | RESCJ/EXC LES BASE ANT CRANIAL FOSSA EXTRADURAL | 2011-07-01 00:00:00 | 1796.38 | N | Y | N/A | N/A
61601 | RESCJ/EXC LES BASE ANT CRNL FOSSA INDRL W/WO GRF | 2011-07-01 00:00:00 | 1945.3 | N | Y | N/A | N/A
61605 | RESCJ/EXC LES INFRATEMPOR FOSSA SPACE APEX XDRL | 2011-07-01 00:00:00 | 1874.65 | N | Y | N/A | N/A
61606 | RESCJ/EXC LES ITPRL FOSSA SPACE APEX IDRL W/RPR | 2011-07-01 00:00:00 | 2462.27 | N | Y | N/A | N/A
61607 | RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB XDRL | 2011-07-01 00:00:00 | 2369.28 | N | Y | N/A | N/A
61608 | RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB IDRL | 2011-07-01 00:00:00 | 2650.06 | N | Y | N/A | N/A
61609 | TRNSXJ/LIGATION CAROTID ARTERY SINUS W/O REPAIR | 2011-07-01 00:00:00 | 491.96 | N | Y | N/A | N/A
61610 | TRNSXJ/LIG CAROTID ARTERY SINUS W/RPR ANAST/GRFT | 2011-07-01 00:00:00 | 1544.3 | N | Y | N/A | N/A
61611 | TRNSXJ/LIG CAROTID ARTERY PETROUS CANAL W/O RPR | 2011-07-01 00:00:00 | 338.05 | N | Y | N/A | N/A
61612 | TRNSXJ/LIG CRTD ART PETROUS CANAL RPR ANAST/GRF | 2011-07-01 00:00:00 | 1254.4 | N | Y | N/A | N/A
61613 | OBLTRJ CAROTID ARYSM ARTVEN CAROTID FISTULA DSJ | 2011-07-01 00:00:00 | 2659.24 | N | Y | N/A | N/A
61615 | RESCJ/EXC LES BASE POST CRNL FOSSA JUG FRMN XDRL | 2011-07-01 00:00:00 | 1990.6 | N | Y | N/A | N/A
61616 | RESCJ/EXC LES BASE PCF FORAMEN VRT BODIES IDRL | 2011-07-01 00:00:00 | 2724.87 | N | Y | N/A | N/A
61618 | SECONDARY RPR DURA CSF LEAK FREE TISSUE GRAFT | 2011-07-01 00:00:00 | 1070.2 | N | Y | N/A | N/A
61619 | SEC RPR [NAME] LEAK LOCAL/REGIONALIZED FLAP | 2011-07-01 00:00:00 | 1233.76 | N | Y | N/A | N/A
61623 | EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK | 2011-07-01 00:00:00 | 471.57 | N | Y | N/A | N/A
61624 | TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS | 2011-07-01 00:00:00 | 943.59 | N | Y | N/A | N/A
61626 | TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS | 2011-07-01 00:00:00 | 748.91 | N | Y | N/A | N/A
61640 | BALLOON DILATION OF INTRACRANIAL VASOPASM, PERCUTANEOUS, INITIAL VESSEL | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
61641 | BALLOON DILATION/ INTRACRANIAL VASOPASM, PERCUTANEOUS, EA ADD VESSEL ADD-ON | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
61642 | BALLOON DILATION OF INTRACRANIAL VASOPLASM, PERCUTANEOUS, EA (ADD-ON) | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
61680 | INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL SMPL | 2011-07-01 00:00:00 | 1845.56 | N | Y | N/A | N/A
61682 | INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL CMPL | 2011-07-01 00:00:00 | 3432.56 | N | Y | N/A | N/A
61684 | [NAME] | 2011-07-01 00:00:00 | 2313.47 | N | Y | N/A | N/A
61686 | [NAME] CMPL | 2011-07-01 00:00:00 | 3689.64 | N | Y | N/A | N/A
61690 | INTRACRANIAL ARVEN MALFRMJ DURAL SMPL | 2011-07-01 00:00:00 | 1779.58 | N | Y | N/A | N/A
61692 | INTRACRANIAL ARVEN MALFRMJ DURAL CMPL | 2011-07-01 00:00:00 | 2991.67 | N | Y | N/A | N/A
61697 | COMPLX INTRACRANIAL ARYSM CAROTID CIRCULATION | 2011-07-01 00:00:00 | 3445.65 | N | Y | N/A | N/A
61698 | CPLX INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ | 2011-07-01 00:00:00 | 3763.85 | N | Y | N/A | N/A
61700 | SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION | 2011-07-01 00:00:00 | 2804.12 | N | Y | N/A | N/A
61702 | SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ | 2011-07-01 00:00:00 | 3273.28 | N | Y | N/A | N/A
61703 | ICRA CRV APPL OCCLUDING CLAMP CRV CRTD ART | 2011-07-01 00:00:00 | 1106.16 | N | Y | N/A | N/A
61705 | ARYSM VASC MALFRMJ/CRTD-OCCLUSION CRTD ART | 2011-07-01 00:00:00 | 2110.52 | N | Y | N/A | N/A
61708 | ARYSM VASC MALFRMJ/ICRA ELECTROTHROMBOSIS | 2011-07-01 00:00:00 | 1785.13 | N | Y | N/A | N/A
61710 | ARYSM VASC MALFRMJ IA [NAME] | 2011-07-01 00:00:00 | 1564.23 | N | Y | N/A | N/A
61711 | ANAST [NAME] ARTERIES | 2011-07-01 00:00:00 | 2127.02 | N | Y | N/A | N/A
61720 | CRTJ LES STRTCTC BURR GLOBUS PALLIDUS/THALAMUS | 2011-07-01 00:00:00 | 1010.83 | N | Y | N/A | N/A
61735 | CRTJ LES STRTCTC BURR SUBCORTICAL STRUX OTH/THN | 2011-07-01 00:00:00 | 1230.3 | N | Y | N/A | N/A
61750 | STEREOTACTIC BX ASPIR/EXC BURR INTRACRANIAL LES | 2011-07-01 00:00:00 | 1144.81 | N | Y | N/A | N/A
61751 | STRTCTC BX ASPIR/EXC BURR ICRA LES W/CT&/MR | 2011-07-01 00:00:00 | 1117.96 | N | Y | N/A | N/A
61760 | STRTCTC IMPLTJ ELTRD CEREBRUM SEIZURE MONITORING | 2011-07-01 00:00:00 | 1272.65 | N | Y | N/A | N/A
61770 | STRTCTC LOCLZJ INSJ CATH/PRB PLMT RADJ SRC | 2011-07-01 00:00:00 | 1302.21 | N | Y | N/A | N/A
61781 | STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL | 2011-07-01 00:00:00 | 197.96 | N | Y | N/A | N/A
61782 | STRTCTC CPTR [NAME] CRANIAL | 2011-07-01 00:00:00 | 164.36 | N | Y | N/A | N/A
61783 | STEREOTACTIC COMPUTER ASSISTED PX SPINAL | 2011-07-01 00:00:00 | 197.96 | N | Y | N/A | N/A
61790 | CREATE LES STRTCTC PRQ NEUROLYTIC GASSERIAN | 2011-07-01 00:00:00 | 703.31 | N | Y | N/A | N/A
61791 | CREATE LES STRTCTC PRQ NEUROLYTIC TRIGEMINAL TRC | 2011-07-01 00:00:00 | 904.74 | N | Y | N/A | N/A
61796 | STEREOTACTIC RADIOSURGERY 1 SIMPLE CRANIAL LES | 2011-07-01 00:00:00 | 792.42 | N | Y | N/A | N/A
61797 | STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE | 2011-07-01 00:00:00 | 178.32 | N | Y | N/A | N/A
61798 | STEREOTACTIC RADIOSURGERY 1 COMPLEX CRANIAL LES | 2011-07-01 00:00:00 | 1055.77 | N | Y | N/A | N/A
61799 | STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX | 2011-07-01 00:00:00 | 246.12 | N | Y | N/A | N/A
61800 | APPL STRTCTC HEADFRAME STEREOTACTIC RADIOSURGERY | 2011-07-01 00:00:00 | 123.96 | N | Y | N/A | N/A
61850 | TWIST/BURR HOLE IMPLTJ NSTIM ELTRD CORTICAL | 2011-07-01 00:00:00 | 755.43 | N | Y | N/A | N/A
61860 | CRNEC/CRX IMPLTJ NSTIM ELTRD CERE CORTICAL | 2011-07-01 00:00:00 | 1276.04 | N | Y | N/A | N/A
61863 | STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD 1ST ARRAY | 2011-07-01 00:00:00 | 1221.79 | N | Y | N/A | N/A
61864 | STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD EA ARRAY | 2011-07-01 00:00:00 | 234.95 | N | Y | N/A | N/A
61867 | STRTCTC IMPLTJ NSTIM ELTRD W/RECORD 1ST ARRAY | 2011-07-01 00:00:00 | 1864.3 | N | Y | N/A | N/A
61868 | STRTCTC IMPLTJ NSTIM ELTRD W/RECORD EA ARRAY | 2011-07-01 00:00:00 | 413.82 | N | Y | N/A | N/A
61870 | CRNEC IMPLTJ NSTIM ELTRD CEREBELLAR CORTICAL | 2011-07-01 00:00:00 | 965.66 | N | Y | N/A | N/A
61875 | CRNEC IMPLTJ NSTIM ELTRD CEREBELLAR SUBCORTICAL | 2011-07-01 00:00:00 | 883.95 | N | Y | N/A | N/A
61880 | REVJ/RMVL INTRACRANIAL NEUROSTIMULATOR ELTRDS | 2011-07-01 00:00:00 | 455.09 | N | Y | N/A | N/A
61885 | INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR | 2011-07-01 00:00:00 | 445.84 | Y | Y | N/A | N/A
61886 | INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/GT ELTRDS | 2011-07-01 00:00:00 | 677.51 | N | Y | N/A | N/A
61888 | REVJ/RMVL NEUROSTIMULATOR PULSE GENERATOR | 2011-07-01 00:00:00 | 320.18 | N | Y | N/A | N/A
62000 | ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL | 2011-07-01 00:00:00 | 803.68 | N | Y | N/A | N/A
62005 | ELVTN DEPRS SKL FX COMPOUND/COMMIND XDRL | 2011-07-01 00:00:00 | 1026.99 | N | Y | N/A | N/A
62010 | ELVTN DEPRS SKL FX W/RPR DURA&/DBRDMT BRN | 2011-07-01 00:00:00 | 1241.09 | N | Y | N/A | N/A
62100 | CRX RPR DURAL/CSF LEAK RHINORRHEA/OTORRHEA | 2011-07-01 00:00:00 | 1317.44 | N | Y | N/A | N/A
62115 | RDCTJ CRANIOMEGALIC SKULL W/O GRAFT/CRANIOPLASTY | 2011-07-01 00:00:00 | 1062.52 | N | Y | N/A | N/A
62116 | RDCTJ CRANIOMEGALIC SKULL W/SIMPLE CRANIOPLASTY | 2011-07-01 00:00:00 | 1444.65 | N | Y | N/A | N/A
62117 | RDCTJ CRANIOMEGALIC CRANIO&RECNSTJ W/WO GRAFT | 2011-07-01 00:00:00 | 1490.91 | N | Y | N/A | N/A
62120 | RPR ENCEPHALOCELE SKULL VAULT W/CRANIOPLASTY | 2011-07-01 00:00:00 | 1462.53 | N | Y | N/A | N/A
62121 | CRANIOTOMY FOR ENCEPHALOCELE REPAIR SKULL BASE | 2011-07-01 00:00:00 | 1388.39 | N | Y | N/A | N/A
62140 | CRANIOPLASTY SKULL DEFECT LT 5 CM DIAMETER | 2011-07-01 00:00:00 | 851.83 | N | Y | N/A | N/A
62141 | CRANIOPLASTY SKULL DEFECT GT5 CM DIAMETER | 2011-07-01 00:00:00 | 934.92 | N | Y | N/A | N/A
62142 | RMVL BONE FLAP/PROSTHETIC PLATE SKULL | 2011-07-01 00:00:00 | 720.89 | N | Y | N/A | N/A
62143 | RPLCMT BONE FLAP/PROSTHETIC PLATE SKULL | 2011-07-01 00:00:00 | 842.42 | N | Y | N/A | N/A
62145 | CRANIOPLASTY SKULL DEFECT REPARATIVE BRAIN SURG | 2011-07-01 00:00:00 | 1152.5 | N | Y | N/A | N/A
62146 | CRANIOPLASTY W/AUTOGRAFT LT 5 CM DIAMETER | 2011-07-01 00:00:00 | 1007.27 | N | Y | N/A | N/A
62147 | CRANIOPLASTY W/AUTOGRAFT GT 5 CM DIAMETER | 2011-07-01 00:00:00 | 1187.69 | N | Y | N/A | N/A
62148 | INCISE&RETRIEVAL SUBQ CRANIOPLASTY BONE GRAFT | 2011-07-01 00:00:00 | 103.85 | N | Y | N/A | N/A
62160 | NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS | 2011-07-01 00:00:00 | 157.05 | N | Y | N/A | N/A
62161 | NUNDSC ICRA DSJ ADS FENESTRATION SEPTUM CSTS | 2011-07-01 00:00:00 | 1234.32 | N | Y | N/A | N/A
62162 | NUNDSC ICRA FENESTEXC CYST W/VENTRIC CATH DRG | 2011-07-01 00:00:00 | 1543.27 | N | Y | N/A | N/A
62163 | NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY | 2011-07-01 00:00:00 | 996.57 | N | Y | N/A | N/A
62164 | NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY | 2011-07-01 00:00:00 | 1688.35 | N | Y | N/A | N/A
62165 | NUNDSC ICRA EXC PITUITRY TUM TRNSNSL/SPHENOID | 2011-07-01 00:00:00 | 1294.09 | N | Y | N/A | N/A
62180 | VENTRICULOCISTERNOSTOMY | 2011-07-01 00:00:00 | 1304.07 | N | Y | N/A | N/A
62190 | CRTJ SHUNT SARACH/SDRL-ATR-JUG-AUR | 2011-07-01 00:00:00 | 747.03 | N | Y | N/A | N/A
62192 | CRTJ SHUNT SARACH/SDRL-PRTL-PLEURAL OTH | 2011-07-01 00:00:00 | 792.27 | N | Y | N/A | N/A
62194 | RPLCMT/IRRG SUBARACHNOID/SUBDURAL CATHETER | 2011-07-01 00:00:00 | 336.29 | N | Y | N/A | N/A
62200 | VENTRICULOCISTERNOSTOMY 3RD VENTRICLE | 2011-07-01 00:00:00 | 1119.97 | N | Y | N/A | N/A
62201 | VENTRICULOCISTERNOSTOMY 3RD VNTRC NEURONDSC | 2011-07-01 00:00:00 | 973.94 | N | Y | N/A | N/A
62220 | CRTJ SHUNT VENTRICULO-ATR-JUG-AUR | 2011-07-01 00:00:00 | 826.78 | N | Y | N/A | N/A
62223 | CRTJ SHUNT VENTRICULO-PERITNEAL-PLEURAL TERMINUS | 2011-07-01 00:00:00 | 855.88 | N | Y | N/A | N/A
62225 | RPLCMT/IRRIGATION VENTRICULAR CATHETER | 2011-07-01 00:00:00 | 416.64 | N | Y | N/A | N/A
62230 | RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS | 2011-07-01 00:00:00 | 683.38 | N | Y | N/A | N/A
62252 | REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT | 2011-07-01 00:00:00 | 76.31 | N | Y | 38.24 | 38.07
62256 | RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT | 2011-07-01 00:00:00 | 482.75 | N | Y | N/A | N/A
62258 | RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT | 2011-07-01 00:00:00 | 914.07 | N | Y | N/A | N/A
62263 | PRQ LYSIS EPIDURAL ADHESIONS MULT SESS 2/GT DAYS | 2011-07-01 00:00:00 | 607.01 | N | Y | N/A | N/A
62264 | PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY | 2011-07-01 00:00:00 | 353.8 | N | Y | N/A | N/A
62267 | PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS | 2011-07-01 00:00:00 | 211.18 | N | Y | N/A | N/A
62268 | PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX | 2011-07-01 00:00:00 | 302.17 | N | Y | N/A | N/A
62269 | BIOPSY SPINAL [NAME] NEEDLE | 2011-07-01 00:00:00 | 324.19 | N | Y | N/A | N/A
62270 | SPINAL PUNCTURE LUMBAR DIAGNOSTIC | 2011-07-01 00:00:00 | 131.56 | N | Y | N/A | N/A
62272 | SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID | 2011-07-01 00:00:00 | 162.11 | N | Y | N/A | N/A
62273 | [NAME] PATCH | 2011-07-01 00:00:00 | 143.64 | N | Y | N/A | N/A
62280 | INJX/INFUSION NEUROLYTIC SUBSTANCE SUBARACHNOID | 2011-07-01 00:00:00 | 273.43 | N | Y | N/A | N/A
62281 | INJX/INFUS NEUROLYT SUBST EPIDURAL CERV/THORACIC | 2011-07-01 00:00:00 | 221.59 | N | Y | N/A | N/A
62282 | INJX/INFUS NEUROLYT SBST EPIDURAL LUMBAR/SACRAL | 2011-07-01 00:00:00 | 249.62 | N | Y | N/A | N/A
62284 | INJECTION PROCEDURE MYELOGRAPHY/CT SPINAL | 2011-07-01 00:00:00 | 182.02 | N | Y | N/A | N/A
62287 | DCMPRN PERQ NUCLEUS PULPOSUS 1/GT LEVELS LUMBAR | 2011-07-01 00:00:00 | 472.71 | N | Y | N/A | N/A
62290 | [NAME] DISCOGRAPHY EACH LEVEL LUMBAR | 2011-07-01 00:00:00 | 283.55 | N | Y | N/A | N/A
62291 | [NAME] DISCOGRPHY EA LVL CERVICAL/THORACIC | 2011-07-01 00:00:00 | 267.88 | N | Y | N/A | N/A
62292 | [NAME] DISCOGRPHY EA LVL CERVICAL/THORACIC | 2011-07-01 00:00:00 | 469.55 | N | Y | N/A | N/A
62294 | NJX ARTERIAL OCCLUSION ARVEN MALFRMJ SPINAL | 2011-07-01 00:00:00 | 593.34 | N | Y | N/A | N/A
62310 | NJX DX/THER SBST EPIDURAL/SUBRACH CERV/THORACIC | 2011-07-01 00:00:00 | 197.02 | N | Y | N/A | N/A
62311 | NJX DX/THER SBST EPIDURAL/SUBARACH LUMBAR/SACRAL | 2011-07-01 00:00:00 | 169.15 | N | Y | N/A | N/A
62318 | NJXS INFUS/BOLUS DX/SBST EDRL/SUBARACH CRV/THRC | 2011-07-01 00:00:00 | 202.73 | N | Y | N/A | N/A
62319 | NJX INFUS/BOLUS DX/SBST EDRL/SUBARACH LUM/SACRAL | 2011-07-01 00:00:00 | 161.78 | N | Y | N/A | N/A
62350 | IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM | 2011-07-01 00:00:00 | 329.38 | N | Y | N/A | N/A
62351 | IMPLTJ REVJ/RPSG ITHCL/EDRL CATH W/LAM | 2011-07-01 00:00:00 | 705.93 | N | Y | N/A | N/A
62355 | RMVL PREVIOUSLY IMPLTED ITHCL/EDRL CATH | 2011-07-01 00:00:00 | 249.02 | N | Y | N/A | N/A
62360 | IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS SUBQ RSVR | 2011-07-01 00:00:00 | 252.87 | N | Y | N/A | N/A
62361 | IMPLTJ/RPLCMT FS NON-PRGRBL PUMP | 2011-07-01 00:00:00 | 326.67 | N | Y | N/A | N/A
62362 | IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP | 2011-07-01 00:00:00 | 341.96 | N | Y | N/A | N/A
62365 | RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS | 2011-07-01 00:00:00 | 273.21 | N | Y | N/A | N/A
62367 | ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL | 2011-07-01 00:00:00 | 34.3 | N | Y | N/A | N/A
62368 | ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG | 2011-07-01 00:00:00 | 49.54 | N | Y | N/A | N/A
62369 | ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFILL | 2012-01-01 00:00:00 | 102.05 | N | N | N/A | N/A
62370 | ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR&REF PHYS | 2012-01-01 00:00:00 | 107.28 | N | N | N/A | N/A
63001 | LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG CRV | 2011-07-01 00:00:00 | 1010.29 | Y | Y | N/A | N/A
63003 | LAMINECTOMY W/O FFD 1/2 VERT SEG THORACIC | 2011-07-01 00:00:00 | 1015.8 | Y | Y | N/A | N/A
63005 | LAMINECTOMY W/O FFD 1/2 VERT SEG LUMBAR | 2011-07-01 00:00:00 | 966.71 | Y | Y | N/A | N/A
63011 | LAMINECTOMY W/O FFD 1/2 VERT SEG SACRAL | 2011-07-01 00:00:00 | 899.22 | Y | Y | N/A | N/A
63012 | LAMINECTOMY W/RMVL ABNORMAL FACETS LUMBAR | 2011-07-01 00:00:00 | 976.44 | Y | Y | N/A | N/A
63015 | LAMINECTOMY W/O FFD GT 2 VERT SEG CERVICAL | 2011-07-01 00:00:00 | 1210.59 | Y | Y | N/A | N/A
63016 | LAMINECTOMY W/O FFD GT 2 VERT SEG THORACIC | 2011-07-01 00:00:00 | 1244.1 | Y | Y | N/A | N/A
63017 | LAMINECTOMY W/O FFD GT 2 VERT SEG LUMBAR | 2011-07-01 00:00:00 | 1020.96 | Y | Y | N/A | N/A
63020 | LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC CERVC | 2011-07-01 00:00:00 | 956.44 | Y | Y | N/A | N/A
63030 | LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR | 2011-07-01 00:00:00 | 795.12 | Y | Y | N/A | N/A
63035 | LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR | 2011-07-01 00:00:00 | 161.6 | Y | Y | N/A | N/A
63040 | LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC CERVICAL | 2011-07-01 00:00:00 | 1153.75 | Y | Y | N/A | N/A
63042 | LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR | 2011-07-01 00:00:00 | 1074.37 | Y | Y | N/A | N/A
63044 | LAMOT W/PRTL FFD HRNA8 REEXPL 1 NTRSPC EA LMBR | 2011-07-01 00:00:00 | 234.13 | Y | Y | N/A | N/A
63045 | LAM FACETEC&FORAMOT 1 SEGMENT CERVICAL | 2011-07-01 00:00:00 | 1041.28 | Y | Y | N/A | N/A
63046 | LAM FACETEC&FORAMOT 1 SEGMENT THORACIC | 2011-07-01 00:00:00 | 995.43 | Y | Y | N/A | N/A
63047 | LAM FACETEC&FORAMOT 1 SEGMENT LUMBAR | 2011-07-01 00:00:00 | 906.14 | Y | Y | N/A | N/A
63048 | LAM FACETEC&FORAMOT 1 SGM EA CRV THRC/LMBR | 2011-07-01 00:00:00 | 178.27 | Y | Y | N/A | N/A
63050 | LAMOP CERVICAL W/DCMPRN SPI CORD 2/GT VERT SEG | 2011-07-01 00:00:00 | 1278.53 | Y | Y | N/A | N/A
63051 | LAMOPLASTY CERVICAL DCMPRN CORD 2/GT SEG RCNSTJ | 2011-07-01 00:00:00 | 1416.52 | Y | Y | N/A | N/A
63055 | TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC | 2011-07-01 00:00:00 | 1334.81 | Y | Y | N/A | N/A
63056 | TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR | 2011-07-01 00:00:00 | 1222.52 | Y | Y | N/A | N/A
63057 | TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR | 2011-07-01 00:00:00 | 269.71 | Y | Y | N/A | N/A
63064 | COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG | 2011-07-01 00:00:00 | 1455.54 | Y | Y | N/A | N/A
63066 | COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG | 2011-07-01 00:00:00 | 171.19 | Y | Y | N/A | N/A
63075 | DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC | 2011-07-01 00:00:00 | 1130.68 | Y | Y | N/A | N/A
63076 | DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC | 2011-07-01 00:00:00 | 208.85 | Y | Y | N/A | N/A
63077 | DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC | 2011-07-01 00:00:00 | 1247.25 | Y | Y | N/A | N/A
63078 | DISCECTOMY ANT DCMPRN CORD THORACIC EA NTRSPC | 2011-07-01 00:00:00 | 164.75 | N | N | N/A | N/A
63081 | VERTEBRAL CORPECTOMY ANT DCMPRN CERVICAL 1 SEG | 2011-07-01 00:00:00 | 1460.34 | N | Y | N/A | N/A
63082 | VERTEBRAL CORPECTOMY DCMPRN CERVICAL EA SEG | 2011-07-01 00:00:00 | 224.87 | N | Y | N/A | N/A
63085 | VERTEBRAL CORPECTOMY [NAME] THORACIC 1 SEG | 2011-07-01 00:00:00 | 1575.34 | N | Y | N/A | N/A
63086 | VERTEBRAL CORPECTOMY [NAME] THORACIC EA SEG | 2011-07-01 00:00:00 | 160.92 | N | Y | N/A | N/A
63087 | [NAME] THORACOLMBR DCMPRN LWR THRC/LMBR 1 SEG | 2011-07-01 00:00:00 | 1990.84 | N | Y | N/A | N/A
63088 | [NAME] THORACOLMBR DCMPRN LWR THRC/LMBR EA SEG | 2011-07-01 00:00:00 | 218.98 | N | Y | N/A | N/A
63090 | [NAME] TRANSPRTL/RPR DCMPRN THRC LMBR/SAC 1 SEG | 2011-07-01 00:00:00 | 1644.99 | N | Y | N/A | N/A
63091 | [NAME] TRANSPRTL/RPR DCMPRN THRC LMBR/SAC EA SEG | 2011-07-01 00:00:00 | 151.26 | N | Y | N/A | N/A
63101 | VERTEB CORPECT LAT [NAME] THRC 1 SEG | 2011-07-01 00:00:00 | 1910.05 | N | Y | N/A | N/A
63102 | VERTEB CORPECT LAT [NAME] | 2011-07-01 00:00:00 | 1865.32 | N | Y | N/A | N/A
63103 | [NAME] LAT [NAME] | 2011-07-01 00:00:00 | 246.65 | N | Y | N/A | N/A
63170 | LAM W/MYELOTOMY CERVICAL/THORACIC/THORACOLUMBAR | 2011-07-01 00:00:00 | 1285.3 | N | Y | N/A | N/A
63172 | LAM W/DRG INTRMEDULLARY CYST/SYRINX SUBARACHNOID | 2011-07-01 00:00:00 | 1144.46 | Y | Y | N/A | N/A
63173 | LAM W/DRG INTRMEDULRY CYST/SYRINX PRTL/PLEURAL | 2011-07-01 00:00:00 | 1405.66 | Y | Y | N/A | N/A
63180 | LAM&SCTJ DENTATE LIG W/WO DURAL GRF CRV 1/2 SEG | 2011-07-01 00:00:00 | 1187.04 | Y | Y | N/A | N/A
63182 | LAM&SCTJ DENTATE LIG W/WO DURAL GRF CRV [NAME] | 2011-07-01 00:00:00 | 1276.19 | Y | Y | N/A | N/A
63185 | LAMINECTOMY W/RHIZOTOMY 1/2 SEGMENTS | 2011-07-01 00:00:00 | 965.65 | Y | Y | N/A | N/A
63190 | LAMINECTOMY W/RHIZOTOMY GT 2 SEGMENTS | 2011-07-01 00:00:00 | 1058.1 | Y | Y | N/A | N/A
63191 | LAMINECTOMY W/SECTION SPINAL ACCESSORY NERVE | 2011-07-01 00:00:00 | 995.18 | Y | Y | N/A | N/A
63194 | LAM CORDOTOMY SCTJ 1 SPINOTHALMIC TRACT CERVICAL | 2011-07-01 00:00:00 | 1168.09 | Y | Y | N/A | N/A
63195 | LAM CORDOTOMY SCTJ 1 SPINOTHALMIC TRACT THORACIC | 2011-07-01 00:00:00 | 1243.72 | Y | Y | N/A | N/A
63196 | LAM CORDOTOMY SCTJ BOTH SPINOTHALMIC TRACTS CRV | 2011-07-01 00:00:00 | 1243.38 | Y | Y | N/A | N/A
63197 | LAM CORDOTOMY SCTJ BOTH SPINOTHALMIC TRACT THRC | 2011-07-01 00:00:00 | 1391.28 | Y | Y | N/A | N/A
63198 | LAM CORDOTOMY SCTJ BOTH TRACTS 2 STAGES CERVICAL | 2011-07-01 00:00:00 | 1377.58 | Y | Y | N/A | N/A
63199 | LAM CORDOTOMY SCTJ BOTH TRACTS 2 STAGES THORACIC | 2011-07-01 00:00:00 | 1516.91 | Y | Y | N/A | N/A
63200 | LAMINECTOMY RELEASE TETHERED SPINAL CORD LUMBAR | 2011-07-01 00:00:00 | 1238.9 | Y | Y | N/A | N/A
63250 | LAM EXC/OCCLUSION AVM SPINAL CORD CERVICAL | 2011-07-01 00:00:00 | 2418.59 | N | Y | N/A | N/A
63251 | LAM EXC/OCCLUSION AVM SPINAL CORD THORACIC | 2011-07-01 00:00:00 | 2477.91 | N | Y | N/A | N/A
63252 | LAM EXC/OCCLUSION AVM SPI CORD THORACOLMBR | 2011-07-01 00:00:00 | 2475.87 | N | Y | N/A | N/A
63265 | LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL [NAME] | 2011-07-01 00:00:00 | 1363.1 | N | Y | N/A | N/A
63266 | LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL THRC | 2011-07-01 00:00:00 | 1403.64 | N | Y | N/A | N/A
63267 | LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL LMBR | 2011-07-01 00:00:00 | 1126.4 | N | Y | N/A | N/A
63268 | LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL SAC | 2011-07-01 00:00:00 | 1173.37 | N | Y | N/A | N/A
63270 | LAM EXC ISPI LES OTH/THN NEO IDRL CERVICAL | 2011-07-01 00:00:00 | 1688.84 | N | Y | N/A | N/A
63271 | LAM EXC ISPI LES OTH/THN NEO IDRL THORACIC | 2011-07-01 00:00:00 | 1689.2 | N | Y | N/A | N/A
63272 | LAM EXC ISPI LES OTH/THN NEO IDRL LUMBAR | 2011-07-01 00:00:00 | 1555.01 | N | Y | N/A | N/A
63273 | LAM EXC ISPI LES OTH/THN NEO IDRL SACRAL | 2011-07-01 00:00:00 | 1500.69 | N | Y | N/A | N/A
63275 | LAMINECTOMY BX/EXC ISPI NEO XDRL CERVICAL | 2011-07-01 00:00:00 | 1466.39 | N | Y | N/A | N/A
63276 | LAMINECTOMY BX/EXC ISPI NEO XDRL THORACIC | 2011-07-01 00:00:00 | 1458.69 | N | Y | N/A | N/A
63277 | LAMINECTOMY BX/EXC ISPI NEO XDRL LUMBAR | 2011-07-01 00:00:00 | 1273.66 | N | Y | N/A | N/A
63278 | LAMINECTOMY BX/EXC ISPI NEO XDRL SACRAL | 2011-07-01 00:00:00 | 1283.75 | N | Y | N/A | N/A
63280 | LAM BX/EXC ISPI NEO IDRL [NAME] | 2011-07-01 00:00:00 | 1725.25 | N | Y | N/A | N/A
63281 | LAM BX/EXC ISPI NEO IDRL [NAME] | 2011-07-01 00:00:00 | 1708.95 | N | Y | N/A | N/A
63282 | LAM BX/EXC ISPI NEO IDRL XMED LUMBAR | 2011-07-01 00:00:00 | 1610.68 | N | Y | N/A | N/A
63283 | LAM BX/EXC ISPI NEO IDRL SACRAL | 2011-07-01 00:00:00 | 1541.87 | N | Y | N/A | N/A
63285 | LAM BX/EXC ISPI NEO IDRL IMED CERVICAL | 2011-07-01 00:00:00 | 2123.06 | N | Y | N/A | N/A
63286 | LAM BX/EXC ISPI NEO IDRL IMED THORACIC | 2011-07-01 00:00:00 | 2100.71 | N | Y | N/A | N/A
63287 | LAM BX/EXC ISPI NEO IDRL IMED THORACOLMBR | 2011-07-01 00:00:00 | 2237.29 | N | Y | N/A | N/A
63290 | LAM BX/EXC ISPI NEO XDRL-IDRL LES ANY LVL | 2011-07-01 00:00:00 | 2269.66 | N | Y | N/A | N/A
63295 | OSTPL RCNSTJ DORSAL SPI ELMNTS FLWG ISPI PX | 2011-07-01 00:00:00 | 272.14 | N | Y | N/A | N/A
63300 | VCRPEC LES 1 SGM XDRL CERVICAL | 2011-07-01 00:00:00 | 1502.78 | N | Y | N/A | N/A
63301 | VCRPEC LES 1 SGM XDRL THORACIC TTHRC | 2011-07-01 00:00:00 | 1768.7 | N | Y | N/A | N/A
63302 | VCRPEC LES 1 SEG XDRL THRC THORACOLMBR | 2011-07-01 00:00:00 | 1750 | N | Y | N/A | N/A
63303 | VCRPEC LES 1 SEG XDRL LMBR/SAC TRANSPRTL/RPR | 2011-07-01 00:00:00 | 1858.32 | N | Y | N/A | N/A
63304 | VERTEBRAL CORPECTOMY [NAME] 1 SEG IDRL CERVICAL | 2011-07-01 00:00:00 | 1910.08 | N | Y | N/A | N/A
63305 | VERTEBRAL CORPECTOMY LES 1 SEG IDRL THRC TTHRC | 2011-07-01 00:00:00 | 2002.42 | N | Y | N/A | N/A
63306 | VERTEBRL CORPECT LES 1 SEG IDRL THRC THORACOLMBR | 2011-07-01 00:00:00 | 1864.66 | N | Y | N/A | N/A
63307 | VCRPEC LES 1 SEG IDRL LMBR/SAC TRANSPRTL/RPR | 2011-07-01 00:00:00 | 1951.08 | N | Y | N/A | N/A
63308 | VERTEBRAL CORPECTOMY EXC INDRL LES EACH SEG | 2011-07-01 00:00:00 | 268.72 | N | Y | N/A | N/A
63600 | CREATION LES SPINAL CORD STEREOTACTIC METHOD PRQ | 2011-07-01 00:00:00 | 725.86 | N | Y | N/A | N/A
63610 | STRTCTC STIMJ SPI CORD PRQ SPX N/FLWD OTH SURG | 2011-07-01 00:00:00 | 736.45 | N | Y | N/A | N/A
63615 | STRTCTC BX ASPIRAT/EXC LESION SPINAL CORD | 2011-07-01 00:00:00 | 990.04 | N | Y | N/A | N/A
63620 | STEREOTACTIC RADIOSURGERY 1 SPINAL LESION | 2011-07-01 00:00:00 | 864.53 | N | Y | N/A | N/A
63621 | STEREOTACTIC RADIOSURGERY EA ADDL SPINAL LESION | 2011-07-01 00:00:00 | 204.8 | N | Y | N/A | N/A
63650 | PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL | 2011-07-01 00:00:00 | 357.37 | Y | Y | N/A | N/A
63655 | LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL | 2011-07-01 00:00:00 | 705.17 | Y | Y | N/A | N/A
63661 | [NAME] PERQ ARAY | 2011-07-01 00:00:00 | 508.02 | N | Y | N/A | N/A
63662 | [NAME] | 2011-07-01 00:00:00 | 609.73 | N | Y | N/A | N/A
63663 | REVISE SPINE ELTRD PERQ ARAY | 2011-07-01 00:00:00 | 725.79 | N | Y | N/A | N/A
63664 | REVISE SPINE ELTRD PLATE | 2011-07-01 00:00:00 | 634.19 | N | Y | N/A | N/A
63685 | INSJ/RPLCMT SPI NPGR DIR/INDUXIVE COUPLING | 2011-07-01 00:00:00 | 334.58 | Y | Y | N/A | N/A
63688 | REVJ/RMVL IMPLANTED SPINAL NEUROSTIM GENERATOR | 2011-07-01 00:00:00 | 302 | N | Y | N/A | N/A
63700 | REPAIR MENINGOCELE LT 5 CM DIAMETER | 2011-07-01 00:00:00 | 1041.64 | N | Y | N/A | N/A
63702 | REPAIR MENINGOCELE GT 5 CM DIAMETER | 2011-07-01 00:00:00 | 1153.46 | N | Y | N/A | N/A
63704 | REPAIR MYELOMENINGOCELE LT 5 CM DIAMETER | 2011-07-01 00:00:00 | 1313.25 | N | Y | N/A | N/A
63706 | REPAIR MYELOMENINGOCELE GT 5 CM DIAMETER | 2011-07-01 00:00:00 | 1483.15 | N | Y | N/A | N/A
63707 | RPR DURAL/CEREBROSPINAL FLUID LEAK X REQ LAM | 2011-07-01 00:00:00 | 747.35 | N | Y | N/A | N/A
63709 | RPR DURAL/CSF LEAK/PSEUDOMENINGOCELE W/LAM | 2011-07-01 00:00:00 | 904.73 | N | Y | N/A | N/A
63710 | DURAL GRAFT SPINAL | 2011-07-01 00:00:00 | 904.26 | N | Y | N/A | N/A
63740 | CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL/OTH W/LAM | 2011-07-01 00:00:00 | 766.38 | N | Y | N/A | N/A
63741 | CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL PRQ X LAM | 2011-07-01 00:00:00 | 509.52 | N | Y | N/A | N/A
63744 | RPLCMT IRRIGATION/REVJ LUMBOSARACH SHUNT | 2011-07-01 00:00:00 | 539.13 | N | Y | N/A | N/A
63746 | RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT | 2011-07-01 00:00:00 | 476.89 | N | Y | N/A | N/A
64400 | NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH | 2011-07-01 00:00:00 | 95.63 | N | Y | N/A | N/A
64402 | INJECTION ANESTHETIC AGENT FACIAL NERVE | 2011-07-01 00:00:00 | 95.58 | N | Y | N/A | N/A
64405 | INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV | 2011-07-01 00:00:00 | 94.8 | N | Y | N/A | N/A
64408 | INJECTION ANESTHETIC AGENT VAGUS NERVE | 2011-07-01 00:00:00 | 104.74 | N | Y | N/A | N/A
64410 | INJECTION ANESTHETIC AGENT PHRENIC NERVE | 2011-07-01 00:00:00 | 124.47 | N | Y | N/A | N/A
64412 | INJECTION ANESTHETIC AGENT SPINAL ACCESSORY NRV | 2011-07-01 00:00:00 | 126.38 | N | Y | N/A | N/A
64413 | INJECTION ANESTHETIC AGENT CERVICAL PLEXUS | 2011-07-01 00:00:00 | 100.81 | N | Y | N/A | N/A
64415 | SINGLE NERVE BLOCK INJECTION ARM NERVE | 2011-07-01 00:00:00 | 105.14 | N | Y | N/A | N/A
64416 | [NAME] BRACHIAL PLEXUS CONT NFS CATH | 2011-07-01 00:00:00 | 70.49 | N | Y | N/A | N/A
64417 | INJECTION ANESTHETIC AGENT AXILLARY NERVE | 2011-07-01 00:00:00 | 110.26 | N | Y | N/A | N/A
64418 | INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE | 2011-07-01 00:00:00 | 117.14 | N | Y | N/A | N/A
64420 | INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE | 2011-07-01 00:00:00 | 116.04 | N | Y | N/A | N/A
64421 | MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES | 2011-07-01 00:00:00 | 166.46 | N | Y | N/A | N/A
64425 | INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS | 2011-07-01 00:00:00 | 111.51 | N | Y | N/A | N/A
64430 | INJECTION ANESTHETIC AGENT PUDENDAL NERVE | 2011-07-01 00:00:00 | 122.07 | N | Y | N/A | N/A
64435 | INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE | 2011-07-01 00:00:00 | 119.48 | N | Y | N/A | N/A
64445 | INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE | 2011-07-01 00:00:00 | 114.09 | N | Y | N/A | N/A
64446 | INJECTION ANES SCIATIC NERVE CONT INFUSION CATH | 2011-07-01 00:00:00 | 71.64 | N | Y | N/A | N/A
64447 | INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE | 2011-07-01 00:00:00 | 102.29 | N | Y | N/A | N/A
64448 | INJECTION ANES FEMORAL NERVE CONT INFUSION CATH | 2011-07-01 00:00:00 | 63.77 | N | Y | N/A | N/A
64449 | [NAME] LUMBAR PLEXUS POST CONT NFS CATH | 2011-07-01 00:00:00 | 72.79 | N | Y | N/A | N/A
64450 | [NAME]/BRANCH | 2011-07-01 00:00:00 | 87.76 | N | Y | N/A | N/A
64455 | NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE | 2011-07-01 00:00:00 | 41.92 | N | Y | N/A | N/A
64479 | NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC 1 LVL | 2011-07-01 00:00:00 | 226.13 | N | Y | N/A | N/A
64480 | NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC EA LVL | 2011-07-01 00:00:00 | 107.32 | N | Y | N/A | N/A
64483 | NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL | 2011-07-01 00:00:00 | 205.22 | N | Y | N/A | N/A
64484 | NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LVL | 2011-07-01 00:00:00 | 91.09 | N | Y | N/A | N/A
64490 | INJ PARAVERT F JNT C/T 1 LEV | 2011-07-01 00:00:00 | 167.57 | N | N | N/A | N/A
64491 | INJ PARAVERT F JNT C/T 2 LEV | 2011-07-01 00:00:00 | 83.24 | N | N | N/A | N/A
64492 | INJ PARAVERT F JNT C/T 3 LEV | 2011-07-01 00:00:00 | 84.11 | N | N | N/A | N/A
64493 | INJ PARAVERT F JNT L/S 1 LEV | 2011-07-01 00:00:00 | 149.56 | N | N | N/A | N/A
64494 | INJ PARAVERT F JNT L/S 2 LEV | 2011-07-01 00:00:00 | 75.23 | N | N | N/A | N/A
64495 | INJ PARAVERT F JNT L/S 3 LEV | 2011-07-01 00:00:00 | 76.38 | N | N | N/A | N/A
64505 | INJECTION ANES AGENT SPHENOPALATINE GANGLION | 2011-07-01 00:00:00 | 84.29 | N | Y | N/A | N/A
64508 | INJECTION ANESTHETIC AGENT CAROTID SINUS SPX | 2011-07-01 00:00:00 | 87.76 | N | Y | N/A | N/A
64510 | NJX ANES STELLATE GANGLION CRV SYMPATHETIC | 2011-07-01 00:00:00 | 115.47 | N | Y | N/A | N/A
64517 | INJECTION ANES SUPERIOR HYPOGASTRIC PLEXUS | 2011-07-01 00:00:00 | 148.85 | N | Y | N/A | N/A
64520 | INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC | 2011-07-01 00:00:00 | 163.16 | N | Y | N/A | N/A
64530 | INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG | 2011-07-01 00:00:00 | 165.24 | N | Y | N/A | N/A
64550 | APPLICATION SURFACE NEUROSTIMULATOR | 2011-07-01 00:00:00 | 13.46 | N | Y | N/A | N/A
64553 | PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE | 2011-07-01 00:00:00 | 174.55 | N | Y | N/A | N/A
64555 | PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV | 2011-07-01 00:00:00 | 171.8 | Y | Y | N/A | N/A
64561 | PRQ IMPLTJ NEUROSTIMULATOR ELTRD SACRAL NERVE | 2011-07-01 00:00:00 | 831.78 | N | Y | N/A | N/A
64565 | PRQ IMPLTJ NSTIM ELTRD NEUROMUSCULAR | 2011-07-01 00:00:00 | 149.81 | Y | Y | N/A | N/A
64566 | POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE | 2011-07-01 00:00:00 | 110.05 | Y | Y | N/A | N/A
64568 | INC IMPLTJ CRNL NRV NSTIM ELTRDS & PULSE GENER | 2011-07-01 00:00:00 | 546.21 | Y | Y | N/A | N/A
64569 | REVISION/REPLMT NEUROSTIMLATOR ELTRD CRANIAL NRV | 2011-07-01 00:00:00 | 521.11 | N | Y | N/A | N/A
64570 | REMOVAL CRNL NRV NSTIM ELTRDS & PULSE GENERATOR | 2011-07-01 00:00:00 | 452.25 | N | Y | N/A | N/A
64575 | INC IMPLTJ PERIPH NERVE NEUROSTIMULATOR ELTRD | 2011-07-01 00:00:00 | 245.8 | Y | Y | N/A | N/A
64580 | INC IMPLTJ NSTIM ELTRD NEUROMUSCULAR | 2011-07-01 00:00:00 | 253.38 | Y | Y | N/A | N/A
64581 | INC IMPLTJ NEUROSTIMULATOR ELTRD SACRAL NERVE | 2011-07-01 00:00:00 | 603.13 | N | Y | N/A | N/A
64585 | REVJ/RMVL PERIPHERAL NEUROSTIMULATOR ELECTRODE | 2011-07-01 00:00:00 | 248.02 | N | Y | N/A | N/A
64590 | INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR | 2011-07-01 00:00:00 | 243.77 | Y | Y | N/A | N/A
64595 | REVISION/RMVL PERIPHERAL/GASTRIC NPGR | 2011-07-01 00:00:00 | 241.39 | N | Y | N/A | N/A
64600 | DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH | 2011-07-01 00:00:00 | 348.12 | N | Y | N/A | N/A
64605 | DSTRJ NEUROLYTIC TRIGEMINAL NRV 2/3 DIV BRANCH | 2011-07-01 00:00:00 | 553.89 | N | Y | N/A | N/A
64610 | DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR | 2011-07-01 00:00:00 | 605.82 | N | Y | N/A | N/A
64611 | CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS BI | 2011-07-01 00:00:00 | 83.57 | N | Y | N/A | N/A
64612 | CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV | 2011-07-01 00:00:00 | 141.46 | N | Y | N/A | N/A
64615 | CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE | 2013-01-01 00:00:00 | 116.45 | N | N | N/A | N/A
64616 | CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA | 2014-01-01 00:00:00 | 111.04 | N | Y | N/A | N/A
64617 | CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG | 2014-01-01 00:00:00 | 159.84 | N | Y | N/A | N/A
64620 | DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE | 2011-07-01 00:00:00 | 204.46 | N | Y | N/A | N/A
64630 | DSTRJ NEUROLYTIC AGENT PUDENDAL NERVE | 2011-07-01 00:00:00 | 192.64 | N | Y | N/A | N/A
64632 | DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE | 2011-07-01 00:00:00 | 73.1 | N | Y | N/A | N/A
64633 | DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA | 2012-01-01 00:00:00 | 373.5 | N | N | N/A | N/A
64634 | DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA | 2012-01-01 00:00:00 | 170.09 | N | N | N/A | N/A
64635 | DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL | 2012-01-01 00:00:00 | 367.09 | N | N | N/A | N/A
64636 | DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL | 2012-01-01 00:00:00 | 153.05 | N | N | N/A | N/A
64640 | DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE | 2011-07-01 00:00:00 | 187.01 | N | Y | N/A | N/A
64642 | CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE | 2014-01-01 00:00:00 | 116.24 | N | Y | N/A | N/A
64643 | CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE | 2014-01-01 00:00:00 | 76.79 | N | Y | N/A | N/A
64644 | CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES | 2014-01-01 00:00:00 | 132.77 | N | Y | N/A | N/A
64645 | CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES | 2014-01-01 00:00:00 | 69.7 | N | Y | N/A | N/A
64646 | CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES | 2014-01-01 00:00:00 | 125.19 | N | Y | N/A | N/A
64647 | CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES | 2014-01-01 00:00:00 | 145.04 | N | Y | N/A | N/A
64650 | CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE | 2011-07-01 00:00:00 | 77.83 | N | Y | N/A | N/A
64653 | CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY | 2011-07-01 00:00:00 | 91.95 | Y | Y | N/A | N/A
64680 | DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS | 2011-07-01 00:00:00 | 267.41 | N | Y | N/A | N/A
64681 | DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS | 2011-07-01 00:00:00 | 320.09 | N | Y | N/A | N/A
64702 | NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT | 2011-07-01 00:00:00 | 405.18 | N | Y | N/A | N/A
64704 | NEUROPLASTY NERVE HAND/FOOT | 2011-07-01 00:00:00 | 274.83 | N | Y | N/A | N/A
64708 | NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC | 2011-07-01 00:00:00 | 405.09 | N | Y | N/A | N/A
64712 | NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV | 2011-07-01 00:00:00 | 462.94 | N | Y | N/A | N/A
64713 | NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS | 2011-07-01 00:00:00 | 635.21 | N | Y | N/A | N/A
64714 | NEURP MAJOR PRPH NRV OPN ARM/LEG LMBR PLEXUS | 2011-07-01 00:00:00 | 566.48 | N | Y | N/A | N/A
64716 | NEUROPLASTY &/TRANSPOSITION CRANIAL NERVE | 2011-07-01 00:00:00 | 448.62 | N | Y | N/A | N/A
64718 | NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW | 2011-07-01 00:00:00 | 486.07 | N | Y | N/A | N/A
64719 | NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST | 2011-07-01 00:00:00 | 330.3 | N | Y | N/A | N/A
64721 | NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNEL | 2011-07-01 00:00:00 | 352.8 | N | Y | N/A | N/A
64722 | DECOMPRESSION UNSPECIFIED NERVE | 2011-07-01 00:00:00 | 288.68 | N | Y | N/A | N/A
64726 | DECOMPRESSION PLANTAR DIGITAL NERVE | 2011-07-01 00:00:00 | 236.88 | N | Y | N/A | N/A
64727 | INTERNAL NEUROLYSIS REQ OPERATING MICROSCOPE | 2011-07-01 00:00:00 | 156.33 | N | Y | N/A | N/A
64732 | TRANSECTION/AVULSION SUPRAORBITAL NERVE | 2011-07-01 00:00:00 | 342.84 | N | Y | N/A | N/A
64734 | TRANSECTION/AVULSION INFRAORBITAL NERVE | 2011-07-01 00:00:00 | 359.47 | N | Y | N/A | N/A
64736 | TRANSECTION/AVULSION MENTAL NERVE | 2011-07-01 00:00:00 | 353.13 | N | Y | N/A | N/A
64738 | TRANSECTION/AVULSION INF ALVEOLAR NRV W/OSTEO | 2011-07-01 00:00:00 | 422.49 | N | Y | N/A | N/A
64740 | TRANSECTION/AVULSION LINGUAL NERVE | 2011-07-01 00:00:00 | 390.47 | N | Y | N/A | N/A
64742 | TRANSECTION/AVULSION FACIAL NRV DIFFERENT/CMPL | 2011-07-01 00:00:00 | 405.49 | N | Y | N/A | N/A
64744 | TRANSECTION/AVULSION GREATER OCCIPITAL NERVE | 2011-07-01 00:00:00 | 376.4 | N | Y | N/A | N/A
64746 | TRANSECTION/AVULSION PHRENIC NERVE | 2011-07-01 00:00:00 | 367.68 | N | Y | N/A | N/A
64752 | TRANSECTION/AVULSION VAGUS NRV TRANSTHORACIC | 2011-07-01 00:00:00 | 429.73 | N | Y | N/A | N/A
64755 | TRANSECTION/AVULSION VAGUS NERVES | 2011-07-01 00:00:00 | 754.25 | N | Y | N/A | N/A
64760 | TRANSECTION/AVULSION VAGUS NERVE ABDOMINAL | 2011-07-01 00:00:00 | 413.66 | N | Y | N/A | N/A
64761 | TRANSECTION/AVULSION PUDENDAL NERVE | 2011-07-01 00:00:00 | 379.72 | N | Y | N/A | N/A
64763 | TRNSXJ/AVLSN OBTURAT NRV XPELV W/WO TENOTOMY | 2011-07-01 00:00:00 | 440.42 | N | Y | N/A | N/A
64766 | TRNSXJ/AVLSN OBTURAT NRV INPELV W/WO TENOTOMY | 2011-07-01 00:00:00 | 505.33 | N | Y | N/A | N/A
64771 | TRANSECTION/AVULSION OTH CRANIAL NRV XDRL | 2011-07-01 00:00:00 | 478.66 | N | Y | N/A | N/A
64772 | TRANSECTION/AVULSION OTH SPINAL NRV XDRL | 2011-07-01 00:00:00 | 477.58 | N | Y | N/A | N/A
64774 | EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE | 2011-07-01 00:00:00 | 347.11 | N | Y | N/A | N/A
64776 | EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT | 2011-07-01 00:00:00 | 328.38 | N | Y | N/A | N/A
64778 | EXCISION NEUROMA DIGITAL NRV EA ADDL DIGIT | 2011-07-01 00:00:00 | 161.42 | N | Y | N/A | N/A
64782 | EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE | 2011-07-01 00:00:00 | 382.27 | N | Y | N/A | N/A
64783 | EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT | 2011-07-01 00:00:00 | 186.78 | N | Y | N/A | N/A
64784 | EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC | 2011-07-01 00:00:00 | 611.17 | N | Y | N/A | N/A
64786 | EXCISION NEUROMA SCIATIC NERVE | 2011-07-01 00:00:00 | 900.52 | N | Y | N/A | N/A
64787 | IMPLANTATION NERVE END BONE/MUSCLE | 2011-07-01 00:00:00 | 207.95 | N | Y | N/A | N/A
64788 | [NAME]/NEUROLEMMOMA CUTAN NRV | 2011-07-01 00:00:00 | 330.22 | N | Y | N/A | N/A
64790 | [NAME]/NEUROLEMMOMA MAJOR PRPH NRV | 2011-07-01 00:00:00 | 692.33 | N | Y | N/A | N/A
64792 | [NAME]/NEUROLEMMOMA X10SV | 2011-07-01 00:00:00 | 922.74 | N | Y | N/A | N/A
64795 | BIOPSY NERVE | 2011-07-01 00:00:00 | 163.76 | N | Y | N/A | N/A
64802 | SYMPATHECTOMY CERVICAL | 2011-07-01 00:00:00 | 529.25 | N | Y | N/A | N/A
64804 | SYMPATHECTOMY CERVICOTHORACIC | 2011-07-01 00:00:00 | 704.81 | N | Y | N/A | N/A
64809 | SYMPATHECTOMY THORACOLUMBAR | 2011-07-01 00:00:00 | 731.24 | N | Y | N/A | N/A
64818 | SYMPATHECTOMY LUMBAR | 2011-07-01 00:00:00 | 561.75 | N | Y | N/A | N/A
64820 | SYMPATHECTOMY DIGITAL ARTERIES EACH DIGIT | 2011-07-01 00:00:00 | 639.23 | N | Y | N/A | N/A
64821 | SYMPATHECTOMY ULNAR ARTERY | 2011-07-01 00:00:00 | 575.86 | N | Y | N/A | N/A
64822 | SYMPATHECTOMY ULNAR ARTERY | 2011-07-01 00:00:00 | 571.53 | N | Y | N/A | N/A
64823 | SYMPATHECTOMY SUPERFICIAL PALMAR [NAME] | 2011-07-01 00:00:00 | 648.39 | N | Y | N/A | N/A
64831 | SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE | 2011-07-01 00:00:00 | 570.73 | N | Y | N/A | N/A
64832 | SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV | 2011-07-01 00:00:00 | 289.34 | N | Y | N/A | N/A
64834 | SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE | 2011-07-01 00:00:00 | 624.46 | N | Y | N/A | N/A
64835 | SUTURE 1 NERVE MEDIAN MOTOR THENAR | 2011-07-01 00:00:00 | 678.05 | N | Y | N/A | N/A
64836 | SUTURE 1 NERVE ULNAR MOTOR | 2011-07-01 00:00:00 | 678.63 | N | Y | N/A | N/A
64837 | SUTURE EACH ADDITIONAL NERVE HAND/FOOT | 2011-07-01 00:00:00 | 308.51 | N | Y | N/A | N/A
64840 | SUTURE POSTERIOR TIBIAL NERVE | 2011-07-01 00:00:00 | 751.82 | N | Y | N/A | N/A
64856 | SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS | 2011-07-01 00:00:00 | 852.49 | N | Y | N/A | N/A
64857 | SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS | 2011-07-01 00:00:00 | 888.18 | N | Y | N/A | N/A
64858 | SUTURE SCIATIC NERVE | 2011-07-01 00:00:00 | 1022.7 | N | Y | N/A | N/A
64859 | SUTURE EACH ADDITIONAL PERIPHERAL NERVE | 2011-07-01 00:00:00 | 222.62 | N | Y | N/A | N/A
64861 | SUTURE BRACHIAL PLEXUS | 2011-07-01 00:00:00 | 1082.55 | N | Y | N/A | N/A
64862 | SUTURE LUMBAR PLEXUS | 2011-07-01 00:00:00 | 1194.57 | N | Y | N/A | N/A
64864 | SUTURE FACIAL NERVE EXTRACRANIAL | 2011-07-01 00:00:00 | 737.09 | N | Y | N/A | N/A
64865 | SUTURE FACIAL NERVE INFRATEMPORAL W/WO GRAFT | 2011-07-01 00:00:00 | 972.34 | N | Y | N/A | N/A
64866 | [NAME] ACCESSORY | 2011-07-01 00:00:00 | 977.46 | N | Y | N/A | N/A
64868 | [NAME] | 2011-07-01 00:00:00 | 886.68 | N | Y | N/A | N/A
64870 | [NAME] | 2011-07-01 00:00:00 | 907.71 | N | Y | N/A | N/A
64872 | SUTURE NERVE REQ SECONDARY/DELAYED SUTURE | 2011-07-01 00:00:00 | 98.85 | N | Y | N/A | N/A
64874 | SUTURE NERVE REQ XTNSV MOBIL/TRPOS NERVE | 2011-07-01 00:00:00 | 150.36 | N | Y | N/A | N/A
64876 | SUTURE NERVE REQ SHORTENING BONE EXTREMITY | 2011-07-01 00:00:00 | 164.3 | N | Y | N/A | N/A
64885 | NERVE GRAFT HEAD/NECK LT 4 CM | 2011-07-01 00:00:00 | 953.27 | N | Y | N/A | N/A
64886 | NERVE GRAFT HEAD/NECK GT4 CM | 2011-07-01 00:00:00 | 1118.77 | N | Y | N/A | N/A
64890 | NERVE GRAFT 1 STRAND HAND/FOOT LT4 CM | 2011-07-01 00:00:00 | 910.13 | N | Y | N/A | N/A
64891 | NRV GRF 1 STRAND HAND/FOOT GT4 CM | 2011-07-01 00:00:00 | 988.47 | N | Y | N/A | N/A
64892 | NERVE GRAFT 1 STRAND ARM/LEG LT4 CM | 2011-07-01 00:00:00 | 882.77 | N | Y | N/A | N/A
64893 | NERVE GRAFT 1 STRAND ARM/LEG GT4 CM | 2011-07-01 00:00:00 | 945 | N | Y | N/A | N/A
64895 | NERVE GRAFT MLT STRANDS HAND/FOOT LT4 CM | 2011-07-01 00:00:00 | 1139.73 | N | Y | N/A | N/A
64896 | NERVE GRAFT MLT STRANDS HAND/FOOT GT 4 CM | 2011-07-01 00:00:00 | 1253.87 | N | Y | N/A | N/A
64897 | NERVE GRAFT MLT STRANDS ARM/LEG LT4 CM | 2011-07-01 00:00:00 | 1073.22 | N | Y | N/A | N/A
64898 | NERVE GRAFT MLT STRANDS ARM/LEG GT4 CM | 2011-07-01 00:00:00 | 1158.59 | N | Y | N/A | N/A
64901 | NERVE GRAFT EACH NERVE 1 STRAND | 2011-07-01 00:00:00 | 530.86 | N | Y | N/A | N/A
64902 | NERVE GRAFT EACH NERVE MULTIPLE STRANDS | 2011-07-01 00:00:00 | 612.62 | N | Y | N/A | N/A
64905 | NERVE PEDICLE TRANSFER FIRST STAGE | 2011-07-01 00:00:00 | 861.35 | N | Y | N/A | N/A
64907 | NERVE PEDICAL TRANSFER SECOND STAGE | 2011-07-01 00:00:00 | 994.32 | N | Y | N/A | N/A
64910 | NERVE REPAIR W/CONDUIT EACH NERVE | 2011-07-01 00:00:00 | 690.14 | N | Y | N/A | N/A
64911 | NERVE REPAIR W/AUTOGENOUS VEIN GRAFT EA NERVE | 2011-07-01 00:00:00 | 857.07 | N | Y | N/A | N/A
64999 | UNLISTED PROCEDURE, [NAME] SYSTEM | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
65091 | [NAME] CONTENTS W/O IMPLANT | 2011-07-01 00:00:00 | 525.46 | N | Y | N/A | N/A
65093 | [NAME] CONTENTS W/IMPLANT | 2011-07-01 00:00:00 | 520.74 | N | Y | N/A | N/A
65101 | ENUCLEATION OF EYE W/O IMPLANT | 2011-07-01 00:00:00 | 608.73 | N | Y | N/A | N/A
65103 | ENUCLEATION EYE IMPLT MUSC X ATTACHED IMPLT | 2011-07-01 00:00:00 | 636.11 | N | Y | N/A | N/A
65105 | ENUCLEATION EYE IMPLT MUSC ATTACHED IMPLT | 2011-07-01 00:00:00 | 701.95 | N | Y | N/A | N/A
65110 | EXENTERATION ORBIT REMVL ORBITAL CONTENTS ONLY | 2011-07-01 00:00:00 | 996.62 | N | Y | N/A | N/A
65112 | EXENTERATION ORBIT RMVL ORBIT CONTENTS & BONE | 2011-07-01 00:00:00 | 1164.22 | N | Y | N/A | N/A
65114 | EXNTJ ORBIT RMVL ORB CNTS W/MUSC/MYOQ FLAP | 2011-07-01 00:00:00 | 1219.93 | N | Y | N/A | N/A
65125 | MODIFICAJ OC IMPLT W/PLMT/RPLCMT PEGS SPX | 2011-07-01 00:00:00 | 370.13 | N | Y | N/A | N/A
65130 | INSJ OC IMPLT SEC AFTER EVSC SCLL SHELL | 2011-07-01 00:00:00 | 603.53 | N | Y | N/A | N/A
65135 | INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED | 2011-07-01 00:00:00 | 613.42 | N | Y | N/A | N/A
65140 | INSJ OC IMPLT AFTER ENCL MUSC ATTACHED | 2011-07-01 00:00:00 | 657.5 | N | Y | N/A | N/A
65150 | REINSERTION OCULAR IMPLT W/WO CONJUNCTIVAL GRAFT | 2011-07-01 00:00:00 | 464.59 | N | Y | N/A | N/A
65155 | REINSERTION OCULAR IMPLT RNFCMT&/ATTACHMENT MUSC | 2011-07-01 00:00:00 | 702.02 | N | Y | N/A | N/A
65175 | REMOVAL OCULAR IMPLANT | 2011-07-01 00:00:00 | 534.14 | N | Y | N/A | N/A
65205 | REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL | 2011-07-01 00:00:00 | 45.67 | N | Y | N/A | N/A
65210 | RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR | 2011-07-01 00:00:00 | 56.62 | N | Y | N/A | N/A
65220 | RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP | 2011-07-01 00:00:00 | 46.99 | N | Y | N/A | N/A
65222 | RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP | 2011-07-01 00:00:00 | 62.32 | N | Y | N/A | N/A
65235 | RMVL FB INTRAOCULAR ANT CHAMBER EYE/LENS | 2011-07-01 00:00:00 | 578.06 | N | Y | N/A | N/A
65260 | RMVL FB IO FROM POST SEG MAG XTRJ ANT/POST ROUTE | 2011-07-01 00:00:00 | 769.39 | N | Y | N/A | N/A
65265 | RMVL FB IO FROM POST SEG NONMAGNETIC XTRJ | 2011-07-01 00:00:00 | 902.71 | N | Y | N/A | N/A
65270 | RPR LAC CJNC W/WO NONPERFOR LAC SCLERA DIR CLSR | 2011-07-01 00:00:00 | 214.59 | N | Y | N/A | N/A
65272 | RPR LAC CJNC MOBLJ&REARGMT W/O HOSPIZATION | 2011-07-01 00:00:00 | 399.36 | N | Y | N/A | N/A
65273 | RPR LAC CJNC MOBLJ&REARGMT W/HOSPIZATION | 2011-07-01 00:00:00 | 307 | N | Y | N/A | N/A
65275 | RPR LAC CORNEA NONPERFOR W/WO RMVL FOREIGN BODY | 2011-07-01 00:00:00 | 462.01 | N | Y | N/A | N/A
65280 | RPR LAC CORNEA&/SCLERA PERFOR X INVG UVEAL TISS | 2011-07-01 00:00:00 | 557.45 | N | Y | N/A | N/A
65285 | RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL TIS | 2011-07-01 00:00:00 | 862.37 | N | Y | N/A | N/A
65286 | RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA | 2011-07-01 00:00:00 | 569.99 | N | Y | N/A | N/A
65290 | RPR WND EXTRAOCULAR MUSCLE TENDON&/TENON CAPSULE | 2011-07-01 00:00:00 | 409.21 | N | Y | N/A | N/A
65400 | EXCISION LESION [NAME] | 2011-07-01 00:00:00 | 550.13 | N | Y | N/A | N/A
65410 | BIOPSY CORNEA | 2011-07-01 00:00:00 | 118.13 | N | Y | N/A | N/A
65420 | EXCISION/TRANSPOSITION PTERYGIUM W/O GRAFT | 2011-07-01 00:00:00 | 415.91 | N | Y | N/A | N/A
65426 | EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG | 2011-07-01 00:00:00 | 527.09 | N | Y | N/A | N/A
65430 | CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE | 2011-07-01 00:00:00 | 94.36 | N | Y | N/A | N/A
65435 | RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION | 2011-07-01 00:00:00 | 65.83 | N | Y | N/A | N/A
65436 | RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT | 2011-07-01 00:00:00 | 318.95 | N | Y | N/A | N/A
65450 | DSTRJ LESION CRYOTHER PHOTO/THERMOCAUTZATION | 2011-07-01 00:00:00 | 262.72 | N | Y | N/A | N/A
65600 | MULTIPLE PUNCTURES ANTERIOR CORNEA | 2011-07-01 00:00:00 | 319.15 | N | Y | N/A | N/A
65710 | KERATOPLASTY ANTERIOR [NAME] | 2011-07-01 00:00:00 | 906.55 | N | Y | N/A | N/A
65730 | KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA | 2011-07-01 00:00:00 | 1006.4 | N | Y | N/A | N/A
65750 | KERATOPLASTY PENETRAING APHAKIA | 2011-07-01 00:00:00 | 1012.76 | N | Y | N/A | N/A
65755 | KERATOPLASTY PENETRATING PSEUDOPHAKIA | 2011-07-01 00:00:00 | 1009.94 | N | Y | N/A | N/A
65756 | KERATOPLASTY ENDOTHELIAL | 2011-07-01 00:00:00 | 954.05 | N | Y | N/A | N/A
65760 | KERATOMILEUSIS | 2008-07-01 00:00:00 | 1835.6899 | N | Y | N/A | N/A
65765 | KERATOPHAKIA | 2008-07-01 00:00:00 | 1836.8199 | N | Y | N/A | N/A
65767 | EPIKERATOPLASTY | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
65770 | KERATOPROSTHESIS | 2011-07-01 00:00:00 | 1234.97 | N | Y | N/A | N/A
65771 | RADIAL KERATOTOMY | 2008-07-01 00:00:00 | 928.33 | N | Y | N/A | N/A
65772 | CRNL RELAXING INC CORRJ INDUCED ASTIGMATISM | 2011-07-01 00:00:00 | 365.41 | N | Y | N/A | N/A
65775 | CRNL WEDGE RESCJ CORRJ INDUCED ASTIGMATISM | 2011-07-01 00:00:00 | 442.77 | N | Y | N/A | N/A
65778 | PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN | 2011-07-01 00:00:00 | 1064.93 | N | Y | N/A | N/A
65779 | PLACE AMNIOTIC MEMBRANE OCULAR SURFACE SUTURED | 2011-07-01 00:00:00 | 963.88 | N | Y | N/A | N/A
65780 | OCULAR SURFACE RECONSTRUCTION AMNIOTIC MEMBRANE | 2011-07-01 00:00:00 | 724.11 | N | Y | N/A | N/A
65781 | OCULAR SURFACE RECONSTRUCTION LIMBAL ALLOGRAFT | 2011-07-01 00:00:00 | 1078.54 | N | Y | N/A | N/A
65782 | OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT | 2011-07-01 00:00:00 | 964.52 | N | Y | N/A | N/A
65800 | PARACENTSIS ANT CHAMB EYE W/DX ASPIR AQUEOUS SPX | 2011-07-01 00:00:00 | 122.53 | N | Y | N/A | N/A
65810 | [NAME] | 2011-07-01 00:00:00 | 384.99 | N | Y | N/A | N/A
65815 | PARACEN ANT CHAM RMVL BLOOD W/WO IRRIG&/AIR INJX | 2011-07-01 00:00:00 | 520.36 | N | Y | N/A | N/A
65820 | GONIOTOMY | 2011-07-01 00:00:00 | 600.38 | N | Y | N/A | N/A
65850 | TRABECULOTOMY AB EXTERNO | 2011-07-01 00:00:00 | 698.56 | N | Y | N/A | N/A
65855 | TRABECULOPLASTY LASER SURG 1/GT SESSIONS | 2011-07-01 00:00:00 | 278.65 | N | Y | N/A | N/A
65860 | SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX | 2011-07-01 00:00:00 | 267.81 | N | Y | N/A | N/A
65865 | SEVERING ADS ANT SEG INCAL TQ SPX GONIOSYNECHIAE | 2011-07-01 00:00:00 | 379.92 | N | Y | N/A | N/A
65870 | SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE | 2011-07-01 00:00:00 | 487.59 | N | Y | N/A | N/A
65875 | SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE | 2011-07-01 00:00:00 | 514.06 | N | Y | N/A | N/A
65880 | SEVERING ADS ANT SEG INCAL SPX CORNEOVITREAL | 2011-07-01 00:00:00 | 531.42 | N | Y | N/A | N/A
65900 | RMVL EPITHELIAL DOWNGROWTH ANT CHAMBER EYE | 2011-07-01 00:00:00 | 775.4 | N | Y | N/A | N/A
65920 | RMVL IMPLANTED MATERIAL ANTERIO SEGMENT EYE | 2011-07-01 00:00:00 | 641.78 | N | Y | N/A | N/A
65930 | RMVL BLOOD CLOT ANTERIOR SEGMENT EYE | 2011-07-01 00:00:00 | 529.57 | N | Y | N/A | N/A
66020 | INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX | 2011-07-01 00:00:00 | 148.67 | N | Y | N/A | N/A
66030 | INJX ANTERIOR CHAMBER EYE MEDICATION SPX | 2011-07-01 00:00:00 | 133.73 | N | Y | N/A | N/A
66130 | EXCISION LESION SCLERA | 2011-07-01 00:00:00 | 579.9 | N | Y | N/A | N/A
66150 | FSTLJ SCLERA GLAUCOMA TREPHIN W/IRIDECTOMY | 2011-07-01 00:00:00 | 698.96 | N | Y | N/A | N/A
66155 | FSTLJ SCLERA GLAUCOMA THERMOCAUT IRRIDEC | 2011-07-01 00:00:00 | 698.36 | N | Y | N/A | N/A
66160 | FSTLJ SCLERA SCLERECTOMY PUNCH/SCISSORS IRIDECT | 2011-07-01 00:00:00 | 790.58 | N | Y | N/A | N/A
66165 | FSTLJ SCLERA GLAUCOMA IRIDENCLEISIS/IRIDOTASIS | 2011-07-01 00:00:00 | 684.73 | N | Y | N/A | N/A
66170 | FSTLJ SCLERA GLAUCOMA TRABECULECT AB EXTERNO | 2011-07-01 00:00:00 | 974.72 | N | Y | N/A | N/A
66172 | FSTLJ SCLERA GLC TRBEC AB EXTERNO SCARRING | 2011-07-01 00:00:00 | 1228.17 | N | Y | N/A | N/A
66174 | TRLUML DILAT AQUEOUS CANAL W/O DEVICE/STENT | 2011-07-01 00:00:00 | 830.29 | N | Y | N/A | N/A
66175 | TRLUML DILAT AQUEOUS CANAL W/DEVICE/STENT | 2011-07-01 00:00:00 | 913.69 | N | Y | N/A | N/A
66180 | AQUEOUS SHUNT EXTRAOCULAR RESERVOIR | 2011-07-01 00:00:00 | 956.81 | N | Y | N/A | N/A
66183 | INSERT ANTER DRAINAGE DEV W/O EXTRAOC RESERVOIR | 2014-01-01 00:00:00 | 898.79 | N | Y | N/A | N/A
66185 | REVISION AQUEOUS SHUNT EXTRAOCULAR RESERVOIR | 2011-07-01 00:00:00 | 617.44 | N | Y | N/A | N/A
66220 | REPAIR SCLERAL STAPHYLOMA W/O GRAFT | 2011-07-01 00:00:00 | 601.14 | N | Y | N/A | N/A
66225 | REPAIR SCLERAL STAPHYLOMA W/GRAFT | 2011-07-01 00:00:00 | 776.77 | N | Y | N/A | N/A
66250 | REVJ/RPR OPRATIVE WOUND ANTERIOR SEGMENT | 2011-07-01 00:00:00 | 613.86 | N | Y | N/A | N/A
66500 | IRIDOTOMY STAB INC SPX XCP TRANSFIXION | 2011-07-01 00:00:00 | 282.46 | N | Y | N/A | N/A
66505 | IRIDOTOMY STAB INC SPX TRANSFIXION | 2011-07-01 00:00:00 | 309.61 | N | Y | N/A | N/A
66600 | IRDEC CRNLSCLRL/CRNL SCTJ RMVL LES | 2011-07-01 00:00:00 | 662.72 | N | Y | N/A | N/A
66605 | IRDEC CRNLSCLRL/CRNL SCTJ CYCLECTOMY | 2011-07-01 00:00:00 | 848.58 | N | Y | N/A | N/A
66625 | IRDEC CRNLSCLRL/CRNL SCTJ PRPH GLC SPX | 2011-07-01 00:00:00 | 350.27 | N | Y | N/A | N/A
66630 | IRDEC CRNLSCLRL/CRNL SCTJ SECTOR GLC SPX | 2011-07-01 00:00:00 | 468.3 | N | Y | N/A | N/A
66635 | IRDEC CRNLSCLRL/CRNL SCTJ OPTICAL SPX | 2011-07-01 00:00:00 | 460.53 | N | Y | N/A | N/A
66680 | [NAME] | 2011-07-01 00:00:00 | 428.54 | N | Y | N/A | N/A
66682 | [NAME] BODY SPX RETRIEVAL SUTURE | 2011-07-01 00:00:00 | 521.32 | N | Y | N/A | N/A
66700 | [NAME] DIATHERMY | 2011-07-01 00:00:00 | 361.54 | N | Y | N/A | N/A
66710 | [NAME] TRANSSCERAL | 2011-07-01 00:00:00 | 364.18 | N | Y | N/A | N/A
66711 | [NAME] ENDOSCOPIC | 2011-07-01 00:00:00 | 513.25 | N | Y | N/A | N/A
66720 | [NAME] CRYOTHERAPY | 2011-07-01 00:00:00 | 379.9 | N | Y | N/A | N/A
66740 | [NAME] CYCLODIAL | 2011-07-01 00:00:00 | 349.87 | N | Y | N/A | N/A
66761 | IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION | 2011-07-01 00:00:00 | 267.44 | N | Y | N/A | N/A
66762 | IRIDOPLASTY PHOTOCOAGULATION 1/GT SESSIONS | 2011-07-01 00:00:00 | 384.61 | N | Y | N/A | N/A
66770 | DSTRJ CYST/LESION IRIS/CILIARY BODY | 2011-07-01 00:00:00 | 421.16 | N | Y | N/A | N/A
66820 | DISCISSION SECONDARY MEMBRANOUS CATARACT | 2011-07-01 00:00:00 | 322.07 | N | Y | N/A | N/A
66821 | POST-CATARACT LASER SURGERY | 2011-07-01 00:00:00 | 266.97 | N | Y | N/A | N/A
66825 | REPOSITIONING IO LENS PROSTHESIS REQ INC SPX | 2011-07-01 00:00:00 | 618.36 | N | Y | N/A | N/A
66830 | RMVL SEC MEMBRANOUS CTRC CORNEO-SCLL SCTJ | 2011-07-01 00:00:00 | 572.93 | N | Y | N/A | N/A
66840 | RMVL LENS MATERIAL ASPIR TQ 1/GT STAGES | 2011-07-01 00:00:00 | 578.82 | N | Y | N/A | N/A
66850 | RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR | 2011-07-01 00:00:00 | 649.19 | N | Y | N/A | N/A
66852 | RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY | 2011-07-01 00:00:00 | 700.51 | N | Y | N/A | N/A
66920 | RMVL LENS MATERIAL INTRACAPSULAR | 2011-07-01 00:00:00 | 606.5 | N | Y | N/A | N/A
66930 | REMOVAL LENS MATRL INTRACAPSULAR DISLOCATED LENS | 2011-07-01 00:00:00 | 689.44 | N | Y | N/A | N/A
66940 | REMOVAL LENS MATERIAL EXTRACAPSULAR | 2011-07-01 00:00:00 | 645.41 | N | Y | N/A | N/A
66982 | XCAPSULAR CATARACT RMVL INSJ LENS PROSTH 1 STG | 2011-07-01 00:00:00 | 875.2 | N | Y | N/A | N/A
66983 | ICAPSULAR CATARACT XTRJ INSJ IO LENS PRSTH 1 STG | 2011-07-01 00:00:00 | 600.18 | N | Y | N/A | N/A
66984 | CATARACT REMOVAL INSERTION OF LENS | 2011-07-01 00:00:00 | 629.68 | N | Y | N/A | N/A
66985 | INSJ IO LENS PROSTHESIS X W/CONCURRENT RMVL | 2011-07-01 00:00:00 | 627.06 | N | Y | N/A | N/A
66986 | EXCHANGE INTRAOCULAR LENS | 2011-07-01 00:00:00 | 746.66 | N | Y | N/A | N/A
66990 | USE OPHTHALMIC ENDOSCOPE | 2011-07-01 00:00:00 | 74.16 | N | Y | N/A | N/A
66999 | UNLISTED ANTERIOR SEG PROC | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
67005 | RMVL VITREOUS ANT APPR PARTIAL REMOVAL | 2011-07-01 00:00:00 | 392.29 | N | Y | N/A | N/A
67010 | RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT | 2011-07-01 00:00:00 | 443.53 | N | Y | N/A | N/A
67015 | ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL | 2011-07-01 00:00:00 | 473.54 | N | Y | N/A | N/A
67025 | INJ SUBSTITUTE PARS PLANA/LIMBL W/WO ASPIR SPX | 2011-07-01 00:00:00 | 595.57 | N | Y | N/A | N/A
67027 | IMPLTJ INTRAVITREAL DRUG DLVR SYS RMVL VTS | 2011-07-01 00:00:00 | 706.01 | N | Y | N/A | N/A
67028 | INTRAVITREAL NJX PHARMACOLOGIC AGT SPX | 2011-07-01 00:00:00 | 109.24 | N | Y | N/A | N/A
67030 | [NAME] PARS PLANA APPROACH | 2011-07-01 00:00:00 | 422.56 | N | Y | N/A | N/A
67031 | SEVERING VITREOUS STRANS LASER 1/GT STAGES | 2011-07-01 00:00:00 | 315.12 | N | Y | N/A | N/A
67036 | VITRECTOMY MECHANICAL PARS PLANA | 2011-07-01 00:00:00 | 789.5 | N | Y | N/A | N/A
67039 | VITRECTOMY MCHNL PARS PLNA FOCAL ENDOLASER PC | 2011-07-01 00:00:00 | 1025.5 | N | Y | N/A | N/A
67040 | VTRECTOMY MCHNL PARS PLNA ENDOLASER PANRTA PC | 2011-07-01 00:00:00 | 1168.34 | N | Y | N/A | N/A
67041 | VITRECTOMY PARS PLANA REMOVE PRERETINAL MEMBRANE | 2011-07-01 00:00:00 | 1090.71 | N | Y | N/A | N/A
67042 | VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA | 2011-07-01 00:00:00 | 1247.64 | N | Y | N/A | N/A
67043 | VITRECTOMY PARS PLANA REMOVE SUBRETINAL MEMBRANE | 2011-07-01 00:00:00 | 1326.49 | N | Y | N/A | N/A
67101 | RPR RETINAL DTCHMNT 1/GTSES CRYOTX/DTHRM W/WO DRG | 2011-07-01 00:00:00 | 640.79 | N | Y | N/A | N/A
67105 | RPR RETINAL DTCHMNT 1/GT SES PC W/WO DRG SUBRETIN | 2011-07-01 00:00:00 | 586.39 | N | Y | N/A | N/A
67107 | RPR RETINAL DTCHMNT SCLERAL BUCKLING W/WO IMPLT | 2011-07-01 00:00:00 | 1009.52 | N | Y | N/A | N/A
67108 | RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH | 2011-07-01 00:00:00 | 1322.65 | N | Y | N/A | N/A
67110 | RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS | 2011-07-01 00:00:00 | 706.02 | N | Y | N/A | N/A
67112 | RPR RETINAL DTCHMNT SCLERAL BUCKLING/VITRECTOMY | 2011-07-01 00:00:00 | 1091.21 | N | Y | N/A | N/A
67113 | RPR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL | 2011-07-01 00:00:00 | 1436.4 | N | Y | N/A | N/A
67115 | RELEASE ENCIRCLING MATERIAL POSTERIOR SEGMENT | 2011-07-01 00:00:00 | 404.35 | N | Y | N/A | N/A
67120 | RMVL IMPLNT MATL POSTERIOR SEGMENT EXTRAOCULAR | 2011-07-01 00:00:00 | 540.91 | N | Y | N/A | N/A
67121 | RMVL IMPLT MATRL POSTERIOR SEGMENT INTRAOCULAR | 2011-07-01 00:00:00 | 752.63 | N | Y | N/A | N/A
67141 | PROPH RTA DTCHMNT W/O DRG 1/GT SESS CRTX DTHRM | 2011-07-01 00:00:00 | 429.44 | N | Y | N/A | N/A
67145 | PROPH RTA DTCHMNT W/O DRG 1/GT SESS | 2011-07-01 00:00:00 | 428.61 | N | Y | N/A | N/A
67208 | DSTRJ LOCLZD LES RETINA 1/GT SESS CRTX DTHRM | 2011-07-01 00:00:00 | 480.23 | N | Y | N/A | N/A
67210 | DSTRJ LOCLZD LES RETINA 1/GT SESS PC | 2011-07-01 00:00:00 | 568.37 | N | Y | N/A | N/A
67218 | DSTRJ LES RETINA 1/GT SESS RADJ IMPLTJ | 2011-07-01 00:00:00 | 1121.32 | N | Y | N/A | N/A
67220 | DSTRJ LES CHOROID PC 1/GT SESS | 2011-07-01 00:00:00 | 881.42 | N | Y | N/A | N/A
67221 | DSTRJ LES CHOROID PDT | 2011-07-01 00:00:00 | 239.04 | Y | Y | N/A | N/A
67225 | DSTRJ LES CHOROID PDT 2ND EYE 1 SESS | 2011-07-01 00:00:00 | 24.42 | N | Y | N/A | N/A
67227 | DESTRUCTION RETINOPATHY 1/GT SESS DIATHERMY | 2011-07-01 00:00:00 | 488.96 | N | Y | N/A | N/A
67228 | EXTENSIVE RETINOPATHY 1/GT SESS PHOTOCOAGULATION | 2011-07-01 00:00:00 | 961.65 | N | Y | N/A | N/A
67229 | EXTENSIVE RETINOPATHY 1/GT SESS PRETERM INFANT | 2011-07-01 00:00:00 | 920.3 | N | Y | N/A | N/A
67250 | SCLERAL REINFORCEMENT SPX W/O GRAFT | 2011-07-01 00:00:00 | 644.29 | N | Y | N/A | N/A
67255 | SCLERAL REINFORCEMENT SPX W/GRAFT | 2011-07-01 00:00:00 | 697.59 | N | Y | N/A | N/A
67299 | UNLISTED PROCEDURE POSTERIOR SEGMENT | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
67311 | STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC | 2011-07-01 00:00:00 | 493.51 | N | Y | N/A | N/A
67312 | STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC | 2011-07-01 00:00:00 | 593.8 | N | Y | N/A | N/A
67314 | STRABISMUS RECESSION/RESCJ 1 VER MUSC | 2011-07-01 00:00:00 | 554.48 | N | Y | N/A | N/A
67316 | STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC | 2011-07-01 00:00:00 | 667.4 | N | Y | N/A | N/A
67318 | STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE | 2011-07-01 00:00:00 | 564.88 | N | Y | N/A | N/A
67320 | TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC | 2011-07-01 00:00:00 | 263.18 | N | Y | N/A | N/A
67331 | STRABISMUS PREVIOUS EYE X INVOLVE EO MUSC | 2011-07-01 00:00:00 | 257.84 | N | Y | N/A | N/A
67332 | STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY | 2011-07-01 00:00:00 | 280.29 | N | Y | N/A | N/A
67334 | STRABISMUS POST FIXJ SUTR TQ W/WO MUSC RECESSION | 2011-07-01 00:00:00 | 246.19 | N | Y | N/A | N/A
67335 | [NAME] | 2011-07-01 00:00:00 | 126.28 | N | Y | N/A | N/A
67340 | STRABISMUS EXPL&/RPR DETACHED EXTROCULAR MUSC | 2011-07-01 00:00:00 | 292.9 | N | Y | N/A | N/A
67343 | RLS XTNSV SCAR TISS W/O DETACHING EO MUSC SPX | 2011-07-01 00:00:00 | 542.37 | N | Y | N/A | N/A
67345 | CHEMODENERVATION EXTRAOCULAR MUSCLE | 2011-07-01 00:00:00 | 198.59 | N | Y | N/A | N/A
67346 | BIOPSY EXTRAOCULAR MUSCLE | 2011-07-01 00:00:00 | 169.66 | N | Y | N/A | N/A
67399 | UNLISTED EYE MUSCLE PROC | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
67400 | ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY | 2011-07-01 00:00:00 | 770.57 | N | Y | N/A | N/A
67405 | ORBITOTOMY W/O BONE FLAP EXPL W/DRAINAGE ONLY | 2011-07-01 00:00:00 | 646.55 | N | Y | N/A | N/A
67412 | ORBITOTOMY W/O BONE FLAP W/REMOVAL LESION | 2011-07-01 00:00:00 | 707.08 | N | Y | N/A | N/A
67413 | ORBITOTOMY W/O BONE FLAP W/RMVL FOREIGN BODY | 2011-07-01 00:00:00 | 711.44 | N | Y | N/A | N/A
67414 | ORBITOTOMY W/O BONE FLAP W/RMVL BONE DCMPRN | 2011-07-01 00:00:00 | 1082.3 | N | Y | N/A | N/A
67415 | FINE NEEDLE ASPIRATION ORBITAL CONTENTS | 2011-07-01 00:00:00 | 88 | N | Y | N/A | N/A
67420 | ORBITOTOMY BONE FLAP/WINDOW LAT RMVL LESION | 2011-07-01 00:00:00 | 1358.06 | N | Y | N/A | N/A
67430 | ORBITOTOMY BONE FLAP/WINDOW LATERAL RMVL FB | 2011-07-01 00:00:00 | 1003.06 | N | Y | N/A | N/A
67440 | ORBITOTOMY BONE FLAP/WINDOW LATERAL W/DRG | 2011-07-01 00:00:00 | 984.91 | N | Y | N/A | N/A
67445 | ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN | 2011-07-01 00:00:00 | 1173.69 | N | Y | N/A | N/A
67450 | ORBITOTOMY BONE FLAP/WINDOW LAT EXPL W/WO BX | 2011-07-01 00:00:00 | 1023.57 | N | Y | N/A | N/A
67500 | [NAME] | 2011-07-01 00:00:00 | 69.89 | N | Y | N/A | N/A
67505 | [NAME] ALCOHOL | 2011-07-01 00:00:00 | 74.53 | N | Y | N/A | N/A
67515 | INJECTION MEDICATION/OTHER SUBST TENON CAPSULE | 2011-07-01 00:00:00 | 79.94 | N | Y | N/A | N/A
67550 | ORBITAL IMPLANT INSERTION | 2011-07-01 00:00:00 | 802.4 | N | Y | N/A | N/A
67560 | ORBITAL IMPLANT REMOVAL/REVISION | 2011-07-01 00:00:00 | 807.94 | N | Y | N/A | N/A
67570 | OPTIC NERVE DECOMPRESSION | 2011-07-01 00:00:00 | 995.13 | N | Y | N/A | N/A
67599 | UNLISTED ORBIT PROC | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
67700 | BLEPHAROTOMY DRAINAGE ABSCESS EYELID | 2011-07-01 00:00:00 | 214.66 | N | Y | N/A | N/A
67710 | SEVERING TARSORRHAPHY | 2011-07-01 00:00:00 | 181.04 | N | Y | N/A | N/A
67715 | CANTHOTOMY SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 191.31 | N | Y | N/A | N/A
67800 | EXCISION CHALAZION SINGLE | 2011-07-01 00:00:00 | 104.12 | N | Y | N/A | N/A
67801 | EXCISION CHALAZION MULTIPLE SAME LID | 2011-07-01 00:00:00 | 134.08 | N | Y | N/A | N/A
67805 | EXCISION CHALAZION MULTIPLE DIFFERENT LIDS | 2011-07-01 00:00:00 | 166.5 | N | Y | N/A | N/A
67808 | EXC CHALAZION ANES REQ HOSPIZATION SINGLE/MULT | 2011-07-01 00:00:00 | 304.91 | N | Y | N/A | N/A
67810 | BIOPSY EYELID | 2011-07-01 00:00:00 | 180.59 | N | Y | N/A | N/A
67820 | [NAME] FORCEPS ONLY | 2011-07-01 00:00:00 | 42.38 | N | Y | N/A | N/A
67825 | [NAME] OTH/THAN FORCEPS | 2011-07-01 00:00:00 | 106.12 | N | Y | N/A | N/A
67830 | [NAME] INCCISION LID MARGIN | 2011-07-01 00:00:00 | 216.32 | N | Y | N/A | N/A
67835 | CORRJ TRICHIASIS INC LID MRGN W/FR MUC MEMB GRF | 2011-07-01 00:00:00 | 365.92 | N | Y | N/A | N/A
67840 | EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE | 2011-07-01 00:00:00 | 224.7 | N | Y | N/A | N/A
67850 | DESTRUCTION LESION LID MRGN LT 1 CM | 2011-07-01 00:00:00 | 179.09 | N | Y | N/A | N/A
67875 | TEMPORARY CLOSURE EYELIDS SUTURE | 2011-07-01 00:00:00 | 140.06 | N | Y | N/A | N/A
67880 | CONSTJ INTERMARGIN ADHES/TARSORRH/CANTHORRHAPY | 2011-07-01 00:00:00 | 374.45 | N | Y | N/A | N/A
67882 | CONSTJ INTERMARGIN ADHES/TARSOR/CANTHOR W/TRPOS | 2011-07-01 00:00:00 | 463.96 | N | Y | N/A | N/A
67900 | REPAIR BROW PTOSIS | 2011-07-01 00:00:00 | 527.76 | N | Y | N/A | N/A
67901 | RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL | 2011-07-01 00:00:00 | 595.42 | N | Y | N/A | N/A
67902 | RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING | 2011-07-01 00:00:00 | 599.33 | N | Y | N/A | N/A
67903 | RPR [NAME]ADVMNT INTERNAL | 2011-07-01 00:00:00 | 497.24 | N | Y | N/A | N/A
67904 | RPR [NAME]ADVMNT XTRNL | 2011-07-01 00:00:00 | 602.2 | N | Y | N/A | N/A
67906 | RPR BLEPHAROPTOSIS SUPERIOR RECTUS FASCIAL SLING | 2011-07-01 00:00:00 | 411.08 | N | Y | N/A | N/A
67908 | RPR BLPOS CONJUNCTIVO-TARSO-MUSC-LEVATOR RESCJ | 2011-07-01 00:00:00 | 406.5 | N | Y | N/A | N/A
67909 | REDUCTION OVERCORRECTION PTOSIS | 2011-07-01 00:00:00 | 442.46 | N | Y | N/A | N/A
67911 | [NAME] RETRACTION | 2011-07-01 00:00:00 | 464.62 | N | Y | N/A | N/A
67912 | CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD | 2011-07-01 00:00:00 | 727.49 | N | Y | N/A | N/A
67914 | REPAIR ECTROPION SUTURE | 2011-07-01 00:00:00 | 318.9 | N | Y | N/A | N/A
67915 | REPAIR ECTROPION THERMOCAUTERIZATION | 2011-07-01 00:00:00 | 282.3 | N | Y | N/A | N/A
67916 | REPAIR ECTROPION EXCISION TARSAL WEDGE | 2011-07-01 00:00:00 | 441.98 | N | Y | N/A | N/A
67917 | REPAIR ECTROPION EXTENSIVE | 2011-07-01 00:00:00 | 483.23 | N | Y | N/A | N/A
67921 | REPAIR ENTROPION SUTURE | 2011-07-01 00:00:00 | 304.86 | N | Y | N/A | N/A
67922 | REPAIR ENTROPION THERMOCAUTERIZATION | 2011-07-01 00:00:00 | 272.92 | N | Y | N/A | N/A
67923 | REPAIR ENTROPION EXCISION TARSAL WEDGE | 2011-07-01 00:00:00 | 467.75 | N | Y | N/A | N/A
67924 | REPAIR ENTROPION EXTENSIVE | 2011-07-01 00:00:00 | 482.54 | N | Y | N/A | N/A
67930 | SUTR WND EYELID/MARGIN/TARSUS/CONJUNC PRTL THICK | 2011-07-01 00:00:00 | 301.37 | N | Y | N/A | N/A
67935 | SUTR WND EYELID/MARGIN/TARSUS/CONJUNC FULL THICK | 2011-07-01 00:00:00 | 491.72 | N | Y | N/A | N/A
67938 | REMOVAL EMBEDDED FOREIGN BODY EYELID | 2011-07-01 00:00:00 | 195.99 | N | Y | N/A | N/A
67950 | CANTHOPLASTY | 2011-07-01 00:00:00 | 473.18 | N | Y | N/A | N/A
67961 | EXCISION & REPAIR EYELID GT ONE-FOURTH LID MARGIN | 2011-07-01 00:00:00 | 474.1 | N | Y | N/A | N/A
67966 | EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN/GT | 2011-07-01 00:00:00 | 633.91 | N | Y | N/A | N/A
67971 | RCNSTJ EYELID FULL THICKNESS LT TWO-THIRDS 1 STG | 2011-07-01 00:00:00 | 608.26 | N | Y | N/A | N/A
67973 | RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG | 2011-07-01 00:00:00 | 785.62 | N | Y | N/A | N/A
67974 | RCNSTJ EYELID FULL THICKNESS UPPER EYELID 1 STG | 2011-07-01 00:00:00 | 783.26 | N | Y | N/A | N/A
67975 | RCNSTJ EYELID FULL THICKNESS SECOND STAGE | 2011-07-01 00:00:00 | 575.02 | N | Y | N/A | N/A
67999 | UNLISTED EYELID PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
68020 | INCISION CONJUNCTIVA DRAINAGE OF CYST | 2011-07-01 00:00:00 | 97.67 | N | Y | N/A | N/A
68040 | EXPRESSION CONJUNCTIVAL FOLLICLES | 2011-07-01 00:00:00 | 54.16 | N | Y | N/A | N/A
68100 | BIOPSY CONJUNCTIVA | 2011-07-01 00:00:00 | 137.92 | N | Y | N/A | N/A
68110 | EXCISION LESION CONJUNCTIVA LT 1 CM | 2011-07-01 00:00:00 | 183.75 | N | Y | N/A | N/A
68115 | EXCISION LESION CONJUNCTIVA GT 1 CM | 2011-07-01 00:00:00 | 251.27 | N | Y | N/A | N/A
68130 | EXCISION LESION CONJUNCTIVA ADJACENT SCLERA | 2011-07-01 00:00:00 | 431.4 | N | Y | N/A | N/A
68135 | DESTRUCTION LESION CONJUNCTIVA | 2011-07-01 00:00:00 | 127.8 | N | Y | N/A | N/A
68200 | SUBCONJUNCTIVAL INJECTION | 2011-07-01 00:00:00 | 34.84 | N | Y | N/A | N/A
68320 | CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT | 2011-07-01 00:00:00 | 591.82 | N | Y | N/A | N/A
68325 | CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT | 2011-07-01 00:00:00 | 548.36 | N | Y | N/A | N/A
68326 | CJP RCNSTJ CUL-DE-SAC BUCCAL GRF/XTNSV REARRGMT | 2011-07-01 00:00:00 | 536.91 | N | Y | N/A | N/A
68328 | CONJUNCTPL CUL-DE-SAC W/BUCCAL MUC MEMB GRAFT | 2011-07-01 00:00:00 | 593.71 | N | Y | N/A | N/A
68330 | RPR SYMBLEPHARON CONJUNCTIVOPLASTY W/O GRAFT | 2011-07-01 00:00:00 | 495.42 | N | Y | N/A | N/A
68335 | RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB | 2011-07-01 00:00:00 | 538.03 | N | Y | N/A | N/A
68340 | RPR & DIV SYMBLEPHARON W/WO CONFORM/CONTACT LENS | 2011-07-01 00:00:00 | 445.54 | N | Y | N/A | N/A
68360 | CONJUNCTIVAL FLAP BRIDGE/PARTIAL SPX | 2011-07-01 00:00:00 | 434.88 | N | Y | N/A | N/A
68362 | CONJUNCTIVAL FLAP TOTAL | 2011-07-01 00:00:00 | 545.73 | N | Y | N/A | N/A
68371 | HARVESTING CONJUNCIVAL ALLOGRAPHY LIVING DONOR | 2011-07-01 00:00:00 | 331.9 | N | Y | N/A | N/A
68399 | UNLISTED CONJUNCTIVA PROC | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
68400 | INCISION DRAINAGE LACRIMAL GLAND | 2011-07-01 00:00:00 | 228.42 | N | Y | N/A | N/A
68420 | INCISION DRAINAGE LACRIMAL SAC | 2011-07-01 00:00:00 | 258.19 | N | Y | N/A | N/A
68440 | SNIP INCISION LACRIMAL PUNCTUM | 2011-07-01 00:00:00 | 86.26 | N | Y | N/A | N/A
68500 | EXCISION LACRIMAL [NAME] TUMOR TOTAL | 2011-07-01 00:00:00 | 819.68 | N | Y | N/A | N/A
68505 | EXCISION LACRIMAL [NAME] PRTL | 2011-07-01 00:00:00 | 811.48 | N | Y | N/A | N/A
68510 | BIOPSY LACRIMAL GLAND | 2011-07-01 00:00:00 | 370.66 | N | Y | N/A | N/A
68520 | EXCISION LACRIMAL SAC | 2011-07-01 00:00:00 | 561.78 | N | Y | N/A | N/A
68525 | BIOPSY LACRIMAL SAC | 2011-07-01 00:00:00 | 226.61 | N | Y | N/A | N/A
68530 | RMVL FB/DACRYOLITH LACRIMAL PASSAGES | 2011-07-01 00:00:00 | 352.67 | N | Y | N/A | N/A
68540 | EXC LACRIMAL GLAND TUMOR FRONTAL APPROACH | 2011-07-01 00:00:00 | 759.78 | N | Y | N/A | N/A
68550 | EXC LACRIMAL GLAND TUMOR W/OSTEOTOMY | 2011-07-01 00:00:00 | 930.74 | N | Y | N/A | N/A
68700 | PLASTIC REPAIR CANALICULI | 2011-07-01 00:00:00 | 502.32 | N | Y | N/A | N/A
68705 | [NAME] CAUTERY | 2011-07-01 00:00:00 | 194.25 | N | Y | N/A | N/A
68720 | DACRYOCSTORHINOSTOMY | 2011-07-01 00:00:00 | 626.57 | N | Y | N/A | N/A
68745 | CONJUNCTIVORHINOSTOMY W/O TUBE | 2011-07-01 00:00:00 | 633.56 | N | Y | N/A | N/A
68750 | CONJUNCTIVORHINOSTOMY INSJ TUBE/STENT | 2011-07-01 00:00:00 | 654.73 | N | Y | N/A | N/A
68760 | CLSR LACRIMAL PUNCTUM THERMOCAUT LIG/LASER | 2011-07-01 00:00:00 | 164.76 | N | Y | N/A | N/A
68761 | CLSR LACRIMAL PUNCTUM PLUG EACH | 2011-07-01 00:00:00 | 120.2 | N | Y | N/A | N/A
68770 | CLOSURE LACRIMAL FISTULA SPX | 2011-07-01 00:00:00 | 510.21 | N | Y | N/A | N/A
68801 | [NAME] IRRGATION | 2011-07-01 00:00:00 | 100.85 | N | Y | N/A | N/A
68810 | PROBE NASOLACRIMAL DUCT W/WO IRRIGATION | 2011-07-01 00:00:00 | 195.98 | N | Y | N/A | N/A
68811 | PROBE NASOLACRIMAL DUCT W/WO IRRIG REQ GEN ANES | 2011-07-01 00:00:00 | 170.97 | N | Y | N/A | N/A
68815 | PROBE NASOLACRIMAL DUCT W/WO IRRG INSJ TUBE/STNT | 2011-07-01 00:00:00 | 362.68 | N | Y | N/A | N/A
68816 | PROBE NASOLACRIMAL DUCT WITH CATHETER DILATION | 2011-07-01 00:00:00 | 573.23 | N | Y | N/A | N/A
68840 | PROBE LACRIMAL CANALICULI W/WO IRRIGATION | 2011-07-01 00:00:00 | 103.93 | N | Y | N/A | N/A
68850 | [NAME] | 2011-07-01 00:00:00 | 51.35 | N | Y | N/A | N/A
68899 | UNLISTED LACRIMAL PROC | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
69000 | DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE | 2011-07-01 00:00:00 | 154.97 | N | Y | N/A | N/A
69005 | DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX | 2011-07-01 00:00:00 | 181.57 | N | Y | N/A | N/A
69020 | DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS | 2011-07-01 00:00:00 | 197.34 | N | Y | N/A | N/A
69100 | BIOPSY EXTERNAL EAR | 2011-07-01 00:00:00 | 87.53 | N | Y | N/A | N/A
69105 | BIOPSY EXTERNAL AUDITORY CANAL | 2011-07-01 00:00:00 | 119.44 | N | Y | N/A | N/A
69110 | EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR | 2011-07-01 00:00:00 | 388.56 | N | Y | N/A | N/A
69120 | EXCISION EXTERNAL EAR COMPLETE AMPUTATION | 2011-07-01 00:00:00 | 343.85 | N | Y | N/A | N/A
69140 | EXCISION EXOSTOSIS EXTERNAL AUDITORY CANAL | 2011-07-01 00:00:00 | 749.99 | N | Y | N/A | N/A
69145 | EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL | 2011-07-01 00:00:00 | 333.79 | N | Y | N/A | N/A
69150 | RAD EXC XTRNL AUDITORY CANAL LES W/O NCK DSJ | 2011-07-01 00:00:00 | 897.81 | N | Y | N/A | N/A
69155 | RAD EXC XTRNL AUDITORY CANAL LES NCK DSJ | 2011-07-01 00:00:00 | 1445.17 | N | Y | N/A | N/A
69200 | RMVL FB XTRNL AUDITORY CANAL W/O ANES | 2011-07-01 00:00:00 | 104.01 | N | Y | N/A | N/A
69205 | RMVL FB XTRNL AUDITORY CANAL ANES | 2011-07-01 00:00:00 | 87.09 | N | Y | N/A | N/A
69210 | RMVL IMPACTED CERUMEN SPX 1/BOTH EARS | 2011-07-01 00:00:00 | 42.66 | N | Y | N/A | N/A
69220 | DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE | 2011-07-01 00:00:00 | 117.1 | N | Y | N/A | N/A
69222 | DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX | 2011-07-01 00:00:00 | 187.92 | N | Y | N/A | N/A
69300 | OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ | 2011-07-01 00:00:00 | 570.55 | Y | Y | N/A | N/A
69310 | RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX | 2011-07-01 00:00:00 | 932.45 | N | Y | N/A | N/A
69320 | RCNSTJ XTRNL AUD CANAL CONGENITAL ATRESIA 1 STG | 2011-07-01 00:00:00 | 1319.32 | N | Y | N/A | N/A
69399 | UNLISTED EXT EAR PROC | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
69400 | EUSTACHIAN TUBE NFLTJ TRANSNSL CATHJ | 2011-07-01 00:00:00 | 123.44 | N | Y | N/A | N/A
69401 | EUSTACHIAN TUBE NFLTJ TRANSNSL W/O CATHJ | 2011-07-01 00:00:00 | 72.11 | N | Y | N/A | N/A
69405 | EUSTACHIAN TUBE CATHJ TRANSTYMPANIC | 2011-07-01 00:00:00 | 222.56 | N | Y | N/A | N/A
69420 | MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ | 2011-07-01 00:00:00 | 163.29 | N | Y | N/A | N/A
69421 | MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ ANES | 2011-07-01 00:00:00 | 129.39 | N | Y | N/A | N/A
69424 | VENTILATING TUBE RMVL REQUIRING GENERAL ANES | 2011-07-01 00:00:00 | 109.64 | N | Y | N/A | N/A
69433 | TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA | 2011-07-01 00:00:00 | 170.08 | N | Y | N/A | N/A
69436 | TYMPANOSTOMY GENERAL ANESTHESIA | 2011-07-01 00:00:00 | 139.83 | N | Y | N/A | N/A
69440 | MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC | 2011-07-01 00:00:00 | 590.45 | N | Y | N/A | N/A
69450 | TYMPANOLYSIS TRANSCANAL | 2011-07-01 00:00:00 | 465.43 | N | Y | N/A | N/A
69501 | TRANSMASTOID ANTROTOMY | 2011-07-01 00:00:00 | 629.56 | N | Y | N/A | N/A
69502 | MASTOIDECTOMY COMPLETE | 2011-07-01 00:00:00 | 836.36 | N | Y | N/A | N/A
69505 | MASTOIDECTOMY MODIFIED RADICAL | 2011-07-01 00:00:00 | 1035.41 | N | Y | N/A | N/A
69511 | MASTOIDECTOMY RADICAL | 2011-07-01 00:00:00 | 1062.36 | N | Y | N/A | N/A
69530 | [NAME] | 2011-07-01 00:00:00 | 1426.37 | N | Y | N/A | N/A
69535 | RESCJ TEMPORAL BONE EXTERNAL APPROACH | 2011-07-01 00:00:00 | 2308.43 | N | Y | N/A | N/A
69540 | EXCISION AURAL POLYP | 2011-07-01 00:00:00 | 178.28 | N | Y | N/A | N/A
69550 | EXCISION AURAL GLOMUS TUMOR TRANSCANAL | 2011-07-01 00:00:00 | 895.56 | N | Y | N/A | N/A
69552 | EXCISION AURAL GLOMUS TUMOR TRANSMASTOID | 2011-07-01 00:00:00 | 1355.11 | N | Y | N/A | N/A
69554 | EXCISION AURAL GLOMUS TUMOR EXTENDED | 2011-07-01 00:00:00 | 2161.55 | N | Y | N/A | N/A
69601 | REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY | 2011-07-01 00:00:00 | 901.7 | N | Y | N/A | N/A
69602 | REVJ MASTOIDECTOMY RSLTG MODF RAD MSTDC | 2011-07-01 00:00:00 | 937.89 | N | Y | N/A | N/A
69603 | REVJ MASTOIDECTOMY RSLTG RAD MASTOIDECTOMY | 2011-07-01 00:00:00 | 1088.9 | N | Y | N/A | N/A
69604 | REVJ MASTOIDECTOMY RSLTG TYMPANOPLASTY | 2011-07-01 00:00:00 | 962.89 | N | Y | N/A | N/A
69605 | REVJ MASTOIDECTOMY W/APICECTOMY | 2011-07-01 00:00:00 | 1345.92 | N | Y | N/A | N/A
69610 | TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH | 2011-07-01 00:00:00 | 333.29 | N | Y | N/A | N/A
69620 | [NAME] | 2011-07-01 00:00:00 | 593.31 | N | Y | N/A | N/A
69631 | TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ | 2011-07-01 00:00:00 | 758.66 | N | Y | N/A | N/A
69632 | TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ | 2011-07-01 00:00:00 | 927.66 | N | Y | N/A | N/A
69633 | TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP | 2011-07-01 00:00:00 | 895.02 | N | Y | N/A | N/A
69635 | TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ | 2011-07-01 00:00:00 | 1050.83 | N | Y | N/A | N/A
69636 | TYMPP ANTRT/MASTOID W/OSSICULAR CHAIN RECNSTJ | 2011-07-01 00:00:00 | 1187.96 | N | Y | N/A | N/A
69637 | TMPP ANTRT/MASTOIDOTOMY PROSTHESIS TORP | 2011-07-01 00:00:00 | 1183.98 | N | Y | N/A | N/A
69641 | TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ | 2011-07-01 00:00:00 | 895.99 | N | Y | N/A | N/A
69642 | TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ | 2011-07-01 00:00:00 | 1153.42 | N | Y | N/A | N/A
69643 | TMPP MASTOIDECT NTC/RCNSTED WALL W/O OCR | 2011-07-01 00:00:00 | 1054.11 | N | Y | N/A | N/A
69644 | TMPP MASTOIDECT NTC/RCNSTED CANAL WALL OCR | 2011-07-01 00:00:00 | 1274.78 | N | Y | N/A | N/A
69645 | TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR | 2011-07-01 00:00:00 | 1250.96 | N | Y | N/A | N/A
69646 | TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR | 2011-07-01 00:00:00 | 1327.77 | N | Y | N/A | N/A
69650 | STAPES MOBILIZATION | 2011-07-01 00:00:00 | 687.47 | N | Y | N/A | N/A
69660 | STAPEDECTOMY/STAPEDOTOMY | 2011-07-01 00:00:00 | 799.83 | N | Y | N/A | N/A
69661 | STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT | 2011-07-01 00:00:00 | 1043.43 | N | Y | N/A | N/A
69662 | REVISION STAPEDECTOMY/STAPEDOTOMY | 2011-07-01 00:00:00 | 999.05 | N | Y | N/A | N/A
69666 | REPAIR OVAL WINDOW FISTULA | 2011-07-01 00:00:00 | 694.77 | N | Y | N/A | N/A
69667 | REPAIR ROUND WINDOW FISTULA | 2011-07-01 00:00:00 | 695.94 | N | Y | N/A | N/A
69670 | MASTOID OBLITERATION SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 811.87 | N | Y | N/A | N/A
69676 | TYMPANIC NEURECTOMY | 2011-07-01 00:00:00 | 715.64 | N | Y | N/A | N/A
69700 | CLOSURE POSTAURICULAR FISTULA MASTOID SPX | 2011-07-01 00:00:00 | 593.47 | N | Y | N/A | N/A
69710 | IMPLANTATION/REPLACEMENT HEARING DEVICE TEMPORAL | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
69711 | RMVL/RPR EMGNT BONE CNDJ DEV TEMPORAL BONE | 2011-07-01 00:00:00 | 744.74 | N | Y | N/A | N/A
69714 | IMPLTJ OSSEOINTEGRATED TEMPORAL BONE W/MASTOID | 2011-07-01 00:00:00 | 928.85 | Y | Y | N/A | N/A
69715 | IMPLJ OSSEOINTEGRATED TEMPORAL BONE W/O MASTOID | 2011-07-01 00:00:00 | 1151.24 | Y | Y | N/A | N/A
69717 | RPLMCT OSSEOINTEGRATE IMPLNT W/O MASTOIDECTOMY | 2011-07-01 00:00:00 | 982.37 | Y | Y | N/A | N/A
69718 | RPLMCT OSSEOINTEGRATE IMPLNT W/MASTOIDECTOMY | 2011-07-01 00:00:00 | 1164.02 | Y | Y | N/A | N/A
69720 | DCMPRN FACIAL NRV INTRATEMPORAL LAT GANGLION | 2011-07-01 00:00:00 | 1012.01 | N | Y | N/A | N/A
69725 | DCMPRN NRV INTRATEMPORAL MEDIAL GENICULATE | 2011-07-01 00:00:00 | 1628.76 | N | Y | N/A | N/A
69740 | SUTR NRV ITPRL W/WO GRF/DCMPRN LAT GENICULATE | 2011-07-01 00:00:00 | 1010.56 | N | Y | N/A | N/A
69745 | SUTR NRV ITPRL W/WO GRF/DCMPRN MEDIAL GENICULATE | 2011-07-01 00:00:00 | 1077.05 | N | Y | N/A | N/A
69799 | UNLISTED MID EAR PROC | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
69801 | LABYRINTHOTOMY TRANSCANAL | 2011-07-01 00:00:00 | 171.81 | N | Y | N/A | N/A
69805 | ENDOLYMPHATIC SAC W/O SHUNT | 2011-07-01 00:00:00 | 910.79 | N | Y | N/A | N/A
69806 | ENDOLYMPHATIC SAC SHUNT | 2011-07-01 00:00:00 | 816.11 | N | Y | N/A | N/A
69820 | FENESTRATION SEMICIRCULAR CANAL | 2011-07-01 00:00:00 | 740.82 | N | Y | N/A | N/A
69840 | REVISION FENESTRATION OPERATION | 2011-07-01 00:00:00 | 724.75 | N | Y | N/A | N/A
69905 | LABYRINTHECTOMY TRANSCANAL | 2011-07-01 00:00:00 | 792.01 | N | Y | N/A | N/A
69910 | LABYRINTHECTOMY W/MASTOIDECTOMY | 2011-07-01 00:00:00 | 881.01 | N | Y | N/A | N/A
69915 | VESTIBULAR NRV SECTION TRANSLABYRINTHINE APPR | 2011-07-01 00:00:00 | 1332.73 | N | Y | N/A | N/A
69930 | COCHLEAR DEVICE IMPLANTATION W/WO MASTOIDECTOMY | 2011-07-01 00:00:00 | 1064.29 | Y | Y | N/A | N/A
69949 | UNLISTED PROCEDURE INNER EAR | 2008-07-01 00:00:00 | 97.18 | N | Y | N/A | N/A
69950 | VESTIBULAR NRV SECTION TRANSCRANIAL APPROACH | 2011-07-01 00:00:00 | 1628.45 | N | Y | N/A | N/A
69955 | TOTAL FACIAL NERVE DECOMPRESSION &/REPAIR | 2011-07-01 00:00:00 | 1716.62 | N | Y | N/A | N/A
69960 | DECOMPRESSION INTERNAL AUDITORY CANAL | 2011-07-01 00:00:00 | 1669.91 | N | Y | N/A | N/A
69970 | REMOVAL TUMOR TEMPORAL BONE | 2011-07-01 00:00:00 | 1861.7 | N | Y | N/A | N/A
69979 | UNLISTED TEMPORAL BONE PROC | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
69990 | MICROSURG TQS REQ USE OPERATING MICROSCOPE | 2011-07-01 00:00:00 | 179.73 | N | Y | N/A | N/A
70010 | MYELOGRAPY POST FOSSA RS&I | 2011-07-01 00:00:00 | 108.86 | N | N | N/A | N/A
70015 | CISTERNOGRAPHY POSITIVE CONTRAST RS&I | 2011-07-01 00:00:00 | 126.89 | N | N | 74.86 | 52.03
70030 | RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY | 2011-07-01 00:00:00 | 24.58 | N | N | 17.19 | 7.39
70100 | RADIOLOGIC EXAMINATION MANDIPLE PRTL LT 4 VIEWS | 2011-07-01 00:00:00 | 28.35 | N | N | 20.37 | 7.98
70110 | RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS | 2011-07-01 00:00:00 | 33.95 | N | N | 23.25 | 10.7
70120 | RADIOLOGIC EXAM MASTOIDS LT 3 VIEWS PER SIDE | 2011-07-01 00:00:00 | 30.08 | N | N | 22.1 | 7.98
70130 | [NAME] MINIMUM 3 VIEWS PR SIDE | 2011-07-01 00:00:00 | 48.23 | N | N | 33.62 | 14.61
70134 | RADEX INTERNAL AUDITORY MEATI COMPLETE | 2011-07-01 00:00:00 | 39.87 | N | N | 25.26 | 14.61
70140 | [NAME] 3 VIEWS | 2011-07-01 00:00:00 | 26.06 | N | N | 17.48 | 8.58
70150 | [NAME] MINIMUM 3 VIEWS | 2011-07-01 00:00:00 | 36.85 | N | N | 25.55 | 11.3
70160 | RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS | 2011-07-01 00:00:00 | 28.33 | N | N | 20.94 | 7.39
70170 | DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I | 2011-07-01 00:00:00 | 43 | N | N | 29.84 | 13.16
70190 | RADEX OPTIC FORAMINA | 2011-07-01 00:00:00 | 30.71 | N | N | 21.52 | 9.19
70200 | RADEX ORBITS COMPLETE MINIMUM 4 VIEWS | 2011-07-01 00:00:00 | 38.03 | N | N | 25.83 | 12.2
70210 | RADEX SINUSES PARANASAL LT 3 VIEWS | 2011-07-01 00:00:00 | 26.6 | N | N | 18.92 | 7.68
70220 | RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS | 2011-07-01 00:00:00 | 33.37 | N | N | 22.67 | 10.7
70240 | RADIOLOGIC EXAMINATION SELLA TURCICA | 2011-07-01 00:00:00 | 25.48 | N | N | 17.19 | 8.29
70250 | RADIOLOGIC EXAMINATION SKULL LT 4 VIEWS | 2011-07-01 00:00:00 | 31.91 | N | N | 21.23 | 10.68
70260 | RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS | 2011-07-01 00:00:00 | 40.73 | N | N | 26.12 | 14.61
70300 | RADIOLOGIC EXAMINATION TEETH 1 VIEW | 2011-07-01 00:00:00 | 12.35 | N | N | 7.39 | 4.96
70310 | RADIOLOGIC EXAM TEETH PRTL EXAM LT FULL MOUTH | 2011-07-01 00:00:00 | 32.06 | N | N | 24.4 | 7.66
70320 | RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH | 2011-07-01 00:00:00 | 35.91 | N | N | 25.84 | 10.07
70328 | RADEX TEMPOROMANDBLE JT OPN&CLSD MOUTH UNI | 2011-07-01 00:00:00 | 26.61 | N | N | 18.63 | 7.98
70330 | RADEX TEMPOROMANDBLE JT OPN&CLSD MOUTH BI | 2011-07-01 00:00:00 | 41.43 | N | N | 30.75 | 10.68
70332 | TEMPOROMANDBLE JT ARTHROGRAPHY RS&I | 2011-07-01 00:00:00 | 73.44 | N | N | 48.62 | 24.82
70336 | MRI TEMPOROMANDIBULAR JOINT | 2011-07-01 00:00:00 | 354.8 | N | N | 290.85 | 63.95
70350 | CEPHALOGRAM ORTHODONTIC | 2011-07-01 00:00:00 | 18.23 | N | N | 9.98 | 8.25
70355 | ORTHOPANTOGRAM | 2011-07-01 00:00:00 | 18.58 | N | N | 9.41 | 9.17
70360 | RADIOLOGIC EXAMINATION NECK SOFT TISSUE | 2011-07-01 00:00:00 | 23.72 | N | N | 16.33 | 7.39
70370 | RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ | 2011-07-01 00:00:00 | 69.82 | N | N | 55.82 | 14
70371 | CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC | 2011-07-01 00:00:00 | 81.46 | N | N | 45.44 | 36.02
70373 | LARYNGOGRAPY CONTRAST RS&I | 2011-07-01 00:00:00 | 70.61 | N | N | 52.08 | 18.53
70380 | RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS | 2011-07-01 00:00:00 | 33.8 | N | N | 25.83 | 7.97
70390 | SIALOGRAPY RS&I | 2011-07-01 00:00:00 | 87 | N | N | 70.24 | 16.76
70450 | [NAME] | 2011-07-01 00:00:00 | 168.45 | N | N | 131.67 | 36.78
70460 | [NAME] | 2011-07-01 00:00:00 | 219.57 | N | N | 170.59 | 48.98
70470 | [NAME] | 2011-07-01 00:00:00 | 265.45 | N | N | 210.11 | 55.34
70480 | CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL | 2011-07-01 00:00:00 | 220.19 | N | N | 164.54 | 55.65
70481 | CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL | 2011-07-01 00:00:00 | 312.81 | N | N | 252.78 | 60.03
70482 | CT ORBIT SELLA/POST FOSSA/EAR W/O&W/CONTR MATRL | 2011-07-01 00:00:00 | 346.38 | N | N | 283.63 | 62.75
70486 | CT MAXILLOFACIAL W/O CONTRAST MATERIAL | 2011-07-01 00:00:00 | 214.11 | N | N | 164.54 | 49.57
70487 | CT MAXILLOFACIAL W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 270.68 | N | N | 214.13 | 56.55
70488 | CT MAXILLOFACIAL W/O &W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 328.74 | N | N | 267.2 | 61.54
70490 | CT SOFT TISSUE NECK W/O CONTRAST MATERIAL | 2011-07-01 00:00:00 | 220.19 | N | N | 164.54 | 55.65
70491 | CT SOFT TISSUE NECK W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 265.35 | N | N | 205.49 | 59.86
70492 | CT SOFT TISSUE NECK W/O &W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 320.14 | N | N | 257.39 | 62.75
70496 | CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST | 2011-07-01 00:00:00 | 363.69 | N | N | 287.38 | 76.31
70498 | CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST | 2011-07-01 00:00:00 | 363.69 | N | N | 287.38 | 76.31
70540 | MRI ORBIT FACE &/NECK W/O CONTRAST | 2011-07-01 00:00:00 | 349.67 | N | N | 291.13 | 58.54
70542 | MRI ORBIT FACE & NECK W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 441.04 | N | N | 370.72 | 70.32
70543 | MRI ORBIT FACE & NCK W/O &W/CONTRAST MATRL | 2011-07-01 00:00:00 | 545.82 | N | N | 452.89 | 92.93
70544 | MRA HEAD W/O CONTRST MATERIAL | 2011-07-01 00:00:00 | 343.18 | N | N | 291.13 | 52.05
70545 | MRA HEAD W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 422.77 | N | N | 370.72 | 52.05
70546 | MRA HEAD W/O &W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 531.2 | N | N | 452.9 | 78.3
70547 | MRA NECK W/O CONTRST MATERIAL | 2011-07-01 00:00:00 | 343.18 | N | N | 291.13 | 52.05
70548 | MRA NECK W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 422.77 | N | N | 370.72 | 52.05
70549 | MRA NECK W/O &W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 531.03 | N | N | 452.9 | 78.13
70551 | MRI [NAME]/O CONTRAST MATERIAL | 2011-07-01 00:00:00 | 355.37 | N | N | 291.13 | 64.24
70552 | MRI [NAME] | 2011-07-01 00:00:00 | 448.41 | N | N | 370.71 | 77.7
70553 | MRI [NAME]/O &W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 555.48 | N | N | 452.9 | 102.58
70554 | MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION | 2011-07-01 00:00:00 | 488.09 | N | N | 395.8 | 92.29
70555 | MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION | 2011-07-01 00:00:00 | 0 | N | N | N/A | 112.44
70557 | MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL | 2011-07-01 00:00:00 | 0 | N | N | N/A | 150.3
70558 | MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL | 2011-07-01 00:00:00 | 0 | N | N | N/A | 141.45
70559 | MRI BRAIN OPEN INTRACRANIAL PX W/O &W/CONTRAST | 2011-07-01 00:00:00 | 0 | N | N | N/A | 142.89
71010 | RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL | 2011-07-01 00:00:00 | 20.27 | N | N | 12.57 | 7.7
71015 | RADIOLOGIC EXAMINATION CHEST STERO FRONTAL | 2011-07-01 00:00:00 | 25.8 | N | N | 16.9 | 8.9
71020 | RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL | 2011-07-01 00:00:00 | 26.69 | N | N | 17.19 | 9.5
71021 | RADEX CH 2 VIEWS FRNT&LAT APICAL LORDOTIC PX | 2011-07-01 00:00:00 | 32.83 | N | N | 21.23 | 11.6
71022 | RADEX CH 2 VIEWS FRONTAL&LATERAL OBLIQUE PRJCJ | 2011-07-01 00:00:00 | 40.1 | N | N | 26.7 | 13.4
71023 | RADEX CH 2 VIEWS FRONTAL&LATERAL W/FLUORO | 2011-07-01 00:00:00 | 59.55 | N | N | 42.85 | 16.7
71030 | RADEX CHEST COMPLETE MINIMUM 4 VIEWS | 2011-07-01 00:00:00 | 39.82 | N | N | 26.42 | 13.4
71034 | RADEX CHEST COMPLETE MINIMUM 4 VIEWS W/FLUORO | 2011-07-01 00:00:00 | 76.41 | N | N | 55.83 | 20.58
71035 | RADEX CHEST SPECIAL VIEWS | 2011-07-01 00:00:00 | 30.37 | N | N | 22.39 | 7.98
71100 | RADEX RIBS UNILATERAL 2 VIEWS | 2011-07-01 00:00:00 | 27.84 | N | N | 18.34 | 9.5
71101 | RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS | 2011-07-01 00:00:00 | 33.98 | N | N | 22.38 | 11.6
71110 | RADEX RIBS BILATERAL 3 VIEWS | 2011-07-01 00:00:00 | 35.14 | N | N | 23.54 | 11.6
71111 | RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS | 2011-07-01 00:00:00 | 45.32 | N | N | 31.61 | 13.71
71120 | RADEX STERNUM MINIMUM 2 VIEWS | 2011-07-01 00:00:00 | 27.51 | N | N | 18.91 | 8.6
71130 | [NAME]JTS MINIMUM 3 VIEWS | 2011-07-01 00:00:00 | 32.17 | N | N | 22.67 | 9.5
71250 | CT THORAX W/O CONTRAST MATERIAL | 2011-07-01 00:00:00 | 208.97 | N | N | 164.54 | 44.43
71260 | CT THORAX W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 266.26 | N | N | 212.12 | 54.14
71270 | CT THORAX W/O &W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 326.76 | N | N | 266.9 | 59.86
71275 | CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST | 2011-07-01 00:00:00 | 370.79 | N | N | 287.09 | 83.7
