Version 3.22 Update - Professional Services and Supplies Charge Table,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, Item Code,Code Type,Description,Modifier,"Technical, Professional Indicator",Service Category Code,Primary/Bundled Indicator,Charge Type Indicator,Work Expense Units,Provider-Based Practice Expense Units,Non-Provider-Based Practice Expense Units,Total Expense Units, Anesthesia Base Units,Unit Charge,Base Charge,Unit Type,Facility Indicator,Outpatient Indicator,Inpatient Indicator,Skilled Nursing Facility Carveout,Freestanding Carve-out,Start Date,End Date 00100,CPT,ANESTHESIA SALIVARY GLANDS WITH BIOPSY,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00102,CPT,ANESTHESIA CLEFT LIP INVOLVING PLASTIC REPAIR,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00103,CPT,ANESTHESIA EYELID RECONSTRUCTIVE PROCEDURE,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00104,CPT,ANESTHESIA ELECTROCONVULSIVE THERAPY,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00120,CPT,ANESTHESIA EXTERNAL MIDDLE & INNER EAR W/BX NOS,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00124,CPT,ANES EXTERNAL MIDDLE & INNER EAR W/BX OTOSCOPY,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00126,CPT,ANES XTRNL MID & INNER EAR W/BX TYMPANOTOMY,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00140,CPT,ANESTHESIA EYE NOT OTHERWISE SPECIFIED,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00142,CPT,ANESTHESIA EYE LENS SURGERY,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00144,CPT,ANESTHESIA EYE CORNEAL TRANSPLANT,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00145,CPT,ANESTHESIA EYE VITREORETINAL SURGERY,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00147,CPT,ANESTHESIA EYE IRIDECTOMY,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00148,CPT,ANESTHESIA EYE OPHTHALMOSCOPY,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00160,CPT,ANESTHESIA NOSE & ACCESSORY SINUSES NOS,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00162,CPT,ANES NOSE & ACCESSORY SINUSES RADICAL SURGERY,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00164,CPT,ANES NOSE & ACCESSORY SINUSES BIOPSY SOFT TISSUE,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00170,CPT,ANESTHESIA INTRAORAL WITH BIOPSY NOS,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00172,CPT,ANES INTRAORAL W/BIOPSY REPAIR CLEFT PALATE,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00174,CPT,ANES INTRAORAL W/BX EXC RETROPHARYNGEAL TUMOR,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00176,CPT,ANESTHESIA INTRAORAL W/BIOPSY RADICAL SURGERY,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00190,CPT,ANESTHESIA FACIAL BONES OR SKULL NOS,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00192,CPT,ANES FACIAL BONES/SKULL RAD SURG W/PROGNATHISM,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00210,CPT,ANESTHESIA INTRACRANIAL PROCEDURE NOS,,,3,,Anesth,,,,,11.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00211,CPT,ANES INTRACRANIAL CRANIOTOMY/CRANIECTOMY HMTMA,,,3,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00212,CPT,ANESTHESIA INTRACRANIAL PROCEDURE SUBDURAL TAPS,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00214,CPT,ANES INTRACRANIAL BURR HOLES W/VENTRICULOGRAPHY,,,3,,Anesth,,,,,9.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00215,CPT,ANES INTRACRANIAL/ELEVATION DEPRSD SKULL FX XDRL,,,3,,Anesth,,,,,9.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00216,CPT,ANESTHESIA INTRACRANIAL VASCULAR PROCEDURE,,,3,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00218,CPT,ANES INTRACRANIAL PROCEDURE IN SITTING POSITION,,,3,,Anesth,,,,,13.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00220,CPT,ANES INTRACRANIAL CEREBROSPINAL FLUID SHUNTING,,,3,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00222,CPT,ANES INTRACRANIAL ELECTROCOAGULATION ICRA NERVE,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00300,CPT,ANES INTEG MUSC & NRV HEAD NECK&POSTERIOR TRUNK,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00320,CPT,ANES ESOPH THYRD LARYNX TRACH & LYMPH NECK 1YR,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00322,CPT,ANES ESOPH THYRD LARX TRACH & LYMPH NCK BX THYRD,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00326,CPT,ANESTHESIA LARYNX & TRACHEA CHILDREN <1 YEAR,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00350,CPT,ANESTHESIA MAJOR VESSELS NECK NOS,,,3,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00352,CPT,ANESTHESIA MAJOR VESSELS NECK SIMPLE LIGATION,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00400,CPT,ANES INTEG EXTREMITIES ANT TRUNK & PERINEUM NOS,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00402,CPT,ANESTHESIA RECONSTRUCTION BREAST,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00404,CPT,ANESTHESIA RADICAL/MODIFIED RADICAL BREAST,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00406,CPT,ANES RADICAL/MODIFIED RADICAL BREAST W/NODES,,,3,,Anesth,,,,,13.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00410,CPT,ANES INTEG SYS ELEC CONVERSION ARRHYTHMIAS,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00450,CPT,ANESTHESIA CLAVICLE AND SCAPULA NOS,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00454,CPT,ANESTHESIA CLAVICLE & SCAPULA BIOPSY CLAVICLE,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00470,CPT,ANESTHESIA PARTIAL RIB RESECTION NOS,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00472,CPT,ANESTHESIA PARTIAL RIB RESECTION THORACOPLASTY,,,3,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00474,CPT,ANESTHESIA PARTIAL RIB RESECTION RADICAL,,,3,,Anesth,,,,,13.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00500,CPT,ANESTHESIA ESOPHAGUS,,,3,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00520,CPT,ANESTHESIA CLOSED CHEST W/BRONCHOSCOPY NOS,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00522,CPT,ANESTHESIA CLOSED CHEST NEEDLE BIOPSY PLEURA,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00524,CPT,ANESTHESIA CLOSED CHEST PNEUMOCENTESIS,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00528,CPT,ANES MEDIASTINOSCOPY&THORACSCOPY W/O 1 LUNG VNTJ,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00529,CPT,ANES MEDIASTINOSCOPY&THORACOSCOPY W/1 LUNG VNT,,,3,,Anesth,,,,,11.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00530,CPT,ANES PERMANENT TRANSVENOUS PACEMAKER INSERTION,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00532,CPT,ANESTHESIA ACCESS CENTRAL VENOUS CIRCULATION,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00534,CPT,ANES TRANSVENOUS INSJ/REPLACEMENT PACING CVDFB,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00537,CPT,ANES CARDIAC ELECTROPHYSIOL STDY W/RF ABLATION,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00539,CPT,ANESTHESIA TRACHEOBRONCHIAL RECONSTRUCTION,,,3,,Anesth,,,,,18.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00540,CPT,ANES THORACOTOMY & THORACOSCOPY NOS,,,3,,Anesth,,,,,12.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00541,CPT,ANES THORACOTOMY & THORACOSCOPY W/1 LUNG VNTJ,,,3,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00542,CPT,ANES THORACOTOMY & THORACOSCOPY DECORTICATION,,,3,,Anesth,,,,,15.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00546,CPT,ANES THORACOTOMY & THORACOSCOPY PULMONARY RESC,,,3,,Anesth,,,,,15.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00548,CPT,ANES THORACOTOMY &THORACSCOPY TRACHEA & BRONCHI,,,3,,Anesth,,,,,17.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00550,CPT,ANESTHESIA FOR STERNAL DEBRIDEMENT,,,3,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00560,CPT,ANES HRT PERICARDIAL SAC& GRT VESLS W/O PMP OXT,,,3,,Anesth,,,,,15.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00561,CPT,ANES HRT PERICARD SAC&GREAT VSLS W/PMP OXTJ <1YR,,,3,,Anesth,,,,,25.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00562,CPT,ANES HRT PERICRD SAC&GRT VSLS W/PMP OXTJ >1MO PO,,,3,,Anesth,,,,,20.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00563,CPT,ANES HRT PRCRD SAC & GREAT VSL W/PUMP OXTJ HYPTH,,,3,,Anesth,,,,,25.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00566,CPT,ANES DIRECT CABG W/O PUMP OXYGENATOR,,,3,,Anesth,,,,,25.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00567,CPT,ANES DIRECT CABG W/PUMP OXYGENATOR,,,3,,Anesth,,,,,18.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00580,CPT,ANES HEART TRANSPLANT/HEART/LUNG TRANSPLANT,,,3,,Anesth,,,,,20.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00600,CPT,ANESTHESIA CERVICAL SPINE & CORD NOS,,,3,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00604,CPT,ANES CERVICAL SPINE & CORD W/PATIENT SITTING,,,3,,Anesth,,,,,13.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00620,CPT,ANESTHESIA THORACIC SPINE & CORD NOS,,,3,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00625,CPT,ANES THRC SPINE & CORD ANT APPR W/O 1 LUNG VENTJ,,,3,,Anesth,,,,,13.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00626,CPT,ANES THORACIC SPINE & CORD ANT APPR W/1 LNG VENT,,,3,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00630,CPT,ANESTHESIA LUMBAR REGION NOS,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00632,CPT,ANESTHESIA LUMBAR REGION LUMBAR SYMPATHECTOMY,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00635,CPT,ANES DIAGNOSTIC/THERAPEUTIC LUMBAR PUNCTURE,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00640,CPT,ANES MANIPULATE SPINE/CLSD CRV THORC/LUMBR SPINE,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00670,CPT,ANESTHESIA EXTENSIVE SPINE & SPINAL CORD,,,3,,Anesth,,,,,13.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00700,CPT,ANESTHESIA UPPER ANTERIOR ABDOMINAL WALL NOS,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00702,CPT,ANES UPR ANT ABDL WALL PERCUTANEOUS LIVER BX,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00730,CPT,ANESTHESIA UPPER POSTERIOR ABDOMINAL WALL,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00740,CPT,ANES UPPER GI ENDOSCOPY PROXIMAL TO DUODENUM,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00750,CPT,ANESTHESIA HERNIA REPAIR UPPER ABDOMEN NOS,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00752,CPT,ANES HRNA RPR UPR ABD LMBR&VENTRAL HERNIA&DEHISC,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00754,CPT,ANES HERNIA REPAIR UPPER ABDOMEN OMPHALOCELE,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00756,CPT,ANES HRNA REPAIR UPR ABD TABDL RPR DIPHRG HRNA,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00770,CPT,ANESTHESIA MAJOR ABDOMINAL BLOOD VESSELS,,,3,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00790,CPT,ANES INTRAPERITONEAL UPPER ABDOMEN W/LAPS NOS,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00792,CPT,ANES LAPS PARTIAL HEPATECTOMY W/MGMT LIVER HEMOR,,,3,,Anesth,,,,,13.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00794,CPT,ANES LAPAROSCOPIC PARTIAL/TOTAL PANCREATECTOMY,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00796,CPT,ANES LAPAROSCOPIC LIVER TRANSPLANT,,,3,,Anesth,,,,,30.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00797,CPT,ANES IPR UPPER ABDOMEN LAPS GASTRIC RSTCV MO,,,3,,Anesth,,,,,11.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00800,CPT,ANESTHESIA LOWER ANTERIOR ABDOMINAL WALL NOS,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00802,CPT,ANES LOWER ANT ABDOMINAL WALL PANNICULECTOMY,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00810,CPT,ANES LOWER INTESTINE ENDOSCOPY DISTAL DUODENUM,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00820,CPT,ANESTHESIA LOWER POSTERIOR ABDOMINAL WALL,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00830,CPT,ANESTHESIA HERNIA REPAIR LOWER ABDOMEN NOS,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00832,CPT,ANES LWR ABD VENTRAL & INCISIONAL HERNIA REPAIR,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00834,CPT,ANES HERNIA REPAIR LOWER ABDOMEN NOS & 1YR AGE,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00836,CPT,ANES HRNA RPR LWR ABD NOS INFTS <37WK BRTH/50WK,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00840,CPT,ANESTHESIA INTRAPERITONEAL LOWER ABD W/LAPS NOS,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00842,CPT,ANES IPER LOWER ABDOMEN W/LAPS AMNIOCENTESIS,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00844,CPT,ANES IPER LOWER ABD W/LAPS ABDOMINOPRNL RESCJ,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00846,CPT,ANES IPER LOWER ABD W/LAPS RAD HYSTERECTOMY,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00848,CPT,ANES IPER LOWER ABD W/LAPS PELVIC EXENTERATION,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00851,CPT,ANES IPER LWR ABD W/LAPS TUBAL LIGATION/TRANSECT,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00860,CPT,ANES EXTRAPERITONEAL LWR ABD W/URINARY TRACT NOS,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00862,CPT,ANES XTRPRTL LOWER ABD UR TRACT RENAL DON NFRCT,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00864,CPT,ANES XTRPRTL LWER ABD W/URINARY TRACT TOT CYSTEC,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00865,CPT,ANES XTRPRTL LWR ABD W/URINARY TRACT RAD PRSTECT,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00866,CPT,ANES XTRPRTL LOWER ABD W/URIN TRACT ADRENLECTOMY,,,3,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00868,CPT,ANES XTRPRTL LWR ABD W/URIN TRACT RENAL TRANSPL,,,3,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00870,CPT,ANES XTRPRTL LWR ABD W/URIN TRACT CSTOLITHOTOMY,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00872,CPT,ANES LITHOTRP XTRCORP SHOCK WAVE W/WATER BATH,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00873,CPT,ANES LITHOTRP XTRCORP SHOCK WAVE W/O WATER BATH,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00880,CPT,ANESTHESIA MAJOR LOWER ABDOMINAL VESSELS NOS,,,3,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00882,CPT,ANES MAJOR LOWER ABDOMINAL VESSELS IVC LIGATION,,,3,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00902,CPT,ANESTHESIA ANORECTAL PROCEDURE,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00904,CPT,ANESTHESIA RADICAL PERINEAL PROCEDURE,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00906,CPT,ANESTHESIA VULVECTOMY,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00908,CPT,ANESTHESIA PERINEAL PROSTATECTOMY,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00910,CPT,ANES TRANSURETHRAL W/URETHROCYSTOSCOPY NOS,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00912,CPT,ANES TRANSURETHRAL RESECTION OF BLADDER TUMOR,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00914,CPT,ANESTHESIA TRANSURETHRAL RESECTION OF PROSTATE,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00916,CPT,ANES TRURL POST-TRURL RESECTION BLEEDING,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00918,CPT,ANES TRURL FRAGMNTJ MANJ&/RMVL URETERAL CALCULUS,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00920,CPT,ANESTHESIA MALE GENITALIA INCL OPEN URETHRAL PX,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00921,CPT,ANES VASECTOMY UNI/BI INCL OPEN URETHRAL PX,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00922,CPT,ANES SEMINAL VESICLES INCL OPEN URETHRAL PX,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00924,CPT,ANES UNDSCND TESTIS UNI/BI INCL OPEN URTL PX,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00926,CPT,ANES RAD ORCHIECTOMY INGUN INCL OPEN URTL PX,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00928,CPT,ANES RAD ORCHIECTOMY ABDOMINAL INCL OPN URTL,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00930,CPT,ANES ORCHIOPEXY UNI/BI INCL OPEN URETHRAL PX,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00932,CPT,ANES COMPLETE AMPUTATION PENIS INCL OPEN URTL,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00934,CPT,ANES RAD AMP PENIS W/BI INGUINAL LYMPH NODE RMVL,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00936,CPT,ANES RAD AMP PENIS W/BI INGUNL&ILIAC LYMPH RMOVL,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00938,CPT,ANES INSJ PENILE PROSTH PRNL INCL OPEN URTL,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00940,CPT,ANESTHESIA VAGINAL PROCEDURE W/BIOPSY NOS,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00942,CPT,ANES COLPTMY VAGNC COLPRPHY INCL BX W/OPN URTL,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00944,CPT,ANESTHESIA VAGINAL HYSTERECTOMY INCL BIOPSY,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 00948,CPT,ANESTHESIA CERVICAL CERCLAGE INCLUDING BIOPSY,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00950,CPT,ANESTHESIA CULDOSCOPY INCLUDING BIOPSY,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 00952,CPT,ANES HYSTEROSCOPY&/HYSTEROSALPINGOGRAPHY W/BX,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01112,CPT,ANES BONE MARROW ASPIR&/BX ANT/PST ILIAC CREST,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01120,CPT,ANESTHESIA ON BONY PELVIS,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01130,CPT,ANESTHESIA BODY CAST APPLICATION OR REVISION,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01140,CPT,ANESTHESIA INTERPELVI ABDOMINAL AMPUTATION,,,3,,Anesth,,,,,15.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01150,CPT,ANES RADICAL TUMOR PELVIS XCP HINDQUARTER AMP,,,3,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01160,CPT,ANES CLOSED SYMPHYSIS PUBIS/SACROILIAC JOINT,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01170,CPT,ANES OPEN SYMPHYSIS PUBIS/SACROILIAC JOINT,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01173,CPT,ANES OPN RPR DISRPJ PELVIS/COLUMN FX ACETABULUM,,,3,,Anesth,,,,,12.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01180,CPT,ANESTHESIA OBTURATOR NEURECTOMY EXTRAPELVIC,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01190,CPT,ANESTHESIA OBTURATOR NEURECTOMY INTRAPELVIC,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01200,CPT,ANESTHESIA CLOSED HIP JOINT PROCEDURE,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01202,CPT,ANESTHESIA ARTHROSCOPIC HIP JOINT PROCEDURE,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01210,CPT,ANESTHESIA OPEN HIP JOINT PROCEDURE NOS,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01212,CPT,ANESTHESIA OPEN HIP JOINT DISARTICULATION,,,3,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01214,CPT,ANESTHESIA OPEN TOTAL HIP ARTHROPLASTY,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01215,CPT,ANESTHESIA OPEN REVISION TOTAL HIP ARTHROPLASTY,,,3,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01220,CPT,ANESTHESIA CLOSED PROCEDURES UPPER 2/3 FEMUR,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01230,CPT,ANESTHESIA OPEN PROCEDURES UPPER 2/3 FEMUR NOS,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01232,CPT,ANESTHESIA UPPER 2/3 FEMUR AMPUTATION,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01234,CPT,ANES UPPER 2/3 FEMUR RADICAL RESCECTION,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01250,CPT,ANES NERVE MUSC TENDON FASCIA & BURSAE UPPER LEG,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01260,CPT,ANES VEINS OF UPPER LEG INCLUDING EXPLORATION,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01270,CPT,ANESTHESIA ARTERIES UPPER LEG INCL BYPASS GRAFT,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01272,CPT,ANES ART UPPER LEG W/BYPASS GRAFT FEM ART LIG,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01274,CPT,ANES UPPER LEG W/BYPASS GRFT FEM ART EMBOLECTOMY,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01320,CPT,ANES NERVE MUSC TENDON FASCIA&BURSA KNEE&/POPLT,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01340,CPT,ANESTHESIA CLOSED PROCEDURES LOWER 1/3 FEMUR,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01360,CPT,ANESTHESIA OPEN PROCEDURES LOWER 1/3 FEMUR,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01380,CPT,ANESTHESIA CLOSED PROCEDURES KNEE JOINT,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01382,CPT,ANESTH DIAGNOSTIC ARTHROSCOPIC PROC KNEE JOINT,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01390,CPT,ANES CLOSED PROC UPPER END TIBIA FIBULA/PATELLA,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01392,CPT,ANES OPEN PROC UPPER ENDS TIBIA FIBULA&/PATELLA,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01400,CPT,ANES OPEN/SURG ARTHROSCOPIC PROC KNEE JOINT NOS,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01402,CPT,ANESTH OPEN/SURG ARTHRS TOTAL KNEE ARTHROPLASTY,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01404,CPT,ANESTH OPEN/SURG ARTHRS KNEE DISARTICULATION,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01420,CPT,ANES CAST APPLICATION REMOVAL/REPAIR KNEE JOINT,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01430,CPT,ANESTHESIA VEINS KNEE & POPLITEAL AREA NOS,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01432,CPT,ANES KNEE & POPLITEAL ARTERY VEIN FISTULA NOS,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01440,CPT,ANES ARTERIES OF KNEE & POPLITEAL AREA NOS,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01442,CPT,ANES ART KNEE POPLITEAL TEAEC W/WO PATCH GRAFT,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01444,CPT,ANES ART KNEE POPLITEAL EXC&GRF/RPR OCCLS/ARYS,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01462,CPT,ANESTHESIA CLOSED PROC LOWER LEG ANKLE & FOOT,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01464,CPT,ANESTHESIA ARTHROSCOPIC PROCEDURE ANKLE & FOOT,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01470,CPT,ANES NRV/MUS/TND/FASC LOWER LEG/ANKLE/FOOT NOS,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01472,CPT,ANES RPR RUPTURED ACHILLES TENDON W/WO GRAFT,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01474,CPT,ANESTHESIA GASTROCNEMIUS RECESSION,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01480,CPT,ANES OPEN PROC BONES LOWER LEG/ANKLE/FOOT NOS,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01482,CPT,ANES RADICAL RESECJ INCL BELOW KNEE AMPUTATION,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01484,CPT,ANES OPEN OSTEOTOMY/OSTEOPLASTY TIBIA&/FIBULA,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01486,CPT,ANESTHESIA OPEN TOTAL ANKLE REPLACEMENT,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01490,CPT,ANES LOWER LEG CAST APPLICATION REMOVAL/REPAIR,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01500,CPT,ANESTHESIA ARTERIES LOWER LEG W/BYPASS GRAFT NOS,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01502,CPT,ANES ART LOWER LEG W/BYP GRAFT EMBLC DIR/W/CATH,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01520,CPT,ANESTHESIA VEINS OF LOWER LEG NOS,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01522,CPT,ANES VEINS LOWER LEG VENOUS THRMBC DIR/W/CATH,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01610,CPT,ANES NRV MUSC TNDN FSCIA BURSA SHOULDER & AXILLA,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01620,CPT,ANES CLOSED HUMRL H/N STRNCLAV JOINT& SHO JOINT,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01622,CPT,ANES DIAG ARTHROSCOPIC SHOULDER JOINT PROC NOS,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01630,CPT,ANES ARTHRS HUMERAL H/N STRNCLAV & SHOULDER NOS,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01634,CPT,ANESTHESIA ARTHROSCOPIC SHOULDER DISARTICULATION,,,3,,Anesth,,,,,9.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01636,CPT,ANES ARTHRS INTERTHORACOSCAPULAR AMPUTATION,,,3,,Anesth,,,,,15.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01638,CPT,ANES ARTHROSCOPIC TOTAL SHOULDER REPLACEMENT,,,3,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01650,CPT,ANESTHESIA ARTERIES SHOULDER & AXILLA NOS,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01652,CPT,ANESTHESIA AXILLARY-BRACHIAL ANEURYSM,,,3,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01654,CPT,ANES ARTERIES SHOULDER & AXILLA BYPASS GRAFT,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01656,CPT,ANESTHESIA AXILLARY-FEMORAL BYPASS GRAFT,,,3,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01670,CPT,ANESTHESIA VEINS SHOULDER & AXILLA,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01680,CPT,ANES SHOULDER CAST APPL REMOVAL/REPAIR NOS,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01682,CPT,ANES SHOULDER SPICA APPLICATION REMOVAL/REPAIR,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01710,CPT,ANES NRV MUSC TDN FSCA&BRS UPR ARM/ELBOW NOS,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01712,CPT,ANESTHESIA OPEN TENOTOMY ELBOW TO SHOULDER,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01714,CPT,ANESTHESIA TENOPLASTY ELBOW TO SHOULDER,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01716,CPT,ANESTHESIA BICEPS TENODESIS RUPTURE LONG TENDON,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01730,CPT,ANESTHESIA CLOSED PROCEDURES HUMERUS & ELBOW,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01732,CPT,ANESTHESIA ELBOW JOINT DIAGNOSTIC ARTHROSCOPIC,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01740,CPT,ANES OPEN/SURG ARTHROSCOPIC ELBOW PROC NOS,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01742,CPT,ANESTHESIA OPEN/SURG ARTHRS OSTEOTOMY HUMERUS,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01744,CPT,ANES OPEN/SURG ARTHRS REPRS NON/MALUNION HUMERUS,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01756,CPT,ANESTHESIA OPEN/SURG ARTHRS RADICAL PROC ELBOW,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01758,CPT,ANESTH OPEN/SURG ARTHRS EXC CYST/TUMOR HUMERUS,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01760,CPT,ANESTH OPEN/SURG ARTHRS TOTAL ELBOW REPLACEMENT,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01770,CPT,ANESTHESIA ARTERIES UPPER ARM & ELBOW NOS,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01772,CPT,ANESTHESIA ARTERIES UPPER ARM&ELBOW EMBOLECTOM,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01780,CPT,ANESTH CLOSED PROC RADIUS ULNA WRIST/HAND BONES,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01782,CPT,ANESTHESIA VEINS UPPER ARM & ELBOW PHLEBORRHAPHY,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01810,CPT,ANES NERVE MUSCLE TDN FASCIA&BURSA FOREARM WRIST,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01820,CPT,ANES RADIUS ULNA WRIST/HAND BONES CLOSED PX,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01829,CPT,ANESTHESIA DIAGNOSTIC ARTHROSCOPIC PROC WRIST,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01830,CPT,ANES ARTHRS/ENDSCPY DSTL RADIUS ULNA/WRIST/HAND,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01832,CPT,ANESTHESIA ARTHRS/ENDOSCPIC TOTAL WRIST REPLCMT,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01840,CPT,ANESTHESIA ARTERIES FOREARM WRIST & HAND NOS,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01842,CPT,ANES ARTERIES FOREARM WRIST & HAND EMBOLECTOMY,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01844,CPT,ANESTHESIA VASCULAR SHUNT/SHUNT REVISION,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01850,CPT,ANESTHESIA VEINS FOREARM WRIST & HAND NOS,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01852,CPT,ANES VEINS FOREARM WRIST & HAND PHLEBORRHAPHY,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01860,CPT,ANES FOREARM WRIST/HAND CAST APPL RMVL/REPAIR,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01916,CPT,ANESTHESIA DIAGNOSTIC ARTERIOGRAPHY/VENOGRAPH,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01920,CPT,ANES C-CATHJ W/C ANGIOGRAPHY & VENTRICULOGRAPHY,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01922,CPT,ANES NON-INVASIVE IMAGING/RADIATION THERAPY,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01924,CPT,ANESTHESIA THER IVNTL RADIOLOGICAL ARTERIAL,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01925,CPT,ANESTHESIA CAROTID/CORONARY THER IVNTL RAD,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01926,CPT,ANES ICRA ICAR/AORTIC THER IVNTL RAD ARTL,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01930,CPT,ANES VENOUS/LYMPHATIC NOS THER IVNTL RAD NOS,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01931,CPT,ANESTHESIA INTRAHEPATIC/PORTAL THER IVNTL RAD,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01932,CPT,ANESTHESIA INTRATHORACIC/JUGULAR THER IVNTL RAD,,,3,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01933,CPT,ANES INTRACRANIAL THER IVNTL RAD VENS/LYMPHTC,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01935,CPT,ANESTHESIA PERQ IMAGE GUIDED SPINE DIAGNOSTIC,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01936,CPT,ANESTHESIA PERQ IMAGE GUIDED SPINE THERAPEUTIC,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01951,CPT,ANES 2/3 DGR BRN EXC/DBRDMT W/WO GRFT 4 % TBSA,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01952,CPT,ANES 2/3 DGR BRN EXC/DBRDMT W/WO GRFT 4-9 % TBSA,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01953,CPT,ANES 2/3 DGR BRN EXC/DBRDMT W/WO GRF EA 9% TBS,,,3,,Anesth,,,,,1.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01958,CPT,ANESTHESIA EXTERNAL CEPHALIC VERSION,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01960,CPT,ANESTHESIA VAGINAL DELIVERY ONLY,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01961,CPT,ANESTHESIA CESAREAN DELIVERY ONLY,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01962,CPT,ANES URGENT HYSTERECTOMY FOLLOWING DELIVERY,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01963,CPT,ANESTHESIA C HYST W/O ANY LABOR ANALG/ANES CARE,,,3,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01965,CPT,ANESTHESIA INCOMPLETE/MISSED ABORTION,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01966,CPT,ANESTHESIA INDUCED ABORTION,,,3,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01967,CPT,NEURAXIAL LABOR ANALG/ANES PLND VAGINAL DELIVERY,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01968,CPT,ANES CESARN DLVR FLWG NEURAXIAL LABOR ANALG/ANES,,,3,,Anesth,,,,,2.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01969,CPT,ANES CESARN HYST FLWG NEURAXIAL LABOR ANALG/ANES,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01990,CPT,PHYSIOL SUPPORT HARVEST ORGAN FROM BRAIN-DEAD PT,,,3,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20171001, 01991,CPT,ANES DX/THER NRV BLK/NJX OTH/THN PRONE POS,,,3,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01992,CPT,ANES DX/THER NERVE BLOCK/INJECTION PRONE POS,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 01996,CPT,DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN,,,3,,TotalUnits,,,,2.66 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 01999,CPT,UNLISTED ANESTHESIA PROCEDURE,,,3,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20171001, 10021,CPT,FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE,,,21,,RBRVS,1.27 ,0.56 ,2.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 10022,CPT,FINE NEEDLE ASPIRATION WITH IMAGING GUIDANCE,,,21,,RBRVS,1.27 ,0.48 ,2.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 10030,CPT,IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE,,,21,,RBRVS,3.00 ,1.17 ,18.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 10035,CPT,PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE,,,21,,RBRVS,1.70 ,0.63 ,13.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 10036,CPT,PERQ SFT TISS LOC DEVICE PLMT ADD LES W/GDNCE,,,21,,RBRVS,0.85 ,0.32 ,12.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 10040,CPT,ACNE SURGERY,,,21,,RBRVS,1.21 ,1.13 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 10060,CPT,INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE,,,21,,RBRVS,1.22 ,1.41 ,1.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 10061,CPT,INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE,,,21,,RBRVS,2.45 ,2.37 ,3.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 10080,CPT,INCISION & DRAINAGE PILONIDAL CYST SIMPLE,,,21,,RBRVS,1.22 ,1.53 ,3.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 10081,CPT,INCISION & DRAINAGE PILONIDAL CYST COMPLICATED,,,21,,RBRVS,2.50 ,2.00 ,4.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 10120,CPT,INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,,,21,,RBRVS,1.22 ,1.59 ,2.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 10121,CPT,INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL,,,21,,RBRVS,2.74 ,2.17 ,4.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 10140,CPT,I&D HEMATOMA SEROMA/FLUID COLLECTION,,,21,,RBRVS,1.58 ,1.60 ,2.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 10160,CPT,PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST,,,21,,RBRVS,1.25 ,1.33 ,2.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 10180,CPT,INCISION & DRAINAGE COMPLEX PO WOUND INFECTION,,,21,,RBRVS,2.30 ,2.33 ,4.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11000,CPT,DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF,,,21,,RBRVS,0.60 ,0.17 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11001,CPT,DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10% BDY SURF,,,21,,RBRVS,0.30 ,0.08 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11004,CPT,DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT&PR,,,21,,RBRVS,10.80 ,3.93 ,3.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 11005,CPT,DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL,,,21,,RBRVS,14.24 ,5.23 ,5.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 11006,CPT,DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT/ABDL,,,21,,RBRVS,13.10 ,4.72 ,4.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 11008,CPT,REMOVAL PROSTHETIC MATRL ABDL WALL FOR INFECTION,,,21,,RBRVS,5.00 ,1.83 ,1.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 11010,CPT,DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS,,,21,,RBRVS,4.19 ,3.09 ,9.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11011,CPT,DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC,,,21,,RBRVS,4.94 ,2.70 ,9.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11012,CPT,DBRDMT FX&/DISLC SUBQ T/M/F BONE,,,21,,RBRVS,6.87 ,4.03 ,12.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11042,CPT,DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<,,,21,,RBRVS,1.01 ,0.64 ,2.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11043,CPT,DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<,,,21,,RBRVS,2.70 ,1.37 ,3.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11044,CPT,DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<,,,21,,RBRVS,4.10 ,1.90 ,4.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11045,CPT,DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM,,,21,,RBRVS,0.50 ,0.18 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11046,CPT,DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM,,,21,,RBRVS,1.03 ,0.40 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11047,CPT,DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM,,,21,,RBRVS,1.80 ,0.73 ,1.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11055,CPT,PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,,,21,,RBRVS,0.35 ,0.09 ,0.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11056,CPT,PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4,,,21,,RBRVS,0.50 ,0.12 ,1.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11057,CPT,PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4,,,21,,RBRVS,0.65 ,0.16 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11100,CPT,BX SKIN SUBCUTANEOUS&/MUCOUS MEMBRANE 1 LESION,,,21,,RBRVS,0.81 ,0.48 ,2.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11101,CPT,BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN,,,21,,RBRVS,0.41 ,0.25 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11200,CPT,REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15,,,21,,RBRVS,0.82 ,1.16 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11201,CPT,REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10,,,21,,RBRVS,0.29 ,0.15 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11300,CPT,SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/<,,,21,,RBRVS,0.60 ,0.33 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11301,CPT,SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,,,21,,RBRVS,0.90 ,0.52 ,2.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11302,CPT,SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,,,21,,RBRVS,1.05 ,0.61 ,2.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11303,CPT,SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,,,21,,RBRVS,1.25 ,0.71 ,2.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11305,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<,,,21,,RBRVS,0.80 ,0.26 ,1.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11306,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM,,,21,,RBRVS,0.96 ,0.42 ,2.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11307,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,,,21,,RBRVS,1.20 ,0.57 ,2.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11308,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM,,,21,,RBRVS,1.46 ,0.52 ,2.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11310,CPT,SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<,,,21,,RBRVS,0.80 ,0.45 ,2.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11311,CPT,SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,,,21,,RBRVS,1.10 ,0.63 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11312,CPT,SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,,,21,,RBRVS,1.30 ,0.76 ,3.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11313,CPT,SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,,,21,,RBRVS,1.68 ,0.96 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11400,CPT,EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<,,,21,,RBRVS,0.90 ,1.26 ,2.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11401,CPT,EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM,,,21,,RBRVS,1.28 ,1.49 ,2.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11402,CPT,EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM,,,21,,RBRVS,1.45 ,1.58 ,3.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11403,CPT,EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM/<,,,21,,RBRVS,1.84 ,2.06 ,3.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11404,CPT,EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM,,,21,,RBRVS,2.11 ,2.15 ,3.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11406,CPT,EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM,,,21,,RBRVS,3.52 ,2.85 ,4.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11420,CPT,EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,,,21,,RBRVS,1.03 ,1.18 ,2.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11421,CPT,EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM,,,21,,RBRVS,1.47 ,1.47 ,2.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11422,CPT,EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM,,,21,,RBRVS,1.68 ,1.94 ,3.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11423,CPT,EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM,,,21,,RBRVS,2.06 ,2.11 ,3.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11424,CPT,EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,,,21,,RBRVS,2.48 ,2.25 ,3.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11426,CPT,EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM,,,21,,RBRVS,4.09 ,3.05 ,4.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11440,CPT,EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<,,,21,,RBRVS,1.05 ,1.76 ,2.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11441,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM,,,21,,RBRVS,1.53 ,2.00 ,2.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11442,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM,,,21,,RBRVS,1.77 ,2.11 ,3.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11443,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM,,,21,,RBRVS,2.34 ,2.39 ,3.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11444,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM,,,21,,RBRVS,3.19 ,2.80 ,4.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11446,CPT,EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM,,,21,,RBRVS,4.80 ,3.76 ,5.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11450,CPT,EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR,,,21,,RBRVS,3.22 ,3.31 ,6.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11451,CPT,EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR,,,21,,RBRVS,4.43 ,3.95 ,8.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11462,CPT,EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR,,,21,,RBRVS,3.00 ,3.27 ,6.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11463,CPT,EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR,,,21,,RBRVS,4.43 ,4.01 ,8.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11470,CPT,EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR,,,21,,RBRVS,3.74 ,3.57 ,7.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11471,CPT,EXCISION H/P/P/U COMPLEX REPAIR,,,21,,RBRVS,4.89 ,4.23 ,8.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11600,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<,,,21,,RBRVS,1.63 ,1.55 ,3.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11601,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM,,,21,,RBRVS,2.07 ,1.89 ,4.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11602,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM,,,21,,RBRVS,2.27 ,2.08 ,4.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11603,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<,,,21,,RBRVS,2.82 ,2.36 ,4.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11604,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM,,,21,,RBRVS,3.17 ,2.50 ,5.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11606,CPT,EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM,,,21,,RBRVS,5.02 ,3.29 ,6.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11620,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<,,,21,,RBRVS,1.64 ,1.57 ,3.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11621,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM,,,21,,RBRVS,2.08 ,1.91 ,4.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11622,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM,,,21,,RBRVS,2.41 ,2.15 ,4.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11623,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<,,,21,,RBRVS,3.11 ,2.50 ,4.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11624,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM,,,21,,RBRVS,3.62 ,2.70 ,5.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11626,CPT,EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM,,,21,,RBRVS,4.61 ,3.06 ,6.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11640,CPT,EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<,,,21,,RBRVS,1.67 ,1.66 ,3.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11641,CPT,EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM,,,21,,RBRVS,2.17 ,1.99 ,4.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11642,CPT,EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM,,,21,,RBRVS,2.62 ,2.27 ,4.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11643,CPT,EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM,,,21,,RBRVS,3.42 ,2.67 ,5.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11644,CPT,EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM,,,21,,RBRVS,4.34 ,3.17 ,6.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11646,CPT,EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM,,,21,,RBRVS,6.26 ,4.11 ,7.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11719,CPT,TRIMMING NONDYSTROPHIC NAILS ANY NUMBER,,,21,,RBRVS,0.17 ,0.04 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11720,CPT,DEBRIDEMENT NAIL ANY METHOD 1-5,,,21,,RBRVS,0.32 ,0.08 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11721,CPT,DEBRIDEMENT NAIL ANY METHOD 6/>,,,21,,RBRVS,0.54 ,0.13 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11730,CPT,AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1,,,21,,RBRVS,1.10 ,0.28 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11732,CPT,AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL,,,21,,RBRVS,0.44 ,0.11 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11740,CPT,EVACUATION SUBUNGUAL HEMATOMA,,,21,,RBRVS,0.37 ,0.53 ,1.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11750,CPT,EXCISION NAIL MATRIX PERMANENT REMOVAL,,,21,,RBRVS,1.58 ,2.31 ,3.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11755,CPT,BIOPSY NAIL UNIT SEPARATE PROCEDURE,,,21,,RBRVS,1.31 ,0.82 ,2.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11760,CPT,REPAIR NAIL BED,,,21,,RBRVS,1.63 ,1.51 ,3.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11762,CPT,RECONSTRUCTION NAIL BED W/GRAFT,,,21,,RBRVS,2.94 ,2.05 ,4.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11765,CPT,WEDGE EXCISION SKIN NAIL FOLD,,,21,,RBRVS,1.22 ,1.37 ,3.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11770,CPT,EXCISION PILONIDAL CYST/SINUS SIMPLE,,,21,,RBRVS,2.66 ,2.09 ,4.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11771,CPT,EXCISION PILONIDAL CYST/SINUS EXTENSIVE,,,21,,RBRVS,6.09 ,5.01 ,8.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11772,CPT,EXCISION PILONIDAL CYST/SINUS COMPLICATED,,,21,,RBRVS,7.35 ,7.55 ,10.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11900,CPT,INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS,,,21,,RBRVS,0.52 ,0.31 ,0.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11901,CPT,INJECTION INTRALESIONAL >7 LESIONS,,,21,,RBRVS,0.80 ,0.48 ,1.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11920,CPT,TATTOOING INCL MICROPIGMENTATION 6.0 CM/<,,,21,,RBRVS,1.61 ,1.39 ,2.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11921,CPT,TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM,,,21,,RBRVS,1.93 ,1.61 ,3.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11922,CPT,TATTOOING INCL MICROPIGMENTATION EA 20.0 CM,,,21,,RBRVS,0.49 ,0.28 ,1.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11950,CPT,SUBCUTANEOUS INJECTION FILLING MATERIAL 1 CC/<,,,21,,RBRVS,0.84 ,0.55 ,1.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11951,CPT,SUBCUTANEOUS INJECTION FILLING MATRL 1.1-5.0 CC,,,21,,RBRVS,1.19 ,0.66 ,1.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11952,CPT,SUBCUTANEOUS INJECTION FILLING MATRL 5.1-10.0CC,,,21,,RBRVS,1.69 ,0.84 ,1.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11954,CPT,SUBCUTANEOUS INJECTION FILLING MATRL >10.0 CC,,,21,,RBRVS,1.85 ,1.13 ,2.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11960,CPT,INSERTION TISSUE EXPANDER INCL SBSQ XPNSJ,,,21,,RBRVS,11.49 ,13.62 ,13.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11970,CPT,REPLACEMENT TISS EXPANDER PERMANENT PROSTHESIS,,,21,,RBRVS,8.01 ,8.05 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11971,CPT,REMOVAL TISS EXPANDER W/O INSERTION PROSTHESIS,,,21,,RBRVS,3.41 ,5.13 ,9.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11976,CPT,REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES,,,21,,RBRVS,1.78 ,0.70 ,2.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11980,CPT,SUBCUTANEOUS HORMONE PELLET IMPLANTATION,,,21,,RBRVS,1.10 ,0.39 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11981,CPT,INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,,,21,,RBRVS,1.48 ,0.63 ,2.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11982,CPT,REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,,,21,,RBRVS,1.78 ,0.79 ,2.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 11983,CPT,RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,,,21,,RBRVS,3.30 ,1.25 ,2.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12001,CPT,SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<,,,21,,RBRVS,0.84 ,0.32 ,1.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12002,CPT,SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM,,,21,,RBRVS,1.14 ,0.38 ,1.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12004,CPT,SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM,,,21,,RBRVS,1.44 ,0.45 ,1.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12005,CPT,SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM,,,21,,RBRVS,1.97 ,0.47 ,2.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12006,CPT,SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM,,,21,,RBRVS,2.39 ,0.60 ,2.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12007,CPT,SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM,,,21,,RBRVS,2.90 ,0.85 ,2.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12011,CPT,SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<,,,21,,RBRVS,1.07 ,0.36 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12013,CPT,SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM,,,21,,RBRVS,1.22 ,0.27 ,1.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12014,CPT,SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM,,,21,,RBRVS,1.57 ,0.35 ,1.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12015,CPT,SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM,,,21,,RBRVS,1.98 ,0.43 ,2.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12016,CPT,SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM,,,21,,RBRVS,2.68 ,0.61 ,2.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12017,CPT,SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM,,,21,,RBRVS,3.18 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12018,CPT,SIMPLE REPAIR F/E/E/N/L/M >30.0 CM,,,21,,RBRVS,3.61 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12020,CPT,TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE,,,21,,RBRVS,2.67 ,2.37 ,5.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12021,CPT,TX SUPERFICIAL WOUND DEHISCENCE W/PACKING,,,21,,RBRVS,1.89 ,1.82 ,2.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12031,CPT,REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<,,,21,,RBRVS,2.00 ,2.08 ,4.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12032,CPT,REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM,,,21,,RBRVS,2.52 ,2.70 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12034,CPT,REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM,,,21,,RBRVS,2.97 ,2.49 ,5.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12035,CPT,REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM,,,21,,RBRVS,3.50 ,2.81 ,6.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12036,CPT,REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM,,,21,,RBRVS,4.23 ,3.01 ,6.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12037,CPT,REPAIR INTERMEDIATE S/A/T/E >30.0 CM,,,21,,RBRVS,5.00 ,3.47 ,7.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12041,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<,,,21,,RBRVS,2.10 ,1.91 ,4.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12042,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM,,,21,,RBRVS,2.79 ,2.55 ,4.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12044,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM,,,21,,RBRVS,3.19 ,2.50 ,6.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12045,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM,,,21,,RBRVS,3.75 ,3.42 ,7.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12046,CPT,RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM,,,21,,RBRVS,4.30 ,3.62 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12047,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM,,,21,,RBRVS,4.95 ,3.95 ,8.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12051,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<,,,21,,RBRVS,2.33 ,2.24 ,4.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12052,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM,,,21,,RBRVS,2.87 ,2.56 ,5.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12053,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM,,,21,,RBRVS,3.17 ,2.61 ,6.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12054,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM,,,21,,RBRVS,3.50 ,2.37 ,6.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12055,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM,,,21,,RBRVS,4.50 ,3.60 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12056,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30.0CM,,,21,,RBRVS,5.30 ,4.69 ,9.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 12057,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC >30.0 CM,,,21,,RBRVS,6.00 ,4.56 ,8.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 13100,CPT,REPAIR COMPLEX TRUNK 1.1-2.5 CM,,,21,,RBRVS,3.00 ,2.47 ,6.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 13101,CPT,REPAIR COMPLEX TRUNK 2.6-7.5 CM,,,21,,RBRVS,3.50 ,3.26 ,7.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 13102,CPT,REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<,,,21,,RBRVS,1.24 ,0.69 ,1.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 13120,CPT,REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM,,,21,,RBRVS,3.23 ,3.07 ,6.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 13121,CPT,REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM,,,21,,RBRVS,4.00 ,3.10 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 13122,CPT,REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<,,,21,,RBRVS,1.44 ,0.79 ,2.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 13131,CPT,REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM,,,21,,RBRVS,3.73 ,2.91 ,6.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 13132,CPT,REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM,,,21,,RBRVS,4.78 ,3.58 ,8.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 13133,CPT,REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<,,,21,,RBRVS,2.19 ,1.26 ,2.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 13151,CPT,REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM,,,21,,RBRVS,4.34 ,3.28 ,6.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 13152,CPT,REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM,,,21,,RBRVS,5.34 ,3.89 ,8.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 13153,CPT,REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<,,,21,,RBRVS,2.38 ,1.33 ,2.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 13160,CPT,SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC,,,21,,RBRVS,12.04 ,8.92 ,8.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 14000,CPT,ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<,,,21,,RBRVS,6.37 ,6.95 ,10.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 14001,CPT,ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM,,,21,,RBRVS,8.78 ,8.44 ,12.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 14020,CPT,ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<,,,21,,RBRVS,7.22 ,7.93 ,11.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 14021,CPT,ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM,,,21,,RBRVS,9.72 ,9.39 ,13.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 14040,CPT,ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<,,,21,,RBRVS,8.60 ,8.28 ,11.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 14041,CPT,ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM,,,21,,RBRVS,10.83 ,9.90 ,14.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 14060,CPT,ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<,,,21,,RBRVS,9.23 ,8.75 ,11.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 14061,CPT,ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM,,,21,,RBRVS,11.48 ,10.72 ,15.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 14301,CPT,ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM,,,21,,RBRVS,12.65 ,10.66 ,15.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 14302,CPT,ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<,,,21,,RBRVS,3.73 ,2.02 ,2.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 14350,CPT,FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE,,,21,,RBRVS,11.05 ,7.67 ,7.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15002,CPT,PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT,,,21,,RBRVS,3.65 ,2.25 ,5.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15003,CPT,PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT,,,21,,RBRVS,0.80 ,0.37 ,1.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15004,CPT,PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT,,,21,,RBRVS,4.58 ,2.58 ,6.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15005,CPT,PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT,,,21,,RBRVS,1.60 ,0.74 ,1.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15040,CPT,HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<,,,21,,RBRVS,2.00 ,1.30 ,4.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15050,CPT,PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM,,,21,,RBRVS,5.57 ,6.31 ,9.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15100,CPT,SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD,,,21,,RBRVS,9.90 ,8.76 ,12.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15101,CPT,SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD,,,21,,RBRVS,1.72 ,1.13 ,3.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15110,CPT,EPIDRM AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD,,,21,,RBRVS,10.97 ,7.28 ,10.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15111,CPT,EPIDRM AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD,,,21,,RBRVS,1.85 ,0.75 ,1.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15115,CPT,EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/<,,,21,,RBRVS,11.28 ,7.65 ,10.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15116,CPT,EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM,,,21,,RBRVS,2.50 ,0.89 ,1.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15120,CPT,SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM//=100SCM ADL 100SQCM,,,21,,RBRVS,0.80 ,0.36 ,1.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15275,CPT,SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM,,,21,,RBRVS,1.83 ,0.74 ,2.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15276,CPT,SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM,,,21,,RBRVS,0.50 ,0.16 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15277,CPT,SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM 1ST 100SQ CM,,,21,,RBRVS,4.00 ,1.84 ,4.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15278,CPT,SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM,,,21,,RBRVS,1.00 ,0.45 ,1.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15570,CPT,FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK,,,21,,RBRVS,10.21 ,9.07 ,13.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15572,CPT,FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS,,,21,,RBRVS,10.12 ,9.57 ,13.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15574,CPT,FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F,,,21,,RBRVS,10.70 ,9.62 ,13.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15576,CPT,FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL,,,21,,RBRVS,9.37 ,8.52 ,12.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15600,CPT,DELAY FLAP/SECTIONING FLAP TRUNK,,,21,,RBRVS,2.01 ,3.57 ,6.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15610,CPT,DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS,,,21,,RBRVS,2.52 ,3.95 ,7.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15620,CPT,DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F,,,21,,RBRVS,3.75 ,5.00 ,8.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15630,CPT,DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS,,,21,,RBRVS,4.08 ,5.22 ,8.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15650,CPT,TRANSFER ANY PEDICLE FLAP ANY LOCATION,,,21,,RBRVS,4.77 ,5.43 ,8.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15731,CPT,FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE,,,21,,RBRVS,14.38 ,12.35 ,15.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15732,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP HEAD&NC,,,21,,RBRVS,16.38 ,13.46 ,18.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15734,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK,,,21,,RBRVS,19.86 ,14.15 ,19.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15736,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR,,,21,,RBRVS,17.04 ,12.62 ,17.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15738,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR,,,21,,RBRVS,19.04 ,12.91 ,17.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15740,CPT,FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY,,,21,,RBRVS,11.80 ,10.91 ,15.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15750,CPT,FLAP NEUROVASCULAR PEDICLE,,,21,,RBRVS,12.96 ,11.16 ,11.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15756,CPT,FREE MUSCLE/MYOCUTANEOUS FLAP W/MVASC ANAST,,,21,,RBRVS,36.94 ,24.01 ,24.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 15757,CPT,FREE SKIN FLAP W/MICROVASCULAR ANASTOMOSIS,,,21,,RBRVS,37.15 ,23.23 ,23.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 15758,CPT,FREE FASCIAL FLAP W/MICROVASCULAR ANASTOMOSIS,,,21,,RBRVS,36.90 ,23.49 ,23.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 15760,CPT,GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA,,,21,,RBRVS,9.86 ,9.06 ,12.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15770,CPT,GRAFT DERMA-FAT-FASCIA,,,21,,RBRVS,8.96 ,8.84 ,8.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15775,CPT,PUNCH GRAFT HAIR TRANSPLANT 1-15 PUNCH GRAFTS,,,21,,RBRVS,3.95 ,1.93 ,4.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15776,CPT,PUNCH GRAFT HAIR TRANSPLANT >15 PUNCH GRAFTS,,,21,,RBRVS,5.53 ,3.81 ,7.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15777,CPT,IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT,,,21,,RBRVS,3.65 ,1.82 ,1.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15780,CPT,DERMABRASION TOTAL FACE,,,21,,RBRVS,8.73 ,8.25 ,14.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15781,CPT,DERMABRASION SEGMENTAL FACE,,,21,,RBRVS,5.02 ,6.58 ,9.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15782,CPT,DERMABRASION REGIONAL OTHER THAN FACE,,,21,,RBRVS,4.44 ,7.66 ,12.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15783,CPT,DERMABRASION SUPERFICIAL ANY SITE,,,21,,RBRVS,4.41 ,5.26 ,8.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15786,CPT,ABRASION 1 LESION,,,21,,RBRVS,2.08 ,1.57 ,4.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15787,CPT,ABRASION EACH ADDITIONAL 4 LESIONS OR LESS,,,21,,RBRVS,0.33 ,0.14 ,1.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15788,CPT,CHEMICAL PEEL FACIAL EPIDERMAL,,,21,,RBRVS,2.09 ,4.68 ,10.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15789,CPT,CHEMICAL PEEL FACIAL DERMAL,,,21,,RBRVS,4.91 ,6.16 ,9.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15792,CPT,CHEMICAL PEEL NONFACIAL EPIDERMAL,,,21,,RBRVS,1.86 ,5.35 ,10.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15793,CPT,CHEMICAL PEEL NONFACIAL DERMAL,,,21,,RBRVS,3.96 ,5.96 ,9.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15819,CPT,CERVICOPLASTY,,,21,,RBRVS,10.65 ,8.83 ,8.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15820,CPT,BLEPHAROPLASTY LOWER EYELID,,,21,,RBRVS,6.27 ,7.62 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15821,CPT,BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD,,,21,,RBRVS,6.84 ,7.99 ,9.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15822,CPT,BLEPHAROPLASTY UPPER EYELID,,,21,,RBRVS,4.62 ,6.00 ,7.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15823,CPT,BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN,,,21,,RBRVS,6.81 ,8.07 ,9.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15824,CPT,RHYTIDECTOMY FOREHEAD,,,21,,TotalUnits,,,,28.69 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15825,CPT,RHYTIDECTOMY NECK W/PLATYSMAL TIGHTENING,,,21,,TotalUnits,,,,32.28 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15826,CPT,RHYTIDECTOMY GLABELLAR FROWN LINES,,,21,,TotalUnits,,,,23.30 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15828,CPT,RHYTIDECTOMY CHEEK CHIN & NECK,,,21,,TotalUnits,,,,60.96 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15829,CPT,RHYTIDECTOMY SMAS FLAP,,,21,,TotalUnits,,,,68.13 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15830,CPT,EXCISION SKIN ABD INFRAUMBILICAL PANNICULECTOMY,,,21,,RBRVS,17.11 ,13.38 ,13.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15832,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE THIGH,,,21,,RBRVS,12.85 ,11.22 ,11.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15833,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE LEG,,,21,,RBRVS,11.90 ,10.72 ,10.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15834,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE HIP,,,21,,RBRVS,12.17 ,11.19 ,11.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15835,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE BUTTOCK,,,21,,RBRVS,12.99 ,11.33 ,11.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15836,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE ARM,,,21,,RBRVS,10.61 ,9.23 ,9.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15837,CPT,EXC EXCESSIVE SKIN &SUBQ TISSUE FOREARM/HAND,,,21,,RBRVS,9.55 ,7.80 ,11.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15838,CPT,EXC EXCSV SKIN & SUBQ TISSUE SUBMENTAL FAT PAD,,,21,,RBRVS,8.25 ,6.96 ,6.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15839,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA,,,21,,RBRVS,10.50 ,8.85 ,12.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15840,CPT,GRAFT FACIAL NERVE PARALYSIS FREE FASCIAL GRAFT,,,21,,RBRVS,14.99 ,11.81 ,11.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15841,CPT,GRAFT FACIAL NERVE PARALYSIS FREE MUSCLE GRAFT,,,21,,RBRVS,25.99 ,16.11 ,16.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15842,CPT,GRF FACIAL NRV PALYSS FR MUSCLE FLAP MICROSURG,,,21,,RBRVS,41.01 ,27.71 ,27.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15845,CPT,GRF FACIAL NERVE PARALYSIS REGIONAL MUSCLE TR,,,21,,RBRVS,14.32 ,13.07 ,13.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15847,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE ABDOMEN,,,21,,TotalUnits,,,,9.06 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15850,CPT,REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON,,,21,,RBRVS,0.78 ,0.30 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15851,CPT,REMOVAL SUTURES UNDER ANESTHESIA OTHER SURGEON,,,21,,RBRVS,0.86 ,0.36 ,1.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15852,CPT,DRESSING CHANGE UNDER ANESTHESIA,,,21,,RBRVS,0.86 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15860,CPT,IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT,,,21,,RBRVS,1.95 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15876,CPT,SUCTION ASSISTED LIPECTOMY HEAD & NECK,,,21,,TotalUnits,,,,21.15 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15877,CPT,SUCTION ASSISTED LIPECTOMY TRUNK,,,21,,TotalUnits,,,,13.22 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15878,CPT,SUCTION ASSISTED LIPECTOMY UPPER EXTREMITY,,,21,,TotalUnits,,,,13.00 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15879,CPT,SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY,,,21,,TotalUnits,,,,27.93 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15920,CPT,EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/PRIM SUTR,,,21,,RBRVS,8.29 ,7.27 ,7.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15922,CPT,EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/FLAP CLSR,,,21,,RBRVS,10.38 ,10.21 ,10.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15931,CPT,EXCISION SACRAL PRESSURE ULCER W/PRIMARY SUTURE,,,21,,RBRVS,10.07 ,7.41 ,7.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15933,CPT,EXC SACRAL PRESSURE ULC W/PRIM SUTR W/OSTECTOMY,,,21,,RBRVS,11.77 ,10.15 ,10.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15934,CPT,EXCISION SACRAL PRESSURE ULCER W/SKIN FLAP CLSR,,,21,,RBRVS,13.68 ,10.09 ,10.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15935,CPT,EXC SACRAL PR ULCER W/SKN FLAP CLSR W/OSTECTOMY,,,21,,RBRVS,15.78 ,12.44 ,12.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15936,CPT,EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR,,,21,,RBRVS,13.16 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15937,CPT,EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC,,,21,,RBRVS,15.14 ,11.60 ,11.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15940,CPT,EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE,,,21,,RBRVS,10.20 ,7.80 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15941,CPT,EXC ISCHIAL PR ULC W/PRIM SUTR W/OSTC ISCHIECT,,,21,,RBRVS,12.41 ,10.98 ,10.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15944,CPT,EXC ISCHIAL PRESSURE ULCER W/SKIN FLAP CLOSURE,,,21,,RBRVS,12.44 ,10.59 ,10.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15945,CPT,EXC ISCHIAL PR ULC W/SKN FLAP CLSR W/OSTECTOMY,,,21,,RBRVS,13.75 ,11.65 ,11.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15946,CPT,EXC ISCHIAL PR ULCER W/OSTC MUSC/MYOQ FLAP/SKIN,,,21,,RBRVS,24.12 ,18.37 ,18.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15950,CPT,EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR,,,21,,RBRVS,8.03 ,7.24 ,7.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15951,CPT,EXC TRCHNTRIC PR ULCER W/PRIM SUTR W/OSTECTOMY,,,21,,RBRVS,11.58 ,11.59 ,11.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15952,CPT,EXC TROCHANTERIC PR ULCER W/SKIN FLAP CLOSURE,,,21,,RBRVS,12.31 ,11.28 ,11.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15953,CPT,EXC TRCHNTRIC PR ULC W/SKN FLAP CLSR W/OSTECTOMY,,,21,,RBRVS,13.57 ,12.59 ,12.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15956,CPT,EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN,,,21,,RBRVS,16.79 ,13.08 ,13.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15958,CPT,EXC TRCHNTRIC PR ULC MUSC/MYOQ FLAP/SKIN W/OSTC,,,21,,RBRVS,16.75 ,13.75 ,13.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 15999,CPT,UNLISTED PROCEDURE EXCISION PRESSURE ULCER,,,21,,TotalUnits,,,,23.39 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 16000,CPT,INITIAL TX 1ST DEGREE BURN LOCAL TX,,,21,,RBRVS,0.89 ,0.32 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 16020,CPT,DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL,,,21,,RBRVS,0.71 ,0.75 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 16025,CPT,DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM,,,21,,RBRVS,1.74 ,1.20 ,2.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 16030,CPT,DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE,,,21,,RBRVS,2.08 ,1.42 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 16035,CPT,ESCHAROTOMY FIRST INCISION,,,21,,RBRVS,3.74 ,1.36 ,1.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 16036,CPT,ESCHAROTOMY EACH ADDITIONAL INCISION,,,21,,RBRVS,1.50 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 17000,CPT,DESTRUCTION PREMALIGNANT LESION 1ST,,,21,,RBRVS,0.61 ,0.82 ,1.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17003,CPT,DESTRUCTION PREMALIGNANT LESION 2-14 EA,,,21,,RBRVS,0.04 ,0.02 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17004,CPT,DESTRUCTION PREMALIGNANT LESION 15/>,,,21,,RBRVS,1.37 ,1.29 ,2.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17106,CPT,DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM,,,21,,RBRVS,3.69 ,3.69 ,5.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17107,CPT,DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM,,,21,,RBRVS,4.79 ,4.47 ,6.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17108,CPT,DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM,,,21,,RBRVS,7.49 ,6.44 ,9.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17110,CPT,DESTRUCTION BENIGN LESIONS UP TO 14,,,21,,RBRVS,0.70 ,1.20 ,2.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17111,CPT,DESTRUCTION BENIGN LESIONS 15/>,,,21,,RBRVS,0.97 ,1.35 ,2.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17250,CPT,CHEMICAL CAUTERIZATION GRANULATION TISSUE,,,21,,RBRVS,0.50 ,0.49 ,1.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17260,CPT,DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<,,,21,,RBRVS,0.96 ,0.91 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17261,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM,,,21,,RBRVS,1.22 ,1.22 ,2.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17262,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM,,,21,,RBRVS,1.63 ,1.47 ,3.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17263,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM,,,21,,RBRVS,1.84 ,1.60 ,3.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17264,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM,,,21,,RBRVS,1.99 ,1.68 ,3.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17266,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG > 4.0 CM,,,21,,RBRVS,2.39 ,1.90 ,3.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17270,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/>,,,21,,RBRVS,1.37 ,1.29 ,2.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17271,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM,,,21,,RBRVS,1.54 ,1.42 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17272,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 1.1-2.0CM,,,21,,RBRVS,1.82 ,1.59 ,3.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17273,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 2.1-3.0CM,,,21,,RBRVS,2.10 ,1.75 ,3.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17274,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM,,,21,,RBRVS,2.64 ,2.05 ,3.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17276,CPT,DSTRJ MAL LESION S/N/H/F/G LESION DIAM > 4.0 CM,,,21,,RBRVS,3.25 ,2.38 ,4.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17280,CPT,DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<,,,21,,RBRVS,1.22 ,1.20 ,2.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17281,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM,,,21,,RBRVS,1.77 ,1.55 ,3.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17282,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM,,,21,,RBRVS,2.09 ,1.74 ,3.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17283,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM,,,21,,RBRVS,2.69 ,2.09 ,3.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17284,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM,,,21,,RBRVS,3.20 ,2.37 ,4.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17286,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M >4.0 CM,,,21,,RBRVS,4.48 ,2.94 ,5.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17311,CPT,MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS,,,21,,RBRVS,6.20 ,3.77 ,11.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17312,CPT,MOHS MICROGRAPHIC H/N/H/F/G EACH ADDL STAGE,,,21,,RBRVS,3.30 ,2.00 ,7.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17313,CPT,MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS,,,21,,RBRVS,5.56 ,3.38 ,11.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17314,CPT,MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE,,,21,,RBRVS,3.06 ,1.86 ,7.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17315,CPT,MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE,,,21,,RBRVS,0.87 ,0.53 ,1.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17340,CPT,CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE,,,21,,RBRVS,0.77 ,0.54 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17360,CPT,CHEMICAL EXFOLIATION ACNE,,,21,,RBRVS,1.46 ,1.15 ,1.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17380,CPT,ELECTROLYSIS EPILATION EACH 30 MINUTES,,,21,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 17999,CPT,UNLISTED PX SKIN MUC MEMBRANE & SUBQ TISSUE,,,21,,TotalUnits,,,,1.70 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19000,CPT,PUNCTURE ASPIRATION CYST BREAST,,,21,,RBRVS,0.84 ,0.31 ,2.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19001,CPT,PUNCTURE ASPIRATION BREAST EACH ADDITIONAL CYST,,,21,,RBRVS,0.42 ,0.16 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19020,CPT,MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP,,,21,,RBRVS,3.83 ,4.08 ,8.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19030,CPT,INJECTION MAMMARY DUCTOGRAM/GALACTOGRAM,,,21,,RBRVS,1.53 ,0.57 ,3.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19081,CPT,BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID,,,21,,RBRVS,3.29 ,1.22 ,16.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19082,CPT,BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID,,,21,,RBRVS,1.65 ,0.61 ,14.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 19083,CPT,BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID,,,21,,RBRVS,3.10 ,1.15 ,15.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19084,CPT,BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID,,,21,,RBRVS,1.55 ,0.58 ,13.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 19085,CPT,BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID,,,21,,RBRVS,3.64 ,1.35 ,25.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19086,CPT,BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID,,,21,,RBRVS,1.82 ,0.68 ,21.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 19100,CPT,BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX,,,21,,RBRVS,1.27 ,0.46 ,2.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19101,CPT,BIOPSY BREAST OPEN INCISIONAL,,,21,,RBRVS,3.23 ,2.40 ,5.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19105,CPT,ABLTJ CRYOSURGICAL W/US GID EA FIBROADENOMA,,,21,,RBRVS,3.69 ,1.54 ,56.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19110,CPT,NIPPLE EXPLORATION,,,21,,RBRVS,4.44 ,4.33 ,8.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19112,CPT,EXCISION LACTIFEROUS DUCT FISTULA,,,21,,RBRVS,3.81 ,4.19 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19120,CPT,EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION,,,21,,RBRVS,5.92 ,4.57 ,6.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19125,CPT,EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES,,,21,,RBRVS,6.69 ,4.92 ,7.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19126,CPT,EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL,,,21,,RBRVS,2.93 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19260,CPT,EXCISION CHEST WALL TUMOR INCLUDING RIBS,,,21,,RBRVS,17.78 ,12.78 ,12.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19271,CPT,EXC CHEST TUMOR W/RCNSTJ W/O MEDSTNL LMPHADEC,,,21,,RBRVS,22.19 ,19.61 ,19.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 19272,CPT,EXC CHEST TUMOR W/RCNSTJ W/MEDSTNL LMPHADEC,,,21,,RBRVS,25.17 ,20.42 ,20.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 19281,CPT,PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE,,,21,,RBRVS,2.00 ,0.75 ,4.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19282,CPT,PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE,,,21,,RBRVS,1.00 ,0.37 ,3.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 19283,CPT,PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE,,,21,,RBRVS,2.00 ,0.74 ,5.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19284,CPT,PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC,,,21,,RBRVS,1.00 ,0.37 ,4.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 19285,CPT,PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG,,,21,,RBRVS,1.70 ,0.63 ,12.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19286,CPT,PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE,,,21,,RBRVS,0.85 ,0.32 ,11.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 19287,CPT,PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID,,,21,,RBRVS,2.55 ,0.95 ,21.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19288,CPT,PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID,,,21,,RBRVS,1.28 ,0.48 ,18.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 19296,CPT,PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST,,,21,,RBRVS,3.63 ,1.63 ,107.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19297,CPT,PLMT EXPANDABLE CATH BRST CONCURRENT PRTL MAST,,,21,,RBRVS,1.72 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19298,CPT,PLMT RADTHX BRACHYTX BRST FOLLOWING PRTL MAST,,,21,,RBRVS,6.00 ,2.60 ,23.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19300,CPT,MASTECTOMY GYNECOMASTIA,,,21,,RBRVS,5.31 ,5.32 ,8.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19301,CPT,MASTECTOMY PARTIAL,,,21,,RBRVS,10.13 ,6.27 ,6.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19302,CPT,MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY,,,21,,RBRVS,13.99 ,8.58 ,8.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19303,CPT,MASTECTOMY SIMPLE COMPLETE,,,21,,RBRVS,15.85 ,9.50 ,9.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19304,CPT,MASTECTOMY SUBCUTANEOUS,,,21,,RBRVS,7.95 ,6.69 ,6.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19305,CPT,MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES,,,21,,RBRVS,17.46 ,10.95 ,10.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 19306,CPT,MAST RAD W/PECTORAL MUSC AX INT MAM LYMPH NODES,,,21,,RBRVS,18.13 ,12.06 ,12.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 19307,CPT,MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN,,,21,,RBRVS,18.23 ,11.90 ,11.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19316,CPT,MASTOPEXY,,,21,,RBRVS,11.09 ,8.98 ,8.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19318,CPT,REDUCTION MAMMAPLASTY,,,21,,RBRVS,16.03 ,12.86 ,12.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19324,CPT,MAMMAPLASTY AUGMENTATION W/O PROSTHETIC IMPLANT,,,21,,RBRVS,6.80 ,5.66 ,5.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19325,CPT,MAMMAPLASTY AUGMENTATION W/PROSTHETIC IMPLANT,,,21,,RBRVS,8.64 ,8.28 ,8.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19328,CPT,REMOVAL INTACT MAMMARY IMPLANT,,,21,,RBRVS,6.48 ,6.57 ,6.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19330,CPT,REMOVAL MAMMARY IMPLANT MATERIAL,,,21,,RBRVS,8.54 ,8.14 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19340,CPT,IMMT INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ,,,21,,RBRVS,13.99 ,12.39 ,12.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19342,CPT,DLYD INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ,,,21,,RBRVS,12.63 ,11.69 ,11.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19350,CPT,NIPPLE/AREOLA RECONSTRUCTION,,,21,,RBRVS,9.11 ,8.61 ,12.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19355,CPT,CORRECTION INVERTED NIPPLES,,,21,,RBRVS,8.52 ,5.87 ,9.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19357,CPT,BRST RCNSTJ IMMT/DLYD W/TISS EXPANDER SBSQ XPNSJ,,,21,,RBRVS,18.50 ,21.47 ,21.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19361,CPT,BRST RCNSTJ W/LATSMS D/SI FLAP WO PRSTHC IMPL,,,21,,RBRVS,23.36 ,17.88 ,17.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 19364,CPT,BREAST RECONSTRUCTION FREE FLAP,,,21,,RBRVS,42.58 ,29.36 ,29.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 19366,CPT,BREAST RECONSTRUCTION OTHER TECHNIQUE,,,21,,RBRVS,21.84 ,14.53 ,14.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19367,CPT,BREAST RECONSTRUCTION TRAM FLAP 1 PEDICLE,,,21,,RBRVS,26.80 ,20.06 ,20.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 19368,CPT,BREAST RECONSTRUCTION TRAM 1 PEDCL MVASC ANAST,,,21,,RBRVS,33.90 ,23.62 ,23.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 19369,CPT,BREAST RECONSTRUCTION TRAM FLAP DOUBLE PEDICLE,,,21,,RBRVS,31.31 ,22.00 ,22.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 19370,CPT,OPEN PERIPROSTHETIC CAPSULOTOMY BREAST,,,21,,RBRVS,9.17 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19371,CPT,PERIPROSTHETIC CAPSULECTOMY BREAST,,,21,,RBRVS,10.62 ,10.02 ,10.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19380,CPT,REVISION RECONSTRUCTED BREAST,,,21,,RBRVS,10.41 ,9.95 ,9.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19396,CPT,PREPARATION MOULAGE CUSTOM BREAST IMPLANT,,,21,,RBRVS,2.17 ,1.51 ,5.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 19499,CPT,UNLISTED PROCEDURE BREAST,,,21,,TotalUnits,,,,7.46 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20005,CPT,I&D SOFT TISSUE ABSCESS SUBFASC,,,21,,RBRVS,3.58 ,2.57 ,4.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20100,CPT,EXPLORATION PENETRATING WOUND SPX NECK,,,21,,RBRVS,10.38 ,5.03 ,5.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20101,CPT,EXPLORATION PENETRATING WOUND SPX CHEST,,,21,,RBRVS,3.23 ,2.02 ,8.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20102,CPT,EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK,,,21,,RBRVS,3.98 ,2.50 ,9.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20103,CPT,EXPLORATION PENETRATING WOUND SPX EXTREMITY,,,21,,RBRVS,5.34 ,3.74 ,10.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20150,CPT,EXCISION EPIPHYSEAL BAR,,,21,,RBRVS,14.75 ,8.94 ,8.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20200,CPT,BIOPSY MUSCLE SUPERFICIAL,,,21,,RBRVS,1.46 ,0.93 ,4.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20205,CPT,BIOPSY MUSCLE DEEP,,,21,,RBRVS,2.35 ,1.52 ,5.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20206,CPT,BIOPSY MUSCLE PERCUTANEOUS NEEDLE,,,21,,RBRVS,0.99 ,0.62 ,5.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20220,CPT,BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL,,,21,,RBRVS,1.27 ,0.71 ,3.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20225,CPT,BIOPSY BONE TROCAR/NEEDLE DEEP,,,21,,RBRVS,1.87 ,1.08 ,12.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20240,CPT,BIOPSY BONE OPEN SUPERFICIAL,,,21,,RBRVS,2.61 ,1.46 ,1.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20245,CPT,BIOPSY BONE OPEN DEEP,,,21,,RBRVS,8.95 ,4.46 ,4.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20250,CPT,BIOPSY VERTEBRAL BODY OPEN THORACIC,,,21,,RBRVS,5.19 ,4.67 ,4.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20251,CPT,BIOPSY VERTEBRAL BODY OPEN LUMBAR/CERVICAL,,,21,,RBRVS,5.72 ,4.99 ,4.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20500,CPT,INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC,,,21,,RBRVS,1.28 ,1.02 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20501,CPT,INJECTION SINUS TRACT DIAGNOSTIC,,,21,,RBRVS,0.76 ,0.27 ,2.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20520,CPT,REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE,,,21,,RBRVS,1.90 ,2.02 ,3.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20525,CPT,RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP,,,21,,RBRVS,3.54 ,2.96 ,9.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20526,CPT,INJECTION THERAPEUTIC CARPAL TUNNEL,,,21,,RBRVS,0.94 ,0.55 ,1.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20527,CPT,INJECTION ENZYME PALMAR FASCIAL CORD,,,21,,RBRVS,1.00 ,0.73 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20550,CPT,INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS,,,21,,RBRVS,0.75 ,0.36 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20551,CPT,INJECTION SINGLE TENDON ORIGIN/INSERTION,,,21,,RBRVS,0.75 ,0.39 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20552,CPT,INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES,,,21,,RBRVS,0.66 ,0.36 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20553,CPT,INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES,,,21,,RBRVS,0.75 ,0.41 ,0.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20555,CPT,PLACEMENT NEEDLES MUSCLE SUBSEQUENT RADIOELEMENT,,,21,,RBRVS,6.00 ,2.61 ,2.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20600,CPT,ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US,,,21,,RBRVS,0.66 ,0.29 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20604,CPT,ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT,,,21,,RBRVS,0.89 ,0.33 ,1.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20605,CPT,ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US,,,21,,RBRVS,0.68 ,0.31 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20606,CPT,ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US,,,21,,RBRVS,1.00 ,0.39 ,1.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20610,CPT,ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US,,,21,,RBRVS,0.79 ,0.41 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20611,CPT,ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US,,,21,,RBRVS,1.10 ,0.51 ,1.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20612,CPT,ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ,,,21,,RBRVS,0.70 ,0.41 ,0.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20615,CPT,ASPIRATION & INJECTION TREATMENT BONE CYST,,,21,,RBRVS,2.33 ,2.06 ,4.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20650,CPT,INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX,,,21,,RBRVS,2.28 ,1.90 ,3.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20660,CPT,APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX,,,21,,RBRVS,4.00 ,1.86 ,1.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20661,CPT,APPLICATION HALO CRANIAL INCLUDING REMOVAL,,,21,,RBRVS,5.26 ,7.46 ,7.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 20662,CPT,APPLICATION HALO PELVIC INCLUDING REMOVAL,,,21,,RBRVS,6.38 ,5.62 ,5.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20663,CPT,APPLICATION HALO FEMORAL INCLUDING REMOVAL,,,21,,RBRVS,5.74 ,6.54 ,6.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20664,CPT,APPL HALO 6/> PINS THIN SKULL OSTEOLOGY,,,21,,RBRVS,10.06 ,11.16 ,11.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 20665,CPT,REMOVAL TONG/HALO APPLIED BY ANOTHER INDIVIDUAL,,,21,,RBRVS,1.36 ,1.13 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20670,CPT,REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE,,,21,,RBRVS,1.79 ,2.15 ,8.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20680,CPT,REMOVAL IMPLANT DEEP,,,21,,RBRVS,5.96 ,5.20 ,10.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20690,CPT,APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM,,,21,,RBRVS,8.78 ,6.61 ,6.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20692,CPT,APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM,,,21,,RBRVS,16.27 ,13.07 ,13.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20693,CPT,ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES,,,21,,RBRVS,6.06 ,5.74 ,5.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20694,CPT,REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES,,,21,,RBRVS,4.28 ,4.65 ,7.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20696,CPT,XTRNL FIXJ W/STEREOTACTIC ADJUSTMENT 1ST & SUBQ,,,21,,RBRVS,17.56 ,13.75 ,13.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20697,CPT,XTRNL FIXJ W/STRTCTC ADJUSTMENT EXCHANGE STRUT,,TC,21,,RBRVS,,56.23 ,56.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 20802,CPT,REPLANTATION ARM COMPLETE AMPUTATION,,,21,,RBRVS,42.62 ,20.82 ,20.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 20805,CPT,REPLANTATION FOREARM COMPLETE AMPUTATION,,,21,,RBRVS,51.46 ,33.59 ,33.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 20808,CPT,REPLANTATION HAND COMPLETE AMPUTATION,,,21,,RBRVS,63.09 ,41.07 ,41.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 20816,CPT,RPLJ DGT EXCEPT THMB MTCARPHLNGL JT COMPL AMP,,,21,,RBRVS,31.95 ,21.25 ,21.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 20822,CPT,RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP,,,21,,RBRVS,26.66 ,20.57 ,20.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20824,CPT,RPLJ THMB CARP/MTCRPL JT MP JT COMPL AMPUTATION,,,21,,RBRVS,31.95 ,20.39 ,20.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 20827,CPT,RPLJ THUMB DISTAL TIP MP JOINT COMPL AMPUTATION,,,21,,RBRVS,27.48 ,19.66 ,19.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 20838,CPT,REPLANTATION FOOT COMPLETE AMPUTATION,,,21,,RBRVS,42.88 ,21.23 ,21.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 20900,CPT,BONE GRAFT ANY DONOR AREA MINOR/SMALL,,,21,,RBRVS,3.00 ,1.93 ,8.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20902,CPT,BONE GRAFT ANY DONOR AREA MAJOR/LARGE,,,21,,RBRVS,4.58 ,2.80 ,2.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20910,CPT,CARTILAGE GRAFT COSTOCHONDRAL,,,21,,RBRVS,5.53 ,5.47 ,5.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20912,CPT,CARTILAGE GRAFT NASAL SEPTUM,,,21,,RBRVS,6.54 ,6.28 ,6.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20920,CPT,FASCIA LATA GRAFT BY STRIPPER,,,21,,RBRVS,5.51 ,5.03 ,5.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20922,CPT,FASCIA LATA GRAFT INCISION & AREA EXPOSURE,,,21,,RBRVS,6.93 ,5.88 ,8.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20924,CPT,TENDON GRAFT FROM A DISTANCE,,,21,,RBRVS,6.68 ,6.61 ,6.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20926,CPT,TISSUE GRAFTS OTHER,,,21,,RBRVS,5.79 ,5.52 ,5.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20930,CPT,ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED,,,21,,TotalUnits,,,,4.06 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20931,CPT,ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL,,,21,,RBRVS,1.81 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20936,CPT,AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION,,,21,,TotalUnits,,,,5.02 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 20937,CPT,AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION,,,21,,RBRVS,2.79 ,1.37 ,1.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 20938,CPT,AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC,,,21,,RBRVS,3.02 ,1.46 ,1.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 20950,CPT,MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME,,,21,,RBRVS,1.26 ,1.14 ,5.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20955,CPT,BONE GRAFT MICROVASCULAR ANASTOMOSIS FIBULA,,,21,,RBRVS,40.26 ,25.58 ,25.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 20956,CPT,BONE GRAFT MICROVASCULAR ANAST ILIAC CREST,,,21,,RBRVS,41.18 ,26.87 ,26.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 20957,CPT,BONE GRAFT MICROVASCULAR ANAST METATARSAL,,,21,,RBRVS,42.61 ,22.61 ,22.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 20962,CPT,BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR,,,21,,RBRVS,39.21 ,18.11 ,18.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 20969,CPT,FREE OSTQ FLAP W/MVASC ANAST METAR/GREAT TOE,,,21,,RBRVS,45.43 ,27.50 ,27.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 20970,CPT,FREE OSTQ FLAP W/MVASC ANASTOMOSIS ILIAC CREST,,,21,,RBRVS,44.58 ,29.05 ,29.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 20972,CPT,FREE OSTQ FLAP W/MVASC ANASTOMOSIS METATARSAL,,,21,,RBRVS,44.51 ,19.40 ,19.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20973,CPT,FR OSTQ FLAP W/MVASC ANAST GRT TOE W/WEB SPACE,,,21,,RBRVS,47.27 ,22.42 ,22.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20974,CPT,ELECTRICAL STIMULATION BONE HEALING NONINVASIVE,,,21,,RBRVS,0.62 ,0.69 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20975,CPT,ELECTRICAL STIMULATION BONE HEALING INVASIVE,,,21,,RBRVS,2.60 ,1.90 ,1.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20979,CPT,LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE,,,21,,RBRVS,0.62 ,0.23 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20982,CPT,ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE,,,21,,RBRVS,7.27 ,2.95 ,77.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20983,CPT,ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD,,,21,,RBRVS,7.13 ,3.55 ,198.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20985,CPT,CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS,,,21,,RBRVS,2.50 ,1.26 ,1.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 20999,CPT,UNLISTED PROCEDURE MUSCSKELETAL SYSTEM GENERAL,,,21,,TotalUnits,,,,1.56 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21010,CPT,ARTHROTOMY TEMPOROMANDIBULAR JOINT,,,21,,RBRVS,11.04 ,8.72 ,8.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21011,CPT,EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM,,,21,,RBRVS,2.99 ,3.91 ,6.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21012,CPT,EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>,,,21,,RBRVS,4.45 ,4.39 ,4.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21013,CPT,EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM,,,21,,RBRVS,5.42 ,5.16 ,8.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21014,CPT,EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>,,,21,,RBRVS,7.13 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21015,CPT,RAD RESECTION TUMOR SOFT TISS FACE/SCALP < 2CM,,,21,,RBRVS,9.89 ,8.74 ,8.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21016,CPT,RAD RESECTION TUMOR SOFT TISS FACE/SCALP 2 CM/>,,,21,,RBRVS,15.26 ,11.47 ,11.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21025,CPT,EXCISION BONE MANDIBLE,,,21,,RBRVS,10.03 ,10.15 ,14.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21026,CPT,EXCISION FACIAL BONE,,,21,,RBRVS,5.70 ,7.83 ,11.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21029,CPT,REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE,,,21,,RBRVS,8.39 ,8.69 ,12.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21030,CPT,EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG,,,21,,RBRVS,4.91 ,6.41 ,9.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21031,CPT,EXCISION TORUS MANDIBULARIS,,,21,,RBRVS,3.30 ,4.73 ,7.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21032,CPT,EXCISION MAXILLARY TORUS PALATINUS,,,21,,RBRVS,3.34 ,4.60 ,7.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21034,CPT,EXCISION MALIGNANT TUMOR MAXILLA/ZYGOMA,,,21,,RBRVS,17.38 ,13.47 ,17.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21040,CPT,EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL & CURT,,,21,,RBRVS,4.91 ,6.43 ,9.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21044,CPT,EXCISION MALIGNANT TUMOR MANDIBLE,,,21,,RBRVS,12.80 ,10.63 ,10.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21045,CPT,EXCISION MALIGNANT TUMOR MANDIBLE RADICAL,,,21,,RBRVS,18.37 ,14.36 ,14.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21046,CPT,EXC BENIGN TUMOR/CYST MNDBL INTRA-ORAL OSTEOT,,,21,,RBRVS,14.21 ,15.89 ,15.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21047,CPT,EXC B9 TUM/CST MNDBL XTR-ORAL OSTEOT&PRTL MNDB,,,21,,RBRVS,20.07 ,15.00 ,15.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21048,CPT,EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT,,,21,,RBRVS,14.71 ,16.14 ,16.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21049,CPT,EXC B9 TUM/CST MAXL XTR-ORAL OSTEOT&PRTL MAXLC,,,21,,RBRVS,19.32 ,12.97 ,12.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21050,CPT,CONDYLECTOMY TEMPOROMANDIBULAR JOINT SPX,,,21,,RBRVS,11.76 ,10.77 ,10.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21060,CPT,MENISCECTOMY PRTL/COMPL TEMPOROMANDIBULAR JT SPX,,,21,,RBRVS,11.07 ,10.26 ,10.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21070,CPT,CORONOIDECTOMY SEPARATE PROCEDURE,,,21,,RBRVS,8.62 ,7.80 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21073,CPT,MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA,,,21,,RBRVS,3.45 ,3.32 ,7.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21076,CPT,IMPRESSION&PREPARATION SURG OBTURATOR PROSTHES,,,21,,RBRVS,13.40 ,8.78 ,13.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21077,CPT,IMPRESSION & PREPARATION ORBITAL PROSTHESIS,,,21,,RBRVS,33.70 ,22.01 ,33.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21079,CPT,IMPRESSION & PREPARATION INTERIM OBTURATOR PROST,,,21,,RBRVS,22.31 ,14.78 ,23.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21080,CPT,IMPRESSION & PREPJ DEFINITIVE OBTURATOR PROSTHES,,,21,,RBRVS,25.06 ,16.26 ,25.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21081,CPT,IMPRESSION & PREPJ MANDIBULAR RESECTION PROSTHES,,,21,,RBRVS,22.85 ,15.14 ,24.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21082,CPT,IMPRESSION & PREPJ PALATAL AUGMENTATION PROSTHES,,,21,,RBRVS,20.84 ,14.89 ,23.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21083,CPT,IMPRESSION & PREPARATION PALATAL LIFT PROSTHESIS,,,21,,RBRVS,19.27 ,13.91 ,23.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21084,CPT,IMPRESSION & PREPARATION SPEECH AID PROSTHESIS,,,21,,RBRVS,22.48 ,15.97 ,26.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21085,CPT,IMPRESSION & PREPARATION ORAL SURGICAL SPLINT,,,21,,RBRVS,8.99 ,6.06 ,11.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21086,CPT,IMPRESSION & PREPARATION AURICULAR PROSTHESIS,,,21,,RBRVS,24.88 ,16.39 ,25.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21087,CPT,IMPRESSION & PREPARATION NASAL PROSTHESIS,,,21,,RBRVS,24.88 ,16.30 ,25.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21088,CPT,IMPRESSION & PREPARATION FACIAL PROSTHESIS,,,21,,TotalUnits,,,,24.09 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21089,CPT,UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE,,,21,,TotalUnits,,,,28.40 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21100,CPT,APPL HALO APPLIANCE MAXILLOFACIAL FIXATION SPX,,,21,,RBRVS,4.73 ,8.26 ,23.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21110,CPT,APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC,,,21,,RBRVS,5.99 ,12.55 ,16.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21116,CPT,INJECTION TEMPOROMANDIBULAR JOINT ARTHROGRAPHY,,,21,,RBRVS,0.81 ,0.36 ,3.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21120,CPT,GENIOPLASTY AUGMENTATION,,,21,,RBRVS,5.10 ,9.09 ,13.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21121,CPT,GENIOPLASTY SLIDING OSTEOTOMY SINGLE PIECE,,,21,,RBRVS,7.81 ,10.43 ,14.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21122,CPT,GENIOPLASTY 2/> SLIDING OSTEOTOMIES,,,21,,RBRVS,8.71 ,9.11 ,9.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21123,CPT,GENIOP SLIDING AGMNTJ W/INTERPOSAL BONE GRAFTS,,,21,,RBRVS,11.34 ,13.76 ,13.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21125,CPT,AGMNTJ MNDBLR BODY/ANGLE PROSTHETIC MATERIAL,,,21,,RBRVS,10.80 ,10.19 ,75.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21127,CPT,AGMNTJ MNDBLR BDY/ANGL W/GRF ONLAY/INTERPOSAL,,,21,,RBRVS,12.44 ,11.37 ,112.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21137,CPT,REDUCTION FOREHEAD CONTOURING ONLY,,,21,,RBRVS,10.24 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21138,CPT,RDCTJ FHD CNTRG & PROSTHETIC MATRL/BONE GRAFT,,,21,,RBRVS,12.87 ,11.31 ,11.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21139,CPT,RDCTJ FHD CNTRG & SETBACK ANT FRONTAL SINUS WALL,,,21,,RBRVS,15.02 ,10.36 ,10.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21141,CPT,RCNSTJ MIDFACE LEFORT I 1 PIECE W/O BONE GRAFT,,,21,,RBRVS,19.57 ,16.04 ,16.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21142,CPT,RCNSTJ MIDFACE LEFORT I 2 PIECES W/O BONE GRAFT,,,21,,RBRVS,20.28 ,16.98 ,16.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21143,CPT,RCNSTJ MIDFACE LEFORT I 3/> PIECE W/O BONE GRAFT,,,21,,RBRVS,21.05 ,16.57 ,16.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21145,CPT,RCNSTJ MIDFACE LEFORT I 1 PIECE W/BONE GRAFTS,,,21,,RBRVS,23.94 ,17.45 ,17.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21146,CPT,RCNSTJ MIDFACE LEFORT I 2 PIECES W/BONE GRAFTS,,,21,,RBRVS,24.87 ,16.33 ,16.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21147,CPT,RCNSTJ MIDFACE LEFORT I 3/> PIECE W/BONE GRAFTS,,,21,,RBRVS,26.47 ,19.79 ,19.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21150,CPT,RCNSTJ MIDFACE LEFORT II ANTERIOR INTRUSION,,,21,,RBRVS,25.96 ,18.93 ,18.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21151,CPT,RCNSTJ MIDFACE LEFORT II W/BONE GRAFTS,,,21,,RBRVS,29.02 ,25.51 ,25.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21154,CPT,RCNSTJ MIDFACE LEFORT III W/O LEFORT I,,,21,,RBRVS,31.29 ,23.25 ,23.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21155,CPT,RCNSTJ MIDFACE LEFORT III W/LEFORT I,,,21,,RBRVS,35.22 ,23.50 ,23.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21159,CPT,RCNSTJ MIDFACE LEFORT III W/FHD W/O LEFORT I,,,21,,RBRVS,43.14 ,23.32 ,23.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21160,CPT,RCNSTJ MIDFACE LEFORT III W/FHD W/LEFORT I,,,21,,RBRVS,47.19 ,36.58 ,36.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21172,CPT,RCNSTJ SUPERIOR-LATERAL ORBITAL RIM & LOWER FHD,,,21,,RBRVS,28.20 ,21.99 ,21.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21175,CPT,RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD,,,21,,RBRVS,33.56 ,24.37 ,24.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21179,CPT,RCNSTJ FOREHEAD &/ SUPRAORB RIMS W/ALGRF/PROSTC,,,21,,RBRVS,22.65 ,17.26 ,17.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21180,CPT,RCNSTJ FOREHEAD &/ SUPRAORBITAL RIMS W/AUTOGRAFT,,,21,,RBRVS,25.58 ,15.54 ,15.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21181,CPT,RCNSTJ CONTOURING BENIGN TUMOR CRNL BONES XTRC,,,21,,RBRVS,10.28 ,9.23 ,9.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21182,CPT,RCNSTJ ORBIT/FHD/NASETHMD EXCBONE TUM GRF<40SQCM,,,21,,RBRVS,32.58 ,18.41 ,18.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21183,CPT,RCNSTJ ORBIT/FHD/NASETHMD EXC BONE GRF>40 <80,,,21,,RBRVS,35.70 ,24.92 ,24.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21184,CPT,RCNSTJ ORBIT/FHD/NASETHMD EXC BONE TUM GRF>80SQ,,,21,,RBRVS,38.62 ,17.78 ,17.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21188,CPT,RCNSTJ MDFC OTH/THN LEFORT OSTEOT & BONE GRAFTS,,,21,,RBRVS,23.15 ,19.68 ,19.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21193,CPT,RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/O GRF,,,21,,RBRVS,18.90 ,13.25 ,13.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21194,CPT,RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT,,,21,,RBRVS,21.82 ,16.30 ,16.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21195,CPT,RCNSTJ MNDBLR RAMI&/BODY SGTL SPLT W/O INT RGD,,,21,,RBRVS,19.16 ,16.90 ,16.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21196,CPT,RCNSTJ MNDBLR RAMI&/BDY SGTL SPLT W/INT RGD FI,,,21,,RBRVS,20.83 ,18.88 ,18.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21198,CPT,OSTEOTOMY MANDIBLE SEGMENTAL,,,21,,RBRVS,15.71 ,15.67 ,15.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21199,CPT,OSTEOTOMY MANDIBLE SGMTL W/GENIOGLOSSUS ADVMNT,,,21,,RBRVS,16.73 ,11.43 ,11.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21206,CPT,OSTEOTOMY MAXILLA SEGMENTAL,,,21,,RBRVS,15.59 ,15.96 ,15.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21208,CPT,OSTEOPLASTY FACIAL BONES AUGMENTATION,,,21,,RBRVS,11.42 ,11.10 ,41.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21209,CPT,OSTEOPLASTY FACIAL BONES REDUCTION,,,21,,RBRVS,7.82 ,8.89 ,14.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21210,CPT,GRAFT BONE NASAL/MAXILLARY/MALAR AREAS,,,21,,RBRVS,11.69 ,11.54 ,52.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21215,CPT,GRAFT BONE MANDIBLE,,,21,,RBRVS,12.23 ,11.90 ,102.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21230,CPT,GRAFT RIB CRTLG AUTOGENOUS FACE/CHIN/NOSE/EAR,,,21,,RBRVS,11.17 ,7.81 ,7.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21235,CPT,GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR,,,21,,RBRVS,7.50 ,7.74 ,12.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21240,CPT,ARTHRP TEMPOROMANDIBULAR JOINT W/WO AUTOGRAFT,,,21,,RBRVS,16.07 ,13.75 ,13.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21242,CPT,ARTHROPLASTY TEMPOROMANDIBULAR JT W/ALLOGRAFT,,,21,,RBRVS,14.59 ,12.74 ,12.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21243,CPT,ARTHRP TMPRMAND JOINT W/PROSTHETIC REPLACEMENT,,,21,,RBRVS,24.53 ,20.61 ,20.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21244,CPT,RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE,,,21,,RBRVS,13.62 ,15.13 ,15.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21245,CPT,RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT PARTIAL,,,21,,RBRVS,13.12 ,10.61 ,16.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21246,CPT,RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT COMPLETE,,,21,,RBRVS,12.92 ,10.21 ,10.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21247,CPT,RCNSTJ MNDBLR CONDYLE W/BONE CARTLG AUTOGRAFTS,,,21,,RBRVS,24.37 ,16.93 ,16.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21248,CPT,RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT PARTIAL,,,21,,RBRVS,12.74 ,11.50 ,17.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21249,CPT,RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT COMPLETE,,,21,,RBRVS,18.77 ,15.55 ,22.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21255,CPT,RCNSTJ ZYGMTC ARCH/GLENOID FOSSA W/BONE CARTLG,,,21,,RBRVS,18.46 ,18.71 ,18.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21256,CPT,RECONSTRUCTION ORBIT W/OSTEOTOMIES & BONE GRAFTS,,,21,,RBRVS,17.66 ,15.14 ,15.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21260,CPT,PERIORBITAL OSTEOTOMIES BONE GRAFTS EXTRACRANIAL,,,21,,RBRVS,17.90 ,19.32 ,19.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21261,CPT,PERIORBITAL OSTEOTOMIES W/BONE GRAFTS ICRA & XTR,,,21,,RBRVS,34.07 ,22.11 ,22.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21263,CPT,PERIORBITAL OSTEOTOMIES W/BONE GRAFTS W/FOREHEAD,,,21,,RBRVS,31.01 ,20.94 ,20.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21267,CPT,ORBITAL REPOSITIONING W/BONE GRAFTS EXTRACRANIAL,,,21,,RBRVS,20.69 ,22.78 ,22.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21268,CPT,ORBITAL REPOSITIONING W/BONE GRAFTS ICRA & XTRC,,,21,,RBRVS,27.07 ,19.43 ,19.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21270,CPT,MALAR AUGMENTATION PROSTHETIC MATERIAL,,,21,,RBRVS,10.63 ,8.93 ,15.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21275,CPT,SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ,,,21,,RBRVS,11.76 ,10.29 ,10.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21280,CPT,MEDIAL CANTHOPEXY SEPARATE PROCEDURE,,,21,,RBRVS,7.13 ,8.38 ,8.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21282,CPT,LATERAL CANTHOPEXY,,,21,,RBRVS,4.27 ,6.08 ,6.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21295,CPT,REDUCTION MASSETER MUSCLE & BONE EXTRAORAL,,,21,,RBRVS,1.90 ,3.01 ,3.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21296,CPT,REDUCTION MASSETER MUSCLE & BONE INTRAORAL,,,21,,RBRVS,4.78 ,6.93 ,6.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21299,CPT,UNLISTED CRANIOFACIAL & MAXILLOFACIAL PROCEDURE,,,21,,TotalUnits,,,,15.44 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21310,CPT,CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION,,,21,,RBRVS,0.58 ,0.12 ,3.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21315,CPT,CLOSED TX NASAL FRACTURE W/O STABILIZATION,,,21,,RBRVS,1.83 ,2.27 ,5.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21320,CPT,CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION,,,21,,RBRVS,1.88 ,1.74 ,5.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21325,CPT,OPEN TREATMENT NASAL FRACTURE UNCOMPLICATED,,,21,,RBRVS,4.18 ,8.78 ,8.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21330,CPT,OPEN TX NASAL FX COMP W/INT&/XTRNL SKELETAL FI,,,21,,RBRVS,5.79 ,9.63 ,9.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21335,CPT,OPEN TX NASAL FX W/CONCOMITANT OPTX FXD SEPTUM,,,21,,RBRVS,9.02 ,10.61 ,10.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21336,CPT,OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION,,,21,,RBRVS,6.77 ,10.77 ,10.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21337,CPT,CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION,,,21,,RBRVS,3.39 ,4.58 ,7.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21338,CPT,OPEN TX NASOETHMOID FX W/O EXTERNAL FIXATION,,,21,,RBRVS,6.87 ,12.70 ,12.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21339,CPT,OPEN TX NASOETHMOID FX W/EXTERNAL FIXATION,,,21,,RBRVS,8.50 ,12.49 ,12.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21340,CPT,PERCUTANEOUS TX NASOETHMOID COMPLEX FRACTURE,,,21,,RBRVS,11.49 ,8.76 ,8.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21343,CPT,OPEN TX DEPRESSED FRONTAL SINUS FRACTURE,,,21,,RBRVS,14.32 ,17.95 ,17.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21344,CPT,OPEN TX COMPLICATED FRONTAL SINUS FRACTURE,,,21,,RBRVS,21.57 ,15.58 ,15.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21345,CPT,CLOSED TX NASOMAXILLARY COMPLEX FRACTURE,,,21,,RBRVS,9.06 ,8.45 ,12.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21346,CPT,OPTX NASOMAX CPLX FX LEFT II TYPE W/WIRG & FXJ,,,21,,RBRVS,11.45 ,13.17 ,13.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21347,CPT,OPTX NASOMAX CPLX FX LEFT II TYPE REQ MLT OPN,,,21,,RBRVS,13.53 ,16.90 ,16.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21348,CPT,OPTX NASOMAX CPLX FX LEFT II TYPE W/BONE GRAFT,,,21,,RBRVS,17.52 ,14.26 ,14.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21355,CPT,PERCUTANEOUS TX MALAR AREA FRACTURE,,,21,,RBRVS,4.45 ,4.17 ,7.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21356,CPT,OPEN TX DEPRESSED ZYGOMATIC ARCH FRACTURE,,,21,,RBRVS,4.83 ,5.31 ,8.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21360,CPT,OPEN TX DEPRESSED MALAR FRACTURE,,,21,,RBRVS,7.19 ,7.22 ,7.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21365,CPT,OPEN TX COMP FX MALAR W/INTERNAL FX&MULT SURG,,,21,,RBRVS,16.77 ,12.68 ,12.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21366,CPT,OPEN TX COMP FRACTURE MALAR AREA W/BONE GRAFT,,,21,,RBRVS,18.60 ,12.07 ,12.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21385,CPT,OPEN TX ORBITAL FLOOR BLOWOUT FX TRANSANTRAL,,,21,,RBRVS,9.57 ,8.77 ,8.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21386,CPT,OPEN TX ORBITAL FLOOR BLOWOUT FX PERIORBITAL,,,21,,RBRVS,9.57 ,8.81 ,8.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21387,CPT,OPEN TX ORBITAL FLOOR BLOWOUT FX COMBINED APPR,,,21,,RBRVS,10.11 ,8.96 ,8.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21390,CPT,OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC,,,21,,RBRVS,11.23 ,10.12 ,10.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21395,CPT,OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/BONE GRF,,,21,,RBRVS,14.70 ,11.77 ,11.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21400,CPT,CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIPULATION,,,21,,RBRVS,1.50 ,2.75 ,3.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21401,CPT,CLOSED TX FX ORBIT EXCEPT BLOWOUT W/MANIPULATION,,,21,,RBRVS,3.68 ,4.00 ,8.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21406,CPT,OPEN TX FX ORBIT EXCEPT BLOWOUT W/O IMPLANT,,,21,,RBRVS,7.42 ,6.45 ,6.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21407,CPT,OPEN TX FX ORBIT EXCEPT BLOWOUT W/IMPLANT,,,21,,RBRVS,9.02 ,8.28 ,8.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21408,CPT,OPEN TX FX ORBIT EXCEPT BLOWOUT W/BONE GRAFT,,,21,,RBRVS,12.78 ,10.33 ,10.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21421,CPT,CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT,,,21,,RBRVS,6.02 ,11.37 ,14.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21422,CPT,OPEN TREATMENT PALATAL/MAXILLARY FRACTURE,,,21,,RBRVS,8.73 ,9.32 ,9.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21423,CPT,OPEN TX PALATAL/MAXILLARY FX COMP MULTIPLE APPR,,,21,,RBRVS,10.85 ,10.94 ,10.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21431,CPT,CLOSED TX CRANIOFACIAL SEPARATION,,,21,,RBRVS,7.90 ,12.18 ,12.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21432,CPT,OPEN TX CRANIOFACIAL SEP W/WIRING&/INT FIXJ,,,21,,RBRVS,8.82 ,8.77 ,8.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21433,CPT,OPEN TX CRANIOFACIAL SEP COMPLICATED MLT APPR,,,21,,RBRVS,26.29 ,19.34 ,19.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21435,CPT,OPEN TX CRANIOFACIAL SEP COMP W/INT&/XTRNL FIX,,,21,,RBRVS,20.26 ,13.27 ,13.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21436,CPT,OPTX CRNFCL SEP LFT III TYP COMP INT FIXJ W/BONE,,,21,,RBRVS,30.30 ,22.07 ,22.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21440,CPT,CLTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX,,,21,,RBRVS,3.44 ,9.56 ,12.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21445,CPT,OPTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX,,,21,,RBRVS,6.26 ,10.86 ,14.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21450,CPT,CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION,,,21,,RBRVS,3.71 ,10.04 ,13.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21451,CPT,CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION,,,21,,RBRVS,5.65 ,11.95 ,15.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21452,CPT,PERCUTANEOUS TX MANDIBULAR FX W/EXTERNAL FIXJ,,,21,,RBRVS,2.40 ,7.41 ,14.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21453,CPT,CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION,,,21,,RBRVS,6.64 ,14.95 ,18.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21454,CPT,OPEN TX MANDIBULAR FX W/EXTERNAL FIXATION,,,21,,RBRVS,7.36 ,8.55 ,8.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21461,CPT,OPEN TX MANDIBULAR FX W/O INTERDENTAL FIXATION,,,21,,RBRVS,9.31 ,16.44 ,51.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21462,CPT,OPEN TX MANDIBULAR FX W/INTERDENTAL FIXATION,,,21,,RBRVS,11.01 ,17.55 ,52.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21465,CPT,OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE,,,21,,RBRVS,13.12 ,12.41 ,12.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21470,CPT,OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION,,,21,,RBRVS,17.54 ,14.49 ,14.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21480,CPT,CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ,,,21,,RBRVS,0.61 ,0.22 ,2.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21485,CPT,CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ,,,21,,RBRVS,4.77 ,11.44 ,14.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21490,CPT,OPEN TREATMENT TEMPOROMANDIBULAR DISLOCATION,,,21,,RBRVS,12.95 ,11.34 ,11.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21497,CPT,INTERDENTAL WIRING OTHER THAN FRACTURE,,,21,,RBRVS,4.64 ,12.29 ,15.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21499,CPT,UNLISTED MUSCULOSKELETAL PROCEDURE HEAD,,,21,,TotalUnits,,,,15.44 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21501,CPT,I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX,,,21,,RBRVS,3.98 ,4.50 ,8.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21502,CPT,I&D DP ABSC/HMTMA SOFT TISS NCK/THORAX PRTL RI,,,21,,RBRVS,7.55 ,6.01 ,6.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21510,CPT,INCISION DEEP OPENING BONE CORTEX THORAX,,,21,,RBRVS,6.20 ,5.21 ,5.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21550,CPT,BIOPSY SOFT TISSUE NECK/THORAX,,,21,,RBRVS,2.11 ,2.12 ,5.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21552,CPT,EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>,,,21,,RBRVS,6.49 ,4.94 ,4.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21554,CPT,EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>,,,21,,RBRVS,11.13 ,7.65 ,7.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21555,CPT,EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM,,,21,,RBRVS,3.96 ,4.04 ,7.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21556,CPT,EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM,,,21,,RBRVS,7.66 ,6.16 ,6.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21557,CPT,RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM,,,21,,RBRVS,14.75 ,9.99 ,9.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21558,CPT,RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>,,,21,,RBRVS,21.58 ,12.95 ,12.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21600,CPT,EXCISION RIB PARTIAL,,,21,,RBRVS,7.26 ,7.29 ,7.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21610,CPT,COSTOTRANSVERSECTOMY SEPARATE PROCEDURE,,,21,,RBRVS,15.91 ,12.45 ,12.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21615,CPT,EXCISION 1ST &/CERVICAL RIB,,,21,,RBRVS,10.45 ,5.08 ,5.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21616,CPT,EXCISION 1ST &/CERVICAL RIB W/SYMPATHECTOMY,,,21,,RBRVS,12.69 ,6.44 ,6.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21620,CPT,OSTECTOMY STERNUM PARTIAL,,,21,,RBRVS,7.28 ,5.69 ,5.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21627,CPT,STERNAL DEBRIDEMENT,,,21,,RBRVS,7.30 ,6.69 ,6.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21630,CPT,RADICAL RESECTION STERNUM,,,21,,RBRVS,19.18 ,11.83 ,11.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21632,CPT,RADICAL RESECTION STERNUM W/MEDSTNL LMPHADEC,,,21,,RBRVS,19.68 ,10.90 ,10.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21685,CPT,HYOID MYOTOMY & SUSPENSION,,,21,,RBRVS,15.26 ,11.47 ,11.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21700,CPT,DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB,,,21,,RBRVS,6.31 ,3.06 ,3.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21705,CPT,DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB,,,21,,RBRVS,9.92 ,3.82 ,3.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21720,CPT,DIVISION STERNOCLEIDOMASTOID OPEN W/O CAST,,,21,,RBRVS,5.80 ,6.04 ,6.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21725,CPT,DIVISION STERNOCLEIDOMASTOID OPEN W/CAST,,,21,,RBRVS,7.19 ,6.17 ,6.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21740,CPT,REPAIR PECTUS EXCAVATUM/CARINATUM OPEN,,,21,,RBRVS,17.57 ,8.28 ,8.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21742,CPT,REPAIR PECTUS EXCAVATM/CARINATM MINLY W/O THRSC,,,21,,TotalUnits,,,,31.21 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21743,CPT,REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC,,,21,,TotalUnits,,,,37.70 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21750,CPT,CLOSE MEDIAN STERNOTOMY SEP W/WO DEBRIDEMENT SPX,,,21,,RBRVS,11.40 ,5.80 ,5.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21811,CPT,OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS,,,21,,RBRVS,10.79 ,4.44 ,4.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21812,CPT,OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS,,,21,,RBRVS,13.00 ,5.23 ,5.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21813,CPT,OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 7+ RIBS,,,21,,RBRVS,17.61 ,6.20 ,6.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21820,CPT,CLOSED TREATMENT STERNUM FRACTURE,,,21,,RBRVS,1.36 ,2.52 ,2.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21825,CPT,OPEN TX STERNUM FRACTURE W/WO SKELETAL FIXATION,,,21,,RBRVS,7.76 ,6.11 ,6.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 21899,CPT,UNLISTED PROCEDURE NECK/THORAX,,,21,,TotalUnits,,,,11.43 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21920,CPT,BIOPSY SOFT TISSUE BACK/FLANK SUPERFICIAL,,,21,,RBRVS,2.11 ,2.18 ,4.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21925,CPT,BIOPSY SOFT TISSUE BACK/FLANK DEEP,,,21,,RBRVS,4.63 ,4.60 ,7.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21930,CPT,EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM,,,21,,RBRVS,4.94 ,4.51 ,7.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21931,CPT,EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>,,,21,,RBRVS,6.88 ,5.10 ,5.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21932,CPT,EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM,,,21,,RBRVS,9.82 ,7.04 ,7.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21933,CPT,EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>,,,21,,RBRVS,11.13 ,7.61 ,7.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21935,CPT,RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK <5CM,,,21,,RBRVS,15.72 ,10.43 ,10.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 21936,CPT,RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/>,,,21,,RBRVS,22.55 ,13.27 ,13.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22010,CPT,I&D DEEP ABSCESS PST SPINE CRV THRC/CERVICOTHR,,,21,,RBRVS,12.75 ,11.19 ,11.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22015,CPT,I&D DEEP ABSCESS PST SPINE LUMBAR SAC/LUMBOSAC,,,21,,RBRVS,12.64 ,10.70 ,10.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22100,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV,,,21,,RBRVS,11.00 ,10.73 ,10.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22101,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC,,,21,,RBRVS,11.08 ,10.47 ,10.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22102,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR,,,21,,RBRVS,11.08 ,9.43 ,9.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22103,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA,,,21,,RBRVS,2.34 ,1.12 ,1.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22110,CPT,PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM CRV,,,21,,RBRVS,14.00 ,11.96 ,11.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22112,CPT,PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM THRC,,,21,,RBRVS,14.07 ,11.57 ,11.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22114,CPT,PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM LMBR,,,21,,RBRVS,14.07 ,11.72 ,11.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22116,CPT,PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM EA,,,21,,RBRVS,2.32 ,1.11 ,1.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22206,CPT,OSTEOTOMY SPINE POSTERIOR 3 COLUMN THORACIC,,,21,,RBRVS,37.18 ,23.32 ,23.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22207,CPT,OSTEOTOMY SPINE POSTERIOR 3 COLUMN LUMBAR,,,21,,RBRVS,36.68 ,23.03 ,23.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22208,CPT,OSTEOTOMY SPINE POSTERIOR 3 COLUMN EA ADDL SGM,,,21,,RBRVS,9.66 ,4.72 ,4.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22210,CPT,OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM CRV,,,21,,RBRVS,25.38 ,18.86 ,18.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22212,CPT,OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM THRC,,,21,,RBRVS,20.99 ,16.43 ,16.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22214,CPT,OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM LMBR,,,21,,RBRVS,21.02 ,16.50 ,16.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22216,CPT,OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM,,,21,,RBRVS,6.03 ,2.96 ,2.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22220,CPT,OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM CRV,,,21,,RBRVS,22.94 ,17.11 ,17.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22222,CPT,OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM THRC,,,21,,RBRVS,23.09 ,17.07 ,17.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22224,CPT,OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM LMBR,,,21,,RBRVS,23.09 ,17.11 ,17.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22226,CPT,OSTEOT SPI W/DSKC ANT APPR 1 VRT SGM EA VRT SGM,,,21,,RBRVS,6.03 ,2.93 ,2.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22310,CPT,CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING,,,21,,RBRVS,3.89 ,3.43 ,4.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22315,CPT,CLTX VRT FX&/DISLC CSTING/BRACING MANJ/TRCJ,,,21,,RBRVS,10.11 ,9.60 ,12.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22318,CPT,OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRAFT,,,21,,RBRVS,22.72 ,16.55 ,16.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22319,CPT,OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ,,,21,,RBRVS,25.33 ,17.75 ,17.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22325,CPT,OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM,,,21,,RBRVS,19.87 ,15.87 ,15.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22326,CPT,OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR,,,21,,RBRVS,20.84 ,15.60 ,15.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22327,CPT,OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH,,,21,,RBRVS,20.77 ,16.35 ,16.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22328,CPT,OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA,,,21,,RBRVS,4.60 ,2.21 ,2.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22505,CPT,MANIPULATION SPINE REQUIRING ANESTHESIA,,,21,,RBRVS,1.87 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22510,CPT,PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC,,,21,,RBRVS,8.15 ,3.95 ,41.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22511,CPT,PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL,,,21,,RBRVS,7.58 ,3.77 ,41.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22512,CPT,VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL,,,21,,RBRVS,4.00 ,1.50 ,23.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22513,CPT,PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION,,,21,,RBRVS,8.90 ,4.99 ,198.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22514,CPT,PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR,,,21,,RBRVS,8.24 ,4.73 ,198.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22515,CPT,PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH,,,21,,RBRVS,4.00 ,1.75 ,121.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22526,CPT,PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY 1 LEVEL,,,21,,RBRVS,6.10 ,3.18 ,60.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22527,CPT,PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY ADDL LVL,,,21,,RBRVS,3.03 ,1.16 ,52.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22532,CPT,ARTHRODESIS LATERAL EXTRACAVITARY THORACIC,,,21,,RBRVS,25.99 ,17.97 ,17.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22533,CPT,ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR,,,21,,RBRVS,24.79 ,17.25 ,17.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22534,CPT,ARTHRODESIS LAT EXTRACAVITARY EA ADDL THRC/LMBR,,,21,,RBRVS,5.99 ,2.90 ,2.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22548,CPT,ARTHRD ANT TRANSORL/XTRORAL C1-C2 W/WO EXC ODNTD,,,21,,RBRVS,27.06 ,19.48 ,19.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22551,CPT,ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2,,,21,,RBRVS,25.00 ,16.80 ,16.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22552,CPT,ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC,,,21,,RBRVS,6.50 ,3.11 ,3.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 22554,CPT,ARTHRD ANT MIN DISCECT INTERBODY CERV BELOW C2,,,21,,RBRVS,17.69 ,13.38 ,13.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22556,CPT,ARTHRD ANT MIN DISCECTOMY INTERBODY THORACIC,,,21,,RBRVS,24.70 ,16.62 ,16.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22558,CPT,ARTHRODESIS ANTERIOR INTERBODY LUMBAR,,,21,,RBRVS,23.53 ,15.15 ,15.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22585,CPT,ARTHRODESIS ANTERIOR INTERBODY EA ADDL NTRSPC,,,21,,RBRVS,5.52 ,2.57 ,2.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 22586,CPT,ARTHRODESIS PRESACRAL INTRBDY W/INSTRUMENT L5-S1,,,21,,RBRVS,28.12 ,18.62 ,18.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22590,CPT,ARTHRODESIS POSTERIOR CRANIOCERVICAL,,,21,,RBRVS,21.76 ,16.57 ,16.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22595,CPT,ARTHRODESIS POSTERIOR ATLAS-AXIS C1-C2,,,21,,RBRVS,20.64 ,16.03 ,16.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22600,CPT,ARTHRODESIS PST/PSTLAT CERVICAL BELW C2 SGM,,,21,,RBRVS,17.40 ,14.35 ,14.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22610,CPT,ARTHRODESIS POSTERIOR/POSTEROLATERAL THORACIC,,,21,,RBRVS,17.28 ,14.13 ,14.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22612,CPT,ARTHRODESIS POSTERIOR/POSTEROLATERAL LUMBAR,,,21,,RBRVS,23.53 ,16.18 ,16.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22614,CPT,ARTHRODESIS POSTERIOR/POSTEROLATERAL EA ADDL,,,21,,RBRVS,6.43 ,3.11 ,3.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22630,CPT,ARTHRODESIS POSTERIOR INTERBODY LUMBAR,,,21,,RBRVS,22.09 ,16.27 ,16.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22632,CPT,ARTHRODESIS POSTERIOR INTERBODY EA ADDL,,,21,,RBRVS,5.22 ,2.50 ,2.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22633,CPT,ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR,,,21,,RBRVS,27.75 ,18.06 ,18.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22634,CPT,ARTHDSIS POST/POSTERLATRL/POSTINTRBDYADL SPC/SEG,,,21,,RBRVS,8.16 ,3.94 ,3.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22800,CPT,ARTHRODESIS POSTERIOR SPINAL DFRM UP 6 VRT SEG,,,21,,RBRVS,19.50 ,14.67 ,14.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22802,CPT,ARTHRODESIS POSTERIOR SPINAL DFRM 7-12 VRT SEG,,,21,,RBRVS,32.11 ,20.81 ,20.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22804,CPT,ARTHRODESIS POSTERIOR SPINAL DFRM 13/> VRT SEG,,,21,,RBRVS,37.50 ,23.47 ,23.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22808,CPT,ARTHRODESIS ANTERIOR SPINAL DFRM 2-3 VRT SEG,,,21,,RBRVS,27.51 ,18.13 ,18.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22810,CPT,ARTHRODESIS ANTERIOR SPINAL DFRM 4-7 VRT SEG,,,21,,RBRVS,31.50 ,19.17 ,19.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22812,CPT,ARTHRODESIS POSTERIOR SPINAL DFRM 8/> VRT SEG,,,21,,RBRVS,34.25 ,22.62 ,22.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22818,CPT,KYPHECTOMY SINGLE OR TWO SEGMENTS,,,21,,RBRVS,34.33 ,21.47 ,21.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22819,CPT,KYPHECTOMY 3 OR MORE SEGMENTS,,,21,,RBRVS,39.38 ,25.23 ,25.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22830,CPT,EXPLORATION SPINAL FUSION,,,21,,RBRVS,11.22 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22840,CPT,POSTERIOR NON-SEGMENTAL INSTRUMENTATION,,,21,,RBRVS,12.52 ,6.05 ,6.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 22841,CPT,INTERNAL SPINAL FIXATION WIRING SPINOUS PROCESS,,,21,,TotalUnits,,,,13.78 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22842,CPT,POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG,,,21,,RBRVS,12.56 ,6.08 ,6.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 22843,CPT,POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG,,,21,,RBRVS,13.44 ,6.52 ,6.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22844,CPT,POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SE,,,21,,RBRVS,16.42 ,8.07 ,8.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22845,CPT,ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS,,,21,,RBRVS,11.94 ,5.71 ,5.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 22846,CPT,ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS,,,21,,RBRVS,12.40 ,5.94 ,5.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22847,CPT,ANTERIOR INSTRUMENTATION 8/> VERTEBRAL SEGMENTS,,,21,,RBRVS,13.78 ,6.74 ,6.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22848,CPT,PELVIC FIXATION OTHER THAN SACRUM,,,21,,RBRVS,5.99 ,2.95 ,2.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22849,CPT,REINSERTION SPINAL FIXATION DEVICE,,,21,,RBRVS,19.17 ,13.20 ,13.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22850,CPT,REMOVAL POSTERIOR NONSEGMENTAL INSTRUMENTATION,,,21,,RBRVS,9.82 ,8.37 ,8.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22852,CPT,REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION,,,21,,RBRVS,9.37 ,8.13 ,8.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22853,CPT,INSJ BIOMECHANICAL DEVICE,,,21,,RBRVS,4.25 ,2.03 ,2.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 22854,CPT,INSJ BIOMECHANICAL DEVICE,,,21,,RBRVS,5.50 ,2.63 ,2.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 22855,CPT,REMOVAL ANTERIOR INSTRUMENTATION,,,21,,RBRVS,15.86 ,11.55 ,11.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22856,CPT,TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC CRV,,,21,,RBRVS,24.05 ,16.01 ,16.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22857,CPT,TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC LMBR,,,21,,RBRVS,27.13 ,19.53 ,19.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22858,CPT,TOT DISC ARTHRP ANT APPR DISC 2ND LEVEL CERVICAL,,,21,,RBRVS,8.40 ,3.69 ,3.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 22859,CPT,INSJ BIOMECHANICAL DEVICE,,,21,,RBRVS,5.50 ,2.63 ,2.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 22861,CPT,REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC CRV,,,21,,RBRVS,33.36 ,18.26 ,18.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22862,CPT,REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC LMBR,,,21,,RBRVS,32.63 ,14.69 ,14.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22864,CPT,RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE CERVICAL,,,21,,RBRVS,29.40 ,19.50 ,19.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22865,CPT,RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE LUMBAR,,,21,,RBRVS,31.75 ,21.03 ,21.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 22867,CPT,INSJ STABLJ DEV W/DCMPRN,,,21,,RBRVS,13.50 ,10.78 ,10.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22868,CPT,INSJ STABLJ DEV W/DCMPRN,,,21,,RBRVS,4.00 ,1.92 ,1.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 22869,CPT,INSJ STABLJ DEV W/O DCMPRN,,,21,,RBRVS,7.03 ,6.71 ,6.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22870,CPT,INSJ STABLJ DEV W/O DCMPRN,,,21,,RBRVS,2.34 ,1.13 ,1.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 22899,CPT,UNLISTED PROCEDURE SPINE,,,21,,TotalUnits,,,,18.34 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22900,CPT,EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM,,,21,,RBRVS,8.32 ,6.07 ,6.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22901,CPT,EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/>,,,21,,RBRVS,10.11 ,6.76 ,6.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22902,CPT,EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM,,,21,,RBRVS,4.42 ,4.11 ,7.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22903,CPT,EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>,,,21,,RBRVS,6.39 ,4.78 ,4.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22904,CPT,RAD RESECTION TUMOR SOFT TISSUE ABDL WALL <5CM,,,21,,RBRVS,16.69 ,9.87 ,9.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22905,CPT,RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5 CM/>,,,21,,RBRVS,21.58 ,12.01 ,12.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 22999,CPT,UNLISTED PX ABDOMEN MUSCULOSKELETAL SYSTEM,,,21,,TotalUnits,,,,11.17 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23000,CPT,REMOVAL SUBDELTOID CALCAREOUS DEPOSITS OPEN,,,21,,RBRVS,4.48 ,5.29 ,11.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23020,CPT,CAPSULAR CONTRACTURE RELEASE,,,21,,RBRVS,9.36 ,8.58 ,8.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23030,CPT,I&D SHOULDER DEEP ABSCESS/HEMATOMA,,,21,,RBRVS,3.47 ,3.18 ,8.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23031,CPT,I&D SHOULDER INFECTED BURSA,,,21,,RBRVS,2.79 ,2.97 ,8.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23035,CPT,INCISION BONE CORTEX SHOULDER AREA,,,21,,RBRVS,9.16 ,8.47 ,8.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23040,CPT,ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL FB,,,21,,RBRVS,9.75 ,8.96 ,8.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23044,CPT,ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB,,,21,,RBRVS,7.59 ,7.17 ,7.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23065,CPT,BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL,,,21,,RBRVS,2.30 ,2.15 ,3.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23066,CPT,BIOPSY SOFT TISSUE SHOULDER DEEP,,,21,,RBRVS,4.30 ,5.04 ,10.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23071,CPT,EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>,,,21,,RBRVS,5.91 ,4.84 ,4.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23073,CPT,EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>,,,21,,RBRVS,10.13 ,7.64 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23075,CPT,EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM,,,21,,RBRVS,4.21 ,4.26 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23076,CPT,EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM,,,21,,RBRVS,7.41 ,6.52 ,6.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23077,CPT,RAD RESECTION TUMOR SOFT TISSUE SHOULDER <5CM,,,21,,RBRVS,17.66 ,11.55 ,11.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23078,CPT,RAD RESECTION TUMOR SOFT TISSUE SHOULDER 5 CM/>,,,21,,RBRVS,22.55 ,14.05 ,14.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23100,CPT,ARTHROTOMY GLENOHUMERAL JOINT W/BIOPSY,,,21,,RBRVS,6.20 ,6.82 ,6.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23101,CPT,ARTHRT ACROMCLAV/STRNCLAV JT W/BX&/EXC CRTLG,,,21,,RBRVS,5.72 ,6.13 ,6.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23105,CPT,ARTHRT GLENOHUMRL JT W/SYNOVECTOMY W/WO BIOPSY,,,21,,RBRVS,8.48 ,8.15 ,8.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23106,CPT,ARTHRT GLENOHUMRL JT STRNCLAV JT W/SYNVCT W/WOBX,,,21,,RBRVS,6.13 ,6.72 ,6.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23107,CPT,ARTHRT GLENOHMRL JT W/JT EXPL W/WO RMVL LOOSE/FB,,,21,,RBRVS,8.87 ,8.33 ,8.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23120,CPT,CLAVICULECTOMY PARTIAL,,,21,,RBRVS,7.39 ,7.91 ,7.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23125,CPT,CLAVICULECTOMY TOTAL,,,21,,RBRVS,9.64 ,8.75 ,8.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23130,CPT,PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE,,,21,,RBRVS,7.77 ,8.15 ,8.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23140,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR CLAV/SCAPULA,,,21,,RBRVS,7.12 ,6.74 ,6.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23145,CPT,EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/AGRFT,,,21,,RBRVS,9.40 ,8.63 ,8.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23146,CPT,EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/ALGRFT,,,21,,RBRVS,8.08 ,8.10 ,8.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23150,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR PROX HUMERUS,,,21,,RBRVS,8.91 ,8.24 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23155,CPT,EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/AGRFT,,,21,,RBRVS,10.86 ,9.70 ,9.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23156,CPT,EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT,,,21,,RBRVS,9.11 ,8.49 ,8.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23170,CPT,SEQUESTRECTOMY CLAVICLE,,,21,,RBRVS,7.21 ,7.22 ,7.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23172,CPT,SEQUESTRECTOMY SCAPULA,,,21,,RBRVS,7.31 ,7.47 ,7.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23174,CPT,SEQUESTRECTOMY HUMERAL HEAD SURGERY NECK,,,21,,RBRVS,10.05 ,9.50 ,9.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23180,CPT,PARTIAL EXCISION BONE CLAVICLE,,,21,,RBRVS,8.99 ,8.27 ,8.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23182,CPT,PARTIAL EXCISION BONE SCAPULA,,,21,,RBRVS,8.61 ,8.40 ,8.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23184,CPT,PARTIAL EXCISION BONE PROXIMAL HUMERUS,,,21,,RBRVS,9.90 ,9.22 ,9.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23190,CPT,OSTECTOMY SCAPULA PARTIAL,,,21,,RBRVS,7.47 ,7.34 ,7.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23195,CPT,RESECTION HUMERAL HEAD,,,21,,RBRVS,10.36 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23200,CPT,RADICAL RESECTION TUMOR CLAVICLE,,,21,,RBRVS,22.71 ,15.28 ,15.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 23210,CPT,RADICAL RESECTION TUMOR SCAPULA,,,21,,RBRVS,27.21 ,18.42 ,18.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 23220,CPT,RADICAL RESECTION BONE TUMOR PROXIMAL HUMERUS,,,21,,RBRVS,30.21 ,19.82 ,19.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 23330,CPT,REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS,,,21,,RBRVS,1.90 ,2.11 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23333,CPT,REMOVAL SHOULDER FOREIGN BODY DEEP SUBFASCIAL/IM,,,21,,RBRVS,6.00 ,5.92 ,5.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23334,CPT,PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT,,,21,,RBRVS,15.50 ,12.37 ,12.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23335,CPT,PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT,,,21,,RBRVS,19.00 ,14.06 ,14.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 23350,CPT,INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG,,,21,,RBRVS,1.00 ,0.38 ,2.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23395,CPT,MUSCLE TRANSFER SHOULDER/UPPER ARM SINGLE,,,21,,RBRVS,18.54 ,14.82 ,14.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23397,CPT,MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE,,,21,,RBRVS,16.76 ,12.68 ,12.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23400,CPT,SCAPULOPEXY,,,21,,RBRVS,13.87 ,11.22 ,11.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23405,CPT,TENOTOMY SHOULDER AREA 1 TENDON,,,21,,RBRVS,8.54 ,7.75 ,7.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23406,CPT,TENOTOMY SHOULDER MULTIPLE THRU SAME INCISION,,,21,,RBRVS,11.01 ,9.07 ,9.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23410,CPT,OPEN REPAIR OF ROTATOR CUFF ACUTE,,,21,,RBRVS,11.39 ,9.97 ,9.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23412,CPT,OPEN REPAIR OF ROTATOR CUFF CHRONIC,,,21,,RBRVS,11.93 ,10.22 ,10.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23415,CPT,CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY,,,21,,RBRVS,9.23 ,8.89 ,8.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23420,CPT,RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC,,,21,,RBRVS,13.54 ,11.63 ,11.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23430,CPT,TENODESIS LONG TENDON BICEPS,,,21,,RBRVS,10.17 ,9.28 ,9.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23440,CPT,RESECTION/TRANSPLANTATION LONG TENDON BICEPS,,,21,,RBRVS,10.64 ,8.98 ,8.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23450,CPT,CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON,,,21,,RBRVS,13.70 ,10.76 ,10.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23455,CPT,CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR,,,21,,RBRVS,14.67 ,11.23 ,11.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23460,CPT,CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK,,,21,,RBRVS,15.82 ,12.32 ,12.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23462,CPT,CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR,,,21,,RBRVS,15.72 ,11.71 ,11.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23465,CPT,CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK,,,21,,RBRVS,16.30 ,12.60 ,12.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23466,CPT,CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS,,,21,,RBRVS,15.80 ,13.36 ,13.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23470,CPT,ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY,,,21,,RBRVS,17.89 ,13.26 ,13.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23472,CPT,ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER,,,21,,RBRVS,22.13 ,15.58 ,15.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 23473,CPT,REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT,,,21,,RBRVS,25.00 ,17.04 ,17.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23474,CPT,REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT,,,21,,RBRVS,27.21 ,18.18 ,18.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 23480,CPT,OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION,,,21,,RBRVS,11.54 ,9.70 ,9.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23485,CPT,OSTEOTOMY CLAV W/WO INT FIXJ W/BONE GRF NON/MAL,,,21,,RBRVS,13.91 ,10.81 ,10.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23490,CPT,PROPH TX W/WO METHYLMETHACRYLATE CLAVICLE,,,21,,RBRVS,12.16 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23491,CPT,PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS,,,21,,RBRVS,14.54 ,11.62 ,11.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23500,CPT,CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION,,,21,,RBRVS,2.21 ,3.73 ,3.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23505,CPT,CLSD TX CLAVICULAR FRACTURE W/MANIPULATION,,,21,,RBRVS,3.83 ,4.96 ,5.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23515,CPT,OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION,,,21,,RBRVS,9.69 ,9.09 ,9.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23520,CPT,CLSD TX STERNOCLAVICULAR DISLC W/O MANIPULATION,,,21,,RBRVS,2.29 ,3.76 ,3.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23525,CPT,CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION,,,21,,RBRVS,3.79 ,5.39 ,6.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23530,CPT,OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC,,,21,,RBRVS,7.48 ,6.89 ,6.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23532,CPT,OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF,,,21,,RBRVS,8.20 ,8.07 ,8.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23540,CPT,CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION,,,21,,RBRVS,2.36 ,3.74 ,3.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23545,CPT,CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION,,,21,,RBRVS,3.43 ,4.83 ,5.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23550,CPT,OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC,,,21,,RBRVS,7.59 ,7.18 ,7.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23552,CPT,OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF,,,21,,RBRVS,8.82 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23570,CPT,CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION,,,21,,RBRVS,2.36 ,4.00 ,3.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23575,CPT,CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION,,,21,,RBRVS,4.23 ,5.60 ,6.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23585,CPT,OPEN TX SCAPULAR FX W/INTERNAL FIXATION IF PFRMD,,,21,,RBRVS,14.23 ,11.21 ,11.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23600,CPT,CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION,,,21,,RBRVS,3.00 ,5.20 ,5.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23605,CPT,CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ,,,21,,RBRVS,5.06 ,6.10 ,7.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23615,CPT,OPEN TREATMENT PROXIMAL HUMERAL FRACTURE,,,21,,RBRVS,12.30 ,10.70 ,10.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23616,CPT,OPEN PROX HUMERAL FRACTURE PROSTHETIC RPLCMT,,,21,,RBRVS,18.37 ,13.77 ,13.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23620,CPT,CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ,,,21,,RBRVS,2.55 ,4.27 ,4.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23625,CPT,CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION,,,21,,RBRVS,4.10 ,5.18 ,5.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23630,CPT,OPEN TREATMENT GRTER HUMERAL TUBEROSITY FRACTURE,,,21,,RBRVS,10.57 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23650,CPT,CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES,,,21,,RBRVS,3.53 ,4.12 ,4.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23655,CPT,CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES,,,21,,RBRVS,4.76 ,5.79 ,5.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23660,CPT,OPEN TX ACUTE SHOULDER DISLOCATION,,,21,,RBRVS,7.66 ,7.53 ,7.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23665,CPT,CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ,,,21,,RBRVS,4.66 ,5.74 ,6.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23670,CPT,OPEN TX SHOULDER DISLC W/HUMERAL TUBEROSITY FX,,,21,,RBRVS,12.28 ,10.47 ,10.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23675,CPT,CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ,,,21,,RBRVS,6.27 ,6.86 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23680,CPT,OPEN TX SHOULDER DISLOCATION W/NECK FRACTURE,,,21,,RBRVS,13.15 ,10.96 ,10.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23700,CPT,MANJ W/ANES SHOULDER JOINT W/FIXATION APPARATUS,,,21,,RBRVS,2.57 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23800,CPT,ARTHRODESIS GLENOHUMERAL JOINT,,,21,,RBRVS,14.73 ,11.77 ,11.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23802,CPT,ARTHRODESIS GLENOHUMERAL JT W/AUTOGENOUS GRAFT,,,21,,RBRVS,18.42 ,14.38 ,14.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23900,CPT,INTERTHORACOSCAPULAR AMPUTATION,,,21,,RBRVS,20.72 ,15.09 ,15.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 23920,CPT,DISARTICULATION SHOULDER,,,21,,RBRVS,16.23 ,12.77 ,12.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 23921,CPT,DISRTCJ SHOULDER SECONDARY CLSR/SCAR REVISION,,,21,,RBRVS,5.72 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23929,CPT,UNLISTED PROCEDURE SHOULDER,,,21,,TotalUnits,,,,17.77 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23930,CPT,I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA,,,21,,RBRVS,2.99 ,2.58 ,6.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23931,CPT,INCISION&DRAINAGE UPPER ARM/ELBOW BURSA,,,21,,RBRVS,1.84 ,2.40 ,6.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 23935,CPT,INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW,,,21,,RBRVS,6.38 ,6.89 ,6.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24000,CPT,ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB,,,21,,RBRVS,6.08 ,6.41 ,6.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24006,CPT,ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX,,,21,,RBRVS,9.74 ,8.69 ,8.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24065,CPT,BIOPSY SOFT TISSUE UPPER ARM/ELBOW SUPERFICIAL,,,21,,RBRVS,2.13 ,2.35 ,4.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24066,CPT,BIOPSY SOFT TISSUE UPPER ARM/ELBOW AREA DEEP,,,21,,RBRVS,5.35 ,5.43 ,11.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24071,CPT,EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>,,,21,,RBRVS,5.70 ,4.73 ,4.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24073,CPT,EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>,,,21,,RBRVS,10.13 ,7.64 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24075,CPT,EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM,,,21,,RBRVS,4.24 ,4.34 ,8.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24076,CPT,EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM,,,21,,RBRVS,7.41 ,6.64 ,6.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24077,CPT,RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW <5CM,,,21,,RBRVS,15.72 ,10.72 ,10.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24079,CPT,RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW 5CM/>,,,21,,RBRVS,20.61 ,13.18 ,13.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24100,CPT,ARTHROTOMY ELBOW W/SYNOVIAL BIOPSY ONLY,,,21,,RBRVS,5.07 ,5.86 ,5.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24101,CPT,ARTHRT ELBOW W/JNT EXPL W/WOBX W/WORMVL LOOSE/FB,,,21,,RBRVS,6.30 ,6.81 ,6.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24102,CPT,ARTHROTOMY ELBOW W/SYNOVECTOMY,,,21,,RBRVS,8.26 ,7.83 ,7.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24105,CPT,EXCISION OLECRANON BURSA,,,21,,RBRVS,3.78 ,5.49 ,5.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24110,CPT,EXCISION/CURTG BONE CYST/BENIGN TUMOR HUMERUS,,,21,,RBRVS,7.58 ,7.59 ,7.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24115,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR HUMERUS W/AGRFT,,,21,,RBRVS,10.12 ,8.99 ,8.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24116,CPT,EXC/CURTG BONE CYST/BENIGN TUM HUMERUS W/ALGRFT,,,21,,RBRVS,12.23 ,10.06 ,10.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24120,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN,,,21,,RBRVS,6.82 ,7.03 ,7.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24125,CPT,EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/AGRFT,,,21,,RBRVS,8.14 ,8.01 ,8.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24126,CPT,EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/ALGRT,,,21,,RBRVS,8.62 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24130,CPT,EXCISION RADIAL HEAD,,,21,,RBRVS,6.42 ,6.88 ,6.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24134,CPT,SEQUESTRECTOMY SHAFT/DISTAL HUMERUS,,,21,,RBRVS,10.22 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24136,CPT,SEQUESTRECTOMY RADIAL HEAD OR NECK,,,21,,RBRVS,8.40 ,8.21 ,8.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24138,CPT,SEQUESTRECTOMY OLECRANON PROCESS,,,21,,RBRVS,8.50 ,9.05 ,9.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24140,CPT,PARTIAL EXCISION BONE HUMERUS,,,21,,RBRVS,9.55 ,8.69 ,8.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24145,CPT,PARTIAL EXCISION BONE RADIAL HEAD/NECK,,,21,,RBRVS,7.81 ,7.58 ,7.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24147,CPT,PARTIAL EXCISION BONE OLECRANON PROCESS,,,21,,RBRVS,7.84 ,8.41 ,8.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24149,CPT,RAD RESCJ CAPSL TISS&HTRTPC BONE ELBW CONTRCT,,,21,,RBRVS,16.22 ,14.46 ,14.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24150,CPT,RADICAL RESECTION TUMOR SHAFT/DISTAL HUMERUS,,,21,,RBRVS,23.46 ,16.64 ,16.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24152,CPT,RADICAL RESECTION TUMOR RADIAL HEAD/NECK,,,21,,RBRVS,19.99 ,14.92 ,14.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24155,CPT,RESECTION ELBOW JOINT ARTHRECTOMY,,,21,,RBRVS,12.09 ,9.74 ,9.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24160,CPT,PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS,,,21,,RBRVS,18.63 ,14.12 ,14.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24164,CPT,PROSTHESIS REMOVAL RADIAL HEAD,,,21,,RBRVS,10.00 ,8.94 ,8.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24200,CPT,RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS,,,21,,RBRVS,1.81 ,1.90 ,3.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24201,CPT,REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP,,,21,,RBRVS,4.70 ,4.68 ,9.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24220,CPT,INJECTION ELBOW ARTHROGRAPHY,,,21,,RBRVS,1.31 ,0.55 ,3.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24300,CPT,MANIPULATION ELBOW UNDER ANESTHESIA,,,21,,RBRVS,4.04 ,7.13 ,7.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24301,CPT,MUSCLE/TENDON TRANSFER UPPER ARM/ELBOW SINGLE,,,21,,RBRVS,10.38 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24305,CPT,TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON,,,21,,RBRVS,7.62 ,7.53 ,7.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24310,CPT,TENOTOMY OPEN ELBOW TO SHOULDER EACH TENDON,,,21,,RBRVS,6.12 ,6.29 ,6.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24320,CPT,TENOPLASTY ELBOW TO SHOULDER SINGLE,,,21,,RBRVS,10.86 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24330,CPT,FLEXOR-PLASTY ELBOW,,,21,,RBRVS,9.79 ,8.82 ,8.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24331,CPT,FLEXOR-PLASTY ELBOW W/EXTENSOR ADVANCEMENT,,,21,,RBRVS,10.95 ,9.40 ,9.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24332,CPT,TENOLYSIS TRICEPS,,,21,,RBRVS,7.91 ,8.01 ,8.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24340,CPT,TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE,,,21,,RBRVS,8.08 ,7.91 ,7.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24341,CPT,REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA,,,21,,RBRVS,9.49 ,10.07 ,10.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24342,CPT,RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF,,,21,,RBRVS,10.86 ,9.33 ,9.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24343,CPT,REPAIR LATERAL COLLATERAL LIGAMENT ELBOW,,,21,,RBRVS,9.16 ,9.34 ,9.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24344,CPT,RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT,,,21,,RBRVS,15.21 ,13.19 ,13.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24345,CPT,REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW,,,21,,RBRVS,9.16 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24346,CPT,RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF,,,21,,RBRVS,15.21 ,13.26 ,13.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24357,CPT,TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS,,,21,,RBRVS,5.44 ,5.95 ,5.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24358,CPT,TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN,,,21,,RBRVS,6.66 ,7.04 ,7.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24359,CPT,TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR,,,21,,RBRVS,8.98 ,8.24 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24360,CPT,ARTHROPLASTY ELBOW W/MEMBRANE,,,21,,RBRVS,12.67 ,10.31 ,10.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24361,CPT,ARTHROPLASTY ELBOW W/DISTAL HUMRL PROSTC RPLCMT,,,21,,RBRVS,14.41 ,11.35 ,11.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24362,CPT,ARTHRP ELBOW W/IMPLT&FSCA LATA LIGAMENT RCNSTJ,,,21,,RBRVS,15.32 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24363,CPT,ARTHRP ELBOW W/DISTAL HUM&PROX UR PROSTC RPLCM,,,21,,RBRVS,22.00 ,15.74 ,15.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24365,CPT,ARTHROPLASTY RADIAL HEAD,,,21,,RBRVS,8.62 ,7.91 ,7.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24366,CPT,ARTHROPLASTY RADIAL HEAD W/IMPLANT,,,21,,RBRVS,9.36 ,8.36 ,8.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24370,CPT,REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT,,,21,,RBRVS,23.55 ,16.42 ,16.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24371,CPT,REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT,,,21,,RBRVS,27.50 ,18.66 ,18.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24400,CPT,OSTEOTOMY HUMERUS W/WO INTERNAL FIXATION,,,21,,RBRVS,11.33 ,9.89 ,9.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24410,CPT,MLT OSTEOT W/RELIGNMT IMED ROD HUMERAL SHAFT,,,21,,RBRVS,15.11 ,12.21 ,12.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24420,CPT,OSTEOPLASTY HUMERUS,,,21,,RBRVS,13.73 ,11.98 ,11.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24430,CPT,REPAIR NON/MALUNION HUMERUS W/O GRAFT,,,21,,RBRVS,15.25 ,12.16 ,12.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24435,CPT,REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT,,,21,,RBRVS,14.99 ,13.03 ,13.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24470,CPT,HEMIEPIPHYSEAL ARREST,,,21,,RBRVS,8.93 ,6.11 ,6.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24495,CPT,DECOMPRESSION FASCT F/ARM W/BRACH ART EXPL,,,21,,RBRVS,8.41 ,8.47 ,8.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24498,CPT,PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT,,,21,,RBRVS,12.28 ,10.19 ,10.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24500,CPT,CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION,,,21,,RBRVS,3.41 ,5.25 ,6.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24505,CPT,CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ,,,21,,RBRVS,5.39 ,6.46 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24515,CPT,OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE,,,21,,RBRVS,12.12 ,10.67 ,10.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24516,CPT,TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE,,,21,,RBRVS,12.19 ,10.11 ,10.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24530,CPT,CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ,,,21,,RBRVS,3.69 ,5.43 ,6.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24535,CPT,CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ,,,21,,RBRVS,7.11 ,7.70 ,9.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24538,CPT,PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX,,,21,,RBRVS,9.77 ,9.57 ,9.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24545,CPT,OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN,,,21,,RBRVS,13.15 ,10.98 ,10.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24546,CPT,OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/XTN,,,21,,RBRVS,14.91 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24560,CPT,CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ,,,21,,RBRVS,2.98 ,4.67 ,5.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24565,CPT,CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ,,,21,,RBRVS,5.78 ,6.93 ,8.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24566,CPT,PRQ SKEL FIXJ HUMRL EPCNDYLR FX MEDIAL/LAT MANJ,,,21,,RBRVS,9.06 ,9.66 ,9.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24575,CPT,OPEN TX HUMERAL EPICONDYLAR FRACTURE,,,21,,RBRVS,9.71 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24576,CPT,CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ,,,21,,RBRVS,3.06 ,5.07 ,6.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24577,CPT,CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ,,,21,,RBRVS,6.01 ,7.05 ,8.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24579,CPT,OPEN TREATMENT HUMERAL CONDYLAR FRACTURE,,,21,,RBRVS,11.44 ,10.32 ,10.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24582,CPT,PRQ SKEL FIXJ HUMRL CNDYLR FX MEDIAL/LAT W/MANJ,,,21,,RBRVS,10.14 ,10.98 ,10.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24586,CPT,OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO,,,21,,RBRVS,15.78 ,12.32 ,12.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24587,CPT,OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHR,,,21,,RBRVS,15.79 ,12.33 ,12.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24600,CPT,TREATMENT CLOSED ELBOW DISLOCATION W/O ANES,,,21,,RBRVS,4.37 ,4.43 ,5.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24605,CPT,TREATMENT CLOSED ELBOW DISLOCATION REQ ANES,,,21,,RBRVS,5.64 ,6.69 ,6.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24615,CPT,OPEN TX ACUTE/CHRONIC ELBOW DISLOCATION,,,21,,RBRVS,9.83 ,8.70 ,8.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24620,CPT,CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ,,,21,,RBRVS,7.22 ,7.19 ,7.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24635,CPT,OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW,,,21,,RBRVS,8.80 ,8.78 ,8.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24640,CPT,CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ,,,21,,RBRVS,1.25 ,1.18 ,2.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24650,CPT,CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION,,,21,,RBRVS,2.31 ,4.11 ,4.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24655,CPT,CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION,,,21,,RBRVS,4.62 ,5.85 ,6.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24665,CPT,OPEN TX RADIAL HEAD/NECK FRACTURE,,,21,,RBRVS,8.36 ,8.71 ,8.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24666,CPT,OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC,,,21,,RBRVS,9.86 ,9.26 ,9.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24670,CPT,CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ,,,21,,RBRVS,2.69 ,4.30 ,5.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24675,CPT,CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ,,,21,,RBRVS,4.91 ,5.99 ,7.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24685,CPT,OPEN TREATMENT ULNAR FRACTURE PROXIMAL END,,,21,,RBRVS,8.37 ,8.74 ,8.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24800,CPT,ARTHRODESIS ELBOW JOINT LOCAL,,,21,,RBRVS,11.41 ,10.09 ,10.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24802,CPT,ARTHRODESIS ELBOW JOINT W/AUTOGENOUS GRAFT,,,21,,RBRVS,14.32 ,11.14 ,11.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24900,CPT,AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE,,,21,,RBRVS,10.18 ,8.77 ,8.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 24920,CPT,AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR,,,21,,RBRVS,10.13 ,8.85 ,8.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 24925,CPT,AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ,,,21,,RBRVS,7.30 ,6.92 ,6.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24930,CPT,AMPUTATION ARM THRU HUMERUS RE-AMPUTATION,,,21,,RBRVS,10.83 ,9.01 ,9.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 24931,CPT,AMPUTATION ARM THRU HUMERUS W/IMPLANT,,,21,,RBRVS,13.44 ,7.76 ,7.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 24935,CPT,STUMP ELONGATION UPPER EXTREMITY,,,21,,RBRVS,16.45 ,11.81 ,11.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 24940,CPT,CINEPLASTY UPPER EXTREMITY COMPLETE PROCEDURE,,,21,,TotalUnits,,,,27.37 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 24999,CPT,UNLISTED PROCEDURE HUMERUS/ELBOW,,,21,,TotalUnits,,,,13.70 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25000,CPT,INCISION EXTENSOR TENDON SHEATH WRIST,,,21,,RBRVS,3.55 ,5.39 ,5.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25001,CPT,INCISION FLEXOR TENDON SHEATH WRIST,,,21,,RBRVS,3.79 ,5.28 ,5.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25020,CPT,DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT,,,21,,RBRVS,6.06 ,9.23 ,9.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25023,CPT,DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT,,,21,,RBRVS,13.83 ,15.02 ,15.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25024,CPT,DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB,,,21,,RBRVS,10.79 ,9.23 ,9.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25025,CPT,DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT,,,21,,RBRVS,17.94 ,13.34 ,13.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25028,CPT,I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA,,,21,,RBRVS,5.39 ,8.48 ,8.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25031,CPT,INCISION & DRAINAGE FOREARM&/WRIST BURSA,,,21,,RBRVS,4.26 ,5.17 ,5.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25035,CPT,INCISION DEEP BONE CORTEX FOREARM&/WRIST,,,21,,RBRVS,7.65 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25040,CPT,ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB,,,21,,RBRVS,7.50 ,7.23 ,7.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25065,CPT,BIOPSY SOFT TISSUE FOREARM&/WRIST SUPERFICIAL,,,21,,RBRVS,2.04 ,2.34 ,4.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25066,CPT,BIOPSY SOFT TISSUE FOREARM&/WRIST DEEP,,,21,,RBRVS,4.27 ,5.16 ,5.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25071,CPT,EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>,,,21,,RBRVS,5.91 ,5.07 ,5.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25073,CPT,EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>,,,21,,RBRVS,7.13 ,6.71 ,6.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25075,CPT,EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM,,,21,,RBRVS,3.96 ,4.31 ,8.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25076,CPT,EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM,,,21,,RBRVS,6.74 ,6.77 ,6.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25077,CPT,RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM,,,21,,RBRVS,12.93 ,9.81 ,9.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25078,CPT,RAD RESCJ TUM SOFT TISSUE FOREARM&/WRIST 3 CM/>,,,21,,RBRVS,17.69 ,12.14 ,12.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25085,CPT,CAPSULOTOMY WRIST,,,21,,RBRVS,5.64 ,6.16 ,6.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25100,CPT,ARTHROTOMY WRIST JOINT WITH BIOPSY,,,21,,RBRVS,4.02 ,5.04 ,5.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25101,CPT,ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB,,,21,,RBRVS,4.83 ,5.80 ,5.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25105,CPT,ARTHROTOMY WRIST JOINT WITH SYNOVECTOMY,,,21,,RBRVS,6.02 ,6.68 ,6.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25107,CPT,ARTHROTOMY DSTL RADIOULNAR JOINT RPR CARTILAGE,,,21,,RBRVS,7.70 ,8.50 ,8.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25109,CPT,EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA,,,21,,RBRVS,6.94 ,7.21 ,7.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25110,CPT,EXCISION LESION TENDON SHEATH FOREARM&/WRIST,,,21,,RBRVS,4.04 ,4.96 ,4.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25111,CPT,EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY,,,21,,RBRVS,3.53 ,4.93 ,4.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25112,CPT,EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT,,,21,,RBRVS,4.67 ,5.48 ,5.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25115,CPT,RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS,,,21,,RBRVS,10.09 ,9.78 ,9.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25116,CPT,RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS,,,21,,RBRVS,7.56 ,8.24 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25118,CPT,SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT,,,21,,RBRVS,4.51 ,5.55 ,5.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25119,CPT,SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA,,,21,,RBRVS,6.21 ,6.80 ,6.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25120,CPT,EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA,,,21,,RBRVS,6.27 ,6.79 ,6.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25125,CPT,EXC/CURTG CYST/TUMOR RADIUS/ULNA W/AUTOGRAFT,,,21,,RBRVS,7.67 ,7.43 ,7.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25126,CPT,EXC/CURTG CYST/TUMOR RADIUS/ULNA W/ALLOGRAFT,,,21,,RBRVS,7.74 ,7.71 ,7.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25130,CPT,EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES,,,21,,RBRVS,5.43 ,6.36 ,6.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25135,CPT,EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT,,,21,,RBRVS,7.08 ,7.34 ,7.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25136,CPT,EXC/CURTG CYST/TUMOR CARPAL BONES W/ALLOGRAFT,,,21,,RBRVS,6.14 ,6.62 ,6.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25145,CPT,SEQUESTRECTOMY FOREARM &/WRIST,,,21,,RBRVS,6.54 ,6.94 ,6.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25150,CPT,PARTIAL EXCISION BONE ULNA,,,21,,RBRVS,7.38 ,7.39 ,7.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25151,CPT,PARTIAL EXCISION BONE RADIUS,,,21,,RBRVS,7.68 ,7.50 ,7.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25170,CPT,RADICAL RESECTION TUMOR RADIUS OR ULNA,,,21,,RBRVS,22.21 ,15.89 ,15.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25210,CPT,CARPECTOMY 1 BONE,,,21,,RBRVS,6.12 ,6.74 ,6.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25215,CPT,CARPECTOMY ALL BONES PROXIMAL ROW,,,21,,RBRVS,8.14 ,8.05 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25230,CPT,RADICAL STYLOIDECTOMY SEPARATE PROCEDURE,,,21,,RBRVS,5.37 ,6.00 ,6.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25240,CPT,EXCISION DISTAL ULNA PARTIAL/COMPLETE,,,21,,RBRVS,5.31 ,5.99 ,5.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25246,CPT,INJECTION WRIST ARTHROGRAPHY,,,21,,RBRVS,1.45 ,0.58 ,3.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25248,CPT,EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST,,,21,,RBRVS,5.31 ,5.52 ,5.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25250,CPT,REMOVAL WRIST PROSTHESIS SEPARATE PROCEDURE,,,21,,RBRVS,6.77 ,7.12 ,7.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25251,CPT,REMOVAL WRIST PROSTH COMPLICATED W/TOTAL WRIST,,,21,,RBRVS,9.82 ,8.73 ,8.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25259,CPT,MANIPULATION WRIST UNDER ANESTHESIA,,,21,,RBRVS,4.04 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25260,CPT,RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU,,,21,,RBRVS,8.04 ,8.50 ,8.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25263,CPT,RPR TDN/MUSC FLXR F/ARM&/WRIST SEC 1 EA TDN/MUS,,,21,,RBRVS,8.04 ,8.28 ,8.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25265,CPT,RPR TDN/MUSC FLXR F/ARM&/WRISTSEC FR GRF EA,,,21,,RBRVS,10.10 ,9.32 ,9.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25270,CPT,RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN,,,21,,RBRVS,6.17 ,6.72 ,6.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25272,CPT,RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU,,,21,,RBRVS,7.21 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25274,CPT,RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN,,,21,,RBRVS,8.94 ,8.43 ,8.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25275,CPT,RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT,,,21,,RBRVS,8.96 ,8.63 ,8.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25280,CPT,LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN,,,21,,RBRVS,7.39 ,7.43 ,7.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25290,CPT,TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA,,,21,,RBRVS,5.43 ,6.05 ,6.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25295,CPT,TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA,,,21,,RBRVS,6.72 ,7.01 ,7.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25300,CPT,TENODESIS WRIST FLEXORS FINGERS,,,21,,RBRVS,9.02 ,8.86 ,8.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25301,CPT,TENODESIS WRIST EXTENSORS FINGERS,,,21,,RBRVS,8.59 ,8.22 ,8.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25310,CPT,TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN,,,21,,RBRVS,8.08 ,8.19 ,8.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25312,CPT,TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GR,,,21,,RBRVS,9.82 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25315,CPT,FLEXOR ORIGIN SLIDE FOREARM &/WRIST,,,21,,RBRVS,10.68 ,9.29 ,9.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25316,CPT,FLEXOR ORIGIN SLIDE F/ARM&/WRST TENDON TRANSFE,,,21,,RBRVS,12.90 ,10.72 ,10.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25320,CPT,CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS,,,21,,RBRVS,12.75 ,13.17 ,13.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25332,CPT,ARTHRP WRST W/WO INTERPOS W/WO XTRNL/INT FIXJ,,,21,,RBRVS,11.74 ,10.24 ,10.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25335,CPT,CENTRALIZATION WRST ULNA,,,21,,RBRVS,13.39 ,7.96 ,7.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25337,CPT,RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ,,,21,,RBRVS,11.73 ,11.59 ,11.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25350,CPT,OSTEOTOMY RADIUS DISTAL THIRD,,,21,,RBRVS,9.09 ,8.55 ,8.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25355,CPT,OSTEOTOMY RADIUS MIDDLE/PROXIMAL THIRD,,,21,,RBRVS,10.53 ,9.01 ,9.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25360,CPT,OSTEOTOMY ULNA,,,21,,RBRVS,8.74 ,8.35 ,8.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25365,CPT,OSTEOTOMY RADIUS & ULNA,,,21,,RBRVS,12.91 ,10.74 ,10.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25370,CPT,MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS/ULNA,,,21,,RBRVS,14.10 ,12.04 ,12.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25375,CPT,MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS&ULNA,,,21,,RBRVS,13.55 ,11.06 ,11.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25390,CPT,OSTEOPLASTY RADIUS/ULNA SHORTENING,,,21,,RBRVS,10.70 ,9.40 ,9.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25391,CPT,OSTEOPLASTY RADIUS/ULNA LENGTHENING W/AUTOGRAFT,,,21,,RBRVS,14.28 ,11.43 ,11.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25392,CPT,OSTEOPLASTY RADIUS & ULNA SHORTENING,,,21,,RBRVS,14.58 ,8.41 ,8.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25393,CPT,OSTEOPLASTY RADIUS&ULNA LENGTHENING W/AUTOGRAF,,,21,,RBRVS,16.56 ,13.15 ,13.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25394,CPT,OSTEOPLASTY CARPAL BONE SHORTENING,,,21,,RBRVS,10.85 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25400,CPT,RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT,,,21,,RBRVS,11.28 ,9.64 ,9.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25405,CPT,RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT,,,21,,RBRVS,15.01 ,11.95 ,11.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25415,CPT,RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAF,,,21,,RBRVS,13.80 ,11.09 ,11.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25420,CPT,RPR NONUNION/MALUNION RADIUS&ULNA W/AUTOGRAFT,,,21,,RBRVS,17.04 ,13.10 ,13.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25425,CPT,REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA,,,21,,RBRVS,13.72 ,11.15 ,11.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25426,CPT,REPAIR DEFECT W/AUTOGRAFT RADIUS&ULNA,,,21,,RBRVS,16.45 ,12.52 ,12.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25430,CPT,INSERTION VASCULAR PEDICLE CARPAL BONE,,,21,,RBRVS,9.71 ,9.29 ,9.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25431,CPT,REPAIR NONUNION CARPAL BONE EACH BONE,,,21,,RBRVS,10.89 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25440,CPT,RPR NONUNION SCAPHOID CARPAL BNE W/WO RDL STYLEC,,,21,,RBRVS,10.68 ,9.34 ,9.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25441,CPT,ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL RADIUS,,,21,,RBRVS,13.29 ,11.38 ,11.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25442,CPT,ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL ULNA,,,21,,RBRVS,11.12 ,10.00 ,10.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25443,CPT,ARTHROPLASTY W/PROSTHETIC RPLCMT SCAPHOID CARPAL,,,21,,RBRVS,10.66 ,9.59 ,9.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25444,CPT,ARTHROPLASTY W/PROSTHETIC REPLACEMENT LUNATE,,,21,,RBRVS,11.42 ,9.97 ,9.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25445,CPT,ARTHROPLASTY W/PROSTHETIC REPLACEMENT TRAPEZIUM,,,21,,RBRVS,9.88 ,8.93 ,8.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25446,CPT,ARTHRP W/PROSTC RPLCMT DSTL RDS&PRTL/CARPUS,,,21,,RBRVS,17.30 ,13.20 ,13.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25447,CPT,ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS,,,21,,RBRVS,11.14 ,10.54 ,10.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25449,CPT,REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT,,,21,,RBRVS,14.94 ,12.01 ,12.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25450,CPT,EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/U,,,21,,RBRVS,8.06 ,5.70 ,5.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25455,CPT,EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS&ULNA,,,21,,RBRVS,9.71 ,6.56 ,6.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25490,CPT,PROPH TX N/P/PLTWR W/WO METHYLACRYLATE RADIUS,,,21,,RBRVS,9.73 ,8.91 ,8.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25491,CPT,PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE ULNA,,,21,,RBRVS,10.15 ,9.01 ,9.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25492,CPT,PROPH TX N/P/PLTWR W/WO METHYLMECRYLATE RAD&UL,,,21,,RBRVS,12.66 ,10.73 ,10.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25500,CPT,CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION,,,21,,RBRVS,2.60 ,4.09 ,4.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25505,CPT,CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION,,,21,,RBRVS,5.45 ,6.70 ,7.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25515,CPT,OPEN TREATMENT RADIAL SHAFT FRACTURE,,,21,,RBRVS,8.80 ,8.66 ,8.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25520,CPT,CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT,,,21,,RBRVS,6.50 ,7.37 ,8.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25525,CPT,OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE,,,21,,RBRVS,10.55 ,9.91 ,9.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25526,CPT,OPEN RDL SHAFT FX OPEN RAD/ULN JT DISLOCATE,,,21,,RBRVS,13.15 ,11.60 ,11.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25530,CPT,CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION,,,21,,RBRVS,2.24 ,4.11 ,4.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25535,CPT,CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION,,,21,,RBRVS,5.36 ,6.54 ,7.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25545,CPT,OPEN TREATMENT OF ULNAR SHAFT FRACTURE,,,21,,RBRVS,7.94 ,8.37 ,8.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25560,CPT,CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN,,,21,,RBRVS,2.59 ,4.11 ,4.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25565,CPT,CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ,,,21,,RBRVS,5.85 ,6.49 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25574,CPT,OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS/ULNA,,,21,,RBRVS,8.80 ,8.75 ,8.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25575,CPT,OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS&ULNA,,,21,,RBRVS,12.29 ,11.15 ,11.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25600,CPT,CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ,,,21,,RBRVS,2.78 ,5.54 ,6.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25605,CPT,CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF,,,21,,RBRVS,6.25 ,7.25 ,8.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25606,CPT,PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP,,,21,,RBRVS,8.31 ,9.00 ,9.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25607,CPT,OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP,,,21,,RBRVS,9.56 ,9.65 ,9.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25608,CPT,OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG,,,21,,RBRVS,11.07 ,10.42 ,10.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25609,CPT,OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG,,,21,,RBRVS,14.38 ,12.92 ,12.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25622,CPT,CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ,,,21,,RBRVS,2.79 ,4.61 ,5.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25624,CPT,CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ,,,21,,RBRVS,4.77 ,6.65 ,7.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25628,CPT,OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE,,,21,,RBRVS,9.67 ,9.18 ,9.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25630,CPT,CLTX CARPAL BONE FX W/O MANJ EACH BONE,,,21,,RBRVS,3.03 ,4.42 ,5.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25635,CPT,CLTX CARPAL BONE FX W/MANJ EACH BONE,,,21,,RBRVS,4.61 ,5.50 ,6.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25645,CPT,OPEN TX CARPAL BONE FRACTURE OTH/THN SCAPHOID EA,,,21,,RBRVS,7.42 ,7.35 ,7.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25650,CPT,CLOSED TREATMENT ULNAR STYLOID FRACTURE,,,21,,RBRVS,3.23 ,4.76 ,5.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25651,CPT,PRQ SKELETAL FIXATION ULNAR STYLOID FRACTURE,,,21,,RBRVS,5.82 ,6.98 ,6.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25652,CPT,OPEN TREATMENT ULNAR STYLOID FRACTURE,,,21,,RBRVS,8.06 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25660,CPT,CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ,,,21,,RBRVS,4.98 ,5.81 ,5.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25670,CPT,OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/> BONES,,,21,,RBRVS,8.09 ,7.75 ,7.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25671,CPT,PRQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION,,,21,,RBRVS,6.46 ,7.42 ,7.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25675,CPT,CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ,,,21,,RBRVS,4.89 ,5.60 ,6.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25676,CPT,OPEN TX DISTAL RADIOULNAR DISLC ACUTE/CHRONIC,,,21,,RBRVS,8.29 ,8.10 ,8.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25680,CPT,CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MANJ,,,21,,RBRVS,6.23 ,6.28 ,6.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25685,CPT,OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC,,,21,,RBRVS,10.09 ,8.91 ,8.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25690,CPT,CLOSED TX LUNATE DISLOCATION W/MANIPULATION,,,21,,RBRVS,5.72 ,6.77 ,6.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25695,CPT,OPEN TREATMENT LUNATE DISLOCATION,,,21,,RBRVS,8.51 ,7.93 ,7.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25800,CPT,ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT,,,21,,RBRVS,10.07 ,9.06 ,9.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25805,CPT,ARTHRODESIS WRIST W/SLIDING GRAFT,,,21,,RBRVS,11.73 ,10.14 ,10.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25810,CPT,ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT,,,21,,RBRVS,11.95 ,10.76 ,10.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25820,CPT,ARTHRODESIS WRIST LIMITED W/O BONE GRAFT,,,21,,RBRVS,7.64 ,8.55 ,8.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25825,CPT,ARTHRODESIS WRIST LIMITED W/AUTOGRAFT,,,21,,RBRVS,9.69 ,10.24 ,10.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25830,CPT,ARTHRD DSTL RAD/ULN JT SGMTL RSCJ ULNA W/WO BONE,,,21,,RBRVS,10.88 ,14.17 ,14.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25900,CPT,AMPUTATION FOREARM THROUGH RADIUS & ULNA,,,21,,RBRVS,9.61 ,8.84 ,8.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 25905,CPT,AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR,,,21,,RBRVS,9.59 ,6.70 ,6.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 25907,CPT,AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE,,,21,,RBRVS,8.09 ,6.99 ,6.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25909,CPT,AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION,,,21,,RBRVS,9.31 ,8.44 ,8.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25915,CPT,KRUKENBERG PROCEDURE,,,21,,RBRVS,17.52 ,13.10 ,13.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 25920,CPT,DISARTICULATION THROUGH WRIST,,,21,,RBRVS,9.03 ,9.01 ,9.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 25922,CPT,DISARTICULATION THRU WRIST SEC CLOSURE/SCAR REVJ,,,21,,RBRVS,7.65 ,7.20 ,7.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25924,CPT,DISARTICULATION THRU WRIST RE-AMPUTATION,,,21,,RBRVS,8.81 ,7.00 ,7.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 25927,CPT,TRANSMETACARPAL AMPUTATION,,,21,,RBRVS,9.09 ,12.27 ,12.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 25929,CPT,TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ,,,21,,RBRVS,7.82 ,7.48 ,7.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25931,CPT,TRANSMETACARPAL AMPUTATION RE-AMPUTATION,,,21,,RBRVS,8.04 ,9.02 ,9.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 25999,CPT,UNLISTED PROCEDURE FOREARM/WRIST,,,21,,TotalUnits,,,,16.19 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26010,CPT,DRAINAGE FINGER ABSCESS SIMPLE,,,21,,RBRVS,1.59 ,2.10 ,5.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26011,CPT,DRAINAGE FINGER ABSCESS COMPLICATED,,,21,,RBRVS,2.24 ,2.65 ,8.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26020,CPT,DRAINAGE TENDON SHEATH DIGIT&/PALM EACH,,,21,,RBRVS,5.08 ,6.36 ,6.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26025,CPT,DRAINAGE OF PALMAR BURSA SINGLE BURSA,,,21,,RBRVS,5.08 ,6.04 ,6.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26030,CPT,DRAINAGE OF PALMAR BURSA MULTIPLE BURSA,,,21,,RBRVS,6.25 ,6.68 ,6.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26034,CPT,INCISION BONE CORTEX HAND/FINGER,,,21,,RBRVS,6.63 ,7.47 ,7.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26035,CPT,DECOMPRESSION FINGERS&/HAND INJECTION INJURY,,,21,,RBRVS,11.37 ,11.17 ,11.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26037,CPT,DECOMPRESSIVE FASCIOTOMY HAND,,,21,,RBRVS,7.57 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26040,CPT,FASCIOTOMY PALMAR PERCUTANEOUS,,,21,,RBRVS,3.46 ,4.81 ,4.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26045,CPT,FASCIOTOMY PALMAR OPEN PARTIAL,,,21,,RBRVS,5.73 ,6.55 ,6.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26055,CPT,TENDON SHEATH INCISION,,,21,,RBRVS,3.11 ,5.15 ,12.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26060,CPT,TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT,,,21,,RBRVS,2.91 ,4.12 ,4.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26070,CPT,ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRPL JT,,,21,,RBRVS,3.81 ,4.51 ,4.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26075,CPT,ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA,,,21,,RBRVS,3.91 ,4.88 ,4.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26080,CPT,ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA,,,21,,RBRVS,4.47 ,5.85 ,5.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26100,CPT,ARTHROTOMY BIOPSY CARP/MTCRPL JOINT EACH,,,21,,RBRVS,3.79 ,4.98 ,4.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26105,CPT,ARTHROTOMY BIOPSY MTCARPHLNGL JOINT EACH,,,21,,RBRVS,3.83 ,4.97 ,4.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26110,CPT,ARTHROTOMY BIOPSY INTERPHALANGEAL JOINT EACH,,,21,,RBRVS,3.65 ,4.85 ,4.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26111,CPT,EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>,,,21,,RBRVS,5.42 ,5.53 ,5.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26113,CPT,EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>,,,21,,RBRVS,7.13 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26115,CPT,EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM,,,21,,RBRVS,3.96 ,4.82 ,9.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26116,CPT,EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM,,,21,,RBRVS,6.74 ,7.10 ,7.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26117,CPT,RAD RESECT TUMOR SOFT TISSUE HAND/FINGER <3CM,,,21,,RBRVS,10.13 ,9.45 ,9.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26118,CPT,RAD RESCJ TUM SOFT TISSUE HAND/FINGER 3 CM/>,,,21,,RBRVS,14.81 ,12.57 ,12.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26121,CPT,FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT,,,21,,RBRVS,7.73 ,7.91 ,7.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26123,CPT,FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR,,,21,,RBRVS,10.88 ,10.98 ,10.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26125,CPT,FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR,,,21,,RBRVS,4.60 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26130,CPT,SYNOVECTOMY CARPOMETACARPAL JOINT,,,21,,RBRVS,5.59 ,6.51 ,6.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26135,CPT,SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD,,,21,,RBRVS,7.13 ,7.31 ,7.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26140,CPT,SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT,,,21,,RBRVS,6.34 ,6.91 ,6.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26145,CPT,SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN,,,21,,RBRVS,6.49 ,6.92 ,6.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26160,CPT,EXC LESION TDN SHTH/JT CAPSL HAND/FNGR,,,21,,RBRVS,3.57 ,5.29 ,12.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26170,CPT,EXCISION TENDON PALM FLEXOR/EXTENSOR SINGLE EACH,,,21,,RBRVS,4.91 ,5.79 ,5.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26180,CPT,EXCISION TENDON FINGER FLEXOR/EXTENSOR EACH,,,21,,RBRVS,5.35 ,6.36 ,6.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26185,CPT,SESAMOIDECTOMY THUMB/FINGER SEPARATE PROCEDURE,,,21,,RBRVS,6.52 ,7.98 ,7.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26200,CPT,EXCISION/CURETTAGE CYST/TUMOR METACARPAL,,,21,,RBRVS,5.65 ,6.19 ,6.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26205,CPT,EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT,,,21,,RBRVS,7.93 ,7.72 ,7.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26210,CPT,EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER,,,21,,RBRVS,5.32 ,6.33 ,6.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26215,CPT,EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT,,,21,,RBRVS,7.27 ,7.38 ,7.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26230,CPT,PARTIAL EXCISION BONE METACARPAL,,,21,,RBRVS,6.47 ,6.63 ,6.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26235,CPT,PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER,,,21,,RBRVS,6.33 ,6.64 ,6.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26236,CPT,PARTIAL EXCISION DISTAL PHALANX FINGER,,,21,,RBRVS,5.46 ,6.15 ,6.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26250,CPT,RADICAL RESECTION TUMOR METACARPAL,,,21,,RBRVS,15.21 ,13.12 ,13.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26260,CPT,RAD RESECTION TUMOR PROX/MIDDLE PHALANX FINGER,,,21,,RBRVS,11.16 ,9.90 ,9.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26262,CPT,RADICAL RESECTION TUMOR DISTAL PHALANX FINGER,,,21,,RBRVS,8.29 ,8.34 ,8.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26320,CPT,REMOVAL IMPLANT FROM FINGER/HAND,,,21,,RBRVS,4.10 ,5.06 ,5.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26340,CPT,MANIPULATION FINGER JOINT UNDER ANES EACH JOINT,,,21,,RBRVS,2.80 ,6.19 ,6.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26341,CPT,MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD,,,21,,RBRVS,0.91 ,1.06 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26350,CPT,RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDON,,,21,,RBRVS,6.21 ,12.66 ,12.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26352,CPT,RPR/ADVMNT FLXR TDN N/Z/2 W/FR GRAFT EA TENDON,,,21,,RBRVS,7.87 ,13.60 ,13.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26356,CPT,RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON,,,21,,RBRVS,9.56 ,13.70 ,13.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26357,CPT,RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON,,,21,,RBRVS,10.53 ,11.94 ,11.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26358,CPT,RPR/ADVMNT FLXR TDN ZONE 2 W/FR GRAFT EA TENDON,,,21,,RBRVS,12.13 ,12.74 ,12.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26370,CPT,RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN,,,21,,RBRVS,7.28 ,12.71 ,12.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26372,CPT,RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/FREE GRAFT EA,,,21,,RBRVS,9.01 ,14.06 ,14.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26373,CPT,RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/O FREE GRF EA,,,21,,RBRVS,8.41 ,13.75 ,13.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26390,CPT,EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F,,,21,,RBRVS,9.43 ,12.32 ,12.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26392,CPT,RMVL SYNTH ROD & INSJ FLXR TDN GRF H/F EA ROD,,,21,,RBRVS,10.50 ,14.75 ,14.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26410,CPT,REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH,,,21,,RBRVS,4.77 ,10.24 ,10.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26412,CPT,REPAIR EXTENSOR TENDON HAND W/GRAFT EACH,,,21,,RBRVS,6.48 ,11.49 ,11.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26415,CPT,EXC XTNSR TDN W/IMPLTJ SYNTH ROD DLYD GRF H/F EA,,,21,,RBRVS,8.51 ,11.62 ,11.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26416,CPT,RMVL SYNTH ROD & INSJ XTNSR TDN GRF H/F EA ROD,,,21,,RBRVS,9.56 ,9.31 ,9.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26418,CPT,REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH,,,21,,RBRVS,4.47 ,10.93 ,10.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26420,CPT,REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH,,,21,,RBRVS,6.94 ,11.72 ,11.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26426,CPT,RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR,,,21,,RBRVS,6.32 ,6.83 ,6.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26428,CPT,RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER,,,21,,RBRVS,7.40 ,12.43 ,12.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26432,CPT,CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING,,,21,,RBRVS,4.16 ,9.09 ,9.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26433,CPT,REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF,,,21,,RBRVS,4.70 ,9.37 ,9.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26434,CPT,REPAIR EXTENSOR TENDON DISTAL INSERTION W/GRAFT,,,21,,RBRVS,6.26 ,10.73 ,10.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26437,CPT,REALIGNMENT EXTENSOR TENDON HAND EACH TENDON,,,21,,RBRVS,5.99 ,10.42 ,10.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26440,CPT,TENOLYSIS FLEXOR TENDON PALM/FINGER EACH TENDON,,,21,,RBRVS,5.16 ,11.30 ,11.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26442,CPT,TENOLYSIS FLEXOR TENDON PALM&FINGER EACH TENDO,,,21,,RBRVS,9.75 ,15.64 ,15.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26445,CPT,TENOLYSIS EXTENSOR TENDON HAND/FINGER EACH,,,21,,RBRVS,4.45 ,10.92 ,10.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26449,CPT,TENOLYSIS CPLX XTNSR TENDON FINGER W/FOREARM EA,,,21,,RBRVS,8.59 ,9.73 ,9.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26450,CPT,TENOTOMY FLEXOR PALM OPEN EACH TENDON,,,21,,RBRVS,3.79 ,7.00 ,7.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26455,CPT,TENOTOMY FLEXOR FINGER OPEN EACH TENDON,,,21,,RBRVS,3.76 ,6.90 ,6.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26460,CPT,TENOTOMY EXTENSOR HAND/FINGER OPEN EACH TENDON,,,21,,RBRVS,3.58 ,6.85 ,6.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26471,CPT,TENODESIS PROXIMAL INTERPHALANGEAL JOINT EACH,,,21,,RBRVS,5.90 ,10.33 ,10.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26474,CPT,TENODESIS DISTAL JOINT EACH,,,21,,RBRVS,5.49 ,10.34 ,10.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26476,CPT,LENGTHENING TENDON EXTENSOR HAND/FINGER EACH,,,21,,RBRVS,5.35 ,10.05 ,10.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26477,CPT,SHORTENING TENDON EXTENSOR HAND/FINGER EACH,,,21,,RBRVS,5.32 ,10.05 ,10.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26478,CPT,LENGTHENING TENDON FLEXOR HAND/FINGER EACH,,,21,,RBRVS,5.97 ,10.41 ,10.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26479,CPT,SHORTENING TENDON FLEXOR HAND/FINGER EACH,,,21,,RBRVS,5.91 ,10.37 ,10.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26480,CPT,TR/TRNSPL TDN CARP/MTCRPL HAND W/O FR GRF EA TDN,,,21,,RBRVS,6.90 ,13.05 ,13.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26483,CPT,TENDON TRANSFER TRANSPLANT CARP/MTCRPL GRAFT,,,21,,RBRVS,8.48 ,13.71 ,13.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26485,CPT,TRANSFER/TRANSPLANT TENDON PALMAR W/O GRAFT EACH,,,21,,RBRVS,7.89 ,13.41 ,13.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26489,CPT,TRANSFER/TRANSPLANT TENDON PALMAR W/GRAFT EACH,,,21,,RBRVS,9.86 ,14.26 ,14.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26490,CPT,OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN,,,21,,RBRVS,8.60 ,12.06 ,12.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26492,CPT,OPPONENSPLASTY TDN TR W/GRF EA TDN,,,21,,RBRVS,9.84 ,13.14 ,13.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26494,CPT,OPPONENSPLASTY HYPOTHENAR MUSC TR,,,21,,RBRVS,8.66 ,12.03 ,12.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26496,CPT,OPPONENSPLASTY OTHER METHODS,,,21,,RBRVS,9.78 ,12.71 ,12.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26497,CPT,TR TDN RESTORE INTRNSC FUNCJ RING&SM FNGR,,,21,,RBRVS,9.76 ,12.75 ,12.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26498,CPT,TR TDN RESTORE INTRNSC FUNCJ ALL 4 FNGRS,,,21,,RBRVS,14.21 ,15.33 ,15.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26499,CPT,CORRECTION CLAW FINGER OTHER METHODS,,,21,,RBRVS,9.17 ,12.45 ,12.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26500,CPT,RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX,,,21,,RBRVS,6.13 ,10.28 ,10.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26502,CPT,RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX,,,21,,RBRVS,7.31 ,11.13 ,11.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26508,CPT,RELEASE THENAR MUSCLE,,,21,,RBRVS,6.18 ,10.68 ,10.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26510,CPT,CROSS INTRINSIC TRANSFER EACH TENDON,,,21,,RBRVS,5.60 ,10.16 ,10.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26516,CPT,CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT,,,21,,RBRVS,7.32 ,11.12 ,11.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26517,CPT,CAPSULODESIS MTCARPHLNGL JOINT 2 DIGITS,,,21,,RBRVS,9.08 ,12.41 ,12.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26518,CPT,CAPSULODESIS MTCARPHLNGL JOINT 3/4 DIGITS,,,21,,RBRVS,9.27 ,12.49 ,12.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26520,CPT,CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH,,,21,,RBRVS,5.47 ,11.81 ,11.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26525,CPT,CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH,,,21,,RBRVS,5.50 ,11.79 ,11.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26530,CPT,ARTHROPLASTY METACARPOPHALANGEAL JOINT EACH,,,21,,RBRVS,6.88 ,7.21 ,7.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26531,CPT,ARTHRP MTCARPHLNGL JT W/PROSTC IMPLT EA JT,,,21,,RBRVS,8.13 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26535,CPT,ARTHROPLASTY INTERPHALANGEAL JOINT EACH,,,21,,RBRVS,5.41 ,5.75 ,5.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26536,CPT,ARTHROPLASTY INTERPHALANGEAL JT W/PROSTHETIC EA,,,21,,RBRVS,6.56 ,12.35 ,12.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26540,CPT,RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT,,,21,,RBRVS,6.60 ,10.70 ,10.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26541,CPT,RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF,,,21,,RBRVS,8.81 ,12.17 ,12.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26542,CPT,RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS,,,21,,RBRVS,6.95 ,10.89 ,10.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26545,CPT,RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT,,,21,,RBRVS,7.11 ,11.06 ,11.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26546,CPT,RPR NON-UNION MTCRPL/PHALANX,,,21,,RBRVS,10.83 ,15.22 ,15.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26548,CPT,RPR & RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL,,,21,,RBRVS,8.22 ,11.73 ,11.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26550,CPT,POLLICIZATION DIGIT,,,21,,RBRVS,21.68 ,18.78 ,18.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26551,CPT,TR TOE-TO-HAND W/MVASC ANAST GRT TOE WRP/ARND,,,21,,RBRVS,48.48 ,26.41 ,26.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 26553,CPT,TR TOE-TO-HAND W/MVASC ANAST OTH/THN GRT TOE 1,,,21,,RBRVS,48.17 ,35.89 ,35.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 26554,CPT,TR TOE-TO-HAND W/MVASC ANAST OTH/THN GRT TOE 2,,,21,,RBRVS,57.01 ,30.00 ,30.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 26555,CPT,TR FNGR AXH POS W/O MVASC ANAST,,,21,,RBRVS,17.08 ,17.95 ,17.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26556,CPT,TRANSFER FREE TOE JOINT W/MVASC ANASTOMOSIS,,,21,,RBRVS,49.75 ,37.65 ,37.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 26560,CPT,REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS,,,21,,RBRVS,5.52 ,9.32 ,9.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26561,CPT,REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS&GRAFT,,,21,,RBRVS,11.10 ,13.29 ,13.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26562,CPT,REPAIR SYNDACTYLY EACH SPACE COMPLEX,,,21,,RBRVS,16.68 ,18.07 ,18.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26565,CPT,OSTEOTOMY METACARPAL EACH,,,21,,RBRVS,6.91 ,10.90 ,10.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26567,CPT,OSTEOTOMY PHALANX FINGER EACH,,,21,,RBRVS,6.99 ,10.93 ,10.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26568,CPT,OSTEOPLASTY LENGTHENING METACARPAL/PHALANX,,,21,,RBRVS,9.27 ,14.30 ,14.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26580,CPT,REPAIR CLEFT HAND,,,21,,RBRVS,19.75 ,18.56 ,18.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26587,CPT,RCNSTJ POLYDACTYLOUS DIGIT SOFT TISSUE & BONE,,,21,,RBRVS,14.50 ,9.44 ,9.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26590,CPT,REPAIR MACRODACTYLIA EACH DIGIT,,,21,,RBRVS,18.67 ,15.87 ,15.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26591,CPT,REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE,,,21,,RBRVS,3.38 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26593,CPT,RELEASE INTRINSIC MUSCLES HAND EACH MUSCLE,,,21,,RBRVS,5.50 ,10.38 ,10.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26596,CPT,EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES,,,21,,RBRVS,9.14 ,10.71 ,10.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26600,CPT,CLTX METACARPAL FX W/O MANIPULATION EACH BONE,,,21,,RBRVS,2.60 ,4.82 ,5.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26605,CPT,CLTX METACARPAL FX W/MANIPULATION EACH BONE,,,21,,RBRVS,3.03 ,4.76 ,5.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26607,CPT,CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE,,,21,,RBRVS,5.48 ,6.49 ,6.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26608,CPT,PRQ SKELETAL FIXJ METACARPAL FX EACH BONE,,,21,,RBRVS,5.55 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26615,CPT,OPEN TX METACARPAL FRACTURE SINGLE EA BONE,,,21,,RBRVS,7.07 ,8.08 ,8.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26641,CPT,CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ,,,21,,RBRVS,4.13 ,4.77 ,5.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26645,CPT,CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ,,,21,,RBRVS,4.58 ,5.59 ,6.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26650,CPT,PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB,,,21,,RBRVS,5.35 ,7.27 ,7.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26665,CPT,OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB,,,21,,RBRVS,7.94 ,8.54 ,8.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26670,CPT,CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES,,,21,,RBRVS,3.83 ,4.31 ,5.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26675,CPT,CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES,,,21,,RBRVS,4.83 ,6.02 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26676,CPT,PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT,,,21,,RBRVS,5.74 ,7.47 ,7.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26685,CPT,OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB,,,21,,RBRVS,7.07 ,8.10 ,8.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26686,CPT,OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ,,,21,,RBRVS,8.17 ,8.04 ,8.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26700,CPT,CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES,,,21,,RBRVS,3.83 ,4.19 ,4.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26705,CPT,CLTX METACARPOPHALANGEAL DISLC W/MANJ W/ANES,,,21,,RBRVS,4.38 ,5.70 ,6.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26706,CPT,PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ,,,21,,RBRVS,5.31 ,6.28 ,6.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26715,CPT,OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION,,,21,,RBRVS,7.03 ,8.05 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26720,CPT,CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA,,,21,,RBRVS,1.76 ,3.18 ,3.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26725,CPT,CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA,,,21,,RBRVS,3.48 ,4.55 ,5.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26727,CPT,PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T,,,21,,RBRVS,5.42 ,6.95 ,6.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26735,CPT,OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA,,,21,,RBRVS,7.42 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26740,CPT,CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ,,,21,,RBRVS,2.07 ,3.70 ,4.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26742,CPT,CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ,,,21,,RBRVS,3.99 ,4.82 ,5.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26746,CPT,OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA,,,21,,RBRVS,9.80 ,9.62 ,9.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26750,CPT,CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA,,,21,,RBRVS,1.80 ,3.15 ,3.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26755,CPT,CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA,,,21,,RBRVS,3.23 ,4.00 ,5.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26756,CPT,PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA,,,21,,RBRVS,4.58 ,6.49 ,6.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26765,CPT,OPEN TX DISTAL PHALANGEAL FRACTURE EACH,,,21,,RBRVS,5.86 ,7.37 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26770,CPT,CLTX IPHAL JT DISLC W/MANJ W/O ANES,,,21,,RBRVS,3.15 ,3.63 ,4.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26775,CPT,CLTX IPHAL JT DISLC W/MANJ REQ ANES,,,21,,RBRVS,3.90 ,5.27 ,6.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26776,CPT,PRQ SKEL FIXJ IPHAL JT DISLC W/MANJ,,,21,,RBRVS,4.99 ,6.70 ,6.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26785,CPT,OPEN TX INTERPHALANGEAL JOINT DISLOCATION,,,21,,RBRVS,6.60 ,7.82 ,7.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26820,CPT,FUSION OPPOSITION THUMB W/AUTOGENOUS GRAFT,,,21,,RBRVS,8.45 ,12.09 ,12.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26841,CPT,ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ,,,21,,RBRVS,7.35 ,11.73 ,11.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26842,CPT,ARTHRD CRP/MTACRPL JT THMB W/WO INT FIXJ W/AGRFT,,,21,,RBRVS,8.49 ,12.06 ,12.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26843,CPT,ARTHRD CARP/MTCRPL JT DGT OTHER THAN THUMB EACH,,,21,,RBRVS,7.78 ,11.49 ,11.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26844,CPT,ARTHRD CARP/MTCRPL JT DGT OTH/THN THMB W/AGRFT,,,21,,RBRVS,8.98 ,12.37 ,12.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26850,CPT,ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ,,,21,,RBRVS,7.14 ,11.06 ,11.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26852,CPT,ARTHRODESIS MTCRPL JT W/WO INT FIXJ W/AUTOGRAFT,,,21,,RBRVS,8.71 ,12.14 ,12.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26860,CPT,ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ,,,21,,RBRVS,4.88 ,10.09 ,10.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26861,CPT,ARTHRODESIS IPHAL JT W/WO INT FIXJ EA IPHAL JT,,,21,,RBRVS,1.74 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26862,CPT,ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AUTOGRAFT,,,21,,RBRVS,7.56 ,11.52 ,11.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26863,CPT,ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AGRFT EA JT,,,21,,RBRVS,3.89 ,1.96 ,1.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26910,CPT,AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER,,,21,,RBRVS,7.79 ,11.02 ,11.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26951,CPT,AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR,,,21,,RBRVS,6.04 ,11.21 ,11.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26952,CPT,AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP,,,21,,RBRVS,6.48 ,10.50 ,10.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26989,CPT,UNLISTED PROCEDURE HANDS/FINGERS,,,21,,TotalUnits,,,,9.94 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26990,CPT,I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA,,,21,,RBRVS,7.95 ,8.31 ,8.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26991,CPT,I&D PELVIS/HIP JOINT AREA INFECTED BURSA,,,21,,RBRVS,7.06 ,6.53 ,11.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 26992,CPT,INCISION BONE CORTEX PELVIS&/HIP JOINT,,,21,,RBRVS,13.48 ,11.50 ,11.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27000,CPT,TENOTOMY ADDUCTOR HIP PERCUTANEOUS SPX,,,21,,RBRVS,5.74 ,5.26 ,5.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27001,CPT,TENOTOMY ADDUCTOR HIP OPEN,,,21,,RBRVS,7.14 ,6.86 ,6.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27003,CPT,TX ADDUXOR SUBQ OPN W/OBTURATOR NEURECTOMY,,,21,,RBRVS,7.81 ,7.70 ,7.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27005,CPT,TENOTOMY HIP FLEXOR OPEN SEPARATE PROCEDURE,,,21,,RBRVS,10.07 ,8.76 ,8.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27006,CPT,TENOTOMY ABDUCTORS&/EXTENSOR HIP OPEN SPX,,,21,,RBRVS,10.11 ,9.05 ,9.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27025,CPT,FASCIOTOMY HIP/THIGH ANY TYPE,,,21,,RBRVS,12.89 ,10.92 ,10.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27027,CPT,DECOMPRESSION FASCIOTOMY PELVIC COMPARTMENT UNI,,,21,,RBRVS,13.04 ,10.24 ,10.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27030,CPT,ARTHROTOMY HIP W/DRAINAGE,,,21,,RBRVS,13.65 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27033,CPT,ARTHROTOMY HIP EXPLORATION/REMOVAL FOREIGN BODY,,,21,,RBRVS,14.11 ,11.05 ,11.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27035,CPT,DNRVTJ HIP JT INTRAPEL/XTRPEL INTRA-ARTCLR BRNCH,,,21,,RBRVS,17.37 ,12.46 ,12.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27036,CPT,CAPSLCTOMY/CAPSUL HIP W/RLS HIP FLXR MUSC,,,21,,RBRVS,14.38 ,11.82 ,11.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27040,CPT,BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL,,,21,,RBRVS,2.92 ,2.36 ,6.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27041,CPT,BIOPSY SOFT TISSUE PELVIS&HIP DEEP/SUBFSCAL/IM,,,21,,RBRVS,10.18 ,7.74 ,7.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27043,CPT,EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3CM/>,,,21,,RBRVS,6.88 ,5.08 ,5.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27045,CPT,EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5CM/>,,,21,,RBRVS,11.13 ,8.08 ,8.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27047,CPT,EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM,,,21,,RBRVS,4.94 ,4.40 ,7.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27048,CPT,EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM,,,21,,RBRVS,8.85 ,6.81 ,6.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27049,CPT,RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5 CM,,,21,,RBRVS,21.55 ,12.82 ,12.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27050,CPT,ARTHROTOMY W/BIOPSY SACROILIAC JOINT,,,21,,RBRVS,4.74 ,5.42 ,5.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27052,CPT,ARTHROTOMY W/BIOPSY HIP JOINT,,,21,,RBRVS,7.42 ,7.62 ,7.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27054,CPT,ARTHROTOMY W/SYNOVECTOMY HIP JOINT,,,21,,RBRVS,9.21 ,8.64 ,8.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27057,CPT,DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI,,,21,,RBRVS,14.91 ,11.20 ,11.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27059,CPT,RAD RESECTION TUMOR SOFT TISS PELVIS&HIP 5 CM/>,,,21,,RBRVS,29.35 ,17.06 ,17.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27060,CPT,EXCISION ISCHIAL BURSA,,,21,,RBRVS,5.87 ,6.22 ,6.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27062,CPT,EXCISION TROCHANTERIC BURSA/CALCIFICATION,,,21,,RBRVS,5.75 ,6.17 ,6.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27065,CPT,EXCISION BONE CYST/BNIGN TUMOR SUPERFICIAL,,,21,,RBRVS,6.55 ,6.85 ,6.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27066,CPT,EXCISION BONE CYST/BENIGN TUMOR DEEP,,,21,,RBRVS,11.20 ,9.90 ,9.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27067,CPT,EXC B1 CST/B9 TUM W/AGRFT REQ SEP INC,,,21,,RBRVS,14.72 ,11.93 ,11.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27070,CPT,PARTIAL EXCISION SUPERFICIAL PELVIS,,,21,,RBRVS,11.56 ,10.51 ,10.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27071,CPT,PARTIAL EXCISION DEEP PELVIS,,,21,,RBRVS,12.39 ,11.46 ,11.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27075,CPT,RAD RESCT TUMOR WING OF ILIUM 1 PUBIC/ISCHIAL,,,21,,RBRVS,32.71 ,21.16 ,21.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27076,CPT,RAD RESCT TUMOR ILIUM ACETABULUM BOTH PUBIC,,,21,,RBRVS,40.21 ,24.70 ,24.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27077,CPT,RADICAL RESCTION TUMOR INNOMINATE BONE TOTAL,,,21,,RBRVS,45.21 ,27.58 ,27.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27078,CPT,RAD RESCT TUMOR ISCHIAL TUBEROSITY&GRT TRCHNTR,,,21,,RBRVS,32.21 ,20.89 ,20.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27080,CPT,COCCYGECTOMY PRIMARY,,,21,,RBRVS,6.89 ,6.33 ,6.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27086,CPT,RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS,,,21,,RBRVS,1.92 ,2.45 ,5.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27087,CPT,REMOVAL FOREIGN BODY PELVIS/HIP DEEP,,,21,,RBRVS,8.83 ,7.43 ,7.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27090,CPT,REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE,,,21,,RBRVS,11.69 ,9.86 ,9.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27091,CPT,RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA,,,21,,RBRVS,24.35 ,16.92 ,16.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27093,CPT,INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA,,,21,,RBRVS,1.30 ,0.58 ,3.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27095,CPT,INJECTION HIP ARTHROGRAPHY W/ANESTHESIA,,,21,,RBRVS,1.50 ,0.69 ,5.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27096,CPT,INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA,,,21,,RBRVS,1.48 ,0.82 ,2.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27097,CPT,RELEASE/RECESSION HAMSTRING PROXIMAL,,,21,,RBRVS,9.27 ,8.23 ,8.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27098,CPT,TRANSFER ADDUCTOR ISCHIUM,,,21,,RBRVS,9.32 ,8.19 ,8.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27100,CPT,TR XTRNL OBLQ MUSC TRCHNTR W/FSCAL/TDN XTN GRF,,,21,,RBRVS,11.35 ,9.99 ,9.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27105,CPT,TR PARASPI MUSC HIP FASC/TDN XTN GRF,,,21,,RBRVS,12.04 ,10.41 ,10.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27110,CPT,TRANSFER ILIOPSOAS GREATER TROCHANTER FEMUR,,,21,,RBRVS,13.77 ,11.28 ,11.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27111,CPT,TRANSFER ILIOPSOAS FEMORAL NECK,,,21,,RBRVS,12.60 ,10.69 ,10.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27120,CPT,ACETABULOPLASTY,,,21,,RBRVS,19.25 ,14.28 ,14.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27122,CPT,ACETABULOPLASTY RESECTION FEMORAL HEAD,,,21,,RBRVS,16.09 ,12.37 ,12.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27125,CPT,HEMIARTHROPLASTY HIP PARTIAL,,,21,,RBRVS,16.64 ,12.69 ,12.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27130,CPT,ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT,,,21,,RBRVS,20.72 ,14.33 ,14.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27132,CPT,CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT,,,21,,RBRVS,25.69 ,17.58 ,17.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27134,CPT,REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT,,,21,,RBRVS,30.28 ,19.12 ,19.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27137,CPT,REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT,,,21,,RBRVS,22.70 ,15.34 ,15.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27138,CPT,REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT,,,21,,RBRVS,23.70 ,15.82 ,15.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27140,CPT,OSTEOTOMY&TRANSFER GREATER TROCHANTER SPX,,,21,,RBRVS,12.78 ,10.44 ,10.