71550 | MRI CHEST W/O CONTRAST MATERIAL | 2011-07-01 00:00:00 | 354.19 | N | N | 291.14 | 63.05
71551 | MRI CHEST W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 445.55 | N | N | 370.71 | 74.84
71552 | MRI CHEST W/O &W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 551.21 | N | N | 452.89 | 98.32
71555 | MRA CHEST W/O &W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 474.53 | N | N | 395.52 | 79.01
72010 | [NAME] ANTEROPOST&LAT | 2011-07-01 00:00:00 | 63.77 | N | N | 44.01 | 19.76
72020 | [NAME] SPECIFY LEVEL | 2011-07-01 00:00:00 | 20.51 | N | N | 13.73 | 6.78
72040 | [NAME] 2/3 VIEWS | 2011-07-01 00:00:00 | 33.38 | N | N | 23.25 | 10.13
72050 | [NAME] MINIMUM 4 VIEWS | 2011-07-01 00:00:00 | 45.36 | N | N | 31.61 | 13.75
72052 | RADEX SPINE CRV COMPL W/OBLQ&FLEX&/XTN STDS | 2011-07-01 00:00:00 | 57.56 | N | N | 41.7 | 15.86
72069 | [NAME] THORACOLMBR STANDING SCOLIOSIS | 2011-07-01 00:00:00 | 31.94 | N | N | 21.81 | 10.13
72070 | [NAME] VIEWS | 2011-07-01 00:00:00 | 29.28 | N | N | 19.5 | 9.78
72072 | [NAME] 3 VIEWS | 2011-07-01 00:00:00 | 32.45 | N | N | 22.95 | 9.5
72074 | [NAME] MINIMUM 4 VIEWS | 2011-07-01 00:00:00 | 38.22 | N | N | 28.72 | 9.5
72080 | RADEX SPINE THORACOLUMBAR 2 VIEWS | 2011-07-01 00:00:00 | 31.37 | N | N | 21.24 | 10.13
72090 | [NAME] | 2011-07-01 00:00:00 | 42.31 | N | N | 29.3 | 13.01
72100 | [NAME] LUMBOSACRAL 2/3 VIEWS | 2011-07-01 00:00:00 | 34.82 | N | N | 24.69 | 10.13
72110 | [NAME] MINIMUM 4 VIEWS | 2011-07-01 00:00:00 | 47.66 | N | N | 33.91 | 13.75
72114 | [NAME] MIN 6 | 2011-07-01 00:00:00 | 63.78 | N | N | 47.45 | 16.33
72120 | [NAME] ONLY BENDING 2/3 VIEWS | 2011-07-01 00:00:00 | 44.05 | N | N | 33.92 | 10.13
72125 | CT CERVICAL SPINE W/O CONTRAST MATERIAL | 2011-07-01 00:00:00 | 208.97 | N | N | 164.54 | 44.43
72126 | CT CERVICAL SPINE W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 265.64 | N | N | 212.69 | 52.95
72127 | CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 321.67 | N | N | 266.62 | 55.05
72128 | CT THORACIC SPINE W/O CONTRAST MATERIAL | 2011-07-01 00:00:00 | 208.97 | N | N | 164.54 | 44.43
72129 | CT THORACIC SPINE W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 266.22 | N | N | 212.98 | 53.24
72130 | CT THORACIC SPINE W/O & W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 321.96 | N | N | 266.91 | 55.05
72131 | CT LUMBAR SPINE W/O CONTRAST MATERIAL | 2011-07-01 00:00:00 | 208.97 | N | N | 164.54 | 44.43
72132 | CT LUMBAR SPINE W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 265.64 | N | N | 212.4 | 53.24
72133 | CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 321.67 | N | N | 266.62 | 55.05
72141 | MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL | 2011-07-01 00:00:00 | 360.55 | N | N | 290.84 | 69.71
72142 | MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL | 2011-07-01 00:00:00 | 454.13 | N | N | 370.72 | 83.41
72146 | MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL | 2011-07-01 00:00:00 | 360.55 | N | N | 290.84 | 69.71
72147 | MRI SPINAL CANAL THORACIC W/CONTRAST MATRL | 2011-07-01 00:00:00 | 450.67 | N | N | 366.97 | 83.7
72148 | MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL | 2011-07-01 00:00:00 | 355.44 | N | N | 290.85 | 64.59
72149 | MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 448.41 | N | N | 370.71 | 77.7
72156 | MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL | 2011-07-01 00:00:00 | 564.85 | N | N | 452.9 | 111.95
72157 | MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL | 2011-07-01 00:00:00 | 564.85 | N | N | 452.9 | 111.95
72158 | MRI SPINAL CANAL LUMBAR W/O &W/CONTR MATRL | 2011-07-01 00:00:00 | 555.83 | N | N | 452.9 | 102.93
72159 | MRA SPINAL CANAL W/WO CONTRAST MATERIAL | 2011-07-01 00:00:00 | 524.45 | N | N | 445.69 | 78.76
72170 | RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS | 2011-07-01 00:00:00 | 23.2 | N | N | 15.17 | 8.03
72190 | RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS | 2011-07-01 00:00:00 | 35.96 | N | N | 26.13 | 9.83
72191 | CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST | 2011-07-01 00:00:00 | 366.77 | N | N | 287.1 | 79.07
72192 | CT PELVIS W/O CONTRAST MATERIAL | 2011-07-01 00:00:00 | 208.26 | N | N | 161.08 | 47.18
72193 | CT PELVIS W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 251.98 | N | N | 201.44 | 50.54
72194 | CT PELVIS W/O & W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 322.45 | N | N | 269.5 | 52.95
72195 | MRI PELVIS W/O CONTRAST MATERIAL | 2011-07-01 00:00:00 | 354.83 | N | N | 291.14 | 63.69
72196 | MRI PELVIS W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 446.13 | N | N | 370.72 | 75.41
72197 | MRI PELVIS W/O & W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 550.92 | N | N | 452.89 | 98.03
72198 | MRA PELVIS W/WO CONTRAST MATERIAL | 2011-07-01 00:00:00 | 472.49 | N | N | 394.36 | 78.13
72200 | RADIOLOGIC EXAMINATION SACROILIAC JNTS LT 3 VIEWS | 2011-07-01 00:00:00 | 25.44 | N | N | 18.05 | 7.39
72202 | RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS | 2011-07-01 00:00:00 | 29.81 | N | N | 21.52 | 8.29
72220 | RADEX SACRUM & COCCYX MINIMUM 2 VIEWS | 2011-07-01 00:00:00 | 25.16 | N | N | 17.77 | 7.39
72240 | MYELOGRAPY CERVICAL RS&I | 2011-07-01 00:00:00 | 124.33 | N | N | 84.67 | 39.66
72255 | MYELOGRAPY THORACIC RS&I | 2011-07-01 00:00:00 | 116.94 | N | N | 77.74 | 39.2
72265 | MYELOGRAPY LUMBOSACRAL RS&I | 2011-07-01 00:00:00 | 118.53 | N | N | 82.36 | 36.17
72270 | MYELOGRAPY 2/MORE REGIONS RS&I | 2011-07-01 00:00:00 | 184.52 | N | N | 126.77 | 57.75
72275 | [NAME] | 2011-07-01 00:00:00 | 95.91 | N | N | 62.74 | 33.17
72285 | DISKOGRAPY CERVICAL/THORACIC RS&I | 2011-07-01 00:00:00 | 127.06 | N | N | 76.01 | 51.05
72291 | RAD S&I PERQ VRTPLS/SACRPLSTY PR VRT BODY FLUOR | 2011-07-01 00:00:00 | 58.29 | N | N | 0.75 | 61.5
72292 | RAD S&I PERQ VRTPLS/SACRPLSTY PER VRT BODY CT | 2011-07-01 00:00:00 | 0 | N | N | N/A | 63.58
72295 | DISKOGRAPY LUMBAR RS&I | 2011-07-01 00:00:00 | 111.61 | N | N | 74.86 | 36.75
73000 | RADEX CLAVICLE COMPLETE | 2011-07-01 00:00:00 | 24.56 | N | N | 17.48 | 7.08
73010 | RADEX SCAPULA COMPLETE | 2011-07-01 00:00:00 | 26.08 | N | N | 18.05 | 8.03
73020 | RADEX SHOULDER 1 VIEW | 2011-07-01 00:00:00 | 20.22 | N | N | 13.73 | 6.49
73030 | RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS | 2011-07-01 00:00:00 | 26.39 | N | N | 17.77 | 8.62
73040 | RADEX SHOULDER ARTHROGRAPHY RS&I | 2011-07-01 00:00:00 | 92.36 | N | N | 68.52 | 23.84
73050 | RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ | 2011-07-01 00:00:00 | 32.77 | N | N | 23.25 | 9.52
73060 | RADEX HUMERUS MINIMUM 2 VIEWS | 2011-07-01 00:00:00 | 25.16 | N | N | 17.48 | 7.68
73070 | RADEX ELBOW 2 VIEWS | 2011-07-01 00:00:00 | 24.26 | N | N | 17.48 | 6.78
73080 | RADEX ELBOW COMPLETE MINIMUM 3 VIEWS | 2011-07-01 00:00:00 | 29.2 | N | N | 21.81 | 7.39
73085 | RADEX ELBOW ARTHROGRAPHY RS&I | 2011-07-01 00:00:00 | 83.83 | N | N | 59.87 | 23.96
73090 | RADEX FOREARM 2 VIEWS | 2011-07-01 00:00:00 | 23.99 | N | N | 16.91 | 7.08
73092 | RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS | 2011-07-01 00:00:00 | 26.29 | N | N | 19.21 | 7.08
73100 | RADEX WRIST 2 VIEWS | 2011-07-01 00:00:00 | 26.35 | N | N | 18.63 | 7.72
73110 | RADEX WRIST COMPLETE MINIMUM 3 VIEWS | 2011-07-01 00:00:00 | 31.21 | N | N | 23.53 | 7.68
73115 | RADEX WRIST ARTHROGRAPHY RS&I | 2011-07-01 00:00:00 | 93.51 | N | N | 69.09 | 24.42
73120 | RADEX HAND 2 VIEWS | 2011-07-01 00:00:00 | 23.7 | N | N | 16.62 | 7.08
73130 | RADEX HAND MINIMUM 3 VIEWS | 2011-07-01 00:00:00 | 27.46 | N | N | 20.07 | 7.39
73140 | RADEX FINGR MINIMUM 2 VIEWS | 2011-07-01 00:00:00 | 26.82 | N | N | 20.94 | 5.88
73200 | CT UPPER EXTREMITY W/O CONTRAST MATERIAL | 2011-07-01 00:00:00 | 208.74 | N | N | 164.54 | 44.2
73201 | CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 256.31 | N | N | 205.77 | 50.54
73202 | CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 327.64 | N | N | 274.69 | 52.95
73206 | CT ANGIOGRAPHY UPPER EXTREMITY | 2011-07-01 00:00:00 | 365.75 | N | N | 287.09 | 78.66
73218 | MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL | 2011-07-01 00:00:00 | 349.79 | N | N | 291.14 | 58.65
73219 | MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL | 2011-07-01 00:00:00 | 441.32 | N | N | 370.71 | 70.61
73220 | MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAST | 2011-07-01 00:00:00 | 546.41 | N | N | 452.9 | 93.51
73221 | MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL | 2011-07-01 00:00:00 | 350.6 | N | N | 291.14 | 59.46
73222 | MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL | 2011-07-01 00:00:00 | 441.32 | N | N | 370.71 | 70.61
73223 | MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL | 2011-07-01 00:00:00 | 546.11 | N | N | 452.89 | 93.22
73225 | MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL | 2011-07-01 00:00:00 | 515.96 | N | N | 440.21 | 75.75
73500 | RADEX HIP UNILATERAL 1 VIEW | 2011-07-01 00:00:00 | 22.91 | N | N | 14.88 | 8.03
73510 | RADEX HIP UNILATERAL COMPLETE MINIMUM 2 VIEWS | 2011-07-01 00:00:00 | 33.08 | N | N | 23.25 | 9.83
73520 | [NAME] 2 VIEWS ANTEROPOST PELVIS | 2011-07-01 00:00:00 | 34.89 | N | N | 23.24 | 11.65
73525 | RADEX HIP ARTHROGRAPHY RS&I | 2011-07-01 00:00:00 | 86.01 | N | N | 61.59 | 24.42
73530 | RADEX HIP OPERATIVE PROCEDURE | 2011-07-01 00:00:00 | 28.77 | N | N | 15.92 | 12.85
73540 | RADEX PELVIS&HIPS INFT/CHLD MINIMUM 2 VIEWS | 2011-07-01 00:00:00 | 34.79 | N | N | 25.56 | 9.23
73550 | RADIOLOGIC EXAMINATION FEMUR 2 VIEWS | 2011-07-01 00:00:00 | 24.35 | N | N | 16.61 | 7.74
73560 | RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS | 2011-07-01 00:00:00 | 26.08 | N | N | 18.05 | 8.03
73562 | RADIOLOGIC EXAMINATION KNEE 3 VIEWS | 2011-07-01 00:00:00 | 31.29 | N | N | 22.67 | 8.62
73564 | RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS | 2011-07-01 00:00:00 | 35.97 | N | N | 25.84 | 10.13
73565 | RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST | 2011-07-01 00:00:00 | 28.97 | N | N | 20.65 | 8.32
73580 | RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I | 2011-07-01 00:00:00 | 112.72 | N | N | 87.55 | 25.17
73590 | RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS | 2011-07-01 00:00:00 | 23.72 | N | N | 16.33 | 7.39
73592 | RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS | 2011-07-01 00:00:00 | 26.58 | N | N | 19.5 | 7.08
73600 | RADIOLOGIC EXAMINATION ANKLE 2 VIEWS | 2011-07-01 00:00:00 | 24.27 | N | N | 17.19 | 7.08
73610 | RADEX ANKLE COMPLETE MINIMUM 3 VIEWS | 2011-07-01 00:00:00 | 27.76 | N | N | 20.37 | 7.39
73615 | RADEX ANKLE ARTHROGGRAPHY RS&I | 2011-07-01 00:00:00 | 89.19 | N | N | 64.77 | 24.42
73620 | RADIOLOGIC EXAMINATION FOOT 2 VIEWS | 2011-07-01 00:00:00 | 23.41 | N | N | 16.61 | 6.8
73630 | RADEX FOOT COMPLETE MINIMUM 3 VIEWS | 2011-07-01 00:00:00 | 27.17 | N | N | 19.78 | 7.39
73650 | RADEX CALCANEUS MINIMUM 2 VIEWS | 2011-07-01 00:00:00 | 23.99 | N | N | 16.91 | 7.08
73660 | RADEX TOE MINIMUM 2 VIEWS | 2011-07-01 00:00:00 | 25.08 | N | N | 19.49 | 5.59
73700 | CT LOWER EXTREMITY W/O CONTRAST MATERIAL | 2011-07-01 00:00:00 | 208.74 | N | N | 164.54 | 44.2
73701 | CT LOWER EXTREMITY W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 258.62 | N | N | 208.08 | 50.54
73702 | CT LOWER EXTREMITY W/O & W/CONTRAST MATRL | 2011-07-01 00:00:00 | 329.37 | N | N | 276.13 | 53.24
73706 | CT ANGIOGRAPHY LOWER EXTREMITY | 2011-07-01 00:00:00 | 370.18 | N | N | 287.09 | 83.09
73718 | MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL | 2011-07-01 00:00:00 | 349.67 | N | N | 291.13 | 58.54
73719 | MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL | 2011-07-01 00:00:00 | 441.04 | N | N | 370.72 | 70.32
73720 | MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATRL | 2011-07-01 00:00:00 | 546.11 | N | N | 452.89 | 93.22
73721 | MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL | 2011-07-01 00:00:00 | 350.31 | N | N | 291.13 | 59.18
73722 | MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 441.78 | N | N | 370.71 | 71.07
73723 | MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL | 2011-07-01 00:00:00 | 546.11 | N | N | 452.89 | 93.22
73725 | MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL | 2011-07-01 00:00:00 | 473.68 | N | N | 394.65 | 79.03
74000 | RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW | 2011-07-01 00:00:00 | 21.43 | N | N | 13.73 | 7.7
74010 | RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS | 2011-07-01 00:00:00 | 32.76 | N | N | 22.96 | 9.8
74020 | RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS | 2011-07-01 00:00:00 | 34.56 | N | N | 22.96 | 11.6
74022 | RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH | 2011-07-01 00:00:00 | 41.56 | N | N | 27.85 | 13.71
74150 | CT ABDOMEN W/O CONTRAST MATERIAL | 2011-07-01 00:00:00 | 211.67 | N | N | 159.93 | 51.74
74160 | CT ABDOMEN W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 285.91 | N | N | 230.57 | 55.34
74170 | CT ABDOMEN W/O &W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 344.57 | N | N | 283.64 | 60.93
74174 | CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES | 2012-01-01 00:00:00 | 458.24 | N | N | 367.44 | 90.79
74175 | CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST | 2011-07-01 00:00:00 | 370.36 | N | N | 287.38 | 82.98
74176 | CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL | 2011-07-01 00:00:00 | 185.47 | N | N | 111.77 | 73.7
74177 | CT ABDOEN & PELVIS W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 290.57 | N | N | 213.27 | 77.3
74178 | CT ABDOMEN & PELVIS W/O CONTRST 1/GT BODY REGIONS | 2011-07-01 00:00:00 | 367.38 | N | N | 281.91 | 85.47
74181 | MRI ABDOMEN W/O CONTRAST MATERIAL | 2011-07-01 00:00:00 | 354.19 | N | N | 290.85 | 63.34
74182 | MRI ABDOMEN W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 445.84 | N | N | 370.72 | 75.12
74183 | MRI ABDOMEN W/O &W/CONTRAST MATERIAL | 2011-07-01 00:00:00 | 550.63 | N | N | 452.89 | 97.74
74185 | MRA ABDOMEN W/WO CONTRAST MATERIAL | 2011-07-01 00:00:00 | 471.63 | N | N | 393.5 | 78.13
74190 | [NAME] | 2011-07-01 00:00:00 | 61.91 | N | N | 40.77 | 21.14
74210 | RADEX PHARYNX&/CERVICAL ESOPHAGUS | 2011-07-01 00:00:00 | 67.3 | N | N | 51.79 | 15.51
74220 | RADEX ESOPHAGUS | 2011-07-01 00:00:00 | 77.34 | N | N | 57.27 | 20.07
74230 | SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG | 2011-07-01 00:00:00 | 78.62 | N | N | 55.54 | 23.08
74235 | RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 56.3
74240 | RADEX GI TRACT UPPER W/WO DELAYED FILMS W/O KUB | 2011-07-01 00:00:00 | 96.08 | N | N | 65.92 | 30.16
74241 | RADEX GI TRACT UPPER W/WO DELAYED FILMS W/KUB | 2011-07-01 00:00:00 | 101.96 | N | N | 72.26 | 29.7
74245 | RADEX GI TRACT UPR W/SM INT W/MULT SERIAL FLMS | 2011-07-01 00:00:00 | 152.9 | N | N | 112.35 | 39.66
74246 | RADEX UPPER GI W/WO GLUCAGON/DELAY FILMS W/O KUB | 2011-07-01 00:00:00 | 103.58 | N | N | 73.42 | 30.16
74247 | RADEX UPPER GI W/WO GLUCAGON/DELAY FLMS W/KUB | 2011-07-01 00:00:00 | 103.58 | N | N | 73.42 | 30.16
74249 | RADEX GI UPR W/WO GLUCOSE W/SM INTEST FOLLW-THRU | 2011-07-01 00:00:00 | 160.08 | N | N | 120.42 | 39.66
74250 | RADEX SMALL INTESTINE W/MULTIPLE SERIAL FILMS | 2011-07-01 00:00:00 | 91.2 | N | N | 70.82 | 20.38
74251 | RADEX SM INT W/MLT SRL FLMS VIA ENTEROCLSS TUBE | 2011-07-01 00:00:00 | 150.41 | N | N | 120.25 | 30.16
74260 | DUODENOGRAPY HYPOTONIC | 2011-07-01 00:00:00 | 95.11 | N | N | 73.53 | 21.58
74261 | CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST | 2011-07-01 00:00:00 | 265.81 | N | N | 164.37 | 101.44
74262 | CT COLONOGRAPHY, W/DYE | 2011-07-01 00:00:00 | 360.5 | N | N | 254.5 | 106
74270 | [NAME] | 2011-07-01 00:00:00 | 103.87 | N | N | 73.71 | 30.16
74280 | RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON | 2011-07-01 00:00:00 | 163.39 | N | N | 120.42 | 42.97
74283 | THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ | 2011-07-01 00:00:00 | 160.28 | N | N | 73.41 | 86.87
74290 | CHOLECYSTOGRAPHY ORAL CONTRST | 2011-07-01 00:00:00 | 58.58 | N | N | 44.87 | 13.71
74291 | CHOLECYST ORAL CNTRST ADDL/REPEAT XM/MULT DAY XM | 2011-07-01 00:00:00 | 54.62 | N | N | 46.02 | 8.6
74300 | CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 15.86
74301 | CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 9.54
74305 | CHOLANGIO&/PANCREATOGRAPHY THRU CATH RS&I | 2011-07-01 00:00:00 | 42.9 | N | N | 24.46 | 18.44
74320 | CHOLANGIO&/PANCREATOGRAPHY TRANSHEPATC RS&I | 2011-07-01 00:00:00 | 92.76 | N | N | 69.09 | 23.67
74327 | POSTOP BILIARY STONE RMVL PRQ T-TUBE RS&I | 2011-07-01 00:00:00 | 117.4 | N | N | 85.53 | 31.87
74328 | ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I | 2011-07-01 00:00:00 | 129.85 | N | N | 98.63 | 31.22
74329 | ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 31.22
74330 | CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I | 2011-07-01 00:00:00 | 138.24 | N | N | 98.25 | 39.99
74340 | INTRO LONG GI TUBE W/MULT FLUORO&FILMS RS&I | 2011-07-01 00:00:00 | 106.4 | N | N | 82.56 | 23.84
74355 | [NAME] ENTEROCLYSIS TUBE RS&I | 2011-07-01 00:00:00 | 115.45 | N | N | 81.47 | 33.98
74360 | INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I | 2011-07-01 00:00:00 | 123.5 | N | N | 98.21 | 25.29
74363 | PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 38.98
74400 | UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY | 2011-07-01 00:00:00 | 95.85 | N | N | 74.57 | 21.28
74410 | UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE | 2011-07-01 00:00:00 | 98.73 | N | N | 77.17 | 21.56
74415 | UROGRAPY INFUSION DRIP &/BOLUS TECHQ W/WO TOMO | 2011-07-01 00:00:00 | 116.6 | N | N | 95.32 | 21.28
74420 | X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL | 2011-07-01 00:00:00 | 98.54 | N | N | 82.68 | 15.86
74425 | UROGRAPHY ANTEGRADE RS&I | 2011-07-01 00:00:00 | 56.78 | N | N | 40.92 | 15.86
74430 | CYSTOGRAPHY MINIMUM 3 VIEWS RS&I | 2011-07-01 00:00:00 | 52.24 | N | N | 38.53 | 13.71
74440 | VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I | 2011-07-01 00:00:00 | 74.03 | N | N | 57.27 | 16.76
74450 | URETHROCYSTOGRAPHY RETROGRADE RS&I | 2011-07-01 00:00:00 | 60.55 | N | N | 45.9 | 14.65
74455 | URETHROCYSTOGRAPHY VOIDING RS&I | 2011-07-01 00:00:00 | 76.76 | N | N | 62.46 | 14.3
74470 | RADEX RENAL CYST STUDY TRANSLUMBAR RS&I | 2011-07-01 00:00:00 | 62.81 | N | N | 38.97 | 23.84
74475 | INTRO CATH IN RENAL PELVIS DRG&/NJX PRQ RS&I | 2011-07-01 00:00:00 | 95.93 | N | N | 72.26 | 23.67
74480 | INTRO URETERAL CATH/STENT PRQ RS&I | 2011-07-01 00:00:00 | 96.22 | N | N | 72.55 | 23.67
74485 | DILATION NEPHROSTOMY/URETER/URETHRA RS&I | 2011-07-01 00:00:00 | 94.78 | N | N | 71.11 | 23.67
74710 | PELVIMETRY W/WOPLACENTAL LOCALIZATION | 2011-07-01 00:00:00 | 34.1 | N | N | 19.49 | 14.61
74740 | HYSTEROSALPINGOGRAPHY RS&I | 2011-07-01 00:00:00 | 67.91 | N | N | 51.5 | 16.41
74742 | TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 26.74
74775 | PERINEOGRAM | 2011-07-01 00:00:00 | 72.91 | N | N | 45.58 | 27.33
75557 | CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST | 2011-07-01 00:00:00 | 384.06 | N | N | 280.17 | 103.89
75559 | CARDIAC MRI W/O CONTRAST W STRESS IMAGING | 2011-07-01 00:00:00 | 423.23 | N | N | 291.13 | 132.1
75561 | CARDIAC MRI W/W/O CONTRAST & FURTHER SEQ | 2011-07-01 00:00:00 | 519.33 | N | N | 404.17 | 115.16
75563 | CARDIAC MRI W/W/O CONTRAST W STRESS | 2011-07-01 00:00:00 | 588.65 | N | N | 452.88 | 135.77
75565 | CARD MRI VEL FLW MAP ADD-ON | 2011-07-01 00:00:00 | 63.36 | N | N | 52.37 | 10.99
75571 | CT HRT W/O DYE W/CA TEST | 2011-07-01 00:00:00 | 60.35 | N | N | 39.39 | 24.26
75572 | CT HRT W/3D IMAGE | 2011-07-01 00:00:00 | 251.23 | N | N | 177.52 | 73.71
75573 | CT HRT W/3D IMAGE, CONGEN | 2011-07-01 00:00:00 | 325.81 | N | N | 217.89 | 107.92
75574 | CT ANGIO HRT W/3D IMAGE | 2011-07-01 00:00:00 | 319.2 | N | N | 217.89 | 101.31
75600 | AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I | 2011-07-01 00:00:00 | 230.51 | N | N | 208.37 | 22.14
75605 | AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I | 2011-07-01 00:00:00 | 184.19 | N | N | 133.69 | 50.5
75625 | AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I | 2011-07-01 00:00:00 | 184.13 | N | N | 133.96 | 50.17
75630 | AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I | 2011-07-01 00:00:00 | 215.54 | N | N | 137.14 | 78.4
75635 | CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTPROCESS | 2011-07-01 00:00:00 | 392.17 | N | N | 286.98 | 105.19
75658 | ANIOGRAPHY BRACHIAL RETROGRADE RS&I | 2011-07-01 00:00:00 | 205.13 | N | N | 148.97 | 56.16
75705 | ANGIOGRAPHY SPINAL SELECTIVE RS&I | 2011-07-01 00:00:00 | 245.12 | N | N | 150.12 | 95
75710 | ANGIOGRAPHY EXTREMITY UNILATERAL RS&I | 2011-07-01 00:00:00 | 199.99 | N | N | 150.71 | 49.28
75716 | ANGIOGRAPHY EXTREMITY BILATERAL RS&I | 2011-07-01 00:00:00 | 230.63 | N | N | 173.25 | 57.38
75726 | ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I | 2011-07-01 00:00:00 | 198.21 | N | N | 148.39 | 49.82
75731 | ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I | 2011-07-01 00:00:00 | 201.54 | N | N | 150.7 | 50.84
75733 | ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I | 2011-07-01 00:00:00 | 231.89 | N | N | 172.68 | 59.21
75736 | ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I | 2011-07-01 00:00:00 | 197.68 | N | N | 148.11 | 49.57
75741 | ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I | 2011-07-01 00:00:00 | 187.83 | N | N | 130.51 | 57.32
75743 | ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I | 2011-07-01 00:00:00 | 210.42 | N | N | 137.73 | 72.69
75746 | ANGRPH [NAME] CATH/VEN NJX RS&I | 2011-07-01 00:00:00 | 191.97 | N | N | 142.05 | 49.92
75756 | ANGIOGRAPHY INTERNAL MAMMARY RS&I | 2011-07-01 00:00:00 | 205.26 | N | N | 150.98 | 54.28
75774 | ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I | 2011-07-01 00:00:00 | 135.7 | N | N | 119.84 | 15.86
75791 | [NAME] SHUNT IMAGING | 2011-07-01 00:00:00 | 209.06 | N | N | 137.14 | 71.92
75801 | LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I | 2011-07-01 00:00:00 | 207.22 | N | N | 169.79 | 37.43
75803 | LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I | 2011-07-01 00:00:00 | 221.45 | N | N | 169.79 | 51.66
75805 | ANGRPH CATH F/U STUDY THER/EMBOLIZATION/INFUSION | 2011-07-01 00:00:00 | 228.61 | N | N | 192.82 | 35.79
75807 | LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 51.95
75809 | SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I | 2011-07-01 00:00:00 | 83.7 | N | N | 63.04 | 20.66
75810 | SPLENOPORTOGRAPY RS&I | 2011-07-01 00:00:00 | 448.11 | N | N | 397.37 | 50.74
75820 | VENOGRAPHY EXTREMITY UNILATERAL RS&I | 2011-07-01 00:00:00 | 107.63 | N | N | 76.88 | 30.75
75822 | VENOGRAPHY EXTREMITY BILATERAL RS&I | 2011-07-01 00:00:00 | 132.15 | N | N | 86.11 | 46.04
75825 | VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I | 2011-07-01 00:00:00 | 176.58 | N | N | 127.34 | 49.24
75827 | VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I | 2011-07-01 00:00:00 | 178.7 | N | N | 129.93 | 48.77
75831 | VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I | 2011-07-01 00:00:00 | 182.55 | N | N | 130.22 | 52.33
75833 | VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I | 2011-07-01 00:00:00 | 207.46 | N | N | 144.06 | 63.4
75840 | VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I | 2011-07-01 00:00:00 | 179.08 | N | N | 127.63 | 51.45
75842 | VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I | 2011-07-01 00:00:00 | 208.04 | N | N | 143.2 | 64.84
75860 | VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I | 2011-07-01 00:00:00 | 182.34 | N | N | 131.66 | 50.68
75870 | VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I | 2011-07-01 00:00:00 | 180.15 | N | N | 130.51 | 49.64
75872 | VENOGRAPHY EPIDURAL RS&I | 2011-07-01 00:00:00 | 242.72 | N | N | 189.62 | 53.1
75880 | VENOGRAPHY ORBITAL RS&I | 2011-07-01 00:00:00 | 146.85 | N | N | 115.52 | 31.33
75885 | PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I | 2011-07-01 00:00:00 | 192.96 | N | N | 130.23 | 62.73
75887 | PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVAL RS&I | 2011-07-01 00:00:00 | 194.74 | N | N | 132.24 | 62.5
75889 | HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I | 2011-07-01 00:00:00 | 179.87 | N | N | 130.23 | 49.64
75891 | HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I | 2011-07-01 00:00:00 | 180.15 | N | N | 130.51 | 49.64
75893 | VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&I | 2011-07-01 00:00:00 | 152.39 | N | N | 129.36 | 23.03
75894 | TRANSCATHETER EMBOLIZATION ANY METH RS&I | 2011-07-01 00:00:00 | 821.47 | N | N | 763.04 | 58.43
75896 | TRANSCATHETER INFUSION ANY METHOD RS&I | 2011-07-01 00:00:00 | 721.94 | N | N | 662.94 | 59
75898 | ANGRPH CATH F-UP STD TCAT THER EMBOLIZATION/NFS | 2011-07-01 00:00:00 | 103.75 | N | N | 29.32 | 74.43
75901 | MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I | 2011-07-01 00:00:00 | 142.85 | N | N | 121.57 | 21.28
75902 | MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I | 2011-07-01 00:00:00 | 65.86 | N | N | 48.91 | 16.95
75945 | IV ULTRASOUND RS&I INITIAL VESSEL | 2011-07-01 00:00:00 | 0 | N | N | N/A | 17.72
75946 | IV ULTRASOUND RS&I EACH NON-CORONARY VESSEL | 2011-07-01 00:00:00 | 0 | N | N | N/A | 17.78
75952 | EVASC RPR INFRARENAL AAA/DISSECTION RS&I | 2011-07-01 00:00:00 | 200.75 | N | N | N/A | 199.63
75953 | PLMT XTN PROSTH EVASC RPR INFRARENAL RS&I | 2011-07-01 00:00:00 | 76.65 | N | N | N/A | 60.73
75954 | EVASC RPR ILIAC ART W/ILIO-ILIAC PROSTH RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 99.91
75956 | EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 312.48
75957 | EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 267.5
75958 | PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 177.61
75959 | PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 155.86
75962 | TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI | 2011-07-01 00:00:00 | 181.29 | N | N | 157.91 | 23.38
75964 | [NAME] ADDL ARTERY RSI | 2011-07-01 00:00:00 | 112.81 | N | N | 97.07 | 15.74
75966 | TRLUML BALO ANGIOPLASTY RENAL/OTH VISC ART RS&I | 2011-07-01 00:00:00 | 218.8 | N | N | 160.79 | 58.01
75968 | TRLUML BALO ANGIOPLASTY EA VISCERAL ART RS&I | 2011-07-01 00:00:00 | 110.84 | N | N | 95.04 | 15.8
75970 | TRANSCATHETER BIOPSY RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 36.69
75978 | TRANSLUMINAL BALLOON ANGIOPLASTY VENOUS RS&I | 2011-07-01 00:00:00 | 181.58 | N | N | 158.49 | 23.09
75980 | PRQ TRANSHEPATC BILIARY DRG W/CONTRAST MNTR RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 63.43
75982 | PRQ PLMT INT/EXT BILIARY DRNG CATH/STENT RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 63.43
75984 | CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I | 2011-07-01 00:00:00 | 98.73 | N | N | 67.36 | 31.37
75989 | RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I | 2011-07-01 00:00:00 | 117.03 | N | N | 65.64 | 51.39
76000 | FLUOROSCOPY SPX LT1 HOUR PHYSICIAN TIME | 2011-07-01 00:00:00 | 66.11 | N | N | 58.72 | 7.39
76001 | FLUOROSCOPY SPX GT 1 HOUR PHYSICIAN TIME | 2011-07-01 00:00:00 | 0 | N | N | N/A | 30.54
76010 | RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD | 2011-07-01 00:00:00 | 23.73 | N | N | 15.75 | 7.98
76080 | RADEX ABSCESS/FISTULA/SINUS TRACT RS&I | 2011-07-01 00:00:00 | 53.84 | N | N | 30.17 | 23.67
76098 | RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN | 2011-07-01 00:00:00 | 16.49 | N | N | 9.41 | 7.08
76100 | RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY | 2011-07-01 00:00:00 | 90.87 | N | N | 64.18 | 26.69
76101 | [NAME] | 2011-07-01 00:00:00 | 150.52 | N | N | 121.87 | 28.65
76102 | [NAME] | 2011-07-01 00:00:00 | 201.91 | N | N | 172.91 | 29
76120 | CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC | 2011-07-01 00:00:00 | 65.66 | N | N | 49.19 | 16.47
76125 | CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION | 2011-07-01 00:00:00 | 0 | N | N | N/A | 12.53
76140 | CONSLTJ X-RAY XM MADE ELSEWHERE WRTTN REPRT | 2008-07-01 00:00:00 | 32.86 | N | N | N/A | N/A
76376 | 3D RENDERING W/INTERP CT/MRI/US/OTHER TOMOGRAPHY | 2011-07-01 00:00:00 | 61.25 | N | N | 52.37 | 8.88
76377 | 3D RENDER W/INTERP CT/MRI/US/OTH TOMO W/POSTPROC | 2011-07-01 00:00:00 | 80.4 | N | N | 46.03 | 34.37
76380 | CT LIMITED/LOCALIZED FOLLOW UP STUDY | 2011-07-01 00:00:00 | 138.69 | N | N | 96.2 | 42.49
76390 | MRI SPECTROSCOPY | 2008-07-01 00:00:00 | 451.86 | N | N | 379.56 | 72.3
76496 | UNLISTED FLUOROSCOPIC PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL) | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
76497 | UNLISTED COMPUTED TOMOGRAPHY PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL) | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
76498 | UNLISTED MAGNETIC RESONANCE PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL) | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
76499 | UNLISTED RADIOLOGY PROCEDURE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
76506 | ECHOENCEPHALOGRAPY REAL TIME IMAGING | 2011-07-01 00:00:00 | 80.41 | N | N | 52.95 | 27.46
76510 | OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR | 2011-07-01 00:00:00 | 141.8 | N | N | 63.04 | 78.76
76511 | OPHTHALMIC ULTRASOUND DX QUAN A-SCAN ONLY | 2011-07-01 00:00:00 | 85.9 | N | N | 41.12 | 44.78
76512 | OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN | 2011-07-01 00:00:00 | 79.51 | N | N | 34.2 | 45.31
76513 | OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM | 2011-07-01 00:00:00 | 75.61 | N | N | 45.74 | 29.87
76514 | OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI | 2011-07-01 00:00:00 | 11.89 | N | N | 3.64 | 8.25
76516 | OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN | 2011-07-01 00:00:00 | 61.85 | N | N | 36.23 | 25.62
76519 | OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL | 2011-07-01 00:00:00 | 66.81 | N | N | 40.55 | 26.26
76529 | OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION | 2011-07-01 00:00:00 | 63.12 | N | N | 35.36 | 27.76
76536 | US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCMTN | 2011-07-01 00:00:00 | 101.45 | N | N | 77.17 | 24.28
76604 | US CHEST REAL TIME W/IMAGE DOCUMENTATION | 2011-07-01 00:00:00 | 75.47 | N | N | 51.78 | 23.69
76645 | US BREAST REAL TIME W/IMAGE DOCUMENTATION | 2011-07-01 00:00:00 | 76.21 | N | N | 52.66 | 23.55
76700 | US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION | 2011-07-01 00:00:00 | 116.48 | N | N | 81.5 | 34.98
76705 | ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED | 2011-07-01 00:00:00 | 91.69 | N | N | 66.2 | 25.49
76770 | US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE | 2011-07-01 00:00:00 | 113.47 | N | N | 83.29 | 30.18
76775 | US RETROPERITONEAL REAL TIME W/IMAGE LIMITED | 2011-07-01 00:00:00 | 95.72 | N | N | 70.25 | 25.47
76776 | US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN | 2011-07-01 00:00:00 | 129.94 | N | N | 97.06 | 32.88
76800 | ULTRASOUND SPINAL CANAL & CONTENTS | 2011-07-01 00:00:00 | 115.01 | N | N | 66.78 | 48.23
76801 | US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT | 2011-07-01 00:00:00 | 112.29 | N | N | 69.38 | 42.91
76802 | US PREG UTERUS 14 WK TRANSABDL EACH GESTATION | 2011-07-01 00:00:00 | 60.69 | N | N | 24.69 | 36
76805 | US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION | 2011-07-01 00:00:00 | 124.4 | N | N | 81.49 | 42.91
76810 | US PREG UTERUS GT 1ST TRIMESTER ABDL EA GESTATION | 2011-07-01 00:00:00 | 84.59 | N | N | 42.27 | 42.32
76811 | US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION | 2011-07-01 00:00:00 | 167.28 | N | N | 84.95 | 82.33
76812 | US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT | 2011-07-01 00:00:00 | 129.88 | N | N | 52.95 | 76.93
76813 | US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION | 2011-07-01 00:00:00 | 109.62 | N | N | 58.71 | 50.91
76814 | US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION | 2011-07-01 00:00:00 | 70.19 | N | N | 27.57 | 42.62
76815 | US PREGNANT UTERUS LIMITED 1/GT FETUSES | 2011-07-01 00:00:00 | 78.76 | N | N | 50.92 | 27.84
76816 | US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS | 2011-07-01 00:00:00 | 89.55 | N | N | 52.65 | 36.9
76817 | US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG | 2011-07-01 00:00:00 | 85.05 | N | N | 52.65 | 32.4
76818 | FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING | 2011-07-01 00:00:00 | 105.76 | N | N | 60.15 | 45.61
76819 | FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING | 2011-07-01 00:00:00 | 79.33 | N | N | 45.74 | 33.59
76820 | DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY | 2011-07-01 00:00:00 | 40.44 | N | N | 18.92 | 21.52
76821 | DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART | 2011-07-01 00:00:00 | 83.24 | N | N | 52.66 | 30.58
76825 | ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING | 2011-07-01 00:00:00 | 187.47 | N | N | 115.51 | 71.96
76826 | ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD | 2011-07-01 00:00:00 | 107.69 | N | N | 71.98 | 35.71
76827 | DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE | 2011-07-01 00:00:00 | 57.3 | N | N | 32.47 | 24.83
76828 | DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT | 2011-07-01 00:00:00 | 42.27 | N | N | 18.05 | 24.22
76830 | ULTRASOUND TRANSVAGINAL | 2011-07-01 00:00:00 | 107.44 | N | N | 77.45 | 29.99
76831 | SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER | 2011-07-01 00:00:00 | 107.78 | N | N | 76.59 | 31.19
76856 | US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE | 2011-07-01 00:00:00 | 107.15 | N | N | 77.16 | 29.99
76857 | US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U | 2011-07-01 00:00:00 | 69.71 | N | N | 52.66 | 17.05
76870 | ULTRASOUND SCROTUM & CONTENTS | 2011-07-01 00:00:00 | 106.38 | N | N | 78.33 | 28.05
76872 | ULTRASOUND TRANSRECTAL | 2011-07-01 00:00:00 | 112.23 | N | N | 81.49 | 30.74
76873 | US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX | 2011-07-01 00:00:00 | 149.61 | N | N | 81.5 | 68.11
76881 | US EXTREMITY NON-VASC REAL-TIME IMG COMPL | 2011-07-01 00:00:00 | 98.22 | N | N | 73.14 | 25.08
76882 | US EXTREMITY NON-VASC REAL-TIME IMG LMTD | 2011-07-01 00:00:00 | 25.93 | N | N | 8.54 | 17.39
76885 | US INFT HIPS R-T IMG DYNAMIC REQ PHYS [NAME] | 2011-07-01 00:00:00 | 85.21 | N | N | 52.94 | 32.27
76886 | US INFT HIPS R-T IMG LMTD STATIC X PHYS MANJ | 2011-07-01 00:00:00 | 79.87 | N | N | 52.66 | 27.21
76930 | US GUIDANCE PERICARDIOCENTESIS RS&I | 2011-07-01 00:00:00 | 78.22 | N | N | 48.33 | 29.89
76932 | US ENDOMYOCARDIAL BIOPSY RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 30.7
76936 | US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL | 2011-07-01 00:00:00 | 178.37 | N | N | 90.43 | 87.94
76937 | US VASC ACCESS SITS VSL PATENCY NDL ENTRY | 2011-07-01 00:00:00 | 29.77 | N | N | 16.61 | 13.16
76940 | US &MNTR PARENCHYMAL TISSUE ABLATION | 2011-07-01 00:00:00 | 140.15 | N | N | 50.28 | 89.87
76941 | US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 59.63
76942 | US GUIDANCE NEEDLE PLACEMENT RS&I | 2011-07-01 00:00:00 | 168.71 | N | N | 139.45 | 29.26
76946 | US GUIDANCE AMNIOCENTESIS RS&I | 2011-07-01 00:00:00 | 32.73 | N | N | 16.32 | 16.41
76948 | US GUIDANCE ASPIRATION OVA RS&I | 2011-07-01 00:00:00 | 33.08 | N | N | 16.32 | 16.76
76950 | US [NAME] RADIATION THERAPY FIELDS | 2011-07-01 00:00:00 | 59.38 | N | N | 33.91 | 25.47
76965 | US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION | 2011-07-01 00:00:00 | 101.95 | N | N | 42.56 | 59.39
76970 | US STUDY FOLLOW UP | 2011-07-01 00:00:00 | 70.2 | N | N | 52.66 | 17.54
76975 | GI ENDOSCOPIC ULTRASOUND RS&I | 2011-07-01 00:00:00 | 0 | N | N | N/A | 37.41
76977 | US BONE DENSITY MEAS & INTERP PERIPH ANY METHOD | 2011-07-01 00:00:00 | 8.8 | N | N | 6.52 | 2.28
76998 | ULTRASONIC GUIDANCE INTRAOPERATIVE | 2011-07-01 00:00:00 | 135.84 | N | N | 81.5 | 54.79
76999 | UNLISTED ULTRASOUND PROC | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
77001 | FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT | 2011-07-01 00:00:00 | 97.68 | N | N | 80.92 | 16.76
77002 | FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT | 2011-07-01 00:00:00 | 64.79 | N | N | 40.83 | 23.96
77003 | FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER | 2011-07-01 00:00:00 | 53.65 | N | N | 27.86 | 25.79
77011 | CT GUIDANCE STEREOTACTIC LOCALIZATION | 2011-07-01 00:00:00 | 412.16 | N | N | 358.89 | 53.27
77012 | CT GUIDANCE NEEDLE PLACEMENT | 2011-07-01 00:00:00 | 140.45 | N | N | 90.44 | 50.01
77013 | CT GUIDANCE &MONITORING VISC TISS ABLATION | 2011-07-01 00:00:00 | 486.32 | N | N | 310.26 | 176.06
77014 | CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT | 2011-07-01 00:00:00 | 163.84 | N | N | 126.77 | 37.07
77021 | MR GUIDANCE NEEDLE PLACEMENT | 2011-07-01 00:00:00 | 369.95 | N | N | 304.11 | 65.84
77022 | MR GUIDANCE &MONITORING TISSUE ABLATION | 2011-07-01 00:00:00 | 0 | N | N | N/A | 186.18
77051 | COMPUTER-AIDED DETECTION DX MAMMOGRAPHY | 2011-07-01 00:00:00 | 9.68 | N | N | 7.1 | 2.58
77052 | COMPUTER-AIDED DETECTION SCREENING MAMMOGRAPHY | 2011-07-01 00:00:00 | 9.68 | N | N | 7.1 | 2.58
77053 | MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE | 2011-07-01 00:00:00 | 58.07 | N | N | 42.56 | 15.51
77054 | MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE | 2011-07-01 00:00:00 | 78.47 | N | N | 58.71 | 19.76
77055 | MAMMOGRAPHY UNILATERAL | 2011-07-01 00:00:00 | 74.19 | N | N | 43.72 | 30.47
77056 | MAMMOGRAPHY BILATERAL | 2011-07-01 00:00:00 | 94.84 | N | N | 56.98 | 37.86
77057 | SCREENING MAMMOGRAPHY BILATERAL | 2011-07-01 00:00:00 | 69.57 | N | N | 39.12 | 30.47
77058 | MRI BREAST UNILATERAL | 2011-07-01 00:00:00 | 523.81 | N | N | 452.9 | 70.91
77059 | MRI BREAST BILATERAL | 2011-07-01 00:00:00 | 523.81 | N | N | 452.9 | 70.91
77071 | MANUAL APPL STRESS PFRMD PHYS JOINT RADIOGRAPHY | 2011-07-01 00:00:00 | 39.72 | N | N | N/A | N/A
77072 | BONE AGE STUDIES | 2011-07-01 00:00:00 | 20.29 | N | N | 12 | 8.29
77073 | BONE LENGTH STUDIES | 2011-07-01 00:00:00 | 33.35 | N | N | 20.64 | 12.71
77074 | RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED | 2011-07-01 00:00:00 | 60.02 | N | N | 40.26 | 19.76
77075 | RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL | 2011-07-01 00:00:00 | 87.57 | N | N | 64.19 | 23.38
77076 | RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT | 2011-07-01 00:00:00 | 86.29 | N | N | 56.4 | 29.89
77077 | [NAME] VIEW 2 OR MORE JOINTS | 2011-07-01 00:00:00 | 36.02 | N | N | 21.8 | 14.22
77078 | CT BONE MINERL DENSITY STUDY 1/GT SITS AXIAL SKEL | 2011-07-01 00:00:00 | 70.39 | N | N | 59.69 | 10.7
77080 | DXA BONE DENSITY STUDY 1/GT SITES AXIAL SKEL | 2011-07-01 00:00:00 | 81.57 | N | N | 72.06 | 9.51
77081 | DXA BONE DENSITY STUDY 1/GTSITES APPENDICLR SKEL | 2011-07-01 00:00:00 | 24.67 | N | N | 16.04 | 8.63
77082 | DXA BONE DENSITY STUDY VERTEBRAL FRACTURE | 2011-07-01 00:00:00 | 23.3 | N | N | 17.71 | 5.59
77084 | BONE MARROW BLOOD SUPPLY | 2011-07-01 00:00:00 | 361.13 | N | N | 291.14 | 69.99
77261 | THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE | 2011-07-01 00:00:00 | 62.71 | N | N | N/A | N/A
77262 | THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE | 2011-07-01 00:00:00 | 94.19 | N | N | N/A | N/A
77263 | THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX | 2011-07-01 00:00:00 | 139.78 | N | N | N/A | N/A
77280 | THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE | 2011-07-01 00:00:00 | 161.09 | N | N | 130.51 | 30.58
77285 | THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED | 2011-07-01 00:00:00 | 282.29 | N | N | 236.34 | 45.95
77290 | THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX | 2011-07-01 00:00:00 | 451.65 | N | N | 383.4 | 68.25
77293 | RESPIRATORY MOTION MANAGEMENT SIMULATION | 2014-01-01 00:00:00 | 389.58 | N | N | 264.79 | 98.33
77295 | THER RAD SIMULAJ-AIDED FLD SETTING 3-DIMENSIONAL | 2011-07-01 00:00:00 | 484.02 | N | N | 284.16 | 199.86
77299 | UNLISTED PROCEDURE, THERAPEUTIC RADIOLOGY PLANNING | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
77300 | BASIC RADIATION DOSIMETRY CALCULATION | 2011-07-01 00:00:00 | 60.03 | N | N | 32.76 | 27.27
77301 | NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS | 2011-07-01 00:00:00 | 1779.03 | N | N | 1428.91 | 350.12
77305 | TELETHERAPY ISODOSE PLAN SIMPLE | 2011-07-01 00:00:00 | 57.29 | N | N | 26.71 | 30.58
77310 | TELETHERAPY ISODOSE PLAN INTERMEDIATE | 2011-07-01 00:00:00 | 81.03 | N | N | 35.08 | 45.95
77315 | TELETHERAPY ISODOSE PLAN COMPLETE | 2011-07-01 00:00:00 | 122.92 | N | N | 54.67 | 68.25
77321 | [NAME] TELETHX PORT PLN PARTS HEMIBDY TOT BDY | 2011-07-01 00:00:00 | 91.92 | N | N | 50.64 | 41.28
77326 | BRACHYTHERAPY ISODOSE PLAN SIMPLE | 2011-07-01 00:00:00 | 123.96 | N | N | 83.58 | 40.38
77327 | BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE | 2011-07-01 00:00:00 | 175.74 | N | N | 115 | 60.74
77328 | BRACHYTHERAPY ISODOSE PLAN COMPLEX | 2011-07-01 00:00:00 | 237.65 | N | N | 146.33 | 91.32
77331 | SPEC DOSIM ONLY PRESCRIBED TREATING PHYS | 2011-07-01 00:00:00 | 54.59 | N | N | 16.33 | 38.26
77332 | TX DEVICES DESIGN & CONSTRUCTION SIMPLE | 2011-07-01 00:00:00 | 67.38 | N | N | 43.71 | 23.67
77333 | TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE | 2011-07-01 00:00:00 | 51.65 | N | N | 14.88 | 36.77
77334 | TX DEVICES DESIGN & CONSTRUCTION COMPLEX | 2011-07-01 00:00:00 | 131.81 | N | N | 77.74 | 54.07
77336 | CONTINUING MEDICAL PHYSICS CONSLTJ PR WK | 2011-07-01 00:00:00 | 44.3 | N | N | N/A | N/A
77338 | DESIGN MLC DEVICE FOR IMRT | 2011-07-01 00:00:00 | 411.29 | N | N | 221.59 | 189.7
77370 | SPEC MEDICAL RADJ PHYSICS CONSLTJ | 2011-07-01 00:00:00 | 98.45 | N | N | N/A | N/A
77371 | RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT | 2008-07-01 00:00:00 | 0 | N | N | 1007 | N/A
77372 | RADIATION DELIVERY STEREOTACTIC CRANIAL LINEAR | 2011-07-01 00:00:00 | 722.35 | N | N | N/A | N/A
77373 | STEREOTACTIC BODY RADIATION DELIVERY | 2011-07-01 00:00:00 | 1349.01 | N | N | N/A | N/A
77399 | UNLISTED ADJUNCT PHYSICS SV | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
77401 | [NAME] VOLTAGE | 2011-07-01 00:00:00 | 21.51 | N | N | N/A | N/A
77402 | RADJ DLVR 1 AREA 1/PRLL OPSD PORTS SMPL LT5MEV | 2011-07-01 00:00:00 | 149.54 | N | N | N/A | N/A
77403 | RADJ DLVR 1 AREA 1/PRLL OPSD PORTS SMPL 6-10MEV | 2011-07-01 00:00:00 | 111.2 | N | N | N/A | N/A
77404 | RADJ DLVR 1 AREA 1/PRLL OPSD PORTS SMPL 11-19MEV | 2011-07-01 00:00:00 | 123.59 | N | N | N/A | N/A
77406 | RADJ DLVR 1 AREA 1/PRLL OPSD PORTS SMPL 20MEV/LT | 2011-07-01 00:00:00 | 124.75 | N | N | N/A | N/A
77407 | RADJ DLVR 2 AREAS 3/GTPORTS 1 MLT BLKS LT5MEV | 2011-07-01 00:00:00 | 216.73 | N | N | N/A | N/A
77408 | RADJ DLVR 2 AREAS 3/GTPORTS 1 MLT BLKS 6-1MEV | 2011-07-01 00:00:00 | 151.27 | N | N | N/A | N/A
77409 | RADJ DLVR 2 AREAS 3/GTPORTS 1 MLT BLKS 11-19MEV | 2011-07-01 00:00:00 | 168.29 | N | N | N/A | N/A
77411 | RADJ DLVR 2 AREAS 3/GT PORTS 1 TX AREA 20 MEV/LT | 2011-07-01 00:00:00 | 167.42 | N | N | N/A | N/A
77412 | RADJ DLVR 3/GT AREAS CUSTOM BLKING LT5MEV | 2011-07-01 00:00:00 | 197.42 | N | N | N/A | N/A
77413 | RADJ DLVR 3/GT AREAS CUSTOM BLKING 6-10MEV | 2011-07-01 00:00:00 | 198.86 | N | N | N/A | N/A
77414 | RADJ DLVR 3/GT AREAS CUSTOM BLKING 11-19MEV | 2011-07-01 00:00:00 | 222.5 | N | N | N/A | N/A
77416 | RADJ DLVR 3/GT AREAS CUSTOM BLKING 20MEV/LT | 2011-07-01 00:00:00 | 223.65 | N | N | N/A | N/A
77417 | THERAPEUTIC RADIOLOGY PORT FILMS | 2011-07-01 00:00:00 | 12.57 | N | N | N/A | N/A
77418 | NTSTY MODUL DLVR 1/MLT FLDS/ARCS PR TX SESSION | 2011-07-01 00:00:00 | 441.07 | N | N | N/A | N/A
77421 | [NAME] GDN [NAME] DLVR RADJ THER | 2011-07-01 00:00:00 | 93.88 | N | N | 76.88 | 17
77422 | HIGH ENERGY NEUTRON RADJ TX DLVR 1 TX AREA | 2011-07-01 00:00:00 | 168.87 | N | N | N/A | N/A
77423 | HIGH ENERGY NEUTRON RADJ TX DLVR 1/GT ISOCENTER | 2011-07-01 00:00:00 | 214.71 | N | N | N/A | N/A
77424 | INTRAOP RADIAJ TX DELIVER XRAY SINGLE TX SESSION | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
77425 | INTRAOP RADIAJ TX DELIVER ELECTRONS SNGL TX SESS | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
77427 | RADIATION TREATMENT MANAGEMENT 5 TREATMENTS | 2011-07-01 00:00:00 | 155.93 | N | N | N/A | N/A
77431 | [NAME] 1/2 FRACTIONS ONLY | 2011-07-01 00:00:00 | 85.48 | N | N | N/A | N/A
77432 | STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION | 2011-07-01 00:00:00 | 353.32 | N | N | N/A | N/A
77435 | STEREOTACTIC BODY RADIATION MANAGEMENT | 2011-07-01 00:00:00 | 585.1 | N | N | N/A | N/A
77469 | INTRAOPERATIVE RADIATION TREATMENT MANAGEMENT | 2012-01-01 00:00:00 | 253.85 | N | N | N/A | N/A
77470 | SPECIAL TREATMENT PROCEDURE | 2011-07-01 00:00:00 | 173.97 | N | N | 82.36 | 91.61
77499 | UNLISTED THERAPEUTIC RADIOLOGY | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
77520 | PROTON BEAM DELIVERY SINLGE TREATMENT AREA | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
77522 | PROTON TREATMENT DELIVERY SIMPLE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
77523 | PROTON BEAM DELIVERY ONE OR TWO TREATMENT AREAS | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
77525 | PROTON TREATMENT DELIVERY COMPLEX | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
77600 | HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL | 2011-07-01 00:00:00 | 347.62 | N | N | 279.37 | 68.25
77605 | HYPERTHERMIA EXTERNAL GENERATED DEEP | 2011-07-01 00:00:00 | 789.67 | N | N | 695.47 | 94.2
77610 | HYPERTHERMIA INTERSTITIAL PROBE 5/LT APPLICATORS | 2011-07-01 00:00:00 | 721.61 | N | N | 654.51 | 67.1
77615 | HYPERTHERMIA INTERSTIAL PROBE 5/GT APPLICATORS | 2011-07-01 00:00:00 | 827.28 | N | N | 735.96 | 91.32
77620 | HYPERTHERMIA INTRACAVITARY PROBES | 2011-07-01 00:00:00 | 410.13 | N | N | 343.84 | 66.29
77750 | NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE | 2011-07-01 00:00:00 | 304.74 | N | N | 85.88 | 218.86
77761 | INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE | 2011-07-01 00:00:00 | 316.57 | N | N | 148.92 | 167.65
77762 | INTRACAVITARY RADIATION SOURCE APPLIC INTERMED | 2011-07-01 00:00:00 | 426.2 | N | N | 174.17 | 252.03
77763 | INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX | 2011-07-01 00:00:00 | 603.9 | N | N | 225.28 | 378.62
77776 | INTERSTITIAL RADIATION SOURCE APPLIC SIMPLE | 2011-07-01 00:00:00 | 362.25 | N | N | 155.44 | 206.81
77777 | INTERSTITIAL RADIATION SOURCE APPLIC INTERMED | 2011-07-01 00:00:00 | 503.24 | N | N | 169.84 | 333.4
77778 | INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX | 2011-07-01 00:00:00 | 726.57 | N | N | 231.23 | 495.34
77785 | REMOTE AFTLD RADIONUCLIDE BRACHYTX 1 CHANNEL | 2011-07-01 00:00:00 | 187.91 | N | N | 125.67 | 62.24
77786 | REMOTE AFTLD RADIONUCLIDE BRACHYTX 2-12 CHANNEL | 2011-07-01 00:00:00 | 488.02 | N | N | 346.91 | 141.11
77787 | REMOTE AFTLD RADIONUCLIDE BRACHYTX GT 12 CHANNEL | 2011-07-01 00:00:00 | 777.75 | N | N | 562.25 | 215.5
77789 | SURFACE APPLICATION RADIATION SOURCE | 2011-07-01 00:00:00 | 95.6 | N | N | 45.45 | 50.15
77790 | SUPERVISION HANDLING LOADING RADIATION SOURCE | 2011-07-01 00:00:00 | 78.54 | N | N | 32.76 | 45.78
77799 | UNLISTED BRACHYTHERAPY | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
78012 | THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT | 2013-01-01 00:00:00 | 67.23 | N | N | 59.31 | 7.92
78013 | THYROID IMAGING WITH VASCULAR FLOW | 2013-01-01 00:00:00 | 135.89 | N | N | 120.55 | 15.35
78014 | THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS | 2013-01-01 00:00:00 | 196.27 | N | N | 175.75 | 20.52
78015 | THYROID CARCINOMA METASTASES IMG LMTD AREA | 2011-07-01 00:00:00 | 183.2 | N | N | 154.52 | 28.68
78016 | THYROID CARCINOMA METASTASES IMG ADDL STUDY | 2011-07-01 00:00:00 | 259.41 | N | N | 226.32 | 33.09
78018 | THYROID CARCINOMA METASTASES IMG WHOLE BODY | 2011-07-01 00:00:00 | 271.19 | N | N | 234.68 | 36.51
78020 | THYROID CARCINOMA METASTASES UPTAKE | 2011-07-01 00:00:00 | 73.84 | N | N | 48.62 | 25.22
78070 | PARATHYROID IMAGING | 2011-07-01 00:00:00 | 141.35 | N | N | 106.06 | 35.29
78071 | PARATHYROID PLANAR IMAGING W/WO SUBTRACTION | 2013-01-01 00:00:00 | 294.08 | N | N | 245.29 | 48.81
78072 | PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT | 2013-01-01 00:00:00 | 0 | N | Y | N/A | N/A
78075 | ADRENAL IMAGING CORTEX &/MEDULLA | 2011-07-01 00:00:00 | 361.98 | N | N | 330.58 | 31.4
78099 | UNLISTED ENDOCRINE SYST TEST | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
78102 | BONE MARROW IMAGING LIMITED AREA | 2011-07-01 00:00:00 | 141.57 | N | N | 118.17 | 23.4
78103 | BONE MARROW IMAGING MULTIPLE AREAS | 2011-07-01 00:00:00 | 186.8 | N | N | 155.09 | 31.71
78104 | BONE MARROW IMAGING WHOLE BODY | 2011-07-01 00:00:00 | 212.26 | N | N | 178.16 | 34.1
78110 | PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE | 2011-07-01 00:00:00 | 70.24 | N | N | 61.95 | 8.29
78111 | PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES | 2011-07-01 00:00:00 | 74.32 | N | N | 65.11 | 9.21
78120 | RED CELL VOLUME DETERMINATION SPX 1 SAMPLING | 2011-07-01 00:00:00 | 74.63 | N | N | 64.54 | 10.09
78121 | RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS | 2011-07-01 00:00:00 | 85.74 | N | N | 72.03 | 13.71
78122 | WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLUME | 2011-07-01 00:00:00 | 95.78 | N | N | 76.94 | 18.84
78130 | RED CELL SURVIVAL STUDY | 2011-07-01 00:00:00 | 131.93 | N | N | 105.08 | 26.85
78135 | RBC SURVIVAL STUDY DIFFERNTL ORGAN/TISS KINETICS | 2011-07-01 00:00:00 | 291.85 | N | N | 263.8 | 28.05
78140 | LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE | 2011-07-01 00:00:00 | 118.49 | N | N | 91.93 | 26.56
78185 | SPLEEN IMAGING ONLY W/WO VASCULAR FLOW | 2011-07-01 00:00:00 | 170.96 | N | N | 153.65 | 17.31
78190 | KINETICS PLATELET W/WO DIFFRNTL ORGAN/TIS LOCLZJ | 2011-07-01 00:00:00 | 194.13 | N | N | 147.41 | 46.72
78191 | PLATELET SURVIVAL STUDY | 2011-07-01 00:00:00 | 150.68 | N | N | 124.12 | 26.56
78195 | LYMPHATICS & LYMPH NODES IMAGING | 2011-07-01 00:00:00 | 269.7 | N | N | 217.94 | 51.76
78199 | UNLISTED NUCLEAR MED TEST | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
78201 | [NAME] STATIC ONLY | 2011-07-01 00:00:00 | 157.71 | N | N | 138.94 | 18.77
78202 | LIVER IMAGING W/VASCULAR FLOW | 2011-07-01 00:00:00 | 172.3 | N | N | 151.34 | 20.96
78205 | [NAME] | 2011-07-01 00:00:00 | 193.64 | N | N | 163.16 | 30.48
78206 | LIVER IMAGING SPECT W/VASCULAR FLOW | 2011-07-01 00:00:00 | 265.88 | N | N | 224.87 | 41.01
78215 | LIVER & SPLEEN IMAGING STATIC ONLY | 2011-07-01 00:00:00 | 163.39 | N | N | 142.11 | 21.28
78216 | LIVER & SPLEEN IMAGING W/VASCULAR FLOW | 2011-07-01 00:00:00 | 111.33 | N | N | 87.03 | 24.3
78226 | HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER | 2012-01-01 00:00:00 | 266.06 | N | N | 235.81 | 30.26
78227 | HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ | 2012-01-01 00:00:00 | 272.33 | N | N | 235.81 | 36.52
78230 | SALIVARY GLAND IMAGING | 2011-07-01 00:00:00 | 141.11 | N | N | 121.63 | 19.48
78231 | SALIVARY GLAND IMAGING SERIAL IMAGES | 2011-07-01 00:00:00 | 109.74 | N | N | 87.61 | 22.13
78232 | SALIVARY GLAND FUNCTION STUDY | 2011-07-01 00:00:00 | 99.91 | N | N | 80.69 | 19.22
78258 | ESOPHAGEAL MOTILITY | 2011-07-01 00:00:00 | 194.38 | N | N | 162.29 | 32.09
78261 | GASTRIC MUCOSA IMAGING | 2011-07-01 00:00:00 | 212.64 | N | N | 182.48 | 30.16
78262 | GASTROESOPHAGEAL REFLUX STUDY | 2011-07-01 00:00:00 | 208.64 | N | N | 179.88 | 28.76
78264 | GASTRIC EMPTYING STUDY | 2011-07-01 00:00:00 | 236.15 | N | N | 202.66 | 33.49
78267 | UREA BREATH TEST C-14 ISOTOPIC ACQUISJ ANALYSIS | 2011-07-01 00:00:00 | 10.98 | N | N | N/A | N/A
78268 | UREA BREATH TEST C-14 ISOTOPIC ANALYSIS | 2011-07-01 00:00:00 | 85.31 | N | N | N/A | N/A
78270 | VITAMIN B-12 ABSRPJ STUDY W/O INTRINSIC FACTOR | 2011-07-01 00:00:00 | 69.04 | N | N | 60.44 | 8.6
78271 | VITAMIN B-12 ABSRPJ STUDY W/INTRINSIC FACTOR | 2011-07-01 00:00:00 | 72.79 | N | N | 64.19 | 8.6
78272 | VITAMIN B-12 ABSRPJ STDY W/&W/O INTRINSIC FACTOR | 2011-07-01 00:00:00 | 77.3 | N | N | 65.99 | 11.31
78278 | ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING | 2011-07-01 00:00:00 | 245.46 | N | N | 202.78 | 42.68
78282 | GASTROINTESTINAL PROTEIN LOSS | 2011-07-01 00:00:00 | 0 | N | N | N/A | 16.76
78290 | INTESTINE IMAGING | 2011-07-01 00:00:00 | 232.52 | N | N | 202.95 | 29.57
78291 | PERITONEAL-VENOUS SHUNT PATENCY TEST | 2011-07-01 00:00:00 | 215.16 | N | N | 177.29 | 37.87
78299 | GASTROINTESTINAL STD/NCLR MED | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
78300 | BONE &/JOINT IMAGING LIMITED AREA | 2011-07-01 00:00:00 | 150.06 | N | N | 123.08 | 26.98
78305 | BONE &/JOINT IMAGING MULTIPLE AREAS | 2011-07-01 00:00:00 | 198.18 | N | N | 162.58 | 35.6
78306 | BONE &/JOINT IMAGING WHOLE BODY | 2011-07-01 00:00:00 | 215.82 | N | N | 178.73 | 37.09
78315 | BONE &/JOINT IMAGING 3 PHASE STUDY | 2011-07-01 00:00:00 | 251.28 | N | N | 207.4 | 43.88
78320 | BONE &/JOINT IMAGING TOMOGRAPHIC SPECT | 2011-07-01 00:00:00 | 208.23 | N | N | 163.73 | 44.5
78350 | BONE DENSITY 1/GT SITES 1 PHOTON ABSORPTIOMETRY | 2008-07-01 00:00:00 | 37.19 | N | N | 26.03 | 11.16
78351 | BONE DENSTY 1/GT SITES DUAL PHOTON ABSORPTIOMETRY | 2008-07-01 00:00:00 | 18.66 | N | N | N/A | N/A
78399 | UNLISTED M-S NUC MED TEST | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
78414 | CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM | 2011-07-01 00:00:00 | 0 | N | N | N/A | 19.48
78428 | CARDIAC SHUNT DETECTION | 2011-07-01 00:00:00 | 165.33 | N | N | 130.86 | 34.47
78445 | NONCARDIAC VASCULAR FLOW IMAGING | 2011-07-01 00:00:00 | 145.74 | N | N | 125.1 | 20.64
78451 | HT MUSCLE IMAGE SPECT, SING | 2011-07-01 00:00:00 | 291.01 | N | N | 233.23 | 57.78
78452 | HT MUSCLE IMAGE SPECT, MULT | 2011-07-01 00:00:00 | 407.23 | N | N | 338.94 | 68.29
78453 | HT MUSCLE IMAGE,PLANAR,SING | 2011-07-01 00:00:00 | 249.69 | N | N | 207.57 | 42.12
78454 | HT MUSC IMAGE, PLANAR, MULT | 2011-07-01 00:00:00 | 360.61 | N | N | 304.34 | 56.27
78456 | ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE | 2011-07-01 00:00:00 | 214.56 | N | N | 169.9 | 44.66
78457 | VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL | 2011-07-01 00:00:00 | 166.36 | N | N | 133.18 | 33.18
78458 | VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL | 2011-07-01 00:00:00 | 167.33 | N | N | 130 | 37.33
78459 | MYOCARDIAL IMAGING PET METABOLIC EVALUATION | 2011-07-01 00:00:00 | 984.73 | N | N | 919.24 | 65.49
78466 | MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN | 2011-07-01 00:00:00 | 153.93 | N | N | 123.37 | 30.56
78468 | MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ | 2011-07-01 00:00:00 | 186.71 | N | N | 150.76 | 35.95
78469 | MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ | 2011-07-01 00:00:00 | 219.79 | N | N | 178.16 | 41.63
78472 | CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS | 2011-07-01 00:00:00 | 214.88 | N | N | 171.81 | 43.07
78473 | CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT | 2011-07-01 00:00:00 | 284.25 | N | N | 219.11 | 65.14
78481 | CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT | 2011-07-01 00:00:00 | 179.75 | N | N | 135.42 | 44.33
78483 | CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT | 2011-07-01 00:00:00 | 249.35 | N | N | 182.47 | 66.88
78491 | MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS | 2011-07-01 00:00:00 | 985.5 | N | N | 919.14 | 66.36
78492 | MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS | 2011-07-01 00:00:00 | 1003.38 | N | N | 919.3 | 84.08
78494 | CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT | 2011-07-01 00:00:00 | 229.09 | N | N | 176.14 | 52.95
78496 | CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT | 2011-07-01 00:00:00 | 69.27 | N | N | 47.17 | 22.1
78499 | UNLISTED C-V NUC MED TEST | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
78579 | PULMONARY VENTILATION IMAGING | 2012-01-01 00:00:00 | 141.64 | N | N | 121.69 | 19.94
78580 | PULMONARY PERFUSION IMAGING PARTICULATE | 2011-07-01 00:00:00 | 181.13 | N | N | 149.32 | 31.81
78582 | PULMONARY VENTILATION & PERFUSION IMAGING | 2012-01-01 00:00:00 | 261.84 | N | N | 218.53 | 43.29
78597 | QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING | 2012-01-01 00:00:00 | 160.37 | N | N | 130.46 | 29.92
78598 | QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGING | 2012-01-01 00:00:00 | 245.42 | N | N | 211.43 | 33.98
78599 | PULMONARY VENTILATION IMAGING | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
78600 | BRAIN IMAGING LT4 STATIC VIEWS | 2011-07-01 00:00:00 | 152.86 | N | N | 133.75 | 19.11
78601 | BRAIN IMAGING LT4 STATIC VIEWS W/VASCULAR FLOW | 2011-07-01 00:00:00 | 181.3 | N | N | 159.41 | 21.89
78605 | BRAIN IMAGING MINIMUM 4 STATIC VIEWS | 2011-07-01 00:00:00 | 167.78 | N | N | 144.42 | 23.36
78606 | BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW | 2011-07-01 00:00:00 | 275.46 | N | N | 248.22 | 27.24
78607 | BRAIN IMAGING TOMOGRAPHIC SPECT | 2011-07-01 00:00:00 | 309.2 | N | N | 257.16 | 52.04
78608 | BRAIN IMAGING PET METABOLIC EVALUATION | 2011-07-01 00:00:00 | 948.8 | N | N | 884.28 | 64.52
78609 | BRAIN IMAGING PET PERFUSION EVALUATION | 2008-07-01 00:00:00 | 1133.8101 | N | N | 1054.44 | 79.37
78610 | BRAIN IMAGING VASCULAR FLOW ONLY | 2011-07-01 00:00:00 | 150.59 | N | N | 137.49 | 13.1
78630 | CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY | 2011-07-01 00:00:00 | 285.98 | N | N | 256.59 | 29.39
78635 | CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY | 2011-07-01 00:00:00 | 272.82 | N | N | 246.49 | 26.33
78645 | CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ | 2011-07-01 00:00:00 | 228.4 | N | N | 203.81 | 24.59
78647 | CEREBROSPINAL FLUID FLOW W/O MATL TOMOG SPECT | 2011-07-01 00:00:00 | 295.65 | N | N | 257.45 | 38.2
78650 | CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATION | 2011-07-01 00:00:00 | 279.97 | N | N | 253.7 | 26.27
78660 | RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY | 2011-07-01 00:00:00 | 150.48 | N | N | 127.12 | 23.36
78699 | UNLISTED NERVOUS SYST TEST | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
78700 | KIDNEY IMAGING MORPHOLOGY | 2011-07-01 00:00:00 | 149.76 | N | N | 130 | 19.76
78701 | KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW | 2011-07-01 00:00:00 | 180.97 | N | N | 159.69 | 21.28
78707 | KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX | 2011-07-01 00:00:00 | 202.73 | N | N | 161.72 | 41.01
78708 | KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W RX | 2011-07-01 00:00:00 | 154.61 | N | N | 102.61 | 52
78709 | KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE | 2011-07-01 00:00:00 | 312.46 | N | N | 251.97 | 60.49
78710 | KIDNEY IMAGING MORPHOLOGY TOMOGRAPHIC | 2011-07-01 00:00:00 | 189.57 | N | N | 162 | 27.57
78725 | KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY | 2011-07-01 00:00:00 | 87.29 | N | N | 71.17 | 16.12
78730 | URINARY BLADDER RESIDUAL STUDY | 2011-07-01 00:00:00 | 63.48 | N | N | 56.41 | 7.07
78740 | URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM | 2011-07-01 00:00:00 | 188.33 | N | N | 163.17 | 25.16
78761 | TESTICULAR IMAGING WITH VASCULAR FLOW | 2011-07-01 00:00:00 | 180.95 | N | N | 149.89 | 31.06
78799 | [NAME] TEST | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
78800 | RP LOCLZJ TUMOR/[NAME] AGENT LIMITED AREA | 2011-07-01 00:00:00 | 159.24 | N | N | 130.86 | 28.38
78801 | RP LOCLZJ TUMOR/[NAME] AGENT MULTIPLE AREAS | 2011-07-01 00:00:00 | 215.12 | N | N | 181.04 | 34.08
78802 | RP LOCLZJ TUMOR/[NAME] AGENT WHOLE BDY 1 DAY | 2011-07-01 00:00:00 | 278.11 | N | N | 241.31 | 36.8
78803 | RP LOCLZJ TUMOR/[NAME] AGENT TOMOG SPECT | 2011-07-01 00:00:00 | 299.15 | N | N | 252.84 | 46.31
78804 | RP LOCLZJ TUMOR/[NAME] AGT WHOL [NAME] | 2011-07-01 00:00:00 | 493.53 | N | N | 447.83 | 45.7
78805 | RP LOCLZJ INFLAMMATORY PROCESS LIMITED AREA | 2011-07-01 00:00:00 | 157.06 | N | N | 125.68 | 31.38
78806 | RP LOCLZJ INFLAMMATORY PROCESS WHOLE BODY | 2011-07-01 00:00:00 | 287.91 | N | N | 251.11 | 36.8
78807 | RP LOCLZJ INFLAMMATORY PROCESS TOMOG SPECT | 2011-07-01 00:00:00 | 298.69 | N | N | 252.83 | 45.86
78808 | NJX RP LOCLZJ NON-IMG PROBE STUDY INTRAVENOUS | 2011-07-01 00:00:00 | 36.59 | N | N | N/A | N/A
78811 | PET IMAGING LIMITED AREA CHEST HEAD/NECK | 2011-07-01 00:00:00 | 952.69 | N | N | 884.28 | 68.41
78812 | PET IMAGING SKULL BASE TO MID-THIGH | 2011-07-01 00:00:00 | 968.59 | N | N | 884.29 | 84.3
78813 | PET IMAGING WHOLE BODY | 2011-07-01 00:00:00 | 972.23 | N | N | 884.28 | 87.95
78814 | PET IMAGING CT FOR ATTENUATION LIMITED AREA | 2011-07-01 00:00:00 | 980.14 | N | N | 884.28 | 95.86
78815 | PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH | 2011-07-01 00:00:00 | 991 | N | N | 884.28 | 106.72
78816 | PET IMAGING FOR CT ATTENUATION WHOLE BODY | 2011-07-01 00:00:00 | 992.84 | N | N | 884.28 | 108.56
78999 | UNLISTED NUC MED TEST | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
79005 | RP THERAPY ORAL ADMINISTRATION | 2011-07-01 00:00:00 | 123.34 | N | N | 46.31 | 77.03
79101 | RP THERAPY INTRAVENOUS ADMINISTRATION | 2011-07-01 00:00:00 | 139.48 | N | N | 50.35 | 89.13
79200 | RP THERAPY INRACAVITARY ADMINISTRATION | 2011-07-01 00:00:00 | 144.27 | N | N | 57.28 | 86.99
79300 | RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN | 2011-07-01 00:00:00 | 0 | N | N | N/A | 70.38
79403 | RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS | 2011-07-01 00:00:00 | 175.35 | N | N | 77.81 | 97.54
79440 | RP THERAPY INTRA-ARTICULAR ADMINISTRATION | 2011-07-01 00:00:00 | 136.3 | N | N | 48.05 | 88.25
79445 | RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN | 2011-07-01 00:00:00 | 0 | N | N | N/A | 104
79999 | RADIOPHARMACEUTICAL THERAPY UNLISTED PROCEDURE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
80047 | BASIC METABOLIC PANEL CALCIUM IONIZED | 2011-07-01 00:00:00 | 10.72 | N | N | N/A | N/A
80048 | BASIC METABOLIC PANEL CALCIUM TOTAL | 2011-07-01 00:00:00 | 10.72 | N | N | N/A | N/A
80050 | GENERAL HEALTH PANEL | 2008-07-01 00:00:00 | 51.11 | N | N | N/A | N/A
80051 | ELECTROLYTE PANEL | 2011-07-01 00:00:00 | 8.88 | N | N | N/A | N/A
80053 | COMPREHENSIVE METABOLIC PANEL | 2011-07-01 00:00:00 | 13.38 | N | N | N/A | N/A
80055 | OBSTETRIC PANEL | 2008-07-01 00:00:00 | 31.55 | N | N | N/A | N/A
80061 | LIPID PANEL | 2011-07-01 00:00:00 | 14.36 | N | N | N/A | N/A
80069 | RENAL FUNCTION PANEL | 2011-07-01 00:00:00 | 11 | N | N | N/A | N/A
80074 | ACUTE HEPATITIS PANEL | 2011-07-01 00:00:00 | 60.31 | N | N | N/A | N/A
80076 | HEPATIC FUNCTION PANEL | 2011-07-01 00:00:00 | 10.34 | N | N | N/A | N/A
80100 | DRUG SCR QUAL MLT DRUG CLASSES CHROM EA PX | 2011-07-01 00:00:00 | 18.42 | N | N | N/A | N/A
80101 | DRUG SCR QUAL 1 DRUG CLASS METH EA DRUG CLASS | 2008-07-01 00:00:00 | 19.24 | N | N | N/A | N/A
80102 | DRUG CONFIRMATION EACH PROCEDURE | 2011-07-01 00:00:00 | 16.78 | N | N | N/A | N/A
80103 | TISSUE PREPARATION DRUG ANALYSIS | 2008-07-01 00:00:00 | 19.64 | N | N | N/A | N/A
80104 | DRUG SCRN QUAL MLT CLASS NONCHROMOTOGRAPHIC EACH | 2013-05-01 00:00:00 | 17.99 | N | N | N/A | N/A
80150 | DRUG SCREEN QUALITATIVE AMIKACIN | 2011-07-01 00:00:00 | 19.09 | N | N | N/A | N/A
80152 | DRUG SCREEN QUALITATIVE AMITRIPTYLINE | 2011-07-01 00:00:00 | 22.67 | N | N | N/A | N/A
80154 | DRUG SCREEN QUALITATIVE BENZODIAZEPINES | 2011-07-01 00:00:00 | 23.43 | N | N | N/A | N/A
80155 | DRUG SCREEN QUANTITATIVE CAFFEINE | 2014-01-01 00:00:00 | 17.37 | N | N | N/A | N/A
80156 | DRUG SCREEN QUALITATIVE CARBAMAZEPINE TOTAL | 2011-07-01 00:00:00 | 18.44 | N | N | N/A | N/A
80157 | DRUG SCREEN QUALITATIVE CARBAMAZEPINE FREE | 2011-07-01 00:00:00 | 16.79 | N | N | N/A | N/A
80158 | DRUG SCREEN QUALITATIVE CYCLOSPORINE | 2011-07-01 00:00:00 | 22.86 | N | N | N/A | N/A
80159 | DRUG SCREEN QUANTITATIVE CLOZAPINE | 2014-01-01 00:00:00 | 22.71 | N | N | N/A | N/A
80160 | DRUG SCREEN QUALITATIVE DESIPRAMINE | 2011-07-01 00:00:00 | 21.8 | N | N | N/A | N/A
80162 | DRUG SCREEN QUALITATIVE DIGOXIN | 2011-07-01 00:00:00 | 16.82 | N | N | N/A | N/A
80164 | DRUG SCREEN QUALITATIVE DIPROPYLACETIC ACID | 2011-07-01 00:00:00 | 17.15 | N | N | N/A | N/A
80166 | DRUG SCREEN QUALITATIVE DOXEPIN | 2011-07-01 00:00:00 | 19.64 | N | N | N/A | N/A
80168 | DRUG SCREEN QUALITATIVE ETHOSUXIMIDE | 2011-07-01 00:00:00 | 20.7 | N | N | N/A | N/A
80169 | DRUG SCREEN QUANTITATIVE EVEROLIMUS | 2014-01-01 00:00:00 | 16.86 | N | N | N/A | N/A
80170 | DRUG SCREEN QUALITATIVE GENTAMICIN | 2011-07-01 00:00:00 | 20.76 | N | N | N/A | N/A
80171 | DRUG SCREEN QUANTITATIVE GABAPENTIN | 2014-01-01 00:00:00 | 16.28 | N | N | N/A | N/A
80172 | DRUG SCREEN QUALITATIVE GOLD | 2011-07-01 00:00:00 | 20.64 | N | N | N/A | N/A
80173 | DRUG SCREEN QUALITATIVE HALOPRIDOL | 2011-07-01 00:00:00 | 18.44 | N | N | N/A | N/A
80174 | DRUG SCREEN QUALITATIVE IMIPRAMINE | 2011-07-01 00:00:00 | 21.8 | N | N | N/A | N/A
80175 | DRUG SCREEN QUANTITATIVE LAMOTRIGINE | 2014-01-01 00:00:00 | 16.28 | N | N | N/A | N/A
80176 | DRUG SCREEN QUALITATIVE LIDOCAINE | 2011-07-01 00:00:00 | 18.6 | N | N | N/A | N/A
80177 | DRUG SCREEN QUANTITATIVE LEVETIRACETAM | 2014-01-01 00:00:00 | 16.28 | N | N | N/A | N/A
80178 | DRUG SCREEN QUALITATIVE LITHIUM | 2011-07-01 00:00:00 | 8.37 | N | N | N/A | N/A
80180 | DRUG SCREEN QUANTITATIVE MYCOPHENOLATE | 2014-01-01 00:00:00 | 22.17 | N | N | N/A | N/A
80182 | DRUG SCREEN QUALITATIVE NORTRIPTYLINE | 2011-07-01 00:00:00 | 17.15 | N | N | N/A | N/A
80183 | DRUG SCREEN QUANTITATIVE OXCARBAZEPINE | 2014-01-01 00:00:00 | 16.28 | N | N | N/A | N/A
80184 | DRUG SCREEN QUALITATIVE PHENOBARBITAL | 2011-07-01 00:00:00 | 14.51 | N | N | N/A | N/A
80185 | DRUG SCREEN QUALITATIVE PHENYTOIN TOTAL | 2011-07-01 00:00:00 | 16.79 | N | N | N/A | N/A
80186 | DRUG SCREEN QUALITATIVE PHENYTOIN FREE | 2011-07-01 00:00:00 | 17.43 | N | N | N/A | N/A
80188 | DRUG SCREEN QUALITATIVE PRIMIDONE | 2011-07-01 00:00:00 | 21.02 | N | N | N/A | N/A
80190 | DRUG SCREEN QUALITATIVE PROCAINAMIDE | 2011-07-01 00:00:00 | 21.21 | N | N | N/A | N/A
80192 | DRUG SCREEN QUALITATIVE PROCAINAMIDE METABOLITES | 2011-07-01 00:00:00 | 21.21 | N | N | N/A | N/A
80194 | DRUG SCREEN QUALITATIVE QUINIDINE | 2011-07-01 00:00:00 | 18.49 | N | N | N/A | N/A
80195 | DRUG SCREEN QUALITATIVE SIROLIMUS | 2011-07-01 00:00:00 | 17.39 | N | N | N/A | N/A
80196 | DRUG SCREEN QUALITATIVE SALICYLATE | 2011-07-01 00:00:00 | 8.98 | N | N | N/A | N/A
80197 | DRUG SCREEN QUALITATIVE TACROLIMUS | 2011-07-01 00:00:00 | 17.39 | N | N | N/A | N/A
80198 | DRUG SCREEN QUALITATIVE THEOPHYLLINE | 2011-07-01 00:00:00 | 17.92 | N | N | N/A | N/A
80199 | DRUG SCREEN QUANTITATIVE TIAGABINE | 2014-01-01 00:00:00 | 22.17 | N | N | N/A | N/A
80200 | DRUG SCREEN QUALITATIVE TOBRAMYCIN | 2011-07-01 00:00:00 | 20.41 | N | N | N/A | N/A
80201 | DRUG SCREEN QUALITATIVE TOPIRAMATE | 2011-07-01 00:00:00 | 15.1 | N | N | N/A | N/A
80202 | DRUG SCREEN QUALITATIVE VANCOMYCIN | 2011-07-01 00:00:00 | 17.15 | N | N | N/A | N/A
80203 | DRUG SCREEN QUANTITATIVE ZONISAMIDE | 2014-01-01 00:00:00 | 16.28 | N | N | N/A | N/A
80299 | QUANTITATION DRUG NOT ELSEWHERE SPECIFIED | 2011-07-01 00:00:00 | 17.34 | N | N | N/A | N/A
80400 | ACTH STIMULATION PANEL ADRENAL INSUFFICIENCY | 2011-07-01 00:00:00 | 36.76 | N | N | N/A | N/A
80402 | ACTH STIMULATION PANEL 21 HYDROXYLASE DEFICIENCY | 2011-07-01 00:00:00 | 105.57 | N | N | N/A | N/A
80406 | ACTH STIMJ PANEL 3 BETA-HYDROXYDEHYD DEFNCY | 2011-07-01 00:00:00 | 94.57 | N | N | N/A | N/A
80408 | ALDOSTERONE SUPPRESSION EVALUATION PANEL | 2011-07-01 00:00:00 | 158.94 | N | N | N/A | N/A
80410 | CALCITONIN STIMULATION PANEL | 2011-07-01 00:00:00 | 101.76 | N | N | N/A | N/A
80412 | CORTICOTROPIC RELEASING HORM STIMJ PANEL | 2011-07-01 00:00:00 | 403.76 | N | N | N/A | N/A
80414 | CHORNC GONAD STIMJ PANEL TSTOSTERONE RESPONSE | 2011-07-01 00:00:00 | 59.51 | N | N | N/A | N/A
80415 | CHORNC GONAD STIMJ PANEL ESTRADIOL RESPONSE | 2011-07-01 00:00:00 | 70.78 | N | N | N/A | N/A
80416 | RENAL VEIN RENIN STIMULATION PANEL | 2011-07-01 00:00:00 | 167.13 | N | N | N/A | N/A
80417 | PERIPHERAL VEIN RENIN STIMULATION PANEL | 2011-07-01 00:00:00 | 55.71 | N | N | N/A | N/A
80418 | COMBINED RAPID ANT PITUITARY EVALUATION PANEL | 2011-07-01 00:00:00 | 694.98 | N | N | N/A | N/A
80420 | DEXMETHASONE SUPPRESSION PANEL 48 HR | 2011-07-01 00:00:00 | 86.69 | N | N | N/A | N/A
80422 | GLUCOSE TOLERANCE PANEL INSULINOMA | 2011-07-01 00:00:00 | 58.35 | N | N | N/A | N/A
80424 | GLUCOSE TOLERANCE PANEL PHEOCHROMOCYTOMA | 2011-07-01 00:00:00 | 63.95 | N | N | N/A | N/A
80426 | GONADOTROPIN RELEASING HORMONE STIMJ PANEL | 2011-07-01 00:00:00 | 163.44 | N | N | N/A | N/A
80428 | GROWTH HORMONE STIMULATION PANEL | 2011-07-01 00:00:00 | 84.49 | N | N | N/A | N/A
80430 | GROWTH HORMONE SUPRJ PANEL GLUCOSE ADMN | 2011-07-01 00:00:00 | 99.4 | N | N | N/A | N/A
80432 | INSULIN-INDUCED C-PEPTIDE SUPRESSION PANEL | 2011-07-01 00:00:00 | 171.08 | N | N | N/A | N/A
80434 | INSULIN TOLERANCE PANEL ACTH INSUFFICIENCY | 2011-07-01 00:00:00 | 116.73 | N | N | N/A | N/A
80435 | INSULIN TOLERANCE PANEL GROWTH HORM DEFNCY | 2011-07-01 00:00:00 | 130.46 | N | N | N/A | N/A
80436 | METYRAPONE PANEL | 2011-07-01 00:00:00 | 110.92 | N | N | N/A | N/A
80438 | THYROTROPIN RELEASING HORMONE STMLJ PANEL 1 HR | 2011-07-01 00:00:00 | 59.78 | N | N | N/A | N/A
80439 | THYROTROPIN RELEASING HORMONE STMLJ PANEL 2 HR | 2011-07-01 00:00:00 | 79.7 | N | N | N/A | N/A
80440 | THYROTROPIN RELEAS HORMONE HYPRPROLACTINEMIA | 2011-07-01 00:00:00 | 73.63 | N | N | N/A | N/A
80500 | CLINICAL PATHOLOGY CONSULTATION LIMITED | 2011-07-01 00:00:00 | 17.89 | N | N | N/A | N/A
80502 | CLINICAL PATHOLOGY CONSULTATION COMPREHENSIVE | 2011-07-01 00:00:00 | 55.74 | N | N | N/A | N/A
81000 | URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY | 2011-07-01 00:00:00 | 4.01 | N | N | N/A | N/A
81001 | URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY | 2011-07-01 00:00:00 | 4.01 | N | N | N/A | N/A
81002 | URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP | 2011-07-01 00:00:00 | 3.24 | N | N | N/A | N/A
81003 | URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY | 2011-07-01 00:00:00 | 2.84 | N | N | N/A | N/A
81005 | URINALYSIS QUAL/SEMIQUANT EXCEPT IMMUNOASSAYS | 2011-07-01 00:00:00 | 2.75 | N | N | N/A | N/A
81007 | URINALYSIS BACTERIURIA SCR XCPT CULTURE/DIPSTICK | 2011-07-01 00:00:00 | 3.25 | N | N | N/A | N/A
81015 | URINALYSIS MICROSCOPIC ONLY | 2011-07-01 00:00:00 | 3.85 | N | N | N/A | N/A
81020 | URINALYSIS 2/3 GLASS TEST | 2011-07-01 00:00:00 | 4.67 | N | N | N/A | N/A
81025 | URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS | 2011-07-01 00:00:00 | 8.01 | N | N | N/A | N/A
81050 | VOLUME MEASUREMENT TIMED COLLECTION EACH | 2011-07-01 00:00:00 | 3.8 | N | N | N/A | N/A
81099 | URINALYSIS | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
81161 | DMD DUPLICATION/DELETION ANALYSIS | 2013-01-01 00:00:00 | 0 | N | Y | N/A | N/A
81200 | [NAME] VARIANTS | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
81201 | [NAME] GENE SEQUENCE | 2013-01-01 00:00:00 | 604.06 | N | N | N/A | N/A
81202 | [NAME] VARIANTS | 2013-01-01 00:00:00 | 75.67 | N | N | N/A | N/A
81203 | [NAME]/DELETION VARIANTS | 2013-01-01 00:00:00 | 459.17 | N | N | N/A | N/A
81205 | BCKDHB GENE ANALYSIS COMMON VARIANTS | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
81206 | BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE | 2012-01-01 00:00:00 | 97.53 | N | N | N/A | N/A
81207 | BCR/ABL1 MINOR BREAKPNT QUALITATIVE/QUANTITATIVE | 2012-01-01 00:00:00 | 81.28 | N | N | N/A | N/A
81208 | BCR/ABL1 OTHER BREAKPNT QUALITATIVE/QUANTITATIVE | 2012-01-01 00:00:00 | 135.15 | N | N | N/A | N/A
81209 | BLM GENE ANALYSIS 2281DEL6INS7 VARIANT | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
81210 | BRAF GENE ANALYSIS V600E VARIANT | 2012-01-01 00:00:00 | 87.71 | N | N | N/A | N/A
81211 | BRCA1&BRCA2 FULL SEQ ANALYS/COMM DUP/DEL BRCA1 | 2012-01-01 00:00:00 | 2515.58 | Y | N | N/A | N/A
81212 | BRCA1&BRCA2 ANAL 185DELAG5385INSC/6174DELT | 2012-01-01 00:00:00 | 160.24 | Y | N | N/A | N/A
81213 | BRCA1&BRCA2 ANAL UNCOMMON DUP/DEL VARIANTS | 2012-01-01 00:00:00 | 528.41 | Y | N | N/A | N/A
81214 | BRCA1 FULL SEQ ANAL&COMMON DUP/DEL VARIANTS | 2012-01-01 00:00:00 | 1304.11 | Y | N | N/A | N/A
81215 | BRCA1 GENE ANALYSIS KNOWN FAMILIAL VARIANT | 2012-01-01 00:00:00 | 84.55 | Y | N | N/A | N/A
81216 | BRCA2 GENE ANALYSIS FULL SEQUENCE ANALYSIS | 2012-01-01 00:00:00 | 0 | Y | N | N/A | N/A
81217 | BRCA2 GENE ANALYSIS KNOWN FAMILIAL VARIANT | 2012-01-01 00:00:00 | 84.55 | Y | N | N/A | N/A
81220 | CFTR GENE ANALYSIS COMMON VARIANTS | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
81221 | CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
81222 | CFTR GENE ANALYSIS DUPLICATION/DELETION VARIANTS | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
81224 | CFTR GENE ANALYSIS INTRON 8 POLY-T ANALYSIS | 2012-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
81225 | CYP2C19 GENE ANALYSIS COMMON VARIANTS | 2012-01-01 00:00:00 | 108.95 | N | N | N/A | N/A
81226 | CYP2D6 [NAME] VARIANTS | 2012-01-01 00:00:00 | 118.81 | N | N | N/A | N/A
81227 | CYP2C9 GENE ANALYSIS COMMON VARIANTS | 2012-01-01 00:00:00 | 77.96 | N | N | N/A | N/A
81228 | CYTOGENOM CONST MICROARRAY COPY NUMBER VARIANTS | 2012-01-01 00:00:00 | 0 | Y | N | N/A | N/A
81229 | CYTOGENOM CONST MOCROARRAY COPY NUMBER&SNT VAR | 2012-01-01 00:00:00 | 0 | Y | N | N/A | N/A
81235 | EGFR GENE ANALYSIS COMMON VARIANTS | 2013-01-01 00:00:00 | 93.64 | N | N | N/A | N/A
81240 | F2 GENE ANALYSIS 20210G GTA VARIANT | 2012-01-01 00:00:00 | 33.35 | N | N | N/A | N/A
81241 | F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT | 2012-01-01 00:00:00 | 55.29 | N | N | N/A | N/A
81242 | FANCC GENE ANALYSIS COMMON VARIANT | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
81243 | FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
81244 | FMR1 GENE ANALYSIS CHARACTERIZATION OF ALLELES | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
81245 | FLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTS | 2012-01-01 00:00:00 | 90.22 | N | N | N/A | N/A
81250 | G6PC GENE ANALYSIS COMMON VARIANTS | 2012-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
81251 | GBA GLUCOSIDASE/BETA/ACID ANAL COMM VARIANTS | 2012-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
81252 | [NAME] GENE SEQUENCE | 2013-01-01 00:00:00 | 126.17 | N | N | N/A | N/A
81253 | [NAME] VARIANTS | 2013-01-01 00:00:00 | 65.7 | N | N | N/A | N/A
81254 | [NAME] VARIANTS | 2013-01-01 00:00:00 | 60.39 | N | N | N/A | N/A
81255 | HEXA GENE ANALYSIS COMMON VARIANTS | 2012-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
81256 | HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS | 2012-01-01 00:00:00 | 56.55 | N | N | N/A | N/A
81260 | IKBKAP GENE ANALYSIS COMMON VARIANTS | 2012-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
81261 | IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED | 2012-01-01 00:00:00 | 119.4 | N | N | N/A | N/A
81262 | IGH@ REARRANGE ABNORMAL CLONAL POP DIRECT PROBE | 2012-01-01 00:00:00 | 41.18 | N | N | N/A | N/A
81263 | IGH@ VARIABLE REGION SOMATIC MUTATION ANALYSIS | 2012-01-01 00:00:00 | 209.38 | N | N | N/A | N/A
81264 | IGK@ GENE REARRANGE DETECT ABNORMAL CLONAL POP | 2012-01-01 00:00:00 | 90.2 | N | N | N/A | N/A
81265 | COMPARATIVE ANAL STR MARKERS PATIENT&COMP SPEC | 2012-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
81266 | COMPARATIVE ANAL STR MARKERS EA ADDL SPECIMEN | 2012-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
81267 | CHIMERISM W/COMP TO BASELINE W/O CELL SELECTION | 2012-01-01 00:00:00 | 120.6 | N | N | N/A | N/A
81268 | CHIMERISM W/COMP TO BASELINE W/CELL SELECTION EA | 2012-01-01 00:00:00 | 120.6 | N | N | N/A | N/A
81270 | JAK2 GENE ANALYSIS P.VAL617PHE [NAME] | 2012-01-01 00:00:00 | 58.64 | N | N | N/A | N/A
81275 | KRAS GENE ANALYSIS VARIANTS IN CODONS 12 AND 13 | 2012-01-01 00:00:00 | 181.94 | N | N | N/A | N/A
81280 | LONG QT SYNDROME FULL SEQUENCE ANALYSIS | 2012-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
81281 | LONG QT SYNDROME ANAL KNOWN FAMILIAL SEQUENCE | 2012-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
81282 | LONG QT SYNDROME GENE ANAL DUP/DEL VARIANTS | 2012-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
81287 | MGMT METHYLATION ANALYSIS | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
81290 | MCOLN1 MUCOLIPIN1 GENE ANALYSIS COMMON VARIANTS | 2012-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
81291 | MTHFR GENE ANALYSIS COMMON VARIANTS | 2012-01-01 00:00:00 | 74.84 | N | N | N/A | N/A
81292 | MLH1 GENE ANALYSIS FULL SEQUENCE ANALYSIS | 2012-01-01 00:00:00 | 647.05 | N | N | N/A | N/A
81293 | MLH1 GENE ANALYSIS KNOWN FAMILIAL VARIANTS | 2012-01-01 00:00:00 | 75.67 | N | N | N/A | N/A
81294 | MLH1 GENE ANALYSIS DUPLICATION/DELETION VARIANTS | 2012-01-01 00:00:00 | 396.27 | N | N | N/A | N/A
81295 | MSH2 GENE ANALYSIS FULL SEQUENCE ANALYSIS | 2012-01-01 00:00:00 | 634.1 | N | N | N/A | N/A
81296 | MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS | 2012-01-01 00:00:00 | 75.67 | N | N | N/A | N/A
81297 | MSH2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS | 2012-01-01 00:00:00 | 437.2 | N | N | N/A | N/A
81298 | MSH6 GENE ANALYSIS FULL SEQUENCE ANALYSIS | 2012-01-01 00:00:00 | 497.48 | N | N | N/A | N/A
81299 | MSH6 GENE ANALYSIS KNOWN FAMILIAL VARIANTS | 2012-01-01 00:00:00 | 75.6 | N | N | N/A | N/A
81300 | MSH6 GENE ANALYSIS DUPLICATION/DELETION VARIA | 2012-01-01 00:00:00 | 406.9 | N | N | N/A | N/A
81301 | MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF | 2012-01-01 00:00:00 | 258.44 | N | N | N/A | N/A
81302 | MECP2 GENE ANALYSIS FULL SEQUENCE | 2012-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
81303 | MECP2 GENE ANALYSIS KNOWN FAMILIAL VARIANT | 2012-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
81304 | MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT | 2012-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
81310 | NPM1 NUCLEOPHOSMIN GENE ANAL EXON 12 VARIANTS | 2012-01-01 00:00:00 | 47.39 | N | N | N/A | N/A
81315 | PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT | 2012-01-01 00:00:00 | 94.68 | N | N | N/A | N/A
81316 | PML/RARALPHA SINGLE [NAME]/QUAN | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
81317 | PMS2 GENE ANALYSIS FULL SEQUENCE | 2012-01-01 00:00:00 | 517.6 | N | N | N/A | N/A
81318 | PMS2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS | 2012-01-01 00:00:00 | 75.67 | N | N | N/A | N/A
81319 | PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS | 2012-01-01 00:00:00 | 372.48 | N | N | N/A | N/A
81321 | PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS | 2013-01-01 00:00:00 | 487.52 | N | N | N/A | N/A
81322 | PTEN GENE ANALYSIS KNOWN FAMILIAL VARIANT | 2013-01-01 00:00:00 | 47.39 | N | N | N/A | N/A
81323 | PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT | 2013-01-01 00:00:00 | 71.09 | N | N | N/A | N/A
81324 | PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS | 2013-01-01 00:00:00 | 391.6 | N | N | N/A | N/A
81325 | PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS | 2013-01-01 00:00:00 | 239.43 | N | N | N/A | N/A
81326 | PMP22 GENE ANALYSIS KNOWN FAMILIAL VARIANT | 2013-01-01 00:00:00 | 75.67 | N | N | N/A | N/A
81330 | SMPD1 GENE ANALYSIS COMMON VARIANTS | 2012-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
81331 | SNRPN/UBE3A METHYLATION ANALYSIS | 2012-01-01 00:00:00 | 0 | Y | N | N/A | N/A
81332 | [NAME] VARIANTS | 2012-01-01 00:00:00 | 56.55 | N | N | N/A | N/A
81340 | TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD | 2012-01-01 00:00:00 | 119.31 | N | N | N/A | N/A
81341 | TRB@ REARRANGEMENT ANAL DIRECT PROBE METHODOLOGY | 2012-01-01 00:00:00 | 36.36 | N | N | N/A | N/A
81342 | TRG@ GENE REARRANGEMENT ANALYSIS | 2012-01-01 00:00:00 | 119.31 | N | N | N/A | N/A
81355 | [NAME] VARIANTS | 2012-01-01 00:00:00 | 67.01 | N | N | N/A | N/A
81370 | HLA CLASS I&II LOW HLA-A -B -C -DRB1/3/4/5&-DQB1 | 2012-01-01 00:00:00 | 497.48 | N | N | N/A | N/A
81371 | HLA I&II LOW [NAME] | 2012-01-01 00:00:00 | 273.28 | N | N | N/A | N/A
81372 | HLA CLASS I TYPING LOW [NAME] | 2012-01-01 00:00:00 | 544.81 | N | N | N/A | N/A
81373 | HLA CLASS I TYPING LOW RESOLUTION ONE LOCUS EACH | 2012-01-01 00:00:00 | 184.65 | N | N | N/A | N/A
81374 | HLA I LOW RESOLUTION ONE ANTIGEN EQUIVALENT EACH | 2012-01-01 00:00:00 | 184.65 | N | N | N/A | N/A
81375 | HLA II LOW [NAME] AND -DQB1 | 2012-01-01 00:00:00 | 203.78 | N | N | N/A | N/A
81376 | HLA CLASS II TYPING LOW RESOLUTION ONE LOCUS EA | 2012-01-01 00:00:00 | 107.07 | N | N | N/A | N/A
81377 | HLA II LOW RESOLUTION ONE ANTIGEN EQUIVALENT EA | 2012-01-01 00:00:00 | 90.46 | N | N | N/A | N/A
81378 | HLA I&II HIGH RESOLUTION HAL-A -B -C AND -DRB1 | 2012-01-01 00:00:00 | 427.5 | N | N | N/A | N/A
81379 | HLA CLASS I TYPING HIGH RESOLUTION COMPLETE | 2012-01-01 00:00:00 | 414.9 | N | N | N/A | N/A
81380 | HLA CLASS I TYPING HIGH RESOLUTINO ONE LOCUS EA | 2012-01-01 00:00:00 | 219.28 | N | N | N/A | N/A
81381 | HLA I TYPING HIGH RESOLUTION 1 ALLELE/ALLELE GRP | 2012-01-01 00:00:00 | 43.48 | N | N | N/A | N/A
81382 | HLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS EA | 2012-01-01 00:00:00 | 114.33 | N | N | N/A | N/A
81383 | HLA II HIGH RESOLUTION 1 ALLELE/ALLELE GROUP | 2012-01-01 00:00:00 | 135 | N | N | N/A | N/A
81400 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 1 | 2012-01-01 00:00:00 | 0 | Y | N | N/A | N/A
81401 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 | 2012-01-01 00:00:00 | 0 | Y | N | N/A | N/A
81402 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 3 | 2012-01-01 00:00:00 | 0 | Y | N | N/A | N/A
81403 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 4 | 2012-01-01 00:00:00 | 0 | Y | N | N/A | N/A
81404 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 5 | 2012-01-01 00:00:00 | 0 | Y | N | N/A | N/A
81405 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 6 | 2012-01-01 00:00:00 | 0 | Y | N | N/A | N/A
81406 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 7 | 2012-01-01 00:00:00 | 0 | Y | N | N/A | N/A
81407 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 8 | 2012-01-01 00:00:00 | 0 | Y | N | N/A | N/A
81408 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 9 | 2012-01-01 00:00:00 | 0 | Y | N | N/A | N/A
81479 | UNLISTED MOLELCULAR PATHOLOGY PROCEDURE | 2012-01-01 00:00:00 | 0 | Y | N | N/A | N/A
81500 | [NAME] (OVARIAN) BIOCHEMICAL ASSAY TWO PROTEINS | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
81503 | [NAME] (OVARIAN) BIOCHEMICAL ASSAY FIVE PROTEINS | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
81504 | ONCOLOGY TISSUE OF ORIGIN SIMILAR SCOR ALGORITHM | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
81506 | ENDOCRINOLOGY BIOCHEMICAL ASSAY SEVEN ANAL | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
81508 | FETAL CONGENITAL ABNOR ASSAY TWO PROTEINS | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
81509 | FETAL CONGENITAL ABNOR ASSAY 3 PROTEINS | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
81510 | FETAL CONGENITAL ABNOR ASSAY THREE ANAL | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
81511 | FETAL CONGENITAL ABNOR ASSAY FOUR ANAL | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
81512 | FETAL CONGENITAL ABNOR ASSAY FIVE ANAL | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
81599 | UNLISTED MULTIANALYTE ASSAY ALGORITHMIC ANALYSIS | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
82000 | ACETALDEHYDE BLOOD | 2011-07-01 00:00:00 | 15.69 | N | N | N/A | N/A
82003 | [NAME] | 2011-07-01 00:00:00 | 25.63 | N | N | N/A | N/A
82009 | ACETONE/OTHER KETONE BODIES SERUM QUALITATIVE | 2011-07-01 00:00:00 | 5.72 | N | N | N/A | N/A
82010 | ACETONE/OTHER KETONE BODIES SERUM QUANTITATIVE | 2011-07-01 00:00:00 | 10.35 | N | N | N/A | N/A
82013 | [NAME] | 2011-07-01 00:00:00 | 14.15 | N | N | N/A | N/A
82016 | ACYLCARNITINES QUALITATIVE EACH SPECIMEN | 2011-07-01 00:00:00 | 17.56 | N | N | N/A | N/A
82017 | ACYLCARNITINES QUANTIATIVE EACH SPECIMEN | 2011-07-01 00:00:00 | 17.42 | N | N | N/A | N/A
82024 | ADRENOCORTICOTROPIC HORMONE ACTH | 2011-07-01 00:00:00 | 48.92 | N | N | N/A | N/A
82030 | ADENOSINE 5-MONOPHOSPHATE CYCLIC | 2011-07-01 00:00:00 | 32.67 | N | N | N/A | N/A
82040 | [NAME] | 2011-07-01 00:00:00 | 6.26 | N | N | N/A | N/A
82042 | [NAME] EACH SPECIMEN | 2011-07-01 00:00:00 | 6.55 | N | N | N/A | N/A
82043 | [NAME] | 2011-07-01 00:00:00 | 7.33 | N | N | N/A | N/A
82044 | [NAME] SEMIQUANTITATIVE | 2011-07-01 00:00:00 | 4.37 | N | N | N/A | N/A
82045 | ALBUMIN ISCHEMIA MODIFIED | 2011-07-01 00:00:00 | 42.99 | N | N | N/A | N/A
82055 | ALCOHOL ANY SPECIMEN EXCEPT BREATH | 2011-07-01 00:00:00 | 13.69 | N | N | N/A | N/A
82075 | ALCOHOL BREATH | 2011-07-01 00:00:00 | 15.26 | N | N | N/A | N/A
82085 | ALDOLASE | 2011-07-01 00:00:00 | 12.29 | N | N | N/A | N/A
82088 | ALDOSTERONE | 2011-07-01 00:00:00 | 51.62 | N | N | N/A | N/A
82101 | ALKALOIDS URINE QUANTITATIVE | 2011-07-01 00:00:00 | 38.02 | N | N | N/A | N/A
82103 | ALPHA-1-ANTITRYPSIN TOTAL | 2011-07-01 00:00:00 | 17.02 | N | N | N/A | N/A
82104 | ALPHA-1-ANTITRYPSIN PHENOTYPE | 2011-07-01 00:00:00 | 18.32 | N | N | N/A | N/A
82105 | ALPHA-FETOPROTEIN SERUM | 2011-07-01 00:00:00 | 21.25 | N | N | N/A | N/A
82106 | ALPHA-FETOPROTEIN AMNIOTIC FLUID | 2011-07-01 00:00:00 | 21.25 | N | N | N/A | N/A
82107 | AFP-L3 FRACTION ISOFORM & TOTAL AFP W/RATIO | 2011-07-01 00:00:00 | 81.58 | N | N | N/A | N/A
82108 | ALUMINUM | 2011-07-01 00:00:00 | 25.51 | N | N | N/A | N/A
82120 | AMINES VAGINAL FLUID QUALITATIVE | 2011-07-01 00:00:00 | 4.76 | N | N | N/A | N/A
82127 | AMINO ACIDS 1 QUALITATIVE EACH SPECIMEN | 2011-07-01 00:00:00 | 17.56 | N | N | N/A | N/A
82128 | AMINO ACIDS MULTIPLE QUALITATIVE EACH SPECIMEN | 2011-07-01 00:00:00 | 17.56 | N | N | N/A | N/A
82131 | AMINO ACIDS 1 QUANTITATIVE EACH SPECIMEN | 2011-07-01 00:00:00 | 21.37 | N | N | N/A | N/A
82135 | AMINOLEVULINIC ACID DELTA | 2011-07-01 00:00:00 | 20.84 | N | N | N/A | N/A
82136 | AMINO ACIDS 2-5 AMINO ACIDS QUANTITATIVE EA SPEC | 2011-07-01 00:00:00 | 17.42 | N | N | N/A | N/A
82139 | AMINO ACIDS 6/GT AMINO ACIDS QUANTITATIVE EA SPEC | 2011-07-01 00:00:00 | 17.42 | N | N | N/A | N/A
82140 | AMMONIA | 2011-07-01 00:00:00 | 18.46 | N | N | N/A | N/A
82143 | AMNIOTIC FLU SCAN | 2011-07-01 00:00:00 | 8.7 | N | N | N/A | N/A
82145 | AMPHETAMINE/METHAMPHETAMINE | 2011-07-01 00:00:00 | 19.68 | N | N | N/A | N/A
82150 | AMYLASE | 2011-07-01 00:00:00 | 8.21 | N | N | N/A | N/A
82154 | ANDROSTANEDIOL GLUCURONIDE | 2011-07-01 00:00:00 | 36.51 | N | N | N/A | N/A
82157 | ANDROSTENEDIONE | 2011-07-01 00:00:00 | 37.08 | N | N | N/A | N/A
82160 | ANDROSTERONE | 2011-07-01 00:00:00 | 31.67 | N | N | N/A | N/A
82163 | ANGIOTENSIN II | 2011-07-01 00:00:00 | 25.99 | N | N | N/A | N/A
82164 | [NAME] I-CONVERTING ENZYME | 2011-07-01 00:00:00 | 18.49 | N | N | N/A | N/A
82175 | ARSENIC | 2011-07-01 00:00:00 | 24.03 | N | N | N/A | N/A
82180 | ASCORBIC ACID BLOOD | 2011-07-01 00:00:00 | 12.52 | N | N | N/A | N/A
82190 | [NAME] | 2011-07-01 00:00:00 | 15.96 | N | N | N/A | N/A
82205 | BARBITURATES NOT ELSEWHERE SPECIFIED | 2011-07-01 00:00:00 | 14.51 | N | N | N/A | N/A
82232 | BETA-2 MICROGLOBULIN | 2011-07-01 00:00:00 | 20.48 | N | N | N/A | N/A
82239 | BILE ACIDS TOTAL | 2011-07-01 00:00:00 | 21.7 | N | N | N/A | N/A
82240 | BILE ACIDS CHOLYLGLYCINE | 2011-07-01 00:00:00 | 33.66 | N | N | N/A | N/A
82247 | BILIRUBIN TOTAL | 2011-07-01 00:00:00 | 6.35 | N | N | N/A | N/A
82248 | BILIRUBIN DIRECT | 2011-07-01 00:00:00 | 6.35 | N | N | N/A | N/A
82252 | BILIRUBIN FECES QUALITATIVE | 2011-07-01 00:00:00 | 5.76 | N | N | N/A | N/A
82261 | BIOTINIDASE EACH SPECIMEN | 2011-07-01 00:00:00 | 17.42 | N | N | N/A | N/A
82270 | BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER | 2011-07-01 00:00:00 | 4.12 | N | N | N/A | N/A
82271 | BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES | 2011-07-01 00:00:00 | 4.12 | N | N | N/A | N/A
82272 | BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC | 2011-07-01 00:00:00 | 4.12 | N | N | N/A | N/A
82274 | BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 | 2011-07-01 00:00:00 | 20.14 | N | N | N/A | N/A
82286 | BRADYKININ | 2011-07-01 00:00:00 | 8.72 | N | N | N/A | N/A
82300 | CADMIUM | 2011-07-01 00:00:00 | 29.31 | N | N | N/A | N/A
82306 | 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED | 2011-07-01 00:00:00 | 37.49 | N | N | N/A | N/A
82308 | CALCITONIN | 2011-07-01 00:00:00 | 33.92 | N | N | N/A | N/A
82310 | CALCIUM TOTAL | 2011-07-01 00:00:00 | 6.53 | N | N | N/A | N/A
82330 | CALCIUM IONIZED | 2011-07-01 00:00:00 | 17.31 | N | N | N/A | N/A