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27146,CPT,OSTEOTOMY ILIAC ACETABULAR/INNOMINATE BONE,,,21,,RBRVS,18.92 ,14.25 ,14.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27147,CPT,OSTEOTOMY ILIAC ACETABULAR/INNOMINATE HIP RDCTJ,,,21,,RBRVS,22.07 ,15.84 ,15.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27151,CPT,OSTEOTOMY ILIAC ACETABULAR/INNOMINATE FEM OSTEOT,,,21,,RBRVS,24.12 ,16.87 ,16.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27156,CPT,OSTEOT ILIAC ACTBLR/INNOMINATE BONE OSTEOT RDCTJ,,,21,,RBRVS,26.23 ,17.93 ,17.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27158,CPT,OSTEOTOMY PELVIS BILATERAL,,,21,,RBRVS,21.04 ,15.12 ,15.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27161,CPT,OSTEOTOMY FEMORAL NECK SEPARATE PROCEDURE,,,21,,RBRVS,17.89 ,13.58 ,13.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27165,CPT,OSTEOT INTERTRCHNTRIC/SUBTRCHNTRIC W/INT/XTRNL,,,21,,RBRVS,20.29 ,15.34 ,15.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27170,CPT,B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA,,,21,,RBRVS,17.61 ,12.77 ,12.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27175,CPT,TX SLP FEMORAL EPIPHYSIS TRCJ W/O REDUCTION,,,21,,RBRVS,9.38 ,7.89 ,7.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27176,CPT,TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU,,,21,,RBRVS,12.92 ,10.44 ,10.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27177,CPT,OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT,,,21,,RBRVS,16.09 ,12.70 ,12.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27178,CPT,OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN,,,21,,RBRVS,12.92 ,10.85 ,10.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27179,CPT,OPTX SLP FEM EPIPHYSIS OSTPL FEM NCK HEYMAN PX,,,21,,RBRVS,13.97 ,11.26 ,11.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27181,CPT,OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ,,,21,,RBRVS,16.18 ,9.35 ,9.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27185,CPT,EPIPHYSL ARRST EPIPHYSIOD/STAPLING TRCHNTR FEMUR,,,21,,RBRVS,9.79 ,6.36 ,6.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27187,CPT,PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR,,,21,,RBRVS,14.23 ,11.46 ,11.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27197,CPT,CLSD TX PELVIC RING FX,,,21,,RBRVS,1.53 ,1.61 ,1.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27198,CPT,CLSD TX PELVIC RING FX,,,21,,RBRVS,4.75 ,3.05 ,3.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27200,CPT,CLOSED TREATMENT COCCYGEAL FRACTURE,,,21,,RBRVS,1.92 ,3.11 ,2.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27202,CPT,OPEN TREATMENT COCCYGEAL FRACTURE,,,21,,RBRVS,7.31 ,6.51 ,6.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27215,CPT,OPTX ILIAC TUBRST AVLS/WING FX FIXJ IF PRFRMD,,,21,,RBRVS,10.45 ,6.07 ,6.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27216,CPT,PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DIS,,,21,,RBRVS,15.73 ,8.72 ,8.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27217,CPT,OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFR,,,21,,RBRVS,14.65 ,8.31 ,8.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27218,CPT,OPTX POST PEL BONE FX&/DISLC INT FIXJ IF PFRMD,,,21,,RBRVS,20.93 ,10.71 ,10.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27220,CPT,CLTX ACETABULUM HIP/SOCKT FX W/O MANJ,,,21,,RBRVS,6.83 ,6.89 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27222,CPT,CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ,,,21,,RBRVS,14.11 ,11.18 ,11.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27226,CPT,OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ,,,21,,RBRVS,15.57 ,11.78 ,11.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27227,CPT,OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT,,,21,,RBRVS,25.41 ,17.37 ,17.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27228,CPT,OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT,,,21,,RBRVS,29.33 ,19.38 ,19.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27230,CPT,CLTX FEM FX PROX END NCK W/O MANJ,,,21,,RBRVS,5.81 ,6.56 ,6.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27232,CPT,CLTX FEM FX PROX END NCK W/MANJ W/WO SKEL TRACJ,,,21,,RBRVS,11.72 ,7.72 ,7.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27235,CPT,PRQ SKEL FIXJ FEMORAL FX PROX END NECK,,,21,,RBRVS,13.00 ,10.53 ,10.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27236,CPT,OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT,,,21,,RBRVS,17.61 ,13.36 ,13.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27238,CPT,CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ,,,21,,RBRVS,5.75 ,6.30 ,6.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27240,CPT,CLTX INTR/PERI/SBTRCHNTC FEMORAL FX W/MANJ,,,21,,RBRVS,13.81 ,10.97 ,10.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27244,CPT,TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT,,,21,,RBRVS,18.18 ,13.67 ,13.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27245,CPT,TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW,,,21,,RBRVS,18.18 ,13.67 ,13.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27246,CPT,CLTX GREATER TROCHANTERIC FX W/O MANJ,,,21,,RBRVS,4.83 ,5.30 ,5.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27248,CPT,OPEN TREATMENT GREATER TROCHANTERIC FRACTURE,,,21,,RBRVS,10.78 ,8.46 ,8.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27250,CPT,CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA,,,21,,RBRVS,3.82 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27252,CPT,CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA,,,21,,RBRVS,11.03 ,8.62 ,8.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27253,CPT,OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ,,,21,,RBRVS,13.58 ,10.77 ,10.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27254,CPT,OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD,,,21,,RBRVS,18.94 ,13.84 ,13.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27256,CPT,TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES,,,21,,RBRVS,4.28 ,1.78 ,3.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27257,CPT,TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES,,,21,,RBRVS,5.38 ,3.98 ,3.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27258,CPT,OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM,,,21,,RBRVS,16.18 ,12.50 ,12.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27259,CPT,OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM SHRT,,,21,,RBRVS,23.26 ,16.78 ,16.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27265,CPT,CLTX POST HIP ARTHRP DISLC W/O ANES,,,21,,RBRVS,5.24 ,5.31 ,5.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27266,CPT,CLTX POST HIP ARTHRP DISLC REQ ANES,,,21,,RBRVS,7.78 ,7.34 ,7.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27267,CPT,CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANJ,,,21,,RBRVS,5.50 ,5.89 ,5.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27268,CPT,CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ,,,21,,RBRVS,7.12 ,6.78 ,6.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27269,CPT,OPEN TX FEMORAL FRACTURE PROXIMAL END HEAD,,,21,,RBRVS,18.89 ,13.13 ,13.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27275,CPT,MANIPULATION HIP JOINT GENERAL ANESTHESIA,,,21,,RBRVS,2.32 ,2.45 ,2.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27279,CPT,ARTHRODESIS SACROILIAC JOINT PERCUTANEOUS,,,21,,RBRVS,9.03 ,8.53 ,8.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27280,CPT,ARTHRODESIS SACROILIAC JOINT W/OBTAINING GRAFT,,,21,,RBRVS,20.00 ,13.95 ,13.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27282,CPT,ARTHRODESIS SYMPHYSIS PUBIS W/OBTAINING GRAFT,,,21,,RBRVS,11.85 ,9.71 ,9.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27284,CPT,ARTHRODESIS HIP JOINT W/OBTAINING GRAFT,,,21,,RBRVS,25.06 ,15.30 ,15.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27286,CPT,ARTHRD HIP JT W/OBTG GRF W/SUBTRCHNTRIC OSTEOT,,,21,,RBRVS,25.17 ,17.40 ,17.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27290,CPT,INTERPELVIABDOMINAL AMPUTATION,,,21,,RBRVS,24.55 ,16.83 ,16.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27295,CPT,DISARTICULATION HIP,,,21,,RBRVS,19.66 ,12.63 ,12.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27299,CPT,UNLISTED PROCEDURE PELVIS/HIP JOINT,,,21,,TotalUnits,,,,13.76 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27301,CPT,I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION,,,21,,RBRVS,6.78 ,6.20 ,10.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27303,CPT,INC DEEP W/OPNG BONE CORTEX FEMUR/KNEE,,,21,,RBRVS,8.63 ,7.95 ,7.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27305,CPT,FASCIOTOMY ILIOTIBIAL OPEN,,,21,,RBRVS,6.18 ,6.44 ,6.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27306,CPT,TENOTOMY PRQ ADDUCTOR/HAMSTRING 1 TENDON SPX,,,21,,RBRVS,4.74 ,4.80 ,4.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27307,CPT,TENOTOMY PRQ ADDUCTOR/HAMSTRING MULTIPLE TENDON,,,21,,RBRVS,6.06 ,6.03 ,6.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27310,CPT,ARTHRT KNE W/EXPL DRG/RMVL FB,,,21,,RBRVS,10.00 ,9.01 ,9.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27323,CPT,BIOPSY SOFT TISSUE THIGH/KNEE AREA SUPERFICIAL,,,21,,RBRVS,2.33 ,2.38 ,4.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27324,CPT,BIOPSY SOFT TISSUE THIGH/KNEE AREA DEEP,,,21,,RBRVS,5.04 ,5.28 ,5.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27325,CPT,NEURECTOMY HAMSTRING MUSCLE,,,21,,RBRVS,7.20 ,7.09 ,7.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27326,CPT,NEURECTOMY POPLITEAL,,,21,,RBRVS,6.47 ,6.97 ,6.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27327,CPT,EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM,,,21,,RBRVS,3.96 ,4.21 ,8.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27328,CPT,EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM,,,21,,RBRVS,8.85 ,7.11 ,7.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27329,CPT,RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM,,,21,,RBRVS,15.72 ,10.81 ,10.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27330,CPT,ARTHROTOMY KNEE W/SYNOVIAL BIOPSY ONLY,,,21,,RBRVS,5.11 ,5.84 ,5.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27331,CPT,ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB,,,21,,RBRVS,6.02 ,6.40 ,6.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27332,CPT,ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL/LAT,,,21,,RBRVS,8.46 ,8.23 ,8.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27333,CPT,ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL&LAT,,,21,,RBRVS,7.55 ,7.71 ,7.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27334,CPT,ARTHROTOMY W/SYNOVECTOMY KNEE ANTERIOR/POSTERIOR,,,21,,RBRVS,9.19 ,8.61 ,8.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27335,CPT,ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA,,,21,,RBRVS,10.55 ,9.30 ,9.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27337,CPT,EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>,,,21,,RBRVS,5.91 ,4.81 ,4.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27339,CPT,EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5 CM/>,,,21,,RBRVS,11.13 ,8.17 ,8.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27340,CPT,EXCISION PREPATELLAR BURSA,,,21,,RBRVS,4.32 ,5.45 ,5.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27345,CPT,EXCISION SYNOVIAL CYST POPLITEAL SPACE,,,21,,RBRVS,6.09 ,6.49 ,6.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27347,CPT,EXCISION LESION MENISCUS/CAPSULE KNEE,,,21,,RBRVS,6.73 ,7.12 ,7.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27350,CPT,PATELLECTOMY/HEMIPATELLECTOMY,,,21,,RBRVS,8.66 ,8.32 ,8.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27355,CPT,EXCISION/CURETTAGE CYST/TUMOR FEMUR,,,21,,RBRVS,8.00 ,7.68 ,7.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27356,CPT,EXCISION/CURETTAGE CYST/TUMOR FEMUR W/ALLOGRAFT,,,21,,RBRVS,10.09 ,9.06 ,9.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27357,CPT,EXCISION/CURETTAGE CYST/TUMOR FEMUR W/AUTOGRAFT,,,21,,RBRVS,11.16 ,9.97 ,9.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27358,CPT,EXCISION/CURETTAGE CYST/TUMOR FEMUR INT FIXATION,,,21,,RBRVS,4.73 ,2.39 ,2.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27360,CPT,PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA,,,21,,RBRVS,11.46 ,10.70 ,10.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27364,CPT,RAD RESECTION TUMOR SOFT TIS THIGH/KNEE 5 CM/>,,,21,,RBRVS,24.49 ,15.44 ,15.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27365,CPT,RADICAL RESECTION TUMOR FEMOR OR KNEE,,,21,,RBRVS,32.21 ,21.09 ,21.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27370,CPT,INJECTION KNEE ARTHROGRAPHY,,,21,,RBRVS,0.96 ,0.39 ,3.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27372,CPT,REMOVAL FOREIGN BODY DEEP THIGH/KNEE,,,21,,RBRVS,5.21 ,5.34 ,11.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27380,CPT,SUTURE INFRAPATELLAR TENDON PRIMARY,,,21,,RBRVS,7.45 ,8.10 ,8.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27381,CPT,SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF,,,21,,RBRVS,10.76 ,10.00 ,10.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27385,CPT,SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY,,,21,,RBRVS,6.93 ,8.18 ,8.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27386,CPT,SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ,,,21,,RBRVS,11.13 ,10.49 ,10.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27390,CPT,TENOTOMY OPEN HAMSTRING KNEE HIP SINGLE TENDON,,,21,,RBRVS,5.53 ,6.20 ,6.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27391,CPT,TENOTOMY OPN HAMSTRING KNEE HIP MULTIPLE 1 LEG,,,21,,RBRVS,7.49 ,7.53 ,7.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27392,CPT,TENOTOMY OPEN HAMSTRING KNEE HIP MULTIPLE BI,,,21,,RBRVS,9.63 ,8.94 ,8.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27393,CPT,LENGTHENING HAMSTRING TENDON SINGLE,,,21,,RBRVS,6.59 ,6.67 ,6.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27394,CPT,LENGTHENING HAMSTRING TENDON MULTIPLE 1 LEG,,,21,,RBRVS,8.79 ,8.18 ,8.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27395,CPT,LENGTHENING HAMSTRING TENDON MULTIPLE BILATERAL,,,21,,RBRVS,12.24 ,10.51 ,10.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27396,CPT,TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR 1 TENDON,,,21,,RBRVS,8.15 ,7.86 ,7.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27397,CPT,TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR MULT TDN,,,21,,RBRVS,12.66 ,10.72 ,10.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27400,CPT,TRANSFER TENDON/MUSCLE HAMSTRINGS FEMUR,,,21,,RBRVS,9.33 ,8.70 ,8.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27403,CPT,ARTHROTOMY W/MENISCUS REPAIR KNEE,,,21,,RBRVS,8.62 ,8.05 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27405,CPT,RPR PRIMARY TORN LIGM&/CAPSULE KNEE COLLATERAL,,,21,,RBRVS,9.08 ,8.50 ,8.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27407,CPT,REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT,,,21,,RBRVS,10.85 ,9.32 ,9.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27409,CPT,RPR 1 TORN LIGM&/CAPSL KNE COLTRL&CRUCIATE,,,21,,RBRVS,13.71 ,11.03 ,11.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27412,CPT,AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE,,,21,,RBRVS,24.74 ,17.94 ,17.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27415,CPT,OSTEOCHONDRAL ALLOGRAFT KNEE OPEN,,,21,,RBRVS,20.00 ,15.46 ,15.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27416,CPT,OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY,,,21,,RBRVS,14.16 ,11.17 ,11.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27418,CPT,ANTERIOR TIBIAL TUBERCLEPLASTY,,,21,,RBRVS,11.60 ,9.95 ,9.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27420,CPT,RCNSTJ DISLOCATING PATELLA,,,21,,RBRVS,10.26 ,9.08 ,9.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27422,CPT,RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL,,,21,,RBRVS,10.21 ,9.09 ,9.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27424,CPT,RCNSTJ DISLC PATELLA W/PATELLECTOMY,,,21,,RBRVS,10.24 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27425,CPT,LATERAL RETINACULAR RELEASE OPEN,,,21,,RBRVS,5.39 ,6.35 ,6.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27427,CPT,LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR,,,21,,RBRVS,9.79 ,8.76 ,8.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27428,CPT,LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR,,,21,,RBRVS,15.58 ,13.36 ,13.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27429,CPT,LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR,,,21,,RBRVS,17.54 ,14.90 ,14.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27430,CPT,QUADRICEPSPLASTY,,,21,,RBRVS,10.16 ,9.09 ,9.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27435,CPT,CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE,,,21,,RBRVS,10.88 ,10.17 ,10.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27437,CPT,ARTHROPLASTY PATELLA W/O PROSTHESIS,,,21,,RBRVS,8.93 ,8.22 ,8.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27438,CPT,ARTHROPLASTY PATELLA W/PROSTHESIS,,,21,,RBRVS,11.89 ,9.95 ,9.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27440,CPT,ARTHROPLASTY KNEE TIBIAL PLATEAU,,,21,,RBRVS,11.09 ,9.58 ,9.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27441,CPT,ARTHRP KNEE TIBIAL PLATEAU DBRDMT&PRTL SYNVCT,,,21,,RBRVS,11.54 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27442,CPT,ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE,,,21,,RBRVS,12.37 ,10.19 ,10.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27443,CPT,ARTHRP FEM CONDYLES/TIBL PLATU KNE DBRDMT&PRTL,,,21,,RBRVS,11.41 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27445,CPT,ARTHROPLASTY KNEE HINGE PROSTHESIS,,,21,,RBRVS,18.66 ,13.62 ,13.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27446,CPT,ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT,,,21,,RBRVS,17.48 ,12.52 ,12.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27447,CPT,ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS,,,21,,RBRVS,20.72 ,14.32 ,14.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27448,CPT,OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/O FIXATION,,,21,,RBRVS,11.60 ,8.75 ,8.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27450,CPT,OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/FIXATION,,,21,,RBRVS,14.61 ,11.61 ,11.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27454,CPT,OSTEOT MLT W/RELIGNMT IMED ROD FEM SHFT,,,21,,RBRVS,19.17 ,14.38 ,14.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27455,CPT,OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL,,,21,,RBRVS,13.36 ,11.03 ,11.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27457,CPT,OSTEOT PROX TIBIA FIB EXC/OSTEOT AFTER EPIPHYSL,,,21,,RBRVS,14.03 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27465,CPT,OSTEOPLASTY FEMUR SHORTENING EXCLUDING 64876,,,21,,RBRVS,18.60 ,13.39 ,13.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27466,CPT,OSTEOPLASTY FEMUR LENGTHENING,,,21,,RBRVS,17.28 ,13.29 ,13.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27468,CPT,OSTPL FEMUR CMBN LNGTH&SHRT W/FEMORAL SGM TRNSFR,,,21,,RBRVS,19.97 ,12.29 ,12.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27470,CPT,RPR NON/MAL FEMUR DSTL H/N W/O GRF,,,21,,RBRVS,17.14 ,13.33 ,13.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27472,CPT,RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG BONE,,,21,,RBRVS,18.72 ,13.95 ,13.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27475,CPT,ARREST EPIPHYSEAL DISTAL FEMUR,,,21,,RBRVS,8.93 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27477,CPT,ARREST EPIPHYSEAL TIBIA & FIBULA PROXIMAL,,,21,,RBRVS,10.14 ,8.85 ,8.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27479,CPT,ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB,,,21,,RBRVS,13.16 ,7.73 ,7.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27485,CPT,ARRST HEMIEPIPHYSL DSTL FEMUR/PROX TIBIA/FIBULA,,,21,,RBRVS,9.13 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27486,CPT,REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT,,,21,,RBRVS,21.12 ,15.30 ,15.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27487,CPT,REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE,,,21,,RBRVS,27.11 ,18.31 ,18.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27488,CPT,RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER,,,21,,RBRVS,17.60 ,13.52 ,13.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27495,CPT,PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR,,,21,,RBRVS,16.54 ,12.63 ,12.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27496,CPT,DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT,,,21,,RBRVS,6.78 ,7.37 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27497,CPT,DCMPRN FASCT THIGH&/KNEE DBRDMT MUSCLE&/NERVE,,,21,,RBRVS,7.79 ,7.35 ,7.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27498,CPT,DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS,,,21,,RBRVS,8.66 ,8.11 ,8.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27499,CPT,DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE,,,21,,RBRVS,9.43 ,8.75 ,8.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27500,CPT,CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION,,,21,,RBRVS,6.30 ,6.23 ,7.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27501,CPT,CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ,,,21,,RBRVS,6.45 ,6.57 ,6.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27502,CPT,CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ,,,21,,RBRVS,11.36 ,8.49 ,8.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27503,CPT,CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ,,,21,,RBRVS,11.27 ,9.55 ,9.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27506,CPT,OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW,,,21,,RBRVS,19.65 ,14.98 ,14.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27507,CPT,OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE,,,21,,RBRVS,14.48 ,10.67 ,10.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27508,CPT,CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ,,,21,,RBRVS,6.20 ,6.76 ,7.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27509,CPT,PRQ SKELETAL FIXJ FEMORAL FX DISTAL END,,,21,,RBRVS,8.14 ,8.71 ,8.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27510,CPT,CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ,,,21,,RBRVS,9.80 ,7.95 ,7.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27511,CPT,OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/O XTN,,,21,,RBRVS,15.11 ,10.62 ,10.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27513,CPT,OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/XTN,,,21,,RBRVS,19.25 ,12.70 ,12.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27514,CPT,OPEN TX FEMORAL FRACTURE DISTAL MED/LAT CONDYLE,,,21,,RBRVS,14.60 ,10.36 ,10.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27516,CPT,CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,,,21,,RBRVS,5.59 ,6.93 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27517,CPT,CLTX DSTL FEM EPIPHYSL SEP W/MANJ W/WO SKIN/SKEL,,,21,,RBRVS,9.12 ,8.32 ,8.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27519,CPT,OPEN TX DISTAL FEMORAL EPIPHYSEAL SEPARATION,,,21,,RBRVS,13.25 ,9.72 ,9.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27520,CPT,CLOSED TX PATELLAR FRACTURE W/O MANIPULATION,,,21,,RBRVS,3.04 ,4.80 ,5.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27524,CPT,OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR,,,21,,RBRVS,10.37 ,9.19 ,9.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27530,CPT,CLTX TIBIAL FX PROXIMAL W/O MANIPULATION,,,21,,RBRVS,2.65 ,4.84 ,5.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27532,CPT,CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ,,,21,,RBRVS,7.55 ,7.48 ,8.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27535,CPT,OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR,,,21,,RBRVS,13.41 ,9.77 ,9.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27536,CPT,OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ,,,21,,RBRVS,17.39 ,13.43 ,13.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27538,CPT,CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN,,,21,,RBRVS,5.09 ,6.57 ,7.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27540,CPT,OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE,,,21,,RBRVS,11.30 ,9.76 ,9.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27550,CPT,CLOSED TX KNEE DISLOCATION W/O ANESTHESIA,,,21,,RBRVS,5.98 ,6.34 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27552,CPT,CLOSED TX KNEE DISLOCATION W/ANESTHESIA,,,21,,RBRVS,8.18 ,8.14 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27556,CPT,OPEN TX KNEE DISLOCATION W/O LIGAMENTOUS REPAIR,,,21,,RBRVS,13.00 ,9.61 ,9.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27557,CPT,OPEN TX KNEE DISLOCATION W/LIGAMENTOUS REPAIR,,,21,,RBRVS,15.90 ,11.03 ,11.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27558,CPT,OPEN TX KNEE DISLOCATION W/REPAIR/RECONSTRUCTION,,,21,,RBRVS,18.39 ,12.31 ,12.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27560,CPT,CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA,,,21,,RBRVS,3.99 ,4.85 ,5.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27562,CPT,CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA,,,21,,RBRVS,5.98 ,6.31 ,6.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27566,CPT,OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY,,,21,,RBRVS,12.71 ,10.41 ,10.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27570,CPT,MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA,,,21,,RBRVS,1.79 ,2.18 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27580,CPT,ARTHRODESIS KNEE ANY TECHNIQUE,,,21,,RBRVS,21.10 ,16.11 ,16.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27590,CPT,AMPUTATION THIGH THROUGH FEMUR ANY LEVEL,,,21,,RBRVS,13.47 ,6.88 ,6.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27591,CPT,AMP THI THRU FEMUR LVL IMMT FITG TQ W/1ST CST,,,21,,RBRVS,13.94 ,10.99 ,10.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27592,CPT,AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR,,,21,,RBRVS,10.98 ,6.45 ,6.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27594,CPT,AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION,,,21,,RBRVS,7.29 ,5.81 ,5.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27596,CPT,AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION,,,21,,RBRVS,11.29 ,7.23 ,7.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27598,CPT,DISARTICULATION KNEE,,,21,,RBRVS,11.22 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27599,CPT,UNLISTED PROCEDURE FEMUR/KNEE,,,21,,TotalUnits,,,,35.04 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27600,CPT,DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY,,,21,,RBRVS,6.03 ,4.61 ,4.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27601,CPT,DCMPRN FASCT LEG POST COMPARTMENT ONLY,,,21,,RBRVS,6.05 ,5.47 ,5.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27602,CPT,DCMPRN FASCT LEG ANT&/LAT&PST CMPRT,,,21,,RBRVS,7.82 ,4.72 ,4.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27603,CPT,INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA,,,21,,RBRVS,5.23 ,4.92 ,8.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27604,CPT,INCISION & DRAINAGE LEG/ANKLE INFECTED BURSA,,,21,,RBRVS,4.59 ,4.59 ,8.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27605,CPT,TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES,,,21,,RBRVS,2.92 ,2.09 ,6.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27606,CPT,TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES,,,21,,RBRVS,4.18 ,3.28 ,3.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27607,CPT,INCISION LEG/ANKLE,,,21,,RBRVS,8.62 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27610,CPT,ARTHROTOMY ANKLE W/EXPL DRAINAGE/REMOVAL FB,,,21,,RBRVS,9.13 ,7.95 ,7.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27612,CPT,ARTHRT PST CAPSUL RLS ANKLE W/WO ACHLL TDN LNGTH,,,21,,RBRVS,8.15 ,6.72 ,6.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27613,CPT,BIOPSY SOFT TISSUE LEG/ANKLE AREA SUPERFICIAL,,,21,,RBRVS,2.22 ,2.15 ,4.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27614,CPT,BIOPSY SOFT TISSUE LEG/ANKLE AREA DEEP,,,21,,RBRVS,5.80 ,4.91 ,9.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27615,CPT,RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE <5CM,,,21,,RBRVS,15.72 ,10.60 ,10.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27616,CPT,RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE 5 CM/>,,,21,,RBRVS,19.63 ,12.97 ,12.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27618,CPT,EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM,,,21,,RBRVS,3.96 ,4.09 ,8.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27619,CPT,EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <5CM,,,21,,RBRVS,6.91 ,5.48 ,5.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27620,CPT,ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB,,,21,,RBRVS,6.15 ,5.90 ,5.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27625,CPT,ARTHROTOMY W/SYNOVECTOMY ANKLE,,,21,,RBRVS,8.49 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27626,CPT,ARTHROTOMY W/SYNOVECTOMY ANKLE TENOSYNOVECTOMY,,,21,,RBRVS,9.10 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27630,CPT,EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK,,,21,,RBRVS,4.94 ,4.82 ,10.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27632,CPT,EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>,,,21,,RBRVS,5.91 ,4.80 ,4.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27634,CPT,EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5 CM/>,,,21,,RBRVS,10.13 ,7.62 ,7.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27635,CPT,EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA,,,21,,RBRVS,8.03 ,7.39 ,7.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27637,CPT,EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/AGRAFT,,,21,,RBRVS,10.31 ,9.33 ,9.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27638,CPT,EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/ALGRAFT,,,21,,RBRVS,10.99 ,8.98 ,8.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27640,CPT,PARTIAL EXCISION BONE TIBIA,,,21,,RBRVS,12.24 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27641,CPT,PARTIAL EXCISION BONE FIBULA,,,21,,RBRVS,9.84 ,7.75 ,7.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27645,CPT,RADICAL RESECTION OF TUMOR TIBIA,,,21,,RBRVS,27.21 ,18.49 ,18.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27646,CPT,RADICAL RESECTION TUMOR BONE FIBULA,,,21,,RBRVS,23.21 ,16.31 ,16.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27647,CPT,RADICAL RESECTION OF TUMOR TALUS OR CALCANEUS,,,21,,RBRVS,20.26 ,7.79 ,7.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27648,CPT,INJECTION ANKLE ARTHROGRAPHY,,,21,,RBRVS,0.96 ,0.43 ,3.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27650,CPT,REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON,,,21,,RBRVS,9.21 ,8.30 ,8.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27652,CPT,RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT,,,21,,RBRVS,10.78 ,7.46 ,7.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27654,CPT,REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT,,,21,,RBRVS,10.53 ,8.35 ,8.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27656,CPT,REPAIR FASCIAL DEFECT LEG,,,21,,RBRVS,4.71 ,5.70 ,12.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27658,CPT,REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH,,,21,,RBRVS,5.12 ,4.87 ,4.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27659,CPT,RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH,,,21,,RBRVS,7.10 ,5.78 ,5.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27664,CPT,RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH,,,21,,RBRVS,4.73 ,4.92 ,4.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27665,CPT,RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH,,,21,,RBRVS,5.57 ,5.44 ,5.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27675,CPT,RPR DISLOC PERONEAL TENDON W/O FIBULAR OSTEOTOMY,,,21,,RBRVS,7.35 ,5.69 ,5.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27676,CPT,REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT,,,21,,RBRVS,8.73 ,7.22 ,7.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27680,CPT,TENOLYSIS FLXR/XTNSR TENDON LEG&/ANKLE 1 EACH,,,21,,RBRVS,5.88 ,5.51 ,5.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27681,CPT,TNOLS FLXR/XTNSR TDN LEG&/ANKLE MLT TDN,,,21,,RBRVS,7.05 ,7.15 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27685,CPT,LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX,,,21,,RBRVS,6.69 ,5.77 ,11.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27686,CPT,LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA,,,21,,RBRVS,7.75 ,6.94 ,6.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27687,CPT,GASTROCNEMIUS RECESSION,,,21,,RBRVS,6.41 ,5.71 ,5.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27690,CPT,TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC,,,21,,RBRVS,9.17 ,7.69 ,7.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27691,CPT,TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP,,,21,,RBRVS,10.49 ,9.28 ,9.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27692,CPT,TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING EA TDN,,,21,,RBRVS,1.87 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27695,CPT,RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL,,,21,,RBRVS,6.70 ,5.99 ,5.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27696,CPT,RPR PRIM DISRUPTED LIGM ANKLE BTH COLTRL LIGMS,,,21,,RBRVS,8.58 ,6.31 ,6.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27698,CPT,REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL,,,21,,RBRVS,9.61 ,7.38 ,7.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27700,CPT,ARTHROPLASTY ANKLE,,,21,,RBRVS,9.66 ,6.32 ,6.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27702,CPT,ARTHROPLASTY ANKLE W/IMPLANT,,,21,,RBRVS,14.42 ,10.81 ,10.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27703,CPT,ARTHROPLASTY ANKLE REVISION TOTAL ANKLE,,,21,,RBRVS,16.94 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27704,CPT,REMOVAL ANKLE IMPLANT,,,21,,RBRVS,7.81 ,7.34 ,7.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27705,CPT,OSTEOTOMY TIBIA,,,21,,RBRVS,10.86 ,8.98 ,8.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27707,CPT,OSTEOTOMY FIBULA,,,21,,RBRVS,4.78 ,5.90 ,5.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27709,CPT,OSTEOTOMY TIBIA & FIBULA,,,21,,RBRVS,17.48 ,12.82 ,12.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27712,CPT,OSTEOT MLT W/RELIGNMT IMED ROD,,,21,,RBRVS,15.87 ,12.72 ,12.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27715,CPT,OSTEOPLASTY TIBIA & FIBULA LENGTHENING/SHORTENIN,,,21,,RBRVS,15.50 ,12.18 ,12.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27720,CPT,REPAIR NONUNION/MALUNION TIBIA W/O GRAFT,,,21,,RBRVS,12.36 ,10.40 ,10.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27722,CPT,REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT,,,21,,RBRVS,12.45 ,10.36 ,10.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27724,CPT,RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT,,,21,,RBRVS,19.31 ,13.35 ,13.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27725,CPT,RPR NON/MAL TIBIA SYNOSTOSIS W/FIBULA ANY METH,,,21,,RBRVS,17.41 ,13.95 ,13.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27726,CPT,REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION,,,21,,RBRVS,14.34 ,10.71 ,10.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27727,CPT,REPAIR CONGENITAL PSEUDARTHROSIS TIBIA,,,21,,RBRVS,14.84 ,11.97 ,11.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27730,CPT,ARREST EPIPHYSEAL OPEN DISTAL TIBIA,,,21,,RBRVS,7.70 ,7.17 ,7.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27732,CPT,ARREST EPIPHYSEAL OPEN DISTAL FIBULA,,,21,,RBRVS,5.46 ,5.25 ,5.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27734,CPT,ARREST EPIPHYSEAL OPEN DISTAL TIBIA&FIBULA,,,21,,RBRVS,8.83 ,8.21 ,8.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27740,CPT,ARREST EPIPHYSEAL ANY METHOD TIBIA & FIBULA,,,21,,RBRVS,9.61 ,8.77 ,8.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27742,CPT,ARRST EPIPHYSL ANY METH TIBFIB&DSTL FEMUR,,,21,,RBRVS,10.63 ,9.89 ,9.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27745,CPT,PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA,,,21,,RBRVS,10.49 ,9.17 ,9.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27750,CPT,CLTX TIBIAL SHAFT FX W/O MANIPULATION,,,21,,RBRVS,3.37 ,5.07 ,5.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27752,CPT,CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ,,,21,,RBRVS,6.27 ,6.71 ,7.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27756,CPT,PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE,,,21,,RBRVS,7.45 ,7.56 ,7.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27758,CPT,OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE,,,21,,RBRVS,12.54 ,10.59 ,10.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27759,CPT,TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA,,,21,,RBRVS,14.45 ,11.42 ,11.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27760,CPT,CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION,,,21,,RBRVS,3.21 ,4.93 ,5.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27762,CPT,CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ,,,21,,RBRVS,5.47 ,5.97 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27766,CPT,OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE,,,21,,RBRVS,7.89 ,8.11 ,8.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27767,CPT,CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ,,,21,,RBRVS,2.64 ,4.95 ,4.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27768,CPT,CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,,,21,,RBRVS,5.14 ,6.42 ,6.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27769,CPT,OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE,,,21,,RBRVS,10.14 ,8.83 ,8.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27780,CPT,CLTX PROX FIBULA/SHFT FX W/O MANJ,,,21,,RBRVS,2.83 ,4.61 ,5.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27781,CPT,CLTX PROX FIBULA/SHFT FX W/MANJ,,,21,,RBRVS,4.59 ,5.74 ,6.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27784,CPT,OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE,,,21,,RBRVS,9.67 ,9.01 ,9.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27786,CPT,CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ,,,21,,RBRVS,3.02 ,4.62 ,5.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27788,CPT,CLTX DSTL FIBULAR FX LAT MALLS W/MANJ,,,21,,RBRVS,4.64 ,5.53 ,6.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27792,CPT,OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS,,,21,,RBRVS,8.75 ,8.33 ,8.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27808,CPT,CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ,,,21,,RBRVS,3.03 ,4.99 ,5.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27810,CPT,CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ,,,21,,RBRVS,5.32 ,5.86 ,7.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27814,CPT,OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,,,21,,RBRVS,10.62 ,9.52 ,9.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27816,CPT,CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION,,,21,,RBRVS,3.07 ,4.59 ,5.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27818,CPT,CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION,,,21,,RBRVS,5.69 ,5.74 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27822,CPT,OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP,,,21,,RBRVS,11.21 ,10.80 ,10.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27823,CPT,OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP,,,21,,RBRVS,13.16 ,11.76 ,11.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27824,CPT,CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ,,,21,,RBRVS,3.31 ,4.79 ,5.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27825,CPT,CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ,,,21,,RBRVS,6.69 ,6.21 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27826,CPT,OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA,,,21,,RBRVS,11.10 ,10.69 ,10.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27827,CPT,OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY,,,21,,RBRVS,14.79 ,13.40 ,13.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27828,CPT,OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA,,,21,,RBRVS,18.43 ,15.24 ,15.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27829,CPT,OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION,,,21,,RBRVS,8.80 ,9.17 ,9.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27830,CPT,CLTX PROX TIBFIB JT DISLC W/O ANES,,,21,,RBRVS,3.96 ,5.37 ,6.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27831,CPT,CLTX PROX TIBFIB JT DISLC REQ ANES,,,21,,RBRVS,4.73 ,5.53 ,5.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27832,CPT,OPEN TX PROX TIBFIB JOINT DISLOCATE EXC PROX FIB,,,21,,RBRVS,10.17 ,9.49 ,9.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27840,CPT,CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA,,,21,,RBRVS,4.77 ,5.00 ,5.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27842,CPT,CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ,,,21,,RBRVS,6.46 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27846,CPT,OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ,,,21,,RBRVS,10.28 ,8.71 ,8.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27848,CPT,OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ,,,21,,RBRVS,11.68 ,9.48 ,9.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27860,CPT,MANIPULATION ANKLE UNDER GENERAL ANESTHESIA,,,21,,RBRVS,2.39 ,2.24 ,2.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27870,CPT,ARTHRODESIS ANKLE OPEN,,,21,,RBRVS,15.41 ,11.54 ,11.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27871,CPT,ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL,,,21,,RBRVS,9.54 ,8.37 ,8.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27880,CPT,AMPUTATION LEG THROUGH TIBIA&FIBULA,,,21,,RBRVS,15.37 ,7.98 ,7.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27881,CPT,AMP LEG THRU TIBFIB W/IMMT FITG TQ W/1ST CST,,,21,,RBRVS,13.47 ,8.98 ,8.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27882,CPT,AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR,,,21,,RBRVS,9.79 ,5.57 ,5.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27884,CPT,AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV,,,21,,RBRVS,8.76 ,6.09 ,6.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27886,CPT,AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION,,,21,,RBRVS,10.02 ,6.95 ,6.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27888,CPT,AMP ANKLE-MALLI TIBFIB W/PLSTC CLSR&RESCJ NRV,,,21,,RBRVS,10.37 ,7.39 ,7.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 27889,CPT,ANKLE DISARTICULATION,,,21,,RBRVS,10.86 ,5.71 ,5.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27892,CPT,DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE,,,21,,RBRVS,7.94 ,6.46 ,6.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27893,CPT,DCMPRN FASCT LEG PST W/DBRDMT MUSC&/NRV,,,21,,RBRVS,7.90 ,7.83 ,7.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27894,CPT,DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS,,,21,,RBRVS,12.67 ,9.38 ,9.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 27899,CPT,UNLISTED PROCEDURE LEG/ANKLE,,,21,,TotalUnits,,,,17.08 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28001,CPT,INCISION&DRAINAGE BURSA FOOT,,,21,,RBRVS,2.78 ,1.87 ,4.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28002,CPT,I&D BELOW FASCIA FOOT 1 BURSAL SPACE,,,21,,RBRVS,5.34 ,3.32 ,6.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28003,CPT,I&D BELOW FASCIA FOOT MULTIPLE AREAS,,,21,,RBRVS,9.06 ,6.31 ,10.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28005,CPT,INCISION BONE CORTEX FOOT,,,21,,RBRVS,9.44 ,6.28 ,6.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28008,CPT,FASCIOTOMY FOOT&/TOE,,,21,,RBRVS,4.59 ,3.45 ,7.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28010,CPT,TENOTOMY PERCUTANEOUS TOE SINGLE TENDON,,,21,,RBRVS,2.97 ,2.79 ,3.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28011,CPT,TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDON,,,21,,RBRVS,4.28 ,3.58 ,4.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28020,CPT,ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT,,,21,,RBRVS,5.15 ,4.60 ,9.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28022,CPT,ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT,,,21,,RBRVS,4.81 ,4.05 ,8.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28024,CPT,ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT,,,21,,RBRVS,4.52 ,3.82 ,8.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28035,CPT,RELEASE TARSAL TUNNEL,,,21,,RBRVS,5.23 ,4.38 ,9.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28039,CPT,EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>,,,21,,RBRVS,5.42 ,4.04 ,8.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28041,CPT,EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>,,,21,,RBRVS,7.13 ,5.32 ,5.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28043,CPT,EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM,,,21,,RBRVS,3.96 ,3.24 ,7.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28045,CPT,EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM,,,21,,RBRVS,5.45 ,4.08 ,8.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28046,CPT,RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE <3CM,,,21,,RBRVS,12.38 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28047,CPT,RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE 3 CM/>,,,21,,RBRVS,17.45 ,10.64 ,10.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28050,CPT,ARTHRT W/BX INTERTARSAL/TARSOMETATARSAL JOINT,,,21,,RBRVS,4.39 ,3.35 ,7.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28052,CPT,ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT,,,21,,RBRVS,4.06 ,3.70 ,8.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28054,CPT,ARTHRTOMY W/BX INTERPHALANGEAL JOINT,,,21,,RBRVS,3.57 ,3.17 ,7.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28055,CPT,NEURECTOMY INTRINSIC MUSCULATURE OF FOOT,,,21,,RBRVS,6.29 ,4.01 ,4.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28060,CPT,FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,,,21,,RBRVS,5.40 ,4.33 ,9.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28062,CPT,FASCIOTOMY PLANTAR FASCIA RADICAL SPX,,,21,,RBRVS,6.69 ,4.46 ,9.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28070,CPT,SYNVCT INTERTARSAL/TARSOMETATARSAL JT EA SPX,,,21,,RBRVS,5.24 ,4.40 ,9.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28072,CPT,SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH,,,21,,RBRVS,4.72 ,4.26 ,9.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28080,CPT,EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH,,,21,,RBRVS,4.86 ,5.22 ,9.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28086,CPT,SYNOVECTOMY TENDON SHEATH FOOT FLEXOR,,,21,,RBRVS,4.92 ,4.78 ,10.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28088,CPT,SYNOVECTOMY TENDON SHEATH FOOT EXTENSOR,,,21,,RBRVS,3.98 ,3.70 ,8.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28090,CPT,EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT,,,21,,RBRVS,4.55 ,3.87 ,8.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28092,CPT,EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA,,,21,,RBRVS,3.78 ,3.59 ,8.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28100,CPT,EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS,,,21,,RBRVS,5.83 ,5.27 ,10.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28102,CPT,EXC/CURTG CST/B9 TUM TALUS/CLCNS W/ILIAC/AGRFT,,,21,,RBRVS,7.92 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28103,CPT,EXC/CURETTAGE CYST/TUMOR TALUS/CALCANEUS ALGRFT,,,21,,RBRVS,6.67 ,4.13 ,4.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28104,CPT,EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL,,,21,,RBRVS,5.26 ,4.32 ,9.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28106,CPT,EXC/CURTG CST/B9 TUM TARSAL/METAR W/ILIAC/AGRFT,,,21,,RBRVS,7.35 ,5.25 ,5.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28107,CPT,EXC/CURTG CST/B9 TUM TARSAL/METAR W/ALGRFT,,,21,,RBRVS,5.73 ,4.48 ,9.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28108,CPT,EXC/CURTG CST/B9 TUM PHALANGES FOOT,,,21,,RBRVS,4.30 ,3.62 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28110,CPT,OSTECTOMY PRTL 5TH METAR HEAD SPX,,,21,,RBRVS,4.22 ,3.71 ,8.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28111,CPT,OSTECTOMY COMPLETE 1ST METATARSAL HEAD,,,21,,RBRVS,5.15 ,3.69 ,8.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28112,CPT,OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4,,,21,,RBRVS,4.63 ,3.90 ,9.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28113,CPT,OSTECTOMY COMPLETE 5TH METATARSAL HEAD,,,21,,RBRVS,6.11 ,5.55 ,10.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28114,CPT,OSTC COMPL ALL METAR HEADS W/PRTL PROX PHALANGC,,,21,,RBRVS,12.00 ,10.52 ,17.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28116,CPT,OSTECTOMY TARSAL COALITION,,,21,,RBRVS,9.14 ,6.31 ,11.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28118,CPT,OSTECTOMY CALCANEUS,,,21,,RBRVS,6.13 ,5.02 ,10.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28119,CPT,OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS,,,21,,RBRVS,5.56 ,4.32 ,9.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28120,CPT,PARTIAL EXCISION BONE TALUS/CALCANEUS,,,21,,RBRVS,7.31 ,6.09 ,11.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28122,CPT,PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS,,,21,,RBRVS,6.76 ,5.23 ,9.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28124,CPT,PARTICAL EXCISION BONE PHALANX TOE,,,21,,RBRVS,5.00 ,4.10 ,8.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28126,CPT,RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH,,,21,,RBRVS,3.64 ,3.19 ,7.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28130,CPT,TALECTOMY ASTRAGALECTOMY,,,21,,RBRVS,9.50 ,7.64 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28140,CPT,METATARSECTOMY,,,21,,RBRVS,7.14 ,4.67 ,9.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28150,CPT,PHALANGECTOMY TOE EACH TOE,,,21,,RBRVS,4.23 ,3.46 ,7.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28153,CPT,RESECTION CONDYLE DISTAL END PHALANX EACH TOE,,,21,,RBRVS,3.80 ,3.45 ,7.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28160,CPT,HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXC TOE,,,21,,RBRVS,3.88 ,3.53 ,7.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28171,CPT,RAD RESCJ TUMOR TARSAL EXCEPT TALUS/CALCANEUS,,,21,,RBRVS,16.41 ,6.85 ,6.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28173,CPT,RADICAL RESECTION TUMOR METATARSAL,,,21,,RBRVS,14.16 ,6.62 ,6.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28175,CPT,RADICAL RESECTION TUMOR PHALANX OR TOE,,,21,,RBRVS,8.29 ,5.10 ,5.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28190,CPT,REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS,,,21,,RBRVS,2.01 ,1.66 ,5.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28192,CPT,REMOVAL FOREIGN BODY FOOT DEEP,,,21,,RBRVS,4.78 ,3.81 ,8.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28193,CPT,REMOVAL FOREIGN BODY FOOT COMPLICATED,,,21,,RBRVS,5.90 ,4.19 ,8.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28200,CPT,RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON,,,21,,RBRVS,4.74 ,4.02 ,8.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28202,CPT,RPR TENDON FLXR FOOT SEC W/FREE GRAFT EA TENDON,,,21,,RBRVS,7.07 ,4.59 ,9.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28208,CPT,REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,,,21,,RBRVS,4.51 ,3.98 ,8.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28210,CPT,RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON,,,21,,RBRVS,6.52 ,4.61 ,9.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28220,CPT,TENOLYSIS FLEXOR FOOT SINGLE TENDON,,,21,,RBRVS,4.67 ,3.62 ,7.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28222,CPT,TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS,,,21,,RBRVS,5.76 ,3.83 ,8.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28225,CPT,TENOLYSIS EXTENSOR FOOT SINGLE TENDON,,,21,,RBRVS,3.78 ,3.33 ,7.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28226,CPT,TENOLYSIS EXTENSOR FOOT MULTIPLE TENDON,,,21,,RBRVS,4.67 ,5.65 ,11.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28230,CPT,TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX,,,21,,RBRVS,4.36 ,3.41 ,7.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28232,CPT,TX OPEN TENDON FLEXOR TOE 1 TENDON SPX,,,21,,RBRVS,3.51 ,3.18 ,7.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28234,CPT,TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON,,,21,,RBRVS,3.54 ,3.72 ,7.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28238,CPT,RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR,,,21,,RBRVS,7.96 ,5.25 ,10.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28240,CPT,TENOTOMY LENGTHENING/RLS ABDUCTOR HALLUCIS MUSC,,,21,,RBRVS,4.48 ,3.48 ,7.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28250,CPT,DIVISION PLANTAR FASCIA & MUSCLE SPX,,,21,,RBRVS,6.06 ,4.87 ,9.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28260,CPT,CAPSULOTOMY MIDFOOT MEDIAL RELEASE ONLY SPX,,,21,,RBRVS,8.19 ,5.57 ,10.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28261,CPT,CAPSULOTOMY MIDFOOT W/TENDON LENGTHENING,,,21,,RBRVS,13.11 ,7.82 ,13.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28262,CPT,CAPSUL MIDFOOT W/PST TALOTIBL CAPSUL&TDN LNGTH,,,21,,RBRVS,17.21 ,13.38 ,21.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28264,CPT,CAPSULOTOMY MIDTARSAL,,,21,,RBRVS,10.65 ,9.19 ,16.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28270,CPT,CAPSUL MTTARPHLNGL JT W/WO TENORRHAPHY EA JT SPX,,,21,,RBRVS,4.93 ,4.20 ,8.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28272,CPT,CAPSULOTOMY IPHAL JOINT EACH JOINT SPX,,,21,,RBRVS,3.92 ,3.11 ,7.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28280,CPT,SYNDACTYLIZATION TOES,,,21,,RBRVS,5.33 ,4.20 ,9.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28285,CPT,CORRECTION HAMMERTOE,,,21,,RBRVS,5.62 ,4.72 ,9.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28286,CPT,CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE,,,21,,RBRVS,4.70 ,3.56 ,8.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28288,CPT,OSTC PRTL EXOSTC/CONDYLC METAR HEAD,,,21,,RBRVS,6.02 ,5.72 ,10.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28289,CPT,HALLUX RIGIDUS CORRECT W/CHEILECTOMY 1ST MP JT,,,21,,RBRVS,8.31 ,6.47 ,11.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28291,CPT,CORRJ HALUX RIGDUS W/IMPLT,,,21,,RBRVS,8.01 ,5.06 ,12.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28292,CPT,KELLER/MCBRIDE/MAYO PROCEDURE,,,21,,RBRVS,9.05 ,7.43 ,12.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28295,CPT,CORRECTION HALLUX VALGUS,,,21,,RBRVS,8.57 ,6.12 ,17.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28296,CPT,CORRJ HALLUX VALGUS W/WO SESMDC W/METAR OSTEOT,,,21,,RBRVS,8.35 ,5.91 ,11.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28297,CPT,CORRJ HALLUX VALGUS W/WO SESMDC LAPIDUS-TYP PX,,,21,,RBRVS,9.43 ,6.25 ,12.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28298,CPT,CORRJ HALLUX VALGUS W/WO SESMDC PHALANX OSTEOT,,,21,,RBRVS,8.13 ,5.58 ,11.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28299,CPT,CORRJ HALLUX VALGUS W/WO SESMDC 2 OSTEOT,,,21,,RBRVS,11.57 ,6.80 ,13.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28300,CPT,OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION,,,21,,RBRVS,9.73 ,7.54 ,7.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28302,CPT,OSTEOTOMY TALUS,,,21,,RBRVS,9.74 ,8.83 ,8.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28304,CPT,OSTEOTOMY TARSAL BONES OTH/THN CALCANEUS/TALUS,,,21,,RBRVS,9.41 ,6.79 ,13.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28305,CPT,OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT,,,21,,RBRVS,10.77 ,7.12 ,7.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28306,CPT,OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR,,,21,,RBRVS,6.00 ,4.87 ,10.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28307,CPT,OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST TOE,,,21,,RBRVS,6.50 ,5.55 ,12.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28308,CPT,OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA,,,21,,RBRVS,5.48 ,4.79 ,10.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28309,CPT,OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT,,,21,,RBRVS,14.16 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28310,CPT,OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE,,,21,,RBRVS,5.57 ,4.19 ,9.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28312,CPT,OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE,,,21,,RBRVS,4.69 ,4.02 ,9.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28313,CPT,RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY,,,21,,RBRVS,5.15 ,4.54 ,9.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28315,CPT,SESAMOIDECTOMY FIRST TOE SPX,,,21,,RBRVS,5.00 ,3.89 ,8.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28320,CPT,REPAIR NONUNION/MALUNION TARSAL BONES,,,21,,RBRVS,9.37 ,6.91 ,6.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28322,CPT,RPR NON/MALUNION METARSAL W/WO BONE GRAFT,,,21,,RBRVS,8.53 ,6.87 ,13.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28340,CPT,RCNSTJ TOE MACRODACTYLY SOFT TISSUE RESECTION,,,21,,RBRVS,7.15 ,4.24 ,9.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28341,CPT,RCNSTJ TOE MACRODACTYLY REQUIRING BONE RESECTION,,,21,,RBRVS,8.72 ,4.83 ,10.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28344,CPT,RECONSTRUCTION TOE POLYDACTYLY,,,21,,RBRVS,4.40 ,3.93 ,8.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28345,CPT,RCNSTJ TOE SYNDACTYLY W/WO SKIN GRAFT EACH WEB,,,21,,RBRVS,6.09 ,3.98 ,8.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28360,CPT,RECONSTRUCTION CLEFT FOOT,,,21,,RBRVS,14.92 ,9.55 ,9.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28400,CPT,CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION,,,21,,RBRVS,2.31 ,3.85 ,4.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28405,CPT,CLOSED TX CALCANEAL FRACTURE W/MANIPULATION,,,21,,RBRVS,4.74 ,4.83 ,5.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28406,CPT,PRQ SKELETAL FIXJ CALCANEAL FRACTURE W/MANJ,,,21,,RBRVS,6.56 ,7.30 ,7.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28415,CPT,OPEN TREATMENT CALCANEAL FRACTURE,,,21,,RBRVS,16.19 ,12.90 ,12.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28420,CPT,OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT,,,21,,RBRVS,17.52 ,15.01 ,15.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28430,CPT,CLOSED TX TALUS FRACTURE W/O MANIPULATION,,,21,,RBRVS,2.22 ,3.47 ,4.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28435,CPT,CLOSED TX TALUS FRACTURE W/MANIPULATION,,,21,,RBRVS,3.54 ,4.11 ,5.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28436,CPT,PRQ SKELETAL FIXATION TALUS FRACTURE W/MANJ,,,21,,RBRVS,4.90 ,6.99 ,6.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28445,CPT,OPEN TREATMENT TALUS FRACTURE,,,21,,RBRVS,15.76 ,12.11 ,12.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28446,CPT,OPEN OSTEOCHONDRAL AUTOGRAFT TALUS,,,21,,RBRVS,17.71 ,13.65 ,13.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28450,CPT,TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ,,,21,,RBRVS,2.03 ,3.20 ,3.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28455,CPT,TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ,,,21,,RBRVS,3.24 ,3.86 ,4.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28456,CPT,PRQ SKEL FIXJ TARSL FX XCP TALUS&CALCNS W/MANJ,,,21,,RBRVS,2.86 ,5.71 ,5.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28465,CPT,OPEN TX TARSAL FRACTURE XCP TALUS & CALCANEUS EA,,,21,,RBRVS,8.80 ,7.81 ,7.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28470,CPT,CLOSED TX METATARSAL FRACTURE W/O MANIPULATION,,,21,,RBRVS,2.03 ,3.54 ,3.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28475,CPT,CLTX METAR FX W/MANJ,,,21,,RBRVS,3.01 ,3.16 ,3.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28476,CPT,PRQ SKEL FIXJ METAR FX W/MANJ,,,21,,RBRVS,3.60 ,5.92 ,5.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28485,CPT,OPEN TREATMENT METATARSAL FRACTURE EACH,,,21,,RBRVS,7.44 ,6.75 ,6.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28490,CPT,CLTX FX GRT TOE PHLX/PHLG W/O MANJ,,,21,,RBRVS,1.17 ,2.27 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28495,CPT,CLTX FX GRT TOE PHLX/PHLG W/MANJ,,,21,,RBRVS,1.68 ,2.43 ,3.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28496,CPT,PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ,,,21,,RBRVS,2.48 ,3.88 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28505,CPT,OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES,,,21,,RBRVS,7.44 ,6.02 ,10.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28510,CPT,CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ,,,21,,RBRVS,1.17 ,2.15 ,2.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28515,CPT,CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ,,,21,,RBRVS,1.56 ,2.37 ,2.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28525,CPT,OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE,,,21,,RBRVS,5.62 ,5.21 ,10.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28530,CPT,CLOSED TREATMENT SESAMOID FRACTURE,,,21,,RBRVS,1.11 ,1.72 ,2.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28531,CPT,OPEN TX SESAMOID FRACTURE W/WO INTERNAL FIXATION,,,21,,RBRVS,2.57 ,2.53 ,7.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28540,CPT,CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES,,,21,,RBRVS,2.19 ,2.95 ,3.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28545,CPT,CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES,,,21,,RBRVS,2.60 ,4.33 ,5.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28546,CPT,PRQ SKEL FIXJ TARSL DISLC XCP TALOTARSAL W/MANJ,,,21,,RBRVS,3.40 ,5.42 ,12.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28555,CPT,OPEN TREATMENT TARSAL BONE DISLOCATION,,,21,,RBRVS,9.65 ,8.09 ,14.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28570,CPT,CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,,,21,,RBRVS,1.76 ,3.31 ,4.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28575,CPT,CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES,,,21,,RBRVS,3.49 ,5.27 ,6.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28576,CPT,PRQ SKEL FIXJ TALOTARSAL JT DISLC W/MANJ,,,21,,RBRVS,4.60 ,5.69 ,5.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28585,CPT,OPEN TREATMENT TALOTARSAL JOINT DISLOCATION,,,21,,RBRVS,11.13 ,7.09 ,12.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28600,CPT,CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES,,,21,,RBRVS,2.02 ,3.09 ,3.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28605,CPT,CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES,,,21,,RBRVS,2.89 ,4.93 ,5.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28606,CPT,PRQ SKEL FIXJ TARS JT DISLC W/MANJ,,,21,,RBRVS,5.09 ,5.42 ,5.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28615,CPT,OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION,,,21,,RBRVS,10.70 ,10.25 ,10.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28630,CPT,CLTX METATARSOPHLNGL JT DISLC W/O ANES,,,21,,RBRVS,1.75 ,1.18 ,2.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28635,CPT,CLTX METATARSOPHLNGL JT DISLC REQ ANES,,,21,,RBRVS,1.96 ,1.61 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28636,CPT,PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ,,,21,,RBRVS,2.77 ,2.26 ,5.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28645,CPT,OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION,,,21,,RBRVS,7.44 ,5.72 ,10.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28660,CPT,CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES,,,21,,RBRVS,1.28 ,1.10 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28665,CPT,CLTX INTERPHALANGEAL JOINT DISLOCATION REQ ANES,,,21,,RBRVS,1.97 ,1.59 ,2.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28666,CPT,PRQ SKEL FIXJ INTERPHALANGEAL JOINT DISLC W/MANJ,,,21,,RBRVS,2.66 ,2.35 ,2.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28675,CPT,OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION,,,21,,RBRVS,5.62 ,5.51 ,10.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28705,CPT,ARTHRODESIS PANTALAR,,,21,,RBRVS,20.33 ,12.67 ,12.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28715,CPT,ARTHRODESIS TRIPLE,,,21,,RBRVS,13.42 ,11.31 ,11.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28725,CPT,ARTHRODESIS SUBTALAR,,,21,,RBRVS,11.22 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28730,CPT,ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS,,,21,,RBRVS,10.70 ,8.78 ,8.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28735,CPT,ARTHRD MIDTARSL/TARS MLT/TRANSVRS W/OSTEOT,,,21,,RBRVS,12.23 ,8.59 ,8.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28737,CPT,ARTHRD W/TDN LNGTH&ADVMNT TARSL NVCLR-CUNEIFOR,,,21,,RBRVS,11.03 ,7.51 ,7.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28740,CPT,ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT,,,21,,RBRVS,9.29 ,7.40 ,13.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28750,CPT,ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT,,,21,,RBRVS,8.57 ,7.28 ,13.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28755,CPT,ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT,,,21,,RBRVS,4.88 ,4.12 ,9.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28760,CPT,ARTHRD W/XTNSR HALLUCIS LONGUS TR 1ST METAR NCK,,,21,,RBRVS,9.14 ,6.51 ,12.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28800,CPT,AMPUTATION FOOT MIDTARSAL,,,21,,RBRVS,8.79 ,5.71 ,5.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 28805,CPT,AMPUTATION FOOT TRANSMETARSAL,,,21,,RBRVS,12.71 ,6.64 ,6.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28810,CPT,AMPUTATION METATARSAL W/TOE SINGLE,,,21,,RBRVS,6.64 ,4.75 ,4.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28820,CPT,AMPUTATION TOE METATARSOPHALANGEAL JOINT,,,21,,RBRVS,5.82 ,4.85 ,9.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28825,CPT,AMPUTATION TOE INTERPHALANGEAL JOINT,,,21,,RBRVS,5.37 ,4.66 ,9.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28890,CPT,ESWT HI NRG PHYS/QHP W/US GDN INVG PLNTAR FASCIA,,,21,,RBRVS,3.45 ,2.69 ,5.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 28899,CPT,UNLISTED PROCEDURE FOOT/TOES,,,21,,TotalUnits,,,,11.03 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29000,CPT,APPLICATION HALO TYPE BODY CAST,,,21,,RBRVS,2.25 ,2.07 ,5.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29010,CPT,APPLICATION RISSER JACKET LOCALIZER BODY ONLY,,,21,,RBRVS,2.06 ,1.83 ,4.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29015,CPT,APPLICATION RISSER JACKET LOCALIZER BODY W/HEAD,,,21,,RBRVS,2.41 ,2.34 ,5.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29035,CPT,APPLICATION BODY CAST SHOULDER HIPS,,,21,,RBRVS,1.77 ,1.44 ,3.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29040,CPT,APPLICATION BODY CAST SHOULDER HIPS HEAD MINERVA,,,21,,RBRVS,2.22 ,1.67 ,3.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29044,CPT,APPLICATION BODY CAST SHOULDER HIPS W/ONE THIGH,,,21,,RBRVS,2.12 ,1.97 ,5.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29046,CPT,APPLICATION BODY CAST SHOULDER HIPS BOTH THIGHS,,,21,,RBRVS,2.41 ,1.81 ,4.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29049,CPT,APPLICATION CAST FIGURE-OF-8,,,21,,RBRVS,0.89 ,0.75 ,1.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29055,CPT,APPLICATION CAST SHOULDER SPICA,,,21,,RBRVS,1.78 ,1.85 ,4.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29058,CPT,APPLICATION CAST PLASTER VELPEAU,,,21,,RBRVS,1.31 ,1.13 ,1.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29065,CPT,APPLICATION CAST SHOULDER HAND LONG ARM,,,21,,RBRVS,0.87 ,0.94 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29075,CPT,APPLICATION CAST ELBOW FINGER SHORT ARM,,,21,,RBRVS,0.77 ,0.88 ,1.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29085,CPT,APPLICATION CAST HAND & LOWER FOREARM GAUNTLET,,,21,,RBRVS,0.87 ,0.92 ,1.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29086,CPT,APPLICATION CAST FINGER,,,21,,RBRVS,0.62 ,0.77 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29105,CPT,APPLICATION LONG ARM SPLINT SHOULDER HAND,,,21,,RBRVS,0.87 ,0.70 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29125,CPT,APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC,,,21,,RBRVS,0.50 ,0.56 ,1.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29126,CPT,APPLICATION SHORT ARM SPLINT DYNAMIC,,,21,,RBRVS,0.68 ,0.62 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29130,CPT,APPLICATION FINGER SPLINT STATIC,,,21,,RBRVS,0.50 ,0.25 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29131,CPT,APPLICATION FINGER SPLINT DYNAMIC,,,21,,RBRVS,0.55 ,0.32 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29200,CPT,STRAPPING THORAX,,,21,,RBRVS,0.39 ,0.11 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29240,CPT,STRAPPING SHOULDER,,,21,,RBRVS,0.39 ,0.12 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29260,CPT,STRAPPING ELBOW/WRIST,,,21,,RBRVS,0.39 ,0.13 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29280,CPT,STRAPPING HAND/FINGER,,,21,,RBRVS,0.39 ,0.15 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29305,CPT,APPLICATION HIP SPICA CAST 1 LEG,,,21,,RBRVS,2.03 ,2.15 ,4.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29325,CPT,APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS,,,21,,RBRVS,2.32 ,2.32 ,4.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29345,CPT,APPLICATION LONG LEG CAST THIGH-TOE,,,21,,RBRVS,1.40 ,1.24 ,2.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29355,CPT,APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE,,,21,,RBRVS,1.53 ,1.25 ,2.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29358,CPT,APPLICATION LONG LEG CAST BRACE,,,21,,RBRVS,1.43 ,1.28 ,2.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29365,CPT,APPLICATION CYLINDER CAST THIGH ANKLE,,,21,,RBRVS,1.18 ,1.12 ,2.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29405,CPT,APPLICATION SHORT LEG CAST BELOW KNEE-TOE,,,21,,RBRVS,0.80 ,0.80 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29425,CPT,APPLICATION SHORT LEG CAST WALKING/AMBULATORY,,,21,,RBRVS,0.80 ,0.72 ,1.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29435,CPT,APPLICATION PATELLAR TENDON BEARING CAST,,,21,,RBRVS,1.18 ,1.00 ,1.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29440,CPT,ADDING WALKER PREVIOUSLY APPLIED CAST,,,21,,RBRVS,0.57 ,0.22 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29445,CPT,APPLICATION RIGID TOTAL CONTACT LEG CAST,,,21,,RBRVS,1.78 ,1.01 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29450,CPT,APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG,,,21,,RBRVS,2.08 ,0.96 ,1.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29505,CPT,APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES,,,21,,RBRVS,0.69 ,0.64 ,1.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29515,CPT,APPLICATION SHORT LEG SPLINT CALF FOOT,,,21,,RBRVS,0.73 ,0.60 ,1.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29520,CPT,STRAPPING HIP,,,21,,RBRVS,0.39 ,0.12 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29530,CPT,STRAPPING KNEE,,,21,,RBRVS,0.39 ,0.11 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29540,CPT,STRAPPING ANKLE &/FOOT,,,21,,RBRVS,0.39 ,0.10 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29550,CPT,STRAPPING TOES,,,21,,RBRVS,0.25 ,0.06 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29580,CPT,STRAPPING UNNA BOOT,,,21,,RBRVS,0.55 ,0.40 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29581,CPT,APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT,,,21,,RBRVS,0.25 ,0.10 ,1.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29582,CPT,APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE,,,21,,RBRVS,0.35 ,0.09 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29583,CPT,APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM,,,21,,RBRVS,0.25 ,0.06 ,0.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29584,CPT,APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING,,,21,,RBRVS,0.35 ,0.09 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29700,CPT,REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST,,,21,,RBRVS,0.57 ,0.30 ,1.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29705,CPT,REMOVAL/BIVALVING FULL ARM/FULL LEG CAST,,,21,,RBRVS,0.76 ,0.47 ,1.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29710,CPT,RMVL/BIVALV SHO/HIP SPICA MINERVA/RISSER JACKET,,,21,,RBRVS,1.34 ,0.79 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29720,CPT,REPAIR SPICA BODY CAST/JACKET,,,21,,RBRVS,0.68 ,0.46 ,1.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29730,CPT,WINDOWING CAST,,,21,,RBRVS,0.75 ,0.43 ,0.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29740,CPT,WEDGING CAST EXCEPT CLUBFOOT CASTS,,,21,,RBRVS,1.12 ,0.68 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29750,CPT,WEDGING CLUBFOOT CAST,,,21,,RBRVS,1.26 ,0.52 ,1.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29799,CPT,UNLISTED PROCEDURE CASTING/STRAPPING,,,21,,TotalUnits,,,,1.39 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29800,CPT,ARTHRS TEMPOROMANDIBULR JT DX W/WO SYNVAL BX SPX,,,21,,RBRVS,6.84 ,6.65 ,6.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29804,CPT,ARTHROSCOPY TEMPOROMANDIBULAR JOINT SURGICAL,,,21,,RBRVS,8.87 ,8.19 ,8.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29805,CPT,ARTHROSCOPY SHOULDER DX W/WO SYNOVIAL BIOPSY SPX,,,21,,RBRVS,6.03 ,6.32 ,6.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29806,CPT,ARTHROSCOPY SHOULDER SURGICAL CAPSULORRHAPHY,,,21,,RBRVS,15.14 ,12.37 ,12.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29807,CPT,ARTHROSCOPY SHOULDER SURGICAL REPAIR SLAP LESION,,,21,,RBRVS,14.67 ,12.18 ,12.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29819,CPT,ARTHROSCOPY SHOULDER SURGICAL REMOVAL LOOSE/FB,,,21,,RBRVS,7.79 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29820,CPT,ARTHROSCOPY SHOULDER SURG SYNOVECTOMY PARTIAL,,,21,,RBRVS,7.21 ,6.88 ,6.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29821,CPT,ARTHROSCOPY SHOULDER SURG SYNOVECTOMY COMPLETE,,,21,,RBRVS,7.89 ,7.52 ,7.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29822,CPT,ARTHROSCOPY SHOULDER SURG DEBRIDEMENT LIMITED,,,21,,RBRVS,7.60 ,7.41 ,7.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29823,CPT,ARTHROSCOPY SHOULDER SURG DEBRIDEMENT EXTENSIVE,,,21,,RBRVS,8.36 ,8.02 ,8.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29824,CPT,ARTHROSCOPY SHOULDER DISTAL CLAVICULECTOMY,,,21,,RBRVS,8.98 ,8.69 ,8.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29825,CPT,ARTHROSCOPY SHOULDER AHESIOLYSIS W/WO MANIPJ,,,21,,RBRVS,7.79 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29826,CPT,ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RELEASE,,,21,,RBRVS,3.00 ,1.50 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29827,CPT,ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR,,,21,,RBRVS,15.59 ,12.22 ,12.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29828,CPT,ARTHROSCOPY SHOULDER BICEPS TENODESIS,,,21,,RBRVS,13.16 ,10.81 ,10.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29830,CPT,ARTHROSCOPY ELBOW DIAG W/WO SYNOVIAL BIOPSY SPX,,,21,,RBRVS,5.88 ,6.06 ,6.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29834,CPT,ARTHROSCOPY ELBOW SURGICAL W/REMOVAL LOOSE/FB,,,21,,RBRVS,6.42 ,6.45 ,6.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29835,CPT,ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY PARTIAL,,,21,,RBRVS,6.62 ,6.57 ,6.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29836,CPT,ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY COMPLETE,,,21,,RBRVS,7.72 ,7.34 ,7.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29837,CPT,ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT LIMITED,,,21,,RBRVS,7.01 ,6.78 ,6.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29838,CPT,ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT EXTENSIVE,,,21,,RBRVS,7.88 ,7.53 ,7.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29840,CPT,ARTHROSCOPY WRIST DIAG W/WO SYNOVIAL BIOPSY SPX,,,21,,RBRVS,5.68 ,6.16 ,6.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29843,CPT,ARTHROSCOPY WRIST INFECTION LAVAGE&DRAINAGE,,,21,,RBRVS,6.15 ,6.51 ,6.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29844,CPT,ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY PARTIAL,,,21,,RBRVS,6.51 ,6.60 ,6.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29845,CPT,ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY COMPLETE,,,21,,RBRVS,7.69 ,7.54 ,7.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29846,CPT,ARTHRS WRST EXC&/RPR TRIANG FIBROCART&/JOINT,,,21,,RBRVS,6.89 ,6.82 ,6.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29847,CPT,ARTHROSCOPY WRIST SURG INT FIXJ FX/INSTABILITY,,,21,,RBRVS,7.22 ,6.93 ,6.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29848,CPT,NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM,,,21,,RBRVS,6.39 ,7.06 ,7.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29850,CPT,ARTHROSCOPY AID TX SPINE&/FX KNEE W/O FIXJ,,,21,,RBRVS,8.27 ,7.89 ,7.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29851,CPT,ARTHROSCOPY AID TX SPINE&/FX KNEE W/FIXJ,,,21,,RBRVS,13.26 ,9.88 ,9.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29855,CPT,ARTHRS AID TIBIAL FRACTURE PROXIMAL UNICONDYLAR,,,21,,RBRVS,10.76 ,9.63 ,9.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29856,CPT,ARTHRS AID TIBIAL FX PROX UNICONDYLAR BICONDYLAR,,,21,,RBRVS,14.28 ,11.51 ,11.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29860,CPT,ARTHROSCOPY HIP DIAGNOSTIC W/WO SYNOVIAL BYP SPX,,,21,,RBRVS,9.00 ,8.24 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29861,CPT,ARTHROSCOPY HIP SURGICAL W/REMOVAL LOOSE/FB,,,21,,RBRVS,10.10 ,8.78 ,8.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29862,CPT,ARTHRS HIP DEBRIDEMENT/SHAVING ARTICULAR CRTLG,,,21,,RBRVS,11.17 ,10.12 ,10.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29863,CPT,ARTHROSCOPY HIP SURGICAL W/SYNOVECTOMY,,,21,,RBRVS,11.17 ,10.10 ,10.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29866,CPT,ARTHROSCOPY KNEE OSTEOCHONDRAL AGRFT MOSAICPLAST,,,21,,RBRVS,14.67 ,12.43 ,12.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29867,CPT,ARTHROSCOPY KNEE OSTEOCHONDRAL ALLOGRAFT,,,21,,RBRVS,18.39 ,14.32 ,14.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29868,CPT,ARTHROSCOPY KNEE MENISCAL TRNSPLJ MED/LAT,,,21,,RBRVS,25.10 ,16.51 ,16.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29870,CPT,ARTHROSCOPY KNEE DIAGNOSTIC W/WO SYNOVIAL BX SPX,,,21,,RBRVS,5.19 ,5.62 ,10.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29871,CPT,ARTHROSCOPY KNEE INFECTION LAVAGE & DRAINAGE,,,21,,RBRVS,6.69 ,6.75 ,6.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29873,CPT,ARTHROSCOPY KNEE LATERAL RELEASE,,,21,,RBRVS,6.24 ,7.57 ,7.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29874,CPT,ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY,,,21,,RBRVS,7.19 ,6.86 ,6.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29875,CPT,ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX,,,21,,RBRVS,6.45 ,6.52 ,6.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29876,CPT,ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS,,,21,,RBRVS,8.87 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29877,CPT,ARTHRS KNEE DEBRIDEMENT/SHAVING ARTCLR CRTLG,,,21,,RBRVS,8.30 ,7.97 ,7.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29879,CPT,ARTHRS KNEE ABRASION ARTHRP/MLT DRLG/MICROFX,,,21,,RBRVS,8.99 ,8.30 ,8.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29880,CPT,ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING,,,21,,RBRVS,7.39 ,7.34 ,7.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29881,CPT,ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG,,,21,,RBRVS,7.03 ,7.17 ,7.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29882,CPT,ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL,,,21,,RBRVS,9.60 ,8.61 ,8.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29883,CPT,ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL,,,21,,RBRVS,11.77 ,10.12 ,10.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29884,CPT,ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX,,,21,,RBRVS,8.28 ,7.93 ,7.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29885,CPT,ARTHRS KNEE DRILL OSTEOCHONDRITIS DISSECANS GRFG,,,21,,RBRVS,10.21 ,9.38 ,9.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29886,CPT,ARTHRS KNEE DRILLING OSTEOCHOND DISSECANS LESION,,,21,,RBRVS,8.49 ,8.11 ,8.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29887,CPT,ARTHRS KNEE DRLG OSTEOCHOND DISSECANS INT FIXJ,,,21,,RBRVS,10.16 ,9.27 ,9.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29888,CPT,ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ,,,21,,RBRVS,14.30 ,11.30 ,11.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29889,CPT,ARTHRS AIDED PST CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ,,,21,,RBRVS,17.41 ,14.27 ,14.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29891,CPT,ARTHRS ANKLE EXC OSTCHNDRL DFCT W/DRLG DFCT,,,21,,RBRVS,9.67 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29892,CPT,ARTHRS AID RPR LES/TALAR DOME FX/TIBL PLAFOND FX,,,21,,RBRVS,10.27 ,5.75 ,5.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29893,CPT,ENDOSCOPIC PLANTAR FASCIOTOMY,,,21,,RBRVS,6.32 ,5.51 ,10.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29894,CPT,ARTHROSCOPY ANKLE W/REMOVAL LOOSE/FOREIGN BODY,,,21,,RBRVS,7.35 ,5.94 ,5.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29895,CPT,ARTHROSCOPY ANKLE SURGICAL SYNOVECTOMY PARTIAL,,,21,,RBRVS,7.13 ,5.59 ,5.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29897,CPT,ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT LIMITED,,,21,,RBRVS,7.32 ,6.10 ,6.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29898,CPT,ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE,,,21,,RBRVS,8.49 ,6.55 ,6.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29899,CPT,ARTHROSCOPY ANKLE SURGICAL W/ANKLE ARTHRODESIS,,,21,,RBRVS,15.41 ,11.63 ,11.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29900,CPT,ARTHROSCOPY METACARPOPHALANGEAL SYNOVIAL BIOPSY,,,21,,RBRVS,5.88 ,6.61 ,6.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29901,CPT,ARTHRS METACARPOPHALANGEAL JOINT DEBRIDEMENT,,,21,,RBRVS,6.59 ,7.38 ,7.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29902,CPT,ARTHRS MTCARPHLNGL JT W/RDCTJ UR COLTRL LIGM,,,21,,RBRVS,7.16 ,7.81 ,7.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29904,CPT,ARTHRS SUBTALAR JOINT REMOVE LOOSE/FOREIGN BODY,,,21,,RBRVS,8.65 ,7.95 ,7.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29905,CPT,ARTHROSCOPY SUBTALAR JOINT WITH SYNOVECTOMY,,,21,,RBRVS,9.18 ,8.70 ,8.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29906,CPT,ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT,,,21,,RBRVS,9.65 ,9.15 ,9.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29907,CPT,ARTHROSCOPY SUBTALAR JOINT SUBTALAR ARTHRODESIS,,,21,,RBRVS,12.18 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29914,CPT,ARTHROSCOPY HIP W/FEMOROPLASTY,,,21,,RBRVS,14.67 ,11.44 ,11.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29915,CPT,ARTHROSCOPY HIP W/ACETABULOPLASTY,,,21,,RBRVS,15.00 ,11.61 ,11.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29916,CPT,ARTHROSCOPY HIP W/LABRAL REPAIR,,,21,,RBRVS,15.00 ,11.65 ,11.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 29999,CPT,UNLISTED PROCEDURE ARTHROSCOPY,,,21,,TotalUnits,,,,15.01 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30000,CPT,DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH,,,21,,RBRVS,1.48 ,1.70 ,4.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30020,CPT,DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM,,,21,,RBRVS,1.48 ,1.72 ,4.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30100,CPT,BIOPSY INTRANASAL,,,21,,RBRVS,0.94 ,0.91 ,2.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30110,CPT,EXCISION NASAL POLYP SIMPLE,,,21,,RBRVS,1.68 ,1.82 ,4.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30115,CPT,EXCISION NASAL POLYP EXTENSIVE,,,21,,RBRVS,4.44 ,7.31 ,7.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30117,CPT,EXCISION/DESTRUCTION INTRANASAL LESION INT APPR,,,21,,RBRVS,3.26 ,6.04 ,21.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30118,CPT,EXCISION/DESTRUCTION INTRANASAL LESION XTRNL,,,21,,RBRVS,9.92 ,10.66 ,10.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30120,CPT,EXCISION/SURGICAL PLANING SKIN NOSE RHINOPHYMA,,,21,,RBRVS,5.39 ,6.33 ,8.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30124,CPT,EXCISION DERMOID CYST NOSE SIMPLE SUBCUTANEOUS,,,21,,RBRVS,3.20 ,4.53 ,4.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30125,CPT,EXC DERMOID CYST NOSE COMPLEX UNDER BONE/CRTLG,,,21,,RBRVS,7.30 ,9.04 ,9.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30130,CPT,EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE,,,21,,RBRVS,3.47 ,6.95 ,6.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30140,CPT,SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL,,,21,,RBRVS,3.57 ,8.53 ,8.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30150,CPT,RHINECTOMY PARTIAL,,,21,,RBRVS,9.55 ,11.02 ,11.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30160,CPT,RHINECTOMY TOTAL,,,21,,RBRVS,9.99 ,10.64 ,10.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30200,CPT,INJECTION TURBINATE THERAPEUTIC,,,21,,RBRVS,0.78 ,0.82 ,2.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30210,CPT,DISPLACEMENT THERAPY PROETZ TYPE,,,21,,RBRVS,1.13 ,1.56 ,3.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30220,CPT,INSERTION NASAL SEPTAL PROSTHESIS BUTTON,,,21,,RBRVS,1.59 ,1.77 ,6.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30300,CPT,REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE,,,21,,RBRVS,1.09 ,1.80 ,4.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30310,CPT,REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES,,,21,,RBRVS,2.01 ,3.62 ,3.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30320,CPT,RMVL FOREIGN BODY INTRANASAL LATERAL RHINOTOMY,,,21,,RBRVS,4.64 ,7.40 ,7.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30400,CPT,RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI,,,21,,RBRVS,10.86 ,16.49 ,16.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30410,CPT,RHINP PRIM COMPLETE XTRNL PARTS,,,21,,RBRVS,14.00 ,17.84 ,17.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30420,CPT,RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR,,,21,,RBRVS,16.90 ,19.82 ,19.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30430,CPT,RHINOPLASTY SECONDARY MINOR REVISION,,,21,,RBRVS,8.24 ,17.88 ,17.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30435,CPT,RHINOPLASTY SECONDARY INTERMEDIATE REVISION,,,21,,RBRVS,12.73 ,17.22 ,17.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30450,CPT,RHINOPLASTY SECONDARY MAJOR REVISION,,,21,,RBRVS,19.66 ,20.35 ,20.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30460,CPT,RHINP DFRM W/COLUM LNGTH TIP ONLY,,,21,,RBRVS,10.32 ,8.72 ,8.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30462,CPT,RHINP DFRM COLUM LNGTH TIP SEPTUM OSTEOT,,,21,,RBRVS,20.28 ,20.87 ,20.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30465,CPT,REPAIR NASAL VESTIBULAR STENOSIS,,,21,,RBRVS,12.36 ,13.88 ,13.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30520,CPT,SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF,,,21,,RBRVS,7.01 ,9.83 ,9.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30540,CPT,REPAIR CHOANAL ATRESIA INTRANASAL,,,21,,RBRVS,7.92 ,10.77 ,10.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30545,CPT,REPAIR CHOANAL ATRESIA TRANSPALATINE,,,21,,RBRVS,11.62 ,11.98 ,11.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30560,CPT,LYSIS INTRANASAL SYNECHIA,,,21,,RBRVS,1.31 ,2.44 ,6.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30580,CPT,REPAIR FISTULA OROMAXILLARY,,,21,,RBRVS,6.88 ,6.73 ,10.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30600,CPT,REPAIR FISTULA ORONASAL,,,21,,RBRVS,6.16 ,5.68 ,9.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30620,CPT,SEPTAL/OTHER INTRANASAL DERMATOPLASTY,,,21,,RBRVS,6.16 ,10.78 ,10.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30630,CPT,REPAIR NASAL SEPTAL PERFORATIONS,,,21,,RBRVS,7.29 ,9.47 ,9.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30801,CPT,ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC,,,21,,RBRVS,1.14 ,2.62 ,5.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30802,CPT,ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL,,,21,,RBRVS,2.08 ,3.07 ,5.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30901,CPT,CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE,,,21,,RBRVS,1.10 ,0.37 ,1.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30903,CPT,CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX,,,21,,RBRVS,1.54 ,0.56 ,4.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30905,CPT,CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST,,,21,,RBRVS,1.97 ,0.82 ,5.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30906,CPT,CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ,,,21,,RBRVS,2.45 ,1.16 ,7.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30915,CPT,LIGATION ARTERIES ETHMOIDAL,,,21,,RBRVS,7.44 ,7.99 ,7.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30920,CPT,LIGATION ARTERIES INT MAXILLARY TRANSANTRAL,,,21,,RBRVS,11.14 ,11.17 ,11.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30930,CPT,FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC,,,21,,RBRVS,1.31 ,2.04 ,2.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 30999,CPT,UNLISTED PROCEDURE NOSE,,,21,,TotalUnits,,,,12.10 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31000,CPT,LAVAGE CANNULATION MAXILLARY SINUS,,,21,,RBRVS,1.20 ,1.67 ,3.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31002,CPT,LAVAGE CANNULATION SPHENOID SINUS,,,21,,RBRVS,1.96 ,3.33 ,3.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31020,CPT,SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL,,,21,,RBRVS,3.07 ,6.79 ,10.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31030,CPT,SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS,,,21,,RBRVS,6.01 ,8.26 ,12.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31032,CPT,SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS,,,21,,RBRVS,6.69 ,8.79 ,8.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31040,CPT,PTERYGOMAXILLARY FOSSA SURGERY ANY APPROACH,,,21,,RBRVS,9.77 ,10.62 ,10.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31050,CPT,SINUSOTOMY SPHENOID W/WO BIOPSY,,,21,,RBRVS,5.37 ,7.77 ,7.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31051,CPT,SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP,,,21,,RBRVS,7.25 ,10.18 ,10.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31070,CPT,SINUSOTOMY FRONTAL EXTERNAL SIMPLE,,,21,,RBRVS,4.40 ,7.55 ,7.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31075,CPT,SINUSOTOMY FRONTAL TRANSORBITAL UNILATERAL,,,21,,RBRVS,9.51 ,11.53 ,11.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31080,CPT,SINUSOTOMY FRNT OBLITERATIVE W/O FLAP BROW INC,,,21,,RBRVS,12.74 ,15.16 ,15.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31081,CPT,SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC,,,21,,RBRVS,14.19 ,22.58 ,22.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31084,CPT,SINUSOT FRNT OBLIT W/OSTPL FLAP BROW INC,,,21,,RBRVS,14.95 ,16.14 ,16.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31085,CPT,SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC,,,21,,RBRVS,15.64 ,23.27 ,23.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31086,CPT,SINUSOT FRNT NONOBLIT W/OSTPL FLAP BROW INC,,,21,,RBRVS,14.36 ,15.98 ,15.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31087,CPT,SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC,,,21,,RBRVS,14.57 ,14.18 ,14.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31090,CPT,SINUSOT UNI 3/> PARANSL SINUSES,,,21,,RBRVS,11.17 ,16.59 ,16.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31200,CPT,ETHMOIDECTOMY INTRANASAL ANTERIOR,,,21,,RBRVS,5.14 ,10.64 ,10.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31201,CPT,ETHMOIDECTOMY INTRANASAL TOTAL,,,21,,RBRVS,8.60 ,11.36 ,11.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31205,CPT,ETHMOIDECTOMY EXTRANASAL TOTAL,,,21,,RBRVS,10.58 ,13.99 ,13.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31225,CPT,MAXILLECTOMY W/O ORBITAL EXENTERATION,,,21,,RBRVS,26.70 ,23.17 ,23.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31230,CPT,MAXILLECTOMY W/ORBITAL EXENTERATION,,,21,,RBRVS,30.82 ,24.28 ,24.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31231,CPT,NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX,,,21,,RBRVS,1.10 ,0.62 ,4.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31233,CPT,NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY,,,21,,RBRVS,2.18 ,1.45 ,5.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31235,CPT,NASAL/SINUS ENDOSCOPY DX SPHENOID SINUSOSCOPY,,,21,,RBRVS,2.64 ,1.66 ,5.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31237,CPT,NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX,,,21,,RBRVS,2.60 ,1.69 ,4.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31238,CPT,NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG,,,21,,RBRVS,2.74 ,1.75 ,4.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31239,CPT,NASAL/SINUS NDSC SURG W/DACRYOCSTORHINOSTOMY,,,21,,RBRVS,9.04 ,7.62 ,7.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31240,CPT,NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION,,,21,,RBRVS,2.61 ,1.66 ,1.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31254,CPT,NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY PARTIAL,,,21,,RBRVS,4.64 ,2.57 ,2.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31255,CPT,NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY TOTAL,,,21,,RBRVS,6.95 ,3.60 ,3.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31256,CPT,NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY,,,21,,RBRVS,3.29 ,1.95 ,1.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31267,CPT,NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS,,,21,,RBRVS,5.45 ,2.93 ,2.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31276,CPT,NASAL/SINUS NDSC W/FRONTAL SINUS EXPLORATION,,,21,,RBRVS,8.84 ,4.46 ,4.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31287,CPT,NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY,,,21,,RBRVS,3.91 ,2.23 ,2.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31288,CPT,NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS,,,21,,RBRVS,4.57 ,2.53 ,2.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31290,CPT,NASAL/SINUS NDSC RPR CEREBRSP FLUID LEAK ETHMOID,,,21,,RBRVS,18.61 ,11.79 ,11.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31291,CPT,NASAL/SINUS NDSC RPR CEREBSP FLUID LEAK SPHENOID,,,21,,RBRVS,19.56 ,12.50 ,12.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31292,CPT,NSL/SINUS NDSC SURG W/MEDIAL/INF ORB WALL DCMPRN,,,21,,RBRVS,15.90 ,10.60 ,10.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31293,CPT,NASAL/SINUS NDSC MEDIAL ORB&NF ORB WALL DCMPR,,,21,,RBRVS,17.47 ,11.30 ,11.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31294,CPT,NASAL/SINUS NDSC SURG W/OPTIC NERVE DCMPRN,,,21,,RBRVS,20.31 ,12.51 ,12.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31295,CPT,NASAL/SINUS NDSC SURG W/DILAT MAXILLARY SINUS,,,21,,RBRVS,2.70 ,1.65 ,55.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31296,CPT,NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS,,,21,,RBRVS,3.29 ,1.91 ,55.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31297,CPT,NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS,,,21,,RBRVS,2.64 ,1.62 ,55.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31299,CPT,UNLISTED PROCEDURE ACCESSORY SINUSES,,,21,,TotalUnits,,,,5.67 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31300,CPT,LARYNGOTOMY W/RMVL TUMOR/LARYNGOCELE CORDECTOMY,,,21,,RBRVS,15.91 ,19.31 ,19.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31320,CPT,LARYNGOTOMY THYROTOMY LARYNGOFISSURE DX,,,21,,RBRVS,5.73 ,13.32 ,13.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31360,CPT,LARYNGECTOMY TOTAL W/O RADICAL NECK DISSECTION,,,21,,RBRVS,29.91 ,26.75 ,26.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31365,CPT,LARYNGECTOMY TOTAL W/RADICAL NECK DISSECTION,,,21,,RBRVS,38.81 ,30.82 ,30.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31367,CPT,LARYNGECTOMY STOT SUPRAGLOTTIC W/O RAD NECK DSJ,,,21,,RBRVS,30.57 ,29.72 ,29.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31368,CPT,LARYNGECTOMY STOT SUPRAGLOTTIC W/RAD NCK DSJ,,,21,,RBRVS,34.19 ,32.98 ,32.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31370,CPT,PARTIAL LARYNGECTOMY HEMILARYGECTOMY HORIZONTAL,,,21,,RBRVS,27.57 ,29.36 ,29.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31375,CPT,PARTIAL LARYNGECTOMY HEMILARYNG LATEROVERTICAL,,,21,,RBRVS,26.07 ,27.55 ,27.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31380,CPT,PARTIAL LARYNGECTOMY HEMILARYNG ANTEROVERTICAL,,,21,,RBRVS,25.57 ,27.66 ,27.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31382,CPT,PARTIAL LARYNG HEMILARYNG ANTERO-LATERO-VERTICAL,,,21,,RBRVS,28.57 ,29.97 ,29.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31390,CPT,PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/O RCNSTJ,,,21,,RBRVS,42.51 ,35.31 ,35.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31395,CPT,PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/RCNSTJ,,,21,,RBRVS,43.80 ,38.63 ,38.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31400,CPT,ARYTENOIDECTOMY/ARYTENOIDOPEXY XTRNL APPROACH,,,21,,RBRVS,11.60 ,15.01 ,15.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31420,CPT,EPIGLOTTIDECTOMY,,,21,,RBRVS,11.43 ,10.91 ,10.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31500,CPT,INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE,,,21,,RBRVS,2.33 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31502,CPT,TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT,,,21,,RBRVS,0.65 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31505,CPT,LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX,,,21,,RBRVS,0.61 ,0.73 ,1.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31510,CPT,LARYNGOSCOPY INDIRECT W/BIOPSY,,,21,,RBRVS,1.92 ,1.31 ,3.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31511,CPT,LARYNGOSCOPY INDIRECT W/REMOVAL FOREIGN BODY,,,21,,RBRVS,2.16 ,1.28 ,3.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31512,CPT,LARYNGOSCOPY INDIRECT W/REMOVAL LESION,,,21,,RBRVS,2.07 ,1.38 ,3.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31513,CPT,LARYNGOSCOPY INDIRECT W/VOCAL CORD INJECTION,,,21,,RBRVS,2.10 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31515,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY ASPIRATION,,,21,,RBRVS,1.80 ,1.04 ,3.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31520,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY DX NEWBORN,,,21,,RBRVS,2.56 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31525,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN,,,21,,RBRVS,2.63 ,1.64 ,4.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31526,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY W/MICRO/TELESCOPE,,,21,,RBRVS,2.57 ,1.63 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31527,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY INSERT OBTURATOR,,,21,,RBRVS,3.27 ,1.89 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31528,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY W/DILATION IN,,,21,,RBRVS,2.37 ,1.49 ,1.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31529,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY DILATION SUBSQ,,,21,,RBRVS,2.68 ,1.63 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31530,CPT,LARYNGOSCOPY W/FOREIGN BODY REMOVAL,,,21,,RBRVS,3.38 ,1.88 ,1.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31531,CPT,LARYNGOSCOPY FOREIGN BODY RMVL MICRO/TELESCOPE,,,21,,RBRVS,3.58 ,2.08 ,2.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31535,CPT,LARYNGOSCOPY DIRECT OPERATIVE W/BIOPSY,,,21,,RBRVS,3.16 ,1.89 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31536,CPT,LARYNGOSCOPY W/BIOPSY MICROSCOPE/TELESCOPE,,,21,,RBRVS,3.55 ,2.07 ,2.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31540,CPT,LARYNGOSCOPY EXC TUM&/STRIPPING CORDS/EPIGLOTT,,,21,,RBRVS,4.12 ,2.31 ,2.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31541,CPT,LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP,,,21,,RBRVS,4.52 ,2.51 ,2.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31545,CPT,LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD FLAP,,,21,,RBRVS,6.30 ,3.34 ,3.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31546,CPT,LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD GRAFT,,,21,,RBRVS,9.73 ,4.85 ,4.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31551,CPT,LARYNGOPLASTY LARYNGEAL STEN,,,21,,RBRVS,21.50 ,16.35 ,16.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31552,CPT,LARYNGOPLASTY LARYNGEAL STEN,,,21,,RBRVS,20.50 ,17.94 ,17.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31553,CPT,LARYNGOPLASTY LARYNGEAL STEN,,,21,,RBRVS,22.00 ,19.95 ,19.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31554,CPT,LARYNGOPLASTY LARYNGEAL STEN,,,21,,RBRVS,22.00 ,22.33 ,22.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31560,CPT,LARYNGOSCOPY DIRECT OPERATIVE W/ARYTENOIDECTOMY,,,21,,RBRVS,5.45 ,2.88 ,2.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31561,CPT,LARGSC ARYTENOIDECTOMY MICROSCOPE/TELESCOPE,,,21,,RBRVS,5.99 ,3.12 ,3.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31570,CPT,LARYNGOSCOPE INJECTION VOCAL CORD THERAPEUTIC,,,21,,RBRVS,3.86 ,2.22 ,5.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31571,CPT,LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE,,,21,,RBRVS,4.26 ,2.39 ,2.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31572,CPT,LARGSC W/LASER DSTRJ LES,,,21,,RBRVS,3.01 ,1.77 ,10.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31573,CPT,LARGSC W/THER INJECTION,,,21,,RBRVS,2.43 ,1.52 ,4.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31574,CPT,LARGSC W/NJX AUGMENTATION,,,21,,RBRVS,2.43 ,1.52 ,26.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31575,CPT,LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC,,,21,,RBRVS,1.10 ,0.96 ,2.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31576,CPT,LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY,,,21,,RBRVS,1.97 ,1.34 ,4.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31577,CPT,LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY,,,21,,RBRVS,2.47 ,1.52 ,4.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31578,CPT,LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION,,,21,,RBRVS,2.84 ,1.74 ,4.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31579,CPT,LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY,,,21,,RBRVS,2.26 ,1.50 ,3.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31580,CPT,LARYNGOPLASTY LARYN WEB 2 STG W/KEEL INSJ&RMVL,,,21,,RBRVS,14.66 ,18.35 ,18.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31584,CPT,LARYNGOPLASTY W/OPEN REDUCTION FRACTURE,,,21,,RBRVS,20.47 ,19.97 ,19.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31587,CPT,LARYNGOPLASTY CRICOID SPLIT,,,21,,RBRVS,15.27 ,11.33 ,11.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31590,CPT,LARYNGEAL REINNERVATION NEUROMUSCULAR PEDICLE,,,21,,RBRVS,7.85 ,16.68 ,16.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31591,CPT,LARYNGOPLASTY MEDIALIZATION,,,21,,RBRVS,13.56 ,14.44 ,14.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31592,CPT,CRICOTRACHEAL RESECTION,,,21,,RBRVS,25.00 ,19.94 ,19.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31595,CPT,SECTION RECURRENT LARYNGEAL NERVE THER UNI SPX,,,21,,RBRVS,8.84 ,11.87 ,11.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31599,CPT,UNLISTED PROCEDURE LARYNX,,,21,,TotalUnits,,,,3.02 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31600,CPT,TRACHEOSTOMY PLANNED SEPARATE PROCEDURE,,,21,,RBRVS,7.17 ,2.97 ,2.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31601,CPT,TRACHEOSTOMY PLANNED UNDER 2 YEARS SPX,,,21,,RBRVS,4.44 ,2.39 ,2.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31603,CPT,TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL,,,21,,RBRVS,4.14 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31605,CPT,TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE,,,21,,RBRVS,3.57 ,1.10 ,1.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31610,CPT,TRACHEOSTOMY FENESTRATION W/SKIN FLAPS,,,21,,RBRVS,9.38 ,9.76 ,9.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31611,CPT,CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH,,,21,,RBRVS,6.00 ,8.66 ,8.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31612,CPT,TRACHEAL PNXR PRQ W/TRANSTRACHEAL ASPIR&/NJX,,,21,,RBRVS,0.91 ,0.35 ,1.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31613,CPT,TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION,,,21,,RBRVS,4.71 ,7.59 ,7.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31614,CPT,TRACHEOSTOMA REVJ CPLX W/FLAP ROTATION,,,21,,RBRVS,8.63 ,11.78 ,11.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31615,CPT,TRACHEOBRNCHSC THRU EST TRACHS INC,,,21,,RBRVS,2.09 ,1.34 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31622,CPT,BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX,,,21,,RBRVS,2.78 ,1.07 ,5.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31623,CPT,BRNCHSC BRUSHING/PROTECTED BRUSHINGS,,,21,,RBRVS,2.88 ,1.09 ,6.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31624,CPT,BRNCHSC W/BRNCL ALVEOLAR LAVAGE,,,21,,RBRVS,2.88 ,1.13 ,5.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31625,CPT,BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES,,,21,,RBRVS,3.36 ,1.21 ,7.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31626,CPT,BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT,,,21,,RBRVS,4.16 ,1.47 ,21.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31627,CPT,BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION,,,21,,RBRVS,2.00 ,0.60 ,37.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 31628,CPT,BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE,,,21,,RBRVS,3.80 ,1.33 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31629,CPT,BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON,,,21,,RBRVS,4.00 ,1.39 ,9.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31630,CPT,BRNCHSC W/TRACHEAL/BRONCHIAL DILAT/CLSD RDCTJ FX,,,21,,RBRVS,3.81 ,1.50 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31631,CPT,BRONCHOSCOPY W/PLACEMENT TRACHEAL STENT,,,21,,RBRVS,4.36 ,1.69 ,1.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31632,CPT,BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE,,,21,,RBRVS,1.03 ,0.31 ,1.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31633,CPT,BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA LOBE,,,21,,RBRVS,1.32 ,0.40 ,1.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31634,CPT,BRONCHOSCOPY BALLOON OCCLUSION,,,21,,RBRVS,4.00 ,1.46 ,48.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31635,CPT,BRONCHOSCOPY W/REMOVAL FOREIGN BODY,,,21,,RBRVS,3.67 ,1.37 ,5.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31636,CPT,BRNCHSC W/PLACEMENT BRNCL STENT 1ST BRONCHUS,,,21,,RBRVS,4.30 ,1.57 ,1.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31637,CPT,BRONCHOSCOPY EACH MAJOR BRONCHUS STENTED,,,21,,RBRVS,1.58 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31638,CPT,BRNCHSC REVJ TRACHEAL/BRNCL STENT INS PREV SESS,,,21,,RBRVS,4.88 ,1.81 ,1.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31640,CPT,BRONCHOSCOPY W/EXCISION TUMOR,,,21,,RBRVS,4.93 ,1.82 ,1.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31641,CPT,BRNCHSC W/DSTRJ TUM RELIEF STENOSIS OTH/THN EXC,,,21,,RBRVS,5.02 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31643,CPT,BRNCHSC W/PLMT CATH INTRCV RADIOELMNT APPL,,,21,,RBRVS,3.49 ,1.30 ,1.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31645,CPT,BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST,,,21,,RBRVS,3.16 ,1.21 ,5.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31646,CPT,BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ,,,21,,RBRVS,2.72 ,1.06 ,5.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31647,CPT,BRNCHSC OCCLUSION&INSERT BRONCH VALVE INIT LOBE,,,21,,RBRVS,4.40 ,1.58 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31648,CPT,BRNCHSC REMOVAL BRONCHIAL VALVE INITIAL,,,21,,RBRVS,4.20 ,1.35 ,1.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31649,CPT,BRNCHSC REMOVAL BRONCHIAL VALVE EA ADDL,,,21,,RBRVS,1.44 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31651,CPT,BRNCHSC OCCLUSION&INSERT BRONCH VALVE ADDL LOBE,,,21,,RBRVS,1.58 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31652,CPT,BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX,,,21,,RBRVS,4.71 ,1.61 ,20.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31653,CPT,BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX,,,21,,RBRVS,5.21 ,1.76 ,21.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31654,CPT,BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES,,,21,,RBRVS,1.40 ,0.42 ,2.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 31660,CPT,BRONCHOSCOPIC THERMOPLASTY ONE LOBE,,,21,,RBRVS,4.25 ,1.47 ,1.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31661,CPT,BRONCHOSCOPIC THERMOPLASTY 2/> LOBES,,,21,,RBRVS,4.50 ,1.51 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31717,CPT,CATHETERIZATION W/BRONCHIAL BRUSH BIOPSY,,,21,,RBRVS,2.12 ,0.84 ,5.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31720,CPT,CATHETER ASPIRATION NASOTRACHEAL SPX,,,21,,RBRVS,1.06 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31725,CPT,CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,,,21,,RBRVS,1.96 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31730,CPT,TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER,,,21,,RBRVS,2.85 ,0.93 ,31.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31750,CPT,TRACHEOPLASTY CERVICAL,,,21,,RBRVS,15.39 ,22.76 ,22.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31755,CPT,TRACHEOPLASTY TRACHEOPHARYNGEAL FSTLJ EA STG,,,21,,RBRVS,17.54 ,30.80 ,30.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31760,CPT,TRACHEOPLASTY INTRATHORACIC,,,21,,RBRVS,23.48 ,11.30 ,11.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31766,CPT,CARINAL RECONSTRUCTION,,,21,,RBRVS,31.67 ,12.63 ,12.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31770,CPT,BRONCHOPLASTY GRAFT REPAIR,,,21,,RBRVS,23.54 ,9.75 ,9.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31775,CPT,BRONCHOPLASTY EXCISION STENOSIS & ANASTOMOSIS,,,21,,RBRVS,24.59 ,10.60 ,10.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31780,CPT,EXCISION TRACHEAL STENOSIS&ANASTOMOSIS CERVICA,,,21,,RBRVS,19.84 ,10.76 ,10.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31781,CPT,EXC TRACHEAL STENOSIS&ANAST CERVICOTHORACIC,,,21,,RBRVS,24.85 ,13.21 ,13.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31785,CPT,EXCISION TRACHEAL TUMOR/CARCINOMA CERVICAL,,,21,,RBRVS,18.35 ,10.11 ,10.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31786,CPT,EXCISION TRACHEAL TUMOR/CARCINOMA THORACIC,,,21,,RBRVS,25.42 ,10.54 ,10.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31800,CPT,SUTURE TRACHEAL WOUND/INJURY CERVICAL,,,21,,RBRVS,8.18 ,11.78 ,11.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31805,CPT,SUTURE TRACHEAL WOUND/INJURY INTRATHORACIC,,,21,,RBRVS,13.42 ,7.40 ,7.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 31820,CPT,SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR,,,21,,RBRVS,4.64 ,4.12 ,7.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31825,CPT,SURG CLSR TRACHEOSTOMY/FISTULA W/PLASTIC RPR,,,21,,RBRVS,7.07 ,5.70 ,9.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31830,CPT,REVISION TRACHEOSTOMY SCAR,,,21,,RBRVS,4.62 ,4.52 ,7.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 31899,CPT,UNLISTED PROCEDURE TRACHEA BRONCHI,,,21,,TotalUnits,,,,3.99 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32035,CPT,THORACOSTOMY W/RIB RESECTION EMPYEMA,,,21,,RBRVS,11.29 ,6.96 ,6.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32036,CPT,THORACOSTOMY OPEN FLAP DRAINAGE EMPYEMA,,,21,,RBRVS,12.30 ,7.39 ,7.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32096,CPT,THORACTOMY W/DX BX LUNG INFILTRATE UNILATERAL,,,21,,RBRVS,13.75 ,6.46 ,6.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32097,CPT,THORACTOMY W/DX BX LUNG NODULE/MASS UNILATERAL,,,21,,RBRVS,13.75 ,6.47 ,6.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32098,CPT,THORACOTOMY W/BIOPSY OF PLEURA,,,21,,RBRVS,12.91 ,6.28 ,6.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32100,CPT,THORACOTOMY WITH EXPLORATION,,,21,,RBRVS,13.75 ,6.55 ,6.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32110,CPT,THORCOM CTRL TRAUMTC HEMRRG&/RPR LNG TEAR,,,21,,RBRVS,25.28 ,11.37 ,11.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32120,CPT,THORACOTOMY POSTOPERATIVE COMPLICATIONS,,,21,,RBRVS,14.39 ,7.57 ,7.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32124,CPT,THORACOTOMY OPN INTRAPLEURAL PNEUMONOLYSIS,,,21,,RBRVS,15.45 ,7.85 ,7.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32140,CPT,THORCOM W/REMOVAL OF CYST,,,21,,RBRVS,16.66 ,8.31 ,8.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32141,CPT,THORACOTOMY W/RESECTION BULLAE,,,21,,RBRVS,27.18 ,10.87 ,10.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32150,CPT,THORCOM W/RMVL INTRAPLEURAL FB/FIBRIN DEP,,,21,,RBRVS,16.82 ,8.43 ,8.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32151,CPT,THORCOM W/RMVL IPUL FB,,,21,,RBRVS,16.94 ,8.37 ,8.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32160,CPT,THORACOTOMY W/CARDIAC MASSAGE,,,21,,RBRVS,13.10 ,6.87 ,6.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32200,CPT,PNEUMONOSTOMY W/OPEN DRAINAGE ABSCESS/CYST,,,21,,RBRVS,18.68 ,10.07 ,10.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32215,CPT,PLEURAL SCARIFICATION REPEAT PNEUMOTHORAX,,,21,,RBRVS,13.05 ,7.28 ,7.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32220,CPT,DECORTICATION PULMONARY TOTAL SEPARATE PROCEDURE,,,21,,RBRVS,26.65 ,13.18 ,13.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32225,CPT,DECORTICATION PULMONARY PARTIAL SEPARATE PROC,,,21,,RBRVS,16.75 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32310,CPT,PLEURECTOMY PARIETAL SEPARATE PROCEDURE,,,21,,RBRVS,15.28 ,7.75 ,7.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32320,CPT,DECORTICATION & PARIETAL PLEURECTOMY,,,21,,RBRVS,27.25 ,12.88 ,12.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32400,CPT,BIOPSY PLEURA PERCUTANEOUS NEEDLE,,,21,,RBRVS,1.76 ,0.60 ,2.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32405,CPT,BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE,,,21,,RBRVS,1.93 ,0.90 ,10.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32440,CPT,REMOVAL OF LUNG PNEUMONECTOMY,,,21,,RBRVS,27.28 ,11.90 ,11.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32442,CPT,REMOVAL LUNG PNEUMONECTOMY RESXN SGMNT TRACHEA,,,21,,RBRVS,56.47 ,22.96 ,22.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32445,CPT,REMOVAL LUNG PNEUMONECTOMY EXTRAPLEURAL,,,21,,RBRVS,63.84 ,24.78 ,24.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32480,CPT,RMVL LUNG OTHER THAN PNEUMONECTOMY 1 LOBE LOBECT,,,21,,RBRVS,25.82 ,11.15 ,11.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32482,CPT,RMVL LUNG OTHER THAN PNEUMONECT 2 LOBES BILOBEC,,,21,,RBRVS,27.44 ,12.24 ,12.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32484,CPT,RMVL LUNG OTHER THAN PNEUMONECT 1 SEGMENTECTOMY,,,21,,RBRVS,25.38 ,10.47 ,10.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32486,CPT,RMVL LUNG XCP TOT PNEUMONECTOMY SLEEVE LOBECTOMY,,,21,,RBRVS,42.88 ,15.50 ,15.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32488,CPT,RMVL LUNG OTHER/THAN PNUMEC COMPLETION PNUMEC,,,21,,RBRVS,42.99 ,16.73 ,16.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32491,CPT,RMVL LUNG OTH/THN PNUMEC RESXN-PLCTJ EMPHY LUNG,,,21,,RBRVS,25.24 ,11.66 ,11.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32501,CPT,RESCJ&BRONCHOPLASTY PFRMD TM LOBEC/SGMECTOMY,,,21,,RBRVS,4.68 ,1.37 ,1.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32503,CPT,RESCJ APICAL LUNG TUMOR W/O CHEST WALL RCNSTJ,,,21,,RBRVS,31.74 ,13.40 ,13.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32504,CPT,RESCJ APICAL LUNG TUMOR W/CHEST WALL RCNSTJ,,,21,,RBRVS,36.54 ,14.92 ,14.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32505,CPT,THORACOTOMY W/THERAPEUTIC WEDGE RESEXN INITIAL,,,21,,RBRVS,15.75 ,7.68 ,7.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32506,CPT,THORACOTOMY W/THERAP WEDGE RESEXN ADDL IPSILATRL,,,21,,RBRVS,3.00 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32507,CPT,THORACOTOMY W/DX WEDGE RESEXN & ANTOM LUNG RESE,,,21,,RBRVS,3.00 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32540,CPT,EXTRAPLEURAL ENUCLEATION EMPYEMA EMPYEMECTOMY,,,21,,RBRVS,30.35 ,13.02 ,13.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32550,CPT,INSERTION INDWELLING TUNNELED PLEURAL CATHETER,,,21,,RBRVS,4.17 ,1.63 ,17.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32551,CPT,TUBE THORACOSTOMY INCLUDES WATER SEAL,,,21,,RBRVS,3.29 ,1.10 ,1.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32552,CPT,RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF,,,21,,RBRVS,2.53 ,1.69 ,2.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32553,CPT,PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT,,,21,,RBRVS,3.80 ,1.48 ,12.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32554,CPT,THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING,,,21,,RBRVS,1.82 ,0.59 ,3.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32555,CPT,THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING,,,21,,RBRVS,2.27 ,0.78 ,5.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32556,CPT,PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING,,,21,,RBRVS,2.50 ,0.83 ,12.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32557,CPT,PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING,,,21,,RBRVS,3.12 ,1.04 ,11.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32560,CPT,INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS,,,21,,RBRVS,1.54 ,0.47 ,5.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32561,CPT,INSTLJ VIA CH TUBE/CATH AGENT FBRNLYSIS 1ST DAY,,,21,,RBRVS,1.39 ,0.43 ,1.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32562,CPT,INSTLJ CH TUBE/CATH AGENT FBRNLYSIS SBSQ DAY,,,21,,RBRVS,1.24 ,0.38 ,0.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32601,CPT,THORSC DX LUNGS/PERICAR/MED/PLEURAL SPACE W/O BX,,,21,,RBRVS,5.50 ,2.24 ,2.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32604,CPT,THORACOSCOPY DX PERICARDIAL SAC W/BIOPSY SPX,,,21,,RBRVS,8.77 ,3.21 ,3.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32606,CPT,THORACOSCOPY DX MEDIASTINAL SPACE W/BIOPSY SPX,,,21,,RBRVS,8.39 ,3.13 ,3.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32607,CPT,THORACOSCOPY W/DX BX OF LUNG INFILTRATE UNILATRL,,,21,,RBRVS,5.50 ,2.23 ,2.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32608,CPT,THORACOSCOPY W/DX BX OF LUNG NODULES UNILATRL,,,21,,RBRVS,6.84 ,2.62 ,2.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32609,CPT,THORACOSCOPY WITH BIOPSYIES OF PLEURA,,,21,,RBRVS,4.58 ,1.95 ,1.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32650,CPT,THORACOSCOPY W/PLEURODESIS,,,21,,RBRVS,10.83 ,6.03 ,6.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32651,CPT,THORACOSCOPY W/PARTIAL PULMONARY DECORTICATION,,,21,,RBRVS,18.78 ,8.69 ,8.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32652,CPT,THRSC TOT PULM DCRTCTJ INTRAPLEURAL PNEUMONOLSS,,,21,,RBRVS,29.13 ,12.40 ,12.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32653,CPT,THORACOSCOPY RMVL INTRAPLEURAL FB/FIBRIN DEPOSIT,,,21,,RBRVS,18.17 ,8.42 ,8.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32654,CPT,THORACOSCOPY CONTROL TRAUMATIC HEMORRHAGE,,,21,,RBRVS,20.52 ,9.01 ,9.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32655,CPT,THORACOSCOPY W/RESECTION BULLAE W/WO PLEURAL PX,,,21,,RBRVS,16.17 ,7.85 ,7.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32656,CPT,THORACOSCOPY W/PARIETAL PLEURECTOMY,,,21,,RBRVS,13.26 ,6.97 ,6.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32658,CPT,THORACOSCOPY W/RMVL CLOT/FB FROM PERICARDIAL SAC,,,21,,RBRVS,11.71 ,6.26 ,6.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32659,CPT,THRSC CRTJ PRCRD WINDOW/PRTL RESCJ PRCRD SAC,,,21,,RBRVS,11.94 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32661,CPT,THORACOSCOPY W/EXC PERICARDIAL CYST TUMOR/MASS,,,21,,RBRVS,13.33 ,6.76 ,6.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32662,CPT,THORACOSCOPY W/EXC MEDIASTINAL CYST TUMOR/MASS,,,21,,RBRVS,14.99 ,7.46 ,7.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32663,CPT,THORACOSCOPY W/LOBECTOMY SINGLE LOBE,,,21,,RBRVS,24.64 ,10.37 ,10.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32664,CPT,THORACOSCOPY W/THORACIC SYMPATHECTOMY,,,21,,RBRVS,14.28 ,7.15 ,7.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32665,CPT,THORACOSCOPY W/ESOPHAGOMYOTOMY HELLER TYPE,,,21,,RBRVS,21.53 ,9.18 ,9.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32666,CPT,THORACOSCOPY W/THERA WEDGE RESEXN INITIAL UNILAT,,,21,,RBRVS,14.50 ,7.43 ,7.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32667,CPT,THORACOSCOPY W/THERA WEDGE RESEXN ADDL IPSILATRL,,,21,,RBRVS,3.00 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32668,CPT,THORACOSCOPY W/DX WEDGE RESEXN ANATO LUNG RESEXN,,,21,,RBRVS,3.00 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32669,CPT,THORACOSCOPY W/SEGMENTECTOMY,,,21,,RBRVS,23.53 ,10.11 ,10.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32670,CPT,THORACOSCOPY W/BILOBECTOMY,,,21,,RBRVS,28.52 ,11.45 ,11.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32671,CPT,THORACOSCOPY W/PNEUMONECTOMY,,,21,,RBRVS,31.92 ,12.25 ,12.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32672,CPT,THORACOSCOPY W/RESEXN-PLICAJ EMPHYSEMA LUNG UNIL,,,21,,RBRVS,27.00 ,11.02 ,11.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32673,CPT,THORACOSCOPY RESEXN THYMUS UNI/BILATERAL,,,21,,RBRVS,21.13 ,9.43 ,9.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32674,CPT,THORCOSCPY W/MEDIASTINL & REGIONL LYMPHDENECTOMY,,,21,,RBRVS,4.12 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32701,CPT,THORAX STEREOTACTIC RADIATION TARGET W/TX COURSE,,PC,21,,RBRVS,4.18 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32800,CPT,REPAIR LUNG HERNIA THROUGH CHEST WALL,,,21,,RBRVS,15.71 ,8.00 ,8.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32810,CPT,CLSR CH WALL FLWG OPN FLAP DRG EMPYEMA,,,21,,RBRVS,14.95 ,7.68 ,7.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32815,CPT,OPEN CLOSURE MAJOR BRONCHIAL FISTULA,,,21,,RBRVS,50.03 ,19.84 ,19.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32820,CPT,MAJOR RECONSTRUCTION CHEST WALL POSTTRAUMATIC,,,21,,RBRVS,22.51 ,11.04 ,11.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32851,CPT,LUNG TRANSPLANT 1 W/O CARDIOPULMONARY BYPASS,,,21,,RBRVS,59.64 ,22.16 ,22.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32852,CPT,LUNG TRANSPLANT 1 W/CARDIOPULMONARY BYPASS,,,21,,RBRVS,65.50 ,23.79 ,23.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32853,CPT,LUNG TRANSPLANT 2 W/O CARDIOPULMONARY BYPASS,,,21,,RBRVS,84.48 ,29.27 ,29.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32854,CPT,LUNG TRANSPLANT 2 W/CARDIOPULMONARY BYPASS,,,21,,RBRVS,90.00 ,31.01 ,31.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32855,CPT,BKBENCH PREPJ CADAVER DONOR LUNG ALLOGRAFT UNI,,,21,,TotalUnits,,,,11.48 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32856,CPT,BKBENCH PREPJ CADAVER DONOR LUNG ALLOGRAFT BI,,,21,,TotalUnits,,,,16.10 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32900,CPT,RESECTION RIBS EXTRAPLEURAL ALL STAGES,,,21,,RBRVS,23.81 ,11.58 ,11.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32905,CPT,THORACOPLASTY SCHEDE TYPE/EXTRAPLEURAL,,,21,,RBRVS,23.29 ,10.21 ,10.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32906,CPT,THORACOP SCHEDE TYP/XTRPLEURAL CLSR BRNCPLR FSTL,,,21,,RBRVS,29.30 ,11.98 ,11.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32940,CPT,PNEUMONOLYSIS XTRPRIOSTEAL W/FILLING/PACKING PX,,,21,,RBRVS,21.34 ,9.45 ,9.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32960,CPT,PNEUMOTHORAX THER INTRAPLEURAL INJECTION AIR,,,21,,RBRVS,1.84 ,0.71 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32997,CPT,TOTAL LUNG LAVAGE UNILATERAL,,,21,,RBRVS,7.31 ,2.02 ,2.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 32998,CPT,ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI,,,21,,RBRVS,5.68 ,2.05 ,61.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 32999,CPT,UNLISTED PROCEDURE LUNGS & PLEURA,,,21,,TotalUnits,,,,3.40 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33010,CPT,PERICARDIOCENTESIS INITIAL,,,21,,RBRVS,2.24 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33011,CPT,PERICARDIOCENTESIS SUBSEQUENT,,,21,,RBRVS,2.24 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33015,CPT,TUBE PERICARDIOSTOMY,,,21,,RBRVS,8.52 ,4.53 ,4.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33020,CPT,PERICARDIOTOMY REMOVAL CLOT/FOREIGN BODY PRIMARY,,,21,,RBRVS,14.95 ,7.16 ,7.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33025,CPT,CRTJ PERICARDIAL WINDOW/PRTL RESECJ W/DRG/BX,,,21,,RBRVS,13.70 ,6.34 ,6.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33030,CPT,PRICARDIECTOMY STOT/COMPL W/O CARDPULM BYPASS,,,21,,RBRVS,36.00 ,13.90 ,13.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33031,CPT,PRICARDIECTOMY STOT/COMPL W/CARDPULM BYPASS,,,21,,RBRVS,45.00 ,16.65 ,16.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33050,CPT,RESECTION PERICARDIAL CYST/TUMOR,,,21,,RBRVS,16.97 ,8.21 ,8.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33120,CPT,EXC INTRACARDIAC TUMOR RESCJ CARDIOPULMONARY BYP,,,21,,RBRVS,38.45 ,13.82 ,13.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33130,CPT,RESECTION EXTERNAL CARDIAC TUMOR,,,21,,RBRVS,24.17 ,10.41 ,10.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33140,CPT,TRANSMYOCARDIAL LASER REVASCULAR THORACOTOMY SPX,,,21,,RBRVS,28.34 ,10.69 ,10.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33141,CPT,TRANSMYOCRD LASER REVSC PFRMD TM OTH OPN CAR PX,,,21,,RBRVS,2.54 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33202,CPT,INSERTION EPICARDIAL ELECTRODE OPEN,,,21,,RBRVS,13.20 ,6.22 ,6.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33203,CPT,INSERTION EPICARDIAL ELECTRODE ENDOSCOPIC,,,21,,RBRVS,13.97 ,6.16 ,6.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33206,CPT,INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL,,,21,,RBRVS,7.39 ,4.30 ,4.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33207,CPT,INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR,,,21,,RBRVS,8.05 ,4.36 ,4.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33208,CPT,INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT,,,21,,RBRVS,8.77 ,4.65 ,4.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33210,CPT,INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH,,,21,,RBRVS,3.30 ,1.16 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33211,CPT,INSJ/RPLCMT TEMP TRANSVNS 2CHMBR PACG ELTRDS SPX,,,21,,RBRVS,3.39 ,1.17 ,1.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33212,CPT,INS PM PLS GEN W/EXIST SINGLE LEAD,,,21,,RBRVS,5.26 ,3.19 ,3.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33213,CPT,INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS,,,21,,RBRVS,5.53 ,3.27 ,3.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33214,CPT,UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS,,,21,,RBRVS,7.84 ,4.57 ,4.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33215,CPT,RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE,,,21,,RBRVS,4.92 ,2.91 ,2.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33216,CPT,INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB,,,21,,RBRVS,5.87 ,3.86 ,3.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33217,CPT,INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB,,,21,,RBRVS,5.84 ,3.69 ,3.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33218,CPT,RPR 1 TRANSVNS ELTRD PRM PM/PACING IMPLNTBL DFB,,,21,,RBRVS,6.07 ,4.12 ,4.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33220,CPT,RPR 2 TRANSVNS ELECTRODES PRM PM/IMPLANTABLE DFB,,,21,,RBRVS,6.15 ,4.05 ,4.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33221,CPT,INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS,,,21,,RBRVS,5.80 ,3.66 ,3.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33222,CPT,RELOCATION OF SKIN POCKET FOR PACEMAKER,,,21,,RBRVS,5.10 ,3.82 ,3.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33223,CPT,RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR,,,21,,RBRVS,6.55 ,4.10 ,4.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33224,CPT,INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN,,,21,,RBRVS,9.04 ,3.81 ,3.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33225,CPT,INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN,,,21,,RBRVS,8.33 ,3.32 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33226,CPT,RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD,,,21,,RBRVS,8.68 ,3.66 ,3.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33227,CPT,REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD,,,21,,RBRVS,5.50 ,3.38 ,3.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33228,CPT,REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS,,,21,,RBRVS,5.77 ,3.49 ,3.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33229,CPT,REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD,,,21,,RBRVS,6.04 ,3.72 ,3.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33230,CPT,INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS,,,21,,RBRVS,6.32 ,3.69 ,3.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33231,CPT,INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS,,,21,,RBRVS,6.59 ,3.84 ,3.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33233,CPT,REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY,,,21,,RBRVS,3.39 ,2.84 ,2.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33234,CPT,RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR,,,21,,RBRVS,7.91 ,4.64 ,4.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33235,CPT,RMVL TRANSVNS PM ELTRD DUAL LEAD SYS,,,21,,RBRVS,10.15 ,6.25 ,6.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33236,CPT,RMVL PRM EPICAR PM&ELTRDS THORCOM 1 LEAD SYS,,,21,,RBRVS,12.73 ,7.00 ,7.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33237,CPT,RMVL PRM EPICAR PM&ELTRDS THORCOM DUAL LEAD SY,,,21,,RBRVS,13.84 ,7.38 ,7.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33238,CPT,RMVL PRM TRANSVENOUS ELECTRODE THORACOTOMY,,,21,,RBRVS,15.40 ,8.21 ,8.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33240,CPT,INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD,,,21,,RBRVS,6.05 ,3.51 ,3.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33241,CPT,REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY,,,21,,RBRVS,3.29 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33243,CPT,RMVL 1/DUAL CHAMBER DEFIB ELECTRODE BY THORACOM,,,21,,RBRVS,23.57 ,10.76 ,10.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33244,CPT,RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ,,,21,,RBRVS,13.99 ,7.95 ,7.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33249,CPT,INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR,,,21,,RBRVS,15.17 ,8.18 ,8.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33250,CPT,ABLATION ARRHYTHMOGENIC FOCI/PATHWAY W/O BYPASS,,,21,,RBRVS,25.90 ,10.59 ,10.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33251,CPT,ABLATION ARRHYTHMOGENIC FOCI/PATHWAY W/BYPASS,,,21,,RBRVS,28.92 ,11.77 ,11.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33254,CPT,ABLATION & RECONSTRUCTION ATRIA LIMITED,,,21,,RBRVS,23.71 ,10.60 ,10.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33255,CPT,ABLATION & RCNSTJ ATRIA EXTNSV W/O BYPASS,,,21,,RBRVS,29.04 ,11.66 ,11.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33256,CPT,ABLATION & RCNSTJ ATRIA EXTNSV W/BYPASS,,,21,,RBRVS,34.90 ,13.77 ,13.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33257,CPT,ATRIA ABLATE & RCNSTJ W/OTHER PROCEDURE LIMITE,,,21,,RBRVS,9.63 ,5.10 ,5.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33258,CPT,ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTENSIV W/O BYP,,,21,,RBRVS,11.00 ,5.53 ,5.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33259,CPT,ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTEN W/BYPASS,,,21,,RBRVS,14.14 ,7.18 ,7.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33261,CPT,OPRATIVE ABLTJ VENTR ARRHYTHMOGENIC FOC W/BYPASS,,,21,,RBRVS,28.92 ,12.04 ,12.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33262,CPT,RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD,,,21,,RBRVS,6.06 ,3.69 ,3.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33263,CPT,RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD,,,21,,RBRVS,6.33 ,3.80 ,3.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33264,CPT,RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD,,,21,,RBRVS,6.60 ,3.95 ,3.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33265,CPT,NDSC ABLATION & RCNSTJ ATRIA LIMITED W/O BYPAS,,,21,,RBRVS,23.71 ,10.50 ,10.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33266,CPT,NDSC ABLATION & RCNSTJ ATRIA EXTEN W/O BYPASS,,,21,,RBRVS,33.04 ,13.07 ,13.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33270,CPT,INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD,,,21,,RBRVS,9.10 ,5.88 ,5.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33271,CPT,INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE,,,21,,RBRVS,7.50 ,5.15 ,5.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33272,CPT,RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE,,,21,,RBRVS,5.42 ,3.47 ,3.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33273,CPT,REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB,,,21,,RBRVS,6.50 ,4.20 ,4.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33282,CPT,IMPLANTATION PT-ACTIVATED CARDIAC EVENT RECORDER,,,21,,RBRVS,3.50 ,2.60 ,2.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33284,CPT,RMVL IMPLANTABLE PT-ACTIVATED CAR EVENT RECORDER,,,21,,RBRVS,3.00 ,2.41 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33300,CPT,REPAIR CARDIAC WOUND W/O BYPASS,,,21,,RBRVS,44.97 ,15.96 ,15.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33305,CPT,REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS,,,21,,RBRVS,76.93 ,24.82 ,24.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33310,CPT,CARDIOT EXPL W/RMVL FB ATR/VENTR THRMB W/O BYP,,,21,,RBRVS,20.34 ,9.04 ,9.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33315,CPT,CARDIOT EXPL RMVL FB ATR/VENTR THRMB CARD BYP,,,21,,RBRVS,35.00 ,12.71 ,12.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33320,CPT,SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP,,,21,,RBRVS,18.54 ,8.08 ,8.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33321,CPT,SUTR RPR AORTA/GREAT VESSEL W/SHUNT BYPASS,,,21,,RBRVS,20.81 ,9.95 ,9.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33322,CPT,SUTURE REPAIR AORTA/GREAT VESSEL W/BYPASS,,,21,,RBRVS,24.42 ,10.36 ,10.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33330,CPT,INSJ GRAFT AORTA/GREAT VESSEL W/O SHUNT/BYPASS,,,21,,RBRVS,25.29 ,10.44 ,10.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33335,CPT,INSJ GRAFT AORTA/GREAT VESSEL W/BYPASS,,,21,,RBRVS,33.91 ,13.12 ,13.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33340,CPT,PERQ CLSR TCAT L ATR APNDGE,,,21,,RBRVS,14.00 ,6.14 ,6.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33361,CPT,REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH,,,21,,RBRVS,25.13 ,8.62 ,8.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33362,CPT,REPLACE AORTIC VALVE OPENFEMORAL ARTERY APPROACH,,,21,,RBRVS,27.52 ,9.31 ,9.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33363,CPT,REPLACE AORTIC VALVE OPEN AXILLRY ARTRY APPROACH,,,21,,RBRVS,28.50 ,9.84 ,9.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33364,CPT,REPLACE AORTIC VALVE OPEN ILIAC ARTERY APPROACH,,,21,,RBRVS,30.00 ,10.10 ,10.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33365,CPT,REPLACE AORTIC VALVE OPEN TRANSAORTIC APPROACH,,,21,,RBRVS,33.12 ,11.03 ,11.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33366,CPT,TRANSCATHETER TRANSAPICAL REPLACEMT AORTIC VALVE,,,21,,RBRVS,35.88 ,11.83 ,11.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33367,CPT,REPLACE AORTIC VALVE W/BYP PRQ ART/VENOUS APPRCH,,,21,,RBRVS,11.88 ,3.66 ,3.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33368,CPT,REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS APRCH,,,21,,RBRVS,14.39 ,4.00 ,4.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33369,CPT,REPLACE AORTA VALVE W/BYP CNTRL ART/VENOUS APRCH,,,21,,RBRVS,19.00 ,5.30 ,5.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33390,CPT,VALVULOPLASTY AORTIC VALVE,,,21,,RBRVS,35.00 ,13.06 ,13.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33391,CPT,VALVULOPLASTY AORTIC VALVE,,,21,,RBRVS,41.50 ,15.45 ,15.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33404,CPT,CONSTRUCTION APICAL-AORTIC CONDUIT,,,21,,RBRVS,31.37 ,12.43 ,12.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33405,CPT,RPLCMT PROST AORTIC VALVE XCP HOMOGRF/STENT,,,21,,RBRVS,41.32 ,15.33 ,15.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33406,CPT,RPLCMT AORTIC VALVE ALLOGRAFT VALVE FREEHAND,,,21,,RBRVS,52.68 ,19.01 ,19.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33410,CPT,RPLCMT AORTIC VALVE W/STENTLESS TISSUE VALVE,,,21,,RBRVS,46.41 ,17.02 ,17.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33411,CPT,RPLCMT AORTIC VALVE ANNULUS ENLGMENT NONC SINUS,,,21,,RBRVS,62.07 ,21.54 ,21.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33412,CPT,REPLACEMENT AORTIC VALVE KONNO PROCEDURE,,,21,,RBRVS,59.00 ,19.43 ,19.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33413,CPT,REPLACEMENT AORTIC&PULMON VALVES ROSS PROCEDUR,,,21,,RBRVS,59.87 ,20.65 ,20.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33414,CPT,RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC,,,21,,RBRVS,39.37 ,14.22 ,14.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33415,CPT,RESECTION/INCISION SUBVALVULAR TISSUE,,,21,,RBRVS,37.27 ,13.68 ,13.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33416,CPT,VENTRICULOMYOTOMY-MYECTOMY,,,21,,RBRVS,36.56 ,14.17 ,14.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33417,CPT,AORTOPLASTY SUPRAVALVULAR STENOSIS,,,21,,RBRVS,29.33 ,12.47 ,12.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33418,CPT,TCAT MITRAL VALVE REPAIR INITIAL PROSTHESIS,,,21,,RBRVS,32.25 ,13.10 ,13.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33419,CPT,TCAT MITRAL VALVE REPAIR ADDL PROSTHESIS,,,21,,RBRVS,7.93 ,2.76 ,2.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33420,CPT,VALVOTOMY MITRAL VALVE CLOSED HEART,,,21,,RBRVS,25.79 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33422,CPT,VALVOTOMY MITRAL VALVE OPEN HEART W/BYPASS,,,21,,RBRVS,29.73 ,12.22 ,12.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33425,CPT,VALVULOPLASTY MITRAL VALVE W/CARDIAC BYPASS,,,21,,RBRVS,49.96 ,18.20 ,18.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33426,CPT,VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING,,,21,,RBRVS,43.28 ,16.22 ,16.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33427,CPT,VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING,,,21,,RBRVS,44.83 ,16.15 ,16.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33430,CPT,REPLACEMENT MITRAL VALVE W/CARDIOPULMONARY BYP,,,21,,RBRVS,50.93 ,18.91 ,18.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33460,CPT,VALVECTOMY TRICUSPID VALVE W/CARDIOPULMONARY BYP,,,21,,RBRVS,44.70 ,15.72 ,15.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33463,CPT,VALVULOPLASTY TRICUSPID VALVE W/O RING INSERTION,,,21,,RBRVS,57.08 ,19.97 ,19.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33464,CPT,VALVULOPLASTY TRICUSPID VALVE W/RING INSERTION,,,21,,RBRVS,44.62 ,16.44 ,16.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33465,CPT,REPLACEMENT TRICUSPID VALVE W/CARD BYPASS,,,21,,RBRVS,50.72 ,18.03 ,18.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33468,CPT,TRICUSPID VALVE RPSG&PLCTJ EBSTEIN ANOMALY,,,21,,RBRVS,45.13 ,15.92 ,15.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33470,CPT,VALVOTOMY PULMONARY VALVE CLSD HEART TRANSVENTR,,,21,,RBRVS,21.54 ,11.05 ,11.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33471,CPT,VALVOTOMY PULM VALVE CLSD HEART VIA PULM ARTERY,,,21,,RBRVS,22.96 ,11.90 ,11.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33474,CPT,VALVOTOMY PULMONARY VALVE OPEN HEART W/BYPASS,,,21,,RBRVS,39.40 ,14.98 ,14.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33475,CPT,REPLACEMENT PULMONARY VALVE,,,21,,RBRVS,42.40 ,15.82 ,15.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33476,CPT,R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY,,,21,,RBRVS,26.57 ,11.63 ,11.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33477,CPT,TCAT PULMONARY VALVE IMPLANTATION PRQ APPROACH,,,21,,RBRVS,25.00 ,8.81 ,8.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33478,CPT,OUTFLOW TRACT AGMNTJ W/WO COMMISSUR/INFUND RESCJ,,,21,,RBRVS,27.54 ,11.91 ,11.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33496,CPT,RPR NON-STRUCT PROSTC VALVE DYSFUNCTION W/BYPASS,,,21,,RBRVS,29.84 ,11.85 ,11.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33500,CPT,RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/BYPASS,,,21,,RBRVS,27.94 ,11.51 ,11.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33501,CPT,RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/O BYPASS,,,21,,RBRVS,19.51 ,8.80 ,8.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33502,CPT,RPR ANOM CORONARY ART PULM ART ORIGIN LIGATION,,,21,,RBRVS,21.85 ,10.27 ,10.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33503,CPT,RPR ANOM CORONARY ARTERY PULM ART ORIGIN GRAFT,,,21,,RBRVS,22.51 ,10.92 ,10.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33504,CPT,RPR ANOM CORONARY ART PULM ART ORIGIN GRF W/BYP,,,21,,RBRVS,25.46 ,11.36 ,11.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33505,CPT,RPR ANOM CORON ART W/CONSTJ INTRAPULM ART TUNNEL,,,21,,RBRVS,38.40 ,12.89 ,12.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33506,CPT,RPR ANOM CORONARY ART FROM PULM ART TO AORTA,,,21,,RBRVS,37.85 ,13.31 ,13.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33507,CPT,RPR ANOM AORTIC ORIGIN CORONARY ART UNROOF/TLCJ,,,21,,RBRVS,31.40 ,11.60 ,11.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33508,CPT,NDSC SURG W/VIDEO-ASSISTED HARVEST VEIN CABG,,,21,,RBRVS,0.31 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 33510,CPT,CORONARY ARTERY BYPASS 1 CORONARY VENOUS GRAFT,,,21,,RBRVS,34.98 ,13.33 ,13.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33511,CPT,CORONARY ARTERY BYPASS 2 CORONARY VENOUS GRAFTS,,,21,,RBRVS,38.45 ,14.62 ,14.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33512,CPT,CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS,,,21,,RBRVS,43.98 ,16.27 ,16.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33513,CPT,CORONARY ARTERY BYPASS 4 CORONARY VENOUS GRAFTS,,,21,,RBRVS,45.37 ,16.60 ,16.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33514,CPT,CORONARY ARTERY BYPASS 5 CORONARY VENOUS GRAFTS,,,21,,RBRVS,48.08 ,17.23 ,17.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33516,CPT,CORONARY ARTERY BYPASS 6/+ CORONARY VENOUS GRAFT,,,21,,RBRVS,49.76 ,17.89 ,17.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33517,CPT,CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 1 VEIN,,,21,,RBRVS,3.61 ,1.03 ,1.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33518,CPT,CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 2 VEIN,,,21,,RBRVS,7.93 ,2.27 ,2.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33519,CPT,CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 3 VEIN,,,21,,RBRVS,10.49 ,3.00 ,3.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33521,CPT,CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 4 VEIN,,,21,,RBRVS,12.59 ,3.59 ,3.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33522,CPT,CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 5 VEIN,,,21,,RBRVS,14.14 ,4.02 ,4.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33523,CPT,CORONARY ARTERY BYP W/VEIN &ARTERY GRAFT 6 VEIN,,,21,,RBRVS,16.08 ,4.60 ,4.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33530,CPT,ROPRTJ CAB/VALVE PX > 1 MO AFTER ORIGINAL OPERJ,,,21,,RBRVS,10.13 ,2.89 ,2.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33533,CPT,CABG W/ARTERIAL GRAFT SINGLE ARTERIAL GRAFT,,,21,,RBRVS,33.75 ,12.97 ,12.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33534,CPT,CABG W/ARTERIAL GRAFT TWO ARTERIAL GRAFTS,,,21,,RBRVS,39.88 ,15.05 ,15.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33535,CPT,CABG W/ARTERIAL GRAFT THREE ARTERIAL GRAFTS,,,21,,RBRVS,44.75 ,16.48 ,16.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33536,CPT,CABG W/ARTERIAL GRAFT FOUR/>ARTERIAL GRAFTS,,,21,,RBRVS,48.43 ,17.59 ,17.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33542,CPT,MYOCARDIAL RESECTION,,,21,,RBRVS,48.21 ,17.26 ,17.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33545,CPT,RPR POSTINFRCJ VENTRICULAR SEPTAL DEFECT,,,21,,RBRVS,57.06 ,19.88 ,19.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33548,CPT,SURG VENTRICULAR RSTRJ PX W/PROSTC PATCH PFRMD,,,21,,RBRVS,54.14 ,19.81 ,19.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33572,CPT,CORONARY ENDARTERCOMY OPEN ANY METHOD,,,21,,RBRVS,4.44 ,1.27 ,1.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33600,CPT,CLOSURE ATRIOVENTRICULAR VALVE SUTURE/PATCH,,,21,,RBRVS,30.31 ,12.76 ,12.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33602,CPT,CLOSURE SEMILUNAR VALVE AORTIC/PULM SUTURE/PATCH,,,21,,RBRVS,29.34 ,12.48 ,12.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33606,CPT,ANAST PULMONARY ART AORTA DAMUS-KAYE-STANSEL PX,,,21,,RBRVS,31.53 ,15.37 ,15.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33608,CPT,RPR CAR ANOMAL XCP PULM ATRESIA VENTR SEPTL DFCT,,,21,,RBRVS,31.88 ,13.21 ,13.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33610,CPT,RPR CAR ANOMAL SURG ENLGMENT VENTR SEPTL DFCT,,,21,,RBRVS,31.40 ,13.07 ,13.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33611,CPT,RPR 2 OUTLET R VNTRC W/INTRAVENTR TUNNEL RPR,,,21,,RBRVS,35.57 ,16.04 ,16.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33612,CPT,RPR 2 OUTLET R VNTRC RPR R VENTR O/F TRC OBSTRCJ,,,21,,RBRVS,36.57 ,13.41 ,13.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33615,CPT,RPR CAR ANOMAL CLSR SEPTL DFCT SMPL FONTAN PX,,,21,,RBRVS,35.89 ,14.01 ,14.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33617,CPT,RPR COMPLEX CARDIAC ANOMALY MODIFIED FONTAN PX,,,21,,RBRVS,39.09 ,14.94 ,14.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33619,CPT,RPR 1 VNTRC W/O/F OBSTRCJ&AORTIC ARCH HYPOPLAS,,,21,,RBRVS,48.76 ,19.43 ,19.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33620,CPT,APPLICATION RIGHT & LEFT PULMONARY ARTERY BAND,,,21,,RBRVS,30.00 ,11.19 ,11.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33621,CPT,TRANSTHORACIC CATHETER INSERTION FOR STENT PLMT,,,21,,RBRVS,16.18 ,7.22 ,7.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33622,CPT,RECONSTRUCTION COMPLEX CARDIAC ANOMALY,,,21,,RBRVS,64.00 ,26.93 ,26.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33641,CPT,RPR ATRIAL SEPTAL DFCT SECUNDUM W/BYP W/WO PATCH,,,21,,RBRVS,29.58 ,11.40 ,11.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33645,CPT,DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG,,,21,,RBRVS,31.30 ,11.93 ,11.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33647,CPT,RPR ATRIAL & VENTRIC SEPTAL DFCT DIR/PATCH CLS,,,21,,RBRVS,33.00 ,12.39 ,12.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33660,CPT,RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR,,,21,,RBRVS,31.83 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33665,CPT,RPR INTRM/TRANSJ AV CANAL W/WO AV VALVE RPR,,,21,,RBRVS,34.85 ,12.92 ,12.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33670,CPT,RPR COMPL AV CANAL W/WO PROSTC VALVE,,,21,,RBRVS,36.63 ,12.47 ,12.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33675,CPT,CLOSURE MULTIPLE VENTRICULAR SEPTAL DEFECTS,,,21,,RBRVS,35.95 ,13.27 ,13.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33676,CPT,CLOSURE MULTIPLE VSD W/RESECTION,,,21,,RBRVS,36.95 ,16.60 ,16.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33677,CPT,CLOSURE MULTIPLE VSD W/REMOVAL ARTERY BAND,,,21,,RBRVS,38.45 ,17.17 ,17.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33681,CPT,CLSR 1 VENTRICULAR SEPTAL DEFECT W/WO PATCH,,,21,,RBRVS,32.34 ,13.78 ,13.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33684,CPT,CLSR V-SEPTL DFCT W/PULM VLVT/INFUND RESCJ,,,21,,RBRVS,34.37 ,15.58 ,15.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33688,CPT,CLSR V-SEPTAL DFCT W/RMVL P-ART BAND W/WO GUSSET,,,21,,RBRVS,34.75 ,12.18 ,12.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33690,CPT,BANDING PULMONARY ARTERY,,,21,,RBRVS,20.36 ,9.89 ,9.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33692,CPT,COMPL RPR TETRALOGY FALLOT W/O PULM ATRESIA,,,21,,RBRVS,36.15 ,15.66 ,15.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33694,CPT,COMPL RPR T-FALLOT W/O PULM ATRESIA TANULR PATCH,,,21,,RBRVS,35.57 ,16.04 ,16.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33697,CPT,COMPL RPR T-FALLOT W/PULM ATRESIA,,,21,,RBRVS,37.57 ,13.70 ,13.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33702,CPT,RPR SINUS VALSALVA FISTULA,,,21,,RBRVS,27.24 ,11.52 ,11.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33710,CPT,RPR SINUS VALSALVA FISTULA W/RPR V-SEPTAL DEFECT,,,21,,RBRVS,37.50 ,16.78 ,16.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33720,CPT,RPR SINUS VALSALVA ANEURYSM,,,21,,RBRVS,27.26 ,11.52 ,11.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33722,CPT,CLOSURE AORTICO-LEFT VENTRICULAR TUNNEL,,,21,,RBRVS,29.21 ,11.43 ,11.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33724,CPT,REPAIR ISOLATED PARTIAL PULM VENOUS RETURN,,,21,,RBRVS,27.63 ,10.87 ,10.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33726,CPT,REPAIR PULMONARY VENOUS STENOSIS,,,21,,RBRVS,37.12 ,13.61 ,13.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33730,CPT,COMPLETE RPR ANOMALOUS PULMONARY VENOUS RETURN,,,21,,RBRVS,36.14 ,13.96 ,13.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33732,CPT,RPR COR TRIATM/SUPVALVR RING RESCJ L ATRIAL MEMB,,,21,,RBRVS,28.96 ,12.37 ,12.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33735,CPT,ATRIAL SEPTECTOMY/SEPTOSTOMY CLOSED HEART,,,21,,RBRVS,22.20 ,10.42 ,10.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33736,CPT,ATRIAL SEPTECTOMY/SEPTOSTOMY OPEN HEART W/BYPASS,,,21,,RBRVS,24.32 ,11.03 ,11.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33737,CPT,ATRIAL SEPTECT/SEPTOST OPN HRT W/INFL OCCLUSION,,,21,,RBRVS,22.47 ,11.71 ,11.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33750,CPT,SHUNT SUBCLAVIAN PULMONARY ARTERY,,,21,,RBRVS,22.22 ,9.42 ,9.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33755,CPT,SHUNT ASCENDING AORTA PULMONARY ARTERY,,,21,,RBRVS,22.60 ,10.53 ,10.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33762,CPT,SHUNT DESCENDING AORTA PULMONARY ARTERY,,,21,,RBRVS,22.60 ,11.20 ,11.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33764,CPT,SHUNT CENTRAL W/PROSTHETIC GRAFT,,,21,,RBRVS,22.60 ,10.53 ,10.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33766,CPT,SHUNT SUPERIOR VENA CAVA PULMONARY ART 1 LUNG,,,21,,RBRVS,23.57 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33767,CPT,SHUNT SUPERIOR VENA CAVA PULM ARTERY BOTH LUNGS,,,21,,RBRVS,25.30 ,10.30 ,10.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33768,CPT,ANASTOMOSIS CAVOPULMARY 2ND SUPRIOR VENA CAVA,,,21,,RBRVS,8.00 ,2.31 ,2.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33770,CPT,RPR TRPOS GREAT VSLS W/O ENLGMNT V-SEPTL DFCT,,,21,,RBRVS,39.07 ,16.97 ,16.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33771,CPT,RPR TRPOS GREAT VSLS W/ENLGMNT V-SEPTL DFCT,,,21,,RBRVS,40.63 ,17.07 ,17.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33774,CPT,RPR TRPOS GREAT VSLS ATRIAL BAFFLE PX W/BYPASS,,,21,,RBRVS,31.73 ,13.37 ,13.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33775,CPT,RPR TRPOS GREAT VSLS ATR BAFFLE W/RMVL PULM BAND,,,21,,RBRVS,32.99 ,15.92 ,15.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33776,CPT,RPR TRPOS GRT VSL ATR BAFFLE W/CLSR V-SEPTL DFCT,,,21,,RBRVS,34.75 ,16.95 ,16.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33777,CPT,RPR TRPOS GRT VSL ATR BAFFLE W/BYP SBPULM OBSTRC,,,21,,RBRVS,34.17 ,15.80 ,15.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33778,CPT,RPR TRPOS GRT VESSEL AORTIC PULMONARY ART RCNSTJ,,,21,,RBRVS,42.75 ,19.35 ,19.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33779,CPT,RPR TGV AORTIC PULM ART RCNSTJ W/RMVL PULM BAND,,,21,,RBRVS,43.23 ,18.36 ,18.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33780,CPT,RPR TGV AORTIC P-ART RCNSTJ W/CLSR V-SEPTL DFCT,,,21,,RBRVS,43.90 ,15.05 ,15.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33781,CPT,RPR TGV AORTIC P-ART RCNSTJ RPR SBPULMC OBSTRCJ,,,21,,RBRVS,43.21 ,18.06 ,18.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33782,CPT,A-ROOT TLCJ VSD PULM STNS RPR W/O C OST RIMPLTJ,,,21,,RBRVS,60.08 ,20.23 ,20.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33783,CPT,A-ROOT TLCJ VSD PULM STNS RPR W/RIMPLTJ C OSTIA,,,21,,RBRVS,65.08 ,27.34 ,27.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33786,CPT,TOTAL REPAIR TRUNCUS ARTERIOSUS,,,21,,RBRVS,41.87 ,14.82 ,14.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33788,CPT,REIMPLANTATION ANOMALOUS PULMONARY ARTERY,,,21,,RBRVS,27.42 ,13.04 ,13.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33800,CPT,AORTIC SUSPENSION TRACHEAL DECOMPRESSION SPX,,,21,,RBRVS,17.28 ,7.51 ,7.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33802,CPT,DIVISION ABERRANT VESSEL VASCULAR RING,,,21,,RBRVS,18.37 ,8.96 ,8.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33803,CPT,DIVISION ABERRANT VESSEL W/REANASTOMOSIS,,,21,,RBRVS,20.31 ,8.52 ,8.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33813,CPT,OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS,,,21,,RBRVS,21.36 ,11.28 ,11.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33814,CPT,OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/BYPASS,,,21,,RBRVS,26.57 ,11.68 ,11.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33820,CPT,REPAIR PATENT DUCTUS ARTERIOSUS LIGATION,,,21,,RBRVS,16.69 ,7.69 ,7.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33822,CPT,RPR PATENT DUXUS ARTERIOSUS DIV UNDER 18 YR,,,21,,RBRVS,17.71 ,9.21 ,9.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33824,CPT,RPR PATENT DUXUS ARTERIOSUS DIV 18 YR & OLDER,,,21,,RBRVS,20.23 ,9.45 ,9.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33840,CPT,EXC COARCJ AORTA W/WO PDA W/DIRECT ANASTOMOSIS,,,21,,RBRVS,21.34 ,9.82 ,9.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33845,CPT,EXCISION COARCTATION AORTA W/WO PDA W/GRAFT,,,21,,RBRVS,22.93 ,10.63 ,10.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33851,CPT,EXC COARCJ AORTA W/L SUBCLAV ART/PROSTC GUSSET,,,21,,RBRVS,21.98 ,10.00 ,10.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33852,CPT,RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/O BYPASS,,,21,,RBRVS,24.41 ,10.70 ,10.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33853,CPT,RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/BYPASS,,,21,,RBRVS,32.51 ,13.39 ,13.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33860,CPT,ASCENDING AORTA GRF W/CARD BYP & VALVE SSP,,,21,,RBRVS,59.46 ,20.53 ,20.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33863,CPT,AS-AORT GRF W/CARD BYP & AORTIC ROOT RPLCMT,,,21,,RBRVS,58.79 ,19.56 ,19.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33864,CPT,ASCENDING AORTA GRF VALVE SPARE ROOT REMODEL,,,21,,RBRVS,60.08 ,19.95 ,19.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33870,CPT,TRANSVERSE ARCH GRAFT W/CARDIOPULMONARY BYPASS,,,21,,RBRVS,46.06 ,16.78 ,16.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33875,CPT,DESCENDING THORACIC AORTA GRAFT W/WO BYPASS,,,21,,RBRVS,50.72 ,17.73 ,17.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33877,CPT,RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS,,,21,,RBRVS,69.03 ,21.33 ,21.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33880,CPT,EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH,,,21,,RBRVS,34.58 ,10.61 ,10.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33881,CPT,EVASC RPR DTA EXP COVERAGE W/O ART ORIGIN,,,21,,RBRVS,29.58 ,9.26 ,9.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33883,CPT,PLMT PROX XTN PROSTH EVASC RPR DTA 1ST XTN,,,21,,RBRVS,21.09 ,7.21 ,7.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33884,CPT,PLMT PROX XTN PROSTH EVASC RPR DTA EA PROX XTN,,,21,,RBRVS,8.20 ,2.02 ,2.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33886,CPT,PLMT DSTL XTN PROSTH DLYD AFTER EVASC RPR DTA,,,21,,RBRVS,18.09 ,6.30 ,6.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33889,CPT,OPN SUBCLA CRTD ART TRPOS NCK INC ULAT,,,21,,RBRVS,15.92 ,3.66 ,3.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33891,CPT,BYP GRF W/DESCENDING THORACIC AORTA RPR NECK INC,,,21,,RBRVS,20.00 ,3.95 ,3.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33910,CPT,PULMONARY ARTERY EMBOLECTOMY W/CARD BYPASS,,,21,,RBRVS,48.21 ,17.43 ,17.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33915,CPT,PULMONARY ARTERY EMBOLECTOMY W/O CARD BYPASS,,,21,,RBRVS,24.95 ,6.69 ,6.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33916,CPT,PULMONARY ENDARTERCOMY W/WO EMBOLECTOMY W/BYPASS,,,21,,RBRVS,78.00 ,26.16 ,26.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33917,CPT,RPR PULMONARY ART STENOSIS RCNSTJ W/PATCH/GRAFT,,,21,,RBRVS,25.30 ,11.31 ,11.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33920,CPT,RPR PULMONARY ATRESIA W/CONSTJ/RPLCMT CONDUIT,,,21,,RBRVS,32.74 ,15.07 ,15.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33922,CPT,TRANSECTION PULMONARY ARTERY W/CARD BYPASS,,,21,,RBRVS,24.22 ,10.65 ,10.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33924,CPT,LIG&TKDN SYSIC-TO-PULM ART SHUNT W/CGEN HEART,,,21,,RBRVS,5.49 ,1.58 ,1.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33925,CPT,RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/O BYPASS,,,21,,RBRVS,31.30 ,11.57 ,11.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33926,CPT,RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/BYPASS,,,21,,RBRVS,44.73 ,19.26 ,19.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33935,CPT,HEART-LUNG TRNSPL W/RECIPIENT CARDIECTOMY-PNUMEC,,,21,,RBRVS,91.78 ,33.46 ,33.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33940,CPT,DONOR CARDIECTOMY,,,21,,TotalUnits,,,,39.56 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33944,CPT,BKBENCH PREPJ CADAVER DONOR HEART ALLOGRAFT,,,21,,TotalUnits,,,,17.53 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33945,CPT,HEART TRANSPLANT W/WO RECIPIENT CARDIECTOMY,,,21,,RBRVS,89.50 ,31.28 ,31.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33946,CPT,ECMO/ECLS INITIATION VENO-VENOUS,,,21,,RBRVS,6.00 ,1.79 ,1.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33947,CPT,ECMO/ECLS INITIATION VENO-ARTERIAL,,,21,,RBRVS,6.63 ,1.98 ,1.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33948,CPT,ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,,,21,,RBRVS,4.73 ,1.47 ,1.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33949,CPT,ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,,,21,,RBRVS,4.60 ,1.43 ,1.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33951,CPT,ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,,,21,,RBRVS,8.15 ,2.78 ,2.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33952,CPT,ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,,,21,,RBRVS,8.15 ,2.48 ,2.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33953,CPT,ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,,,21,,RBRVS,9.11 ,3.10 ,3.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33954,CPT,ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN,,,21,,RBRVS,9.11 ,2.77 ,2.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33955,CPT,ECMO/ECLS INSJ OF CENTRAL CANNULA BIRTH-5 YRS,,,21,,RBRVS,16.00 ,6.20 ,6.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33956,CPT,ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,,,21,,RBRVS,16.00 ,4.78 ,4.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33957,CPT,ECMO/ECLS REPOS PERIPH CANNULA PERQ BIRTH-5 YRS,,,21,,RBRVS,3.51 ,1.43 ,1.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33958,CPT,ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,,,21,,RBRVS,3.51 ,1.31 ,1.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33959,CPT,ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,,,21,,RBRVS,4.47 ,1.80 ,1.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33962,CPT,ECMO/ECLS REPOS PERPH CANNULA OPEN 6 YRS & OLDER,,,21,,RBRVS,4.47 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33963,CPT,ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,,,21,,RBRVS,9.00 ,3.53 ,3.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33964,CPT,ECMO/ECLS ECLS REPOS CENTRAL CNULA 6YRS & OLDER,,,21,,RBRVS,9.50 ,3.43 ,3.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33965,CPT,ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,,,21,,RBRVS,3.51 ,1.43 ,1.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33966,CPT,ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,,,21,,RBRVS,4.50 ,1.37 ,1.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33967,CPT,INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ,,,21,,RBRVS,4.84 ,1.61 ,1.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33968,CPT,REMOVAL INTRA-AORTIC BALLOON ASSIST DEVICE PRQ,,,21,,RBRVS,0.64 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33969,CPT,ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,,,21,,RBRVS,5.22 ,2.08 ,2.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33970,CPT,INSJ INTRA-AORT BALO ASSIST DEV VIA FEM ART OPEN,,,21,,RBRVS,6.74 ,2.07 ,2.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33971,CPT,RMVL I-AORT BALO ASST DEV W/RPR FEM ART W/WO GRF,,,21,,RBRVS,11.99 ,5.97 ,5.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33973,CPT,INSJ I-AORT BALO ASSIST DEV VIA ASCENDING AORTA,,,21,,RBRVS,9.75 ,3.05 ,3.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33974,CPT,RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA,,,21,,RBRVS,15.03 ,7.50 ,7.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33975,CPT,INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE,,,21,,RBRVS,25.00 ,7.67 ,7.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33976,CPT,INSJ VENTRIC ASSIST DEV XTRCORP BIVENTRICULAR,,,21,,RBRVS,30.75 ,8.93 ,8.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33977,CPT,REMOVAL VENTR ASSIST DEVICE XTRCORP 1 VENTRICLE,,,21,,RBRVS,20.86 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33978,CPT,REMOVAL VENTR ASSIST DEVICE XTRCORP BIVENTR,,,21,,RBRVS,25.00 ,8.23 ,8.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33979,CPT,INSJ VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC,,,21,,RBRVS,37.50 ,10.83 ,10.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33980,CPT,RMVL VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC,,,21,,RBRVS,33.50 ,10.87 ,10.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33981,CPT,RPLCMT XTRCORP VAD 1/BIVENTR PUMP 1/EA PUMP,,,21,,RBRVS,16.11 ,4.50 ,4.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33982,CPT,PLCMT VAD PMP IMPLTBL ICORP 1 VENTR W/O BYPASS,,,21,,RBRVS,37.86 ,11.44 ,11.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33983,CPT,RPLCMT VAD PMP IMPLTBL ICORP 1 VNTR W/BYPASS,,,21,,RBRVS,44.54 ,12.87 ,12.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33984,CPT,ECMO/ECLS RMVL PRPH CANNULA OPEN 6 YRS & OLDER,,,21,,RBRVS,5.46 ,1.64 ,1.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33985,CPT,ECMO/ECLS REMOVAL OF CENTRAL CANNULA BIRTH-5 YRS,,,21,,RBRVS,9.89 ,3.87 ,3.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33986,CPT,ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,,,21,,RBRVS,10.00 ,3.28 ,3.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33987,CPT,ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS,,,21,,RBRVS,4.04 ,1.14 ,1.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33988,CPT,INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,,,21,,RBRVS,15.00 ,4.32 ,4.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33989,CPT,RMVL LEFT HEART VENT BY THORACIC INCIS ECMO/ECLS,,,21,,RBRVS,9.50 ,3.08 ,3.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33990,CPT,INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY,,,21,,RBRVS,8.15 ,2.75 ,2.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33991,CPT,INSJ PERQ VAD TRNSPTAL W/IMAGE ART&VENOUS ACCESS,,,21,,RBRVS,11.88 ,4.00 ,4.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33992,CPT,REMOVAL PERCUTANEOUS VAD DIFFERENT SESSION,,,21,,RBRVS,4.00 ,1.14 ,1.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33993,CPT,REPOSITION VAD W/IMAGING DIFFERENT SESSION,,,21,,RBRVS,3.51 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 33999,CPT,UNLISTED CARDIAC SURGERY,,,21,,TotalUnits,,,,13.42 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 34001,CPT,EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART,,,21,,RBRVS,17.88 ,6.70 ,6.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34051,CPT,EMBLC/THRMBC INNOMINATE SUBCLAVIAN ARTERY,,,21,,RBRVS,16.99 ,7.89 ,7.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34101,CPT,EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART,,,21,,RBRVS,10.93 ,4.31 ,4.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 34111,CPT,EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC,,,21,,RBRVS,10.93 ,4.28 ,4.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 34151,CPT,EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART,,,21,,RBRVS,26.52 ,8.75 ,8.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34201,CPT,EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART,,,21,,RBRVS,19.48 ,6.51 ,6.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 34203,CPT,EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC,,,21,,RBRVS,17.86 ,6.28 ,6.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 34401,CPT,THRMBC DIR/W/CATH VENA CAVA ILIAC VEIN ABDL INC,,,21,,RBRVS,26.52 ,10.38 ,10.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34421,CPT,THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN LEG INC,,,21,,RBRVS,13.37 ,5.18 ,5.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 34451,CPT,THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN ABDL&LEG,,,21,,RBRVS,28.52 ,7.82 ,7.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34471,CPT,THRMBC DIR/W/CATH SUBCLAVIAN VEIN NECK INC,,,21,,RBRVS,21.11 ,5.92 ,5.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 34490,CPT,THRMBC DIR/W/CATH AXILL&SUBCLAVIAN VEIN ARM IN,,,21,,RBRVS,10.91 ,4.54 ,4.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 34501,CPT,VALVULOPLASTY FEMORAL VEIN,,,21,,RBRVS,16.85 ,7.94 ,7.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 34502,CPT,RECONSTRUCTION VENA CAVA ANY METHOD,,,21,,RBRVS,28.07 ,10.77 ,10.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34510,CPT,VENOUS VALVE TRANSPOSITION ANY VEIN DONOR,,,21,,RBRVS,19.91 ,10.17 ,10.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 34520,CPT,CROSS-OVER VEIN GRAFT VENOUS SYSTEM,,,21,,RBRVS,19.18 ,6.06 ,6.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 34530,CPT,SAPHENOPOPLITEAL VEIN ANASTOMOSIS,,,21,,RBRVS,17.93 ,10.12 ,10.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 34800,CPT,EVASC RPR AAA W/AORTO-AORTIC TUBE PROSTH,,,21,,RBRVS,21.54 ,7.01 ,7.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34802,CPT,EVASC RPR AAA W/MDLR BFRC PROSTH 1 LIMB,,,21,,RBRVS,23.79 ,7.76 ,7.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34803,CPT,EVASC RPR AAA W/MDLR BFRC PROSTH 2 LIMBS,,,21,,RBRVS,24.82 ,7.74 ,7.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34804,CPT,EVASC RPR AAA W/UNIBDY BFRC PROSTH,,,21,,RBRVS,23.79 ,7.67 ,7.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34805,CPT,EVASC RPR AAA AORTO-UNIILIAC/AORTO-UNIFEM PROSTH,,,21,,RBRVS,22.67 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34806,CPT,TCAT PLACEMENT PHYSIOLOGIC SENSOR ANEURYSMAL SAC,,,21,,RBRVS,2.06 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34808,CPT,EVASC PLACEMENT ILIAC ARTERY OCCLUSION DEVICE,,,21,,RBRVS,4.12 ,1.02 ,1.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34812,CPT,OPN FEM ART EXPOS DLVR EVASC PROSTH UNI,,,21,,RBRVS,6.74 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34813,CPT,PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR,,,21,,RBRVS,4.79 ,1.10 ,1.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34820,CPT,ILIAC ART EXPOS PROSTH/ILIAC OCCLS EVASC UNI,,,21,,RBRVS,9.74 ,2.53 ,2.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34825,CPT,PLMT XTN PROSTH EVASC RPR ARYSM/DSJ 1ST VSL,,,21,,RBRVS,12.80 ,4.95 ,4.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34826,CPT,PLMT XTN PROSTH EVASC RPR ARYSM/DSJ EA VSL,,,21,,RBRVS,4.12 ,1.02 ,1.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34830,CPT,OPN RPR ARYSM RPR ARTL TRAUMA TUBE PROSTH,,,21,,RBRVS,35.23 ,9.09 ,9.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34831,CPT,OPN RPR ARYSM RPR ARTL TRMA AORTOBIILIAC PROSTH,,,21,,RBRVS,37.98 ,9.41 ,9.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34832,CPT,OPN RPR ARYSM RPR ARTL TRMA AORTO-BIFEM PROSTH,,,21,,RBRVS,37.98 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34833,CPT,ILIAC ART EXPOS W/CRTJ CONDUIT UNI,,,21,,RBRVS,11.98 ,3.24 ,3.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34834,CPT,BRACH ART EXPOS DPLMNT AORTIC/ILIAC PROSTH UNI,,,21,,RBRVS,5.34 ,1.50 ,1.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34841,CPT,ENDOVASC VISCER AORTA REPAIR FENEST 1 ENDOGRAFT,,,21,,TotalUnits,,,,15.50 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34842,CPT,ENDOVASC VISCER AORTA REPAIR FENEST 2 ENDOGRAFT,,,21,,TotalUnits,,,,31.00 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34843,CPT,ENDOVASC VISCER AORTA REPAIR FENEST 3 ENDOGRAFT,,,21,,TotalUnits,,,,46.50 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34844,CPT,ENDOVASC VISCER AORTA REPR FENEST 4+ ENDOGRAFT,,,21,,TotalUnits,,,,62.00 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34845,CPT,VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS,,,21,,TotalUnits,,,,21.51 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34846,CPT,VISCER AND INFRARENAL ABDOM AORTA 2 PROSTHESIS,,,21,,TotalUnits,,,,43.03 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34847,CPT,VISCER AND INFRARENAL ABDOM AORTA 3 PROSTHESIS,,,21,,TotalUnits,,,,64.54 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34848,CPT,VISCER AND INFRARENAL ABDOM AORTA 4+ PROSTHESIS,,,21,,TotalUnits,,,,86.05 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 34900,CPT,EVASC RPR ILIAC ART ILIO-ILIAC PROSTHESIS,,,21,,RBRVS,16.85 ,5.85 ,5.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35001,CPT,DIR RPR ANEURYSM CAROTID-SUBCLAVIAN ARTERY,,,21,,RBRVS,20.81 ,7.51 ,7.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35002,CPT,DIR RPR RUPTD ANEURYSM CAROTID-SUBCLAVIAN ARTERY,,,21,,RBRVS,22.23 ,6.22 ,6.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35005,CPT,DIR RPR ANEURYSM VERTEBRAL ARTERY,,,21,,RBRVS,19.29 ,8.99 ,8.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35011,CPT,DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION,,,21,,RBRVS,18.58 ,6.73 ,6.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35013,CPT,DIR RPR RUPTD ANEURYSM AXIL-BRACHIAL ARM INCIS,,,21,,RBRVS,23.23 ,8.45 ,8.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35021,CPT,DIR RPR ANEURYSM INNOMINATE/SUBCLAVIAN ARTERY,,,21,,RBRVS,22.17 ,9.35 ,9.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35022,CPT,DIR RPR RUPTD ANEURYSM INNOMINATE/SUBCLAVIAN,,,21,,RBRVS,25.70 ,10.24 ,10.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35045,CPT,DIR RPR RUPTD ANEURYSM RADIAL/ULNAR ARTERY,,,21,,RBRVS,18.01 ,7.22 ,7.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35081,CPT,DIR RPR ANEURYSM ABDOMINAL AORTA,,,21,,RBRVS,33.53 ,10.42 ,10.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35082,CPT,DIR RPR RUPTD ANEURYSM ABDOMINAL AORTA,,,21,,RBRVS,42.09 ,13.08 ,13.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35091,CPT,DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS,,,21,,RBRVS,35.35 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35092,CPT,DIR RPR RUPTD ANEURSM ABDOM AORTA W/VISCERA VSLS,,,21,,RBRVS,50.97 ,14.29 ,14.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35102,CPT,DIR RPR ANEURYSM ABDOM AORTA W/ILIAC VESSELS,,,21,,RBRVS,36.53 ,10.97 ,10.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35103,CPT,DIR RPR RUPTD ANEURYSM ABDOM AORTA W/ILIAC VSLS,,,21,,RBRVS,43.62 ,12.76 ,12.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35111,CPT,DIR RPR ANEURYSM SPLENIC ARTERY,,,21,,RBRVS,26.28 ,12.33 ,12.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35112,CPT,DIR RPR RUPTD ANEURYSM SPLENIC ARTERY,,,21,,RBRVS,32.57 ,14.24 ,14.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35121,CPT,DIR RPR ANEURYSM HEPATIC/CELIAC/RENAL/MESENTERIC,,,21,,RBRVS,31.52 ,9.76 ,9.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35122,CPT,DIR RPR RUPTD ANEURSM HEPATIC/CELIAC/RENAL/MESEN,,,21,,RBRVS,37.89 ,16.42 ,16.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35131,CPT,DIR RPR ANEURYSM & GRAFT ILIAC ARTERY,,,21,,RBRVS,26.40 ,8.62 ,8.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35132,CPT,DIR RPR RUPTD ANEURYSM & GRAFT ILIAC ARTERY,,,21,,RBRVS,32.57 ,8.40 ,8.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35141,CPT,DIR RPR ANEURYSM & GRAFT COMMON FEMORAL ARTERY,,,21,,RBRVS,20.91 ,7.01 ,7.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35142,CPT,DIR RPR RUPTD ANEURYSM & GRF COMMON FEMORAL ART,,,21,,RBRVS,25.16 ,8.21 ,8.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35151,CPT,DIR RPR ANEURYSM & GRAFT POPLITEAL ARTERY,,,21,,RBRVS,23.72 ,7.61 ,7.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35152,CPT,DIR RPR RUPTD ANEURYSM & GRF POPLITEAL ARTERY,,,21,,RBRVS,27.66 ,7.42 ,7.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35180,CPT,REPAIR CONGENITAL AV FISTULA HEAD & NECK,,,21,,RBRVS,15.10 ,9.60 ,9.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35182,CPT,RPR CONGENITAL AV FISTULA THORAX & ABDOMEN,,,21,,RBRVS,31.71 ,13.02 ,13.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35184,CPT,RPR CONGENITAL AV FISTULA EXTREMITIES,,,21,,RBRVS,18.82 ,7.48 ,7.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35188,CPT,RPR/TRAUMATIC AV FISTULA HEAD & NECK,,,21,,RBRVS,18.00 ,12.69 ,12.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35189,CPT,RPR/TRAUMATIC AV FISTULA THORAX & ABDOMEN,,,21,,RBRVS,29.98 ,8.53 ,8.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35190,CPT,RPR/TRAUMATIC AV FISTULA EXTREMITIES,,,21,,RBRVS,13.42 ,5.89 ,5.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35201,CPT,REPAIR BLOOD VESSEL DIRECT NECK,,,21,,RBRVS,16.93 ,7.23 ,7.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35206,CPT,REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY,,,21,,RBRVS,13.84 ,5.88 ,5.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35207,CPT,REPAIR BLOOD VESSEL DIRECT HAND FINGER,,,21,,RBRVS,10.94 ,8.96 ,8.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35211,CPT,RPR BLOOD VESSEL DIRECT INTRATHORACIC W/BYPASS,,,21,,RBRVS,24.58 ,10.11 ,10.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35216,CPT,RPR BLOOD VESSEL DIRECT INTRATHORACIC W/O BYPASS,,,21,,RBRVS,36.61 ,14.85 ,14.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35221,CPT,RPR BLOOD VESSEL DIRECT INTRA-ABDOMINAL,,,21,,RBRVS,26.62 ,9.95 ,9.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35226,CPT,RPR BLOOD VESSEL DIRECT LOWER EXTREMITY,,,21,,RBRVS,15.30 ,5.76 ,5.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35231,CPT,REPAIR BLOOD VESSEL W/VEIN GRAFT NECK,,,21,,RBRVS,21.16 ,10.54 ,10.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35236,CPT,REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY,,,21,,RBRVS,18.02 ,6.87 ,6.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35241,CPT,RPR BLOOD VESSEL VEIN GRAFT INTRATHORACIC W/BYP,,,21,,RBRVS,25.58 ,10.54 ,10.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35246,CPT,RPR BLOOD VESSEL VEIN GRF INTRATHORACIC W/O BYP,,,21,,RBRVS,28.23 ,11.40 ,11.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35251,CPT,REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL,,,21,,RBRVS,31.91 ,10.75 ,10.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35256,CPT,REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY,,,21,,RBRVS,19.06 ,6.69 ,6.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35261,CPT,REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK,,,21,,RBRVS,18.96 ,7.80 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35266,CPT,RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY,,,21,,RBRVS,15.83 ,6.21 ,6.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35271,CPT,RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/BYP,,,21,,RBRVS,24.58 ,10.09 ,10.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35276,CPT,RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/O BYP,,,21,,RBRVS,25.83 ,10.63 ,10.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35281,CPT,RPR BLVSL W/GRFT OTHER/THAN VEIN INTRA-ABDOMINAL,,,21,,RBRVS,30.06 ,10.66 ,10.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35286,CPT,RPR BLVSL W/GRF OTHER/THAN VEIN LOWER EXTREMITY,,,21,,RBRVS,17.19 ,6.49 ,6.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35301,CPT,TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC,,,21,,RBRVS,21.16 ,7.40 ,7.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35302,CPT,TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY,,,21,,RBRVS,21.35 ,7.07 ,7.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35303,CPT,TEAEC W/GRAFT POPLITEAL ARTERY,,,21,,RBRVS,23.60 ,7.85 ,7.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35304,CPT,TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY,,,21,,RBRVS,24.60 ,7.80 ,7.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35305,CPT,TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL,,,21,,RBRVS,23.60 ,7.42 ,7.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35306,CPT,TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART,,,21,,RBRVS,9.25 ,2.17 ,2.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35311,CPT,TEAEC W/WO PATCH GRF SUBCLAV INNOM THORACIC INC,,,21,,RBRVS,28.60 ,7.79 ,7.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35321,CPT,TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL,,,21,,RBRVS,16.59 ,5.90 ,5.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35331,CPT,TEAEC W/WO PATCH GRAFT ABDOMINAL AORTA,,,21,,RBRVS,27.72 ,8.83 ,8.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35341,CPT,TEAEC W/WO PATCH GRAFT MESENTERIC CELIAC/RENAL,,,21,,RBRVS,26.21 ,8.24 ,8.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35351,CPT,TEAEC W/WO PATCH GRAFT ILIAC,,,21,,RBRVS,24.61 ,7.64 ,7.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35355,CPT,TEAEC W/WO PATCH GRAFT ILIOFEMORAL,,,21,,RBRVS,19.86 ,6.25 ,6.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35361,CPT,TEAEC W/WO PATCH GRAFT COMBINED AORTOILIAC,,,21,,RBRVS,30.24 ,8.30 ,8.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35363,CPT,TEAEC W/WO PATCH GRAFT COMBINED AORTOILIOFEMORAL,,,21,,RBRVS,32.35 ,11.70 ,11.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35371,CPT,TEAEC W/WO PATCH GRAFT COMMON FEMORAL,,,21,,RBRVS,15.31 ,5.42 ,5.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35372,CPT,TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL,,,21,,RBRVS,18.58 ,6.21 ,6.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35390,CPT,ROPRTJ CRTD TEAEC > 1 MO AFTER ORIGINAL OPRATIO,,,21,,RBRVS,3.19 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35400,CPT,ANGIOSCOPY NON-CORONARY VESSEL/GRAFTS THER IVNTJ,,,21,,RBRVS,3.00 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35500,CPT,HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX,,,21,,RBRVS,6.44 ,1.51 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35501,CPT,BYPASS W/VEIN COMMON-IPSILATERAL CAROTID,,,21,,RBRVS,29.09 ,8.49 ,8.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35506,CPT,BYPASS W/VEIN CAROTID-SUBCLV/SUBCLAVIAN CAROTID,,,21,,RBRVS,25.33 ,6.56 ,6.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35508,CPT,BYPASS W/VEIN CAROTID-VERTEBRAL,,,21,,RBRVS,26.09 ,7.76 ,7.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35509,CPT,BYPASS W/VEIN CAROTID-CONTRALATERAL CAROTID,,,21,,RBRVS,28.09 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35510,CPT,BYPASS W/VEIN CAROTID-BRACHIAL,,,21,,RBRVS,24.39 ,6.41 ,6.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35511,CPT,BYPASS W/VEIN SUBCLAVIAN-SUBCLAVIAN,,,21,,RBRVS,22.20 ,5.85 ,5.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35512,CPT,BYPASS W/VEIN SUBCLAVIAN-BRACHIAL,,,21,,RBRVS,23.89 ,6.67 ,6.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35515,CPT,BYPASS W/VEIN SUBCLAVIAN-VERTEBRAL,,,21,,RBRVS,26.09 ,12.75 ,12.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35516,CPT,BYPASS W/VEIN SUBCLAVIAN-AXILLARY,,,21,,RBRVS,24.21 ,6.34 ,6.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35518,CPT,BYPASS W/VEIN AXILLARY-AXILLARY,,,21,,RBRVS,22.65 ,6.39 ,6.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35521,CPT,BYPASS W/VEIN AXILLARY-FEMORAL,,,21,,RBRVS,24.13 ,6.85 ,6.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35522,CPT,BYPASS W/VEIN AXILLARY-BRACHIAL,,,21,,RBRVS,23.15 ,7.35 ,7.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35523,CPT,BYPASS W/VEIN BRACHIAL-ULNAR/-RADIAL,,,21,,RBRVS,24.13 ,8.43 ,8.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35525,CPT,BYPASS W/VEIN BRACHIAL-BRACHIAL,,,21,,RBRVS,21.69 ,7.27 ,7.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35526,CPT,BYPASS W/VEIN AORTOSUBCLAV/CAROTID/INNOMINATE,,,21,,RBRVS,31.55 ,11.43 ,11.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35531,CPT,BYPASS W/VEIN AORTOCELIAC/AORTOMESENTERIC,,,21,,RBRVS,39.11 ,11.81 ,11.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35533,CPT,BYPASS W/VEIN AXILLARY-FEMORAL-FEMORAL,,,21,,RBRVS,29.92 ,7.75 ,7.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35535,CPT,BYPASS W/VEIN HEPATORENAL,,,21,,RBRVS,38.13 ,9.74 ,9.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35536,CPT,BYPASS W/VEIN SPLENORENAL,,,21,,RBRVS,33.73 ,8.50 ,8.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35537,CPT,BYPASS W/VEIN AORTOILIAC,,,21,,RBRVS,41.88 ,13.11 ,13.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35538,CPT,BYPASS W/VEIN AORTOBI-ILIAC,,,21,,RBRVS,47.03 ,11.80 ,11.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35539,CPT,BYPASS W/VEIN AORTOFEMORAL,,,21,,RBRVS,44.11 ,11.06 ,11.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35540,CPT,BYPASS W/VEIN AORTOBIFEMORAL,,,21,,RBRVS,49.33 ,11.95 ,11.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35556,CPT,BYPASS W/VEIN FEMORAL-POPLITEAL,,,21,,RBRVS,26.75 ,8.66 ,8.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35558,CPT,BYPASS W/VEIN FEMORAL-FEMORAL,,,21,,RBRVS,23.13 ,8.15 ,8.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35560,CPT,BYPASS W/VEIN AORTORENAL,,,21,,RBRVS,34.03 ,9.08 ,9.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35563,CPT,BYPASS W/VEIN ILIOILIAC,,,21,,RBRVS,26.12 ,7.45 ,7.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35565,CPT,BYPASS W/VEIN ILIOFEMORAL,,,21,,RBRVS,25.13 ,8.31 ,8.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35566,CPT,BYP FEM-ANT TIBL PST TIBL PRONEAL ART/OTH DSTL,,,21,,RBRVS,32.35 ,9.79 ,9.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35570,CPT,BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL,,,21,,RBRVS,29.15 ,9.14 ,9.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35571,CPT,BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL,,,21,,RBRVS,25.52 ,8.05 ,8.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35572,CPT,HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX,,,21,,RBRVS,6.81 ,1.82 ,1.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35583,CPT,IN-SITU VEIN BYPASS FEMORAL-POPLITEAL,,,21,,RBRVS,27.75 ,8.82 ,8.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35585,CPT,IN-SITU FEM-ANT TIBL PST TIBL/PRONEAL ART,,,21,,RBRVS,32.35 ,9.99 ,9.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35587,CPT,IN-SITU VEIN BYP POP-TIBL PRONEAL,,,21,,RBRVS,26.21 ,8.31 ,8.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35600,CPT,HARVEST UPPER EXTREMITY ARTERY 1 SEGMENT CABG,,,21,,RBRVS,4.94 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35601,CPT,BYP OTH/THN VEIN COMMON-IPSILATERAL CAROTID,,,21,,RBRVS,27.09 ,8.27 ,8.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35606,CPT,BYP OTH/THN VEIN CAROTID-SUBCLAVIAN,,,21,,RBRVS,22.46 ,7.17 ,7.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35612,CPT,BYP OTH/THN VEIN SUBCLAVIAN-SUBCLAVIAN,,,21,,RBRVS,20.35 ,6.69 ,6.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35616,CPT,BYP OTH/THN VEIN SUBCLAVIAN-AXILLARY,,,21,,RBRVS,21.82 ,5.80 ,5.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35621,CPT,BYP OTH/THN VEIN AXILLARY-FEMORAL,,,21,,RBRVS,21.03 ,6.71 ,6.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35623,CPT,BYP OTH/THN VEIN AXILLARY-POPLITEAL/-TIBIAL,,,21,,RBRVS,25.92 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35626,CPT,BYPASS NOT VEIN AORTOSUBCLA/CAROTID/INNOMINATE,,,21,,RBRVS,29.14 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35631,CPT,BYP OTH/THN VEIN AORTOCELIAC AORTOMSN AORTORNL,,,21,,RBRVS,36.03 ,10.50 ,10.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35632,CPT,BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC,,,21,,RBRVS,36.13 ,9.12 ,9.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35633,CPT,BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC,,,21,,RBRVS,39.11 ,11.39 ,11.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35634,CPT,BYPASS GRAFT W/OTHER THAN VEIN ILIORENAL,,,21,,RBRVS,35.33 ,8.96 ,8.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35636,CPT,BYP OTH/THN VEIN SPLENORENAL,,,21,,RBRVS,31.75 ,8.30 ,8.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35637,CPT,BYP OTH/THN VEIN AORTOILIAC,,,21,,RBRVS,33.05 ,10.58 ,10.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35638,CPT,BYP OTH/THN VEIN AORTOBI-ILIAC,,,21,,RBRVS,33.60 ,10.86 ,10.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35642,CPT,BYP OTH/THN VEIN CAROTID-VERTEBRAL,,,21,,RBRVS,18.94 ,5.88 ,5.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35645,CPT,BYP OTH/THN VEIN SUBCLAVIAN-VERTEBRAL,,,21,,RBRVS,18.43 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35646,CPT,BYP OTH/THN VEIN AORTOBIFEMORAL,,,21,,RBRVS,32.98 ,10.37 ,10.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35647,CPT,BYP OTH/THN VEIN AORTOFEMORAL,,,21,,RBRVS,29.73 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35650,CPT,BYP OTH/THN VEIN AXILLARY-AXILLARY,,,21,,RBRVS,20.16 ,7.21 ,7.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35654,CPT,BYP OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL,,,21,,RBRVS,26.28 ,8.30 ,8.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35656,CPT,BYP OTH/THN VEIN FEMORAL-POPLITEAL,,,21,,RBRVS,20.47 ,6.99 ,6.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35661,CPT,BYP OTH/THN VEIN FEMORAL-FEMORAL,,,21,,RBRVS,20.35 ,7.15 ,7.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35663,CPT,BYP OTH/THN VEIN ILIOILIAC,,,21,,RBRVS,23.93 ,7.92 ,7.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35665,CPT,BYP OTH/THN VEIN ILIOFEMORAL,,,21,,RBRVS,22.35 ,7.35 ,7.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35666,CPT,BYP OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRONEAL,,,21,,RBRVS,23.66 ,8.49 ,8.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35671,CPT,BYP OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART,,,21,,RBRVS,20.77 ,7.64 ,7.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35681,CPT,BYPASS COMPOSITE GRAFT PROSTHETIC & VEIN,,,21,,RBRVS,1.60 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35682,CPT,BYP AUTOG COMPOSIT 2 SEG VEINS FROM 2 LOCATIONS,,,21,,RBRVS,7.19 ,1.64 ,1.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35683,CPT,BYP AUTOG COMPOSIT 3/> SEG FROM 2/> LOCATION,,,21,,RBRVS,8.49 ,1.76 ,1.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35685,CPT,PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT,,,21,,RBRVS,4.04 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35686,CPT,CRTJ DSTL ARVEN FSTL LXTR BYP SURG NON-HEMO,,,21,,RBRVS,3.34 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35691,CPT,TRPOS&/RIMPLTJ VERTEBRAL CAROTID ART,,,21,,RBRVS,18.41 ,5.88 ,5.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35693,CPT,TRPOS&/RIMPLTJ VERTEBRAL SUBCLAVIAN ART,,,21,,RBRVS,15.73 ,5.32 ,5.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35694,CPT,TRPOS&/RIMPLTJ SUBCLAVIAN CAROTID ART,,,21,,RBRVS,19.28 ,5.57 ,5.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35695,CPT,TRPOS&/RIMPLTJ CAROTID SUBCLAVIAN ART,,,21,,RBRVS,20.06 ,6.46 ,6.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35697,CPT,RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART,,,21,,RBRVS,3.00 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35700,CPT,ROPRTJ > 1 MO AFTER ORIGINAL OPRATION,,,21,,RBRVS,3.08 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35701,CPT,EXPL N/FLWD SURG RPR W/WO LYSIS CAROTID ARTERY,,,21,,RBRVS,9.19 ,5.70 ,5.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35721,CPT,EXPL N/FLWD SURG RPR W/WO LYSIS FEMORAL ARTERY,,,21,,RBRVS,7.72 ,3.96 ,3.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35741,CPT,EXPL N/FLWD SURG RPR W/WO LYSIS POPLITEAL ARTERY,,,21,,RBRVS,8.69 ,4.56 ,4.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35761,CPT,EXPL N/FLWD SURG RPR W/WO LYSIS OTHER ARTERY,,,21,,RBRVS,5.93 ,4.23 ,4.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35800,CPT,EXPL PO HEMRRG THROMBOSIS/INFCTJ NCK,,,21,,RBRVS,12.00 ,6.47 ,6.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35820,CPT,EXPL PO HEMRRG THROMBOSIS/INFCTJ CH,,,21,,RBRVS,36.89 ,13.34 ,13.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35840,CPT,EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD,,,21,,RBRVS,20.75 ,9.27 ,9.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35860,CPT,EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR,,,21,,RBRVS,15.25 ,6.07 ,6.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35870,CPT,RPR GRF-ENTERIC FSTL,,,21,,RBRVS,24.50 ,6.74 ,6.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35875,CPT,THRMBC ARTL/VEN GRF OTH/THN HEMO GRF/FSTL,,,21,,RBRVS,10.72 ,4.39 ,4.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35876,CPT,THRMBC ARTL/VEN GRF XCP HEMO GRF/FSTL W/REVJ GRF,,,21,,RBRVS,17.82 ,6.10 ,6.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35879,CPT,REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP,,,21,,RBRVS,17.41 ,5.97 ,5.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35881,CPT,REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS,,,21,,RBRVS,19.35 ,6.46 ,6.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35883,CPT,REVISION FEMORAL ANAST OPEN NONAUTOG GRAFT,,,21,,RBRVS,23.15 ,7.36 ,7.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35884,CPT,REVISION FEMORAL ANAST OPEN W/AUTOG GRAFT,,,21,,RBRVS,24.65 ,6.40 ,6.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35901,CPT,EXCISION INFECTED NECK GRAFT,,,21,,RBRVS,8.38 ,3.69 ,3.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35903,CPT,EXCISION INFECTED GRAFT EXTREMITY,,,21,,RBRVS,9.53 ,4.96 ,4.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 35905,CPT,EXCISION INFECTED GRAFT THORAX,,,21,,RBRVS,33.52 ,8.68 ,8.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 35907,CPT,EXCISION INFECTED GRAFT ABDOMEN,,,21,,RBRVS,37.27 ,10.74 ,10.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 36000,CPT,INTRODUCTION NEEDLE/INTRACATHETER VEIN,,,21,,RBRVS,0.18 ,0.07 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36002,CPT,INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM,,,21,,RBRVS,1.96 ,0.86 ,2.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36005,CPT,NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH,,,21,,RBRVS,0.95 ,0.31 ,8.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36010,CPT,INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA,,,21,,RBRVS,2.43 ,0.74 ,11.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36011,CPT,SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH,,,21,,RBRVS,3.14 ,0.97 ,20.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36012,CPT,SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC,,,21,,RBRVS,3.51 ,1.07 ,20.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36013,CPT,INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY,,,21,,RBRVS,2.52 ,0.80 ,19.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36014,CPT,SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY,,,21,,RBRVS,3.02 ,0.97 ,19.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36015,CPT,SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART,,,21,,RBRVS,3.51 ,1.12 ,20.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36100,CPT,INTRO NEEDLE/INTRACATH CAROTID/VERTEBRAL ARTERY,,,21,,RBRVS,3.02 ,0.91 ,10.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36120,CPT,INTRO NEEDLE/INTRACATH RETROGRADE BRACHIAL ART,,,21,,RBRVS,2.01 ,0.55 ,9.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36140,CPT,INTRO NEEDLE/INTRACATH EXTREMITY ARTERY,,,21,,RBRVS,2.01 ,0.60 ,10.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36160,CPT,INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR,,,21,,RBRVS,2.52 ,0.79 ,11.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36200,CPT,INTRODUCTION CATHETER AORTA,,,21,,RBRVS,3.02 ,0.82 ,14.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36215,CPT,SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH,,,21,,RBRVS,4.67 ,1.48 ,26.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36216,CPT,SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH,,,21,,RBRVS,5.27 ,1.74 ,27.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36217,CPT,SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH,,,21,,RBRVS,6.29 ,2.06 ,48.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36218,CPT,SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH,,,21,,RBRVS,1.01 ,0.35 ,4.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36221,CPT,NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART,,,21,,RBRVS,4.17 ,1.26 ,26.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36222,CPT,SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART,,,21,,RBRVS,5.53 ,1.91 ,30.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36223,CPT,SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART,,,21,,RBRVS,6.00 ,2.14 ,36.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36224,CPT,SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART,,,21,,RBRVS,6.50 ,2.52 ,43.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36225,CPT,SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY,,,21,,RBRVS,6.00 ,2.06 ,35.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36226,CPT,SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY,,,21,,RBRVS,6.50 ,2.53 ,44.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36227,CPT,SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC,,,21,,RBRVS,2.09 ,0.77 ,4.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36228,CPT,SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT,,,21,,RBRVS,4.25 ,1.59 ,29.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36245,CPT,SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH,,,21,,RBRVS,4.90 ,1.63 ,33.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36246,CPT,SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH,,,21,,RBRVS,5.27 ,1.57 ,19.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36247,CPT,SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH,,,21,,RBRVS,6.29 ,1.89 ,37.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36248,CPT,SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH,,,21,,RBRVS,1.01 ,0.32 ,3.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36251,CPT,SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN,,,21,,RBRVS,5.35 ,1.80 ,34.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36252,CPT,SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL,,,21,,RBRVS,6.99 ,2.41 ,35.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36253,CPT,SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I,,,21,,RBRVS,7.55 ,2.52 ,56.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36254,CPT,SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I,,,21,,RBRVS,8.15 ,2.78 ,52.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36260,CPT,INSJ IMPLANTABLE INTRA-ARTERIAL INFUSION PUM,,,21,,RBRVS,9.91 ,5.93 ,5.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36261,CPT,REVJ IMPLANTED INTRA-ARTERIAL INFUSION PUMP,,,21,,RBRVS,5.63 ,4.60 ,4.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36262,CPT,REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP,,,21,,RBRVS,4.11 ,3.77 ,3.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36299,CPT,UNLISTED PROCEDURE VASCULAR INJECTION,,,21,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36400,CPT,VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN,,,21,,RBRVS,0.38 ,0.15 ,0.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36405,CPT,VNPNXR <3 YEARS PHYS/QHP SKILL SCALP VEIN,,,21,,RBRVS,0.31 ,0.13 ,0.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36406,CPT,VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN,,,21,,RBRVS,0.18 ,0.04 ,0.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36410,CPT,VNPNXR 3 YEARS/> PHYS/QHP SKILL,,,21,,RBRVS,0.18 ,0.07 ,0.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36415,CPT,COLLECTION VENOUS BLOOD VENIPUNCTURE,,,17,,TotalUnits,,,,0.08 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36416,CPT,COLLECTION CAPILLARY BLOOD SPECIMEN,,,17,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36420,CPT,VENIPUNCTURE CUTDOWN UNDER AGE 1 YR,,,21,,RBRVS,1.01 ,0.36 ,0.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36425,CPT,VENIPUNCTURE CUTDOWN AGE 1 YR/>,,,21,,RBRVS,0.76 ,0.29 ,0.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36430,CPT,TRANSFUSION BLOOD/BLOOD COMPONENTS,,,21,,RBRVS,,0.96 ,0.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36440,CPT,PUSH TRANSFUSION BLOOD 2 YR/UNDER,,,21,,RBRVS,1.03 ,0.52 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36450,CPT,EXCHNG TRANSFUSION BLOOD NEWBORN,,,21,,RBRVS,2.23 ,0.85 ,0.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36455,CPT,EXCHNG TRANSFUSION BLOOD OTHER/THAN NEW BORN,,,21,,RBRVS,2.43 ,0.73 ,0.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36456,CPT,PRTL EXCHANGE TRANSFUSE NB,,,21,,RBRVS,2.00 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36460,CPT,TRANSFUSION INTRAUTERINE FETAL,,,21,,RBRVS,6.58 ,2.48 ,2.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36468,CPT,1/MLT NJXS SCLRSG SLNS SPIDER VEINS LIMB/TRUNK,,,21,,TotalUnits,,,,2.06 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36470,CPT,NJX SCLEROSING SOLUTION SINGLE VEIN,,,21,,RBRVS,1.10 ,1.12 ,2.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36471,CPT,NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG,,,21,,RBRVS,1.65 ,0.96 ,3.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36473,CPT,ENDOVENOUS MCHNCHEM 1ST VEIN,,,21,,RBRVS,3.50 ,0.95 ,38.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36474,CPT,ENDOVENOUS MCHNCHEM ADD-ON,,,21,,RBRVS,1.75 ,0.48 ,5.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36475,CPT,ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN,,,21,,RBRVS,5.30 ,1.81 ,37.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36476,CPT,ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS,,,21,,RBRVS,2.65 ,0.77 ,5.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36478,CPT,ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN,,,21,,RBRVS,5.30 ,1.81 ,28.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36479,CPT,ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS,,,21,,RBRVS,2.65 ,0.81 ,5.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36481,CPT,PRQ PORTAL VEIN CATHETERIZATION ANY METHOD,,,21,,RBRVS,6.98 ,2.49 ,50.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36500,CPT,VEN CATHJ SLCTV ORGAN BLD SAMPLING,,,21,,RBRVS,3.51 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36510,CPT,CATHJ UMBILICAL VEIN DX/THER NB,,,21,,RBRVS,1.09 ,0.41 ,1.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36511,CPT,THERAPEUTIC APHERESIS WHITE BLOOD CELLS,,,21,,RBRVS,1.74 ,0.83 ,0.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36512,CPT,THERAPEUTIC APHERESIS RED BLOOD CELLS,,,21,,RBRVS,1.74 ,0.85 ,0.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36513,CPT,THERAPEUTIC APHERESIS PLATELETS,,,21,,RBRVS,1.74 ,0.81 ,0.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36514,CPT,THERAPEUTIC APHERESIS PLASMA PHERESIS,,,21,,RBRVS,1.74 ,0.77 ,13.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36515,CPT,THER APHERESIS W/XTRCORP IMMUNODSPTJ& PLSM RENFJ,,,21,,RBRVS,1.74 ,0.57 ,56.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36516,CPT,THER APHRS XTRCORP SLCTV ADSRPJ/FILTRJ & REINFSJ,,,21,,RBRVS,1.22 ,0.49 ,57.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36522,CPT,PHOTOPHERESIS EXTRACORPOREAL,,,21,,RBRVS,1.67 ,1.14 ,37.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36555,CPT,INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y,,,21,,RBRVS,2.68 ,0.51 ,4.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36556,CPT,INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>,,,21,,RBRVS,2.50 ,0.70 ,3.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36557,CPT,INSERT TUNNELED CVC W/O SUBQ PORT/PMP AGE <5 YR,,,21,,RBRVS,5.14 ,3.20 ,22.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36558,CPT,INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>,,,21,,RBRVS,4.84 ,2.54 ,16.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36560,CPT,INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR,,,21,,RBRVS,6.29 ,3.59 ,30.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36561,CPT,INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>,,,21,,RBRVS,6.04 ,3.19 ,26.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36563,CPT,INSJ TUNNELED CTR VAD W/SUBQ PUMP,,,21,,RBRVS,6.24 ,3.42 ,30.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36565,CPT,INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP,,,21,,RBRVS,6.04 ,2.80 ,20.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36566,CPT,INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT,,,21,,RBRVS,6.54 ,3.35 ,147.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36568,CPT,INSJ PRPH CVC W/O SUBQ PORT/PMP UNDER 5 YR,,,21,,RBRVS,1.92 ,0.72 ,6.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36569,CPT,INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>,,,21,,RBRVS,1.82 ,0.67 ,5.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36570,CPT,INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR,,,21,,RBRVS,5.36 ,3.06 ,27.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36571,CPT,INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>,,,21,,RBRVS,5.34 ,3.01 ,30.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36575,CPT,RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP,,,21,,RBRVS,0.67 ,0.26 ,3.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36576,CPT,RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT,,,21,,RBRVS,3.24 ,1.89 ,7.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36578,CPT,RPLCMT CATH CTR VAD SUBQ PORT/PMP,,,21,,RBRVS,3.54 ,2.19 ,10.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36580,CPT,RPLCMT COMPL NON-TUN CVC W/O SUBQ PORT/PMP,,,21,,RBRVS,1.31 ,0.48 ,4.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36581,CPT,RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP,,,21,,RBRVS,3.48 ,1.80 ,18.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36582,CPT,RPLCMT COMPL TUN CTR VAD W/SUBQ PORT,,,21,,RBRVS,5.24 ,2.75 ,25.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36583,CPT,RPLCMT COMPL TUN CTR VAD W/SUBQ PMP,,,21,,RBRVS,5.29 ,3.27 ,32.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36584,CPT,RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP,,,21,,RBRVS,1.20 ,0.62 ,4.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36585,CPT,RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT,,,21,,RBRVS,4.84 ,2.65 ,27.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36589,CPT,RMVL TUN CVC W/O SUBQ PORT/PMP,,,21,,RBRVS,2.28 ,1.38 ,2.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36590,CPT,RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ,,,21,,RBRVS,3.35 ,1.98 ,4.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36591,CPT,COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE,,TC,21,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36592,CPT,COLLECT BLOOD FROM CATHETER VENOUS NOS,,TC,21,,RBRVS,,0.73 ,0.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36593,CPT,DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH,,TC,21,,RBRVS,,0.86 ,0.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36595,CPT,MCHNL RMVL PRICATH OBSTR CV DEV VIA VEN ACCESS,,,21,,RBRVS,3.59 ,1.37 ,12.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36596,CPT,MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN,,,21,,RBRVS,0.75 ,0.45 ,2.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36597,CPT,RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE,,,21,,RBRVS,1.21 ,0.45 ,2.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36598,CPT,CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT,,,21,,RBRVS,0.74 ,0.26 ,2.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36600,CPT,ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX,,,21,,RBRVS,0.32 ,0.10 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36620,CPT,ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ,,,21,,RBRVS,1.15 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36625,CPT,ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX CUTDOWN,,,21,,RBRVS,2.11 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36640,CPT,ARTL CATHJ PROLNG NFS THER CHEMOTX CUTDOWN,,,21,,RBRVS,2.10 ,1.16 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36660,CPT,CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY,,,21,,RBRVS,1.40 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 36680,CPT,PLACEMENT NEEDLE INTRAOSSEOUS INFUSION,,,21,,RBRVS,1.20 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36800,CPT,INSJ CANNULA HEMO OTH PURPOSE SPX VEIN VEIN,,,21,,RBRVS,2.43 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36810,CPT,INSJ CANNULA HEMO OTH PURPOSE SPX ARVEN XTRNL,,,21,,RBRVS,3.96 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36815,CPT,INSJ CANNULA HEMO OTH SPX ARVEN XTRNL REVJ/CLSR,,,21,,RBRVS,2.62 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36818,CPT,ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS,,,21,,RBRVS,12.39 ,5.23 ,5.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36819,CPT,ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS,,,21,,RBRVS,13.29 ,5.29 ,5.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36820,CPT,ARVEN ANAST OPN F/ARM VEIN TRPOS,,,21,,RBRVS,13.07 ,5.49 ,5.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36821,CPT,ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT,,,21,,RBRVS,11.90 ,4.98 ,4.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36823,CPT,INSJ CNULA ISLTD XC-CIRCJ REG CHEMOTX XTR RMVL,,,21,,RBRVS,22.98 ,10.95 ,10.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 36825,CPT,CRTJ ARVEN FSTL XCP DIR ARVEN ANAST AUTOG GRF,,,21,,RBRVS,14.17 ,6.22 ,6.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36830,CPT,CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF,,,21,,RBRVS,12.03 ,4.94 ,4.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36831,CPT,THRMBC OPN ARVEN FSTL W/O REVJ DIAL GRF,,,21,,RBRVS,11.00 ,4.69 ,4.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36832,CPT,REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF,,,21,,RBRVS,13.50 ,5.77 ,5.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36833,CPT,REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF,,,21,,RBRVS,14.50 ,6.15 ,6.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36835,CPT,INSERTION THOMAS SHUNT SEPARATE PROCEDURE,,,21,,RBRVS,7.51 ,5.11 ,5.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36838,CPT,DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS,,,21,,RBRVS,21.69 ,7.13 ,7.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36860,CPT,XTRNL CANNULA DECLTNG SPX W/O BALO CATH,,,21,,RBRVS,2.01 ,1.01 ,3.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36861,CPT,XTRNL CANNULA DECLTNG SPX W/BALO CATH,,,21,,RBRVS,2.52 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36901,CPT,INTRO CATH DIALYSIS CIRCUIT,,,21,,RBRVS,2.82 ,0.92 ,12.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36902,CPT,INTRO CATH DIALYSIS CIRCUIT,,,21,,RBRVS,4.24 ,1.33 ,29.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36903,CPT,INTRO CATH DIALYSIS CIRCUIT,,,21,,RBRVS,5.85 ,1.77 ,150.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36904,CPT,THRMBC/NFS DIALYSIS CIRCUIT,,,21,,RBRVS,6.73 ,2.04 ,42.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36905,CPT,THRMBC/NFS DIALYSIS CIRCUIT,,,21,,RBRVS,8.46 ,2.54 ,54.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36906,CPT,THRMBC/NFS DIALYSIS CIRCUIT,,,21,,RBRVS,9.88 ,2.95 ,179.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 36907,CPT,BALO ANGIOP CTR DIALYSIS SEG,,,21,,RBRVS,2.48 ,0.72 ,17.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36908,CPT,STENT PLMT CTR DIALYSIS SEG,,,21,,RBRVS,3.73 ,1.06 ,71.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 36909,CPT,DIALYSIS CIRCUIT EMBOLJ,,,21,,RBRVS,3.48 ,1.08 ,51.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 37140,CPT,VENOUS ANASTOMOSIS OPEN PORTOCAVAL,,,21,,RBRVS,40.00 ,17.19 ,17.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 37145,CPT,VENOUS ANASTOMOSIS OPEN RENOPORTAL,,,21,,RBRVS,37.00 ,16.49 ,16.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 37160,CPT,VENOUS ANASTOMOSIS OPEN CAVAL-MESENTERIC,,,21,,RBRVS,38.00 ,16.95 ,16.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 37180,CPT,VENOUS ANASTOMOSIS OPEN SPLENORENAL PROXIMAL,,,21,,RBRVS,36.50 ,15.87 ,15.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 37181,CPT,VENOUS ANASTOMOSIS OPEN SPLENORENAL DISTAL,,,21,,RBRVS,40.00 ,17.83 ,17.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 37182,CPT,INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT,,,21,,RBRVS,16.97 ,5.80 ,5.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 37183,CPT,REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT,,,21,,RBRVS,7.99 ,2.76 ,159.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37184,CPT,PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST,,,21,,RBRVS,8.66 ,3.05 ,54.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37185,CPT,PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ,,,21,,RBRVS,3.28 ,0.94 ,16.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37186,CPT,SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL,,,21,,RBRVS,4.92 ,1.40 ,33.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37187,CPT,PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN,,,21,,RBRVS,8.03 ,2.58 ,49.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37188,CPT,PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX,,,21,,RBRVS,5.71 ,2.04 ,44.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37191,CPT,INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I,,,21,,RBRVS,4.71 ,1.58 ,69.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37192,CPT,REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&,,,21,,RBRVS,7.35 ,2.12 ,35.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37193,CPT,RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I,,,21,,RBRVS,7.35 ,2.30 ,37.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37195,CPT,THROMBOLYSIS CEREBRAL IV INFUSION,,,21,,TotalUnits,,,,6.86 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37197,CPT,PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING,,,21,,RBRVS,6.29 ,1.95 ,36.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37200,CPT,TRANSCATHETER BIOPSY,,,21,,RBRVS,4.55 ,1.45 ,1.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37211,CPT,THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX,,,21,,RBRVS,8.00 ,2.32 ,2.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37212,CPT,THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX,,,21,,RBRVS,7.06 ,2.06 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37213,CPT,THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX,,,21,,RBRVS,5.00 ,1.50 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37214,CPT,CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL,,,21,,RBRVS,2.74 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37215,CPT,TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ,,,21,,RBRVS,18.00 ,7.27 ,7.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 37216,CPT,TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ,,,21,,TotalUnits,,,,29.40 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37217,CPT,TCATH STENT PLACEMT RETROGRAD CAROTID/INNOMINATE,,,21,,RBRVS,20.38 ,7.34 ,7.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 37218,CPT,TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE,,,21,,RBRVS,15.00 ,6.02 ,6.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 37220,CPT,REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL,,,21,,RBRVS,8.15 ,2.33 ,80.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37221,CPT,REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY,,,21,,RBRVS,10.00 ,2.91 ,120.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37222,CPT,REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL,,,21,,RBRVS,3.73 ,0.97 ,20.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37223,CPT,REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL,,,21,,RBRVS,4.25 ,1.16 ,68.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37224,CPT,REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI,,,21,,RBRVS,9.00 ,2.61 ,98.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37225,CPT,REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL,,,21,,RBRVS,12.00 ,3.62 ,299.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37226,CPT,REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL,,,21,,RBRVS,10.49 ,3.07 ,245.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37227,CPT,REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL,,,21,,RBRVS,14.50 ,4.27 ,406.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37228,CPT,REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI,,,21,,RBRVS,11.00 ,3.12 ,142.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37229,CPT,REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL,,,21,,RBRVS,14.05 ,4.18 ,292.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37230,CPT,REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL,,,21,,RBRVS,13.80 ,4.15 ,219.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37231,CPT,REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL,,,21,,RBRVS,15.00 ,4.55 ,362.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37232,CPT,REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL,,,21,,RBRVS,4.00 ,1.13 ,29.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37233,CPT,REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL,,,21,,RBRVS,6.50 ,1.83 ,33.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37234,CPT,REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL,,,21,,RBRVS,5.50 ,1.66 ,103.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37235,CPT,REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP EA VSL,,,21,,RBRVS,7.80 ,2.49 ,107.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37236,CPT,OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL,,,21,,RBRVS,9.00 ,2.75 ,106.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37237,CPT,OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL,,,21,,RBRVS,4.25 ,1.17 ,65.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37238,CPT,OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST,,,21,,RBRVS,6.29 ,1.94 ,112.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37239,CPT,OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL,,,21,,RBRVS,2.97 ,0.84 ,54.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37241,CPT,VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I,,,21,,RBRVS,9.00 ,2.80 ,125.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37242,CPT,VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I,,,21,,RBRVS,10.05 ,3.15 ,207.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37243,CPT,VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT,,,21,,RBRVS,11.99 ,3.85 ,264.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37244,CPT,VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE,,,21,,RBRVS,14.00 ,4.49 ,178.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37246,CPT,TRLUML BALO ANGIOP 1ST ART,,,21,,RBRVS,7.00 ,2.09 ,52.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37247,CPT,TRLUML BALO ANGIOP ADDL ART,,,21,,RBRVS,3.50 ,1.00 ,20.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 37248,CPT,TRLUML BALO ANGIOP 1ST VEIN,,,21,,RBRVS,6.00 ,1.82 ,34.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37249,CPT,TRLUML BALO ANGIOP ADDL VEIN,,,21,,RBRVS,2.97 ,0.86 ,14.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 37252,CPT,INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL,,,21,,RBRVS,1.80 ,0.50 ,37.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 37253,CPT,INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL,,,21,,RBRVS,1.44 ,0.39 ,4.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 37500,CPT,VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX,,,21,,RBRVS,11.67 ,7.77 ,7.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37501,CPT,UNLISTED VASCULAR ENDOSCOPY PROCEDURE,,,21,,TotalUnits,,,,18.98 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37565,CPT,LIGATION INTERNAL JUGULAR VEIN,,,21,,RBRVS,12.05 ,6.83 ,6.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37600,CPT,LIGATION EXTERNAL CAROTID ARTERY,,,21,,RBRVS,12.42 ,5.80 ,5.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37605,CPT,LIGATION INTERNAL/COMMON CAROTID ARTERY,,,21,,RBRVS,14.28 ,5.82 ,5.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37606,CPT,LIG INT/COMMON CAROTID ART W/GRADUAL OCCLUSION,,,21,,RBRVS,8.81 ,6.09 ,6.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37607,CPT,LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA,,,21,,RBRVS,6.25 ,3.38 ,3.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37609,CPT,LIGATION/BIOPSY TEMPORAL ARTERY,,,21,,RBRVS,3.05 ,2.35 ,5.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37615,CPT,LIGATION MAJOR ARTERY NECK,,,21,,RBRVS,7.80 ,5.86 ,5.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37616,CPT,LIGATION MAJOR ARTERY CHEST,,,21,,RBRVS,18.97 ,8.75 ,8.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 37617,CPT,LIGATION MAJOR ARTERY ABDOMEN,,,21,,RBRVS,23.79 ,9.92 ,9.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 37618,CPT,LIGATION MAJOR ARTERY EXTREMITY,,,21,,RBRVS,6.03 ,3.85 ,3.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 37619,CPT,INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I,,,21,,RBRVS,30.00 ,11.07 ,11.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37650,CPT,REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&,,,21,,RBRVS,8.49 ,4.45 ,4.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37660,CPT,RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I,,,21,,RBRVS,22.28 ,6.55 ,6.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 37700,CPT,LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ,,,21,,RBRVS,3.82 ,2.63 ,2.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37718,CPT,LIGJ DIVJ & STRIPPING SHORT SAPHENOUS VEIN,,,21,,RBRVS,7.13 ,4.05 ,4.