82331 | CALCIUM AFTER CALCIUM INFUSION TEST | 2011-07-01 00:00:00 | 6.55 | N | N | N/A | N/A
82340 | CALCIUM URINE QUANTITATIVE TIMED SPECIMEN | 2011-07-01 00:00:00 | 7.64 | N | N | N/A | N/A
82355 | CALCULUS QUALITATIVE ANALYSIS | 2011-07-01 00:00:00 | 14.66 | N | N | N/A | N/A
82360 | CALCULUS QUANTITATIVE CHEMICAL | 2011-07-01 00:00:00 | 16.31 | N | N | N/A | N/A
82365 | CALCULUS INFRARED SPECTROSCOPY | 2011-07-01 00:00:00 | 16.33 | N | N | N/A | N/A
82370 | CALCULUS XRAY DIFFRACTION | 2011-07-01 00:00:00 | 15.87 | N | N | N/A | N/A
82373 | CARBOHYDRATE DEFICIENT TRANSFERRIN | 2011-07-01 00:00:00 | 22.87 | N | N | N/A | N/A
82374 | CARBON DIOXIDE BICARBONATE | 2011-07-01 00:00:00 | 6.19 | N | N | N/A | N/A
82375 | CARBOXYHEMOGLOBIN QUANTITATIVE | 2011-07-01 00:00:00 | 15.62 | N | N | N/A | N/A
82376 | CARBOXYHEMOGLOBIN QUALITATIVE | 2011-07-01 00:00:00 | 7.6 | N | N | N/A | N/A
82378 | CARCINOEMBRYONIC ANTIGEN CEA | 2011-07-01 00:00:00 | 24.03 | N | N | N/A | N/A
82379 | CARNITINE QUANTITATIVE EACH SPECIMEN | 2011-07-01 00:00:00 | 17.42 | N | N | N/A | N/A
82380 | CAROTENE | 2011-07-01 00:00:00 | 11.68 | N | N | N/A | N/A
82382 | CATECHOLAMINES TOTAL URINE | 2011-07-01 00:00:00 | 21.78 | N | N | N/A | N/A
82383 | CATECHOLAMINES BLOOD | 2011-07-01 00:00:00 | 31.73 | N | N | N/A | N/A
82384 | CATECHOLAMINES FRACTIONATED | 2011-07-01 00:00:00 | 31.98 | N | N | N/A | N/A
82387 | CATHEPSIN-D | 2011-07-01 00:00:00 | 26.35 | N | N | N/A | N/A
82390 | CERULOPLASMIN | 2011-07-01 00:00:00 | 13.61 | N | N | N/A | N/A
82397 | CHEMILUMINESCENT ASSAY | 2011-07-01 00:00:00 | 17.89 | N | N | N/A | N/A
82415 | CHLORAMPHENICOL | 2011-07-01 00:00:00 | 16.05 | N | N | N/A | N/A
82435 | CHLORIDE BLD | 2011-07-01 00:00:00 | 5.82 | N | N | N/A | N/A
82436 | CHLORIDE URINE | 2011-07-01 00:00:00 | 6.36 | N | N | N/A | N/A
82438 | CHLORIDE OTHER SOURCE | 2011-07-01 00:00:00 | 6.19 | N | N | N/A | N/A
82441 | CHLORINATED HYDROCARBONS SCREEN | 2011-07-01 00:00:00 | 7.61 | N | N | N/A | N/A
82465 | CHOLESTEROL SERUM/WHOLE BLOOD TOTAL | 2011-07-01 00:00:00 | 5.52 | N | N | N/A | N/A
82480 | CHOLINESTERASE SERUM | 2011-07-01 00:00:00 | 9.98 | N | N | N/A | N/A
82482 | CHOLINESTERASE RBC | 2011-07-01 00:00:00 | 9.73 | N | N | N/A | N/A
82485 | CHONDROITIN B SULFATE QUANTITATIVE | 2011-07-01 00:00:00 | 26.15 | N | N | N/A | N/A
82486 | CHROMATOGRAPHY QUAL COLUMN ANALYTE NES | 2011-07-01 00:00:00 | 22.87 | N | N | N/A | N/A
82487 | CHROMATOGRAPHY QUAL PAPR 1-DIMENSNL ANALYTE NES | 2011-07-01 00:00:00 | 20.22 | N | N | N/A | N/A
82488 | CHROMATOGRAPHY QUAL PAPR 2-DIMENSIONAL ANAL NES | 2011-07-01 00:00:00 | 27.06 | N | N | N/A | N/A
82489 | CHROMATOGRAPHY QUAL THIN LAYER ANALYTE NES | 2011-07-01 00:00:00 | 18.74 | N | N | N/A | N/A
82491 | CHROMATOGRAPHY QUAN COLUMN 1 ANALYTE NES | 2011-07-01 00:00:00 | 22.87 | N | N | N/A | N/A
82492 | CHROMATOGRAPHY QUAN COLUMN MULTIPLE ANALYTES | 2011-07-01 00:00:00 | 22.87 | N | N | N/A | N/A
82495 | [NAME] | 2011-07-01 00:00:00 | 25.69 | N | N | N/A | N/A
82507 | CITRATE | 2011-07-01 00:00:00 | 35.22 | N | N | N/A | N/A
82520 | COCAINE/METABOLITE | 2011-07-01 00:00:00 | 19.2 | N | N | N/A | N/A
82523 | COLLAGEN CROSS LINKS ANY METHOD | 2011-07-01 00:00:00 | 18.56 | N | N | N/A | N/A
82525 | COPPER | 2011-07-01 00:00:00 | 15.71 | N | N | N/A | N/A
82528 | CORTICOSTERONE | 2011-07-01 00:00:00 | 28.51 | N | N | N/A | N/A
82530 | CORTISOL FREE | 2011-07-01 00:00:00 | 21.17 | N | N | N/A | N/A
82533 | CORTISOL TOTAL | 2011-07-01 00:00:00 | 18.38 | N | N | N/A | N/A
82540 | CREATINE | 2011-07-01 00:00:00 | 5.87 | N | N | N/A | N/A
82541 | COL-CHR/MS QUAL 1 STATIONARY&MOBILE PHASE NES | 2011-07-01 00:00:00 | 22.87 | N | N | N/A | N/A
82542 | COL-CHR/MS QUAN 1 STATIONARY&MOBILE PHASE NES | 2011-07-01 00:00:00 | 22.87 | N | N | N/A | N/A
82543 | COL-CHR/MS STABLE ISOTOPE DIL 1 ANALYTE NES | 2011-07-01 00:00:00 | 22.87 | N | N | N/A | N/A
82544 | COL-CHR/MS STABLE ISOTOPE DIL MLT ANALYTES NES | 2011-07-01 00:00:00 | 22.87 | N | N | N/A | N/A
82550 | CREATINE KINASE TOTAL | 2011-07-01 00:00:00 | 8.25 | N | N | N/A | N/A
82552 | CREATINE KINASE ISOENZYMES | 2011-07-01 00:00:00 | 16.97 | N | N | N/A | N/A
82553 | CREATINE KINASE MB FRACTION ONLY | 2011-07-01 00:00:00 | 14.63 | N | N | N/A | N/A
82554 | CREATINE KINASE ISOFORMS | 2011-07-01 00:00:00 | 15.03 | N | N | N/A | N/A
82565 | CREATININE BLOOD | 2011-07-01 00:00:00 | 6.5 | N | N | N/A | N/A
82570 | CREATININE OTHER SOURCE | 2011-07-01 00:00:00 | 6.55 | N | N | N/A | N/A
82575 | CREATININE CLEARANCE | 2011-07-01 00:00:00 | 11.97 | N | N | N/A | N/A
82585 | CRYOFIBRN | 2011-07-01 00:00:00 | 10.86 | N | N | N/A | N/A
82595 | CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE | 2011-07-01 00:00:00 | 8.2 | N | N | N/A | N/A
82600 | CYANIDE | 2011-07-01 00:00:00 | 24.57 | N | N | N/A | N/A
82607 | CYANOCOBALAMIN VITAMIN B-12 | 2011-07-01 00:00:00 | 19.09 | N | N | N/A | N/A
82608 | CYANOCOBALAMIN VIT B-12 UNSAT BINDING CAPACITY | 2011-07-01 00:00:00 | 18.14 | N | N | N/A | N/A
82610 | CYSTATIN C | 2011-07-01 00:00:00 | 11.62 | N | N | N/A | N/A
82615 | CSTINE&HOMOCSTINE URINE QUALITATIVE | 2011-07-01 00:00:00 | 10.33 | N | N | N/A | N/A
82626 | DEHYDROEPIANDROSTERONE | 2011-07-01 00:00:00 | 32 | N | N | N/A | N/A
82627 | DEHYDROEPIANDROSTERONE-SULFATE | 2011-07-01 00:00:00 | 23.22 | N | N | N/A | N/A
82633 | DESOXYCORTICOSTERONE 11- | 2011-07-01 00:00:00 | 39.23 | N | N | N/A | N/A
82634 | DEOXYCORTISOL 11- | 2011-07-01 00:00:00 | 37.08 | N | N | N/A | N/A
82638 | DIBUCAINE NUMBER | 2011-07-01 00:00:00 | 15.51 | N | N | N/A | N/A
82646 | DIHYDROCODEINONE | 2011-07-01 00:00:00 | 26.15 | N | N | N/A | N/A
82649 | DIHYDROMORPHINONE | 2011-07-01 00:00:00 | 32.55 | N | N | N/A | N/A
82651 | DIHYDROTSTOSTERONE | 2011-07-01 00:00:00 | 32.7 | N | N | N/A | N/A
82652 | 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED | 2011-07-01 00:00:00 | 48.76 | N | N | N/A | N/A
82654 | DIMETHADIONE | 2011-07-01 00:00:00 | 17.53 | N | N | N/A | N/A
82656 | ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN | 2011-07-01 00:00:00 | 13.69 | N | N | N/A | N/A
82657 | NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA | 2011-07-01 00:00:00 | 22.87 | N | N | N/A | N/A
82658 | NZYM ACTV BLOOD CELLS/TISS RADACT SUBSTRATE EA | 2011-07-01 00:00:00 | 22.87 | N | N | N/A | N/A
82664 | ELCTROPHORETIC TECHNIQUE NOT ELSEWHERE SPECIFIED | 2011-07-01 00:00:00 | 43.52 | N | N | N/A | N/A
82666 | EPIANDROSTERONE | 2011-07-01 00:00:00 | 27.21 | N | N | N/A | N/A
82668 | ERYTHROPOIETIN | 2011-07-01 00:00:00 | 23.81 | N | N | N/A | N/A
82670 | [NAME] | 2011-07-01 00:00:00 | 35.39 | N | N | N/A | N/A
82671 | ESTROGENS FRACTIONATED | 2011-07-01 00:00:00 | 40.91 | N | N | N/A | N/A
82672 | ESTROGENS TOTAL | 2011-07-01 00:00:00 | 27.48 | N | N | N/A | N/A
82677 | ESTRIOL | 2011-07-01 00:00:00 | 30.63 | N | N | N/A | N/A
82679 | ESTRONE | 2011-07-01 00:00:00 | 31.61 | N | N | N/A | N/A
82690 | ETHCHLORVYNOL | 2011-07-01 00:00:00 | 21.89 | N | N | N/A | N/A
82693 | ETHYLENE GLYCOL | 2011-07-01 00:00:00 | 18.86 | N | N | N/A | N/A
82696 | ETIOCHOLANOLONE | 2011-07-01 00:00:00 | 29.87 | N | N | N/A | N/A
82705 | FAT/LIPIDS FECES QUALITATIVE | 2011-07-01 00:00:00 | 6.44 | N | N | N/A | N/A
82710 | FAT/LIPIDS FECES QUANTITATIVE | 2011-07-01 00:00:00 | 21.28 | N | N | N/A | N/A
82715 | FAT DIFFIAL FECES QUANTITATIVE | 2011-07-01 00:00:00 | 21.8 | N | N | N/A | N/A
82725 | FATTY ACIDS NONESTERIFIED | 2011-07-01 00:00:00 | 16.87 | N | N | N/A | N/A
82726 | VERY LONG CHAIN FATTY ACIDS | 2011-07-01 00:00:00 | 22.87 | N | N | N/A | N/A
82728 | FERRITIN | 2011-07-01 00:00:00 | 17.25 | N | N | N/A | N/A
82731 | FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN | 2011-07-01 00:00:00 | 81.58 | N | N | N/A | N/A
82735 | FLUORIDE | 2011-07-01 00:00:00 | 23.48 | N | N | N/A | N/A
82742 | FLURAZEPAM | 2011-07-01 00:00:00 | 25.07 | N | N | N/A | N/A
82746 | FOLIC ACID SERUM | 2011-07-01 00:00:00 | 18.62 | N | N | N/A | N/A
82747 | FOLIC ACID RBC | 2011-07-01 00:00:00 | 21.94 | N | N | N/A | N/A
82757 | FRUCTOSE SEMEN | 2011-07-01 00:00:00 | 21.97 | N | N | N/A | N/A
82759 | GALACTOKINASE RBC | 2011-07-01 00:00:00 | 27.21 | N | N | N/A | N/A
82760 | GALACTOSE | 2011-07-01 00:00:00 | 10.59 | N | N | N/A | N/A
82775 | GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE QUAN | 2011-07-01 00:00:00 | 26.68 | N | N | N/A | N/A
82776 | GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE SCREEN | 2011-07-01 00:00:00 | 10.62 | N | N | N/A | N/A
82777 | GALECTIN 3 | 2013-01-01 00:00:00 | 0 | N | Y | N/A | N/A
82784 | GAMMAGLOBULIN IGA IGD IGG IGM EACH | 2011-07-01 00:00:00 | 11.78 | N | N | N/A | N/A
82785 | GAMMAGLOBULIN IGE | 2011-07-01 00:00:00 | 20.86 | N | N | N/A | N/A
82787 | GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES | 2011-07-01 00:00:00 | 3.13 | N | N | N/A | N/A
82800 | GASES BLOOD PH ONLY | 2011-07-01 00:00:00 | 10.26 | N | N | N/A | N/A
82803 | BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 | 2011-07-01 00:00:00 | 24.5 | N | N | N/A | N/A
82805 | GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY | 2011-07-01 00:00:00 | 35.95 | N | N | N/A | N/A
82810 | GASES BLOOD O2 SATURATION ONLY DIRECT MEAS | 2011-07-01 00:00:00 | 11.05 | N | N | N/A | N/A
82820 | HGB-O2 AFFINITY PO2 50% SATURATION OXYGEN | 2011-07-01 00:00:00 | 12.66 | N | N | N/A | N/A
82930 | GASTRIC ACID ANALYIS W/PH EACH SPECIMEN | 2011-07-01 00:00:00 | 6.9 | N | N | N/A | N/A
82938 | GASTRIN AFTER SECRETIN STIMULATION | 2011-07-01 00:00:00 | 22.41 | N | N | N/A | N/A
82941 | GASTRIN | 2011-07-01 00:00:00 | 22.34 | N | N | N/A | N/A
82943 | GLUCAGON | 2011-07-01 00:00:00 | 18.1 | N | N | N/A | N/A
82945 | GLUCOSE BODY FLUID OTHER THAN BLOOD | 2011-07-01 00:00:00 | 4.97 | N | N | N/A | N/A
82946 | GLUCOSE TOLERANCE TEST | 2011-07-01 00:00:00 | 19.09 | N | N | N/A | N/A
82947 | GLUCOSE QUANTITATIVE BLOOD [NAME] | 2011-07-01 00:00:00 | 4.97 | N | N | N/A | N/A
82948 | [NAME] | 2011-07-01 00:00:00 | 3.38 | N | N | N/A | N/A
82950 | GLUCOSE POST GLUCOSE DOSE | 2011-07-01 00:00:00 | 6.01 | N | N | N/A | N/A
82951 | GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS | 2011-07-01 00:00:00 | 16.31 | N | N | N/A | N/A
82952 | GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS | 2011-07-01 00:00:00 | 4.96 | N | N | N/A | N/A
82953 | GLUC TOLBUTAMIDE TOLERANCE TST | 2011-07-01 00:00:00 | 19.19 | N | N | N/A | N/A
82955 | [NAME] DEHYDROGENASE QUANTITATIVE | 2011-07-01 00:00:00 | 12.29 | N | N | N/A | N/A
82960 | [NAME] DEHYDROGENASE SCREEN | 2011-07-01 00:00:00 | 7.67 | N | N | N/A | N/A
82962 | GLUC BLD GLUC MNTR DEV CLEARED [NAME] HOME USE | 2011-07-01 00:00:00 | 2.96 | N | N | N/A | N/A
82963 | GLUCOSIDASE BETA | 2011-07-01 00:00:00 | 27.21 | N | N | N/A | N/A
82965 | GLUTAMATE DEHYDROGENASE | 2011-07-01 00:00:00 | 9.79 | N | N | N/A | N/A
82975 | GLUTAMINE | 2011-07-01 00:00:00 | 20.06 | N | N | N/A | N/A
82977 | GLUTAMYLTRASE GAMMA | 2011-07-01 00:00:00 | 9.12 | N | N | N/A | N/A
82978 | GLUTATHIONE | 2011-07-01 00:00:00 | 18.05 | N | N | N/A | N/A
82979 | GLUTATHIONE REDUCTASE [NAME] | 2011-07-01 00:00:00 | 8.72 | N | N | N/A | N/A
82980 | GLUTETHIMIDE | 2011-07-01 00:00:00 | 23.2 | N | N | N/A | N/A
82985 | GLYCATED PROTEIN | 2011-07-01 00:00:00 | 19.09 | N | N | N/A | N/A
83001 | GONADOTROPIN FOLLICLE STIMULATING HORMONE | 2011-07-01 00:00:00 | 23.54 | N | N | N/A | N/A
83002 | GONADOTROPIN LUTEINIZING HORMONE | 2011-07-01 00:00:00 | 17.33 | N | N | N/A | N/A
83003 | GROWTH HORMONE HUMAN | 2011-07-01 00:00:00 | 21.12 | N | N | N/A | N/A
83008 | [NAME] CYCLIC | 2011-07-01 00:00:00 | 21.26 | N | N | N/A | N/A
83009 | HPYLORI BLOOD ANAL UREASE ACT NON-RADACT ISOTOPE | 2011-07-01 00:00:00 | 85.31 | N | N | N/A | N/A
83010 | HAPTOGLOBIN QUANTITATIVE | 2011-07-01 00:00:00 | 15.93 | N | N | N/A | N/A
83012 | HAPTOGLOBIN PHENOTYPES | 2011-07-01 00:00:00 | 21.78 | N | N | N/A | N/A
83013 | HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE | 2011-07-01 00:00:00 | 85.31 | N | N | N/A | N/A
83014 | HPYLORI DRUG ADMINISTRATION | 2011-07-01 00:00:00 | 9.95 | N | N | N/A | N/A
83015 | HEAVY METAL SCREEN | 2011-07-01 00:00:00 | 11.08 | N | N | N/A | N/A
83018 | HEAVY METAL QUANTIATIVE EACH | 2011-07-01 00:00:00 | 27.82 | N | N | N/A | N/A
83020 | HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS | 2011-07-01 00:00:00 | 16.31 | N | N | N/A | 16.74
83021 | HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY | 2011-07-01 00:00:00 | 22.87 | N | N | N/A | N/A
83026 | HEMOGLOBIN COPPER SULFATE METHOD NON-AUTOMATED | 2011-07-01 00:00:00 | 2.99 | N | N | N/A | N/A
83030 | HEMOGLOBIN F FETAL CHEMICAL | 2011-07-01 00:00:00 | 10.48 | N | N | N/A | N/A
83033 | HEMOGLOBIN F FETAL QUALITATIVE | 2011-07-01 00:00:00 | 5.89 | N | N | N/A | N/A
83036 | HEMOGLOBIN GLYCOSYLATED A1C | 2011-07-01 00:00:00 | 8.86 | N | N | N/A | N/A
83037 | HGB GLYCOSYLATED DEVICE CLEARED FDA HOME USE | 2011-07-01 00:00:00 | 8.86 | N | N | N/A | N/A
83045 | HEMOGLOBIN METHEMOGLOBIN QUALITATIVE | 2011-07-01 00:00:00 | 6.27 | N | N | N/A | N/A
83050 | HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE | 2011-07-01 00:00:00 | 9.28 | N | N | N/A | N/A
83051 | HEMOGLOBIN PLASMA | 2011-07-01 00:00:00 | 9.26 | N | N | N/A | N/A
83055 | HEMOGLOBIN SULFHEMOGLOBIN QUALITATIVE | 2011-07-01 00:00:00 | 6.24 | N | N | N/A | N/A
83060 | HEMOGLOBIN SULFHEMOGLOBIN [NAME] | 2011-07-01 00:00:00 | 10.48 | N | N | N/A | N/A
83065 | HEMOGLOBIN THERMOLABILE | 2011-07-01 00:00:00 | 8.72 | N | N | N/A | N/A
83068 | HEMOGLOBIN UNSTABLE SCREEN | 2011-07-01 00:00:00 | 10.72 | N | N | N/A | N/A
83069 | HEMOGLOBIN URINE | 2011-07-01 00:00:00 | 5 | N | N | N/A | N/A
83070 | HEMOSIDERIN QUALITATIVE | 2011-07-01 00:00:00 | 6.01 | N | N | N/A | N/A
83071 | HEMOSIDERIN QUANTITATIVE | 2011-07-01 00:00:00 | 8.7 | N | N | N/A | N/A
83080 | B-HEXOSAMINIDASE EACH ASSAY | 2011-07-01 00:00:00 | 17.42 | N | N | N/A | N/A
83088 | HISTAMINE | 2011-07-01 00:00:00 | 37.4 | N | N | N/A | N/A
83090 | HOMOCYSTEINE | 2011-07-01 00:00:00 | 21.37 | N | N | N/A | N/A
83150 | HOMOVANILLIC ACID | 2011-07-01 00:00:00 | 24.5 | N | N | N/A | N/A
83491 | HYDROXYCORTICOSTEROIDS 17 | 2011-07-01 00:00:00 | 22.19 | N | N | N/A | N/A
83497 | HYDROXYINDOLACETIC ACID 5 | 2011-07-01 00:00:00 | 16.33 | N | N | N/A | N/A
83498 | HYDROXYPROGESTERONE 17-D | 2011-07-01 00:00:00 | 34.41 | N | N | N/A | N/A
83499 | HYDROXYPROGESTERONE 20- | 2011-07-01 00:00:00 | 31.93 | N | N | N/A | N/A
83500 | HYDROXYPROLINE FREE | 2011-07-01 00:00:00 | 28.68 | N | N | N/A | N/A
83505 | HYDROXYPROLINE TOTAL | 2011-07-01 00:00:00 | 30.79 | N | N | N/A | N/A
83516 | IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP | 2011-07-01 00:00:00 | 13.69 | N | N | N/A | N/A
83518 | IMMUNOASSAY ANALYTE QUAL/SEMIQUAL SINGLE STEP | 2011-07-01 00:00:00 | 8.66 | N | N | N/A | N/A
83519 | IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY | 2011-07-01 00:00:00 | 17.11 | N | N | N/A | N/A
83520 | IMMUNOASSAY ANALYTE QUANTITATIVE NOS | 2011-07-01 00:00:00 | 16.4 | N | N | N/A | N/A
83525 | INSULIN TOTAL | 2011-07-01 00:00:00 | 14.48 | N | N | N/A | N/A
83527 | INSULIN FREE | 2011-07-01 00:00:00 | 16.41 | N | N | N/A | N/A
83528 | INTRINSIC FACTOR | 2011-07-01 00:00:00 | 20.14 | N | N | N/A | N/A
83540 | IRON | 2011-07-01 00:00:00 | 8.21 | N | N | N/A | N/A
83550 | IRON BINDING CAPACITY | 2011-07-01 00:00:00 | 11.07 | N | N | N/A | N/A
83570 | ISOCITRIC DEHYDROGENASE | 2011-07-01 00:00:00 | 11.21 | N | N | N/A | N/A
83582 | KETOGENIC STEROIDS FRACTIONATION | 2011-07-01 00:00:00 | 15.08 | N | N | N/A | N/A
83586 | KETOSTEROIDS 17- TOTAL | 2011-07-01 00:00:00 | 16.22 | N | N | N/A | N/A
83593 | KETOSTEROIDS 17- FRACTIONATION | 2011-07-01 00:00:00 | 33.31 | N | N | N/A | N/A
83605 | LACTATE | 2011-07-01 00:00:00 | 11.9 | N | N | N/A | N/A
83615 | LACTATE DEHYDROGENASE LDH | 2011-07-01 00:00:00 | 7.65 | N | N | N/A | N/A
83625 | LACTATE DEHYDROGENASE ISOENZYMES SEP&QUAN | 2011-07-01 00:00:00 | 16.21 | N | N | N/A | N/A
83630 | LACTOFERRIN FECAL QUALITATIVE | 2011-07-01 00:00:00 | 24.86 | N | N | N/A | N/A
83631 | LACTOFERRIN FECAL QUANTITATIVE | 2011-07-01 00:00:00 | 24.86 | N | N | N/A | N/A
83632 | LACTOGEN HPL HUMAN CHORIONIC SOMATOMAMMOTROPIN | 2011-07-01 00:00:00 | 25.61 | N | N | N/A | N/A
83633 | [NAME] | 2011-07-01 00:00:00 | 6.97 | N | N | N/A | N/A
83634 | [NAME] | 2011-07-01 00:00:00 | 14.6 | N | N | N/A | N/A
83655 | LEAD | 2011-07-01 00:00:00 | 15.33 | N | N | N/A | N/A
83661 | FETAL LUNG MATURITY LECITHIN SPHINGOMYELIN RATIO | 2011-07-01 00:00:00 | 27.85 | N | N | N/A | N/A
83662 | FETAL LUNG MATURITY FOAM STABILITY TEST | 2011-07-01 00:00:00 | 23.97 | N | N | N/A | N/A
83663 | FETAL LUNG MATURITY [NAME] | 2011-07-01 00:00:00 | 23.97 | N | N | N/A | N/A
83664 | FETAL LUNG MATURITY LAMELLAR BODY DENSITY | 2011-07-01 00:00:00 | 23.97 | N | N | N/A | N/A
83670 | LEUCINE AMINOPEPTIDASE LAP | 2011-07-01 00:00:00 | 11.61 | N | N | N/A | N/A
83690 | [NAME] | 2011-07-01 00:00:00 | 8.72 | N | N | N/A | N/A
83695 | LIPOPROTEIN A | 2011-07-01 00:00:00 | 16.4 | N | N | N/A | N/A
83698 | LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 | 2011-07-01 00:00:00 | 42.99 | N | N | N/A | N/A
83700 | LIPOPROTEIN BLOOD ELECTROPHORECTIC SEP&QUAN | 2011-07-01 00:00:00 | 14.26 | N | N | N/A | N/A
83701 | LIPOPROTEIN BLOOD HIGH RESOLTJ&QUANTJ SUBCLASSES | 2011-07-01 00:00:00 | 31.44 | N | N | N/A | N/A
83704 | LIPOPROTEIN BLOOD QUAN NUMBERS&SUBCLASSES | 2011-07-01 00:00:00 | 39.96 | N | N | N/A | N/A
83718 | [NAME] HIGH DENSITY CHOLESTEROL | 2011-07-01 00:00:00 | 10.37 | N | N | N/A | N/A
83719 | LIPOPROTEIN DIRECT MEASSUREMENT VLDL CHOLESTEROL | 2011-07-01 00:00:00 | 14.74 | N | N | N/A | N/A
83721 | LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL | 2011-07-01 00:00:00 | 12.08 | N | N | N/A | N/A
83727 | LUTEINIZING RELEASING FACTOR | 2011-07-01 00:00:00 | 21.78 | N | N | N/A | N/A
83735 | MAGNESIUM | 2011-07-01 00:00:00 | 8.49 | N | N | N/A | N/A
83775 | MALATE DEHYDROGENASE | 2011-07-01 00:00:00 | 9.33 | N | N | N/A | N/A
83785 | MANGANESE | 2011-07-01 00:00:00 | 31.15 | N | N | N/A | N/A
83788 | MASS SPECT&TANDEM MASS SPECT ANAL QUAL EA SPEC | 2011-07-01 00:00:00 | 22.87 | N | N | N/A | N/A
83789 | MASS SPECT&TANDEM MASS SPECT ANAL QUAN EA SPEC | 2011-07-01 00:00:00 | 22.87 | N | N | N/A | N/A
83805 | MEPROBAMATE | 2011-07-01 00:00:00 | 22.32 | N | N | N/A | N/A
83825 | MERCURY QUANTITATIVE | 2011-07-01 00:00:00 | 20.59 | N | N | N/A | N/A
83835 | [NAME] | 2011-07-01 00:00:00 | 21.46 | N | N | N/A | N/A
83840 | METHADONE | 2011-07-01 00:00:00 | 20.68 | N | N | N/A | N/A
83857 | METHEMALBUMIN | 2011-07-01 00:00:00 | 13.61 | N | N | N/A | N/A
83858 | METHSUXIMIDE | 2011-07-01 00:00:00 | 18.77 | N | N | N/A | N/A
83861 | [NAME] | 2011-07-01 00:00:00 | 5.22 | N | N | N/A | N/A
83864 | MUCOPOLYSACCHARIDES ACID QUANTITATIVE | 2011-07-01 00:00:00 | 25.22 | N | N | N/A | N/A
83866 | MUCOPOLYSACCHARIDES ACID SCREEN | 2011-07-01 00:00:00 | 12.48 | N | N | N/A | N/A
83872 | MUCIN SYNOVIAL FLUID ROPES TEST | 2011-07-01 00:00:00 | 7.06 | N | N | N/A | N/A
83873 | [NAME] BASIC PROTEIN CEREBROSPINAL FLUID | 2011-07-01 00:00:00 | 21.79 | N | N | N/A | N/A
83874 | MYOGLOBIN | 2011-07-01 00:00:00 | 16.35 | N | N | N/A | N/A
83876 | MYELOPEROXIDASE MPO | 2011-07-01 00:00:00 | 42.99 | N | N | N/A | N/A
83880 | NATRIURETIC PEPTIDE | 2011-07-01 00:00:00 | 42.99 | N | N | N/A | N/A
83883 | NEPHELOMETRY EACH ANALYTE NES | 2011-07-01 00:00:00 | 11.62 | N | N | N/A | N/A
83885 | NICKEL | 2011-07-01 00:00:00 | 31.03 | N | N | N/A | N/A
83887 | NICOTINE | 2011-07-01 00:00:00 | 30 | N | N | N/A | N/A
83915 | NUCLEOTIDASE 5'- | 2011-07-01 00:00:00 | 14.13 | N | N | N/A | N/A
83916 | OLIGOCLONAL IMMUNE | 2011-07-01 00:00:00 | 25.47 | N | N | N/A | N/A
83918 | ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN | 2011-07-01 00:00:00 | 20.84 | N | N | N/A | N/A
83919 | ORGANIC ACIDS QUALITATIVE EACH SPECIMEN | 2011-07-01 00:00:00 | 20.84 | N | N | N/A | N/A
83921 | ORGANIC ACID 1 QUANTITATIVE | 2011-07-01 00:00:00 | 20.84 | N | N | N/A | N/A
83925 | OPIATE(S) DRUG AND METABOLITES EACH PROCEDURE | 2011-07-01 00:00:00 | 24.64 | N | N | N/A | N/A
83930 | OSMOLALITY BLOOD | 2011-07-01 00:00:00 | 8.37 | N | N | N/A | N/A
83935 | OSMOLALITY URINE | 2011-07-01 00:00:00 | 8.63 | N | N | N/A | N/A
83937 | OSTEOCALCIN | 2011-07-01 00:00:00 | 37.81 | N | N | N/A | N/A
83945 | OXALATE | 2011-07-01 00:00:00 | 16.31 | N | N | N/A | N/A
83950 | ONCOPROTEIN HER-2/NEU | 2011-07-01 00:00:00 | 81.58 | N | N | N/A | N/A
83951 | ONCOPROTEIN DES-GAMMA-CARBOXY-PROTHROMBIN DCP | 2011-07-01 00:00:00 | 81.58 | N | N | N/A | N/A
83970 | PARATHORMONE | 2011-07-01 00:00:00 | 52.27 | N | N | N/A | N/A
83986 | PH BODY FLUID NOT ELSEWHERE SPECIFIED | 2011-07-01 00:00:00 | 4.54 | N | N | N/A | N/A
83987 | EXHALED BREATH CONDENSATE | 2011-07-01 00:00:00 | 19.46 | N | N | N/A | N/A
83992 | PHENCYCLIDINE | 2011-07-01 00:00:00 | 18.61 | N | N | N/A | N/A
83993 | CALPROTECTIN FECAL | 2011-07-01 00:00:00 | 24.86 | N | N | N/A | N/A
84022 | PHENOTHIAZINE | 2011-07-01 00:00:00 | 19.73 | N | N | N/A | N/A
84030 | PHENYLALANINE BLOOD | 2011-07-01 00:00:00 | 6.97 | N | N | N/A | N/A
84035 | [NAME] | 2011-07-01 00:00:00 | 4.64 | N | N | N/A | N/A
84060 | PHOSPHATASE ACID TOTAL | 2011-07-01 00:00:00 | 9.35 | N | N | N/A | N/A
84061 | PHOSPHATASE ACID FORENSIC EXAMINATION | 2011-07-01 00:00:00 | 10.02 | N | N | N/A | N/A
84066 | PHOSPHATASE ACID PROSTATIC | 2011-07-01 00:00:00 | 12.23 | N | N | N/A | N/A
84075 | PHOSPHATASE ALKALINE | 2011-07-01 00:00:00 | 6.55 | N | N | N/A | N/A
84078 | PHOSPHATASE ALKALINE HEAT STABLE | 2011-07-01 00:00:00 | 9.24 | N | N | N/A | N/A
84080 | PHOSPHATASE ALKALINE ISOENZYMES | 2011-07-01 00:00:00 | 18.74 | N | N | N/A | N/A
84081 | PHOSPHATIDYLGLYCEROL | 2011-07-01 00:00:00 | 20.93 | N | N | N/A | N/A
84085 | PHOSPHOGLUCONATE 6-DEHYD RBC | 2011-07-01 00:00:00 | 8.54 | N | N | N/A | N/A
84087 | PHOSPHOHEXOSE ISOMERASE | 2011-07-01 00:00:00 | 13.08 | N | N | N/A | N/A
84100 | PHOSPHORUS INORGANIC | 2011-07-01 00:00:00 | 6 | N | N | N/A | N/A
84105 | PHOSPHORUS INORGANIC URINE | 2011-07-01 00:00:00 | 6.24 | N | N | N/A | N/A
84106 | PORPHOBILINOGEN URINE QUALITATIVE | 2011-07-01 00:00:00 | 5.42 | N | N | N/A | N/A
84110 | PORPHOBILINOGEN URINE QUANTITATIVE | 2011-07-01 00:00:00 | 10.69 | N | N | N/A | N/A
84119 | PORPHYRINS URINE QUALITATAIVE | 2011-07-01 00:00:00 | 10.91 | N | N | N/A | N/A
84120 | PORPHYRINS URINE QUANTITATION & FRACTIONATION | 2011-07-01 00:00:00 | 18.63 | N | N | N/A | N/A
84126 | PORPHYRINS FECES QUANTITATIVE | 2011-07-01 00:00:00 | 32.27 | N | N | N/A | N/A
84127 | PORPHYRINS FECES QUALITATIVE | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
84132 | POTASSIUM SERUM PLASMA/WHOLE BLOOD | 2011-07-01 00:00:00 | 5.82 | N | N | N/A | N/A
84133 | POTASSIUM URINE | 2011-07-01 00:00:00 | 5.45 | N | N | N/A | N/A
84134 | PREALBUMIN | 2011-07-01 00:00:00 | 17.17 | N | N | N/A | N/A
84135 | PREGNANEDIOL | 2011-07-01 00:00:00 | 24.23 | N | N | N/A | N/A
84138 | PREGNANETRIOL | 2011-07-01 00:00:00 | 23.99 | N | N | N/A | N/A
84140 | PREGNENOLONE | 2011-07-01 00:00:00 | 26.19 | N | N | N/A | N/A
84143 | 17-HYDROXYPREGNENOLONE | 2011-07-01 00:00:00 | 28.91 | N | N | N/A | N/A
84144 | PROGESTERONE | 2011-07-01 00:00:00 | 26.42 | N | N | N/A | N/A
84145 | PROCALCITONIN (PCT) | 2011-07-01 00:00:00 | 33.92 | N | N | N/A | N/A
84146 | PROLACTIN | 2011-07-01 00:00:00 | 24.54 | N | N | N/A | N/A
84150 | PROSTAGLNDIN EACH | 2011-07-01 00:00:00 | 31.61 | N | N | N/A | N/A
84152 | PROSTATE SPECIFIC ANTIGEN COMPLEXED | 2011-07-01 00:00:00 | 23.3 | N | N | N/A | N/A
84153 | PROSTATE SPECIFIC ANTIGEN TOTAL | 2011-07-01 00:00:00 | 23.3 | N | N | N/A | N/A
84154 | PROSTATE SPECIFIC ANTIGEN FREE | 2011-07-01 00:00:00 | 23.3 | N | N | N/A | N/A
84155 | PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD | 2011-07-01 00:00:00 | 4.64 | N | N | N/A | N/A
84156 | PROTEIN TOTAL XCPT REFRACTOMETRY URINE | 2011-07-01 00:00:00 | 4.64 | N | N | N/A | N/A
84157 | PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC | 2011-07-01 00:00:00 | 4.64 | N | N | N/A | N/A
84160 | PROTEIN TOTAL REFRACTOMETRY ANY SRC | 2011-07-01 00:00:00 | 3.65 | N | N | N/A | N/A
84163 | PREGNANCY-ASSOCIATED PLASMA PROTEIN-A | 2011-07-01 00:00:00 | 19.07 | N | N | N/A | N/A
84165 | PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM | 2011-07-01 00:00:00 | 13.61 | N | N | N/A | 16.45
84166 | PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATION | 2011-07-01 00:00:00 | 22.58 | N | N | N/A | 16.45
84181 | PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID | 2011-07-01 00:00:00 | 21.57 | N | N | N/A | 16.74
84182 | PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL | 2011-07-01 00:00:00 | 22.8 | N | N | N/A | 16.45
84202 | PROTOPORPHYRIN RBC QUANTITATIVE | 2011-07-01 00:00:00 | 18.17 | N | N | N/A | N/A
84203 | PROTOPORPHYRIN RBC SCREEN | 2011-07-01 00:00:00 | 10.9 | N | N | N/A | N/A
84206 | PROINSULIN | 2011-07-01 00:00:00 | 22.56 | N | N | N/A | N/A
84207 | PYRIDOXAL PHOSPHATE | 2011-07-01 00:00:00 | 35.59 | N | N | N/A | N/A
84210 | PYRUVATE | 2011-07-01 00:00:00 | 13.74 | N | N | N/A | N/A
84220 | PYRUVATE KINASE | 2011-07-01 00:00:00 | 11.95 | N | N | N/A | N/A
84228 | QUININE | 2011-07-01 00:00:00 | 14.74 | N | N | N/A | N/A
84233 | RECEPTOR ASSAY ESTROGEN | 2011-07-01 00:00:00 | 81.58 | N | N | N/A | N/A
84234 | RECEPTOR ASSAY PROGESTERONE | 2011-07-01 00:00:00 | 82.16 | N | N | N/A | N/A
84235 | RECEPTOR ASSAY ENDOCRINE OTH/THN ESTRGN/PROGST | 2011-07-01 00:00:00 | 66.29 | N | N | N/A | N/A
84238 | RECEPTOR ASSAY NON-ENDOCRINE SPECIFY RECEPTOR | 2011-07-01 00:00:00 | 46.31 | N | N | N/A | N/A
84244 | RENIN | 2011-07-01 00:00:00 | 27.86 | N | N | N/A | N/A
84252 | RIBOFLAVIN | 2011-07-01 00:00:00 | 25.63 | N | N | N/A | N/A
84255 | SELENIUM | 2011-07-01 00:00:00 | 32.34 | N | N | N/A | N/A
84260 | SEROTONIN | 2011-07-01 00:00:00 | 39.23 | N | N | N/A | N/A
84270 | SEX HORM BINDING GLOBULIN | 2011-07-01 00:00:00 | 27.52 | N | N | N/A | N/A
84275 | SIALIC ACID | 2011-07-01 00:00:00 | 17.02 | N | N | N/A | N/A
84285 | SILICA | 2011-07-01 00:00:00 | 29.83 | N | N | N/A | N/A
84295 | SODIUM SERUM PLASMA OR WHOLE BLOOD | 2011-07-01 00:00:00 | 6.09 | N | N | N/A | N/A
84300 | SODIUM URINE | 2011-07-01 00:00:00 | 6.17 | N | N | N/A | N/A
84302 | [NAME] | 2011-07-01 00:00:00 | 6.17 | N | N | N/A | N/A
84305 | SOMATOMEDIN | 2011-07-01 00:00:00 | 26.93 | N | N | N/A | N/A
84307 | SOMATOSTATIN | 2011-07-01 00:00:00 | 23.16 | N | N | N/A | N/A
84311 | SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED | 2011-07-01 00:00:00 | 8.85 | N | N | N/A | N/A
84315 | SPECIFIC GRAVITY EXCEPT URINE | 2011-07-01 00:00:00 | 3.18 | N | N | N/A | N/A
84375 | SUGARS CHROMATOGRAPHIC TLC/PAPER CHROMATOGRAPHY | 2011-07-01 00:00:00 | 24.83 | N | N | N/A | N/A
84376 | SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC | 2011-07-01 00:00:00 | 6.97 | N | N | N/A | N/A
84377 | SUGARS MONO DI&OLIGOS MLT QUALITATIVE EACH SPEC | 2011-07-01 00:00:00 | 6.97 | N | N | N/A | N/A
84378 | SUGARS MONO DI&OLIGOS 1 QUANTITATIVE EACH SPEC | 2011-07-01 00:00:00 | 14.6 | N | N | N/A | N/A
84379 | SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC | 2011-07-01 00:00:00 | 14.6 | N | N | N/A | N/A
84392 | SULFATE URINE | 2011-07-01 00:00:00 | 6.01 | N | N | N/A | N/A
84402 | TESTOSTERONE FREE | 2011-07-01 00:00:00 | 29.69 | N | N | N/A | N/A
84403 | TESTOSTERONE TOTAL | 2011-07-01 00:00:00 | 29.75 | N | N | N/A | N/A
84425 | THIAMINE | 2011-07-01 00:00:00 | 26.89 | N | N | N/A | N/A
84430 | THIOCYANATE | 2011-07-01 00:00:00 | 14.74 | N | N | N/A | N/A
84431 | THROMBOXANE, URINE | 2011-07-01 00:00:00 | 19.93 | N | N | N/A | N/A
84432 | [NAME] | 2011-07-01 00:00:00 | 18.39 | N | N | N/A | N/A
84436 | THYROXINE TOTAL | 2011-07-01 00:00:00 | 8.7 | N | N | N/A | N/A
84437 | THYROXINE REQUIRING ELUTION | 2011-07-01 00:00:00 | 8.2 | N | N | N/A | N/A
84439 | THYROXINE FREE | 2011-07-01 00:00:00 | 11.42 | N | N | N/A | N/A
84442 | THYROXINE BINDING GLOBULIN | 2011-07-01 00:00:00 | 18.74 | N | N | N/A | N/A
84443 | THYROID STIMULATING HORMONE TSH | 2011-07-01 00:00:00 | 19.93 | N | N | N/A | N/A
84445 | THYROID STIMULATING IMMUNE GLOBULINS TSI | 2011-07-01 00:00:00 | 64.4 | N | N | N/A | N/A
84446 | TOCOPHEROL ALPHA VITAMIN E | 2011-07-01 00:00:00 | 17.96 | N | N | N/A | N/A
84449 | TRANSCORTIN CORTISOL BINDING GLOBULIN | 2011-07-01 00:00:00 | 22.8 | N | N | N/A | N/A
84450 | TRANSFERASE ASPARTATE AMINO AST SGOT | 2011-07-01 00:00:00 | 6.55 | N | N | N/A | N/A
84460 | TRANSFERASE ALANINE AMINO ALT SGPT | 2011-07-01 00:00:00 | 6.7 | N | N | N/A | N/A
84466 | TRANSFERRIN | 2011-07-01 00:00:00 | 16.17 | N | N | N/A | N/A
84478 | TRIGLYCERIDES | 2011-07-01 00:00:00 | 7.29 | N | N | N/A | N/A
84479 | THYROID HORM UPTK/THYROID HORMONE BINDING RATIO | 2011-07-01 00:00:00 | 8.2 | N | N | N/A | N/A
84480 | TRIIODOTHYRONINE T3 TOTAL TT3 | 2011-07-01 00:00:00 | 17.96 | N | N | N/A | N/A
84481 | TRIIODOTHYRONINE T3 FREE | 2011-07-01 00:00:00 | 21.46 | N | N | N/A | N/A
84482 | TRIIODOTHYRONINE T3 REVERSE | 2011-07-01 00:00:00 | 19.96 | N | N | N/A | N/A
84484 | TROPONIN QUANTITATIVE | 2011-07-01 00:00:00 | 12.47 | N | N | N/A | N/A
84485 | TRYPSIN DUODENAL FLUID | 2011-07-01 00:00:00 | 9.51 | N | N | N/A | N/A
84488 | TRYPSIN FECES QUALITATIVE | 2011-07-01 00:00:00 | 5.89 | N | N | N/A | N/A
84490 | TRYPSIN FECES QUANTITATIVE 24-HR COLLECTION | 2011-07-01 00:00:00 | 9.64 | N | N | N/A | N/A
84510 | TYROSINE | 2011-07-01 00:00:00 | 13.18 | N | N | N/A | N/A
84512 | TROPONIN QUALITATIVE | 2011-07-01 00:00:00 | 7.88 | N | N | N/A | N/A
84520 | UREA NITROGEN QUANTITATIVE | 2011-07-01 00:00:00 | 5 | N | N | N/A | N/A
84525 | UREA NITROGEN SEMIQUANTITATIVE | 2011-07-01 00:00:00 | 4.76 | N | N | N/A | N/A
84540 | UREA NITROGEN URINE | 2011-07-01 00:00:00 | 6.01 | N | N | N/A | N/A
84545 | UREA NITROGEN CLEARANCE | 2011-07-01 00:00:00 | 8.36 | N | N | N/A | N/A
84550 | URIC ACID BLOOD | 2011-07-01 00:00:00 | 5.72 | N | N | N/A | N/A
84560 | URIC ACID OTHER SOURCE | 2011-07-01 00:00:00 | 6.01 | N | N | N/A | N/A
84577 | UROBILINOGEN FECES QUANTITATIVE | 2011-07-01 00:00:00 | 15.8 | N | N | N/A | N/A
84578 | UROBILINOGEN URINE QUALITATIVE | 2011-07-01 00:00:00 | 4.11 | N | N | N/A | N/A
84580 | UROBILINOGEN URINE QUANTITATIVE TIMED SPECIMEN | 2011-07-01 00:00:00 | 8.98 | N | N | N/A | N/A
84583 | UROBILINOGEN URINE SEMIQUANTITATIVE | 2011-07-01 00:00:00 | 6.36 | N | N | N/A | N/A
84585 | VANILLYLMANDELIC ACID URINE | 2011-07-01 00:00:00 | 19.64 | N | N | N/A | N/A
84586 | VASOACTIVE INTESTINAL PEPTIDE | 2011-07-01 00:00:00 | 44.75 | N | N | N/A | N/A
84588 | VASOPRESSIN | 2011-07-01 00:00:00 | 42.99 | N | N | N/A | N/A
84590 | VITAMIN A | 2011-07-01 00:00:00 | 14.69 | N | N | N/A | N/A
84591 | VITAMIN NOT OTHERWISE SPECIFIED | 2011-07-01 00:00:00 | 14.69 | N | N | N/A | N/A
84597 | VITAMIN K | 2011-07-01 00:00:00 | 17.36 | N | N | N/A | N/A
84600 | VOLATILES | 2011-07-01 00:00:00 | 20.36 | N | N | N/A | N/A
84620 | XYLOSE ABSORPTION TEST BLOOD &/URINE | 2011-07-01 00:00:00 | 15 | N | N | N/A | N/A
84630 | ZINC | 2011-07-01 00:00:00 | 14.42 | N | N | N/A | N/A
84681 | C-PEPTIDE | 2011-07-01 00:00:00 | 26.35 | N | N | N/A | N/A
84702 | GONADOTROPIN CHORIONIC QUANTITATIVE | 2011-07-01 00:00:00 | 19.07 | N | N | N/A | N/A
84703 | GONADOTROPIN CHORIONIC QUALITATIVE | 2011-07-01 00:00:00 | 9.51 | N | N | N/A | N/A
84704 | GONADOTROPIN CHORIONIC HCG FREE BETA CHAIN | 2011-07-01 00:00:00 | 19.07 | N | N | N/A | N/A
84830 | OVULATION TEST VISUAL COLOR COMPARISON HLH | 2011-07-01 00:00:00 | 12.71 | N | N | N/A | N/A
84999 | UNLISTED CHEMISTRY/TOXICOLOGY TEST | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
85002 | BLEEDING TIME | 2011-07-01 00:00:00 | 5.7 | N | N | N/A | N/A
85004 | BLOOD COUNT AUTOMATED DIFFERENTIAL WBC COUNT | 2011-07-01 00:00:00 | 7.79 | N | N | N/A | N/A
85007 | BLOOD COUNT SMEAR MCRSCP W/MNL DIFRNTL WBC COUNT | 2011-07-01 00:00:00 | 4.36 | N | N | N/A | N/A
85008 | BLD COUNT SMEAR MCRSCP W/O MNL DIFRNTL WBC COUNT | 2011-07-01 00:00:00 | 4.36 | N | N | N/A | N/A
85009 | BLOOD COUNT MANUAL DIFRNTL WBC COUNT BUFFY COAT | 2011-07-01 00:00:00 | 3.65 | N | N | N/A | N/A
85013 | BLOOD COUNT SPUN MICROHEMATOCRIT | 2011-07-01 00:00:00 | 3 | N | N | N/A | N/A
85014 | BLOOD COUNT HEMATOCRIT | 2011-07-01 00:00:00 | 3 | N | N | N/A | N/A
85018 | BLOOD COUNT HEMOGLOBIN | 2011-07-01 00:00:00 | 3 | N | N | N/A | N/A
85025 | BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC COUNT | 2011-07-01 00:00:00 | 9.85 | N | N | N/A | N/A
85027 | BLOOD COUNT COMPLETE AUTOMATED | 2011-07-01 00:00:00 | 7.79 | N | N | N/A | N/A
85032 | BLOOD COUNT MANUAL CELL COUNT EACH | 2011-07-01 00:00:00 | 5.45 | N | N | N/A | N/A
85041 | BLOOD COUNT RED BLOOD CELL AUTOMATED | 2011-07-01 00:00:00 | 3.82 | N | N | N/A | N/A
85044 | BLOOD COUNT RETICULOCYTE AUTOMATED | 2011-07-01 00:00:00 | 5.45 | N | N | N/A | N/A
85045 | BLOOD COUNT RETICULOCYTE AUTOMATED | 2011-07-01 00:00:00 | 5.07 | N | N | N/A | N/A
85046 | BLOOD COUNT RETICULOCYTES AUTO 1/GT CELL MEAS | 2011-07-01 00:00:00 | 7.07 | N | N | N/A | N/A
85048 | BLOOD COUNT LEUKOCYTE WBC AUTOMATED | 2011-07-01 00:00:00 | 3.21 | N | N | N/A | N/A
85049 | BLOOD COUNT PLATELET [NAME] | 2011-07-01 00:00:00 | 5.66 | N | N | N/A | N/A
85060 | BLOOD SMEAR PERIPHERAL INTERP PHYS W/WRIT REPORT | 2011-07-01 00:00:00 | 20.05 | N | N | N/A | N/A
85097 | BONE MARROW SMEAR INTERPRETATION | 2011-07-01 00:00:00 | 73.74 | N | N | N/A | 85.09
85130 | CHROMOGENIC SUBSTRATE ASSAY | 2011-07-01 00:00:00 | 15.07 | N | N | N/A | N/A
85170 | CLOT RETRACTION | 2011-07-01 00:00:00 | 4.58 | N | N | N/A | N/A
85175 | CLOT LYSIS TIME WHOLE BLOOD DILUTION | 2011-07-01 00:00:00 | 5.76 | N | N | N/A | N/A
85210 | CLOTTING FACTOR I PROTHROMBIN SPECIFIC | 2011-07-01 00:00:00 | 16.44 | N | N | N/A | N/A
85220 | CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR | 2011-07-01 00:00:00 | 22.35 | N | N | N/A | N/A
85230 | CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR | 2011-07-01 00:00:00 | 22.68 | N | N | N/A | N/A
85240 | CLOTTING FACTOR VIII AHG 1 STAGE | 2011-07-01 00:00:00 | 13.2 | N | N | N/A | N/A
85244 | CLOTTING FACTOR VIII RELATED ANTIGEN | 2011-07-01 00:00:00 | 25.86 | N | N | N/A | N/A
85245 | CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT | 2011-07-01 00:00:00 | 29.06 | N | N | N/A | N/A
85246 | CLOTTING FACTOR VIII VW FACTOR ANTIGEN | 2011-07-01 00:00:00 | 29.06 | N | N | N/A | N/A
85247 | CLOTTING FACTOR VIII MULTIMETRIC ANALYSIS | 2011-07-01 00:00:00 | 29.06 | N | N | N/A | N/A
85250 | CLOTTING FACTOR IX PTC/CHRISTMAS | 2011-07-01 00:00:00 | 24.12 | N | N | N/A | N/A
85260 | CLOTTING FACTOR X STUART-PROWER | 2011-07-01 00:00:00 | 22.68 | N | N | N/A | N/A
85270 | CLOTTING FACTOR XI PTA | 2011-07-01 00:00:00 | 22.68 | N | N | N/A | N/A
85280 | CLOTTING FACTOR XII HAGEMAN | 2011-07-01 00:00:00 | 24.5 | N | N | N/A | N/A
85290 | CLOTTING FACTOR XIII FIBRIN STABILIZING | 2011-07-01 00:00:00 | 20.7 | N | N | N/A | N/A
85291 | CLOTTING FACTOR XIII FIBRN STABILIZ SCREEN SOLUB | 2011-07-01 00:00:00 | 11.26 | N | N | N/A | N/A
85292 | CLOTTING PREKALLIKREIN ASSAY FLETCHER FACT ASSAY | 2011-07-01 00:00:00 | 23.99 | N | N | N/A | N/A
85293 | CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY | 2011-07-01 00:00:00 | 23.99 | N | N | N/A | N/A
85300 | CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY | 2011-07-01 00:00:00 | 15.01 | N | N | N/A | N/A
85301 | CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY | 2011-07-01 00:00:00 | 13.69 | N | N | N/A | N/A
85302 | CLOTTING INHIBITORS PROTEIN C ANTIGEN | 2011-07-01 00:00:00 | 15.23 | N | N | N/A | N/A
85303 | CLOTTING INHIBITORS PROTEIN C ACTIVITY | 2011-07-01 00:00:00 | 17.51 | N | N | N/A | N/A
85305 | CLOTTING INHIBITORS PROTEIN S TOTAL | 2011-07-01 00:00:00 | 14.69 | N | N | N/A | N/A
85306 | CLOTTING INHIBITORS PROTEIN S FREE | 2011-07-01 00:00:00 | 19.4 | N | N | N/A | N/A
85307 | ACTIVATED PROTEIN C APC RESISTANCE ASSAY | 2011-07-01 00:00:00 | 19.4 | N | N | N/A | N/A
85335 | FACTOR INHIBITOR TEST | 2011-07-01 00:00:00 | 16.31 | N | N | N/A | N/A
85337 | THROMBOMODULIN | 2011-07-01 00:00:00 | 13.2 | N | N | N/A | N/A
85345 | [NAME] AND WHITE | 2011-07-01 00:00:00 | 5.45 | N | N | N/A | N/A
85347 | COAGULATION TIME ACTIVATED | 2011-07-01 00:00:00 | 5.39 | N | N | N/A | N/A
85348 | [NAME] | 2011-07-01 00:00:00 | 4.72 | N | N | N/A | N/A
85360 | EUGLOBULIN LYSIS | 2011-07-01 00:00:00 | 10.26 | N | N | N/A | N/A
85362 | FIBRIN DGRADJ SPLT PRODUXS AGGLUJ SLIDE SEMIQUAN | 2011-07-01 00:00:00 | 8.72 | N | N | N/A | N/A
85366 | FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ | 2011-07-01 00:00:00 | 8.13 | N | N | N/A | N/A
85370 | FIBRIN DGRADJ SPLT PRODUCTS QUANTITATIVE | 2011-07-01 00:00:00 | 14.38 | N | N | N/A | N/A
85378 | FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN | 2011-07-01 00:00:00 | 9.03 | N | N | N/A | N/A
85379 | FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE | 2011-07-01 00:00:00 | 12.89 | N | N | N/A | N/A
85380 | FIBRIN DGRADJ PRODUCTS D-DIMER ULTRASENSITIVE | 2011-07-01 00:00:00 | 12.89 | N | N | N/A | N/A
85384 | FIBRINOGEN ACTIVITY | 2011-07-01 00:00:00 | 10.76 | N | N | N/A | N/A
85385 | FIBRINOGEN ANTIGEN | 2011-07-01 00:00:00 | 10.76 | N | N | N/A | N/A
85390 | FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPORT | 2011-07-01 00:00:00 | 6.54 | N | N | N/A | 17.03
85396 | COAGJ/FBRNLYS ASSAY WHOLE BLOOD ADDITIVE PER DAY | 2011-07-01 00:00:00 | 16.45 | N | N | N/A | N/A
85397 | COAGJ&FIBRINOLYSIS FUNCTIONAL ACTV NOS EA ANALYT | 2011-07-01 00:00:00 | 29.06 | N | N | N/A | N/A
85400 | FIBRINOLYTIC FACTORS & INHIBITORS PLASMIN | 2011-07-01 00:00:00 | 11.21 | N | N | N/A | N/A
85410 | FBRNLYC FACTORS&INHIBITORS ALPHA-2 ANTIPLASMIN | 2011-07-01 00:00:00 | 9.77 | N | N | N/A | N/A
85415 | FBRNLYC FACTORS&INHIBITORS PLSMNG ACTIVATOR | 2011-07-01 00:00:00 | 21.78 | N | N | N/A | N/A
85420 | FBRNLYC FACTORS&INHIBITRS PLSMNG XCPT AGIC ASSAY | 2011-07-01 00:00:00 | 8.28 | N | N | N/A | N/A
85421 | FBRNLYC FACTORS&INHIBITORS PLSMNG AGIC ASSAY | 2011-07-01 00:00:00 | 12.9 | N | N | N/A | N/A
85441 | HEINZ BODIES DIRECT | 2011-07-01 00:00:00 | 5.33 | N | N | N/A | N/A
85445 | HEINZ BODIES INDUCED ACETYL PHENYLHYDRAZINE | 2011-07-01 00:00:00 | 8.63 | N | N | N/A | N/A
85460 | HGB/RBCS FETAL FETOMATERNAL HEMRRG DIFRNTL LYSIS | 2011-07-01 00:00:00 | 9.8 | N | N | N/A | N/A
85461 | HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE | 2011-07-01 00:00:00 | 8.41 | N | N | N/A | N/A
85475 | HEMOLYSIN ACID | 2011-07-01 00:00:00 | 11.23 | N | N | N/A | N/A
85520 | HEPARIN ASSAY | 2011-07-01 00:00:00 | 16.59 | N | N | N/A | N/A
85525 | HEPARIN NEUTRALIZATION | 2011-07-01 00:00:00 | 8.24 | N | N | N/A | N/A
85530 | HEPARIN-PROTAMINE TOLERANCE TST | 2011-07-01 00:00:00 | 17.96 | N | N | N/A | N/A
85536 | IRON STAIN PERIPHERAL BLOOD | 2011-07-01 00:00:00 | 7.31 | N | N | N/A | N/A
85540 | WBC ALKALINE PHOSPHATASE COUNT | 2011-07-01 00:00:00 | 10.9 | N | N | N/A | N/A
85547 | MECHANICAL FRAGILITY RBC | 2011-07-01 00:00:00 | 10.9 | N | N | N/A | N/A
85549 | MURAMIDASE | 2011-07-01 00:00:00 | 23.76 | N | N | N/A | N/A
85555 | OSMOTIC FRAGILITY RBC UNINCUBATED | 2011-07-01 00:00:00 | 8.47 | N | N | N/A | N/A
85557 | OSMOTIC FRAGILITY RBC INCUBATED | 2011-07-01 00:00:00 | 16.92 | N | N | N/A | N/A
85576 | PLATELET AGGREGATION IN VITRO EACH AGENT | 2011-07-01 00:00:00 | 27.21 | N | N | N/A | 16.74
85597 | PHOSPHOLIPID NEUTRALIZATION PLATELET | 2011-07-01 00:00:00 | 22.77 | N | N | N/A | N/A
85598 | PHOSPHOLIPID NEUTRALIZATION HEXAGONAL | 2011-07-01 00:00:00 | 22.77 | N | N | N/A | N/A
85610 | PROTHROMBIN TIME | 2011-07-01 00:00:00 | 4.98 | N | N | N/A | N/A
85611 | PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH | 2011-07-01 00:00:00 | 4.99 | N | N | N/A | N/A
85612 | [NAME] UNDILUTED | 2011-07-01 00:00:00 | 8.86 | N | N | N/A | N/A
85613 | [NAME] VENOM TIME DILUTED | 2011-07-01 00:00:00 | 8.86 | N | N | N/A | N/A
85635 | REPTILASE TEST | 2011-07-01 00:00:00 | 9.54 | N | N | N/A | N/A
85651 | [NAME] | 2011-07-01 00:00:00 | 4.5 | N | N | N/A | N/A
85652 | [NAME] | 2011-07-01 00:00:00 | 3.42 | N | N | N/A | N/A
85660 | SICKLING RBC REDUCTION | 2011-07-01 00:00:00 | 6.98 | N | N | N/A | N/A
85670 | THROMBIN TIME PLASMA | 2011-07-01 00:00:00 | 7.32 | N | N | N/A | N/A
85675 | THROMBIN TIME TITER | 2011-07-01 00:00:00 | 8.68 | N | N | N/A | N/A
85705 | THROMBOPLASTIN INHIBITION TISSUE | 2011-07-01 00:00:00 | 12.2 | N | N | N/A | N/A
85730 | THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD | 2011-07-01 00:00:00 | 7.61 | N | N | N/A | N/A
85732 | THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA | 2011-07-01 00:00:00 | 8.2 | N | N | N/A | N/A
85810 | VISCOSITY | 2011-07-01 00:00:00 | 14.79 | N | N | N/A | N/A
85999 | UNLISTED HEMATOLOGY TEST | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
86000 | AGGLUTININS FEBRILE EACH ANTIGEN | 2011-07-01 00:00:00 | 8.13 | N | N | N/A | N/A
86001 | ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN | 2011-07-01 00:00:00 | 5.25 | N | N | N/A | N/A
86003 | ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN | 2011-07-01 00:00:00 | 5.25 | N | N | N/A | N/A
86005 | ALLERGEN SPECIFIC IGE QUAL MULTIALLERGEN SCREEN | 2011-07-01 00:00:00 | 3.57 | N | N | N/A | N/A
86021 | ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES | 2011-07-01 00:00:00 | 15.28 | N | N | N/A | N/A
86022 | ANTIBODY IDENTIFICATION PLATELET ANTIBODIES | 2011-07-01 00:00:00 | 23.27 | N | N | N/A | N/A
86023 | ANTIBODY IDENTIFICATION PLATELET IMMUNOGL ASSAY | 2011-07-01 00:00:00 | 15.78 | N | N | N/A | N/A
86038 | ANTINUCLEAR ANTIBODIES ANA | 2011-07-01 00:00:00 | 12.49 | N | N | N/A | N/A
86039 | ANTINUCLEAR ANTIBODIES ANA TITER | 2011-07-01 00:00:00 | 14.14 | N | N | N/A | N/A
86060 | ANTISTREPTOLYSIN 0 TITER | 2011-07-01 00:00:00 | 9.24 | N | N | N/A | N/A
86063 | ANTISTREPTOLYSIN 0 SCREEN | 2011-07-01 00:00:00 | 7.32 | N | N | N/A | N/A
86077 | BLD BANK PHYS SVCS DIFFC CROSS MATCH&/EVAL REPRT | 2011-07-01 00:00:00 | 44.33 | N | N | N/A | N/A
86078 | BLD BANK PHYS SVCS INVSTGJ TFUJ RXN REPRT | 2011-07-01 00:00:00 | 44.61 | N | N | N/A | N/A
86079 | BLD BANK PHYS SVCS AUTHJ DEVIJ STANDARD REPRT | 2011-07-01 00:00:00 | 44.61 | N | N | N/A | N/A
86140 | C-REACTIVE PROTEIN | 2011-07-01 00:00:00 | 6.55 | N | N | N/A | N/A
86141 | C-REACTIVE PROTEIN HIGH SENSITIVITY | 2011-07-01 00:00:00 | 16.4 | N | N | N/A | N/A
86146 | BETA 2 GLYCOPROTEIN I ANTIBODY EACH | 2011-07-01 00:00:00 | 32.22 | N | N | N/A | N/A
86147 | CARDIOLIPIN ANTIBODY EACH IG CLASS | 2011-07-01 00:00:00 | 32.22 | N | N | N/A | N/A
86148 | ANTI-PHOSPHATIDYLSERINE ANTIBODY | 2011-07-01 00:00:00 | 18.92 | N | N | N/A | N/A
86152 | CELL ENUMERATION IMMUNE SELECTJ & ID FLUID SPEC | 2013-01-01 00:00:00 | 0 | N | Y | N/A | N/A
86153 | CELL ENUMERATION IMMUNE SELECTJ & ID PHYS INTERP | 2013-01-01 00:00:00 | 0 | N | Y | N/A | N/A
86155 | CHEMOTAXIS ASSAY SPECIFY METHOD | 2011-07-01 00:00:00 | 20.24 | N | N | N/A | N/A
86156 | COLD AGGLUTININ SCREEN | 2011-07-01 00:00:00 | 8.49 | N | N | N/A | N/A
86157 | COLD AGGLUTININ TITER | 2011-07-01 00:00:00 | 10.22 | N | N | N/A | N/A
86160 | COMPLEMENT ANTIGEN EACH COMPONENT | 2011-07-01 00:00:00 | 15.2 | N | N | N/A | N/A
86161 | COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT | 2011-07-01 00:00:00 | 15.2 | N | N | N/A | N/A
86162 | COMPLEMENT TOTAL HEMOLYTIC | 2011-07-01 00:00:00 | 25.73 | N | N | N/A | N/A
86171 | COMPLEMENT FIXATION TESTS EACH ANTIGEN | 2011-07-01 00:00:00 | 12.69 | N | N | N/A | N/A
86185 | CNTERIMMUNOELECTROPHORESIS EACH ANTIGEN | 2011-07-01 00:00:00 | 11.33 | N | N | N/A | N/A
86200 | CYCLIC CITRULLINATED PEPTIDE ANTIBODY | 2011-07-01 00:00:00 | 16.4 | N | N | N/A | N/A
86215 | DEOXYRIBONUCLEASE ANTIBODY | 2011-07-01 00:00:00 | 16.79 | N | N | N/A | N/A
86225 | DNA ANTIBODY NATIVE/DOUBLE STRANDED | 2011-07-01 00:00:00 | 17.4 | N | N | N/A | N/A
86226 | DNA ANTIBODY SINGLE STRANDED | 2011-07-01 00:00:00 | 15.34 | N | N | N/A | N/A
86235 | EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD | 2011-07-01 00:00:00 | 22.71 | N | N | N/A | N/A
86243 | FC RECEPTOR | 2011-07-01 00:00:00 | 25.98 | N | N | N/A | N/A
86255 | FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY | 2011-07-01 00:00:00 | 15.26 | N | N | N/A | 16.74
86256 | FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY | 2011-07-01 00:00:00 | 15.26 | N | N | N/A | 16.39
86277 | GROWTH HORMONE HUMAN ANTIBODY | 2011-07-01 00:00:00 | 19.94 | N | N | N/A | N/A
86280 | HEMAGGLUTINATION INHIBITION TEST HAI | 2011-07-01 00:00:00 | 10.37 | N | N | N/A | N/A
86294 | IMMUNOASSAY TUMOR ANTIGEN QUAL/SEMIQUANTITATIVE | 2011-07-01 00:00:00 | 24.85 | N | N | N/A | N/A
86300 | IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3 | 2011-07-01 00:00:00 | 26.36 | N | N | N/A | N/A
86301 | IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9 | 2011-07-01 00:00:00 | 26.36 | N | N | N/A | N/A
86304 | IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 | 2011-07-01 00:00:00 | 26.36 | N | N | N/A | N/A
86305 | QUANTITATIVE TITER | 2011-07-01 00:00:00 | 26.36 | N | N | N/A | N/A
86308 | HETEROPHILE ANTIBODIES SCREEN | 2011-07-01 00:00:00 | 6.55 | N | N | N/A | N/A
86309 | HETEROPHILE ANTIBODIES TITER | 2011-07-01 00:00:00 | 8.2 | N | N | N/A | N/A
86310 | HETEROPHILE ANTIBODIES TITER AFTER ABSORPTION | 2011-07-01 00:00:00 | 9.33 | N | N | N/A | N/A
86316 | IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE | 2011-07-01 00:00:00 | 26.36 | N | N | N/A | N/A
86317 | IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS | 2011-07-01 00:00:00 | 10.26 | N | N | N/A | N/A
86318 | IMMUNOASSAY NFCT AGT ANTB QUAL/SEMIQUAN 1 STEP | 2011-07-01 00:00:00 | 16.4 | N | N | N/A | N/A
86320 | IMMUNOELECTROPHORESIS SERUM | 2011-07-01 00:00:00 | 28.39 | N | N | N/A | 16.39
86325 | [NAME] CONCENTRATION | 2011-07-01 00:00:00 | 28.31 | N | N | N/A | 16.1
86327 | IMMUNOELECTROPHORESIS CROSSED | 2011-07-01 00:00:00 | 28.74 | N | N | N/A | 19.13
86329 | IMMUNODIFFUSION NOT ELSEWHERE SPECIFIED | 2011-07-01 00:00:00 | 12.49 | N | N | N/A | N/A
86331 | IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY | 2011-07-01 00:00:00 | 15.17 | N | N | N/A | N/A
86332 | IMMUNE COMPLEX ASSAY | 2011-07-01 00:00:00 | 30.68 | N | N | N/A | N/A
86334 | IMMUNOFIXJ ELECTROPHORESIS SERUM | 2011-07-01 00:00:00 | 28.3 | N | N | N/A | 16.74
86335 | IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS | 2011-07-01 00:00:00 | 37.17 | N | N | N/A | 16.45
86336 | INHIBIN A | 2011-07-01 00:00:00 | 18.98 | N | N | N/A | N/A
86337 | INSULIN ANTIBODIES | 2011-07-01 00:00:00 | 27.12 | N | N | N/A | N/A
86340 | INTRINSIC FACTOR ANTIBODIES | 2011-07-01 00:00:00 | 19.09 | N | N | N/A | N/A
86341 | ISLET CELL ANTIBODY | 2011-07-01 00:00:00 | 25.07 | N | N | N/A | N/A
86343 | [NAME] RELEASE TEST LHR | 2011-07-01 00:00:00 | 15.79 | N | N | N/A | N/A
86344 | LEUKOCYTE PHAGOCYTOSIS | 2011-07-01 00:00:00 | 10.12 | N | N | N/A | N/A
86352 | CELL FUNCTION ASSAY W/STIM | 2011-07-01 00:00:00 | 172.07 | N | N | N/A | N/A
86353 | LYMPHOCYTE TR MITOGEN/AG INDUCED BLASTOGENESIS | 2011-07-01 00:00:00 | 62.09 | N | N | N/A | N/A
86355 | B CELLS TOTAL COUNT | 2011-07-01 00:00:00 | 47.77 | N | N | N/A | N/A
86356 | MONONUCLEAR CELL ANTIGEN QUANTITATIVE NOS EA | 2011-07-01 00:00:00 | 33.9 | N | N | N/A | N/A
86357 | NATURAL KILLER CELLS TOTAL COUNT | 2011-07-01 00:00:00 | 47.77 | N | N | N/A | N/A
86359 | T CELLS TOTAL COUNT | 2011-07-01 00:00:00 | 47.77 | N | N | N/A | N/A
86360 | T CELLS ABSOLUTE CD4&CD8 COUNT RATIO | 2011-07-01 00:00:00 | 59.51 | N | N | N/A | N/A
86361 | T CELLS ABSOLUTE CD4 COUNT | 2011-07-01 00:00:00 | 33.9 | N | N | N/A | N/A
86367 | [NAME] TOTAL COUNT | 2011-07-01 00:00:00 | 47.77 | N | N | N/A | N/A
86376 | MICROSOMAL ANTIBODIES EACH | 2011-07-01 00:00:00 | 18.43 | N | N | N/A | N/A
86378 | MIGRATION INHIBITORY FACTOR TEST MIF | 2011-07-01 00:00:00 | 24.94 | N | N | N/A | N/A
86382 | NEUTRALIZATION TEST VIRAL | 2011-07-01 00:00:00 | 21.42 | N | N | N/A | N/A
86384 | NITROBLUE TETRAZOLIUM DYE TEST [NAME] | 2011-07-01 00:00:00 | 14.42 | N | N | N/A | N/A
86386 | NUCLEAR MATRIX PROTEIN 22 NMP22 QUALITATIVE | 2012-01-01 00:00:00 | 20.35 | Y | Y | N/A | N/A
86403 | PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY | 2011-07-01 00:00:00 | 12.91 | N | N | N/A | N/A
86406 | PARTICLE AGGLUTINATION TITER EACH ANTIBODY | 2011-07-01 00:00:00 | 13.47 | N | N | N/A | N/A
86430 | RHEUMATOID FACTOR QUALITATIVE | 2011-07-01 00:00:00 | 7.18 | N | N | N/A | N/A
86431 | RHEUMATOID FACTOR QUANTITATIVE | 2011-07-01 00:00:00 | 7.18 | N | N | N/A | N/A
86480 | TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON | 2011-07-01 00:00:00 | 78.5 | N | N | N/A | N/A
86481 | TB ANTIGEN RESPONSE GAMMA INTERFERON T-CELL SUSP | 2011-07-01 00:00:00 | 78.5 | N | N | N/A | N/A
86485 | SKIN TEST CANDIDA | 2011-07-01 00:00:00 | 8.42 | N | N | N/A | N/A
86486 | SKIN TEST UNLISTED ANTIGEN EACH | 2011-07-01 00:00:00 | 4.21 | N | N | N/A | N/A
86490 | SKIN TEST COCCIDIOIDOMYCOSIS | 2011-07-01 00:00:00 | 5.65 | N | N | N/A | N/A
86510 | SKIN TEST HISTOPLASMOSIS | 2011-07-01 00:00:00 | 5.36 | N | N | N/A | N/A
86580 | SKIN TEST TUBERCULOSIS INTRADERMAL | 2011-07-01 00:00:00 | 6.23 | N | N | N/A | N/A
86590 | STREPTOKINASE ANTIBODY | 2011-07-01 00:00:00 | 13.98 | N | N | N/A | N/A
86592 | SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL | 2011-07-01 00:00:00 | 5.41 | N | N | N/A | N/A
86593 | SYPHILIS TEST QUANTITATIVE | 2011-07-01 00:00:00 | 5.57 | N | N | N/A | N/A
86602 | ANTIBODY ACTINOMYCES | 2011-07-01 00:00:00 | 12.89 | N | N | N/A | N/A
86603 | [NAME] | 2011-07-01 00:00:00 | 16.3 | N | N | N/A | N/A
86606 | ANTIBODY ASPERGILLUS | 2011-07-01 00:00:00 | 15.96 | N | N | N/A | N/A
86609 | ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED | 2011-07-01 00:00:00 | 16.32 | N | N | N/A | N/A
86611 | ANTIBODY BARTONELLA | 2011-07-01 00:00:00 | 12.89 | N | N | N/A | N/A
86612 | ANTIBODY BLASTOMYCES | 2011-07-01 00:00:00 | 15.96 | N | N | N/A | N/A
86615 | ANTIBODY BORDETELLA | 2011-07-01 00:00:00 | 16.7 | N | N | N/A | N/A
86617 | ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST | 2011-07-01 00:00:00 | 19.62 | N | N | N/A | N/A
86618 | ANTIBODY BORRELIA BURGDORFERI LYME DISEASE | 2011-07-01 00:00:00 | 21.57 | N | N | N/A | N/A
86619 | ANTIBODY BORRELIA RELAPSING FEVER | 2011-07-01 00:00:00 | 16.95 | N | N | N/A | N/A
86622 | [NAME] | 2011-07-01 00:00:00 | 10.66 | N | N | N/A | N/A
86625 | ANTIBODY CAMPYLOBACTER | 2011-07-01 00:00:00 | 16.61 | N | N | N/A | N/A
86628 | ANTIBODY CANDIDA | 2011-07-01 00:00:00 | 15.21 | N | N | N/A | N/A
86631 | ANTIBODY CHLAMYDIA | 2011-07-01 00:00:00 | 14.98 | N | N | N/A | N/A
86632 | ANTIBODY CHLAMYDIA IGM | 2011-07-01 00:00:00 | 16.07 | N | N | N/A | N/A
86635 | ANTIBODY COCCIDIOIDES | 2011-07-01 00:00:00 | 13.54 | N | N | N/A | N/A
86638 | ANTIBODY COXIELLA BURNETII Q FEVER | 2011-07-01 00:00:00 | 15.35 | N | N | N/A | N/A
86641 | ANTIBODY CRYPTOCOCCUS | 2011-07-01 00:00:00 | 18.25 | N | N | N/A | N/A
86644 | ANTIBODY CYTOMEGALOVIRUS CMV | 2011-07-01 00:00:00 | 12.44 | N | N | N/A | N/A
86645 | ANTIBODY CYTOMEGALOVIRUS CMV IGM | 2011-07-01 00:00:00 | 14.51 | N | N | N/A | N/A
86648 | ANTIBODY DIPHTHERIA | 2011-07-01 00:00:00 | 18.39 | N | N | N/A | N/A
86651 | ANTIBODY ENCEPHALITIS CALIFORNIA LA CROSSE | 2011-07-01 00:00:00 | 16.7 | N | N | N/A | N/A
86652 | ANTIBODY ENCEPHALITIS EASTERN EQUINE | 2011-07-01 00:00:00 | 16.7 | N | N | N/A | N/A
86653 | ANTIBODY ENCEPHALITIS ST. LOUIS | 2011-07-01 00:00:00 | 16.7 | N | N | N/A | N/A
86654 | ANTIBODY ENCEPHALITIS WESTRN EQUINE | 2011-07-01 00:00:00 | 16.7 | N | N | N/A | N/A
86658 | ANTIBODY ENTEROVIRUS | 2011-07-01 00:00:00 | 16.51 | N | N | N/A | N/A
86663 | ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA | 2011-07-01 00:00:00 | 16.61 | N | N | N/A | N/A
86664 | ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA | 2011-07-01 00:00:00 | 19.38 | N | N | N/A | N/A
86665 | ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA | 2011-07-01 00:00:00 | 22.25 | N | N | N/A | N/A
86666 | ANTIBODY EHRLICHIA | 2011-07-01 00:00:00 | 12.89 | N | N | N/A | N/A
86668 | ANTIBODY FRANCISELLA TULARENSIS | 2011-07-01 00:00:00 | 9.68 | N | N | N/A | N/A
86671 | ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED | 2011-07-01 00:00:00 | 15.53 | N | N | N/A | N/A
86674 | ANTIBODY GIARDIA LAMBLIA | 2011-07-01 00:00:00 | 18.65 | N | N | N/A | N/A
86677 | ANTIBODY HELICOBACTER PYLORI | 2011-07-01 00:00:00 | 18.38 | N | N | N/A | N/A
86682 | ANTIBODY HELMINTH NOT ELSEWHERE SPECIFIED | 2011-07-01 00:00:00 | 16.48 | N | N | N/A | N/A
86684 | ANTIBODY HAEMOPHILUS INFLUENZA | 2011-07-01 00:00:00 | 20.07 | N | N | N/A | N/A
86687 | ANTIBODY HTLV-I | 2011-07-01 00:00:00 | 10.63 | N | N | N/A | N/A
86688 | ANTIBODY HTLV-II | 2011-07-01 00:00:00 | 17.74 | N | N | N/A | N/A
86689 | ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST | 2011-07-01 00:00:00 | 24.51 | N | N | N/A | N/A
86692 | ANTIBODY HEP DELTA AGENT | 2011-07-01 00:00:00 | 16.2 | N | N | N/A | N/A
86694 | ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST | 2011-07-01 00:00:00 | 12.44 | N | N | N/A | N/A
86695 | ANTIBODY HERPES SMPLX TYPE 1 | 2011-07-01 00:00:00 | 7.73 | N | N | N/A | N/A
86696 | ANTIBODY HERPES SMPLX TYPE 2 | 2011-07-01 00:00:00 | 24.51 | N | N | N/A | N/A
86698 | ANTIBODY HISTOPLASMA | 2011-07-01 00:00:00 | 15.83 | N | N | N/A | N/A
86701 | ANTIBODY HIV-1 | 2011-07-01 00:00:00 | 11.25 | N | N | N/A | N/A
86702 | ANTIBODY HIV-2 | 2011-07-01 00:00:00 | 15.48 | N | N | N/A | N/A
86703 | ANTIBODY HIV-1&HIV-2 SINGLE RESULT | 2011-07-01 00:00:00 | 17.37 | N | N | N/A | N/A
86704 | HEPATITIS B CORE ANTIBODY HBCAB TOTAL | 2011-07-01 00:00:00 | 15.26 | N | N | N/A | N/A
86705 | HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY | 2011-07-01 00:00:00 | 14.9 | N | N | N/A | N/A
86706 | HEPATITIS B SURF ANTIBODY HBSAB | 2011-07-01 00:00:00 | 13.61 | N | N | N/A | N/A
86707 | HEPATITIS BE ANTIBODY HBEAB | 2011-07-01 00:00:00 | 14.65 | N | N | N/A | N/A
86708 | HEPATITIS ANTIBODY HAAB TOTAL | 2011-07-01 00:00:00 | 15.69 | N | N | N/A | N/A
86709 | HEPATITIS ANTIBODY HAAB IGM ANTIBODY | 2011-07-01 00:00:00 | 14.26 | N | N | N/A | N/A
86710 | ANTIBODY INF VIRUS | 2011-07-01 00:00:00 | 12.56 | N | N | N/A | N/A
86711 | ANTIBODY JOHN CUNNINGHAM VIRUS | 2013-01-01 00:00:00 | 12.15 | N | Y | N/A | N/A
86713 | ANTIBODY [NAME] | 2011-07-01 00:00:00 | 11.12 | N | N | N/A | N/A
86717 | ANTIBODY LEISHMANIA | 2011-07-01 00:00:00 | 15.52 | N | N | N/A | N/A
86720 | ANTIBODY LEPTOSPIRA | 2011-07-01 00:00:00 | 11.12 | N | N | N/A | N/A
86723 | ANTIBODY LISTERIA MONOCYTOGENES | 2011-07-01 00:00:00 | 16.7 | N | N | N/A | N/A
86727 | ANTIBODY LYMPHOCYTIC CHORIOMENINGITIS | 2011-07-01 00:00:00 | 16.3 | N | N | N/A | N/A
86729 | ANTIBODY LYMPHOGRANULOMA VENEREUM | 2011-07-01 00:00:00 | 15.13 | N | N | N/A | N/A
86732 | ANTIBODY MUCORMYCOSIS | 2011-07-01 00:00:00 | 16.7 | N | N | N/A | N/A
86735 | ANTIBODY MUMPS | 2011-07-01 00:00:00 | 16.53 | N | N | N/A | N/A
86738 | ANTIBODY MYCOPLSM | 2011-07-01 00:00:00 | 16.78 | N | N | N/A | N/A
86741 | ANTIBODY NEISSERIA MENINGITIDIS | 2011-07-01 00:00:00 | 16.7 | N | N | N/A | N/A
86744 | ANTIBODY NOCARDIA | 2011-07-01 00:00:00 | 16.7 | N | N | N/A | N/A
86747 | ANTIBODY PARVOVIRUS | 2011-07-01 00:00:00 | 19.04 | N | N | N/A | N/A
86750 | ANTIBODY PLASMODIUM MALARIA | 2011-07-01 00:00:00 | 16.7 | N | N | N/A | N/A
86753 | ANTIBODY PROTOZOA [NAME] | 2011-07-01 00:00:00 | 15.69 | N | N | N/A | N/A
86756 | ANTIBODY RESPIRATORY SYNCTIAL VIRUS | 2011-07-01 00:00:00 | 16.33 | N | N | N/A | N/A
86757 | ANTIBODY RICKETTSIA | 2011-07-01 00:00:00 | 24.51 | N | N | N/A | N/A
86759 | ANTIBODY ROTAVIRUS | 2011-07-01 00:00:00 | 16.7 | N | N | N/A | N/A
86762 | ANTIBODY RUBELLA | 2011-07-01 00:00:00 | 12.44 | N | N | N/A | N/A
86765 | ANTIBODY RUBEOLA | 2011-07-01 00:00:00 | 16.32 | N | N | N/A | N/A
86768 | ANTIBODY SALMONELLA | 2011-07-01 00:00:00 | 16.7 | N | N | N/A | N/A
86771 | ANTIBODY SHIGELLA | 2011-07-01 00:00:00 | 16.7 | N | N | N/A | N/A
86774 | ANTIBODY TETANUS | 2011-07-01 00:00:00 | 18.74 | N | N | N/A | N/A
86777 | ANTIBODY TOXOPLASMA | 2011-07-01 00:00:00 | 12.44 | N | N | N/A | N/A
86778 | ANTIBODY TOXOPLASMA IGM | 2011-07-01 00:00:00 | 13.54 | N | N | N/A | N/A
86780 | TREPONEMA PALLIDUM | 2011-07-01 00:00:00 | 16.77 | N | N | N/A | N/A
86784 | ANTIBODY TRICHINELLA | 2011-07-01 00:00:00 | 14.51 | N | N | N/A | N/A
86787 | ANTIBODY VARICELLA-ZOSTER | 2011-07-01 00:00:00 | 16.32 | N | N | N/A | N/A
86788 | ANTIBODY WEST NILE VIRUS IGM | 2011-07-01 00:00:00 | 14.51 | N | N | N/A | N/A
86789 | ANTIBODY WEST NILE VIRUS | 2011-07-01 00:00:00 | 12.44 | N | N | N/A | N/A
86790 | ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED | 2011-07-01 00:00:00 | 16.32 | N | N | N/A | N/A
86793 | ANTIBODY YERSINIA | 2011-07-01 00:00:00 | 16.7 | N | N | N/A | N/A
86800 | THYROGLOBULIN ANTIBODY | 2011-07-01 00:00:00 | 20.14 | N | N | N/A | N/A
86803 | HEPATITIS C ANTIBODY | 2011-07-01 00:00:00 | 18.07 | N | N | N/A | N/A
86804 | HEPATITIS C ANTIBODY CONFIRMATORY TEST | 2011-07-01 00:00:00 | 19.62 | N | N | N/A | N/A
86805 | LYMPHOCYTOTOXICITY ASSAY VIS CROSSMATCH TITRATJ | 2011-07-01 00:00:00 | 55.89 | N | N | N/A | N/A
86806 | LMPHOCYTOTOXICITY ASSAY VIS CROSSMTCH W/O TITRAT | 2011-07-01 00:00:00 | 27.96 | N | N | N/A | N/A
86807 | SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH | 2011-07-01 00:00:00 | 50.12 | N | N | N/A | N/A
86808 | SERUM SCREENING % REACTIVE ANTIBODY QUICK METH | 2011-07-01 00:00:00 | 37.59 | N | N | N/A | N/A
86812 | HLA TYPING A/B/C SINGLE ANTIGEN | 2011-07-01 00:00:00 | 32.69 | N | N | N/A | N/A
86813 | HLA TYPING A/B/C MULTIPLE ANTIGENS | 2011-07-01 00:00:00 | 73.45 | N | N | N/A | N/A
86816 | HLA TYPING DR/DQ SINGLE ANTIGEN | 2011-07-01 00:00:00 | 35.29 | N | N | N/A | N/A
86817 | HLA TYPING DR/DQ MULTIPLE ANTIGENS | 2011-07-01 00:00:00 | 81.55 | N | N | N/A | N/A
86821 | HLA TYPING LYMPHOCYTE CULTURE MIXED | 2011-07-01 00:00:00 | 71.51 | N | N | N/A | N/A
86822 | HLA TYPING LYMPHOCYTE CULTURE PRIMED | 2011-07-01 00:00:00 | 46.3 | N | N | N/A | N/A
86825 | [NAME], NON-CYTOTOXIC | 2011-07-01 00:00:00 | 101.73 | N | N | N/A | N/A
86826 | HLA CROSSMATCH NONCYTOTOXIC ADDL SERUM/DILUTION | 2011-07-01 00:00:00 | 33.9 | N | N | N/A | N/A
86828 | ANTIBODY HLA CLASS I & CLASS II ANTIGENS QUAL | 2013-01-01 00:00:00 | 48.96 | N | Y | N/A | N/A
86829 | ANTIBODY HLA CLASS I OR CLASS II ANTIGENS QUAL | 2013-01-01 00:00:00 | 36.72 | N | Y | N/A | N/A
86830 | ANTIBODY HLA CLASS I PHENOTYPE PANEL QUALITATIVE | 2013-01-01 00:00:00 | 93.62 | N | Y | N/A | N/A
86831 | ANTIBODY HLA CLASS II PHENOTYPE PANEL QUAL | 2013-01-01 00:00:00 | 80.24 | N | Y | N/A | N/A
86832 | ANTIBODY HLA CLASS I HIGH DEFINITION PANEL QUAL | 2013-01-01 00:00:00 | 147.11 | N | Y | N/A | N/A
86833 | ANTIBODY HLA CLASS II HIGH DEFINITION PANEL QUAL | 2013-01-01 00:00:00 | 133.74 | N | Y | N/A | N/A
86834 | ANTIBODY HLA CLASS I SEMIQUANTITATIVE PANEL | 2013-01-01 00:00:00 | 414.59 | N | Y | N/A | N/A
86835 | ANTIBODY HLA CLASS II SEMIQUANTITATIVE PANEL | 2013-01-01 00:00:00 | 374.47 | N | Y | N/A | N/A
86849 | UNLISTED IMMUNOLOGY PROCEDURE | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
86850 | ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE | 2008-07-01 00:00:00 | 11.16 | N | N | N/A | N/A
86860 | ANTIBODY ELUTION RBC EACH ELUTION | 2008-07-01 00:00:00 | 19.6 | N | N | N/A | N/A
86870 | ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ | 2008-07-01 00:00:00 | 11.8 | N | N | N/A | N/A
86880 | ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM | 2011-07-01 00:00:00 | 6.8 | N | N | N/A | N/A
86885 | ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL | 2011-07-01 00:00:00 | 5.2 | N | N | N/A | N/A
86886 | ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER | 2011-07-01 00:00:00 | 6.55 | N | N | N/A | N/A
86890 | AUTOL BLD/COMPONENT COLLJ STORAGE PREDEPOSITED | 2008-07-01 00:00:00 | 39.8 | N | N | N/A | N/A
86891 | AUTOL BLD/COMPONENT COLLJ STORAGE SALVAGE | 2008-07-01 00:00:00 | 25.02 | N | N | N/A | N/A
86900 | BLOOD TYPING ABO | 2011-07-01 00:00:00 | 3.78 | N | N | N/A | N/A
86901 | BLOOD TYPING RH D | 2011-07-01 00:00:00 | 3.78 | N | N | N/A | N/A
86902 | BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH | 2011-07-01 00:00:00 | 4.84 | N | N | N/A | N/A
86904 | BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT | 2011-07-01 00:00:00 | 12.04 | N | N | N/A | N/A
86905 | BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH | 2011-07-01 00:00:00 | 4.84 | N | N | N/A | N/A
86906 | BLOOD TYPING RH PHENOTYPING COMPLETE | 2011-07-01 00:00:00 | 9.82 | N | N | N/A | N/A
86910 | BLOOD TYPING PATERNITY PR INDIV ABO RH&MN | 2008-07-01 00:00:00 | 25.24 | N | N | N/A | N/A
86911 | BLOOD TYPING PATERNITY INDIV ADDL ANTIGEN SYS | 2008-07-01 00:00:00 | 8.24 | N | N | N/A | N/A
86920 | COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE | 2008-07-01 00:00:00 | 19.18 | N | N | N/A | N/A
86921 | COMPATIBILITY EACH UNIT INCUBATION | 2008-07-01 00:00:00 | 21.6 | N | N | N/A | N/A
86922 | COMPATIBILITY EACH UNIT ANTIGLOBULIN | 2008-07-01 00:00:00 | 22.6 | N | N | N/A | N/A
86923 | COMPATIBILITY TEST, EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
86927 | FRESH [NAME] THAWING EACH UNIT | 2008-07-01 00:00:00 | 17.06 | N | N | N/A | N/A
86930 | [NAME] [NAME] | 2008-07-01 00:00:00 | 25.02 | N | N | N/A | N/A
86931 | [NAME] | 2008-07-01 00:00:00 | 25.02 | N | N | N/A | N/A
86932 | [NAME] | 2008-07-01 00:00:00 | 25.02 | N | N | N/A | N/A
86940 | HEMOLYSINS&AGGLUTININS AUTO SCREEN EACH | 2011-07-01 00:00:00 | 8.81 | N | N | N/A | N/A
86941 | HEMOLYSINS&AGGLUTININS INCUBATED | 2011-07-01 00:00:00 | 15.34 | N | N | N/A | N/A
86945 | IRRADIATION OF BLOOD PRODUCT EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
86950 | LEUKOCYTE TRANSFUSION | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
86960 | VOLUME REDUCTION OF BLOOD OR BLOOD PRODUCT, EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
86965 | POOLING PLATELETS/OTHER BLOOD PRODUCTS | 2008-07-01 00:00:00 | 4.67 | N | N | N/A | N/A
86970 | PRETREAT RBC'S FOR USE IN ANTIBODY DETECTION,IDENTI | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
86971 | INCUBATION WITH ENZYMES, EACH | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
86972 | BY DENSITY RADIENT SEPARATION | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
86975 | PRETREAT SERUM TO USE IN RBC ANTI IDENT,INCUBAT W/ | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
86976 | BY DILUTION | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
86977 | INCUBATION WITH INHIBITORS, EACH | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
86978 | BY DIFFERNTIAL RED CELL ABSORPTION USING PATIENT R | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
86985 | SPLITTING OF BLOOD OR BLOOD PRODUCTS EA UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
86999 | UNLISTED TRANSFUSION MEDICINE PROCEDURE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
87001 | ANIMAL INOCULATION SMALL ANIMAL W/OBSERVATION | 2011-07-01 00:00:00 | 5.89 | N | N | N/A | N/A
87003 | ANIMAL INOCULATION SMALL ANIMAL W/OBS&DSJ | 2011-07-01 00:00:00 | 21.32 | N | N | N/A | N/A
87015 | CONCENTRATION INFECTIOUS AGENTS | 2011-07-01 00:00:00 | 8.46 | N | N | N/A | N/A
87040 | CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES | 2011-07-01 00:00:00 | 13.08 | N | N | N/A | N/A
87045 | CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELLA | 2011-07-01 00:00:00 | 11.95 | N | N | N/A | N/A
87046 | CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA | 2011-07-01 00:00:00 | 11.95 | N | N | N/A | N/A
87070 | [NAME] | 2011-07-01 00:00:00 | 10.91 | N | N | N/A | N/A
87071 | CUL BACT QUAN AEROBIC ISOL XCPT UR BLOOD/STOOL | 2011-07-01 00:00:00 | 11.95 | N | N | N/A | N/A
87073 | CUL BACT QUAN ANAERC ISOL XCPT UR BLOOD/STOOL | 2011-07-01 00:00:00 | 11.95 | N | N | N/A | N/A
87075 | CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID | 2011-07-01 00:00:00 | 11.98 | N | N | N/A | N/A
87076 | CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL | 2011-07-01 00:00:00 | 10.23 | N | N | N/A | N/A
87077 | CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL | 2011-07-01 00:00:00 | 10.23 | N | N | N/A | N/A
87081 | CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ | 2011-07-01 00:00:00 | 6.24 | N | N | N/A | N/A
87084 | CUL PRSMPTV PTHGNC ORGANISMS SCR [NAME] | 2011-07-01 00:00:00 | 8.86 | N | N | N/A | N/A
87086 | CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE | 2011-07-01 00:00:00 | 10.22 | N | N | N/A | N/A
87088 | CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE | 2011-07-01 00:00:00 | 10.26 | N | N | N/A | N/A
87101 | [NAME]/YEAST PRSMPTV ID SKN HAIR/NAIL | 2011-07-01 00:00:00 | 9.77 | N | N | N/A | N/A
87102 | CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD | 2011-07-01 00:00:00 | 9.41 | N | N | N/A | N/A
87103 | CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD | 2011-07-01 00:00:00 | 11.42 | N | N | N/A | N/A
87106 | CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST | 2011-07-01 00:00:00 | 13.08 | N | N | N/A | N/A
87107 | CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD | 2011-07-01 00:00:00 | 13.08 | N | N | N/A | N/A
87109 | CULTURE MYCOPLASMA ANY SOURCE | 2011-07-01 00:00:00 | 9.41 | N | N | N/A | N/A
87110 | CULTURE CHLAMYDIA ANY SOURCE | 2011-07-01 00:00:00 | 24.81 | N | N | N/A | N/A
87116 | CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL | 2011-07-01 00:00:00 | 13.69 | N | N | N/A | N/A
87118 | CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL | 2011-07-01 00:00:00 | 13.86 | N | N | N/A | N/A
87140 | CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM | 2011-07-01 00:00:00 | 5.2 | N | N | N/A | N/A
87143 | CULTURE TYPING GAS/HIGH PRES LIQ CHROMATOGRAPHY | 2011-07-01 00:00:00 | 15.87 | N | N | N/A | N/A
87147 | CULTURE TYPING IMMUNOLOGIC OTH/THN IMMUNOFLUORES | 2011-07-01 00:00:00 | 6.55 | N | N | N/A | N/A
87149 | CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87150 | DNA/RNA, AMPLIFIED PROBE | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87152 | CULTURE TYPING IDENTIFJ PULSE FIELD GEL TYPING | 2011-07-01 00:00:00 | 6.62 | N | N | N/A | N/A
87153 | DNA/RNA SEQUENCING | 2011-07-01 00:00:00 | 112.34 | N | N | N/A | N/A
87158 | CULTURE TYPING OTHER METHODS | 2011-07-01 00:00:00 | 6.62 | N | N | N/A | N/A
87164 | DARK FIELD EXAM ANY SOURCE W/SPECIMEN COLLECTION | 2011-07-01 00:00:00 | 13.61 | N | N | N/A | 16.74
87166 | DARK FIELD EXAM ANY SOURCE W/O SPECIMEN COLLECT | 2011-07-01 00:00:00 | 14.31 | N | N | N/A | N/A
87168 | MACROSCOPIC EXAMINATION ARTHROPOD | 2011-07-01 00:00:00 | 5.41 | N | N | N/A | N/A
87169 | MACROSCOPIC EXAMINATION PARASITE | 2011-07-01 00:00:00 | 5.41 | N | N | N/A | N/A
87172 | PINWORM EXAMINATION | 2011-07-01 00:00:00 | 5.41 | N | N | N/A | N/A
87176 | HOMOGENIZATION TISSUE CULTURE | 2011-07-01 00:00:00 | 7.45 | N | N | N/A | N/A
87177 | OVA&PARASITES DIRECT SMEARS CONCENTRATION&ID | 2011-07-01 00:00:00 | 11.27 | N | N | N/A | N/A
87181 | SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ | 2011-07-01 00:00:00 | 6.01 | N | N | N/A | N/A
87184 | SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD | 2011-07-01 00:00:00 | 8.74 | N | N | N/A | N/A
87185 | SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ | 2011-07-01 00:00:00 | 6.01 | N | N | N/A | N/A
87186 | SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ | 2011-07-01 00:00:00 | 10.95 | N | N | N/A | N/A
87187 | SUSCEPTIBLTY STDY ANTMCRB MICRO/AGAR DILUTJ EA | 2011-07-01 00:00:00 | 11.18 | N | N | N/A | N/A
87188 | SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT | 2011-07-01 00:00:00 | 8.41 | N | N | N/A | N/A
87190 | SUSCEPTIBLTY STDY ANTMCRB MYCOBACT PROPORJ MTHD | 2011-07-01 00:00:00 | 7.16 | N | N | N/A | N/A
87197 | SERUM BACTERICIDAL TITER | 2011-07-01 00:00:00 | 19.03 | N | N | N/A | N/A
87205 | SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL | 2011-07-01 00:00:00 | 5.41 | N | N | N/A | N/A
87206 | SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASITS | 2011-07-01 00:00:00 | 6.8 | N | N | N/A | N/A
87207 | SMR PRIM SRC SPEC STAIN BODIES/PARASITS | 2011-07-01 00:00:00 | 0 | N | N | N/A | 16.74
87209 | SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS | 2011-07-01 00:00:00 | 22.76 | N | N | N/A | N/A
87210 | SMR PRIM SRC WET MOUNT NFCT AGT | 2011-07-01 00:00:00 | 5.41 | N | N | N/A | N/A
87220 | TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT | 2011-07-01 00:00:00 | 5.41 | N | N | N/A | N/A
87230 | TOXIN/ANTITOXIN ASSAY TISSUE CULTURE | 2011-07-01 00:00:00 | 14.74 | N | N | N/A | N/A
87250 | VIRUS INOCULATION EGGS/SM ANIMAL OBS&DSJ | 2011-07-01 00:00:00 | 24.77 | N | N | N/A | N/A
87252 | VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT | 2011-07-01 00:00:00 | 20.12 | N | N | N/A | N/A
87253 | VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE | 2011-07-01 00:00:00 | 25.58 | N | N | N/A | N/A
87254 | VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA | 2011-07-01 00:00:00 | 24.77 | N | N | N/A | N/A
87255 | VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC | 2011-07-01 00:00:00 | 33.56 | N | N | N/A | N/A
87260 | IAADI [NAME] | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87265 | IAADI BORDETELLA PRTUSSIS/PARAPRTUSSIS | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87269 | IAADI [NAME] | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87270 | IAADI CHLAMYDIA TRACHOMATIS | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87271 | IAADI [NAME] ANTIBODY | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87272 | IAADI CRYPTOSPORIDIUM | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87273 | IAADI HERPES SMPLX VIRUS TYPE 2 | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87274 | IAADI HERPES SMPLX VIRUS TYPE 1 | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87275 | IAADI INFLUENZA B VIRUS | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87276 | IAADI INFFLUENZA A VIRUS | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87277 | IAADI [NAME] | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87278 | IAADI [NAME] | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87279 | IAADI PARAINFLUENZA VIRUS EACH TYPE | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87280 | IAADI RESPIRATORY SYNCTIAL VIRUS | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87281 | IAADI PNEUMOCUSTIS CARINII | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87283 | IAADI RUBEOLA | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87285 | IAADI TREPONEMA PALLIDUM | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87290 | IAADI VARICELLA ZOSTER VIRUS | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87299 | IAADI NOT OTHERWISE SPECIFIED EACH ORGANISM | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87300 | IAADI POLYV MLT ORGANISMS EA POLYV ANTISERUM | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87301 | IAAD EIA ADENOVIRUS ENTERIC TYP 40/41 | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87305 | IAAD EIA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87320 | IAAD EIA CHLAMYDIA TRACHOMATIS | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87324 | IAAD EIA CLOSTRIDIUM [NAME] | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87327 | IAAD EIA CRYPTOCOCCUS NEOFORMANS | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87328 | IAAD EIA CRYPTOSPORIDIUM | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87329 | IAAD EIA GIARDIA | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87332 | IAAD EIA CYTOMEGALOVIRUS | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87335 | IAAD EIA ESCHERICHIA COLI 0157 | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87336 | IAAD EIA ENTAMOEBA HISTOLYTICA DISPAR GRP | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87337 | IAAD EIA ENTAMOEBA HISTOLYTICA GRP | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87338 | IAAD EIA HPYLORI STOOL | 2011-07-01 00:00:00 | 18.22 | N | N | N/A | N/A
87339 | IAAD EIA HPYLORI | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87340 | IAAD EIA HEPATITIS B SURFACE ANTIGEN | 2011-07-01 00:00:00 | 13.08 | N | N | N/A | N/A
87341 | IAAD EIA HEPATITIS B SURFACE AG NEUTRALIZATION | 2011-07-01 00:00:00 | 13.08 | N | N | N/A | N/A
87350 | IAAD EIA HEPATITIS BE ANTIGEN | 2011-07-01 00:00:00 | 14.6 | N | N | N/A | N/A
87380 | IAAD EIA HEPATITIS DELTA ANTIGEN | 2011-07-01 00:00:00 | 20.79 | N | N | N/A | N/A
[NAME] | IAAD EIA HISTOPLASM CAPSULATUM | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87390 | IAAD EIA HIV-1 | 2011-07-01 00:00:00 | 22.35 | N | N | N/A | N/A
87391 | IAAD EIA HIV-2 | 2011-07-01 00:00:00 | 22.35 | N | N | N/A | N/A
87400 | IAAD EIA INFLUENZA A/B EACH | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87420 | IAAD EIA RESPIRATORY SYNCTIAL VIRUS | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87425 | IAAD EIA ROTAVIRUS | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87427 | IAAD EIA SHIGA-LIKE TOXIN | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87430 | IAAD EIA STREPTOCOCCUS GROUP A | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87449 | IAAD EIA MULT STEP METHOD NOS EACH ORGANISM | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87450 | IAAD EIA SINGLE STEP METHOD NOS EA ORGANISM | 2011-07-01 00:00:00 | 8.95 | N | N | N/A | N/A
87451 | IAAD EIA POLYV MLT ORGANISMS EA POLYV ANTISERUM | 2011-07-01 00:00:00 | 8.95 | N | N | N/A | N/A
87470 | IADNA BARTONELLA DIRECT PROBE TECHNIQUE | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87471 | IADNA BARTONELLA AMPLIFIED PROBE TECHNIQUE | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87472 | IADNA BARTONELLA HENSELAE&QUINTANA QUANTJ | 2011-07-01 00:00:00 | 54.25 | N | N | N/A | N/A
87475 | IADNA BORRELIA BURGDORFERI DIRECT PROBE TQ | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87476 | IADNA BORRELIA BURGDORFERI AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87477 | IADNA BORRELIA BURGDORFERI QUANTIFICATION | 2011-07-01 00:00:00 | 54.25 | N | N | N/A | N/A
87480 | IADNA CANDIDA SPECIES DIRECT PROBE TQ | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87481 | IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87482 | IADNA CANDIDA SPECIES QUANTIFICATION | 2011-07-01 00:00:00 | 52.88 | N | N | N/A | N/A
87485 | IADNA CHLAMYDIA PNEUMONIAE DIRECT PROBE TQ | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87486 | IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87487 | IADNA CHLAMYDIA PNEUMONIAE QUANTIFICATION | 2011-07-01 00:00:00 | 54.25 | N | N | N/A | N/A
87490 | IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87491 | IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87492 | IADNA CHLAMYDIA TRACHOMATIS QUANTIFICATION | 2011-07-01 00:00:00 | 44.28 | N | N | N/A | N/A
87493 | INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87495 | IADNA CYTOMEGALOVIRUS DIRECT PROBE TQ | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87496 | IADNA CYTOMEGALOVIRUS AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87497 | IADNA CYTOMEGALOVIRUS [NAME] | 2011-07-01 00:00:00 | 54.25 | N | N | N/A | N/A
87498 | IADNA ENTEROVIRUS AMPLIFIED PROBE TECHNIQUE | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87500 | INFECTIOUS AGENT DNA/RNA VANCOMYCIN RESISTANCE | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87501 | INFECTIOUS AGENT DNA/RNA INFLUENZA EA TYPE | 2011-07-01 00:00:00 | 65 | N | N | N/A | N/A
87502 | INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES | 2011-07-01 00:00:00 | 107.78 | N | N | N/A | N/A
87503 | NFCT AGENT DNA/RNA INFLUENZA 1/GTTYPES EA ADDL | 2011-07-01 00:00:00 | 26.3 | N | N | N/A | N/A
87510 | IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87511 | IADNA GARDNERELLA VAGINALIS AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87512 | IADNA GARDNERELLA VAGINALIS QUANTIFICATION | 2011-07-01 00:00:00 | 52.88 | N | N | N/A | N/A
87515 | IADNA HEPATITIS B VIRUS DIRECT PROBE TECHNIQUE | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87516 | IADNA HEPATITIS B VIRUS AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87517 | IADNA HEPATITIS B VIRUS QUANTIFICATION | 2011-07-01 00:00:00 | 54.25 | N | N | N/A | N/A
87520 | IADNA HEPATITIS C DIRECT PROBE TECHNIQUE | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87521 | IADNA HEPATITIS C AMPLIFIED PROBE TECHNIQUE | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87522 | IADNA HEPATITIS C QUANTIFICATION | 2011-07-01 00:00:00 | 54.25 | N | N | N/A | N/A
87525 | IADNA HEPATITIS G DIRECT PROBE TECHNIQUE | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87526 | IADNA HEPATITIS G AMPLIFIED PROBE TECHNIQUE | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87527 | IADNA HEPATITIS G QUANTIFICATION | 2011-07-01 00:00:00 | 52.88 | N | N | N/A | N/A
87528 | IADNA HERPES SIMPLX VIRUS DIRECT PROBE TQ | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87529 | IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87530 | IADNA HERPES SOMPLX VIRUS QUANTIFICATION | 2011-07-01 00:00:00 | 54.25 | N | N | N/A | N/A
87531 | IADNA HERPES VIRUS-6 DIRECT PROBE TQ | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87532 | IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87533 | IADNA HERPES VIRUS-6 QUANTIFICATION | 2011-07-01 00:00:00 | 52.88 | N | N | N/A | N/A
87534 | IADNA HIV-1 DIRECT PROBE TECHNIQUE | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87535 | IADNA HIV-1 AMPLIFIED PROBE TECHNIQUE | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87536 | IADNA HIV-1 QUANTIFICATION | 2011-07-01 00:00:00 | 107.78 | N | N | N/A | N/A
87537 | IADNA HIV-2 DIRECT PROBE TECHNIQUE | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87538 | IADNA HIV-2 AMPLIFIED PROBE TECHNIQUE | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87539 | IADNA HIV-2 QUANTIFICATION | 2011-07-01 00:00:00 | 54.25 | N | N | N/A | N/A
87540 | IADNA LEGIONELLA PNEUMOPHILA DIRECT PROBE TQ | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87541 | IADNA LEGIONELLA PNEUMOPHILA AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87542 | IADNA LEGIONELLA PNEUMOPHILA QUANTIFICATION | 2011-07-01 00:00:00 | 52.88 | N | N | N/A | N/A
87550 | IADNA MYCOBACTERIA SPECIES DIRECT PROBE TQ | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87551 | IADNA MYCOBACTERIA SPECIES AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87552 | IADNA MYCOBACTERIA SPECIES QUANTIFICATION | 2011-07-01 00:00:00 | 54.25 | N | N | N/A | N/A
87555 | IADNA MYCOBACTERIA TUBERCULOSIS DIR PRB | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87556 | IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87557 | IADNA MYCOBACTERIA TUBERCULOSIS QUANTIFICATION | 2011-07-01 00:00:00 | 54.25 | N | N | N/A | N/A
87560 | IADNA MYCOBACTERIA AVIUM-INTRACLRE DIR PRB | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87561 | IADNA MYCOBACTERIA AVIUM-INTRACLRE AMP PRB | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87562 | IADNA MYCOBACTERIA AVIUM-INTRACELLULARE QUANT | 2011-07-01 00:00:00 | 54.25 | N | N | N/A | N/A
87580 | IADNA MYCOPLSM PNEUMONIAE DIRECT PROBE TQ | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87581 | IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87582 | IADNA MYCOPLSM PNEUMONIAE QUANTIFICATION | 2011-07-01 00:00:00 | 52.88 | N | N | N/A | N/A
87590 | IADNA NEISSERIA GONORRHOEAE DIRECT PROBE TQ | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87591 | IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87592 | IADNA NEISSERIA GONORRHOEAE QUANTIFICATION | 2011-07-01 00:00:00 | 54.25 | N | N | N/A | N/A
87620 | IADNA PAPILLOMAVIRUS HUMAN DIRECT PROBE TQ | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87621 | IADNA PAPILLOMAVIRUS HUMAN AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87622 | IADNA PAPILLOMAVIRUS HUMAN QUANTIFICATION | 2011-07-01 00:00:00 | 52.88 | N | N | N/A | N/A
87631 | IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS | 2013-01-01 00:00:00 | 158.71 | N | Y | N/A | N/A
87632 | IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS | 2013-01-01 00:00:00 | 264.03 | N | Y | N/A | N/A
87633 | IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET | 2013-01-01 00:00:00 | 515.62 | N | Y | N/A | N/A
87640 | IADNA S AUREUS AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87641 | IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87650 | IADNA STREPTOCOCCUS GROUP A DIRECT PROBE TQ | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87651 | IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87652 | IADNA STREPTOCOCCUS GROUP A QUANTIFICATION | 2011-07-01 00:00:00 | 52.88 | N | N | N/A | N/A
87653 | IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87660 | IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87661 | IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH | 2014-01-01 00:00:00 | 43.08 | N | Y | N/A | N/A
87797 | IADNA NOS DIRECT PROBE TQ EACH ORGANISM | 2011-07-01 00:00:00 | 25.4 | N | N | N/A | N/A
87798 | IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM | 2011-07-01 00:00:00 | 44.45 | N | N | N/A | N/A
87799 | IADNA NOS QUANTIFICATION EACH ORGANISM | 2011-07-01 00:00:00 | 54.25 | N | N | N/A | N/A
87800 | IADNA MULTIPLE ORGANISMS DIRECT PROBE TQ | 2011-07-01 00:00:00 | 50.8 | N | N | N/A | N/A
87801 | IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ | 2011-07-01 00:00:00 | 88.9 | N | N | N/A | N/A
87802 | IAADIADOO STREPTOCOCCUS GROUP B | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87803 | IAADIADOO CLOSTRIDIUM [NAME] | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87804 | IAADIADOO INFLUENZA | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87807 | IAADIADOO RESPIRATORY SYNCTIAL VIRUS | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87808 | IAADIADOO TRICHOMONAS VAGINALIS | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87809 | INFECTIOUS AGENT IMMUNOASSAY OPTICAL ADENOVIRUS | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87810 | CHLAMYDIA TRACHOMATIS | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87850 | IAADIADOO NEISSERIA GONORRHOEAE | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87880 | IAADIADOO STREPTOCOCCUS GROUP A | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87899 | IAADIADOO NOT OTHERWISE SPECIFIED | 2011-07-01 00:00:00 | 14.76 | N | N | N/A | N/A
87900 | NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION | 2011-07-01 00:00:00 | 100.63 | N | N | N/A | N/A
87901 | NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEASE | 2011-07-01 00:00:00 | 176.19 | N | N | N/A | N/A
87902 | NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS | 2011-07-01 00:00:00 | 176.19 | N | N | N/A | N/A
87903 | NFCT PHEXYP RESIST TISS CUL HIV FIRST 1-10 DRUGS | 2011-07-01 00:00:00 | 493.75 | Y | N | N/A | N/A
87904 | NFCT PHEXYP RESIST TISS CUL HIV EA ADDL DRUG | 2011-07-01 00:00:00 | 20.12 | Y | N | N/A | N/A
87905 | INFECTIOUS AGENT ENZYMATIC ACTV OTH/THN VIRUS | 2011-07-01 00:00:00 | 15.48 | N | N | N/A | N/A
87906 | NFCT GEXYP DNA/RNA HIV 1 OTHER REGION | 2011-07-01 00:00:00 | 88.1 | N | N | N/A | N/A
87910 | NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS | 2013-01-01 00:00:00 | 172.11 | N | Y | N/A | N/A
87912 | NFCT AGENT GENOTYPE HEPATITIS B VIRUS | 2013-01-01 00:00:00 | 172.11 | N | Y | N/A | N/A
87999 | UNLISTED MICROBIOLOGY TEST | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
88104 | [NAME] FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ | 2011-07-01 00:00:00 | 56.12 | N | N | 31.9 | 24.22
88106 | [NAME] FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ | 2011-07-01 00:00:00 | 68.52 | N | N | 44.59 | 23.93
88108 | CYTP CONCENTRATION SMEARS & INTERPRETATION | 2011-07-01 00:00:00 | 64.76 | N | N | 40.83 | 23.93
88112 | CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V | 2011-07-01 00:00:00 | 88.58 | N | N | 39.11 | 49.47
88120 | [NAME] PROBES EA MNL | 2011-07-01 00:00:00 | 388.67 | N | N | 342.51 | 46.16
88121 | [NAME] SPEC 3-5 PROBES CPTR EA | 2011-07-01 00:00:00 | 328.28 | N | N | 287.38 | 40.91
88125 | CYTOPATHOLOGY FORENSIC | 2011-07-01 00:00:00 | 18.97 | N | N | 7.38 | 11.59
88130 | SEX CHROMATIN IDENTIFICATION BARR BODIES | 2011-07-01 00:00:00 | 19.06 | N | N | N/A | N/A
88140 | SEX CHROMATIN IDENTJ PERIPHERAL BLOOD SMEAR | 2011-07-01 00:00:00 | 10.13 | N | N | N/A | N/A
88141 | CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN | 2011-07-01 00:00:00 | 24.9 | N | N | N/A | N/A
88142 | [NAME] SCREEN | 2011-07-01 00:00:00 | 25.66 | N | N | N/A | N/A
88143 | [NAME] PHYS | 2011-07-01 00:00:00 | 25.66 | N | N | N/A | N/A
88147 | [NAME] PHYS SUPV | 2011-07-01 00:00:00 | 13.38 | N | N | N/A | N/A
88148 | [NAME] RESCR PHYS | 2011-07-01 00:00:00 | 13.38 | N | N | N/A | N/A
88150 | CYTP SLIDES C/V MNL SCR UNDER PHYS | 2011-07-01 00:00:00 | 13.38 | N | N | N/A | N/A
88152 | CYTP SLIDES C/V MNL SCR&CPTR RESCR PHYS | 2011-07-01 00:00:00 | 13.38 | N | N | N/A | N/A
88153 | CYTP SLIDES C/V MNL SCR&RESCR PHYS | 2011-07-01 00:00:00 | 13.38 | N | N | N/A | N/A
88154 | CYTP SLIDES C/V MNL SCR&CPTR-RESCR CELL S&R PHYS | 2011-07-01 00:00:00 | 13.38 | N | N | N/A | N/A
88155 | CYTP SLIDES C/V DEFINITIVE HORMONAL EVAL | 2011-07-01 00:00:00 | 7.6 | N | N | N/A | N/A
88160 | [NAME] ANY OTH SRC SCR&INTERPJ | 2011-07-01 00:00:00 | 46.78 | N | N | 25.26 | 21.52
88161 | [NAME] ANY OTH SRC PREPJ SCR&INTERPJ | 2011-07-01 00:00:00 | 46.78 | N | N | 25.84 | 20.94
88162 | [NAME] ANY OTH SRC EXTND STD GT 5 SLIDES | 2011-07-01 00:00:00 | 67.19 | N | N | 34.78 | 32.41
88164 | CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV | 2011-07-01 00:00:00 | 13.38 | N | N | N/A | N/A
88165 | CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV | 2011-07-01 00:00:00 | 13.38 | N | N | N/A | N/A
88166 | CYTP SLIDES C/V MNL SCR&CPTR RESCR PHYS SUPV | 2011-07-01 00:00:00 | 13.38 | N | N | N/A | N/A
88167 | CYTP SLIDES C/V MNL SCR&CPTR RESCR CELL S&R PHYS | 2011-07-01 00:00:00 | 13.38 | N | N | N/A | N/A
88172 | CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST | 2011-07-01 00:00:00 | 43.79 | N | N | 17.48 | 26.31
88173 | CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT | 2011-07-01 00:00:00 | 118.64 | N | N | 58.72 | 59.92
88174 | [NAME] PREPJ SCR SYS PHYS | 2011-07-01 00:00:00 | 27.05 | N | N | N/A | N/A
88175 | [NAME] PREPJ SCR MNL RESCR PHYS | 2011-07-01 00:00:00 | 32.91 | N | N | N/A | N/A
88177 | CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL | 2011-07-01 00:00:00 | 24.15 | N | N | 5.36 | 18.78
88182 | FLOW CYTOMETRY CELL CYCLE/DNA ALYS | 2011-07-01 00:00:00 | 88.9 | N | N | 58.48 | 30.42
88184 | FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST | 2011-07-01 00:00:00 | 71.11 | N | N | N/A | N/A
88185 | FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA | 2011-07-01 00:00:00 | 42.56 | N | N | N/A | N/A
88187 | FLOW CYTOMETRY INTERPJ 2-8 MARKERS | 2011-07-01 00:00:00 | 58.84 | N | N | N/A | N/A
88188 | FLOW CYTOMETRY INTERPJ 9-15 MARKERS | 2011-07-01 00:00:00 | 73.04 | N | N | N/A | N/A
88189 | FLOW CYTOMETRY INTERPJ 16/GT MARKERS | 2011-07-01 00:00:00 | 90.19 | N | N | N/A | N/A
88199 | UNLISTED CYTOPATHOLOGY TEST | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
88230 | TISS CUL NON-NEO DISORDERS LYMPHOCYTE | 2011-07-01 00:00:00 | 147.55 | N | N | N/A | N/A
88233 | TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX | 2011-07-01 00:00:00 | 178.24 | N | N | N/A | N/A
88235 | TISS CUL NON-NEO DISORDERS AMNIOTIC/CHORNC CELLS | 2011-07-01 00:00:00 | 186.5 | N | N | N/A | N/A
88237 | TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS | 2011-07-01 00:00:00 | 159.97 | N | N | N/A | N/A
88239 | TISS CUL NEO DISORDERS SOLID TUMOR | 2011-07-01 00:00:00 | 186.84 | N | N | N/A | N/A
88240 | CRYOPRSRV FRZING&STORAGE CELLS EA CELL LINE | 2011-07-01 00:00:00 | 12.8 | N | N | N/A | N/A
88241 | THAWING&EXPANSION [NAME] EACH ALIQUOT | 2011-07-01 00:00:00 | 12.8 | N | N | N/A | N/A
88245 | CHRMSM BREAKAGE BASELINE SISTER 20-25 CLL | 2011-07-01 00:00:00 | 188.54 | N | N | N/A | N/A
88248 | CHRMSM BREAKAGE BASELINE BREAKAGE 50-100 CLL | 2011-07-01 00:00:00 | 219.33 | N | N | N/A | N/A
88249 | CHRMSM BREAKAGE SYNDS SCORE 100 CLL | 2011-07-01 00:00:00 | 219.33 | N | N | N/A | N/A
88261 | CHRMSM COUNT 5 CLL 1KARYOTYP BANDING | 2011-07-01 00:00:00 | 223.84 | N | N | N/A | N/A
88262 | CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING | 2011-07-01 00:00:00 | 157.86 | N | N | N/A | N/A
88263 | CHRMSM COUNT 45 CLL MOSAICISM 2KARYOTYP | 2011-07-01 00:00:00 | 118.25 | N | N | N/A | N/A
88264 | CHRMSM ANALYZE 20-25 CELLS | 2011-07-01 00:00:00 | 157.86 | N | N | N/A | N/A
88267 | CHRMSM ALYS AMNIOTIC/VILLUS 15 CLL 1KARYOTYP | 2011-07-01 00:00:00 | 227.68 | N | N | N/A | N/A
88269 | CHRMSM SITU AMNIOTIC CLL 6-12 COLONIES 1KARYOTYP | 2011-07-01 00:00:00 | 210.65 | N | N | N/A | N/A
88271 | MOLECULAR CYTOGENETICS DNA PROBE EACH | 2011-07-01 00:00:00 | 18.33 | N | N | N/A | N/A
88272 | MOLECULAR CYTOGENETICS CHRMOML ISH 3-5 CELLS | 2011-07-01 00:00:00 | 22.92 | N | N | N/A | N/A
88273 | MOLECULAR CYTOGENETICS CHRMOML ISH 10-30 CLL | 2011-07-01 00:00:00 | 32.09 | N | N | N/A | N/A
88274 | MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL | 2011-07-01 00:00:00 | 41.25 | N | N | N/A | N/A
88275 | MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL | 2011-07-01 00:00:00 | 50.86 | N | N | N/A | N/A
88280 | CHRMSM ANALYSIS ADDL KARYOTYP EACH STUDY | 2011-07-01 00:00:00 | 31.79 | N | N | N/A | N/A
88283 | CHRMSM ANALYSIS ADDL SPECIALIZED BANDING | 2011-07-01 00:00:00 | 86.88 | N | N | N/A | N/A
88285 | CHRMSM ANALYSIS ADDL CELLS COUNTED EACH STUDY | 2011-07-01 00:00:00 | 24.07 | N | N | N/A | N/A
88289 | [NAME] | 2011-07-01 00:00:00 | 43.61 | N | N | N/A | N/A
88291 | CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REPORT | 2011-07-01 00:00:00 | 25.36 | N | N | N/A | N/A
88299 | UNLISTED CYTOGENIC TEST | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
88300 | LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY | 2011-07-01 00:00:00 | 22.69 | N | N | 18.92 | 3.77
88302 | LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM | 2011-07-01 00:00:00 | 45.27 | N | N | 39.68 | 5.59
88304 | LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM | 2011-07-01 00:00:00 | 53.22 | N | N | 43.71 | 9.51
88305 | LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM | 2011-07-01 00:00:00 | 91.04 | N | N | 59 | 32.04
88307 | LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM | 2011-07-01 00:00:00 | 194.25 | N | N | 124.46 | 69.79
88309 | LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM | 2011-07-01 00:00:00 | 294.59 | N | N | 172.67 | 121.92
88311 | DECALCIFICATION PROCEDURE | 2011-07-01 00:00:00 | 16.05 | N | N | 5.65 | 10.4
88312 | SPECIAL STAIN GROUP 1 MICROORGANISMS I&R | 2011-07-01 00:00:00 | 91.26 | N | N | 68.23 | 23.03
88313 | [NAME] I&R EXCPT MICROORG/ENZYME/IMCYT&IMHIS | 2011-07-01 00:00:00 | 66.22 | N | N | 56.12 | 10.1
88314 | SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSUE | 2011-07-01 00:00:00 | 76.97 | N | N | 57.27 | 19.7
88319 | SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS | 2011-07-01 00:00:00 | 124.75 | N | N | 101.67 | 23.08
88321 | CONSLTJ&REPRT SLIDES PREPARED ELSEWHERE | 2011-07-01 00:00:00 | 78.7 | N | N | N/A | N/A
88323 | CONSLTJ&REPRT MATERIAL REQUIRING PREPJ SLIDES | 2011-07-01 00:00:00 | 123.73 | N | N | 49.77 | 73.96
88325 | CONSLTJ COMPRE REVIEW REPRT REFERRED MATRL | 2011-07-01 00:00:00 | 172.26 | N | N | N/A | N/A
88329 | PATHOLOGY CONSULTATION DURING SURGERY | 2011-07-01 00:00:00 | 44.83 | N | N | N/A | N/A
88331 | PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC | 2011-07-01 00:00:00 | 79.42 | N | N | 26.99 | 52.43
88332 | PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION | 2011-07-01 00:00:00 | 35.12 | N | N | 9.41 | 25.71
88333 | PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE | 2011-07-01 00:00:00 | 82.27 | N | N | 29.58 | 52.69
88334 | PATH CONSLTJ SURG CYTOLOGIC EXAM ADDL SITE | 2011-07-01 00:00:00 | 50.71 | N | N | 18.63 | 32.08
88342 | IMCYTCHM TISS IMMUNOPROXIDASE EA ANTIBODY | 2011-07-01 00:00:00 | 89.26 | N | N | 53.24 | 36.02
88343 | IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
88346 | IMMUNOFLUORESCENT STUDY EA ANTIBODY DIR METHOD | 2011-07-01 00:00:00 | 87.78 | N | N | 51.51 | 36.27
88347 | IMMUNOFLUORESCENT STUDY EA ANTIBODY INDIR METHOD | 2011-07-01 00:00:00 | 66.73 | N | N | 33.05 | 33.68
88348 | ELECTRON MICROSCOPY DIAGNOSTIC | 2011-07-01 00:00:00 | 579.14 | N | N | 514.96 | 64.18
88349 | ELECTRON MICROSCOPY SCANNING | 2011-07-01 00:00:00 | 305.33 | N | N | 271.47 | 33.86
88355 | [NAME] SKELETAL [NAME] | 2011-07-01 00:00:00 | 183.92 | N | N | 110.33 | 73.59
88356 | [NAME] | 2011-07-01 00:00:00 | 243.42 | N | N | 128.44 | 114.98
88358 | [NAME] | 2011-07-01 00:00:00 | 64.64 | N | N | 27.57 | 37.07
88360 | M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL | 2011-07-01 00:00:00 | 106.14 | N | N | 60.16 | 45.98
88361 | M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST | 2011-07-01 00:00:00 | 130.1 | N | N | 81.21 | 48.89
88362 | NERVE TEASING PREPARATIONS | 2011-07-01 00:00:00 | 241.82 | N | N | 148.34 | 93.48
88363 | EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSIS | 2011-07-01 00:00:00 | 32.6 | N | N | N/A | N/A
88365 | IN SITU HYBRIDIZATION EACH PROBE | 2011-07-01 00:00:00 | 142.07 | N | N | 91.87 | 50.2
88367 | M/PHMTRC ALYS ISH EA PRB CPTR-ASST TECHNOLOGY | 2011-07-01 00:00:00 | 219.01 | N | N | 165.69 | 53.32
88368 | M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL | 2011-07-01 00:00:00 | 188.44 | N | N | 133.69 | 54.75
88371 | PROTEIN ANAL TISSUE WESTERN BLOT W/INTERP&REPORT | 2011-07-01 00:00:00 | 28.14 | N | N | N/A | 16.45
88372 | PROTEIN ALYS WSTRN BLOT I&R IMMUNOLOGICAL EA | 2011-07-01 00:00:00 | 28.81 | N | N | N/A | 16.74
88375 | OPTICAL ENDOMICROSCOPIC IMAGE INTERP & REPORT | 2013-01-01 00:00:00 | 0 | N | Y | N/A | N/A
88380 | MICRODISSECTION PREP IDENTIFIED TARGET LASER | 2011-07-01 00:00:00 | 150.66 | N | N | 86.97 | N/A
88381 | MICRODISSECTION PREP IDENTIFIED TARGET MANUAL | 2011-07-01 00:00:00 | 157.9 | N | N | 110.91 | 46.99
88387 | TISS EXAM MOLECULAR STUDY | 2011-07-01 00:00:00 | 35.17 | N | N | 7.38 | 27.79
88388 | TISS EX MOLECUL STUDY ADD-ON | 2011-07-01 00:00:00 | 20.46 | N | N | 3.64 | 16.82
88399 | UNLISTED SURGICAL PATH TEST | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
88720 | BILIRUBIN TOTAL TRANSCUTANEOUS | 2011-07-01 00:00:00 | 6.35 | N | N | N/A | N/A
88738 | HGB QUANT TRANSCUTANEOUS | 2011-07-01 00:00:00 | 6.35 | N | N | N/A | N/A
88740 | HEMOGLOBIN QUAN TC PER DAY CARBOXYHEMOGLOBIN | 2011-07-01 00:00:00 | 6.35 | N | N | N/A | N/A
88741 | HEMOGLOBIN QUANTITATIVE TC PER DAY METHEMOGLOBIN | 2011-07-01 00:00:00 | 6.35 | N | N | N/A | N/A
88749 | UNLISTED IN VIVO LABORTORY SERVICE | 2011-07-01 00:00:00 | 0 | N | N | N/A | N/A
89049 | CAFFEINE HALOTHANE CONTRACTURE TEST | 2011-07-01 00:00:00 | 217.58 | N | N | N/A | N/A
89050 | CELL COUNT MISCELLANEOUS BODY FLUIDS | 2011-07-01 00:00:00 | 5.99 | N | N | N/A | N/A
89051 | CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT | 2011-07-01 00:00:00 | 6.98 | N | N | N/A | N/A
89055 | LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE | 2011-07-01 00:00:00 | 5.41 | N | N | N/A | N/A
89060 | CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID | 2011-07-01 00:00:00 | 9.05 | N | N | N/A | 16.74
89125 | FAT STAIN FECES URINE/RESPIR SECRETIONS | 2011-07-01 00:00:00 | 5.47 | N | N | N/A | N/A
89160 | MEAT FIBERS FECES | 2011-07-01 00:00:00 | 4.67 | N | N | N/A | N/A
89190 | NASAL SMEAR EOSINOPHILS | 2011-07-01 00:00:00 | 6.01 | N | N | N/A | N/A
89220 | [NAME], [NAME], AEROSOL INDUCED TECHNIQUE | 2011-07-01 00:00:00 | 13.44 | N | N | N/A | N/A
89230 | SWEAT COLLECTION IONTOPHORESIS | 2011-07-01 00:00:00 | 2.48 | N | N | N/A | N/A
89321 | SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM | 2011-07-01 00:00:00 | 14.74 | N | N | N/A | N/A
89398 | UNLISTED REPRODUCTIVE MEDICINE LABORATORY PROCEDURE | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
90281 | IMMUNE GLOBULIN IG HUMAN IM USE | 2008-01-01 00:00:00 | 28 | N | Y | N/A | N/A
90283 | IMMUNE GLOBULIN IGIV HUMAN FOR INTRAVENOUS USE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
90284 | IMMUNE GLOBULIN , HUMAN, FOR USE IN SUBCUTANEOUS INFUSIONS, 100 MG, EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
90287 | BOTULINUM ANTITOXIN EQUINE ANY ROUTE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
90288 | BOTULISM IMMUNE GLOBULIN HUMAN FOR INTRAVENOUS USE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
90291 | [NAME], HUMAN FOR INTRAVENOUS USE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
90296 | DIPHTHERIA ANTITOXIN, EQUINE, ANY ROUTE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
90371 | HEPATITIS B IMMUNE GLOBULIN HBIG HUMAN IM | 2011-07-01 00:00:00 | 102.89 | N | Y | N/A | N/A
90375 | RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ | 2011-07-01 00:00:00 | 146.65 | N | Y | N/A | N/A
90376 | RABIES IG HEAT-TREATED HUMAN IM/SUBQ | 2011-07-01 00:00:00 | 141.42 | N | Y | N/A | N/A
90378 | RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E | 2013-12-01 00:00:00 | 1273.8 | Y | Y | N/A | N/A
90384 | RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM | 2008-01-01 00:00:00 | 113.05 | N | Y | N/A | N/A
90385 | RHO(D) IMMUNE GLOBULIN HUMAN MINI-DOSE IM | 2011-07-01 00:00:00 | 22.41 | N | Y | N/A | N/A
90386 | [NAME], HUMAN FOR INTRAVENOUS USE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
90389 | TETANUS IMMUNE GLOBULIN, HUMAN FOR INTRAMUSCULAR USE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
90393 | [NAME], HUMAN FOR INTRAMUSCULAR USE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
90396 | VARICELLA-ZOSTER IMMUNE GLOBULIN HUMAN IM | 2008-01-01 00:00:00 | 109.82 | N | Y | N/A | N/A
90399 | UNLISTED IMMUNE GLOBULIN | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
90460 | IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX | 2012-06-01 00:00:00 | 19.79 | N | N | N/A | N/A
90461 | IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT | 2012-06-01 00:00:00 | 9.95 | N | N | N/A | N/A
90471 | IMADM PRQ ID SUBQ/IM NJXS 1 VACCINE | 2011-07-01 00:00:00 | 19.79 | N | N | N/A | N/A
90472 | IMADM PRQ ID SUBQ/IM NJXS EA VACCINE | 2011-07-01 00:00:00 | 9.95 | N | N | N/A | N/A
90473 | IMADM INTRANSL/ORAL 1 VACCINE | 2011-07-01 00:00:00 | 19.79 | N | N | N/A | N/A
90474 | IMADM INTRANSL/ORAL EA VACCINE | 2011-07-01 00:00:00 | 9.95 | N | N | N/A | N/A
90476 | [NAME] TYPE 4, LIVE FOR ORAL USE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
90477 | [NAME] TYPE 7, LIVE FOR ORAL USE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
90581 | [NAME] FOR SUBCUTANEOUS USE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
90585 | BACILLUS CALMETTE-GUERIN VACC FOR TB LIVE PERQ | 2011-07-01 00:00:00 | 103.16 | N | N | N/A | N/A
90586 | BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL | 2011-07-01 00:00:00 | 104.92 | N | N | N/A | N/A
90632 | HEPATITIS A VACCINE ADULT FOR INTRAMUSCULAR USE | 2011-07-01 00:00:00 | 46.92 | N | N | N/A | N/A
90633 | HEPATITIS A VACCINE PEDIATRIC 2 DOSE SCHEDULE IM | 2009-01-01 00:00:00 | 25.15 | N | N | N/A | N/A
90634 | HEPATITIS A VACCINE PEDIATRIC 3 DOSE SCHEDULE IM | 2008-01-01 00:00:00 | 24.28 | N | N | N/A | N/A
90636 | HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM | 2008-01-01 00:00:00 | 85 | N | N | N/A | N/A
90645 | HEMOPHILUS INFLUENZA B VACC HBOC CONJ 4 DOSE IM | 2009-01-01 00:00:00 | 23.34 | N | N | N/A | N/A
90646 | HEMOPHILUS INFLUENZA B VACCINE PRP-D BOOSTER IM | 2008-01-01 00:00:00 | 24 | N | N | N/A | N/A
90647 | HEMOPHILUS INFLUENZA B VACCINE PRP-OMP 3 DOSE IM | 2009-01-01 00:00:00 | 23.34 | N | N | N/A | N/A
90648 | HEMOPHILUS INFLUENZA B VACCINE PRP-T 4 DOSE IM | 2009-01-01 00:00:00 | 21.78 | N | N | N/A | N/A
90649 | HUMAN PAPILLOMA VIRUS VACCINE QUADRIV 3 DOSE IM | 2008-01-01 00:00:00 | 131.73 | N | N | N/A | N/A
90650 | HUMAN PAPILLOMA VIRUS BIVALENT VACCINE 3 DOSE IM | 2010-04-01 00:00:00 | 128.75 | N | N | N/A | N/A
90653 | INFLUENZA VACCINE INACT SUBUNIT ADJUVANT IM | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
90654 | INFLUENZA VIRUS VACCINE, SPLIT VIRUS, PRESERVATIVE FREE, FOR INTRADERMAL USE | 2012-11-01 00:00:00 | 17.08 | N | N | N/A | N/A
90655 | INFLUENZA VIRUS VACC SPLIT PRSRV FREE 6-35 MO IM | 2012-11-01 00:00:00 | 14.81 | N | N | N/A | N/A
90656 | INFLUENZA VIRUS VACC SPLIT PRSRV FREE 3 YRS/GT IM | 2012-11-01 00:00:00 | 11.16 | N | N | N/A | N/A
90657 | INFLUENZA VIRUS VACCINE SPLIT VIRUS 6-35 MO IM | 2012-11-01 00:00:00 | 5.42 | N | N | N/A | N/A
90658 | INFLUENZA VIRUS VACCINE SPLIT VIRUS 3/GT YRS IM | 2008-01-01 00:00:00 | 13.22 | N | N | N/A | N/A
90660 | INFLUENZA VIRUS VACCINE LIVE INTRANASAL | 2012-11-01 00:00:00 | 21.11 | N | N | N/A | N/A
90662 | INFLUENZA VACCINE SPLT PRSRV FREE INC ANTIGEN IM | 2012-12-01 00:00:00 | 27.83 | N | N | N/A | N/A
90669 | PNEUMOCOCCAL CONJ VACCINE 7 VALENT IM | 2012-11-01 00:00:00 | 85.93 | N | N | N/A | N/A
90670 | PNEUMOCOCCAL VACC, 13 VAL IM | 2012-11-01 00:00:00 | 123.33 | N | N | N/A | N/A
90672 | INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL | 2013-11-15 00:00:00 | 22.14 | N | N | N/A | N/A
90673 | INFLUENZA VIRUS VACCINE TRIVALEN RIV3 PRSR FR IM | 2014-01-01 00:00:00 | 32.83 | N | N | N/A | N/A
90675 | RABIES VACCINE INTRAMUSCULAR | 2011-07-01 00:00:00 | 175.03 | N | N | N/A | N/A
90676 | RABIES VACCINE FOR INTRADERMAL USE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
90680 | [NAME] 3 DOSE LIVE ORAL | 2008-01-01 00:00:00 | 68.75 | N | N | N/A | N/A
90681 | [NAME], HUMAN, ATTENUATED, 2 DOSE SCHEDULE, LIVE FOR ORAL USE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
90685 | INFLUENZA VAC QUADRIVALENT PRSRV FREE 6-35 MO IM | 2013-09-01 00:00:00 | 20.91 | N | N | N/A | N/A
90686 | INFLUENZA VAC 4 VALENT PRSRV FREE 3 YRS PLUS IM | 2013-09-01 00:00:00 | 17.47 | N | N | N/A | N/A
90688 | INFLUENZA VACCINE QUADRIVALENT 3 YRS PLUS IM | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
90690 | TYPHOID VACCINE LIVE ORAL | 2008-01-01 00:00:00 | 30 | N | N | N/A | N/A
90691 | TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM | 2011-07-01 00:00:00 | 55.69 | N | N | N/A | N/A
90692 | TYPHOID VACCINE HEAT & PHENOL INACTIVATED H-P FOR SUBCUTANEOUS /INTRADERMAL/ | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
90693 | TYPHOID VACCINE ACETON-KILLED & DRIED FOR SUBCUTANEOUS OR JET INJECTION USE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
90696 | INACTIVE (DTAP-IPV), WHEN ADMINISTERED TO CHILDREN 4- 6 YEARS OF AGE, FOR IM USE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
90698 | DTAP-HIB-IPV INACTIVATED VACCINE IM | 2009-01-01 00:00:00 | 56.64 | N | N | N/A | N/A
90700 | DIPHTH TETANUS TOX ACELL PERTUSSIS VACC LT7 YR IM | 2009-01-01 00:00:00 | 17.58 | N | N | N/A | N/A
90702 | DIPHTHERIA TETANUS TOXOID ADSORBED LT 7 YR IM | 2009-01-01 00:00:00 | 24.96 | N | N | N/A | N/A
90703 | TETANUS TOXOID ADSORBED INTRAMUSCULAR | 2011-07-01 00:00:00 | 24.93 | N | N | N/A | N/A
90704 | MUMPS VIRUS VACCINE LIVE SUBCUTANEOUS | 2009-01-01 00:00:00 | 22.2 | N | N | N/A | N/A
90705 | MEASLES VIRUS VACCINE LIVE SUBCUTANEOUS | 2009-01-01 00:00:00 | 17.14 | N | N | N/A | N/A
90706 | RUBELLA VIRUS VACCINE LIVE SUBCUTANEOUS | 2009-01-01 00:00:00 | 18.92 | N | N | N/A | N/A
90707 | [NAME] VIRUS VACCINE LIVE SUBQ | 2009-01-01 00:00:00 | 44.82 | N | N | N/A | N/A
90708 | MEASLES & RUBELLA VIRUS VACCINE LIVE SUBQ | 2008-01-01 00:00:00 | 22.3 | N | N | N/A | N/A
90710 | [NAME] VARICELLA VACC LIVE SUBQ | 2013-09-01 00:00:00 | 99.63 | N | N | N/A | N/A
90712 | POLIOVIRUS VACCINE ANY LIVE ORAL | 2008-01-01 00:00:00 | 16.22 | N | N | N/A | N/A
90713 | POLIOVIRUS VACCINE INACTIVATED SUBQ/IM | 2009-01-01 00:00:00 | 26.52 | N | N | N/A | N/A
90714 | TD TOXOIDS ADSORBED PRSRV FR 7/GT YR IM | 2011-07-01 00:00:00 | 17.13 | N | N | N/A | N/A
90715 | TDAP VACCINE 7/GT YR IM | 2011-07-01 00:00:00 | 33.49 | N | N | N/A | N/A
90716 | VARICELLA VIRUS VACCINE LIVE SUBQ | 2009-01-01 00:00:00 | 77.33 | N | N | N/A | N/A
90717 | [NAME] | 2011-07-01 00:00:00 | 58.36 | N | N | N/A | N/A
90719 | DIPHTHERIA TOXOID INTRAMUSCULAR | 2008-01-01 00:00:00 | 5 | N | N | N/A | N/A
90720 | DTP-HIB VACCINE INTRAMUSCULAR | 2008-01-01 00:00:00 | 28.34 | N | N | N/A | N/A
90721 | DTAP-HIB VACCINE INTRAMUSCULAR | 2009-01-01 00:00:00 | 42.89 | N | N | N/A | N/A
90723 | [NAME] VACCINE INTRAMUSCULAR | 2008-01-01 00:00:00 | 75.53 | N | N | N/A | N/A
90725 | CHOLERA VACCINE INJECTABLE | 2008-01-01 00:00:00 | 5 | N | N | N/A | N/A
90727 | PLAGUE VACCINE INTRAMUSCULAR | 2008-01-01 00:00:00 | 4 | N | N | N/A | N/A
90732 | PNEUMOCOCCAL POLYSAC VACCINE 23-V 2 /GTYR SUBQ/IM | 2011-07-01 00:00:00 | 44.76 | N | N | N/A | N/A
90733 | MENINGOCOCCAL POLYSAC VACCINE SUBCUTANEOUS | 2011-07-01 00:00:00 | 95.84 | N | N | N/A | N/A
90734 | MENINGOCOCCAL CONJ VACCINE TETRAVALENT IM | 2008-01-01 00:00:00 | 90.2 | N | N | N/A | N/A
90735 | JAPANESE ENCEPHALITIS VIRUS VACCINE SUBCUTANEOUS | 2011-07-01 00:00:00 | 91.87 | N | N | N/A | N/A
90736 | [NAME] (SHINGLES) VACCINE LIVE FOR SUBCUTANEOUS INJECTION | 2012-08-01 00:00:00 | 159.16 | N | N | N/A | N/A
90738 | JAPANESE ENCEPHALITIS VIRUS VACCINE, INACTIVATED, FOR INTRAMUSCULAR USE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
90739 | HEPATITIS B VACCINE ADULT 2 DOSE IM | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
90740 | HEPATITIS B VACCINE DIALYSIS DOSAGE 3 DOSE IM | 2011-07-01 00:00:00 | 107.47 | N | N | N/A | N/A
90743 | HEPATITIS B VACCINE ADOLESCENT 2 DOSE IM | 2011-07-01 00:00:00 | 21.79 | N | N | N/A | N/A
90744 | HEPATITIS B VACCINE PEDIATRIC3 DOSE IM | 2011-07-01 00:00:00 | 21.79 | N | N | N/A | N/A
90746 | HEPATITIS B VACCINE ADULT DOSAGE INTRAMUSCULAR | 2011-07-01 00:00:00 | 53.74 | N | N | N/A | N/A
90747 | HEPATITIS B VACCINE DIALYSIS DOSAGE 4 DOSE IM | 2011-07-01 00:00:00 | 107.47 | N | N | N/A | N/A
90748 | HEPB-HIB VACCINE INTRAMUSCULAR | 2008-01-01 00:00:00 | 39.75 | N | N | N/A | N/A
90749 | UNLISTED IMMUNIZATION PROCEDURE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
90785 | PSYCHOTHERAPY COMPLEX INTERACTIVE | 2013-01-01 00:00:00 | 4.1 | N | N | N/A | N/A
90791 | PSYCHIATRIC DIAGNOSTIC EVALUATION | 2013-01-01 00:00:00 | 129.38 | N | N | N/A | N/A
90792 | PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES | 2013-01-01 00:00:00 | 108.55 | N | N | N/A | N/A
90832 | PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES | 2013-01-01 00:00:00 | 53.98 | N | N | N/A | N/A
90833 | PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN | 2013-01-01 00:00:00 | 36.23 | N | N | N/A | N/A
90834 | PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES | 2013-01-01 00:00:00 | 70.39 | N | N | N/A | N/A
90836 | PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN | 2013-01-01 00:00:00 | 58.86 | N | N | N/A | N/A
90837 | PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES | 2013-01-01 00:00:00 | 103.19 | N | N | N/A | N/A
90838 | PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 60 MIN | 2013-01-01 00:00:00 | 95.02 | N | N | N/A | N/A
90839 | PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
90840 | PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
90845 | PSYCHOANALYSIS | 2011-07-01 00:00:00 | 69.8 | N | Y | N/A | N/A
90846 | FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT | 2011-07-01 00:00:00 | 73.91 | N | Y | N/A | N/A
90847 | FAMILY PSYCHOTHERAPY W/PATIENT PRESENT | 2011-07-01 00:00:00 | 92.04 | N | Y | N/A | N/A
90849 | MULTIPLE FAMILY GROUP PSYCHOTHERAPY | 2011-07-01 00:00:00 | 29.52 | N | Y | N/A | N/A
90853 | GROUP PSYCHOTHERAPY | 2011-07-01 00:00:00 | 27.79 | N | Y | N/A | N/A
90863 | PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY | 2013-01-01 00:00:00 | 50.22 | N | N | N/A | N/A
90865 | [NAME] | 2011-07-01 00:00:00 | 137.5 | N | Y | N/A | N/A
90870 | [NAME] | 2011-07-01 00:00:00 | 144.69 | N | Y | N/A | N/A
90880 | HYPNOTHERAPY | 2011-07-01 00:00:00 | 88.26 | N | Y | N/A | N/A
90885 | PSYCHIATRIC EVAL HOSPITAL RECORDS DX PURPOSES | 2008-07-01 00:00:00 | 34.5 | N | Y | N/A | N/A
90887 | INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY | 2008-07-01 00:00:00 | 48.59 | N | Y | N/A | N/A
90889 | PREP REPORT PT PSYCH STATUS PHYS/AGENCY/PAYER | 2008-07-01 00:00:00 | 48.55 | N | Y | N/A | N/A
90935 | HEMODIALYSIS PROCEDURE W/1 PHYSICIAN EVALUATION | 2011-07-01 00:00:00 | 65.12 | N | Y | N/A | N/A
90937 | HEMODIALYSIS PX REPEAT EVAL W/WO REVJ DIALYS RX | 2011-07-01 00:00:00 | 92.97 | N | Y | N/A | N/A
90940 | HEMODIALYSIS ACCESS FLOW | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
90945 | [NAME] HEMODIALYSIS 1 PHYS EVAL | 2011-07-01 00:00:00 | 71.88 | N | Y | N/A | N/A
90947 | DIALYSIS OTH/THN HEMODIALYSIS REPEAT PHYS EVALS | 2011-07-01 00:00:00 | 108.81 | N | Y | N/A | N/A
90951 | ESRD RELATED SVC MONTHLY LT2 YR OLD 4/GTVISITS | 2011-07-01 00:00:00 | 831.47 | N | Y | N/A | N/A
90952 | ESRD RELATED SVC MONTHLY LT2 YR OLD 2/3 VISITS | 2009-01-01 00:00:00 | 689.88 | N | Y | N/A | N/A
90953 | ESRD RELATED SVC MONTHLY LT2 YR OLD 1 VISIT | 2009-01-01 00:00:00 | 229.96 | N | Y | N/A | N/A
90954 | ESRD RELATED SVC MONTHLY 2-11 YR OLD 4/GTVISITS | 2011-07-01 00:00:00 | 697.88 | N | Y | N/A | N/A
90955 | ESRD RELATED SVC MONTHLY 2-11 YR OLD 2/3 VISITS | 2011-07-01 00:00:00 | 394.15 | N | Y | N/A | N/A
90956 | ESRD RELATED SVC MONTHLY 2-11 YR OLD 1 VISIT | 2011-07-01 00:00:00 | 270.36 | N | Y | N/A | N/A
90957 | ESRD RELATED SVC MONTHLY 12-19 YR OLD 4/GTVISITS | 2011-07-01 00:00:00 | 557.78 | N | Y | N/A | N/A
90958 | ESRD RELATED SVC MONTHLY 12-19 YR OLD 2/3 VISITS | 2011-07-01 00:00:00 | 377.61 | N | Y | N/A | N/A
90959 | ESRD RELATED SVC MONTHLY 12-19 YR OLD 1 VISIT | 2011-07-01 00:00:00 | 251.46 | N | Y | N/A | N/A
90960 | ESRD RELATED SVC MONTHLY 20&GT YR OLD 4/GT VISITS | 2011-07-01 00:00:00 | 247.45 | N | Y | N/A | N/A
90961 | ESRD RELATED SVC MONTHLY 20&GT YR OLD 2/3 VISITS | 2011-07-01 00:00:00 | 203.45 | N | Y | N/A | N/A
90962 | ESRD RELATED SVC MONTHLY 20&GT YR OLD 1 VISIT | 2011-07-01 00:00:00 | 152.01 | N | Y | N/A | N/A
90963 | ESRD SVC HOME DIALYSIS FULL MONTH LT2YR OLD | 2011-07-01 00:00:00 | 474.99 | N | Y | N/A | N/A
90964 | ESRD SVC HOME DIALYSIS FULL MONTH 2-11 YR OLD | 2011-07-01 00:00:00 | 403.64 | N | Y | N/A | N/A
90965 | ESRD SVC HOME DIALYSIS FULL MONTH 12-19 YR OLD | 2011-07-01 00:00:00 | 384.74 | N | Y | N/A | N/A
90966 | ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD | 2011-07-01 00:00:00 | 202.29 | N | Y | N/A | N/A
90967 | ESRD RELATED SVC LTFULL MONTH LT 2 YR OLD | 2011-07-01 00:00:00 | 16.35 | N | Y | N/A | N/A
90968 | ESRD RELATED SVC LTFULL MONTH 2-11 YR OLD | 2011-07-01 00:00:00 | 13.38 | N | Y | N/A | N/A
90969 | ESRD RELATED SVC LTFULL MONTH 12-19 YR OLD | 2011-07-01 00:00:00 | 13.08 | N | Y | N/A | N/A
90970 | ESRD RELATED SVC LTFULL MONTH 20&GT YR OLD | 2011-07-01 00:00:00 | 6.76 | N | Y | N/A | N/A
90989 | [NAME] | 2008-07-01 00:00:00 | 518.25 | N | Y | N/A | N/A
90993 | [NAME] PATIENT PER TRAINING SESSION | 2008-07-01 00:00:00 | 20.73 | N | Y | N/A | N/A
90999 | [NAME] PROCEDURE INPATIENT/OUTPATIENT | 2008-07-01 00:00:00 | 151.18 | N | Y | N/A | N/A
91010 | ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT | 2011-07-01 00:00:00 | 160.5 | N | Y | 100.52 | 59.98
91013 | ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION | 2011-07-01 00:00:00 | 19.69 | N | Y | 11.13 | 8.56
91020 | [NAME] | 2011-07-01 00:00:00 | 202.88 | N | Y | 135.7 | 67.18
91022 | DUODENAL MOTILITY MANOMETRIC STUDY | 2011-07-01 00:00:00 | 157.26 | N | Y | 88.99 | 68.27
91030 | ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS | 2011-07-01 00:00:00 | 120.69 | N | Y | 77.45 | 43.24
91034 | GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT | 2011-07-01 00:00:00 | 168.95 | N | Y | 123.88 | 45.07
91035 | GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD | 2011-07-01 00:00:00 | 414.79 | N | Y | 340.43 | 74.36
91037 | GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD | 2011-07-01 00:00:00 | 139.77 | N | Y | 93.6 | 46.17
91038 | ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG | 2011-07-01 00:00:00 | 254.99 | N | Y | 203.18 | 51.81
91040 | ESOPHGL BALO DISTENSION PROVOCATION STD | 2011-07-01 00:00:00 | 292.19 | N | Y | 248.45 | 43.74
91065 | BREATH HYDROGEN TEST | 2011-07-01 00:00:00 | 67.6 | N | Y | 58.42 | 9.18
91110 | GI IMAG INTRALUMIN ESOPH-ILEUM PHYS INTERP/RPT | 2011-07-01 00:00:00 | 785.29 | N | Y | 613.51 | 171.78
91111 | GASTROINTESTINAL TRACT IMAGING ESOPHAGUS | 2011-07-01 00:00:00 | 626.34 | N | Y | 578.91 | 47.43
91112 | GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP | 2013-01-01 00:00:00 | 961.04 | N | N | 864.95 | 96.08
91117 | COLON MOTILITY STDY MIN 6 HR CONT RECORD W/I&R | 2011-07-01 00:00:00 | 120.78 | N | Y | N/A | N/A
91120 | RECTAL SESATION TONE & COMPLIANCE TEST | 2011-07-01 00:00:00 | 327.38 | N | Y | 284.21 | 43.17
91122 | ANORECTAL MANOMETRY | 2011-07-01 00:00:00 | 195.9 | N | Y | 117.83 | 78.07
91132 | ELECTROGASTROGRAPHY DX TRANSCUTANEOUS | 2011-07-01 00:00:00 | 120.41 | N | Y | 95.91 | 24.5
91133 | ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG | 2011-07-01 00:00:00 | 147.07 | N | Y | 115.52 | 31.55
91299 | UNLISTED DX GASTROENTEROLOGY PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
92002 | OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT | 2011-07-01 00:00:00 | 64.76 | N | N | N/A | N/A
92004 | OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/GT VST | 2011-07-01 00:00:00 | 120.62 | N | N | N/A | N/A
92012 | OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT | 2011-07-01 00:00:00 | 68.57 | N | N | N/A | N/A
92014 | OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/GT VST | 2011-07-01 00:00:00 | 99.68 | N | N | N/A | N/A
92015 | [NAME] | 2008-07-01 00:00:00 | 17.8 | N | N | N/A | N/A
92018 | OPHTH XM&EVAL ANES W/WO MANJ GLOBE COMPL | 2011-07-01 00:00:00 | 120.2 | N | N | N/A | N/A
92019 | OPHTH XM&EVAL ANES W/WO MANJ GLOBE LMTD | 2011-07-01 00:00:00 | 58.29 | N | N | N/A | N/A
92020 | GONIOSCOPY SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 22.51 | N | Y | N/A | N/A
92025 | COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI | 2011-07-01 00:00:00 | 30.09 | N | Y | 13.44 | 16.65
92060 | SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX | 2011-07-01 00:00:00 | 52.07 | N | N | 19.49 | 32.58
92071 | FIT CONTACT LENS TX OCULAR SURFACE DISEASE | 2012-01-01 00:00:00 | 31.84 | N | N | N/A | N/A
92072 | FITTING CONTACT LENS FOR MNGT OF KERATOCONUS | 2012-01-01 00:00:00 | 101.55 | N | N | N/A | N/A
92081 | VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM | 2011-07-01 00:00:00 | 41.3 | N | Y | 26.99 | 14.31
92082 | VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM | 2011-07-01 00:00:00 | 57.51 | N | Y | 38.53 | 18.98
92083 | VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM | 2011-07-01 00:00:00 | 71.93 | N | Y | 48.04 | 23.89
92100 | SERIAL TONOMETRY SPX W/MLT MEAS INTRAOCULAR PRES | 2011-07-01 00:00:00 | 78.03 | N | N | N/A | N/A
92132 | CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI | 2011-07-01 00:00:00 | 31.01 | N | Y | 12.86 | 18.15
92133 | COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE | 2011-07-01 00:00:00 | 38.2 | N | Y | 12.86 | 25.34
92134 | COMPUTERIZED OPHTHALMIC IMAGING RETINA | 2011-07-01 00:00:00 | 38.2 | N | Y | 12.86 | 25.34
92136 | OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL | 2011-07-01 00:00:00 | 71.07 | N | Y | 45.16 | 25.91
92140 | PROVOCATIVE TESTS GLAUCOMA I&R W/O TONOGRAPHY | 2011-07-01 00:00:00 | 50.42 | N | Y | N/A | N/A
92225 | OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R 1ST | 2011-07-01 00:00:00 | 21.95 | N | Y | N/A | N/A
92226 | OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R SBSQ | 2011-07-01 00:00:00 | 19.78 | N | Y | N/A | N/A
92227 | REMOTE IMG DX RETINL DIS W/ALYS & REPORT UNI/BI | 2011-07-01 00:00:00 | 9.69 | N | Y | N/A | N/A
92228 | REMOTE IMAGING MGT RETINAL DISEASE W/I&R UNI/BI | 2011-07-01 00:00:00 | 25.67 | N | Y | 10.56 | 15.11
92230 | FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT | 2011-07-01 00:00:00 | 49.32 | N | Y | N/A | N/A
92235 | FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT | 2011-07-01 00:00:00 | 111.69 | N | Y | 72.26 | 39.43
92240 | INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPORT | 2011-07-01 00:00:00 | 188.03 | N | Y | 134.84 | 53.19
92250 | FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT | 2011-07-01 00:00:00 | 62.83 | N | Y | 42.56 | 20.27
92260 | OPHTHALMODYNAMOMETRY | 2011-07-01 00:00:00 | 15.23 | N | Y | N/A | N/A
92265 | NEEDLE OCULOGRAPHY 1/GT XOC MUSC 1/BOTH EYE W/I&R | 2011-07-01 00:00:00 | 67.51 | N | Y | 29.88 | 37.63
92270 | ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT | 2011-07-01 00:00:00 | 75.07 | N | Y | 39.39 | 35.68
92275 | ELECTRORETINOGRAPY W/INTERPRETATION & REPORT | 2011-07-01 00:00:00 | 121.44 | N | Y | 72.84 | 48.6
92283 | COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV | 2011-07-01 00:00:00 | 41.3 | N | Y | 33.62 | 7.68
92284 | DARK ADAPTATION XM W/INTERPRETATION & REPORT | 2011-07-01 00:00:00 | 50.36 | N | Y | 39.97 | 10.39
92285 | XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRESS | 2011-07-01 00:00:00 | 23.51 | N | Y | 20.07 | 3.44
92286 | SPEC ANT SGM PHTGRPHY I&R SPECLR ENDOTHELIAL | 2011-07-01 00:00:00 | 101.56 | N | Y | 70.82 | 30.74
92287 | SPEC ANT SGM PHTGRPHY I&R FLUORESCEIN ANGRPH | 2011-07-01 00:00:00 | 99.58 | N | Y | N/A | N/A
92310 | [NAME] SUPVJ CRNL LENS OU XCPT APHK | 2008-07-01 00:00:00 | 81.55 | Y | N | N/A | N/A
92311 | RX&FITG CONTACT CORNEAL LENS APHAKIA 1 EYE | 2011-07-01 00:00:00 | 82.58 | N | Y | N/A | N/A
92312 | RX&FITG CONTACT CORNEAL LENS APHAKIA BOTH EYES | 2011-07-01 00:00:00 | 94.19 | N | N | N/A | N/A
92313 | [NAME] | 2011-07-01 00:00:00 | 81.2 | N | N | N/A | N/A
92314 | RX&FTG CONTACT CORNEAL LENS EYES XCPT APHAKIA | 2008-07-01 00:00:00 | 81.55 | N | N | N/A | N/A
92315 | RX CONTACT CORNEAL LENS APHAKIA 1 EYE | 2011-07-01 00:00:00 | 59.73 | N | N | N/A | N/A
92316 | RX CONTACT CORNEAL LENS APHAKIA BOTH EYES | 2011-07-01 00:00:00 | 80.32 | N | N | N/A | N/A
92317 | RX CONTACT CORNEOSCLERAL LENS | 2011-07-01 00:00:00 | 59.79 | N | N | N/A | N/A
92340 | FITTING SPECTACLES XCPT APHAKIA MONOFOCAL | 2008-07-01 00:00:00 | 23.62 | N | N | N/A | N/A
92341 | FITTING SPECTACLES XCPT APHAKIA BIFOCAL | 2008-07-01 00:00:00 | 23.62 | N | N | N/A | N/A
92342 | FITTING SPECTACLES XCPT APHAKIA MULTIFOCAL | 2008-07-01 00:00:00 | 23.62 | N | N | N/A | N/A
92352 | FITTING SPECTACLE PROSTH APHAKIA MONOFOCAL | 2008-07-01 00:00:00 | 20.9 | N | N | N/A | N/A
92353 | FITTING SPECTACLE PROSTH APHAKIA MULTIFOCAL | 2008-07-01 00:00:00 | 28.18 | N | N | N/A | N/A
92354 | FITTING SPECTACLE MOUNTED LW VIS AID 1 ELMNT | 2008-07-01 00:00:00 | 264.64 | N | Y | N/A | N/A
92355 | FITTING SPECTACLE MOUNTED LW VIS AID TLSCP | 2008-07-01 00:00:00 | 128.2 | N | Y | N/A | N/A
92358 | PROSTHESIS SERVICE APHAKIA TEMPORARY | 2008-07-01 00:00:00 | 30.1 | N | N | N/A | N/A
92370 | [NAME] APHAKIA | 2008-07-01 00:00:00 | 4.37 | N | N | N/A | N/A
92371 | [NAME] APHAKIA | 2008-07-01 00:00:00 | 18.95 | N | N | N/A | N/A
92499 | UNLISTED OPHTHALMOLOGICAL SERVICE OR PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
92502 | OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA | 2011-07-01 00:00:00 | 84.02 | N | Y | N/A | N/A
92504 | BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE | 2011-07-01 00:00:00 | 25.87 | N | Y | N/A | N/A
92507 | TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC INDIV | 2011-07-01 00:00:00 | 71.25 | N | Y | N/A | N/A
92508 | TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC 2/GT | 2011-07-01 00:00:00 | 23.24 | Y | N | N/A | N/A
92511 | NASOPHARYNGOSCOPY W/ENDOSCOPE SPX | 2011-07-01 00:00:00 | 136.83 | N | Y | N/A | N/A
92512 | NASAL FUNCTION STUDIES | 2011-07-01 00:00:00 | 52.81 | N | Y | N/A | N/A
92516 | FACIAL NERVE FUNCTION STUDIES | 2011-07-01 00:00:00 | 58.08 | N | Y | N/A | N/A
92520 | LARYNGEAL FUNCTION STUDIES | 2011-07-01 00:00:00 | 58.24 | N | Y | N/A | N/A
92521 | EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER) | 2014-01-01 00:00:00 | 97.58 | N | Y | N/A | N/A
92522 | EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE | 2014-01-01 00:00:00 | 79.52 | N | Y | N/A | N/A
92523 | EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION | 2014-01-01 00:00:00 | 164.71 | N | Y | N/A | N/A
92524 | BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE | 2014-01-01 00:00:00 | 82.15 | N | Y | N/A | N/A
92526 | TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING | 2011-07-01 00:00:00 | 81.41 | N | Y | N/A | N/A
92531 | SPONTANEOUS NYSTAGMUS W/GAZE | 2008-07-01 00:00:00 | 34.94 | N | Y | N/A | N/A
92532 | POSITIONAL NYSTAGMUS TEST | 2008-07-01 00:00:00 | 53.91 | N | Y | N/A | N/A
92533 | CALORIC VESTIBULAR TEST EACH IRRIGATION | 2008-07-01 00:00:00 | 12.15 | N | Y | 12.15 | N/A
92534 | OPTOKINETIC NYSTAGMUS TEST | 2008-07-01 00:00:00 | 34.94 | N | Y | N/A | N/A
92540 | BASIC VESTIBULAR EVALUATION | 2011-07-01 00:00:00 | 84.52 | N | Y | 15.75 | 68.77
92541 | SPONTANEOUS NYSTAGMUS TEST | 2011-07-01 00:00:00 | 39.11 | N | Y | 21.22 | 17.89
92542 | POSITIONAL NYSTAGMUS TEST | 2011-07-01 00:00:00 | 38.7 | N | Y | 23.82 | 14.88
92543 | CALORIC VESTIBULAR TEST EA IRRIGATION W/RECORD | 2011-07-01 00:00:00 | 18.98 | N | Y | 14.3 | 4.68
92544 | OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC | 2011-07-01 00:00:00 | 31.65 | N | Y | 20.07 | 11.58
92545 | OSCILLATING TRACKING TEST W/RECORDING | 2011-07-01 00:00:00 | 29.58 | N | Y | 19.21 | 10.37
92546 | SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING | 2011-07-01 00:00:00 | 80.15 | N | Y | 67.37 | 12.78
92547 | USE VERTICAL ELECTRODES | 2011-07-01 00:00:00 | 4.21 | N | Y | N/A | N/A
92548 | [NAME] | 2011-07-01 00:00:00 | 87.44 | N | Y | 65.05 | 22.39
92550 | TYMPANOMETRY & REFLEX THRESH | 2011-07-01 00:00:00 | 18.09 | N | Y | N/A | N/A
92551 | SCREENING TEST PURE TONE AIR ONLY | 2008-07-01 00:00:00 | 14.59 | N | Y | N/A | N/A
92552 | [NAME] ONLY | 2011-07-01 00:00:00 | 21.51 | N | Y | N/A | N/A
92553 | [NAME] | 2011-07-01 00:00:00 | 27.28 | N | Y | N/A | N/A
92555 | SPEECH AUDIOMETRY THRESHOLD | 2011-07-01 00:00:00 | 15.75 | N | Y | N/A | N/A
92556 | SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ | 2011-07-01 00:00:00 | 24.4 | N | Y | N/A | N/A
92557 | COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ | 2011-07-01 00:00:00 | 35.02 | N | Y | N/A | N/A
92560 | BEKESY AUDIOMETRY SCREENING | 2008-07-01 00:00:00 | 21.86 | N | N | N/A | N/A
92561 | BEKESY AUDIOMETRY DIAGNOSTIC | 2011-07-01 00:00:00 | 27.57 | N | Y | N/A | N/A
92562 | LOUDNESS BALANCE BINAURAL/MONAURAL | 2011-07-01 00:00:00 | 26.7 | N | Y | N/A | N/A
92563 | TONE DECAY TEST | 2011-07-01 00:00:00 | 20.93 | N | Y | N/A | N/A
92564 | SHORT INCREMENT SENSITIVITY INDEX | 2011-07-01 00:00:00 | 18.92 | N | Y | N/A | N/A
92565 | STENGER TEST PURE TONE | 2011-07-01 00:00:00 | 10.85 | N | Y | N/A | N/A
92567 | TYMPANOMETRY | 2011-07-01 00:00:00 | 13.21 | N | Y | N/A | N/A
92568 | ACOUSTIC REFLEX THRESHOLD | 2011-07-01 00:00:00 | 14.53 | N | Y | N/A | N/A
92570 | ACOUSTIC IMMITTANCE TESTING | 2011-07-01 00:00:00 | 27.72 | N | N | N/A | N/A
92571 | FILTERED SPEECH TEST | 2011-07-01 00:00:00 | 16.9 | N | Y | N/A | N/A
92572 | STAGGERED SPONDAIC WORD | 2011-07-01 00:00:00 | 26.7 | N | Y | N/A | N/A
92575 | SENSORINEURAL ACUITY LEVEL | 2011-07-01 00:00:00 | 41.7 | N | Y | N/A | N/A
92576 | SYNTHETIC SENTENCE IDENTIFICATION TEST | 2011-07-01 00:00:00 | 22.37 | N | Y | N/A | N/A
92577 | STENGER TEST SPEECH | 2011-07-01 00:00:00 | 13.73 | N | Y | N/A | N/A
92579 | VISUAL REINFORCEMENT AUDIOMETRY | 2011-07-01 00:00:00 | 37.79 | N | Y | N/A | N/A
92582 | CONDITIONING PLAY AUDIOMETRY | 2011-07-01 00:00:00 | 43.43 | N | Y | N/A | N/A
92583 | SELECT PICTURE AUDIOMETRY | 2011-07-01 00:00:00 | 30.17 | N | Y | N/A | N/A
92584 | ELECTROCOCHLEOGRAPY | 2011-07-01 00:00:00 | 56.4 | N | Y | N/A | N/A
92585 | AUDITORY EVOKED POTENTIALS COMPREHENSIVE | 2011-07-01 00:00:00 | 96.67 | N | Y | 74.29 | 22.38
92586 | AUDITORY EVOKED POTENTIALS LIMITED | 2011-07-01 00:00:00 | 59.58 | N | Y | 59.1 | N/A
92587 | DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD | 2011-07-01 00:00:00 | 31.43 | N | Y | 25.26 | 6.17
92588 | DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL | 2011-07-01 00:00:00 | 56.63 | N | Y | 40.26 | 16.37
92590 | HEARING AID EXAMINATION & SELECTION MONAURAL | 2008-07-01 00:00:00 | 48.58 | N | Y | N/A | N/A
92591 | HEARING AID EXAMINATION & SELECTION BINAURAL | 2008-07-01 00:00:00 | 97.15 | N | Y | N/A | N/A
92592 | HEARING AID CHECK MONAURAL | 2008-07-01 00:00:00 | 24.26 | N | Y | N/A | N/A
92593 | HEARING AID CHECK BINAURAL | 2008-07-01 00:00:00 | 48.58 | N | Y | N/A | N/A
92594 | ELECTROACOUS EVAL HEARING AID MONAURAL | 2008-07-01 00:00:00 | 17.72 | N | Y | N/A | N/A
92595 | ELECTRACOUSTIC EVALUATION FOR HEARING AID, BINAURA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
92596 | EAR PROTECTOR ATTENUATION MEASUREMENTS | 2011-07-01 00:00:00 | 33.62 | N | Y | N/A | N/A
92597 | EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEECH | 2011-07-01 00:00:00 | 84.45 | N | Y | N/A | N/A
92601 | ANALYSIS COCHLEAR IMPLT PT LT7 YR PRGRMG | 2011-07-01 00:00:00 | 126.47 | N | Y | N/A | N/A
92602 | ANALYSIS COCHLEAR IMPLT PT LT7 YR SBSQ REPRGRMG | 2011-07-01 00:00:00 | 77.89 | N | Y | N/A | N/A
92603 | ANALYSIS COCHLEAR IMPLT 7 YR/GT PRGRMG | 2011-07-01 00:00:00 | 123.5 | N | Y | N/A | N/A
92604 | ANALYSIS COCHLEAR IMPLT 7 YR/GT SBSQ REPRGRMG | 2011-07-01 00:00:00 | 73.13 | N | Y | N/A | N/A
92607 | RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR | 2011-07-01 00:00:00 | 151.75 | N | Y | N/A | N/A
92608 | RX SP-GENRATJ AUGMNT&COMUNICAJ DEV EA 30 MIN | 2011-07-01 00:00:00 | 45.17 | N | Y | N/A | N/A
92609 | THER SP-GENRATJ DEV PRGRMG&MODIFICAJ | 2011-07-01 00:00:00 | 100.15 | N | Y | N/A | N/A
92610 | EVAL ORAL&PHARYNGEAL SWLNG FUNCJ | 2011-07-01 00:00:00 | 90.58 | N | Y | N/A | N/A
92611 | [NAME]/V REC | 2011-07-01 00:00:00 | 97.74 | N | Y | N/A | N/A
92612 | FLX FIBOPT NDSC EVAL SWLNG C/V REC | 2011-07-01 00:00:00 | 143 | N | Y | N/A | N/A
92614 | FLX FIBOPT NDSC EVAL LARYN SENS C/V REC | 2011-07-01 00:00:00 | 127.43 | N | Y | N/A | N/A
92616 | FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS C/V REC | 2011-07-01 00:00:00 | 172.85 | N | Y | N/A | N/A
92620 | EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN | 2011-07-01 00:00:00 | 71.89 | N | Y | N/A | N/A
92621 | EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN | 2011-07-01 00:00:00 | 16.64 | N | Y | N/A | N/A
92625 | ASSESSMENT TINNITUS | 2011-07-01 00:00:00 | 55.07 | N | Y | N/A | N/A
92626 | EVALUATION AUDITORY REHAB STATUS 1ST HR | 2011-07-01 00:00:00 | 72.87 | N | Y | N/A | N/A
92627 | EVALUATION AUDITORY REHAB STATUS EA 15 MIN | 2011-07-01 00:00:00 | 17.77 | N | Y | N/A | N/A
92640 | ANALYSIS W/PRGRMG AUD BRAINSTEM IMPLANT PR HR | 2011-07-01 00:00:00 | 82.78 | N | Y | N/A | N/A
92700 | OTHER OTORHINOLARYNGOLOGICAL SERVICE OR PROCEDURE | 2013-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
92920 | PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH | 2013-01-01 00:00:00 | 450.99 | N | N | N/A | N/A
92921 | PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
92924 | PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH | 2013-01-01 00:00:00 | 536.06 | N | N | N/A | N/A
92925 | PRQ TRLUML CORONARY ANGIO/ATHEREC ADDL ART/BRNCH | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
92928 | PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH | 2013-01-01 00:00:00 | 500.73 | N | N | N/A | N/A
92929 | PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
92933 | PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH | 2013-01-01 00:00:00 | 559.95 | N | N | N/A | N/A
92934 | PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
92937 | PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL | 2013-01-01 00:00:00 | 500.16 | N | N | N/A | N/A
92938 | PRQ TRLUML CORONARY BYP [NAME] ADDL VESSEL | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
92941 | PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL | 2013-01-01 00:00:00 | 561.02 | N | N | N/A | N/A
92943 | PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL | 2013-01-01 00:00:00 | 561.02 | N | N | N/A | N/A
92944 | PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
92950 | CARDIOPULMONARY RESUSCITATION | 2011-07-01 00:00:00 | 241.68 | N | Y | N/A | N/A
92953 | [NAME] | 2011-07-01 00:00:00 | 9.8 | N | Y | N/A | N/A
92960 | CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL | 2011-07-01 00:00:00 | 206.78 | N | Y | N/A | N/A
92961 | CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX | 2011-07-01 00:00:00 | 219.28 | N | Y | N/A | N/A
92970 | CARDIOASSIST-METH CIRCULATORY ASSIST INTERNAL | 2011-07-01 00:00:00 | 155.36 | N | Y | N/A | N/A
92971 | CARDIOASSIST-METH CIRCULATORY ASSIST EXTERNAL | 2011-07-01 00:00:00 | 86.04 | N | Y | N/A | N/A
92973 | PRQ TRANSLUMINAL [NAME] | 2011-07-01 00:00:00 | 160.01 | N | Y | N/A | N/A
92974 | TCAT PLMT RADJ DLVR DEV SBSQ C IV BRACHYTX | 2011-07-01 00:00:00 | 146.65 | N | Y | N/A | N/A
92975 | THROMBOLYSIS INTRACORONARY NFS SLCTV ANGRPH | 2011-07-01 00:00:00 | 353.41 | N | Y | N/A | N/A
92977 | THROMBOLYSIS CORONARY INTRAVENOUS INFUSION | 2011-07-01 00:00:00 | 78.09 | N | Y | N/A | N/A
92978 | INTRAVASC US CORONARY INTERP&RPT INITIAL VESSEL | 2011-07-01 00:00:00 | 224.69 | N | Y | 141.59 | 83.1
92979 | INTRAVASC US CORONARY INTERP&RPT ADDL VESSEL | 2011-07-01 00:00:00 | 137.11 | N | Y | 70.56 | 66.55
92986 | PRQ BALLOON VALVULOPLASTY AORTIC VALVE | 2011-07-01 00:00:00 | 1206.25 | N | Y | N/A | N/A
92987 | PRQ BALLOON VALVULOPLASTY MITRAL VALVE | 2011-07-01 00:00:00 | 1245.02 | N | Y | N/A | N/A
92990 | PRQ BALLOON VALVULOPLASTY PULMONARY VALVE | 2011-07-01 00:00:00 | 968.72 | N | Y | N/A | N/A
92992 | ATRIAL SEPTECTOMY OR SEPTOSTOMY,TRANSVENOUS,BALLOO | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
92993 | BLADE METHOD | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
92997 | PRQ TRLUML PULMONARY ART BALLOON ANGIOP 1 VSL | 2011-07-01 00:00:00 | 573.75 | N | Y | N/A | N/A
92998 | PRQ TRLUML PULMONARY ART BALLOON ANGIOP EA VSL | 2011-07-01 00:00:00 | 288.55 | N | Y | N/A | N/A
93000 | ECG ROUTINE ECG W/LEAST 12 LDS W/I&R | 2011-07-01 00:00:00 | 16.79 | N | Y | N/A | N/A
93005 | ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R | 2011-07-01 00:00:00 | 9.12 | N | Y | N/A | N/A
93010 | ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY | 2011-07-01 00:00:00 | 7.68 | N | Y | N/A | N/A
93015 | [NAME] PHYS SI&R | 2011-07-01 00:00:00 | 79.4 | N | Y | N/A | N/A
93016 | [NAME] PHYS SUPVJ | 2011-07-01 00:00:00 | 20.28 | N | Y | N/A | N/A
93017 | [NAME] TRCG ONLY | 2011-07-01 00:00:00 | 45.74 | N | Y | N/A | N/A
93018 | [NAME] ONLY | 2011-07-01 00:00:00 | 13.38 | N | Y | N/A | N/A
93024 | ERGONOVINE PROVOCATION TST | 2011-07-01 00:00:00 | 100.67 | N | Y | 48.04 | 52.63
93025 | MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS | 2011-07-01 00:00:00 | 164.64 | N | Y | 130.51 | 34.13
93040 | RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT | 2011-07-01 00:00:00 | 11.28 | N | Y | N/A | N/A
93041 | RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R | 2011-07-01 00:00:00 | 4.79 | N | Y | N/A | N/A
93042 | RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ONLY | 2011-07-01 00:00:00 | 6.49 | N | Y | N/A | N/A
93224 | XTRNL ECG LT 48 HR RECORD SCAN STOR W/PHY R&I | 2011-07-01 00:00:00 | 82.75 | N | Y | N/A | N/A
93225 | XTRNL ECG LT 48 HR RECORDING | 2011-07-01 00:00:00 | 23.82 | N | Y | N/A | N/A
93226 | EXTERNAL ECG SCANNING ANALYSIS REPORT | 2011-07-01 00:00:00 | 35.06 | N | Y | N/A | N/A
93227 | XTRNL ECG [NAME] PHYS REVIEW&INTERPJ | 2011-07-01 00:00:00 | 23.86 | N | Y | N/A | N/A
93228 | XTRNL MOBILE CV TELEMETRY W/PHYS R&I W/REPORT | 2011-07-01 00:00:00 | 22.48 | N | Y | N/A | N/A
93268 | XTRNL PT ACTIV ECG TRANSMIS PHYS R&I 30 DAYS | 2011-07-01 00:00:00 | 213.37 | N | Y | N/A | N/A
93270 | XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS | 2011-07-01 00:00:00 | 12.86 | N | Y | N/A | N/A
93271 | XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS | 2011-07-01 00:00:00 | 177.8 | N | Y | N/A | N/A
93272 | XTRNL PT ACTIVTD ECG DWNLD 30 DAYS PHYS R&I | 2011-07-01 00:00:00 | 22.71 | N | Y | N/A | N/A
93278 | SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG | 2011-07-01 00:00:00 | 29.91 | N | Y | 18.92 | 10.99
93279 | PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER | 2011-07-01 00:00:00 | 45.38 | N | Y | 15.46 | 29.92
93280 | PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER | 2011-07-01 00:00:00 | 53.66 | N | Y | 18.05 | 35.61
93281 | PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER | 2011-07-01 00:00:00 | 62.53 | N | Y | 20.93 | 41.6
93282 | PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB | 2011-07-01 00:00:00 | 57.55 | N | Y | 18.63 | 38.92
93283 | PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB | 2011-07-01 00:00:00 | 73.82 | N | Y | 21.51 | 52.31
93284 | PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB | 2011-07-01 00:00:00 | 82.06 | N | Y | 24.4 | 57.66
93285 | PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM | 2011-07-01 00:00:00 | 38.17 | N | Y | 14.3 | 23.87
93286 | PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM | 2011-07-01 00:00:00 | 22.79 | N | Y | 9.98 | 12.81
93287 | PERI-PX EVAL&PROGRAM CARDIOVERTER/DEFIBRILLATOR | 2011-07-01 00:00:00 | 29.97 | N | Y | 10.85 | 19.12
93288 | INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM | 2011-07-01 00:00:00 | 34.26 | N | Y | 14.59 | 19.67
93289 | [NAME] 1/DUAL/MLT LEADS CVDFB | 2011-07-01 00:00:00 | 59.11 | N | Y | 18.05 | 41.06
93290 | [NAME] IMPLANTABLE CV MNTR SYS | 2011-07-01 00:00:00 | 26.48 | N | Y | 8.25 | 18.23
93291 | INTERROGATION EVALUATION IN PERSON ILR SYSTEM | 2011-07-01 00:00:00 | 32.82 | N | Y | 13.15 | 19.67
93292 | INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR | 2011-07-01 00:00:00 | 29.65 | N | Y | 9.98 | 19.67
93293 | TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL | 2011-07-01 00:00:00 | 47.91 | N | Y | 33.91 | 14
93294 | INTERROGATION EVAL REMOTE  LE OR 90 D 1/2/MLT LEAD PM | 2011-07-01 00:00:00 | 30.1 | N | Y | N/A | N/A
93295 | INTERROGATION EVAL REMOTE  LE OR 90 D 1/2/GT LD CVDFB | 2011-07-01 00:00:00 | 59.3 | N | Y | N/A | N/A
93296 | [NAME]LE OR 90 D TECHNICIAN REVIEW | 2011-07-01 00:00:00 | 27.57 | N | Y | N/A | N/A
93297 | INTERROGATION EVAL REMOTE  LE OR 30 D CV MNTR SYS | 2011-07-01 00:00:00 | 22.48 | N | Y | N/A | N/A
93298 | INTERROGATION EVALUATION REMOTE  LE OR 30 D ILR SYS | 2011-07-01 00:00:00 | 24.21 | N | Y | N/A | N/A
93303 | COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY | 2011-07-01 00:00:00 | 180.19 | N | Y | 122.15 | 58.04
93304 | F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY | 2011-07-01 00:00:00 | 114.76 | N | Y | 81.5 | 33.26
93306 | ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR DOP | 2011-07-01 00:00:00 | 199.22 | N | Y | 140.03 | 59.19
93307 | ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP | 2011-07-01 00:00:00 | 126.87 | N | Y | 85.24 | 41.63
93308 | ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD | 2011-07-01 00:00:00 | 90.09 | N | Y | 66.21 | 23.88
93312 | ECG TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R | 2011-07-01 00:00:00 | 277.51 | N | Y | 181.04 | 96.47
93313 | ECHO R-T 2D W/PROBE PLACEMENT ONLY | 2011-07-01 00:00:00 | 36.05 | N | Y | N/A | N/A
93314 | ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY | 2011-07-01 00:00:00 | 243.6 | N | Y | 188.53 | 55.07
93315 | ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R | 2011-07-01 00:00:00 | 247.16 | N | Y | 116.24 | 130.92
93316 | ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY | 2011-07-01 00:00:00 | 38.93 | N | Y | N/A | N/A
93317 | ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT | 2011-07-01 00:00:00 | 201.98 | N | Y | 116.24 | 85.74
93320 | DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY | 2011-07-01 00:00:00 | 53.5 | N | Y | 36.52 | 16.98
93321 | DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD | 2011-07-01 00:00:00 | 24.83 | N | Y | 18.05 | 6.78
93325 | DOP ECHOCARD COLOR FLOW VELOCITY MAPPING | 2011-07-01 00:00:00 | 30.18 | N | Y | 26.99 | 3.19
93350 | ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&STRS | 2011-07-01 00:00:00 | 180.36 | N | Y | 113.79 | 66.57
93351 | ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG | 2011-07-01 00:00:00 | 212.36 | N | Y | 132.01 | 80.34
93352 | USE OF ECHO CONTRAST AGENT DURING STRESS ECHO | 2011-07-01 00:00:00 | 31.07 | N | Y | N/A | N/A
93451 | RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT | 2011-07-01 00:00:00 | 645.65 | N | Y | 521.59 | 124.06
93452 | L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I | 2011-07-01 00:00:00 | 715.37 | N | Y | 498.23 | 217.14
93453 | R & L HRT CATH W/NJX L VENTRICULOG IMG S&I | 2011-07-01 00:00:00 | 936.37 | N | Y | 651.52 | 284.85
93454 | CATH PLMT & NJX CORONARY ART ANGIO IMG S&I | 2011-07-01 00:00:00 | 737.93 | N | Y | 518.99 | 218.94
93455 | CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I | 2011-07-01 00:00:00 | 861.13 | N | Y | 608.27 | 252.86
93456 | CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I | 2011-07-01 00:00:00 | 923.69 | N | Y | 643.16 | 280.53
93457 | CATH PLMT R HRT/ARTS/GRFTS W/NJX&ANGIO IMG S&I | 2011-07-01 00:00:00 | 1046.75 | N | Y | 732.27 | 314.48
93458 | CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I | 2011-07-01 00:00:00 | 890.46 | N | Y | 623.27 | 267.19
93459 | CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I | 2011-07-01 00:00:00 | 983.61 | N | Y | 682.67 | 300.94
93460 | R & L HRT CATH WINJX HRT ART& L VENTR IMG S&I | 2011-07-01 00:00:00 | 1052.6 | N | Y | 717.27 | 335.33
93461 | R&L HRT CATH W/INJEC HRT ART/GRFT&L VENT IMG S&I | 2011-07-01 00:00:00 | 1206.02 | N | Y | 836.24 | 369.78
93462 | LEFT HEART CATH BY TRANSEPTAL PUNCTURE | 2011-07-01 00:00:00 | 170.44 | N | Y | N/A | N/A
93463 | MEDICATION ADMIN & HEMODYNAMIC MEASURMENT | 2011-07-01 00:00:00 | 90.76 | N | Y | N/A | N/A
93464 | PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASURE | 2011-07-01 00:00:00 | 213.01 | N | Y | 133.11 | 79.9
93503 | INSERTION FLOW DIRECTED CATHETER FOR MONITORING | 2011-07-01 00:00:00 | 115.91 | N | Y | N/A | N/A
93505 | ENDOMYOCARDIAL BIOPSY | 2011-07-01 00:00:00 | 678.67 | N | Y | 468.24 | 210.43
93530 | R HRT CATHETERIZATION CONGENITAL CARDIAC ANOMALY | 2011-07-01 00:00:00 | 737.44 | N | Y | 533.36 | 204.08
93531 | CMBN R HRT & RETROGRADE L HRT CATHJ CGEN ANOMALY | 2011-07-01 00:00:00 | 1924.66 | N | Y | 1523.61 | 401.05
93561 | INDIC DIL STD ARTL&/OR VEN CATHJ W/OUTP MEAS | 2011-07-01 00:00:00 | 38.14 | N | Y | 16.67 | 21.47
93562 | INDIC DIL STD ARTL&/OR VEN CATHJ SBSQ OUTP MEAS | 2011-07-01 00:00:00 | 17.15 | N | Y | 10.64 | 6.51
93563 | NJX SEL HRT ART CONGENITAL HRT CATH W/S&I | 2011-07-01 00:00:00 | 48.38 | N | Y | N/A | N/A
93564 | NJX SEL HRT ART/GRFT CONGENITAL HRT CATH W/S&I | 2011-07-01 00:00:00 | 49.17 | N | Y | N/A | N/A
93565 | NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I | 2011-07-01 00:00:00 | 37.22 | N | Y | N/A | N/A
93566 | NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I | 2011-07-01 00:00:00 | 144.2 | N | Y | N/A | N/A
93567 | NJX SUPRAVALV AORTOG HRT CATH W/S&I | 2011-07-01 00:00:00 | 119.3 | N | Y | N/A | N/A
93568 | NJX PULMONARY ANGIO HRT CATH W/S&I | 2011-07-01 00:00:00 | 130.38 | N | Y | N/A | N/A
93571 | IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL | 2011-07-01 00:00:00 | 223.77 | N | Y | 141.14 | 82.63
93580 | PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT | 2011-07-01 00:00:00 | 883.06 | N | Y | N/A | N/A
93581 | PRQ TCAT CLSR CGEN VENTR SEPTAL DFCT W/IMPLT | 2011-07-01 00:00:00 | 1171.34 | N | N | N/A | N/A
93582 | PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS | 2014-01-01 00:00:00 | 575.84 | N | Y | N/A | N/A
93583 | PERCUTANEOUS TRANSCATHETER SEPTAL REDUCTION THER | 2014-01-01 00:00:00 | 640.93 | Y | Y | N/A | N/A
93600 | BUNDLE OF HIS RECORDING | 2011-07-01 00:00:00 | 158.16 | N | Y | 55.47 | 102.69
93602 | INTRA-ATRIAL RECORDING | 2011-07-01 00:00:00 | 130.9 | N | Y | 28.5 | 102.4
93603 | RIGHT VENTRICULAR RECORDING | 2011-07-01 00:00:00 | 148.92 | N | Y | 46.52 | 102.4
93609 | INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MANJ | 2011-07-01 00:00:00 | 311.71 | N | Y | 68.84 | 242.87
93610 | INTRA-ATRIAL PACING | 2011-07-01 00:00:00 | 179.04 | N | Y | 33.51 | 145.53
93612 | INTRAVENTRICULAR PACING | 2011-07-01 00:00:00 | 187.35 | N | Y | 42.4 | 144.95
93613 | INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING | 2011-07-01 00:00:00 | 340.68 | N | Y | N/A | N/A
93615 | ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS | 2011-07-01 00:00:00 | 50.49 | N | Y | 5.5 | 44.99
93618 | INDUCTION ARRHYTHMIA ELECTRICAL PACING | 2011-07-01 00:00:00 | 317.53 | N | Y | 120.81 | 207.3
93619 | COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION | 2011-07-01 00:00:00 | 584.17 | N | Y | 239.58 | 358.04
93620 | COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION | 2011-07-01 00:00:00 | 828.31 | N | Y | 273.28 | 564.83
93621 | COMPREHENSIVE ELECTROPHYSIOLOGIC EVAL W/LT ATRIAL (ADD-ON) | 2011-07-01 00:00:00 | N/A | N | N | N/A | 102.08
93623 | PROGRAMMED STIMULATION AND PACING (ADD-ON) | 2011-07-01 00:00:00 | N/A | N | N | N/A | 138.83
93624 | ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT | 2011-07-01 00:00:00 | 289.33 | N | Y | 59.94 | 235.22
93631 | INTRAOP EPICAR&ENDOCAR PACG&MAPG | 2011-07-01 00:00:00 | 540.29 | N | Y | 197.61 | 352.28
93640 | EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE | 2011-07-01 00:00:00 | 385.63 | N | Y | 223.71 | 170.8
93641 | EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN | 2011-07-01 00:00:00 | 494.42 | N | Y | 221.24 | 288.37
93642 | EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS | 2011-07-01 00:00:00 | 369.16 | N | Y | 145.28 | 223.88
93650 | ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION | 2011-07-01 00:00:00 | 519.36 | N | Y | N/A | N/A
93653 | EPHYS EVAL W/ ABLATION SUPRAVENT ARRHYTHMIA | 2013-01-01 00:00:00 | 681.47 | N | N | N/A | N/A
93654 | EPHYS EVAL W/ ABLATION VENTRICULAR TACHYCARDIA | 2013-01-01 00:00:00 | 909.45 | N | N | N/A | N/A
93655 | ICAR CATHETER ABLATION ARRHYTHMIA ADD ON | 2013-01-01 00:00:00 | 340.79 | N | N | N/A | N/A
93656 | EPHYS EVL TRNSPTL TX ATRIAL FIB ISOLAT PULM VEIN | 2013-01-01 00:00:00 | 909.79 | N | N | N/A | N/A
93657 | ABLATE L/R ATRIAL FIBRIL W/ ISOLATED PULM VEIN | 2013-01-01 00:00:00 | 340.97 | N | N | N/A | N/A
93660 | CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR | 2011-07-01 00:00:00 | 141.95 | N | Y | 55.83 | 86.12
93662 | INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I | 2011-07-01 00:00:00 | 261.59 | N | Y | N/A | 128.92
93701 | BIOMPEDANCE-DERIVED PHYSIOLOGIC [NAME] | 2011-07-01 00:00:00 | 22.67 | N | Y | N/A | N/A
93724 | ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM | 2011-07-01 00:00:00 | 261.26 | N | Y | 124.83 | 222.16
93740 | TEMPRATURE GRADIENT STUDY | 2008-07-01 00:00:00 | 19.9 | N | Y | N/A | 15.12
93745 | 1ST SET-UP&PRGRMG BY PHYS OF WEARABLE CVDFB | 2008-07-01 00:00:00 | 72.23 | N | Y | N/A | N/A
93750 | [NAME], IN PERSON | 2011-07-01 00:00:00 | 44.58 | N | N | N/A | N/A
93770 | DERMINATION OF VENOUS PRESSUE | 2008-07-01 00:00:00 | 18.77 | N | Y | N/A | 17.27
93784 | AMBL BLD PRESS W/TAPE&/DISK 24/GT HR ALYS I&R | 2011-07-01 00:00:00 | 53.09 | N | Y | N/A | N/A
93786 | AMBL BLD PRESS W/TAPE&/DISK 24/GT HR REC ONLY | 2011-07-01 00:00:00 | 26.42 | N | Y | N/A | N/A
93788 | AMBL BLD PRESS W/TAPE/DISK 24/GTHR ALYS W/REPRT | 2011-07-01 00:00:00 | 9.98 | N | Y | N/A | N/A
93790 | AMBL BLD PRESS TAPE&/DISK 24/GT HR PHYS REV W/I&R | 2011-07-01 00:00:00 | 16.7 | N | Y | N/A | N/A
93797 | OUTPATIENT CARDIAC REHAB W/O CONT ECG MONITOR | 2011-07-01 00:00:00 | 15.48 | N | Y | N/A | N/A
93798 | OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING | 2011-07-01 00:00:00 | 22.01 | N | Y | N/A | N/A
93799 | UNLISTED CARDIOVASCULAR SERVICE OR PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
93880 | DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY | 2011-07-01 00:00:00 | 156.2 | N | Y | 129.95 | 26.25
93882 | DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY | 2011-07-01 00:00:00 | 147.08 | N | Y | 129.65 | 17.43
93886 | TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL | 2011-07-01 00:00:00 | 170.91 | N | Y | 129.93 | 40.98
93888 | TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD | 2011-07-01 00:00:00 | 79.93 | N | Y | 52.78 | 27.15
93890 | TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY | 2011-07-01 00:00:00 | 124.7 | N | Y | 81.6 | 43.1
93892 | TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT | 2011-07-01 00:00:00 | 131.49 | N | Y | 81.61 | 49.88
93893 | TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ | 2011-07-01 00:00:00 | 131.78 | N | Y | 81.61 | 50.17
93922 | NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL | 2011-07-01 00:00:00 | 93.92 | N | Y | 83.22 | 10.7
93923 | NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS | 2011-07-01 00:00:00 | 145.26 | N | Y | 125.61 | 19.65
93924 | N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI | 2011-07-01 00:00:00 | 181.4 | N | Y | 159.63 | 21.75
93925 | DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY | 2011-07-01 00:00:00 | 154.89 | N | Y | 129.82 | 25.07
93926 | DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY | 2011-07-01 00:00:00 | 98.81 | N | Y | 81.78 | 17.13
93930 | DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY | 2011-07-01 00:00:00 | 149.9 | N | Y | 129.95 | 19.95
93931 | DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY | 2011-07-01 00:00:00 | 95.25 | N | Y | 81.77 | 13.46
93965 | N-INVAS PHYSIOLOGIC STD XTR VEINS COMPL BI STD | 2011-07-01 00:00:00 | 107.71 | N | Y | 92.45 | 15.26
93970 | DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY | 2011-07-01 00:00:00 | 159.74 | N | Y | 129.93 | 29.81
93971 | DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY | 2011-07-01 00:00:00 | 101.43 | N | Y | 81.78 | 19.65
93975 | DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COMPL | 2011-07-01 00:00:00 | 208.36 | N | Y | 129.82 | 78.54
93976 | DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMTD | 2011-07-01 00:00:00 | 182.47 | N | Y | 129.65 | 52.82
93978 | DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE | 2011-07-01 00:00:00 | 158.54 | N | Y | 129.94 | 28.6
93979 | DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD | 2011-07-01 00:00:00 | 100.84 | N | Y | 81.79 | 19.05
93980 | DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL | 2011-07-01 00:00:00 | 150.93 | N | Y | 95.91 | 55.02
93981 | DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD STD | 2011-07-01 00:00:00 | 102.68 | N | Y | 83.51 | 19.17
93982 | IMPLANT WIRELESS PRESS SENSOR STUDY ANEURYSM SAC | 2011-07-01 00:00:00 | 36.58 | N | N | N/A | N/A
93990 | DUPLEX SCAN HEMODIALYSIS ACCESS | 2011-07-01 00:00:00 | 92.55 | N | Y | 81.61 | 10.94
94002 | VENTILATION ASSIST & MGMT INPATIENT 1ST DAY | 2011-07-01 00:00:00 | 78.64 | N | Y | N/A | N/A
94003 | VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DAY | 2011-07-01 00:00:00 | 56.62 | N | Y | N/A | N/A
94004 | VENTILATION ASSIST & MGMT NURSING FAC PR DAY | 2011-07-01 00:00:00 | 41.32 | N | Y | N/A | N/A
94010 | SPMTRY W/VC EXPIRATORY FLO +-MXML VOL VNTJ | 2011-07-01 00:00:00 | 30.06 | N | Y | 22.67 | 7.39
94011 | MEAS SPIROMTRC FORCD EXPIRATORY FLO INFANTLT/2 YR | 2011-07-01 00:00:00 | 85.81 | N | N | N/A | N/A
94012 | MEAS SPIRO FRCD EXP FLO PRE&POST BRONCH INF LT/2Y | 2011-07-01 00:00:00 | 132.26 | N | N | N/A | N/A
94013 | [NAME] LT/2 YRS | 2011-07-01 00:00:00 | 27.23 | N | N | N/A | N/A
94014 | PT-INITIATE SPIROMETRIC RECORDING&PHYS R&I | 2011-07-01 00:00:00 | 42.2 | N | Y | N/A | N/A
94015 | PATIENT-INITIATED SPIROMETRIC RECORDING | 2011-07-01 00:00:00 | 20.65 | N | Y | N/A | N/A
94016 | PATIENT-INITIATED SPIROMETRIC PHYS R&I ONLY | 2011-07-01 00:00:00 | 21.56 | N | Y | N/A | N/A
94060 | BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN | 2011-07-01 00:00:00 | 51.93 | N | Y | 39.11 | 12.83
94070 | BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT | 2011-07-01 00:00:00 | 51.35 | N | Y | 26.42 | 24.93
94150 | VITAL CAPACITY TOTAL SEPARATE PROCEDURE | 2008-07-01 00:00:00 | 9.71 | N | Y | N/A | 7.09
94200 | MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ | 2011-07-01 00:00:00 | 20.44 | N | Y | 15.75 | 4.69
94250 | EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX | 2011-07-01 00:00:00 | 21.59 | N | Y | 16.9 | 10.72
94375 | RESPIRATORY FLOW VOLUME LOOP | 2011-07-01 00:00:00 | 32.9 | N | Y | 20.07 | 12.83
94400 | BREATHING RESPONSE TO CO2 | 2011-07-01 00:00:00 | 46.04 | N | Y | 29.58 | 16.44
94450 | BREATHING RESPONSE TO HYPOXIA | 2011-07-01 00:00:00 | 50.64 | N | Y | 33.91 | 16.73
94610 | INTRAPULMONARY SURFACTANT ADMINISTRATION | 2011-07-01 00:00:00 | 51.4 | N | Y | N/A | N/A
94620 | PULMONARY STRESS TESTING SIMPLE | 2011-07-01 00:00:00 | 54.59 | N | Y | 27.86 | 26.73
94621 | PULMONARY STRESS TESTING COMPLEX | 2011-07-01 00:00:00 | 139.91 | N | Y | 79.76 | 60.16
94640 | PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT | 2011-07-01 00:00:00 | 13.44 | N | Y | N/A | N/A
94642 | PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH | 2008-07-01 00:00:00 | 37.37 | N | Y | N/A | N/A
94644 | [NAME] 1ST HR | 2011-07-01 00:00:00 | 33.91 | N | Y | N/A | N/A
94645 | [NAME] ADDL HR | 2011-07-01 00:00:00 | 12.29 | N | Y | N/A | N/A
94660 | CPAP VENTILATION CPAP INITIATION&MGMT | 2011-07-01 00:00:00 | 51.22 | N | Y | N/A | N/A
94662 | [NAME] VENTJ INITIAT&MGMT | 2011-07-01 00:00:00 | 31.32 | N | Y | N/A | N/A
94664 | DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IPPB | 2011-07-01 00:00:00 | 13.44 | N | Y | N/A | N/A
94667 | MANJ CH WALL FACILITATE LNG FUNCJ 1 DEMO&/EVAL | 2011-07-01 00:00:00 | 18.92 | N | Y | N/A | N/A
94668 | MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ | 2011-07-01 00:00:00 | 18.34 | N | Y | N/A | N/A
94669 | MECHANICAL CHEST WALL OSCILLATION LUNG FUNCTION | 2014-01-01 00:00:00 | 28.49 | N | Y | N/A | N/A
94680 | O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMPLE | 2011-07-01 00:00:00 | 50.11 | N | Y | 39.11 | 11.01
94681 | O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC | 2011-07-01 00:00:00 | 48.56 | N | Y | 40.26 | 8.31
94690 | O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX | 2011-07-01 00:00:00 | 43.72 | N | Y | 40.55 | 3.18
94726 | PLETHYSMOGRAPHY LUNG [NAME] RESIST | 2012-01-01 00:00:00 | 43.85 | N | N | 33.24 | 10.61
94727 | GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL | 2012-01-01 00:00:00 | 34.62 | N | N | 24.01 | 10.61
94728 | AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY | 2012-01-01 00:00:00 | 34.62 | N | N | 24.01 | 10.61
94729 | DIFFUSING CAPACITY | 2012-01-01 00:00:00 | 43.37 | N | N | 36.33 | 7.04
94750 | PULMONARY COMPLIANCE STUDY | 2011-07-01 00:00:00 | 66.2 | N | Y | 56.69 | 9.51
94760 | NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER | 2011-07-01 00:00:00 | 2.2 | N | Y | N/A | N/A
94761 | NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER | 2011-07-01 00:00:00 | 3.64 | N | Y | N/A | N/A
94762 | NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR | 2011-07-01 00:00:00 | 16.9 | N | Y | N/A | N/A
94770 | CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER | 2011-07-01 00:00:00 | 19.53 | N | Y | N/A | N/A
94772 | CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT | 2008-07-01 00:00:00 | 205.09 | N | Y | N/A | 106.65
94780 | CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN | 2012-01-01 00:00:00 | 42.09 | N | N | N/A | N/A
94781 | CAR SEAT/BED TESTNG W/INTERP & REPORT +30MIN | 2012-01-01 00:00:00 | 16.34 | N | N | N/A | N/A
94799 | UNLISTED PULMONARY SERVICE OR PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
95004 | PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS | 2011-07-01 00:00:00 | 5.38 | N | Y | N/A | N/A
95012 | NITRIC OXIDE EXPIRED GAS [NAME] | 2011-07-01 00:00:00 | 17.48 | N | Y | N/A | N/A
95017 | ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R | 2013-01-01 00:00:00 | 7.25 | N | N | N/A | N/A
95018 | ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R | 2013-01-01 00:00:00 | 6.11 | N | N | N/A | N/A
95024 | INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS | 2011-07-01 00:00:00 | 6.25 | N | Y | N/A | N/A
95027 | INTRACUTANEOUS TESTS W/ALLERGENIC XTRCS AIRBORNE | 2011-07-01 00:00:00 | 3.94 | N | Y | N/A | N/A
95028 | IQ TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING | 2011-07-01 00:00:00 | 10.56 | N | Y | N/A | N/A
95044 | PATCH/APPLICATION TEST SPECIFY NUMBER TESTS | 2011-07-01 00:00:00 | 5.08 | N | Y | N/A | N/A
95052 | PHOTO PATCH TEST SPECIFY NUMBER TSTS | 2011-07-01 00:00:00 | 5.94 | N | Y | N/A | N/A
95056 | PHOTO TESTS | 2011-07-01 00:00:00 | 34.49 | N | Y | N/A | N/A
95060 | OPHTHALMIC MUCOUS MEMBRANE TESTS | 2011-07-01 00:00:00 | 24.11 | N | Y | N/A | N/A
95065 | DIRECT NASAL MUCOUS MEMBRANE TEST | 2011-07-01 00:00:00 | 20.65 | N | Y | N/A | N/A
95070 | INHLJ BRNCL CHALLENGE TSTG W/HISTAM/METHACHOL | 2011-07-01 00:00:00 | 32.18 | N | Y | N/A | N/A
95071 | INHLJ BRNCL CHALLENGE TSTG W/AGS/GASES | 2011-07-01 00:00:00 | 43.14 | N | Y | N/A | N/A
95076 | INGESTION CHALLENGE TEST INITIAL 120 MINUTES | 2013-01-01 00:00:00 | 98.6 | N | N | N/A | N/A
95079 | INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES | 2013-01-01 00:00:00 | 70.28 | N | N | N/A | N/A
95115 | PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX | 2011-07-01 00:00:00 | 8.54 | N | Y | N/A | N/A
95117 | PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS | 2011-07-01 00:00:00 | 10.56 | N | Y | N/A | N/A
95120 | PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX | 2008-07-01 00:00:00 | 18.03 | N | Y | N/A | N/A
95125 | PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/GT NJXS | 2008-07-01 00:00:00 | 24.05 | N | Y | N/A | N/A
95130 | PROF SVCS ALLG IMMNTX W/PRV XTRC 1 STING INSECT | 2008-07-01 00:00:00 | 18.03 | N | Y | N/A | N/A
95131 | PROF SVCS ALLG IMMNTX W/PRV XTRC 2 STING INSECT | 2008-07-01 00:00:00 | 24.05 | N | Y | N/A | N/A
95132 | PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 3 INSECT | 2008-07-01 00:00:00 | 30.04 | N | Y | N/A | N/A
95133 | PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 4 INSECT | 2008-07-01 00:00:00 | 36.04 | N | Y | N/A | N/A
95134 | PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 5 INSECT | 2008-07-01 00:00:00 | 42.07 | N | Y | N/A | N/A
95144 | PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DOSE | 2011-07-01 00:00:00 | 10.66 | N | Y | N/A | N/A
95145 | PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT | 2011-07-01 00:00:00 | 16.14 | N | Y | N/A | N/A
95146 | PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECTS | 2011-07-01 00:00:00 | 28.25 | N | Y | N/A | N/A
95147 | PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 3 INSECTS | 2011-07-01 00:00:00 | 26.52 | N | Y | N/A | N/A
95148 | PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECTS | 2011-07-01 00:00:00 | 38.34 | N | Y | N/A | N/A
95149 | PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECTS | 2011-07-01 00:00:00 | 51.03 | N | Y | N/A | N/A
95165 | PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN | 2011-07-01 00:00:00 | 10.66 | N | Y | N/A | N/A
95170 | PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSECT | 2011-07-01 00:00:00 | 8.35 | N | Y | N/A | N/A
95180 | RAPID DESENSITIZATION PROCEDURE EACH HOUR | 2011-07-01 00:00:00 | 122.38 | N | Y | N/A | N/A
95199 | UNLISTED ALLERGY/CLINICAL IMMUNOLOGIC SERVICE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
95250 | GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID | 2011-07-01 00:00:00 | 125.61 | N | Y | N/A | N/A
95251 | GLUC MNTR CONT REC FROM NTRSTL TISS FLU I&R | 2011-07-01 00:00:00 | 36.5 | N | Y | N/A | N/A
95782 | POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND | 2013-01-01 00:00:00 | 846.81 | N | N | 736.61 | 110.21
95783 | POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM | 2013-01-01 00:00:00 | 903.87 | N | N | 783.51 | 120.36
95800 | SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME | 2011-07-01 00:00:00 | 175.72 | N | Y | 125.04 | 50.69
95801 | SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL | 2011-07-01 00:00:00 | 83.36 | N | Y | 38.53 | 44.83
95803 | ACTIGRAPHY TESTING RECORDING ANALYSIS I&R | 2011-07-01 00:00:00 | 138.83 | N | N | 97.93 | 40.91
95805 | MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG | 2011-07-01 00:00:00 | 349.52 | N | Y | 295.4 | 54.12
95806 | SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATTN | 2011-07-01 00:00:00 | 155.84 | N | Y | 100.87 | 54.95
95807 | SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN | 2011-07-01 00:00:00 | 399.33 | N | Y | 344.03 | 55.3
95808 | POLYSOMNOGRAPHY SLEEP STAGING 1-3 ADDL PARAM | 2011-07-01 00:00:00 | 552.45 | N | Y | 473.79 | 78.65
95810 | POLYSOMNOGRAPHY SLEEP STAGING 4/GT ADDL PARAM | 2011-07-01 00:00:00 | 591.09 | N | Y | 481.46 | 109.63
95811 | POLYSM SLEEP STAGING 4/GT ADDL PARAM W/CPAP TX | 2011-07-01 00:00:00 | 637.75 | N | Y | 523.16 | 114.59
95812 | ELECTROENCEPHALOGRAM EXTND MNTR 41-60 MIN | 2011-07-01 00:00:00 | 268.4 | N | Y | 221.12 | 47.28
95813 | ELECTROENCEPHALOGRAM EXTND MNTR GT 1 HR | 2011-07-01 00:00:00 | 303.1 | N | Y | 227.64 | 75.47
95816 | ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY | 2011-07-01 00:00:00 | 248.67 | N | Y | 200.93 | 47.75
95819 | ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP | 2011-07-01 00:00:00 | 277.34 | N | Y | 229.77 | 47.57
95822 | ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY | 2011-07-01 00:00:00 | 259.46 | N | Y | 211.89 | 47.57
95824 | ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY | 2011-07-01 00:00:00 | 51.69 | N | Y | 13.69 | 32.73
95827 | ELECTROENCEPHALOGRAM ALL NIGHT RECORDING | 2011-07-01 00:00:00 | 475.05 | N | Y | 427.59 | 47.45
95829 | ELECTROCORTICOGRAM SURGERY SPX | 2011-07-01 00:00:00 | 1276.05 | N | Y | 1004.65 | 271.4
95830 | INSERTION SPHENOIDAL ELECTRODES EEG RECORDING | 2011-07-01 00:00:00 | 163.14 | N | Y | N/A | N/A
95831 | MUSC TSTG MNL W/REPRT XTR EX HAND/TRNK | 2011-07-01 00:00:00 | 24.66 | N | Y | N/A | N/A
95832 | MUSC TSTG MNL W/REPRT HAND W/WO CMPRSN NRML SIDE | 2011-07-01 00:00:00 | 23.81 | N | Y | N/A | N/A
95833 | MUSC TSTG MNL W/REPRT TOTAL EVAL BODY EX HANDS | 2011-07-01 00:00:00 | 31.85 | N | Y | N/A | N/A
95834 | MUSC TSTG MNL W/REPRT TOTAL EVAL BODY W/HANDS | 2011-07-01 00:00:00 | 39.92 | N | Y | N/A | N/A
95851 | ROM MEAS&REPRT EA XTR EX HAND/EA TRNK SCTJ SPINE | 2011-07-01 00:00:00 | 14.87 | N | Y | N/A | N/A
95852 | ROM MEAS&REPRT HAND W/WO COMPARISON NORMAL SIDE | 2011-07-01 00:00:00 | 12.47 | N | Y | N/A | N/A
95857 | CHOLINESTERASE INHIBITOR CHALLENGE TEST | 2011-07-01 00:00:00 | 40.27 | N | Y | N/A | N/A
95860 | NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS | 2011-07-01 00:00:00 | 77.92 | N | Y | 34.49 | 43.43
95861 | NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS | 2011-07-01 00:00:00 | 113.31 | N | Y | 44 | 69.3
95863 | NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS | 2011-07-01 00:00:00 | 136.73 | N | Y | 53.52 | 83.21
95864 | NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS | 2011-07-01 00:00:00 | 150.2 | N | Y | 61.31 | 88.89
95865 | NEEDLE ELECTROMYOGRAPHY LARYNX | 2011-07-01 00:00:00 | 103.67 | N | Y | 32.47 | 71.2
95866 | NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM | 2011-07-01 00:00:00 | 89.45 | N | Y | 33.62 | 55.83
95867 | NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI | 2011-07-01 00:00:00 | 68.98 | N | Y | 33.34 | 35.64
95868 | NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI | 2011-07-01 00:00:00 | 93.76 | N | Y | 41.12 | 52.64
95869 | NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12 | 2011-07-01 00:00:00 | 50.01 | N | Y | 33.34 | 16.68
95870 | NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI | 2011-07-01 00:00:00 | 48.86 | N | Y | 32.47 | 16.39
95872 | NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER | 2011-07-01 00:00:00 | 154.47 | N | Y | 29.58 | 124.88
95873 | ELECTRICAL STIMULATION GUID W/CHEMODENERVATION | 2011-07-01 00:00:00 | 49.73 | N | Y | 32.47 | 17.25
95874 | NEEDLE EMG GUID W/CHEMODENERVATION | 2011-07-01 00:00:00 | 47.42 | N | Y | 30.74 | 16.68
95875 | [NAME] ACQUISJ METAB | 2011-07-01 00:00:00 | 90.34 | N | Y | 41.7 | 48.65
95885 | NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED | 2012-01-01 00:00:00 | 45.87 | N | N | 30.58 | 15.29
95886 | NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE | 2012-01-01 00:00:00 | 73.02 | N | N | 32.23 | 40.79
95887 | NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION | 2012-01-01 00:00:00 | 64.82 | N | N | 32.78 | 32.04
95905 | MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB | 2011-07-01 00:00:00 | 71.37 | N | N | 68.81 | 2.57
95907 | NERVE CONDUCTION STUDIES 1-2 STUDIES | 2013-01-01 00:00:00 | 78.81 | N | N | 34.23 | 44.59
95908 | NERVE CONDUCTION STUDIES 3-4 STUDIES | 2013-01-01 00:00:00 | 97.33 | N | N | 41.35 | 55.99
95909 | NERVE CONDUCTION STUDIES 5-6 STUDIES | 2013-01-01 00:00:00 | 116.58 | N | N | 49.65 | 66.92
95910 | NERVE CONDUCTION STUDIES 7-8 STUDIES | 2013-01-01 00:00:00 | 153.52 | N | N | 64.07 | 89.45
95911 | NERVE CONDUCTION STUDIES 9-10 STUDIES | 2013-01-01 00:00:00 | 186.08 | N | N | 74.3 | 111.79
95912 | NERVE CONDUCTION STUDIES 11-12 STUDIES | 2013-01-01 00:00:00 | 218.1 | N | N | 84.06 | 134.04
95913 | NERVE CONDUCTION STUDIES 13/> STUDIES | 2013-01-01 00:00:00 | 253.04 | N | N | 94.01 | 159.04
95924 | TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT | 2013-01-01 00:00:00 | 123.62 | N | N | 48.92 | 74.71
95925 | SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS | 2011-07-01 00:00:00 | 133.65 | N | Y | 110.04 | 23.61
95926 | SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS | 2011-07-01 00:00:00 | 129.38 | N | Y | 105.43 | 23.96
95927 | SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD | 2011-07-01 00:00:00 | 121.54 | N | Y | 97.64 | 23.9
95928 | CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS | 2011-07-01 00:00:00 | 199.87 | N | Y | 133.75 | 66.12
95929 | CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS | 2011-07-01 00:00:00 | 211.69 | N | Y | 145.28 | 66.41
95930 | VISUAL EP TSTG CNS CHECKERBOARD/FLASH | 2011-07-01 00:00:00 | 113.42 | N | Y | 97.93 | 15.49
95933 | ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST | 2011-07-01 00:00:00 | 63.44 | N | Y | 37.09 | 26.34
95937 | NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH | 2011-07-01 00:00:00 | 55.35 | N | Y | 26.42 | 28.94
95938 | SHORT-LATENCY SOMATOSENS EP STD UPR & LOW [NAME] | 2012-01-01 00:00:00 | 240.16 | N | N | 202.67 | 37.49
95939 | CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LIMB | 2012-01-01 00:00:00 | 378.42 | N | N | 279.81 | 98.62
95940 | IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES | 2013-01-01 00:00:00 | 27.41 | N | N | N/A | N/A
95941 | IONM REMOTE/NEARBY/>1 PATIENT IN OR PER HOUR | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
95943 | PARASYMP & SYMP NRV FUNCJ HRT RATE VARIABILITY | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
95950 | MONITOR ID& LATERALIZATION SEIZURE FOCUS EEG | 2011-07-01 00:00:00 | 231.03 | N | Y | 164.6 | 66.43
95951 | LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO | 2011-07-01 00:00:00 | 1453.61 | N | Y | 1161.2 | 267.98
95953 | LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG | 2011-07-01 00:00:00 | 353.68 | N | Y | 216.79 | 136.89
95954 | RX/PHYSICAL ACTIVAJ PHYS ATTN DURING EEG ACTIVAJ | 2011-07-01 00:00:00 | 265.84 | N | Y | 166.22 | 99.62
95955 | EEG NONINTRACRANIAL SURGERY | 2011-07-01 00:00:00 | 143.64 | N | Y | 99.66 | 43.98
95956 | [NAME] CMPTR 16GTCHAN EEG ATND EA 24 HR | 2011-07-01 00:00:00 | 859.37 | N | Y | 704.38 | 155
95957 | DIGITAL ANALYSIS ELECTROENCEPHALOGRAM | 2011-07-01 00:00:00 | 289.69 | N | Y | 202.31 | 87.38
95958 | WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG | 2011-07-01 00:00:00 | 389.39 | N | Y | 202.84 | 186.56
95961 | FUNCJAL CORT&SUBCORT MAPG ELTRDS 1 HR PHYS ATTN | 2011-07-01 00:00:00 | 216.57 | N | Y | 84.09 | 132.48
95962 | FUNCJAL CORT&SUBCORT MAPG ELTRDS EA HR PHYS ATTN | 2011-07-01 00:00:00 | 195.65 | N | Y | 53.81 | 141.84
95970 | ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM | 2011-07-01 00:00:00 | 50.22 | N | Y | N/A | N/A
95971 | ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG | 2011-07-01 00:00:00 | 49.59 | N | Y | N/A | N/A
95972 | ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR | 2011-07-01 00:00:00 | 91.28 | N | Y | N/A | N/A
95973 | ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH EA 30 MIN | 2011-07-01 00:00:00 | 51.44 | N | Y | N/A | N/A
95974 | ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV 1ST HR | 2011-07-01 00:00:00 | 159.15 | N | Y | N/A | N/A
95975 | ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV EA 30 MIN | 2011-07-01 00:00:00 | 86.38 | N | Y | N/A | N/A
95978 | ELEC ALYS NSTIM PLS GEN CPLX DP BRN 1ST HR | 2011-07-01 00:00:00 | 191.82 | N | Y | N/A | N/A
95979 | ELEC ALYS NSTIM PLS GEN CPLX DP BRN EA 30 MIN | 2011-07-01 00:00:00 | 84.32 | N | Y | N/A | N/A
95980 | ELEC ALYS NSTIM PLS GEN GASTRIC INTRAOP W/PRGRMG | 2011-07-01 00:00:00 | 37.94 | N | Y | N/A | N/A
95981 | ELEC ALYS NSTIM GEN GASTRIC SBSQ W/O REPRGRMG | 2011-07-01 00:00:00 | 26.14 | N | Y | N/A | N/A
95982 | ELEC ALYS NSTIM PLS GEN GASTRIC SBSQ W/REPRGRMG | 2011-07-01 00:00:00 | 40.93 | N | Y | N/A | N/A
95990 | REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN | 2011-07-01 00:00:00 | 63.68 | N | Y | N/A | N/A
95991 | RFL&MAIN IMPLT PMP/RSVR RX DLVR SPI/BRN BY PHYS | 2011-07-01 00:00:00 | 90.16 | N | Y | N/A | N/A
95992 | CANALITH REPOSITIONING PROCEDURE | 2011-07-01 00:00:00 | 36.78 | N | Y | N/A | N/A
95999 | UNLISTED NEUROLOGICAL OR NEUROMUSCULAR DX PROCEDUR | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
96000 | COMPRE CPTR MTN ALYS VIDEO TAPING 3-D KINEMATICS | 2011-07-01 00:00:00 | 79.17 | N | Y | N/A | N/A
96001 | COMPRE CPTR MTN ALYS W/DYN PLNTR PRES MEAS WALKG | 2011-07-01 00:00:00 | 87.45 | N | Y | N/A | N/A
96002 | DYN SURF EMG WALKG/FUNCJAL ACTV 1-12 MUSC | 2011-07-01 00:00:00 | 18.25 | N | Y | N/A | N/A
96003 | DYN FINE WIRE EMG WALKG/FUNCJAL ACTV 1 MUSC | 2011-07-01 00:00:00 | 16.16 | N | Y | N/A | N/A
96004 | PHYS R&I CPTR MTN ALYS WALKG/FUNCJAL ACTV REPRT | 2011-07-01 00:00:00 | 96.72 | N | Y | N/A | N/A
96101 | PSYCHOLOGICAL TESTING PR HR WITH PATIENT | 2011-07-01 00:00:00 | 72.81 | N | Y | N/A | N/A
96102 | PSYCHOLOGICAL TESTING ADMN BY TECH PR HR | 2011-07-01 00:00:00 | 57.05 | N | Y | N/A | N/A
96103 | PSYCHOLOGICAL TESTING COMPUTER W/PROF I&R | 2011-07-01 00:00:00 | 48.13 | N | Y | N/A | N/A
96105 | ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR | 2011-07-01 00:00:00 | 93.14 | N | Y | N/A | N/A
96110 | DEVELOPMENTAL SCREENING W/INTERP&REPRT STD FORM | 2011-07-01 00:00:00 | 6.8 | N | Y | N/A | N/A
96111 | DEVELOPMENTAL TESTING W/INTERP & REPORT | 2011-07-01 00:00:00 | 109.13 | N | Y | N/A | N/A
96116 | NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ | 2011-07-01 00:00:00 | 79.39 | N | Y | N/A | N/A
96118 | NUROPSYC TESTING PR HR W/PT & INTERPJ TIME | 2011-07-01 00:00:00 | 84.92 | N | Y | N/A | N/A
96119 | NUROPSYC TSTG WPROF I&R ADMN BY TECH PR HR | 2011-07-01 00:00:00 | 60.53 | N | Y | N/A | N/A
96120 | NEUROPSYCHOLOG TESTING COMPUTER W/PROF I&R | 2011-07-01 00:00:00 | 70.34 | N | Y | N/A | N/A
96125 | STANDARDIZED COGNITIVE PERFORMANCE TESTING | 2011-07-01 00:00:00 | 81.76 | Y | N | N/A | N/A
96150 | HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT 1ST ASSMT | 2011-07-01 00:00:00 | 18.64 | N | Y | N/A | N/A
96151 | HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT RE-ASSMT | 2011-07-01 00:00:00 | 18.03 | N | Y | N/A | N/A
96152 | HLTH&BEHAVIOR IVNTJ EA 15 MIN INDIV | 2011-07-01 00:00:00 | 17.13 | N | Y | N/A | N/A
96153 | HLTH&BEHAVIOR IVNTJ EA 15 MIN GRP 2/GT PTS | 2011-07-01 00:00:00 | 4.1 | N | Y | N/A | N/A
96154 | HLTH&BEHAVIOR IVNTJ EA 15 MIN FAM W/PT | 2011-07-01 00:00:00 | 16.82 | N | Y | N/A | N/A
96360 | [NAME] INITIAL 31 MIN-1 HOUR | 2011-07-01 00:00:00 | 48.4 | N | Y | N/A | N/A
96361 | IV INFUSION HYDRATION EACH ADDITIONAL HOUR | 2011-07-01 00:00:00 | 13.02 | N | Y | N/A | N/A
96365 | IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR | 2011-07-01 00:00:00 | 60.29 | N | Y | N/A | N/A
96366 | IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR | 2011-07-01 00:00:00 | 18.66 | N | Y | N/A | N/A
96367 | [NAME] ADDL SEQUENTIAL TO 1 HR | 2011-07-01 00:00:00 | 28.19 | N | Y | N/A | N/A
96368 | IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS | 2011-07-01 00:00:00 | 16.62 | N | Y | N/A | N/A
96369 | [NAME] INITIAL 1 HR W/PUMP SET-UP | 2011-07-01 00:00:00 | 145.07 | N | Y | N/A | N/A
96370 | [NAME] EACH ADDITIONAL HOUR | 2011-07-01 00:00:00 | 13.18 | N | Y | N/A | N/A
96371 | SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE | 2011-07-01 00:00:00 | 67.94 | N | Y | N/A | N/A
96372 | THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM | 2011-07-01 00:00:00 | 19.79 | N | Y | N/A | N/A
96373 | THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL | 2011-07-01 00:00:00 | 16.34 | N | Y | N/A | N/A
96374 | THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG | 2011-07-01 00:00:00 | 47.27 | N | Y | N/A | N/A
96375 | THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG | 2011-07-01 00:00:00 | 19.38 | N | Y | N/A | N/A
96379 | UNLIS THERAPUTIC PROPHYLACTIC OR DIAG IV OR INTRA-ARTERIAL INJ OR INFUSION | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
96401 | CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO | 2011-07-01 00:00:00 | 61.62 | N | Y | N/A | N/A
96402 | CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO | 2011-07-01 00:00:00 | 29.92 | N | Y | N/A | N/A
96405 | CHEMOTHERAPY ADMINISTRATION INTRALESIONAL LT/7 | 2011-07-01 00:00:00 | 73.52 | N | Y | N/A | N/A
96406 | CHEMOTHERAPY ADMINISTRATION INTRALESIONAL GT 7 | 2011-07-01 00:00:00 | 101.29 | N | Y | N/A | N/A
96409 | CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG | 2011-07-01 00:00:00 | 95.59 | N | Y | N/A | N/A
96411 | CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG | 2011-07-01 00:00:00 | 53.64 | N | Y | N/A | N/A
96413 | CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG | 2011-07-01 00:00:00 | 124.2 | N | Y | N/A | N/A
96415 | CHEMOTHERAPY ADMN IV INFUSION TQ EA HR | 2011-07-01 00:00:00 | 26.75 | N | Y | N/A | N/A
96416 | CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP | 2011-07-01 00:00:00 | 136.54 | N | Y | N/A | N/A
96417 | CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR | 2011-07-01 00:00:00 | 61.44 | N | Y | N/A | N/A
96420 | CHEMOTHERAPY ADMIN INTRA-ARTERIAL PUSH TQ | 2011-07-01 00:00:00 | 91.95 | N | Y | N/A | N/A
96422 | CHEMOTHERAPY ADMIN INTRA-ARTERIAL INFUS LT/1 HR | 2011-07-01 00:00:00 | 148.19 | N | Y | N/A | N/A
96423 | CHEMOTHERAPY ADMN INTRAARTERIAL INFUSION EA HR | 2011-07-01 00:00:00 | 67.61 | N | Y | N/A | N/A
96425 | CHEMOTX ADMN IA NFS GT 8 HR PRTBLE IMPLTBL PMP | 2011-07-01 00:00:00 | 151.7 | N | Y | N/A | N/A
96440 | CHEMOTX ADMN PLEURAL CAVITY REQ&W/THORACNTS | 2011-07-01 00:00:00 | 616.54 | N | Y | N/A | N/A
96446 | CHEMOTX ADMN PRTL CAVITY PORT/CATH | 2011-07-01 00:00:00 | 150.08 | N | Y | N/A | N/A
96450 | CHEMOTX ADMN CNS REQ SPINAL PUNCTURE | 2011-07-01 00:00:00 | 170.11 | N | Y | N/A | N/A
96521 | REFILLING & MAINTENANCE PORTABLE PUMP | 2011-07-01 00:00:00 | 112.83 | N | Y | N/A | N/A
96522 | REFILL&MAINTENANCE PUMP DRUG DLVR SYSTEMIC | 2011-07-01 00:00:00 | 94.1 | N | Y | N/A | N/A
96523 | IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST | 2011-07-01 00:00:00 | 21.58 | N | Y | N/A | N/A
96542 | CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT | 2011-07-01 00:00:00 | 108.7 | N | Y | N/A | N/A
96549 | UNLISTED CHEMOTHERAPY PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
96567 | PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX | 2011-07-01 00:00:00 | 110.91 | N | Y | N/A | N/A
96570 | PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX 30 MIN | 2011-07-01 00:00:00 | 50.34 | N | Y | N/A | N/A
96571 | PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX A 15 MIN | 2011-07-01 00:00:00 | 23.57 | N | Y | N/A | N/A
96900 | ACTINOTHERAPY ULTRAVIOLET LIGHT | 2011-07-01 00:00:00 | 17.48 | N | Y | N/A | N/A
96902 | MCRSCP XM HAIR PLUCK/CLIP FOR CNTS/STRUCT ABNORM | 2008-07-01 00:00:00 | 9.71 | N | Y | N/A | N/A
96910 | PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB | 2011-07-01 00:00:00 | 58.72 | N | Y | N/A | N/A
96912 | PHOTOCHEMOTX PSORALENS&ULTRAVIOLET PUVA | 2011-07-01 00:00:00 | 75.44 | N | Y | N/A | N/A
96913 | PHOTOCHEMOTHERAPY DERMATOSES 4-8 HRS SUPERVISION | 2011-07-01 00:00:00 | 104.85 | N | Y | N/A | N/A
96920 | LASER SKIN DISEASE PSORIASIS TOT AREA LT250 SQ CM | 2011-07-01 00:00:00 | 148.62 | N | Y | N/A | N/A
96921 | LASER SKIN DISEASE PSORIASIS 250-500 SQ CM | 2011-07-01 00:00:00 | 148.93 | N | Y | N/A | N/A
96922 | LASER SKIN DISEASE PSORIASIS GT500 SQ CM | 2011-07-01 00:00:00 | 214.7 | N | Y | N/A | N/A
96999 | UNLISTED DERMATOLOGICAL SERVICE OR PROCEDURE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
97001 | PHYSICAL THERAPY EVALUATION | 2011-07-01 00:00:00 | 62.95 | N | Y | N/A | N/A
97002 | PHYSICAL THERAPY RE-EVALUATION | 2011-07-01 00:00:00 | 34.73 | N | Y | N/A | N/A
97003 | OCCUPATIONAL THERAPY EVALUATION | 2011-07-01 00:00:00 | 69.29 | N | Y | N/A | N/A
97004 | OCCUPATIONAL THERAPY RE-EVALUATION | 2011-07-01 00:00:00 | 41.94 | N | Y | N/A | N/A
97012 | APPL MODALITY 1/GT AREAS TRACTION MECHANICAL | 2011-07-01 00:00:00 | 13.3 | N | Y | N/A | N/A
97016 | APPL MODALITY 1/GT AREAS VASOPNEUMATIC DEVICES | 2011-07-01 00:00:00 | 14.9 | N | Y | N/A | N/A
97018 | APPL MODALITY 1/GT AREAS PARAFFIN BATH | 2011-07-01 00:00:00 | 8.06 | N | Y | N/A | N/A
97022 | APPLICATION MODALITY 1/GT AREAS WHIRLPOOL | 2011-07-01 00:00:00 | 17.49 | N | Y | N/A | N/A
97024 | APPLICATION MODALITY 1/GT AREAS DIATHERMY | 2011-07-01 00:00:00 | 5.18 | N | Y | N/A | N/A
97026 | APPLICATION MODALITY 1/GT AREAS INFRARED | 2011-07-01 00:00:00 | 4.61 | N | Y | N/A | N/A
97028 | APPL MODALITY 1/GT AREAS ULTRAVIOLET | 2011-07-01 00:00:00 | 5.8 | N | Y | N/A | N/A
97032 | APPL MODALITY 1/GT AREAS ELEC STIMJ EA 15 MIN | 2011-07-01 00:00:00 | 15.32 | N | Y | N/A | N/A
97033 | APPL MODALITY 1/GT AREAS IONTOPHORESIS EA 15 MIN | 2011-07-01 00:00:00 | 24.27 | N | Y | N/A | N/A
97034 | APPL MODALITY 1/GT AREAS CONTRAST BATHS EA 15 MIN | 2011-07-01 00:00:00 | 14.09 | N | Y | N/A | N/A
97035 | APPL MODALITY 1/GT AREAS ULTRASOUND EA 15 MIN | 2011-07-01 00:00:00 | 10.34 | N | Y | N/A | N/A
97036 | APPL MODALITY 1/GT AREAS HUBBARD TANK EA 15 MIN | 2011-07-01 00:00:00 | 25.17 | N | Y | N/A | N/A
97039 | UNLIST MODALITY SPEC TYPE&TIME CONSTANT ATTENDCE | 2008-06-01 00:00:00 | 10.12 | Y | Y | N/A | N/A
97110 | THERAPEUTIC PX 1/GT AREAS EACH 15 MIN EXERCISES | 2011-07-01 00:00:00 | 25.76 | N | Y | N/A | N/A
97112 | THER PX 1/GT AREAS EACH 15 MIN NEUROMUSC REEDUCAJ | 2011-07-01 00:00:00 | 26.91 | N | Y | N/A | N/A
97113 | THER PX 1/GT AREAS EACH 15 MIN AQUA THER W/XERSS | 2011-07-01 00:00:00 | 33.53 | N | Y | N/A | N/A
97116 | THER PX 1/GT AREAS EA 15 MIN GAIT TRAINJ W/STAIR | 2011-07-01 00:00:00 | 22.79 | N | Y | N/A | N/A
97139 | UNLISTED THERAPEUTIC PROCEDURE SPECIFY | 2008-06-01 00:00:00 | 15.32 | Y | Y | N/A | N/A
97140 | MANUAL THERAPY TQS 1/GT REGIONS EACH 15 MINUTES | 2011-07-01 00:00:00 | 24.28 | N | Y | N/A | N/A
97150 | THERAPEUTIC PROCEDURES GROUP 2/GT INDIVIDUALS | 2011-07-01 00:00:00 | 16.51 | Y | N | N/A | N/A
97530 | THER ACTV DIR PT CONTACT BY PROVIDER EACH 15 MIN | 2011-07-01 00:00:00 | 28.04 | N | Y | N/A | N/A
97535 | SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES | 2011-07-01 00:00:00 | 28.06 | N | Y | N/A | N/A
97537 | COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN | 2011-07-01 00:00:00 | 24.61 | N | Y | N/A | N/A
97542 | WHEELCHAIR MGMT EA 15 MIN | 2011-07-01 00:00:00 | 24.89 | N | Y | N/A | N/A
97597 | DEBRIDEMENT OPEN WOUND 20 SQ CM/LT | 2011-07-01 00:00:00 | 61.45 | N | Y | N/A | N/A
97598 | DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM | 2011-07-01 00:00:00 | 20.55 | N | Y | N/A | N/A
97605 | NEGATIVE PRESSURE WOUND THERAPY LT/EQUAL 50 SQ CM | 2011-07-01 00:00:00 | 33.5 | N | Y | N/A | N/A
97606 | NEGATIVE PRESSURE WOUND THERAPY GT 50 SQ CM | 2011-07-01 00:00:00 | 35.67 | N | Y | N/A | N/A
97610 | LOW FREQUENCY NON-THERMAL ULTRASOUND PER DAY | 2014-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
97750 | PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN | 2011-07-01 00:00:00 | 26.97 | N | Y | N/A | N/A
97760 | ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15 MIN | 2011-07-01 00:00:00 | 30.14 | N | Y | N/A | N/A
97761 | PROSTHETIC TRAINING UPPR&/LOWER EXTREM EA 15 MIN | 2011-07-01 00:00:00 | 26.69 | N | Y | N/A | N/A
97762 | CHECKOUT ORTHOTIC/PROSTHETIC ESTAB PT EA 15 MIN | 2011-07-01 00:00:00 | 34.64 | N | Y | N/A | N/A
97799 | UNLISTED PHYSICAL MEDICINE SERVICE OR PROCEDURE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
98925 | OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS | 2011-07-01 00:00:00 | 26.11 | N | Y | N/A | N/A