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37722,CPT,LIGJ DIVJ&STRIP LONG SAPH SAPHFEM JUNCT KNE/BELW,,,21,,RBRVS,8.16 ,4.04 ,4.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37735,CPT,LIGJ & DIVJ RADICAL STRIP LONG/SHORT SAPHENOUS,,,21,,RBRVS,10.90 ,6.64 ,6.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37760,CPT,LIG PRFRATR VEIN SUBFSCAL RAD INCL SKN GRF 1 LEG,,,21,,RBRVS,10.78 ,4.86 ,4.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37761,CPT,LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG,,,21,,RBRVS,9.13 ,5.00 ,5.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37765,CPT,STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS,,,21,,RBRVS,7.71 ,3.89 ,9.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37766,CPT,STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS,,,21,,RBRVS,9.66 ,4.48 ,10.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37780,CPT,LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX,,,21,,RBRVS,3.93 ,2.63 ,2.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37785,CPT,LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG,,,21,,RBRVS,3.93 ,2.87 ,5.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37788,CPT,PENILE REVASCULARIZATION ARTERY W/WO VEIN GRAFT,,,21,,RBRVS,23.33 ,11.01 ,11.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 37790,CPT,PENILE VENOUS OCCLUSIVE PROCEDURE,,,21,,RBRVS,8.43 ,4.86 ,4.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 37799,CPT,UNLISTED PROCEDURE VASCULAR SURGERY,,,21,,TotalUnits,,,,0.08 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38100,CPT,SPLENECTOMY TOTAL SEPARATE PROCEDURE,,,21,,RBRVS,19.55 ,9.37 ,9.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 38101,CPT,SPLENECTOMY TOTAL EN BLOC W/OTHER PROCEDURE,,,21,,RBRVS,19.55 ,9.59 ,9.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 38102,CPT,SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX,,,21,,RBRVS,4.79 ,1.74 ,1.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 38115,CPT,RPR RPTD SPLEEN SPLENORRHAPHY W/WO PRTL SPLENECT,,,21,,RBRVS,21.88 ,10.07 ,10.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 38120,CPT,LAPAROSCOPIC SURGICAL SPLENECTOMY,,,21,,RBRVS,17.07 ,9.43 ,9.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38129,CPT,UNLISTED LAPAROSCOPY PROCEDURE SPLEEN,,,21,,TotalUnits,,,,26.50 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38200,CPT,INJECTION PROCEDURE SPLENOPORTOGRAPY,,,21,,RBRVS,2.64 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38204,CPT,MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ,,,21,,RBRVS,2.00 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38205,CPT,BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC,,,21,,RBRVS,1.50 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38206,CPT,BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL,,,21,,RBRVS,1.50 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38207,CPT,TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR,,,21,,RBRVS,0.89 ,0.34 ,0.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 38208,CPT,TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR,,,21,,RBRVS,0.56 ,0.21 ,0.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 38209,CPT,TRNSP PREP HMATOP PROG THAW PREV HRV WSH PER DNR,,,21,,RBRVS,0.24 ,0.09 ,0.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 38210,CPT,TRNSPL PREPJ HEMATOP PROGEN DEPLJ IN HRV T-CELL,,,21,,RBRVS,1.57 ,0.60 ,0.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 38211,CPT,TRNSPL PREPJ HEMATOP PROGEN TUM CELL DEPLJ,,,21,,RBRVS,1.42 ,0.54 ,0.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 38212,CPT,TRNSPL PREPJ HEMATOP PROGEN RED BLD CELL RMVL,,,21,,RBRVS,0.94 ,0.36 ,0.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 38213,CPT,TRNSPL PREPJ HEMATOP PROGEN PLTLT DEPLJ,,,21,,RBRVS,0.24 ,0.09 ,0.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 38214,CPT,TRNSPL PREPJ HEMATOP PROGEN PLSM VOL DEPLJ,,,21,,RBRVS,0.81 ,0.31 ,0.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 38215,CPT,TRNSPL PREPJ HEMATOP PROGEN CONCENTRATION PLSM,,,21,,RBRVS,0.94 ,0.36 ,0.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 38220,CPT,MARROW ASPIRATION ONLY,,,21,,RBRVS,1.08 ,0.55 ,3.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38221,CPT,BONE MARROW BIOPSY NEEDLE/TROCAR,,,21,,RBRVS,1.37 ,0.69 ,3.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38230,CPT,BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC,,,21,,RBRVS,3.50 ,1.78 ,1.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38232,CPT,BONE MARROW HARVEST TRANSPLANTATION AUTOLOGOUS,,,21,,RBRVS,3.50 ,1.76 ,1.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38240,CPT,TRNSPLJ ALLOGENEIC HEMATOPOIETIC CELLS PER DONOR,,,21,,RBRVS,4.00 ,2.17 ,2.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38241,CPT,TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR,,,21,,RBRVS,3.00 ,1.63 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38242,CPT,ALLOGENEIC LYMPHOCYTE INFUSIONS,,,21,,RBRVS,2.11 ,1.14 ,1.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38243,CPT,TRNSPLJ HEMATOPOIETIC CELL BOOST,,,21,,RBRVS,2.13 ,1.11 ,1.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38300,CPT,DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL,,,21,,RBRVS,2.36 ,2.50 ,5.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38305,CPT,DRG LYMPH NODE ABSC/LYMPHADENITIS EXTNSV,,,21,,RBRVS,6.68 ,5.54 ,5.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38308,CPT,LYMPHANGIOTOMY/OTH OPRATIONS LYMPHATIC CHANNELS,,,21,,RBRVS,6.81 ,4.52 ,4.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38380,CPT,SUTR&/LIG THORACIC DUCT CERVICAL APPROACH,,,21,,RBRVS,8.46 ,6.76 ,6.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 38381,CPT,SUTR&/LIG THORACIC DUCT THORACIC APPROACH,,,21,,RBRVS,13.38 ,6.79 ,6.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 38382,CPT,SUTR&/LIG THORACIC DUCT ABDOMINAL APPROACH,,,21,,RBRVS,10.65 ,4.96 ,4.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 38500,CPT,BX/EXC LYMPH NODE OPEN SUPERFICIAL,,,21,,RBRVS,3.79 ,2.68 ,4.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38505,CPT,BX/EXC LYMPH NODE NEEDLE SUPERFICIAL,,,21,,RBRVS,1.14 ,0.81 ,2.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38510,CPT,BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE,,,21,,RBRVS,6.74 ,4.12 ,6.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38520,CPT,BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD,,,21,,RBRVS,7.03 ,4.89 ,4.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38525,CPT,BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE,,,21,,RBRVS,6.43 ,4.65 ,4.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38530,CPT,BX/EXC LYMPH NODE OPEN INT MAMMARY NODE,,,21,,RBRVS,8.34 ,5.75 ,5.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38542,CPT,DISSECTION DEEP JUGULAR NODE,,,21,,RBRVS,7.95 ,5.66 ,5.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38550,CPT,EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ,,,21,,RBRVS,7.11 ,5.82 ,5.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38555,CPT,EXC CSTIC HYGROMA AX/CRV W/DP NEUROVASC DSJ,,,21,,RBRVS,15.59 ,9.74 ,9.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38562,CPT,LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC,,,21,,RBRVS,11.06 ,7.04 ,7.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 38564,CPT,LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC,,,21,,RBRVS,11.38 ,6.47 ,6.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 38570,CPT,LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT,,,21,,RBRVS,8.49 ,4.61 ,4.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38571,CPT,LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY,,,21,,RBRVS,12.00 ,5.67 ,5.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38572,CPT,LAPS BI TOT PEL LMPHADEC & PRI-AORTIC LYMPH BX 1,,,21,,RBRVS,15.60 ,8.20 ,8.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38589,CPT,UNLISTED LAPAROSCOPY PX LYMPHATIC SYSTEM,,,21,,TotalUnits,,,,17.67 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38700,CPT,SUPRAHYOID LYMPHADENECTOMY,,,21,,RBRVS,12.81 ,8.56 ,8.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38720,CPT,CERVICAL LYMPHADENECTOMY,,,21,,RBRVS,21.95 ,13.34 ,13.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38724,CPT,CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ,,,21,,RBRVS,23.95 ,14.51 ,14.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 38740,CPT,AXILLARY LYMPHADENECTOMY SUPERFICIAL,,,21,,RBRVS,10.70 ,6.84 ,6.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38745,CPT,AXILLARY LYMPHADENECTOMY COMPLETE,,,21,,RBRVS,13.87 ,8.21 ,8.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38746,CPT,THORCOM THRC W/MEDSTNL & REGIONAL LMPHADEC,,,21,,RBRVS,4.12 ,1.20 ,1.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 38747,CPT,ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC,,,21,,RBRVS,4.88 ,1.74 ,1.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 38760,CPT,INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX,,,21,,RBRVS,13.62 ,7.73 ,7.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38765,CPT,INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC,,,21,,RBRVS,21.91 ,10.86 ,10.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 38770,CPT,PEL LMPHADEC W/XTRNL ILIAC HYPOGSTR&OBTURATOR,,,21,,RBRVS,14.06 ,7.10 ,7.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 38780,CPT,RPR TABDL LMPHADEC EXTNSV W/PEL AORTIC&RNL,,,21,,RBRVS,17.70 ,9.07 ,9.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 38790,CPT,INJECTION PROCEDURE LYMPHANGIOGRAPHY,,,21,,RBRVS,1.29 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38792,CPT,INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE,,,21,,RBRVS,0.52 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38794,CPT,CANNULATION THORACIC DUCT,,,21,,RBRVS,4.62 ,3.60 ,3.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 38900,CPT,INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION,,,21,,RBRVS,2.50 ,0.91 ,0.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 38999,CPT,UNLISTED PROCEDURE HEMIC OR LYMPHATIC SYSTEM,,,21,,TotalUnits,,,,2.95 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 39000,CPT,MEDIAST W/EXPL DRG RMVL FB/BX CRV APPR,,,21,,RBRVS,7.57 ,5.19 ,5.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 39010,CPT,MEDIAST W/EXPL DRG RMVL FB/BX TTHRC APPR,,,21,,RBRVS,13.19 ,6.65 ,6.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 39200,CPT,RESECTION OF MEDIASTINAL CYST,,,21,,RBRVS,15.09 ,7.01 ,7.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 39220,CPT,RESECTION MEDIASTINAL TUMOR,,,21,,RBRVS,19.55 ,9.17 ,9.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 39401,CPT,MEDIASTINOSCOPY INCLUDES MEDIASTINAL MASS BIOPSY,,,21,,RBRVS,5.44 ,2.32 ,2.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 39402,CPT,MEDIASTINOSCOPY WITH LYMPH NODE BIOPSY/IES,,,21,,RBRVS,7.25 ,2.85 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 39499,CPT,UNLISTED PROCEDURE MEDIASTINUM,,,21,,TotalUnits,,,,19.84 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 39501,CPT,REPAIR LACERATION DIAPHRAGM ANY APPROACH,,,21,,RBRVS,13.98 ,7.46 ,7.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 39503,CPT,RPR NEONATAL DIPHRG HERNIA W/WO CHEST TUBE INSJ,,,21,,RBRVS,108.91 ,43.00 ,43.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 39540,CPT,RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC AQT,,,21,,RBRVS,14.57 ,7.22 ,7.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 39541,CPT,RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC CHRNC,,,21,,RBRVS,15.75 ,7.94 ,7.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 39545,CPT,IMBRICATION DIAPHRAGM EVENTRATION,,,21,,RBRVS,14.67 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 39560,CPT,RESCJ DIAPHRAGM W/SIMPLE REPAIR,,,21,,RBRVS,13.06 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 39561,CPT,RESCJ DIAPHRAGM W/COMPLEX REPAIR,,,21,,RBRVS,19.99 ,11.32 ,11.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 39599,CPT,UNLISTED PROCEDURE DIAPHRAGM,,,21,,TotalUnits,,,,21.79 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 40490,CPT,BIOPSY OF LIP,,,21,,RBRVS,1.22 ,0.73 ,2.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40500,CPT,VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT,,,21,,RBRVS,4.47 ,5.40 ,9.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40510,CPT,EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR,,,21,,RBRVS,4.82 ,4.78 ,8.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40520,CPT,EXC LIP V-EXC W/PRIM DIR LINR CLSR,,,21,,RBRVS,4.79 ,4.86 ,8.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40525,CPT,EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP,,,21,,RBRVS,7.72 ,7.04 ,7.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40527,CPT,EXC LIP FULL THKNS RCNSTJ W/CROSS LIP FLAP,,,21,,RBRVS,9.32 ,7.27 ,7.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40530,CPT,RESCJ LIP > ONE-FOURTH W/O RCNSTJ,,,21,,RBRVS,5.54 ,5.28 ,9.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40650,CPT,RPR LIP FULL THICKNESS VERMILION ONLY,,,21,,RBRVS,3.78 ,4.33 ,8.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40652,CPT,RPR LIP FULL THICKNESS HALF/< VERTICAL HEIGHT,,,21,,RBRVS,4.43 ,5.06 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40654,CPT,RPR LIP FULL THKNS >ONE-HALF VERT HEIGHT/COMPLE,,,21,,RBRVS,5.48 ,5.94 ,10.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40700,CPT,PLSTC RPR CL LIP/NSL DFRM PRIM PRTL/COMPL UNI,,,21,,RBRVS,14.17 ,10.01 ,10.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40701,CPT,PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 STG PX,,,21,,RBRVS,17.23 ,9.83 ,9.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40702,CPT,PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 2 STGS,,,21,,RBRVS,14.27 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40720,CPT,PLSTC RPR CL LIP/NSL DFRM SEC RECRTJ DFCT & RECL,,,21,,RBRVS,14.72 ,12.32 ,12.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40761,CPT,PLSTC RPR CL LIP/NSL DFRM W/CROSS LIP PEDCL FLAP,,,21,,RBRVS,15.84 ,12.72 ,12.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40799,CPT,UNLISTED PROCEDURE LIPS,,,21,,TotalUnits,,,,3.45 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40800,CPT,DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL,,,21,,RBRVS,1.23 ,2.44 ,4.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40801,CPT,DRG ABSC CST HMTMA VESTIBULE MOUTH COMP,,,21,,RBRVS,2.63 ,3.47 ,6.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40804,CPT,RMVL EMBEDDED FB VESTIBULE MOUTH SMPL,,,21,,RBRVS,1.30 ,1.94 ,4.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40805,CPT,RMVL EMBEDDED FB VESTIBULE MOUTH COMP,,,21,,RBRVS,2.79 ,3.61 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40806,CPT,INCISION LABIAL FRENUM FRENOTOMY,,,21,,RBRVS,0.31 ,0.60 ,2.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40808,CPT,BIOPSY VESTIBULE MOUTH,,,21,,RBRVS,1.01 ,2.02 ,4.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40810,CPT,EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR,,,21,,RBRVS,1.36 ,2.18 ,4.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40812,CPT,EXC LESION MUCOSA & SBMCSL VESTIBULE SMPL RPR,,,21,,RBRVS,2.37 ,3.06 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40814,CPT,EXC LESION MUCOSA & SBMCSL VESTIBULE CPLX RPR,,,21,,RBRVS,3.52 ,4.89 ,7.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40816,CPT,EXC LESION MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC,,,21,,RBRVS,3.77 ,4.96 ,7.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40818,CPT,EXC MUCOSA VESTIBULE MOUTH AS DON GRF,,,21,,RBRVS,2.83 ,4.79 ,7.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40819,CPT,EXC FRENUM LABIAL/BUCCAL,,,21,,RBRVS,2.51 ,4.14 ,6.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40820,CPT,DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS,,,21,,RBRVS,1.34 ,3.52 ,6.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40830,CPT,CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<,,,21,,RBRVS,1.82 ,2.76 ,5.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40831,CPT,CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL,,,21,,RBRVS,2.57 ,3.62 ,6.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40840,CPT,VESTIBULOPLASTY ANTERIOR,,,21,,RBRVS,9.15 ,7.76 ,13.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40842,CPT,VESTIBULOPLASTY POSTERIOR UNILATERAL,,,21,,RBRVS,9.15 ,7.11 ,12.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40843,CPT,VESTIBULOPLASTY POSTERIOR BILATERAL,,,21,,RBRVS,12.79 ,9.91 ,16.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40844,CPT,VESTIBULOPLASTY ENTIRE ARCH,,,21,,RBRVS,16.80 ,11.43 ,18.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40845,CPT,VESTIBULOPLASTY CPLX W/RIDGE XTN MUSC RPSG,,,21,,RBRVS,19.36 ,13.41 ,20.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 40899,CPT,UNLISTED PROCEDURE VESTIBULE MOUTH,,,21,,TotalUnits,,,,5.18 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41000,CPT,INTRAORAL I&D TONGUE/FLOOR LINGUAL,,,21,,RBRVS,1.35 ,1.74 ,3.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41005,CPT,INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC,,,21,,RBRVS,1.31 ,2.17 ,5.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41006,CPT,INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD,,,21,,RBRVS,3.34 ,3.56 ,6.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41007,CPT,INTRAORAL I&D TONGUE/FLOOR SUBMENTAL SPACE,,,21,,RBRVS,3.20 ,3.47 ,6.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41008,CPT,INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE,,,21,,RBRVS,3.46 ,3.91 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41009,CPT,INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE,,,21,,RBRVS,3.71 ,4.29 ,7.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41010,CPT,INCISION LINGUAL FRENUM FRENOTOMY,,,21,,RBRVS,1.11 ,1.90 ,4.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41015,CPT,XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL,,,21,,RBRVS,4.08 ,5.54 ,8.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41016,CPT,XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMENT,,,21,,RBRVS,4.19 ,5.48 ,8.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41017,CPT,XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB,,,21,,RBRVS,4.19 ,5.52 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41018,CPT,XTRORAL I&D FLOOR MASTICATOR SPACE,,,21,,RBRVS,5.22 ,6.08 ,8.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41019,CPT,PLACEMENT NEEDLE HEAD/NECK RADIOELEMENT APPLICAT,,,21,,RBRVS,8.84 ,4.00 ,4.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41100,CPT,BIOPSY TONGUE ANTERIOR TWO-THIRDS,,,21,,RBRVS,1.42 ,1.52 ,3.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41105,CPT,BIOPSY TONGUE POSTERIOR ONE-THIRD,,,21,,RBRVS,1.47 ,1.57 ,3.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41108,CPT,BIOPSY FLOOR MOUTH,,,21,,RBRVS,1.10 ,1.39 ,3.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41110,CPT,EXCISION LESION TONGUE W/O CLOSURE,,,21,,RBRVS,1.56 ,2.07 ,4.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41112,CPT,EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS,,,21,,RBRVS,2.83 ,4.17 ,6.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41113,CPT,EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD,,,21,,RBRVS,3.29 ,4.43 ,6.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41114,CPT,EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP,,,21,,RBRVS,8.82 ,8.40 ,8.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41115,CPT,EXCISION LINGUAL FRENUM FRENECTOMY,,,21,,RBRVS,1.79 ,2.40 ,5.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41116,CPT,EXCISION LESION FLOOR MOUTH,,,21,,RBRVS,2.52 ,3.57 ,6.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41120,CPT,GLOSSECTOMY 2.6 CM/CPLX,,,21,,RBRVS,3.02 ,2.67 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41500,CPT,FIXJ TONGUE MECHANICAL OTHER/THAN SUTURE,,,21,,RBRVS,3.80 ,7.85 ,7.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41510,CPT,SUTURE TONGUE LIP MICROGNATHIA,,,21,,RBRVS,3.51 ,8.38 ,8.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41512,CPT,TONGUE BASE SUSPENSION PERMANENT SUTURE TQ,,,21,,RBRVS,6.86 ,11.61 ,11.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41520,CPT,FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY,,,21,,RBRVS,2.83 ,4.30 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41530,CPT,SUBMUCOSAL ABLTJ TONGUE RF 1/> SITES PR SESSION,,,21,,RBRVS,3.50 ,7.03 ,24.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41599,CPT,UNLISTED PROCEDURE TONGUE FLOOR MOUTH,,,21,,TotalUnits,,,,4.54 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41800,CPT,DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS,,,21,,RBRVS,1.27 ,2.85 ,6.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41805,CPT,RMVL EMBEDDED FB FROM DENTALVLR STRUXS SOFT TISS,,,21,,RBRVS,1.34 ,3.58 ,5.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41806,CPT,RMVL EMBEDDED FB FROM DENTOALVEOLAR STRUXS BONE,,,21,,RBRVS,2.79 ,4.41 ,7.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41820,CPT,GINGIVECTOMY EXC GINGIVA EACH QUADRANT,,,21,,TotalUnits,,,,5.42 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41821,CPT,OPRCULECTOMY EXC PRICORONAL TISSUE,,,21,,TotalUnits,,,,1.22 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41822,CPT,EXC FIBROUS TUBEROSITIES DENTOALVEOLAR STRUXS,,,21,,RBRVS,2.41 ,2.56 ,5.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41823,CPT,EXC OSS TUBEROSITIES DENTOALVEOLAR STRUXS,,,21,,RBRVS,3.77 ,5.14 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41825,CPT,EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR,,,21,,RBRVS,1.41 ,1.96 ,4.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41826,CPT,EXC LESION/TUMOR DENTOALVEOLAR STRUX W/SMPL RPR,,,21,,RBRVS,2.41 ,3.47 ,6.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41827,CPT,EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR,,,21,,RBRVS,3.83 ,4.61 ,8.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41828,CPT,EXC HYPRPLSTC ALVEOLAR MUCOSA EA QUADRANT SPEC,,,21,,RBRVS,3.14 ,2.60 ,5.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41830,CPT,ALVEOLECTOMY W/CURTG OSTEITIS/SEQUESTRECTOMY,,,21,,RBRVS,3.45 ,4.38 ,7.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41850,CPT,DESTRUCTION LESION DENTOALVEOLAR STRUCTURES,,,21,,TotalUnits,,,,3.17 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41870,CPT,PERIODONTAL MUCOSAL GRAFTING,,,21,,TotalUnits,,,,6.77 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41872,CPT,GINGIVOPLASTY EACH QUADRANT SPECIFY,,,21,,RBRVS,3.01 ,4.10 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41874,CPT,ALVEOLOPLASTY EACH QUADRANT SPECIFY,,,21,,RBRVS,3.19 ,3.84 ,7.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 41899,CPT,UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES,,,21,,TotalUnits,,,,9.52 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42000,CPT,DRAINAGE ABSCESS PALATE UVULA,,,21,,RBRVS,1.28 ,1.57 ,3.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42100,CPT,BIOPSY PALATE UVULA,,,21,,RBRVS,1.36 ,1.65 ,2.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42104,CPT,EXC LESION PALATE UVULA W/O CLOSURE,,,21,,RBRVS,1.69 ,2.14 ,4.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42106,CPT,EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE,,,21,,RBRVS,2.15 ,2.76 ,5.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42107,CPT,EXC LESION PALATE UVULA W/LOCAL FLAP CLOSURE,,,21,,RBRVS,4.56 ,4.92 ,8.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42120,CPT,RESCJ PALATE/EXTENSIVE RESCJ LESION,,,21,,RBRVS,11.86 ,16.29 ,16.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42140,CPT,UVULECTOMY EXCISION UVULA,,,21,,RBRVS,1.70 ,2.58 ,5.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42145,CPT,PALATOPHARYNGOPLASTY,,,21,,RBRVS,9.78 ,9.32 ,9.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42160,CPT,DSTRJ LESION PALATE/UVULA THERMAL CRYO/CHEM,,,21,,RBRVS,1.85 ,2.18 ,4.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42180,CPT,REPAIR LACERATION PALATE 2 CM/COMPLEX,,,21,,RBRVS,3.87 ,3.03 ,4.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42200,CPT,PALATOP CL PALATE SOFT&/HARD PALATE ONLY,,,21,,RBRVS,12.53 ,10.43 ,10.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42205,CPT,PALATOPLASTY W/CLSR ALVEOLAR RIDGE SOFT TISSUE,,,21,,RBRVS,13.66 ,10.18 ,10.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42210,CPT,PALATOP CLSR ALVEOLAR RIDGE GRF ALVEOLAR RIDGE,,,21,,RBRVS,15.03 ,11.55 ,11.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42215,CPT,PALATOPLASTY CLEFT PALATE MAJOR REVJ,,,21,,RBRVS,8.99 ,8.79 ,8.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42220,CPT,PALATOPLASTY CLEFT PALATE SEC LNGTH PX,,,21,,RBRVS,7.16 ,6.34 ,6.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42225,CPT,PALATOP CL PALATE ATTACHMENT PHARYNGEAL FLAP,,,21,,RBRVS,9.77 ,14.42 ,14.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42226,CPT,LENGTHENING PALATE & PHARYNGEAL FLAP,,,21,,RBRVS,10.35 ,14.32 ,14.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42227,CPT,LENGTHENING PALATE W/ISLAND FLAP,,,21,,RBRVS,9.90 ,13.27 ,13.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42235,CPT,REPAIR ANTERIOR PALATE W/VOMER FLAP,,,21,,RBRVS,8.01 ,12.28 ,12.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42260,CPT,REPAIR NASOLABIAL FISTULA,,,21,,RBRVS,10.22 ,7.64 ,11.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42280,CPT,MAXILLARY IMPRESJ PALATAL PROSTHESIS,,,21,,RBRVS,1.59 ,1.37 ,2.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42281,CPT,INSJ PIN-RETAINED PALATAL PROSTHESIS,,,21,,RBRVS,1.98 ,2.14 ,3.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42299,CPT,UNLISTED PROCEDURE PALATE UVULA,,,21,,TotalUnits,,,,7.00 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42300,CPT,DRAINAGE ABSCESS PAROTID SIMPLE,,,21,,RBRVS,1.98 ,2.19 ,3.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42305,CPT,DRAINAGE ABSCESS PAROTID COMPLICATED,,,21,,RBRVS,6.31 ,5.29 ,5.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42310,CPT,DRG ABSC SUBMAXILLARY/SUBLINGUAL INTRAORAL,,,21,,RBRVS,1.61 ,1.77 ,2.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42320,CPT,DRAINAGE ABSCESS SUBMAXILLARY INTRAORAL,,,21,,RBRVS,2.40 ,2.37 ,4.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42330,CPT,SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL,,,21,,RBRVS,2.26 ,2.23 ,4.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42335,CPT,SIALOLITHOTOMY SUBMNDBLR SUBMAX COMP INTRAORAL,,,21,,RBRVS,3.41 ,3.62 ,7.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42340,CPT,SIALOLITHOTOMY PRTD XTRORAL/COMP INTRAORAL,,,21,,RBRVS,4.72 ,4.39 ,8.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42400,CPT,BIOPSY SALIVARY GLAND NEEDLE,,,21,,RBRVS,0.78 ,0.73 ,2.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42405,CPT,BIOPSY SALIVARY GLAND INCISIONAL,,,21,,RBRVS,3.34 ,2.76 ,4.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42408,CPT,EXC SUBLINGUAL SALIVARY CYST RANULA,,,21,,RBRVS,4.66 ,4.17 ,7.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42409,CPT,MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA,,,21,,RBRVS,2.91 ,3.14 ,6.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42410,CPT,EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ,,,21,,RBRVS,9.57 ,6.97 ,6.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42415,CPT,EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR,,,21,,RBRVS,17.16 ,10.99 ,10.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42420,CPT,EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR,,,21,,RBRVS,19.53 ,12.04 ,12.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42425,CPT,EXCISION PAROTID TUMOR/GLAND TOTAL EN BLOC RMVL,,,21,,RBRVS,13.42 ,8.87 ,8.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42426,CPT,EXC PRTD TUM/PRTD GLND TOT W/UNI RAD NCK DSJ,,,21,,RBRVS,22.66 ,13.15 ,13.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 42440,CPT,EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND,,,21,,RBRVS,6.14 ,4.93 ,4.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42450,CPT,EXISION OF SUBLINGUAL GLAND,,,21,,RBRVS,4.74 ,5.00 ,7.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42500,CPT,PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM,,,21,,RBRVS,4.42 ,4.92 ,7.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42505,CPT,PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY SEC/COMP,,,21,,RBRVS,6.32 ,5.98 ,8.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42507,CPT,PAROTID DUCT DIVERSION BILATERAL WILKE PX,,,21,,RBRVS,6.25 ,7.78 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42509,CPT,PAROTID DUCT DVRJ BI W/EXC BOTH SUBMNDBLR GLANDS,,,21,,RBRVS,11.76 ,11.13 ,11.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42510,CPT,PAROTID DUCT DVRJ BILATERAL WITH LIG BOTH DUCTS,,,21,,RBRVS,8.35 ,9.09 ,9.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42550,CPT,INJECTION PROCEDURE SIALOGRAPHY,,,21,,RBRVS,1.25 ,0.47 ,2.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42600,CPT,CLOSURE SALIVARY FISTULA,,,21,,RBRVS,4.94 ,4.49 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42650,CPT,DILATION SALIVARY DUCT,,,21,,RBRVS,0.77 ,0.83 ,1.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42660,CPT,DILAT&CATHJ SALIVARY DUCT W/WO INJECTION,,,21,,RBRVS,1.13 ,1.14 ,2.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42665,CPT,LIGATION SALIVARY DUCT INTRAORAL,,,21,,RBRVS,2.63 ,2.94 ,5.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42699,CPT,UNLISTED PX SALIVARY GLANDS/DUCTS,,,21,,TotalUnits,,,,19.41 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42700,CPT,I&D ABSCESS PERITONSILLAR,,,21,,RBRVS,1.67 ,2.04 ,3.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42720,CPT,I&D ABSC RTRPHRNGL/PARAPHARYNGEAL INTRAORAL,,,21,,RBRVS,6.31 ,4.19 ,5.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42725,CPT,I&D ABSC RTRPHRNGL/PARAPHARYNGEAL XTRNL APPR,,,21,,RBRVS,12.41 ,9.49 ,9.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42800,CPT,BIOPSY OROPHARYNX,,,21,,RBRVS,1.44 ,1.61 ,2.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42804,CPT,BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE,,,21,,RBRVS,1.29 ,1.82 ,4.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42806,CPT,BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION,,,21,,RBRVS,1.63 ,1.98 ,4.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42808,CPT,EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD,,,21,,RBRVS,2.35 ,2.04 ,3.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42809,CPT,REMOVAL FOREIGN BODY PHARYNX,,,21,,RBRVS,1.86 ,1.43 ,3.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42810,CPT,EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS,,,21,,RBRVS,3.38 ,4.55 ,7.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42815,CPT,EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX,,,21,,RBRVS,7.31 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42820,CPT,TONSILLECTOMY & ADENOIDECTOMY ,,,21,,RBRVS,4.36 ,3.78 ,3.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42825,CPT,TONSILLECTOMY ONE-HALF ,,,21,,RBRVS,3.45 ,3.37 ,3.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42830,CPT,ADENOIDECTOMY PRIMARY ,,,21,,RBRVS,2.81 ,3.30 ,3.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42835,CPT,ADENOIDECTOMY SECONDARY,,,21,,RBRVS,3.26 ,3.28 ,3.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42842,CPT,RADICAL RESECTION TONSIL W/O CLOSURE,,,21,,RBRVS,12.23 ,15.85 ,15.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42844,CPT,RADICAL RESCJ TONSIL CLOSURE W/LOCAL FLAP,,,21,,RBRVS,17.78 ,20.59 ,20.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42845,CPT,RADICAL RESCJ TONSIL CLOSURE W/OTHER FLAP,,,21,,RBRVS,32.56 ,28.66 ,28.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 42860,CPT,EXCISION TONSIL TAGS,,,21,,RBRVS,2.30 ,2.85 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42870,CPT,EXC/DSTRJ LINGUAL TONSIL ANY METHOD SPX,,,21,,RBRVS,5.52 ,11.30 ,11.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42890,CPT,LIMITED PHARYNGECTOMY,,,21,,RBRVS,19.13 ,20.33 ,20.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42892,CPT,RESCJ LAT PHRNGL WALL/PYRIFORM SINUS DIR CLSR,,,21,,RBRVS,26.03 ,25.89 ,25.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42894,CPT,RESCJ PHRNGL WALL CLSR W/FLP OR FLP W/MVASC ANAS,,,21,,RBRVS,33.92 ,31.24 ,31.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 42900,CPT,SUTURE PHARYNX WOUND/INJURY,,,21,,RBRVS,5.29 ,3.78 ,3.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42950,CPT,PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX,,,21,,RBRVS,8.27 ,14.60 ,14.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42953,CPT,PHARYNGOESOPHAGEAL REPAIR,,,21,,RBRVS,9.45 ,18.12 ,18.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 42955,CPT,PHARYNGOSTOMY FSTLJ PHARYNX XTRNL FEEDING,,,21,,RBRVS,8.01 ,13.61 ,13.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42960,CPT,CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE,,,21,,RBRVS,2.38 ,2.22 ,2.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42961,CPT,CTRL OROPHARYNGEAL HEMORRHAGE COMP REQ HOSPITJ,,,21,,RBRVS,5.77 ,5.71 ,5.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 42962,CPT,CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ,,,21,,RBRVS,7.40 ,6.62 ,6.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42970,CPT,CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS,,,21,,RBRVS,5.82 ,5.32 ,5.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42971,CPT,CTRL NASOPHARYNGEAL HEMRRG COMP REQ HOSPIZATION,,,21,,RBRVS,6.60 ,5.70 ,5.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 42972,CPT,CTRL NASOPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ,,,21,,RBRVS,7.59 ,6.18 ,6.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 42999,CPT,UNLISTED PROCEDURE PHARYNX ADENOIDS/TONSILS,,,21,,TotalUnits,,,,6.82 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43020,CPT,ESOPHAGOTOMY CERVICAL APPR W/RMVL FB,,,21,,RBRVS,8.23 ,5.36 ,5.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43030,CPT,CRICOPHARYNGEAL MYOTOMY,,,21,,RBRVS,7.99 ,5.84 ,5.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43045,CPT,ESOPHAGOTOMY THORACIC APPR W/RMVL FB,,,21,,RBRVS,21.88 ,10.88 ,10.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43100,CPT,EXC LESION ESOPHOGUS W/PRIM RPR CERVICAL APPR,,,21,,RBRVS,9.66 ,7.04 ,7.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43101,CPT,EXC LESION ESOPHAGUS W/PRIM RPR THRC/ABDL APPR,,,21,,RBRVS,17.07 ,8.47 ,8.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43107,CPT,TOT ESOPHAGECTOMY W/O THORCOM W/WO PYLOROPLASTY,,,21,,RBRVS,44.18 ,19.69 ,19.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43108,CPT,TOT ESOPHG W/O THORCOM COLON NTRPSTJ/INT RCNSTJ,,,21,,RBRVS,82.87 ,32.83 ,32.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43112,CPT,TOTAL ESOPHAGECTOMY W/THORCOM W/WO PYLORPLASTY,,,21,,RBRVS,47.48 ,19.73 ,19.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43113,CPT,TOT ESOPHG W/THORCOM W/COLON NTRPSTJ/INT RCNSTJ,,,21,,RBRVS,80.06 ,34.18 ,34.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43116,CPT,PRTL ESOPHAGECTOMY CERVICAL W/FREE INTSTINAL GRF,,,21,,RBRVS,92.99 ,41.33 ,41.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43117,CPT,PRTL ESOPHECT DSTL W/WO PROX GASTRECT/PYLORPLSTY,,,21,,RBRVS,43.65 ,17.93 ,17.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43118,CPT,PRTL ESOPH DSTL W/WO PROX GASTRC W/COLON NTRPSTJ,,,21,,RBRVS,67.07 ,24.88 ,24.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43121,CPT,PRTL ESOPHAGEC W/WO PROX GASTREC/PYLOROPLASTY,,,21,,RBRVS,51.43 ,19.99 ,19.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43122,CPT,PRTL ESOPHG THORACOABD W/WO PROXGASTREC/PYLOROPL,,,21,,RBRVS,44.18 ,20.13 ,20.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43123,CPT,PRTL ESPHG THORACOABDL/ABDL APPR NTRPSTJ/RCNSTJ,,,21,,RBRVS,83.12 ,34.86 ,34.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43124,CPT,TOT/PRTL ESPHG W/O RCNSTJ W/CRV ESOPHAGOSTOMY,,,21,,RBRVS,69.09 ,26.68 ,26.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43130,CPT,DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR,,,21,,RBRVS,12.53 ,8.19 ,8.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43135,CPT,DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR,,,21,,RBRVS,26.17 ,11.15 ,11.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43180,CPT,ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH,,,21,,RBRVS,9.03 ,5.66 ,5.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43191,CPT,ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH,,,21,,RBRVS,2.49 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43192,CPT,ESOPHAGOSCOPY RIGID TRANSORAL INJ SUBMUCOSAL,,,21,,RBRVS,2.79 ,1.76 ,1.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43193,CPT,ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY,,,21,,RBRVS,2.79 ,1.72 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43194,CPT,ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY,,,21,,RBRVS,3.51 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43195,CPT,ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION,,,21,,RBRVS,3.07 ,1.84 ,1.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43196,CPT,ESOPHAGOSCOPY RIG TRANSORAL GUIDE WIRE DILATION,,,21,,RBRVS,3.31 ,1.92 ,1.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43197,CPT,ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC,,,21,,RBRVS,1.52 ,0.66 ,3.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43198,CPT,ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY,,,21,,RBRVS,1.82 ,0.79 ,3.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43200,CPT,ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC,,,21,,RBRVS,1.52 ,0.98 ,5.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43201,CPT,ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ,,,21,,RBRVS,1.82 ,1.10 ,5.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43202,CPT,ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY,,,21,,RBRVS,1.82 ,1.09 ,8.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43204,CPT,ESOPHAGOSCOPY FLEX TRANSORAL INJECTION VARICES,,,21,,RBRVS,2.43 ,1.38 ,1.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43205,CPT,ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES,,,21,,RBRVS,2.54 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43206,CPT,ESOPHAGOSCOPY TRANSORAL W/OPTICAL ENDOMICROSCOPY,,,21,,RBRVS,2.39 ,1.38 ,6.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43210,CPT,EGD PARTIAL/COMPL ESOPHAGOGASTRIC FUNDOPLASTY,,,21,,RBRVS,7.75 ,3.66 ,3.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43211,CPT,ESOPHAGOSCOPY FLEXIBLE TRANSORAL MUCOSAL RESEXN,,,21,,RBRVS,4.30 ,2.21 ,2.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43212,CPT,ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT,,,21,,RBRVS,3.50 ,1.63 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43213,CPT,ESOPHAGOSCOPY RETROGRADE DILATE BALLOON/OTHER,,,21,,RBRVS,4.73 ,2.36 ,29.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43214,CPT,ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM,,,21,,RBRVS,3.50 ,1.81 ,1.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43215,CPT,ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY,,,21,,RBRVS,2.54 ,1.37 ,8.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43216,CPT,ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS,,,21,,RBRVS,2.40 ,1.37 ,9.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43217,CPT,ESOPHAGOSCOPY FLEXIB LESION REMOVAL TUMOR SNARE,,,21,,RBRVS,2.90 ,1.53 ,9.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43220,CPT,ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM,,,21,,RBRVS,2.10 ,1.22 ,29.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43226,CPT,ESOPHAGOSCOPY FLEXIBLE GUIDE WIRE DILATION,,,21,,RBRVS,2.34 ,1.29 ,8.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43227,CPT,ESOPHAGOSCOPY FLEXIBLE W/BLEEDING CONTROL,,,21,,RBRVS,2.99 ,1.61 ,16.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43229,CPT,ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION,,,21,,RBRVS,3.59 ,1.87 ,16.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43231,CPT,ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM,,,21,,RBRVS,2.90 ,1.59 ,8.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43232,CPT,ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE ASPIRAT/BX,,,21,,RBRVS,3.69 ,1.84 ,9.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43233,CPT,EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER,,,21,,RBRVS,4.17 ,2.09 ,2.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43235,CPT,ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC,,,21,,RBRVS,2.19 ,1.26 ,6.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43236,CPT,ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION,,,21,,RBRVS,2.49 ,1.41 ,8.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43237,CPT,ESOPHAGOGASTRODUODENOSCOPY US SCOPE W/ADJ STRXRS,,,21,,RBRVS,3.57 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43238,CPT,EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS,,,21,,RBRVS,4.26 ,2.18 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43239,CPT,EGD TRANSORAL BIOPSY SINGLE/MULTIPLE,,,21,,RBRVS,2.49 ,1.40 ,8.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43240,CPT,EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST,,,21,,RBRVS,7.25 ,3.50 ,3.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43241,CPT,EGD INTRALUMINAL TUBE/CATHETER INSERTION,,,21,,RBRVS,2.59 ,1.39 ,1.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43242,CPT,EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY,,,21,,RBRVS,4.83 ,2.45 ,2.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43243,CPT,EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES,,,21,,RBRVS,4.37 ,2.17 ,2.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43244,CPT,EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES,,,21,,RBRVS,4.50 ,2.30 ,2.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43245,CPT,EGD DILATION GASTRIC/DUODENAL STRICTURE,,,21,,RBRVS,3.18 ,1.66 ,13.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43246,CPT,EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE,,,21,,RBRVS,3.66 ,1.81 ,1.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43247,CPT,EGD FLEXIBLE FOREIGN BODY REMOVAL,,,21,,RBRVS,3.21 ,1.70 ,8.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43248,CPT,EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS,,,21,,RBRVS,3.01 ,1.64 ,8.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43249,CPT,EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM,,,21,,RBRVS,2.77 ,1.52 ,27.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43250,CPT,EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS,,,21,,RBRVS,3.07 ,1.61 ,9.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43251,CPT,EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH,,,21,,RBRVS,3.57 ,1.87 ,10.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43252,CPT,EGD FLEX TRANSORAL W/OPTICAL ENDOMICROSCOPY,,,21,,RBRVS,3.06 ,1.60 ,6.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43253,CPT,EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER,,,21,,RBRVS,4.83 ,2.44 ,2.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43254,CPT,EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION,,,21,,RBRVS,4.97 ,2.49 ,2.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43255,CPT,EGD TRANSORAL CONTROL BLEEDING ANY METHOD,,,21,,RBRVS,3.66 ,1.92 ,16.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43257,CPT,EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD,,,21,,RBRVS,4.25 ,2.18 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43259,CPT,EDG US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM,,,21,,RBRVS,4.14 ,2.14 ,2.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43260,CPT,ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING,,,21,,RBRVS,5.95 ,2.93 ,2.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43261,CPT,ERCP W/BIOPSY SINGLE/MULTIPLE,,,21,,RBRVS,6.25 ,3.06 ,3.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43262,CPT,ERCP W/SPHINCTEROTOMY/PAPILLOTOMY,,,21,,RBRVS,6.60 ,3.22 ,3.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43263,CPT,ERCP W/PRESSURE MEASUREMENT SPHINCTER OF ODDI,,,21,,RBRVS,6.60 ,3.22 ,3.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43264,CPT,ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT,,,21,,RBRVS,6.73 ,3.28 ,3.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43265,CPT,ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD,,,21,,RBRVS,8.03 ,3.84 ,3.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43266,CPT,EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION,,,21,,RBRVS,4.17 ,2.04 ,2.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43270,CPT,EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE,,,21,,RBRVS,4.26 ,2.18 ,16.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43273,CPT,ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC,,,21,,RBRVS,2.24 ,0.98 ,0.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43274,CPT,ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT,,,21,,RBRVS,8.58 ,4.09 ,4.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43275,CPT,ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT,,,21,,RBRVS,6.96 ,3.38 ,3.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43276,CPT,ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE,,,21,,RBRVS,8.94 ,4.25 ,4.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43277,CPT,ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA,,,21,,RBRVS,7.00 ,3.40 ,3.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43278,CPT,ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE,,,21,,RBRVS,8.02 ,3.84 ,3.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43279,CPT,LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED,,,21,,RBRVS,22.10 ,10.22 ,10.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43280,CPT,LAPS SURG ESOPG/GSTR FUNDOPLASTY,,,21,,RBRVS,18.10 ,9.02 ,9.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43281,CPT,LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH,,,21,,RBRVS,26.60 ,11.99 ,11.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43282,CPT,LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/MESH,,,21,,RBRVS,30.10 ,13.26 ,13.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43283,CPT,LAPS ESOPHAGEAL LENGTHENING ADDL,,,21,,RBRVS,2.95 ,0.97 ,0.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43284,CPT,LAPS ESOPHGL SPHNCTR AGMNTJ,,,21,,RBRVS,10.13 ,6.26 ,6.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43285,CPT,RMVL ESOPHGL SPHNCTR DEV,,,21,,RBRVS,10.47 ,6.06 ,6.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43289,CPT,UNLISTED LAPAROSCOPIC PROCEDURE ESOPHAGUS,,,21,,TotalUnits,,,,38.06 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43300,CPT,ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL,,,21,,RBRVS,9.33 ,7.24 ,7.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43305,CPT,ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL,,,21,,RBRVS,18.10 ,11.04 ,11.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43310,CPT,ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL,,,21,,RBRVS,26.26 ,10.79 ,10.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43312,CPT,ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL,,,21,,RBRVS,29.25 ,11.01 ,11.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43313,CPT,ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL,,,21,,RBRVS,48.45 ,23.52 ,23.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43314,CPT,ESPHGP CGEN DFCT THRC APPR W/RPR FSTL,,,21,,RBRVS,53.43 ,26.02 ,26.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43320,CPT,EGST W/WO VAGOTOMY&PYLOROPLASTY TABDL/TTHRC AP,,,21,,RBRVS,23.31 ,11.51 ,11.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43325,CPT,ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH,,,21,,RBRVS,22.60 ,11.02 ,11.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43327,CPT,ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY,,,21,,RBRVS,13.35 ,7.30 ,7.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43328,CPT,ESOPG/GSTR FUNDOPLASTY W/THORACOTOMY,,,21,,RBRVS,19.91 ,8.46 ,8.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43330,CPT,ESOPHAGOMYOTOMY HELLER TYPE ABDOMINAL APPROACH,,,21,,RBRVS,22.19 ,11.14 ,11.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43331,CPT,ESOPHAGOMYOTOMY HELLER TYPE THORACIC APPROACH,,,21,,RBRVS,23.06 ,10.70 ,10.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43332,CPT,RPR PARAESOPH HIATAL HERNIA W/LAPT W/O MESH,,,21,,RBRVS,19.62 ,9.46 ,9.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43333,CPT,LAPT RPR PARAESOPH HIATAL HERNIA W/MESH,,,21,,RBRVS,21.46 ,10.20 ,10.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43334,CPT,RPR PARAESOPH HIATAL HERNIA W/THORCOM W/O MESH,,,21,,RBRVS,22.12 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43335,CPT,RPR PARAESOPH HIATAL HERNIA W/THORCOM W/MESH,,,21,,RBRVS,23.97 ,9.47 ,9.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43336,CPT,RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/O MESH,,,21,,RBRVS,25.81 ,12.16 ,12.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43337,CPT,RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/MESH,,,21,,RBRVS,27.65 ,13.14 ,13.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43338,CPT,ESOPHAGUS LENGTHENING,,,21,,RBRVS,2.21 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43340,CPT,ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT ABDL APPR,,,21,,RBRVS,22.99 ,11.16 ,11.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43341,CPT,ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT THRC APPR,,,21,,RBRVS,24.23 ,10.92 ,10.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43351,CPT,ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR,,,21,,RBRVS,22.05 ,10.78 ,10.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43352,CPT,ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR,,,21,,RBRVS,17.81 ,9.15 ,9.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43360,CPT,GI RCNSTJ PREV ESPHG/EXCLUSION W/STOMACH,,,21,,RBRVS,40.11 ,19.23 ,19.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43361,CPT,GI RCNSTJ PREV ESPHG/EXCLUSION W/COLON SM INT,,,21,,RBRVS,45.68 ,18.07 ,18.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43400,CPT,LIGATION DIRECT ESOPHAGEAL VARICES,,,21,,RBRVS,25.60 ,14.17 ,14.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43401,CPT,TRNSXJ ESOPH W/RPR ESOPHAGEAL VARICES,,,21,,RBRVS,26.49 ,12.32 ,12.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43405,CPT,LIG/STAPLING G-ESOP JUNCT PRE-ESOPHGL PRF8J,,,21,,RBRVS,24.73 ,11.87 ,11.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43410,CPT,SUTR ESOPHGL WND/INJ CRV APPR,,,21,,RBRVS,16.41 ,10.22 ,10.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43415,CPT,SUTR ESOPHGL WND/INJ TTHRC/TABDL APPR,,,21,,RBRVS,44.88 ,19.56 ,19.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43420,CPT,CLSR ESOPHAGOSTOMY/FSTL CRV APPR,,,21,,RBRVS,16.78 ,10.36 ,10.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43425,CPT,CLSR ESOPHAGOSTOMY/FSTL TTHRC/TABDL APPR,,,21,,RBRVS,25.04 ,11.38 ,11.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43450,CPT,DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS,,,21,,RBRVS,1.38 ,0.92 ,4.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43453,CPT,DILATION ESOPHAGUS GUIDE WIRE,,,21,,RBRVS,1.51 ,0.97 ,25.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43460,CPT,ESOPG/GSTR TAMPONADE W/BALO SENGSTAKEN TYPE,,,21,,RBRVS,3.79 ,1.97 ,1.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43496,CPT,FREE JEJUNUM TRSF W/MICROVASC ANASTOMOSIS,,,21,,TotalUnits,,,,3.93 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43499,CPT,UNLISTED PROCEDURE ESOPHAGUS,,,21,,TotalUnits,,,,4.34 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43500,CPT,GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL,,,21,,RBRVS,12.79 ,7.03 ,7.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43501,CPT,GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER,,,21,,RBRVS,22.60 ,11.10 ,11.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43502,CPT,GASTROTOMY W/SUTR RPR PRE-ESOPG/GASTRIC LAC,,,21,,RBRVS,25.69 ,12.35 ,12.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43510,CPT,GSTRT W/ESOPHGL DILAT&INSJ PRM INTRAL TUBE,,,21,,RBRVS,15.14 ,8.52 ,8.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43520,CPT,PYLOROMYOTOMY CUTTING PYLORIC MUSC,,,21,,RBRVS,11.29 ,5.98 ,5.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43605,CPT,BIOPSY STOMACH LAPAROTOMY,,,21,,RBRVS,13.72 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43610,CPT,EXC LOCAL ULCER/BENIGN TUMOR STOMACH,,,21,,RBRVS,16.34 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43611,CPT,EXC LOCAL MALIGNANT TUMOR STOMACH,,,21,,RBRVS,20.38 ,10.28 ,10.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43620,CPT,GSTRCT TOT W/ESOPHAGOENTEROSTOMY,,,21,,RBRVS,34.04 ,14.90 ,14.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43621,CPT,GSTRCT TOT W/ROUX-EN-Y RCNSTJ,,,21,,RBRVS,39.53 ,16.99 ,16.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43622,CPT,GSTRCT TOT W/FRMJ INTSTINAL POUCH ANY TYPE,,,21,,RBRVS,40.03 ,17.48 ,17.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43631,CPT,GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY,,,21,,RBRVS,24.51 ,11.77 ,11.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43632,CPT,GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY,,,21,,RBRVS,35.14 ,15.53 ,15.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43633,CPT,GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ,,,21,,RBRVS,33.14 ,14.77 ,14.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43634,CPT,GSTRCT PRTL DSTL W/FRMJ INTSTINAL POUCH,,,21,,RBRVS,36.64 ,16.19 ,16.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43635,CPT,VAGOTOMY PFRMD W/PRTL DSTL GSTRCT,,,21,,RBRVS,2.06 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43640,CPT,VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV,,,21,,RBRVS,19.56 ,10.02 ,10.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43641,CPT,VGTMY W/PYLOROPLASTY W/WO GASTROST PARIETAL CELL,,,21,,RBRVS,19.81 ,10.30 ,10.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43644,CPT,LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM,,,21,,RBRVS,29.40 ,13.96 ,13.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43645,CPT,LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ,,,21,,RBRVS,31.53 ,14.72 ,14.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43647,CPT,LAPS IMPLTJ/RPLCMT GASTRIC NSTIM ELTRD ANTRUM,,,21,,TotalUnits,,,,22.69 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43651,CPT,LAPS SURG TRNSXJ VAGUS NRV TRUNCAL,,,21,,RBRVS,10.13 ,6.48 ,6.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43652,CPT,LAPS SURG TRNSXJ VAGUS NRV SLCTV/HILY SLCTV,,,21,,RBRVS,12.13 ,7.11 ,7.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43653,CPT,LAPS SURG GASTROSTOMY W/O CONSTJ GSTR TUBE SPX,,,21,,RBRVS,8.48 ,6.09 ,6.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43659,CPT,UNLISTED LAPAROSCOPIC PROCEDURE STOMACH,,,21,,TotalUnits,,,,43.36 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43752,CPT,NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE,,,21,,RBRVS,0.81 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43753,CPT,GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE,,,21,,RBRVS,0.45 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43754,CPT,GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIMEN,,,21,,RBRVS,0.45 ,0.47 ,2.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43755,CPT,GASTRIC INTUBATION DX & ASPIRATJ MULTIPLE SPEC,,,21,,RBRVS,0.94 ,0.64 ,2.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43756,CPT,DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN,,,21,,RBRVS,0.77 ,0.61 ,4.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43757,CPT,DUODENAL INTUBAT W/IMAG GUIDED MULTIPLE SPECIMEN,,,21,,RBRVS,1.26 ,0.83 ,6.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43760,CPT,CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GDNCE,,,21,,RBRVS,0.90 ,0.33 ,12.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43761,CPT,REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO,,,21,,RBRVS,2.01 ,0.75 ,1.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43770,CPT,LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE,,,21,,RBRVS,18.00 ,10.18 ,10.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43771,CPT,LAPS GASTRIC RESTRICTIVE PX REVISION DEVICE,,,21,,RBRVS,20.79 ,11.20 ,11.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43772,CPT,LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE,,,21,,RBRVS,15.70 ,8.17 ,8.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43773,CPT,LAPS GASTRIC RESTRICTIVE PX REMOVE&RPLCMT DEVICE,,,21,,RBRVS,20.79 ,11.21 ,11.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43774,CPT,LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT,,,21,,RBRVS,15.76 ,8.36 ,8.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43775,CPT,LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY,,,21,,RBRVS,20.38 ,7.23 ,7.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43800,CPT,PYLOROPLASTY,,,21,,RBRVS,15.43 ,7.89 ,7.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43810,CPT,GASTRODUODENOSTOMY,,,21,,RBRVS,16.88 ,8.63 ,8.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43820,CPT,GASTROJEJUNOSTOMY W/O VAGOTOMY,,,21,,RBRVS,22.53 ,11.06 ,11.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43825,CPT,GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE,,,21,,RBRVS,21.76 ,10.89 ,10.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43830,CPT,GASTROSTOMY OPN W/O CONSTJ GSTR TUBE SPX,,,21,,RBRVS,10.85 ,6.90 ,6.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43831,CPT,GASTROSTOMY OPN NEONATAL FEEDING,,,21,,RBRVS,8.49 ,6.33 ,6.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43832,CPT,GASTROSTOMY OPN W/CONSTJ GSTR TUBE,,,21,,RBRVS,17.34 ,8.83 ,8.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43840,CPT,GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ,,,21,,RBRVS,22.83 ,11.21 ,11.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43842,CPT,GASTRIC RSTCV W/O BYP VERTICAL-BANDED GASTROPLY,,,21,,RBRVS,21.03 ,10.56 ,10.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43843,CPT,GSTR RSTCV W/O BYP OTH/THN VER-BANDED GSTP,,,21,,RBRVS,21.21 ,10.83 ,10.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43845,CPT,GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM,,,21,,RBRVS,33.30 ,15.77 ,15.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43846,CPT,GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/<,,,21,,RBRVS,27.41 ,12.95 ,12.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43847,CPT,GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ,,,21,,RBRVS,30.28 ,14.55 ,14.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43848,CPT,REVISION OPEN GASTRIC RESTRICTIVE PX NOT DEVICE,,,21,,RBRVS,32.75 ,15.41 ,15.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43850,CPT,REVJ GASTRODUOL ANAST W/RCNSTJ W/O VAGOTOMY,,,21,,RBRVS,27.58 ,13.51 ,13.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43855,CPT,REVJ GASTRODUOL ANAST W/RCNSTJ W/VGTMY,,,21,,RBRVS,28.69 ,13.31 ,13.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43860,CPT,REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY,,,21,,RBRVS,27.89 ,13.05 ,13.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43865,CPT,REVJ GSTR/JJ ANAST W/RCNSTJ W/VGTMY,,,21,,RBRVS,29.05 ,13.49 ,13.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43870,CPT,CLOSURE GASTROSTOMY SURG,,,21,,RBRVS,11.44 ,6.55 ,6.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43880,CPT,CLOSURE GASTROCOLIC FISTULA,,,21,,RBRVS,27.18 ,12.84 ,12.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 43886,CPT,GSTR RSTCV PX OPN REVJ SUBQ PORT COMPONENT ONLY,,,21,,RBRVS,4.64 ,4.72 ,4.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43887,CPT,GSTR RSTCV PX OPN RMVL SUBQ PORT COMPONENT ONLY,,,21,,RBRVS,4.32 ,4.00 ,4.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43888,CPT,GSTR RSTCV OPN RMVL & RPLCMT SUBQ PORT,,,21,,RBRVS,6.44 ,5.30 ,5.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 43999,CPT,UNLISTED PROCEDURE STOMACH,,,21,,TotalUnits,,,,4.90 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44005,CPT,ENTEROLSS FRING INTSTINAL ADHESION SPX,,,21,,RBRVS,18.46 ,8.99 ,8.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44010,CPT,DUODENOTOMY EXPLORATION/BX/FOREIGN BODY REMOVAL,,,21,,RBRVS,14.26 ,7.76 ,7.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44015,CPT,TUBE/NEEDLE CATH JEJUNOSTOMY ANY METHOD,,,21,,RBRVS,2.62 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44020,CPT,ENTEROTOMY SM INT OTH/THN DUO EXPL BX/FB RMVL,,,21,,RBRVS,16.22 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44021,CPT,ENTEROTOMY SM INT OTH/THN DUO DCMPRN,,,21,,RBRVS,16.31 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44025,CPT,COLOTOMY EXPLORATION/BIOPSY/FOREIGN BODY REMOVAL,,,21,,RBRVS,16.51 ,8.33 ,8.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44050,CPT,RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT,,,21,,RBRVS,15.52 ,8.00 ,8.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44055,CPT,CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS,,,21,,RBRVS,25.63 ,11.78 ,11.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44100,CPT,BX INTESTINE CAPSULE TUBE PRORAL 1/> SPECIMENS,,,21,,RBRVS,2.01 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44110,CPT,EXC 1/> SMALL/LARGE LESIONS INTESTINE ENTEROTOM,,,21,,RBRVS,14.04 ,7.46 ,7.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44111,CPT,EXC 1/> SM/LG LESIONS INTESTNE MULT ENTEROTOMIE,,,21,,RBRVS,16.52 ,8.41 ,8.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44120,CPT,ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST,,,21,,RBRVS,20.82 ,9.86 ,9.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44121,CPT,ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ & ANA,,,21,,RBRVS,4.44 ,1.59 ,1.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44125,CPT,ENTERECTOMY RESCJ SMALL INTESTINE W/ENTEROSTOMY,,,21,,RBRVS,20.03 ,9.75 ,9.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44126,CPT,ENTRC RESCJ ATRESIA RESCJ & ANAST W/O TAPRING,,,21,,RBRVS,42.23 ,19.19 ,19.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44127,CPT,ENTRC RESCJ ATRESIA RESCJ & ANAST SGM W/TAPRING,,,21,,RBRVS,49.30 ,21.67 ,21.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44128,CPT,ENTRC RESCJ ATRESIA EA RESCJ & ANASTOMOSIS,,,21,,RBRVS,4.44 ,1.60 ,1.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44130,CPT,ENTEROENTEROST ANAST INT W/WO CUTAN NTRSTM SPX,,,21,,RBRVS,22.11 ,10.94 ,10.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44139,CPT,MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT,,,21,,RBRVS,2.23 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44140,CPT,COLECTOMY PARTIAL W/ANASTOMOSIS,,,21,,RBRVS,22.59 ,11.16 ,11.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44141,CPT,COLECTOMY PRTL W/SKIN LEVEL CECOST/COLOSTOMY,,,21,,RBRVS,29.91 ,16.24 ,16.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44143,CPT,COLECTOMY PRTL W/END COLOSTOMY & CLSR DSTL SGMT,,,21,,RBRVS,27.79 ,14.17 ,14.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44144,CPT,COLECTOMY PRTL W/COLOST/ILEOST & MUCOFISTULA,,,21,,RBRVS,29.91 ,14.66 ,14.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44145,CPT,COLECTOMY PRTL W/COLOPROCTOSTOMY,,,21,,RBRVS,28.58 ,13.35 ,13.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44146,CPT,COLECTOMY PRTL W/COLOPROCTOSTOMY & COLOSTOMY,,,21,,RBRVS,35.30 ,18.63 ,18.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44147,CPT,COLECTOMY PRTL ABDOMINAL & TRANSANAL APPROACH,,,21,,RBRVS,33.69 ,15.17 ,15.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44150,CPT,COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS,,,21,,RBRVS,30.18 ,17.40 ,17.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44151,CPT,COLCT TOT ABDL W/O PRCTECT W/CONTINENT ILEOST,,,21,,RBRVS,34.92 ,19.17 ,19.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44155,CPT,COLECTOMY TOT ABDL W/PROCTECTOMY W/ILEOSTOMY,,,21,,RBRVS,34.42 ,18.97 ,18.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44156,CPT,COLECTOMY TOT ABDL W/PROCTECTOMY W/CONTNT ILEOST,,,21,,RBRVS,37.42 ,20.70 ,20.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44157,CPT,COLECTOMY TOT ABD W/PROCTECTOMY ILEOANAL ANAST,,,21,,RBRVS,35.70 ,19.11 ,19.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44158,CPT,COLCT TTL ABD W/PRCTECT ILEOANAL ANAST & RSVR,,,21,,RBRVS,36.70 ,19.56 ,19.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44160,CPT,COLECTOMY PRTL W/RMVL TERMINAL ILEUM & ILEOCOLOS,,,21,,RBRVS,20.89 ,10.42 ,10.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44180,CPT,LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE,,,21,,RBRVS,15.27 ,7.89 ,7.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44186,CPT,LAPAROSCOPY SURGICAL JEJUNOSTOMY,,,21,,RBRVS,10.38 ,6.07 ,6.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44187,CPT,LAPAROSCOPY SURG ILEOSTOMY/JEJUNOSTOMY NON-TUBE,,,21,,RBRVS,17.40 ,11.11 ,11.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44188,CPT,LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY,,,21,,RBRVS,19.35 ,12.00 ,12.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44202,CPT,LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA,,,21,,RBRVS,23.39 ,11.50 ,11.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44203,CPT,LAPAROSCOPY SMALL INTESTINE RESCJ & ANASTOMOSIS,,,21,,RBRVS,4.44 ,1.59 ,1.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44204,CPT,LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS,,,21,,RBRVS,26.42 ,12.55 ,12.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44205,CPT,LAPS COLECTOMY PRTL W/RMVL TERMINAL ILEUM,,,21,,RBRVS,22.95 ,11.00 ,11.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44206,CPT,LAPS COLECTOMY PRTL W/END CLST & CLSR DSTL SGM,,,21,,RBRVS,29.79 ,14.60 ,14.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44207,CPT,LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST,,,21,,RBRVS,31.92 ,14.42 ,14.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44208,CPT,LAPS COLECTMY PRTL W/COLOPXTSTMY LW ANAST W/CLST,,,21,,RBRVS,33.99 ,16.80 ,16.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44210,CPT,LAPS COLECTOMY TOT W/O PRCTECT W/ILEOST/ILEOPXTS,,,21,,RBRVS,30.09 ,15.73 ,15.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44211,CPT,LAPS COLCT TTL ABD W/PRCTECT ILEOANAL ANASTOMSIS,,,21,,RBRVS,37.08 ,19.32 ,19.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44212,CPT,LAPS COLECTOMY ABDL W/PROCTECTOMY W/ILEOSTOMY,,,21,,RBRVS,34.58 ,18.52 ,18.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44213,CPT,LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY,,,21,,RBRVS,3.50 ,1.25 ,1.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44227,CPT,LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS,,,21,,RBRVS,28.62 ,13.43 ,13.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44238,CPT,UNLISTED LAPAROSCOPY PX INTESTINE XCP RECTUM,,,21,,TotalUnits,,,,38.97 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44300,CPT,PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN,,,21,,RBRVS,13.75 ,7.45 ,7.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44310,CPT,ILEOSTOMY/JEJUNOSTOMY NON-TUBE,,,21,,RBRVS,17.59 ,8.91 ,8.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44312,CPT,REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX,,,21,,RBRVS,9.43 ,5.81 ,5.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44314,CPT,REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX,,,21,,RBRVS,16.74 ,8.98 ,8.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44316,CPT,CONTINENT ILEOSTOMY KOCK PROCEDURE SPX,,,21,,RBRVS,23.59 ,11.76 ,11.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44320,CPT,COLOSTOMY/SKIN LEVEL CECOSTOMY,,,21,,RBRVS,19.91 ,10.49 ,10.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44322,CPT,COLOSTOMY/SKN LVL CECOSTOMY W/MULT BXS SPX,,,21,,RBRVS,13.32 ,12.43 ,12.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44340,CPT,REVJ COLOSTOMY SMPL RLS SUPFC SCAR SPX,,,21,,RBRVS,9.28 ,6.75 ,6.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44345,CPT,REVJ COLOSTOMY COMP RCNSTJ IN-DEPTH SPX,,,21,,RBRVS,17.22 ,9.55 ,9.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44346,CPT,REVJ COLOSTOMY W/RPR PARACLST HERNIA SPX,,,21,,RBRVS,19.63 ,10.45 ,10.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44360,CPT,ENDOSCOPY UPPER SMALL INTESTINE,,,21,,RBRVS,2.59 ,1.45 ,1.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44361,CPT,ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY,,,21,,RBRVS,2.87 ,1.58 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44363,CPT,ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY,,,21,,RBRVS,3.49 ,1.82 ,1.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44364,CPT,ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE,,,21,,RBRVS,3.73 ,1.95 ,1.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44365,CPT,ENTEROSCOPY > 2ND PRTN W/RMVL LESION CAUTERY,,,21,,RBRVS,3.31 ,1.76 ,1.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44366,CPT,ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING,,,21,,RBRVS,4.40 ,2.26 ,2.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44369,CPT,ENTEROSCOPY > 2ND PRTN ABLTJ LESION,,,21,,RBRVS,4.51 ,2.30 ,2.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44370,CPT,ENTEROSCOPY > 2ND PRTN TNDSC STENT PLMT,,,21,,RBRVS,4.79 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44372,CPT,ENTEROSCOPY > 2ND PRTN W/PLMT PRQ TUBE,,,21,,RBRVS,4.40 ,2.19 ,2.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44373,CPT,ENTEROSCOPY > 2ND PRTN CONV GSTRST TUBE,,,21,,RBRVS,3.49 ,1.81 ,1.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44376,CPT,ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX,,,21,,RBRVS,5.25 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44377,CPT,ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE,,,21,,RBRVS,5.52 ,2.71 ,2.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44378,CPT,ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING,,,21,,RBRVS,7.12 ,3.45 ,3.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44379,CPT,ENTEROSCOPY > 2ND PRTN W/ILEUM W/STENT PLMT,,,21,,RBRVS,7.46 ,3.77 ,3.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44380,CPT,ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD,,,21,,RBRVS,0.97 ,0.71 ,5.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44381,CPT,ILEOSCOPY STOMA W/BALLOON DILATION,,,21,,RBRVS,1.48 ,0.93 ,26.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44382,CPT,ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE,,,21,,RBRVS,1.27 ,0.86 ,7.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44384,CPT,ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT,,,21,,RBRVS,2.95 ,1.29 ,1.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44385,CPT,NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX,,,21,,RBRVS,1.30 ,0.76 ,5.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44386,CPT,NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE,,,21,,RBRVS,1.60 ,0.93 ,7.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44388,CPT,COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX,,,21,,RBRVS,2.82 ,1.47 ,6.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44389,CPT,COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE,,,21,,RBRVS,3.12 ,1.63 ,9.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44390,CPT,COLONOSCOPY STOMA W/RMVL FOREIGN BODY,,,21,,RBRVS,3.84 ,2.00 ,8.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44391,CPT,COLONOSCOPY STOMA CONTROL BLEEDING,,,21,,RBRVS,4.22 ,2.14 ,16.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44392,CPT,COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS,,,21,,RBRVS,3.63 ,1.80 ,7.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44394,CPT,COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE,,,21,,RBRVS,4.13 ,2.06 ,8.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44401,CPT,COLONOSCOPY STOMA ABLATION LESION,,,21,,RBRVS,4.44 ,2.16 ,87.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44402,CPT,COLONOSCOPY STOMA W/ENDOSCOPIC STENT PLCMT,,,21,,RBRVS,4.80 ,2.35 ,2.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44403,CPT,COLONOSCOPY STOMA W/ENDOSCOPIC MUCOSAL RESCJ,,,21,,RBRVS,5.60 ,2.64 ,2.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44404,CPT,COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION,,,21,,RBRVS,3.12 ,1.61 ,8.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44405,CPT,COLONOSCOPY STOMA W/BALLOON DILATION,,,21,,RBRVS,3.33 ,1.70 ,13.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44406,CPT,COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM,,,21,,RBRVS,4.20 ,2.06 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44407,CPT,COLONOSCOPY STOMA W/US GID NDL ASPIR/BX,,,21,,RBRVS,5.06 ,2.42 ,2.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44408,CPT,COLONOSCOPY THROUGH STOMA WITH DECOMPRESSION,,,21,,RBRVS,4.24 ,2.08 ,2.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44500,CPT,INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE,,,21,,RBRVS,0.49 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44602,CPT,ENTERORRHAPHY 1PERFORATION,,,21,,RBRVS,24.72 ,10.58 ,10.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44603,CPT,ENTERORRHAPHY MULTIPLE PERFORATIONS,,,21,,RBRVS,28.16 ,12.47 ,12.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44604,CPT,SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY,,,21,,RBRVS,18.16 ,8.41 ,8.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44605,CPT,SUTR LG INTESTINE 1/MULT PERFORAT W/COLOSTOMY,,,21,,RBRVS,22.08 ,10.81 ,10.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44615,CPT,INTSTINAL STRICTUROPLASTY W/WO DILAT OBSTRCJ,,,21,,RBRVS,18.16 ,8.96 ,8.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44620,CPT,CLOSURE ENTEROSTOMY LG/SMALL INTESTINE,,,21,,RBRVS,14.43 ,7.65 ,7.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44625,CPT,CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT,,,21,,RBRVS,17.28 ,8.66 ,8.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44626,CPT,CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS,,,21,,RBRVS,27.90 ,12.43 ,12.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44640,CPT,CLOSURE INTESTINAL CUTANEOUS FISTULA,,,21,,RBRVS,24.20 ,11.17 ,11.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44650,CPT,CLSR ENTEROENTERIC/ENTEROCOLIC FSTL,,,21,,RBRVS,25.12 ,11.48 ,11.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44660,CPT,CLSR ENTEROVES FSTL W/O INTSTINAL/BLADDER RESCJ,,,21,,RBRVS,23.91 ,10.51 ,10.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44661,CPT,CLSR ENTEROVES FSTL W/INTESTINE&/BLADDER RESCJ,,,21,,RBRVS,27.35 ,12.09 ,12.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44680,CPT,INTESTINAL PLICATION SEPARATE PROCEDURE,,,21,,RBRVS,17.96 ,8.87 ,8.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44700,CPT,EXCLUSION SM INT FROM PELVIS MESH/PROSTH/TISS,,,21,,RBRVS,17.48 ,8.74 ,8.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44701,CPT,INTRAOPERATIVE COLONIC LAVAGE,,,21,,RBRVS,3.10 ,1.12 ,1.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44705,CPT,PREPARE FECAL MICROBIOTA FOR INSTILLATION,,,21,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44720,CPT,BKBENCH RCNSTJ INT ALGRFT VEN ANAST EA,,,21,,RBRVS,5.00 ,1.79 ,1.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44721,CPT,BKBENCH RCNSTJ INT ALGRFT ARTL ANAST EA,,,21,,RBRVS,7.00 ,2.50 ,2.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44799,CPT,UNLISTED PROCEDURE SMALL INTESTINE,,,21,,TotalUnits,,,,30.68 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44800,CPT,EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT,,,21,,RBRVS,12.05 ,7.36 ,7.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44820,CPT,EXCISION LESION MESENTERY SEPARATE PROCEDURE,,,21,,RBRVS,13.73 ,7.52 ,7.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44850,CPT,SUTURE MESENTERY SEPARATE PROCEDURE,,,21,,RBRVS,12.11 ,6.88 ,6.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44899,CPT,UNLISTED PX MECKEL'S DIVERTICULUM & MESENTERY,,,21,,TotalUnits,,,,19.41 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44900,CPT,INCISION AND DRAINAGE APPENDICEAL ABSCESS OPEN,,,21,,RBRVS,12.57 ,6.92 ,6.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44950,CPT,APPENDECTOMY,,,21,,RBRVS,10.60 ,5.54 ,5.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44955,CPT,APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX,,,21,,RBRVS,1.53 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44960,CPT,APPENDEC RPTD APPENDIX ABSC/PRITONITIS,,,21,,RBRVS,14.50 ,7.43 ,7.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 44970,CPT,LAPAROSCOPIC APPENDECTOMY,,,21,,RBRVS,9.45 ,5.73 ,5.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 44979,CPT,UNLISTED LAPAROSCOPY PROCEDURE APPENDIX,,,21,,TotalUnits,,,,15.18 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45000,CPT,TRANSRECTAL DRAINAGE OF PELVIC ABSCESS,,,21,,RBRVS,6.30 ,4.73 ,4.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45005,CPT,I&D SUBMUCOSAL ABSCESS RECTUM,,,21,,RBRVS,2.02 ,2.20 ,5.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45020,CPT,I&D DP SUPRALEVATOR PELVIRCT/RETRORCT ABSC,,,21,,RBRVS,8.56 ,6.15 ,6.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45100,CPT,BX ANORECTAL WALL ANAL APPROACH,,,21,,RBRVS,4.04 ,3.82 ,3.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45108,CPT,ANORECTAL MYOMECTOMY,,,21,,RBRVS,5.12 ,4.27 ,4.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45110,CPT,PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST,,,21,,RBRVS,30.76 ,16.65 ,16.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45111,CPT,PRCTECT PRTL RESCJ RECTUM TABDL APPR,,,21,,RBRVS,18.01 ,9.72 ,9.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45112,CPT,PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX,,,21,,RBRVS,33.18 ,15.08 ,15.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45113,CPT,PRCTECT PRTL W/MUCOSEC ILEOANAL ANAST RSVR,,,21,,RBRVS,33.22 ,16.67 ,16.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45114,CPT,PRCTECT PRTL W/ANAST ABDL & TRANSSAC APPROACH,,,21,,RBRVS,30.79 ,14.52 ,14.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45116,CPT,PRCTECT PRTL W/ANAST TRANSSAC APPR ONLY,,,21,,RBRVS,27.72 ,13.61 ,13.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45119,CPT,PRCTECT CMBN PULL-THRU W/RSVR W/NTRSTM,,,21,,RBRVS,33.48 ,16.85 ,16.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45120,CPT,PRCTECT COMPL W/PULL-THRU PX & ANASTOMOSIS,,,21,,RBRVS,26.40 ,13.32 ,13.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45121,CPT,PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS,,,21,,RBRVS,29.08 ,14.48 ,14.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45123,CPT,PRCTECT PRTL W/O ANAST PRNL APPR,,,21,,RBRVS,18.86 ,10.18 ,10.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45126,CPT,PELVIC EXENTERATION COLORECTAL MALIGNANCY,,,21,,RBRVS,49.10 ,22.75 ,22.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45130,CPT,EXC RCT PROCIDENTIA W/ANAST PERINEAL APPROACH,,,21,,RBRVS,18.50 ,9.77 ,9.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45135,CPT,EXC RCT PROCIDENTIA W/ANAST ABDL & PRNL APPROACH,,,21,,RBRVS,22.36 ,12.09 ,12.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45136,CPT,EXC ILEOANAL RSVR W/ILEOSTOMY,,,21,,RBRVS,30.82 ,17.03 ,17.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45150,CPT,DIVISION STRICTURE RECTUM,,,21,,RBRVS,5.85 ,4.57 ,4.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45160,CPT,EXC RCT TUM PROCTOTOMY TRANSSAC/TRANSCOCCYGEAL,,,21,,RBRVS,16.33 ,9.38 ,9.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45171,CPT,EXC RCT TUM NOT INCL MUSCULARIS PROPRIA,,,21,,RBRVS,8.13 ,7.62 ,7.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45172,CPT,EXC RCT TUM INCL MUSCULARIS PROPRIA,,,21,,RBRVS,12.13 ,9.02 ,9.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45190,CPT,DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH,,,21,,RBRVS,10.42 ,7.78 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45300,CPT,PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX,,,21,,RBRVS,0.80 ,0.63 ,2.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45303,CPT,PROCTOSGMDSC RIGID W/DILATION,,,21,,RBRVS,1.50 ,0.89 ,25.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45305,CPT,PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE,,,21,,RBRVS,1.25 ,0.80 ,4.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45307,CPT,PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY,,,21,,RBRVS,1.70 ,0.97 ,4.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45308,CPT,PROCTOSGMDSC RIGID RMVL 1 LESION CAUTERY,,,21,,RBRVS,1.40 ,0.86 ,4.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45309,CPT,PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ,,,21,,RBRVS,1.50 ,0.90 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45315,CPT,PROCTOSGMDSC RIGID RMVL MULT TUMOR CAUTERY/SNARE,,,21,,RBRVS,1.80 ,1.08 ,4.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45317,CPT,PROCTOSGMDSC RIGID CONTROL BLEEDING,,,21,,RBRVS,2.00 ,1.07 ,4.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45320,CPT,PROCTOSGMDSC RIGID ABLATION LESION,,,21,,RBRVS,1.78 ,1.00 ,4.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45321,CPT,PROCTOSGMDSC RIGID DCMPRN VOLVULUS,,,21,,RBRVS,1.75 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45327,CPT,PROCTOSGMDSC RIGID TNDSC STENT PLMT,,,21,,RBRVS,2.00 ,1.08 ,1.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45330,CPT,SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD,,,21,,RBRVS,0.84 ,0.67 ,3.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45331,CPT,SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE,,,21,,RBRVS,1.14 ,0.81 ,5.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45332,CPT,SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY,,,21,,RBRVS,1.86 ,1.10 ,6.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45333,CPT,SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS,,,21,,RBRVS,1.65 ,1.00 ,8.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45334,CPT,SIGMOIDOSCOPY FLX CONTROL BLEEDING,,,21,,RBRVS,2.10 ,1.23 ,14.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45335,CPT,SGMDSC FLX DIRED SBMCSL NJX ANY SBST,,,21,,RBRVS,1.14 ,0.80 ,6.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45337,CPT,SGMDSC FLX W/DCMPRN W/PLMT DCMPRN TUBE,,,21,,RBRVS,2.20 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45338,CPT,SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ,,,21,,RBRVS,2.15 ,1.23 ,6.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45340,CPT,SIGMOIDOSCOPY FLX TNDSC BALO DILAT,,,21,,RBRVS,1.35 ,0.88 ,12.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45341,CPT,SIGMOIDOSCOPY FLX NDSC US XM,,,21,,RBRVS,2.22 ,1.28 ,1.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45342,CPT,SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX,,,21,,RBRVS,3.08 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45346,CPT,SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES,,,21,,RBRVS,2.91 ,1.55 ,85.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45347,CPT,SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT,,,21,,RBRVS,2.82 ,1.49 ,1.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45349,CPT,SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION,,,21,,RBRVS,3.62 ,1.82 ,1.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45350,CPT,SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S),,,21,,RBRVS,1.78 ,1.06 ,14.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45378,CPT,COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD,,,21,,RBRVS,3.36 ,1.74 ,6.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45379,CPT,COLONOSCOPY FLX W/REMOVAL OF FOREIGN BODY(S),,,21,,RBRVS,4.38 ,2.19 ,8.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45380,CPT,COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE,,,21,,RBRVS,3.66 ,1.90 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45381,CPT,COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST,,,21,,RBRVS,3.66 ,1.91 ,8.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45382,CPT,COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD,,,21,,RBRVS,4.76 ,2.40 ,17.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45384,CPT,COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS,,,21,,RBRVS,4.17 ,2.06 ,9.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45385,CPT,COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ,,,21,,RBRVS,4.67 ,2.34 ,8.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45386,CPT,COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT,,,21,,RBRVS,3.87 ,1.96 ,14.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45388,CPT,COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES,,,21,,RBRVS,4.98 ,2.42 ,87.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45389,CPT,COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT,,,21,,RBRVS,5.34 ,2.60 ,2.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45390,CPT,COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION,,,21,,RBRVS,6.14 ,2.87 ,2.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45391,CPT,COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX,,,21,,RBRVS,4.74 ,2.38 ,2.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45392,CPT,COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL,,,21,,RBRVS,5.60 ,2.76 ,2.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45393,CPT,COLONOSCOPY FLEXIBLE WITH DECOMPRESSION,,,21,,RBRVS,4.78 ,2.11 ,2.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45395,CPT,LAPS PROCTECTOMY ABDOMINOPERINEAL W/COLOSTOMY,,,21,,RBRVS,33.00 ,18.17 ,18.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45397,CPT,LAPS PROCTECTOMY COMBINED PULL-THRU W/RESERVOIR,,,21,,RBRVS,36.50 ,19.53 ,19.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45398,CPT,COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S),,,21,,RBRVS,4.30 ,2.10 ,15.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45399,CPT,UNLISTED PROCEDURE COLON,,,21,,TotalUnits,,,,5.91 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45400,CPT,LAPAROSCOPY PROCTOPEXY PROLAPSE,,,21,,RBRVS,19.44 ,10.15 ,10.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45402,CPT,LAPAROSCOPY PROCTOPEXY PROLAPSE SIGMOID RESCJ,,,21,,RBRVS,26.51 ,12.70 ,12.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45499,CPT,UNLISTED LAPAROSCOPY PROCEDURE RECTUM,,,21,,TotalUnits,,,,32.60 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45500,CPT,PROCTOPLASTY STENOSIS,,,21,,RBRVS,7.73 ,6.19 ,6.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45505,CPT,PROCTOPLASTY PROLAPSE MUCOUS MEMBRANE,,,21,,RBRVS,8.36 ,7.15 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45520,CPT,PERIRECTAL INJ SCLEROSING SOLUTION PROLAPSE,,,21,,RBRVS,0.55 ,0.54 ,3.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45540,CPT,PROCTOPEXY ABDOMINAL APPROACH,,,21,,RBRVS,18.12 ,9.23 ,9.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45541,CPT,PROCTOPEXY PERINEAL APPROACH,,,21,,RBRVS,14.85 ,9.38 ,9.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45550,CPT,PROCTOPEXY W/SIGMOID RESCJ ABDL APPR,,,21,,RBRVS,24.80 ,12.94 ,12.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45560,CPT,REPAIR RECTOCELE SEPARATE PROCEDURE,,,21,,RBRVS,11.50 ,6.82 ,6.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45562,CPT,EXPL RPR & PRESACRAL DRG RECTAL INJURY,,,21,,RBRVS,17.98 ,10.69 ,10.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45563,CPT,EXPL RPR & PRESACRAL DRG RECTAL INJ W/COLOSTOMY,,,21,,RBRVS,26.38 ,15.08 ,15.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45800,CPT,CLOSURE RECTOVESICAL FISTULA,,,21,,RBRVS,20.31 ,10.77 ,10.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45805,CPT,CLSR RECTOVESICAL FISTULA W/COLOSTOMY,,,21,,RBRVS,23.32 ,13.43 ,13.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45820,CPT,CLOSURE RECTOURETHRAL FISTULA,,,21,,RBRVS,20.37 ,11.15 ,11.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45825,CPT,CLOSURE RECTOURETHRAL FISTULA W/COLOSTOMY,,,21,,RBRVS,24.17 ,12.57 ,12.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 45900,CPT,RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE,,,21,,RBRVS,2.99 ,2.28 ,2.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45905,CPT,DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL,,,21,,RBRVS,2.35 ,2.09 ,2.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45910,CPT,DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL,,,21,,RBRVS,2.85 ,2.26 ,2.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45915,CPT,RMVL FECAL IMPACTION/FB SPX UNDER ANES,,,21,,RBRVS,3.19 ,2.84 ,5.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45990,CPT,ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX,,,21,,RBRVS,1.80 ,0.97 ,0.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 45999,CPT,UNLISTED PROCEDURE RECTUM,,,21,,TotalUnits,,,,5.91 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46020,CPT,PLACEMENT SETON,,,21,,RBRVS,3.00 ,3.18 ,4.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46030,CPT,REMOVAL ANAL SETON OTHER MARKER,,,21,,RBRVS,1.26 ,1.11 ,2.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46040,CPT,I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX,,,21,,RBRVS,5.37 ,5.45 ,8.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46045,CPT,I&D INTRAMURAL IM/ABSC TRANSANAL ANES,,,21,,RBRVS,5.87 ,5.40 ,5.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46050,CPT,I&D PERIANAL ABSCESS SUPERFICIAL,,,21,,RBRVS,1.24 ,1.33 ,4.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46060,CPT,I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON,,,21,,RBRVS,6.37 ,6.12 ,6.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46070,CPT,INCISION ANAL SEPTUM INFANT,,,21,,RBRVS,2.79 ,3.36 ,3.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46080,CPT,SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX,,,21,,RBRVS,2.52 ,1.56 ,4.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46083,CPT,INCISION THROMBOSED HEMORRHOID EXTERNAL,,,21,,RBRVS,1.45 ,1.37 ,3.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46200,CPT,FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED,,,21,,RBRVS,3.59 ,5.10 ,8.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46220,CPT,EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS,,,21,,RBRVS,1.61 ,1.50 ,3.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46221,CPT,HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS,,,21,,RBRVS,2.36 ,2.74 ,4.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46230,CPT,EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS,,,21,,RBRVS,2.62 ,1.87 ,4.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46250,CPT,HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP,,,21,,RBRVS,4.25 ,3.97 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46255,CPT,HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP,,,21,,RBRVS,4.96 ,4.24 ,8.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46257,CPT,HEMORRHOID NTRNL & XTRNL 1 COLUMN W/FISSURECTO,,,21,,RBRVS,5.76 ,5.27 ,5.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46258,CPT,HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY,,,21,,RBRVS,6.41 ,5.50 ,5.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46260,CPT,HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO,,,21,,RBRVS,6.73 ,5.62 ,5.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46261,CPT,HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU,,,21,,RBRVS,7.76 ,5.86 ,5.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46262,CPT,HRHC 2/> COL/GRP W/FSTULECTMY INCL FSSRECTMY,,,21,,RBRVS,7.91 ,6.55 ,6.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46270,CPT,SURG TX ANAL FISTULA SUBQ,,,21,,RBRVS,4.92 ,5.35 ,8.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46275,CPT,SURG TX ANAL FISTULA INTERSPHINCTERIC,,,21,,RBRVS,5.42 ,5.49 ,8.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46280,CPT,TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON,,,21,,RBRVS,6.39 ,5.97 ,5.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46285,CPT,SURG TX ANAL FISTULA 2ND STAGE,,,21,,RBRVS,5.42 ,5.48 ,8.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46288,CPT,CLSR ANAL FSTL W/RCT ADVMNT FLAP,,,21,,RBRVS,7.81 ,6.62 ,6.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46320,CPT,EXC THROMBOSED HEMORRHOID XTRNL,,,21,,RBRVS,1.64 ,1.25 ,3.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46500,CPT,INJECTION SCLEROSING SOLUTION HEMORRHOIDS,,,21,,RBRVS,1.42 ,1.89 ,3.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46505,CPT,CHEMODENERVATION INTERNAL ANAL SPHINCTER,,,21,,RBRVS,3.18 ,3.12 ,4.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46600,CPT,ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD,,,21,,RBRVS,0.55 ,0.54 ,1.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46601,CPT,ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT,,,21,,RBRVS,1.60 ,0.98 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46604,CPT,ANOSCOPY W/DILATION,,,21,,RBRVS,1.03 ,0.72 ,16.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46606,CPT,ANOSCOPY W/BX SINGLE/MULTIPLE,,,21,,RBRVS,1.20 ,0.80 ,5.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46607,CPT,ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX,,,21,,RBRVS,2.20 ,1.23 ,3.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46608,CPT,ANOSCOPY W/RMVL FOREIGN BODY,,,21,,RBRVS,1.30 ,0.79 ,5.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46610,CPT,ANOSCOPY W/RMVL LESION CAUTERY,,,21,,RBRVS,1.28 ,0.80 ,4.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46611,CPT,ANOSC RMVL 1 TUM POLYP/OTH LES SNARE TQ,,,21,,RBRVS,1.30 ,0.83 ,3.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46612,CPT,ANOSC RMVL MULT TUMORS CAUTERY/SNARE,,,21,,RBRVS,1.50 ,0.88 ,5.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46614,CPT,ANOSCOPY CONTROL BLEEDING,,,21,,RBRVS,1.00 ,0.71 ,2.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46615,CPT,ANOSCOPY ABLATION LESION,,,21,,RBRVS,1.50 ,0.90 ,2.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46700,CPT,ANOPLASTY PLASTIC OPERATION STRICTURE ADULT,,,21,,RBRVS,9.81 ,7.34 ,7.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46705,CPT,ANOPLASTY PLASTIC OPERATION STRICTURE INFANT,,,21,,RBRVS,7.43 ,5.99 ,5.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 46706,CPT,REPAIR ANAL FISTULA W/FIBRIN GLUE,,,21,,RBRVS,2.44 ,1.99 ,1.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46707,CPT,REPAIR ANORECTAL FISTULA PLUG,,,21,,RBRVS,6.39 ,6.02 ,6.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46710,CPT,RPR ILEOANAL POUCH FSTL/POUCH ADVMNT TPRNL APPR,,,21,,RBRVS,17.14 ,10.58 ,10.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 46712,CPT,RPR ILEOANAL POUCH FSTL/POUCH ADVMNT CMBN APPR,,,21,,RBRVS,36.45 ,19.29 ,19.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 46715,CPT,RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK,,,21,,RBRVS,7.62 ,6.18 ,6.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 46716,CPT,RPR LW IMPERFORATE ANUS W/TRPOS FISTULA,,,21,,RBRVS,17.54 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 46730,CPT,RPR HI IMPRF ANUS W/O FSTL PRNL/SACROPRNL APPR,,,21,,RBRVS,30.65 ,17.79 ,17.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 46735,CPT,RPR HI IMPRF ANUS W/O FISTULA CMBN APPR,,,21,,RBRVS,36.14 ,19.88 ,19.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 46740,CPT,RPR HI IMPRF ANUS W/FSTL PRNL/SACROPRNL APPR,,,21,,RBRVS,33.90 ,20.04 ,20.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 46742,CPT,RPR HI IMPRF ANUS W/FSTL TABDL & SACROPRNL,,,21,,RBRVS,40.14 ,22.17 ,22.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 46744,CPT,RPR CLOACAL ANOMALY SACROPERINEAL,,,21,,RBRVS,58.94 ,28.97 ,28.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 46746,CPT,RPR CLOACAL ANOMALY CMBN ABDL&SACROPRNL,,,21,,RBRVS,65.44 ,31.21 ,31.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 46748,CPT,RPR CLOACAL ANOMALY CMBN ABDL & SACROPRNL W/GRF,,,21,,RBRVS,71.42 ,33.50 ,33.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 46750,CPT,SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT,,,21,,RBRVS,12.15 ,7.78 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46751,CPT,SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD,,,21,,RBRVS,9.30 ,6.63 ,6.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 46753,CPT,GRAFT THIERSCH RCT INCONTINENCE &/PROLAPSE,,,21,,RBRVS,8.89 ,6.60 ,6.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46754,CPT,RMVL THIERSCH WIRE/SUTURE ANAL CANAL,,,21,,RBRVS,3.01 ,3.13 ,4.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46760,CPT,SPHINCTEROPLASTY ANAL MUSCLE TRANSPLANT,,,21,,RBRVS,17.45 ,11.58 ,11.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46761,CPT,SPHNCTROP ANAL LEVATOR MUSC IMBRCJ,,,21,,RBRVS,15.29 ,9.06 ,9.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46762,CPT,SPHNCTROP ANAL IMPLTJ ARTIF SPHNCTR,,,21,,RBRVS,14.82 ,9.64 ,9.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46900,CPT,DSTRJ LESION ANUS SIMPLE CHEMICAL,,,21,,RBRVS,1.91 ,1.76 ,4.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46910,CPT,DSTRJ LESION ANUS SMPL ELTRDSICCATION,,,21,,RBRVS,1.91 ,1.61 ,5.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46916,CPT,DSTRJ LESION ANUS SIMPLE CRYOSURGERY,,,21,,RBRVS,1.91 ,1.95 ,4.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46917,CPT,DSTRJ LESION ANUS SIMPLE LASER SURG,,,21,,RBRVS,1.91 ,1.62 ,10.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46922,CPT,DSTRJ LESION ANUS SIMPLE SURG EXCISION,,,21,,RBRVS,1.91 ,1.62 ,5.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46924,CPT,DSTRJ LESION ANUS EXTENSIVE,,,21,,RBRVS,2.81 ,2.02 ,11.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46930,CPT,DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY,,,21,,RBRVS,1.61 ,2.39 ,4.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46940,CPT,CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX 1ST,,,21,,RBRVS,2.35 ,1.49 ,3.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46942,CPT,CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX SBSQ,,,21,,RBRVS,2.07 ,1.39 ,3.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46945,CPT,HRHC NTRNL LIG OTH THAN RBBR BAND 1 COL/GRP,,,21,,RBRVS,2.21 ,3.86 ,6.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46946,CPT,HRHC NTRNL LIG OTH THAN RBBR BAND 2/> COL/GRP,,,21,,RBRVS,2.63 ,3.38 ,5.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46947,CPT,HEMORRHOIDOPEXY STAPLING,,,21,,RBRVS,5.57 ,4.27 ,4.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 46999,CPT,UNLISTED PROCEDURE ANUS,,,21,,TotalUnits,,,,6.40 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47000,CPT,BIOPSY LIVER NEEDLE PERCUTANEOUS,,,21,,RBRVS,1.90 ,0.91 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47001,CPT,BX LVR NDL DONE PURPOSE TM OTH MAJOR PX,,,21,,RBRVS,1.90 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47010,CPT,HEPATOTOMY OPEN DRAINAGE ABSCESS/CYST 1/2 STAGES,,,21,,RBRVS,19.40 ,11.07 ,11.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47015,CPT,LAPT W/ASPIR &/NJX HEPATC PARASITIC CYST/ABSCESS,,,21,,RBRVS,18.50 ,10.61 ,10.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47100,CPT,BIOPSY LIVER WEDGE,,,21,,RBRVS,12.91 ,8.50 ,8.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47120,CPT,HEPATECTOMY RESCJ PARTIAL LOBECTOMY,,,21,,RBRVS,39.01 ,19.26 ,19.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47122,CPT,HEPATECTOMY RESCJ TRISEGMENTECTOMY,,,21,,RBRVS,59.48 ,25.87 ,25.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47125,CPT,HEPATECTOMY RESCJ TOTAL LEFT LOBECTOMY,,,21,,RBRVS,53.04 ,23.48 ,23.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47130,CPT,HEPATECTOMY RESCJ TOTAL RIGHT LOBECTOMY,,,21,,RBRVS,57.19 ,24.94 ,24.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47135,CPT,LVR ALTRNSPLJ ORTHOTOPIC PRTL/WHL DON ANY AGE,,,21,,RBRVS,90.00 ,44.40 ,44.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47140,CPT,DONOR HEPATECTOMY LIVING DONOR SEG II & III,,,21,,RBRVS,59.40 ,29.81 ,29.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47141,CPT,DONOR HEPATECTOMY LIVING DONOR SEG II III & IV,,,21,,RBRVS,71.50 ,35.01 ,35.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47142,CPT,DONOR HEPATECTOMY LIVING DONOR SEG V VI VII &VI,,,21,,RBRVS,79.44 ,37.85 ,37.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47143,CPT,BKBENCH PREP CADAVER DONOR,,,21,,TotalUnits,,,,14.37 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47146,CPT,BKBENCH RCNSTJ LVR GRF VENOUS ANAST EA,,,21,,RBRVS,6.00 ,2.12 ,2.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47147,CPT,BKBENCH RCNSTJ LVR GRF ARTL ANAST EA,,,21,,RBRVS,7.00 ,2.49 ,2.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47300,CPT,MARSUPIALIZATION CST/ABSC LVR,,,21,,RBRVS,18.14 ,10.39 ,10.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47350,CPT,MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ,,,21,,RBRVS,22.49 ,12.01 ,12.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47360,CPT,MGMT LVR HEMRRG CPLX SUTR WND/INJ,,,21,,RBRVS,31.31 ,15.40 ,15.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47361,CPT,MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR,,,21,,RBRVS,52.60 ,23.16 ,23.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47362,CPT,MGMT LVR HEMRRG RE-EXPL WND RMVL PACKING,,,21,,RBRVS,23.54 ,12.80 ,12.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47370,CPT,LAPS SURG ABLTJ 1/> LVR TUM RF,,,21,,RBRVS,20.80 ,10.43 ,10.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47371,CPT,LAPS SURG ABLTJ 1 > LVR TUM CRYOSURG,,,21,,RBRVS,20.80 ,10.09 ,10.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47379,CPT,UNLIS LAPAROSCOPIC PROCEDURE LIVER,,,21,,TotalUnits,,,,31.23 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47380,CPT,ABLTJ OPN 1/> LVR TUM RF,,,21,,RBRVS,24.56 ,11.68 ,11.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47381,CPT,ABLTJ OPN 1/> LVR TUM CRYOSURG,,,21,,RBRVS,24.88 ,11.62 ,11.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47382,CPT,ABLTJ 1/> LVR TUM PRQ RF,,,21,,RBRVS,15.22 ,5.78 ,126.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47383,CPT,ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION,,,21,,RBRVS,9.13 ,3.78 ,204.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47399,CPT,UNLISTED PROCEDURE LIVER,,,21,,TotalUnits,,,,3.16 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47400,CPT,HEPATCOTOMY/HEPATCOSTOMY W/EXPL DRG/RMVL ST1,,,21,,RBRVS,36.36 ,17.51 ,17.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47420,CPT,CHOLEDOCHOT/OST W/O SPHNCTROTOMY/SPHNCTROP,,,21,,RBRVS,22.03 ,11.66 ,11.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47425,CPT,CHOLEDOCHOT/OST W/SPHNCTROTOMY/SPHNCTROP,,,21,,RBRVS,22.31 ,11.66 ,11.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47460,CPT,TRANSDUOL SPHINCTEROT/PLASTY W/WO RMVL CALCULUS,,,21,,RBRVS,20.52 ,11.02 ,11.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47480,CPT,CHOLECSTOT/CHOLECSTOST W/EXPL DRG/RMVL ST1 SPX,,,21,,RBRVS,13.25 ,9.01 ,9.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47490,CPT,CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT,,,21,,RBRVS,4.76 ,4.42 ,4.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47531,CPT,NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS,,,21,,RBRVS,1.80 ,0.81 ,8.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47532,CPT,NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS,,,21,,RBRVS,4.25 ,1.58 ,18.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47533,CPT,PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL,,,21,,RBRVS,6.00 ,2.17 ,31.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47534,CPT,PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT,,,21,,RBRVS,8.03 ,2.81 ,37.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47535,CPT,CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH,,,21,,RBRVS,4.50 ,1.70 ,26.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47536,CPT,EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I,,,21,,RBRVS,2.88 ,1.14 ,20.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47537,CPT,REMOVAL BILIARY DRG CATHETER REQ FLUOR GID RS&I,,,21,,RBRVS,1.83 ,0.82 ,9.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47538,CPT,PLMT BILE DUCT STENT PRQ EXISTING ACCESS,,,21,,RBRVS,6.60 ,2.37 ,120.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47539,CPT,PLMT BILE DUCT STENT PRQ NEW ACCESS W/O SEP CATH,,,21,,RBRVS,9.00 ,3.12 ,130.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47540,CPT,PLMT BILE DUCT STENT PRQ NEW ACCESS W/SEP CATH,,,21,,RBRVS,10.75 ,3.72 ,133.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47541,CPT,PLMT ACCESS THRU BILIARY TREE INTO SMALL BWL NEW,,,21,,RBRVS,5.61 ,2.02 ,27.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47542,CPT,BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT,,,21,,RBRVS,2.50 ,0.79 ,11.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 47543,CPT,ENDOLUMINAL BX BILIARY TREE PRQ ANY METH SNG/MLT,,,21,,RBRVS,3.07 ,1.08 ,33.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 47544,CPT,REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,,,21,,RBRVS,4.29 ,1.41 ,18.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 47550,CPT,BILIARY NDSC INTRAOPERATIVE,,,21,,RBRVS,3.02 ,1.08 ,1.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47552,CPT,BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH,,,21,,RBRVS,6.03 ,2.45 ,2.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47553,CPT,BILIARY NDSC PRQ T-TUBE W/BX SINGLE/MULTIPLE,,,21,,RBRVS,6.34 ,2.02 ,2.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47554,CPT,BILIARY ENDOSCOPY PRQ VIA T-TUBE W/RMVL CALCULUS,,,21,,RBRVS,9.05 ,3.54 ,3.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47555,CPT,BILIARY NDSC PRQ T-TUBE W/DIL DUCT W/O STENT,,,21,,RBRVS,7.55 ,2.47 ,2.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47556,CPT,BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT,,,21,,RBRVS,8.55 ,2.85 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47562,CPT,LAPAROSCOPY SURG CHOLECYSTECTOMY,,,21,,RBRVS,10.47 ,6.11 ,6.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47563,CPT,LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY,,,21,,RBRVS,11.47 ,6.51 ,6.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47564,CPT,LAPS SURG CHOLECSTC W/EXPL COMMON DUCT,,,21,,RBRVS,18.00 ,9.99 ,9.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47570,CPT,LAPAROSCOPY SURG CHOLECYSTOENETEROSTOMY,,,21,,RBRVS,12.56 ,6.68 ,6.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47579,CPT,UNLISTED LAPAROSCOPY PROCEDURE BILIARY TRACT,,,21,,TotalUnits,,,,16.58 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 47600,CPT,CHOLECYSTECTOMY,,,21,,RBRVS,17.48 ,9.34 ,9.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47605,CPT,CHOLECYSTECTOMY W/CHOLANGIOGRAPHY,,,21,,RBRVS,18.48 ,9.72 ,9.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47610,CPT,CHOLECYSTECTOMY W/EXPLORATION COMMON DUCT,,,21,,RBRVS,20.92 ,10.50 ,10.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47612,CPT,CHOLECYSTECTOMY EXPL DUCT CHOLEDOCHOENTEROSTOMY,,,21,,RBRVS,21.21 ,10.59 ,10.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47620,CPT,CHOLECSTC EXPL DUX SPHNCTROTOMY/SPHNCTROP,,,21,,RBRVS,23.07 ,11.31 ,11.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47700,CPT,EXPL CONGENITAL ATRESIA BILE DUCTS,,,21,,RBRVS,16.50 ,9.85 ,9.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47701,CPT,PORTOENETEROSTOMY,,,21,,RBRVS,28.73 ,14.64 ,14.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47711,CPT,EXC BILE DUX TUM W/WO PRIM RPR XTRHEPATC,,,21,,RBRVS,25.90 ,13.06 ,13.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47712,CPT,EXC BILE DUX TUM W/WO PRIM RPR INTRAHEPATC,,,21,,RBRVS,33.72 ,16.11 ,16.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47715,CPT,EXCISION CHOLEDOCHAL CYST,,,21,,RBRVS,21.55 ,11.83 ,11.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47720,CPT,CHOLECYSTOENTEROSTOMY DIRECT,,,21,,RBRVS,18.34 ,10.62 ,10.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47721,CPT,CHOLECYSTOENTEROSTOMY W/GASTROENTEROSTOMY,,,21,,RBRVS,21.99 ,11.99 ,11.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47740,CPT,CHOLECYSTOENTEROSTOMY ROUX-EN-Y,,,21,,RBRVS,21.23 ,11.62 ,11.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47741,CPT,CHOLECSTONTRSTM ROUX-EN-Y W/GASTRONTRSTM,,,21,,RBRVS,24.21 ,12.69 ,12.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47760,CPT,ANAST XTRHEPATC BILIARY DUCTS & GI TRACT,,,21,,RBRVS,38.32 ,18.02 ,18.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47765,CPT,ANAST INTRAHEPATC DUCTS & GI TRACT,,,21,,RBRVS,52.19 ,23.44 ,23.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47780,CPT,ANAST ROUX-EN-Y XTRHEPATC BILIARY DUCTS & GI,,,21,,RBRVS,42.32 ,19.37 ,19.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47785,CPT,ANAST ROUX-EN-Y INTRAHEPATC BILIARY DUCTS & GI,,,21,,RBRVS,56.19 ,24.63 ,24.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47800,CPT,RCNSTJ PLSTC BILIARY DUCTS W/END-TO-END ANAST,,,21,,RBRVS,26.17 ,13.28 ,13.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47801,CPT,PLACEMENT CHOLEDOCHAL STENT,,,21,,RBRVS,17.60 ,8.91 ,8.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47802,CPT,U-TUBE HEPATICOENTEROSTOMY,,,21,,RBRVS,24.93 ,13.21 ,13.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47900,CPT,SUTURE EXTRAHEPATIC BILE DUCT PRE-EXIST INJURY,,,21,,RBRVS,22.44 ,11.96 ,11.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 47999,CPT,UNLISTED PROCEDURE BILIARY TRACT,,,21,,TotalUnits,,,,16.58 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 48000,CPT,PLACE DRAIN PERIPANCREATIC ACUTE PANCREATITIS,,,21,,RBRVS,31.95 ,14.93 ,14.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48001,CPT,PLACE DRAIN PERIPANCREATIC W/CHOLECYSTOSTOMY,,,21,,RBRVS,39.69 ,17.54 ,17.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48020,CPT,REMOVAL PANCREATIC CALCULUS,,,21,,RBRVS,19.09 ,10.37 ,10.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48100,CPT,BIOPSY PANCREAS OPEN,,,21,,RBRVS,14.46 ,7.90 ,7.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48102,CPT,BIOPSY PANCREA PERCUTANEOUS NEEDLE,,,21,,RBRVS,4.70 ,1.91 ,10.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 48105,CPT,RESECJ/DBRDMT PANCREAS NECROTIZING PANCREATITIS,,,21,,RBRVS,49.26 ,21.92 ,21.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48120,CPT,EXCISION LESION PANCREAS,,,21,,RBRVS,18.41 ,9.39 ,9.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48140,CPT,PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY,,,21,,RBRVS,26.32 ,12.77 ,12.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48145,CPT,PNCRTECT DSTL STOT W/PNCRTCOJEJUNOSTOMY,,,21,,RBRVS,27.39 ,13.26 ,13.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48146,CPT,PNCRTECT DSTL NR-TOT W/PRSRV DUO CHLD-TYP PX,,,21,,RBRVS,30.60 ,16.53 ,16.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48148,CPT,EXCISION AMPULLA VATER,,,21,,RBRVS,20.39 ,10.91 ,10.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48150,CPT,PNCRTECT PROX STOT W/PANCREATOJEJUNOSTOMY,,,21,,RBRVS,52.84 ,24.78 ,24.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48152,CPT,PNCRTECT WHIPPLE W/O PANCREATOJEJUNOSTOMY,,,21,,RBRVS,48.65 ,23.10 ,23.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48153,CPT,PNCRTECT W/PANCREATOJEJUNOSTOMY,,,21,,RBRVS,52.79 ,24.47 ,24.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48154,CPT,PNCRTECT PROX STOT W/O PANCREATOJEJUNOSTOMY,,,21,,RBRVS,48.88 ,23.51 ,23.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48155,CPT,PANCREATECTOMY TOTAL,,,21,,RBRVS,29.45 ,16.14 ,16.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48160,CPT,PANCREATECTOMY W/TRNSPLJ PANCREAS/ISLET CELLS,,,21,,TotalUnits,,,,81.30 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 48400,CPT,INJECTION INTRAOPERATIVE PANCREATOGRAPHY,,,21,,RBRVS,1.95 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48500,CPT,MARSUPIALIZATION PANCREATIC CYST,,,21,,RBRVS,18.16 ,10.74 ,10.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48510,CPT,EXTERNAL DRAINAGE PSEUDOCYST OF PANCREAS OPEN,,,21,,RBRVS,17.19 ,10.34 ,10.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48520,CPT,INT ANAST PANCREATIC CYST GI TRACT DIRECT,,,21,,RBRVS,18.15 ,9.28 ,9.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48540,CPT,INT ANAST PANCREATIC CYST GI TRACT ROUX-EN-Y,,,21,,RBRVS,21.94 ,10.54 ,10.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48545,CPT,PANCREATORRHAPHY INJURY,,,21,,RBRVS,22.23 ,11.23 ,11.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48547,CPT,DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ,,,21,,RBRVS,30.38 ,14.35 ,14.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48548,CPT,PANCREATICOJEJUNOSTOMY SIDE-TO-SIDE ANAST,,,21,,RBRVS,28.09 ,13.52 ,13.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48552,CPT,BKBENCH RCNSTJ CDVR PNCRS ALGRFT VEN ANAST EA,,,21,,RBRVS,4.30 ,1.53 ,1.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48554,CPT,TRANSPLANTATION PANCREATIC ALLOGRAFT,,,21,,RBRVS,37.80 ,27.34 ,27.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48556,CPT,RMVL TRANSPLANTED PANCREATIC ALLOGRAFT,,,21,,RBRVS,19.47 ,12.69 ,12.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 48999,CPT,UNLISTED PROCEDURE PANCREAS,,,21,,TotalUnits,,,,47.13 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49000,CPT,EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX,,,21,,RBRVS,12.54 ,6.95 ,6.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49002,CPT,REOPENING RECENT LAPAROTOMY,,,21,,RBRVS,17.63 ,8.67 ,8.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49010,CPT,EXPL RETROPERITONEUM W/WO BX SPX,,,21,,RBRVS,16.06 ,7.51 ,7.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49020,CPT,DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN,,,21,,RBRVS,26.67 ,13.41 ,13.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49040,CPT,DRAINAGE SUBDIAPHRAGMATIC/SUBPHREN ABSCESS OPEN,,,21,,RBRVS,16.52 ,8.71 ,8.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49060,CPT,DRAINAGE OF RETROPERITONEAL ABSCESS OPEN,,,21,,RBRVS,18.53 ,9.26 ,9.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49062,CPT,DRG XTRAPERITONEAL LYMPHOCELE PERITON CAVITY OPN,,,21,,RBRVS,12.22 ,6.42 ,6.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49082,CPT,ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE,,,21,,RBRVS,1.24 ,0.75 ,4.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49083,CPT,ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE,,,21,,RBRVS,2.00 ,0.97 ,6.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49084,CPT,PERITONEAL LAVAGE W/WO IMAGING GUIDANCE,,,21,,RBRVS,2.00 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49180,CPT,BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE,,,21,,RBRVS,1.73 ,0.60 ,2.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49185,CPT,SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID,,,21,,RBRVS,2.35 ,0.98 ,25.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49203,CPT,EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/<,,,21,,RBRVS,20.13 ,10.20 ,10.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49204,CPT,EXC/DESTRUCTION OPEN ABDMNL TUMORS 5.1-10.0 CM,,,21,,RBRVS,26.13 ,12.57 ,12.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49205,CPT,EXC/DESTRUCTION OPEN ABDOMINAL TUMORS >10.0 CM,,,21,,RBRVS,30.13 ,14.10 ,14.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49215,CPT,EXC PRESAC/SACROCOCCYGEAL TUMOR,,,21,,RBRVS,37.81 ,18.38 ,18.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49220,CPT,STAGING LAPAROTOMY HODGKINS DISEASE/LYMPHOMA,,,21,,RBRVS,15.79 ,8.13 ,8.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49250,CPT,UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX,,,21,,RBRVS,9.01 ,5.92 ,5.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49255,CPT,OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX,,,21,,RBRVS,12.56 ,7.59 ,7.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49320,CPT,LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX,,,21,,RBRVS,5.14 ,3.22 ,3.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49321,CPT,LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE,,,21,,RBRVS,5.44 ,3.38 ,3.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49322,CPT,LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE,,,21,,RBRVS,6.01 ,3.47 ,3.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49323,CPT,LAPS SURG W/DRG LYMPHOCELE PRTL CAVITY,,,21,,RBRVS,10.23 ,6.14 ,6.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49324,CPT,LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER,,,21,,RBRVS,6.32 ,3.55 ,3.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49325,CPT,LAPS W/REVISION INTRAPERITONEAL CATHETER,,,21,,RBRVS,6.82 ,3.68 ,3.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49326,CPT,LAPAROSCOPY W/OMENTOPEXY,,,21,,RBRVS,3.50 ,1.18 ,1.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49327,CPT,LAPS W/INSERTION NTRSTL DEV W/IMG GUID 1/MLT,,,21,,RBRVS,2.38 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49329,CPT,UNLISTED LAPAROSCOPIC PX ABD PERTONEUM & OMENTUM,,,21,,TotalUnits,,,,8.82 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49400,CPT,INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX,,,21,,RBRVS,1.88 ,0.62 ,1.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49402,CPT,REMOVAL PERITONEAL FOREIGN BODY FROM CAVITY,,,21,,RBRVS,14.09 ,7.47 ,7.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49405,CPT,IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ,,,21,,RBRVS,4.25 ,1.52 ,20.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49406,CPT,IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ,,,21,,RBRVS,4.25 ,1.52 ,20.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49407,CPT,IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL,,,21,,RBRVS,4.50 ,1.62 ,15.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49411,CPT,INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT,,,21,,RBRVS,3.82 ,1.57 ,11.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49412,CPT,PLACEMENT INTRSTL DEV OPN W/IMG GUID 1/MLT,,,21,,RBRVS,1.50 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49418,CPT,INSJ INTRAPERITONEAL CATHETER W/IMG GUID,,,21,,RBRVS,4.21 ,1.69 ,36.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49419,CPT,INSERTION TUNNEL INTRAPERITONEAL CATH SUBQ PORT,,,21,,RBRVS,7.08 ,4.37 ,4.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49421,CPT,INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN,,,21,,RBRVS,4.21 ,1.53 ,1.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49422,CPT,REMOVAL TUNNELED INTRAPERITONEAL CATHETER,,,21,,RBRVS,6.29 ,3.32 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49423,CPT,EXCHNG ABSC/CST DRG CATH RAD GID SPX,,,21,,RBRVS,1.46 ,0.50 ,14.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49424,CPT,CNTRST NJX ASSMT ABSC/CST VIA DRG CATH/TUBE SPX,,,21,,RBRVS,0.76 ,0.28 ,3.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49425,CPT,INSERTION PERITONEAL-VENOUS SHUNT,,,21,,RBRVS,12.22 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49426,CPT,REVIS PERITONEAL-VENOUS SHUNT,,,21,,RBRVS,10.41 ,5.09 ,5.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49427,CPT,INJECT EVALUATE PREVIOUS PERITONEAL-VENOUS SHUNT,,,21,,RBRVS,0.89 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49428,CPT,LIGATION PERITONEAL-VENOUS SHUNT,,,21,,RBRVS,6.87 ,3.98 ,3.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49429,CPT,RMVL PERITONEAL-VENOUS SHUNT,,,21,,RBRVS,7.44 ,4.04 ,4.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49435,CPT,INSJ SUBQ EXTENSION INTRAPERITONEAL CATHETER,,,21,,RBRVS,2.25 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49436,CPT,DELAYED CREATION EXIT SITE EMBEDDED CATHETER,,,21,,RBRVS,2.72 ,2.05 ,2.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49440,CPT,INSERT GASTROSTOMY TUBE PERCUTANEOUS,,,21,,RBRVS,4.18 ,1.85 ,25.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49441,CPT,INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ,,,21,,RBRVS,4.77 ,2.08 ,28.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49442,CPT,INSERT CECOSTOMY/OTHER COLONIC TUBE PERCUTANEOUS,,,21,,RBRVS,4.00 ,2.07 ,23.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49446,CPT,CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ,,,21,,RBRVS,3.31 ,1.11 ,24.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49450,CPT,REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS,,,21,,RBRVS,1.36 ,0.46 ,17.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49451,CPT,REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ,,,21,,RBRVS,1.84 ,0.62 ,18.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49452,CPT,REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS,,,21,,RBRVS,2.86 ,0.95 ,22.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49460,CPT,OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE,,,21,,RBRVS,0.96 ,0.34 ,19.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49465,CPT,CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE,,,21,,RBRVS,0.62 ,0.23 ,3.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49491,CPT,RPR 1ST INGUN HRNA PRETERM INFT RDC,,,21,,RBRVS,12.53 ,7.43 ,7.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49492,CPT,RPR 1ST INGUN HRNA PRETERM INFT INCARCERATED,,,21,,RBRVS,15.43 ,8.56 ,8.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49495,CPT,RPR 1ST INGUN HRNA FULL TERM INFT <6 MO RDC,,,21,,RBRVS,6.20 ,3.76 ,3.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49496,CPT,RPR 1ST INGUN HRNA FULL TERM INFT <6 MO INCARCER,,,21,,RBRVS,9.42 ,6.08 ,6.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49500,CPT,RPR 1ST INGUN HRNA AGE 6 MO-5 YRS REDUCIBLE,,,21,,RBRVS,5.84 ,3.83 ,3.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49501,CPT,RPR 1ST INGUN HRNA AGE 6 MO-5 YRS INCARCERATED,,,21,,RBRVS,9.36 ,5.70 ,5.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49505,CPT,RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE,,,21,,RBRVS,7.96 ,5.23 ,5.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49507,CPT,RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED,,,21,,RBRVS,9.09 ,5.70 ,5.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49520,CPT,RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE,,,21,,RBRVS,9.99 ,5.94 ,5.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49521,CPT,RPR RECRT INGUN HERNIA ANY AGE INCARCERATED,,,21,,RBRVS,11.48 ,6.54 ,6.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49525,CPT,RPR INGUN HERNIA SLIDING ANY AGE,,,21,,RBRVS,8.93 ,5.55 ,5.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49540,CPT,REPAIR LUMBAR HERNIA,,,21,,RBRVS,10.74 ,6.21 ,6.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49550,CPT,RPR 1ST FEM HRNA ANY AGE REDUCIBLE,,,21,,RBRVS,8.99 ,5.54 ,5.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49553,CPT,RPR 1ST FEM HERNIA ANY AGE INCARCERATED,,,21,,RBRVS,9.92 ,6.00 ,6.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49555,CPT,RPR RECRT FEM HERNIA REDUCIBLE,,,21,,RBRVS,9.39 ,5.69 ,5.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49557,CPT,RPR RECRT FEM HRNA INCARCERATED,,,21,,RBRVS,11.62 ,6.57 ,6.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49560,CPT,REPAIR FIRST ABDOMINAL WALL HERNIA,,,21,,RBRVS,11.92 ,6.66 ,6.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49561,CPT,RPR 1ST INCAL/VNT HERNIA INCARCERATED,,,21,,RBRVS,15.38 ,7.95 ,7.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49565,CPT,RPR RECRT INCAL/VNT HERNIA REDUCIBLE,,,21,,RBRVS,12.37 ,7.00 ,7.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49566,CPT,RPR RECRT INCAL/VNT HERNIA INCARCERATED,,,21,,RBRVS,15.53 ,8.03 ,8.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49568,CPT,IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE,,,21,,RBRVS,4.88 ,1.75 ,1.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49570,CPT,RPR EPIGASTRIC HERNIA REDUCIBLE SPX,,,21,,RBRVS,6.05 ,4.57 ,4.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49572,CPT,RPR EPIGASTRIC HERNIA INCARCERATED,,,21,,RBRVS,7.87 ,5.20 ,5.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49580,CPT,RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE,,,21,,RBRVS,4.47 ,4.05 ,4.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49582,CPT,RPR UMBILICAL HERNIA < 5 YRS INCARCERATED,,,21,,RBRVS,7.13 ,5.11 ,5.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49585,CPT,RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE,,,21,,RBRVS,6.59 ,4.72 ,4.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49587,CPT,RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED,,,21,,RBRVS,7.08 ,5.00 ,5.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49590,CPT,RPR SPIGELIAN HERNIA,,,21,,RBRVS,8.90 ,5.58 ,5.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49600,CPT,RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE,,,21,,RBRVS,11.55 ,6.52 ,6.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49605,CPT,RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH,,,21,,RBRVS,87.09 ,35.31 ,35.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49606,CPT,RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH,,,21,,RBRVS,19.00 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49610,CPT,RPR OMPHALOCELE GROSS TYP OPRATION 1ST STG,,,21,,RBRVS,10.91 ,6.38 ,6.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49611,CPT,RPR OMPHALOCELE GROSS TYP OPRATION 2ND STG,,,21,,RBRVS,9.34 ,5.93 ,5.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49650,CPT,LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA,,,21,,RBRVS,6.36 ,4.53 ,4.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49651,CPT,LAPS SURG RPR RECURRENT INGUINAL HERNIA,,,21,,RBRVS,8.38 ,5.74 ,5.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49652,CPT,LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE,,,21,,RBRVS,11.92 ,6.83 ,6.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49653,CPT,LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED,,,21,,RBRVS,14.94 ,8.42 ,8.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49654,CPT,LAPAROSCOPY REPAIR INCISIONAL HERNIA REDUCIBLE,,,21,,RBRVS,13.76 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49655,CPT,LAPS RPR INCISIONAL HERNIA NCRC8/STRANGULATED,,,21,,RBRVS,16.84 ,9.10 ,9.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49656,CPT,LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE,,,21,,RBRVS,15.08 ,7.98 ,7.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49657,CPT,LAPS RPR RECURRENT INCAL HRNA NCRC8/STRANGULATED,,,21,,RBRVS,22.11 ,10.95 ,10.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49659,CPT,UNLIS LAPS PX HRNAP HERNIORRHAPHY HERNIOTOMY,,,21,,TotalUnits,,,,12.80 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 49900,CPT,SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN,,,21,,RBRVS,12.41 ,8.35 ,8.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49904,CPT,OMENTAL FLAP EXTRA-ABDOMINAL,,,21,,RBRVS,22.35 ,14.20 ,14.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49905,CPT,OMENTAL FLAP INTRA-ABDOMINAL,,,21,,RBRVS,6.54 ,2.33 ,2.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 49999,CPT,UNLISTED PROCEDURE ABDOMEN PERITONEUM & OMENTUM,,,21,,TotalUnits,,,,6.63 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50010,CPT,RNL EXPL X NECESSITATING OTH SPEC PX,,,21,,RBRVS,12.28 ,6.92 ,6.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50020,CPT,DRAINAGE PERIRENAL/RENAL ABSCESS OPEN,,,21,,RBRVS,18.08 ,9.07 ,9.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50040,CPT,NEPHROSTOMY/NEPHROTOMY W/DRAINAGE,,,21,,RBRVS,16.68 ,8.08 ,8.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50045,CPT,NEPHROTOMY W/EXPLORATION,,,21,,RBRVS,16.82 ,8.48 ,8.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50060,CPT,NEPHROLITHOTOMY REMOVAL STAGE 1,,,21,,RBRVS,20.95 ,9.52 ,9.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50065,CPT,NEPHROLITHOTOMY SECONDARY FOR CALCULUS,,,21,,RBRVS,22.32 ,9.95 ,9.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50070,CPT,NEPHROLITHOTOMY COMP CGEN KDN ABNORMALITY,,,21,,RBRVS,21.85 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50075,CPT,NEPHROLITHOTOMY RMVL LG STAGHORN STAGE 1,,,21,,RBRVS,27.09 ,11.80 ,11.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50080,CPT,PRQ NEPHROSTOLITHOTOMY/PYELOSTOLITHOTOMY 2 CM,,,21,,RBRVS,23.50 ,10.58 ,10.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50100,CPT,TRNSXJ/REPOSITIONING ABERRANT RENAL VESSEL SPX,,,21,,RBRVS,17.45 ,10.25 ,10.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50120,CPT,PYELOTOMY W/EXPLORATION,,,21,,RBRVS,17.21 ,8.16 ,8.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50125,CPT,PYELOTOMY W/DRAINAGE PYELOSTOMY,,,21,,RBRVS,17.82 ,9.41 ,9.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50130,CPT,PYELOTOMY W/REMOVAL CALCULUS,,,21,,RBRVS,18.82 ,8.77 ,8.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50135,CPT,PYELOTOMY COMPLICATED,,,21,,RBRVS,20.59 ,9.51 ,9.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50200,CPT,RENAL BIOPSY PRQ TROCAR/NEEDLE,,,21,,RBRVS,2.63 ,1.22 ,14.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50205,CPT,RENAL BIOPSY SURG EXPOSURE KIDNEY,,,21,,RBRVS,12.29 ,6.79 ,6.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50220,CPT,NEPHRECTOMY W/PRTL URETERECTOMY W/OPEN RIB RESCJ,,,21,,RBRVS,18.68 ,8.87 ,8.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50225,CPT,NEPHRECTOMY W/PRTL URETERECT OPN RIB RESCJ COMPL,,,21,,RBRVS,21.88 ,9.95 ,9.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50230,CPT,NEPHRECTOMY W/PRTL URETERECT OPEN RIB RESCJ RAD,,,21,,RBRVS,23.81 ,10.23 ,10.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50234,CPT,NEPHRECTOMY W/TOT URETERECT&BLDR CUFF SAME INC,,,21,,RBRVS,24.05 ,10.56 ,10.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50236,CPT,NEPHRECTOMY TOT URETEREC&BLDR CUFF SEPAR INCISN,,,21,,RBRVS,26.94 ,12.17 ,12.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50240,CPT,NEPHRECTOMY PARTIAL,,,21,,RBRVS,24.21 ,11.09 ,11.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50250,CPT,OPEN ABLATION RENAL MASS CRYOSURG ULTRASOUND,,,21,,RBRVS,22.22 ,10.30 ,10.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50280,CPT,EXCISION/UNROOFING CYST KIDNEY,,,21,,RBRVS,17.09 ,8.27 ,8.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50290,CPT,EXCISION PERINEPHRIC CYST,,,21,,RBRVS,16.15 ,7.87 ,7.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50300,CPT,DONOR NEPHRECTOMY CADAVER DONOR UNI/BILATERAL,,,21,,TotalUnits,,,,23.05 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50320,CPT,DONOR NEPHRECTOMY OPEN LIVING DONOR,,,21,,RBRVS,22.43 ,14.62 ,14.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50323,CPT,BKBENCH PREPJ CADAVER DONOR RENAL ALLOGRAFT,,,21,,TotalUnits,,,,9.96 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50325,CPT,BKBENCH PREPJ LIVING RENAL DONOR ALLOGRAFT,,,21,,TotalUnits,,,,11.17 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50327,CPT,BKBENCH RCNSTJ RENAL ALGRFT VENOUS ANAST EA,,,21,,RBRVS,4.00 ,1.40 ,1.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50328,CPT,BKBENCH RCNSTJ RENAL ALLOGRAFT ARTERIAL ANAST EA,,,21,,RBRVS,3.50 ,1.24 ,1.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50329,CPT,BKBENCH RCNSTJ ALGRFT URETERAL ANAST EA,,,21,,RBRVS,3.34 ,1.16 ,1.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50340,CPT,RECIPIENT NEPHRECTOMY SEPARATE PROCEDURE,,,21,,RBRVS,14.04 ,9.81 ,9.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50360,CPT,RENAL ALTRNSPLJ IMPLTJ GRF W/O RCP NEPHRECTOMY,,,21,,RBRVS,39.88 ,21.03 ,21.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50365,CPT,RENAL ALTRNSPLJ IMPLTJ GRF W/RCP NEPHRECTOMY,,,21,,RBRVS,46.13 ,25.71 ,25.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50370,CPT,RMVL TRNSPLED RENAL ALLOGRAFT,,,21,,RBRVS,18.88 ,11.61 ,11.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50380,CPT,RENAL AUTOTRNSPLJ REIMPLANTATION KIDNEY,,,21,,RBRVS,30.11 ,20.08 ,20.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50382,CPT,RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ,,,21,,RBRVS,5.50 ,1.84 ,27.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50384,CPT,REMOVAL INDWELLING URETERAL STENT PRQ,,,21,,RBRVS,5.00 ,1.66 ,21.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50385,CPT,REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL,,,21,,RBRVS,4.44 ,1.82 ,27.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50386,CPT,REMOVE INT DWELL URETERAL STENT TRANSURETHRAL,,,21,,RBRVS,3.30 ,1.44 ,17.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50387,CPT,RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH,,,21,,RBRVS,2.00 ,0.65 ,13.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50389,CPT,RMVL NFROS TUBE REQ FLUORO GUIDANCE,,,21,,RBRVS,1.10 ,0.37 ,7.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50390,CPT,ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ,,,21,,RBRVS,1.96 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50391,CPT,INSTLJ THER AGENT RENAL PELVIS&/URETER VIA TUB,,,21,,RBRVS,1.96 ,0.66 ,1.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50395,CPT,INTRO GUIDE PELVIS&/URETER W/DILAT NFROS TRACT,,,21,,RBRVS,3.37 ,1.48 ,1.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50396,CPT,MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH,,,21,,RBRVS,2.09 ,1.14 ,1.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50400,CPT,PYELOPLASTY SIMPLE,,,21,,RBRVS,21.27 ,9.58 ,9.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50405,CPT,PYELOPLASTY COMPLICATED,,,21,,RBRVS,25.86 ,11.40 ,11.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50430,CPT,NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS,,,21,,RBRVS,3.15 ,1.41 ,11.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50431,CPT,NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS,,,21,,RBRVS,1.10 ,0.72 ,3.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50432,CPT,PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I,,,21,,RBRVS,4.25 ,1.78 ,19.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50433,CPT,PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I,,,21,,RBRVS,5.30 ,2.12 ,26.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50434,CPT,CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ,,,21,,RBRVS,4.00 ,1.69 ,21.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50435,CPT,EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I,,,21,,RBRVS,1.82 ,0.96 ,11.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50500,CPT,NEPHRORRHAPHY SUTURE KIDNEY WOUND/INJURY,,,21,,RBRVS,21.22 ,10.75 ,10.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50520,CPT,CLOSURE NEPHROCUTANEOUS/PYELOCUTANEOUS FISTULA,,,21,,RBRVS,18.88 ,9.81 ,9.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50525,CPT,CLSR NEPHROVISCERAL FISTULA W/VISC RPR ABDL APPR,,,21,,RBRVS,24.39 ,12.24 ,12.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50526,CPT,CLSR NEPHROVISCERAL FISTULA W/VISC RPR THRC APPR,,,21,,RBRVS,26.31 ,12.83 ,12.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50540,CPT,SYMPHYSIOTOMY HORSESHOE KDN W/WO PLOP UNI/BI,,,21,,RBRVS,21.10 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50541,CPT,LAPAROSCOPY SURG ABLATION RENAL CYSTS,,,21,,RBRVS,16.86 ,7.66 ,7.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50542,CPT,LAPS ABLTJ RENAL MASS LESION W/INTRAOP US,,,21,,RBRVS,21.36 ,9.78 ,9.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50543,CPT,LAPAROSCOPY SURG PARTIAL NEPHRECTOMY,,,21,,RBRVS,27.41 ,12.29 ,12.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50544,CPT,LAPAROSCOPY SURG PYELOPLASTY,,,21,,RBRVS,23.37 ,9.84 ,9.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50545,CPT,LAPAROSCOPY RADICAL NEPHRECTOMY,,,21,,RBRVS,25.06 ,10.64 ,10.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50546,CPT,LAPAROSCOPY NEPHRECTOMY W/PARTIAL URETERECT,,,21,,RBRVS,21.87 ,10.08 ,10.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50547,CPT,LAPAROSCOPY DONOR NEPHRECTOMY LIVING DONOR,,,21,,RBRVS,26.34 ,14.69 ,14.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50548,CPT,LAPAROSCOPY NEPHRECTOMY W/TOTAL URETERECTOMY,,,21,,RBRVS,25.36 ,10.53 ,10.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50549,CPT,UNLISTED LAPAROSCOPY PROCEDURE RENAL,,,21,,TotalUnits,,,,35.70 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50551,CPT,RENAL ENDOSCOPY NEPHROSTOMY W/WO IRRIGATION,,,21,,RBRVS,5.59 ,2.28 ,4.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50553,CPT,RENAL NDSC NEPHROST W/URETERAL CATH W/WO DILA,,,21,,RBRVS,5.98 ,2.35 ,4.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50555,CPT,RENAL NDSC NEPHROS/PYELOSTOMY BIOPSY,,,21,,RBRVS,6.52 ,2.56 ,4.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50557,CPT,RENAL NDSC NEPHROS/PYELOSTOMY FULG&/INC W/WO BI,,,21,,RBRVS,6.61 ,2.63 ,4.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50561,CPT,RENAL NDSC NEPHROS/PYELOSTOMY RMVL FB/CALCULUS,,,21,,RBRVS,7.58 ,2.96 ,5.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50562,CPT,RENAL NDSC NEPHROS/PYELOSTOMY RESCJ TUMOR,,,21,,RBRVS,10.90 ,4.62 ,4.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50570,CPT,RENAL NDSC NEPHROTOMY W/WO IRRIGATION,,,21,,RBRVS,9.53 ,3.58 ,3.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50572,CPT,RNL NDSC NFROT W/URTRL CATHJ W/WO DILAT URETER,,,21,,RBRVS,10.33 ,3.85 ,3.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50574,CPT,RENAL NDSC NEPHROTOMY W/BIOPSY,,,21,,RBRVS,11.00 ,4.08 ,4.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50575,CPT,RNL NDSC NFROT/PLOT W/ENDOPYELOTOMY,,,21,,RBRVS,13.96 ,5.08 ,5.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50576,CPT,RNL NDSC NFROT FULGURATION &/INCISION W/WO BX,,,21,,RBRVS,10.97 ,4.07 ,4.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50580,CPT,RNL NDSC NFROT/PLOT W/RMVL FB/CALCULUS,,,21,,RBRVS,11.84 ,4.37 ,4.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50590,CPT,LITHOTRIPSY XTRCORP SHOCK WAVE,,,21,,RBRVS,9.77 ,5.46 ,9.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50592,CPT,ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY,,,21,,RBRVS,6.80 ,3.05 ,64.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50593,CPT,ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY,,,21,,RBRVS,9.13 ,3.92 ,121.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50600,CPT,URTROTOMY W/EXPL/DRG SEPARATE PROCEDURE,,,21,,RBRVS,17.17 ,7.84 ,7.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50605,CPT,URETEROTOMY INSERTION INDWELLING STENT ALL TYPES,,,21,,RBRVS,16.79 ,8.43 ,8.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50606,CPT,ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC,,,21,,RBRVS,3.16 ,1.05 ,11.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 50610,CPT,URTROLITHOTOMY UPPER ONE-THIRD URETER,,,21,,RBRVS,17.25 ,8.61 ,8.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50620,CPT,URTROLITHOTOMY MIDDLE ONE-THIRD URETER,,,21,,RBRVS,16.43 ,7.75 ,7.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50630,CPT,URTROLITHOTOMY LOWER ONE-THIRD URETER,,,21,,RBRVS,16.21 ,7.57 ,7.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50650,CPT,URETRECECTOMY W/BLADDER CUFF SEPARATE PROCEDURE,,,21,,RBRVS,18.82 ,8.79 ,8.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50660,CPT,URETERECTOMY TOT ECTOPIC URETER CMBN APPR,,,21,,RBRVS,21.02 ,9.53 ,9.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50684,CPT,INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH,,,21,,RBRVS,0.76 ,0.61 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50686,CPT,MANOMETRIC STDS THRU URTROST/NDWELLG URTRL CATH,,,21,,RBRVS,1.51 ,0.86 ,2.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50688,CPT,CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL,,,21,,RBRVS,1.20 ,0.99 ,0.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50690,CPT,NJX VISUALIZATION ILEAL CONDUIT&/URETEROPYELOG,,,21,,RBRVS,1.16 ,0.76 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50693,CPT,PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT,,,21,,RBRVS,4.21 ,1.75 ,25.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50694,CPT,PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH,,,21,,RBRVS,5.50 ,2.19 ,27.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50695,CPT,PLMT URTRL STENT PRQ NEW ACCESS W/SEP NFROS CATH,,,21,,RBRVS,7.05 ,2.71 ,32.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50700,CPT,URETEROPLASTY PLASTIC OPERATION URETER,,,21,,RBRVS,16.69 ,8.10 ,8.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50705,CPT,URETERAL EMBOLIZATION/OCCLUSION W/IMG GID RS&I,,,21,,RBRVS,4.03 ,1.34 ,43.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 50706,CPT,BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I,,,21,,RBRVS,3.80 ,1.27 ,17.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 50715,CPT,URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS,,,21,,RBRVS,20.64 ,10.65 ,10.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50722,CPT,URETEROLYSIS FOR OVARIAN VEIN SYNDROME,,,21,,RBRVS,17.95 ,9.28 ,9.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50725,CPT,URTROLSS RETROCAVAL URTR W/REANAST,,,21,,RBRVS,20.20 ,9.52 ,9.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50727,CPT,REVJ URINARY-CUTANEOUS ANASTAMOSIS,,,21,,RBRVS,8.28 ,5.28 ,5.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50728,CPT,REVJ UR-CUTAN ANAST RPR FSCAL DFCT & HERNIA,,,21,,RBRVS,12.18 ,6.58 ,6.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50740,CPT,EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR,,,21,,RBRVS,20.07 ,10.51 ,10.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50750,CPT,URETEROCALYCOSTOMY ANAST URETER RENAL CALYX,,,21,,RBRVS,21.22 ,9.58 ,9.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50760,CPT,URETEROURETEROSTOMY,,,21,,RBRVS,20.07 ,9.49 ,9.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50770,CPT,TRANSURETEROURETEROSTOMY ANAST URETER CLAT URTR,,,21,,RBRVS,21.22 ,9.41 ,9.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50780,CPT,URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER,,,21,,RBRVS,19.95 ,9.31 ,9.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50782,CPT,URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR,,,21,,RBRVS,19.66 ,6.54 ,6.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50783,CPT,URETERONEOCYSTOSTOMY W/URETERAL TAILORING,,,21,,RBRVS,20.70 ,9.40 ,9.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50785,CPT,URTRONEOCSTOST W/VESICO-PSOAS HITCH/BLDR FLAP,,,21,,RBRVS,22.23 ,10.03 ,10.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50800,CPT,URETEROENTEROSTOMY ANAST URETER INTESTINE,,,21,,RBRVS,16.41 ,8.21 ,8.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50810,CPT,URETEROSIGMOIDOSTOMY W/SIGMOID BLADDER & COLOSTO,,,21,,RBRVS,22.61 ,10.78 ,10.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50815,CPT,URETEROCOLON CONDUIT INTESTINE ANASTOMOSIS,,,21,,RBRVS,22.26 ,10.41 ,10.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50820,CPT,URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS,,,21,,RBRVS,24.07 ,10.86 ,10.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50825,CPT,CONTINENT DVRJ W/INT ANAST ANY SGM SM&/LG INTSTN,,,21,,RBRVS,30.68 ,13.37 ,13.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50830,CPT,URINARY UNIDIVERSION,,,21,,RBRVS,33.77 ,14.38 ,14.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50840,CPT,RPLCMT ALL/PART URETER INTESTINE SGM W/ANAST,,,21,,RBRVS,22.39 ,10.47 ,10.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50845,CPT,CUTANANEOUS APPENDICO-VESICOSTOMY,,,21,,RBRVS,22.46 ,10.95 ,10.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50860,CPT,URETEROSTOMY TRANSPLANTATION URETER SKIN,,,21,,RBRVS,17.08 ,8.19 ,8.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50900,CPT,URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE,,,21,,RBRVS,15.04 ,7.62 ,7.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50920,CPT,CLOSURE URETEROCUTANEOUS FISTULA,,,21,,RBRVS,15.81 ,7.90 ,7.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50930,CPT,CLOSURE URETEROCUTANEOUS FISTULA W/VISC RPR,,,21,,RBRVS,20.19 ,9.70 ,9.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50940,CPT,DELIGATION URETER,,,21,,RBRVS,15.93 ,7.85 ,7.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 50945,CPT,LAPAROSCOPY URTROLITHOTOMY,,,21,,RBRVS,17.97 ,8.02 ,8.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50947,CPT,LAPS URTRONEOCSTOST W/CSTSC&URTRL STENT PLMT,,,21,,RBRVS,25.78 ,11.21 ,11.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50948,CPT,LAPS URTRONEOCSTOST W/O CSTSC&URTRL STENT PLMT,,,21,,RBRVS,23.82 ,10.20 ,10.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50949,CPT,UNLISTED LAPAROSCOPY PROCEDURE URETER,,,21,,TotalUnits,,,,36.99 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50951,CPT,URETERAL ENDOSCOPY VIA URETEROSTOMY,,,21,,RBRVS,5.83 ,2.36 ,4.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50953,CPT,URETERAL ENDOSCOPY VIA URETEROST W/WO DIL URETER,,,21,,RBRVS,6.23 ,2.46 ,4.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50955,CPT,URETERAL ENDOSCOPY VIA URETEROSTOMY W/BIOPSY,,,21,,RBRVS,6.74 ,2.67 ,4.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50957,CPT,URETERAL ENDOSCOPY W/DEST&/INC W/WO BIOPSY,,,21,,RBRVS,6.78 ,2.69 ,4.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50961,CPT,URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE,,,21,,RBRVS,6.04 ,2.44 ,4.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50970,CPT,URETERAL ENDOSCOPY VIA URETEROTOMY W/O IMAGING,,,21,,RBRVS,7.13 ,2.81 ,2.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50972,CPT,NDSC URETEROTOMY URTRL CATHJ W/WO DILAT URETER,,,21,,RBRVS,6.88 ,2.70 ,2.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50974,CPT,URETERAL ENDOSCOPY VIA URETEROT W/O IMAGING W/BX,,,21,,RBRVS,9.16 ,3.46 ,3.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50976,CPT,URETERAL ENDOSC VIA URETEROT W/DEST&/INC W/WO BX,,,21,,RBRVS,9.03 ,3.41 ,3.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 50980,CPT,NDSC URETEROTOMY RMVL FB/CALCULUS,,,21,,RBRVS,6.84 ,2.62 ,2.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51020,CPT,CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL,,,21,,RBRVS,7.69 ,4.92 ,4.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51030,CPT,CSTOTOMY/CSTOST CRYOSURG DSTRJ INTRAVESICAL LES,,,21,,RBRVS,7.81 ,5.04 ,5.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51040,CPT,CYSTOSTOMY CYSTOTOMY W/DRAINAGE,,,21,,RBRVS,4.49 ,3.30 ,3.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51045,CPT,CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX,,,21,,RBRVS,7.81 ,5.14 ,5.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51050,CPT,CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS,,,21,,RBRVS,7.97 ,4.70 ,4.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51060,CPT,TRANSVESICAL URETROLITHOTOMY,,,21,,RBRVS,9.95 ,5.72 ,5.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51065,CPT,CYSTOTOMY W/CALCULUS BASKET XTRJ&/FRAGMENTATIO,,,21,,RBRVS,9.95 ,5.55 ,5.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51080,CPT,DRG PRIVESICAL/PREVESICAL SPACE ABSC,,,21,,RBRVS,6.71 ,4.28 ,4.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51100,CPT,ASPIRATION BLADDER NEEDLE,,,21,,RBRVS,0.78 ,0.26 ,0.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51101,CPT,ASPIRATION BLADDER TROCAR/INTRACATHETER,,,21,,RBRVS,1.02 ,0.36 ,2.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51102,CPT,ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER,,,21,,RBRVS,2.70 ,1.18 ,3.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51500,CPT,EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR,,,21,,RBRVS,11.05 ,6.00 ,6.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51520,CPT,CYSTOTOMY SIMPLE EXCISION VESICAL NECK,,,21,,RBRVS,10.21 ,5.74 ,5.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51525,CPT,CYSTOTOMY EXCISE BLADDER DIVERTICULUM 1/MULTIPLE,,,21,,RBRVS,15.42 ,7.51 ,7.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51530,CPT,CYSTOTOMY EXCISION BLADDER TUMOR,,,21,,RBRVS,13.71 ,7.21 ,7.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51535,CPT,CYSTOTOMY EXCISE/INCISE/REPAIR URETEROCELE,,,21,,RBRVS,13.90 ,6.95 ,6.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51550,CPT,CYSTECTOMY PARTIAL SIMPLE,,,21,,RBRVS,17.23 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51555,CPT,CYSTECTOMY PARTIAL COMPLICATED,,,21,,RBRVS,23.18 ,10.44 ,10.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51565,CPT,CSTC PRTL W/RIMPLTJ URTR IN BLDR URTRONEOCSTOST,,,21,,RBRVS,23.68 ,10.82 ,10.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51570,CPT,CYSTECTOMY COMPLETE SEPARATE PROCEDURE,,,21,,RBRVS,27.46 ,11.85 ,11.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51575,CPT,CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY,,,21,,RBRVS,34.18 ,14.39 ,14.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51580,CPT,CYSTECTOMY W/URETEROSIGMOIDOSTOMY W/NODES,,,21,,RBRVS,35.37 ,15.20 ,15.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51585,CPT,CYSTECTOMY W/URETEROSIGMOID BI PELV LYMPH NODES,,,21,,RBRVS,39.64 ,16.55 ,16.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51590,CPT,CSTC COMPL W/URTROILEAL CONDUIT/BLDR W/INT ANAST,,,21,,RBRVS,36.33 ,15.12 ,15.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51595,CPT,CSTC COMPL W/CONDUIT/SIGMOID BLDR PEL LMPHADEC,,,21,,RBRVS,41.32 ,16.99 ,16.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51596,CPT,CSTC COMPL W/CONTINENT DVRJ OPN NEOBLDR,,,21,,RBRVS,44.26 ,18.42 ,18.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51597,CPT,PELVIC EXENTERATION COMPLETE MALIGNANCY,,,21,,RBRVS,42.86 ,18.12 ,18.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51600,CPT,NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY,,,21,,RBRVS,0.88 ,0.31 ,4.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51605,CPT,NJX & PLACEMENT CHAIN CONTRAST&/URETHROCSTOGRAPY,,,21,,RBRVS,0.64 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51610,CPT,NJX RETROGRADE URETHROCSTOGRAPY,,,21,,RBRVS,1.05 ,0.70 ,1.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51700,CPT,BLDR IRRIGATION SMPL LAVAGE &/INSTLJ,,,21,,RBRVS,0.88 ,0.31 ,1.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51701,CPT,INSJ NON-NDWELLG BLADDER CATHETER,,,21,,RBRVS,0.50 ,0.24 ,0.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51702,CPT,INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE,,,21,,RBRVS,0.50 ,0.31 ,1.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51703,CPT,INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED,,,21,,RBRVS,1.47 ,0.71 ,2.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51705,CPT,CHANGE CYSTOSTOMY TUBE SIMPLE,,,21,,RBRVS,0.90 ,0.49 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51710,CPT,CHANGE CYSTOSTOMY TUBE COMPLICATED,,,21,,RBRVS,1.35 ,0.80 ,2.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51715,CPT,NDSC NJX IMPLT MATRL URT&/BLDR NCK,,,21,,RBRVS,3.73 ,1.60 ,4.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51720,CPT,BLADDER INSTILLATION ANTICARCINOGENIC AGENT,,,21,,RBRVS,1.50 ,0.64 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51725,CPT,SIMPLE CYSTOMETROGRAM,,,21,,RBRVS,1.51 ,3.65 ,3.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 51725,CPT,SIMPLE CYSTOMETROGRAM,26,,21,,RBRVS,1.51 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51725,CPT,SIMPLE CYSTOMETROGRAM,TC,,21,,RBRVS,,3.10 ,3.10 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 51726,CPT,BLADDER PRESSURE MEASUREMENT DURING FILLING,,,21,,RBRVS,1.71 ,5.57 ,5.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 51726,CPT,BLADDER PRESSURE MEASUREMENT DURING FILLING,26,,21,,RBRVS,1.71 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51726,CPT,BLADDER PRESSURE MEASUREMENT DURING FILLING,TC,,21,,RBRVS,,4.97 ,4.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 51727,CPT,COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE,,,21,,RBRVS,2.11 ,6.50 ,6.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 51727,CPT,COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE,26,,21,,RBRVS,2.11 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51727,CPT,COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE,TC,,21,,RBRVS,,5.72 ,5.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 51728,CPT,COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES,,,21,,RBRVS,2.11 ,6.59 ,6.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 51728,CPT,COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES,26,,21,,RBRVS,2.11 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51728,CPT,COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES,TC,,21,,RBRVS,,5.87 ,5.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 51729,CPT,COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL,,,21,,RBRVS,2.51 ,6.87 ,6.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 51729,CPT,COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL,26,,21,,RBRVS,2.51 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51729,CPT,COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL,TC,,21,,RBRVS,,5.96 ,5.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 51736,CPT,SIMPLE UROFLOMETRY,,,21,,RBRVS,0.17 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 51736,CPT,SIMPLE UROFLOMETRY,26,,21,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51736,CPT,SIMPLE UROFLOMETRY,TC,,21,,RBRVS,,0.19 ,0.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 51741,CPT,COMPLEX UROFLOMETRY,,,21,,RBRVS,0.17 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 51741,CPT,COMPLEX UROFLOMETRY,26,,21,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51741,CPT,COMPLEX UROFLOMETRY,TC,,21,,RBRVS,,0.20 ,0.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 51784,CPT,EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL,,,21,,RBRVS,1.53 ,3.76 ,3.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 51784,CPT,EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL,26,,21,,RBRVS,1.53 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51784,CPT,EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL,TC,,21,,RBRVS,,3.22 ,3.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 51785,CPT,NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ,,,21,,RBRVS,1.53 ,5.56 ,5.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 51785,CPT,NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ,26,,21,,RBRVS,1.53 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51785,CPT,NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ,TC,,21,,RBRVS,,4.93 ,4.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 51792,CPT,STIMULUS EVOKED RESPONSE,,,21,,RBRVS,1.10 ,4.76 ,4.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 51792,CPT,STIMULUS EVOKED RESPONSE,26,,21,,RBRVS,1.10 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51792,CPT,STIMULUS EVOKED RESPONSE,TC,,21,,RBRVS,,4.37 ,4.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 51797,CPT,VOID PRESSURE STUDIES INTRAABDOMINAL,,,21,,RBRVS,0.80 ,2.29 ,2.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 51797,CPT,VOID PRESSURE STUDIES INTRAABDOMINAL,26,,21,,RBRVS,0.80 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51797,CPT,VOID PRESSURE STUDIES INTRAABDOMINAL,TC,,21,,RBRVS,,2.01 ,2.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 51798,CPT,MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP,,TC,21,,RBRVS,,0.52 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 51800,CPT,CSTOPLASTY/CSTOURTP PLSTC ANY,,,21,,RBRVS,18.89 ,8.89 ,8.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51820,CPT,CSTOURTP W/UNI/BI URTRONEOCSTOST,,,21,,RBRVS,19.59 ,9.53 ,9.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51840,CPT,ANT VESICOURETHROPEXY/URETHROPEXY SMPL,,,21,,RBRVS,11.36 ,6.15 ,6.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51841,CPT,ANT VESICOURETHROPEXY/URETHROPEXY COMP,,,21,,RBRVS,13.68 ,7.03 ,7.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51845,CPT,ABDOMINO-VAG VESICAL NCK SSP W/WO NDSC CTRL,,,21,,RBRVS,10.15 ,5.50 ,5.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51860,CPT,CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE,,,21,,RBRVS,12.60 ,6.98 ,6.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51865,CPT,CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED,,,21,,RBRVS,15.80 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51880,CPT,CLOSURE CYSTOSTOMY SEPARATE PROCEDURE,,,21,,RBRVS,7.87 ,4.58 ,4.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51900,CPT,CLSR VESICOVAGINAL FISTUL AABDL APPROACH,,,21,,RBRVS,14.63 ,7.60 ,7.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51920,CPT,CLOSURE VESICOUTERINE FISTULA,,,21,,RBRVS,13.41 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51925,CPT,CLSR VESICOUTERINE FISTULA W/HYSTERECTOMY,,,21,,RBRVS,17.53 ,9.61 ,9.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51940,CPT,CLOSURE EXSTROPHY BLADDER,,,21,,RBRVS,30.66 ,12.71 ,12.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51960,CPT,ENTEROCYSTOPLASTY W/INTESTINAL ANASTOMOSIS,,,21,,RBRVS,25.40 ,11.63 ,11.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51980,CPT,CUTANEOUS VESICOSTOMY,,,21,,RBRVS,12.57 ,6.52 ,6.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 51990,CPT,LAPAROSCOPY URETHRAL SUSPENSION STRESS INCONT,,,21,,RBRVS,13.36 ,6.65 ,6.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51992,CPT,LAPAROSCOPY SLING OPERATION STRESS INCONT,,,21,,RBRVS,14.87 ,7.51 ,7.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 51999,CPT,UNLISTED LAPAROSCOPY PROCEDURE BLADDER,,,21,,TotalUnits,,,,20.01 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52000,CPT,CYSTOURETHROSCOPY,,,21,,RBRVS,2.23 ,1.15 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52001,CPT,CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS,,,21,,RBRVS,5.44 ,2.23 ,4.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52005,CPT,CYSTO BLADDER W/URETERAL CATHETERIZATION,,,21,,RBRVS,2.37 ,1.19 ,4.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52007,CPT,CYSTO W/URTRL CATHJ BRUSH BX URTR&/RENAL PELVIS,,,21,,RBRVS,3.02 ,1.41 ,9.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52010,CPT,CYSTO W/EJACULATORY DUCT CATHETERIZATION,,,21,,RBRVS,3.02 ,1.42 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52204,CPT,CYSTOURETHROSCOPY WITH BIOPSY,,,21,,RBRVS,2.59 ,1.20 ,7.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52214,CPT,CYSTO W/DESTRUCTION OF LESIONS,,,21,,RBRVS,3.50 ,1.19 ,14.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52224,CPT,CYSTO W/REMOVAL OF LESIONS SMALL,,,21,,RBRVS,4.05 ,1.37 ,15.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52234,CPT,CYSTO W/REMOVAL OF TUMORS SMALL,,,21,,RBRVS,4.62 ,1.95 ,1.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52235,CPT,CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM,,,21,,RBRVS,5.44 ,2.27 ,2.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52240,CPT,CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE,,,21,,RBRVS,7.50 ,2.96 ,2.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52250,CPT,CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG,,,21,,RBRVS,4.49 ,1.91 ,1.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52260,CPT,CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH,,,21,,RBRVS,3.91 ,1.71 ,1.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52265,CPT,CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA,,,21,,RBRVS,2.94 ,1.41 ,7.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52270,CPT,CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE,,,21,,RBRVS,3.36 ,1.50 ,6.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52275,CPT,CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE,,,21,,RBRVS,4.69 ,1.95 ,8.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52276,CPT,CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE,,,21,,RBRVS,4.99 ,2.08 ,2.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52277,CPT,CYSTOURETHROSCOPY W/RESECJ EXTERNAL SPHINCTER,,,21,,RBRVS,6.16 ,2.47 ,2.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52281,CPT,CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS,,,21,,RBRVS,2.75 ,1.32 ,4.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52282,CPT,CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT,,,21,,RBRVS,6.39 ,2.58 ,2.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52283,CPT,CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE,,,21,,RBRVS,3.73 ,1.65 ,3.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52285,CPT,CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME,,,21,,RBRVS,3.60 ,1.63 ,3.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52287,CPT,CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER,,,21,,RBRVS,3.20 ,1.31 ,5.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52290,CPT,CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI,,,21,,RBRVS,4.58 ,1.94 ,1.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52300,CPT,CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI,,,21,,RBRVS,5.30 ,2.20 ,2.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52301,CPT,CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI,,,21,,RBRVS,5.50 ,2.25 ,2.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52305,CPT,CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT,,,21,,RBRVS,5.30 ,2.14 ,2.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52310,CPT,CYSTO W/SIMPLE REMOVAL STONE & STENT,,,21,,RBRVS,2.81 ,1.24 ,3.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52315,CPT,CYSTO W/COMPLEX REMOVAL STONE & STENT,,,21,,RBRVS,5.20 ,2.13 ,5.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52317,CPT,LITHOLAPAXY SMPL/SM <2.5 CM,,,21,,RBRVS,6.71 ,2.56 ,15.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52318,CPT,LITHOLAPAXY COMP/LG > 2.5 CM,,,21,,RBRVS,9.18 ,3.45 ,3.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52320,CPT,CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS,,,21,,RBRVS,4.69 ,1.90 ,1.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52325,CPT,CYSTO FRAGMENTATION URETERAL STONE,,,21,,RBRVS,6.15 ,2.41 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52327,CPT,CYSTO W/SUBURTRIC NJX IMPLT MATRL,,,21,,RBRVS,5.18 ,1.79 ,1.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52330,CPT,CYSTO MANJ W/O RMVL URETERAL STONE,,,21,,RBRVS,5.03 ,2.01 ,8.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52332,CPT,CYSTO W/INSERT URETERAL STENT,,,21,,RBRVS,2.82 ,1.34 ,10.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52334,CPT,CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR,,,21,,RBRVS,4.82 ,2.03 ,2.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52341,CPT,CYSTO W/TX URETERAL STRICTURE,,,21,,RBRVS,5.35 ,2.24 ,2.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52342,CPT,CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE,,,21,,RBRVS,5.85 ,2.41 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52343,CPT,CYSTO W/TX INTRA-RENAL STRICTURE,,,21,,RBRVS,6.55 ,2.64 ,2.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52344,CPT,CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE,,,21,,RBRVS,7.05 ,2.81 ,2.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52345,CPT,CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX,,,21,,RBRVS,7.55 ,2.98 ,2.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52346,CPT,CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE,,,21,,RBRVS,8.58 ,3.33 ,3.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52351,CPT,CYSTO W/URTROSCOPY&/PYELOSCOPY DX,,,21,,RBRVS,5.75 ,2.34 ,2.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52352,CPT,CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES,,,21,,RBRVS,6.75 ,2.71 ,2.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52353,CPT,CYSTO W/URETEROSCOPY W/LITHOTRIPSY,,,21,,RBRVS,7.50 ,2.96 ,2.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52354,CPT,CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION,,,21,,RBRVS,8.00 ,3.13 ,3.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52355,CPT,CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR,,,21,,RBRVS,9.00 ,3.47 ,3.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52356,CPT,CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT,,,21,,RBRVS,8.00 ,3.10 ,3.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52400,CPT,CYSTO INC FULG/RESCJ URTL VALVES/FOLDS,,,21,,RBRVS,8.69 ,4.09 ,4.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52402,CPT,CSTO W/TRURL RESCJ/INC EJACULATORY DUXS,,,21,,RBRVS,5.27 ,1.83 ,1.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52441,CPT,CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE,,,21,,RBRVS,4.50 ,1.53 ,30.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52442,CPT,CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL,,,21,,RBRVS,1.20 ,0.41 ,25.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52450,CPT,TRANSURETHRAL INCISION PROSTATE,,,21,,RBRVS,7.78 ,4.85 ,4.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52500,CPT,TRANSURETHRAL RESECTION PROSTATE,,,21,,RBRVS,8.14 ,4.97 ,4.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52601,CPT,TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE,,,21,,RBRVS,15.26 ,7.34 ,7.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52630,CPT,TRURL RESCJ RESIDUAL/REGROWTH OBSTR PRSTATE TISS,,,21,,RBRVS,6.55 ,4.20 ,4.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52640,CPT,TRURL RESCJ POSTOP BLADDER NECK CONTRACTURE,,,21,,RBRVS,4.79 ,3.72 ,3.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52647,CPT,LASER COAGULATION OF PROSTATE FOR URINE FLOW,,,21,,RBRVS,11.30 ,6.04 ,37.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52648,CPT,LASER VAPORIZATION OF PROSTATE FOR URINE FLOW,,,21,,RBRVS,12.15 ,6.33 ,38.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52649,CPT,LASER ENUCLEATION PROSTATE W/MORCELLATION,,,21,,RBRVS,14.56 ,7.47 ,7.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 52700,CPT,TRURL DRAINAGE PROSTATIC ABSCESS,,,21,,RBRVS,7.49 ,4.34 ,4.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53000,CPT,URTT/URTS XTRNL SPX PENDULOUS URETHRA,,,21,,RBRVS,2.33 ,1.66 ,1.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53010,CPT,URETHROTOMY/URETHROSTOMY XT SPX PERINEAL URETHRA,,,21,,RBRVS,4.45 ,3.53 ,3.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53020,CPT,MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT,,,21,,RBRVS,1.77 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53025,CPT,MEATOTOMY CUTTING MEATUS SPX INFANT,,,21,,RBRVS,1.13 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53040,CPT,DRAINAGE DEEP PERIURETHRAL ABSCESS,,,21,,RBRVS,6.55 ,3.99 ,3.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53060,CPT,DRG OF SKENE'S GLAND ABSCESS OR CYST,,,21,,RBRVS,2.68 ,1.72 ,2.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53080,CPT,DRG PERINEAL URINARY XTRVASATION UNCOMP SPX,,,21,,RBRVS,6.92 ,4.37 ,4.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53085,CPT,DRG PERINEAL URINARY XTRVASATION COMPLIC,,,21,,RBRVS,11.18 ,6.76 ,6.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53200,CPT,BIOPSY URETHRA,,,21,,RBRVS,2.59 ,1.19 ,1.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53210,CPT,URETHRECTOMY TOT W/CYSTOST FEMALE,,,21,,RBRVS,13.72 ,6.88 ,6.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53215,CPT,URETHRECTOMY TOT W/CYSTOST MALE,,,21,,RBRVS,16.85 ,7.95 ,7.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53220,CPT,EXC/FULGURATION CARCINOMA URETHRA,,,21,,RBRVS,7.63 ,4.54 ,4.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53230,CPT,EXC URETHRAL DIVERTICULUM SPX FEMALE,,,21,,RBRVS,10.44 ,5.78 ,5.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53235,CPT,EXC URETHRAL DIVERTICULUM SPX MALE,,,21,,RBRVS,10.99 ,5.96 ,5.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53240,CPT,MARSUPIALIZATION URTL DIVERTICULUM MALE/FEMALE,,,21,,RBRVS,7.08 ,4.35 ,4.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53250,CPT,EXCISION OF BULBOURETHRAL GLAND,,,21,,RBRVS,6.52 ,4.34 ,4.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53260,CPT,EXC/FULGURATION URETHRAL POLYP DSTL URETHRA,,,21,,RBRVS,3.03 ,1.79 ,2.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53265,CPT,EXC/FULGURATION URETHRAL CARUNCLE,,,21,,RBRVS,3.17 ,1.81 ,2.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53270,CPT,EXCISION OR FULGURATION SKENES GLANDS,,,21,,RBRVS,3.14 ,1.81 ,2.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53275,CPT,EXCISION/FULGURATION URETHRAL PROLAPSE,,,21,,RBRVS,4.57 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53400,CPT,URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX,,,21,,RBRVS,14.13 ,7.29 ,7.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53405,CPT,URETHROPLASTY 2ND STAGE W/URINARY DIVERSION,,,21,,RBRVS,15.66 ,7.70 ,7.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53410,CPT,URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA,,,21,,RBRVS,17.68 ,8.46 ,8.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53415,CPT,URTP TRANSPUBIC/PRNL 1 STG RCNSTJ/RPR URT,,,21,,RBRVS,20.70 ,9.47 ,9.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 53420,CPT,URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 1ST STAGE,,,21,,RBRVS,15.17 ,7.64 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53425,CPT,URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 2ND STAGE,,,21,,RBRVS,17.07 ,7.95 ,7.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53430,CPT,URETHROPLASTY RCNSTJ FEMALE URETHRA,,,21,,RBRVS,17.43 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53431,CPT,URTP W/TUBULARIZATION POST URT&/LWR BLDR,,,21,,RBRVS,21.18 ,9.65 ,9.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53440,CPT,SLING OPRATION CORRJ MALE URINARY INCONTINENCE,,,21,,RBRVS,13.36 ,6.78 ,6.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53442,CPT,RMVL/REVJ SLING MALE URINARY INCONTINENCE,,,21,,RBRVS,13.49 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53444,CPT,INSERTION TANDEM CUFF,,,21,,RBRVS,14.19 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53445,CPT,INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER,,,21,,RBRVS,13.00 ,7.17 ,7.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53446,CPT,REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER,,,21,,RBRVS,11.02 ,6.19 ,6.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53447,CPT,RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC,,,21,,RBRVS,14.28 ,7.35 ,7.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53448,CPT,RMVL & RPLCMT NFLTBL NCK SPHNCTR THRU INFCT FLD,,,21,,RBRVS,23.44 ,10.78 ,10.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 53449,CPT,RPR NFLTBL URETHRAL/BLADDER NECK SPHINCTER,,,21,,RBRVS,10.56 ,5.82 ,5.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53450,CPT,URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT,,,21,,RBRVS,6.77 ,4.21 ,4.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53460,CPT,URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM,,,21,,RBRVS,7.75 ,4.53 ,4.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53500,CPT,URETHROLSS TRVG SEC OPN W/CSTO,,,21,,RBRVS,13.00 ,6.99 ,6.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53502,CPT,URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE,,,21,,RBRVS,8.26 ,4.79 ,4.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53505,CPT,URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE,,,21,,RBRVS,8.26 ,4.81 ,4.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53510,CPT,URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PERINEAL,,,21,,RBRVS,10.96 ,5.95 ,5.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53515,CPT,URTORR SUTR URETHRAL WND/INJ PROSTATOMEMBRANOUS,,,21,,RBRVS,14.22 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53520,CPT,CLSR URETHROSTOMY/URETHROQ FSTL MALE SPX,,,21,,RBRVS,9.48 ,5.45 ,5.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53600,CPT,DILAT URETHRAL STRIX DILATOR MALE 1ST,,,21,,RBRVS,1.21 ,0.49 ,1.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53601,CPT,DILAT URETHRAL STRIX DILATOR MALE SBSQ,,,21,,RBRVS,0.98 ,0.45 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53605,CPT,DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES,,,21,,RBRVS,1.28 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53620,CPT,DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST,,,21,,RBRVS,1.62 ,0.71 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53621,CPT,DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ,,,21,,RBRVS,1.35 ,0.58 ,1.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53660,CPT,DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI,,,21,,RBRVS,0.71 ,0.41 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53661,CPT,DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ,,,21,,RBRVS,0.72 ,0.36 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53665,CPT,DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES,,,21,,RBRVS,0.76 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53850,CPT,TRURL DSTRJ PRSTATE TISS MICROWAVE THERMOTH,,,21,,RBRVS,10.08 ,6.22 ,47.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53852,CPT,TRURL DSTRJ PRSTATE TISS RF THERMOTH,,,21,,RBRVS,10.83 ,5.84 ,41.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53855,CPT,INSERT TEMP PROSTATIC URETH STENT W/MEASUREMENT,,,21,,RBRVS,1.64 ,0.56 ,20.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53860,CPT,TRURL RF FEMALE BLADDER NECK STRS URIN INCONT,,,21,,RBRVS,3.97 ,2.09 ,39.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 53899,CPT,UNLISTED PROCEDURE URINARY SYSTEM,,,21,,TotalUnits,,,,4.06 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54000,CPT,SLITTING PREPUCE DORSAL/LATERAL SPX NEWBORN,,,21,,RBRVS,1.59 ,1.33 ,2.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54001,CPT,SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN,,,21,,RBRVS,2.24 ,1.48 ,2.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54015,CPT,I&D PENIS DEEP,,,21,,RBRVS,5.36 ,2.91 ,2.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54050,CPT,DSTRJ LESION PENIS SIMPLE CHEMICAL,,,21,,RBRVS,1.29 ,1.55 ,2.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54055,CPT,DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION,,,21,,RBRVS,1.25 ,1.24 ,1.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54056,CPT,DSTRJ LESION PENIS SIMPLE CRYOSURGERY,,,21,,RBRVS,1.29 ,1.71 ,2.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54057,CPT,DSTRJ LESION PENIS SIMPLE LASER,,,21,,RBRVS,1.29 ,1.28 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54060,CPT,DSTRJ LESION PENIS SIMPLE SURG EXCISION,,,21,,RBRVS,1.98 ,1.53 ,2.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54065,CPT,DSTRJ LESION PENIS EXTENSIVE,,,21,,RBRVS,2.47 ,2.17 ,3.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54100,CPT,BIOPSY PENIS SEPARATE PROCEDURE,,,21,,RBRVS,1.90 ,1.46 ,3.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54105,CPT,BIOPSY PENIS DEEP STRUCTURES,,,21,,RBRVS,3.54 ,2.18 ,3.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54110,CPT,EXCISION OF PENILE PLAQUE,,,21,,RBRVS,10.92 ,5.94 ,5.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54111,CPT,EXC PENILE PLAQUE GRAFT &/5 CM LENGTH,,,21,,RBRVS,14.42 ,6.98 ,6.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54112,CPT,EXC PENILE PLAQUE GRAFT > 5 CM LENGTH,,,21,,RBRVS,16.98 ,8.09 ,8.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54115,CPT,REMOVAL FOREIGN BODY DEEP PENILE TISSUE,,,21,,RBRVS,6.95 ,4.46 ,5.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54120,CPT,AMPUTATION PENIS PARTIAL,,,21,,RBRVS,11.01 ,5.91 ,5.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54125,CPT,AMPUTATION PENIS COMPLETE,,,21,,RBRVS,14.56 ,7.10 ,7.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 54130,CPT,AMPUTATION PENIS RADW/BI INGUINOFEMORAL LMPHADE,,,21,,RBRVS,21.84 ,10.03 ,10.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 54135,CPT,AMPUTATION PENIS RADICAL W/LYMPH NODES,,,21,,RBRVS,28.17 ,12.17 ,12.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 54150,CPT,CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK,,,21,,RBRVS,1.90 ,0.68 ,2.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54160,CPT,CIRCUMCISION NEONATE,,,21,,RBRVS,2.53 ,1.36 ,3.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54161,CPT,CIRCUMCISION AGE >28 DAYS,,,21,,RBRVS,3.32 ,1.95 ,1.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54162,CPT,LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS,,,21,,RBRVS,3.32 ,2.02 ,3.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54163,CPT,REPAIR INCOMPLETE CIRCUMCISION,,,21,,RBRVS,3.32 ,2.58 ,2.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54164,CPT,FRENULOTOMY PENIS,,,21,,RBRVS,2.82 ,2.40 ,2.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54200,CPT,INJECTION PEYRONIE DISEASE,,,21,,RBRVS,1.11 ,1.17 ,1.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54205,CPT,NJX PEYRONIE W/SURG EXPOS PLAQUE,,,21,,RBRVS,8.97 ,5.32 ,5.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54220,CPT,IRRIGATION CORPORA CAVERNOSA PRIAPISM,,,21,,RBRVS,2.42 ,1.14 ,3.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54230,CPT,INJECTION CORPORA CAVERNOSOGRAPY,,,21,,RBRVS,1.34 ,0.80 ,1.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54231,CPT,DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS,,,21,,RBRVS,2.04 ,1.07 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54235,CPT,NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT,,,21,,RBRVS,1.19 ,0.79 ,1.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54240,CPT,PENILE PLETHYSMOGRAPHY,,,21,,RBRVS,1.31 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 54240,CPT,PENILE PLETHYSMOGRAPHY,26,,21,,RBRVS,1.31 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54240,CPT,PENILE PLETHYSMOGRAPHY,TC,,21,,RBRVS,,0.98 ,0.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 54250,CPT,NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST,,,21,,RBRVS,2.22 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 54250,CPT,NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST,26,,21,,RBRVS,2.22 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54250,CPT,NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST,TC,,21,,RBRVS,,0.30 ,0.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 54300,CPT,PENIS STRAIGHTENING CHORDEE,,,21,,RBRVS,11.20 ,5.97 ,5.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54304,CPT,PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR,,,21,,RBRVS,13.28 ,6.79 ,6.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54308,CPT,URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR <3 CM,,,21,,RBRVS,12.62 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54312,CPT,URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR > 3 CM,,,21,,RBRVS,14.51 ,8.23 ,8.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54316,CPT,URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR SKIN GRF,,,21,,RBRVS,18.05 ,9.62 ,9.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54318,CPT,URETHROPLASTY 3RD STG HYPOSPADIAS RPR RLS PENIS,,,21,,RBRVS,12.43 ,7.36 ,7.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54322,CPT,1 STG DSTL HYPOSPADIAS RPR W/SMPL MEATAL ADVMNT,,,21,,RBRVS,13.98 ,6.67 ,6.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54324,CPT,1 STG DSTL HYPOSPADIAS RPR W/URTP SKIN FLAPS,,,21,,RBRVS,17.55 ,9.21 ,9.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54326,CPT,1 STG DSTL HYPOSPADIAS RPR URTP SKN FLAPS,,,21,,RBRVS,17.02 ,8.27 ,8.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54328,CPT,1 STAGE DSTL HYPOSPADIAS RPR W/EXTENSIVE DSJ,,,21,,RBRVS,16.89 ,8.24 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54332,CPT,1 STAGE PROX PENILE/PENOSCROTAL HYPOSPADIAS RPR,,,21,,RBRVS,18.37 ,9.91 ,9.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54336,CPT,1 STG PERINEAL HYPOSPADIAS RPR W/GRF&/FLAP,,,21,,RBRVS,21.62 ,11.35 ,11.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54340,CPT,RPR HYPOSPADIAS COMPLCTJS CLSR INC/EXC SIMPLE,,,21,,RBRVS,9.71 ,5.58 ,5.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54344,CPT,RPR HYPOSPADIAS COMPLCTJS MOBLJ FLAPS & URTP,,,21,,RBRVS,17.06 ,9.21 ,9.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54348,CPT,RPR HYPOSPADIAS COMPLCTJS DSJ & URTP FLAP/GRF,,,21,,RBRVS,18.32 ,8.78 ,8.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54352,CPT,RPR HYPOSPADIAS CRIPPLE W/DSJ & EXC & GRFS/FLAP,,,21,,RBRVS,26.13 ,11.69 ,11.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54360,CPT,PLASTIC RPR PENIS CORRECT ANGULATION,,,21,,RBRVS,12.78 ,6.50 ,6.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54380,CPT,PLASTIC RPR PENIS EPISPADIAS DSTL SPHNCTR,,,21,,RBRVS,14.18 ,7.21 ,7.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54385,CPT,PLASTIC PENIS EPISPADIAS DSTL SPHNCTR W/INCONT,,,21,,RBRVS,16.56 ,9.21 ,9.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54390,CPT,PLASTIC RPR PENIS EPISPADIAS W/EXSTROPHY BLADDER,,,21,,RBRVS,22.77 ,11.58 ,11.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 54400,CPT,INSJ PENILE PROSTHESIS NON-INFLATABLE SEMI-RIGID,,,21,,RBRVS,9.17 ,5.02 ,5.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54401,CPT,INSJ PENILE PROSTHESOS INFLATABLE SELF-CONTAINED,,,21,,RBRVS,10.44 ,7.23 ,7.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54405,CPT,INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH,,,21,,RBRVS,14.52 ,7.10 ,7.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54406,CPT,RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH,,,21,,RBRVS,12.89 ,6.66 ,6.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54408,CPT,RPR COMPONENT INFLATABLE PENILE PROSTHESIS,,,21,,RBRVS,13.91 ,7.24 ,7.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54410,CPT,RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS,,,21,,RBRVS,15.18 ,7.82 ,7.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54411,CPT,RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL,,,21,,RBRVS,18.35 ,9.08 ,9.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54415,CPT,RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT,,,21,,RBRVS,8.88 ,5.29 ,5.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54416,CPT,RMVL & RPLCMT NON-NFLTBL/NFLTBL PENILE PROSTHESI,,,21,,RBRVS,12.08 ,6.97 ,6.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54417,CPT,RMVL & RPLCMT PENILE PROSTHESIS INFECTED FIELD,,,21,,RBRVS,16.10 ,7.94 ,7.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54420,CPT,CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT UNI/BI,,,21,,RBRVS,12.39 ,6.48 ,6.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54430,CPT,CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI,,,21,,RBRVS,11.06 ,6.10 ,6.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 54435,CPT,CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM,,,21,,RBRVS,6.81 ,4.38 ,4.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54437,CPT,REPAIR OF TRAUMATIC CORPOREAL TEAR(S),,,21,,RBRVS,11.50 ,6.65 ,6.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54438,CPT,REPLANTATION PENIS COMP AMPUTATION W/URETH REP,,,21,,RBRVS,24.50 ,11.62 ,11.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 54440,CPT,PLASTIC OPERATION PENIS INJURY,,,21,,TotalUnits,,,,15.70 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54450,CPT,FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING,,,21,,RBRVS,1.12 ,0.41 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54500,CPT,BIOPSY TESTIS NEEDLE SEPARATE PROCEDURE,,,21,,RBRVS,1.31 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54505,CPT,BIOPSY TESTIS INCISIONAL SEPARATE PROCEDURE,,,21,,RBRVS,3.50 ,2.15 ,2.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54512,CPT,EXC XTRPARENCHYMAL LESION TESTIS,,,21,,RBRVS,9.33 ,5.09 ,5.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54520,CPT,ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH,,,21,,RBRVS,5.30 ,3.41 ,3.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54522,CPT,ORCHIECTOMY PARTIAL,,,21,,RBRVS,10.25 ,5.90 ,5.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54530,CPT,ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH,,,21,,RBRVS,8.46 ,5.08 ,5.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54535,CPT,ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL,,,21,,RBRVS,13.19 ,6.73 ,6.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54550,CPT,EXPL UNDESCENDED TSTIS INGUN/SCROTAL AREA,,,21,,RBRVS,8.41 ,4.80 ,4.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54560,CPT,EXPL UNDESCENDED TESTIS W/ABDOMINAL EXPL,,,21,,RBRVS,12.10 ,6.29 ,6.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54600,CPT,RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS,,,21,,RBRVS,7.64 ,4.59 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54620,CPT,FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE,,,21,,RBRVS,5.21 ,2.87 ,2.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54640,CPT,ORCHIOPEXY INGUINAL APPROACH W/WO HERNIA RPR,,,21,,RBRVS,7.73 ,5.07 ,5.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54650,CPT,ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS,,,21,,RBRVS,12.39 ,6.67 ,6.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54660,CPT,INSJ TESTICULAR PROSTH SEPARATE PROCEDURE,,,21,,RBRVS,5.74 ,3.88 ,3.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54670,CPT,SUTURE/REPAIR TESTICULAR INJURY,,,21,,RBRVS,6.65 ,4.25 ,4.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54680,CPT,TRANSPLANTATION TESTIS TO THIGH,,,21,,RBRVS,14.04 ,7.13 ,7.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54690,CPT,LAPAROSCOPY SURGICAL ORCHIECTOMY,,,21,,RBRVS,11.70 ,6.88 ,6.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54692,CPT,LAPAROSCOPY ORCHIOPEXY INTRA-ABDOMINAL TESTIS,,,21,,RBRVS,13.74 ,7.57 ,7.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54699,CPT,UNLISTED LAPAROSCOPY PROCEDURE TESTIS,,,21,,TotalUnits,,,,18.58 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54700,CPT,I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE,,,21,,RBRVS,3.47 ,2.24 ,2.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54800,CPT,BIOPSY EPIDIDYMIS NEEDLE,,,21,,RBRVS,2.33 ,1.07 ,1.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54830,CPT,EXCISION LOCAL LESION EPIDIDYMIS,,,21,,RBRVS,6.01 ,4.00 ,4.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54840,CPT,EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY,,,21,,RBRVS,5.27 ,3.36 ,3.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54860,CPT,EPIDIDYMECTOMY UNILATERAL,,,21,,RBRVS,6.95 ,4.30 ,4.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54861,CPT,EPIDIDYMECTOMY BILATERAL,,,21,,RBRVS,9.70 ,5.49 ,5.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54865,CPT,EXPLORATION EPIDIDYMIS W/WO BIOPSY,,,21,,RBRVS,5.77 ,3.89 ,3.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54900,CPT,EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS UNI,,,21,,RBRVS,14.20 ,8.05 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 54901,CPT,EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS BI,,,21,,RBRVS,19.10 ,10.19 ,10.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55000,CPT,PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED,,,21,,RBRVS,1.43 ,0.85 ,1.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55040,CPT,EXCISION HYDROCELE UNILATERAL,,,21,,RBRVS,5.45 ,3.61 ,3.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55041,CPT,EXCISION HYDROCELE BILATERAL,,,21,,RBRVS,8.54 ,5.11 ,5.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55060,CPT,RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE,,,21,,RBRVS,6.15 ,4.06 ,4.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55100,CPT,DRAINAGE SCROTAL WALL ABSCESS,,,21,,RBRVS,2.45 ,2.01 ,3.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55110,CPT,SCROTAL EXPLORATION,,,21,,RBRVS,6.33 ,4.05 ,4.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55120,CPT,REMOVAL FOREIGN BODY SCROTUM,,,21,,RBRVS,5.72 ,3.85 ,3.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55150,CPT,RESECTION SCROTUM,,,21,,RBRVS,8.14 ,5.00 ,5.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55175,CPT,SCROTOPLASTY SIMPLE,,,21,,RBRVS,5.87 ,3.88 ,3.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55180,CPT,SCROTOPLASTY COMPLICATED,,,21,,RBRVS,11.78 ,6.72 ,6.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55200,CPT,VASOTOMY CANNULIZATION W/WO VAS INC UNI/BI SPX,,,21,,RBRVS,4.55 ,2.94 ,7.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55250,CPT,VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS,,,21,,RBRVS,3.37 ,2.77 ,7.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55300,CPT,VASOTOMY VASOGRAMS UNI/BI,,,21,,RBRVS,3.50 ,1.50 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55400,CPT,VASOVASOSTOMY VASOVASORRHAPHY,,,21,,RBRVS,8.61 ,4.86 ,4.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55450,CPT,LIGATION PRQ VAS DEFERENS UNI/BI SPX,,,21,,RBRVS,4.43 ,2.47 ,5.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55500,CPT,EXC HYDROCELE SPRMATIC CORD UNI SPX,,,21,,RBRVS,6.22 ,4.25 ,4.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55520,CPT,EXC LESION SPERMATIC CORD SEPARATE PROCEDURE,,,21,,RBRVS,6.66 ,4.92 ,4.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55530,CPT,EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX,,,21,,RBRVS,5.75 ,3.68 ,3.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55535,CPT,EXC VARICOCELE/LIGATION SPERMATIC VEINS ABDL,,,21,,RBRVS,7.19 ,4.37 ,4.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55540,CPT,EXC VARICOCELE/LIGATION VEINS W/HERNIA RPR,,,21,,RBRVS,8.30 ,5.50 ,5.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55550,CPT,LAPS LIGATION SPERMATIC VEINS VARICOCELE,,,21,,RBRVS,7.20 ,4.33 ,4.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55559,CPT,UNLISTED LAPROSCOPY PROCEDURE SPERMATIC CORD,,,21,,TotalUnits,,,,11.53 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55600,CPT,VESICULOTOMY,,,21,,RBRVS,7.01 ,4.32 ,4.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55605,CPT,VESICULOTOMY COMPLICATED,,,21,,RBRVS,8.76 ,5.81 ,5.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 55650,CPT,VESICULECTOMY ANY APPROACH,,,21,,RBRVS,12.65 ,6.57 ,6.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 55680,CPT,EXCISION MULLERIAN DUCT CYST,,,21,,RBRVS,5.67 ,3.84 ,3.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55700,CPT,PROSTATE NEEDLE BIOPSY ANY APPROACH,,,21,,RBRVS,2.58 ,1.14 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55705,CPT,BIOPSY PROSTATE INCISIONAL ANY APPROACH,,,21,,RBRVS,4.61 ,2.52 ,2.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55706,CPT,BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID,,,21,,RBRVS,6.28 ,3.74 ,3.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55720,CPT,PROSTATOTOMY EXTERNAL DRG ABSCESS SIMPLE,,,21,,RBRVS,7.73 ,4.43 ,4.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55725,CPT,PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED,,,21,,RBRVS,10.05 ,5.87 ,5.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55801,CPT,PROSTATECTOMY PERINEAL SUBTOTAL,,,21,,RBRVS,19.80 ,9.45 ,9.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 55810,CPT,PROSTATECTOMY PERINEAL RADICAL,,,21,,RBRVS,24.29 ,10.75 ,10.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 55812,CPT,PROSTATECTOMY PERINEAL RADICAL W/LYMPH NODE BX,,,21,,RBRVS,29.89 ,13.06 ,13.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 55815,CPT,PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC,,,21,,RBRVS,32.95 ,14.15 ,14.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 55821,CPT,PROSTATECTOMY SUPRAPUBIC SUBTOTAL 1/2 STAGES,,,21,,RBRVS,15.76 ,7.59 ,7.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 55831,CPT,PROSTATECTOMY RETROPUBIC SUBTOTAL,,,21,,RBRVS,17.19 ,8.07 ,8.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 55840,CPT,PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING,,,21,,RBRVS,21.36 ,9.93 ,9.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 55842,CPT,PROSTECT RETROPUBIC RAD W/WO NRV SPAR W/LYMPH BX,,,21,,RBRVS,21.36 ,9.93 ,9.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 55845,CPT,PROSTECT RETROPUB RAD W/WO NRV SPAR & BI PLV LYM,,,21,,RBRVS,25.18 ,11.23 ,11.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 55860,CPT,EXPOS PROSTATE ANY APPROACH INSJ RADIOACT SUBST,,,21,,RBRVS,15.84 ,7.56 ,7.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55862,CPT,EXPOS PROSTATE INSJ RADIOACT SBST W/LYMPH BX,,,21,,RBRVS,20.04 ,10.34 ,10.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 55865,CPT,EXPOS PROSTATE INSJ RADIOAC SBST W/BI PELV LYMPH,,,21,,RBRVS,24.57 ,11.06 ,11.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 55866,CPT,LAPS PROSTECT RETROPUBIC RAD W/NRV SPARING ROBOT,,,21,,RBRVS,21.36 ,16.57 ,16.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 55870,CPT,ELECTROEJACULATION,,,21,,RBRVS,2.58 ,1.23 ,2.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55873,CPT,CRYOSURGICAL ABLATION PROSTATE W/US & MONITORI,,,21,,RBRVS,13.60 ,6.88 ,185.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55875,CPT,TRANSPERINEAL PLMT NDL/CATHS PROSTATE RADJ INSJ,,,21,,RBRVS,13.46 ,7.03 ,7.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55876,CPT,PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT,,,21,,RBRVS,1.73 ,0.98 ,1.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55899,CPT,UNLISTED PROCEDURE MALE GENITAL SYSTEM,,,21,,TotalUnits,,,,5.20 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 55920,CPT,PLACEMENT NEEDLE PELVIC ORGAN RADIOELEMENT APPL,,,21,,RBRVS,8.31 ,3.78 ,3.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56405,CPT,I&D VULVA/PERINEAL ABSCESS,,,21,,RBRVS,1.49 ,1.39 ,1.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56420,CPT,I&D OF BARTHOLINS GLAND ABSCESS,,,21,,RBRVS,1.44 ,0.97 ,1.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56440,CPT,MARSUPIALIZATION BARTHOLINS GLAND CYST,,,21,,RBRVS,2.89 ,1.92 ,1.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56441,CPT,LYSIS LABIAL ADHESIONS,,,21,,RBRVS,2.02 ,1.67 ,1.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56442,CPT,HYMENOTOMY SIMPLE INCISION,,,21,,RBRVS,0.68 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56501,CPT,DESTRUCTION LESIONS VULVA SIMPLE,,,21,,RBRVS,1.58 ,1.48 ,1.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56515,CPT,DESTRUCTION LESIONS VULVA EXTENSIVE,,,21,,RBRVS,3.08 ,2.21 ,2.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56605,CPT,BIOPSY VULVA/PERINEUM 1 LESION SPX,,,21,,RBRVS,1.10 ,0.48 ,1.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56606,CPT,BIOPSY VULVA/PERINEUM EACH ADDL LESION,,,21,,RBRVS,0.55 ,0.22 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56620,CPT,VULVECTOMY SIMPLE PARTIAL,,,21,,RBRVS,7.53 ,5.96 ,5.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56625,CPT,VULVECTOMY SIMPLE COMPLETE,,,21,,RBRVS,9.68 ,6.43 ,6.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56630,CPT,VULVECTOMY RADICAL PARTIAL,,,21,,RBRVS,14.80 ,8.76 ,8.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 56631,CPT,VULVECTOMY RAD PRTL UNI INGUINOFEM LMPHADECTOMY,,,21,,RBRVS,18.99 ,10.98 ,10.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 56632,CPT,VULVECTOMY RAD PRTL BI INGUINOFEM LMPHADECTOMY,,,21,,RBRVS,21.86 ,13.10 ,13.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 56633,CPT,VULVECTOMY RADICAL COMPLETE,,,21,,RBRVS,19.62 ,11.08 ,11.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 56634,CPT,VULVECTOMY RAD COMPL UNI INGUINOFEM LMPHADECTOMY,,,21,,RBRVS,20.66 ,11.96 ,11.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 56637,CPT,VULVECTOMY RAD COMPL BI INGUINOFEM LMPHADECTOMY,,,21,,RBRVS,24.75 ,13.32 ,13.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 56640,CPT,VULVECTOMY RAD COMPL ILIAC & PELVIC LMPHADECTOMY,,,21,,RBRVS,24.78 ,13.24 ,13.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 56700,CPT,PRTL HYMENECTOMY/REVJ HYMENAL RING,,,21,,RBRVS,2.84 ,2.11 ,2.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56740,CPT,EXC BARTHOLINS GLAND/CYST,,,21,,RBRVS,4.88 ,2.97 ,2.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56800,CPT,PLASTIC REPAIR INTROITUS,,,21,,RBRVS,3.93 ,2.41 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56805,CPT,CLITOROPLASTY INTERSEX STATE,,,21,,RBRVS,19.88 ,10.26 ,10.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56810,CPT,PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX,,,21,,RBRVS,4.29 ,2.56 ,2.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56820,CPT,COLPOSCOPY VULVA,,,21,,RBRVS,1.50 ,0.74 ,1.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 56821,CPT,COLPOSCOPY VULVA W/BIOPSY,,,21,,RBRVS,2.05 ,0.95 ,1.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57000,CPT,COLPOTOMY W/EXPLORATION,,,21,,RBRVS,3.02 ,1.97 ,1.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57010,CPT,COLPOTOMY W/DRAINAGE PELVIC ABSCESS,,,21,,RBRVS,6.84 ,4.62 ,4.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57020,CPT,COLPOCENTESIS SEPARATE PROCEDURE,,,21,,RBRVS,1.50 ,0.62 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57022,CPT,I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM,,,21,,RBRVS,2.73 ,1.75 ,1.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57023,CPT,I&D VAGINAL HEMATOMA NON-OBSTETRICAL,,,21,,RBRVS,5.18 ,3.00 ,3.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57061,CPT,DESTRUCTION VAGINAL LESIONS SIMPLE,,,21,,RBRVS,1.30 ,1.32 ,1.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57065,CPT,DESTRUCTION VAGINAL LESIONS EXTENSIVE,,,21,,RBRVS,2.66 ,1.90 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57100,CPT,BIOPSY VAGINAL MUCOSA SIMPLE,,,21,,RBRVS,1.20 ,0.53 ,1.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57105,CPT,BIOPSY VAGINAL MUCOSA EXTENSIVE,,,21,,RBRVS,1.74 ,1.59 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57106,CPT,VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL,,,21,,RBRVS,7.50 ,5.35 ,5.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57107,CPT,VAGINECTOMY PRTL RMVL VAG WALL & PARAVAGINAL T,,,21,,RBRVS,24.56 ,12.53 ,12.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57109,CPT,VAGNC PRTL RMVL VAG WALL W/BI TOT PEL LMPHADEC,,,21,,RBRVS,28.40 ,14.86 ,14.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57110,CPT,VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL,,,21,,RBRVS,15.48 ,8.00 ,8.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 57111,CPT,VAGINECTOMY COMPL RMVL VAG WALL & PARAVAG TISS,,,21,,RBRVS,28.40 ,13.72 ,13.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 57112,CPT,VAGNC COMPL RMVL VAG WALL TOT PEL LMPHADEC BX,,,21,,RBRVS,30.52 ,15.81 ,15.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 57120,CPT,COLPOCLEISIS LE FORT TYPE,,,21,,RBRVS,8.28 ,5.17 ,5.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57130,CPT,EXCISION VAGINAL SEPTUM,,,21,,RBRVS,2.46 ,1.75 ,2.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57135,CPT,EXCISION VAGINAL CYST/TUMOR,,,21,,RBRVS,2.70 ,1.86 ,2.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57150,CPT,IRRIGATION VAGINA&/APPL MEDICAMENT TX DISEASE,,,21,,RBRVS,0.55 ,0.21 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57155,CPT,INSERTION UTERINE TANDEM&/VAGINAL OVOIDS,,,21,,RBRVS,5.40 ,2.44 ,6.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57156,CPT,INSERTION VAGINAL RADIATION DEVICE,,,21,,RBRVS,2.69 ,1.30 ,2.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57160,CPT,FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI,,,21,,RBRVS,0.89 ,0.34 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57170,CPT,DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS,,,21,,RBRVS,0.91 ,0.36 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57180,CPT,INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX,,,21,,RBRVS,1.63 ,1.16 ,2.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57200,CPT,COLPORRHAPHY SUTURE INJURY VAGINA,,,21,,RBRVS,4.42 ,3.53 ,3.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57210,CPT,COLPOPERINEORRHAPHY SUTURE INJ VAGINA&/PERINEU,,,21,,RBRVS,5.71 ,3.98 ,3.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57220,CPT,PLASTIC URETHRAL SPHINCTER VAGINAL APPROACH,,,21,,RBRVS,4.85 ,3.61 ,3.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57230,CPT,PLASTIC REPAIR URETHROCELE,,,21,,RBRVS,6.30 ,4.13 ,4.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57240,CPT,ANT COLPORRHAPHY CYSTOCELE W/WO RPR URETHROCELE,,,21,,RBRVS,11.50 ,6.20 ,6.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57250,CPT,POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY,,,21,,RBRVS,11.50 ,6.29 ,6.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57260,CPT,COMBINED ANTEROPOSTERIOR COLPORRHAPHY,,,21,,RBRVS,14.44 ,7.45 ,7.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57265,CPT,CMBND ANTEROPOST COLPORRHAPHY W/ENTEROCELE RPR,,,21,,RBRVS,15.94 ,8.02 ,8.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57267,CPT,INSJ MESH/PROSTH PELVIC FLOOR DEFECT EACH SITE,,,21,,RBRVS,4.88 ,1.84 ,1.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57268,CPT,REPAIR ENTEROCELE VAGINAL APPROACH SPX,,,21,,RBRVS,7.57 ,5.20 ,5.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57270,CPT,REPAIR ENTEROCELE ABDOMINAL APPROACH SPX,,,21,,RBRVS,13.67 ,7.25 ,7.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 57280,CPT,COLPOPEXY ABDOMINAL APPROACH,,,21,,RBRVS,16.72 ,8.31 ,8.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 57282,CPT,COLPOPEXY VAGINAL EXTRAPERITONEAL APPROACH,,,21,,RBRVS,7.97 ,5.29 ,5.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57283,CPT,COLPOPEXY VAGINAL INTRAPERITONEAL APPROACH,,,21,,RBRVS,11.66 ,6.46 ,6.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57284,CPT,PARAVAGINAL DEFECT REPAIR OPEN ABDOMINAL APPR,,,21,,RBRVS,14.33 ,7.13 ,7.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57285,CPT,PARAVAGINAL DEFECT REPAIR VAGINAL APPROACH,,,21,,RBRVS,11.60 ,6.12 ,6.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57287,CPT,RMVL/REVJ SLING STRESS INCONTINENCE,,,21,,RBRVS,11.15 ,6.91 ,6.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57288,CPT,SLING OPERATION STRESS INCONTINENCE,,,21,,RBRVS,12.13 ,6.81 ,6.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57289,CPT,PEREYRA PX W/ANTERIOR COLPORRHAPHY,,,21,,RBRVS,12.80 ,6.73 ,6.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57291,CPT,CONSTRUCTION ARTIFICIAL VAGINA W/O GRAFT,,,21,,RBRVS,8.64 ,7.46 ,7.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57292,CPT,CONSTRUCTION ARTIFICIAL VAGINA W/GRAFT,,,21,,RBRVS,14.01 ,7.59 ,7.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57295,CPT,REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP,,,21,,RBRVS,7.82 ,4.81 ,4.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57296,CPT,REVJ W/RMVL PROSTHETIC VAGINAL GRAFT ABDML APPR,,,21,,RBRVS,16.56 ,8.31 ,8.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 57300,CPT,CLSR RECTOVAGINAL FISTULA VAGINAL/TRANSANAL APPR,,,21,,RBRVS,8.71 ,5.90 ,5.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57305,CPT,CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH,,,21,,RBRVS,15.35 ,8.50 ,8.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 57307,CPT,CLSR RECTOVAG FSTL ABDL APPR W/CONCOMITANT CLST,,,21,,RBRVS,17.17 ,9.70 ,9.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 57308,CPT,CLSR RECTOVAG FSTL TPRNL PRNL BDY RCNSTJ,,,21,,RBRVS,10.59 ,6.65 ,6.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 57310,CPT,CLOSURE URETHROVAGINAL FISTULA,,,21,,RBRVS,7.65 ,4.71 ,4.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57311,CPT,CLSR URETHROVAG FSTL W/BULBOCAVERNOSUS TRNSPL,,,21,,RBRVS,8.91 ,5.16 ,5.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 57320,CPT,CLOSURE VESICOVAGINAL FISTULA VAGINAL APPROACH,,,21,,RBRVS,8.88 ,5.30 ,5.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57330,CPT,CLSR VESICOVAG FSTL TRANSVESICAL&VAG APPR,,,21,,RBRVS,13.21 ,6.55 ,6.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57335,CPT,VAGINOPLASTY INTERSEX STATE,,,21,,RBRVS,20.02 ,10.01 ,10.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57400,CPT,DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL,,,21,,RBRVS,2.27 ,1.23 ,1.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57410,CPT,PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL,,,21,,RBRVS,1.75 ,1.08 ,1.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57415,CPT,REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL,,,21,,RBRVS,2.49 ,1.76 ,1.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57420,CPT,COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT,,,21,,RBRVS,1.60 ,0.77 ,1.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57421,CPT,COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX,,,21,,RBRVS,2.20 ,1.02 ,1.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57423,CPT,PARAVAGINAL DEFECT REPAIR LAPAROSCOPIC APPROACH,,,21,,RBRVS,16.08 ,7.85 ,7.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57425,CPT,LAPAROSCOPY COLPOPEXY SUSPENSION VAGINAL APEX,,,21,,RBRVS,17.03 ,8.44 ,8.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57426,CPT,REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC,,,21,,RBRVS,14.30 ,7.92 ,7.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57452,CPT,COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA,,,21,,RBRVS,1.50 ,0.93 ,1.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57454,CPT,COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE,,,21,,RBRVS,2.33 ,1.25 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57455,CPT,COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX,,,21,,RBRVS,1.99 ,0.91 ,1.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57456,CPT,COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE,,,21,,RBRVS,1.85 ,0.85 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57460,CPT,COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX,,,21,,RBRVS,2.83 ,1.45 ,4.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57461,CPT,COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX,,,21,,RBRVS,3.43 ,1.48 ,5.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57500,CPT,BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX,,,21,,RBRVS,1.20 ,0.81 ,2.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57505,CPT,ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE,,,21,,RBRVS,1.19 ,1.27 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57510,CPT,CAUTERY CERVIX ELECTRO/THERMAL,,,21,,RBRVS,1.90 ,1.15 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57511,CPT,CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT,,,21,,RBRVS,1.95 ,1.56 ,1.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57513,CPT,CAUTERY CERVIX LASER ABLATION,,,21,,RBRVS,1.95 ,1.58 ,1.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57520,CPT,CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER,,,21,,RBRVS,4.11 ,3.13 ,4.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57522,CPT,CONIZATION CERVIX W/WO D&C RPR ELTRD EXC,,,21,,RBRVS,3.67 ,2.77 ,3.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57530,CPT,TRACHELECTOMY CERVICECTOMY AMP CERVIX SPX,,,21,,RBRVS,5.27 ,3.86 ,3.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57531,CPT,RAD TRACHELECTOMY W/BI PEL LMPHADEC,,,21,,RBRVS,29.95 ,15.80 ,15.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 57540,CPT,EXCISION CERVICAL STUMP ABDOMINAL APPROACH,,,21,,RBRVS,13.29 ,7.17 ,7.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 57545,CPT,EXC CERVICAL STUMP ABDL APPR W/PELVIC FLOOR RPR,,,21,,RBRVS,14.10 ,7.68 ,7.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 57550,CPT,EXCISION CERVICAL STUMP VAGINAL APPROACH,,,21,,RBRVS,6.34 ,4.45 ,4.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57555,CPT,EXC CRV STUMP VAG APPR W/ANT &/POST REPAIR,,,21,,RBRVS,9.94 ,5.87 ,5.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57556,CPT,EXC CRV STUMP VAG APPR W/RPR NTRCL,,,21,,RBRVS,9.36 ,5.60 ,5.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57558,CPT,DILATION & CURETTAGE CERVICAL STUMP,,,21,,RBRVS,1.72 ,1.29 ,1.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57700,CPT,CERCLAGE UTERINE CERVIX NONOBSTETRICAL,,,21,,RBRVS,4.35 ,4.01 ,4.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57720,CPT,TRACHELORRHAPHY PLSTC RPR UTERINE CERVIX VAG,,,21,,RBRVS,4.61 ,3.54 ,3.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 57800,CPT,DILATION CERVICAL CANAL INSTRUMENTAL SPX,,,21,,RBRVS,0.77 ,0.51 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58100,CPT,ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX,,,21,,RBRVS,1.53 ,0.77 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58110,CPT,ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY,,,21,,RBRVS,0.77 ,0.30 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58120,CPT,DILATION & CURETTAGE DX&/THER NONOBSTETRIC,,,21,,RBRVS,3.59 ,2.15 ,3.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58140,CPT,MYOMECTOMY 1-4 MYOMAS W/250 GM/< ABDOMINAL APPR,,,21,,RBRVS,15.79 ,8.19 ,8.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58145,CPT,MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR,,,21,,RBRVS,8.91 ,5.45 ,5.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58146,CPT,MYOMECTOMY 5/> MYOMAS &/>250 GM ABDOMINA,,,21,,RBRVS,20.34 ,9.84 ,9.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58150,CPT,TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY,,,21,,RBRVS,17.31 ,8.91 ,8.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58152,CPT,TOT ABD HYST W/WO RMVL TUBE OVARY W/COLPURETHRXY,,,21,,RBRVS,21.86 ,10.74 ,10.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58180,CPT,SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY,,,21,,RBRVS,16.60 ,8.50 ,8.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58200,CPT,TOT ABD HYST W/PARAORTIC & PELVIC LYMPH NODE SAM,,,21,,RBRVS,23.10 ,11.68 ,11.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58210,CPT,RAD ABDL HYSTERECTOMY W/BI PELVIC LMPHADENECTOMY,,,21,,RBRVS,30.91 ,15.68 ,15.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58240,CPT,PEL EXNTJ GYNECOLOGIC MAL,,,21,,RBRVS,49.33 ,24.52 ,24.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58260,CPT,VAGINAL HYSTERECTOMY UTERUS 250 GM/<,,,21,,RBRVS,14.15 ,7.54 ,7.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58262,CPT,VAG HYST 250 GM/< W/RMVL TUBE&/OVARY,,,21,,RBRVS,15.94 ,8.23 ,8.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58263,CPT,VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL,,,21,,RBRVS,17.23 ,8.71 ,8.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58267,CPT,VAG HYST 250 GM/< W/COLPO-URTCSTOPEXY,,,21,,RBRVS,18.36 ,9.24 ,9.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58270,CPT,VAGINAL HYSTERECTOMY 250 GM/< W/RPR ENTEROCELE,,,21,,RBRVS,15.30 ,7.80 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58275,CPT,VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY,,,21,,RBRVS,17.03 ,8.73 ,8.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58280,CPT,VAG HYSTER W/TOT/PRTL VAGINECT W/RPR ENTEROCELE,,,21,,RBRVS,18.33 ,9.21 ,9.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58285,CPT,VAGINAL HYSTERECTOMY RADICAL SCHAUTA OPERATION,,,21,,RBRVS,23.38 ,11.01 ,11.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58290,CPT,VAGINAL HYSTERECTOMY UTERUS > 250 GM,,,21,,RBRVS,20.27 ,9.82 ,9.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58291,CPT,VAG HYST > 250 GM RMVL TUBE&/OVARY,,,21,,RBRVS,22.06 ,10.51 ,10.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58292,CPT,VAG HYST > 250 GM RMVL TUBE&/OVARY W/RPR ENTRCLE,,,21,,RBRVS,23.35 ,11.02 ,11.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58293,CPT,VAG HYST >250 GM COLPOURTCSTOPEXY W/WO NDSC CTR,,,21,,RBRVS,24.33 ,11.40 ,11.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58294,CPT,VAGINAL HYSTERECTOMY >250 GM RPR ENTEROCELE,,,21,,RBRVS,21.55 ,10.37 ,10.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58300,CPT,INSERTION INTRAUTERINE DEVICE IUD,,,21,,RBRVS,1.01 ,0.39 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58301,CPT,REMOVAL INTRAUTERINE DEVICE IUD,,,21,,RBRVS,1.27 ,0.50 ,1.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58321,CPT,ARTIFICIAL INSEMINATION INTRA-CERVICAL,,,21,,RBRVS,0.92 ,0.36 ,1.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58322,CPT,ARTIFICIAL INSEMINATION INTRA-UTERINE,,,21,,RBRVS,1.10 ,0.43 ,1.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58323,CPT,SPERM WASHING ARTIFICIAL INSEMINATION,,,21,,RBRVS,0.23 ,0.09 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58340,CPT,CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI,,,21,,RBRVS,0.88 ,0.68 ,2.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58345,CPT,TRANSCERV FALLOPIAN TUBE CATH W/WO HYSTOSALPING,,,21,,RBRVS,4.70 ,2.48 ,2.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58346,CPT,INSERTION HEYMAN CAPSULES CLINICAL BRACHYTHERAPY,,,21,,RBRVS,7.56 ,4.62 ,4.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58350,CPT,CHROMOTUBATION OVIDUCT W/MATERIALS,,,21,,RBRVS,1.06 ,1.04 ,1.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58353,CPT,ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID,,,21,,RBRVS,3.60 ,2.17 ,24.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58356,CPT,ENDOMETRIAL CRYOABLATION W/US & ENDOMETRIAL CR,,,21,,RBRVS,6.41 ,2.61 ,45.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58400,CPT,UTERINE SUSPENSION W/WO SHORTENING LIGAMENTS SPX,,,21,,RBRVS,7.14 ,4.48 ,4.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58410,CPT,UTERINE SUSP W/WO SHORT LIGAMNTS W/SYMPATHECTOMY,,,21,,RBRVS,13.80 ,7.39 ,7.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58520,CPT,HYSTERORRHAPHY REPAIR RUPT UTERUS NONOBSTETRICAL,,,21,,RBRVS,13.48 ,7.61 ,7.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58540,CPT,HYSTEROPLASTY RPR UTERINE ANOMALY,,,21,,RBRVS,15.71 ,8.11 ,8.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58541,CPT,LAPAROSCOPY SUPRACERVICAL HYSTERECTOMY 250 GM/<,,,21,,RBRVS,12.29 ,6.56 ,6.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58542,CPT,LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR,,,21,,RBRVS,14.16 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58543,CPT,LAPS SUPRACERVICAL HYSTERECTOMY >250,,,21,,RBRVS,14.39 ,7.38 ,7.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58544,CPT,LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY,,,21,,RBRVS,15.60 ,7.96 ,7.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58545,CPT,LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/<,,,21,,RBRVS,15.55 ,7.90 ,7.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58546,CPT,LAPS MYOMECTOMY EXC 5/> MYOMAS >250 GRAMS,,,21,,RBRVS,19.94 ,9.49 ,9.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58548,CPT,LAPS W/RAD HYST W/BILAT LMPHADEC RMVL TUBE/OVARY,,,21,,RBRVS,31.63 ,16.32 ,16.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58550,CPT,LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/<,,,21,,RBRVS,15.10 ,8.05 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58552,CPT,LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES,,,21,,RBRVS,16.91 ,8.80 ,8.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58553,CPT,LAPS W/VAGINAL HYSTERECTOMY > 250 GRAMS,,,21,,RBRVS,20.06 ,9.60 ,9.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58554,CPT,LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR,,,21,,RBRVS,23.11 ,11.34 ,11.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58555,CPT,HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE,,,21,,RBRVS,3.33 ,1.64 ,5.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58558,CPT,HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C,,,21,,RBRVS,4.17 ,2.03 ,33.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58559,CPT,HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS,,,21,,RBRVS,6.16 ,2.77 ,2.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58560,CPT,HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM,,,21,,RBRVS,6.99 ,3.11 ,3.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58561,CPT,HYSTEROSCOPY REMOVAL LEIOMYOMATA,,,21,,RBRVS,9.99 ,4.29 ,4.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58562,CPT,HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY,,,21,,RBRVS,5.20 ,2.38 ,6.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58563,CPT,HYSTEROSCOPY ENDOMETRIAL ABLATION,,,21,,RBRVS,6.16 ,2.78 ,40.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58565,CPT,HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS,,,21,,RBRVS,7.12 ,4.29 ,44.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58570,CPT,LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/<,,,21,,RBRVS,13.36 ,7.04 ,7.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58571,CPT,LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY,,,21,,RBRVS,15.00 ,8.00 ,8.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58572,CPT,LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM,,,21,,RBRVS,17.71 ,8.83 ,8.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58573,CPT,LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR,,,21,,RBRVS,20.79 ,10.35 ,10.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58578,CPT,UNLISTED LAPAROSCOPY PROCEDURE UTERUS,,,21,,TotalUnits,,,,25.71 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58579,CPT,UNLISTED HYSTEROSCOPY PROCEDURE UTERUS,,,21,,TotalUnits,,,,10.52 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58600,CPT,LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI,,,21,,RBRVS,5.91 ,3.70 ,3.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58605,CPT,LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX,,,21,,RBRVS,5.28 ,3.44 ,3.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58611,CPT,LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG,,,21,,RBRVS,1.45 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58615,CPT,OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR,,,21,,RBRVS,3.94 ,2.48 ,2.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58660,CPT,LAPAROSCOPY W/LYSIS OF ADHESIONS,,,21,,RBRVS,11.59 ,5.95 ,5.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58661,CPT,LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES,,,21,,RBRVS,11.35 ,5.49 ,5.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58662,CPT,LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE,,,21,,RBRVS,12.15 ,6.33 ,6.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58670,CPT,LAPAROSCOPY FULGURATION OVIDUCTS,,,21,,RBRVS,5.91 ,3.71 ,3.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58671,CPT,LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS,,,21,,RBRVS,5.91 ,3.70 ,3.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58672,CPT,LAPAROSCOPY FIMBRIOPLASTY,,,21,,RBRVS,12.91 ,6.34 ,6.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58673,CPT,LAPAROSCOPY SALPINGOSTOMY,,,21,,RBRVS,14.04 ,6.86 ,6.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58674,CPT,LAPS ABLTJ UTERINE FIBROIDS,,,21,,RBRVS,14.08 ,7.51 ,7.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58679,CPT,UNLISTED LAPAROSCOPY PROCEDURE OVIDUCT/OVARY,,,21,,TotalUnits,,,,16.84 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58700,CPT,SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX,,,21,,RBRVS,12.95 ,7.19 ,7.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58720,CPT,SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX,,,21,,RBRVS,12.16 ,6.80 ,6.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58740,CPT,LYSIS OF ADHESIONS SALPINX/OVARY,,,21,,RBRVS,14.90 ,7.97 ,7.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58750,CPT,TUBOTUBAL ANASTATOMOSIS,,,21,,RBRVS,15.64 ,8.33 ,8.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58752,CPT,TUBOUTERINE IMPLANTATION,,,21,,RBRVS,15.64 ,8.17 ,8.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58760,CPT,FIMBRIOPLASTY,,,21,,RBRVS,13.93 ,7.37 ,7.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58770,CPT,SALPINGOSTOMY,,,21,,RBRVS,14.77 ,7.96 ,7.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58800,CPT,DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR,,,21,,RBRVS,4.62 ,3.27 ,3.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58805,CPT,DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL,,,21,,RBRVS,6.42 ,4.25 ,4.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58820,CPT,DRAINAGE OVARIAN ABSCESS VAGINAL APPR OPEN,,,21,,RBRVS,4.70 ,3.57 ,3.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58822,CPT,DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH,,,21,,RBRVS,11.81 ,6.97 ,6.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58825,CPT,TRANSPOSITION OVARY,,,21,,RBRVS,11.78 ,6.51 ,6.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58900,CPT,BIOPSY OVARY UNI/BI SEPARATE PROCEDURE,,,21,,RBRVS,6.59 ,4.95 ,4.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58920,CPT,WEDGE RESCJ/BISCTJ OVARY UNI/BI,,,21,,RBRVS,11.95 ,7.03 ,7.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58925,CPT,OVARIAN CYSTECTOMY UNI/BI,,,21,,RBRVS,12.43 ,6.90 ,6.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58940,CPT,OOPHORECTOMY PARTIAL/TOTAL UNI/BI,,,21,,RBRVS,8.22 ,5.33 ,5.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58943,CPT,OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY,,,21,,RBRVS,19.52 ,10.24 ,10.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58950,CPT,RESCJ OVARIAN/TUBAL/PERITONEAL MALIGNANCY W/BSO,,,21,,RBRVS,18.37 ,10.22 ,10.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58951,CPT,RESCJ PRIM PRTL MAL W/BSO & OMNTC TAH & LMPHAD,,,21,,RBRVS,24.26 ,12.46 ,12.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58952,CPT,RESCJ PRIM PRTL MAL W/BSO & OMNTC RAD DEBULKING,,,21,,RBRVS,27.29 ,14.18 ,14.