98926 | OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS | 2011-07-01 00:00:00 | 35.11 | N | Y | N/A | N/A
98927 | OSTEOPATHIC MANIPULATIVE TX 5-6 BODY REGIONS | 2011-07-01 00:00:00 | 45.76 | N | Y | N/A | N/A
98928 | OSTEOPATHIC MANIPULATIVE TX 7-8 BODY REGIONS | 2011-07-01 00:00:00 | 53.42 | N | Y | N/A | N/A
98929 | OSTEOPATHIC MANIPULATIVE TX 9-10 BODY REGIONS | 2011-07-01 00:00:00 | 61.55 | N | Y | N/A | N/A
98940 | CHIROPRACTIC MANIPULATIVE TX SPINAL 1-2 REGIONS | 2011-07-01 00:00:00 | 21.85 | N | Y | N/A | N/A
98941 | CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS | 2011-07-01 00:00:00 | 30.17 | N | Y | N/A | N/A
98942 | CHIROPRACTIC MANIPULATIVE TX SPINAL 5 REGIONS | 2011-07-01 00:00:00 | 39.02 | N | Y | N/A | N/A
99001 | HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB | 2008-07-01 00:00:00 | 8.09 | N | N | N/A | N/A
99050 | SERVICES PROVIDED OFFICE OTH/THN REG SCHED HOURS | 2008-07-01 00:00:00 | 13.59 | N | Y | N/A | N/A
99058 | SVC PRV EMER BASIS IN OFFICE DISRUPTING SVCS | 2008-07-01 00:00:00 | 6.33 | N | Y | N/A | N/A
99080 | SPEC REPORTS GT USUAL MED COMUNICAJ/STAND RPRTG | 2008-07-01 00:00:00 | 10.93 | N | Y | N/A | N/A
99091 | COLLECTION AND INTERPRETATION OF PATIENT TRANSMITTED DATA; MINIMUM 30 MINUTES | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
99143 | MODERATE SEDATION PHYS PERF DX/THER SVC LT 5 YRS | 2011-07-01 00:00:00 | 21.02 | N | Y | N/A | N/A
99144 | MODERATE SEDATION PHYS PERF DX/THER SVC 5/GT YRS | 2011-07-01 00:00:00 | 17.28 | N | Y | N/A | N/A
99145 | MODERAT SEDATION PHYS PERF DX/THER SVC EA 15 MIN | 2011-07-01 00:00:00 | 8.42 | N | Y | N/A | N/A
99148 | MOD SEDATJ PHYS OTH/THN PERF DX/THER SVC LT5 YRS | 2011-07-01 00:00:00 | 27.45 | N | Y | N/A | N/A
99149 | MOD SEDATJ PHYS OTH/THN PERF DX/THER SVC 5/GT YRS | 2011-07-01 00:00:00 | 27.45 | N | Y | N/A | N/A
99150 | MOD SEDATJ PHY OTH/THN PER DX/THER SVC EA 15 MIN | 2011-07-01 00:00:00 | 13.73 | N | Y | N/A | N/A
99170 | ANOGENITAL XM W/COLPOSCOPY CHILD/SUSPECT TRAUMA | 2011-07-01 00:00:00 | 124.25 | N | Y | N/A | N/A
99172 | OCCULAR FUNCTION SCREENING | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
99173 | SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT | 2008-07-01 00:00:00 | 26.32 | N | Y | N/A | N/A
99175 | IPECAC/SIMILAR ADMN EMESIS&OBS STOMACH EMPTIED | 2011-07-01 00:00:00 | 20.65 | N | Y | N/A | N/A
99183 | PHYS ATTN&SUPVJ HYPRBARIC OXYGEN THER PR SESS | 2011-07-01 00:00:00 | 177.61 | N | Y | N/A | N/A
99190 | ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH EA HR | 2008-07-01 00:00:00 | 97.15 | N | Y | N/A | N/A
99191 | ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH 45 MIN | 2008-07-01 00:00:00 | 72.84 | N | Y | N/A | N/A
99192 | ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH 30 MIN | 2008-07-01 00:00:00 | 48.58 | N | Y | N/A | N/A
99195 | PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE | 2011-07-01 00:00:00 | 72.68 | N | Y | N/A | N/A
99201 | OFFICE OUTPATIENT NEW 10 MINUTES | 2008-07-01 00:00:00 | 34.15 | N | Y | N/A | N/A
99202 | OFFICE OUTPATIENT NEW 20 MINUTES | 2008-07-01 00:00:00 | 59.02 | N | Y | N/A | N/A
99203 | OFFICE OUTPATIENT NEW 30 MINUTES | 2008-07-01 00:00:00 | 86.54 | N | Y | N/A | N/A
99204 | OFFICE OUTPATIENT NEW 45 MINUTES | 2008-07-01 00:00:00 | 133.19 | N | Y | N/A | N/A
99205 | OFFICE OUTPATIENT NEW 60 MINUTES | 2008-07-01 00:00:00 | 167.67 | N | Y | N/A | N/A
99211 | OFFICE OUTPATIENT VISIT 5 MINUTES | 2011-01-01 00:00:00 | 18.25 | N | Y | N/A | N/A
99212 | OFFICE OUTPATIENT VISIT 10 MINUTES | 2008-07-01 00:00:00 | 35.18 | N | Y | N/A | N/A
99213 | OFFICE OUTPATIENT VISIT 15 MINUTES | 2008-07-01 00:00:00 | 57.45 | N | Y | N/A | N/A
99214 | OFFICE OUTPATIENT VISIT 25 MINUTES | 2008-07-01 00:00:00 | 86.45 | N | Y | N/A | N/A
99215 | OFFICE OUTPATIENT VISIT 40 MINUTES | 2008-07-01 00:00:00 | 117.01 | N | Y | N/A | N/A
99217 | OBSERVATION CARE DISCHARGE MANAGEMENT | 2011-07-01 00:00:00 | 60.15 | N | Y | N/A | N/A
99218 | INITIAL OBSERVATION CARE/DAY LOW SEVERITY | 2011-07-01 00:00:00 | 55.83 | N | Y | N/A | N/A
99219 | INITIAL OBSERVATION CARE/DAY MODERATE SEVERITY | 2011-07-01 00:00:00 | 93.27 | N | Y | N/A | N/A
99220 | INITIAL OBSERVATION CARE/DAY HIGH SEVERITY | 2011-07-01 00:00:00 | 130.4 | N | Y | N/A | N/A
99221 | INITIAL HOSPITAL CARE/DAY 30 MINUTES | 2011-07-01 00:00:00 | 83.77 | N | Y | N/A | N/A
99222 | INITIAL HOSPITAL CARE/DAY 50 MINUTES | 2011-07-01 00:00:00 | 114.23 | N | Y | N/A | N/A
99223 | INITIAL HOSPITAL CARE/DAY 70 MINUTES | 2011-07-01 00:00:00 | 168.09 | N | Y | N/A | N/A
99224 | SBSQ OBSERVATION CARE/DAY LOW [NAME] | 2011-07-01 00:00:00 | 24.13 | N | Y | N/A | N/A
99225 | SBSQ OBSERVATION CARE/DAY MODERATE SEVERITY | 2011-07-01 00:00:00 | 42.92 | N | Y | N/A | N/A
99226 | SBSQ OBSERVATION CARE/DAY HIGH SEVERITY | 2011-07-01 00:00:00 | 64.18 | N | Y | N/A | N/A
99231 | SBSQ HOSPITAL CARE/DAY 15 MINUTES | 2011-07-01 00:00:00 | 33.35 | N | Y | N/A | N/A
99232 | SBSQ HOSPITAL CARE/DAY 25 MINUTES | 2011-07-01 00:00:00 | 60.34 | N | Y | N/A | N/A
99233 | SBSQ HOSPITAL CARE/DAY 35 MINUTES | 2011-07-01 00:00:00 | 86.62 | N | Y | N/A | N/A
99234 | OBSERVATION/INPATIENT HOSPITAL CARE LOW [NAME] | 2011-07-01 00:00:00 | 113.56 | N | Y | N/A | N/A
99235 | OBSERVATION/INPATIENT HOSPITAL CARE MOD SEVERITY | 2011-07-01 00:00:00 | 149.54 | N | Y | N/A | N/A
99236 | OBSERVATION/INPATIENT HOSPITAL CARE HI SEVERITY | 2011-07-01 00:00:00 | 185.81 | N | Y | N/A | N/A
99238 | HOSPITAL DISCHARGE DAY MANAGEMENT 30 MIN/LT | 2011-07-01 00:00:00 | 59.98 | N | Y | N/A | N/A
99239 | HOSPITAL DISCHARGE DAY MANAGEMENT GT 30 MIN | 2011-07-01 00:00:00 | 87.99 | N | Y | N/A | N/A
99281 | EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB | 2011-07-01 00:00:00 | 18.04 | N | Y | N/A | N/A
99282 | EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY | 2011-07-01 00:00:00 | 35.06 | N | Y | N/A | N/A
99283 | EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY | 2011-07-01 00:00:00 | 53.11 | N | Y | N/A | N/A
99284 | EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY | 2011-07-01 00:00:00 | 100.01 | N | Y | N/A | N/A
99285 | EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ | 2011-07-01 00:00:00 | 146.83 | N | Y | N/A | N/A
99288 | PHYSICIAN DIRECTION EMERGENCY MEDICAL SYSTEMS | 2008-07-01 00:00:00 | 57.59 | N | Y | N/A | N/A
99291 | CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN | 2011-07-01 00:00:00 | 228.33 | N | Y | N/A | N/A
99292 | CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN | 2011-07-01 00:00:00 | 102.81 | N | Y | N/A | N/A
99304 | INITIAL NURSING FACILITY CARE/DAY LOW SEVERITY | 2011-07-01 00:00:00 | 75.95 | N | Y | N/A | N/A
99305 | INITIAL NURSING FACILITY CARE/DAY MODER SEVERITY | 2011-07-01 00:00:00 | 106.79 | N | Y | N/A | N/A
99306 | INITIAL NURSING FACILITY CARE/DAY HIGH SEVERITY | 2011-07-01 00:00:00 | 136.23 | N | Y | N/A | N/A
99307 | SBSQ NURSING FACILITY CARE/DAY E/M STABLE 10 MIN | 2011-07-01 00:00:00 | 36.63 | N | Y | N/A | N/A
99308 | SBSQ NURSING FACIL CARE/DAY MINOR COMPLJ 15 MIN | 2011-07-01 00:00:00 | 56.3 | N | Y | N/A | N/A
99309 | SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 25 MIN | 2011-07-01 00:00:00 | 74.17 | N | Y | N/A | N/A
99310 | SBSQ NURS FACIL CARE/DAY UNSTABL/NEW PROB 35 MIN | 2011-07-01 00:00:00 | 109.77 | N | Y | N/A | N/A
99315 | NURSING FACILITY DISCHARGE MANAGEMENT 30 MIN/LT | 2011-07-01 00:00:00 | 53.37 | N | Y | N/A | N/A
99316 | NURSING FACILITY DISCHARGE MANAGEMENT GT 30 MIN | 2011-07-01 00:00:00 | 69.47 | N | Y | N/A | N/A
99318 | E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN | 2011-07-01 00:00:00 | 78.26 | N | Y | N/A | N/A
99324 | DOMICIL/REST HOME NEW PT VISIT LOW SEVER 20 MIN | 2011-07-01 00:00:00 | 47.68 | N | Y | N/A | N/A
99325 | DOMICIL/REST HOME NEW PT VISIT MOD SEVER 30 MIN | 2011-07-01 00:00:00 | 68.99 | N | Y | N/A | N/A
99326 | DOMICIL/REST HOME NEW PT HI-MOD SEVER 45 MIN | 2011-07-01 00:00:00 | 117.24 | N | Y | N/A | N/A
99327 | DOMICIL/REST HOME NEW PT VISIT HI SEVER 60 MIN | 2011-07-01 00:00:00 | 154.06 | N | Y | N/A | N/A
99328 | DOM/R-HOME E/M NEW PT SIGNIFICANT NEW PROBLEM | 2011-07-01 00:00:00 | 180.31 | N | Y | N/A | N/A
99334 | DOM/R-HOME E/M EST PT SELF-LMTD/MINOR | 2011-07-01 00:00:00 | 50.67 | N | Y | N/A | N/A
99335 | DOM/R-HOME E/M EST PT LW [NAME] | 2011-07-01 00:00:00 | 78.57 | N | Y | N/A | N/A
99336 | DOM/R-HOME E/M EST PT MOD HI SEVERITY | 2011-07-01 00:00:00 | 110.84 | N | Y | N/A | N/A
99337 | DOM/R-HOME E/M EST PT SIGNIFICANT NEW PROBLEM | 2011-07-01 00:00:00 | 159.35 | N | Y | N/A | N/A
99340 | IND PHYSICIAN SUPERVISION OF PT (PT NOT PRESENT) IN HOME, DOMICILE OR REST HOME | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
99341 | HOME VISIT NEW PATIENT LOW [NAME] 20 MIN | 2011-07-01 00:00:00 | 47.39 | N | Y | N/A | N/A
99342 | HOME VISIT NEW PATIENT MOD SEVERITY 30 MIN | 2011-07-01 00:00:00 | 68.88 | N | Y | N/A | N/A
99343 | HOME VST NEW PATIENT MOD-HI SEVERITY 45 MIN | 2011-07-01 00:00:00 | 112.52 | N | Y | N/A | N/A
99344 | HOME VISIT NEW PATIENT HI SEVERITY60 MIN | 2011-07-01 00:00:00 | 151.33 | N | Y | N/A | N/A
99345 | HOME VISIT NEW PT UNSTABL/SIGNIF NEW PROB 75 MIN | 2011-07-01 00:00:00 | 181.81 | N | Y | N/A | N/A
99347 | HOME VISIT EST PT SELF LIMITED/MINOR 15 MIN | 2011-07-01 00:00:00 | 47.09 | N | Y | N/A | N/A
99348 | HOME VISIT EST PT LOW-MOD SEVERITY 25 MIN | 2011-07-01 00:00:00 | 71.37 | N | Y | N/A | N/A
99349 | HOME VISIT EST PT MOD-HI SEVERITY 40 MIN | 2011-07-01 00:00:00 | 105.71 | N | Y | N/A | N/A
99350 | HOME VST EST PT UNSTABLE/SIGNIFICANT NEW PROBLEM | 2011-07-01 00:00:00 | 147.11 | N | Y | N/A | N/A
99354 | PROLNG SVC OFFICE O/P DIR CONTACT 1ST HR | 2011-07-01 00:00:00 | 82.86 | N | Y | N/A | N/A
99355 | PROLNG SVC OFFICE O/P DIR CONTACT EA 30 MIN | 2011-07-01 00:00:00 | 82 | N | Y | N/A | N/A
99356 | PROLONGED SERVICE I/P REQ UNIT/FLOOR TIME 1ST HR | 2011-07-01 00:00:00 | 75.84 | N | Y | N/A | N/A
99357 | PROLONGED SVC I/P REQ UNIT/FLOOR TIME EA 30 MIN | 2011-07-01 00:00:00 | 76.13 | N | Y | N/A | N/A
99360 | PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MIN | 2008-07-01 00:00:00 | 38.88 | N | Y | N/A | N/A
99368 | TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN | 2011-07-01 00:00:00 | 22.7 | Y | N | N/A | N/A
99381 | INITIAL PREVENTIVE MEDICINE NEW PATIENT LT 1YR | 2008-07-01 00:00:00 | 108.25 | N | Y | N/A | N/A
99382 | INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS | 2008-07-01 00:00:00 | 121.5 | N | Y | N/A | N/A
99383 | INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS | 2008-07-01 00:00:00 | 120.72 | N | Y | N/A | N/A
99384 | INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR | 2008-07-01 00:00:00 | 134.65 | N | Y | N/A | N/A
99385 | INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS | 2008-07-01 00:00:00 | 134.65 | N | Y | N/A | N/A
99386 | INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS | 2008-07-01 00:00:00 | 134.65 | N | Y | N/A | N/A
99387 | INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&GT | 2008-07-01 00:00:00 | 134.65 | N | Y | N/A | N/A
99391 | PERIODIC PREVENTIVE MED ESTABLISHED PATIENT LT1YR | 2008-07-01 00:00:00 | 89.46 | N | Y | N/A | N/A
99392 | PERIODIC PREVENTIVE MED EST [NAME] 1-4YRS | 2008-07-01 00:00:00 | 102.99 | N | Y | N/A | N/A
99393 | PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS | 2008-07-01 00:00:00 | 102.6 | N | Y | N/A | N/A
99394 | PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS | 2008-07-01 00:00:00 | 116.24 | N | Y | N/A | N/A
99395 | PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS | 2008-07-01 00:00:00 | 116.63 | N | Y | N/A | N/A
99396 | PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS | 2008-07-01 00:00:00 | 116.63 | N | Y | N/A | N/A
99397 | PERIODIC PREVENTIVE MED EST PATIENT 65YRS&GT | 2008-07-01 00:00:00 | 116.63 | N | Y | N/A | N/A
99401 | PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 15 MIN | 2008-07-01 00:00:00 | 41.9 | N | Y | N/A | N/A
99402 | PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 MIN | 2008-07-01 00:00:00 | 70.86 | N | Y | N/A | N/A
99403 | PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN | 2008-07-01 00:00:00 | 97.94 | N | Y | N/A | N/A
99404 | PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN | 2008-07-01 00:00:00 | 126.13 | N | Y | N/A | N/A
99408 | ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN | 2009-01-01 00:00:00 | 30.01 | N | Y | N/A | N/A
99409 | ALCOHOL/SUBSTANCE SCREEN & INTERVEN GT30 MIN | 2009-01-01 00:00:00 | 58.62 | N | Y | N/A | N/A
99429 | UNLISTED PREVENTIVE MEDICINE SERVICE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
99450 | BASIC LIFE AND/OR DISABILITY EXAMINATION | 2008-07-01 00:00:00 | 47.5 | N | Y | N/A | N/A
99460 | 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB | 2011-07-01 00:00:00 | 50.49 | N | Y | N/A | N/A
99461 | 1ST CARE PR DAY NML NB [NAME] | 2011-07-01 00:00:00 | 78.57 | N | Y | N/A | N/A
99462 | SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN | 2011-07-01 00:00:00 | 27.15 | N | Y | N/A | N/A
99463 | 1ST HOSP/BIRTHING CENTER NB ADMIT&DSCHG SM DATE | 2011-07-01 00:00:00 | 68.9 | N | Y | N/A | N/A
99464 | ATTN AT DELIVERY& 1ST STABILIZATION OF NEWBORN | 2011-07-01 00:00:00 | 62.67 | N | Y | N/A | N/A
99465 | DELIVERY/BIRTHING ROOM RESUSCITATION | 2011-07-01 00:00:00 | 120.26 | N | Y | N/A | N/A
99466 | CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN | 2011-07-01 00:00:00 | 221.41 | N | Y | N/A | N/A
99467 | CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN | 2011-07-01 00:00:00 | 103.23 | N | Y | N/A | N/A
99468 | 1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/LT | 2011-07-01 00:00:00 | 777.64 | N | Y | N/A | N/A
99469 | SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/LT | 2011-07-01 00:00:00 | 341.35 | N | Y | N/A | N/A
99471 | INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS | 2011-07-01 00:00:00 | 675.15 | N | Y | N/A | N/A
99472 | SUBSQ PED CRITICAL CARE 29 DAYS THRU 24 MO | 2011-07-01 00:00:00 | 339.23 | N | Y | N/A | N/A
99475 | INITIAL PED CRITICAL CARE 2 THRU 5 YEARS | 2011-07-01 00:00:00 | 474.4 | N | Y | N/A | N/A
99476 | SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS | 2011-07-01 00:00:00 | 287.31 | N | Y | N/A | N/A
99477 | INITIAL HOSP NEONATE 28 D/LT NOT CRITICALLY ILL | 2011-07-01 00:00:00 | 301.15 | N | Y | N/A | N/A
99478 | SUBSEQUENT INTENSIVE CARE INFANT LT 1500 GRAMS | 2011-07-01 00:00:00 | 119.25 | N | Y | N/A | N/A
99479 | SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS | 2011-07-01 00:00:00 | 109.52 | N | Y | N/A | N/A
99480 | SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS | 2011-07-01 00:00:00 | 102.14 | N | Y | N/A | N/A
99481 | TOT BODY SYSTEMIC HYPOTHERMIA CRITICAL NEONATE | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
99482 | SELECTIVE HEAD HYPOTHERMIA CRITICAL NEONATE | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
99485 | SUPERVISION INTERFACILITY TRANSPORT INIT 30 MIN | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
99486 | SUPERVISION INTERFACILITY TRANSPORT ADDL 30 MIN | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
99495 | TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE | 2013-01-01 00:00:00 | 137.55 | N | N | N/A | N/A
99496 | TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE | 2013-01-01 00:00:00 | 194.27 | N | N | N/A | N/A
99499 | UNLISTED EVALUATION AND MANAGEMENT SERVICE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | NON-EMERGENCY TRANSPORTATION; TAXI | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
A0110 | BUS OR VAN TRAVEL 1 UNIT = 1 LOADED VEHICLE MILE | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
A0130 | NON-EMERG TRANS WHEEL CHAIR VAN | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A0140 | NON-EMERGENCY TRANSPORTATION/AIR TRAVEL (PRIVATE OR COMM) INTRA OR INTER STATE | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
[NAME] | PARKING FEES AND TOLLS. 1 UNIT = 1 DAYS TOTAL FEES. | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A0180 | LODGING FOR CLIENT. ONE UNIT = 1 DAYS LODGING. | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
A0190 | NON-EMERG TRANSPORT MEALS RECIP; ANCILLARY | 2008-01-01 00:00:00 | 7 | Y | N | N/A | N/A
A0200 | LODGING FOR ATTENDANT. 1 UNIT = 1 DAYS LODGING. | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
A0210 | NON-EMERG TRANSPORT MEALS ESCORT; ANCILLARY | 2008-01-01 00:00:00 | 7 | Y | N | N/A | N/A
A0225 | NEONATAL EMERGENCY TRANSPORT; ONE WAY, BASE | 2008-01-01 00:00:00 | 146.47 | Y | N | N/A | N/A
A0380 | BASIC LIFE SUPPORT MILEAGE: PER MILE | 2008-01-01 00:00:00 | 1.47 | Y | N | N/A | N/A
A0390 | ADVANCED LIFE SUPPORT MILEAGE, PER [NAME] | 2008-01-01 00:00:00 | 1.47 | Y | N | N/A | N/A
A0392 | ALS DEFIBRILLATION DISPOSABLE SUPPLIES | 2008-01-01 00:00:00 | 5.97 | N | N | N/A | N/A
A0396 | ALS ESOPHAGEAL INTUBE DISPOSABLE SUPPLIES | 2008-01-01 00:00:00 | 6.81 | N | N | N/A | N/A
A0398 | ALS ROUTINE DISPOSABLE SUPPLIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A0420 | AMBULANCE WAITING 1/2 HR INCREMENTS | 2008-01-01 00:00:00 | 4.42 | Y | N | N/A | N/A
A0422 | [NAME] AND O2 SUPPLIES LIFE SUSTAINING | 2008-01-01 00:00:00 | 17.81 | Y | N | N/A | N/A
A0424 | EXTRA AMBULANCE ATTENDANT: REQ MEDICAL REVIEW | 2008-01-01 00:00:00 | 145.21 | Y | N | N/A | N/A
A0425 | GROUND MILEAGE, PER STATUTE MILE | 2011-07-01 00:00:00 | 6.18 | Y | N | N/A | N/A
A0426 | ALS1 NON-EMERGENCY TRANSPORT | 2011-07-01 00:00:00 | 221.51 | Y | N | N/A | N/A
A0427 | ALS1 EMERGENCY TRANSPORT | 2011-07-01 00:00:00 | 350.73 | Y | N | N/A | N/A
A0428 | BLS NON-EMERGENCY | 2011-07-01 00:00:00 | 184.59 | Y | N | N/A | N/A
A0429 | BLS EMERGENCY | 2011-07-01 00:00:00 | 295.35 | Y | N | N/A | N/A
A0430 | AMBULANCE SERVICE, FIXED WING AIR TRANSPORT | 2011-07-01 00:00:00 | 2485.16 | Y | N | N/A | N/A
A0431 | AMBULANCE SERVICE, ROTARY WING AIR TRANSPORT | 2011-07-01 00:00:00 | 2889.36 | Y | N | N/A | N/A
A0433 | ALS 2, ADVANCED LIFE SUPPORT LEVEL 2 | 2011-07-01 00:00:00 | 507.63 | Y | N | N/A | N/A
A0434 | SPECIALTY CARE TRANSPORT SCT | 2011-07-01 00:00:00 | 599.93 | Y | N | N/A | N/A
A0435 | FIXED WING AIR MILEAGE, PER STATUTE MILE | 2011-07-01 00:00:00 | 7.25 | Y | N | N/A | N/A
A0436 | ROTARY WING AIR MILEAGE, PER STATUTE MILE | 2011-07-01 00:00:00 | 19.36 | Y | N | N/A | N/A
A0998 | [NAME], NO TRANSPORT | 2011-07-01 00:00:00 | 184.59 | Y | N | N/A | N/A
A0999 | UNLISTED AMBULANCE SERVICE | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
A4206 | 1 CC STERILE SYRINGE & NEEDLE, EACH | 2008-01-01 00:00:00 | 0.21 | N | Y | N/A | N/A
A4207 | 2 CC STERILE SYRINGE & NEEDLE, EACH | 2008-01-01 00:00:00 | 0.14 | N | Y | N/A | N/A
A4208 | 3 CC STERILE SYRINGE & NEEDLE, EACH | 2008-01-01 00:00:00 | 0.14 | N | Y | N/A | N/A
A4209 | 5+ CC STERILE SYRINGE & NEEDLE, EACH | 2008-01-01 00:00:00 | 0.28 | N | Y | N/A | N/A
A4211 | SUPPLIES FOR SELF-ADMINISTERED INJECTIONS | 2008-01-01 00:00:00 | 38.4 | N | Y | N/A | N/A
A4212 | NON CORING NEEDLE OR STYLET W/O CATHETER | 2008-01-01 00:00:00 | 12.5 | N | Y | N/A | N/A
A4213 | 20+ CC SYRINGE ONLY, EACH | 2008-01-01 00:00:00 | 0.6 | N | Y | N/A | N/A
A4215 | STERILE NEEDLE, ANY SIZE, EACH | 2008-01-01 00:00:00 | 0.25 | N | Y | N/A | N/A
A4216 | STERILE WATER/SALINE, 10 ML | 2011-07-01 00:00:00 | 0.36 | N | Y | N/A | N/A
A4217 | STERILE WATER/SALINE, 500 ML | 2011-07-01 00:00:00 | 2.52 | N | Y | N/A | N/A
A4218 | STERILINE SALINE OR WATER, METERED DOSE DISPENSER, 10ML | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A4220 | REFILL KIT FOR IMPLANTABLE INFUSION KIT | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A4221 | SUPPLIES MAINT DRUG INFUSION CATHETER PER WK | 2011-07-01 00:00:00 | 21.02 | N | Y | N/A | N/A
A4222 | EXTERNAL DRUG INFUSION PUMP SUPPLIES, PER BAG | 2011-07-01 00:00:00 | 41.7 | N | Y | N/A | N/A
A4223 | INFUSION SUPPLIES W/O PUMP | 2008-01-01 00:00:00 | 42.13 | N | Y | N/A | N/A
[NAME] | SYRINGE W/NEEDLE  EXTERNAL INSULIN 3CC | 2008-01-01 00:00:00 | 2.49 | N | Y | N/A | N/A
A4233 | ALKALINE BATTERY FOR GLUCOSE MONITOR | 2011-07-01 00:00:00 | 0.76 | N | Y | N/A | N/A
A4234 | J-CELL BATTERY FOR GLUCOSE MONITOR | 2011-07-01 00:00:00 | 3.43 | N | Y | N/A | N/A
A4235 | LITHIUM BATTERY FOR GLUCOSE MONITOR | 2011-07-01 00:00:00 | 2.21 | N | Y | N/A | N/A
A4236 | SILVER OXIDE BATTERY GLUCOSE MONITOR | 2011-07-01 00:00:00 | 1.58 | N | Y | N/A | N/A
A4244 | ALCOHOL OR PEROXIDE, PER PINT | 2008-01-01 00:00:00 | 0.86 | N | Y | N/A | N/A
A4245 | ALCOHOL WIPES, PER BOX | 2008-01-01 00:00:00 | 1.65 | N | Y | N/A | N/A
A4246 | BETADINE/PHISOHEX SOLUTION, PER PINT | 2008-01-01 00:00:00 | 10.91 | N | Y | N/A | N/A
A4247 | BETADINE/IODINE SWABS/WIPES, PER BOX | 2008-01-01 00:00:00 | 10.98 | N | Y | N/A | N/A
A4248 | CHLORHEXIDINE ANTISEPT, 1 ML | 2008-01-01 00:00:00 | 1.73 | N | Y | N/A | N/A
A4250 | URINE REAGENT STRIPS/TABLETS 100 TABS/STRIPS | 2008-01-01 00:00:00 | 33 | N | Y | N/A | N/A
A4253 | BLOOD GLUCOSE/REAGENT STRIPS, PER 50 STRIPS | 2013-08-01 00:00:00 | 29.14 | N | Y | N/A | N/A
[NAME] | [NAME], 50 PER BOX | 2011-07-01 00:00:00 | 3.89 | N | Y | N/A | N/A
A4256 | CALIBRATOR SOLUTION/CHIPS NORMAL HIGH LOW | 2011-07-01 00:00:00 | 10.8 | N | Y | N/A | N/A
A4257 | REPLACE LENS SHIELD CARTRIDGE, EACH | 2011-07-01 00:00:00 | 12.04 | Y | Y | N/A | N/A
A4258 | SPRING- POWERED LANCET DEVICE ,EACH | 2011-07-01 00:00:00 | 16.76 | N | Y | N/A | N/A
A4259 | LANCETS PER BOX OF 100 | 2011-07-01 00:00:00 | 10.27 | N | Y | N/A | N/A
[NAME] | CERVICAL CAP FOR CORTRACEPTIVE USE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4262 | TEMPORARY ABSORBABLE LACRIMALDUCT IMPLANT EACH | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A4263 | PERMANENT TEAR DUCT PLUG, EACH | 2008-01-01 00:00:00 | 31.59 | N | Y | N/A | N/A
A4264 | PERMANENT IMPLANTABLE CONTRACEPTIVE INTRATUBAL OCCLUSION DEVICE/DELIVERY SYSTEM | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | DIAPHRAGM FOR CONTRACEPTIVE USE | 2008-01-01 00:00:00 | 25.07 | N | N | N/A | N/A
A4280 | BREAST PROSTHESIS ADHESIVE ATTACHMENT, EACH | 2011-07-01 00:00:00 | 4.9 | N | Y | N/A | N/A
A4281 | REPLACEMENT BREAST PUMP TUBE | 2008-01-01 00:00:00 | 7.5 | Y | Y | N/A | N/A
A4283 | REPLACEMENT BREAST PUMP CAP | 2008-01-01 00:00:00 | 1.12 | Y | Y | N/A | N/A
[NAME] | REPLACEMENT BREAST PUMP SHIELD | 2008-01-01 00:00:00 | 17.25 | Y | Y | N/A | N/A
A4285 | REPLACEMENT BREAST PUMP BOTTLE | 2008-01-01 00:00:00 | 3.5 | Y | Y | N/A | N/A
A4286 | LOCKING RING FOR BREAST PUMP REPLACEMENT | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
A4290 | SACRAL NERVE STIMULATION TEST, LEAD, EACH | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A4300 | IMPLANTABLE ACCESS CATHETER, EXT. ACCESS (VEN,ART, | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A4301 | IMPLANTABLE ACCESS TOTAL SYSTEM; CATHETER, PORT/RE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A4305 | DRUG DELIVERY SYSTEM GT=50 ML PER HOUR | 2008-01-01 00:00:00 | 8.8 | N | Y | N/A | N/A
A4306 | DRUG DELIVERY SYSTEM LT=50 ML PER HOUR | 2008-01-01 00:00:00 | 8.8 | N | Y | N/A | N/A
A4310 | INSERT TRAY W/O  DRAINAGE BAG/CATH | 2011-07-01 00:00:00 | 6.2 | N | Y | N/A | N/A
A4311 | CATHETER W/O BAG 2-WAY LATEX | 2011-07-01 00:00:00 | 11.91 | N | Y | N/A | N/A
A4312 | CATHETER W/O BAG 2-WAY SILICONE | 2011-07-01 00:00:00 | 14.47 | N | Y | N/A | N/A
A4313 | CATHETER W/O BAG 3-WAY, [NAME] IRRIGATION | 2011-07-01 00:00:00 | 14.87 | N | Y | N/A | N/A
A4314 | CATHETER W/DRAINAGE 2-WAY LATEX WITH COATING | 2011-07-01 00:00:00 | 20.29 | N | Y | N/A | N/A
A4315 | CATHETER W/DRAINAGE 2-WAY ALL SILICONE | 2011-07-01 00:00:00 | 21.18 | N | Y | N/A | N/A
[NAME] | CATH W/DRAINAGE 3-WAY, [NAME] | 2011-07-01 00:00:00 | 22.79 | N | Y | N/A | N/A
A4320 | IRRIGATION TRAY WITH BULB OR PISTON SYRINGE | 2011-07-01 00:00:00 | 5.03 | N | Y | N/A | N/A
A4322 | IRRIGATION SYRINGE, BULB OR PISTON, EACH | 2011-07-01 00:00:00 | 2.5 | N | Y | N/A | N/A
A4326 | MALE EXTERNAL CATHETER W INTERNAL COLL, EACH | 2011-07-01 00:00:00 | 10.19 | N | Y | N/A | N/A
A4327 | FEMALE URINARY COLLECT DEVICE METAL CUP, EACH | 2011-07-01 00:00:00 | 42.12 | N | Y | N/A | N/A
A4328 | FEMALE URINARY COLLECTION POUCH, EACH | 2011-07-01 00:00:00 | 9.32 | N | Y | N/A | N/A
A4331 | EXTENSION DRAINAGE TUBING, ANY TYPE, EACH | 2011-07-01 00:00:00 | 3.01 | N | Y | N/A | N/A
A4332 | LUBRICANT INDIVIDUAL STERILE PACKET EACH | 2011-07-01 00:00:00 | 0.12 | N | Y | N/A | N/A
A4333 | URINARY CATHETER ANCHOR DEVICE ADHESIVE, EACH | 2011-07-01 00:00:00 | 2.08 | N | Y | N/A | N/A
A4334 | URINARY CATHETER LEG STRAP, EACH | 2011-07-01 00:00:00 | 4.65 | N | Y | N/A | N/A
A4335 | [NAME], [NAME] | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
A4336 | [NAME], URETHRAL INSERT, ANY TYPE, EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A4338 | INDWELLING CATHETER LATEX; FOLEY TYPE,  EACH | 2011-07-01 00:00:00 | 11.57 | N | Y | N/A | N/A
A4340 | INDWELLING CATHETER SPECIAL, COUDE WING, EACH | 2011-07-01 00:00:00 | 29.98 | N | Y | N/A | N/A
A4344 | CATHETER INDWELLNG FOLEY 2 WAY SILICONE, EACH | 2011-07-01 00:00:00 | 12.85 | N | Y | N/A | N/A
A4346 | CATHETER INDWELLING FOLEY 3 WAY, EACH | 2011-07-01 00:00:00 | 15.72 | N | Y | N/A | N/A
A4349 | DISPOSABLE MALE EXTERNAL CATHETER | 2011-07-01 00:00:00 | 1.91 | N | Y | N/A | N/A
A4351 | STRAIGHT TIP URINE CATHETER, EACH | 2011-07-01 00:00:00 | 1.46 | N | Y | N/A | N/A
A4352 | COUDE TIP URINARY CATHETER, EACH | 2011-07-01 00:00:00 | 6.06 | N | Y | N/A | N/A
A4353 | INTERMITTENT URINARY CATHETER, W INSERTION | 2011-07-01 00:00:00 | 6.61 | N | Y | N/A | N/A
A4354 | CATHETER INSERTION TRAY W/BAG, W/O CATHETER | 2011-07-01 00:00:00 | 10.47 | N | Y | N/A | N/A
A4355 | BLADDER IRRIGATION TUBING CONT, 3 WAY, EACH | 2011-07-01 00:00:00 | 7.16 | N | Y | N/A | N/A
A4356 | [NAME] CLAMP OR COMPRESSION DEVICE, EACH | 2011-07-01 00:00:00 | 36.61 | N | Y | N/A | N/A
A4357 | [NAME], EACH | 2011-07-01 00:00:00 | 7.79 | N | Y | N/A | N/A
A4358 | URINARY LEG BAG W STRAPS, EACH | 2011-07-01 00:00:00 | 5.32 | N | Y | N/A | N/A
A4361 | OSTOMY FACE PLATE, EACH | 2011-07-01 00:00:00 | 17.34 | N | Y | N/A | N/A
A4362 | SOLID SKIN BARRIER, 4 X 4 EQUIVALENT, EACH | 2011-07-01 00:00:00 | 3.27 | N | Y | N/A | N/A
A4363 | OSTOMY CLAMP, ANY TYPE, REPLACEMENT | 2011-07-01 00:00:00 | 2.23 | N | Y | N/A | N/A
A4364 | OSTOMY/CATHETER ADHESIVE, ANY TYPE, EACH | 2011-07-01 00:00:00 | 2.77 | N | Y | N/A | N/A
A4366 | OSTOMY VENT, ANY TYPE, EACH | 2011-07-01 00:00:00 | 1.23 | N | Y | N/A | N/A
A4367 | OSTOMY BELT, EACH | 2011-07-01 00:00:00 | 6.52 | N | Y | N/A | N/A
A4368 | OSTOMY FILTER, ANY TYPE, EACH | 2011-07-01 00:00:00 | 0.24 | N | Y | N/A | N/A
A4369 | SKIN BARRIER LIQUID, SPRAY, BRUSH,ETC.,PER OZ | 2011-07-01 00:00:00 | 1.94 | N | Y | N/A | N/A
A4371 | SKIN BARRIER POWDER PER OZ | 2011-07-01 00:00:00 | 3.4 | N | Y | N/A | N/A
A4372 | SKIN BARRIER SOLID 4X4 [NAME], EACH | 2011-07-01 00:00:00 | 3.95 | N | Y | N/A | N/A
A4373 | SKIN BARRIER WITH FLANGE, W CONVEXITY, EACH | 2011-07-01 00:00:00 | 5.92 | N | Y | N/A | N/A
A4375 | DRAINABLE PLASTIC POUCH W FACEPLATE, EACH | 2011-07-01 00:00:00 | 16.22 | N | Y | N/A | N/A
A4376 | DRAINABLE RUBBER POUCH W FACEPLATE, EACH | 2011-07-01 00:00:00 | 44.92 | N | Y | N/A | N/A
A4377 | DRAINABLE PLASTIC POUCH W/O FACEPLATE, EACH | 2011-07-01 00:00:00 | 4.05 | N | Y | N/A | N/A
A4378 | DRAINABLE RUBBER POUCH W/O FACEPLATE, EACH | 2011-07-01 00:00:00 | 29.03 | N | Y | N/A | N/A
A4379 | URINARY PLASTIC POUCH W FACEPLATE, EACH | 2011-07-01 00:00:00 | 14.18 | N | Y | N/A | N/A
A4380 | URINARY RUBBER POUCH W FACEPLATE, EACH | 2011-07-01 00:00:00 | 35.24 | N | Y | N/A | N/A
A4381 | URINARY PLASTIC POUCH W/O FACEPLATE, EACH | 2011-07-01 00:00:00 | 4.36 | N | Y | N/A | N/A
A4382 | URINARY HVY PLSTC PCH W/O FACEPLATE, EACH | 2011-07-01 00:00:00 | 23.24 | N | Y | N/A | N/A
A4383 | URINARY RUBBER POUCH W/O FACEPLATE, EACH | 2011-07-01 00:00:00 | 26.61 | N | Y | N/A | N/A
A4384 | OSTOMY FACEPLATE EQUIV, SILICONE RING, EACH | 2011-07-01 00:00:00 | 9.08 | N | Y | N/A | N/A
A4385 | OST SKN BARRIER SLD EXT WEAR W/O CONVEX, EACH | 2011-07-01 00:00:00 | 4.82 | N | Y | N/A | N/A
A4387 | OST CLSD POUCH W ATT ST [NAME], 1 EACH | 2008-01-01 00:00:00 | 3.83 | N | Y | N/A | N/A
A4388 | DRAINABLE PCH W EXT WEAR BARR, 1 PIECE, EACH | 2011-07-01 00:00:00 | 4.12 | N | Y | N/A | N/A
A4389 | DRAINABLE PCH W STAN WEAR BARR, 1 PIECE, EACH | 2011-07-01 00:00:00 | 5.87 | N | Y | N/A | N/A
A4390 | DRAINABLE PCH EXT WEAR CONVEX, 1 PIECE, EACH | 2011-07-01 00:00:00 | 9.07 | N | Y | N/A | N/A
A4391 | URINARY POUCH W EX WEAR BARR, 1 PIECE, EACH | 2011-07-01 00:00:00 | 6.67 | N | Y | N/A | N/A
A4392 | URINARY POUCH W STA WEAR BARR W CONVEX, 1, EA | 2011-07-01 00:00:00 | 7.72 | N | Y | N/A | N/A
A4393 | URINE PCH W EXT WEAR BAR CONV W CONVEX, 1, EA | 2011-07-01 00:00:00 | 8.53 | N | Y | N/A | N/A
A4394 | OSTOMY POUCH LIQ DEODORANT, PER FL OZ | 2011-07-01 00:00:00 | 2.44 | N | Y | N/A | N/A
A4395 | OSTOMY POUCH SOLID DEODORANT, PER TABLET | 2011-07-01 00:00:00 | 0.05 | N | Y | N/A | N/A
A4396 | PERISTOMAL HERNIA SUPPORT BELT | 2011-07-01 00:00:00 | 38.21 | N | Y | N/A | N/A
A4397 | IRRIGATION SUPPLY SLEEVE, EACH | 2011-07-01 00:00:00 | 4.52 | N | Y | N/A | N/A
A4398 | IRRIGATION SUPPLY BAGS, EACH | 2011-07-01 00:00:00 | 13.04 | N | Y | N/A | N/A
A4399 | OSTOMY IRRIGATION CONE/CATHETER, INCL BRUSH | 2011-07-01 00:00:00 | 9.84 | N | Y | N/A | N/A
A4402 | LUBRICANT PER OUNCE | 2011-07-01 00:00:00 | 1.31 | N | Y | N/A | N/A
A4404 | OSTOMY RING EACH | 2011-07-01 00:00:00 | 1.59 | N | Y | N/A | N/A
A4405 | NONPECTIN BASED OSTOMY PASTE, PER OZ | 2011-07-01 00:00:00 | 3.21 | N | Y | N/A | N/A
A4406 | PECTIN BASED OSTOMY PASTE, PER OZ | 2011-07-01 00:00:00 | 5.42 | N | Y | N/A | N/A
A4407 | EXT WEAR OSTOMY SKIN BARR LT=4 SQ INCH, EACH | 2011-07-01 00:00:00 | 8.27 | N | Y | N/A | N/A
A4408 | EXTEND WEAR OSTOMY SKIN BARR GT4 SQ INCH, EACH | 2011-07-01 00:00:00 | 9.32 | N | Y | N/A | N/A
A4409 | OSTOMY SKIN BARRIER W FLANG LT=4 SQ INCH, EACH | 2011-07-01 00:00:00 | 5.87 | N | Y | N/A | N/A
A4410 | OSTOMY SKIN BARIERR W FLANGE GT4 SQ INCH, EACH | 2011-07-01 00:00:00 | 8.53 | N | Y | N/A | N/A
A4411 | OSTOMY SKIN BARRIER EXTEND =4SQ | 2011-07-01 00:00:00 | 4.82 | N | Y | N/A | N/A
A4412 | OSTOMY POUCH DRAIN HIGH OUTPUT USE ON BARRIER | 2011-07-01 00:00:00 | 2.56 | N | Y | N/A | N/A
A4413 | 2 PC DRAINABLE OSTOMY POUCH, W FILTER, EACH | 2011-07-01 00:00:00 | 5.19 | N | Y | N/A | N/A
A4414 | OSTOMY SKIN BARRIER W FLANG LT=4 SQ INCH, EACH | 2011-07-01 00:00:00 | 4.65 | N | Y | N/A | N/A
A4415 | OSTOMY SKIN BARRIER W FLANGE GT4 SQ INCH, EACH | 2011-07-01 00:00:00 | 5.66 | N | Y | N/A | N/A
[NAME] | OSTOMY POUCH CLOSED W BARRIER/FILTER, EACH | 2011-07-01 00:00:00 | 2.6 | N | Y | N/A | N/A
A4417 | OST POUCH W BAR/BLTINCONV/FLTR, 1 PIECE, EACH | 2011-07-01 00:00:00 | 3.52 | N | Y | N/A | N/A
A4418 | OST POUCH CLSD W/O BAR W FILTR, 1 PIECE, EACH | 2011-07-01 00:00:00 | 1.71 | N | Y | N/A | N/A
[NAME] | OST POUCH FOR BAR W FLANGE/FLT, 2 PIECE, EACH | 2011-07-01 00:00:00 | 1.65 | N | Y | N/A | N/A
A4420 | OST POUCH CLSD FOR BAR W LK FL, 2 PIECE, EACH | 2008-01-01 00:00:00 | 4.16 | N | Y | N/A | N/A
A4421 | OSTOMY SUPPLIES MISC. URETEROSTOMY SUPPLIE NOS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | OSTOMY POUCH ABSORBENT MATERIAL, EACH | 2011-07-01 00:00:00 | 0.12 | N | Y | N/A | N/A
A4423 | OST POUCH FOR BAR W LK FL/FLTR, 2 PIECE, EACH | 2011-07-01 00:00:00 | 1.76 | N | Y | N/A | N/A
A4424 | OST POUCH DRAIN W BAR & FILTER, 1 PIECE, EACH | 2011-07-01 00:00:00 | 4.49 | N | Y | N/A | N/A
A4425 | OST POUCH DRAIN FOR BARRIER FL, 2 PIECE, EACH | 2011-07-01 00:00:00 | 3.38 | N | Y | N/A | N/A
A4426 | OST POUCH DRAIN 2 PIECE SYSTEM, 2 PIECE, EACH | 2011-07-01 00:00:00 | 2.58 | N | Y | N/A | N/A
A4427 | OST PCH DRAIN/BARR LK FLNG/FILTR, 2 PIECE, EA | 2011-07-01 00:00:00 | 2.63 | N | Y | N/A | N/A
A4428 | URINE OSTOMY POUCH W FAUCET/TAP, 1PIECE, EACH | 2011-07-01 00:00:00 | 6.15 | N | Y | N/A | N/A
A4429 | URINE OSTOMY POUCH W BLTINCONV, 1 PIECE, EACH | 2011-07-01 00:00:00 | 7.79 | N | Y | N/A | N/A
A4430 | OST URINE POUCH W B/BLTIN CONV, 1 PIECE, EACH | 2011-07-01 00:00:00 | 8.05 | N | Y | N/A | N/A
A4431 | OST POUCH URINE W BARRIER/TAPV, 1 PIECE, EACH | 2011-07-01 00:00:00 | 5.87 | N | Y | N/A | N/A
A4432 | OST PCH URINE W BAR/FANGE/TAP, 2 PIECE, EACH | 2011-07-01 00:00:00 | 3.39 | N | Y | N/A | N/A
A4433 | URINE OST POUCH BAR W LOCK FLN, 2 PIECE, EACH | 2011-07-01 00:00:00 | 3.16 | N | Y | N/A | N/A
A4434 | OST POUCH URINE W LOCK FLNG/FT, 2 PIECE, EACH | 2011-07-01 00:00:00 | 3.56 | N | Y | N/A | N/A
A4435 | OST POUCH DRAIN HIGH OUTPUT, 1 PIECE, EACH | 2013-01-01 00:00:00 | 5.63 | N | N | N/A | N/A
A4450 | NON-WATERPROOF TAPE, PER 18 SQ INCHES | 2011-07-01 00:00:00 | 0.11 | N | Y | N/A | N/A
A4452 | WATERPROOF TAPE, PER 18 SQ INCHES | 2011-07-01 00:00:00 | 0.38 | N | Y | N/A | N/A
A4455 | ADHESIVE REMOVER OR SOLVENT PER OUNCE | 2011-07-01 00:00:00 | 1.35 | N | Y | N/A | N/A
A4456 | ADHESIVE REMOVER, WIPES | 2011-07-01 00:00:00 | 0.23 | N | Y | N/A | N/A
A4458 | REUSABLE ENEMA BAG W TUBING | 2008-01-01 00:00:00 | 9 | N | Y | N/A | N/A
A4461 | SURGICAL DRESSING HOLDER, NON-REUSABLE, EACH | 2011-07-01 00:00:00 | 3.11 | N | Y | N/A | N/A
A4463 | SURGICAL DRESSING HOLDER, REUSABLE, EACH | 2011-07-01 00:00:00 | 12.57 | N | Y | N/A | N/A
A4465 | NON-ELASTIC BINDER FOR EXTREMITY | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
A4470 | GRAVLEE JET WASHER | 2008-01-01 00:00:00 | 24.41 | N | Y | N/A | N/A
[NAME] | [NAME] | 2008-01-01 00:00:00 | 112.5 | N | Y | N/A | N/A
A4481 | TRACHEOSTOMA FILTER, ANY TYPE OR SIZE, EACH | 2011-07-01 00:00:00 | 0.36 | N | Y | N/A | N/A
A4483 | [NAME], FOR MECHAN VENT, DISPOSAB | 2008-01-01 00:00:00 | 8.18 | N | Y | N/A | N/A
A4490 | ABOVE KNEE SURGICAL STOCKING, EACH | 2008-01-01 00:00:00 | 8.27 | N | Y | N/A | N/A
A4495 | THIGH LENGTH SURGICAL STOCKING, EACH | 2008-01-01 00:00:00 | 12.8 | N | Y | N/A | N/A
A4500 | BELOW KNEE SURGICAL STOCKING, EACH | 2008-01-01 00:00:00 | 8.27 | N | Y | N/A | N/A
A4510 | FULL LENGTH SURGICAL STOCKING, EACH | 2008-01-01 00:00:00 | 13.8 | N | Y | N/A | N/A
A4556 | ELECTRODES, E.G., APNEA MONITOR, PER PAIR | 2011-07-01 00:00:00 | 9.75 | N | Y | N/A | N/A
A4557 | LEAD WIRES, E.G., APNEA MONITOR, PER PAIR | 2011-07-01 00:00:00 | 19.93 | N | Y | N/A | N/A
A4558 | CONDUCTIVE GEL OR PASTE, PER OZ | 2011-07-01 00:00:00 | 5.14 | N | Y | N/A | N/A
[NAME] | COUPLING GEL OR PASTE, FOR ULTRASOUND, PER OZ | 2011-07-01 00:00:00 | 0.1 | N | Y | N/A | N/A
A4561 | PESSARY, RUBBER, ANY TYPE | 2011-07-01 00:00:00 | 18.84 | N | Y | N/A | N/A
A4562 | PESSARY, NON RUBBER, ANY TYPE | 2011-07-01 00:00:00 | 46.9 | N | Y | N/A | N/A
A4565 | SLINGS | 2008-01-01 00:00:00 | 9.73 | N | Y | N/A | N/A
A4570 | SPLINT | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A4590 | SPECIAL CASTING MATERIAL E.G., FIBERGLASS | 2008-01-01 00:00:00 | 36.3 | N | Y | N/A | N/A
A4595 | ELECTRICAL STIMUL SUPPLIES, 2 LEAD, PER MONTH | 2011-07-01 00:00:00 | 26.77 | N | Y | N/A | N/A
A4604 | TUBING WITH HEATING ELEMENT | 2011-07-01 00:00:00 | 54.36 | N | Y | N/A | N/A
A4605 | TRACHEAL SUCTION CATHETER CLOSE SYSTEM | 2011-07-01 00:00:00 | 15.48 | N | Y | N/A | N/A
A4606 | OXYGEN PROBE USED W OXIMETER, REPLACEMENT | 2008-01-01 00:00:00 | 190 | Y | Y | N/A | N/A
A4608 | TRANSTRACHEAL OXYGEN CATHETER, EACH | 2011-07-01 00:00:00 | 47.32 | N | Y | N/A | N/A
A4611 | HEAVY DUTY BATTERY, REPLACE FOR PT OWNED VENT | 2011-07-01 00:00:00 | 157.64 | N | Y | N/A | N/A
A4612 | BATTERY CABLES, REPLACEMENT FOR PT OWNED VENT | 2011-07-01 00:00:00 | 75.47 | N | Y | N/A | N/A
A4613 | BATTERY CHARGER, REPLACEMNT FOR PT OWNED VENT | 2011-07-01 00:00:00 | 136.14 | N | Y | N/A | N/A
A4614 | HAND-HELD PEAK EXPIRATORY FLOW RATE METER | 2011-07-01 00:00:00 | 22.46 | N | Y | N/A | N/A
A4615 | [NAME] | 2011-07-01 00:00:00 | 0.68 | N | Y | N/A | N/A
A4616 | TUBING (OXYGEN) PER FOOT | 2011-07-01 00:00:00 | 0.06 | N | Y | N/A | N/A
[NAME] | MOUTH PIECE | 2011-07-01 00:00:00 | 2.93 | N | Y | N/A | N/A
A4618 | BREATHING CIRCUITS | 2011-07-01 00:00:00 | 7.13 | N | Y | N/A | N/A
A4619 | FACE TENT | 2011-07-01 00:00:00 | 1.14 | N | Y | N/A | N/A
A4620 | VARIABLE CONCENTRATION MASK | 2011-07-01 00:00:00 | 0.56 | N | Y | N/A | N/A
A4623 | TRACHEOSTOMY, INNER CANNULA | 2011-07-01 00:00:00 | 5.26 | N | Y | N/A | N/A
A4624 | TRACHEAL SUCTION CATHERTER, ANY TYPE, EACH | 2011-07-01 00:00:00 | 2.48 | N | Y | N/A | N/A
A4625 | TRACHEOSTOMY CARE KIT FOR NEW TRACHEOSTOMY | 2011-07-01 00:00:00 | 5.56 | N | Y | N/A | N/A
A4626 | TRACHEOSTOMY CLEANING BRUSH, EACH | 2011-07-01 00:00:00 | 2.57 | N | Y | N/A | N/A
A4628 | OROPHARYNGEAL SUCTION CATHETER, EACH | 2011-07-01 00:00:00 | 3.45 | N | Y | N/A | N/A
A4629 | TRACHEOSTOMY CARE KIT FOR ESTABLISHED TRACH | 2011-07-01 00:00:00 | 4.36 | N | Y | N/A | N/A
A4630 | REPLACEMENT BATTERIES TENS OWNED BY PATIENT | 2011-07-01 00:00:00 | 5.9 | N | Y | N/A | N/A
A4633 | UVL REPLACEMENT BULB/LAMP FOR UVL THERAPY, EA | 2011-07-01 00:00:00 | 38.75 | Y | Y | N/A | N/A
A4634 | REPLACEMENT BULB FOR THERAPEUTIC LIGHT BOX, TABLETOP MODEL | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
A4635 | UNDERARM CRUTCH PAD, REPLACEMENT, EACH | 2011-07-01 00:00:00 | 4.1 | N | Y | N/A | N/A
A4636 | HANDGRIP FOR CANE/CRUTCH/WALKER, EACH | 2011-07-01 00:00:00 | 3.43 | N | Y | N/A | N/A
A4637 | REPLACEMENT TIP CANE/CRUTCH/WALKER, EACH | 2011-07-01 00:00:00 | 1.48 | N | Y | N/A | N/A
A4638 | REPLACEMENT BATTERY FOR PT OWNED EAR PULSE GENERATOR, EACH | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
A4640 | ALTERNATING PRESSURE PAD, REPLACE PT OWNED | 2011-07-01 00:00:00 | 50.81 | N | Y | N/A | N/A
A4641 | PROVISION OF DIAGNOSTIC RADIONUCLIDE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4642 | DIAGNOSTIC IMAGING, SATUMOMAB PENETIDE, PER DOSE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4649 | SURGICAL SUPPLIES NEC | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4651 | CALIBRATED MICROCAPILLARY TUBE, EACH | 2008-01-01 00:00:00 | 2.07 | N | N | N/A | N/A
A4652 | MICROCAPILLARY TUBE SEALANT | 2008-01-01 00:00:00 | 1.65 | N | N | N/A | N/A
A4653 | PERITONEAL DIALYSIS CATHETER ANCHORING DEVICE, BELT, EACH | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4657 | DIALYSIS SYRINGE W/WO NEEDLE, EACH | 2008-01-01 00:00:00 | 0.48 | N | N | N/A | N/A
A4660 | SPHYGMOMANOMETER/BLOOD PRESS APP WITH CUFF AND STE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4663 | BLOOD PRESSURE CUFF ONLY FOR DIALYSIS | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4670 | AUTOMATIC BLOOD PRESSURE MONITOR | 2008-01-01 00:00:00 | 56.28 | N | N | N/A | N/A
A4671 | DISPOSABLE CYCLER SET USED W/CYCLER DIALYSIS MACHINE, EACH | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
A4672 | DRAINAGE EXTENS LINE, DIALYSIS, STERILE, EACH | 2008-01-01 00:00:00 | 3.05 | N | N | N/A | N/A
A4673 | EXTENS LINE W EASY LOCK CONNECT, FOR DIALYSIS | 2008-01-01 00:00:00 | 2.96 | N | N | N/A | N/A
A4674 | CHEMICALS/ANTISEPTICS SOLUTION USED TO CLEAN/STERILIZE DIALYSIS EQUIP, PER 8OZ | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4680 | ACTIVATED CARBON FILTERS FOR HEMODIALYSIS, EA | 2008-01-01 00:00:00 | 110.25 | N | N | N/A | N/A
A4690 | DIALYZERS, ANY TYPE, FOR HEMODIALYSIS, EACH | 2008-01-01 00:00:00 | 103.92 | N | N | N/A | N/A
[NAME] | BICARBONATE CONC SOL FOR HEMODIALYSIS PER GAL | 2008-01-01 00:00:00 | 11.99 | N | N | N/A | N/A
A4707 | BICARB CONC POWDER FOR [NAME], PER PACKET | 2008-01-01 00:00:00 | 4.27 | N | N | N/A | N/A
A4708 | ACETATE CONCENTRATE SOLUTION FOR HEMODIALYSIS PER GALLON | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4709 | ACID CONCENTR SOL FOR HEMODIALYSIS PER GALLON | 2008-01-01 00:00:00 | 9.23 | N | N | N/A | N/A
[NAME] | TREAT WATER (DEION, DISTILL, REVER OSMOS USES DIAL | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4719 | Y SET TUBING FOR PERITONEAL DIALYSIS | 2008-01-01 00:00:00 | 7.12 | N | N | N/A | N/A
A4720 | DIALYSAT SOL FLD VOL GT249CC, FOR PERITONEAL | 2008-01-01 00:00:00 | 14.73 | N | N | N/A | N/A
A4721 | DIALYSAT SOL FLD VOL GT999CC LT1999CC, FOR PERI | 2008-01-01 00:00:00 | 20.38 | N | N | N/A | N/A
A4722 | DIALYS SOL FLD VOL GT1999CC LT2999CC, FOR PERI | 2008-01-01 00:00:00 | 18.79 | N | N | N/A | N/A
A4723 | DIALYS SOL FLD VOL GT2999CC LT3999CC, FOR PERI | 2008-01-01 00:00:00 | 28.19 | N | N | N/A | N/A
A4724 | DIALYS SOL FLD VOL GT3999CC LT4999CC, FOR PERI | 2008-01-01 00:00:00 | 28.45 | N | N | N/A | N/A
A4725 | DIALYS SOL FLD VOL GT4999CC LT5999CC, FOR PERI | 2008-01-01 00:00:00 | 27.9 | N | N | N/A | N/A
A4726 | DIALYSATE SOLUTN FLUID VOL GT5999CC, FOR PERI | 2008-01-01 00:00:00 | 33.48 | N | N | N/A | N/A
A4728 | [NAME], NON-DEXTROSE CONTAINING 500ML | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4730 | FISTULA CANNULATION SET FOR DIALYSIS, EACH | 2008-01-01 00:00:00 | 1.37 | N | N | N/A | N/A
A4736 | TOPICAL ANESTHESIA FOR DIALYSIS PER GRAM | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4737 | INJECTABLE ANESTHETIC FOR DIALYSIS PER S0 ML | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4740 | SHUNT ACC FOR DIALY ONLY | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4750 | ARTERIAL OR VENOUS TUBING FOR DIALYSIS, EACH | 2008-01-01 00:00:00 | 7.35 | N | N | N/A | N/A
A4755 | ARTERIAL AND VENOUS TUBING FOR DIALYSIS, EACH | 2008-01-01 00:00:00 | 9.37 | N | N | N/A | N/A
[NAME] | DIALYSATE STAND TEST SOLUTION, SUP | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | DIALYSATE CONCENTRATE | 2008-01-01 00:00:00 | 4.49 | N | N | N/A | N/A
A4766 | DIALYSATE CONCENTRATE SOLUTION ADDITIVE FOR PERITONEAL DIALYSIS PER 10 ML | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4770 | BLOOD TESTING SUPPLIES, VACUUM TUBE, PER 50 | 2008-01-01 00:00:00 | 22.06 | N | N | N/A | N/A
A4771 | BLOOD CLOTTING TIME TUBE, DIALYSIS, PER 50 | 2008-01-01 00:00:00 | 71.7 | N | N | N/A | N/A
A4772 | DEXTROSTICK/GLUCOSE STRIPS, DIALYSIS, PER 50 | 2008-01-01 00:00:00 | 57.44 | N | N | N/A | N/A
A4773 | HEMOSTIX FOR DIALYSIS, PER 50 | 2008-01-01 00:00:00 | 26.68 | N | N | N/A | N/A
A4774 | AMMONIA TEST PAPER, PER BOX | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4802 | PROTAMINE SULFATE FOR DIALYSIS, PER 50 MG | 2008-01-01 00:00:00 | 5.64 | N | N | N/A | N/A
A4860 | DISPOSABLE CATHETER CAPS FOR DIALYSIS, PER 10 | 2008-01-01 00:00:00 | 30.61 | N | N | N/A | N/A
A4870 | PLUMBING AND/OR ELECTRIC WORK FOR HOME DIALY EQUIP | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4890 | CONTR, REPR AND MAINT, FOR HOME DIAL EQUIP NON COV | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4911 | DRAIN BAG/BOTTLE, FOR DIALYSIS, EACH | 2008-01-01 00:00:00 | 12.53 | N | N | N/A | N/A
[NAME] | [NAME] SUPPLIES, NOS | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4918 | VENOUS PRESS CLAMPS, EACH | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A4927 | [NAME], PER 100 | 2008-01-01 00:00:00 | 6.65 | N | N | N/A | N/A
A4928 | SURGICAL MASK, PER 20 | 2008-01-01 00:00:00 | 7.64 | N | N | N/A | N/A
A4929 | TOURNIQUET FOR [NAME], EACH | 2008-01-01 00:00:00 | 0.2 | N | N | N/A | N/A
A4930 | GLOVES, STERILE, PER PAIR | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A5051 | CLOSED OSTOMY POUCH W/BARRIER ATTACH, 1 PC EA | 2011-07-01 00:00:00 | 1.95 | N | Y | N/A | N/A
A5052 | CLOSED OSTOMY POUCH W/O BARRIER, 1 PIECE EACH | 2011-07-01 00:00:00 | 1.4 | N | Y | N/A | N/A
A5053 | CLOSED OSTOMY POUCH FOR USE W/FACEPLATE, EACH | 2011-07-01 00:00:00 | 1.65 | N | Y | N/A | N/A
A5054 | CLOSED OSTOMY POUCH USE W/BAR W/FLNG, 2 PC EA | 2011-07-01 00:00:00 | 1.69 | N | Y | N/A | N/A
A5055 | STOMA CAP | 2011-07-01 00:00:00 | 1.31 | N | Y | N/A | N/A
A5056 | 1 PIECE OSTOMY POUCH W FILTER | 2012-01-01 00:00:00 | 4.51 | N | N | N/A | N/A
A5061 | OSTOMY POUCH DRNBLE W BARRIER ATTACH, 1 PC EA | 2011-07-01 00:00:00 | 3.33 | N | Y | N/A | N/A
A5062 | DRAINABLE OSTOMY POUCH W/O BARRIER, 1 PC EACH | 2011-07-01 00:00:00 | 1.97 | N | Y | N/A | N/A
A5063 | DRNBLE OSTOMY POUCH USE W/BAR W/FLNG, 2 PC EA | 2011-07-01 00:00:00 | 2.56 | N | Y | N/A | N/A
A5071 | URINARY OSTOMY POUCH W/BARRIER ATTCH, 1 PC EA | 2011-07-01 00:00:00 | 5.67 | N | Y | N/A | N/A
A5072 | URNRY OSTOMY POUCH W/O BARRIER ATTCH, 1 PC EA | 2011-07-01 00:00:00 | 2.84 | N | Y | N/A | N/A
A5073 | URINRY OSTOMY POUCH USE W/BAR W/FLNG, 2 PC EA | 2011-07-01 00:00:00 | 2.75 | N | Y | N/A | N/A
A5081 | CONTINENT STOMA PLUG | 2011-07-01 00:00:00 | 2.66 | N | Y | N/A | N/A
A5082 | CONTINENT STOMA CATHETER | 2011-07-01 00:00:00 | 9.59 | N | Y | N/A | N/A
A5083 | STOMA ABSORPTIVE COVER, CONTINENT DEVICE | 2011-07-01 00:00:00 | 0.59 | N | Y | N/A | N/A
A5093 | OSTOMY ACCESSORY, CONVEX INSERT | 2011-07-01 00:00:00 | 1.58 | N | Y | N/A | N/A
A5102 | BEDSIDE BOTTLE W/WO TUBE RIGID/EXPANABLE, EA | 2011-07-01 00:00:00 | 21.17 | N | Y | N/A | N/A
A5105 | URINARY SUSPENSORY WITH LEG BAG, W/WO TUBE | 2011-07-01 00:00:00 | 38.48 | N | Y | N/A | N/A
A5112 | URINARY DRAINAGE LEG BAG; LATEX | 2011-07-01 00:00:00 | 32.68 | N | Y | N/A | N/A
A5113 | LATEX LEG STRAP, REPLACEMENT, PER SET | 2011-07-01 00:00:00 | 3.78 | N | Y | N/A | N/A
A5114 | FOAM/FABRIC LEG STRAP, REPLACEMENT, PER SET | 2011-07-01 00:00:00 | 7.17 | N | Y | N/A | N/A
A5120 | SKIN BARRIER, WIPE OR SWAB | 2011-07-01 00:00:00 | 0.23 | N | Y | N/A | N/A
A5121 | SOLID SKIN BARRIER 6X6 OR EQUIVALENT, EACH | 2011-07-01 00:00:00 | 5.99 | N | Y | N/A | N/A
A5122 | SOLID SKIN BARRIER 8X8 OR EQUIVALENT, EACH | 2011-07-01 00:00:00 | 10.31 | N | Y | N/A | N/A
A5126 | ADHESIVE OR NON-ADHESIVE, DISC/FOAM PAD | 2011-07-01 00:00:00 | 1.06 | N | Y | N/A | N/A
A5131 | APPLIANCE CLEANER, INCONT/OSTMY APP PER 16 OZ | 2011-07-01 00:00:00 | 12.73 | N | Y | N/A | N/A
A5200 | PERCUTANEOUS CATH/TUBE ANCHOR, ADHES SKIN ATT | 2013-01-01 00:00:00 | 11 | N | N | N/A | N/A
A5500 | DIABETIC SHOE FOR DENSITY INSERT, PER SHOE | 2011-07-01 00:00:00 | 60.02 | N | Y | N/A | N/A
A5501 | DIABETIC CUSTOM MOLDED SHOE, PER SHOE | 2011-07-01 00:00:00 | 180.05 | N | Y | N/A | N/A
A5503 | DIABETIC SHOE W/ROLLER/ROCKER, PER SHOE | 2011-07-01 00:00:00 | 29.34 | N | Y | N/A | N/A
A5504 | DIABETIC SHOE WITH WEDGE, FITTING, PER SHOE | 2011-07-01 00:00:00 | 29.34 | N | Y | N/A | N/A
A5505 | DIABETIC SHOE W/METATARSAL BAR, PER SHOE | 2011-07-01 00:00:00 | 29.34 | N | Y | N/A | N/A
A5506 | DIABETIC SHOE W/OFFSET HEEL,FITTING, PER SHOE | 2011-07-01 00:00:00 | 29.34 | N | Y | N/A | N/A
A5507 | MODIFICATION DIABETIC SHOE, FITTING, PER SHOE | 2011-07-01 00:00:00 | 29.34 | N | Y | N/A | N/A
A5508 | [NAME], PER SHOE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A5510 | DIABETICS ONLY DIRECT FORMED COMPRESSION MOLDED WITHOUT HEAT, MULTIPLE DENSITY | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A5512 | MULTIPLE DENSITY INSERT DIRECT FORM | 2011-07-01 00:00:00 | 24.49 | N | Y | N/A | N/A
A5513 | MULTIPLE DENSITY INSERT CUSTOM MOLD | 2011-07-01 00:00:00 | 36.55 | N | Y | N/A | N/A
A6010 | COLLAGEN BASED WOUND FILLER, PER GRAM | 2011-07-01 00:00:00 | 29.23 | N | Y | N/A | N/A
A6011 | COLLAGEN GEL/PASTE WOUND FILLER, PER GRAM | 2011-07-01 00:00:00 | 2.15 | N | Y | N/A | N/A
A6021 | COLLAGEN DRESSING PAD LT=16 SQ IN, EACH | 2011-07-01 00:00:00 | 19.85 | N | Y | N/A | N/A
A6022 | COLLAGEN DRESSING PAD GT16LT=48 SQ IN, EACH | 2011-07-01 00:00:00 | 19.85 | N | Y | N/A | N/A
A6023 | COLLAGEN DRESSING PAD GT48 SQ IN, EACH | 2011-07-01 00:00:00 | 179.66 | N | Y | N/A | N/A
A6024 | COLLAGEN DRESSING WOUND FILLER, PER 6 INCHES | 2011-07-01 00:00:00 | 5.84 | N | Y | N/A | N/A
A6025 | SILICON GEL SHEET, EACH | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6154 | WOUND POUCH, EACH | 2011-07-01 00:00:00 | 13.55 | N | Y | N/A | N/A
A6196 | ALGINATE DRESSING LT=16 SQ IN, EACH DRESSING | 2011-07-01 00:00:00 | 6.94 | N | Y | N/A | N/A
A6197 | ALGINATE DRESSING GT16 LT=48 SQ IN, EACH DRSNG | 2011-07-01 00:00:00 | 15.52 | N | Y | N/A | N/A
A6198 | ALGINATE DRESSING GT48 SQ IN, EACH DRESSING | 2008-01-01 00:00:00 | 112.5 | N | Y | N/A | N/A
[NAME] | ALGINATE DRESSING WOUND FILLER, PER 6 INCHES | 2011-07-01 00:00:00 | 4.99 | N | Y | N/A | N/A
A6203 | COMPOSITE DRESSING LT=16 SQ IN, EACH DRSNG | 2011-07-01 00:00:00 | 3.17 | N | Y | N/A | N/A
A6204 | COMPOSITE DRESSING GT16 LT=48 SQ IN, EA DRSNG | 2011-07-01 00:00:00 | 5.88 | N | Y | N/A | N/A
A6205 | COMPOSITE DRESSING GT48 SQ IN, EACH DRESSING | 2008-01-01 00:00:00 | 4.57 | N | Y | N/A | N/A
A6206 | CONTACT LAYER LT= 16 SQ IN, EACH DRESSING | 2008-01-01 00:00:00 | 0.97 | N | Y | N/A | N/A
A6207 | CONTACT LAYER GT16 LT=48 SQ IN, EACH DRESSING | 2011-07-01 00:00:00 | 6.93 | N | Y | N/A | N/A
A6208 | CONTACT LAYER GT48 SQ IN, EACH DRESSING | 2008-01-01 00:00:00 | 3.42 | N | Y | N/A | N/A
A6209 | FOAM DRSG LT=16 SQ IN W/O BORDER, EACH DRSNG | 2011-07-01 00:00:00 | 7.06 | N | Y | N/A | N/A
A6210 | FOAM DRSG GT16 LT=48 SQ IN W/O BRDR, EA DRSNG | 2011-07-01 00:00:00 | 18.81 | N | Y | N/A | N/A
A6211 | FOAM DRSG GT48 SQ IN W/O BORDER, EACH DRSNG | 2011-07-01 00:00:00 | 27.73 | N | Y | N/A | N/A
A6212 | FOAM DRSG LT=16 SQ IN W/BORDER, EACH DRESSING | 2011-07-01 00:00:00 | 9.16 | N | Y | N/A | N/A
A6213 | FOAM DRSG GT16 LT=48 SQ IN W/BORDER, EACH DRSNG | 2008-01-01 00:00:00 | 14.63 | N | Y | N/A | N/A
A6214 | FOAM DRSG GT48 SQ IN W/BORDER, EACH DRESSING | 2011-07-01 00:00:00 | 9.71 | N | Y | N/A | N/A
A6215 | FOAM DRESSING, WOUND FILLER, PER GRAM | 2008-01-01 00:00:00 | 2.33 | N | Y | N/A | N/A
A6216 | NON-STERILE GAUZE LT=16 SQ IN, EACH DRESSING | 2011-07-01 00:00:00 | 0.05 | N | Y | N/A | N/A
A6217 | NON-STERILE GAUZE GT16 LT=48 SQ IN, EACH DRSNG | 2008-01-01 00:00:00 | 0.4 | N | Y | N/A | N/A
A6218 | NON-STERILE GAUZE GT48 SQ IN, EACH DRESSING | 2008-01-01 00:00:00 | 0.58 | N | Y | N/A | N/A
A6219 | GAUZE LT=16 SQ IN W/BORDER, EACH DRESSING | 2011-07-01 00:00:00 | 0.9 | N | Y | N/A | N/A
A6220 | GAUZE GT16 LT=48 SQ IN W/BORDER, EACH DRESSING | 2011-07-01 00:00:00 | 2.44 | N | Y | N/A | N/A
A6221 | GAUZE GT48 SQ IN W/BORDER, EACH DRESSING | 2008-01-01 00:00:00 | 1.09 | N | Y | N/A | N/A
A6222 | GAUZE LT=16 IN NO WTR/SAL W/O BRDR, EACH DRSNG | 2011-07-01 00:00:00 | 2.02 | N | Y | N/A | N/A
A6223 | GAUZE GT16LT=48 NO WTR/SAL W/O BRDR, EACH DRSNG | 2011-07-01 00:00:00 | 2.29 | N | Y | N/A | N/A
A6224 | GAUZE GT 48 IN NO WTR/SAL W/O BRDR, EACH DRSNG | 2011-07-01 00:00:00 | 3.41 | N | Y | N/A | N/A
[NAME] | GAUZE LT=16 SQ IN WATER/SALINE, EACH DRESSING | 2008-01-01 00:00:00 | 1.31 | N | Y | N/A | N/A
A6229 | GAUZE GT16 LT= 48 SQ IN WATER/SALINE, EA DRSNG | 2011-07-01 00:00:00 | 3.41 | N | Y | N/A | N/A
A6230 | GAUZE GT48 SQ IN WATER/SALINE, EACH DRESSING | 2008-01-01 00:00:00 | 1.46 | N | Y | N/A | N/A
A6231 | HYDROGEL DSG LT=16 SQ IN, EACH DRESSING | 2011-07-01 00:00:00 | 4.42 | N | Y | N/A | N/A
A6232 | HYDROGEL DRESSNG GT16 LT=48 SQ IN,EACH DRESSING | 2011-07-01 00:00:00 | 6.49 | N | Y | N/A | N/A
A6233 | HYDROGEL DRESSING GT48 SQ IN, EACH DRESSING | 2011-07-01 00:00:00 | 18.12 | N | Y | N/A | N/A
A6234 | HYDROCOLLOID DRSG LT=6 W/O BORDER, EACH DRSNG | 2011-07-01 00:00:00 | 6.17 | N | Y | N/A | N/A
A6235 | HYDROCOLLOID DRSG GT16 LT=48 W/O BRD, EA DRSNG | 2011-07-01 00:00:00 | 15.88 | N | Y | N/A | N/A
A6236 | HYDROCOLLOID DRSG GT48 IN W/O BRDR, EA DRESSNG | 2011-07-01 00:00:00 | 25.72 | N | Y | N/A | N/A
A6237 | HYDROCOLLOID DRSG LT=16 IN W/BRDR, EA DRESSING | 2011-07-01 00:00:00 | 7.47 | N | Y | N/A | N/A
A6238 | HYDROCOLLOID DRSG GT16 LT=48 W/BRDR, EA DRSNG | 2011-07-01 00:00:00 | 21.52 | N | Y | N/A | N/A
A6239 | HYDROCOLLOID DRSG GT48 IN W/BORDR, EA DRESSING | 2008-01-01 00:00:00 | 18.24 | N | Y | N/A | N/A
A6240 | HYDROCOLLOID DRESSING FILLER PASTE, PER FL OZ | 2011-07-01 00:00:00 | 11.56 | N | Y | N/A | N/A
A6241 | HYDROCOLLOID DRESSING FILLER DRY FORM, PER GM | 2011-07-01 00:00:00 | 2.43 | N | Y | N/A | N/A
A6242 | HYDROGEL DRSG LT=16 IN W/O BORDER, EA DRESSING | 2011-07-01 00:00:00 | 5.72 | N | Y | N/A | N/A
A6243 | HYDROGEL DRSG GT16 LT= 48 W/O BORDER, EA DRSNG | 2011-07-01 00:00:00 | 11.63 | N | Y | N/A | N/A
A6244 | HYDROGEL DRSG GT48 IN W/O BORDER, EA DRESSING | 2011-07-01 00:00:00 | 37.08 | N | Y | N/A | N/A
A6245 | HYDROGEL DRSG LT=16 IN W/BORDER, EA DRESSING | 2011-07-01 00:00:00 | 6.86 | N | Y | N/A | N/A
A6246 | HYDROGEL DRSG GT16 LT=48 IN W/BORDER, EA DRSNG | 2011-07-01 00:00:00 | 9.37 | N | Y | N/A | N/A
A6247 | HYDROGEL DRSG GT48 SQ IN W/BORDER, EA DRESSING | 2011-07-01 00:00:00 | 22.46 | N | Y | N/A | N/A
A6248 | HYDROGEL DRESSING WOUND FILLER GEL, PER FLUID OZ | 2011-07-01 00:00:00 | 15.33 | N | Y | N/A | N/A
A6250 | SKIN SEALANTS,PROTECTANTS,MOISTURIZERS,ANY TYPE/SI | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6251 | ABSORPTV DRSG LT=16 SQ IN W/O BORDER, EA DRSNG | 2011-07-01 00:00:00 | 1.88 | N | Y | N/A | N/A
A6252 | ABSORPTIV DRSG GT16 LT=48 W/O BORDER, EA DRSNG | 2011-07-01 00:00:00 | 3.07 | N | Y | N/A | N/A
A6253 | ABSORPTIV DRSG GT48 SQ IN W/O BORDER, EA DRSNG | 2011-07-01 00:00:00 | 5.99 | N | Y | N/A | N/A
A6254 | ABSORPTIV DRSG LT=16 SQ IN W/BORDER,  EA DRSNG | 2011-07-01 00:00:00 | 1.14 | N | Y | N/A | N/A
[NAME] | ABSORPTIV DRSG GT16 LT=48 IN W/BORDER, EA DRSNG | 2011-07-01 00:00:00 | 2.86 | N | Y | N/A | N/A
A6256 | ABSORPTIVE DRSG GT48 SQ IN W/BORDER, EA DRSNG | 2008-01-01 00:00:00 | 4.45 | N | Y | N/A | N/A
A6257 | TRANSPARENT FILM LT=16 SQ IN, EA DRESSING | 2011-07-01 00:00:00 | 1.45 | N | Y | N/A | N/A
A6258 | TRANSPARENT FILM GT16 LT=48 SQ IN, EA DRESSING | 2011-07-01 00:00:00 | 4.07 | N | Y | N/A | N/A
A6259 | TRANSPARENT FILM GT48 SQ IN, EACH DRESSING | 2011-07-01 00:00:00 | 10.33 | N | Y | N/A | N/A
A6260 | WOUND CLEANSERS, ANY TYPE, ANY SIZE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | WOUND FILLER GEL/PASTE, PER OZ, NOS | 2008-01-01 00:00:00 | 2.58 | N | Y | N/A | N/A
A6262 | WOUND FILLER, DRY FORM, PER GRAM, NOS | 2008-01-01 00:00:00 | 0.99 | N | Y | N/A | N/A
A6266 | IMPREG GAUZE, NO WATR/SALN, ANY WIDTH, PER YD | 2011-07-01 00:00:00 | 1.82 | N | Y | N/A | N/A
A6402 | STERILE GAUZE LT=16 SQ IN, WO ADHES, EA DRSNG | 2011-07-01 00:00:00 | 0.12 | N | Y | N/A | N/A
A6403 | STERILE GAUZE GT16 LT=48 SQ IN, WO ADH,EA DRSNG | 2011-07-01 00:00:00 | 0.41 | N | Y | N/A | N/A
A6404 | STERILE GAUZE GT48 SQ IN, WO ADHES,EA DRESSING | 2008-01-01 00:00:00 | 0.58 | N | Y | N/A | N/A
A6407 | PACKING STRIPS, NON-IMPREG,UP TO 2IN W,PER YD | 2011-07-01 00:00:00 | 1.77 | N | Y | N/A | N/A
[NAME] | STERILE EYE PAD, EACH | 2011-07-01 00:00:00 | 0.37 | N | Y | N/A | N/A
A6412 | EYE PATCH, OCCLUSIVE, EACH | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | [NAME], NON-ELASTIC W GT=3 INCH LT5 INCH PER YD | 2011-07-01 00:00:00 | 0.63 | N | Y | N/A | N/A
A6442 | CONFORM BAND NON-ELASTIC N/S WLT3 INCH PER YD | 2011-07-01 00:00:00 | 0.16 | N | Y | N/A | N/A
A6443 | CONFORM BAND NON-ELASTIC N/S WGT=3 INCHLT5 IN/YD | 2011-07-01 00:00:00 | 0.27 | N | Y | N/A | N/A
[NAME] | CONFORM BAND NON-ELASTIC N/S WGT=5 INCH PER YD | 2011-07-01 00:00:00 | 0.53 | N | Y | N/A | N/A
A6445 | CONFORMING BAND NON-ELASTIC ST W LT3 INCH PER YD | 2011-07-01 00:00:00 | 0.31 | N | Y | N/A | N/A
A6446 | CONFORM BAND NON-ELASTIC ST WGT=3 INCH LT5 INCH/YD | 2011-07-01 00:00:00 | 0.39 | N | Y | N/A | N/A
[NAME] | CONFORMING BAND NON-ELASTIC ST WGT=5 INCH PER YD | 2011-07-01 00:00:00 | 0.63 | N | Y | N/A | N/A
A6448 | LIGHT COMPRESSION BAND ELASTIC W LT3 INCH PER YD | 2011-07-01 00:00:00 | 1.1 | N | Y | N/A | N/A
A6449 | LT COMPRESSION BAND ELASTIC WGT=3 INCH LT5 INCH/YD | 2011-07-01 00:00:00 | 1.66 | N | Y | N/A | N/A
A6450 | LIGHT COMPRESSION BANDAGE, ELASTIC, KNIT/WOVEN WIDTH >= 5 INCHES/YD | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6451 | MODERATE COMP BANDAGE, ELASTIC, KNIT/WOVEN, LOAD RESISTANCE OF 1.25 TO 1.34 LB | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6452 | HIGH COMPRESSION BAND ELASTIC WGT=3 INLT5 IN/YD | 2011-07-01 00:00:00 | 5.58 | N | Y | N/A | N/A
A6453 | SELF-ADHERING BAND ELASTIC W LT3 INCH PER YARD | 2011-07-01 00:00:00 | 0.58 | N | Y | N/A | N/A
A6454 | SELF-ADHERING BAND ELASTIC WGT=3IN LT5IN PER YD | 2011-07-01 00:00:00 | 0.73 | N | Y | N/A | N/A
A6455 | SELF-ADHERING BAND ELASTIC WGT=5 INCH PER YD | 2011-07-01 00:00:00 | 1.31 | N | Y | N/A | N/A
A6456 | ZINC PASTE BAND NON-ELASTIC WGT=3 IN LT5 IN /YD | 2011-07-01 00:00:00 | 1.21 | N | Y | N/A | N/A
A6457 | TUBULAR DRESSING W/WO ELASTIC ANY WIDTH | 2011-07-01 00:00:00 | 1.08 | N | Y | N/A | N/A
A6501 | COMPRESSION BURN GARMENT BODYSUIT (HEAD TO FOOT) CUSTOM FABRICATED | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6502 | COMPRESSION BODY GARMENT CAID STRAP CUSTOM FABRICATED | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6503 | COMPRESSION BODY GARMENT FACIAL HOOD CUSTOM FABRICATED | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6504 | COMPRESSION BODY GARMENT GLOVE TO WRIST CUSTOM FABRICATED | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6505 | COMPRESSION BODY GARMENT GLOVE TO ELBOW CUSTOM FABRICATED | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6506 | COMPRESSION BODY GARMENT GLOVE TO AXILLA CUSTOM FABRICATED | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6507 | COMPRESSION BODY GARMENT FOOT TO KNEE LENGTH CUSTOM FABRICATED | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6508 | COMPRESSION BODY GARMENT FOOT TO THIGH LENGTH CUSTOM FABRICATED | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6509 | COMPRESSION BODY GARMENT UPPER TRUNK TO WAIST INCLUDING ARM OPENINGS (VEST) | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6510 | COMPRESSION BODY GARMENT TRUNK INCLUDING ARMS DOWN TO LEG OPENINGS (LEOTARD) | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6511 | COMPRESSION BODY GARMENT LOWER TRUNK INCLUDING LEG OPENINGS (PANTY) CUSTOM FABRI | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6512 | COMPRESSION BODY GARMENT NOT OTHERWISE CLASSIFIED | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
A6513 | COMPRESSION BURN MASK, FACE AND/PR NECK, PLASTIC OR EQUAL, CUSTOM FAB | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6530 | COMPRESSION STOCKING BK 18-30 MM | 2012-09-01 00:00:00 | 22.72 | N | Y | N/A | N/A
A6531 | COMPRESSION STOCKING BK 30-40 MM | 2011-07-01 00:00:00 | 40.84 | N | Y | N/A | N/A
A6532 | COMPRESSION STOCKING BK 40-50 MM | 2011-07-01 00:00:00 | 57.56 | N | Y | N/A | N/A
A6533 | COMPRESSION STOCKING THIGH LENGTH 18-30 MM | 2008-01-01 00:00:00 | 34.87 | N | Y | N/A | N/A
A6534 | COMPRESSION STOCKING THIGH LENGTH 30-40 MM | 2008-01-01 00:00:00 | 42.66 | N | Y | N/A | N/A
A6535 | COMPRESSION STOCKING THIGH LENGTH 40-50 MM | 2008-01-01 00:00:00 | 48.75 | N | Y | N/A | N/A
A6536 | COMPRESSION STOCKING FULL LENGTH 18-30 MM | 2008-01-01 00:00:00 | 72.37 | N | Y | N/A | N/A
A6537 | COMPRESSION STOCKING FULL LENGTH 30-40 MM | 2008-01-01 00:00:00 | 117 | N | Y | N/A | N/A
A6538 | COMPRESSION STOCKING FULL LENGTH 40-50 MM | 2008-01-01 00:00:00 | 136 | N | Y | N/A | N/A
A6539 | COMPRESSION STOCKING WAIST LENGTH 18-30 MM | 2008-01-01 00:00:00 | 35.9 | N | Y | N/A | N/A
A6540 | COMPRESSION STOCKING WAIST LENGTH 30-40 MM | 2008-01-01 00:00:00 | 63.8 | N | Y | N/A | N/A
A6541 | COMPRESSION STOCKING WAIST LENGTH 40-50 MM | 2008-01-01 00:00:00 | 136 | N | Y | N/A | N/A
A6544 | COMPRESSION STOCKING GARTER BELT | 2008-01-01 00:00:00 | 25 | N | Y | N/A | N/A
[NAME] | GRADIENT COMPRESSION WRAP, NON-ELASTIC, BK, 30-50 MM HG, EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6549 | GRADIENT COMPRESSION STOCKING/SLEEVE, NOT OTHERWISE SPEC | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A6550 | NEG PRESSURE WOUND THERAPY DRESSING SET, EACH | 2011-07-01 00:00:00 | 22.32 | N | Y | N/A | N/A
A7000 | DISPOSABLE CANISTER FOR SUCTION PUMP, EACH | 2011-07-01 00:00:00 | 7.76 | N | Y | N/A | N/A
A7001 | NONDISPOSABLE SUCTION PUMP CANISTER, EACH | 2011-07-01 00:00:00 | 31.23 | N | Y | N/A | N/A
A7002 | TUBING USED WITH SUCTION PUMP, EACH | 2011-07-01 00:00:00 | 3.62 | N | Y | N/A | N/A
A7003 | PNEU NEBULIZER ADMINISTRATION SET, DISPOSABLE | 2011-07-01 00:00:00 | 2.59 | N | Y | N/A | N/A
A7004 | DISPOSABLE NEBULIZER SMALL VOLUME NONFILTERED | 2011-07-01 00:00:00 | 1.7 | N | Y | N/A | N/A
A7005 | NONDISPOSABLE PNEUMTC NEBULIZER SET ADMIN SET | 2011-07-01 00:00:00 | 29.11 | N | Y | N/A | N/A
A7006 | FILTERED SM VOL NEBULIZER ADMINISTRATION SET | 2011-07-01 00:00:00 | 9.01 | N | Y | N/A | N/A
A7007 | LG VOLUME NEBULIZER DISPOSABLE USE W AEROSOL | 2011-07-01 00:00:00 | 4.36 | N | Y | N/A | N/A
A7008 | DISPOSABLE NEBULIZER PREFILL, USE W AEROSOL | 2011-07-01 00:00:00 | 10.39 | N | Y | N/A | N/A
A7009 | LG VOL NEBULIZER RESERV BOTTLE,NON-DISPOSABLE | 2011-07-01 00:00:00 | 39.69 | N | Y | N/A | N/A
A7010 | DISP CORRUGATE TUBNG USED W/LG VOL NEB, 100FT | 2011-07-01 00:00:00 | 22.28 | N | Y | N/A | N/A
A7011 | CORRUGATED TUBING, NON-DISPOSABLE, USED W/ LARGE VOLUME NEBULIZER, 10 FEET | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A7012 | LARGE VOL NEBULIZER WATER COLLECTION DEVICE | 2011-07-01 00:00:00 | 3.57 | N | Y | N/A | N/A
A7013 | DISPOSABLE AEROSOL COMPRESSOR FILTER | 2011-07-01 00:00:00 | 0.78 | N | Y | N/A | N/A
A7014 | NON-DISPOSABLE AEROSOL COMPRESSOR FILTER | 2011-07-01 00:00:00 | 4.24 | N | Y | N/A | N/A
A7015 | AEROSOL MASK USED WITH DME NEBULIZER | 2011-07-01 00:00:00 | 1.77 | N | Y | N/A | N/A
A7016 | NEBULIZER DOME & MOUTHPIECE USE W SML NEB | 2011-07-01 00:00:00 | 6.84 | N | Y | N/A | N/A
A7017 | NEBULIZER , DURABLE, GLASS NOT USED W OXYGEN | 2011-07-01 00:00:00 | 126.54 | N | Y | N/A | N/A
A7018 | WATER DISTILLED W/NEBULIZER, NOT USED W OXYGN | 2011-07-01 00:00:00 | 0.36 | N | Y | N/A | N/A
A7025 | REPLACE CHEST COMPRESS VEST, PT OWNED, EACH | 2011-07-01 00:00:00 | 410.61 | Y | Y | N/A | N/A
A7026 | REPLACE CHEST CMPRSS [NAME], PT OWNED, EACH | 2011-07-01 00:00:00 | 27.14 | Y | Y | N/A | N/A
A7027 | COMBINATION ORAL/NASAL MASK, EACH | 2011-07-01 00:00:00 | 169.32 | N | Y | N/A | N/A
A7028 | REPLACEMENT ORAL CUSHION COMBO MASK, EACH | 2011-07-01 00:00:00 | 46.77 | N | Y | N/A | N/A
A7029 | REPLACEMENT ORAL/NASAL PILLOW COMB MASK, PAIR | 2011-07-01 00:00:00 | 19.11 | N | Y | N/A | N/A
A7030 | CPAP FULL FACE MASK, EACH | 2011-07-01 00:00:00 | 153.5 | N | Y | N/A | N/A
A7031 | REPLACEMENT FACE MASK INTERFACE, FULL, EACH | 2011-07-01 00:00:00 | 56.77 | N | Y | N/A | N/A
A7032 | REPLACEMENT NASAL CUSHION FOR NASAL DEV, EACH | 2011-07-01 00:00:00 | 32.98 | N | Y | N/A | N/A
A7033 | REPLACEMENT NASAL PILLOWS FOR NASAL DEV, PAIR | 2011-07-01 00:00:00 | 23.11 | N | Y | N/A | N/A
A7034 | NASAL INTERFACE USED W PAP, W/WO HEAD STRAP | 2011-07-01 00:00:00 | 95.72 | N | Y | N/A | N/A
A7035 | HEADGEAR USED W/ POSITIVE AIRWAY PRESSURE DEV | 2011-07-01 00:00:00 | 32.34 | N | Y | N/A | N/A
A7036 | CHINSTRAP USED W/POSITIVE AIRWAY PRESSURE DEV | 2011-07-01 00:00:00 | 14.81 | N | Y | N/A | N/A
A7037 | TUBING USED W/ POSITIVE AIRWAY PRESSURE DEV | 2011-07-01 00:00:00 | 33.37 | N | Y | N/A | N/A
A7038 | POSITIVE AIRWAY PRESSURE DISPOSABLE FILTER | 2011-07-01 00:00:00 | 4.39 | N | Y | N/A | N/A
A7039 | POSITIVE AIRWAY PRESSURE NONDISPOSABLE FILTER | 2011-07-01 00:00:00 | 12.47 | N | Y | N/A | N/A
A7040 | ONE WAY CHEST DRAIN VALVE | 2011-07-01 00:00:00 | 37.27 | N | Y | N/A | N/A
A7041 | WATER SEAL DRAINAGE CONTAINER AND TUBING | 2011-07-01 00:00:00 | 70.04 | N | Y | N/A | N/A
A7042 | IMPLANTED PLEURAL CATHETER, EACH | 2011-07-01 00:00:00 | 169.24 | N | Y | N/A | N/A
A7043 | VACUUM DRAINAGEBOTTLE/TUBING FOR IMPLNTD CATH | 2011-07-01 00:00:00 | 26.54 | N | Y | N/A | N/A
A7044 | POSITIVE AIRWAY PRESSURE ORAL INTERFACE, EACH | 2011-07-01 00:00:00 | 98.38 | N | Y | N/A | N/A
A7045 | REPLACEMENT EXHALATION PORT FOR PAP | 2011-07-01 00:00:00 | 15.84 | N | Y | N/A | N/A
A7046 | REPLACEMENT WATER CHAMBER, PAP DEVICE, EACH | 2011-07-01 00:00:00 | 15.88 | N | Y | N/A | N/A
A7407 | RESP SUCTION ORAL INTERFACE | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
A7501 | TRACHEOSTOMA VALVE INCLUDING DIAPHRAGM, EACH | 2011-07-01 00:00:00 | 99.15 | N | Y | N/A | N/A
A7502 | REPLACEMENT DIAPHRAGM/FPLATE TRACH VALV, EACH | 2011-07-01 00:00:00 | 47.12 | N | Y | N/A | N/A
A7503 | HEAT/MOISTURE EXCH SYS FILTER HOLDER/CAP, EA | 2011-07-01 00:00:00 | 10.7 | N | Y | N/A | N/A
A7504 | TRACHEOSTOMA HEAT/MOISTURE EXCH SYS FILTER,EA | 2011-07-01 00:00:00 | 0.63 | N | Y | N/A | N/A
A7505 | HEAT/MOISTURE EXCH SYS TRACH VALVE HOUSING,EA | 2011-07-01 00:00:00 | 4.42 | N | Y | N/A | N/A
A7506 | HEAT/MOISTURE EXCH SYS TRACH VLV ADHSV DSK,EA | 2011-07-01 00:00:00 | 0.32 | N | Y | N/A | N/A
A7507 | HEAT/MOIST EXCH SYS INTGRTD FILTER&HOLDER, EA | 2011-07-01 00:00:00 | 2.35 | N | Y | N/A | N/A
A7508 | HEAT/MOIST EXCH SYS/VLV HSNG&INTGRTD ADHS, EA | 2011-07-01 00:00:00 | 2.71 | N | Y | N/A | N/A
A7509 | TRACHSTOMA HEAT/MOIST EXCH SYS FLTR HLD, EACH | 2011-07-01 00:00:00 | 1.33 | N | Y | N/A | N/A
A7520 | TRACHEOSTOMY/LARYNGECT TUBE NON-CUFFED, EACH | 2011-07-01 00:00:00 | 44.82 | N | Y | N/A | N/A
[NAME] | TRACHEOSTOMY/LARYNGECTOMY TUBE CUFFED, EACH | 2011-07-01 00:00:00 | 44.42 | N | Y | N/A | N/A
A7522 | TRACHEOSTOMY/LARYNGECTMY TUBE STAINLESS, EACH | 2011-07-01 00:00:00 | 42.63 | N | Y | N/A | N/A
A7525 | TRACHEOSTOMY MASK, EACH | 2011-07-01 00:00:00 | 1.95 | N | Y | N/A | N/A
A7526 | TRACHEOSTOMY TUBE COLLAR/HOLDER, EACH | 2011-07-01 00:00:00 | 3.19 | N | Y | N/A | N/A
A7527 | TRACHEOSTOMY/LARYNGECTOMY TUBE PLUG/STOP, EAC | 2011-07-01 00:00:00 | 3.38 | N | Y | N/A | N/A
A8000 | HELMET, PROTECTIVE, SOFT, PREFABRICATED | 2011-07-01 00:00:00 | 144.77 | N | Y | N/A | N/A
A8001 | HELMET, PROTECTIVE, HARD, PREFABRICATED | 2011-07-01 00:00:00 | 144.77 | N | Y | N/A | N/A
A8002 | HELMET, PROTECTIVE, SOFT, CUSTOM FABRICATED, INCL ALL COMPONENTS/ACCESSORIES | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A8003 | HELMET, PROTECTIVE, HARD, CUSTOM FABRICATED, INCL/ COMPONENTS AND ACCESSORIES | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A8004 | SOFT INTERFACE FOR HELMET, REPLACEMENT ONLY | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A9152 | MULTIPLE VITAMINS, W/ OR W/O MINERALS & TRACE ELEMENTS, ORAL, PER DOSE, NOS | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
A9153 | MULTIPLE VITAMINS WITH OR WITHOUT TRACE ELEMENTS, ORAL, PER DOSE | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
A9180 | LICE TREATMENT, TOPICAL | 2008-01-01 00:00:00 | 4.65 | N | N | N/A | N/A
A9275 | HOME GLUCOSE DISP MONITOR, INCLUDES TEST STRIPS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A9284 | SPIROMETER, NON-ELECTRONIC, INCLUDES ALL ACCESSORIES | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
A9500 | TECHNETIUM TC 99M SESTAMIBI, PER DOSE | 2008-01-01 00:00:00 | 64.28 | N | N | N/A | N/A
A9502 | TECHNETIUM TC 99M TETROFOSMIN, PER UNIT DOSE | 2008-01-01 00:00:00 | 58.06 | N | N | N/A | N/A
A9503 | TECHNETIUM TC 99M MEDRONATE, UP TO 30 MCI | 2008-01-01 00:00:00 | 50.65 | N | N | N/A | N/A
A9504 | SUPPLY-TECHNETIUM TC-99M APCITIDE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9505 | THALLOUS CHLORIDE TL 201/MCI, PER MCI | 2008-01-01 00:00:00 | 19.89 | N | N | N/A | N/A
A9507 | INDIUM 111 CAPROMAB PENDETIDE, PER DOSE | 2008-01-01 00:00:00 | 687.71 | N | N | N/A | N/A
A9508 | IOBENGUANE SULFATE I-131, PER 0.5 MCI | 2008-01-01 00:00:00 | 165.82 | N | N | N/A | N/A
A9510 | SUPPLY RADIOPHARMACEUTICAL DIAGNOSTIC IMAGAGING AGENT TECHNETIUM TC99 DISOFENIN | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9512 | SUPPLY OF RADIOPHARMACEUTICAL DIAGN IMAG AGENT TECHNETIUM TC 99M PER MCI | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9516 | SUPPLY OF RADIOPHARMACEUTICAL DIAGN IMAG AGENT I-123 SODIUM IODIDE PER MCI | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9517 | I-131 SODIUM IODIDE CAPSULE PER MCI | 2008-01-01 00:00:00 | 5.48 | N | N | N/A | N/A
A9520 | TC99 TILMANOCEPT DIAG 0.5MCI | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
A9521 | TECHNETIUM TC 99M EXAMETAZINE, PER DOSE | 2008-01-01 00:00:00 | 210.65 | N | N | N/A | N/A
A9524 | IODINATED I-131 SERUM ALBUMIN, 5 MICROCURIES | 2008-01-01 00:00:00 | 0.36 | N | N | N/A | N/A
A9526 | DIAGNOSIS AMMONIA N-13, PER DOSE | 2008-01-01 00:00:00 | 143.89 | N | N | N/A | N/A
A9527 | IODINE I-125, SODIUM IODIDE SOLUTION, THERAPEUTIC, PER MILLICURIE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9528 | DX I-131 SODIUM IODIDE CAPSULE, PER  MILLICUR | 2008-01-01 00:00:00 | 5.48 | N | N | N/A | N/A
A9529 | DX I-131 SODIUM IODIDE SOLUTION, PRER MILLICU | 2008-01-01 00:00:00 | 6.49 | N | N | N/A | N/A
A9530 | TH I-131 SODIUM IODIDE SOLUTION, PER  MILLICU | 2008-01-01 00:00:00 | 6.49 | N | N | N/A | N/A
A9531 | SUPPLY OF RADIOPHARM DIAGN AGENT, I-131 SODIUM IODIDE SOL, PER MILLIC UP TO 100 | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9532 | SUPPLY OF RADIOPHARM THEARP AGENT, IODINATED 1-125, SERUM ALBUMIN, 5 MICRO CUR | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9536 | TECHNETIUM TC-99M DEPREOTIDE, DIAGNOSTIC, UP TO 35 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9537 | TECHNETIUM TC-99M MEBROFENIN, DIAGNOSTIC, UP TO 15 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9538 | TECHNETIUM TC-99M PYROPHOSPHATE, DIAGNOSTIC, UP TO 25 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9539 | TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, UP TO 25 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9540 | TECHNETIUM TC-99M MACROAGGREGATED ALBUMIN, DIAGNOSTIC, UP TO 10 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9541 | TECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC, UP TO 20 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9542 | INDIUM IN-111 IBRITUMOMAB, TIUXETAN, DIAGNOSTIC, UP TO 5 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9543 | YTTRIUM Y-90 IBRITUMOMAB, TIUXETAN, THERAPEUTIC, UP TO 40 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9544 | IODINE I-131 TOSITUMOMAB, DIAGNOSTIC, PER TREATMENT DOSE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9545 | IODINE I-131 TOSITUMOMAB, THERAPEUTIC, PER TREATMENT DOSE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9546 | COBALT CO-57/58 CYANOCOBALAMIN, DIAGNOSTIC, UP TO 1 MICROCURIE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9547 | INDIUM IN-111 OXYQUINOLINE, DIAGNOSTIC, PER 0.5 MILLICURE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9548 | INDIUM IN-111 PENTETATE DIAGNOSTIC, PER 0.5 MILLICURE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9550 | TECHNETIUM TC-99M SODIUM GLUCEPTATE, DIAGNOSTIC, UP TO 25 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9551 | TECHNETIUM TC-99M SUCCIMER, DIAGNOSTIC, UP TO 10 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9552 | FLOURODEOXYGLUCOSE [NAME], DIAGNOSTIC PER STUDY DOSE, UP TO 45 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9553 | [NAME], DIAGNOSTIC, UP TO 250 MICROCURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9554 | IODINE I-125 [NAME], DIAGNOSTIC, UP TO 10 MICROCURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9555 | RUBIDIUM RB-82, DIAGNOSTIC, PER STUDY DOSE, UP TO 60 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9556 | GALLIUM GA-67 CITRATE DIAGNOSTIC, PER MILLICURIE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9557 | TECHNETIUM TC-99M BICISATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9558 | [NAME] GAS, DIAGNOSTIC, PER 10 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9559 | COBALT CO-57 CYANOBOBALAMIN, ORAL, DIAGNOSTIC, UP TO 1 MICROCURIE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9560 | TECHNETIUM TC-99M LABELED RED BLODD CELLS, DIAGNOSTIC, UP TO 30 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | TECHNETIUM TC-99M OXIDRONATE, DIAGNOSTIC, UP TO 30 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9562 | TECHNETIUM TC-99M MERTIATIDE, DIAGNOSTIC, UP TO 15 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9563 | SODIUM PHOSPHATE P-32 THERAPEUTIC PER MILLICURIE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9564 | CHROMIC PHOSPHATE P-32 SUSPENSION, THERAPEUTIC, PER MILLICURIE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9566 | TECHNETIUM TC-99M FANOLESOMAB, DIAGNOSTIC, UP TO 25 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9567 | TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, AEROSOL, UP TO 25 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9568 | TECHNETIUM TC-99M ARCITUMOMAB, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9569 | TECHNETIUM TC -99M EXAMETAZIME LABELED AUTOLOGUS WHITE BLOOD CELLS | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9570 | INDIUM IN -111 LABELED AUTOLOGUS WHITE BLOOD CELLS, DIAGNOSTIC PER STUDY DOSE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | INDIUM IN -111 LABELED AUTOLOGUS PLATELETS, DIAGNOSTIC PER STUDY DOSE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9572 | INDIUM IN -111 PENTETREOTIDE, DIAGNOSTIC PER STUDY DOSE, UP TO 6 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9576 | [NAME] | 2008-01-01 00:00:00 | 2.46 | N | N | N/A | N/A
[NAME] | INJECTION GADOTERATE MEGLUMI 0.1ML | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
A9577 | INJECTION MULTIHANCE PER ML | 2011-07-01 00:00:00 | 2.21 | N | N | N/A | N/A
A9578 | INJECTION MULTIHANCE MULTIPACK PER ML | 2011-07-01 00:00:00 | 2.06 | N | N | N/A | N/A
A9579 | GADOLINIUM-BASE MR CONTRAST NOS,1ML | 2011-07-01 00:00:00 | 2 | N | N | N/A | N/A
A9580 | NAFL F-18, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9581 | GADOXETATE DISODIUM INJ | 2011-07-01 00:00:00 | 12.15 | N | N | N/A | N/A
A9582 | IODINE I-123 IOBENGUANE, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9583 | GADOFOSVESET TRISODIUM INJ | 2011-07-01 00:00:00 | 11.5 | N | N | N/A | N/A
A9586 | FLORBETAPIR F18, DX, PER DOSE, UP TO 10 MC | 2013-01-01 00:00:00 | 0 | N | Y | N/A | N/A
A9599 | RADIOPHARMA DX BETA AMYLOID PET PER STUDY DOSE | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
A9600 | STRONTIUM-89 CHLORIDE, PER MCI | 2008-01-01 00:00:00 | 402.85 | N | N | N/A | N/A
A9604 | SAMARIUM SM-153 LEXIDRONAM, THERAPEUTIC, PER [NAME], UP TO 150 | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9698 | NON-RADIOACTIVE CONTRAST IMAGING MATERIAL, NOC | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9699 | SUPPLY OF RADIOPHARM THERAPEUTIC IMAGNG AGNT, NOT OTHERWISE CLASSIFIED | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
A9700 | ECHOCARDIOGRAPHY CONTRAST, PER STUDY | 2008-01-01 00:00:00 | 118.6 | N | N | N/A | N/A
A9900 | MISC DME SUPPLY ACCESSORY AND OR SERVICE COMPONENT OF ANOTHER HCPC CODE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
A9999 | MISC DME SUPPLY OR ACCESSORY, NOT OTHERWISE SPECIFIED | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
B4034 | ENTERAL FEEDING SUPPLY KIT; SYRINGE, PER DAY | 2011-07-01 00:00:00 | 5.33 | N | Y | N/A | N/A
B4035 | ENTERAL FEEDING SUPPLY KIT; PUMP, PER DAY | 2011-07-01 00:00:00 | 10.16 | N | Y | N/A | N/A
B4036 | ENTERAL FEEDING SUPPLY KIT; GRAVITY, PER DAY | 2011-07-01 00:00:00 | 6.98 | N | Y | N/A | N/A
B4081 | ENTERAL NASOGASTRIC TUBING W/STYLET | 2011-07-01 00:00:00 | 18.85 | N | Y | N/A | N/A
B4082 | ENTERAL NASOGASTRIC TUBING W/O STYLET | 2011-07-01 00:00:00 | 14.01 | N | Y | N/A | N/A
B4083 | ENTERAL STOMACH TUBE LEVINE TYPE | 2008-01-01 00:00:00 | 2.38 | N | Y | N/A | N/A
B4087 | GASTRO/JEJUNO TUBE, STANDARD, ANY TYPE, EACH | 2011-07-01 00:00:00 | 31.1 | N | Y | N/A | N/A
B4088 | GASTRO/JEJUNO TUBE, LOW-PROFILE, ANY TYPE, EACH | 2011-07-01 00:00:00 | 31.1 | N | Y | N/A | N/A
B4100 | FOOD THICKENERADMINISTERED ORAL, PER OZ | 2008-01-01 00:00:00 | 0.55 | N | Y | N/A | N/A
B4102 | EF ADULT, REPLACE FLUIDS AND ELECTROLYTES | 2008-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
B4103 | EF PEDIATRICS REPLACE FLUIDS AND ELECTROLYTES | 2008-01-01 00:00:00 | 2.45 | N | Y | N/A | N/A
B4104 | ADDITIVE FOR ENTERAL FORMULA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
B4149 | EF BLENDERIZED FOODS WITH INTACT NUTRIENTS | 2011-07-01 00:00:00 | 1.37 | N | Y | N/A | N/A
B4150 | EF NUTRITIONALLY COMP WITH INTACT NUTRIENTS | 2011-07-01 00:00:00 | 0.59 | N | Y | N/A | N/A
B4152 | EF NUTRITIONALLY COMPLETE CALORICALY DENSE | 2011-07-01 00:00:00 | 0.49 | N | Y | N/A | N/A
B4153 | EF NUTRITIONALLY COMPLETE HYDROLYSED PROTIENS | 2011-07-01 00:00:00 | 1.67 | N | Y | N/A | N/A
B4154 | EF SPECIAL METABOLIC NEEDS W/O INHERIT DISEAS | 2011-07-01 00:00:00 | 1.06 | N | Y | N/A | N/A
B4155 | EF NUTRITIONALLY INCOMP/MODULAR NUTRIENT | 2011-07-01 00:00:00 | 0.83 | N | Y | N/A | N/A
[NAME] | ENT FORM, NUTRITIONALLY COMPLETE, FOR SPECIAL METABOLIC NEEDS, 100 CAL=1 UNIT | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
B4158 | EF PED NUTRITIONALLY COMPLETE INTACT NUTRIENT | 2008-01-01 00:00:00 | 0.61 | N | Y | N/A | N/A
B4159 | ENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COMPLETE SOY BASED,100 CAL=1 UNIT | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
B4160 | EF PED CALORICALLY DENSEGT/=0.7KC | 2010-04-01 00:00:00 | 0.7 | N | Y | N/A | N/A
B4161 | EF PED HYDROLYZED/AMINO ACID | 2010-04-01 00:00:00 | 1.93 | N | Y | N/A | N/A
[NAME] | ENTERAL FORMULA, FOR PEDIATRIC, HYDROLYZED/AMINO ACIDS, 100 CAL=1 UN | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
B4164 | PARENTERAL 50% DEXTROSE SOLUTION, 500 ML= 1UN | 2008-01-01 00:00:00 | 15.96 | N | Y | N/A | N/A
B4168 | PARENTERAL SOL AMINO ACID 3.5%, 500 ML=1 UNIT | 2008-01-01 00:00:00 | 21.96 | N | Y | N/A | N/A
[NAME] | PARENTERAL SOL AMINO ACID 5.5%, 500 ML=1 UNIT | 2008-01-01 00:00:00 | 47.78 | N | Y | N/A | N/A
B4176 | PARENTERAL SOL AMINO ACID 7-8.5%, 500 ML= 1UN | 2008-01-01 00:00:00 | 37.43 | N | Y | N/A | N/A
B4178 | PARENTERAL SOL AMINO ACID GT 8.5%, 500 ML= 1UN | 2008-01-01 00:00:00 | 52.47 | N | Y | N/A | N/A
B4180 | PARENTERAL SOLUTION CARB GT50%, 500 ML=1 UNIT | 2008-01-01 00:00:00 | 22.88 | N | Y | N/A | N/A
B4185 | PARENTERAL NUTRITION SOLUTION 10 GM LIPIDS | 2011-07-01 00:00:00 | 11.02 | N | Y | N/A | N/A
B4189 | PARENTERAL SOLU AMINO ACID &, 10-51 GRAMS PRT | 2011-07-01 00:00:00 | 174.25 | N | Y | N/A | N/A
B4193 | PARENTERAL SOLUTION 52-73 GM PROTEIN PREMIX | 2011-07-01 00:00:00 | 225.17 | N | Y | N/A | N/A
B4197 | PARENTERAL SOLUTION 74-100 GM PROTEIN PREMIX | 2011-07-01 00:00:00 | 274.13 | N | Y | N/A | N/A
B4199 | PARENTERAL SOLUTION GT100 GM PROTEIN PREMIX | 2011-07-01 00:00:00 | 313.25 | N | Y | N/A | N/A
B4216 | PARENTERAL NUTRITION ADDITIVE HOMEMIX,PER DAY | 2011-07-01 00:00:00 | 7.57 | N | Y | N/A | N/A
B4220 | PARENTERAL NUTRITN SUPPLY KIT PREMIX, PER DAY | 2011-07-01 00:00:00 | 7.85 | N | Y | N/A | N/A
B4222 | PARENTERAL NUTRITN SUPPLY KIT HOMEMIX,PER DAY | 2008-01-01 00:00:00 | 7.71 | N | Y | N/A | N/A
B4224 | PARENTERAL NUTRITN ADMINISTRATION KIT,PER DAY | 2011-07-01 00:00:00 | 24.52 | N | Y | N/A | N/A
B5000 | PARENTERAL SOLUTION RENAL-AMIRO SYN PREMIX | 2008-01-01 00:00:00 | 10.84 | N | Y | N/A | N/A
B5100 | PARENTERAL SOL HEPATIC-FREAMINE HBC PREMIX | 2008-01-01 00:00:00 | 4.36 | N | Y | N/A | N/A
B5200 | TPN PREMIX W/PREP ANY STRENGTH PER GM STRESS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
B9000 | ENTERAL NUTRITION INFUSION PUMP W/O ALARM | 2011-07-01 00:00:00 | 1068.8 | N | Y | N/A | N/A
B9002 | ENTERAL NUTRITION INFUSION PUMP WITH ALARM | 2011-07-01 00:00:00 | 1068.8 | N | Y | N/A | N/A
B9004 | PARENTERAL NUTRITION INFUSION PUMP PORTABLE | 2011-07-01 00:00:00 | 2473.52 | N | Y | N/A | N/A
B9006 | PARENTERAL NUTRITION INFUSION PUMP STATIONARY | 2011-07-01 00:00:00 | 2473.52 | N | Y | N/A | N/A
B9998 | NOC FOR ENTERAL SUPPLIES | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
B9999 | NOC FOR PARENTERAL SUPPLIES | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
C1300 | HYPERBARIC OXYGEN UNDER PRESSURE, FULL BODY CHAMBER, PER 30 MIN INTERVAL | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
C1749 | ENDOSCOPE, RETROGRADE IMAGING/ILLUMINATION COLONOSCOPE DEVICE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
C1765 | ADHESIVE BARRIER | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
C1783 | OCCULAR IMPLANT, AQUEOUS DRAINAGE ASSIST DEVICE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
C1814 | RETINAL TAMPONADE DEVICE, SILICONE OIL | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
C1886 | CATHETER, EXTRAVASC TISSUE ABLATION, ANY MODE | 2013-06-01 00:00:00 | 0 | N | Y | N/A | N/A
C1818 | INTEGRATED KERATOPROSTHESIS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
C1900 | LEAD, [NAME] | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
C2614 | PROBE, PERCUTANEOUS LUMBAR DISCECTOMY | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
C2616 | BRACHYTHERAPY SOURCE, YTTRIUM-90 | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
C2618 | PROBE, CRYOABLATION | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
C8900 | MAGNETIC RESONANCE ANGIOGRAPHY W CONTRAST, ABDOMEN | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8901 | MAGNETIC RESONANCE ANGIOGRAPHY W/O CONTRAST, ABDOMEN | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8902 | MAGNETIC RESONANCE ANGIOGRAPHY W/O CONTRAST FOLLOWED BY CONTRAST, ABDOMEN | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8903 | MAGNETIC RESONANCE ANGIOGRAPHY W CONTRAST, BREAST, UNILATERAL | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8904 | MAGNETIC RESONANCE IMAGING W/O CONTRAST, BREAST, UNILATERAL | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8905 | MAGNETIC RESONANCE IMAGING W/O CONTRAST BREAST, UNILATERAL | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8906 | MAGNETIC RESONANCE IMAGING W CONTRAST, BREAST BILATERAL | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8907 | MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST, BREAST BILATERAL | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8908 | MAGNETIC RESONANCE IMAGING W/O CONTRAST BREAST, BILATERAL | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8909 | MAGNETIC RESONANCE ANGIOGRAPHY W CONTRAST, CHEST (EXCLUDING MYOCARDIUM) | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8910 | MAGNETIC RESONANCE ANGIOGRAPHY W/O CONTRAST, CHEST (EXCLUDING MYOCARDIUM) | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8911 | MAGNETIC RESONANCE ANGIOGRAPHY W/O CONTRAST FOLLOWED BY CONTRAST - CHEST | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8912 | MAGNETIC RESONANCE ANGIOGRAPHY W CONTRAST LOWER EXTREMITY | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8913 | MAGNETIC RESONANCE ANGIOGRAPHY W/O CONTRAST LOWER EXTREMITY | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8914 | MAGNETIC RESONANCE ANGIOGRAPHY W/O CONTRAST FOLLOWED W CONTRAST L EXTREMITY | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8918 | MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, PELVIS | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8919 | MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, PELVIS | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8920 | MAGNETIC RESONANCE ANGIOGRAPHY W/O CONTRAST,FOLLOWED BY CONTRAST, PELVIS | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8929 | TTE W/WO CNTRST W/ BYRECRD, IF, W/ SPCTRL DPLR ECHOCARD, & W/ COLR FLOW DPLR | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8930 | TTE W OR W/O CONTR, CONT ECG | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8931 | MAGNETIC RESONANCE ANGIOGRAPHY W/O CONTRAST; FOLLOWED BY W/ CONTRAST, SPINAL CANAL | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8932 | MAGNETIC RESONANCE ANGIOGRAPHY W/O CONTRAST, SPINAL CANAL AND CONTENTS | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8933 | MAGNETIC RESONANCE ANGIOGRAPHY W/OCONTRAST FOLLOWED BY W/ CONTRAST, SPINAL CANAL | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8934 | MAGNETIC RESONANCE ANGIOGRAPHY W/ CONTRAST, UPPER EXTREMITY | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8935 | MAGNETIC RESONANCE ANGIOGRAPHY W/O CONTRAST, UPPER EXTREMITY | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C8936 | MAGNETIC RESONANCE ANGIOGRAPHY W/O CONTRAST FOLLOWED BY W/ CONTRAST, UPPER EXTREMITY | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
C9132 | KCENTRA, PER I.U. | 2013-10-01 00:00:00 | 0 | N | Y | N/A | N/A
C9133 | FACTOR IX ANTIHEMO RECOMB RIXIBUS PER I.U. | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
C9248 | INJECTION, CLEVIDIPIEN BUTYRATE, 1 MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
C9290 | [NAME], BUPIVACAINE LIPOSOME, 1 MG | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
C9293 | [NAME], GLUCARPIDASE, 10 UNITS | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
C9356 | TENDON, POROUS MATRIX OF CROSS [NAME] AND GLYCOSAMINOGLYCAN | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
C9358 | DERMAL SUBS NATIVE NON DENATURED COLLAGEN PER 0.5 SQ CENTIMETERS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
C9359 | POROUS PURIFIED COLLAGEN MATRIX BONE VOID FILLER PER 0.5CC | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
C9441 | INJ, FERRIC CARBOXYMALTOSE 1 MG | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
C9497 | LOXAPINE, [NAME] 10 MG | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
C9734 | ULTRASOUND TREATMENT, NOT LEIOMYOMATA WITH MR | 2013-10-01 00:00:00 | 0 | N | Y | N/A | N/A
C9735 | ANOSCOPY, SUBMUCOSAL INJECTION, ANY SUBSTANCE | 2013-10-01 00:00:00 | 0 | N | Y | N/A | N/A
C9737 | LAP ESOPH SPHINCTER AUGMENTATION W DEVICE | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
D1208 | TOPICAL APPLICATION OF FLOURIDE | 2013-01-01 00:00:00 | 14.26 | N | N | N/A | N/A
E0100 | CANE ALL MATERIALS ADJUSTABLE/FIXED WITH TIP | 2011-07-01 00:00:00 | 16.91 | N | Y | N/A | N/A
E0105 | CANE ALL MATER ADJUSTABLE/FIXED QUAD/3 PRONG | 2011-07-01 00:00:00 | 43.83 | N | Y | N/A | N/A
E0110 | CRUTCH ADJUST/FIXED FOREARM PAIR W/TIPS GRIPS | 2011-07-01 00:00:00 | 65.41 | N | Y | N/A | N/A
E0111 | CRUTCH ADJUST/FIXED FOREARM EACH W/TIPS GRIPS | 2011-07-01 00:00:00 | 42.73 | N | Y | N/A | N/A
E0112 | CRUTCH ADJUSTABLE/FIXED UNDERARM PAIR WOOD | 2011-07-01 00:00:00 | 34.93 | N | Y | N/A | N/A
E0113 | CRUTCH ADJUSTABLE/FIXED UNDERARM EACH WOOD | 2011-07-01 00:00:00 | 19.95 | N | Y | N/A | N/A
E0114 | CRUTCH UNDERARM ADJUST/FIXED PAIR ALUMINUM | 2011-07-01 00:00:00 | 40.58 | N | Y | N/A | N/A
E0116 | CRUTCH UNDERARM ADJUST/FIXED EACH ALUMINUM | 2011-07-01 00:00:00 | 26.19 | N | Y | N/A | N/A
E0118 | CRUTCH SUBSTITUTE, LOWER LEG PLATFORM, W OR W/O WHEELS, EACH | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E0130 | WALKER RIGID/PICKUP ADJUSTABLE/FIXED HEIGHT | 2011-07-01 00:00:00 | 57.15 | N | Y | N/A | N/A
E0135 | WALKER FOLDING/PICKUP ADJUSTABLE/FIXED HEIGHT | 2011-07-01 00:00:00 | 66.1 | N | Y | N/A | N/A
E0140 | WALKER W TRUNK SUPPORT ADJUST/FIXED HEIGHT | 2011-07-01 00:00:00 | 293.5 | Y | Y | N/A | N/A
E0141 | WALKER RIGID WHEELED ADJUST/FIXED HEIGHT | 2011-07-01 00:00:00 | 93.82 | N | Y | N/A | N/A
E0143 | WALKER FOLDING WHEELED ADJUST/FIXED HEIGHT | 2011-07-01 00:00:00 | 86.65 | N | Y | N/A | N/A
E0144 | ENCLOSED WALKER RIGID/FOLD WHEEL W REAR SEAT | 2011-07-01 00:00:00 | 259.12 | N | Y | N/A | N/A
E0147 | WALKER HVY DUTY BRAKING VARIABLE WHEEL RESIST | 2011-07-01 00:00:00 | 467.71 | Y | Y | N/A | N/A
E0148 | HEAVY DUTY WALKER NO WHEELS RIGID/FOLD EACH | 2011-07-01 00:00:00 | 103.38 | N | Y | N/A | N/A
E0149 | HEAVY DUTY WHEELED WALKER RIGID/FOLD ANY TYPE | 2011-07-01 00:00:00 | 181.62 | N | Y | N/A | N/A
E0153 | [NAME] EACH | 2011-07-01 00:00:00 | 65.5 | N | Y | N/A | N/A
E0154 | WALKER PLATFORM ATTACHMENT EACH | 2011-07-01 00:00:00 | 57.38 | N | Y | N/A | N/A
E0155 | WALKER RIGID PICK-UP/WHEEL ATTACHMNT PER PAIR | 2011-07-01 00:00:00 | 21.83 | N | Y | N/A | N/A
E0156 | [NAME] | 2011-07-01 00:00:00 | 21.51 | N | Y | N/A | N/A
E0157 | [NAME] EACH | 2011-07-01 00:00:00 | 66.66 | N | Y | N/A | N/A
E0158 | WALKER LEG EXTENSIONS PER SET OF FOUR | 2011-07-01 00:00:00 | 26.18 | Y | Y | N/A | N/A
E0159 | BRAKE ATTACHMNT REPLACE FOR WHEEL WALKER EACH | 2011-07-01 00:00:00 | 14.54 | N | Y | N/A | N/A
E0160 | SITZ TYPE BATH OR EQUIPMENT PORTABLE | 2011-07-01 00:00:00 | 31.21 | N | Y | N/A | N/A
E0161 | SITZ BATH/EQUIP PORTABLE W/FAUCET ATTACHMNTS | 2011-07-01 00:00:00 | 24.76 | N | Y | N/A | N/A
E0163 | COMMODE CHAIR MOBILE WITH FIXED ARM | 2011-07-01 00:00:00 | 104.11 | N | Y | N/A | N/A
E0165 | COMMODE CHAIR WITH DETACHABLE ARM | 2011-07-01 00:00:00 | 184.18 | N | Y | N/A | N/A
E0167 | COMMODE CHAIR PAIL OR [NAME] | 2011-07-01 00:00:00 | 11.33 | N | Y | N/A | N/A
E0168 | HEAVYDUTY/EXTRA WIDE COMMODE CHAIR ANY TYPE | 2011-07-01 00:00:00 | 142.48 | N | Y | N/A | N/A
E0170 | COMMODE CHAIR W/SEAT LIFT MECH, ELECTRIC | 2011-07-01 00:00:00 | 159.32 | N | Y | N/A | N/A
E0171 | COMMODE CHAIR W/SEAT LIFT NON-ELECTRIC | 2011-07-01 00:00:00 | 28.67 | N | Y | N/A | N/A
E0172 | SEAT LIFT MECHANISM PLACED OVER OR ON TOP OF TOILET, ANY TYPE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
E0175 | COMMODE CHAIR FOOT REST EACH | 2011-07-01 00:00:00 | 62.52 | N | Y | N/A | N/A
[NAME] | PRESSURE PAD ALTERNATING W/PUMP HVY DUTY | 2011-07-01 00:00:00 | 258.27 | N | Y | N/A | N/A
[NAME] | REPLACE PUMP, ALTERNATE PRESSURE PAD | 2011-07-01 00:00:00 | 259.5 | N | Y | N/A | N/A