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58953,CPT,BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION,,,21,,RBRVS,34.13 ,17.14 ,17.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58954,CPT,BSO W/OMENTECTOMY TAH DEBULKING W/LMPHADECTOMY,,,21,,RBRVS,37.13 ,18.51 ,18.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58956,CPT,BSO W/TOT OMENTECTOMY & HYSTERECTOMY MALIGNANC,,,21,,RBRVS,22.80 ,12.22 ,12.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58957,CPT,RESECJ RECUR OVARIAN/TUBAL/PERITONEAL MALIGNANCY,,,21,,RBRVS,26.22 ,13.80 ,13.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58958,CPT,RESECTION RECRT MAL W/OMENTECTOMY PEL LMPHADEC,,,21,,RBRVS,29.22 ,14.91 ,14.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58960,CPT,LAPT STG/RESTG OVARIAN TUBAL/PRIM MAL 2ND LOOK,,,21,,RBRVS,15.79 ,8.81 ,8.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 58970,CPT,FOLLICLE PUNCTURE OOCYTE RETRIEVAL ANY METHOD,,,21,,RBRVS,3.52 ,1.74 ,2.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58974,CPT,EMBRYO TRANSFER INTRAUTERINE,,,21,,TotalUnits,,,,3.90 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58976,CPT,GAMETE ZYGOTE/EMBRYO FALLOPIAN TRANSFER ANY METH,,,21,,RBRVS,3.82 ,1.88 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 58999,CPT,UNLISTED PX FEMALE GENITAL SYSTEM NONOBSTETRICAL,,,21,,TotalUnits,,,,3.37 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59000,CPT,AMNIOCENTESIS DIAGNOSIC,,,12,,RBRVS,1.30 ,0.71 ,1.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59001,CPT,AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID,,,12,,RBRVS,3.00 ,1.43 ,1.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59012,CPT,CORDOCENTESIS INTRAUTERINE,,,12,,RBRVS,3.44 ,1.55 ,1.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59015,CPT,CHORIONIC VILLUS SAMPLING,,,12,,RBRVS,2.20 ,1.06 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59020,CPT,FETAL CONTRACTION STRESS TEST,,,12,,RBRVS,0.66 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 59020,CPT,FETAL CONTRACTION STRESS TEST,26,,12,,RBRVS,0.66 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59020,CPT,FETAL CONTRACTION STRESS TEST,TC,,12,,RBRVS,,0.95 ,0.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 59025,CPT,FETAL NONSTRESS TEST,,,12,,RBRVS,0.53 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 59025,CPT,FETAL NONSTRESS TEST,26,,12,,RBRVS,0.53 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59025,CPT,FETAL NONSTRESS TEST,TC,,12,,RBRVS,,0.51 ,0.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 59030,CPT,FETAL SCALP BLOOD SAMPLING,,,12,,RBRVS,1.99 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59050,CPT,FETAL MONITORING LABOR PHYS WRITTEN REPORT,,,12,,RBRVS,0.89 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59051,CPT,FETAL MONITR LABOR PHYS WRTTN REPRT INTERPJ ONLY,,,12,,RBRVS,0.74 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59070,CPT,TRANSABDOMINAL AMNIOINFUSION W/ULTRSND GUIDANCE,,,12,,RBRVS,5.24 ,2.42 ,5.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59072,CPT,FETAL UMBILICAL CORD OCCLUSION W/ULTRSND GUIDNCE,,,12,,RBRVS,8.99 ,3.86 ,3.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59074,CPT,FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE,,,12,,RBRVS,5.24 ,2.42 ,4.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59076,CPT,FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE,,,12,,RBRVS,8.99 ,3.86 ,3.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59100,CPT,HYSTEROTOMY ABDOMINAL,,,12,,RBRVS,13.37 ,7.17 ,7.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59120,CPT,TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPR,,,12,,RBRVS,12.67 ,7.00 ,7.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59121,CPT,TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY,,,12,,RBRVS,12.74 ,6.94 ,6.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59130,CPT,TX ECTOPIC PREGNANCY ABDL PREGNANCY,,,12,,RBRVS,15.08 ,7.86 ,7.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59135,CPT,TX ECTOPIC PREGNANCY NTRSTL REQ TOT HYST,,,12,,RBRVS,14.92 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59136,CPT,TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER,,,12,,RBRVS,14.25 ,7.55 ,7.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59140,CPT,TX ECTOPIC PREGNANCY CERVICAL W/EVACUATION,,,12,,RBRVS,5.94 ,4.56 ,4.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59150,CPT,LAPS TX ECTOPIC PREG W/O SALPING&/OOPHORECTOMY,,,12,,RBRVS,12.29 ,6.77 ,6.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59151,CPT,LAPS TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY,,,12,,RBRVS,12.11 ,6.40 ,6.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59160,CPT,CURETTAGE POSTPARTUM,,,12,,RBRVS,2.76 ,1.53 ,2.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59200,CPT,INSERTION CERVICAL DILATOR SEPARATE PROCEDURE,,,12,,RBRVS,0.79 ,0.31 ,1.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59300,CPT,EPISIOTOMY/VAG RPR OTH/THN ATTENDING,,,12,,RBRVS,2.41 ,1.27 ,2.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59320,CPT,CERCLAGE CERVIX PREGNANCY VAGINAL,,,12,,RBRVS,2.48 ,1.30 ,1.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59325,CPT,CERCLAGE CERVIX PREGNANCY ABDOMINAL,,,12,,RBRVS,4.06 ,1.92 ,1.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59350,CPT,HYSTERORRHAPHY RUPTURED UTERUS,,,12,,RBRVS,4.94 ,1.84 ,1.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59400,CPT,OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM,,,13,,RBRVS,32.16 ,20.23 ,20.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59409,CPT,VAGINAL DELIVERY ONLY,,,13,,RBRVS,14.37 ,5.74 ,5.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59410,CPT,VAGINAL DELIVERY ONLY W/POSTPARTUM CARE,,,13,,RBRVS,18.01 ,7.68 ,7.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59412,CPT,EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS,,,13,,RBRVS,1.71 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59414,CPT,DELIVERY PLACENTA SEPARATE PROCEDURE,,,13,,RBRVS,1.61 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59425,CPT,ANTEPARTUM CARE ONLY 4-6 VISITS,,,13,,RBRVS,6.31 ,2.49 ,5.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59426,CPT,ANTEPARTUM CARE ONLY 7/> VISITS,,,13,,RBRVS,11.16 ,4.42 ,9.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59430,CPT,POSTPARTUM CARE ONLY SEPARATE PROCEDURE,,,13,,RBRVS,2.47 ,0.98 ,2.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59510,CPT,OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM,,,11,,RBRVS,35.64 ,22.02 ,22.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59514,CPT,CESAREAN DELIVERY ONLY,,,11,,RBRVS,16.13 ,6.40 ,6.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59515,CPT,CESAREAN DELIVERY ONLY W/POSTPARTUM CARE,,,11,,RBRVS,21.47 ,9.58 ,9.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59525,CPT,STOT/TOT HYSTERECTOMY AFTER CESAREAN DELIVERY,,,21,,RBRVS,8.53 ,3.35 ,3.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59610,CPT,ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB,,,13,,RBRVS,33.87 ,20.71 ,20.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59612,CPT,VAGINAL DELIVERY AFTER CESAREAN DELIVERY,,,13,,RBRVS,16.09 ,6.32 ,6.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59614,CPT,VAGINAL DELIVERY & POSTPARTUM CARE VBAC,,,13,,RBRVS,19.73 ,8.21 ,8.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59618,CPT,ROUTINE OBSTETRICAL CARE ATTEMPTED VBAC,,,11,,RBRVS,36.16 ,22.18 ,22.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59620,CPT,CESAREAN DELIVERY ATTEMPTED VBAC,,,11,,RBRVS,16.66 ,6.54 ,6.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59622,CPT,CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBA,,,11,,RBRVS,22.00 ,9.82 ,9.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59812,CPT,TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL,,,12,,RBRVS,4.44 ,2.95 ,3.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59820,CPT,TX MISSED ABORTION FIRST TRIMESTER SURGICAL,,,12,,RBRVS,4.84 ,4.17 ,4.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59821,CPT,TX MISSED ABORTION SECOND TRIMESTER SURGICAL,,,12,,RBRVS,5.09 ,3.90 ,4.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59830,CPT,TX SEPTIC ABORTION SURGICAL,,,12,,RBRVS,6.59 ,4.30 ,4.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59840,CPT,INDUCED ABORTION DILATION AND CURETTAGE,,,12,,RBRVS,3.01 ,2.21 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59841,CPT,INDUCED ABORTION DILATION & EVACUATION,,,12,,RBRVS,5.65 ,3.31 ,3.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59850,CPT,INDUCED ABORTION 1/> AMNIOTIC INJX W/D&C/EVACJ,,,12,,RBRVS,5.90 ,3.68 ,3.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59851,CPT,INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS D&C,,,12,,RBRVS,5.92 ,4.27 ,4.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59852,CPT,INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS HYSTOTM,,,12,,RBRVS,8.23 ,5.65 ,5.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59855,CPT,INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS,,,12,,RBRVS,6.43 ,3.89 ,3.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59856,CPT,INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C &/EVAC,,,12,,RBRVS,7.79 ,4.29 ,4.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59857,CPT,INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT,,,12,,RBRVS,9.33 ,4.87 ,4.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 59866,CPT,MULTIFETAL PREGNANCY REDUCTION,,,12,,RBRVS,3.99 ,1.95 ,1.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59870,CPT,UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE,,,12,,RBRVS,6.57 ,5.33 ,5.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59871,CPT,REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA,,,12,,RBRVS,2.13 ,1.19 ,1.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59897,CPT,UNLISTED FETAL INVASIVE PX W/ULTRASOUND,,,12,,TotalUnits,,,,1.25 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59898,CPT,UNLISTED LAPAROSCOPY PX MATERNITY CARE&DELIVERY,,,12,,TotalUnits,,,,18.51 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 59899,CPT,UNLISTED PROCEDURE MATERNITY CARE & DELIVERY,,,12,,TotalUnits,,,,1.25 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60000,CPT,I&D THYROGLOSSAL DUCT CYST INFECTED,,,21,,RBRVS,1.81 ,2.34 ,2.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60100,CPT,BIOPSY THYROID PERCUTANEOUS CORE NEEDLE,,,21,,RBRVS,1.56 ,0.57 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60200,CPT,EXC CYST/ADENOMA THYROID/TRANSECTION ISTHMUS,,,21,,RBRVS,10.02 ,7.19 ,7.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60210,CPT,PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY,,,21,,RBRVS,11.23 ,7.01 ,7.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60212,CPT,PRTL THYROID LOBEC UNI W/CONTRATLAT STOT LOBEC,,,21,,RBRVS,16.43 ,9.46 ,9.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60220,CPT,TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY,,,21,,RBRVS,11.19 ,7.18 ,7.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60225,CPT,TOTAL THYROID LOBEC UNI W/CONTRALAT STOT LOBEC,,,21,,RBRVS,14.79 ,9.28 ,9.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60240,CPT,THYROIDECTOMY TOTAL/COMPLETE,,,21,,RBRVS,15.04 ,8.60 ,8.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60252,CPT,THYROIDECTOMY TOTAL/SUBTOTAL LMTD NECK DISSECT,,,21,,RBRVS,22.01 ,11.92 ,11.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60254,CPT,THYROIDECTOMY TOTAL/SUBTOTAL RAD NECK DISSECT,,,21,,RBRVS,28.42 ,14.87 ,14.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 60260,CPT,THYROIDECTOMY RMVL REMAINING TISS FLWG PRTL RMVL,,,21,,RBRVS,18.26 ,9.97 ,9.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60270,CPT,THYROIDECT W/SUBSTERNAL SPLIT/TRANSTHORACIC,,,21,,RBRVS,23.20 ,11.76 ,11.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 60271,CPT,THYROIDECTOMY SUBSTERNAL CERVICAL APPROACH,,,21,,RBRVS,17.62 ,9.66 ,9.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60280,CPT,EXCISION THYROGLOSSAL DUCT CYST/SINUS,,,21,,RBRVS,6.16 ,5.69 ,5.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60281,CPT,EXCISION THYROGLOSSAL DUCT CYST/SINUS RECURRENT,,,21,,RBRVS,8.82 ,6.87 ,6.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60300,CPT,ASPIRATION AND/OR INJECTION THYROID CYST,,,21,,RBRVS,0.97 ,0.36 ,2.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60500,CPT,PARATHYROIDECTOMY/EXPLORATION PARATHYROIDS,,,21,,RBRVS,15.60 ,9.08 ,9.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60502,CPT,PARATHYROIDECTOMY/EXPLOR PARATHYROIDS RE-EXPLOR,,,21,,RBRVS,21.15 ,11.62 ,11.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60505,CPT,PARATHYRDEC/EXPL PARATHYR MEDSTNL STERNAL/TTHRC,,,21,,RBRVS,23.06 ,12.51 ,12.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 60512,CPT,PARATHYROID AUTOTRANSPLANTATION ADD-ON,,,21,,RBRVS,4.44 ,1.71 ,1.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60520,CPT,THYMECTOMY PRTL/TOT TRANSCERVICAL APPR SPX,,,21,,RBRVS,17.16 ,9.13 ,9.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60521,CPT,THYMECTOMY PRTL/TOT W/O RAD MEDSTNL DSJ SPX,,,21,,RBRVS,19.18 ,9.02 ,9.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 60522,CPT,THYMECTOMY PRTL/TOT RAD MEDSTNL DSJ SPX,,,21,,RBRVS,23.48 ,10.58 ,10.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 60540,CPT,ADRENALECTOMY W/EXPL W/WO BX ABDL/LMBR/DRSAL SPX,,,21,,RBRVS,18.02 ,9.18 ,9.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 60545,CPT,ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR,,,21,,RBRVS,20.93 ,10.21 ,10.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 60600,CPT,EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY,,,21,,RBRVS,25.09 ,10.21 ,10.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 60605,CPT,EXC CAROTID BODY TUMOR W EXC CAROTID ARTERY,,,21,,RBRVS,31.96 ,11.35 ,11.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 60650,CPT,LAPAROSCOPY ADRENALECTOMY PRTL/COMPL TABDL,,,21,,RBRVS,20.73 ,9.63 ,9.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 60659,CPT,UNLISTED LAPAROSCOPY PROCEDURE ENDOCRINE SYSTEM,,,21,,TotalUnits,,,,30.36 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 60699,CPT,UNLISTED PROCEDURE ENDOCRINE SYSTEM,,,21,,TotalUnits,,,,18.37 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61000,CPT,SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT,,,21,,RBRVS,1.58 ,1.13 ,1.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61001,CPT,SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI SBSQ,,,21,,RBRVS,1.49 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61020,CPT,VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX,,,21,,RBRVS,1.51 ,1.00 ,1.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61026,CPT,VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/INJ,,,21,,RBRVS,1.69 ,1.03 ,1.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61050,CPT,CISTERNAL/LATERAL C1-C2 PUNCTURE W/O INJ SPX,,,21,,RBRVS,1.51 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61055,CPT,CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION,,,21,,RBRVS,2.10 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61070,CPT,PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX,,,21,,RBRVS,0.89 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61105,CPT,TWIST DRILL HOLE SUBDURAL/VENTRICULAR PUNCTURE,,,21,,RBRVS,5.45 ,5.73 ,5.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61107,CPT,TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE,,,21,,RBRVS,4.99 ,2.33 ,2.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61108,CPT,TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA,,,21,,RBRVS,11.64 ,10.34 ,10.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61120,CPT,BURR HOLE VENTRICULAR PUNCTURE,,,21,,RBRVS,9.60 ,8.32 ,8.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61140,CPT,BURR HOLE/TREPHINE W/BX BRAIN/INTRACRNIAL LESION,,,21,,RBRVS,17.23 ,12.98 ,12.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61150,CPT,BURR HOLE/TREPHINE W/DRG BRAIN ABSCESS/CYST,,,21,,RBRVS,18.90 ,12.94 ,12.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61151,CPT,BURR HOLE/TREPHINE W/SBSQ TAPPING ICRA ABSC/CST,,,21,,RBRVS,13.49 ,10.22 ,10.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61154,CPT,BURR HOLE W/EVAC&/DRG HEMATOMA XDRL/SDRL,,,21,,RBRVS,17.07 ,13.37 ,13.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61156,CPT,BURR HOLE W/ASPIR HEMATOMA/CYST INTRACEREBRAL,,,21,,RBRVS,17.45 ,12.08 ,12.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61210,CPT,BURR HOLE IMPLANT VENTRICULAR CATH/OTHER DEVICE,,,21,,RBRVS,5.83 ,2.71 ,2.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61215,CPT,INSJ SUBQ RSVR PUMP/INFUSION SYSTEM VENTRIC CATH,,,21,,RBRVS,5.85 ,6.58 ,6.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61250,CPT,BURR HOLE/TREPHINE SUPRATENTORIAL W/O OTH SURG,,,21,,RBRVS,11.49 ,8.73 ,8.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61253,CPT,BURR HOLE/TREPHINE INFRATENTORIAL UNI/BI,,,21,,RBRVS,13.49 ,8.24 ,8.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61304,CPT,CRANIECTOMY/CRANIOTOMY EXPL SUPRATENTORIAL,,,21,,RBRVS,23.41 ,15.63 ,15.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61305,CPT,CRANIECTOMY/CRANIOTOMY EXPL INFRATENTORIAL,,,21,,RBRVS,28.64 ,18.68 ,18.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61312,CPT,CRANIECTOMY HMTMA SUPRATENTORIAL EXTRA/SUBDURAL,,,21,,RBRVS,30.17 ,18.91 ,18.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61313,CPT,CRANIECTOMY HMTMA SUPRATENTORIAL INTRACEREBRAL,,,21,,RBRVS,28.09 ,18.98 ,18.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61314,CPT,CRANIECTOMY HMTMA INFRATENTORIAL EXTRA/SUBDURAL,,,21,,RBRVS,25.90 ,17.44 ,17.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61315,CPT,CRANIECTOMY HMTMA SUPRATENTORIAL INTRACEREBRAL,,,21,,RBRVS,29.65 ,19.22 ,19.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61316,CPT,INCISION & SUBCUTANEOUS PLMT CRANIAL BONE GRAF,,,21,,RBRVS,1.39 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61320,CPT,CRANIECTOMY/CRANIOTMY DRG ABSCESS SUPRATENTORIAL,,,21,,RBRVS,27.42 ,17.61 ,17.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61321,CPT,CRANIECTOMY/CRANIOTMY DRG ABSCESS INFRATENTORIAL,,,21,,RBRVS,30.53 ,19.22 ,19.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61322,CPT,CRANIECT/CRANIOT W/WO DURAPLASTY W/O LOBECTOMY,,,21,,RBRVS,34.26 ,21.84 ,21.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61323,CPT,CRANIECT/CRANIOT W/WO DURAPLASTY W/LOBECTOMY,,,21,,RBRVS,35.06 ,21.26 ,21.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61330,CPT,DECOMPRESSION ORBIT ONLY TRANSCRANIAL APPROACH,,,21,,RBRVS,25.30 ,18.66 ,18.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61332,CPT,EXPLORATION ORBIT TRANSCRANIAL APPROACH W/BIOPSY,,,21,,RBRVS,28.60 ,20.70 ,20.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61333,CPT,EXPL ORBIT TRANSCRANIAL APPROACH W/RMVL LESION,,,21,,RBRVS,29.27 ,20.85 ,20.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61340,CPT,SUBTEMPORAL CRANIAL DECOMPRESSION,,,21,,RBRVS,20.11 ,14.21 ,14.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61343,CPT,CRNEC SUBOCCIPITAL CRV LAM DCMPRN MEDULLA & CORD,,,21,,RBRVS,31.86 ,20.05 ,20.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61345,CPT,OTHER CRANIAL DECOMPRESSION POSTERIOR FOSSA,,,21,,RBRVS,29.23 ,18.85 ,18.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61450,CPT,CRNEC STPL SCTJ COMPRESSION/DCMPRN GANGLION,,,21,,RBRVS,27.69 ,17.63 ,17.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61458,CPT,CRNEC SOPL EXPL/DCMPRN CRNL NRV,,,21,,RBRVS,28.84 ,18.60 ,18.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61460,CPT,CRANIECTOMY SUBOCCIPITAL SECTION 1/> CRANIAL NR,,,21,,RBRVS,30.24 ,19.38 ,19.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61480,CPT,CRNEC SUBOCPTL MESENCEPHAL TRCOTOMY/PEDUNCULOTMY,,,21,,RBRVS,28.05 ,14.87 ,14.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61500,CPT,CRANIECTOMY W/EXCISION TUMOR/LESION SKULL,,,21,,RBRVS,19.18 ,13.31 ,13.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61501,CPT,CRANIECTOMY OSTEOMYELITIS,,,21,,RBRVS,16.35 ,12.23 ,12.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61510,CPT,CRANIEC TREPHINE BONE FLP BRAIN TUMOR SUPRTENTOR,,,21,,RBRVS,30.83 ,21.02 ,21.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61512,CPT,CRNEC TREPHINE BONE FLAP MENINGIOMA SUPRATENTOR,,,21,,RBRVS,37.14 ,22.97 ,22.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61514,CPT,CRNEC TREPHINE BONE FLAP BRAIN ABSC SUPRATENTOR,,,21,,RBRVS,27.23 ,17.85 ,17.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61516,CPT,CRNEC TREPHINE BONE FLAP FENEST CYST SUPRATENTOR,,,21,,RBRVS,26.58 ,17.47 ,17.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61517,CPT,IMPLTJ BRAIN INTRACAVITARY CHEMOTHERAPY AGENT,,,21,,RBRVS,1.38 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61518,CPT,CRNEC EXC BRAIN TUMOR INFRATENTORIAL/POST FOSSA,,,21,,RBRVS,39.89 ,25.22 ,25.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61519,CPT,CRNEC EXC TUM INFRATENTOR/POST FOSSA MENINGIOMA,,,21,,RBRVS,43.43 ,25.70 ,25.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61520,CPT,CRNEC TUM INFRATTL/POSTFOSSA CRBLOPNT ANGLE TUM,,,21,,RBRVS,57.09 ,32.52 ,32.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61521,CPT,CRNEC TUM INFRATTL/PFOSSA MIDLINE TUM BASE SKULL,,,21,,RBRVS,46.99 ,27.05 ,27.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61522,CPT,CRNEC INFRATNTORIAL/POST FOSSA EXC BRAIN ABSCESS,,,21,,RBRVS,31.54 ,19.72 ,19.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61524,CPT,CRNEC INFRATNTOR/POSTFOSSA EXC/FENESTRATION CYST,,,21,,RBRVS,29.89 ,18.91 ,18.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61526,CPT,CRNEC TRANSTEMPOR EXC CEREBELLOPONTINE ANGLE TUM,,,21,,RBRVS,54.08 ,31.43 ,31.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61530,CPT,CRNEC EXC CEREBELLOPNTIN ANGLE TUM MID/POSTFOSSA,,,21,,RBRVS,45.56 ,26.53 ,26.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61531,CPT,SUBDURAL IMPLTJ ELECTRODES SEIZURE MONITORING,,,21,,RBRVS,16.41 ,12.64 ,12.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61533,CPT,CRANIOT SUBDURAL IMPLT ELCTRD SEIZURE MONITORING,,,21,,RBRVS,21.46 ,14.54 ,14.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61534,CPT,CRANIOT EPILEPTOGENIC FOC W/O ELECTRCORTICOGRPHY,,,21,,RBRVS,23.01 ,16.00 ,16.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61535,CPT,CRANIOT RMVL EPID/SUBDURL ELCTRD W/O EXC TIS SPX,,,21,,RBRVS,13.15 ,10.77 ,10.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61536,CPT,CRANIOT EPILEPTOGENIC FOCUS W/ELECTROCORTCOGRPHY,,,21,,RBRVS,37.72 ,22.87 ,22.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61537,CPT,CRANIOT TEMPORAL LOBE W/O ELECTROCORTICOGRAPHY,,,21,,RBRVS,36.45 ,21.36 ,21.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61538,CPT,CRANIOT LOBEC TEMPORAL LOBE W/ELECTROCORTCOGRPHY,,,21,,RBRVS,39.45 ,23.03 ,23.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61539,CPT,CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/ECOG,,,21,,RBRVS,34.28 ,21.26 ,21.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61540,CPT,CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/O ECOG,,,21,,RBRVS,31.43 ,20.02 ,20.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61541,CPT,CRANIOTOMY TRANSECTION CORPUS CALLOSUM,,,21,,RBRVS,30.94 ,19.70 ,19.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61543,CPT,CRANIOTOMY PARTIAL/SUBTOTAL HEMISPHERECTOMY,,,21,,RBRVS,31.31 ,19.88 ,19.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61544,CPT,CRANIOTOMY EXCISION/COAGULATION CHOROID PLEXUS,,,21,,RBRVS,27.36 ,17.48 ,17.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61545,CPT,CRANIOTOMY EXCISION CRANIOPHARYNGIOMA,,,21,,RBRVS,46.43 ,28.43 ,28.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61546,CPT,CRANIOT HYPOPHYSEC/EXC PITUITARY TUMOR ICRL APPR,,,21,,RBRVS,33.44 ,20.87 ,20.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61548,CPT,HYPOPHYSEC/EXC PITUITARY TUM TRANSNASAL/SEPTAL,,,21,,RBRVS,23.37 ,14.64 ,14.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61550,CPT,CRANIECTOMY CRANIOSYNOSTOSIS 1 CRANIAL SUTURE,,,21,,RBRVS,15.59 ,10.07 ,10.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61552,CPT,CRANIECT CRANIOSYNOSTOSIS MULT CRANIAL SUTURES,,,21,,RBRVS,20.40 ,10.37 ,10.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61556,CPT,CRANIEC CRANIOSYNOSTOSIS FRONT/PARIET BONE FLAP,,,21,,RBRVS,24.09 ,14.85 ,14.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61557,CPT,CRANIECTOMY CRANIOSYNOSTOSIS BIFRONTAL BONE FLAP,,,21,,RBRVS,23.31 ,15.47 ,15.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61558,CPT,XTN CRANIECT MULTIPLE SUTURE CRANIOSYNOSTOSIS,,,21,,RBRVS,26.50 ,17.94 ,17.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61559,CPT,XTN CRNEC MLT SUTR CRANIOSYNOSTOSIS W/BONE GRAFT,,,21,,RBRVS,34.02 ,19.99 ,19.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61563,CPT,EXC BENIGN TUM CRANIAL BONE W/O OPTIC NRV DCMPRN,,,21,,RBRVS,28.44 ,17.03 ,17.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61564,CPT,EXC BENIGN TUM CRANIAL BONE W/OPTIC NRV DCMPRN,,,21,,RBRVS,34.74 ,21.73 ,21.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61566,CPT,CRANIOTOMY SELECTIVE AMYGDALOHIPPOCAMPECTOMY,,,21,,RBRVS,32.45 ,20.49 ,20.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61567,CPT,CRANIOTOMY MULTIPLE SUBPIAL TRANSECTIONS W/ECOG,,,21,,RBRVS,37.00 ,23.36 ,23.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61570,CPT,CRANIECTOMY/CRANIOTOMY EXC FOREIGN BODY BRAIN,,,21,,RBRVS,26.51 ,17.63 ,17.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61571,CPT,CRANIECTOMY/CRANIOTOMY TX PENETRATNG WOUND BRAIN,,,21,,RBRVS,28.42 ,18.47 ,18.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61575,CPT,TRNSRAL SKULL BSE/BR STEM/CORD BX/DCOMPR/EXC LES,,,21,,RBRVS,36.56 ,19.63 ,19.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61576,CPT,TRNSRL SKUL BSE/BR STM/CORD BX/DCMP/ SPLT TONGUE,,,21,,RBRVS,55.31 ,38.73 ,38.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61580,CPT,CRANIOFACIAL ANT CRANIAL FOSSA W/O ORBITAL EXNTJ,,,21,,RBRVS,34.51 ,29.88 ,29.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61581,CPT,CRANIOFACIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ,,,21,,RBRVS,39.13 ,31.98 ,31.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61582,CPT,CRANFCL ANT CRANIAL FOSSA UNI/BI CRANIOT/OSTEOT,,,21,,RBRVS,35.14 ,36.77 ,36.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61583,CPT,CRANFCL ANT CRANIAL FOSSA UNI/BIFRNTL ELEV LOBE,,,21,,RBRVS,38.50 ,31.20 ,31.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61584,CPT,ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ,,,21,,RBRVS,37.70 ,31.24 ,31.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61585,CPT,ORBITOCRANIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ,,,21,,RBRVS,42.57 ,34.46 ,34.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61586,CPT,BICORONAL TRANSZYGMTC&/LEFORT I W/O BONE GRFT,,,21,,RBRVS,27.48 ,31.79 ,31.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61590,CPT,INFRATEMPORAL MID CRANIAL FOSSA W/WO DISARTICLTN,,,21,,RBRVS,47.04 ,32.15 ,32.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61591,CPT,INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBI,,,21,,RBRVS,47.02 ,32.47 ,32.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61592,CPT,ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE,,,21,,RBRVS,43.08 ,33.57 ,33.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61595,CPT,TRANSTEMP APPR POST CRAN FOSSA DCOMPR SINUS/NRV,,,21,,RBRVS,33.74 ,26.84 ,26.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61596,CPT,TRANSCOCHLR POST CRNL FOSSA W/WO MOBIL NRV/ART,,,21,,RBRVS,39.43 ,25.61 ,25.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61597,CPT,TRNSCONDLR POST CRNL FOSSA DCOMPR ART W/WO MOBIL,,,21,,RBRVS,40.82 ,27.36 ,27.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61598,CPT,TRANSPTRSAL POST CRNL FOSSA CLIVUS/FORAMN MAGNUM,,,21,,RBRVS,36.53 ,31.79 ,31.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61600,CPT,RESCJ/EXC LES BASE ANT CRANIAL FOSSA EXTRADURAL,,,21,,RBRVS,30.01 ,25.27 ,25.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61601,CPT,RESCJ/EXC LES BASE ANT CRNL FOSSA INDRL W/WO GRF,,,21,,RBRVS,31.14 ,27.73 ,27.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61605,CPT,RESCJ/EXC LES INFRATEMPOR FOSSA SPACE APEX XDRL,,,21,,RBRVS,32.57 ,24.99 ,24.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61606,CPT,RESCJ/EXC LES ITPRL FOSSA SPACE APEX IDRL W/RPR,,,21,,RBRVS,42.05 ,30.39 ,30.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61607,CPT,RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB XDRL,,,21,,RBRVS,40.93 ,27.30 ,27.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61608,CPT,RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB IDRL,,,21,,RBRVS,45.54 ,32.34 ,32.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61610,CPT,TRNSXJ/LIG CAROTID ARTERY SINUS W/RPR ANAST/GRFT,,,21,,RBRVS,29.63 ,11.31 ,11.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61611,CPT,TRNSXJ/LIG CAROTID ARTERY PETROUS CANAL W/O RPR,,,21,,RBRVS,7.41 ,2.83 ,2.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61612,CPT,TRNSXJ/LIG CRTD ART PETROUS CANAL RPR ANAST/GRF,,,21,,RBRVS,27.84 ,10.63 ,10.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61613,CPT,OBLTRJ CAROTID ARYSM ARTVEN CAROTID FISTULA DSJ,,,21,,RBRVS,45.03 ,33.11 ,33.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61615,CPT,RESCJ/EXC LES BASE POST CRNL FOSSA JUG FRMN XDRL,,,21,,RBRVS,35.77 ,24.74 ,24.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61616,CPT,RESCJ/EXC LES BASE PCF FORAMEN VRT BODIES IDRL,,,21,,RBRVS,46.74 ,34.34 ,34.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61618,CPT,SECONDARY RPR DURA CSF LEAK FREE TISSUE GRAFT,,,21,,RBRVS,18.69 ,12.96 ,12.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61619,CPT,SEC RPR DURA CSF LEAK LOCAL/REGIONALIZED FLAP,,,21,,RBRVS,22.10 ,13.94 ,13.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61623,CPT,EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK,,,21,,RBRVS,9.95 ,4.11 ,4.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61624,CPT,TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS,,,21,,RBRVS,20.12 ,8.00 ,8.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61626,CPT,TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS,,,21,,RBRVS,16.60 ,5.88 ,5.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61630,CPT,BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS,,,21,,RBRVS,22.07 ,10.90 ,10.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61635,CPT,TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD,,,21,,RBRVS,24.28 ,11.54 ,11.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61640,CPT,BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL,,,21,,RBRVS,12.32 ,4.71 ,4.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61641,CPT,BALLOON DILAT INCRNL VASOSPSM PRQ EA VESSEL,,,21,,RBRVS,4.33 ,1.65 ,1.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61642,CPT,BALLOON DILAT INCRNL VASOSPSM PRQ EA VESSEL,,,21,,RBRVS,8.66 ,3.31 ,3.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61645,CPT,PERQ ART TRLUML M-THROMBEC &/NFS INTRACRANIAL,,,21,,RBRVS,15.00 ,4.55 ,4.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61650,CPT,EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART 1ST,,,21,,RBRVS,10.00 ,3.26 ,3.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61651,CPT,EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART ADDL,,,21,,RBRVS,4.25 ,1.38 ,1.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61680,CPT,INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL SMPL,,,21,,RBRVS,32.55 ,20.54 ,20.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61682,CPT,INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL CMPL,,,21,,RBRVS,63.41 ,33.98 ,33.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61684,CPT,INTRACRANIAL ARVEN MALFRMJ INFRATENTRL SMPL,,,21,,RBRVS,41.64 ,25.17 ,25.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61686,CPT,INTRACRANIAL ARVEN MALFRMJ INFRATENTRL CMPL,,,21,,RBRVS,67.50 ,37.32 ,37.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61690,CPT,INTRACRANIAL ARVEN MALFRMJ DURAL SMPL,,,21,,RBRVS,31.34 ,20.00 ,20.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61692,CPT,INTRACRANIAL ARVEN MALFRMJ DURAL CMPL,,,21,,RBRVS,54.59 ,31.01 ,31.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61697,CPT,COMPLX INTRACRANIAL ARYSM CAROTID CIRCULATION,,,21,,RBRVS,63.40 ,35.48 ,35.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61698,CPT,CPLX INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ,,,21,,RBRVS,69.63 ,38.27 ,38.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61700,CPT,SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION,,,21,,RBRVS,50.62 ,29.37 ,29.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61702,CPT,SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ,,,21,,RBRVS,60.04 ,33.83 ,33.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61703,CPT,ICRA CRV APPL OCCLUDING CLAMP CRV CRTD ART,,,21,,RBRVS,18.80 ,13.48 ,13.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61705,CPT,ARYSM VASC MALFRMJ/CRTD-OCCLUSION CRTD ART,,,21,,RBRVS,38.10 ,23.31 ,23.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61708,CPT,ARYSM VASC MALFRMJ/ICRA ELECTROTHROMBOSIS,,,21,,RBRVS,37.20 ,18.85 ,18.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61710,CPT,ARYSM VASC MALFRMJ IA EMBOLIZATION,,,21,,RBRVS,31.29 ,19.31 ,19.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61711,CPT,ANAST ARTL EXTRACRANIAL-INTRACRANIAL ARTERIES,,,21,,RBRVS,38.23 ,22.97 ,22.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61720,CPT,CRTJ LES STRTCTC BURR GLOBUS PALLIDUS/THALAMUS,,,21,,RBRVS,17.62 ,12.54 ,12.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61735,CPT,CRTJ LES STRTCTC BURR SUBCORTICAL STRUX OTH/THN,,,21,,RBRVS,22.35 ,14.93 ,14.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61750,CPT,STEREOTACTIC BX ASPIR/EXC BURR INTRACRANIAL LES,,,21,,RBRVS,19.83 ,13.42 ,13.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61751,CPT,STRTCTC BX ASPIR/EXC BURR ICRA LESION W/CT&I/MR,,,21,,RBRVS,18.79 ,14.07 ,14.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61760,CPT,STRTCTC IMPLTJ ELTRD CEREBRUM SEIZURE MONITORING,,,21,,RBRVS,22.39 ,14.98 ,14.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61770,CPT,STRTCTC LOCLZJ INSJ CATH/PRB PLMT RADJ SRC,,,21,,RBRVS,23.19 ,14.96 ,14.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61781,CPT,STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL,,,21,,RBRVS,3.75 ,1.74 ,1.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 61782,CPT,STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL,,,21,,RBRVS,3.18 ,1.44 ,1.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 61783,CPT,STEREOTACTIC COMPUTER ASSISTED PX SPINAL,,,21,,RBRVS,3.75 ,1.77 ,1.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 61790,CPT,CREATE LESION STRTCTC PRQ NEUROLYTIC GASSERIAN,,,21,,RBRVS,11.60 ,9.51 ,9.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61791,CPT,CREATE LES STRTCTC PRQ NEUROLYTIC TRIGEMINAL TRC,,,21,,RBRVS,15.41 ,10.39 ,10.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61796,CPT,STEREOTACTIC RADIOSURGERY 1 SIMPLE CRANIAL LES,,,21,,RBRVS,13.93 ,10.24 ,10.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61797,CPT,STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE,,,21,,RBRVS,3.48 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61798,CPT,STEREOTACTIC RADIOSURGERY 1 COMPLEX CRANIAL LES,,,21,,RBRVS,19.85 ,12.91 ,12.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61799,CPT,STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX,,,21,,RBRVS,4.81 ,2.23 ,2.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61800,CPT,APPL STRTCTC HEADFRAME STEREOTACTIC RADIOSURGERY,,,21,,RBRVS,2.25 ,1.39 ,1.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61850,CPT,TWIST/BURR HOLE IMPLTJ NSTIM ELTRD CORTICAL,,,21,,RBRVS,13.34 ,10.06 ,10.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61860,CPT,CRNEC/CRX IMPLTJ NSTIM ELTRD CERE CORTICAL,,,21,,RBRVS,22.26 ,14.70 ,14.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61863,CPT,STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD 1ST ARRAY,,,21,,RBRVS,20.71 ,15.04 ,15.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61864,CPT,STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD EA ARRAY,,,21,,RBRVS,4.49 ,2.10 ,2.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61867,CPT,STRTCTC IMPLTJ NSTIM ELTRD W/RECORD 1ST ARRAY,,,21,,RBRVS,33.03 ,20.73 ,20.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61868,CPT,STRTCTC IMPLTJ NSTIM ELTRD W/RECORD EA ARRAY,,,21,,RBRVS,7.91 ,3.68 ,3.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61870,CPT,CRNEC IMPLTJ NSTIM ELTRD CEREBELLAR CORTICAL,,,21,,RBRVS,16.34 ,11.78 ,11.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 61880,CPT,REVJ/RMVL INTRACRANIAL NEUROSTIMULATOR ELTRDS,,,21,,RBRVS,6.95 ,7.00 ,7.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61885,CPT,INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR,,,21,,RBRVS,6.05 ,6.74 ,6.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61886,CPT,INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS,,,21,,RBRVS,9.93 ,10.84 ,10.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 61888,CPT,REVJ/RMVL NEUROSTIMULATOR PULSE GENERATOR,,,21,,RBRVS,5.23 ,4.32 ,4.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62000,CPT,ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL,,,21,,RBRVS,13.93 ,10.65 ,10.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62005,CPT,ELVTN DEPRS SKL FX COMPOUND/COMMIND XDRL,,,21,,RBRVS,17.63 ,12.14 ,12.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62010,CPT,ELVTN DEPRS SKL FX W/RPR DURA&/DBRDMT BRN,,,21,,RBRVS,21.43 ,14.88 ,14.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62100,CPT,CRX RPR DURAL/CSF LEAK RHINORRHEA/OTORRHEA,,,21,,RBRVS,23.53 ,15.02 ,15.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62115,CPT,RDCTJ CRANIOMEGALIC SKULL W/O GRAFT/CRANIOPLASTY,,,21,,RBRVS,22.91 ,11.79 ,11.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62117,CPT,RDCTJ CRANIOMEGALIC CRANIO&RECNSTJ W/WO GRAFT,,,21,,RBRVS,28.35 ,15.05 ,15.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62120,CPT,RPR ENCEPHALOCELE SKULL VAULT W/CRANIOPLASTY,,,21,,RBRVS,24.59 ,20.00 ,20.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62121,CPT,CRANIOTOMY FOR ENCEPHALOCELE REPAIR SKULL BASE,,,21,,RBRVS,23.03 ,17.64 ,17.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62140,CPT,CRANIOPLASTY SKULL DEFECT 5 CM DIAMETER,,,21,,RBRVS,16.07 ,11.46 ,11.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62142,CPT,RMVL BONE FLAP/PROSTHETIC PLATE SKULL,,,21,,RBRVS,11.83 ,9.61 ,9.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62143,CPT,RPLCMT BONE FLAP/PROSTHETIC PLATE SKULL,,,21,,RBRVS,14.15 ,10.75 ,10.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62145,CPT,CRANIOPLASTY SKULL DEFECT REPARATIVE BRAIN SURG,,,21,,RBRVS,20.09 ,13.61 ,13.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62146,CPT,CRANIOPLASTY W/AUTOGRAFT 5 CM DIAMETER,,,21,,RBRVS,20.67 ,13.71 ,13.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62148,CPT,INCISE&RETRIEVAL SUBQ CRANIOPLASTY BONE GRAFT,,,21,,RBRVS,2.00 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62160,CPT,NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS,,,21,,RBRVS,3.00 ,1.40 ,1.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62161,CPT,NUNDSC ICRA DSJ ADS FENESTRATION SEPTUM CSTS,,,21,,RBRVS,21.23 ,14.86 ,14.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62162,CPT,NUNDSC ICRA FENESTEXC CYST W/VENTRIC CATH DRG,,,21,,RBRVS,26.80 ,17.73 ,17.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62163,CPT,NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY,,,21,,RBRVS,16.53 ,11.54 ,11.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62164,CPT,NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY,,,21,,RBRVS,29.43 ,19.87 ,19.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62165,CPT,NUNDSC ICRA EXC PITUITRY TUM TRNSNSL/SPHENOID,,,21,,RBRVS,23.23 ,14.81 ,14.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62180,CPT,VENTRICULOCISTERNOSTOMY,,,21,,RBRVS,22.58 ,15.29 ,15.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62190,CPT,CRTJ SHUNT SARACH/SDRL-ATR-JUG-AUR,,,21,,RBRVS,12.17 ,9.29 ,9.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62192,CPT,CRTJ SHUNT SARACH/SDRL-PRTL-PLEURAL OTH,,,21,,RBRVS,13.35 ,10.08 ,10.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62194,CPT,RPLCMT/IRRG SUBARACHNOID/SUBDURAL CATHETER,,,21,,RBRVS,5.78 ,5.53 ,5.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62200,CPT,VENTRICULOCISTERNOSTOMY 3RD VENTRICLE,,,21,,RBRVS,19.29 ,13.28 ,13.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62201,CPT,VENTRICULOCISTERNOSTOMY 3RD VNTRC NEURONDSC,,,21,,RBRVS,16.04 ,12.79 ,12.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62220,CPT,CRTJ SHUNT VENTRICULO-ATR-JUG-AUR,,,21,,RBRVS,14.10 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62223,CPT,CRTJ SHUNT VENTRICULO-PERITNEAL-PLEURAL TERMINUS,,,21,,RBRVS,14.05 ,11.31 ,11.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62225,CPT,RPLCMT/IRRIGATION VENTRICULAR CATHETER,,,21,,RBRVS,6.19 ,6.64 ,6.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62230,CPT,RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS,,,21,,RBRVS,11.43 ,8.83 ,8.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62252,CPT,REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT,,,21,,RBRVS,0.74 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 62252,CPT,REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT,26,,21,,RBRVS,0.74 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62252,CPT,REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT,TC,,21,,RBRVS,,1.09 ,1.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 62256,CPT,RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT,,,21,,RBRVS,7.38 ,7.17 ,7.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62258,CPT,RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT,,,21,,RBRVS,15.64 ,11.33 ,11.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 62263,CPT,PRQ LYSIS EPIDURAL ADHESIONS MULT SESS 2/> DAYS,,,21,,RBRVS,5.00 ,4.38 ,13.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62264,CPT,PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY,,,21,,RBRVS,4.42 ,2.08 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62267,CPT,PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS,,,21,,RBRVS,3.00 ,1.34 ,3.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62268,CPT,PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX,,,21,,RBRVS,4.73 ,2.29 ,2.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62269,CPT,BIOPSY SPINAL CORD PERCUTANEOUS NEEDLE,,,21,,RBRVS,5.01 ,2.23 ,2.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62270,CPT,SPINAL PUNCTURE LUMBAR DIAGNOSTIC,,,21,,RBRVS,1.37 ,0.69 ,2.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62272,CPT,SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID,,,21,,RBRVS,1.35 ,0.77 ,4.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62273,CPT,INJECTION EPIDURAL BLOOD/CLOT PATCH,,,21,,RBRVS,2.15 ,0.94 ,2.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62280,CPT,INJX/INFUSION NEUROLYTIC SUBSTANCE SUBARACHNOID,,,21,,RBRVS,2.63 ,1.69 ,5.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62281,CPT,INJX/INFUS NEUROLYT SUBST EPIDURAL CERV/THORACIC,,,21,,RBRVS,2.66 ,1.53 ,3.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62282,CPT,INJX/INFUS NEUROLYT SBST EPIDURAL LUMBAR/SACRAL,,,21,,RBRVS,2.33 ,1.57 ,5.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62284,CPT,INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR,,,21,,RBRVS,1.54 ,0.78 ,3.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62287,CPT,DCMPRN PERQ NUCLEUS PULPOSUS 1/> LEVELS LUMBAR,,,21,,RBRVS,9.03 ,6.33 ,6.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62290,CPT,INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR,,,21,,RBRVS,3.00 ,1.69 ,6.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62291,CPT,INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC,,,21,,RBRVS,2.91 ,1.77 ,6.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62292,CPT,INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC,,,21,,RBRVS,9.24 ,6.79 ,6.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62294,CPT,NJX ARTERIAL OCCLUSION ARVEN MALFRMJ SPINAL,,,21,,RBRVS,12.87 ,8.77 ,8.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62302,CPT,MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL,,,20,,RBRVS,2.29 ,1.04 ,4.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62303,CPT,MYELOGRAPHY VIA LUMBAR INJECTION RS&I THORACIC,,,20,,RBRVS,2.29 ,1.10 ,4.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62304,CPT,MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL,,,20,,RBRVS,2.25 ,1.03 ,4.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62305,CPT,MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS,,,20,,RBRVS,2.35 ,1.08 ,4.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62320,CPT,NJX INTERLAMINAR CRV/THRC,,,21,,RBRVS,1.80 ,0.92 ,2.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62321,CPT,NJX INTERLAMINAR CRV/THRC,,,21,,RBRVS,1.95 ,0.98 ,4.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62322,CPT,NJX INTERLAMINAR LMBR/SAC,,,21,,RBRVS,1.55 ,0.80 ,2.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62323,CPT,NJX INTERLAMINAR LMBR/SAC,,,21,,RBRVS,1.80 ,0.89 ,4.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62324,CPT,NJX INTERLAMINAR CRV/THRC,,,21,,RBRVS,1.89 ,0.55 ,2.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62325,CPT,NJX INTERLAMINAR CRV/THRC,,,21,,RBRVS,2.20 ,0.60 ,3.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62326,CPT,NJX INTERLAMINAR LMBR/SAC,,,21,,RBRVS,1.78 ,0.64 ,2.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62327,CPT,NJX INTERLAMINAR LMBR/SAC,,,21,,RBRVS,1.90 ,0.67 ,4.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62350,CPT,IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM,,,21,,RBRVS,6.05 ,4.43 ,4.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62351,CPT,IMPLTJ REVJ/RPSG ITHCL/EDRL CATH W/LAM,,,21,,RBRVS,11.66 ,10.03 ,10.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62355,CPT,RMVL PREVIOUSLY IMPLTED ITHCL/EDRL CATH,,,21,,RBRVS,3.55 ,3.50 ,3.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62360,CPT,IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS SUBQ RSVR,,,21,,RBRVS,4.33 ,3.75 ,3.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62361,CPT,IMPLTJ/RPLCMT FS NON-PRGRBL PUMP,,,21,,RBRVS,5.00 ,4.31 ,4.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62362,CPT,IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP,,,21,,RBRVS,5.60 ,4.39 ,4.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62365,CPT,RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS,,,21,,RBRVS,3.93 ,3.75 ,3.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62367,CPT,ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL,,,21,,RBRVS,0.48 ,0.20 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62368,CPT,ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG,,,21,,RBRVS,0.67 ,0.28 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62369,CPT,ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL,,,21,,RBRVS,0.67 ,0.29 ,2.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 62370,CPT,ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP,,,21,,RBRVS,0.90 ,0.36 ,2.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63001,CPT,LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG CRV,,,21,,RBRVS,17.61 ,12.34 ,12.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63003,CPT,LAMINECTOMY W/O FFD 1/2 VERT SEG THORACIC,,,21,,RBRVS,17.74 ,12.31 ,12.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63005,CPT,LAMINECTOMY W/O FFD 1/2 VERT SEG LUMBAR,,,21,,RBRVS,16.43 ,12.47 ,12.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63011,CPT,LAMINECTOMY W/O FFD 1/2 VERT SEG SACRAL,,,21,,RBRVS,15.91 ,11.59 ,11.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63012,CPT,LAMINECTOMY W/RMVL ABNORMAL FACETS LUMBAR,,,21,,RBRVS,16.85 ,12.38 ,12.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63015,CPT,LAMINECTOMY W/O FFD > 2 VERT SEG CERVICAL,,,21,,RBRVS,20.85 ,14.89 ,14.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63016,CPT,LAMINECTOMY W/O FFD > 2 VERT SEG THORACIC,,,21,,RBRVS,22.03 ,14.87 ,14.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63017,CPT,LAMINECTOMY W/O FFD > 2 VERT SEG LUMBAR,,,21,,RBRVS,17.33 ,13.10 ,13.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63020,CPT,LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC CERVC,,,21,,RBRVS,16.20 ,12.41 ,12.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63030,CPT,LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR,,,21,,RBRVS,13.18 ,10.93 ,10.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63035,CPT,LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR,,,21,,RBRVS,3.15 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63040,CPT,LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC CERVICAL,,,21,,RBRVS,20.31 ,13.95 ,13.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63042,CPT,LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR,,,21,,RBRVS,18.76 ,13.54 ,13.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63043,CPT,LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC EA CRV,,,21,,TotalUnits,,,,15.45 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63044,CPT,LAMOT W/PRTL FFD HRNA8 REEXPL 1 NTRSPC EA LMBR,,,21,,TotalUnits,,,,14.68 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63045,CPT,LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT CERVICAL,,,21,,RBRVS,17.95 ,13.42 ,13.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63046,CPT,LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT THORACIC,,,21,,RBRVS,17.25 ,12.92 ,12.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63047,CPT,LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT LUMBAR,,,21,,RBRVS,15.37 ,11.99 ,11.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63048,CPT,LAM FACETECTOMY&FORAMTOMY 1 SGM EA CRV THRC/LMBR,,,21,,RBRVS,3.47 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63050,CPT,LAMOP CERVICAL W/DCMPRN SPI CORD 2/> VERT SEG,,,21,,RBRVS,22.01 ,14.88 ,14.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63051,CPT,LAMOPLASTY CERVICAL DCMPRN CORD 2/> SEG RCNSTJ,,,21,,RBRVS,25.51 ,16.73 ,16.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63055,CPT,TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC,,,21,,RBRVS,23.55 ,15.66 ,15.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63056,CPT,TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR,,,21,,RBRVS,21.86 ,14.63 ,14.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63057,CPT,TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR,,,21,,RBRVS,5.25 ,2.53 ,2.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63064,CPT,COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG,,,21,,RBRVS,26.22 ,16.86 ,16.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63066,CPT,COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG,,,21,,RBRVS,3.26 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63075,CPT,DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC,,,21,,RBRVS,19.60 ,13.71 ,13.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63076,CPT,DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC,,,21,,RBRVS,4.04 ,1.91 ,1.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63077,CPT,DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC,,,21,,RBRVS,22.88 ,14.31 ,14.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63078,CPT,DISCECTOMY ANT DCMPRN CORD THORACIC EA NTRSPC,,,21,,RBRVS,3.28 ,1.57 ,1.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63081,CPT,VERTEBRAL CORPECTOMY ANT DCMPRN CERVICAL 1 SEG,,,21,,RBRVS,26.10 ,17.04 ,17.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63082,CPT,VERTEBRAL CORPECTOMY DCMPRN CERVICAL EA SEG,,,21,,RBRVS,4.36 ,2.09 ,2.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63085,CPT,VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC 1 SEG,,,21,,RBRVS,29.47 ,17.44 ,17.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63086,CPT,VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC EA SEG,,,21,,RBRVS,3.19 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63087,CPT,VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR 1 SEG,,,21,,RBRVS,37.53 ,21.71 ,21.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63088,CPT,VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR EA SEG,,,21,,RBRVS,4.32 ,2.04 ,2.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63090,CPT,VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC 1 SEG,,,21,,RBRVS,30.93 ,18.47 ,18.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63091,CPT,VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC EA SEG,,,21,,RBRVS,3.03 ,1.43 ,1.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63101,CPT,VERTEB CORPECT LAT XTRCAVITARY DCMPRN THRC 1 SEG,,,21,,RBRVS,34.10 ,22.07 ,22.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63102,CPT,VERTEB CORPECT LAT XTRCAVITARY DCMPRN LMBR 1 SEG,,,21,,RBRVS,34.10 ,22.03 ,22.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63103,CPT,VCRPEC LAT XTRCAVITARY DCMPRN THRC/LMBR EA SEG,,,21,,RBRVS,4.82 ,2.32 ,2.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63170,CPT,LAM W/MYELOTOMY CERVICAL/THORACIC/THORACOLUMBAR,,,21,,RBRVS,22.21 ,15.57 ,15.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63172,CPT,LAM W/DRG INTRMEDULLARY CYST/SYRINX SUBARACHNOID,,,21,,RBRVS,19.76 ,13.70 ,13.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63173,CPT,LAM W/DRG INTRMEDULRY CYST/SYRINX PRTL/PLEURAL,,,21,,RBRVS,24.31 ,16.29 ,16.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63180,CPT,LAM&SCTJ DENTATE LIG W/WO DURAL GRF CRV 1/2 SEG,,,21,,RBRVS,20.53 ,14.78 ,14.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63182,CPT,LAM&SCTJ DENTATE LIG W/WO DURAL GRF CRV >2 SEG,,,21,,RBRVS,22.82 ,11.74 ,11.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63185,CPT,LAMINECTOMY W/RHIZOTOMY 1/2 SEGMENTS,,,21,,RBRVS,16.49 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63190,CPT,LAMINECTOMY W/RHIZOTOMY > 2 SEGMENTS,,,21,,RBRVS,18.89 ,13.11 ,13.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63191,CPT,LAMINECTOMY W/SECTION SPINAL ACCESSORY NERVE,,,21,,RBRVS,18.92 ,13.88 ,13.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63194,CPT,LAM CORDOTOMY SCTJ 1 SPINOTHALMIC TRACT CERVICAL,,,21,,RBRVS,22.10 ,15.86 ,15.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63195,CPT,LAM CORDOTOMY SCTJ 1 SPINOTHALMIC TRACT THORACIC,,,21,,RBRVS,21.64 ,14.75 ,14.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63196,CPT,LAM CORDOTOMY SCTJ BOTH SPINOTHALMIC TRACTS CRV,,,21,,RBRVS,25.27 ,12.13 ,12.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63197,CPT,LAM CORDOTOMY SCTJ BOTH SPINOTHALMIC TRACT THRC,,,21,,RBRVS,24.08 ,16.44 ,16.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63198,CPT,LAM CORDOTOMY SCTJ BOTH TRACTS 2 STAGES CERVICAL,,,21,,RBRVS,29.90 ,14.13 ,14.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63199,CPT,LAM CORDOTOMY SCTJ BOTH TRACTS 2 STAGES THORACIC,,,21,,RBRVS,31.47 ,14.73 ,14.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63200,CPT,LAMINECTOMY RELEASE TETHERED SPINAL CORD LUMBAR,,,21,,RBRVS,21.44 ,15.14 ,15.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63250,CPT,LAM EXC/OCCLUSION AVM SPINAL CORD CERVICAL,,,21,,RBRVS,43.86 ,23.94 ,23.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63251,CPT,LAM EXC/OCCLUSION AVM SPINAL CORD THORACIC,,,21,,RBRVS,44.64 ,26.57 ,26.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63252,CPT,LAM EXC/OCCLUSION AVM SPI CORD THORACOLUMBAR,,,21,,RBRVS,44.63 ,26.54 ,26.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63265,CPT,LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL CERVICAL,,,21,,RBRVS,23.82 ,16.19 ,16.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63266,CPT,LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL THORACIC,,,21,,RBRVS,24.68 ,16.50 ,16.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63267,CPT,LAM EXC/EVAC ISPI LESION OTH/THN NEO XDRL LUMBAR,,,21,,RBRVS,19.45 ,13.95 ,13.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63268,CPT,LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL SACRAL,,,21,,RBRVS,20.02 ,14.20 ,14.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63270,CPT,LAM EXC ISPI LES OTH/THN NEO IDRL CERVICAL,,,21,,RBRVS,29.80 ,19.17 ,19.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63271,CPT,LAM EXC ISPI LES OTH/THN NEO IDRL THORACIC,,,21,,RBRVS,29.92 ,19.10 ,19.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63272,CPT,LAM EXC ISPI LES OTH/THN NEO IDRL LUMBAR,,,21,,RBRVS,27.50 ,17.83 ,17.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63273,CPT,LAM EXC ISPI LES OTH/THN NEO IDRL SACRAL,,,21,,RBRVS,26.47 ,17.61 ,17.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63275,CPT,LAMINECTOMY BX/EXC ISPI NEO XDRL CERVICAL,,,21,,RBRVS,25.86 ,17.11 ,17.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63276,CPT,LAMINECTOMY BX/EXC ISPI NEO XDRL THORACIC,,,21,,RBRVS,25.69 ,17.04 ,17.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63277,CPT,LAMINECTOMY BX/EXC ISPI NEO XDRL LUMBAR,,,21,,RBRVS,22.39 ,15.32 ,15.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63278,CPT,LAMINECTOMY BX/EXC ISPI NEO XDRL SACRAL,,,21,,RBRVS,22.12 ,15.58 ,15.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63280,CPT,LAM BX/EXC ISPI NEO IDRL XMED CERVICAL,,,21,,RBRVS,30.29 ,19.78 ,19.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63281,CPT,LAM BX/EXC ISPI NEO IDRL XMED THORACIC,,,21,,RBRVS,29.99 ,19.61 ,19.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63282,CPT,LAM BX/EXC ISPI NEO IDRL XMED LUMBAR,,,21,,RBRVS,28.15 ,18.72 ,18.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63283,CPT,LAM BX/EXC ISPI NEO IDRL SACRAL,,,21,,RBRVS,26.76 ,18.16 ,18.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63285,CPT,LAM BX/EXC ISPI NEO IDRL IMED CERVICAL,,,21,,RBRVS,38.05 ,23.50 ,23.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63286,CPT,LAM BX/EXC ISPI NEO IDRL IMED THORACIC,,,21,,RBRVS,37.62 ,23.29 ,23.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63287,CPT,LAM BX/EXC ISPI NEO IDRL IMED THORACOLMBR,,,21,,RBRVS,40.08 ,24.45 ,24.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63290,CPT,LAM BX/EXC ISPI NEO XDRL-IDRL LES ANY LVL,,,21,,RBRVS,40.82 ,24.70 ,24.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63295,CPT,OSTPL RCNSTJ DORSAL SPI ELMNTS FLWG ISPI PX,,,21,,RBRVS,5.25 ,2.45 ,2.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63300,CPT,VCRPEC LES 1 SGM XDRL CERVICAL,,,21,,RBRVS,26.80 ,17.41 ,17.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63301,CPT,VCRPEC LES 1 SGM XDRL THORACIC TTHRC,,,21,,RBRVS,31.57 ,20.32 ,20.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63302,CPT,VCRPEC LES 1 SEG XDRL THRC THORACOLMBR,,,21,,RBRVS,31.15 ,20.14 ,20.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63303,CPT,VCRPEC LES 1 SEG XDRL LMBR/SAC TRANSPRTL/RPR,,,21,,RBRVS,33.55 ,20.69 ,20.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63304,CPT,VERTEBRAL CORPECTOMY EXC LES 1 SEG IDRL CERVICAL,,,21,,RBRVS,33.85 ,21.53 ,21.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63305,CPT,VERTEBRAL CORPECTOMY LES 1 SEG IDRL THRC TTHRC,,,21,,RBRVS,36.24 ,21.85 ,21.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63306,CPT,VERTEBRL CORPECT LES 1 SEG IDRL THRC THORACOLMBR,,,21,,RBRVS,35.55 ,22.03 ,22.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63307,CPT,VCRPEC LES 1 SEG IDRL LMBR/SAC TRANSPRTL/RPR,,,21,,RBRVS,34.96 ,21.66 ,21.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63308,CPT,VERTEBRAL CORPECTOMY EXC INDRL LES EACH SEG,,,21,,RBRVS,5.24 ,2.45 ,2.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63600,CPT,CREATION LES SPINAL CORD STEREOTACTIC METHOD PRQ,,,21,,RBRVS,15.12 ,9.61 ,9.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63610,CPT,STRTCTC STIMJ SPI CORD PRQ SPX N/FLWD OTH SURG,,,21,,RBRVS,8.72 ,2.94 ,2.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63615,CPT,STRTCTC BX ASPIRAT/EXC LESION SPINAL CORD,,,21,,RBRVS,17.32 ,8.53 ,8.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63620,CPT,STEREOTACTIC RADIOSURGERY 1 SPINAL LESION,,,21,,RBRVS,15.60 ,10.97 ,10.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63621,CPT,STEREOTACTIC RADIOSURGERY EA ADDL SPINAL LESION,,,21,,RBRVS,4.00 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63650,CPT,PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL,,,21,,RBRVS,7.15 ,4.11 ,30.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63655,CPT,LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL,,,21,,RBRVS,10.92 ,9.51 ,9.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63661,CPT,RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR,,,21,,RBRVS,5.08 ,3.47 ,10.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63662,CPT,RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR,,,21,,RBRVS,11.00 ,9.62 ,9.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63663,CPT,REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR,,,21,,RBRVS,7.75 ,4.38 ,13.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63664,CPT,REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR,,,21,,RBRVS,11.52 ,9.74 ,9.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63685,CPT,INSJ/RPLCMT SPI NPGR DIR/INDUXIVE COUPLING,,,21,,RBRVS,5.19 ,4.31 ,4.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63688,CPT,REVJ/RMVL IMPLANTED SPINAL NEUROSTIM GENERATOR,,,21,,RBRVS,5.30 ,4.29 ,4.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63700,CPT,REPAIR MENINGOCELE < 5 CM DIAMETER,,,21,,RBRVS,17.47 ,12.66 ,12.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63702,CPT,REPAIR MENINGOCELE > 5 CM DIAMETER,,,21,,RBRVS,19.41 ,13.70 ,13.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63704,CPT,REPAIR MYELOMENINGOCELE < 5 CM DIAMETER,,,21,,RBRVS,22.43 ,16.88 ,16.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63706,CPT,REPAIR MYELOMENINGOCELE > 5 CM DIAMETER,,,21,,RBRVS,25.35 ,17.46 ,17.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63707,CPT,RPR DURAL/CEREBROSPINAL FLUID LEAK X REQ LAM,,,21,,RBRVS,12.65 ,10.17 ,10.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63709,CPT,RPR DURAL/CSF LEAK/PSEUDOMENINGOCELE W/LAM,,,21,,RBRVS,15.65 ,11.62 ,11.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63710,CPT,DURAL GRAFT SPINAL,,,21,,RBRVS,15.40 ,11.55 ,11.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63740,CPT,CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL/OTH W/LAM,,,21,,RBRVS,12.63 ,10.28 ,10.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 63741,CPT,CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL PRQ X LAM,,,21,,RBRVS,9.12 ,7.52 ,7.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63744,CPT,RPLCMT IRRIGATION/REVJ LUMBOSARACH SHUNT,,,21,,RBRVS,8.94 ,7.46 ,7.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 63746,CPT,RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT,,,21,,RBRVS,7.33 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64400,CPT,NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH,,,21,,RBRVS,1.11 ,0.71 ,2.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64402,CPT,INJECTION ANESTHETIC AGENT FACIAL NERVE,,,21,,RBRVS,1.25 ,0.75 ,2.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64405,CPT,INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV,,,21,,RBRVS,0.94 ,0.69 ,1.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64408,CPT,INJECTION ANESTHETIC AGENT VAGUS NERVE,,,21,,RBRVS,1.41 ,0.61 ,1.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64410,CPT,INJECTION ANESTHETIC AGENT PHRENIC NERVE,,,21,,RBRVS,1.43 ,0.46 ,1.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64413,CPT,INJECTION ANESTHETIC AGENT CERVICAL PLEXUS,,,21,,RBRVS,1.40 ,0.74 ,2.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64415,CPT,SINGLE NERVE BLOCK INJECTION ARM NERVE,,,21,,RBRVS,1.48 ,0.27 ,1.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64416,CPT,INJECTION ANES BRACHIAL PLEXUS CONT NFS CATH,,,21,,RBRVS,1.81 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64417,CPT,INJECTION ANESTHETIC AGENT AXILLARY NERVE,,,21,,RBRVS,1.44 ,0.47 ,2.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64418,CPT,INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE,,,21,,RBRVS,1.32 ,0.73 ,2.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64420,CPT,INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE,,,21,,RBRVS,1.18 ,0.67 ,1.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64421,CPT,MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES,,,21,,RBRVS,1.68 ,0.82 ,2.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64425,CPT,INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS,,,21,,RBRVS,1.75 ,0.75 ,1.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64430,CPT,INJECTION ANESTHETIC AGENT PUDENDAL NERVE,,,21,,RBRVS,1.46 ,0.75 ,2.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64435,CPT,INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE,,,21,,RBRVS,1.45 ,0.77 ,2.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64445,CPT,INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE,,,21,,RBRVS,1.48 ,0.44 ,2.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64446,CPT,INJECTION ANES SCIATIC NERVE CONT INFUSION CATH,,,21,,RBRVS,1.81 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64447,CPT,INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE,,,21,,RBRVS,1.50 ,0.28 ,1.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64448,CPT,INJECTION ANES FEMORAL NERVE CONT INFUSION CATH,,,21,,RBRVS,1.63 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64449,CPT,INJECTION ANES LUMBAR PLEXUS POST CONT NFS CATH,,,21,,RBRVS,1.81 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64450,CPT,INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH,,,21,,RBRVS,0.75 ,0.49 ,1.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64455,CPT,NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE,,,21,,RBRVS,0.75 ,0.19 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64461,CPT,PVB THORACIC SINGLE INJECTION SITE W/IMG GID,,,21,,RBRVS,1.75 ,0.58 ,2.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64462,CPT,PVB THORACIC SECOND & ADDL INJ SITE W/IMG GID,,,21,,RBRVS,1.10 ,0.37 ,1.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 64463,CPT,PVB THORACIC CONT CATHETER INFUSION W/IMG GID,,,21,,RBRVS,1.81 ,0.46 ,2.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64479,CPT,NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC 1 LVL,,,21,,RBRVS,2.29 ,1.32 ,4.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64480,CPT,NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC EA LV,,,21,,RBRVS,1.20 ,0.51 ,1.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64483,CPT,NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL,,,21,,RBRVS,1.90 ,1.19 ,4.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64484,CPT,NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV,,,21,,RBRVS,1.00 ,0.42 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64486,CPT,TAP BLOCK UNILATERAL BY INJECTION(S),,,21,,RBRVS,1.27 ,0.43 ,2.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64487,CPT,TAP BLOCK UNILATERAL BY CONTINUOUS INFUSION(S),,,21,,RBRVS,1.48 ,0.50 ,2.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64488,CPT,TAP BLOCK BILATERAL BY INJECTION(S),,,21,,RBRVS,1.60 ,0.54 ,2.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64489,CPT,TAP BLOCK BILATERAL BY CONTINUOUS INFUSION(S),,,21,,RBRVS,1.80 ,0.61 ,4.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64490,CPT,NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL,,,21,,RBRVS,1.82 ,1.09 ,3.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64491,CPT,NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL,,,21,,RBRVS,1.16 ,0.48 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64492,CPT,NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL,,,21,,RBRVS,1.16 ,0.50 ,1.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64493,CPT,NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL,,,21,,RBRVS,1.52 ,0.97 ,3.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64494,CPT,NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL,,,21,,RBRVS,1.00 ,0.41 ,1.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64495,CPT,NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL,,,21,,RBRVS,1.00 ,0.43 ,1.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64505,CPT,INJECTION ANES AGENT SPHENOPALATINE GANGLION,,,21,,RBRVS,1.36 ,0.99 ,1.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64508,CPT,INJECTION ANESTHETIC AGENT CAROTID SINUS SPX,,,21,,RBRVS,1.12 ,0.85 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64510,CPT,NJX ANES STELLATE GANGLION CRV SYMPATHETIC,,,21,,RBRVS,1.22 ,0.80 ,2.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64517,CPT,INJECTION ANES SUPERIOR HYPOGASTRIC PLEXUS,,,21,,RBRVS,2.20 ,1.15 ,2.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64520,CPT,INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC,,,21,,RBRVS,1.35 ,0.86 ,3.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64530,CPT,INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG,,,21,,RBRVS,1.58 ,0.94 ,3.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64550,CPT,APPLICATION SURFACE NEUROSTIMULATOR,,,21,,RBRVS,0.18 ,0.06 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64553,CPT,PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE,,,21,,RBRVS,2.36 ,1.91 ,3.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64555,CPT,PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV,,,21,,RBRVS,2.32 ,1.84 ,3.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64561,CPT,PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING,,,21,,RBRVS,5.44 ,2.63 ,17.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64565,CPT,PRQ IMPLTJ NSTIM ELTRD NEUROMUSCULAR,,,21,,RBRVS,1.81 ,1.74 ,3.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64566,CPT,POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE,,,21,,RBRVS,0.60 ,0.21 ,2.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64568,CPT,INC IMPLTJ CRNL NRV NSTIM ELTRDS & PULSE GENER,,,21,,RBRVS,9.00 ,7.24 ,7.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64569,CPT,REVISION/REPLMT NEUROSTIMLATOR ELTRD CRANIAL NRV,,,21,,RBRVS,11.00 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64570,CPT,REMOVAL CRNL NRV NSTIM ELTRDS & PULSE GENERATO,,,21,,RBRVS,9.10 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64575,CPT,INC IMPLTJ PERIPH NERVE NEUROSTIMULATOR ELTRD,,,21,,RBRVS,4.42 ,3.91 ,3.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64580,CPT,INC IMPLTJ NSTIM ELTRD NEUROMUSCULAR,,,21,,RBRVS,4.19 ,3.53 ,3.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64581,CPT,INC IMPLTJ NEUROSTIMULATOR ELTRD SACRAL NERVE,,,21,,RBRVS,12.20 ,5.42 ,5.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64585,CPT,REVJ/RMVL PERIPHERAL NEUROSTIMULATOR ELECTRODE,,,21,,RBRVS,2.11 ,1.74 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64590,CPT,INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR,,,21,,RBRVS,2.45 ,1.85 ,4.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64595,CPT,REVISION/RMVL PERIPHERAL/GASTRIC NPGR,,,21,,RBRVS,1.78 ,1.62 ,4.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64600,CPT,DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH,,,21,,RBRVS,3.49 ,2.20 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64605,CPT,DSTRJ NEUROLYTIC TRIGEMINAL NRV 2/3 DIV BRANCH,,,21,,RBRVS,5.65 ,4.12 ,13.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64610,CPT,DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR,,,21,,RBRVS,7.20 ,4.60 ,11.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64611,CPT,CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS,,,21,,RBRVS,1.03 ,1.52 ,1.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64612,CPT,CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL,,,21,,RBRVS,1.41 ,1.65 ,2.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64615,CPT,CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE,,,21,,RBRVS,1.85 ,1.13 ,1.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64616,CPT,CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA,,,21,,RBRVS,1.53 ,1.11 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64617,CPT,CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG,,,21,,RBRVS,1.90 ,1.10 ,3.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64620,CPT,DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE,,,21,,RBRVS,2.89 ,1.80 ,2.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64630,CPT,DSTRJ NEUROLYTIC AGENT PUDENDAL NERVE,,,21,,RBRVS,3.05 ,2.04 ,3.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64632,CPT,DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE,,,21,,RBRVS,1.23 ,0.66 ,1.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64633,CPT,DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA,,,21,,RBRVS,3.84 ,2.39 ,7.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64634,CPT,DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA,,,21,,RBRVS,1.32 ,0.55 ,3.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64635,CPT,DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL,,,21,,RBRVS,3.78 ,2.37 ,7.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64636,CPT,DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL,,,21,,RBRVS,1.16 ,0.48 ,3.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64640,CPT,DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE,,,21,,RBRVS,1.23 ,1.34 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64642,CPT,CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE,,,21,,RBRVS,1.65 ,1.10 ,2.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64643,CPT,CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE,,,21,,RBRVS,1.22 ,0.62 ,1.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 64644,CPT,CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES,,,21,,RBRVS,1.82 ,1.20 ,2.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64645,CPT,CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES,,,21,,RBRVS,1.39 ,0.70 ,1.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 64646,CPT,CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES,,,21,,RBRVS,1.80 ,1.15 ,2.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64647,CPT,CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES,,,21,,RBRVS,2.11 ,1.33 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64650,CPT,CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE,,,21,,RBRVS,0.70 ,0.38 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64653,CPT,CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY,,,21,,RBRVS,0.88 ,0.44 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64680,CPT,DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS,,,21,,RBRVS,2.67 ,1.85 ,5.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64681,CPT,DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS,,,21,,RBRVS,3.78 ,1.39 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64702,CPT,NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT,,,21,,RBRVS,6.26 ,6.97 ,6.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64704,CPT,NEUROPLASTY NERVE HAND/FOOT,,,21,,RBRVS,4.69 ,3.93 ,3.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64708,CPT,NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC,,,21,,RBRVS,6.36 ,6.70 ,6.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64712,CPT,NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV,,,21,,RBRVS,8.07 ,6.90 ,6.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64713,CPT,NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS,,,21,,RBRVS,11.40 ,7.37 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64714,CPT,NEURP MAJOR PRPH NRV OPN ARM/LEG LMBR PLEXUS,,,21,,RBRVS,10.55 ,6.42 ,6.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64716,CPT,NEUROPLASTY &/TRANSPOSITION CRANIAL NERVE,,,21,,RBRVS,6.99 ,7.29 ,7.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64718,CPT,NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW,,,21,,RBRVS,7.26 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64719,CPT,NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST,,,21,,RBRVS,4.97 ,5.53 ,5.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64721,CPT,NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE,,,21,,RBRVS,4.97 ,6.24 ,6.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64722,CPT,DECOMPRESSION UNSPECIFIED NERVE,,,21,,RBRVS,4.82 ,4.85 ,4.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64726,CPT,DECOMPRESSION PLANTAR DIGITAL NERVE,,,21,,RBRVS,4.27 ,3.22 ,3.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64727,CPT,INTERNAL NEUROLYSIS REQ OPERATING MICROSCOPE,,,21,,RBRVS,3.10 ,1.58 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64732,CPT,TRANSECTION/AVULSION SUPRAORBITAL NERVE,,,21,,RBRVS,4.89 ,4.99 ,4.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64734,CPT,TRANSECTION/AVULSION INFRAORBITAL NERVE,,,21,,RBRVS,5.55 ,5.50 ,5.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64736,CPT,TRANSECTION/AVULSION MENTAL NERVE,,,21,,RBRVS,5.23 ,5.34 ,5.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64738,CPT,TRANSECTION/AVULSION INF ALVEOLAR NRV W/OSTEO,,,21,,RBRVS,6.36 ,4.92 ,4.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64740,CPT,TRANSECTION/AVULSION LINGUAL NERVE,,,21,,RBRVS,6.22 ,6.05 ,6.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64742,CPT,TRANSECTION/AVULSION FACIAL NRV DIFFERENT/CMPL,,,21,,RBRVS,6.85 ,6.49 ,6.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64744,CPT,TRANSECTION/AVULSION GREATER OCCIPITAL NERVE,,,21,,RBRVS,5.72 ,6.24 ,6.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64746,CPT,TRANSECTION/AVULSION PHRENIC NERVE,,,21,,RBRVS,6.56 ,4.72 ,4.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64755,CPT,TRANSECTION/AVULSION VAGUS NERVES,,,21,,RBRVS,15.05 ,7.96 ,7.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 64760,CPT,TRANSECTION/AVULSION VAGUS NERVE ABDOMINAL,,,21,,RBRVS,7.59 ,5.34 ,5.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 64763,CPT,TRNSXJ/AVLSN OBTURAT NRV XPELV W/WO TENOTOMY,,,21,,RBRVS,7.56 ,5.42 ,5.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64766,CPT,TRNSXJ/AVLSN OBTURAT NRV INPELV W/WO TENOTOMY,,,21,,RBRVS,9.47 ,6.46 ,6.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64771,CPT,TRANSECTION/AVULSION OTH CRANIAL NRV XDRL,,,21,,RBRVS,8.15 ,7.62 ,7.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64772,CPT,TRANSECTION/AVULSION OTH SPINAL NRV XDRL,,,21,,RBRVS,7.84 ,6.68 ,6.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64774,CPT,EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE,,,21,,RBRVS,5.80 ,5.10 ,5.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64776,CPT,EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT,,,21,,RBRVS,5.60 ,4.82 ,4.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64778,CPT,EXCISION NEUROMA DIGITAL NRV EA ADDL DIGIT,,,21,,RBRVS,3.11 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64782,CPT,EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE,,,21,,RBRVS,6.86 ,5.23 ,5.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64783,CPT,EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT,,,21,,RBRVS,3.71 ,2.08 ,2.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64784,CPT,EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC,,,21,,RBRVS,10.62 ,8.48 ,8.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64786,CPT,EXCISION NEUROMA SCIATIC NERVE,,,21,,RBRVS,16.25 ,11.38 ,11.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64787,CPT,IMPLANTATION NERVE END BONE/MUSCLE,,,21,,RBRVS,4.29 ,2.06 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64788,CPT,EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV,,,21,,RBRVS,5.24 ,5.10 ,5.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64790,CPT,EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV,,,21,,RBRVS,12.10 ,9.05 ,9.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64792,CPT,EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV,,,21,,RBRVS,15.86 ,12.54 ,12.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64795,CPT,BIOPSY NERVE,,,21,,RBRVS,3.01 ,1.78 ,1.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64802,CPT,SYMPATHECTOMY CERVICAL,,,21,,RBRVS,10.37 ,7.56 ,7.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64804,CPT,SYMPATHECTOMY CERVICOTHORACIC,,,21,,RBRVS,15.91 ,8.24 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64809,CPT,SYMPATHECTOMY THORACOLUMBAR,,,21,,RBRVS,14.71 ,9.82 ,9.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 64818,CPT,SYMPATHECTOMY LUMBAR,,,21,,RBRVS,11.34 ,4.76 ,4.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 64820,CPT,SYMPATHECTOMY DIGITAL ARTERIES EACH DIGIT,,,21,,RBRVS,10.74 ,8.38 ,8.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64821,CPT,SYMPATHECTOMY RADIAL ARTERY,,,21,,RBRVS,9.33 ,8.93 ,8.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64822,CPT,SYMPATHECTOMY ULNAR ARTERY,,,21,,RBRVS,9.33 ,8.93 ,8.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64823,CPT,SYMPATHECTOMY SUPERFICIAL PALMAR ARCH,,,21,,RBRVS,10.94 ,9.78 ,9.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64831,CPT,SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE,,,21,,RBRVS,9.16 ,8.87 ,8.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64832,CPT,SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV,,,21,,RBRVS,5.65 ,3.10 ,3.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64834,CPT,SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE,,,21,,RBRVS,10.81 ,8.59 ,8.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64835,CPT,SUTURE 1 NERVE MEDIAN MOTOR THENAR,,,21,,RBRVS,11.73 ,9.19 ,9.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64836,CPT,SUTURE 1 NERVE ULNAR MOTOR,,,21,,RBRVS,11.73 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64837,CPT,SUTURE EACH ADDITIONAL NERVE HAND/FOOT,,,21,,RBRVS,6.25 ,3.50 ,3.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64840,CPT,SUTURE POSTERIOR TIBIAL NERVE,,,21,,RBRVS,14.02 ,11.22 ,11.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64856,CPT,SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS,,,21,,RBRVS,15.07 ,11.16 ,11.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64857,CPT,SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS,,,21,,RBRVS,15.82 ,11.63 ,11.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64858,CPT,SUTURE SCIATIC NERVE,,,21,,RBRVS,17.82 ,11.72 ,11.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64859,CPT,SUTURE EACH ADDITIONAL PERIPHERAL NERVE,,,21,,RBRVS,4.25 ,2.38 ,2.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64861,CPT,SUTURE BRACHIAL PLEXUS,,,21,,RBRVS,20.89 ,13.00 ,13.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64862,CPT,SUTURE LUMBAR PLEXUS,,,21,,RBRVS,21.09 ,15.02 ,15.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64864,CPT,SUTURE FACIAL NERVE EXTRACRANIAL,,,21,,RBRVS,13.41 ,9.91 ,9.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64865,CPT,SUTURE FACIAL NERVE INFRATEMPORAL W/WO GRAFT,,,21,,RBRVS,16.09 ,13.90 ,13.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64866,CPT,ANASTOMOSIS FACIAL-SPINAL ACCESSORY,,,21,,RBRVS,16.83 ,14.01 ,14.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 64868,CPT,ANASTOMOSIS FACIAL HYPOGLOSSAL,,,21,,RBRVS,14.90 ,12.15 ,12.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 64872,CPT,SUTURE NERVE REQ SECONDARY/DELAYED SUTURE,,,21,,RBRVS,1.99 ,1.17 ,1.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64874,CPT,SUTURE NERVE REQ XTNSV MOBIL/TRPOS NERVE,,,21,,RBRVS,2.98 ,1.45 ,1.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64876,CPT,SUTURE NERVE REQ SHORTENING BONE EXTREMITY,,,21,,RBRVS,3.37 ,1.29 ,1.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64885,CPT,NERVE GRAFT HEAD/NECK 4 CM,,,21,,RBRVS,20.82 ,13.71 ,13.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64890,CPT,NERVE GRAFT 1 STRAND HAND/FOOT 4 CM,,,21,,RBRVS,17.35 ,13.28 ,13.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64892,CPT,NERVE GRAFT 1 STRAND ARM/LEG <4 CM,,,21,,RBRVS,15.74 ,11.77 ,11.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64893,CPT,NERVE GRAFT 1 STRAND ARM/LEG >4 CM,,,21,,RBRVS,16.87 ,12.98 ,12.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64895,CPT,NERVE GRAFT MLT STRANDS HAND/FOOT 4 CM,,,21,,RBRVS,21.96 ,15.94 ,15.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64897,CPT,NERVE GRAFT MLT STRANDS ARM/LEG 4 CM,,,21,,RBRVS,20.97 ,14.10 ,14.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64901,CPT,NERVE GRAFT EACH NERVE 1 STRAND,,,21,,RBRVS,10.20 ,4.54 ,4.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64902,CPT,NERVE GRAFT EACH NERVE MULTIPLE STRANDS,,,21,,RBRVS,11.81 ,5.48 ,5.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64905,CPT,NERVE PEDICLE TRANSFER FIRST STAGE,,,21,,RBRVS,15.11 ,11.82 ,11.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64907,CPT,NERVE PEDICAL TRANSFER SECOND STAGE,,,21,,RBRVS,20.03 ,13.54 ,13.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64910,CPT,NERVE REPAIR W/CONDUIT EACH NERVE,,,21,,RBRVS,11.39 ,10.28 ,10.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64911,CPT,NERVE REPAIR W/AUTOGENOUS VEIN GRAFT EA NERVE,,,21,,RBRVS,14.39 ,12.36 ,12.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 64999,CPT,UNLISTED PROCEDURE NERVOUS SYSTEM,,,21,,TotalUnits,,,,3.71 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65091,CPT,EVISCERATION OCULAR CONTENTS W/O IMPLANT,,,21,,RBRVS,7.26 ,10.16 ,10.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65093,CPT,EVISCERATION OCULAR CONTENTS W/IMPLANT,,,21,,RBRVS,7.04 ,10.18 ,10.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65101,CPT,ENUCLEATION OF EYE W/O IMPLANT,,,21,,RBRVS,8.30 ,11.94 ,11.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65103,CPT,ENUCLEATION EYE IMPLT MUSC X ATTACHED IMPLT,,,21,,RBRVS,8.84 ,12.29 ,12.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65105,CPT,ENUCLEATION EYE IMPLT MUSC ATTACHED IMPLT,,,21,,RBRVS,9.93 ,13.34 ,13.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65110,CPT,EXENTERATION ORBIT REMVL ORBITAL CONTENTS ONLY,,,21,,RBRVS,15.70 ,17.65 ,17.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65112,CPT,EXENTERATION ORBIT RMVL ORBIT CONTENTS & BONE,,,21,,RBRVS,18.51 ,20.12 ,20.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65114,CPT,EXNTJ ORBIT RMVL ORB CNTS W/MUSC/MYOQ FLAP,,,21,,RBRVS,19.65 ,20.92 ,20.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65125,CPT,MODIFICAJ OC IMPLT W/PLMT/RPLCMT PEGS SPX,,,21,,RBRVS,3.27 ,4.74 ,9.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65130,CPT,INSJ OC IMPLT SEC AFTER EVSC SCLL SHELL,,,21,,RBRVS,8.42 ,11.65 ,11.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65135,CPT,INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED,,,21,,RBRVS,8.60 ,11.76 ,11.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65140,CPT,INSJ OC IMPLT AFTER ENCL MUSC ATTACHED,,,21,,RBRVS,9.46 ,12.67 ,12.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65150,CPT,REINSERTION OCULAR IMPLT W/WO CONJUNCTIVAL GRAFT,,,21,,RBRVS,6.43 ,9.30 ,9.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65155,CPT,REINSERTION OCULAR IMPLT RNFCMT &/ ATTACH MUSCLE,,,21,,RBRVS,10.10 ,13.07 ,13.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65175,CPT,REMOVAL OCULAR IMPLANT,,,21,,RBRVS,7.40 ,10.63 ,10.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65205,CPT,REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL,,,21,,RBRVS,0.71 ,0.50 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65210,CPT,RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR,,,21,,RBRVS,0.84 ,0.62 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65220,CPT,RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP,,,21,,RBRVS,0.71 ,0.41 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65222,CPT,RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP,,,21,,RBRVS,0.84 ,0.59 ,0.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65235,CPT,RMVL FB INTRAOCULAR ANT CHAMBER EYE/LENS,,,21,,RBRVS,9.01 ,10.47 ,10.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65260,CPT,RMVL FB IO FROM POST SEG MAG XTRJ ANT/POST ROUTE,,,21,,RBRVS,12.54 ,13.74 ,13.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65265,CPT,RMVL FB IO FROM POST SEG NONMAGNETIC XTRJ,,,21,,RBRVS,14.34 ,15.25 ,15.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65270,CPT,RPR LAC CJNC W/WO NONPERFOR LAC SCLERA DIR CLSR,,,21,,RBRVS,1.95 ,1.88 ,5.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65272,CPT,RPR LAC CJNC MOBLJ& REARGMT W/O HOSPITALIZATION,,,21,,RBRVS,4.62 ,4.99 ,9.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65273,CPT,RPR LAC CJNC MOBLJ & REARGMT W/HOSPIZATION,,,21,,RBRVS,5.16 ,5.26 ,5.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 65275,CPT,RPR LAC CORNEA NONPERFOR W/WO RMVL FOREIGN BODY,,,21,,RBRVS,6.29 ,6.35 ,9.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65280,CPT,RPR LAC CORNEA&/SCLERA PERFOR X INVG UVEAL TIS,,,21,,RBRVS,9.10 ,9.26 ,9.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65285,CPT,RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T,,,21,,RBRVS,15.36 ,14.93 ,14.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65286,CPT,RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA,,,21,,RBRVS,6.63 ,6.94 ,12.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65290,CPT,RPR WND EXTRAOCULAR MUSCLE TENDON&/TENON CAPSU,,,21,,RBRVS,6.53 ,6.83 ,6.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65400,CPT,EXCISION LESION CORNEA XCP PTERYGIUM,,,21,,RBRVS,7.50 ,9.04 ,11.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65410,CPT,BIOPSY CORNEA,,,21,,RBRVS,1.47 ,1.38 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65420,CPT,EXCISION/TRANSPOSITION PTERYGIUM W/O GRAFT,,,21,,RBRVS,4.36 ,6.02 ,9.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65426,CPT,EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG,,,21,,RBRVS,6.05 ,7.07 ,11.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65430,CPT,CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE,,,21,,RBRVS,1.47 ,1.36 ,1.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65435,CPT,RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION,,,21,,RBRVS,0.92 ,0.99 ,1.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65436,CPT,RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT,,,21,,RBRVS,4.82 ,5.37 ,5.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65450,CPT,DSTRJ LESION CRYOTHER PHOTO/THERMOCAUTZATION,,,21,,RBRVS,3.47 ,5.38 ,5.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65600,CPT,MULTIPLE PUNCTURES ANTERIOR CORNEA,,,21,,RBRVS,4.20 ,5.25 ,6.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65710,CPT,KERATOPLASTY ANTERIOR LAMELLAR,,,21,,RBRVS,14.45 ,15.83 ,15.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65730,CPT,KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA,,,21,,RBRVS,16.35 ,17.21 ,17.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65750,CPT,KERATOPLASTY PENETRAING APHAKIA,,,21,,RBRVS,16.90 ,16.81 ,16.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65755,CPT,KERATOPLASTY PENETRATING PSEUDOPHAKIA,,,21,,RBRVS,16.79 ,16.74 ,16.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65756,CPT,KERATOPLASTY ENDOTHELIAL,,,21,,RBRVS,16.84 ,15.50 ,15.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65757,CPT,BACKBENCH PREPJ CORNEAL ENDOTHELIAL ALLOGRAFT,,,21,,TotalUnits,,,,4.89 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 65760,CPT,KERATOMILEUSIS,,,21,,TotalUnits,,,,17.90 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65765,CPT,KERATOPHAKIA,,,21,,TotalUnits,,,,43.24 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65767,CPT,EPIKERATOPLASTY,,,21,,TotalUnits,,,,40.26 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65770,CPT,KERATOPROSTHESIS,,,21,,RBRVS,19.74 ,18.61 ,18.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65771,CPT,RADIAL KERATOTOMY,,,21,,TotalUnits,,,,9.84 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65772,CPT,CRNL RELAXING INC CORRJ INDUCED ASTIGMATISM,,,21,,RBRVS,5.09 ,6.06 ,7.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65775,CPT,CRNL WEDGE RESCJ CORRJ INDUCED ASTIGMATISM,,,21,,RBRVS,6.91 ,8.21 ,8.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65778,CPT,PLACE AMNIOTIC MEMBRA OCULAR SURFACE W/O SUTURES,,,21,,RBRVS,1.00 ,0.59 ,39.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65779,CPT,PLACE AMNIOTIC MEMBRANE OCULAR SURFACE SUTURED,,,21,,RBRVS,2.50 ,1.64 ,31.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65780,CPT,OCULAR SURFACE RECONSTRUCTION AMNIOTIC MEMBRANE,,,21,,RBRVS,7.81 ,11.98 ,11.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65781,CPT,OCULAR SURFACE RECONSTRUCTION LIMBAL ALLOGRAFT,,,21,,RBRVS,18.14 ,18.31 ,18.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65782,CPT,OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT,,,21,,RBRVS,15.43 ,16.02 ,16.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65785,CPT,IMPLANTATION INTRASTROMAL CORNEAL RING SEGMENTS,,,21,,RBRVS,5.39 ,4.90 ,53.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65800,CPT,PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX,,,21,,RBRVS,1.53 ,0.96 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65810,CPT,PARACENTSIS ANT CHAM RMVL VITREOUS W/WO AIR INJX,,,21,,RBRVS,5.82 ,6.93 ,6.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65815,CPT,PARACEN ANT CHAM RMVL BLOOD W/WO IRRIG&/AIR IN,,,21,,RBRVS,6.00 ,7.09 ,11.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65820,CPT,GONIOTOMY,,,21,,RBRVS,8.91 ,11.64 ,11.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65850,CPT,TRABECULOTOMY AB EXTERNO,,,21,,RBRVS,11.39 ,11.56 ,11.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65855,CPT,TRABECULOPLASTY BY LASER SURGERY,,,21,,RBRVS,2.66 ,3.96 ,4.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65860,CPT,SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX,,,21,,RBRVS,3.59 ,3.33 ,4.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65865,CPT,SEVERING ADS ANT SEG INCAL TQ SPX GONIOSYNECHIAE,,,21,,RBRVS,5.77 ,7.20 ,7.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65870,CPT,SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE,,,21,,RBRVS,7.39 ,8.80 ,8.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65875,CPT,SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE,,,21,,RBRVS,7.81 ,9.46 ,9.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65880,CPT,SEVERING ADS ANT SEG INCAL SPX CORNEOVITREAL,,,21,,RBRVS,8.36 ,9.74 ,9.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65900,CPT,RMVL EPITHELIAL DOWNGROWTH ANT CHAMBER EYE,,,21,,RBRVS,12.51 ,13.77 ,13.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65920,CPT,RMVL IMPLANTED MATERIAL ANTERIO SEGMENT EYE,,,21,,RBRVS,9.99 ,11.61 ,11.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 65930,CPT,RMVL BLOOD CLOT ANTERIOR SEGMENT EYE,,,21,,RBRVS,8.39 ,9.05 ,9.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66020,CPT,INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX,,,21,,RBRVS,1.64 ,1.97 ,3.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66030,CPT,INJX ANTERIOR CHAMBER EYE MEDICATION SPX,,,21,,RBRVS,1.30 ,1.74 ,3.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66130,CPT,EXCISION LESION SCLERA,,,21,,RBRVS,7.83 ,7.70 ,11.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66150,CPT,FSTLJ SCLERA GLAUCOMA TREPHIN W/IRIDECTOMY,,,21,,RBRVS,10.53 ,13.51 ,13.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66155,CPT,FSTLJ SCLERA GLAUCOMA THERMOCAUT IRRIDEC,,,21,,RBRVS,10.52 ,13.50 ,13.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66160,CPT,FSTLJ SCLERA SCLERECTOMY PUNCH/SCISSORS IRIDECT,,,21,,RBRVS,12.39 ,14.67 ,14.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66170,CPT,FSTLJ SCLERA GLAUCOMA TRABECULECT AB EXTERNO,,,21,,RBRVS,11.27 ,15.39 ,15.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66172,CPT,FSTLJ SCLERA GLC TRBEC AB EXTERNO SCARRING,,,21,,RBRVS,12.57 ,21.17 ,21.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66174,CPT,TRLUML DILAT AQUEOUS CANAL W/O DEVICE/STENT,,,21,,RBRVS,12.85 ,13.04 ,13.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66175,CPT,TRLUML DILAT AQUEOUS CANAL W/DEVICE/STENT,,,21,,RBRVS,13.60 ,13.52 ,13.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66179,CPT,AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT,,,21,,RBRVS,14.00 ,15.49 ,15.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66180,CPT,AQUEOUS SHUNT EXTRAOC EQUAT PLATE RSVR W/GRAFT,,,21,,RBRVS,15.00 ,16.12 ,16.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66183,CPT,INSERT ANTER DRAINAGE DEV W/O EXTRAOC RESERVOIR,,,21,,RBRVS,13.20 ,15.01 ,15.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66184,CPT,REVJ SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT,,,21,,RBRVS,9.58 ,11.94 ,11.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66185,CPT,REVJ AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/GRAFT,,,21,,RBRVS,10.58 ,12.58 ,12.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66220,CPT,REPAIR SCLERAL STAPHYLOMA W/O GRAFT,,,21,,RBRVS,9.21 ,11.25 ,11.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66225,CPT,REPAIR SCLERAL STAPHYLOMA W/GRAFT,,,21,,RBRVS,12.63 ,12.80 ,12.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66250,CPT,REVJ/RPR OPRATIVE WOUND ANTERIOR SEGMENT,,,21,,RBRVS,7.10 ,8.17 ,13.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66500,CPT,IRIDOTOMY STAB INC SPX XCP TRANSFIXION,,,21,,RBRVS,3.83 ,5.90 ,5.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66505,CPT,IRIDOTOMY STAB INC SPX TRANSFIXION,,,21,,RBRVS,4.22 ,6.45 ,6.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66600,CPT,IRDEC CRNLSCLRL/CRNL SCTJ RMVL LES,,,21,,RBRVS,10.12 ,12.67 ,12.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66605,CPT,IRDEC CRNLSCLRL/CRNL SCTJ CYCLECTOMY,,,21,,RBRVS,14.22 ,14.66 ,14.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66625,CPT,IRDEC CRNLSCLRL/CRNL SCTJ PRPH GLC SPX,,,21,,RBRVS,5.30 ,6.47 ,6.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66630,CPT,IRDEC CRNLSCLRL/CRNL SCTJ SECTOR GLC SPX,,,21,,RBRVS,7.28 ,8.31 ,8.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66635,CPT,IRDEC CRNLSCLRL/CRNL SCTJ OPTICAL SPX,,,21,,RBRVS,7.37 ,8.37 ,8.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66680,CPT,REPAIR IRIS CILIARY BODY,,,21,,RBRVS,6.39 ,7.80 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66682,CPT,SUTURE IRIS CILIARY BODY SPX RETRIEVAL SUTURE,,,21,,RBRVS,7.33 ,10.17 ,10.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66700,CPT,CILIARY BODY DESTRUCTION DIATHERMY,,,21,,RBRVS,5.14 ,5.63 ,7.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66710,CPT,CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL,,,21,,RBRVS,5.14 ,5.62 ,6.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66711,CPT,CILIARY BODY DSTRJ CYCLOPHOTOCOAG ENDOSCOPIC,,,21,,RBRVS,7.93 ,9.68 ,9.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66720,CPT,CILIARY BODY DESTRUCTION CRYOTHERAPY,,,21,,RBRVS,5.00 ,6.62 ,8.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66740,CPT,CILIARY BODY DESTRUCTION CYCLODIAL,,,21,,RBRVS,5.14 ,5.63 ,6.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66761,CPT,IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION,,,21,,RBRVS,3.00 ,3.47 ,5.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66762,CPT,IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS,,,21,,RBRVS,5.38 ,6.31 ,7.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66770,CPT,DSTRJ CYST/LESION IRIS/CILIARY BODY,,,21,,RBRVS,6.13 ,7.12 ,8.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66820,CPT,DISCISSION SECONDARY MEMBRANOUS CATARACT,,,21,,RBRVS,4.01 ,6.82 ,6.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66821,CPT,POST-CATARACT LASER SURGERY,,,21,,RBRVS,3.42 ,5.14 ,5.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66825,CPT,REPOSITIONING IO LENS PROSTHESIS REQ INC SPX,,,21,,RBRVS,9.01 ,11.84 ,11.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66830,CPT,RMVL SEC MEMBRANOUS CTRC CORNEO-SCLL SCTJ,,,21,,RBRVS,9.47 ,10.01 ,10.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66840,CPT,RMVL LENS MATERIAL ASPIR TQ 1/> STAGES,,,21,,RBRVS,9.18 ,9.88 ,9.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66850,CPT,RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR,,,21,,RBRVS,10.55 ,11.13 ,11.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66852,CPT,RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY,,,21,,RBRVS,11.41 ,11.68 ,11.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66920,CPT,RMVL LENS MATERIAL INTRACAPSULAR,,,21,,RBRVS,10.13 ,10.49 ,10.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66930,CPT,REMOVAL LENS MATRL INTRACAPSULAR DISLOCATED LENS,,,21,,RBRVS,11.61 ,11.81 ,11.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66940,CPT,REMOVAL LENS MATERIAL EXTRACAPSULAR,,,21,,RBRVS,10.37 ,11.03 ,11.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66982,CPT,XCAPSULAR CATARACT RMVL INSJ LENS PROSTH 1 STG,,,21,,RBRVS,11.08 ,10.64 ,10.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66983,CPT,ICAPSULAR CATARACT XTRJ INSJ IO LENS PRSTH 1 STG,,,21,,RBRVS,10.43 ,9.88 ,9.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66984,CPT,CATARACT REMOVAL INSERTION OF LENS,,,21,,RBRVS,8.52 ,8.98 ,8.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66985,CPT,INSJ IO LENS PROSTHESIS NOT W/CONCURRENT RMVL,,,21,,RBRVS,9.98 ,11.11 ,11.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66986,CPT,EXCHANGE INTRAOCULAR LENS,,,21,,RBRVS,12.26 ,12.58 ,12.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66990,CPT,USE OPHTHALMIC ENDOSCOPE,,,21,,RBRVS,1.51 ,0.95 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 66999,CPT,UNLISTED PROCEDURE ANTERIOR SEGMENT EYE,,,21,,TotalUnits,,,,17.50 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67005,CPT,RMVL VITREOUS ANT APPR PARTIAL REMOVAL,,,21,,RBRVS,5.89 ,7.07 ,7.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67010,CPT,RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT,,,21,,RBRVS,7.06 ,7.79 ,7.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67015,CPT,ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL,,,21,,RBRVS,7.14 ,8.76 ,8.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67025,CPT,INJ SUBSTITUTE PARS PLANA/LIMBL W/WO ASPIR SPX,,,21,,RBRVS,8.11 ,9.22 ,11.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67027,CPT,IMPLTJ INTRAVITREAL DRUG DLVR SYS RMVL VTS,,,21,,RBRVS,11.62 ,11.68 ,11.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67028,CPT,INTRAVITREAL NJX PHARMACOLOGIC AGT SPX,,,21,,RBRVS,1.44 ,1.29 ,1.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67030,CPT,DISCISSION VITREOUS STRANS PARS PLANA APPROACH,,,21,,RBRVS,6.11 ,8.50 ,8.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67031,CPT,SEVERING VITREOUS STRANS LASER 1/> STAGES,,,21,,RBRVS,4.47 ,5.31 ,6.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67036,CPT,VITRECTOMY MECHANICAL PARS PLANA,,,21,,RBRVS,12.13 ,12.52 ,12.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67039,CPT,VITRECTOMY MCHNL PARS PLNA FOCAL ENDOLASER PC,,,21,,RBRVS,13.20 ,13.19 ,13.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67040,CPT,VTRECTOMY MCHNL PARS PLNA ENDOLASER PANRTA PC,,,21,,RBRVS,14.50 ,14.00 ,14.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67041,CPT,VITRECTOMY PARS PLANA REMOVE PRERETINAL MEMBRANE,,,21,,RBRVS,16.33 ,15.14 ,15.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67042,CPT,VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA,,,21,,RBRVS,16.33 ,15.15 ,15.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67043,CPT,VITRECTOMY PARS PLANA REMOVE SUBRETINAL MEMBRANE,,,21,,RBRVS,17.40 ,15.82 ,15.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67101,CPT,RPR RETINAL DTCHMNT 1/>SES CRYOTX/DTHRM INCL DRG,,,21,,RBRVS,8.80 ,9.65 ,12.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67105,CPT,RPR RETINAL DTCHMNT 1/> SES PC INCL SUBRETI DRG,,,21,,RBRVS,8.53 ,9.09 ,11.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67107,CPT,REPAIR RETINAL DETACHMENT SCLERAL BUCKLING,,,21,,RBRVS,14.06 ,13.73 ,13.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67108,CPT,RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH,,,21,,RBRVS,15.19 ,20.45 ,20.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67110,CPT,RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS,,,21,,RBRVS,8.31 ,10.81 ,12.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67113,CPT,RPR COMPLEX RETINA DETACH VITRECT &MEMBRANE PEEL,,,21,,RBRVS,19.00 ,19.56 ,19.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67115,CPT,RELEASE ENCIRCLING MATERIAL POSTERIOR SEGMENT,,,21,,RBRVS,6.11 ,7.59 ,7.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67120,CPT,RMVL IMPLNT MATL POSTERIOR SEGMENT EXTRAOCULAR,,,21,,RBRVS,7.10 ,8.19 ,10.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67121,CPT,RMVL IMPLT MATRL POSTERIOR SEGMENT INTRAOCULAR,,,21,,RBRVS,12.25 ,12.59 ,12.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67141,CPT,PROPH RTA DTCHMNT W/O DRG 1/> SESS CRTX DTHRM,,,21,,RBRVS,6.15 ,7.22 ,8.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67145,CPT,PROPH RTA DTCHMNT W/O DRG 1/> SESS,,,21,,RBRVS,6.32 ,7.33 ,8.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67208,CPT,DSTRJ LOCLZD LESION RETINA 1/> SESS CRTX DTHRM,,,21,,RBRVS,7.65 ,8.18 ,8.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67210,CPT,DSTRJ LOCLZD LESION RETINA 1/> SESS PC,,,21,,RBRVS,6.36 ,7.35 ,7.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67218,CPT,DSTRJ LESION RETINA 1/> SESS RADJ IMPLTJ,,,21,,RBRVS,20.36 ,17.37 ,17.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67220,CPT,DSTRJ LESION CHOROID PC 1/> SESS,,,21,,RBRVS,6.36 ,7.35 ,8.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67221,CPT,DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY,,,21,,RBRVS,3.45 ,2.36 ,4.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67225,CPT,DSTRJ LESION CHOROID PDT 2ND EYE 1 SESSION,,,21,,RBRVS,0.47 ,0.29 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67227,CPT,DESTRUCTION RETINOPATHY CRYOTHERAPY DIATHERMY,,,21,,RBRVS,3.50 ,3.53 ,4.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67228,CPT,TREATMENT EXTENSIVE RETINOPATHY PHOTOCOAGULATION,,,21,,RBRVS,4.39 ,4.00 ,4.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67229,CPT,EXTENSIVE RETINOPATHY 1/> SESS PRETERM INFANT,,,21,,RBRVS,16.30 ,13.78 ,13.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67250,CPT,SCLERAL REINFORCEMENT SPX W/O GRAFT,,,21,,RBRVS,9.61 ,11.79 ,11.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67255,CPT,SCLERAL REINFORCEMENT SPX W/GRAFT,,,21,,RBRVS,8.38 ,10.35 ,10.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67299,CPT,UNLISTED PROCEDURE POSTERIOR SEGMENT,,,21,,TotalUnits,,,,2.78 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67311,CPT,STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC,,,21,,RBRVS,7.77 ,8.60 ,8.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67312,CPT,STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC,,,21,,RBRVS,9.66 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67314,CPT,STRABISMUS RECESSION/RESCJ 1 VER MUSC,,,21,,RBRVS,8.79 ,9.64 ,9.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67316,CPT,STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC,,,21,,RBRVS,10.93 ,10.97 ,10.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67318,CPT,STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE,,,21,,RBRVS,9.12 ,10.16 ,10.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67320,CPT,TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC,,,21,,RBRVS,5.40 ,3.37 ,3.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67331,CPT,STRABISMUS PREVIOUS EYE X INVOLVE EO MUSC,,,21,,RBRVS,5.13 ,3.19 ,3.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67332,CPT,STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY,,,21,,RBRVS,5.56 ,3.47 ,3.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67334,CPT,STRABISMUS POST FIXJ SUTR TQ W/WO MUSC RECESSION,,,21,,RBRVS,5.05 ,3.16 ,3.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67335,CPT,PLACEMENT ADJUSTABLE SUTURE STRABISMUS,,,21,,RBRVS,2.49 ,1.55 ,1.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67340,CPT,STRABISMUS EXPL&/RPR DETACHED EXTROCULAR MUSC,,,21,,RBRVS,6.00 ,3.76 ,3.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67343,CPT,RLS XTNSV SCAR TISS W/O DETACHING EO MUSC SPX,,,21,,RBRVS,8.47 ,9.42 ,9.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67345,CPT,CHEMODENERVATION EXTRAOCULAR MUSCLE,,,21,,RBRVS,3.01 ,2.78 ,3.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67346,CPT,BIOPSY EXTRAOCULAR MUSCLE,,,21,,RBRVS,2.87 ,2.39 ,2.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67399,CPT,UNLISTED PROCEDURE EXTRAOCULAR MUSCLE,,,21,,TotalUnits,,,,16.37 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67400,CPT,ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY,,,21,,RBRVS,11.20 ,14.26 ,14.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67405,CPT,ORBITOTOMY W/O BONE FLAP EXPL W/DRAINAGE ONLY,,,21,,RBRVS,9.20 ,12.51 ,12.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67412,CPT,ORBITOTOMY W/O BONE FLAP W/REMOVAL LESION,,,21,,RBRVS,10.30 ,12.99 ,12.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67413,CPT,ORBITOTOMY W/O BONE FLAP W/RMVL FOREIGN BODY,,,21,,RBRVS,10.24 ,13.14 ,13.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67414,CPT,ORBITOTOMY W/O BONE FLAP W/RMVL BONE DCMPRN,,,21,,RBRVS,17.94 ,18.18 ,18.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67415,CPT,FINE NEEDLE ASPIRATION ORBITAL CONTENTS,,,21,,RBRVS,1.76 ,1.08 ,1.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67420,CPT,ORBITOTOMY BONE FLAP/WINDOW LAT RMVL LESION,,,21,,RBRVS,21.87 ,22.08 ,22.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67430,CPT,ORBITOTOMY BONE FLAP/WINDOW LATERAL RMVL FB,,,21,,RBRVS,15.29 ,18.58 ,18.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67440,CPT,ORBITOTOMY BONE FLAP/WINDOW LATERAL W/DRG,,,21,,RBRVS,14.84 ,17.95 ,17.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67445,CPT,ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN,,,21,,RBRVS,19.12 ,19.04 ,19.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67450,CPT,ORBITOTOMY BONE FLAP/WINDOW LAT EXPL W/WO BX,,,21,,RBRVS,15.41 ,18.78 ,18.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67500,CPT,RETROBULBAR INJECTION MEDICATION SPX,,,21,,RBRVS,1.44 ,0.50 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67505,CPT,RETROBULBAR INJECTION ALCOHOL,,,21,,RBRVS,1.27 ,0.95 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67515,CPT,INJECTION MEDICATION/OTHER SUBST TENON CAPSULE,,,21,,RBRVS,1.40 ,1.03 ,1.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67550,CPT,ORBITAL IMPLANT INSERTION,,,21,,RBRVS,11.77 ,14.61 ,14.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67560,CPT,ORBITAL IMPLANT REMOVAL/REVISION,,,21,,RBRVS,12.18 ,14.83 ,14.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67570,CPT,OPTIC NERVE DECOMPRESSION,,,21,,RBRVS,14.40 ,16.72 ,16.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67599,CPT,UNLISTED PROCEDURE ORBIT,,,21,,TotalUnits,,,,2.62 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67700,CPT,BLEPHAROTOMY DRAINAGE ABSCESS EYELID,,,21,,RBRVS,1.40 ,1.79 ,6.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67710,CPT,SEVERING TARSORRHAPHY,,,21,,RBRVS,1.07 ,1.61 ,5.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67715,CPT,CANTHOTOMY SEPARATE PROCEDURE,,,21,,RBRVS,1.27 ,1.69 ,5.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67800,CPT,EXCISION CHALAZION SINGLE,,,21,,RBRVS,1.41 ,1.42 ,2.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67801,CPT,EXCISION CHALAZION MULTIPLE SAME LID,,,21,,RBRVS,1.91 ,1.74 ,2.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67805,CPT,EXCISION CHALAZION MULTIPLE DIFFERENT LIDS,,,21,,RBRVS,2.27 ,2.23 ,3.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67808,CPT,EXC CHALAZION ANES REQ HOSPIZATION SINGLE/MULT,,,21,,RBRVS,4.60 ,5.50 ,5.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67810,CPT,INCISIONAL BIOPSY EYELID SKIN & LID MARGIN,,,21,,RBRVS,1.18 ,0.72 ,3.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67820,CPT,CORRECTION TRICHIASIS EPILATION FORCEPS ONLY,,,21,,RBRVS,0.71 ,0.76 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67825,CPT,CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS,,,21,,RBRVS,1.43 ,1.91 ,2.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67830,CPT,CORRECTION TRICHIASIS INCCISION LID MARGIN,,,21,,RBRVS,1.75 ,2.03 ,5.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67835,CPT,CORRJ TRICHIASIS INC LID MRGN W/FR MUC MEMB GRF,,,21,,RBRVS,5.70 ,6.29 ,6.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67840,CPT,EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE,,,21,,RBRVS,2.09 ,2.24 ,5.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67850,CPT,DESTRUCTION LESION LID MARGIN ONE-FOURTH LID MARGIN,,,21,,RBRVS,5.86 ,6.58 ,9.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67966,CPT,EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN,,,21,,RBRVS,8.97 ,8.96 ,12.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 67971,CPT,RCNSTJ EYELID FULL THICKNESS 1 CM,,,21,,RBRVS,2.41 ,2.63 ,6.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68130,CPT,EXCISION LESION CONJUNCTIVA ADJACENT SCLERA,,,21,,RBRVS,5.10 ,6.21 ,9.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68135,CPT,DESTRUCTION LESION CONJUNCTIVA,,,21,,RBRVS,1.89 ,2.25 ,2.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68200,CPT,SUBCONJUNCTIVAL INJECTION,,,21,,RBRVS,0.49 ,0.46 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68320,CPT,CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT,,,21,,RBRVS,6.64 ,8.14 ,13.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68325,CPT,CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT,,,21,,RBRVS,8.63 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68326,CPT,CJP RCNSTJ CUL-DE-SAC BUCCAL GRF/XTNSV REARRGMT,,,21,,RBRVS,8.42 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68328,CPT,CONJUNCTPL CUL-DE-SAC W/BUCCAL MUC MEMB GRAFT,,,21,,RBRVS,9.45 ,9.89 ,9.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68330,CPT,RPR SYMBLEPHARON CONJUNCTIVOPLASTY W/O GRAFT,,,21,,RBRVS,5.78 ,6.86 ,10.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68335,CPT,RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB,,,21,,RBRVS,8.46 ,9.27 ,9.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68340,CPT,RPR & DIV SYMBLEPHARON W/WO CONFORM/CONTACT LE,,,21,,RBRVS,4.97 ,5.98 ,10.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68360,CPT,CONJUNCTIVAL FLAP BRIDGE/PARTIAL SPX,,,21,,RBRVS,5.17 ,6.11 ,9.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68362,CPT,CONJUNCTIVAL FLAP TOTAL,,,21,,RBRVS,8.61 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68371,CPT,HARVESTING CONJUNCIVAL ALLOGRAPHY LIVING DONOR,,,21,,RBRVS,5.09 ,6.24 ,6.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68399,CPT,UNLISTED PROCEDURE CONJUNCTIVA,,,21,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68400,CPT,INCISION DRAINAGE LACRIMAL GLAND,,,21,,RBRVS,1.74 ,1.87 ,6.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68420,CPT,INCISION DRAINAGE LACRIMAL SAC,,,21,,RBRVS,2.35 ,2.24 ,6.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68440,CPT,SNIP INCISION LACRIMAL PUNCTUM,,,21,,RBRVS,0.99 ,1.75 ,1.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68500,CPT,EXCISION LACRIMAL GLAND XCPT TUMOR TOTAL,,,21,,RBRVS,12.77 ,13.92 ,13.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68505,CPT,EXCISION LACRIMAL GLAND XCPT TUMOR PRTL,,,21,,RBRVS,12.69 ,13.82 ,13.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68510,CPT,BIOPSY LACRIMAL GLAND,,,21,,RBRVS,4.60 ,3.35 ,7.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68520,CPT,EXCISION LACRIMAL SAC,,,21,,RBRVS,8.78 ,9.99 ,9.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68525,CPT,BIOPSY LACRIMAL SAC,,,21,,RBRVS,4.42 ,2.72 ,2.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68530,CPT,RMVL FB/DACRYOLITH LACRIMAL PASSAGES,,,21,,RBRVS,3.70 ,3.33 ,8.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68540,CPT,EXC LACRIMAL GLAND TUMOR FRONTAL APPROACH,,,21,,RBRVS,12.18 ,13.25 ,13.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68550,CPT,EXC LACRIMAL GLAND TUMOR W/OSTEOTOMY,,,21,,RBRVS,15.16 ,14.49 ,14.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68700,CPT,PLASTIC REPAIR CANALICULI,,,21,,RBRVS,7.87 ,8.65 ,8.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68705,CPT,CORRECTION EVERTED PUNCTUM CAUTERY,,,21,,RBRVS,2.11 ,2.45 ,4.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68720,CPT,DACRYOCSTORHINOSTOMY,,,21,,RBRVS,9.96 ,10.71 ,10.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68745,CPT,CONJUNCTIVORHINOSTOMY W/O TUBE,,,21,,RBRVS,9.90 ,10.90 ,10.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68750,CPT,CONJUNCTIVORHINOSTOMY INSJ TUBE/STENT,,,21,,RBRVS,10.10 ,11.40 ,11.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68760,CPT,CLSR LACRIMAL PUNCTUM THERMOCAUT LIG/LASER,,,21,,RBRVS,1.78 ,2.23 ,3.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68761,CPT,CLSR LACRIMAL PUNCTUM PLUG EACH,,,21,,RBRVS,1.41 ,1.87 ,2.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68770,CPT,CLOSURE LACRIMAL FISTULA SPX,,,21,,RBRVS,8.29 ,8.92 ,8.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68801,CPT,DILATION LACRIMAL PUNCTUM W/WO IRRGATION,,,21,,RBRVS,0.82 ,1.59 ,1.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68810,CPT,PROBE NASOLACRIMAL DUCT W/WO IRRIGATION,,,21,,RBRVS,1.54 ,2.65 ,3.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68811,CPT,PROBE NASOLACRIMAL DUCT W/WO IRRIG REQ GEN ANES,,,21,,RBRVS,1.74 ,2.85 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68815,CPT,PROBE NASOLACRIMAL DUCT W/WO IRRG INSJ TUBE/STNT,,,21,,RBRVS,2.70 ,3.38 ,8.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68816,CPT,PROBE NASOLACRIMAL DUCT WITH CATHETER DILATION,,,21,,RBRVS,2.10 ,3.47 ,15.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68840,CPT,PROBE LACRIMAL CANALICULI W/WO IRRIGATION,,,21,,RBRVS,1.30 ,1.92 ,2.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68850,CPT,INJECTION CONTRAST MEDIUM DACRYOCYSTOGRAPY,,,21,,RBRVS,0.80 ,0.72 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 68899,CPT,UNLISTED PROCEDURE LACRIMAL SYSTEM,,,21,,TotalUnits,,,,4.07 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69000,CPT,DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE,,,21,,RBRVS,1.50 ,1.73 ,3.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69005,CPT,DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX,,,21,,RBRVS,2.16 ,2.06 ,3.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69020,CPT,DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS,,,21,,RBRVS,1.53 ,2.35 ,4.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69090,CPT,EAR PIERCING,,,14,,TotalUnits,,,,1.09 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69100,CPT,BIOPSY EXTERNAL EAR,,,21,,RBRVS,0.81 ,0.49 ,1.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69105,CPT,BIOPSY EXTERNAL AUDITORY CANAL,,,21,,RBRVS,0.85 ,0.87 ,3.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69110,CPT,EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR,,,21,,RBRVS,3.53 ,5.24 ,9.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69120,CPT,EXCISION EXTERNAL EAR COMPLETE AMPUTATION,,,21,,RBRVS,4.14 ,6.97 ,6.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69140,CPT,EXCISION EXOSTOSIS EXTERNAL AUDITORY CANAL,,,21,,RBRVS,8.14 ,15.99 ,15.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69145,CPT,EXCISION SOFT TIS LESION EXTERNAL AUDITORY CANAL,,,21,,RBRVS,2.70 ,4.12 ,8.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69150,CPT,RAD EXC XTRNL AUDITORY CANAL LES W/O NCK DSJ,,,21,,RBRVS,13.61 ,14.54 ,14.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69155,CPT,RAD EXC XTRNL AUDITORY CANAL LES NCK DSJ,,,21,,RBRVS,23.35 ,21.42 ,21.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 69200,CPT,RMVL FB XTRNL AUDITORY CANAL W/O ANES,,,21,,RBRVS,0.77 ,0.49 ,1.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69205,CPT,RMVL FB XTRNL AUDITORY CANAL ANES,,,21,,RBRVS,1.21 ,1.55 ,1.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69209,CPT,REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT,,TC,21,,RBRVS,,0.35 ,0.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 69210,CPT,REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,,,21,,RBRVS,0.61 ,0.26 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69220,CPT,DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE,,,21,,RBRVS,0.83 ,0.55 ,2.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69222,CPT,DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX,,,21,,RBRVS,1.45 ,2.29 ,4.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69300,CPT,OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ,,,21,,RBRVS,6.69 ,6.17 ,13.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69310,CPT,RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX,,,21,,RBRVS,10.97 ,18.90 ,18.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69320,CPT,RCNSTJ XTRNL AUD CANAL CONGENITAL ATRESIA 1 STG,,,21,,RBRVS,17.18 ,24.79 ,24.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69399,CPT,UNLISTED PROCEDURE EXTERNAL EAR,,,21,,TotalUnits,,,,1.32 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69420,CPT,MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ,,,21,,RBRVS,1.38 ,1.90 ,3.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69421,CPT,MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ ANES,,,21,,RBRVS,1.78 ,2.26 ,2.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69424,CPT,VENTILATING TUBE RMVL REQUIRING GENERAL ANES,,,21,,RBRVS,0.85 ,0.83 ,2.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69433,CPT,TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA,,,21,,RBRVS,1.57 ,2.03 ,4.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69436,CPT,TYMPANOSTOMY GENERAL ANESTHESIA,,,21,,RBRVS,2.01 ,2.33 ,2.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69440,CPT,MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC,,,21,,RBRVS,7.71 ,11.09 ,11.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69450,CPT,TYMPANOLYSIS TRANSCANAL,,,21,,RBRVS,5.69 ,9.22 ,9.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69501,CPT,TRANSMASTOID ANTROTOMY,,,21,,RBRVS,9.21 ,10.64 ,10.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69502,CPT,MASTOIDECTOMY COMPLETE,,,21,,RBRVS,12.56 ,13.69 ,13.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69505,CPT,MASTOIDECTOMY MODIFIED RADICAL,,,21,,RBRVS,13.17 ,19.67 ,19.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69511,CPT,MASTOIDECTOMY RADICAL,,,21,,RBRVS,13.70 ,19.84 ,19.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69530,CPT,PETROUS APICECTOMY RADICAL MASTOIDECTOMY,,,21,,RBRVS,20.38 ,24.50 ,24.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69535,CPT,RESCJ TEMPORAL BONE EXTERNAL APPROACH,,,21,,RBRVS,37.42 ,34.27 ,34.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 69540,CPT,EXCISION AURAL POLYP,,,21,,RBRVS,1.25 ,2.24 ,4.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69550,CPT,EXCISION AURAL GLOMUS TUMOR TRANSCANAL,,,21,,RBRVS,11.15 ,17.34 ,17.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69552,CPT,EXCISION AURAL GLOMUS TUMOR TRANSMASTOID,,,21,,RBRVS,19.81 ,22.52 ,22.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69554,CPT,EXCISION AURAL GLOMUS TUMOR EXTENDED,,,21,,RBRVS,35.97 ,29.30 ,29.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 69601,CPT,REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY,,,21,,RBRVS,13.45 ,14.85 ,14.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69602,CPT,REVJ MASTOIDECTOMY RSLTG MODF RAD MSTDC,,,21,,RBRVS,13.76 ,15.70 ,15.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69603,CPT,REVJ MASTOIDECTOMY RSLTG RAD MASTOIDECTOMY,,,21,,RBRVS,14.20 ,20.40 ,20.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69604,CPT,REVJ MASTOIDECTOMY RSLTG TYMPANOPLASTY,,,21,,RBRVS,14.20 ,15.90 ,15.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69605,CPT,REVJ MASTOIDECTOMY W/APICECTOMY,,,21,,RBRVS,18.69 ,23.72 ,23.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69610,CPT,TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH,,,21,,RBRVS,4.47 ,3.30 ,5.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69620,CPT,MYRINGOPLASTY,,,21,,RBRVS,6.03 ,7.23 ,13.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69631,CPT,TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ,,,21,,RBRVS,10.05 ,14.04 ,14.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69632,CPT,TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ,,,21,,RBRVS,12.96 ,16.28 ,16.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69633,CPT,TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP,,,21,,RBRVS,12.31 ,16.07 ,16.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69635,CPT,TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ,,,21,,RBRVS,13.51 ,20.15 ,20.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69636,CPT,TYMPP ANTRT/MASTOID W/OSSICULAR CHAIN RECNSTJ,,,21,,RBRVS,15.43 ,22.30 ,22.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69637,CPT,TMPP ANTRT/MASTOIDOTOMY PROSTHESIS TORP,,,21,,RBRVS,15.32 ,22.20 ,22.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69641,CPT,TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ,,,21,,RBRVS,12.89 ,15.35 ,15.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69642,CPT,TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ,,,21,,RBRVS,17.06 ,19.08 ,19.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69643,CPT,TMPP MASTOIDECT NTC/RCNSTED WALL W/O OCR,,,21,,RBRVS,15.59 ,17.52 ,17.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69644,CPT,TMPP MASTOIDECT NTC/RCNSTED CANAL WALL OCR,,,21,,RBRVS,17.23 ,23.01 ,23.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69645,CPT,TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR,,,21,,RBRVS,16.71 ,22.86 ,22.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69646,CPT,TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR,,,21,,RBRVS,18.37 ,23.61 ,23.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69650,CPT,STAPES MOBILIZATION,,,21,,RBRVS,9.80 ,12.09 ,12.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69660,CPT,STAPEDECTOMY/STAPEDOTOMY,,,21,,RBRVS,12.03 ,13.03 ,13.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69661,CPT,STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT,,,21,,RBRVS,15.92 ,16.70 ,16.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69662,CPT,REVISION STAPEDECTOMY/STAPEDOTOMY,,,21,,RBRVS,15.60 ,15.60 ,15.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69666,CPT,REPAIR OVAL WINDOW FISTULA,,,21,,RBRVS,9.89 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69667,CPT,REPAIR ROUND WINDOW FISTULA,,,21,,RBRVS,9.90 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69670,CPT,MASTOID OBLITERATION SEPARATE PROCEDURE,,,21,,RBRVS,11.73 ,13.92 ,13.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69676,CPT,TYMPANIC NEURECTOMY,,,21,,RBRVS,9.69 ,12.92 ,12.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69700,CPT,CLOSURE POSTAURICULAR FISTULA MASTOID SPX,,,21,,RBRVS,8.37 ,10.23 ,10.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69710,CPT,IMPLTJ/RPLCMT EMGNT BONE CNDJ DEV TEMPORAL BONE,,,21,,TotalUnits,,,,19.59 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69711,CPT,RMVL/RPR EMGNT BONE CNDJ DEV TEMPORAL BONE,,,21,,RBRVS,10.62 ,12.85 ,12.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69714,CPT,IMPLTJ OSSEOINTEGRATED TEMPORAL BONE W/MASTOID,,,21,,RBRVS,14.45 ,14.59 ,14.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69715,CPT,IMPLJ OSSEOINTEGRATED TEMPORAL BONE W/O MASTOID,,,21,,RBRVS,18.96 ,16.74 ,16.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69717,CPT,RPLMCT OSSEOINTEGRATE IMPLNT W/O MASTOIDECTOMY,,,21,,RBRVS,15.43 ,15.06 ,15.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69718,CPT,RPLMCT OSSEOINTEGRATE IMPLNT W/MASTOIDECTOMY,,,21,,RBRVS,19.21 ,16.85 ,16.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69720,CPT,DCMPRN FACIAL NRV INTRATEMPORAL LAT GANGLION,,,21,,RBRVS,14.71 ,17.89 ,17.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69725,CPT,DCMPRN NRV INTRATEMPORAL MEDIAL GENICULATE,,,21,,RBRVS,27.64 ,22.77 ,22.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69740,CPT,SUTR NRV ITPRL W/WO GRF/DCMPRN LAT GENICULATE,,,21,,RBRVS,16.27 ,15.14 ,15.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69745,CPT,SUTR NRV ITPRL W/WO GRF/DCMPRN MEDIAL GENICULATE,,,21,,RBRVS,17.02 ,18.65 ,18.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69799,CPT,UNLISTED PROCEDURE MIDDLE EAR,,,21,,TotalUnits,,,,5.49 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69801,CPT,LABYRINTHOTOMY TRANSCANAL,,,21,,RBRVS,2.06 ,1.28 ,3.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69805,CPT,ENDOLYMPHATIC SAC W/O SHUNT,,,21,,RBRVS,14.71 ,13.66 ,13.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69806,CPT,ENDOLYMPHATIC SAC SHUNT,,,21,,RBRVS,12.63 ,12.89 ,12.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69820,CPT,FENESTRATION SEMICIRCULAR CANAL,,,21,,RBRVS,10.52 ,12.73 ,12.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69840,CPT,REVISION FENESTRATION OPERATION,,,21,,RBRVS,10.44 ,14.35 ,14.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69905,CPT,LABYRINTHECTOMY TRANSCANAL,,,21,,RBRVS,11.26 ,13.63 ,13.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69910,CPT,LABYRINTHECTOMY W/MASTOIDECTOMY,,,21,,RBRVS,13.91 ,13.50 ,13.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69915,CPT,VESTIBULAR NRV SECTION TRANSLABYRINTHINE APPR,,,21,,RBRVS,22.77 ,18.46 ,18.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69930,CPT,COCHLEAR DEVICE IMPLANTATION W/WO MASTOIDECTOMY,,,21,,RBRVS,17.73 ,15.13 ,15.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69949,CPT,UNLISTED PROCEDURE INNER EAR,,,21,,TotalUnits,,,,32.86 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69950,CPT,VESTIBULAR NRV SECTION TRANSCRANIAL APPROACH,,,21,,RBRVS,27.63 ,19.97 ,19.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 69955,CPT,TOTAL FACIAL NERVE DECOMPRESSION &/REPAIR,,,21,,RBRVS,29.42 ,23.98 ,23.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69960,CPT,DECOMPRESSION INTERNAL AUDITORY CANAL,,,21,,RBRVS,29.42 ,22.04 ,22.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69970,CPT,REMOVAL TUMOR TEMPORAL BONE,,,21,,RBRVS,32.41 ,24.83 ,24.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69979,CPT,UNLISTED PROCEDURE TEMPORAL BONE MIDDLE FOSSA,,,21,,TotalUnits,,,,51.46 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 69990,CPT,MICROSURG TQS REQ USE OPERATING MICROSCOPE,,,21,,RBRVS,3.46 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70010,CPT,MYELOGRAPY POST FOSSA RS&I,,,20,,TotalUnits,,,,1.65 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70010,CPT,MYELOGRAPY POST FOSSA RS&I,26,,20,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70010,CPT,MYELOGRAPY POST FOSSA RS&I,TC,,20,,TotalUnits,,,,1.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70015,CPT,CISTERNOGRAPHY POSITIVE CONTRAST RS&I,,,20,,RBRVS,1.19 ,2.99 ,2.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70015,CPT,CISTERNOGRAPHY POSITIVE CONTRAST RS&I,26,,20,,RBRVS,1.19 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70015,CPT,CISTERNOGRAPHY POSITIVE CONTRAST RS&I,TC,,20,,RBRVS,,2.54 ,2.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70030,CPT,RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY,,,20,,RBRVS,0.17 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70030,CPT,RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY,26,,20,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70030,CPT,RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY,TC,,20,,RBRVS,,0.53 ,0.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70100,CPT,RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS,,,20,,RBRVS,0.18 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70100,CPT,RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS,26,,20,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70100,CPT,RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS,TC,,20,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70110,CPT,RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS,,,20,,RBRVS,0.25 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70110,CPT,RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS,26,,20,,RBRVS,0.25 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70110,CPT,RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS,TC,,20,,RBRVS,,0.69 ,0.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70120,CPT,RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE,,,20,,RBRVS,0.18 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70120,CPT,RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE,26,,20,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70120,CPT,RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE,TC,,20,,RBRVS,,0.68 ,0.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70130,CPT,RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE,,,20,,RBRVS,0.34 ,1.16 ,1.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70130,CPT,RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE,26,,20,,RBRVS,0.34 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70130,CPT,RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE,TC,,20,,RBRVS,,1.03 ,1.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70134,CPT,RADEX INTERNAL AUDITORY MEATI COMPLETE,,,20,,RBRVS,0.34 ,1.08 ,1.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70134,CPT,RADEX INTERNAL AUDITORY MEATI COMPLETE,26,,20,,RBRVS,0.34 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70134,CPT,RADEX INTERNAL AUDITORY MEATI COMPLETE,TC,,20,,RBRVS,,0.93 ,0.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70140,CPT,RADEX FACIAL BONES < 3 VIEWS,,,20,,RBRVS,0.19 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70140,CPT,RADEX FACIAL BONES < 3 VIEWS,26,,20,,RBRVS,0.19 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70140,CPT,RADEX FACIAL BONES < 3 VIEWS,TC,,20,,RBRVS,,0.52 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70150,CPT,RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS,,,20,,RBRVS,0.26 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70150,CPT,RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS,26,,20,,RBRVS,0.26 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70150,CPT,RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS,TC,,20,,RBRVS,,0.77 ,0.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70160,CPT,RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS,,,20,,RBRVS,0.17 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70160,CPT,RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS,26,,20,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70160,CPT,RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS,TC,,20,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70170,CPT,DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I,,,20,,TotalUnits,,,,1.03 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70170,CPT,DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I,26,,20,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70170,CPT,DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I,TC,,20,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70190,CPT,RADEX OPTIC FORAMINA,,,20,,RBRVS,0.21 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70190,CPT,RADEX OPTIC FORAMINA,26,,20,,RBRVS,0.21 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70190,CPT,RADEX OPTIC FORAMINA,TC,,20,,RBRVS,,0.67 ,0.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70200,CPT,RADEX ORBITS COMPLETE MINIMUM 4 VIEWS,,,20,,RBRVS,0.28 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70200,CPT,RADEX ORBITS COMPLETE MINIMUM 4 VIEWS,26,,20,,RBRVS,0.28 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70200,CPT,RADEX ORBITS COMPLETE MINIMUM 4 VIEWS,TC,,20,,RBRVS,,0.77 ,0.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70210,CPT,RADEX SINUSES PARANASAL <3 VIEWS,,,20,,RBRVS,0.17 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70210,CPT,RADEX SINUSES PARANASAL <3 VIEWS,26,,20,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70210,CPT,RADEX SINUSES PARANASAL <3 VIEWS,TC,,20,,RBRVS,,0.57 ,0.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70220,CPT,RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS,,,20,,RBRVS,0.25 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70220,CPT,RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS,26,,20,,RBRVS,0.25 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70220,CPT,RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS,TC,,20,,RBRVS,,0.68 ,0.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70240,CPT,RADIOLOGIC EXAMINATION SELLA TURCICA,,,20,,RBRVS,0.19 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70240,CPT,RADIOLOGIC EXAMINATION SELLA TURCICA,26,,20,,RBRVS,0.19 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70240,CPT,RADIOLOGIC EXAMINATION SELLA TURCICA,TC,,20,,RBRVS,,0.55 ,0.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70250,CPT,RADIOLOGIC EXAMINATION SKULL 4/> VIEWS,,,20,,RBRVS,0.24 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70250,CPT,RADIOLOGIC EXAMINATION SKULL 4/> VIEWS,26,,20,,RBRVS,0.24 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70250,CPT,RADIOLOGIC EXAMINATION SKULL 4/> VIEWS,TC,,20,,RBRVS,,0.64 ,0.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70260,CPT,RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS,,,20,,RBRVS,0.34 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70260,CPT,RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS,26,,20,,RBRVS,0.34 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70260,CPT,RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS,TC,,20,,RBRVS,,0.77 ,0.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70300,CPT,RADIOLOGIC EXAMINATION TEETH 1 VIEW,,,20,,RBRVS,0.10 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70300,CPT,RADIOLOGIC EXAMINATION TEETH 1 VIEW,26,,20,,RBRVS,0.10 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70300,CPT,RADIOLOGIC EXAMINATION TEETH 1 VIEW,TC,,20,,RBRVS,,0.24 ,0.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70310,CPT,RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH,,,20,,RBRVS,0.16 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70310,CPT,RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH,26,,20,,RBRVS,0.16 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70310,CPT,RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH,TC,,20,,RBRVS,,0.79 ,0.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70320,CPT,RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH,,,20,,RBRVS,0.22 ,1.23 ,1.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70320,CPT,RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH,26,,20,,RBRVS,0.22 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70320,CPT,RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH,TC,,20,,RBRVS,,1.12 ,1.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70328,CPT,RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT,,,20,,RBRVS,0.18 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70328,CPT,RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT,26,,20,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70328,CPT,RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT,TC,,20,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70330,CPT,RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT,,,20,,RBRVS,0.24 ,1.06 ,1.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70330,CPT,RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT,26,,20,,RBRVS,0.24 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70330,CPT,RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT,TC,,20,,RBRVS,,0.95 ,0.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70332,CPT,TEMPOROMANDBLE JT ARTHROGRAPHY RS&I,,,20,,RBRVS,0.54 ,1.69 ,1.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70332,CPT,TEMPOROMANDBLE JT ARTHROGRAPHY RS&I,26,,20,,RBRVS,0.54 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70332,CPT,TEMPOROMANDBLE JT ARTHROGRAPHY RS&I,TC,,20,,RBRVS,,1.38 ,1.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70336,CPT,MRI TEMPOROMANDIBULAR JOINT,,,20,,RBRVS,1.48 ,7.44 ,7.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70336,CPT,MRI TEMPOROMANDIBULAR JOINT,26,,20,,RBRVS,1.48 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70336,CPT,MRI TEMPOROMANDIBULAR JOINT,TC,,20,,RBRVS,,6.90 ,6.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70350,CPT,CEPHALOGRAM ORTHODONTIC,,,20,,RBRVS,0.17 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70350,CPT,CEPHALOGRAM ORTHODONTIC,26,,20,,RBRVS,0.17 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70350,CPT,CEPHALOGRAM ORTHODONTIC,TC,,20,,RBRVS,,0.26 ,0.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70355,CPT,ORTHOPANTOGRAM,,,20,,RBRVS,0.20 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70355,CPT,ORTHOPANTOGRAM,26,,20,,RBRVS,0.20 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70355,CPT,ORTHOPANTOGRAM,TC,,20,,RBRVS,,0.25 ,0.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70360,CPT,RADIOLOGIC EXAMINATION NECK SOFT TISSUE,,,20,,RBRVS,0.17 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70360,CPT,RADIOLOGIC EXAMINATION NECK SOFT TISSUE,26,,20,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70360,CPT,RADIOLOGIC EXAMINATION NECK SOFT TISSUE,TC,,20,,RBRVS,,0.54 ,0.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70370,CPT,RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ,,,20,,RBRVS,0.32 ,1.86 ,1.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70370,CPT,RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ,26,,20,,RBRVS,0.32 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70370,CPT,RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ,TC,,20,,RBRVS,,1.74 ,1.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70371,CPT,CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC,,,20,,RBRVS,0.84 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70371,CPT,CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC,26,,20,,RBRVS,0.84 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70371,CPT,CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC,TC,,20,,RBRVS,,1.34 ,1.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70380,CPT,RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS,,,20,,RBRVS,0.17 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70380,CPT,RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS,26,,20,,RBRVS,0.17 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70380,CPT,RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS,TC,,20,,RBRVS,,0.74 ,0.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70390,CPT,SIALOGRAPHY RS&I,,,20,,RBRVS,0.38 ,2.23 ,2.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70390,CPT,SIALOGRAPHY RS&I,26,,20,,RBRVS,0.38 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70390,CPT,SIALOGRAPHY RS&I,TC,,20,,RBRVS,,2.09 ,2.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70450,CPT,CT HEAD/BRAIN W/O CONTRAST MATERIAL,,,20,,RBRVS,0.85 ,2.36 ,2.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70450,CPT,CT HEAD/BRAIN W/O CONTRAST MATERIAL,26,,20,,RBRVS,0.85 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70450,CPT,CT HEAD/BRAIN W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,2.04 ,2.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70460,CPT,CT HEAD/BRAIN W/CONTRAST MATERIAL,,,20,,RBRVS,1.13 ,3.35 ,3.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70460,CPT,CT HEAD/BRAIN W/CONTRAST MATERIAL,26,,20,,RBRVS,1.13 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70460,CPT,CT HEAD/BRAIN W/CONTRAST MATERIAL,TC,,20,,RBRVS,,2.93 ,2.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70470,CPT,CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL,,,20,,RBRVS,1.27 ,4.05 ,4.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70470,CPT,CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL,26,,20,,RBRVS,1.27 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70470,CPT,CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL,TC,,20,,RBRVS,,3.57 ,3.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70480,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL,,,20,,RBRVS,1.28 ,5.21 ,5.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70480,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL,26,,20,,RBRVS,1.28 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70480,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL,TC,,20,,RBRVS,,4.73 ,4.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70481,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL,,,20,,RBRVS,1.38 ,6.30 ,6.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70481,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL,26,,20,,RBRVS,1.38 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70481,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL,TC,,20,,RBRVS,,5.79 ,5.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70482,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR,,,20,,RBRVS,1.45 ,6.93 ,6.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70482,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR,26,,20,,RBRVS,1.45 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70482,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR,TC,,20,,RBRVS,,6.40 ,6.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70486,CPT,CT MAXILLOFACIAL W/O CONTRAST MATERIAL,,,20,,RBRVS,0.85 ,3.03 ,3.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70486,CPT,CT MAXILLOFACIAL W/O CONTRAST MATERIAL,26,,20,,RBRVS,0.85 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70486,CPT,CT MAXILLOFACIAL W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,2.71 ,2.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70487,CPT,CT MAXILLOFACIAL W/CONTRAST MATERIAL,,,20,,RBRVS,1.13 ,3.54 ,3.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70487,CPT,CT MAXILLOFACIAL W/CONTRAST MATERIAL,26,,20,,RBRVS,1.13 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70487,CPT,CT MAXILLOFACIAL W/CONTRAST MATERIAL,TC,,20,,RBRVS,,3.12 ,3.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70488,CPT,CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL,,,20,,RBRVS,1.27 ,4.42 ,4.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70488,CPT,CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL,26,,20,,RBRVS,1.27 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70488,CPT,CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL,TC,,20,,RBRVS,,3.95 ,3.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70490,CPT,CT SOFT TISSUE NECK W/O CONTRAST MATERIAL,,,20,,RBRVS,1.28 ,4.07 ,4.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70490,CPT,CT SOFT TISSUE NECK W/O CONTRAST MATERIAL,26,,20,,RBRVS,1.28 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70490,CPT,CT SOFT TISSUE NECK W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,3.59 ,3.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70491,CPT,CT SOFT TISSUE NECK W/CONTRAST MATERIAL,,,20,,RBRVS,1.38 ,5.16 ,5.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70491,CPT,CT SOFT TISSUE NECK W/CONTRAST MATERIAL,26,,20,,RBRVS,1.38 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70491,CPT,CT SOFT TISSUE NECK W/CONTRAST MATERIAL,TC,,20,,RBRVS,,4.64 ,4.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70492,CPT,CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL,,,20,,RBRVS,1.45 ,6.28 ,6.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70492,CPT,CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL,26,,20,,RBRVS,1.45 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70492,CPT,CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL,TC,,20,,RBRVS,,5.74 ,5.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70496,CPT,CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST,,,20,,RBRVS,1.75 ,6.41 ,6.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70496,CPT,CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST,26,,20,,RBRVS,1.75 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70496,CPT,CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST,TC,,20,,RBRVS,,5.77 ,5.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70498,CPT,CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST,,,20,,RBRVS,1.75 ,6.38 ,6.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70498,CPT,CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST,26,,20,,RBRVS,1.75 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70498,CPT,CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST,TC,,20,,RBRVS,,5.74 ,5.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70540,CPT,MRI ORBIT FACE &/NECK W/O CONTRAST,,,20,,RBRVS,1.35 ,8.65 ,8.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70540,CPT,MRI ORBIT FACE &/NECK W/O CONTRAST,26,,20,,RBRVS,1.35 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70540,CPT,MRI ORBIT FACE &/NECK W/O CONTRAST,TC,,20,,RBRVS,,8.16 ,8.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70542,CPT,MRI ORBIT FACE & NECK W/CONTRAST MATERIAL,,,20,,RBRVS,1.62 ,9.57 ,9.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70542,CPT,MRI ORBIT FACE & NECK W/CONTRAST MATERIAL,26,,20,,RBRVS,1.62 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70542,CPT,MRI ORBIT FACE & NECK W/CONTRAST MATERIAL,TC,,20,,RBRVS,,8.97 ,8.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70543,CPT,MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL,,,20,,RBRVS,2.15 ,11.54 ,11.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70543,CPT,MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL,26,,20,,RBRVS,2.15 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70543,CPT,MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL,TC,,20,,RBRVS,,10.75 ,10.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70544,CPT,MRA HEAD W/O CONTRST MATERIAL,,,20,,RBRVS,1.20 ,9.73 ,9.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70544,CPT,MRA HEAD W/O CONTRST MATERIAL,26,,20,,RBRVS,1.20 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70544,CPT,MRA HEAD W/O CONTRST MATERIAL,TC,,20,,RBRVS,,9.28 ,9.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70545,CPT,MRA HEAD W/CONTRAST MATERIAL,,,20,,RBRVS,1.20 ,9.59 ,9.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70545,CPT,MRA HEAD W/CONTRAST MATERIAL,26,,20,,RBRVS,1.20 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70545,CPT,MRA HEAD W/CONTRAST MATERIAL,TC,,20,,RBRVS,,9.15 ,9.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70546,CPT,MRA HEAD W/O & W/CONTRAST MATERIAL,,,20,,RBRVS,1.80 ,14.91 ,14.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70546,CPT,MRA HEAD W/O & W/CONTRAST MATERIAL,26,,20,,RBRVS,1.80 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70546,CPT,MRA HEAD W/O & W/CONTRAST MATERIAL,TC,,20,,RBRVS,,14.24 ,14.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70547,CPT,MRA NECK W/O CONTRST MATERIAL,,,20,,RBRVS,1.20 ,9.77 ,9.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70547,CPT,MRA NECK W/O CONTRST MATERIAL,26,,20,,RBRVS,1.20 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70547,CPT,MRA NECK W/O CONTRST MATERIAL,TC,,20,,RBRVS,,9.32 ,9.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70548,CPT,MRA NECK W/CONTRAST MATERIAL,,,20,,RBRVS,1.20 ,10.32 ,10.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70548,CPT,MRA NECK W/CONTRAST MATERIAL,26,,20,,RBRVS,1.20 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70548,CPT,MRA NECK W/CONTRAST MATERIAL,TC,,20,,RBRVS,,9.87 ,9.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70549,CPT,MRA NECK W/O &W/CONTRAST MATERIAL,,,20,,RBRVS,1.80 ,15.01 ,15.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70549,CPT,MRA NECK W/O &W/CONTRAST MATERIAL,26,,20,,RBRVS,1.80 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70549,CPT,MRA NECK W/O &W/CONTRAST MATERIAL,TC,,20,,RBRVS,,14.34 ,14.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70551,CPT,MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL,,,20,,RBRVS,1.48 ,4.91 ,4.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70551,CPT,MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL,26,,20,,RBRVS,1.48 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70551,CPT,MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,4.36 ,4.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70552,CPT,MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL,,,20,,RBRVS,1.78 ,7.09 ,7.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70552,CPT,MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL,26,,20,,RBRVS,1.78 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70552,CPT,MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL,TC,,20,,RBRVS,,6.43 ,6.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70553,CPT,MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL,,,20,,RBRVS,2.29 ,8.18 ,8.18 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70553,CPT,MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL,26,,20,,RBRVS,2.29 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70553,CPT,MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL,TC,,20,,RBRVS,,7.33 ,7.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70554,CPT,MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION,,,20,,RBRVS,2.11 ,10.41 ,10.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70554,CPT,MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION,26,,20,,RBRVS,2.11 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70554,CPT,MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION,TC,,20,,RBRVS,,9.62 ,9.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70555,CPT,MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION,,,20,,TotalUnits,,,,21.23 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70555,CPT,MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION,26,,20,,TotalUnits,,,,3.46 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70555,CPT,MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION,TC,,20,,TotalUnits,,,,17.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70557,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL,,,20,,TotalUnits,,,,37.06 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70557,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL,26,,20,,TotalUnits,,,,3.99 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70557,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL,TC,,20,,TotalUnits,,,,33.07 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70558,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL,,,20,,TotalUnits,,,,40.54 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70558,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL,26,,20,,TotalUnits,,,,4.40 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70558,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL,TC,,20,,TotalUnits,,,,36.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 70559,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O & W/CONTRAST,,,20,,TotalUnits,,,,51.80 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 70559,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O & W/CONTRAST,26,,20,,TotalUnits,,,,4.41 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 70559,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O & W/CONTRAST,TC,,20,,TotalUnits,,,,47.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71010,CPT,RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL,,,20,,RBRVS,0.18 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71010,CPT,RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL,26,,20,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71010,CPT,RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL,TC,,20,,RBRVS,,0.36 ,0.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71015,CPT,RADIOLOGIC EXAMINATION CHEST STERO FRONTAL,,,20,,RBRVS,0.21 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71015,CPT,RADIOLOGIC EXAMINATION CHEST STERO FRONTAL,26,,20,,RBRVS,0.21 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71015,CPT,RADIOLOGIC EXAMINATION CHEST STERO FRONTAL,TC,,20,,RBRVS,,0.46 ,0.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71020,CPT,RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL,,,20,,RBRVS,0.22 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71020,CPT,RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL,26,,20,,RBRVS,0.22 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71020,CPT,RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL,TC,,20,,RBRVS,,0.46 ,0.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71021,CPT,RADEX CH 2 VIEWS FRNT & LAT APICAL LORDOTIC PX,,,20,,RBRVS,0.27 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71021,CPT,RADEX CH 2 VIEWS FRNT & LAT APICAL LORDOTIC PX,26,,20,,RBRVS,0.27 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71021,CPT,RADEX CH 2 VIEWS FRNT & LAT APICAL LORDOTIC PX,TC,,20,,RBRVS,,0.55 ,0.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71022,CPT,RADEX CH 2 VIEWS FRONTAL & LATERAL OBLIQUE PRJCJ,,,20,,RBRVS,0.31 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71022,CPT,RADEX CH 2 VIEWS FRONTAL & LATERAL OBLIQUE PRJCJ,26,,20,,RBRVS,0.31 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71022,CPT,RADEX CH 2 VIEWS FRONTAL & LATERAL OBLIQUE PRJCJ,TC,,20,,RBRVS,,0.69 ,0.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71023,CPT,RADEX CH 2 VIEWS FRONTAL & LATERAL W/FLUORO,,,20,,RBRVS,0.38 ,1.37 ,1.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71023,CPT,RADEX CH 2 VIEWS FRONTAL & LATERAL W/FLUORO,26,,20,,RBRVS,0.38 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71023,CPT,RADEX CH 2 VIEWS FRONTAL & LATERAL W/FLUORO,TC,,20,,RBRVS,,1.23 ,1.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71030,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS,,,20,,RBRVS,0.31 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71030,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS,26,,20,,RBRVS,0.31 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71030,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS,TC,,20,,RBRVS,,0.71 ,0.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71034,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS W/FLUORO,,,20,,RBRVS,0.46 ,1.83 ,1.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71034,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS W/FLUORO,26,,20,,RBRVS,0.46 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71034,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS W/FLUORO,TC,,20,,RBRVS,,1.66 ,1.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71035,CPT,RADEX CHEST SPECIAL VIEWS,,,20,,RBRVS,0.18 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71035,CPT,RADEX CHEST SPECIAL VIEWS,26,,20,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71035,CPT,RADEX CHEST SPECIAL VIEWS,TC,,20,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71100,CPT,RADEX RIBS UNILATERAL 2 VIEWS,,,20,,RBRVS,0.22 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71100,CPT,RADEX RIBS UNILATERAL 2 VIEWS,26,,20,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71100,CPT,RADEX RIBS UNILATERAL 2 VIEWS,TC,,20,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71101,CPT,RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS,,,20,,RBRVS,0.27 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71101,CPT,RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS,26,,20,,RBRVS,0.27 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71101,CPT,RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS,TC,,20,,RBRVS,,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71110,CPT,RADEX RIBS BILATERAL 3 VIEWS,,,20,,RBRVS,0.27 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71110,CPT,RADEX RIBS BILATERAL 3 VIEWS,26,,20,,RBRVS,0.27 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71110,CPT,RADEX RIBS BILATERAL 3 VIEWS,TC,,20,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71111,CPT,RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS,,,20,,RBRVS,0.32 ,0.99 ,0.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71111,CPT,RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS,26,,20,,RBRVS,0.32 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71111,CPT,RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS,TC,,20,,RBRVS,,0.86 ,0.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71120,CPT,RADEX STERNUM MINIMUM 2 VIEWS,,,20,,RBRVS,0.20 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71120,CPT,RADEX STERNUM MINIMUM 2 VIEWS,26,,20,,RBRVS,0.20 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71120,CPT,RADEX STERNUM MINIMUM 2 VIEWS,TC,,20,,RBRVS,,0.53 ,0.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71130,CPT,RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS,,,20,,RBRVS,0.22 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71130,CPT,RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS,26,,20,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71130,CPT,RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS,TC,,20,,RBRVS,,0.68 ,0.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71250,CPT,CT THORAX W/O CONTRAST MATERIAL,,,20,,RBRVS,1.02 ,3.99 ,3.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71250,CPT,CT THORAX W/O CONTRAST MATERIAL,26,,20,,RBRVS,1.02 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71250,CPT,CT THORAX W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,3.61 ,3.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71260,CPT,CT THORAX W/CONTRAST MATERIAL,,,20,,RBRVS,1.24 ,5.13 ,5.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71260,CPT,CT THORAX W/CONTRAST MATERIAL,26,,20,,RBRVS,1.24 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71260,CPT,CT THORAX W/CONTRAST MATERIAL,TC,,20,,RBRVS,,4.66 ,4.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71270,CPT,CT THORAX W/O & W/CONTRAST MATERIAL,,,20,,RBRVS,1.38 ,6.27 ,6.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71270,CPT,CT THORAX W/O & W/CONTRAST MATERIAL,26,,20,,RBRVS,1.38 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71270,CPT,CT THORAX W/O & W/CONTRAST MATERIAL,TC,,20,,RBRVS,,5.76 ,5.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71275,CPT,CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,,,20,,RBRVS,1.82 ,6.49 ,6.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71275,CPT,CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,26,,20,,RBRVS,1.82 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71275,CPT,CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,TC,,20,,RBRVS,,5.82 ,5.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71550,CPT,MRI CHEST W/O CONTRAST MATERIAL,,,20,,RBRVS,1.46 ,10.08 ,10.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71550,CPT,MRI CHEST W/O CONTRAST MATERIAL,26,,20,,RBRVS,1.46 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71550,CPT,MRI CHEST W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,9.54 ,9.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71551,CPT,MRI CHEST W/CONTRAST MATERIAL,,,20,,RBRVS,1.73 ,11.03 ,11.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71551,CPT,MRI CHEST W/CONTRAST MATERIAL,26,,20,,RBRVS,1.73 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71551,CPT,MRI CHEST W/CONTRAST MATERIAL,TC,,20,,RBRVS,,10.40 ,10.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71552,CPT,MRI CHEST W/O & W/CONTRAST MATERIAL,,,20,,RBRVS,2.26 ,13.88 ,13.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71552,CPT,MRI CHEST W/O & W/CONTRAST MATERIAL,26,,20,,RBRVS,2.26 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71552,CPT,MRI CHEST W/O & W/CONTRAST MATERIAL,TC,,20,,RBRVS,,13.04 ,13.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 71555,CPT,MRA CHEST W/O & W/CONTRAST MATERIAL,,,20,,RBRVS,1.81 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 71555,CPT,MRA CHEST W/O & W/CONTRAST MATERIAL,26,,20,,RBRVS,1.81 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 71555,CPT,MRA CHEST W/O & W/CONTRAST MATERIAL,TC,,20,,RBRVS,,8.60 ,8.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72020,CPT,RADEX SPINE 1 VIEW SPECIFY LEVEL,,,20,,RBRVS,0.15 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72020,CPT,RADEX SPINE 1 VIEW SPECIFY LEVEL,26,,20,,RBRVS,0.15 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72020,CPT,RADEX SPINE 1 VIEW SPECIFY LEVEL,TC,,20,,RBRVS,,0.39 ,0.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72040,CPT,RADEX SPINE CERVICAL 2 OR 3 VIEWS,,,20,,RBRVS,0.22 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72040,CPT,RADEX SPINE CERVICAL 2 OR 3 VIEWS,26,,20,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72040,CPT,RADEX SPINE CERVICAL 2 OR 3 VIEWS,TC,,20,,RBRVS,,0.60 ,0.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72050,CPT,RADEX SPINE CERVICAL 4 OR 5 VIEWS,,,20,,RBRVS,0.31 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72050,CPT,RADEX SPINE CERVICAL 4 OR 5 VIEWS,26,,20,,RBRVS,0.31 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72050,CPT,RADEX SPINE CERVICAL 4 OR 5 VIEWS,TC,,20,,RBRVS,,0.80 ,0.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72052,CPT,RADEX SPINE CERVICAL 6 OR MORE VIEWS,,,20,,RBRVS,0.36 ,1.19 ,1.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72052,CPT,RADEX SPINE CERVICAL 6 OR MORE VIEWS,26,,20,,RBRVS,0.36 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72052,CPT,RADEX SPINE CERVICAL 6 OR MORE VIEWS,TC,,20,,RBRVS,,1.05 ,1.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72070,CPT,RADEX SPINE THORACIC 2 VIEWS,,,20,,RBRVS,0.22 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72070,CPT,RADEX SPINE THORACIC 2 VIEWS,26,,20,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72070,CPT,RADEX SPINE THORACIC 2 VIEWS,TC,,20,,RBRVS,,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72072,CPT,RADEX SPINE THORACIC 3 VIEWS,,,20,,RBRVS,0.22 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72072,CPT,RADEX SPINE THORACIC 3 VIEWS,26,,20,,RBRVS,0.22 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72072,CPT,RADEX SPINE THORACIC 3 VIEWS,TC,,20,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72074,CPT,RADEX SPINE THORACIC MINIMUM 4 VIEWS,,,20,,RBRVS,0.22 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72074,CPT,RADEX SPINE THORACIC MINIMUM 4 VIEWS,26,,20,,RBRVS,0.22 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72074,CPT,RADEX SPINE THORACIC MINIMUM 4 VIEWS,TC,,20,,RBRVS,,0.78 ,0.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72080,CPT,RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS,,,20,,RBRVS,0.22 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72080,CPT,RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS,26,,20,,RBRVS,0.22 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72080,CPT,RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS,TC,,20,,RBRVS,,0.54 ,0.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72081,CPT,RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW,,,20,,RBRVS,0.26 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72081,CPT,RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW,26,,20,,RBRVS,0.26 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72081,CPT,RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW,TC,,20,,RBRVS,,0.70 ,0.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72082,CPT,RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW,,,20,,RBRVS,0.31 ,1.41 ,1.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72082,CPT,RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW,26,,20,,RBRVS,0.31 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72082,CPT,RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW,TC,,20,,RBRVS,,1.28 ,1.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72083,CPT,RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW,,,20,,RBRVS,0.35 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72083,CPT,RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW,26,,20,,RBRVS,0.35 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72083,CPT,RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW,TC,,20,,RBRVS,,1.39 ,1.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72084,CPT,RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW,,,20,,RBRVS,0.41 ,1.83 ,1.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72084,CPT,RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW,26,,20,,RBRVS,0.41 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72084,CPT,RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW,TC,,20,,RBRVS,,1.68 ,1.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72100,CPT,RADEX SPINE LUMBOSACRAL 2/3 VIEWS,,,20,,RBRVS,0.22 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72100,CPT,RADEX SPINE LUMBOSACRAL 2/3 VIEWS,26,,20,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72100,CPT,RADEX SPINE LUMBOSACRAL 2/3 VIEWS,TC,,20,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72110,CPT,RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS,,,20,,RBRVS,0.31 ,1.03 ,1.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72110,CPT,RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS,26,,20,,RBRVS,0.31 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72110,CPT,RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS,TC,,20,,RBRVS,,0.91 ,0.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72114,CPT,RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6,,,20,,RBRVS,0.32 ,1.40 ,1.40 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72114,CPT,RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6,26,,20,,RBRVS,0.32 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72114,CPT,RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6,TC,,20,,RBRVS,,1.27 ,1.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72120,CPT,RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS,,,20,,RBRVS,0.22 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72120,CPT,RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS,26,,20,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72120,CPT,RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS,TC,,20,,RBRVS,,0.80 ,0.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72125,CPT,CT CERVICAL SPINE W/O CONTRAST MATERIAL,,,20,,RBRVS,1.07 ,4.05 ,4.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72125,CPT,CT CERVICAL SPINE W/O CONTRAST MATERIAL,26,,20,,RBRVS,1.07 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72125,CPT,CT CERVICAL SPINE W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,3.65 ,3.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72126,CPT,CT CERVICAL SPINE W/CONTRAST MATERIAL,,,20,,RBRVS,1.22 ,5.14 ,5.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72126,CPT,CT CERVICAL SPINE W/CONTRAST MATERIAL,26,,20,,RBRVS,1.22 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72126,CPT,CT CERVICAL SPINE W/CONTRAST MATERIAL,TC,,20,,RBRVS,,4.69 ,4.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72127,CPT,CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL,,,20,,RBRVS,1.27 ,6.27 ,6.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72127,CPT,CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL,26,,20,,RBRVS,1.27 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72127,CPT,CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL,TC,,20,,RBRVS,,5.80 ,5.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72128,CPT,CT THORACIC SPINE W/O CONTRAST MATERIAL,,,20,,RBRVS,1.00 ,4.00 ,4.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72128,CPT,CT THORACIC SPINE W/O CONTRAST MATERIAL,26,,20,,RBRVS,1.00 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72128,CPT,CT THORACIC SPINE W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,3.63 ,3.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72129,CPT,CT THORACIC SPINE W/CONTRAST MATERIAL,,,20,,RBRVS,1.22 ,5.15 ,5.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72129,CPT,CT THORACIC SPINE W/CONTRAST MATERIAL,26,,20,,RBRVS,1.22 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72129,CPT,CT THORACIC SPINE W/CONTRAST MATERIAL,TC,,20,,RBRVS,,4.70 ,4.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72130,CPT,CT THORACIC SPINE W/O & W/CONTRAST MATERIAL,,,20,,RBRVS,1.27 ,6.32 ,6.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72130,CPT,CT THORACIC SPINE W/O & W/CONTRAST MATERIAL,26,,20,,RBRVS,1.27 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72130,CPT,CT THORACIC SPINE W/O & W/CONTRAST MATERIAL,TC,,20,,RBRVS,,5.85 ,5.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72131,CPT,CT LUMBAR SPINE W/O CONTRAST MATERIAL,,,20,,RBRVS,1.00 ,3.98 ,3.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72131,CPT,CT LUMBAR SPINE W/O CONTRAST MATERIAL,26,,20,,RBRVS,1.00 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72131,CPT,CT LUMBAR SPINE W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,3.61 ,3.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72132,CPT,CT LUMBAR SPINE W/CONTRAST MATERIAL,,,20,,RBRVS,1.22 ,5.13 ,5.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72132,CPT,CT LUMBAR SPINE W/CONTRAST MATERIAL,26,,20,,RBRVS,1.22 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72132,CPT,CT LUMBAR SPINE W/CONTRAST MATERIAL,TC,,20,,RBRVS,,4.68 ,4.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72133,CPT,CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL,,,20,,RBRVS,1.27 ,6.25 ,6.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72133,CPT,CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL,26,,20,,RBRVS,1.27 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72133,CPT,CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL,TC,,20,,RBRVS,,5.79 ,5.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72141,CPT,MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL,,,20,,RBRVS,1.48 ,4.72 ,4.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72141,CPT,MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL,26,,20,,RBRVS,1.48 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72141,CPT,MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL,TC,,20,,RBRVS,,4.17 ,4.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72142,CPT,MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL,,,20,,RBRVS,1.78 ,7.23 ,7.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72142,CPT,MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL,26,,20,,RBRVS,1.78 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72142,CPT,MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL,TC,,20,,RBRVS,,6.56 ,6.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72146,CPT,MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL,,,20,,RBRVS,1.48 ,4.72 ,4.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72146,CPT,MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL,26,,20,,RBRVS,1.48 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72146,CPT,MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL,TC,,20,,RBRVS,,4.17 ,4.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72147,CPT,MRI SPINAL CANAL THORACIC W/CONTRAST MATRL,,,20,,RBRVS,1.78 ,7.14 ,7.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72147,CPT,MRI SPINAL CANAL THORACIC W/CONTRAST MATRL,26,,20,,RBRVS,1.78 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72147,CPT,MRI SPINAL CANAL THORACIC W/CONTRAST MATRL,TC,,20,,RBRVS,,6.48 ,6.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72148,CPT,MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL,,,20,,RBRVS,1.48 ,4.69 ,4.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72148,CPT,MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL,26,,20,,RBRVS,1.48 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72148,CPT,MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,4.14 ,4.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72149,CPT,MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL,,,20,,RBRVS,1.78 ,7.12 ,7.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72149,CPT,MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL,26,,20,,RBRVS,1.78 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72149,CPT,MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL,TC,,20,,RBRVS,,6.45 ,6.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72156,CPT,MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL,,,20,,RBRVS,2.29 ,8.23 ,8.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72156,CPT,MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL,26,,20,,RBRVS,2.29 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72156,CPT,MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL,TC,,20,,RBRVS,,7.38 ,7.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72157,CPT,MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL,,,20,,RBRVS,2.29 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72157,CPT,MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL,26,,20,,RBRVS,2.29 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72157,CPT,MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL,TC,,20,,RBRVS,,7.40 ,7.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72158,CPT,MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL,,,20,,RBRVS,2.29 ,8.21 ,8.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72158,CPT,MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL,26,,20,,RBRVS,2.29 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72158,CPT,MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL,TC,,20,,RBRVS,,7.36 ,7.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72159,CPT,MRA SPINAL CANAL W/WO CONTRAST MATERIAL,,,20,,RBRVS,1.80 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72159,CPT,MRA SPINAL CANAL W/WO CONTRAST MATERIAL,26,,20,,RBRVS,1.80 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72159,CPT,MRA SPINAL CANAL W/WO CONTRAST MATERIAL,TC,,20,,RBRVS,,9.12 ,9.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72170,CPT,RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS,,,20,,RBRVS,0.17 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72170,CPT,RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS,26,,20,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72170,CPT,RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS,TC,,20,,RBRVS,,0.63 ,0.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72190,CPT,RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS,,,20,,RBRVS,0.21 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72190,CPT,RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS,26,,20,,RBRVS,0.21 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72190,CPT,RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS,TC,,20,,RBRVS,,0.75 ,0.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72191,CPT,CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST,,,20,,RBRVS,1.81 ,6.65 ,6.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72191,CPT,CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST,26,,20,,RBRVS,1.81 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72191,CPT,CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST,TC,,20,,RBRVS,,5.99 ,5.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72192,CPT,CT PELVIS W/O CONTRAST MATERIAL,,,20,,RBRVS,1.09 ,2.95 ,2.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72192,CPT,CT PELVIS W/O CONTRAST MATERIAL,26,,20,,RBRVS,1.09 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72192,CPT,CT PELVIS W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,2.54 ,2.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72193,CPT,CT PELVIS W/CONTRAST MATERIAL,,,20,,RBRVS,1.16 ,5.12 ,5.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72193,CPT,CT PELVIS W/CONTRAST MATERIAL,26,,20,,RBRVS,1.16 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72193,CPT,CT PELVIS W/CONTRAST MATERIAL,TC,,20,,RBRVS,,4.69 ,4.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72194,CPT,CT PELVIS W/O & W/CONTRAST MATERIAL,,,20,,RBRVS,1.22 ,6.03 ,6.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72194,CPT,CT PELVIS W/O & W/CONTRAST MATERIAL,26,,20,,RBRVS,1.22 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72194,CPT,CT PELVIS W/O & W/CONTRAST MATERIAL,TC,,20,,RBRVS,,5.58 ,5.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72195,CPT,MRI PELVIS W/O CONTRAST MATERIAL,,,20,,RBRVS,1.46 ,8.98 ,8.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72195,CPT,MRI PELVIS W/O CONTRAST MATERIAL,26,,20,,RBRVS,1.46 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72195,CPT,MRI PELVIS W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,8.43 ,8.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72196,CPT,MRI PELVIS W/CONTRAST MATERIAL,,,20,,RBRVS,1.73 ,9.72 ,9.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72196,CPT,MRI PELVIS W/CONTRAST MATERIAL,26,,20,,RBRVS,1.73 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72196,CPT,MRI PELVIS W/CONTRAST MATERIAL,TC,,20,,RBRVS,,9.07 ,9.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72197,CPT,MRI PELVIS W/O & W/CONTRAST MATERIAL,,,20,,RBRVS,2.26 ,11.81 ,11.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72197,CPT,MRI PELVIS W/O & W/CONTRAST MATERIAL,26,,20,,RBRVS,2.26 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72197,CPT,MRI PELVIS W/O & W/CONTRAST MATERIAL,TC,,20,,RBRVS,,10.97 ,10.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72198,CPT,MRA PELVIS W/WO CONTRAST MATERIAL,,,20,,RBRVS,1.80 ,9.35 ,9.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72198,CPT,MRA PELVIS W/WO CONTRAST MATERIAL,26,,20,,RBRVS,1.80 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72198,CPT,MRA PELVIS W/WO CONTRAST MATERIAL,TC,,20,,RBRVS,,8.70 ,8.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72200,CPT,RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS,,,20,,RBRVS,0.17 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72200,CPT,RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS,26,,20,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72200,CPT,RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS,TC,,20,,RBRVS,,0.54 ,0.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72202,CPT,RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS,,,20,,RBRVS,0.19 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72202,CPT,RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS,26,,20,,RBRVS,0.19 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72202,CPT,RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS,TC,,20,,RBRVS,,0.64 ,0.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72220,CPT,RADEX SACRUM & COCCYX MINIMUM 2 VIEWS,,,20,,RBRVS,0.17 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72220,CPT,RADEX SACRUM & COCCYX MINIMUM 2 VIEWS,26,,20,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72220,CPT,RADEX SACRUM & COCCYX MINIMUM 2 VIEWS,TC,,20,,RBRVS,,0.53 ,0.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72240,CPT,MYELOGRAPHY CERVICAL RS&I,,,20,,RBRVS,0.91 ,1.78 ,1.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72240,CPT,MYELOGRAPHY CERVICAL RS&I,26,,20,,RBRVS,0.91 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72240,CPT,MYELOGRAPHY CERVICAL RS&I,TC,,20,,RBRVS,,1.44 ,1.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72255,CPT,MYELOGRAPHY THORACIC RS&I,,,20,,RBRVS,0.91 ,1.76 ,1.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72255,CPT,MYELOGRAPHY THORACIC RS&I,26,,20,,RBRVS,0.91 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72255,CPT,MYELOGRAPHY THORACIC RS&I,TC,,20,,RBRVS,,1.41 ,1.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72265,CPT,MYELOGRAPY LUMBOSACRAL RS&I,,,20,,RBRVS,0.83 ,1.70 ,1.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72265,CPT,MYELOGRAPY LUMBOSACRAL RS&I,26,,20,,RBRVS,0.83 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72265,CPT,MYELOGRAPY LUMBOSACRAL RS&I,TC,,20,,RBRVS,,1.39 ,1.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72270,CPT,MYELOGRAPY 2/MORE REGIONS RS&I,,,20,,RBRVS,1.33 ,2.16 ,2.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72270,CPT,MYELOGRAPY 2/MORE REGIONS RS&I,26,,20,,RBRVS,1.33 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72270,CPT,MYELOGRAPY 2/MORE REGIONS RS&I,TC,,20,,RBRVS,,1.66 ,1.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72275,CPT,EPIDUROGRAPY RS&I,,,20,,RBRVS,0.76 ,2.44 ,2.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72275,CPT,EPIDUROGRAPY RS&I,26,,20,,RBRVS,0.76 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72275,CPT,EPIDUROGRAPY RS&I,TC,,20,,RBRVS,,2.12 ,2.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72285,CPT,DISKOGRAPY CERVICAL/THORACIC RS&I,,,20,,RBRVS,1.16 ,1.97 ,1.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72285,CPT,DISKOGRAPY CERVICAL/THORACIC RS&I,26,,20,,RBRVS,1.16 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72285,CPT,DISKOGRAPY CERVICAL/THORACIC RS&I,TC,,20,,RBRVS,,1.47 ,1.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 72295,CPT,DISKOGRAPY LUMBAR RS&I,,,20,,RBRVS,0.83 ,1.88 ,1.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 72295,CPT,DISKOGRAPY LUMBAR RS&I,26,,20,,RBRVS,0.83 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 72295,CPT,DISKOGRAPY LUMBAR RS&I,TC,,20,,RBRVS,,1.53 ,1.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73000,CPT,RADEX CLAVICLE COMPLETE,,,20,,RBRVS,0.16 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73000,CPT,RADEX CLAVICLE COMPLETE,26,,20,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73000,CPT,RADEX CLAVICLE COMPLETE,TC,,20,,RBRVS,,0.52 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73010,CPT,RADEX SCAPULA COMPLETE,,,20,,RBRVS,0.17 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73010,CPT,RADEX SCAPULA COMPLETE,26,,20,,RBRVS,0.17 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73010,CPT,RADEX SCAPULA COMPLETE,TC,,20,,RBRVS,,0.57 ,0.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73020,CPT,RADEX SHOULDER 1 VIEW,,,20,,RBRVS,0.15 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73020,CPT,RADEX SHOULDER 1 VIEW,26,,20,,RBRVS,0.15 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73020,CPT,RADEX SHOULDER 1 VIEW,TC,,20,,RBRVS,,0.41 ,0.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73030,CPT,RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,,,20,,RBRVS,0.18 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73030,CPT,RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,26,,20,,RBRVS,0.18 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73030,CPT,RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,TC,,20,,RBRVS,,0.53 ,0.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73040,CPT,RADEX SHOULDER ARTHROGRAPHY RS&I,,,20,,RBRVS,0.54 ,2.23 ,2.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73040,CPT,RADEX SHOULDER ARTHROGRAPHY RS&I,26,,20,,RBRVS,0.54 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73040,CPT,RADEX SHOULDER ARTHROGRAPHY RS&I,TC,,20,,RBRVS,,2.02 ,2.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73050,CPT,RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ,,,20,,RBRVS,0.20 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73050,CPT,RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ,26,,20,,RBRVS,0.20 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73050,CPT,RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ,TC,,20,,RBRVS,,0.68 ,0.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73060,CPT,RADEX HUMERUS MINIMUM 2 VIEWS,,,20,,RBRVS,0.16 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73060,CPT,RADEX HUMERUS MINIMUM 2 VIEWS,26,,20,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73060,CPT,RADEX HUMERUS MINIMUM 2 VIEWS,TC,,20,,RBRVS,,0.56 ,0.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73070,CPT,RADEX ELBOW 2 VIEWS,,,20,,RBRVS,0.15 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73070,CPT,RADEX ELBOW 2 VIEWS,26,,20,,RBRVS,0.15 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73070,CPT,RADEX ELBOW 2 VIEWS,TC,,20,,RBRVS,,0.52 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73080,CPT,RADEX ELBOW COMPLETE MINIMUM 3 VIEWS,,,20,,RBRVS,0.17 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73080,CPT,RADEX ELBOW COMPLETE MINIMUM 3 VIEWS,26,,20,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73080,CPT,RADEX ELBOW COMPLETE MINIMUM 3 VIEWS,TC,,20,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73085,CPT,RADEX ELBOW ARTHROGRAPHY RS&I,,,20,,RBRVS,0.54 ,2.14 ,2.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73085,CPT,RADEX ELBOW ARTHROGRAPHY RS&I,26,,20,,RBRVS,0.54 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73085,CPT,RADEX ELBOW ARTHROGRAPHY RS&I,TC,,20,,RBRVS,,1.90 ,1.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73090,CPT,RADEX FOREARM 2 VIEWS,,,20,,RBRVS,0.16 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73090,CPT,RADEX FOREARM 2 VIEWS,26,,20,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73090,CPT,RADEX FOREARM 2 VIEWS,TC,,20,,RBRVS,,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73092,CPT,RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS,,,20,,RBRVS,0.16 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73092,CPT,RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS,26,,20,,RBRVS,0.16 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73092,CPT,RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS,TC,,20,,RBRVS,,0.52 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73100,CPT,RADEX WRIST 2 VIEWS,,,20,,RBRVS,0.16 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73100,CPT,RADEX WRIST 2 VIEWS,26,,20,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73100,CPT,RADEX WRIST 2 VIEWS,TC,,20,,RBRVS,,0.56 ,0.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73110,CPT,RADEX WRIST COMPLETE MINIMUM 3 VIEWS,,,20,,RBRVS,0.17 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73110,CPT,RADEX WRIST COMPLETE MINIMUM 3 VIEWS,26,,20,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73110,CPT,RADEX WRIST COMPLETE MINIMUM 3 VIEWS,TC,,20,,RBRVS,,0.73 ,0.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73115,CPT,RADEX WRIST ARTHROGRAPHY RS&I,,,20,,RBRVS,0.54 ,2.41 ,2.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73115,CPT,RADEX WRIST ARTHROGRAPHY RS&I,26,,20,,RBRVS,0.54 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73115,CPT,RADEX WRIST ARTHROGRAPHY RS&I,TC,,20,,RBRVS,,2.18 ,2.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73120,CPT,RADEX HAND 2 VIEWS,,,20,,RBRVS,0.16 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73120,CPT,RADEX HAND 2 VIEWS,26,,20,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73120,CPT,RADEX HAND 2 VIEWS,TC,,20,,RBRVS,,0.48 ,0.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73130,CPT,RADEX HAND MINIMUM 3 VIEWS,,,20,,RBRVS,0.17 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73130,CPT,RADEX HAND MINIMUM 3 VIEWS,26,,20,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73130,CPT,RADEX HAND MINIMUM 3 VIEWS,TC,,20,,RBRVS,,0.60 ,0.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73140,CPT,RADEX FINGR MINIMUM 2 VIEWS,,,20,,RBRVS,0.13 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73140,CPT,RADEX FINGR MINIMUM 2 VIEWS,26,,20,,RBRVS,0.13 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73140,CPT,RADEX FINGR MINIMUM 2 VIEWS,TC,,20,,RBRVS,,0.67 ,0.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73200,CPT,CT UPPER EXTREMITY W/O CONTRAST MATERIAL,,,20,,RBRVS,1.00 ,3.97 ,3.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73200,CPT,CT UPPER EXTREMITY W/O CONTRAST MATERIAL,26,,20,,RBRVS,1.00 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73200,CPT,CT UPPER EXTREMITY W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,3.60 ,3.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73201,CPT,CT UPPER EXTREMITY W/CONTRAST MATERIAL,,,20,,RBRVS,1.16 ,5.03 ,5.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73201,CPT,CT UPPER EXTREMITY W/CONTRAST MATERIAL,26,,20,,RBRVS,1.16 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73201,CPT,CT UPPER EXTREMITY W/CONTRAST MATERIAL,TC,,20,,RBRVS,,4.60 ,4.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73202,CPT,CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,,,20,,RBRVS,1.22 ,6.51 ,6.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73202,CPT,CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,26,,20,,RBRVS,1.22 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73202,CPT,CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,TC,,20,,RBRVS,,6.06 ,6.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73206,CPT,CT ANGIOGRAPHY UPPER EXTREMITY,,,20,,RBRVS,1.81 ,7.28 ,7.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73206,CPT,CT ANGIOGRAPHY UPPER EXTREMITY,26,,20,,RBRVS,1.81 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73206,CPT,CT ANGIOGRAPHY UPPER EXTREMITY,TC,,20,,RBRVS,,6.63 ,6.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73218,CPT,MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL,,,20,,RBRVS,1.35 ,8.80 ,8.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73218,CPT,MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL,26,,20,,RBRVS,1.35 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73218,CPT,MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL,TC,,20,,RBRVS,,8.30 ,8.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73219,CPT,MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL,,,20,,RBRVS,1.62 ,9.64 ,9.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73219,CPT,MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL,26,,20,,RBRVS,1.62 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73219,CPT,MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL,TC,,20,,RBRVS,,9.03 ,9.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73220,CPT,MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS,,,20,,RBRVS,2.15 ,11.76 ,11.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73220,CPT,MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS,26,,20,,RBRVS,2.15 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73220,CPT,MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS,TC,,20,,RBRVS,,10.96 ,10.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73221,CPT,MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL,,,20,,RBRVS,1.35 ,5.19 ,5.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73221,CPT,MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL,26,,20,,RBRVS,1.35 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73221,CPT,MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL,TC,,20,,RBRVS,,4.68 ,4.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73222,CPT,MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL,,,20,,RBRVS,1.62 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73222,CPT,MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL,26,,20,,RBRVS,1.62 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73222,CPT,MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL,TC,,20,,RBRVS,,8.29 ,8.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73223,CPT,MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL,,,20,,RBRVS,2.15 ,10.89 ,10.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73223,CPT,MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL,26,,20,,RBRVS,2.15 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73223,CPT,MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL,TC,,20,,RBRVS,,10.09 ,10.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73225,CPT,MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL,,,20,,RBRVS,1.73 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73225,CPT,MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL,26,,20,,RBRVS,1.73 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73225,CPT,MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL,TC,,20,,RBRVS,,8.93 ,8.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73501,CPT,RADEX HIP UNILATERAL WITH PELVIS 1 VIEW,,,20,,RBRVS,0.18 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73501,CPT,RADEX HIP UNILATERAL WITH PELVIS 1 VIEW,26,,20,,RBRVS,0.18 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73501,CPT,RADEX HIP UNILATERAL WITH PELVIS 1 VIEW,TC,,20,,RBRVS,,0.55 ,0.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73502,CPT,RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS,,,20,,RBRVS,0.22 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73502,CPT,RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS,26,,20,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73502,CPT,RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS,TC,,20,,RBRVS,,0.83 ,0.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73503,CPT,RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS,,,20,,RBRVS,0.27 ,1.15 ,1.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73503,CPT,RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS,26,,20,,RBRVS,0.27 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73503,CPT,RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS,TC,,20,,RBRVS,,1.03 ,1.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73521,CPT,RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS,,,20,,RBRVS,0.22 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73521,CPT,RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS,26,,20,,RBRVS,0.22 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73521,CPT,RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS,TC,,20,,RBRVS,,0.77 ,0.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73522,CPT,RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS,,,20,,RBRVS,0.29 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73522,CPT,RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS,26,,20,,RBRVS,0.29 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73522,CPT,RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS,TC,,20,,RBRVS,,0.93 ,0.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73523,CPT,RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS,,,20,,RBRVS,0.31 ,1.25 ,1.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73523,CPT,RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS,26,,20,,RBRVS,0.31 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73523,CPT,RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS,TC,,20,,RBRVS,,1.12 ,1.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73525,CPT,RADEX HIP ARTHROGRAPHY RS&I,,,20,,RBRVS,0.54 ,2.26 ,2.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73525,CPT,RADEX HIP ARTHROGRAPHY RS&I,26,,20,,RBRVS,0.54 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73525,CPT,RADEX HIP ARTHROGRAPHY RS&I,TC,,20,,RBRVS,,2.02 ,2.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73551,CPT,RADIOLOGIC EXAMINATION FEMUR 1 VIEW,,,20,,RBRVS,0.16 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73551,CPT,RADIOLOGIC EXAMINATION FEMUR 1 VIEW,26,,20,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73551,CPT,RADIOLOGIC EXAMINATION FEMUR 1 VIEW,TC,,20,,RBRVS,,0.53 ,0.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73552,CPT,RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS,,,20,,RBRVS,0.18 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73552,CPT,RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS,26,,20,,RBRVS,0.18 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73552,CPT,RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS,TC,,20,,RBRVS,,0.63 ,0.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73560,CPT,RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS,,,20,,RBRVS,0.16 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73560,CPT,RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS,26,,20,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73560,CPT,RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS,TC,,20,,RBRVS,,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73562,CPT,RADIOLOGIC EXAMINATION KNEE 3 VIEWS,,,20,,RBRVS,0.18 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73562,CPT,RADIOLOGIC EXAMINATION KNEE 3 VIEWS,26,,20,,RBRVS,0.18 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73562,CPT,RADIOLOGIC EXAMINATION KNEE 3 VIEWS,TC,,20,,RBRVS,,0.72 ,0.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73564,CPT,RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS,,,20,,RBRVS,0.22 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73564,CPT,RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS,26,,20,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73564,CPT,RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS,TC,,20,,RBRVS,,0.77 ,0.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73565,CPT,RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST,,,20,,RBRVS,0.16 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73565,CPT,RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST,26,,20,,RBRVS,0.16 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73565,CPT,RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST,TC,,20,,RBRVS,,0.74 ,0.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73580,CPT,RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I,,,20,,RBRVS,0.54 ,2.65 ,2.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73580,CPT,RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I,26,,20,,RBRVS,0.54 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73580,CPT,RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I,TC,,20,,RBRVS,,2.42 ,2.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73590,CPT,RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS,,,20,,RBRVS,0.16 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73590,CPT,RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS,26,,20,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73590,CPT,RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS,TC,,20,,RBRVS,,0.55 ,0.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73592,CPT,RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS,,,20,,RBRVS,0.16 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73592,CPT,RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS,26,,20,,RBRVS,0.16 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73592,CPT,RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS,TC,,20,,RBRVS,,0.54 ,0.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73600,CPT,RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,,,20,,RBRVS,0.16 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73600,CPT,RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,26,,20,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73600,CPT,RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,TC,,20,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73610,CPT,RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,,,20,,RBRVS,0.17 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73610,CPT,RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,26,,20,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73610,CPT,RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,TC,,20,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73615,CPT,RADEX ANKLE ARTHROGRAPHY RS&I,,,20,,RBRVS,0.54 ,2.36 ,2.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73615,CPT,RADEX ANKLE ARTHROGRAPHY RS&I,26,,20,,RBRVS,0.54 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73615,CPT,RADEX ANKLE ARTHROGRAPHY RS&I,TC,,20,,RBRVS,,2.11 ,2.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73620,CPT,RADIOLOGIC EXAMINATION FOOT 2 VIEWS,,,20,,RBRVS,0.16 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73620,CPT,RADIOLOGIC EXAMINATION FOOT 2 VIEWS,26,,20,,RBRVS,0.16 ,0.05 ,0.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73620,CPT,RADIOLOGIC EXAMINATION FOOT 2 VIEWS,TC,,20,,RBRVS,,0.50 ,0.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73630,CPT,RADEX FOOT COMPLETE MINIMUM 3 VIEWS,,,20,,RBRVS,0.17 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73630,CPT,RADEX FOOT COMPLETE MINIMUM 3 VIEWS,26,,20,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73630,CPT,RADEX FOOT COMPLETE MINIMUM 3 VIEWS,TC,,20,,RBRVS,,0.56 ,0.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73650,CPT,RADEX CALCANEUS MINIMUM 2 VIEWS,,,20,,RBRVS,0.16 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73650,CPT,RADEX CALCANEUS MINIMUM 2 VIEWS,26,,20,,RBRVS,0.16 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73650,CPT,RADEX CALCANEUS MINIMUM 2 VIEWS,TC,,20,,RBRVS,,0.52 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73660,CPT,RADEX TOE MINIMUM 2 VIEWS,,,20,,RBRVS,0.13 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73660,CPT,RADEX TOE MINIMUM 2 VIEWS,26,,20,,RBRVS,0.13 ,0.05 ,0.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73660,CPT,RADEX TOE MINIMUM 2 VIEWS,TC,,20,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73700,CPT,CT LOWER EXTREMITY W/O CONTRAST MATERIAL,,,20,,RBRVS,1.00 ,3.97 ,3.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73700,CPT,CT LOWER EXTREMITY W/O CONTRAST MATERIAL,26,,20,,RBRVS,1.00 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73700,CPT,CT LOWER EXTREMITY W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,3.60 ,3.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73701,CPT,CT LOWER EXTREMITY W/CONTRAST MATERIAL,,,20,,RBRVS,1.16 ,5.12 ,5.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73701,CPT,CT LOWER EXTREMITY W/CONTRAST MATERIAL,26,,20,,RBRVS,1.16 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73701,CPT,CT LOWER EXTREMITY W/CONTRAST MATERIAL,TC,,20,,RBRVS,,4.69 ,4.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73702,CPT,CT LOWER EXTREMITY W/O & W/CONTRAST MATRL,,,20,,RBRVS,1.22 ,6.42 ,6.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73702,CPT,CT LOWER EXTREMITY W/O & W/CONTRAST MATRL,26,,20,,RBRVS,1.22 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73702,CPT,CT LOWER EXTREMITY W/O & W/CONTRAST MATRL,TC,,20,,RBRVS,,5.98 ,5.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73706,CPT,CT ANGIOGRAPHY LOWER EXTREMITY,,,20,,RBRVS,1.90 ,7.87 ,7.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73706,CPT,CT ANGIOGRAPHY LOWER EXTREMITY,26,,20,,RBRVS,1.90 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73706,CPT,CT ANGIOGRAPHY LOWER EXTREMITY,TC,,20,,RBRVS,,7.18 ,7.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73718,CPT,MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL,,,20,,RBRVS,1.35 ,8.80 ,8.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73718,CPT,MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL,26,,20,,RBRVS,1.35 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73718,CPT,MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL,TC,,20,,RBRVS,,8.30 ,8.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73719,CPT,MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL,,,20,,RBRVS,1.62 ,9.63 ,9.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73719,CPT,MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL,26,,20,,RBRVS,1.62 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73719,CPT,MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL,TC,,20,,RBRVS,,9.03 ,9.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73720,CPT,MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR,,,20,,RBRVS,2.15 ,11.84 ,11.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73720,CPT,MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR,26,,20,,RBRVS,2.15 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73720,CPT,MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR,TC,,20,,RBRVS,,11.04 ,11.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73721,CPT,MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL,,,20,,RBRVS,1.35 ,5.20 ,5.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73721,CPT,MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL,26,,20,,RBRVS,1.35 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73721,CPT,MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL,TC,,20,,RBRVS,,4.69 ,4.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73722,CPT,MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL,,,20,,RBRVS,1.62 ,9.00 ,9.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73722,CPT,MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL,26,,20,,RBRVS,1.62 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73722,CPT,MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL,TC,,20,,RBRVS,,8.39 ,8.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73723,CPT,MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL,,,20,,RBRVS,2.15 ,10.94 ,10.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73723,CPT,MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL,26,,20,,RBRVS,2.15 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73723,CPT,MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL,TC,,20,,RBRVS,,10.14 ,10.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 73725,CPT,MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL,,,20,,RBRVS,1.82 ,9.35 ,9.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 73725,CPT,MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL,26,,20,,RBRVS,1.82 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 73725,CPT,MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL,TC,,20,,RBRVS,,8.70 ,8.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74000,CPT,RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW,,,20,,RBRVS,0.18 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74000,CPT,RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW,26,,20,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74000,CPT,RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW,TC,,20,,RBRVS,,0.39 ,0.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74010,CPT,RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS,,,20,,RBRVS,0.23 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74010,CPT,RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS,26,,20,,RBRVS,0.23 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74010,CPT,RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS,TC,,20,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74020,CPT,RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS,,,20,,RBRVS,0.27 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74020,CPT,RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS,26,,20,,RBRVS,0.27 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74020,CPT,RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS,TC,,20,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74022,CPT,RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH,,,20,,RBRVS,0.32 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74022,CPT,RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH,26,,20,,RBRVS,0.32 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74022,CPT,RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH,TC,,20,,RBRVS,,0.78 ,0.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74150,CPT,CT ABDOMEN W/O CONTRAST MATERIAL,,,20,,RBRVS,1.19 ,2.94 ,2.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74150,CPT,CT ABDOMEN W/O CONTRAST MATERIAL,26,,20,,RBRVS,1.19 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74150,CPT,CT ABDOMEN W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,2.50 ,2.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74160,CPT,CT ABDOMEN W/CONTRAST MATERIAL,,,20,,RBRVS,1.27 ,5.14 ,5.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74160,CPT,CT ABDOMEN W/CONTRAST MATERIAL,26,,20,,RBRVS,1.27 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74160,CPT,CT ABDOMEN W/CONTRAST MATERIAL,TC,,20,,RBRVS,,4.66 ,4.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74170,CPT,CT ABDOMEN W/O & W/CONTRAST MATERIAL,,,20,,RBRVS,1.40 ,5.89 ,5.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74170,CPT,CT ABDOMEN W/O & W/CONTRAST MATERIAL,26,,20,,RBRVS,1.40 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74170,CPT,CT ABDOMEN W/O & W/CONTRAST MATERIAL,TC,,20,,RBRVS,,5.37 ,5.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74174,CPT,CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG,,,20,,RBRVS,2.20 ,8.58 ,8.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74174,CPT,CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG,26,,20,,RBRVS,2.20 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74174,CPT,CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG,TC,,20,,RBRVS,,7.79 ,7.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74175,CPT,CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST,,,20,,RBRVS,1.82 ,6.69 ,6.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74175,CPT,CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST,26,,20,,RBRVS,1.82 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74175,CPT,CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST,TC,,20,,RBRVS,,6.03 ,6.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74176,CPT,CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL,,,20,,RBRVS,1.74 ,3.79 ,3.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74176,CPT,CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL,26,,20,,RBRVS,1.74 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74176,CPT,CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,3.14 ,3.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74177,CPT,CT ABDOMEN & PELVIS W/CONTRAST MATERIAL,,,20,,RBRVS,1.82 ,6.82 ,6.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74177,CPT,CT ABDOMEN & PELVIS W/CONTRAST MATERIAL,26,,20,,RBRVS,1.82 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74177,CPT,CT ABDOMEN & PELVIS W/CONTRAST MATERIAL,TC,,20,,RBRVS,,6.14 ,6.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74178,CPT,CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE,,,20,,RBRVS,2.01 ,7.79 ,7.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74178,CPT,CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE,26,,20,,RBRVS,2.01 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74178,CPT,CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE,TC,,20,,RBRVS,,7.04 ,7.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74181,CPT,MRI ABDOMEN W/O CONTRAST MATERIAL,,,20,,RBRVS,1.46 ,7.81 ,7.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74181,CPT,MRI ABDOMEN W/O CONTRAST MATERIAL,26,,20,,RBRVS,1.46 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74181,CPT,MRI ABDOMEN W/O CONTRAST MATERIAL,TC,,20,,RBRVS,,7.27 ,7.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74182,CPT,MRI ABDOMEN W/CONTRAST MATERIAL,,,20,,RBRVS,1.73 ,10.91 ,10.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74182,CPT,MRI ABDOMEN W/CONTRAST MATERIAL,26,,20,,RBRVS,1.73 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74182,CPT,MRI ABDOMEN W/CONTRAST MATERIAL,TC,,20,,RBRVS,,10.27 ,10.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74183,CPT,MRI ABDOMEN W/O & W/CONTRAST MATERIAL,,,20,,RBRVS,2.26 ,11.83 ,11.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74183,CPT,MRI ABDOMEN W/O & W/CONTRAST MATERIAL,26,,20,,RBRVS,2.26 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74183,CPT,MRI ABDOMEN W/O & W/CONTRAST MATERIAL,TC,,20,,RBRVS,,10.99 ,10.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74185,CPT,MRA ABDOMEN W/WO CONTRAST MATERIAL,,,20,,RBRVS,1.80 ,9.41 ,9.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74185,CPT,MRA ABDOMEN W/WO CONTRAST MATERIAL,26,,20,,RBRVS,1.80 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74185,CPT,MRA ABDOMEN W/WO CONTRAST MATERIAL,TC,,20,,RBRVS,,8.76 ,8.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74190,CPT,PERITONEOGRAM RS&I,,,20,,TotalUnits,,,,1.37 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74190,CPT,PERITONEOGRAM RS&I,26,,20,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74190,CPT,PERITONEOGRAM RS&I,TC,,20,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74210,CPT,RADEX PHARYNX&/CERVICAL ESOPHAGUS,,,20,,RBRVS,0.36 ,1.79 ,1.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74210,CPT,RADEX PHARYNX&/CERVICAL ESOPHAGUS,26,,20,,RBRVS,0.36 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74210,CPT,RADEX PHARYNX&/CERVICAL ESOPHAGUS,TC,,20,,RBRVS,,1.66 ,1.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74220,CPT,RADEX ESOPHAGUS,,,20,,RBRVS,0.46 ,1.99 ,1.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74220,CPT,RADEX ESOPHAGUS,26,,20,,RBRVS,0.46 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74220,CPT,RADEX ESOPHAGUS,TC,,20,,RBRVS,,1.82 ,1.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74230,CPT,SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG,,,20,,RBRVS,0.53 ,3.03 ,3.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74230,CPT,SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG,26,,20,,RBRVS,0.53 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74230,CPT,SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG,TC,,20,,RBRVS,,2.83 ,2.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74235,CPT,RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I,,,20,,TotalUnits,,,,4.41 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74235,CPT,RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I,26,,20,,TotalUnits,,,,1.53 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74235,CPT,RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I,TC,,20,,TotalUnits,,,,2.88 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74240,CPT,RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB,,,20,,RBRVS,0.69 ,2.44 ,2.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74240,CPT,RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB,26,,20,,RBRVS,0.69 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74240,CPT,RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB,TC,,20,,RBRVS,,2.18 ,2.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74241,CPT,RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/KUB,,,20,,RBRVS,0.69 ,2.57 ,2.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74241,CPT,RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/KUB,26,,20,,RBRVS,0.69 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74241,CPT,RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/KUB,TC,,20,,RBRVS,,2.31 ,2.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74245,CPT,RADEX GI TRACT UPR W/SM INT W/MULT SERIAL IMAGES,,,20,,RBRVS,0.91 ,3.85 ,3.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74245,CPT,RADEX GI TRACT UPR W/SM INT W/MULT SERIAL IMAGES,26,,20,,RBRVS,0.91 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74245,CPT,RADEX GI TRACT UPR W/SM INT W/MULT SERIAL IMAGES,TC,,20,,RBRVS,,3.51 ,3.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74246,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY IMGES W/O KUB,,,20,,RBRVS,0.69 ,2.84 ,2.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74246,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY IMGES W/O KUB,26,,20,,RBRVS,0.69 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74246,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY IMGES W/O KUB,TC,,20,,RBRVS,,2.58 ,2.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74247,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY IMAGES W/KUB,,,20,,RBRVS,0.69 ,3.22 ,3.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74247,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY IMAGES W/KUB,26,,20,,RBRVS,0.69 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74247,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY IMAGES W/KUB,TC,,20,,RBRVS,,2.96 ,2.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74249,CPT,RADEX GI UPR W/WO GLUCOSE W/SM INTEST FOLLW-THRU,,,20,,RBRVS,0.91 ,4.20 ,4.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74249,CPT,RADEX GI UPR W/WO GLUCOSE W/SM INTEST FOLLW-THRU,26,,20,,RBRVS,0.91 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74249,CPT,RADEX GI UPR W/WO GLUCOSE W/SM INTEST FOLLW-THRU,TC,,20,,RBRVS,,3.86 ,3.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74250,CPT,RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES,,,20,,RBRVS,0.47 ,2.41 ,2.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74250,CPT,RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES,26,,20,,RBRVS,0.47 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74250,CPT,RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES,TC,,20,,RBRVS,,2.24 ,2.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74251,CPT,RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE,,,20,,RBRVS,0.69 ,11.02 ,11.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74251,CPT,RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE,26,,20,,RBRVS,0.69 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74251,CPT,RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE,TC,,20,,RBRVS,,10.76 ,10.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74260,CPT,DUODENOGRAPY HYPOTONIC,,,20,,RBRVS,0.50 ,9.38 ,9.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74260,CPT,DUODENOGRAPY HYPOTONIC,26,,20,,RBRVS,0.50 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74260,CPT,DUODENOGRAPY HYPOTONIC,TC,,20,,RBRVS,,9.19 ,9.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74261,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST,,,20,,RBRVS,2.40 ,11.10 ,11.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74261,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST,26,,20,,RBRVS,2.40 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74261,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST,TC,,20,,RBRVS,,10.20 ,10.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74262,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST,,,20,,RBRVS,2.50 ,12.53 ,12.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74262,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST,26,,20,,RBRVS,2.50 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74262,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST,TC,,20,,RBRVS,,11.60 ,11.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74263,CPT,CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING,,,20,,RBRVS,2.28 ,18.83 ,18.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74263,CPT,CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING,26,,20,,RBRVS,2.28 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74263,CPT,CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING,TC,,20,,RBRVS,,17.96 ,17.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74270,CPT,RADEX COLON BARIUM ENEMA W/WO KUB,,,20,,RBRVS,0.69 ,3.49 ,3.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74270,CPT,RADEX COLON BARIUM ENEMA W/WO KUB,26,,20,,RBRVS,0.69 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74270,CPT,RADEX COLON BARIUM ENEMA W/WO KUB,TC,,20,,RBRVS,,3.23 ,3.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74280,CPT,RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON,,,20,,RBRVS,0.99 ,4.92 ,4.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74280,CPT,RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON,26,,20,,RBRVS,0.99 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74280,CPT,RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON,TC,,20,,RBRVS,,4.55 ,4.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74283,CPT,THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ,,,20,,RBRVS,2.02 ,3.63 ,3.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74283,CPT,THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ,26,,20,,RBRVS,2.02 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74283,CPT,THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ,TC,,20,,RBRVS,,2.86 ,2.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74290,CPT,CHOLECYSTOGRAPHY ORAL CONTRST,,,20,,RBRVS,0.32 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74290,CPT,CHOLECYSTOGRAPHY ORAL CONTRST,26,,20,,RBRVS,0.32 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74290,CPT,CHOLECYSTOGRAPHY ORAL CONTRST,TC,,20,,RBRVS,,1.50 ,1.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74300,CPT,CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I,,,20,,TotalUnits,,,,1.54 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74300,CPT,CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I,26,,20,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74300,CPT,CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I,TC,,20,,TotalUnits,,,,1.05 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74301,CPT,CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS,,,20,,TotalUnits,,,,1.05 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74301,CPT,CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS,26,,20,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74301,CPT,CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS,TC,,20,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74328,CPT,ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I,,,20,,TotalUnits,,,,3.62 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74328,CPT,ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I,26,,20,,TotalUnits,,,,0.97 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74328,CPT,ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I,TC,,20,,TotalUnits,,,,2.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74329,CPT,ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I,,,20,,TotalUnits,,,,2.98 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74329,CPT,ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I,26,,20,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74329,CPT,ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I,TC,,20,,TotalUnits,,,,2.00 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74330,CPT,CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I,,,20,,TotalUnits,,,,4.47 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74330,CPT,CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I,26,,20,,TotalUnits,,,,1.25 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74330,CPT,CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I,TC,,20,,TotalUnits,,,,3.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74340,CPT,INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I,,,20,,TotalUnits,,,,2.17 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74340,CPT,INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I,26,,20,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74340,CPT,INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I,TC,,20,,TotalUnits,,,,1.43 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74355,CPT,PERCUTANEOUS PLACEMENT ENTEROCLYSIS TUBE RS&I,,,20,,TotalUnits,,,,3.86 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74355,CPT,PERCUTANEOUS PLACEMENT ENTEROCLYSIS TUBE RS&I,26,,20,,TotalUnits,,,,1.03 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74355,CPT,PERCUTANEOUS PLACEMENT ENTEROCLYSIS TUBE RS&I,TC,,20,,TotalUnits,,,,2.83 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74360,CPT,INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I,,,20,,TotalUnits,,,,3.28 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74360,CPT,INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I,26,,20,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74360,CPT,INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I,TC,,20,,TotalUnits,,,,2.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74363,CPT,PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I,,,20,,TotalUnits,,,,3.17 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74363,CPT,PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I,26,,20,,TotalUnits,,,,1.17 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74363,CPT,PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I,TC,,20,,TotalUnits,,,,2.00 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74400,CPT,UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY,,,20,,RBRVS,0.49 ,2.56 ,2.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74400,CPT,UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY,26,,20,,RBRVS,0.49 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74400,CPT,UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY,TC,,20,,RBRVS,,2.38 ,2.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74410,CPT,UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE,,,20,,RBRVS,0.49 ,2.51 ,2.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74410,CPT,UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE,26,,20,,RBRVS,0.49 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74410,CPT,UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE,TC,,20,,RBRVS,,2.34 ,2.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74415,CPT,UROGRAPY INFUSION DRIP &/BOLUS TECHQ W/WO TOMO,,,20,,RBRVS,0.49 ,3.31 ,3.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74415,CPT,UROGRAPY INFUSION DRIP &/BOLUS TECHQ W/WO TOMO,26,,20,,RBRVS,0.49 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74415,CPT,UROGRAPY INFUSION DRIP &/BOLUS TECHQ W/WO TOMO,TC,,20,,RBRVS,,3.13 ,3.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74420,CPT,X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL,,,20,,TotalUnits,,,,2.53 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74420,CPT,X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL,26,,20,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74420,CPT,X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL,TC,,20,,TotalUnits,,,,2.04 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74425,CPT,UROGRAPHY ANTEGRADE RS&I,,,20,,TotalUnits,,,,1.83 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74425,CPT,UROGRAPHY ANTEGRADE RS&I,26,,20,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74425,CPT,UROGRAPHY ANTEGRADE RS&I,TC,,20,,TotalUnits,,,,1.35 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74430,CPT,CYSTOGRAPHY MINIMUM 3 VIEWS RS&I,,,20,,RBRVS,0.32 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74430,CPT,CYSTOGRAPHY MINIMUM 3 VIEWS RS&I,26,,20,,RBRVS,0.32 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74430,CPT,CYSTOGRAPHY MINIMUM 3 VIEWS RS&I,TC,,20,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74440,CPT,VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I,,,20,,RBRVS,0.38 ,1.88 ,1.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74440,CPT,VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I,26,,20,,RBRVS,0.38 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74440,CPT,VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I,TC,,20,,RBRVS,,1.75 ,1.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74445,CPT,CORPORA CAVERNOSOGRAPY RS&I,,,20,,TotalUnits,,,,2.89 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74445,CPT,CORPORA CAVERNOSOGRAPY RS&I,26,,20,,TotalUnits,,,,1.51 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74445,CPT,CORPORA CAVERNOSOGRAPY RS&I,TC,,20,,TotalUnits,,,,1.38 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74450,CPT,URETHROCYSTOGRAPHY RETROGRADE RS&I,,,20,,TotalUnits,,,,2.06 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74450,CPT,URETHROCYSTOGRAPHY RETROGRADE RS&I,26,,20,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74450,CPT,URETHROCYSTOGRAPHY RETROGRADE RS&I,TC,,20,,TotalUnits,,,,1.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74455,CPT,URETHROCYSTOGRAPHY VOIDING RS&I,,,20,,RBRVS,0.33 ,1.93 ,1.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74455,CPT,URETHROCYSTOGRAPHY VOIDING RS&I,26,,20,,RBRVS,0.33 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74455,CPT,URETHROCYSTOGRAPHY VOIDING RS&I,TC,,20,,RBRVS,,1.81 ,1.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74470,CPT,RADEX RENAL CYST STUDY TRANSLUMBAR RS&I,,,20,,TotalUnits,,,,2.51 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74470,CPT,RADEX RENAL CYST STUDY TRANSLUMBAR RS&I,26,,20,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74470,CPT,RADEX RENAL CYST STUDY TRANSLUMBAR RS&I,TC,,20,,TotalUnits,,,,1.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74485,CPT,DILATION NEPHROSTOMY/URETER/URETHRA RS&I,,,20,,RBRVS,0.54 ,2.02 ,2.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74485,CPT,DILATION NEPHROSTOMY/URETER/URETHRA RS&I,26,,20,,RBRVS,0.54 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74485,CPT,DILATION NEPHROSTOMY/URETER/URETHRA RS&I,TC,,20,,RBRVS,,1.84 ,1.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74710,CPT,PELVIMETRY W/WOPLACENTAL LOCALIZATION,,,20,,RBRVS,0.34 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74710,CPT,PELVIMETRY W/WOPLACENTAL LOCALIZATION,26,,20,,RBRVS,0.34 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74710,CPT,PELVIMETRY W/WOPLACENTAL LOCALIZATION,TC,,20,,RBRVS,,0.53 ,0.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74712,CPT,FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES,,,20,,RBRVS,3.00 ,10.36 ,10.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74712,CPT,FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES,26,,20,,RBRVS,3.00 ,1.12 ,1.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74712,CPT,FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES,TC,,20,,RBRVS,,9.24 ,9.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74713,CPT,FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES,,,20,,RBRVS,1.78 ,4.63 ,4.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74713,CPT,FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES,26,,20,,RBRVS,1.78 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74713,CPT,FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES,TC,,20,,RBRVS,,3.96 ,3.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74740,CPT,HYSTEROSALPINGOGRAPHY RS&I,,,20,,RBRVS,0.38 ,1.69 ,1.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74740,CPT,HYSTEROSALPINGOGRAPHY RS&I,26,,20,,RBRVS,0.38 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74740,CPT,HYSTEROSALPINGOGRAPHY RS&I,TC,,20,,RBRVS,,1.55 ,1.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74742,CPT,TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I,,,20,,TotalUnits,,,,2.91 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74742,CPT,TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I,26,,20,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74742,CPT,TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I,TC,,20,,TotalUnits,,,,2.11 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 74775,CPT,PERINEOGRAM,,,20,,TotalUnits,,,,3.38 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 74775,CPT,PERINEOGRAM,26,,20,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 74775,CPT,PERINEOGRAM,TC,,20,,TotalUnits,,,,2.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75557,CPT,CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST,,,20,,RBRVS,2.35 ,6.48 ,6.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75557,CPT,CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST,26,,20,,RBRVS,2.35 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75557,CPT,CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST,TC,,20,,RBRVS,,5.65 ,5.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75559,CPT,CARDIAC MRI W/O CONTRAST W/STRESS IMAGING,,,20,,RBRVS,2.95 ,9.19 ,9.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75559,CPT,CARDIAC MRI W/O CONTRAST W/STRESS IMAGING,26,,20,,RBRVS,2.95 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75559,CPT,CARDIAC MRI W/O CONTRAST W/STRESS IMAGING,TC,,20,,RBRVS,,8.18 ,8.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75561,CPT,CARDIAC MRI W/WO CONTRAST & FURTHER SEQ,,,20,,RBRVS,2.60 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75561,CPT,CARDIAC MRI W/WO CONTRAST & FURTHER SEQ,26,,20,,RBRVS,2.60 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75561,CPT,CARDIAC MRI W/WO CONTRAST & FURTHER SEQ,TC,,20,,RBRVS,,8.24 ,8.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75563,CPT,CARDIAC MRI W/W/O CONTRAST W/STRESS,,,20,,RBRVS,3.00 ,10.97 ,10.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75563,CPT,CARDIAC MRI W/W/O CONTRAST W/STRESS,26,,20,,RBRVS,3.00 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75563,CPT,CARDIAC MRI W/W/O CONTRAST W/STRESS,TC,,20,,RBRVS,,9.92 ,9.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75565,CPT,CARDIAC MRI FOR VELOCITY FLOW MAPPING,,,20,,RBRVS,0.25 ,1.28 ,1.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75565,CPT,CARDIAC MRI FOR VELOCITY FLOW MAPPING,26,,20,,RBRVS,0.25 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75565,CPT,CARDIAC MRI FOR VELOCITY FLOW MAPPING,TC,,20,,RBRVS,,1.19 ,1.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75571,CPT,CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM,,,20,,RBRVS,0.58 ,2.20 ,2.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75571,CPT,CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM,26,,20,,RBRVS,0.58 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75571,CPT,CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM,TC,,20,,RBRVS,,1.99 ,1.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75572,CPT,CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH,,,20,,RBRVS,1.75 ,6.13 ,6.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75572,CPT,CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH,26,,20,,RBRVS,1.75 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75572,CPT,CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH,TC,,20,,RBRVS,,5.50 ,5.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75573,CPT,CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT D,,,20,,RBRVS,2.55 ,8.30 ,8.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75573,CPT,CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT D,26,,20,,RBRVS,2.55 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75573,CPT,CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT D,TC,,20,,RBRVS,,7.39 ,7.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75574,CPT,CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST,,,20,,RBRVS,2.40 ,9.23 ,9.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75574,CPT,CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST,26,,20,,RBRVS,2.40 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75574,CPT,CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST,TC,,20,,RBRVS,,8.38 ,8.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75600,CPT,AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,,,20,,RBRVS,0.49 ,5.02 ,5.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75600,CPT,AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,26,,20,,RBRVS,0.49 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75600,CPT,AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,TC,,20,,RBRVS,,4.87 ,4.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75605,CPT,AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I,,,20,,RBRVS,1.14 ,2.67 ,2.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75605,CPT,AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I,26,,20,,RBRVS,1.14 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75605,CPT,AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I,TC,,20,,RBRVS,,2.32 ,2.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75625,CPT,AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I,,,20,,RBRVS,1.14 ,2.63 ,2.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75625,CPT,AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I,26,,20,,RBRVS,1.14 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75625,CPT,AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I,TC,,20,,RBRVS,,2.31 ,2.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75630,CPT,AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I,,,20,,RBRVS,1.79 ,2.85 ,2.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75630,CPT,AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I,26,,20,,RBRVS,1.79 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75630,CPT,AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I,TC,,20,,RBRVS,,2.31 ,2.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75635,CPT,CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP,,,20,,RBRVS,2.40 ,8.14 ,8.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75635,CPT,CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP,26,,20,,RBRVS,2.40 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75635,CPT,CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP,TC,,20,,RBRVS,,7.28 ,7.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75658,CPT,ANIOGRAPHY BRACHIAL RETROGRADE RS&I,,,20,,RBRVS,1.31 ,3.25 ,3.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75658,CPT,ANIOGRAPHY BRACHIAL RETROGRADE RS&I,26,,20,,RBRVS,1.31 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75658,CPT,ANIOGRAPHY BRACHIAL RETROGRADE RS&I,TC,,20,,RBRVS,,2.89 ,2.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75705,CPT,ANGIOGRAPHY SPINAL SELECTIVE RS&I,,,20,,RBRVS,2.18 ,4.41 ,4.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75705,CPT,ANGIOGRAPHY SPINAL SELECTIVE RS&I,26,,20,,RBRVS,2.18 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75705,CPT,ANGIOGRAPHY SPINAL SELECTIVE RS&I,TC,,20,,RBRVS,,3.62 ,3.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75710,CPT,ANGIOGRAPHY EXTREMITY UNILATERAL RS&I,,,20,,RBRVS,1.14 ,3.34 ,3.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75710,CPT,ANGIOGRAPHY EXTREMITY UNILATERAL RS&I,26,,20,,RBRVS,1.14 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75710,CPT,ANGIOGRAPHY EXTREMITY UNILATERAL RS&I,TC,,20,,RBRVS,,3.00 ,3.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75716,CPT,ANGIOGRAPHY EXTREMITY BILATERAL RS&I,,,20,,RBRVS,1.31 ,3.83 ,3.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75716,CPT,ANGIOGRAPHY EXTREMITY BILATERAL RS&I,26,,20,,RBRVS,1.31 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75716,CPT,ANGIOGRAPHY EXTREMITY BILATERAL RS&I,TC,,20,,RBRVS,,3.44 ,3.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75726,CPT,ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I,,,20,,RBRVS,1.14 ,3.00 ,3.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75726,CPT,ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I,26,,20,,RBRVS,1.14 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75726,CPT,ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I,TC,,20,,RBRVS,,2.64 ,2.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75731,CPT,ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I,,,20,,RBRVS,1.14 ,3.65 ,3.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75731,CPT,ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I,26,,20,,RBRVS,1.14 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75731,CPT,ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I,TC,,20,,RBRVS,,3.22 ,3.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75733,CPT,ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I,,,20,,RBRVS,1.31 ,3.81 ,3.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75733,CPT,ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I,26,,20,,RBRVS,1.31 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75733,CPT,ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I,TC,,20,,RBRVS,,3.36 ,3.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75736,CPT,ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I,,,20,,RBRVS,1.14 ,3.29 ,3.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75736,CPT,ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I,26,,20,,RBRVS,1.14 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75736,CPT,ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I,TC,,20,,RBRVS,,2.95 ,2.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75741,CPT,ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I,,,20,,RBRVS,1.31 ,2.88 ,2.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75741,CPT,ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I,26,,20,,RBRVS,1.31 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75741,CPT,ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I,TC,,20,,RBRVS,,2.46 ,2.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75743,CPT,ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I,,,20,,RBRVS,1.66 ,3.02 ,3.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75743,CPT,ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I,26,,20,,RBRVS,1.66 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75743,CPT,ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I,TC,,20,,RBRVS,,2.49 ,2.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75746,CPT,ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I,,,20,,RBRVS,1.14 ,3.07 ,3.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75746,CPT,ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I,26,,20,,RBRVS,1.14 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75746,CPT,ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I,TC,,20,,RBRVS,,2.68 ,2.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75756,CPT,ANGIOGRAPHY INTERNAL MAMMARY RS&I,,,20,,RBRVS,1.14 ,3.43 ,3.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75756,CPT,ANGIOGRAPHY INTERNAL MAMMARY RS&I,26,,20,,RBRVS,1.14 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75756,CPT,ANGIOGRAPHY INTERNAL MAMMARY RS&I,TC,,20,,RBRVS,,3.11 ,3.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75774,CPT,ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I,,,20,,RBRVS,0.36 ,2.08 ,2.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75774,CPT,ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I,26,,20,,RBRVS,0.36 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75774,CPT,ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I,TC,,20,,RBRVS,,1.97 ,1.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75801,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I,,,20,,TotalUnits,,,,6.99 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75801,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I,26,,20,,TotalUnits,,,,1.10 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75801,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I,TC,,20,,TotalUnits,,,,5.89 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75803,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I,,,20,,TotalUnits,,,,7.41 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75803,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I,26,,20,,TotalUnits,,,,1.61 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75803,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I,TC,,20,,TotalUnits,,,,5.80 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75805,CPT,LYMPHANGIOGRAPHY PELVIC/ABDOMINAL UNILAT RS&I,,,20,,TotalUnits,,,,7.47 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75805,CPT,LYMPHANGIOGRAPHY PELVIC/ABDOMINAL UNILAT RS&I,26,,20,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75805,CPT,LYMPHANGIOGRAPHY PELVIC/ABDOMINAL UNILAT RS&I,TC,,20,,TotalUnits,,,,6.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75807,CPT,LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I,,,20,,TotalUnits,,,,8.11 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75807,CPT,LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I,26,,20,,TotalUnits,,,,1.61 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75807,CPT,LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I,TC,,20,,TotalUnits,,,,6.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75809,CPT,SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I,,,20,,RBRVS,0.47 ,2.29 ,2.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75809,CPT,SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I,26,,20,,RBRVS,0.47 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75809,CPT,SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I,TC,,20,,RBRVS,,2.11 ,2.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75810,CPT,SPLENOPORTOGRAPY RS&I,,,20,,TotalUnits,,,,14.48 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75810,CPT,SPLENOPORTOGRAPY RS&I,26,,20,,TotalUnits,,,,1.57 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75810,CPT,SPLENOPORTOGRAPY RS&I,TC,,20,,TotalUnits,,,,12.91 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75820,CPT,VENOGRAPHY EXTREMITY UNILATERAL RS&I,,,20,,RBRVS,0.70 ,2.49 ,2.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75820,CPT,VENOGRAPHY EXTREMITY UNILATERAL RS&I,26,,20,,RBRVS,0.70 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75820,CPT,VENOGRAPHY EXTREMITY UNILATERAL RS&I,TC,,20,,RBRVS,,2.26 ,2.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75822,CPT,VENOGRAPHY EXTREMITY BILATERAL RS&I,,,20,,RBRVS,1.06 ,2.73 ,2.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75822,CPT,VENOGRAPHY EXTREMITY BILATERAL RS&I,26,,20,,RBRVS,1.06 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75822,CPT,VENOGRAPHY EXTREMITY BILATERAL RS&I,TC,,20,,RBRVS,,2.39 ,2.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75825,CPT,VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I,,,20,,RBRVS,1.14 ,2.58 ,2.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75825,CPT,VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I,26,,20,,RBRVS,1.14 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75825,CPT,VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I,TC,,20,,RBRVS,,2.24 ,2.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75827,CPT,VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I,,,20,,RBRVS,1.14 ,2.64 ,2.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75827,CPT,VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I,26,,20,,RBRVS,1.14 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75827,CPT,VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I,TC,,20,,RBRVS,,2.31 ,2.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75831,CPT,VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I,,,20,,RBRVS,1.14 ,2.74 ,2.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75831,CPT,VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I,26,,20,,RBRVS,1.14 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75831,CPT,VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I,TC,,20,,RBRVS,,2.40 ,2.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75833,CPT,VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I,,,20,,RBRVS,1.49 ,2.97 ,2.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75833,CPT,VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I,26,,20,,RBRVS,1.49 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75833,CPT,VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I,TC,,20,,RBRVS,,2.58 ,2.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75840,CPT,VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I,,,20,,RBRVS,1.14 ,2.99 ,2.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75840,CPT,VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I,26,,20,,RBRVS,1.14 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75840,CPT,VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I,TC,,20,,RBRVS,,2.56 ,2.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75842,CPT,VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I,,,20,,RBRVS,1.49 ,3.51 ,3.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75842,CPT,VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I,26,,20,,RBRVS,1.49 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75842,CPT,VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I,TC,,20,,RBRVS,,2.96 ,2.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75860,CPT,VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I,,,20,,RBRVS,1.14 ,2.81 ,2.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75860,CPT,VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I,26,,20,,RBRVS,1.14 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75860,CPT,VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I,TC,,20,,RBRVS,,2.45 ,2.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75870,CPT,VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I,,,20,,RBRVS,1.14 ,2.97 ,2.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75870,CPT,VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I,26,,20,,RBRVS,1.14 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75870,CPT,VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I,TC,,20,,RBRVS,,2.54 ,2.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75872,CPT,VENOGRAPHY EPIDURAL RS&I,,,20,,RBRVS,1.14 ,2.74 ,2.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75872,CPT,VENOGRAPHY EPIDURAL RS&I,26,,20,,RBRVS,1.14 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75872,CPT,VENOGRAPHY EPIDURAL RS&I,TC,,20,,RBRVS,,2.44 ,2.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75880,CPT,VENOGRAPHY ORBITAL RS&I,,,20,,RBRVS,0.70 ,3.28 ,3.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75880,CPT,VENOGRAPHY ORBITAL RS&I,26,,20,,RBRVS,0.70 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75880,CPT,VENOGRAPHY ORBITAL RS&I,TC,,20,,RBRVS,,2.99 ,2.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75885,CPT,PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I,,,20,,RBRVS,1.44 ,2.94 ,2.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75885,CPT,PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I,26,,20,,RBRVS,1.44 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75885,CPT,PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I,TC,,20,,RBRVS,,2.49 ,2.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75887,CPT,PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP,,,20,,RBRVS,1.44 ,2.98 ,2.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75887,CPT,PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP,26,,20,,RBRVS,1.44 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75887,CPT,PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP,TC,,20,,RBRVS,,2.51 ,2.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75889,CPT,HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I,,,20,,RBRVS,1.14 ,2.86 ,2.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75889,CPT,HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I,26,,20,,RBRVS,1.14 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75889,CPT,HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I,TC,,20,,RBRVS,,2.50 ,2.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75891,CPT,HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I,,,20,,RBRVS,1.14 ,2.89 ,2.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75891,CPT,HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I,26,,20,,RBRVS,1.14 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75891,CPT,HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I,TC,,20,,RBRVS,,2.51 ,2.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75893,CPT,VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&,,,20,,RBRVS,0.54 ,2.77 ,2.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75893,CPT,VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&,26,,20,,RBRVS,0.54 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75893,CPT,VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&,TC,,20,,RBRVS,,2.57 ,2.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75894,CPT,TRANSCATHETER EMBOLIZATION ANY METH RS&I,,,20,,TotalUnits,,,,26.52 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75894,CPT,TRANSCATHETER EMBOLIZATION ANY METH RS&I,26,,20,,TotalUnits,,,,1.75 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75894,CPT,TRANSCATHETER EMBOLIZATION ANY METH RS&I,TC,,20,,TotalUnits,,,,24.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75898,CPT,ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS,,,20,,TotalUnits,,,,3.59 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75898,CPT,ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS,26,,20,,TotalUnits,,,,2.22 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75898,CPT,ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS,TC,,20,,TotalUnits,,,,1.37 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75901,CPT,MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I,,,20,,RBRVS,0.49 ,4.47 ,4.47 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75901,CPT,MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I,26,,20,,RBRVS,0.49 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75901,CPT,MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I,TC,,20,,RBRVS,,4.31 ,4.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75902,CPT,MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I,,,20,,RBRVS,0.39 ,1.60 ,1.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75902,CPT,MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I,26,,20,,RBRVS,0.39 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75902,CPT,MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I,TC,,20,,RBRVS,,1.48 ,1.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75952,CPT,EVASC RPR INFRARENAL AAA/DISSECTION RS&I,,,20,,TotalUnits,,,,5.63 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75952,CPT,EVASC RPR INFRARENAL AAA/DISSECTION RS&I,26,,20,,RBRVS,4.49 ,1.14 ,1.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 75953,CPT,PLMT XTN PROSTH EVASC RPR INFRARENAL RS&I,,,20,,TotalUnits,,,,3.05 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75953,CPT,PLMT XTN PROSTH EVASC RPR INFRARENAL RS&I,26,,20,,TotalUnits,,,,1.70 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 75953,CPT,PLMT XTN PROSTH EVASC RPR INFRARENAL RS&I,TC,,20,,TotalUnits,,,,1.35 ,,$0.00,$0.00,1,1,0,0,1,1,20171001, 75954,CPT,EVASC RPR ILIAC ART W/ILIO-ILIAC PROSTH RS&I,,,20,,TotalUnits,,,,2.82 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75954,CPT,EVASC RPR ILIAC ART W/ILIO-ILIAC PROSTH RS&I,26,,20,,RBRVS,2.25 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 75956,CPT,EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I,,,20,,TotalUnits,,,,8.74 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75956,CPT,EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I,26,,20,,RBRVS,7.00 ,1.74 ,1.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 75957,CPT,EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I,,,20,,TotalUnits,,,,7.49 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75957,CPT,EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I,26,,20,,RBRVS,6.00 ,1.49 ,1.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 75958,CPT,PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&I,,,20,,TotalUnits,,,,4.98 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75958,CPT,PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&I,26,,20,,RBRVS,4.00 ,0.98 ,0.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 75959,CPT,PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I,,,20,,TotalUnits,,,,4.34 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75959,CPT,PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I,26,,20,,RBRVS,3.50 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 75970,CPT,TRANSCATHETER BIOPSY RS&I,,,20,,TotalUnits,,,,13.92 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75970,CPT,TRANSCATHETER BIOPSY RS&I,26,,20,,TotalUnits,,,,1.10 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75970,CPT,TRANSCATHETER BIOPSY RS&I,TC,,20,,TotalUnits,,,,12.82 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75984,CPT,CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I,,,20,,RBRVS,0.72 ,2.23 ,2.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75984,CPT,CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I,26,,20,,RBRVS,0.72 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75984,CPT,CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I,TC,,20,,RBRVS,,1.99 ,1.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 75989,CPT,RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I,,,20,,RBRVS,1.19 ,2.14 ,2.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 75989,CPT,RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I,26,,20,,RBRVS,1.19 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 75989,CPT,RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I,TC,,20,,RBRVS,,1.73 ,1.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76000,CPT,FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME,,,20,,RBRVS,0.17 ,1.13 ,1.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76000,CPT,FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME,26,,20,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76000,CPT,FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME,TC,,20,,RBRVS,,1.07 ,1.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76001,CPT,FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME,,,20,,TotalUnits,,,,3.90 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76001,CPT,FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME,26,,20,,TotalUnits,,,,0.94 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76001,CPT,FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME,TC,,20,,TotalUnits,,,,2.96 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76010,CPT,RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD,,,20,,RBRVS,0.18 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76010,CPT,RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD,,PC,20,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,0,20171001, 76010,CPT,RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD,,TC,20,,RBRVS,,0.46 ,0.46 ,,,$0.00,$0.00,1,1,1,0,1,0,20171001, 76080,CPT,RADEX ABSCESS/FISTULA/SINUS TRACT RS&I,,,20,,RBRVS,0.54 ,0.98 ,0.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76080,CPT,RADEX ABSCESS/FISTULA/SINUS TRACT RS&I,,PC,20,,RBRVS,0.54 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,0,20171001, 76080,CPT,RADEX ABSCESS/FISTULA/SINUS TRACT RS&I,,TC,20,,RBRVS,,0.80 ,0.80 ,,,$0.00,$0.00,1,1,1,0,1,0,20171001, 76098,CPT,RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN,,,20,,RBRVS,0.16 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76098,CPT,RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN,,PC,20,,RBRVS,0.16 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,0,20171001, 76098,CPT,RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN,,TC,20,,RBRVS,,0.23 ,0.23 ,,,$0.00,$0.00,1,1,1,0,1,0,20171001, 76100,CPT,RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY,,,20,,RBRVS,0.58 ,1.96 ,1.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76100,CPT,RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY,,PC,20,,RBRVS,0.58 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,0,20171001, 76100,CPT,RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY,,TC,20,,RBRVS,,1.69 ,1.69 ,,,$0.00,$0.00,1,1,1,0,1,0,20171001, 76101,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY UNI,,,20,,RBRVS,0.58 ,3.08 ,3.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76101,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY UNI,,PC,20,,RBRVS,0.58 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,0,20171001, 76101,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY UNI,,TC,20,,RBRVS,,2.73 ,2.73 ,,,$0.00,$0.00,1,1,1,0,1,0,20171001, 76102,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY BI,,,20,,RBRVS,0.58 ,4.26 ,4.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76102,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY BI,,PC,20,,RBRVS,0.58 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,0,20171001, 76102,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY BI,,TC,20,,RBRVS,,3.91 ,3.91 ,,,$0.00,$0.00,1,1,1,0,1,0,20171001, 76120,CPT,CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC,,,20,,RBRVS,0.38 ,1.94 ,1.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76120,CPT,CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC,,PC,20,,RBRVS,0.38 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,0,20171001, 76120,CPT,CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC,,TC,20,,RBRVS,,1.79 ,1.79 ,,,$0.00,$0.00,1,1,1,0,1,0,20171001, 76125,CPT,CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION,,,20,,TotalUnits,,,,1.16 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76125,CPT,CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION,,PC,20,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 76125,CPT,CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION,,TC,20,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 76140,CPT,CONSLTJ X-RAY XM MADE ELSEWHERE WRTTN REPRT,,,20,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76376,CPT,3D RENDERING W/INTERP & POSTPROCESS SUPERVISION,,,20,,RBRVS,0.20 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76376,CPT,3D RENDERING W/INTERP & POSTPROCESS SUPERVISION,26,,20,,RBRVS,0.20 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76376,CPT,3D RENDERING W/INTERP & POSTPROCESS SUPERVISION,TC,,20,,RBRVS,,0.36 ,0.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76377,CPT,3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION,,,20,,RBRVS,0.79 ,1.16 ,1.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76377,CPT,3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION,26,,20,,RBRVS,0.79 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76377,CPT,3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION,TC,,20,,RBRVS,,0.87 ,0.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76380,CPT,CT LIMITED/LOCALIZED FOLLOW UP STUDY,,,20,,RBRVS,0.98 ,3.07 ,3.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76380,CPT,CT LIMITED/LOCALIZED FOLLOW UP STUDY,26,,20,,RBRVS,0.98 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76380,CPT,CT LIMITED/LOCALIZED FOLLOW UP STUDY,TC,,20,,RBRVS,,2.71 ,2.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76390,CPT,MRI SPECTROSCOPY,,,20,,RBRVS,1.40 ,11.04 ,11.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76390,CPT,MRI SPECTROSCOPY,26,,20,,RBRVS,1.40 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76390,CPT,MRI SPECTROSCOPY,TC,,20,,RBRVS,,10.50 ,10.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76496,CPT,UNLISTED FLUOROSCOPIC PROCEDURE,,,20,,TotalUnits,,,,1.30 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76496,CPT,UNLISTED FLUOROSCOPIC PROCEDURE,26,,20,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76496,CPT,UNLISTED FLUOROSCOPIC PROCEDURE,TC,,20,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76497,CPT,UNLISTED COMPUTED TOMOGRAPHY PROCEDURE,,,20,,TotalUnits,,,,5.01 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76497,CPT,UNLISTED COMPUTED TOMOGRAPHY PROCEDURE,26,,20,,TotalUnits,,,,1.40 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76497,CPT,UNLISTED COMPUTED TOMOGRAPHY PROCEDURE,TC,,20,,TotalUnits,,,,3.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76498,CPT,UNLISTED MAGNETIC RESONANCE PROCEDURE,,,20,,TotalUnits,,,,6.54 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76498,CPT,UNLISTED MAGNETIC RESONANCE PROCEDURE,26,,20,,TotalUnits,,,,2.03 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76498,CPT,UNLISTED MAGNETIC RESONANCE PROCEDURE,TC,,20,,TotalUnits,,,,4.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76499,CPT,UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE,,,20,,TotalUnits,,,,2.55 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76499,CPT,UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE,26,,20,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76499,CPT,UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE,TC,,20,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76506,CPT,ECHOENCEPHALOGRAPHY REAL TIME IMAGING,,,20,,RBRVS,0.63 ,2.67 ,2.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76506,CPT,ECHOENCEPHALOGRAPHY REAL TIME IMAGING,26,,20,,RBRVS,0.63 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76506,CPT,ECHOENCEPHALOGRAPHY REAL TIME IMAGING,TC,,20,,RBRVS,,2.43 ,2.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76510,CPT,OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR,,,20,,RBRVS,1.55 ,3.23 ,3.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76510,CPT,OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR,26,,20,,RBRVS,1.55 ,0.95 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76510,CPT,OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR,TC,,20,,RBRVS,,2.28 ,2.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76511,CPT,OPHTHALMIC ULTRASOUND DX QUAN A-SCAN ONLY,,,20,,RBRVS,0.94 ,1.90 ,1.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76511,CPT,OPHTHALMIC ULTRASOUND DX QUAN A-SCAN ONLY,26,,20,,RBRVS,0.94 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76511,CPT,OPHTHALMIC ULTRASOUND DX QUAN A-SCAN ONLY,TC,,20,,RBRVS,,1.35 ,1.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76512,CPT,OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN,,,20,,RBRVS,0.94 ,1.66 ,1.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76512,CPT,OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN,26,,20,,RBRVS,0.94 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76512,CPT,OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN,TC,,20,,RBRVS,,1.11 ,1.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76513,CPT,OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM,,,20,,RBRVS,0.66 ,2.01 ,2.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76513,CPT,OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM,26,,20,,RBRVS,0.66 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76513,CPT,OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM,TC,,20,,RBRVS,,1.67 ,1.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76514,CPT,OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI,,,20,,RBRVS,0.17 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76514,CPT,OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI,26,,20,,RBRVS,0.17 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76514,CPT,OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI,TC,,20,,RBRVS,,0.14 ,0.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76516,CPT,OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN,,,20,,RBRVS,0.54 ,1.66 ,1.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76516,CPT,OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN,26,,20,,RBRVS,0.54 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76516,CPT,OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN,TC,,20,,RBRVS,,1.33 ,1.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76519,CPT,OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL,,,20,,RBRVS,0.54 ,1.81 ,1.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76519,CPT,OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL,26,,20,,RBRVS,0.54 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76519,CPT,OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL,TC,,20,,RBRVS,,1.48 ,1.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76529,CPT,OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION,,,20,,RBRVS,0.57 ,1.65 ,1.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76529,CPT,OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION,26,,20,,RBRVS,0.57 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76529,CPT,OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION,TC,,20,,RBRVS,,1.31 ,1.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76536,CPT,US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM,,,20,,RBRVS,0.56 ,2.69 ,2.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76536,CPT,US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM,26,,20,,RBRVS,0.56 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76536,CPT,US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM,TC,,20,,RBRVS,,2.48 ,2.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76604,CPT,US CHEST REAL TIME W/IMAGE DOCUMENTATION,,,20,,RBRVS,0.55 ,1.90 ,1.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76604,CPT,US CHEST REAL TIME W/IMAGE DOCUMENTATION,26,,20,,RBRVS,0.55 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76604,CPT,US CHEST REAL TIME W/IMAGE DOCUMENTATION,TC,,20,,RBRVS,,1.71 ,1.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76641,CPT,US BREAST UNI REAL TIME WITH IMAGE COMPLETE,,,20,,RBRVS,0.73 ,2.26 ,2.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76641,CPT,US BREAST UNI REAL TIME WITH IMAGE COMPLETE,26,,20,,RBRVS,0.73 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76641,CPT,US BREAST UNI REAL TIME WITH IMAGE COMPLETE,TC,,20,,RBRVS,,1.99 ,1.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76642,CPT,US BREAST UNI REAL TIME WITH IMAGE LIMITED,,,20,,RBRVS,0.68 ,1.77 ,1.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76642,CPT,US BREAST UNI REAL TIME WITH IMAGE LIMITED,26,,20,,RBRVS,0.68 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76642,CPT,US BREAST UNI REAL TIME WITH IMAGE LIMITED,TC,,20,,RBRVS,,1.52 ,1.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76700,CPT,US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION,,,20,,RBRVS,0.81 ,2.61 ,2.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76700,CPT,US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION,26,,20,,RBRVS,0.81 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76700,CPT,US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION,TC,,20,,RBRVS,,2.31 ,2.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76705,CPT,US ABDOMINAL REAL TIME W/IMAGE LIMITED,,,20,,RBRVS,0.59 ,1.96 ,1.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76705,CPT,US ABDOMINAL REAL TIME W/IMAGE LIMITED,26,,20,,RBRVS,0.59 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76705,CPT,US ABDOMINAL REAL TIME W/IMAGE LIMITED,TC,,20,,RBRVS,,1.74 ,1.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76706,CPT,US ABDL AORTA SCREEN AAA,,,20,,RBRVS,0.55 ,2.07 ,2.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76706,CPT,US ABDL AORTA SCREEN AAA,26,,20,,RBRVS,0.55 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76706,CPT,US ABDL AORTA SCREEN AAA,TC,,20,,RBRVS,,1.86 ,1.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76770,CPT,US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE,,,20,,RBRVS,0.74 ,2.42 ,2.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76770,CPT,US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE,26,,20,,RBRVS,0.74 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76770,CPT,US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE,TC,,20,,RBRVS,,2.15 ,2.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76775,CPT,US RETROPERITONEAL REAL TIME W/IMAGE LIMITED,,,20,,RBRVS,0.58 ,1.02 ,1.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76775,CPT,US RETROPERITONEAL REAL TIME W/IMAGE LIMITED,26,,20,,RBRVS,0.58 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76775,CPT,US RETROPERITONEAL REAL TIME W/IMAGE LIMITED,TC,,20,,RBRVS,,0.81 ,0.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76776,CPT,US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN,,,20,,RBRVS,0.76 ,3.63 ,3.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76776,CPT,US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN,26,,20,,RBRVS,0.76 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76776,CPT,US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN,TC,,20,,RBRVS,,3.35 ,3.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76800,CPT,ULTRASOUND SPINAL CANAL & CONTENTS,,,20,,RBRVS,1.13 ,2.70 ,2.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76800,CPT,ULTRASOUND SPINAL CANAL & CONTENTS,26,,20,,RBRVS,1.13 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76800,CPT,ULTRASOUND SPINAL CANAL & CONTENTS,TC,,20,,RBRVS,,2.27 ,2.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76801,CPT,US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT,,,20,,RBRVS,0.99 ,2.43 ,2.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76801,CPT,US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT,26,,20,,RBRVS,0.99 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76801,CPT,US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT,TC,,20,,RBRVS,,2.05 ,2.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76802,CPT,US PREG UTERUS 14 WK TRANSABDL EACH GESTATION,,,20,,RBRVS,0.83 ,0.95 ,0.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76802,CPT,US PREG UTERUS 14 WK TRANSABDL EACH GESTATION,26,,20,,RBRVS,0.83 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76802,CPT,US PREG UTERUS 14 WK TRANSABDL EACH GESTATION,TC,,20,,RBRVS,,0.63 ,0.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76805,CPT,US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION,,,20,,RBRVS,0.99 ,2.96 ,2.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76805,CPT,US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION,26,,20,,RBRVS,0.99 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76805,CPT,US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION,TC,,20,,RBRVS,,2.58 ,2.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76810,CPT,US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO,,,20,,RBRVS,0.98 ,1.60 ,1.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76810,CPT,US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO,26,,20,,RBRVS,0.98 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76810,CPT,US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO,TC,,20,,RBRVS,,1.22 ,1.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76811,CPT,US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION,,,20,,RBRVS,1.90 ,3.09 ,3.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76811,CPT,US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION,26,,20,,RBRVS,1.90 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76811,CPT,US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION,TC,,20,,RBRVS,,2.35 ,2.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76812,CPT,US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT,,,20,,RBRVS,1.78 ,3.93 ,3.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76812,CPT,US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT,26,,20,,RBRVS,1.78 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76812,CPT,US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT,TC,,20,,RBRVS,,3.23 ,3.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76813,CPT,US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION,,,20,,RBRVS,1.18 ,2.15 ,2.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76813,CPT,US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION,26,,20,,RBRVS,1.18 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76813,CPT,US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION,TC,,20,,RBRVS,,1.69 ,1.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76814,CPT,US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION,,,20,,RBRVS,0.99 ,1.22 ,1.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76814,CPT,US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION,26,,20,,RBRVS,0.99 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76814,CPT,US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION,TC,,20,,RBRVS,,0.83 ,0.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76815,CPT,US PREGNANT UTERUS LIMITED 1/> FETUSES,,,20,,RBRVS,0.65 ,1.69 ,1.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76815,CPT,US PREGNANT UTERUS LIMITED 1/> FETUSES,26,,20,,RBRVS,0.65 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76815,CPT,US PREGNANT UTERUS LIMITED 1/> FETUSES,TC,,20,,RBRVS,,1.45 ,1.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76816,CPT,US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS,,,20,,RBRVS,0.85 ,2.34 ,2.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76816,CPT,US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS,26,,20,,RBRVS,0.85 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76816,CPT,US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS,TC,,20,,RBRVS,,2.01 ,2.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76817,CPT,US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG,,,20,,RBRVS,0.75 ,1.95 ,1.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76817,CPT,US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG,26,,20,,RBRVS,0.75 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76817,CPT,US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG,TC,,20,,RBRVS,,1.66 ,1.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76818,CPT,FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING,,,20,,RBRVS,1.05 ,2.30 ,2.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76818,CPT,FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING,26,,20,,RBRVS,1.05 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76818,CPT,FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING,TC,,20,,RBRVS,,1.89 ,1.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76819,CPT,FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING,,,20,,RBRVS,0.77 ,1.68 ,1.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76819,CPT,FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING,26,,20,,RBRVS,0.77 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76819,CPT,FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING,TC,,20,,RBRVS,,1.38 ,1.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76820,CPT,DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY,,,20,,RBRVS,0.50 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76820,CPT,DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY,26,,20,,RBRVS,0.50 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76820,CPT,DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY,TC,,20,,RBRVS,,0.60 ,0.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76821,CPT,DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART,,,20,,RBRVS,0.70 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76821,CPT,DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART,26,,20,,RBRVS,0.70 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76821,CPT,DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART,TC,,20,,RBRVS,,1.60 ,1.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76825,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING,,,20,,RBRVS,1.67 ,6.05 ,6.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76825,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING,26,,20,,RBRVS,1.67 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76825,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING,TC,,20,,RBRVS,,5.43 ,5.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76826,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD,,,20,,RBRVS,0.83 ,3.75 ,3.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76826,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD,26,,20,,RBRVS,0.83 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76826,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD,TC,,20,,RBRVS,,3.44 ,3.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76827,CPT,DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE,,,20,,RBRVS,0.58 ,1.53 ,1.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76827,CPT,DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE,26,,20,,RBRVS,0.58 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76827,CPT,DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE,TC,,20,,RBRVS,,1.32 ,1.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76828,CPT,DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT,,,20,,RBRVS,0.56 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76828,CPT,DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT,26,,20,,RBRVS,0.56 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76828,CPT,DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT,TC,,20,,RBRVS,,0.70 ,0.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76830,CPT,US TRANSVAGINAL,,,20,,RBRVS,0.69 ,2.72 ,2.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76830,CPT,US TRANSVAGINAL,26,,20,,RBRVS,0.69 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76830,CPT,US TRANSVAGINAL,TC,,20,,RBRVS,,2.46 ,2.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76831,CPT,SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER,,,20,,RBRVS,0.72 ,2.58 ,2.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76831,CPT,SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER,26,,20,,RBRVS,0.72 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76831,CPT,SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER,TC,,20,,RBRVS,,2.30 ,2.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76856,CPT,US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE,,,20,,RBRVS,0.69 ,2.37 ,2.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76856,CPT,US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE,26,,20,,RBRVS,0.69 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76856,CPT,US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE,TC,,20,,RBRVS,,2.12 ,2.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76857,CPT,US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U,,,20,,RBRVS,0.50 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76857,CPT,US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U,26,,20,,RBRVS,0.50 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76857,CPT,US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U,TC,,20,,RBRVS,,0.63 ,0.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76870,CPT,US SCROTUM & CONTENTS,,,20,,RBRVS,0.64 ,1.22 ,1.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76870,CPT,US SCROTUM & CONTENTS,26,,20,,RBRVS,0.64 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76870,CPT,US SCROTUM & CONTENTS,TC,,20,,RBRVS,,0.99 ,0.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76872,CPT,US TRANSRECTAL,,,20,,RBRVS,0.69 ,1.94 ,1.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76872,CPT,US TRANSRECTAL,26,,20,,RBRVS,0.69 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76872,CPT,US TRANSRECTAL,TC,,20,,RBRVS,,1.70 ,1.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76873,CPT,US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX,,,20,,RBRVS,1.55 ,3.13 ,3.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76873,CPT,US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX,26,,20,,RBRVS,1.55 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76873,CPT,US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX,TC,,20,,RBRVS,,2.53 ,2.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76881,CPT,US EXTREMITY NON-VASC REAL-TIME IMG COMPL,,,20,,RBRVS,0.63 ,2.57 ,2.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76881,CPT,US EXTREMITY NON-VASC REAL-TIME IMG COMPL,26,,20,,RBRVS,0.63 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76881,CPT,US EXTREMITY NON-VASC REAL-TIME IMG COMPL,TC,,20,,RBRVS,,2.34 ,2.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76882,CPT,US EXTREMITY NON-VASC REAL-TIME IMG LMTD,,,20,,RBRVS,0.49 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76882,CPT,US EXTREMITY NON-VASC REAL-TIME IMG LMTD,26,,20,,RBRVS,0.49 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76882,CPT,US EXTREMITY NON-VASC REAL-TIME IMG LMTD,TC,,20,,RBRVS,,0.31 ,0.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76885,CPT,US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ,,,20,,RBRVS,0.74 ,3.34 ,3.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76885,CPT,US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ,26,,20,,RBRVS,0.74 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76885,CPT,US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ,TC,,20,,RBRVS,,3.06 ,3.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76886,CPT,US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ,,,20,,RBRVS,0.62 ,2.34 ,2.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76886,CPT,US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ,26,,20,,RBRVS,0.62 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76886,CPT,US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ,TC,,20,,RBRVS,,2.12 ,2.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76930,CPT,US GUIDANCE PERICARDIOCENTESIS RS&I,,,20,,TotalUnits,,,,2.34 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76930,CPT,US GUIDANCE PERICARDIOCENTESIS RS&I,26,,20,,TotalUnits,,,,0.90 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76930,CPT,US GUIDANCE PERICARDIOCENTESIS RS&I,TC,,20,,TotalUnits,,,,1.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76932,CPT,US ENDOMYOCARDIAL BIOPSY RS&I,,,20,,TotalUnits,,,,2.46 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76932,CPT,US ENDOMYOCARDIAL BIOPSY RS&I,26,,20,,TotalUnits,,,,0.90 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76932,CPT,US ENDOMYOCARDIAL BIOPSY RS&I,TC,,20,,TotalUnits,,,,1.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76936,CPT,US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,,,20,,RBRVS,1.99 ,5.44 ,5.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76936,CPT,US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,26,,20,,RBRVS,1.99 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76936,CPT,US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,TC,,20,,RBRVS,,4.88 ,4.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76937,CPT,US VASC ACCESS SITS VSL PATENCY NDL ENTRY,,,20,,RBRVS,0.30 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76937,CPT,US VASC ACCESS SITS VSL PATENCY NDL ENTRY,26,,20,,RBRVS,0.30 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76937,CPT,US VASC ACCESS SITS VSL PATENCY NDL ENTRY,TC,,20,,RBRVS,,0.48 ,0.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76940,CPT,US &MNTR PARENCHYMAL TISSUE ABLATION,,,20,,TotalUnits,,,,4.31 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76940,CPT,US &MNTR PARENCHYMAL TISSUE ABLATION,26,,20,,TotalUnits,,,,2.69 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76940,CPT,US &MNTR PARENCHYMAL TISSUE ABLATION,TC,,20,,TotalUnits,,,,1.62 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76941,CPT,US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I,,,20,,TotalUnits,,,,2.83 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76941,CPT,US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I,26,,20,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76941,CPT,US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I,TC,,20,,TotalUnits,,,,1.01 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76942,CPT,US GUIDANCE NEEDLE PLACEMENT IMG S&I,,,20,,RBRVS,0.67 ,1.00 ,1.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76942,CPT,US GUIDANCE NEEDLE PLACEMENT IMG S&I,26,,20,,RBRVS,0.67 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76942,CPT,US GUIDANCE NEEDLE PLACEMENT IMG S&I,TC,,20,,RBRVS,,0.76 ,0.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76945,CPT,US GUIDANCE CHORIONIC VILLUS SAMPLING IMG S&I,,,20,,TotalUnits,,,,2.62 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76945,CPT,US GUIDANCE CHORIONIC VILLUS SAMPLING IMG S&I,26,,20,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76945,CPT,US GUIDANCE CHORIONIC VILLUS SAMPLING IMG S&I,TC,,20,,TotalUnits,,,,1.69 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76946,CPT,US GUIDANCE AMNIOCENTESIS IMG S&I,,,20,,RBRVS,0.38 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76946,CPT,US GUIDANCE AMNIOCENTESIS IMG S&I,26,,20,,RBRVS,0.38 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76946,CPT,US GUIDANCE AMNIOCENTESIS IMG S&I,TC,,20,,RBRVS,,0.36 ,0.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76948,CPT,US GUIDANCE ASPIRATION OVA IMG S&I,,,20,,RBRVS,0.67 ,1.24 ,1.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76948,CPT,US GUIDANCE ASPIRATION OVA IMG S&I,26,,20,,RBRVS,0.67 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76948,CPT,US GUIDANCE ASPIRATION OVA IMG S&I,TC,,20,,RBRVS,,1.10 ,1.10 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76965,CPT,US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION,,,20,,RBRVS,1.34 ,1.16 ,1.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76965,CPT,US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION,26,,20,,RBRVS,1.34 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76965,CPT,US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION,TC,,20,,RBRVS,,0.66 ,0.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76970,CPT,US STUDY FOLLOW UP,,,20,,RBRVS,0.40 ,2.20 ,2.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76970,CPT,US STUDY FOLLOW UP,26,,20,,RBRVS,0.40 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76970,CPT,US STUDY FOLLOW UP,TC,,20,,RBRVS,,2.07 ,2.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76975,CPT,GI ENDOSCOPIC US S&I,,,20,,TotalUnits,,,,4.31 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76975,CPT,GI ENDOSCOPIC US S&I,26,,20,,TotalUnits,,,,1.14 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76975,CPT,GI ENDOSCOPIC US S&I,TC,,20,,TotalUnits,,,,3.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76977,CPT,US BONE DENSITY MEAS & INTERP PERIPH ANY METHO,,,20,,RBRVS,0.05 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76977,CPT,US BONE DENSITY MEAS & INTERP PERIPH ANY METHO,26,,20,,RBRVS,0.05 ,0.02 ,0.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76977,CPT,US BONE DENSITY MEAS & INTERP PERIPH ANY METHO,TC,,20,,RBRVS,,0.11 ,0.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76998,CPT,ULTRASONIC GUIDANCE INTRAOPERATIVE,,,20,,TotalUnits,,,,3.01 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76998,CPT,ULTRASONIC GUIDANCE INTRAOPERATIVE,26,,20,,TotalUnits,,,,1.59 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 76998,CPT,ULTRASONIC GUIDANCE INTRAOPERATIVE,TC,,20,,TotalUnits,,,,1.42 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 76999,CPT,UNLISTED US PROCEDURE,,,20,,TotalUnits,,,,2.55 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 76999,CPT,UNLISTED US PROCEDURE,,PC,20,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 76999,CPT,UNLISTED US PROCEDURE,,TC,20,,TotalUnits,,,,1.69 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 77001,CPT,FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT,,,20,,RBRVS,0.38 ,1.57 ,1.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77001,CPT,FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT,26,,20,,RBRVS,0.38 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77001,CPT,FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT,TC,,20,,RBRVS,,1.44 ,1.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77002,CPT,FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT,,,20,,RBRVS,0.54 ,2.03 ,2.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77002,CPT,FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT,26,,20,,RBRVS,0.54 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77002,CPT,FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT,TC,,20,,RBRVS,,1.81 ,1.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77003,CPT,FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER,,,20,,RBRVS,0.60 ,1.77 ,1.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77003,CPT,FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER,26,,20,,RBRVS,0.60 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77003,CPT,FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER,TC,,20,,RBRVS,,1.54 ,1.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77011,CPT,CT GUIDANCE STEREOTACTIC LOCALIZATION,,,20,,RBRVS,1.21 ,4.99 ,4.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77011,CPT,CT GUIDANCE STEREOTACTIC LOCALIZATION,,PC,20,,RBRVS,1.21 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,0,20171001, 77011,CPT,CT GUIDANCE STEREOTACTIC LOCALIZATION,,TC,20,,RBRVS,,4.49 ,4.49 ,,,$0.00,$0.00,1,1,1,0,1,0,20171001, 77012,CPT,CT GUIDANCE NEEDLE PLACEMENT,,,20,,RBRVS,1.16 ,2.28 ,2.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77012,CPT,CT GUIDANCE NEEDLE PLACEMENT,,PC,20,,RBRVS,1.16 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,0,20171001, 77012,CPT,CT GUIDANCE NEEDLE PLACEMENT,,TC,20,,RBRVS,,1.87 ,1.87 ,,,$0.00,$0.00,1,1,1,0,1,0,20171001, 77013,CPT,CT GUIDANCE &MONITORING VISC TISS ABLATION,,,20,,TotalUnits,,,,23.16 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77013,CPT,CT GUIDANCE &MONITORING VISC TISS ABLATION,,PC,20,,TotalUnits,,,,5.33 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 77013,CPT,CT GUIDANCE &MONITORING VISC TISS ABLATION,,TC,20,,TotalUnits,,,,17.83 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 77014,CPT,CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT,,,20,,RBRVS,0.85 ,2.42 ,2.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77014,CPT,CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT,,PC,20,,RBRVS,0.85 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,0,20171001, 77014,CPT,CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT,,TC,20,,RBRVS,,2.07 ,2.07 ,,,$0.00,$0.00,1,1,1,0,1,0,20171001, 77021,CPT,MR GUIDANCE NEEDLE PLACEMENT,,,20,,RBRVS,1.50 ,9.75 ,9.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77021,CPT,MR GUIDANCE NEEDLE PLACEMENT,26,,20,,RBRVS,1.50 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77021,CPT,MR GUIDANCE NEEDLE PLACEMENT,TC,,20,,RBRVS,,9.20 ,9.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77022,CPT,MR GUIDANCE &MONITORING TISSUE ABLATION,,,20,,TotalUnits,,,,28.72 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77022,CPT,MR GUIDANCE &MONITORING TISSUE ABLATION,26,,20,,TotalUnits,,,,5.78 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77022,CPT,MR GUIDANCE &MONITORING TISSUE ABLATION,TC,,20,,TotalUnits,,,,22.94 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77053,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE,,,20,,RBRVS,0.36 ,1.25 ,1.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77053,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE,26,,20,,RBRVS,0.36 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77053,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE,TC,,20,,RBRVS,,1.12 ,1.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77054,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE,,,20,,RBRVS,0.45 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77054,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE,26,,20,,RBRVS,0.45 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77054,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE,TC,,20,,RBRVS,,1.50 ,1.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77058,CPT,MRI BREAST UNILATERAL,,,20,,RBRVS,1.63 ,13.39 ,13.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77058,CPT,MRI BREAST UNILATERAL,26,,20,,RBRVS,1.63 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77058,CPT,MRI BREAST UNILATERAL,TC,,20,,RBRVS,,12.79 ,12.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77059,CPT,MRI BREAST BILATERAL,,,20,,RBRVS,1.63 ,13.31 ,13.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77059,CPT,MRI BREAST BILATERAL,26,,20,,RBRVS,1.63 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77059,CPT,MRI BREAST BILATERAL,TC,,20,,RBRVS,,12.71 ,12.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77061,CPT,DIGITAL BREAST TOMOSYNTHESIS UNILATERAL,,,20,,TotalUnits,,,,3.57 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77061,CPT,DIGITAL BREAST TOMOSYNTHESIS UNILATERAL,26,,20,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77061,CPT,DIGITAL BREAST TOMOSYNTHESIS UNILATERAL,TC,,20,,TotalUnits,,,,2.62 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77062,CPT,DIGITAL BREAST TOMOSYNTHESIS BILATERAL,,,20,,TotalUnits,,,,4.42 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77062,CPT,DIGITAL BREAST TOMOSYNTHESIS BILATERAL,26,,20,,TotalUnits,,,,1.16 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77062,CPT,DIGITAL BREAST TOMOSYNTHESIS BILATERAL,TC,,20,,TotalUnits,,,,3.26 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77063,CPT,SCREENING DIGITAL BREAST TOMOSYNTHESIS BI,,,20,,RBRVS,0.60 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77063,CPT,SCREENING DIGITAL BREAST TOMOSYNTHESIS BI,26,,20,,RBRVS,0.60 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77063,CPT,SCREENING DIGITAL BREAST TOMOSYNTHESIS BI,TC,,20,,RBRVS,,0.71 ,0.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77065,CPT,DX MAMMO INCL CAD UNI,,,20,,TotalUnits,,,,3.57 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77065,CPT,DX MAMMO INCL CAD UNI - PROFESSIONAL COMPONENT,26,,20,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77065,CPT,DX MAMMO INCL CAD UNI - TECHNICAL COMPONENT,TC,,20,,TotalUnits,,,,2.62 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77066,CPT,DX MAMMO INCL CAD BI,,,20,,TotalUnits,,,,4.55 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77066,CPT,DX MAMMO INCL CAD BI - PROFESSIONAL COMPONENT,26,,20,,TotalUnits,,,,1.19 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77066,CPT,DX MAMMO INCL CAD BI - TECHNICAL COMPONENT,TC,,20,,TotalUnits,,,,3.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77067,CPT,SCR MAMMO BI INCL CAD,,,20,,TotalUnits,,,,3.72 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77067,CPT,SCR MAMMO BI INCL CAD - PROFESSIONAL COMPONENT,26,,20,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77067,CPT,SCR MAMMO BI INCL CAD - TECHNICAL COMPONENT,TC,,20,,TotalUnits,,,,2.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77071,CPT,MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS,,PC,20,,RBRVS,0.41 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77072,CPT,BONE AGE STUDIES,,,20,,RBRVS,0.19 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77072,CPT,BONE AGE STUDIES,26,,20,,RBRVS,0.19 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77072,CPT,BONE AGE STUDIES,TC,,20,,RBRVS,,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77073,CPT,BONE LENGTH STUDIES,,,20,,RBRVS,0.27 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77073,CPT,BONE LENGTH STUDIES,26,,20,,RBRVS,0.27 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77073,CPT,BONE LENGTH STUDIES,TC,,20,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77074,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED,,,20,,RBRVS,0.45 ,1.32 ,1.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77074,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED,26,,20,,RBRVS,0.45 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77074,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED,TC,,20,,RBRVS,,1.15 ,1.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77075,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL,,,20,,RBRVS,0.54 ,1.88 ,1.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77075,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL,26,,20,,RBRVS,0.54 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77075,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL,TC,,20,,RBRVS,,1.68 ,1.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77076,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT,,,20,,RBRVS,0.70 ,1.95 ,1.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77076,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT,26,,20,,RBRVS,0.70 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77076,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT,TC,,20,,RBRVS,,1.69 ,1.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77077,CPT,JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS,,,20,,RBRVS,0.31 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77077,CPT,JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS,26,,20,,RBRVS,0.31 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77077,CPT,JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS,TC,,20,,RBRVS,,0.58 ,0.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77078,CPT,CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE,,,20,,RBRVS,0.25 ,2.93 ,2.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77078,CPT,CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE,26,,20,,RBRVS,0.25 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77078,CPT,CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE,TC,,20,,RBRVS,,2.84 ,2.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77080,CPT,DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL,,,20,,RBRVS,0.20 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77080,CPT,DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL,26,,20,,RBRVS,0.20 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77080,CPT,DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL,TC,,20,,RBRVS,,0.86 ,0.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77081,CPT,DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL,,,20,,RBRVS,0.22 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77081,CPT,DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL,26,,20,,RBRVS,0.22 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77081,CPT,DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL,TC,,20,,RBRVS,,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77084,CPT,BONE MARROW BLOOD SUPPLY,,,20,,RBRVS,1.60 ,9.27 ,9.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77084,CPT,BONE MARROW BLOOD SUPPLY,26,,20,,RBRVS,1.60 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77084,CPT,BONE MARROW BLOOD SUPPLY,TC,,20,,RBRVS,,8.67 ,8.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77085,CPT,DXA BONE DENSITY STUDY AXIAL SKELETON,,,20,,RBRVS,0.30 ,1.26 ,1.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77085,CPT,DXA BONE DENSITY STUDY AXIAL SKELETON,26,,20,,RBRVS,0.30 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77085,CPT,DXA BONE DENSITY STUDY AXIAL SKELETON,TC,,20,,RBRVS,,1.14 ,1.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77086,CPT,VERTEBRAL FRACTURE ASSESSMENT VIA DXA,,,20,,RBRVS,0.17 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77086,CPT,VERTEBRAL FRACTURE ASSESSMENT VIA DXA,26,,20,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77086,CPT,VERTEBRAL FRACTURE ASSESSMENT VIA DXA,TC,,20,,RBRVS,,0.74 ,0.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77261,CPT,THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE,,PC,20,,RBRVS,1.39 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77262,CPT,THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE,,PC,20,,RBRVS,2.11 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77263,CPT,THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX,,PC,20,,RBRVS,3.14 ,1.31 ,1.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77280,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE,,,20,,RBRVS,0.70 ,6.97 ,6.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77280,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE,26,,20,,RBRVS,0.70 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77280,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE,TC,,20,,RBRVS,,6.68 ,6.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77285,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED,,,20,,RBRVS,1.05 ,11.05 ,11.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77285,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED,26,,20,,RBRVS,1.05 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77285,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED,TC,,20,,RBRVS,,10.61 ,10.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77290,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX,,,20,,RBRVS,1.56 ,12.90 ,12.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77290,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX,26,,20,,RBRVS,1.56 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77290,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX,TC,,20,,RBRVS,,12.24 ,12.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77293,CPT,RESPIRATORY MOTION MANAGEMENT SIMULATION,,,20,,RBRVS,2.00 ,11.05 ,11.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77293,CPT,RESPIRATORY MOTION MANAGEMENT SIMULATION,26,,20,,RBRVS,2.00 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77293,CPT,RESPIRATORY MOTION MANAGEMENT SIMULATION,TC,,20,,RBRVS,,10.21 ,10.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77295,CPT,3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS,,,20,,RBRVS,4.29 ,9.33 ,9.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77295,CPT,3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS,26,,20,,RBRVS,4.29 ,1.79 ,1.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77295,CPT,3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS,TC,,20,,RBRVS,,7.54 ,7.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77299,CPT,UNLIS PX THER RADIOL CLINICAL TX PLANNING,,,20,,TotalUnits,,,,13.05 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77299,CPT,UNLIS PX THER RADIOL CLINICAL TX PLANNING,26,,20,,TotalUnits,,,,3.33 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77299,CPT,UNLIS PX THER RADIOL CLINICAL TX PLANNING,TC,,20,,TotalUnits,,,,9.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77300,CPT,BASIC RADIATION DOSIMETRY CALCULATION,,,20,,RBRVS,0.62 ,1.22 ,1.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77300,CPT,BASIC RADIATION DOSIMETRY CALCULATION,26,,20,,RBRVS,0.62 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77300,CPT,BASIC RADIATION DOSIMETRY CALCULATION,TC,,20,,RBRVS,,0.96 ,0.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77301,CPT,NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS,,,20,,RBRVS,7.99 ,46.58 ,46.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77301,CPT,NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS,26,,20,,RBRVS,7.99 ,3.34 ,3.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77301,CPT,NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS,TC,,20,,RBRVS,,43.24 ,43.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77306,CPT,TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION,,,20,,RBRVS,1.40 ,2.74 ,2.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77306,CPT,TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION,26,,20,,RBRVS,1.40 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77306,CPT,TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION,TC,,20,,RBRVS,,2.15 ,2.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77307,CPT,TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY,,,20,,RBRVS,2.90 ,5.10 ,5.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77307,CPT,TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY,26,,20,,RBRVS,2.90 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77307,CPT,TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY,TC,,20,,RBRVS,,3.89 ,3.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77316,CPT,BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL,,,20,,RBRVS,1.40 ,3.84 ,3.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77316,CPT,BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL,26,,20,,RBRVS,1.40 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77316,CPT,BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL,TC,,20,,RBRVS,,3.25 ,3.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77317,CPT,BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL,,,20,,RBRVS,1.83 ,4.99 ,4.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77317,CPT,BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL,26,,20,,RBRVS,1.83 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77317,CPT,BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL,TC,,20,,RBRVS,,4.22 ,4.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77318,CPT,BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL,,,20,,RBRVS,2.90 ,6.93 ,6.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77318,CPT,BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL,26,,20,,RBRVS,2.90 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77318,CPT,BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL,TC,,20,,RBRVS,,5.72 ,5.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77321,CPT,SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY,,,20,,RBRVS,0.95 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77321,CPT,SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY,26,,20,,RBRVS,0.95 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77321,CPT,SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY,TC,,20,,RBRVS,,1.22 ,1.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77331,CPT,SPEC DOSIM ONLY PRESCRIBED TREATING PHYS,,,20,,RBRVS,0.87 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77331,CPT,SPEC DOSIM ONLY PRESCRIBED TREATING PHYS,26,,20,,RBRVS,0.87 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77331,CPT,SPEC DOSIM ONLY PRESCRIBED TREATING PHYS,TC,,20,,RBRVS,,0.52 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77332,CPT,TX DEVICES DESIGN & CONSTRUCTION SIMPLE,,,20,,RBRVS,0.54 ,1.77 ,1.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77332,CPT,TX DEVICES DESIGN & CONSTRUCTION SIMPLE,26,,20,,RBRVS,0.54 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77332,CPT,TX DEVICES DESIGN & CONSTRUCTION SIMPLE,TC,,20,,RBRVS,,1.53 ,1.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77333,CPT,TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE,,,20,,RBRVS,0.75 ,1.95 ,1.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77333,CPT,TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE,26,,20,,RBRVS,0.75 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77333,CPT,TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE,TC,,20,,RBRVS,,1.63 ,1.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77334,CPT,TX DEVICES DESIGN & CONSTRUCTION COMPLEX,,,20,,RBRVS,1.24 ,3.01 ,3.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77334,CPT,TX DEVICES DESIGN & CONSTRUCTION COMPLEX,26,,20,,RBRVS,1.24 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77334,CPT,TX DEVICES DESIGN & CONSTRUCTION COMPLEX,TC,,20,,RBRVS,,2.49 ,2.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77336,CPT,CONTINUING MEDICAL PHYSICS CONSLTJ PR WK,,TC,20,,RBRVS,,2.17 ,2.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77338,CPT,MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN,,,20,,RBRVS,4.29 ,9.81 ,9.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77338,CPT,MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN,,PC,20,,RBRVS,4.29 ,1.79 ,1.79 ,,,$0.00,$0.00,1,0,1,1,1,0,20171001, 77338,CPT,MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN,,TC,20,,RBRVS,,8.02 ,8.02 ,,,$0.00,$0.00,1,1,1,0,1,0,20171001, 77370,CPT,SPEC MEDICAL RADJ PHYSICS CONSLTJ,,TC,20,,RBRVS,,3.32 ,3.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77371,CPT,RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT,,TC,20,,TotalUnits,,,,27.66 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77372,CPT,RADIATION DELIVERY STEREOTACTIC CRANIAL LINEAR,,TC,20,,RBRVS,,30.11 ,30.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77373,CPT,STEREOTACTIC BODY RADIATION DELIVERY,,TC,20,,RBRVS,,38.28 ,38.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77385,CPT,INTENSITY MODULATED RADIATION TX DLVR SIMPLE,,TC,20,,TotalUnits,,,,11.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77386,CPT,INTENSITY MODULATED RADIATION TX DLVR COMPLEX,,TC,20,,TotalUnits,,,,13.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77387,CPT,GUIDANCE FOR LOC OF TARGET VOL RADIAJ TX DLVR,,,20,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77387,CPT,GUIDANCE FOR LOC OF TARGET VOL RADIAJ TX DLVR,26,,20,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77387,CPT,GUIDANCE FOR LOC OF TARGET VOL RADIAJ TX DLVR,TC,,20,,TotalUnits,,,,1.08 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77399,CPT,UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS,,,20,,TotalUnits,,,,2.60 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77399,CPT,UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS,,PC,20,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 77399,CPT,UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS,,TC,20,,TotalUnits,,,,1.53 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 77401,CPT,RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTA,,TC,20,,RBRVS,,0.67 ,0.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77402,CPT,RADIATION TREATMENT DELIVERY 1 MEV >= SIMPLE,,TC,20,,TotalUnits,,,,1.48 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77407,CPT,RADIATION TX DELIVERY 1 MEV >= INTERMEDIATE,,TC,20,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77412,CPT,RADIATION TREATMENT DELIVERY 1 MEV >= COMPLEX,,TC,20,,TotalUnits,,,,2.26 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77417,CPT,THERAPEUTIC RADIOLOGY PORT IMAGES(S),,TC,20,,RBRVS,,0.30 ,0.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77422,CPT,HIGH ENERGY NEUTRON RADJ TX DLVR 1 TX AREA,,TC,20,,TotalUnits,,,,1.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77423,CPT,HIGH ENERGY NEUTRON RADJ TX DLVR 1/> ISOCENTER,,TC,20,,TotalUnits,,,,2.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77427,CPT,RADIATION TREATMENT MANAGEMENT 5 TREATMENTS,,PC,20,,RBRVS,3.37 ,1.63 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77431,CPT,RADIATION THERAPY MGMT 1/2 FRACTIONS ONLY,,PC,20,,RBRVS,1.81 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77432,CPT,STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION,,PC,20,,RBRVS,7.92 ,3.31 ,3.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77435,CPT,STEREOTACTIC BODY RADIATION MANAGEMENT,,PC,20,,RBRVS,11.87 ,5.08 ,5.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77469,CPT,INTRAOPERATIVE RADIATION TREATMENT MANAGEMENT,,,20,,RBRVS,5.75 ,2.97 ,2.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77470,CPT,SPECIAL TREATMENT PROCEDURE,,,20,,RBRVS,2.09 ,2.21 ,2.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77470,CPT,SPECIAL TREATMENT PROCEDURE,26,,20,,RBRVS,2.09 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77470,CPT,SPECIAL TREATMENT PROCEDURE,TC,,20,,RBRVS,,1.34 ,1.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77499,CPT,UNLISTED PROCEDURE THERAPEUTIC RADIOLOGY TX MGMT,,,20,,TotalUnits,,,,4.30 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77499,CPT,UNLISTED PROCEDURE THERAPEUTIC RADIOLOGY TX MGMT,,PC,20,,TotalUnits,,,,2.96 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 77499,CPT,UNLISTED PROCEDURE THERAPEUTIC RADIOLOGY TX MGMT,,TC,20,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 77520,CPT,PROTON TX DELIVERY SIMPLE W/O COMPENSATION,,TC,20,,TotalUnits,,,,13.43 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77522,CPT,PROTON TX DELIVERY SIMPLE W/COMPENSATION,,TC,20,,TotalUnits,,,,18.92 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77523,CPT,PROTON TX DELIVERY INTERMEDIATE,,TC,20,,TotalUnits,,,,17.07 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77525,CPT,PROTON TX DELIVERY COMPLEX,,TC,20,,TotalUnits,,,,22.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77600,CPT,HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL,,,20,,RBRVS,1.56 ,10.20 ,10.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77600,CPT,HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL,26,,20,,RBRVS,1.56 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77600,CPT,HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL,TC,,20,,RBRVS,,9.52 ,9.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77605,CPT,HYPERTHERMIA EXTERNAL GENERATED DEEP,,,20,,RBRVS,2.09 ,20.05 ,20.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77605,CPT,HYPERTHERMIA EXTERNAL GENERATED DEEP,26,,20,,RBRVS,2.09 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77605,CPT,HYPERTHERMIA EXTERNAL GENERATED DEEP,TC,,20,,RBRVS,,19.22 ,19.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77610,CPT,HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS,,,20,,RBRVS,1.56 ,26.12 ,26.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77610,CPT,HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS,26,,20,,RBRVS,1.56 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77610,CPT,HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS,TC,,20,,RBRVS,,25.55 ,25.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77615,CPT,HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS,,,20,,RBRVS,2.09 ,27.73 ,27.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77615,CPT,HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS,26,,20,,RBRVS,2.09 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77615,CPT,HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS,TC,,20,,RBRVS,,26.87 ,26.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77620,CPT,HYPERTHERMIA INTRACAVITARY PROBES,,,20,,RBRVS,1.56 ,9.17 ,9.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77620,CPT,HYPERTHERMIA INTRACAVITARY PROBES,26,,20,,RBRVS,1.56 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77620,CPT,HYPERTHERMIA INTRACAVITARY PROBES,TC,,20,,RBRVS,,8.52 ,8.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77750,CPT,NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE,,,20,,RBRVS,5.00 ,5.24 ,5.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77750,CPT,NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE,26,,20,,RBRVS,5.00 ,2.08 ,2.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77750,CPT,NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE,TC,,20,,RBRVS,,3.16 ,3.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77761,CPT,INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE,,,20,,RBRVS,3.85 ,6.91 ,6.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77761,CPT,INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE,26,,20,,RBRVS,3.85 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77761,CPT,INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE,TC,,20,,RBRVS,,5.39 ,5.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77762,CPT,INTRACAVITARY RADIATION SOURCE APPLIC INTERMED,,,20,,RBRVS,5.76 ,8.57 ,8.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77762,CPT,INTRACAVITARY RADIATION SOURCE APPLIC INTERMED,26,,20,,RBRVS,5.76 ,2.39 ,2.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77762,CPT,INTRACAVITARY RADIATION SOURCE APPLIC INTERMED,TC,,20,,RBRVS,,6.18 ,6.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77763,CPT,INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX,,,20,,RBRVS,8.66 ,11.61 ,11.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77763,CPT,INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX,26,,20,,RBRVS,8.66 ,3.62 ,3.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77763,CPT,INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX,TC,,20,,RBRVS,,7.99 ,7.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77767,CPT,HDR RDNCL SKN SURF BRACHYTX LES 2CM&2CHAN/MLT LES,,,20,,RBRVS,1.40 ,8.44 ,8.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77768,CPT,HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES,26,,20,,RBRVS,1.40 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77768,CPT,HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES,TC,,20,,RBRVS,,7.86 ,7.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77770,CPT,HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL,,,20,,RBRVS,1.95 ,6.99 ,6.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77770,CPT,HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL,26,,20,,RBRVS,1.95 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77770,CPT,HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL,TC,,20,,RBRVS,,6.17 ,6.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77771,CPT,HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL,,,20,,RBRVS,3.80 ,12.83 ,12.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77771,CPT,HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL,26,,20,,RBRVS,3.80 ,1.59 ,1.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77771,CPT,HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL,TC,,20,,RBRVS,,11.24 ,11.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77772,CPT,HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS,,,20,,RBRVS,5.40 ,20.01 ,20.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77772,CPT,HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS,26,,20,,RBRVS,5.40 ,2.25 ,2.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77772,CPT,HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS,TC,,20,,RBRVS,,17.76 ,17.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77778,CPT,INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX,,,20,,RBRVS,8.00 ,13.58 ,13.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77778,CPT,INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX,26,,20,,RBRVS,8.00 ,3.31 ,3.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77778,CPT,INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX,TC,,20,,RBRVS,,10.27 ,10.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77789,CPT,SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE,,,20,,RBRVS,1.14 ,2.18 ,2.18 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77789,CPT,SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE,26,,20,,RBRVS,1.14 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77789,CPT,SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE,TC,,20,,RBRVS,,1.69 ,1.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77790,CPT,SUPERVISION HANDLING LOADING RADIATION SOURCE,,,20,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77790,CPT,SUPERVISION HANDLING LOADING RADIATION SOURCE,26,,20,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77790,CPT,SUPERVISION HANDLING LOADING RADIATION SOURCE,TC,,20,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 77799,CPT,UNLISTED PROCEDURE CLINICAL BRACHYTHERAPY,,,20,,TotalUnits,,,,21.58 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 77799,CPT,UNLISTED PROCEDURE CLINICAL BRACHYTHERAPY,26,,20,,TotalUnits,,,,11.31 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 77799,CPT,UNLISTED PROCEDURE CLINICAL BRACHYTHERAPY,TC,,20,,TotalUnits,,,,10.27 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78012,CPT,THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT,,,20,,RBRVS,0.19 ,2.08 ,2.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78012,CPT,THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT,26,,20,,RBRVS,0.19 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78012,CPT,THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT,TC,,20,,RBRVS,,2.01 ,2.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78013,CPT,THYROID IMAGING WITH VASCULAR FLOW,,,20,,RBRVS,0.37 ,5.14 ,5.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78013,CPT,THYROID IMAGING WITH VASCULAR FLOW,26,,20,,RBRVS,0.37 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78013,CPT,THYROID IMAGING WITH VASCULAR FLOW,TC,,20,,RBRVS,,5.01 ,5.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78014,CPT,THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS,,,20,,RBRVS,0.50 ,6.48 ,6.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78014,CPT,THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS,26,,20,,RBRVS,0.50 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78014,CPT,THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS,TC,,20,,RBRVS,,6.31 ,6.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78015,CPT,THYROID CARCINOMA METASTASES IMG LMTD AREA,,,20,,RBRVS,0.67 ,5.68 ,5.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78015,CPT,THYROID CARCINOMA METASTASES IMG LMTD AREA,26,,20,,RBRVS,0.67 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78015,CPT,THYROID CARCINOMA METASTASES IMG LMTD AREA,TC,,20,,RBRVS,,5.45 ,5.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78016,CPT,THYROID CARCINOMA METASTASES IMG ADDL STUDY,,,20,,RBRVS,0.82 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78016,CPT,THYROID CARCINOMA METASTASES IMG ADDL STUDY,26,,20,,RBRVS,0.82 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78016,CPT,THYROID CARCINOMA METASTASES IMG ADDL STUDY,TC,,20,,RBRVS,,7.12 ,7.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78018,CPT,THYROID CARCINOMA METASTASES IMG WHOLE BODY,,,20,,RBRVS,0.86 ,8.17 ,8.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78018,CPT,THYROID CARCINOMA METASTASES IMG WHOLE BODY,26,,20,,RBRVS,0.86 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78018,CPT,THYROID CARCINOMA METASTASES IMG WHOLE BODY,TC,,20,,RBRVS,,7.89 ,7.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78020,CPT,THYROID CARCINOMA METASTASES UPTAKE,,,20,,RBRVS,0.60 ,1.79 ,1.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78020,CPT,THYROID CARCINOMA METASTASES UPTAKE,26,,20,,RBRVS,0.60 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78020,CPT,THYROID CARCINOMA METASTASES UPTAKE,TC,,20,,RBRVS,,1.62 ,1.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78070,CPT,PARATHYROID PLANAR IMAGING,,,20,,RBRVS,0.80 ,7.86 ,7.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78070,CPT,PARATHYROID PLANAR IMAGING,26,,20,,RBRVS,0.80 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78070,CPT,PARATHYROID PLANAR IMAGING,TC,,20,,RBRVS,,7.59 ,7.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78071,CPT,PARATHYROID PLANAR IMAGING W/WO SUBTRACTION,,,20,,RBRVS,1.20 ,9.13 ,9.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78071,CPT,PARATHYROID PLANAR IMAGING W/WO SUBTRACTION,26,,20,,RBRVS,1.20 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78071,CPT,PARATHYROID PLANAR IMAGING W/WO SUBTRACTION,TC,,20,,RBRVS,,8.72 ,8.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78072,CPT,PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT,,,20,,RBRVS,1.60 ,10.33 ,10.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78072,CPT,PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT,26,,20,,RBRVS,1.60 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78072,CPT,PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT,TC,,20,,RBRVS,,9.82 ,9.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78075,CPT,ADRENAL IMAGING CORTEX &/MEDULLA,,,20,,RBRVS,0.74 ,11.64 ,11.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78075,CPT,ADRENAL IMAGING CORTEX &/MEDULLA,26,,20,,RBRVS,0.74 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78075,CPT,ADRENAL IMAGING CORTEX &/MEDULLA,TC,,20,,RBRVS,,11.41 ,11.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78099,CPT,UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE,,,20,,TotalUnits,,,,6.98 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78099,CPT,UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE,26,,20,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78099,CPT,UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE,TC,,20,,TotalUnits,,,,6.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78102,CPT,BONE MARROW IMAGING LIMITED AREA,,,20,,RBRVS,0.55 ,4.33 ,4.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78102,CPT,BONE MARROW IMAGING LIMITED AREA,26,,20,,RBRVS,0.55 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78102,CPT,BONE MARROW IMAGING LIMITED AREA,TC,,20,,RBRVS,,4.15 ,4.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78103,CPT,BONE MARROW IMAGING MULTIPLE AREAS,,,20,,RBRVS,0.75 ,5.66 ,5.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78103,CPT,BONE MARROW IMAGING MULTIPLE AREAS,26,,20,,RBRVS,0.75 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78103,CPT,BONE MARROW IMAGING MULTIPLE AREAS,TC,,20,,RBRVS,,5.42 ,5.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78104,CPT,BONE MARROW IMAGING WHOLE BODY,,,20,,RBRVS,0.80 ,6.27 ,6.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78104,CPT,BONE MARROW IMAGING WHOLE BODY,26,,20,,RBRVS,0.80 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78104,CPT,BONE MARROW IMAGING WHOLE BODY,TC,,20,,RBRVS,,6.02 ,6.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78110,CPT,PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE,,,20,,RBRVS,0.19 ,2.50 ,2.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78110,CPT,PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE,26,,20,,RBRVS,0.19 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78110,CPT,PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE,TC,,20,,RBRVS,,2.43 ,2.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78111,CPT,PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES,,,20,,RBRVS,0.22 ,2.54 ,2.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78111,CPT,PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES,26,,20,,RBRVS,0.22 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78111,CPT,PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES,TC,,20,,RBRVS,,2.46 ,2.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78120,CPT,RED CELL VOLUME DETERMINATION SPX 1 SAMPLING,,,20,,RBRVS,0.23 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78120,CPT,RED CELL VOLUME DETERMINATION SPX 1 SAMPLING,26,,20,,RBRVS,0.23 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78120,CPT,RED CELL VOLUME DETERMINATION SPX 1 SAMPLING,TC,,20,,RBRVS,,2.37 ,2.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78121,CPT,RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS,,,20,,RBRVS,0.32 ,2.60 ,2.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78121,CPT,RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS,26,,20,,RBRVS,0.32 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78121,CPT,RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS,TC,,20,,RBRVS,,2.48 ,2.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78122,CPT,WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU,,,20,,RBRVS,0.45 ,2.34 ,2.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78122,CPT,WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU,26,,20,,RBRVS,0.45 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78122,CPT,WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU,TC,,20,,RBRVS,,2.20 ,2.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78130,CPT,RED CELL SURVIVAL STUDY,,,20,,RBRVS,0.61 ,4.22 ,4.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78130,CPT,RED CELL SURVIVAL STUDY,26,,20,,RBRVS,0.61 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78130,CPT,RED CELL SURVIVAL STUDY,TC,,20,,RBRVS,,3.99 ,3.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78135,CPT,RBC SURVIVAL STUDY DIFFERNTL ORGAN/TISS KINETICS,,,20,,RBRVS,0.64 ,9.55 ,9.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78135,CPT,RBC SURVIVAL STUDY DIFFERNTL ORGAN/TISS KINETICS,26,,20,,RBRVS,0.64 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78135,CPT,RBC SURVIVAL STUDY DIFFERNTL ORGAN/TISS KINETICS,TC,,20,,RBRVS,,9.31 ,9.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78140,CPT,LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE,,,20,,RBRVS,0.61 ,3.30 ,3.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78140,CPT,LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE,26,,20,,RBRVS,0.61 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78140,CPT,LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE,TC,,20,,RBRVS,,3.07 ,3.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78185,CPT,SPLEEN IMAGING ONLY W/WO VASCULAR FLOW,,,20,,RBRVS,0.40 ,5.72 ,5.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78185,CPT,SPLEEN IMAGING ONLY W/WO VASCULAR FLOW,26,,20,,RBRVS,0.40 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78185,CPT,SPLEEN IMAGING ONLY W/WO VASCULAR FLOW,TC,,20,,RBRVS,,5.57 ,5.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78190,CPT,KINETICS PLATELET W/WO DIFFRNTL ORGAN/TIS LOCLZJ,,,20,,RBRVS,1.09 ,10.27 ,10.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78190,CPT,KINETICS PLATELET W/WO DIFFRNTL ORGAN/TIS LOCLZJ,26,,20,,RBRVS,1.09 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78190,CPT,KINETICS PLATELET W/WO DIFFRNTL ORGAN/TIS LOCLZJ,TC,,20,,RBRVS,,9.85 ,9.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78191,CPT,PLATELET SURVIVAL STUDY,,,20,,RBRVS,0.61 ,4.22 ,4.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78191,CPT,PLATELET SURVIVAL STUDY,26,,20,,RBRVS,0.61 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78191,CPT,PLATELET SURVIVAL STUDY,TC,,20,,RBRVS,,3.99 ,3.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78195,CPT,LYMPHATICS & LYMPH NODES IMAGING,,,20,,RBRVS,1.20 ,9.06 ,9.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78195,CPT,LYMPHATICS & LYMPH NODES IMAGING,26,,20,,RBRVS,1.20 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78195,CPT,LYMPHATICS & LYMPH NODES IMAGING,TC,,20,,RBRVS,,8.65 ,8.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78199,CPT,UNLIS HEMATOP RET/ENDO&LYMPHATIC DX NUC MED,,,20,,TotalUnits,,,,10.26 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78199,CPT,UNLIS HEMATOP RET/ENDO&LYMPHATIC DX NUC MED,26,,20,,TotalUnits,,,,1.61 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78199,CPT,UNLIS HEMATOP RET/ENDO&LYMPHATIC DX NUC MED,TC,,20,,TotalUnits,,,,8.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78201,CPT,LIVER IMAGING STATIC ONLY,,,20,,RBRVS,0.44 ,4.98 ,4.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78201,CPT,LIVER IMAGING STATIC ONLY,26,,20,,RBRVS,0.44 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78201,CPT,LIVER IMAGING STATIC ONLY,TC,,20,,RBRVS,,4.84 ,4.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78202,CPT,LIVER IMAGING W/VASCULAR FLOW,,,20,,RBRVS,0.51 ,5.32 ,5.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78202,CPT,LIVER IMAGING W/VASCULAR FLOW,26,,20,,RBRVS,0.51 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78202,CPT,LIVER IMAGING W/VASCULAR FLOW,TC,,20,,RBRVS,,5.17 ,5.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78205,CPT,LIVER IMAGING SPECT,,,20,,RBRVS,0.71 ,5.39 ,5.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78205,CPT,LIVER IMAGING SPECT,26,,20,,RBRVS,0.71 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78205,CPT,LIVER IMAGING SPECT,TC,,20,,RBRVS,,5.17 ,5.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78206,CPT,LIVER IMAGING SPECT W/VASCULAR FLOW,,,20,,RBRVS,0.96 ,8.93 ,8.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78206,CPT,LIVER IMAGING SPECT W/VASCULAR FLOW,26,,20,,RBRVS,0.96 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78206,CPT,LIVER IMAGING SPECT W/VASCULAR FLOW,TC,,20,,RBRVS,,8.61 ,8.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78215,CPT,LIVER & SPLEEN IMAGING STATIC ONLY,,,20,,RBRVS,0.49 ,5.12 ,5.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78215,CPT,LIVER & SPLEEN IMAGING STATIC ONLY,26,,20,,RBRVS,0.49 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78215,CPT,LIVER & SPLEEN IMAGING STATIC ONLY,TC,,20,,RBRVS,,4.95 ,4.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78216,CPT,LIVER & SPLEEN IMAGING W/VASCULAR FLOW,,,20,,RBRVS,0.57 ,3.03 ,3.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78216,CPT,LIVER & SPLEEN IMAGING W/VASCULAR FLOW,26,,20,,RBRVS,0.57 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78216,CPT,LIVER & SPLEEN IMAGING W/VASCULAR FLOW,TC,,20,,RBRVS,,2.85 ,2.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78226,CPT,HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER,,,20,,RBRVS,0.74 ,8.85 ,8.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78226,CPT,HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER,26,,20,,RBRVS,0.74 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78226,CPT,HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER,TC,,20,,RBRVS,,8.59 ,8.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78227,CPT,HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ,,,20,,RBRVS,0.90 ,12.12 ,12.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78227,CPT,HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ,26,,20,,RBRVS,0.90 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78227,CPT,HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ,TC,,20,,RBRVS,,11.80 ,11.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78230,CPT,SALIVARY GLAND IMAGING,,,20,,RBRVS,0.45 ,3.62 ,3.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78230,CPT,SALIVARY GLAND IMAGING,26,,20,,RBRVS,0.45 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78230,CPT,SALIVARY GLAND IMAGING,TC,,20,,RBRVS,,3.54 ,3.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78231,CPT,SALIVARY GLAND IMAGING SERIAL IMAGES,,,20,,RBRVS,0.52 ,3.21 ,3.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78231,CPT,SALIVARY GLAND IMAGING SERIAL IMAGES,26,,20,,RBRVS,0.52 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78231,CPT,SALIVARY GLAND IMAGING SERIAL IMAGES,TC,,20,,RBRVS,,3.01 ,3.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78232,CPT,SALIVARY GLAND FUNCTION STUDY,,,20,,RBRVS,0.47 ,2.36 ,2.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78232,CPT,SALIVARY GLAND FUNCTION STUDY,26,,20,,RBRVS,0.47 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78232,CPT,SALIVARY GLAND FUNCTION STUDY,TC,,20,,RBRVS,,2.28 ,2.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78258,CPT,ESOPHAGEAL MOTILITY,,,20,,RBRVS,0.74 ,5.65 ,5.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78258,CPT,ESOPHAGEAL MOTILITY,26,,20,,RBRVS,0.74 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78258,CPT,ESOPHAGEAL MOTILITY,TC,,20,,RBRVS,,5.39 ,5.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78261,CPT,GASTRIC MUCOSA IMAGING,,,20,,RBRVS,0.69 ,6.48 ,6.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78261,CPT,GASTRIC MUCOSA IMAGING,26,,20,,RBRVS,0.69 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78261,CPT,GASTRIC MUCOSA IMAGING,TC,,20,,RBRVS,,6.24 ,6.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78262,CPT,GASTROESOPHAGEAL REFLUX STUDY,,,20,,RBRVS,0.68 ,6.38 ,6.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78262,CPT,GASTROESOPHAGEAL REFLUX STUDY,26,,20,,RBRVS,0.68 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78262,CPT,GASTROESOPHAGEAL REFLUX STUDY,TC,,20,,RBRVS,,6.15 ,6.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78264,CPT,GASTRIC EMPTYING IMAGING STUDY,,,20,,RBRVS,0.74 ,8.93 ,8.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78264,CPT,GASTRIC EMPTYING IMAGING STUDY,26,,20,,RBRVS,0.74 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78264,CPT,GASTRIC EMPTYING IMAGING STUDY,TC,,20,,RBRVS,,8.67 ,8.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78265,CPT,GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT,,,20,,RBRVS,0.98 ,10.55 ,10.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78265,CPT,GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT,26,,20,,RBRVS,0.98 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78265,CPT,GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT,TC,,20,,RBRVS,,10.21 ,10.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78266,CPT,GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY,,,20,,RBRVS,1.08 ,12.61 ,12.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78266,CPT,GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY,26,,20,,RBRVS,1.08 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78266,CPT,GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY,TC,,20,,RBRVS,,12.23 ,12.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78267,CPT,UREA BREATH TEST C-14 ISOTOPIC ACQUISJ ANALYSIS,,,17,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78268,CPT,UREA BREATH TEST C-14 ISOTOPIC ANALYSIS,,,17,,TotalUnits,,,,2.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78270,CPT,VITAMIN B-12 ABSRPJ STUDY W/O INTRINSIC FACTOR,,,20,,RBRVS,0.20 ,2.70 ,2.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78270,CPT,VITAMIN B-12 ABSRPJ STUDY W/O INTRINSIC FACTOR,26,,20,,RBRVS,0.20 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78270,CPT,VITAMIN B-12 ABSRPJ STUDY W/O INTRINSIC FACTOR,TC,,20,,RBRVS,,2.61 ,2.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78271,CPT,VITAMIN B-12 ABSRPJ STUDY W/INTRINSIC FACTOR,,,20,,RBRVS,0.20 ,2.38 ,2.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78271,CPT,VITAMIN B-12 ABSRPJ STUDY W/INTRINSIC FACTOR,26,,20,,RBRVS,0.20 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78271,CPT,VITAMIN B-12 ABSRPJ STUDY W/INTRINSIC FACTOR,TC,,20,,RBRVS,,2.30 ,2.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78272,CPT,VITAMIN B-12 ABSRPJ STDY W/WO INTRINSIC FACT,,,20,,RBRVS,0.27 ,2.50 ,2.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78272,CPT,VITAMIN B-12 ABSRPJ STDY W/WO INTRINSIC FACT,26,,20,,RBRVS,0.27 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78272,CPT,VITAMIN B-12 ABSRPJ STDY W/WO INTRINSIC FACT,TC,,20,,RBRVS,,2.40 ,2.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78278,CPT,ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING,,,20,,RBRVS,0.99 ,9.09 ,9.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78278,CPT,ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING,26,,20,,RBRVS,0.99 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78278,CPT,ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING,TC,,20,,RBRVS,,8.74 ,8.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78282,CPT,GASTROINTESTINAL PROTEIN LOSS,,,20,,TotalUnits,,,,2.09 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78282,CPT,GASTROINTESTINAL PROTEIN LOSS,26,,20,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78282,CPT,GASTROINTESTINAL PROTEIN LOSS,TC,,20,,TotalUnits,,,,1.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78290,CPT,INTESTINE IMAGING,,,20,,RBRVS,0.68 ,8.97 ,8.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78290,CPT,INTESTINE IMAGING,26,,20,,RBRVS,0.68 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78290,CPT,INTESTINE IMAGING,TC,,20,,RBRVS,,8.73 ,8.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78291,CPT,PERITONEAL-VENOUS SHUNT PATENCY TEST,,,20,,RBRVS,0.88 ,6.39 ,6.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78291,CPT,PERITONEAL-VENOUS SHUNT PATENCY TEST,26,,20,,RBRVS,0.88 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78291,CPT,PERITONEAL-VENOUS SHUNT PATENCY TEST,TC,,20,,RBRVS,,6.11 ,6.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78299,CPT,UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE,,,20,,TotalUnits,,,,9.67 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78299,CPT,UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE,26,,20,,TotalUnits,,,,1.00 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78299,CPT,UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE,TC,,20,,TotalUnits,,,,8.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78300,CPT,BONE &/JOINT IMAGING LIMITED AREA,,,20,,RBRVS,0.62 ,4.58 ,4.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78300,CPT,BONE &/JOINT IMAGING LIMITED AREA,26,,20,,RBRVS,0.62 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78300,CPT,BONE &/JOINT IMAGING LIMITED AREA,TC,,20,,RBRVS,,4.35 ,4.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78305,CPT,BONE &/JOINT IMAGING MULTIPLE AREAS,,,20,,RBRVS,0.83 ,5.82 ,5.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78305,CPT,BONE &/JOINT IMAGING MULTIPLE AREAS,26,,20,,RBRVS,0.83 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78305,CPT,BONE &/JOINT IMAGING MULTIPLE AREAS,TC,,20,,RBRVS,,5.53 ,5.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78306,CPT,BONE &/JOINT IMAGING WHOLE BODY,,,20,,RBRVS,0.86 ,6.41 ,6.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78306,CPT,BONE &/JOINT IMAGING WHOLE BODY,26,,20,,RBRVS,0.86 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78306,CPT,BONE &/JOINT IMAGING WHOLE BODY,TC,,20,,RBRVS,,6.11 ,6.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78315,CPT,BONE &/JOINT IMAGING 3 PHASE STUDY,,,20,,RBRVS,1.02 ,9.00 ,9.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78315,CPT,BONE &/JOINT IMAGING 3 PHASE STUDY,26,,20,,RBRVS,1.02 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78315,CPT,BONE &/JOINT IMAGING 3 PHASE STUDY,TC,,20,,RBRVS,,8.64 ,8.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78320,CPT,BONE &/JOINT IMAGING TOMOGRAPHIC SPECT,,,20,,RBRVS,1.04 ,5.52 ,5.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78320,CPT,BONE &/JOINT IMAGING TOMOGRAPHIC SPECT,26,,20,,RBRVS,1.04 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78320,CPT,BONE &/JOINT IMAGING TOMOGRAPHIC SPECT,TC,,20,,RBRVS,,5.18 ,5.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78350,CPT,BONE DENSITY 1/> SITES 1 PHOTON ABSORPTIOMETRY,,,20,,RBRVS,0.22 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78350,CPT,BONE DENSITY 1/> SITES 1 PHOTON ABSORPTIOMETRY,26,,20,,RBRVS,0.22 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78350,CPT,BONE DENSITY 1/> SITES 1 PHOTON ABSORPTIOMETRY,TC,,20,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78351,CPT,BONE DENSTY 1/> SITES DUAL PHOTON ABSORPTIOMETR,,,20,,RBRVS,0.30 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78399,CPT,UNLISTED MUSCULOSKELETAL PX DX NUCLEAR MEDICINE,,,20,,TotalUnits,,,,7.27 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78399,CPT,UNLISTED MUSCULOSKELETAL PX DX NUCLEAR MEDICINE,,PC,20,,TotalUnits,,,,1.16 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 78399,CPT,UNLISTED MUSCULOSKELETAL PX DX NUCLEAR MEDICINE,,TC,20,,TotalUnits,,,,6.11 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 78414,CPT,CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM,,,20,,TotalUnits,,,,2.03 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78414,CPT,CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM,26,,20,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78414,CPT,CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM,TC,,20,,TotalUnits,,,,1.42 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78428,CPT,CARDIAC SHUNT DETECTION,,,20,,RBRVS,0.78 ,4.41 ,4.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78428,CPT,CARDIAC SHUNT DETECTION,26,,20,,RBRVS,0.78 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78428,CPT,CARDIAC SHUNT DETECTION,TC,,20,,RBRVS,,4.15 ,4.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78445,CPT,NONCARDIAC VASCULAR FLOW IMAGING,,,20,,RBRVS,0.49 ,4.56 ,4.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78445,CPT,NONCARDIAC VASCULAR FLOW IMAGING,26,,20,,RBRVS,0.49 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78445,CPT,NONCARDIAC VASCULAR FLOW IMAGING,TC,,20,,RBRVS,,4.41 ,4.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78451,CPT,MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS,,,20,,RBRVS,1.38 ,8.46 ,8.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78451,CPT,MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS,26,,20,,RBRVS,1.38 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78451,CPT,MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS,TC,,20,,RBRVS,,7.99 ,7.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78452,CPT,MYOCARDIAL SPECT MULTIPLE STUDIES,,,20,,RBRVS,1.62 ,12.02 ,12.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78452,CPT,MYOCARDIAL SPECT MULTIPLE STUDIES,26,,20,,RBRVS,1.62 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78452,CPT,MYOCARDIAL SPECT MULTIPLE STUDIES,TC,,20,,RBRVS,,11.47 ,11.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78453,CPT,MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS,,,20,,RBRVS,1.00 ,7.77 ,7.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78453,CPT,MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS,26,,20,,RBRVS,1.00 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78453,CPT,MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS,TC,,20,,RBRVS,,7.42 ,7.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78454,CPT,MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES,,,20,,RBRVS,1.34 ,11.28 ,11.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78454,CPT,MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES,26,,20,,RBRVS,1.34 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78454,CPT,MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES,TC,,20,,RBRVS,,10.79 ,10.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78456,CPT,ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE,,,20,,RBRVS,1.00 ,8.12 ,8.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78456,CPT,ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE,26,,20,,RBRVS,1.00 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78456,CPT,ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE,TC,,20,,RBRVS,,7.78 ,7.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78457,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL,,,20,,RBRVS,0.77 ,4.61 ,4.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78457,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL,26,,20,,RBRVS,0.77 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78457,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL,TC,,20,,RBRVS,,4.36 ,4.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78458,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL,,,20,,RBRVS,0.90 ,3.92 ,3.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78458,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL,26,,20,,RBRVS,0.90 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78458,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL,TC,,20,,RBRVS,,3.76 ,3.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78459,CPT,MYOCARDIAL IMAGING PET METABOLIC EVALUATION,,,20,,TotalUnits,,,,9.56 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78459,CPT,MYOCARDIAL IMAGING PET METABOLIC EVALUATION,26,,20,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78459,CPT,MYOCARDIAL IMAGING PET METABOLIC EVALUATION,TC,,20,,TotalUnits,,,,7.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78466,CPT,MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN,,,20,,RBRVS,0.69 ,4.80 ,4.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78466,CPT,MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN,26,,20,,RBRVS,0.69 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78466,CPT,MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN,TC,,20,,RBRVS,,4.53 ,4.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78468,CPT,MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ,,,20,,RBRVS,0.80 ,4.90 ,4.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78468,CPT,MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ,26,,20,,RBRVS,0.80 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78468,CPT,MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ,TC,,20,,RBRVS,,4.62 ,4.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78469,CPT,MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ,,,20,,RBRVS,0.92 ,5.60 ,5.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78469,CPT,MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ,26,,20,,RBRVS,0.92 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78469,CPT,MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ,TC,,20,,RBRVS,,5.27 ,5.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78472,CPT,CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS,,,20,,RBRVS,0.98 ,5.62 ,5.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78472,CPT,CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS,26,,20,,RBRVS,0.98 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78472,CPT,CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS,TC,,20,,RBRVS,,5.29 ,5.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78473,CPT,CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT,,,20,,RBRVS,1.47 ,6.84 ,6.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78473,CPT,CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT,26,,20,,RBRVS,1.47 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78473,CPT,CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT,TC,,20,,RBRVS,,6.35 ,6.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78481,CPT,CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT,,,20,,RBRVS,0.98 ,4.03 ,4.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78481,CPT,CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT,26,,20,,RBRVS,0.98 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78481,CPT,CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT,TC,,20,,RBRVS,,3.70 ,3.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78483,CPT,CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT,,,20,,RBRVS,1.47 ,5.46 ,5.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78483,CPT,CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT,26,,20,,RBRVS,1.47 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78483,CPT,CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT,TC,,20,,RBRVS,,4.97 ,4.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78491,CPT,MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS,,,20,,TotalUnits,,,,9.93 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78491,CPT,MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS,26,,20,,TotalUnits,,,,1.97 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78491,CPT,MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS,TC,,20,,TotalUnits,,,,7.96 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78492,CPT,MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS,,,20,,TotalUnits,,,,12.46 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78492,CPT,MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS,26,,20,,TotalUnits,,,,2.47 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78492,CPT,MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS,TC,,20,,TotalUnits,,,,9.99 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78494,CPT,CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT,,,20,,RBRVS,1.19 ,5.27 ,5.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78494,CPT,CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT,26,,20,,RBRVS,1.19 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78494,CPT,CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT,TC,,20,,RBRVS,,4.86 ,4.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78496,CPT,CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT,,,20,,RBRVS,0.50 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78496,CPT,CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT,26,,20,,RBRVS,0.50 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78496,CPT,CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT,TC,,20,,RBRVS,,0.58 ,0.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78499,CPT,UNLISTED CARDIOVASCULAR PX DX NUCLEAR MEDICINE,,,20,,TotalUnits,,,,13.64 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78499,CPT,UNLISTED CARDIOVASCULAR PX DX NUCLEAR MEDICINE,26,,20,,TotalUnits,,,,2.17 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78499,CPT,UNLISTED CARDIOVASCULAR PX DX NUCLEAR MEDICINE,TC,,20,,TotalUnits,,,,11.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78579,CPT,PULMONARY VENTILATION IMAGING,,,20,,RBRVS,0.49 ,4.90 ,4.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78579,CPT,PULMONARY VENTILATION IMAGING,26,,20,,RBRVS,0.49 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78579,CPT,PULMONARY VENTILATION IMAGING,TC,,20,,RBRVS,,4.74 ,4.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78580,CPT,PULMONARY PERFUSION IMAGING PARTICULATE,,,20,,RBRVS,0.74 ,6.17 ,6.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78580,CPT,PULMONARY PERFUSION IMAGING PARTICULATE,26,,20,,RBRVS,0.74 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78580,CPT,PULMONARY PERFUSION IMAGING PARTICULATE,TC,,20,,RBRVS,,5.91 ,5.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78582,CPT,PULMONARY VENTILATION & PERFUSION IMAGING,,,20,,RBRVS,1.07 ,8.60 ,8.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78582,CPT,PULMONARY VENTILATION & PERFUSION IMAGING,26,,20,,RBRVS,1.07 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78582,CPT,PULMONARY VENTILATION & PERFUSION IMAGING,TC,,20,,RBRVS,,8.23 ,8.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78597,CPT,QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING,,,20,,RBRVS,0.75 ,5.08 ,5.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78597,CPT,QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING,26,,20,,RBRVS,0.75 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78597,CPT,QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING,TC,,20,,RBRVS,,4.85 ,4.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78598,CPT,QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN,,,20,,RBRVS,0.85 ,8.02 ,8.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78598,CPT,QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN,26,,20,,RBRVS,0.85 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78598,CPT,QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN,TC,,20,,RBRVS,,7.73 ,7.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78599,CPT,UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE,,,20,,TotalUnits,,,,9.67 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78599,CPT,UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE,26,,20,,TotalUnits,,,,1.44 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78599,CPT,UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE,TC,,20,,TotalUnits,,,,8.23 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78600,CPT,BRAIN IMAGING <4 STATIC VIEWS,,,20,,RBRVS,0.44 ,4.90 ,4.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78600,CPT,BRAIN IMAGING <4 STATIC VIEWS,26,,20,,RBRVS,0.44 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78600,CPT,BRAIN IMAGING <4 STATIC VIEWS,TC,,20,,RBRVS,,4.73 ,4.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78601,CPT,BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW,,,20,,RBRVS,0.51 ,5.66 ,5.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78601,CPT,BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW,26,,20,,RBRVS,0.51 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78601,CPT,BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW,TC,,20,,RBRVS,,5.49 ,5.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78605,CPT,BRAIN IMAGING MINIMUM 4 STATIC VIEWS,,,20,,RBRVS,0.53 ,5.21 ,5.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78605,CPT,BRAIN IMAGING MINIMUM 4 STATIC VIEWS,26,,20,,RBRVS,0.53 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78605,CPT,BRAIN IMAGING MINIMUM 4 STATIC VIEWS,TC,,20,,RBRVS,,5.01 ,5.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78606,CPT,BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW,,,20,,RBRVS,0.64 ,8.94 ,8.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78606,CPT,BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW,26,,20,,RBRVS,0.64 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78606,CPT,BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW,TC,,20,,RBRVS,,8.72 ,8.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78607,CPT,BRAIN IMAGING TOMOGRAPHIC SPECT,,,20,,RBRVS,1.23 ,8.89 ,8.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78607,CPT,BRAIN IMAGING TOMOGRAPHIC SPECT,26,,20,,RBRVS,1.23 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78607,CPT,BRAIN IMAGING TOMOGRAPHIC SPECT,TC,,20,,RBRVS,,8.50 ,8.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78608,CPT,BRAIN IMAGING PET METABOLIC EVALUATION,,,20,,TotalUnits,,,,12.48 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78608,CPT,BRAIN IMAGING PET METABOLIC EVALUATION,,PC,20,,TotalUnits,,,,1.97 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 78608,CPT,BRAIN IMAGING PET METABOLIC EVALUATION,,TC,20,,TotalUnits,,,,10.51 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 78609,CPT,BRAIN IMAGING PET PERFUSION EVALUATION,,,20,,TotalUnits,,,,8.28 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78609,CPT,BRAIN IMAGING PET PERFUSION EVALUATION,,PC,20,,TotalUnits,,,,2.07 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 78609,CPT,BRAIN IMAGING PET PERFUSION EVALUATION,,TC,20,,TotalUnits,,,,6.21 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 78610,CPT,BRAIN IMAGING VASCULAR FLOW ONLY,,,20,,RBRVS,0.30 ,4.75 ,4.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78610,CPT,BRAIN IMAGING VASCULAR FLOW ONLY,26,,20,,RBRVS,0.30 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78610,CPT,BRAIN IMAGING VASCULAR FLOW ONLY,TC,,20,,RBRVS,,4.64 ,4.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78630,CPT,CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY,,,20,,RBRVS,0.68 ,9.11 ,9.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78630,CPT,CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY,26,,20,,RBRVS,0.68 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78630,CPT,CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY,TC,,20,,RBRVS,,8.87 ,8.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78635,CPT,CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY,,,20,,RBRVS,0.61 ,9.20 ,9.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78635,CPT,CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY,26,,20,,RBRVS,0.61 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78635,CPT,CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY,TC,,20,,RBRVS,,8.97 ,8.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78645,CPT,CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ,,,20,,RBRVS,0.57 ,8.77 ,8.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78645,CPT,CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ,26,,20,,RBRVS,0.57 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78645,CPT,CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ,TC,,20,,RBRVS,,8.58 ,8.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78647,CPT,CEREBROSPINAL FLUID FLOW W/O MATL TOMOG SPECT,,,20,,RBRVS,0.90 ,9.21 ,9.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78647,CPT,CEREBROSPINAL FLUID FLOW W/O MATL TOMOG SPECT,26,,20,,RBRVS,0.90 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78647,CPT,CEREBROSPINAL FLUID FLOW W/O MATL TOMOG SPECT,TC,,20,,RBRVS,,8.88 ,8.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78650,CPT,CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO,,,20,,RBRVS,0.61 ,8.92 ,8.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78650,CPT,CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO,26,,20,,RBRVS,0.61 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78650,CPT,CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO,TC,,20,,RBRVS,,8.71 ,8.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78660,CPT,RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY,,,20,,RBRVS,0.53 ,4.66 ,4.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78660,CPT,RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY,26,,20,,RBRVS,0.53 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78660,CPT,RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY,TC,,20,,RBRVS,,4.46 ,4.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78699,CPT,UNLISTED NERVOUS SYSTEM PX DX NUCLEAR MEDICINE,,,20,,TotalUnits,,,,12.48 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78699,CPT,UNLISTED NERVOUS SYSTEM PX DX NUCLEAR MEDICINE,26,,20,,TotalUnits,,,,1.97 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78699,CPT,UNLISTED NERVOUS SYSTEM PX DX NUCLEAR MEDICINE,TC,,20,,TotalUnits,,,,10.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78700,CPT,KIDNEY IMAGING MORPHOLOGY,,,20,,RBRVS,0.45 ,4.51 ,4.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78700,CPT,KIDNEY IMAGING MORPHOLOGY,26,,20,,RBRVS,0.45 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78700,CPT,KIDNEY IMAGING MORPHOLOGY,TC,,20,,RBRVS,,4.35 ,4.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78701,CPT,KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW,,,20,,RBRVS,0.49 ,5.60 ,5.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78701,CPT,KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW,26,,20,,RBRVS,0.49 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78701,CPT,KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW,TC,,20,,RBRVS,,5.44 ,5.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78707,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX,,,20,,RBRVS,0.96 ,5.73 ,5.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78707,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX,26,,20,,RBRVS,0.96 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78707,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX,TC,,20,,RBRVS,,5.41 ,5.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78708,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX,,,20,,RBRVS,1.21 ,3.75 ,3.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78708,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX,26,,20,,RBRVS,1.21 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78708,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX,TC,,20,,RBRVS,,3.34 ,3.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78709,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE,,,20,,RBRVS,1.41 ,9.07 ,9.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78709,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE,26,,20,,RBRVS,1.41 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78709,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE,TC,,20,,RBRVS,,8.60 ,8.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78710,CPT,KIDNEY IMAGING MORPHOLOGY TOMOGRAPHIC,,,20,,RBRVS,0.66 ,5.11 ,5.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78710,CPT,KIDNEY IMAGING MORPHOLOGY TOMOGRAPHIC,26,,20,,RBRVS,0.66 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78710,CPT,KIDNEY IMAGING MORPHOLOGY TOMOGRAPHIC,TC,,20,,RBRVS,,4.93 ,4.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78725,CPT,KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY,,,20,,RBRVS,0.38 ,2.73 ,2.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78725,CPT,KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY,26,,20,,RBRVS,0.38 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78725,CPT,KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY,TC,,20,,RBRVS,,2.61 ,2.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78730,CPT,URINARY BLADDER RESIDUAL STUDY,,,20,,RBRVS,0.15 ,2.05 ,2.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78730,CPT,URINARY BLADDER RESIDUAL STUDY,26,,20,,RBRVS,0.15 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78730,CPT,URINARY BLADDER RESIDUAL STUDY,TC,,20,,RBRVS,,1.99 ,1.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78740,CPT,URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,,,20,,RBRVS,0.57 ,5.73 ,5.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78740,CPT,URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,26,,20,,RBRVS,0.57 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78740,CPT,URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,TC,,20,,RBRVS,,5.54 ,5.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78761,CPT,TESTICULAR IMAGING WITH VASCULAR FLOW,,,20,,RBRVS,0.71 ,5.30 ,5.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78761,CPT,TESTICULAR IMAGING WITH VASCULAR FLOW,26,,20,,RBRVS,0.71 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78761,CPT,TESTICULAR IMAGING WITH VASCULAR FLOW,TC,,20,,RBRVS,,5.03 ,5.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78799,CPT,UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE,,,20,,TotalUnits,,,,6.01 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78799,CPT,UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE,26,,20,,TotalUnits,,,,1.62 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78799,CPT,UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE,TC,,20,,TotalUnits,,,,4.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78800,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT LIMITED AREA,,,20,,RBRVS,0.66 ,4.82 ,4.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78800,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT LIMITED AREA,26,,20,,RBRVS,0.66 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78800,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT LIMITED AREA,TC,,20,,RBRVS,,4.58 ,4.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78801,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT MULTIPLE AREAS,,,20,,RBRVS,0.79 ,6.71 ,6.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78801,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT MULTIPLE AREAS,26,,20,,RBRVS,0.79 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78801,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT MULTIPLE AREAS,TC,,20,,RBRVS,,6.43 ,6.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78802,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY,,,20,,RBRVS,0.86 ,8.53 ,8.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78802,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY,26,,20,,RBRVS,0.86 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78802,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY,TC,,20,,RBRVS,,8.24 ,8.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78803,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT,,,20,,RBRVS,1.09 ,8.73 ,8.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78803,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT,26,,20,,RBRVS,1.09 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78803,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT,TC,,20,,RBRVS,,8.39 ,8.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78804,CPT,RP LOCLZJ TUMOR/DSTRBJ AGT WHOL BDY REQ 2/> DAY,,,20,,RBRVS,1.07 ,15.34 ,15.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78804,CPT,RP LOCLZJ TUMOR/DSTRBJ AGT WHOL BDY REQ 2/> DAY,26,,20,,RBRVS,1.07 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78804,CPT,RP LOCLZJ TUMOR/DSTRBJ AGT WHOL BDY REQ 2/> DAY,TC,,20,,RBRVS,,14.98 ,14.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78805,CPT,RP LOCLZJ INFLAMMATORY PROCESS LIMITED AREA,,,20,,RBRVS,0.73 ,4.51 ,4.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78805,CPT,RP LOCLZJ INFLAMMATORY PROCESS LIMITED AREA,26,,20,,RBRVS,0.73 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78805,CPT,RP LOCLZJ INFLAMMATORY PROCESS LIMITED AREA,TC,,20,,RBRVS,,4.26 ,4.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78806,CPT,RP LOCLZJ INFLAMMATORY PROCESS WHOLE BODY,,,20,,RBRVS,0.86 ,8.77 ,8.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78806,CPT,RP LOCLZJ INFLAMMATORY PROCESS WHOLE BODY,26,,20,,RBRVS,0.86 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78806,CPT,RP LOCLZJ INFLAMMATORY PROCESS WHOLE BODY,TC,,20,,RBRVS,,8.48 ,8.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78807,CPT,RP LOCLZJ INFLAMMATORY PROCESS TOMOG SPECT,,,20,,RBRVS,1.09 ,8.73 ,8.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78807,CPT,RP LOCLZJ INFLAMMATORY PROCESS TOMOG SPECT,26,,20,,RBRVS,1.09 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78807,CPT,RP LOCLZJ INFLAMMATORY PROCESS TOMOG SPECT,TC,,20,,RBRVS,,8.40 ,8.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78808,CPT,NJX RP LOCLZJ NON-IMG PROBE STUDY INTRAVENOUS,,,20,,RBRVS,0.18 ,1.10 ,1.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78811,CPT,PET IMAGING LIMITED AREA CHEST HEAD/NECK,,,20,,TotalUnits,,,,16.95 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78811,CPT,PET IMAGING LIMITED AREA CHEST HEAD/NECK,26,,20,,TotalUnits,,,,2.11 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78811,CPT,PET IMAGING LIMITED AREA CHEST HEAD/NECK,TC,,20,,TotalUnits,,,,14.84 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78812,CPT,PET IMAGING SKULL BASE TO MID-THIGH,,,20,,TotalUnits,,,,20.55 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78812,CPT,PET IMAGING SKULL BASE TO MID-THIGH,26,,20,,TotalUnits,,,,2.58 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78812,CPT,PET IMAGING SKULL BASE TO MID-THIGH,TC,,20,,TotalUnits,,,,17.97 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78813,CPT,PET IMAGING WHOLE BODY,,,20,,TotalUnits,,,,21.34 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78813,CPT,PET IMAGING WHOLE BODY,26,,20,,TotalUnits,,,,2.69 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78813,CPT,PET IMAGING WHOLE BODY,TC,,20,,TotalUnits,,,,18.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78814,CPT,PET IMAGING CT FOR ATTENUATION LIMITED AREA,,,20,,TotalUnits,,,,23.65 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78814,CPT,PET IMAGING CT FOR ATTENUATION LIMITED AREA,26,,20,,TotalUnits,,,,2.97 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78814,CPT,PET IMAGING CT FOR ATTENUATION LIMITED AREA,TC,,20,,TotalUnits,,,,20.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78815,CPT,PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH,,,20,,TotalUnits,,,,25.82 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78815,CPT,PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH,26,,20,,TotalUnits,,,,3.28 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78815,CPT,PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH,TC,,20,,TotalUnits,,,,22.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78816,CPT,PET IMAGING FOR CT ATTENUATION WHOLE BODY,,,20,,TotalUnits,,,,26.30 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78816,CPT,PET IMAGING FOR CT ATTENUATION WHOLE BODY,26,,20,,TotalUnits,,,,3.31 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78816,CPT,PET IMAGING FOR CT ATTENUATION WHOLE BODY,TC,,20,,TotalUnits,,,,22.99 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 78999,CPT,UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE,,,20,,TotalUnits,,,,25.82 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 78999,CPT,UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE,26,,20,,TotalUnits,,,,3.28 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 78999,CPT,UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE,TC,,20,,TotalUnits,,,,22.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 79005,CPT,RP THERAPY ORAL ADMINISTRATION,,,20,,RBRVS,1.80 ,1.99 ,1.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 79005,CPT,RP THERAPY ORAL ADMINISTRATION,26,,20,,RBRVS,1.80 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 79005,CPT,RP THERAPY ORAL ADMINISTRATION,TC,,20,,RBRVS,,1.37 ,1.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 79101,CPT,RP THERAPY INTRAVENOUS ADMINISTRATION,,,20,,RBRVS,1.96 ,2.01 ,2.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 79101,CPT,RP THERAPY INTRAVENOUS ADMINISTRATION,26,,20,,RBRVS,1.96 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 79101,CPT,RP THERAPY INTRAVENOUS ADMINISTRATION,TC,,20,,RBRVS,,1.34 ,1.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 79200,CPT,RP THERAPY INRACAVITARY ADMINISTRATION,,,20,,RBRVS,1.99 ,2.45 ,2.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 79200,CPT,RP THERAPY INRACAVITARY ADMINISTRATION,26,,20,,RBRVS,1.99 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 79200,CPT,RP THERAPY INRACAVITARY ADMINISTRATION,TC,,20,,RBRVS,,1.63 ,1.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 79300,CPT,RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN,,,20,,TotalUnits,,,,3.66 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 79300,CPT,RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN,26,,20,,TotalUnits,,,,2.21 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 79300,CPT,RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN,TC,,20,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 79403,CPT,RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS,,,20,,RBRVS,2.25 ,3.10 ,3.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 79403,CPT,RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS,26,,20,,RBRVS,2.25 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 79403,CPT,RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS,TC,,20,,RBRVS,,2.30 ,2.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 79440,CPT,RP THERAPY INTRA-ARTICULAR ADMINISTRATION,,,20,,RBRVS,1.99 ,2.05 ,2.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 79440,CPT,RP THERAPY INTRA-ARTICULAR ADMINISTRATION,26,,20,,RBRVS,1.99 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 79440,CPT,RP THERAPY INTRA-ARTICULAR ADMINISTRATION,TC,,20,,RBRVS,,1.41 ,1.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 79445,CPT,RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN,,,20,,TotalUnits,,,,9.55 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 79445,CPT,RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN,26,,20,,TotalUnits,,,,3.16 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 79445,CPT,RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN,TC,,20,,TotalUnits,,,,6.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 79999,CPT,RP THERAPY UNLISTED PROCEDURE,,,20,,TotalUnits,,,,3.97 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 79999,CPT,RP THERAPY UNLISTED PROCEDURE,,PC,20,,TotalUnits,,,,2.53 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 79999,CPT,RP THERAPY UNLISTED PROCEDURE,,TC,20,,TotalUnits,,,,1.44 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 80047,CPT,BASIC METABOLIC PANEL CALCIUM IONIZED,,,17,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80048,CPT,BASIC METABOLIC PANEL CALCIUM TOTAL,,,17,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80050,CPT,GENERAL HEALTH PANEL,,,17,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80051,CPT,ELECTROLYTE PANEL,,,17,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80053,CPT,COMPREHENSIVE METABOLIC PANEL,,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80055,CPT,OBSTETRIC PANEL,,,17,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80061,CPT,LIPID PANEL,,,17,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80069,CPT,RENAL FUNCTION PANEL,,,17,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80074,CPT,ACUTE HEPATITIS PANEL,,,17,,TotalUnits,,,,1.81 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80076,CPT,HEPATIC FUNCTION PANEL,,,17,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80081,CPT,OBSTETRIC PANEL,,,17,,TotalUnits,,,,2.85 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80150,CPT,DRUG SCREEN QUANTITATIVE AMIKACIN,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80155,CPT,DRUG ASSAY CAFFEINE,,,17,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80156,CPT,DRUG ASSAY CARBAMAZEPINE TOTAL,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80157,CPT,DRUG ASSAY CARBAMAZEPINE FREE,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80158,CPT,DRUG ASSAY CYCLOSPORINE,,,17,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80159,CPT,DRUG ASSAY CLOZAPINE,,,17,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80162,CPT,DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL,,,17,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80163,CPT,DRUG SCREEN QUANTITATIVE DIGOXIN FREE,,,17,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80164,CPT,DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80165,CPT,DRUG SCREEN QUANT DIPROPYLACETIC ACID FREE,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80168,CPT,DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE,,,17,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80169,CPT,DRUG ASSAY EVEROLIMUS,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80170,CPT,DRUG SCREEN QUANTITATIVE GENTAMICIN,,,17,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80171,CPT,DRUG SCREEN QUANTITATIVE GABAPENTIN,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80173,CPT,DRUG SCREEN QUANTITATIVE HALOPRIDOL,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80175,CPT,DRUG SCREEN QUANTITATIVE LAMOTRIGINE,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80176,CPT,DRUG SCREEN QUANTITATIVE LIDOCAINE,,,17,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80177,CPT,DRUG SCREEN QUANTITATIVE LEVETIRACETAM,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80178,CPT,DRUG SCREEN QUANTITATIVE LITHIUM,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80180,CPT,DRUG SCREEN QUANTITATIVE MYCOPHENOLATE,,,17,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80183,CPT,DRUG SCREEN QUANTITATIVE OXCARBAZEPINE,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80184,CPT,DRUG SCREEN QUANTITATIVE PHENOBARBITAL,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80185,CPT,DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80186,CPT,DRUG SCREEN QUANTITATIVE PHENYTOIN FREE,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80188,CPT,DRUG SCREEN QUANTITATIVE PRIMIDONE,,,17,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80190,CPT,DRUG SCREEN QUANTITATIVE PROCAINAMIDE,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80192,CPT,DRUG SCREEN QUANTITATIVE PROCAINAMIDE METABOLITE,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80194,CPT,DRUG SCREEN QUANTITATIVE QUINIDINE,,,17,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80195,CPT,DRUG SCREEN QUANTITATIVE SIROLIMUS,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80197,CPT,DRUG SCREEN QUANTITATIVE TACROLIMUS,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80198,CPT,DRUG SCREEN QUANTITATIVE THEOPHYLLINE,,,17,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80199,CPT,DRUG SCREEN QUANTITATIVE TIAGABINE,,,17,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80200,CPT,DRUG SCREEN QUANTITATIVE TOBRAMYCIN,,,17,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80201,CPT,DRUG SCREEN QUANTITATIVE TOPIRAMATE,,,17,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80202,CPT,DRUG SCREEN QUANTITATIVE VANCOMYCIN,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80203,CPT,DRUG SCREEN QUANTITATIVE ZONISAMIDE,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80299,CPT,QUANTITATION DRUG NOT ELSEWHERE SPECIFIED,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80305,CPT,DRUG TEST PRSMV DIR OPT OBS,,,17,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80306,CPT,DRUG TEST PRSMV INSTRMNT,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80307,CPT,DRUG TEST PRSMV CHEM ANLYZR,,,17,,TotalUnits,,,,2.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80320,CPT,DRUG SCREEN QUANTITATIVE ALCOHOLS,,,17,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80321,CPT,DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2,,,17,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80322,CPT,DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 3 OR MORE,,,17,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80323,CPT,ALKALOIDS NOT OTHERWISE SPECIFIED,,,17,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80324,CPT,DRUG SCREEN QUANT AMPHETAMINES 1 OR 2,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80325,CPT,DRUG SCREEN QUANT AMPHETAMINES 3 OR 4,,,17,,TotalUnits,,,,0.99 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80326,CPT,DRUG SCREEN QUANT AMPHETAMINES 5 OR MORE,,,17,,TotalUnits,,,,1.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80327,CPT,DRUG SCREEN QUANT ANABOLIC STEROID 1 OR 2,,,17,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80329,CPT,DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2,,,17,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80330,CPT,DRUG SCREEN ANALGESICS NON-OPIOID 3-5,,,17,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80331,CPT,DRUG SCREEN ANALGESICS NON-OPIOID 6 OR MORE,,,17,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80332,CPT,ANTIDEPRESSANTS SEROTONERGIC CLASS 1 OR 2,,,17,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80333,CPT,ANTIDEPRESSANTS SEROTONERGIC CLASS 3-5,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80334,CPT,ANTIDEPRESSANTS SEROTONERGIC CLASS 6 OR MORE,,,17,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80335,CPT,ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80336,CPT,ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 3-5,,,17,,TotalUnits,,,,1.58 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80337,CPT,ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 6/MORE,,,17,,TotalUnits,,,,1.80 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80338,CPT,ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80339,CPT,ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3,,,17,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80340,CPT,ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 4-6,,,17,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80341,CPT,ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 7/MORE,,,17,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80342,CPT,ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3,,,17,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80343,CPT,ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 4-6,,,17,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80344,CPT,ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 7/MORE,,,17,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80345,CPT,DRUG SCREENING BARBITURATES,,,17,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80346,CPT,DRUG SCREENING BENZODIAZEPINES 1-12,,,17,,TotalUnits,,,,1.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80347,CPT,DRUG SCREENING BENZODIAZEPINES 13 OR MORE,,,17,,TotalUnits,,,,2.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80348,CPT,DRUG SCREENING BUPRENORPHINE,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80349,CPT,DRUG SCREENING CANNABINOIDS NATURAL,,,17,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80350,CPT,DRUG SCREENING CANNABINOIDS SYNTHETIC 1-3,,,17,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80351,CPT,DRUG SCREENING CANNABINOIDS SYNTHETIC 4-6,,,17,,TotalUnits,,,,1.08 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80352,CPT,DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE,,,17,,TotalUnits,,,,1.69 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80353,CPT,DRUG SCREENING COCAINE,,,17,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80354,CPT,DRUG SCREENING FENTANYL,,,17,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80355,CPT,DRUG SCREENING GABAPENTIN NON-BLOOD,,,17,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80356,CPT,DRUG SCREENING HEROIN METABOLITE,,,17,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80357,CPT,DRUG SCREENING KETAMINE AND NORKETAMINE,,,17,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80358,CPT,DRUG SCREENING METHADONE,,,17,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80359,CPT,DRUG SCREENING METHYLENEDIOXYAMPHETAMINES,,,17,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80360,CPT,DRUG SCREENING METHYLPHENIDATE,,,17,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80361,CPT,DRUG SCREENING OPIATES 1 OR MORE,,,17,,TotalUnits,,,,1.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80362,CPT,DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2,,,17,,TotalUnits,,,,1.03 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80363,CPT,DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 3 OR 4,,,17,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80364,CPT,DRUG SCREENING OPIOIDS & OPIATE ANALOGS 5/MORE,,,17,,TotalUnits,,,,2.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80365,CPT,DRUG SCREENING OXYCODONE,,,17,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80366,CPT,DRUG SCREENING PREGABALIN,,,17,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80367,CPT,DRUG SCREENING PROPOXYPHENE,,,17,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80368,CPT,DRUG SCREENING SEDATIVE HYPNOTICS,,,17,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80369,CPT,DRUG SCREENING SKELETAL MUSCLE RELAXANTS 1 OR 2,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80370,CPT,DRUG SCREENING SKEL MUSCLE RELAXANTS 3 OR MORE,,,17,,TotalUnits,,,,0.94 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80371,CPT,DRUG SCREENING STIMULANTS SYNTHETIC,,,17,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80372,CPT,DRUG SCREENING TAPENTADOL,,,17,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80373,CPT,DRUG SCREENING TRAMADOL,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80374,CPT,DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS,,,17,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80375,CPT,DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80376,CPT,DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 4-6,,,17,,TotalUnits,,,,1.71 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80377,CPT,DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 7/MORE,,,17,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80400,CPT,ACTH STIMULATION PANEL ADRENAL INSUFFICIENCY,,,17,,TotalUnits,,,,1.24 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80402,CPT,ACTH STIMULATION PANEL 21 HYDROXYLASE DEFICIENCY,,,17,,TotalUnits,,,,3.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80406,CPT,ACTH STIMJ PANEL 3 BETA-HYDROXYDEHYD DEFNCY,,,17,,TotalUnits,,,,2.98 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80408,CPT,ALDOSTERONE SUPPRESSION EVALUATION PANEL,,,17,,TotalUnits,,,,4.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80410,CPT,CALCITONIN STIMULATION PANEL,,,17,,TotalUnits,,,,3.06 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80412,CPT,CORTICOTROPIC RELEASING HORM STIMJ PANEL,,,17,,TotalUnits,,,,12.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80414,CPT,CHORNC GONAD STIMJ PANEL TSTOSTERONE RESPONSE,,,17,,TotalUnits,,,,1.96 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80415,CPT,CHORNC GONAD STIMJ PANEL ESTRADIOL RESPONSE,,,17,,TotalUnits,,,,2.13 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80416,CPT,RENAL VEIN RENIN STIMULATION PANEL,,,17,,TotalUnits,,,,5.02 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80417,CPT,PERIPHERAL VEIN RENIN STIMULATION PANEL,,,17,,TotalUnits,,,,1.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80418,CPT,COMBINED RAPID ANT PITUITARY EVALUATION PANEL,,,17,,TotalUnits,,,,22.05 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80420,CPT,DEXMETHASONE SUPPRESSION PANEL 48 HR,,,17,,TotalUnits,,,,2.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80422,CPT,GLUCOSE TOLERANCE PANEL INSULINOMA,,,17,,TotalUnits,,,,1.75 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80424,CPT,GLUCOSE TOLERANCE PANEL PHEOCHROMOCYTOMA,,,17,,TotalUnits,,,,1.92 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80426,CPT,GONADOTROPIN RELEASING HORMONE STIMJ PANEL,,,17,,TotalUnits,,,,5.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80428,CPT,GROWTH HORMONE STIMULATION PANEL,,,17,,TotalUnits,,,,2.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80430,CPT,GROWTH HORMONE SUPRJ PANEL GLUCOSE ADMN,,,17,,TotalUnits,,,,2.99 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80432,CPT,INSULIN-INDUCED C-PEPTIDE SUPRESSION PANEL,,,17,,TotalUnits,,,,5.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80434,CPT,INSULIN TOLERANCE PANEL ACTH INSUFFICIENCY,,,17,,TotalUnits,,,,3.85 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80435,CPT,INSULIN TOLERANCE PANEL GROWTH HORM DEFNCY,,,17,,TotalUnits,,,,3.92 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80436,CPT,METYRAPONE PANEL,,,17,,TotalUnits,,,,3.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80438,CPT,THYROTROPIN RELEASING HORMONE STMLJ PANEL 1 HR,,,17,,TotalUnits,,,,1.92 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80439,CPT,THYROTROPIN RELEASING HORMONE STMLJ PANEL 2 HR,,,17,,TotalUnits,,,,2.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 80500,CPT,CLINICAL PATHOLOGY CONSULTATION LIMITED,,,17,,RBRVS,0.37 ,0.16 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 80502,CPT,CLINICAL PATHOLOGY CONSULTATION COMPREHENSIVE,,,17,,RBRVS,1.33 ,0.56 ,0.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 81000,CPT,URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY,,,17,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81001,CPT,URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY,,,17,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81002,CPT,URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP,,,17,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81003,CPT,URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY,,,17,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81005,CPT,URINALYSIS QUAL/SEMIQUANT EXCEPT IMMUNOASSAYS,,,17,,TotalUnits,,,,0.08 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81007,CPT,URINALYSIS BACTERIURIA SCR XCPT CULTURE/DIPSTICK,,,17,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81015,CPT,URINALYSIS MICROSCOPIC ONLY,,,17,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81020,CPT,URINALYSIS 2/3 GLASS TEST,,,17,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81025,CPT,URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS,,,17,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81050,CPT,VOLUME MEASUREMENT TIMED COLLECTION EACH,,,17,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81099,CPT,UNLISTED URINALYSIS PROCEDURE,,,17,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81161,CPT,DMD DUPLICATION/DELETION ANALYSIS,,,17,,TotalUnits,,,,3.91 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81162,CPT,BRCA1&BRCA2 FULL SEQ ANALYS/FULL DUP/DEL ANALYS,,,17,,TotalUnits,,,,69.43 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81170,CPT,ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS,,,17,,TotalUnits,,,,9.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81201,CPT,APC GENE ANALYSIS FULL GENE SEQUENCE,,,17,,TotalUnits,,,,0.99 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81202,CPT,APC GENE ANALYSIS KNOWN FAMILIAL VARIANTS,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81203,CPT,APC GENE ANALYSIS DUPLICATION/DELETION VARIANTS,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81205,CPT,BCKDHB GENE ANALYSIS COMMON VARIANTS,,,17,,TotalUnits,,,,1.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81206,CPT,BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE,,,17,,TotalUnits,,,,6.24 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81207,CPT,BCR/ABL1 MINOR BREAKPNT QUALITATIVE/QUANTITATIVE,,,17,,TotalUnits,,,,5.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81208,CPT,BCR/ABL1 OTHER BREAKPNT QUALITATIVE/QUANTITATIVE,,,17,,TotalUnits,,,,6.12 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81209,CPT,BLM GENE ANALYSIS 2281DEL6INS7 VARIANT,,,17,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81210,CPT,BRAF GENE ANALYSIS V600 VARIANT(S),,,17,,TotalUnits,,,,5.00 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81211,CPT,BRCA1&BRCA2 FULL SEQ ANALYS/COMM DUP/DEL BRCA,,,17,,TotalUnits,,,,60.89 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81212,CPT,BRCA1&BRCA2 ANAL 185DELAG5385INSC/6174DELT,,,17,,TotalUnits,,,,4.93 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81213,CPT,BRCA1&BRCA2 ANAL UNCOMMON DUP/DEL VARIANTS,,,17,,TotalUnits,,,,16.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81214,CPT,BRCA1 FULL SEQ ANAL&COMMON DUP/DEL VARIANTS,,,17,,TotalUnits,,,,40.11 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81215,CPT,BRCA1 GENE ANALYSIS KNOWN FAMILIAL VARIANT,,,17,,TotalUnits,,,,2.60 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81217,CPT,BRCA2 GENE ANALYSIS KNOWN FAMILIAL VARIANT,,,17,,TotalUnits,,,,2.60 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81218,CPT,CEBPA GENE ANALYSIS FULL GENE SEQUENCE,,,17,,TotalUnits,,,,9.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81219,CPT,CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9,,,17,,TotalUnits,,,,4.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81220,CPT,CFTR GENE ANALYSIS COMMON VARIANTS,,,17,,TotalUnits,,,,6.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81221,CPT,CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS,,,17,,TotalUnits,,,,3.90 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81222,CPT,CFTR GENE ANALYSIS DUPLICATION/DELETION VARIANTS,,,17,,TotalUnits,,,,3.27 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81224,CPT,CFTR GENE ANALYSIS INTRON 8 POLY-T ANALYSIS,,,17,,TotalUnits,,,,2.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81225,CPT,CYP2C19 GENE ANALYSIS COMMON VARIANTS,,,17,,TotalUnits,,,,8.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81226,CPT,CYP2D6 GENE ANALYSIS COMMON VARIANTS,,,17,,TotalUnits,,,,12.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81227,CPT,CYP2C9 GENE ANALYSIS COMMON VARIANTS,,,17,,TotalUnits,,,,4.88 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81228,CPT,CYTOGENOM CONST MICROARRAY COPY NUMBER VARIANTS,,,17,,TotalUnits,,,,12.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81229,CPT,CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR,,,17,,TotalUnits,,,,22.90 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81235,CPT,EGFR GENE ANALYSIS COMMON VARIANTS,,,17,,TotalUnits,,,,9.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81240,CPT,F2 GENE ANALYSIS 20210G >A VARIANT,,,17,,TotalUnits,,,,1.87 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81241,CPT,F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT,,,17,,TotalUnits,,,,2.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81242,CPT,FANCC GENE ANALYSIS COMMON VARIANT,,,17,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81243,CPT,FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES,,,17,,TotalUnits,,,,2.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81244,CPT,FMR1 GENE ANALYSIS CHARACTERIZATION OF ALLELES,,,17,,TotalUnits,,,,1.00 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81245,CPT,FLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTS,,,17,,TotalUnits,,,,4.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81246,CPT,FLT3 GENE ANLYS TYROSINE KINASE DOMAIN VARIANTS,,,17,,TotalUnits,,,,2.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81250,CPT,G6PC GENE ANALYSIS COMMON VARIANTS,,,17,,TotalUnits,,,,1.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81251,CPT,GBA GLUCOSIDASE/BETA/ACID ANAL COMM VARIANTS,,,17,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81252,CPT,GJB2 GENE ANALYSIS FULL GENE SEQUENCE,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81253,CPT,GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS,,,17,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81254,CPT,GJB6 GENE ANALYSIS COMMON VARIANTS,,,17,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81255,CPT,HEXA GENE ANALYSIS COMMON VARIANTS,,,17,,TotalUnits,,,,3.02 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81256,CPT,HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS,,,17,,TotalUnits,,,,2.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81257,CPT,HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT,,,17,,TotalUnits,,,,3.42 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81260,CPT,IKBKAP GENE ANALYSIS COMMON VARIANTS,,,17,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81261,CPT,IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED,,,17,,TotalUnits,,,,7.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81262,CPT,IGH@ REARRANGE ABNORMAL CLONAL POP DIRECT PROBE,,,17,,TotalUnits,,,,1.66 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81263,CPT,IGH@ VARIABLE REGION SOMATIC MUTATION ANALYSIS,,,17,,TotalUnits,,,,11.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81264,CPT,IGK@ GENE REARRANGE DETECT ABNORMAL CLONAL POP,,,17,,TotalUnits,,,,5.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81265,CPT,COMPARATIVE ANAL STR MARKERS PATIENT&COMP SPEC,,,17,,TotalUnits,,,,8.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81266,CPT,COMPARATIVE ANAL STR MARKERS EA ADDL SPECIMEN,,,17,,TotalUnits,,,,8.62 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81267,CPT,CHIMERISM W/COMP TO BASELINE W/O CELL SELECTION,,,17,,TotalUnits,,,,7.89 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81268,CPT,CHIMERISM W/COMP TO BASELINE W/CELL SELECTION EA,,,17,,TotalUnits,,,,9.92 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81270,CPT,JAK2 GENE ANALYSIS P.VAL617PHE VARIANT,,,17,,TotalUnits,,,,3.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81272,CPT,KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,,,17,,TotalUnits,,,,9.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81273,CPT,KIT GENE ANALYSIS D816 VARIANT(S),,,17,,TotalUnits,,,,3.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81275,CPT,KRAS GENE ANALYSIS VARIANTS IN EXON 2,,,17,,TotalUnits,,,,5.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81276,CPT,KRAS GENE ANALYSIS ADDITIONAL VARIANT(S),,,17,,TotalUnits,,,,5.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81287,CPT,MGMT METHYLATION ANALYSIS,,,17,,TotalUnits,,,,2.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81288,CPT,MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS,,,17,,TotalUnits,,,,4.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81290,CPT,MCOLN1 MUCOLIPIN1 GENE ANALYSIS COMMON VARIANTS,,,17,,TotalUnits,,,,0.91 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81291,CPT,MTHFR GENE ANALYSIS COMMON VARIANTS,,,17,,TotalUnits,,,,1.66 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81292,CPT,MLH1 GENE ANALYSIS FULL SEQUENCE ANALYSIS,,,17,,TotalUnits,,,,18.02 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81293,CPT,MLH1 GENE ANALYSIS KNOWN FAMILIAL VARIANTS,,,17,,TotalUnits,,,,7.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81294,CPT,MLH1 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,,,17,,TotalUnits,,,,5.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81295,CPT,MSH2 GENE ANALYSIS FULL SEQUENCE ANALYSIS,,,17,,TotalUnits,,,,4.23 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81296,CPT,MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS,,,17,,TotalUnits,,,,3.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81297,CPT,MSH2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,,,17,,TotalUnits,,,,4.23 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81298,CPT,MSH6 GENE ANALYSIS FULL SEQUENCE ANALYSIS,,,17,,TotalUnits,,,,8.03 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81299,CPT,MSH6 GENE ANALYSIS KNOWN FAMILIAL VARIANTS,,,17,,TotalUnits,,,,4.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81300,CPT,MSH6 GENE ANALYSIS DUPLICATION/DELETION VARIA,,,17,,TotalUnits,,,,4.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81301,CPT,MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF,,,17,,TotalUnits,,,,11.02 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81302,CPT,MECP2 GENE ANALYSIS FULL SEQUENCE,,,17,,TotalUnits,,,,7.41 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81310,CPT,NPM1 NUCLEOPHOSMIN GENE ANAL EXON 12 VARIANTS,,,17,,TotalUnits,,,,6.89 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81311,CPT,NRAS GENE ANALYSIS VARIANTS IN EXON 2&3,,,17,,TotalUnits,,,,8.26 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81313,CPT,PCA3/KLK3 PROSTATE SPECIFIC ANTIGEN RATIO,,,17,,TotalUnits,,,,7.27 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81314,CPT,PDGFRA GENE ANALYS TARGETED SEQUENCE ANALYS,,,17,,TotalUnits,,,,9.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81315,CPT,PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT,,,17,,TotalUnits,,,,7.89 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81316,CPT,PML/RARALPHA SINGLE BREAKPOINT QUAL/QUAN,,,17,,TotalUnits,,,,12.03 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81317,CPT,PMS2 GENE ANALYSIS FULL SEQUENCE,,,17,,TotalUnits,,,,21.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81318,CPT,PMS2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS,,,17,,TotalUnits,,,,5.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81319,CPT,PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,,,17,,TotalUnits,,,,6.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81321,CPT,PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,,,17,,TotalUnits,,,,16.75 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81322,CPT,PTEN GENE ANALYSIS KNOWN FAMILIAL VARIANT,,,17,,TotalUnits,,,,1.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81323,CPT,PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,,,17,,TotalUnits,,,,2.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81324,CPT,PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,,,17,,TotalUnits,,,,6.97 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81325,CPT,PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,,,17,,TotalUnits,,,,10.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81327,CPT,SEPT9 METHYLATION ANALYSIS,,,17,,TotalUnits,,,,2.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81330,CPT,SMPD1 GENE ANALYSIS COMMON VARIANTS,,,17,,TotalUnits,,,,1.01 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81331,CPT,SNRPN/UBE3A METHYLATION ANALYSIS,,,17,,TotalUnits,,,,3.09 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81332,CPT,SERPINA1 GENE ANALYSIS COMMON VARIANTS,,,17,,TotalUnits,,,,1.66 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81340,CPT,TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD,,,17,,TotalUnits,,,,7.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81341,CPT,TRB@ REARRANGEMENT ANAL DIRECT PROBE METHODOLOGY,,,17,,TotalUnits,,,,1.89 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81342,CPT,TRG@ GENE REARRANGEMENT ANALYSIS,,,17,,TotalUnits,,,,7.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81350,CPT,UGT1A1 GENE ANALYSIS COMMON VARIANTS,,,17,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81355,CPT,VKORC1 GENE ANALYSIS COMMON VARIANT(S),,,17,,TotalUnits,,,,1.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81370,CPT,HLA CLASS I&II LOW HLA-A -B -C -DRB1/3/4/5&DQB,,,17,,TotalUnits,,,,15.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81371,CPT,HLA I&LI LOW RESOLUTION HLA-A -B&-DRB1,,,17,,TotalUnits,,,,9.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81372,CPT,HLA CLASS I TYPING LOW RESOLUTION COMPLETE,,,17,,TotalUnits,,,,8.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81373,CPT,HLA CLASS I TYPING LOW RESOLUTION ONE LOCUS EACH,,,17,,TotalUnits,,,,4.24 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81374,CPT,HLA I LOW RESOLUTION ONE ANTIGEN EQUIVALENT EACH,,,17,,TotalUnits,,,,2.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81375,CPT,HLA II LOW RESOLUTION HLA-DRB1/3/4/5 AND -DQB1,,,17,,TotalUnits,,,,8.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81376,CPT,HLA CLASS II TYPING LOW RESOLUTION ONE LOCUS EA,,,17,,TotalUnits,,,,4.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81377,CPT,HLA II LOW RESOLUTION ONE ANTIGEN EQUIVALENT EA,,,17,,TotalUnits,,,,3.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81378,CPT,HLA I&II HIGH RESOLUTION HLA-A -B -C AND -DRB1,,,17,,TotalUnits,,,,13.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81379,CPT,HLA CLASS I TYPING HIGH RESOLUTION COMPLETE,,,17,,TotalUnits,,,,12.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81380,CPT,HLA CLASS I TYPING HIGH RESOLUTION ONE LOCUS EA,,,17,,TotalUnits,,,,6.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81381,CPT,HLA I TYPING HIGH RESOLUTION 1 ALLELE/ALLELE GRP,,,17,,TotalUnits,,,,3.60 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81382,CPT,HLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS EA,,,17,,TotalUnits,,,,4.71 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81383,CPT,HLA II HIGH RESOLUTION 1 ALLELE/ALLELE GROUP,,,17,,TotalUnits,,,,4.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81400,CPT,MOLECULAR PATHOLOGY PROCEDURE LEVEL 1,,,17,,TotalUnits,,,,1.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81401,CPT,MOLECULAR PATHOLOGY PROCEDURE LEVEL 2,,,17,,TotalUnits,,,,2.27 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81402,CPT,MOLECULAR PATHOLOGY PROCEDURE LEVEL 3,,,17,,TotalUnits,,,,3.06 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81403,CPT,MOLECULAR PATHOLOGY PROCEDURE LEVEL 4,,,17,,TotalUnits,,,,4.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81404,CPT,MOLECULAR PATHOLOGY PROCEDURE LEVEL 5,,,17,,TotalUnits,,,,5.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81405,CPT,MOLECULAR PATHOLOGY PROCEDURE LEVEL 6,,,17,,TotalUnits,,,,7.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81406,CPT,MOLECULAR PATHOLOGY PROCEDURE LEVEL 7,,,17,,TotalUnits,,,,9.43 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81407,CPT,MOLECULAR PATHOLOGY PROCEDURE LEVEL 8,,,17,,TotalUnits,,,,11.82 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81408,CPT,MOLECULAR PATHOLOGY PROCEDURE LEVEL 9,,,17,,TotalUnits,,,,14.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81412,CPT,ASHKENAZI JEWISH ASSOC DSRDRS GEN SEQ ANAL 9 GEN,,,17,,TotalUnits,,,,16.78 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81413,CPT,CAR ION CHNNLPATH INC 10 GNS,,,17,,TotalUnits,,,,22.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81414,CPT,CAR ION CHNNLPATH INC 2 GNS,,,17,,TotalUnits,,,,22.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81420,CPT,FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS,,,17,,TotalUnits,,,,22.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81422,CPT,FETAL CHRMOML MICRODELTJ,,,17,,TotalUnits,,,,22.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81432,CPT,HEREDITARY BRST CA-RELATED GEN SEQ ANALYS 14 GEN,,,17,,TotalUnits,,,,25.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81433,CPT,HEREDITARY BRST CA-RELATED DUP/DEL ANALYSIS,,,17,,TotalUnits,,,,16.78 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81434,CPT,HEREDITARY RETINAL DSRDRS GEN SEQ ANALYS 15 GEN,,,17,,TotalUnits,,,,16.78 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81435,CPT,HEREDITARY COLON CA DSRDRS GEN SEQ ANALYS 10 GEN,,,17,,TotalUnits,,,,22.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81436,CPT,HEREDITARY COLON CA DSRDRS DUP/DEL ANALYS 5 GEN,,,17,,TotalUnits,,,,22.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81437,CPT,HEREDTRY NURONDCRN TUM DSRDRS GEN SEQ ANAL 6 GEN,,,17,,TotalUnits,,,,16.78 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81438,CPT,HEREDTRY NURONDCRN TUM DSRDRS DUP/DEL ANALYSIS,,,17,,TotalUnits,,,,16.78 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81439,CPT,INHERITED CARDMYPTHY 5 GNS,,,17,,TotalUnits,,,,22.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81442,CPT,NOONAN SPECTRUM DISORDERS GEN SEQ ANALYS 12 GEN,,,17,,TotalUnits,,,,16.78 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81445,CPT,GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE,,,17,,TotalUnits,,,,16.70 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81450,CPT,GEN SEQ ANALYS HEMATOLYMPHOID NEO 5-50 GENE,,,17,,TotalUnits,,,,18.11 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81455,CPT,GEN SEQ ANALYS SOL ORG/HEMTOLMPHOID NEO 51/> GEN,,,17,,TotalUnits,,,,52.97 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81479,CPT,UNLISTED MOLELCULAR PATHOLOGY PROCEDURE,,,17,,TotalUnits,,,,4.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81490,CPT,AUTOIMMUNE RHEUMATOID ARTHRTS ANALYS 12 BIOMRKRS,,,17,,TotalUnits,,,,6.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81493,CPT,COR ART DISEASE MRNA GENE EXPRESSION 23 GENES,,,17,,TotalUnits,,,,10.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81500,CPT,ONCO (OVARIAN) BIOCHEMICAL ASSAY TWO PROTEINS,,,17,,TotalUnits,,,,6.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81503,CPT,ONCO (OVARIAN) BIOCHEMICAL ASSAY FIVE PROTEINS,,,17,,TotalUnits,,,,5.82 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81507,CPT,FETAL ANEUPLOIDY 21 18 13 SEQ ANALY TRISOM RISK,,,17,,TotalUnits,,,,17.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81508,CPT,FETAL CONGENITAL ABNOR ASSAY TWO PROTEINS,,,17,,TotalUnits,,,,1.71 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81509,CPT,FETAL CONGENITAL ABNOR ASSAY 3 PROTEINS,,,17,,TotalUnits,,,,11.90 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81511,CPT,FETAL CONGENITAL ABNOR ASSAY FOUR ANAL,,,17,,TotalUnits,,,,1.71 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81512,CPT,FETAL CONGENITAL ABNOR ASSAY FIVE ANAL,,,17,,TotalUnits,,,,3.10 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81519,CPT,ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES,,,17,,TotalUnits,,,,95.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81525,CPT,ONCOLOGY COLON MRNA GENE EXPRESSION 12 GENES,,,17,,TotalUnits,,,,17.98 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81528,CPT,ONCOLOGY COLORECTAL SCREENING QUAN 10 DNA MARKRS,,,17,,TotalUnits,,,,14.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81535,CPT,ONCOLOGY GYNE LIVE TUM CELL CLTR&CHEMO RESP 1ST,,,17,,TotalUnits,,,,16.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81536,CPT,ONCOLOGY GYNE LIVE TUM CELL CLTR&CHEMO RESP ADD,,,17,,TotalUnits,,,,4.96 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81538,CPT,ONCOLOGY LUNG MS 8-PROTEIN SIGNATURE,,,17,,TotalUnits,,,,5.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81539,CPT,ONCOLOGY PROSTATE PROB SCORE,,,17,,TotalUnits,,,,16.78 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81540,CPT,ONCOLOGY TUM UNKNOWN ORIGIN MRNA 92 GENES,,,17,,TotalUnits,,,,40.02 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81545,CPT,ONCOLOGY THYROID GENE EXPRESSION 142 GENES,,,17,,TotalUnits,,,,23.11 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81595,CPT,CARDIOLOGY HRT TRNSPL MRNA GENE EXPRESS 20 GENES,,,17,,TotalUnits,,,,10.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 81599,CPT,UNLISTED MULTIANALYTE ASSAY ALGORITHMIC ANALYSIS,,,17,,TotalUnits,,,,1.71 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82009,CPT,KETONE BODIES SERUM QUALITATIVE,,,17,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82010,CPT,KETONE BODIES SERUM QUANTITATIVE,,,17,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82013,CPT,ASSAY OF ACETYLCHOLINESTERASE,,,17,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82016,CPT,ACYLCARNITINES QUALITATIVE EACH SPECIMEN,,,17,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82017,CPT,ACYLCARNITINES QUANTIATIVE EACH SPECIMEN,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82024,CPT,ADRENOCORTICOTROPIC HORMONE ACTH,,,17,,TotalUnits,,,,1.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82030,CPT,ADENOSINE 5-MONOPHOSPHATE CYCLIC,,,17,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82040,CPT,ALBUMIN SERUM PLASMA/WHOLE BLOOD,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82042,CPT,ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82043,CPT,ALBUMIN URINE MICROALBUMIN QUANTIATIVE,,,17,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82044,CPT,ALBUMIN URINE MICROALBUMIN SEMIQUANTITATIVE,,,17,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82045,CPT,ALBUMIN ISCHEMIA MODIFIED,,,17,,TotalUnits,,,,1.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82075,CPT,ASSAY OF ALCOHOL BREATH,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82085,CPT,ASSAY OF ALDOLASE,,,17,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82088,CPT,ASSAY OF ALDOSTERONE,,,17,,TotalUnits,,,,1.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82103,CPT,ALPHA-1-ANTITRYPSIN TOTAL,,,17,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82104,CPT,ALPHA-1-ANTITRYPSIN PHENOTYPE,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82105,CPT,ALPHA-FETOPROTEIN SERUM,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82106,CPT,ALPHA-FETOPROTEIN AMNIOTIC FLUID,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82107,CPT,AFP-L3 FRACTION ISOFORM & TOTAL AFP W/RATIO,,,17,,TotalUnits,,,,2.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82108,CPT,ASSAY OF ALUMINUM,,,17,,TotalUnits,,,,0.97 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82120,CPT,AMINES VAGINAL FLUID QUALITATIVE,,,17,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82127,CPT,AMINO ACIDS 1 QUALITATIVE EACH SPECIMEN,,,17,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82128,CPT,AMINO ACIDS MULTIPLE QUALITATIVE EACH SPECIMEN,,,17,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82131,CPT,AMINO ACIDS 1 QUANTITATIVE EACH SPECIMEN,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82135,CPT,AMINOLEVULINIC ACID DELTA,,,17,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82136,CPT,AMINO ACIDS 2-5 AMINO ACIDS QUANTITATIVE EA SPEC,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82139,CPT,AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82140,CPT,ASSAY OF AMMONIA,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82143,CPT,AMNIOTIC FLU SCAN,,,17,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82150,CPT,ASSAY OF AMYLASE,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82154,CPT,ANDROSTANEDIOL GLUCURONIDE,,,17,,TotalUnits,,,,1.10 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82157,CPT,ANDROSTENEDIONE,,,17,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82160,CPT,ANDROSTERONE,,,17,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82163,CPT,ANGIOTENSIN II,,,17,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82164,CPT,ANGIOTENSIN I-CONVERTING ENZYME,,,17,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82172,CPT,APOLIPOPROTEIN EACH,,,17,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82175,CPT,ASSAY OF ARSENIC,,,17,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82180,CPT,ASSAY OF ASCORBIC ACID BLOOD,,,17,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82190,CPT,ATOMIC ABSRPJ SPECTROSCOPY EA ANALYTE,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82232,CPT,BETA-2 MICROGLOBULIN,,,17,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82239,CPT,BILE ACIDS TOTAL,,,17,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82240,CPT,BILE ACIDS CHOLYLGLYCINE,,,17,,TotalUnits,,,,1.01 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82247,CPT,BILIRUBIN TOTAL,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82248,CPT,BILIRUBIN DIRECT,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82252,CPT,BILIRUBIN FECES QUALITATIVE,,,17,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82261,CPT,BIOTINIDASE EACH SPECIMEN,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82270,CPT,BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER,,,17,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82271,CPT,BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES,,,17,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82272,CPT,BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC,,,17,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82274,CPT,BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3,,,17,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82286,CPT,BRADYKININ,,,17,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82300,CPT,CADMIUM,,,17,,TotalUnits,,,,0.88 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82306,CPT,25 HYDROXY INCLUDES FRACTIONS IF PERFORMED,,,17,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82308,CPT,CALCITONIN,,,17,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82310,CPT,CALCIUM TOTAL,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82330,CPT,CALCIUM IONIZED,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82331,CPT,CALCIUM AFTER CALCIUM INFUSION TEST,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82340,CPT,CALCIUM URINE QUANTITATIVE TIMED SPECIMEN,,,17,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82355,CPT,CALCULUS QUALITATIVE ANALYSIS,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82360,CPT,CALCULUS QUANTITATIVE CHEMICAL,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82365,CPT,CALCULUS INFRARED SPECTROSCOPY,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82370,CPT,CALCULUS XRAY DIFFRACTION,,,17,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82373,CPT,CARBOHYDRATE DEFICIENT TRANSFERRIN,,,17,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82374,CPT,CARBON DIOXIDE BICARBONATE,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82375,CPT,CARBOXYHEMOGLOBIN QUANTITATIVE,,,17,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82376,CPT,CARBOXYHEMOGLOBIN QUALITATIVE,,,17,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82378,CPT,CARCINOEMBRYONIC ANTIGEN CEA,,,17,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82379,CPT,CARNITINE QUANTITATIVE EACH SPECIMEN,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82380,CPT,CAROTENE,,,17,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82382,CPT,CATECHOLAMINES TOTAL URINE,,,17,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82383,CPT,CATECHOLAMINES BLOOD,,,17,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82384,CPT,CATECHOLAMINES FRACTIONATED,,,17,,TotalUnits,,,,0.96 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82387,CPT,CATHEPSIN-D,,,17,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82390,CPT,CERULOPLASMIN,,,17,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82397,CPT,CHEMILUMINESCENT ASSAY,,,17,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82415,CPT,CHLORAMPHENICOL,,,17,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82435,CPT,CHLORIDE BLD,,,17,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82436,CPT,CHLORIDE URINE,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82438,CPT,CHLORIDE OTHER SOURCE,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82441,CPT,CHLORINATED HYDROCARBONS SCREEN,,,17,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82465,CPT,CHOLESTEROL SERUM/WHOLE BLOOD TOTAL,,,17,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82480,CPT,CHOLINESTERASE SERUM,,,17,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82482,CPT,CHOLINESTERASE RBC,,,17,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82485,CPT,CHONDROITIN B SULFATE QUANTITATIVE,,,17,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82495,CPT,ASSAY OF CHROMIUM,,,17,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82507,CPT,ASSAY OF CITRATE,,,17,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82523,CPT,COLLAGEN CROSS LINKS ANY METHOD,,,17,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82525,CPT,ASSAY OF COPPER,,,17,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82528,CPT,CORTICOSTERONE,,,17,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82530,CPT,CORTISOL FREE,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82533,CPT,CORTISOL TOTAL,,,17,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82540,CPT,ASSAY OF CREATINE,,,17,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82542,CPT,COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC,,,17,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82550,CPT,CREATINE KINASE TOTAL,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82552,CPT,CREATINE KINASE ISOENZYMES,,,17,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82553,CPT,CREATINE KINASE MB FRACTION ONLY,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82554,CPT,CREATINE KINASE ISOFORMS,,,17,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82565,CPT,CREATININE BLOOD,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82570,CPT,CREATININE OTHER SOURCE,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82575,CPT,CREATININE CLEARANCE,,,17,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82585,CPT,ASSAY OF CRYOFIBRN,,,17,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82595,CPT,CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82600,CPT,ASSAY OF CYANIDE,,,17,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82607,CPT,CYANOCOBALAMIN VITAMIN B-12,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82608,CPT,CYANOCOBALAMIN VIT B-12 UNSAT BINDING CAPACITY,,,17,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82610,CPT,CYSTATIN C,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82615,CPT,CSTINE&HOMOCSTINE URINE QUALITATIVE,,,17,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82626,CPT,DEHYDROEPIANDROSTERONE,,,17,,TotalUnits,,,,0.96 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82627,CPT,DEHYDROEPIANDROSTERONE-SULFATE,,,17,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82633,CPT,DESOXYCORTICOSTERONE 11-,,,17,,TotalUnits,,,,1.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82634,CPT,DEOXYCORTISOL 11-,,,17,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82638,CPT,ASSAY OF DIBUCAINE NUMBER,,,17,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82652,CPT,1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED,,,17,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82656,CPT,ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82657,CPT,NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA,,,17,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82658,CPT,NZYM ACTV BLOOD CELLS/TISS RADACT SUBSTRATE EA,,,17,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82664,CPT,ELCTROPHORETIC TECHNIQUE NOT ELSEWHERE SPECIFIED,,,17,,TotalUnits,,,,1.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82668,CPT,ASSAY OF ERYTHROPOIETIN,,,17,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82670,CPT,ASSAY OF ESTRADIOL,,,17,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82671,CPT,ASSAY OF ESTROGENS FRACTIONATED,,,17,,TotalUnits,,,,1.23 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82672,CPT,ASSAY OF ESTROGENS TOTAL,,,17,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82677,CPT,ASSAY OF ESTRIOL,,,17,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82679,CPT,ASSAY OF ESTRONE,,,17,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82693,CPT,ASSAY OF ETHYLENE GLYCOL,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82696,CPT,ASSAY OF ETIOCHOLANOLONE,,,17,,TotalUnits,,,,0.90 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82705,CPT,FAT/LIPIDS FECES QUALITATIVE,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82710,CPT,FAT/LIPIDS FECES QUANTITATIVE,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82715,CPT,FAT DIFFIAL FECES QUANTITATIVE,,,17,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82725,CPT,FATTY ACIDS NONESTERIFIED,,,17,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82726,CPT,VERY LONG CHAIN FATTY ACIDS,,,17,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82728,CPT,ASSAY OF FERRITIN,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82731,CPT,FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN,,,17,,TotalUnits,,,,2.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82735,CPT,ASSAY OF FLUORIDE,,,17,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82746,CPT,ASSAY OF FOLIC ACID SERUM,,,17,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82747,CPT,ASSAY OF FOLIC ACID RBC,,,17,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82757,CPT,ASSAY OF FRUCTOSE SEMEN,,,17,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82759,CPT,ASSAY OF GALACTOKINASE RBC,,,17,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82760,CPT,ASSAY OF GALACTOSE,,,17,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82775,CPT,GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE QUAN,,,17,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82776,CPT,GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE SCREEN,,,17,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82777,CPT,GALECTIN-3,,,17,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82784,CPT,ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH,,,17,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82785,CPT,ASSAY OF GAMMAGLOBULIN IGE,,,17,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82787,CPT,GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES,,,17,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82800,CPT,GASES BLOOD PH ONLY,,,17,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82803,CPT,BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3,,,17,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82805,CPT,GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY,,,17,,TotalUnits,,,,1.08 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82810,CPT,GASES BLOOD O2 SATURATION ONLY DIRECT MEAS,,,17,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82820,CPT,HGB-O2 AFFINITY PO2 50% SATURATION OXYGEN,,,17,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82930,CPT,GASTRIC ACID ANALYIS W/PH EACH SPECIMEN,,,17,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82938,CPT,GASTRIN AFTER SECRETIN STIMULATION,,,17,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82941,CPT,ASSAY OF GASTRIN,,,17,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82943,CPT,ASSAY OF GLUCAGON,,,17,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82945,CPT,GLUCOSE BODY FLUID OTHER THAN BLOOD,,,17,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82946,CPT,GLUCOSE TOLERANCE TEST,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82947,CPT,GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP,,,17,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82948,CPT,GLUCOSE BLOOD REAGENT STRIP,,,17,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82950,CPT,GLUCOSE POST GLUCOSE DOSE,,,17,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82951,CPT,GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82952,CPT,GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS,,,17,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82955,CPT,GLUC-6-PHOSPHATE DEHYDROGENASE QUANTITATIVE,,,17,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82960,CPT,GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN,,,17,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82962,CPT,GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE,,,17,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82963,CPT,ASSAY OF GLUCOSIDASE BETA,,,17,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82965,CPT,ASSAY OF GLUTAMATE DEHYDROGENASE,,,17,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82977,CPT,ASSAY OF GLUTAMYLTRASE GAMMA,,,17,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82978,CPT,ASSAY OF GLUTATHIONE,,,17,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82979,CPT,ASSAY OF GLUTATHIONE REDUCTASE RBC,,,17,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 82985,CPT,ASSAY OF GLYCATED PROTEIN,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83001,CPT,GONADOTROPIN FOLLICLE STIMULATING HORMONE,,,17,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83002,CPT,GONADOTROPIN LUTEINIZING HORMONE,,,17,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83003,CPT,ASSAY OF GROWTH HORMONE HUMAN,,,17,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83006,CPT,GROWTH STIMULATION EXPRESSED GENE 2,,,17,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83009,CPT,HPYLORI BLOOD ANAL UREASE ACT NON-RADACT ISOTOPE,,,17,,TotalUnits,,,,2.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83010,CPT,ASSAY OF HAPTOGLOBIN QUANTITATIVE,,,17,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83012,CPT,ASSAY OF HAPTOGLOBIN PHENOTYPES,,,17,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83013,CPT,HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE,,,17,,TotalUnits,,,,2.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83014,CPT,HPYLORI DRUG ADMINISTRATION,,,17,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83015,CPT,HEAVY METAL SCREEN,,,17,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83018,CPT,HEAVY METAL QUANTIATIVE EACH,,,17,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83020,CPT,HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 83020,CPT,HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 83021,CPT,HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY,,,17,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83026,CPT,HEMOGLOBIN COPPER SULFATE METHOD NON-AUTOMATED,,,17,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83030,CPT,HEMOGLOBIN F FETAL CHEMICAL,,,17,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83033,CPT,HEMOGLOBIN F FETAL QUALITATIVE,,,17,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83036,CPT,HEMOGLOBIN GLYCOSYLATED A1C,,,17,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83037,CPT,HGB GLYCOSYLATED DEVICE CLEARED FDA HOME USE,,,17,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83045,CPT,HEMOGLOBIN METHEMOGLOBIN QUALITATIVE,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83050,CPT,HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE,,,17,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83051,CPT,ASSAY OF HEMOGLOBIN PLASMA,,,17,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83060,CPT,HEMOGLOBIN SULFHEMOGLOBIN QUANTITATIVE,,,17,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83065,CPT,HEMOGLOBIN THERMOLABILE,,,17,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83068,CPT,HEMOGLOBIN UNSTABLE SCREEN,,,17,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83069,CPT,ASSAY OF HEMOGLOBIN URINE,,,17,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83070,CPT,ASSAY OF HEMOSIDERIN QUALITATIVE,,,17,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83080,CPT,ASSAY OF B-HEXOSAMINIDASE EACH ASSAY,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83088,CPT,ASSAY OF HISTAMINE,,,17,,TotalUnits,,,,1.12 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83090,CPT,ASSAY OF HOMOCYSTEINE,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83150,CPT,ASSAY OF HOMOVANILLIC ACID,,,17,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83491,CPT,HYDROXYCORTICOSTEROIDS 17,,,17,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83497,CPT,ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83498,CPT,ASSAY OF HYDROXYPROGESTERONE 17-D,,,17,,TotalUnits,,,,1.03 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83499,CPT,ASSAY OF HYDROXYPROGESTERONE 20-,,,17,,TotalUnits,,,,0.96 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83500,CPT,ASSAY OF HYDROXYPROLINE FREE,,,17,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83505,CPT,ASSAY OF HYDROXYPROLINE TOTAL,,,17,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83516,CPT,IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83518,CPT,IMMUNOASSAY ANALYTE QUAL/SEMIQUAL SINGLE STEP,,,17,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83519,CPT,IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY,,,17,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83520,CPT,IMMUNOASSAY ANALYTE QUANTITATIVE NOS,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83525,CPT,ASSAY OF INSULIN TOTAL,,,17,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83527,CPT,ASSAY OF INSULIN FREE,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83528,CPT,ASSAY OF INTRINSIC FACTOR,,,17,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83540,CPT,ASSAY OF IRON,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83550,CPT,IRON BINDING CAPACITY,,,17,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83570,CPT,ISOCITRIC DEHYDROGENASE,,,17,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83582,CPT,ASSAY OF KETOGENIC STEROIDS FRACTIONATION,,,17,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83586,CPT,ASSAY OF KETOSTEROIDS 17- TOTAL,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83593,CPT,KETOSTEROIDS 17- FRACTIONATION,,,17,,TotalUnits,,,,1.00 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83605,CPT,ASSAY OF LACTATE,,,17,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83615,CPT,LACTATE DEHYDROGENASE LDH,,,17,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83625,CPT,LACTATE DEHYDROGENASE ISOENZYMES SEP&QUAN,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83630,CPT,LACTOFERRIN FECAL QUALITATIVE,,,17,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83631,CPT,LACTOFERRIN FECAL QUANTITATIVE,,,17,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83632,CPT,LACTOGEN HPL HUMAN CHORIONIC SOMATOMAMMOTROPIN,,,17,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83633,CPT,LACTOSE URINE QUALITATIVE,,,17,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83655,CPT,ASSAY OF LEAD,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83661,CPT,FETAL LUNG MATURITY LECITHIN SPHINGOMYELIN RATIO,,,17,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83662,CPT,FETAL LUNG MATURITY FOAM STABILITY TEST,,,17,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83663,CPT,FETAL LUNG MATURITY FLUORESCENCE POLARIZATION,,,17,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83664,CPT,FETAL LUNG MATURITY LAMELLAR BODY DENSITY,,,17,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83670,CPT,LEUCINE AMINOPEPTIDASE LAP,,,17,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83690,CPT,ASSAY OF LIPASE,,,17,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83695,CPT,LIPOPROTEIN (A),,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83698,CPT,LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2,,,17,,TotalUnits,,,,1.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83700,CPT,LIPOPROTEIN BLOOD ELECTROPHORECTIC SEP&QUAN,,,17,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83701,CPT,LIPOPROTEIN BLOOD HIGH RESOLTJ&QUANTJ SUBCLASS,,,17,,TotalUnits,,,,0.94 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83704,CPT,LIPOPROTEIN BLOOD QUAN NUMBERS&SUBCLASSES,,,17,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83718,CPT,LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL,,,17,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83719,CPT,LIPOPROTEIN DIRECT MEASUREMENT VLDL CHOLESTEROL,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83721,CPT,LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL,,,17,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83727,CPT,LUTEINIZING RELEASING FACTOR,,,17,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83735,CPT,ASSAY OF MAGNESIUM,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83775,CPT,ASSAY OF MALATE DEHYDROGENASE,,,17,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83785,CPT,ASSAY OF MANGANESE,,,17,,TotalUnits,,,,0.94 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83789,CPT,MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA,,,17,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83825,CPT,ASSAY OF MERCURY QUANTITATIVE,,,17,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83835,CPT,METANEPHRINES,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83857,CPT,METHEMALBUMIN,,,17,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83861,CPT,MICROFLUIDIC ANALYSIS TEAR OSMOLARITY,,,17,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83864,CPT,MUCOPOLYSACCHARIDES ACID QUANTITATIVE,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83872,CPT,MUCIN SYNOVIAL FLUID ROPES TEST,,,17,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83873,CPT,MYELIN BASIC PROTEIN CEREBROSPINAL FLUID,,,17,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83874,CPT,MYOGLOBIN,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83876,CPT,MYELOPEROXIDASE MPO,,,17,,TotalUnits,,,,1.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83880,CPT,NATRIURETIC PEPTIDE,,,17,,TotalUnits,,,,1.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83883,CPT,ASSAY OF NEPHELOMETRY EACH ANALYTE NES,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83885,CPT,ASSAY OF NICKEL,,,17,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83915,CPT,ASSAY OF NUCLEOTIDASE 5'-,,,17,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83916,CPT,OLIGOCLONAL IMMUNE,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83918,CPT,ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN,,,17,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83919,CPT,ORGANIC ACIDS QUALITATIVE EACH SPECIMEN,,,17,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83921,CPT,ORGANIC ACID 1 QUANTITATIVE,,,17,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83930,CPT,ASSAY OF OSMOLALITY BLOOD,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83935,CPT,ASSAY OF OSMOLALITY URINE,,,17,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83937,CPT,ASSAY OF OSTEOCALCIN,,,17,,TotalUnits,,,,1.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83945,CPT,ASSAY OF OXALATE,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83950,CPT,ONCOPROTEIN HER-2/NEU,,,17,,TotalUnits,,,,2.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83951,CPT,ONCOPROTEIN DES-GAMMA-CARBOXY-PROTHROMBIN DCP,,,17,,TotalUnits,,,,2.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83970,CPT,ASSAY OF PARATHORMONE,,,17,,TotalUnits,,,,1.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83986,CPT,PH BODY FLUID NOT ELSEWHERE SPECIFIED,,,17,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83987,CPT,PH EXHALED BREATH CONDENSATE,,,17,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83992,CPT,ASSAY OF PHENCYCLIDINE,,,17,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 83993,CPT,ASSAY OF CALPROTECTIN FECAL,,,17,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84030,CPT,ASSAY OF PHENYLALANINE BLOOD,,,17,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84035,CPT,ASSAY OF PHENYLKETONES QUALITATIVE,,,17,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84060,CPT,ASSAY OF PHOSPHATASE ACID TOTAL,,,17,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84061,CPT,PHOSPHATASE ACID FORENSIC EXAMINATION,,,17,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84066,CPT,ASSAY OF PHOSPHATASE ACID PROSTATIC,,,17,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84075,CPT,ASSAY OF PHOSPHATASE ALKALINE,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84078,CPT,ASSAY OF PHOSPHATASE ALKALINE HEAT STABLE,,,17,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84080,CPT,ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES,,,17,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84081,CPT,PHOSPHATIDYLGLYCEROL,,,17,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84085,CPT,PHOSPHOGLUCONATE 6-DEHYD RBC,,,17,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84087,CPT,ASSAY OF PHOSPHOHEXOSE ISOMERASE,,,17,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84100,CPT,ASSAY OF PHOSPHORUS INORGANIC,,,17,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84105,CPT,ASSAY OF PHOSPHORUS INORGANIC URINE,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84106,CPT,PORPHOBILINOGEN URINE QUALITATIVE,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84110,CPT,ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE,,,17,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84112,CPT,EVAL C/V AMNIOTIC FLUID PROTEIN QUAL EA SPECIMEN,,,17,,TotalUnits,,,,2.