E0184 | DRY PRESSURE MATTRESS | 2011-07-01 00:00:00 | 183.82 | N | Y | N/A | N/A
E0185 | GEL PRESSURE STANDARD LNGTH/WDTH MATTRESS PAD | 2011-07-01 00:00:00 | 301.96 | N | Y | N/A | N/A
E0186 | AIR PRESSURE MATTRESS | 2011-07-01 00:00:00 | 201.29 | N | Y | N/A | N/A
E0187 | WATER PRESSURE MATTRESS | 2011-07-01 00:00:00 | 230.11 | N | Y | N/A | N/A
E0188 | SYNTHETIC SHEEPSKIN PAD | 2011-07-01 00:00:00 | 22.64 | N | Y | N/A | N/A
E0189 | LAMBSWOOL SHEEPSKIN PAD ANY SIZE | 2011-07-01 00:00:00 | 49.06 | N | Y | N/A | N/A
E0190 | POSITIONING CUSHION/PILLOW/WEDGE, ANY SHAPE OR SIZE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E0191 | PROTECTOR HEEL OR ELBOW EACH | 2011-07-01 00:00:00 | 9.43 | N | Y | N/A | N/A
E0193 | POWERED AIR FLOTATION BED FOR LOW AIR LOSS TH | 2011-07-01 00:00:00 | 7718.85 | Y | Y | N/A | N/A
[NAME] | AIR FLUIDIZED BED | 2011-07-01 00:00:00 | 32258.9 | Y | Y | N/A | N/A
[NAME] | GEL PRESSURE MATTRESS | 2011-07-01 00:00:00 | 273.77 | N | Y | N/A | N/A
E0197 | AIR PRESSURE PAD STNDRD LENGTH/WIDTH MATTRESS | 2011-07-01 00:00:00 | 209.19 | N | Y | N/A | N/A
E0198 | WATER PRESSURE PAD STND LENGTH/WIDTH MATTRESS | 2011-07-01 00:00:00 | 209.19 | N | Y | N/A | N/A
E0199 | DRY PRESSURE PAD STNDRD LENGTH/WIDTH MATTRESS | 2011-07-01 00:00:00 | 30.26 | N | Y | N/A | N/A
E0200 | HEAT LAMP WITHOUT STAND INC BULB/INFRD ELEMNT | 2011-07-01 00:00:00 | 74.84 | Y | Y | N/A | N/A
E0202 | PHOTOTHERAPY/BILIRUBIN LIGHT WITH PHOTOMETER | 2011-07-01 00:00:00 | 527.5 | N | Y | N/A | N/A
E0205 | HEAT LAMP WITH STAND INC BULB/INFRARD ELEMENT | 2011-07-01 00:00:00 | 155.73 | Y | Y | N/A | N/A
E0210 | ELECTRIC HEAT PAD STANDARD | 2011-07-01 00:00:00 | 26.19 | Y | Y | N/A | N/A
E0215 | ELECTRIC HEAT PAD MOIST | 2011-07-01 00:00:00 | 66.88 | Y | Y | N/A | N/A
E0217 | WATER CIRCULATING HEAT PAD WITH PUMP | 2011-07-01 00:00:00 | 468.69 | Y | Y | N/A | N/A
E0225 | HYDROCOLLATOR UNIT INCLUDES PADS | 2011-07-01 00:00:00 | 366.9 | Y | Y | N/A | N/A
E0239 | HYDROCOLLATOR UNIT PORTABLE | 2011-07-01 00:00:00 | 360.96 | Y | Y | N/A | N/A
E0240 | BATH/SHOWER CHAIR W/WO WHEELS ANY SIZE | 2008-01-01 00:00:00 | 66.7 | N | Y | N/A | N/A
E0241 | BATH TUB WALL RAIL EACH | 2008-01-01 00:00:00 | 19.99 | N | Y | N/A | N/A
E0242 | BATH TUB RAIL FLOOR BASE | 2008-01-01 00:00:00 | 63.5 | N | Y | N/A | N/A
E0243 | TOILET RAIL EACH | 2008-01-01 00:00:00 | 16.62 | N | Y | N/A | N/A
E0244 | TOILET SEAT RAISED | 2008-01-01 00:00:00 | 27.43 | N | Y | N/A | N/A
E0245 | TUB STOOL OR BENCH | 2008-01-01 00:00:00 | 66.7 | N | Y | N/A | N/A
E0246 | TRANSFER TUB RAIL ATTACHMENT | 2008-01-01 00:00:00 | 39.79 | N | Y | N/A | N/A
E0247 | TRANSFER BENCH FOR TUB OR TIOLET WITH OR W/O COMMODE OPENING | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
E0248 | TRANSFER BENCH, HEAVY DUTY, FOR TUB OR TOILET WITH OR W/O COMMODE OPENING | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
E0249 | PAD FOR WATER CIRCULATING HEAT UNIT | 2011-07-01 00:00:00 | 94.03 | Y | Y | N/A | N/A
E0250 | HOSPITAL BED FIXED HEIGHT W/MATTRESS W/RAILS | 2011-07-01 00:00:00 | 786.43 | N | Y | N/A | N/A
E0251 | HOSPITAL BED FIXED HGT W/O MATTRESS W/RAILS | 2011-07-01 00:00:00 | 601.78 | Y | Y | N/A | N/A
E0255 | HOSPITAL BED VARIABLE HGT W/MATTRESS W/RAILS | 2011-07-01 00:00:00 | 853.15 | N | Y | N/A | N/A
E0256 | HOSPITAL BED VARIABLE HGT W/O MATTRSS W/RAILS | 2011-07-01 00:00:00 | 650.63 | Y | Y | N/A | N/A
E0260 | HOSPITAL BED SEMI-ELECTRIC W/MATTRESS W/RAILS | 2011-07-01 00:00:00 | 1200.06 | Y | Y | N/A | N/A
E0261 | HOSPITAL BED SEMI-ELECTRC W/O MATTRESS W/RAIL | 2011-07-01 00:00:00 | 1170 | Y | Y | N/A | N/A
E0265 | HOSPITAL BED TOTAL ELECTRIC W/MATRESS W/RAILS | 2011-07-01 00:00:00 | 1707.71 | Y | Y | N/A | N/A
E0266 | HOSPITAL BED TOTAL [NAME] | 2011-07-01 00:00:00 | 1432.05 | Y | Y | N/A | N/A
E0271 | MATTRESS INNERSPRING | 2011-07-01 00:00:00 | 180.68 | N | Y | N/A | N/A
E0272 | MATTRESS FOAM RUBBER | 2011-07-01 00:00:00 | 139.97 | N | Y | N/A | N/A
E0273 | BED BOARD | 2008-01-01 00:00:00 | 25.19 | N | Y | N/A | N/A
E0275 | BED PAN STANDARD METAL OR PLASTIC | 2011-07-01 00:00:00 | 14.45 | N | Y | N/A | N/A
E0276 | BED PAN FRACTURE METAL OR PLASTIC | 2011-07-01 00:00:00 | 10.74 | N | Y | N/A | N/A
E0277 | POWERED PRESSURE REDUCING AIR MATTRESS | 2011-07-01 00:00:00 | 6010.2 | Y | Y | N/A | N/A
E0280 | BED CRADLE ANY TYPE | 2011-07-01 00:00:00 | 29.16 | N | Y | N/A | N/A
E0290 | HOSPITAL BED FIXED HGT W/O RAILS W/ MATTRESS | 2011-07-01 00:00:00 | 593.55 | N | Y | N/A | N/A
E0291 | HOSPITAL BED FIXED HGT W/O RAILS W/O MATTRESS | 2011-07-01 00:00:00 | 424.31 | N | Y | N/A | N/A
E0292 | HOSPITAL BED VARIABLE HGT W/O RAIL W/O MATTRS | 2011-07-01 00:00:00 | 658 | N | Y | N/A | N/A
E0293 | HOSPITAL BED VARIABLE HGT W/O RAIL W/MATTRESS | 2011-07-01 00:00:00 | 431 | N | Y | N/A | N/A
E0294 | HOSPITAL BED SEMI-ELECTRIC W/O RAIL W/MATTRES | 2011-07-01 00:00:00 | 1116.23 | Y | Y | N/A | N/A
E0295 | HOSPITAL BED SEMI-ELECTRC W/O RAIL W/O MATTRS | 2011-07-01 00:00:00 | 1087.98 | Y | Y | N/A | N/A
E0296 | HOSPITAL BED TOTAL ELECTR W/O RAIL W/MATTRESS | 2011-07-01 00:00:00 | 1402.85 | Y | Y | N/A | N/A
E0297 | HOSPITAL BED TOTAL ELECT W/O RAIL W/O MATRESS | 2011-07-01 00:00:00 | 1192.97 | Y | Y | N/A | N/A
E0300 | ENCLOSED PEDIATRIC CRIB HOSPITAL GRADE | 2011-07-01 00:00:00 | 2309.74 | N | Y | N/A | N/A
E0301 | HEAVY DUTY HOSPITAL BED, 350-600 LBS W/O MATR | 2011-07-01 00:00:00 | 2312.98 | N | Y | N/A | N/A
E0302 | EX HVYDTY HOSPITAL BED GT 600 LBS W/O MATTRESS | 2011-07-01 00:00:00 | 6112.45 | N | Y | N/A | N/A
E0303 | HOSPITAL BED HEAVY DUTY EXTRA WIDE W/ MATRESS | 2011-07-01 00:00:00 | 2597.05 | N | Y | N/A | N/A
E0304 | HOSP BED EXTRA HEAVY DUTY XTR WIDE W/ MATRESS | 2011-07-01 00:00:00 | 7315.98 | N | Y | N/A | N/A
E0305 | RAILS BED SIDE HALF LENGTH | 2011-07-01 00:00:00 | 144.96 | Y | Y | N/A | N/A
E0310 | RAILS BED SIDE FULL LENGTH | 2011-07-01 00:00:00 | 140.95 | Y | Y | N/A | N/A
E0316 | BED SAFETY ENCLOSURE/FRAME/CANOPY ANY TYPE | 2011-07-01 00:00:00 | 1719.62 | Y | Y | N/A | N/A
E0325 | URINAL MALE JUG-TYPE ANY MATERIAL | 2011-07-01 00:00:00 | 9.55 | N | Y | N/A | N/A
E0326 | URINAL FEMALE JUG-TYPE ANY MATERIAL | 2011-07-01 00:00:00 | 9.05 | N | Y | N/A | N/A
E0371 | NONPOWERED STD LENGTH/WIDTH MATTRESS OVERLAY | 2011-07-01 00:00:00 | 3797.48 | Y | Y | N/A | N/A
E0372 | POWERED STD LENGTH/WIDTH AIR MATTRESS OVERLAY | 2011-07-01 00:00:00 | 4607.91 | Y | Y | N/A | N/A
E0373 | NONPOWERED ADVANCD PRESSURE REDUCING MATTRESS | 2011-07-01 00:00:00 | 5249.85 | Y | Y | N/A | N/A
E0424 | STATIONARY COMPRESSED GAS O2 SYSTEM RENTAL | 2011-07-01 00:00:00 | 1559.79 | N | Y | N/A | N/A
E0431 | PORTABLE GASEOUS OXYGEN SYSTEM RENTAL | 2011-07-01 00:00:00 | 258.66 | N | Y | N/A | N/A
E0433 | PORTABLE LIQUID OXYGEN SYS | 2011-07-01 00:00:00 | 464.67 | N | Y | N/A | N/A
E0434 | PORTABLE LIQUID OXYGEN SYSTEM RENTAL | 2011-07-01 00:00:00 | 258.66 | N | Y | N/A | N/A
E0435 | PORTABLE LIQUID OXYGEN SYSTEM PURCHASE | 2008-01-01 00:00:00 | 67.25 | Y | Y | N/A | N/A
E0439 | [NAME] OXYGEN SYSTEM RENTAL | 2011-07-01 00:00:00 | 1559.79 | N | Y | N/A | N/A
[NAME] | STATIONARY O2 GAS PER/UNIT, 1 MONTH SUPPLY | 2011-07-01 00:00:00 | 69.71 | N | Y | N/A | N/A
E0442 | STATIONARY O2 LIQUID PER/UNIT, 1 MONTH SUPPLY | 2011-07-01 00:00:00 | 69.71 | N | Y | N/A | N/A
E0443 | PORTABLE OXYGEN CONTENTS GAS/UNIT USE W/SYSTM | 2011-07-01 00:00:00 | 69.71 | N | Y | N/A | N/A
E0444 | PORTABLE OXYGEN CONTENTS LIQ/UNIT USE W/SYSTM | 2011-07-01 00:00:00 | 69.71 | N | Y | N/A | N/A
E0445 | OXIMETER DEVICE FOR MEASURING BLOOD OXYGEN LEVELS NON-INVASIVELY | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E0450 | VOLUME VENTILATOR W/O PRESSURE SUPPORT MODE | 2011-07-01 00:00:00 | 8114.53 | Y | Y | N/A | N/A
E0455 | OXYGEN TENT, EXCLUDING CROUP OR PEDIATRIC TENTS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E0457 | CHEST SHELL/CUIRASS | 2011-07-01 00:00:00 | 580.13 | N | Y | N/A | N/A
E0459 | CHEST WRAP | 2011-07-01 00:00:00 | 504.44 | N | Y | N/A | N/A
E0460 | NEG PRESSURE VENTILATOR PORTABLE/STATIONARY | 2011-07-01 00:00:00 | 7271.59 | Y | Y | N/A | N/A
E0461 | VOL VENT NONINVASIVE INTERFACE PORT/STATIONRY | 2011-07-01 00:00:00 | 8114.53 | Y | Y | N/A | N/A
E0462 | ROCKING BED WITH OR WITHOUT SIDE RAILS | 2011-07-01 00:00:00 | 2888.49 | Y | Y | N/A | N/A
E0463 | PRESS SUPP VENT USED WITH INVASIVE INTERFACE | 2011-07-01 00:00:00 | 13940.83 | Y | Y | N/A | N/A
E0464 | PRESS SUPP VENT USED WITH NONINV INT | 2011-07-01 00:00:00 | 15489.81 | Y | Y | N/A | N/A
E0470 | RESP ASSIST DEV W/O BACKUP NON-INV INTERFACE | 2011-07-01 00:00:00 | 2192.31 | Y | Y | N/A | N/A
E0471 | RESP ASSIST DEV W/BACKUP NON-INV INTERFACE | 2011-07-01 00:00:00 | 5486.48 | Y | Y | N/A | N/A
E0472 | RESP ASSIST DEV W/BACKUP INVASIVE INTERFACE | 2011-07-01 00:00:00 | 5486.48 | Y | Y | N/A | N/A
E0480 | PERCUSSOR ELECTRIC/PNEUMATIC HOME MODEL | 2011-07-01 00:00:00 | 435.55 | N | Y | N/A | N/A
E0482 | COUGH STIMULATING DEVICE ALT POS/NEG PRESSURE | 2011-07-01 00:00:00 | 4262.61 | Y | Y | N/A | N/A
E0483 | HIGH FREQ CHEST COMPRESSION GENERATOR SYSTEM | 2011-07-01 00:00:00 | 10538.36 | Y | Y | N/A | N/A
E0484 | NON-ELEC OSCILLATORY POS EXPIRATORY DEVICE EA | 2011-07-01 00:00:00 | 34.86 | Y | Y | N/A | N/A
E0485 | ORAL DEVICE APPLIANCE TO REDUCE UPPER AIRWAY COLLAPSIBILITY, PRE-FAB | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E0486 | ORAL DEVICE APPLIANCE TO REDUCE UPPER AIRWAY COLLAPSIBILITY, CUSTOM-FAB | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E0500 | IPPB MACHINE ALL TYPES W BUILTIN NEBULIZATION | 2011-07-01 00:00:00 | 999.43 | Y | Y | N/A | N/A
E0550 | HUMIDIFER FOR EXTENSIVE SUPPLEMNT DURING IBBP | 2011-07-01 00:00:00 | 496.98 | N | Y | N/A | N/A
E0555 | HUMIDIFIER FOR USE W/REGULATOR OR FLOWMETER | 2008-01-01 00:00:00 | 4.04 | N | Y | N/A | N/A
E0560 | HUMIDIFIER FOR SUPPLEMENTAL HUMID DURING IBBP | 2011-07-01 00:00:00 | 130.3 | Y | Y | N/A | N/A
E0561 | [NAME] USED W/POS AIRWAY PRESS | 2011-07-01 00:00:00 | 87.07 | N | Y | N/A | N/A
E0562 | HUMIDIFIER HEATED USED W/POSITIVE AIRWAY PRES | 2011-07-01 00:00:00 | 245.1 | N | Y | N/A | N/A
E0565 | COMPRESSOR AIR POWER SOURCE FOR EQUIP NONCONT | 2011-07-01 00:00:00 | 582.59 | N | Y | N/A | N/A
E0570 | NEBULIZER WITH COMPRESSOR | 2011-07-01 00:00:00 | 159.61 | N | Y | N/A | N/A
E0572 | AEROSOL COMPRESSOR ADJUST PRESSURE LIGHT DUTY | 2011-07-01 00:00:00 | 419.48 | N | Y | N/A | N/A
E0574 | ULTRASONC/ELEC AEROSOL GENERATOR W/SM VOL NEB | 2011-07-01 00:00:00 | 443.42 | N | Y | N/A | N/A
E0575 | NEBULIZER ULTRASONIC LARGE VOLUME | 2011-07-01 00:00:00 | 991.02 | Y | Y | N/A | N/A
E0580 | NEBULIZER W/COMPRSR USE W/REGULATOR/FLOWMETER | 2011-07-01 00:00:00 | 109.07 | N | Y | N/A | N/A
E0585 | NEBULIZER WITH COMPRESSOR AND HEATER | 2011-07-01 00:00:00 | 295.41 | N | Y | N/A | N/A
E0600 | RESP SUCTION PUMP ELEC PORT/STATNRY HOME MODL | 2011-07-01 00:00:00 | 453.88 | N | Y | N/A | N/A
[NAME] | [NAME] PRESSURE DEVICE/CPAP | 2011-07-01 00:00:00 | 954.45 | Y | Y | N/A | N/A
E0602 | BREAST PUMP MANUAL ANY TYPE | 2011-07-01 00:00:00 | 27.87 | N | Y | N/A | N/A
E0603 | ELECTRIC BREAST PUMP ANY TYPE | 2008-01-01 00:00:00 | 394.34 | N | Y | N/A | N/A
E0605 | VAPORIZER ROOM TYPE | 2011-07-01 00:00:00 | 24.95 | Y | Y | N/A | N/A
E0606 | DRAINAGE BOARD POSTURAL | 2011-07-01 00:00:00 | 227.46 | Y | Y | N/A | N/A
E0607 | BLOOD GLUCOSE MONITOR HOME | 2011-07-01 00:00:00 | 63.08 | N | Y | N/A | N/A
E0610 | PACEMAKER MONITER SELFCONTAIN AUDIBLE/VISIBLE | 2011-07-01 00:00:00 | 212.09 | Y | Y | N/A | N/A
E0615 | PACEMAKER MONITER SELFCONTAIN DIGITAL/VISIBLE | 2011-07-01 00:00:00 | 452.03 | Y | Y | N/A | N/A
E0616 | IMPLANTABLE CARDIAC EVENT RECORDER WITH MEMORY, ACTIVATOR, AND PROGRAMMER | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E0617 | AUTOMATIC EXTERNAL DEFIBRILLATOR W/ECG ANALYS | 2011-07-01 00:00:00 | 3013.89 | N | Y | N/A | N/A
E0619 | APNEA MONITOR WITH RECORDING FEATURE | 2008-01-01 00:00:00 | 2228.4 | Y | Y | N/A | N/A
E0621 | PATIENT LIFT SLING/SEAT CANVAS OR NYLON | 2011-07-01 00:00:00 | 82.72 | N | Y | N/A | N/A
E0625 | PATIENT LIFT, KARATOP, BATHROOM OR TOILET | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
E0627 | SEAT LIFT INCORPORATED INTO COMBO LIFT-CHAIR | 2011-07-01 00:00:00 | 318.46 | N | Y | N/A | N/A
[NAME] | SEAT LIFT FOR PATIENT OWND FURNITURE ELECTRIC | 2011-07-01 00:00:00 | 318.46 | N | Y | N/A | N/A
E0629 | SEAT LIFT FOR PT OWNED FURNITURE NONELECTRIC | 2011-07-01 00:00:00 | 312.21 | N | Y | N/A | N/A
E0630 | PATIENT LIFT HYDRAULIC WITH SEAT OR SLING | 2011-07-01 00:00:00 | 985.16 | N | Y | N/A | N/A
E0635 | PATIENT LIFT ELECTRIC WITH SEAT OR SLING | 2011-07-01 00:00:00 | 1212.91 | N | Y | N/A | N/A
E0636 | [NAME] SUPPORT SYSTEM W/LIFT | 2011-07-01 00:00:00 | 10453.4 | Y | Y | N/A | N/A
E0637 | COMBINATION SIT TO STAND SYSTEM, ANY SIZE, W/SEAT LIFT FEATURE, W OR W/O WHEELS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E0638 | STANDING FRAME SYSTEM, ANY SIZE, W OR W/O WHEELS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E0639 | PATIENT LIFT, MOVEABLE FROM ROOM TO ROOM W DISASSEMBLY AND REASSEMBLY | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E0640 | PATIENT LIFT, FIXED SYSTEM, INCLUDES ALL COMPONENTS/ACCESSORIES | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
[NAME] | STANDING FRAME SYSTEM, MULTI POSITION | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E0642 | STANDING FRAME SYSTEM, MOBILE ANY SIZE INCL PEDIATRIC | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E0650 | PNEUMATIC COMPRESSOR NON-SEGMENTAL HOME | 2011-07-01 00:00:00 | 679.92 | N | Y | N/A | N/A
E0651 | PNEUMATIC COMPRES SEGMENTAL HOME WO/CAL PRESS | 2011-07-01 00:00:00 | 867.04 | Y | Y | N/A | N/A
E0652 | PNEUMATIC COMPRES SEGMNTAL HOME W/CAL PRESSRE | 2011-07-01 00:00:00 | 4315.06 | Y | Y | N/A | N/A
E0655 | NONSEGMENTAL PNEUMATIC APPLIANCE HALF ARM | 2011-07-01 00:00:00 | 101.89 | Y | Y | N/A | N/A
E0660 | NONSEGMENTAL PNEUMATIC APPLIANCE FULL LEG | 2011-07-01 00:00:00 | 150.81 | Y | Y | N/A | N/A
E0665 | NONSEGMENTAL PNEUMATIC APPLIANCE FULL ARM | 2011-07-01 00:00:00 | 129.33 | Y | Y | N/A | N/A
E0666 | NONSEGMENTAL PNEUMATIC APPLIANCE HALF LEG | 2011-07-01 00:00:00 | 130.36 | Y | Y | N/A | N/A
E0667 | SEGMENTAL PNEUMATIC APPLIANCE FULL LEG | 2011-07-01 00:00:00 | 305.66 | N | Y | N/A | N/A
E0668 | SEGMENTAL PNEUMATIC APPLIANCE FULL ARM | 2011-07-01 00:00:00 | 354.58 | N | Y | N/A | N/A
E0669 | SEGMENTAL PNEUMATIC APPLIANCE HALF LEG | 2011-07-01 00:00:00 | 173.06 | N | Y | N/A | N/A
E0671 | SEGMNTAL GRADIENT PNEUMATC APPLIANCE FULL LEG | 2011-07-01 00:00:00 | 392.11 | Y | Y | N/A | N/A
E0672 | SEGMNTAL GRADIENT PNEUMATC APPLIANCE FULL ARM | 2011-07-01 00:00:00 | 304.68 | Y | Y | N/A | N/A
E0673 | SEGMNTAL GRADIENT PNEUMATC APPLIANCE HALF LEG | 2011-07-01 00:00:00 | 253.17 | Y | Y | N/A | N/A
E0676 | INTERMITTENT LIMB COMPRESSION DEVICE (INCL ACCESSORIES), NOT OTHERWISE SPECIFIED | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E0691 | ULTRAVIOLET LIGHT TX TREAT AREA 2 SQ FT OR LESS | 2011-07-01 00:00:00 | 848.32 | Y | Y | N/A | N/A
E0692 | ULTRAVIOLET LIGHT THERAPY SYSTEM 4 FOOT PANEL | 2011-07-01 00:00:00 | 1065.25 | Y | Y | N/A | N/A
E0693 | ULTRAVIOLET LIGHT THERAPY SYSTEM 6 FOOT PANEL | 2011-07-01 00:00:00 | 1313.16 | Y | Y | N/A | N/A
E0694 | ULTRAVIOLET MULTIDIR CABINET SYSTEM 6 FT CABN | 2011-07-01 00:00:00 | 4179.65 | Y | Y | N/A | N/A
E0700 | SAFETY EQUIP, DEVICE OR ACCESSORY, ANY TYPE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
E0705 | TRANSFER DEVICE, EACH | 2011-07-01 00:00:00 | 47.84 | N | Y | N/A | N/A
E0710 | RESTRAINT, ANY TYPE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E0720 | TENS TWO LEAD LOCALIZED STIMULATION | 2011-07-01 00:00:00 | 347.01 | Y | Y | N/A | N/A
E0730 | TENS FOUR OR MORE LEADS MULTIPLE NERVE STIMUL | 2011-07-01 00:00:00 | 349.83 | Y | Y | N/A | N/A
E0731 | FORM FITTING CONDUCTIVE GARMENT FOR TENS/NMES | 2011-07-01 00:00:00 | 294.4 | Y | Y | N/A | N/A
E0740 | [NAME] STIMULTR/MONTR | 2011-07-01 00:00:00 | 493.61 | Y | Y | N/A | N/A
E0744 | NEUROMUSCULAR STIMULATOR FOR SCOLIOSIS | 2011-07-01 00:00:00 | 907.67 | Y | Y | N/A | N/A
E0745 | NEUROMUSCULAR STIMULATOR ELECTRONC SHOCK UNIT | 2011-07-01 00:00:00 | 887.36 | Y | Y | N/A | N/A
E0746 | ELECTROMYOGRAPHY (EMG) FEEDBACK DEVICE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | OSTEOGENISIS STIMULATOR NONINVASIV NOT SPINAL | 2011-07-01 00:00:00 | 3696.98 | Y | Y | N/A | N/A
[NAME] | OSTEOGENISIS STIMULATOR NONINVASIVE SPINAL | 2011-07-01 00:00:00 | 3673.03 | Y | Y | N/A | N/A
E0749 | OSTEOGENESIS STIMULATOR ELECT SURGICAL IMPLNT | 2011-07-01 00:00:00 | 2818.84 | Y | Y | N/A | N/A
E0760 | OSTEOGENES LOW INTENS ULTRASOUND STIM NONINVA | 2011-07-01 00:00:00 | 3052.23 | Y | Y | N/A | N/A
E0762 | TRANSCUTANEOUS ELECTRIC JOINT STIM DEVICE SYS | 2011-07-01 00:00:00 | 1038.05 | Y | Y | N/A | N/A
E0764 | FUNCTIONAL NEUROMUSCULAR STIM TRANSCUTANEOUS | 2011-07-01 00:00:00 | 10447.69 | Y | Y | N/A | N/A
E0765 | FDA APPROVE NERVE STIMULATOR FOR TX NAUSEA/VT | 2011-07-01 00:00:00 | 79.43 | N | Y | N/A | N/A
E0769 | ELECTRICAL STIMULATION OR ELECTROMAGNETIC WOUND TREATMENT DEVICE, NOC | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E0770 | FUNCT ELECT STIM, TRNSCUT STIM NRV &/OR MSCL GRPS, ANY TYPE, CMPLT SYST, NOS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
E0776 | IV POLE | 2011-07-01 00:00:00 | 135.15 | N | Y | N/A | N/A
E0779 | MECH AMB INFUSION PUMP REUSE 8 HRS OR GREATR | 2011-07-01 00:00:00 | 184.28 | N | Y | N/A | N/A
E0780 | MECH AMB INFUSION PUMP REUSE LESS THAN 8HRS | 2011-07-01 00:00:00 | 9.79 | N | Y | N/A | N/A
E0781 | EXTERNAL AMB INFUSION PUMP SINGLE/MULT CHANNL | 2011-07-01 00:00:00 | 2625.49 | N | Y | N/A | N/A
E0782 | NON-PROGRAMMABLE IMPLANTABLE INFUSION PUMP | 2011-07-01 00:00:00 | 4053.21 | Y | Y | N/A | N/A
E0783 | PROGRAMMABLE IMPLANTABLE INFUSION PUMP | 2011-07-01 00:00:00 | 7485.02 | Y | Y | N/A | N/A
E0784 | EXTERNAL AMBULATORY INFUSION PUMP INSULIN | 2011-07-01 00:00:00 | 4138.34 | Y | Y | N/A | N/A
E0786 | IMPLANTABLE PROGRAMMABLE INFUS PUMP REPLACMNT | 2011-07-01 00:00:00 | 7539.07 | N | Y | N/A | N/A
E0791 | PARENTERAL INFUSION PUMP STATIONRY SINGL/MULT | 2011-07-01 00:00:00 | 3134.38 | N | Y | N/A | N/A
E0830 | AMBULATORY TRACTION DEVICE; ALL TYPES; EACH | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
E0840 | CERVICAL TRACTION FRAME ATTACH TO HEADBOARD | 2011-07-01 00:00:00 | 69.17 | N | Y | N/A | N/A
E0849 | CERVICAL PNEUMATIC TRACTION EQUIPMENT | 2011-07-01 00:00:00 | 486.49 | N | Y | N/A | N/A
E0850 | CERVICAL TRACTION STAND FREE STANDING | 2011-07-01 00:00:00 | 88.08 | N | Y | N/A | N/A
E0855 | CERVICAL TRACTION EQUIP NOT REQ ADD STAND/FRM | 2011-07-01 00:00:00 | 466.57 | N | Y | N/A | N/A
E0856 | CERVICAL COLLAR WITH AIR BLADDER | 2011-07-01 00:00:00 | 145.41 | N | Y | N/A | N/A
E0860 | OVERDOOR TRACTION EQUIPMENT CERVICAL TRACTION | 2011-07-01 00:00:00 | 36.38 | N | Y | N/A | N/A
E0870 | EXTREMITY TRACTION FRAME ATTACH TO FOOTBOARD | 2011-07-01 00:00:00 | 109.81 | N | Y | N/A | N/A
E0880 | EXTREMITY TRACTION STAND FREE STANDING | 2011-07-01 00:00:00 | 118.52 | N | Y | N/A | N/A
E0890 | PELVIC TRACTION FRAME ATTACHED TO FOOTBOARD | 2011-07-01 00:00:00 | 113.67 | N | Y | N/A | N/A
E0900 | PELVIC TRACTION STAND FREE STANDING | 2011-07-01 00:00:00 | 120.96 | N | Y | N/A | N/A
E0910 | TRAPEZE BAR ATTACHED TO BED WITH GRAB BAR | 2011-07-01 00:00:00 | 158.67 | N | Y | N/A | N/A
E0911 | HEAVY DUTY, TRAPEZE BAR ATTACH TO BED | 2011-07-01 00:00:00 | 473.13 | N | Y | N/A | N/A
E0912 | HEAVY DUTY, TRAPEZE BAR FREE STANDING | 2011-07-01 00:00:00 | 978.08 | N | Y | N/A | N/A
E0920 | FRACTURE FRAME ATTACHED TO BED INCL WEIGHTS | 2011-07-01 00:00:00 | 388.77 | N | Y | N/A | N/A
[NAME] | FRACTURE FRAME FREE STANDING INCLUDES WEIGHTS | 2011-07-01 00:00:00 | 452.84 | N | Y | N/A | N/A
E0935 | EXERCISE DEVICE PASSIVE MOTION | 2011-07-01 00:00:00 | 191.55 | Y | Y | N/A | N/A
E0940 | TRAPEZE BAR FREE STANDING COMPLETE W GRAB BAR | 2011-07-01 00:00:00 | 297.11 | N | Y | N/A | N/A
E0941 | GRAVITY ASSISTED TRACTION DEVICE ANY TYPE | 2011-07-01 00:00:00 | 365.72 | N | Y | N/A | N/A
E0942 | CERVICAL HEAD HARNESS/HALTER | 2011-07-01 00:00:00 | 18.74 | N | Y | N/A | N/A
E0944 | PELVIC BELT/HARNESS/BOOT | 2011-07-01 00:00:00 | 42.9 | N | Y | N/A | N/A
E0945 | BELT/HARNESS EXTREMITY | 2011-07-01 00:00:00 | 38.34 | Y | Y | N/A | N/A
E0946 | FRACTURE FRAME DUAL W CROSS BARS ATTACHED BED | 2011-07-01 00:00:00 | 586.47 | Y | Y | N/A | N/A
E0947 | FRACTURE FRAME ATTACHMNTS COMPLEX PELVIC TRX | 2011-07-01 00:00:00 | 486.65 | Y | Y | N/A | N/A
E0948 | FRACTURE FRAME ATTACHMNTS COMPLEX CERVICAL TR | 2011-07-01 00:00:00 | 553.77 | Y | Y | N/A | N/A
E0950 | WHEELCHAIR ACCESSORY TRAY EACH | 2011-07-01 00:00:00 | 84.58 | Y | Y | N/A | N/A
E0951 | HEEL LOOP/HOLDER W OR WO ANKLE STRAP EACH | 2011-07-01 00:00:00 | 15.44 | Y | Y | N/A | N/A
E0952 | TOE LOOP/HOLDER EACH | 2011-07-01 00:00:00 | 15.32 | Y | Y | N/A | N/A
E0955 | WHEELCHAIR ACCESSORY CUSHIONED HEADREST EACH | 2011-07-01 00:00:00 | 164.51 | Y | Y | N/A | N/A
E0956 | WHEELCHAIR LATERAL TRUNK/HIP SUPPORT EACH | 2011-07-01 00:00:00 | 80.21 | Y | Y | N/A | N/A
E0957 | WHEELCHAIR ACCES MEDIAL THIGH SUPPORT EACH | 2011-07-01 00:00:00 | 112.24 | Y | Y | N/A | N/A
E0958 | [NAME] EACH | 2011-07-01 00:00:00 | 432.43 | Y | Y | N/A | N/A
E0959 | [NAME] ACCSSORY AMPUTEE ADAPTER EA | 2011-07-01 00:00:00 | 41.73 | Y | Y | N/A | N/A
E0960 | WHEELCHR SHOULDER HARNESS/STRAPS OR CHEST STR | 2011-07-01 00:00:00 | 74.03 | Y | Y | N/A | N/A
E0961 | [NAME] WHEEL LOCK BRAKE EXTENSION | 2011-07-01 00:00:00 | 23.87 | Y | Y | N/A | N/A
E0966 | [NAME] HEAD REST EXTENSION EACH | 2011-07-01 00:00:00 | 67.38 | Y | Y | N/A | N/A
E0967 | [NAME] PROJECTIONS EACH | 2011-07-01 00:00:00 | 60.98 | Y | Y | N/A | N/A
E0968 | WHEELCHAIR COMMODE SEAT | 2011-07-01 00:00:00 | 151.11 | Y | Y | N/A | N/A
E0969 | WHEELCHAIR NARROWING DEVICE | 2011-07-01 00:00:00 | 147.87 | Y | Y | N/A | N/A
[NAME] | WHEELCHAIR NO.2 FOOTPLATES EXCPT FOR FOOT RST | 2008-01-01 00:00:00 | 39.05 | Y | Y | N/A | N/A
E0971 | [NAME] DEVICE | 2011-07-01 00:00:00 | 40.96 | Y | Y | N/A | N/A
E0973 | WHEELCHAIR ADJUSTABLE HEIGHT DETACH ARMREST | 2011-07-01 00:00:00 | 93.56 | Y | Y | N/A | N/A
E0974 | [NAME] DEVICE EACH | 2011-07-01 00:00:00 | 74.03 | Y | Y | N/A | N/A
E0978 | WHEELCHAIR BELT SAFETY BELT/PELVIC STRAP EACH | 2011-07-01 00:00:00 | 33.44 | Y | Y | N/A | N/A
E0980 | WHEELCHAIR SAFETY VEST | 2011-07-01 00:00:00 | 31.21 | Y | Y | N/A | N/A
E0981 | WHEELCHAIR SEAT UPHOLSTERY, REPLACEMENT EACH | 2011-07-01 00:00:00 | 38.37 | Y | Y | N/A | N/A
E0982 | WHEELCHAIR BACK UPHOLSTERY, REPLACEMENT EACH | 2011-07-01 00:00:00 | 41.92 | Y | Y | N/A | N/A
E0983 | [NAME] ADD POWER JOYSTICK CONTROL | 2011-07-01 00:00:00 | 2477.51 | Y | Y | N/A | N/A
E0984 | [NAME] ADD POWER TILLER CONTROL | 2011-07-01 00:00:00 | 1533.14 | Y | Y | N/A | N/A
E0985 | WHEELCHAIR ACCESSORY SEAT LIFT MECHANISM | 2011-07-01 00:00:00 | 191.5 | Y | Y | N/A | N/A
E0986 | [NAME] PUSH-RIM POWER ASSIST EACH | 2011-07-01 00:00:00 | 4592.11 | Y | Y | N/A | N/A
E0988 | LEVER-ACTIVATED WHEEL DRIVE, WHEELCHAIR ACCESSRY | 2012-01-01 00:00:00 | 278.25 | N | N | N/A | N/A
E0990 | WHEELCHAIR ELEVATING LEG REST EACH | 2011-07-01 00:00:00 | 95.54 | Y | Y | N/A | N/A
E0992 | MANUAL WHEELCHAIR ACCESSORY SOLID SEAT INSERT | 2011-07-01 00:00:00 | 89.83 | Y | Y | N/A | N/A
E0994 | WHEELCHAIR ARM REST EACH | 2011-07-01 00:00:00 | 16.64 | Y | Y | N/A | N/A
E0995 | WHEELCHAIR ACCESSORY CALF REST/PAD EACH | 2011-07-01 00:00:00 | 24.08 | Y | Y | N/A | N/A
E1002 | WHEELCHAIR POWER SEAT SYSTEM TILT ONLY | 2011-07-01 00:00:00 | 3298.04 | Y | Y | N/A | N/A
E1003 | WHEELCHAIR POWER SEAT RECLINE ONLY W/O SHEAR | 2011-07-01 00:00:00 | 3573.14 | Y | Y | N/A | N/A
E1004 | WHEELCHR POWER SEAT RECLINE ONLY W/MECH SHEAR | 2011-07-01 00:00:00 | 3961.87 | Y | Y | N/A | N/A
E1005 | WHEELCHR POWER SEAT RECLINE ONLY W/POWR SHEAR | 2011-07-01 00:00:00 | 4288.42 | Y | Y | N/A | N/A
E1006 | WHLCHR POWER SEAT TILT/RECLINE WO SHEAR REDUC | 2011-07-01 00:00:00 | 5252.91 | Y | Y | N/A | N/A
E1007 | WHLCHR POWER SEAT TILT/RECLINE W/MECH SHEAR | 2011-07-01 00:00:00 | 7112.65 | Y | Y | N/A | N/A
E1008 | WHLCHR POWER SEAT TILT/RECLINE W/POWER SHEAR | 2011-07-01 00:00:00 | 7113.28 | Y | Y | N/A | N/A
[NAME] | WHEELCHAIR ACCESS ADDITION TO POWER SEATING MECHANICALLY LINKED LEG ELEVATION | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1010 | WHEELCHAIR ADD POWER LEG ELEVATION W/REST EA | 2011-07-01 00:00:00 | 930.68 | Y | Y | N/A | N/A
E1011 | MODIFY PED. [NAME], WIDTH ADJUST PACKAGE (NOT DISPENSED W/INITIAL WC) | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1014 | RECLINING BACK ADDITION PEDIATRIC WHEELCHAIR | 2011-07-01 00:00:00 | 344.72 | Y | Y | N/A | N/A
E1015 | SHOCK ABSORBER FOR MANUAL WHEELCHAIR EACH | 2011-07-01 00:00:00 | 108.29 | Y | Y | N/A | N/A
E1016 | SHOCK ABSORBER FOR POWER WHEELCHAIR EACH | 2011-07-01 00:00:00 | 106.85 | Y | Y | N/A | N/A
E1017 | HEAVY DUTY SHOCK ABSORBER FOR HEAVY DUTY/EXTRA HD MANUAL WC, EACH | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1018 | HEAVY DUTY SHOCK ABSORBER FOR HD/EXTRA HD POWER WHEELCHAIR, EACH | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1020 | RESIDUAL LIMB SUPPORT SYSTEM FOR WHEELCHAIR | 2011-07-01 00:00:00 | 198.06 | Y | Y | N/A | N/A
E1028 | WHEELCHAIR MANUAL SWINGAWAY WITH MOUNT HRDWAR | 2011-07-01 00:00:00 | 168.06 | Y | Y | N/A | N/A
E1029 | WHEELCHAIR ACCESSORY VENTILATOR TRAY FIXED | 2011-07-01 00:00:00 | 300.69 | Y | Y | N/A | N/A
E1030 | WHEELCHAIR ACCESSORY VENTILATOR TRAY FIXED | 2011-07-01 00:00:00 | 948.17 | Y | Y | N/A | N/A
E1035 | [NAME] TRANSFR SYS W SEAT LT=300LBS | 2011-07-01 00:00:00 | 607.84 | Y | Y | N/A | N/A
E1036 | MULTI-POSITION PT TRANSFER SYS, XTRA-WIDE, INTEG SEAT, WEIGHT CAP GRTR/300 LBS. | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1037 | TRANSPORT CHAIR PEDIATRIC SIZE | 2011-07-01 00:00:00 | 1075.41 | Y | Y | N/A | N/A
E1038 | TRANSPORT CHAIR ADULT SIZE WT LT250 LBS | 2011-07-01 00:00:00 | 178.7 | Y | Y | N/A | N/A
E1039 | TRANSPORT CHAIR PATIENT WT GT= 250LB | 2011-07-01 00:00:00 | 376.64 | Y | Y | N/A | N/A
E1050 | WHEELCHAIR FULL RECLINE FIXED FULL LENGTH ARM | 2011-07-01 00:00:00 | 858.06 | Y | Y | N/A | N/A
E1060 | WHEELCHAIR FULL RECLINE DETACHABLE ARMS | 2011-07-01 00:00:00 | 1219.33 | Y | Y | N/A | N/A
E1070 | WHEELCHAIR FULL RECLINE DETACH ARMS/FOOT REST | 2011-07-01 00:00:00 | 1085.71 | Y | Y | N/A | N/A
E1083 | HEMI-WHEELCHAIR FIXED ARMS/DETACH FOOT REST | 2011-07-01 00:00:00 | 780.57 | Y | Y | N/A | N/A
E1084 | HEMI-WHEELCHAIR DETACHABLE ARMS/FOOT REST | 2011-07-01 00:00:00 | 826.59 | Y | Y | N/A | N/A
E1085 | HEMI-WHEELCHAIR FIXED ARMS/DETACH FOOT REST | 2008-01-01 00:00:00 | 561.1 | Y | Y | N/A | N/A
E1086 | HEMI-WHEELCHAIR DETACHABLE ARMS/FOOT REST | 2008-01-01 00:00:00 | 681.14 | Y | Y | N/A | N/A
E1087 | HIGH STRENGTH WHEELCHAIR LIGHTWT FIXED ARMS | 2011-07-01 00:00:00 | 1254.11 | Y | Y | N/A | N/A
E1088 | HIGH STRENGTH WHEELCHAIR LIGHTWEIGHT DET ARMS | 2011-07-01 00:00:00 | 1494.52 | Y | Y | N/A | N/A
[NAME] | HIGH STRENGTH WHEELCHAIR LIGHTWT FIXED ARMS | 2008-01-01 00:00:00 | 1146.5 | Y | Y | N/A | N/A
E1090 | HIGH STRENGTH WHEELCHAIR LIGHTWEIGHT DET ARMS | 2008-01-01 00:00:00 | 1298.8 | Y | Y | N/A | N/A
E1092 | WHEELCHAIR WIDE HEAVY DUTY DET ARMS/LEG RESTS | 2011-07-01 00:00:00 | 1273.95 | Y | Y | N/A | N/A
E1093 | WHEELCHAIR WIDE HEAVY DUTY DET ARMS/FOOT REST | 2011-07-01 00:00:00 | 1095.54 | Y | Y | N/A | N/A
E1100 | WHEELCHAIR SEMI-RECL FIXED ARM DETACH LEG RES | 2011-07-01 00:00:00 | 1029.01 | Y | Y | N/A | N/A
E1110 | WHEELCHAIR SEMI-RECL DETACH ARMS ELEVATE LEG | 2011-07-01 00:00:00 | 1007.65 | Y | Y | N/A | N/A
E1130 | WHEELCHAIR STANDARD FIXED ARM DETACH FOOTREST | 2008-01-01 00:00:00 | 381.2 | Y | Y | N/A | N/A
E1140 | WHEELCHAIR STANDARD DETACH ARMS/FOOTRESTS | 2008-01-01 00:00:00 | 665.2 | Y | Y | N/A | N/A
E1150 | WHEELCHAIR STANDARD DETACH ARMS/FOOT/LEGRESTS | 2011-07-01 00:00:00 | 748.25 | Y | Y | N/A | N/A
E1160 | WHEELCHAIR FIXED ARMS DETACH ELEVATE LEG REST | 2011-07-01 00:00:00 | 571.06 | Y | Y | N/A | N/A
E1161 | MANUAL ADULT WHEELCHAIR WITH TILT IN SPACE | 2011-07-01 00:00:00 | 2233.72 | Y | Y | N/A | N/A
E1170 | WHEELCHAIR AMPUTEE FIXED ARMS DETACH LEG REST | 2011-07-01 00:00:00 | 885.37 | Y | Y | N/A | N/A
E1171 | WHEELCHAIR AMPUTEE FIXED ARMS W/O LEG REST | 2011-07-01 00:00:00 | 794.56 | Y | Y | N/A | N/A
[NAME] | WHEELCHAIR AMPUTEE DETACH ARMS W/O LEG REST | 2011-07-01 00:00:00 | 970.99 | Y | Y | N/A | N/A
E1180 | WHEELCHAIR AMPUTEE DETACH ARMS W/FOOT REST | 2011-07-01 00:00:00 | 1004.54 | Y | Y | N/A | N/A
E1190 | WHEELCHAIR AMPUTEE DETACH ARMS W/LEG REST | 2011-07-01 00:00:00 | 1160.46 | Y | Y | N/A | N/A
E1195 | WHEELCHAIR AMPUTEE HEAVY DUTY FIXED ARMS | 2011-07-01 00:00:00 | 1245.32 | Y | Y | N/A | N/A
E1200 | WHEELCHAIR AMPUTEE FIXED ARM DETACH FOOT REST | 2011-07-01 00:00:00 | 862.5 | Y | Y | N/A | N/A
E1221 | WHEELCHAIR SPECIAL SIZE FIXED ARMS FOOT RESTS | 2011-07-01 00:00:00 | 400.3 | Y | Y | N/A | N/A
E1222 | WHEELCHAIR SPECIAL SIZE FIXED ARMS LEG RESTS | 2011-07-01 00:00:00 | 671.99 | Y | Y | N/A | N/A
E1223 | WHEELCHAIR SPECIAL SIZE DETACH ARM FOOT RESTS | 2011-07-01 00:00:00 | 733.7 | Y | Y | N/A | N/A
E1224 | WHEELCHAIR SPECIAL SIZE DETACH ARM LEG RESTS | 2011-07-01 00:00:00 | 688.53 | Y | Y | N/A | N/A
E1225 | WHEELCHAIR SPECIAL SIZE ACCSRY SEMI-RECL BACK | 2011-07-01 00:00:00 | 448.02 | Y | Y | N/A | N/A
E1226 | WHEELCHAIR SPECIAL SIZE ACCSRY FULL-RECL BACK | 2011-07-01 00:00:00 | 515.12 | Y | Y | N/A | N/A
E1227 | WHEELCHAIR SPECIAL SIZE ACCSRY SPEC HGT ARM | 2011-07-01 00:00:00 | 252.2 | Y | Y | N/A | N/A
E1228 | WHEELCHAIR SPECIAL SIZE ACCSRY SPEC HGT BACK | 2011-07-01 00:00:00 | 277.74 | Y | Y | N/A | N/A
E1229 | WHEELCHAIR, PEDIATRIC SIZE NOT ELSEWHERE SPECIFIED | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1230 | POWER OPERATED VEHICLE SPECIFY BRAND/MODEL NO | 2011-07-01 00:00:00 | 1814.97 | Y | Y | N/A | N/A
E1231 | WHEELCHAIR, PED. SIZE,TILT-IN-SPACE, RIGID, ADJUSTABLE, W/SITTING SYSTEM | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1232 | FOLDING PEDIATRIC WHEELCHAIR TILT-IN-SPACE | 2011-07-01 00:00:00 | 2018.77 | Y | Y | N/A | N/A
E1233 | RIGID PEDIATRIC WHEELCHAIR TILTNSPAC W/O SEAT | 2011-07-01 00:00:00 | 2091.77 | Y | Y | N/A | N/A
E1234 | FOLD PEDIATRIC WHEELCHAIR TILTNSPACE W/O SEAT | 2011-07-01 00:00:00 | 1821.03 | Y | Y | N/A | N/A
E1235 | RIGID PEDIATRIC WHEELCHAIR ADJUSTABLE W SEAT | 2011-07-01 00:00:00 | 1753.52 | Y | Y | N/A | N/A
E1236 | FOLDNG PEDIATRIC WHEELCHAIR ADJUSTABLE W SEAT | 2011-07-01 00:00:00 | 1547.06 | Y | Y | N/A | N/A
E1237 | RIGID PEDIATRIC WHEELCHAIR ADJUSTABL W/O SEAT | 2011-07-01 00:00:00 | 1560.56 | Y | Y | N/A | N/A
E1238 | FOLD PEDIATRIC WHEELCHAIR ADJUSTABLE W/O SEAT | 2011-07-01 00:00:00 | 1547.06 | Y | Y | N/A | N/A
E1240 | WHEELCHAIR LIGHTWEIGHT DETACH ARMS LEG RESTS | 2011-07-01 00:00:00 | 1021.17 | Y | Y | N/A | N/A
E1250 | WHEELCHAIR LIGHTWEIGHT FIXED ARMS DETACH FOOT | 2008-01-01 00:00:00 | 616.2 | Y | Y | N/A | N/A
E1260 | WHEELCHAIR LIGHTWEIGHT DETACH ARMS FOOT REST | 2008-01-01 00:00:00 | 755.7 | Y | Y | N/A | N/A
E1270 | WHEELCHAIR LIGHTWGT FIXED ARMS DETACH LEGREST | 2011-07-01 00:00:00 | 782.55 | Y | Y | N/A | N/A
E1280 | WHEELCHAIR HEAVY DUTY DETACH ARM LEG RESTS | 2011-07-01 00:00:00 | 1445.64 | Y | Y | N/A | N/A
E1285 | WHEELCHAIR HVY DUTY FIXED ARM DETACH FOOTRST | 2008-01-01 00:00:00 | 1150.3 | Y | Y | N/A | N/A
E1290 | WHEELCHAIR HEAVY DUTY DETACH ARMS FOOT RESTS | 2008-01-01 00:00:00 | 1014.6 | Y | Y | N/A | N/A
E1295 | WHEELCHAIR HEAVY DUTY FIXED ARMS LEG RESTS | 2011-07-01 00:00:00 | 1204.02 | Y | Y | N/A | N/A
E1296 | [NAME] FROM FLOOR | 2011-07-01 00:00:00 | 407.47 | Y | Y | N/A | N/A
E1297 | WHEELCHAIR SPECIAL SEAT DEPTH BY UPHOLSTERY | 2011-07-01 00:00:00 | 98.76 | Y | Y | N/A | N/A
E1298 | WHEELCHAIR SPEC SEAT DEPTH/WIDTH BY CONSTRUCT | 2011-07-01 00:00:00 | 339.96 | Y | Y | N/A | N/A
E1352 | O2 ACCS FLOW REG POS INSIPIRATORY PRESSURE | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
E1353 | OXYGEN SUPPLIES [NAME] | 2011-07-01 00:00:00 | 26.75 | N | Y | N/A | N/A
E1354 | O2 ACCESS, WHEEL CRT FOR PORT CYL OR PORT CONC, ANY TYPE, REPLACE ONLY, EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
E1355 | OXYGEN SUPPLIES STAND/RACK | 2011-07-01 00:00:00 | 20.14 | N | Y | N/A | N/A
E1356 | O2 ACCESS, BATT PACK/CARTRIDGE FOR PORT CONCENTRATOR, ANY TYPE, REPLACE ONLY, EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
E1357 | O2 ACCESSORY, BATRY CHRGR FOR PORT CONCENTRATOR, ANY TYPE, REPLACE ONLY, EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
E1358 | O2 ACCESS, DC PWR ADAPT FOR PORT CONCENTRATOR, ANY TYPE, REPLACE ONLY, EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
E1372 | OXYGEN SUPPL IMMERSION HEATER FOR NEBULIZER | 2011-07-01 00:00:00 | 153.91 | N | Y | N/A | N/A
[NAME] | OXYGEN CONCENTRATOR 85 PERCENT PLUS SNG PORT | 2011-07-01 00:00:00 | 1559.79 | N | Y | N/A | N/A
E1391 | OXYGEN CONCENTRATOR 85 PERCENT PLUS DUAL PORT | 2011-07-01 00:00:00 | 1559.79 | Y | Y | N/A | N/A
E1392 | PORTABLE OXYGEN CONCENTRATOR, RENTAL | 2011-07-01 00:00:00 | 464.67 | N | Y | N/A | N/A
E1399 | DURABLE MEDICAL EQUIP NOT OTHERWISE CLASSIFIED | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
[NAME] | OXYGEN/WATER VAPOR ENRICHING SYSTEM W/HEATER | 2011-07-01 00:00:00 | 1841.13 | N | Y | N/A | N/A
E1406 | OXYGEN/WATER VAPOR ENRICHING SYSTM W/O HEATER | 2011-07-01 00:00:00 | 1711.8 | N | Y | N/A | N/A
E1500 | CENTRIFUGE FOR DIALYSIS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1510 | KIDNEY DIALYSATE DELIVERY SYSTEM | 2008-01-01 00:00:00 | 1984.5 | Y | Y | N/A | N/A
E1520 | HEPARIN INFUSION PUMP FOR DIALYSIS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1530 | AIR BUBBLE DETECTOR FOR DIALYSIS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1540 | PRESSURE ALARM FOR DIALYSIS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1550 | [NAME] FOR DIALYSIS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1560 | BLOOD LEAK DETECTOR FOR DIALYSIS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1570 | ADJUSTABLE CHAIR FOR ESRD PATIENTS | 2008-01-01 00:00:00 | 100.49 | Y | Y | N/A | N/A
E1575 | TRANSDUCER PROTECTOR/FLUID BARRIER PER 10 | 2008-01-01 00:00:00 | 26.87 | Y | Y | N/A | N/A
E1580 | UNIPUNCTURE CONTROL SYSTEM FOR DIALYSIS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1590 | HEMODIALYSIS MACHINE | 2008-01-01 00:00:00 | 1721.69 | Y | Y | N/A | N/A
E1592 | AUTO INTERMITTENT PERITIONEAL DIALYSIS SYSTEM | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1594 | CYCLER DIALYSIS MACHINE PERITONEAL DIALYSIS | 2008-01-01 00:00:00 | 3640 | N | Y | N/A | N/A
E1600 | DELIVERY/INSTALLATION CHARGE DIALYSIS EQUIPMT | 2008-01-01 00:00:00 | 461.86 | Y | Y | N/A | N/A
E1610 | REVERSE OSMOSIS WATER PURIFICATION DIALYSIS | 2008-01-01 00:00:00 | 614.64 | Y | Y | N/A | N/A
E1615 | DEIONIZER WATER PURIFICATION SYSTEM | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1620 | BLOODPUMP FOR DIALYSIS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1625 | WATER SOFTENING SYSTEM | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1630 | RECIPROCATING PERITONEAL DIALYSIS SYSTEM | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1632 | WEARABLE ARTIFICAL KIDNEY | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1634 | PERITONEAL DIALYSIS CLAMPS, EACH | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1635 | COMPACT (PORTABLE) TRAVEL HEMODIALYSIS SYS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1636 | SORBENT CARTRIDGES, PER CASE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1637 | HEMOSTATS FOR DIALYSIS, EACH | 2008-01-01 00:00:00 | 3.99 | N | Y | N/A | N/A
E1639 | DIALYSIS SCALE EACH | 2008-01-01 00:00:00 | 223.34 | N | Y | N/A | N/A
E1699 | DIALYSIS EQUIPMENT, NOT OTHERWISE SPECIFIED | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E1700 | [NAME] REHABILITATION SYSTEM | 2011-07-01 00:00:00 | 325.55 | Y | Y | N/A | N/A
E1701 | REPLACE CUSHIONS FOR JAW MOTION REHAB PKG 6 | 2011-07-01 00:00:00 | 10.02 | Y | Y | N/A | N/A
E1702 | REPACEL MEASURING SCALES JAW MOTION PKG 200 | 2011-07-01 00:00:00 | 21.31 | Y | Y | N/A | N/A
[NAME] | DYNAMIC ADJUST ELBOW EXTENSION/FLEXION DEVICE | 2011-07-01 00:00:00 | 1214.33 | Y | Y | N/A | N/A
E1801 | BIDIRC STATIC PROGRESSIVE STRECH ELBOW DEVICE | 2011-07-01 00:00:00 | 1278.68 | Y | Y | N/A | N/A
E1802 | [NAME] FOREARM PRONATE/SUP DEVICE | 2011-07-01 00:00:00 | 3599.4 | N | Y | N/A | N/A
E1805 | DYNAMIC ADJUSTABLE WRIST EXTEND/FLEXIO DEVICE | 2011-07-01 00:00:00 | 1252.41 | Y | Y | N/A | N/A
E1806 | BIDIRC STATIC PROGRESSIVE STRECH WRIST DEVICE | 2011-07-01 00:00:00 | 1049.9 | Y | Y | N/A | N/A
E1810 | [NAME]/[NAME] DEVICE | 2011-07-01 00:00:00 | 1234.93 | Y | Y | N/A | N/A
E1811 | BIDIREC STATIC PROGRESSIVE STRECH KNEE DEVICE | 2011-07-01 00:00:00 | 1329.52 | Y | Y | N/A | N/A
E1812 | KNEE EXTENSION/FLEXION W ACTIVE RESIST CTRL | 2011-07-01 00:00:00 | 852.39 | N | Y | N/A | N/A
E1815 | DYNAMIC ADJUSTABLE ANKLE EXTEND/FLEXIO DEVICE | 2011-07-01 00:00:00 | 1252.41 | Y | Y | N/A | N/A
E1816 | BIDIRC STATIC PROGRESSIVE STRECH ANKLE DEVICE | 2011-07-01 00:00:00 | 1350.5 | Y | Y | N/A | N/A
E1818 | BIDIR STATIC PROGRESIVE STRECH FOREARM DEVICE | 2011-07-01 00:00:00 | 1378.66 | Y | Y | N/A | N/A
E1820 | REPLACE SOFT INTERFACE MATERIAL EXT/FLEX DEV | 2011-07-01 00:00:00 | 72.8 | Y | Y | N/A | N/A
E1821 | REPLACE SOFT INTERFACE MATERIAL BIDIR SPS DEV | 2011-07-01 00:00:00 | 99.36 | Y | Y | N/A | N/A
E1825 | DYNAMIC ADJUSTABLE FINGER EXTEND/FLEXION DEV | 2011-07-01 00:00:00 | 1252.41 | Y | Y | N/A | N/A
E1830 | DYNAMIC ADJUSTABLE TOE EXTEND/FLEXION DEVICE | 2011-07-01 00:00:00 | 1252.41 | Y | Y | N/A | N/A
E1840 | DYNAMIC ADJUSTABLE SHOULDER EXTEND/FLEX DEVIC | 2011-07-01 00:00:00 | 3793.7 | Y | Y | N/A | N/A
E1841 | STATIC STRETCH SHOULDER DEV ROM ADJUSTMENT | 2014-01-01 00:00:00 | 404.13 | Y | Y | N/A | N/A
E1902 | COMMUNICATION BOARD NON-ELECTRONIC AUGMENTATION OR ALTERNATIVE COMMUNICATION | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2000 | GASTRIC SUCTION PUMP HOME MODEL STATNRY/PORT | 2011-07-01 00:00:00 | 513.8 | N | Y | N/A | N/A
E2100 | BLOOD [NAME] INT VOICE SYNTHESIZER | 2011-07-01 00:00:00 | 516.12 | Y | Y | N/A | N/A
E2101 | BLOOD [NAME] SAMPLE | 2011-07-01 00:00:00 | 178.01 | Y | Y | N/A | N/A
E2120 | PULSE GEN SYS TREAT INNER EAR ENDOLYMP FLUID | 2011-07-01 00:00:00 | 3122.7 | Y | Y | N/A | N/A
E2201 | MAN WHEELCHAIR ACCSRY SEAT WID 20 IN TO LT 24 IN | 2011-07-01 00:00:00 | 352.23 | Y | Y | N/A | N/A
E2202 | [NAME] ACCSRY SEAT WIDTH 24-27 IN | 2011-07-01 00:00:00 | 447.46 | Y | Y | N/A | N/A
E2203 | MAN WHEELCHAIR ACCSRY SEAT DPTH 20 TO LT 22IN | 2011-07-01 00:00:00 | 452.25 | Y | Y | N/A | N/A
E2204 | [NAME] ACCSRY SEAT DEPTH 22-25 IN | 2011-07-01 00:00:00 | 767.9 | Y | Y | N/A | N/A
E2205 | MANUAL WC ACCESSORY, HANDRIM W/O PROJECTIONS | 2011-07-01 00:00:00 | 30.31 | Y | Y | N/A | N/A
E2206 | COMPLETE WHEEL LOCK ASSEMBLY | 2011-07-01 00:00:00 | 37.77 | Y | Y | N/A | N/A
E2207 | CRUTCH AND CANE HOLDER | 2011-07-01 00:00:00 | 40.24 | Y | Y | N/A | N/A
E2208 | CYLINDER TANK CARRIER | 2011-07-01 00:00:00 | 95.03 | Y | Y | N/A | N/A
E2209 | ARM TROUGH EACH | 2011-07-01 00:00:00 | 85.75 | Y | Y | N/A | N/A
E2210 | WHEELCHAIR BEARINGS, REPLACEMENT ONLY | 2011-07-01 00:00:00 | 5.33 | Y | Y | N/A | N/A
E2211 | PNEUMATIC PROPULSION TIRE | 2011-07-01 00:00:00 | 32.83 | Y | Y | N/A | N/A
E2212 | PNEUMATIC PROPULSION TIRE TUBE | 2011-07-01 00:00:00 | 5.45 | Y | Y | N/A | N/A
E2213 | PNEUMATIC PROPULSION TIRE INSERT | 2011-07-01 00:00:00 | 28.24 | Y | Y | N/A | N/A
E2214 | PNEUMATIC CASTER TIRE EACH | 2011-07-01 00:00:00 | 33.98 | Y | Y | N/A | N/A
E2215 | PNEUMATIC CASTER TIRE TUBE | 2011-07-01 00:00:00 | 8.92 | Y | Y | N/A | N/A
E2216 | MANUAL WHEELCHAIR ACCESSORY, FOAM FILLED PROPULSION TIRE, EACH | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2217 | MANUAL WHEELCHAIR ACCESSORY, FOAM FILLED CASTER TIRE, EACH | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2218 | MANUAL WHEELCHAIR ACCESSORY, FOAM PROPULSION TIRE, EACH | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2219 | [NAME] ANY SIZE EACH | 2011-07-01 00:00:00 | 39.51 | Y | Y | N/A | N/A
E2220 | SOLID PROPULSION TIRE EACH | 2011-07-01 00:00:00 | 26.93 | Y | Y | N/A | N/A
E2221 | SOLID CASTER TIRE EACH | 2011-07-01 00:00:00 | 23.72 | Y | Y | N/A | N/A
E2222 | SOLID CASTER TIRE WITH INTEGRATED WHEEL | 2011-07-01 00:00:00 | 19.88 | Y | Y | N/A | N/A
E2224 | PROPULSION WHEEL EXCLUDES TIRE | 2011-07-01 00:00:00 | 87.28 | Y | Y | N/A | N/A
E2225 | CASTER WHEEL EXCLUDES TIRE | 2011-07-01 00:00:00 | 16.43 | Y | Y | N/A | N/A
E2226 | CASTER FORK REPLACEMENT ONLY | 2011-07-01 00:00:00 | 35.82 | Y | Y | N/A | N/A
E2227 | GEAR REDUCTION DRIVE WHEEL, EACH | 2011-07-01 00:00:00 | 1698.08 | N | Y | N/A | N/A
E2228 | MANUAL WHEELCHAIR ACC, WHEELCHAIR BRAKE | 2011-07-01 00:00:00 | 883.88 | N | Y | N/A | N/A
E2230 | MANUAL WC ACCESSORY, MANUAL STANDING SYSTEM | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2231 | [NAME], SOLID SEAT SUPPORT BASE | 2011-07-01 00:00:00 | 145.08 | N | Y | N/A | N/A
E2291 | BACK, PLANAR, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING HARDWARE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2292 | SEAT, PLANAR, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING HARDWARE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2293 | BACK CONTOURED, FOR PEDIATRIC SIZE WHEELCHAIR INCL FIXED ATTACHING HARDWARE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2294 | SEAT CONTOURED FOR PEDIATRIC SIZE WHEELCHAIR INCL FIXED ATTACHING HARDWARE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2295 | MAN WC ACESY, PED WC, [NAME], FOR COORD MOV OF MULT POSITION FEATURES | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2300 | POWER WHEELCHAIR ACCESS POWER SEAT ELEVATION SYSTEM | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2301 | POWER WHEELCHAIR ACCESS, POWER STANDING SYSTEM | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2310 | ELECTRO CONNECTION BETWEEN CONTROL/SEAT SYSTE | 2011-07-01 00:00:00 | 952.21 | Y | Y | N/A | N/A
E2311 | ELECTRO CONNECTION BETWEEN CONTROL/MULT SEAT | 2011-07-01 00:00:00 | 1927.79 | Y | Y | N/A | N/A
E2312 | MINI-PROPORTIONAL REMOTE JOYSTICK | 2011-07-01 00:00:00 | 1830.69 | N | Y | N/A | N/A
E2313 | POWER WHEELCHAIR HARNESS, EXPAND CONTROL, EACH | 2011-07-01 00:00:00 | 290.71 | N | Y | N/A | N/A
E2321 | [NAME] ACCSRY HAND INTERFACE JOYSTICK | 2011-07-01 00:00:00 | 1293.03 | Y | Y | N/A | N/A
[NAME] | [NAME] ACCSRY MULTIPLE MECH SWITCHES | 2011-07-01 00:00:00 | 1147.59 | Y | Y | N/A | N/A
E2323 | [NAME] ACCSRY SPECIAL JOYSTICK HANDLE | 2011-07-01 00:00:00 | 56.28 | Y | Y | N/A | N/A
[NAME] | POWER WHEELCHAIR ACCESSORY CHIN CUP INTERFACE | 2011-07-01 00:00:00 | 35.66 | Y | Y | N/A | N/A
E2325 | [NAME] ACCSRY SIP AND PUFF INTERFACE | 2011-07-01 00:00:00 | 1095.89 | Y | Y | N/A | N/A
E2326 | [NAME] ACCSRY BREATH TUBE KIT FOR SIP | 2011-07-01 00:00:00 | 282.47 | Y | Y | N/A | N/A
E2327 | [NAME] HEAD CONTROL INTERFACE MECH | 2011-07-01 00:00:00 | 2125.66 | Y | Y | N/A | N/A
E2328 | [NAME] | 2011-07-01 00:00:00 | 4032.07 | Y | Y | N/A | N/A
E2329 | [NAME] | 2011-07-01 00:00:00 | 1437.08 | Y | Y | N/A | N/A
E2330 | [NAME] PROXIMITY SWITCH | 2011-07-01 00:00:00 | 2784.5 | Y | Y | N/A | N/A
[NAME] | POWER WHEELCHAIR ACCESS, ATTENDANT CONTROL INTERFACE PROPORT. ELECTRONICS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2340 | [NAME] ACCSR WDTH 20-23 IN SEAT FRAME | 2011-07-01 00:00:00 | 338.31 | Y | Y | N/A | N/A
E2341 | [NAME] ACCSR WDTH 24-27 IN SEAT FRAME | 2011-07-01 00:00:00 | 507.51 | Y | Y | N/A | N/A
E2342 | [NAME] 20-21 IN SEAT FRAME | 2011-07-01 00:00:00 | 422.92 | Y | Y | N/A | N/A
E2343 | [NAME] 22-25 IN SEAT FRAME | 2011-07-01 00:00:00 | 676.68 | Y | Y | N/A | N/A
E2351 | [NAME] ACCSR ELECTRONIC SGD INTERFACE | 2011-07-01 00:00:00 | 568.47 | Y | Y | N/A | N/A
E2359 | [NAME] ACCSR GRP 34 SEALED LEAD ACID | 2012-01-01 00:00:00 | 161.85 | N | N | N/A | N/A
E2360 | [NAME] ACCSR 22NF NONSEALED LEADACID | 2011-07-01 00:00:00 | 106.06 | Y | Y | N/A | N/A
E2361 | [NAME] ACCSR 22NF SEALED LEADACID BAT | 2011-07-01 00:00:00 | 111.6 | Y | Y | N/A | N/A
E2362 | [NAME] ACCSR GR24 NONSEALED LEADACID | 2011-07-01 00:00:00 | 85.38 | Y | Y | N/A | N/A
E2363 | GR24 SEALED LEADACID BATTERY | 2011-07-01 00:00:00 | 148.82 | Y | Y | N/A | N/A
E2364 | [NAME] ACCSR U1NONSEALED LEADACID BAT | 2011-07-01 00:00:00 | 106.06 | Y | Y | N/A | N/A
E2365 | [NAME] ACCSR U1 SEALED LEADACID BATTR | 2011-07-01 00:00:00 | 89.76 | Y | Y | N/A | N/A
E2366 | POWER WHEELCHAIR BATTERY CHARGER, SINGLE MODE | 2011-07-01 00:00:00 | 182.33 | Y | Y | N/A | N/A
E2367 | POWER WHEELCHAIR BATTERY CHARGER, DUAL MODE | 2011-07-01 00:00:00 | 341 | Y | Y | N/A | N/A
E2368 | POWER WHEELCHAIR MOTOR REPLACEMENT | 2011-07-01 00:00:00 | 420.33 | Y | Y | N/A | N/A
[NAME] | POWER WHEELCHAIR GEAR BOX REPLACEMENT | 2011-07-01 00:00:00 | 366.11 | Y | Y | N/A | N/A
E2370 | POWER WHEELCHAIR MOTOR/GEAR BOX COMBO | 2011-07-01 00:00:00 | 653.26 | Y | Y | N/A | N/A
E2371 | GROUP 27 SEALED LEAD ACID BATTERY | 2011-07-01 00:00:00 | 122.65 | Y | Y | N/A | N/A
E2372 | POWER WHEELCHAIR ACCESSORY GROUP 27 NON-SEALED LEAD ACID BATTERY, EACH | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2373 | HAND/CHIN CONTROL INTERFACE SPECIAL JOYSTICK | 2011-07-01 00:00:00 | 638.11 | Y | Y | N/A | N/A
E2374 | HAND/CHIN CONTROL INTERFACE STANDARD JOYSTICK | 2011-07-01 00:00:00 | 434.53 | Y | Y | N/A | N/A
E2375 | NON-EXPANDABLE CONTROLLER | 2011-07-01 00:00:00 | 696.97 | Y | Y | N/A | N/A
E2376 | EXPANDABLE CONTROLLER, REPLACEMENT | 2011-07-01 00:00:00 | 1092.19 | Y | Y | N/A | N/A
E2377 | EXPANDABLE CONTROLLER, INITIAL | 2011-07-01 00:00:00 | 395.22 | Y | Y | N/A | N/A
E2381 | PNEUMATIC DRIVE WHEEL TIRE, ANY SIZE | 2011-07-01 00:00:00 | 60.94 | N | Y | N/A | N/A
E2382 | TUBE FOR PNEUMATIC WHEEL TIRE, REPLACEMENT | 2011-07-01 00:00:00 | 16.61 | N | Y | N/A | N/A
E2383 | INSERT FOR PNEUMATIC WHEEL TIRE, REPLACEMENT | 2011-07-01 00:00:00 | 121.51 | N | Y | N/A | N/A
E2384 | PNEUMATIC CASTER TIRE, REPLACEMENT | 2011-07-01 00:00:00 | 64.75 | N | Y | N/A | N/A
E2385 | TUBE FOR PNEUMATIC CASTER TIRE, REPLACEMENT | 2011-07-01 00:00:00 | 39.61 | N | Y | N/A | N/A
E2386 | FOAM FILLED DRIVE WHEEL TIRE, REPLACEMENT | 2011-07-01 00:00:00 | 120.41 | N | Y | N/A | N/A
E2387 | FOAM FILLED CASTER TIRE, REPLACEMENT | 2011-07-01 00:00:00 | 51.95 | N | Y | N/A | N/A
E2388 | [NAME], REPLACEMENT | 2011-07-01 00:00:00 | 41 | N | Y | N/A | N/A
E2389 | [NAME], REPLACEMENT | 2011-07-01 00:00:00 | 22.27 | N | Y | N/A | N/A
E2390 | SOLID DRIVE WHEEL TIRE, REPLACEMENT | 2011-07-01 00:00:00 | 34.81 | N | Y | N/A | N/A
E2391 | SOLID CASTER TIRE, REPLACEMENT | 2011-07-01 00:00:00 | 16.68 | N | Y | N/A | N/A
E2392 | SOLID CASTER TIRE, INTEGRATED, REPLACEMENT | 2011-07-01 00:00:00 | 43.84 | N | Y | N/A | N/A
E2394 | DRIVE WHEEL EXCLUDES TIRE, REPLACEMENT | 2011-07-01 00:00:00 | 62.45 | N | Y | N/A | N/A
E2395 | CASTER WHEEL EXCLUDES TIRE, REPLACEMENT | 2011-07-01 00:00:00 | 44.39 | N | Y | N/A | N/A
E2396 | CASTER FORK, REPLACEMENT | 2011-07-01 00:00:00 | 51.77 | N | Y | N/A | N/A
E2397 | POWER WHEELCHAIR ACC, LITHIUM-BASED BATTERY | 2011-07-01 00:00:00 | 390.97 | N | Y | N/A | N/A
E2402 | NEG PRESSURE WOUND THERAPY PUMP STAT/PORTABLE | 2011-07-01 00:00:00 | 14664.98 | Y | Y | N/A | N/A
E2500 | SPEECH GENERATE DEV DIGITIZED PRE-REC LT=8MIN | 2011-07-01 00:00:00 | 369.18 | Y | Y | N/A | N/A
E2502 | SPEECH GENERATE DEV PREREC MSG GT8MIN LT=20MIN | 2011-07-01 00:00:00 | 1128.9 | Y | Y | N/A | N/A
E2504 | SPEECH GENERATE DEV PREREC MSGGT20MIN LT=40MIN | 2011-07-01 00:00:00 | 1489.17 | Y | Y | N/A | N/A
E2506 | SPEECH GENERATE DEV DGTZD PREREC MSG GT 40 MIN | 2011-07-01 00:00:00 | 2183.56 | Y | Y | N/A | N/A
E2508 | SPEECH GENERATE DEV DGT SPELLING PHYS CONTACT | 2011-07-01 00:00:00 | 3376.51 | N | Y | N/A | N/A
E2510 | SPEECH GENERATE DEV W MULTI METHODS MSG/ACCS | 2011-07-01 00:00:00 | 6389.59 | Y | Y | N/A | N/A
E2511 | SPEECH GENERATING SOFTWARE PROGRAM, FOR PERSONAL COMPUTER OR DIGITAL ASSIST | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2512 | ACCESSORY FOR SPEECH GENERATING DEVICE, MOUNTING SYSTEM | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2599 | ACCESSORY FOR SPEECH GENERATING DEVICE, NOT OTHERWISE CLASSIFIED | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2601 | GEN USE WHEELCHAIR SEAT CUSHION WDTH LT 22 IN | 2011-07-01 00:00:00 | 49.76 | Y | Y | N/A | N/A
E2602 | GEN USE WHEELCHAIR CUSHION WIDTH GT=22 IN | 2011-07-01 00:00:00 | 97.16 | Y | Y | N/A | N/A
E2603 | SKIN PROTECT WC CUSHION WIDTH LT22IN | 2011-07-01 00:00:00 | 123.35 | Y | Y | N/A | N/A
E2604 | SKIN PROTECT WC CUSHION WIDTH GT=22IN | 2011-07-01 00:00:00 | 153.31 | Y | Y | N/A | N/A
E2605 | POSITION WC CUSHION WIDTH LT22 IN | 2011-07-01 00:00:00 | 219.02 | Y | Y | N/A | N/A
E2606 | POSITION WC CUSHION WIDTHGT=22 IN | 2011-07-01 00:00:00 | 341.69 | Y | Y | N/A | N/A
E2607 | SKIN PROTECT & POSITION WC CUSHION WD LT22IN | 2011-07-01 00:00:00 | 235.85 | Y | Y | N/A | N/A
E2608 | SKIN PROTECT & POSITION WC CUSHION WDGT=22IN | 2011-07-01 00:00:00 | 283.23 | Y | Y | N/A | N/A
E2609 | CUSTOM FABRICATED WHEELCHAIR CUSHION | 2013-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2610 | [NAME], POWERED | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2611 | GEN USE WHEELCHAIR BACK CUSHION WIDTH LT22 IN | 2011-07-01 00:00:00 | 254.16 | Y | Y | N/A | N/A
E2612 | GEN USE WHEELCHAIR BACK CUSHION WIDTHGT=22IN | 2011-07-01 00:00:00 | 343.82 | Y | Y | N/A | N/A
E2613 | POSITION WC BACK CUSHION WIDTH LT22IN | 2011-07-01 00:00:00 | 319.81 | Y | Y | N/A | N/A
E2614 | POSITION WC BACK CUSHION WIDTH GT=22IN | 2011-07-01 00:00:00 | 442.59 | Y | Y | N/A | N/A
E2615 | POSITION WC BACK POST/LAT WIDTH LT22IN | 2011-07-01 00:00:00 | 368.05 | Y | Y | N/A | N/A
E2616 | POSITION WC BACK POST/LAT WDTHGT=22IN | 2011-07-01 00:00:00 | 495.19 | Y | Y | N/A | N/A
[NAME] | CUSTOM FABRICATED WHEELCHAIR BACK CUSHION | 2013-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
E2619 | REPLACE [NAME] | 2011-07-01 00:00:00 | 41.75 | Y | Y | N/A | N/A
E2620 | WHEELCHAIR PLANAR BACK CUSHION WIDTH LT22IN | 2011-07-01 00:00:00 | 445.65 | Y | Y | N/A | N/A
E2621 | WHEELCHAIR PLANAR BACK CUSHION WIDTHGT=22IN | 2011-07-01 00:00:00 | 467.68 | Y | Y | N/A | N/A
[NAME] | ADJUSTABLE SKIN PROTECTN W/C CUSHION WIDTH LT22IN | 2011-07-01 00:00:00 | 269.71 | Y | Y | N/A | N/A
E2623 | ADJUSTABLE SKIN PROTECTN W/C CUSHION WIDTHGT=22IN | 2011-01-01 00:00:00 | 442.43 | Y | Y | N/A | N/A
E2624 | ADJUSTABLE SKIN PROTECTN/POSITION CUSHION LT22IN | 2011-01-01 00:00:00 | 350.55 | Y | Y | N/A | N/A
E2625 | ADJUSTABLE SKIN PROTECTN/POSITION CUSHIONGT=22IN | 2011-01-01 00:00:00 | 443.77 | Y | Y | N/A | N/A
E2626 | SHOULDER ELBOW MOBILE ARM SUP ATT TO WHEELCHAIR | 2012-01-01 00:00:00 | 600.44 | N | N | N/A | N/A
E2627 | SHOULDER ELBOW MOBILE ARM SUP RANCHO TYPE | 2012-01-01 00:00:00 | 958.12 | N | N | N/A | N/A
E2628 | SHOULDER ELBOW MOBILE ARM SUPPORT RECLINING | 2012-01-01 00:00:00 | 721.79 | N | N | N/A | N/A
E2629 | SHOULDER ELBOW MOBILE ARM SUPPORT FRICTION DAMP | 2012-01-01 00:00:00 | 913.41 | N | N | N/A | N/A
E2630 | SHOULDER ELBOW MOBILE ARM SUPPORT MONOSUSPENSION | 2012-01-01 00:00:00 | 638.75 | N | N | N/A | N/A
E2631 | ELEVATING PROXIMAL ARM SUPPORT ADDITION | 2012-01-01 00:00:00 | 217.19 | N | N | N/A | N/A
E2632 | OFFSET/LATERAL ROCKER ARM W/ELASTIC BALANCE CTRL | 2012-01-01 00:00:00 | 138.1 | N | N | N/A | N/A
E2633 | MOBILE ARM SUPPORT ADDITION, [NAME] | 2012-01-01 00:00:00 | 137.81 | N | N | N/A | N/A
E8000 | GAIT TRAINER, PEDIATRIC SIZE, POSTERIOR SUPPORT, INCL ALL ACCESSORIES | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E8001 | GAIT TRAINER, PEDIATRIC SIZE, UPRIGHT SUPPORT, INCLUDES ALL ACCESSORIES | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
E8002 | GAIT TRAINER, PEDIATRIC SIZE, ANTERIOR SUPPORT, INCL ALL ACCESSORIES | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
G0008 | ADMINISTRATION OF INFLUENZA VIRUS VACCINE | 2008-01-01 00:00:00 | 16.83 | N | N | N/A | N/A
G0009 | ADMINISTRATION OF PNEUMOCOCCAL VACCINE | 2008-01-01 00:00:00 | 16.83 | N | N | N/A | N/A
G0010 | ADMINISTRATION OF HEPATITIS B VACCINE | 2008-01-01 00:00:00 | 16.83 | N | N | N/A | N/A
G0105 | COLORECTAL CA SCREEN, COLONOSCOPY HIGH RISK | 2011-07-01 00:00:00 | 335.67 | N | N | N/A | N/A
G0108 | [NAME], INDIV PER 30 MN | 2011-07-01 00:00:00 | 47.43 | N | N | N/A | N/A
G0109 | [NAME], GROUP PER 30 MN | 2011-07-01 00:00:00 | 16.18 | N | N | N/A | N/A
G0121 | COLORECTAL CA SCRN, BARIUM ENEMA NOT HIGH RSK | 2011-07-01 00:00:00 | 335.67 | N | N | N/A | N/A
G0123 | SCREEN CERV/VAG CYTOPATH BY TECH W/MD SUPERV | 2011-07-01 00:00:00 | 24.9 | N | N | N/A | N/A
G0127 | TRIMMING OF DYSTROPHIC NAIL(S), ANY NUMBER | 2011-07-01 00:00:00 | 18.35 | N | Y | N/A | N/A
G0166 | EXTERNAL COUNTERPULSATION, PER TREATMENT | 2011-07-01 00:00:00 | 129.83 | N | Y | N/A | N/A
G0168 | WOUND CLOSURE BY TISSUE ADHESIVE(S) ONLY | 2011-07-01 00:00:00 | 73.68 | N | Y | N/A | N/A
G0179 | MC RECERTIFICATION SERVICES HOME HEALTH PT | 2010-06-01 00:00:00 | 34.59 | N | N | N/A | N/A
G0180 | MD CERTIFICATION HOME HEALTH AGENCY PATIENT | 2011-07-01 00:00:00 | 45.7 | N | Y | N/A | N/A
G0182 | MD SUPERVISION OF HOSPICE CARE 30 MIN OR MORE | 2011-07-01 00:00:00 | 91.56 | N | Y | N/A | N/A
G0202 | SCREENING MAMMOGRAM, DIGITAL BILATERAL | 2011-07-01 00:00:00 | 119.75 | N | N | 89.28 | 30.47
G0204 | DIAGNOSTIC MAMMOGRAM, DIGITAL BILATERAL | 2011-07-01 00:00:00 | 143.28 | N | N | 105.71 | 37.58
G0206 | DIAGNOSTIC MAMMOGRAM, DIGITAL UNILATERAL | 2011-07-01 00:00:00 | 113.4 | N | N | 82.94 | 30.47
G0219 | PET IMAGING WHOLE BODY NONCOVERED INDICATIONS | 2008-01-01 00:00:00 | 1981.45 | N | N | 1902.19 | 79.26
G0235 | PET IMAGING, ANY SITE, NOS | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
G0246 | FOLLOWUP FOOT EVAL DIABETIC NEURO PT W/LOPS | 2011-07-01 00:00:00 | 34.47 | N | Y | N/A | N/A
G0270 | MEDICAL NUTRITION TX SUBS TX CHANGE DX 15 MIN | 2011-07-01 00:00:00 | 24.09 | N | Y | N/A | N/A
G0281 | ELEC STIMULATION UNATTEND FOR PRESSURE ULCERS | 2011-07-01 00:00:00 | 10.87 | N | Y | N/A | N/A
G0283 | ELECTRICAL STIMULATION OTHER THAN WOUND CARE | 2011-07-01 00:00:00 | 10.87 | N | Y | N/A | N/A
G0289 | ARTHROSCOPY, LOOSE BODY/DEBRIDE/CHONDROPLASTY | 2011-07-01 00:00:00 | 74.84 | N | N | N/A | N/A
G0306 | COMPLETE AUTOMATED CBC/WBC DIFF W/O PLATELET | 2011-07-01 00:00:00 | 9.85 | N | Y | N/A | N/A
G0307 | [NAME]/O PLATELET | 2011-07-01 00:00:00 | 7.79 | N | Y | N/A | N/A
G0328 | COLORECTAL CA SCRN 1-3FECAL BLOOD IMMUNOASSAY | 2011-07-01 00:00:00 | 20.14 | N | Y | N/A | N/A
G0329 | ELECTROMAGNETIC THERAPY FOR NONHEALING ULCERS | 2011-07-01 00:00:00 | 7.78 | N | Y | N/A | N/A
G0339 | IMAGE GUIDED ROBOTIC LINEAR ACCELERATOR BASE STEREOTATIC RADIOSURGERY | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
G0340 | IMAGE GUIDED ROBOTIC LINEAR ACCELERATOR BASED STEROTATIC RADIOSURGERY | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
G0341 | PERCUTANEOUS ISLET CELL TRANSPLANT | 2011-07-01 00:00:00 | 1072.09 | N | Y | N/A | N/A
G0342 | LAPAROSCOPY ISLET CELL TRANSPLANT | 2011-07-01 00:00:00 | 585.08 | N | Y | N/A | N/A
G0343 | LAPAROTOMY ISLET CELL TRANSPLANT | 2011-07-01 00:00:00 | 980.1 | N | Y | N/A | N/A
G0365 | VESSEL MAPPING OF HEMODIALYSIS ACCESS | 2011-07-01 00:00:00 | 140.7 | N | N | 129.94 | 10.76
G0389 | ULTRASOUND EXAM AAA SCREENING | 2011-07-01 00:00:00 | 95.72 | N | N | 70.25 | 25.47
G0398 | HOME SLEEP TEST/TYPE 2 PORTABLE MONITOR | 2011-07-01 00:00:00 | 149.95 | N | Y | 99.96 | 49.99
G0399 | HOME SLEEP TEST/TYPE 3 PORTABLE MONITOR | 2011-07-01 00:00:00 | 145.07 | N | Y | 96.71 | 48.36
G0400 | HOME SLEEP TEST/TYPE 4 PORTABLE MONITOR | 2011-07-01 00:00:00 | 140.18 | N | Y | 93.47 | 46.73
G0412 | OPEN TREATMENT ILIAC SPINE UNILATERAL/BILATERAL | 2011-07-01 00:00:00 | 606.97 | N | Y | N/A | N/A
G0413 | PELVIC RING FRACTURE UNILATERAL/BILATERAL | 2011-07-01 00:00:00 | 886.9 | N | Y | N/A | N/A
G0414 | PELVIC RING FRACTURE TREATMENT INTERNAL FIXATION | 2011-07-01 00:00:00 | 844.03 | N | Y | N/A | N/A
G0415 | OPEN TREATMENT POST PELVIC FRACTURE | 2011-07-01 00:00:00 | 1155.99 | N | Y | N/A | N/A
G0416 | SATURATION BIOPSY PROSTATE 1-20 SPECIMENS | 2011-07-01 00:00:00 | 499.13 | N | Y | 350.24 | 148.9
G0417 | SATURATION BIOPSY PROSTATE 21-40 SPECIMENS | 2011-07-01 00:00:00 | 969.62 | N | Y | 683.87 | 285.76
G0418 | SATURATION BIOPSY PROSTATE 41-60 SPECIMENS | 2011-07-01 00:00:00 | 1664.9 | N | Y | 1168.02 | 496.88
G0419 | SATURATION BIOPSY PROSTATE: GT60 SPECIMENS | 2011-07-01 00:00:00 | 1973.84 | N | Y | 1401.6 | 572.24
G0429 | DERMAL FILLER INJECTIONS(S) FOR TREATMENT OF LDS | 2011-07-01 00:00:00 | 74.9 | Y | N | N/A | N/A
G0431 | DRUG SCREEN, QUALITATIVE, MULTIPLE CLASS METHOD | 2010-01-01 00:00:00 | 20.32 | Y | N | N/A | N/A
G0432 | INFECTIOUS ANTIB DETECT BY EIA, HIV1/HIV2 SCREEN | 2011-01-01 00:00:00 | 19.3 | N | Y | N/A | N/A
G0433 | INFECT ANTIBODY DETECT ELISA, HIV1/HIV2 SCREEN | 2011-01-01 00:00:00 | 19.3 | N | Y | N/A | N/A
G0434 | DRUG SCREEN, ANY NUMBER DRUG CLASSES | 2011-01-01 00:00:00 | 20.47 | N | Y | N/A | N/A
G0435 | INFECT AGENT RAPID ANTIBODY, HIV1/HIV2 SCREEN | 2011-01-01 00:00:00 | 16.4 | N | Y | N/A | N/A
G0452 | [NAME], INTERPRETATION & REPORT | 2013-01-01 00:00:00 | 0 | N | N | N/A | 15.99
G0461 | IMMUNOHISTO/CYTO CHEM 1ST SINGLE OR MULTI ANTIB | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G0462 | IMMUNOHISTO/CYTO CHEM EACH ADD SINGLE OR MULTI | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G0463 | HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSMNT MNGT | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G3001 | ADMINISTRATION AND SUPPLY OF TOSITUMOMAB, 450 MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
G9187 | BPCI HOME VISIT | 2013-10-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | BETA-BLOCKER THERAPY NOT GIVEN NO REASON | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9189 | BETA-BLOCKER THERAPY PRESC OR BEING TAKEN | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9190 | MEDICAL REASON FOR NO BETA-BLOCKER THERAPY | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9191 | PT REASON FOR NO BETA-BLOCKER THERAPY | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9192 | SYSTEM REASON FOR NO BETA-BLOCKER THERAPY | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9193 | DOC NOT ELIGIBLE FOR ANTIDEP MEDICATION | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | MDD PT TREATED ANTIDEP 180 DAY | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9195 | MDD PT NOT TREATED ANTIDEP 180 DAY | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | DOC MED REASON FOR NO CEPHALOSPORIN ANTIMIC PROP | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9197 | DOC ORDER FOR CEPHALOSPORIN ANTIMIC PROPHYLAXIS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9198 | NO DOC ORDER FOR CEPH NO REASON | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9199 | DOC REASON FOR NO VTE HOSPITAL ADMISSION | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | NO VTE HOSPITAL ADMISSION REASON NOT GIVEN | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9201 | VTE GIVEN UPON HOSPITAL ADMISSION | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9202 | PT POS HEPATITIS C ANTIBODY TEST | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9203 | RNA HEP C DONE PRIOR TO ANTIVIRAL TREATMENT | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9204 | RNA HEP C NOT DOC PRIOR TO ANTIVIRAL NO REASON | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9205 | PT STARTING ANTIVIRAL TRTMNT HEP C | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9206 | PT STARTING ANTIVIRAL TRTMNT HEP C | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9207 | HEP C GENOTYPE DOC PRIOR TO ANTIVIRAL TREATMENT | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9208 | HEP C GENOTYPE NOT DOC PRIOR ANTIVIRAL NO REASON | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9209 | HEP C RNA DOC 4-12 WK AFTER ANTIVIRAL TREATMENT | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9210 | NO HEP C RNA 4-12 WKS AFTER NO REASON DOC | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9211 | HEP C RNA 4-12 WK AFTER NO REASON GIVEN | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9212 | DOC OF DSM-IV INIT EVAL | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9213 | NO DOC OF DSM-IV MDD REASON NOT SPECIFIED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9214 | CD4+ CELL COUNT OR PERCENTAGE DOCUMENTED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9215 | CD4+ CELL COUNT OR PERCENTAGE NOT DOCUMENTED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9216 | NO PCP PROPH AT DX OR HIV NO REASON | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9217 | NO PCP PROPH LOW CD4 COUNT BELOW 200 NORSN | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9218 | NO PCP PROP LOW AT CD4 COUNT BELOW 500/15 NORSN | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9219 | NO ODER PJP LOW CD4 200 FOR MED REASON | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9220 | NO ODER PJP LOW CD4 500/15 FOR MED REASON | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9221 | PJP PROPH PRESCRIBED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9222 | PJP PROPH ORDERED LOW CD4 BELOW 200 | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9223 | PJP PROPH ORDERED CD4 LOW 500/15 | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9224 | DOC FOR MEDRSN NO FOOT EXAM | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9225 | FOOT EXAM NOT PERFROMED, NORSN | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9226 | 3 COMPONENTS FOOT EXAM COMPLETED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9227 | DOCRSN NO CARE PLAN, PT NOT ELIG | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | GC CHL SYP SCREENING DOCUMENTED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9229 | PTRSN GC CHL SYP NOT SCREENED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9230 | GC CHL SYP NOT SCREENED, REASON NOT GIVEN | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9231 | DOC ESRD DIALYSIS RENAL TRANS OR PREG | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9232 | DOCRSN NO COMM COMORB | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9233 | TKR MEASURES GROUP PERFORMED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9234 | INTENT REPORT TKR MEASURES GROUP | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9235 | GENERAL SURGERY MEASURE GROUP PERFROMED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9236 | OP PT EXP RAD MEASURES GROUP PERFROMED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9237 | INTENT REPORT GENERAL SURGERY MEASURES GROUP | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9238 | INTENT REP OP PT EXP RAD MEASURES GROUP | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9239 | DOCRSN FOR PT INIT MNT HEMODYLS CATHETER | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9240 | PT MODE VASC ACCS CATHETER MAINT HEMODIALYSIS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9241 | PT MODE VASC ACCS NOT CATH MAINT HEMODIALYSIS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9242 | DOC VIRAL LOAD >=200 COPIES/ML | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9243 | DOC VIRAL LOAD <200 COPIES/ML | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9244 | ANTIRETROVIRAL THERAPY NOT PRESCRIBED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9245 | ANTIRETROVIRAL THERAPY PRESCRIBED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9246 | PT NO MED VISIT IN 24 MONTHS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9247 | PT HAD AT LEAST 1 MED VISIT IN 24 MONTHS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9248 | PT NO MED VISIT IN LAST 6 MONTHS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9249 | PT HAD MED VISIT IN LAST 6 MONTHS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9250 | DOC PT PAIN COMFORT 48 HR INIT ASSESSMENT | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | DOC PT PAIN NO COMFORT 48 HR INITIAL ASSESSMENT | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9252 | ADENOMA/NEOPLASM DETECT SCR COLONOSCOPY | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9253 | NO ADENOMA/NEOPL DETECT SCR COLONOSCOPY | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9254 | DOC PT DISCHARGE TO HOME > 2 DAY | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9255 | DOC PT DISCHARGE TO HOME NO LATER 2 DAY | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9256 | DOC PATIENT DEATH FOLLOWING CAS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9257 | DOC PATIENT STROKE FOLLOWING CAS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9258 | DOC PATIENT STROKE FOLLOWING CEA | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9259 | DOC PT SURV NO STROKE FOLLOWING CAS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9260 | DOC PATIENT DEATH FOLLOWING CEA | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9261 | DOC PT SURV NO STROKE FOLLOWING CEA | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9262 | DOC PT DEATH HOSPITAL FOLLOWING ENDOVASC AAA REP | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9263 | DOC PT SURV HOSPITAL FOLLOWING ENDOVASC AAA REP | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9264 | DOC MAINT HEMOD >=90 DAYS WITH CATH | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9265 | PT MAINT HEMOD >=90D WITH CATH VASC ACCESS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9266 | PT MAINT HEMOD >=90D W/OUT CATH VASC ACCESS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9267 | DOC PT W 1 OR MORE COMP OR [NAME] WITHIN 30 DAYS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9268 | DOC PT W 1 OR MORE COMP WITHIN 90 DAYS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9269 | DOC PT W/OUT 1 OR MORE COMP OR MORT W/IN 30 DAYS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9270 | DOC PT W/OUT 1 OR MORE COMP WITHIN 90 DAYS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9271 | LDL UNDER 100 | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9272 | LDL 100 AND OVER | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9273 | SYS<140 AND DIA<90 | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9274 | BP OUT OF NORMAL LIMITS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9275 | DOC PT CURRENT NON-TOBACCO USER | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9276 | DOC PT IS CURRENT TOBACCO USER | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9277 | DOC PT DAILY ASPIRIN OR CONTRA | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9278 | DOC PT NOT ON DAILY ASPIRIN REGIME | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9279 | PNE SCREEN PERF DOC VAC RCVD PRIOR DISCHARGE | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9280 | PNE VACC NOT ADMIN PRIOR TO DISC REASON NOT SPEC | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9281 | SCRN PERFM DOC NO [NAME] INDICATED/PT REFUSED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9282 | DOC MEDRSN NO HISTO TYPE | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9283 | HIST TYPE DOC ON REPORT | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9284 | NO HIST TYPE DOC ON REPORT | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9285 | SITE NON SMALL CELL LUNG CA | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9286 | DOC ANTIBIO ORDER W IN 7D DIAG OR W/IN 10D ONSET | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | NO DOC ANTIBIO ORDER W IN 7D OR W/IN 10D ONSET | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | DOC MEDRSN NO HIST TYPE REPORTING | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9289 | DOC TYPE NON SMALL CELL LUNG CA BIOPSY | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9290 | NO DOC TYPE NON SMALL CELL LUNG CA BIOPSY | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9291 | NOT NON SMALL CELL LUNG CA SPEC SITE OTHER | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9292 | MEDRSN NO PT CATEGORY ULCERATION PT1 | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9293 | NO PT CATEGORY ON PATHO REPORT | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9294 | PATHO REPORT INCLDS PT CAT AND THCK | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9295 | SPEC SIT OTHER THEN ANATOMIC CUTANEOUS LOCATION | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9296 | PT W/DOC SHARE DEC PRIOR PROCEDURE | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9297 | NO DOC SHARE DEC PRIOR PROC REASON NOT GIVEN | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9298 | EVAL RISK VTE CARD 30 DAYS PRIOR PROC | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9299 | NO EVAL RISKK VTE CARD W/IN 30 DAYS PRIOR PROC | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9300 | DOC MEDRSN NO COMPL ANITBIO PRIOR TO INFLATION | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9301 | COMPL INFUSED ANTIBIO PRIOR TO INFLATION | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | NORSN IMCOMP INFUSED ANTIBIO PRIOR TO INFLATION | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9303 | NORSN NO PROS IMPLANT INFO OP REPORT | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9304 | PROS IMPLANT INFO OP REPORT | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | NOT REQ INTERV FOR LEAK OF ENDOLUMINAL CONTENTS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9306 | INTERV REQ FOR LEAK OF ENDOLUMINAL CONTENTS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9307 | NO RET FOR SURGERY W/IN 30 DAYS PRINC OP PROC | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9308 | UNPLND RET TO SURGERY W/IN 30 DAYS PRINC OP PROC | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9309 | NO UNPLND HOSP READM W/IN 30 DAY PRINC PROC | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9310 | UNPLND HOSP READMISSION W/IN 30 DAYS PRINC PROC | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9311 | NO SURGICAL SITE INFECTION | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9312 | SURGICAL SITE INFECTION | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9313 | DOC RSN NOT FIRST LINE AMOXICILLIN | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9314 | NO RSN NOT PRES FIRST LINE AMOXICILLIN | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9315 | DOC PRES FIRST LINE AMOXICILLIN | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9316 | DOC COMM RISK CALC W PT | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9317 | NO DOC COMM TISK CALC W PT | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9318 | IMAGING STUDY NAMED STD NOMENCLATURE | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9319 | IMAGING STUDY NOT NAMED STD NOMENCLATURE | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9320 | MEDRSN NO STD NOMECLATURE PROVIDED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9321 | DOC COUNT OF CT IN 12 MONTHS PRIOR TO STUDY | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | NO DOC COUNT OF CT IN 12 MONTHS PRIOR TO STUDY | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9323 | MDRSN NO DOC COUNT OF CT AND CARDIAC NUC MED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9324 | ALL NEC DATA ELEMENTS NOT INCLD REASON NOT GIVEN | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9325 | MEDRSN NO CT REPORTED TO REGISTRY | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9326 | NO REASON NO CT REPORTED TO REGISTRY | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9327 | CT REPORTED TO REGISTRY W ALL NEC DATA ELEMENTS | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | MEDRSN NO [NAME] DATA | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9329 | NO RSN NO [NAME] | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9340 | [NAME] DOCUMENTED ON FINAL REPORT | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9341 | SRCH FOR CT WITHIN PAST 12 MOS AVAILABLE | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9342 | SRCH FOR CT WITHIN PAST 12 MOS NO REASON | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9343 | MEDRSN NO [NAME] | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9344 | SYS RSN NO [NAME] | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | FOLLOW UP REC [NAME] | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9346 | NO DOC FOLLOW UP REC [NAME] MDRSN | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9347 | NO DOC FOLLOW UP PULM NODULES NO REASON GIVEN | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9348 | DOC RSN SINUS CT AT TIME OF DX | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9349 | DOC SINUS CT TIME OF DX OR 28 DAYS AFTER | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9350 | NO SINUS CT TIME OF DX OR 28 DAYS AFTER | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9351 | MORE THAN 1 SINUS CT 90 DAYS DX | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9352 | MORE THAN 1 SINUS CT 90D DX NO REASON GIVEN | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9353 | MORE THAN 1 SINUS CT 90D DX DOC REASON | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9354 | MORE THAN 1 SINUS CT NOT ORD 90D DX | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9355 | ELECTIVE DELIVERY OR EARLY INDUCTION NOT PERFORM | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9356 | ELECTIVE DELIVERY OR EARLY INDUCTION PERFORMED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9357 | POST PARTUM SCRN EVAL AND ED PERFORMED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | POST PARTUM SCRN EVAL AND ED NOT PERFORMED | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9359 | DOC NEGATIVE OR MNGD POS TB SCRN TB NOT ACTIVE | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
G9360 | NO DOC NEGATIVE OR MNGD POS TB SCREEN | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
H2032 | ACTIVITY THERAPY, PER 15 MINUTES | 2011-07-01 00:00:00 | 3.02 | Y | Y | N/A | N/A
J0120 | TETRACYCLIN, UP TO 250 MG, INJECTION | 2008-01-01 00:00:00 | 13 | N | Y | N/A | N/A
J0129 | ABATACEPT INJECTION, 10 MG | 2011-07-01 00:00:00 | 18.58 | N | Y | N/A | N/A
J0130 | ABCIXIMAB, 10 MG,  INJECTION | 2011-07-01 00:00:00 | 472.71 | N | Y | N/A | N/A
[NAME] | ACETYLCYSTEINE INJECTION, 100 MG | 2011-07-01 00:00:00 | 2.46 | N | Y | N/A | N/A
J0133 | ACYCLOVIR INJECTION, 5 MG | 2011-07-01 00:00:00 | 0.03 | N | Y | N/A | N/A
J0135 | ADALIMUMAB INJECTION 20MG | 2011-07-01 00:00:00 | 361.56 | N | Y | N/A | N/A
J0150 | ADENOSINE, 6 MG, INJECTION | 2011-07-01 00:00:00 | 9.12 | N | Y | N/A | N/A
J0151 | INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 1 MG | 2014-01-01 00:00:00 | 2.98 | N | Y | N/A | N/A
J0171 | ADRENALIN EPINEPHRINE INJECTION, 0.1 MG | 2011-07-01 00:00:00 | 0.08 | N | Y | N/A | N/A
J0178 | AFLIBERCEPT INJECTION, 1 MG | 2013-01-01 00:00:00 | 882.45 | N | Y | N/A | N/A
J0180 | AGALSIDASE BETA INJECTION 1MG | 2013-05-01 00:00:00 | 138 | N | Y | N/A | N/A
J0190 | BIPERIDEN LACTATE, PER 5 MG, [NAME] | 2008-01-01 00:00:00 | 6 | N | Y | N/A | N/A
J0205 | ALGLUCERASE, PER 10 UNITS, INJECTION | 2011-07-01 00:00:00 | 37.79 | N | Y | N/A | N/A
J0207 | AMIFOSTINE, 500 [NAME], INJECTION | 2011-07-01 00:00:00 | 288.08 | N | Y | N/A | N/A
[NAME] | METHYLDOPATE HCL, TO 250 MG, [NAME] | 2011-07-01 00:00:00 | 36 | N | Y | N/A | N/A
J0215 | ALEFACEPT, 0.5 MG,  INJECTION | 2011-07-01 00:00:00 | 32.89 | N | Y | N/A | N/A
J0220 | [NAME] INJECTION 10MG, NOS | 2011-07-01 00:00:00 | 142.96 | N | Y | N/A | N/A
[NAME] | LUMIZYME INJECTION, 10 MG | 2012-07-01 00:00:00 | 133.48 | Y | N | N/A | N/A
[NAME] | ALPHA 1-PROTEINASE INHIBITOR, NOS, 10MG, INJ | 2012-03-01 00:00:00 | 3.78 | N | Y | N/A | N/A
J0257 | GLASSIA INJECTION, 10 MG | 2012-07-01 00:00:00 | 3.49 | Y | N | N/A | N/A
J0270 | ALPROSTADIL, PER 1.25 MCG, INJECTION | 2011-07-01 00:00:00 | 0.52 | N | Y | N/A | N/A
[NAME] | ALPROSTADIL URETHRAL SUPPOSITORY | 2008-01-01 00:00:00 | 23.24 | N | Y | N/A | N/A
J0278 | AMIKACIN SULFATE INJECTION, 100 MG | 2011-07-01 00:00:00 | 0.39 | N | Y | N/A | N/A
J0280 | AMINOPHYLLIN, UP TO 250 MG, INJECTION | 2011-07-01 00:00:00 | 0.3 | N | Y | N/A | N/A
J0282 | AMIODARONE HCL, 30 MG,  INJECTION | 2011-07-01 00:00:00 | 0.2 | N | N | N/A | N/A
J0285 | AMPHOTERICIN B, 50 MG, INJECTION | 2011-07-01 00:00:00 | 10.91 | N | Y | N/A | N/A
J0287 | AMPHOTERICIN B LIPID COMPLEX, 10 MG, INJECTN | 2011-07-01 00:00:00 | 8.03 | N | Y | N/A | N/A
[NAME] | AMPHO B CHOLESTERYL SULFATE CMPLX, 10 MG, IN | 2011-07-01 00:00:00 | 12.6 | N | Y | N/A | N/A
J0289 | AMPHOTERICIN B LIPOSOME, 10 MG, INJECTION | 2011-07-01 00:00:00 | 13.54 | N | Y | N/A | N/A
[NAME] | AMPICILLIN SODIUM, 500 [NAME], INJECTION | 2011-07-01 00:00:00 | 1.67 | N | Y | N/A | N/A
J0295 | AMPICILLIN SODIUM,/SULBACTAM PER 1.5 GM, INJ | 2011-07-01 00:00:00 | 1.97 | N | Y | N/A | N/A
J0300 | AMOBARBITAL, UP TO 125 MG, INJECTION | 2008-01-01 00:00:00 | 7.66 | N | Y | N/A | N/A
[NAME] | SUCCINYCHOLINE CHLORIDE, UP TO 20 MG, INJECTN | 2011-07-01 00:00:00 | 0.14 | N | Y | N/A | N/A
J0348 | ANIDULAFUNGIN INJECTION, 1 MG | 2011-07-01 00:00:00 | 1.18 | N | Y | N/A | N/A
J0350 | ANISTREPLASE, PER 30 UNITS, INJECTION | 2008-01-01 00:00:00 | 2458 | N | Y | N/A | N/A
J0360 | [NAME], UP TO 20 MG, INJECTION | 2011-07-01 00:00:00 | 3.47 | N | Y | N/A | N/A
J0364 | APOMORPHINE HYDROCHLORIDE INJECTION, 1MG | 2011-07-01 00:00:00 | 4.32 | N | Y | N/A | N/A
J0365 | APROTONIN, 10,000 KIU | 2011-07-01 00:00:00 | 2.38 | N | Y | N/A | N/A
J0380 | METARAMINOL BITARTRATE, PER 10 MG, INJECTION | 2008-01-01 00:00:00 | 1.07 | N | Y | N/A | N/A
J0390 | CHLOROQUINE HCL, UP TO 250 MG, INJECTION | 2008-01-01 00:00:00 | 17.27 | N | Y | N/A | N/A
[NAME] | ARBUTAMINE HCL, 1 MG,  INJECTION | 2008-01-01 00:00:00 | 160 | N | Y | N/A | N/A
J0400 | ARIPIPRAZOLE INJECTION 0.25 MG | 2011-07-01 00:00:00 | 0.34 | N | Y | N/A | N/A
J0401 | INJ ARIPIPRAZOLE EXT RELEASE 1MG | 2014-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
J0456 | AZITHROMYCIN, 500 [NAME], INJECTION | 2011-07-01 00:00:00 | 3.21 | N | Y | N/A | N/A
J0461 | ATROPINE SULFATE INJECTION | 2011-07-01 00:00:00 | 0.02 | N | Y | N/A | N/A
J0470 | DIMECAPROL, PER 100 MG, INJECTION | 2011-07-01 00:00:00 | 26.03 | N | Y | N/A | N/A
[NAME] | BACLOFEN. 10 MG, INJECTION | 2011-07-01 00:00:00 | 183.95 | N | Y | N/A | N/A
[NAME] | [NAME], 50 MCG, INJECTION | 2011-07-01 00:00:00 | 66.21 | N | Y | N/A | N/A
[NAME] | BASILIXIMAB, INJECTION, 20 MG | 2011-07-01 00:00:00 | 1859.63 | N | Y | N/A | N/A
J0485 | BELATACEPT INJECTION, 1 MG | 2013-01-01 00:00:00 | 3.43 | N | N | N/A | N/A
J0490 | [NAME]. 10 MG | 2012-01-01 00:00:00 | 34.49 | Y | N | N/A | N/A
J0500 | [NAME], UP TO 20 MG, INJECTION | 2011-07-01 00:00:00 | 19.12 | N | Y | N/A | N/A
[NAME] | BENZTROPINE MESYLATE, PER 1 MG, INJ | 2011-07-01 00:00:00 | 25.08 | N | Y | N/A | N/A
[NAME] | BETHANECHOL CL/MYOTONACHOL/URECHOL,TO 5MG,INJ | 2008-01-01 00:00:00 | 4.49 | N | Y | N/A | N/A
[NAME] | PENICILLIN G BENZATHINE/PROCAINE INJ, 100,000 UN | 2011-07-01 00:00:00 | 2.91 | N | N | N/A | N/A
[NAME] | PENICILLIN G BENZATHINE INJECTION, 100,000 UNITS | 2011-07-01 00:00:00 | 3.69 | N | N | N/A | N/A
J0583 | BIVALIRUDIN, 1 MG, INJECTION | 2011-07-01 00:00:00 | 2.33 | N | Y | N/A | N/A
J0585 | INJECTION, ONABOTULINUMTOXINA, PER UNIT | 2012-04-01 00:00:00 | 5.25 | N | Y | N/A | N/A
[NAME] | ABOBOTULINUMTOXINA | 2011-07-01 00:00:00 | 6.8 | N | Y | N/A | N/A
J0587 | INJECTION, RIMABOTULINUMTOXINB, PER 100 UNITS | 2011-07-01 00:00:00 | 9.48 | N | Y | N/A | N/A
J0588 | INCOBOTULINUMTOXIN A INJECTION, 1 UNIT | 2012-01-01 00:00:00 | 4.02 | Y | N | N/A | N/A
J0592 | BUPRENORPHINE HYDROCHLORIDE, 0.1 MG, INJECTN | 2011-07-01 00:00:00 | 0.78 | N | Y | N/A | N/A
J0594 | BUSULFAN INJECTION, 1 MG | 2011-07-01 00:00:00 | 14.94 | N | Y | N/A | N/A
J0595 | BUTORPHANOL TARTRATE, 1 MG, INJECTION | 2011-07-01 00:00:00 | 0.81 | N | Y | N/A | N/A
J0597 | C1 ESTERASE INHIBITOR INJECTION,BERINERT,10 UNIT | 2011-07-01 00:00:00 | 24.78 | N | N | N/A | N/A
[NAME] | C1 ESTERASE INHIBITOR INJECTION, CINRYZE,10 UNIT | 2011-07-01 00:00:00 | 39.78 | Y | Y | N/A | N/A
J0600 | EDETATE CALCIUM DISODIUM, TO 1000 MG, INJECTN | 2011-07-01 00:00:00 | 176.19 | N | Y | N/A | N/A
J0610 | CALCIUM GLUCONATE, PER 10 ML, INJECTION | 2011-07-01 00:00:00 | 0.31 | N | Y | N/A | N/A
J0620 | CALCIUM GLYCEROPHOSPH/LACTATE, PER 10 ML, INJ | 2008-01-01 00:00:00 | 8.53 | N | Y | N/A | N/A
[NAME] | CALCITONIN SALMON, UP TO 400 UNITS, INJECTION | 2011-07-01 00:00:00 | 46.77 | N | Y | N/A | N/A
[NAME] | CALCITRIOL, 0.1 MCG, INJECTION | 2011-07-01 00:00:00 | 0.38 | N | Y | N/A | N/A
J0637 | [NAME], 5 MG | 2011-07-01 00:00:00 | 11.13 | N | Y | N/A | N/A
[NAME] | [NAME], 1 MG | 2011-07-01 00:00:00 | 80.22 | N | N | N/A | N/A
J0640 | LEUCOVORIN CALCIUM, PER 50 MG, INJECTION | 2011-07-01 00:00:00 | 1.06 | N | Y | N/A | N/A
[NAME] | LEVOLEUCOVORIN INJECTION 0.5 MG | 2011-07-01 00:00:00 | 1.62 | N | Y | N/A | N/A
[NAME] | MEPIVACAINE HCL, PER 10 ML, INJECTION | 2011-07-01 00:00:00 | 1.34 | N | Y | N/A | N/A
[NAME] | CEFAZOLIN SODIUM, 500 [NAME], INJECTION | 2011-07-01 00:00:00 | 0.51 | N | Y | N/A | N/A
J0692 | CEFEPIME HYDROCHLORIDE, 500 MG, INJECTION | 2011-07-01 00:00:00 | 3.38 | N | Y | N/A | N/A
J0694 | CEFOXITIN SODIUM, 1 GM, INJECTION | 2011-07-01 00:00:00 | 2.86 | N | Y | N/A | N/A
[NAME] | CEFTRIAXONE SODIUM, PER 250 MG, INJECTION | 2011-07-01 00:00:00 | 0.76 | N | Y | N/A | N/A
J0697 | STERILE CEFUROXIME SODIUM, PER 750 MG, INJECT | 2011-07-01 00:00:00 | 1.98 | N | Y | N/A | N/A
J0698 | CEFOTAXIME SODIUM, PER GRAM, [NAME] | 2011-07-01 00:00:00 | 1.6 | N | Y | N/A | N/A
J0702 | BETAMETHASONE ACETATE/SOD PHOSP PER3MG INJECT | 2011-07-01 00:00:00 | 5.25 | N | Y | N/A | N/A
[NAME] | CAFFEINE CITRATE, 5 MG,  INJECTION | 2011-07-01 00:00:00 | 0.42 | N | Y | N/A | N/A
J0710 | [NAME], UP TO 1 GM, INJECTION | 2008-01-01 00:00:00 | 7 | N | Y | N/A | N/A
J0712 | CEFTAROLINE FOSAMIL INJECTION, 10 MG | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | CEFTAZIDIME, PER 500 MG, INJECTION | 2011-07-01 00:00:00 | 1.9 | N | Y | N/A | N/A
J0715 | [NAME], PER 500 MG, INJECTION | 2008-01-01 00:00:00 | 4.75 | N | Y | N/A | N/A
J0716 | CENTRUROIDES IMMUNE F(AB) INJECT, UP TO 120 MG | 2013-01-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | INJ CERTOLIZUMAB PEGOL 1MG | 2014-01-01 00:00:00 | 4.62 | Y | Y | N/A | N/A
J0720 | CHLORAMPHENICOL SODIUM, UP TO 1 GM INJECTION | 2011-07-01 00:00:00 | 15.82 | N | Y | N/A | N/A
J0725 | CHORIONIC GONADOTROPIN, PER 1000USP UNIT, INJ | 2011-07-01 00:00:00 | 8.09 | N | Y | N/A | N/A
J0735 | CLONIDINE HYDROCHLORIDE, 1 MG, INJECTION | 2011-07-01 00:00:00 | 14.61 | N | Y | N/A | N/A
J0740 | CIDOFOVIR, 375 MG, INJECTION | 2011-07-01 00:00:00 | 678.9 | N | Y | N/A | N/A
[NAME] | CILASTATIN SODIUM/IMIPENEM, PER 250 MG, INJEC | 2011-07-01 00:00:00 | 11.03 | N | Y | N/A | N/A
J0744 | CIPROFLOXACIN FOR IV INFUSION, 200 MG, INJECT | 2011-07-01 00:00:00 | 0.94 | N | Y | N/A | N/A
J0745 | CODEINE PHOSPHATE, PER 30 MG, INJECTION | 2011-07-01 00:00:00 | 1.21 | N | Y | N/A | N/A
[NAME] | COLCHICINE, PER 1 MG, INJECTION | 2011-07-01 00:00:00 | 5.91 | N | Y | N/A | N/A
J0770 | COLISTIMETHATE SODIUM, UP TO 150 MG INJECTION | 2011-07-01 00:00:00 | 15.66 | N | Y | N/A | N/A
J0775 | COLLAGENASE, [NAME] INJECTION, 0.01 MG | 2011-07-01 00:00:00 | 33.76 | N | N | N/A | N/A
J0780 | PROCHLORPERAZINE, UP TO 10 MG, INJECTION | 2011-07-01 00:00:00 | 1.72 | N | Y | N/A | N/A
J0795 | CORTICORELIN OVINE TRIFLUTAL, INJECTION 1MCG | 2011-07-01 00:00:00 | 4.64 | N | Y | N/A | N/A
J0800 | CORTICOTROPIN, UP TO 40 UNITS, INJECTION | 2011-07-01 00:00:00 | 2197.15 | N | Y | N/A | N/A
J0833 | COSYNTROPIN INJECTION NOS | 2010-01-01 00:00:00 | 65.42 | N | Y | N/A | N/A
[NAME] | COSYNTROPIN [NAME] | 2011-07-01 00:00:00 | 63.44 | N | Y | N/A | N/A
J0840 | CROTALIDAE POLY IMMUNE FAB INJECT, UP TO 1 GR | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
J0850 | [NAME], INJ | 2011-07-01 00:00:00 | 845.83 | N | Y | N/A | N/A
J0878 | DAPTOMYCIN INJECTION 1MG | 2012-09-01 00:00:00 | 0.57 | N | Y | N/A | N/A
J0881 | DARBEPOETIN ALFA, NON-ESRD, INJECTION 1 MCG | 2011-07-01 00:00:00 | 2.73 | N | Y | N/A | N/A
J0882 | DARBEPOETIN ALFA, ESRD USE, INJECTION 1 MCG | 2011-07-01 00:00:00 | 2.73 | N | Y | N/A | N/A
J0885 | [NAME], NON-ESRD, INJECTION, 1000 UNITS | 2011-07-01 00:00:00 | 8.78 | N | Y | N/A | N/A
J0886 | EPOETIN ALFA 1000 UNITS ESRD, INJECTION | 2011-07-01 00:00:00 | 8.78 | N | Y | N/A | N/A
[NAME] | [NAME], 1 MG | 2011-07-01 00:00:00 | 28.17 | N | Y | N/A | N/A
[NAME] | DEFEROXAMINE MESYLATE, 500 [NAME], INJECTION | 2011-07-01 00:00:00 | 9.6 | N | Y | N/A | N/A
J0897 | [NAME], 1 MG | 2012-01-01 00:00:00 | 13.75 | Y | N | N/A | N/A
J0900 | TESTOSTERONE ENANTHATE/ESTRADIOL VAL 1CC, INJ | 2008-01-01 00:00:00 | 1.38 | N | Y | N/A | N/A
J0945 | BROMPHENIRAMINE MALEATE, PER 10 MG, INJECTION | 2008-01-01 00:00:00 | 0.8 | N | Y | N/A | N/A
J1000 | DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG, INJECTN | 2011-07-01 00:00:00 | 6.15 | N | Y | N/A | N/A
J1020 | METHYLPREDNISOLONE ACETATE, 20 MG, INJECTION | 2011-07-01 00:00:00 | 1.23 | N | Y | N/A | N/A
J1030 | METHYLPREDNISOLONE ACETATE, 40 MG, INJECTION | 2011-07-01 00:00:00 | 2.28 | N | Y | N/A | N/A
J1040 | METHYLPREDNISOLONE ACETATE, 80 MG, INJECTION | 2011-07-01 00:00:00 | 5.22 | N | Y | N/A | N/A
[NAME] | MEDROXYPROGESTERONE ACETATE, 1 MG, INJECTION | 2013-01-01 00:00:00 | 0.26 | N | Y | N/A | N/A
J1060 | TESTOSTERONE/ESTRAD CYPIONATE, UP TO 1ML, INJ | 2008-01-01 00:00:00 | 4.14 | N | Y | N/A | N/A
J1070 | TESTOSTERONE/ESTRAD CYPIONATE UP TO 100MG INJ | 2011-07-01 00:00:00 | 3 | N | Y | N/A | N/A
[NAME] | TESTOSTERONE CYPIONATE, 1 CC, 200 MG INJECTN | 2011-07-01 00:00:00 | 4.54 | N | Y | N/A | N/A
[NAME] | DEXAMETHASONE ACETATE, 1 MG, [NAME] | 2008-01-01 00:00:00 | 0.23 | N | Y | N/A | N/A
[NAME] | DEXAMETHOSONE SODIUM PHOSPHATE, 1 MG, INJECTN | 2011-07-01 00:00:00 | 0.07 | N | Y | N/A | N/A
[NAME] | DIHYDROERGOTAMINE MESYLATE, PER 1 MG, INJECTN | 2011-07-01 00:00:00 | 20.95 | N | Y | N/A | N/A
J1120 | ACETAZOLAMID SODIUM, UP TO 500 MG, INJECTION | 2011-07-01 00:00:00 | 28.82 | N | Y | N/A | N/A
J1160 | DIGOXIN, UP TO 0.5 MG, INJECTION | 2011-07-01 00:00:00 | 0.81 | N | Y | N/A | N/A
[NAME] | [NAME] (OVINE), INJ PER VIAL | 2011-07-01 00:00:00 | 535.61 | N | Y | N/A | N/A
J1165 | [NAME], PER 50 MG, [NAME] | 2011-07-01 00:00:00 | 0.29 | N | Y | N/A | N/A
J1170 | HYDROMORPHONE, UP TO 0.4 MG, [NAME] | 2011-07-01 00:00:00 | 1.86 | N | Y | N/A | N/A
[NAME] | DYPHYLLINE, UP TO 500 MG, INJECTION | 2008-01-01 00:00:00 | 4 | N | Y | N/A | N/A
J1190 | DEXRAZOXANE HYDROCHLORIDE, PER 250 MG, INJECT | 2011-07-01 00:00:00 | 251.73 | N | Y | N/A | N/A
J1200 | DIPHENHYDRAMINE HCL, UP TO 50 MG, INJECTION | 2011-07-01 00:00:00 | 0.67 | N | Y | N/A | N/A
J1205 | CHLOROTHIAZIDE SODIUM, PER 500 MG, INJECTION | 2011-07-01 00:00:00 | 250.09 | N | Y | N/A | N/A
[NAME] | DIMETHYL SULFOXIDE/DMSO 50%, 50 ML, INJECTION | 2011-07-01 00:00:00 | 75.84 | N | Y | N/A | N/A
[NAME] | [NAME], UP TO 10 MG, INJECTN | 2011-07-01 00:00:00 | 5.56 | N | Y | N/A | N/A
J1240 | DIMENHYDRINATE, UP TO 50 MG, [NAME] | 2011-07-01 00:00:00 | 3.14 | N | Y | N/A | N/A
J1245 | DIPYRIDAMOLE, PER 10 MG, INJECTION | 2011-07-01 00:00:00 | 0.87 | N | Y | N/A | N/A
J1250 | DOBUTAMINE HYDROCHLORIDE, PER 250 MG, INJECTN | 2011-07-01 00:00:00 | 5.09 | N | Y | N/A | N/A
[NAME] | DOLASETRON MESYLATE, 10 MG, INJECTION | 2011-07-01 00:00:00 | 3.74 | N | Y | N/A | N/A
J1265 | DOPAMINE  HCL INJECTION, 40 MG | 2011-07-01 00:00:00 | 0.42 | N | Y | N/A | N/A
J1267 | DORIPENEM INJECTION, 10 MG | 2011-07-01 00:00:00 | 0.5 | N | Y | N/A | N/A
J1270 | DOXERCALCIFEROL, 1 MCG, INJECTION | 2011-07-01 00:00:00 | 3.08 | N | Y | N/A | N/A
J1290 | ECALLANTIDE INJECTION, 1 MG | 2011-07-01 00:00:00 | 247.75 | N | N | N/A | N/A
J1300 | ECULIZUMAB INJECTION, 10 MG | 2011-07-01 00:00:00 | 168.52 | N | Y | N/A | N/A
J1320 | AMITRIPTYLINE HCL, UP TO 20 MG, INJECTION | 2008-01-01 00:00:00 | 1.79 | N | Y | N/A | N/A
J1324 | INJECTION, ENFUVIRTIDE, 1 [NAME] (FUZEON T-20) | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J1325 | EPOPROSTENOL, 0.5 MG, INJECTION | 2011-07-01 00:00:00 | 13.22 | N | Y | N/A | N/A
J1327 | EPTIFIBATIDE, 5 MG, INJECTION | 2011-07-01 00:00:00 | 18.64 | N | Y | N/A | N/A
J1330 | ERGONOVINE MALEATE, UP TO 0.2 MG, INJECTION | 2008-01-01 00:00:00 | 4.75 | N | Y | N/A | N/A
J1335 | ERTAPENEM SODIUM, 500 [NAME], INJECTION | 2013-03-01 00:00:00 | 29.36 | N | Y | N/A | N/A
[NAME] | ERYTHROMYCIN LACTOBIONATE, PER 500 MG, INJECT | 2011-07-01 00:00:00 | 8.64 | N | Y | N/A | N/A
J1380 | [NAME], UP TO 10 MG, INJECTION | 2011-07-01 00:00:00 | 6.75 | N | Y | N/A | N/A
[NAME] | ESTROGEN CONJUGATED, PER 25 MG, INJECTION | 2011-07-01 00:00:00 | 86.25 | N | Y | N/A | N/A