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84119,CPT,PORPHYRINS URINE QUALITATAIVE,,,17,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84120,CPT,PORPHYRINS URINE QUANTITATION & FRACTIONATION,,,17,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84126,CPT,PORPHYRINS FECES QUANTITATIVE,,,17,,TotalUnits,,,,0.97 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84132,CPT,POTASSIUM SERUM PLASMA/WHOLE BLOOD,,,17,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84133,CPT,POTASSIUM URINE,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84134,CPT,PREALBUMIN,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84135,CPT,PREGNANEDIOL,,,17,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84138,CPT,PREGNANETRIOL,,,17,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84140,CPT,PREGNENOLONE,,,17,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84143,CPT,17-HYDROXYPREGNENOLONE,,,17,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84144,CPT,ASSAY OF PROGESTERONE,,,17,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84145,CPT,PROCALCITONIN (PCT),,,17,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84146,CPT,ASSAY OF PROLACTIN,,,17,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84150,CPT,ASSAY OF PROSTAGLNDIN EACH,,,17,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84152,CPT,ASSAY OF PROSTATE SPECIFIC ANTIGEN COMPLEXED,,,17,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84153,CPT,ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL,,,17,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84154,CPT,ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE,,,17,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84155,CPT,PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD,,,17,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84156,CPT,PROTEIN TOTAL XCPT REFRACTOMETRY URINE,,,17,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84157,CPT,PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC,,,17,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84160,CPT,PROTEIN TOTAL REFRACTOMETRY ANY SRC,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84163,CPT,PREGNANCY-ASSOCIATED PLASMA PROTEIN-A,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84165,CPT,PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM,,,17,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 84165,CPT,PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 84166,CPT,PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI,,,17,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 84166,CPT,PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 84181,CPT,PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID,,,17,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 84181,CPT,PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 84182,CPT,PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL,,,17,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 84182,CPT,PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 84202,CPT,PROTOPORPHYRIN RBC QUANTITATIVE,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84203,CPT,PROTOPORPHYRIN RBC SCREEN,,,17,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84206,CPT,ASSAY OF PROINSULIN,,,17,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84207,CPT,ASSAY OF PYRIDOXAL PHOSPHATE,,,17,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84210,CPT,ASSAY OF PYRUVATE,,,17,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84220,CPT,ASSAY OF PYRUVATE KINASE,,,17,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84228,CPT,ASSAY OF QUININE,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84233,CPT,ASSAY OF RECEPTOR ASSAY ESTROGEN,,,17,,TotalUnits,,,,2.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84234,CPT,ASSAY OF RECEPTOR ASSAY PROGESTERONE,,,17,,TotalUnits,,,,2.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84235,CPT,RECEPTOR ASSAY ENDOCRINE OTH/THN ESTRGN/PROGST,,,17,,TotalUnits,,,,1.99 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84238,CPT,RECEPTOR ASSAY NON-ENDOCRINE SPECIFY RECEPTOR,,,17,,TotalUnits,,,,1.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84244,CPT,ASSAY OF RENIN,,,17,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84252,CPT,ASSAY OF RIBOFLAVIN-VITAMIN B-2,,,17,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84255,CPT,ASSAY OF SELENIUM,,,17,,TotalUnits,,,,0.97 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84260,CPT,ASSAY OF SEROTONIN,,,17,,TotalUnits,,,,1.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84270,CPT,ASSAY OF SEX HORMONE BINDING GLOBULIN,,,17,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84275,CPT,ASSAY OF SIALIC ACID,,,17,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84285,CPT,ASSAY OF SILICA,,,17,,TotalUnits,,,,0.90 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84295,CPT,SODIUM SERUM PLASMA OR WHOLE BLOOD,,,17,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84300,CPT,ASSAY OF URINE SODIUM,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84302,CPT,ASSAY OF SODIUM OTHER SOURCE,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84305,CPT,ASSAY OF SOMATOMEDIN,,,17,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84307,CPT,ASSAY OF SOMATOSTATIN,,,17,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84311,CPT,SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED,,,17,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84315,CPT,SPECIFIC GRAVITY EXCEPT URINE,,,17,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84375,CPT,SUGARS CHROMATOGRAPHIC TLC/PAPER CHROMATOGRAPHY,,,17,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84376,CPT,SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC,,,17,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84377,CPT,SUGARS MONO DI&OLIGOS MLT QUALITATIVE EACH SPE,,,17,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84378,CPT,SUGARS MONO DI&OLIGOS 1 QUANTITATIVE EACH SPEC,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84379,CPT,SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84392,CPT,ASSAY OF SULFATE URINE,,,17,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84402,CPT,ASSAY OF TESTOSTERONE FREE,,,17,,TotalUnits,,,,0.97 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84403,CPT,ASSAY OF TESTOSTERONE TOTAL,,,17,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84410,CPT,TESTOSTERONE BIOAVAILABLE,,,17,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84425,CPT,ASSAY OF THIAMINE-VITAMIN B-1,,,17,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84430,CPT,ASSAY OF THIOCYANATE,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84431,CPT,THROMBOXANE METABOLITE W/WO THROMBOXANE URINE,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84432,CPT,ASSAY OF THYROGLOBULIN,,,17,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84436,CPT,ASSAY OF THYROXINE TOTAL,,,17,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84437,CPT,ASSAY OF THYROXINE REQUIRING ELUTION,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84439,CPT,ASSAY OF FREE THYROXINE,,,17,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84442,CPT,ASSAY OF THYROXINE BINDING GLOBULIN,,,17,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84443,CPT,ASSAY OF THYROID STIMULATING HORMONE TSH,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84445,CPT,THYROID STIMULATING IMMUNE GLOBULINS TSI,,,17,,TotalUnits,,,,1.93 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84446,CPT,ASSAY OF TOCOPHEROL ALPHA VITAMIN E,,,17,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84449,CPT,ASSAY OF TRANSCORTIN CORTISOL BINDING GLOBULIN,,,17,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84450,CPT,TRANSFERASE ASPARTATE AMINO AST SGOT,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84460,CPT,TRANSFERASE ALANINE AMINO ALT SGPT,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84466,CPT,ASSAY OF L7383TRANSFERRIN,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84478,CPT,ASSAY OF TRIGLYCERIDES,,,17,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84479,CPT,THYROID HORM UPTK/THYROID HORMONE BINDING RATIO,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84480,CPT,ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3,,,17,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84481,CPT,ASSAY OF TRIIODOTHYRONINE T3 FREE,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84482,CPT,TRIIODOTHYRONINE T3 REVERSE,,,17,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84484,CPT,ASSAY OF TROPONIN QUANTITATIVE,,,17,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84485,CPT,ASSAY OF TRYPSIN DUODENAL FLUID,,,17,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84488,CPT,ASSAY OF TRYPSIN FECES QUALITATIVE,,,17,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84490,CPT,TRYPSIN FECES QUANTITATIVE 24-HR COLLECTION,,,17,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84510,CPT,ASSAY OF TYROSINE,,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84512,CPT,ASSAY OF TROPONIN QUALITATIVE,,,17,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84520,CPT,ASSAY OF UREA NITROGEN QUANTITATIVE,,,17,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84525,CPT,ASSAY OF UREA NITROGEN SEMIQUANTITATIVE,,,17,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84540,CPT,ASSAY OF UREA NITROGEN URINE,,,17,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84545,CPT,UREA NITROGEN CLEARANCE,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84550,CPT,ASSAY OF BLOOD/URIC ACID,,,17,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84560,CPT,ASSAY OF URIC ACID OTHER SOURCE,,,17,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84577,CPT,ASSAY OF UROBILINOGEN FECES QUANTITATIVE,,,17,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84578,CPT,ASSAY OF UROBILINOGEN URINE QUALITATIVE,,,17,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84580,CPT,UROBILINOGEN URINE QUANTITATIVE TIMED SPECIMEN,,,17,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84583,CPT,ASSAY OF UROBILINOGEN URINE SEMIQUANTITATIVE,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84585,CPT,ASSAY OF VANILLYLMANDELIC ACID URINE,,,17,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84586,CPT,ASSAY OF VASOACTIVE INTESTINAL PEPTIDE,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84588,CPT,ASSAY OF VASOPRESSIN ANTI-DIURETIC HORMONE,,,17,,TotalUnits,,,,1.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84590,CPT,ASSAY OF VITAMIN A,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84591,CPT,ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84597,CPT,ASSAY OF VITAMIN K,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84600,CPT,ASSAY OF VOLATILES,,,17,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84620,CPT,XYLOSE ABSORPTION TEST BLOOD &/URINE,,,17,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84630,CPT,ASSAY OF ZINC,,,17,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84681,CPT,ASSAY OF C-PEPTIDE,,,17,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84702,CPT,GONADOTROPIN CHORIONIC QUANTITATIVE,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84703,CPT,GONADOTROPIN CHORIONIC QUALITATIVE,,,17,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84704,CPT,GONADOTROPIN CHORIONIC HCG FREE BETA CHAIN,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84830,CPT,OVULATION TEST VISUAL COLOR COMPARISON HLH,,,17,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 84999,CPT,UNLISTED CHEMISTRY PROCEDURE,,,17,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85002,CPT,BLEEDING TIME TEST,,,17,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85004,CPT,BLOOD COUNT AUTOMATED DIFFERENTIAL WBC COUNT,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85007,CPT,BLOOD COUNT SMEAR MCRSCP W/MNL DIFRNTL WBC COUNT,,,17,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85008,CPT,BLD COUNT SMEAR MCRSCP W/O MNL DIFRNTL WBC COUNT,,,17,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85009,CPT,BLOOD COUNT MANUAL DIFRNTL WBC COUNT BUFFY COAT,,,17,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85013,CPT,BLOOD COUNT SPUN MICROHEMATOCRIT,,,17,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85014,CPT,BLOOD COUNT HEMATOCRIT,,,17,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85018,CPT,BLOOD COUNT HEMOGLOBIN,,,17,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85025,CPT,BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC,,,17,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85027,CPT,BLOOD COUNT COMPLETE AUTOMATED,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85032,CPT,BLOOD COUNT MANUAL CELL COUNT EACH,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85041,CPT,BLOOD COUNT RED BLOOD CELL AUTOMATED,,,17,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85044,CPT,BLOOD COUNT RETICULOCYTE AUTOMATED,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85045,CPT,BLOOD COUNT RETICULOCYTE AUTOMATED,,,17,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85046,CPT,BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS,,,17,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85048,CPT,BLOOD COUNT LEUKOCYTE WBC AUTOMATED,,,17,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85049,CPT,BLOOD COUNT PLATELET AUTOMATED,,,17,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85055,CPT,RETICULATED PLATELET ASSAY,,,17,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85060,CPT,BLOOD SMEAR PERIPHERAL INTERP PHYS W/WRIT REPORT,,,17,,RBRVS,0.45 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 85097,CPT,BONE MARROW SMEAR INTERPRETATION,,,17,,RBRVS,0.94 ,0.43 ,1.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 85130,CPT,CHROMOGENIC SUBSTRATE ASSAY,,,17,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85170,CPT,BLOOD CLOT RETRACTION,,,17,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85175,CPT,CLOT LYSIS TIME WHOLE BLOOD DILUTION,,,17,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85210,CPT,CLOTTING FACTOR II PROTHROMBIN SPECIFIC,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85220,CPT,CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR,,,17,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85230,CPT,CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR,,,17,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85240,CPT,CLOTTING FACTOR VIII AHG 1 STAGE,,,17,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85244,CPT,CLOTTING FACTOR VIII RELATED ANTIGEN,,,17,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85245,CPT,CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT,,,17,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85246,CPT,CLOTTING FACTOR VIII VW FACTOR ANTIGEN,,,17,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85247,CPT,CLOTTING FACTOR VIII MULTIMETRIC ANALYSIS,,,17,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85250,CPT,CLOTTING FACTOR IX PTC/CHRISTMAS,,,17,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85260,CPT,CLOTTING FACTOR X STUART-PROWER,,,17,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85270,CPT,CLOTTING FACTOR XI PTA,,,17,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85280,CPT,CLOTTING FACTOR XII HAGEMAN,,,17,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85290,CPT,CLOTTING FACTOR XIII FIBRIN STABILIZING,,,17,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85291,CPT,CLOTTING FACTOR XIII FIBRN STABILIZ SCREEN SOLUB,,,17,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85292,CPT,CLOTTING PREKALLIKREIN ASSAY FLETCHER FACT ASSAY,,,17,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85293,CPT,CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY,,,17,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85300,CPT,CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY,,,17,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85301,CPT,CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY,,,17,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85302,CPT,CLOTTING INHIBITORS PROTEIN C ANTIGEN,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85303,CPT,CLOTTING INHIBITORS PROTEIN C ACTIVITY,,,17,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85305,CPT,CLOTTING INHIBITORS PROTEIN S TOTAL,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85306,CPT,CLOTTING INHIBITORS PROTEIN S FREE,,,17,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85307,CPT,ACTIVATED PROTEIN C APC RESISTANCE ASSAY,,,17,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85335,CPT,FACTOR INHIBITOR TEST,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85337,CPT,THROMBOMODULIN,,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85345,CPT,COAGULATION TIME LEE AND WHITE,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85347,CPT,COAGULATION TIME ACTIVATED,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85348,CPT,COAGULATION TIME OTHER METHODS,,,17,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85360,CPT,EUGLOBULIN LYSIS,,,17,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85362,CPT,FIBRIN DGRADJ SPLT PRODUXS AGGLUJ SLIDE SEMIQUAN,,,17,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85366,CPT,FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ,,,17,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85370,CPT,FIBRIN DGRADJ SPLT PRODUCTS QUANTITATIVE,,,17,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85378,CPT,FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN,,,17,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85379,CPT,FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE,,,17,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85380,CPT,FIBRIN DGRADJ PRODUCTS D-DIMER ULTRASENSITIVE,,,17,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85384,CPT,FIBRINOGEN ACTIVITY,,,17,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85385,CPT,FIBRINOGEN ANTIGEN,,,17,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85390,CPT,FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPOR,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 85390,CPT,FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPOR,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 85396,CPT,COAGJ/FBRNLYS ASSAY WHOLE BLOOD ADDITIVE PER DAY,,,17,,RBRVS,0.37 ,0.20 ,0.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85397,CPT,COAGJ&FIBRINOLYSIS FUNCTIONAL ACTV NOS EA ANAL,,,17,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85400,CPT,FIBRINOLYTIC FACTORS & INHIBITORS PLASMIN,,,17,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85410,CPT,FBRNLYC FACTORS&INHIBITORS ALPHA-2 ANTIPLASMIN,,,17,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85415,CPT,FBRNLYC FACTORS&INHIBITORS PLSMNG ACTIVATOR,,,17,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85420,CPT,FBRNLYC FACTORS&INHIBITRS PLSMNG XCPT AGIC ASS,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85421,CPT,FBRNLYC FACTORS&INHIBITORS PLSMNG AGIC ASSAY,,,17,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85441,CPT,HEINZ BODIES DIRECT,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85445,CPT,HEINZ BODIES INDUCED ACETYL PHENYLHYDRAZINE,,,17,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85460,CPT,HGB/RBCS FETAL FETOMATERNAL HEMRRG DIFRNTL LYSIS,,,17,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85461,CPT,HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85475,CPT,HEMOLYSIN ACID,,,17,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85520,CPT,HEPARIN ASSAY,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85525,CPT,HEPARIN NEUTRALIZATION,,,17,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85530,CPT,HEPARIN-PROTAMINE TOLERANCE TST,,,17,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85536,CPT,IRON STAIN PERIPHERAL BLOOD,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85540,CPT,WBC ALKALINE PHOSPHATASE COUNT,,,17,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85547,CPT,MECHANICAL FRAGILITY RBC,,,17,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85549,CPT,MURAMIDASE,,,17,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85555,CPT,OSMOTIC FRAGILITY RBC UNINCUBATED,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85557,CPT,OSMOTIC FRAGILITY RBC INCUBATED,,,17,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85576,CPT,PLATELET AGGREGATION IN VITRO EACH AGENT,,,17,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 85576,CPT,PLATELET AGGREGATION IN VITRO EACH AGENT,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 85597,CPT,PHOSPHOLIPID NEUTRALIZATION PLATELET,,,17,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85598,CPT,PHOSPHOLIPID NEUTRALIZATION HEXAGONAL,,,17,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85610,CPT,PROTHROMBIN TIME,,,17,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85611,CPT,PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH,,,17,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85612,CPT,RUSSELL VIPER VENON TIME UNDILUTED,,,17,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85613,CPT,RUSSELL VIPER VENOM TIME DILUTED,,,17,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85635,CPT,REPTILASE TEST,,,17,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85651,CPT,SEDIMENTATION RATE RBC NON-AUTOMATED,,,17,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85652,CPT,SEDIMENTATION RATE RBC AUTOMATED,,,17,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85660,CPT,SICKLING RBC REDUCTION,,,17,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85670,CPT,THROMBIN TIME PLASMA,,,17,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85675,CPT,THROMBIN TIME TITER,,,17,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85705,CPT,THROMBOPLASTIN INHIBITION TISSUE,,,17,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85730,CPT,THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD,,,17,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85732,CPT,THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85810,CPT,VISCOSITY,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 85999,CPT,UNLISTED HEMATOLOGY & COAGULATION PROCEDURE,,,17,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86000,CPT,AGGLUTININS FEBRILE EACH ANTIGEN,,,17,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86001,CPT,ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86003,CPT,ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86005,CPT,ALLERGEN SPECIFIC IGE QUAL MULTIALLERGEN SCREEN,,,17,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86021,CPT,ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86022,CPT,ANTIBODY IDENTIFICATION PLATELET ANTIBODIES,,,17,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86023,CPT,ANTIBODY IDENTIFICATION PLATELET IMMUNOGL ASSAY,,,17,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86038,CPT,ANTINUCLEAR ANTIBODIES ANA,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86039,CPT,ANTINUCLEAR ANTIBODIES ANA TITER,,,17,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86060,CPT,ANTISTREPTOLYSIN O TITER,,,17,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86063,CPT,ANTISTREPTOLYSIN O SCREEN,,,17,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86077,CPT,BLD BANK PHYS SVCS DIFFC CROSS MATCH&/EVAL REP,,,17,,RBRVS,0.94 ,0.49 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86078,CPT,BLD BANK PHYS SVCS INVSTGJ TFUJ RXN REPRT,,,17,,RBRVS,0.94 ,0.49 ,0.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86079,CPT,BLD BANK PHYS SVCS AUTHJ DEVIJ STANDARD REPRT,,,17,,RBRVS,0.94 ,0.47 ,0.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86140,CPT,C-REACTIVE PROTEIN,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86141,CPT,C-REACTIVE PROTEIN HIGH SENSITIVITY,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86146,CPT,BETA 2 GLYCOPROTEIN I ANTIBODY EACH,,,17,,TotalUnits,,,,0.97 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86147,CPT,CARDIOLIPIN ANTIBODY EACH IG CLASS,,,17,,TotalUnits,,,,0.97 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86148,CPT,ANTI-PHOSPHATIDYLSERINE ANTIBODY,,,17,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86152,CPT,CELL ENUMERATION IMMUNE SELECTJ & ID FLUID SPEC,,,17,,TotalUnits,,,,9.35 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86153,CPT,CELL ENUMERATION IMMUNE SELECTJ & ID PHYS INTERP,,,17,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86153,CPT,CELL ENUMERATION IMMUNE SELECTJ & ID PHYS INTERP,26,,17,,RBRVS,0.69 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 86155,CPT,CHEMOTAXIS ASSAY SPECIFY METHOD,,,17,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86156,CPT,COLD AGGLUTININ SCREEN,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86157,CPT,COLD AGGLUTININ TITER,,,17,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86160,CPT,COMPLEMENT ANTIGEN EACH COMPONENT,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86161,CPT,COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86162,CPT,COMPLEMENT TOTAL HEMOLYTIC,,,17,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86171,CPT,COMPLEMENT FIXATION TESTS EACH ANTIGEN,,,17,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86185,CPT,CNTERIMMUNOELECTROPHORESIS EACH ANTIGEN,,,17,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86200,CPT,CYCLIC CITRULLINATED PEPTIDE ANTIBODY,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86215,CPT,DEOXYRIBONUCLEASE ANTIBODY,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86225,CPT,DNA ANTIBODY NATIVE/DOUBLE STRANDED,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86226,CPT,DNA ANTIBODY SINGLE STRANDED,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86235,CPT,EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD,,,17,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86243,CPT,FC RECEPTOR,,,17,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86255,CPT,FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 86255,CPT,FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 86256,CPT,FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 86256,CPT,FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 86277,CPT,GROWTH HORMONE HUMAN ANTIBODY,,,17,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86280,CPT,HEMAGGLUTINATION INHIBITION TEST HAI,,,17,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86294,CPT,IMMUNOASSAY TUMOR ANTIGEN QUAL/SEMIQUANTITATIVE,,,17,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86300,CPT,IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3,,,17,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86301,CPT,IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9,,,17,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86304,CPT,IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125,,,17,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86305,CPT,HUMAN EPIDIDYMIS PROTEIN 4 (HE4),,,17,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86308,CPT,HETEROPHILE ANTIBODIES SCREEN,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86309,CPT,HETEROPHILE ANTIBODIES TITER,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86310,CPT,HETEROPHILE ANTIBODIES TITER AFTER ABSORPTION,,,17,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86316,CPT,IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE,,,17,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86317,CPT,IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86318,CPT,IMMUNOASSAY NFCT AGT ANTB QUAL/SEMIQUAN 1 STEP,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86320,CPT,IMMUNOELECTROPHORESIS SERUM,,,17,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 86320,CPT,IMMUNOELECTROPHORESIS SERUM,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 86325,CPT,IMMUNOELECTROPHORESIS OTHER FLUIDS CONCENTRATION,,,17,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 86325,CPT,IMMUNOELECTROPHORESIS OTHER FLUIDS CONCENTRATION,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 86327,CPT,IMMUNOELECTROPHORESIS CROSSED,,,17,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 86327,CPT,IMMUNOELECTROPHORESIS CROSSED,26,,17,,RBRVS,0.42 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 86329,CPT,IMMUNODIFFUSION NOT ELSEWHERE SPECIFIED,,,17,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86331,CPT,IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86332,CPT,IMMUNE COMPLEX ASSAY,,,17,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86334,CPT,IMMUNOFIXJ ELECTROPHORESIS SERUM,,,17,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 86334,CPT,IMMUNOFIXJ ELECTROPHORESIS SERUM,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 86335,CPT,IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS,,,17,,TotalUnits,,,,1.12 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 86335,CPT,IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 86336,CPT,INHIBIN A,,,17,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86337,CPT,INSULIN ANTIBODIES,,,17,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86340,CPT,INTRINSIC FACTOR ANTIBODIES,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86341,CPT,ISLET CELL ANTIBODY,,,17,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86343,CPT,LEUKOCYTE HISTAMINE RELEASE TEST LHR,,,17,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86344,CPT,LEUKOCYTE PHAGOCYTOSIS,,,17,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86352,CPT,CELLULAR FUNCTION ASSAY STIMUL&DETECT BIOMARKE,,,17,,TotalUnits,,,,5.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86353,CPT,LYMPHOCYTE TR MITOGEN/AG INDUCED BLASTOGENESIS,,,17,,TotalUnits,,,,1.87 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86355,CPT,B CELLS TOTAL COUNT,,,17,,TotalUnits,,,,1.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86356,CPT,MONONUCLEAR CELL ANTIGEN QUANTITATIVE NOS EA,,,17,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86357,CPT,NATURAL KILLER CELLS TOTAL COUNT,,,17,,TotalUnits,,,,1.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86359,CPT,T CELLS TOTAL COUNT,,,17,,TotalUnits,,,,1.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86360,CPT,T CELLS ABSOLUTE CD4&CD8 COUNT RATIO,,,17,,TotalUnits,,,,1.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86361,CPT,T CELLS ABSOLUTE CD4 COUNT,,,17,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86367,CPT,STEM CELLS TOTAL COUNT,,,17,,TotalUnits,,,,1.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86376,CPT,MICROSOMAL ANTIBODIES EACH,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86378,CPT,MIGRATION INHIBITORY FACTOR TEST MIF,,,17,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86382,CPT,NEUTRALIZATION TEST VIRAL,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86384,CPT,NITROBLUE TETRAZOLIUM DYE TEST NTD,,,17,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86386,CPT,NUCLEAR MATRIX PROTEIN 22 NMP22 QUALITATIVE,,,17,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86403,CPT,PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY,,,17,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86406,CPT,PARTICLE AGGLUTINATION TITER EACH ANTIBODY,,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86430,CPT,RHEUMATOID FACTOR QUALITATIVE,,,17,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86431,CPT,RHEUMATOID FACTOR QUANTITATIVE,,,17,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86480,CPT,TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON,,,17,,TotalUnits,,,,2.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86481,CPT,TB ANTIGEN RESPONSE GAMMA INTERFERON T-CELL SUSP,,,17,,TotalUnits,,,,2.85 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86485,CPT,SKIN TEST CANDIDA,,TC,17,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86486,CPT,SKIN TEST UNLISTED ANTIGEN EACH,,TC,17,,RBRVS,,0.13 ,0.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86490,CPT,SKIN TEST COCCIDIOIDOMYCOSIS,,TC,17,,RBRVS,,1.96 ,1.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86510,CPT,SKIN TEST HISTOPLASMOSIS,,TC,17,,RBRVS,,0.16 ,0.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86580,CPT,SKIN TEST TUBERCULOSIS INTRADERMAL,,TC,17,,RBRVS,,0.21 ,0.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86590,CPT,STREPTOKINASE ANTIBODY,,,17,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86592,CPT,SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86593,CPT,SYPHILIS TEST QUANTITATIVE,,,17,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86602,CPT,ANTIBODY ACTINOMYCES,,,17,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86603,CPT,ANTIBODY ADENOVIRUS,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86606,CPT,ANTIBODY ASPERGILLUS,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86609,CPT,ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86611,CPT,ANTIBODY BARTONELLA,,,17,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86612,CPT,ANTIBODY BLASTOMYCES,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86615,CPT,ANTIBODY BORDETELLA,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86617,CPT,ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST,,,17,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86618,CPT,ANTIBODY BORRELIA BURGDORFERI LYME DISEASE,,,17,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86619,CPT,ANTIBODY BORRELIA RELAPSING FEVER,,,17,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86622,CPT,ANTIBODY BRUCELLA,,,17,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86625,CPT,ANTIBODY CAMPYLOBACTER,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86628,CPT,ANTIBODY CANDIDA,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86631,CPT,ANTIBODY CHLAMYDIA,,,17,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86632,CPT,ANTIBODY CHLAMYDIA IGM,,,17,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86635,CPT,ANTIBODY COCCIDIOIDES,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86638,CPT,ANTIBODY COXIELLA BURNETII Q FEVER,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86641,CPT,ANTIBODY CRYPTOCOCCUS,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86644,CPT,ANTIBODY CYTOMEGALOVIRUS CMV,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86645,CPT,ANTIBODY CYTOMEGALOVIRUS CMV IGM,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86648,CPT,ANTIBODY DIPHTHERIA,,,17,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86651,CPT,ANTIBODY ENCEPHALITIS CALIFORNIA LA CROSSE,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86652,CPT,ANTIBODY ENCEPHALITIS EASTERN EQUINE,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86653,CPT,ANTIBODY ENCEPHALITIS ST. LOUIS,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86654,CPT,ANTIBODY ENCEPHALITIS WESTRN EQUINE,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86658,CPT,ANTIBODY ENTEROVIRUS,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86663,CPT,ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86664,CPT,ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA,,,17,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86665,CPT,ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA,,,17,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86666,CPT,ANTIBODY EHRLICHIA,,,17,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86668,CPT,ANTIBODY FRANCISELLA TULARENSIS,,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86671,CPT,ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED,,,17,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86674,CPT,ANTIBODY GIARDIA LAMBLIA,,,17,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86677,CPT,ANTIBODY HELICOBACTER PYLORI,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86682,CPT,ANTIBODY HELMINTH NOT ELSEWHERE SPECIFIED,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86684,CPT,ANTIBODY HAEMOPHILUS INFLUENZA,,,17,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86687,CPT,ANTIBODY HTLV-I,,,17,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86688,CPT,ANTIBODY HTLV-II,,,17,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86689,CPT,ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,,,17,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86692,CPT,ANTIBODY HEP DELTA AGENT,,,17,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86694,CPT,ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86695,CPT,ANTIBODY HERPES SMPLX TYPE 1,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86696,CPT,ANTIBODY HERPES SMPLX TYPE 2,,,17,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86698,CPT,ANTIBODY HISTOPLASMA,,,17,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86701,CPT,ANTIBODY HIV-1,,,17,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86702,CPT,ANTIBODY HIV-2,,,17,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86703,CPT,ANTIBODY HIV-1&HIV-2 SINGLE RESULT,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86704,CPT,HEPATITIS B CORE ANTIBODY HBCAB TOTAL,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86705,CPT,HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY,,,17,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86706,CPT,HEPATITIS B SURF ANTIBODY HBSAB,,,17,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86707,CPT,HEPATITIS BE ANTIBODY HBEAB,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86708,CPT,HEPATITIS A ANTIBODY HAAB,,,17,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86709,CPT,HEPATITIS ANTIBODY HAAB IGM ANTIBODY,,,17,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86710,CPT,ANTIBODY INFLUENZA VIRUS,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86711,CPT,ANTIBODY JOHN CUNNINGHAM VIRUS,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86713,CPT,ANTIBODY LEGIONELLA,,,17,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86717,CPT,ANTIBODY LEISHMANIA,,,17,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86720,CPT,ANTIBODY LEPTOSPIRA,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86723,CPT,ANTIBODY LISTERIA MONOCYTOGENES,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86727,CPT,ANTIBODY LYMPHOCYTIC CHORIOMENINGITIS,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86729,CPT,ANTIBODY LYMPHOGRANULOMA VENEREUM,,,17,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86732,CPT,ANTIBODY MUCORMYCOSIS,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86735,CPT,ANTIBODY MUMPS,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86738,CPT,ANTIBODY MYCOPLSM,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86741,CPT,ANTIBODY NEISSERIA MENINGITIDIS,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86744,CPT,ANTIBODY NOCARDIA,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86747,CPT,ANTIBODY PARVOVIRUS,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86750,CPT,ANTIBODY PLASMODIUM MALARIA,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86753,CPT,ANTIBODY PROTOZOA NES,,,17,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86756,CPT,ANTIBODY RESPIRATORY SYNCTIAL VIRUS,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86757,CPT,ANTIBODY RICKETTSIA,,,17,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86759,CPT,ANTIBODY ROTAVIRUS,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86762,CPT,ANTIBODY RUBELLA,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86765,CPT,ANTIBODY RUBEOLA,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86768,CPT,ANTIBODY SALMONELLA,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86771,CPT,ANTIBODY SHIGELLA,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86774,CPT,ANTIBODY TETANUS,,,17,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86777,CPT,ANTIBODY TOXOPLASMA,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86778,CPT,ANTIBODY TOXOPLASMA IGM,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86780,CPT,ANTIBODY TREPONEMA PALLIDUM,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86784,CPT,ANTIBODY TRICHINELLA,,,17,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86787,CPT,ANTIBODY VARICELLA-ZOSTER,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86788,CPT,ANTIBODY WEST NILE VIRUS IGM,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86789,CPT,ANTIBODY WEST NILE VIRUS,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86790,CPT,ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86793,CPT,ANTIBODY YERSINIA,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86800,CPT,THYROGLOBULIN ANTIBODY,,,17,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86803,CPT,HEPATITIS C ANTIBODY,,,17,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86804,CPT,HEPATITIS C ANTIBODY CONFIRMATORY TEST,,,17,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86805,CPT,LYMPHOCYTOTOXICITY ASSAY VIS CROSSMATCH TITRATJ,,,17,,TotalUnits,,,,1.99 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86806,CPT,LMPHOCYTOTOXICITY ASSAY VIS CROSSMTCH W/O TITRAT,,,17,,TotalUnits,,,,1.81 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86807,CPT,SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH,,,17,,TotalUnits,,,,1.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86808,CPT,SERUM SCREENING % REACTIVE ANTIBODY QUICK METH,,,17,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86812,CPT,HLA TYPING A/B/C SINGLE ANTIGEN,,,17,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86813,CPT,HLA TYPING A/B/C MULTIPLE ANTIGENS,,,17,,TotalUnits,,,,2.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86816,CPT,HLA TYPING DR/DQ SINGLE ANTIGEN,,,17,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86817,CPT,HLA TYPING DR/DQ MULTIPLE ANTIGENS,,,17,,TotalUnits,,,,2.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86821,CPT,HLA TYPING LYMPHOCYTE CULTURE MIXED,,,17,,TotalUnits,,,,2.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86822,CPT,HLA TYPING LYMPHOCYTE CULTURE PRIMED,,,17,,TotalUnits,,,,1.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86825,CPT,HLA CROSSMATCH NONCYTOTOXIC 1ST SERUM/DILUTION,,,17,,TotalUnits,,,,3.06 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86826,CPT,HLA CROSSMATCH NONCYTOTOXIC ADDL SERUM/DILUTION,,,17,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86828,CPT,ANTIBODY HLA CLASS I & CLASS II ANTIGENS QUAL,,,17,,TotalUnits,,,,1.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86829,CPT,ANTIBODY HLA CLASS I OR CLASS II ANTIGENS QUAL,,,17,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86830,CPT,ANTIBODY HLA CLASS I PHENOTYPE PANEL QUALITATIVE,,,17,,TotalUnits,,,,3.07 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86831,CPT,ANTIBODY HLA CLASS II PHENOTYPE PANEL QUAL,,,17,,TotalUnits,,,,2.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86832,CPT,ANTIBODY HLA CLASS I HIGH DEFINITION PANEL QUAL,,,17,,TotalUnits,,,,4.83 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86833,CPT,ANTIBODY HLA CLASS II HIGH DEFINITION PANEL QUAL,,,17,,TotalUnits,,,,4.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86834,CPT,ANTIBODY HLA CLASS I SEMIQUANTITATIVE PANEL,,,17,,TotalUnits,,,,13.60 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86835,CPT,ANTIBODY HLA CLASS II SEMIQUANTITATIVE PANEL,,,17,,TotalUnits,,,,12.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86849,CPT,UNLISTED IMMUNOLOGY,,,17,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86850,CPT,ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE,,,17,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86860,CPT,ANTIBODY ELUTION RBC EACH ELUTION,,,17,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86870,CPT,ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ,,,17,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86880,CPT,ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86885,CPT,ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL,,,17,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86886,CPT,ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86890,CPT,AUTOL BLD/COMPONENT COLLJ STORAGE PREDEPOSITED,,,17,,TotalUnits,,,,1.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86891,CPT,AUTOL BLD/COMPONENT COLLJ STORAGE SALVAGE,,,17,,TotalUnits,,,,2.28 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86900,CPT,BLOOD TYPING SEROLOGIC ABO,,,17,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86901,CPT,BLOOD TYPING SEROLOGIC RH (D),,,17,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86902,CPT,BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH,,,17,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86904,CPT,BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT,,,17,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86905,CPT,BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH,,,17,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86906,CPT,BLOOD TYPING SEROLOGIC RH PHENOTYPING COMPLETE,,,17,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86910,CPT,BLOOD TYPING PATERNITY PR INDIV ABO RH&MN,,,17,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86911,CPT,BLOOD TYPING PATERNITY INDIV ADDL ANTIGEN SYS,,,17,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86920,CPT,COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86921,CPT,COMPATIBILITY EACH UNIT INCUBATION,,,17,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86922,CPT,COMPATIBILITY EACH UNIT ANTIGLOBULIN,,,17,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86923,CPT,COMPATIBILITY EACH UNIT ELECTRONIC,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86927,CPT,FRESH FROZEN PLASMA THAWING EACH UNIT,,,17,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86930,CPT,FROZEN BLOOD EACH UNIT FREEZING,,,17,,TotalUnits,,,,3.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86931,CPT,FROZEN BLOOD EACH UNIT THAWING,,,17,,TotalUnits,,,,2.37 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86932,CPT,FROZEN BLOOD EACH UNIT FREEZING & THAWING,,,17,,TotalUnits,,,,2.69 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86940,CPT,HEMOLYSINS&AGGLUTININS AUTO SCREEN EACH,,,17,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86941,CPT,HEMOLYSINS&AGGLUTININS INCUBATED,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86945,CPT,IRRADIATION BLOOD PRODUCT EACH UNIT,,,17,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86950,CPT,LEUKOCYTE TRANSFUSION,,,17,,TotalUnits,,,,2.05 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86960,CPT,VOLUME REDUCTION BLOOD/BLOOD PRODUCT EACH UNIT,,,17,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86965,CPT,POOLING PLATELETS/OTHER BLOOD PRODUCTS,,,17,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86970,CPT,PRETX RBC ANTIBODY INCUBAT W/CHEM AGNTS/DRUGS EA,,,17,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86971,CPT,PRETX RBC ANTIBODY INCUBAT W/ENZYMES EACH,,,17,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86972,CPT,PRETX RBC ANTIBODY INCUBAT W/DENSITY GRAD SEP,,,17,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86975,CPT,PRETX SERUM RBC ANTIBODY INCUBATION DRUGS EACH,,,17,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86976,CPT,PRETX SERUM RBC ANTIBODY IDENTIFICATION DILUTION,,,17,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86977,CPT,PRETX SERUM RBC ANTB ID INCUBATION INHIBITORS EA,,,17,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86978,CPT,PRETX SERUM RBC ANTIBODY ID DIFFIAL EACH ABSRPJ,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86985,CPT,SPLITTING BLOOD/BLOOD PRODUCTS EACH UNIT,,,17,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 86999,CPT,UNLISTED TRANSFUSION MEDICINE PROCEDURE,,,17,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87003,CPT,ANIMAL INOCULATION SMALL ANIMAL W/OBS&DSJ,,,17,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87015,CPT,CONCENTRATION INFECTIOUS AGENTS,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87040,CPT,CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES,,,17,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87045,CPT,CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL,,,17,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87046,CPT,CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA,,,17,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87070,CPT,CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL,,,17,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87071,CPT,CUL BACT QUAN AEROBIC ISOL XCPT UR BLOOD/STOOL,,,17,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87073,CPT,CUL BACT QUAN ANAERC ISOL XCPT UR BLOOD/STOOL,,,17,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87075,CPT,CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID,,,17,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87076,CPT,CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL,,,17,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87077,CPT,CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL,,,17,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87081,CPT,CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87084,CPT,CUL PRSMPTV PTHGNC ORGANISMS SCR DNS CHART,,,17,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87086,CPT,CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE,,,17,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87088,CPT,CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE,,,17,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87101,CPT,CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL,,,17,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87102,CPT,CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD,,,17,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87103,CPT,CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD,,,17,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87106,CPT,CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST,,,17,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87107,CPT,CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD,,,17,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87109,CPT,CULTURE MYCOPLASMA ANY SOURCE,,,17,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87110,CPT,CULTURE CHLAMYDIA ANY SOURCE,,,17,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87116,CPT,CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL,,,17,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87118,CPT,CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL,,,17,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87140,CPT,CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM,,,17,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87143,CPT,CULTURE TYPING GAS/HIGH PRES LIQ CHROMATOGRAPHY,,,17,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87147,CPT,CULTURE TYPING IMMUNOLOGIC OTH/THN IMMUNOFLUORES,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87149,CPT,CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87150,CPT,CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87152,CPT,CULTURE TYPING IDENTIFJ PULSE FIELD GEL TYPING,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87153,CPT,CULTYP NUCLEIC ACID SEQUENCING METH EA ISOLATE,,,17,,TotalUnits,,,,4.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87158,CPT,CULTURE TYPING OTHER METHODS,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87164,CPT,DARK FIELD EXAM ANY SOURCE W/SPECIMEN COLLECTION,,,17,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 87164,CPT,DARK FIELD EXAM ANY SOURCE W/SPECIMEN COLLECTION,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 87166,CPT,DARK FIELD EXAM ANY SOURCE W/O SPECIMEN COLLECT,,,17,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87168,CPT,MACROSCOPIC EXAMINATION ARTHROPOD,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87169,CPT,MACROSCOPIC EXAMINATION PARASITE,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87172,CPT,PINWORM EXAMINATION,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87176,CPT,HOMOGENIZATION TISSUE CULTURE,,,17,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87177,CPT,OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID,,,17,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87181,CPT,SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ,,,17,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87184,CPT,SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD,,,17,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87185,CPT,SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ,,,17,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87186,CPT,SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ,,,17,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87187,CPT,SUSCEPTIBLTY STDY ANTMCRB MICRO/AGAR DILUTJ EA,,,17,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87188,CPT,SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87190,CPT,SUSCEPTIBLTY STDY ANTMCRB MYCOBACT PROPORJ MTHD,,,17,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87197,CPT,SERUM BACTERICIDAL TITER,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87205,CPT,SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87206,CPT,SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT,,,17,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87207,CPT,SMR PRIM SRC SPEC STAIN BODIES/PARASITS,,,17,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 87207,CPT,SMR PRIM SRC SPEC STAIN BODIES/PARASITS,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 87209,CPT,SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS,,,17,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87210,CPT,SMR PRIM SRC WET MOUNT NFCT AGT,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87220,CPT,TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87230,CPT,TOXIN/ANTITOXIN ASSAY TISSUE CULTURE,,,17,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87250,CPT,VIRUS INOCULATION EGGS/SM ANIMAL OBS&DSJ,,,17,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87252,CPT,VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT,,,17,,TotalUnits,,,,0.99 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87253,CPT,VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE,,,17,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87254,CPT,VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA,,,17,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87255,CPT,VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC,,,17,,TotalUnits,,,,1.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87260,CPT,IAADI ADENOVIRUS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87265,CPT,IAADI BORDETELLA PRTUSSIS/PARAPRTUSSIS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87267,CPT,IAADI ENTEROVIRUS DIRECT FLUORESCENT ANTIBODY,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87269,CPT,IAADI GIARDIA,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87270,CPT,IAADI CHLAMYDIA TRACHOMATIS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87271,CPT,IAADI CYTOMEGALOVIRUS DIR FLUORESCENT ANTIBODY,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87272,CPT,IAADI CRYPTOSPORIDIUM,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87273,CPT,IAADI HERPES SMPLX VIRUS TYPE 2,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87274,CPT,IAADI HERPES SMPLX VIRUS TYPE 1,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87275,CPT,IAADI INFLUENZA B VIRUS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87276,CPT,IAADI INFFLUENZA A VIRUS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87277,CPT,IAADI LEGIONELLA MICDADEI,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87278,CPT,IAADI LEGIONELLA PNEUMOPHILA,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87279,CPT,IAADI PARAINFLUENZA VIRUS EACH TYPE,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87280,CPT,IAADI RESPIRATORY SYNCTIAL VIRUS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87281,CPT,IAADI PNEUMOCUSTIS CARINII,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87283,CPT,IAADI RUBEOLA,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87285,CPT,IAADI TREPONEMA PALLIDUM,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87290,CPT,IAADI VARICELLA ZOSTER VIRUS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87299,CPT,IAADI NOT OTHERWISE SPECIFIED EACH ORGANISM,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87300,CPT,IAADI POLYV MLT ORGANISMS EA POLYV ANTISERUM,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87301,CPT,IAAD IA ADENOVIRUS ENTERIC TYP 40/41,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87305,CPT,IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87320,CPT,IAAD IA CHLAMYDIA TRACHOMATIS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87324,CPT,IAAD IA CLOSTRIDIUM DIFFICILE TOXIN,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87327,CPT,IAAD IA CRYPTOCOCCUS NEOFORMANS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87328,CPT,IAAD IA CRYPTOSPORIDIUM,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87329,CPT,IAAD IA GIARDIA,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87332,CPT,IAAD IA CYTOMEGALOVIRUS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87335,CPT,IAAD IA ESCHERICHIA COLI 0157,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87336,CPT,IAAD IA ENTAMOEBA HISTOLYTICA DISPAR GRP,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87337,CPT,IAAD IA ENTAMOEBA HISTOLYTICA GRP,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87338,CPT,IAAD IA HPYLORI STOOL,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87339,CPT,IAAD IA HPYLORI,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87340,CPT,IAAD IA HEPATITIS B SURFACE ANTIGEN,,,17,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87341,CPT,IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION,,,17,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87350,CPT,IAAD IA HEPATITIS BE ANTIGEN,,,17,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87380,CPT,IAAD IA HEPATITIS DELTA ANTIGEN,,,17,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87385,CPT,IAAD IA HISTOPLASM CAPSULATUM,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87389,CPT,IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE,,,17,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87390,CPT,IAAD IA HIV-1,,,17,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87391,CPT,IAAD IA HIV-2,,,17,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87400,CPT,IAAD IA INFLUENZA A/B EACH,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87420,CPT,IAAD IA RESPIRATORY SYNCTIAL VIRUS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87425,CPT,IAAD IA ROTAVIRUS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87427,CPT,IAAD IA SHIGA-LIKE TOXIN,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87430,CPT,IAAD IA STREPTOCOCCUS GROUP A,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87449,CPT,IAAD IA MULT STEP METHOD NOS EACH ORGANISM,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87450,CPT,IAAD IA SINGLE STEP METHOD NOS EA ORGANISM,,,17,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87451,CPT,IAAD IA POLYV MLT ORGANISMS EA POLYV ANTISERUM,,,17,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87470,CPT,IADNA BARTONELLA DIRECT PROBE TECHNIQUE,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87471,CPT,IADNA BARTONELLA AMPLIFIED PROBE TECHNIQUE,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87472,CPT,IADNA BARTONELLA HENSELAE&QUINTANA QUANTJ,,,17,,TotalUnits,,,,1.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87475,CPT,IADNA BORRELIA BURGDORFERI DIRECT PROBE TQ,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87476,CPT,IADNA BORRELIA BURGDORFERI AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87477,CPT,IADNA BORRELIA BURGDORFERI QUANTIFICATION,,,17,,TotalUnits,,,,1.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87480,CPT,IADNA CANDIDA SPECIES DIRECT PROBE TQ,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87481,CPT,IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87482,CPT,IADNA CANDIDA SPECIES QUANTIFICATION,,,17,,TotalUnits,,,,1.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87483,CPT,CNS DNA AMP PROBE TYPE 12-25,,,17,,TotalUnits,,,,15.86 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87485,CPT,IADNA CHLAMYDIA PNEUMONIAE DIRECT PROBE TQ,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87486,CPT,IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87487,CPT,IADNA CHLAMYDIA PNEUMONIAE QUANTIFICATION,,,17,,TotalUnits,,,,1.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87490,CPT,IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87491,CPT,IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87492,CPT,IADNA CHLAMYDIA TRACHOMATIS QUANTIFICATION,,,17,,TotalUnits,,,,1.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87493,CPT,INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87495,CPT,IADNA CYTOMEGALOVIRUS DIRECT PROBE TQ,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87496,CPT,IADNA CYTOMEGALOVIRUS AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87497,CPT,IADNA CYTOMEGALOVIRUS QUANTIFICATION,,,17,,TotalUnits,,,,1.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87498,CPT,IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87500,CPT,INFECTIOUS AGENT DNA/RNA VANCOMYCIN RESISTANCE,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87501,CPT,INFECTIOUS AGENT DNA/RNA INFLUENZA EA TYPE,,,17,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87502,CPT,INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES,,,17,,TotalUnits,,,,3.24 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87503,CPT,NFCT AGENT DNA/RNA INFLUENZA >2 TYPES EA ADDL,,,17,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87505,CPT,NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN,,,17,,TotalUnits,,,,4.88 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87506,CPT,IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11,,,17,,TotalUnits,,,,8.12 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87507,CPT,IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25,,,17,,TotalUnits,,,,15.86 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87510,CPT,IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87511,CPT,IADNA GARDNERELLA VAGINALIS AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87512,CPT,IADNA GARDNERELLA VAGINALIS QUANTIFICATION,,,17,,TotalUnits,,,,1.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87515,CPT,IADNA HEPATITIS B VIRUS DIRECT PROBE TECHNIQUE,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87516,CPT,IADNA HEPATITIS B VIRUS AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87517,CPT,IADNA HEPATITIS B VIRUS QUANTIFICATION,,,17,,TotalUnits,,,,1.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87520,CPT,IADNA HEPATITIS C DIRECT PROBE TECHNIQUE,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87521,CPT,IADNA HEPATITIS C AMPLIFIED PROBE&REVRSE TRANSCR,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87522,CPT,IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION,,,17,,TotalUnits,,,,1.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87525,CPT,IADNA HEPATITIS G DIRECT PROBE TECHNIQUE,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87526,CPT,IADNA HEPATITIS G AMPLIFIED PROBE TECHNIQUE,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87527,CPT,IADNA HEPATITIS G QUANTIFICATION,,,17,,TotalUnits,,,,1.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87528,CPT,IADNA HERPES SIMPLX VIRUS DIRECT PROBE TQ,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87529,CPT,IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87530,CPT,IADNA HERPES SOMPLX VIRUS QUANTIFICATION,,,17,,TotalUnits,,,,1.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87531,CPT,IADNA HERPES VIRUS-6 DIRECT PROBE TQ,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87532,CPT,IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87533,CPT,IADNA HERPES VIRUS-6 QUANTIFICATION,,,17,,TotalUnits,,,,1.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87534,CPT,IADNA HIV-1 DIRECT PROBE TECHNIQUE,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87535,CPT,IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87536,CPT,IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION,,,17,,TotalUnits,,,,3.24 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87537,CPT,IADNA HIV-2 DIRECT PROBE TECHNIQUE,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87538,CPT,IADNA HIV-2 AMPLIFIED PROBE & REVERSE TRANSCRIPJ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87539,CPT,IADNA HIV-2 QUANT & REVERSE TRANSCRIPTION,,,17,,TotalUnits,,,,1.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87540,CPT,IADNA LEGIONELLA PNEUMOPHILA DIRECT PROBE TQ,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87541,CPT,IADNA LEGIONELLA PNEUMOPHILA AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87542,CPT,IADNA LEGIONELLA PNEUMOPHILA QUANTIFICATION,,,17,,TotalUnits,,,,1.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87550,CPT,IADNA MYCOBACTERIA SPECIES DIRECT PROBE TQ,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87551,CPT,IADNA MYCOBACTERIA SPECIES AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87552,CPT,IADNA MYCOBACTERIA SPECIES QUANTIFICATION,,,17,,TotalUnits,,,,1.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87555,CPT,IADNA MYCOBACTERIA TUBERCULOSIS DIR PRB,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87556,CPT,IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87557,CPT,IADNA MYCOBACTERIA TUBERCULOSIS QUANTIFICATION,,,17,,TotalUnits,,,,1.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87560,CPT,IADNA MYCOBACTERIA AVIUM-INTRACLRE DIR PRB,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87561,CPT,IADNA MYCOBACTERIA AVIUM-INTRACLRE AMP PRB,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87562,CPT,IADNA MYCOBACTERIA AVIUM-INTRACELLULARE QUANT,,,17,,TotalUnits,,,,1.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87580,CPT,IADNA MYCOPLSM PNEUMONIAE DIRECT PROBE TQ,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87581,CPT,IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87582,CPT,IADNA MYCOPLSM PNEUMONIAE QUANTIFICATION,,,17,,TotalUnits,,,,1.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87590,CPT,IADNA NEISSERIA GONORRHOEAE DIRECT PROBE TQ,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87591,CPT,IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87592,CPT,IADNA NEISSERIA GONORRHOEAE QUANTIFICATION,,,17,,TotalUnits,,,,1.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87623,CPT,IADNA HUMAN PAPILLOMAVIRUS LOW-RISK TYPES,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87624,CPT,IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87625,CPT,IADNA HUMAN PAPILLOMAVIRUS TYPES 16 & 18 ONLY,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87631,CPT,IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS,,,17,,TotalUnits,,,,4.88 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87632,CPT,IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS,,,17,,TotalUnits,,,,8.12 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87633,CPT,IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET,,,17,,TotalUnits,,,,15.86 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87640,CPT,IADNA S AUREUS AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87641,CPT,IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87650,CPT,IADNA STREPTOCOCCUS GROUP A DIRECT PROBE TQ,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87651,CPT,IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87652,CPT,IADNA STREPTOCOCCUS GROUP A QUANTIFICATION,,,17,,TotalUnits,,,,1.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87653,CPT,IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87660,CPT,IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87661,CPT,IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87797,CPT,IADNA NOS DIRECT PROBE TQ EACH ORGANISM,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87798,CPT,IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87799,CPT,IADNA NOS QUANTIFICATION EACH ORGANISM,,,17,,TotalUnits,,,,1.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87800,CPT,IADNA MULTIPLE ORGANISMS DIRECT PROBE TQ,,,17,,TotalUnits,,,,1.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87801,CPT,IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ,,,17,,TotalUnits,,,,2.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87802,CPT,IAADIADOO STREPTOCOCCUS GROUP B,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87803,CPT,IAADIADOO CLOSTRIDIUM DIFFICILE TOXIN,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87804,CPT,IAADIADOO INFLUENZA,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87806,CPT,IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES,,,17,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87807,CPT,IAADIADOO RESPIRATORY SYNCTIAL VIRUS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87808,CPT,IAADIADOO TRICHOMONAS VAGINALIS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87809,CPT,INFECTIOUS AGENT IMMUNOASSAY OPTICAL ADENOVIRUS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87810,CPT,CHLAMYDIA TRACHOMATIS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87850,CPT,IAADIADOO NEISSERIA GONORRHOEAE,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87880,CPT,IAADIADOO STREPTOCOCCUS GROUP A,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87899,CPT,IAADIADOO NOT OTHERWISE SPECIFIED,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87900,CPT,NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION,,,17,,TotalUnits,,,,4.96 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87901,CPT,NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS,,,17,,TotalUnits,,,,9.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87902,CPT,NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS,,,17,,TotalUnits,,,,9.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87903,CPT,NFCT PHEXYP RESIST TISS CUL HIV FIRST 1-10 DRUGS,,,17,,TotalUnits,,,,18.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87904,CPT,NFCT PHEXYP RESIST TISS CUL HIV EA ADDL DRUG,,,17,,TotalUnits,,,,0.99 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87905,CPT,INFECTIOUS AGENT ENZYMATIC ACTV OTH/THN VIRUS,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87906,CPT,NFCT GEXYP DNA/RNA HIV 1 OTHER REGION,,,17,,TotalUnits,,,,4.90 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87910,CPT,NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,,,17,,TotalUnits,,,,9.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87912,CPT,NFCT AGENT GENOTYPE HEPATITIS B VIRUS,,,17,,TotalUnits,,,,9.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 87999,CPT,UNLISTED MICROBIOLOGY,,,17,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88000,CPT,NECROPSY GROSS EXAMINATION ONLY W/O CNS,,,17,,TotalUnits,,,,6.50 ,,$0.00,$0.00,1,0,1,0,1,1,20171001, 88005,CPT,NECROPSY GROSS EXAMINATION W/BRAIN,,,17,,TotalUnits,,,,7.58 ,,$0.00,$0.00,1,0,1,0,1,1,20171001, 88007,CPT,NECROPSY GROSS EXAMINATION W/BRAIN&SPINAL CORD,,,17,,TotalUnits,,,,7.94 ,,$0.00,$0.00,1,0,1,0,1,1,20171001, 88012,CPT,NECROPSY GROSS EXAMINATION INFANT W/BRAIN,,,17,,TotalUnits,,,,6.50 ,,$0.00,$0.00,1,0,1,0,1,1,20171001, 88014,CPT,NECROPSY GROSS EXAM STILLBORN/NEWBORN W/BRAIN,,,17,,TotalUnits,,,,5.96 ,,$0.00,$0.00,1,0,1,0,1,1,20171001, 88016,CPT,NECROPSY GROSS EXAM MACERATED STILLBORN,,,17,,TotalUnits,,,,8.30 ,,$0.00,$0.00,1,0,1,0,1,1,20171001, 88020,CPT,NECROPSY GROSS & MICROSCOPIC W/O CNS,,,17,,TotalUnits,,,,11.19 ,,$0.00,$0.00,1,0,1,0,1,1,20171001, 88025,CPT,NECROPSY GROSS & MICROSCOPIC W/BRAIN,,,17,,TotalUnits,,,,10.83 ,,$0.00,$0.00,1,0,1,0,1,1,20171001, 88027,CPT,NECROPSY GROSS&MCRSCP BRAIN & SPINAL CORD,,,17,,TotalUnits,,,,11.55 ,,$0.00,$0.00,1,0,1,0,1,1,20171001, 88028,CPT,NECROPSY GROSS & MICROSCOPIC INFANT W/BRAIN,,,17,,TotalUnits,,,,6.50 ,,$0.00,$0.00,1,0,1,0,1,1,20171001, 88029,CPT,NECROPSY GROSS&MCRSCP STILLBORN/NEWBORN BRAIN,,,17,,TotalUnits,,,,6.50 ,,$0.00,$0.00,1,0,1,0,1,1,20171001, 88036,CPT,NECROPSY LIMITED GROSS&/MCRSCP REGIONAL,,,17,,TotalUnits,,,,3.25 ,,$0.00,$0.00,1,0,1,0,1,1,20171001, 88037,CPT,NECROPSY LIMITD GROSS&/MCRSCP SINGLE ORGAN,,,17,,TotalUnits,,,,2.89 ,,$0.00,$0.00,1,0,1,0,1,1,20171001, 88040,CPT,NECROPSY FORENSIC EXAMINATION,,,17,,TotalUnits,,,,18.05 ,,$0.00,$0.00,1,0,1,0,1,1,20171001, 88045,CPT,NECROPSY CORONER CALL,,,17,,TotalUnits,,,,1.81 ,,$0.00,$0.00,1,0,1,0,1,1,20171001, 88099,CPT,UNLISTED NECROPSY PROCEDURE,,,17,,TotalUnits,,,,10.83 ,,$0.00,$0.00,1,0,1,0,1,1,20171001, 88104,CPT,CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ,,,17,,RBRVS,0.56 ,1.56 ,1.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88104,CPT,CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ,26,,17,,RBRVS,0.56 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88104,CPT,CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ,TC,,17,,RBRVS,,1.29 ,1.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88106,CPT,CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ,,,17,,RBRVS,0.37 ,1.72 ,1.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88106,CPT,CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ,26,,17,,RBRVS,0.37 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88106,CPT,CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ,TC,,17,,RBRVS,,1.53 ,1.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88108,CPT,CYTP CONCENTRATION SMEARS & INTERPRETATION,,,17,,RBRVS,0.44 ,1.58 ,1.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88108,CPT,CYTP CONCENTRATION SMEARS & INTERPRETATION,26,,17,,RBRVS,0.44 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88108,CPT,CYTP CONCENTRATION SMEARS & INTERPRETATION,TC,,17,,RBRVS,,1.37 ,1.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88112,CPT,CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V,,,17,,RBRVS,0.56 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88112,CPT,CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V,26,,17,,RBRVS,0.56 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88112,CPT,CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V,TC,,17,,RBRVS,,1.20 ,1.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88120,CPT,CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL,,,17,,RBRVS,1.20 ,16.62 ,16.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88120,CPT,CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL,26,,17,,RBRVS,1.20 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88120,CPT,CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL,TC,,17,,RBRVS,,16.17 ,16.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88121,CPT,CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA,,,17,,RBRVS,1.00 ,14.57 ,14.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88121,CPT,CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA,26,,17,,RBRVS,1.00 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88121,CPT,CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA,TC,,17,,RBRVS,,14.14 ,14.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88125,CPT,CYTOPATHOLOGY FORENSIC,,,17,,RBRVS,0.26 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88125,CPT,CYTOPATHOLOGY FORENSIC,26,,17,,RBRVS,0.26 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88125,CPT,CYTOPATHOLOGY FORENSIC,TC,,17,,RBRVS,,0.26 ,0.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88130,CPT,SEX CHROMATIN IDENTIFICATION BARR BODIES,,,17,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88140,CPT,SEX CHROMATIN IDENTJ PERIPHERAL BLOOD SMEAR,,,17,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88141,CPT,CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN,,PC,17,,RBRVS,0.42 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88142,CPT,CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN,,,17,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88143,CPT,CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS,,,17,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88147,CPT,CYTP SMRS C/V SCR AUTOMATED SYSTEM PHYS SUPV,,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88148,CPT,CYTP SMRS C/V SCR AUTO SYS MNL RESCR PHYS,,,17,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88150,CPT,CYTP SLIDES C/V MNL SCR UNDER PHYS,,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88152,CPT,CYTP SLIDES C/V MNL SCR&CPTR RESCR PHYS,,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88153,CPT,CYTP SLIDES C/V MNL SCR&RESCR PHYS,,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88154,CPT,CYTP SLIDES C/V MNL SCR&CPTR-RESCR CELL S&I,,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88155,CPT,CYTP SLIDES C/V DEFINITIVE HORMONAL EVAL,,,17,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88160,CPT,CYTP SMRS ANY OTH SRC SCR&INTERPJ,,,17,,RBRVS,0.50 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88160,CPT,CYTP SMRS ANY OTH SRC SCR&INTERPJ,26,,17,,RBRVS,0.50 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88160,CPT,CYTP SMRS ANY OTH SRC SCR&INTERPJ,TC,,17,,RBRVS,,1.27 ,1.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88161,CPT,CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ,,,17,,RBRVS,0.50 ,1.31 ,1.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88161,CPT,CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ,26,,17,,RBRVS,0.50 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88161,CPT,CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ,TC,,17,,RBRVS,,1.09 ,1.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88162,CPT,CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES,,,17,,RBRVS,0.76 ,2.15 ,2.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88162,CPT,CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES,26,,17,,RBRVS,0.76 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88162,CPT,CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES,TC,,17,,RBRVS,,1.78 ,1.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88164,CPT,CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV,,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88165,CPT,CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV,,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88166,CPT,CYTP SLIDES C/V MNL SCR&CPTR RESCR PHYS SUPV,,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88167,CPT,CYTP SLIDES C/V MNL SCR&CPTR RESCR CELL S&I,,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88172,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST,,,17,,RBRVS,0.69 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88172,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST,26,,17,,RBRVS,0.69 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88172,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST,TC,,17,,RBRVS,,0.55 ,0.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88173,CPT,CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT,,,17,,RBRVS,1.39 ,2.90 ,2.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88173,CPT,CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT,26,,17,,RBRVS,1.39 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88173,CPT,CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT,TC,,17,,RBRVS,,2.25 ,2.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88174,CPT,CYTP C/V AUTO THIN LYR PREPJ SCR SYS PHYS,,,17,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88175,CPT,CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS,,,17,,TotalUnits,,,,1.01 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88177,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL,,,17,,RBRVS,0.42 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88177,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL,26,,17,,RBRVS,0.42 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88177,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL,TC,,17,,RBRVS,,0.21 ,0.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88182,CPT,FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,,,17,,RBRVS,0.77 ,2.35 ,2.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88182,CPT,FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,26,,17,,RBRVS,0.77 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88182,CPT,FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,TC,,17,,RBRVS,,2.08 ,2.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88184,CPT,FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST,,TC,17,,RBRVS,,2.12 ,2.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88185,CPT,FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA,,TC,17,,RBRVS,,1.30 ,1.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88187,CPT,FLOW CYTOMETRY INTERPJ 2-8 MARKERS,,PC,17,,RBRVS,1.36 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88188,CPT,FLOW CYTOMETRY INTERPJ 9-15 MARKERS,,PC,17,,RBRVS,1.69 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88189,CPT,FLOW CYTOMETRY INTERPRETATION 16/> MARKERS,,PC,17,,RBRVS,2.23 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88199,CPT,UNLISTED CYTOPATHOLOGY PROCEDURE,,,17,,TotalUnits,,,,2.00 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88199,CPT,UNLISTED CYTOPATHOLOGY PROCEDURE,,PC,17,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 88199,CPT,UNLISTED CYTOPATHOLOGY PROCEDURE,,TC,17,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 88230,CPT,TISS CUL NON-NEO DISORDERS LYMPHOCYTE,,,17,,TotalUnits,,,,4.43 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88233,CPT,TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX,,,17,,TotalUnits,,,,5.35 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88235,CPT,TISS CUL NON-NEO DISORDERS AMNIOTIC/CHORNC CELLS,,,17,,TotalUnits,,,,5.60 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88237,CPT,TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS,,,17,,TotalUnits,,,,4.81 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88239,CPT,TISS CUL NEO DISORDERS SOLID TUMOR,,,17,,TotalUnits,,,,5.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88240,CPT,CRYOPRSRV FRZING&STORAGE CELLS EA CELL LINE,,,17,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88241,CPT,THAWING&EXPANSION FROZEN CELLS EACH ALIQUOT,,,17,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88245,CPT,CHRMSM BREAKAGE BASELINE SISTER 20-25 CLL,,,17,,TotalUnits,,,,5.66 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88248,CPT,CHRMSM BREAKAGE BASELINE BREAKAGE 50-100 CLL,,,17,,TotalUnits,,,,6.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88249,CPT,CHRMSM BREAKAGE SYNDS SCORE 100 CLL,,,17,,TotalUnits,,,,6.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88261,CPT,CHRMSM COUNT 5 CELL 1KARYOTYPE BANDING,,,17,,TotalUnits,,,,6.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88262,CPT,CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING,,,17,,TotalUnits,,,,4.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88263,CPT,CHRMSM COUNT 45 CELL MOSAICISM 2KARYOTYPE,,,17,,TotalUnits,,,,5.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88264,CPT,CHRMSM ANALYZE 20-25 CELLS,,,17,,TotalUnits,,,,4.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88267,CPT,CHRMSM ALYS AMNIOTIC/VILLUS 15 CELL 1KARYOTYPE,,,17,,TotalUnits,,,,6.84 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88269,CPT,CHRMSM SITU AMNIOTIC CLL 6-12 COLONIES 1KARYOTYP,,,17,,TotalUnits,,,,6.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88271,CPT,MOLECULAR CYTOGENETICS DNA PROBE EACH,,,17,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88272,CPT,MOLECULAR CYTOGENETICS CHRMOML ISH 3-5 CELLS,,,17,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88273,CPT,MOLECULAR CYTOGENETICS CHRMOML ISH 10-30 CLL,,,17,,TotalUnits,,,,1.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88274,CPT,MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL,,,17,,TotalUnits,,,,1.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88275,CPT,MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL,,,17,,TotalUnits,,,,1.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88280,CPT,CHRMSM ANALYSIS ADDL KARYOTYP EACH STUDY,,,17,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88283,CPT,CHRMSM ANALYSIS ADDL SPECIALIZED BANDING,,,17,,TotalUnits,,,,2.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88285,CPT,CHRMSM ANALYSIS ADDL CELLS COUNTED EACH STUDY,,,17,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88289,CPT,CHRMSM ANALYSIS ADDL HIGH RESOLUTION STUDY,,,17,,TotalUnits,,,,1.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88291,CPT,CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP,,PC,17,,RBRVS,0.52 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88299,CPT,UNLISTED CYTOGENETIC STUDY,,,17,,TotalUnits,,,,1.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88300,CPT,LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY,,,17,,RBRVS,0.08 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88300,CPT,LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY,26,,17,,RBRVS,0.08 ,0.04 ,0.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88300,CPT,LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY,TC,,17,,RBRVS,,0.29 ,0.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88302,CPT,LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,,17,,RBRVS,0.13 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88302,CPT,LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,26,,17,,RBRVS,0.13 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88302,CPT,LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,TC,,17,,RBRVS,,0.70 ,0.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88304,CPT,LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,,17,,RBRVS,0.22 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88304,CPT,LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,26,,17,,RBRVS,0.22 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88304,CPT,LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,TC,,17,,RBRVS,,0.95 ,0.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88305,CPT,LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,,17,,RBRVS,0.75 ,1.29 ,1.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88305,CPT,LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,26,,17,,RBRVS,0.75 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88305,CPT,LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,TC,,17,,RBRVS,,0.95 ,0.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88307,CPT,LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,,17,,RBRVS,1.59 ,7.07 ,7.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88307,CPT,LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,26,,17,,RBRVS,1.59 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88307,CPT,LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,TC,,17,,RBRVS,,6.26 ,6.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88309,CPT,LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,,17,,RBRVS,2.80 ,10.34 ,10.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88309,CPT,LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,26,,17,,RBRVS,2.80 ,1.45 ,1.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88309,CPT,LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,TC,,17,,RBRVS,,8.89 ,8.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88311,CPT,DECALCIFICATION PROCEDURE,,,17,,RBRVS,0.24 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88311,CPT,DECALCIFICATION PROCEDURE,26,,17,,RBRVS,0.24 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88311,CPT,DECALCIFICATION PROCEDURE,TC,,17,,RBRVS,,0.23 ,0.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88312,CPT,SPECIAL STAIN GROUP 1 MICROORGANISMS I&R,,,17,,RBRVS,0.54 ,2.20 ,2.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88312,CPT,SPECIAL STAIN GROUP 1 MICROORGANISMS I&R,26,,17,,RBRVS,0.54 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88312,CPT,SPECIAL STAIN GROUP 1 MICROORGANISMS I&R,TC,,17,,RBRVS,,1.96 ,1.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88313,CPT,SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT,,,17,,RBRVS,0.24 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88313,CPT,SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT,26,,17,,RBRVS,0.24 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88313,CPT,SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT,TC,,17,,RBRVS,,1.57 ,1.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88314,CPT,SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSU,,,17,,RBRVS,0.45 ,1.70 ,1.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88314,CPT,SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSU,26,,17,,RBRVS,0.45 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88314,CPT,SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSU,TC,,17,,RBRVS,,1.51 ,1.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88319,CPT,SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS,,,17,,RBRVS,0.53 ,1.96 ,1.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88319,CPT,SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS,26,,17,,RBRVS,0.53 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88319,CPT,SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS,TC,,17,,RBRVS,,1.71 ,1.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88321,CPT,CONSLTJ&REPRT SLIDES PREPARED ELSEWHERE,,,17,,RBRVS,1.63 ,0.74 ,1.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88323,CPT,CONSLTJ&REPRT MATERIAL REQUIRING PREPJ SLIDES,,,17,,RBRVS,1.83 ,2.06 ,2.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88323,CPT,CONSLTJ&REPRT MATERIAL REQUIRING PREPJ SLIDES,26,,17,,RBRVS,1.83 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88323,CPT,CONSLTJ&REPRT MATERIAL REQUIRING PREPJ SLIDES,TC,,17,,RBRVS,,1.41 ,1.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88325,CPT,CONSLTJ COMPRE REVIEW REPRT REFERRED MATRL,,,17,,RBRVS,2.50 ,1.24 ,2.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88329,CPT,PATHOLOGY CONSULTATION DURING SURGERY,,,17,,RBRVS,0.67 ,0.35 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88331,CPT,PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC,,,17,,RBRVS,1.19 ,1.48 ,1.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88331,CPT,PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC,26,,17,,RBRVS,1.19 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88331,CPT,PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC,TC,,17,,RBRVS,,0.87 ,0.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88332,CPT,PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION,,,17,,RBRVS,0.59 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88332,CPT,PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION,26,,17,,RBRVS,0.59 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88332,CPT,PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION,TC,,17,,RBRVS,,0.52 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88333,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE,,,17,,RBRVS,1.20 ,1.60 ,1.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88333,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE,26,,17,,RBRVS,1.20 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88333,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE,TC,,17,,RBRVS,,0.99 ,0.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88334,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM ADDL SITE,,,17,,RBRVS,0.73 ,0.99 ,0.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88334,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM ADDL SITE,26,,17,,RBRVS,0.73 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88334,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM ADDL SITE,TC,,17,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88341,CPT,IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE,,,17,,RBRVS,0.53 ,1.98 ,1.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88341,CPT,IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE,26,,17,,RBRVS,0.53 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88341,CPT,IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE,TC,,17,,RBRVS,,1.74 ,1.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88342,CPT,IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE,,,17,,RBRVS,0.70 ,2.27 ,2.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88342,CPT,IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE,26,,17,,RBRVS,0.70 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88342,CPT,IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE,TC,,17,,RBRVS,,1.95 ,1.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88344,CPT,IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE,,,17,,RBRVS,0.77 ,4.06 ,4.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88344,CPT,IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE,26,,17,,RBRVS,0.77 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88344,CPT,IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE,TC,,17,,RBRVS,,3.71 ,3.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88346,CPT,IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN,,,17,,RBRVS,0.74 ,1.85 ,1.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88346,CPT,IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN,26,,17,,RBRVS,0.74 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88346,CPT,IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN,TC,,17,,RBRVS,,1.54 ,1.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88348,CPT,ELECTRON MICROSCOPY DIAGNOSTIC,,,17,,RBRVS,1.51 ,8.15 ,8.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88348,CPT,ELECTRON MICROSCOPY DIAGNOSTIC,26,,17,,RBRVS,1.51 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88348,CPT,ELECTRON MICROSCOPY DIAGNOSTIC,TC,,17,,RBRVS,,7.48 ,7.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88350,CPT,IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN,,,17,,RBRVS,0.56 ,1.45 ,1.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88350,CPT,IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN,26,,17,,RBRVS,0.56 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88350,CPT,IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN,TC,,17,,RBRVS,,1.22 ,1.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88355,CPT,MORPHOMETRIC ANALYSIS SKELETAL MUSCLE,,,17,,RBRVS,1.85 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88355,CPT,MORPHOMETRIC ANALYSIS SKELETAL MUSCLE,26,,17,,RBRVS,1.85 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88355,CPT,MORPHOMETRIC ANALYSIS SKELETAL MUSCLE,TC,,17,,RBRVS,,2.06 ,2.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88356,CPT,MORPHOMETRIC ANALYSIS NERVE,,,17,,RBRVS,2.80 ,2.91 ,2.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88356,CPT,MORPHOMETRIC ANALYSIS NERVE,26,,17,,RBRVS,2.80 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88356,CPT,MORPHOMETRIC ANALYSIS NERVE,TC,,17,,RBRVS,,2.30 ,2.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88358,CPT,MORPHOMETRIC ANALYSIS TUMOR,,,17,,RBRVS,0.95 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88358,CPT,MORPHOMETRIC ANALYSIS TUMOR,26,,17,,RBRVS,0.95 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88358,CPT,MORPHOMETRIC ANALYSIS TUMOR,TC,,17,,RBRVS,,1.10 ,1.10 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88360,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL,,,17,,RBRVS,1.10 ,2.27 ,2.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88360,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL,26,,17,,RBRVS,1.10 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88360,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL,TC,,17,,RBRVS,,1.81 ,1.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88361,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST,,,17,,RBRVS,1.18 ,2.96 ,2.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88361,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST,26,,17,,RBRVS,1.18 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88361,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST,TC,,17,,RBRVS,,2.47 ,2.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88362,CPT,NERVE TEASING PREPARATIONS,,,17,,RBRVS,2.17 ,5.05 ,5.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88362,CPT,NERVE TEASING PREPARATIONS,26,,17,,RBRVS,2.17 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88362,CPT,NERVE TEASING PREPARATIONS,TC,,17,,RBRVS,,4.13 ,4.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88363,CPT,EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI,,,17,,RBRVS,0.37 ,0.17 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88364,CPT,IN SITU HYBRIDIZATION EA ADDL PROBE STAIN,,,17,,RBRVS,0.67 ,3.08 ,3.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88364,CPT,IN SITU HYBRIDIZATION EA ADDL PROBE STAIN,26,,17,,RBRVS,0.67 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88364,CPT,IN SITU HYBRIDIZATION EA ADDL PROBE STAIN,TC,,17,,RBRVS,,2.79 ,2.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88365,CPT,IN SITU HYBRIDIZATION 1ST PROBE STAIN,,,17,,RBRVS,0.88 ,4.07 ,4.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88365,CPT,IN SITU HYBRIDIZATION 1ST PROBE STAIN,26,,17,,RBRVS,0.88 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88365,CPT,IN SITU HYBRIDIZATION 1ST PROBE STAIN,TC,,17,,RBRVS,,3.69 ,3.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88366,CPT,IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN,,,17,,RBRVS,1.24 ,6.07 ,6.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88366,CPT,IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN,26,,17,,RBRVS,1.24 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88366,CPT,IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN,TC,,17,,RBRVS,,5.53 ,5.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88367,CPT,M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN,,,17,,RBRVS,0.73 ,2.24 ,2.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88367,CPT,M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN,26,,17,,RBRVS,0.73 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88367,CPT,M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN,TC,,17,,RBRVS,,1.98 ,1.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88368,CPT,M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL,,,17,,RBRVS,0.88 ,2.30 ,2.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88368,CPT,M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL,26,,17,,RBRVS,0.88 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88368,CPT,M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL,TC,,17,,RBRVS,,2.04 ,2.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88369,CPT,M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH,,,17,,RBRVS,0.67 ,2.34 ,2.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88369,CPT,M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH,26,,17,,RBRVS,0.67 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88369,CPT,M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH,TC,,17,,RBRVS,,2.13 ,2.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88371,CPT,PROTEIN ANAL TISSUE WESTERN BLOT W/INTERP&REPO,,,17,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 88371,CPT,PROTEIN ANAL TISSUE WESTERN BLOT W/INTERP&REPO,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88372,CPT,PROTEIN ALYS WSTRN BLOT I&R IMMUNOLOGICAL EA,,,17,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 88372,CPT,PROTEIN ALYS WSTRN BLOT I&R IMMUNOLOGICAL EA,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88373,CPT,M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH,,,17,,RBRVS,0.43 ,1.66 ,1.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88373,CPT,M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH,26,,17,,RBRVS,0.43 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88373,CPT,M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH,TC,,17,,RBRVS,,1.50 ,1.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88374,CPT,M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB,,,17,,RBRVS,0.93 ,8.70 ,8.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88374,CPT,M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB,26,,17,,RBRVS,0.93 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88374,CPT,M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB,TC,,17,,RBRVS,,8.36 ,8.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88375,CPT,OPTICAL ENDOMICROSCOPIC IMAGE INTERP & REPORT,,,17,,TotalUnits,,,,1.35 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 88377,CPT,M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB,,,17,,RBRVS,1.40 ,10.07 ,10.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88377,CPT,M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB,26,,17,,RBRVS,1.40 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88377,CPT,M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB,TC,,17,,RBRVS,,9.63 ,9.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88380,CPT,MICRODISSECTION PREP IDENTIFIED TARGET LASER,,,17,,RBRVS,1.14 ,2.88 ,2.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88380,CPT,MICRODISSECTION PREP IDENTIFIED TARGET LASER,26,,17,,RBRVS,1.14 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88380,CPT,MICRODISSECTION PREP IDENTIFIED TARGET LASER,TC,,17,,RBRVS,,2.41 ,2.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88381,CPT,MICRODISSECTION PREP IDENTIFIED TARGET MANUAL,,,17,,RBRVS,0.53 ,2.74 ,2.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88381,CPT,MICRODISSECTION PREP IDENTIFIED TARGET MANUAL,26,,17,,RBRVS,0.53 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 88381,CPT,MICRODISSECTION PREP IDENTIFIED TARGET MANUAL,TC,,17,,RBRVS,,2.56 ,2.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88387,CPT,MACRO EXAM DISSECT&PREP TISS NONMICRO STD EA,,,17,,RBRVS,0.62 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88387,CPT,MACRO EXAM DISSECT&PREP TISS NONMICRO STD EA,,PC,17,,RBRVS,0.62 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,0,20171001, 88387,CPT,MACRO EXAM DISSECT&PREP TISS NONMICRO STD EA,,TC,17,,RBRVS,,0.25 ,0.25 ,,,$0.00,$0.00,1,1,1,0,1,0,20171001, 88388,CPT,MACR EXM DISS&PRP NONMICR IMPRNT/CONSLT/FRZ SE,,,17,,RBRVS,0.45 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88388,CPT,MACR EXM DISS&PRP NONMICR IMPRNT/CONSLT/FRZ SE,,PC,17,,RBRVS,0.45 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,0,20171001, 88388,CPT,MACR EXM DISS&PRP NONMICR IMPRNT/CONSLT/FRZ SE,,TC,17,,RBRVS,,0.27 ,0.27 ,,,$0.00,$0.00,1,1,1,0,1,0,20171001, 88399,CPT,UNLISTED SURGICAL PATHOLOGY PROCEDURE,,,17,,TotalUnits,,,,2.04 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 88399,CPT,UNLISTED SURGICAL PATHOLOGY PROCEDURE,,PC,17,,TotalUnits,,,,1.09 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 88399,CPT,UNLISTED SURGICAL PATHOLOGY PROCEDURE,,TC,17,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 88720,CPT,BILIRUBIN TOTAL TRANSCUTANEOUS,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88738,CPT,HGB QUANTITATIVE TRANSCUTANEOUS,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88740,CPT,HEMOGLOBIN QUAN TC PER DAY CARBOXYHEMOGLOBIN,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88741,CPT,HEMOGLOBIN QUANTITATIVE TC PER DAY METHEMOGLOBIN,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 88749,CPT,UNLISTED IN VIVO LABORTORY SERVICE,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89049,CPT,CAFFEINE HALOTHANE CONTRACTURE TEST,,,17,,RBRVS,1.40 ,0.35 ,5.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89050,CPT,CELL COUNT MISCELLANEOUS BODY FLUIDS,,,17,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89051,CPT,CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT,,,17,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89055,CPT,LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89060,CPT,CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID,,,17,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 89060,CPT,CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 89125,CPT,FAT STAIN FECES URINE/RESPIR SECRETIONS,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89160,CPT,MEAT FIBERS FECES,,,17,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89190,CPT,NASAL SMEAR EOSINOPHILS,,,17,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89220,CPT,SPUTUM OBTAINING SPEC AEROSOL INDUCED TX SPX,,TC,17,,RBRVS,,0.45 ,0.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89230,CPT,SWEAT COLLECTION IONTOPHORESIS,,TC,17,,RBRVS,,0.14 ,0.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89240,CPT,UNLIS MISC PATH,,,17,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89250,CPT,CUL OOCYTE/EMBRYO <4 DAYS,,,17,,TotalUnits,,,,11.83 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89251,CPT,CUL OOCYTE/EMBRYO < 4 D CO-CULT OCYTE/EMBRY,,,17,,TotalUnits,,,,12.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89253,CPT,ASSTD EMBRYO HATCHING MICROTQS ANY METH,,,17,,TotalUnits,,,,6.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89254,CPT,OOCYTE ID FROM FOLLICULAR FLU,,,17,,TotalUnits,,,,5.73 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89255,CPT,PREPJ EMBRYO TR,,,17,,TotalUnits,,,,3.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89257,CPT,SPRM ID FROM ASPIR OTH/THN SEMINAL,,,17,,TotalUnits,,,,4.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89258,CPT,CRYOPRSRV EMBRYO,,,17,,TotalUnits,,,,7.09 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89259,CPT,CRYOPRSRV SPRM,,,17,,TotalUnits,,,,1.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89260,CPT,SPRM ISOL SMPL PREP INSEMINATION/DX SEMEN ALYS,,,17,,TotalUnits,,,,1.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89261,CPT,SPRM ISOL CPLX PREP INSEMINATION/DX SEMEN ALYS,,,17,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89264,CPT,SPRM ID FROM TSTIS TISS FRSH/CRYOPRSRVD,,,17,,TotalUnits,,,,5.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89268,CPT,INSEMINATION OOCYTES,,,17,,TotalUnits,,,,4.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89272,CPT,EXTND CUL OOCYTE/EMBRYO 4-7 DAYS,,,17,,TotalUnits,,,,8.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89280,CPT,ASSTD FERTILIZATION MICROTQ 10 OOCYTES,,,17,,TotalUnits,,,,16.43 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89290,CPT,BX OOCYTE MICROTQ 5 EMBRY,,,17,,TotalUnits,,,,15.93 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89300,CPT,SEMEN ALYS PRESENCE&/MOTILITY SPRM HUHNER,,,17,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89310,CPT,SEMEN ALYS MOTILITY&CNT X W/HUHNER TST,,,17,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89320,CPT,SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89321,CPT,SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89322,CPT,SEMEN ANALYSIS STRICT MORPHOLOGIC CRITERIA,,,17,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89325,CPT,SPERM ANTIBODIES,,,17,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89329,CPT,SPERM EVALUATION HAMSTER PENETRATION TEST,,,17,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89330,CPT,SPERM EVALUATION CERVICAL MUCOUS PENETRATION,,,17,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89331,CPT,SPERM EVALUATION RETROGRADE EJACULATION URINE,,,17,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89337,CPT,CRYOPRESERVATION MATURE OOCYTE(S),,,17,,TotalUnits,,,,12.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89342,CPT,STORAGE PER YEAR EMBRYO,,,17,,TotalUnits,,,,2.74 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89343,CPT,STORAGE PER YEAR SPERM/SEMEN,,,17,,TotalUnits,,,,2.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89346,CPT,STORAGE PER YEAR OOCYTE,,,17,,TotalUnits,,,,3.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89352,CPT,THAWING CRYOPRESERVED EMBRYO,,,17,,TotalUnits,,,,6.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89353,CPT,THAWING CRYOPRESERVED SPERM/SEMEN EACH ALIQUOT,,,17,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89354,CPT,THAWING CRYOPRESERVED TESTICULAR/OVARIAN,,,17,,TotalUnits,,,,1.62 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 89398,CPT,UNLISTED REPRODUCTIVE MEDICINE LAB PROCEDURE,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90281,CPT,IMMUNE GLOBULIN IG HUMAN IM USE,,,22,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90283,CPT,IMMUNE GLOBULIN IGIV HUMAN IV USE,,,22,,TotalUnits,,,,1.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90284,CPT,IMMUNE GLOBULIN HUMAN SUBQ INFUSION 100 MG EA,,,22,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90287,CPT,BOTULINUM ANTITOXIN EQUINE ANY ROUTE,,,22,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90291,CPT,CYTOMEGALOVIRUS IMMUNE GLOBULIN HUMAN IV,,,22,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90296,CPT,DIPHTHERIA ANTITOXIN EQUINE ANY ROUTE,,,22,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90371,CPT,HEPATITIS B IMMUNE GLOBULIN HBIG HUMAN IM,,,22,,TotalUnits,,,,2.85 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90375,CPT,RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ,,,22,,TotalUnits,,,,3.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90376,CPT,RABIES IG HEAT-TREATED HUMAN IM/SUBQ,,,22,,TotalUnits,,,,3.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90378,CPT,RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E,,,22,,TotalUnits,,,,21.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90384,CPT,RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM,,,22,,TotalUnits,,,,2.10 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90385,CPT,RHO(D) IMMUNE GLOBULIN HUMAN MINI-DOSE IM,,,22,,TotalUnits,,,,0.96 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90386,CPT,RHO(D) IMMUNE GLOBULIN HUMAN IV,,,22,,TotalUnits,,,,3.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90389,CPT,TETANUS IMMUNE GLOBULIN TIG HUMAN IM,,,22,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90396,CPT,VARICELLA-ZOSTER IMMUNE GLOBULIN HUMAN IM,,,22,,TotalUnits,,,,2.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90399,CPT,UNLISTED IMMUNE GLOBULIN,,,22,,TotalUnits,,,,1.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90460,CPT,IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX,,,9,,RBRVS,0.17 ,0.53 ,0.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90461,CPT,IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT,,,9,,RBRVS,0.15 ,0.19 ,0.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90471,CPT,IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE,,,9,,RBRVS,0.17 ,0.53 ,0.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90472,CPT,IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE,,,9,,RBRVS,0.15 ,0.19 ,0.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90473,CPT,IM ADM INTRANSL/ORAL 1 VACCINE,,,9,,RBRVS,0.17 ,0.53 ,0.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90474,CPT,IM ADM INTRANSL/ORAL EA VACCINE,,,9,,RBRVS,0.15 ,0.19 ,0.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90476,CPT,ADENOVIRUS VACCINE TYPE 4 LIVE ORAL,,,9,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90477,CPT,ADENOVIRUS VACCINE TYPE 7 LIVE FOR ORAL,,,9,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90581,CPT,ANTHRAX VACCINE SUBCUTANEOUS/IM USE,,,9,,TotalUnits,,,,3.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90585,CPT,BACILLUS CALMETTE-GUERIN VACC FOR TB LIVE PERQ,,,9,,TotalUnits,,,,4.02 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90586,CPT,BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL,,,9,,TotalUnits,,,,6.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90620,CPT,MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM,,,9,,TotalUnits,,,,7.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90621,CPT,MENB RECOMBINANT LIPOPROTEIN VACCINE IM,,,9,,TotalUnits,,,,5.24 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90630,CPT,INFLUENZA VACC IIV4 SPLIT VIRUS PRSRV FREE ID,,,9,,TotalUnits,,,,2.00 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90632,CPT,HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE,,,9,,TotalUnits,,,,2.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90633,CPT,HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE,,,9,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90634,CPT,HEPA VACCINE 3 DOSE SCHEDULE PED/ADOLESC IM USE,,,9,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90636,CPT,HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM,,,9,,TotalUnits,,,,2.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90644,CPT,HIB-MENCY VACC 4 DOSE SCHEDULE 2-18 MONTHS IM,,,9,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90647,CPT,HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE,,,9,,TotalUnits,,,,0.91 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90648,CPT,HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE,,,9,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90649,CPT,4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE,,,9,,TotalUnits,,,,4.07 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90650,CPT,2VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE,,,9,,TotalUnits,,,,2.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90651,CPT,9VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE,,,9,,TotalUnits,,,,4.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90653,CPT,IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE,,,9,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90654,CPT,INFLUENZA VACC IIV3 SPLIT VIRUS PRSRV FREE ID,,,9,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90655,CPT,IIV3 VACC PRESRV FREE CHILD 6-35 MONTHS IM USE,,,9,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90656,CPT,IIV3 VACC PRESERVATIVE FREE 3 YRS & OLDER IM USE,,,9,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90657,CPT,IIV3 VACCINE TO CHILD 6-35 MONTHS FOR IM USE,,,9,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90658,CPT,IIV3 VACCINE 3 YRS & OLDER FOR IM USE,,,9,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90660,CPT,LAIV3 VACCINE LIVE FOR INTRANASAL USE,,,9,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90661,CPT,CCIIV3 VACCINE PRESERVATIVE FREE FOR IM USE,,,9,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90662,CPT,IIV VACCINE PRESERV FREE INCREASED AG COUNT IM,,,9,,TotalUnits,,,,0.94 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90664,CPT,LAIV VACCINE PANDEMIC FORMULA FOR INTRANASAL USE,,,9,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90666,CPT,INFLUENZA VACCINE PANDEMIC SPLT PRSRV FREE IM,,,9,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90667,CPT,IIV VACCINE PANDEMIC ADJUVANT FOR IM USE,,,9,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90668,CPT,IIV VACCINE PANDEMIC FOR INTRAMUSCULAR USE,,,9,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90670,CPT,PCV13 VACCINE FOR INTRAMUSCULAR USE,,,9,,TotalUnits,,,,3.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90672,CPT,LAIV4 VACCINE FOR INTRANASAL USE,,,9,,TotalUnits,,,,1.47 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90673,CPT,RIV3 VACCINE PRESERVATIVE FREE FOR IM USE,,,9,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90674,CPT,CCIIV4 VAC NO PRSV 0.5 ML IM,,,9,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90675,CPT,RABIES VACCINE INTRAMUSCULAR,,,9,,TotalUnits,,,,6.11 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90676,CPT,RABIES VACCINE INTRADERMAL,,,9,,TotalUnits,,,,3.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90680,CPT,RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE,,,9,,TotalUnits,,,,2.41 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90681,CPT,RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE,,,9,,TotalUnits,,,,2.41 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90685,CPT,IIV4 PRESRV FREE VACC CHILD 6-35 MO FOR IM USE,,,9,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90686,CPT,IIV4 VACC PRESRV FREE 3 YRS & OLDER IM USE,,,9,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90687,CPT,IIV4 VACCINE CHILD 6-35 MO FOR IM USE,,,9,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90688,CPT,IIV4 VACCINE 3 YRS & OLDER FOR IM USE,,,9,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90690,CPT,TYPHOID VACCINE LIVE ORAL,,,9,,TotalUnits,,,,1.23 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90691,CPT,TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM,,,9,,TotalUnits,,,,1.75 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90696,CPT,DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE,,,9,,TotalUnits,,,,1.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90697,CPT,DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR,,,9,,TotalUnits,,,,3.04 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90698,CPT,DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE,,,9,,TotalUnits,,,,2.41 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90700,CPT,DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM,,,9,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90702,CPT,DT VACCINE YOUNGER THAN 7 YRS FOR IM USE,,,9,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90707,CPT,MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ,,,9,,TotalUnits,,,,1.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90710,CPT,MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ,,,9,,TotalUnits,,,,4.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90713,CPT,POLIOVIRUS VACCINE INACTIVATED SUBQ/IM,,,9,,TotalUnits,,,,0.91 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90714,CPT,TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE,,,9,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90715,CPT,TDAP VACCINE 7 YRS/> IM,,,9,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90716,CPT,VAR VACCINE LIVE FOR SUBCUTANEOUS USE,,,9,,TotalUnits,,,,2.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90717,CPT,YELLOW FEVER VACCINE LIVE SUBQ,,,9,,TotalUnits,,,,2.73 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90723,CPT,DTAP-HEPB-IPV VACCINE INTRAMUSCULAR,,,9,,TotalUnits,,,,2.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90732,CPT,PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE,,,9,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90733,CPT,MPSV4 VACCINE GROUPS ACYW-135 SUBQ USE,,,9,,TotalUnits,,,,3.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90734,CPT,MENACWY CONJUGATE VACCINE GROUPS ACYW-135 IM USE,,,9,,TotalUnits,,,,3.05 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90736,CPT,ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE,,,9,,TotalUnits,,,,5.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90738,CPT,JAPANESE ENCEPHALITIS VACCINE INACTIVATED IM,,,9,,TotalUnits,,,,2.12 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90739,CPT,HEPB VACCINE ADULT 2 DOSE SCHEDULE FOR IM USE,,,9,,TotalUnits,,,,2.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90740,CPT,HEPB VACCINE DIALYSIS/IMMUNSUP PAT 3 DOSE IM,,,9,,TotalUnits,,,,6.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90743,CPT,HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM,,,9,,TotalUnits,,,,1.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90744,CPT,HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM,,,9,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90746,CPT,HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE,,,9,,TotalUnits,,,,2.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90747,CPT,HEPB VACCINE DIALYSIS/IMMUNSUP PAT 4 DOSE IM,,,9,,TotalUnits,,,,6.94 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90748,CPT,HIB-HEPB VACCINE FOR INTRAMUSCULAR USE,,,9,,TotalUnits,,,,1.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90749,CPT,UNLISTED VACCINE/TOXOID,,,9,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 90785,CPT,PSYCHOTHERAPY COMPLEX INTERACTIVE,,,16,,RBRVS,0.33 ,0.05 ,0.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90791,CPT,PSYCHIATRIC DIAGNOSTIC EVALUATION,,,16,,RBRVS,3.00 ,0.47 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90792,CPT,PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES,,,16,,RBRVS,3.25 ,0.58 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90832,CPT,PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES,,,16,,RBRVS,1.50 ,0.23 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90833,CPT,PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN,,,16,,RBRVS,1.50 ,0.27 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90834,CPT,PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES,,,16,,RBRVS,2.00 ,0.30 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90836,CPT,PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN,,,16,,RBRVS,1.90 ,0.35 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90837,CPT,PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES,,,16,,RBRVS,3.00 ,0.44 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90838,CPT,PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 60 MIN,,,16,,RBRVS,2.50 ,0.47 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90839,CPT,PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES,,,16,,RBRVS,3.13 ,0.47 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90840,CPT,PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES,,,16,,RBRVS,1.50 ,0.22 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90845,CPT,PSYCHOANALYSIS,,,16,,RBRVS,2.10 ,0.38 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90846,CPT,FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT,,,16,,RBRVS,2.40 ,0.38 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90847,CPT,FAMILY PSYCHOTHERAPY W/PATIENT PRESENT,,,16,,RBRVS,2.50 ,0.38 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90849,CPT,MULTIPLE FAMILY GROUP PSYCHOTHERAPY,,,16,,RBRVS,0.59 ,0.24 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90853,CPT,GROUP PSYCHOTHERAPY,,,16,,RBRVS,0.59 ,0.10 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90863,CPT,PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY,,,16,,TotalUnits,,,,1.42 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90865,CPT,NARCOSYNTHESIS PSYC DX&THER PURPOSES,,,16,,RBRVS,2.84 ,0.68 ,1.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90867,CPT,REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M,,,16,,TotalUnits,,,,10.75 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90868,CPT,THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG,,,16,,TotalUnits,,,,6.16 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90869,CPT,REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MN,,,16,,TotalUnits,,,,8.98 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90870,CPT,ELECTROCONVULSIVE THERAPY,,,16,,RBRVS,2.50 ,0.52 ,2.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90875,CPT,INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 30 MIN,,,16,,RBRVS,1.20 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90876,CPT,INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN,,,16,,RBRVS,1.90 ,0.73 ,1.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90880,CPT,HYPNOTHERAPY,,,16,,RBRVS,2.19 ,0.37 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90882,CPT,ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC PT,,,16,,TotalUnits,,,,1.93 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90885,CPT,PSYCHIATRIC EVAL HOSPITAL RECORDS DX PURPOSES,,,16,,RBRVS,0.97 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90887,CPT,INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY,,,16,,RBRVS,1.48 ,0.57 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90889,CPT,PREP REPORT PT PSYCH STATUS AGENCY/PAYER,,,16,,TotalUnits,,,,1.64 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90899,CPT,UNLISTED PSYCHIATRIC SERVICE/PROCEDURE,,,16,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90901,CPT,BIOFEEDBACK TRAINING ANY MODALITY,,,14,,RBRVS,0.41 ,0.13 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90911,CPT,BIOFDBK TRNG PERINL MUSC ANORECT/URO SPHX W/EMG,,,14,,RBRVS,0.89 ,0.31 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90935,CPT,HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION,,,14,,RBRVS,1.48 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90937,CPT,HEMODIALYSIS PX REPEAT EVAL W/WO REVJ DIALYS RX,,,14,,RBRVS,2.11 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90940,CPT,HEMODIALYSIS ACCESS FLOW STUDY,,,14,,TotalUnits,,,,1.28 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90945,CPT,DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL,,,14,,RBRVS,1.56 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90947,CPT,DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS,,,14,,RBRVS,2.52 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90951,CPT,ESRD RELATED SVC MONTHLY & <2 YR OLD 4/> VISITS,,,14,,RBRVS,18.46 ,6.85 ,6.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90952,CPT,ESRD RELATED SVC MONTHLY <2 YR OLD 2/3 VISITS,,,14,,TotalUnits,,,,19.80 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90953,CPT,ESRD RELATED SVC MONTHLY <2 YR OLD 1 VISIT,,,14,,TotalUnits,,,,13.20 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90954,CPT,ESRD RELATED SVC MONTHLY 2-11 YR OLD 4/> VISITS,,,14,,RBRVS,15.98 ,6.05 ,6.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90955,CPT,ESRD RELATED SVC MONTHLY 2-11 YR OLD 2/3 VISITS,,,14,,RBRVS,8.79 ,3.60 ,3.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90956,CPT,ESRD RELATED SVC MONTHLY 2-11 YR OLD 1 VISIT,,,14,,RBRVS,5.95 ,2.70 ,2.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90957,CPT,ESRD RELATED SVC MONTHLY 12-19 YR OLD 4/> VISITS,,,14,,RBRVS,12.52 ,4.94 ,4.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90958,CPT,ESRD RELATED SVC MONTHLY 12-19 YR OLD 2/3 VISITS,,,14,,RBRVS,8.34 ,3.49 ,3.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90959,CPT,ESRD RELATED SVC MONTHLY 12-19 YR OLD 1 VISIT,,,14,,RBRVS,5.50 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90960,CPT,ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS,,,14,,RBRVS,5.18 ,2.54 ,2.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90961,CPT,ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS,,,14,,RBRVS,4.26 ,2.23 ,2.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90962,CPT,ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT,,,14,,RBRVS,3.15 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90963,CPT,ESRD SVC HOME DIALYSIS FULL MONTH <2YR OLD,,,14,,RBRVS,10.56 ,4.18 ,4.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90964,CPT,ESRD SVC HOME DIALYSIS FULL MONTH 2-11 YR OLD,,,14,,RBRVS,9.14 ,3.74 ,3.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90965,CPT,ESRD SVC HOME DIALYSIS FULL MONTH 12-19 YR OLD,,,14,,RBRVS,8.69 ,3.58 ,3.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90966,CPT,ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD,,,14,,RBRVS,4.26 ,2.22 ,2.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90967,CPT,ESRD RELATED SVC YR OLD,,,14,,RBRVS,0.14 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90989,CPT,DIALYSIS TRAINING PATIENT COMPLETED COURSE,,,14,,TotalUnits,,,,8.01 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90993,CPT,DIALYSIS TRAINING PATIENT PER TRAINING SESSION,,,14,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90997,CPT,HEMOPERFUSION,,,14,,RBRVS,1.84 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 90999,CPT,UNLISTED DIALYSIS PROCEDURE INPATIENT/OUTPATIENT,,,14,,TotalUnits,,,,1.97 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91010,CPT,ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT,,,14,,RBRVS,1.28 ,3.60 ,3.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91010,CPT,ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT,26,,14,,RBRVS,1.28 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91010,CPT,ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT,TC,,14,,RBRVS,,3.05 ,3.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91013,CPT,ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION,,,14,,RBRVS,0.18 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91013,CPT,ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION,26,,14,,RBRVS,0.18 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91013,CPT,ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION,TC,,14,,RBRVS,,0.38 ,0.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91020,CPT,GASTRIC MOTILITY MANOMETRIC STUDIES,,,14,,RBRVS,1.44 ,5.07 ,5.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91020,CPT,GASTRIC MOTILITY MANOMETRIC STUDIES,26,,14,,RBRVS,1.44 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91020,CPT,GASTRIC MOTILITY MANOMETRIC STUDIES,TC,,14,,RBRVS,,4.44 ,4.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91022,CPT,DUODENAL MOTILITY MANOMETRIC STUDY,,,14,,RBRVS,1.44 ,3.21 ,3.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91022,CPT,DUODENAL MOTILITY MANOMETRIC STUDY,26,,14,,RBRVS,1.44 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91022,CPT,DUODENAL MOTILITY MANOMETRIC STUDY,TC,,14,,RBRVS,,2.58 ,2.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91030,CPT,ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS,,,14,,RBRVS,0.91 ,2.88 ,2.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91030,CPT,ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS,26,,14,,RBRVS,0.91 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91030,CPT,ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS,TC,,14,,RBRVS,,2.49 ,2.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91034,CPT,GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT,,,14,,RBRVS,0.97 ,4.30 ,4.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91034,CPT,GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT,26,,14,,RBRVS,0.97 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91034,CPT,GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT,TC,,14,,RBRVS,,3.88 ,3.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91035,CPT,GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD,,,14,,RBRVS,1.59 ,11.82 ,11.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91035,CPT,GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD,26,,14,,RBRVS,1.59 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91035,CPT,GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD,TC,,14,,RBRVS,,11.14 ,11.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91037,CPT,GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD,,,14,,RBRVS,0.97 ,3.49 ,3.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91037,CPT,GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD,26,,14,,RBRVS,0.97 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91037,CPT,GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD,TC,,14,,RBRVS,,3.07 ,3.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91038,CPT,ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG,,,14,,RBRVS,1.10 ,11.49 ,11.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91038,CPT,ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG,26,,14,,RBRVS,1.10 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91038,CPT,ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG,TC,,14,,RBRVS,,11.02 ,11.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91040,CPT,ESOPHGL BALO DISTENSION DX STD W/PROVOCATION,,,14,,RBRVS,0.97 ,11.24 ,11.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91040,CPT,ESOPHGL BALO DISTENSION DX STD W/PROVOCATION,26,,14,,RBRVS,0.97 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91040,CPT,ESOPHGL BALO DISTENSION DX STD W/PROVOCATION,TC,,14,,RBRVS,,10.82 ,10.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91065,CPT,BREATH HYDROGEN/METHANE TEST,,,14,,RBRVS,0.20 ,1.98 ,1.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91065,CPT,BREATH HYDROGEN/METHANE TEST,26,,14,,RBRVS,0.20 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91065,CPT,BREATH HYDROGEN/METHANE TEST,TC,,14,,RBRVS,,1.90 ,1.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91110,CPT,GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R,,,14,,RBRVS,3.64 ,21.06 ,21.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91110,CPT,GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R,26,,14,,RBRVS,3.64 ,1.60 ,1.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91110,CPT,GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R,TC,,14,,RBRVS,,19.46 ,19.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91111,CPT,GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R,,,14,,RBRVS,1.00 ,19.35 ,19.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91111,CPT,GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R,26,,14,,RBRVS,1.00 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91111,CPT,GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R,TC,,14,,RBRVS,,18.91 ,18.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91112,CPT,GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP,,,14,,RBRVS,2.10 ,28.23 ,28.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91112,CPT,GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP,26,,14,,RBRVS,2.10 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91112,CPT,GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP,TC,,14,,RBRVS,,27.32 ,27.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91117,CPT,COLON MOTILITY STDY MIN 6 HR CONT RECORD W/I&R,,,14,,RBRVS,2.45 ,1.32 ,1.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91120,CPT,RECTAL SESATION TONE & COMPLIANCE TEST,,,14,,RBRVS,0.97 ,10.93 ,10.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91120,CPT,RECTAL SESATION TONE & COMPLIANCE TEST,26,,14,,RBRVS,0.97 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91120,CPT,RECTAL SESATION TONE & COMPLIANCE TEST,TC,,14,,RBRVS,,10.54 ,10.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91122,CPT,ANORECTAL MANOMETRY,,,14,,RBRVS,1.77 ,4.49 ,4.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91122,CPT,ANORECTAL MANOMETRY,26,,14,,RBRVS,1.77 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91122,CPT,ANORECTAL MANOMETRY,TC,,14,,RBRVS,,3.82 ,3.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91132,CPT,ELECTROGASTROGRAPHY DX TRANSCUTANEOUS,,,14,,RBRVS,0.52 ,3.76 ,3.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91132,CPT,ELECTROGASTROGRAPHY DX TRANSCUTANEOUS,26,,14,,RBRVS,0.52 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91132,CPT,ELECTROGASTROGRAPHY DX TRANSCUTANEOUS,TC,,14,,RBRVS,,3.55 ,3.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91133,CPT,ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG,,,14,,RBRVS,0.66 ,4.15 ,4.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91133,CPT,ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG,26,,14,,RBRVS,0.66 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91133,CPT,ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG,TC,,14,,RBRVS,,3.86 ,3.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91200,CPT,LIVER ELASTOGRAPHY W/O IMAG W/I&R,,,20,,RBRVS,0.27 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91200,CPT,LIVER ELASTOGRAPHY W/O IMAG W/I&R,26,,20,,RBRVS,0.27 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 91200,CPT,LIVER ELASTOGRAPHY W/O IMAG W/I&R,TC,,20,,RBRVS,,0.51 ,0.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 91299,CPT,UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE,,,14,,TotalUnits,,,,6.93 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 91299,CPT,UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE,,PC,14,,TotalUnits,,,,2.35 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 91299,CPT,UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE,,TC,14,,TotalUnits,,,,4.57 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 92002,CPT,OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT,,,23,,RBRVS,0.88 ,0.44 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92004,CPT,OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST,,,23,,RBRVS,1.82 ,0.93 ,2.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92012,CPT,OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT,,,23,,RBRVS,0.92 ,0.53 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92014,CPT,OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/>,,,23,,RBRVS,1.42 ,0.78 ,2.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92015,CPT,DETERMINATION REFRACTIVE STATE,,,23,,RBRVS,0.38 ,0.15 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92018,CPT,OPHTH XM&EVAL ANES W/WO MANJ GLOBE COMPL,,,14,,RBRVS,2.50 ,1.51 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92019,CPT,OPHTH XM&EVAL ANES W/WO MANJ GLOBE LMTD,,,14,,RBRVS,1.31 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92020,CPT,GONIOSCOPY SEPARATE PROCEDURE,,,14,,RBRVS,0.37 ,0.21 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92025,CPT,COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI,,,14,,RBRVS,0.35 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92025,CPT,COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI,26,,14,,RBRVS,0.35 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92025,CPT,COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI,TC,,14,,RBRVS,,0.49 ,0.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92060,CPT,SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX,,,14,,RBRVS,0.69 ,1.12 ,1.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92060,CPT,SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX,26,,14,,RBRVS,0.69 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92060,CPT,SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX,TC,,14,,RBRVS,,0.74 ,0.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92065,CPT,ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ,,,14,,RBRVS,0.37 ,1.11 ,1.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92065,CPT,ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ,26,,14,,RBRVS,0.37 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92065,CPT,ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ,TC,,14,,RBRVS,,0.98 ,0.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92071,CPT,FIT CONTACT LENS TX OCULAR SURFACE DISEASE,,,14,,RBRVS,0.61 ,0.32 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92072,CPT,FITTING CONTACT LENS FOR MNGT OF KERATOCONUS,,,14,,RBRVS,1.97 ,0.88 ,1.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92081,CPT,VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM,,,14,,RBRVS,0.30 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92081,CPT,VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM,26,,14,,RBRVS,0.30 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92081,CPT,VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM,TC,,14,,RBRVS,,0.48 ,0.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92082,CPT,VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM,,,14,,RBRVS,0.40 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92082,CPT,VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM,26,,14,,RBRVS,0.40 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92082,CPT,VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM,TC,,14,,RBRVS,,0.73 ,0.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92083,CPT,VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM,,,14,,RBRVS,0.50 ,1.29 ,1.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92083,CPT,VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM,26,,14,,RBRVS,0.50 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92083,CPT,VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM,TC,,14,,RBRVS,,1.01 ,1.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92100,CPT,SERIAL TONOMETRY SPX W/MLT MEAS INTRAOCULAR PRES,,,14,,RBRVS,0.61 ,0.33 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92132,CPT,CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI,,,14,,RBRVS,0.35 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92132,CPT,CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI,26,,14,,RBRVS,0.35 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92132,CPT,CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI,TC,,14,,RBRVS,,0.43 ,0.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92133,CPT,COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE,,,14,,RBRVS,0.50 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92133,CPT,COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE,26,,14,,RBRVS,0.50 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92133,CPT,COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE,TC,,14,,RBRVS,,0.44 ,0.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92134,CPT,COMPUTERIZED OPHTHALMIC IMAGING RETINA,,,14,,RBRVS,0.50 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92134,CPT,COMPUTERIZED OPHTHALMIC IMAGING RETINA,26,,14,,RBRVS,0.50 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92134,CPT,COMPUTERIZED OPHTHALMIC IMAGING RETINA,TC,,14,,RBRVS,,0.45 ,0.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92136,CPT,OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL,,,14,,RBRVS,0.54 ,1.98 ,1.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92136,CPT,OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL,26,,14,,RBRVS,0.54 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92136,CPT,OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL,TC,,14,,RBRVS,,1.65 ,1.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92145,CPT,CORNEA HYSTERESIS DETERMIN IMPULSE STIMJ UNI/BI,,,14,,RBRVS,0.17 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92145,CPT,CORNEA HYSTERESIS DETERMIN IMPULSE STIMJ UNI/BI,26,,14,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92145,CPT,CORNEA HYSTERESIS DETERMIN IMPULSE STIMJ UNI/BI,TC,,14,,RBRVS,,0.18 ,0.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92225,CPT,OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R 1ST,,,14,,RBRVS,0.38 ,0.21 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92226,CPT,OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R SBS,,,14,,RBRVS,0.33 ,0.20 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92227,CPT,REMOTE IMG DX RETINL DIS W/ALYS & REPORT UNI/B,,TC,14,,RBRVS,,0.40 ,0.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92228,CPT,REMOTE IMAGING MGT RETINAL DISEASE W/I&R UNI/B,,,14,,RBRVS,0.37 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92228,CPT,REMOTE IMAGING MGT RETINAL DISEASE W/I&R UNI/B,26,,14,,RBRVS,0.37 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92228,CPT,REMOTE IMAGING MGT RETINAL DISEASE W/I&R UNI/B,TC,,14,,RBRVS,,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92230,CPT,FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT,,,14,,RBRVS,0.60 ,0.32 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92235,CPT,FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT,,,14,,RBRVS,0.81 ,2.26 ,2.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92235,CPT,FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT,26,,14,,RBRVS,0.81 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92235,CPT,FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT,TC,,14,,RBRVS,,1.75 ,1.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92240,CPT,INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR,,,14,,RBRVS,1.10 ,6.06 ,6.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92240,CPT,INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR,26,,14,,RBRVS,1.10 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92240,CPT,INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR,TC,,14,,RBRVS,,5.37 ,5.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92242,CPT,FLUORESCEIN ICG ANGIOGRAPHY,,,14,,RBRVS,0.95 ,5.42 ,5.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92242,CPT,FLUORESCEIN ICG ANGIOGRAPHY,26,,14,,RBRVS,0.95 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92242,CPT,FLUORESCEIN ICG ANGIOGRAPHY,TC,,14,,RBRVS,,4.82 ,4.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92250,CPT,FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT,,,14,,RBRVS,0.44 ,1.76 ,1.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92250,CPT,FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT,26,,14,,RBRVS,0.44 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92250,CPT,FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT,TC,,14,,RBRVS,,1.53 ,1.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92260,CPT,OPHTHALMODYNAMOMETRY,,,14,,RBRVS,0.20 ,0.10 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92265,CPT,NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R,,,14,,RBRVS,0.81 ,1.38 ,1.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92265,CPT,NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R,26,,14,,RBRVS,0.81 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92265,CPT,NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R,TC,,14,,RBRVS,,1.00 ,1.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92270,CPT,ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT,,,14,,RBRVS,0.81 ,1.73 ,1.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92270,CPT,ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT,26,,14,,RBRVS,0.81 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92270,CPT,ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT,TC,,14,,RBRVS,,1.40 ,1.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92275,CPT,ELECTRORETINOGRAPY W/INTERPRETATION & REPORT,,,14,,RBRVS,1.01 ,3.14 ,3.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92275,CPT,ELECTRORETINOGRAPY W/INTERPRETATION & REPORT,26,,14,,RBRVS,1.01 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92275,CPT,ELECTRORETINOGRAPY W/INTERPRETATION & REPORT,TC,,14,,RBRVS,,2.63 ,2.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92283,CPT,COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV,,,14,,RBRVS,0.17 ,1.37 ,1.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92283,CPT,COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV,26,,14,,RBRVS,0.17 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92283,CPT,COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV,TC,,14,,RBRVS,,1.29 ,1.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92284,CPT,DARK ADAPTATION XM W/INTERPRETATION & REPORT,,,14,,RBRVS,0.24 ,1.47 ,1.47 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92284,CPT,DARK ADAPTATION XM W/INTERPRETATION & REPORT,26,,14,,RBRVS,0.24 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92284,CPT,DARK ADAPTATION XM W/INTERPRETATION & REPORT,TC,,14,,RBRVS,,1.37 ,1.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92285,CPT,XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE,,,14,,RBRVS,0.05 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92285,CPT,XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE,26,,14,,RBRVS,0.05 ,0.03 ,0.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92285,CPT,XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE,TC,,14,,RBRVS,,0.48 ,0.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92286,CPT,ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY,,,14,,RBRVS,0.40 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92286,CPT,ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY,26,,14,,RBRVS,0.40 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92286,CPT,ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY,TC,,14,,RBRVS,,0.44 ,0.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92287,CPT,ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R,,,14,,RBRVS,0.81 ,3.04 ,3.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92287,CPT,ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R,26,,14,,RBRVS,0.81 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92287,CPT,ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R,TC,,14,,RBRVS,,2.54 ,2.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92310,CPT,RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK,,,23,,RBRVS,1.17 ,0.45 ,1.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92311,CPT,RX&FITG CONTACT CORNEAL LENS APHAKIA 1 EYE,,,14,,RBRVS,1.08 ,0.46 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92312,CPT,RX&FITG CONTACT CORNEAL LENS APHAKIA BOTH EYES,,,14,,RBRVS,1.26 ,0.50 ,1.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92313,CPT,RX&FITG CORNEOSCLERAL LENS,,,14,,RBRVS,0.92 ,0.39 ,1.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92314,CPT,RX&FTG CONTACT CORNEAL LENS EYES XCPT APHAKIA,,,23,,RBRVS,0.69 ,0.26 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92315,CPT,RX CONTACT CORNEAL LENS APHAKIA 1 EYE,,,14,,RBRVS,0.45 ,0.15 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92316,CPT,RX CONTACT CORNEAL LENS APHAKIA BOTH EYES,,,14,,RBRVS,0.68 ,0.23 ,1.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92317,CPT,RX CONTACT CORNEOSCLERAL LENS,,,14,,RBRVS,0.45 ,0.16 ,1.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92325,CPT,MODIFICAJ CONTACT LENX SPX SUPVJ ADAPTATION,,,14,,RBRVS,,1.17 ,1.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92326,CPT,REPLACEMENT CONTACT LENS,,,14,,RBRVS,,0.98 ,0.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92340,CPT,FITTING SPECTACLES XCPT APHAKIA MONOFOCAL,,,14,,RBRVS,0.37 ,0.14 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92341,CPT,FITTING SPECTACLES XCPT APHAKIA BIFOCAL,,,14,,RBRVS,0.47 ,0.18 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92342,CPT,FITTING SPECTACLES XCPT APHAKIA MULTIFOCAL,,,14,,RBRVS,0.53 ,0.20 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92352,CPT,FITTING SPECTACLE PROSTH APHAKIA MONOFOCAL,,,14,,RBRVS,0.37 ,0.14 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92353,CPT,FITTING SPECTACLE PROSTH APHAKIA MULTIFOCAL,,,14,,RBRVS,0.50 ,0.19 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92354,CPT,FITTING SPECTACLE MOUNTED LW VIS AID 1 ELMNT,,,14,,RBRVS,,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92355,CPT,FITTING SPECTACLE MOUNTED LW VIS AID TLSCP,,,14,,RBRVS,,0.58 ,0.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92358,CPT,PROSTHESIS SERVICE APHAKIA TEMPORARY,,,14,,RBRVS,,0.31 ,0.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92370,CPT,RPR&REFITG SPECTACLES EXCEPT APHAKIA,,,14,,RBRVS,0.32 ,0.12 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92371,CPT,RPR&REFITG SPECTACLE PROSTHESIS APHAKIA,,,14,,RBRVS,,0.32 ,0.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92499,CPT,UNLIVSTED OPHTHALMOLOGICAL SERVICE/PROCEDURE,,,14,,TotalUnits,,,,1.25 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92499,CPT,UNLIVSTED OPHTHALMOLOGICAL SERVICE/PROCEDURE,,PC,14,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 92499,CPT,UNLIVSTED OPHTHALMOLOGICAL SERVICE/PROCEDURE,,TC,14,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 92502,CPT,OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA,,,14,,RBRVS,1.51 ,1.15 ,1.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92504,CPT,BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE,,,14,,RBRVS,0.18 ,0.08 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92507,CPT,TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND,,,8,,RBRVS,1.30 ,0.88 ,0.88 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92508,CPT,TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV,,,8,,RBRVS,0.33 ,0.32 ,0.32 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92511,CPT,NASOPHARYNGOSCOPY W/ENDOSCOPE SPX,,,14,,RBRVS,0.61 ,0.47 ,2.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92512,CPT,NASAL FUNCTION STUDIES,,,14,,RBRVS,0.55 ,0.23 ,1.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92516,CPT,FACIAL NERVE FUNCTION STUDIES,,,14,,RBRVS,0.43 ,0.20 ,1.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92520,CPT,LARYNGEAL FUNCTION STUDIES,,,14,,RBRVS,0.75 ,0.37 ,1.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92521,CPT,EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER),,,8,,RBRVS,1.75 ,1.30 ,1.30 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92522,CPT,EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE,,,8,,RBRVS,1.50 ,1.04 ,1.04 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92523,CPT,EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION,,,8,,RBRVS,3.00 ,2.34 ,2.34 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92524,CPT,BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE,,,8,,RBRVS,1.50 ,0.96 ,0.96 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92526,CPT,TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING,,,14,,RBRVS,1.34 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92531,CPT,SPONTANEOUS NYSTAGMUS W/GAZE,,,14,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92532,CPT,POSITIONAL NYSTAGMUS TEST,,,14,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92533,CPT,CALORIC VESTIBULAR TEST EACH IRRIGATION,,,14,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92534,CPT,OPTOKINETIC NYSTAGMUS TEST,,,14,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92537,CPT,CALORIC VESTIBULAR TEST W/REC BI BITHERMAL,,,14,,RBRVS,0.60 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92537,CPT,CALORIC VESTIBULAR TEST W/REC BI BITHERMAL,26,,14,,RBRVS,0.60 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92537,CPT,CALORIC VESTIBULAR TEST W/REC BI BITHERMAL,TC,,14,,RBRVS,,0.23 ,0.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92538,CPT,CALORIC VESTIBULAR TEST W/REC BI MONOTHERMAL,,,14,,RBRVS,0.30 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92538,CPT,CALORIC VESTIBULAR TEST W/REC BI MONOTHERMAL,26,,14,,RBRVS,0.30 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92538,CPT,CALORIC VESTIBULAR TEST W/REC BI MONOTHERMAL,TC,,14,,RBRVS,,0.12 ,0.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92540,CPT,VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK,,,14,,RBRVS,1.50 ,1.31 ,1.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92540,CPT,VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK,,PC,14,,RBRVS,1.50 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,0,20171001, 92540,CPT,VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK,,TC,14,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,0,20171001, 92541,CPT,SPONTANEOUS NYSTAGMUS TEST,,,14,,RBRVS,0.40 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92541,CPT,SPONTANEOUS NYSTAGMUS TEST,26,,14,,RBRVS,0.40 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92541,CPT,SPONTANEOUS NYSTAGMUS TEST,TC,,14,,RBRVS,,0.08 ,0.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92542,CPT,POSITIONAL NYSTAGMUS TEST,,,14,,RBRVS,0.48 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92542,CPT,POSITIONAL NYSTAGMUS TEST,26,,14,,RBRVS,0.48 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92542,CPT,POSITIONAL NYSTAGMUS TEST,TC,,14,,RBRVS,,0.07 ,0.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92544,CPT,OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC,,,14,,RBRVS,0.27 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92544,CPT,OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC,26,,14,,RBRVS,0.27 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92544,CPT,OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC,TC,,14,,RBRVS,,0.06 ,0.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92545,CPT,OSCILLATING TRACKING TEST W/RECORDING,,,14,,RBRVS,0.25 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92545,CPT,OSCILLATING TRACKING TEST W/RECORDING,26,,14,,RBRVS,0.25 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92545,CPT,OSCILLATING TRACKING TEST W/RECORDING,TC,,14,,RBRVS,,0.05 ,0.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92546,CPT,SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING,,,14,,RBRVS,0.29 ,2.59 ,2.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92546,CPT,SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING,26,,14,,RBRVS,0.29 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92546,CPT,SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING,TC,,14,,RBRVS,,2.47 ,2.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92547,CPT,USE VERTICAL ELECTRODES,,TC,14,,RBRVS,,0.17 ,0.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92548,CPT,COMPUTERIZED DYNAMIC POSTUROGRAPY,,,14,,RBRVS,0.50 ,2.36 ,2.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92548,CPT,COMPUTERIZED DYNAMIC POSTUROGRAPY,26,,14,,RBRVS,0.50 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92548,CPT,COMPUTERIZED DYNAMIC POSTUROGRAPY,TC,,14,,RBRVS,,2.14 ,2.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92550,CPT,TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS,,,8,,RBRVS,0.35 ,0.23 ,0.23 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92551,CPT,SCREENING TEST PURE TONE AIR ONLY,,,8,,RBRVS,,0.33 ,0.33 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92552,CPT,PURE TONE AUDIOMETRY AIR ONLY,,TC,8,,RBRVS,,0.87 ,0.87 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92553,CPT,PURE TONE AUDIOMETRY AIR & BONE,,TC,8,,RBRVS,,1.04 ,1.04 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92555,CPT,SPEECH AUDIOMETRY THRESHOLD,,TC,8,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92556,CPT,SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ,,TC,8,,RBRVS,,1.04 ,1.04 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92557,CPT,COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ,,,8,,RBRVS,0.60 ,0.30 ,0.43 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92558,CPT,EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS,,,8,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92559,CPT,AUDIOMETRIC TESTING GROUPS,,,8,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92560,CPT,BEKESY AUDIOMETRY SCREENING,,,8,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92561,CPT,BEKESY AUDIOMETRY DIAGNOSTIC,,TC,8,,RBRVS,,1.05 ,1.05 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92562,CPT,LOUDNESS BALANCE BINAURAL/MONAURAL,,TC,8,,RBRVS,,1.30 ,1.30 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92563,CPT,TONE DECAY TEST,,TC,8,,RBRVS,,0.86 ,0.86 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92564,CPT,SHORT INCREMENT SENSITIVITY INDEX,,TC,8,,RBRVS,,0.78 ,0.78 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92565,CPT,STENGER TEST PURE TONE,,TC,8,,RBRVS,,0.44 ,0.44 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92567,CPT,TYMPANOMETRY,,,8,,RBRVS,0.20 ,0.10 ,0.20 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92568,CPT,ACOUSTIC REFLEX THRESHOLD,,,8,,RBRVS,0.29 ,0.13 ,0.14 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92570,CPT,ACOUSTIC IMMIT TEST TYMPANOM/ACOUST REFLX/DECAY,,,8,,RBRVS,0.55 ,0.27 ,0.33 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92571,CPT,FILTERED SPEECH TEST,,TC,8,,RBRVS,,0.76 ,0.76 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92572,CPT,STAGGERED SPONDAIC WORD,,TC,8,,RBRVS,,1.00 ,1.00 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92575,CPT,SENSORINEURAL ACUITY LEVEL,,TC,8,,RBRVS,,2.02 ,2.02 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92576,CPT,SYNTHETIC SENTENCE IDENTIFICATION TEST,,TC,8,,RBRVS,,1.00 ,1.00 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92577,CPT,STENGER TEST SPEECH,,TC,8,,RBRVS,,0.46 ,0.46 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92579,CPT,VISUAL REINFORCEMENT AUDIOMETRY,,,8,,RBRVS,0.70 ,0.31 ,0.44 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92582,CPT,CONDITIONING PLAY AUDIOMETRY,,TC,8,,RBRVS,,1.89 ,1.89 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92583,CPT,SELECT PICTURE AUDIOMETRY,,TC,8,,RBRVS,,1.47 ,1.47 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92584,CPT,ELECTROCOCHLEOGRAPHY,,TC,8,,RBRVS,,2.05 ,2.05 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92585,CPT,AUDITORY EVOKED POTENTIALS COMPREHENSIVE,,,8,,RBRVS,0.50 ,3.29 ,3.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92585,CPT,AUDITORY EVOKED POTENTIALS COMPREHENSIVE,26,,8,,RBRVS,0.50 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92585,CPT,AUDITORY EVOKED POTENTIALS COMPREHENSIVE,TC,,8,,RBRVS,,3.05 ,3.05 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92586,CPT,AUDITORY EVOKED POTENTIALS LIMITED,,TC,8,,RBRVS,,2.39 ,2.39 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92587,CPT,DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD,,,8,,RBRVS,0.35 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92587,CPT,DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD,26,,8,,RBRVS,0.35 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92587,CPT,DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD,TC,,8,,RBRVS,,0.08 ,0.08 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92588,CPT,DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL,,,8,,RBRVS,0.55 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92588,CPT,DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL,26,,8,,RBRVS,0.55 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92588,CPT,DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL,TC,,8,,RBRVS,,0.10 ,0.10 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92590,CPT,HEARING AID EXAMINATION & SELECTION MONAURAL,,,8,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92591,CPT,HEARING AID EXAMINATION & SELECTION BINAURAL,,,8,,TotalUnits,,,,1.85 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92592,CPT,HEARING AID CHECK MONAURAL,,,8,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92593,CPT,HEARING AID CHECK BINAURAL,,,8,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92594,CPT,ELECTROACOUS EVAL HEARING AID MONAURAL,,,8,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92595,CPT,ELECTROACOUS EVAL HEARING AID BINAURAL,,,8,,TotalUnits,,,,1.19 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92596,CPT,EAR PROTECTOR ATTENUATION MEASUREMENTS,,TC,8,,RBRVS,,1.17 ,1.17 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92597,CPT,EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC,,,8,,RBRVS,1.26 ,0.71 ,0.71 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92601,CPT,ANALYSIS COCHLEAR IMPLT PT <7 YR PRGRMG,,,14,,RBRVS,2.30 ,0.96 ,1.56 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92602,CPT,ANALYSIS COCHLEAR IMPLT PT <7 YR SBSQ REPRGRMG,,,14,,RBRVS,1.30 ,0.59 ,1.16 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92603,CPT,ANALYSIS COCHLEAR IMPLT 7 YR/> PRGRMG,,,14,,RBRVS,2.25 ,1.12 ,1.93 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92604,CPT,ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG,,,14,,RBRVS,1.25 ,0.62 ,1.23 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92605,CPT,EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV F2F 1ST HR,,,14,,RBRVS,1.75 ,0.67 ,0.78 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92606,CPT,THER SVC N-SP-GENRATJ DEV PRGRMG&MODIFICAJ,,,14,,RBRVS,1.40 ,0.54 ,0.87 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92607,CPT,RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR,,,14,,RBRVS,1.85 ,1.64 ,1.64 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92608,CPT,RX SP-GENRATJ AUGMNT&COMUNICAJ DEV EA 30 MIN,,,14,,RBRVS,0.70 ,0.76 ,0.76 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92609,CPT,THER SP-GENRATJ DEV PRGRMG&MODIFICAJ,,,14,,RBRVS,1.50 ,1.57 ,1.57 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92610,CPT,EVAL ORAL&PHARYNGEAL SWLNG FUNCJ,,,14,,RBRVS,1.30 ,0.70 ,1.05 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92611,CPT,MOTION FLUOR EVAL SWLNG FUNCJ C/V REC,,,14,,RBRVS,1.34 ,1.03 ,1.03 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92612,CPT,FLX FIBOPT NDSC EVAL SWLNG C/V REC,,,14,,RBRVS,1.27 ,0.59 ,3.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92613,CPT,FLX FIBOPT NDSC EVAL SWLNG C/V REC PHYS I&R,,,14,,RBRVS,0.71 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92614,CPT,FLX FIBOPT NDSC EVAL LARYN SENS C/V REC,,,14,,RBRVS,1.27 ,0.58 ,2.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92615,CPT,FLX FIBOPT NDSC EVAL LARYN SENS PHYS I&R,,,14,,RBRVS,0.63 ,0.28 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92616,CPT,FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS C/V REC,,,14,,RBRVS,1.88 ,0.88 ,3.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92617,CPT,FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS PHYS I&R,,,14,,RBRVS,0.79 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92618,CPT,EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV ADD 30 MIN,,,14,,RBRVS,0.65 ,0.25 ,0.27 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 92620,CPT,EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN,,,14,,RBRVS,1.50 ,0.78 ,1.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92621,CPT,EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN,,,14,,RBRVS,0.35 ,0.18 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92625,CPT,ASSESSMENT TINNITUS,,,14,,RBRVS,1.15 ,0.57 ,0.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92626,CPT,EVALUATION AUDITORY REHAB STATUS 1ST HR,,,14,,RBRVS,1.40 ,0.71 ,1.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92627,CPT,EVALUATION AUDITORY REHAB STATUS EA 15 MIN,,,14,,RBRVS,0.33 ,0.17 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92630,CPT,AUDITORY REHABILITATION PRELINGUAL HEARING LOSS,,,14,,TotalUnits,,,,1.49 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92633,CPT,AUDITORY REHABILITATION POSTLINGUAL HEARING LOSS,,,14,,TotalUnits,,,,1.23 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92640,CPT,ANALYSIS W/PRGRMG AUD BRAINSTEM IMPLANT PR HR,,,14,,RBRVS,1.76 ,0.89 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92700,CPT,UNLISTED OTORHINOLARYNGOLOGICAL SERVICE,,,14,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92920,CPT,PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH,,,21,,RBRVS,10.10 ,3.45 ,3.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92921,CPT,PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH,,,21,,TotalUnits,,,,3.83 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92924,CPT,PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH,,,21,,RBRVS,11.99 ,4.10 ,4.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92928,CPT,PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH,,,21,,RBRVS,11.21 ,3.82 ,3.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92929,CPT,PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH,,,21,,TotalUnits,,,,4.26 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92933,CPT,PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH,,,21,,RBRVS,12.54 ,4.27 ,4.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92934,CPT,PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH,,,21,,TotalUnits,,,,5.27 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92937,CPT,PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL,,,21,,RBRVS,11.20 ,3.82 ,3.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92938,CPT,PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL,,,21,,TotalUnits,,,,5.75 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92941,CPT,PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL,,,21,,RBRVS,12.56 ,4.28 ,4.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92943,CPT,PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL,,,21,,RBRVS,12.56 ,4.28 ,4.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92944,CPT,PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL,,,21,,TotalUnits,,,,5.75 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92950,CPT,CARDIOPULMONARY RESUSCITATION,,,4,,RBRVS,4.00 ,0.97 ,4.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92953,CPT,TEMPORARY TRANSCUTANEOUS PACING,,,4,,RBRVS,0.23 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92960,CPT,CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL,,,4,,RBRVS,2.25 ,1.08 ,3.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92961,CPT,CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX,,,4,,RBRVS,4.59 ,1.97 ,1.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92970,CPT,CARDIOASSIST-METH CIRCULATORY ASSIST INTERNAL,,,4,,RBRVS,3.51 ,1.32 ,1.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 92971,CPT,CARDIOASSIST-METH CIRCULATORY ASSIST EXTERNAL,,,4,,RBRVS,1.77 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 92973,CPT,PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY,,,21,,RBRVS,3.28 ,1.12 ,1.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92974,CPT,TCAT PLACEMENT RADJ DLVR DEV SBSQ C IV BRACHYTX,,,21,,RBRVS,3.00 ,1.02 ,1.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92975,CPT,THROMBOLYSIS INTRACORONARY NFS SLCTV ANGRPH,,,4,,RBRVS,7.24 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 92977,CPT,THROMBOLYSIS CORONARY INTRAVENOUS INFUSION,,,4,,RBRVS,,1.62 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92978,CPT,INTRAVASC US CORONARY INTERP&RPT INITIAL VESSE,,,4,,TotalUnits,,,,7.45 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92978,CPT,INTRAVASC US CORONARY INTERP&RPT INITIAL VESSE,26,,4,,TotalUnits,,,,2.42 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92978,CPT,INTRAVASC US CORONARY INTERP&RPT INITIAL VESSE,TC,,4,,TotalUnits,,,,5.03 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92979,CPT,INTRAVASC US CORONARY INTERP&RPT ADDL VESSEL,,,4,,TotalUnits,,,,3.97 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 92979,CPT,INTRAVASC US CORONARY INTERP&RPT ADDL VESSEL,26,,4,,TotalUnits,,,,1.93 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92979,CPT,INTRAVASC US CORONARY INTERP&RPT ADDL VESSEL,TC,,4,,TotalUnits,,,,2.04 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 92986,CPT,PRQ BALLOON VALVULOPLASTY AORTIC VALVE,,,21,,RBRVS,22.85 ,10.60 ,10.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92987,CPT,PRQ BALLOON VALVULOPLASTY MITRAL VALVE,,,21,,RBRVS,23.63 ,10.95 ,10.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92990,CPT,PRQ BALLOON VALVULOPLASTY PULMONARY VALVE,,,21,,RBRVS,18.27 ,8.99 ,8.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92992,CPT,ATRIAL SEPTECT/SEPTOST TRANSVENOUS BALLOON,,,21,,TotalUnits,,,,30.88 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 92993,CPT,ATRIAL SEPTECT/SEPTOSTOMY BLADE METHOD,,,21,,TotalUnits,,,,23.86 ,,$0.00,$0.00,1,0,0,1,1,1,20171001, 92997,CPT,PRQ TRLUML PULMONARY ART BALLOON ANGIOP 1 VSL,,,21,,RBRVS,11.98 ,4.26 ,4.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 92998,CPT,PRQ TRLUML PULMONARY ART BALLOON ANGIOP EA VSL,,,21,,RBRVS,5.99 ,2.05 ,2.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93000,CPT,ECG ROUTINE ECG W/LEAST 12 LDS W/I&R,,,4,,RBRVS,0.17 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93005,CPT,ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R,,TC,4,,RBRVS,,0.23 ,0.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93010,CPT,ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY,,PC,4,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93015,CPT,CV STRS TST XERS&/OR RX CONT ECG W/SI&R,,,4,,RBRVS,0.75 ,1.36 ,1.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93016,CPT,CV STRS TST XERS&/OR RX CONT ECG W/O I&R,,PC,4,,RBRVS,0.45 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93017,CPT,CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY,,TC,4,,RBRVS,,1.10 ,1.10 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93018,CPT,CV STRS TST XERS&/OR RX CONT ECG I&R ONLY,,PC,4,,RBRVS,0.30 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93024,CPT,ERGONOVINE PROVOCATION TST,,,4,,RBRVS,1.17 ,1.93 ,1.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93024,CPT,ERGONOVINE PROVOCATION TST,26,,4,,RBRVS,1.17 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93024,CPT,ERGONOVINE PROVOCATION TST,TC,,4,,RBRVS,,1.52 ,1.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93025,CPT,MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS,,,4,,RBRVS,0.75 ,3.71 ,3.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93025,CPT,MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS,26,,4,,RBRVS,0.75 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93025,CPT,MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS,TC,,4,,RBRVS,,3.45 ,3.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93040,CPT,RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT,,,4,,RBRVS,0.15 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93041,CPT,RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R,,TC,4,,RBRVS,,0.15 ,0.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93042,CPT,RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON,,PC,4,,RBRVS,0.15 ,0.04 ,0.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93050,CPT,ART PRESS WAVEFORM ANALYS CENTRAL ART PRESSURE,,,4,,RBRVS,0.17 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93050,CPT,ART PRESS WAVEFORM ANALYS CENTRAL ART PRESSURE,26,,4,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93050,CPT,ART PRESS WAVEFORM ANALYS CENTRAL ART PRESSURE,TC,,4,,RBRVS,,0.24 ,0.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93224,CPT,XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I,,,4,,RBRVS,0.52 ,2.01 ,2.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93225,CPT,XTRNL ECG & 48 HR RECORDING,,TC,4,,RBRVS,,0.74 ,0.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93226,CPT,EXTERNAL ECG SCANNING ANALYSIS REPORT,,TC,4,,RBRVS,,1.06 ,1.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93227,CPT,XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS,,PC,4,,RBRVS,0.52 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93228,CPT,XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS,,PC,4,,RBRVS,0.52 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93229,CPT,XTRNL MOBILE CV TELEMETRY W/TECHNICAL SUPPORT,,TC,4,,RBRVS,,20.44 ,20.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93260,CPT,PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM,,,4,,RBRVS,0.85 ,1.00 ,1.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93260,CPT,PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM,26,,4,,RBRVS,0.85 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93260,CPT,PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM,TC,,4,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93261,CPT,INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB,,,4,,RBRVS,0.74 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93261,CPT,INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB,26,,4,,RBRVS,0.74 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93261,CPT,INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB,TC,,4,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93268,CPT,XTRNL PT ACTIV ECG TRANSMIS W/R&I HR ALYS I&R,,,4,,RBRVS,0.38 ,1.11 ,1.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93786,CPT,BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL,,TC,4,,RBRVS,,0.83 ,0.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93788,CPT,AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT,,TC,4,,RBRVS,,0.14 ,0.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93790,CPT,AMBL BLD PRESS TAPE&/DISK 24/> HR REVIEW,,PC,4,,RBRVS,0.38 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93797,CPT,OUTPATIENT CARDIAC REHAB W/O CONT ECG MONITOR,,,4,,RBRVS,0.18 ,0.06 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93798,CPT,OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING,,,4,,RBRVS,0.28 ,0.10 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93799,CPT,UNLISTED CARDIOVASCULAR SERVICE/PROCEDURE,,,4,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93799,CPT,UNLISTED CARDIOVASCULAR SERVICE/PROCEDURE,,PC,4,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 93799,CPT,UNLISTED CARDIOVASCULAR SERVICE/PROCEDURE,,TC,4,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 93880,CPT,DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,,,14,,RBRVS,0.80 ,4.87 ,4.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93880,CPT,DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,26,,14,,RBRVS,0.80 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93880,CPT,DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,TC,,14,,RBRVS,,4.60 ,4.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93882,CPT,DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY,,,14,,RBRVS,0.50 ,3.10 ,3.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93882,CPT,DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY,26,,14,,RBRVS,0.50 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93882,CPT,DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY,TC,,14,,RBRVS,,2.95 ,2.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93886,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL,,,14,,RBRVS,0.91 ,7.00 ,7.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93886,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL,26,,14,,RBRVS,0.91 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93886,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL,TC,,14,,RBRVS,,6.63 ,6.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93888,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD,,,14,,RBRVS,0.50 ,3.65 ,3.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93888,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD,26,,14,,RBRVS,0.50 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93888,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD,TC,,14,,RBRVS,,3.46 ,3.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93890,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY,,,14,,RBRVS,1.00 ,7.13 ,7.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93890,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY,26,,14,,RBRVS,1.00 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93890,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY,TC,,14,,RBRVS,,6.72 ,6.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93892,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT,,,14,,RBRVS,1.15 ,8.24 ,8.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93892,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT,26,,14,,RBRVS,1.15 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93892,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT,TC,,14,,RBRVS,,7.76 ,7.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93893,CPT,TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ,,,14,,RBRVS,1.15 ,8.69 ,8.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93893,CPT,TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ,26,,14,,RBRVS,1.15 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93893,CPT,TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ,TC,,14,,RBRVS,,8.22 ,8.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93895,CPT,CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI,,,4,,TotalUnits,,,,2.18 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93922,CPT,NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL,,,14,,RBRVS,0.25 ,2.24 ,2.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93922,CPT,NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL,26,,14,,RBRVS,0.25 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93922,CPT,NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL,TC,,14,,RBRVS,,2.16 ,2.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93923,CPT,NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS,,,14,,RBRVS,0.45 ,3.42 ,3.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93923,CPT,NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS,26,,14,,RBRVS,0.45 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93923,CPT,NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS,TC,,14,,RBRVS,,3.28 ,3.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93924,CPT,N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI,,,14,,RBRVS,0.50 ,4.37 ,4.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93924,CPT,N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI,26,,14,,RBRVS,0.50 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93924,CPT,N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI,TC,,14,,RBRVS,,4.21 ,4.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93925,CPT,DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY,,,14,,RBRVS,0.80 ,6.52 ,6.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93925,CPT,DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY,26,,14,,RBRVS,0.80 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93925,CPT,DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY,TC,,14,,RBRVS,,6.26 ,6.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93926,CPT,DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY,,,14,,RBRVS,0.50 ,3.79 ,3.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93926,CPT,DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY,26,,14,,RBRVS,0.50 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93926,CPT,DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY,TC,,14,,RBRVS,,3.65 ,3.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93930,CPT,DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY,,,14,,RBRVS,0.80 ,5.05 ,5.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93930,CPT,DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY,26,,14,,RBRVS,0.80 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93930,CPT,DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY,TC,,14,,RBRVS,,4.79 ,4.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93931,CPT,DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY,,,14,,RBRVS,0.50 ,3.12 ,3.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93931,CPT,DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY,26,,14,,RBRVS,0.50 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93931,CPT,DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY,TC,,14,,RBRVS,,2.96 ,2.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93970,CPT,DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,,,14,,RBRVS,0.70 ,4.83 ,4.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93970,CPT,DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,26,,14,,RBRVS,0.70 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93970,CPT,DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,TC,,14,,RBRVS,,4.60 ,4.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93971,CPT,DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY,,,14,,RBRVS,0.45 ,2.93 ,2.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93971,CPT,DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY,26,,14,,RBRVS,0.45 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93971,CPT,DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY,TC,,14,,RBRVS,,2.78 ,2.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93975,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM,,,14,,RBRVS,1.16 ,6.76 ,6.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93975,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM,26,,14,,RBRVS,1.16 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93975,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM,TC,,14,,RBRVS,,6.37 ,6.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93976,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT,,,14,,RBRVS,0.80 ,3.78 ,3.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93976,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT,26,,14,,RBRVS,0.80 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93976,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT,TC,,14,,RBRVS,,3.49 ,3.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93978,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE,,,14,,RBRVS,0.80 ,4.55 ,4.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93978,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE,26,,14,,RBRVS,0.80 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93978,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE,TC,,14,,RBRVS,,4.30 ,4.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93979,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD,,,14,,RBRVS,0.50 ,2.85 ,2.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93979,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD,26,,14,,RBRVS,0.50 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93979,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD,TC,,14,,RBRVS,,2.70 ,2.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93980,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL,,,14,,RBRVS,1.25 ,2.11 ,2.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93980,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL,26,,14,,RBRVS,1.25 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93980,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL,TC,,14,,RBRVS,,1.67 ,1.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93981,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD STD,,,14,,RBRVS,0.44 ,1.58 ,1.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93981,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD STD,26,,14,,RBRVS,0.44 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93981,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD STD,TC,,14,,RBRVS,,1.44 ,1.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93982,CPT,IMPLANT WIRELESS PRESS SENSOR STUDY ANEURYSM SAC,,,14,,RBRVS,0.30 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93990,CPT,DUPLEX SCAN HEMODIALYSIS ACCESS,,,14,,RBRVS,0.50 ,4.01 ,4.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 93990,CPT,DUPLEX SCAN HEMODIALYSIS ACCESS,26,,14,,RBRVS,0.50 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 93990,CPT,DUPLEX SCAN HEMODIALYSIS ACCESS,TC,,14,,RBRVS,,3.88 ,3.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 93998,CPT,UNLISTED NONINVASIVE VASCULAR DIAGNOSTIC STUDY,,,14,,TotalUnits,,,,5.35 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94002,CPT,VENTILATION ASSIST & MGMT INPATIENT 1ST DAY,,,14,,RBRVS,1.99 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94003,CPT,VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA,,,14,,RBRVS,1.37 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94004,CPT,VENTILATION ASSIST & MGMT NURSING FAC PR DAY,,,14,,RBRVS,1.00 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94005,CPT,HOME VENTILATOR MGMT CARE OVERSIGHT 30 MIN/>,,,14,,RBRVS,1.50 ,1.03 ,1.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94010,CPT,SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ,,,14,,RBRVS,0.17 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94010,CPT,SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ,26,,14,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94010,CPT,SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ,TC,,14,,RBRVS,,0.77 ,0.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94011,CPT,MEAS SPIROMTRC FORCD EXPIRATORY FLO INFANT&/2 Y,,,14,,RBRVS,2.00 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94012,CPT,MEAS SPIRO FRCD EXP FLO PRE&POST BRONCH INF/2YRS,,,14,,RBRVS,3.10 ,1.19 ,1.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94013,CPT,MEASUREMENT LUNG VOLUMES INFANT/CHILD/2 YRS,,,14,,RBRVS,0.66 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94014,CPT,PT-INITIATE SPIROMETRIC RECORDING PHYS/QHP R&I,,,14,,RBRVS,0.52 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94015,CPT,PATIENT-INITIATED SPIROMETRIC RECORDING,,TC,14,,RBRVS,,0.86 ,0.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94016,CPT,PATIENT-INITIATED SPIROMETRIC PHYS/QHP R&I ONLY,,PC,14,,RBRVS,0.52 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94060,CPT,BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN,,,14,,RBRVS,0.27 ,1.43 ,1.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94060,CPT,BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN,26,,14,,RBRVS,0.27 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94060,CPT,BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN,TC,,14,,RBRVS,,1.34 ,1.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94070,CPT,BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT,,,14,,RBRVS,0.60 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94070,CPT,BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT,26,,14,,RBRVS,0.60 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94070,CPT,BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT,TC,,14,,RBRVS,,0.86 ,0.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94150,CPT,VITAL CAPACITY TOTAL SEPARATE PROCEDURE,,,14,,RBRVS,0.07 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94150,CPT,VITAL CAPACITY TOTAL SEPARATE PROCEDURE,26,,14,,RBRVS,0.07 ,0.03 ,0.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94150,CPT,VITAL CAPACITY TOTAL SEPARATE PROCEDURE,TC,,14,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94200,CPT,MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ,,,14,,RBRVS,0.11 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94200,CPT,MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ,26,,14,,RBRVS,0.11 ,0.04 ,0.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94200,CPT,MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ,TC,,14,,RBRVS,,0.54 ,0.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94250,CPT,EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX,,,14,,RBRVS,0.11 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94250,CPT,EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX,26,,14,,RBRVS,0.11 ,0.03 ,0.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94250,CPT,EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX,TC,,14,,RBRVS,,0.58 ,0.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94375,CPT,RESPIRATORY FLOW VOLUME LOOP,,,14,,RBRVS,0.31 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94375,CPT,RESPIRATORY FLOW VOLUME LOOP,26,,14,,RBRVS,0.31 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94375,CPT,RESPIRATORY FLOW VOLUME LOOP,TC,,14,,RBRVS,,0.68 ,0.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94400,CPT,BREATHING RESPONSE TO CO2,,,14,,RBRVS,0.40 ,1.15 ,1.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94400,CPT,BREATHING RESPONSE TO CO2,26,,14,,RBRVS,0.40 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94400,CPT,BREATHING RESPONSE TO CO2,TC,,14,,RBRVS,,1.01 ,1.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94450,CPT,BREATHING RESPONSE TO HYPOXIA,,,14,,RBRVS,0.40 ,1.50 ,1.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94450,CPT,BREATHING RESPONSE TO HYPOXIA,26,,14,,RBRVS,0.40 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94450,CPT,BREATHING RESPONSE TO HYPOXIA,TC,,14,,RBRVS,,1.35 ,1.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94452,CPT,HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT,,,14,,RBRVS,0.31 ,1.30 ,1.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94452,CPT,HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT,26,,14,,RBRVS,0.31 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94452,CPT,HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT,TC,,14,,RBRVS,,1.21 ,1.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94453,CPT,HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION,,,14,,RBRVS,0.40 ,1.83 ,1.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94453,CPT,HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION,26,,14,,RBRVS,0.40 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94453,CPT,HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION,TC,,14,,RBRVS,,1.71 ,1.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94610,CPT,INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP,,,14,,RBRVS,1.16 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94620,CPT,PULMONARY STRESS TESTING SIMPLE,,,14,,RBRVS,0.64 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94620,CPT,PULMONARY STRESS TESTING SIMPLE,26,,14,,RBRVS,0.64 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94620,CPT,PULMONARY STRESS TESTING SIMPLE,TC,,14,,RBRVS,,0.71 ,0.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94621,CPT,PULMONARY STRESS TESTING COMPLEX,,,14,,RBRVS,1.42 ,3.12 ,3.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94621,CPT,PULMONARY STRESS TESTING COMPLEX,26,,14,,RBRVS,1.42 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94621,CPT,PULMONARY STRESS TESTING COMPLEX,TC,,14,,RBRVS,,2.64 ,2.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94640,CPT,PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT,,,14,,RBRVS,,0.51 ,0.51 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 94642,CPT,PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH,,,14,,TotalUnits,,,,1.26 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 94644,CPT,CONTINUOUS INHALATION TREATMENT 1ST HR,,,14,,RBRVS,,1.23 ,1.23 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 94645,CPT,CONTINUOUS INHALATION TREATMENT EA ADDL HR,,,14,,RBRVS,,0.39 ,0.39 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 94660,CPT,CPAP VENTILATION CPAP INITIATION&MGMT,,,14,,RBRVS,0.76 ,0.26 ,0.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94662,CPT,CONTINUOUS NEGATIVE PRESSURE VENTJ INITIAT&MGM,,,14,,RBRVS,0.76 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94664,CPT,DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP,,,14,,RBRVS,,0.48 ,0.48 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 94667,CPT,MANJ CH WALL FACILITATE LNG FUNCJ 1 DEMO&/EVAL,,,14,,RBRVS,,0.72 ,0.72 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 94668,CPT,MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ,,,14,,RBRVS,,0.80 ,0.80 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 94669,CPT,MECHANICAL CHEST WALL OSCILLATION LUNG FUNCTION,,,14,,RBRVS,,0.91 ,0.91 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 94680,CPT,O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP,,,14,,RBRVS,0.26 ,1.34 ,1.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94680,CPT,O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP,26,,14,,RBRVS,0.26 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94680,CPT,O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP,TC,,14,,RBRVS,,1.25 ,1.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94681,CPT,O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC,,,14,,RBRVS,0.20 ,1.27 ,1.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94681,CPT,O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC,26,,14,,RBRVS,0.20 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94681,CPT,O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC,TC,,14,,RBRVS,,1.20 ,1.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94690,CPT,O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX,,,14,,RBRVS,0.07 ,1.32 ,1.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94690,CPT,O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX,26,,14,,RBRVS,0.07 ,0.03 ,0.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94690,CPT,O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX,TC,,14,,RBRVS,,1.29 ,1.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94726,CPT,PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST,,,14,,RBRVS,0.26 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94726,CPT,PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST,26,,14,,RBRVS,0.26 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94726,CPT,PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST,TC,,14,,RBRVS,,1.13 ,1.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94727,CPT,GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V,,,14,,RBRVS,0.26 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94727,CPT,GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V,26,,14,,RBRVS,0.26 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94727,CPT,GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V,TC,,14,,RBRVS,,0.83 ,0.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94728,CPT,AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY,,,14,,RBRVS,0.26 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94728,CPT,AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY,26,,14,,RBRVS,0.26 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94728,CPT,AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY,TC,,14,,RBRVS,,0.77 ,0.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94729,CPT,CO DIFFUSING CAPACITY,,,14,,RBRVS,0.19 ,1.33 ,1.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94729,CPT,CO DIFFUSING CAPACITY,26,,14,,RBRVS,0.19 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94729,CPT,CO DIFFUSING CAPACITY,TC,,14,,RBRVS,,1.27 ,1.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94750,CPT,PULMONARY COMPLIANCE STUDY,,,14,,RBRVS,0.23 ,2.03 ,2.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94750,CPT,PULMONARY COMPLIANCE STUDY,26,,14,,RBRVS,0.23 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94750,CPT,PULMONARY COMPLIANCE STUDY,TC,,14,,RBRVS,,1.95 ,1.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94760,CPT,NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER,,TC,14,,RBRVS,,0.08 ,0.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94761,CPT,NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER,,TC,14,,RBRVS,,0.13 ,0.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94762,CPT,NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR,,TC,14,,RBRVS,,0.68 ,0.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94770,CPT,CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER,,,14,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94770,CPT,CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER,26,,14,,TotalUnits,,,,0.04 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94770,CPT,CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER,TC,,14,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94772,CPT,CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT,,,14,,TotalUnits,,,,2.48 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94772,CPT,CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT,26,,14,,TotalUnits,,,,1.00 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94772,CPT,CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT,TC,,14,,TotalUnits,,,,1.48 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94774,CPT,PEDIATRIC APNEA MONITOR ATTACHMENT PHYS I&R,,,14,,TotalUnits,,,,3.27 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94776,CPT,PEDIATRIC APNEA MONITOR ANALYSES COMPUTER,,TC,14,,TotalUnits,,,,2.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94777,CPT,PEDIATRIC APNEA MONITOR PHYS/QHP REVIEW,,PC,14,,TotalUnits,,,,2.01 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 94780,CPT,CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN,,,14,,RBRVS,0.48 ,0.13 ,1.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94781,CPT,CAR SEAT/BED TESTNG W/INTERP & REPORT ADDL 30MIN,,,14,,RBRVS,0.17 ,0.06 ,0.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 94799,CPT,UNLISTED PULMONARY SERVICE/PROCEDURE,,,14,,TotalUnits,,,,1.47 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 94799,CPT,UNLISTED PULMONARY SERVICE/PROCEDURE,,PC,14,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 94799,CPT,UNLISTED PULMONARY SERVICE/PROCEDURE,,TC,14,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 95004,CPT,PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS,,,2,,RBRVS,0.01 ,0.17 ,0.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95012,CPT,NITRIC OXIDE EXPIRED GAS DETERMINATION,,,2,,RBRVS,,0.53 ,0.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95017,CPT,ALLG TSTG PERQ & IC VENOMS IMMED REACT W/I&R,,,2,,RBRVS,0.07 ,0.02 ,0.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95018,CPT,ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/I&R,,,2,,RBRVS,0.14 ,0.05 ,0.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95024,CPT,INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS,,,2,,RBRVS,0.01 ,0.01 ,0.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95027,CPT,INTRACUTANEOUS TESTS W/ALLERGENIC XTRCS AIRBORNE,,,2,,RBRVS,0.01 ,0.11 ,0.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95028,CPT,IC TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING,,TC,2,,RBRVS,,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95044,CPT,PATCH/APPLICATION TEST SPECIFY NUMBER TESTS,,,2,,RBRVS,,0.15 ,0.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95052,CPT,PHOTO PATCH TEST SPECIFY NUMBER TSTS,,,2,,RBRVS,,0.18 ,0.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95056,CPT,PHOTO TESTS,,,2,,RBRVS,,1.23 ,1.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95060,CPT,OPHTHALMIC MUCOUS MEMBRANE TESTS,,TC,2,,RBRVS,,0.98 ,0.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95065,CPT,DIRECT NASAL MUCOUS MEMBRANE TEST,,TC,2,,RBRVS,,0.71 ,0.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95070,CPT,INHLJ BRNCL CHALLENGE TSTG W/HISTAM/METHACHOL,,TC,2,,RBRVS,,0.84 ,0.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95071,CPT,INHLJ BRNCL CHALLENGE TSTG W/AGS/GASES,,TC,2,,RBRVS,,0.97 ,0.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95076,CPT,INGESTION CHALLENGE TEST INITIAL 120 MINUTES,,,2,,RBRVS,1.50 ,0.52 ,1.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95079,CPT,INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES,,,2,,RBRVS,1.38 ,0.47 ,0.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95115,CPT,PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX,,,1,,RBRVS,,0.24 ,0.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95117,CPT,PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS,,,1,,RBRVS,,0.28 ,0.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95120,CPT,PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX,,,1,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95125,CPT,PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX,,,1,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95130,CPT,PROF SVCS ALLG IMMNTX W/PRV XTRC 1 STING INSECT,,,1,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95131,CPT,PROF SVCS ALLG IMMNTX W/PRV XTRC 2 STING INSECT,,,1,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95132,CPT,PROF SVCS ALLG IMMNTX W/PRV XTRC 3 STING INSECT,,,1,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95133,CPT,PROF SVCS ALLG IMMNTX W/PRV XTRC 4 STING INSECT,,,1,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95134,CPT,PROF SVCS ALLG IMMNTX W/PRV XTRC 5 STING INSECT,,,1,,TotalUnits,,,,1.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95144,CPT,PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO,,,1,,RBRVS,0.06 ,0.02 ,0.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95145,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT,,,1,,RBRVS,0.06 ,0.02 ,0.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95146,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT,,,1,,RBRVS,0.06 ,0.02 ,1.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95147,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 3 INSECT,,,1,,RBRVS,0.06 ,0.02 ,0.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95148,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT,,,1,,RBRVS,0.06 ,0.02 ,1.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95149,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT,,,1,,RBRVS,0.06 ,0.02 ,1.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95165,CPT,PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN,,,1,,RBRVS,0.06 ,0.02 ,0.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95170,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE,,,1,,RBRVS,0.06 ,0.02 ,0.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95180,CPT,RAPID DESENSITIZATION PROCEDURE EACH HOUR,,,1,,RBRVS,2.01 ,0.78 ,1.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95199,CPT,UNLISTED ALLERGY/CLINICAL IMMUNOLOGIC SRVC/PX,,,1,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95250,CPT,GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID,,TC,14,,RBRVS,,4.42 ,4.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95251,CPT,GLUC MNTR CONT REC FROM NTRSTL TISS FLU I&R,,PC,14,,RBRVS,0.85 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95782,CPT,POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND,,,14,,RBRVS,2.60 ,26.15 ,26.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95782,CPT,POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND,26,,14,,RBRVS,2.60 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95782,CPT,POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND,TC,,14,,RBRVS,,25.27 ,25.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95783,CPT,POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM,,,14,,RBRVS,2.83 ,27.34 ,27.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95783,CPT,POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM,26,,14,,RBRVS,2.83 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95783,CPT,POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM,TC,,14,,RBRVS,,26.29 ,26.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95800,CPT,SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME,,,14,,RBRVS,1.05 ,3.94 ,3.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95800,CPT,SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME,26,,14,,RBRVS,1.05 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95800,CPT,SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME,TC,,14,,RBRVS,,3.56 ,3.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95801,CPT,SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL,,,14,,RBRVS,1.00 ,1.50 ,1.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95801,CPT,SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL,26,,14,,RBRVS,1.00 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95801,CPT,SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL,TC,,14,,RBRVS,,1.15 ,1.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95803,CPT,ACTIGRAPHY TESTING RECORDING ANALYSIS I&R,,,14,,RBRVS,0.90 ,3.05 ,3.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95803,CPT,ACTIGRAPHY TESTING RECORDING ANALYSIS I&R,26,,14,,RBRVS,0.90 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95803,CPT,ACTIGRAPHY TESTING RECORDING ANALYSIS I&R,TC,,14,,RBRVS,,2.75 ,2.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95805,CPT,MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG,,,14,,RBRVS,1.20 ,10.77 ,10.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95805,CPT,MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG,26,,14,,RBRVS,1.20 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95805,CPT,MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG,TC,,14,,RBRVS,,10.34 ,10.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95806,CPT,SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT,,,14,,RBRVS,1.25 ,3.45 ,3.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95806,CPT,SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT,26,,14,,RBRVS,1.25 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95806,CPT,SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT,TC,,14,,RBRVS,,3.02 ,3.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95807,CPT,SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN,,,14,,RBRVS,1.28 ,12.12 ,12.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95807,CPT,SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN,26,,14,,RBRVS,1.28 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95807,CPT,SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN,TC,,14,,RBRVS,,11.69 ,11.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95808,CPT,POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND,,,14,,RBRVS,1.74 ,15.94 ,15.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95808,CPT,POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND,26,,14,,RBRVS,1.74 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95808,CPT,POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND,TC,,14,,RBRVS,,15.26 ,15.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95810,CPT,POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND,,,14,,RBRVS,2.50 ,14.93 ,14.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95810,CPT,POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND,26,,14,,RBRVS,2.50 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95810,CPT,POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND,TC,,14,,RBRVS,,14.08 ,14.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95811,CPT,POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND,,,14,,RBRVS,2.60 ,15.71 ,15.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95811,CPT,POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND,26,,14,,RBRVS,2.60 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95811,CPT,POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND,TC,,14,,RBRVS,,14.83 ,14.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95812,CPT,ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN,,,14,,RBRVS,1.08 ,8.69 ,8.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95812,CPT,ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN,26,,14,,RBRVS,1.08 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95812,CPT,ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN,TC,,14,,RBRVS,,8.19 ,8.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95813,CPT,ELECTROENCEPHALOGRAM EXTND MNTR >1 HR,,,14,,RBRVS,1.73 ,10.10 ,10.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95813,CPT,ELECTROENCEPHALOGRAM EXTND MNTR >1 HR,26,,14,,RBRVS,1.73 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95813,CPT,ELECTROENCEPHALOGRAM EXTND MNTR >1 HR,TC,,14,,RBRVS,,9.30 ,9.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95816,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY,,,14,,RBRVS,1.08 ,9.07 ,9.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95816,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY,26,,14,,RBRVS,1.08 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95816,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY,TC,,14,,RBRVS,,8.57 ,8.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95819,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP,,,14,,RBRVS,1.08 ,10.53 ,10.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95819,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP,26,,14,,RBRVS,1.08 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95819,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP,TC,,14,,RBRVS,,10.03 ,10.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95822,CPT,ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY,,,14,,RBRVS,1.08 ,9.38 ,9.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95822,CPT,ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY,26,,14,,RBRVS,1.08 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95822,CPT,ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY,TC,,14,,RBRVS,,8.88 ,8.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95824,CPT,ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY,,,14,,TotalUnits,,,,2.76 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95824,CPT,ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY,26,,14,,TotalUnits,,,,1.08 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95824,CPT,ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY,TC,,14,,TotalUnits,,,,1.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95827,CPT,ELECTROENCEPHALOGRAM ALL NIGHT RECORDING,,,14,,RBRVS,1.08 ,18.48 ,18.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95827,CPT,ELECTROENCEPHALOGRAM ALL NIGHT RECORDING,26,,14,,RBRVS,1.08 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95827,CPT,ELECTROENCEPHALOGRAM ALL NIGHT RECORDING,TC,,14,,RBRVS,,17.99 ,17.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95829,CPT,ELECTROCORTICOGRAM SURGERY SPX,,,14,,RBRVS,6.20 ,46.47 ,46.47 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95829,CPT,ELECTROCORTICOGRAM SURGERY SPX,26,,14,,RBRVS,6.20 ,2.87 ,2.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95829,CPT,ELECTROCORTICOGRAM SURGERY SPX,TC,,14,,RBRVS,,43.60 ,43.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95830,CPT,INSERTION SPHENOIDAL ELECTRODES EEG PHYS/QHP,,,14,,RBRVS,1.70 ,0.78 ,5.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95831,CPT,MUSC TSTG MNL W/REPRT XTR EX HAND/TRNK,,,14,,RBRVS,0.28 ,0.12 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95832,CPT,MUSC TSTG MNL W/REPRT HAND W/WO CMPRSN NRML SIDE,,,14,,RBRVS,0.29 ,0.12 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95833,CPT,MUSC TSTG MNL W/REPRT TOTAL EVAL BODY EX HANDS,,,14,,RBRVS,0.47 ,0.12 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95834,CPT,MUSC TSTG MNL W/REPRT TOTAL EVAL BODY W/HANDS,,,14,,RBRVS,0.60 ,0.25 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95851,CPT,ROM MEAS&REPRT EA XTR EX HAND/EA TRNK SCTJ SPI,,,14,,RBRVS,0.16 ,0.05 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95852,CPT,ROM MEAS&REPRT HAND W/WO COMPARISON NORMAL SID,,,14,,RBRVS,0.11 ,0.05 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95857,CPT,CHOLINESTERASE INHIBITOR CHALLENGE TEST,,,14,,RBRVS,0.53 ,0.27 ,0.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95860,CPT,NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS,,,14,,RBRVS,0.96 ,2.44 ,2.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95860,CPT,NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS,26,,14,,RBRVS,0.96 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95860,CPT,NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS,TC,,14,,RBRVS,,1.97 ,1.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95861,CPT,NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS,,,14,,RBRVS,1.54 ,3.21 ,3.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95861,CPT,NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS,26,,14,,RBRVS,1.54 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95861,CPT,NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS,TC,,14,,RBRVS,,2.48 ,2.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95863,CPT,NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS,,,14,,RBRVS,1.87 ,4.05 ,4.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95863,CPT,NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS,26,,14,,RBRVS,1.87 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95863,CPT,NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS,TC,,14,,RBRVS,,3.17 ,3.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95864,CPT,NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS,,,14,,RBRVS,1.99 ,4.66 ,4.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95864,CPT,NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS,26,,14,,RBRVS,1.99 ,0.95 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95864,CPT,NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS,TC,,14,,RBRVS,,3.71 ,3.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95865,CPT,NEEDLE ELECTROMYOGRAPHY LARYNX,,,14,,RBRVS,1.57 ,2.39 ,2.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95865,CPT,NEEDLE ELECTROMYOGRAPHY LARYNX,26,,14,,RBRVS,1.57 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95865,CPT,NEEDLE ELECTROMYOGRAPHY LARYNX,TC,,14,,RBRVS,,1.66 ,1.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95866,CPT,NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM,,,14,,RBRVS,1.25 ,2.47 ,2.47 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95866,CPT,NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM,26,,14,,RBRVS,1.25 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95866,CPT,NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM,TC,,14,,RBRVS,,1.86 ,1.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95867,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI,,,14,,RBRVS,0.79 ,1.83 ,1.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95867,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI,26,,14,,RBRVS,0.79 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95867,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI,TC,,14,,RBRVS,,1.47 ,1.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95868,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI,,,14,,RBRVS,1.18 ,2.49 ,2.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95868,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI,26,,14,,RBRVS,1.18 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95868,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI,TC,,14,,RBRVS,,1.94 ,1.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95869,CPT,NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12,,,14,,RBRVS,0.37 ,2.23 ,2.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95869,CPT,NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12,26,,14,,RBRVS,0.37 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95869,CPT,NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12,TC,,14,,RBRVS,,2.05 ,2.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95870,CPT,NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI,,,14,,RBRVS,0.37 ,2.23 ,2.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95870,CPT,NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI,26,,14,,RBRVS,0.37 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95870,CPT,NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI,TC,,14,,RBRVS,,2.06 ,2.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95872,CPT,NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER,,,14,,RBRVS,2.88 ,2.50 ,2.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95872,CPT,NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER,26,,14,,RBRVS,2.88 ,1.33 ,1.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95872,CPT,NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER,TC,,14,,RBRVS,,1.17 ,1.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95873,CPT,ELECTRICAL STIMULATION GUID W/CHEMODENERVATION,,,14,,RBRVS,0.37 ,1.70 ,1.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95873,CPT,ELECTRICAL STIMULATION GUID W/CHEMODENERVATION,26,,14,,RBRVS,0.37 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95873,CPT,ELECTRICAL STIMULATION GUID W/CHEMODENERVATION,TC,,14,,RBRVS,,1.51 ,1.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95874,CPT,NEEDLE EMG GUID W/CHEMODENERVATION,,,14,,RBRVS,0.37 ,1.68 ,1.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95874,CPT,NEEDLE EMG GUID W/CHEMODENERVATION,26,,14,,RBRVS,0.37 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95874,CPT,NEEDLE EMG GUID W/CHEMODENERVATION,TC,,14,,RBRVS,,1.50 ,1.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95875,CPT,ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB,,,14,,RBRVS,1.10 ,2.35 ,2.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95875,CPT,ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB,26,,14,,RBRVS,1.10 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95875,CPT,ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB,TC,,14,,RBRVS,,1.84 ,1.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95885,CPT,NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED,,,14,,RBRVS,0.35 ,1.29 ,1.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95885,CPT,NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED,26,,14,,RBRVS,0.35 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95885,CPT,NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED,TC,,14,,RBRVS,,1.12 ,1.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95886,CPT,NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE,,,14,,RBRVS,0.86 ,1.68 ,1.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95886,CPT,NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE,26,,14,,RBRVS,0.86 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95886,CPT,NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE,TC,,14,,RBRVS,,1.26 ,1.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95887,CPT,NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION,,,14,,RBRVS,0.71 ,1.54 ,1.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95887,CPT,NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION,26,,14,,RBRVS,0.71 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95887,CPT,NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION,TC,,14,,RBRVS,,1.21 ,1.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95905,CPT,MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB,,,14,,RBRVS,0.05 ,1.91 ,1.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95905,CPT,MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB,26,,14,,RBRVS,0.05 ,0.02 ,0.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95905,CPT,MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB,TC,,14,,RBRVS,,1.89 ,1.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95907,CPT,NERVE CONDUCTION STUDIES 1-2 STUDIES,,,14,,RBRVS,1.00 ,1.64 ,1.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95907,CPT,NERVE CONDUCTION STUDIES 1-2 STUDIES,26,,14,,RBRVS,1.00 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95907,CPT,NERVE CONDUCTION STUDIES 1-2 STUDIES,TC,,14,,RBRVS,,1.17 ,1.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95908,CPT,NERVE CONDUCTION STUDIES 3-4 STUDIES,,,14,,RBRVS,1.25 ,2.03 ,2.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95908,CPT,NERVE CONDUCTION STUDIES 3-4 STUDIES,26,,14,,RBRVS,1.25 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95908,CPT,NERVE CONDUCTION STUDIES 3-4 STUDIES,TC,,14,,RBRVS,,1.44 ,1.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95909,CPT,NERVE CONDUCTION STUDIES 5-6 STUDIES,,,14,,RBRVS,1.50 ,2.50 ,2.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95909,CPT,NERVE CONDUCTION STUDIES 5-6 STUDIES,26,,14,,RBRVS,1.50 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95909,CPT,NERVE CONDUCTION STUDIES 5-6 STUDIES,TC,,14,,RBRVS,,1.79 ,1.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95910,CPT,NERVE CONDUCTION STUDIES 7-8 STUDIES,,,14,,RBRVS,2.00 ,3.33 ,3.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95910,CPT,NERVE CONDUCTION STUDIES 7-8 STUDIES,26,,14,,RBRVS,2.00 ,0.95 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95910,CPT,NERVE CONDUCTION STUDIES 7-8 STUDIES,TC,,14,,RBRVS,,2.38 ,2.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95911,CPT,NERVE CONDUCTION STUDIES 9-10 STUDIES,,,14,,RBRVS,2.50 ,3.94 ,3.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95911,CPT,NERVE CONDUCTION STUDIES 9-10 STUDIES,26,,14,,RBRVS,2.50 ,1.19 ,1.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95911,CPT,NERVE CONDUCTION STUDIES 9-10 STUDIES,TC,,14,,RBRVS,,2.75 ,2.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95912,CPT,NERVE CONDUCTION STUDIES 11-12 STUDIES,,,14,,RBRVS,3.00 ,4.19 ,4.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95912,CPT,NERVE CONDUCTION STUDIES 11-12 STUDIES,26,,14,,RBRVS,3.00 ,1.37 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95912,CPT,NERVE CONDUCTION STUDIES 11-12 STUDIES,TC,,14,,RBRVS,,2.82 ,2.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95913,CPT,NERVE CONDUCTION STUDIES 13/> STUDIES,,,14,,RBRVS,3.56 ,4.66 ,4.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95913,CPT,NERVE CONDUCTION STUDIES 13/> STUDIES,26,,14,,RBRVS,3.56 ,1.61 ,1.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95913,CPT,NERVE CONDUCTION STUDIES 13/> STUDIES,TC,,14,,RBRVS,,3.05 ,3.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95921,CPT,TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP,,,14,,RBRVS,0.90 ,1.49 ,1.