J1430 | ETHANOLAMINE OLEATE, INJECTION 100 MG | 2011-07-01 00:00:00 | 134.97 | N | Y | N/A | N/A
J1435 | ESTRONE, PER 1 MG, INJECTION | 2008-01-01 00:00:00 | 0.14 | N | Y | N/A | N/A
J1436 | ETIDRONATE DISODIUM, PER 300 MG, INJECTION | 2008-01-01 00:00:00 | 71.41 | N | Y | N/A | N/A
J1438 | ETANERCEPT, 25 MG, INJECTION | 2011-07-01 00:00:00 | 186.22 | N | N | N/A | N/A
J1442 | [NAME] 1 MCG | 2014-01-01 00:00:00 | 0.89 | N | Y | N/A | N/A
J1446 | INJECTION TBO-FILGRASTIM, 5 MCG | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
J1450 | FLUCONAZOLE, 200 [NAME], INJECTION | 2011-07-01 00:00:00 | 5.09 | N | Y | N/A | N/A
J1451 | FOMEPIZOLE, INJECTION 15 MG | 2011-07-01 00:00:00 | 6.2 | N | Y | N/A | N/A
J1452 | FOMIVIRSEN SODIUM INTRAOCULAR, 1.65 MG, INJEC | 2008-01-01 00:00:00 | 200 | N | Y | N/A | N/A
J1453 | FOSAPREPITANT INJECTION, 1 MG | 2011-07-01 00:00:00 | 1.58 | N | Y | N/A | N/A
J1455 | FOSCARNET SODIUM, PER 1000 MG, INJECTION | 2011-07-01 00:00:00 | 11.98 | N | Y | N/A | N/A
J1457 | GALLIUM NITRATE INJECTION 1MG | 2011-07-01 00:00:00 | 1.83 | N | Y | N/A | N/A
[NAME] | GALSULFASE INJECTION, 1 MG | 2011-07-01 00:00:00 | 310.29 | N | Y | N/A | N/A
J1459 | INJ IVIG PRIVIGEN 500 MG | 2011-07-01 00:00:00 | 31.6 | N | Y | N/A | N/A
J1460 | GAMMA GLOBULIN, INTRAMUSCULAR 1 CC, INJECTION | 2011-07-01 00:00:00 | 16.43 | N | Y | N/A | N/A
J1556 | INJECTION IMM GLOB BIVIGAM, 500MG | 2014-01-01 00:00:00 | 34.78 | Y | Y | N/A | N/A
J1557 | GAMMAPLEX INJECTION, IV, 500 MG | 2012-01-01 00:00:00 | 33.56 | N | N | N/A | N/A
J1559 | IMMUNE GLOBULIN (HIZENTRA) INJECTION, 100 MG | 2011-07-01 00:00:00 | 6.56 | N | N | N/A | N/A
[NAME] | GAMMA GLOBULIN, INTRAMSCLR OVER 10 CC, INJECT | 2011-07-01 00:00:00 | 164.25 | N | Y | N/A | N/A
J1561 | GAMUNEX/GAMUNEX-C/GAMMAKED INJECTION 500 [NAME] | 2011-07-01 00:00:00 | 33.85 | N | Y | N/A | N/A
J1566 | IMMUNE GLOBULIN, POWDER 500MG INJECTION | 2011-07-01 00:00:00 | 28.08 | N | Y | N/A | N/A
J1568 | OCTAGAM INJECTION, [NAME] 500 MG | 2011-07-01 00:00:00 | 51.19 | N | Y | N/A | N/A
J1569 | GAMMAGARD LIQUID INJECTION, INTRAVENOUS 500 MG | 2011-07-01 00:00:00 | 34.55 | N | Y | N/A | N/A
[NAME] | [NAME], 500 [NAME], INJECTION | 2011-07-01 00:00:00 | 57.34 | N | Y | N/A | N/A
[NAME] | HEPAGAM B IM INJECTION, INTRAMUSCULAR 0.5 ML | 2011-07-01 00:00:00 | 52.35 | N | Y | N/A | N/A
J1572 | FLEBOGAMMA INJECTION, [NAME] 500 MG | 2011-07-01 00:00:00 | 32.15 | N | Y | N/A | N/A
J1573 | HEPAGAM B INTRAVENOUS, INJECTION, 0.5 ML | 2011-07-01 00:00:00 | 52.35 | N | Y | N/A | N/A
J1580 | GARAMYCIN GENTAMICIN, UP TO 80 MG, INJECTION | 2011-07-01 00:00:00 | 0.87 | N | Y | N/A | N/A
J1590 | GATIFLOXACIN, 10 MG, INJECTION | 2008-01-01 00:00:00 | 0.8 | N | Y | N/A | N/A
J1595 | GLATIRAMER ACETATE, 20 MG, INJECTION | 2008-01-01 00:00:00 | 52.58 | N | Y | N/A | N/A
J1600 | GOLD SODIUM THIOMALEATE, UP TO 50 MG, INJECTN | 2011-07-01 00:00:00 | 13.56 | N | Y | N/A | N/A
J1602 | INJECTION GOLIMUMAB FOR IV USE 1MG | 2014-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
J1610 | GLUCAGON HYDROCHLORIDE, PER 1 MG, INJECTION | 2011-07-01 00:00:00 | 87.69 | N | Y | N/A | N/A
J1620 | GONADORELIN HYDROCHLORIDE, PER 100MCG, INJECT | 2008-01-01 00:00:00 | 180.3 | Y | Y | N/A | N/A
J1626 | GRANISETRON HYDROCHLORIDE, 100 MCG, INJECTION | 2011-07-01 00:00:00 | 1.61 | N | Y | N/A | N/A
[NAME] | HALOPERIDOL, UP TO 5 MG, INJECTION | 2011-07-01 00:00:00 | 2.25 | N | Y | N/A | N/A
J1631 | HALOPERIDOL DECANOATE, PER 50 MG, INJECTION | 2011-07-01 00:00:00 | 10.77 | N | Y | N/A | N/A
J1640 | HEMIN, 1 MG, [NAME] | 2011-07-01 00:00:00 | 7.64 | N | Y | N/A | N/A
J1642 | HEPARIN SODIUM, PER 10 UNITS, INJECTION | 2011-07-01 00:00:00 | 0.17 | N | Y | N/A | N/A
J1644 | HEPARIN SODIUM, PER 1000 UNITS, INJECTION | 2011-07-01 00:00:00 | 0.28 | N | Y | N/A | N/A
J1645 | DALTEPARIN SODIUM, PER 2500 IU, INJECTION | 2011-07-01 00:00:00 | 10.65 | N | Y | N/A | N/A
J1650 | ENOXAPARIN SODIUM, 10 MG, INJECTION | 2011-07-01 00:00:00 | 6.03 | N | Y | N/A | N/A
J1652 | [NAME], 0.5 MG, [NAME] | 2011-07-01 00:00:00 | 5.42 | N | Y | N/A | N/A
[NAME] | [NAME], 1000 IU,  INJECTION | 2011-07-01 00:00:00 | 3.2 | N | Y | N/A | N/A
[NAME] | TETANUS IMMUNE GLOBULIN, HUMAN, TO 250 U, INJ | 2011-07-01 00:00:00 | 204.53 | N | Y | N/A | N/A
J1700 | HYDROCORTISONE ACETATE, UP TO 25 MG, INJECTN | 2008-01-01 00:00:00 | 0.66 | N | Y | N/A | N/A
J1710 | HYDROCORTISONE SODIUM PHOS, UP TO 50 MG, INJ | 2008-01-01 00:00:00 | 4.69 | N | Y | N/A | N/A
J1720 | HYDROCORTISONE SODIUM SUCCINATE, 100 MG, INJ | 2011-07-01 00:00:00 | 3.38 | N | Y | N/A | N/A
J1725 | HYDROXYPROGESTERONE CAPROATE INJECTION 1 MG | 2012-01-01 00:00:00 | 0 | Y | N | N/A | N/A
J1730 | DIAZOXIDE, UP TO 300 MG, INJECTION | 2008-01-01 00:00:00 | 111.85 | N | Y | N/A | N/A
J1740 | IBANDRONATE SODIUM INJECTION, 1 MG | 2011-07-01 00:00:00 | 132.43 | N | Y | N/A | N/A
J1741 | IBUPROFEN INJECTION, 100 MG | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | IBUTILIDE FUMARATE, 1 MG, INJECTION | 2011-07-01 00:00:00 | 118.62 | N | Y | N/A | N/A
[NAME] | IDURSULFASE INJECTION 1 MG | 2011-07-01 00:00:00 | 409.53 | N | Y | N/A | N/A
J1744 | ICATIBANT INJECTION, 1 MG | 2013-01-01 00:00:00 | 0 | Y | N | N/A | N/A
J1745 | INFLIXIMAB, 10 MG, INJECTION | 2012-07-01 00:00:00 | 59.93 | N | Y | N/A | N/A
[NAME] | IRON DEXTRAN, 50 MG, INJECTION | 2011-07-01 00:00:00 | 10.63 | N | Y | N/A | N/A
J1756 | IRON SUCROSE,  1 MG, INJECTION | 2011-07-01 00:00:00 | 0.32 | N | Y | N/A | N/A
J1786 | IMUGLUCERASE INJECTION, 10 UNITS | 2011-07-01 00:00:00 | 37.79 | N | N | N/A | N/A
J1790 | DROPERIDOL, UP TO 5 MG, INJECTION | 2011-07-01 00:00:00 | 1.94 | N | Y | N/A | N/A
[NAME] | PROPRANOLOL HYDROCHLORIDE, UP TO 1 MG, INJECT | 2011-07-01 00:00:00 | 2.65 | N | Y | N/A | N/A
J1815 | INSULIN, PER 5 UNITS, INJECTION | 2011-07-01 00:00:00 | 0.41 | N | Y | N/A | N/A
J1817 | INSULIN FOR ADMIN THROUGH DME PER 50 UNITS | 2011-07-01 00:00:00 | 2.24 | N | Y | N/A | N/A
J1830 | INTERFERON BETA-1B, PER 0.25 [NAME], INJECTION | 2008-01-01 00:00:00 | 116.23 | N | Y | N/A | N/A
J1835 | INTRACONAZOLE, 50 MG, INJECTION | 2008-01-01 00:00:00 | 40.28 | N | Y | N/A | N/A
J1840 | KANAMYCIN SULFATE, UP TO 500 MG, INJECTION | 2011-07-01 00:00:00 | 6.92 | N | Y | N/A | N/A
J1850 | KANAMYCIN SULFATE, UP TO 75 MG, INJECTION | 2011-07-01 00:00:00 | 1.04 | N | Y | N/A | N/A
[NAME] | KETOROLAC TROMETHAMINE,  PER 15 MG, INJECTION | 2011-07-01 00:00:00 | 0.24 | N | Y | N/A | N/A
[NAME] | LANREOTIDE INJECTION, 1 MG | 2011-07-01 00:00:00 | 27.45 | N | Y | N/A | N/A
[NAME] | LARONIDASE INJECTION 0.1 MG | 2011-07-01 00:00:00 | 23 | N | Y | N/A | N/A
[NAME] | FUROSEMIDE, UP TO 20 MG, INJECTION | 2011-07-01 00:00:00 | 1.21 | N | Y | N/A | N/A
J1945 | LEPIRUDIN INJECTION, 50 MG | 2011-07-01 00:00:00 | 274.79 | N | Y | N/A | N/A
[NAME] | LEUPROLIDE ACETATE, PER 3.75 MG, INJECTION | 2011-07-01 00:00:00 | 502.26 | N | Y | N/A | N/A
[NAME] | [NAME], 10 MG | 2011-07-01 00:00:00 | 0.41 | N | Y | N/A | N/A
J1955 | LEVOCARNITINE, PER 1 GRAM, INJECTION | 2011-07-01 00:00:00 | 6.34 | N | Y | N/A | N/A
J1956 | LEVOFLOXACIN, 250 [NAME], INJECTION | 2011-07-01 00:00:00 | 5 | N | Y | N/A | N/A
J1960 | LEVORPHANOL TARTRATE, UP TO 2 MG, INJECTION | 2008-01-01 00:00:00 | 3.63 | N | Y | N/A | N/A
J1980 | HYOSCYAMINE SULFATE, TO 0.25MG, INJECTION | 2011-07-01 00:00:00 | 11.05 | N | Y | N/A | N/A
J1990 | [NAME], UP TO 100MG, INJECTION | 2008-01-01 00:00:00 | 21.05 | N | Y | N/A | N/A
J2001 | LIDOCAINE HCL FOR IV INFUSION, 10MG INJECTION | 2011-07-01 00:00:00 | 0.02 | N | Y | N/A | N/A
J2020 | LINEZOLID, 200 MG, INJECTION | 2011-07-01 00:00:00 | 31.18 | N | Y | N/A | N/A
J2060 | LORAZEPAM, 2 MG, INJECTION | 2011-07-01 00:00:00 | 0.69 | N | Y | N/A | N/A
J2150 | MANNITOL, 25% IN 50 ML, INJECTION | 2011-07-01 00:00:00 | 0.91 | N | Y | N/A | N/A
J2170 | INJECTION, MECASERMIN, 1 MG (INCRELEX - GROWTH HORMONE) | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
J2175 | MEPERIDINE HYDROCHLORIDE, PER 100 MG, INJECTN | 2011-07-01 00:00:00 | 1.79 | N | Y | N/A | N/A
J2180 | MEPERIDINE/PROMETHAZINE HCL, UP TO 50 MG, INJ | 2008-01-01 00:00:00 | 3.79 | N | Y | N/A | N/A
J2185 | MEROPENEM, 100 MG, INJECTION | 2011-07-01 00:00:00 | 2.9 | N | Y | N/A | N/A
J2210 | METHYLERGONOVINE MALEATE, UP TO 0.2 MG, INJEC | 2011-07-01 00:00:00 | 5.15 | N | Y | N/A | N/A
[NAME] | METHYLNALTREXONE INJECTION, 0.1 MG | 2013-01-01 00:00:00 | 0 | Y | N | N/A | N/A
J2248 | [NAME], 1 MG | 2011-07-01 00:00:00 | 0.93 | N | Y | N/A | N/A
[NAME] | MIDAZOLAM HYDROCHLORIDE, PER 1 MG, INJECTION | 2011-07-01 00:00:00 | 0.07 | N | N | N/A | N/A
J2260 | MILRINONE LACTATE, 5 MG, INJECTION | 2011-07-01 00:00:00 | 3.53 | N | Y | N/A | N/A
J2265 | MINOCYCLINE HYDROCHLORIDE INJECTION, 1 MG | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
J2270 | [NAME], UP TO 10 MG, INJECTION | 2011-07-01 00:00:00 | 1.89 | N | Y | N/A | N/A
J2271 | [NAME], 100 MG, INJECTION | 2011-07-01 00:00:00 | 0.98 | N | Y | N/A | N/A
[NAME] | [NAME], PER 10 MG, INJECTN | 2011-07-01 00:00:00 | 3.13 | N | Y | N/A | N/A
J2278 | [NAME], 1 MCG | 2012-06-01 00:00:00 | 6.61 | N | Y | N/A | N/A
J2280 | MOXIFLOXACIN, 100 [NAME], INJECTION | 2011-07-01 00:00:00 | 2.84 | N | Y | N/A | N/A
J2300 | NALBUPHINE HYDROCHLORIDE, PER 10 MG, INJECTN | 2011-07-01 00:00:00 | 0.89 | N | Y | N/A | N/A
[NAME] | NALOXONE HYDROCHLORIDE, PER 1 MG, INJECTION | 2011-07-01 00:00:00 | 7.05 | N | Y | N/A | N/A
[NAME] | NALTREXONE, DEPOT FORM, INJECTION, 1 MG | 2011-07-01 00:00:00 | 2.54 | N | Y | N/A | N/A
J2320 | NANDROLONE DECANOATE, UP TO 50 MG, INJECTION | 2008-01-01 00:00:00 | 4.71 | N | Y | N/A | N/A
[NAME] | NATALIZUMAB INJECTION 1 MG | 2011-07-01 00:00:00 | 9.06 | N | Y | N/A | N/A
J2325 | NESIRITIDE INJECTION, 0.1 MG | 2011-07-01 00:00:00 | 40.3 | N | Y | N/A | N/A
J2353 | OCTREOTIDE DEPOT FORM FOR IM, 1 MG, INJECTION | 2011-07-01 00:00:00 | 104.09 | N | Y | N/A | N/A
J2354 | OCTREOTIDE NON-DEPOT SUBCUTAN/IV, 25 MCG, INJ | 2011-07-01 00:00:00 | 1.17 | N | Y | N/A | N/A
J2355 | OPRELVEKIN, 5 MG, INJECTION | 2011-07-01 00:00:00 | 220.97 | N | Y | N/A | N/A
J2357 | OMALIZUMAB INJECTION 5 MG | 2011-07-01 00:00:00 | 18.93 | N | Y | N/A | N/A
[NAME] | OLANZAPINE LONG-ACTING INJECTION, 1 MG | 2011-07-01 00:00:00 | 2.48 | N | N | N/A | N/A
J2360 | ORPHENADRINE CITRATE, UP TO 60 MG, INJECTION | 2011-07-01 00:00:00 | 5.15 | N | Y | N/A | N/A
[NAME] | PHENYLEPHRINE HCL, UP TO 1 ML, INJECTION | 2011-07-01 00:00:00 | 0.52 | N | Y | N/A | N/A
[NAME] | CHLOROPROCAINE HCL, PER 30 ML, INJECTION | 2011-07-01 00:00:00 | 13.08 | N | Y | N/A | N/A
J2405 | ONDANSETRON HCL, PER 1 MG, INJECTION | 2011-07-01 00:00:00 | 0.13 | N | Y | N/A | N/A
J2410 | OXYMORPHONE HCL, UP TO 1 MG, [NAME] | 2011-07-01 00:00:00 | 2.1 | N | Y | N/A | N/A
[NAME] | PALIFERMIN INJECTION, 50 MCG | 2011-07-01 00:00:00 | 10.23 | N | Y | N/A | N/A
J2426 | PALIPERIDONE PALMITATE INJECTION, 1 MG | 2011-07-01 00:00:00 | 5.86 | N | N | N/A | N/A
J2430 | PAMIDRONATE DISODIUM, PER 30 MG, INJECTION | 2011-07-01 00:00:00 | 10.7 | N | Y | N/A | N/A
J2440 | PAPAVERIN HYDROCHLORIDE, UP TO 60 MG, INJECTN | 2011-07-01 00:00:00 | 0.69 | N | Y | N/A | N/A
J2460 | OXYTETRACYCLINE HCL, UP TO 50 MG, INJECTION | 2008-01-01 00:00:00 | 0.94 | N | Y | N/A | N/A
J2469 | PALONOSETRON HCL 25 MCGC | 2011-07-01 00:00:00 | 16.98 | N | Y | N/A | N/A
J2501 | PARICALCITOL, 1 MCG, INJECTION | 2011-07-01 00:00:00 | 2.67 | N | Y | N/A | N/A
[NAME] | [NAME], 0.3MG | 2011-07-01 00:00:00 | 919.33 | Y | Y | N/A | N/A
[NAME] | PEGADEMASE BOVINE, INJECTION 25 IU | 2011-07-01 00:00:00 | 222.6 | N | Y | N/A | N/A
[NAME] | PEGFILGRASTIM, 6 [NAME], INJECTION | 2011-07-01 00:00:00 | 2318.84 | N | Y | N/A | N/A
J2507 | PEGLOTICASE INJECTION, 1 MG | 2012-07-01 00:00:00 | 271.84 | Y | N | N/A | N/A
[NAME] | PENICILLIN G PROCAINE AQUEOUS, TO 600000U,INJ | 2011-07-01 00:00:00 | 10.39 | N | Y | N/A | N/A
J2513 | PENTASTARCH 10% SOLUTION, [NAME], 100 ML | 2008-01-01 00:00:00 | 12.72 | N | Y | N/A | N/A
[NAME] | PENTOBARBITAL SODIUM, PER 50 MG, INJECTION | 2011-07-01 00:00:00 | 16.43 | N | Y | N/A | N/A
J2540 | PENICILLIN G POTASSIUM, UP TO  600,000 U, INJ | 2011-07-01 00:00:00 | 0.61 | N | Y | N/A | N/A
J2543 | PIPERACILLIN/TAZOBACTAM SODIUM, 1.125GR, INJ | 2011-07-01 00:00:00 | 4.09 | N | Y | N/A | N/A
J2545 | PENTAMIDINE ISETHIONTE, PER 300 MG, THRU DME | 2011-07-01 00:00:00 | 46.23 | N | Y | N/A | N/A
[NAME] | PROMETHAZINE HCL, UP TO 50 MG, INJECTION | 2011-07-01 00:00:00 | 1.54 | N | Y | N/A | N/A
[NAME] | PHENOBARBITAL SODIUM, UP TO 120 MG, INJECTION | 2011-07-01 00:00:00 | 2.73 | N | Y | N/A | N/A
J2562 | PLERIXAFOR INJECTION | 2011-07-01 00:00:00 | 252.93 | N | Y | N/A | N/A
[NAME] | OXYTOCIN, UP TO 10 UNITS, INJECTION | 2011-07-01 00:00:00 | 0.6 | N | Y | N/A | N/A
J2597 | [NAME], PER 1 MCG, INJECTION | 2011-07-01 00:00:00 | 3.6 | N | Y | N/A | N/A
J2650 | PREDNISOLONE ACETATE, UP TO 1 ML, INJECTION | 2008-01-01 00:00:00 | 0.17 | N | Y | N/A | N/A
J2670 | TOTAZOLINE HCL, UP TO 25 MG, [NAME] | 2008-01-01 00:00:00 | 3.44 | N | Y | N/A | N/A
J2675 | PROGESTERONE, PER 50 MG, INJECTION | 2011-07-01 00:00:00 | 1.23 | N | Y | N/A | N/A
J2680 | FLUPHENAZINE DECANOATE, UP TO 25 MG INJECTION | 2011-07-01 00:00:00 | 7.75 | N | Y | N/A | N/A
J2690 | PROCAINAMIDE HCL, UP TO 1 GRAM, INJECTION | 2011-07-01 00:00:00 | 6.58 | N | Y | N/A | N/A
J2700 | OXACILLIN SODIUM, UP TO 250 MG, INJECTION | 2011-07-01 00:00:00 | 1.88 | N | Y | N/A | N/A
J2710 | NEOSTIGMINE METHYLSULFATE, UP TO 0.5GM, INJEC | 2011-07-01 00:00:00 | 0.08 | N | Y | N/A | N/A
J2720 | PROTAMINE SULFATE, PER 10 MG, INJECTION | 2011-07-01 00:00:00 | 0.42 | N | Y | N/A | N/A
J2724 | PROTEIN C CONCENTRATE, INTRAVENOUS | 2011-07-01 00:00:00 | 11.47 | N | Y | N/A | N/A
J2725 | PROTIRELIN, PER 250 MCG, INJECTION | 2008-01-01 00:00:00 | 20.55 | N | Y | N/A | N/A
J2730 | PRALIDOXIME CHLORIDE, UP TO 1 GRAM, INJECTION | 2011-07-01 00:00:00 | 81.24 | N | Y | N/A | N/A
J2760 | PHENTOLAINE MESYLATE, UP TO 5 GM, INJECTION | 2011-07-01 00:00:00 | 51.69 | N | Y | N/A | N/A
J2765 | METOCLOPRAMIDE HCL, UP TO 10 MG, INJECTION | 2011-07-01 00:00:00 | 0.33 | N | Y | N/A | N/A
J2770 | QUINUPRISTIN/DALFOPRISTIN, 500 [NAME], INJECTION | 2011-07-01 00:00:00 | 144.23 | N | Y | N/A | N/A
J2778 | RANIBIZUMAB INJECTION 0.1 MG | 2011-07-01 00:00:00 | 365.19 | N | Y | N/A | N/A
J2780 | RANITIDINE HYDROCHLORIDE, 25 MG, INJECTION | 2011-07-01 00:00:00 | 0.8 | N | Y | N/A | N/A
J2783 | RASBURICASE, 0.5 MG, INJECTION | 2011-07-01 00:00:00 | 167.94 | N | Y | N/A | N/A
J2785 | REGADENOSON INJECTION, 0.1 MG | 2011-07-01 00:00:00 | 47.11 | N | Y | N/A | N/A
J2788 | RHO D IMMUNE GLOBULIN, HUMAN, 50 MCG, INJECTN | 2011-07-01 00:00:00 | 22.76 | N | Y | N/A | N/A
J2790 | RHO D IMMUNE GLOBULIN, HUMAN, 300 MCG, INJECT | 2011-07-01 00:00:00 | 75.36 | N | Y | N/A | N/A
J2791 | RHOPHYLAC INJECTION 100 IU | 2011-12-01 00:00:00 | 5.17 | N | Y | N/A | N/A
[NAME] | RHO D IMMUNE GLOBULIN, HUMAN, SD, 100 IU, INJ | 2011-07-01 00:00:00 | 17.27 | N | Y | N/A | N/A
J2793 | INJECTION, RILONACEPT, 1 MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J2794 | RISPERIDONE, LONG ACTING 0.5 MG | 2011-07-01 00:00:00 | 4.53 | N | Y | N/A | N/A
J2795 | ROPIVACAINE HYDROCHLORIDE, 1 MG, INJECTION | 2011-07-01 00:00:00 | 0.06 | N | Y | N/A | N/A
[NAME] | ROMIPLOSTIM INJECTION | 2011-07-01 00:00:00 | 41.13 | N | Y | N/A | N/A
[NAME] | METHOCARBAMOL, UP TO 10 ML, INJECTION | 2011-07-01 00:00:00 | 25.73 | N | Y | N/A | N/A
J2805 | SINCALIDE INJECTION, 5 MCG | 2011-07-01 00:00:00 | 65.48 | N | Y | N/A | N/A
J2810 | THEOPHYLLINE, PER 40 MG, INJECTION | 2011-07-01 00:00:00 | 0.19 | N | Y | N/A | N/A
J2820 | SARGRAMOSTIM/GM-CSF, 50 MCG, [NAME] | 2011-07-01 00:00:00 | 21.67 | N | Y | N/A | N/A
J2850 | INJECTION SECRETIN SYNTHETIC HUMAN, 1 MCG | 2011-07-01 00:00:00 | 24.74 | N | Y | N/A | N/A
J2910 | AUROTHIOGLUCOSE, UP TO 50 MG, INJECTION | 2008-01-01 00:00:00 | 14.62 | N | Y | N/A | N/A
J2916 | NA FERRIC GLUCONATE CMPLX/SUCROSE, 12.5M, INJ | 2011-07-01 00:00:00 | 4.4 | N | Y | N/A | N/A
J2920 | METHYLPREDNISOLONE, UP TO 40 MG, INJECTION | 2011-07-01 00:00:00 | 1.73 | N | Y | N/A | N/A
J2930 | METHYLPREDNISOLONE, UP TO 125 MG, INJECTION | 2011-07-01 00:00:00 | 2.4 | N | Y | N/A | N/A
J2940 | SOMATREM, 1 MG, [NAME] | 2008-01-01 00:00:00 | 40.16 | N | Y | N/A | N/A
[NAME] | SOMATROPIN, 1 MG,  INJECTION | 2008-01-01 00:00:00 | 49.24 | N | Y | N/A | N/A
[NAME] | PROMAZINE HCL, UP TO 25 MG, INJECTION | 2008-01-01 00:00:00 | 0.38 | N | Y | N/A | N/A
J2993 | RETEPLASE, 18.1 MG, INJECTION | 2011-07-01 00:00:00 | 1222.17 | N | Y | N/A | N/A
[NAME] | STREPTOKINASE, PER 250,000 IU, INJECTION | 2008-01-01 00:00:00 | 76.32 | N | Y | N/A | N/A
J2997 | ALTEPLASE RECOMBINANT, 1 MG, [NAME] | 2011-07-01 00:00:00 | 35.98 | N | Y | N/A | N/A
[NAME] | STREPTOMYCIN, UP TO 1 GRAM, INJECTION | 2011-07-01 00:00:00 | 9.02 | N | Y | N/A | N/A
[NAME] | FENTANYL CITRATE, 0.1 MG, INJECTION | 2011-07-01 00:00:00 | 0.38 | N | N | N/A | N/A
J3030 | SUMATRIPTAN SUCCINATE, 6 [NAME], [NAME] | 2011-07-01 00:00:00 | 42.12 | N | Y | N/A | N/A
J3060 | INJ, TALIGLUCERACE ALFA 10 UNITS | 2014-01-01 00:00:00 | 27.81 | Y | Y | N/A | N/A
J3070 | PENTAZOCINE HCL, 30 MG, INJECTION | 2011-07-01 00:00:00 | 9.75 | N | Y | N/A | N/A
J3095 | [NAME], 10 MG | 2011-07-01 00:00:00 | 1.76 | N | N | N/A | N/A
J3101 | TENECTEPLASE INJECTION 1 MG | 2011-07-01 00:00:00 | 47.66 | N | Y | N/A | N/A
[NAME] | TERBUTALINE SULFATE, UP TO 1 MG, INJECTION | 2011-07-01 00:00:00 | 1.54 | N | Y | N/A | N/A
J3110 | TERIPARATIDE INJECTION 10 MCG | 2008-01-01 00:00:00 | 6.99 | N | Y | N/A | N/A
J3120 | [NAME], UP TO 100 MG, INJECTN | 2011-07-01 00:00:00 | 3.78 | N | Y | N/A | N/A
J3130 | [NAME], UP TO 200 MG, INJECTN | 2011-07-01 00:00:00 | 8.91 | N | Y | N/A | N/A
J3140 | TESTOSTERONE SUSPENSION, UP TO 50 MG, INJECTN | 2008-01-01 00:00:00 | 0.56 | N | Y | N/A | N/A
J3150 | TESTOSTRONE PROPIONATE, UP TO 100 MG, INJECTN | 2008-01-01 00:00:00 | 0.79 | N | Y | N/A | N/A
J3230 | CHLORPROMAZINE HCL, UP TO 50 MG, INJECTION | 2011-07-01 00:00:00 | 8.25 | N | Y | N/A | N/A
J3240 | THYROTROPIN ALPHA, 0.9 MG IN 1.1 MG VIAL, INJ | 2011-07-01 00:00:00 | 948.52 | N | Y | N/A | N/A
[NAME] | TIGECYCLINE INJECTION, 1 MG | 2011-07-01 00:00:00 | 1.12 | N | Y | N/A | N/A
J3246 | TIROFIBAN HCL 0.25.MG | 2011-07-01 00:00:00 | 8.1 | N | Y | N/A | N/A
[NAME] | TRIMETHOBENZAMIDE HCL, UP TO 200 MG, INJECTN | 2011-07-01 00:00:00 | 4.74 | N | Y | N/A | N/A
[NAME] | [NAME], UP TO 80 MG, INJECTION | 2011-07-01 00:00:00 | 1.97 | N | Y | N/A | N/A
J3262 | TOCILIZUMAB INJECTION, 1 MG | 2011-07-01 00:00:00 | 3.13 | N | N | N/A | N/A
J3265 | TORSEMIDE, 10 MG/ML, INJECTION | 2008-01-01 00:00:00 | 2.62 | N | Y | N/A | N/A
J3280 | THIETHYLPERAZINE MALEATE, UP TO 10MG, INJECTN | 2008-01-01 00:00:00 | 4.76 | N | Y | N/A | N/A
J3285 | TREPROSTINIL INJECTION, 1 MG | 2011-07-01 00:00:00 | 55.11 | N | Y | N/A | N/A
J3300 | TRIAMCINOLONE A INJ PRS-FREE, 1 MG | 2011-07-01 00:00:00 | 2.91 | N | Y | N/A | N/A
J3301 | TRIAMCINOLONE ACETONIDE NOS PER 10 MG, INJECTION | 2011-07-01 00:00:00 | 1.47 | N | Y | N/A | N/A
[NAME] | TRIAMCINOLONE DIACETATE, PER 5 MG, INJECTION | 2011-07-01 00:00:00 | 0.25 | N | Y | N/A | N/A
[NAME] | TRIAMCINOLONE HEXACETONIDE, PER /5 MG, INJECT | 2011-07-01 00:00:00 | 1.16 | N | Y | N/A | N/A
[NAME] | TRIMETREXATE GLUCORONATE, PER  25 MG, INJECTN | 2008-01-01 00:00:00 | 145.06 | N | Y | N/A | N/A
[NAME] | PERPHENAZINE, UP TO 5 MG, INJECTION | 2008-01-01 00:00:00 | 5.96 | N | Y | N/A | N/A
[NAME] | TRIPTORELIN PAMOATE, 3.75 [NAME], INJECTION | 2011-07-01 00:00:00 | 177.58 | N | Y | N/A | N/A
J3320 | SPECTINOMYCIN HCL, UP TO 2 GM, INJECTION | 2008-01-01 00:00:00 | 18.3 | N | Y | N/A | N/A
J3350 | UREA, UP TO 40 GRAMS, INJECTION | 2008-01-01 00:00:00 | 73.77 | N | Y | N/A | N/A
J3355 | UROFOLLITROPIN, INJECTION 75 IU | 2011-07-01 00:00:00 | 58.34 | N | Y | N/A | N/A
J3357 | [NAME], 1 MG | 2011-07-01 00:00:00 | 101.07 | N | N | N/A | N/A
J3360 | DIAZEPAM, UP TO 5 MG, INJECTION | 2011-07-01 00:00:00 | 0.94 | N | Y | N/A | N/A
J3364 | UROKINASE, 5000 IU VIAL, INJECTION | 2008-01-01 00:00:00 | 9.16 | N | Y | N/A | N/A
J3365 | UROKINASE, 250,000 IU VIAL, INJECTION | 2011-07-01 00:00:00 | 411.96 | N | Y | N/A | N/A
J3370 | VANCOMYCIN HCL, UP TO 500 MG, INJECTION | 2011-07-01 00:00:00 | 2.77 | N | Y | N/A | N/A
[NAME] | VELAGLUCERASE ALFA INJECTION, 100 UNITS | 2011-07-01 00:00:00 | 314.89 | N | N | N/A | N/A
J3396 | VERTEPORFIN INJECTION 0.1MG | 2011-07-01 00:00:00 | 8.76 | N | Y | N/A | N/A
[NAME] | TRIFLUPROMAZINE HCL, UP TO 20 MG, INJECTION | 2008-01-01 00:00:00 | 9 | N | Y | N/A | N/A
J3410 | HYDROXYZINE HCL, UP TO 25 MG, INJECTION | 2011-07-01 00:00:00 | 1.31 | N | Y | N/A | N/A
J3411 | THIAMINE HYDROCHLORIDE, 100 MG, INJECTION | 2011-07-01 00:00:00 | 2.82 | N | Y | N/A | N/A
J3415 | PYRIDOXINE HYDROCHLORIDE, 100 MG, INJECTION | 2011-07-01 00:00:00 | 6.01 | N | Y | N/A | N/A
J3420 | VITAMIN B-12 CYANOCOBALAMIN, TO 1000 MCG, INJ | 2011-07-01 00:00:00 | 0.27 | N | Y | N/A | N/A
J3430 | VITAMIN K/PHYTONADIONE, PER 1 MG, INJECTION | 2011-07-01 00:00:00 | 1.54 | N | Y | N/A | N/A
J3465 | VORICONAZOLE, 10 MG, INJECTION | 2011-07-01 00:00:00 | 5.52 | N | Y | N/A | N/A
J3470 | HYALURONIDASE, UP TO 150 UNITS, INJECTION | 2011-07-01 00:00:00 | 19.08 | N | Y | N/A | N/A
J3471 | OVINE, HYALURONIDASE, UP TO 999 USP UNITS | 2011-07-01 00:00:00 | 0.16 | N | Y | N/A | N/A
[NAME] | OVINE, HYALURONIDASE, 1000 USP UNITS | 2011-07-01 00:00:00 | 124.02 | N | Y | N/A | N/A
J3473 | HYALURONIDASE RECOMBINANT INJECTION | 2011-07-01 00:00:00 | 0.57 | N | Y | N/A | N/A
[NAME] | MAGNESIUM SULFATE, PER 500 MG, INJECTION | 2011-07-01 00:00:00 | 0.07 | N | Y | N/A | N/A
[NAME] | POTASSIUM CHLORIDE, PER 2 MEQ, INJECTION | 2011-07-01 00:00:00 | 0.01 | N | Y | N/A | N/A
[NAME] | ZIDOVUDINE, 10 MG, INJECTION | 2011-07-01 00:00:00 | 1.24 | N | Y | N/A | N/A
J3486 | ZIPRASIDONE MESYLATE, 10 MG, [NAME] | 2011-07-01 00:00:00 | 6.31 | N | Y | N/A | N/A
J3489 | INJ, ZOLEDRONIC ACID 1MG | 2014-01-01 00:00:00 | 94.88 | Y | Y | N/A | N/A
J3490 | UNCLASSIFIED DRUGS | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
J3520 | EDETATE DISODIUM, PER 150 MG | 2008-01-01 00:00:00 | 29.43 | N | Y | N/A | N/A
J3530 | NASAL VACCINE INHALATION | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | UNCLASSIFIED BIOLOGICS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7030 | NORMAL SALINE INFUSION, 1000 CC | 2011-07-01 00:00:00 | 0.43 | N | Y | N/A | N/A
J7040 | [NAME], STERILE | 2011-07-01 00:00:00 | 0.51 | N | Y | N/A | N/A
J7042 | 5% DEXTROSE/NORMAL SALINE SOLUTION | 2011-07-01 00:00:00 | 0.31 | N | Y | N/A | N/A
J7050 | [NAME], 250 CC | 2011-07-01 00:00:00 | 0.25 | N | Y | N/A | N/A
J7060 | 5% DEXTROSE/WATER, 500 ML = 1 UNIT | 2011-07-01 00:00:00 | 1.01 | N | Y | N/A | N/A
J7070 | D5W INFUSION, 1000 CC | 2011-07-01 00:00:00 | 1.99 | N | Y | N/A | N/A
J7100 | DEXTRAN 40, 500 ML, INFUSION | 2011-07-01 00:00:00 | 18.43 | N | Y | N/A | N/A
J7110 | DEXTRAN 75, 500 ML, INFUSION | 2011-07-01 00:00:00 | 11.45 | N | Y | N/A | N/A
J7120 | RINGERS LACTATE, TO 1000 CC, INFUSION | 2011-07-01 00:00:00 | 0.94 | N | Y | N/A | N/A
J7131 | [NAME], 1 ML | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
J7178 | HUMAN FIBRINOGEN CONCENTRATE INJECTION, 1 MG | 2013-01-01 00:00:00 | 0 | N | Y | N/A | N/A
J7180 | FACTOR XIII ANTI-HEMOPHILIC FACTOR INJ 1 I.U. | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | VON WILLEBRAND FACTOR, WILATE, INJECTION, 1 I.U. | 2013-10-01 00:00:00 | 0.82 | N | N | N/A | N/A
J7185 | XYNTHA INJ | 2011-07-01 00:00:00 | 0.96 | N | Y | N/A | N/A
[NAME] | ANTIHEMOPHILIC FACTOR VIII/VWF COMPLEX | 2011-07-01 00:00:00 | 0.83 | N | Y | N/A | N/A
[NAME] | HUMATE-P, INJECTION, PER IU | 2011-07-01 00:00:00 | 0.79 | N | Y | N/A | N/A
J7189 | FACTOR VIIA, PER 1 MICROGRAM | 2011-07-01 00:00:00 | 1.37 | N | Y | N/A | N/A
J7190 | FACTOR VIII (HUMAN) ANTIHEMOPHILIC, PER IU | 2011-07-01 00:00:00 | 0.79 | N | Y | N/A | N/A
J7192 | FACTOR VIII RECOMBINANT ANTIHEMOPHILC, PER IU | 2011-07-01 00:00:00 | 0.99 | N | Y | N/A | N/A
J7193 | FACTOR IX PURIFIED NON-RECOMBINANT, PER IU | 2011-07-01 00:00:00 | 0.81 | N | Y | N/A | N/A
J7194 | FACTOR IX COMPLEX ANTIHEMOPHILIC, PER IU | 2011-07-01 00:00:00 | 0.78 | N | Y | N/A | N/A
[NAME] | FACTOR IX RECOMBINANT ANTIHEMOPHILIC, PER IU | 2011-07-01 00:00:00 | 1.04 | N | Y | N/A | N/A
J7197 | ANTITHROMBIN III (HUMAN), PER IU | 2011-07-01 00:00:00 | 2.27 | N | Y | N/A | N/A
[NAME] | ANTI-INHIBITOR, PER IU | 2011-07-01 00:00:00 | 1.44 | N | Y | N/A | N/A
[NAME] | HEMOPHILIA CLOTTING FACTOR; NOT OTHERWISE CLASSIFIED | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | INTRAUTERINE COPPER CONTRACEPTIVE | 2011-05-01 00:00:00 | 598 | N | N | N/A | N/A
J7301 | SKYLA 13.5 MG | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
J7302 | LEVONORGESTREL, 52 MG, IU CONTRACEPTIVE SYS | 2014-01-01 00:00:00 | 726.29 | N | N | N/A | N/A
[NAME] | CONTRACEPTIVE SUPPLY, HORMONE CONTAINING VAGINAL RING, EACH | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
J7304 | CONTRACEPTIVE SUPPLY, HORMONE CONTAINING PATCH, EACH | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
J7306 | LEVONORGESTREL IMPLANT SYSTEM, INCLUDING IMPLANTS AND SUPPLIES | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
J7307 | ETONOGESTREL IMPLANT SYSTEM CONTRACEPTIVE | 2012-01-01 00:00:00 | 659.42 | N | N | N/A | N/A
J7308 | AMINOLEVULINIC ACID HCL TOPICAL 20% (354 MG) | 2011-07-01 00:00:00 | 127.23 | N | Y | N/A | N/A
J7310 | GANCICLOVIR, 4.5 MG LONG-ACTING IMPLANT | 2011-07-01 00:00:00 | 15264 | N | Y | N/A | N/A
J7311 | FLUOCINOLONE ACETONIDE IMPLANT | 2011-07-01 00:00:00 | 17410.5 | Y | Y | N/A | N/A
J7312 | DEXAMETHASONE INTRAVITREAL IMPLANT, 0.1 MG | 2011-07-01 00:00:00 | 176.43 | N | N | N/A | N/A
J7315 | OPTHALMIC MITOMYCIN, 0.2.MG | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | INJECTION, OCRIPLASMIN, 0.125 MG | 2014-01-01 00:00:00 | 942.08 | Y | Y | N/A | N/A
[NAME] | HYALGAN/SUPARTZ INJECTION PER DOSE | 2011-07-01 00:00:00 | 81.46 | N | Y | N/A | N/A
[NAME] | EUFLEXXA INJECTION PER DOSE | 2011-07-01 00:00:00 | 134.98 | N | Y | N/A | N/A
[NAME] | ORTHOVISC INJECTION PER DOSE | 2011-07-01 00:00:00 | 153.19 | N | Y | N/A | N/A
[NAME] | SYNVISC OR SYNVISC-ONE | 2011-07-01 00:00:00 | 10.83 | N | Y | N/A | N/A
J7335 | CAPSAICIN 8% PATCH, PER 10 SQUARE CENTIMETERS | 2011-07-01 00:00:00 | 23 | N | N | N/A | N/A
J7500 | AZATHIOPRINE, 50 MG, ORAL | 2011-07-01 00:00:00 | 0.12 | N | Y | N/A | N/A
J7501 | AZATHIOPRINE, 10 MG, PARENTERAL | 2011-07-01 00:00:00 | 96.11 | N | Y | N/A | N/A
[NAME] | CYCLOSPORINE, 100 MG, ORAL | 2011-07-01 00:00:00 | 2.82 | N | Y | N/A | N/A
J7504 | LYMPHO IMMN/ANTITHYMOCYTE GLOBULIN EQU, 250MG | 2011-07-01 00:00:00 | 497.51 | N | Y | N/A | N/A
J7505 | MUROMONAB-CD3, 5 MG, PARENTERAL | 2011-07-01 00:00:00 | 1020.17 | N | Y | N/A | N/A
J7506 | PREDNISONE, PER 5 MG,  ORAL | 2011-07-01 00:00:00 | 0.02 | N | Y | N/A | N/A
J7507 | TACROLIMUS, PER 1 MG, ORAL | 2011-07-01 00:00:00 | 2.51 | N | Y | N/A | N/A
J7508 | TACROLIMUS EXTENDED RELEASE, ORAL, 0.1MG | 2014-01-01 00:00:00 | 0.38 | N | Y | N/A | N/A
[NAME] | METHYLPREDNISOLONE, PER 4 MG, ORAL | 2011-07-01 00:00:00 | 0.06 | N | Y | N/A | N/A
J7510 | PREDNISOLONE, PER 5 MG, ORAL | 2011-07-01 00:00:00 | 0.03 | N | Y | N/A | N/A
[NAME] | LYMPHO IMMN/ANTITHYMOCYTE GLOBULIN RABT, 25MG | 2011-07-01 00:00:00 | 355.16 | N | Y | N/A | N/A
J7513 | DACLIZUMAB,  25MG, PARENTERAL | 2011-07-01 00:00:00 | 473.71 | N | Y | N/A | N/A
J7515 | CYCLOSPORINE, 25 MG, ORAL | 2011-07-01 00:00:00 | 0.74 | N | Y | N/A | N/A
[NAME] | CYCLOSPORIN, 250MG, PARENTERAL | 2011-07-01 00:00:00 | 20.19 | N | Y | N/A | N/A
J7517 | MYCOPHENOLATE MOFETIL, 250 MG, ORAL | 2011-07-01 00:00:00 | 1.18 | N | Y | N/A | N/A
J7518 | MYCOPHENOLIC ACID ORAL 180 MG | 2011-07-01 00:00:00 | 2.84 | N | Y | N/A | N/A
[NAME] | SIROLIMUS, 1 MG, ORAL | 2011-07-01 00:00:00 | 9.12 | N | Y | N/A | N/A
J7525 | TACROLIMUS, 5 MG, PARENTERAL | 2011-07-01 00:00:00 | 125.54 | N | Y | N/A | N/A
J7527 | ORAL EVEROLIMUS, 0.25 MG | 2013-01-01 00:00:00 | 0.23 | N | N | N/A | N/A
J7599 | METHYLPREDNISOLONE SODIUM SUCCINATE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7604 | ACETYLCYSTEINE COMPOUNDED UNIT [NAME] | 2008-01-01 00:00:00 | 2.37 | N | Y | N/A | N/A
J7605 | ARFORMOTEROL NON-COMPOUNDED UNIT DOSE | 2011-07-01 00:00:00 | 4.77 | N | Y | N/A | N/A
J7606 | FORMOTEROL FUMARATE, INHALATION | 2011-07-01 00:00:00 | 4.23 | N | Y | N/A | N/A
[NAME] | LEVALBUTEROL, INHALATION SOL, COMPOUNDED PROD, ADMIN THROUGH DME, 0.5 MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7608 | ACETYLCYSTEINE NON-COMPOUNDED UNIT, PER GRAM | 2011-07-01 00:00:00 | 1.92 | N | Y | N/A | N/A
J7609 | ALBUTEROL, INHALATION SOL, COMPOUNDED PROD, ADMIN THROUGH DME, UNIT DOSE, 1 MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7610 | ALBUTEROL, INHALATION SOL, COMPOUNDED PROD, ADMIN THRU DME, CONCEN FORM, 1 MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7611 | ALBUTEROL NON-COMPOUNDED CONCENTRATED, 1MG | 2011-07-01 00:00:00 | 0.09 | N | Y | N/A | N/A
J7612 | [NAME], 0.5MG | 2011-07-01 00:00:00 | 0.17 | N | Y | N/A | N/A
[NAME] | ALBUTEROL NON-COMPOUNDED UNIT, 1MG | 2011-07-01 00:00:00 | 0.06 | N | Y | N/A | N/A
[NAME] | [NAME] UNIT, 0.5MG | 2011-07-01 00:00:00 | 0.25 | N | Y | N/A | N/A
J7615 | LEVALBUTEROL, INHALATION SOL, COMPOUNDED PROD, ADMIN THRU DME, UNIT DOSE, 0.5 MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7620 | ALBUTEROL IPRATROPIUM BROMIDE NON-COMPOUND | 2011-07-01 00:00:00 | 0.18 | N | Y | N/A | N/A
[NAME] | BETHAMETHASONE, [NAME], UNIT DOSE FORM PER MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7624 | BETHAMETHASONE INHALATION SOLUTION ADMINISTERED THROUGH DME UNIT DOSE FORM/ [NAME]. | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7626 | BUDESONIDE NON-COMPOUND UNIT UP TO 0.5 MG | 2011-07-01 00:00:00 | 3.74 | N | Y | N/A | N/A
J7627 | BUDESONIDE, POWDER, COMPOUNDED FOR INHALATION SOLUTION | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7628 | BITOLTEROL MESYLATE COMPOUND CONCENTRATE PER MG | 2008-01-01 00:00:00 | 0.25 | N | Y | N/A | N/A
[NAME] | BITOLTEROL MESYLATE COMPOUND UNIT PER MG | 2008-01-01 00:00:00 | 0.33 | N | Y | N/A | N/A
J7631 | CROMOLYN SODIUM NONCOMPOUNDED UNIT PER MG | 2011-07-01 00:00:00 | 0.38 | N | Y | N/A | N/A
J7632 | [NAME], INHALATION SOL, COMPOUNDED PRODUCT, PER 10 ML | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7633 | BUDESONIDE INHALATION SOLUTION THRU DME, CONCENTRATED FORM, PER 0.25 MILLIGRAM | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7634 | BUDESONIDE, INHALATION SOL, COMPOUNDED PROD, ADMIN THRU DME, PER 0.25 MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7635 | ATROPINE COMPOUND CONCENTRATE PER MG | 2008-01-01 00:00:00 | 0.13 | N | Y | N/A | N/A
[NAME] | ATROPINE COMPOUND UNIT PER MG | 2008-01-01 00:00:00 | 0.34 | N | Y | N/A | N/A
J7637 | DEXAMETHASONE COMPOUND CONCENTRATE PER MG | 2008-01-01 00:00:00 | 0.33 | N | Y | N/A | N/A
[NAME] | DEXAMETHASONE COMPOUND UNIT PER MG | 2008-01-01 00:00:00 | 0.21 | N | Y | N/A | N/A
J7639 | DORNASE ALFA NON-COMPOUNDED UNIT PER MG | 2011-07-01 00:00:00 | 23.64 | N | Y | N/A | N/A
J7640 | FORMORTEROL, INHALATION SOLUTION ADMINISTERED THROUGH DME, 12 MCGS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | FLUNISOLIDE, INHALATION SOLUTION ADMIN. THROUGH DME, UNIT DOSE PER MILLIGRAM | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7642 | GLYCOPYRROLATE COMPOUND CONCENTRATE PER MG | 2008-01-01 00:00:00 | 0.31 | N | Y | N/A | N/A
J7643 | GLYCOPYRROLATE COMPOUND UNIT PER MG | 2008-01-01 00:00:00 | 0.84 | N | Y | N/A | N/A
J7644 | IPRATROPIUM BROMIDE NON-COMPOUND UNIT PER MG | 2011-07-01 00:00:00 | 0.24 | N | Y | N/A | N/A
J7645 | [NAME], INHALATION SOL, COMPOUNDED, (ADMIN THRU DME) PER MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7647 | ISOETHARINE HCL, INHALATION SOL, COMPOUNDED PROD, ADMIN THRU DME, PER MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7648 | ISOETHARINE NON-COMPOUND CONCENTRATE PER MG | 2008-01-01 00:00:00 | 0.17 | N | Y | N/A | N/A
J7649 | ISOETHARINE NON-COMPOUND UNIT PER MG | 2008-01-01 00:00:00 | 0.17 | N | Y | N/A | N/A
[NAME] | ISOETHARINE HCL 0.1% PER ML ADMINISTERED | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7657 | ISOPROTERENOL HCL, INHALATION SOL, COMPOUNDED PROD, ADMIN THRU DME, PER MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7658 | ISOPROTERENOL NON-COMPOUND CONCENTRATE PER MG | 2008-01-01 00:00:00 | 0.31 | N | Y | N/A | N/A
J7659 | ISOPROTERENOL NON-COMPOUND UNIT PER MG | 2008-01-01 00:00:00 | 0.4 | N | Y | N/A | N/A
[NAME] | ISOPROTERENOL HCL, INHAL SOL, COMPOUND PROD, ADMIN THRU DME, UNIT DOSE , PER MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7667 | METAPROTERENOL SULFATE, INHALATION SOL, COMPOUND PROD, CONCENTRATE, PER 10 MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | METAPROTERENOL NON-COMP CONCENTRATE PER 10 MG | 2008-01-01 00:00:00 | 0.25 | N | Y | N/A | N/A
J7669 | METAPROTERENOL NON-COMPOUND PER 10 MG | 2011-07-01 00:00:00 | 0.23 | N | Y | N/A | N/A
J7670 | METAPROTERENOL SULFATE, INHAL SOL, [NAME], ADM THRU DME, UNIT DOSE, PER 10 MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7674 | METHACHOLINE CHLORIDE, NEB 1 MG | 2011-07-01 00:00:00 | 0.41 | N | Y | N/A | N/A
J7676 | PENTAMIDINE ISETHIONATE, INHALATION SOLUTION, PER 300 MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7680 | TERBUTALINE SULFATE COMPOUND PER MG | 2008-01-01 00:00:00 | 1.86 | N | Y | N/A | N/A
J7681 | TERBUTALINE SULFATE COMPOUND UNIT PER MG | 2008-01-01 00:00:00 | 2.07 | N | Y | N/A | N/A
J7682 | [NAME] UNIT PER 300 MG | 2011-07-01 00:00:00 | 67.67 | N | Y | N/A | N/A
J7683 | TRIAMCINOLONE COMPOUND CONCENTRATE PER MG | 2008-01-01 00:00:00 | 0.04 | N | Y | N/A | N/A
J7684 | TRIAMCINOLONE COMPOUND UNIT PER MG | 2008-01-01 00:00:00 | 0.14 | N | Y | N/A | N/A
J7685 | TOBRAMYCIN, INHALATION SOL, COMPOUND, ADMIN THRU DME, UNIT DOSE , PER 300 MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J7686 | TREPROSTINIL, NON-COMP UNIT DOSE FORM 1.74 MG | 2011-07-01 00:00:00 | 360.69 | N | N | N/A | N/A
J7799 | NOC DRUGS,OTHER THAN INHALATION DRUGS, THROUGH DME | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J8498 | ANTIEMETIC DRUG, RECTAL SUPPOSITORY, NOC | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J8501 | ORAL APREPITANT 5 MG | 2011-07-01 00:00:00 | 5.42 | N | Y | N/A | N/A
J8510 | BUSULFAN, 2 MG, ORAL | 2011-07-01 00:00:00 | 3.29 | N | Y | N/A | N/A
J8520 | CAPECITABINE, 150 MG, ORAL | 2011-07-01 00:00:00 | 6.25 | N | Y | N/A | N/A
J8521 | CAPECITABINE, 500 [NAME], ORAL | 2011-07-01 00:00:00 | 20.63 | N | Y | N/A | N/A
J8530 | CYCLOPHOSPHAMIDE, 25 MG, ORAL | 2011-07-01 00:00:00 | 0.76 | N | Y | N/A | N/A
J8540 | ORAL DEXAMETHASONE, 0.25MG | 2011-07-01 00:00:00 | 0.34 | N | Y | N/A | N/A
J8560 | ETOPOSIDE, 50 MG, ORAL | 2011-07-01 00:00:00 | 31.5 | N | Y | N/A | N/A
J8597 | ANTIEMETIC DRUG, ORAL, NOC | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J8600 | MELPHALAN, 2 MG, ORAL | 2011-07-01 00:00:00 | 4.23 | N | Y | N/A | N/A
J8610 | METHOTREXATE, 2.5 MG, ORAL | 2011-07-01 00:00:00 | 0.1 | N | Y | N/A | N/A
J8650 | NABILONE, ORAL, 1 MG | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
J8700 | TEMOZOLMIDE, 5 MG, ORAL | 2011-07-01 00:00:00 | 8.54 | N | Y | N/A | N/A
J8705 | TOPOTECAN ORAL, 0.25 MG | 2011-07-01 00:00:00 | 69.42 | N | Y | N/A | N/A
J9000 | [NAME], 10 MG, INJECTION | 2011-07-01 00:00:00 | 3.15 | N | Y | N/A | N/A
[NAME] | ALEMTUZUMAB, 10 MG, INJECTION | 2011-07-01 00:00:00 | 529.83 | N | Y | N/A | N/A
[NAME] | ALDESLEUKIN, PER SINGLE USE VIAL, INJECTION | 2011-07-01 00:00:00 | 839.75 | N | Y | N/A | N/A
J9017 | ARSENIC TRIOXIDE, 1 MG, INJECTION | 2011-07-01 00:00:00 | 36.81 | N | Y | N/A | N/A
[NAME] | [NAME], 1000 IU | 2013-01-01 00:00:00 | 300.89 | Y | N | N/A | N/A
J9020 | ASPARAGINASE, 10,000 UNITS, INJECTION | 2011-07-01 00:00:00 | 56.94 | N | Y | N/A | N/A
J9025 | AZACITIDINE INJECTION, 1 MG | 2011-07-01 00:00:00 | 4.73 | N | Y | N/A | N/A
J9027 | CLOFARABINE INJECTION, 1 MG | 2011-07-01 00:00:00 | 104.91 | N | Y | N/A | N/A
[NAME] | BCG (INTRAVESICAL), PER INSTILLATION | 2011-07-01 00:00:00 | 104.92 | N | Y | N/A | N/A
J9033 | BENDAMUSTINE INJECTION, 1 MG | 2011-07-01 00:00:00 | 16.65 | N | Y | N/A | N/A
J9035 | BEVACIZUMAB INJECTION 10 MG | 2011-07-01 00:00:00 | 53.86 | N | Y | N/A | N/A
J9040 | BLEOMYCIN SULFATE, 15 UNITS, [NAME] | 2011-07-01 00:00:00 | 24.46 | N | Y | N/A | N/A
J9041 | BORTEZOMIB INJECTION 0.1 MG | 2011-07-01 00:00:00 | 36.32 | N | Y | N/A | N/A
J9042 | BRENTUXIMAB VEDOTIN INJECTION, 1 MG | 2013-01-01 00:00:00 | 89.09 | Y | N | N/A | N/A
J9043 | CABAZITAXEL INJECTION, 1 MG | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
J9045 | CARBOPLATIN, 50 MG, INJECTION | 2011-07-01 00:00:00 | 3.7 | N | Y | N/A | N/A
J9047 | INJECTION, CARFILZOMIB, 1 MG | 2014-01-01 00:00:00 | 26.36 | Y | Y | N/A | N/A
J9050 | CARMUSTINE. 100 [NAME], INJECTION | 2011-07-01 00:00:00 | 158.29 | N | Y | N/A | N/A
J9055 | CETUXIMAB INJECTION 10 MG | 2011-07-01 00:00:00 | 45.43 | N | Y | N/A | N/A
[NAME] | CISPLATIN, PER 10 MG, POWDER OR [NAME] | 2011-07-01 00:00:00 | 1.86 | N | Y | N/A | N/A
J9065 | CLADRIBINE, PER 1 MG, INJECTION | 2011-07-01 00:00:00 | 21.64 | N | Y | N/A | N/A
J9070 | CYCLOPHOSPHAMIDE, 100 MG | 2011-07-01 00:00:00 | 6.8 | N | Y | N/A | N/A
[NAME] | CYTARABINE LIPOSOME, 10 MG, INJECTION | 2011-07-01 00:00:00 | 439.41 | N | Y | N/A | N/A
J9100 | CYTARABINE, 100 MG | 2011-07-01 00:00:00 | 0.85 | N | Y | N/A | N/A
[NAME] | DACTINOMYCIN, 0.5 MG,INJECTION | 2011-07-01 00:00:00 | 485.64 | N | Y | N/A | N/A
J9130 | DACARBAZINE, 100 MG | 2011-07-01 00:00:00 | 3.46 | N | Y | N/A | N/A
J9150 | DAUNORUBICIN, 10 MG, INJECTION | 2011-07-01 00:00:00 | 12.07 | N | Y | N/A | N/A
J9151 | DAUNORUBICIN CITRATE, 10 MG, LIPOSOMAL FORMULA | 2011-07-01 00:00:00 | 51.9 | N | Y | N/A | N/A
J9155 | DEGARELIX INJECTION | 2011-07-01 00:00:00 | 2.54 | N | Y | N/A | N/A
J9160 | DENILEUKIN DIFTITOX, 300 MCG, INJECTION | 2011-07-01 00:00:00 | 1430.58 | N | Y | N/A | N/A
[NAME] | DIETHYLSTILBESTROL DIPHOSPHTE, 250MG, INJECTION | 2008-01-01 00:00:00 | 13 | N | Y | N/A | N/A
J9171 | DOCETAXEL INJECTION | 2011-07-01 00:00:00 | 19.12 | N | Y | N/A | N/A
J9175 | ELLIOTTS'B SOLUTION PER ML, INJECTION | 2011-07-01 00:00:00 | 3.67 | N | Y | N/A | N/A
J9178 | EPIRUBICIN HYDROCHLORIDE, 2 MG, INJECTION | 2011-07-01 00:00:00 | 1.72 | N | Y | N/A | N/A
J9179 | ERIBULIN MESYLATE INJECTION, 0.1 MG | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
J9181 | ETOPOSIDE, 10 MG, INJECTION | 2011-07-01 00:00:00 | 0.57 | N | Y | N/A | N/A
J9185 | FLUDARABINE PHOSPHATE, 50 MG, INJECTION | 2011-07-01 00:00:00 | 56.79 | N | Y | N/A | N/A
J9190 | FLUOROURACIL, 500 [NAME], INJECTION | 2011-07-01 00:00:00 | 1.39 | N | Y | N/A | N/A
J9200 | FLOXURIDINE, 500 [NAME], INJECTION | 2011-07-01 00:00:00 | 33.57 | N | Y | N/A | N/A
J9201 | GEMCITABINE HYDROCHLORIDE, 200 [NAME], INJECTION | 2011-07-01 00:00:00 | 102.19 | N | Y | N/A | N/A
J9202 | GOSERELIN ACETATE, PER 3.6 MG, IMPLANT | 2011-07-01 00:00:00 | 179.03 | N | Y | N/A | N/A
[NAME] | IRINOTECAN, 20 MG, INJECTION | 2011-07-01 00:00:00 | 4.5 | N | Y | N/A | N/A
[NAME] | IXABEPILONE INJECTION, 1 MG, [NAME] | 2011-07-01 00:00:00 | 57.36 | N | Y | N/A | N/A
J9208 | IFOSFOMIDE, 1.0 GRAM, INJECTION | 2011-07-01 00:00:00 | 28.63 | N | Y | N/A | N/A
J9209 | MESNA, 200 MG, INJECTION | 2011-07-01 00:00:00 | 2.68 | N | Y | N/A | N/A
J9211 | IDARUBICIN HYDROCHLORIDE, 5 MG, INJECTION | 2011-07-01 00:00:00 | 42.6 | N | Y | N/A | N/A
J9212 | INTERFERON ALFACON-1, RECOMBINANT, 1 MCG, INJ | 2008-01-01 00:00:00 | 4.66 | N | Y | N/A | N/A
J9213 | INTERFERON ALFA-2A, RECOMBINANT, 3 MIL UNITS | 2008-01-01 00:00:00 | 41.8 | N | Y | N/A | N/A
[NAME] | INTERFERON ALFA-2B, RECOMBINANT, 1 MIL UNITS | 2011-07-01 00:00:00 | 14.85 | N | Y | N/A | N/A
J9215 | INTERFERON ALFA-N3, 250,000 IU | 2008-01-01 00:00:00 | 8.6 | N | Y | N/A | N/A
J9216 | INTERFERON GAMMA 1-B, 3 MILLION UNITS | 2008-01-01 00:00:00 | 309.58 | N | Y | N/A | N/A
J9217 | LEUPROLIDE ACETATE DEPOT SUSPENSION,  7.5 MG | 2011-07-01 00:00:00 | 193.52 | N | Y | N/A | N/A
[NAME] | LEUPROLIDE ACETATE, PER 1 MG | 2011-07-01 00:00:00 | 4.48 | N | Y | N/A | N/A
J9219 | LEUPROLIDE ACETATE, 65 MG, IMPLANT | 2011-07-01 00:00:00 | 4337.84 | N | Y | N/A | N/A
[NAME] | VANTAS IMPLANT 50 MG | 2011-07-01 00:00:00 | 2957.01 | N | Y | N/A | N/A
J9226 | SUPPRELIN LA IMPLANT 50 MG | 2011-07-01 00:00:00 | 13928.89 | N | Y | N/A | N/A
[NAME] | [NAME], 1 MG | 2014-04-01 00:00:00 | 117.78 | N | N | N/A | N/A
J9230 | [NAME], 10 MG, INJECTION | 2011-07-01 00:00:00 | 142.07 | N | Y | N/A | N/A
J9245 | MELPHALAN HYDROCHLORIDE, 50 MG, INJECTION | 2011-07-01 00:00:00 | 1166.82 | N | Y | N/A | N/A
J9250 | METHOTREXATE SODIUM, 5 MG | 2011-07-01 00:00:00 | 0.17 | N | Y | N/A | N/A
J9260 | METHOTREXATE SODIUM, 50 MG | 2011-07-01 00:00:00 | 1.72 | N | Y | N/A | N/A
[NAME] | NELARABINE INJECTION, 50 MG | 2011-07-01 00:00:00 | 101.08 | N | Y | N/A | N/A
J9262 | INJ, OMACETAXINE MEP, 0.01 MG | 2014-01-01 00:00:00 | 0 | Y | Y | N/A | N/A
J9263 | OXALIPLATIN, 0.5 MG, INJECTION | 2011-07-01 00:00:00 | 7.67 | N | Y | N/A | N/A
J9264 | PACLITAXEL PROTEIN BOUND, 1 MG, INJECTION | 2011-07-01 00:00:00 | 8.45 | N | Y | N/A | N/A
J9265 | PACLITAXEL, 30 MG, INJECTION | 2011-07-01 00:00:00 | 5.4 | N | Y | N/A | N/A
[NAME] | PEGASPARGASE, PER SINGLE DOSE VIAL, INJECTION | 2011-07-01 00:00:00 | 2454.17 | N | Y | N/A | N/A
[NAME] | PENTOSTATIN, PER 10 MG, INJECTION | 2011-07-01 00:00:00 | 979.83 | N | Y | N/A | N/A
J9270 | PLICAMYCIN, 2.5 MG, INJECTION | 2008-01-01 00:00:00 | 78.99 | N | Y | N/A | N/A
[NAME] | MITOMYCIN, 5 MG | 2011-07-01 00:00:00 | 18.68 | N | Y | N/A | N/A
J9293 | MITOXANTRONE HYDROCHLORIDE, PER 5 MG, INJECTN | 2011-07-01 00:00:00 | 31.14 | N | Y | N/A | N/A
J9300 | GEMTUZUMAB OZOGAMICIN, 5 MG, [NAME] | 2011-07-01 00:00:00 | 2418.96 | N | Y | N/A | N/A
J9302 | [NAME], 10 MG | 2011-07-01 00:00:00 | 40.87 | N | N | N/A | N/A
J9303 | PANITUMUMAB INJECTION, 10 MG | 2011-07-01 00:00:00 | 78.54 | N | Y | N/A | N/A
[NAME] | PEMETREXED INJECTION, 10 MG | 2011-07-01 00:00:00 | 47.12 | N | Y | N/A | N/A
[NAME] | INJECTION, PERTUZUMAB, 1 MG | 2014-01-01 00:00:00 | 9.19 | N | Y | N/A | N/A
[NAME] | PRALATREXATE INJECTION, 1 MG | 2011-07-01 00:00:00 | 149.06 | N | N | N/A | N/A
[NAME] | RITUXIMAB, 100 MG, INJECTION | 2011-07-01 00:00:00 | 549.62 | N | Y | N/A | N/A
[NAME] | ROMIDEPSIN INJECTION, 1 MG | 2011-07-01 00:00:00 | 197.37 | N | N | N/A | N/A
J9320 | STREPTOZOCIN, 1.0 GRAM, INJECTION | 2011-07-01 00:00:00 | 242.92 | N | Y | N/A | N/A
J9330 | TEMSIROLIMUS INJECTION, 1 MG | 2011-07-01 00:00:00 | 45.75 | N | Y | N/A | N/A
[NAME] | THIOTEPA, 15 MG, INJECTION | 2011-07-01 00:00:00 | 97.73 | N | Y | N/A | N/A
J9351 | TOPOTECAN INJECTINO, 0.1 MG | 2011-07-01 00:00:00 | 17.71 | N | Y | N/A | N/A
J9354 | [NAME] EMT 1 MG | 2014-01-01 00:00:00 | 26.25 | N | Y | N/A | N/A
J9355 | TRASTUZUMAB, 10 MG, INJECTION | 2011-07-01 00:00:00 | 63.34 | N | Y | N/A | N/A
J9357 | VALRUBICIN, 200 MG, INTRAVESICAL, INJECTION | 2011-07-01 00:00:00 | 868.36 | N | N | N/A | N/A
[NAME] | VINBLASTINE SULFATE, 1 MG, INJECTION | 2011-07-01 00:00:00 | 0.92 | N | Y | N/A | N/A
[NAME] | VINCRISTINE SULFATE, 1 MG | 2011-07-01 00:00:00 | 3.6 | N | Y | N/A | N/A
J9371 | INJECTION VINCRISTINE SUL LIP 1 MG | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | VINORELBINE TARTRATE, PER 10 MG, INJECTION | 2011-07-01 00:00:00 | 11.78 | N | Y | N/A | N/A
[NAME] | FULVESTRANT, 25 MG, INJECTION | 2011-07-01 00:00:00 | 75.05 | N | Y | N/A | N/A
J9400 | [NAME], 1 MG | 2014-01-01 00:00:00 | 8.43 | Y | Y | N/A | N/A
J9600 | PORFIMER SODIUM, 75 MG, INJECTION | 2011-07-01 00:00:00 | 2768.27 | N | Y | N/A | N/A
J9999 | NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
K0001 | STANDARD WHEELCHAIR | 2011-07-01 00:00:00 | 479.87 | Y | Y | N/A | N/A
K0002 | STANDARD HEMI (LOW SEAT) WHEELCHAIR | 2011-07-01 00:00:00 | 689.47 | Y | Y | N/A | N/A
K0003 | LIGHTWEIGHT WHEELCHAIR | 2011-07-01 00:00:00 | 754.87 | Y | Y | N/A | N/A
K0004 | HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR | 2011-07-01 00:00:00 | 1324.7 | Y | Y | N/A | N/A
K0005 | [NAME] | 2011-07-01 00:00:00 | 1716.14 | Y | Y | N/A | N/A
K0006 | HEAVY DUTY WHEELCHAIR | 2011-07-01 00:00:00 | 1150.92 | Y | Y | N/A | N/A
K0007 | EXTRA HEAVY DUTY WHEELCHAIR | 2011-07-01 00:00:00 | 1769.42 | Y | Y | N/A | N/A
K0008 | CUSTOM MANUAL WHEELCHAIR/BASE | 2013-07-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0009 | OTHER MANUAL WHEELCHAIR BASE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
[NAME] | STANDARD WEIGHT FRAME POWER WHEELCHAIR | 2011-07-01 00:00:00 | 2681.04 | Y | Y | N/A | N/A
[NAME] | STANDARD WEIGHT POWER WHEELCHAIR WITH CONTROL | 2011-07-01 00:00:00 | 3224.1 | Y | Y | N/A | N/A
K0012 | LIGHTWEIGHT PORTABLE POWER WHEELCHAIR | 2011-07-01 00:00:00 | 2044.98 | Y | Y | N/A | N/A
K0013 | CUSTOM POWER WHLCHR BASE | 2013-07-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0014 | OTHER MOTORIZED/POWER WHEELCHAIR BASE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0015 | DETACHABLE NON-ADJUSTABLE HEIGHT ARMREST | 2011-07-01 00:00:00 | 145.39 | Y | Y | N/A | N/A
K0017 | DETACHABLE ADJUSTABLE HEIGHT ARMREST BASE | 2011-07-01 00:00:00 | 40.89 | Y | Y | N/A | N/A
K0018 | DETACHABLE ADJUSTABLE HEIGHT ARMREST UPPER | 2011-07-01 00:00:00 | 22.85 | Y | Y | N/A | N/A
[NAME] | ARM PAD EACH | 2011-07-01 00:00:00 | 14.02 | Y | Y | N/A | N/A
K0020 | FIXED ADJUSTABLE HEIGHT ARMREST PAIR | 2011-07-01 00:00:00 | 37.16 | Y | Y | N/A | N/A
K0037 | HIGH MOUNT FLIP-UP FOOT REST, EACH | 2011-07-01 00:00:00 | 33.31 | Y | Y | N/A | N/A
K0038 | LEG STRAP EACH | 2011-07-01 00:00:00 | 19.4 | Y | Y | N/A | N/A
K0039 | LEG STRAP H STYLE EACH | 2011-07-01 00:00:00 | 43.12 | Y | Y | N/A | N/A
K0040 | ADJUSTABLE ANGLE FOOTPLATE | 2011-07-01 00:00:00 | 59.73 | Y | Y | N/A | N/A
K0041 | LARGE SIZE FOOTPLATE EACH | 2011-07-01 00:00:00 | 42.35 | Y | Y | N/A | N/A
K0042 | STANDARD SIZE FOOTPLATE EACH | 2011-07-01 00:00:00 | 25.2 | Y | Y | N/A | N/A
K0043 | FOOT REST LOWER EXTENSION TUBE | 2011-07-01 00:00:00 | 15.62 | Y | Y | N/A | N/A
K0044 | FOOT REST UPPER HANGER BRACKET | 2011-07-01 00:00:00 | 13.32 | Y | Y | N/A | N/A
K0045 | FOOT REST COMPLETE ASSEMBLY | 2011-07-01 00:00:00 | 39.16 | Y | Y | N/A | N/A
K0046 | ELEVATING LEG REST LOWER EXTENSION TUBE | 2011-07-01 00:00:00 | 15.62 | Y | Y | N/A | N/A
K0047 | ELEVATING LEG REST UPPER HANGER BRACKET | 2011-07-01 00:00:00 | 61.17 | Y | Y | N/A | N/A
[NAME] | RATCHET ASSEMBLY | 2011-07-01 00:00:00 | 26 | Y | Y | N/A | N/A
K0051 | CAM RELESE ASSEMBLY FOOT REST/LEG REST | 2011-07-01 00:00:00 | 42.08 | Y | Y | N/A | N/A
K0052 | SWINGAWAY DETACHABLE FOOT RESTS | 2011-07-01 00:00:00 | 73.96 | Y | Y | N/A | N/A
K0053 | ELEVATING FOOT RESTS ARTICULATING | 2011-07-01 00:00:00 | 81.62 | Y | Y | N/A | N/A
[NAME] | SEAT HEIGHT LT17OR =GT21 LIGHTWEIGHT WHEELCHAIR | 2011-07-01 00:00:00 | 88.28 | Y | Y | N/A | N/A
K0065 | SPOKE PROTECTORS EACH | 2011-07-01 00:00:00 | 41.27 | Y | Y | N/A | N/A
K0069 | REAR WHEEL ASSEMBLY COMPLETE SOLID TIRE | 2011-07-01 00:00:00 | 92.74 | Y | Y | N/A | N/A
K0070 | REAR WHEEL ASSEMBLY COMPLETE PNEUMATIC TIRE | 2011-07-01 00:00:00 | 170.04 | Y | Y | N/A | N/A
[NAME] | FRONT CASTER ASSEMBLY COMPLETE PNEUMATIC TIRE | 2011-07-01 00:00:00 | 101.4 | Y | Y | N/A | N/A
K0072 | FRONT CASTER COMPLETE SEMIPNEUMATIC TIRE | 2011-07-01 00:00:00 | 57.37 | Y | Y | N/A | N/A
K0073 | CASTER PIN LOCK EACH | 2011-07-01 00:00:00 | 31.07 | Y | Y | N/A | N/A
[NAME] | FRONT CASTER ASSEMBLY COMPLETE W SOLID TIRE | 2011-07-01 00:00:00 | 54.6 | Y | Y | N/A | N/A
K0105 | IV HANGER, EACH | 2011-07-01 00:00:00 | 92.3 | Y | Y | N/A | N/A
[NAME] | OTHER W/C ACCESSORIES | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0195 | ELEVATING LEG RESTS PAIR RENTAL WHEELCHAIR | 2011-07-01 00:00:00 | 162.45 | Y | Y | N/A | N/A
K0455 | INFUSION PUMP UNINTERRUPTED PARENTERAL ADMIN | 2011-07-01 00:00:00 | 2625.49 | N | Y | N/A | N/A
K0462 | TEMPORARY REPLACEMENT OF PT OWNED EQUIP BEING REPAIRED ANY TYPE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0552 | SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP | 2011-07-01 00:00:00 | 2.47 | N | Y | N/A | N/A
K0601 | REPLACEMENT BATTERY SILVER OXIDE 1.5 VOLT EA | 2011-07-01 00:00:00 | 1.04 | N | Y | N/A | N/A
K0602 | REPLACEMENT BATTERY SILVER OXIDE 3 VOLT EACH | 2011-07-01 00:00:00 | 6 | N | Y | N/A | N/A
K0603 | REPLACEMENT BATTERY ALKALINE 1.5 VOLT EACH | 2011-07-01 00:00:00 | 0.54 | N | Y | N/A | N/A
K0604 | REPLACEMENT BATTERY LITHIUM 3.6 VOLT EACH | 2011-07-01 00:00:00 | 5.74 | N | Y | N/A | N/A
K0605 | REPLACEMENT BATTERY LITHIUM 4.5 VOLT EACH | 2011-07-01 00:00:00 | 13.78 | N | Y | N/A | N/A
K0606 | AUTOMATIC EXTERNAL DEFIBRILLATOR W/ECG ANALYS | 2011-07-01 00:00:00 | 24962.55 | Y | Y | N/A | N/A
K0607 | REPLACEMENT BATTERY AUTOMATED EXT DEFIBRILLAT | 2011-07-01 00:00:00 | 183.37 | N | Y | N/A | N/A
K0608 | REPLACEMENT GARMENT AUTOMATED EXT DEFIBRILLAT | 2011-07-01 00:00:00 | 114.43 | N | Y | N/A | N/A
K0609 | REPLACEMENT ELECTRODE AUTOMATED EXT DEFIBRILL | 2011-07-01 00:00:00 | 760.99 | N | Y | N/A | N/A
K0672 | [NAME], REPLACEMENT ONLY, EACH | 2011-07-01 00:00:00 | 69.99 | N | Y | N/A | N/A
K0730 | CTRL DOSE INH DRUG DELIVERY SYSTEM | 2009-04-01 00:00:00 | 1810.22 | N | Y | N/A | N/A
[NAME] | 12-24 HOUR SEALED LEAD ACID BATTERY | 2011-07-01 00:00:00 | 24.58 | N | Y | N/A | N/A
K0738 | PORTABLE GAS OXYGEN SYSTEM, [NAME] | 2011-07-01 00:00:00 | 464.67 | N | Y | N/A | N/A
K0739 | REPAIR/NONROUTINE SERV DME NON-OXYGEN EQUIPMENT | 2012-06-01 00:00:00 | 12.2 | N | Y | N/A | N/A
K0740 | REPAIR OR NONROUTINE SERVICE OXYGEN EQUIPMENT | 2010-01-01 00:00:00 | 7 | N | Y | N/A | N/A
K0800 | POV GROUP 1 STANDARD UP TO AND INCLUDING 300 LBS | 2011-07-01 00:00:00 | 1051.91 | Y | Y | N/A | N/A
[NAME] | POV GROUP 1 HEAVY DUTY 301-450 LBS | 2011-07-01 00:00:00 | 1695.9 | Y | Y | N/A | N/A
K0802 | POV GROUP 1 VERY HEAVY DUTY 451-600 LBS | 2011-07-01 00:00:00 | 1919.21 | Y | Y | N/A | N/A
K0806 | POV GROUP 2 STANDARD UP TO AND INCLUDING 300LBS | 2011-07-01 00:00:00 | 1272.53 | Y | Y | N/A | N/A
[NAME] | POV GROUP 2 HEAVY DUTY 301-450 LBS | 2011-07-01 00:00:00 | 1930.91 | Y | Y | N/A | N/A
K0808 | POV GROUP 2 VERY HEAVY DUTY 451-600 LBS | 2011-07-01 00:00:00 | 2987.53 | Y | Y | N/A | N/A
K0812 | POWER OPERATED VEHICLE, NOT OTHERWISE CLASSIFIED | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0813 | PWC GRP 1 STANDARD PORTABLE SEAT/BACK | 2011-07-01 00:00:00 | 1962.9 | Y | Y | N/A | N/A
K0814 | PWC GRP 1 STANDARD PORTABLE CAPTAINS CHAIR | 2011-07-01 00:00:00 | 2512.74 | Y | Y | N/A | N/A
K0815 | PWC GRP 1 STANDARD SEAT/BACK | 2011-07-01 00:00:00 | 2861.04 | Y | Y | N/A | N/A
[NAME] | PWC GRP 1 STANDARD CAPTAINS CHAIR | 2011-07-01 00:00:00 | 2740.08 | Y | Y | N/A | N/A
K0820 | PWC GRP 2 STANDARD PORTABLE SEAT/BACK | 2011-07-01 00:00:00 | 2096.64 | Y | Y | N/A | N/A
[NAME] | PWC GRP 2 STANDARD PORTABLE CAPTAINS CHAIR | 2011-07-01 00:00:00 | 2691.42 | Y | Y | N/A | N/A
K0822 | PWC GRP 2 STANDARD SEAT/BACK | 2011-07-01 00:00:00 | 3252.72 | Y | Y | N/A | N/A
K0823 | PWC GRP 2 STANDARD CAPTAINS CHAIR | 2011-07-01 00:00:00 | 3274.14 | Y | Y | N/A | N/A
K0824 | PWC GRP 2 HEAVY DUTY SEAT/BACK | 2011-07-01 00:00:00 | 3940.38 | Y | Y | N/A | N/A
K0825 | PWC GRP 2 HEAVY DUTY CAPTAINS CHAIR | 2011-07-01 00:00:00 | 3607.38 | Y | Y | N/A | N/A
[NAME] | PWC GRP 2 VERY HEAVY DUTY SEAT/BACK | 2011-07-01 00:00:00 | 5101.32 | Y | Y | N/A | N/A
K0827 | PWC GRP VERY HEAVY DUTY CAPTAINS CHAIR | 2011-07-01 00:00:00 | 4337.64 | Y | Y | N/A | N/A
K0828 | PWC GRP 2 EXTRA HEAVY DUTY SEAT/BACK | 2011-07-01 00:00:00 | 5621.16 | Y | Y | N/A | N/A
K0829 | PWC GRP 2 EXTRA HEAVY DUTY CAPTAINS CHAIR | 2011-07-01 00:00:00 | 5161.86 | Y | Y | N/A | N/A
K0830 | PWC GRP 2 STANDARD SEAT ELEVATOR SEAT/BACK | 2008-01-01 00:00:00 | 4109.81 | Y | Y | N/A | N/A
K0831 | PWC GRP 2 STANDARD SEAT ELEVATOR CAPTAINS | 2008-01-01 00:00:00 | 4109.81 | Y | Y | N/A | N/A
K0835 | PWC GRP 2 STANDARD SINGLE POWER OPT SEAT/BACK | 2011-07-01 00:00:00 | 3301.44 | Y | Y | N/A | N/A
K0836 | PWC GRP2 STANDARD SINGLE POWER OPT CAPTAINS | 2011-07-01 00:00:00 | 3423.78 | Y | Y | N/A | N/A
K0837 | PWC GRP 2 HEAVY DUTY SINGLE POWER OPT SEAT/BACK | 2011-07-01 00:00:00 | 3940.38 | Y | Y | N/A | N/A
K0838 | PWC GRP 2 HEAVY DUTY SINGLE POWER OPT CAPTAINS | 2011-07-01 00:00:00 | 3525.06 | Y | Y | N/A | N/A
K0839 | PWC GRP2 VERY HEAVY DUTY SING POW OPT SEAT/BACK | 2011-07-01 00:00:00 | 5101.32 | Y | Y | N/A | N/A
K0840 | PWC GRP2 EXTRA HVY DUTY SINGLE POW OPT SEAT/BACK | 2011-07-01 00:00:00 | 7728.48 | Y | Y | N/A | N/A
K0841 | PWC GP2 STANDARD MULTIPLE POWER OPT SEAT/BACK | 2011-07-01 00:00:00 | 3514.02 | Y | Y | N/A | N/A
K0842 | PWC GP2 STANDARD MULTIPLE POWER OPT CAPTAINS | 2011-07-01 00:00:00 | 3514.02 | Y | Y | N/A | N/A
[NAME] | PWC GP2 HEAVY DUTY MULTIPLE POWER OPT SEAT/BACK | 2011-07-01 00:00:00 | 4230.84 | Y | Y | N/A | N/A
[NAME] | PWC GP 3 STANDARD SEAT/BACK | 2011-07-01 00:00:00 | 4299.78 | Y | Y | N/A | N/A
[NAME] | PWC GP 3 STANDARD CAPTAINS CHAIR | 2011-07-01 00:00:00 | 4134.12 | Y | Y | N/A | N/A
K0850 | PWC GP 3 HEAVY DUTY SEAT/BACK | 2011-07-01 00:00:00 | 4987.68 | Y | Y | N/A | N/A
K0851 | PWC GP 3 HEAVY DUTY CAPTAINS CHAIR | 2011-07-01 00:00:00 | 4795.62 | Y | Y | N/A | N/A
K0852 | PWC GP 3 VERY HEAVY DUTY SEAT/BACK | 2011-07-01 00:00:00 | 5762.94 | Y | Y | N/A | N/A
[NAME] | PWC GP 3 VERY HEAVY DUTY CAPTAINS CHAIR | 2011-07-01 00:00:00 | 5920.02 | Y | Y | N/A | N/A
[NAME] | PWC GP 3 EXTRA HEAVY DUTY SEAT/BACK | 2011-07-01 00:00:00 | 7842.66 | Y | Y | N/A | N/A
K0855 | PWC GP 3 EXTRA HEAVY DUTY CAPTAINS CHAIR | 2011-07-01 00:00:00 | 7408.56 | Y | Y | N/A | N/A
K0856 | PWC GP3 STANDARD SINGLE POWER OPT SEAT/BACK | 2011-07-01 00:00:00 | 4615.44 | Y | Y | N/A | N/A
K0857 | PWC GP3 STANDARD SINGLE POWER OPT CAPTAINS | 2011-07-01 00:00:00 | 4707.9 | Y | Y | N/A | N/A
K0858 | PWC GP3 HEAVY DUTY SINGLE POWER OPT SEAT/BACK | 2011-07-01 00:00:00 | 5726.4 | Y | Y | N/A | N/A
K0859 | PWC GP3 HEAVY DUTY SINGLE POWER OPT CAPTAINS | 2011-07-01 00:00:00 | 5461.2 | Y | Y | N/A | N/A
K0860 | PWC GP3 VERY HEAVY DUTY SINGLE POW OPT SEAT/BACK | 2011-07-01 00:00:00 | 8180.88 | Y | Y | N/A | N/A
K0861 | PWC GP3 STANDARD MULTIPLE POWER OPT SEAT/BACK | 2011-07-01 00:00:00 | 4622.82 | Y | Y | N/A | N/A
K0862 | PWC GP3 HEAVY DUTY MULTIPLE POWER OPT SEAT/BACK | 2011-07-01 00:00:00 | 5726.4 | Y | Y | N/A | N/A
K0863 | PWC GP3 VERY HEAVY DUTY MULT POW OPT SEAT/BACK | 2011-07-01 00:00:00 | 8180.88 | Y | Y | N/A | N/A
[NAME] | PWC GP3 EXTRA HEAVY DUTY MULT POW OPT SEAT/BACK | 2011-07-01 00:00:00 | 9735.3 | Y | Y | N/A | N/A
K0868 | [NAME], GRP 4, PT WEIGHT CAP UP TO & INCL 300 LBS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0869 | [NAME], GRP 4, CAPT CHAIR, PT WEIGHT CAP UP TO & INCL 300 LBS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0870 | [NAME], GRP 4 HVY DTY, SLING/SOLID SEAT/BK, PT WEIGHT CAP 301-450 LBS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0871 | [NAME], GRP 4 VRY HVY DTY, SLING/SOLID SEAT, PT WEIGHT CAP 451-600 LBS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0877 | [NAME], GRP 4 STANDARD, PT WEIGHT CAP UP TO & INCL 300 LBS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0878 | [NAME], GRP 4 STANDARD, CAPT CHAIR, PT WEIGHT CAP UP TO/INCL 300LBS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0879 | [NAME], GRP 4 HVY DTY, PT WEIGHT CAP 301-450 LBS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0880 | [NAME], GRP 4 VRY HVY DTY, PT WEIGHT 451- 600 LBS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0884 | [NAME], GRP 4 STANDARD, PT WEIGHT CAP UP TO & INCL 300 LBS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0885 | [NAME], GRP 4, CAPT CHAIR, PT WEIGHT CAP UP TO & INCL 300 LBS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
[NAME] | [NAME], GRP 4 HVY DTY, MULTIPLE PWR OPT, PT WEIGHT CAP 301-450 LBS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0890 | [NAME], GRP 5 PEDIATRIC, PT WEIGHT CAP UP TO & INCL 125 LBS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0891 | [NAME], GRP 5 PEDIATRIC, PT WEIGHT CAPACITY UP TO & INCL 125 LBS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0898 | [NAME], NOT OTHERWISE CLASSIFIED | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
K0900 | CUSTOM DME OTHER THAN WHEELCHAIR | 2013-07-01 00:00:00 | 0 | Y | Y | N/A | N/A
L0112 | CRANIAL CERVICAL ORTHOSIS CONGENITAL TYPE | 2011-07-01 00:00:00 | 1112.12 | Y | Y | N/A | N/A
[NAME] | CRANIAL CERVICAL ORTHOSIS, TORTICOLLIS TYPE, WITH OR WITHOUT JOINT | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
L0120 | CERVICAL FLEXIBLE NON-ADJUSTABLE | 2011-07-01 00:00:00 | 26.93 | N | Y | N/A | N/A
L0130 | CERVICAL FLEXIBLE THERMOPLASTIC COLLAR MOLDED | 2011-07-01 00:00:00 | 149.84 | N | Y | N/A | N/A
L0140 | CERVICAL SEMI-RIGID ADJUSTABLE | 2011-07-01 00:00:00 | 64.97 | N | Y | N/A | N/A
L0150 | CERVICAL SEMI-RIGID ADJUSTABLE [NAME] | 2011-07-01 00:00:00 | 86.53 | N | Y | N/A | N/A
[NAME] | CERVICAL SEMI-RIGID WIRE OCCIPITAL SUPPORT | 2011-07-01 00:00:00 | 119.22 | N | Y | N/A | N/A
L0170 | [NAME] MOLDED TO PATIENT | 2011-07-01 00:00:00 | 578.3 | N | Y | N/A | N/A
[NAME] | CERVICAL COLLAR THERMOPLASTIC FOAM 2 PIECE | 2011-07-01 00:00:00 | 104.37 | N | Y | N/A | N/A
L0174 | [NAME] FOAM 2 PIECE WITH THORACIC | 2011-07-01 00:00:00 | 219.74 | N | Y | N/A | N/A
L0180 | CERVICAL POST COLLAR OCCIPITAL SUPPORTS | 2011-07-01 00:00:00 | 320.39 | N | Y | N/A | N/A
L0190 | [NAME] BARS | 2011-07-01 00:00:00 | 450.77 | N | Y | N/A | N/A
L0200 | CERVICAL COLLAR ADJUSTABLE BARS & THORACIC | 2011-07-01 00:00:00 | 503.33 | N | Y | N/A | N/A
L0220 | THORACIC RIB BELT CUSTOM FABRICATED | 2011-07-01 00:00:00 | 100.29 | N | Y | N/A | N/A
L0450 | TLSO FLEXIBLE PREFABRICATED THORACIC | 2011-07-01 00:00:00 | 174.72 | N | Y | N/A | N/A
L0452 | TLSO CUSTOM FAB FLEXIBLE UPPER THORACIC INCLUDES SHOULDER STRAPS CLOSURE FITTING | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L0454 | TLSO FLEXIBLE PREFABRICATED SACROCOCCYGEL-T9 | 2011-07-01 00:00:00 | 275.58 | N | Y | N/A | N/A
L0455 | TLSO FLEX TRNK SJ-T9 PRE OTS | 2014-01-01 00:00:00 | 287.3 | N | Y | N/A | N/A
L0456 | TLSO FLEXIBLE PREFABRICATED SACROCOCCYGEL | 2011-07-01 00:00:00 | 790.29 | N | Y | N/A | N/A
L0457 | TLSO FLEX TRNK SJ-SS PRE OTS | 2014-01-01 00:00:00 | 823.88 | N | Y | N/A | N/A
L0458 | TLSO 2MODULAR SYMPHYIS-XIPHOID PREFABRICATED | 2011-07-01 00:00:00 | 708.63 | N | Y | N/A | N/A
L0460 | TLSO 2MODULAR SYMPHYSIS-STERNAL PREFABRICATED | 2011-07-01 00:00:00 | 797.61 | N | Y | N/A | N/A
L0462 | TLSO 3MODULAR SACROCCYGEAL-SCAPULAR PREFABRIC | 2011-07-01 00:00:00 | 992.12 | N | Y | N/A | N/A
L0464 | TLSO 4MODULAR SACROCCYGEAL-SCAPULAR PREFABRIC | 2011-07-01 00:00:00 | 1181.09 | N | Y | N/A | N/A
L0466 | TLSO RIGID FRAME PREFABRICATED SOFT APRON | 2011-07-01 00:00:00 | 359.14 | N | Y | N/A | N/A
L0467 | TLSO R FRAM SOFT PRE OTS | 2014-01-01 00:00:00 | 374.41 | N | Y | N/A | N/A
L0468 | TLSO RIGID FRAME PREFABRICATED SOFT PELVIC | 2011-07-01 00:00:00 | 431.07 | N | Y | N/A | N/A
L0469 | TLSO RIG FRAM PELVIC PRE OTS | 2014-01-01 00:00:00 | 449.4 | N | Y | N/A | N/A
[NAME] | TLSO RIGID FRAME PREFABRICATED SUBCLAVICULAR | 2011-07-01 00:00:00 | 517.4 | N | Y | N/A | N/A
L0472 | TLSO RIGID FRAME HYPEREXTENSION PREFABRICATED | 2011-07-01 00:00:00 | 367.43 | N | Y | N/A | N/A
L0480 | TLSO 1 RIGID PLASTIC CUSTOM FABRICATED | 2011-07-01 00:00:00 | 1266.93 | N | Y | N/A | N/A
[NAME] | TLSO 1 RIGID LINED CUSTOM FABRICATED | 2011-07-01 00:00:00 | 1291.2 | N | Y | N/A | N/A
L0484 | TLSO 1 RIGID PLASTIC CUSTOM FABRICATED | 2011-07-01 00:00:00 | 1352.77 | N | Y | N/A | N/A
L0486 | TLSO 2 RIGID LINED CUSTOM FABRICATED | 2011-07-01 00:00:00 | 1435.22 | N | Y | N/A | N/A
L0488 | TLSO RIGID LINED PREFABRICATED ONE PIECE | 2011-07-01 00:00:00 | 797.61 | N | Y | N/A | N/A
L0490 | TLSO RIGID PLASTIC PREFABRICATED ONE PIECE | 2011-07-01 00:00:00 | 224.78 | N | Y | N/A | N/A
L0491 | TLSO 2 PIECE RIGID SHELL | 2008-01-01 00:00:00 | 603.47 | N | Y | N/A | N/A
[NAME] | TLSO 3 PIECE RIGID SHELL | 2008-01-01 00:00:00 | 396.93 | N | Y | N/A | N/A
[NAME] | SIO FLEX PELVIC-SACRAL PREFABRICATED | 2011-07-01 00:00:00 | 91.99 | N | Y | N/A | N/A
L0622 | SIO FLEX PELVIC- SACRAL CUSTOM FABRICATED | 2011-07-01 00:00:00 | 244.14 | N | Y | N/A | N/A
[NAME] | SACROILIAC ORTHOSIS, PRE FABRICATED INCL FITTING AND ADJ | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L0624 | SACROILIAC ORTHOSIS, CUSTOM FABRICATED, SEMI RIGID PANELS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L0625 | LO FLEXIBLE L1-BELOW L5 PREFABRICATED | 2011-07-01 00:00:00 | 43.76 | N | Y | N/A | N/A
L0626 | LO SAGITTAL STAYS/PANELS PRE-FABRICATED | 2011-07-01 00:00:00 | 61.93 | N | Y | N/A | N/A
L0627 | LO SAGITTAL RIGID PANEL PREFABRICATED | 2011-07-01 00:00:00 | 326.62 | N | Y | N/A | N/A
L0628 | LO FLEXIBLE W/O RIGID STAYS PREFABRICATED | 2011-07-01 00:00:00 | 66.66 | N | Y | N/A | N/A
L0629 | LUMBAR SACRAL ORTHOSIS, FLEXIBLE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | LSO POST RIGID PANEL PREFABRICATED | 2011-07-01 00:00:00 | 128.69 | N | Y | N/A | N/A
L0631 | LSO SAGITTAL RIGID FRAME PREFABRICATED | 2011-07-01 00:00:00 | 815.71 | N | Y | N/A | N/A
L0632 | LUMBAR SACRAL ORTHOSIS, SAGITAL CONTROL WITH RIGID ANTERIOR/POSTERIOR PANELS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L0633 | [NAME] PREFABRICATED | 2011-07-01 00:00:00 | 227.85 | N | Y | N/A | N/A
L0634 | LUMBAR SACRAL ORTHOSIS, SAGITAL CONTROL WITH RIGID POSTERIOR FRAME/PANELS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L0635 | LSO SAGITTAL CORONAL RIGID PANEL PREFABRICATE | 2011-07-01 00:00:00 | 839.64 | N | Y | N/A | N/A
L0636 | LSO SAGITTAL CORONAL RIGID PANEL CUS FABRICA | 2011-07-01 00:00:00 | 1094.76 | N | Y | N/A | N/A
L0637 | LSO SAGITTAL CORONAL PANEL PREFABRICATED | 2011-07-01 00:00:00 | 893.09 | N | Y | N/A | N/A
[NAME] | LSO SAGITTAL CORONAL PANEL CUSTOM FABRICATED | 2011-07-01 00:00:00 | 1047.98 | N | Y | N/A | N/A
L0639 | LSO SAGITTAL CORONAL SHELL/PANEL PREFABRICATE | 2011-07-01 00:00:00 | 893.09 | N | Y | N/A | N/A
L0640 | LSO SAGITTAL CORONAL SHELL/PANEL CUSTOM FABR | 2011-07-01 00:00:00 | 831.46 | N | Y | N/A | N/A
[NAME] | LO RIG POS [NAME] OTS | 2014-01-01 00:00:00 | 64.56 | N | Y | N/A | N/A
L0642 | [NAME] AN/POS PNL PRE OTS | 2014-01-01 00:00:00 | 340.51 | N | Y | N/A | N/A
L0643 | [NAME] RIGI POS PRE OTS | 2014-01-01 00:00:00 | 134.16 | N | Y | N/A | N/A
L0648 | [NAME] R AN/POS PNL PRE OTS | 2014-01-01 00:00:00 | 850.38 | N | Y | N/A | N/A
L0649 | LSO SC R POS/LAT PNL PRE OTS | 2014-01-01 00:00:00 | 237.54 | N | Y | N/A | N/A
[NAME] | LSO SC R ANT/POS PNL PRE OTS | 2014-01-01 00:00:00 | 931.06 | N | Y | N/A | N/A
L0651 | [NAME]/POS PANEL PREFAB OTS | 2014-01-01 00:00:00 | 931.06 | N | Y | N/A | N/A
L0700 | CTLSO ANT-POSTERIOR-LATERAL CONTROL MOLDED | 2011-07-01 00:00:00 | 1538.95 | N | Y | N/A | N/A
L0710 | [NAME] CONTROL WITH INTERFACE | 2011-07-01 00:00:00 | 1738.22 | N | Y | N/A | N/A
L0810 | HALO PX, CERVICAL HALO INTO JACKET VEST | 2011-07-01 00:00:00 | 2092.94 | N | Y | N/A | N/A
L0820 | HALO CERVICAL INTO PLASTER BODY JACKET | 2011-07-01 00:00:00 | 2055.43 | N | Y | N/A | N/A
L0830 | HALO CERVICAL INTO MILWAUKEE TYPE ORTHOSIS | 2011-07-01 00:00:00 | 2883.02 | N | Y | N/A | N/A
L0859 | MRI COMPATIBLE SYSTEM | 2011-07-01 00:00:00 | 927.33 | N | Y | N/A | N/A
L0861 | HALO REPLACEMENT LINER/INTERFACE MATERIAL | 2011-07-01 00:00:00 | 171.26 | N | Y | N/A | N/A
L0970 | TLSO CORSET FRONT | 2011-07-01 00:00:00 | 87 | N | Y | N/A | N/A
L0972 | [NAME] FRONT | 2011-07-01 00:00:00 | 78.34 | N | Y | N/A | N/A
L0974 | TLSO FULL CORSET | 2011-07-01 00:00:00 | 141.01 | N | Y | N/A | N/A
L0976 | [NAME] | 2011-07-01 00:00:00 | 149.01 | N | Y | N/A | N/A
[NAME] | [NAME] | 2011-07-01 00:00:00 | 156.2 | N | Y | N/A | N/A
L0980 | PERONEAL STRAPS PAIR | 2011-07-01 00:00:00 | 14.13 | N | Y | N/A | N/A
L0982 | STOCKING SUPPORTER GRIPS SET OF FOUR | 2011-07-01 00:00:00 | 13.19 | N | Y | N/A | N/A
[NAME] | PROTECTIVE BODY SOCK EACH | 2011-07-01 00:00:00 | 52.04 | N | Y | N/A | N/A
[NAME] | ADDITION TO SPINAL ORTHOSIS- NOS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
[NAME] | CTLSO MILWAUKEE INITIAL ORTHOSIS INCLUD MODEL | 2011-07-01 00:00:00 | 1850.97 | N | Y | N/A | N/A
L1001 | CERVICAL THORACIC LUMBAR SACRAL ORTHOSIS, [NAME], PREFAB, INCL FITTING/ADJ | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | TENSION BASED SCOLIOSIS ORTHOSIS AND PADS | 2011-07-01 00:00:00 | 2543.18 | Y | Y | N/A | N/A
L1010 | ADDITION TO CTLSO OR SO, AXILLA SLING | 2011-07-01 00:00:00 | 52.99 | N | Y | N/A | N/A
L1020 | ADDITION TO CTLSO OR SO, KYPHOSIS PAD | 2011-07-01 00:00:00 | 77.68 | N | Y | N/A | N/A
L1025 | ADDITION TO CTLSO/SO, KYPHOSIS PAD FLOATING | 2011-07-01 00:00:00 | 94.92 | N | Y | N/A | N/A
[NAME] | ADDITION TO CTLSO/SO, LUMBAR BOLSTER PAD | 2011-07-01 00:00:00 | 49.75 | N | Y | N/A | N/A
L1040 | ADDITION TO CTLSO/SO, LUMBAR/ LUMBAR RIB PAD | 2011-07-01 00:00:00 | 73.46 | N | Y | N/A | N/A
L1050 | ADDITION TO CTLSO/SO, STERNAL PAD | 2011-07-01 00:00:00 | 78.01 | N | Y | N/A | N/A
L1060 | ADDITION TO CTLSO/SO, THORACIC PAD | 2011-07-01 00:00:00 | 85.78 | N | Y | N/A | N/A
L1070 | ADDITION TO CTLSO/SO, TRAPEZIUS SLING | 2011-07-01 00:00:00 | 77.53 | N | Y | N/A | N/A
[NAME] | ADDITION TO CTLSO/SO, OUTRIGGER | 2011-07-01 00:00:00 | 47.93 | N | Y | N/A | N/A
L1085 | ADD TO CTLSO/SO, OUTRIGGER BILAT W/ VERT EXT | 2011-07-01 00:00:00 | 125.1 | N | Y | N/A | N/A
L1090 | ADDITION TO CTLSO/SO, LUMBAR SLING | 2011-07-01 00:00:00 | 75.66 | N | Y | N/A | N/A
L1100 | ADD TO CTLSO/SO, RING FLANGE PLASTIC/LEATHER | 2011-07-01 00:00:00 | 137.49 | N | Y | N/A | N/A
[NAME] | ADD TO CTLSO/SO, RING FLNG PLAST/LEATHER MOLD | 2011-07-01 00:00:00 | 227.52 | N | Y | N/A | N/A
L1120 | ADDITION TO CTLSO/SO, OVERS FOR UPRIGHT EACH | 2011-07-01 00:00:00 | 37.41 | N | Y | N/A | N/A
L1200 | TSLO FURNISHING INITIAL ORTHOSIS ONLY | 2011-07-01 00:00:00 | 1590.26 | N | Y | N/A | N/A
L1210 | ADDITION TO TSLO, [NAME] THORACIC EXTENSION | 2011-07-01 00:00:00 | 199.18 | N | Y | N/A | N/A
L1220 | ADDITION TO TSLO, ANTERIOR THORACIC EXTENSION | 2011-07-01 00:00:00 | 206.31 | N | Y | N/A | N/A
L1230 | ADD TO TSLO, MILWAUKEE TYPE SUPERSTRUCTURE | 2011-07-01 00:00:00 | 432.71 | N | Y | N/A | N/A
L1240 | ADDITION TO TSLO, LUMBAR DEROTATION PAD | 2011-07-01 00:00:00 | 63.18 | N | Y | N/A | N/A
L1250 | ADDITION TO TSLO, ANTERIOR ASIS PAD | 2011-07-01 00:00:00 | 57.79 | N | Y | N/A | N/A
L1260 | ADD TO TSLO, ANTERIOR THORACIC DEROTATION PAD | 2011-07-01 00:00:00 | 60.99 | N | Y | N/A | N/A
L1270 | ADDITION TO TSLO, ABDOMINAL PAD | 2011-07-01 00:00:00 | 58.98 | N | Y | N/A | N/A
L1280 | ADDITION TO TSLO, [NAME] (ELASTIC) EACH | 2011-07-01 00:00:00 | 68.32 | N | Y | N/A | N/A
L1290 | ADDITION TO TSLO, LATERAL TROCHANTERIC PAD | 2011-07-01 00:00:00 | 61.12 | N | Y | N/A | N/A
L1300 | OTHER SCOLIOSIS BODY JACKET MOLDED TO PATIENT | 2011-07-01 00:00:00 | 1285.91 | N | Y | N/A | N/A
L1310 | OTHER SCOLIOSIS POST-OPERATIVE BODY JACKET | 2011-07-01 00:00:00 | 1440.32 | N | Y | N/A | N/A
L1499 | UNLISTED PROCEDURE FOR SPINAL ORTHOSIS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
L1600 | ABDUCTION HIP FLEXIBLE FREJKA TYPE WITH COVER | 2011-07-01 00:00:00 | 98.09 | N | Y | N/A | N/A
[NAME] | ABDUCTION HIP FLEXIBLE FREJKA COVER ONLY | 2011-07-01 00:00:00 | 33.42 | N | Y | N/A | N/A
L1620 | ABDUCTION HIP FLEXIBLE PAVLIK HARNESS | 2011-07-01 00:00:00 | 107.45 | N | Y | N/A | N/A
[NAME] | ABDUCTION CONTROL HIP SEMI-FLEXIBLE CUST FABR | 2011-07-01 00:00:00 | 139.32 | N | Y | N/A | N/A
L1640 | PELVIC BAND/SPREADER BAR THIGH CUFFS CUST FAB | 2011-07-01 00:00:00 | 367.44 | N | Y | N/A | N/A
L1650 | ABDUCTION HIP STATIC ADJUSTABLE PREFABRICATED | 2011-07-01 00:00:00 | 176.24 | N | Y | N/A | N/A
L1652 | HO BILATERAL THIGH CUFFS W/SPREADER BAR PREFA | 2011-07-01 00:00:00 | 283.24 | N | Y | N/A | N/A
L1660 | HO ABDUCTION HIP STATIC PLASTIC PREFABRICATE | 2011-07-01 00:00:00 | 141.17 | N | Y | N/A | N/A
L1680 | HO PELVIC & HIP CONTROL THIGH CUFFS CUST FAB | 2011-07-01 00:00:00 | 1236.64 | N | Y | N/A | N/A
L1685 | POSTOPERATIVE HIP ABDUCTION CUSTOM FABRICATED | 2011-07-01 00:00:00 | 905.45 | N | Y | N/A | N/A
[NAME] | POSTOPERATIVE HIP ABDUCTION PREFABRICATED | 2011-07-01 00:00:00 | 704.12 | N | Y | N/A | N/A
L1690 | COMBINATION BILATERAL LUMBOSACRAL/HIP/FEMUR | 2011-07-01 00:00:00 | 1536.53 | N | Y | N/A | N/A
L1700 | [NAME] TYPE CUSTOM FAB | 2011-07-01 00:00:00 | 1250.22 | N | Y | N/A | N/A
L1710 | [NAME] TYPE CUSTOM | 2011-07-01 00:00:00 | 1512.63 | N | Y | N/A | N/A
L1720 | [NAME] FABRI | 2011-07-01 00:00:00 | 1055.21 | N | Y | N/A | N/A
[NAME] | [NAME] RITE CUSTOM | 2011-07-01 00:00:00 | 900.31 | N | Y | N/A | N/A
L1755 | [NAME] PATTEN BOTTOM TYPE CUSTOM FABR | 2011-07-01 00:00:00 | 1205.18 | N | Y | N/A | N/A
L1810 | KNEE ORTHOSIS ELASTIC W/JOINTS PREFABRICATED | 2011-07-01 00:00:00 | 86.79 | N | Y | N/A | N/A
L1812 | KNEE ORTHO ELASTIC W/JOINTS PRE OTS | 2014-01-01 00:00:00 | 90.48 | N | Y | N/A | N/A
L1820 | KO ELASTIC WITH CONDYLAR PADS & JOINTS | 2011-07-01 00:00:00 | 109.81 | N | Y | N/A | N/A
L1830 | KO IMMOBILIZER CANVAS LONGITUDINAL PREFABRIC | 2011-07-01 00:00:00 | 85.11 | N | Y | N/A | N/A
L1831 | KNEE ORTHOSIS POSITIONAL LOCKING JOINT | 2011-07-01 00:00:00 | 233.86 | N | Y | N/A | N/A
L1832 | KO ADJUSTABLE POSITIONAL RIGID SUPPORT PREFAB | 2011-07-01 00:00:00 | 462.8 | N | Y | N/A | N/A
L1833 | KNEE ORTHO ADJ JNT POS R SUP PRE OTS | 2014-01-01 00:00:00 | 482.47 | N | Y | N/A | N/A
L1834 | KO WITH OUT KNEE JOINT RIGID CUSTOM FABRICATE | 2011-07-01 00:00:00 | 590.9 | N | Y | N/A | N/A
L1836 | KO RIGID WITHOUT JOINTS SOFT INTERFACE PREFAB | 2011-07-01 00:00:00 | 106.02 | N | Y | N/A | N/A
L1840 | KO DEROTATION MEDIAL-LATERAL CRUCIATE CUSTOM | 2011-07-01 00:00:00 | 809.64 | N | Y | N/A | N/A
L1843 | KO SINGLE UPRIGHT THIGH AND CALF CUSTOM FIT | 2011-07-01 00:00:00 | 712.95 | N | Y | N/A | N/A
L1844 | KO WITH ADJUSTABLE JOINT ROTATION CUSTOM FAB | 2011-07-01 00:00:00 | 1601.53 | N | Y | N/A | N/A
L1845 | KO WITH ADJUSTABLE FLEXION EXTENSION ROTATION | 2011-07-01 00:00:00 | 646.16 | N | Y | N/A | N/A
[NAME] | KO WITH ADJUSTABLE FLEXION ROTATION CONTROL | 2011-07-01 00:00:00 | 973.23 | N | Y | N/A | N/A
L1847 | KO ADJUSTABLE WITH AIR CHAMBERS PREFABRICATED | 2011-07-01 00:00:00 | 457.02 | N | Y | N/A | N/A
L1848 | KNEE ORTHO DBL UPRIGHT W/AIR PRE OTS | 2014-01-01 00:00:00 | 476.45 | N | Y | N/A | N/A
L1850 | KNEE ORTHOSIS SWEDISH TYPE PREFABRICATED | 2011-07-01 00:00:00 | 244.67 | N | Y | N/A | N/A
L1860 | KO SUPRACONDYLAR PROSTHETIC SOCKET MOLD | 2011-07-01 00:00:00 | 998.69 | N | Y | N/A | N/A
L1900 | AFO SPRING WIRE DORSIFLEXION ASSIST CALF BAND | 2011-07-01 00:00:00 | 226.4 | N | Y | N/A | N/A
L1902 | AFO ANKLE GAUNTLET PREFABRICATED | 2011-07-01 00:00:00 | 74.51 | N | Y | N/A | N/A
L1904 | AFO MOLDED ANKLE GAUNTLET CUSTOM FABRICATED | 2011-07-01 00:00:00 | 357.96 | N | Y | N/A | N/A
L1906 | AFO MULTILIGAMENTUS ANKLE SUPPORT PREFABRICAT | 2011-07-01 00:00:00 | 91.54 | N | Y | N/A | N/A
L1907 | AFO SUPRAMALLEOLAR WITH STRAPS CUSTOM FABRIC | 2011-07-01 00:00:00 | 447.1 | N | Y | N/A | N/A
L1910 | AFO SINGLE BAR CLASP ATTACHMENT TO SHOE | 2011-07-01 00:00:00 | 257.49 | N | Y | N/A | N/A
L1920 | AFP SINGLE UPRIGHT WITH STATIC OR ADJUSTABLE | 2011-07-01 00:00:00 | 341.09 | N | Y | N/A | N/A
L1930 | AFO PLASTIC OTHER MATERIAL PREFABRICATED | 2011-07-01 00:00:00 | 210.31 | N | Y | N/A | N/A
L1932 | AFO RIG ANT TIB PREFAB TCF/ EQUAL MATERIAL | 2011-07-01 00:00:00 | 709.06 | N | Y | N/A | N/A
L1940 | AFO PLASTIC OTHER MATERIAL CUSTOM FABRICATED | 2011-07-01 00:00:00 | 404.41 | N | Y | N/A | N/A
L1945 | AFO PLASTIC RIGID ANTERIOR TIBIAL SECTION | 2011-07-01 00:00:00 | 795.14 | N | Y | N/A | N/A
L1950 | AFO SPIRAL MOLDED TO PATIENT PLASTIC | 2011-07-01 00:00:00 | 755.98 | N | Y | N/A | N/A
L1951 | AFO SPIRAL PLASTIC PREFABRICATED | 2011-07-01 00:00:00 | 667.32 | N | Y | N/A | N/A
L1960 | AFO POSTERIOR SOLID ANKLE PLASTIC MOLDED | 2011-07-01 00:00:00 | 421.93 | N | Y | N/A | N/A
L1970 | AFO PLASTIC WITH ANKLE JOINT CUSTOM FABRICATE | 2011-07-01 00:00:00 | 563.07 | N | Y | N/A | N/A
L1971 | AFO PLASTIC WITH ANKLE JOINT, PREFABRICATED | 2011-07-01 00:00:00 | 372.45 | N | Y | N/A | N/A
L1980 | AFO SINGLE UPRIGHT PLANTAR SOLID STIRRUP CALF | 2011-07-01 00:00:00 | 357.29 | N | Y | N/A | N/A
L1990 | AFO DOUBLE UPRIGHT PLANTAR SOLID STIRRUP CALF | 2011-07-01 00:00:00 | 431.74 | N | Y | N/A | N/A
L2000 | KAFO SINGLE FREE KNEE STIRRUP THIGH CALF | 2011-07-01 00:00:00 | 1029.46 | N | Y | N/A | N/A
L2005 | [NAME] TYPE ACTIVATION | 2011-07-01 00:00:00 | 3255.99 | Y | Y | N/A | N/A
[NAME] | KAFO SINGLE SOLID STIRRUP WITHOUT JOINT | 2011-07-01 00:00:00 | 929.3 | N | Y | N/A | N/A
L2020 | [NAME] SOLID STIRRUP THIGH BAND/CUFFS | 2011-07-01 00:00:00 | 1185.11 | N | Y | N/A | N/A
[NAME] | [NAME] SOLID STIRRUP WITHOUT KNEE JOINT | 2011-07-01 00:00:00 | 1020.63 | N | Y | N/A | N/A
L2034 | KAFO PLASTIC SINGLE UPRIGHT W/WO KNEE/ANK CUS | 2011-07-01 00:00:00 | 1611.3 | N | Y | N/A | N/A
L2035 | KAFO PLASTIC PEDIATRIC SIZE PREFABRICATED | 2011-07-01 00:00:00 | 142.98 | N | Y | N/A | N/A
L2036 | [NAME] UPRIGHT FREE KNEE | 2011-07-01 00:00:00 | 1821.94 | N | Y | N/A | N/A
L2037 | KAFO PLASTIC SINGLE UPRIGHT FREE KNEE MOLDED | 2011-07-01 00:00:00 | 1503.08 | N | Y | N/A | N/A
L2038 | [NAME] ANKLE | 2011-07-01 00:00:00 | 1266.19 | N | Y | N/A | N/A
L2040 | [NAME] ROTATION STRAPS PELVI | 2011-07-01 00:00:00 | 173.93 | N | Y | N/A | N/A
L2050 | HKAFO TORSION CABLE HIP JOINT PELVIC BAND | 2011-07-01 00:00:00 | 367.76 | N | Y | N/A | N/A
L2060 | [NAME] JOINT PELVIC | 2011-07-01 00:00:00 | 520.69 | N | Y | N/A | N/A
L2070 | [NAME] UNILATERAL ROTATION STRAP | 2011-07-01 00:00:00 | 102.37 | N | Y | N/A | N/A
[NAME] | HKAFO UNILATERAL TORSION CABLE HIP JOINT | 2011-07-01 00:00:00 | 315.63 | N | Y | N/A | N/A
L2090 | HKAFO UNILATERAL TORSION BALL BEARING HIP | 2011-07-01 00:00:00 | 445.05 | N | Y | N/A | N/A
L2106 | AFO TIBIAL FRACTURE CAST ORTHOSIS THERMOPLAST | 2011-07-01 00:00:00 | 533.48 | N | Y | N/A | N/A
L2108 | AFO TIBIAL FRACTURE CAST CUSTOM FABRICATED | 2011-07-01 00:00:00 | 912.2 | N | Y | N/A | N/A
L2112 | AFO TIBIAL FRACTURE SOFT PREFABRICATED | 2011-07-01 00:00:00 | 368.22 | N | Y | N/A | N/A
L2114 | AFO TIBIAL FRACTURE SEMI-RIGID PREFABRICATED | 2011-07-01 00:00:00 | 451.85 | N | Y | N/A | N/A
L2116 | AFO TIBIAL FRACTURE RIGID PREFABRICATED | 2011-07-01 00:00:00 | 541.91 | N | Y | N/A | N/A
L2126 | KAFO FEMORAL FRACTURE CAST THERMOPLASTIC | 2011-07-01 00:00:00 | 911.52 | N | Y | N/A | N/A
L2128 | KAFO FEMORAL FRACTURE CUSTOM FABRICATED | 2011-07-01 00:00:00 | 1740.37 | N | Y | N/A | N/A
L2132 | KAFO FEMORAL FRACTURE CAST SOFT PREFABRICATED | 2011-07-01 00:00:00 | 614.05 | N | Y | N/A | N/A
L2134 | KAFO FEMORAL FRACTURE CAST SEMI-RIGID PREFAB | 2011-07-01 00:00:00 | 769.91 | N | Y | N/A | N/A
L2136 | KAFO FEMORAL FRACTURE CAST RIGID PREFABRICATE | 2011-07-01 00:00:00 | 900.22 | N | Y | N/A | N/A
L2180 | ADDITION TO,LASTIC SHOE INSRT W/ANKLE JOINTS | 2011-07-01 00:00:00 | 89.15 | N | Y | N/A | N/A
[NAME] | ADDITION TO LWR EXT FX, DROP LOCK KNEE JOINT | 2011-07-01 00:00:00 | 82.03 | N | Y | N/A | N/A
L2184 | ADD TO LWR EXT FX, [NAME] JOINT | 2011-07-01 00:00:00 | 94.29 | N | Y | N/A | N/A
L2186 | ADJUSTMENT MOTION KNEE JT LERMAN TYPE | 2011-07-01 00:00:00 | 131.94 | N | Y | N/A | N/A
[NAME] | LOWER EXTREMITY QUADRILATERAL BRIM | 2011-07-01 00:00:00 | 247.02 | N | Y | N/A | N/A
L2190 | ADDITION TO LWR EXT FX, WAIST BELT | 2011-07-01 00:00:00 | 66.47 | N | Y | N/A | N/A
L2192 | ADD TO LWR EXT, PELVIC BAND&BELT THIGH FLANGE | 2011-07-01 00:00:00 | 271.41 | N | Y | N/A | N/A
L2200 | ADD TO LWR EXT, LIMITED ANKLE MOTION EA JNT | 2011-07-01 00:00:00 | 48.26 | N | Y | N/A | N/A
L2210 | ADD TO LWR EXT, DORSIFLEXION ASSIST EA JOINT | 2011-07-01 00:00:00 | 53.63 | N | Y | N/A | N/A
L2220 | DORSIFLEXION & PLANTAR FLEXION ASSIST/RESIST | 2011-07-01 00:00:00 | 73.67 | N | Y | N/A | N/A
L2230 | SPLIT FLAT CALIPER STIRRUP & PLATE ATTACHMENT | 2011-07-01 00:00:00 | 71.71 | N | Y | N/A | N/A
L2232 | ROCKER BOTTOM, CONTACT AFO | 2011-07-01 00:00:00 | 79.07 | N | Y | N/A | N/A
L2240 | ROUND CALIPER AND PLATE ATTACHMENT | 2011-07-01 00:00:00 | 64.26 | N | Y | N/A | N/A
L2250 | FOOT PLATE MOLDED STIRRUP ATTACHMENT | 2011-07-01 00:00:00 | 360.65 | N | Y | N/A | N/A
L2260 | ADD TO LOWER EXT, REINFORCED SOLID STIRRUP | 2011-07-01 00:00:00 | 152.6 | N | Y | N/A | N/A
L2265 | ADD TO LOWER EXT, LONG TONGUE STIRRUP | 2011-07-01 00:00:00 | 89.65 | N | Y | N/A | N/A
L2270 | VARUS/VALGUS CORRECTION T STRAP PADDED/LINED | 2011-07-01 00:00:00 | 54.5 | N | Y | N/A | N/A
[NAME] | ADD TO LOWER EXT, PLASTIC MODIFICATION PADDED | 2011-07-01 00:00:00 | 119.06 | N | Y | N/A | N/A
[NAME] | ADD TO LOWER EXT, MOLDED INNER BOOT | 2011-07-01 00:00:00 | 345.2 | N | Y | N/A | N/A
L2300 | ADD TO LOWER EXT,ABDUCTION BAR JOINTED ADJUST | 2011-07-01 00:00:00 | 255.54 | N | Y | N/A | N/A
L2310 | ADD TO LOWER EXT, ABDUCTION BAR-STRAIGHT | 2011-07-01 00:00:00 | 124.86 | N | Y | N/A | N/A
L2320 | ADD TO LOWER EXT, NON-MOLDED LACER | 2011-07-01 00:00:00 | 200.08 | N | Y | N/A | N/A
L2330 | ADD TO LWR EXT, LACER MOLDED TO PATIENT MODEL | 2011-07-01 00:00:00 | 353.62 | N | Y | N/A | N/A
L2335 | ADD TO LOWER EXT, ANTERIOR SWING BAND | 2011-07-01 00:00:00 | 189.32 | N | Y | N/A | N/A
L2340 | ADD TO LOWER EXT, PRE-TIBIAL SHELL MOLDED | 2011-07-01 00:00:00 | 420.11 | N | Y | N/A | N/A
L2350 | ADD TO LWR EXT, PROSTHETIC TYPE SOCKET MOLDED | 2011-07-01 00:00:00 | 765.22 | N | Y | N/A | N/A
L2360 | ADD TO LOWER EXT, EXTENDED STEEL SHANK | 2011-07-01 00:00:00 | 52.52 | N | Y | N/A | N/A
L2370 | ADD TO LOWER EXT, PATTEN BOTTOM | 2011-07-01 00:00:00 | 208.81 | N | Y | N/A | N/A
L2375 | ADD TO LWR EXT, TORSION ANKLE & SOLID STIRRUP | 2011-07-01 00:00:00 | 86.01 | N | Y | N/A | N/A
L2380 | ADD TO LOWER EXT, TORSION STRAIGHT KNEE JOINT | 2011-07-01 00:00:00 | 95.41 | N | Y | N/A | N/A
[NAME] | ADD TO LOWER EXT, STRAIGHT KNEE JOINT HEAVY | 2011-07-01 00:00:00 | 101.96 | N | Y | N/A | N/A
L2387 | ADD LE POLYCENTRIC KNEE JOINT CUSTOM KAFO | 2011-07-01 00:00:00 | 154.58 | N | Y | N/A | N/A
[NAME] | ADD TO LOWER EXT, OFFSET KNEE JOINT EACH | 2011-07-01 00:00:00 | 83.33 | N | Y | N/A | N/A
[NAME] | ADD TO LWR EXT, OFFSET KNEE JOINT HEAVY DUTY | 2011-07-01 00:00:00 | 119.1 | N | Y | N/A | N/A
L2397 | ADD TO LOWER EXT, SUSPENSION SLEEVE | 2011-07-01 00:00:00 | 100.6 | N | Y | N/A | N/A
L2405 | ADD TO KNEE JOINT DROP LOCK STANCE EA JOINT | 2011-07-01 00:00:00 | 69.27 | N | Y | N/A | N/A
L2415 | ADD TO KNEE LOCK W/INTEGRTD RELEASE MECHANISM | 2011-07-01 00:00:00 | 96.5 | N | Y | N/A | N/A
L2425 | ADD KNEE JOINT DISC/DIAL LOCK FOR ADJUST KNEE | 2011-07-01 00:00:00 | 113.9 | N | Y | N/A | N/A
[NAME] | ADD KNEE JOINT RATCHET LOCK FOR ACTIVE EA JNT | 2011-07-01 00:00:00 | 113.9 | N | Y | N/A | N/A
L2492 | ADDITION TO KNEE JT, LIFT LOOP DROP LOCK RING | 2011-07-01 00:00:00 | 80.49 | N | Y | N/A | N/A
L2500 | ADD TO LOWR EXT, THIGH/GLUTEAL WEIGHT BEARING | 2011-07-01 00:00:00 | 257.83 | N | Y | N/A | N/A
L2510 | ADD TO THIGH/WEIGHT BEARG QUADRILAT BRIM MOLD | 2011-07-01 00:00:00 | 628.97 | N | Y | N/A | N/A
L2520 | ADD TO THIGH/WEIGHT BEAR QUADRILAT BRIM CUSTM | 2011-07-01 00:00:00 | 370.56 | N | Y | N/A | N/A
L2525 | ADD TO THIGH/WEIGHT BEAR NARROW M-L BRIM MOLD | 2011-07-01 00:00:00 | 987.77 | N | Y | N/A | N/A
L2526 | ADD TO THIGH/WGT BEAR NARRW M-L BRIM CUST FIT | 2011-07-01 00:00:00 | 695.19 | N | Y | N/A | N/A
L2530 | ADD TO THIGH/WEIGHT BEAR LACER NON-MOLDED | 2011-07-01 00:00:00 | 186.75 | N | Y | N/A | N/A
L2540 | ADD TO THIGH/WEIGHT BEARING LACER MOLDED | 2011-07-01 00:00:00 | 405.94 | N | Y | N/A | N/A
L2550 | ADDITION TO THIGH/WEIGHT BEAR HIGH ROLL CUFF | 2011-07-01 00:00:00 | 238.54 | N | Y | N/A | N/A
L2570 | ADD TO PELVIC HIP JOINT CLEVIS TYPE 2 POS JNT | 2011-07-01 00:00:00 | 373.51 | N | Y | N/A | N/A
L2580 | ADD TO LWR EXT, PELVIC CONTROL PELVIC SLING | 2011-07-01 00:00:00 | 417.53 | N | Y | N/A | N/A
[NAME] | ADD TO PELVIC CTRL HIP CLEVIS/THRST BEAR FREE | 2011-07-01 00:00:00 | 181.08 | N | Y | N/A | N/A
[NAME] | ADD TO PELVIC CTRL HIP CLEVIS/THRST BEAR LOCK | 2011-07-01 00:00:00 | 218.24 | N | Y | N/A | N/A
L2620 | ADD TO LWR EXT, PELVIC CONTROL HIP HEAVY DUTY | 2011-07-01 00:00:00 | 239.41 | N | Y | N/A | N/A
L2622 | ADD TO PELVIC CTRL HIP JOINT ADJUST [NAME] | 2011-07-01 00:00:00 | 233.43 | N | Y | N/A | N/A
L2624 | ADD TO PELVIC ADJUST FLEXION ABDUCTION CTRL | 2011-07-01 00:00:00 | 252.07 | N | Y | N/A | N/A
[NAME] | ADD TO PELVIC PLASTIC MOLD RECIPROCAT HIP JNT | 2011-07-01 00:00:00 | 1304.95 | N | Y | N/A | N/A
L2628 | ADD TO METAL FRAME RECIPROCRATING HIP&CABLES | 2011-07-01 00:00:00 | 1700.44 | N | Y | N/A | N/A
L2630 | ADD TO PELVIC CONTROL BAND & BELT UNILATERAL | 2011-07-01 00:00:00 | 199.12 | N | Y | N/A | N/A
L2640 | ADD TO PELVIC CONTROL BAND & BELT BILATERAL | 2011-07-01 00:00:00 | 310.32 | N | Y | N/A | N/A
L2650 | ADD TO L EXT, PELVIC&THORACIC CONTROL GLUTEAL | 2011-07-01 00:00:00 | 121.8 | N | Y | N/A | N/A
[NAME] | ADD TO L EXT, THORACIC CONTROL THORACIC BAND | 2011-07-01 00:00:00 | 141.88 | N | Y | N/A | N/A
L2670 | ADD LWR EXT,THORACIC CTRL PARASPINAL UPRIGHTS | 2011-07-01 00:00:00 | 134.24 | N | Y | N/A | N/A
L2680 | ADD LW EXT, THORACIC CTRL LAT SUPPRT UPRIGHTS | 2011-07-01 00:00:00 | 119.12 | N | Y | N/A | N/A
L2750 | ADD L EXT ORTHOSIS PLTNG CHRME/NICKEL PER BAR | 2011-07-01 00:00:00 | 74.75 | N | Y | N/A | N/A
L2755 | ADD L EXT ORTHOSIS HGH STNGTH ALL HYBRID LAM | 2011-07-01 00:00:00 | 103.83 | N | Y | N/A | N/A
L2760 | ADD L EXT ORTHOSIS EXTENS PER EXTENS PER BAR | 2011-07-01 00:00:00 | 47.23 | N | Y | N/A | N/A
L2768 | ADD L EXT ORTHOTIC SIDE BAR DISCONNECT DEVICE | 2011-07-01 00:00:00 | 103.52 | N | Y | N/A | N/A
L2780 | ADD TO LOW [NAME] FINISH | 2011-07-01 00:00:00 | 68.69 | N | Y | N/A | N/A
L2785 | ADD TO LOWER EXT ORTHOSIS DROP LOCK RETAINER | 2011-07-01 00:00:00 | 26.63 | N | Y | N/A | N/A
L2795 | ADD L EXT ORTHOSIS KNEE CONTROL FULL KNEECAP | 2011-07-01 00:00:00 | 80.18 | N | Y | N/A | N/A
[NAME] | ADD TO ORTHOSOIS KNEE CAP MEDIAL/LATERAL PULL | 2011-07-01 00:00:00 | 93.08 | N | Y | N/A | N/A
L2810 | ADD TO ORTHOSIS KNEE CONTROL CONDYLAR PAD | 2011-07-01 00:00:00 | 59.45 | N | Y | N/A | N/A
L2820 | ADD TO ORTHOSIS SOFT INTRFC BELOW KNEE SECTN | 2011-07-01 00:00:00 | 66.11 | N | Y | N/A | N/A
L2830 | ADD TO ORTHOSIS SOFT INTRFC ABOVE KNEE SECTN | 2011-07-01 00:00:00 | 71.51 | N | Y | N/A | N/A
L2840 | ADD TO ORTHOSIS TIBIAL LNGTH SOCK FX OR EQUAL | 2011-07-01 00:00:00 | 33.26 | N | Y | N/A | N/A
L2850 | ADD TO ORTHOSIS FEMORAL LENGTH SOCK FX/EQUAL | 2011-07-01 00:00:00 | 47.13 | N | Y | N/A | N/A
L2999 | UNLISTED PROCEDURES FOR LOWER EXTREMITY ORTHOSES | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
[NAME] | FOOT INSERT REMOVABLE MOLD UCB BERKELEY SHELL | 2011-07-01 00:00:00 | 249.6 | N | Y | N/A | N/A
L3001 | FOOT INSERT REMOVABLE MOLDED SPENCO | 2011-07-01 00:00:00 | 105.09 | N | Y | N/A | N/A
L3002 | FOOT INSERT REMOVABLE PLASTAZOTE OR EQUAL | 2011-07-01 00:00:00 | 128.33 | N | Y | N/A | N/A
L3003 | FOOT INSERT REMOVABLE SILICONE GEL EACH | 2011-07-01 00:00:00 | 138.47 | N | Y | N/A | N/A
L3010 | FOOT INSERT REMVBL LONGITUDINAL ARCH SUPPORT | 2011-07-01 00:00:00 | 138.47 | N | Y | N/A | N/A
L3020 | FOOT INSERT LONGITUDINAL/METATARSAL SUPPORT | 2011-07-01 00:00:00 | 157.65 | N | Y | N/A | N/A
L3030 | FOOT INSERT REMOVABLE FORMED TO PATIENT FOOT | 2011-07-01 00:00:00 | 60.64 | N | Y | N/A | N/A
L3031 | FOOT, [NAME], REMOVABLE, ADDITION TO LOWER EXTREMITY ORTHOSIS, HIGH STRGTH | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3040 | FOOT ARCH SUPPORT PREMOLDED LONGITUDINAL | 2011-07-01 00:00:00 | 37.39 | N | Y | N/A | N/A
L3050 | FOOT ARCH SUPPORT PREMOLDED METATARSAL | 2011-07-01 00:00:00 | 37.39 | N | Y | N/A | N/A
L3060 | FOOT ARCH SUPPORT LONGITUDINAL/METATARSAL | 2011-07-01 00:00:00 | 58.61 | N | Y | N/A | N/A
L3070 | FOOT ARCH SUPPORT ATTACH TO SHOE LONGITUDINAL | 2011-07-01 00:00:00 | 25.24 | N | Y | N/A | N/A
[NAME] | FOOT ARCH SUPPORT ATTACH TO SHOE METATARSAL | 2011-07-01 00:00:00 | 25.24 | N | Y | N/A | N/A
L3090 | FOOT ARCH SUPPORT ATTACHED TO SHOE LONG/META | 2011-07-01 00:00:00 | 32.35 | N | Y | N/A | N/A
[NAME] | HALLUS-VALGUS NIGHT DYNAMIC SPLINT | 2011-07-01 00:00:00 | 34.35 | N | Y | N/A | N/A
[NAME] | FOOT ABDUCTION ROTATION BAR INCLUDING SHOES | 2011-07-01 00:00:00 | 70.75 | N | Y | N/A | N/A
L3150 | FOOT ABDUCTION ROTATION BAR WITHOUT SHOES | 2011-07-01 00:00:00 | 64.68 | N | Y | N/A | N/A
L3160 | FOOT, ADJ. SHOE STYLED POSITIONING DEVICE, EACH | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3170 | FOOT PLASTIC HEEL STABILIZER | 2011-07-01 00:00:00 | 40.45 | N | Y | N/A | N/A
L3201 | ORTHO SHOE OXFORD W/SUPINATOR/PRONATOR INFANT | 2008-01-01 00:00:00 | 55 | N | Y | N/A | N/A
L3202 | ORTHOPEDIC SHOE OXFORD W/SUPINATOR OR PRONATOR, CHILD | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3203 | ORTHOPEDIC SHOE OXFORD W/SUPINATOR OR PRONATOR, JUNIOR | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3204 | ORTHOPEDIC SHOE HIGHTOP W/WUPINATOR OR PRONATOR, INFANT | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3206 | ORTHO SHOE HIGHTOP W/SUPINATOR/PRONATOR CHILD | 2008-01-01 00:00:00 | 50 | N | Y | N/A | N/A
L3207 | ORTHOPEDIC SHOE HIGHTOP W/SUPINATOR OR PRONATOR, JUNIOR | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3208 | SURGICAL BOOT EA. INFANT | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3209 | SURGICAL BOOT EA. CHILD | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3211 | SURGICAL BOOT EA JUNIOR | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3212 | BENESCH BOOT PAIR INFANT | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | BENESCH BOOT PAIR CHILD | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3214 | BENESCH BOOT PAIR JUNIOR | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3215 | ORTHOPEDIC FOOTWEAR LADIES SHOES OXFORD | 2008-01-01 00:00:00 | 78.94 | N | Y | N/A | N/A
L3216 | ORTHOPEDIC LADIES SHOE DEPTH INLAY, EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | ORTHOPEDIC LADIES SHOE HIGHTOP DEPTH INLAY, EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3219 | ORTHOPEDIC FOOTWEAR [NAME] OXFORD | 2008-01-01 00:00:00 | 90.8 | N | Y | N/A | N/A
L3221 | ORTHOPEDIC MENS SHOE DEPTH INLAY, EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3222 | ORTHOPEDIC FOOTWEAR MENS SHOES HIGH TOP DEPTH INLAY, EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3224 | ORTHOPEDIC FOOTWEAR WOMANS SHOE [NAME] | 2011-07-01 00:00:00 | 44.77 | N | Y | N/A | N/A
L3225 | ORTHOPEDIC FOOTWEAR MANS SHOE [NAME] | 2011-07-01 00:00:00 | 51.49 | N | Y | N/A | N/A
L3230 | [NAME], CUSTOM SHOE, DEPTH INLAY, EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3250 | [NAME], CUSTOM MOLDED SHOE REMOV INNER [NAME], EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | FOOT SHOE MOLDED TO PATIENT MODEL, SILICONE, EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3252 | FOOT SHOE MOLDED TO PATIENT MODEL, PLASTAZOTE, CUSTOM FAB, EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3253 | FOOT, MOLDED SHOE, PLASTAZOTE, CUSTOM FITTED, EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3254 | NON-STANDARD SIZE OR WIDTH | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3255 | NON-STANDARD SIZE OR LENGTH | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3257 | [NAME], ADDITIONAL CHARGE FOR SPLIT SIZE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3260 | SURGICAL BOOT/SHOE EACH | 2008-01-01 00:00:00 | 50 | N | Y | N/A | N/A
L3265 | SANDAL, PLASTAZOTE, EA | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3300 | SHOE LIFT ELEVAT TAPERED TO METATARSAL PER IN | 2011-07-01 00:00:00 | 41.42 | N | Y | N/A | N/A
[NAME] | SHOE LIFT ELEVAT HEEL & SOLE NEOPRENE PER IN | 2011-07-01 00:00:00 | 64.68 | N | Y | N/A | N/A
L3320 | LIFT, ELEVATION, HEEL & SOLE CORK, PER INCH | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3330 | SHOE LIFT ELEVATION METAL EXTENSION | 2011-07-01 00:00:00 | 449.69 | N | Y | N/A | N/A
L3332 | SHOE LIFT ELEVATION TAPERED UP TO ONE-HALF IN | 2011-07-01 00:00:00 | 58.61 | N | Y | N/A | N/A
L3334 | SHOE LIFT ELEVATION HEEL PER INCH | 2011-07-01 00:00:00 | 30.32 | N | Y | N/A | N/A
L3340 | SHOE HEEL WEDGE SACH | 2011-07-01 00:00:00 | 67.72 | N | Y | N/A | N/A
L3350 | SHOE HEEL WEDGE | 2011-07-01 00:00:00 | 18.2 | N | Y | N/A | N/A
L3360 | SHOE SOLE WEDGE OUTSIDE SOLE | 2011-07-01 00:00:00 | 28.3 | N | Y | N/A | N/A
L3370 | SHOE SOLE WEDGE BETWEEN SOLE | 2011-07-01 00:00:00 | 39.39 | N | Y | N/A | N/A
L3380 | SHOE CLUBFOOT WEDGE | 2011-07-01 00:00:00 | 39.39 | N | Y | N/A | N/A
[NAME] | SHOE OUTFLARE WEDGE | 2011-07-01 00:00:00 | 39.39 | N | Y | N/A | N/A