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95921,CPT,TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP,26,,14,,RBRVS,0.90 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95921,CPT,TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP,TC,,14,,RBRVS,,1.14 ,1.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95922,CPT,TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ,,,14,,RBRVS,0.96 ,1.84 ,1.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95922,CPT,TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ,26,,14,,RBRVS,0.96 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95922,CPT,TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ,TC,,14,,RBRVS,,1.46 ,1.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95923,CPT,TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION,,,14,,RBRVS,0.90 ,3.67 ,3.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95923,CPT,TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION,26,,14,,RBRVS,0.90 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95923,CPT,TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION,TC,,14,,RBRVS,,3.31 ,3.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95924,CPT,TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT,,,14,,RBRVS,1.73 ,2.36 ,2.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95924,CPT,TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT,26,,14,,RBRVS,1.73 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95924,CPT,TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT,TC,,14,,RBRVS,,1.66 ,1.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95925,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS,,,14,,RBRVS,0.54 ,3.81 ,3.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95925,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS,26,,14,,RBRVS,0.54 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95925,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS,TC,,14,,RBRVS,,3.58 ,3.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95926,CPT,SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS,,,14,,RBRVS,0.54 ,3.30 ,3.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95926,CPT,SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS,26,,14,,RBRVS,0.54 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95926,CPT,SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS,TC,,14,,RBRVS,,3.09 ,3.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95927,CPT,SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD,,,14,,RBRVS,0.54 ,3.42 ,3.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95927,CPT,SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD,26,,14,,RBRVS,0.54 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95927,CPT,SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD,TC,,14,,RBRVS,,3.21 ,3.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95928,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS,,,14,,RBRVS,1.50 ,4.76 ,4.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95928,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS,26,,14,,RBRVS,1.50 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95928,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS,TC,,14,,RBRVS,,4.06 ,4.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95929,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS,,,14,,RBRVS,1.50 ,4.79 ,4.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95929,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS,26,,14,,RBRVS,1.50 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95929,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS,TC,,14,,RBRVS,,4.09 ,4.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95930,CPT,VISUAL EP TSTG CNS CHECKERBOARD/FLASH,,,14,,RBRVS,0.35 ,3.28 ,3.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95930,CPT,VISUAL EP TSTG CNS CHECKERBOARD/FLASH,26,,14,,RBRVS,0.35 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95930,CPT,VISUAL EP TSTG CNS CHECKERBOARD/FLASH,TC,,14,,RBRVS,,3.11 ,3.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95933,CPT,ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST,,,14,,RBRVS,0.59 ,1.49 ,1.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95933,CPT,ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST,26,,14,,RBRVS,0.59 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95933,CPT,ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST,TC,,14,,RBRVS,,1.22 ,1.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95937,CPT,NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH,,,14,,RBRVS,0.65 ,1.61 ,1.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95937,CPT,NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH,26,,14,,RBRVS,0.65 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95937,CPT,NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH,TC,,14,,RBRVS,,1.31 ,1.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95938,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMB,,,14,,RBRVS,0.86 ,8.72 ,8.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95938,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMB,26,,14,,RBRVS,0.86 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95938,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMB,TC,,14,,RBRVS,,8.32 ,8.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95939,CPT,CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI,,,14,,RBRVS,2.25 ,11.75 ,11.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95939,CPT,CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI,26,,14,,RBRVS,2.25 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95939,CPT,CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI,TC,,14,,RBRVS,,10.71 ,10.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95940,CPT,IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES,,,14,,RBRVS,0.60 ,0.28 ,0.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95941,CPT,IONM REMOTE/NEARBY/>1 PATIENT IN OR PER HOUR,,,14,,TotalUnits,,,,1.81 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95943,CPT,PARASYMP & SYMP NRV FUNCJ HRT RATE VARIABILITY,,,14,,TotalUnits,,,,5.60 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95950,CPT,MONITOR ID& LATERALIZATION SEIZURE FOCUS EEG,,,14,,RBRVS,1.51 ,7.74 ,7.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95950,CPT,MONITOR ID& LATERALIZATION SEIZURE FOCUS EEG,26,,14,,RBRVS,1.51 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95950,CPT,MONITOR ID& LATERALIZATION SEIZURE FOCUS EEG,TC,,14,,RBRVS,,7.05 ,7.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95951,CPT,LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO,,,14,,TotalUnits,,,,15.65 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95951,CPT,LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO,26,,14,,TotalUnits,,,,8.77 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95951,CPT,LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO,TC,,14,,TotalUnits,,,,6.88 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95953,CPT,LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG,,,14,,RBRVS,3.08 ,8.65 ,8.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95953,CPT,LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG,26,,14,,RBRVS,3.08 ,1.41 ,1.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95953,CPT,LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG,TC,,14,,RBRVS,,7.24 ,7.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95954,CPT,RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE,,,14,,RBRVS,2.45 ,10.12 ,10.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95954,CPT,RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE,26,,14,,RBRVS,2.45 ,0.97 ,0.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95954,CPT,RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE,TC,,14,,RBRVS,,9.15 ,9.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95955,CPT,EEG NONINTRACRANIAL SURGERY,,,14,,RBRVS,1.01 ,5.04 ,5.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95955,CPT,EEG NONINTRACRANIAL SURGERY,26,,14,,RBRVS,1.01 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95955,CPT,EEG NONINTRACRANIAL SURGERY,TC,,14,,RBRVS,,4.57 ,4.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95956,CPT,MNTR SEIZURE CMPTR 16CHAN EEG ATND EA 24 HR,,,14,,RBRVS,3.61 ,42.45 ,42.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95956,CPT,MNTR SEIZURE CMPTR 16CHAN EEG ATND EA 24 HR,26,,14,,RBRVS,3.61 ,1.64 ,1.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95956,CPT,MNTR SEIZURE CMPTR 16CHAN EEG ATND EA 24 HR,TC,,14,,RBRVS,,40.81 ,40.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95957,CPT,DIGITAL ANALYSIS ELECTROENCEPHALOGRAM,,,14,,RBRVS,1.98 ,6.80 ,6.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95957,CPT,DIGITAL ANALYSIS ELECTROENCEPHALOGRAM,26,,14,,RBRVS,1.98 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95957,CPT,DIGITAL ANALYSIS ELECTROENCEPHALOGRAM,TC,,14,,RBRVS,,5.90 ,5.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95958,CPT,WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG,,,14,,RBRVS,4.24 ,11.60 ,11.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95958,CPT,WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG,26,,14,,RBRVS,4.24 ,1.90 ,1.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95958,CPT,WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG,TC,,14,,RBRVS,,9.70 ,9.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95961,CPT,FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR,,,14,,RBRVS,2.97 ,5.06 ,5.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95961,CPT,FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR,26,,14,,RBRVS,2.97 ,1.36 ,1.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95961,CPT,FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR,TC,,14,,RBRVS,,3.70 ,3.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95962,CPT,FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR,,,14,,RBRVS,3.21 ,3.97 ,3.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95962,CPT,FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR,26,,14,,RBRVS,3.21 ,1.50 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95962,CPT,FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR,TC,,14,,RBRVS,,2.47 ,2.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95965,CPT,MAGNETOENCEPHALOGRAPHY SPON BRAIN ACTIVITY,,,14,,TotalUnits,,,,58.09 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95965,CPT,MAGNETOENCEPHALOGRAPHY SPON BRAIN ACTIVITY,26,,14,,TotalUnits,,,,11.54 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95965,CPT,MAGNETOENCEPHALOGRAPHY SPON BRAIN ACTIVITY,TC,,14,,TotalUnits,,,,46.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95966,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS 1 MODALITY,,,14,,TotalUnits,,,,29.32 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95966,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS 1 MODALITY,26,,14,,TotalUnits,,,,5.84 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95966,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS 1 MODALITY,TC,,14,,TotalUnits,,,,23.48 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95967,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS EACH ADDL,,,14,,TotalUnits,,,,25.57 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 95967,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS EACH ADDL,26,,14,,TotalUnits,,,,5.09 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95967,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS EACH ADDL,TC,,14,,TotalUnits,,,,20.48 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 95970,CPT,ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM,,,14,,RBRVS,0.45 ,0.19 ,1.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95971,CPT,ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG,,,14,,RBRVS,0.78 ,0.31 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95972,CPT,ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH W/PRGRMG,,,14,,RBRVS,0.80 ,0.31 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95974,CPT,ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV 1ST HR,,,14,,RBRVS,3.00 ,1.37 ,2.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95975,CPT,ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV EA 30 MIN,,,14,,RBRVS,1.70 ,0.79 ,1.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95978,CPT,ELEC ALYS NSTIM PLS GEN CPLX DP BRN 1ST HR,,,14,,RBRVS,3.50 ,1.63 ,3.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95979,CPT,ELEC ALYS NSTIM PLS GEN CPLX DP BRN EA 30 MIN,,,14,,RBRVS,1.64 ,0.76 ,1.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95980,CPT,ELEC ALYS NSTIM PLS GEN GASTRIC INTRAOP W/PRGRMG,,,14,,RBRVS,0.80 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95981,CPT,ELEC ALYS NSTIM GEN GASTRIC SBSQ W/O REPRGRMG,,,14,,RBRVS,0.30 ,0.17 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95982,CPT,ELEC ALYS NSTIM PLS GEN GASTRIC SBSQ W/REPRGRMG,,,14,,RBRVS,0.65 ,0.30 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95990,CPT,REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN,,,14,,RBRVS,,2.56 ,2.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95991,CPT,RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP,,,14,,RBRVS,0.77 ,0.30 ,2.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95992,CPT,CANALITH REPOSITIONING PROCEDURE,,,14,,RBRVS,0.75 ,0.27 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 95999,CPT,UNLIS NEUROLOGICAL/NEUROMUSCULAR DX PX,,,14,,TotalUnits,,,,1.42 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96000,CPT,COMPRE CPTR MTN ALYS VIDEO TAPING 3D KINEMATICS,,,14,,RBRVS,1.80 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96001,CPT,COMPRE CPTR MTN ALYS W/DYN PLNTR PRES MEAS WALKG,,,14,,RBRVS,2.15 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96002,CPT,DYN SURF EMG WALKG/FUNCJAL ACTV 1-12 MUSC,,,14,,RBRVS,0.41 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96003,CPT,DYN FINE WIRE EMG WALKG/FUNCJAL ACTV 1 MUSC,,,14,,RBRVS,0.37 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96004,CPT,PHYS/QHP R&I CPTR MTN ALYS WALK/FUNCJL ACTV REPR,,PC,14,,RBRVS,2.14 ,1.02 ,1.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96020,CPT,TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP,,,14,,TotalUnits,,,,6.99 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 96020,CPT,TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP,26,,14,,TotalUnits,,,,4.49 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96020,CPT,TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP,TC,,14,,TotalUnits,,,,2.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96040,CPT,MEDICAL GENETICS COUNSELING EACH 30 MINUTES,,,14,,RBRVS,,1.29 ,1.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96101,CPT,PSYCHOLOGICAL TESTING PR HR WITH PATIENT,,,16,,RBRVS,1.86 ,0.31 ,0.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96102,CPT,PSYCHOLOGICAL TESTING ADMN BY TECH PR HR,,,16,,RBRVS,0.50 ,0.13 ,1.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96103,CPT,PSYCHOLOGICAL TESTING COMPUTER W/PROF I&R,,,16,,RBRVS,0.51 ,0.21 ,0.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96105,CPT,ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR,,,16,,RBRVS,1.75 ,1.20 ,1.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96110,CPT,DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM,,,16,,RBRVS,,0.24 ,0.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96111,CPT,DEVELOPMENTAL TESTING W/INTERP & REPORT,,,16,,RBRVS,2.60 ,0.74 ,0.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96116,CPT,NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ,,,16,,RBRVS,1.86 ,0.50 ,0.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96118,CPT,NUROPSYC TESTING PR HR W/PT & INTERPJ TIME,,,16,,RBRVS,1.86 ,0.29 ,0.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96119,CPT,NEUROPSYC TSTG W/PROF I&R ADMN BY TECH PR HR,,,16,,RBRVS,0.55 ,0.10 ,1.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96120,CPT,NEUROPSYCHOLOG TESTING COMPUTER W/PROF I&R,,,16,,RBRVS,0.51 ,0.19 ,0.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96125,CPT,STANDARDIZED COGNITIVE PERFORMANCE TESTING,,,16,,RBRVS,1.70 ,1.54 ,1.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96127,CPT,BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT,,TC,16,,RBRVS,,0.14 ,0.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96150,CPT,HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT 1ST ASSMT,,,16,,RBRVS,0.50 ,0.08 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96151,CPT,HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT RE-ASSMT,,,16,,RBRVS,0.48 ,0.07 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96152,CPT,HLTH&BEHAVIOR IVNTJ EA 15 MIN INDIV,,,16,,RBRVS,0.46 ,0.07 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96153,CPT,HLTH&BEHAVIOR IVNTJ EA 15 MIN GRP 2/>PTS,,,16,,RBRVS,0.10 ,0.02 ,0.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96154,CPT,HLTH&BEHAVIOR IVNTJ EA 15 MIN FAM W/PT,,,16,,RBRVS,0.45 ,0.07 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96155,CPT,HLTH&BEHAVIOR IVNTJ EA 15 MIN FAM W/O PT,,,16,,RBRVS,0.44 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96160,CPT,PT-FOCUSED HLTH RISK ASSMT,,,18,,RBRVS,,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96161,CPT,CAREGIVER HEALTH RISK ASSMT,,,18,,RBRVS,,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96360,CPT,IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,,,22,,RBRVS,0.17 ,1.41 ,1.41 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 96361,CPT,IV INFUSION HYDRATION EACH ADDITIONAL HOUR,,,22,,RBRVS,0.09 ,0.33 ,0.33 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 96365,CPT,IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR,,,22,,RBRVS,0.21 ,1.70 ,1.70 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 96366,CPT,IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR,,,22,,RBRVS,0.18 ,0.34 ,0.34 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 96367,CPT,IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR,,,22,,RBRVS,0.19 ,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 96368,CPT,IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS,,,22,,RBRVS,0.17 ,0.40 ,0.40 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 96369,CPT,SUBCUTANEOUS INFUSION INITIAL 1 HR W/PUMP SET-UP,,,22,,RBRVS,0.21 ,5.18 ,5.18 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 96370,CPT,SUBCUTANEOUS INFUSION EACH ADDITIONAL HOUR,,,22,,RBRVS,0.18 ,0.23 ,0.23 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 96371,CPT,SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE,,,22,,RBRVS,,2.05 ,2.05 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 96372,CPT,THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM,,,22,,RBRVS,0.17 ,0.53 ,0.53 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 96373,CPT,THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL,,,22,,RBRVS,0.17 ,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 96374,CPT,THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG,,,22,,RBRVS,0.18 ,1.38 ,1.38 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 96375,CPT,THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG,,,22,,RBRVS,0.10 ,0.52 ,0.52 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 96376,CPT,THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC,,,22,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 96379,CPT,UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,,,22,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 96401,CPT,CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO,,,14,,RBRVS,0.21 ,1.84 ,1.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96402,CPT,CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO,,,14,,RBRVS,0.19 ,0.70 ,0.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96405,CPT,CHEMOTHERAPY ADMINISTRATION INTRALESIONAL 7,,,14,,RBRVS,0.80 ,0.47 ,2.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96409,CPT,CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG,,,14,,RBRVS,0.24 ,2.81 ,2.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96411,CPT,CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG,,,14,,RBRVS,0.20 ,1.51 ,1.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96413,CPT,CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG,,,14,,RBRVS,0.28 ,3.45 ,3.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96415,CPT,CHEMOTHERAPY ADMN IV INFUSION TQ EA HR,,,14,,RBRVS,0.19 ,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96416,CPT,CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP,,,14,,RBRVS,0.21 ,3.67 ,3.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96417,CPT,CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR,,,14,,RBRVS,0.21 ,1.51 ,1.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96420,CPT,CHEMOTHERAPY ADMIN INTRA-ARTERIAL PUSH TQ,,,14,,RBRVS,0.17 ,2.73 ,2.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96422,CPT,CHEMOTHERAPY ADMIN INTRA-ARTERIAL INFUS 8 HR PRTBLE IMPLTBL PMP,,,14,,RBRVS,0.17 ,4.82 ,4.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96440,CPT,CHEMOTX ADMN PLEURAL CAVITY REQ&W/THORACNTS,,,14,,RBRVS,2.37 ,1.08 ,20.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96446,CPT,CHEMOTX ADMN PRTL CAVITY PORT/CATH,,,14,,RBRVS,0.37 ,0.18 ,5.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96450,CPT,CHEMOTX ADMN CNS REQ SPINAL PUNCTURE,,,14,,RBRVS,1.53 ,0.65 ,3.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96521,CPT,REFILLING & MAINTENANCE PORTABLE PUMP,,,14,,RBRVS,0.21 ,3.61 ,3.61 ,,,$0.00,$0.00,1,1,1,1,1,1,20171001, 96522,CPT,REFILL&MAINTENANCE PUMP DRUG DLVR SYSTEMIC,,,14,,RBRVS,0.21 ,2.90 ,2.90 ,,,$0.00,$0.00,1,1,1,1,1,1,20171001, 96523,CPT,IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST,,,14,,RBRVS,0.04 ,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,1,1,1,20171001, 96542,CPT,CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT,,,14,,RBRVS,0.75 ,0.39 ,2.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96549,CPT,UNLISTED CHEMOTHERAPY PROCEDURE,,,14,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96567,CPT,PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX,,,14,,RBRVS,,3.79 ,3.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96570,CPT,PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX 30 MIN,,,14,,RBRVS,1.10 ,0.35 ,0.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96571,CPT,PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX A 15 MIN,,,14,,RBRVS,0.55 ,0.17 ,0.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96900,CPT,ACTINOTHERAPY ULTRAVIOLET LIGHT,,,14,,RBRVS,,0.57 ,0.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96902,CPT,MCRSCP XM HAIR PLUCK/CLIP FOR CNTS/STRUCT ABNORM,,,14,,RBRVS,0.41 ,0.16 ,0.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96904,CPT,WHOLE BODY INTEGUMENTARY PHOTOGRAPHY,,,14,,RBRVS,,1.75 ,1.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96910,CPT,PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB,,,14,,RBRVS,,2.00 ,2.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96912,CPT,PHOTOCHEMOTX PSORALENS&ULTRAVIOLET PUVA,,,14,,RBRVS,,2.56 ,2.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96913,CPT,PHOTOCHEMOTHERAPY DERMATOSES 4-8 HRS SUPERVISION,,,14,,RBRVS,,3.66 ,3.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96920,CPT,LASER SKIN DISEASE PSORIASIS TOT AREA <250 SQ CM,,,14,,RBRVS,1.15 ,0.69 ,3.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96921,CPT,LASER SKIN DISEASE PSORIASIS 250-500 SQ CM,,,14,,RBRVS,1.30 ,0.79 ,3.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96922,CPT,LASER SKIN DISEASE PSORIASIS >500 SQ CM,,,14,,RBRVS,2.10 ,1.26 ,4.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96931,CPT,RCM CELULR & SUBCELULR SKN IMGNG IMG ACQ I&R 1ST,,,14,,RBRVS,0.80 ,3.59 ,3.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96932,CPT,RCM CELULR & SUBCELULR SKN IMGNG IMG ACQUISITION,,TC,14,,RBRVS,,2.90 ,2.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96933,CPT,RCM CELULR & SUBCELULR SKN IMGNG I&R 1ST LES,,PC,14,,RBRVS,0.80 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96934,CPT,RCM CELULR & SUBCELULR SKN IMGNG IMG ACQ I&R ADD,,,14,,RBRVS,0.76 ,1.44 ,1.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96935,CPT,RCM CELULR & SUBCELULR SKN IMGNG IMG ACQ EA ADDL,,TC,14,,RBRVS,,0.97 ,0.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 96936,CPT,RCM CELULR & SUBCELULR SKN IMGNG I&R EA ADDL,,PC,14,,RBRVS,0.76 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 96999,CPT,UNLISTED SPECIAL DERMATOLOGICAL SERVICE/PROCED,,,14,,TotalUnits,,,,2.00 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 97010,CPT,APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS,,,19,,RBRVS,0.06 ,0.10 ,0.10 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97012,CPT,APPL MODALITY 1/> AREAS TRACTION MECHANICAL,,,19,,RBRVS,0.25 ,0.19 ,0.19 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97014,CPT,APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED,,,19,,RBRVS,0.18 ,0.26 ,0.26 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97016,CPT,APPL MODALITY 1/> AREAS VASOPNEUMATIC DEVICES,,,19,,RBRVS,0.18 ,0.35 ,0.35 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97018,CPT,APPL MODALITY 1/> AREAS PARAFFIN BATH,,,19,,RBRVS,0.06 ,0.24 ,0.24 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97022,CPT,APPLICATION MODALITY 1/> AREAS WHIRLPOOL,,,19,,RBRVS,0.17 ,0.48 ,0.48 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97024,CPT,APPLICATION MODALITY 1/> AREAS DIATHERMY,,,19,,RBRVS,0.06 ,0.11 ,0.11 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97026,CPT,APPLICATION MODALITY 1/> AREAS INFRARED,,,19,,RBRVS,0.06 ,0.10 ,0.10 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97028,CPT,APPL MODALITY 1/> AREAS ULTRAVIOLET,,,19,,RBRVS,0.08 ,0.12 ,0.12 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97032,CPT,APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN,,,19,,RBRVS,0.25 ,0.28 ,0.28 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97033,CPT,APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN,,,19,,RBRVS,0.26 ,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97034,CPT,APPL MODALITY 1/> AREAS CONTRAST BATHS EA 15 MIN,,,19,,RBRVS,0.21 ,0.29 ,0.29 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97035,CPT,APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN,,,19,,RBRVS,0.21 ,0.14 ,0.14 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97036,CPT,APPL MODALITY 1/> AREAS HUBBARD TANK EA 15 MIN,,,19,,RBRVS,0.28 ,0.64 ,0.64 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97039,CPT,UNLIST MODALITY SPEC TYPE&TIME CONSTANT ATTEND,,,19,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97110,CPT,THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES,,,19,,RBRVS,0.45 ,0.44 ,0.44 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97112,CPT,THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA,,,19,,RBRVS,0.45 ,0.48 ,0.48 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97113,CPT,THER PX 1/> AREAS EACH 15 MIN AQUA THER W/XERSS,,,19,,RBRVS,0.44 ,0.76 ,0.76 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97116,CPT,THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR,,,19,,RBRVS,0.40 ,0.39 ,0.39 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97124,CPT,THER PX 1/> AREAS EACH 15 MINUTES MASSAGE,,,19,,RBRVS,0.35 ,0.38 ,0.38 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97139,CPT,UNLISTED THERAPEUTIC PROCEDURE SPECIFY,,,19,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97140,CPT,MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES,,,19,,RBRVS,0.43 ,0.40 ,0.40 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97150,CPT,THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS,,,19,,RBRVS,0.29 ,0.19 ,0.19 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97161,CPT,PT EVAL LOW COMPLEX 20 MIN,,,19,,RBRVS,1.20 ,0.98 ,0.98 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97162,CPT,PT EVAL MOD COMPLEX 30 MIN,,,19,,RBRVS,1.20 ,0.98 ,0.98 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97163,CPT,PT EVAL HIGH COMPLEX 45 MIN,,,19,,RBRVS,1.20 ,0.98 ,0.98 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97164,CPT,PT RE-EVAL EST PLAN CARE,,,19,,RBRVS,0.75 ,0.73 ,0.73 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97165,CPT,OT EVAL LOW COMPLEX 30 MIN,,,19,,RBRVS,1.20 ,0.91 ,0.91 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97166,CPT,OT EVAL MOD COMPLEX 45 MIN,,,19,,RBRVS,1.20 ,0.91 ,0.91 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97167,CPT,OT EVAL HIGH COMPLEX 60 MIN,,,19,,RBRVS,1.20 ,0.91 ,0.91 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97168,CPT,OT RE-EVAL EST PLAN CARE,,,19,,RBRVS,0.75 ,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97530,CPT,THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN,,,19,,RBRVS,0.44 ,0.53 ,0.53 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97532,CPT,DEVELOPMENT OF COGNITIVE SKILLS EACH 15 MINUTES,,,19,,RBRVS,0.44 ,0.30 ,0.30 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97533,CPT,SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES,,,19,,RBRVS,0.44 ,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97535,CPT,SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES,,,19,,RBRVS,0.45 ,0.52 ,0.52 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97537,CPT,COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN,,,19,,RBRVS,0.45 ,0.38 ,0.38 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97542,CPT,WHEELCHAIR MGMT EA 15 MIN,,,19,,RBRVS,0.45 ,0.40 ,0.40 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97545,CPT,WORK HARDENING/CONDITIONING 1ST 2 HR,,,19,,TotalUnits,,,,3.03 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97546,CPT,WORK HARDENING/CONDITIONING EACH HOUR,,,19,,TotalUnits,,,,1.21 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97597,CPT,DEBRIDEMENT OPEN WOUND 20 SQ CM/<,,,14,,RBRVS,0.51 ,0.13 ,1.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 97598,CPT,DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM,,,14,,RBRVS,0.24 ,0.06 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 97602,CPT,RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS,,,14,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 97605,CPT,NEGATIVE PRESSURE WOUND THERAPY DME 50 SQ CM,,,14,,RBRVS,0.60 ,0.15 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 97610,CPT,LOW FREQUENCY NON-THERMAL ULTRASOUND PER DAY,,,19,,RBRVS,0.35 ,0.09 ,3.01 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97750,CPT,PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN,,,19,,RBRVS,0.45 ,0.46 ,0.46 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97755,CPT,ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN,,,19,,RBRVS,0.62 ,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97760,CPT,ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15,,,19,,RBRVS,0.45 ,0.60 ,0.60 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97761,CPT,PROSTHETIC TRAINING UPPR&/LOWER EXTREM EA 15 M,,,19,,RBRVS,0.45 ,0.46 ,0.46 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97762,CPT,CHECKOUT ORTHOTIC/PROSTHETIC ESTAB PT EA 15 MIN,,,19,,RBRVS,0.25 ,1.08 ,1.08 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97799,CPT,UNLISTED PHYSICAL MEDICINE/REHAB SERVICE/PROC,,,19,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 97802,CPT,MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI,,,14,,RBRVS,0.53 ,0.37 ,0.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 97803,CPT,MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M,,,14,,RBRVS,0.45 ,0.31 ,0.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 97804,CPT,MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI,,,14,,RBRVS,0.25 ,0.17 ,0.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 97810,CPT,ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN,,,14,,RBRVS,0.60 ,0.23 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 97811,CPT,ACUPUNCTURE 1/> NDLS W/O ELEC STIMJ EA 15 MIN,,,14,,RBRVS,0.50 ,0.19 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 97813,CPT,ACUPUNCTURE 1/> NDLS W/ELEC STIMJ 1ST 15 MIN,,,14,,RBRVS,0.65 ,0.25 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 97814,CPT,ACUP 1/> NDLS W/ELEC STIMJ EA 15 MIN W/RE-INSJ,,,14,,RBRVS,0.55 ,0.21 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 98925,CPT,OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS,,,19,,RBRVS,0.46 ,0.18 ,0.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 98926,CPT,OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS,,,19,,RBRVS,0.71 ,0.27 ,0.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 98927,CPT,OSTEOPATHIC MANIPULATIVE TX 5-6 BODY REGIONS,,,19,,RBRVS,0.96 ,0.33 ,0.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 98928,CPT,OSTEOPATHIC MANIPULATIVE TX 7-8 BODY REGIONS,,,19,,RBRVS,1.21 ,0.42 ,0.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 98929,CPT,OSTEOPATHIC MANIPULATIVE TX 9-10 BODY REGIONS,,,19,,RBRVS,1.46 ,0.50 ,0.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 98940,CPT,CHIROPRACTIC MANIPULATIVE TX SPINAL 1-2 REGIONS,,,5,,RBRVS,0.46 ,0.16 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 98941,CPT,CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS,,,5,,RBRVS,0.71 ,0.25 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 98942,CPT,CHIROPRACTIC MANIPULATIVE TX SPINAL 5 REGIONS,,,5,,RBRVS,0.96 ,0.33 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 98943,CPT,CHIROPRACTIC MANIPLTV TX EXTRASPINAL 1/> REGION,,,5,,RBRVS,0.46 ,0.18 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 98960,CPT,EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT,,,14,,RBRVS,,0.77 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 98961,CPT,EDUCATION&TRAINING SELF-MGMT NONPHYS 2-4 PTS,,,14,,RBRVS,,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 98962,CPT,EDUCATION&TRAINING SELF-MGMT NONPHYS 5-8 PTS,,,14,,RBRVS,,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 98966,CPT,NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN,,,15,,RBRVS,0.25 ,0.10 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 98967,CPT,NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN,,,15,,RBRVS,0.50 ,0.19 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 98968,CPT,NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN,,,15,,RBRVS,0.75 ,0.29 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 98969,CPT,NONPHYSICIAN ONLINE ASSESSMENT AND MANAGEMENT,,,15,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99000,CPT,HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB,,,14,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99001,CPT,HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB,,,14,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99002,CPT,HANDLE/CONVEY/ANY OTH SVC DEVICE FIT PHYS/QHP,,,14,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99024,CPT,POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX,,,14,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99026,CPT,HOSPITAL MANDATED CALL SERVICE IN-HOSPITAL EA HR,,,14,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99027,CPT,HOSPITAL MANDATED CALL SVC OUT-OF-HOSPITAL EA HR,,,14,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99050,CPT,SERVICES PROVIDED OFFICE OTH/THN REG SCHED HOURS,,,15,,TotalUnits,,,,0.91 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99051,CPT,SVC PRV OFFICE REG SCHEDD EVN WKEND/HOLIDAY HRS,,,15,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99053,CPT,SERVICES PROVIDED BTW 10 PM&8 AM AT 24-HR FACI,,,15,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99056,CPT,SVC TYPICAL PRV OFFICE PRV OUT OFFICE REQUEST PT,,,15,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99058,CPT,SVC PRV EMER BASIS IN OFFICE DISRUPTING SVCS,,,15,,TotalUnits,,,,1.08 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99060,CPT,SVC PRV EMER OUT OFFICE DISRUPTS OFFICE SVC,,,15,,TotalUnits,,,,1.21 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99070,CPT,SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP,,,14,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 99071,CPT,EDUCATIONAL SUPPLIES PRV BY THE PHYS AT COST,,,14,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, 99075,CPT,MEDICAL TESTIMONY,,,14,,TotalUnits,,,,1.91 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99078,CPT,PHYS/QHP EDUCATION SVCS RENDERED PTS GRP SETTING,,,14,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99080,CPT,SPEC REPORTS > USUAL MED COMUNICAJ/STAND RPRTG,,,14,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99082,CPT,UNUSUAL TRAVEL,,,14,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99090,CPT,ANALYSIS CLINICAL DATA STORED IN COMPUTERS,,,14,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99091,CPT,COLLJ&INTERPJ PHYS/QHP PHYSIO COMPUTR DATA 30 MI,,,14,,RBRVS,1.10 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99100,CPT,ANESTHESIA EXTREME AGE PATIENT UNDER 1 YR/<,,,14,,TotalUnits,,,,1.26 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99116,CPT,ANES COMPLICJ UTILIZATION TOTAL BODY HYPOTHERMIA,,,14,,TotalUnits,,,,3.76 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99135,CPT,ANES COMPLICJ UTILIZATION CONTROLLED HYPOTENSION,,,14,,TotalUnits,,,,6.22 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99140,CPT,ANES COMPLICJ EMERGENCY CONDITIONS SPECIFY,,,14,,TotalUnits,,,,2.31 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99151,CPT,MOD SED SAME PHYS/QHP <5 YRS,,,14,,RBRVS,0.50 ,0.12 ,1.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99152,CPT,MOD SED SAME PHYS/QHP 5/>YRS,,,14,,RBRVS,0.25 ,0.08 ,1.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99153,CPT,MOD SED SAME PHYS/QHP EA,,TC,14,,RBRVS,,0.30 ,0.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99155,CPT,MOD SED OTH PHYS/QHP <5 YRS,,,14,,RBRVS,1.90 ,0.56 ,0.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99156,CPT,MOD SED OTH PHYS/QHP 5/>YRS,,,14,,RBRVS,1.65 ,0.35 ,0.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99157,CPT,MOD SED OTHER PHYS/QHP EA,,,14,,RBRVS,1.25 ,0.27 ,0.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99170,CPT,ANOGENITAL XM MAGNIFY CHILD/SUSPECT TRAUMA W IMG,,,14,,RBRVS,1.75 ,0.67 ,3.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99172,CPT,VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM,,,23,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 99172,CPT,VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM,,PC,23,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 99172,CPT,VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM,,TC,23,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 99173,CPT,SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT,,,23,,RBRVS,,0.08 ,0.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99174,CPT,INSTRUMENT BASED OCULAR SCR BI W/RMT ANAL & RPT,,,23,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 99174,CPT,INSTRUMENT BASED OCULAR SCR BI W/RMT ANAL & RPT,,PC,23,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, 99174,CPT,INSTRUMENT BASED OCULAR SCR BI W/RMT ANAL & RPT,,TC,23,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, 99175,CPT,IPECAC/SIMILAR ADMN EMESIS&OBS STOMACH EMPTIED,,,14,,RBRVS,,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99183,CPT,PHYS/QHP ATTN&SUPVJ HYPRBARIC OXYGEN TX/SESSION,,PC,14,,RBRVS,2.11 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99184,CPT,INITIAT SELECTIVE HEAD/BODY HYPOTHERMIA NEONATE,,,10,,RBRVS,4.50 ,1.72 ,1.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 99188,CPT,APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP,,,14,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99190,CPT,ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH EA HR,,,14,,TotalUnits,,,,11.78 ,,$0.00,$0.00,1,1,0,0,1,1,20171001, 99191,CPT,ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH 45 MI,,,14,,TotalUnits,,,,8.25 ,,$0.00,$0.00,1,1,0,0,1,1,20171001, 99192,CPT,ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH 30 MI,,,14,,TotalUnits,,,,5.89 ,,$0.00,$0.00,1,1,0,0,1,1,20171001, 99195,CPT,PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE,,,14,,RBRVS,,2.76 ,2.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99199,CPT,UNLISTED SPECIAL SERVICE PROCEDURE/REPORT,,,14,,TotalUnits,,,,2.00 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99201,CPT,OFFICE OUTPATIENT NEW 10 MINUTES,,,15,,RBRVS,0.48 ,0.22 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99202,CPT,OFFICE OUTPATIENT NEW 20 MINUTES,,,15,,RBRVS,0.93 ,0.41 ,1.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99203,CPT,OFFICE OUTPATIENT NEW 30 MINUTES,,,15,,RBRVS,1.42 ,0.60 ,1.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99204,CPT,OFFICE OUTPATIENT NEW 45 MINUTES,,,15,,RBRVS,2.43 ,1.02 ,1.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99205,CPT,OFFICE OUTPATIENT NEW 60 MINUTES,,,15,,RBRVS,3.17 ,1.31 ,2.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99211,CPT,OFFICE OUTPATIENT VISIT 5 MINUTES,,,15,,RBRVS,0.18 ,0.07 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99212,CPT,OFFICE OUTPATIENT VISIT 10 MINUTES,,,15,,RBRVS,0.48 ,0.19 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99213,CPT,OFFICE OUTPATIENT VISIT 15 MINUTES,,,15,,RBRVS,0.97 ,0.40 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99214,CPT,OFFICE OUTPATIENT VISIT 25 MINUTES,,,15,,RBRVS,1.50 ,0.61 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99215,CPT,OFFICE OUTPATIENT VISIT 40 MINUTES,,,15,,RBRVS,2.11 ,0.87 ,1.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99217,CPT,OBSERVATION CARE DISCHARGE MANAGEMENT,,,10,,RBRVS,1.28 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99218,CPT,INITIAL OBSERVATION CARE/DAY 30 MINUTES,,,10,,RBRVS,1.92 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99219,CPT,INITIAL OBSERVATION CARE/DAY 50 MINUTES,,,10,,RBRVS,2.60 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99220,CPT,INITIAL OBSERVATION CARE/DAY 70 MINUTES,,,10,,RBRVS,3.56 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99221,CPT,INITIAL HOSPITAL CARE/DAY 30 MINUTES,,,10,,RBRVS,1.92 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99222,CPT,INITIAL HOSPITAL CARE/DAY 50 MINUTES,,,10,,RBRVS,2.61 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99223,CPT,INITIAL HOSPITAL CARE/DAY 70 MINUTES,,,10,,RBRVS,3.86 ,1.56 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99224,CPT,SBSQ OBSERVATION CARE/DAY 15 MINUTES,,,10,,RBRVS,0.76 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99225,CPT,SBSQ OBSERVATION CARE/DAY 25 MINUTES,,,10,,RBRVS,1.39 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99226,CPT,SBSQ OBSERVATION CARE/DAY 35 MINUTES,,,10,,RBRVS,2.00 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99231,CPT,SBSQ HOSPITAL CARE/DAY 15 MINUTES,,,10,,RBRVS,0.76 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99232,CPT,SBSQ HOSPITAL CARE/DAY 25 MINUTES,,,10,,RBRVS,1.39 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99233,CPT,SBSQ HOSPITAL CARE/DAY 35 MINUTES,,,10,,RBRVS,2.00 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99234,CPT,OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES,,,10,,RBRVS,2.56 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99235,CPT,OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES,,,10,,RBRVS,3.24 ,1.29 ,1.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99236,CPT,OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES,,,10,,RBRVS,4.20 ,1.64 ,1.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99238,CPT,HOSPITAL DISCHARGE DAY MANAGEMENT 30 MIN/<,,,10,,RBRVS,1.28 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99239,CPT,HOSPITAL DISCHARGE DAY MANAGEMENT > 30 MIN,,,10,,RBRVS,1.90 ,1.00 ,1.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99241,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN,,,6,,RBRVS,0.64 ,0.24 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99242,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN,,,6,,RBRVS,1.34 ,0.51 ,1.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99243,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN,,,6,,RBRVS,1.88 ,0.71 ,1.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99244,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN,,,6,,RBRVS,3.02 ,1.14 ,1.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99245,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN,,,6,,RBRVS,3.77 ,1.38 ,2.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99251,CPT,INITIAL INPATIENT CONSULT NEW/ESTAB PT 20 MIN,,,6,,RBRVS,1.00 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99252,CPT,INITIAL INPATIENT CONSULT NEW/ESTAB PT 40 MIN,,,6,,RBRVS,1.50 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99253,CPT,INITIAL INPATIENT CONSULT NEW/ESTAB PT 55 MIN,,,6,,RBRVS,2.27 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99254,CPT,INITIAL INPATIENT CONSULT NEW/ESTAB PT 80 MIN,,,6,,RBRVS,3.29 ,1.23 ,1.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99255,CPT,INITIAL INPATIENT CONSULT NEW/ESTAB PT 110 MIN,,,6,,RBRVS,4.00 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99281,CPT,EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB,,,7,,RBRVS,0.45 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99282,CPT,EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY,,,7,,RBRVS,0.88 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99283,CPT,EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY,,,7,,RBRVS,1.34 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99284,CPT,EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY,,,7,,RBRVS,2.56 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99285,CPT,EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ,,,7,,RBRVS,3.80 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99288,CPT,PHYS/QHP DIRECTION EMERGENCY MEDICAL SYSTEMS,,,7,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99291,CPT,CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN,,,10,,RBRVS,4.50 ,1.42 ,2.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99292,CPT,CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN,,,10,,RBRVS,2.25 ,0.72 ,1.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99304,CPT,INITIAL NURSING FACILITY CARE/DAY 25 MINUTES,,,10,,RBRVS,1.64 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99305,CPT,INITIAL NURSING FACILITY CARE/DAY 35 MINUTES,,,10,,RBRVS,2.35 ,1.17 ,1.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99306,CPT,INITIAL NURSING FACILITY CARE/DAY 45 MINUTES,,,10,,RBRVS,3.06 ,1.43 ,1.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99307,CPT,SBSQ NURSING FACILITY CARE/DAY E/M STABLE 10 MIN,,,10,,RBRVS,0.76 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99308,CPT,SBSQ NURSING FACIL CARE/DAY MINOR COMPLJ 15 MIN,,,10,,RBRVS,1.16 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99309,CPT,SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 25 MIN,,,10,,RBRVS,1.55 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99310,CPT,SBSQ NURS FACIL CARE/DAY UNSTABL/NEW PROB 35 MIN,,,10,,RBRVS,2.35 ,1.31 ,1.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99315,CPT,NURSING FACILITY DISCHARGE MANAGEMENT 30 MINUTES,,,10,,RBRVS,1.28 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99316,CPT,NURSING FACILITY DISCHARGE MANAGEMENT 30 MINUTES,,,10,,RBRVS,1.90 ,0.95 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99318,CPT,E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN,,,10,,RBRVS,1.71 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99324,CPT,DOMICIL/REST HOME NEW PT VISIT LOW SEVER 20 MIN,,,15,,RBRVS,1.01 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99325,CPT,DOMICIL/REST HOME NEW PT VISIT MOD SEVER 30 MIN,,,15,,RBRVS,1.52 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99326,CPT,DOMICIL/REST HOME NEW PT HI-MOD SEVER 45 MINUTES,,,15,,RBRVS,2.63 ,1.12 ,1.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99327,CPT,DOMICIL/REST HOME NEW PT VISIT HI SEVER 60 MIN,,,15,,RBRVS,3.46 ,1.55 ,1.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99328,CPT,DOM/R-HOME E/M NEW PT SIGNIF NEW PROB 75 MINUTES,,,15,,RBRVS,4.09 ,1.76 ,1.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99334,CPT,DOM/R-HOME E/M EST PT SELF-LMTD/MINOR 15 MINUTES,,,15,,RBRVS,1.07 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99335,CPT,DOM/R-HOME E/M EST PT LW MOD SEVERITY 25 MINUTES,,,15,,RBRVS,1.72 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99336,CPT,DOM/R-HOME E/M EST PT MOD HI SEVERITY 40 MINUTES,,,15,,RBRVS,2.46 ,1.17 ,1.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99337,CPT,DOM/R-HOME E/M EST PT SIGNIF NEW PROB 60 MINUTES,,,15,,RBRVS,3.58 ,1.61 ,1.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99339,CPT,INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 15-29 MIN,,,15,,RBRVS,1.25 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99340,CPT,INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 30 MIN/>,,,15,,RBRVS,1.80 ,1.15 ,1.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99341,CPT,HOME VISIT NEW PATIENT LOW SEVERITY 20 MINUTES,,,15,,RBRVS,1.01 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99342,CPT,HOME VISIT NEW PATIENT MOD SEVERITY 30 MINUTES,,,15,,RBRVS,1.52 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99343,CPT,HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES,,,15,,RBRVS,2.53 ,0.96 ,0.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99344,CPT,HOME VISIT NEW PATIENT HI SEVERITY 60 MINUTES,,,15,,RBRVS,3.38 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99345,CPT,HOME VISIT NEW PT UNSTABL/SIGNIF NEW PROB 75 MIN,,,15,,RBRVS,4.09 ,1.84 ,1.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99347,CPT,HOME VISIT EST PT SELF LIMITED/MINOR 15 MINUTES,,,15,,RBRVS,1.00 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99348,CPT,HOME VISIT EST PT LOW-MOD SEVERITY 25 MINUTES,,,15,,RBRVS,1.56 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99349,CPT,HOME VISIT EST PT MOD-HI SEVERITY 40 MINUTES,,,15,,RBRVS,2.33 ,1.12 ,1.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99350,CPT,HOME VST EST PT UNSTABLE/SIGNIF NEW PROB 60 MINS,,,15,,RBRVS,3.28 ,1.50 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99354,CPT,PROLNG E&M/PSYCTX SVC OFFICE O/P DIR CON 1ST HR,,,15,,RBRVS,1.77 ,0.72 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99355,CPT,PROLNG E&M/PSYCTX SVC OFFICE O/P DIR CON ADDL 30,,,15,,RBRVS,1.77 ,0.65 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99356,CPT,PROLONGED SERVICE I/P REQ UNIT/FLOOR TIME 1ST HR,,,10,,RBRVS,1.71 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 99357,CPT,PROLONGED SVC I/P REQ UNIT/FLOOR TIME EA 30 MIN,,,10,,RBRVS,1.71 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 99358,CPT,PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR,,,15,,RBRVS,2.10 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99359,CPT,PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MINUTES,,,15,,RBRVS,1.00 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99360,CPT,PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MINUTES,,,14,,RBRVS,1.20 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99363,CPT,ANTICOAGULANT MGMT OUTPATIENT INIT 90 DAYS,,,14,,RBRVS,1.65 ,0.63 ,1.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99364,CPT,ANTICOAGULANT MGMT OUTPATIENT EA SBSQ 90 DAYS,,,14,,RBRVS,0.63 ,0.24 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99366,CPT,TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN,,,15,,RBRVS,0.82 ,0.31 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99367,CPT,TEAM CONFERENCE NON-FACE-TO-FACE PHYSICIAN,,,15,,RBRVS,1.10 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99368,CPT,TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN,,,15,,RBRVS,0.72 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99374,CPT,SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES,,,15,,RBRVS,1.10 ,0.42 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99375,CPT,SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/>,,,15,,RBRVS,1.73 ,0.66 ,1.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99377,CPT,SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN,,,15,,RBRVS,1.10 ,0.42 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99378,CPT,SUPERVISION HOSPICE PATIENT/MONTH 30 MINUTES/>,,,15,,RBRVS,1.73 ,0.66 ,1.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99379,CPT,SUPERVISION NURS FACILITY PATIENT MO 15-29 MIN,,,15,,RBRVS,1.10 ,0.42 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99380,CPT,SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/>,,,15,,RBRVS,1.73 ,0.66 ,1.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99381,CPT,INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR,,,24,,RBRVS,1.50 ,0.57 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99382,CPT,INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS,,,24,,RBRVS,1.60 ,0.61 ,1.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99383,CPT,INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS,,,18,,RBRVS,1.70 ,0.65 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99384,CPT,INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR,,,18,,RBRVS,2.00 ,0.76 ,1.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99385,CPT,INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS,,,18,,RBRVS,1.92 ,0.73 ,1.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99386,CPT,INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS,,,18,,RBRVS,2.33 ,0.89 ,1.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99387,CPT,INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>,,,18,,RBRVS,2.50 ,0.96 ,2.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99391,CPT,PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y,,,24,,RBRVS,1.37 ,0.52 ,1.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99392,CPT,PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS,,,24,,RBRVS,1.50 ,0.57 ,1.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99393,CPT,PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS,,,18,,RBRVS,1.50 ,0.57 ,1.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99394,CPT,PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS,,,18,,RBRVS,1.70 ,0.65 ,1.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99395,CPT,PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS,,,18,,RBRVS,1.75 ,0.67 ,1.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99396,CPT,PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS,,,18,,RBRVS,1.90 ,0.73 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99397,CPT,PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER,,,18,,RBRVS,2.00 ,0.76 ,1.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99401,CPT,PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 15 MIN,,,18,,RBRVS,0.48 ,0.18 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99402,CPT,PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 MIN,,,18,,RBRVS,0.98 ,0.37 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99403,CPT,PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN,,,18,,RBRVS,1.46 ,0.56 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99404,CPT,PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN,,,18,,RBRVS,1.95 ,0.75 ,1.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99406,CPT,TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES,,,14,,RBRVS,0.24 ,0.09 ,0.14 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 99407,CPT,TOBACCO USE CESSATION INTENSIVE >10 MINUTES,,,14,,RBRVS,0.50 ,0.19 ,0.24 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, 99408,CPT,ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN,,,16,,RBRVS,0.65 ,0.25 ,0.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99409,CPT,ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN,,,16,,RBRVS,1.30 ,0.50 ,0.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99411,CPT,PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 30 M,,,18,,RBRVS,0.15 ,0.06 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99412,CPT,PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 60 M,,,18,,RBRVS,0.25 ,0.10 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99415,CPT,PROLNG CLINCL STAFF SVC DURING O/P E/M 1ST HR,,TC,15,,RBRVS,,0.24 ,0.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99416,CPT,PROLNG CLINCL STAFF SVC DURING O/P E/M EA 30 MIN,,TC,15,,RBRVS,,0.13 ,0.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99429,CPT,UNLISTED PREVENTIVE MEDICINE SERVICE,,,18,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99441,CPT,PHYS/QHP TELEPHONE EVALUATION 5-10 MIN,,,15,,RBRVS,0.25 ,0.10 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99442,CPT,PHYS/QHP TELEPHONE EVALUATION 11-20 MIN,,,15,,RBRVS,0.50 ,0.19 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99443,CPT,PHYS/QHP TELEPHONE EVALUATION 21-30 MIN,,,15,,RBRVS,0.75 ,0.29 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99444,CPT,PHYS/QHP ONLINE EVALUATION & MANAGEMENT SERVICE,,,15,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99446,CPT,INTERPROF PHONE/INTERNET ASSESS/MANAGE 5-10,,,15,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99447,CPT,INTERPROF PHONE/INTERNET ASSESS/MANAGE 11-20,,,15,,TotalUnits,,,,1.64 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99448,CPT,INTERPROF PHONE/INTERNET ASSESS/MANAGE 21-30,,,15,,TotalUnits,,,,2.38 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99449,CPT,INTERPROF PHONE/INTERNET ASSESS/MANAGE 31/>,,,15,,TotalUnits,,,,2.66 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99450,CPT,BASIC LIFE AND/OR DISABILITY EXAMINATION,,,14,,TotalUnits,,,,1.09 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99455,CPT,WORK RELATED/MED DBLT XM TREATING PHYS,,,14,,TotalUnits,,,,1.69 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99456,CPT,WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,,,14,,TotalUnits,,,,5.02 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99460,CPT,1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB,,,10,,RBRVS,1.92 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99461,CPT,1ST CARE PR DAY NML NB XCPT HOSP/BIRTHING CENTER,,,24,,RBRVS,1.26 ,0.44 ,1.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99462,CPT,SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN,,,10,,RBRVS,0.84 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 99463,CPT,1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT,,,10,,RBRVS,2.13 ,1.09 ,1.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99464,CPT,ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN,,,10,,RBRVS,1.50 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99465,CPT,DELIVERY/BIRTHING ROOM RESUSCITATION,,,10,,RBRVS,2.93 ,1.19 ,1.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99466,CPT,CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN,,,10,,RBRVS,4.79 ,1.37 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99467,CPT,CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN,,,10,,RBRVS,2.40 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99468,CPT,1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/<,,,10,,RBRVS,18.46 ,7.06 ,7.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 99469,CPT,SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<,,,10,,RBRVS,7.99 ,2.74 ,2.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 99471,CPT,INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS,,,10,,RBRVS,15.98 ,7.10 ,7.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 99472,CPT,SUBSQ PED CRITICAL CARE 29 DAYS THRU 24 MO,,,10,,RBRVS,7.99 ,2.96 ,2.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 99475,CPT,INITIAL PED CRITICAL CARE 2 THRU 5 YEARS,,,10,,RBRVS,11.25 ,4.16 ,4.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 99476,CPT,SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS,,,10,,RBRVS,6.75 ,2.51 ,2.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 99477,CPT,INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL,,,10,,RBRVS,7.00 ,2.68 ,2.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 99478,CPT,SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS,,,10,,RBRVS,2.75 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 99479,CPT,SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS,,,10,,RBRVS,2.50 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 99480,CPT,SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS,,,10,,RBRVS,2.40 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 99485,CPT,SUPERVISION INTERFACILITY TRANSPORT INIT 30 MIN,,,10,,RBRVS,1.50 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99486,CPT,SUPERVISION INTERFACILITY TRANSPORT ADDL 30 MIN,,,10,,RBRVS,1.30 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99487,CPT,CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MO,,,10,,TotalUnits,,,,2.28 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99489,CPT,CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,,,10,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99490,CPT,CHRON CARE MANAGEMENT SRVC 20 MIN PER MONTH,,,10,,RBRVS,0.61 ,0.23 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99495,CPT,TRANSITIONAL CARE MANAGE SRVC 14 DAY DISCHARGE,,,10,,RBRVS,2.11 ,0.87 ,2.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99496,CPT,TRANSITIONAL CARE MANAGE SRVC 7 DAY DISCHARGE,,,10,,RBRVS,3.05 ,1.26 ,3.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99497,CPT,ADVANCE CARE PLANNING FIRST 30 MINS,,,14,,RBRVS,1.50 ,0.62 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99498,CPT,ADVANCE CARE PLANNING EA ADDL 30 MINS,,,14,,RBRVS,1.40 ,0.58 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, 99499,CPT,UNLISTED EVALUATION AND MANAGEMENT SERVICE,,,15,,TotalUnits,,,,1.96 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 99500,CPT,HOME VISIT PRENATAL MONITORING & ASSESSMENT,,,14,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, 99501,CPT,HOME VISIT POSTNATAL ASSMT&F-UP CARE,,,14,,TotalUnits,,,,1.65 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, 99502,CPT,HOME VISIT NEWBORN CARE & ASSESSMENT,,,14,,TotalUnits,,,,1.79 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, 99503,CPT,HOME VISIT RESPIRATORY THERAPY CARE,,,14,,TotalUnits,,,,1.40 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, 99504,CPT,HOME VISIT MECHANICAL VENTILATION CARE,,,14,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, 99505,CPT,HOME VISIT STOMA CARE&MAINT CLST&CSTOST,,,14,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, 99506,CPT,HOME VISIT INTRAMUSCULAR INJECTIONS,,,14,,TotalUnits,,,,1.58 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, 99507,CPT,HOME VISIT CARE&MAINT CATH,,,14,,TotalUnits,,,,0.88 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, 99509,CPT,HOME VISIT ASSISTANCE DAILY LIV&PRSONAL CARE,,,14,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, 99510,CPT,HOME VISIT INDIV FAM/MARRIAGE COUNSELING,,,14,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, 99511,CPT,HOME VISIT FECAL IMPACTION MGMT&ENEMA ADMN,,,14,,TotalUnits,,,,0.99 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, 99512,CPT,HOME VISIT HEMODIALYSIS,,,14,,TotalUnits,,,,37.64 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, 99600,CPT,UNLISTED HOME VISIT SERVICE/PROCEDURE,,,14,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, 99601,CPT,HOME NFS/SPECTY DRUG ADMN PR VST NDLS,,,20,,TotalUnits,,,,15.88 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0206T,CPT,CPTR DBS ALYS MLT CYCLS CAR ELEC DTA 2/> ECG LDS,,TC,14,,TotalUnits,,,,3.24 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 0213T,CPT,NJX DX/THER PARAVER FCT JT W/US CER/THOR 1 LVL,,,21,,TotalUnits,,,,3.30 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0214T,CPT,NJX DX/THER PARAVER FCT JT W/US CER/THOR 2ND LVL,,,21,,TotalUnits,,,,1.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 0216T,CPT,NJX DX/THER PARAVER FCT JT W/US LUMB/SAC 1 LVL,,,21,,TotalUnits,,,,3.57 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0217T,CPT,NJX DX/THER PARAVER FCT JT W/US LUMB/SAC LVL 2,,,21,,TotalUnits,,,,2.66 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 0228T,CPT,NJX ANES/STEROID TFRML EDRL W/US CER/THOR 1 LVL,,,21,,TotalUnits,,,,7.09 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0229T,CPT,NJX ANES/STERD TFRML EDRL W/US CER/THOR EA ADDL,,,21,,TotalUnits,,,,3.53 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0230T,CPT,NJX ANES/STEROID TFRML EDRL W/US LUM/SAC 1 LVL,,,21,,TotalUnits,,,,6.90 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0231T,CPT,NJX ANES/STEROID TFRML EDRL W/US LUM/SAC EA ADDL,,,21,,TotalUnits,,,,3.48 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0232T,CPT,NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION,,,14,,TotalUnits,,,,9.77 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0234T,CPT,TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA,,,21,,RBRVS,5.53 ,2.54 ,2.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0235T,CPT,TRLUML PERIPHERAL ATHERECTOMY VISCERAL ARTERY EA,,,21,,RBRVS,5.53 ,2.54 ,2.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 0236T,CPT,TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA,,,21,,RBRVS,7.60 ,3.18 ,3.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0237T,CPT,TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL,,,21,,RBRVS,10.42 ,4.80 ,4.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0238T,CPT,TRLUML PERIPHERAL ATHERECTOMY ILIAC ARTERY EA,,,21,,TotalUnits,,,,10.94 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0275T,CPT,PERC LAMINO-/LAMINECTOMY INDIR IMAG GUIDE LUMBAR,,,21,,TotalUnits,,,,43.13 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0278T,CPT,TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS,,,14,,TotalUnits,,,,1.88 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0290T,CPT,CORNEA INCISNS RECIPIENT CORNEA W/LASR KERTPLSTY,,,21,,TotalUnits,,,,3.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 0295T,CPT,EXT ECG > 48HR TO 21 DAY RCRD SCAN ANLYS REP R&I,,,4,,TotalUnits,,,,3.86 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, 0296T,CPT,EXT ECG > 48HR TO 21 DAY RCRD W/CONECT INTL RCRD,,TC,4,,TotalUnits,,,,0.94 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 0297T,CPT,EXT ECG > 48HR TO 21 DAY SCAN ANALYSIS W/REPORT,,TC,4,,TotalUnits,,,,2.00 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 0298T,CPT,EXT ECG > 48HR TO 21 DAY REVIEW AND INTERPRETATN,,PC,4,,TotalUnits,,,,1.05 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0330T,CPT,TEAR FILM IMAGING UNILATERAL OR BILATERAL W/I&R,,,14,,TotalUnits,,,,1.64 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0331T,CPT,MYOCRD SYMPATHETIC INNERVAJ IMG PLNR QUAL&QUANT,,,20,,TotalUnits,,,,3.78 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0332T,CPT,MYOCRD SYMP INNERVAJ IMG PLNR QUAL&QUANT W/SPECT,,,20,,TotalUnits,,,,5.25 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0333T,CPT,VISUAL EVOKED POTENTIAL ACUITY SCREENING AUTO,,,14,,TotalUnits,,,,3.72 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0346T,CPT,ULTRASOUND ELASTOGRAPHY,,,20,,TotalUnits,,,,1.71 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 0357T,CPT,CRYOPRESERVATION IMMATURE OOCYTE(S),,,17,,TotalUnits,,,,5.78 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, 0375T,CPT,TOTAL DISC ARTHRP ANT APPR W/DISCECTOMY CRV 3+,,,21,,RBRVS,10.08 ,4.20 ,4.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, 0387T,CPT,TRANSCATH INSERT OR REPLACE LEADLESS PM VENTR,,,21,,TotalUnits,,,,160.64 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0388T,CPT,TRANSCATH REMOVAL LEADLESS PM VENTRICULAR,,,21,,TotalUnits,,,,66.58 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0389T,CPT,PROG DEVICE EVAL IN PERSON LEADLESS PM SYSTEM,,,4,,TotalUnits,,,,1.10 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0391T,CPT,INTERROG DEVICE EVAL IN PERSON LEADLESS PM SYST,,,4,,TotalUnits,,,,1.10 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0394T,CPT,HDR ELECTRONIC BRACHYTHERAPY SKIN SURFACE,,,20,,TotalUnits,,,,21.54 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, 0395T,CPT,HDR ELECTRONIC BRACHYTHERAPY NTRSTL/INTRCAV,,,20,,TotalUnits,,,,21.54 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, A0080,HCPCS,NONINTEREST ESCORT IN NON ER,,,28,,NW,,,,,,$558.57,$0.00,1,1,1,0,0,1,20171001, A0090,HCPCS,INTEREST ESCORT IN NON ER,,,28,,NW,,,,,,$59.01,$0.00,1,1,1,0,0,1,20171001, A0100,HCPCS,NONEMERGENCY TRANSPORT TAXI,,,28,,NW,,,,,,$22.27,$0.00,1,1,1,0,0,1,20171001, A0110,HCPCS,NONEMERGENCY TRANSPORT BUS,,,28,,NW,,,,,,$59.59,$0.00,1,1,1,0,0,1,20171001, A0120,HCPCS,NONER TRANSPORT MINI-BUS,,,28,,NW,,,,,,$154.32,$0.00,1,1,1,0,0,1,20171001, A0130,HCPCS,NONER TRANSPORT WHEELCH VAN,,,28,,NW,,,,,,$82.40,$0.00,1,1,1,0,0,1,20171001, A0140,HCPCS,NONEMERGENCY TRANSPORT AIR,,,28,,NW,,,,,,"$1,011.57",$0.00,1,1,1,0,0,1,20171001, A0160,HCPCS,NONER TRANSPORT CASE WORKER,,,28,,NW,,,,,,$3.11,$0.00,1,1,1,0,0,1,20171001, A0170,HCPCS,TRANSPORT PARKING FEES/TOLLS,,,28,,NW,,,,,,$298.40,$0.00,1,1,1,0,0,1,20171001, A0180,HCPCS,NONER TRANSPORT LODGNG RECIP,,,28,,NW,,,,,,$851.62,$0.00,1,1,1,0,0,1,20171001, A0190,HCPCS,NONER TRANSPORT MEALS RECIP,,,28,,NW,,,,,,$157.98,$0.00,1,1,1,0,0,1,20171001, A0398,HCPCS,ALS ROUTINE DISPOSBLE SUPPLS,,,28,,NW,,,,,,$112.73,$0.00,1,1,1,0,0,1,20171001, A0422,HCPCS,AMBULANCE 02 LIFE SUSTAINING,,,28,,NW,,,,,,$132.50,$0.00,1,1,1,0,0,1,20171001, A4206,HCPCS,1 CC STERILE SYRINGE&NEEDLE,,,28,,NW,,,,,,$0.91,$0.00,1,1,1,0,0,1,20171001, A4207,HCPCS,2 CC STERILE SYRINGE&NEEDLE,,,28,,NW,,,,,,$0.91,$0.00,1,1,1,0,0,1,20171001, A4208,HCPCS,3 CC STERILE SYRINGE&NEEDLE,,,28,,NW,,,,,,$0.91,$0.00,1,1,1,0,0,1,20171001, A4209,HCPCS,5+ CC STERILE SYRINGE&NEEDLE,,,28,,NW,,,,,,$0.91,$0.00,1,1,1,0,0,1,20171001, A4210,HCPCS,NONNEEDLE INJECTION DEVICE,,,28,,NW,,,,,,"$1,185.99",$0.00,1,1,1,0,0,1,20171001, A4211,HCPCS,SUPP FOR SELF-ADM INJECTIONS,,,28,,NW,,,,,,$55.19,$0.00,1,1,1,0,0,1,20171001, A4212,HCPCS,NON CORING NEEDLE OR STYLET,,,28,,NW,,,,,,$12.83,$0.00,1,1,1,0,0,1,20171001, A4213,HCPCS,20+ CC SYRINGE ONLY,,,28,,NW,,,,,,$1.82,$0.00,1,1,1,0,0,1,20171001, A4215,HCPCS,STERILE NEEDLE,,,28,,NW,,,,,,$1.26,$0.00,1,1,1,0,0,1,20171001, A4216,HCPCS,"STERILE WATER/SALINE, 10 ML",,,28,,NW,,,,,,$1.06,$0.00,1,1,1,0,0,1,20171001, A4217,HCPCS,"STERILE WATER/SALINE, 500 ML",,,28,,NW,,,,,,$6.72,$0.00,1,1,1,0,0,1,20171001, A4217,HCPCS,"STERILE WATER/SALINE, 500 ML",AU,,28,,NW,,,,,,$6.72,$0.00,1,1,1,0,0,1,20171001, A4218,HCPCS,STERILE SALINE OR WATER,,,28,,NW,,,,,,$1.72,$0.00,1,1,1,0,0,1,20171001, A4220,HCPCS,INFUSION PUMP REFILL KIT,,,28,,NW,,,,,,$85.46,$0.00,1,1,1,0,0,1,20171001, A4221,HCPCS,SUPP NON-INSULIN INF CATH/WK,,,28,,NW,,,,,,$105.56,$0.00,1,1,1,0,0,1,20171001, A4222,HCPCS,INFUSION SUPPLIES WITH PUMP,,,28,,NW,,,,,,$139.53,$0.00,1,1,1,0,0,1,20171001, A4223,HCPCS,INFUSION SUPPLIES W/O PUMP,,,28,,NW,,,,,,$151.39,$0.00,1,1,1,0,0,1,20171001, A4230,HCPCS,INFUS INSULIN PUMP NON NEEDL,,,28,,NW,,,,,,$21.78,$0.00,1,1,1,0,0,1,20171001, A4231,HCPCS,INFUSION INSULIN PUMP NEEDLE,,,28,,NW,,,,,,$8.94,$0.00,1,1,1,0,0,1,20171001, A4232,HCPCS,SYRINGE W/NEEDLE INSULIN 3CC,,,28,,NW,,,,,,$5.61,$0.00,1,1,1,0,0,1,20171001, A4233,HCPCS,ALKALIN BATT FOR GLUCOSE MON,,,28,,NW,,,,,,$4.66,$0.00,1,1,1,0,0,1,20171001, A4233,HCPCS,ALKALIN BATT FOR GLUCOSE MON,NU,,28,,NW,,,,,,$4.66,$0.00,1,1,1,0,0,1,20171001, A4234,HCPCS,J-CELL BATT FOR GLUCOSE MON,,,28,,NW,,,,,,$21.55,$0.00,1,1,1,0,0,1,20171001, A4234,HCPCS,J-CELL BATT FOR GLUCOSE MON,NU,,28,,NW,,,,,,$21.55,$0.00,1,1,1,0,0,1,20171001, A4235,HCPCS,LITHIUM BATT FOR GLUCOSE MON,,,28,,NW,,,,,,$9.13,$0.00,1,1,1,0,0,1,20171001, A4235,HCPCS,LITHIUM BATT FOR GLUCOSE MON,NU,,28,,NW,,,,,,$9.13,$0.00,1,1,1,0,0,1,20171001, A4236,HCPCS,SILVR OXIDE BATT GLUCOSE MON,,,28,,NW,,,,,,$10.59,$0.00,1,1,1,0,0,1,20171001, A4236,HCPCS,SILVR OXIDE BATT GLUCOSE MON,NU,,28,,NW,,,,,,$10.59,$0.00,1,1,1,0,0,1,20171001, A4244,HCPCS,ALCOHOL OR PEROXIDE PER PINT,,,28,,NW,,,,,,$1.82,$0.00,1,1,1,0,0,1,20171001, A4245,HCPCS,ALCOHOL WIPES PER BOX,,,28,,NW,,,,,,$5.28,$0.00,1,1,1,0,0,1,20171001, A4246,HCPCS,BETADINE/PHISOHEX SOLUTION,,,28,,NW,,,,,,$5.28,$0.00,1,1,1,0,0,1,20171001, A4247,HCPCS,BETADINE/IODINE SWABS/WIPES,,,28,,NW,,,,,,$7.34,$0.00,1,1,1,0,0,1,20171001, A4248,HCPCS,CHLORHEXIDINE ANTISEPT,,,28,,NW,,,,,,$5.93,$0.00,1,1,1,0,0,1,20171001, A4250,HCPCS,URINE REAGENT STRIPS/TABLETS,,,28,,NW,,,,,,$25.19,$0.00,1,1,1,0,0,1,20171001, A4252,HCPCS,BLOOD KETONE TEST OR STRIP,,,28,,NW,,,,,,$11.04,$0.00,1,1,1,0,0,1,20171001, A4253,HCPCS,BLOOD GLUCOSE/REAGENT STRIPS,,,28,,NW,,,,,,$109.46,$0.00,1,1,1,0,0,1,20171001, A4253,HCPCS,BLOOD GLUCOSE/REAGENT STRIPS,NU,,28,,NW,,,,,,$109.46,$0.00,1,1,1,0,0,1,20171001, A4255,HCPCS,GLUCOSE MONITOR PLATFORMS,,,28,,NW,,,,,,$40.57,$0.00,1,1,1,0,0,1,20171001, A4256,HCPCS,CALIBRATOR SOLUTION/CHIPS,,,28,,NW,,,,,,$30.87,$0.00,1,1,1,0,0,1,20171001, A4256,HCPCS,CALIBRATOR SOLUTION/CHIPS,KL,,28,,NW,,,,,,$28.01,$0.00,1,1,1,0,0,1,20171001, A4257,HCPCS,REPLACE LENSSHIELD CARTRIDGE,,,28,,NW,,,,,,$95.27,$0.00,1,1,1,0,0,1,20171001, A4258,HCPCS,LANCET DEVICE EACH,,,28,,NW,,,,,,$19.36,$0.00,1,1,1,0,0,1,20171001, A4258,HCPCS,LANCET DEVICE EACH,KL,,28,,NW,,,,,,$17.30,$0.00,1,1,1,0,0,1,20171001, A4259,HCPCS,LANCETS PER BOX,,,28,,NW,,,,,,$12.97,$0.00,1,1,1,0,0,1,20171001, A4259,HCPCS,LANCETS PER BOX,KL,,28,,NW,,,,,,$11.73,$0.00,1,1,1,0,0,1,20171001, A4261,HCPCS,CERVICAL CAP CONTRACEPTIVE,,,28,,NW,,,,,,$75.32,$0.00,1,1,1,1,1,1,20171001, A4262,HCPCS,TEMPORARY TEAR DUCT PLUG,,,28,,NW,,,,,,$0.91,$0.00,1,1,1,0,0,1,20171001, A4263,HCPCS,PERMANENT TEAR DUCT PLUG,,,28,,NW,,,,,,$56.08,$0.00,1,1,1,0,0,1,20171001, A4264,HCPCS,INTRATUBAL OCCLUSION DEVICE,,,28,,NW,,,,,,"$2,145.18",$0.00,1,1,1,1,1,1,20171001, A4265,HCPCS,PARAFFIN,,,28,,NW,,,,,,$34.42,$0.00,1,1,1,0,0,1,20171001, A4266,HCPCS,DIAPHRAGM,,,28,,NW,,,,,,$55.15,$0.00,1,1,1,1,1,1,20171001, A4267,HCPCS,MALE CONDOM,,,28,,NW,,,,,,$0.91,$0.00,1,1,1,1,1,1,20171001, A4268,HCPCS,FEMALE CONDOM,,,28,,NW,,,,,,$1.49,$0.00,1,1,1,1,1,1,20171001, A4269,HCPCS,SPERMICIDE,,,28,,NW,,,,,,$1.82,$0.00,1,1,1,1,1,1,20171001, A4270,HCPCS,DISPOSABLE ENDOSCOPE SHEATH,,,28,,NW,,,,,,$23.36,$0.00,1,1,1,0,0,1,20171001, A4280,HCPCS,BRST PRSTHS ADHSV ATTCHMNT,,,28,,NW,,,,,,$9.79,$0.00,1,1,1,0,0,1,20171001, A4281,HCPCS,REPLACEMENT BREASTPUMP TUBE,,,28,,NW,,,,,,$20.98,$0.00,1,1,1,0,0,1,20171001, A4282,HCPCS,REPLACEMENT BREASTPUMP ADPT,,,28,,NW,,,,,,$7.12,$0.00,1,1,1,0,0,1,20171001, A4283,HCPCS,REPLACEMENT BREASTPUMP CAP,,,28,,NW,,,,,,$216.76,$0.00,1,1,1,0,0,1,20171001, A4284,HCPCS,REPLCMNT BREAST PUMP SHIELD,,,28,,NW,,,,,,$25.19,$0.00,1,1,1,0,0,1,20171001, A4285,HCPCS,REPLCMNT BREAST PUMP BOTTLE,,,28,,NW,,,,,,$11.27,$0.00,1,1,1,0,0,1,20171001, A4286,HCPCS,REPLCMNT BREASTPUMP LOK RING,,,28,,NW,,,,,,$109.40,$0.00,1,1,1,0,0,1,20171001, A4290,HCPCS,SACRAL NERVE STIM TEST LEAD,,,28,,NW,,,,,,$585.27,$0.00,1,1,1,0,0,1,20171001, A4300,HCPCS,CATH IMPL VASC ACCESS PORTAL,,,28,,NW,,,,,,$39.08,$0.00,1,1,1,0,0,1,20171001, A4301,HCPCS,IMPLANTABLE ACCESS SYST PERC,,,28,,NW,,,,,,$19.88,$0.00,1,1,1,0,0,1,20171001, A4305,HCPCS,DRUG DELIVERY SYSTEM >=50 ML,,,28,,NW,,,,,,$19.01,$0.00,1,1,1,0,0,1,20171001, A4306,HCPCS,DRUG DELIVERY SYSTEM <=50 ML,,,28,,NW,,,,,,$25.87,$0.00,1,1,1,0,0,1,20171001, A4310,HCPCS,INSERT TRAY W/O BAG/CATH,,,28,,NW,,,,,,$15.26,$0.00,1,1,1,0,0,1,20171001, A4311,HCPCS,CATHETER W/O BAG 2-WAY LATEX,,,28,,NW,,,,,,$27.48,$0.00,1,1,1,0,0,1,20171001, A4312,HCPCS,CATH W/O BAG 2-WAY SILICONE,,,28,,NW,,,,,,$33.80,$0.00,1,1,1,0,0,1,20171001, A4313,HCPCS,CATHETER W/BAG 3-WAY,,,28,,NW,,,,,,$34.76,$0.00,1,1,1,0,0,1,20171001, A4314,HCPCS,CATH W/DRAINAGE 2-WAY LATEX,,,28,,NW,,,,,,$46.92,$0.00,1,1,1,0,0,1,20171001, A4315,HCPCS,CATH W/DRAINAGE 2-WAY SILCNE,,,28,,NW,,,,,,$49.07,$0.00,1,1,1,0,0,1,20171001, A4316,HCPCS,CATH W/DRAINAGE 3-WAY,,,28,,NW,,,,,,$52.95,$0.00,1,1,1,0,0,1,20171001, A4320,HCPCS,IRRIGATION TRAY,,,28,,NW,,,,,,$10.56,$0.00,1,1,1,0,0,1,20171001, A4321,HCPCS,CATH THERAPEUTIC IRRIG AGENT,,,28,,NW,,,,,,$9.73,$0.00,1,1,1,0,0,1,20171001, A4322,HCPCS,IRRIGATION SYRINGE,,,28,,NW,,,,,,$6.77,$0.00,1,1,1,0,0,1,20171001, A4326,HCPCS,MALE EXTERNAL CATHETER,,,28,,NW,,,,,,$20.56,$0.00,1,1,1,0,0,1,20171001, A4327,HCPCS,FEM URINARY COLLECT DEV CUP,,,28,,NW,,,,,,$83.76,$0.00,1,1,1,0,0,1,20171001, A4328,HCPCS,FEM URINARY COLLECT POUCH,,,28,,NW,,,,,,$20.22,$0.00,1,1,1,0,0,1,20171001, A4330,HCPCS,STOOL COLLECTION POUCH,,,28,,NW,,,,,,$13.95,$0.00,1,1,1,0,0,1,20171001, A4331,HCPCS,EXTENSION DRAINAGE TUBING,,,28,,NW,,,,,,$7.18,$0.00,1,1,1,0,0,1,20171001, A4332,HCPCS,LUBE STERILE PACKET,,,28,,NW,,,,,,$0.30,$0.00,1,1,1,0,0,1,20171001, A4333,HCPCS,URINARY CATH ANCHOR DEVICE,,,28,,NW,,,,,,$4.09,$0.00,1,1,1,0,0,1,20171001, A4334,HCPCS,URINARY CATH LEG STRAP,,,28,,NW,,,,,,$9.08,$0.00,1,1,1,0,0,1,20171001, A4335,HCPCS,INCONTINENCE SUPPLY,,,28,,NW,,,,,,$0.60,$0.00,1,1,1,0,0,1,20171001, A4336,HCPCS,URETHRAL INSERT,,,28,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20171001, A4338,HCPCS,INDWELLING CATHETER LATEX,,,28,,NW,,,,,,$23.51,$0.00,1,1,1,0,0,1,20171001, A4340,HCPCS,INDWELLING CATHETER SPECIAL,,,28,,NW,,,,,,$57.45,$0.00,1,1,1,0,0,1,20171001, A4344,HCPCS,CATH INDW FOLEY 2 WAY SILICN,,,28,,NW,,,,,,$30.12,$0.00,1,1,1,0,0,1,20171001, A4346,HCPCS,CATH INDW FOLEY 3 WAY,,,28,,NW,,,,,,$36.02,$0.00,1,1,1,0,0,1,20171001, A4349,HCPCS,DISPOSABLE MALE EXTERNAL CAT,,,28,,NW,,,,,,$4.97,$0.00,1,1,1,0,0,1,20171001, A4351,HCPCS,STRAIGHT TIP URINE CATHETER,,,28,,NW,,,,,,$4.38,$0.00,1,1,1,0,0,1,20171001, A4352,HCPCS,COUDE TIP URINARY CATHETER,,,28,,NW,,,,,,$12.71,$0.00,1,1,1,0,0,1,20171001, A4353,HCPCS,INTERMITTENT URINARY CATH,,,28,,NW,,,,,,$14.38,$0.00,1,1,1,0,0,1,20171001, A4354,HCPCS,CATH INSERTION TRAY W/BAG,,,28,,NW,,,,,,$22.65,$0.00,1,1,1,0,0,1,20171001, A4355,HCPCS,BLADDER IRRIGATION TUBING,,,28,,NW,,,,,,$17.84,$0.00,1,1,1,0,0,1,20171001, A4356,HCPCS,EXT URETH CLMP OR COMPR DVC,,,28,,NW,,,,,,$83.11,$0.00,1,1,1,0,0,1,20171001, A4357,HCPCS,BEDSIDE DRAINAGE BAG,,,28,,NW,,,,,,$18.72,$0.00,1,1,1,0,0,1,20171001, A4358,HCPCS,URINARY LEG OR ABDOMEN BAG,,,28,,NW,,,,,,$13.08,$0.00,1,1,1,0,0,1,20171001, A4360,HCPCS,DISPOSABLE EXT URETHRAL DEV,,,28,,NW,,,,,,$1.17,$0.00,1,1,1,0,0,1,20171001, A4361,HCPCS,OSTOMY FACE PLATE,,,28,,NW,,,,,,$34.57,$0.00,1,1,1,0,0,1,20171001, A4362,HCPCS,SOLID SKIN BARRIER,,,28,,NW,,,,,,$7.37,$0.00,1,1,1,0,0,1,20171001, A4363,HCPCS,"OSTOMY CLAMP, REPLACEMENT",,,28,,NW,,,,,,$5.44,$0.00,1,1,1,0,0,1,20171001, A4364,HCPCS,"ADHESIVE, LIQUID OR EQUAL",,,28,,NW,,,,,,$5.14,$0.00,1,1,1,0,0,1,20171001, A4366,HCPCS,OSTOMY VENT,,,28,,NW,,,,,,$2.40,$0.00,1,1,1,0,0,1,20171001, A4367,HCPCS,OSTOMY BELT,,,28,,NW,,,,,,$14.42,$0.00,1,1,1,0,0,1,20171001, A4368,HCPCS,OSTOMY FILTER,,,28,,NW,,,,,,$0.64,$0.00,1,1,1,0,0,1,20171001, A4369,HCPCS,SKIN BARRIER LIQUID PER OZ,,,28,,NW,,,,,,$5.56,$0.00,1,1,1,0,0,1,20171001, A4371,HCPCS,SKIN BARRIER POWDER PER OZ,,,28,,NW,,,,,,$8.03,$0.00,1,1,1,0,0,1,20171001, A4372,HCPCS,SKIN BARRIER SOLID 4X4 EQUIV,,,28,,NW,,,,,,$9.09,$0.00,1,1,1,0,0,1,20171001, A4373,HCPCS,SKIN BARRIER WITH FLANGE,,,28,,NW,,,,,,$13.00,$0.00,1,1,1,0,0,1,20171001, A4375,HCPCS,DRAINABLE PLASTIC PCH W FCPL,,,28,,NW,,,,,,$33.61,$0.00,1,1,1,0,0,1,20171001, A4376,HCPCS,DRAINABLE RUBBER PCH W FCPLT,,,28,,NW,,,,,,$91.06,$0.00,1,1,1,0,0,1,20171001, A4377,HCPCS,DRAINABLE PLSTIC PCH W/O FP,,,28,,NW,,,,,,$9.28,$0.00,1,1,1,0,0,1,20171001, A4378,HCPCS,DRAINABLE RUBBER PCH W/O FP,,,28,,NW,,,,,,$59.23,$0.00,1,1,1,0,0,1,20171001, A4379,HCPCS,URINARY PLASTIC POUCH W FCPL,,,28,,NW,,,,,,$29.53,$0.00,1,1,1,0,0,1,20171001, A4380,HCPCS,URINARY RUBBER POUCH W FCPLT,,,28,,NW,,,,,,$71.67,$0.00,1,1,1,0,0,1,20171001, A4381,HCPCS,URINARY PLASTIC POUCH W/O FP,,,28,,NW,,,,,,$9.89,$0.00,1,1,1,0,0,1,20171001, A4382,HCPCS,URINARY HVY PLSTC PCH W/O FP,,,28,,NW,,,,,,$47.66,$0.00,1,1,1,0,0,1,20171001, A4383,HCPCS,URINARY RUBBER POUCH W/O FP,,,28,,NW,,,,,,$54.41,$0.00,1,1,1,0,0,1,20171001, A4384,HCPCS,OSTOMY FACEPLT/SILICONE RING,,,28,,NW,,,,,,$19.33,$0.00,1,1,1,0,0,1,20171001, A4385,HCPCS,OST SKN BARRIER SLD EXT WEAR,,,28,,NW,,,,,,$10.80,$0.00,1,1,1,0,0,1,20171001, A4387,HCPCS,OST CLSD POUCH W ATT ST BARR,,,28,,NW,,,,,,$5.40,$0.00,1,1,1,0,0,1,20171001, A4388,HCPCS,DRAINABLE PCH W EX WEAR BARR,,,28,,NW,,,,,,$9.41,$0.00,1,1,1,0,0,1,20171001, A4389,HCPCS,DRAINABLE PCH W ST WEAR BARR,,,28,,NW,,,,,,$12.90,$0.00,1,1,1,0,0,1,20171001, A4390,HCPCS,DRAINABLE PCH EX WEAR CONVEX,,,28,,NW,,,,,,$19.31,$0.00,1,1,1,0,0,1,20171001, A4391,HCPCS,URINARY POUCH W EX WEAR BARR,,,28,,NW,,,,,,$14.52,$0.00,1,1,1,0,0,1,20171001, A4392,HCPCS,URINARY POUCH W ST WEAR BARR,,,28,,NW,,,,,,$16.62,$0.00,1,1,1,0,0,1,20171001, A4393,HCPCS,URINE PCH W EX WEAR BAR CONV,,,28,,NW,,,,,,$18.26,$0.00,1,1,1,0,0,1,20171001, A4394,HCPCS,OSTOMY POUCH LIQ DEODORANT,,,28,,NW,,,,,,$6.05,$0.00,1,1,1,0,0,1,20171001, A4395,HCPCS,OSTOMY POUCH SOLID DEODORANT,,,28,,NW,,,,,,$0.11,$0.00,1,1,1,0,0,1,20171001, A4396,HCPCS,PERISTOMAL HERNIA SUPPRT BLT,,,28,,NW,,,,,,$77.70,$0.00,1,1,1,0,0,1,20171001, A4397,HCPCS,IRRIGATION SUPPLY SLEEVE,,,28,,NW,,,,,,$9.58,$0.00,1,1,1,0,0,1,20171001, A4398,HCPCS,OSTOMY IRRIGATION BAG,,,28,,NW,,,,,,$26.75,$0.00,1,1,1,0,0,1,20171001, A4399,HCPCS,OSTOMY IRRIG CONE/CATH W BRS,,,28,,NW,,,,,,$23.04,$0.00,1,1,1,0,0,1,20171001, A4400,HCPCS,OSTOMY IRRIGATION SET,,,28,,NW,,,,,,$87.80,$0.00,1,1,1,0,0,1,20171001, A4402,HCPCS,LUBRICANT PER OUNCE,,,28,,NW,,,,,,$3.97,$0.00,1,1,1,0,0,1,20171001, A4404,HCPCS,OSTOMY RING EACH,,,28,,NW,,,,,,$4.19,$0.00,1,1,1,0,0,1,20171001, A4405,HCPCS,NONPECTIN BASED OSTOMY PASTE,,,28,,NW,,,,,,$7.61,$0.00,1,1,1,0,0,1,20171001, A4406,HCPCS,PECTIN BASED OSTOMY PASTE,,,28,,NW,,,,,,$11.99,$0.00,1,1,1,0,0,1,20171001, A4407,HCPCS,EXT WEAR OST SKN BARR <=4SQ,,,28,,NW,,,,,,$17.72,$0.00,1,1,1,0,0,1,20171001, A4408,HCPCS,EXT WEAR OST SKN BARR >4SQ,,,28,,NW,,,,,,$19.82,$0.00,1,1,1,0,0,1,20171001, A4409,HCPCS,OST SKN BARR CONVEX <=4 SQ I,,,28,,NW,,,,,,$12.91,$0.00,1,1,1,0,0,1,20171001, A4410,HCPCS,OST SKN BARR EXTND >4 SQ,,,28,,NW,,,,,,$18.26,$0.00,1,1,1,0,0,1,20171001, A4411,HCPCS,OST SKN BARR EXTND =4SQ,,,28,,NW,,,,,,$10.81,$0.00,1,1,1,0,0,1,20171001, A4412,HCPCS,OST POUCH DRAIN HIGH OUTPUT,,,28,,NW,,,,,,$6.27,$0.00,1,1,1,0,0,1,20171001, A4413,HCPCS,2 PC DRAINABLE OST POUCH,,,28,,NW,,,,,,$11.58,$0.00,1,1,1,0,0,1,20171001, A4414,HCPCS,OST SKNBAR W/O CONV<=4 SQ IN,,,28,,NW,,,,,,$10.46,$0.00,1,1,1,0,0,1,20171001, A4415,HCPCS,OST SKN BARR W/O CONV >4 SQI,,,28,,NW,,,,,,$12.48,$0.00,1,1,1,0,0,1,20171001, A4416,HCPCS,OST PCH CLSD W BARRIER/FILTR,,,28,,NW,,,,,,$5.11,$0.00,1,1,1,0,0,1,20171001, A4417,HCPCS,OST PCH W BAR/BLTINCONV/FLTR,,,28,,NW,,,,,,$6.88,$0.00,1,1,1,0,0,1,20171001, A4418,HCPCS,OST PCH CLSD W/O BAR W FILTR,,,28,,NW,,,,,,$3.36,$0.00,1,1,1,0,0,1,20171001, A4419,HCPCS,OST PCH FOR BAR W FLANGE/FLT,,,28,,NW,,,,,,$3.21,$0.00,1,1,1,0,0,1,20171001, A4420,HCPCS,OST PCH CLSD FOR BAR W LK FL,,,28,,NW,,,,,,$3.76,$0.00,1,1,1,0,0,1,20171001, A4421,HCPCS,OSTOMY SUPPLY MISC,,,28,,NW,,,,,,$8.36,$0.00,1,1,1,0,0,1,20171001, A4422,HCPCS,OST POUCH ABSORBENT MATERIAL,,,28,,NW,,,,,,$0.30,$0.00,1,1,1,0,0,1,20171001, A4423,HCPCS,OST PCH FOR BAR W LK FL/FLTR,,,28,,NW,,,,,,$3.45,$0.00,1,1,1,0,0,1,20171001, A4424,HCPCS,OST PCH DRAIN W BAR & FILTER,,,28,,NW,,,,,,$8.80,$0.00,1,1,1,0,0,1,20171001, A4425,HCPCS,OST PCH DRAIN FOR BARRIER FL,,,28,,NW,,,,,,$6.63,$0.00,1,1,1,0,0,1,20171001, A4426,HCPCS,OST PCH DRAIN 2 PIECE SYSTEM,,,28,,NW,,,,,,$5.06,$0.00,1,1,1,0,0,1,20171001, A4427,HCPCS,OST PCH DRAIN/BARR LK FLNG/F,,,28,,NW,,,,,,$5.16,$0.00,1,1,1,0,0,1,20171001, A4428,HCPCS,URINE OST POUCH W FAUCET/TAP,,,28,,NW,,,,,,$12.05,$0.00,1,1,1,0,0,1,20171001, A4429,HCPCS,URINE OST POUCH W BLTINCONV,,,28,,NW,,,,,,$15.10,$0.00,1,1,1,0,0,1,20171001, A4430,HCPCS,OST URINE PCH W B/BLTIN CONV,,,28,,NW,,,,,,$15.52,$0.00,1,1,1,0,0,1,20171001, A4431,HCPCS,OST PCH URINE W BARRIER/TAPV,,,28,,NW,,,,,,$11.51,$0.00,1,1,1,0,0,1,20171001, A4432,HCPCS,OS PCH URINE W BAR/FANGE/TAP,,,28,,NW,,,,,,$6.65,$0.00,1,1,1,0,0,1,20171001, A4433,HCPCS,URINE OST PCH BAR W LOCK FLN,,,28,,NW,,,,,,$6.19,$0.00,1,1,1,0,0,1,20171001, A4434,HCPCS,OST PCH URINE W LOCK FLNG/FT,,,28,,NW,,,,,,$6.95,$0.00,1,1,1,0,0,1,20171001, A4435,HCPCS,1PC OST PCH DRAIN HGH OUTPUT,,,28,,NW,,,,,,$10.69,$0.00,1,1,1,0,0,1,20171001, A4450,HCPCS,NON-WATERPROOF TAPE,,,28,,NW,,,,,,$0.20,$0.00,1,1,1,0,0,1,20171001, A4450,HCPCS,NON-WATERPROOF TAPE,AU,,28,,NW,,,,,,$0.20,$0.00,1,1,1,0,0,1,20171001, A4450,HCPCS,NON-WATERPROOF TAPE,AV,,28,,NW,,,,,,$0.20,$0.00,1,1,1,0,0,1,20171001, A4450,HCPCS,NON-WATERPROOF TAPE,AW,,28,,NW,,,,,,$0.27,$0.00,1,1,1,0,0,1,20171001, A4452,HCPCS,WATERPROOF TAPE,,,28,,NW,,,,,,$0.91,$0.00,1,1,1,0,0,1,20171001, A4452,HCPCS,WATERPROOF TAPE,AU,,28,,NW,,,,,,$0.91,$0.00,1,1,1,0,0,1,20171001, A4452,HCPCS,WATERPROOF TAPE,AV,,28,,NW,,,,,,$0.91,$0.00,1,1,1,0,0,1,20171001, A4452,HCPCS,WATERPROOF TAPE,AW,,28,,NW,,,,,,$1.00,$0.00,1,1,1,0,0,1,20171001, A4455,HCPCS,ADHESIVE REMOVER PER OUNCE,,,28,,NW,,,,,,$3.40,$0.00,1,1,1,0,0,1,20171001, A4456,HCPCS,"ADHESIVE REMOVER, WIPES",,,28,,NW,,,,,,$0.61,$0.00,1,1,1,0,0,1,20171001, A4458,HCPCS,REUSABLE ENEMA BAG,,,28,,NW,,,,,,$23.67,$0.00,1,1,1,0,0,1,20171001, A4459,HCPCS,"MANUAL PUMP ENEMA, REUSABLE",,,28,,NW,,,,,,$23.67,$0.00,1,1,1,0,0,1,20171001, A4461,HCPCS,SURGICL DRESS HOLD NON-REUSE,,,28,,NW,,,,,,$7.39,$0.00,1,1,1,0,0,1,20171001, A4463,HCPCS,SURGICAL DRESS HOLDER REUSE,,,28,,NW,,,,,,$26.31,$0.00,1,1,1,0,0,1,20171001, A4465,HCPCS,NON-ELASTIC EXTREMITY BINDER,,,28,,NW,,,,,,$13.52,$0.00,1,1,1,0,0,1,20171001, A4467,HCPCS,BELT STRAP SLEEV GRMNT COVER,,,28,,NW,,,,,,$54.38,$0.00,1,1,1,1,1,1,20171001, A4470,HCPCS,GRAVLEE JET WASHER,,,28,,NW,,,,,,$10.08,$0.00,1,1,1,0,0,1,20171001, A4480,HCPCS,VABRA ASPIRATOR,,,28,,NW,,,,,,$8.02,$0.00,1,1,1,0,0,1,20171001, A4481,HCPCS,TRACHEOSTOMA FILTER,,,28,,NW,,,,,,$3.81,$0.00,1,1,1,0,0,1,20171001, A4483,HCPCS,MOISTURE EXCHANGER,,,28,,NW,,,,,,$8.77,$0.00,1,1,1,0,0,1,20171001, A4490,HCPCS,ABOVE KNEE SURGICAL STOCKING,,,28,,NW,,,,,,$10.08,$0.00,1,1,1,0,0,1,20171001, A4495,HCPCS,THIGH LENGTH SURG STOCKING,,,28,,NW,,,,,,$10.08,$0.00,1,1,1,0,0,1,20171001, A4500,HCPCS,BELOW KNEE SURGICAL STOCKING,,,28,,NW,,,,,,$8.02,$0.00,1,1,1,0,0,1,20171001, A4510,HCPCS,FULL LENGTH SURG STOCKING,,,28,,NW,,,,,,$17.63,$0.00,1,1,1,0,0,1,20171001, A4520,HCPCS,INCONTINENCE GARMENT ANYTYPE,,,28,,NW,,,,,,$1.50,$0.00,1,1,1,0,0,1,20171001, A4550,HCPCS,SURGICAL TRAYS,,,28,,NW,,,,,,$41.66,$0.00,1,1,1,0,0,1,20171001, A4554,HCPCS,DISPOSABLE UNDERPADS,,,28,,NW,,,,,,$5.28,$0.00,1,1,1,0,0,1,20171001, A4555,HCPCS,CA TX E-STIM ELECTR/TRANSDUC,,,28,,NW,,,,,,$23.66,$0.00,1,1,1,0,0,1,20171001, A4556,HCPCS,"ELECTRODES, PAIR",,,28,,NW,,,,,,$91.90,$0.00,1,1,1,0,0,1,20171001, A4557,HCPCS,"LEAD WIRES, PAIR",,,28,,NW,,,,,,$88.12,$0.00,1,1,1,0,0,1,20171001, A4558,HCPCS,CONDUCTIVE GEL OR PASTE,,,28,,NW,,,,,,$53.47,$0.00,1,1,1,0,0,1,20171001, A4559,HCPCS,COUPLING GEL OR PASTE,,,28,,NW,,,,,,$1.01,$0.00,1,1,1,0,0,1,20171001, A4561,HCPCS,"PESSARY RUBBER, ANY TYPE",,,28,,NW,,,,,,$39.44,$0.00,1,1,1,0,0,1,20171001, A4562,HCPCS,"PESSARY, NON RUBBER,ANY TYPE",,,28,,NW,,,,,,$96.38,$0.00,1,1,1,0,0,1,20171001, A4565,HCPCS,SLINGS,,,28,,NW,,,,,,$15.68,$0.00,1,1,1,0,0,1,20171001, A4566,HCPCS,SHOULD SLING/VEST/ABRESTRAIN,,,28,,NW,,,,,,$42.37,$0.00,1,1,1,0,0,1,20171001, A4570,HCPCS,SPLINT,,,28,,NW,,,,,,$25.19,$0.00,1,1,1,0,0,1,20171001, A4575,HCPCS,HYPERBARIC O2 CHAMBER DISPS,,,28,,NW,,,,,,$821.57,$0.00,1,1,1,0,0,1,20171001, A4580,HCPCS,CAST SUPPLIES (PLASTER),,,28,,NW,,,,,,$75.17,$0.00,1,1,1,0,0,1,20171001, A4590,HCPCS,SPECIAL CASTING MATERIAL,,,28,,NW,,,,,,$54.70,$0.00,1,1,1,0,0,1,20171001, A4595,HCPCS,TENS SUPPL 2 LEAD PER MONTH,,,28,,NW,,,,,,$88.28,$0.00,1,1,1,0,0,1,20171001, A4600,HCPCS,"SLEEVE, INTER LIMB COMP DEV",,,28,,NW,,,,,,$326.76,$0.00,1,1,1,0,0,1,20171001, A4601,HCPCS,LITH ION NON PROSTH RECHARGE,,,28,,NW,,,,,,$3.78,$0.00,1,1,1,0,0,1,20171001, A4602,HCPCS,REPLACE LITHIUM BATTERY 1.5V,,,28,,NW,,,,,,$37.62,$0.00,1,1,1,0,0,1,20171001, A4602,HCPCS,REPLACE LITHIUM BATTERY 1.5V,NU,,28,,NW,,,,,,$37.62,$0.00,1,1,1,0,0,1,20171001, A4604,HCPCS,TUBING WITH HEATING ELEMENT,,,28,,NW,,,,,,$146.44,$0.00,1,1,1,0,0,1,20171001, A4604,HCPCS,TUBING WITH HEATING ELEMENT,NU,,28,,NW,,,,,,$146.44,$0.00,1,1,1,0,0,1,20171001, A4605,HCPCS,TRACH SUCTION CATH CLOSE SYS,,,28,,NW,,,,,,$103.16,$0.00,1,1,1,0,0,1,20171001, A4605,HCPCS,TRACH SUCTION CATH CLOSE SYS,NU,,28,,NW,,,,,,$103.16,$0.00,1,1,1,0,0,1,20171001, A4606,HCPCS,OXYGEN PROBE USED W OXIMETER,,,28,,NW,,,,,,$50.75,$0.00,1,1,1,0,0,1,20171001, A4608,HCPCS,TRANSTRACHEAL OXYGEN CATH,,,28,,NW,,,,,,$176.16,$0.00,1,1,1,0,0,1,20171001, A4611,HCPCS,HEAVY DUTY BATTERY,,,28,,NW,,,,,,$272.43,$0.00,1,1,1,0,0,1,20171001, A4611,HCPCS,HEAVY DUTY BATTERY,NU,,28,,NW,,,,,,$258.34,$0.00,1,1,1,0,0,1,20171001, A4611,HCPCS,HEAVY DUTY BATTERY,RR,,28,,NW,,,,,,$87.48,$0.00,1,1,1,0,0,1,20171001, A4611,HCPCS,HEAVY DUTY BATTERY,UE,,28,,NW,,,,,,$210.67,$0.00,1,1,1,0,0,1,20171001, A4612,HCPCS,BATTERY CABLES,,,28,,NW,,,,,,$145.33,$0.00,1,1,1,0,0,1,20171001, A4612,HCPCS,BATTERY CABLES,NU,,28,,NW,,,,,,$145.33,$0.00,1,1,1,0,0,1,20171001, A4612,HCPCS,BATTERY CABLES,RR,,28,,NW,,,,,,$37.56,$0.00,1,1,1,0,0,1,20171001, A4612,HCPCS,BATTERY CABLES,UE,,28,,NW,,,,,,$126.58,$0.00,1,1,1,0,0,1,20171001, A4613,HCPCS,BATTERY CHARGER,,,28,,NW,,,,,,$207.46,$0.00,1,1,1,0,0,1,20171001, A4613,HCPCS,BATTERY CHARGER,NU,,28,,NW,,,,,,$207.46,$0.00,1,1,1,0,0,1,20171001, A4613,HCPCS,BATTERY CHARGER,RR,,28,,NW,,,,,,$71.43,$0.00,1,1,1,0,0,1,20171001, A4613,HCPCS,BATTERY CHARGER,UE,,28,,NW,,,,,,$168.90,$0.00,1,1,1,0,0,1,20171001, A4614,HCPCS,HAND-HELD PEFR METER,,,28,,NW,,,,,,$46.12,$0.00,1,1,1,0,0,1,20171001, A4615,HCPCS,CANNULA NASAL,,,28,,NW,,,,,,$2.86,$0.00,1,1,1,0,0,1,20171001, A4616,HCPCS,TUBING (OXYGEN) PER FOOT,,,28,,NW,,,,,,$2.89,$0.00,1,1,1,0,0,1,20171001, A4617,HCPCS,MOUTH PIECE,,,28,,NW,,,,,,$2.77,$0.00,1,1,1,0,0,1,20171001, A4618,HCPCS,BREATHING CIRCUITS,,,28,,NW,,,,,,$17.09,$0.00,1,1,1,0,0,1,20171001, A4618,HCPCS,BREATHING CIRCUITS,NU,,28,,NW,,,,,,$17.09,$0.00,1,1,1,0,0,1,20171001, A4618,HCPCS,BREATHING CIRCUITS,RR,,28,,NW,,,,,,$2.43,$0.00,1,1,1,0,0,1,20171001, A4618,HCPCS,BREATHING CIRCUITS,UE,,28,,NW,,,,,,$13.10,$0.00,1,1,1,0,0,1,20171001, A4619,HCPCS,FACE TENT,,,28,,NW,,,,,,$2.82,$0.00,1,1,1,0,0,1,20171001, A4619,HCPCS,FACE TENT,NU,,28,,NW,,,,,,$2.82,$0.00,1,1,1,0,0,1,20171001, A4620,HCPCS,VARIABLE CONCENTRATION MASK,,,28,,NW,,,,,,$2.87,$0.00,1,1,1,0,0,1,20171001, A4623,HCPCS,TRACHEOSTOMY INNER CANNULA,,,28,,NW,,,,,,$12.45,$0.00,1,1,1,0,0,1,20171001, A4624,HCPCS,TRACHEAL SUCTION TUBE,,,28,,NW,,,,,,$25.03,$0.00,1,1,1,0,0,1,20171001, A4624,HCPCS,TRACHEAL SUCTION TUBE,NU,,28,,NW,,,,,,$25.03,$0.00,1,1,1,0,0,1,20171001, A4625,HCPCS,TRACH CARE KIT FOR NEW TRACH,,,28,,NW,,,,,,$14.45,$0.00,1,1,1,0,0,1,20171001, A4626,HCPCS,TRACHEOSTOMY CLEANING BRUSH,,,28,,NW,,,,,,$6.65,$0.00,1,1,1,0,0,1,20171001, A4627,HCPCS,SPACER BAG/RESERVOIR,,,28,,NW,,,,,,$24.50,$0.00,1,1,1,0,0,1,20171001, A4628,HCPCS,OROPHARYNGEAL SUCTION CATH,,,28,,NW,,,,,,$8.14,$0.00,1,1,1,0,0,1,20171001, A4628,HCPCS,OROPHARYNGEAL SUCTION CATH,NU,,28,,NW,,,,,,$8.14,$0.00,1,1,1,0,0,1,20171001, A4629,HCPCS,TRACHEOSTOMY CARE KIT,,,28,,NW,,,,,,$9.92,$0.00,1,1,1,0,0,1,20171001, A4630,HCPCS,REPL BAT T.E.N.S. OWN BY PT,,,28,,NW,,,,,,$61.99,$0.00,1,1,1,0,0,1,20171001, A4630,HCPCS,REPL BAT T.E.N.S. OWN BY PT,NU,,28,,NW,,,,,,$61.99,$0.00,1,1,1,0,0,1,20171001, A4633,HCPCS,UVL REPLACEMENT BULB,,,28,,NW,,,,,,$156.48,$0.00,1,1,1,0,0,1,20171001, A4633,HCPCS,UVL REPLACEMENT BULB,NU,,28,,NW,,,,,,$156.48,$0.00,1,1,1,0,0,1,20171001, A4634,HCPCS,REPLACEMENT BULB TH LIGHTBOX,,,28,,NW,,,,,,$121.88,$0.00,1,1,1,0,0,1,20171001, A4635,HCPCS,UNDERARM CRUTCH PAD,,,28,,NW,,,,,,$48.91,$0.00,1,1,1,0,0,1,20171001, A4635,HCPCS,UNDERARM CRUTCH PAD,NU,,28,,NW,,,,,,$48.91,$0.00,1,1,1,0,0,1,20171001, A4635,HCPCS,UNDERARM CRUTCH PAD,RR,,28,,NW,,,,,,$6.58,$0.00,1,1,1,0,0,1,20171001, A4635,HCPCS,UNDERARM CRUTCH PAD,UE,,28,,NW,,,,,,$32.31,$0.00,1,1,1,0,0,1,20171001, A4636,HCPCS,HANDGRIP FOR CANE ETC,,,28,,NW,,,,,,$26.68,$0.00,1,1,1,0,0,1,20171001, A4636,HCPCS,HANDGRIP FOR CANE ETC,NU,,28,,NW,,,,,,$26.68,$0.00,1,1,1,0,0,1,20171001, A4636,HCPCS,HANDGRIP FOR CANE ETC,RR,,28,,NW,,,,,,$2.74,$0.00,1,1,1,0,0,1,20171001, A4636,HCPCS,HANDGRIP FOR CANE ETC,UE,,28,,NW,,,,,,$20.04,$0.00,1,1,1,0,0,1,20171001, A4637,HCPCS,REPL TIP CANE/CRUTCH/WALKER,,,28,,NW,,,,,,$14.89,$0.00,1,1,1,0,0,1,20171001, A4637,HCPCS,REPL TIP CANE/CRUTCH/WALKER,NU,,28,,NW,,,,,,$14.89,$0.00,1,1,1,0,0,1,20171001, A4637,HCPCS,REPL TIP CANE/CRUTCH/WALKER,RR,,28,,NW,,,,,,$1.46,$0.00,1,1,1,0,0,1,20171001, A4637,HCPCS,REPL TIP CANE/CRUTCH/WALKER,UE,,28,,NW,,,,,,$11.14,$0.00,1,1,1,0,0,1,20171001, A4638,HCPCS,REPL BATT PULSE GEN SYS,,,28,,NW,,,,,,"$16,677.92",$0.00,1,1,1,0,0,1,20171001, A4638,HCPCS,REPL BATT PULSE GEN SYS,NU,,28,,NW,,,,,,"$16,677.92",$0.00,1,1,1,0,0,1,20171001, A4638,HCPCS,REPL BATT PULSE GEN SYS,RR,,28,,NW,,,,,,"$1,750.27",$0.00,1,1,1,0,0,1,20171001, A4638,HCPCS,REPL BATT PULSE GEN SYS,UE,,28,,NW,,,,,,"$12,532.49",$0.00,1,1,1,0,0,1,20171001, A4639,HCPCS,INFRARED HT SYS REPLCMNT PAD,,,28,,NW,,,,,,$471.51,$0.00,1,1,1,0,0,1,20171001, A4639,HCPCS,INFRARED HT SYS REPLCMNT PAD,NU,,28,,NW,,,,,,$471.51,$0.00,1,1,1,0,0,1,20171001, A4639,HCPCS,INFRARED HT SYS REPLCMNT PAD,RR,,28,,NW,,,,,,$129.85,$0.00,1,1,1,0,0,1,20171001, A4640,HCPCS,ALTERNATING PRESSURE PAD,,,28,,NW,,,,,,$167.73,$0.00,1,1,1,0,0,1,20171001, A4640,HCPCS,ALTERNATING PRESSURE PAD,NU,,28,,NW,,,,,,$167.73,$0.00,1,1,1,0,0,1,20171001, A4640,HCPCS,ALTERNATING PRESSURE PAD,RR,,28,,NW,,,,,,$47.11,$0.00,1,1,1,0,0,1,20171001, A4640,HCPCS,ALTERNATING PRESSURE PAD,UE,,28,,NW,,,,,,$142.70,$0.00,1,1,1,0,0,1,20171001, A4641,HCPCS,RADIOPHARM DX AGENT NOC,,,28,,NW,,,,,,$43.63,$0.00,1,1,1,0,0,1,20171001, A4642,HCPCS,IN111 SATUMOMAB,,,28,,NW,,,,,,$29.14,$0.00,1,1,1,0,0,1,20171001, A4648,HCPCS,IMPLANTABLE TISSUE MARKER,,,28,,NW,,,,,,$367.90,$0.00,1,1,1,0,0,1,20171001, A4649,HCPCS,SURGICAL SUPPLIES,,,28,,NW,,,,,,$34.69,$0.00,1,1,1,0,0,1,20171001, A4651,HCPCS,CALIBRATED MICROCAP TUBE,,,28,,NW,,,,,,$5.90,$0.00,1,1,1,0,0,1,20171001, A4652,HCPCS,MICROCAPILLARY TUBE SEALANT,,,28,,NW,,,,,,$1.98,$0.00,1,1,1,0,0,1,20171001, A4653,HCPCS,PD CATHETER ANCHOR BELT,,,28,,NW,,,,,,$77.58,$0.00,1,1,1,0,0,1,20171001, A4657,HCPCS,SYRINGE W/WO NEEDLE,,,28,,NW,,,,,,$5.51,$0.00,1,1,1,0,0,1,20171001, A4660,HCPCS,SPHYG/BP APP W CUFF AND STET,,,28,,NW,,,,,,$36.78,$0.00,1,1,1,0,0,1,20171001, A4663,HCPCS,DIALYSIS BLOOD PRESSURE CUFF,,,28,,NW,,,,,,$70.46,$0.00,1,1,1,0,0,1,20171001, A4670,HCPCS,"AUTOMATIC BP MONITOR, DIAL",,,28,,NW,,,,,,$179.01,$0.00,1,1,1,0,0,1,20171001, A4671,HCPCS,DISPOSABLE CYCLER SET,,,28,,NW,,,,,,$72.52,$0.00,1,1,1,0,0,1,20171001, A4672,HCPCS,"DRAINAGE EXT LINE, DIALYSIS",,,28,,NW,,,,,,$15.52,$0.00,1,1,1,0,0,1,20171001, A4673,HCPCS,EXT LINE W EASY LOCK CONNECT,,,28,,NW,,,,,,$14.85,$0.00,1,1,1,0,0,1,20171001, A4674,HCPCS,"CHEM/ANTISEPT SOLUTION, 8OZ",,,28,,NW,,,,,,$3.11,$0.00,1,1,1,0,0,1,20171001, A4680,HCPCS,"ACTIVATED CARBON FILTER, EA",,,28,,NW,,,,,,$183.20,$0.00,1,1,1,0,0,1,20171001, A4690,HCPCS,"DIALYZER, EACH",,,28,,NW,,,,,,"$1,680.91",$0.00,1,1,1,0,0,1,20171001, A4706,HCPCS,BICARBONATE CONC SOL PER GAL,,,28,,NW,,,,,,$22.52,$0.00,1,1,1,0,0,1,20171001, A4707,HCPCS,BICARBONATE CONC POW PER PAC,,,28,,NW,,,,,,$18.44,$0.00,1,1,1,0,0,1,20171001, A4708,HCPCS,ACETATE CONC SOL PER GALLON,,,28,,NW,,,,,,$22.88,$0.00,1,1,1,0,0,1,20171001, A4709,HCPCS,ACID CONC SOL PER GALLON,,,28,,NW,,,,,,$44.30,$0.00,1,1,1,0,0,1,20171001, A4714,HCPCS,TREATED WATER PER GALLON,,,28,,NW,,,,,,$7.96,$0.00,1,1,1,0,0,1,20171001, A4719,HCPCS,Y SET TUBING,,,28,,NW,,,,,,$24.12,$0.00,1,1,1,0,0,1,20171001, A4720,HCPCS,DIALYSAT SOL FLD VOL > 249CC,,,28,,NW,,,,,,$32.44,$0.00,1,1,1,0,0,1,20171001, A4721,HCPCS,DIALYSAT SOL FLD VOL > 999CC,,,28,,NW,,,,,,$49.11,$0.00,1,1,1,0,0,1,20171001, A4722,HCPCS,DIALYS SOL FLD VOL > 1999CC,,,28,,NW,,,,,,$50.70,$0.00,1,1,1,0,0,1,20171001, A4723,HCPCS,DIALYS SOL FLD VOL > 2999CC,,,28,,NW,,,,,,$36.75,$0.00,1,1,1,0,0,1,20171001, A4724,HCPCS,DIALYS SOL FLD VOL > 3999CC,,,28,,NW,,,,,,$62.42,$0.00,1,1,1,0,0,1,20171001, A4725,HCPCS,DIALYS SOL FLD VOL > 4999CC,,,28,,NW,,,,,,$69.90,$0.00,1,1,1,0,0,1,20171001, A4726,HCPCS,DIALYS SOL FLD VOL > 5999CC,,,28,,NW,,,,,,$77.71,$0.00,1,1,1,0,0,1,20171001, A4728,HCPCS,"DIALYSATE SOLUTION, NON-DEX",,,28,,NW,,,,,,$20.04,$0.00,1,1,1,0,0,1,20171001, A4730,HCPCS,"FISTULA CANNULATION SET, EA",,,28,,NW,,,,,,$4.86,$0.00,1,1,1,0,0,1,20171001, A4736,HCPCS,"TOPICAL ANESTHETIC, PER GRAM",,,28,,NW,,,,,,$45.45,$0.00,1,1,1,0,0,1,20171001, A4737,HCPCS,INJ ANESTHETIC PER 10 ML,,,28,,NW,,,,,,$4.52,$0.00,1,1,1,0,0,1,20171001, A4740,HCPCS,SHUNT ACCESSORY,,,28,,NW,,,,,,$64.27,$0.00,1,1,1,0,0,1,20171001, A4750,HCPCS,ART OR VENOUS BLOOD TUBING,,,28,,NW,,,,,,$34.95,$0.00,1,1,1,0,0,1,20171001, A4755,HCPCS,COMB ART/VENOUS BLOOD TUBING,,,28,,NW,,,,,,$47.13,$0.00,1,1,1,0,0,1,20171001, A4760,HCPCS,"DIALYSATE SOL TEST KIT, EACH",,,28,,NW,,,,,,$185.63,$0.00,1,1,1,0,0,1,20171001, A4765,HCPCS,DIALYSATE CONC POW PER PACK,,,28,,NW,,,,,,$27.87,$0.00,1,1,1,0,0,1,20171001, A4766,HCPCS,DIALYSATE CONC SOL ADD 10 ML,,,28,,NW,,,,,,$38.02,$0.00,1,1,1,0,0,1,20171001, A4770,HCPCS,BLOOD COLLECTION TUBE/VACUUM,,,28,,NW,,,,,,$18.71,$0.00,1,1,1,0,0,1,20171001, A4771,HCPCS,SERUM CLOTTING TIME TUBE,,,28,,NW,,,,,,$12.41,$0.00,1,1,1,0,0,1,20171001, A4772,HCPCS,BLOOD GLUCOSE TEST STRIPS,,,28,,NW,,,,,,$73.28,$0.00,1,1,1,0,0,1,20171001, A4773,HCPCS,OCCULT BLOOD TEST STRIPS,,,28,,NW,,,,,,$46.48,$0.00,1,1,1,0,0,1,20171001, A4774,HCPCS,AMMONIA TEST STRIPS,,,28,,NW,,,,,,$15.50,$0.00,1,1,1,0,0,1,20171001, A4802,HCPCS,PROTAMINE SULFATE PER 50 MG,,,28,,NW,,,,,,$13.22,$0.00,1,1,1,0,0,1,20171001, A4860,HCPCS,DISPOSABLE CATHETER TIPS,,,28,,NW,,,,,,$9.44,$0.00,1,1,1,0,0,1,20171001, A4870,HCPCS,PLUMB/ELEC WK HM HEMO EQUIP,,,28,,NW,,,,,,$250.48,$0.00,1,1,1,0,0,1,20171001, A4890,HCPCS,REPAIR/MAINT CONT HEMO EQUIP,,,28,,NW,,,,,,$39.52,$0.00,1,1,1,0,0,1,20171001, A4911,HCPCS,DRAIN BAG/BOTTLE,,,28,,NW,,,,,,$29.04,$0.00,1,1,1,0,0,1,20171001, A4913,HCPCS,MISC DIALYSIS SUPPLIES NOC,,,28,,NW,,,,,,$179.01,$0.00,1,1,1,0,0,1,20171001, A4918,HCPCS,VENOUS PRESSURE CLAMP,,,28,,NW,,,,,,$7.96,$0.00,1,1,1,0,0,1,20171001, A4927,HCPCS,NON-STERILE GLOVES,,,28,,NW,,,,,,$14.79,$0.00,1,1,1,0,0,1,20171001, A4928,HCPCS,SURGICAL MASK,,,28,,NW,,,,,,$1.11,$0.00,1,1,1,0,0,1,20171001, A4929,HCPCS,"TOURNIQUET FOR DIALYSIS, EA",,,28,,NW,,,,,,$0.38,$0.00,1,1,1,0,0,1,20171001, A4930,HCPCS,"STERILE, GLOVES PER PAIR",,,28,,NW,,,,,,$2.53,$0.00,1,1,1,0,0,1,20171001, A4931,HCPCS,REUSABLE ORAL THERMOMETER,,,28,,NW,,,,,,$11.49,$0.00,1,1,1,0,0,1,20171001, A5051,HCPCS,POUCH CLSD W BARR ATTACHED,,,28,,NW,,,,,,$5.06,$0.00,1,1,1,0,0,1,20171001, A5052,HCPCS,CLSD OSTOMY POUCH W/O BARR,,,28,,NW,,,,,,$3.80,$0.00,1,1,1,0,0,1,20171001, A5053,HCPCS,CLSD OSTOMY POUCH FACEPLATE,,,28,,NW,,,,,,$4.22,$0.00,1,1,1,0,0,1,20171001, A5054,HCPCS,CLSD OSTOMY POUCH W/FLANGE,,,28,,NW,,,,,,$4.56,$0.00,1,1,1,0,0,1,20171001, A5055,HCPCS,STOMA CAP,,,28,,NW,,,,,,$3.57,$0.00,1,1,1,0,0,1,20171001, A5056,HCPCS,1 PC OST POUCH W FILTER,,,28,,NW,,,,,,$9.97,$0.00,1,1,1,0,0,1,20171001, A5057,HCPCS,1 PC OST POU W BUILT-IN CONV,,,28,,NW,,,,,,$19.31,$0.00,1,1,1,0,0,1,20171001, A5061,HCPCS,POUCH DRAINABLE W BARRIER AT,,,28,,NW,,,,,,$7.83,$0.00,1,1,1,0,0,1,20171001, A5062,HCPCS,DRNBLE OSTOMY POUCH W/O BARR,,,28,,NW,,,,,,$5.22,$0.00,1,1,1,0,0,1,20171001, A5063,HCPCS,DRAIN OSTOMY POUCH W/FLANGE,,,28,,NW,,,,,,$6.27,$0.00,1,1,1,0,0,1,20171001, A5071,HCPCS,URINARY POUCH W/BARRIER,,,28,,NW,,,,,,$12.52,$0.00,1,1,1,0,0,1,20171001, A5072,HCPCS,URINARY POUCH W/O BARRIER,,,28,,NW,,,,,,$7.59,$0.00,1,1,1,0,0,1,20171001, A5073,HCPCS,URINARY POUCH ON BARR W/FLNG,,,28,,NW,,,,,,$7.02,$0.00,1,1,1,0,0,1,20171001, A5081,HCPCS,"STOMA PLUG OR SEAL, ANY TYPE",,,28,,NW,,,,,,$7.02,$0.00,1,1,1,0,0,1,20171001, A5082,HCPCS,CONTINENT STOMA CATHETER,,,28,,NW,,,,,,$21.78,$0.00,1,1,1,0,0,1,20171001, A5083,HCPCS,STOMA ABSORPTIVE COVER,,,28,,NW,,,,,,$1.61,$0.00,1,1,1,0,0,1,20171001, A5093,HCPCS,OSTOMY ACCESSORY CONVEX INSE,,,28,,NW,,,,,,$4.70,$0.00,1,1,1,0,0,1,20171001, A5102,HCPCS,BEDSIDE DRAIN BTL W/WO TUBE,,,28,,NW,,,,,,$43.53,$0.00,1,1,1,0,0,1,20171001, A5105,HCPCS,URINARY SUSPENSORY,,,28,,NW,,,,,,$75.25,$0.00,1,1,1,0,0,1,20171001, A5112,HCPCS,URINARY LEG BAG,,,28,,NW,,,,,,$63.57,$0.00,1,1,1,0,0,1,20171001, A5113,HCPCS,LATEX LEG STRAP,,,28,,NW,,,,,,$9.51,$0.00,1,1,1,0,0,1,20171001, A5114,HCPCS,FOAM/FABRIC LEG STRAP,,,28,,NW,,,,,,$17.09,$0.00,1,1,1,0,0,1,20171001, A5120,HCPCS,"SKIN BARRIER, WIPE OR SWAB",,,28,,NW,,,,,,$0.59,$0.00,1,1,1,0,0,1,20171001, A5120,HCPCS,"SKIN BARRIER, WIPE OR SWAB",AU,,28,,NW,,,,,,$0.59,$0.00,1,1,1,0,0,1,20171001, A5120,HCPCS,"SKIN BARRIER, WIPE OR SWAB",AV,,28,,NW,,,,,,$0.59,$0.00,1,1,1,0,0,1,20171001, A5121,HCPCS,SOLID SKIN BARRIER 6X6,,,28,,NW,,,,,,$14.42,$0.00,1,1,1,0,0,1,20171001, A5122,HCPCS,SOLID SKIN BARRIER 8X8,,,28,,NW,,,,,,$24.20,$0.00,1,1,1,0,0,1,20171001, A5126,HCPCS,DISK/FOAM PAD +OR- ADHESIVE,,,28,,NW,,,,,,$3.07,$0.00,1,1,1,0,0,1,20171001, A5131,HCPCS,APPLIANCE CLEANER,,,28,,NW,,,,,,$30.10,$0.00,1,1,1,0,0,1,20171001, A5200,HCPCS,PERCUTANEOUS CATHETER ANCHOR,,,28,,NW,,,,,,$22.52,$0.00,1,1,1,0,0,1,20171001, A5500,HCPCS,DIAB SHOE FOR DENSITY INSERT,,,28,,NW,,,,,,$111.17,$0.00,1,1,1,0,0,1,20171001, A5501,HCPCS,DIABETIC CUSTOM MOLDED SHOE,,,28,,NW,,,,,,$346.29,$0.00,1,1,1,0,0,1,20171001, A5503,HCPCS,DIABETIC SHOE W/ROLLER/ROCKR,,,28,,NW,,,,,,$53.41,$0.00,1,1,1,0,0,1,20171001, A5504,HCPCS,DIABETIC SHOE WITH WEDGE,,,28,,NW,,,,,,$53.41,$0.00,1,1,1,0,0,1,20171001, A5505,HCPCS,DIAB SHOE W/METATARSAL BAR,,,28,,NW,,,,,,$53.41,$0.00,1,1,1,0,0,1,20171001, A5506,HCPCS,DIABETIC SHOE W/OFF SET HEEL,,,28,,NW,,,,,,$53.41,$0.00,1,1,1,0,0,1,20171001, A5507,HCPCS,MODIFICATION DIABETIC SHOE,,,28,,NW,,,,,,$53.41,$0.00,1,1,1,0,0,1,20171001, A5508,HCPCS,DIABETIC DELUXE SHOE,,,28,,NW,,,,,,$47.43,$0.00,1,1,1,0,0,1,20171001, A5510,HCPCS,COMPRESSION FORM SHOE INSERT,,,28,,NW,,,,,,$43.16,$0.00,1,1,1,0,0,1,20171001, A5512,HCPCS,MULTI DEN INSERT DIRECT FORM,,,28,,NW,,,,,,$44.54,$0.00,1,1,1,0,0,1,20171001, A5513,HCPCS,MULTI DEN INSERT CUSTOM MOLD,,,28,,NW,,,,,,$65.83,$0.00,1,1,1,0,0,1,20171001, A6000,HCPCS,WOUND WARMING WOUND COVER,,,28,,NW,,,,,,$85.47,$0.00,1,1,1,0,0,1,20171001, A6010,HCPCS,COLLAGEN BASED WOUND FILLER,,,28,,NW,,,,,,$59.72,$0.00,1,1,1,0,0,1,20171001, A6011,HCPCS,COLLAGEN GEL/PASTE WOUND FIL,,,28,,NW,,,,,,$5.47,$0.00,1,1,1,0,0,1,20171001, A6021,HCPCS,COLLAGEN DRESSING <=16 SQ IN,,,28,,NW,,,,,,$40.91,$0.00,1,1,1,0,0,1,20171001, A6022,HCPCS,COLLAGEN DRSG>16<=48 SQ IN,,,28,,NW,,,,,,$40.91,$0.00,1,1,1,0,0,1,20171001, A6023,HCPCS,COLLAGEN DRESSING >48 SQ IN,,,28,,NW,,,,,,$360.99,$0.00,1,1,1,0,0,1,20171001, A6024,HCPCS,COLLAGEN DSG WOUND FILLER,,,28,,NW,,,,,,$12.86,$0.00,1,1,1,0,0,1,20171001, A6025,HCPCS,"SILICONE GEL SHEET, EACH",,,28,,NW,,,,,,$34.80,$0.00,1,1,1,0,0,1,20171001, A6154,HCPCS,WOUND POUCH EACH,,,28,,NW,,,,,,$28.09,$0.00,1,1,1,0,0,1,20171001, A6196,HCPCS,ALGINATE DRESSING <=16 SQ IN,,,28,,NW,,,,,,$15.07,$0.00,1,1,1,0,0,1,20171001, A6197,HCPCS,ALGINATE DRSG >16 <=48 SQ IN,,,28,,NW,,,,,,$32.25,$0.00,1,1,1,0,0,1,20171001, A6198,HCPCS,ALGINATE DRESSING > 48 SQ IN,,,28,,NW,,,,,,$77.25,$0.00,1,1,1,0,0,1,20171001, A6199,HCPCS,ALGINATE DRSG WOUND FILLER,,,28,,NW,,,,,,$11.17,$0.00,1,1,1,0,0,1,20171001, A6203,HCPCS,COMPOSITE DRSG <= 16 SQ IN,,,28,,NW,,,,,,$7.53,$0.00,1,1,1,0,0,1,20171001, A6204,HCPCS,COMPOSITE DRSG >16<=48 SQ IN,,,28,,NW,,,,,,$12.94,$0.00,1,1,1,0,0,1,20171001, A6205,HCPCS,COMPOSITE DRSG > 48 SQ IN,,,28,,NW,,,,,,$23.22,$0.00,1,1,1,0,0,1,20171001, A6206,HCPCS,CONTACT LAYER <= 16 SQ IN,,,28,,NW,,,,,,$7.34,$0.00,1,1,1,0,0,1,20171001, A6207,HCPCS,CONTACT LAYER >16<= 48 SQ IN,,,28,,NW,,,,,,$15.04,$0.00,1,1,1,0,0,1,20171001, A6208,HCPCS,CONTACT LAYER > 48 SQ IN,,,28,,NW,,,,,,$58.46,$0.00,1,1,1,0,0,1,20171001, A6209,HCPCS,FOAM DRSG <=16 SQ IN W/O BDR,,,28,,NW,,,,,,$15.29,$0.00,1,1,1,0,0,1,20171001, A6210,HCPCS,FOAM DRG >16<=48 SQ IN W/O B,,,28,,NW,,,,,,$38.85,$0.00,1,1,1,0,0,1,20171001, A6211,HCPCS,FOAM DRG > 48 SQ IN W/O BRDR,,,28,,NW,,,,,,$56.71,$0.00,1,1,1,0,0,1,20171001, A6212,HCPCS,FOAM DRG <=16 SQ IN W/BORDER,,,28,,NW,,,,,,$19.52,$0.00,1,1,1,0,0,1,20171001, A6213,HCPCS,FOAM DRG >16<=48 SQ IN W/BDR,,,28,,NW,,,,,,$30.68,$0.00,1,1,1,0,0,1,20171001, A6214,HCPCS,FOAM DRG > 48 SQ IN W/BORDER,,,28,,NW,,,,,,$42.02,$0.00,1,1,1,0,0,1,20171001, A6215,HCPCS,FOAM DRESSING WOUND FILLER,,,28,,NW,,,,,,$6.64,$0.00,1,1,1,0,0,1,20171001, A6216,HCPCS,NON-STERILE GAUZE<=16 SQ IN,,,28,,NW,,,,,,$0.11,$0.00,1,1,1,0,0,1,20171001, A6217,HCPCS,NON-STERILE GAUZE>16<=48 SQ,,,28,,NW,,,,,,$0.29,$0.00,1,1,1,0,0,1,20171001, A6218,HCPCS,NON-STERILE GAUZE > 48 SQ IN,,,28,,NW,,,,,,$0.91,$0.00,1,1,1,0,0,1,20171001, A6219,HCPCS,GAUZE <= 16 SQ IN W/BORDER,,,28,,NW,,,,,,$2.42,$0.00,1,1,1,0,0,1,20171001, A6220,HCPCS,GAUZE >16 <=48 SQ IN W/BORDR,,,28,,NW,,,,,,$6.05,$0.00,1,1,1,0,0,1,20171001, A6221,HCPCS,GAUZE > 48 SQ IN W/BORDER,,,28,,NW,,,,,,$16.10,$0.00,1,1,1,0,0,1,20171001, A6222,HCPCS,GAUZE <=16 IN NO W/SAL W/O B,,,28,,NW,,,,,,$5.18,$0.00,1,1,1,0,0,1,20171001, A6223,HCPCS,GAUZE >16<=48 NO W/SAL W/O B,,,28,,NW,,,,,,$5.74,$0.00,1,1,1,0,0,1,20171001, A6224,HCPCS,GAUZE > 48 IN NO W/SAL W/O B,,,28,,NW,,,,,,$7.99,$0.00,1,1,1,0,0,1,20171001, A6228,HCPCS,GAUZE <= 16 SQ IN WATER/SAL,,,28,,NW,,,,,,$3.72,$0.00,1,1,1,0,0,1,20171001, A6229,HCPCS,GAUZE >16<=48 SQ IN WATR/SAL,,,28,,NW,,,,,,$7.99,$0.00,1,1,1,0,0,1,20171001, A6230,HCPCS,GAUZE > 48 SQ IN WATER/SALNE,,,28,,NW,,,,,,$5.28,$0.00,1,1,1,0,0,1,20171001, A6231,HCPCS,HYDROGEL DSG<=16 SQ IN,,,28,,NW,,,,,,$10.00,$0.00,1,1,1,0,0,1,20171001, A6232,HCPCS,HYDROGEL DSG>16<=48 SQ IN,,,28,,NW,,,,,,$14.14,$0.00,1,1,1,0,0,1,20171001, A6233,HCPCS,HYDROGEL DRESSING >48 SQ IN,,,28,,NW,,,,,,$37.42,$0.00,1,1,1,0,0,1,20171001, A6234,HCPCS,HYDROCOLLD DRG <=16 W/O BDR,,,28,,NW,,,,,,$13.53,$0.00,1,1,1,0,0,1,20171001, A6235,HCPCS,HYDROCOLLD DRG >16<=48 W/O B,,,28,,NW,,,,,,$32.97,$0.00,1,1,1,0,0,1,20171001, A6236,HCPCS,HYDROCOLLD DRG > 48 IN W/O B,,,28,,NW,,,,,,$52.71,$0.00,1,1,1,0,0,1,20171001, A6237,HCPCS,HYDROCOLLD DRG <=16 IN W/BDR,,,28,,NW,,,,,,$16.13,$0.00,1,1,1,0,0,1,20171001, A6238,HCPCS,HYDROCOLLD DRG >16<=48 W/BDR,,,28,,NW,,,,,,$44.28,$0.00,1,1,1,0,0,1,20171001, A6239,HCPCS,HYDROCOLLD DRG > 48 IN W/BDR,,,28,,NW,,,,,,$60.48,$0.00,1,1,1,0,0,1,20171001, A6240,HCPCS,HYDROCOLLD DRG FILLER PASTE,,,28,,NW,,,,,,$24.33,$0.00,1,1,1,0,0,1,20171001, A6241,HCPCS,HYDROCOLLOID DRG FILLER DRY,,,28,,NW,,,,,,$6.02,$0.00,1,1,1,0,0,1,20171001, A6242,HCPCS,HYDROGEL DRG <=16 IN W/O BDR,,,28,,NW,,,,,,$12.62,$0.00,1,1,1,0,0,1,20171001, A6243,HCPCS,HYDROGEL DRG >16<=48 W/O BDR,,,28,,NW,,,,,,$24.46,$0.00,1,1,1,0,0,1,20171001, A6244,HCPCS,HYDROGEL DRG >48 IN W/O BDR,,,28,,NW,,,,,,$75.46,$0.00,1,1,1,0,0,1,20171001, A6245,HCPCS,HYDROGEL DRG <= 16 IN W/BDR,,,28,,NW,,,,,,$14.90,$0.00,1,1,1,0,0,1,20171001, A6246,HCPCS,HYDROGEL DRG >16<=48 IN W/B,,,28,,NW,,,,,,$19.95,$0.00,1,1,1,0,0,1,20171001, A6247,HCPCS,HYDROGEL DRG > 48 SQ IN W/B,,,28,,NW,,,,,,$46.14,$0.00,1,1,1,0,0,1,20171001, A6248,HCPCS,HYDROGEL DRSG GEL FILLER,,,28,,NW,,,,,,$31.89,$0.00,1,1,1,0,0,1,20171001, A6250,HCPCS,SKIN SEAL PROTECT MOISTURIZR,,,28,,NW,,,,,,$10.15,$0.00,1,1,1,0,0,1,20171001, A6251,HCPCS,ABSORPT DRG <=16 SQ IN W/O B,,,28,,NW,,,,,,$4.92,$0.00,1,1,1,0,0,1,20171001, A6252,HCPCS,ABSORPT DRG >16 <=48 W/O BDR,,,28,,NW,,,,,,$7.33,$0.00,1,1,1,0,0,1,20171001, A6253,HCPCS,ABSORPT DRG > 48 SQ IN W/O B,,,28,,NW,,,,,,$13.15,$0.00,1,1,1,0,0,1,20171001, A6254,HCPCS,ABSORPT DRG <=16 SQ IN W/BDR,,,28,,NW,,,,,,$3.06,$0.00,1,1,1,0,0,1,20171001, A6255,HCPCS,ABSORPT DRG >16<=48 IN W/BDR,,,28,,NW,,,,,,$6.91,$0.00,1,1,1,0,0,1,20171001, A6256,HCPCS,ABSORPT DRG > 48 SQ IN W/BDR,,,28,,NW,,,,,,$15.85,$0.00,1,1,1,0,0,1,20171001, A6257,HCPCS,TRANSPARENT FILM <= 16 SQ IN,,,28,,NW,,,,,,$3.95,$0.00,1,1,1,0,0,1,20171001, A6258,HCPCS,TRANSPARENT FILM >16<=48 IN,,,28,,NW,,,,,,$9.32,$0.00,1,1,1,0,0,1,20171001, A6259,HCPCS,TRANSPARENT FILM > 48 SQ IN,,,28,,NW,,,,,,$21.86,$0.00,1,1,1,0,0,1,20171001, A6260,HCPCS,WOUND CLEANSER ANY TYPE/SIZE,,,28,,NW,,,,,,$1.82,$0.00,1,1,1,0,0,1,20171001, A6261,HCPCS,WOUND FILLER GEL/PASTE /OZ,,,28,,NW,,,,,,$6.65,$0.00,1,1,1,0,0,1,20171001, A6262,HCPCS,WOUND FILLER DRY FORM / GRAM,,,28,,NW,,,,,,$1.82,$0.00,1,1,1,0,0,1,20171001, A6266,HCPCS,IMPREG GAUZE NO H20/SAL/YARD,,,28,,NW,,,,,,$4.80,$0.00,1,1,1,0,0,1,20171001, A6402,HCPCS,STERILE GAUZE <= 16 SQ IN,,,28,,NW,,,,,,$0.30,$0.00,1,1,1,0,0,1,20171001, A6403,HCPCS,STERILE GAUZE>16 <= 48 SQ IN,,,28,,NW,,,,,,$1.07,$0.00,1,1,1,0,0,1,20171001, A6404,HCPCS,STERILE GAUZE > 48 SQ IN,,,28,,NW,,,,,,$0.91,$0.00,1,1,1,0,0,1,20171001, A6407,HCPCS,"PACKING STRIPS, NON-IMPREG",,,28,,NW,,,,,,$4.72,$0.00,1,1,1,0,0,1,20171001, A6410,HCPCS,STERILE EYE PAD,,,28,,NW,,,,,,$0.98,$0.00,1,1,1,0,0,1,20171001, A6411,HCPCS,NON-STERILE EYE PAD,,,28,,NW,,,,,,$0.98,$0.00,1,1,1,0,0,1,20171001, A6412,HCPCS,OCCLUSIVE EYE PATCH,,,28,,NW,,,,,,$0.91,$0.00,1,1,1,0,0,1,20171001, A6413,HCPCS,"ADHESIVE BANDAGE, FIRST-AID",,,28,,NW,,,,,,$1.29,$0.00,1,1,1,0,0,1,20171001, A6441,HCPCS,PAD BAND W>=3 <5/YD,,,28,,NW,,,,,,$1.70,$0.00,1,1,1,0,0,1,20171001, A6442,HCPCS,CONFORM BAND N/S W<3/YD,,,28,,NW,,,,,,$0.41,$0.00,1,1,1,0,0,1,20171001, A6443,HCPCS,CONFORM BAND N/S W>=3<5/YD,,,28,,NW,,,,,,$0.70,$0.00,1,1,1,0,0,1,20171001, A6444,HCPCS,CONFORM BAND N/S W>=5/YD,,,28,,NW,,,,,,$1.41,$0.00,1,1,1,0,0,1,20171001, A6445,HCPCS,CONFORM BAND S W <3/YD,,,28,,NW,,,,,,$0.82,$0.00,1,1,1,0,0,1,20171001, A6446,HCPCS,CONFORM BAND S W>=3 <5/YD,,,28,,NW,,,,,,$1.02,$0.00,1,1,1,0,0,1,20171001, A6447,HCPCS,CONFORM BAND S W >=5/YD,,,28,,NW,,,,,,$1.70,$0.00,1,1,1,0,0,1,20171001, A6448,HCPCS,LT COMPRES BAND <3/YD,,,28,,NW,,,,,,$2.94,$0.00,1,1,1,0,0,1,20171001, A6449,HCPCS,LT COMPRES BAND >=3 <5/YD,,,28,,NW,,,,,,$4.48,$0.00,1,1,1,0,0,1,20171001, A6450,HCPCS,LT COMPRES BAND >=5/YD,,,28,,NW,,,,,,$4.48,$0.00,1,1,1,0,0,1,20171001, A6451,HCPCS,MOD COMPRES BAND W>=3<5/YD,,,28,,NW,,,,,,$4.48,$0.00,1,1,1,0,0,1,20171001, A6452,HCPCS,HIGH COMPRES BAND W>=3<5YD,,,28,,NW,,,,,,$12.33,$0.00,1,1,1,0,0,1,20171001, A6453,HCPCS,SELF-ADHER BAND W <3/YD,,,28,,NW,,,,,,$1.57,$0.00,1,1,1,0,0,1,20171001, A6454,HCPCS,SELF-ADHER BAND W>=3 <5/YD,,,28,,NW,,,,,,$1.95,$0.00,1,1,1,0,0,1,20171001, A6455,HCPCS,SELF-ADHER BAND >=5/YD,,,28,,NW,,,,,,$3.56,$0.00,1,1,1,0,0,1,20171001, A6456,HCPCS,ZINC PASTE BAND W >=3<5/YD,,,28,,NW,,,,,,$3.23,$0.00,1,1,1,0,0,1,20171001, A6457,HCPCS,TUBULAR DRESSING,,,28,,NW,,,,,,$2.89,$0.00,1,1,1,0,0,1,20171001, A6504,HCPCS,CMPRSBURNGARMENT GLOVE-WRIST,,,28,,NW,,,,,,$505.47,$0.00,1,1,1,0,0,1,20171001, A6505,HCPCS,CMPRSBURNGARMENT GLOVE-ELBOW,,,28,,NW,,,,,,$263.71,$0.00,1,1,1,0,0,1,20171001, A6506,HCPCS,CMPRSBURNGRMNT GLOVE-AXILLA,,,28,,NW,,,,,,$149.77,$0.00,1,1,1,0,0,1,20171001, A6507,HCPCS,CMPRS BURNGARMENT FOOT-KNEE,,,28,,NW,,,,,,$205.23,$0.00,1,1,1,0,0,1,20171001, A6508,HCPCS,CMPRS BURNGARMENT FOOT-THIGH,,,28,,NW,,,,,,$592.52,$0.00,1,1,1,0,0,1,20171001, A6509,HCPCS,COMPRES BURN GARMENT JACKET,,,28,,NW,,,,,,$777.64,$0.00,1,1,1,0,0,1,20171001, A6510,HCPCS,COMPRES BURN GARMENT LEOTARD,,,28,,NW,,,,,,$334.06,$0.00,1,1,1,0,0,1,20171001, A6511,HCPCS,COMPRES BURN GARMENT PANTY,,,28,,NW,,,,,,$721.31,$0.00,1,1,1,0,0,1,20171001, A6512,HCPCS,"COMPRES BURN GARMENT, NOC",,,28,,NW,,,,,,$309.69,$0.00,1,1,1,0,0,1,20171001, A6530,HCPCS,COMPRESSION STOCKING BK18-30,,,28,,NW,,,,,,$60.09,$0.00,1,1,1,0,0,1,20171001, A6531,HCPCS,COMPRESSION STOCKING BK30-40,,,28,,NW,,,,,,$82.96,$0.00,1,1,1,0,0,1,20171001, A6531,HCPCS,COMPRESSION STOCKING BK30-40,AW,,28,,NW,,,,,,$82.96,$0.00,1,1,1,0,0,1,20171001, A6532,HCPCS,COMPRESSION STOCKING BK40-50,,,28,,NW,,,,,,$116.42,$0.00,1,1,1,0,0,1,20171001, A6532,HCPCS,COMPRESSION STOCKING BK40-50,AW,,28,,NW,,,,,,$116.42,$0.00,1,1,1,0,0,1,20171001, A6533,HCPCS,GC STOCKING THIGHLNGTH 18-30,,,28,,NW,,,,,,$85.96,$0.00,1,1,1,0,0,1,20171001, A6534,HCPCS,GC STOCKING THIGHLNGTH 30-40,,,28,,NW,,,,,,$55.72,$0.00,1,1,1,0,0,1,20171001, A6535,HCPCS,GC STOCKING THIGHLNGTH 40-50,,,28,,NW,,,,,,$102.40,$0.00,1,1,1,0,0,1,20171001, A6536,HCPCS,GC STOCKING FULL LNGTH 18-30,,,28,,NW,,,,,,$82.13,$0.00,1,1,1,0,0,1,20171001, A6537,HCPCS,GC STOCKING FULL LNGTH 30-40,,,28,,NW,,,,,,$125.19,$0.00,1,1,1,0,0,1,20171001, A6538,HCPCS,GC STOCKING FULL LNGTH 40-50,,,28,,NW,,,,,,$199.00,$0.00,1,1,1,0,0,1,20171001, A6539,HCPCS,GC STOCKING WAISTLNGTH 18-30,,,28,,NW,,,,,,$193.49,$0.00,1,1,1,0,0,1,20171001, A6540,HCPCS,GC STOCKING WAISTLNGTH 30-40,,,28,,NW,,,,,,$216.12,$0.00,1,1,1,0,0,1,20171001, A6541,HCPCS,GC STOCKING WAISTLNGTH 40-50,,,28,,NW,,,,,,$225.26,$0.00,1,1,1,0,0,1,20171001, A6544,HCPCS,GC STOCKING GARTER BELT,,,28,,NW,,,,,,$50.16,$0.00,1,1,1,0,0,1,20171001, A6545,HCPCS,GRAD COMP NON-ELASTIC BK,,,28,,NW,,,,,,$162.22,$0.00,1,1,1,0,0,1,20171001, A6545,HCPCS,GRAD COMP NON-ELASTIC BK,AW,,28,,NW,,,,,,$162.22,$0.00,1,1,1,0,0,1,20171001, A6549,HCPCS,G COMPRESSION STOCKING,,,28,,NW,,,,,,$339.21,$0.00,1,1,1,0,0,1,20171001, A6550,HCPCS,NEG PRES WOUND THER DRSG SET,,,28,,NW,,,,,,$116.21,$0.00,1,1,1,0,0,1,20171001, A7000,HCPCS,DISPOSABLE CANISTER FOR PUMP,,,28,,NW,,,,,,$83.55,$0.00,1,1,1,0,0,1,20171001, A7000,HCPCS,DISPOSABLE CANISTER FOR PUMP,NU,,28,,NW,,,,,,$83.55,$0.00,1,1,1,0,0,1,20171001, A7001,HCPCS,NONDISPOSABLE PUMP CANISTER,,,28,,NW,,,,,,$134.89,$0.00,1,1,1,0,0,1,20171001, A7001,HCPCS,NONDISPOSABLE PUMP CANISTER,NU,,28,,NW,,,,,,$134.89,$0.00,1,1,1,0,0,1,20171001, A7002,HCPCS,TUBING USED W SUCTION PUMP,,,28,,NW,,,,,,$35.97,$0.00,1,1,1,0,0,1,20171001, A7002,HCPCS,TUBING USED W SUCTION PUMP,NU,,28,,NW,,,,,,$35.97,$0.00,1,1,1,0,0,1,20171001, A7003,HCPCS,NEBULIZER ADMINISTRATION SET,,,28,,NW,,,,,,$14.01,$0.00,1,1,1,0,0,1,20171001, A7003,HCPCS,NEBULIZER ADMINISTRATION SET,NU,,28,,NW,,,,,,$14.01,$0.00,1,1,1,0,0,1,20171001, A7004,HCPCS,DISPOSABLE NEBULIZER SML VOL,,,28,,NW,,,,,,$11.45,$0.00,1,1,1,0,0,1,20171001, A7004,HCPCS,DISPOSABLE NEBULIZER SML VOL,NU,,28,,NW,,,,,,$11.45,$0.00,1,1,1,0,0,1,20171001, A7005,HCPCS,NONDISPOSABLE NEBULIZER SET,,,28,,NW,,,,,,$90.83,$0.00,1,1,1,0,0,1,20171001, A7005,HCPCS,NONDISPOSABLE NEBULIZER SET,NU,,28,,NW,,,,,,$90.83,$0.00,1,1,1,0,0,1,20171001, A7006,HCPCS,FILTERED NEBULIZER ADMIN SET,,,28,,NW,,,,,,$71.27,$0.00,1,1,1,0,0,1,20171001, A7006,HCPCS,FILTERED NEBULIZER ADMIN SET,NU,,28,,NW,,,,,,$71.27,$0.00,1,1,1,0,0,1,20171001, A7007,HCPCS,LG VOL NEBULIZER DISPOSABLE,,,28,,NW,,,,,,$28.57,$0.00,1,1,1,0,0,1,20171001, A7007,HCPCS,LG VOL NEBULIZER DISPOSABLE,NU,,28,,NW,,,,,,$28.57,$0.00,1,1,1,0,0,1,20171001, A7008,HCPCS,DISPOSABLE NEBULIZER PREFILL,,,28,,NW,,,,,,$90.19,$0.00,1,1,1,0,0,1,20171001, A7008,HCPCS,DISPOSABLE NEBULIZER PREFILL,NU,,28,,NW,,,,,,$90.19,$0.00,1,1,1,0,0,1,20171001, A7009,HCPCS,NEBULIZER RESERVOIR BOTTLE,,,28,,NW,,,,,,$155.83,$0.00,1,1,1,0,0,1,20171001, A7009,HCPCS,NEBULIZER RESERVOIR BOTTLE,NU,,28,,NW,,,,,,$155.83,$0.00,1,1,1,0,0,1,20171001, A7010,HCPCS,DISPOSABLE CORRUGATED TUBING,,,28,,NW,,,,,,$97.52,$0.00,1,1,1,0,0,1,20171001, A7010,HCPCS,DISPOSABLE CORRUGATED TUBING,NU,,28,,NW,,,,,,$97.52,$0.00,1,1,1,0,0,1,20171001, A7012,HCPCS,NEBULIZER WATER COLLEC DEVIC,,,28,,NW,,,,,,$25.36,$0.00,1,1,1,0,0,1,20171001, A7012,HCPCS,NEBULIZER WATER COLLEC DEVIC,NU,,28,,NW,,,,,,$25.36,$0.00,1,1,1,0,0,1,20171001, A7013,HCPCS,DISPOSABLE COMPRESSOR FILTER,,,28,,NW,,,,,,$5.05,$0.00,1,1,1,0,0,1,20171001, A7013,HCPCS,DISPOSABLE COMPRESSOR FILTER,NU,,28,,NW,,,,,,$5.05,$0.00,1,1,1,0,0,1,20171001, A7014,HCPCS,COMPRESSOR NONDISPOS FILTER,,,28,,NW,,,,,,$29.41,$0.00,1,1,1,0,0,1,20171001, A7014,HCPCS,COMPRESSOR NONDISPOS FILTER,NU,,28,,NW,,,,,,$29.41,$0.00,1,1,1,0,0,1,20171001, A7015,HCPCS,AEROSOL MASK USED W NEBULIZE,,,28,,NW,,,,,,$11.41,$0.00,1,1,1,0,0,1,20171001, A7015,HCPCS,AEROSOL MASK USED W NEBULIZE,NU,,28,,NW,,,,,,$11.41,$0.00,1,1,1,0,0,1,20171001, A7016,HCPCS,NEBULIZER DOME & MOUTHPIECE,,,28,,NW,,,,,,$78.70,$0.00,1,1,1,0,0,1,20171001, A7016,HCPCS,NEBULIZER DOME & MOUTHPIECE,NU,,28,,NW,,,,,,$78.70,$0.00,1,1,1,0,0,1,20171001, A7017,HCPCS,NEBULIZER NOT USED W OXYGEN,,,28,,NW,,,,,,$292.50,$0.00,1,1,1,0,0,1,20171001, A7017,HCPCS,NEBULIZER NOT USED W OXYGEN,NU,,28,,NW,,,,,,$292.50,$0.00,1,1,1,0,0,1,20171001, A7017,HCPCS,NEBULIZER NOT USED W OXYGEN,RR,,28,,NW,,,,,,$90.16,$0.00,1,1,1,0,0,1,20171001, A7017,HCPCS,NEBULIZER NOT USED W OXYGEN,UE,,28,,NW,,,,,,$236.30,$0.00,1,1,1,0,0,1,20171001, A7018,HCPCS,WATER DISTILLED W/NEBULIZER,,,28,,NW,,,,,,$2.93,$0.00,1,1,1,0,0,1,20171001, A7020,HCPCS,"INTERFACE, COUGH STIM DEVICE",,,28,,NW,,,,,,$98.49,$0.00,1,1,1,0,0,1,20171001, A7020,HCPCS,"INTERFACE, COUGH STIM DEVICE",NU,,28,,NW,,,,,,$98.49,$0.00,1,1,1,0,0,1,20171001, A7020,HCPCS,"INTERFACE, COUGH STIM DEVICE",RR,,28,,NW,,,,,,$12.46,$0.00,1,1,1,0,0,1,20171001, A7020,HCPCS,"INTERFACE, COUGH STIM DEVICE",UE,,28,,NW,,,,,,$74.88,$0.00,1,1,1,0,0,1,20171001, A7025,HCPCS,REPLACE CHEST COMPRESS VEST,,,28,,NW,,,,,,"$1,278.78",$0.00,1,1,1,0,0,1,20171001, A7025,HCPCS,REPLACE CHEST COMPRESS VEST,NU,,28,,NW,,,,,,"$1,278.78",$0.00,1,1,1,0,0,1,20171001, A7025,HCPCS,REPLACE CHEST COMPRESS VEST,RR,,28,,NW,,,,,,$161.83,$0.00,1,1,1,0,0,1,20171001, A7026,HCPCS,REPLACE CHST CMPRSS SYS HOSE,,,28,,NW,,,,,,$129.89,$0.00,1,1,1,0,0,1,20171001, A7026,HCPCS,REPLACE CHST CMPRSS SYS HOSE,NU,,28,,NW,,,,,,$129.89,$0.00,1,1,1,0,0,1,20171001, A7027,HCPCS,COMBINATION ORAL/NASAL MASK,,,28,,NW,,,,,,$302.89,$0.00,1,1,1,0,0,1,20171001, A7027,HCPCS,COMBINATION ORAL/NASAL MASK,NU,,28,,NW,,,,,,$302.89,$0.00,1,1,1,0,0,1,20171001, A7028,HCPCS,REPL ORAL CUSHION COMBO MASK,,,28,,NW,,,,,,$133.65,$0.00,1,1,1,0,0,1,20171001, A7028,HCPCS,REPL ORAL CUSHION COMBO MASK,NU,,28,,NW,,,,,,$133.65,$0.00,1,1,1,0,0,1,20171001, A7029,HCPCS,REPL NASAL PILLOW COMB MASK,,,28,,NW,,,,,,$97.94,$0.00,1,1,1,0,0,1,20171001, A7029,HCPCS,REPL NASAL PILLOW COMB MASK,NU,,28,,NW,,,,,,$97.94,$0.00,1,1,1,0,0,1,20171001, A7030,HCPCS,CPAP FULL FACE MASK,,,28,,NW,,,,,,$243.55,$0.00,1,1,1,0,0,1,20171001, A7030,HCPCS,CPAP FULL FACE MASK,NU,,28,,NW,,,,,,$243.55,$0.00,1,1,1,0,0,1,20171001, A7031,HCPCS,REPLACEMENT FACEMASK INTERFA,,,28,,NW,,,,,,$134.65,$0.00,1,1,1,0,0,1,20171001, A7031,HCPCS,REPLACEMENT FACEMASK INTERFA,NU,,28,,NW,,,,,,$134.65,$0.00,1,1,1,0,0,1,20171001, A7032,HCPCS,REPLACEMENT NASAL CUSHION,,,28,,NW,,,,,,$105.04,$0.00,1,1,1,0,0,1,20171001, A7032,HCPCS,REPLACEMENT NASAL CUSHION,NU,,28,,NW,,,,,,$105.04,$0.00,1,1,1,0,0,1,20171001, A7033,HCPCS,REPLACEMENT NASAL PILLOWS,,,28,,NW,,,,,,$98.05,$0.00,1,1,1,0,0,1,20171001, A7033,HCPCS,REPLACEMENT NASAL PILLOWS,NU,,28,,NW,,,,,,$98.05,$0.00,1,1,1,0,0,1,20171001, A7034,HCPCS,NASAL APPLICATION DEVICE,,,28,,NW,,,,,,$177.27,$0.00,1,1,1,0,0,1,20171001, A7034,HCPCS,NASAL APPLICATION DEVICE,NU,,28,,NW,,,,,,$177.27,$0.00,1,1,1,0,0,1,20171001, A7035,HCPCS,POS AIRWAY PRESS HEADGEAR,,,28,,NW,,,,,,$103.87,$0.00,1,1,1,0,0,1,20171001, A7035,HCPCS,POS AIRWAY PRESS HEADGEAR,NU,,28,,NW,,,,,,$103.87,$0.00,1,1,1,0,0,1,20171001, A7036,HCPCS,POS AIRWAY PRESS CHINSTRAP,,,28,,NW,,,,,,$88.40,$0.00,1,1,1,0,0,1,20171001, A7036,HCPCS,POS AIRWAY PRESS CHINSTRAP,NU,,28,,NW,,,,,,$88.40,$0.00,1,1,1,0,0,1,20171001, A7037,HCPCS,POS AIRWAY PRESSURE TUBING,,,28,,NW,,,,,,$91.78,$0.00,1,1,1,0,0,1,20171001, A7037,HCPCS,POS AIRWAY PRESSURE TUBING,NU,,28,,NW,,,,,,$91.78,$0.00,1,1,1,0,0,1,20171001, A7038,HCPCS,POS AIRWAY PRESSURE FILTER,,,28,,NW,,,,,,$19.41,$0.00,1,1,1,0,0,1,20171001, A7038,HCPCS,POS AIRWAY PRESSURE FILTER,NU,,28,,NW,,,,,,$19.41,$0.00,1,1,1,0,0,1,20171001, A7039,HCPCS,"FILTER, NON DISPOSABLE W PAP",,,28,,NW,,,,,,$59.89,$0.00,1,1,1,0,0,1,20171001, A7039,HCPCS,"FILTER, NON DISPOSABLE W PAP",NU,,28,,NW,,,,,,$59.89,$0.00,1,1,1,0,0,1,20171001, A7040,HCPCS,ONE WAY CHEST DRAIN VALVE,,,28,,NW,,,,,,$76.83,$0.00,1,1,1,0,0,1,20171001, A7041,HCPCS,WATER SEAL DRAIN CONTAINER,,,28,,NW,,,,,,$143.36,$0.00,1,1,1,0,0,1,20171001, A7044,HCPCS,PAP ORAL INTERFACE,,,28,,NW,,,,,,$230.87,$0.00,1,1,1,0,0,1,20171001, A7044,HCPCS,PAP ORAL INTERFACE,NU,,28,,NW,,,,,,$230.87,$0.00,1,1,1,0,0,1,20171001, A7045,HCPCS,REPL EXHALATION PORT FOR PAP,,,28,,NW,,,,,,$91.56,$0.00,1,1,1,0,0,1,20171001, A7045,HCPCS,REPL EXHALATION PORT FOR PAP,NU,,28,,NW,,,,,,$91.56,$0.00,1,1,1,0,0,1,20171001, A7045,HCPCS,REPL EXHALATION PORT FOR PAP,RR,,28,,NW,,,,,,$11.19,$0.00,1,1,1,0,0,1,20171001, A7045,HCPCS,REPL EXHALATION PORT FOR PAP,UE,,28,,NW,,,,,,$85.59,$0.00,1,1,1,0,0,1,20171001, A7046,HCPCS,"REPL WATER CHAMBER, PAP DEV",,,28,,NW,,,,,,$93.57,$0.00,1,1,1,0,0,1,20171001, A7046,HCPCS,"REPL WATER CHAMBER, PAP DEV",NU,,28,,NW,,,,,,$93.57,$0.00,1,1,1,0,0,1,20171001, A7047,HCPCS,RESP SUCTION ORAL INTERFACE,,,28,,NW,,,,,,$329.37,$0.00,1,1,1,0,0,1,20171001, A7047,HCPCS,RESP SUCTION ORAL INTERFACE,NU,,28,,NW,,,,,,$329.37,$0.00,1,1,1,0,0,1,20171001, A7048,HCPCS,VACUUM DRAIN BOTTLE/TUBE KIT,,,28,,NW,,,,,,$80.38,$0.00,1,1,1,0,0,1,20171001, A7501,HCPCS,TRACHEOSTOMA VALVE W DIAPHRA,,,28,,NW,,,,,,$199.73,$0.00,1,1,1,0,0,1,20171001, A7502,HCPCS,REPLACEMENT DIAPHRAGM/FPLATE,,,28,,NW,,,,,,$95.55,$0.00,1,1,1,0,0,1,20171001, A7503,HCPCS,HMES FILTER HOLDER OR CAP,,,28,,NW,,,,,,$22.61,$0.00,1,1,1,0,0,1,20171001, A7504,HCPCS,TRACHEOSTOMA HMES FILTER,,,28,,NW,,,,,,$1.70,$0.00,1,1,1,0,0,1,20171001, A7505,HCPCS,HMES OR TRACH VALVE HOUSING,,,28,,NW,,,,,,$10.02,$0.00,1,1,1,0,0,1,20171001, A7506,HCPCS,HMES/TRACHVALVE ADHESIVEDISK,,,28,,NW,,,,,,$0.84,$0.00,1,1,1,0,0,1,20171001, A7507,HCPCS,INTEGRATED FILTER & HOLDER,,,28,,NW,,,,,,$5.86,$0.00,1,1,1,0,0,1,20171001, A7508,HCPCS,HOUSING & INTEGRATED ADHESIV,,,28,,NW,,,,,,$6.58,$0.00,1,1,1,0,0,1,20171001, A7509,HCPCS,HEAT & MOISTURE EXCHANGE SYS,,,28,,NW,,,,,,$3.61,$0.00,1,1,1,0,0,1,20171001, A7520,HCPCS,TRACH/LARYN TUBE NON-CUFFED,,,28,,NW,,,,,,$81.60,$0.00,1,1,1,0,0,1,20171001, A7521,HCPCS,TRACH/LARYN TUBE CUFFED,,,28,,NW,,,,,,$80.78,$0.00,1,1,1,0,0,1,20171001, A7522,HCPCS,TRACH/LARYN TUBE STAINLESS,,,28,,NW,,,,,,$77.30,$0.00,1,1,1,0,0,1,20171001, A7523,HCPCS,TRACHEOSTOMY SHOWER PROTECT,,,28,,NW,,,,,,$27.57,$0.00,1,1,1,0,0,1,20171001, A7524,HCPCS,TRACHEOSTOMA STENT/STUD/BTTN,,,28,,NW,,,,,,$137.09,$0.00,1,1,1,0,0,1,20171001, A7525,HCPCS,TRACHEOSTOMY MASK,,,28,,NW,,,,,,$3.82,$0.00,1,1,1,0,0,1,20171001, A7526,HCPCS,TRACHEOSTOMY TUBE COLLAR,,,28,,NW,,,,,,$6.27,$0.00,1,1,1,0,0,1,20171001, A7527,HCPCS,TRACH/LARYN TUBE PLUG/STOP,,,28,,NW,,,,,,$7.93,$0.00,1,1,1,0,0,1,20171001, A8000,HCPCS,SOFT PROTECT HELMET PREFAB,,,28,,NW,,,,,,$399.62,$0.00,1,1,1,0,0,1,20171001, A8000,HCPCS,SOFT PROTECT HELMET PREFAB,NU,,28,,NW,,,,,,$399.62,$0.00,1,1,1,0,0,1,20171001, A8000,HCPCS,SOFT PROTECT HELMET PREFAB,RR,,28,,NW,,,,,,$100.85,$0.00,1,1,1,0,0,1,20171001, A8000,HCPCS,SOFT PROTECT HELMET PREFAB,UE,,28,,NW,,,,,,$316.68,$0.00,1,1,1,0,0,1,20171001, A8001,HCPCS,HARD PROTECT HELMET PREFAB,,,28,,NW,,,,,,$399.62,$0.00,1,1,1,0,0,1,20171001, A8001,HCPCS,HARD PROTECT HELMET PREFAB,NU,,28,,NW,,,,,,$399.62,$0.00,1,1,1,0,0,1,20171001, A8001,HCPCS,HARD PROTECT HELMET PREFAB,RR,,28,,NW,,,,,,$100.85,$0.00,1,1,1,0,0,1,20171001, A8001,HCPCS,HARD PROTECT HELMET PREFAB,UE,,28,,NW,,,,,,$316.68,$0.00,1,1,1,0,0,1,20171001, A8002,HCPCS,SOFT PROTECT HELMET CUSTOM,,,28,,NW,,,,,,$507.47,$0.00,1,1,1,0,0,1,20171001, A8002,HCPCS,SOFT PROTECT HELMET CUSTOM,NU,,28,,NW,,,,,,$507.47,$0.00,1,1,1,0,0,1,20171001, A8002,HCPCS,SOFT PROTECT HELMET CUSTOM,RR,,28,,NW,,,,,,$53.50,$0.00,1,1,1,0,0,1,20171001, A8002,HCPCS,SOFT PROTECT HELMET CUSTOM,UE,,28,,NW,,,,,,$380.58,$0.00,1,1,1,0,0,1,20171001, A8003,HCPCS,HARD PROTECT HELMET CUSTOM,,,28,,NW,,,,,,$530.07,$0.00,1,1,1,0,0,1,20171001, A8003,HCPCS,HARD PROTECT HELMET CUSTOM,NU,,28,,NW,,,,,,$530.07,$0.00,1,1,1,0,0,1,20171001, A8003,HCPCS,HARD PROTECT HELMET CUSTOM,RR,,28,,NW,,,,,,$56.38,$0.00,1,1,1,0,0,1,20171001, A8003,HCPCS,HARD PROTECT HELMET CUSTOM,UE,,28,,NW,,,,,,$398.51,$0.00,1,1,1,0,0,1,20171001, A8004,HCPCS,"REPL SOFT INTERFACE, HELMET",,,28,,NW,,,,,,$63.32,$0.00,1,1,1,0,0,1,20171001, A8004,HCPCS,"REPL SOFT INTERFACE, HELMET",NU,,28,,NW,,,,,,$63.32,$0.00,1,1,1,0,0,1,20171001, A8004,HCPCS,"REPL SOFT INTERFACE, HELMET",RR,,28,,NW,,,,,,$6.74,$0.00,1,1,1,0,0,1,20171001, A8004,HCPCS,"REPL SOFT INTERFACE, HELMET",UE,,28,,NW,,,,,,$47.60,$0.00,1,1,1,0,0,1,20171001, A9150,HCPCS,MISC/EXPER NON-PRESCRIPT DRU,,,29,,NW,,,,,,$20.99,$0.00,1,1,1,0,0,1,20171001, A9152,HCPCS,SINGLE VITAMIN NOS,,,29,,NW,,,,,,$22.98,$0.00,1,1,1,0,0,1,20171001, A9153,HCPCS,MULTI-VITAMIN NOS,,,29,,NW,,,,,,$22.98,$0.00,1,1,1,0,0,1,20171001, A9155,HCPCS,ARTIFICIAL SALIVA,,,29,,NW,,,,,,$8.31,$0.00,1,1,1,0,0,1,20171001, A9180,HCPCS,"LICE TREATMENT, TOPICAL",,,29,,NW,,,,,,$190.50,$0.00,1,1,1,0,0,1,20171001, A9270,HCPCS,NON-COVERED ITEM OR SERVICE,,,28,,NW,,,,,,$154.19,$0.00,1,1,1,0,0,1,20171001, A9272,HCPCS,"DISP WOUND SUCT, DRSG/ACCESS",,,28,,NW,,,,,,$487.18,$0.00,1,1,1,0,0,1,20171001, A9273,HCPCS,HOT/COLD H2OBOT/CAP/COL/WRAP,,,28,,NW,,,,,,$16.91,$0.00,1,1,1,0,0,1,20171001, A9274,HCPCS,EXT AMB INSULIN DELIVERY SYS,,,28,,NW,,,,,,$46.10,$0.00,1,1,1,0,0,1,20171001, A9275,HCPCS,DISP HOME GLUCOSE MONITOR,,,28,,NW,,,,,,$24.57,$0.00,1,1,1,0,0,1,20171001, A9276,HCPCS,"DISPOSABLE SENSOR, CGM SYS",,,28,,NW,,,,,,$36.96,$0.00,1,1,1,0,0,1,20171001, A9277,HCPCS,"EXTERNAL TRANSMITTER, CGM",,,28,,NW,,,,,,"$1,616.71",$0.00,1,1,1,0,0,1,20171001, A9278,HCPCS,"EXTERNAL RECEIVER, CGM SYS",,,28,,NW,,,,,,"$1,510.91",$0.00,1,1,1,0,0,1,20171001, A9279,HCPCS,MONITORING FEATURE/DEVICENOC,,,28,,NW,,,,,,$81.67,$0.00,1,1,1,0,0,1,20171001, A9280,HCPCS,"ALERT DEVICE, NOC",,,28,,NW,,,,,,$293.84,$0.00,1,1,1,0,0,1,20171001, A9281,HCPCS,REACHING/GRABBING DEVICE,,,28,,NW,,,,,,$41.34,$0.00,1,1,1,0,0,1,20171001, A9282,HCPCS,WIG ANY TYPE,,,28,,NW,,,,,,$503.28,$0.00,1,1,1,0,0,1,20171001, A9283,HCPCS,FOOT PRESS OFF LOAD SUPP DEV,,,28,,NW,,,,,,$56.07,$0.00,1,1,1,0,0,1,20171001, A9284,HCPCS,NON-ELECTRONIC SPIROMETER,,,28,,NW,,,,,,$33.38,$0.00,1,1,1,0,0,1,20171001, A9300,HCPCS,EXERCISE EQUIPMENT,,,28,,NW,,,,,,$14.78,$0.00,1,1,1,0,0,1,20171001, A9500,HCPCS,TC99M SESTAMIBI,,,28,,NW,,,,,,$337.01,$0.00,1,1,1,0,0,1,20171001, A9501,HCPCS,TECHNETIUM TC-99M TEBOROXIME,,,28,,NW,,,,,,$459.06,$0.00,1,1,1,0,0,1,20171001, A9502,HCPCS,TC99M TETROFOSMIN,,,28,,NW,,,,,,$299.65,$0.00,1,1,1,0,0,1,20171001, A9503,HCPCS,TC99M MEDRONATE,,,28,,NW,,,,,,$73.58,$0.00,1,1,1,0,0,1,20171001, A9504,HCPCS,TC99M APCITIDE,,,28,,NW,,,,,,$328.16,$0.00,1,1,1,0,0,1,20171001, A9505,HCPCS,TL201 THALLIUM,,,28,,NW,,,,,,$218.53,$0.00,1,1,1,0,0,1,20171001, A9507,HCPCS,IN111 CAPROMAB,,,28,,NW,,,,,,"$4,071.09",$0.00,1,1,1,0,0,1,20171001, A9508,HCPCS,"I131 IODOBENGUATE, DX",,,28,,NW,,,,,,$49.43,$0.00,1,1,1,0,0,1,20171001, A9509,HCPCS,IODINE I-123 SOD IODIDE MIL,,,28,,NW,,,,,,$178.64,$0.00,1,1,1,0,0,1,20171001, A9510,HCPCS,TC99M DISOFENIN,,,28,,NW,,,,,,$124.16,$0.00,1,1,1,0,0,1,20171001, A9512,HCPCS,TC99M PERTECHNETATE,,,28,,NW,,,,,,$7.35,$0.00,1,1,1,0,0,1,20171001, A9516,HCPCS,IODINE I-123 SOD IODIDE MIC,,,28,,NW,,,,,,$158.19,$0.00,1,1,1,0,0,1,20171001, A9517,HCPCS,"I131 IODIDE CAP, RX",,,28,,NW,,,,,,$77.25,$0.00,1,1,1,0,0,1,20171001, A9520,HCPCS,TC99 TILMANOCEPT DIAG 0.5MCI,,,28,,NW,,,,,,$811.72,$0.00,1,1,1,0,0,1,20171001, A9521,HCPCS,TC99M EXAMETAZIME,,,28,,NW,,,,,,"$1,474.60",$0.00,1,1,1,0,0,1,20171001, A9524,HCPCS,"I131 SERUM ALBUMIN, DX",,,28,,NW,,,,,,$252.48,$0.00,1,1,1,0,0,1,20171001, A9526,HCPCS,NITROGEN N-13 AMMONIA,,,28,,NW,,,,,,$919.73,$0.00,1,1,1,0,0,1,20171001, A9527,HCPCS,IODINE I-125 SODIUM IODIDE,,,28,,NW,,,,,,$153.02,$0.00,1,1,1,0,0,1,20171001, A9528,HCPCS,"IODINE I-131 IODIDE CAP, DX",,,28,,NW,,,,,,$461.48,$0.00,1,1,1,0,0,1,20171001, A9529,HCPCS,"I131 IODIDE SOL, DX",,,28,,NW,,,,,,$78.04,$0.00,1,1,1,0,0,1,20171001, A9530,HCPCS,"I131 IODIDE SOL, RX",,,28,,NW,,,,,,$43.08,$0.00,1,1,1,0,0,1,20171001, A9531,HCPCS,I131 MAX 100UCI,,,28,,NW,,,,,,$18.05,$0.00,1,1,1,0,0,1,20171001, A9532,HCPCS,"I125 SERUM ALBUMIN, DX",,,28,,NW,,,,,,"$1,000.28",$0.00,1,1,1,0,0,1,20171001, A9536,HCPCS,TC99M DEPREOTIDE,,,28,,NW,,,,,,$841.60,$0.00,1,1,1,0,0,1,20171001, A9537,HCPCS,TC99M MEBROFENIN,,,28,,NW,,,,,,$130.59,$0.00,1,1,1,0,0,1,20171001, A9538,HCPCS,TC99M PYROPHOSPHATE,,,28,,NW,,,,,,$111.00,$0.00,1,1,1,0,0,1,20171001, A9539,HCPCS,TC99M PENTETATE,,,28,,NW,,,,,,$74.00,$0.00,1,1,1,0,0,1,20171001, A9540,HCPCS,TC99M MAA,,,28,,NW,,,,,,$38.48,$0.00,1,1,1,0,0,1,20171001, A9541,HCPCS,TC99M SULFUR COLLOID,,,28,,NW,,,,,,$174.38,$0.00,1,1,1,0,0,1,20171001, A9546,HCPCS,CO57/58,,,28,,NW,,,,,,$31.71,$0.00,1,1,1,0,0,1,20171001, A9547,HCPCS,IN111 OXYQUINOLINE,,,28,,NW,,,,,,"$1,442.34",$0.00,1,1,1,0,0,1,20171001, A9548,HCPCS,IN111 PENTETATE,,,28,,NW,,,,,,$865.40,$0.00,1,1,1,0,0,1,20171001, A9550,HCPCS,TC99M GLUCEPTATE,,,28,,NW,,,,,,$52.02,$0.00,1,1,1,0,0,1,20171001, A9551,HCPCS,TC99M SUCCIMER,,,28,,NW,,,,,,$428.45,$0.00,1,1,1,0,0,1,20171001, A9552,HCPCS,F18 FDG,,,28,,NW,,,,,,$930.15,$0.00,1,1,1,0,0,1,20171001, A9554,HCPCS,"I125 IOTHALAMATE, DX",,,28,,NW,,,,,,"$1,443.03",$0.00,1,1,1,0,0,1,20171001, A9555,HCPCS,RB82 RUBIDIUM,,,28,,NW,,,,,,"$1,103.68",$0.00,1,1,1,0,0,1,20171001, A9556,HCPCS,GA67 GALLIUM,,,28,,NW,,,,,,$108.11,$0.00,1,1,1,0,0,1,20171001, A9557,HCPCS,TC99M BICISATE,,,28,,NW,,,,,,$382.54,$0.00,1,1,1,0,0,1,20171001, A9558,HCPCS,XE133 XENON 10MCI,,,28,,NW,,,,,,$130.30,$0.00,1,1,1,0,0,1,20171001, A9560,HCPCS,TC99M LABELED RBC,,,28,,NW,,,,,,$252.76,$0.00,1,1,1,0,0,1,20171001, A9561,HCPCS,TC99M OXIDRONATE,,,28,,NW,,,,,,$93.53,$0.00,1,1,1,0,0,1,20171001, A9562,HCPCS,TC99M MERTIATIDE,,,28,,NW,,,,,,$569.71,$0.00,1,1,1,0,0,1,20171001, A9564,HCPCS,P32 CHROMIC PHOSPHATE,,,28,,NW,,,,,,$738.48,$0.00,1,1,1,0,0,1,20171001, A9567,HCPCS,TECHNETIUM TC-99M AEROSOL,,,28,,NW,,,,,,$62.16,$0.00,1,1,1,0,0,1,20171001, A9569,HCPCS,TECHNETIUM TC-99M AUTO WBC,,,28,,NW,,,,,,$3.61,$0.00,1,1,1,0,0,1,20171001, A9570,HCPCS,INDIUM IN-111 AUTO WBC,,,28,,NW,,,,,,$354.48,$0.00,1,1,1,0,0,1,20171001, A9571,HCPCS,INDIUM IN-111 AUTO PLATELET,,,28,,NW,,,,,,$15.85,$0.00,1,1,1,0,0,1,20171001, A9572,HCPCS,INDIUM IN-111 PENTETREOTIDE,,,28,,NW,,,,,,"$5,646.32",$0.00,1,1,1,0,0,1,20171001, A9575,HCPCS,INJ GADOTERATE MEGLUMI 0.1ML,,,28,,NW,,,,,,$1.37,$0.00,1,1,1,0,0,1,20171001, A9576,HCPCS,INJ PROHANCE MULTIPACK,,,28,,NW,,,,,,$7.35,$0.00,1,1,1,0,0,1,20171001, A9577,HCPCS,INJ MULTIHANCE,,,28,,NW,,,,,,$11.03,$0.00,1,1,1,0,0,1,20171001, A9578,HCPCS,INJ MULTIHANCE MULTIPACK,,,28,,NW,,,,,,$8.43,$0.00,1,1,1,0,0,1,20171001, A9579,HCPCS,"GAD-BASE MR CONTRAST NOS,1ML",,,28,,NW,,,,,,$8.43,$0.00,1,1,1,0,0,1,20171001, A9580,HCPCS,SODIUM FLUORIDE F-18,,,28,,NW,,,,,,$822.30,$0.00,1,1,1,0,0,1,20171001, A9581,HCPCS,GADOXETATE DISODIUM INJ,,,28,,NW,,,,,,$28.13,$0.00,1,1,1,0,0,1,20171001, A9582,HCPCS,IODINE I-123 IOBENGUANE,,,28,,NW,,,,,,"$5,450.18",$0.00,1,1,1,0,0,1,20171001, A9583,HCPCS,GADOFOSVESET TRISODIUM INJ,,,28,,NW,,,,,,$50.00,$0.00,1,1,1,0,0,1,20171001, A9584,HCPCS,IODINE I-123 IOFLUPANE,,,28,,NW,,,,,,"$3,516.55",$0.00,1,1,1,0,0,1,20171001, A9585,HCPCS,GADOBUTROL INJECTION,,,28,,NW,,,,,,$1.85,$0.00,1,1,1,0,0,1,20171001, A9599,HCPCS,RADIOPH DX B AMYLOID PET NOS,,,28,,NW,,,,,,$34.37,$0.00,1,1,1,0,0,1,20171001, A9600,HCPCS,SR89 STRONTIUM,,,28,,NW,,,,,,"$1,866.39",$0.00,1,1,1,0,0,1,20171001, A9604,HCPCS,SM 153 LEXIDRONAM,,,28,,NW,,,,,,"$15,781.29",$0.00,1,1,1,0,0,1,20171001, A9606,HCPCS,RADIUM RA223 DICHLORIDE THER,,,28,,NW,,,,,,$348.69,$0.00,1,1,1,0,0,1,20171001, A9698,HCPCS,NON-RAD CONTRAST MATERIALNOC,,,28,,NW,,,,,,$33.96,$0.00,1,1,1,0,0,1,20171001, A9699,HCPCS,RADIOPHARM RX AGENT NOC,,,28,,NW,,,,,,$33.96,$0.00,1,1,1,0,0,1,20171001, A9700,HCPCS,ECHOCARDIOGRAPHY CONTRAST,,,28,,NW,,,,,,$446.26,$0.00,1,1,1,0,0,1,20171001, A9900,HCPCS,SUPPLY/ACCESSORY/SERVICE,,,28,,NW,,,,,,$37.37,$0.00,1,1,1,0,0,1,20171001, A9999,HCPCS,"DME SUPPLY OR ACCESSORY, NOS",,,28,,NW,,,,,,$4.20,$0.00,1,1,1,0,0,1,20171001, B4034,HCPCS,ENTER FEED SUPKIT SYR BY DAY,,,28,,NW,,,,,,$11.43,$0.00,1,1,1,0,0,1,20171001, B4035,HCPCS,ENTERAL FEED SUPP PUMP PER D,,,28,,NW,,,,,,$19.56,$0.00,1,1,1,0,0,1,20171001, B4036,HCPCS,ENTERAL FEED SUP KIT GRAV BY,,,28,,NW,,,,,,$15.49,$0.00,1,1,1,0,0,1,20171001, B4081,HCPCS,ENTERAL NG TUBING W/ STYLET,,,28,,NW,,,,,,$55.88,$0.00,1,1,1,0,0,1,20171001, B4082,HCPCS,ENTERAL NG TUBING W/O STYLET,,,28,,NW,,,,,,$40.18,$0.00,1,1,1,0,0,1,20171001, B4083,HCPCS,ENTERAL STOMACH TUBE LEVINE,,,28,,NW,,,,,,$6.35,$0.00,1,1,1,0,0,1,20171001, B4087,HCPCS,"GASTRO/JEJUNO TUBE, STD",,,28,,NW,,,,,,$97.52,$0.00,1,1,1,0,0,1,20171001, B4088,HCPCS,"GASTRO/JEJUNO TUBE, LOW-PRO",,,28,,NW,,,,,,$97.52,$0.00,1,1,1,0,0,1,20171001, B4100,HCPCS,FOOD THICKENER ORAL,,,28,,NW,,,,,,$0.96,$0.00,1,1,1,0,0,1,20171001, B4102,HCPCS,EF ADULT FLUIDS AND ELECTRO,,,28,,NW,,,,,,$3.97,$0.00,1,1,1,0,0,1,20171001, B4103,HCPCS,EF PED FLUID AND ELECTROLYTE,,,28,,NW,,,,,,$13.57,$0.00,1,1,1,0,0,1,20171001, B4104,HCPCS,ADDITIVE FOR ENTERAL FORMULA,,,28,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, B4149,HCPCS,EF BLENDERIZED FOODS,,,28,,NW,,,,,,$4.07,$0.00,1,1,1,0,0,1,20171001, B4150,HCPCS,EF COMPLET W/INTACT NUTRIENT,,,28,,NW,,,,,,$1.77,$0.00,1,1,1,0,0,1,20171001, B4152,HCPCS,EF CALORIE DENSE>/=1.5KCAL,,,28,,NW,,,,,,$1.09,$0.00,1,1,1,0,0,1,20171001, B4153,HCPCS,EF HYDROLYZED/AMINO ACIDS,,,28,,NW,,,,,,$4.76,$0.00,1,1,1,0,0,1,20171001, B4154,HCPCS,EF SPEC METABOLIC NONINHERIT,,,28,,NW,,,,,,$2.78,$0.00,1,1,1,0,0,1,20171001, B4155,HCPCS,EF INCOMPLETE/MODULAR,,,28,,NW,,,,,,$3.01,$0.00,1,1,1,0,0,1,20171001, B4157,HCPCS,EF SPECIAL METABOLIC INHERIT,,,28,,NW,,,,,,$10.61,$0.00,1,1,1,0,0,1,20171001, B4158,HCPCS,EF PED COMPLETE INTACT NUT,,,28,,NW,,,,,,$4.68,$0.00,1,1,1,0,0,1,20171001, B4159,HCPCS,EF PED COMPLETE SOY BASED,,,28,,NW,,,,,,$5.20,$0.00,1,1,1,0,0,1,20171001, B4160,HCPCS,EF PED CALORIC DENSE>/=0.7KC,,,28,,NW,,,,,,$4.37,$0.00,1,1,1,0,0,1,20171001, B4161,HCPCS,EF PED HYDROLYZED/AMINO ACID,,,28,,NW,,,,,,$9.77,$0.00,1,1,1,0,0,1,20171001, B4162,HCPCS,EF PED SPECMETABOLIC INHERIT,,,28,,NW,,,,,,$16.15,$0.00,1,1,1,0,0,1,20171001, B4164,HCPCS,PARENTERAL 50% DEXTROSE SOLU,,,28,,NW,,,,,,$47.16,$0.00,1,1,1,0,0,1,20171001, B4168,HCPCS,PARENTERAL SOL AMINO ACID 3.,,,28,,NW,,,,,,$68.59,$0.00,1,1,1,0,0,1,20171001, B4172,HCPCS,PARENTERAL SOL AMINO ACID 5.,,,28,,NW,,,,,,$119.30,$0.00,1,1,1,0,0,1,20171001, B4176,HCPCS,PARENTERAL SOL AMINO ACID 7-,,,28,,NW,,,,,,$132.32,$0.00,1,1,1,0,0,1,20171001, B4178,HCPCS,PARENTERAL SOL AMINO ACID >,,,28,,NW,,,,,,$158.74,$0.00,1,1,1,0,0,1,20171001, B4180,HCPCS,PARENTERAL SOL CARB > 50%,,,28,,NW,,,,,,$67.53,$0.00,1,1,1,0,0,1,20171001, B4185,HCPCS,PARENTERAL SOL 10 GM LIPIDS,,,28,,NW,,,,,,$31.34,$0.00,1,1,1,0,0,1,20171001, B4189,HCPCS,PARENTERAL SOL AMINO ACID &,,,28,,NW,,,,,,$489.56,$0.00,1,1,1,0,0,1,20171001, B4193,HCPCS,PARENTERAL SOL 52-73 GM PROT,,,28,,NW,,,,,,$632.45,$0.00,1,1,1,0,0,1,20171001, B4197,HCPCS,PARENTERAL SOL 74-100 GM PRO,,,28,,NW,,,,,,$769.89,$0.00,1,1,1,0,0,1,20171001, B4199,HCPCS,PARENTERAL SOL > 100GM PROTE,,,28,,NW,,,,,,$879.68,$0.00,1,1,1,0,0,1,20171001, B4216,HCPCS,PARENTERAL NUTRITION ADDITIV,,,28,,NW,,,,,,$21.65,$0.00,1,1,1,0,0,1,20171001, B4220,HCPCS,PARENTERAL SUPPLY KIT PREMIX,,,28,,NW,,,,,,$22.44,$0.00,1,1,1,0,0,1,20171001, B4222,HCPCS,PARENTERAL SUPPLY KIT HOMEMI,,,28,,NW,,,,,,$27.57,$0.00,1,1,1,0,0,1,20171001, B4224,HCPCS,PARENTERAL ADMINISTRATION KI,,,28,,NW,,,,,,$69.21,$0.00,1,1,1,0,0,1,20171001, B5000,HCPCS,PARENTERAL SOL RENAL-AMIROSY,,,28,,NW,,,,,,$33.13,$0.00,1,1,1,0,0,1,20171001, B5100,HCPCS,PARENTERAL SOLUTION HEPATIC,,,28,,NW,,,,,,$13.19,$0.00,1,1,1,0,0,1,20171001, B5200,HCPCS,PARENTERAL SOL HEPATIC FREAM,,,28,,NW,,,,,,$632.64,$0.00,1,1,1,0,0,1,20171001, B9002,HCPCS,ENTER NUTR INF PUMP ANY TYPE,,,28,,NW,,,,,,"$2,237.21",$0.00,1,1,1,0,0,1,20171001, B9002,HCPCS,ENTER NUTR INF PUMP ANY TYPE,MS,,28,,NW,,,,,,$75.60,$0.00,1,1,1,0,0,1,20171001, B9002,HCPCS,ENTER NUTR INF PUMP ANY TYPE,NU,,28,,NW,,,,,,"$2,237.21",$0.00,1,1,1,0,0,1,20171001, B9002,HCPCS,ENTER NUTR INF PUMP ANY TYPE,RR,,28,,NW,,,,,,$224.09,$0.00,1,1,1,0,0,1,20171001, B9002,HCPCS,ENTER NUTR INF PUMP ANY TYPE,UE,,28,,NW,,,,,,"$1,678.02",$0.00,1,1,1,0,0,1,20171001, B9004,HCPCS,PARENTERAL INFUS PUMP PORTAB,,,28,,NW,,,,,,"$6,943.60",$0.00,1,1,1,0,0,1,20171001, B9004,HCPCS,PARENTERAL INFUS PUMP PORTAB,MS,,28,,NW,,,,,,$549.99,$0.00,1,1,1,0,0,1,20171001, B9004,HCPCS,PARENTERAL INFUS PUMP PORTAB,NU,,28,,NW,,,,,,"$6,943.60",$0.00,1,1,1,0,0,1,20171001, B9004,HCPCS,PARENTERAL INFUS PUMP PORTAB,RR,,28,,NW,,,,,,"$1,099.54",$0.00,1,1,1,0,0,1,20171001, B9004,HCPCS,PARENTERAL INFUS PUMP PORTAB,UE,,28,,NW,,,,,,"$5,207.80",$0.00,1,1,1,0,0,1,20171001, B9006,HCPCS,PARENTERAL INFUS PUMP STATIO,,,28,,NW,,,,,,"$6,943.60",$0.00,1,1,1,0,0,1,20171001, B9006,HCPCS,PARENTERAL INFUS PUMP STATIO,MS,,28,,NW,,,,,,$549.99,$0.00,1,1,1,0,0,1,20171001, B9006,HCPCS,PARENTERAL INFUS PUMP STATIO,NU,,28,,NW,,,,,,"$6,943.60",$0.00,1,1,1,0,0,1,20171001, B9006,HCPCS,PARENTERAL INFUS PUMP STATIO,RR,,28,,NW,,,,,,"$1,099.54",$0.00,1,1,1,0,0,1,20171001, B9006,HCPCS,PARENTERAL INFUS PUMP STATIO,UE,,28,,NW,,,,,,"$5,207.80",$0.00,1,1,1,0,0,1,20171001, B9998,HCPCS,ENTERAL SUPP NOT OTHERWISE C,,,28,,NW,,,,,,$100.47,$0.00,1,1,1,0,0,1,20171001, B9999,HCPCS,PARENTERAL SUPP NOT OTHRWS C,,,28,,NW,,,,,,$100.47,$0.00,1,1,1,0,0,1,20171001, C1713,HCPCS,"ANCHOR/SCREW BN/BN,TIS/BN",,,28,,NW,,,,,,$636.42,$0.00,1,1,1,0,0,1,20171001, C1714,HCPCS,"CATH, TRANS ATHERECTOMY, DIR",,,28,,NW,,,,,,$280.41,$0.00,1,1,1,0,0,1,20171001, C1715,HCPCS,BRACHYTHERAPY NEEDLE,,,28,,NW,,,,,,$47.55,$0.00,1,1,1,0,0,1,20171001, C1717,HCPCS,"BRACHYTX, NON-STR,HDR IR-192",,,28,,NW,,,,,,"$1,054.49",$0.00,1,1,1,0,0,1,20171001, C1721,HCPCS,"AICD, DUAL CHAMBER",,,28,,NW,,,,,,"$28,078.42",$0.00,1,1,1,0,0,1,20171001, C1722,HCPCS,"AICD, SINGLE CHAMBER",,,28,,NW,,,,,,"$24,464.24",$0.00,1,1,1,0,0,1,20171001, C1724,HCPCS,"CATH, TRANS ATHEREC,ROTATION",,,28,,NW,,,,,,"$2,507.59",$0.00,1,1,1,0,0,1,20171001, C1725,HCPCS,"CATH, TRANSLUMIN NON-LASER",,,28,,NW,,,,,,"$1,257.10",$0.00,1,1,1,0,0,1,20171001, C1726,HCPCS,"CATH, BAL DIL, NON-VASCULAR",,,28,,NW,,,,,,$905.74,$0.00,1,1,1,0,0,1,20171001, C1727,HCPCS,"CATH, BAL TIS DIS, NON-VAS",,,28,,NW,,,,,,$935.95,$0.00,1,1,1,0,0,1,20171001, C1728,HCPCS,"CATH, BRACHYTX SEED ADM",,,28,,NW,,,,,,$41.25,$0.00,1,1,1,0,0,1,20171001, C1729,HCPCS,"CATH, DRAINAGE",,,28,,NW,,,,,,$283.27,$0.00,1,1,1,0,0,1,20171001, C1730,HCPCS,"CATH, EP, 19 OR FEW ELECT",,,28,,NW,,,,,,"$1,915.77",$0.00,1,1,1,0,0,1,20171001, C1731,HCPCS,"CATH, EP, 20 OR MORE ELEC",,,28,,NW,,,,,,"$5,283.75",$0.00,1,1,1,0,0,1,20171001, C1732,HCPCS,"CATH, EP, DIAG/ABL, 3D/VECT",,,28,,NW,,,,,,"$5,283.75",$0.00,1,1,1,0,0,1,20171001, C1733,HCPCS,"CATH, EP, OTHR THAN COOL-TIP",,,28,,NW,,,,,,"$1,915.77",$0.00,1,1,1,0,0,1,20171001, C1750,HCPCS,"CATH, HEMODIALYSIS,LONG-TERM",,,28,,NW,,,,,,$632.80,$0.00,1,1,1,0,0,1,20171001, C1751,HCPCS,"CATH, INF, PER/CENT/MIDLINE",,,28,,NW,,,,,,$888.74,$0.00,1,1,1,0,0,1,20171001, C1752,HCPCS,"CATH,HEMODIALYSIS,SHORT-TERM",,,28,,NW,,,,,,$974.27,$0.00,1,1,1,0,0,1,20171001, C1753,HCPCS,"CATH, INTRAVAS ULTRASOUND",,,28,,NW,,,,,,"$1,485.99",$0.00,1,1,1,0,0,1,20171001, C1754,HCPCS,"CATHETER, INTRADISCAL",,,28,,NW,,,,,,$770.33,$0.00,1,1,1,0,0,1,20171001, C1755,HCPCS,"CATHETER, INTRASPINAL",,,28,,NW,,,,,,"$1,347.46",$0.00,1,1,1,0,0,1,20171001, C1756,HCPCS,"CATH, PACING, TRANSESOPH",,,28,,NW,,,,,,"$1,263.97",$0.00,1,1,1,0,0,1,20171001, C1757,HCPCS,"CATH, THROMBECTOMY/EMBOLECT",,,28,,NW,,,,,,"$3,125.74",$0.00,1,1,1,0,0,1,20171001, C1758,HCPCS,"CATHETER, URETERAL",,,28,,NW,,,,,,$496.39,$0.00,1,1,1,0,0,1,20171001, C1759,HCPCS,"CATH, INTRA ECHOCARDIOGRAPHY",,,28,,NW,,,,,,"$4,194.55",$0.00,1,1,1,0,0,1,20171001, C1760,HCPCS,"CLOSURE DEV, VASC",,,28,,NW,,,,,,$879.22,$0.00,1,1,1,0,0,1,20171001, C1762,HCPCS,"CONN TISS, HUMAN(INC FASCIA)",,,28,,NW,,,,,,"$2,559.56",$0.00,1,1,1,0,0,1,20171001, C1763,HCPCS,"CONN TISS, NON-HUMAN",,,28,,NW,,,,,,"$2,451.22",$0.00,1,1,1,0,0,1,20171001, C1764,HCPCS,"EVENT RECORDER, CARDIAC",,,28,,NW,,,,,,"$3,599.61",$0.00,1,1,1,0,0,1,20171001, C1765,HCPCS,ADHESION BARRIER,,,28,,NW,,,,,,$447.38,$0.00,1,1,1,0,0,1,20171001, C1766,HCPCS,"INTRO/SHEATH,STRBLE,NON-PEEL",,,28,,NW,,,,,,$626.28,$0.00,1,1,1,0,0,1,20171001, C1767,HCPCS,"GENERATOR, NEURO NON-RECHARG",,,28,,NW,,,,,,"$18,045.76",$0.00,1,1,1,0,0,1,20171001, C1768,HCPCS,"GRAFT, VASCULAR",,,28,,NW,,,,,,"$3,151.05",$0.00,1,1,1,0,0,1,20171001, C1769,HCPCS,GUIDE WIRE,,,28,,NW,,,,,,$380.18,$0.00,1,1,1,0,0,1,20171001, C1770,HCPCS,"IMAGING COIL, MR, INSERTABLE",,,28,,NW,,,,,,$364.61,$0.00,1,1,1,0,0,1,20171001, C1771,HCPCS,"REP DEV, URINARY, W/SLING",,,28,,NW,,,,,,"$3,789.22",$0.00,1,1,1,0,0,1,20171001, C1772,HCPCS,"INFUSION PUMP, PROGRAMMABLE",,,28,,NW,,,,,,$168.54,$0.00,1,1,1,0,0,1,20171001, C1776,HCPCS,JOINT DEVICE (IMPLANTABLE),,,28,,NW,,,,,,"$4,884.95",$0.00,1,1,1,0,0,1,20171001, C1777,HCPCS,"LEAD, AICD, ENDO SINGLE COIL",,,28,,NW,,,,,,"$6,514.17",$0.00,1,1,1,0,0,1,20171001, C1778,HCPCS,"LEAD, NEUROSTIMULATOR",,,28,,NW,,,,,,"$4,874.14",$0.00,1,1,1,0,0,1,20171001, C1779,HCPCS,"LEAD, PMKR, TRANSVENOUS VDD",,,28,,NW,,,,,,"$3,207.96",$0.00,1,1,1,0,0,1,20171001, C1780,HCPCS,"LENS, INTRAOCULAR (NEW TECH)",,,28,,NW,,,,,,$303.99,$0.00,1,1,1,0,0,1,20171001, C1781,HCPCS,MESH (IMPLANTABLE),,,28,,NW,,,,,,$975.68,$0.00,1,1,1,0,0,1,20171001, C1782,HCPCS,MORCELLATOR,,,28,,NW,,,,,,$409.01,$0.00,1,1,1,0,0,1,20171001, C1783,HCPCS,"OCULAR IMP, AQUEOUS DRAIN DE",,,28,,NW,,,,,,$879.72,$0.00,1,1,1,0,0,1,20171001, C1784,HCPCS,"OCULAR DEV, INTRAOP, DET RET",,,28,,NW,,,,,,$996.33,$0.00,1,1,1,0,0,1,20171001, C1785,HCPCS,"PMKR, DUAL, RATE-RESP",,,28,,NW,,,,,,"$8,445.41",$0.00,1,1,1,0,0,1,20171001, C1786,HCPCS,"PMKR, SINGLE, RATE-RESP",,,28,,NW,,,,,,"$6,879.65",$0.00,1,1,1,0,0,1,20171001, C1787,HCPCS,"PATIENT PROGR, NEUROSTIM",,,28,,NW,,,,,,"$5,107.42",$0.00,1,1,1,0,0,1,20171001, C1788,HCPCS,"PORT, INDWELLING, IMP",,,28,,NW,,,,,,$997.99,$0.00,1,1,1,0,0,1,20171001, C1789,HCPCS,"PROSTHESIS, BREAST, IMP",,,28,,NW,,,,,,"$1,342.56",$0.00,1,1,1,0,0,1,20171001, C1813,HCPCS,"PROSTHESIS, PENILE, INFLATAB",,,28,,NW,,,,,,"$5,357.55",$0.00,1,1,1,0,0,1,20171001, C1815,HCPCS,"PROS, URINARY SPH, IMP",,,28,,NW,,,,,,"$4,823.12",$0.00,1,1,1,0,0,1,20171001, C1816,HCPCS,"RECEIVER/TRANSMITTER, NEURO",,,28,,NW,,,,,,"$1,873.19",$0.00,1,1,1,0,0,1,20171001, C1817,HCPCS,SEPTAL DEFECT IMP SYS,,,28,,NW,,,,,,"$7,098.04",$0.00,1,1,1,0,0,1,20171001, C1818,HCPCS,INTEGRATED KERATOPROSTHESIS,,,28,,NW,,,,,,"$4,312.57",$0.00,1,1,1,0,0,1,20171001, C1821,HCPCS,INTERSPINOUS IMPLANT,,,28,,NW,,,,,,"$1,944.60",$0.00,1,1,1,0,0,1,20171001, C1830,HCPCS,POWER BONE MARROW BX NEEDLE,,,28,,NW,,,,,,$207.14,$0.00,1,1,1,0,0,1,20171001, C1840,HCPCS,TELESCOPIC INTRAOCULAR LENS,,,28,,NW,,,,,,$430.15,$0.00,1,1,1,0,0,1,20171001, C1874,HCPCS,"STENT, COATED/COV W/DEL SYS",,,28,,NW,,,,,,"$2,681.02",$0.00,1,1,1,0,0,1,20171001, C1875,HCPCS,"STENT, COATED/COV W/O DEL SY",,,28,,NW,,,,,,"$3,166.00",$0.00,1,1,1,0,0,1,20171001, C1876,HCPCS,"STENT, NON-COA/NON-COV W/DEL",,,28,,NW,,,,,,"$1,965.59",$0.00,1,1,1,0,0,1,20171001, C1877,HCPCS,"STENT, NON-COAT/COV W/O DEL",,,28,,NW,,,,,,"$2,807.86",$0.00,1,1,1,0,0,1,20171001, C1878,HCPCS,MATRL FOR VOCAL CORD,,,28,,NW,,,,,,$838.19,$0.00,1,1,1,0,0,1,20171001, C1880,HCPCS,VENA CAVA FILTER,,,28,,NW,,,,,,"$2,518.19",$0.00,1,1,1,0,0,1,20171001, C1881,HCPCS,DIALYSIS ACCESS SYSTEM,,,28,,NW,,,,,,$885.92,$0.00,1,1,1,0,0,1,20171001, C1882,HCPCS,"AICD, OTHER THAN SING/DUAL",,,28,,NW,,,,,,"$35,401.51",$0.00,1,1,1,0,0,1,20171001, C1883,HCPCS,"ADAPT/EXT, PACING/NEURO LEAD",,,28,,NW,,,,,,"$2,768.45",$0.00,1,1,1,0,0,1,20171001, C1884,HCPCS,EMBOLIZATION PROTECT SYST,,,28,,NW,,,,,,$306.00,$0.00,1,1,1,0,0,1,20171001, C1885,HCPCS,"CATH, TRANSLUMIN ANGIO LASER",,,28,,NW,,,,,,$348.76,$0.00,1,1,1,0,0,1,20171001, C1887,HCPCS,"CATHETER, GUIDING",,,28,,NW,,,,,,$66.70,$0.00,1,1,1,0,0,1,20171001, C1888,HCPCS,ENDOVAS NON-CARDIAC ABL CATH,,,28,,NW,,,,,,"$1,021.66",$0.00,1,1,1,0,0,1,20171001, C1891,HCPCS,"INFUSION PUMP,NON-PROG, PERM",,,28,,NW,,,,,,"$7,115.47",$0.00,1,1,1,0,0,1,20171001, C1892,HCPCS,"INTRO/SHEATH,FIXED,PEEL-AWAY",,,28,,NW,,,,,,"$1,209.09",$0.00,1,1,1,0,0,1,20171001, C1893,HCPCS,"INTRO/SHEATH, FIXED,NON-PEEL",,,28,,NW,,,,,,$645.70,$0.00,1,1,1,0,0,1,20171001, C1894,HCPCS,"INTRO/SHEATH, NON-LASER",,,28,,NW,,,,,,$168.01,$0.00,1,1,1,0,0,1,20171001, C1895,HCPCS,"LEAD, AICD, ENDO DUAL COIL",,,28,,NW,,,,,,"$6,226.02",$0.00,1,1,1,0,0,1,20171001, C1896,HCPCS,"LEAD, AICD, NON SING/DUAL",,,28,,NW,,,,,,"$5,800.93",$0.00,1,1,1,0,0,1,20171001, C1897,HCPCS,"LEAD, NEUROSTIM TEST KIT",,,28,,NW,,,,,,"$1,909.98",$0.00,1,1,1,0,0,1,20171001, C1898,HCPCS,"LEAD, PMKR, OTHER THAN TRANS",,,28,,NW,,,,,,$966.94,$0.00,1,1,1,0,0,1,20171001, C1899,HCPCS,"LEAD, PMKR/AICD COMBINATION",,,28,,NW,,,,,,"$4,712.90",$0.00,1,1,1,0,0,1,20171001, C1900,HCPCS,"LEAD, CORONARY VENOUS",,,28,,NW,,,,,,"$4,089.40",$0.00,1,1,1,0,0,1,20171001, C2613,HCPCS,LUNG BX PLUG W/DEL SYS,,,28,,NW,,,,,,$118.84,$0.00,1,1,1,0,0,1,20171001, C2614,HCPCS,"PROBE, PERC LUMB DISC",,,28,,NW,,,,,,$854.13,$0.00,1,1,1,0,0,1,20171001, C2615,HCPCS,"SEALANT, PULMONARY, LIQUID",,,28,,NW,,,,,,$950.07,$0.00,1,1,1,0,0,1,20171001, C2617,HCPCS,"STENT, NON-COR, TEM W/O DEL",,,28,,NW,,,,,,"$2,964.04",$0.00,1,1,1,0,0,1,20171001, C2618,HCPCS,"PROBE/NEEDLE, CRYO",,,28,,NW,,,,,,"$2,668.31",$0.00,1,1,1,0,0,1,20171001, C2619,HCPCS,"PMKR, DUAL, NON RATE-RESP",,,28,,NW,,,,,,"$6,860.96",$0.00,1,1,1,0,0,1,20171001, C2620,HCPCS,"PMKR, SINGLE, NON RATE-RESP",,,28,,NW,,,,,,"$19,056.29",$0.00,1,1,1,0,0,1,20171001, C2621,HCPCS,"PMKR, OTHER THAN SING/DUAL",,,28,,NW,,,,,,"$12,011.00",$0.00,1,1,1,0,0,1,20171001, C2622,HCPCS,"PROSTHESIS, PENILE, NON-INF",,,28,,NW,,,,,,"$5,427.28",$0.00,1,1,1,0,0,1,20171001, C2623,HCPCS,"CATH, TRANSLUMIN, DRUG-COAT",,,28,,NW,,,,,,"$4,941.55",$0.00,1,1,1,0,0,1,20171001, C2625,HCPCS,"STENT, NON-COR, TEM W/DEL SY",,,28,,NW,,,,,,"$3,382.96",$0.00,1,1,1,0,0,1,20171001, C2626,HCPCS,"INFUSION PUMP, NON-PROG,TEMP",,,28,,NW,,,,,,"$1,241.50",$0.00,1,1,1,0,0,1,20171001, C2627,HCPCS,"CATH, SUPRAPUBIC/CYSTOSCOPIC",,,28,,NW,,,,,,$913.70,$0.00,1,1,1,0,0,1,20171001, C2628,HCPCS,"CATHETER, OCCLUSION",,,28,,NW,,,,,,"$1,190.14",$0.00,1,1,1,0,0,1,20171001, C2631,HCPCS,"REP DEV, URINARY, W/O SLING",,,28,,NW,,,,,,"$3,370.31",$0.00,1,1,1,0,0,1,20171001, C2638,HCPCS,"BRACHYTX, STRANDED, I-125",,,28,,NW,,,,,,$65.17,$0.00,1,1,1,0,0,1,20171001, C2639,HCPCS,"BRACHYTX, NON-STRANDED,I-125",,,28,,NW,,,,,,$42.42,$0.00,1,1,1,0,0,1,20171001, C2640,HCPCS,"BRACHYTX, STRANDED, P-103",,,28,,NW,,,,,,$151.38,$0.00,1,1,1,0,0,1,20171001, C2641,HCPCS,"BRACHYTX, NON-STRANDED,P-103",,,28,,NW,,,,,,$77.50,$0.00,1,1,1,0,0,1,20171001, C2645,HCPCS,"BRACHYTX PLANAR, P-103",,,28,,NW,,,,,,$31.89,$0.00,1,1,1,0,0,1,20171001, C2698,HCPCS,"BRACHYTX, STRANDED, NOS",,,28,,NW,,,,,,"$2,681.02",$0.00,1,1,1,0,0,1,20171001, C2699,HCPCS,"BRACHYTX, NON-STRANDED, NOS",,,28,,NW,,,,,,"$2,681.02",$0.00,1,1,1,0,0,1,20171001, C8908,HCPCS,"MRI W/O FOL W/CONT, BREAST,",,,20,,TotalUnits,,,,16.38 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, C9113,HCPCS,"INJ PANTOPRAZOLE SODIUM, VIA",,,29,,NW,,,,,,$192.49,$0.00,1,1,1,0,0,1,20171001, C9248,HCPCS,"INJ, CLEVIDIPINE BUTYRATE",,,29,,NW,,,,,,$11.81,$0.00,1,1,1,0,0,1,20171001, C9250,HCPCS,ARTISS FIBRIN SEALANT,,,29,,NW,,,,,,$811.61,$0.00,1,1,1,0,0,1,20171001, C9254,HCPCS,"INJECTION, LACOSAMIDE",,,29,,NW,,,,,,$1.27,$0.00,1,1,1,0,0,1,20171001, C9257,HCPCS,BEVACIZUMAB INJECTION,,,29,,NW,,,,,,$24.33,$0.00,1,1,1,0,0,1,20171001, C9285,HCPCS,"PATCH, LIDOCAINE/TETRACAINE",,,29,,NW,,,,,,$104.79,$0.00,1,1,1,0,0,1,20171001, C9290,HCPCS,"INJ, BUPIVACAINE LIPOSOME",,,29,,NW,,,,,,$8.11,$0.00,1,1,1,0,0,1,20171001, C9358,HCPCS,"SURGIMEND, FETAL",,,28,,NW,,,,,,$974.64,$0.00,1,1,1,0,0,1,20171001, C9359,HCPCS,"IMPLNT,BON VOID FILLER-PUTTY",,,28,,NW,,,,,,$873.98,$0.00,1,1,1,0,0,1,20171001, C9360,HCPCS,"SURGIMEND, NEONATAL",,,28,,NW,,,,,,$67.40,$0.00,1,1,1,0,0,1,20171001, C9361,HCPCS,NEUROMEND NERVE WRAP,,,28,,NW,,,,,,"$2,629.70",$0.00,1,1,1,0,0,1,20171001, C9362,HCPCS,"IMPLNT,BON VOID FILLER-STRIP",,,28,,NW,,,,,,$299.89,$0.00,1,1,1,0,0,1,20171001, C9363,HCPCS,INTEGRA MESHED BIL WOUND MAT,,,28,,NW,,,,,,$118.40,$0.00,1,1,1,0,0,1,20171001, C9364,HCPCS,"PORCINE IMPLANT, PERMACOL",,,28,,NW,,,,,,$104.16,$0.00,1,1,1,0,0,1,20171001, C9399,HCPCS,UNCLASSIFIED DRUGS OR BIOLOG,,,29,,NW,,,,,,"$2,681.02",$0.00,1,1,1,0,0,1,20171001, C9447,HCPCS,"INJ, PHENYLEPHRINE KETOROLAC",,,29,,NW,,,,,,"$2,611.82",$0.00,1,1,1,0,0,1,20171001, C9497,HCPCS,"LOXAPINE, INHALATION POWDER",,,29,,NW,,,,,,$7.45,$0.00,1,1,1,0,0,1,20171001, C9734,HCPCS,"U/S TRTMT, NOT LEIOMYOMATA",,,14,,TotalUnits,,,,133.08 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, C9741,HCPCS,IMPL PRESSURE SENSOR W/ANGIO         ,,,28,,NW,,,,,,"$14,943.18",$0.00,1,0,1,1,1,1,20171001, D0120,HCPCS,PERIODIC ORAL EVALUATION,,,25,,NW,,,,,,$63.65,$0.00,1,0,1,1,1,1,20171001, D0140,HCPCS,LIMIT ORAL EVAL PROBLM FOCUS,,,25,,NW,,,,,,$95.14,$0.00,1,0,1,1,1,1,20171001, D0145,HCPCS,"ORAL EVALUATION, PT < 3YRS",,,25,,NW,,,,,,$92.33,$0.00,1,0,1,1,1,1,20171001, D0150,HCPCS,COMPREHENSVE ORAL EVALUATION,,,25,,NW,,,,,,$106.87,$0.00,1,0,1,1,1,1,20171001, D0160,HCPCS,EXTENSV ORAL EVAL PROB FOCUS,,,25,,NW,,,,,,$206.20,$0.00,1,0,1,1,1,1,20171001, D0170,HCPCS,"RE-EVAL,EST PT,PROBLEM FOCUS",,,25,,NW,,,,,,$82.16,$0.00,1,0,1,1,1,1,20171001, D0171,HCPCS,RE-EVAL POST-OP VISIT,,,25,,NW,,,,,,$76.93,$0.00,1,0,1,1,1,1,20171001, D0180,HCPCS,COMP PERIODONTAL EVALUATION,,,25,,NW,,,,,,$120.96,$0.00,1,0,1,1,1,1,20171001, D0190,HCPCS,SCREENING OF A PATIENT,,,25,,NW,,,,,,$80.40,$0.00,1,0,1,1,1,1,20171001, D0191,HCPCS,ASSESSMENT OF A PATIENT,,,25,,NW,,,,,,$71.37,$0.00,1,0,1,1,1,1,20171001, D0210,HCPCS,INTRAOR COMPLETE FILM SERIES,,,25,,NW,,,,,,$164.20,$0.00,1,0,1,1,1,1,20171001, D0220,HCPCS,INTRAORAL PERIAPICAL FIRST,,,25,,NW,,,,,,$36.19,$0.00,1,0,1,1,1,1,20171001, D0230,HCPCS,INTRAORAL PERIAPICAL EA ADD,,,25,,NW,,,,,,$30.94,$0.00,1,0,1,1,1,1,20171001, D0240,HCPCS,INTRAORAL OCCLUSAL FILM,,,25,,NW,,,,,,$51.75,$0.00,1,0,1,1,1,1,20171001, D0250,HCPCS,EXTRAORAL 2D PROJECT IMAGE,,,25,,NW,,,,,,$71.25,$0.00,1,0,1,1,1,1,20171001, D0251,HCPCS,EXTRAORAL POSTERIOR IMAGE,,,25,,NW,,,,,,$58.97,$0.00,1,0,1,1,1,1,20171001, D0270,HCPCS,DENTAL BITEWING SINGLE IMAGE,,,25,,NW,,,,,,$35.14,$0.00,1,0,1,1,1,1,20171001, D0272,HCPCS,DENTAL BITEWINGS TWO IMAGES,,,25,,NW,,,,,,$55.77,$0.00,1,0,1,1,1,1,20171001, D0273,HCPCS,BITEWINGS - THREE IMAGES,,,25,,NW,,,,,,$66.82,$0.00,1,0,1,1,1,1,20171001, D0274,HCPCS,BITEWINGS FOUR IMAGES,,,25,,NW,,,,,,$79.21,$0.00,1,0,1,1,1,1,20171001, D0277,HCPCS,VERT BITEWINGS 7 TO 8 IMAGES,,,25,,NW,,,,,,$116.85,$0.00,1,0,1,1,1,1,20171001, D0310,HCPCS,DENTAL SALIOGRAPHY,,,25,,NW,,,,,,$455.81,$0.00,1,0,1,1,1,1,20171001, D0320,HCPCS,DENTAL TMJ ARTHROGRAM INCL I,,,25,,NW,,,,,,$746.83,$0.00,1,0,1,1,1,1,20171001, D0321,HCPCS,OTHER TMJ IMAGES BY REPORT,,,25,,NW,,,,,,$254.23,$0.00,1,0,1,1,1,1,20171001, D0322,HCPCS,DENTAL TOMOGRAPHIC SURVEY,,,25,,NW,,,,,,$620.01,$0.00,1,0,1,1,1,1,20171001, D0330,HCPCS,PANORAMIC IMAGE,,,25,,NW,,,,,,$137.77,$0.00,1,0,1,1,1,1,20171001, D0340,HCPCS,2D CEPHALOMETRIC IMAGE,,,25,,NW,,,,,,$151.45,$0.00,1,0,1,1,1,1,20171001, D0350,HCPCS,ORAL/FACIAL PHOTO IMAGES,,,25,,NW,,,,,,$81.98,$0.00,1,0,1,1,1,1,20171001, D0351,HCPCS,3D PHOTOGRAPHIC IMAGE,,,25,,NW,,,,,,$74.01,$0.00,1,0,1,1,1,1,20171001, D0364,HCPCS,CONE BEAM CT CAPT & INTERP,,,25,,NW,,,,,,$554.78,$0.00,1,0,1,1,1,1,20171001, D0365,HCPCS,CONE BEAM CT INTERPRETE MAN,,,25,,NW,,,,,,$559.54,$0.00,1,0,1,1,1,1,20171001, D0366,HCPCS,CONE BEAM CT INTERPRETE MAX,,,25,,NW,,,,,,$551.86,$0.00,1,0,1,1,1,1,20171001, D0367,HCPCS,CONE BEAM CT INTERP BOTH JAW,,,25,,NW,,,,,,$561.00,$0.00,1,0,1,1,1,1,20171001, D0368,HCPCS,CONE BEAM CT INTERPRETE TMJ,,,25,,NW,,,,,,$747.01,$0.00,1,0,1,1,1,1,20171001, D0369,HCPCS,MAX MRI CAPTURE & INTERPRETE,,,25,,NW,,,,,,"$1,518.14",$0.00,1,0,1,1,1,1,20171001, D0370,HCPCS,MAX ULTRASOUND CAPT & INTERP,,,25,,NW,,,,,,$583.46,$0.00,1,0,1,1,1,1,20171001, D0371,HCPCS,SIALOENDOSCOPY CAPT & INTERP,,,25,,NW,,,,,,$580.64,$0.00,1,0,1,1,1,1,20171001, D0380,HCPCS,CONE BEAM CT CAPTURE LIMITED,,,25,,NW,,,,,,$519.74,$0.00,1,0,1,1,1,1,20171001, D0381,HCPCS,CONE BEAM CT CAPT MANDIBLE,,,25,,NW,,,,,,$530.47,$0.00,1,0,1,1,1,1,20171001, D0382,HCPCS,CONE BEAM CT CAPT MAXILLA,,,25,,NW,,,,,,$531.20,$0.00,1,0,1,1,1,1,20171001, D0383,HCPCS,CONE BEAM CT BOTH JAWS,,,25,,NW,,,,,,$546.37,$0.00,1,0,1,1,1,1,20171001, D0384,HCPCS,CONE BEAM CT CAPTURE TMJ,,,25,,NW,,,,,,$722.31,$0.00,1,0,1,1,1,1,20171001, D0385,HCPCS,MAX MRI IMAGE CAPTURE,,,25,,NW,,,,,,"$1,418.29",$0.00,1,0,1,1,1,1,20171001, D0386,HCPCS,MAX ULTRASOUND IMAGE CAPTURE,,,25,,NW,,,,,,$554.58,$0.00,1,0,1,1,1,1,20171001, D0391,HCPCS,IMTERPRETE DIAGNOSTIC IMAGE,,,25,,NW,,,,,,$428.39,$0.00,1,0,1,1,1,1,20171001, D0393,HCPCS,TRTMNT SIMULATION 3D IMAGE,,,25,,NW,,,,,,$558.33,$0.00,1,0,1,1,1,1,20171001, D0394,HCPCS,DIGITAL SUB 2 OR MORE IMAGES,,,25,,NW,,,,,,$442.88,$0.00,1,0,1,1,1,1,20171001, D0395,HCPCS,FUSION 2 OR MORE 3D IMAGES,,,25,,NW,,,,,,$471.27,$0.00,1,0,1,1,1,1,20171001, D0415,HCPCS,COLLECTION OF MICROORGANISMS,,,25,,NW,,,,,,$134.67,$0.00,1,0,1,1,1,1,20171001, D0416,HCPCS,VIRAL CULTURE,,,25,,NW,,,,,,$136.21,$0.00,1,0,1,1,1,1,20171001, D0417,HCPCS,COLLECT & PREP SALIVA SAMPLE,,,25,,NW,,,,,,$153.85,$0.00,1,0,1,1,1,1,20171001, D0418,HCPCS,ANALYSIS OF SALIVA SAMPLE,,,25,,NW,,,,,,$130.61,$0.00,1,0,1,1,1,1,20171001, D0422,HCPCS,COLLECT & PREP GENETIC SAMP,,,25,,NW,,,,,,$82.13,$0.00,1,0,1,1,1,1,20171001, D0423,HCPCS,GENETIC TEST SPEC ANALYSIS,,,25,,NW,,,,,,$116.72,$0.00,1,0,1,1,1,1,20171001, D0425,HCPCS,CARIES SUSCEPTIBILITY TEST,,,25,,NW,,,,,,$74.90,$0.00,1,0,1,1,1,1,20171001, D0431,HCPCS,DIAG TST DETECT MUCOS ABNORM,,,25,,NW,,,,,,$77.25,$0.00,1,0,1,1,1,1,20171001, D0460,HCPCS,PULP VITALITY TEST,,,25,,NW,,,,,,$69.41,$0.00,1,0,1,1,1,1,20171001, D0470,HCPCS,DIAGNOSTIC CASTS,,,25,,NW,,,,,,$145.37,$0.00,1,0,1,1,1,1,20171001, D0472,HCPCS,"GROSS EXAM, PREP & REPORT",,,25,,NW,,,,,,$122.50,$0.00,1,0,1,1,1,1,20171001, D0473,HCPCS,"MICRO EXAM, PREP & REPORT",,,25,,NW,,,,,,$196.57,$0.00,1,0,1,1,1,1,20171001, D0474,HCPCS,MICRO W EXAM OF SURG MARGINS,,,25,,NW,,,,,,$238.39,$0.00,1,0,1,1,1,1,20171001, D0475,HCPCS,DECALCIFICATION PROCEDURE,,,25,,NW,,,,,,$182.40,$0.00,1,0,1,1,1,1,20171001, D0476,HCPCS,SPEC STAINS FOR MICROORGANIS,,,25,,NW,,,,,,$234.12,$0.00,1,0,1,1,1,1,20171001, D0477,HCPCS,SPEC STAINS NOT FOR MICROORG,,,25,,NW,,,,,,$253.57,$0.00,1,0,1,1,1,1,20171001, D0478,HCPCS,IMMUNOHISTOCHEMICAL STAINS,,,25,,NW,,,,,,$172.21,$0.00,1,0,1,1,1,1,20171001, D0479,HCPCS,TISSUE IN-SITU HYBRIDIZATION,,,25,,NW,,,,,,$242.57,$0.00,1,0,1,1,1,1,20171001, D0480,HCPCS,CYTOPATH SMEAR PREP & REPORT,,,25,,NW,,,,,,$172.82,$0.00,1,0,1,1,1,1,20171001, D0481,HCPCS,ELECTRON MICROSCOPY,,,25,,NW,,,,,,$380.88,$0.00,1,0,1,1,1,1,20171001, D0482,HCPCS,DIRECT IMMUNOFLUORESCENCE,,,25,,NW,,,,,,$147.89,$0.00,1,0,1,1,1,1,20171001, D0483,HCPCS,INDIRECT IMMUNOFLUORESCENCE,,,25,,NW,,,,,,$158.87,$0.00,1,0,1,1,1,1,20171001, D0484,HCPCS,CONSULT SLIDES PREP ELSEWHER,,,25,,NW,,,,,,$227.06,$0.00,1,0,1,1,1,1,20171001, D0485,HCPCS,CONSULT INC PREP OF SLIDES,,,25,,NW,,,,,,$292.09,$0.00,1,0,1,1,1,1,20171001, D0486,HCPCS,ACCESS OF TRANSEP CYTOL SAMP,,,25,,NW,,,,,,$176.52,$0.00,1,0,1,1,1,1,20171001, D0502,HCPCS,OTHER ORAL PATHOLOGY PROCEDU,,,25,,NW,,,,,,$200.87,$0.00,1,0,1,1,1,1,20171001, D0601,HCPCS,CARIES RISK ASSESS LOW RISK,,,25,,NW,,,,,,$98.88,$0.00,1,0,1,1,1,1,20171001, D0602,HCPCS,CARIES RISK ASSESS MOD RISK,,,25,,NW,,,,,,$92.60,$0.00,1,0,1,1,1,1,20171001, D0603,HCPCS,CARIES RISK ASSESS HIGH RISK,,,25,,NW,,,,,,$96.26,$0.00,1,0,1,1,1,1,20171001, D0999,HCPCS,UNSPECIFIED DIAGNOSTIC PROCE,,,25,,NW,,,,,,$79.21,$0.00,1,0,1,1,1,1,20171001, D1110,HCPCS,DENTAL PROPHYLAXIS ADULT,,,25,,NW,,,,,,$111.10,$0.00,1,0,1,1,1,1,20171001, D1120,HCPCS,DENTAL PROPHYLAXIS CHILD,,,25,,NW,,,,,,$85.77,$0.00,1,0,1,1,1,1,20171001, D1206,HCPCS,TOPICAL FLUORIDE VARNISH,,,25,,NW,,,,,,$54.86,$0.00,1,0,1,1,1,1,20171001, D1208,HCPCS,TOPICAL APP FLUORID EX VRNSH,,,25,,NW,,,,,,$47.53,$0.00,1,0,1,1,1,1,20171001, D1310,HCPCS,NUTRI COUNSEL-CONTROL CARIES,,,25,,NW,,,,,,$69.75,$0.00,1,0,1,1,1,1,20171001, D1320,HCPCS,TOBACCO COUNSELING,,,25,,NW,,,,,,$80.12,$0.00,1,0,1,1,1,1,20171001, D1330,HCPCS,ORAL HYGIENE INSTRUCTION,,,25,,NW,,,,,,$74.94,$0.00,1,0,1,1,1,1,20171001, D1351,HCPCS,DENTAL SEALANT PER TOOTH,,,25,,NW,,,,,,$68.39,$0.00,1,0,1,1,1,1,20171001, D1352,HCPCS,"PREV RESIN REST, PERM TOOTH",,,25,,NW,,,,,,$111.67,$0.00,1,0,1,1,1,1,20171001, D1353,HCPCS,SEALANT REPAIR PER TOOTH,,,25,,NW,,,,,,$79.76,$0.00,1,0,1,1,1,1,20171001, D1354,HCPCS,INTERIM CARIES MED APP,,,25,,NW,,,,,,$65.67,$0.00,1,0,1,1,1,1,20171001, D1510,HCPCS,SPACE MAINTAINER FXD UNILAT,,,26,,NW,,,,,,$399.48,$0.00,1,0,1,1,1,1,20171001, D1515,HCPCS,FIXED BILAT SPACE MAINTAINER,,,26,,NW,,,,,,$546.93,$0.00,1,0,1,1,1,1,20171001, D1520,HCPCS,REMOVE UNILAT SPACE MAINTAIN,,,26,,NW,,,,,,$462.24,$0.00,1,0,1,1,1,1,20171001, D1525,HCPCS,REMOVE BILAT SPACE MAINTAIN,,,26,,NW,,,,,,$643.66,$0.00,1,0,1,1,1,1,20171001, D1550,HCPCS,RECEMENT SPACE MAINTAINER,,,26,,NW,,,,,,$97.91,$0.00,1,0,1,1,1,1,20171001, D1555,HCPCS,REMOVE FIX SPACE MAINTAINER,,,26,,NW,,,,,,$96.28,$0.00,1,0,1,1,1,1,20171001, D1575,HCPCS,"DIST SPACE MAINT, FIXED UNIL",,,26,,NW,,,,,,$448.63,$0.00,1,0,1,1,1,1,20171001, D1999,HCPCS,UNSPECIFIED PREVENTIVE PROC,,,26,,NW,,,,,,$74.94,$0.00,1,0,1,1,1,1,20171001, D2140,HCPCS,AMALGAM ONE SURFACE PERMANEN,,,26,,NW,,,,,,$173.96,$0.00,1,0,1,1,1,1,20171001, D2150,HCPCS,AMALGAM TWO SURFACES PERMANE,,,26,,NW,,,,,,$222.11,$0.00,1,0,1,1,1,1,20171001, D2160,HCPCS,AMALGAM THREE SURFACES PERMA,,,26,,NW,,,,,,$270.42,$0.00,1,0,1,1,1,1,20171001, D2161,HCPCS,AMALGAM 4 OR > SURFACES PERM,,,26,,NW,,,,,,$326.08,$0.00,1,0,1,1,1,1,20171001, D2330,HCPCS,RESIN ONE SURFACE-ANTERIOR,,,26,,NW,,,,,,$203.17,$0.00,1,0,1,1,1,1,20171001, D2331,HCPCS,RESIN TWO SURFACES-ANTERIOR,,,26,,NW,,,,,,$245.91,$0.00,1,0,1,1,1,1,20171001, D2332,HCPCS,RESIN THREE SURFACES-ANTERIO,,,26,,NW,,,,,,$296.25,$0.00,1,0,1,1,1,1,20171001, D2335,HCPCS,RESIN 4/> SURF OR W INCIS AN,,,26,,NW,,,,,,$359.11,$0.00,1,0,1,1,1,1,20171001, D2390,HCPCS,ANT RESIN-BASED CMPST CROWN,,,26,,NW,,,,,,$466.20,$0.00,1,0,1,1,1,1,20171001, D2391,HCPCS,POST 1 SRFC RESINBASED CMPST,,,26,,NW,,,,,,$219.75,$0.00,1,0,1,1,1,1,20171001, D2392,HCPCS,POST 2 SRFC RESINBASED CMPST,,,26,,NW,,,,,,$278.33,$0.00,1,0,1,1,1,1,20171001, D2393,HCPCS,POST 3 SRFC RESINBASED CMPST,,,26,,NW,,,,,,$343.21,$0.00,1,0,1,1,1,1,20171001, D2394,HCPCS,POST >=4SRFC RESINBASE CMPST,,,26,,NW,,,,,,$420.26,$0.00,1,0,1,1,1,1,20171001, D2410,HCPCS,DENTAL GOLD FOIL ONE SURFACE,,,27,,NW,,,,,,$569.96,$0.00,1,0,1,1,1,1,20171001, D2420,HCPCS,DENTAL GOLD FOIL TWO SURFACE,,,27,,NW,,,,,,$767.72,$0.00,1,0,1,1,1,1,20171001, D2430,HCPCS,DENTAL GOLD FOIL THREE SURFA,,,27,,NW,,,,,,"$1,040.04",$0.00,1,0,1,1,1,1,20171001, D2510,HCPCS,DENTAL INLAY METALIC 1 SURF,,,27,,NW,,,,,,"$1,008.91",$0.00,1,0,1,1,1,1,20171001, D2520,HCPCS,DENTAL INLAY METALLIC 2 SURF,,,27,,NW,,,,,,"$1,110.40",$0.00,1,0,1,1,1,1,20171001, D2530,HCPCS,DENTAL INLAY METL 3/MORE SUR,,,27,,NW,,,,,,"$1,215.82",$0.00,1,0,1,1,1,1,20171001, D2542,HCPCS,DENTAL ONLAY METALLIC 2 SURF,,,27,,NW,,,,,,"$1,220.27",$0.00,1,0,1,1,1,1,20171001, D2543,HCPCS,DENTAL ONLAY METALLIC 3 SURF,,,27,,NW,,,,,,"$1,266.57",$0.00,1,0,1,1,1,1,20171001, D2544,HCPCS,DENTAL ONLAY METL 4/MORE SUR,,,27,,NW,,,,,,"$1,316.27",$0.00,1,0,1,1,1,1,20171001, D2610,HCPCS,INLAY PORCELAIN/CERAMIC 1 SU,,,27,,NW,,,,,,"$1,157.22",$0.00,1,0,1,1,1,1,20171001, D2620,HCPCS,INLAY PORCELAIN/CERAMIC 2 SU,,,27,,NW,,,,,,"$1,183.65",$0.00,1,0,1,1,1,1,20171001, D2630,HCPCS,DENTAL ONLAY PORC 3/MORE SUR,,,27,,NW,,,,,,"$1,242.76",$0.00,1,0,1,1,1,1,20171001, D2642,HCPCS,DENTAL ONLAY PORCELIN 2 SURF,,,27,,NW,,,,,,"$1,235.44",$0.00,1,0,1,1,1,1,20171001, D2643,HCPCS,DENTAL ONLAY PORCELIN 3 SURF,,,27,,NW,,,,,,"$1,298.74",$0.00,1,0,1,1,1,1,20171001, D2644,HCPCS,DENTAL ONLAY PORC 4/MORE SUR,,,27,,NW,,,,,,"$1,371.46",$0.00,1,0,1,1,1,1,20171001, D2650,HCPCS,INLAY COMPOSITE/RESIN ONE SU,,,27,,NW,,,,,,$945.85,$0.00,1,0,1,1,1,1,20171001, D2651,HCPCS,INLAY COMPOSITE/RESIN TWO SU,,,27,,NW,,,,,,$990.33,$0.00,1,0,1,1,1,1,20171001, D2652,HCPCS,DENTAL INLAY RESIN 3/MRE SUR,,,27,,NW,,,,,,"$1,041.07",$0.00,1,0,1,1,1,1,20171001, D2662,HCPCS,DENTAL ONLAY RESIN 2 SURFACE,,,27,,NW,,,,,,$989.27,$0.00,1,0,1,1,1,1,20171001, D2663,HCPCS,DENTAL ONLAY RESIN 3 SURFACE,,,27,,NW,,,,,,"$1,068.80",$0.00,1,0,1,1,1,1,20171001, D2664,HCPCS,DENTAL ONLAY RESIN 4/MRE SUR,,,27,,NW,,,,,,"$1,129.49",$0.00,1,0,1,1,1,1,20171001, D2710,HCPCS,CROWN RESIN-BASED INDIRECT,,,27,,NW,,,,,,$856.43,$0.00,1,0,1,1,1,1,20171001, D2712,HCPCS,CROWN 3/4 RESIN-BASED COMPOS,,,27,,NW,,,,,,$895.13,$0.00,1,0,1,1,1,1,20171001, D2720,HCPCS,CROWN RESIN W/ HIGH NOBLE ME,,,27,,NW,,,,,,"$1,314.15",$0.00,1,0,1,1,1,1,20171001, D2721,HCPCS,CROWN RESIN W/ BASE METAL,,,27,,NW,,,,,,"$1,242.86",$0.00,1,0,1,1,1,1,20171001, D2722,HCPCS,CROWN RESIN W/ NOBLE METAL,,,27,,NW,,,,,,"$1,271.43",$0.00,1,0,1,1,1,1,20171001, D2740,HCPCS,CROWN PORCELAIN/CERAMIC SUBS,,,27,,NW,,,,,,"$1,398.91",$0.00,1,0,1,1,1,1,20171001, D2750,HCPCS,CROWN PORCELAIN W/ H NOBLE M,,,27,,NW,,,,,,"$1,371.51",$0.00,1,0,1,1,1,1,20171001, D2751,HCPCS,CROWN PORCELAIN FUSED BASE M,,,27,,NW,,,,,,"$1,275.36",$0.00,1,0,1,1,1,1,20171001, D2752,HCPCS,CROWN PORCELAIN W/ NOBLE MET,,,27,,NW,,,,,,"$1,310.12",$0.00,1,0,1,1,1,1,20171001, D2780,HCPCS,CROWN 3/4 CAST HI NOBLE MET,,,27,,NW,,,,,,"$1,324.31",$0.00,1,0,1,1,1,1,20171001, D2781,HCPCS,CROWN 3/4 CAST BASE METAL,,,27,,NW,,,,,,"$1,246.81",$0.00,1,0,1,1,1,1,20171001, D2782,HCPCS,CROWN 3/4 CAST NOBLE METAL,,,27,,NW,,,,,,"$1,293.36",$0.00,1,0,1,1,1,1,20171001, D2783,HCPCS,CROWN 3/4 PORCELAIN/CERAMIC,,,27,,NW,,,,,,"$1,348.45",$0.00,1,0,1,1,1,1,20171001, D2790,HCPCS,CROWN FULL CAST HIGH NOBLE M,,,27,,NW,,,,,,"$1,377.20",$0.00,1,0,1,1,1,1,20171001, D2791,HCPCS,CROWN FULL CAST BASE METAL,,,27,,NW,,,,,,"$1,245.88",$0.00,1,0,1,1,1,1,20171001, D2792,HCPCS,CROWN FULL CAST NOBLE METAL,,,27,,NW,,,,,,"$1,295.76",$0.00,1,0,1,1,1,1,20171001, D2794,HCPCS,CROWN-TITANIUM,,,27,,NW,,,,,,"$1,323.56",$0.00,1,0,1,1,1,1,20171001, D2799,HCPCS,PROVISIONAL CROWN,,,27,,NW,,,,,,$543.61,$0.00,1,0,1,1,1,1,20171001, D2910,HCPCS,RECEMENT INLAY ONLAY OR PART,,,27,,NW,,,,,,$134.85,$0.00,1,0,1,1,1,1,20171001, D2915,HCPCS,RECEMENT CAST OR PREFAB POST,,,27,,NW,,,,,,$133.28,$0.00,1,0,1,1,1,1,20171001, D2920,HCPCS,RE-CEMENT OR RE-BOND CROWN,,,27,,NW,,,,,,$133.59,$0.00,1,0,1,1,1,1,20171001, D2921,HCPCS,REATTACH TOOTH FRAGMENT,,,27,,NW,,,,,,$245.55,$0.00,1,0,1,1,1,1,20171001, D2929,HCPCS,PREFAB PORC/CERAM CROWN PRI,,,27,,NW,,,,,,$460.73,$0.00,1,0,1,1,1,1,20171001, D2930,HCPCS,PREFAB STNLSS STEEL CRWN PRI,,,27,,NW,,,,,,$333.88,$0.00,1,0,1,1,1,1,20171001, D2931,HCPCS,PREFAB STNLSS STEEL CROWN PE,,,27,,NW,,,,,,$385.39,$0.00,1,0,1,1,1,1,20171001, D2932,HCPCS,PREFABRICATED RESIN CROWN,,,27,,NW,,,,,,$417.77,$0.00,1,0,1,1,1,1,20171001, D2933,HCPCS,PREFAB STAINLESS STEEL CROWN,,,27,,NW,,,,,,$454.81,$0.00,1,0,1,1,1,1,20171001, D2934,HCPCS,PREFAB STEEL CROWN PRIMARY,,,27,,NW,,,,,,$457.43,$0.00,1,0,1,1,1,1,20171001, D2940,HCPCS,PROTECTIVE RESTORATION,,,27,,NW,,,,,,$144.99,$0.00,1,0,1,1,1,1,20171001, D2941,HCPCS,INT THERAPEUTIC RESTORATION,,,27,,NW,,,,,,$177.42,$0.00,1,0,1,1,1,1,20171001, D2949,HCPCS,RESTORATIVE FOUNDATION,,,27,,NW,,,,,,$197.30,$0.00,1,0,1,1,1,1,20171001, D2950,HCPCS,CORE BUILD-UP INCL ANY PINS,,,27,,NW,,,,,,$327.07,$0.00,1,0,1,1,1,1,20171001, D2951,HCPCS,TOOTH PIN RETENTION,,,27,,NW,,,,,,$88.17,$0.00,1,0,1,1,1,1,20171001, D2952,HCPCS,POST AND CORE CAST + CROWN,,,27,,NW,,,,,,$508.62,$0.00,1,0,1,1,1,1,20171001, D2953,HCPCS,EACH ADDTNL CAST POST,,,27,,NW,,,,,,$328.07,$0.00,1,0,1,1,1,1,20171001, D2954,HCPCS,PREFAB POST/CORE + CROWN,,,27,,NW,,,,,,$413.07,$0.00,1,0,1,1,1,1,20171001, D2955,HCPCS,POST REMOVAL,,,27,,NW,,,,,,$338.95,$0.00,1,0,1,1,1,1,20171001, D2957,HCPCS,EACH ADDTNL PREFAB POST,,,27,,NW,,,,,,$234.52,$0.00,1,0,1,1,1,1,20171001, D2960,HCPCS,LAMINATE LABIAL VENEER,,,27,,NW,,,,,,$912.15,$0.00,1,0,1,1,1,1,20171001, D2961,HCPCS,LAB LABIAL VENEER RESIN,,,27,,NW,,,,,,"$1,172.84",$0.00,1,0,1,1,1,1,20171001, D2962,HCPCS,LAB LABIAL VENEER PORCELAIN,,,27,,NW,,,,,,"$1,329.19",$0.00,1,0,1,1,1,1,20171001, D2971,HCPCS,ADD PROC CONSTRUCT NEW CROWN,,,27,,NW,,,,,,$253.37,$0.00,1,0,1,1,1,1,20171001, D2975,HCPCS,COPING,,,27,,NW,,,,,,$664.35,$0.00,1,0,1,1,1,1,20171001, D2980,HCPCS,CROWN REPAIR,,,27,,NW,,,,,,$298.28,$0.00,1,0,1,1,1,1,20171001, D2981,HCPCS,INLAY REPAIR,,,27,,NW,,,,,,$289.91,$0.00,1,0,1,1,1,1,20171001, D2982,HCPCS,ONLAY REPAIR,,,27,,NW,,,,,,$289.91,$0.00,1,0,1,1,1,1,20171001, D2983,HCPCS,VENEER REPAIR,,,27,,NW,,,,,,$292.52,$0.00,1,0,1,1,1,1,20171001, D2990,HCPCS,RESIN INFILTRATION OF LESION,,,27,,NW,,,,,,$149.46,$0.00,1,0,1,1,1,1,20171001, D2999,HCPCS,DENTAL UNSPEC RESTORATIVE PR,,,27,,NW,,,,,,$270.42,$0.00,1,0,1,1,1,1,20171001, D3110,HCPCS,PULP CAP DIRECT,,,26,,NW,,,,,,$109.97,$0.00,1,0,1,1,1,1,20171001, D3120,HCPCS,PULP CAP INDIRECT,,,26,,NW,,,,,,$98.64,$0.00,1,0,1,1,1,1,20171001, D3220,HCPCS,THERAPEUTIC PULPOTOMY,,,26,,NW,,,,,,$244.73,$0.00,1,0,1,1,1,1,20171001, D3221,HCPCS,GROSS PULPAL DEBRIDEMENT,,,26,,NW,,,,,,$270.70,$0.00,1,0,1,1,1,1,20171001, D3222,HCPCS,PART PULP FOR APEXOGENESIS,,,26,,NW,,,,,,$302.59,$0.00,1,0,1,1,1,1,20171001, D3230,HCPCS,PULPAL THERAPY ANTERIOR PRIM,,,26,,NW,,,,,,$282.21,$0.00,1,0,1,1,1,1,20171001, D3240,HCPCS,PULPAL THERAPY POSTERIOR PRI,,,26,,NW,,,,,,$328.62,$0.00,1,0,1,1,1,1,20171001, D3310,HCPCS,"END THXPY, ANTERIOR TOOTH",,,26,,NW,,,,,,$917.19,$0.00,1,0,1,1,1,1,20171001, D3320,HCPCS,"END THXPY, BICUSPID TOOTH",,,26,,NW,,,,,,"$1,076.01",$0.00,1,0,1,1,1,1,20171001, D3330,HCPCS,"END THXPY, MOLAR",,,26,,NW,,,,,,"$1,323.25",$0.00,1,0,1,1,1,1,20171001, D3331,HCPCS,NON-SURG TX ROOT CANAL OBS,,,26,,NW,,,,,,$594.51,$0.00,1,0,1,1,1,1,20171001, D3332,HCPCS,INCOMPLETE ENDODONTIC TX,,,26,,NW,,,,,,$617.20,$0.00,1,0,1,1,1,1,20171001, D3333,HCPCS,INTERNAL ROOT REPAIR,,,26,,NW,,,,,,$371.44,$0.00,1,0,1,1,1,1,20171001, D3346,HCPCS,RETREAT ROOT CANAL ANTERIOR,,,26,,NW,,,,,,"$1,126.84",$0.00,1,0,1,1,1,1,20171001, D3347,HCPCS,RETREAT ROOT CANAL BICUSPID,,,26,,NW,,,,,,"$1,296.80",$0.00,1,0,1,1,1,1,20171001, D3348,HCPCS,RETREAT ROOT CANAL MOLAR,,,26,,NW,,,,,,"$1,579.24",$0.00,1,0,1,1,1,1,20171001, D3351,HCPCS,APEXIFICATION/RECALC INITIAL,,,26,,NW,,,,,,$493.57,$0.00,1,0,1,1,1,1,20171001, D3352,HCPCS,APEXIFICATION/RECALC INTERIM,,,26,,NW,,,,,,$286.63,$0.00,1,0,1,1,1,1,20171001, D3353,HCPCS,APEXIFICATION/RECALC FINAL,,,26,,NW,,,,,,$702.54,$0.00,1,0,1,1,1,1,20171001, D3355,HCPCS,PULPAL REGENERATION INITIAL,,,26,,NW,,,,,,$530.71,$0.00,1,0,1,1,1,1,20171001, D3356,HCPCS,PULPAL REGENERATION INTERIM,,,26,,NW,,,,,,$286.63,$0.00,1,0,1,1,1,1,20171001, D3357,HCPCS,PULPAL REGENERATION COMPLETE,,,26,,NW,,,,,,$610.98,$0.00,1,0,1,1,1,1,20171001, D3410,HCPCS,APICOECTOMY - ANTERIOR,,,26,,NW,,,,,,$960.67,$0.00,1,0,1,1,1,1,20171001, D3421,HCPCS,ROOT SURGERY BICUSPID,,,26,,NW,,,,,,"$1,064.23",$0.00,1,0,1,1,1,1,20171001, D3425,HCPCS,ROOT SURGERY MOLAR,,,26,,NW,,,,,,"$1,193.65",$0.00,1,0,1,1,1,1,20171001, D3426,HCPCS,ROOT SURGERY EA ADD ROOT,,,26,,NW,,,,,,$492.26,$0.00,1,0,1,1,1,1,20171001, D3427,HCPCS,PERIRADICULAR SURGERY,,,26,,NW,,,,,,$897.51,$0.00,1,0,1,1,1,1,20171001, D3428,HCPCS,BONE GRAFT PERI PER TOOTH,,,26,,NW,,,,,,"$1,070.64",$0.00,1,0,1,1,1,1,20171001, D3429,HCPCS,BONE GRAFT PERI EACH ADDL,,,26,,NW,,,,,,$994.12,$0.00,1,0,1,1,1,1,20171001, D3430,HCPCS,RETROGRADE FILLING,,,26,,NW,,,,,,$344.24,$0.00,1,0,1,1,1,1,20171001, D3431,HCPCS,BIOLOGICAL MATERIALS,,,26,,NW,,,,,,"$1,136.75",$0.00,1,0,1,1,1,1,20171001, D3432,HCPCS,GUIDED TISSUE REGENERATION,,,26,,NW,,,,,,"$1,061.78",$0.00,1,0,1,1,1,1,20171001, D3450,HCPCS,ROOT AMPUTATION,,,26,,NW,,,,,,$659.09,$0.00,1,0,1,1,1,1,20171001, D3460,HCPCS,ENDODONTIC ENDOSSEOUS IMPLAN,,,26,,NW,,,,,,"$2,258.55",$0.00,1,0,1,1,1,1,20171001, D3470,HCPCS,INTENTIONAL REPLANTATION,,,26,,NW,,,,,,"$1,144.89",$0.00,1,0,1,1,1,1,20171001, D3910,HCPCS,ISOLATION- TOOTH W RUBB DAM,,,26,,NW,,,,,,$235.01,$0.00,1,0,1,1,1,1,20171001, D3920,HCPCS,TOOTH SPLITTING,,,26,,NW,,,,,,$552.89,$0.00,1,0,1,1,1,1,20171001, D3950,HCPCS,CANAL PREP/FITTING OF DOWEL,,,26,,NW,,,,,,$284.53,$0.00,1,0,1,1,1,1,20171001, D3999,HCPCS,ENDODONTIC PROCEDURE,,,26,,NW,,,,,,"$1,076.01",$0.00,1,0,1,1,1,1,20171001, D4210,HCPCS,GINGIVECTOMY/PLASTY 4 OR MOR,,,26,,NW,,,,,,$823.42,$0.00,1,0,1,1,1,1,20171001, D4211,HCPCS,GINGIVECTOMY/PLASTY 1 TO 3,,,26,,NW,,,,,,$401.83,$0.00,1,0,1,1,1,1,20171001, D4212,HCPCS,GINGIVECTOMY/PLASTY REST,,,26,,NW,,,,,,$329.83,$0.00,1,0,1,1,1,1,20171001, D4230,HCPCS,ANA CROWN EXP 4 OR> PER QUAD,,,26,,NW,,,,,,"$1,091.17",$0.00,1,0,1,1,1,1,20171001, D4231,HCPCS,ANA CROWN EXP 1-3 PER QUAD,,,26,,NW,,,,,,$657.40,$0.00,1,0,1,1,1,1,20171001, D4240,HCPCS,GINGIVAL FLAP PROC W/ PLANIN,,,26,,NW,,,,,,"$1,011.16",$0.00,1,0,1,1,1,1,20171001, D4241,HCPCS,GNGVL FLAP W ROOTPLAN 1-3 TH,,,26,,NW,,,,,,$693.22,$0.00,1,0,1,1,1,1,20171001, D4245,HCPCS,APICALLY POSITIONED FLAP,,,26,,NW,,,,,,$890.13,$0.00,1,0,1,1,1,1,20171001, D4249,HCPCS,CROWN LENGTHEN HARD TISSUE,,,26,,NW,,,,,,"$1,082.23",$0.00,1,0,1,1,1,1,20171001, D4260,HCPCS,OSSEOUS SURGERY 4 OR MORE,,,26,,NW,,,,,,"$1,608.02",$0.00,1,0,1,1,1,1,20171001, D4261,HCPCS,OSSEOUS SURG 1 TO 3 TEETH,,,26,,NW,,,,,,"$1,037.34",$0.00,1,0,1,1,1,1,20171001, D4263,HCPCS,BONE REPLCE GRAFT FIRST SITE,,,26,,NW,,,,,,$754.51,$0.00,1,0,1,1,1,1,20171001, D4264,HCPCS,BONE REPLCE GRAFT EACH ADD,,,26,,NW,,,,,,$624.37,$0.00,1,0,1,1,1,1,20171001, D4265,HCPCS,BIO MTRLS TO AID SOFT/OS REG,,,26,,NW,,,,,,$738.62,$0.00,1,0,1,1,1,1,20171001, D4266,HCPCS,GUIDED TISS REGEN RESORBLE,,,26,,NW,,,,,,$820.50,$0.00,1,0,1,1,1,1,20171001, D4267,HCPCS,GUIDED TISS REGEN NONRESORB,,,26,,NW,,,,,,$994.47,$0.00,1,0,1,1,1,1,20171001, D4268,HCPCS,SURGICAL REVISION PROCEDURE,,,26,,NW,,,,,,$987.62,$0.00,1,0,1,1,1,1,20171001, D4270,HCPCS,PEDICLE SOFT TISSUE GRAFT PR,,,26,,NW,,,,,,"$1,171.57",$0.00,1,0,1,1,1,1,20171001, D4273,HCPCS,AUTO TISSUE GRAFT 1ST TOOTH,,,26,,NW,,,,,,"$1,453.20",$0.00,1,0,1,1,1,1,20171001, D4274,HCPCS,MESIAL/DISTAL WEDGE PROC,,,26,,NW,,,,,,$859.87,$0.00,1,0,1,1,1,1,20171001, D4275,HCPCS,NON-AUTO GRAFT 1ST TOOTH,,,26,,NW,,,,,,"$1,208.26",$0.00,1,0,1,1,1,1,20171001, D4276,HCPCS,CON TISSUE W DBLE PED GRAFT,,,26,,NW,,,,,,"$1,556.55",$0.00,1,0,1,1,1,1,20171001, D4277,HCPCS,SOFT TISSUE GRAFT FIRSTTOOTH,,,26,,NW,,,,,,"$1,265.94",$0.00,1,0,1,1,1,1,20171001, D4278,HCPCS,SOFT TISSUE GRAFT ADDL TOOTH,,,26,,NW,,,,,,$688.21,$0.00,1,0,1,1,1,1,20171001, D4283,HCPCS,AUTO TISSUE GRAFT ADDL TOOTH,,,26,,NW,,,,,,"$1,335.48",$0.00,1,0,1,1,1,1,20171001, D4285,HCPCS,NON-AUTO GRAFT ADDL TOOTH,,,26,,NW,,,,,,"$1,004.94",$0.00,1,0,1,1,1,1,20171001, D4320,HCPCS,PROVISION SPLNT INTRACORONAL,,,26,,NW,,,,,,$580.63,$0.00,1,0,1,1,1,1,20171001, D4321,HCPCS,PROVISIONAL SPLINT EXTRACORO,,,26,,NW,,,,,,$528.85,$0.00,1,0,1,1,1,1,20171001, D4341,HCPCS,PERIODONTAL SCALING & ROOT,,,26,,NW,,,,,,$309.73,$0.00,1,0,1,1,1,1,20171001, D4342,HCPCS,PERIODONTAL SCALING 1-3TEETH,,,26,,NW,,,,,,$206.27,$0.00,1,0,1,1,1,1,20171001, D4346,HCPCS,SCALING GINGIV INFLAMMATION,,,26,,NW,,,,,,$133.32,$0.00,1,0,1,1,1,1,20171001, D4355,HCPCS,FULL MOUTH DEBRIDEMENT,,,26,,NW,,,,,,$213.77,$0.00,1,0,1,1,1,1,20171001, D4381,HCPCS,LOCALIZED DELIVERY ANTIMICRO,,,26,,NW,,,,,,$170.53,$0.00,1,0,1,1,1,1,20171001, D4910,HCPCS,PERIODONTAL MAINT PROCEDURES,,,26,,NW,,,,,,$169.23,$0.00,1,0,1,1,1,1,20171001, D4920,HCPCS,UNSCHEDULED DRESSING CHANGE,,,26,,NW,,,,,,$137.92,$0.00,1,0,1,1,1,1,20171001, D4921,HCPCS,GINGIVAL IRRIGATION PER QUAD,,,26,,NW,,,,,,$108.81,$0.00,1,0,1,1,1,1,20171001, D4999,HCPCS,UNSPECIFIED PERIODONTAL PROC,,,26,,NW,,,,,,$206.27,$0.00,1,0,1,1,1,1,20171001, D5110,HCPCS,DENTURES COMPLETE MAXILLARY,,,27,,NW,,,,,,"$2,044.00",$0.00,1,0,1,1,1,1,20171001, D5120,HCPCS,DENTURES COMPLETE MANDIBLE,,,27,,NW,,,,,,"$2,050.28",$0.00,1,0,1,1,1,1,20171001, D5130,HCPCS,DENTURES IMMEDIAT MAXILLARY,,,27,,NW,,,,,,"$2,189.24",$0.00,1,0,1,1,1,1,20171001, D5140,HCPCS,DENTURES IMMEDIAT MANDIBLE,,,27,,NW,,,,,,"$2,202.32",$0.00,1,0,1,1,1,1,20171001, D5211,HCPCS,DENTURES MAXILL PART RESIN,,,27,,NW,,,,,,"$1,683.71",$0.00,1,0,1,1,1,1,20171001, D5212,HCPCS,DENTURES MAND PART RESIN,,,27,,NW,,,,,,"$1,791.94",$0.00,1,0,1,1,1,1,20171001, D5213,HCPCS,DENTURES MAXILL PART METAL,,,27,,NW,,,,,,"$2,172.93",$0.00,1,0,1,1,1,1,20171001, D5214,HCPCS,DENTURES MANDIBL PART METAL,,,27,,NW,,,,,,"$2,176.59",$0.00,1,0,1,1,1,1,20171001, D5221,HCPCS,IMMED MAX PART DENTURE RESIN,,,27,,NW,,,,,,"$1,702.35",$0.00,1,0,1,1,1,1,20171001, D5222,HCPCS,IMMED MAN PART DENTURE RESIN,,,27,,NW,,,,,,"$1,977.35",$0.00,1,0,1,1,1,1,20171001, D5223,HCPCS,IMMED MAX PART DENT METAL,,,27,,NW,,,,,,"$2,227.05",$0.00,1,0,1,1,1,1,20171001, D5224,HCPCS,IMMED MAND PART DENT METAL,,,27,,NW,,,,,,"$2,227.05",$0.00,1,0,1,1,1,1,20171001, D5225,HCPCS,MAXILLARY PART DENTURE FLEX,,,27,,NW,,,,,,"$1,784.67",$0.00,1,0,1,1,1,1,20171001, D5226,HCPCS,MANDIBULAR PART DENTURE FLEX,,,27,,NW,,,,,,"$1,897.08",$0.00,1,0,1,1,1,1,20171001, D5281,HCPCS,REMOVABLE PARTIAL DENTURE,,,27,,NW,,,,,,"$1,272.46",$0.00,1,0,1,1,1,1,20171001, D5410,HCPCS,DENTURES ADJUST CMPLT MAXIL,,,27,,NW,,,,,,$108.68,$0.00,1,0,1,1,1,1,20171001, D5411,HCPCS,DENTURES ADJUST CMPLT MAND,,,27,,NW,,,,,,$107.63,$0.00,1,0,1,1,1,1,20171001, D5421,HCPCS,DENTURES ADJUST PART MAXILL,,,27,,NW,,,,,,$107.63,$0.00,1,0,1,1,1,1,20171001, D5422,HCPCS,DENTURES ADJUST PART MANDBL,,,27,,NW,,,,,,$107.63,$0.00,1,0,1,1,1,1,20171001, D5510,HCPCS,DENTUR REPR BROKEN COMPL BAS,,,27,,NW,,,,,,$239.85,$0.00,1,0,1,1,1,1,20171001, D5520,HCPCS,REPLACE DENTURE TEETH COMPLT,,,27,,NW,,,,,,$206.24,$0.00,1,0,1,1,1,1,20171001, D5610,HCPCS,DENTURES REPAIR RESIN BASE,,,27,,NW,,,,,,$244.10,$0.00,1,0,1,1,1,1,20171001, D5620,HCPCS,REP PART DENTURE CAST FRAME,,,27,,NW,,,,,,$303.28,$0.00,1,0,1,1,1,1,20171001, D5630,HCPCS,REP PARTIAL DENTURE CLASP,,,27,,NW,,,,,,$314.99,$0.00,1,0,1,1,1,1,20171001, D5640,HCPCS,REPLACE PART DENTURE TEETH,,,27,,NW,,,,,,$219.91,$0.00,1,0,1,1,1,1,20171001, D5650,HCPCS,ADD TOOTH TO PARTIAL DENTURE,,,27,,NW,,,,,,$273.01,$0.00,1,0,1,1,1,1,20171001, D5660,HCPCS,ADD CLASP TO PARTIAL DENTURE,,,27,,NW,,,,,,$320.28,$0.00,1,0,1,1,1,1,20171001, D5670,HCPCS,REPLC TTH&ACRLC ON MTL FRMWK,,,27,,NW,,,,,,$832.03,$0.00,1,0,1,1,1,1,20171001, D5671,HCPCS,REPLC TTH&ACRLC MANDIBULAR,,,27,,NW,,,,,,$840.92,$0.00,1,0,1,1,1,1,20171001, D5710,HCPCS,DENTURES REBASE CMPLT MAXIL,,,27,,NW,,,,,,$746.27,$0.00,1,0,1,1,1,1,20171001, D5711,HCPCS,DENTURES REBASE CMPLT MAND,,,27,,NW,,,,,,$729.92,$0.00,1,0,1,1,1,1,20171001, D5720,HCPCS,DENTURES REBASE PART MAXILL,,,27,,NW,,,,,,$711.58,$0.00,1,0,1,1,1,1,20171001, D5721,HCPCS,DENTURES REBASE PART MANDBL,,,27,,NW,,,,,,$706.88,$0.00,1,0,1,1,1,1,20171001, D5730,HCPCS,DENTURE RELN CMPLT MAXIL CH,,,27,,NW,,,,,,$454.98,$0.00,1,0,1,1,1,1,20171001, D5731,HCPCS,DENTURE RELN CMPLT MAND CHR,,,27,,NW,,,,,,$450.80,$0.00,1,0,1,1,1,1,20171001, D5740,HCPCS,DENTURE RELN PART MAXIL CHR,,,27,,NW,,,,,,$424.71,$0.00,1,0,1,1,1,1,20171001, D5741,HCPCS,DENTURE RELN PART MAND CHR,,,27,,NW,,,,,,$424.71,$0.00,1,0,1,1,1,1,20171001, D5750,HCPCS,DENTURE RELN CMPLT MAX LAB,,,27,,NW,,,,,,$578.15,$0.00,1,0,1,1,1,1,20171001, D5751,HCPCS,DENTURE RELN CMPLT MAND LAB,,,27,,NW,,,,,,$581.81,$0.00,1,0,1,1,1,1,20171001, D5760,HCPCS,DENTURE RELN PART MAXIL LAB,,,27,,NW,,,,,,$571.84,$0.00,1,0,1,1,1,1,20171001, D5761,HCPCS,DENTURE RELN PART MAND LAB,,,27,,NW,,,,,,$571.84,$0.00,1,0,1,1,1,1,20171001, D5810,HCPCS,DENTURE INTERM CMPLT MAXILL,,,27,,NW,,,,,,$995.31,$0.00,1,0,1,1,1,1,20171001, D5811,HCPCS,DENTURE INTERM CMPLT MANDBL,,,27,,NW,,,,,,"$1,050.50",$0.00,1,0,1,1,1,1,20171001, D5820,HCPCS,DENTURE INTERM PART MAXILL,,,27,,NW,,,,,,$807.24,$0.00,1,0,1,1,1,1,20171001, D5821,HCPCS,DENTURE INTERM PART MANDBL,,,27,,NW,,,,,,$825.72,$0.00,1,0,1,1,1,1,20171001, D5850,HCPCS,DENTURE TISS CONDITN MAXILL,,,27,,NW,,,,,,$224.06,$0.00,1,0,1,1,1,1,20171001, D5851,HCPCS,DENTURE TISS CONDTIN MANDBL,,,27,,NW,,,,,,$220.40,$0.00,1,0,1,1,1,1,20171001, D5862,HCPCS,PRECISION ATTACHMENT,,,27,,NW,,,,,,$903.92,$0.00,1,0,1,1,1,1,20171001, D5863,HCPCS,OVERDENTURE COMPLETE MAX,,,27,,NW,,,,,,"$2,384.65",$0.00,1,0,1,1,1,1,20171001, D5864,HCPCS,OVERDENTURE PARTIAL MAX,,,27,,NW,,,,,,"$2,711.95",$0.00,1,0,1,1,1,1,20171001, D5865,HCPCS,OVERDENTURE COMPLETE MANDIB,,,27,,NW,,,,,,"$2,470.97",$0.00,1,0,1,1,1,1,20171001, D5866,HCPCS,OVERDENTURE PARTIAL MANDIB,,,27,,NW,,,,,,"$2,781.92",$0.00,1,0,1,1,1,1,20171001, D5867,HCPCS,REPLACEMENT OF PRECISION ATT,,,27,,NW,,,,,,$512.64,$0.00,1,0,1,1,1,1,20171001, D5875,HCPCS,PROSTHESIS MODIFICATION,,,27,,NW,,,,,,$577.51,$0.00,1,0,1,1,1,1,20171001, D5899,HCPCS,REMOVABLE PROSTHODONTIC PROC,,,27,,NW,,,,,,$578.15,$0.00,1,0,1,1,1,1,20171001, D5911,HCPCS,FACIAL MOULAGE SECTIONAL,,,27,,NW,,,,,,$558.84,$0.00,1,0,1,1,1,1,20171001, D5912,HCPCS,FACIAL MOULAGE COMPLETE,,,27,,NW,,,,,,$562.50,$0.00,1,0,1,1,1,1,20171001, D5913,HCPCS,NASAL PROSTHESIS,,,27,,NW,,,,,,"$8,541.98",$0.00,1,0,1,1,1,1,20171001, D5914,HCPCS,AURICULAR PROSTHESIS,,,27,,NW,,,,,,"$8,282.52",$0.00,1,0,1,1,1,1,20171001, D5915,HCPCS,ORBITAL PROSTHESIS,,,27,,NW,,,,,,"$13,365.70",$0.00,1,0,1,1,1,1,20171001, D5916,HCPCS,OCULAR PROSTHESIS,,,27,,NW,,,,,,"$3,564.97",$0.00,1,0,1,1,1,1,20171001, D5919,HCPCS,FACIAL PROSTHESIS,,,27,,NW,,,,,,"$1,534.89",$0.00,1,0,1,1,1,1,20171001, D5922,HCPCS,NASAL SEPTAL PROSTHESIS,,,27,,NW,,,,,,"$1,534.89",$0.00,1,0,1,1,1,1,20171001, D5923,HCPCS,OCULAR PROSTHESIS INTERIM,,,27,,NW,,,,,,"$1,534.89",$0.00,1,0,1,1,1,1,20171001, D5924,HCPCS,CRANIAL PROSTHESIS,,,27,,NW,,,,,,"$1,169.20",$0.00,1,0,1,1,1,1,20171001, D5925,HCPCS,FACIAL AUGMENTATION IMPLANT,,,27,,NW,,,,,,$376.12,$0.00,1,0,1,1,1,1,20171001, D5926,HCPCS,REPLACEMENT NASAL PROSTHESIS,,,27,,NW,,,,,,"$1,534.89",$0.00,1,0,1,1,1,1,20171001, D5927,HCPCS,AURICULAR REPLACEMENT,,,27,,NW,,,,,,"$1,534.89",$0.00,1,0,1,1,1,1,20171001, D5928,HCPCS,ORBITAL REPLACEMENT,,,27,,NW,,,,,,"$1,534.89",$0.00,1,0,1,1,1,1,20171001, D5929,HCPCS,FACIAL REPLACEMENT,,,27,,NW,,,,,,"$1,534.89",$0.00,1,0,1,1,1,1,20171001, D5931,HCPCS,SURGICAL OBTURATOR,,,27,,NW,,,,,,"$5,317.93",$0.00,1,0,1,1,1,1,20171001, D5932,HCPCS,POSTSURGICAL OBTURATOR,,,27,,NW,,,,,,"$9,945.82",$0.00,1,0,1,1,1,1,20171001, D5933,HCPCS,REFITTING OF OBTURATOR,,,27,,NW,,,,,,$306.32,$0.00,1,0,1,1,1,1,20171001, D5934,HCPCS,MANDIBULAR FLANGE PROSTHESIS,,,27,,NW,,,,,,"$9,065.12",$0.00,1,0,1,1,1,1,20171001, D5935,HCPCS,MANDIBULAR DENTURE PROSTH,,,27,,NW,,,,,,"$7,887.48",$0.00,1,0,1,1,1,1,20171001, D5936,HCPCS,TEMP OBTURATOR PROSTHESIS,,,27,,NW,,,,,,"$8,859.29",$0.00,1,0,1,1,1,1,20171001, D5937,HCPCS,TRISMUS APPLIANCE,,,27,,NW,,,,,,"$1,006.11",$0.00,1,0,1,1,1,1,20171001, D5951,HCPCS,FEEDING AID,,,27,,NW,,,,,,"$1,350.99",$0.00,1,0,1,1,1,1,20171001, D5952,HCPCS,PEDIATRIC SPEECH AID,,,27,,NW,,,,,,"$4,700.43",$0.00,1,0,1,1,1,1,20171001, D5953,HCPCS,ADULT SPEECH AID,,,27,,NW,,,,,,"$8,926.77",$0.00,1,0,1,1,1,1,20171001, D5954,HCPCS,SUPERIMPOSED PROSTHESIS,,,27,,NW,,,,,,"$8,272.15",$0.00,1,0,1,1,1,1,20171001, D5955,HCPCS,PALATAL LIFT PROSTHESIS,,,27,,NW,,,,,,"$7,651.28",$0.00,1,0,1,1,1,1,20171001, D5958,HCPCS,INTRAORAL CON DEF INTER PLT,,,27,,NW,,,,,,"$1,534.89",$0.00,1,0,1,1,1,1,20171001, D5959,HCPCS,INTRAORAL CON DEF MOD PALAT,,,27,,NW,,,,,,"$1,534.89",$0.00,1,0,1,1,1,1,20171001, D5960,HCPCS,MODIFY SPEECH AID PROSTHESIS,,,27,,NW,,,,,,$553.62,$0.00,1,0,1,1,1,1,20171001, D5982,HCPCS,SURGICAL STENT,,,27,,NW,,,,,,$665.19,$0.00,1,0,1,1,1,1,20171001, D5983,HCPCS,RADIATION APPLICATOR,,,27,,NW,,,,,,"$1,687.16",$0.00,1,0,1,1,1,1,20171001, D5984,HCPCS,RADIATION SHIELD,,,27,,NW,,,,,,"$1,687.16",$0.00,1,0,1,1,1,1,20171001, D5985,HCPCS,RADIATION CONE LOCATOR,,,27,,NW,,,,,,"$1,687.16",$0.00,1,0,1,1,1,1,20171001, D5986,HCPCS,FLUORIDE APPLICATOR,,,27,,NW,,,,,,$219.32,$0.00,1,0,1,1,1,1,20171001, D5987,HCPCS,COMMISSURE SPLINT,,,27,,NW,,,,,,"$1,914.54",$0.00,1,0,1,1,1,1,20171001, D5988,HCPCS,SURGICAL SPLINT,,,27,,NW,,,,,,$740.61,$0.00,1,0,1,1,1,1,20171001, D5991,HCPCS,VESICULOBULLOUS DISEASE CARR,,,27,,NW,,,,,,$252.90,$0.00,1,0,1,1,1,1,20171001, D5992,HCPCS,ADJUST MAX PROST APPLIANCE,,,27,,NW,,,,,,$590.64,$0.00,1,0,1,1,1,1,20171001, D5993,HCPCS,MAIN/CLEAN MAX PROSTHESIS,,,27,,NW,,,,,,$590.64,$0.00,1,0,1,1,1,1,20171001, D5994,HCPCS,PERIDONTAL MEDICAMENT,,,27,,NW,,,,,,$217.98,$0.00,1,0,1,1,1,1,20171001, D5999,HCPCS,MAXILLOFACIAL PROSTHESIS,,,27,,NW,,,,,,"$8,926.77",$0.00,1,0,1,1,1,1,20171001, D6010,HCPCS,ODONTICS ENDOSTEAL IMPLANT,,,27,,NW,,,,,,"$2,791.67",$0.00,1,0,1,1,1,1,20171001, D6011,HCPCS,SECOND STAGE IMPLANT SURGERY,,,27,,NW,,,,,,"$1,446.26",$0.00,1,0,1,1,1,1,20171001, D6012,HCPCS,ENDOSTEAL IMPLANT,,,27,,NW,,,,,,"$2,592.43",$0.00,1,0,1,1,1,1,20171001, D6013,HCPCS,SURGICAL PLACE MINI IMPLANT,,,27,,NW,,,,,,"$2,224.63",$0.00,1,0,1,1,1,1,20171001, D6040,HCPCS,ODONTICS EPOSTEAL IMPLANT,,,27,,NW,,,,,,"$10,005.74",$0.00,1,0,1,1,1,1,20171001, D6050,HCPCS,ODONTICS TRANSOSTEAL IMPLNT,,,27,,NW,,,,,,"$7,255.67",$0.00,1,0,1,1,1,1,20171001, D6051,HCPCS,INTERIM ABUTMENT,,,27,,NW,,,,,,$670.62,$0.00,1,0,1,1,1,1,20171001, D6052,HCPCS,SEMI PRECISION ATTACH ABUT,,,27,,NW,,,,,,"$1,197.60",$0.00,1,0,1,1,1,1,20171001, D6055,HCPCS,IMPLANT CONNECTING BAR,,,27,,NW,,,,,,"$2,414.10",$0.00,1,0,1,1,1,1,20171001, D6056,HCPCS,PREFABRICATED ABUTMENT,,,27,,NW,,,,,,$795.54,$0.00,1,0,1,1,1,1,20171001, D6057,HCPCS,CUSTOM ABUTMENT,,,27,,NW,,,,,,$951.49,$0.00,1,0,1,1,1,1,20171001, D6058,HCPCS,ABUTMENT SUPPORTED CROWN,,,27,,NW,,,,,,"$1,785.73",$0.00,1,0,1,1,1,1,20171001, D6059,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27,,NW,,,,,,"$1,781.77",$0.00,1,0,1,1,1,1,20171001, D6060,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27,,NW,,,,,,"$1,676.14",$0.00,1,0,1,1,1,1,20171001, D6061,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27,,NW,,,,,,"$1,683.08",$0.00,1,0,1,1,1,1,20171001, D6062,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27,,NW,,,,,,"$1,711.09",$0.00,1,0,1,1,1,1,20171001, D6063,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27,,NW,,,,,,"$1,599.13",$0.00,1,0,1,1,1,1,20171001, D6064,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27,,NW,,,,,,"$1,608.81",$0.00,1,0,1,1,1,1,20171001, D6065,HCPCS,IMPLANT SUPPORTED CROWN,,,27,,NW,,,,,,"$1,846.72",$0.00,1,0,1,1,1,1,20171001, D6066,HCPCS,IMPLANT SUPPORTED MTL CROWN,,,27,,NW,,,,,,"$1,801.97",$0.00,1,0,1,1,1,1,20171001, D6067,HCPCS,IMPLANT SUPPORTED MTL CROWN,,,27,,NW,,,,,,"$1,789.22",$0.00,1,0,1,1,1,1,20171001, D6068,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27,,NW,,,,,,"$1,777.09",$0.00,1,0,1,1,1,1,20171001, D6069,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27,,NW,,,,,,"$1,787.00",$0.00,1,0,1,1,1,1,20171001, D6070,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27,,NW,,,,,,"$1,695.50",$0.00,1,0,1,1,1,1,20171001, D6071,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27,,NW,,,,,,"$1,700.86",$0.00,1,0,1,1,1,1,20171001, D6072,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27,,NW,,,,,,"$1,781.60",$0.00,1,0,1,1,1,1,20171001, D6073,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27,,NW,,,,,,"$1,659.24",$0.00,1,0,1,1,1,1,20171001, D6074,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27,,NW,,,,,,"$1,672.08",$0.00,1,0,1,1,1,1,20171001, D6075,HCPCS,IMPLANT SUPPORTED RETAINER,,,27,,NW,,,,,,"$1,819.52",$0.00,1,0,1,1,1,1,20171001, D6076,HCPCS,IMPLANT SUPPORTED RETAINER,,,27,,NW,,,,,,"$1,803.02",$0.00,1,0,1,1,1,1,20171001, D6077,HCPCS,IMPLANT SUPPORTED RETAINER,,,27,,NW,,,,,,"$1,810.14",$0.00,1,0,1,1,1,1,20171001, D6080,HCPCS,IMPLANT MAINTENANCE,,,27,,NW,,,,,,$262.43,$0.00,1,0,1,1,1,1,20171001, D6090,HCPCS,REPAIR IMPLANT,,,27,,NW,,,,,,$915.43,$0.00,1,0,1,1,1,1,20171001, D6091,HCPCS,REPL SEMI/PRECISION ATTACH,,,27,,NW,,,,,,$716.26,$0.00,1,0,1,1,1,1,20171001, D6092,HCPCS,RECEMENT SUPP CROWN,,,27,,NW,,,,,,$165.10,$0.00,1,0,1,1,1,1,20171001, D6093,HCPCS,RECEMENT SUPP PART DENTURE,,,27,,NW,,,,,,$222.22,$0.00,1,0,1,1,1,1,20171001, D6094,HCPCS,ABUT SUPPORT CROWN TITANIUM,,,27,,NW,,,,,,"$1,514.61",$0.00,1,0,1,1,1,1,20171001, D6095,HCPCS,ODONTICS REPR ABUTMENT,,,27,,NW,,,,,,$878.81,$0.00,1,0,1,1,1,1,20171001, D6100,HCPCS,REMOVAL OF IMPLANT,,,27,,NW,,,,,,$936.35,$0.00,1,0,1,1,1,1,20171001, D6101,HCPCS,DEBRIDEMENT OF A PERIIMPLANT,,,27,,NW,,,,,,$677.92,$0.00,1,0,1,1,1,1,20171001, D6102,HCPCS,DEBRIDEMENT & CONTOURING,,,27,,NW,,,,,,$916.46,$0.00,1,0,1,1,1,1,20171001, D6103,HCPCS,BONE GRAFT REPAIR PERIMPLANT,,,27,,NW,,,,,,$747.15,$0.00,1,0,1,1,1,1,20171001, D6104,HCPCS,BONE GRAFT TIME OF IMPLANT,,,27,,NW,,,,,,$728.84,$0.00,1,0,1,1,1,1,20171001, D6110,HCPCS,IMPLNT/ABUT REMOV DENT MAX,,,27,,NW,,,,,,"$2,971.48",$0.00,1,0,1,1,1,1,20171001, D6111,HCPCS,IMPLNT/ABUT REMOV DENT MAND,,,27,,NW,,,,,,"$2,952.12",$0.00,1,0,1,1,1,1,20171001, D6112,HCPCS,IMP/ABUT REM DENT PART MAX,,,27,,NW,,,,,,"$2,867.91",$0.00,1,0,1,1,1,1,20171001, D6113,HCPCS,IMP/ABUT REM DENT PART MAND,,,27,,NW,,,,,,"$2,889.88",$0.00,1,0,1,1,1,1,20171001, D6114,HCPCS,IMPLNT/ABUT FIXED DENT MAX,,,27,,NW,,,,,,"$7,229.63",$0.00,1,0,1,1,1,1,20171001, D6115,HCPCS,IMPLNT/ABUT FIXED DENT MAND,,,27,,NW,,,,,,"$7,001.56",$0.00,1,0,1,1,1,1,20171001, D6116,HCPCS,IMP/ABUT FIXED DENT PART MAX,,,27,,NW,,,,,,"$4,393.97",$0.00,1,0,1,1,1,1,20171001, D6117,HCPCS,IMP/ABUT FIXED DENT PART MAN,,,27,,NW,,,,,,"$4,533.64",$0.00,1,0,1,1,1,1,20171001, D6190,HCPCS,RADIO/SURGICAL IMPLANT INDEX,,,27,,NW,,,,,,$443.77,$0.00,1,0,1,1,1,1,20171001, D6194,HCPCS,ABUT SUPPORT RETAINER TITANI,,,27,,NW,,,,,,"$1,570.22",$0.00,1,0,1,1,1,1,20171001, D6199,HCPCS,IMPLANT PROCEDURE,,,27,,NW,,,,,,"$1,197.60",$0.00,1,0,1,1,1,1,20171001, D6205,HCPCS,PONTIC-INDIRECT RESIN BASED,,,27,,NW,,,,,,"$1,048.91",$0.00,1,0,1,1,1,1,20171001, D6210,HCPCS,PROSTHODONT HIGH NOBLE METAL,,,27,,NW,,,,,,"$1,354.40",$0.00,1,0,1,1,1,1,20171001, D6211,HCPCS,BRIDGE BASE METAL CAST,,,27,,NW,,,,,,"$1,254.48",$0.00,1,0,1,1,1,1,20171001, D6212,HCPCS,BRIDGE NOBLE METAL CAST,,,27,,NW,,,,,,"$1,298.84",$0.00,1,0,1,1,1,1,20171001, D6214,HCPCS,PONTIC TITANIUM,,,27,,NW,,,,,,"$1,338.07",$0.00,1,0,1,1,1,1,20171001, D6240,HCPCS,BRIDGE PORCELAIN HIGH NOBLE,,,27,,NW,,,,,,"$1,346.24",$0.00,1,0,1,1,1,1,20171001, D6241,HCPCS,BRIDGE PORCELAIN BASE METAL,,,27,,NW,,,,,,"$1,250.72",$0.00,1,0,1,1,1,1,20171001, D6242,HCPCS,BRIDGE PORCELAIN NOBEL METAL,,,27,,NW,,,,,,"$1,302.71",$0.00,1,0,1,1,1,1,20171001, D6245,HCPCS,BRIDGE PORCELAIN/CERAMIC,,,27,,NW,,,,,,"$1,368.73",$0.00,1,0,1,1,1,1,20171001, D6250,HCPCS,BRIDGE RESIN W/HIGH NOBLE,,,27,,NW,,,,,,"$1,316.11",$0.00,1,0,1,1,1,1,20171001, D6251,HCPCS,BRIDGE RESIN BASE METAL,,,27,,NW,,,,,,"$1,234.71",$0.00,1,0,1,1,1,1,20171001, D6252,HCPCS,BRIDGE RESIN W/NOBLE METAL,,,27,,NW,,,,,,"$1,262.90",$0.00,1,0,1,1,1,1,20171001, D6253,HCPCS,PROVISIONAL PONTIC,,,27,,NW,,,,,,$755.90,$0.00,1,0,1,1,1,1,20171001, D6545,HCPCS,DENTAL RETAINR CAST METL,,,27,,NW,,,,,,$780.96,$0.00,1,0,1,1,1,1,20171001, D6548,HCPCS,PORCELAIN/CERAMIC RETAINER,,,27,,NW,,,,,,$846.76,$0.00,1,0,1,1,1,1,20171001, D6549,HCPCS,RESIN RETAINER,,,27,,NW,,,,,,$697.29,$0.00,1,0,1,1,1,1,20171001, D6600,HCPCS,PORCELAIN/CERAMIC INLAY 2SRF,,,27,,NW,,,,,,"$1,099.00",$0.00,1,0,1,1,1,1,20171001, D6601,HCPCS,PORC/CERAM INLAY >= 3 SURFAC,,,27,,NW,,,,,,"$1,149.96",$0.00,1,0,1,1,1,1,20171001, D6602,HCPCS,CST HGH NBLE MTL INLAY 2 SRF,,,27,,NW,,,,,,"$1,131.67",$0.00,1,0,1,1,1,1,20171001, D6603,HCPCS,CST HGH NBLE MTL INLAY >=3SR,,,27,,NW,,,,,,"$1,191.38",$0.00,1,0,1,1,1,1,20171001, D6604,HCPCS,CST BSE MTL INLAY 2 SURFACES,,,27,,NW,,,,,,"$1,103.20",$0.00,1,0,1,1,1,1,20171001, D6605,HCPCS,CST BSE MTL INLAY >= 3 SURFA,,,27,,NW,,,,,,"$1,137.67",$0.00,1,0,1,1,1,1,20171001, D6606,HCPCS,CAST NOBLE METAL INLAY 2 SUR,,,27,,NW,,,,,,"$1,099.92",$0.00,1,0,1,1,1,1,20171001, D6607,HCPCS,CST NOBLE MTL INLAY >=3 SURF,,,27,,NW,,,,,,"$1,171.95",$0.00,1,0,1,1,1,1,20171001, D6608,HCPCS,ONLAY PORC/CRMC 2 SURFACES,,,27,,NW,,,,,,"$1,182.23",$0.00,1,0,1,1,1,1,20171001, D6609,HCPCS,ONLAY PORC/CRMC >=3 SURFACES,,,27,,NW,,,,,,"$1,247.10",$0.00,1,0,1,1,1,1,20171001, D6610,HCPCS,ONLAY CST HGH NBL MTL 2 SRFC,,,27,,NW,,,,,,"$1,213.97",$0.00,1,0,1,1,1,1,20171001, D6611,HCPCS,ONLAY CST HGH NBL MTL >=3SRF,,,27,,NW,,,,,,"$1,314.68",$0.00,1,0,1,1,1,1,20171001, D6612,HCPCS,ONLAY CST BASE MTL 2 SURFACE,,,27,,NW,,,,,,"$1,184.38",$0.00,1,0,1,1,1,1,20171001, D6613,HCPCS,ONLAY CST BASE MTL >=3 SURFA,,,27,,NW,,,,,,"$1,229.99",$0.00,1,0,1,1,1,1,20171001, D6614,HCPCS,ONLAY CST NBL MTL 2 SURFACES,,,27,,NW,,,,,,"$1,163.35",$0.00,1,0,1,1,1,1,20171001, D6615,HCPCS,ONLAY CST NBL MTL >=3 SURFAC,,,27,,NW,,,,,,"$1,240.38",$0.00,1,0,1,1,1,1,20171001, D6624,HCPCS,INLAY TITANIUM,,,27,,NW,,,,,,"$1,154.16",$0.00,1,0,1,1,1,1,20171001, D6634,HCPCS,ONLAY TITANIUM,,,27,,NW,,,,,,"$1,213.05",$0.00,1,0,1,1,1,1,20171001, D6710,HCPCS,CROWN-INDIRECT RESIN BASED,,,27,,NW,,,,,,"$1,194.64",$0.00,1,0,1,1,1,1,20171001, D6720,HCPCS,RETAIN CROWN RESIN W HI NBLE,,,27,,NW,,,,,,"$1,297.41",$0.00,1,0,1,1,1,1,20171001, D6721,HCPCS,CROWN RESIN W/BASE METAL,,,27,,NW,,,,,,"$1,240.68",$0.00,1,0,1,1,1,1,20171001, D6722,HCPCS,CROWN RESIN W/NOBLE METAL,,,27,,NW,,,,,,"$1,264.65",$0.00,1,0,1,1,1,1,20171001, D6740,HCPCS,CROWN PORCELAIN/CERAMIC,,,27,,NW,,,,,,"$1,377.16",$0.00,1,0,1,1,1,1,20171001, D6750,HCPCS,CROWN PORCELAIN HIGH NOBLE,,,27,,NW,,,,,,"$1,369.67",$0.00,1,0,1,1,1,1,20171001, D6751,HCPCS,CROWN PORCELAIN BASE METAL,,,27,,NW,,,,,,"$1,260.73",$0.00,1,0,1,1,1,1,20171001, D6752,HCPCS,CROWN PORCELAIN NOBLE METAL,,,27,,NW,,,,,,"$1,299.84",$0.00,1,0,1,1,1,1,20171001, D6780,HCPCS,CROWN 3/4 HIGH NOBLE METAL,,,27,,NW,,,,,,"$1,310.68",$0.00,1,0,1,1,1,1,20171001, D6781,HCPCS,CROWN 3/4 CAST BASED METAL,,,27,,NW,,,,,,"$1,281.91",$0.00,1,0,1,1,1,1,20171001, D6782,HCPCS,CROWN 3/4 CAST NOBLE METAL,,,27,,NW,,,,,,"$1,243.59",$0.00,1,0,1,1,1,1,20171001, D6783,HCPCS,CROWN 3/4 PORCELAIN/CERAMIC,,,27,,NW,,,,,,"$1,310.00",$0.00,1,0,1,1,1,1,20171001, D6790,HCPCS,CROWN FULL HIGH NOBLE METAL,,,27,,NW,,,,,,"$1,333.57",$0.00,1,0,1,1,1,1,20171001, D6791,HCPCS,CROWN FULL BASE METAL CAST,,,27,,NW,,,,,,"$1,233.42",$0.00,1,0,1,1,1,1,20171001, D6792,HCPCS,CROWN FULL NOBLE METAL CAST,,,27,,NW,,,,,,"$1,295.48",$0.00,1,0,1,1,1,1,20171001, D6793,HCPCS,PROVISIONAL RETAINER CROWN,,,27,,NW,,,,,,$625.96,$0.00,1,0,1,1,1,1,20171001, D6794,HCPCS,CROWN TITANIUM,,,27,,NW,,,,,,"$1,285.54",$0.00,1,0,1,1,1,1,20171001, D6920,HCPCS,DENTAL CONNECTOR BAR,,,27,,NW,,,,,,$794.68,$0.00,1,0,1,1,1,1,20171001, D6930,HCPCS,RECEMENT/BOND PART DENTURE,,,27,,NW,,,,,,$202.14,$0.00,1,0,1,1,1,1,20171001, D6940,HCPCS,STRESS BREAKER,,,27,,NW,,,,,,$477.69,$0.00,1,0,1,1,1,1,20171001, D6950,HCPCS,PRECISION ATTACHMENT,,,27,,NW,,,,,,$819.35,$0.00,1,0,1,1,1,1,20171001, D6980,HCPCS,FIXED PARTIAL REPAIR,,,27,,NW,,,,,,$488.58,$0.00,1,0,1,1,1,1,20171001, D6985,HCPCS,PEDIATRIC PARTIAL DENTURE FX,,,27,,NW,,,,,,$892.91,$0.00,1,0,1,1,1,1,20171001, D6999,HCPCS,FIXED PROSTHODONTIC PROC,,,27,,NW,,,,,,"$1,346.24",$0.00,1,0,1,1,1,1,20171001, D7111,HCPCS,EXTRACTION CORONAL REMNANTS,,,26,,NW,,,,,,$164.70,$0.00,1,0,1,1,1,1,20171001, D7140,HCPCS,EXTRACTION ERUPTED TOOTH/EXR,,,26,,NW,,,,,,$216.07,$0.00,1,0,1,1,1,1,20171001, D7210,HCPCS,REM IMP TOOTH W MUCOPER FLP,,,26,,NW,,,,,,$343.95,$0.00,1,0,1,1,1,1,20171001, D7220,HCPCS,IMPACT TOOTH REMOV SOFT TISS,,,26,,NW,,,,,,$398.40,$0.00,1,0,1,1,1,1,20171001, D7230,HCPCS,IMPACT TOOTH REMOV PART BONY,,,26,,NW,,,,,,$515.99,$0.00,1,0,1,1,1,1,20171001, D7240,HCPCS,IMPACT TOOTH REMOV COMP BONY,,,26,,NW,,,,,,$612.12,$0.00,1,0,1,1,1,1,20171001, D7241,HCPCS,IMPACT TOOTH REM BONY W/COMP,,,26,,NW,,,,,,$742.25,$0.00,1,0,1,1,1,1,20171001, D7250,HCPCS,TOOTH ROOT REMOVAL,,,26,,NW,,,,,,$365.84,$0.00,1,0,1,1,1,1,20171001, D7251,HCPCS,CORONECTOMY,,,26,,NW,,,,,,$596.36,$0.00,1,0,1,1,1,1,20171001, D7260,HCPCS,ORAL ANTRAL FISTULA CLOSURE,,,26,,NW,,,,,,"$1,833.25",$0.00,1,0,1,1,1,1,20171001, D7261,HCPCS,PRIMARY CLOSURE SINUS PERF,,,26,,NW,,,,,,$933.69,$0.00,1,0,1,1,1,1,20171001, D7270,HCPCS,TOOTH REIMPLANTATION,,,26,,NW,,,,,,$696.60,$0.00,1,0,1,1,1,1,20171001, D7272,HCPCS,TOOTH TRANSPLANTATION,,,26,,NW,,,,,,$915.90,$0.00,1,0,1,1,1,1,20171001, D7280,HCPCS,EXPOSURE OF UNERUPTED TOOTH,,,26,,NW,,,,,,$623.45,$0.00,1,0,1,1,1,1,20171001, D7282,HCPCS,MOBILIZE ERUPTED/MALPOS TOOT,,,26,,NW,,,,,,$469.70,$0.00,1,0,1,1,1,1,20171001, D7283,HCPCS,PLACE DEVICE IMPACTED TOOTH,,,26,,NW,,,,,,$438.92,$0.00,1,0,1,1,1,1,20171001, D7285,HCPCS,BIOPSY OF ORAL TISSUE HARD,,,26,,NW,,,,,,$956.06,$0.00,1,0,1,1,1,1,20171001, D7286,HCPCS,BIOPSY OF ORAL TISSUE SOFT,,,26,,NW,,,,,,$492.31,$0.00,1,0,1,1,1,1,20171001, D7287,HCPCS,EXFOLIATIVE CYTOLOG COLLECT,,,26,,NW,,,,,,$243.48,$0.00,1,0,1,1,1,1,20171001, D7288,HCPCS,BRUSH BIOPSY,,,26,,NW,,,,,,$245.57,$0.00,1,0,1,1,1,1,20171001, D7290,HCPCS,REPOSITIONING OF TEETH,,,26,,NW,,,,,,$588.56,$0.00,1,0,1,1,1,1,20171001, D7291,HCPCS,TRANSSEPTAL FIBEROTOMY,,,26,,NW,,,,,,$379.77,$0.00,1,0,1,1,1,1,20171001, D7292,HCPCS,SCREW RETAINED PLATE,,,26,,NW,,,,,,"$2,283.25",$0.00,1,0,1,1,1,1,20171001, D7293,HCPCS,TEMP ANCHORAGE DEV W FLAP,,,26,,NW,,,,,,"$1,794.84",$0.00,1,0,1,1,1,1,20171001, D7294,HCPCS,TEMP ANCHORAGE DEV W/O FLAP,,,26,,NW,,,,,,"$1,201.80",$0.00,1,0,1,1,1,1,20171001, D7295,HCPCS,"BONE HARVEST,AUTO GRAFT PROC",,,26,,NW,,,,,,"$1,135.13",$0.00,1,0,1,1,1,1,20171001, D7310,HCPCS,ALVEOPLASTY W/ EXTRACTION,,,26,,NW,,,,,,$378.18,$0.00,1,0,1,1,1,1,20171001, D7311,HCPCS,ALVEOLOPLASTY W/EXTRACT 1-3,,,26,,NW,,,,,,$360.40,$0.00,1,0,1,1,1,1,20171001, D7320,HCPCS,ALVEOPLASTY W/O EXTRACTION,,,26,,NW,,,,,,$585.83,$0.00,1,0,1,1,1,1,20171001, D7321,HCPCS,ALVEOLOPLASTY NOT W/EXTRACTS,,,26,,NW,,,,,,$520.45,$0.00,1,0,1,1,1,1,20171001, D7340,HCPCS,VESTIBULOPLASTY RIDGE EXTENS,,,26,,NW,,,,,,"$2,077.59",$0.00,1,0,1,1,1,1,20171001, D7350,HCPCS,VESTIBULOPLASTY EXTEN GRAFT,,,26,,NW,,,,,,"$5,192.34",$0.00,1,0,1,1,1,1,20171001, D7410,HCPCS,RAD EXC LESION UP TO 1.25 CM,,,26,,NW,,,,,,$833.75,$0.00,1,0,1,1,1,1,20171001, D7411,HCPCS,EXCISION BENIGN LESION>1.25C,,,26,,NW,,,,,,"$1,289.33",$0.00,1,0,1,1,1,1,20171001, D7412,HCPCS,EXCISION BENIGN LESION COMPL,,,26,,NW,,,,,,"$1,567.61",$0.00,1,0,1,1,1,1,20171001, D7413,HCPCS,EXCISION MALIG LESION<=1.25C,,,26,,NW,,,,,,"$1,162.25",$0.00,1,0,1,1,1,1,20171001, D7414,HCPCS,EXCISION MALIG LESION>1.25CM,,,26,,NW,,,,,,"$1,741.80",$0.00,1,0,1,1,1,1,20171001, D7415,HCPCS,EXCISION MALIG LES COMPLICAT,,,26,,NW,,,,,,"$1,893.49",$0.00,1,0,1,1,1,1,20171001, D7440,HCPCS,MALIG TUMOR EXC TO 1.25 CM,,,26,,NW,,,,,,"$1,478.17",$0.00,1,0,1,1,1,1,20171001, D7441,HCPCS,MALIG TUMOR > 1.25 CM,,,26,,NW,,,,,,"$2,310.89",$0.00,1,0,1,1,1,1,20171001, D7450,HCPCS,REM ODONTOGEN CYST TO 1.25CM,,,26,,NW,,,,,,$957.73,$0.00,1,0,1,1,1,1,20171001, D7451,HCPCS,REM ODONTOGEN CYST > 1.25 CM,,,26,,NW,,,,,,"$1,323.35",$0.00,1,0,1,1,1,1,20171001, D7460,HCPCS,REM NONODONTO CYST TO 1.25CM,,,26,,NW,,,,,,$944.13,$0.00,1,0,1,1,1,1,20171001, D7461,HCPCS,REM NONODONTO CYST > 1.25 CM,,,26,,NW,,,,,,"$1,441.57",$0.00,1,0,1,1,1,1,20171001, D7465,HCPCS,LESION DESTRUCTION,,,26,,NW,,,,,,$588.45,$0.00,1,0,1,1,1,1,20171001, D7471,HCPCS,REM EXOSTOSIS ANY SITE,,,26,,NW,,,,,,"$1,165.59",$0.00,1,0,1,1,1,1,20171001, D7472,HCPCS,REMOVAL OF TORUS PALATINUS,,,26,,NW,,,,,,"$1,371.67",$0.00,1,0,1,1,1,1,20171001, D7473,HCPCS,REMOVE TORUS MANDIBULARIS,,,26,,NW,,,,,,"$1,302.11",$0.00,1,0,1,1,1,1,20171001, D7485,HCPCS,SURG REDUCT OSSEOUSTUBEROSIT,,,26,,NW,,,,,,"$1,161.41",$0.00,1,0,1,1,1,1,20171001, D7490,HCPCS,MAXILLA OR MANDIBLE RESECTIO,,,26,,NW,,,,,,"$10,289.21",$0.00,1,0,1,1,1,1,20171001, D7510,HCPCS,I&D ABSC INTRAORAL SOFT TISS,,,26,,NW,,,,,,$359.34,$0.00,1,0,1,1,1,1,20171001, D7511,HCPCS,INCISION/DRAIN ABSCESS INTRA,,,26,,NW,,,,,,$523.06,$0.00,1,0,1,1,1,1,20171001, D7520,HCPCS,I&D ABSCESS EXTRAORAL,,,26,,NW,,,,,,"$1,264.84",$0.00,1,0,1,1,1,1,20171001, D7521,HCPCS,INCISION/DRAIN ABSCESS EXTRA,,,26,,NW,,,,,,"$1,458.27",$0.00,1,0,1,1,1,1,20171001, D7530,HCPCS,REMOVAL FB SKIN/AREOLAR TISS,,,26,,NW,,,,,,$573.38,$0.00,1,0,1,1,1,1,20171001, D7540,HCPCS,REMOVAL OF FB REACTION,,,26,,NW,,,,,,$789.94,$0.00,1,0,1,1,1,1,20171001, D7550,HCPCS,REMOVAL OF SLOUGHED OFF BONE,,,26,,NW,,,,,,$616.71,$0.00,1,0,1,1,1,1,20171001, D7560,HCPCS,MAXILLARY SINUSOTOMY,,,26,,NW,,,,,,"$2,890.41",$0.00,1,0,1,1,1,1,20171001, D7610,HCPCS,MAXILLA OPEN REDUCT SIMPLE,,,26,,NW,,,,,,"$5,882.93",$0.00,1,0,1,1,1,1,20171001, D7620,HCPCS,CLSD REDUCT SIMPL MAXILLA FX,,,26,,NW,,,,,,"$4,447.53",$0.00,1,0,1,1,1,1,20171001, D7630,HCPCS,OPEN RED SIMPL MANDIBLE FX,,,26,,NW,,,,,,"$6,786.94",$0.00,1,0,1,1,1,1,20171001, D7640,HCPCS,CLSD RED SIMPL MANDIBLE FX,,,26,,NW,,,,,,"$4,636.24",$0.00,1,0,1,1,1,1,20171001, D7650,HCPCS,OPEN RED SIMP MALAR/ZYGOM FX,,,26,,NW,,,,,,"$4,259.16",$0.00,1,0,1,1,1,1,20171001, D7660,HCPCS,CLSD RED SIMP MALAR/ZYGOM FX,,,26,,NW,,,,,,"$3,070.25",$0.00,1,0,1,1,1,1,20171001, D7670,HCPCS,CLOSD RDUCTN SPLINT ALVEOLUS,,,26,,NW,,,,,,"$1,974.91",$0.00,1,0,1,1,1,1,20171001, D7671,HCPCS,ALVEOLUS OPEN REDUCTION,,,26,,NW,,,,,,"$2,634.13",$0.00,1,0,1,1,1,1,20171001, D7680,HCPCS,REDUCT SIMPLE FACIAL BONE FX,,,26,,NW,,,,,,"$9,982.55",$0.00,1,0,1,1,1,1,20171001, D7710,HCPCS,MAXILLA OPEN REDUCT COMPOUND,,,26,,NW,,,,,,"$6,355.32",$0.00,1,0,1,1,1,1,20171001, D7720,HCPCS,CLSD REDUCT COMPD MAXILLA FX,,,26,,NW,,,,,,"$4,638.85",$0.00,1,0,1,1,1,1,20171001, D7730,HCPCS,OPEN REDUCT COMPD MANDBLE FX,,,26,,NW,,,,,,"$8,341.44",$0.00,1,0,1,1,1,1,20171001, D7740,HCPCS,CLSD REDUCT COMPD MANDBLE FX,,,26,,NW,,,,,,"$4,766.17",$0.00,1,0,1,1,1,1,20171001, D7750,HCPCS,OPEN RED COMP MALAR/ZYGMA FX,,,26,,NW,,,,,,"$5,877.25",$0.00,1,0,1,1,1,1,20171001, D7760,HCPCS,CLSD RED COMP MALAR/ZYGMA FX,,,26,,NW,,,,,,"$4,935.72",$0.00,1,0,1,1,1,1,20171001, D7770,HCPCS,OPEN REDUC COMPD ALVEOLUS FX,,,26,,NW,,,,,,"$3,486.77",$0.00,1,0,1,1,1,1,20171001, D7771,HCPCS,ALVEOLUS CLSD REDUC STBLZ TE,,,26,,NW,,,,,,"$2,578.19",$0.00,1,0,1,1,1,1,20171001, D7780,HCPCS,REDUCT COMPND FACIAL BONE FX,,,26,,NW,,,,,,"$12,932.38",$0.00,1,0,1,1,1,1,20171001, D7810,HCPCS,TMJ OPEN REDUCT-DISLOCATION,,,26,,NW,,,,,,"$6,080.94",$0.00,1,0,1,1,1,1,20171001, D7820,HCPCS,CLOSED TMP MANIPULATION,,,26,,NW,,,,,,$961.91,$0.00,1,0,1,1,1,1,20171001, D7830,HCPCS,TMJ MANIPULATION UNDER ANEST,,,26,,NW,,,,,,$930.77,$0.00,1,0,1,1,1,1,20171001, D7840,HCPCS,REMOVAL OF TMJ CONDYLE,,,26,,NW,,,,,,"$8,022.22",$0.00,1,0,1,1,1,1,20171001, D7850,HCPCS,TMJ MENISCECTOMY,,,26,,NW,,,,,,"$7,248.63",$0.00,1,0,1,1,1,1,20171001, D7852,HCPCS,TMJ REPAIR OF JOINT DISC,,,26,,NW,,,,,,"$7,990.84",$0.00,1,0,1,1,1,1,20171001, D7854,HCPCS,TMJ EXCISN OF JOINT MEMBRANE,,,26,,NW,,,,,,"$8,078.18",$0.00,1,0,1,1,1,1,20171001, D7856,HCPCS,TMJ CUTTING OF A MUSCLE,,,26,,NW,,,,,,"$5,696.67",$0.00,1,0,1,1,1,1,20171001, D7858,HCPCS,TMJ RECONSTRUCTION,,,26,,NW,,,,,,"$21,802.59",$0.00,1,0,1,1,1,1,20171001, D7860,HCPCS,TMJ CUTTING INTO JOINT,,,26,,NW,,,,,,"$9,292.94",$0.00,1,0,1,1,1,1,20171001, D7865,HCPCS,TMJ RESHAPING COMPONENTS,,,26,,NW,,,,,,"$14,975.43",$0.00,1,0,1,1,1,1,20171001, D7870,HCPCS,TMJ ASPIRATION JOINT FLUID,,,26,,NW,,,,,,$579.05,$0.00,1,0,1,1,1,1,20171001, D7871,HCPCS,LYSIS + LAVAGE W CATHETERS,,,26,,NW,,,,,,$989.75,$0.00,1,0,1,1,1,1,20171001, D7872,HCPCS,TMJ DIAGNOSTIC ARTHROSCOPY,,,26,,NW,,,,,,"$5,282.28",$0.00,1,0,1,1,1,1,20171001, D7873,HCPCS,TMJ ARTHROSCOPY LYSIS ADHESN,,,26,,NW,,,,,,"$6,360.25",$0.00,1,0,1,1,1,1,20171001, D7874,HCPCS,TMJ ARTHROSCOPY DISC REPOSIT,,,26,,NW,,,,,,"$9,122.96",$0.00,1,0,1,1,1,1,20171001, D7875,HCPCS,TMJ ARTHROSCOPY SYNOVECTOMY,,,26,,NW,,,,,,"$9,994.38",$0.00,1,0,1,1,1,1,20171001, D7876,HCPCS,TMJ ARTHROSCOPY DISCECTOMY,,,26,,NW,,,,,,"$10,775.42",$0.00,1,0,1,1,1,1,20171001, D7877,HCPCS,TMJ ARTHROSCOPY DEBRIDEMENT,,,26,,NW,,,,,,"$9,510.26",$0.00,1,0,1,1,1,1,20171001, D7880,HCPCS,OCCLUSAL ORTHOTIC APPLIANCE,,,26,,NW,,,,,,"$1,172.00",$0.00,1,0,1,1,1,1,20171001, D7881,HCPCS,OCC ORTHOTIC DEVICE ADJUST,,,26,,NW,,,,,,$862.76,$0.00,1,0,1,1,1,1,20171001, D7899,HCPCS,TMJ UNSPECIFIED THERAPY,,,26,,NW,,,,,,"$1,172.00",$0.00,1,0,1,1,1,1,20171001, D7910,HCPCS,DENT SUTUR RECENT WND TO 5CM,,,26,,NW,,,,,,$506.53,$0.00,1,0,1,1,1,1,20171001, D7911,HCPCS,DENTAL SUTURE WOUND TO 5 CM,,,26,,NW,,,,,,"$1,095.90",$0.00,1,0,1,1,1,1,20171001, D7912,HCPCS,SUTURE COMPLICATE WND > 5 CM,,,26,,NW,,,,,,"$1,902.97",$0.00,1,0,1,1,1,1,20171001, D7920,HCPCS,DENTAL SKIN GRAFT,,,26,,NW,,,,,,"$4,029.16",$0.00,1,0,1,1,1,1,20171001, D7921,HCPCS,COLLECT & APPL BLOOD PRODUCT,,,26,,NW,,,,,,$464.17,$0.00,1,0,1,1,1,1,20171001, D7940,HCPCS,RESHAPING BONE ORTHOGNATHIC,,,26,,NW,,,,,,"$4,940.18",$0.00,1,0,1,1,1,1,20171001, D7941,HCPCS,BONE CUTTING RAMUS CLOSED,,,26,,NW,,,,,,"$11,150.74",$0.00,1,0,1,1,1,1,20171001, D7943,HCPCS,CUTTING RAMUS OPEN W/GRAFT,,,26,,NW,,,,,,"$10,608.34",$0.00,1,0,1,1,1,1,20171001, D7944,HCPCS,BONE CUTTING SEGMENTED,,,26,,NW,,,,,,"$8,986.80",$0.00,1,0,1,1,1,1,20171001, D7945,HCPCS,BONE CUTTING BODY MANDIBLE,,,26,,NW,,,,,,"$10,742.65",$0.00,1,0,1,1,1,1,20171001, D7946,HCPCS,RECONSTRUCTION MAXILLA TOTAL,,,26,,NW,,,,,,"$13,180.11",$0.00,1,0,1,1,1,1,20171001, D7947,HCPCS,RECONSTRUCT MAXILLA SEGMENT,,,26,,NW,,,,,,"$11,808.70",$0.00,1,0,1,1,1,1,20171001, D7948,HCPCS,RECONSTRUCT MIDFACE NO GRAFT,,,26,,NW,,,,,,"$14,710.09",$0.00,1,0,1,1,1,1,20171001, D7949,HCPCS,RECONSTRUCT MIDFACE W/GRAFT,,,26,,NW,,,,,,"$18,519.51",$0.00,1,0,1,1,1,1,20171001, D7950,HCPCS,MANDIBLE GRAFT,,,26,,NW,,,,,,"$3,583.25",$0.00,1,0,1,1,1,1,20171001, D7951,HCPCS,SINUS AUG W BONE OR BONE SUB,,,26,,NW,,,,,,"$3,798.77",$0.00,1,0,1,1,1,1,20171001, D7952,HCPCS,SINUS AUGMENTATION VERTICAL,,,26,,NW,,,,,,"$2,556.92",$0.00,1,0,1,1,1,1,20171001, D7953,HCPCS,BONE REPLACEMENT GRAFT,,,26,,NW,,,,,,$781.47,$0.00,1,0,1,1,1,1,20171001, D7955,HCPCS,REPAIR MAXILLOFACIAL DEFECTS,,,26,,NW,,,,,,"$4,218.30",$0.00,1,0,1,1,1,1,20171001, D7960,HCPCS,FRENULECTOMY/FRENECTOMY,,,26,,NW,,,,,,$539.28,$0.00,1,0,1,1,1,1,20171001, D7963,HCPCS,FRENULOPLASTY,,,26,,NW,,,,,,$739.09,$0.00,1,0,1,1,1,1,20171001, D7970,HCPCS,EXCISION HYPERPLASTIC TISSUE,,,26,,NW,,,,,,$702.48,$0.00,1,0,1,1,1,1,20171001, D7971,HCPCS,EXCISION PERICORONAL GINGIVA,,,26,,NW,,,,,,$315.41,$0.00,1,0,1,1,1,1,20171001, D7972,HCPCS,SURG REDCT FIBROUS TUBEROSIT,,,26,,NW,,,,,,$968.72,$0.00,1,0,1,1,1,1,20171001, D7980,HCPCS,SIALOLITHOTOMY,,,26,,NW,,,,,,"$1,113.08",$0.00,1,0,1,1,1,1,20171001, D7981,HCPCS,EXCISION OF SALIVARY GLAND,,,26,,NW,,,,,,$716.77,$0.00,1,0,1,1,1,1,20171001, D7982,HCPCS,SIALODOCHOPLASTY,,,26,,NW,,,,,,"$2,478.28",$0.00,1,0,1,1,1,1,20171001, D7983,HCPCS,CLOSURE OF SALIVARY FISTULA,,,26,,NW,,,,,,"$2,306.71",$0.00,1,0,1,1,1,1,20171001, D7990,HCPCS,EMERGENCY TRACHEOTOMY,,,26,,NW,,,,,,"$2,153.46",$0.00,1,0,1,1,1,1,20171001, D7991,HCPCS,DENTAL CORONOIDECTOMY,,,26,,NW,,,,,,"$5,334.23",$0.00,1,0,1,1,1,1,20171001, D7995,HCPCS,SYNTHETIC GRAFT FACIAL BONES,,,26,,NW,,,,,,$539.11,$0.00,1,0,1,1,1,1,20171001, D7996,HCPCS,IMPLANT MANDIBLE FOR AUGMENT,,,26,,NW,,,,,,"$2,266.73",$0.00,1,0,1,1,1,1,20171001, D7997,HCPCS,APPLIANCE REMOVAL,,,26,,NW,,,,,,$432.05,$0.00,1,0,1,1,1,1,20171001, D7998,HCPCS,INTRAORAL PLACE OF FIX DEV,,,26,,NW,,,,,,"$2,460.55",$0.00,1,0,1,1,1,1,20171001, D7999,HCPCS,ORAL SURGERY PROCEDURE,,,26,,NW,,,,,,$781.47,$0.00,1,0,1,1,1,1,20171001, D8010,HCPCS,LIMITED DENTAL TX PRIMARY,,,27,,NW,,,,,,"$2,804.88",$0.00,1,0,1,1,1,1,20171001, D8020,HCPCS,LIMITED DENTAL TX TRANSITION,,,27,,NW,,,,,,"$3,148.03",$0.00,1,0,1,1,1,1,20171001, D8030,HCPCS,LIMITED DENTAL TX ADOLESCENT,,,27,,NW,,,,,,"$3,798.77",$0.00,1,0,1,1,1,1,20171001, D8040,HCPCS,LIMITED DENTAL TX ADULT,,,27,,NW,,,,,,"$4,204.70",$0.00,1,0,1,1,1,1,20171001, D8050,HCPCS,INTERCEP DENTAL TX PRIMARY,,,27,,NW,,,,,,"$3,246.37",$0.00,1,0,1,1,1,1,20171001, D8060,HCPCS,INTERCEP DENTAL TX TRANSITN,,,27,,NW,,,,,,"$3,475.49",$0.00,1,0,1,1,1,1,20171001, D8070,HCPCS,COMPRE DENTAL TX TRANSITION,,,27,,NW,,,,,,"$6,296.06",$0.00,1,0,1,1,1,1,20171001, D8080,HCPCS,COMPRE DENTAL TX ADOLESCENT,,,27,,NW,,,,,,"$6,403.82",$0.00,1,0,1,1,1,1,20171001, D8090,HCPCS,COMPRE DENTAL TX ADULT,,,27,,NW,,,,,,"$6,512.63",$0.00,1,0,1,1,1,1,20171001, D8210,HCPCS,ORTHODONTIC REM APPLIANCE TX,,,27,,NW,,,,,,"$1,082.82",$0.00,1,0,1,1,1,1,20171001, D8220,HCPCS,FIXED APPLIANCE THERAPY HABT,,,27,,NW,,,,,,"$1,179.07",$0.00,1,0,1,1,1,1,20171001, D8660,HCPCS,PREORTHODONTIC TX VISIT,,,27,,NW,,,,,,$545.07,$0.00,1,0,1,1,1,1,20171001, D8670,HCPCS,PERIODIC ORTHODONTC TX VISIT,,,27,,NW,,,,,,$355.71,$0.00,1,0,1,1,1,1,20171001, D8680,HCPCS,ORTHODONTIC RETENTION,,,27,,NW,,,,,,$646.55,$0.00,1,0,1,1,1,1,20171001, D8681,HCPCS,REMOVABLE RETAINER ADJUST,,,27,,NW,,,,,,"$1,082.82",$0.00,1,0,1,1,1,1,20171001, D8690,HCPCS,ORTHODONTIC TREATMENT,,,27,,NW,,,,,,$431.04,$0.00,1,0,1,1,1,1,20171001, D8691,HCPCS,REPAIR ORTHO APPLIANCE,,,27,,NW,,,,,,$272.01,$0.00,1,0,1,1,1,1,20171001, D8692,HCPCS,REPLACEMENT RETAINER,,,27,,NW,,,,,,$412.20,$0.00,1,0,1,1,1,1,20171001, D8693,HCPCS,REBOND/RECEMENT RETAINERS,,,27,,NW,,,,,,$402.79,$0.00,1,0,1,1,1,1,20171001, D8694,HCPCS,REPAIR FIXED RETAINERS,,,27,,NW,,,,,,$378.73,$0.00,1,0,1,1,1,1,20171001, D8999,HCPCS,ORTHODONTIC PROCEDURE,,,27,,NW,,,,,,$355.71,$0.00,1,0,1,1,1,1,20171001, D9110,HCPCS,TX DENTAL PAIN MINOR PROC,,,26,,NW,,,,,,$158.88,$0.00,1,0,1,1,1,1,20171001, D9120,HCPCS,FIX PARTIAL DENTURE SECTION,,,27,,NW,,,,,,$227.62,$0.00,1,0,1,1,1,1,20171001, D9210,HCPCS,DENT ANESTHESIA W/O SURGERY,,,26,,NW,,,,,,$73.43,$0.00,1,0,1,1,1,1,20171001, D9211,HCPCS,REGIONAL BLOCK ANESTHESIA,,,26,,NW,,,,,,$86.72,$0.00,1,0,1,1,1,1,20171001, D9212,HCPCS,TRIGEMINAL BLOCK ANESTHESIA,,,26,,NW,,,,,,$204.16,$0.00,1,0,1,1,1,1,20171001, D9215,HCPCS,LOCAL ANESTHESIA,,,26,,NW,,,,,,$63.47,$0.00,1,0,1,1,1,1,20171001, D9219,HCPCS,EVAL FOR DEEP SED/GEN ANESTH,,,26,,NW,,,,,,$119.23,$0.00,1,0,1,1,1,1,20171001, D9223,HCPCS,GENERAL ANESTHESIA EACH 15M,,,26,,NW,,,,,,$245.60,$0.00,1,0,1,1,1,1,20171001, D9230,HCPCS,ANALGESIA,,,26,,NW,,,,,,$95.04,$0.00,1,0,1,1,1,1,20171001, D9243,HCPCS,IV SEDATION EACH 15M,,,26,,NW,,,,,,$207.82,$0.00,1,0,1,1,1,1,20171001, D9248,HCPCS,SEDATION (NON-IV),,,26,,NW,,,,,,$260.72,$0.00,1,0,1,1,1,1,20171001, D9310,HCPCS,DENTAL CONSULTATION,,,25,,NW,,,,,,$172.06,$0.00,1,0,1,1,1,1,20171001, D9410,HCPCS,DENTAL HOUSE CALL,,,25,,NW,,,,,,$244.32,$0.00,1,0,1,1,1,1,20171001, D9420,HCPCS,HOSPITAL/ASC CALL,,,25,,NW,,,,,,$345.62,$0.00,1,0,1,1,1,1,20171001, D9430,HCPCS,OFFICE VISIT DURING HOURS,,,25,,NW,,,,,,$103.57,$0.00,1,0,1,1,1,1,20171001, D9440,HCPCS,OFFICE VISIT AFTER HOURS,,,25,,NW,,,,,,$161.42,$0.00,1,0,1,1,1,1,20171001, D9450,HCPCS,CASE PRESENTATION TX PLAN,,,25,,NW,,,,,,$130.40,$0.00,1,0,1,1,1,1,20171001, D9610,HCPCS,DENT THERAPEUTIC DRUG INJECT,,,27,,NW,,,,,,$136.01,$0.00,1,0,1,1,1,1,20171001, D9612,HCPCS,THERA PAR DRUGS 2 OR > ADMIN,,,27,,NW,,,,,,$219.70,$0.00,1,0,1,1,1,1,20171001, D9630,HCPCS,DRUGS/MEDS DISP FOR HOME USE,,,27,,NW,,,,,,$54.40,$0.00,1,0,1,1,1,1,20171001, D9910,HCPCS,DENT APPL DESENSITIZING MED,,,27,,NW,,,,,,$77.29,$0.00,1,0,1,1,1,1,20171001, D9911,HCPCS,APPL DESENSITIZING RESIN,,,27,,NW,,,,,,$101.51,$0.00,1,0,1,1,1,1,20171001, D9920,HCPCS,BEHAVIOR MANAGEMENT,,,27,,NW,,,,,,$190.41,$0.00,1,0,1,1,1,1,20171001, D9930,HCPCS,TREATMENT OF COMPLICATIONS,,,27,,NW,,,,,,$161.12,$0.00,1,0,1,1,1,1,20171001, D9932,HCPCS,CLEAN & INSPECT REM DENT MAX,,,27,,NW,,,,,,$181.90,$0.00,1,0,1,1,1,1,20171001, D9933,HCPCS,CLEAN & INSPECT REM DENT MAN,,,27,,NW,,,,,,$181.90,$0.00,1,0,1,1,1,1,20171001, D9934,HCPCS,CLEAN REM PART DENTURE MAX,,,27,,NW,,,,,,$181.90,$0.00,1,0,1,1,1,1,20171001, D9935,HCPCS,CLEAN REM PART DENTURE MAND,,,27,,NW,,,,,,$181.90,$0.00,1,0,1,1,1,1,20171001, D9940,HCPCS,DENTAL OCCLUSAL GUARD,,,27,,NW,,,,,,$679.13,$0.00,1,0,1,1,1,1,20171001, D9941,HCPCS,FABRICATION ATHLETIC GUARD,,,27,,NW,,,,,,$279.42,$0.00,1,0,1,1,1,1,20171001, D9942,HCPCS,REPAIR/RELINE OCCLUSAL GUARD,,,27,,NW,,,,,,$285.40,$0.00,1,0,1,1,1,1,20171001, D9943,HCPCS,OCCLUSAL GUARD ADJUSTMENT,,,27,,NW,,,,,,$205.14,$0.00,1,0,1,1,1,1,20171001, D9950,HCPCS,OCCLUSION ANALYSIS,,,27,,NW,,,,,,$418.02,$0.00,1,0,1,1,1,1,20171001, D9951,HCPCS,LIMITED OCCLUSAL ADJUSTMENT,,,27,,NW,,,,,,$211.77,$0.00,1,0,1,1,1,1,20171001, D9952,HCPCS,COMPLETE OCCLUSAL ADJUSTMENT,,,27,,NW,,,,,,$850.39,$0.00,1,0,1,1,1,1,20171001, D9970,HCPCS,ENAMEL MICROABRASION,,,27,,NW,,,,,,$178.36,$0.00,1,0,1,1,1,1,20171001, D9971,HCPCS,ODONTOPLASTY 1-2 TEETH,,,27,,NW,,,,,,$170.14,$0.00,1,0,1,1,1,1,20171001, D9972,HCPCS,EXTRNL BLEACHING PER ARCH,,,27,,NW,,,,,,$421.79,$0.00,1,0,1,1,1,1,20171001, D9973,HCPCS,EXTRNL BLEACHING PER TOOTH,,,27,,NW,,,,,,$176.14,$0.00,1,0,1,1,1,1,20171001, D9974,HCPCS,INTRNL BLEACHING PER TOOTH,,,27,,NW,,,,,,$362.40,$0.00,1,0,1,1,1,1,20171001, D9975,HCPCS,EXTERNAL BLEACHING HOME APP,,,27,,NW,,,,,,$401.39,$0.00,1,0,1,1,1,1,20171001, D9999,HCPCS,ADJUNCTIVE PROCEDURE,,,27,,NW,,,,,,$172.06,$0.00,1,0,1,1,1,1,20171001, E0100,HCPCS,CANE ADJUST/FIXED WITH TIP,,,28,,NW,,,,,,$111.61,$0.00,1,1,1,1,1,1,20171001, E0100,HCPCS,CANE ADJUST/FIXED WITH TIP,NU,,28,,NW,,,,,,$111.61,$0.00,1,1,1,1,1,1,20171001, E0100,HCPCS,CANE ADJUST/FIXED WITH TIP,RR,,28,,NW,,,,,,$60.38,$0.00,1,1,1,1,1,1,20171001, E0100,HCPCS,CANE ADJUST/FIXED WITH TIP,UE,,28,,NW,,,,,,$102.05,$0.00,1,1,1,1,1,1,20171001, E0105,HCPCS,CANE ADJUST/FIXED QUAD/3 PRO,,,28,,NW,,,,,,$172.06,$0.00,1,1,1,1,1,1,20171001, E0105,HCPCS,CANE ADJUST/FIXED QUAD/3 PRO,NU,,28,,NW,,,,,,$172.06,$0.00,1,1,1,1,1,1,20171001, E0105,HCPCS,CANE ADJUST/FIXED QUAD/3 PRO,RR,,28,,NW,,,,,,$85.70,$0.00,1,1,1,1,1,1,20171001, E0105,HCPCS,CANE ADJUST/FIXED QUAD/3 PRO,UE,,28,,NW,,,,,,$146.98,$0.00,1,1,1,1,1,1,20171001, E0110,HCPCS,CRUTCH FOREARM PAIR,,,28,,NW,,,,,,$226.89,$0.00,1,1,1,1,1,1,20171001, E0110,HCPCS,CRUTCH FOREARM PAIR,NU,,28,,NW,,,,,,$226.89,$0.00,1,1,1,1,1,1,20171001, E0110,HCPCS,CRUTCH FOREARM PAIR,RR,,28,,NW,,,,,,$100.04,$0.00,1,1,1,1,1,1,20171001, E0110,HCPCS,CRUTCH FOREARM PAIR,UE,,28,,NW,,,,,,$187.05,$0.00,1,1,1,1,1,1,20171001, E0111,HCPCS,CRUTCH FOREARM EACH,,,28,,NW,,,,,,$176.00,$0.00,1,1,1,1,1,1,20171001, E0111,HCPCS,CRUTCH FOREARM EACH,NU,,28,,NW,,,,,,$176.00,$0.00,1,1,1,1,1,1,20171001, E0111,HCPCS,CRUTCH FOREARM EACH,RR,,28,,NW,,,,,,$84.63,$0.00,1,1,1,1,1,1,20171001, E0111,HCPCS,CRUTCH FOREARM EACH,UE,,28,,NW,,,,,,$150.81,$0.00,1,1,1,1,1,1,20171001, E0112,HCPCS,CRUTCH UNDERARM PAIR WOOD,,,28,,NW,,,,,,$143.70,$0.00,1,1,1,1,1,1,20171001, E0112,HCPCS,CRUTCH UNDERARM PAIR WOOD,NU,,28,,NW,,,,,,$143.70,$0.00,1,1,1,1,1,1,20171001, E0112,HCPCS,CRUTCH UNDERARM PAIR WOOD,RR,,28,,NW,,,,,,$87.61,$0.00,1,1,1,1,1,1,20171001, E0112,HCPCS,CRUTCH UNDERARM PAIR WOOD,UE,,28,,NW,,,,,,$125.93,$0.00,1,1,1,1,1,1,20171001, E0113,HCPCS,CRUTCH UNDERARM EACH WOOD,,,28,,NW,,,,,,$110.66,$0.00,1,1,1,1,1,1,20171001, E0113,HCPCS,CRUTCH UNDERARM EACH WOOD,NU,,28,,NW,,,,,,$110.66,$0.00,1,1,1,1,1,1,20171001, E0113,HCPCS,CRUTCH UNDERARM EACH WOOD,RR,,28,,NW,,,,,,$49.65,$0.00,1,1,1,1,1,1,20171001, E0113,HCPCS,CRUTCH UNDERARM EACH WOOD,UE,,28,,NW,,,,,,$99.91,$0.00,1,1,1,1,1,1,20171001, E0114,HCPCS,CRUTCH UNDERARM PAIR NO WOOD,,,28,,NW,,,,,,$163.79,$0.00,1,1,1,1,1,1,20171001, E0114,HCPCS,CRUTCH UNDERARM PAIR NO WOOD,NU,,28,,NW,,,,,,$163.79,$0.00,1,1,1,1,1,1,20171001, E0114,HCPCS,CRUTCH UNDERARM PAIR NO WOOD,RR,,28,,NW,,,,,,$84.96,$0.00,1,1,1,1,1,1,20171001, E0114,HCPCS,CRUTCH UNDERARM PAIR NO WOOD,UE,,28,,NW,,,,,,$140.17,$0.00,1,1,1,1,1,1,20171001, E0116,HCPCS,CRUTCH UNDERARM EACH NO WOOD,,,28,,NW,,,,,,$121.99,$0.00,1,1,1,1,1,1,20171001, E0116,HCPCS,CRUTCH UNDERARM EACH NO WOOD,NU,,28,,NW,,,,,,$121.99,$0.00,1,1,1,1,1,1,20171001, E0116,HCPCS,CRUTCH UNDERARM EACH NO WOOD,RR,,28,,NW,,,,,,$51.66,$0.00,1,1,1,1,1,1,20171001, E0116,HCPCS,CRUTCH UNDERARM EACH NO WOOD,UE,,28,,NW,,,,,,$108.55,$0.00,1,1,1,1,1,1,20171001, E0117,HCPCS,UNDERARM SPRINGASSIST CRUTCH,,,28,,NW,,,,,,$338.68,$0.00,1,1,1,1,1,1,20171001, E0117,HCPCS,UNDERARM SPRINGASSIST CRUTCH,NU,,28,,NW,,,,,,$338.68,$0.00,1,1,1,1,1,1,20171001, E0117,HCPCS,UNDERARM SPRINGASSIST CRUTCH,RR,,28,,NW,,,,,,$109.35,$0.00,1,1,1,1,1,1,20171001, E0117,HCPCS,UNDERARM SPRINGASSIST CRUTCH,UE,,28,,NW,,,,,,$270.66,$0.00,1,1,1,1,1,1,20171001, E0118,HCPCS,CRUTCH SUBSTITUTE,,,28,,NW,,,,,,$561.47,$0.00,1,1,1,1,1,1,20171001, E0118,HCPCS,CRUTCH SUBSTITUTE,RR,,28,,NW,,,,,,$118.26,$0.00,1,1,1,1,1,1,20171001, E0130,HCPCS,WALKER RIGID ADJUST/FIXED HT,,,28,,NW,,,,,,$161.15,$0.00,1,1,1,1,1,1,20171001, E0130,HCPCS,WALKER RIGID ADJUST/FIXED HT,NU,,28,,NW,,,,,,$161.15,$0.00,1,1,1,1,1,1,20171001, E0130,HCPCS,WALKER RIGID ADJUST/FIXED HT,RR,,28,,NW,,,,,,$43.71,$0.00,1,1,1,1,1,1,20171001, E0130,HCPCS,WALKER RIGID ADJUST/FIXED HT,UE,,28,,NW,,,,,,$137.78,$0.00,1,1,1,1,1,1,20171001, E0135,HCPCS,WALKER FOLDING ADJUST/FIXED,,,28,,NW,,,,,,$153.83,$0.00,1,1,1,1,1,1,20171001, E0135,HCPCS,WALKER FOLDING ADJUST/FIXED,NU,,28,,NW,,,,,,$153.83,$0.00,1,1,1,1,1,1,20171001, E0135,HCPCS,WALKER FOLDING ADJUST/FIXED,RR,,28,,NW,,,,,,$40.30,$0.00,1,1,1,1,1,1,20171001, E0135,HCPCS,WALKER FOLDING ADJUST/FIXED,UE,,28,,NW,,,,,,$132.29,$0.00,1,1,1,1,1,1,20171001, E0140,HCPCS,WALKER W TRUNK SUPPORT,,,28,,NW,,,,,,$954.20,$0.00,1,1,1,1,1,1,20171001, E0140,HCPCS,WALKER W TRUNK SUPPORT,NU,,28,,NW,,,,,,$954.20,$0.00,1,1,1,1,1,1,20171001, E0140,HCPCS,WALKER W TRUNK SUPPORT,RR,,28,,NW,,,,,,$120.75,$0.00,1,1,1,1,1,1,20171001, E0140,HCPCS,WALKER W TRUNK SUPPORT,UE,,28,,NW,,,,,,$355.29,$0.00,1,1,1,1,1,1,20171001, E0141,HCPCS,RIGID WHEELED WALKER ADJ/FIX,,,28,,NW,,,,,,$216.56,$0.00,1,1,1,1,1,1,20171001, E0141,HCPCS,RIGID WHEELED WALKER ADJ/FIX,NU,,28,,NW,,,,,,$216.56,$0.00,1,1,1,1,1,1,20171001, E0141,HCPCS,RIGID WHEELED WALKER ADJ/FIX,RR,,28,,NW,,,,,,$77.39,$0.00,1,1,1,1,1,1,20171001, E0141,HCPCS,RIGID WHEELED WALKER ADJ/FIX,UE,,28,,NW,,,,,,$179.35,$0.00,1,1,1,1,1,1,20171001, E0143,HCPCS,WALKER FOLDING WHEELED W/O S,,,28,,NW,,,,,,$160.70,$0.00,1,1,1,1,1,1,20171001, E0143,HCPCS,WALKER FOLDING WHEELED W/O S,NU,,28,,NW,,,,,,$160.70,$0.00,1,1,1,1,1,1,20171001, E0143,HCPCS,WALKER FOLDING WHEELED W/O S,RR,,28,,NW,,,,,,$43.50,$0.00,1,1,1,1,1,1,20171001, E0143,HCPCS,WALKER FOLDING WHEELED W/O S,UE,,28,,NW,,,,,,$137.44,$0.00,1,1,1,1,1,1,20171001, E0144,HCPCS,ENCLOSED WALKER W REAR SEAT,,,28,,NW,,,,,,$926.93,$0.00,1,1,1,1,1,1,20171001, E0144,HCPCS,ENCLOSED WALKER W REAR SEAT,NU,,28,,NW,,,,,,$926.93,$0.00,1,1,1,1,1,1,20171001, E0144,HCPCS,ENCLOSED WALKER W REAR SEAT,RR,,28,,NW,,,,,,$117.30,$0.00,1,1,1,1,1,1,20171001, E0144,HCPCS,ENCLOSED WALKER W REAR SEAT,UE,,28,,NW,,,,,,$321.54,$0.00,1,1,1,1,1,1,20171001, E0147,HCPCS,WALKER VARIABLE WHEEL RESIST,,,28,,NW,,,,,,$802.78,$0.00,1,1,1,1,1,1,20171001, E0147,HCPCS,WALKER VARIABLE WHEEL RESIST,NU,,28,,NW,,,,,,$802.78,$0.00,1,1,1,1,1,1,20171001, E0147,HCPCS,WALKER VARIABLE WHEEL RESIST,RR,,28,,NW,,,,,,$141.18,$0.00,1,1,1,1,1,1,20171001, E0147,HCPCS,WALKER VARIABLE WHEEL RESIST,UE,,28,,NW,,,,,,$619.00,$0.00,1,1,1,1,1,1,20171001, E0148,HCPCS,HEAVYDUTY WALKER NO WHEELS,,,28,,NW,,,,,,$226.18,$0.00,1,1,1,1,1,1,20171001, E0148,HCPCS,HEAVYDUTY WALKER NO WHEELS,NU,,28,,NW,,,,,,$226.18,$0.00,1,1,1,1,1,1,20171001, E0148,HCPCS,HEAVYDUTY WALKER NO WHEELS,RR,,28,,NW,,,,,,$83.37,$0.00,1,1,1,1,1,1,20171001, E0148,HCPCS,HEAVYDUTY WALKER NO WHEELS,UE,,28,,NW,,,,,,$186.56,$0.00,1,1,1,1,1,1,20171001, E0149,HCPCS,HEAVY DUTY WHEELED WALKER,,,28,,NW,,,,,,$715.10,$0.00,1,1,1,1,1,1,20171001, E0149,HCPCS,HEAVY DUTY WHEELED WALKER,NU,,28,,NW,,,,,,$715.10,$0.00,1,1,1,1,1,1,20171001, E0149,HCPCS,HEAVY DUTY WHEELED WALKER,RR,,28,,NW,,,,,,$90.49,$0.00,1,1,1,1,1,1,20171001, E0149,HCPCS,HEAVY DUTY WHEELED WALKER,UE,,28,,NW,,,,,,$245.49,$0.00,1,1,1,1,1,1,20171001, E0153,HCPCS,FOREARM CRUTCH PLATFORM ATTA,,,28,,NW,,,,,,$210.35,$0.00,1,1,1,1,1,1,20171001, E0153,HCPCS,FOREARM CRUTCH PLATFORM ATTA,NU,,28,,NW,,,,,,$210.35,$0.00,1,1,1,1,1,1,20171001, E0153,HCPCS,FOREARM CRUTCH PLATFORM ATTA,RR,,28,,NW,,,,,,$84.04,$0.00,1,1,1,1,1,1,20171001, E0153,HCPCS,FOREARM CRUTCH PLATFORM ATTA,UE,,28,,NW,,,,,,$174.66,$0.00,1,1,1,1,1,1,20171001, E0154,HCPCS,WALKER PLATFORM ATTACHMENT,,,28,,NW,,,,,,$160.21,$0.00,1,1,1,1,1,1,20171001, E0154,HCPCS,WALKER PLATFORM ATTACHMENT,NU,,28,,NW,,,,,,$160.21,$0.00,1,1,1,1,1,1,20171001, E0154,HCPCS,WALKER PLATFORM ATTACHMENT,RR,,28,,NW,,,,,,$43.28,$0.00,1,1,1,1,1,1,20171001, E0154,HCPCS,WALKER PLATFORM ATTACHMENT,UE,,28,,NW,,,,,,$137.08,$0.00,1,1,1,1,1,1,20171001, E0155,HCPCS,"WALKER WHEEL ATTACHMENT,PAIR",,,28,,NW,,,,,,$107.88,$0.00,1,1,1,1,1,1,20171001, E0155,HCPCS,"WALKER WHEEL ATTACHMENT,PAIR",NU,,28,,NW,,,,,,$107.88,$0.00,1,1,1,1,1,1,20171001, E0155,HCPCS,"WALKER WHEEL ATTACHMENT,PAIR",RR,,28,,NW,,,,,,$18.82,$0.00,1,1,1,1,1,1,20171001, E0155,HCPCS,"WALKER WHEEL ATTACHMENT,PAIR",UE,,28,,NW,,,,,,$97.83,$0.00,1,1,1,1,1,1,20171001, E0156,HCPCS,WALKER SEAT ATTACHMENT,,,28,,NW,,,,,,$97.91,$0.00,1,1,1,1,1,1,20171001, E0156,HCPCS,WALKER SEAT ATTACHMENT,NU,,28,,NW,,,,,,$97.91,$0.00,1,1,1,1,1,1,20171001, E0156,HCPCS,WALKER SEAT ATTACHMENT,RR,,28,,NW,,,,,,$14.15,$0.00,1,1,1,1,1,1,20171001, E0156,HCPCS,WALKER SEAT ATTACHMENT,UE,,28,,NW,,,,,,$90.36,$0.00,1,1,1,1,1,1,20171001, E0157,HCPCS,WALKER CRUTCH ATTACHMENT,,,28,,NW,,,,,,$172.67,$0.00,1,1,1,1,1,1,20171001, E0157,HCPCS,WALKER CRUTCH ATTACHMENT,NU,,28,,NW,,,,,,$172.67,$0.00,1,1,1,1,1,1,20171001, E0157,HCPCS,WALKER CRUTCH ATTACHMENT,RR,,28,,NW,,,,,,$50.21,$0.00,1,1,1,1,1,1,20171001, E0157,HCPCS,WALKER CRUTCH ATTACHMENT,UE,,28,,NW,,,,,,$146.42,$0.00,1,1,1,1,1,1,20171001, E0158,HCPCS,WALKER LEG EXTENDERS SET OF4,,,28,,NW,,,,,,$108.84,$0.00,1,1,1,1,1,1,20171001, E0158,HCPCS,WALKER LEG EXTENDERS SET OF4,NU,,28,,NW,,,,,,$108.84,$0.00,1,1,1,1,1,1,20171001, E0158,HCPCS,WALKER LEG EXTENDERS SET OF4,RR,,28,,NW,,,,,,$19.26,$0.00,1,1,1,1,1,1,20171001, E0158,HCPCS,WALKER LEG EXTENDERS SET OF4,UE,,28,,NW,,,,,,$98.55,$0.00,1,1,1,1,1,1,20171001, E0159,HCPCS,BRAKE FOR WHEELED WALKER,,,28,,NW,,,,,,$95.59,$0.00,1,1,1,1,1,1,20171001, E0159,HCPCS,BRAKE FOR WHEELED WALKER,NU,,28,,NW,,,,,,$95.59,$0.00,1,1,1,1,1,1,20171001, E0159,HCPCS,BRAKE FOR WHEELED WALKER,RR,,28,,NW,,,,,,$13.07,$0.00,1,1,1,1,1,1,20171001, E0159,HCPCS,BRAKE FOR WHEELED WALKER,UE,,28,,NW,,,,,,$88.62,$0.00,1,1,1,1,1,1,20171001, E0160,HCPCS,SITZ TYPE BATH OR EQUIPMENT,,,28,,NW,,,,,,$123.00,$0.00,1,1,1,1,1,1,20171001, E0160,HCPCS,SITZ TYPE BATH OR EQUIPMENT,NU,,28,,NW,,,,,,$123.00,$0.00,1,1,1,1,1,1,20171001, E0160,HCPCS,SITZ TYPE BATH OR EQUIPMENT,RR,,28,,NW,,,,,,$25.92,$0.00,1,1,1,1,1,1,20171001, E0160,HCPCS,SITZ TYPE BATH OR EQUIPMENT,UE,,28,,NW,,,,,,$109.18,$0.00,1,1,1,1,1,1,20171001, E0161,HCPCS,SITZ BATH/EQUIPMENT W/FAUCET,,,28,,NW,,,,,,$114.92,$0.00,1,1,1,1,1,1,20171001, E0161,HCPCS,SITZ BATH/EQUIPMENT W/FAUCET,NU,,28,,NW,,,,,,$114.92,$0.00,1,1,1,1,1,1,20171001, E0161,HCPCS,SITZ BATH/EQUIPMENT W/FAUCET,RR,,28,,NW,,,,,,$22.17,$0.00,1,1,1,1,1,1,20171001, E0161,HCPCS,SITZ BATH/EQUIPMENT W/FAUCET,UE,,28,,NW,,,,,,$103.10,$0.00,1,1,1,1,1,1,20171001, E0162,HCPCS,SITZ BATH CHAIR,,,28,,NW,,,,,,$359.89,$0.00,1,1,1,1,1,1,20171001, E0162,HCPCS,SITZ BATH CHAIR,NU,,28,,NW,,,,,,$359.89,$0.00,1,1,1,1,1,1,20171001, E0162,HCPCS,SITZ BATH CHAIR,RR,,28,,NW,,,,,,$98.42,$0.00,1,1,1,1,1,1,20171001, E0162,HCPCS,SITZ BATH CHAIR,UE,,28,,NW,,,,,,$292.98,$0.00,1,1,1,1,1,1,20171001, E0163,HCPCS,COMMODE CHAIR WITH FIXED ARM,,,28,,NW,,,,,,$170.60,$0.00,1,1,1,1,1,1,20171001, E0163,HCPCS,COMMODE CHAIR WITH FIXED ARM,NU,,28,,NW,,,,,,$170.60,$0.00,1,1,1,1,1,1,20171001, E0163,HCPCS,COMMODE CHAIR WITH FIXED ARM,RR,,28,,NW,,,,,,$48.93,$0.00,1,1,1,1,1,1,20171001, E0163,HCPCS,COMMODE CHAIR WITH FIXED ARM,UE,,28,,NW,,,,,,$144.87,$0.00,1,1,1,1,1,1,20171001, E0165,HCPCS,COMMODE CHAIR WITH DETACHARM,,,28,,NW,,,,,,$720.08,$0.00,1,1,1,1,1,1,20171001, E0165,HCPCS,COMMODE CHAIR WITH DETACHARM,RR,,28,,NW,,,,,,$91.12,$0.00,1,1,1,1,1,1,20171001, E0167,HCPCS,COMMODE CHAIR PAIL OR PAN,,,28,,NW,,,,,,$88.36,$0.00,1,1,1,1,1,1,20171001, E0167,HCPCS,COMMODE CHAIR PAIL OR PAN,NU,,28,,NW,,,,,,$88.36,$0.00,1,1,1,1,1,1,20171001, E0167,HCPCS,COMMODE CHAIR PAIL OR PAN,RR,,28,,NW,,,,,,$9.71,$0.00,1,1,1,1,1,1,20171001, E0167,HCPCS,COMMODE CHAIR PAIL OR PAN,UE,,28,,NW,,,,,,$81.34,$0.00,1,1,1,1,1,1,20171001, E0168,HCPCS,HEAVYDUTY/WIDE COMMODE CHAIR,,,28,,NW,,,,,,$292.60,$0.00,1,1,1,1,1,1,20171001, E0168,HCPCS,HEAVYDUTY/WIDE COMMODE CHAIR,NU,,28,,NW,,,,,,$292.60,$0.00,1,1,1,1,1,1,20171001, E0168,HCPCS,HEAVYDUTY/WIDE COMMODE CHAIR,RR,,28,,NW,,,,,,$90.16,$0.00,1,1,1,1,1,1,20171001, E0168,HCPCS,HEAVYDUTY/WIDE COMMODE CHAIR,UE,,28,,NW,,,,,,$236.37,$0.00,1,1,1,1,1,1,20171001, E0170,HCPCS,COMMODE CHAIR ELECTRIC,,,28,,NW,,,,,,"$3,000.80",$0.00,1,1,1,1,1,1,20171001, E0170,HCPCS,COMMODE CHAIR ELECTRIC,RR,,28,,NW,,,,,,$379.74,$0.00,1,1,1,1,1,1,20171001, E0171,HCPCS,COMMODE CHAIR NON-ELECTRIC,,,28,,NW,,,,,,$993.94,$0.00,1,1,1,1,1,1,20171001, E0171,HCPCS,COMMODE CHAIR NON-ELECTRIC,RR,,28,,NW,,,,,,$125.78,$0.00,1,1,1,1,1,1,20171001, E0172,HCPCS,SEAT LIFT MECHANISM TOILET,,,28,,NW,,,,,,$349.68,$0.00,1,1,1,1,1,1,20171001, E0175,HCPCS,COMMODE CHAIR FOOT REST,,,28,,NW,,,,,,$201.96,$0.00,1,1,1,1,1,1,20171001, E0175,HCPCS,COMMODE CHAIR FOOT REST,NU,,28,,NW,,,,,,$201.96,$0.00,1,1,1,1,1,1,20171001, E0175,HCPCS,COMMODE CHAIR FOOT REST,RR,,28,,NW,,,,,,$68.28,$0.00,1,1,1,1,1,1,20171001, E0175,HCPCS,COMMODE CHAIR FOOT REST,UE,,28,,NW,,,,,,$166.45,$0.00,1,1,1,1,1,1,20171001, E0181,HCPCS,PRESS PAD ALTERNATING W/ PUM,,,28,,NW,,,,,,$775.06,$0.00,1,1,1,1,1,1,20171001, E0181,HCPCS,PRESS PAD ALTERNATING W/ PUM,RR,,28,,NW,,,,,,$98.08,$0.00,1,1,1,1,1,1,20171001, E0182,HCPCS,"REPLACE PUMP, ALT PRESS PAD",,,28,,NW,,,,,,$851.91,$0.00,1,1,1,1,1,1,20171001, E0182,HCPCS,"REPLACE PUMP, ALT PRESS PAD",RR,,28,,NW,,,,,,$107.81,$0.00,1,1,1,1,1,1,20171001, E0184,HCPCS,DRY PRESSURE MATTRESS,,,28,,NW,,,,,,$374.06,$0.00,1,1,1,1,1,1,20171001, E0184,HCPCS,DRY PRESSURE MATTRESS,NU,,28,,NW,,,,,,$374.06,$0.00,1,1,1,1,1,1,20171001, E0184,HCPCS,DRY PRESSURE MATTRESS,RR,,28,,NW,,,,,,$98.37,$0.00,1,1,1,1,1,1,20171001, E0184,HCPCS,DRY PRESSURE MATTRESS,UE,,28,,NW,,,,,,$297.56,$0.00,1,1,1,1,1,1,20171001, E0185,HCPCS,GEL PRESSURE MATTRESS PAD,,,28,,NW,,,,,,$395.99,$0.00,1,1,1,1,1,1,20171001, E0185,HCPCS,GEL PRESSURE MATTRESS PAD,NU,,28,,NW,,,,,,$395.99,$0.00,1,1,1,1,1,1,20171001, E0185,HCPCS,GEL PRESSURE MATTRESS PAD,RR,,28,,NW,,,,,,$100.50,$0.00,1,1,1,1,1,1,20171001, E0185,HCPCS,GEL PRESSURE MATTRESS PAD,UE,,28,,NW,,,,,,$313.91,$0.00,1,1,1,1,1,1,20171001, E0186,HCPCS,AIR PRESSURE MATTRESS,,,28,,NW,,,,,,$824.08,$0.00,1,1,1,1,1,1,20171001, E0186,HCPCS,AIR PRESSURE MATTRESS,RR,,28,,NW,,,,,,$104.28,$0.00,1,1,1,1,1,1,20171001, E0187,HCPCS,WATER PRESSURE MATTRESS,,,28,,NW,,,,,,$864.96,$0.00,1,1,1,1,1,1,20171001, E0187,HCPCS,WATER PRESSURE MATTRESS,RR,,28,,NW,,,,,,$109.46,$0.00,1,1,1,1,1,1,20171001, E0188,HCPCS,SYNTHETIC SHEEPSKIN PAD,,,28,,NW,,,,,,$114.94,$0.00,1,1,1,1,1,1,20171001, E0188,HCPCS,SYNTHETIC SHEEPSKIN PAD,NU,,28,,NW,,,,,,$114.94,$0.00,1,1,1,1,1,1,20171001, E0188,HCPCS,SYNTHETIC SHEEPSKIN PAD,RR,,28,,NW,,,,,,$22.18,$0.00,1,1,1,1,1,1,20171001, E0188,HCPCS,SYNTHETIC SHEEPSKIN PAD,UE,,28,,NW,,,,,,$103.12,$0.00,1,1,1,1,1,1,20171001, E0189,HCPCS,LAMBSWOOL SHEEPSKIN PAD,,,28,,NW,,,,,,$163.18,$0.00,1,1,1,1,1,1,20171001, E0189,HCPCS,LAMBSWOOL SHEEPSKIN PAD,NU,,28,,NW,,,,,,$163.18,$0.00,1,1,1,1,1,1,20171001, E0189,HCPCS,LAMBSWOOL SHEEPSKIN PAD,RR,,28,,NW,,,,,,$44.86,$0.00,1,1,1,1,1,1,20171001, E0189,HCPCS,LAMBSWOOL SHEEPSKIN PAD,UE,,28,,NW,,,,,,$139.31,$0.00,1,1,1,1,1,1,20171001, E0190,HCPCS,POSITIONING CUSHION,,,28,,NW,,,,,,$66.82,$0.00,1,1,1,1,1,1,20171001, E0191,HCPCS,PROTECTOR HEEL OR ELBOW,,,28,,NW,,,,,,$87.76,$0.00,1,1,1,1,1,1,20171001, E0191,HCPCS,PROTECTOR HEEL OR ELBOW,NU,,28,,NW,,,,,,$87.76,$0.00,1,1,1,1,1,1,20171001, E0191,HCPCS,PROTECTOR HEEL OR ELBOW,RR,,28,,NW,,,,,,$9.62,$0.00,1,1,1,1,1,1,20171001, E0191,HCPCS,PROTECTOR