L3400 | SHOE METATARSAL BAR WEDGE ROCKER | 2011-07-01 00:00:00 | 32.35 | N | Y | N/A | N/A
L3410 | SHOE METATARSAL BAR BETWEEN SOLE | 2011-07-01 00:00:00 | 73.76 | N | Y | N/A | N/A
L3420 | [NAME] | 2011-07-01 00:00:00 | 43.45 | N | Y | N/A | N/A
L3430 | SHOE HEEL COUNTER PLASTIC REINFORCED | 2011-07-01 00:00:00 | 127.33 | N | Y | N/A | N/A
L3440 | SHOE HEEL COUNTER LEATHER REINFORCED | 2011-07-01 00:00:00 | 60.64 | N | Y | N/A | N/A
L3450 | SHOE HEEL SACH CUSHION TYPE | 2011-07-01 00:00:00 | 83.88 | N | Y | N/A | N/A
L3455 | SHOE HEEL NEW LEATHER STANDARD | 2011-07-01 00:00:00 | 32.35 | N | Y | N/A | N/A
L3460 | SHOE HEEL NEW RUBBER STANDARD | 2011-07-01 00:00:00 | 27.27 | N | Y | N/A | N/A
L3465 | SHOE HEEL THOMAS WITH WEDGE | 2011-07-01 00:00:00 | 46.49 | N | Y | N/A | N/A
L3470 | SHOE HEEL THOMAS EXTENDED TO BALL | 2011-07-01 00:00:00 | 49.51 | N | Y | N/A | N/A
L3480 | SHOE HEEL PAD & DEPRESSION FOR SPUR | 2011-07-01 00:00:00 | 49.51 | N | Y | N/A | N/A
L3485 | HEEL PAD REMOVABLE FOR SPUR | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3500 | ORTHOPEDIC SHOE ADDITION INSOLE LEATHER | 2011-07-01 00:00:00 | 23.24 | N | Y | N/A | N/A
L3510 | ORTHOPEDIC SHOE ADDITION INSOLE RUBBER | 2011-07-01 00:00:00 | 23.24 | N | Y | N/A | N/A
L3520 | ORTHO SHOE ADDN INSOLE FELT COVERED W/LEATHER | 2011-07-01 00:00:00 | 25.24 | N | Y | N/A | N/A
L3530 | ORTHOPEDIC SHOE ADDITION SOLE HALF | 2011-07-01 00:00:00 | 25.24 | N | Y | N/A | N/A
L3540 | ORTHOPEDIC SHOE ADDITION SOLE FULL | 2011-07-01 00:00:00 | 40.45 | N | Y | N/A | N/A
L3550 | ORTHOPEDIC SHOE ADDITION TOE TAP STANDARD | 2011-07-01 00:00:00 | 7.06 | N | Y | N/A | N/A
L3560 | ORTHOPEDIC SHOE ADDITION TOE TAP HORSESHOE | 2011-07-01 00:00:00 | 18.2 | N | Y | N/A | N/A
L3570 | ORTHOPEDIC SHOE ADDITION EXTENSION TO INSTEP | 2011-07-01 00:00:00 | 67.72 | N | Y | N/A | N/A
L3580 | ORTHO SHOE ADDN CONVERT INSTEP VELCRO CLOSURE | 2011-07-01 00:00:00 | 51.53 | N | Y | N/A | N/A
L3590 | ORTHO SHOE ADDTN CONVERT FIRM TO SOFT COUNTER | 2011-07-01 00:00:00 | 42.44 | N | Y | N/A | N/A
L3595 | ORTHOPEDIC SHOE ADDITION MARCH BAR | 2011-07-01 00:00:00 | 33.35 | N | Y | N/A | N/A
L3600 | TRANSFER FROM SHOE CALIPER PLATE EXISTING | 2011-07-01 00:00:00 | 60.64 | N | Y | N/A | N/A
[NAME] | TRANSFER FROM SHOE CALIPER PLATE NEW | 2011-07-01 00:00:00 | 79.82 | N | Y | N/A | N/A
L3620 | TRANSFER FROM SHOE SOLID STIRRUP EXISTING | 2011-07-01 00:00:00 | 60.64 | N | Y | N/A | N/A
L3630 | TRANSFER FROM SHOE SOLID STIRRUP NEW | 2011-07-01 00:00:00 | 79.82 | N | Y | N/A | N/A
L3640 | TRANSFER SHOE DENNIS BROWNE SPLINT BOTH SHOES | 2011-07-01 00:00:00 | 34.35 | N | Y | N/A | N/A
L3649 | UNLISTED PROCEDURES FOR FOOT ORTHOPEDIC SHOES | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | SHOULDER ORTHOSIS FIGR 8 ABDUCTION RESTRAINER | 2011-07-01 00:00:00 | 47.08 | N | Y | N/A | N/A
L3660 | SHOULDER ORTHO FIG8 ABDUCTN RESTRAINER CANVAS | 2011-07-01 00:00:00 | 76.55 | N | Y | N/A | N/A
L3670 | SHOULDER ACROMIO/CLAVICULAR CANVAS & WEBBING | 2011-07-01 00:00:00 | 87.55 | N | Y | N/A | N/A
L3671 | SO CAP DESIGN W/O JOINTS CUSTOM FABRICATED | 2011-07-01 00:00:00 | 651.62 | N | Y | N/A | N/A
L3674 | SO AIRPLANE W/WO JOINT CUSTOM FABRICATED | 2011-01-01 00:00:00 | 949.77 | N | Y | N/A | N/A
L3675 | SO VEST TYPE ABDUCTION CANVAS & WEBBING/EQUAL | 2011-07-01 00:00:00 | 126.9 | N | Y | N/A | N/A
L3677 | SHOULDER STABILIZER PRE-FABRICATED INCLUDES FIT | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3678 | SHOULDER ORTHO HARD PLAS STABILI PRE OTS | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
L3702 | EO W/O JOINTS CUSTOM FABRICATED | 2011-07-01 00:00:00 | 208.81 | N | Y | N/A | N/A
L3710 | ELBOW ELASTIC WITH METAL JOINTS PREFABRICATED | 2011-07-01 00:00:00 | 92.08 | N | Y | N/A | N/A
L3720 | EO DOUBLE UPRIGHT WITH FOREARM FREE MOTION | 2011-07-01 00:00:00 | 581.95 | N | Y | N/A | N/A
L3730 | EO FOREARM/ARM CUFFS EXTENSION/FLEXION ASSIST | 2011-07-01 00:00:00 | 782.94 | N | Y | N/A | N/A
L3740 | EO ARM CUFFS ADJUSTABLE LOCK ACTIVE CONTROL | 2011-07-01 00:00:00 | 799.25 | N | Y | N/A | N/A
L3760 | EO WITH ADJUSTABLE LOCKING JOINT, PREFABRICAT | 2011-07-01 00:00:00 | 361.64 | N | Y | N/A | N/A
L3762 | EO RIGID WITHOUT JOINTS SOFT MATERIAL | 2011-07-01 00:00:00 | 77.76 | N | Y | N/A | N/A
L3763 | EWHO RIGID W/O JOINTS CUSTOM FABRICATED | 2011-07-01 00:00:00 | 534.63 | N | Y | N/A | N/A
L3764 | EWHO W/JOINT(S) CUSTOM FABRICATED | 2011-07-01 00:00:00 | 600.29 | N | Y | N/A | N/A
L3765 | [NAME] FABRICATED | 2011-07-01 00:00:00 | 927.24 | N | Y | N/A | N/A
L3766 | EWHFO W/JOINT(S) CUSTOM FABRICATED | 2011-07-01 00:00:00 | 981.88 | N | Y | N/A | N/A
L3806 | WHFO W/JOINT(S) CUSTOM FABRICATED | 2011-07-01 00:00:00 | 328.48 | N | Y | N/A | N/A
L3807 | WHFO WITHOUT JOINTS PREFABRICATED | 2011-07-01 00:00:00 | 180.83 | N | Y | N/A | N/A
L3808 | WHFO RIGID W/O JOINT(S) PREFABRICATED | 2011-07-01 00:00:00 | 260.58 | N | Y | N/A | N/A
L3809 | WHF ORTHO W/O JOINTS PRE OTS | 2014-01-01 00:00:00 | 188.51 | N | Y | N/A | N/A
L3900 | WHFO HINGE EXTENSION/[NAME] WRIST/[NAME] | 2011-07-01 00:00:00 | 1084.79 | N | Y | N/A | N/A
[NAME] | [NAME] EXTENSN/FLEXION CABLE DRIVEN CUSTM | 2011-07-01 00:00:00 | 1341.14 | N | Y | N/A | N/A
L3904 | WHFO EXTERNAL POWERED, ELECTRIC CUSTOM FARIC | 2011-07-01 00:00:00 | 2181.36 | N | Y | N/A | N/A
L3905 | WHO W/NONTORSION JOINT(S) CUSTOM FABRICATED | 2011-07-01 00:00:00 | 717.16 | N | Y | N/A | N/A
L3906 | WHO WRIST GAUNTLET CUSTOM FABRICATED | 2011-07-01 00:00:00 | 308.7 | N | Y | N/A | N/A
L3908 | WHO WRIST EXTENSION COCK-UP PREFABRICATED | 2011-07-01 00:00:00 | 59.51 | N | Y | N/A | N/A
L3912 | HFO [NAME] GLOVE WITH ELASTIC FINGER CONTROL | 2011-07-01 00:00:00 | 94.19 | N | Y | N/A | N/A
L3913 | HFO W/O JOINTS CUSTOM FABRICATED | 2011-07-01 00:00:00 | 195.86 | N | Y | N/A | N/A
[NAME] | WHO W NONTOR JNT(S) PREFABRICATED | 2011-07-01 00:00:00 | 384.39 | N | Y | N/A | N/A
L3916 | WHO INCL 1 OR MORE NONTORSION JNTS PRE OTS | 2014-01-01 00:00:00 | 400.73 | N | Y | N/A | N/A
L3917 | HAND ORTHOSIS METACARPL FX ORTHOSIS PREFABRC | 2011-07-01 00:00:00 | 76.4 | N | Y | N/A | N/A
L3918 | METACARP FRACTURE ORTHOSIS PRE OTS | 2014-01-01 00:00:00 | 79.66 | N | Y | N/A | N/A
[NAME] | HO W/O JOINTS CUSTOM FABRICATED | 2011-07-01 00:00:00 | 195.86 | N | Y | N/A | N/A
L3921 | HFO W/JOINT(S) CUSTOM FABRICATED | 2011-07-01 00:00:00 | 232.29 | N | Y | N/A | N/A
L3923 | HFO, NO JOINT, PREFABRICATED, ANY TYPE | 2011-07-01 00:00:00 | 71.21 | N | Y | N/A | N/A
[NAME] | HAND FINGER ORTHOSIS WITHOUT JOINTS PRE OTS | 2014-01-01 00:00:00 | 74.24 | N | Y | N/A | N/A
L3925 | FINGER ORTHOSIS PIP/DIP WITH JOINT/SPRING | 2011-07-01 00:00:00 | 46.23 | N | Y | N/A | N/A
L3929 | HAND FINGER ORTHOSIS NONTORSION JOINT, PREFAB | 2011-07-01 00:00:00 | 70.55 | N | Y | N/A | N/A
L3930 | HAND FINGER ORTHOSIS NONTORSION JNTS PRE OTS | 2014-01-01 00:00:00 | 73.55 | N | Y | N/A | N/A
L3931 | WRIST HAND FINGER ORTHOS NONTORSION JOINT PREFAB | 2011-07-01 00:00:00 | 139.32 | N | Y | N/A | N/A
L3933 | FO W/O JOINTS CUSTOM FABRICATED | 2011-07-01 00:00:00 | 154.3 | N | Y | N/A | N/A
L3935 | FO NONTORSION JOINT CUSTOM FABRICATED | 2011-07-01 00:00:00 | 159.75 | N | Y | N/A | N/A
L3956 | [NAME] EXTREMITY ORTHOSIS; PER JOINT | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L3960 | SEWHO AIRPLANE DESIGN ABDUCTION POSITIONING | 2011-07-01 00:00:00 | 615.56 | N | Y | N/A | N/A
L3961 | SEWHO CAP DESIGN W/O JOINTS CUSTOM FABRICATED | 2011-07-01 00:00:00 | 1214.96 | N | Y | N/A | N/A
[NAME] | SEWHO ERBS PALSEY DESIGN ABDUCTION PREFABRIC | 2011-07-01 00:00:00 | 665.2 | N | Y | N/A | N/A
L3967 | SEWHO AIRPLANE W/O JOINTS CUSTOM FABRICATED | 2011-07-01 00:00:00 | 1434.47 | N | Y | N/A | N/A
L3971 | SEWHO CAP DESIGN W/JOINT(S) CUSTOM FABRICATED | 2011-07-01 00:00:00 | 1361.65 | N | Y | N/A | N/A
L3973 | SEWHO AIRPLANE W/JOINT(S) CUSTOM FABRICATED | 2011-07-01 00:00:00 | 1434.47 | N | Y | N/A | N/A
L3975 | SEWHFO CAP DESIGN W/O JOINT CUSTOM FABRICATED | 2011-07-01 00:00:00 | 1214.96 | N | Y | N/A | N/A
L3976 | SEWHFO AIRPLANE W/O JOINTS CUSTOM FABRICATED | 2011-07-01 00:00:00 | 1214.96 | N | Y | N/A | N/A
L3977 | SEWHFO CAP DESGN W/JOINT(S) CUSTOM FABRICATED | 2011-07-01 00:00:00 | 1361.65 | N | Y | N/A | N/A
[NAME] | SEWHFO AIRPLANE W/JOINT(S) CUSTOM FABRICATED | 2011-07-01 00:00:00 | 1434.47 | N | Y | N/A | N/A
L3980 | UPPER EXTREMITY FRACTURE ORTHOSIS HUMERAL | 2011-07-01 00:00:00 | 230.28 | N | Y | N/A | N/A
L3982 | UPPER EXTREMITY FRACTURE ORTHOSIS RADIUSULNAR | 2011-07-01 00:00:00 | 278.07 | N | Y | N/A | N/A
L3984 | UPPER EXTREMITY FRACTURE ORTHOSIS WRIST | 2011-07-01 00:00:00 | 267.59 | N | Y | N/A | N/A
L3995 | SOCK FRACTURE OR EQUAL EACH | 2011-07-01 00:00:00 | 27.04 | N | Y | N/A | N/A
[NAME] | UNLISTED PROC FOR UPPER LIMB ORTHOSIS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
L4000 | REPLACE GIRDLE FOR SPINAL ORTHOSIS | 2011-07-01 00:00:00 | 1102.64 | N | Y | N/A | N/A
[NAME] | REPLACEMENT STRAP, ANY ORTHOSIS, INCLUDES ALL COMPONENTS, ANY LENGTH/TYPE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | REPLACE TRILATERAL SOCKET BRIM | 2011-07-01 00:00:00 | 609.25 | N | Y | N/A | N/A
L4020 | REPLACE QUADRILATERAL SOCKET BRIM MOLDED | 2011-07-01 00:00:00 | 729.42 | N | Y | N/A | N/A
[NAME] | REPLACE QUADRILATER SOCKET BRIM CUSTOM FITTED | 2011-07-01 00:00:00 | 502.97 | N | Y | N/A | N/A
L4040 | REPLACE MOLDED THIGH LACER | 2011-07-01 00:00:00 | 414.3 | N | Y | N/A | N/A
L4045 | [NAME] THIGH LACER | 2011-07-01 00:00:00 | 251.88 | N | Y | N/A | N/A
L4050 | REPLACE MOLDED CALF LACER | 2011-07-01 00:00:00 | 378.63 | N | Y | N/A | N/A
L4055 | [NAME] CALF LACER | 2011-07-01 00:00:00 | 206.43 | N | Y | N/A | N/A
L4060 | REPLACE HIGH ROLL CUFF | 2011-07-01 00:00:00 | 307.58 | N | Y | N/A | N/A
L4070 | REPLACE PROXIMAL & DISTAL UPRIGHT FOR KAFO | 2011-07-01 00:00:00 | 253.57 | N | Y | N/A | N/A
L4080 | REPLACE METAL BANDS KAFO PROXIMAL THIGH | 2011-07-01 00:00:00 | 91.19 | N | Y | N/A | N/A
L4090 | REPLACE METAL BAND KAFO-AFO CALF/DISTAL THIGH | 2011-07-01 00:00:00 | 91.58 | N | Y | N/A | N/A
[NAME] | REPLACE LEATHER CUFF KAFO PROXIMAL THIGH | 2011-07-01 00:00:00 | 105.86 | N | Y | N/A | N/A
[NAME] | REPLACE LEATHER CUFF KAFO-AFO CALF/THIGH | 2011-07-01 00:00:00 | 86.07 | N | Y | N/A | N/A
L4130 | REPLACE PRETIBIAL SHELL | 2011-07-01 00:00:00 | 503.55 | N | Y | N/A | N/A
L4205 | ORTHOTIC DEVICE REPAIR, LABOR COMP PER 15 MIN | 2012-06-01 00:00:00 | 18.17 | N | Y | N/A | N/A
L4210 | REPAIR ORTHO, REPLACE MINOR PARTS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | ANKLE CONTROL ORTHOSIS STIRRUP STYLE RIGID | 2011-07-01 00:00:00 | 74.94 | N | Y | N/A | N/A
L4361 | PNEUMA/VAC WALK BOOT PRE OTS | 2014-01-01 00:00:00 | 292.98 | N | Y | N/A | N/A
L4360 | WALKING BOOT PNEUMATIC W/WO JOINTS PREFABRICA | 2011-07-01 00:00:00 | 281.03 | N | Y | N/A | N/A
L4370 | PNEUMATIC FULL LEG SPLINT PREFABRICATED | 2008-01-01 00:00:00 | 177.17 | N | Y | N/A | N/A
L4386 | WALKING BOOT NON-PNEUMATIC W/WO JOINT PREFABR | 2011-07-01 00:00:00 | 125.98 | N | Y | N/A | N/A
L4387 | NON-PNEUM WALK BOOT PRE OTS | 2014-01-01 00:00:00 | 131.34 | N | Y | N/A | N/A
L4392 | REPLACEMENT SOFT INTERFACE MATERIAL AFO | 2011-07-01 00:00:00 | 18.39 | N | Y | N/A | N/A
L4394 | REPLACEMENT SOFT INTRFC MAT FOOT DROP SPLINT | 2011-07-01 00:00:00 | 13.4 | N | Y | N/A | N/A
[NAME] | STATIC ANKLE FOOT ORTHOSIS SOFT INTERFACE | 2011-07-01 00:00:00 | 131.11 | N | Y | N/A | N/A
L4397 | STATIC OR DYNAMI AFO PRE OTS | 2014-01-01 00:00:00 | 136.68 | N | Y | N/A | N/A
[NAME] | FOOT DROP SPLINT RECUMBENT POSITIONING DEVICE | 2011-07-01 00:00:00 | 60.36 | N | Y | N/A | N/A
L4631 | ANKLE/FOOT ORTH, WALK BOOT TYPE, CUST FABRICATED | 2011-01-01 00:00:00 | 1350.6 | N | Y | N/A | N/A
[NAME] | PARTIAL FOOT SHOE INSERT WITH ARCH TOE FILLER | 2011-07-01 00:00:00 | 409.75 | N | Y | N/A | N/A
[NAME] | PARTIAL FOOT MOLDED SOCKET ANKLE HEIGHT | 2011-07-01 00:00:00 | 987.32 | N | Y | N/A | N/A
L5020 | PARTIAL FOOT TIBIAL TUBERCLE HGT TOE FILLER | 2011-07-01 00:00:00 | 1831 | N | Y | N/A | N/A
L5050 | ANKLE SYMES MOLDED SOCKET SACH FOOT | 2011-07-01 00:00:00 | 2186.09 | Y | Y | N/A | N/A
L5060 | SYMES METAL FRAME LEATHER SOCKET ARTICULATED | 2011-07-01 00:00:00 | 2900.88 | Y | Y | N/A | N/A
L5100 | BELOW KNEE MOLDED SOCKET SHIN SACH FOOT | 2011-07-01 00:00:00 | 2265.9 | Y | Y | N/A | N/A
L5105 | BELOW KNEE PLASTIC SOCKET JOINTS/THIGH LACER | 2011-07-01 00:00:00 | 3197.94 | Y | Y | N/A | N/A
L5150 | MOLDED SOCKET EXTERNAL KNEE JOINTS SHIN SACH | 2011-07-01 00:00:00 | 3306.65 | Y | Y | N/A | N/A
[NAME] | [NAME] SACH FOOT | 2011-07-01 00:00:00 | 4034.21 | Y | Y | N/A | N/A
L5200 | ABOVE KNEE MOLDED SINGLE AXIS FRICTION KNEE | 2011-07-01 00:00:00 | 3303.49 | Y | Y | N/A | N/A
L5210 | ABOVE KNEE SHORT PROSTHESIS NO KNEE JOINT EA | 2011-07-01 00:00:00 | 2623.87 | Y | Y | N/A | N/A
L5220 | NO KNEE JOINT WITH ARTICULATED ANKLE FOOT EA | 2011-07-01 00:00:00 | 2982.51 | Y | Y | N/A | N/A
L5230 | FEMORAL FOCAL DEFICIENCY CONST FRICTION EA FT | 2011-07-01 00:00:00 | 3988.92 | Y | Y | N/A | N/A
L5250 | HIP CANADIAN SINGLE AXIS CONSTANT FRICTION | 2011-07-01 00:00:00 | 5190.78 | Y | Y | N/A | N/A
L5270 | TILT TABLE LOCKING HIP JOINT SINGLE AXIS SACH | 2011-07-01 00:00:00 | 5561.25 | Y | Y | N/A | N/A
L5280 | HEMIPELVECTOMY CANADIAN SINGLE AXIS SACH | 2011-07-01 00:00:00 | 5505.64 | Y | Y | N/A | N/A
L5301 | BK MOLDED SOCKET EACH FOOT ENDOSKELETAL SYSTM | 2011-07-01 00:00:00 | 2272.01 | Y | Y | N/A | N/A
L5312 | KNEE DISARTICULATION, SACH FT, ENDOSKELTAL SYS | 2012-01-01 00:00:00 | 3652.28 | Y | N | N/A | N/A
L5321 | AK MOLDED SOCKET OPEN END SACH FOOT ENDOSK SY | 2011-07-01 00:00:00 | 3509.88 | Y | Y | N/A | N/A
L5331 | HIP DISARTICULATON CANADIAN TYPE SACH FOOT | 2011-07-01 00:00:00 | 4980.11 | Y | Y | N/A | N/A
L5341 | HEMIPELVECTOMY CANADIAN MOLDED SOCKET SACH | 2011-07-01 00:00:00 | 5197.89 | Y | Y | N/A | N/A
L5400 | POST SURGICAL DRESSING & 1 CAST CHANGE BK | 2011-07-01 00:00:00 | 1084.52 | N | Y | N/A | N/A
L5410 | POST SURGICAL RIGID BK EA ADDL CAST CHANGE | 2011-07-01 00:00:00 | 416.89 | N | Y | N/A | N/A
L5420 | POST SURGICAL DRESSING & 1 CAST CHANGE AK | 2011-07-01 00:00:00 | 1309.94 | N | Y | N/A | N/A
L5430 | POST SURGICAL DRESSING AK EACH CAST CHANGE | 2011-07-01 00:00:00 | 408.89 | N | Y | N/A | N/A
L5450 | POST SURGICAL APPLICATION NON-WEIGHT DRSSNGBK | 2011-07-01 00:00:00 | 357.81 | N | Y | N/A | N/A
L5460 | POST SURGICAL APPLICATION NON-WEIGHT DRSSNGAK | 2011-07-01 00:00:00 | 473.77 | N | Y | N/A | N/A
L5500 | INITIAL BK PTB  TYPE PLASTER DIRECT FORMED | 2011-07-01 00:00:00 | 1041.56 | N | Y | N/A | N/A
L5505 | INITIAL AK ISCHIAL LEVEL PLASTER SOCKET | 2011-07-01 00:00:00 | 1410.55 | N | Y | N/A | N/A
L5510 | PREPARATORY BK PTB PLASTER MOLDED | 2011-07-01 00:00:00 | 1279.36 | N | Y | N/A | N/A
[NAME] | PERPARATORY BK PTB THERMOPLASTIC DIRECT | 2011-07-01 00:00:00 | 1166.23 | N | Y | N/A | N/A
L5530 | PREPARATORY BK PTB THERMOPLASTIC MOLDED | 2011-07-01 00:00:00 | 1627.49 | N | Y | N/A | N/A
L5535 | PREPARATORY BK PTB OPEN END SOCKET | 2011-07-01 00:00:00 | 1681.07 | N | Y | N/A | N/A
[NAME] | PREPARATORY BK PTB LAMINATED SOCKET | 2011-07-01 00:00:00 | 1794.32 | N | Y | N/A | N/A
L5560 | PREPARATORY AK ISCHIAL PLASTER SOCKET MOLDED | 2011-07-01 00:00:00 | 1752.97 | N | Y | N/A | N/A
L5570 | PREPARATORY AK ISCHIAL DIRECT FORMED | 2011-07-01 00:00:00 | 1843.78 | N | Y | N/A | N/A
L5580 | PREPARATORY AK ISCHIAL THERMOPLASTIC MOLD | 2011-07-01 00:00:00 | 2112.17 | N | Y | N/A | N/A
L5585 | PREPARATORY AK ISCHIAL OPEN END PREFABRICATED | 2011-07-01 00:00:00 | 2341 | N | Y | N/A | N/A
L5590 | PREPARATORY AK ISCHIAL LAMINATED SOCKET MOLD | 2011-07-01 00:00:00 | 2049.45 | N | Y | N/A | N/A
L5595 | PREP HIP DISARTICULAT SACH FOOT THERMOPLASTIC | 2011-07-01 00:00:00 | 3660.93 | N | Y | N/A | N/A
[NAME] | PREP HIP [NAME] LAMINATED MOLDED | 2011-07-01 00:00:00 | 4614.34 | N | Y | N/A | N/A
L5610 | ADD TO LWR ENDOSKELETAL AK HYDRACADENCE SYSTM | 2011-07-01 00:00:00 | 2154.09 | N | Y | N/A | N/A
[NAME] | ADD TOAK 4 BAR LINKAGE W/FRICTION SWING PHASE | 2011-07-01 00:00:00 | 1430.79 | N | Y | N/A | N/A
L5613 | ADD TOAK 4BAR LINKAGE W/HYDRAULIC SWING PHASE | 2011-07-01 00:00:00 | 1987.46 | N | Y | N/A | N/A
L5614 | ADD TOAK 4BAR LINKAGE W/PNEUMATIC SWING CNTRL | 2011-07-01 00:00:00 | 1343.44 | N | Y | N/A | N/A
L5616 | AK UNIVERSAL MULTIPLEX SYSTEM FRICTION SWING | 2011-07-01 00:00:00 | 1101.44 | N | Y | N/A | N/A
[NAME] | AK/BK QUIK CHANGE SELF-ALIGNING UNIT EACH | 2011-07-01 00:00:00 | 445.44 | N | Y | N/A | N/A
L5618 | ADDITION TO LOWER EXTREMITY,TEST SOCKET SYMES | 2011-07-01 00:00:00 | 253.33 | N | Y | N/A | N/A
L5620 | ADDITION TO LOWER EXTREMITY, TEST SOCKET BK | 2011-07-01 00:00:00 | 240.56 | N | Y | N/A | N/A
[NAME] | ADD TO LOWER EXTRMTY,TEST SOCKET KNEE DISARTC | 2011-07-01 00:00:00 | 339.27 | N | Y | N/A | N/A
L5624 | ADDITION TO LOWER EXTREMITY, TEST SOCKET AK | 2011-07-01 00:00:00 | 305.45 | N | Y | N/A | N/A
L5626 | ADD TO LOWER EXTRMTY,TEST SOCKET HIP DISARTIC | 2011-07-01 00:00:00 | 443.46 | N | Y | N/A | N/A
L5628 | ADD TO LWR EXT, TEST SOCKET HEMIPELVECTOMY | 2011-07-01 00:00:00 | 490.32 | N | Y | N/A | N/A
[NAME] | ADD TO LWR EXT, BELOW KNEE ACRYLIC SOCKET | 2011-07-01 00:00:00 | 257.72 | N | Y | N/A | N/A
L5630 | ADD TO LWR EXT, SYME TYPE EXP WALL SOCKET | 2011-07-01 00:00:00 | 410.72 | N | Y | N/A | N/A
L5631 | ADD TO LWR EXT, AK/KNEE DISART ACRYLIC SOCKET | 2011-07-01 00:00:00 | 356.33 | N | Y | N/A | N/A
L5632 | ADD TO L EXT,SYMES TYPEPTB BRIM DESIGN SOCKET | 2011-07-01 00:00:00 | 240.09 | N | Y | N/A | N/A
L5634 | ADD TO LWR EXT,SYMES POSTERIOR OPENING SOCKET | 2011-07-01 00:00:00 | 286.03 | N | Y | N/A | N/A
L5636 | ADD TO LWR EXT, SYMES MEDIAL OPENING SOCKET | 2011-07-01 00:00:00 | 254.93 | N | Y | N/A | N/A
L5637 | ADD TO LWR EXT, BELOW KNEE TOTAL CONTACT | 2011-07-01 00:00:00 | 241.44 | N | Y | N/A | N/A
[NAME] | ADD TO LWR EXT, BELOW KNEE LEATHER SOCKET | 2011-07-01 00:00:00 | 447.4 | N | Y | N/A | N/A
[NAME] | ADD TO LWR EXT, BELOW KNEE WOOD SOCKET | 2011-07-01 00:00:00 | 1024.8 | N | Y | N/A | N/A
L5640 | ADD TO LWR EXT, KNEE DISARTIC LEATHER SOCKET | 2011-07-01 00:00:00 | 678.73 | N | Y | N/A | N/A
L5642 | ADD TO LWR EXT, ABOVE KNEE LEATHER SOCKET | 2011-07-01 00:00:00 | 669.94 | N | Y | N/A | N/A
L5643 | ADD TO L EXT,HIP DISART FLEXIBLE INNER SOCKET | 2011-07-01 00:00:00 | 1449.02 | N | Y | N/A | N/A
L5644 | ADD TO LWR EXT, ABOVE KNEE WOOD SOCKET | 2011-07-01 00:00:00 | 534.82 | N | Y | N/A | N/A
L5645 | ADD TO L EXT,BK FLEXIBLE INNER SOCKET EXTERNL | 2011-07-01 00:00:00 | 647.07 | N | Y | N/A | N/A
L5646 | ADD TO L EXT, BK AIR FLUID/GEL CUSHION SOCKET | 2011-07-01 00:00:00 | 475.66 | N | Y | N/A | N/A
L5647 | ADD TO LOWER EXT, BELOW KNEE SUCTION SOCKET | 2011-07-01 00:00:00 | 645.1 | N | Y | N/A | N/A
L5648 | ADD TO LOWER EXT, AK AIR FLUID CUSHION SOCKET | 2011-07-01 00:00:00 | 533.93 | N | Y | N/A | N/A
L5649 | ADD TO L EXT,ISCHIAL CNTAINMNT/NRRW M-L SOCKT | 2011-07-01 00:00:00 | 1632.13 | N | Y | N/A | N/A
L5650 | ADD TO L EXT,TOTAL CONTCT AK/KNEE DISART SCKT | 2011-07-01 00:00:00 | 465.41 | N | Y | N/A | N/A
L5651 | ADD TO L EXT,AK FLXIBL INNER SOCKET EXT FRAME | 2011-07-01 00:00:00 | 973.92 | N | Y | N/A | N/A
L5652 | ADD TO LWR EXT, SUCTION SUSP AK/KNEE DISART | 2011-07-01 00:00:00 | 353.57 | N | Y | N/A | N/A
L5653 | ADD TO LWR EXT,KNEE DISART EXPAND WALL SOCKET | 2011-07-01 00:00:00 | 580.09 | N | Y | N/A | N/A
L5654 | ADD TO LWR EXT, SOCKET INSERT SYMES | 2011-07-01 00:00:00 | 314.19 | N | Y | N/A | N/A
L5655 | ADD TO LWR EXT, SOCKET INSERT BELOW KNEE | 2011-07-01 00:00:00 | 281.53 | N | Y | N/A | N/A
L5656 | ADD TO LWR EXT, SOCKET INSERT KNEE DISARTICUL | 2011-07-01 00:00:00 | 401.11 | N | Y | N/A | N/A
L5658 | ADD TO LWR EXT, SOCKET INSERT ABOVE KNEE | 2011-07-01 00:00:00 | 393.16 | N | Y | N/A | N/A
L5661 | ADD TO L EXT,SOCKT INSRT MULTIDUROMETER SYMES | 2011-07-01 00:00:00 | 493.52 | N | Y | N/A | N/A
L5665 | ADD TO L EXT,SOCKET INSERT MULTI-DUROMETER BK | 2011-07-01 00:00:00 | 415.24 | N | Y | N/A | N/A
L5666 | BELOW KNEE CUFF SUSPENSION | 2011-07-01 00:00:00 | 57.61 | N | Y | N/A | N/A
L5668 | ADD TO L EXT,BELOW KNEE MOLDED DISTAL CUSHION | 2011-07-01 00:00:00 | 90.99 | N | Y | N/A | N/A
L5670 | ADD TO LWR EXT, BK MOLDED SUPRACONDYLAR SUSP | 2011-07-01 00:00:00 | 240.19 | N | Y | N/A | N/A
L5671 | ADD TO LWR EXT, BK/AK SUSP LOCKING MECHANISM | 2011-07-01 00:00:00 | 537.85 | N | Y | N/A | N/A
L5672 | ADD TO L EXT, BK REMOV MEDIAL BRIM SUSPENSION | 2011-07-01 00:00:00 | 261.69 | N | Y | N/A | N/A
[NAME] | ADD TO L EXT, BK/BK SOCKET INSERT W/LOCK MECH | 2011-07-01 00:00:00 | 580.91 | N | Y | N/A | N/A
L5676 | ADD TO L EXT, BK KNEE JOINTS SINGLE AXIS PAIR | 2011-07-01 00:00:00 | 342.34 | N | Y | N/A | N/A
L5677 | ADD TO L EXT, BK KNEE JOINTS POLYCENTRIC PAIR | 2011-07-01 00:00:00 | 435.81 | N | Y | N/A | N/A
L5678 | ADD TO LOWER EXTREMITY, BK JOINT COVERS PAIR | 2011-07-01 00:00:00 | 38.38 | N | Y | N/A | N/A
L5679 | ADD TO L EXT,AK/BK SOCKET INSRT W/LOCKNG MECH | 2011-07-01 00:00:00 | 484.09 | N | Y | N/A | N/A
L5680 | ADD TO LWR EXTREM, BK THIGH LACER NON-MOLDED | 2011-07-01 00:00:00 | 287.53 | N | Y | N/A | N/A
L5681 | ADD TO L EXT,AK/BK CUSTOM FAB CONGEN/ATYPICAL | 2011-07-01 00:00:00 | 1047.22 | N | Y | N/A | N/A
L5682 | ADD TO L EXT,BK THIGH LACER GLUT/ISCHIAL MOLD | 2011-07-01 00:00:00 | 512.76 | N | Y | N/A | N/A
L5683 | ADD TO L EXT,BK/AK SOCKT INSERT OTR THAN CONG | 2011-07-01 00:00:00 | 1047.22 | N | Y | N/A | N/A
L5684 | ADD TO LOWER EXTREMITY, BK FORK STRAP | 2011-07-01 00:00:00 | 52.05 | N | Y | N/A | N/A
L5685 | BELOW KNEE SUSPENSION/SEALING SLEEVE | 2011-07-01 00:00:00 | 101.97 | N | Y | N/A | N/A
L5686 | ADD TO LOWER EXTREMITY, BK BACK CHECK | 2011-07-01 00:00:00 | 51.7 | N | Y | N/A | N/A
L5688 | ADD TO LOWER EXTREMITY, BK WAIST BELT WEBBING | 2011-07-01 00:00:00 | 56.6 | N | Y | N/A | N/A
L5690 | ADD TO LWR EXTREM, BK WAIST BELT PADDED/LINED | 2011-07-01 00:00:00 | 86.07 | N | Y | N/A | N/A
L5692 | ADD TO LOWR EXT, AK PELVIC CONTROL BELT LIGHT | 2011-07-01 00:00:00 | 126.47 | N | Y | N/A | N/A
L5694 | ADD TO L EXT,AK PELVIC CTRL BELT PADDED/LINED | 2011-07-01 00:00:00 | 195.4 | N | Y | N/A | N/A
L5695 | ADD TO AK PELVIC CTRL SUSP SLV NEOPRENE/EQUAL | 2011-07-01 00:00:00 | 132.26 | N | Y | N/A | N/A
L5696 | ADD TO L EXT,AK/KNEE/KNEE DISART PELVIC JOINT | 2011-07-01 00:00:00 | 200.06 | N | Y | N/A | N/A
L5697 | ADD TO LWR EXT, AK/KNEE DISARTIC PELVIC BAND | 2011-07-01 00:00:00 | 86.81 | N | Y | N/A | N/A
L5698 | ADD TO L EXT, AK/KNEE DISARTIC SILESIAN BNDG | 2011-07-01 00:00:00 | 101.41 | N | Y | N/A | N/A
[NAME] | ALL LWR EXTREMITY PROSTHESES,SHOULDER HARNESS | 2011-07-01 00:00:00 | 199.35 | N | Y | N/A | N/A
L5700 | REPLACEMENT SOCKET BK MOLDED TO PATIENT MODEL | 2011-07-01 00:00:00 | 2961.21 | N | Y | N/A | N/A
L5701 | REPLACEMENT SOCKET AK MOLDED TO PATIENT MODEL | 2011-07-01 00:00:00 | 3598.49 | N | Y | N/A | N/A
L5702 | REPLACEMENT SOCKET, HIP DISARTICUL HIP JOINT | 2011-07-01 00:00:00 | 4308.87 | N | Y | N/A | N/A
L5703 | SYMES ANKLE W/O (SACH) FOOT REPLACEMENT ONLY | 2011-07-01 00:00:00 | 1987.15 | N | Y | N/A | N/A
L5704 | CUSTOM SHAPED PROTECTIVE COVER, BELOW KNEE | 2011-07-01 00:00:00 | 494.54 | N | Y | N/A | N/A
L5705 | CUSTOM SHAPED PROTECTIVE COVER, ABOVE KNEE | 2011-07-01 00:00:00 | 811.88 | N | Y | N/A | N/A
[NAME] | CUSTOM SHAPE COVER ,KNEE DISARTICULATION | 2011-07-01 00:00:00 | 804.68 | N | Y | N/A | N/A
L5707 | CUSTOM SHAPED COVER, HIP DISARTICULATION | 2011-07-01 00:00:00 | 1143.89 | N | Y | N/A | N/A
L5710 | KNEE-SHIN EXOSKELETAL SINGLE AXIS MANUAL LOCK | 2011-07-01 00:00:00 | 369 | N | Y | N/A | N/A
L5711 | KNEE-SHIN EXOSKELETAL MANUAL LOCK ULTRA LIGHT | 2011-07-01 00:00:00 | 499.54 | N | Y | N/A | N/A
L5712 | KNEE-SHIN EXOSKELETAL FRICTION SWING & STANCE | 2011-07-01 00:00:00 | 448.45 | N | Y | N/A | N/A
[NAME] | KNEE-SHIN EXOSKELETAL VARIABLE FRICTION SWING | 2011-07-01 00:00:00 | 339.21 | N | Y | N/A | N/A
L5716 | KNEE-SHIN EXOSKELETAL MECHANICAL STANCE PHASE | 2011-07-01 00:00:00 | 591.08 | N | Y | N/A | N/A
L5718 | KNEE-SHIN EXOSKELETAL FRICTION SWING & STANCE | 2011-07-01 00:00:00 | 738.78 | N | Y | N/A | N/A
[NAME] | KNEE-SHIN EXOSKELETAL PNEUMATIC SWING FRICTIO | 2011-07-01 00:00:00 | 860.19 | N | Y | N/A | N/A
L5724 | KNEE-SHIN EXOSKELETAL FLUID SWING PHASE | 2011-07-01 00:00:00 | 1302.53 | N | Y | N/A | N/A
L5726 | KNEE-SHIN EXOSKELETAL EXTERNAL JOINTS FLUID | 2011-07-01 00:00:00 | 1576.35 | N | Y | N/A | N/A
L5728 | KNEE-SHIN EXOSKELETAL FLUID SWING & STANCE | 2011-07-01 00:00:00 | 2097.91 | N | Y | N/A | N/A
L5780 | KNEE-SHIN PNEUMATIC/HYDRAPNEUMATIC SWING | 2011-07-01 00:00:00 | 928.49 | N | Y | N/A | N/A
L5781 | LOWER LIMB PROSTHESIS VACUUM PUMP | 2011-07-01 00:00:00 | 3185.47 | N | Y | N/A | N/A
L5782 | HEAVY DUTY LOWER LIMB PROSTHESIS VACUUM PUMP | 2011-07-01 00:00:00 | 3358.21 | N | Y | N/A | N/A
L5785 | ADDITION, EXOSKELETAL BK ULTRA LIGHT MATERIAL | 2011-07-01 00:00:00 | 503.34 | N | Y | N/A | N/A
L5790 | ADDITION, [NAME] | 2011-07-01 00:00:00 | 606.05 | N | Y | N/A | N/A
L5795 | ADDITION,EXOSKELETAL HIP DISARTIC ULTRA-LIGHT | 2011-07-01 00:00:00 | 870.74 | N | Y | N/A | N/A
L5810 | [NAME] 1 AXIS MANUAL LOCK | 2011-07-01 00:00:00 | 450.89 | N | Y | N/A | N/A
L5811 | [NAME] MANUAL LOCK ULTRALIGHT | 2011-07-01 00:00:00 | 591.46 | N | Y | N/A | N/A
L5812 | [NAME] FRICTION SWING &STANCE | 2011-07-01 00:00:00 | 511.88 | N | Y | N/A | N/A
L5814 | [NAME] HYDRAULIC SWING PHASE | 2011-07-01 00:00:00 | 2956.76 | N | Y | N/A | N/A
[NAME] | [NAME] MECHANICAL STANCE LOCK | 2011-07-01 00:00:00 | 689.69 | N | Y | N/A | N/A
L5818 | [NAME] FRICTION SWING &STANCE | 2011-07-01 00:00:00 | 778.8 | N | Y | N/A | N/A
L5822 | [NAME] PNEUMATIC SWING FRIC | 2011-07-01 00:00:00 | 1381.01 | N | Y | N/A | N/A
[NAME] | [NAME] FLUID SWING PHASE | 2011-07-01 00:00:00 | 1243.69 | N | Y | N/A | N/A
L5826 | [NAME] HYDRAULIC SWING PHASE | 2011-07-01 00:00:00 | 2582.73 | N | Y | N/A | N/A
L5828 | [NAME] | 2011-07-01 00:00:00 | 2290.15 | N | Y | N/A | N/A
L5830 | [NAME] PNEUMATIC SWING PHASE | 2011-07-01 00:00:00 | 1996.83 | N | Y | N/A | N/A
[NAME] | [NAME] PNEUMATIC | 2011-07-01 00:00:00 | 3273.26 | N | Y | N/A | N/A
L5845 | [NAME] SYSTEM STANCE FLEXION | 2011-07-01 00:00:00 | 1426.97 | N | Y | N/A | N/A
L5848 | KNEE-SHIN SYSTEM HYDRAULIC [NAME] | 2011-07-01 00:00:00 | 856.11 | N | Y | N/A | N/A
L5850 | ENDOSKELETAL AK/HIP KNEE EXTENSION ASSIST | 2011-07-01 00:00:00 | 103.74 | N | Y | N/A | N/A
L5855 | ENDOSKELETAL MECHANICAL HIP EXTENSION ASSIST | 2011-07-01 00:00:00 | 333.94 | N | Y | N/A | N/A
L5858 | STANCE PHASE ONLY, ENDOSKELETAL KNEE SHIN SYS | 2011-07-01 00:00:00 | 14796.35 | N | Y | N/A | N/A
L5910 | ENDOSKELETAL BELOW KNEE ALIGNABLE SYSTEM | 2011-07-01 00:00:00 | 293.72 | N | Y | N/A | N/A
L5920 | ENDOSKELETAL ABOVE KNEE/HIP ALIGNABLE SYSTEM | 2011-07-01 00:00:00 | 430.3 | N | Y | N/A | N/A
L5925 | ENDOSKELETAL [NAME] DISARTICULATION LOCK | 2011-07-01 00:00:00 | 353.69 | N | Y | N/A | N/A
L5930 | ENDOSKELETAL HIGH ACTIVITY KNEE CONTROL FRAME | 2011-07-01 00:00:00 | 2679.73 | N | Y | N/A | N/A
L5940 | ENDOSKELETAL BELOW KNEE ULTRA-LIGHT MATERIAL | 2011-07-01 00:00:00 | 505.77 | N | Y | N/A | N/A
[NAME] | ENDOSKELETAL ABOVE KNEE ULTRA-LIGHT MATERIAL | 2011-07-01 00:00:00 | 726.98 | N | Y | N/A | N/A
L5960 | ENDOSKELETAL HIP DISARTICULATION ULTRA-LIGHT | 2011-07-01 00:00:00 | 830.92 | N | Y | N/A | N/A
L5962 | ENDOSKELETAL BK FLEXIBLE COVERING SYSTEM | 2011-07-01 00:00:00 | 635.58 | N | Y | N/A | N/A
[NAME] | ENDOSKELETAL AK FLEXIBLE COVERING SYSTEM | 2011-07-01 00:00:00 | 914.97 | N | Y | N/A | N/A
L5966 | ENDOSKELETAL HIP DISARTICULATION FLEXIBLE | 2011-07-01 00:00:00 | 1186.22 | N | Y | N/A | N/A
L5968 | MULTIAXIAL ANKLE SWING PHASE DORSIFLEXION | 2011-07-01 00:00:00 | 2893.1 | N | Y | N/A | N/A
L5970 | ADD TO PROSTHESES FOOT EXTERNAL KEEL EA FOOT | 2011-07-01 00:00:00 | 198.94 | N | Y | N/A | N/A
L5971 | [NAME], REPLACEMENT | 2011-07-01 00:00:00 | 198.94 | N | Y | N/A | N/A
[NAME] | ADD TO PROSTHESES FLEXIBLE KEEL FOOT | 2011-07-01 00:00:00 | 317.93 | N | Y | N/A | N/A
L5974 | ADD TO PROSTHESES FOOT SINGLE AXIS ANKLE/FOOT | 2011-07-01 00:00:00 | 251.97 | N | Y | N/A | N/A
L5975 | ADD TO PROSTHESES COMBO SINGLE AXIS ANKLE | 2011-07-01 00:00:00 | 369.08 | N | N | N/A | N/A
L5976 | ADD TO PROSTHESES ENERGY STORING FOOT | 2011-07-01 00:00:00 | 507.71 | N | Y | N/A | N/A
L5978 | ADD TO PROSTHESES FOOT MULTIAXIAL ANKLE/FOOT | 2011-07-01 00:00:00 | 286.94 | N | Y | N/A | N/A
L5979 | ADD TO PROSTHESES MULTIAXIAL ANKLE/FOOT | 2011-07-01 00:00:00 | 2444.49 | Y | Y | N/A | N/A
L5980 | ADD TO PROSTHESES FLEX FOOT SYSTEM | 2011-07-01 00:00:00 | 3287.71 | Y | Y | N/A | N/A
[NAME] | ADD TO PROSTHESES FLEX-WALK SYSTEM | 2011-07-01 00:00:00 | 2656.46 | Y | Y | N/A | N/A
L5982 | EXOSKELETAL LOWER EXT AXIAL ROTATION UNIT | 2011-07-01 00:00:00 | 619.71 | N | Y | N/A | N/A
[NAME] | ENDOSKELETAL LOWER EXT AXIAL ROTATION UNIT | 2011-07-01 00:00:00 | 585.87 | N | Y | N/A | N/A
L5985 | ENDOSKELETAL LWR EXT DYNAMIC PROSTHETIC PYLON | 2011-07-01 00:00:00 | 224.82 | N | Y | N/A | N/A
L5986 | LOWER EXTREMITY MULTI-AXIAL ROTATION UNIT | 2011-07-01 00:00:00 | 620.09 | N | Y | N/A | N/A
L5987 | LWR EXT SHANK FOOT SYS VERTICAL LOADING PYLON | 2011-07-01 00:00:00 | 5727.19 | N | Y | N/A | N/A
L5988 | LWR [NAME] SHOCK REDUC PYLON | 2011-07-01 00:00:00 | 1590.45 | N | Y | N/A | N/A
[NAME] | LWR LIMB PROSTHESIS USER ADJUSTABLE HEEL HGT | 2011-07-01 00:00:00 | 1444.36 | N | Y | N/A | N/A
[NAME] | UNLISTED PROCEDURE, LOWER EXTREMITY PROSTHESIS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L6000 | PARTIAL HAND ROBIN-AIDS THUMB REMAINING | 2011-07-01 00:00:00 | 1436.72 | N | Y | N/A | N/A
L6010 | PARTIAL HAND ROBIN-AIDS LITTLE/RING FINGER | 2011-07-01 00:00:00 | 1598.83 | N | Y | N/A | N/A
L6020 | PARTIAL HAND ROBIN-AIDS NO FINGER REMAINING | 2011-07-01 00:00:00 | 1490.66 | N | Y | N/A | N/A
L6050 | WRIST MOLD SOCKET FLEXIBLE HINGES TRICEPS PAD | 2011-07-01 00:00:00 | 1760.71 | N | Y | N/A | N/A
L6055 | WRIST MOLD SOCKET WITH EXPANDABLE INTERFACE | 2011-07-01 00:00:00 | 2629.01 | N | Y | N/A | N/A
L6100 | BELOW ELBOW MOLD SOCKET FLEXIBLE HINGE TRICEP | 2011-07-01 00:00:00 | 1896.52 | N | Y | N/A | N/A
L6110 | BELOW ELBOW MOLD SOCKET SUSPENSION TYPES | 2011-07-01 00:00:00 | 1934.32 | N | Y | N/A | N/A
L6120 | BELOW ELBOW MOLD DOUBLE [NAME] | 2011-07-01 00:00:00 | 2432.34 | N | Y | N/A | N/A
L6130 | BELOW ELBOW STUMP ACTIVATED LOCKING HINGES | 2011-07-01 00:00:00 | 2799.19 | N | Y | N/A | N/A
L6200 | ELBOW DISARTIC MOLDED OUTSIDE LOCKING HINGE | 2011-07-01 00:00:00 | 2872.72 | N | Y | N/A | N/A
L6205 | ELBOW DISARTIC MOLDED W/EXPANDABLE INTERFACE | 2011-07-01 00:00:00 | 3599.1 | N | Y | N/A | N/A
L6250 | ABOVE ELBOW INTERNAL LOCKING ELBOW FOREARM | 2011-07-01 00:00:00 | 2679.01 | N | Y | N/A | N/A
L6300 | SHOULDER DISARTICULATION INTERNAL LOCK ELBOW | 2011-07-01 00:00:00 | 3768.37 | N | Y | N/A | N/A
[NAME] | SHOULDER DISARTICULATION PASSIVE RESTORE | 2011-07-01 00:00:00 | 3128.06 | N | Y | N/A | N/A
L6320 | SHOULDER DISTARTICULATION PASSIVE RESTORE CAP | 2011-07-01 00:00:00 | 1385.91 | N | Y | N/A | N/A
L6350 | INTERSCAP THORACIC MOLD SOCKET INT LOCK ELBOW | 2011-07-01 00:00:00 | 4235.39 | N | Y | N/A | N/A
L6360 | INTERSCAPULR THORACIC PASSIVE RESTOR COMPLETE | 2011-07-01 00:00:00 | 3444.15 | N | Y | N/A | N/A
L6370 | INTERSCAPLR THORACIC PASSIVE RESTOR SHLDR CAP | 2011-07-01 00:00:00 | 1647.16 | N | Y | N/A | N/A
L6380 | POSTOP RIGID DRESSING CAST CHANGE WRIST/ELBOW | 2011-07-01 00:00:00 | 1108.99 | N | Y | N/A | N/A
[NAME] | POSTOP DRESSING CAST CHANGE ELBOW DISARTICULA | 2011-07-01 00:00:00 | 1305.54 | N | Y | N/A | N/A
L6384 | POSTOP DRESSING CAST CHANGE SHOULDER/THORACIC | 2011-07-01 00:00:00 | 1652.81 | N | Y | N/A | N/A
L6386 | POSTOP EACH ADDTNL CAST CHANGE & REALIGNMENT | 2011-07-01 00:00:00 | 374.36 | N | Y | N/A | N/A
L6388 | POSTOP DRSSNG APPLICATION RIGID DRESSING ONLY | 2011-07-01 00:00:00 | 411.46 | N | Y | N/A | N/A
L6400 | BELOW ELBOW SOFT PROSTHETIC TISSUE SHAPING | 2011-07-01 00:00:00 | 2099.6 | N | Y | N/A | N/A
L6450 | ELBOW DISARTICULATION SOFT PROSTHETIC TISSUE | 2011-07-01 00:00:00 | 2850.18 | N | Y | N/A | N/A
L6500 | ABOVE ELBOW SOFT PROSTHETIC TISSUE SHAPING | 2011-07-01 00:00:00 | 2882.75 | N | Y | N/A | N/A
L6550 | SHOULDER DISARTICULATION PROSTHETIC SHAPING | 2011-07-01 00:00:00 | 3856.31 | N | Y | N/A | N/A
L6570 | INTERSCAPULAR THORACIC PROSTHETIC TISSUE SHAP | 2011-07-01 00:00:00 | 4298.67 | N | Y | N/A | N/A
L6580 | WRIST/ELBOW DISARTICULATION BOWDEN CABLE MOLD | 2011-07-01 00:00:00 | 1460.85 | N | Y | N/A | N/A
L6582 | WRIST/ELBOW BOWDEN CABLE CONTROL EQUAL PYLON | 2011-07-01 00:00:00 | 1160.89 | N | Y | N/A | N/A
L6584 | ABOVE ELBOW FAIR LEAD CABLE CONTROL MOLDED | 2011-07-01 00:00:00 | 1972.44 | N | Y | N/A | N/A
L6586 | ABOVE ELBOW FAIR LEAD CABLE DIRECT FORMED | 2011-07-01 00:00:00 | 1685.75 | N | Y | N/A | N/A
L6588 | SHOULDER DISARTICULATION FAIR LEAD CABLE MOLD | 2011-07-01 00:00:00 | 2854.31 | N | Y | N/A | N/A
L6590 | SHOULDER JOINT FAIR LEAD CABLE DIRECT FORMED | 2011-07-01 00:00:00 | 2630.01 | N | Y | N/A | N/A
L6600 | UPPER EXTREMITY ADDTNS,[NAME] | 2011-07-01 00:00:00 | 164.83 | N | Y | N/A | N/A
L6605 | UPPR EXTREMITY ADDTNS,SINGLE PIVOT HINGE PAIR | 2011-07-01 00:00:00 | 155.5 | N | Y | N/A | N/A
L6610 | UPPER EXTREMITY ADD,FLEXIBLE METAL HINGE PAIR | 2011-07-01 00:00:00 | 141.82 | N | Y | N/A | N/A
L6615 | UPPER EXTREMITY DISCONNECT LOCKING WRIST UNIT | 2011-07-01 00:00:00 | 173.32 | N | Y | N/A | N/A
L6616 | DISCONNECT INSERT LOCKING WRIST UNIT EACH | 2011-07-01 00:00:00 | 63.17 | N | Y | N/A | N/A
L6620 | UPR EXT ADD, [NAME] WRIST UNIT W/WO FRICTION | 2011-07-01 00:00:00 | 271.47 | N | Y | N/A | N/A
[NAME] | [NAME]/EXTENSION WRIST W/WO FRICTION | 2011-07-01 00:00:00 | 1821.01 | N | Y | N/A | N/A
L6623 | SPRING ASSISTED ROTATIONAL WRIST WITH LATCH | 2011-07-01 00:00:00 | 583.98 | N | Y | N/A | N/A
L6624 | [NAME]/EXTENSION/ROTATION WRIST UNIT | 2011-07-01 00:00:00 | 2998.33 | N | Y | N/A | N/A
L6625 | ROTATION WRIST UNIT WITH CABLE LOCK | 2011-07-01 00:00:00 | 499.44 | N | Y | N/A | N/A
L6628 | QUICK DISCONNECT HOOK ADAPTER OTTO BOCK | 2011-07-01 00:00:00 | 469.03 | N | Y | N/A | N/A
[NAME] | QUICK DISCONNECT LAMINATION COLLAR COUPLING | 2011-07-01 00:00:00 | 118.87 | N | Y | N/A | N/A
L6630 | UPPER EXT ADDTIONS, STAINLESS STEEL ANY WRIST | 2011-07-01 00:00:00 | 174.78 | N | Y | N/A | N/A
L6632 | UPR EXT ADD, LATEX SUSPENSION SLEEVE EACH | 2011-07-01 00:00:00 | 52.7 | N | Y | N/A | N/A
L6635 | UPPER EXT ADDTIONS, LIFT ASSIST FOR ELBOW | 2011-07-01 00:00:00 | 153.23 | N | Y | N/A | N/A
L6637 | UPPER EXT ADDTIONS, NUDGE CONTROL ELBOW LOCK | 2011-07-01 00:00:00 | 352.37 | N | Y | N/A | N/A
L6640 | UPR EXT ADD, SHOULDER ABDUCTION JOINT PAIR | 2011-07-01 00:00:00 | 279.4 | N | Y | N/A | N/A
[NAME] | UPR EXT ADD, EXCURSION AMPLIFIER PULLEY TYPE | 2011-07-01 00:00:00 | 139.27 | N | Y | N/A | N/A
L6642 | UPR EXT ADD, EXCURSION AMPLIFIER LEVER TYPE | 2011-07-01 00:00:00 | 188.36 | N | Y | N/A | N/A
L6645 | SHOULDER [NAME] FRICTION CTR | 2011-07-01 00:00:00 | 321.5 | N | Y | N/A | N/A
L6650 | UPPER EXTREMITY SHOULDER UNIVERSAL JOINT EACH | 2011-07-01 00:00:00 | 277.28 | N | Y | N/A | N/A
L6655 | UPPER EXTREMITY STANDARD CONTROL CABLE EXTRA | 2011-07-01 00:00:00 | 81.23 | N | Y | N/A | N/A
[NAME] | UPPER EXTREMITY HEAVY DUTY CONTROL CABLE | 2011-07-01 00:00:00 | 85.99 | N | Y | N/A | N/A
L6665 | UPPER EXTREMITY TEFLON OR EQUAL CABLE LINING | 2011-07-01 00:00:00 | 39.99 | N | Y | N/A | N/A
L6670 | UPPER EXTREMITY HOOK TO HAND CABLE ADAPTER | 2011-07-01 00:00:00 | 41.35 | N | Y | N/A | N/A
L6672 | UPPER EXTREMITY HARNESS CHEST/SHOULDER SADDLE | 2011-07-01 00:00:00 | 156.99 | N | Y | N/A | N/A
L6675 | UPR EXT HARNESS FIGURE 8 SINGLE CABLE DESIGN | 2011-07-01 00:00:00 | 97.39 | N | Y | N/A | N/A
L6676 | UPR EXT HARNESS FIGURE OF 8 DUAL CABLE DESIGN | 2011-07-01 00:00:00 | 119.74 | N | Y | N/A | N/A
L6677 | UE TRIPLE CONTROL HARNESS | 2011-07-01 00:00:00 | 236.17 | N | Y | N/A | N/A
L6680 | TEST SOCKET WRIST DISARTICULATION BELOW ELBOW | 2011-07-01 00:00:00 | 192.93 | N | Y | N/A | N/A
L6682 | TEST SOCKET ELBOW DISARTICULATION ABOVE ELBOW | 2011-07-01 00:00:00 | 245.46 | N | Y | N/A | N/A
L6684 | TEST SOCKET SHOULDER DISARTICULATION/THORACIC | 2011-07-01 00:00:00 | 376.1 | N | Y | N/A | N/A
L6686 | UPPER EXTREMITY ADDITIONS, SUCTION SOCKET | 2011-07-01 00:00:00 | 539.19 | N | Y | N/A | N/A
L6687 | FRAME TYPE SOCKET BELOW ELBOW/WRIST DISARTICU | 2011-07-01 00:00:00 | 467.78 | N | Y | N/A | N/A
[NAME] | FRAME TYPE SOCK ABOVE ELBOW/DISARTICULATON | 2011-07-01 00:00:00 | 572.81 | N | Y | N/A | N/A
L6689 | FRAME TYPE SOCKET SHOULDER DISARTICULATION | 2011-07-01 00:00:00 | 701.08 | N | Y | N/A | N/A
L6690 | FRAME TYPE SOCK INTERSCAPULAR-THORACIC | 2011-07-01 00:00:00 | 743.52 | N | Y | N/A | N/A
L6691 | UPPER EXTREMITY ADDTNS, REMOVABLE INSERT EACH | 2011-07-01 00:00:00 | 321.66 | N | Y | N/A | N/A
L6692 | UPR EXT ADD,SILICONE GEL INSERT OR EQUAL EACH | 2011-07-01 00:00:00 | 453.53 | N | Y | N/A | N/A
L6693 | LOCKING ELBOW FOREARM COUNTERBALANCE | 2011-07-01 00:00:00 | 2260.24 | N | Y | N/A | N/A
L6694 | ELBOW SOCKET INSERT USE WITH LOCK | 2011-07-01 00:00:00 | 580.91 | N | Y | N/A | N/A
L6695 | ELBOW SOCKET INSERT USE W/O LOCK | 2011-07-01 00:00:00 | 484.09 | N | Y | N/A | N/A
[NAME] | CUSTOM ELBOW SKT IN FOR CON/ATYP | 2011-07-01 00:00:00 | 1047.22 | N | Y | N/A | N/A
L6697 | CUSTOM ELBOW SKT IN NOT CON/ATYP | 2011-07-01 00:00:00 | 1047.22 | N | Y | N/A | N/A
L6698 | BELOW/ABOVE ELBOW LOCK MECHANISM | 2011-07-01 00:00:00 | 537.85 | N | Y | N/A | N/A
L6703 | TERMINAL DEVICE, PASSIVE HAND/MITT | 2011-07-01 00:00:00 | 267.75 | N | Y | N/A | N/A
[NAME] | TERMINAL DEVICE, MECHANICAL HOOK VOL OPENING | 2011-07-01 00:00:00 | 323.27 | Y | Y | N/A | N/A
L6707 | TERMINAL DEVICE, MECHANICAL HOOK VOL CLOSING | 2011-07-01 00:00:00 | 1140.49 | Y | Y | N/A | N/A
L6708 | TERMINAL DEVICE, MECHANICAL HAND VOL OPENING | 2011-07-01 00:00:00 | 795.83 | Y | Y | N/A | N/A
L6709 | TERMINAL DEVICE, MECHANICAL HAND VOL CLOSING | 2011-07-01 00:00:00 | 1141.22 | Y | Y | N/A | N/A
L6711 | PEDIATRIC TERMINAL DEVICE, HOOK, VOLUNTARY OPEN | 2011-07-01 00:00:00 | 535.26 | Y | Y | N/A | N/A
L6712 | PEDIATRIC TERMINAL DEVICE, HOOK, VOLUNTARY CLOS | 2011-07-01 00:00:00 | 985.5 | Y | Y | N/A | N/A
L6713 | PEDIATRIC TERMINAL DEVICE, HAND, VOLUNTARY OPEN | 2011-07-01 00:00:00 | 1243.82 | Y | Y | N/A | N/A
L6714 | PEDIATRIC TERMINAL DEVICE, HAND, VOLUNTARY CLOS | 2011-07-01 00:00:00 | 1053.51 | Y | Y | N/A | N/A
L6721 | HOOK/HAND, HEAVY DUTY, VOLUNTARY OPENING | 2011-07-01 00:00:00 | 1872.49 | Y | Y | N/A | N/A
L6722 | HOOK/HAND, HEAVY DUTY, VOLUNTARY CLOSING | 2011-07-01 00:00:00 | 1614.22 | Y | Y | N/A | N/A
L6805 | MODIFIER WRIST [NAME] UNIT ADDITION TERM DEVICE | 2011-07-01 00:00:00 | 343.01 | N | Y | N/A | N/A
L6810 | TERMINAL DEVICE PRECISION PINCH DEVICE | 2011-07-01 00:00:00 | 162.31 | N | Y | N/A | N/A
L6881 | TERMINAL DEVICE AUTO GRASP FEATURE | 2011-07-01 00:00:00 | 3254.81 | Y | Y | N/A | N/A
L6882 | MICROPROCESSOR CONTROL UPPER LIMB PROSTHETIC | 2011-07-01 00:00:00 | 2468.91 | N | Y | N/A | N/A
[NAME] | REPLC SOCKET BELOW ELBOW/WRIST DISARTICULATIO | 2011-07-01 00:00:00 | 1661.88 | Y | Y | N/A | N/A
[NAME] | REPLC SOCKET ABOVE ELBOW DISARTICULATION | 2011-07-01 00:00:00 | 2270.95 | Y | Y | N/A | N/A
L6885 | REPLC SOCKET SHOULDER DISARTICUL/INTERSCAPULA | 2011-07-01 00:00:00 | 3444.15 | Y | Y | N/A | N/A
L6890 | TERMINAL DEVICE ABOVE HANDS PRODUCTION GLOVE | 2011-07-01 00:00:00 | 150.59 | N | Y | N/A | N/A
[NAME] | TERMINAL DEVICE ABOVE HANDS CUSTOM GLOVE | 2011-07-01 00:00:00 | 502.77 | N | Y | N/A | N/A
L6900 | HAND RESTORATION PARTIAL HAND THUMB/1 FINGER | 2011-07-01 00:00:00 | 1574.7 | N | Y | N/A | N/A
L6905 | HAND RESTORATION WITH GLOVE MULTIPLE FINGER | 2011-07-01 00:00:00 | 1587.58 | N | Y | N/A | N/A
L6910 | HAND RESTORATION WITH GLOVE NO FINGERS | 2011-07-01 00:00:00 | 1302.99 | N | Y | N/A | N/A
L6915 | HAND RESTORATION REPLACEMENT GLOVE FOR ABOVE | 2011-07-01 00:00:00 | 588.87 | N | Y | N/A | N/A
L7400 | ADD UE PROST BELOW ELBOW/WRIST DISAR, ULTLITE | 2011-07-01 00:00:00 | 244.01 | N | Y | N/A | N/A
L7401 | ADD UE PROST ABOVE/ELBOW ULTLITE MATERIAL | 2011-07-01 00:00:00 | 273.17 | N | Y | N/A | N/A
[NAME] | ADD UE PROST SHOULDER/INTRASCAPUL ULTLITE MAT | 2011-07-01 00:00:00 | 294.99 | N | Y | N/A | N/A
L7403 | ADD UE PROST BELOW ELBOW/WRIST ACRYLIC MAT | 2011-07-01 00:00:00 | 293.18 | N | Y | N/A | N/A
L7404 | ADD UE PROST ABOVE ELBOW ACRYLIC MATERIAL | 2011-07-01 00:00:00 | 442.5 | N | Y | N/A | N/A
L7405 | ADD UE PROST SHOULDER DISARTIC/INTERS ACRYLIC | 2011-07-01 00:00:00 | 578.74 | N | Y | N/A | N/A
L7510 | REPAIR PROSTHETIC DEVICE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | REPAIR PROSTHESIC DEVICE, LABOR PER 15 MIN | 2012-06-01 00:00:00 | 24.7 | N | Y | N/A | N/A
L7600 | PROSTHETIC DONNING SLEEVE, ANY MATERIAL | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | BREAST PROSTHESIS MASTECTOMY BRA | 2011-07-01 00:00:00 | 33.49 | N | Y | N/A | N/A
L8001 | BREAST PROSTHESIS MASTECTOMY BRA UNILATERAL | 2011-07-01 00:00:00 | 99.86 | N | Y | N/A | N/A
[NAME] | BREAST PROSTHESIS MASTECTOMY BRA BILATERAL | 2011-07-01 00:00:00 | 131.34 | N | Y | N/A | N/A
L8010 | BREAST PROSTHESIS  MASTECTOMY SLEEVE | 2008-01-01 00:00:00 | 54.8 | N | Y | N/A | N/A
L8015 | EXTERNAL BREAST PROSTHESIS GARMENT POST MASTE | 2011-07-01 00:00:00 | 49.56 | N | Y | N/A | N/A
L8020 | BREAST PROSTHESIS MASTECTOMY FORM | 2011-07-01 00:00:00 | 195.39 | N | Y | N/A | N/A
L8030 | BREAST PROSTHESIS SILICONE OR EQUAL | 2011-07-01 00:00:00 | 255.85 | N | Y | N/A | N/A
L8031 | BREAST PROSTHESIS, SILICONE OR EQUAL, WITH INTEGRAL ADHESIVE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L8032 | NIPPLE PROSTHESIS, REUSABLE, ANY TYPE, EACH | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
L8035 | CUSTOM BREAST PROSTHESIS POST MASTECTOMY | 2008-01-01 00:00:00 | 2696.96 | Y | Y | N/A | N/A
L8039 | BREAST PROSTHESIS, NOT OTHERWISE CLASSIFIED | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
L8040 | NASAL PROSTHESIS PROVIDED BY NON-PHYSICIAN | 2011-07-01 00:00:00 | 1990.47 | N | Y | N/A | N/A
L8041 | MIDFACIAL PROSTHESIS BY NON-PHYSICIAN | 2011-07-01 00:00:00 | 2399.32 | N | Y | N/A | N/A
L8042 | ORBITAL PROSTHESIS PROVIDED BY NON-PHYSICIAN | 2011-07-01 00:00:00 | 2695.84 | N | Y | N/A | N/A
[NAME] | UPPER FACIAL PROSTHESIS BY NON-PHYSICIAN | 2011-07-01 00:00:00 | 3019.35 | N | Y | N/A | N/A
L8044 | [NAME] PROSTHESIS BY NON-PHYSICIAN | 2011-07-01 00:00:00 | 3342.85 | N | Y | N/A | N/A
L8045 | AURICULAR PROSTHESIS BY NON-PHYSICIAN | 2011-07-01 00:00:00 | 2098.44 | N | Y | N/A | N/A
L8046 | PARTIAL FACIAL PROSTHESIS BY NON-PHYSICIAN | 2011-07-01 00:00:00 | 2156.67 | N | Y | N/A | N/A
L8047 | NASAL SEPTAL PROSTHESIS BY NON-PHYSICIAN | 2011-07-01 00:00:00 | 1105.29 | N | Y | N/A | N/A
L8048 | UNSPECIFIED MAXILLOFACIAL PROSTHESIS BY REPORT PROVIDED BY NON PHYSICIAN | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L8300 | [NAME] SINGLE WITH STANDARD PAD | 2011-07-01 00:00:00 | 85 | N | Y | N/A | N/A
L8310 | [NAME] WITH STANDARD PADS | 2011-07-01 00:00:00 | 119.05 | N | Y | N/A | N/A
L8320 | [NAME] | 2011-07-01 00:00:00 | 45.32 | N | Y | N/A | N/A
L8330 | [NAME] | 2011-07-01 00:00:00 | 40.04 | N | Y | N/A | N/A
L8400 | PROSTHETIC SHEATH BELOW KNEE EACH | 2011-07-01 00:00:00 | 15.05 | N | Y | N/A | N/A
L8410 | PROSTHETIC SHEATH ABOVE KNEE EACH | 2011-07-01 00:00:00 | 21.45 | N | Y | N/A | N/A
L8415 | PROSTHETIC SHEATH UPPER LIMB | 2011-07-01 00:00:00 | 22.02 | N | Y | N/A | N/A
L8417 | PROSTHETIC SHEATH/SOCK GEL CUSHION LAYER | 2011-07-01 00:00:00 | 59.87 | N | Y | N/A | N/A
L8420 | PROSTHETIC SOCK MULTIPLE PLY BELOW KNEE | 2011-07-01 00:00:00 | 16.27 | N | Y | N/A | N/A
L8430 | PROSTHETIC SOCK MULTIPLE PLY ABOVE KNEE | 2011-07-01 00:00:00 | 18.59 | N | Y | N/A | N/A
L8435 | PROSTHETIC SOCK MULTIPLE PLY  UPPER LIMB | 2011-07-01 00:00:00 | 22.73 | N | Y | N/A | N/A
L8440 | PROSTHETIC SHRINKER BELOW KNEE | 2011-07-01 00:00:00 | 33.91 | N | Y | N/A | N/A
L8460 | PROSTHETIC SHRINKER ABOVE KNEE | 2011-07-01 00:00:00 | 70.78 | N | Y | N/A | N/A
L8465 | PROSTHETIC SHRINKER UPPER LIMB | 2011-07-01 00:00:00 | 39.56 | N | Y | N/A | N/A
L8470 | PROSTHETIC SOCK SINGLE PLY FITTING BELOW KNEE | 2011-07-01 00:00:00 | 5.41 | N | Y | N/A | N/A
L8480 | PROSTHETIC SOCK SINGLE PLY FITTING ABOVE KNEE | 2011-07-01 00:00:00 | 9.95 | N | Y | N/A | N/A
L8485 | PROSTHETIC SOCK SINGLE PLY FITTING UPPER LIMB | 2011-07-01 00:00:00 | 11.66 | N | Y | N/A | N/A
L8499 | UNLISTED PROCEDURE, PROSTHETIC SERVICES | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
L8500 | ARTIFICIAL LARYNX ANY TYPE | 2011-07-01 00:00:00 | 633.14 | N | Y | N/A | N/A
L8501 | TRACHEOSTOMY SPEAKING VALVE | 2011-07-01 00:00:00 | 97.97 | N | Y | N/A | N/A
L8505 | ARTIFICIAL LARYNX REPLACEMENT BATTERY/ACCESSORY, ANY TYPE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L8507 | TRACH-ESOPHAGEAL VOICE PROSTHESIS PATIENT INS | 2011-07-01 00:00:00 | 33.35 | N | Y | N/A | N/A
L8509 | TRACH-ESOPHAGEAL VOICE PROSTHESIS INSERTED PR | 2011-07-01 00:00:00 | 86.95 | N | Y | N/A | N/A
L8510 | VOICE AMPLIFIER | 2011-07-01 00:00:00 | 201.17 | N | Y | N/A | N/A
L8511 | INSERT FOR INDWELLING TRACHEOESOPHAGEAL PROST | 2011-07-01 00:00:00 | 57.91 | N | Y | N/A | N/A
L8512 | GELATIN CAPSULE FOR TRACHEOESOPHAGEAL VOICE | 2011-07-01 00:00:00 | 1.72 | N | Y | N/A | N/A
L8513 | CLEANING DEVICE TRACHEOESOPHAGEAL PROSTHESIS | 2011-07-01 00:00:00 | 4.14 | N | Y | N/A | N/A
L8514 | TRACHEOESOPHAGEAL PUNCTURE DILATOR REPLACEMNT | 2011-07-01 00:00:00 | 75.08 | N | Y | N/A | N/A
L8515 | [NAME] APP DEVICE FOR TRACHEOESOPHAGEAL | 2011-07-01 00:00:00 | 50.25 | N | Y | N/A | N/A
[NAME] | [NAME] | 2008-01-01 00:00:00 | 546.87 | Y | Y | N/A | N/A
[NAME] | COLLAGEN IMPLANT URINARY TRACT 2.5 ML SYRINGE | 2008-01-01 00:00:00 | 330.32 | N | Y | N/A | N/A
L8604 | INJECTABLE BULKING AGENT, DEXTRANOMER/HYALURONIC ACID COPOLYMER | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
L8605 | INJECTABLE BULKING AGENT, ANAL CANAL, 1 ML | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
L8606 | SYNTHETIC IMPLANT URINARY TRACT 1ML SYRINGE | 2011-07-01 00:00:00 | 181.14 | N | Y | N/A | N/A
L8609 | ARTIFICIAL CORNEA | 2011-07-01 00:00:00 | 5187.19 | N | Y | N/A | N/A
L8610 | OCULAR IMPLANT | 2008-01-01 00:00:00 | 497.45 | N | Y | N/A | N/A
L8612 | AQUEOUS SHUNT | 2011-07-01 00:00:00 | 587.33 | N | Y | N/A | N/A
L8613 | OSSICULA IMPLANT | 2011-07-01 00:00:00 | 244.11 | N | Y | N/A | N/A
L8614 | COCHLEAR DEVICE, INTERNAL AND EXTERNAL COMPONENT | 2011-07-01 00:00:00 | 15234.92 | Y | Y | N/A | N/A
L8615 | COCH IMPLANT HEADSET REPLACEMENT | 2011-07-01 00:00:00 | 359.06 | Y | Y | N/A | N/A
L8616 | COCH IMPLANT MICROPHONE REPLACEMENT | 2011-07-01 00:00:00 | 83.64 | Y | Y | N/A | N/A
[NAME] | COCH IMPLANT TRANSMITTING COIL REPLACEMENT | 2011-07-01 00:00:00 | 73.04 | Y | Y | N/A | N/A
[NAME] | COCH IMPLANT TRAN CABLE REPLACEMENT | 2011-07-01 00:00:00 | 20.88 | Y | Y | N/A | N/A
L8619 | COCHLEAR IMPLANT EXTRNL PROCESSOR REPLACEMENT | 2011-07-01 00:00:00 | 6540.24 | Y | Y | N/A | N/A
L8621 | REPLACEMENT ZINC AIR BATTERY | 2011-07-01 00:00:00 | 0.5 | N | Y | N/A | N/A
L8622 | REPLACEMENT ALKALINE BATTERY | 2011-07-01 00:00:00 | 0.26 | N | Y | N/A | N/A
L8623 | LITH ION BATT CID,NON-EARLVL | 2011-07-01 00:00:00 | 51.5 | Y | Y | N/A | N/A
L8624 | LITH ION BATT CID, EAR LEVEL | 2011-07-01 00:00:00 | 128.39 | Y | Y | N/A | N/A
L8627 | COCHLEAR IMPLANT, EXTERNAL SPEECH PROCESSOR, COMPONENT, REPLACEMENT | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
L8628 | COCHLEAR IMPLANT, EXTERNAL CONTROLLER COMPONENT, REPLACEMENT | 2010-01-01 00:00:00 | 1023.12 | Y | Y | N/A | N/A
[NAME] | TRANSMITTING COIL AND CABLE, INTEGRATED | 2010-01-01 00:00:00 | 142.55 | Y | Y | N/A | N/A
[NAME] | METACARPOPHALANGEAL JOINT IMPLANT | 2008-01-01 00:00:00 | 252.64 | Y | Y | N/A | N/A
L8641 | METATARSAL JOINT IMPLANT | 2008-01-01 00:00:00 | 349.98 | Y | Y | N/A | N/A
L8642 | HALLUX IMPLANT | 2008-01-01 00:00:00 | 230.32 | Y | Y | N/A | N/A
L8658 | INTERPHALANGEAL JOINT SPACER SILICONE/EQ EACH | 2008-01-01 00:00:00 | 305.15 | Y | Y | N/A | N/A
[NAME] | VASCULAR GRAFT MATERIAL, SYNTHETIC IMPLANT | 2011-07-01 00:00:00 | 451.43 | Y | Y | N/A | N/A
L8679 | IMP NEUROSTI PLS GN ANY TYPE | 2014-01-01 00:00:00 | 7194.22 | N | Y | N/A | N/A
L8680 | IMPLT NEUROSTIM ELCTR EACH | 2011-07-01 00:00:00 | 379.91 | Y | Y | N/A | N/A
L8681 | PT PRGRM FOR IMPLANTABLE NEUROSTIMULATOR | 2011-07-01 00:00:00 | 874.88 | Y | Y | N/A | N/A
L8682 | IMPLANTABLE NEUROSTIMULATOR RADIOFREQUENC REC | 2011-07-01 00:00:00 | 4930.52 | Y | Y | N/A | N/A
[NAME] | RADIOFQ TRSMTR FOR IMPLANTABLE NEUROSTIMULATO | 2011-07-01 00:00:00 | 4339.99 | Y | Y | N/A | N/A
L8684 | RADIOF TRSMTR IMPLANTABLE SACRAL NEUROSIMULAT | 2011-07-01 00:00:00 | 642.34 | Y | Y | N/A | N/A
L8685 | IMPLT NROSTM PULSE GEN SINGLE RECHARGEABLE | 2011-07-01 00:00:00 | 10814.99 | Y | Y | N/A | N/A
L8686 | IMPLT NROSTM PULSE GEN SINGLE NON-RECHARGEABL | 2011-07-01 00:00:00 | 6900.84 | Y | Y | N/A | N/A
L8687 | IMPLT NROSTM PULSE GEN DUAL RECHARGEABLE | 2011-07-01 00:00:00 | 14074.61 | Y | Y | N/A | N/A
L8688 | IMPLT NROSTM PULSE GEN DUAL NON-RECHARGEABLE | 2011-07-01 00:00:00 | 8980.73 | Y | Y | N/A | N/A
L8689 | EXTERNAL RECHARGING SYSTEM INTERNAL | 2011-07-01 00:00:00 | 1373.29 | Y | Y | N/A | N/A
L8690 | AUDITORY OSSEO, INT/EXT DEVICE | 2011-07-01 00:00:00 | 3787.36 | Y | Y | N/A | N/A
L8691 | AUDITORY OSSEO DEVICE, EXT SND, REPLACEMENT | 2011-07-01 00:00:00 | 2122.94 | Y | Y | N/A | N/A
L8692 | AUDITORY OSSEOINTEGRATED DEVICE, EXTERNAL SOUND PROCESSOR, W/O OSSEOINTEGRATION | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
L8693 | AUDITORY OSSEOINTEGRATED DEVICE, ABUTMENT | 2011-01-01 00:00:00 | 1341.33 | Y | Y | N/A | N/A
L8699 | PROSTHETIC IMPLANT, NOS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
L9900 | ORTHOTIC AND PROSTHETIC SUPPLY ACCESS AND OR SERVICE COMPONENT OF ANOTHER L CODE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
M0064 | VISIT FOR DRUG MONITORING, BRIEF, MENTAL | 2011-07-01 00:00:00 | 40.03 | N | Y | N/A | N/A
M0075 | CELLULAR THERAPY | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
M0076 | PROLOTHERAPY | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
M0300 | IV CHELATION THERAPY (CHEMICAL ENDARTERECTOMY) | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
M0301 | FABRIC WRAPPING OF ABDOMINAL ANEURYSM (MND) | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
P2038 | BLOOD MUCOPROTEIN (SEROMUCOID) | 2011-07-01 00:00:00 | 6.95 | N | N | N/A | N/A
P7001 | CULTURE BACTERIAL URINE, QUANTITATIVE, SENSIT | 2008-01-01 00:00:00 | 13.04 | N | N | N/A | N/A
P9019 | PLATELETS, EACH UNIT | 2008-01-01 00:00:00 | 47.8 | N | N | N/A | N/A
P9021 | RED BLOOD CELLS, EACH UNIT | 2008-01-01 00:00:00 | 72.1 | N | N | N/A | N/A
P9033 | PLATELETS LEUKOCYTES REDUCED EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9034 | PLATELETS PHERESIS EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9035 | PLATELETS PHERESIS LEUKOCYTE REDUCED EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9036 | PLATELETS PHERESIS IRRADIATED EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9037 | PLATELETS PHERESIS LEUKOCYTE REDUCED IRRADIATED EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9038 | RED BLOOD CELLS IRRADIATED EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9039 | RED BLOOD CELLS DEGLYCEROLYZED EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9040 | RED BLOOD CELLS LEUKOCYTES REDUCED IRRADIATED EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9041 | ALBUMIN(HUMAN), 5%, 50 ML, INFUSION | 2011-07-01 00:00:00 | 8.59 | N | N | N/A | N/A
P9043 | [NAME], 5%, 50 ML, INFUSION | 2011-07-01 00:00:00 | 7.5 | N | N | N/A | N/A
P9044 | [NAME] EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9045 | INFUSION, ALBUMIN (HUMAN), 5%, 250 ML | 2011-07-01 00:00:00 | 42.96 | N | N | N/A | N/A
P9046 | INFUSION, ALBUMIN (HUMAN), 25%, 20 ML | 2011-07-01 00:00:00 | 17.71 | N | N | N/A | N/A
P9047 | INFUSION, ALBUMIN (HUMAN), 25%, 50 ML | 2011-07-01 00:00:00 | 44.28 | N | N | N/A | N/A
P9048 | INFUSION, PLASMA PROTEIN FRACTION, 5%, 250 ML | 2011-07-01 00:00:00 | 37.5 | N | N | N/A | N/A
P9051 | WHOLE BLOOD OR REC BLOOD CELLS, LEUKOCYTES REDUCED, CMV-NEGATIVE, EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9052 | PLATELETS, HLA-MATCHED LEUKOCYTES REDUCED, APHERESIS/PHERESIS, EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9053 | PLATELETS, PHERESIS LEUKOCYTES REDUCED, CMV-NEGATIVE, IRRADIATED, EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9054 | WHOLE BLOOD OR RED BLOOD CELLS, LEUKOCYTES REDUCED, [NAME], DEGLYCEROL, WASHED | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9055 | PLATELETS, LEUKOCYTES REDUCED, CMV-NEGATIVE, APHERESIS/PHERESIS, EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9056 | WHOLE BLOOD, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9057 | RED BLOOD CELLS, FROZEN/DEGLYCEROLIZED/WASHED, LEUKOCYTES REDUCED, EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9058 | RED BLOOD CELLS, LEUKOCYTES REDUCED, CMV-NEGATIVE, IRRADIATED EACJ UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9059 | FRESH [NAME], HONOR RETESTED, EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9060 | FRESH [NAME], DONOR RETESTED, EACH UNIT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
P9612 | CATHETERIZE FOR URINE SPECIMEN, SINGLE PT | 2011-07-01 00:00:00 | 3 | N | N | N/A | N/A
Q0083 | ADMINISTRACTION OF CHEMOTHERAPY BY ANY ROUTE OTHER THAN INFUSION, PER VISIT | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
Q0111 | WET MOUNTS INCLUDING PREPARATN, VAG/CERV/SKIN | 2011-07-01 00:00:00 | 5.9 | N | N | N/A | N/A
Q0112 | ALL POTASSIUM HYDROXIDE PREPARATIONS | 2011-07-01 00:00:00 | 5.9 | N | N | N/A | N/A
Q0113 | PINWORM EXAMINATIONS | 2011-07-01 00:00:00 | 7.47 | N | N | N/A | N/A
Q0114 | FERN TEST | 2011-07-01 00:00:00 | 9.88 | N | N | N/A | N/A
[NAME] | FERUMOXYTOL, NON-ESRD, TREAT FE ANEMIA, 1 MG | 2011-07-01 00:00:00 | 0.63 | N | Y | N/A | N/A
Q0139 | FERUMOXYTOL, ESRD USE | 2011-07-01 00:00:00 | 0.63 | N | Y | N/A | N/A
Q0161 | CHLORPROMAZINE HCL 5 MG ORAL | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | ONDANSETRON ORAL, 1 MG, NOT EXCEED 48 HR DOSE | 2012-01-01 00:00:00 | 0.07 | N | N | N/A | N/A
[NAME] | DIPHENHYDRAMINE HCL 50 MG, ORAL LT=48 HR REG | 2011-07-01 00:00:00 | 0.02 | N | Y | N/A | N/A
Q0164 | PROCHLORPERAZINE MALEATE 5 MG,ORAL LT=48 HR RG | 2011-07-01 00:00:00 | 0.04 | N | Y | N/A | N/A
Q0166 | GRANISETRON HCL 1 MG, ORAL, LT=24 HR REGIMEN | 2011-07-01 00:00:00 | 0.31 | N | Y | N/A | N/A
Q0167 | DRONABINOL 2.5 MG, ORAL, NOT EXCEED 48 HR REG | 2011-07-01 00:00:00 | 4.84 | N | Y | N/A | N/A
Q0169 | PROMETHAZINE HCL 12.5 MG, ORAL, LT=48 HR REGMN | 2011-07-01 00:00:00 | 0.37 | N | Y | N/A | N/A
Q0173 | TRIMETHOBENZAMIDE HCL 250 MG, ORAL LT= 48HR RG | 2011-07-01 00:00:00 | 0.75 | N | Y | N/A | N/A
Q0175 | PERPHENAZINE 4 MG, ORAL, NOT TO EXCEED 48H RG | 2011-07-01 00:00:00 | 0.49 | N | Y | N/A | N/A
Q0177 | HYDROXYZINE PAMOATE 25 MG, ORAL LT= 48H RG | 2011-07-01 00:00:00 | 0.03 | N | Y | N/A | N/A
Q0180 | DOLASETRON HCL 100 MG, ORAL, LT=24 HR REGIMEN | 2011-07-01 00:00:00 | 58.69 | N | Y | N/A | N/A
Q0478 | [NAME], COMBO VASCULAR ACCESS DEVICE | 2011-01-01 00:00:00 | 162.56 | Y | Y | N/A | N/A
Q0479 | [NAME], COMBO VASCULAR ACCESS DEV, REPLCM | 2011-01-01 00:00:00 | 10683.9 | Y | Y | N/A | N/A
Q0480 | DRIVER PNEUMATIC VAD, REPLACEMENT | 2011-07-01 00:00:00 | 71703.68 | Y | Y | N/A | N/A
Q0481 | MICROPRCSR CU ELEC VAD, REPLACEMENT | 2011-07-01 00:00:00 | 11568.55 | Y | Y | N/A | N/A
[NAME] | MICROPRCSR CU COMBO VAD, REPLACEMENT | 2011-07-01 00:00:00 | 3623.49 | Y | Y | N/A | N/A
[NAME] | MONITOR ELEC VAD, REPLACEMENT | 2011-07-01 00:00:00 | 14927.15 | Y | Y | N/A | N/A
Q0484 | MONITOR ELEC OR COMB VAD REPLACEMENT | 2011-07-01 00:00:00 | 2898.81 | Y | Y | N/A | N/A
Q0485 | MONITOR CABLE ELEC VAD, REPLACEMENT | 2011-07-01 00:00:00 | 279.87 | Y | Y | N/A | N/A
Q0486 | MONITOR CABLE ELEC/PNEUM VAD REPL | 2011-07-01 00:00:00 | 232.95 | Y | Y | N/A | N/A
Q0487 | LEADS ANY TYPE VAD, REPLACEMENT ONLY | 2011-07-01 00:00:00 | 271.76 | Y | Y | N/A | N/A
[NAME] | POWER PACK BASE FOR USE W/ELECTRIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
Q0489 | PWR PACK BASE COMBO VAD, REPLACEMENT | 2011-07-01 00:00:00 | 12941.04 | Y | Y | N/A | N/A
Q0490 | EMRG PWR SOURCE ELEC VAD, REPLACEMENT | 2011-07-01 00:00:00 | 559.76 | Y | Y | N/A | N/A
Q0491 | EMRG PWR SOURCE COMBO VAD REPLACEMENT | 2011-07-01 00:00:00 | 880.02 | Y | Y | N/A | N/A
[NAME] | EMRG PWR CBL ELEC VAD, REPLACEMENT | 2011-07-01 00:00:00 | 70.88 | Y | Y | N/A | N/A
Q0493 | EMRG PWR CBL COMBO VAD, REPLACEMENT | 2011-07-01 00:00:00 | 201.88 | Y | Y | N/A | N/A
Q0494 | EMRG HND PMP ELEC/COMBO, REPLACEMENT | 2011-07-01 00:00:00 | 170.83 | Y | Y | N/A | N/A
[NAME] | CHARGER ELEC/COMBO VAD, REPLACEMENT | 2011-07-01 00:00:00 | 3325.51 | Y | Y | N/A | N/A
Q0496 | BATTERY ELEC/COMBO VAD, REPLACEMENT | 2011-07-01 00:00:00 | 1193.58 | Y | Y | N/A | N/A
Q0497 | BAT CLIPS ELEC/COMBO VAD, REPLACEMENT | 2011-07-01 00:00:00 | 372.71 | Y | Y | N/A | N/A
[NAME] | HOLSTER ELEC/COMBO VAD, REPLACEMENT | 2011-07-01 00:00:00 | 408.94 | Y | Y | N/A | N/A
Q0499 | BELT/VEST ELEC/COMBO VAD, REPLACEMENT | 2011-07-01 00:00:00 | 132.87 | Y | Y | N/A | N/A
Q0500 | FILTERS ELEC/COMBO VAD, REPLACEMENT | 2011-07-01 00:00:00 | 24.31 | Y | Y | N/A | N/A
Q0501 | SHWR COV ELEC/COMBO VAD, REPLACEMENT | 2011-07-01 00:00:00 | 406.58 | Y | Y | N/A | N/A
Q0502 | [NAME], REPLACEMENT | 2011-07-01 00:00:00 | 517.64 | Y | Y | N/A | N/A
Q0503 | BATTERY PNEUMATIC VAD REPLACEMENT | 2011-07-01 00:00:00 | 1035.28 | Y | Y | N/A | N/A
[NAME] | [NAME] VAD, REPLACEMENT, VEHICLE | 2011-07-01 00:00:00 | 546.29 | Y | Y | N/A | N/A
Q0506 | BATTERY, LITHIUM-ION, FOR USE W/ELECTRIC OR ELECTRIC/PNEUMATIC VAD, REPL ONLY | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
Q0507 | [NAME] VAD | 2013-04-01 00:00:00 | 0 | N | Y | N/A | N/A
Q0508 | [NAME] IMPLANTED VAD | 2013-04-01 00:00:00 | 0 | N | Y | N/A | N/A
Q0509 | MISC SUPPLY/ACCES IMPLANTED VAD NO PAY MEDICARE | 2013-04-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | SERMORELIN ACETATE INJECTION 1MCG | 2011-07-01 00:00:00 | 1.62 | Y | Y | N/A | N/A
Q2009 | INJECTION FOSPHENYTOIN, 50 MG, PE | 2011-07-01 00:00:00 | 0.67 | N | Y | N/A | N/A
Q2017 | INJECTION TENIPOSIDE, 50 MG | 2011-07-01 00:00:00 | 290.34 | N | Y | N/A | N/A
Q2033 | INFLUENZA VACCINE, (FLUBLOK) | 2013-07-01 00:00:00 | 0 | N | N | N/A | N/A
Q2034 | INFLUENZA (AGRIFLU) VACCINE, SPLIT VIRUS, IM | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q2035 | INFLUENZA (AFLURIA) VACCINE, 3 YRS & OLDER, IM | 2011-01-01 00:00:00 | 13.22 | N | Y | N/A | N/A
Q2036 | INFLUENZA (FLULAVAL) VACCINE, 3 YRS & OLDER, IM | 2011-07-01 00:00:00 | 7.91 | N | N | N/A | N/A
Q2037 | INFLUENZA (FLUVIRIN) VACCINE, 3 YRS & OLDER, IM | 2011-07-01 00:00:00 | 11.93 | N | N | N/A | N/A
Q2038 | INFLUENZA (FLUZONE) VACCINE, 3 YRS & OLDER, IM | 2011-07-01 00:00:00 | 11.33 | N | N | N/A | N/A
Q2039 | [NAME], 3 YEARS & OLDER, IM | 2011-01-01 00:00:00 | 13.22 | N | Y | N/A | N/A
Q2043 | SIPULEUCEL-T AUTO CD54+, PER INFUSION | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q2049 | IMPORTED DOXORUBICIN HCL (LIPODOX) INJ, 10MG | 2012-09-01 00:00:00 | 448.43 | N | N | N/A | N/A
Q2050 | DOXORUBICIN INJECTION 10MG | 2013-07-01 00:00:00 | 0 | N | Y | N/A | N/A
Q2052 | IVIG DEMO, SERVICES/SUPPLIES | 2014-01-01 00:00:00 | 0 | N | Y | N/A | N/A
Q3001 | RADIOELEMENTS FOR BRACHTHERAPY, ANY TYPE, EACH | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | TELEHEALTH ORIGINATING SITE FACILITY FEE | 2008-01-01 00:00:00 | 20 | N | Y | N/A | N/A
Q3027 | INJ BETA-1A INTERFERON IM 1 MCG | 2014-01-01 00:00:00 | 29.55 | N | Y | N/A | N/A
Q3031 | COLLAGEN SKIN TEST | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
Q4001 | CAST SUPPLIES BODY CAST ADULT, PLAST W/O HEAD | 2008-01-01 00:00:00 | 34.78 | N | Y | N/A | N/A
Q4002 | CAST SUPPLIES BODY CAST, FIBERGLASS W/O HEAD | 2008-01-01 00:00:00 | 131.44 | N | Y | N/A | N/A
Q4003 | CAST SUPPLIE SHOULDER CAST, PLASTER (11+)YRS | 2008-01-01 00:00:00 | 24.98 | N | Y | N/A | N/A
Q4004 | CAST SUPP SHOULDER CAST, FIBERGLASS (11+)YRS | 2008-01-01 00:00:00 | 86.48 | N | Y | N/A | N/A
Q4005 | CAST SUPPL LONG ARM, ADULT, PLASTER (11+)YRS | 2008-01-01 00:00:00 | 9.21 | N | Y | N/A | N/A
Q4006 | CAST SUPPL LONG ARM, ADULT, FIBERGL (11+) YRS | 2008-01-01 00:00:00 | 20.76 | N | Y | N/A | N/A
Q4007 | CAST SUPPL LONG ARM, PED, PLASTER (0-10)YRS | 2008-01-01 00:00:00 | 4.61 | N | Y | N/A | N/A
Q4008 | CAST SUPPL LONG ARM, PED, FIBERGLASS(0-10)YRS | 2008-01-01 00:00:00 | 10.38 | N | Y | N/A | N/A
Q4009 | CAST SUPP SHORT ARM,ADULT, PLASTER(11+)YRS | 2008-01-01 00:00:00 | 6.14 | N | Y | N/A | N/A
Q4010 | CAST SUPP SHORT ARM, ADULT, FIBERGLAS(11+)YRS | 2008-01-01 00:00:00 | 13.84 | N | Y | N/A | N/A
Q4011 | CAST SUPP SHORT ARM, PED, PLASTER (0-10)YRS | 2008-01-01 00:00:00 | 3.07 | N | Y | N/A | N/A
Q4012 | CAST SUPP SHORT ARM, PED, FIBERGLASS(0-10)YRS | 2008-01-01 00:00:00 | 6.92 | N | Y | N/A | N/A
[NAME] | CAST SUPP GAUNTLET, ADULT, PLASTER(11+) [NAME] | 2008-01-01 00:00:00 | 11.18 | N | Y | N/A | N/A
Q4014 | CAST SUP GAUNTLET, ADULT, FIBERGLASS(11+) YRS | 2008-01-01 00:00:00 | 18.88 | N | Y | N/A | N/A
[NAME] | CAST SUPP GAUNTLET, PED, PLASTER (0-10) YRS | 2008-01-01 00:00:00 | 5.59 | N | Y | N/A | N/A
Q4016 | CAST SUP GAUNTLET, PED, FIBERGLASS (0-10)YRS | 2008-01-01 00:00:00 | 9.44 | N | Y | N/A | N/A
Q4017 | CAST SUPP 1 ARM SPLINT, ADULT, PLASTR(11+)YRS | 2008-01-01 00:00:00 | 6.47 | N | Y | N/A | N/A
Q4018 | CAST SUPP 1 ARM SPLINT, ADULT, FBRGLS(11+)YRS | 2008-01-01 00:00:00 | 10.32 | N | Y | N/A | N/A
Q4019 | CAST SUPP 1 ARM SPLINT, PED, PLASTER (0-0)YRS | 2008-01-01 00:00:00 | 3.24 | N | Y | N/A | N/A
Q4020 | CAST SUPP 1 ARM SPLINT, PED, FBRGLSS(0-10)YRS | 2008-01-01 00:00:00 | 5.16 | N | Y | N/A | N/A
Q4021 | CAST SUPP SHORT ARM SPLINT,ADULT,PLS (11+)YRS | 2008-01-01 00:00:00 | 4.79 | N | Y | N/A | N/A
Q4022 | CAST SUPP SHORT ARM SPLINT, AD, FIBER(11+)YRS | 2008-01-01 00:00:00 | 8.64 | N | Y | N/A | N/A
Q4023 | CAST SUPP SHORT ARM SPLINT, PED, PL (0-0)YRS | 2008-01-01 00:00:00 | 2.4 | N | Y | N/A | N/A
Q4024 | CAST SUP SHORT ARM SPLINT, PED, FIB(0-10)YRS | 2008-01-01 00:00:00 | 4.32 | N | Y | N/A | N/A
Q4025 | CAST SUPP, HIP SPICA, ADULT, PLASTER (11+)YRS | 2008-01-01 00:00:00 | 26.86 | N | Y | N/A | N/A
Q4026 | CAST SUPP, HIP SPICA, ADULT, FBRGLSS (11+)YRS | 2008-01-01 00:00:00 | 83.85 | N | Y | N/A | N/A
Q4027 | CAST SUPP, HIP SPICA, PED, PLASTER (0-10)YRS | 2008-01-01 00:00:00 | 13.43 | N | Y | N/A | N/A
Q4028 | CAST SUPP, HIP SPICA, PED, FIBERGLAS(0-10)YRS | 2008-01-01 00:00:00 | 41.93 | N | Y | N/A | N/A
Q4029 | CAST SUPP LONG LEG, ADULT, PLASTER (11+)YRS | 2008-01-01 00:00:00 | 20.53 | N | Y | N/A | N/A
Q4030 | CAST SUPP LONG LEG, ADULT, FIBERGLASS(11+)YRS | 2008-01-01 00:00:00 | 54.05 | N | Y | N/A | N/A
[NAME] | CAST SUP LONG LEG, PEDIATRC, PLASTIC(0-10)YRS | 2008-01-01 00:00:00 | 10.27 | N | Y | N/A | N/A
Q4032 | CAST SUP LONG LEG, PED, FIBERGLASS (0-10)YRS | 2008-01-01 00:00:00 | 27.03 | N | Y | N/A | N/A
Q4033 | CAST SUPP, LEG CYLINDER, ADULT, PLSTR(11+)YRS | 2008-01-01 00:00:00 | 19.15 | N | Y | N/A | N/A
Q4034 | CAST SUPP, LEG CYLINDER, ADULT, FBRGL(11+)YRS | 2008-01-01 00:00:00 | 47.65 | N | Y | N/A | N/A
Q4035 | CAST SUPP, LEG CYLINDER, PED, PLASTR(0-10)YRS | 2008-01-01 00:00:00 | 9.58 | N | Y | N/A | N/A
Q4036 | CAST SUPP, LEG CYLINDER, PED, FIBER(0-10)YRS | 2008-01-01 00:00:00 | 23.83 | N | Y | N/A | N/A
Q4037 | CAST SUPP, SHORT LEG, ADULT, PLASTER(11+)YRS | 2008-01-01 00:00:00 | 11.69 | N | Y | N/A | N/A
Q4038 | CAST SUPP, SHORT LEG, ADULT, FIBERGLS(11+)YRS | 2008-01-01 00:00:00 | 29.27 | N | Y | N/A | N/A
Q4039 | CAST SUPP, SHORT LEG, PED, PLASTER (0-10)YRS | 2008-01-01 00:00:00 | 5.85 | N | Y | N/A | N/A
Q4040 | CAST SUPP, SHORT LEG, PED, FIBERGLAS(0-10)YRS | 2008-01-01 00:00:00 | 14.64 | N | Y | N/A | N/A
Q4041 | CAST SUPP, 1 LEG SPLINT, ADULT, PLAST(11+)YRS | 2008-01-01 00:00:00 | 14.21 | N | Y | N/A | N/A
Q4042 | CAST SUPP, 1 LEG SPLINT, ADULT, FBRGL(11+)YRS | 2008-01-01 00:00:00 | 24.25 | N | Y | N/A | N/A
Q4043 | CAST SUPP, 1 LEG SPLINT, PED, PLSTR(0-10 )YRS | 2008-01-01 00:00:00 | 7.1 | N | Y | N/A | N/A
[NAME] | CAST SUPP, 1 LEG SPLINT, PED, FBRGLS(0-10)YRS | 2008-01-01 00:00:00 | 12.13 | N | Y | N/A | N/A
Q4045 | CAST SUPP, SHORT LEG SPLINT,ADULT, PL(11+)YRS | 2008-01-01 00:00:00 | 8.25 | N | Y | N/A | N/A
Q4046 | CAST SUPP, SHORT LEG SPLINT, ADU, FIB(11+)YRS | 2008-01-01 00:00:00 | 13.27 | N | Y | N/A | N/A
Q4047 | CAST SUPP, SHORT LEG SPLINT, PED, PL(0-10)YRS | 2008-01-01 00:00:00 | 4.12 | N | Y | N/A | N/A
Q4048 | CAST SUP, SHORT LEG SPLINT, PED, FIB(0-10)YRS | 2008-01-01 00:00:00 | 6.64 | N | Y | N/A | N/A
Q4049 | FINGER SPLINT, STATIC | 2008-01-01 00:00:00 | 1.5 | N | Y | N/A | N/A
Q4050 | CAST SUPPLIES FOR UNLISTED TYPES AND MATERIALS OF CASTS | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
Q4051 | SPLINT SUPPLIES MISC. | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
Q4074 | [NAME] UNIT DOSE | 2011-07-01 00:00:00 | 59.15 | N | Y | N/A | N/A
Q4081 | [NAME], 100 UNITS, INJECTION | 2011-07-01 00:00:00 | 0.88 | N | Y | N/A | N/A
[NAME] | SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
[NAME] | APLIGRAF SKIN SUBSTITUTE, PER SQ CM | 2011-07-01 00:00:00 | 31.25 | N | Y | N/A | N/A
Q4102 | OASIS WOUND MATRIX SKIN SUBSTITUTE, PER SQ CM | 2011-07-01 00:00:00 | 4.28 | N | Y | N/A | N/A
Q4103 | OASIS BURN MATRIX SKIN SUBSTITUTE, PER SQ CM | 2011-07-01 00:00:00 | 4.28 | N | Y | N/A | N/A
Q4104 | INTEGRA BMWD SKIN SUBSTITUTE, PER SQ CM | 2011-07-01 00:00:00 | 14.17 | N | Y | N/A | N/A
Q4105 | INTEGRA DRT SKIN SUBSTITUTE, PER SQ CM | 2011-07-01 00:00:00 | 10.05 | N | Y | N/A | N/A
Q4106 | DERMAGRAFT SKIN SUBSTITUTE, PER SQ CM | 2013-08-01 00:00:00 | 38.29 | N | Y | N/A | N/A
Q4107 | GRAFTJACKET SKIN SUBSTITUTE, PER SQ CM | 2011-07-01 00:00:00 | 85.12 | N | Y | N/A | N/A
[NAME] | INTEGRA MATRIX SKIN SUBSTITUTE, PER SQ CM | 2011-07-01 00:00:00 | 19.21 | N | Y | N/A | N/A
Q4110 | PRIMATRIX SKIN SUBSTITUTE, PER SQ CM | 2011-07-01 00:00:00 | 29.04 | N | Y | N/A | N/A
Q4111 | GAMMAGRAFT SKIN SUBSTITUTE, PER SQ CM | 2011-07-01 00:00:00 | 6.58 | N | Y | N/A | N/A
Q4112 | CYMETRA ALLOGRAFT, INJECTABLE, 1CC | 2011-07-01 00:00:00 | 306.45 | Y | Y | N/A | N/A
Q4113 | GRAFTJACKET EXPRESS ALLOGRAF, INJECTABLE, 1CC | 2011-07-01 00:00:00 | 306.45 | Y | Y | N/A | N/A
Q4114 | INTEGRA FLOWABLE WOUND MATRIX, INJECTABLE, 1CC | 2011-07-01 00:00:00 | 892.31 | Y | Y | N/A | N/A
Q4115 | ALLOSKIN SKIN SUB | 2011-07-01 00:00:00 | 5.57 | N | Y | N/A | N/A
Q4116 | ALLODERM SKIN SUB | 2011-07-01 00:00:00 | 28.54 | N | Y | N/A | N/A
Q4121 | THERASKIN, PER SQUARE CENTIMETER | 2014-01-01 00:00:00 | 20.82 | N | Y | N/A | N/A
Q4122 | DERMACELL, PER SQUARE CENTIMETER | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4123 | [NAME], PER SQUARE CENTIMETER | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4124 | OASIS TRI-LAYER WOUND MATRIX, PER SQUARE CM | 2012-01-01 00:00:00 | 10.26 | N | N | N/A | N/A
Q4125 | ARTHROFLEX, PER SQUARE CENTIMETER | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4126 | MEMODERM, PER SQUARE CENTIMETER | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4127 | TALYMED, PER SQUARE CENTIMETER | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4128 | FLEXHD OR ALLOPATCH HD, PER SQUARE CENTIMETER | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4129 | UNITE BIOMATRIX, PER SQUARE CENTIMETER | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4130 | STRATTICE TM, PER SQUARE CENTIMETER | 2012-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | EPIFIX, PER SQUARE CENTIMETER | 2013-01-01 00:00:00 | 0 | Y | N | N/A | N/A
Q4132 | GRAFIX CORE, PER SQUARE CENTIMETER | 2013-01-01 00:00:00 | 0 | Y | N | N/A | N/A
Q4133 | GRAFIX PRIME, PER SQUARE CENTIMETER | 2013-01-01 00:00:00 | 0 | Y | N | N/A | N/A
Q4134 | HMATRIX, PER SQUARE CENTIMETER | 2013-01-01 00:00:00 | 0 | Y | N | N/A | N/A
Q4135 | MEDISKIN, PER SQUARE CENTIMETER | 2013-01-01 00:00:00 | 0 | Y | N | N/A | N/A
Q4136 | EZ-DERM, PER SQUARE CENTIMETER | 2013-01-01 00:00:00 | 0 | Y | N | N/A | N/A
Q4137 | AMNIOEXCEL OR BIODEXCEL PER SQUARE CM | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4138 | BIODFENCE DRYFLEX PER SQUARE CM | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4139 | AMNIOMATRIX OR BIODMATRIX INJECTABLE 1CC | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4140 | BIODFENCE PER SQUARE CENTIMETER | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4141 | ALLOSKIN AC PER SQUARE CENTIMETER | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4142 | XCM BIOLOGIC TISSUE MATRIX PER SQUARE CENTIMETER | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4143 | REPRIZA, PER SQUARE CENTIMETER | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4145 | EPIFIX, INJECTABLE, 1 MG | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4146 | TENSIX, PER SQUARE CENTIMETER | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
[NAME] | ARCHITECT EXTRACELLULAR MATRIX PER SQ CM | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4148 | [NAME], PER SQUARE CENTIMETER | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q4149 | EXCELLAGEN, 0.1 CC | 2014-01-01 00:00:00 | 0 | N | N | N/A | N/A
Q9951 | LOW [NAME] MATERIAL 400 OR GREATER MG/ML | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
Q9953 | INJ FE-BASED MR CONTRAST, PER ML | 2008-01-01 00:00:00 | 30.41 | N | N | N/A | N/A
Q9954 | ORAL MR CONTRAST, PER ML | 2011-07-01 00:00:00 | 9.57 | N | N | N/A | N/A
Q9955 | INJECTION PERFLEXANE LIPID MICROSPHERES, PER ML | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
Q9956 | INJ OCTAFLUOROPROPANE MIC, PER ML | 2011-07-01 00:00:00 | 37.39 | N | N | N/A | N/A
Q9957 | INJ PERFLUTREN [NAME], PER ML | 2011-07-01 00:00:00 | 56.09 | N | N | N/A | N/A
Q9958 | HOCM UP TO 149MG/ML IODINE, PER ML | 2011-07-01 00:00:00 | 0.07 | N | N | N/A | N/A
Q9959 | HIGH OSMOLAR CONTRAST MATERIAL, UP TO 150-199 IODINE CONCENTRATE PER ML | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
Q9960 | HOCM 200-249 MG/ML IODINE, PER ML | 2011-07-01 00:00:00 | 0.13 | N | N | N/A | N/A
Q9961 | HOCM 250-299 MG/ML IODINE, PER ML | 2011-07-01 00:00:00 | 0.15 | N | N | N/A | N/A
[NAME] | HOCM 300-349 MG/ML IODINE, PER ML | 2008-01-01 00:00:00 | 0.18 | N | N | N/A | N/A
Q9963 | HOCM 350-399 MG/ML IODINE, PER ML | 2011-07-01 00:00:00 | 0.15 | N | N | N/A | N/A
Q9964 | HOCM OVER 400 MG/ML IODINE, PER ML | 2008-01-01 00:00:00 | 0.29 | N | N | N/A | N/A
Q9965 | LOCM 100-199MG/ML IODINE, PER 1ML | 2011-07-01 00:00:00 | 1.02 | N | N | N/A | N/A
Q9966 | LOCM 200-299MG/ML IODINE, PER 1ML | 2011-07-01 00:00:00 | 0.27 | N | N | N/A | N/A
Q9967 | LOCM 300-399MG/ML IODINE, PER 1ML | 2011-07-01 00:00:00 | 0.15 | N | N | N/A | N/A
[NAME] | INJECTION, NON-RADIOACTIVE, NON-CONTRAST, VISUALIZATION ADJUNCT, 1 MG | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
Q9969 | NON-HIGHLY ENRICHED URANIUM TC-99M ADD-ON/DOSE | 2013-01-01 00:00:00 | 10 | N | N | N/A | N/A
R0070 | TRANSPORT PORTABLE X-RAY PER TRIP,ONE PT SEEN | 2011-07-01 00:00:00 | 106.95 | N | N | N/A | N/A
R0075 | TRANSPORT PORT X-RAY MULTIPLE PATIENTS,PER PT | 2011-07-01 00:00:00 | 106.95 | N | N | N/A | N/A
S0119 | ONDANSETRON, ORAL, 4 MG | 2012-01-01 00:00:00 | 0.27 | N | N | N/A | N/A
S1040 | CRANIAL REMOLDING ORTHOSIS, RIGID W/SOFT MATERIAL, CUSTOM, INCL FITTING & ADJ | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
S3620 | NEWBORN METABOLIC SCREENING PANEL | 2012-07-01 00:00:00 | 30 | N | N | N/A | N/A
S3721 | PROSTATE CANCER ANTEGEN 3 (PCA3) TESTING | 2013-01-01 00:00:00 | 0 | N | N | N/A | N/A
S3854 | GENE EXPRESSION PROFILING PANEL FOR USE IN THE MNGMNT OF BREAST CANCER | 2012-08-01 00:00:00 | 1528 | Y | N | N/A | N/A
S4993 | CONTRACEPTIVE PILLS FOR BIRTH CONTROL | 2008-01-01 00:00:00 | 6.61 | N | N | N/A | N/A
S5145 | CHILD FOSTER CARE, THERAPEUTIC, PER DIEM | 2008-07-01 00:00:00 | 81.07 | Y | N | N/A | N/A
S5165 | HOME MODIFICATIONS; PER SERVICE | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
S8100 | HOLDNG CHMBR/SPACER FOR USE W INHALER WO MASK | 2008-01-01 00:00:00 | 31.05 | N | Y | N/A | N/A
S8101 | HOLDNG CHAMBR/SPACER FOR USE W INHALER W MASK | 2008-01-01 00:00:00 | 41.87 | N | Y | N/A | N/A
S8265 | HABERMAN FEEDER FOR CLEFT LIP/PALATE | 2008-01-01 00:00:00 | 20.62 | N | Y | N/A | N/A
S9123 | NURSING CARE, IN THE HOME, BY RN, PER HOUR | 2008-01-01 00:00:00 | 26.65 | N | Y | N/A | N/A
S9124 | NURSING CARE, IN THE HOME, BY LPN, PER HOUR | 2013-07-01 00:00:00 | 0 | N | Y | N/A | N/A
S9470 | NUTRITIONAL COUNSELING, DIETITIAN VISIT | 2008-01-01 00:00:00 | 26.65 | N | Y | N/A | N/A
T1001 | NURSING ASSESSMENT/EVALUATION | 2006-01-01 00:00:00 | 35.59 | N | Y | N/A | N/A
T1004 | SERVICES OF A QUALIFIED NURSING AIDE TO 15MIN | 2009-07-01 00:00:00 | 4.01 | N | N | N/A | N/A
T1013 | SIGN LANGUGE/ORAL INTERPRETER SERVICES | 2008-01-01 00:00:00 | 3.04 | N | N | N/A | N/A
T1014 | TELEHEALTH TRANSMISSION, PER MIN PROF SERVICE | 2008-01-01 00:00:00 | 20 | N | Y | N/A | N/A
T1017 | TARGETED CASE MANAGEMENT, EACH 15 MIN | 2011-07-01 00:00:00 | 12.09 | N | Y | N/A | N/A
T1023 | SCREENING APPROPRIATENESS PROG PARTICIPATION | 2008-01-01 00:00:00 | 7.69 | N | N | N/A | N/A
T1028 | ASSESSMENT OF HOME PHYSICAL & FAMILY ENVIRNMT | 2008-01-01 00:00:00 | 9.94 | N | N | N/A | N/A
T2001 | NON-EMERGENCY TRANSP, PATIENT ATTENDNT/ESCORT | 2008-01-01 00:00:00 | 1.91 | Y | N | N/A | N/A
T2003 | NON-EMERGENCY TRANSPORTATION; ENCOUNTER/TRIP | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
T2004 | NON-EMERGENCY TRANSPORT, COM CARRIER, MULTI | 2008-01-01 00:00:00 | 27 | Y | N | N/A | N/A
T2021 | DAY [NAME], PER 15 MIN | 2008-09-01 00:00:00 | 4.53 | Y | N | N/A | N/A
T2024 | SERV ASSESSMNT/PLAN OF CARE DEVELOPMNT WAIVER | 2011-07-01 00:00:00 | 11.35 | Y | Y | N/A | N/A
T2040 | FINANCIAL MANAGEMENT SELF-DIREC WAIVER/15 MIN | 2009-03-16 00:00:00 | 108 | Y | N | N/A | N/A
T4521 | ADULT SIZE BRIEF/DIAPER SMALL EACH | 2008-12-01 00:00:00 | 0.48 | N | Y | N/A | N/A
T4522 | ADULT SIZE BRIEF/DIAPER MEDIUM EACH | 2008-12-01 00:00:00 | 0.6 | N | Y | N/A | N/A
T4523 | ADULT SIZE BRIEF/DIAPER LARGE EACH | 2008-12-01 00:00:00 | 0.72 | N | Y | N/A | N/A
T4524 | ADULT SIZE BRIEF/DIAPER EXTRALARGE EACH | 2008-12-01 00:00:00 | 0.77 | N | Y | N/A | N/A
T4525 | ADULT SIZE PULL-ON SMALL | 2008-12-01 00:00:00 | 0.54 | N | Y | N/A | N/A
T4526 | ADULT SIZE PULL-ON MEDIUM | 2008-12-01 00:00:00 | 0.62 | N | Y | N/A | N/A
T4527 | ADULT SIZE PULL-ON LARGE | 2008-12-01 00:00:00 | 0.74 | N | Y | N/A | N/A
T4528 | ADULT SIZE PULL-ON EXTRALARGE | 2008-12-01 00:00:00 | 0.82 | N | Y | N/A | N/A
T4529 | PED SIZE BRIEF/DIAPER SM/MED | 2008-12-01 00:00:00 | 0.41 | N | Y | N/A | N/A
T4530 | PED SIZE BRIEF/DIAPER LARGE | 2008-12-01 00:00:00 | 0.47 | N | Y | N/A | N/A
T4531 | PED SIZE PULL-ON SM/MED | 2008-12-01 00:00:00 | 0.46 | N | Y | N/A | N/A
T4532 | PED SIZE PULL-ON LARGE | 2008-12-01 00:00:00 | 0.54 | N | Y | N/A | N/A
T4533 | YOUTH SIZE BRIEF/DIAPER | 2008-12-01 00:00:00 | 0.48 | N | Y | N/A | N/A
T4534 | YOUTH SIZE PULL-ON | 2008-12-01 00:00:00 | 0.52 | N | Y | N/A | N/A
T4535 | DISPOSABLE LINER/SHIELD/PAD | 2008-12-01 00:00:00 | 0.34 | N | Y | N/A | N/A
T4536 | REUSABLE PULL-ON ANY SIZE | 2008-12-01 00:00:00 | 6.73 | N | Y | N/A | N/A
T4537 | REUSABLE UNDERPAD BED SIZE | 2008-12-01 00:00:00 | 14.07 | N | Y | N/A | N/A
T4539 | [NAME]/BRIEF ANY SIZE | 2008-12-01 00:00:00 | 11.18 | N | Y | N/A | N/A
T4540 | REUSABLE UNDERPAD CHAIR SIZE | 2008-12-01 00:00:00 | 9.9 | N | Y | N/A | N/A
T4541 | LARGE DISPOSABLE UNDERPAD | 2008-12-01 00:00:00 | 0.25 | N | Y | N/A | N/A
T4542 | SMALL DISPOSABLE UNDERPAD | 2008-12-01 00:00:00 | 0.24 | N | Y | N/A | N/A
T4543 | DISPOSABLE BARIATRIC BRIEF/DIAPER | 2008-12-01 00:00:00 | 0.76 | N | Y | N/A | N/A
T5001 | POSITIONING SEAT SPECIAL ORTHOPEDIC NEED | 2008-01-01 00:00:00 | 520.71 | N | Y | N/A | N/A
V2020 | VISION SERVICES, FRAMES, PURCHASES | 2013-06-01 00:00:00 | 10 | N | N | N/A | N/A
V2025 | EYEGLASSES, DELUXE FRAMES | 2013-06-01 00:00:00 | 35 | Y | N | N/A | N/A
V2100 | SPHERE SINGLE VISION PLANO TO 4.00 PER LENS | 2013-06-01 00:00:00 | 5 | N | N | N/A | N/A
V2101 | SINGLE VISION SPHERE 4.12-7.00D PER LENS | 2013-06-01 00:00:00 | 5 | N | N | N/A | N/A
V2102 | SINGLE VISION SPHERE 7.12-20.00D CYLINDR/LENS | 2013-06-01 00:00:00 | 8 | N | N | N/A | N/A
V2103 | SPHEROCYLINDER 4.00D, 2.12-2.00D CYLINDR/LENS | 2013-06-01 00:00:00 | 5 | N | N | N/A | N/A
V2104 | SPHEROCYLINDER 4.00D, 2.12-2.00D CYLINDR/LENS | 2013-06-01 00:00:00 | 5 | N | N | N/A | N/A
V2105 | SPHEROCYLINDER 4.00D, 4.25-6.00D CYLINDR/LENS | 2013-06-01 00:00:00 | 6 | N | N | N/A | N/A
V2106 | SPHEROCYLINDER 4.00D, OVER 6.00D CYLINDR/LENS | 2013-06-01 00:00:00 | 8 | N | N | N/A | N/A
V2107 | SPHEROCYLINDER 4.25D TO 7.00D/12-2.00D /LENS | 2013-06-01 00:00:00 | 5 | N | N | N/A | N/A
V2108 | SPHEROCYLINDER 4.25D TO 7.00D/2.12-4.00D/LENS | 2013-06-01 00:00:00 | 8 | N | N | N/A | N/A
V2109 | SPHEROCYLINDER 4.25D TO 7.00D/4.25-6.00D/LENS | 2013-06-01 00:00:00 | 8 | N | N | N/A | N/A
V2110 | SPHEROCYLINDER 4.25D TO 7.00D OVER 6.00D/LENS | 2013-06-01 00:00:00 | 8 | N | N | N/A | N/A
V2111 | SPHEROCYLINDER 7.25D/12.00D .25-2.25D CYLINDR | 2013-06-01 00:00:00 | 8 | N | N | N/A | N/A
V2112 | SPHEROCYLINDER 7.25D/12.00D 2.25 TO 4.00D CYL | 2013-06-01 00:00:00 | 8 | N | N | N/A | N/A
V2113 | SPHEROCYLINDER 7.25D/12.00D 4.25-6.00D CYLIND | 2013-06-01 00:00:00 | 8 | N | N | N/A | N/A
V2114 | SPHEROCYLINDER OVER 12.00D CYLINDER PER LENS | 2013-06-01 00:00:00 | 8 | N | N | N/A | N/A
V2115 | LENTICULAR (MYODISC) PER LENS SINGLE VISION | 2013-06-01 00:00:00 | 30 | Y | N | N/A | N/A
V2118 | LENS ANISEIKONIC, SINGLE VISION | 2013-06-01 00:00:00 | 49 | N | N | N/A | N/A
V2121 | [NAME], PER LENS, SINGLE | 2013-06-01 00:00:00 | 58 | Y | N | N/A | N/A
V2199 | NOT OTHERWISE CLASSIFIED, SINGLE VISION LENS | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
V2200 | LENS SPHERE BIFOCAL PLANO TO 4.00D, PER LENS | 2013-06-01 00:00:00 | 11 | N | N | N/A | N/A
V2201 | LENS SPHERE BIFOCAL 4.12-7.00D, PER LENS | 2013-06-01 00:00:00 | 11 | N | N | N/A | N/A
V2202 | LENS SPHERE BIFOCAL 7.12-20.00D, PER LENS | 2013-06-01 00:00:00 | 11 | N | N | N/A | N/A
V2203 | LENS SPHRCYLINDER BIFOCAL 4.00D/.12D TO 2.00D | 2013-06-01 00:00:00 | 11 | N | N | N/A | N/A
V2204 | LENS SPHCYL BIFOCAL 4.00D/2.12 TO 4.00D /LENS | 2013-06-01 00:00:00 | 11 | N | N | N/A | N/A
V2205 | LENS SPHCYL BIFOCAL 4.00D/4.25 TO 6.00D /LENS | 2013-06-01 00:00:00 | 11 | N | N | N/A | N/A
V2206 | LENS SPHCYL BIFOCAL 4.00D/OVER 6.00D PER LENS | 2013-06-01 00:00:00 | 11 | N | N | N/A | N/A
V2207 | LENS SPHCYL BIFOCAL 4.25-7.00D/2.12-2.00D | 2013-06-01 00:00:00 | 11 | N | N | N/A | N/A
V2208 | LENS SPHCYL BIFOCAL 4.25-7.00D/2.12-4.00D | 2013-06-01 00:00:00 | 11 | N | N | N/A | N/A
V2209 | LENS SPHCYL BIFOCAL 4.25-7.00D/4.25-6.00D | 2013-06-01 00:00:00 | 11 | N | N | N/A | N/A
V2210 | LENS SPHCYL BIFOCAL 4.25-7.00D/OVER 6.00D | 2013-06-01 00:00:00 | 11 | N | N | N/A | N/A
V2211 | LENS SPHCYL BIFOC 7.25-12.00D/.25-2.25D /LENS | 2013-06-01 00:00:00 | 15 | N | N | N/A | N/A
V2212 | LENS SPHCYL BIFOC 7.25-12.00D/2.25-4.00D | 2013-06-01 00:00:00 | 15 | N | N | N/A | N/A
V2213 | LENS SPHCYL BIFOC 7.25-12/4.25-6.00D PER LENS | 2013-06-01 00:00:00 | 15 | N | N | N/A | N/A
V2214 | LENS SPHCYL BIFOCAL OVER 12.00D PER LENS | 2013-06-01 00:00:00 | 50 | N | N | N/A | N/A
V2215 | [NAME], BIFOCAL, PER LENS | 2013-06-01 00:00:00 | 40 | Y | N | N/A | N/A
V2218 | LENS ANISEIKONIC, BIFOCAL, PER LENS | 2013-06-01 00:00:00 | 50 | N | N | N/A | N/A
V2219 | LENS BIFOCAL, SEG WIDTH OVER 28MM, PER LENS | 2013-06-01 00:00:00 | 6 | N | N | N/A | N/A
V2220 | LENS BIFOCAL, ADD OVER 3.25D, PER LENS | 2013-06-01 00:00:00 | 15 | N | N | N/A | N/A
V2221 | [NAME], BIFOCAL, PER LENS | 2013-06-01 00:00:00 | 15 | Y | N | N/A | N/A
V2299 | SPECIALTY BIFOCAL (BY REPORT) | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
V2410 | LENS VARIABLE ASPHERICITY SINGLE VISION,/LENS | 2013-06-01 00:00:00 | 15 | Y | N | N/A | N/A
V2430 | LENS VARIABLE ASPHERICITY BIFOCAL FULL FIELD | 2013-06-01 00:00:00 | 20 | Y | N | N/A | N/A
V2499 | VARIABLE ASPHERICITY LENS OTHER TYPE, /LENS | 2008-07-01 00:00:00 | 16 | Y | N | N/A | N/A
V2500 | CONTACT LENS, PMMA, SPHERICAL, PER LENS | 2013-06-01 00:00:00 | 45 | Y | N | N/A | N/A
V2501 | CONTACT LENS PMMA, TORIC/PRISM BALLAST, /LENS | 2013-06-01 00:00:00 | 45 | Y | N | N/A | N/A
[NAME] | CONTACT LENS, PMMA, BIFOCAL, PER LENS | 2013-06-01 00:00:00 | 45 | Y | N | N/A | N/A
V2503 | CONTACT LENS, PMMA, COLOR VISION DEFICIENCY | 2013-06-01 00:00:00 | 45 | Y | N | N/A | N/A
V2510 | CONTACT LENS, GAS PERMEABLE, SPHERICAL, /LENS | 2013-06-01 00:00:00 | 40 | Y | N | N/A | N/A
[NAME] | CONTACT LENS, TORIC PRISM BALLAST, PER LENS | 2013-06-01 00:00:00 | 40 | Y | N | N/A | N/A
V2512 | CONTACT LENS, GAS PERMEABLE, BIFOCAL,PER LENS | 2013-06-01 00:00:00 | 45 | Y | N | N/A | N/A
V2513 | CONTACT LENS, EXTENDED WEAR, PER LENS | 2013-06-01 00:00:00 | 40 | Y | N | N/A | N/A
V2520 | CONTACT LENS, HYDROPHILIC SPHERICAL, PER LENS | 2013-06-01 00:00:00 | 7.5 | Y | N | N/A | N/A
V2521 | CONTACT LENS, HYDROPHILIC TORIC PRISM BALLAST | 2013-06-01 00:00:00 | 9 | Y | N | N/A | N/A
V2522 | CONTACT LENS, HYDROPHILIC BIFOCAL, PER LENS | 2013-06-01 00:00:00 | 45 | Y | N | N/A | N/A
V2523 | CONTACT LENS, HYDROPHILIC EXTEND WEAR, /LENS | 2013-06-01 00:00:00 | 75 | Y | N | N/A | N/A
V2530 | CONTACT LENS SCLERAL GAS IMPERMEABLE PER LENS | 2013-06-01 00:00:00 | 150 | Y | N | N/A | N/A
V2531 | CONTACT LENS, SCLETAL GAS PERMEABLE, PER LENS | 2013-06-01 00:00:00 | 150 | Y | N | N/A | N/A
V2599 | NOT OTHERWISE CLASSIFIED, CONTACT LENS | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
V2610 | SINGLE LENS SPECTACLE MOUNTED LOW VISION AIDS | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
V2615 | TELESCOPIC AND OTHER COMPOUND LENS SYSTEM, INCL DIST-NEAR-MICROSCOPIC | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
V2623 | PLASTIC EYE PROSTHESIS, CUSTOM | 2011-07-01 00:00:00 | 872.5 | N | Y | N/A | N/A
V2624 | POLISHING/RESURFACING OR OCULAR PROSTHESIS | 2011-07-01 00:00:00 | 65.83 | N | Y | N/A | N/A
V2625 | ENLARGEMENT OF OCULAR PROSTHESIS | 2011-07-01 00:00:00 | 400.21 | N | Y | N/A | N/A
V2626 | REDUCTION OF OCULAR PROSTHESIS | 2011-07-01 00:00:00 | 215.73 | N | Y | N/A | N/A
V2627 | SCLERAL COVER SHELL | 2011-07-01 00:00:00 | 1393.3 | N | Y | N/A | N/A
V2628 | FABRICATION & FITTING OF OCULAR CONFORMER | 2011-07-01 00:00:00 | 328.99 | N | Y | N/A | N/A
V2629 | NOT OTHERWISE CLASSIFIED, PROSTHETIC EYE | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
V2630 | ANTERIOR CHAMBER INTRAOCULAR LENS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
V2631 | IRIS SUPPORTED INTRAOCULAR LENS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
V2632 | POSTERIOR CHAMBER INTRA0CULAR LENS | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
V2700 | [NAME], PER LENS | 2008-07-01 00:00:00 | 5 | N | N | N/A | N/A
V2702 | DELUXE LENS FEATURE | 2013-06-01 00:00:00 | 50 | Y | N | N/A | N/A
V2710 | GLASS/PLASTIC, SLAB OFF PRISM, PER LENS | 2013-06-01 00:00:00 | 40 | N | N | N/A | N/A
V2715 | PRISM, PER LENS | 2013-06-01 00:00:00 | 3 | N | N | N/A | N/A
[NAME] | FRESNELL PRISM PRESS-ON LENS | 2013-06-01 00:00:00 | 20 | N | N | N/A | N/A
V2730 | SPECIAL BASE CURVE, GLASS OR PLASTIC,PER LENS | 2013-06-01 00:00:00 | 25 | N | N | N/A | N/A
V2744 | [NAME], PHOTOCHROMATIC, PER LENS | 2013-06-01 00:00:00 | 30 | Y | N | N/A | N/A
V2745 | [NAME], ANY COLOR/SOLID/GRADIENT OR EQUAL,/LENS | 2013-06-01 00:00:00 | 7.5 | Y | N | N/A | N/A
V2760 | SCRATCH RESISTANT COATING, PER LENS | 2008-01-01 00:00:00 | 3 | N | N | N/A | N/A
V2770 | OCCLUDER LENS, PER LENS | 2013-06-01 00:00:00 | 20 | N | N | N/A | N/A
V2780 | OVERSIZE LENS, PER LENS | 2013-06-01 00:00:00 | 20 | N | N | N/A | 0.08
[NAME] | PROGRESSIVE LENS, PER LENS | 2013-06-01 00:00:00 | 50 | Y | N | N/A | N/A
V2782 | LENS, INDEX 1.54-1.65 PLASTIC/1.60-1.79 GLASS | 2013-06-01 00:00:00 | 25 | Y | N | N/A | N/A
V2783 | LENS, INDEX GT= 1.66 PLASTIC / GT=1.80 GLASS | 2013-06-01 00:00:00 | 25 | Y | N | N/A | N/A
V2784 | LENS POLYCARBONATE OR EQUAL, ANY INDEX, /LENS | 2008-07-01 00:00:00 | 1 | N | N | N/A | N/A
V2785 | CORNEAL TISSUE; PROCESSING, PRESERVING & TRANSPORT | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
V2787 | ASTIGMATISM-CORRECTING FUNCTION OF LENS | 2013-06-01 00:00:00 | 100 | N | N | N/A | N/A
V2788 | PRESBYOPIA CORRECT FUNCTION INTRAOCULAR LENS | 2013-06-01 00:00:00 | 100 | N | N | N/A | N/A
V2790 | AMNIOTIC MEMBRANE FOR SURGICAL RECONSTRUCTION, PER PROCEDURE | 2010-06-01 00:00:00 | 0 | N | N | N/A | N/A
V2797 | VISION SUPPLY, ACCESSORY AND/OR SERVICE COMPONENT | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
V2799 | VISION SERVICE, [NAME] | 2010-06-01 00:00:00 | 0 | Y | N | N/A | N/A
V5008 | HEARING SCREENING | 2008-01-01 00:00:00 | 12.57 | N | N | N/A | N/A
V5010 | ASSESSMENT FOR HEARING AID | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
V5014 | REPAIR/MODIFICATION OF HEARING AID | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
V5030 | BODY-WORN MONAURAL HEARING AID, AIR CONDUCTN | 2008-01-01 00:00:00 | 565.38 | Y | Y | N/A | N/A
V5040 | BODY-WORN MONAURAL HEARING AID, BONE CONDUCTN | 2008-01-01 00:00:00 | 565.38 | Y | Y | N/A | N/A
V5050 | BODY-WORN MONAURAL HEARING AID, IN THE EAR | 2008-01-01 00:00:00 | 629 | N | Y | N/A | N/A
V5060 | BODY-WORN MONAURAL HEARING AID, BEHIND EAR | 2008-01-01 00:00:00 | 625.11 | N | Y | N/A | N/A
V5100 | HEARING AID, BILAT, BODY WORN | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
V5120 | BINAURAL; BODY | 2011-07-01 00:00:00 | 962.4 | N | Y | N/A | N/A
V5130 | BINAURAL; IN THE EAR | 2011-07-01 00:00:00 | 1088.72 | N | Y | N/A | N/A
V5140 | BINAURAL; BEHIND THE EAR | 2011-07-01 00:00:00 | 1088.72 | N | Y | N/A | N/A
V5170 | HEARING AID, CROS, IN THE EAR | 2008-01-01 00:00:00 | 432.15 | N | Y | N/A | N/A
V5180 | HEARING AID, CROS, BEHIND EAR | 2008-01-01 00:00:00 | 432.15 | N | Y | N/A | N/A
V5210 | HEARING AID, BICROS, IN EAR | 2008-01-01 00:00:00 | 757.85 | N | Y | N/A | N/A
V5220 | HEARING AID, BICROS, BEHIND EAR | 2008-01-01 00:00:00 | 777.13 | N | Y | N/A | N/A
V5254 | HEARING AID, DIGITAL, MONAURAL, CIC | 2008-01-01 00:00:00 | 581.87 | N | Y | N/A | N/A
[NAME] | HEARING AID, DIGITAL, MONAURAL, ITC | 2008-01-01 00:00:00 | 581.87 | N | Y | N/A | N/A
V5256 | HEARING AID, DIGITAL, MONAURAL, ITE | 2008-01-01 00:00:00 | 549.75 | N | Y | N/A | N/A
V5257 | HEARING AID, DIGITAL, MONAURAL, BTE | 2008-01-01 00:00:00 | 549.74 | N | Y | N/A | N/A
V5258 | HEARING AID, DIGITAL, BINAURAL, CIC | 2011-07-01 00:00:00 | 1097.64 | N | Y | N/A | N/A
V5259 | HEARING AID, DIGITAL, BINAURAL, ITC | 2011-07-01 00:00:00 | 1097.64 | N | Y | N/A | N/A
V5260 | HEARING AID, DIGITAL, BINAURAL, ITE | 2011-07-01 00:00:00 | 1049.92 | N | Y | N/A | N/A
V5261 | HEARING AID, DIGITAL, BINAURAL, BTE | 2011-07-01 00:00:00 | 1049.92 | N | Y | N/A | N/A
V5264 | EAR MOLD/INSERT, NOT DISPOSABLE; ANY TYPE | 2010-06-01 00:00:00 | 0 | N | Y | N/A | N/A
V5266 | BATTERY FOR USE IN HEARING DEVICE | 2008-01-01 00:00:00 | 1 | N | Y | N/A | N/A
V5281 | ASSISTIVE LISTENING DEVICE, PERSONAL FM/DM SYSTEM, MONAURAL, (1 RECEIVER, TRANSMITTER, MICROPHONE), ANY TYPE | 2013-08-01 00:00:00 | 0 | Y | Y | N/A | N/A
V5282 | ASSISTIVE LISTENING DEVICE, PERSONAL FM/DM SYSTEM, BINAURAL, (2 RECEIVER, TRANSMITTER, MICROPHONE), ANY TYPE | 2013-08-01 00:00:00 | 0 | Y | Y | N/A | N/A
V5283 | ASSISTIVE LISTENING DEVICE, PERSONAL FM/DM NECK, LOOP INDUCTION RECEIVER | 2013-08-01 00:00:00 | 0 | Y | Y | N/A | N/A
V5284 | ASSISTIVE LISTENING DEVICE, PERSONAL FM/DM, EAR LEVEL RECEIVER AUDIO INPUT RECEIVER | 2013-08-01 00:00:00 | 0 | Y | Y | N/A | N/A
V5286 | ASSISTIVE LISTENING DEVICE, PERSONAL BLUE TOOTH FM/DM RECEIVER | 2013-08-01 00:00:00 | 0 | Y | Y | N/A | N/A
V5287 | ASSISTIVE LISTENING DEVICE, PERSONAL FM/DM RECEIVER, NOT OTHERWISE SPECIFIED | 2013-08-01 00:00:00 | 0 | Y | Y | N/A | N/A
V5288 | ASSISTIVE LISTENING DEVICE, PERSONAL FM/DM TRANSMITTER ASSISTIVE LISTENING DEVICE | 2013-08-01 00:00:00 | 0 | Y | Y | N/A | N/A
V5289 | ASSISTIVE LISTENING DEVICE, PERSONAL FM/DM ADAPTER/BOOT COUPLING DEVICE FOR RECEIVER, ANY TYPE | 2013-08-01 00:00:00 | 0 | Y | Y | N/A | N/A
V5290 | ASSISTIVE LISTENING DEVICE, TRANSMITTER MICROPHONE, ANY TYPE | 2013-08-01 00:00:00 | 0 | Y | Y | N/A | N/A
V5298 | HEARING AID; NOT OTHERWISE CLASSIFIED | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A
V5299 | HEARING SERVICE, [NAME] | 2010-06-01 00:00:00 | 0 | Y | Y | N/A | N/A