HEEL OR ELBOW,UE,,28,,NW,,,,,,$78.22,$0.00,1,1,1,1,1,1,20171001, E0193,HCPCS,POWERED AIR FLOTATION BED,,,28,,NW,,,,,,"$11,321.70",$0.00,1,1,1,1,1,1,20171001, E0193,HCPCS,POWERED AIR FLOTATION BED,RR,,28,,NW,,,,,,"$1,432.73",$0.00,1,1,1,1,1,1,20171001, E0194,HCPCS,AIR FLUIDIZED BED,,,28,,NW,,,,,,"$50,914.37",$0.00,1,1,1,1,1,1,20171001, E0194,HCPCS,AIR FLUIDIZED BED,RR,,28,,NW,,,,,,"$6,443.08",$0.00,1,1,1,1,1,1,20171001, E0194,HCPCS,AIR FLUIDIZED BED,UE,,28,,NW,,,,,,"$35,705.51",$0.00,1,1,1,1,1,1,20171001, E0196,HCPCS,GEL PRESSURE MATTRESS,,,28,,NW,,,,,,$984.58,$0.00,1,1,1,1,1,1,20171001, E0196,HCPCS,GEL PRESSURE MATTRESS,RR,,28,,NW,,,,,,$124.60,$0.00,1,1,1,1,1,1,20171001, E0196,HCPCS,GEL PRESSURE MATTRESS,UE,,28,,NW,,,,,,$464.69,$0.00,1,1,1,1,1,1,20171001, E0197,HCPCS,AIR PRESSURE PAD FOR MATTRES,,,28,,NW,,,,,,$808.61,$0.00,1,1,1,1,1,1,20171001, E0197,HCPCS,AIR PRESSURE PAD FOR MATTRES,NU,,28,,NW,,,,,,$808.61,$0.00,1,1,1,1,1,1,20171001, E0197,HCPCS,AIR PRESSURE PAD FOR MATTRES,RR,,28,,NW,,,,,,$102.33,$0.00,1,1,1,1,1,1,20171001, E0197,HCPCS,AIR PRESSURE PAD FOR MATTRES,UE,,28,,NW,,,,,,$307.62,$0.00,1,1,1,1,1,1,20171001, E0198,HCPCS,WATER PRESSURE PAD FOR MATTR,,,28,,NW,,,,,,$898.49,$0.00,1,1,1,1,1,1,20171001, E0198,HCPCS,WATER PRESSURE PAD FOR MATTR,NU,,28,,NW,,,,,,$898.49,$0.00,1,1,1,1,1,1,20171001, E0198,HCPCS,WATER PRESSURE PAD FOR MATTR,RR,,28,,NW,,,,,,$113.70,$0.00,1,1,1,1,1,1,20171001, E0198,HCPCS,WATER PRESSURE PAD FOR MATTR,UE,,28,,NW,,,,,,$301.19,$0.00,1,1,1,1,1,1,20171001, E0199,HCPCS,DRY PRESSURE PAD FOR MATTRES,,,28,,NW,,,,,,$127.57,$0.00,1,1,1,1,1,1,20171001, E0199,HCPCS,DRY PRESSURE PAD FOR MATTRES,NU,,28,,NW,,,,,,$127.57,$0.00,1,1,1,1,1,1,20171001, E0199,HCPCS,DRY PRESSURE PAD FOR MATTRES,RR,,28,,NW,,,,,,$28.00,$0.00,1,1,1,1,1,1,20171001, E0199,HCPCS,DRY PRESSURE PAD FOR MATTRES,UE,,28,,NW,,,,,,$112.60,$0.00,1,1,1,1,1,1,20171001, E0200,HCPCS,HEAT LAMP WITHOUT STAND,,,28,,NW,,,,,,$234.55,$0.00,1,1,1,1,1,1,20171001, E0200,HCPCS,HEAT LAMP WITHOUT STAND,NU,,28,,NW,,,,,,$234.55,$0.00,1,1,1,1,1,1,20171001, E0200,HCPCS,HEAT LAMP WITHOUT STAND,RR,,28,,NW,,,,,,$90.51,$0.00,1,1,1,1,1,1,20171001, E0200,HCPCS,HEAT LAMP WITHOUT STAND,UE,,28,,NW,,,,,,$192.89,$0.00,1,1,1,1,1,1,20171001, E0202,HCPCS,PHOTOTHERAPY LIGHT W/ PHOTOM,,,28,,NW,,,,,,"$1,574.13",$0.00,1,1,1,1,1,1,20171001, E0202,HCPCS,PHOTOTHERAPY LIGHT W/ PHOTOM,RR,,28,,NW,,,,,,$199.20,$0.00,1,1,1,1,1,1,20171001, E0203,HCPCS,THERAPEUTIC LIGHTBOX TABLETP,,,28,,NW,,,,,,$309.08,$0.00,1,1,1,1,1,1,20171001, E0205,HCPCS,HEAT LAMP WITH STAND,,,28,,NW,,,,,,$459.06,$0.00,1,1,1,1,1,1,20171001, E0205,HCPCS,HEAT LAMP WITH STAND,NU,,28,,NW,,,,,,$459.06,$0.00,1,1,1,1,1,1,20171001, E0205,HCPCS,HEAT LAMP WITH STAND,RR,,28,,NW,,,,,,$112.72,$0.00,1,1,1,1,1,1,20171001, E0205,HCPCS,HEAT LAMP WITH STAND,UE,,28,,NW,,,,,,$361.20,$0.00,1,1,1,1,1,1,20171001, E0210,HCPCS,ELECTRIC HEAT PAD STANDARD,,,28,,NW,,,,,,$133.84,$0.00,1,1,1,1,1,1,20171001, E0210,HCPCS,ELECTRIC HEAT PAD STANDARD,NU,,28,,NW,,,,,,$133.84,$0.00,1,1,1,1,1,1,20171001, E0210,HCPCS,ELECTRIC HEAT PAD STANDARD,RR,,28,,NW,,,,,,$32.47,$0.00,1,1,1,1,1,1,20171001, E0210,HCPCS,ELECTRIC HEAT PAD STANDARD,UE,,28,,NW,,,,,,$117.25,$0.00,1,1,1,1,1,1,20171001, E0215,HCPCS,ELECTRIC HEAT PAD MOIST,,,28,,NW,,,,,,$211.71,$0.00,1,1,1,1,1,1,20171001, E0215,HCPCS,ELECTRIC HEAT PAD MOIST,NU,,28,,NW,,,,,,$211.71,$0.00,1,1,1,1,1,1,20171001, E0215,HCPCS,ELECTRIC HEAT PAD MOIST,RR,,28,,NW,,,,,,$83.64,$0.00,1,1,1,1,1,1,20171001, E0215,HCPCS,ELECTRIC HEAT PAD MOIST,UE,,28,,NW,,,,,,$175.89,$0.00,1,1,1,1,1,1,20171001, E0217,HCPCS,WATER CIRC HEAT PAD W PUMP,,,28,,NW,,,,,,"$1,069.30",$0.00,1,1,1,1,1,1,20171001, E0217,HCPCS,WATER CIRC HEAT PAD W PUMP,NU,,28,,NW,,,,,,"$1,069.30",$0.00,1,1,1,1,1,1,20171001, E0217,HCPCS,WATER CIRC HEAT PAD W PUMP,RR,,28,,NW,,,,,,$179.03,$0.00,1,1,1,1,1,1,20171001, E0217,HCPCS,WATER CIRC HEAT PAD W PUMP,UE,,28,,NW,,,,,,$818.83,$0.00,1,1,1,1,1,1,20171001, E0218,HCPCS,WATER CIRC COLD PAD W PUMP,,,28,,NW,,,,,,"$1,069.30",$0.00,1,1,1,1,1,1,20171001, E0221,HCPCS,INFRARED HEATING PAD SYSTEM,,,28,,NW,,,,,,$147.59,$0.00,1,1,1,1,1,1,20171001, E0225,HCPCS,HYDROCOLLATOR UNIT,,,28,,NW,,,,,,$853.77,$0.00,1,1,1,1,1,1,20171001, E0225,HCPCS,HYDROCOLLATOR UNIT,NU,,28,,NW,,,,,,$853.77,$0.00,1,1,1,1,1,1,20171001, E0225,HCPCS,HYDROCOLLATOR UNIT,RR,,28,,NW,,,,,,$145.33,$0.00,1,1,1,1,1,1,20171001, E0225,HCPCS,HYDROCOLLATOR UNIT,UE,,28,,NW,,,,,,$656.73,$0.00,1,1,1,1,1,1,20171001, E0231,HCPCS,WOUND WARMING DEVICE,,,28,,NW,,,,,,$501.71,$0.00,1,1,1,1,1,1,20171001, E0231,HCPCS,WOUND WARMING DEVICE,RR,,28,,NW,,,,,,$54.90,$0.00,1,1,1,1,1,1,20171001, E0232,HCPCS,WARMING CARD FOR NWT,,,28,,NW,,,,,,$158.26,$0.00,1,1,1,1,1,1,20171001, E0235,HCPCS,PARAFFIN BATH UNIT PORTABLE,,,28,,NW,,,,,,$823.29,$0.00,1,1,1,1,1,1,20171001, E0235,HCPCS,PARAFFIN BATH UNIT PORTABLE,RR,,28,,NW,,,,,,$104.18,$0.00,1,1,1,1,1,1,20171001, E0235,HCPCS,PARAFFIN BATH UNIT PORTABLE,UE,,28,,NW,,,,,,$249.77,$0.00,1,1,1,1,1,1,20171001, E0236,HCPCS,PUMP FOR WATER CIRCULATING P,,,28,,NW,,,,,,"$1,244.22",$0.00,1,1,1,1,1,1,20171001, E0236,HCPCS,PUMP FOR WATER CIRCULATING P,RR,,28,,NW,,,,,,$157.45,$0.00,1,1,1,1,1,1,20171001, E0236,HCPCS,PUMP FOR WATER CIRCULATING P,UE,,28,,NW,,,,,,$534.18,$0.00,1,1,1,1,1,1,20171001, E0239,HCPCS,HYDROCOLLATOR UNIT PORTABLE,,,28,,NW,,,,,,$996.53,$0.00,1,1,1,1,1,1,20171001, E0239,HCPCS,HYDROCOLLATOR UNIT PORTABLE,NU,,28,,NW,,,,,,$996.53,$0.00,1,1,1,1,1,1,20171001, E0239,HCPCS,HYDROCOLLATOR UNIT PORTABLE,RR,,28,,NW,,,,,,$161.00,$0.00,1,1,1,1,1,1,20171001, E0239,HCPCS,HYDROCOLLATOR UNIT PORTABLE,UE,,28,,NW,,,,,,$764.34,$0.00,1,1,1,1,1,1,20171001, E0240,HCPCS,BATH/SHOWER CHAIR,,,28,,NW,,,,,,$126.76,$0.00,1,1,1,1,1,1,20171001, E0241,HCPCS,BATH TUB WALL RAIL,,,28,,NW,,,,,,$100.34,$0.00,1,1,1,1,1,1,20171001, E0242,HCPCS,BATH TUB RAIL FLOOR,,,28,,NW,,,,,,$141.04,$0.00,1,1,1,1,1,1,20171001, E0243,HCPCS,TOILET RAIL,,,28,,NW,,,,,,$126.05,$0.00,1,1,1,1,1,1,20171001, E0244,HCPCS,TOILET SEAT RAISED,,,28,,NW,,,,,,$112.12,$0.00,1,1,1,1,1,1,20171001, E0245,HCPCS,TUB STOOL OR BENCH,,,28,,NW,,,,,,$140.51,$0.00,1,1,1,1,1,1,20171001, E0246,HCPCS,TRANSFER TUB RAIL ATTACHMENT,,,28,,NW,,,,,,$167.29,$0.00,1,1,1,1,1,1,20171001, E0247,HCPCS,TRANS BENCH W/WO COMM OPEN,,,28,,NW,,,,,,$164.49,$0.00,1,1,1,1,1,1,20171001, E0248,HCPCS,HDTRANS BENCH W/WO COMM OPEN,,,28,,NW,,,,,,$166.01,$0.00,1,1,1,1,1,1,20171001, E0249,HCPCS,PAD WATER CIRCULATING HEAT U,,,28,,NW,,,,,,$270.31,$0.00,1,1,1,1,1,1,20171001, E0249,HCPCS,PAD WATER CIRCULATING HEAT U,NU,,28,,NW,,,,,,$270.31,$0.00,1,1,1,1,1,1,20171001, E0249,HCPCS,PAD WATER CIRCULATING HEAT U,RR,,28,,NW,,,,,,$89.95,$0.00,1,1,1,1,1,1,20171001, E0249,HCPCS,PAD WATER CIRCULATING HEAT U,UE,,28,,NW,,,,,,$219.65,$0.00,1,1,1,1,1,1,20171001, E0250,HCPCS,HOSP BED FIXED HT W/ MATTRES,,,28,,NW,,,,,,"$2,155.24",$0.00,1,1,1,1,1,1,20171001, E0250,HCPCS,HOSP BED FIXED HT W/ MATTRES,RR,,28,,NW,,,,,,$272.74,$0.00,1,1,1,1,1,1,20171001, E0250,HCPCS,HOSP BED FIXED HT W/ MATTRES,UE,,28,,NW,,,,,,$960.86,$0.00,1,1,1,1,1,1,20171001, E0251,HCPCS,HOSP BED FIXD HT W/O MATTRES,,,28,,NW,,,,,,"$1,946.38",$0.00,1,1,1,1,1,1,20171001, E0251,HCPCS,HOSP BED FIXD HT W/O MATTRES,RR,,28,,NW,,,,,,$246.31,$0.00,1,1,1,1,1,1,20171001, E0251,HCPCS,HOSP BED FIXD HT W/O MATTRES,UE,,28,,NW,,,,,,$765.50,$0.00,1,1,1,1,1,1,20171001, E0255,HCPCS,HOSPITAL BED VAR HT W/ MATTR,,,28,,NW,,,,,,"$2,200.79",$0.00,1,1,1,1,1,1,20171001, E0255,HCPCS,HOSPITAL BED VAR HT W/ MATTR,RR,,28,,NW,,,,,,$278.50,$0.00,1,1,1,1,1,1,20171001, E0255,HCPCS,HOSPITAL BED VAR HT W/ MATTR,UE,,28,,NW,,,,,,"$1,124.03",$0.00,1,1,1,1,1,1,20171001, E0256,HCPCS,HOSPITAL BED VAR HT W/O MATT,,,28,,NW,,,,,,"$2,014.50",$0.00,1,1,1,1,1,1,20171001, E0256,HCPCS,HOSPITAL BED VAR HT W/O MATT,RR,,28,,NW,,,,,,$254.93,$0.00,1,1,1,1,1,1,20171001, E0256,HCPCS,HOSPITAL BED VAR HT W/O MATT,UE,,28,,NW,,,,,,$842.09,$0.00,1,1,1,1,1,1,20171001, E0260,HCPCS,HOSP BED SEMI-ELECTR W/ MATT,,,28,,NW,,,,,,"$2,119.75",$0.00,1,1,1,1,1,1,20171001, E0260,HCPCS,HOSP BED SEMI-ELECTR W/ MATT,RR,,28,,NW,,,,,,$268.25,$0.00,1,1,1,1,1,1,20171001, E0260,HCPCS,HOSP BED SEMI-ELECTR W/ MATT,UE,,28,,NW,,,,,,"$1,611.56",$0.00,1,1,1,1,1,1,20171001, E0261,HCPCS,HOSP BED SEMI-ELECTR W/O MAT,,,28,,NW,,,,,,"$2,051.71",$0.00,1,1,1,1,1,1,20171001, E0261,HCPCS,HOSP BED SEMI-ELECTR W/O MAT,RR,,28,,NW,,,,,,$259.64,$0.00,1,1,1,1,1,1,20171001, E0261,HCPCS,HOSP BED SEMI-ELECTR W/O MAT,UE,,28,,NW,,,,,,"$1,284.43",$0.00,1,1,1,1,1,1,20171001, E0265,HCPCS,HOSP BED TOTAL ELECTR W/ MAT,,,28,,NW,,,,,,"$3,230.38",$0.00,1,1,1,1,1,1,20171001, E0265,HCPCS,HOSP BED TOTAL ELECTR W/ MAT,RR,,28,,NW,,,,,,$408.80,$0.00,1,1,1,1,1,1,20171001, E0265,HCPCS,HOSP BED TOTAL ELECTR W/ MAT,UE,,28,,NW,,,,,,"$1,804.46",$0.00,1,1,1,1,1,1,20171001, E0266,HCPCS,HOSP BED TOTAL ELEC W/O MATT,,,28,,NW,,,,,,"$2,968.25",$0.00,1,1,1,1,1,1,20171001, E0266,HCPCS,HOSP BED TOTAL ELEC W/O MATT,RR,,28,,NW,,,,,,$375.62,$0.00,1,1,1,1,1,1,20171001, E0266,HCPCS,HOSP BED TOTAL ELEC W/O MATT,UE,,28,,NW,,,,,,"$1,620.20",$0.00,1,1,1,1,1,1,20171001, E0270,HCPCS,HOSPITAL BED INSTITUTIONAL T,,,28,,NW,,,,,,$494.39,$0.00,1,1,1,1,1,1,20171001, E0270,HCPCS,HOSPITAL BED INSTITUTIONAL T,RR,,28,,NW,,,,,,$52.08,$0.00,1,1,1,1,1,1,20171001, E0270,HCPCS,HOSPITAL BED INSTITUTIONAL T,UE,,28,,NW,,,,,,$371.60,$0.00,1,1,1,1,1,1,20171001, E0271,HCPCS,MATTRESS INNERSPRING,,,28,,NW,,,,,,$379.03,$0.00,1,1,1,1,1,1,20171001, E0271,HCPCS,MATTRESS INNERSPRING,NU,,28,,NW,,,,,,$379.03,$0.00,1,1,1,1,1,1,20171001, E0271,HCPCS,MATTRESS INNERSPRING,RR,,28,,NW,,,,,,$35.13,$0.00,1,1,1,1,1,1,20171001, E0271,HCPCS,MATTRESS INNERSPRING,UE,,28,,NW,,,,,,$322.61,$0.00,1,1,1,1,1,1,20171001, E0272,HCPCS,MATTRESS FOAM RUBBER,,,28,,NW,,,,,,$410.30,$0.00,1,1,1,1,1,1,20171001, E0272,HCPCS,MATTRESS FOAM RUBBER,NU,,28,,NW,,,,,,$410.30,$0.00,1,1,1,1,1,1,20171001, E0272,HCPCS,MATTRESS FOAM RUBBER,RR,,28,,NW,,,,,,$43.03,$0.00,1,1,1,1,1,1,20171001, E0272,HCPCS,MATTRESS FOAM RUBBER,UE,,28,,NW,,,,,,$345.85,$0.00,1,1,1,1,1,1,20171001, E0273,HCPCS,BED BOARD,,,28,,NW,,,,,,$66.43,$0.00,1,1,1,1,1,1,20171001, E0273,HCPCS,BED BOARD,RR,,28,,NW,,,,,,$14.58,$0.00,1,1,1,1,1,1,20171001, E0273,HCPCS,BED BOARD,UE,,28,,NW,,,,,,$51.01,$0.00,1,1,1,1,1,1,20171001, E0274,HCPCS,OVER-BED TABLE,,,28,,NW,,,,,,$131.53,$0.00,1,1,1,1,1,1,20171001, E0274,HCPCS,OVER-BED TABLE,RR,,28,,NW,,,,,,$42.60,$0.00,1,1,1,1,1,1,20171001, E0274,HCPCS,OVER-BED TABLE,UE,,28,,NW,,,,,,$97.24,$0.00,1,1,1,1,1,1,20171001, E0275,HCPCS,BED PAN STANDARD,,,28,,NW,,,,,,$94.61,$0.00,1,1,1,1,1,1,20171001, E0275,HCPCS,BED PAN STANDARD,NU,,28,,NW,,,,,,$94.61,$0.00,1,1,1,1,1,1,20171001, E0275,HCPCS,BED PAN STANDARD,RR,,28,,NW,,,,,,$12.63,$0.00,1,1,1,1,1,1,20171001, E0275,HCPCS,BED PAN STANDARD,UE,,28,,NW,,,,,,$87.88,$0.00,1,1,1,1,1,1,20171001, E0276,HCPCS,BED PAN FRACTURE,,,28,,NW,,,,,,$90.85,$0.00,1,1,1,1,1,1,20171001, E0276,HCPCS,BED PAN FRACTURE,NU,,28,,NW,,,,,,$90.85,$0.00,1,1,1,1,1,1,20171001, E0276,HCPCS,BED PAN FRACTURE,RR,,28,,NW,,,,,,$10.86,$0.00,1,1,1,1,1,1,20171001, E0276,HCPCS,BED PAN FRACTURE,UE,,28,,NW,,,,,,$85.08,$0.00,1,1,1,1,1,1,20171001, E0277,HCPCS,POWERED PRES-REDU AIR MATTRS,,,28,,NW,,,,,,"$4,018.25",$0.00,1,1,1,1,1,1,20171001, E0277,HCPCS,POWERED PRES-REDU AIR MATTRS,RR,,28,,NW,,,,,,$508.50,$0.00,1,1,1,1,1,1,20171001, E0277,HCPCS,POWERED PRES-REDU AIR MATTRS,UE,,28,,NW,,,,,,"$3,054.91",$0.00,1,1,1,1,1,1,20171001, E0280,HCPCS,BED CRADLE,,,28,,NW,,,,,,$123.68,$0.00,1,1,1,1,1,1,20171001, E0280,HCPCS,BED CRADLE,NU,,28,,NW,,,,,,$123.68,$0.00,1,1,1,1,1,1,20171001, E0280,HCPCS,BED CRADLE,RR,,28,,NW,,,,,,$3.38,$0.00,1,1,1,1,1,1,20171001, E0280,HCPCS,BED CRADLE,UE,,28,,NW,,,,,,$87.30,$0.00,1,1,1,1,1,1,20171001, E0290,HCPCS,HOSP BED FX HT W/O RAILS W/M,,,28,,NW,,,,,,"$1,927.13",$0.00,1,1,1,1,1,1,20171001, E0290,HCPCS,HOSP BED FX HT W/O RAILS W/M,RR,,28,,NW,,,,,,$243.87,$0.00,1,1,1,1,1,1,20171001, E0290,HCPCS,HOSP BED FX HT W/O RAILS W/M,UE,,28,,NW,,,,,,$770.50,$0.00,1,1,1,1,1,1,20171001, E0291,HCPCS,HOSP BED FX HT W/O RAIL W/O,,,28,,NW,,,,,,"$1,430.12",$0.00,1,1,1,1,1,1,20171001, E0291,HCPCS,HOSP BED FX HT W/O RAIL W/O,RR,,28,,NW,,,,,,$180.98,$0.00,1,1,1,1,1,1,20171001, E0291,HCPCS,HOSP BED FX HT W/O RAIL W/O,UE,,28,,NW,,,,,,$601.78,$0.00,1,1,1,1,1,1,20171001, E0292,HCPCS,HOSP BED VAR HT NO SR W/MATT,,,28,,NW,,,,,,"$2,135.73",$0.00,1,1,1,1,1,1,20171001, E0292,HCPCS,HOSP BED VAR HT W/O RAIL W/O,RR,,28,,NW,,,,,,$270.27,$0.00,1,1,1,1,1,1,20171001, E0292,HCPCS,HOSP BED VAR HT W/O RAIL W/O,UE,,28,,NW,,,,,,$847.64,$0.00,1,1,1,1,1,1,20171001, E0293,HCPCS,HOSP BED VAR HT NO SR NO MAT,,,28,,NW,,,,,,"$1,886.60",$0.00,1,1,1,1,1,1,20171001, E0293,HCPCS,HOSP BED VAR HT W/O RAIL W/,RR,,28,,NW,,,,,,$238.74,$0.00,1,1,1,1,1,1,20171001, E0293,HCPCS,HOSP BED VAR HT W/O RAIL W/,UE,,28,,NW,,,,,,$743.86,$0.00,1,1,1,1,1,1,20171001, E0294,HCPCS,HOSP BED SEMI-ELECT W/ MATTR,,,28,,NW,,,,,,"$2,228.56",$0.00,1,1,1,1,1,1,20171001, E0294,HCPCS,HOSP BED SEMI-ELECT W/ MATTR,RR,,28,,NW,,,,,,$282.02,$0.00,1,1,1,1,1,1,20171001, E0294,HCPCS,HOSP BED SEMI-ELECT W/ MATTR,UE,,28,,NW,,,,,,"$1,232.81",$0.00,1,1,1,1,1,1,20171001, E0295,HCPCS,HOSP BED SEMI-ELECT W/O MATT,,,28,,NW,,,,,,"$2,198.39",$0.00,1,1,1,1,1,1,20171001, E0295,HCPCS,HOSP BED SEMI-ELECT W/O MATT,RR,,28,,NW,,,,,,$278.20,$0.00,1,1,1,1,1,1,20171001, E0295,HCPCS,HOSP BED SEMI-ELECT W/O MATT,UE,,28,,NW,,,,,,"$1,205.62",$0.00,1,1,1,1,1,1,20171001, E0296,HCPCS,HOSP BED TOTAL ELECT W/ MATT,,,28,,NW,,,,,,"$2,786.68",$0.00,1,1,1,1,1,1,20171001, E0296,HCPCS,HOSP BED TOTAL ELECT W/ MATT,RR,,28,,NW,,,,,,$352.65,$0.00,1,1,1,1,1,1,20171001, E0296,HCPCS,HOSP BED TOTAL ELECT W/ MATT,UE,,28,,NW,,,,,,"$1,699.57",$0.00,1,1,1,1,1,1,20171001, E0297,HCPCS,HOSP BED TOTAL ELECT W/O MAT,,,28,,NW,,,,,,"$2,601.69",$0.00,1,1,1,1,1,1,20171001, E0297,HCPCS,HOSP BED TOTAL ELECT W/O MAT,RR,,28,,NW,,,,,,$329.24,$0.00,1,1,1,1,1,1,20171001, E0297,HCPCS,HOSP BED TOTAL ELECT W/O MAT,UE,,28,,NW,,,,,,"$1,315.51",$0.00,1,1,1,1,1,1,20171001, E0300,HCPCS,ENCLOSED PED CRIB HOSP GRADE,,,28,,NW,,,,,,"$4,721.41",$0.00,1,1,1,1,1,1,20171001, E0300,HCPCS,ENCLOSED PED CRIB HOSP GRADE,NU,,28,,NW,,,,,,"$4,721.41",$0.00,1,1,1,1,1,1,20171001, E0300,HCPCS,ENCLOSED PED CRIB HOSP GRADE,RR,,28,,NW,,,,,,$597.48,$0.00,1,1,1,1,1,1,20171001, E0300,HCPCS,ENCLOSED PED CRIB HOSP GRADE,UE,,28,,NW,,,,,,"$2,498.21",$0.00,1,1,1,1,1,1,20171001, E0301,HCPCS,"HD HOSP BED, 350-600 LBS",,,28,,NW,,,,,,"$3,600.68",$0.00,1,1,1,1,1,1,20171001, E0301,HCPCS,"HD HOSP BED, 350-600 LBS",RR,,28,,NW,,,,,,$455.66,$0.00,1,1,1,1,1,1,20171001, E0302,HCPCS,EX HD HOSP BED > 600 LBS,,,28,,NW,,,,,,"$8,179.14",$0.00,1,1,1,1,1,1,20171001, E0302,HCPCS,EX HD HOSP BED > 600 LBS,RR,,28,,NW,,,,,,"$1,035.05",$0.00,1,1,1,1,1,1,20171001, E0303,HCPCS,HOSP BED HVY DTY XTRA WIDE,,,28,,NW,,,,,,"$3,579.52",$0.00,1,1,1,1,1,1,20171001, E0303,HCPCS,HOSP BED HVY DTY XTRA WIDE,RR,,28,,NW,,,,,,$452.98,$0.00,1,1,1,1,1,1,20171001, E0304,HCPCS,HOSP BED XTRA HVY DTY X WIDE,,,28,,NW,,,,,,"$8,239.52",$0.00,1,1,1,1,1,1,20171001, E0304,HCPCS,HOSP BED XTRA HVY DTY X WIDE,RR,,28,,NW,,,,,,"$1,042.69",$0.00,1,1,1,1,1,1,20171001, E0305,HCPCS,RAILS BED SIDE HALF LENGTH,,,28,,NW,,,,,,$220.47,$0.00,1,1,1,1,1,1,20171001, E0305,HCPCS,RAILS BED SIDE HALF LENGTH,RR,,28,,NW,,,,,,$27.90,$0.00,1,1,1,1,1,1,20171001, E0305,HCPCS,RAILS BED SIDE HALF LENGTH,UE,,28,,NW,,,,,,$300.41,$0.00,1,1,1,1,1,1,20171001, E0310,HCPCS,RAILS BED SIDE FULL LENGTH,,,28,,NW,,,,,,$358.02,$0.00,1,1,1,1,1,1,20171001, E0310,HCPCS,RAILS BED SIDE FULL LENGTH,NU,,28,,NW,,,,,,$358.02,$0.00,1,1,1,1,1,1,20171001, E0310,HCPCS,RAILS BED SIDE FULL LENGTH,RR,,28,,NW,,,,,,$29.82,$0.00,1,1,1,1,1,1,20171001, E0310,HCPCS,RAILS BED SIDE FULL LENGTH,UE,,28,,NW,,,,,,$306.84,$0.00,1,1,1,1,1,1,20171001, E0315,HCPCS,BED ACCESSORY BRD/TBL/SUPPRT,,,28,,NW,,,,,,$149.77,$0.00,1,1,1,1,1,1,20171001, E0316,HCPCS,BED SAFETY ENCLOSURE,,,28,,NW,,,,,,"$3,727.23",$0.00,1,1,1,1,1,1,20171001, E0316,HCPCS,BED SAFETY ENCLOSURE,RR,,28,,NW,,,,,,$471.67,$0.00,1,1,1,1,1,1,20171001, E0325,HCPCS,URINAL MALE JUG-TYPE,,,28,,NW,,,,,,$84.99,$0.00,1,1,1,1,1,1,20171001, E0325,HCPCS,URINAL MALE JUG-TYPE,NU,,28,,NW,,,,,,$84.99,$0.00,1,1,1,1,1,1,20171001, E0325,HCPCS,URINAL MALE JUG-TYPE,RR,,28,,NW,,,,,,$8.11,$0.00,1,1,1,1,1,1,20171001, E0325,HCPCS,URINAL MALE JUG-TYPE,UE,,28,,NW,,,,,,$63.96,$0.00,1,1,1,1,1,1,20171001, E0326,HCPCS,URINAL FEMALE JUG-TYPE,,,28,,NW,,,,,,$86.43,$0.00,1,1,1,1,1,1,20171001, E0326,HCPCS,URINAL FEMALE JUG-TYPE,NU,,28,,NW,,,,,,$86.43,$0.00,1,1,1,1,1,1,20171001, E0326,HCPCS,URINAL FEMALE JUG-TYPE,RR,,28,,NW,,,,,,$8.82,$0.00,1,1,1,1,1,1,20171001, E0326,HCPCS,URINAL FEMALE JUG-TYPE,UE,,28,,NW,,,,,,$72.36,$0.00,1,1,1,1,1,1,20171001, E0328,HCPCS,"PED HOSPITAL BED, MANUAL",,,28,,NW,,,,,,$143.36,$0.00,1,1,1,1,1,1,20171001, E0329,HCPCS,PED HOSPITAL BED SEMI/ELECT,,,28,,NW,,,,,,$599.44,$0.00,1,1,1,1,1,1,20171001, E0352,HCPCS,DISPOSABLE PACK W/BOWEL SYST,,,28,,NW,,,,,,$76.83,$0.00,1,1,1,1,1,1,20171001, E0370,HCPCS,AIR ELEVATOR FOR HEEL,,,28,,NW,,,,,,$90.76,$0.00,1,1,1,1,1,1,20171001, E0371,HCPCS,NONPOWER MATTRESS OVERLAY,,,28,,NW,,,,,,"$4,602.76",$0.00,1,1,1,1,1,1,20171001, E0371,HCPCS,NONPOWER MATTRESS OVERLAY,RR,,28,,NW,,,,,,$582.47,$0.00,1,1,1,1,1,1,20171001, E0372,HCPCS,POWERED AIR MATTRESS OVERLAY,,,28,,NW,,,,,,"$4,419.99",$0.00,1,1,1,1,1,1,20171001, E0372,HCPCS,POWERED AIR MATTRESS OVERLAY,RR,,28,,NW,,,,,,$559.34,$0.00,1,1,1,1,1,1,20171001, E0373,HCPCS,NONPOWERED PRESSURE MATTRESS,,,28,,NW,,,,,,"$6,021.12",$0.00,1,1,1,1,1,1,20171001, E0373,HCPCS,NONPOWERED PRESSURE MATTRESS,RR,,28,,NW,,,,,,$761.96,$0.00,1,1,1,1,1,1,20171001, E0424,HCPCS,STATIONARY COMPRESSED GAS 02,,,28,,NW,,,,,,"$4,524.83",$0.00,1,1,1,1,1,1,20171001, E0424,HCPCS,STATIONARY COMPRESSED GAS 02,RR,,28,,NW,,,,,,$572.61,$0.00,1,1,1,1,1,1,20171001, E0425,HCPCS,GAS SYSTEM STATIONARY COMPRE,,,28,,NW,,,,,,"$17,089.31",$0.00,1,1,1,1,1,1,20171001, E0425,HCPCS,GAS SYSTEM STATIONARY COMPRE,NU,,28,,NW,,,,,,"$20,738.53",$0.00,1,1,1,1,1,1,20171001, E0430,HCPCS,OXYGEN SYSTEM GAS PORTABLE,,,28,,NW,,,,,,"$7,712.74",$0.00,1,1,1,1,1,1,20171001, E0430,HCPCS,OXYGEN SYSTEM GAS PORTABLE,NU,,28,,NW,,,,,,"$9,340.07",$0.00,1,1,1,1,1,1,20171001, E0430,HCPCS,OXYGEN SYSTEM GAS PORTABLE,UE,,28,,NW,,,,,,"$6,981.15",$0.00,1,1,1,1,1,1,20171001, E0431,HCPCS,PORTABLE GASEOUS 02,,,28,,NW,,,,,,$432.04,$0.00,1,1,1,1,1,1,20171001, E0431,HCPCS,PORTABLE GASEOUS 02,RR,,28,,NW,,,,,,$54.67,$0.00,1,1,1,1,1,1,20171001, E0433,HCPCS,PORTABLE LIQUID OXYGEN SYS,,,28,,NW,,,,,,"$1,821.40",$0.00,1,1,1,1,1,1,20171001, E0433,HCPCS,PORTABLE LIQUID OXYGEN SYS,RR,,28,,NW,,,,,,$230.49,$0.00,1,1,1,1,1,1,20171001, E0434,HCPCS,PORTABLE LIQUID 02,,,28,,NW,,,,,,$432.04,$0.00,1,1,1,1,1,1,20171001, E0434,HCPCS,PORTABLE LIQUID 02,RR,,28,,NW,,,,,,$54.67,$0.00,1,1,1,1,1,1,20171001, E0435,HCPCS,OXYGEN SYSTEM LIQUID PORTABL,,,28,,NW,,,,,,"$5,287.65",$0.00,1,1,1,1,1,1,20171001, E0435,HCPCS,OXYGEN SYSTEM LIQUID PORTABL,NU,,28,,NW,,,,,,"$6,392.06",$0.00,1,1,1,1,1,1,20171001, E0435,HCPCS,OXYGEN SYSTEM LIQUID PORTABL,UE,,28,,NW,,,,,,"$4,772.05",$0.00,1,1,1,1,1,1,20171001, E0439,HCPCS,STATIONARY LIQUID 02,,,28,,NW,,,,,,"$4,524.83",$0.00,1,1,1,1,1,1,20171001, E0439,HCPCS,STATIONARY LIQUID 02,RR,,28,,NW,,,,,,$572.61,$0.00,1,1,1,1,1,1,20171001, E0440,HCPCS,OXYGEN SYSTEM LIQUID STATION,,,28,,NW,,,,,,"$10,785.35",$0.00,1,1,1,1,1,1,20171001, E0440,HCPCS,OXYGEN SYSTEM LIQUID STATION,NU,,28,,NW,,,,,,"$13,075.23",$0.00,1,1,1,1,1,1,20171001, E0440,HCPCS,OXYGEN SYSTEM LIQUID STATION,UE,,28,,NW,,,,,,"$9,781.89",$0.00,1,1,1,1,1,1,20171001, E0441,HCPCS,"STATIONARY O2 CONTENTS, GAS",,,28,,NW,,,,,,$357.49,$0.00,1,1,1,1,1,1,20171001, E0442,HCPCS,"STATIONARY O2 CONTENTS, LIQ",,,28,,NW,,,,,,$357.49,$0.00,1,1,1,1,1,1,20171001, E0443,HCPCS,"PORTABLE 02 CONTENTS, GAS",,,28,,NW,,,,,,$312.76,$0.00,1,1,1,1,1,1,20171001, E0444,HCPCS,"PORTABLE 02 CONTENTS, LIQUID",,,28,,NW,,,,,,$312.76,$0.00,1,1,1,1,1,1,20171001, E0445,HCPCS,OXIMETER NON-INVASIVE,,,28,,NW,,,,,,$265.73,$0.00,1,1,1,1,1,1,20171001, E0446,HCPCS,"TOPICAL OX DELIVER SYS, NOS",,,28,,NW,,,,,,$312.76,$0.00,1,1,1,1,1,1,20171001, E0455,HCPCS,OXYGEN TENT EXCL CROUP/PED T,,,28,,NW,,,,,,$27.28,$0.00,1,1,1,1,1,1,20171001, E0457,HCPCS,CHEST SHELL,,,28,,NW,,,,,,"$1,110.09",$0.00,1,1,1,1,1,1,20171001, E0457,HCPCS,CHEST SHELL,NU,,28,,NW,,,,,,$825.55,$0.00,1,1,1,1,1,1,20171001, E0457,HCPCS,CHEST SHELL,RR,,28,,NW,,,,,,$143.19,$0.00,1,1,1,1,1,1,20171001, E0457,HCPCS,CHEST SHELL,UE,,28,,NW,,,,,,$635.95,$0.00,1,1,1,1,1,1,20171001, E0459,HCPCS,CHEST WRAP,,,28,,NW,,,,,,$917.87,$0.00,1,1,1,1,1,1,20171001, E0459,HCPCS,CHEST WRAP,NU,,28,,NW,,,,,,$695.40,$0.00,1,1,1,1,1,1,20171001, E0459,HCPCS,CHEST WRAP,RR,,28,,NW,,,,,,$130.33,$0.00,1,1,1,1,1,1,20171001, E0459,HCPCS,CHEST WRAP,UE,,28,,NW,,,,,,$538.47,$0.00,1,1,1,1,1,1,20171001, E0462,HCPCS,ROCKING BED W/ OR W/O SIDE R,,,28,,NW,,,,,,"$5,777.74",$0.00,1,1,1,1,1,1,20171001, E0462,HCPCS,ROCKING BED W/ OR W/O SIDE R,NU,,28,,NW,,,,,,"$5,777.74",$0.00,1,1,1,1,1,1,20171001, E0462,HCPCS,ROCKING BED W/ OR W/O SIDE R,RR,,28,,NW,,,,,,$731.16,$0.00,1,1,1,1,1,1,20171001, E0462,HCPCS,ROCKING BED W/ OR W/O SIDE R,UE,,28,,NW,,,,,,"$3,336.81",$0.00,1,1,1,1,1,1,20171001, E0465,HCPCS,HOME VENT INVASIVE INTERFACE,,,28,,NW,,,,,,"$16,196.61",$0.00,1,1,1,1,1,1,20171001, E0465,HCPCS,HOME VENT INVASIVE INTERFACE,RR,,28,,NW,,,,,,"$2,049.64",$0.00,1,1,1,1,1,1,20171001, E0466,HCPCS,HOME VENT NON-INVASIVE INTER,,,28,,NW,,,,,,"$16,196.61",$0.00,1,1,1,1,1,1,20171001, E0466,HCPCS,HOME VENT NON-INVASIVE INTER,RR,,28,,NW,,,,,,"$2,049.64",$0.00,1,1,1,1,1,1,20171001, E0470,HCPCS,RAD W/O BACKUP NON-INV INTFC,,,28,,NW,,,,,,"$2,195.55",$0.00,1,1,1,1,1,1,20171001, E0470,HCPCS,RAD W/O BACKUP NON-INV INTFC,RR,,28,,NW,,,,,,$277.84,$0.00,1,1,1,1,1,1,20171001, E0471,HCPCS,RAD W/BACKUP NON INV INTRFC,,,28,,NW,,,,,,"$4,662.24",$0.00,1,1,1,1,1,1,20171001, E0471,HCPCS,RAD W/BACKUP NON INV INTRFC,RR,,28,,NW,,,,,,$589.99,$0.00,1,1,1,1,1,1,20171001, E0472,HCPCS,RAD W BACKUP INVASIVE INTRFC,,,28,,NW,,,,,,"$6,735.42",$0.00,1,1,1,1,1,1,20171001, E0472,HCPCS,RAD W BACKUP INVASIVE INTRFC,RR,,28,,NW,,,,,,$852.35,$0.00,1,1,1,1,1,1,20171001, E0480,HCPCS,PERCUSSOR ELECT/PNEUM HOME M,,,28,,NW,,,,,,"$1,242.59",$0.00,1,1,1,1,1,1,20171001, E0480,HCPCS,PERCUSSOR ELECT/PNEUM HOME M,NU,,28,,NW,,,,,,"$1,242.59",$0.00,1,1,1,1,1,1,20171001, E0480,HCPCS,PERCUSSOR ELECT/PNEUM HOME M,RR,,28,,NW,,,,,,$157.25,$0.00,1,1,1,1,1,1,20171001, E0480,HCPCS,PERCUSSOR ELECT/PNEUM HOME M,UE,,28,,NW,,,,,,$530.97,$0.00,1,1,1,1,1,1,20171001, E0481,HCPCS,INTRPULMNRY PERCUSS VENT SYS,,,28,,NW,,,,,,$617.30,$0.00,1,1,1,1,1,1,20171001, E0482,HCPCS,COUGH STIMULATING DEVICE,,,28,,NW,,,,,,"$7,680.80",$0.00,1,1,1,1,1,1,20171001, E0482,HCPCS,COUGH STIMULATING DEVICE,RR,,28,,NW,,,,,,$971.98,$0.00,1,1,1,1,1,1,20171001, E0483,HCPCS,CHEST COMPRESSION GEN SYSTEM,,,28,,NW,,,,,,"$18,719.39",$0.00,1,1,1,1,1,1,20171001, E0483,HCPCS,CHEST COMPRESSION GEN SYSTEM,RR,,28,,NW,,,,,,"$2,368.89",$0.00,1,1,1,1,1,1,20171001, E0484,HCPCS,NON-ELEC OSCILLATORY PEP DVC,,,28,,NW,,,,,,$147.61,$0.00,1,1,1,1,1,1,20171001, E0484,HCPCS,NON-ELEC OSCILLATORY PEP DVC,NU,,28,,NW,,,,,,$147.61,$0.00,1,1,1,1,1,1,20171001, E0484,HCPCS,NON-ELEC OSCILLATORY PEP DVC,RR,,28,,NW,,,,,,$37.26,$0.00,1,1,1,1,1,1,20171001, E0484,HCPCS,NON-ELEC OSCILLATORY PEP DVC,UE,,28,,NW,,,,,,$127.64,$0.00,1,1,1,1,1,1,20171001, E0485,HCPCS,ORAL DEVICE/APPLIANCE PREFAB,,,28,,NW,,,,,,"$1,058.62",$0.00,1,1,1,1,1,1,20171001, E0485,HCPCS,ORAL DEVICE/APPLIANCE PREFAB,NU,,28,,NW,,,,,,"$1,058.62",$0.00,1,1,1,1,1,1,20171001, E0485,HCPCS,ORAL DEVICE/APPLIANCE PREFAB,RR,,28,,NW,,,,,,$116.53,$0.00,1,1,1,1,1,1,20171001, E0485,HCPCS,ORAL DEVICE/APPLIANCE PREFAB,UE,,28,,NW,,,,,,$797.21,$0.00,1,1,1,1,1,1,20171001, E0486,HCPCS,ORAL DEVICE/APPLIANCE CUSFAB,,,28,,NW,,,,,,"$4,398.43",$0.00,1,1,1,1,1,1,20171001, E0486,HCPCS,ORAL DEVICE/APPLIANCE CUSFAB,NU,,28,,NW,,,,,,"$4,398.43",$0.00,1,1,1,1,1,1,20171001, E0486,HCPCS,ORAL DEVICE/APPLIANCE CUSFAB,RR,,28,,NW,,,,,,$393.44,$0.00,1,1,1,1,1,1,20171001, E0486,HCPCS,ORAL DEVICE/APPLIANCE CUSFAB,UE,,28,,NW,,,,,,"$2,707.29",$0.00,1,1,1,1,1,1,20171001, E0487,HCPCS,ELECTRONIC SPIROMETER,,,28,,NW,,,,,,$310.16,$0.00,1,1,1,1,1,1,20171001, E0500,HCPCS,IPPB ALL TYPES,,,28,,NW,,,,,,"$2,348.01",$0.00,1,1,1,1,1,1,20171001, E0500,HCPCS,IPPB ALL TYPES,NU,,28,,NW,,,,,,"$2,348.01",$0.00,1,1,1,1,1,1,20171001, E0500,HCPCS,IPPB ALL TYPES,RR,,28,,NW,,,,,,$297.13,$0.00,1,1,1,1,1,1,20171001, E0500,HCPCS,IPPB ALL TYPES,UE,,28,,NW,,,,,,"$1,224.58",$0.00,1,1,1,1,1,1,20171001, E0550,HCPCS,HUMIDIF EXTENS SUPPLE W IPPB,,,28,,NW,,,,,,"$1,355.32",$0.00,1,1,1,1,1,1,20171001, E0550,HCPCS,HUMIDIF EXTENS SUPPLE W IPPB,NU,,28,,NW,,,,,,"$1,355.32",$0.00,1,1,1,1,1,1,20171001, E0550,HCPCS,HUMIDIF EXTENS SUPPLE W IPPB,RR,,28,,NW,,,,,,$171.51,$0.00,1,1,1,1,1,1,20171001, E0550,HCPCS,HUMIDIF EXTENS SUPPLE W IPPB,UE,,28,,NW,,,,,,$596.31,$0.00,1,1,1,1,1,1,20171001, E0555,HCPCS,HUMIDIFIER FOR USE W/ REGULA,,,28,,NW,,,,,,$6.66,$0.00,1,1,1,1,1,1,20171001, E0555,HCPCS,HUMIDIFIER FOR USE W/ REGULA,NU,,28,,NW,,,,,,$6.29,$0.00,1,1,1,1,1,1,20171001, E0555,HCPCS,HUMIDIFIER FOR USE W/ REGULA,RR,,28,,NW,,,,,,$0.64,$0.00,1,1,1,1,1,1,20171001, E0555,HCPCS,HUMIDIFIER FOR USE W/ REGULA,UE,,28,,NW,,,,,,$5.80,$0.00,1,1,1,1,1,1,20171001, E0560,HCPCS,HUMIDIFIER SUPPLEMENTAL W/ I,,,28,,NW,,,,,,$365.02,$0.00,1,1,1,1,1,1,20171001, E0560,HCPCS,HUMIDIFIER SUPPLEMENTAL W/ I,NU,,28,,NW,,,,,,$365.02,$0.00,1,1,1,1,1,1,20171001, E0560,HCPCS,HUMIDIFIER SUPPLEMENTAL W/ I,RR,,28,,NW,,,,,,$103.37,$0.00,1,1,1,1,1,1,20171001, E0560,HCPCS,HUMIDIFIER SUPPLEMENTAL W/ I,UE,,28,,NW,,,,,,$290.69,$0.00,1,1,1,1,1,1,20171001, E0561,HCPCS,HUMIDIFIER NONHEATED W PAP,,,28,,NW,,,,,,$208.66,$0.00,1,1,1,1,1,1,20171001, E0561,HCPCS,HUMIDIFIER NONHEATED W PAP,NU,,28,,NW,,,,,,$208.66,$0.00,1,1,1,1,1,1,20171001, E0561,HCPCS,HUMIDIFIER NONHEATED W PAP,RR,,28,,NW,,,,,,$72.51,$0.00,1,1,1,1,1,1,20171001, E0561,HCPCS,HUMIDIFIER NONHEATED W PAP,UE,,28,,NW,,,,,,$173.41,$0.00,1,1,1,1,1,1,20171001, E0562,HCPCS,HUMIDIFIER HEATED USED W PAP,,,28,,NW,,,,,,$336.82,$0.00,1,1,1,1,1,1,20171001, E0562,HCPCS,HUMIDIFIER HEATED USED W PAP,NU,,28,,NW,,,,,,$336.82,$0.00,1,1,1,1,1,1,20171001, E0562,HCPCS,HUMIDIFIER HEATED USED W PAP,RR,,28,,NW,,,,,,$94.58,$0.00,1,1,1,1,1,1,20171001, E0562,HCPCS,HUMIDIFIER HEATED USED W PAP,UE,,28,,NW,,,,,,$269.53,$0.00,1,1,1,1,1,1,20171001, E0565,HCPCS,COMPRESSOR AIR POWER SOURCE,,,28,,NW,,,,,,"$1,180.94",$0.00,1,1,1,1,1,1,20171001, E0565,HCPCS,COMPRESSOR AIR POWER SOURCE,NU,,28,,NW,,,,,,"$1,180.94",$0.00,1,1,1,1,1,1,20171001, E0565,HCPCS,COMPRESSOR AIR POWER SOURCE,RR,,28,,NW,,,,,,$149.45,$0.00,1,1,1,1,1,1,20171001, E0565,HCPCS,COMPRESSOR AIR POWER SOURCE,UE,,28,,NW,,,,,,$632.20,$0.00,1,1,1,1,1,1,20171001, E0570,HCPCS,NEBULIZER WITH COMPRESSION,,,28,,NW,,,,,,$441.61,$0.00,1,1,1,1,1,1,20171001, E0570,HCPCS,NEBULIZER WITH COMPRESSION,NU,,28,,NW,,,,,,$441.61,$0.00,1,1,1,1,1,1,20171001, E0570,HCPCS,NEBULIZER WITH COMPRESSION,RR,,28,,NW,,,,,,$55.88,$0.00,1,1,1,1,1,1,20171001, E0570,HCPCS,NEBULIZER WITH COMPRESSION,UE,,28,,NW,,,,,,$335.74,$0.00,1,1,1,1,1,1,20171001, E0572,HCPCS,AEROSOL COMPRESSOR ADJUST PR,,,28,,NW,,,,,,"$1,153.75",$0.00,1,1,1,1,1,1,20171001, E0572,HCPCS,AEROSOL COMPRESSOR ADJUST PR,RR,,28,,NW,,,,,,$146.00,$0.00,1,1,1,1,1,1,20171001, E0574,HCPCS,ULTRASONIC GENERATOR W SVNEB,,,28,,NW,,,,,,"$1,449.72",$0.00,1,1,1,1,1,1,20171001, E0574,HCPCS,ULTRASONIC GENERATOR W SVNEB,RR,,28,,NW,,,,,,$183.46,$0.00,1,1,1,1,1,1,20171001, E0575,HCPCS,NEBULIZER ULTRASONIC,,,28,,NW,,,,,,"$2,225.45",$0.00,1,1,1,1,1,1,20171001, E0575,HCPCS,NEBULIZER ULTRASONIC,NU,,28,,NW,,,,,,"$2,225.45",$0.00,1,1,1,1,1,1,20171001, E0575,HCPCS,NEBULIZER ULTRASONIC,RR,,28,,NW,,,,,,$281.62,$0.00,1,1,1,1,1,1,20171001, E0575,HCPCS,NEBULIZER ULTRASONIC,UE,,28,,NW,,,,,,"$1,151.20",$0.00,1,1,1,1,1,1,20171001, E0580,HCPCS,NEBULIZER FOR USE W/ REGULAT,,,28,,NW,,,,,,$316.66,$0.00,1,1,1,1,1,1,20171001, E0580,HCPCS,NEBULIZER FOR USE W/ REGULAT,NU,,28,,NW,,,,,,$316.66,$0.00,1,1,1,1,1,1,20171001, E0580,HCPCS,NEBULIZER FOR USE W/ REGULAT,RR,,28,,NW,,,,,,$92.57,$0.00,1,1,1,1,1,1,20171001, E0580,HCPCS,NEBULIZER FOR USE W/ REGULAT,UE,,28,,NW,,,,,,$254.40,$0.00,1,1,1,1,1,1,20171001, E0585,HCPCS,NEBULIZER W/ COMPRESSOR & HE,,,28,,NW,,,,,,$969.65,$0.00,1,1,1,1,1,1,20171001, E0585,HCPCS,NEBULIZER W/ COMPRESSOR & HE,NU,,28,,NW,,,,,,$969.65,$0.00,1,1,1,1,1,1,20171001, E0585,HCPCS,NEBULIZER W/ COMPRESSOR & HE,RR,,28,,NW,,,,,,$122.71,$0.00,1,1,1,1,1,1,20171001, E0585,HCPCS,NEBULIZER W/ COMPRESSOR & HE,UE,,28,,NW,,,,,,$392.24,$0.00,1,1,1,1,1,1,20171001, E0600,HCPCS,SUCTION PUMP PORTAB HOM MODL,,,28,,NW,,,,,,"$1,281.88",$0.00,1,1,1,1,1,1,20171001, E0600,HCPCS,SUCTION PUMP PORTAB HOM MODL,NU,,28,,NW,,,,,,"$1,281.88",$0.00,1,1,1,1,1,1,20171001, E0600,HCPCS,SUCTION PUMP PORTAB HOM MODL,RR,,28,,NW,,,,,,$162.22,$0.00,1,1,1,1,1,1,20171001, E0600,HCPCS,SUCTION PUMP PORTAB HOM MODL,UE,,28,,NW,,,,,,$550.25,$0.00,1,1,1,1,1,1,20171001, E0601,HCPCS,CONT AIRWAY PRESSURE DEVICE,,,28,,NW,,,,,,"$1,172.54",$0.00,1,1,1,1,1,1,20171001, E0601,HCPCS,CONT AIRWAY PRESSURE DEVICE,NU,,28,,NW,,,,,,"$1,172.54",$0.00,1,1,1,1,1,1,20171001, E0601,HCPCS,CONT AIRWAY PRESSURE DEVICE,RR,,28,,NW,,,,,,$148.38,$0.00,1,1,1,1,1,1,20171001, E0601,HCPCS,CONT AIRWAY PRESSURE DEVICE,UE,,28,,NW,,,,,,$958.38,$0.00,1,1,1,1,1,1,20171001, E0602,HCPCS,MANUAL BREAST PUMP,,,28,,NW,,,,,,$131.56,$0.00,1,1,1,1,1,1,20171001, E0602,HCPCS,MANUAL BREAST PUMP,NU,,28,,NW,,,,,,$131.56,$0.00,1,1,1,1,1,1,20171001, E0602,HCPCS,MANUAL BREAST PUMP,RR,,28,,NW,,,,,,$30.02,$0.00,1,1,1,1,1,1,20171001, E0602,HCPCS,MANUAL BREAST PUMP,UE,,28,,NW,,,,,,$115.60,$0.00,1,1,1,1,1,1,20171001, E0603,HCPCS,ELECTRIC BREAST PUMP,,,28,,NW,,,,,,$171.57,$0.00,1,1,1,1,1,1,20171001, E0603,HCPCS,ELECTRIC BREAST PUMP,NU,,28,,NW,,,,,,$171.57,$0.00,1,1,1,1,1,1,20171001, E0603,HCPCS,ELECTRIC BREAST PUMP,RR,,28,,NW,,,,,,$102.48,$0.00,1,1,1,1,1,1,20171001, E0603,HCPCS,ELECTRIC BREAST PUMP,UE,,28,,NW,,,,,,$150.69,$0.00,1,1,1,1,1,1,20171001, E0604,HCPCS,HOSP GRADE ELEC BREAST PUMP,,,28,,NW,,,,,,$431.41,$0.00,1,1,1,1,1,1,20171001, E0604,HCPCS,HOSP GRADE ELEC BREAST PUMP,NU,,28,,NW,,,,,,$366.00,$0.00,1,1,1,1,1,1,20171001, E0604,HCPCS,HOSP GRADE ELEC BREAST PUMP,RR,,28,,NW,,,,,,$182.29,$0.00,1,1,1,1,1,1,20171001, E0604,HCPCS,HOSP GRADE ELEC BREAST PUMP,UE,,28,,NW,,,,,,$291.55,$0.00,1,1,1,1,1,1,20171001, E0605,HCPCS,VAPORIZER ROOM TYPE,,,28,,NW,,,,,,$123.83,$0.00,1,1,1,1,1,1,20171001, E0605,HCPCS,VAPORIZER ROOM TYPE,NU,,28,,NW,,,,,,$123.83,$0.00,1,1,1,1,1,1,20171001, E0605,HCPCS,VAPORIZER ROOM TYPE,RR,,28,,NW,,,,,,$32.19,$0.00,1,1,1,1,1,1,20171001, E0605,HCPCS,VAPORIZER ROOM TYPE,UE,,28,,NW,,,,,,$112.77,$0.00,1,1,1,1,1,1,20171001, E0606,HCPCS,DRAINAGE BOARD POSTURAL,,,28,,NW,,,,,,$902.19,$0.00,1,1,1,1,1,1,20171001, E0606,HCPCS,DRAINAGE BOARD POSTURAL,NU,,28,,NW,,,,,,$902.19,$0.00,1,1,1,1,1,1,20171001, E0606,HCPCS,DRAINAGE BOARD POSTURAL,RR,,28,,NW,,,,,,$114.17,$0.00,1,1,1,1,1,1,20171001, E0606,HCPCS,DRAINAGE BOARD POSTURAL,UE,,28,,NW,,,,,,$309.76,$0.00,1,1,1,1,1,1,20171001, E0607,HCPCS,BLOOD GLUCOSE MONITOR HOME,,,28,,NW,,,,,,$212.31,$0.00,1,1,1,1,1,1,20171001, E0607,HCPCS,BLOOD GLUCOSE MONITOR HOME,NU,,28,,NW,,,,,,$212.31,$0.00,1,1,1,1,1,1,20171001, E0607,HCPCS,BLOOD GLUCOSE MONITOR HOME,RR,,28,,NW,,,,,,$74.70,$0.00,1,1,1,1,1,1,20171001, E0607,HCPCS,BLOOD GLUCOSE MONITOR HOME,UE,,28,,NW,,,,,,$176.14,$0.00,1,1,1,1,1,1,20171001, E0610,HCPCS,PACEMAKER MONITR AUDIBLE/VIS,,,28,,NW,,,,,,$574.66,$0.00,1,1,1,1,1,1,20171001, E0610,HCPCS,PACEMAKER MONITR AUDIBLE/VIS,NU,,28,,NW,,,,,,$574.66,$0.00,1,1,1,1,1,1,20171001, E0610,HCPCS,PACEMAKER MONITR AUDIBLE/VIS,RR,,28,,NW,,,,,,$121.22,$0.00,1,1,1,1,1,1,20171001, E0610,HCPCS,PACEMAKER MONITR AUDIBLE/VIS,UE,,28,,NW,,,,,,$447.82,$0.00,1,1,1,1,1,1,20171001, E0615,HCPCS,PACEMAKER MONITR DIGITAL/VIS,,,28,,NW,,,,,,"$1,054.19",$0.00,1,1,1,1,1,1,20171001, E0615,HCPCS,PACEMAKER MONITR DIGITAL/VIS,NU,,28,,NW,,,,,,"$1,054.19",$0.00,1,1,1,1,1,1,20171001, E0615,HCPCS,PACEMAKER MONITR DIGITAL/VIS,RR,,28,,NW,,,,,,$186.72,$0.00,1,1,1,1,1,1,20171001, E0615,HCPCS,PACEMAKER MONITR DIGITAL/VIS,UE,,28,,NW,,,,,,$806.17,$0.00,1,1,1,1,1,1,20171001, E0616,HCPCS,CARDIAC EVENT RECORDER,,,28,,NW,,,,,,"$6,587.84",$0.00,1,1,1,1,1,1,20171001, E0617,HCPCS,AUTOMATIC EXT DEFIBRILLATOR,,,28,,NW,,,,,,"$5,735.29",$0.00,1,1,1,1,1,1,20171001, E0617,HCPCS,AUTOMATIC EXT DEFIBRILLATOR,RR,,28,,NW,,,,,,$725.79,$0.00,1,1,1,1,1,1,20171001, E0618,HCPCS,APNEA MONITOR,,,28,,NW,,,,,,"$5,048.50",$0.00,1,1,1,1,1,1,20171001, E0618,HCPCS,APNEA MONITOR,RR,,28,,NW,,,,,,$638.87,$0.00,1,1,1,1,1,1,20171001, E0619,HCPCS,APNEA MONITOR W RECORDER,,,28,,NW,,,,,,"$5,048.50",$0.00,1,1,1,1,1,1,20171001, E0619,HCPCS,APNEA MONITOR W RECORDER,RR,,28,,NW,,,,,,$638.87,$0.00,1,1,1,1,1,1,20171001, E0620,HCPCS,CAP BLD SKIN PIERCING LASER,,,28,,NW,,,,,,"$2,030.12",$0.00,1,1,1,1,1,1,20171001, E0620,HCPCS,CAP BLD SKIN PIERCING LASER,NU,,28,,NW,,,,,,"$2,030.12",$0.00,1,1,1,1,1,1,20171001, E0620,HCPCS,CAP BLD SKIN PIERCING LASER,RR,,28,,NW,,,,,,$256.91,$0.00,1,1,1,1,1,1,20171001, E0620,HCPCS,CAP BLD SKIN PIERCING LASER,UE,,28,,NW,,,,,,$989.45,$0.00,1,1,1,1,1,1,20171001, E0621,HCPCS,PATIENT LIFT SLING OR SEAT,,,28,,NW,,,,,,$227.55,$0.00,1,1,1,1,1,1,20171001, E0621,HCPCS,PATIENT LIFT SLING OR SEAT,NU,,28,,NW,,,,,,$227.55,$0.00,1,1,1,1,1,1,20171001, E0621,HCPCS,PATIENT LIFT SLING OR SEAT,RR,,28,,NW,,,,,,$83.63,$0.00,1,1,1,1,1,1,20171001, E0621,HCPCS,PATIENT LIFT SLING OR SEAT,UE,,28,,NW,,,,,,$187.58,$0.00,1,1,1,1,1,1,20171001, E0625,HCPCS,PATIENT LIFT BATHROOM OR TOI,,,28,,NW,,,,,,"$1,363.68",$0.00,1,1,1,1,1,1,20171001, E0625,HCPCS,PATIENT LIFT BATHROOM OR TOI,NU,,28,,NW,,,,,,"$1,363.68",$0.00,1,1,1,1,1,1,20171001, E0625,HCPCS,PATIENT LIFT BATHROOM OR TOI,RR,,28,,NW,,,,,,$172.57,$0.00,1,1,1,1,1,1,20171001, E0625,HCPCS,PATIENT LIFT BATHROOM OR TOI,UE,,28,,NW,,,,,,"$1,036.75",$0.00,1,1,1,1,1,1,20171001, E0627,HCPCS,"SEAT LIFT MECH, ELECTRIC ANY",,,28,,NW,,,,,,$563.06,$0.00,1,1,1,1,1,1,20171001, E0627,HCPCS,SEAT LIFT INCORP LIFT-CHAIR,NU,,28,,NW,,,,,,$563.06,$0.00,1,1,1,1,1,1,20171001, E0627,HCPCS,SEAT LIFT INCORP LIFT-CHAIR,RR,,28,,NW,,,,,,$117.20,$0.00,1,1,1,1,1,1,20171001, E0627,HCPCS,SEAT LIFT INCORP LIFT-CHAIR,UE,,28,,NW,,,,,,$439.21,$0.00,1,1,1,1,1,1,20171001, E0629,HCPCS,"SEAT LIFT MECH, NON-ELECTRIC",,,28,,NW,,,,,,$605.53,$0.00,1,1,1,1,1,1,20171001, E0629,HCPCS,SEAT LIFT FOR PT FURN-NON-EL,NU,,28,,NW,,,,,,$605.53,$0.00,1,1,1,1,1,1,20171001, E0629,HCPCS,SEAT LIFT FOR PT FURN-NON-EL,RR,,28,,NW,,,,,,$121.45,$0.00,1,1,1,1,1,1,20171001, E0629,HCPCS,SEAT LIFT FOR PT FURN-NON-EL,UE,,28,,NW,,,,,,$471.07,$0.00,1,1,1,1,1,1,20171001, E0630,HCPCS,PATIENT LIFT HYDRAULIC,,,28,,NW,,,,,,"$1,432.14",$0.00,1,1,1,1,1,1,20171001, E0630,HCPCS,PATIENT LIFT HYDRAULIC,NU,,28,,NW,,,,,,"$1,432.14",$0.00,1,1,1,1,1,1,20171001, E0630,HCPCS,PATIENT LIFT HYDRAULIC,RR,,28,,NW,,,,,,$181.23,$0.00,1,1,1,1,1,1,20171001, E0630,HCPCS,PATIENT LIFT HYDRAULIC,UE,,28,,NW,,,,,,"$1,010.34",$0.00,1,1,1,1,1,1,20171001, E0635,HCPCS,PATIENT LIFT ELECTRIC,,,28,,NW,,,,,,"$2,319.55",$0.00,1,1,1,1,1,1,20171001, E0635,HCPCS,PATIENT LIFT ELECTRIC,NU,,28,,NW,,,,,,"$2,319.55",$0.00,1,1,1,1,1,1,20171001, E0635,HCPCS,PATIENT LIFT ELECTRIC,RR,,28,,NW,,,,,,$293.53,$0.00,1,1,1,1,1,1,20171001, E0635,HCPCS,PATIENT LIFT ELECTRIC,UE,,28,,NW,,,,,,"$1,199.41",$0.00,1,1,1,1,1,1,20171001, E0636,HCPCS,PT SUPPORT & POSITIONING SYS,,,28,,NW,,,,,,"$15,469.59",$0.00,1,1,1,1,1,1,20171001, E0636,HCPCS,PT SUPPORT & POSITIONING SYS,RR,,28,,NW,,,,,,"$1,957.64",$0.00,1,1,1,1,1,1,20171001, E0637,HCPCS,COMBINATION SIT TO STAND SYS,,,28,,NW,,,,,,"$1,949.26",$0.00,1,1,1,1,1,1,20171001, E0638,HCPCS,STANDING FRAME SYS,,,28,,NW,,,,,,"$1,559.56",$0.00,1,1,1,1,1,1,20171001, E0639,HCPCS,MOVEABLE PATIENT LIFT SYSTEM,,,28,,NW,,,,,,"$2,356.86",$0.00,1,1,1,1,1,1,20171001, E0639,HCPCS,MOVEABLE PATIENT LIFT SYSTEM,RR,,28,,NW,,,,,,$298.25,$0.00,1,1,1,1,1,1,20171001, E0640,HCPCS,FIXED PATIENT LIFT SYSTEM,,,28,,NW,,,,,,"$2,356.86",$0.00,1,1,1,1,1,1,20171001, E0640,HCPCS,FIXED PATIENT LIFT SYSTEM,RR,,28,,NW,,,,,,$298.25,$0.00,1,1,1,1,1,1,20171001, E0641,HCPCS,MULTI-POSITION STND FRAM SYS,,,28,,NW,,,,,,"$1,197.90",$0.00,1,1,1,1,1,1,20171001, E0642,HCPCS,DYNAMIC STANDING FRAME,,,28,,NW,,,,,,"$2,460.38",$0.00,1,1,1,1,1,1,20171001, E0650,HCPCS,PNEUMA COMPRESOR NON-SEGMENT,,,28,,NW,,,,,,"$1,549.49",$0.00,1,1,1,1,1,1,20171001, E0650,HCPCS,PNEUMA COMPRESOR NON-SEGMENT,NU,,28,,NW,,,,,,"$1,549.49",$0.00,1,1,1,1,1,1,20171001, E0650,HCPCS,PNEUMA COMPRESOR NON-SEGMENT,RR,,28,,NW,,,,,,$250.69,$0.00,1,1,1,1,1,1,20171001, E0650,HCPCS,PNEUMA COMPRESOR NON-SEGMENT,UE,,28,,NW,,,,,,"$1,162.12",$0.00,1,1,1,1,1,1,20171001, E0651,HCPCS,PNEUM COMPRESSOR SEGMENTAL,,,28,,NW,,,,,,"$1,942.88",$0.00,1,1,1,1,1,1,20171001, E0651,HCPCS,PNEUM COMPRESSOR SEGMENTAL,NU,,28,,NW,,,,,,"$1,942.88",$0.00,1,1,1,1,1,1,20171001, E0651,HCPCS,PNEUM COMPRESSOR SEGMENTAL,RR,,28,,NW,,,,,,$261.63,$0.00,1,1,1,1,1,1,20171001, E0651,HCPCS,PNEUM COMPRESSOR SEGMENTAL,UE,,28,,NW,,,,,,"$1,474.11",$0.00,1,1,1,1,1,1,20171001, E0652,HCPCS,PNEUM COMPRES W/CAL PRESSURE,,,28,,NW,,,,,,"$11,227.80",$0.00,1,1,1,1,1,1,20171001, E0652,HCPCS,PNEUM COMPRES W/CAL PRESSURE,NU,,28,,NW,,,,,,"$11,227.80",$0.00,1,1,1,1,1,1,20171001, E0652,HCPCS,PNEUM COMPRES W/CAL PRESSURE,RR,,28,,NW,,,,,,"$1,162.24",$0.00,1,1,1,1,1,1,20171001, E0652,HCPCS,PNEUM COMPRES W/CAL PRESSURE,UE,,28,,NW,,,,,,"$8,350.78",$0.00,1,1,1,1,1,1,20171001, E0655,HCPCS,PNEUMATIC APPLIANCE HALF ARM,,,28,,NW,,,,,,$290.39,$0.00,1,1,1,1,1,1,20171001, E0655,HCPCS,PNEUMATIC APPLIANCE HALF ARM,NU,,28,,NW,,,,,,$290.39,$0.00,1,1,1,1,1,1,20171001, E0655,HCPCS,PNEUMATIC APPLIANCE HALF ARM,RR,,28,,NW,,,,,,$92.76,$0.00,1,1,1,1,1,1,20171001, E0655,HCPCS,PNEUMATIC APPLIANCE HALF ARM,UE,,28,,NW,,,,,,$235.67,$0.00,1,1,1,1,1,1,20171001, E0656,HCPCS,SEGMENTAL PNEUMATIC TRUNK,,,28,,NW,,,,,,"$1,523.08",$0.00,1,1,1,1,1,1,20171001, E0656,HCPCS,SEGMENTAL PNEUMATIC TRUNK,NU,,28,,NW,,,,,,"$1,523.08",$0.00,1,1,1,1,1,1,20171001, E0656,HCPCS,SEGMENTAL PNEUMATIC TRUNK,RR,,28,,NW,,,,,,$192.74,$0.00,1,1,1,1,1,1,20171001, E0656,HCPCS,SEGMENTAL PNEUMATIC TRUNK,UE,,28,,NW,,,,,,$676.65,$0.00,1,1,1,1,1,1,20171001, E0657,HCPCS,SEGMENTAL PNEUMATIC CHEST,,,28,,NW,,,,,,"$1,463.20",$0.00,1,1,1,1,1,1,20171001, E0657,HCPCS,SEGMENTAL PNEUMATIC CHEST,NU,,28,,NW,,,,,,"$1,463.20",$0.00,1,1,1,1,1,1,20171001, E0657,HCPCS,SEGMENTAL PNEUMATIC CHEST,RR,,28,,NW,,,,,,$185.16,$0.00,1,1,1,1,1,1,20171001, E0657,HCPCS,SEGMENTAL PNEUMATIC CHEST,UE,,28,,NW,,,,,,$640.23,$0.00,1,1,1,1,1,1,20171001, E0660,HCPCS,PNEUMATIC APPLIANCE FULL LEG,,,28,,NW,,,,,,$394.51,$0.00,1,1,1,1,1,1,20171001, E0660,HCPCS,PNEUMATIC APPLIANCE FULL LEG,NU,,28,,NW,,,,,,$394.51,$0.00,1,1,1,1,1,1,20171001, E0660,HCPCS,PNEUMATIC APPLIANCE FULL LEG,RR,,28,,NW,,,,,,$101.53,$0.00,1,1,1,1,1,1,20171001, E0660,HCPCS,PNEUMATIC APPLIANCE FULL LEG,UE,,28,,NW,,,,,,$312.30,$0.00,1,1,1,1,1,1,20171001, E0665,HCPCS,PNEUMATIC APPLIANCE FULL ARM,,,28,,NW,,,,,,$346.79,$0.00,1,1,1,1,1,1,20171001, E0665,HCPCS,PNEUMATIC APPLIANCE FULL ARM,NU,,28,,NW,,,,,,$346.79,$0.00,1,1,1,1,1,1,20171001, E0665,HCPCS,PNEUMATIC APPLIANCE FULL ARM,RR,,28,,NW,,,,,,$96.54,$0.00,1,1,1,1,1,1,20171001, E0665,HCPCS,PNEUMATIC APPLIANCE FULL ARM,UE,,28,,NW,,,,,,$275.62,$0.00,1,1,1,1,1,1,20171001, E0666,HCPCS,PNEUMATIC APPLIANCE HALF LEG,,,28,,NW,,,,,,$350.17,$0.00,1,1,1,1,1,1,20171001, E0666,HCPCS,PNEUMATIC APPLIANCE HALF LEG,NU,,28,,NW,,,,,,$350.17,$0.00,1,1,1,1,1,1,20171001, E0666,HCPCS,PNEUMATIC APPLIANCE HALF LEG,RR,,28,,NW,,,,,,$96.89,$0.00,1,1,1,1,1,1,20171001, E0666,HCPCS,PNEUMATIC APPLIANCE HALF LEG,UE,,28,,NW,,,,,,$280.01,$0.00,1,1,1,1,1,1,20171001, E0667,HCPCS,SEG PNEUMATIC APPL FULL LEG,,,28,,NW,,,,,,$756.58,$0.00,1,1,1,1,1,1,20171001, E0667,HCPCS,SEG PNEUMATIC APPL FULL LEG,NU,,28,,NW,,,,,,$756.58,$0.00,1,1,1,1,1,1,20171001, E0667,HCPCS,SEG PNEUMATIC APPL FULL LEG,RR,,28,,NW,,,,,,$144.41,$0.00,1,1,1,1,1,1,20171001, E0667,HCPCS,SEG PNEUMATIC APPL FULL LEG,UE,,28,,NW,,,,,,$584.35,$0.00,1,1,1,1,1,1,20171001, E0668,HCPCS,SEG PNEUMATIC APPL FULL ARM,,,28,,NW,,,,,,$969.53,$0.00,1,1,1,1,1,1,20171001, E0668,HCPCS,SEG PNEUMATIC APPL FULL ARM,NU,,28,,NW,,,,,,$969.53,$0.00,1,1,1,1,1,1,20171001, E0668,HCPCS,SEG PNEUMATIC APPL FULL ARM,RR,,28,,NW,,,,,,$156.81,$0.00,1,1,1,1,1,1,20171001, E0668,HCPCS,SEG PNEUMATIC APPL FULL ARM,UE,,28,,NW,,,,,,$744.87,$0.00,1,1,1,1,1,1,20171001, E0669,HCPCS,SEG PNEUMATIC APPLI HALF LEG,,,28,,NW,,,,,,$456.06,$0.00,1,1,1,1,1,1,20171001, E0669,HCPCS,SEG PNEUMATIC APPLI HALF LEG,NU,,28,,NW,,,,,,$456.06,$0.00,1,1,1,1,1,1,20171001, E0669,HCPCS,SEG PNEUMATIC APPLI HALF LEG,RR,,28,,NW,,,,,,$106.52,$0.00,1,1,1,1,1,1,20171001, E0669,HCPCS,SEG PNEUMATIC APPLI HALF LEG,UE,,28,,NW,,,,,,$358.99,$0.00,1,1,1,1,1,1,20171001, E0670,HCPCS,SEG PNEUM INT LEGS/TRUNK,,,28,,NW,,,,,,"$2,723.25",$0.00,1,1,1,1,1,1,20171001, E0670,HCPCS,SEG PNEUM INT LEGS/TRUNK,NU,,28,,NW,,,,,,"$2,723.25",$0.00,1,1,1,1,1,1,20171001, E0670,HCPCS,SEG PNEUM INT LEGS/TRUNK,RR,,28,,NW,,,,,,$350.24,$0.00,1,1,1,1,1,1,20171001, E0670,HCPCS,SEG PNEUM INT LEGS/TRUNK,UE,,28,,NW,,,,,,"$2,059.30",$0.00,1,1,1,1,1,1,20171001, E0671,HCPCS,PRESSURE PNEUM APPL FULL LEG,,,28,,NW,,,,,,$967.07,$0.00,1,1,1,1,1,1,20171001, E0671,HCPCS,PRESSURE PNEUM APPL FULL LEG,NU,,28,,NW,,,,,,$967.07,$0.00,1,1,1,1,1,1,20171001, E0671,HCPCS,PRESSURE PNEUM APPL FULL LEG,RR,,28,,NW,,,,,,$157.65,$0.00,1,1,1,1,1,1,20171001, E0671,HCPCS,PRESSURE PNEUM APPL FULL LEG,UE,,28,,NW,,,,,,$742.19,$0.00,1,1,1,1,1,1,20171001, E0672,HCPCS,PRESSURE PNEUM APPL FULL ARM,,,28,,NW,,,,,,$766.48,$0.00,1,1,1,1,1,1,20171001, E0672,HCPCS,PRESSURE PNEUM APPL FULL ARM,NU,,28,,NW,,,,,,$766.48,$0.00,1,1,1,1,1,1,20171001, E0672,HCPCS,PRESSURE PNEUM APPL FULL ARM,RR,,28,,NW,,,,,,$137.57,$0.00,1,1,1,1,1,1,20171001, E0672,HCPCS,PRESSURE PNEUM APPL FULL ARM,UE,,28,,NW,,,,,,$591.82,$0.00,1,1,1,1,1,1,20171001, E0673,HCPCS,PRESSURE PNEUM APPL HALF LEG,,,28,,NW,,,,,,$648.35,$0.00,1,1,1,1,1,1,20171001, E0673,HCPCS,PRESSURE PNEUM APPL HALF LEG,NU,,28,,NW,,,,,,$648.35,$0.00,1,1,1,1,1,1,20171001, E0673,HCPCS,PRESSURE PNEUM APPL HALF LEG,RR,,28,,NW,,,,,,$125.74,$0.00,1,1,1,1,1,1,20171001, E0673,HCPCS,PRESSURE PNEUM APPL HALF LEG,UE,,28,,NW,,,,,,$503.24,$0.00,1,1,1,1,1,1,20171001, E0675,HCPCS,PNEUMATIC COMPRESSION DEVICE,,,28,,NW,,,,,,"$7,096.69",$0.00,1,1,1,1,1,1,20171001, E0675,HCPCS,PNEUMATIC COMPRESSION DEVICE,RR,,28,,NW,,,,,,$898.07,$0.00,1,1,1,1,1,1,20171001, E0676,HCPCS,INTER LIMB COMPRESS DEV NOS,,,28,,NW,,,,,,$186.10,$0.00,1,1,1,1,1,1,20171001, E0691,HCPCS,UVL PNL 2 SQ FT OR LESS,,,28,,NW,,,,,,"$2,012.73",$0.00,1,1,1,1,1,1,20171001, E0691,HCPCS,UVL PNL 2 SQ FT OR LESS,NU,,28,,NW,,,,,,"$2,012.73",$0.00,1,1,1,1,1,1,20171001, E0691,HCPCS,UVL PNL 2 SQ FT OR LESS,RR,,28,,NW,,,,,,$262.15,$0.00,1,1,1,1,1,1,20171001, E0691,HCPCS,UVL PNL 2 SQ FT OR LESS,UE,,28,,NW,,,,,,"$1,526.47",$0.00,1,1,1,1,1,1,20171001, E0692,HCPCS,UVL SYS PANEL 4 FT,,,28,,NW,,,,,,"$2,510.14",$0.00,1,1,1,1,1,1,20171001, E0692,HCPCS,UVL SYS PANEL 4 FT,NU,,28,,NW,,,,,,"$2,510.14",$0.00,1,1,1,1,1,1,20171001, E0692,HCPCS,UVL SYS PANEL 4 FT,RR,,28,,NW,,,,,,$311.84,$0.00,1,1,1,1,1,1,20171001, E0692,HCPCS,UVL SYS PANEL 4 FT,UE,,28,,NW,,,,,,"$1,899.50",$0.00,1,1,1,1,1,1,20171001, E0693,HCPCS,UVL SYS PANEL 6 FT,,,28,,NW,,,,,,"$3,078.54",$0.00,1,1,1,1,1,1,20171001, E0693,HCPCS,UVL SYS PANEL 6 FT,NU,,28,,NW,,,,,,"$3,078.54",$0.00,1,1,1,1,1,1,20171001, E0693,HCPCS,UVL SYS PANEL 6 FT,RR,,28,,NW,,,,,,$368.77,$0.00,1,1,1,1,1,1,20171001, E0693,HCPCS,UVL SYS PANEL 6 FT,UE,,28,,NW,,,,,,"$2,325.81",$0.00,1,1,1,1,1,1,20171001, E0694,HCPCS,UVL MD CABINET SYS 6 FT,,,28,,NW,,,,,,"$9,650.96",$0.00,1,1,1,1,1,1,20171001, E0694,HCPCS,UVL MD CABINET SYS 6 FT,NU,,28,,NW,,,,,,"$9,650.96",$0.00,1,1,1,1,1,1,20171001, E0694,HCPCS,UVL MD CABINET SYS 6 FT,RR,,28,,NW,,,,,,"$1,025.98",$0.00,1,1,1,1,1,1,20171001, E0694,HCPCS,UVL MD CABINET SYS 6 FT,UE,,28,,NW,,,,,,"$7,255.19",$0.00,1,1,1,1,1,1,20171001, E0700,HCPCS,SAFETY EQUIPMENT,,,28,,NW,,,,,,$54.51,$0.00,1,1,1,1,1,1,20171001, E0705,HCPCS,TRANSFER DEVICE,,,28,,NW,,,,,,$156.13,$0.00,1,1,1,1,1,1,20171001, E0705,HCPCS,TRANSFER DEVICE,NU,,28,,NW,,,,,,$156.13,$0.00,1,1,1,1,1,1,20171001, E0705,HCPCS,TRANSFER DEVICE,RR,,28,,NW,,,,,,$41.39,$0.00,1,1,1,1,1,1,20171001, E0705,HCPCS,TRANSFER DEVICE,UE,,28,,NW,,,,,,$134.01,$0.00,1,1,1,1,1,1,20171001, E0710,HCPCS,RESTRAINTS ANY TYPE,,,28,,NW,,,,,,$97.42,$0.00,1,1,1,1,1,1,20171001, E0720,HCPCS,TENS TWO LEAD,,,28,,NW,,,,,,$222.51,$0.00,1,1,1,1,1,1,20171001, E0720,HCPCS,TENS TWO LEAD,NU,,28,,NW,,,,,,$222.51,$0.00,1,1,1,1,1,1,20171001, E0720,HCPCS,TENS TWO LEAD,RR,,28,,NW,,,,,,$113.19,$0.00,1,1,1,1,1,1,20171001, E0720,HCPCS,TENS TWO LEAD,UE,,28,,NW,,,,,,$407.78,$0.00,1,1,1,1,1,1,20171001, E0730,HCPCS,TENS FOUR LEAD,,,28,,NW,,,,,,$209.58,$0.00,1,1,1,1,1,1,20171001, E0730,HCPCS,TENS FOUR LEAD,NU,,28,,NW,,,,,,$209.58,$0.00,1,1,1,1,1,1,20171001, E0730,HCPCS,TENS FOUR LEAD,RR,,28,,NW,,,,,,$113.19,$0.00,1,1,1,1,1,1,20171001, E0730,HCPCS,TENS FOUR LEAD,UE,,28,,NW,,,,,,$410.46,$0.00,1,1,1,1,1,1,20171001, E0731,HCPCS,CONDUCTIVE GARMENT FOR TENS/,,,28,,NW,,,,,,$246.57,$0.00,1,1,1,1,1,1,20171001, E0731,HCPCS,CONDUCTIVE GARMENT FOR TENS/,NU,,28,,NW,,,,,,$246.57,$0.00,1,1,1,1,1,1,20171001, E0731,HCPCS,CONDUCTIVE GARMENT FOR TENS/,RR,,28,,NW,,,,,,$31.20,$0.00,1,1,1,1,1,1,20171001, E0740,HCPCS,NON-IMPLANT PELV FLR E-STIM,,,28,,NW,,,,,,"$1,429.32",$0.00,1,1,1,1,1,1,20171001, E0740,HCPCS,INCONTINENCE TREATMENT SYSTM,NU,,28,,NW,,,,,,"$1,429.32",$0.00,1,1,1,1,1,1,20171001, E0740,HCPCS,INCONTINENCE TREATMENT SYSTM,RR,,28,,NW,,,,,,$180.88,$0.00,1,1,1,1,1,1,20171001, E0740,HCPCS,INCONTINENCE TREATMENT SYSTM,UE,,28,,NW,,,,,,$619.34,$0.00,1,1,1,1,1,1,20171001, E0744,HCPCS,NEUROMUSCULAR STIM FOR SCOLI,,,28,,NW,,,,,,"$2,014.30",$0.00,1,1,1,1,1,1,20171001, E0744,HCPCS,NEUROMUSCULAR STIM FOR SCOLI,NU,,28,,NW,,,,,,"$2,014.30",$0.00,1,1,1,1,1,1,20171001, E0744,HCPCS,NEUROMUSCULAR STIM FOR SCOLI,RR,,28,,NW,,,,,,$254.90,$0.00,1,1,1,1,1,1,20171001, E0744,HCPCS,NEUROMUSCULAR STIM FOR SCOLI,UE,,28,,NW,,,,,,"$1,033.37",$0.00,1,1,1,1,1,1,20171001, E0745,HCPCS,NEUROMUSCULAR STIM FOR SHOCK,,,28,,NW,,,,,,"$1,986.30",$0.00,1,1,1,1,1,1,20171001, E0745,HCPCS,NEUROMUSCULAR STIM FOR SHOCK,NU,,28,,NW,,,,,,"$1,986.30",$0.00,1,1,1,1,1,1,20171001, E0745,HCPCS,NEUROMUSCULAR STIM FOR SHOCK,RR,,28,,NW,,,,,,$251.36,$0.00,1,1,1,1,1,1,20171001, E0745,HCPCS,NEUROMUSCULAR STIM FOR SHOCK,UE,,28,,NW,,,,,,"$1,011.41",$0.00,1,1,1,1,1,1,20171001, E0746,HCPCS,ELECTROMYOGRAPH BIOFEEDBACK,,,28,,NW,,,,,,$235.56,$0.00,1,1,1,1,1,1,20171001, E0746,HCPCS,ELECTROMYOGRAPH BIOFEEDBACK,NU,,28,,NW,,,,,,$235.56,$0.00,1,1,1,1,1,1,20171001, E0746,HCPCS,ELECTROMYOGRAPH BIOFEEDBACK,RR,,28,,NW,,,,,,$25.78,$0.00,1,1,1,1,1,1,20171001, E0746,HCPCS,ELECTROMYOGRAPH BIOFEEDBACK,UE,,28,,NW,,,,,,$177.38,$0.00,1,1,1,1,1,1,20171001, E0747,HCPCS,ELEC OSTEOGEN STIM NOT SPINE,,,28,,NW,,,,,,"$8,126.92",$0.00,1,1,1,1,1,1,20171001, E0747,HCPCS,ELEC OSTEOGEN STIM NOT SPINE,NU,,28,,NW,,,,,,"$8,126.92",$0.00,1,1,1,1,1,1,20171001, E0747,HCPCS,ELEC OSTEOGEN STIM NOT SPINE,RR,,28,,NW,,,,,,$875.99,$0.00,1,1,1,1,1,1,20171001, E0747,HCPCS,ELEC OSTEOGEN STIM NOT SPINE,UE,,28,,NW,,,,,,"$6,014.01",$0.00,1,1,1,1,1,1,20171001, E0748,HCPCS,ELEC OSTEOGEN STIM SPINAL,,,28,,NW,,,,,,"$8,492.50",$0.00,1,1,1,1,1,1,20171001, E0748,HCPCS,ELEC OSTEOGEN STIM SPINAL,NU,,28,,NW,,,,,,"$8,492.50",$0.00,1,1,1,1,1,1,20171001, E0748,HCPCS,ELEC OSTEOGEN STIM SPINAL,RR,,28,,NW,,,,,,$910.11,$0.00,1,1,1,1,1,1,20171001, E0748,HCPCS,ELEC OSTEOGEN STIM SPINAL,UE,,28,,NW,,,,,,"$6,386.30",$0.00,1,1,1,1,1,1,20171001, E0749,HCPCS,ELEC OSTEOGEN STIM IMPLANTED,,,28,,NW,,,,,,"$5,135.79",$0.00,1,1,1,1,1,1,20171001, E0749,HCPCS,ELEC OSTEOGEN STIM IMPLANTED,RR,,28,,NW,,,,,,$649.92,$0.00,1,1,1,1,1,1,20171001, E0760,HCPCS,OSTEOGEN ULTRASOUND STIMLTOR,,,28,,NW,,,,,,"$7,065.97",$0.00,1,1,1,1,1,1,20171001, E0760,HCPCS,OSTEOGEN ULTRASOUND STIMLTOR,NU,,28,,NW,,,,,,"$7,065.97",$0.00,1,1,1,1,1,1,20171001, E0760,HCPCS,OSTEOGEN ULTRASOUND STIMLTOR,RR,,28,,NW,,,,,,$767.51,$0.00,1,1,1,1,1,1,20171001, E0760,HCPCS,OSTEOGEN ULTRASOUND STIMLTOR,UE,,28,,NW,,,,,,"$5,316.35",$0.00,1,1,1,1,1,1,20171001, E0761,HCPCS,NONTHERM ELECTROMGNTC DEVICE,,,28,,NW,,,,,,"$2,029.13",$0.00,1,1,1,1,1,1,20171001, E0762,HCPCS,TRANS ELEC JT STIM DEV SYS,,,28,,NW,,,,,,"$2,289.26",$0.00,1,1,1,1,1,1,20171001, E0762,HCPCS,TRANS ELEC JT STIM DEV SYS,NU,,28,,NW,,,,,,"$2,289.26",$0.00,1,1,1,1,1,1,20171001, E0762,HCPCS,TRANS ELEC JT STIM DEV SYS,RR,,28,,NW,,,,,,$289.70,$0.00,1,1,1,1,1,1,20171001, E0762,HCPCS,TRANS ELEC JT STIM DEV SYS,UE,,28,,NW,,,,,,"$1,226.72",$0.00,1,1,1,1,1,1,20171001, E0764,HCPCS,FUNCTIONAL NEUROMUSCULARSTIM,,,28,,NW,,,,,,"$19,464.08",$0.00,1,1,1,1,1,1,20171001, E0764,HCPCS,FUNCTIONAL NEUROMUSCULARSTIM,NU,,28,,NW,,,,,,"$19,464.08",$0.00,1,1,1,1,1,1,20171001, E0764,HCPCS,FUNCTIONAL NEUROMUSCULARSTIM,RR,,28,,NW,,,,,,"$2,463.13",$0.00,1,1,1,1,1,1,20171001, E0764,HCPCS,FUNCTIONAL NEUROMUSCULARSTIM,UE,,28,,NW,,,,,,"$11,734.83",$0.00,1,1,1,1,1,1,20171001, E0765,HCPCS,NERVE STIMULATOR FOR TX N&V,,,28,,NW,,,,,,$249.78,$0.00,1,1,1,1,1,1,20171001, E0765,HCPCS,NERVE STIMULATOR FOR TX N&V,NU,,28,,NW,,,,,,$249.78,$0.00,1,1,1,1,1,1,20171001, E0765,HCPCS,NERVE STIMULATOR FOR TX N&V,RR,,28,,NW,,,,,,$85.89,$0.00,1,1,1,1,1,1,20171001, E0765,HCPCS,NERVE STIMULATOR FOR TX N&V,UE,,28,,NW,,,,,,$204.29,$0.00,1,1,1,1,1,1,20171001, E0766,HCPCS,ELEC STIM CANCER TREATMENT,,,28,,NW,,,,,,$316.71,$0.00,1,1,1,1,1,1,20171001, E0769,HCPCS,ELECTRIC WOUND TREATMENT DEV,,,28,,NW,,,,,,$209.58,$0.00,1,1,1,1,1,1,20171001, E0770,HCPCS,FUNCTIONAL ELECTRIC STIM NOS,,,28,,NW,,,,,,$209.58,$0.00,1,1,1,1,1,1,20171001, E0776,HCPCS,IV POLE,,,28,,NW,,,,,,$334.69,$0.00,1,1,1,1,1,1,20171001, E0776,HCPCS,IV POLE,NU,,28,,NW,,,,,,$334.69,$0.00,1,1,1,1,1,1,20171001, E0776,HCPCS,IV POLE,RR,,28,,NW,,,,,,$94.58,$0.00,1,1,1,1,1,1,20171001, E0776,HCPCS,IV POLE,UE,,28,,NW,,,,,,$266.66,$0.00,1,1,1,1,1,1,20171001, E0779,HCPCS,AMB INFUSION PUMP MECHANICAL,,,28,,NW,,,,,,$808.32,$0.00,1,1,1,1,1,1,20171001, E0779,HCPCS,AMB INFUSION PUMP MECHANICAL,RR,,28,,NW,,,,,,$102.29,$0.00,1,1,1,1,1,1,20171001, E0780,HCPCS,MECH AMB INFUSION PUMP <8HRS,,,28,,NW,,,,,,$89.86,$0.00,1,1,1,1,1,1,20171001, E0780,HCPCS,MECH AMB INFUSION PUMP <8HRS,NU,,28,,NW,,,,,,$89.86,$0.00,1,1,1,1,1,1,20171001, E0781,HCPCS,EXTERNAL AMBULATORY INFUS PU,,,28,,NW,,,,,,"$4,114.99",$0.00,1,1,1,1,1,1,20171001, E0781,HCPCS,EXTERNAL AMBULATORY INFUS PU,RR,,28,,NW,,,,,,$520.74,$0.00,1,1,1,1,1,1,20171001, E0782,HCPCS,NON-PROGRAMBLE INFUSION PUMP,,,28,,NW,,,,,,"$8,882.08",$0.00,1,1,1,1,1,1,20171001, E0782,HCPCS,NON-PROGRAMBLE INFUSION PUMP,NU,,28,,NW,,,,,,"$8,882.08",$0.00,1,1,1,1,1,1,20171001, E0782,HCPCS,NON-PROGRAMBLE INFUSION PUMP,RR,,28,,NW,,,,,,$949.13,$0.00,1,1,1,1,1,1,20171001, E0782,HCPCS,NON-PROGRAMBLE INFUSION PUMP,UE,,28,,NW,,,,,,"$6,678.47",$0.00,1,1,1,1,1,1,20171001, E0783,HCPCS,PROGRAMMABLE INFUSION PUMP,,,28,,NW,,,,,,"$17,426.82",$0.00,1,1,1,1,1,1,20171001, E0783,HCPCS,PROGRAMMABLE INFUSION PUMP,NU,,28,,NW,,,,,,"$17,426.82",$0.00,1,1,1,1,1,1,20171001, E0783,HCPCS,PROGRAMMABLE INFUSION PUMP,RR,,28,,NW,,,,,,"$1,803.62",$0.00,1,1,1,1,1,1,20171001, E0783,HCPCS,PROGRAMMABLE INFUSION PUMP,UE,,28,,NW,,,,,,"$13,087.05",$0.00,1,1,1,1,1,1,20171001, E0784,HCPCS,EXT AMB INFUSN PUMP INSULIN,,,28,,NW,,,,,,"$6,990.34",$0.00,1,1,1,1,1,1,20171001, E0784,HCPCS,EXT AMB INFUSN PUMP INSULIN,RR,,28,,NW,,,,,,$884.61,$0.00,1,1,1,1,1,1,20171001, E0785,HCPCS,REPLACEMENT IMPL PUMP CATHET,,,28,,NW,,,,,,"$1,049.09",$0.00,1,1,1,1,1,1,20171001, E0785,HCPCS,REPLACEMENT IMPL PUMP CATHET,KF,,28,,NW,,,,,,"$1,049.09",$0.00,1,1,1,1,1,1,20171001, E0786,HCPCS,IMPLANTABLE PUMP REPLACEMENT,,,28,,NW,,,,,,"$16,986.21",$0.00,1,1,1,1,1,1,20171001, E0786,HCPCS,IMPLANTABLE PUMP REPLACEMENT,NU,,28,,NW,,,,,,"$16,986.21",$0.00,1,1,1,1,1,1,20171001, E0786,HCPCS,IMPLANTABLE PUMP REPLACEMENT,RR,,28,,NW,,,,,,"$1,759.50",$0.00,1,1,1,1,1,1,20171001, E0786,HCPCS,IMPLANTABLE PUMP REPLACEMENT,UE,,28,,NW,,,,,,"$12,756.60",$0.00,1,1,1,1,1,1,20171001, E0791,HCPCS,PARENTERAL INFUSION PUMP STA,,,28,,NW,,,,,,"$8,014.52",$0.00,1,1,1,1,1,1,20171001, E0791,HCPCS,PARENTERAL INFUSION PUMP STA,RR,,28,,NW,,,,,,$671.34,$0.00,1,1,1,1,1,1,20171001, E0791,HCPCS,PARENTERAL INFUSION PUMP STA,UE,,28,,NW,,,,,,"$5,033.25",$0.00,1,1,1,1,1,1,20171001, E0830,HCPCS,AMBULATORY TRACTION DEVICE,,,28,,NW,,,,,,"$1,684.11",$0.00,1,1,1,1,1,1,20171001, E0840,HCPCS,TRACT FRAME ATTACH HEADBOARD,,,28,,NW,,,,,,$298.21,$0.00,1,1,1,1,1,1,20171001, E0840,HCPCS,TRACT FRAME ATTACH HEADBOARD,NU,,28,,NW,,,,,,$298.21,$0.00,1,1,1,1,1,1,20171001, E0840,HCPCS,TRACT FRAME ATTACH HEADBOARD,RR,,28,,NW,,,,,,$61.97,$0.00,1,1,1,1,1,1,20171001, E0840,HCPCS,TRACT FRAME ATTACH HEADBOARD,UE,,28,,NW,,,,,,$251.48,$0.00,1,1,1,1,1,1,20171001, E0849,HCPCS,CERVICAL PNEUM TRAC EQUIP,,,28,,NW,,,,,,"$1,416.32",$0.00,1,1,1,1,1,1,20171001, E0849,HCPCS,CERVICAL PNEUM TRAC EQUIP,NU,,28,,NW,,,,,,"$1,416.32",$0.00,1,1,1,1,1,1,20171001, E0849,HCPCS,CERVICAL PNEUM TRAC EQUIP,RR,,28,,NW,,,,,,$179.23,$0.00,1,1,1,1,1,1,20171001, E0849,HCPCS,CERVICAL PNEUM TRAC EQUIP,UE,,28,,NW,,,,,,$610.77,$0.00,1,1,1,1,1,1,20171001, E0850,HCPCS,TRACTION STAND FREE STANDING,,,28,,NW,,,,,,$359.39,$0.00,1,1,1,1,1,1,20171001, E0850,HCPCS,TRACTION STAND FREE STANDING,NU,,28,,NW,,,,,,$359.39,$0.00,1,1,1,1,1,1,20171001, E0850,HCPCS,TRACTION STAND FREE STANDING,RR,,28,,NW,,,,,,$50.29,$0.00,1,1,1,1,1,1,20171001, E0850,HCPCS,TRACTION STAND FREE STANDING,UE,,28,,NW,,,,,,$308.63,$0.00,1,1,1,1,1,1,20171001, E0855,HCPCS,CERVICAL TRACTION EQUIPMENT,,,28,,NW,,,,,,"$1,387.76",$0.00,1,1,1,1,1,1,20171001, E0855,HCPCS,CERVICAL TRACTION EQUIPMENT,NU,,28,,NW,,,,,,"$1,387.76",$0.00,1,1,1,1,1,1,20171001, E0855,HCPCS,CERVICAL TRACTION EQUIPMENT,RR,,28,,NW,,,,,,$175.62,$0.00,1,1,1,1,1,1,20171001, E0855,HCPCS,CERVICAL TRACTION EQUIPMENT,UE,,28,,NW,,,,,,$597.38,$0.00,1,1,1,1,1,1,20171001, E0856,HCPCS,CERVIC COLLAR W AIR BLADDERS,,,28,,NW,,,,,,$797.90,$0.00,1,1,1,1,1,1,20171001, E0856,HCPCS,CERVIC COLLAR W AIR BLADDER,NU,,28,,NW,,,,,,$797.90,$0.00,1,1,1,1,1,1,20171001, E0856,HCPCS,CERVIC COLLAR W AIR BLADDERS,RR,,28,,NW,,,,,,$100.97,$0.00,1,1,1,1,1,1,20171001, E0856,HCPCS,CERVIC COLLAR W AIR BLADDER,UE,,28,,NW,,,,,,$229.96,$0.00,1,1,1,1,1,1,20171001, E0860,HCPCS,TRACT EQUIP CERVICAL TRACT,,,28,,NW,,,,,,$166.56,$0.00,1,1,1,1,1,1,20171001, E0860,HCPCS,TRACT EQUIP CERVICAL TRACT,NU,,28,,NW,,,,,,$166.56,$0.00,1,1,1,1,1,1,20171001, E0860,HCPCS,TRACT EQUIP CERVICAL TRACT,RR,,28,,NW,,,,,,$10.42,$0.00,1,1,1,1,1,1,20171001, E0860,HCPCS,TRACT EQUIP CERVICAL TRACT,UE,,28,,NW,,,,,,$123.35,$0.00,1,1,1,1,1,1,20171001, E0870,HCPCS,TRACT FRAME ATTACH FOOTBOARD,,,28,,NW,,,,,,$378.69,$0.00,1,1,1,1,1,1,20171001, E0870,HCPCS,TRACT FRAME ATTACH FOOTBOARD,NU,,28,,NW,,,,,,$378.69,$0.00,1,1,1,1,1,1,20171001, E0870,HCPCS,TRACT FRAME ATTACH FOOTBOARD,RR,,28,,NW,,,,,,$47.46,$0.00,1,1,1,1,1,1,20171001, E0870,HCPCS,TRACT FRAME ATTACH FOOTBOARD,UE,,28,,NW,,,,,,$323.09,$0.00,1,1,1,1,1,1,20171001, E0880,HCPCS,TRAC STAND FREE STAND EXTREM,,,28,,NW,,,,,,$393.20,$0.00,1,1,1,1,1,1,20171001, E0880,HCPCS,TRAC STAND FREE STAND EXTREM,NU,,28,,NW,,,,,,$393.20,$0.00,1,1,1,1,1,1,20171001, E0880,HCPCS,TRAC STAND FREE STAND EXTREM,RR,,28,,NW,,,,,,$75.52,$0.00,1,1,1,1,1,1,20171001, E0880,HCPCS,TRAC STAND FREE STAND EXTREM,UE,,28,,NW,,,,,,$335.05,$0.00,1,1,1,1,1,1,20171001, E0890,HCPCS,TRACTION FRAME ATTACH PELVIC,,,28,,NW,,,,,,$384.52,$0.00,1,1,1,1,1,1,20171001, E0890,HCPCS,TRACTION FRAME ATTACH PELVIC,NU,,28,,NW,,,,,,$384.52,$0.00,1,1,1,1,1,1,20171001, E0890,HCPCS,TRACTION FRAME ATTACH PELVIC,RR,,28,,NW,,,,,,$141.38,$0.00,1,1,1,1,1,1,20171001, E0890,HCPCS,TRACTION FRAME ATTACH PELVIC,UE,,28,,NW,,,,,,$338.02,$0.00,1,1,1,1,1,1,20171001, E0900,HCPCS,TRAC STAND FREE STAND PELVIC,,,28,,NW,,,,,,$401.71,$0.00,1,1,1,1,1,1,20171001, E0900,HCPCS,TRAC STAND FREE STAND PELVIC,NU,,28,,NW,,,,,,$401.71,$0.00,1,1,1,1,1,1,20171001, E0900,HCPCS,TRAC STAND FREE STAND PELVIC,RR,,28,,NW,,,,,,$113.26,$0.00,1,1,1,1,1,1,20171001, E0900,HCPCS,TRAC STAND FREE STAND PELVIC,UE,,28,,NW,,,,,,$340.61,$0.00,1,1,1,1,1,1,20171001, E0910,HCPCS,TRAPEZE BAR ATTACHED TO BED,,,28,,NW,,,,,,$234.56,$0.00,1,1,1,1,1,1,20171001, E0910,HCPCS,TRAPEZE BAR ATTACHED TO BED,RR,,28,,NW,,,,,,$29.68,$0.00,1,1,1,1,1,1,20171001, E0910,HCPCS,TRAPEZE BAR ATTACHED TO BED,UE,,28,,NW,,,,,,$318.73,$0.00,1,1,1,1,1,1,20171001, E0911,HCPCS,HD TRAPEZE BAR ATTACH TO BED,,,28,,NW,,,,,,"$1,373.79",$0.00,1,1,1,1,1,1,20171001, E0911,HCPCS,HD TRAPEZE BAR ATTACH TO BED,RR,,28,,NW,,,,,,$173.85,$0.00,1,1,1,1,1,1,20171001, E0912,HCPCS,HD TRAPEZE BAR FREE STANDING,,,28,,NW,,,,,,"$2,406.53",$0.00,1,1,1,1,1,1,20171001, E0912,HCPCS,HD TRAPEZE BAR FREE STANDING,RR,,28,,NW,,,,,,$304.54,$0.00,1,1,1,1,1,1,20171001, E0920,HCPCS,FRACTURE FRAME ATTACHED TO B,,,28,,NW,,,,,,"$1,636.51",$0.00,1,1,1,1,1,1,20171001, E0920,HCPCS,FRACTURE FRAME ATTACHED TO B,RR,,28,,NW,,,,,,$207.10,$0.00,1,1,1,1,1,1,20171001, E0920,HCPCS,FRACTURE FRAME ATTACHED TO B,UE,,28,,NW,,,,,,$657.28,$0.00,1,1,1,1,1,1,20171001, E0930,HCPCS,FRACTURE FRAME FREE STANDING,,,28,,NW,,,,,,"$1,616.37",$0.00,1,1,1,1,1,1,20171001, E0930,HCPCS,FRACTURE FRAME FREE STANDING,RR,,28,,NW,,,,,,$204.55,$0.00,1,1,1,1,1,1,20171001, E0930,HCPCS,FRACTURE FRAME FREE STANDING,UE,,28,,NW,,,,,,"$1,228.86",$0.00,1,1,1,1,1,1,20171001, E0935,HCPCS,CONT PAS MOTION EXERCISE DEV,,,28,,NW,,,,,,$899.56,$0.00,1,1,1,1,1,1,20171001, E0935,HCPCS,CONT PAS MOTION EXERCISE DEV,RR,,28,,NW,,,,,,$113.84,$0.00,1,1,1,1,1,1,20171001, E0936,HCPCS,"CPM DEVICE, OTHER THAN KNEE",,,28,,NW,,,,,,$91.68,$0.00,1,1,1,1,1,1,20171001, E0936,HCPCS,"CPM DEVICE, OTHER THAN KNEE",RR,,28,,NW,,,,,,$7.54,$0.00,1,1,1,1,1,1,20171001, E0940,HCPCS,TRAPEZE BAR FREE STANDING,,,28,,NW,,,,,,$597.11,$0.00,1,1,1,1,1,1,20171001, E0940,HCPCS,TRAPEZE BAR FREE STANDING,RR,,28,,NW,,,,,,$75.56,$0.00,1,1,1,1,1,1,20171001, E0940,HCPCS,TRAPEZE BAR FREE STANDING,UE,,28,,NW,,,,,,$440.83,$0.00,1,1,1,1,1,1,20171001, E0941,HCPCS,GRAVITY ASSISTED TRACTION DE,,,28,,NW,,,,,,"$1,569.64",$0.00,1,1,1,1,1,1,20171001, E0941,HCPCS,GRAVITY ASSISTED TRACTION DE,NU,,28,,NW,,,,,,"$1,569.64",$0.00,1,1,1,1,1,1,20171001, E0941,HCPCS,GRAVITY ASSISTED TRACTION DE,RR,,28,,NW,,,,,,$198.63,$0.00,1,1,1,1,1,1,20171001, E0941,HCPCS,GRAVITY ASSISTED TRACTION DE,UE,,28,,NW,,,,,,"$1,193.33",$0.00,1,1,1,1,1,1,20171001, E0942,HCPCS,CERVICAL HEAD HARNESS/HALTER,,,28,,NW,,,,,,$76.63,$0.00,1,1,1,1,1,1,20171001, E0942,HCPCS,CERVICAL HEAD HARNESS/HALTER,NU,,28,,NW,,,,,,$76.63,$0.00,1,1,1,1,1,1,20171001, E0942,HCPCS,CERVICAL HEAD HARNESS/HALTER,RR,,28,,NW,,,,,,$2.68,$0.00,1,1,1,1,1,1,20171001, E0942,HCPCS,CERVICAL HEAD HARNESS/HALTER,UE,,28,,NW,,,,,,$51.91,$0.00,1,1,1,1,1,1,20171001, E0944,HCPCS,PELVIC BELT/HARNESS/BOOT,,,28,,NW,,,,,,$115.55,$0.00,1,1,1,1,1,1,20171001, E0944,HCPCS,PELVIC BELT/HARNESS/BOOT,NU,,28,,NW,,,,,,$115.55,$0.00,1,1,1,1,1,1,20171001, E0944,HCPCS,PELVIC BELT/HARNESS/BOOT,RR,,28,,NW,,,,,,$12.49,$0.00,1,1,1,1,1,1,20171001, E0944,HCPCS,PELVIC BELT/HARNESS/BOOT,UE,,28,,NW,,,,,,$94.38,$0.00,1,1,1,1,1,1,20171001, E0945,HCPCS,BELT/HARNESS EXTREMITY,,,28,,NW,,,,,,$114.35,$0.00,1,1,1,1,1,1,20171001, E0945,HCPCS,BELT/HARNESS EXTREMITY,NU,,28,,NW,,,,,,$114.35,$0.00,1,1,1,1,1,1,20171001, E0945,HCPCS,BELT/HARNESS EXTREMITY,RR,,28,,NW,,,,,,$12.23,$0.00,1,1,1,1,1,1,20171001, E0945,HCPCS,BELT/HARNESS EXTREMITY,UE,,28,,NW,,,,,,$95.00,$0.00,1,1,1,1,1,1,20171001, E0946,HCPCS,FRACTURE FRAME DUAL W CROSS,,,28,,NW,,,,,,"$2,091.32",$0.00,1,1,1,1,1,1,20171001, E0946,HCPCS,FRACTURE FRAME DUAL W CROSS,NU,,28,,NW,,,,,,"$2,091.32",$0.00,1,1,1,1,1,1,20171001, E0946,HCPCS,FRACTURE FRAME DUAL W CROSS,RR,,28,,NW,,,,,,$264.65,$0.00,1,1,1,1,1,1,20171001, E0946,HCPCS,FRACTURE FRAME DUAL W CROSS,UE,,28,,NW,,,,,,"$1,589.95",$0.00,1,1,1,1,1,1,20171001, E0947,HCPCS,FRACTURE FRAME ATTACHMNTS PE,,,28,,NW,,,,,,"$1,315.05",$0.00,1,1,1,1,1,1,20171001, E0947,HCPCS,FRACTURE FRAME ATTACHMNTS PE,NU,,28,,NW,,,,,,"$1,315.05",$0.00,1,1,1,1,1,1,20171001, E0947,HCPCS,FRACTURE FRAME ATTACHMNTS PE,RR,,28,,NW,,,,,,$275.22,$0.00,1,1,1,1,1,1,20171001, E0947,HCPCS,FRACTURE FRAME ATTACHMNTS PE,UE,,28,,NW,,,,,,"$1,024.60",$0.00,1,1,1,1,1,1,20171001, E0948,HCPCS,FRACTURE FRAME ATTACHMNTS CE,,,28,,NW,,,,,,"$1,291.77",$0.00,1,1,1,1,1,1,20171001, E0948,HCPCS,FRACTURE FRAME ATTACHMNTS CE,NU,,28,,NW,,,,,,"$1,291.77",$0.00,1,1,1,1,1,1,20171001, E0948,HCPCS,FRACTURE FRAME ATTACHMNTS CE,RR,,28,,NW,,,,,,$266.38,$0.00,1,1,1,1,1,1,20171001, E0948,HCPCS,FRACTURE FRAME ATTACHMNTS CE,UE,,28,,NW,,,,,,$964.49,$0.00,1,1,1,1,1,1,20171001, E0950,HCPCS,TRAY,,,28,,NW,,,,,,$230.46,$0.00,1,1,1,1,1,1,20171001, E0950,HCPCS,TRAY,NU,,28,,NW,,,,,,$230.46,$0.00,1,1,1,1,1,1,20171001, E0950,HCPCS,TRAY,RR,,28,,NW,,,,,,$19.43,$0.00,1,1,1,1,1,1,20171001, E0950,HCPCS,TRAY,UE,,28,,NW,,,,,,$180.42,$0.00,1,1,1,1,1,1,20171001, E0951,HCPCS,LOOP HEEL,,,28,,NW,,,,,,$47.15,$0.00,1,1,1,1,1,1,20171001, E0951,HCPCS,LOOP HEEL,NU,,28,,NW,,,,,,$47.15,$0.00,1,1,1,1,1,1,20171001, E0951,HCPCS,LOOP HEEL,RR,,28,,NW,,,,,,$3.36,$0.00,1,1,1,1,1,1,20171001, E0951,HCPCS,LOOP HEEL,UE,,28,,NW,,,,,,$25.17,$0.00,1,1,1,1,1,1,20171001, E0952,HCPCS,"TOE LOOP/HOLDER, EACH",,,28,,NW,,,,,,$45.17,$0.00,1,1,1,1,1,1,20171001, E0952,HCPCS,"TOE LOOP/HOLDER, EACH",NU,,28,,NW,,,,,,$45.17,$0.00,1,1,1,1,1,1,20171001, E0952,HCPCS,"TOE LOOP/HOLDER, EACH",RR,,28,,NW,,,,,,$4.06,$0.00,1,1,1,1,1,1,20171001, E0952,HCPCS,"TOE LOOP/HOLDER, EACH",UE,,28,,NW,,,,,,$31.75,$0.00,1,1,1,1,1,1,20171001, E0955,HCPCS,CUSHIONED HEADREST,,,28,,NW,,,,,,$420.55,$0.00,1,1,1,1,1,1,20171001, E0955,HCPCS,CUSHIONED HEADREST,NU,,28,,NW,,,,,,$420.55,$0.00,1,1,1,1,1,1,20171001, E0955,HCPCS,CUSHIONED HEADREST,RR,,28,,NW,,,,,,$53.22,$0.00,1,1,1,1,1,1,20171001, E0955,HCPCS,CUSHIONED HEADREST,UE,,28,,NW,,,,,,$314.92,$0.00,1,1,1,1,1,1,20171001, E0956,HCPCS,W/C LATERAL TRUNK/HIP SUPPOR,,,28,,NW,,,,,,$232.69,$0.00,1,1,1,1,1,1,20171001, E0956,HCPCS,W/C LATERAL TRUNK/HIP SUPPOR,NU,,28,,NW,,,,,,$232.69,$0.00,1,1,1,1,1,1,20171001, E0956,HCPCS,W/C LATERAL TRUNK/HIP SUPPOR,RR,,28,,NW,,,,,,$19.65,$0.00,1,1,1,1,1,1,20171001, E0956,HCPCS,W/C LATERAL TRUNK/HIP SUPPOR,UE,,28,,NW,,,,,,$182.09,$0.00,1,1,1,1,1,1,20171001, E0957,HCPCS,W/C MEDIAL THIGH SUPPORT,,,28,,NW,,,,,,$346.38,$0.00,1,1,1,1,1,1,20171001, E0957,HCPCS,W/C MEDIAL THIGH SUPPORT,NU,,28,,NW,,,,,,$346.38,$0.00,1,1,1,1,1,1,20171001, E0957,HCPCS,W/C MEDIAL THIGH SUPPORT,RR,,28,,NW,,,,,,$42.38,$0.00,1,1,1,1,1,1,20171001, E0957,HCPCS,W/C MEDIAL THIGH SUPPORT,UE,,28,,NW,,,,,,$267.36,$0.00,1,1,1,1,1,1,20171001, E0958,HCPCS,WHLCHR ATT- CONV 1 ARM DRIVE,,,28,,NW,,,,,,"$1,104.99",$0.00,1,1,1,1,1,1,20171001, E0958,HCPCS,WHLCHR ATT- CONV 1 ARM DRIVE,NU,,28,,NW,,,,,,"$1,104.99",$0.00,1,1,1,1,1,1,20171001, E0958,HCPCS,WHLCHR ATT- CONV 1 ARM DRIVE,RR,,28,,NW,,,,,,$139.83,$0.00,1,1,1,1,1,1,20171001, E0958,HCPCS,WHLCHR ATT- CONV 1 ARM DRIVE,UE,,28,,NW,,,,,,$742.37,$0.00,1,1,1,1,1,1,20171001, E0959,HCPCS,AMPUTEE ADAPTER,,,28,,NW,,,,,,$108.21,$0.00,1,1,1,1,1,1,20171001, E0959,HCPCS,AMPUTEE ADAPTER,NU,,28,,NW,,,,,,$108.21,$0.00,1,1,1,1,1,1,20171001, E0959,HCPCS,AMPUTEE ADAPTER,RR,,28,,NW,,,,,,$11.25,$0.00,1,1,1,1,1,1,20171001, E0959,HCPCS,AMPUTEE ADAPTER,UE,,28,,NW,,,,,,$88.76,$0.00,1,1,1,1,1,1,20171001, E0960,HCPCS,W/C SHOULDER HARNESS/STRAPS,,,28,,NW,,,,,,$222.93,$0.00,1,1,1,1,1,1,20171001, E0960,HCPCS,W/C SHOULDER HARNESS/STRAPS,NU,,28,,NW,,,,,,$222.93,$0.00,1,1,1,1,1,1,20171001, E0960,HCPCS,W/C SHOULDER HARNESS/STRAPS,RR,,28,,NW,,,,,,$18.70,$0.00,1,1,1,1,1,1,20171001, E0960,HCPCS,W/C SHOULDER HARNESS/STRAPS,UE,,28,,NW,,,,,,$174.77,$0.00,1,1,1,1,1,1,20171001, E0961,HCPCS,WHEELCHAIR BRAKE EXTENSION,,,28,,NW,,,,,,$78.38,$0.00,1,1,1,1,1,1,20171001, E0961,HCPCS,WHEELCHAIR BRAKE EXTENSION,NU,,28,,NW,,,,,,$78.38,$0.00,1,1,1,1,1,1,20171001, E0961,HCPCS,WHEELCHAIR BRAKE EXTENSION,RR,,28,,NW,,,,,,$5.25,$0.00,1,1,1,1,1,1,20171001, E0961,HCPCS,WHEELCHAIR BRAKE EXTENSION,UE,,28,,NW,,,,,,$42.30,$0.00,1,1,1,1,1,1,20171001, E0966,HCPCS,WHEELCHAIR HEAD REST EXTENSI,,,28,,NW,,,,,,$215.04,$0.00,1,1,1,1,1,1,20171001, E0966,HCPCS,WHEELCHAIR HEAD REST EXTENSI,NU,,28,,NW,,,,,,$215.04,$0.00,1,1,1,1,1,1,20171001, E0966,HCPCS,WHEELCHAIR HEAD REST EXTENSI,RR,,28,,NW,,,,,,$17.92,$0.00,1,1,1,1,1,1,20171001, E0966,HCPCS,WHEELCHAIR HEAD REST EXTENSI,UE,,28,,NW,,,,,,$168.86,$0.00,1,1,1,1,1,1,20171001, E0967,HCPCS,MAN WC RIM/PROJECTION REP EA,,,28,,NW,,,,,,$156.67,$0.00,1,1,1,1,1,1,20171001, E0967,HCPCS,MANUAL WC HAND RIM W PROJECT,NU,,28,,NW,,,,,,$156.67,$0.00,1,1,1,1,1,1,20171001, E0967,HCPCS,MANUAL WC HAND RIM W PROJECT,RR,,28,,NW,,,,,,$18.25,$0.00,1,1,1,1,1,1,20171001, E0967,HCPCS,MANUAL WC HAND RIM W PROJECT,UE,,28,,NW,,,,,,$125.07,$0.00,1,1,1,1,1,1,20171001, E0968,HCPCS,WHEELCHAIR COMMODE SEAT,,,28,,NW,,,,,,$466.08,$0.00,1,1,1,1,1,1,20171001, E0968,HCPCS,WHEELCHAIR COMMODE SEAT,NU,,28,,NW,,,,,,$466.08,$0.00,1,1,1,1,1,1,20171001, E0968,HCPCS,WHEELCHAIR COMMODE SEAT,RR,,28,,NW,,,,,,$58.98,$0.00,1,1,1,1,1,1,20171001, E0968,HCPCS,WHEELCHAIR COMMODE SEAT,UE,,28,,NW,,,,,,$364.10,$0.00,1,1,1,1,1,1,20171001, E0969,HCPCS,WHEELCHAIR NARROWING DEVICE,,,28,,NW,,,,,,$337.53,$0.00,1,1,1,1,1,1,20171001, E0969,HCPCS,WHEELCHAIR NARROWING DEVICE,NU,,28,,NW,,,,,,$337.53,$0.00,1,1,1,1,1,1,20171001, E0969,HCPCS,WHEELCHAIR NARROWING DEVICE,RR,,28,,NW,,,,,,$49.89,$0.00,1,1,1,1,1,1,20171001, E0969,HCPCS,WHEELCHAIR NARROWING DEVICE,UE,,28,,NW,,,,,,$262.04,$0.00,1,1,1,1,1,1,20171001, E0970,HCPCS,WHEELCHAIR NO. 2 FOOTPLATES,,,28,,NW,,,,,,$138.85,$0.00,1,1,1,1,1,1,20171001, E0970,HCPCS,WHEELCHAIR NO. 2 FOOTPLATES,NU,,28,,NW,,,,,,$153.21,$0.00,1,1,1,1,1,1,20171001, E0970,HCPCS,WHEELCHAIR NO. 2 FOOTPLATES,RR,,28,,NW,,,,,,$16.38,$0.00,1,1,1,1,1,1,20171001, E0970,HCPCS,WHEELCHAIR NO. 2 FOOTPLATES,UE,,28,,NW,,,,,,$122.95,$0.00,1,1,1,1,1,1,20171001, E0971,HCPCS,WHEELCHAIR ANTI-TIPPING DEVI,,,28,,NW,,,,,,$110.33,$0.00,1,1,1,1,1,1,20171001, E0971,HCPCS,WHEELCHAIR ANTI-TIPPING DEVI,NU,,28,,NW,,,,,,$110.33,$0.00,1,1,1,1,1,1,20171001, E0971,HCPCS,WHEELCHAIR ANTI-TIPPING DEVI,RR,,28,,NW,,,,,,$7.77,$0.00,1,1,1,1,1,1,20171001, E0971,HCPCS,WHEELCHAIR ANTI-TIPPING DEVI,UE,,28,,NW,,,,,,$88.25,$0.00,1,1,1,1,1,1,20171001, E0973,HCPCS,W/CH ACCESS DET ADJ ARMREST,,,28,,NW,,,,,,$174.86,$0.00,1,1,1,1,1,1,20171001, E0973,HCPCS,W/CH ACCESS DET ADJ ARMREST,NU,,28,,NW,,,,,,$174.86,$0.00,1,1,1,1,1,1,20171001, E0973,HCPCS,W/CH ACCESS DET ADJ ARMREST,RR,,28,,NW,,,,,,$14.03,$0.00,1,1,1,1,1,1,20171001, E0973,HCPCS,W/CH ACCESS DET ADJ ARMREST,UE,,28,,NW,,,,,,$138.71,$0.00,1,1,1,1,1,1,20171001, E0974,HCPCS,W/CH ACCESS ANTI-ROLLBACK,,,28,,NW,,,,,,$222.33,$0.00,1,1,1,1,1,1,20171001, E0974,HCPCS,W/CH ACCESS ANTI-ROLLBACK,NU,,28,,NW,,,,,,$222.33,$0.00,1,1,1,1,1,1,20171001, E0974,HCPCS,W/CH ACCESS ANTI-ROLLBACK,RR,,28,,NW,,,,,,$18.72,$0.00,1,1,1,1,1,1,20171001, E0974,HCPCS,W/CH ACCESS ANTI-ROLLBACK,UE,,28,,NW,,,,,,$174.39,$0.00,1,1,1,1,1,1,20171001, E0978,HCPCS,"W/C ACC,SAF BELT PELV STRAP",,,28,,NW,,,,,,$94.83,$0.00,1,1,1,1,1,1,20171001, E0978,HCPCS,"W/C ACC,SAF BELT PELV STRAP",NU,,28,,NW,,,,,,$94.83,$0.00,1,1,1,1,1,1,20171001, E0978,HCPCS,"W/C ACC,SAF BELT PELV STRAP",RR,,28,,NW,,,,,,$6.27,$0.00,1,1,1,1,1,1,20171001, E0978,HCPCS,"W/C ACC,SAF BELT PELV STRAP",UE,,28,,NW,,,,,,$69.48,$0.00,1,1,1,1,1,1,20171001, E0980,HCPCS,WHEELCHAIR SAFETY VEST,,,28,,NW,,,,,,$92.43,$0.00,1,1,1,1,1,1,20171001, E0980,HCPCS,WHEELCHAIR SAFETY VEST,NU,,28,,NW,,,,,,$92.43,$0.00,1,1,1,1,1,1,20171001, E0980,HCPCS,WHEELCHAIR SAFETY VEST,RR,,28,,NW,,,,,,$9.00,$0.00,1,1,1,1,1,1,20171001, E0980,HCPCS,WHEELCHAIR SAFETY VEST,UE,,28,,NW,,,,,,$76.72,$0.00,1,1,1,1,1,1,20171001, E0981,HCPCS,"SEAT UPHOLSTERY, REPLACEMENT",,,28,,NW,,,,,,$135.18,$0.00,1,1,1,1,1,1,20171001, E0981,HCPCS,"SEAT UPHOLSTERY, REPLACEMENT",NU,,28,,NW,,,,,,$135.18,$0.00,1,1,1,1,1,1,20171001, E0981,HCPCS,"SEAT UPHOLSTERY, REPLACEMENT",RR,,28,,NW,,,,,,$10.18,$0.00,1,1,1,1,1,1,20171001, E0981,HCPCS,"SEAT UPHOLSTERY, REPLACEMENT",UE,,28,,NW,,,,,,$109.04,$0.00,1,1,1,1,1,1,20171001, E0982,HCPCS,"BACK UPHOLSTERY, REPLACEMENT",,,28,,NW,,,,,,$107.84,$0.00,1,1,1,1,1,1,20171001, E0982,HCPCS,"BACK UPHOLSTERY, REPLACEMENT",NU,,28,,NW,,,,,,$107.84,$0.00,1,1,1,1,1,1,20171001, E0982,HCPCS,"BACK UPHOLSTERY, REPLACEMENT",RR,,28,,NW,,,,,,$11.18,$0.00,1,1,1,1,1,1,20171001, E0982,HCPCS,"BACK UPHOLSTERY, REPLACEMENT",UE,,28,,NW,,,,,,$88.45,$0.00,1,1,1,1,1,1,20171001, E0983,HCPCS,ADD PWR JOYSTICK,,,28,,NW,,,,,,"$4,157.59",$0.00,1,1,1,1,1,1,20171001, E0983,HCPCS,ADD PWR JOYSTICK,RR,,28,,NW,,,,,,$526.13,$0.00,1,1,1,1,1,1,20171001, E0984,HCPCS,ADD PWR TILLER,,,28,,NW,,,,,,"$3,107.01",$0.00,1,1,1,1,1,1,20171001, E0984,HCPCS,ADD PWR TILLER,NU,,28,,NW,,,,,,"$3,107.01",$0.00,1,1,1,1,1,1,20171001, E0984,HCPCS,ADD PWR TILLER,RR,,28,,NW,,,,,,$393.18,$0.00,1,1,1,1,1,1,20171001, E0984,HCPCS,ADD PWR TILLER,UE,,28,,NW,,,,,,"$3,585.99",$0.00,1,1,1,1,1,1,20171001, E0985,HCPCS,W/C SEAT LIFT MECHANISM,,,28,,NW,,,,,,$504.94,$0.00,1,1,1,1,1,1,20171001, E0985,HCPCS,W/C SEAT LIFT MECHANISM,NU,,28,,NW,,,,,,$504.94,$0.00,1,1,1,1,1,1,20171001, E0985,HCPCS,W/C SEAT LIFT MECHANISM,RR,,28,,NW,,,,,,$63.90,$0.00,1,1,1,1,1,1,20171001, E0985,HCPCS,W/C SEAT LIFT MECHANISM,UE,,28,,NW,,,,,,$361.26,$0.00,1,1,1,1,1,1,20171001, E0986,HCPCS,MAN W/C PUSH-RIM POWR SYSTEM,,,28,,NW,,,,,,"$8,065.41",$0.00,1,1,1,1,1,1,20171001, E0986,HCPCS,MAN W/C PUSH-RIM POW ASSIST,NU,,28,,NW,,,,,,"$8,065.41",$0.00,1,1,1,1,1,1,20171001, E0986,HCPCS,MAN W/C PUSH-RIM POWR SYSTEM,RR,,28,,NW,,,,,,"$1,020.66",$0.00,1,1,1,1,1,1,20171001, E0986,HCPCS,MAN W/C PUSH-RIM POW ASSIST,UE,,28,,NW,,,,,,"$9,085.06",$0.00,1,1,1,1,1,1,20171001, E0988,HCPCS,LEVER-ACTIVATED WHEEL DRIVE,,,28,,NW,,,,,,"$4,964.10",$0.00,1,1,1,1,1,1,20171001, E0988,HCPCS,LEVER-ACTIVATED WHEEL DRIVE,RR,,28,,NW,,,,,,$628.19,$0.00,1,1,1,1,1,1,20171001, E0990,HCPCS,WHEELCHAIR ELEVATING LEG RES,,,28,,NW,,,,,,$216.05,$0.00,1,1,1,1,1,1,20171001, E0990,HCPCS,WHEELCHAIR ELEVATING LEG RES,NU,,28,,NW,,,,,,$216.05,$0.00,1,1,1,1,1,1,20171001, E0990,HCPCS,WHEELCHAIR ELEVATING LEG RES,RR,,28,,NW,,,,,,$18.03,$0.00,1,1,1,1,1,1,20171001, E0990,HCPCS,WHEELCHAIR ELEVATING LEG RES,UE,,28,,NW,,,,,,$169.61,$0.00,1,1,1,1,1,1,20171001, E0992,HCPCS,WHEELCHAIR SOLID SEAT INSERT,,,28,,NW,,,,,,$243.01,$0.00,1,1,1,1,1,1,20171001, E0992,HCPCS,WHEELCHAIR SOLID SEAT INSERT,NU,,28,,NW,,,,,,$243.01,$0.00,1,1,1,1,1,1,20171001, E0992,HCPCS,WHEELCHAIR SOLID SEAT INSERT,RR,,28,,NW,,,,,,$20.65,$0.00,1,1,1,1,1,1,20171001, E0992,HCPCS,WHEELCHAIR SOLID SEAT INSERT,UE,,28,,NW,,,,,,$189.84,$0.00,1,1,1,1,1,1,20171001, E0994,HCPCS,WHEELCHAIR ARM REST,,,28,,NW,,,,,,$56.17,$0.00,1,1,1,1,1,1,20171001, E0994,HCPCS,WHEELCHAIR ARM REST,NU,,28,,NW,,,,,,$56.17,$0.00,1,1,1,1,1,1,20171001, E0994,HCPCS,WHEELCHAIR ARM REST,RR,,28,,NW,,,,,,$4.95,$0.00,1,1,1,1,1,1,20171001, E0994,HCPCS,WHEELCHAIR ARM REST,UE,,28,,NW,,,,,,$40.08,$0.00,1,1,1,1,1,1,20171001, E0995,HCPCS,"WC CALF REST, PAD REPLACEMNT",,,28,,NW,,,,,,$75.60,$0.00,1,1,1,1,1,1,20171001, E0995,HCPCS,WHEELCHAIR CALF REST,NU,,28,,NW,,,,,,$75.60,$0.00,1,1,1,1,1,1,20171001, E0995,HCPCS,WHEELCHAIR CALF REST,RR,,28,,NW,,,,,,$6.55,$0.00,1,1,1,1,1,1,20171001, E0995,HCPCS,WHEELCHAIR CALF REST,UE,,28,,NW,,,,,,$56.34,$0.00,1,1,1,1,1,1,20171001, E1002,HCPCS,PWR SEAT TILT,,,28,,NW,,,,,,"$7,638.40",$0.00,1,1,1,1,1,1,20171001, E1002,HCPCS,PWR SEAT TILT,NU,,28,,NW,,,,,,"$7,638.40",$0.00,1,1,1,1,1,1,20171001, E1002,HCPCS,PWR SEAT TILT,RR,,28,,NW,,,,,,$966.62,$0.00,1,1,1,1,1,1,20171001, E1002,HCPCS,PWR SEAT TILT,UE,,28,,NW,,,,,,"$5,735.50",$0.00,1,1,1,1,1,1,20171001, E1003,HCPCS,PWR SEAT RECLINE,,,28,,NW,,,,,,"$6,063.56",$0.00,1,1,1,1,1,1,20171001, E1003,HCPCS,PWR SEAT RECLINE,NU,,28,,NW,,,,,,"$6,063.56",$0.00,1,1,1,1,1,1,20171001, E1003,HCPCS,PWR SEAT RECLINE,RR,,28,,NW,,,,,,$767.33,$0.00,1,1,1,1,1,1,20171001, E1003,HCPCS,PWR SEAT RECLINE,UE,,28,,NW,,,,,,"$6,211.17",$0.00,1,1,1,1,1,1,20171001, E1004,HCPCS,PWR SEAT RECLINE MECH,,,28,,NW,,,,,,"$6,640.97",$0.00,1,1,1,1,1,1,20171001, E1004,HCPCS,PWR SEAT RECLINE MECH,NU,,28,,NW,,,,,,"$6,640.97",$0.00,1,1,1,1,1,1,20171001, E1004,HCPCS,PWR SEAT RECLINE MECH,RR,,28,,NW,,,,,,$840.40,$0.00,1,1,1,1,1,1,20171001, E1004,HCPCS,PWR SEAT RECLINE MECH,UE,,28,,NW,,,,,,"$6,884.49",$0.00,1,1,1,1,1,1,20171001, E1005,HCPCS,PWR SEAT RECLINE PWR,,,28,,NW,,,,,,"$7,242.33",$0.00,1,1,1,1,1,1,20171001, E1005,HCPCS,PWR SEAT RECLINE PWR,NU,,28,,NW,,,,,,"$7,242.33",$0.00,1,1,1,1,1,1,20171001, E1005,HCPCS,PWR SEAT RECLINE PWR,RR,,28,,NW,,,,,,$916.50,$0.00,1,1,1,1,1,1,20171001, E1005,HCPCS,PWR SEAT RECLINE PWR,UE,,28,,NW,,,,,,"$7,449.05",$0.00,1,1,1,1,1,1,20171001, E1006,HCPCS,PWR SEAT COMBO W/O SHEAR,,,28,,NW,,,,,,"$8,873.79",$0.00,1,1,1,1,1,1,20171001, E1006,HCPCS,PWR SEAT COMBO W/O SHEAR,NU,,28,,NW,,,,,,"$8,873.79",$0.00,1,1,1,1,1,1,20171001, E1006,HCPCS,PWR SEAT COMBO W/O SHEAR,RR,,28,,NW,,,,,,"$1,122.95",$0.00,1,1,1,1,1,1,20171001, E1006,HCPCS,PWR SEAT COMBO W/O SHEAR,UE,,28,,NW,,,,,,"$9,117.21",$0.00,1,1,1,1,1,1,20171001, E1007,HCPCS,PWR SEAT COMBO W/SHEAR,,,28,,NW,,,,,,"$16,176.10",$0.00,1,1,1,1,1,1,20171001, E1007,HCPCS,PWR SEAT COMBO W/SHEAR,NU,,28,,NW,,,,,,"$16,176.10",$0.00,1,1,1,1,1,1,20171001, E1007,HCPCS,PWR SEAT COMBO W/SHEAR,RR,,28,,NW,,,,,,"$2,047.04",$0.00,1,1,1,1,1,1,20171001, E1007,HCPCS,PWR SEAT COMBO W/SHEAR,UE,,28,,NW,,,,,,"$12,334.38",$0.00,1,1,1,1,1,1,20171001, E1008,HCPCS,PWR SEAT COMBO PWR SHEAR,,,28,,NW,,,,,,"$11,232.92",$0.00,1,1,1,1,1,1,20171001, E1008,HCPCS,PWR SEAT COMBO PWR SHEAR,NU,,28,,NW,,,,,,"$11,232.92",$0.00,1,1,1,1,1,1,20171001, E1008,HCPCS,PWR SEAT COMBO PWR SHEAR,RR,,28,,NW,,,,,,"$1,421.50",$0.00,1,1,1,1,1,1,20171001, E1008,HCPCS,PWR SEAT COMBO PWR SHEAR,UE,,28,,NW,,,,,,"$12,336.27",$0.00,1,1,1,1,1,1,20171001, E1009,HCPCS,ADD MECH LEG ELEVATION,,,28,,NW,,,,,,"$2,937.37",$0.00,1,1,1,1,1,1,20171001, E1009,HCPCS,ADD MECH LEG ELEVATION,NU,,28,,NW,,,,,,"$2,937.37",$0.00,1,1,1,1,1,1,20171001, E1009,HCPCS,ADD MECH LEG ELEVATION,RR,,28,,NW,,,,,,$319.28,$0.00,1,1,1,1,1,1,20171001, E1009,HCPCS,ADD MECH LEG ELEVATION,UE,,28,,NW,,,,,,"$2,211.28",$0.00,1,1,1,1,1,1,20171001, E1010,HCPCS,ADD PWR LEG ELEVATION,,,28,,NW,,,,,,"$1,733.23",$0.00,1,1,1,1,1,1,20171001, E1010,HCPCS,ADD PWR LEG ELEVATION,NU,,28,,NW,,,,,,"$1,733.23",$0.00,1,1,1,1,1,1,20171001, E1010,HCPCS,ADD PWR LEG ELEVATION,RR,,28,,NW,,,,,,$219.34,$0.00,1,1,1,1,1,1,20171001, E1010,HCPCS,ADD PWR LEG ELEVATION,UE,,28,,NW,,,,,,"$1,640.75",$0.00,1,1,1,1,1,1,20171001, E1012,HCPCS,CTR MOUNT PWR ELEV LEG REST,,,28,,NW,,,,,,"$1,733.23",$0.00,1,1,1,1,1,1,20171001, E1012,HCPCS,CTR MOUNT PWR ELEV LEG REST,RR,,28,,NW,,,,,,$219.34,$0.00,1,1,1,1,1,1,20171001, E1014,HCPCS,RECLINING BACK ADD PED W/C,,,28,,NW,,,,,,$826.92,$0.00,1,1,1,1,1,1,20171001, E1014,HCPCS,RECLINING BACK ADD PED W/C,NU,,28,,NW,,,,,,$826.92,$0.00,1,1,1,1,1,1,20171001, E1014,HCPCS,RECLINING BACK ADD PED W/C,RR,,28,,NW,,,,,,$104.64,$0.00,1,1,1,1,1,1,20171001, E1014,HCPCS,RECLINING BACK ADD PED W/C,UE,,28,,NW,,,,,,$710.21,$0.00,1,1,1,1,1,1,20171001, E1015,HCPCS,SHOCK ABSORBER FOR MAN W/C,,,28,,NW,,,,,,$342.31,$0.00,1,1,1,1,1,1,20171001, E1015,HCPCS,SHOCK ABSORBER FOR MAN W/C,NU,,28,,NW,,,,,,$342.31,$0.00,1,1,1,1,1,1,20171001, E1015,HCPCS,SHOCK ABSORBER FOR MAN W/C,RR,,28,,NW,,,,,,$41.72,$0.00,1,1,1,1,1,1,20171001, E1015,HCPCS,SHOCK ABSORBER FOR MAN W/C,UE,,28,,NW,,,,,,$264.30,$0.00,1,1,1,1,1,1,20171001, E1016,HCPCS,SHOCK ABSORBER FOR POWER W/C,,,28,,NW,,,,,,$323.76,$0.00,1,1,1,1,1,1,20171001, E1016,HCPCS,SHOCK ABSORBER FOR POWER W/C,NU,,28,,NW,,,,,,$323.76,$0.00,1,1,1,1,1,1,20171001, E1016,HCPCS,SHOCK ABSORBER FOR POWER W/C,RR,,28,,NW,,,,,,$38.74,$0.00,1,1,1,1,1,1,20171001, E1016,HCPCS,SHOCK ABSORBER FOR POWER W/C,UE,,28,,NW,,,,,,$250.39,$0.00,1,1,1,1,1,1,20171001, E1017,HCPCS,HD SHCK ABSRBR FOR HD MAN WC,,,28,,NW,,,,,,$728.77,$0.00,1,1,1,1,1,1,20171001, E1017,HCPCS,HD SHCK ABSRBR FOR HD MAN WC,NU,,28,,NW,,,,,,$728.77,$0.00,1,1,1,1,1,1,20171001, E1017,HCPCS,HD SHCK ABSRBR FOR HD MAN WC,RR,,28,,NW,,,,,,$77.48,$0.00,1,1,1,1,1,1,20171001, E1017,HCPCS,HD SHCK ABSRBR FOR HD MAN WC,UE,,28,,NW,,,,,,$547.91,$0.00,1,1,1,1,1,1,20171001, E1018,HCPCS,HD SHCK ABSRBER FOR HD POWWC,,,28,,NW,,,,,,$153.58,$0.00,1,1,1,1,1,1,20171001, E1018,HCPCS,HD SHCK ABSRBER FOR HD POWWC,NU,,28,,NW,,,,,,$153.58,$0.00,1,1,1,1,1,1,20171001, E1018,HCPCS,HD SHCK ABSRBER FOR HD POWWC,RR,,28,,NW,,,,,,$16.34,$0.00,1,1,1,1,1,1,20171001, E1018,HCPCS,HD SHCK ABSRBER FOR HD POWWC,UE,,28,,NW,,,,,,$115.46,$0.00,1,1,1,1,1,1,20171001, E1020,HCPCS,RESIDUAL LIMB SUPPORT SYSTEM,,,28,,NW,,,,,,$539.88,$0.00,1,1,1,1,1,1,20171001, E1020,HCPCS,RESIDUAL LIMB SUPPORT SYSTEM,NU,,28,,NW,,,,,,$539.88,$0.00,1,1,1,1,1,1,20171001, E1020,HCPCS,RESIDUAL LIMB SUPPORT SYSTEM,RR,,28,,NW,,,,,,$68.32,$0.00,1,1,1,1,1,1,20171001, E1020,HCPCS,RESIDUAL LIMB SUPPORT SYSTEM,UE,,28,,NW,,,,,,$372.61,$0.00,1,1,1,1,1,1,20171001, E1028,HCPCS,W/C MANUAL SWINGAWAY,,,28,,NW,,,,,,$385.72,$0.00,1,1,1,1,1,1,20171001, E1028,HCPCS,W/C MANUAL SWINGAWAY,NU,,28,,NW,,,,,,$385.72,$0.00,1,1,1,1,1,1,20171001, E1028,HCPCS,W/C MANUAL SWINGAWAY,RR,,28,,NW,,,,,,$48.81,$0.00,1,1,1,1,1,1,20171001, E1028,HCPCS,W/C MANUAL SWINGAWAY,UE,,28,,NW,,,,,,$320.60,$0.00,1,1,1,1,1,1,20171001, E1029,HCPCS,W/C VENT TRAY FIXED,,,28,,NW,,,,,,$742.62,$0.00,1,1,1,1,1,1,20171001, E1029,HCPCS,W/C VENT TRAY FIXED,RR,,28,,NW,,,,,,$93.98,$0.00,1,1,1,1,1,1,20171001, E1030,HCPCS,W/C VENT TRAY GIMBALED,,,28,,NW,,,,,,"$1,811.48",$0.00,1,1,1,1,1,1,20171001, E1030,HCPCS,W/C VENT TRAY GIMBALED,NU,,28,,NW,,,,,,"$1,811.48",$0.00,1,1,1,1,1,1,20171001, E1030,HCPCS,W/C VENT TRAY GIMBALED,RR,,28,,NW,,,,,,$229.24,$0.00,1,1,1,1,1,1,20171001, E1030,HCPCS,W/C VENT TRAY GIMBALED,UE,,28,,NW,,,,,,"$1,671.01",$0.00,1,1,1,1,1,1,20171001, E1031,HCPCS,ROLLABOUT CHAIR WITH CASTERS,,,28,,NW,,,,,,"$1,133.40",$0.00,1,1,1,1,1,1,20171001, E1031,HCPCS,ROLLABOUT CHAIR WITH CASTERS,NU,,28,,NW,,,,,,"$1,133.40",$0.00,1,1,1,1,1,1,20171001, E1031,HCPCS,ROLLABOUT CHAIR WITH CASTERS,RR,,28,,NW,,,,,,$143.43,$0.00,1,1,1,1,1,1,20171001, E1031,HCPCS,ROLLABOUT CHAIR WITH CASTERS,UE,,28,,NW,,,,,,$854.90,$0.00,1,1,1,1,1,1,20171001, E1035,HCPCS,PATIENT TRANSFER SYSTEM <300,,,28,,NW,,,,,,"$12,464.21",$0.00,1,1,1,1,1,1,20171001, E1035,HCPCS,PATIENT TRANSFER SYSTEM <300,RR,,28,,NW,,,,,,"$1,577.31",$0.00,1,1,1,1,1,1,20171001, E1036,HCPCS,PATIENT TRANSFER SYSTEM >300,,,28,,NW,,,,,,"$18,108.67",$0.00,1,1,1,1,1,1,20171001, E1036,HCPCS,PATIENT TRANSFER SYSTEM >300,RR,,28,,NW,,,,,,"$2,291.61",$0.00,1,1,1,1,1,1,20171001, E1037,HCPCS,"TRANSPORT CHAIR, PED SIZE",,,28,,NW,,,,,,"$2,456.53",$0.00,1,1,1,1,1,1,20171001, E1037,HCPCS,"TRANSPORT CHAIR, PED SIZE",RR,,28,,NW,,,,,,$310.87,$0.00,1,1,1,1,1,1,20171001, E1038,HCPCS,TRANSPORT CHAIR PT WT<=300LB,,,28,,NW,,,,,,$422.82,$0.00,1,1,1,1,1,1,20171001, E1038,HCPCS,TRANSPORT CHAIR PT WT<=300LB,RR,,28,,NW,,,,,,$53.51,$0.00,1,1,1,1,1,1,20171001, E1039,HCPCS,TRANSPORT CHAIR PT WT >300LB,,,28,,NW,,,,,,$923.34,$0.00,1,1,1,1,1,1,20171001, E1039,HCPCS,TRANSPORT CHAIR PT WT >300LB,RR,,28,,NW,,,,,,$116.85,$0.00,1,1,1,1,1,1,20171001, E1050,HCPCS,WHELCHR FXD FULL LENGTH ARMS,,,28,,NW,,,,,,"$1,810.79",$0.00,1,1,1,1,1,1,20171001, E1050,HCPCS,WHELCHR FXD FULL LENGTH ARMS,NU,,28,,NW,,,,,,"$1,810.79",$0.00,1,1,1,1,1,1,20171001, E1050,HCPCS,WHELCHR FXD FULL LENGTH ARMS,RR,,28,,NW,,,,,,$229.15,$0.00,1,1,1,1,1,1,20171001, E1050,HCPCS,WHELCHR FXD FULL LENGTH ARMS,UE,,28,,NW,,,,,,"$1,925.40",$0.00,1,1,1,1,1,1,20171001, E1060,HCPCS,WHEELCHAIR DETACHABLE ARMS,,,28,,NW,,,,,,"$2,133.93",$0.00,1,1,1,1,1,1,20171001, E1060,HCPCS,WHEELCHAIR DETACHABLE ARMS,NU,,28,,NW,,,,,,"$2,133.93",$0.00,1,1,1,1,1,1,20171001, E1060,HCPCS,WHEELCHAIR DETACHABLE ARMS,RR,,28,,NW,,,,,,$270.04,$0.00,1,1,1,1,1,1,20171001, E1060,HCPCS,WHEELCHAIR DETACHABLE ARMS,UE,,28,,NW,,,,,,"$2,376.48",$0.00,1,1,1,1,1,1,20171001, E1070,HCPCS,WHEELCHAIR DETACHABLE FOOT R,,,28,,NW,,,,,,"$1,925.70",$0.00,1,1,1,1,1,1,20171001, E1070,HCPCS,WHEELCHAIR DETACHABLE FOOT R,NU,,28,,NW,,,,,,"$1,925.70",$0.00,1,1,1,1,1,1,20171001, E1070,HCPCS,WHEELCHAIR DETACHABLE FOOT R,RR,,28,,NW,,,,,,$243.69,$0.00,1,1,1,1,1,1,20171001, E1070,HCPCS,WHEELCHAIR DETACHABLE FOOT R,UE,,28,,NW,,,,,,"$2,069.14",$0.00,1,1,1,1,1,1,20171001, E1083,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,,,28,,NW,,,,,,"$1,411.67",$0.00,1,1,1,1,1,1,20171001, E1083,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,NU,,28,,NW,,,,,,"$1,411.67",$0.00,1,1,1,1,1,1,20171001, E1083,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,RR,,28,,NW,,,,,,$178.64,$0.00,1,1,1,1,1,1,20171001, E1083,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,UE,,28,,NW,,,,,,"$1,496.06",$0.00,1,1,1,1,1,1,20171001, E1084,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,,,28,,NW,,,,,,"$1,753.43",$0.00,1,1,1,1,1,1,20171001, E1084,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,NU,,28,,NW,,,,,,"$1,753.43",$0.00,1,1,1,1,1,1,20171001, E1084,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,RR,,28,,NW,,,,,,$221.89,$0.00,1,1,1,1,1,1,20171001, E1084,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,UE,,28,,NW,,,,,,"$1,856.36",$0.00,1,1,1,1,1,1,20171001, E1085,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,,,28,,NW,,,,,,"$1,844.38",$0.00,1,1,1,1,1,1,20171001, E1085,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,NU,,28,,NW,,,,,,"$1,932.96",$0.00,1,1,1,1,1,1,20171001, E1085,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,RR,,28,,NW,,,,,,$220.36,$0.00,1,1,1,1,1,1,20171001, E1085,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,UE,,28,,NW,,,,,,"$1,396.77",$0.00,1,1,1,1,1,1,20171001, E1086,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,,,28,,NW,,,,,,"$2,237.05",$0.00,1,1,1,1,1,1,20171001, E1086,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,NU,,28,,NW,,,,,,"$2,348.11",$0.00,1,1,1,1,1,1,20171001, E1086,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,RR,,28,,NW,,,,,,$241.16,$0.00,1,1,1,1,1,1,20171001, E1086,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,UE,,28,,NW,,,,,,"$1,713.57",$0.00,1,1,1,1,1,1,20171001, E1087,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,,,28,,NW,,,,,,"$2,185.06",$0.00,1,1,1,1,1,1,20171001, E1087,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,NU,,28,,NW,,,,,,"$2,185.06",$0.00,1,1,1,1,1,1,20171001, E1087,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,RR,,28,,NW,,,,,,$276.51,$0.00,1,1,1,1,1,1,20171001, E1087,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,UE,,28,,NW,,,,,,"$2,385.94",$0.00,1,1,1,1,1,1,20171001, E1088,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,,,28,,NW,,,,,,"$2,509.04",$0.00,1,1,1,1,1,1,20171001, E1088,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,NU,,28,,NW,,,,,,"$2,509.04",$0.00,1,1,1,1,1,1,20171001, E1088,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,RR,,28,,NW,,,,,,$317.51,$0.00,1,1,1,1,1,1,20171001, E1088,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,UE,,28,,NW,,,,,,"$2,837.02",$0.00,1,1,1,1,1,1,20171001, E1089,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,,,28,,NW,,,,,,"$2,954.39",$0.00,1,1,1,1,1,1,20171001, E1089,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,NU,,28,,NW,,,,,,"$3,106.54",$0.00,1,1,1,1,1,1,20171001, E1089,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,RR,,28,,NW,,,,,,$337.62,$0.00,1,1,1,1,1,1,20171001, E1089,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,UE,,28,,NW,,,,,,"$2,337.71",$0.00,1,1,1,1,1,1,20171001, E1090,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,,,28,,NW,,,,,,"$3,044.73",$0.00,1,1,1,1,1,1,20171001, E1090,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,NU,,28,,NW,,,,,,"$3,202.05",$0.00,1,1,1,1,1,1,20171001, E1090,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,RR,,28,,NW,,,,,,$337.62,$0.00,1,1,1,1,1,1,20171001, E1090,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,UE,,28,,NW,,,,,,"$2,348.11",$0.00,1,1,1,1,1,1,20171001, E1092,HCPCS,WHEELCHAIR WIDE W/ LEG RESTS,,,28,,NW,,,,,,"$2,189.18",$0.00,1,1,1,1,1,1,20171001, E1092,HCPCS,WHEELCHAIR WIDE W/ LEG RESTS,NU,,28,,NW,,,,,,"$2,189.18",$0.00,1,1,1,1,1,1,20171001, E1092,HCPCS,WHEELCHAIR WIDE W/ LEG RESTS,RR,,28,,NW,,,,,,$277.04,$0.00,1,1,1,1,1,1,20171001, E1092,HCPCS,WHEELCHAIR WIDE W/ LEG RESTS,UE,,28,,NW,,,,,,"$2,422.82",$0.00,1,1,1,1,1,1,20171001, E1093,HCPCS,WHEELCHAIR WIDE W/ FOOT REST,,,28,,NW,,,,,,"$1,929.13",$0.00,1,1,1,1,1,1,20171001, E1093,HCPCS,WHEELCHAIR WIDE W/ FOOT REST,NU,,28,,NW,,,,,,"$1,929.13",$0.00,1,1,1,1,1,1,20171001, E1093,HCPCS,WHEELCHAIR WIDE W/ FOOT REST,RR,,28,,NW,,,,,,$244.13,$0.00,1,1,1,1,1,1,20171001, E1093,HCPCS,WHEELCHAIR WIDE W/ FOOT REST,UE,,28,,NW,,,,,,"$2,087.11",$0.00,1,1,1,1,1,1,20171001, E1100,HCPCS,WHCHR S-RECL FXD ARM LEG RES,,,28,,NW,,,,,,"$1,819.42",$0.00,1,1,1,1,1,1,20171001, E1100,HCPCS,WHCHR S-RECL FXD ARM LEG RES,NU,,28,,NW,,,,,,"$1,819.42",$0.00,1,1,1,1,1,1,20171001, E1100,HCPCS,WHCHR S-RECL FXD ARM LEG RES,RR,,28,,NW,,,,,,$230.24,$0.00,1,1,1,1,1,1,20171001, E1100,HCPCS,WHCHR S-RECL FXD ARM LEG RES,UE,,28,,NW,,,,,,"$1,962.28",$0.00,1,1,1,1,1,1,20171001, E1110,HCPCS,WHEELCHAIR SEMI-RECL DETACH,,,28,,NW,,,,,,"$1,772.69",$0.00,1,1,1,1,1,1,20171001, E1110,HCPCS,WHEELCHAIR SEMI-RECL DETACH,NU,,28,,NW,,,,,,"$1,772.69",$0.00,1,1,1,1,1,1,20171001, E1110,HCPCS,WHEELCHAIR SEMI-RECL DETACH,RR,,28,,NW,,,,,,$224.33,$0.00,1,1,1,1,1,1,20171001, E1110,HCPCS,WHEELCHAIR SEMI-RECL DETACH,UE,,28,,NW,,,,,,"$1,922.56",$0.00,1,1,1,1,1,1,20171001, E1130,HCPCS,WHLCHR STAND FXD ARM FT REST,,,28,,NW,,,,,,"$1,198.60",$0.00,1,1,1,1,1,1,20171001, E1130,HCPCS,WHLCHR STAND FXD ARM FT REST,NU,,28,,NW,,,,,,"$1,250.19",$0.00,1,1,1,1,1,1,20171001, E1130,HCPCS,WHLCHR STAND FXD ARM FT REST,RR,,28,,NW,,,,,,$152.27,$0.00,1,1,1,1,1,1,20171001, E1130,HCPCS,WHLCHR STAND FXD ARM FT REST,UE,,28,,NW,,,,,,$957.03,$0.00,1,1,1,1,1,1,20171001, E1140,HCPCS,WHEELCHAIR STANDARD DETACH A,,,28,,NW,,,,,,"$1,706.65",$0.00,1,1,1,1,1,1,20171001, E1140,HCPCS,WHEELCHAIR STANDARD DETACH A,NU,,28,,NW,,,,,,"$1,787.33",$0.00,1,1,1,1,1,1,20171001, E1140,HCPCS,WHEELCHAIR STANDARD DETACH A,RR,,28,,NW,,,,,,$206.17,$0.00,1,1,1,1,1,1,20171001, E1140,HCPCS,WHEELCHAIR STANDARD DETACH A,UE,,28,,NW,,,,,,"$1,274.78",$0.00,1,1,1,1,1,1,20171001, E1150,HCPCS,WHEELCHAIR STANDARD W/ LEG R,,,28,,NW,,,,,,"$1,486.76",$0.00,1,1,1,1,1,1,20171001, E1150,HCPCS,WHEELCHAIR STANDARD W/ LEG R,NU,,28,,NW,,,,,,"$1,486.76",$0.00,1,1,1,1,1,1,20171001, E1150,HCPCS,WHEELCHAIR STANDARD W/ LEG R,RR,,28,,NW,,,,,,$188.15,$0.00,1,1,1,1,1,1,20171001, E1150,HCPCS,WHEELCHAIR STANDARD W/ LEG R,UE,,28,,NW,,,,,,"$1,549.02",$0.00,1,1,1,1,1,1,20171001, E1160,HCPCS,WHEELCHAIR FIXED ARMS,,,28,,NW,,,,,,"$1,206.75",$0.00,1,1,1,1,1,1,20171001, E1160,HCPCS,WHEELCHAIR FIXED ARMS,NU,,28,,NW,,,,,,"$1,206.75",$0.00,1,1,1,1,1,1,20171001, E1160,HCPCS,WHEELCHAIR FIXED ARMS,RR,,28,,NW,,,,,,$152.71,$0.00,1,1,1,1,1,1,20171001, E1160,HCPCS,WHEELCHAIR FIXED ARMS,UE,,28,,NW,,,,,,"$1,193.45",$0.00,1,1,1,1,1,1,20171001, E1161,HCPCS,MANUAL ADULT WC W TILTINSPAC,,,28,,NW,,,,,,"$4,045.95",$0.00,1,1,1,1,1,1,20171001, E1161,HCPCS,MANUAL ADULT WC W TILTINSPAC,NU,,28,,NW,,,,,,"$4,045.95",$0.00,1,1,1,1,1,1,20171001, E1161,HCPCS,MANUAL ADULT WC W TILTINSPAC,RR,,28,,NW,,,,,,$512.00,$0.00,1,1,1,1,1,1,20171001, E1161,HCPCS,MANUAL ADULT WC W TILTINSPAC,UE,,28,,NW,,,,,,"$4,434.26",$0.00,1,1,1,1,1,1,20171001, E1170,HCPCS,WHLCHR AMPU FXD ARM LEG REST,,,28,,NW,,,,,,"$1,567.61",$0.00,1,1,1,1,1,1,20171001, E1170,HCPCS,WHLCHR AMPU FXD ARM LEG REST,NU,,28,,NW,,,,,,"$1,567.61",$0.00,1,1,1,1,1,1,20171001, E1170,HCPCS,WHLCHR AMPU FXD ARM LEG REST,RR,,28,,NW,,,,,,$198.38,$0.00,1,1,1,1,1,1,20171001, E1170,HCPCS,WHLCHR AMPU FXD ARM LEG REST,UE,,28,,NW,,,,,,"$1,692.76",$0.00,1,1,1,1,1,1,20171001, E1171,HCPCS,WHEELCHAIR AMPUTEE W/O LEG R,,,28,,NW,,,,,,"$1,459.67",$0.00,1,1,1,1,1,1,20171001, E1171,HCPCS,WHEELCHAIR AMPUTEE W/O LEG R,NU,,28,,NW,,,,,,"$1,459.67",$0.00,1,1,1,1,1,1,20171001, E1171,HCPCS,WHEELCHAIR AMPUTEE W/O LEG R,RR,,28,,NW,,,,,,$184.72,$0.00,1,1,1,1,1,1,20171001, E1171,HCPCS,WHEELCHAIR AMPUTEE W/O LEG R,UE,,28,,NW,,,,,,"$1,522.54",$0.00,1,1,1,1,1,1,20171001, E1172,HCPCS,WHEELCHAIR AMPUTEE DETACH AR,,,28,,NW,,,,,,"$1,741.03",$0.00,1,1,1,1,1,1,20171001, E1172,HCPCS,WHEELCHAIR AMPUTEE DETACH AR,NU,,28,,NW,,,,,,"$1,741.03",$0.00,1,1,1,1,1,1,20171001, E1172,HCPCS,WHEELCHAIR AMPUTEE DETACH AR,RR,,28,,NW,,,,,,$220.32,$0.00,1,1,1,1,1,1,20171001, E1172,HCPCS,WHEELCHAIR AMPUTEE DETACH AR,UE,,28,,NW,,,,,,"$1,853.53",$0.00,1,1,1,1,1,1,20171001, E1180,HCPCS,WHEELCHAIR AMPUTEE W/ FOOT R,,,28,,NW,,,,,,"$1,781.76",$0.00,1,1,1,1,1,1,20171001, E1180,HCPCS,WHEELCHAIR AMPUTEE W/ FOOT R,NU,,28,,NW,,,,,,"$1,781.76",$0.00,1,1,1,1,1,1,20171001, E1180,HCPCS,WHEELCHAIR AMPUTEE W/ FOOT R,RR,,28,,NW,,,,,,$225.48,$0.00,1,1,1,1,1,1,20171001, E1180,HCPCS,WHEELCHAIR AMPUTEE W/ FOOT R,UE,,28,,NW,,,,,,"$1,916.89",$0.00,1,1,1,1,1,1,20171001, E1190,HCPCS,WHEELCHAIR AMPUTEE W/ LEG RE,,,28,,NW,,,,,,"$2,000.12",$0.00,1,1,1,1,1,1,20171001, E1190,HCPCS,WHEELCHAIR AMPUTEE W/ LEG RE,NU,,28,,NW,,,,,,"$2,000.12",$0.00,1,1,1,1,1,1,20171001, E1190,HCPCS,WHEELCHAIR AMPUTEE W/ LEG RE,RR,,28,,NW,,,,,,$253.11,$0.00,1,1,1,1,1,1,20171001, E1190,HCPCS,WHEELCHAIR AMPUTEE W/ LEG RE,UE,,28,,NW,,,,,,"$2,210.04",$0.00,1,1,1,1,1,1,20171001, E1195,HCPCS,WHEELCHAIR AMPUTEE HEAVY DUT,,,28,,NW,,,,,,"$2,122.78",$0.00,1,1,1,1,1,1,20171001, E1195,HCPCS,WHEELCHAIR AMPUTEE HEAVY DUT,NU,,28,,NW,,,,,,"$2,122.78",$0.00,1,1,1,1,1,1,20171001, E1195,HCPCS,WHEELCHAIR AMPUTEE HEAVY DUT,RR,,28,,NW,,,,,,$268.63,$0.00,1,1,1,1,1,1,20171001, E1195,HCPCS,WHEELCHAIR AMPUTEE HEAVY DUT,UE,,28,,NW,,,,,,"$2,368.92",$0.00,1,1,1,1,1,1,20171001, E1200,HCPCS,WHEELCHAIR AMPUTEE FIXED ARM,,,28,,NW,,,,,,"$1,576.95",$0.00,1,1,1,1,1,1,20171001, E1200,HCPCS,WHEELCHAIR AMPUTEE FIXED ARM,NU,,28,,NW,,,,,,"$1,576.95",$0.00,1,1,1,1,1,1,20171001, E1200,HCPCS,WHEELCHAIR AMPUTEE FIXED ARM,RR,,28,,NW,,,,,,$199.56,$0.00,1,1,1,1,1,1,20171001, E1200,HCPCS,WHEELCHAIR AMPUTEE FIXED ARM,UE,,28,,NW,,,,,,"$1,650.21",$0.00,1,1,1,1,1,1,20171001, E1220,HCPCS,WHLCHR SPECIAL SIZE/CONSTRC,,,28,,NW,,,,,,"$5,372.88",$0.00,1,1,1,1,1,1,20171001, E1221,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,,,28,,NW,,,,,,$963.99,$0.00,1,1,1,1,1,1,20171001, E1221,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,NU,,28,,NW,,,,,,$963.99,$0.00,1,1,1,1,1,1,20171001, E1221,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,RR,,28,,NW,,,,,,$121.99,$0.00,1,1,1,1,1,1,20171001, E1221,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,UE,,28,,NW,,,,,,$914.48,$0.00,1,1,1,1,1,1,20171001, E1222,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,,,28,,NW,,,,,,"$1,290.61",$0.00,1,1,1,1,1,1,20171001, E1222,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,NU,,28,,NW,,,,,,"$1,290.61",$0.00,1,1,1,1,1,1,20171001, E1222,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,RR,,28,,NW,,,,,,$163.32,$0.00,1,1,1,1,1,1,20171001, E1222,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,UE,,28,,NW,,,,,,"$1,291.80",$0.00,1,1,1,1,1,1,20171001, E1223,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,,,28,,NW,,,,,,"$1,359.18",$0.00,1,1,1,1,1,1,20171001, E1223,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,NU,,28,,NW,,,,,,"$1,359.18",$0.00,1,1,1,1,1,1,20171001, E1223,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,RR,,28,,NW,,,,,,$172.00,$0.00,1,1,1,1,1,1,20171001, E1223,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,UE,,28,,NW,,,,,,"$1,408.12",$0.00,1,1,1,1,1,1,20171001, E1224,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,,,28,,NW,,,,,,"$1,464.67",$0.00,1,1,1,1,1,1,20171001, E1224,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,NU,,28,,NW,,,,,,"$1,464.67",$0.00,1,1,1,1,1,1,20171001, E1224,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,RR,,28,,NW,,,,,,$185.35,$0.00,1,1,1,1,1,1,20171001, E1224,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,UE,,28,,NW,,,,,,"$1,540.51",$0.00,1,1,1,1,1,1,20171001, E1225,HCPCS,MANUAL SEMI-RECLINING BACK,,,28,,NW,,,,,,"$1,023.53",$0.00,1,1,1,1,1,1,20171001, E1225,HCPCS,MANUAL SEMI-RECLINING BACK,NU,,28,,NW,,,,,,"$1,023.53",$0.00,1,1,1,1,1,1,20171001, E1225,HCPCS,MANUAL SEMI-RECLINING BACK,RR,,28,,NW,,,,,,$129.52,$0.00,1,1,1,1,1,1,20171001, E1225,HCPCS,MANUAL SEMI-RECLINING BACK,UE,,28,,NW,,,,,,$768.85,$0.00,1,1,1,1,1,1,20171001, E1226,HCPCS,MANUAL FULLY RECLINING BACK,,,28,,NW,,,,,,"$1,029.20",$0.00,1,1,1,1,1,1,20171001, E1226,HCPCS,MANUAL FULLY RECLINING BACK,NU,,28,,NW,,,,,,"$1,029.20",$0.00,1,1,1,1,1,1,20171001, E1226,HCPCS,MANUAL FULLY RECLINING BACK,RR,,28,,NW,,,,,,$130.17,$0.00,1,1,1,1,1,1,20171001, E1226,HCPCS,MANUAL FULLY RECLINING BACK,UE,,28,,NW,,,,,,$779.47,$0.00,1,1,1,1,1,1,20171001, E1227,HCPCS,WHEELCHAIR SPEC SZ SPEC HT A,,,28,,NW,,,,,,$560.75,$0.00,1,1,1,1,1,1,20171001, E1227,HCPCS,WHEELCHAIR SPEC SZ SPEC HT A,NU,,28,,NW,,,,,,$560.75,$0.00,1,1,1,1,1,1,20171001, E1227,HCPCS,WHEELCHAIR SPEC SZ SPEC HT A,RR,,28,,NW,,,,,,$83.55,$0.00,1,1,1,1,1,1,20171001, E1227,HCPCS,WHEELCHAIR SPEC SZ SPEC HT A,UE,,28,,NW,,,,,,$428.46,$0.00,1,1,1,1,1,1,20171001, E1228,HCPCS,WHEELCHAIR SPEC SZ SPEC HT B,,,28,,NW,,,,,,$651.47,$0.00,1,1,1,1,1,1,20171001, E1228,HCPCS,WHEELCHAIR SPEC SZ SPEC HT B,NU,,28,,NW,,,,,,$651.47,$0.00,1,1,1,1,1,1,20171001, E1228,HCPCS,WHEELCHAIR SPEC SZ SPEC HT B,RR,,28,,NW,,,,,,$82.44,$0.00,1,1,1,1,1,1,20171001, E1228,HCPCS,WHEELCHAIR SPEC SZ SPEC HT B,UE,,28,,NW,,,,,,$552.29,$0.00,1,1,1,1,1,1,20171001, E1229,HCPCS,PEDIATRIC WHEELCHAIR NOS,,,28,,NW,,,,,,"$1,733.47",$0.00,1,1,1,1,1,1,20171001, E1230,HCPCS,POWER OPERATED VEHICLE,,,28,,NW,,,,,,"$4,292.29",$0.00,1,1,1,1,1,1,20171001, E1230,HCPCS,POWER OPERATED VEHICLE,NU,,28,,NW,,,,,,"$4,292.29",$0.00,1,1,1,1,1,1,20171001, E1230,HCPCS,POWER OPERATED VEHICLE,RR,,28,,NW,,,,,,$454.55,$0.00,1,1,1,1,1,1,20171001, E1230,HCPCS,POWER OPERATED VEHICLE,UE,,28,,NW,,,,,,"$3,346.34",$0.00,1,1,1,1,1,1,20171001, E1231,HCPCS,RIGID PED W/C TILT-IN-SPACE,,,28,,NW,,,,,,"$3,321.71",$0.00,1,1,1,1,1,1,20171001, E1231,HCPCS,RIGID PED W/C TILT-IN-SPACE,NU,,28,,NW,,,,,,"$3,321.71",$0.00,1,1,1,1,1,1,20171001, E1231,HCPCS,RIGID PED W/C TILT-IN-SPACE,RR,,28,,NW,,,,,,$363.54,$0.00,1,1,1,1,1,1,20171001, E1231,HCPCS,RIGID PED W/C TILT-IN-SPACE,UE,,28,,NW,,,,,,"$2,501.45",$0.00,1,1,1,1,1,1,20171001, E1232,HCPCS,FOLDING PED WC TILT-IN-SPACE,,,28,,NW,,,,,,"$3,679.94",$0.00,1,1,1,1,1,1,20171001, E1232,HCPCS,FOLDING PED WC TILT-IN-SPACE,NU,,28,,NW,,,,,,"$3,679.94",$0.00,1,1,1,1,1,1,20171001, E1232,HCPCS,FOLDING PED WC TILT-IN-SPACE,RR,,28,,NW,,,,,,$465.69,$0.00,1,1,1,1,1,1,20171001, E1232,HCPCS,FOLDING PED WC TILT-IN-SPACE,UE,,28,,NW,,,,,,"$4,011.54",$0.00,1,1,1,1,1,1,20171001, E1233,HCPCS,RIG PED WC TLTNSPC W/O SEAT,,,28,,NW,,,,,,"$3,804.08",$0.00,1,1,1,1,1,1,20171001, E1233,HCPCS,RIG PED WC TLTNSPC W/O SEAT,NU,,28,,NW,,,,,,"$3,804.08",$0.00,1,1,1,1,1,1,20171001, E1233,HCPCS,RIG PED WC TLTNSPC W/O SEAT,RR,,28,,NW,,,,,,$481.40,$0.00,1,1,1,1,1,1,20171001, E1233,HCPCS,RIG PED WC TLTNSPC W/O SEAT,UE,,28,,NW,,,,,,"$4,154.34",$0.00,1,1,1,1,1,1,20171001, E1234,HCPCS,FLD PED WC TLTNSPC W/O SEAT,,,28,,NW,,,,,,"$3,342.89",$0.00,1,1,1,1,1,1,20171001, E1234,HCPCS,FLD PED WC TLTNSPC W/O SEAT,NU,,28,,NW,,,,,,"$3,342.89",$0.00,1,1,1,1,1,1,20171001, E1234,HCPCS,FLD PED WC TLTNSPC W/O SEAT,RR,,28,,NW,,,,,,$423.03,$0.00,1,1,1,1,1,1,20171001, E1234,HCPCS,FLD PED WC TLTNSPC W/O SEAT,UE,,28,,NW,,,,,,"$3,620.98",$0.00,1,1,1,1,1,1,20171001, E1235,HCPCS,RIGID PED WC ADJUSTABLE,,,28,,NW,,,,,,"$3,227.92",$0.00,1,1,1,1,1,1,20171001, E1235,HCPCS,RIGID PED WC ADJUSTABLE,NU,,28,,NW,,,,,,"$3,227.92",$0.00,1,1,1,1,1,1,20171001, E1235,HCPCS,RIGID PED WC ADJUSTABLE,RR,,28,,NW,,,,,,$408.48,$0.00,1,1,1,1,1,1,20171001, E1235,HCPCS,RIGID PED WC ADJUSTABLE,UE,,28,,NW,,,,,,"$3,488.59",$0.00,1,1,1,1,1,1,20171001, E1236,HCPCS,FOLDING PED WC ADJUSTABLE,,,28,,NW,,,,,,"$2,875.73",$0.00,1,1,1,1,1,1,20171001, E1236,HCPCS,FOLDING PED WC ADJUSTABLE,NU,,28,,NW,,,,,,"$2,875.73",$0.00,1,1,1,1,1,1,20171001, E1236,HCPCS,FOLDING PED WC ADJUSTABLE,RR,,28,,NW,,,,,,$363.92,$0.00,1,1,1,1,1,1,20171001, E1236,HCPCS,FOLDING PED WC ADJUSTABLE,UE,,28,,NW,,,,,,"$3,081.01",$0.00,1,1,1,1,1,1,20171001, E1237,HCPCS,RGD PED WC ADJSTABL W/O SEAT,,,28,,NW,,,,,,"$2,898.86",$0.00,1,1,1,1,1,1,20171001, E1237,HCPCS,RGD PED WC ADJSTABL W/O SEAT,NU,,28,,NW,,,,,,"$2,898.86",$0.00,1,1,1,1,1,1,20171001, E1237,HCPCS,RGD PED WC ADJSTABL W/O SEAT,RR,,28,,NW,,,,,,$366.84,$0.00,1,1,1,1,1,1,20171001, E1237,HCPCS,RGD PED WC ADJSTABL W/O SEAT,UE,,28,,NW,,,,,,"$3,107.48",$0.00,1,1,1,1,1,1,20171001, E1238,HCPCS,FLD PED WC ADJSTABL W/O SEAT,,,28,,NW,,,,,,"$2,875.73",$0.00,1,1,1,1,1,1,20171001, E1238,HCPCS,FLD PED WC ADJSTABL W/O SEAT,NU,,28,,NW,,,,,,"$2,875.73",$0.00,1,1,1,1,1,1,20171001, E1238,HCPCS,FLD PED WC ADJSTABL W/O SEAT,RR,,28,,NW,,,,,,$363.92,$0.00,1,1,1,1,1,1,20171001, E1238,HCPCS,FLD PED WC ADJSTABL W/O SEAT,UE,,28,,NW,,,,,,"$3,081.01",$0.00,1,1,1,1,1,1,20171001, E1239,HCPCS,PED POWER WHEELCHAIR NOS,,,28,,NW,,,,,,"$3,673.76",$0.00,1,1,1,1,1,1,20171001, E1240,HCPCS,WHCHR LITWT DET ARM LEG REST,,,28,,NW,,,,,,"$1,789.87",$0.00,1,1,1,1,1,1,20171001, E1240,HCPCS,WHCHR LITWT DET ARM LEG REST,NU,,28,,NW,,,,,,"$1,789.87",$0.00,1,1,1,1,1,1,20171001, E1240,HCPCS,WHCHR LITWT DET ARM LEG REST,RR,,28,,NW,,,,,,$226.50,$0.00,1,1,1,1,1,1,20171001, E1240,HCPCS,WHCHR LITWT DET ARM LEG REST,UE,,28,,NW,,,,,,"$1,948.09",$0.00,1,1,1,1,1,1,20171001, E1250,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,,,28,,NW,,,,,,"$1,822.02",$0.00,1,1,1,1,1,1,20171001, E1250,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,NU,,28,,NW,,,,,,"$1,909.32",$0.00,1,1,1,1,1,1,20171001, E1250,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,RR,,28,,NW,,,,,,$201.44,$0.00,1,1,1,1,1,1,20171001, E1250,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,UE,,28,,NW,,,,,,"$1,518.76",$0.00,1,1,1,1,1,1,20171001, E1260,HCPCS,WHEELCHAIR LIGHTWT FOOT REST,,,28,,NW,,,,,,"$2,121.66",$0.00,1,1,1,1,1,1,20171001, E1260,HCPCS,WHEELCHAIR LIGHTWT FOOT REST,NU,,28,,NW,,,,,,"$2,226.12",$0.00,1,1,1,1,1,1,20171001, E1260,HCPCS,WHEELCHAIR LIGHTWT FOOT REST,RR,,28,,NW,,,,,,$249.67,$0.00,1,1,1,1,1,1,20171001, E1260,HCPCS,WHEELCHAIR LIGHTWT FOOT REST,UE,,28,,NW,,,,,,"$1,762.74",$0.00,1,1,1,1,1,1,20171001, E1270,HCPCS,WHEELCHAIR LIGHTWEIGHT LEG R,,,28,,NW,,,,,,"$1,427.57",$0.00,1,1,1,1,1,1,20171001, E1270,HCPCS,WHEELCHAIR LIGHTWEIGHT LEG R,NU,,28,,NW,,,,,,"$1,427.57",$0.00,1,1,1,1,1,1,20171001, E1270,HCPCS,WHEELCHAIR LIGHTWEIGHT LEG R,RR,,28,,NW,,,,,,$180.66,$0.00,1,1,1,1,1,1,20171001, E1270,HCPCS,WHEELCHAIR LIGHTWEIGHT LEG R,UE,,28,,NW,,,,,,"$1,499.85",$0.00,1,1,1,1,1,1,20171001, E1280,HCPCS,WHCHR H-DUTY DET ARM LEG RES,,,28,,NW,,,,,,"$2,226.44",$0.00,1,1,1,1,1,1,20171001, E1280,HCPCS,WHCHR H-DUTY DET ARM LEG RES,NU,,28,,NW,,,,,,"$2,226.44",$0.00,1,1,1,1,1,1,20171001, E1280,HCPCS,WHCHR H-DUTY DET ARM LEG RES,RR,,28,,NW,,,,,,$281.75,$0.00,1,1,1,1,1,1,20171001, E1280,HCPCS,WHCHR H-DUTY DET ARM LEG RES,UE,,28,,NW,,,,,,"$2,473.89",$0.00,1,1,1,1,1,1,20171001, E1285,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,,,28,,NW,,,,,,"$2,721.83",$0.00,1,1,1,1,1,1,20171001, E1285,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,NU,,28,,NW,,,,,,"$2,860.66",$0.00,1,1,1,1,1,1,20171001, E1285,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,RR,,28,,NW,,,,,,$313.03,$0.00,1,1,1,1,1,1,20171001, E1285,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,UE,,28,,NW,,,,,,"$2,104.13",$0.00,1,1,1,1,1,1,20171001, E1290,HCPCS,WHEELCHAIR HVY DUTY DETACH A,,,28,,NW,,,,,,"$2,813.96",$0.00,1,1,1,1,1,1,20171001, E1290,HCPCS,WHEELCHAIR HVY DUTY DETACH A,NU,,28,,NW,,,,,,"$2,958.07",$0.00,1,1,1,1,1,1,20171001, E1290,HCPCS,WHEELCHAIR HVY DUTY DETACH A,RR,,28,,NW,,,,,,$323.44,$0.00,1,1,1,1,1,1,20171001, E1290,HCPCS,WHEELCHAIR HVY DUTY DETACH A,UE,,28,,NW,,,,,,"$2,165.60",$0.00,1,1,1,1,1,1,20171001, E1295,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,,,28,,NW,,,,,,"$2,113.94",$0.00,1,1,1,1,1,1,20171001, E1295,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,NU,,28,,NW,,,,,,"$2,113.94",$0.00,1,1,1,1,1,1,20171001, E1295,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,RR,,28,,NW,,,,,,$267.51,$0.00,1,1,1,1,1,1,20171001, E1295,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,UE,,28,,NW,,,,,,"$2,291.37",$0.00,1,1,1,1,1,1,20171001, E1296,HCPCS,WHEELCHAIR SPECIAL SEAT HEIG,,,28,,NW,,,,,,$948.19,$0.00,1,1,1,1,1,1,20171001, E1296,HCPCS,WHEELCHAIR SPECIAL SEAT HEIG,NU,,28,,NW,,,,,,$948.19,$0.00,1,1,1,1,1,1,20171001, E1296,HCPCS,WHEELCHAIR SPECIAL SEAT HEIG,RR,,28,,NW,,,,,,$124.09,$0.00,1,1,1,1,1,1,20171001, E1296,HCPCS,WHEELCHAIR SPECIAL SEAT HEIG,UE,,28,,NW,,,,,,$718.67,$0.00,1,1,1,1,1,1,20171001, E1297,HCPCS,WHEELCHAIR SPECIAL SEAT DEPT,,,28,,NW,,,,,,$225.78,$0.00,1,1,1,1,1,1,20171001, E1297,HCPCS,WHEELCHAIR SPECIAL SEAT DEPT,NU,,28,,NW,,,,,,$225.78,$0.00,1,1,1,1,1,1,20171001, E1297,HCPCS,WHEELCHAIR SPECIAL SEAT DEPT,RR,,28,,NW,,,,,,$34.16,$0.00,1,1,1,1,1,1,20171001, E1297,HCPCS,WHEELCHAIR SPECIAL SEAT DEPT,UE,,28,,NW,,,,,,$176.88,$0.00,1,1,1,1,1,1,20171001, E1298,HCPCS,WHEELCHAIR SPEC SEAT DEPTH/W,,,28,,NW,,,,,,$833.51,$0.00,1,1,1,1,1,1,20171001, E1298,HCPCS,WHEELCHAIR SPEC SEAT DEPTH/W,NU,,28,,NW,,,,,,$833.51,$0.00,1,1,1,1,1,1,20171001, E1298,HCPCS,WHEELCHAIR SPEC SEAT DEPTH/W,RR,,28,,NW,,,,,,$112.12,$0.00,1,1,1,1,1,1,20171001, E1298,HCPCS,WHEELCHAIR SPEC SEAT DEPTH/W,UE,,28,,NW,,,,,,$632.69,$0.00,1,1,1,1,1,1,20171001, E1300,HCPCS,WHIRLPOOL PORTABLE,,,28,,NW,,,,,,$270.54,$0.00,1,1,1,1,1,1,20171001, E1300,HCPCS,WHIRLPOOL PORTABLE,NU,,28,,NW,,,,,,$270.54,$0.00,1,1,1,1,1,1,20171001, E1300,HCPCS,WHIRLPOOL PORTABLE,RR,,28,,NW,,,,,,$28.77,$0.00,1,1,1,1,1,1,20171001, E1300,HCPCS,WHIRLPOOL PORTABLE,UE,,28,,NW,,,,,,$203.40,$0.00,1,1,1,1,1,1,20171001, E1310,HCPCS,WHIRLPOOL NON-PORTABLE,,,28,,NW,,,,,,"$4,420.84",$0.00,1,1,1,1,1,1,20171001, E1310,HCPCS,WHIRLPOOL NON-PORTABLE,NU,,28,,NW,,,,,,"$4,420.84",$0.00,1,1,1,1,1,1,20171001, E1310,HCPCS,WHIRLPOOL NON-PORTABLE,RR,,28,,NW,,,,,,$445.15,$0.00,1,1,1,1,1,1,20171001, E1310,HCPCS,WHIRLPOOL NON-PORTABLE,UE,,28,,NW,,,,,,"$3,332.57",$0.00,1,1,1,1,1,1,20171001, E1352,HCPCS,O2 FLOW REG POS INSPIR PRESS,,,28,,NW,,,,,,$95.01,$0.00,1,1,1,1,1,1,20171001, E1353,HCPCS,OXYGEN SUPPLIES REGULATOR,,,28,,NW,,,,,,$106.54,$0.00,1,1,1,1,1,1,20171001, E1353,HCPCS,OXYGEN SUPPLIES REGULATOR,NU,,28,,NW,,,,,,$95.01,$0.00,1,1,1,1,1,1,20171001, E1353,HCPCS,OXYGEN SUPPLIES REGULATOR,RR,,28,,NW,,,,,,$6.41,$0.00,1,1,1,1,1,1,20171001, E1353,HCPCS,OXYGEN SUPPLIES REGULATOR,UE,,28,,NW,,,,,,$48.08,$0.00,1,1,1,1,1,1,20171001, E1354,HCPCS,"WHEELED CART, PORT CYL/CONC",,,28,,NW,,,,,,$29.79,$0.00,1,1,1,1,1,1,20171001, E1355,HCPCS,OXYGEN SUPPLIES STAND/RACK,,,28,,NW,,,,,,$57.33,$0.00,1,1,1,1,1,1,20171001, E1355,HCPCS,OXYGEN SUPPLIES STAND/RACK,NU,,28,,NW,,,,,,$57.33,$0.00,1,1,1,1,1,1,20171001, E1355,HCPCS,OXYGEN SUPPLIES STAND/RACK,RR,,28,,NW,,,,,,$4.82,$0.00,1,1,1,1,1,1,20171001, E1355,HCPCS,OXYGEN SUPPLIES STAND/RACK,UE,,28,,NW,,,,,,$36.20,$0.00,1,1,1,1,1,1,20171001, E1356,HCPCS,"BATT PACK/CART, PORT CONC",,,28,,NW,,,,,,$55.36,$0.00,1,1,1,1,1,1,20171001, E1357,HCPCS,"BATTERY CHARGER, PORT CONC",,,28,,NW,,,,,,$180.71,$0.00,1,1,1,1,1,1,20171001, E1358,HCPCS,"DC POWER ADAPTER, PORT CONC",,,28,,NW,,,,,,$104.44,$0.00,1,1,1,1,1,1,20171001, E1372,HCPCS,OXY SUPPL HEATER FOR NEBULIZ,,,28,,NW,,,,,,$303.70,$0.00,1,1,1,1,1,1,20171001, E1372,HCPCS,OXY SUPPL HEATER FOR NEBULIZ,NU,,28,,NW,,,,,,$303.70,$0.00,1,1,1,1,1,1,20171001, E1372,HCPCS,OXY SUPPL HEATER FOR NEBULIZ,RR,,28,,NW,,,,,,$91.27,$0.00,1,1,1,1,1,1,20171001, E1372,HCPCS,OXY SUPPL HEATER FOR NEBULIZ,UE,,28,,NW,,,,,,$244.69,$0.00,1,1,1,1,1,1,20171001, E1390,HCPCS,OXYGEN CONCENTRATOR,,,28,,NW,,,,,,"$4,524.83",$0.00,1,1,1,1,1,1,20171001, E1390,HCPCS,OXYGEN CONCENTRATOR,NU,,28,,NW,,,,,,"$4,524.83",$0.00,1,1,1,1,1,1,20171001, E1390,HCPCS,OXYGEN CONCENTRATOR,RR,,28,,NW,,,,,,$572.61,$0.00,1,1,1,1,1,1,20171001, E1391,HCPCS,"OXYGEN CONCENTRATOR, DUAL",,,28,,NW,,,,,,"$4,524.83",$0.00,1,1,1,1,1,1,20171001, E1391,HCPCS,"OXYGEN CONCENTRATOR, DUAL",RR,,28,,NW,,,,,,$572.61,$0.00,1,1,1,1,1,1,20171001, E1392,HCPCS,PORTABLE OXYGEN CONCENTRATOR,,,28,,NW,,,,,,"$1,821.40",$0.00,1,1,1,1,1,1,20171001, E1392,HCPCS,PORTABLE OXYGEN CONCENTRATOR,RR,,28,,NW,,,,,,$230.49,$0.00,1,1,1,1,1,1,20171001, E1399,HCPCS,DURABLE MEDICAL EQUIPMENT MI,,,28,,NW,,,,,,$84.08,$0.00,1,1,1,1,1,1,20171001, E1405,HCPCS,O2/WATER VAPOR ENRICH W/HEAT,,,28,,NW,,,,,,"$6,391.61",$0.00,1,1,1,1,1,1,20171001, E1405,HCPCS,O2/WATER VAPOR ENRICH W/HEAT,NU,,28,,NW,,,,,,"$6,391.61",$0.00,1,1,1,1,1,1,20171001, E1405,HCPCS,O2/WATER VAPOR ENRICH W/HEAT,RR,,28,,NW,,,,,,$808.84,$0.00,1,1,1,1,1,1,20171001, E1405,HCPCS,O2/WATER VAPOR ENRICH W/HEAT,UE,,28,,NW,,,,,,"$4,859.29",$0.00,1,1,1,1,1,1,20171001, E1406,HCPCS,O2/WATER VAPOR ENRICH W/O HE,,,28,,NW,,,,,,"$4,911.97",$0.00,1,1,1,1,1,1,20171001, E1406,HCPCS,O2/WATER VAPOR ENRICH W/O HE,NU,,28,,NW,,,,,,"$4,911.97",$0.00,1,1,1,1,1,1,20171001, E1406,HCPCS,O2/WATER VAPOR ENRICH W/O HE,RR,,28,,NW,,,,,,$621.60,$0.00,1,1,1,1,1,1,20171001, E1406,HCPCS,O2/WATER VAPOR ENRICH W/O HE,UE,,28,,NW,,,,,,"$3,734.38",$0.00,1,1,1,1,1,1,20171001, E1500,HCPCS,CENTRIFUGE,,,28,,NW,,,,,,$310.43,$0.00,1,1,1,1,1,1,20171001, E1510,HCPCS,KIDNEY DIALYSATE DELIVRY SYS,,,28,,NW,,,,,,"$2,767.30",$0.00,1,1,1,1,1,1,20171001, E1510,HCPCS,KIDNEY DIALYSATE DELIVRY SYS,NU,,28,,NW,,,,,,"$2,767.30",$0.00,1,1,1,1,1,1,20171001, E1510,HCPCS,KIDNEY DIALYSATE DELIVRY SYS,RR,,28,,NW,,,,,,$291.50,$0.00,1,1,1,1,1,1,20171001, E1510,HCPCS,KIDNEY DIALYSATE DELIVRY SYS,UE,,28,,NW,,,,,,"$2,083.95",$0.00,1,1,1,1,1,1,20171001, E1520,HCPCS,HEPARIN INFUSION PUMP,,,28,,NW,,,,,,"$2,089.91",$0.00,1,1,1,1,1,1,20171001, E1520,HCPCS,HEPARIN INFUSION PUMP,NU,,28,,NW,,,,,,"$2,089.91",$0.00,1,1,1,1,1,1,20171001, E1520,HCPCS,HEPARIN INFUSION PUMP,RR,,28,,NW,,,,,,$222.30,$0.00,1,1,1,1,1,1,20171001, E1520,HCPCS,HEPARIN INFUSION PUMP,UE,,28,,NW,,,,,,"$1,571.23",$0.00,1,1,1,1,1,1,20171001, E1530,HCPCS,REPLACEMENT AIR BUBBLE DETEC,,,28,,NW,,,,,,"$2,027.91",$0.00,1,1,1,1,1,1,20171001, E1530,HCPCS,REPLACEMENT AIR BUBBLE DETEC,NU,,28,,NW,,,,,,"$2,027.91",$0.00,1,1,1,1,1,1,20171001, E1530,HCPCS,REPLACEMENT AIR BUBBLE DETEC,RR,,28,,NW,,,,,,$209.11,$0.00,1,1,1,1,1,1,20171001, E1530,HCPCS,REPLACEMENT AIR BUBBLE DETEC,UE,,28,,NW,,,,,,"$1,521.36",$0.00,1,1,1,1,1,1,20171001, E1540,HCPCS,REPLACEMENT PRESSURE ALARM,,,28,,NW,,,,,,$235.28,$0.00,1,1,1,1,1,1,20171001, E1540,HCPCS,REPLACEMENT PRESSURE ALARM,NU,,28,,NW,,,,,,$235.28,$0.00,1,1,1,1,1,1,20171001, E1540,HCPCS,REPLACEMENT PRESSURE ALARM,RR,,28,,NW,,,,,,$24.63,$0.00,1,1,1,1,1,1,20171001, E1540,HCPCS,REPLACEMENT PRESSURE ALARM,UE,,28,,NW,,,,,,$176.36,$0.00,1,1,1,1,1,1,20171001, E1550,HCPCS,BATH CONDUCTIVITY METER,,,28,,NW,,,,,,$115.29,$0.00,1,1,1,1,1,1,20171001, E1550,HCPCS,BATH CONDUCTIVITY METER,NU,,28,,NW,,,,,,$115.29,$0.00,1,1,1,1,1,1,20171001, E1550,HCPCS,BATH CONDUCTIVITY METER,RR,,28,,NW,,,,,,$12.26,$0.00,1,1,1,1,1,1,20171001, E1550,HCPCS,BATH CONDUCTIVITY METER,UE,,28,,NW,,,,,,$86.68,$0.00,1,1,1,1,1,1,20171001, E1560,HCPCS,REPLACE BLOOD LEAK DETECTOR,,,28,,NW,,,,,,"$2,346.60",$0.00,1,1,1,1,1,1,20171001, E1560,HCPCS,REPLACE BLOOD LEAK DETECTOR,NU,,28,,NW,,,,,,"$2,346.60",$0.00,1,1,1,1,1,1,20171001, E1560,HCPCS,REPLACE BLOOD LEAK DETECTOR,RR,,28,,NW,,,,,,$241.95,$0.00,1,1,1,1,1,1,20171001, E1560,HCPCS,REPLACE BLOOD LEAK DETECTOR,UE,,28,,NW,,,,,,"$1,736.47",$0.00,1,1,1,1,1,1,20171001, E1570,HCPCS,ADJUSTABLE CHAIR FOR ESRD PT,,,28,,NW,,,,,,$707.35,$0.00,1,1,1,1,1,1,20171001, E1570,HCPCS,ADJUSTABLE CHAIR FOR ESRD PT,NU,,28,,NW,,,,,,$707.35,$0.00,1,1,1,1,1,1,20171001, E1570,HCPCS,ADJUSTABLE CHAIR FOR ESRD PT,RR,,28,,NW,,,,,,$75.24,$0.00,1,1,1,1,1,1,20171001, E1570,HCPCS,ADJUSTABLE CHAIR FOR ESRD PT,UE,,28,,NW,,,,,,$531.79,$0.00,1,1,1,1,1,1,20171001, E1575,HCPCS,TRANSDUCER PROTECT/FLD BAR,,,28,,NW,,,,,,$123.09,$0.00,1,1,1,1,1,1,20171001, E1575,HCPCS,TRANSDUCER PROTECT/FLD BAR,NU,,28,,NW,,,,,,$123.09,$0.00,1,1,1,1,1,1,20171001, E1575,HCPCS,TRANSDUCER PROTECT/FLD BAR,RR,,28,,NW,,,,,,$12.69,$0.00,1,1,1,1,1,1,20171001, E1575,HCPCS,TRANSDUCER PROTECT/FLD BAR,UE,,28,,NW,,,,,,$91.09,$0.00,1,1,1,1,1,1,20171001, E1590,HCPCS,HEMODIALYSIS MACHINE,,,28,,NW,,,,,,"$3,130.44",$0.00,1,1,1,1,1,1,20171001, E1590,HCPCS,HEMODIALYSIS MACHINE,NU,,28,,NW,,,,,,"$3,130.44",$0.00,1,1,1,1,1,1,20171001, E1590,HCPCS,HEMODIALYSIS MACHINE,RR,,28,,NW,,,,,,$180.01,$0.00,1,1,1,1,1,1,20171001, E1590,HCPCS,HEMODIALYSIS MACHINE,UE,,28,,NW,,,,,,"$2,357.41",$0.00,1,1,1,1,1,1,20171001, E1592,HCPCS,AUTO INTERM PERITONEAL DIALY,,,28,,NW,,,,,,$7.81,$0.00,1,1,1,1,1,1,20171001, E1594,HCPCS,CYCLER DIALYSIS MACHINE,,,28,,NW,,,,,,"$8,263.40",$0.00,1,1,1,1,1,1,20171001, E1594,HCPCS,CYCLER DIALYSIS MACHINE,NU,,28,,NW,,,,,,"$8,263.40",$0.00,1,1,1,1,1,1,20171001, E1594,HCPCS,CYCLER DIALYSIS MACHINE,RR,,28,,NW,,,,,,$904.35,$0.00,1,1,1,1,1,1,20171001, E1594,HCPCS,CYCLER DIALYSIS MACHINE,UE,,28,,NW,,,,,,"$6,222.87",$0.00,1,1,1,1,1,1,20171001, E1600,HCPCS,DELI/INSTALL CHRG HEMO EQUIP,,,28,,NW,,,,,,$449.13,$0.00,1,1,1,1,1,1,20171001, E1610,HCPCS,REVERSE OSMOSIS H2O PURI SYS,,,28,,NW,,,,,,"$5,492.29",$0.00,1,1,1,1,1,1,20171001, E1610,HCPCS,REVERSE OSMOSIS H2O PURI SYS,NU,,28,,NW,,,,,,"$5,492.29",$0.00,1,1,1,1,1,1,20171001, E1610,HCPCS,REVERSE OSMOSIS H2O PURI SYS,RR,,28,,NW,,,,,,$573.97,$0.00,1,1,1,1,1,1,20171001, E1610,HCPCS,REVERSE OSMOSIS H2O PURI SYS,UE,,28,,NW,,,,,,"$4,125.95",$0.00,1,1,1,1,1,1,20171001, E1615,HCPCS,DEIONIZER H2O PURI SYSTEM,,,28,,NW,,,,,,$330.88,$0.00,1,1,1,1,1,1,20171001, E1620,HCPCS,REPLACEMENT BLOOD PUMP,,,28,,NW,,,,,,$689.58,$0.00,1,1,1,1,1,1,20171001, E1625,HCPCS,WATER SOFTENING SYSTEM,,,28,,NW,,,,,,"$1,781.89",$0.00,1,1,1,1,1,1,20171001, E1630,HCPCS,RECIPROCATING PERITONEAL DIA,,,28,,NW,,,,,,$192.73,$0.00,1,1,1,1,1,1,20171001, E1634,HCPCS,PERITONEAL DIALYSIS CLAMP,,,28,,NW,,,,,,$13.97,$0.00,1,1,1,1,1,1,20171001, E1635,HCPCS,COMPACT TRAVEL HEMODIALYZER,,,28,,NW,,,,,,$601.80,$0.00,1,1,1,1,1,1,20171001, E1636,HCPCS,SORBENT CARTRIDGES PER 10,,,28,,NW,,,,,,$259.25,$0.00,1,1,1,1,1,1,20171001, E1637,HCPCS,"HEMOSTATS FOR DIALYSIS, EACH",,,28,,NW,,,,,,$51.22,$0.00,1,1,1,1,1,1,20171001, E1639,HCPCS,DIALYSIS SCALE,,,28,,NW,,,,,,$151.75,$0.00,1,1,1,1,1,1,20171001, E1699,HCPCS,DIALYSIS EQUIPMENT NOC,,,28,,NW,,,,,,$271.40,$0.00,1,1,1,1,1,1,20171001, E1700,HCPCS,JAW MOTION REHAB SYSTEM,,,28,,NW,,,,,,"$1,091.79",$0.00,1,1,1,1,1,1,20171001, E1700,HCPCS,JAW MOTION REHAB SYSTEM,NU,,28,,NW,,,,,,"$1,091.79",$0.00,1,1,1,1,1,1,20171001, E1700,HCPCS,JAW MOTION REHAB SYSTEM,RR,,28,,NW,,,,,,$138.16,$0.00,1,1,1,1,1,1,20171001, E1700,HCPCS,JAW MOTION REHAB SYSTEM,UE,,28,,NW,,,,,,$431.34,$0.00,1,1,1,1,1,1,20171001, E1701,HCPCS,REPL CUSHIONS FOR JAW MOTION,,,28,,NW,,,,,,$89.92,$0.00,1,1,1,1,1,1,20171001, E1702,HCPCS,REPL MEASR SCALES JAW MOTION,,,28,,NW,,,,,,$113.78,$0.00,1,1,1,1,1,1,20171001, E1800,HCPCS,ADJUST ELBOW EXT/FLEX DEVICE,,,28,,NW,,,,,,"$2,464.41",$0.00,1,1,1,1,1,1,20171001, E1800,HCPCS,ADJUST ELBOW EXT/FLEX DEVICE,RR,,28,,NW,,,,,,$311.87,$0.00,1,1,1,1,1,1,20171001, E1801,HCPCS,SPS ELBOW DEVICE,,,28,,NW,,,,,,"$2,678.62",$0.00,1,1,1,1,1,1,20171001, E1801,HCPCS,SPS ELBOW DEVICE,RR,,28,,NW,,,,,,$338.97,$0.00,1,1,1,1,1,1,20171001, E1802,HCPCS,ADJST FOREARM PRO/SUP DEVICE,,,28,,NW,,,,,,"$6,124.72",$0.00,1,1,1,1,1,1,20171001, E1802,HCPCS,ADJST FOREARM PRO/SUP DEVICE,RR,,28,,NW,,,,,,$775.07,$0.00,1,1,1,1,1,1,20171001, E1805,HCPCS,ADJUST WRIST EXT/FLEX DEVICE,,,28,,NW,,,,,,"$2,547.68",$0.00,1,1,1,1,1,1,20171001, E1805,HCPCS,ADJUST WRIST EXT/FLEX DEVICE,RR,,28,,NW,,,,,,$322.40,$0.00,1,1,1,1,1,1,20171001, E1806,HCPCS,SPS WRIST DEVICE,,,28,,NW,,,,,,"$2,294.68",$0.00,1,1,1,1,1,1,20171001, E1806,HCPCS,SPS WRIST DEVICE,RR,,28,,NW,,,,,,$290.39,$0.00,1,1,1,1,1,1,20171001, E1810,HCPCS,ADJUST KNEE EXT/FLEX DEVICE,,,28,,NW,,,,,,"$2,518.82",$0.00,1,1,1,1,1,1,20171001, E1810,HCPCS,ADJUST KNEE EXT/FLEX DEVICE,RR,,28,,NW,,,,,,$318.75,$0.00,1,1,1,1,1,1,20171001, E1811,HCPCS,SPS KNEE DEVICE,,,28,,NW,,,,,,"$2,763.66",$0.00,1,1,1,1,1,1,20171001, E1811,HCPCS,SPS KNEE DEVICE,RR,,28,,NW,,,,,,$349.73,$0.00,1,1,1,1,1,1,20171001, E1812,HCPCS,KNEE EXT/FLEX W ACT RES CTRL,,,28,,NW,,,,,,"$2,005.52",$0.00,1,1,1,1,1,1,20171001, E1812,HCPCS,KNEE EXT/FLEX W ACT RES CTRL,RR,,28,,NW,,,,,,$253.79,$0.00,1,1,1,1,1,1,20171001, E1815,HCPCS,ADJUST ANKLE EXT/FLEX DEVICE,,,28,,NW,,,,,,"$2,552.13",$0.00,1,1,1,1,1,1,20171001, E1815,HCPCS,ADJUST ANKLE EXT/FLEX DEVICE,RR,,28,,NW,,,,,,$322.97,$0.00,1,1,1,1,1,1,20171001, E1816,HCPCS,SPS ANKLE DEVICE,,,28,,NW,,,,,,"$2,798.77",$0.00,1,1,1,1,1,1,20171001, E1816,HCPCS,SPS ANKLE DEVICE,RR,,28,,NW,,,,,,$354.18,$0.00,1,1,1,1,1,1,20171001, E1818,HCPCS,SPS FOREARM DEVICE,,,28,,NW,,,,,,"$2,845.98",$0.00,1,1,1,1,1,1,20171001, E1818,HCPCS,SPS FOREARM DEVICE,RR,,28,,NW,,,,,,$360.15,$0.00,1,1,1,1,1,1,20171001, E1820,HCPCS,SOFT INTERFACE MATERIAL,,,28,,NW,,,,,,$240.92,$0.00,1,1,1,1,1,1,20171001, E1820,HCPCS,SOFT INTERFACE MATERIAL,NU,,28,,NW,,,,,,$240.92,$0.00,1,1,1,1,1,1,20171001, E1820,HCPCS,SOFT INTERFACE MATERIAL,RR,,28,,NW,,,,,,$85.00,$0.00,1,1,1,1,1,1,20171001, E1820,HCPCS,SOFT INTERFACE MATERIAL,UE,,28,,NW,,,,,,$197.62,$0.00,1,1,1,1,1,1,20171001, E1821,HCPCS,REPLACEMENT INTERFACE SPSD,,,28,,NW,,,,,,$295.48,$0.00,1,1,1,1,1,1,20171001, E1821,HCPCS,REPLACEMENT INTERFACE SPSD,NU,,28,,NW,,,,,,$295.48,$0.00,1,1,1,1,1,1,20171001, E1821,HCPCS,REPLACEMENT INTERFACE SPSD,RR,,28,,NW,,,,,,$90.40,$0.00,1,1,1,1,1,1,20171001, E1821,HCPCS,REPLACEMENT INTERFACE SPSD,UE,,28,,NW,,,,,,$238.58,$0.00,1,1,1,1,1,1,20171001, E1825,HCPCS,ADJUST FINGER EXT/FLEX DEVC,,,28,,NW,,,,,,"$2,547.68",$0.00,1,1,1,1,1,1,20171001, E1825,HCPCS,ADJUST FINGER EXT/FLEX DEVC,RR,,28,,NW,,,,,,$322.40,$0.00,1,1,1,1,1,1,20171001, E1830,HCPCS,ADJUST TOE EXT/FLEX DEVICE,,,28,,NW,,,,,,"$2,547.68",$0.00,1,1,1,1,1,1,20171001, E1830,HCPCS,ADJUST TOE EXT/FLEX DEVICE,RR,,28,,NW,,,,,,$322.40,$0.00,1,1,1,1,1,1,20171001, E1831,HCPCS,STATIC STR TOE DEV EXT/FLEX,,,28,,NW,,,,,,"$1,645.34",$0.00,1,1,1,1,1,1,20171001, E1831,HCPCS,STATIC STR TOE DEV EXT/FLEX,RR,,28,,NW,,,,,,$208.21,$0.00,1,1,1,1,1,1,20171001, E1840,HCPCS,ADJ SHOULDER EXT/FLEX DEVICE,,,28,,NW,,,,,,"$6,943.83",$0.00,1,1,1,1,1,1,20171001, E1840,HCPCS,ADJ SHOULDER EXT/FLEX DEVICE,RR,,28,,NW,,,,,,$878.72,$0.00,1,1,1,1,1,1,20171001, E1841,HCPCS,STATIC STR SHLDR DEV ROM ADJ,,,28,,NW,,,,,,"$8,282.96",$0.00,1,1,1,1,1,1,20171001, E1841,HCPCS,STATIC STR SHLDR DEV ROM ADJ,RR,,28,,NW,,,,,,"$1,048.19",$0.00,1,1,1,1,1,1,20171001, E1902,HCPCS,AAC NON-ELECTRONIC BOARD,,,28,,NW,,,,,,"$1,175.00",$0.00,1,1,1,1,1,1,20171001, E2000,HCPCS,GASTRIC SUCTION PUMP HME MDL,,,28,,NW,,,,,,"$1,395.87",$0.00,1,1,1,1,1,1,20171001, E2000,HCPCS,GASTRIC SUCTION PUMP HME MDL,RR,,28,,NW,,,,,,$176.64,$0.00,1,1,1,1,1,1,20171001, E2100,HCPCS,BLD GLUCOSE MONITOR W VOICE,,,28,,NW,,,,,,"$1,343.25",$0.00,1,1,1,1,1,1,20171001, E2100,HCPCS,BLD GLUCOSE MONITOR W VOICE,NU,,28,,NW,,,,,,"$1,343.25",$0.00,1,1,1,1,1,1,20171001, E2100,HCPCS,BLD GLUCOSE MONITOR W VOICE,RR,,28,,NW,,,,,,$196.87,$0.00,1,1,1,1,1,1,20171001, E2100,HCPCS,BLD GLUCOSE MONITOR W VOICE,UE,,28,,NW,,,,,,"$1,027.41",$0.00,1,1,1,1,1,1,20171001, E2101,HCPCS,BLD GLUCOSE MONITOR W LANCE,,,28,,NW,,,,,,$475.81,$0.00,1,1,1,1,1,1,20171001, E2101,HCPCS,BLD GLUCOSE MONITOR W LANCE,NU,,28,,NW,,,,,,$475.81,$0.00,1,1,1,1,1,1,20171001, E2101,HCPCS,BLD GLUCOSE MONITOR W LANCE,RR,,28,,NW,,,,,,$108.47,$0.00,1,1,1,1,1,1,20171001, E2101,HCPCS,BLD GLUCOSE MONITOR W LANCE,UE,,28,,NW,,,,,,$373.78,$0.00,1,1,1,1,1,1,20171001, E2120,HCPCS,PULSE GEN SYS TX ENDOLYMP FL,,,28,,NW,,,,,,"$5,384.37",$0.00,1,1,1,1,1,1,20171001, E2120,HCPCS,PULSE GEN SYS TX ENDOLYMP FL,RR,,28,,NW,,,,,,$681.38,$0.00,1,1,1,1,1,1,20171001, E2201,HCPCS,MAN W/CH ACC SEAT W>=20<24,,,28,,NW,,,,,,$839.39,$0.00,1,1,1,1,1,1,20171001, E2201,HCPCS,MAN W/CH ACC SEAT W>=20<24,NU,,28,,NW,,,,,,$839.39,$0.00,1,1,1,1,1,1,20171001, E2201,HCPCS,MAN W/CH ACC SEAT W>=20<24,RR,,28,,NW,,,,,,$111.20,$0.00,1,1,1,1,1,1,20171001, E2201,HCPCS,MAN W/CH ACC SEAT W>=20<24,UE,,28,,NW,,,,,,$637.11,$0.00,1,1,1,1,1,1,20171001, E2202,HCPCS,SEAT WIDTH 24-27 IN,,,28,,NW,,,,,,"$1,192.90",$0.00,1,1,1,1,1,1,20171001, E2202,HCPCS,SEAT WIDTH 24-27 IN,NU,,28,,NW,,,,,,"$1,192.90",$0.00,1,1,1,1,1,1,20171001, E2202,HCPCS,SEAT WIDTH 24-27 IN,RR,,28,,NW,,,,,,$146.54,$0.00,1,1,1,1,1,1,20171001, E2202,HCPCS,SEAT WIDTH 24-27 IN,UE,,28,,NW,,,,,,$902.25,$0.00,1,1,1,1,1,1,20171001, E2203,HCPCS,FRAME DEPTH LESS THAN 22 IN,,,28,,NW,,,,,,"$1,135.70",$0.00,1,1,1,1,1,1,20171001, E2203,HCPCS,FRAME DEPTH LESS THAN 22 IN,NU,,28,,NW,,,,,,"$1,135.70",$0.00,1,1,1,1,1,1,20171001, E2203,HCPCS,FRAME DEPTH LESS THAN 22 IN,RR,,28,,NW,,,,,,$140.82,$0.00,1,1,1,1,1,1,20171001, E2203,HCPCS,FRAME DEPTH LESS THAN 22 IN,UE,,28,,NW,,,,,,$859.35,$0.00,1,1,1,1,1,1,20171001, E2204,HCPCS,FRAME DEPTH 22 TO 25 IN,,,28,,NW,,,,,,"$1,955.36",$0.00,1,1,1,1,1,1,20171001, E2204,HCPCS,FRAME DEPTH 22 TO 25 IN,NU,,28,,NW,,,,,,"$1,955.36",$0.00,1,1,1,1,1,1,20171001, E2204,HCPCS,FRAME DEPTH 22 TO 25 IN,RR,,28,,NW,,,,,,$222.79,$0.00,1,1,1,1,1,1,20171001, E2204,HCPCS,FRAME DEPTH 22 TO 25 IN,UE,,28,,NW,,,,,,"$1,474.10",$0.00,1,1,1,1,1,1,20171001, E2205,HCPCS,"MANUAL WC ACCESSORY, HANDRIM",,,28,,NW,,,,,,$91.10,$0.00,1,1,1,1,1,1,20171001, E2205,HCPCS,"MANUAL WC ACCESSORY, HANDRIM",NU,,28,,NW,,,,,,$91.10,$0.00,1,1,1,1,1,1,20171001, E2205,HCPCS,"MANUAL WC ACCESSORY, HANDRIM",RR,,28,,NW,,,,,,$8.77,$0.00,1,1,1,1,1,1,20171001, E2205,HCPCS,"MANUAL WC ACCESSORY, HANDRIM",UE,,28,,NW,,,,,,$75.91,$0.00,1,1,1,1,1,1,20171001, E2206,HCPCS,MAN WC WHL LOCK COMP REPL EA,,,28,,NW,,,,,,$129.98,$0.00,1,1,1,1,1,1,20171001, E2206,HCPCS,COMPLETE WHEEL LOCK ASSEMBLY,NU,,28,,NW,,,,,,$129.98,$0.00,1,1,1,1,1,1,20171001, E2206,HCPCS,COMPLETE WHEEL LOCK ASSEMBLY,RR,,28,,NW,,,,,,$9.68,$0.00,1,1,1,1,1,1,20171001, E2206,HCPCS,COMPLETE WHEEL LOCK ASSEMBLY,UE,,28,,NW,,,,,,$105.05,$0.00,1,1,1,1,1,1,20171001, E2207,HCPCS,CRUTCH AND CANE HOLDER,,,28,,NW,,,,,,$110.16,$0.00,1,1,1,1,1,1,20171001, E2207,HCPCS,CRUTCH AND CANE HOLDER,NU,,28,,NW,,,,,,$110.16,$0.00,1,1,1,1,1,1,20171001, E2207,HCPCS,CRUTCH AND CANE HOLDER,RR,,28,,NW,,,,,,$11.53,$0.00,1,1,1,1,1,1,20171001, E2207,HCPCS,CRUTCH AND CANE HOLDER,UE,,28,,NW,,,,,,$90.19,$0.00,1,1,1,1,1,1,20171001, E2208,HCPCS,CYLINDER TANK CARRIER,,,28,,NW,,,,,,$232.73,$0.00,1,1,1,1,1,1,20171001, E2208,HCPCS,CYLINDER TANK CARRIER,NU,,28,,NW,,,,,,$232.73,$0.00,1,1,1,1,1,1,20171001, E2208,HCPCS,CYLINDER TANK CARRIER,RR,,28,,NW,,,,,,$19.65,$0.00,1,1,1,1,1,1,20171001, E2208,HCPCS,CYLINDER TANK CARRIER,UE,,28,,NW,,,,,,$182.12,$0.00,1,1,1,1,1,1,20171001, E2209,HCPCS,ARM TROUGH EACH,,,28,,NW,,,,,,$250.02,$0.00,1,1,1,1,1,1,20171001, E2209,HCPCS,ARM TROUGH EACH,NU,,28,,NW,,,,,,$250.02,$0.00,1,1,1,1,1,1,20171001, E2209,HCPCS,ARM TROUGH EACH,RR,,28,,NW,,,,,,$21.33,$0.00,1,1,1,1,1,1,20171001, E2209,HCPCS,ARM TROUGH EACH,UE,,28,,NW,,,,,,$195.09,$0.00,1,1,1,1,1,1,20171001, E2210,HCPCS,WHEELCHAIR BEARINGS,,,28,,NW,,,,,,$13.60,$0.00,1,1,1,1,1,1,20171001, E2210,HCPCS,WHEELCHAIR BEARINGS,NU,,28,,NW,,,,,,$13.60,$0.00,1,1,1,1,1,1,20171001, E2210,HCPCS,WHEELCHAIR BEARINGS,RR,,28,,NW,,,,,,$1.36,$0.00,1,1,1,1,1,1,20171001, E2210,HCPCS,WHEELCHAIR BEARINGS,UE,,28,,NW,,,,,,$10.21,$0.00,1,1,1,1,1,1,20171001, E2211,HCPCS,PNEUMATIC PROPULSION TIRE,,,28,,NW,,,,,,$120.42,$0.00,1,1,1,1,1,1,20171001, E2211,HCPCS,PNEUMATIC PROPULSION TIRE,NU,,28,,NW,,,,,,$120.42,$0.00,1,1,1,1,1,1,20171001, E2211,HCPCS,PNEUMATIC PROPULSION TIRE,RR,,28,,NW,,,,,,$8.75,$0.00,1,1,1,1,1,1,20171001, E2211,HCPCS,PNEUMATIC PROPULSION TIRE,UE,,28,,NW,,,,,,$97.89,$0.00,1,1,1,1,1,1,20171001, E2212,HCPCS,PNEUMATIC PROP TIRE TUBE,,,28,,NW,,,,,,$15.71,$0.00,1,1,1,1,1,1,20171001, E2212,HCPCS,PNEUMATIC PROP TIRE TUBE,NU,,28,,NW,,,,,,$15.71,$0.00,1,1,1,1,1,1,20171001, E2212,HCPCS,PNEUMATIC PROP TIRE TUBE,RR,,28,,NW,,,,,,$1.57,$0.00,1,1,1,1,1,1,20171001, E2212,HCPCS,PNEUMATIC PROP TIRE TUBE,UE,,28,,NW,,,,,,$11.79,$0.00,1,1,1,1,1,1,20171001, E2213,HCPCS,PNEUMATIC PROP TIRE INSERT,,,28,,NW,,,,,,$108.11,$0.00,1,1,1,1,1,1,20171001, E2213,HCPCS,PNEUMATIC PROP TIRE INSERT,NU,,28,,NW,,,,,,$108.11,$0.00,1,1,1,1,1,1,20171001, E2213,HCPCS,PNEUMATIC PROP TIRE INSERT,RR,,28,,NW,,,,,,$7.56,$0.00,1,1,1,1,1,1,20171001, E2213,HCPCS,PNEUMATIC PROP TIRE INSERT,UE,,28,,NW,,,,,,$85.55,$0.00,1,1,1,1,1,1,20171001, E2214,HCPCS,PNEUMATIC CASTER TIRE EACH,,,28,,NW,,,,,,$115.74,$0.00,1,1,1,1,1,1,20171001, E2214,HCPCS,PNEUMATIC CASTER TIRE EACH,NU,,28,,NW,,,,,,$115.74,$0.00,1,1,1,1,1,1,20171001, E2214,HCPCS,PNEUMATIC CASTER TIRE EACH,RR,,28,,NW,,,,,,$8.30,$0.00,1,1,1,1,1,1,20171001, E2214,HCPCS,PNEUMATIC CASTER TIRE EACH,UE,,28,,NW,,,,,,$94.38,$0.00,1,1,1,1,1,1,20171001, E2215,HCPCS,PNEUMATIC CASTER TIRE TUBE,,,28,,NW,,,,,,$25.81,$0.00,1,1,1,1,1,1,20171001, E2215,HCPCS,PNEUMATIC CASTER TIRE TUBE,NU,,28,,NW,,,,,,$25.81,$0.00,1,1,1,1,1,1,20171001, E2215,HCPCS,PNEUMATIC CASTER TIRE TUBE,RR,,28,,NW,,,,,,$2.59,$0.00,1,1,1,1,1,1,20171001, E2215,HCPCS,PNEUMATIC CASTER TIRE TUBE,UE,,28,,NW,,,,,,$19.36,$0.00,1,1,1,1,1,1,20171001, E2216,HCPCS,FOAM FILLED PROPULSION TIRE,,,28,,NW,,,,,,$193.12,$0.00,1,1,1,1,1,1,20171001, E2216,HCPCS,FOAM FILLED PROPULSION TIRE,NU,,28,,NW,,,,,,$193.12,$0.00,1,1,1,1,1,1,20171001, E2216,HCPCS,FOAM FILLED PROPULSION TIRE,RR,,28,,NW,,,,,,$20.54,$0.00,1,1,1,1,1,1,20171001, E2216,HCPCS,FOAM FILLED PROPULSION TIRE,UE,,28,,NW,,,,,,$145.18,$0.00,1,1,1,1,1,1,20171001, E2217,HCPCS,FOAM FILLED CASTER TIRE EACH,,,28,,NW,,,,,,$207.57,$0.00,1,1,1,1,1,1,20171001, E2217,HCPCS,FOAM FILLED CASTER TIRE EACH,NU,,28,,NW,,,,,,$207.57,$0.00,1,1,1,1,1,1,20171001, E2217,HCPCS,FOAM FILLED CASTER TIRE EACH,RR,,28,,NW,,,,,,$14.78,$0.00,1,1,1,1,1,1,20171001, E2217,HCPCS,FOAM FILLED CASTER TIRE EACH,UE,,28,,NW,,,,,,$104.44,$0.00,1,1,1,1,1,1,20171001, E2218,HCPCS,FOAM PROPULSION TIRE EACH,,,28,,NW,,,,,,$167.13,$0.00,1,1,1,1,1,1,20171001, E2218,HCPCS,FOAM PROPULSION TIRE EACH,NU,,28,,NW,,,,,,$167.13,$0.00,1,1,1,1,1,1,20171001, E2218,HCPCS,FOAM PROPULSION TIRE EACH,RR,,28,,NW,,,,,,$11.90,$0.00,1,1,1,1,1,1,20171001, E2218,HCPCS,FOAM PROPULSION TIRE EACH,UE,,28,,NW,,,,,,$84.09,$0.00,1,1,1,1,1,1,20171001, E2219,HCPCS,FOAM CASTER TIRE ANY SIZE EA,,,28,,NW,,,,,,$135.53,$0.00,1,1,1,1,1,1,20171001, E2219,HCPCS,FOAM CASTER TIRE ANY SIZE EA,NU,,28,,NW,,,,,,$135.53,$0.00,1,1,1,1,1,1,20171001, E2219,HCPCS,FOAM CASTER TIRE ANY SIZE EA,RR,,28,,NW,,,,,,$10.26,$0.00,1,1,1,1,1,1,20171001, E2219,HCPCS,FOAM CASTER TIRE ANY SIZE EA,UE,,28,,NW,,,,,,$109.22,$0.00,1,1,1,1,1,1,20171001, E2220,HCPCS,"SOLID PROPULS TIRE, REPL, EA",,,28,,NW,,,,,,$80.60,$0.00,1,1,1,1,1,1,20171001, E2220,HCPCS,SOLID PROPULSION TIRE EACH,NU,,28,,NW,,,,,,$80.60,$0.00,1,1,1,1,1,1,20171001, E2220,HCPCS,SOLID PROPULSION TIRE EACH,RR,,28,,NW,,,,,,$7.25,$0.00,1,1,1,1,1,1,20171001, E2220,HCPCS,SOLID PROPULSION TIRE EACH,UE,,28,,NW,,,,,,$63.82,$0.00,1,1,1,1,1,1,20171001, E2221,HCPCS,"SOLID CASTER TIRE REPL, EACH",,,28,,NW,,,,,,$99.66,$0.00,1,1,1,1,1,1,20171001, E2221,HCPCS,SOLID CASTER TIRE EACH,NU,,28,,NW,,,,,,$99.66,$0.00,1,1,1,1,1,1,20171001, E2221,HCPCS,SOLID CASTER TIRE EACH,RR,,28,,NW,,,,,,$6.73,$0.00,1,1,1,1,1,1,20171001, E2221,HCPCS,SOLID CASTER TIRE EACH,UE,,28,,NW,,,,,,$75.32,$0.00,1,1,1,1,1,1,20171001, E2222,HCPCS,"SOLID CASTER INTEG WHL, REPL",,,28,,NW,,,,,,$65.96,$0.00,1,1,1,1,1,1,20171001, E2222,HCPCS,SOLID CASTER INTEGRATED WHL,NU,,28,,NW,,,,,,$65.96,$0.00,1,1,1,1,1,1,20171001, E2222,HCPCS,SOLID CASTER INTEGRATED WHL,RR,,28,,NW,,,,,,$5.63,$0.00,1,1,1,1,1,1,20171001, E2222,HCPCS,SOLID CASTER INTEGRATED WHL,UE,,28,,NW,,,,,,$47.33,$0.00,1,1,1,1,1,1,20171001, E2224,HCPCS,PROPULSION WHL EXCL TIRE REP,,,28,,NW,,,,,,$271.71,$0.00,1,1,1,1,1,1,20171001, E2224,HCPCS,PROPULSION WHL EXCLUDES TIRE,NU,,28,,NW,,,,,,$271.71,$0.00,1,1,1,1,1,1,20171001, E2224,HCPCS,PROPULSION WHL EXCLUDES TIRE,RR,,28,,NW,,,,,,$23.52,$0.00,1,1,1,1,1,1,20171001, E2224,HCPCS,PROPULSION WHL EXCLUDES TIRE,UE,,28,,NW,,,,,,$211.31,$0.00,1,1,1,1,1,1,20171001, E2225,HCPCS,CASTER WHEEL EXCLUDES TIRE,,,28,,NW,,,,,,$53.77,$0.00,1,1,1,1,1,1,20171001, E2225,HCPCS,CASTER WHEEL EXCLUDES TIRE,NU,,28,,NW,,,,,,$53.77,$0.00,1,1,1,1,1,1,20171001, E2225,HCPCS,CASTER WHEEL EXCLUDES TIRE,RR,,28,,NW,,,,,,$4.71,$0.00,1,1,1,1,1,1,20171001, E2225,HCPCS,CASTER WHEEL EXCLUDES TIRE,UE,,28,,NW,,,,,,$38.16,$0.00,1,1,1,1,1,1,20171001, E2226,HCPCS,CASTER FORK REPLACEMENT ONLY,,,28,,NW,,,,,,$133.26,$0.00,1,1,1,1,1,1,20171001, E2226,HCPCS,CASTER FORK REPLACEMENT ONLY,NU,,28,,NW,,,,,,$133.26,$0.00,1,1,1,1,1,1,20171001, E2226,HCPCS,CASTER FORK REPLACEMENT ONLY,RR,,28,,NW,,,,,,$10.00,$0.00,1,1,1,1,1,1,20171001, E2226,HCPCS,CASTER FORK REPLACEMENT ONLY,UE,,28,,NW,,,,,,$107.51,$0.00,1,1,1,1,1,1,20171001, E2227,HCPCS,GEAR REDUCTION DRIVE WHEEL,,,28,,NW,,,,,,"$3,191.98",$0.00,1,1,1,1,1,1,20171001, E2227,HCPCS,GEAR REDUCTION DRIVE WHEEL,NU,,28,,NW,,,,,,"$3,191.98",$0.00,1,1,1,1,1,1,20171001, E2227,HCPCS,GEAR REDUCTION DRIVE WHEEL,RR,,28,,NW,,,,,,$403.94,$0.00,1,1,1,1,1,1,20171001, E2227,HCPCS,GEAR REDUCTION DRIVE WHEEL,UE,,28,,NW,,,,,,"$3,513.18",$0.00,1,1,1,1,1,1,20171001, E2228,HCPCS,"MWC ACC, WHEELCHAIR BRAKE",,,28,,NW,,,,,,"$2,203.56",$0.00,1,1,1,1,1,1,20171001, E2228,HCPCS,"MWC ACC, WHEELCHAIR BRAKE",NU,,28,,NW,,,,,,"$2,203.56",$0.00,1,1,1,1,1,1,20171001, E2228,HCPCS,"MWC ACC, WHEELCHAIR BRAKE",RR,,28,,NW,,,,,,$278.86,$0.00,1,1,1,1,1,1,20171001, E2228,HCPCS,"MWC ACC, WHEELCHAIR BRAKE",UE,,28,,NW,,,,,,"$1,559.42",$0.00,1,1,1,1,1,1,20171001, E2230,HCPCS,MANUAL STANDING SYSTEM,,,28,,NW,,,,,,"$1,547.51",$0.00,1,1,1,1,1,1,20171001, E2231,HCPCS,SOLID SEAT SUPPORT BASE,,,28,,NW,,,,,,$394.05,$0.00,1,1,1,1,1,1,20171001, E2231,HCPCS,SOLID SEAT SUPPORT BASE,NU,,28,,NW,,,,,,$394.05,$0.00,1,1,1,1,1,1,20171001, E2231,HCPCS,SOLID SEAT SUPPORT BASE,RR,,28,,NW,,,,,,$50.07,$0.00,1,1,1,1,1,1,20171001, E2231,HCPCS,SOLID SEAT SUPPORT BASE,UE,,28,,NW,,,,,,$303.11,$0.00,1,1,1,1,1,1,20171001, E2295,HCPCS,PED DYNAMIC SEATING FRAME,,,28,,NW,,,,,,$90.59,$0.00,1,1,1,1,1,1,20171001, E2300,HCPCS,PWR SEAT ELEVATION SYS,,,28,,NW,,,,,,"$1,049.03",$0.00,1,1,1,1,1,1,20171001, E2301,HCPCS,PWR STANDING,,,28,,NW,,,,,,"$1,082.62",$0.00,1,1,1,1,1,1,20171001, E2310,HCPCS,ELECTRO CONNECT BTW CONTROL,,,28,,NW,,,,,,"$2,405.85",$0.00,1,1,1,1,1,1,20171001, E2310,HCPCS,ELECTRO CONNECT BTW CONTROL,NU,,28,,NW,,,,,,"$2,405.85",$0.00,1,1,1,1,1,1,20171001, E2310,HCPCS,ELECTRO CONNECT BTW CONTROL,RR,,28,,NW,,,,,,$304.45,$0.00,1,1,1,1,1,1,20171001, E2310,HCPCS,ELECTRO CONNECT BTW CONTROL,UE,,28,,NW,,,,,,"$1,677.63",$0.00,1,1,1,1,1,1,20171001, E2311,HCPCS,ELECTRO CONNECT BTW 2 SYS,,,28,,NW,,,,,,"$4,611.30",$0.00,1,1,1,1,1,1,20171001, E2311,HCPCS,ELECTRO CONNECT BTW 2 SYS,NU,,28,,NW,,,,,,"$4,611.30",$0.00,1,1,1,1,1,1,20171001, E2311,HCPCS,ELECTRO CONNECT BTW 2 SYS,RR,,28,,NW,,,,,,$583.55,$0.00,1,1,1,1,1,1,20171001, E2311,HCPCS,ELECTRO CONNECT BTW 2 SYS,UE,,28,,NW,,,,,,"$3,365.65",$0.00,1,1,1,1,1,1,20171001, E2312,HCPCS,MINI-PROP REMOTE JOYSTICK,,,28,,NW,,,,,,"$3,422.46",$0.00,1,1,1,1,1,1,20171001, E2312,HCPCS,MINI-PROP REMOTE JOYSTICK,NU,,28,,NW,,,,,,"$3,422.46",$0.00,1,1,1,1,1,1,20171001, E2312,HCPCS,MINI-PROP REMOTE JOYSTICK,RR,,28,,NW,,,,,,$433.10,$0.00,1,1,1,1,1,1,20171001, E2312,HCPCS,MINI-PROP REMOTE JOYSTICK,UE,,28,,NW,,,,,,"$3,783.64",$0.00,1,1,1,1,1,1,20171001, E2313,HCPCS,"PWC HARNESS, EXPAND CONTROL",,,28,,NW,,,,,,$745.05,$0.00,1,1,1,1,1,1,20171001, E2313,HCPCS,"PWC HARNESS, EXPAND CONTROL",NU,,28,,NW,,,,,,$745.05,$0.00,1,1,1,1,1,1,20171001, E2313,HCPCS,"PWC HARNESS, EXPAND CONTROL",RR,,28,,NW,,,,,,$94.28,$0.00,1,1,1,1,1,1,20171001, E2313,HCPCS,"PWC HARNESS, EXPAND CONTROL",UE,,28,,NW,,,,,,$626.99,$0.00,1,1,1,1,1,1,20171001, E2321,HCPCS,HAND INTERFACE JOYSTICK,,,28,,NW,,,,,,"$3,183.03",$0.00,1,1,1,1,1,1,20171001, E2321,HCPCS,HAND INTERFACE JOYSTICK,NU,,28,,NW,,,,,,"$3,183.03",$0.00,1,1,1,1,1,1,20171001, E2321,HCPCS,HAND INTERFACE JOYSTICK,RR,,28,,NW,,,,,,$402.80,$0.00,1,1,1,1,1,1,20171001, E2321,HCPCS,HAND INTERFACE JOYSTICK,UE,,28,,NW,,,,,,"$2,266.78",$0.00,1,1,1,1,1,1,20171001, E2322,HCPCS,MULT MECH SWITCHES,,,28,,NW,,,,,,"$2,109.70",$0.00,1,1,1,1,1,1,20171001, E2322,HCPCS,MULT MECH SWITCHES,NU,,28,,NW,,,,,,"$2,109.70",$0.00,1,1,1,1,1,1,20171001, E2322,HCPCS,MULT MECH SWITCHES,RR,,28,,NW,,,,,,$266.98,$0.00,1,1,1,1,1,1,20171001, E2322,HCPCS,MULT MECH SWITCHES,UE,,28,,NW,,,,,,"$2,015.24",$0.00,1,1,1,1,1,1,20171001, E2323,HCPCS,SPECIAL JOYSTICK HANDLE,,,28,,NW,,,,,,$145.66,$0.00,1,1,1,1,1,1,20171001, E2323,HCPCS,SPECIAL JOYSTICK HANDLE,NU,,28,,NW,,,,,,$145.66,$0.00,1,1,1,1,1,1,20171001, E2323,HCPCS,SPECIAL JOYSTICK HANDLE,RR,,28,,NW,,,,,,$16.65,$0.00,1,1,1,1,1,1,20171001, E2323,HCPCS,SPECIAL JOYSTICK HANDLE,UE,,28,,NW,,,,,,$116.81,$0.00,1,1,1,1,1,1,20171001, E2324,HCPCS,CHIN CUP INTERFACE,,,28,,NW,,,,,,$106.45,$0.00,1,1,1,1,1,1,20171001, E2324,HCPCS,CHIN CUP INTERFACE,NU,,28,,NW,,,,,,$106.45,$0.00,1,1,1,1,1,1,20171001, E2324,HCPCS,CHIN CUP INTERFACE,RR,,28,,NW,,,,,,$11.00,$0.00,1,1,1,1,1,1,20171001, E2324,HCPCS,CHIN CUP INTERFACE,UE,,28,,NW,,,,,,$87.42,$0.00,1,1,1,1,1,1,20171001, E2325,HCPCS,SIP AND PUFF INTERFACE,,,28,,NW,,,,,,"$2,026.94",$0.00,1,1,1,1,1,1,20171001, E2325,HCPCS,SIP AND PUFF INTERFACE,NU,,28,,NW,,,,,,"$2,026.94",$0.00,1,1,1,1,1,1,20171001, E2325,HCPCS,SIP AND PUFF INTERFACE,RR,,28,,NW,,,,,,$256.50,$0.00,1,1,1,1,1,1,20171001, E2325,HCPCS,SIP AND PUFF INTERFACE,UE,,28,,NW,,,,,,"$1,926.34",$0.00,1,1,1,1,1,1,20171001, E2326,HCPCS,BREATH TUBE KIT,,,28,,NW,,,,,,$708.21,$0.00,1,1,1,1,1,1,20171001, E2326,HCPCS,BREATH TUBE KIT,NU,,28,,NW,,,,,,$708.21,$0.00,1,1,1,1,1,1,20171001, E2326,HCPCS,BREATH TUBE KIT,RR,,28,,NW,,,,,,$89.62,$0.00,1,1,1,1,1,1,20171001, E2326,HCPCS,BREATH TUBE KIT,UE,,28,,NW,,,,,,$519.19,$0.00,1,1,1,1,1,1,20171001, E2327,HCPCS,HEAD CONTROL INTERFACE MECH,,,28,,NW,,,,,,"$3,736.22",$0.00,1,1,1,1,1,1,20171001, E2327,HCPCS,HEAD CONTROL INTERFACE MECH,NU,,28,,NW,,,,,,"$3,736.22",$0.00,1,1,1,1,1,1,20171001, E2327,HCPCS,HEAD CONTROL INTERFACE MECH,RR,,28,,NW,,,,,,$472.81,$0.00,1,1,1,1,1,1,20171001, E2327,HCPCS,HEAD CONTROL INTERFACE MECH,UE,,28,,NW,,,,,,"$3,707.98",$0.00,1,1,1,1,1,1,20171001, E2328,HCPCS,HEAD/EXTREMITY CONTROL INTER,,,28,,NW,,,,,,"$6,839.44",$0.00,1,1,1,1,1,1,20171001, E2328,HCPCS,HEAD/EXTREMITY CONTROL INTER,NU,,28,,NW,,,,,,"$6,839.44",$0.00,1,1,1,1,1,1,20171001, E2328,HCPCS,HEAD/EXTREMITY CONTROL INTER,RR,,28,,NW,,,,,,$865.51,$0.00,1,1,1,1,1,1,20171001, E2328,HCPCS,HEAD/EXTREMITY CONTROL INTER,UE,,28,,NW,,,,,,"$7,005.53",$0.00,1,1,1,1,1,1,20171001, E2329,HCPCS,HEAD CONTROL NONPROPORTIONAL,,,28,,NW,,,,,,"$2,622.79",$0.00,1,1,1,1,1,1,20171001, E2329,HCPCS,HEAD CONTROL NONPROPORTIONAL,NU,,28,,NW,,,,,,"$2,622.79",$0.00,1,1,1,1,1,1,20171001, E2329,HCPCS,HEAD CONTROL NONPROPORTIONAL,RR,,28,,NW,,,,,,$331.91,$0.00,1,1,1,1,1,1,20171001, E2329,HCPCS,HEAD CONTROL NONPROPORTIONAL,UE,,28,,NW,,,,,,"$2,516.44",$0.00,1,1,1,1,1,1,20171001, E2330,HCPCS,HEAD CONTROL PROXIMITY SWITC,,,28,,NW,,,,,,"$4,815.39",$0.00,1,1,1,1,1,1,20171001, E2330,HCPCS,HEAD CONTROL PROXIMITY SWITC,NU,,28,,NW,,,,,,"$4,815.39",$0.00,1,1,1,1,1,1,20171001, E2330,HCPCS,HEAD CONTROL PROXIMITY SWITC,RR,,28,,NW,,,,,,$609.38,$0.00,1,1,1,1,1,1,20171001, E2330,HCPCS,HEAD CONTROL PROXIMITY SWITC,UE,,28,,NW,,,,,,"$4,847.52",$0.00,1,1,1,1,1,1,20171001, E2331,HCPCS,ATTENDANT CONTROL,,,28,,NW,,,,,,"$1,116.55",$0.00,1,1,1,1,1,1,20171001, E2340,HCPCS,W/C WDTH 20-23 IN SEAT FRAME,,,28,,NW,,,,,,$759.89,$0.00,1,1,1,1,1,1,20171001, E2340,HCPCS,W/C WDTH 20-23 IN SEAT FRAME,NU,,28,,NW,,,,,,$759.89,$0.00,1,1,1,1,1,1,20171001, E2340,HCPCS,W/C WDTH 20-23 IN SEAT FRAME,RR,,28,,NW,,,,,,$103.26,$0.00,1,1,1,1,1,1,20171001, E2340,HCPCS,W/C WDTH 20-23 IN SEAT FRAME,UE,,28,,NW,,,,,,$577.55,$0.00,1,1,1,1,1,1,20171001, E2341,HCPCS,W/C WDTH 24-27 IN SEAT FRAME,,,28,,NW,,,,,,"$1,124.78",$0.00,1,1,1,1,1,1,20171001, E2341,HCPCS,W/C WDTH 24-27 IN SEAT FRAME,NU,,28,,NW,,,,,,"$1,124.78",$0.00,1,1,1,1,1,1,20171001, E2341,HCPCS,W/C WDTH 24-27 IN SEAT FRAME,RR,,28,,NW,,,,,,$139.71,$0.00,1,1,1,1,1,1,20171001, E2341,HCPCS,W/C WDTH 24-27 IN SEAT FRAME,UE,,28,,NW,,,,,,$851.17,$0.00,1,1,1,1,1,1,20171001, E2342,HCPCS,W/C DPTH 20-21 IN SEAT FRAME,,,28,,NW,,,,,,$942.37,$0.00,1,1,1,1,1,1,20171001, E2342,HCPCS,W/C DPTH 20-21 IN SEAT FRAME,NU,,28,,NW,,,,,,$942.37,$0.00,1,1,1,1,1,1,20171001, E2342,HCPCS,W/C DPTH 20-21 IN SEAT FRAME,RR,,28,,NW,,,,,,$121.48,$0.00,1,1,1,1,1,1,20171001, E2342,HCPCS,W/C DPTH 20-21 IN SEAT FRAME,UE,,28,,NW,,,,,,$714.37,$0.00,1,1,1,1,1,1,20171001, E2343,HCPCS,W/C DPTH 22-25 IN SEAT FRAME,,,28,,NW,,,,,,"$1,489.64",$0.00,1,1,1,1,1,1,20171001, E2343,HCPCS,W/C DPTH 22-25 IN SEAT FRAME,NU,,28,,NW,,,,,,"$1,489.64",$0.00,1,1,1,1,1,1,20171001, E2343,HCPCS,W/C DPTH 22-25 IN SEAT FRAME,RR,,28,,NW,,,,,,$176.19,$0.00,1,1,1,1,1,1,20171001, E2343,HCPCS,W/C DPTH 22-25 IN SEAT FRAME,UE,,28,,NW,,,,,,"$1,124.78",$0.00,1,1,1,1,1,1,20171001, E2351,HCPCS,ELECTRONIC SGD INTERFACE,,,28,,NW,,,,,,"$1,229.92",$0.00,1,1,1,1,1,1,20171001, E2351,HCPCS,ELECTRONIC SGD INTERFACE,NU,,28,,NW,,,,,,"$1,229.92",$0.00,1,1,1,1,1,1,20171001, E2351,HCPCS,ELECTRONIC SGD INTERFACE,RR,,28,,NW,,,,,,$150.23,$0.00,1,1,1,1,1,1,20171001, E2351,HCPCS,ELECTRONIC SGD INTERFACE,UE,,28,,NW,,,,,,$930.02,$0.00,1,1,1,1,1,1,20171001, E2358,HCPCS,GR 34 NONSEALED LEADACID,,,28,,NW,,,,,,$328.33,$0.00,1,1,1,1,1,1,20171001, E2359,HCPCS,GR34 SEALED LEADACID BATTERY,,,28,,NW,,,,,,$469.88,$0.00,1,1,1,1,1,1,20171001, E2359,HCPCS,GR34 SEALED LEADACID BATTERY,NU,,28,,NW,,,,,,$469.88,$0.00,1,1,1,1,1,1,20171001, E2359,HCPCS,GR34 SEALED LEADACID BATTERY,RR,,28,,NW,,,,,,$62.30,$0.00,1,1,1,1,1,1,20171001, E2359,HCPCS,GR34 SEALED LEADACID BATTERY,UE,,28,,NW,,,,,,$359.98,$0.00,1,1,1,1,1,1,20171001, E2360,HCPCS,22NF NONSEALED LEADACID,,,28,,NW,,,,,,$299.39,$0.00,1,1,1,1,1,1,20171001, E2360,HCPCS,22NF NONSEALED LEADACID,NU,,28,,NW,,,,,,$299.39,$0.00,1,1,1,1,1,1,20171001, E2360,HCPCS,22NF NONSEALED LEADACID,RR,,28,,NW,,,,,,$26.15,$0.00,1,1,1,1,1,1,20171001, E2360,HCPCS,22NF NONSEALED LEADACID,UE,,28,,NW,,,,,,$232.11,$0.00,1,1,1,1,1,1,20171001, E2361,HCPCS,22NF SEALED LEADACID BATTERY,,,28,,NW,,,,,,$330.63,$0.00,1,1,1,1,1,1,20171001, E2361,HCPCS,22NF SEALED LEADACID BATTERY,NU,,28,,NW,,,,,,$330.63,$0.00,1,1,1,1,1,1,20171001, E2361,HCPCS,22NF SEALED LEADACID BATTERY,RR,,28,,NW,,,,,,$39.84,$0.00,1,1,1,1,1,1,20171001, E2361,HCPCS,22NF SEALED LEADACID BATTERY,UE,,28,,NW,,,,,,$255.55,$0.00,1,1,1,1,1,1,20171001, E2362,HCPCS,GR24 NONSEALED LEADACID,,,28,,NW,,,,,,$275.17,$0.00,1,1,1,1,1,1,20171001, E2362,HCPCS,GR24 NONSEALED LEADACID,NU,,28,,NW,,,,,,$275.17,$0.00,1,1,1,1,1,1,20171001, E2362,HCPCS,GR24 NONSEALED LEADACID,RR,,28,,NW,,,,,,$23.77,$0.00,1,1,1,1,1,1,20171001, E2362,HCPCS,GR24 NONSEALED LEADACID,UE,,28,,NW,,,,,,$213.94,$0.00,1,1,1,1,1,1,20171001, E2363,HCPCS,GR24 SEALED LEADACID BATTERY,,,28,,NW,,,,,,$409.40,$0.00,1,1,1,1,1,1,20171001, E2363,HCPCS,GR24 SEALED LEADACID BATTERY,NU,,28,,NW,,,,,,$409.40,$0.00,1,1,1,1,1,1,20171001, E2363,HCPCS,GR24 SEALED LEADACID BATTERY,RR,,28,,NW,,,,,,$52.55,$0.00,1,1,1,1,1,1,20171001, E2363,HCPCS,GR24 SEALED LEADACID BATTERY,UE,,28,,NW,,,,,,$314.62,$0.00,1,1,1,1,1,1,20171001, E2364,HCPCS,U1NONSEALED LEADACID BATTERY,,,28,,NW,,,,,,$291.69,$0.00,1,1,1,1,1,1,20171001, E2364,HCPCS,U1NONSEALED LEADACID BATTERY,NU,,28,,NW,,,,,,$291.69,$0.00,1,1,1,1,1,1,20171001, E2364,HCPCS,U1NONSEALED LEADACID BATTERY,RR,,28,,NW,,,,,,$25.37,$0.00,1,1,1,1,1,1,20171001, E2364,HCPCS,U1NONSEALED LEADACID BATTERY,UE,,28,,NW,,,,,,$226.34,$0.00,1,1,1,1,1,1,20171001, E2365,HCPCS,U1 SEALED LEADACID BATTERY,,,28,,NW,,,,,,$231.83,$0.00,1,1,1,1,1,1,20171001, E2365,HCPCS,U1 SEALED LEADACID BATTERY,NU,,28,,NW,,,,,,$231.83,$0.00,1,1,1,1,1,1,20171001, E2365,HCPCS,U1 SEALED LEADACID BATTERY,RR,,28,,NW,,,,,,$19.56,$0.00,1,1,1,1,1,1,20171001, E2365,HCPCS,U1 SEALED LEADACID BATTERY,UE,,28,,NW,,,,,,$181.44,$0.00,1,1,1,1,1,1,20171001, E2366,HCPCS,"BATTERY CHARGER, SINGLE MODE",,,28,,NW,,,,,,$446.70,$0.00,1,1,1,1,1,1,20171001, E2366,HCPCS,"BATTERY CHARGER, SINGLE MODE",NU,,28,,NW,,,,,,$446.70,$0.00,1,1,1,1,1,1,20171001, E2366,HCPCS,"BATTERY CHARGER, SINGLE MODE",RR,,28,,NW,,,,,,$58.67,$0.00,1,1,1,1,1,1,20171001, E2366,HCPCS,"BATTERY CHARGER, SINGLE MODE",UE,,28,,NW,,,,,,$343.15,$0.00,1,1,1,1,1,1,20171001, E2367,HCPCS,"BATTERY CHARGER, DUAL MODE",,,28,,NW,,,,,,$876.19,$0.00,1,1,1,1,1,1,20171001, E2367,HCPCS,"BATTERY CHARGER, DUAL MODE",NU,,28,,NW,,,,,,$876.19,$0.00,1,1,1,1,1,1,20171001, E2367,HCPCS,"BATTERY CHARGER, DUAL MODE",RR,,28,,NW,,,,,,$114.87,$0.00,1,1,1,1,1,1,20171001, E2367,HCPCS,"BATTERY CHARGER, DUAL MODE",UE,,28,,NW,,,,,,$664.72,$0.00,1,1,1,1,1,1,20171001, E2368,HCPCS,PWR WC DRIVEWHEEL MOTOR REPL,,,28,,NW,,,,,,"$1,096.50",$0.00,1,1,1,1,1,1,20171001, E2368,HCPCS,PWR WC DRIVEWHEEL MOTOR REPL,NU,,28,,NW,,,,,,"$1,096.50",$0.00,1,1,1,1,1,1,20171001, E2368,HCPCS,PWR WC DRIVEWHEEL MOTOR REPL,RR,,28,,NW,,,,,,$138.76,$0.00,1,1,1,1,1,1,20171001, E2368,HCPCS,PWR WC DRIVEWHEEL MOTOR REPL,UE,,28,,NW,,,,,,$757.50,$0.00,1,1,1,1,1,1,20171001, E2369,HCPCS,PWR WC DRIVEWHEEL GEAR REPL,,,28,,NW,,,,,,"$1,037.75",$0.00,1,1,1,1,1,1,20171001, E2369,HCPCS,PWR WC DRIVEWHEEL GEAR REPL,NU,,28,,NW,,,,,,"$1,037.75",$0.00,1,1,1,1,1,1,20171001, E2369,HCPCS,PWR WC DRIVEWHEEL GEAR REPL,RR,,28,,NW,,,,,,$131.32,$0.00,1,1,1,1,1,1,20171001, E2369,HCPCS,PWR WC DRIVEWHEEL GEAR REPL,UE,,28,,NW,,,,,,$663.88,$0.00,1,1,1,1,1,1,20171001, E2370,HCPCS,PWR WC DR WH MOTOR/GEAR COMB,,,28,,NW,,,,,,"$1,345.53",$0.00,1,1,1,1,1,1,20171001, E2370,HCPCS,PWR WC DR WH MOTOR/GEAR COMB,NU,,28,,NW,,,,,,"$1,345.53",$0.00,1,1,1,1,1,1,20171001, E2370,HCPCS,PWR WC DR WH MOTOR/GEAR COMB,RR,,28,,NW,,,,,,$170.27,$0.00,1,1,1,1,1,1,20171001, E2370,HCPCS,PWR WC DR WH MOTOR/GEAR COMB,UE,,28,,NW,,,,,,"$1,160.35",$0.00,1,1,1,1,1,1,20171001, E2371,HCPCS,GR27 SEALED LEADACID BATTERY,,,28,,NW,,,,,,$274.48,$0.00,1,1,1,1,1,1,20171001, E2371,HCPCS,GR27 SEALED LEADACID BATTERY,NU,,28,,NW,,,,,,$274.48,$0.00,1,1,1,1,1,1,20171001, E2371,HCPCS,GR27 SEALED LEADACID BATTERY,RR,,28,,NW,,,,,,$38.08,$0.00,1,1,1,1,1,1,20171001, E2371,HCPCS,GR27 SEALED LEADACID BATTERY,UE,,28,,NW,,,,,,$213.43,$0.00,1,1,1,1,1,1,20171001, E2372,HCPCS,GR27 NON-SEALED LEADACID,,,28,,NW,,,,,,$198.68,$0.00,1,1,1,1,1,1,20171001, E2372,HCPCS,GR27 NON-SEALED LEADACID,NU,,28,,NW,,,,,,$198.68,$0.00,1,1,1,1,1,1,20171001, E2372,HCPCS,GR27 NON-SEALED LEADACID,RR,,28,,NW,,,,,,$21.14,$0.00,1,1,1,1,1,1,20171001, E2372,HCPCS,GR27 NON-SEALED LEADACID,UE,,28,,NW,,,,,,$149.38,$0.00,1,1,1,1,1,1,20171001, E2373,HCPCS,HAND/CHIN CTRL SPEC JOYSTICK,,,28,,NW,,,,,,"$1,300.72",$0.00,1,1,1,1,1,1,20171001, E2373,HCPCS,HAND/CHIN CTRL SPEC JOYSTICK,NU,,28,,NW,,,,,,"$1,300.72",$0.00,1,1,1,1,1,1,20171001, E2373,HCPCS,HAND/CHIN CTRL SPEC JOYSTICK,RR,,28,,NW,,,,,,$164.60,$0.00,1,1,1,1,1,1,20171001, E2373,HCPCS,HAND/CHIN CTRL SPEC JOYSTICK,UE,,28,,NW,,,,,,"$1,339.08",$0.00,1,1,1,1,1,1,20171001, E2374,HCPCS,HAND/CHIN CTRL STD JOYSTICK,,,28,,NW,,,,,,$910.60,$0.00,1,1,1,1,1,1,20171001, E2374,HCPCS,HAND/CHIN CTRL STD JOYSTICK,NU,,28,,NW,,,,,,$910.60,$0.00,1,1,1,1,1,1,20171001, E2374,HCPCS,HAND/CHIN CTRL STD JOYSTICK,RR,,28,,NW,,,,,,$115.23,$0.00,1,1,1,1,1,1,20171001, E2374,HCPCS,HAND/CHIN CTRL STD JOYSTICK,UE,,28,,NW,,,,,,$782.08,$0.00,1,1,1,1,1,1,20171001, E2375,HCPCS,NON-EXPANDABLE CONTROLLER,,,28,,NW,,,,,,"$1,645.23",$0.00,1,1,1,1,1,1,20171001, E2375,HCPCS,NON-EXPANDABLE CONTROLLER,NU,,28,,NW,,,,,,"$1,645.23",$0.00,1,1,1,1,1,1,20171001, E2375,HCPCS,NON-EXPANDABLE CONTROLLER,RR,,28,,NW,,,,,,$208.20,$0.00,1,1,1,1,1,1,20171001, E2375,HCPCS,NON-EXPANDABLE CONTROLLER,UE,,28,,NW,,,,,,"$1,236.01",$0.00,1,1,1,1,1,1,20171001, E2376,HCPCS,"EXPANDABLE CONTROLLER, REPL",,,28,,NW,,,,,,"$2,719.53",$0.00,1,1,1,1,1,1,20171001, E2376,HCPCS,"EXPANDABLE CONTROLLER, REPL",NU,,28,,NW,,,,,,"$2,719.53",$0.00,1,1,1,1,1,1,20171001, E2376,HCPCS,"EXPANDABLE CONTROLLER, REPL",RR,,28,,NW,,,,,,$344.15,$0.00,1,1,1,1,1,1,20171001, E2376,HCPCS,"EXPANDABLE CONTROLLER, REPL",UE,,28,,NW,,,,,,"$1,919.72",$0.00,1,1,1,1,1,1,20171001, E2377,HCPCS,"EXPANDABLE CONTROLLER, INITL",,,28,,NW,,,,,,$857.17,$0.00,1,1,1,1,1,1,20171001, E2377,HCPCS,"EXPANDABLE CONTROLLER, INITL",NU,,28,,NW,,,,,,$857.17,$0.00,1,1,1,1,1,1,20171001, E2377,HCPCS,"EXPANDABLE CONTROLLER, INITL",RR,,28,,NW,,,,,,$108.47,$0.00,1,1,1,1,1,1,20171001, E2377,HCPCS,"EXPANDABLE CONTROLLER, INITL",UE,,28,,NW,,,,,,$714.00,$0.00,1,1,1,1,1,1,20171001, E2378,HCPCS,PW ACTUATOR REPLACEMENT,,,28,,NW,,,,,,"$1,025.04",$0.00,1,1,1,1,1,1,20171001, E2378,HCPCS,PW ACTUATOR REPLACEMENT,NU,,28,,NW,,,,,,"$1,025.04",$0.00,1,1,1,1,1,1,20171001, E2378,HCPCS,PW ACTUATOR REPLACEMENT,RR,,28,,NW,,,,,,$129.72,$0.00,1,1,1,1,1,1,20171001, E2378,HCPCS,PW ACTUATOR REPLACEMENT,UE,,28,,NW,,,,,,$982.57,$0.00,1,1,1,1,1,1,20171001, E2381,HCPCS,PNEUM DRIVE WHEEL TIRE,,,28,,NW,,,,,,$189.82,$0.00,1,1,1,1,1,1,20171001, E2381,HCPCS,PNEUM DRIVE WHEEL TIRE,NU,,28,,NW,,,,,,$189.82,$0.00,1,1,1,1,1,1,20171001, E2381,HCPCS,PNEUM DRIVE WHEEL TIRE,RR,,28,,NW,,,,,,$15.48,$0.00,1,1,1,1,1,1,20171001, E2381,HCPCS,PNEUM DRIVE WHEEL TIRE,UE,,28,,NW,,,,,,$149.94,$0.00,1,1,1,1,1,1,20171001, E2382,HCPCS,"TUBE, PNEUM WHEEL DRIVE TIRE",,,28,,NW,,,,,,$65.68,$0.00,1,1,1,1,1,1,20171001, E2382,HCPCS,"TUBE, PNEUM WHEEL DRIVE TIRE",NU,,28,,NW,,,,,,$65.68,$0.00,1,1,1,1,1,1,20171001, E2382,HCPCS,"TUBE, PNEUM WHEEL DRIVE TIRE",RR,,28,,NW,,,,,,$4.48,$0.00,1,1,1,1,1,1,20171001, E2382,HCPCS,"TUBE, PNEUM WHEEL DRIVE TIRE",UE,,28,,NW,,,,,,$47.14,$0.00,1,1,1,1,1,1,20171001, E2383,HCPCS,"INSERT, PNEUM WHEEL DRIVE",,,28,,NW,,,,,,$363.31,$0.00,1,1,1,1,1,1,20171001, E2383,HCPCS,"INSERT, PNEUM WHEEL DRIVE",NU,,28,,NW,,,,,,$363.31,$0.00,1,1,1,1,1,1,20171001, E2383,HCPCS,"INSERT, PNEUM WHEEL DRIVE",RR,,28,,NW,,,,,,$45.11,$0.00,1,1,1,1,1,1,20171001, E2383,HCPCS,"INSERT, PNEUM WHEEL DRIVE",UE,,28,,NW,,,,,,$280.06,$0.00,1,1,1,1,1,1,20171001, E2384,HCPCS,PNEUMATIC CASTER TIRE,,,28,,NW,,,,,,$191.53,$0.00,1,1,1,1,1,1,20171001, E2384,HCPCS,PNEUMATIC CASTER TIRE,NU,,28,,NW,,,,,,$191.53,$0.00,1,1,1,1,1,1,20171001, E2384,HCPCS,PNEUMATIC CASTER TIRE,RR,,28,,NW,,,,,,$15.65,$0.00,1,1,1,1,1,1,20171001, E2384,HCPCS,PNEUMATIC CASTER TIRE,UE,,28,,NW,,,,,,$151.22,$0.00,1,1,1,1,1,1,20171001, E2385,HCPCS,"TUBE, PNEUMATIC CASTER TIRE",,,28,,NW,,,,,,$140.78,$0.00,1,1,1,1,1,1,20171001, E2385,HCPCS,"TUBE, PNEUMATIC CASTER TIRE",NU,,28,,NW,,,,,,$140.78,$0.00,1,1,1,1,1,1,20171001, E2385,HCPCS,"TUBE, PNEUMATIC CASTER TIRE",RR,,28,,NW,,,,,,$10.74,$0.00,1,1,1,1,1,1,20171001, E2385,HCPCS,"TUBE, PNEUMATIC CASTER TIRE",UE,,28,,NW,,,,,,$113.16,$0.00,1,1,1,1,1,1,20171001, E2386,HCPCS,FOAM FILLED DRIVE WHEEL TIRE,,,28,,NW,,,,,,$301.39,$0.00,1,1,1,1,1,1,20171001, E2386,HCPCS,FOAM FILLED DRIVE WHEEL TIRE,NU,,28,,NW,,,,,,$301.39,$0.00,1,1,1,1,1,1,20171001, E2386,HCPCS,FOAM FILLED DRIVE WHEEL TIRE,RR,,28,,NW,,,,,,$26.31,$0.00,1,1,1,1,1,1,20171001, E2386,HCPCS,FOAM FILLED DRIVE WHEEL TIRE,UE,,28,,NW,,,,,,$233.62,$0.00,1,1,1,1,1,1,20171001, E2387,HCPCS,FOAM FILLED CASTER TIRE,,,28,,NW,,,,,,$159.98,$0.00,1,1,1,1,1,1,20171001, E2387,HCPCS,FOAM FILLED CASTER TIRE,NU,,28,,NW,,,,,,$159.98,$0.00,1,1,1,1,1,1,20171001, E2387,HCPCS,FOAM FILLED CASTER TIRE,RR,,28,,NW,,,,,,$12.59,$0.00,1,1,1,1,1,1,20171001, E2387,HCPCS,FOAM FILLED CASTER TIRE,UE,,28,,NW,,,,,,$127.57,$0.00,1,1,1,1,1,1,20171001, E2388,HCPCS,FOAM DRIVE WHEEL TIRE,,,28,,NW,,,,,,$111.16,$0.00,1,1,1,1,1,1,20171001, E2388,HCPCS,FOAM DRIVE WHEEL TIRE,NU,,28,,NW,,,,,,$111.16,$0.00,1,1,1,1,1,1,20171001, E2388,HCPCS,FOAM DRIVE WHEEL TIRE,RR,,28,,NW,,,,,,$11.67,$0.00,1,1,1,1,1,1,20171001, E2388,HCPCS,FOAM DRIVE WHEEL TIRE,UE,,28,,NW,,,,,,$90.93,$0.00,1,1,1,1,1,1,20171001, E2389,HCPCS,FOAM CASTER TIRE,,,28,,NW,,,,,,$75.48,$0.00,1,1,1,1,1,1,20171001, E2389,HCPCS,FOAM CASTER TIRE,NU,,28,,NW,,,,,,$75.48,$0.00,1,1,1,1,1,1,20171001, E2389,HCPCS,FOAM CASTER TIRE,RR,,28,,NW,,,,,,$6.52,$0.00,1,1,1,1,1,1,20171001, E2389,HCPCS,FOAM CASTER TIRE,UE,,28,,NW,,,,,,$56.18,$0.00,1,1,1,1,1,1,20171001, E2390,HCPCS,SOLID DRIVE WHEEL TIRE,,,28,,NW,,,,,,$100.26,$0.00,1,1,1,1,1,1,20171001, E2390,HCPCS,SOLID DRIVE WHEEL TIRE,NU,,28,,NW,,,,,,$100.26,$0.00,1,1,1,1,1,1,20171001, E2390,HCPCS,SOLID DRIVE WHEEL TIRE,RR,,28,,NW,,,,,,$10.10,$0.00,1,1,1,1,1,1,20171001, E2390,HCPCS,SOLID DRIVE WHEEL TIRE,UE,,28,,NW,,,,,,$82.77,$0.00,1,1,1,1,1,1,20171001, E2391,HCPCS,SOLID CASTER TIRE,,,28,,NW,,,,,,$65.76,$0.00,1,1,1,1,1,1,20171001, E2391,HCPCS,SOLID CASTER TIRE,NU,,28,,NW,,,,,,$65.76,$0.00,1,1,1,1,1,1,20171001, E2391,HCPCS,SOLID CASTER TIRE,RR,,28,,NW,,,,,,$4.48,$0.00,1,1,1,1,1,1,20171001, E2391,HCPCS,SOLID CASTER TIRE,UE,,28,,NW,,,,,,$47.17,$0.00,1,1,1,1,1,1,20171001, E2392,HCPCS,"SOLID CASTER TIRE, INTEGRATE",,,28,,NW,,,,,,$141.89,$0.00,1,1,1,1,1,1,20171001, E2392,HCPCS,"SOLID CASTER TIRE, INTEGRATE",NU,,28,,NW,,,,,,$141.89,$0.00,1,1,1,1,1,1,20171001, E2392,HCPCS,"SOLID CASTER TIRE, INTEGRATE",RR,,28,,NW,,,,,,$10.84,$0.00,1,1,1,1,1,1,20171001, E2392,HCPCS,"SOLID CASTER TIRE, INTEGRATE",UE,,28,,NW,,,,,,$113.99,$0.00,1,1,1,1,1,1,20171001, E2394,HCPCS,DRIVE WHEEL EXCLUDES TIRE,,,28,,NW,,,,,,$184.24,$0.00,1,1,1,1,1,1,20171001, E2394,HCPCS,DRIVE WHEEL EXCLUDES TIRE,NU,,28,,NW,,,,,,$184.24,$0.00,1,1,1,1,1,1,20171001, E2394,HCPCS,DRIVE WHEEL EXCLUDES TIRE,RR,,28,,NW,,,,,,$14.94,$0.00,1,1,1,1,1,1,20171001, E2394,HCPCS,DRIVE WHEEL EXCLUDES TIRE,UE,,28,,NW,,,,,,$145.75,$0.00,1,1,1,1,1,1,20171001, E2395,HCPCS,CASTER WHEEL EXCLUDES TIRE,,,28,,NW,,,,,,$145.03,$0.00,1,1,1,1,1,1,20171001, E2395,HCPCS,CASTER WHEEL EXCLUDES TIRE,NU,,28,,NW,,,,,,$145.03,$0.00,1,1,1,1,1,1,20171001, E2395,HCPCS,CASTER WHEEL EXCLUDES TIRE,RR,,28,,NW,,,,,,$11.14,$0.00,1,1,1,1,1,1,20171001, E2395,HCPCS,CASTER WHEEL EXCLUDES TIRE,UE,,28,,NW,,,,,,$116.35,$0.00,1,1,1,1,1,1,20171001, E2396,HCPCS,CASTER FORK,,,28,,NW,,,,,,$166.43,$0.00,1,1,1,1,1,1,20171001, E2396,HCPCS,CASTER FORK,NU,,28,,NW,,,,,,$166.43,$0.00,1,1,1,1,1,1,20171001, E2396,HCPCS,CASTER FORK,RR,,28,,NW,,,,,,$13.22,$0.00,1,1,1,1,1,1,20171001, E2396,HCPCS,CASTER FORK,UE,,28,,NW,,,,,,$132.39,$0.00,1,1,1,1,1,1,20171001, E2397,HCPCS,"PWC ACC, LITH-BASED BATTERY",,,28,,NW,,,,,,$805.60,$0.00,1,1,1,1,1,1,20171001, E2397,HCPCS,"PWC ACC, LITH-BASED BATTERY",NU,,28,,NW,,,,,,$805.60,$0.00,1,1,1,1,1,1,20171001, E2397,HCPCS,"PWC ACC, LITH-BASED BATTERY",RR,,28,,NW,,,,,,$107.81,$0.00,1,1,1,1,1,1,20171001, E2397,HCPCS,"PWC ACC, LITH-BASED BATTERY",UE,,28,,NW,,,,,,$611.77,$0.00,1,1,1,1,1,1,20171001, E2402,HCPCS,NEG PRESS WOUND THERAPY PUMP,,,28,,NW,,,,,,"$10,776.15",$0.00,1,1,1,1,1,1,20171001, E2402,HCPCS,NEG PRESS WOUND THERAPY PUMP,RR,,28,,NW,,,,,,"$1,363.69",$0.00,1,1,1,1,1,1,20171001, E2500,HCPCS,SGD DIGITIZED PRE-REC <=8MIN,,,28,,NW,,,,,,$914.10,$0.00,1,1,1,1,1,1,20171001, E2500,HCPCS,SGD DIGITIZED PRE-REC <=8MIN,NU,,28,,NW,,,,,,$914.10,$0.00,1,1,1,1,1,1,20171001, E2500,HCPCS,SGD DIGITIZED PRE-REC <=8MIN,RR,,28,,NW,,,,,,$152.33,$0.00,1,1,1,1,1,1,20171001, E2500,HCPCS,SGD DIGITIZED PRE-REC <=8MIN,UE,,28,,NW,,,,,,$702.50,$0.00,1,1,1,1,1,1,20171001, E2502,HCPCS,SGD PREREC MSG >8MIN <=20MIN,,,28,,NW,,,,,,"$2,656.05",$0.00,1,1,1,1,1,1,20171001, E2502,HCPCS,SGD PREREC MSG >8MIN <=20MIN,NU,,28,,NW,,,,,,"$2,656.05",$0.00,1,1,1,1,1,1,20171001, E2502,HCPCS,SGD PREREC MSG >8MIN <=20MIN,RR,,28,,NW,,,,,,$326.51,$0.00,1,1,1,1,1,1,20171001, E2502,HCPCS,SGD PREREC MSG >8MIN <=20MIN,UE,,28,,NW,,,,,,"$2,008.99",$0.00,1,1,1,1,1,1,20171001, E2504,HCPCS,SGD PREREC MSG>20MIN <=40MIN,,,28,,NW,,,,,,"$3,482.08",$0.00,1,1,1,1,1,1,20171001, E2504,HCPCS,SGD PREREC MSG>20MIN <=40MIN,NU,,28,,NW,,,,,,"$3,482.08",$0.00,1,1,1,1,1,1,20171001, E2504,HCPCS,SGD PREREC MSG>20MIN <=40MIN,RR,,28,,NW,,,,,,$409.16,$0.00,1,1,1,1,1,1,20171001, E2504,HCPCS,SGD PREREC MSG>20MIN <=40MIN,UE,,28,,NW,,,,,,"$2,628.48",$0.00,1,1,1,1,1,1,20171001, E2506,HCPCS,SGD PREREC MSG > 40 MIN,,,28,,NW,,,,,,"$5,074.24",$0.00,1,1,1,1,1,1,20171001, E2506,HCPCS,SGD PREREC MSG > 40 MIN,NU,,28,,NW,,,,,,"$5,074.24",$0.00,1,1,1,1,1,1,20171001, E2506,HCPCS,SGD PREREC MSG > 40 MIN,RR,,28,,NW,,,,,,$568.29,$0.00,1,1,1,1,1,1,20171001, E2506,HCPCS,SGD PREREC MSG > 40 MIN,UE,,28,,NW,,,,,,"$3,822.52",$0.00,1,1,1,1,1,1,20171001, E2508,HCPCS,SGD SPELLING PHYS CONTACT,,,28,,NW,,,,,,"$7,809.47",$0.00,1,1,1,1,1,1,20171001, E2508,HCPCS,SGD SPELLING PHYS CONTACT,NU,,28,,NW,,,,,,"$7,809.47",$0.00,1,1,1,1,1,1,20171001, E2508,HCPCS,SGD SPELLING PHYS CONTACT,RR,,28,,NW,,,,,,$841.84,$0.00,1,1,1,1,1,1,20171001, E2508,HCPCS,SGD SPELLING PHYS CONTACT,UE,,28,,NW,,,,,,"$5,874.04",$0.00,1,1,1,1,1,1,20171001, E2510,HCPCS,SGD W MULTI METHODS MSG/ACCS,,,28,,NW,,,,,,"$14,718.02",$0.00,1,1,1,1,1,1,20171001, E2510,HCPCS,SGD W MULTI METHODS MSG/ACCS,NU,,28,,NW,,,,,,"$14,718.02",$0.00,1,1,1,1,1,1,20171001, E2510,HCPCS,SGD W MULTI METHODS MSG/ACCS,RR,,28,,NW,,,,,,"$1,532.71",$0.00,1,1,1,1,1,1,20171001, E2510,HCPCS,SGD W MULTI METHODS MSG/ACCS,UE,,28,,NW,,,,,,"$11,055.43",$0.00,1,1,1,1,1,1,20171001, E2511,HCPCS,SGD SFTWRE PRGRM FOR PC/PDA,,,28,,NW,,,,,,"$1,174.97",$0.00,1,1,1,1,1,1,20171001, E2511,HCPCS,SGD SFTWRE PRGRM FOR PC/PDA,NU,,28,,NW,,,,,,"$1,174.97",$0.00,1,1,1,1,1,1,20171001, E2511,HCPCS,SGD SFTWRE PRGRM FOR PC/PDA,RR,,28,,NW,,,,,,$126.96,$0.00,1,1,1,1,1,1,20171001, E2511,HCPCS,SGD SFTWRE PRGRM FOR PC/PDA,UE,,28,,NW,,,,,,$893.28,$0.00,1,1,1,1,1,1,20171001, E2512,HCPCS,"SGD ACCESSORY, MOUNTING SYS",,,28,,NW,,,,,,"$1,798.04",$0.00,1,1,1,1,1,1,20171001, E2512,HCPCS,"SGD ACCESSORY, MOUNTING SYS",NU,,28,,NW,,,,,,"$1,798.04",$0.00,1,1,1,1,1,1,20171001, E2512,HCPCS,"SGD ACCESSORY, MOUNTING SYS",RR,,28,,NW,,,,,,$227.54,$0.00,1,1,1,1,1,1,20171001, E2512,HCPCS,"SGD ACCESSORY, MOUNTING SYS",UE,,28,,NW,,,,,,"$1,366.98",$0.00,1,1,1,1,1,1,20171001, E2599,HCPCS,SGD ACCESSORY NOC,,,28,,NW,,,,,,$699.36,$0.00,1,1,1,1,1,1,20171001, E2601,HCPCS,GEN W/C CUSHION WDTH < 22 IN,,,28,,NW,,,,,,$132.76,$0.00,1,1,1,1,1,1,20171001, E2601,HCPCS,GEN W/C CUSHION WDTH < 22 IN,NU,,28,,NW,,,,,,$132.76,$0.00,1,1,1,1,1,1,20171001, E2601,HCPCS,GEN W/C CUSHION WDTH < 22 IN,RR,,28,,NW,,,,,,$9.95,$0.00,1,1,1,1,1,1,20171001, E2601,HCPCS,GEN W/C CUSHION WDTH < 22 IN,UE,,28,,NW,,,,,,$107.14,$0.00,1,1,1,1,1,1,20171001, E2602,HCPCS,GEN W/C CUSHION WDTH >=22 IN,,,28,,NW,,,,,,$251.66,$0.00,1,1,1,1,1,1,20171001, E2602,HCPCS,GEN W/C CUSHION WDTH >=22 IN,NU,,28,,NW,,,,,,$251.66,$0.00,1,1,1,1,1,1,20171001, E2602,HCPCS,GEN W/C CUSHION WDTH >=22 IN,RR,,28,,NW,,,,,,$21.49,$0.00,1,1,1,1,1,1,20171001, E2602,HCPCS,GEN W/C CUSHION WDTH >=22 IN,UE,,28,,NW,,,,,,$196.32,$0.00,1,1,1,1,1,1,20171001, E2603,HCPCS,SKIN PROTECT WC CUS WD <22IN,,,28,,NW,,,,,,$301.76,$0.00,1,1,1,1,1,1,20171001, E2603,HCPCS,SKIN PROTECT WC CUS WD <22IN,NU,,28,,NW,,,,,,$301.76,$0.00,1,1,1,1,1,1,20171001, E2603,HCPCS,SKIN PROTECT WC CUS WD <22IN,RR,,28,,NW,,,,,,$26.34,$0.00,1,1,1,1,1,1,20171001, E2603,HCPCS,SKIN PROTECT WC CUS WD <22IN,UE,,28,,NW,,,,,,$233.89,$0.00,1,1,1,1,1,1,20171001, E2604,HCPCS,SKIN PROTECT WC CUS WD>=22IN,,,28,,NW,,,,,,$416.02,$0.00,1,1,1,1,1,1,20171001, E2604,HCPCS,SKIN PROTECT WC CUS WD>=22IN,NU,,28,,NW,,,,,,$416.02,$0.00,1,1,1,1,1,1,20171001, E2604,HCPCS,SKIN PROTECT WC CUS WD>=22IN,RR,,28,,NW,,,,,,$53.62,$0.00,1,1,1,1,1,1,20171001, E2604,HCPCS,SKIN PROTECT WC CUS WD>=22IN,UE,,28,,NW,,,,,,$319.59,$0.00,1,1,1,1,1,1,20171001, E2605,HCPCS,POSITION WC CUSH WDTH <22 IN,,,28,,NW,,,,,,$583.06,$0.00,1,1,1,1,1,1,20171001, E2605,HCPCS,POSITION WC CUSH WDTH <22 IN,NU,,28,,NW,,,,,,$583.06,$0.00,1,1,1,1,1,1,20171001, E2605,HCPCS,POSITION WC CUSH WDTH <22 IN,RR,,28,,NW,,,,,,$80.56,$0.00,1,1,1,1,1,1,20171001, E2605,HCPCS,POSITION WC CUSH WDTH <22 IN,UE,,28,,NW,,,,,,$444.87,$0.00,1,1,1,1,1,1,20171001, E2606,HCPCS,POSITION WC CUSH WDTH>=22 IN,,,28,,NW,,,,,,$918.19,$0.00,1,1,1,1,1,1,20171001, E2606,HCPCS,POSITION WC CUSH WDTH>=22 IN,NU,,28,,NW,,,,,,$918.19,$0.00,1,1,1,1,1,1,20171001, E2606,HCPCS,POSITION WC CUSH WDTH>=22 IN,RR,,28,,NW,,,,,,$119.07,$0.00,1,1,1,1,1,1,20171001, E2606,HCPCS,POSITION WC CUSH WDTH>=22 IN,UE,,28,,NW,,,,,,$696.22,$0.00,1,1,1,1,1,1,20171001, E2607,HCPCS,SKIN PRO/POS WC CUS WD <22IN,,,28,,NW,,,,,,$569.58,$0.00,1,1,1,1,1,1,20171001, E2607,HCPCS,SKIN PRO/POS WC CUS WD <22IN,NU,,28,,NW,,,,,,$569.58,$0.00,1,1,1,1,1,1,20171001, E2607,HCPCS,SKIN PRO/POS WC CUS WD <22IN,RR,,28,,NW,,,,,,$78.37,$0.00,1,1,1,1,1,1,20171001, E2607,HCPCS,SKIN PRO/POS WC CUS WD <22IN,UE,,28,,NW,,,,,,$434.76,$0.00,1,1,1,1,1,1,20171001, E2608,HCPCS,SKIN PRO/POS WC CUS WD>=22IN,,,28,,NW,,,,,,$715.89,$0.00,1,1,1,1,1,1,20171001, E2608,HCPCS,SKIN PRO/POS WC CUS WD>=22IN,NU,,28,,NW,,,,,,$715.89,$0.00,1,1,1,1,1,1,20171001, E2608,HCPCS,SKIN PRO/POS WC CUS WD>=22IN,RR,,28,,NW,,,,,,$98.84,$0.00,1,1,1,1,1,1,20171001, E2608,HCPCS,SKIN PRO/POS WC CUS WD>=22IN,UE,,28,,NW,,,,,,$544.48,$0.00,1,1,1,1,1,1,20171001, E2609,HCPCS,CUSTOM FABRICATE W/C CUSHION,,,28,,NW,,,,,,$508.36,$0.00,1,1,1,1,1,1,20171001, E2610,HCPCS,POWERED W/C CUSHION,,,28,,NW,,,,,,$481.14,$0.00,1,1,1,1,1,1,20171001, E2611,HCPCS,GEN USE BACK CUSH WDTH <22IN,,,28,,NW,,,,,,$450.07,$0.00,1,1,1,1,1,1,20171001, E2611,HCPCS,GEN USE BACK CUSH WDTH <22IN,NU,,28,,NW,,,,,,$450.07,$0.00,1,1,1,1,1,1,20171001, E2611,HCPCS,GEN USE BACK CUSH WDTH <22IN,RR,,28,,NW,,,,,,$59.11,$0.00,1,1,1,1,1,1,20171001, E2611,HCPCS,GEN USE BACK CUSH WDTH <22IN,UE,,28,,NW,,,,,,$345.12,$0.00,1,1,1,1,1,1,20171001, E2612,HCPCS,GEN USE BACK CUSH WDTH>=22IN,,,28,,NW,,,,,,$839.92,$0.00,1,1,1,1,1,1,20171001, E2612,HCPCS,GEN USE BACK CUSH WDTH>=22IN,NU,,28,,NW,,,,,,$839.92,$0.00,1,1,1,1,1,1,20171001, E2612,HCPCS,GEN USE BACK CUSH WDTH>=22IN,RR,,28,,NW,,,,,,$111.25,$0.00,1,1,1,1,1,1,20171001, E2612,HCPCS,GEN USE BACK CUSH WDTH>=22IN,UE,,28,,NW,,,,,,$637.51,$0.00,1,1,1,1,1,1,20171001, E2613,HCPCS,POSITION BACK CUSH WD <22IN,,,28,,NW,,,,,,$835.83,$0.00,1,1,1,1,1,1,20171001, E2613,HCPCS,POSITION BACK CUSH WD <22IN,NU,,28,,NW,,,,,,$835.83,$0.00,1,1,1,1,1,1,20171001, E2613,HCPCS,POSITION BACK CUSH WD <22IN,RR,,28,,NW,,,,,,$110.83,$0.00,1,1,1,1,1,1,20171001, E2613,HCPCS,POSITION BACK CUSH WD <22IN,UE,,28,,NW,,,,,,$634.45,$0.00,1,1,1,1,1,1,20171001, E2614,HCPCS,POSITION BACK CUSH WD>=22IN,,,28,,NW,,,,,,"$1,225.98",$0.00,1,1,1,1,1,1,20171001, E2614,HCPCS,POSITION BACK CUSH WD>=22IN,NU,,28,,NW,,,,,,"$1,225.98",$0.00,1,1,1,1,1,1,20171001, E2614,HCPCS,POSITION BACK CUSH WD>=22IN,RR,,28,,NW,,,,,,$149.85,$0.00,1,1,1,1,1,1,20171001, E2614,HCPCS,POSITION BACK CUSH WD>=22IN,UE,,28,,NW,,,,,,$927.06,$0.00,1,1,1,1,1,1,20171001, E2615,HCPCS,POS BACK POST/LAT WDTH <22IN,,,28,,NW,,,,,,$954.16,$0.00,1,1,1,1,1,1,20171001, E2615,HCPCS,POS BACK POST/LAT WDTH <22IN,NU,,28,,NW,,,,,,$954.16,$0.00,1,1,1,1,1,1,20171001, E2615,HCPCS,POS BACK POST/LAT WDTH <22IN,RR,,28,,NW,,,,,,$122.67,$0.00,1,1,1,1,1,1,20171001, E2615,HCPCS,POS BACK POST/LAT WDTH <22IN,UE,,28,,NW,,,,,,$723.20,$0.00,1,1,1,1,1,1,20171001, E2616,HCPCS,POS BACK POST/LAT WDTH>=22IN,,,28,,NW,,,,,,"$1,277.15",$0.00,1,1,1,1,1,1,20171001, E2616,HCPCS,POS BACK POST/LAT WDTH>=22IN,NU,,28,,NW,,,,,,"$1,277.15",$0.00,1,1,1,1,1,1,20171001, E2616,HCPCS,POS BACK POST/LAT WDTH>=22IN,RR,,28,,NW,,,,,,$154.96,$0.00,1,1,1,1,1,1,20171001, E2616,HCPCS,POS BACK POST/LAT WDTH>=22IN,UE,,28,,NW,,,,,,$965.44,$0.00,1,1,1,1,1,1,20171001, E2617,HCPCS,CUSTOM FAB W/C BACK CUSHION,,,28,,NW,,,,,,$902.25,$0.00,1,1,1,1,1,1,20171001, E2619,HCPCS,REPLACE COVER W/C SEAT CUSH,,,28,,NW,,,,,,$113.54,$0.00,1,1,1,1,1,1,20171001, E2619,HCPCS,REPLACE COVER W/C SEAT CUSH,NU,,28,,NW,,,,,,$113.54,$0.00,1,1,1,1,1,1,20171001, E2619,HCPCS,REPLACE COVER W/C SEAT CUSH,RR,,28,,NW,,,,,,$12.01,$0.00,1,1,1,1,1,1,20171001, E2619,HCPCS,REPLACE COVER W/C SEAT CUSH,UE,,28,,NW,,,,,,$92.73,$0.00,1,1,1,1,1,1,20171001, E2620,HCPCS,WC PLANAR BACK CUSH WD <22IN,,,28,,NW,,,,,,"$1,027.74",$0.00,1,1,1,1,1,1,20171001, E2620,HCPCS,WC PLANAR BACK CUSH WD <22IN,NU,,28,,NW,,,,,,"$1,027.74",$0.00,1,1,1,1,1,1,20171001, E2620,HCPCS,WC PLANAR BACK CUSH WD <22IN,RR,,28,,NW,,,,,,$130.03,$0.00,1,1,1,1,1,1,20171001, E2620,HCPCS,WC PLANAR BACK CUSH WD <22IN,UE,,28,,NW,,,,,,$778.38,$0.00,1,1,1,1,1,1,20171001, E2621,HCPCS,WC PLANAR BACK CUSH WD>=22IN,,,28,,NW,,,,,,"$1,207.91",$0.00,1,1,1,1,1,1,20171001, E2621,HCPCS,WC PLANAR BACK CUSH WD>=22IN,NU,,28,,NW,,,,,,"$1,207.91",$0.00,1,1,1,1,1,1,20171001, E2621,HCPCS,WC PLANAR BACK CUSH WD>=22IN,RR,,28,,NW,,,,,,$148.04,$0.00,1,1,1,1,1,1,20171001, E2621,HCPCS,WC PLANAR BACK CUSH WD>=22IN,UE,,28,,NW,,,,,,$913.51,$0.00,1,1,1,1,1,1,20171001, E2622,HCPCS,ADJ SKIN PRO W/C CUS WD<22IN,,,28,,NW,,,,,,$558.50,$0.00,1,1,1,1,1,1,20171001, E2622,HCPCS,ADJ SKIN PRO W/C CUS WD<22IN,NU,,28,,NW,,,,,,$558.50,$0.00,1,1,1,1,1,1,20171001, E2622,HCPCS,ADJ SKIN PRO W/C CUS WD<22IN,RR,,28,,NW,,,,,,$83.10,$0.00,1,1,1,1,1,1,20171001, E2622,HCPCS,ADJ SKIN PRO W/C CUS WD<22IN,UE,,28,,NW,,,,,,$426.45,$0.00,1,1,1,1,1,1,20171001, E2623,HCPCS,ADJ SKIN PRO WC CUS WD>=22IN,,,28,,NW,,,,,,$698.25,$0.00,1,1,1,1,1,1,20171001, E2623,HCPCS,ADJ SKIN PRO WC CUS WD>=22IN,NU,,28,,NW,,,,,,$698.25,$0.00,1,1,1,1,1,1,20171001, E2623,HCPCS,ADJ SKIN PRO WC CUS WD>=22IN,RR,,28,,NW,,,,,,$97.08,$0.00,1,1,1,1,1,1,20171001, E2623,HCPCS,ADJ SKIN PRO WC CUS WD>=22IN,UE,,28,,NW,,,,,,$531.25,$0.00,1,1,1,1,1,1,20171001, E2624,HCPCS,ADJ SKIN PRO/POS CUS<22IN,,,28,,NW,,,,,,$567.04,$0.00,1,1,1,1,1,1,20171001, E2624,HCPCS,ADJ SKIN PRO/POS CUS<22IN,NU,,28,,NW,,,,,,$567.04,$0.00,1,1,1,1,1,1,20171001, E2624,HCPCS,ADJ SKIN PRO/POS CUS<22IN,RR,,28,,NW,,,,,,$83.96,$0.00,1,1,1,1,1,1,20171001, E2624,HCPCS,ADJ SKIN PRO/POS CUS<22IN,UE,,28,,NW,,,,,,$432.85,$0.00,1,1,1,1,1,1,20171001, E2625,HCPCS,ADJ SKIN PRO/POS WC CUS>=22,,,28,,NW,,,,,,"$1,018.03",$0.00,1,1,1,1,1,1,20171001, E2625,HCPCS,ADJ SKIN PRO/POS WC CUS>=22,NU,,28,,NW,,,,,,"$1,018.03",$0.00,1,1,1,1,1,1,20171001, E2625,HCPCS,ADJ SKIN PRO/POS WC CUS>=22,RR,,28,,NW,,,,,,$129.06,$0.00,1,1,1,1,1,1,20171001, E2625,HCPCS,ADJ SKIN PRO/POS WC CUS>=22,UE,,28,,NW,,,,,,$771.10,$0.00,1,1,1,1,1,1,20171001, E2626,HCPCS,SEO MOBILE ARM SUP ATT TO WC,,,28,,NW,,,,,,"$1,152.70",$0.00,1,1,1,1,1,1,20171001, E2626,HCPCS,SEO MOBILE ARM SUP ATT TO WC,NU,,28,,NW,,,,,,"$1,152.70",$0.00,1,1,1,1,1,1,20171001, E2626,HCPCS,SEO MOBILE ARM SUP ATT TO WC,RR,,28,,NW,,,,,,$142.52,$0.00,1,1,1,1,1,1,20171001, E2626,HCPCS,SEO MOBILE ARM SUP ATT TO WC,UE,,28,,NW,,,,,,$872.10,$0.00,1,1,1,1,1,1,20171001, E2627,HCPCS,ARM SUPP ATT TO WC RANCHO TY,,,28,,NW,,,,,,"$1,766.94",$0.00,1,1,1,1,1,1,20171001, E2627,HCPCS,ARM SUPP ATT TO WC RANCHO TY,NU,,28,,NW,,,,,,"$1,766.94",$0.00,1,1,1,1,1,1,20171001, E2627,HCPCS,ARM SUPP ATT TO WC RANCHO TY,RR,,28,,NW,,,,,,$203.95,$0.00,1,1,1,1,1,1,20171001, E2627,HCPCS,ARM SUPP ATT TO WC RANCHO TY,UE,,28,,NW,,,,,,"$1,332.77",$0.00,1,1,1,1,1,1,20171001, E2628,HCPCS,MOBILE ARM SUPPORTS RECLININ,,,28,,NW,,,,,,"$1,370.42",$0.00,1,1,1,1,1,1,20171001, E2628,HCPCS,MOBILE ARM SUPPORTS RECLININ,NU,,28,,NW,,,,,,"$1,370.42",$0.00,1,1,1,1,1,1,20171001, E2628,HCPCS,MOBILE ARM SUPPORTS RECLININ,RR,,28,,NW,,,,,,$164.29,$0.00,1,1,1,1,1,1,20171001, E2628,HCPCS,MOBILE ARM SUPPORTS RECLININ,UE,,28,,NW,,,,,,"$1,035.39",$0.00,1,1,1,1,1,1,20171001, E2629,HCPCS,FRICTION DAMPENING ARM SUPP,,,28,,NW,,,,,,"$1,739.85",$0.00,1,1,1,1,1,1,20171001, E2629,HCPCS,FRICTION DAMPENING ARM SUPP,NU,,28,,NW,,,,,,"$1,739.85",$0.00,1,1,1,1,1,1,20171001, E2629,HCPCS,FRICTION DAMPENING ARM SUPP,RR,,28,,NW,,,,,,$201.23,$0.00,1,1,1,1,1,1,20171001, E2629,HCPCS,FRICTION DAMPENING ARM SUPP,UE,,28,,NW,,,,,,"$1,312.46",$0.00,1,1,1,1,1,1,20171001, E2630,HCPCS,MONOSUSPENSION ARM/HAND SUPP,,,28,,NW,,,,,,"$1,752.75",$0.00,1,1,1,1,1,1,20171001, E2630,HCPCS,MONOSUSPENSION ARM/HAND SUPP,NU,,28,,NW,,,,,,"$1,752.75",$0.00,1,1,1,1,1,1,20171001, E2630,HCPCS,MONOSUSPENSION ARM/HAND SUPP,RR,,28,,NW,,,,,,$202.53,$0.00,1,1,1,1,1,1,20171001, E2630,HCPCS,MONOSUSPENSION ARM/HAND SUPP,UE,,28,,NW,,,,,,"$1,322.13",$0.00,1,1,1,1,1,1,20171001, E2631,HCPCS,ELEVAT PROXIMAL ARM SUPPORT,,,28,,NW,,,,,,$509.63,$0.00,1,1,1,1,1,1,20171001, E2631,HCPCS,ELEVAT PROXIMAL ARM SUPPORT,NU,,28,,NW,,,,,,$509.63,$0.00,1,1,1,1,1,1,20171001, E2631,HCPCS,ELEVAT PROXIMAL ARM SUPPORT,RR,,28,,NW,,,,,,$78.22,$0.00,1,1,1,1,1,1,20171001, E2631,HCPCS,ELEVAT PROXIMAL ARM SUPPORT,UE,,28,,NW,,,,,,$389.80,$0.00,1,1,1,1,1,1,20171001, E2632,HCPCS,OFFSET/LAT ROCKER ARM W/ELA,,,28,,NW,,,,,,$330.26,$0.00,1,1,1,1,1,1,20171001, E2632,HCPCS,OFFSET/LAT ROCKER ARM W/ELA,NU,,28,,NW,,,,,,$330.26,$0.00,1,1,1,1,1,1,20171001, E2632,HCPCS,OFFSET/LAT ROCKER ARM W/ELA,RR,,28,,NW,,,,,,$48.73,$0.00,1,1,1,1,1,1,20171001, E2632,HCPCS,OFFSET/LAT ROCKER ARM W/ELA,UE,,28,,NW,,,,,,$255.27,$0.00,1,1,1,1,1,1,20171001, E2633,HCPCS,MOBILE ARM SUPPORT SUPINATOR,,,28,,NW,,,,,,$399.34,$0.00,1,1,1,1,1,1,20171001, E2633,HCPCS,MOBILE ARM SUPPORT SUPINATOR,NU,,28,,NW,,,,,,$399.34,$0.00,1,1,1,1,1,1,20171001, E2633,HCPCS,MOBILE ARM SUPPORT SUPINATOR,RR,,28,,NW,,,,,,$50.93,$0.00,1,1,1,1,1,1,20171001, E2633,HCPCS,MOBILE ARM SUPPORT SUPINATOR,UE,,28,,NW,,,,,,$307.08,$0.00,1,1,1,1,1,1,20171001, G0008,HCPCS,ADMIN INFLUENZA VIRUS VAC,,,9,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0009,HCPCS,ADMIN PNEUMOCOCCAL VACCINE,,,9,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0010,HCPCS,ADMIN HEPATITIS B VACCINE,,,9,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0027,HCPCS,SEMEN ANALYSIS,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0101,HCPCS,CA SCREEN;PELVIC/BREAST EXAM,,,18,,RBRVS,0.45 ,0.29 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0102,HCPCS,PROSTATE CA SCREENING; DRE,,,18,,RBRVS,0.17 ,0.07 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0103,HCPCS,PSA SCREENING,,,17,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0104,HCPCS,CA SCREEN;FLEXI SIGMOIDSCOPE,,,21,,RBRVS,0.84 ,0.67 ,3.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0105,HCPCS,COLORECTAL SCRN; HI RISK IND,,,21,,RBRVS,3.36 ,1.74 ,6.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0106,HCPCS,COLON CA SCREEN;BARIUM ENEMA,,,20,,RBRVS,0.99 ,4.92 ,4.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0106,HCPCS,COLON CA SCREEN;BARIUM ENEMA,26,,20,,RBRVS,0.99 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0106,HCPCS,COLON CA SCREEN;BARIUM ENEMA,TC,,20,,RBRVS,,4.55 ,4.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0108,HCPCS,DIAB MANAGE TRN PER INDIV,,,14,,RBRVS,0.90 ,0.54 ,0.54 ,,,$0.00,$0.00,1,1,1,1,1,1,20171001, G0109,HCPCS,DIAB MANAGE TRN IND/GROUP,,,14,,RBRVS,0.25 ,0.14 ,0.14 ,,,$0.00,$0.00,1,1,1,1,1,1,20171001, G0117,HCPCS,GLAUCOMA SCRN HGH RISK DIREC,,,14,,RBRVS,0.45 ,1.06 ,1.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0118,HCPCS,GLAUCOMA SCRN HGH RISK DIREC,,,14,,RBRVS,0.17 ,1.07 ,1.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0120,HCPCS,COLON CA SCRN; BARIUM ENEMA,,,20,,RBRVS,0.99 ,4.92 ,4.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0120,HCPCS,COLON CA SCRN; BARIUM ENEMA,26,,20,,RBRVS,0.99 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0120,HCPCS,COLON CA SCRN; BARIUM ENEMA,TC,,20,,RBRVS,,4.55 ,4.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0121,HCPCS,COLON CA SCRN NOT HI RSK IND,,,21,,RBRVS,3.36 ,1.74 ,6.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0122,HCPCS,COLON CA SCRN; BARIUM ENEMA,,,20,,RBRVS,0.99 ,6.51 ,6.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0122,HCPCS,COLON CA SCRN; BARIUM ENEMA,26,,20,,RBRVS,0.99 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0122,HCPCS,COLON CA SCRN; BARIUM ENEMA,TC,,20,,RBRVS,,6.13 ,6.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0123,HCPCS,SCREEN CERV/VAG THIN LAYER,,,17,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0124,HCPCS,SCREEN C/V THIN LAYER BY MD,,,17,,RBRVS,0.42 ,0.48 ,0.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0127,HCPCS,TRIM NAIL(S),,,21,,RBRVS,0.17 ,0.04 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0128,HCPCS,CORF SKILLED NURSING SERVICE,,TC,14,,RBRVS,,0.21 ,0.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0130,HCPCS,SINGLE ENERGY X-RAY STUDY,,,20,,RBRVS,0.22 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0130,HCPCS,SINGLE ENERGY X-RAY STUDY,26,,20,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0130,HCPCS,SINGLE ENERGY X-RAY STUDY,TC,,20,,RBRVS,,0.63 ,0.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0141,HCPCS,"SCR C/V CYTO,AUTOSYS AND MD",,,17,,RBRVS,0.42 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0143,HCPCS,"SCR C/V CYTO,THINLAYER,RESCR",,,17,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0144,HCPCS,"SCR C/V CYTO,THINLAYER,RESCR",,,17,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0145,HCPCS,"SCR C/V CYTO,THINLAYER,RESCR",,,17,,TotalUnits,,,,1.01 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0147,HCPCS,"SCR C/V CYTO, AUTOMATED SYS",,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0148,HCPCS,"SCR C/V CYTO, AUTOSYS, RESCR",,,17,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0151,HCPCS,"HHCP-SERV OF PT,EA 15 MIN",,,14,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, G0152,HCPCS,"HHCP-SERV OF OT,EA 15 MIN",,,14,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, G0153,HCPCS,"HHCP-SVS OF S/L PATH,EA 15MN",,,14,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, G0155,HCPCS,"HHCP-SVS OF CSW,EA 15 MIN",,,14,,TotalUnits,,,,1.03 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, G0156,HCPCS,"HHCP-SVS OF AIDE,EA 15 MIN",,,14,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, G0157,HCPCS,HHC PT ASSISTANT EA 15,,,14,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, G0158,HCPCS,HHC OT ASSISTANT EA 15,,,14,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, G0159,HCPCS,HHC PT MAINT EA 15 MIN,,,14,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, G0160,HCPCS,HHC OCCUP THERAPY EA 15,,,14,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, G0161,HCPCS,HHC SLP EA 15 MIN,,,14,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, G0162,HCPCS,"HHC RN E&M PLAN SVS, 15 MIN",,,14,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, G0166,HCPCS,"EXTRNL COUNTERPULSE, PER TX",,,14,,RBRVS,0.07 ,3.78 ,3.78 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, G0168,HCPCS,WOUND CLOSURE BY ADHESIVE,,,21,,RBRVS,0.45 ,0.29 ,2.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0175,HCPCS,"OPPS SERVICE,SCHED TEAM CONF",,,14,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0176,HCPCS,OPPS/PHP;ACTIVITY THERAPY,,,16,,TotalUnits,,,,1.89 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0177,HCPCS,OPPS/PHP; TRAIN & EDUC SERV,,,16,,TotalUnits,,,,1.21 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0179,HCPCS,MD RECERTIFICATION HHA PT,,,15,,RBRVS,0.45 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0180,HCPCS,MD CERTIFICATION HHA PATIENT,,,15,,RBRVS,0.67 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0181,HCPCS,HOME HEALTH CARE SUPERVISION,,,15,,RBRVS,1.73 ,1.19 ,1.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0182,HCPCS,HOSPICE CARE SUPERVISION,,,15,,RBRVS,1.73 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0186,HCPCS,"DSTRY EYE LESN,FDR VSSL TECH",,,14,,TotalUnits,,,,9.21 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0202,HCPCS,SCREENINGMAMMOGRAPHYDIGITAL,,,20,,RBRVS,0.70 ,3.02 ,3.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0202,HCPCS,SCREENINGMAMMOGRAPHYDIGITAL,26,,20,,RBRVS,0.70 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0202,HCPCS,SCREENINGMAMMOGRAPHYDIGITAL,TC,,20,,RBRVS,,2.77 ,2.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0204,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,,,20,,RBRVS,0.87 ,3.68 ,3.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0204,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,26,,20,,RBRVS,0.87 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0204,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,TC,,20,,RBRVS,,3.36 ,3.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0206,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,,,20,,RBRVS,0.70 ,2.87 ,2.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0206,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,26,,20,,RBRVS,0.70 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0206,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,TC,,20,,RBRVS,,2.62 ,2.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0219,HCPCS,PET IMG WHOLBOD MELANO NONCO,,,20,,TotalUnits,,,,28.08 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0219,HCPCS,PET IMG WHOLBOD MELANO NONCO,26,,20,,TotalUnits,,,,1.96 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0219,HCPCS,PET IMG WHOLBOD MELANO NONCO,TC,,20,,TotalUnits,,,,26.12 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0235,HCPCS,PET NOT OTHERWISE SPECIFIED,,,20,,TotalUnits,,,,27.81 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0235,HCPCS,PET NOT OTHERWISE SPECIFIED,26,,20,,TotalUnits,,,,1.94 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0235,HCPCS,PET NOT OTHERWISE SPECIFIED,TC,,20,,TotalUnits,,,,25.87 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0237,HCPCS,THERAPEUTIC PROCD STRG ENDUR,,,14,,RBRVS,,0.27 ,0.27 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, G0238,HCPCS,"OTH RESP PROC, INDIV",,,14,,RBRVS,,0.29 ,0.29 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, G0239,HCPCS,"OTH RESP PROC, GROUP",,,14,,RBRVS,,0.36 ,0.36 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, G0245,HCPCS,INITIAL FOOT EXAM PT LOPS,,,15,,RBRVS,0.88 ,0.28 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0246,HCPCS,FOLLOWUP EVAL OF FOOT PT LOP,,,15,,RBRVS,0.45 ,0.13 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0247,HCPCS,ROUTINE FOOTCARE PT W LOPS,,,15,,RBRVS,0.50 ,0.13 ,1.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0248,HCPCS,DEMONSTRATE USE HOME INR MON,,TC,14,,RBRVS,,3.12 ,3.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0249,HCPCS,PROVIDE INR TEST MATER/EQUIP,,TC,14,,RBRVS,,3.13 ,3.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0250,HCPCS,MD INR TEST REVIE INTER MGMT,,PC,4,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0252,HCPCS,PET IMAGING INITIAL DX,,,20,,TotalUnits,,,,2.07 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0252,HCPCS,PET IMAGING INITIAL DX,26,,20,,RBRVS,1.50 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0255,HCPCS,CURRENT PERCEP THRESHOLD TST,,,14,,TotalUnits,,,,0.96 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0255,HCPCS,CURRENT PERCEP THRESHOLD TST,26,,14,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0255,HCPCS,CURRENT PERCEP THRESHOLD TST,TC,,14,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0257,HCPCS,UNSCHED DIALYSIS ESRD PT HOS,,,14,,TotalUnits,,,,7.20 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0259,HCPCS,INJECT FOR SACROILIAC JOINT,,,21,,TotalUnits,,,,4.77 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0260,HCPCS,INJ FOR SACROILIAC JT ANESTH,,,21,,TotalUnits,,,,10.66 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0268,HCPCS,REMOVAL OF IMPACTED WAX MD,,,14,,RBRVS,0.61 ,0.27 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0269,HCPCS,OCCLUSIVE DEVICE IN VEIN ART,,,21,,TotalUnits,,,,2.64 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0270,HCPCS,MNT SUBS TX FOR CHANGE DX,,,14,,RBRVS,0.45 ,0.31 ,0.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0271,HCPCS,GROUP MNT 2 OR MORE 30 MINS,,,14,,RBRVS,0.25 ,0.17 ,0.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0276,HCPCS,PILD/PLACEBO CONTROL CLIN TR,,,14,,RBRVS,7.17 ,3.03 ,3.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0277,HCPCS,"HBOT, FULL BODY CHAMBER, 30M",,TC,14,,RBRVS,,1.25 ,1.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0278,HCPCS,"ILIAC ART ANGIO,CARDIAC CATH",,,20,,RBRVS,0.25 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0279,HCPCS,"TOMOSYNTHESIS, MAMMO",,,20,,RBRVS,0.60 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0279,HCPCS,"TOMOSYNTHESIS, MAMMO",26,,20,,RBRVS,0.60 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0279,HCPCS,"TOMOSYNTHESIS, MAMMO",TC,,20,,RBRVS,,0.71 ,0.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0281,HCPCS,ELEC STIM UNATTEND FOR PRESS,,,19,,RBRVS,0.18 ,0.20 ,0.20 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, G0282,HCPCS,ELECT STIM WOUND CARE NOT PD,,,19,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, G0283,HCPCS,ELEC STIM OTHER THAN WOUND,,,19,,RBRVS,0.18 ,0.20 ,0.20 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, G0288,HCPCS,"RECON, CTA FOR SURG PLAN",,TC,20,,RBRVS,,0.94 ,0.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0289,HCPCS,"ARTHRO, LOOSE BODY + CHONDRO",,,21,,RBRVS,1.48 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0293,HCPCS,"NON-COV SURG PROC,CLIN TRIAL",,,14,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0295,HCPCS,ELECTROMAGNETIC THERAPY ONC,,,19,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, G0296,HCPCS,VISIT TO DETERM LDCT ELIG,,,20,,RBRVS,0.52 ,0.20 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0297,HCPCS,LDCT FOR LUNG CA SCREEN,,,21,,RBRVS,1.02 ,6.06 ,6.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0297,HCPCS,LOW-DOSE COMPUTER TOMOGRAPHY,26,,21,,RBRVS,1.02 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0297,HCPCS,LOW-DOSE COMPUTER TOMOGRAPHY,TC,,21,,RBRVS,,5.67 ,5.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0299,HCPCS,HHS/HOSPICE OF RN EA 15 MIN,,,21,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, G0300,HCPCS,HHS/HOSPICE OF LPN EA 15 MIN,,,21,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, G0306,HCPCS,CBC/DIFFWBC W/O PLATELET,,,17,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0307,HCPCS,CBC WITHOUT PLATELET,,,17,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0328,HCPCS,FECAL BLOOD SCRN IMMUNOASSAY,,,17,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0329,HCPCS,ELECTROMAGNTIC TX FOR ULCERS,,,19,,RBRVS,0.06 ,0.20 ,0.20 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, G0333,HCPCS,DISPENSE FEE INITIAL 30 DAY,,,28,,NW,,,,,,$84.26,$0.00,1,1,1,0,0,1,20171001, G0337,HCPCS,HOSPICE EVALUATION PREELECTI,,,15,,RBRVS,1.42 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0339,HCPCS,"ROBOT LIN-RADSURG COM, FIRST",,,21,,TotalUnits,,,,130.09 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0340,HCPCS,ROBT LIN-RADSURG FRACTX 2-5,,,21,,TotalUnits,,,,70.42 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0341,HCPCS,PERCUTANEOUS ISLET CELLTRANS,,,21,,RBRVS,6.98 ,3.27 ,57.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, G0342,HCPCS,LAPAROSCOPY ISLET CELL TRANS,,,21,,RBRVS,11.92 ,6.62 ,6.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, G0343,HCPCS,LAPAROTOMY ISLET CELL TRANSP,,,21,,RBRVS,19.85 ,11.12 ,11.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, G0364,HCPCS,BONE MARROW ASPIRATE &BIOPSY,,,21,,RBRVS,0.16 ,0.08 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0365,HCPCS,VESSEL MAPPING HEMO ACCESS,,,14,,RBRVS,0.25 ,5.37 ,5.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0365,HCPCS,VESSEL MAPPING HEMO ACCESS,26,,14,,RBRVS,0.25 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0365,HCPCS,VESSEL MAPPING HEMO ACCESS,TC,,14,,RBRVS,,5.30 ,5.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0372,HCPCS,MD SERVICE REQUIRED FOR PMD,,,14,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0378,HCPCS,HOSPITAL OBSERVATION PER HR,,,10,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0382,HCPCS,LEV 3 HOSP TYPE B ED VISIT,,,7,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0396,HCPCS,ALCOHOL/SUBS INTERV 15-30MN,,,16,,RBRVS,0.65 ,0.26 ,0.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0397,HCPCS,ALCOHOL/SUBS INTERV >30 MIN,,,16,,RBRVS,1.30 ,0.56 ,0.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0398,HCPCS,HOME SLEEP TEST/TYPE 2 PORTA,,,14,,TotalUnits,,,,4.46 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0398,HCPCS,HOME SLEEP TEST/TYPE 2 PORTA,26,,14,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0398,HCPCS,HOME SLEEP TEST/TYPE 2 PORTA,TC,,14,,TotalUnits,,,,3.12 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0399,HCPCS,HOME SLEEP TEST/TYPE 3 PORTA,,,14,,TotalUnits,,,,4.15 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0399,HCPCS,HOME SLEEP TEST/TYPE 3 PORTA,,PC,14,,TotalUnits,,,,1.24 ,,$0.00,$0.00,1,0,1,1,1,0,20171001, G0399,HCPCS,HOME SLEEP TEST/TYPE 3 PORTA,,TC,14,,TotalUnits,,,,2.91 ,,$0.00,$0.00,1,1,1,0,1,0,20171001, G0400,HCPCS,HOME SLEEP TEST/TYPE 4 PORTA,,,14,,TotalUnits,,,,3.63 ,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0400,HCPCS,HOME SLEEP TEST/TYPE 4 PORTA,26,,14,,TotalUnits,,,,1.10 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0400,HCPCS,HOME SLEEP TEST/TYPE 4 PORTA,TC,,14,,TotalUnits,,,,2.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0402,HCPCS,INITIAL PREVENTIVE EXAM,,,18,,RBRVS,2.43 ,1.00 ,2.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0403,HCPCS,EKG FOR INITIAL PREVENT EXAM,,,18,,RBRVS,0.17 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0404,HCPCS,EKG TRACING FOR INITIAL PREV,,TC,18,,RBRVS,,0.23 ,0.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0405,HCPCS,EKG INTERPRET & REPORT PREVE,,PC,18,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0406,HCPCS,INPT/TELE FOLLOW UP 15,,,6,,RBRVS,0.76 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0407,HCPCS,INPT/TELE FOLLOW UP 25,,,6,,RBRVS,1.39 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0408,HCPCS,INPT/TELE FOLLOW UP 35,,,6,,RBRVS,2.00 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0409,HCPCS,CORF RELATED SERV 15 MINS EA,,,16,,RBRVS,,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0410,HCPCS,GRP PSYCH PARTIAL HOSP 45-50,,,16,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0412,HCPCS,OPEN TX ILIAC SPINE UNI/BIL,,,21,,RBRVS,10.45 ,8.12 ,8.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, G0413,HCPCS,PELVIC RING FRACTURE UNI/BIL,,,21,,RBRVS,15.73 ,11.86 ,11.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0414,HCPCS,PELVIC RING FX TREAT INT FIX,,,21,,RBRVS,14.65 ,11.09 ,11.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, G0415,HCPCS,OPEN TX POST PELVIC FXCTURE,,,21,,RBRVS,20.93 ,14.39 ,14.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20171001, G0416,HCPCS,"PROSTATE BIOPSY, ANY MTHD",,,17,,RBRVS,3.09 ,11.74 ,11.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, G0416,HCPCS,"PROSTATE BIOPSY, ANY MTHD",,PC,17,,RBRVS,3.09 ,1.26 ,1.26 ,,,$0.00,$0.00,1,0,1,1,1,0,20171001, G0416,HCPCS,"PROSTATE BIOPSY, ANY MTHD",,TC,17,,RBRVS,,10.48 ,10.48 ,,,$0.00,$0.00,1,1,1,0,1,0,20171001, G0420,HCPCS,ED SVC CKD IND PER SESSION,,,14,,RBRVS,2.12 ,0.82 ,0.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0421,HCPCS,ED SVC CKD GRP PER SESSION,,,14,,RBRVS,0.50 ,0.18 ,0.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0422,HCPCS,INTENS CARDIAC REHAB W/EXERC,,,4,,RBRVS,1.56 ,1.24 ,1.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0423,HCPCS,INTENS CARDIAC REHAB NO EXER,,,4,,RBRVS,1.56 ,1.24 ,1.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0424,HCPCS,PULMONARY REHAB W EXER,,,14,,RBRVS,0.28 ,0.09 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0425,HCPCS,INPT/ED TELECONSULT30,,,6,,RBRVS,1.92 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0426,HCPCS,INPT/ED TELECONSULT50,,,6,,RBRVS,2.61 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0427,HCPCS,INPT/ED TELECONSULT70,,,6,,RBRVS,3.86 ,1.56 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0429,HCPCS,DERMAL FILLER INJECTION(S),,,14,,RBRVS,1.19 ,0.68 ,1.44 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, G0432,HCPCS,EIA HIV-1/HIV-2 SCREEN,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0433,HCPCS,ELISA HIV-1/HIV-2 SCREEN,,,17,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0435,HCPCS,ORAL HIV-1/HIV-2 SCREEN,,,17,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0438,HCPCS,"PPPS, INITIAL VISIT",,,15,,RBRVS,2.43 ,2.24 ,2.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0439,HCPCS,"PPPS, SUBSEQ VISIT",,,15,,RBRVS,1.50 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0442,HCPCS,ANNUAL ALCOHOL SCREEN 15 MIN,,,16,,RBRVS,0.18 ,0.08 ,0.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0443,HCPCS,BRIEF ALCOHOL MISUSE COUNSEL,,,16,,RBRVS,0.45 ,0.19 ,0.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0444,HCPCS,DEPRESSION SCREEN ANNUAL,,,16,,RBRVS,0.18 ,0.07 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0445,HCPCS,HIGH INTEN BEH COUNS STD 30M,,,16,,RBRVS,0.45 ,0.19 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0446,HCPCS,INTENS BEHAVE THER CARDIO DX,,,16,,RBRVS,0.45 ,0.19 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0447,HCPCS,BEHAVIOR COUNSEL OBESITY 15M,,,16,,RBRVS,0.45 ,0.19 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0451,HCPCS,DEVLOPMENT TEST INTERPT&REP,,,17,,RBRVS,,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0452,HCPCS,MOLECULAR PATHOLOGY INTERPR,,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0452,HCPCS,MOLECULAR PATHOLOGY INTERPR,26,,17,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0453,HCPCS,CONT INTRAOP NEURO MONITOR,,,14,,RBRVS,0.60 ,0.28 ,0.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0454,HCPCS,MD DOCUMENT VISIT BY NPP,,,14,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0455,HCPCS,FECAL MICROBIOTA PREP INSTIL,,,21,,RBRVS,1.34 ,0.59 ,2.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0459,HCPCS,TELEHEALTH INPT PHARM MGMT,,,14,,RBRVS,0.95 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0460,HCPCS,AUTOLOGOUS PRP FOR ULCERS,,,14,,TotalUnits,,,,15.54 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0464,HCPCS,"COLOREC CA SCR, STO BAS DNA",,,21,,TotalUnits,,,,7.88 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0471,HCPCS,VEN BLOOD COLL SNF/HHA,,,17,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0472,HCPCS,HEP C SCREEN HIGH RISK/OTHER,,TC,17,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0473,HCPCS,GROUP BEHAVE COUNS 2-10,,,16,,RBRVS,0.23 ,0.09 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0475,HCPCS,HIV COMBINATION ASSAY,,,17,,TotalUnits,,,,1.84 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0476,HCPCS,HPV COMBO ASSAY CA SCREEN,,,17,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0477,HCPCS,DRUG TEST PRESUMP OPTICAL,,,17,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0478,HCPCS,DRUG TEST PRESUMP OPT INST,,,17,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0479,HCPCS,DRUG TEST PRESUMP NOT OPT,,,17,,TotalUnits,,,,2.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0480,HCPCS,DRUG TEST DEF 1-7 CLASSES,,,17,,TotalUnits,,,,2.23 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0481,HCPCS,DRUG TEST DEF 8-14 CLASSES,,,17,,TotalUnits,,,,3.44 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0482,HCPCS,DRUG TEST DEF 15-21 CLASSES,,,17,,TotalUnits,,,,4.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0483,HCPCS,DRUG TEST DEF 22+ CLASSES,,,17,,TotalUnits,,,,6.01 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0493,HCPCS,RN CARE EA 15 MIN HH/HOSPICE,,,14,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, G0494,HCPCS,LPN CARE EA 15MIN HH/HOSPICE,,,14,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, G0495,HCPCS,RN CARE TRAIN/EDU IN HH,,,14,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, G0496,HCPCS,LPN CARE TRAIN/EDU IN HH,,,14,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, G0500,HCPCS,MOD SEDAT ENDO SERVICE >5YRS,,,14,,RBRVS,0.10 ,0.04 ,1.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0502,HCPCS,"INIT PSYCH CARE MANAG, 70MIN",,,16,,RBRVS,1.70 ,0.70 ,2.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0503,HCPCS,"SUBSEQ PSYCH CARE MAN,60MI",,,16,,RBRVS,1.53 ,0.63 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0504,HCPCS,INIT/SUB PSYCH CARE ADD 30 M,,,16,,RBRVS,0.82 ,0.34 ,0.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0505,HCPCS,COG/FUNC ASSESSMENT OUTPT,,,16,,RBRVS,3.44 ,1.32 ,3.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0506,HCPCS,COMP ASSES CARE PLAN CCM SVC,,,14,,RBRVS,0.87 ,0.36 ,0.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G0507,HCPCS,CARE MANAGE SERV MINIMUM 20,,,14,,RBRVS,0.61 ,0.25 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0508,HCPCS,CRIT CARE TELEHEA CONSULT 60,,,6,,RBRVS,4.00 ,1.34 ,1.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0509,HCPCS,CRIT CARE TELEHEA CONSULT 50,,,6,,RBRVS,3.86 ,1.29 ,1.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G0659,HCPCS,DRUG TEST DEF SIMPLE ALL CL,,,17,,TotalUnits,,,,2.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6001,HCPCS,ECHO GUIDANCE RADIOTHERAPY,,,20,,RBRVS,0.58 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, G6001,HCPCS,ECHO GUIDANCE RADIOTHERAPY,26,,20,,RBRVS,0.58 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G6001,HCPCS,ECHO GUIDANCE RADIOTHERAPY,TC,,20,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6002,HCPCS,STEREOSCOPIC X-RAY GUIDANCE,,,20,,RBRVS,0.39 ,1.70 ,1.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, G6002,HCPCS,STEREOSCOPIC X-RAY GUIDANCE,26,,20,,RBRVS,0.39 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G6002,HCPCS,STEREOSCOPIC X-RAY GUIDANCE,TC,,20,,RBRVS,,1.54 ,1.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6003,HCPCS,RADIATION TREATMENT DELIVERY,,TC,20,,RBRVS,,5.25 ,5.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6004,HCPCS,RADIATION TREATMENT DELIVERY,,TC,20,,RBRVS,,4.06 ,4.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6005,HCPCS,RADIATION TREATMENT DELIVERY,,TC,20,,RBRVS,,4.05 ,4.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6006,HCPCS,RADIATION TREATMENT DELIVERY,,TC,20,,RBRVS,,4.04 ,4.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6007,HCPCS,RADIATION TREATMENT DELIVERY,,TC,20,,RBRVS,,8.45 ,8.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6008,HCPCS,RADIATION TREATMENT DELIVERY,,TC,20,,RBRVS,,5.62 ,5.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6009,HCPCS,RADIATION TREATMENT DELIVERY,,TC,20,,RBRVS,,5.56 ,5.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6010,HCPCS,RADIATION TREATMENT DELIVERY,,TC,20,,RBRVS,,5.55 ,5.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6011,HCPCS,RADIATION TREATMENT DELIVERY,,TC,20,,RBRVS,,9.03 ,9.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6012,HCPCS,RADIATION TREATMENT DELIVERY,,TC,20,,RBRVS,,7.41 ,7.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6013,HCPCS,RADIATION TREATMENT DELIVERY,,TC,20,,RBRVS,,7.42 ,7.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6014,HCPCS,RADIATION TREATMENT DELIVERY,,TC,20,,RBRVS,,7.42 ,7.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6015,HCPCS,RADIATION TX DELIVERY IMRT,,TC,20,,RBRVS,,9.66 ,9.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6016,HCPCS,DELIVERY COMP IMRT,,TC,20,,RBRVS,,9.66 ,9.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G6017,HCPCS,INTRAFRACTION TRACK MOTION,,,20,,TotalUnits,,,,2.18 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9017,HCPCS,AMANTADINE HCL 100MG ORAL,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, G9018,HCPCS,"ZANAMIVIR,INHALATION PWD 10M",,,29,,NW,,,,,,$21.77,$0.00,1,1,1,0,0,1,20171001, G9019,HCPCS,OSELTAMIVIR PHOSPHATE 75MG,,,29,,NW,,,,,,$22.57,$0.00,1,1,1,0,0,1,20171001, G9020,HCPCS,RIMANTADINE HCL 100MG ORAL,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, G9033,HCPCS,AMANTADINE HCL ORAL BRAND,,,29,,NW,,,,,,$72.03,$0.00,1,1,1,0,0,1,20171001, G9034,HCPCS,"ZANAMIVIR, INH PWDR, BRAND",,,29,,NW,,,,,,$57.49,$0.00,1,1,1,0,0,1,20171001, G9036,HCPCS,"RIMANTADINE HCL, BRAND",,,29,,NW,,,,,,$222.96,$0.00,1,1,1,0,0,1,20171001, G9143,HCPCS,WARFARIN RESPON GENETIC TEST,,,17,,TotalUnits,,,,4.59 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, G9148,HCPCS,MEDICAL HOME LEVEL 1,,,14,,TotalUnits,,,,0.02 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9149,HCPCS,MEDICAL HOME LEVEL II,,,14,,TotalUnits,,,,0.02 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9150,HCPCS,MEDICAL HOME LEVEL III,,,14,,TotalUnits,,,,0.03 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9152,HCPCS,MAPCP DEMO COMMUNITY,,,14,,TotalUnits,,,,0.05 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9153,HCPCS,MAPCP DEMO PHYSICIAN,,,14,,TotalUnits,,,,0.02 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9157,HCPCS,TRANSESOPH DOPPL CARDIAC MON,,PC,4,,RBRVS,2.20 ,0.38 ,0.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, G9187,HCPCS,BPCI HOME VISIT,,,15,,RBRVS,0.18 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9481,HCPCS,REMOTE E/M NEW PT 10MINS,,,15,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9482,HCPCS,REMOTE E/M NEW PT 20MINS,,,15,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9483,HCPCS,REMOTE E/M NEW PT 30MINS,,,15,,TotalUnits,,,,1.42 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9484,HCPCS,REMOTE E/M NEW PT 45MINS,,,15,,TotalUnits,,,,2.43 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9485,HCPCS,REMOTE E/M NEW PT 60MINS,,,15,,TotalUnits,,,,3.17 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9486,HCPCS,REMOTE E/M EST. PT 10MINS,,,15,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9487,HCPCS,REMOTE E/M EST. PT 15MINS,,,15,,TotalUnits,,,,0.97 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9488,HCPCS,REMOTE E/M EST. PT 25MINS,,,15,,TotalUnits,,,,1.50 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9489,HCPCS,REMOTE E/M EST. PT 40MINS,,,15,,TotalUnits,,,,2.11 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9490,HCPCS,JOINT REPLAC MOD HOME VISIT,,,15,,RBRVS,0.18 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9685,HCPCS,ACUTE NURSING FACILITY CARE,,,10,,RBRVS,3.86 ,1.55 ,1.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, G9686,HCPCS,NURSING FACILITY CONFERENCE,,,15,,RBRVS,1.50 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, H0001,HCPCS,ALCOHOL AND/OR DRUG ASSESS,,,16,,TotalUnits,,,,1.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0002,HCPCS,ALCOHOL AND/OR DRUG SCREENIN,,,16,,TotalUnits,,,,2.71 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0003,HCPCS,ALCOHOL AND/OR DRUG SCREENIN,,,16,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0004,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0005,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0006,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0010,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16,,TotalUnits,,,,2.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0011,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16,,TotalUnits,,,,7.96 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0014,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16,,TotalUnits,,,,5.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0015,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16,,TotalUnits,,,,3.35 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0016,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16,,TotalUnits,,,,1.88 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0017,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16,,TotalUnits,,,,3.07 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0018,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16,,TotalUnits,,,,4.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0019,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16,,TotalUnits,,,,2.07 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0020,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0022,HCPCS,ALCOHOL AND/OR DRUG INTERVEN,,,16,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0024,HCPCS,ALCOHOL AND/OR DRUG PREVENTI,,,16,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0025,HCPCS,ALCOHOL AND/OR DRUG PREVENTI,,,16,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0031,HCPCS,MH HEALTH ASSESS BY NON-MD,,,16,,TotalUnits,,,,1.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0032,HCPCS,MH SVC PLAN DEV BY NON-MD,,,16,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0033,HCPCS,ORAL MED ADM DIRECT OBSERVE,,,16,,TotalUnits,,,,2.18 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0034,HCPCS,MED TRNG & SUPPORT PER 15MIN,,,16,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0035,HCPCS,MH PARTIAL HOSP TX UNDER 24H,,,16,,TotalUnits,,,,2.48 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0036,HCPCS,COMM PSY FACE-FACE PER 15MIN,,,16,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0037,HCPCS,COMM PSY SUP TX PGM PER DIEM,,,16,,TotalUnits,,,,2.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0038,HCPCS,SELF-HELP/PEER SVC PER 15MIN,,,16,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0039,HCPCS,ASSER COM TX FACE-FACE/15MIN,,,16,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0040,HCPCS,ASSERT COMM TX PGM PER DIEM,,,16,,TotalUnits,,,,1.35 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0041,HCPCS,FOS C CHLD NON-THER PER DIEM,,,16,,TotalUnits,,,,1.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0043,HCPCS,"SUPPORTED HOUSING, PER DIEM",,,16,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0044,HCPCS,"SUPPORTED HOUSING, PER MONTH",,,16,,TotalUnits,,,,9.57 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0045,HCPCS,RESPITE NOT-IN-HOME PER DIEM,,,16,,TotalUnits,,,,2.29 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0046,HCPCS,"MENTAL HEALTH SERVICE, NOS",,,16,,TotalUnits,,,,0.01 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0047,HCPCS,ALCOHOL/DRUG ABUSE SVC NOS,,,16,,TotalUnits,,,,0.90 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0048,HCPCS,SPEC COLL NON-BLOOD:A/D TEST,,,16,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H0050,HCPCS,ALCOHOL/DRUG SERVICE 15 MIN,,,16,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H1000,HCPCS,PRENATAL CARE ATRISK ASSESSM,,,16,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H1001,HCPCS,ANTEPARTUM MANAGEMENT,,,16,,TotalUnits,,,,2.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H1002,HCPCS,CARECOORDINATION PRENATAL,,,16,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H1003,HCPCS,PRENATAL AT RISK EDUCATION,,,16,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H1004,HCPCS,FOLLOW UP HOME VISIT/PRENTAL,,,16,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H1005,HCPCS,PRENATALCARE ENHANCED SRV PK,,,16,,TotalUnits,,,,1.96 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2000,HCPCS,COMP MULTIDISIPLN EVALUATION,,,16,,TotalUnits,,,,1.94 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2010,HCPCS,COMPREHENSIVE MED SVC 15 MIN,,,16,,TotalUnits,,,,0.97 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2011,HCPCS,"CRISIS INTERVEN SVC, 15 MIN",,,16,,TotalUnits,,,,0.97 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2012,HCPCS,"BEHAV HLTH DAY TREAT, PER HR",,,16,,TotalUnits,,,,1.09 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2013,HCPCS,"PSYCH HLTH FAC SVC, PER DIEM",,,16,,TotalUnits,,,,2.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2014,HCPCS,"SKILLS TRAIN AND DEV, 15 MIN",,,16,,TotalUnits,,,,1.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2015,HCPCS,"COMP COMM SUPP SVC, 15 MIN",,,16,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2017,HCPCS,"PSYSOC REHAB SVC, PER 15 MIN",,,16,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2018,HCPCS,"PSYSOC REHAB SVC, PER DIEM",,,16,,TotalUnits,,,,1.76 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2019,HCPCS,"THER BEHAV SVC, PER 15 MIN",,,16,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2020,HCPCS,"THER BEHAV SVC, PER DIEM",,,16,,TotalUnits,,,,1.56 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2021,HCPCS,"COM WRAP-AROUND SV, 15 MIN",,,16,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2022,HCPCS,"COM WRAP-AROUND SV, PER DIEM",,,16,,TotalUnits,,,,3.13 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2023,HCPCS,"SUPPORTED EMPLOY, PER 15 MIN",,,16,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2024,HCPCS,"SUPPORTED EMPLOY, PER DIEM",,,16,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2026,HCPCS,"SUPP MAINT EMPLOY, PER DIEM",,,16,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2027,HCPCS,"PSYCHOED SVC, PER 15 MIN",,,16,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2029,HCPCS,"SEX OFFEND TX SVC, PER DIEM",,,16,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2032,HCPCS,"ACTIVITY THERAPY, PER 15 MIN",,,16,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2033,HCPCS,MULTISYS THER/JUVENILE 15MIN,,,16,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2035,HCPCS,"A/D TX PROGRAM, PER HOUR",,,16,,TotalUnits,,,,1.10 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, H2036,HCPCS,"A/D TX PROGRAM, PER DIEM",,,16,,TotalUnits,,,,1.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, J0120,HCPCS,TETRACYCLIN INJECTION,,,29,,NW,,,,,,$90.02,$0.00,1,1,1,0,0,1,20171001, J0129,HCPCS,ABATACEPT INJECTION,,,29,,NW,,,,,,$101.40,$0.00,1,1,1,0,0,1,20171001, J0130,HCPCS,ABCIXIMAB INJECTION,,,29,,NW,,,,,,"$2,441.23",$0.00,1,1,1,0,0,1,20171001, J0131,HCPCS,ACETAMINOPHEN INJECTION,,,29,,NW,,,,,,$0.94,$0.00,1,1,1,0,0,1,20171001, J0132,HCPCS,ACETYLCYSTEINE INJECTION,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J0133,HCPCS,ACYCLOVIR INJECTION,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J0135,HCPCS,ADALIMUMAB INJECTION,,,29,,NW,,,,,,"$1,798.56",$0.00,1,1,1,0,0,1,20171001, J0153,HCPCS,ADENOSINE INJ 1MG,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J0171,HCPCS,ADRENALIN EPINEPHRINE INJECT,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J0178,HCPCS,AFLIBERCEPT INJECTION,,,29,,NW,,,,,,"$2,211.18",$0.00,1,1,1,0,0,1,20171001, J0180,HCPCS,AGALSIDASE BETA INJECTION,,,29,,NW,,,,,,$367.63,$0.00,1,1,1,0,0,1,20171001, J0190,HCPCS,INJ BIPERIDEN LACTATE/5 MG,,,29,,NW,,,,,,$4.59,$0.00,1,1,1,0,0,1,20171001, J0200,HCPCS,ALATROFLOXACIN MESYLATE,,,29,,NW,,,,,,$37.92,$0.00,1,1,1,0,0,1,20171001, J0202,HCPCS,"INJECTION, ALEMTUZUMAB",,,29,,NW,,,,,,"$3,914.78",$0.00,1,1,1,0,0,1,20171001, J0205,HCPCS,ALGLUCERASE INJECTION,,,29,,NW,,,,,,$83.70,$0.00,1,1,1,0,0,1,20171001, J0207,HCPCS,AMIFOSTINE,,,29,,NW,,,,,,"$1,377.88",$0.00,1,1,1,0,0,1,20171001, J0210,HCPCS,METHYLDOPATE HCL INJECTION,,,29,,NW,,,,,,$32.22,$0.00,1,1,1,0,0,1,20171001, J0215,HCPCS,ALEFACEPT,,,29,,NW,,,,,,$71.64,$0.00,1,1,1,0,0,1,20171001, J0220,HCPCS,ALGLUCOSIDASE ALFA INJECTION,,,29,,NW,,,,,,$473.00,$0.00,1,1,1,0,0,1,20171001, J0221,HCPCS,LUMIZYME INJECTION,,,29,,NW,,,,,,$356.37,$0.00,1,1,1,0,0,1,20171001, J0256,HCPCS,ALPHA 1 PROTEINASE INHIBITOR,,,29,,NW,,,,,,$19.35,$0.00,1,1,1,0,0,1,20171001, J0257,HCPCS,GLASSIA INJECTION,,,29,,NW,,,,,,$18.55,$0.00,1,1,1,0,0,1,20171001, J0270,HCPCS,ALPROSTADIL FOR INJECTION,,,29,,NW,,,,,,$14.53,$0.00,1,1,1,0,0,1,20171001, J0275,HCPCS,ALPROSTADIL URETHRAL SUPPOS,,,29,,NW,,,,,,$65.09,$0.00,1,1,1,0,0,1,20171001, J0278,HCPCS,AMIKACIN SULFATE INJECTION,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J0280,HCPCS,AMINOPHYLLIN 250 MG INJ,,,29,,NW,,,,,,$27.40,$0.00,1,1,1,0,0,1,20171001, J0282,HCPCS,AMIODARONE HCL,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J0285,HCPCS,AMPHOTERICIN B,,,29,,NW,,,,,,$56.35,$0.00,1,1,1,0,0,1,20171001, J0287,HCPCS,AMPHOTERICIN B LIPID COMPLEX,,,29,,NW,,,,,,$39.46,$0.00,1,1,1,0,0,1,20171001, J0288,HCPCS,AMPHO B CHOLESTERYL SULFATE,,,29,,NW,,,,,,$185.05,$0.00,1,1,1,0,0,1,20171001, J0289,HCPCS,AMPHOTERICIN B LIPOSOME INJ,,,29,,NW,,,,,,$49.11,$0.00,1,1,1,0,0,1,20171001, J0290,HCPCS,AMPICILLIN 500 MG INJ,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J0295,HCPCS,AMPICILLIN SODIUM PER 1.5 GM,,,29,,NW,,,,,,$15.33,$0.00,1,1,1,0,0,1,20171001, J0300,HCPCS,AMOBARBITAL 125 MG INJ,,,29,,NW,,,,,,$37.05,$0.00,1,1,1,0,0,1,20171001, J0330,HCPCS,SUCCINYCHOLINE CHLORIDE INJ,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J0348,HCPCS,ANIDULAFUNGIN INJECTION,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J0350,HCPCS,INJECTION ANISTREPLASE 30 U,,,29,,NW,,,,,,$280.76,$0.00,1,1,1,0,0,1,20171001, J0360,HCPCS,HYDRALAZINE HCL INJECTION,,,29,,NW,,,,,,$29.81,$0.00,1,1,1,0,0,1,20171001, J0364,HCPCS,APOMORPHINE HYDROCHLORIDE,,,29,,NW,,,,,,$16.14,$0.00,1,1,1,0,0,1,20171001, J0365,HCPCS,"APROTONIN, 10,000 KIU",,,29,,NW,,,,,,$15.33,$0.00,1,1,1,0,0,1,20171001, J0380,HCPCS,INJ METARAMINOL BITARTRATE,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J0390,HCPCS,CHLOROQUINE INJECTION,,,29,,NW,,,,,,$237.93,$0.00,1,1,1,0,0,1,20171001, J0395,HCPCS,ARBUTAMINE HCL INJECTION,,,29,,NW,,,,,,$31.72,$0.00,1,1,1,0,0,1,20171001, J0400,HCPCS,ARIPIPRAZOLE INJECTION,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J0401,HCPCS,INJ ARIPIPRAZOLE EXT REL 1MG,,,29,,NW,,,,,,$18.55,$0.00,1,1,1,0,0,1,20171001, J0456,HCPCS,AZITHROMYCIN,,,29,,NW,,,,,,$16.94,$0.00,1,1,1,0,0,1,20171001, J0461,HCPCS,ATROPINE SULFATE INJECTION,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J0470,HCPCS,DIMECAPROL INJECTION,,,29,,NW,,,,,,$94.96,$0.00,1,1,1,0,0,1,20171001, J0475,HCPCS,BACLOFEN 10 MG INJECTION,,,29,,NW,,,,,,$419.11,$0.00,1,1,1,0,0,1,20171001, J0476,HCPCS,BACLOFEN INTRATHECAL TRIAL,,,29,,NW,,,,,,$182.63,$0.00,1,1,1,0,0,1,20171001, J0480,HCPCS,BASILIXIMAB,,,29,,NW,,,,,,"$6,837.76",$0.00,1,1,1,0,0,1,20171001, J0485,HCPCS,BELATACEPT INJECTION,,,29,,NW,,,,,,$17.74,$0.00,1,1,1,0,0,1,20171001, J0490,HCPCS,BELIMUMAB INJECTION,,,29,,NW,,,,,,$102.20,$0.00,1,1,1,0,0,1,20171001, J0500,HCPCS,DICYCLOMINE INJECTION,,,29,,NW,,,,,,$139.20,$0.00,1,1,1,0,0,1,20171001, J0515,HCPCS,INJ BENZTROPINE MESYLATE,,,29,,NW,,,,,,$74.85,$0.00,1,1,1,0,0,1,20171001, J0520,HCPCS,BETHANECHOL CHLORIDE INJECT,,,29,,NW,,,,,,$8.86,$0.00,1,1,1,0,0,1,20171001, J0558,HCPCS,PENG BENZATHINE/PROCAINE INJ,,,29,,NW,,,,,,$23.38,$0.00,1,1,1,0,0,1,20171001, J0561,HCPCS,PENICILLIN G BENZATHINE INJ,,,29,,NW,,,,,,$27.40,$0.00,1,1,1,0,0,1,20171001, J0575,HCPCS,BUPREN/NAL OVER 10MG BUPRENO,,,29,,NW,,,,,,$28.65,$0.00,1,1,1,0,0,1,20171001, J0583,HCPCS,BIVALIRUDIN,,,29,,NW,,,,,,$14.53,$0.00,1,1,1,0,0,1,20171001, J0585,HCPCS,"INJECTION,ONABOTULINUMTOXINA",,,29,,NW,,,,,,$21.77,$0.00,1,1,1,0,0,1,20171001, J0586,HCPCS,ABOBOTULINUMTOXINA,,,29,,NW,,,,,,$26.59,$0.00,1,1,1,0,0,1,20171001, J0587,HCPCS,"INJ, RIMABOTULINUMTOXINB",,,29,,NW,,,,,,$35.44,$0.00,1,1,1,0,0,1,20171001, J0588,HCPCS,INCOBOTULINUMTOXIN A,,,29,,NW,,,,,,$19.35,$0.00,1,1,1,0,0,1,20171001, J0592,HCPCS,BUPRENORPHINE HYDROCHLORIDE,,,29,,NW,,,,,,$16.14,$0.00,1,1,1,0,0,1,20171001, J0594,HCPCS,BUSULFAN INJECTION,,,29,,NW,,,,,,$83.70,$0.00,1,1,1,0,0,1,20171001, J0595,HCPCS,BUTORPHANOL TARTRATE 1 MG,,,29,,NW,,,,,,$13.72,$0.00,1,1,1,0,0,1,20171001, J0596,HCPCS,"INJECTION, RUCONEST",,,29,,NW,,,,,,$109.90,$0.00,1,1,1,0,0,1,20171001, J0597,HCPCS,"C-1 ESTERASE, BERINERT",,,29,,NW,,,,,,$112.66,$0.00,1,1,1,0,0,1,20171001, J0598,HCPCS,"C-1 ESTERASE, CINRYZE",,,29,,NW,,,,,,$131.16,$0.00,1,1,1,0,0,1,20171001, J0600,HCPCS,EDETATE CALCIUM DISODIUM INJ,,,29,,NW,,,,,,"$12,576.73",$0.00,1,1,1,0,0,1,20171001, J0610,HCPCS,CALCIUM GLUCONATE INJECTION,,,29,,NW,,,,,,$14.53,$0.00,1,1,1,0,0,1,20171001, J0620,HCPCS,CALCIUM GLYCER & LACT/10 ML,,,29,,NW,,,,,,$36.24,$0.00,1,1,1,0,0,1,20171001, J0630,HCPCS,CALCITONIN SALMON INJECTION,,,29,,NW,,,,,,"$5,331.22",$0.00,1,1,1,0,0,1,20171001, J0636,HCPCS,INJ CALCITRIOL PER 0.1 MCG,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J0637,HCPCS,CASPOFUNGIN ACETATE,,,29,,NW,,,,,,$38.66,$0.00,1,1,1,0,0,1,20171001, J0638,HCPCS,CANAKINUMAB INJECTION,,,29,,NW,,,,,,$216.42,$0.00,1,1,1,0,0,1,20171001, J0640,HCPCS,LEUCOVORIN CALCIUM INJECTION,,,29,,NW,,,,,,$16.94,$0.00,1,1,1,0,0,1,20171001, J0641,HCPCS,LEVOLEUCOVORIN INJECTION,,,29,,NW,,,,,,$12.11,$0.00,1,1,1,0,0,1,20171001, J0670,HCPCS,INJ MEPIVACAINE HCL/10 ML,,,29,,NW,,,,,,$13.72,$0.00,1,1,1,0,0,1,20171001, J0690,HCPCS,CEFAZOLIN SODIUM INJECTION,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J0692,HCPCS,CEFEPIME HCL FOR INJECTION,,,29,,NW,,,,,,$14.53,$0.00,1,1,1,0,0,1,20171001, J0694,HCPCS,CEFOXITIN SODIUM INJECTION,,,29,,NW,,,,,,$19.35,$0.00,1,1,1,0,0,1,20171001, J0695,HCPCS,INJ CEFTOLOZANE TAZOBACTAM,,,29,,NW,,,,,,$2.03,$0.00,1,1,1,0,0,1,20171001, J0696,HCPCS,CEFTRIAXONE SODIUM INJECTION,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J0697,HCPCS,STERILE CEFUROXIME INJECTION,,,29,,NW,,,,,,$14.53,$0.00,1,1,1,0,0,1,20171001, J0698,HCPCS,CEFOTAXIME SODIUM INJECTION,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J0702,HCPCS,BETAMETHASONE ACET&SOD PHOSP,,,29,,NW,,,,,,$21.77,$0.00,1,1,1,0,0,1,20171001, J0706,HCPCS,CAFFEINE CITRATE INJECTION,,,29,,NW,,,,,,$16.14,$0.00,1,1,1,0,0,1,20171001, J0710,HCPCS,CEPHAPIRIN SODIUM INJECTION,,,29,,NW,,,,,,$16.79,$0.00,1,1,1,0,0,1,20171001, J0712,HCPCS,CEFTAROLINE FOSAMIL INJ,,,29,,NW,,,,,,$13.72,$0.00,1,1,1,0,0,1,20171001, J0713,HCPCS,INJ CEFTAZIDIME PER 500 MG,,,29,,NW,,,,,,$14.53,$0.00,1,1,1,0,0,1,20171001, J0714,HCPCS,CEFTAZIDIME AND AVIBACTAM,,,29,,NW,,,,,,$228.92,$0.00,1,1,1,0,0,1,20171001, J0715,HCPCS,CEFTIZOXIME SODIUM / 500 MG,,,29,,NW,,,,,,$47.24,$0.00,1,1,1,0,0,1,20171001, J0716,HCPCS,CENTRUROIDES IMMUNE F(AB),,,29,,NW,,,,,,"$9,997.68",$0.00,1,1,1,0,0,1,20171001, J0717,HCPCS,CERTOLIZUMAB PEGOL INJ 1MG,,,29,,NW,,,,,,$23.38,$0.00,1,1,1,0,0,1,20171001, J0720,HCPCS,CHLORAMPHENICOL SODIUM INJEC,,,29,,NW,,,,,,$80.48,$0.00,1,1,1,0,0,1,20171001, J0725,HCPCS,CHORIONIC GONADOTROPIN/1000U,,,29,,NW,,,,,,$45.09,$0.00,1,1,1,0,0,1,20171001, J0735,HCPCS,CLONIDINE HYDROCHLORIDE,,,29,,NW,,,,,,$38.66,$0.00,1,1,1,0,0,1,20171001, J0740,HCPCS,CIDOFOVIR INJECTION,,,29,,NW,,,,,,"$1,343.30",$0.00,1,1,1,0,0,1,20171001, J0743,HCPCS,CILASTATIN SODIUM INJECTION,,,29,,NW,,,,,,$25.79,$0.00,1,1,1,0,0,1,20171001, J0744,HCPCS,CIPROFLOXACIN IV,,,29,,NW,,,,,,$12.11,$0.00,1,1,1,0,0,1,20171001, J0745,HCPCS,INJ CODEINE PHOSPHATE /30 MG,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J0770,HCPCS,COLISTIMETHATE SODIUM INJ,,,29,,NW,,,,,,$33.83,$0.00,1,1,1,0,0,1,20171001, J0775,HCPCS,"COLLAGENASE, CLOST HIST INJ",,,29,,NW,,,,,,$95.77,$0.00,1,1,1,0,0,1,20171001, J0780,HCPCS,PROCHLORPERAZINE INJECTION,,,29,,NW,,,,,,$36.24,$0.00,1,1,1,0,0,1,20171001, J0795,HCPCS,CORTICORELIN OVINE TRIFLUTAL,,,29,,NW,,,,,,$26.59,$0.00,1,1,1,0,0,1,20171001, J0800,HCPCS,CORTICOTROPIN INJECTION,,,29,,NW,,,,,,"$8,048.29",$0.00,1,1,1,0,0,1,20171001, J0833,HCPCS,COSYNTROPIN INJECTION NOS,,,29,,NW,,,,,,$235.72,$0.00,1,1,1,0,0,1,20171001, J0834,HCPCS,COSYNTROPIN CORTROSYN INJ,,,29,,NW,,,,,,$107.03,$0.00,1,1,1,0,0,1,20171001, J0840,HCPCS,CROTALIDAE POLY IMMUNE FAB,,,29,,NW,,,,,,"$6,007.68",$0.00,1,1,1,0,0,1,20171001, J0850,HCPCS,CYTOMEGALOVIRUS IMM IV /VIAL,,,29,,NW,,,,,,"$2,401.01",$0.00,1,1,1,0,0,1,20171001, J0875,HCPCS,"INJECTION, DALBAVANCIN",,,29,,NW,,,,,,$41.88,$0.00,1,1,1,0,0,1,20171001, J0878,HCPCS,DAPTOMYCIN INJECTION,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J0881,HCPCS,"DARBEPOETIN ALFA, NON-ESRD",,,29,,NW,,,,,,$18.55,$0.00,1,1,1,0,0,1,20171001, J0882,HCPCS,"DARBEPOETIN ALFA, ESRD USE",,,29,,NW,,,,,,$18.55,$0.00,1,1,1,0,0,1,20171001, J0883,HCPCS,ARGATROBAN NONESRD USE 1MG,,,29,,NW,,,,,,$44.58,$0.00,1,1,1,0,0,1,20171001, J0884,HCPCS,ARGATROBAN ESRD DIALYSIS 1MG,,,29,,NW,,,,,,$44.58,$0.00,1,1,1,0,0,1,20171001, J0885,HCPCS,"EPOETIN ALFA, NON-ESRD",,,29,,NW,,,,,,$37.05,$0.00,1,1,1,0,0,1,20171001, J0887,HCPCS,EPOETIN BETA ESRD USE,,,28,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J0888,HCPCS,EPOETIN BETA NON ESRD,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J0890,HCPCS,PEGINESATIDE INJECTION,,,29,,NW,,,,,,$27.20,$0.00,1,1,1,0,0,1,20171001, J0894,HCPCS,DECITABINE INJECTION,,,29,,NW,,,,,,$61.98,$0.00,1,1,1,0,0,1,20171001, J0895,HCPCS,DEFEROXAMINE MESYLATE INJ,,,29,,NW,,,,,,$26.59,$0.00,1,1,1,0,0,1,20171001, J0897,HCPCS,DENOSUMAB INJECTION,,,29,,NW,,,,,,$44.29,$0.00,1,1,1,0,0,1,20171001, J0945,HCPCS,BROMPHENIRAMINE MALEATE INJ,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J1000,HCPCS,DEPO-ESTRADIOL CYPIONATE INJ,,,29,,NW,,,,,,$40.27,$0.00,1,1,1,0,0,1,20171001, J1020,HCPCS,METHYLPREDNISOLONE 20 MG INJ,,,29,,NW,,,,,,$19.35,$0.00,1,1,1,0,0,1,20171001, J1030,HCPCS,METHYLPREDNISOLONE 40 MG INJ,,,29,,NW,,,,,,$19.35,$0.00,1,1,1,0,0,1,20171001, J1040,HCPCS,METHYLPREDNISOLONE 80 MG INJ,,,29,,NW,,,,,,$28.20,$0.00,1,1,1,0,0,1,20171001, J1050,HCPCS,MEDROXYPROGESTERONE ACETATE,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J1071,HCPCS,INJ TESTOSTERONE CYPIONATE,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J1094,HCPCS,INJ DEXAMETHASONE ACETATE,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J1100,HCPCS,DEXAMETHASONE SODIUM PHOS,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J1110,HCPCS,INJ DIHYDROERGOTAMINE MESYLT,,,29,,NW,,,,,,$160.92,$0.00,1,1,1,0,0,1,20171001, J1120,HCPCS,ACETAZOLAMID SODIUM INJECTIO,,,29,,NW,,,,,,$55.55,$0.00,1,1,1,0,0,1,20171001, J1160,HCPCS,DIGOXIN INJECTION,,,29,,NW,,,,,,$20.16,$0.00,1,1,1,0,0,1,20171001, J1162,HCPCS,DIGOXIN IMMUNE FAB (OVINE),,,29,,NW,,,,,,"$6,837.76",$0.00,1,1,1,0,0,1,20171001, J1165,HCPCS,PHENYTOIN SODIUM INJECTION,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J1170,HCPCS,HYDROMORPHONE INJECTION,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J1180,HCPCS,DYPHYLLINE INJECTION,,,29,,NW,,,,,,$20.15,$0.00,1,1,1,0,0,1,20171001, J1190,HCPCS,DEXRAZOXANE HCL INJECTION,,,29,,NW,,,,,,$376.48,$0.00,1,1,1,0,0,1,20171001, J1200,HCPCS,DIPHENHYDRAMINE HCL INJECTIO,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J1205,HCPCS,CHLOROTHIAZIDE SODIUM INJ,,,29,,NW,,,,,,$254.22,$0.00,1,1,1,0,0,1,20171001, J1212,HCPCS,DIMETHYL SULFOXIDE 50% 50 ML,,,29,,NW,,,,,,$717.52,$0.00,1,1,1,0,0,1,20171001, J1230,HCPCS,METHADONE INJECTION,,,29,,NW,,,,,,$35.44,$0.00,1,1,1,0,0,1,20171001, J1240,HCPCS,DIMENHYDRINATE INJECTION,,,29,,NW,,,,,,$22.57,$0.00,1,1,1,0,0,1,20171001, J1245,HCPCS,DIPYRIDAMOLE INJECTION,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J1250,HCPCS,INJ DOBUTAMINE HCL/250 MG,,,29,,NW,,,,,,$21.77,$0.00,1,1,1,0,0,1,20171001, J1260,HCPCS,DOLASETRON MESYLATE,,,29,,NW,,,,,,$33.88,$0.00,1,1,1,0,0,1,20171001, J1265,HCPCS,DOPAMINE INJECTION,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J1267,HCPCS,DORIPENEM INJECTION,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J1270,HCPCS,"INJECTION, DOXERCALCIFEROL",,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J1290,HCPCS,ECALLANTIDE INJECTION,,,29,,NW,,,,,,$908.15,$0.00,1,1,1,0,0,1,20171001, J1300,HCPCS,ECULIZUMAB INJECTION,,,29,,NW,,,,,,$493.92,$0.00,1,1,1,0,0,1,20171001, J1320,HCPCS,AMITRIPTYLINE INJECTION,,,29,,NW,,,,,,$91.75,$0.00,1,1,1,0,0,1,20171001, J1322,HCPCS,"ELOSULFASE ALFA, INJECTION",,,29,,NW,,,,,,$361.06,$0.00,1,1,1,0,0,1,20171001, J1324,HCPCS,ENFUVIRTIDE INJECTION,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J1325,HCPCS,EPOPROSTENOL INJECTION,,,29,,NW,,,,,,$43.48,$0.00,1,1,1,0,0,1,20171001, J1327,HCPCS,EPTIFIBATIDE INJECTION,,,29,,NW,,,,,,$59.57,$0.00,1,1,1,0,0,1,20171001, J1330,HCPCS,ERGONOVINE MALEATE INJECTION,,,29,,NW,,,,,,$10.28,$0.00,1,1,1,0,0,1,20171001, J1335,HCPCS,ERTAPENEM INJECTION,,,29,,NW,,,,,,$103.01,$0.00,1,1,1,0,0,1,20171001, J1364,HCPCS,ERYTHRO LACTOBIONATE /500 MG,,,29,,NW,,,,,,$119.90,$0.00,1,1,1,0,0,1,20171001, J1380,HCPCS,ESTRADIOL VALERATE 10 MG INJ,,,29,,NW,,,,,,$31.42,$0.00,1,1,1,0,0,1,20171001, J1410,HCPCS,INJ ESTROGEN CONJUGATE 25 MG,,,29,,NW,,,,,,$522.07,$0.00,1,1,1,0,0,1,20171001, J1430,HCPCS,ETHANOLAMINE OLEATE 100 MG,,,29,,NW,,,,,,$917.00,$0.00,1,1,1,0,0,1,20171001, J1435,HCPCS,INJECTION ESTRONE PER 1 MG,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J1436,HCPCS,ETIDRONATE DISODIUM INJ,,,29,,NW,,,,,,$226.62,$0.00,1,1,1,0,0,1,20171001, J1438,HCPCS,ETANERCEPT INJECTION,,,29,,NW,,,,,,$860.69,$0.00,1,1,1,0,0,1,20171001, J1439,HCPCS,INJ FERRIC CARBOXYMALTOS 1MG,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J1442,HCPCS,INJ FILGRASTIM EXCL BIOSIMIL,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J1443,HCPCS,INJ FERRIC PYROPHOSPHATE CIT,,,29,,NW,,,,,,$3.05,$0.00,1,1,1,0,0,1,20171001, J1447,HCPCS,INJ TBO FILGRASTIM 1 MICROG,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J1450,HCPCS,FLUCONAZOLE,,,29,,NW,,,,,,$20.16,$0.00,1,1,1,0,0,1,20171001, J1451,HCPCS,"FOMEPIZOLE, 15 MG",,,29,,NW,,,,,,$25.79,$0.00,1,1,1,0,0,1,20171001, J1452,HCPCS,INTRAOCULAR FOMIVIRSEN NA,,,29,,NW,,,,,,"$2,530.30",$0.00,1,1,1,0,0,1,20171001, J1453,HCPCS,FOSAPREPITANT INJECTION,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J1455,HCPCS,FOSCARNET SODIUM INJECTION,,,29,,NW,,,,,,$56.35,$0.00,1,1,1,0,0,1,20171001, J1457,HCPCS,GALLIUM NITRATE INJECTION,,,29,,NW,,,,,,$12.11,$0.00,1,1,1,0,0,1,20171001, J1458,HCPCS,GALSULFASE INJECTION,,,29,,NW,,,,,,$826.91,$0.00,1,1,1,0,0,1,20171001, J1459,HCPCS,INJ IVIG PRIVIGEN 500 MG,,,29,,NW,,,,,,$94.96,$0.00,1,1,1,0,0,1,20171001, J1460,HCPCS,GAMMA GLOBULIN 1 CC INJ,,,29,,NW,,,,,,$83.70,$0.00,1,1,1,0,0,1,20171001, J1556,HCPCS,"INJ, IMM GLOB BIVIGAM, 500MG",,,29,,NW,,,,,,$97.37,$0.00,1,1,1,0,0,1,20171001, J1557,HCPCS,GAMMAPLEX INJECTION,,,29,,NW,,,,,,$92.55,$0.00,1,1,1,0,0,1,20171001, J1559,HCPCS,HIZENTRA INJECTION,,,29,,NW,,,,,,$28.20,$0.00,1,1,1,0,0,1,20171001, J1560,HCPCS,GAMMA GLOBULIN > 10 CC INJ,,,29,,NW,,,,,,$757.74,$0.00,1,1,1,0,0,1,20171001, J1561,HCPCS,GAMUNEX-C/GAMMAKED,,,29,,NW,,,,,,$103.01,$0.00,1,1,1,0,0,1,20171001, J1562,HCPCS,"VIVAGLOBIN, INJ",,,29,,NW,,,,,,$31.42,$0.00,1,1,1,0,0,1,20171001, J1566,HCPCS,"IMMUNE GLOBULIN, POWDER",,,29,,NW,,,,,,$87.72,$0.00,1,1,1,0,0,1,20171001, J1568,HCPCS,OCTAGAM INJECTION,,,29,,NW,,,,,,$111.85,$0.00,1,1,1,0,0,1,20171001, J1569,HCPCS,GAMMAGARD LIQUID INJECTION,,,29,,NW,,,,,,$95.77,$0.00,1,1,1,0,0,1,20171001, J1570,HCPCS,GANCICLOVIR SODIUM INJECTION,,,29,,NW,,,,,,$166.55,$0.00,1,1,1,0,0,1,20171001, J1571,HCPCS,HEPAGAM B IM INJECTION,,,29,,NW,,,,,,$132.77,$0.00,1,1,1,0,0,1,20171001, J1572,HCPCS,FLEBOGAMMA INJECTION,,,29,,NW,,,,,,$96.57,$0.00,1,1,1,0,0,1,20171001, J1573,HCPCS,"HEPAGAM B INTRAVENOUS, INJ",,,29,,NW,,,,,,$103.72,$0.00,1,1,1,0,0,1,20171001, J1575,HCPCS,HYQVIA 100MG IMMUNEGLOBULIN,,,29,,NW,,,,,,$34.64,$0.00,1,1,1,0,0,1,20171001, J1580,HCPCS,GARAMYCIN GENTAMICIN INJ,,,29,,NW,,,,,,$12.11,$0.00,1,1,1,0,0,1,20171001, J1595,HCPCS,INJECTION GLATIRAMER ACETATE,,,29,,NW,,,,,,"$3,869.74",$0.00,1,1,1,0,0,1,20171001, J1599,HCPCS,"IVIG NON-LYOPHILIZED, NOS",,,29,,NW,,,,,,$106.86,$0.00,1,1,1,0,0,1,20171001, J1600,HCPCS,GOLD SODIUM THIOMALEATE INJ,,,29,,NW,,,,,,$41.88,$0.00,1,1,1,0,0,1,20171001, J1602,HCPCS,GOLIMUMAB FOR IV USE 1MG,,,29,,NW,,,,,,$64.40,$0.00,1,1,1,0,0,1,20171001, J1610,HCPCS,GLUCAGON HYDROCHLORIDE/1 MG,,,29,,NW,,,,,,$450.48,$0.00,1,1,1,0,0,1,20171001, J1620,HCPCS,GONADORELIN HYDROCH/ 100 MCG,,,29,,NW,,,,,,$715.37,$0.00,1,1,1,0,0,1,20171001, J1626,HCPCS,GRANISETRON HCL INJECTION,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J1630,HCPCS,HALOPERIDOL INJECTION,,,29,,NW,,,,,,$13.72,$0.00,1,1,1,0,0,1,20171001, J1631,HCPCS,HALOPERIDOL DECANOATE INJ,,,29,,NW,,,,,,$51.53,$0.00,1,1,1,0,0,1,20171001, J1640,HCPCS,"HEMIN, 1 MG",,,29,,NW,,,,,,$57.96,$0.00,1,1,1,0,0,1,20171001, J1642,HCPCS,INJ HEPARIN SODIUM PER 10 U,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J1644,HCPCS,INJ HEPARIN SODIUM PER 1000U,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J1645,HCPCS,DALTEPARIN SODIUM,,,29,,NW,,,,,,$43.48,$0.00,1,1,1,0,0,1,20171001, J1650,HCPCS,INJ ENOXAPARIN SODIUM,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J1652,HCPCS,FONDAPARINUX SODIUM,,,29,,NW,,,,,,$14.53,$0.00,1,1,1,0,0,1,20171001, J1655,HCPCS,TINZAPARIN SODIUM INJECTION,,,29,,NW,,,,,,$17.74,$0.00,1,1,1,0,0,1,20171001, J1670,HCPCS,TETANUS IMMUNE GLOBULIN INJ,,,29,,NW,,,,,,$916.19,$0.00,1,1,1,0,0,1,20171001, J1675,HCPCS,HISTRELIN ACETATE,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J1700,HCPCS,HYDROCORTISONE ACETATE INJ,,,29,,NW,,,,,,$1.61,$0.00,1,1,1,0,0,1,20171001, J1710,HCPCS,HYDROCORTISONE SODIUM PH INJ,,,29,,NW,,,,,,$23.54,$0.00,1,1,1,0,0,1,20171001, J1720,HCPCS,HYDROCORTISONE SODIUM SUCC I,,,29,,NW,,,,,,$25.79,$0.00,1,1,1,0,0,1,20171001, J1725,HCPCS,HYDROXYPROGESTERONE CAPROATE,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J1730,HCPCS,DIAZOXIDE INJECTION,,,29,,NW,,,,,,$253.42,$0.00,1,1,1,0,0,1,20171001, J1740,HCPCS,IBANDRONATE SODIUM INJECTION,,,29,,NW,,,,,,$242.96,$0.00,1,1,1,0,0,1,20171001, J1741,HCPCS,IBUPROFEN INJECTION,,,29,,NW,,,,,,$12.01,$0.00,1,1,1,0,0,1,20171001, J1742,HCPCS,IBUTILIDE FUMARATE INJECTION,,,29,,NW,,,,,,$254.22,$0.00,1,1,1,0,0,1,20171001, J1743,HCPCS,IDURSULFASE INJECTION,,,29,,NW,,,,,,"$1,183.24",$0.00,1,1,1,0,0,1,20171001, J1744,HCPCS,ICATIBANT INJECTION,,,29,,NW,,,,,,$646.35,$0.00,1,1,1,0,0,1,20171001, J1745,HCPCS,INFLIXIMAB NOT BIOSIMIL 10MG,,,29,,NW,,,,,,$192.29,$0.00,1,1,1,0,0,1,20171001, J1750,HCPCS,INJ IRON DEXTRAN,,,29,,NW,,,,,,$36.24,$0.00,1,1,1,0,0,1,20171001, J1756,HCPCS,IRON SUCROSE INJECTION,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J1786,HCPCS,IMUGLUCERASE INJECTION,,,29,,NW,,,,,,$103.01,$0.00,1,1,1,0,0,1,20171001, J1790,HCPCS,DROPERIDOL INJECTION,,,29,,NW,,,,,,$16.14,$0.00,1,1,1,0,0,1,20171001, J1800,HCPCS,PROPRANOLOL INJECTION,,,29,,NW,,,,,,$15.33,$0.00,1,1,1,0,0,1,20171001, J1810,HCPCS,DROPERIDOL/FENTANYL INJ,,,29,,NW,,,,,,$151.59,$0.00,1,1,1,0,0,1,20171001, J1815,HCPCS,INSULIN INJECTION,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J1817,HCPCS,INSULIN FOR INSULIN PUMP USE,,,29,,NW,,,,,,$27.40,$0.00,1,1,1,0,0,1,20171001, J1826,HCPCS,INTERFERON BETA-1A INJ,,,29,,NW,,,,,,"$1,409.26",$0.00,1,1,1,0,0,1,20171001, J1830,HCPCS,INTERFERON BETA-1B / .25 MG,,,29,,NW,,,,,,$435.44,$0.00,1,1,1,0,0,1,20171001, J1833,HCPCS,"INJECTION, ISAVUCONAZONIUM",,,29,,NW,,,,,,$2.06,$0.00,1,1,1,0,0,1,20171001, J1835,HCPCS,ITRACONAZOLE INJECTION,,,29,,NW,,,,,,"$2,270.71",$0.00,1,1,1,0,0,1,20171001, J1840,HCPCS,KANAMYCIN SULFATE 500 MG INJ,,,29,,NW,,,,,,$20.96,$0.00,1,1,1,0,0,1,20171001, J1850,HCPCS,KANAMYCIN SULFATE 75 MG INJ,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J1885,HCPCS,KETOROLAC TROMETHAMINE INJ,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J1890,HCPCS,CEPHALOTHIN SODIUM INJECTION,,,29,,NW,,,,,,$20.24,$0.00,1,1,1,0,0,1,20171001, J1930,HCPCS,LANREOTIDE INJECTION,,,29,,NW,,,,,,$117.48,$0.00,1,1,1,0,0,1,20171001, J1931,HCPCS,LARONIDASE INJECTION,,,29,,NW,,,,,,$75.66,$0.00,1,1,1,0,0,1,20171001, J1940,HCPCS,FUROSEMIDE INJECTION,,,29,,NW,,,,,,$19.35,$0.00,1,1,1,0,0,1,20171001, J1945,HCPCS,LEPIRUDIN,,,29,,NW,,,,,,$370.05,$0.00,1,1,1,0,0,1,20171001, J1950,HCPCS,LEUPROLIDE ACETATE /3.75 MG,,,29,,NW,,,,,,"$2,108.23",$0.00,1,1,1,0,0,1,20171001, J1953,HCPCS,LEVETIRACETAM INJECTION,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J1955,HCPCS,INJ LEVOCARNITINE PER 1 GM,,,29,,NW,,,,,,$53.14,$0.00,1,1,1,0,0,1,20171001, J1956,HCPCS,LEVOFLOXACIN INJECTION,,,29,,NW,,,,,,$14.53,$0.00,1,1,1,0,0,1,20171001, J1960,HCPCS,LEVORPHANOL TARTRATE INJ,,,29,,NW,,,,,,$16.14,$0.00,1,1,1,0,0,1,20171001, J1980,HCPCS,HYOSCYAMINE SULFATE INJ,,,29,,NW,,,,,,$64.40,$0.00,1,1,1,0,0,1,20171001, J1990,HCPCS,CHLORDIAZEPOXIDE INJECTION,,,29,,NW,,,,,,$58.77,$0.00,1,1,1,0,0,1,20171001, J2001,HCPCS,LIDOCAINE INJECTION,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J2010,HCPCS,LINCOMYCIN INJECTION,,,29,,NW,,,,,,$33.83,$0.00,1,1,1,0,0,1,20171001, J2020,HCPCS,LINEZOLID INJECTION,,,29,,NW,,,,,,$48.31,$0.00,1,1,1,0,0,1,20171001, J2060,HCPCS,LORAZEPAM INJECTION,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J2150,HCPCS,MANNITOL INJECTION,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J2170,HCPCS,MECASERMIN INJECTION,,,29,,NW,,,,,,$25.79,$0.00,1,1,1,0,0,1,20171001, J2175,HCPCS,MEPERIDINE HYDROCHL /100 MG,,,29,,NW,,,,,,$18.55,$0.00,1,1,1,0,0,1,20171001, J2180,HCPCS,MEPERIDINE/PROMETHAZINE INJ,,,29,,NW,,,,,,$27.40,$0.00,1,1,1,0,0,1,20171001, J2182,HCPCS,"INJECTION, MEPOLIZUMAB, 1MG",,,29,,NW,,,,,,$25.00,$0.00,1,1,1,0,0,1,20171001, J2185,HCPCS,MEROPENEM,,,29,,NW,,,,,,$12.11,$0.00,1,1,1,0,0,1,20171001, J2210,HCPCS,METHYLERGONOVIN MALEATE INJ,,,29,,NW,,,,,,$24.98,$0.00,1,1,1,0,0,1,20171001, J2212,HCPCS,METHYLNALTREXONE INJECTION,,,29,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20171001, J2248,HCPCS,MICAFUNGIN SODIUM INJECTION,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J2250,HCPCS,INJ MIDAZOLAM HYDROCHLORIDE,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J2260,HCPCS,INJ MILRINONE LACTATE / 5 MG,,,29,,NW,,,,,,$110.24,$0.00,1,1,1,0,0,1,20171001, J2265,HCPCS,MINOCYCLINE HYDROCHLORIDE,,,29,,NW,,,,,,$1.58,$0.00,1,1,1,0,0,1,20171001, J2270,HCPCS,MORPHINE SULFATE INJECTION,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J2274,HCPCS,IN MORPHINE PRESERVATIV FREE,,,29,,NW,,,,,,$27.40,$0.00,1,1,1,0,0,1,20171001, J2278,HCPCS,ZICONOTIDE INJECTION,,,29,,NW,,,,,,$24.98,$0.00,1,1,1,0,0,1,20171001, J2280,HCPCS,"INJ, MOXIFLOXACIN 100 MG",,,29,,NW,,,,,,$27.40,$0.00,1,1,1,0,0,1,20171001, J2300,HCPCS,INJ NALBUPHINE HYDROCHLORIDE,,,29,,NW,,,,,,$14.53,$0.00,1,1,1,0,0,1,20171001, J2310,HCPCS,INJ NALOXONE HYDROCHLORIDE,,,29,,NW,,,,,,$78.07,$0.00,1,1,1,0,0,1,20171001, J2315,HCPCS,"NALTREXONE, DEPOT FORM",,,29,,NW,,,,,,$16.14,$0.00,1,1,1,0,0,1,20171001, J2320,HCPCS,NANDROLONE DECANOATE 50 MG,,,29,,NW,,,,,,$18.55,$0.00,1,1,1,0,0,1,20171001, J2323,HCPCS,NATALIZUMAB INJECTION,,,29,,NW,,,,,,$47.51,$0.00,1,1,1,0,0,1,20171001, J2325,HCPCS,NESIRITIDE INJECTION,,,29,,NW,,,,,,$81.29,$0.00,1,1,1,0,0,1,20171001, J2353,HCPCS,"OCTREOTIDE INJECTION, DEPOT",,,29,,NW,,,,,,$369.24,$0.00,1,1,1,0,0,1,20171001, J2354,HCPCS,"OCTREOTIDE INJ, NON-DEPOT",,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J2355,HCPCS,OPRELVEKIN INJECTION,,,29,,NW,,,,,,$997.43,$0.00,1,1,1,0,0,1,20171001, J2357,HCPCS,OMALIZUMAB INJECTION,,,29,,NW,,,,,,$78.87,$0.00,1,1,1,0,0,1,20171001, J2358,HCPCS,OLANZAPINE LONG-ACTING INJ,,,29,,NW,,,,,,$15.33,$0.00,1,1,1,0,0,1,20171001, J2360,HCPCS,ORPHENADRINE INJECTION,,,29,,NW,,,,,,$20.16,$0.00,1,1,1,0,0,1,20171001, J2370,HCPCS,PHENYLEPHRINE HCL INJECTION,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J2400,HCPCS,CHLOROPROCAINE HCL INJECTION,,,29,,NW,,,,,,$60.38,$0.00,1,1,1,0,0,1,20171001, J2405,HCPCS,ONDANSETRON HCL INJECTION,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J2407,HCPCS,"INJECTION, ORITAVANCIN",,,29,,NW,,,,,,$64.40,$0.00,1,1,1,0,0,1,20171001, J2410,HCPCS,OXYMORPHONE HCL INJECTION,,,29,,NW,,,,,,$15.33,$0.00,1,1,1,0,0,1,20171001, J2425,HCPCS,PALIFERMIN INJECTION,,,29,,NW,,,,,,$45.90,$0.00,1,1,1,0,0,1,20171001, J2426,HCPCS,PALIPERIDONE PALMITATE INJ,,,29,,NW,,,,,,$28.20,$0.00,1,1,1,0,0,1,20171001, J2430,HCPCS,PAMIDRONATE DISODIUM /30 MG,,,29,,NW,,,,,,$36.24,$0.00,1,1,1,0,0,1,20171001, J2440,HCPCS,PAPAVERIN HCL INJECTION,,,29,,NW,,,,,,$15.33,$0.00,1,1,1,0,0,1,20171001, J2460,HCPCS,OXYTETRACYCLINE INJECTION,,,29,,NW,,,,,,$2.36,$0.00,1,1,1,0,0,1,20171001, J2469,HCPCS,PALONOSETRON HCL,,,29,,NW,,,,,,$58.77,$0.00,1,1,1,0,0,1,20171001, J2501,HCPCS,PARICALCITOL,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J2502,HCPCS,"INJ, PASIREOTIDE LONG ACTING",,,29,,NW,,,,,,$887.42,$0.00,1,1,1,0,0,1,20171001, J2503,HCPCS,PEGAPTANIB SODIUM INJECTION,,,29,,NW,,,,,,"$2,378.49",$0.00,1,1,1,0,0,1,20171001, J2504,HCPCS,"PEGADEMASE BOVINE, 25 IU",,,29,,NW,,,,,,$641.11,$0.00,1,1,1,0,0,1,20171001, J2505,HCPCS,"INJECTION, PEGFILGRASTIM 6MG",,,29,,NW,,,,,,"$8,766.57",$0.00,1,1,1,0,0,1,20171001, J2507,HCPCS,PEGLOTICASE INJECTION,,,29,,NW,,,,,,"$3,108.83",$0.00,1,1,1,0,0,1,20171001, J2510,HCPCS,PENICILLIN G PROCAINE INJ,,,29,,NW,,,,,,$60.38,$0.00,1,1,1,0,0,1,20171001, J2513,HCPCS,PENTASTARCH 10% SOLUTION,,,29,,NW,,,,,,$10.24,$0.00,1,1,1,0,0,1,20171001, J2515,HCPCS,PENTOBARBITAL SODIUM INJ,,,29,,NW,,,,,,$106.22,$0.00,1,1,1,0,0,1,20171001, J2540,HCPCS,PENICILLIN G POTASSIUM INJ,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J2543,HCPCS,PIPERACILLIN/TAZOBACTAM,,,29,,NW,,,,,,$15.33,$0.00,1,1,1,0,0,1,20171001, J2545,HCPCS,PENTAMIDINE NON-COMP UNIT,,,29,,NW,,,,,,$251.81,$0.00,1,1,1,0,0,1,20171001, J2547,HCPCS,"INJECTION, PERAMIVIR",,,29,,NW,,,,,,$7.93,$0.00,1,1,1,0,0,1,20171001, J2550,HCPCS,PROMETHAZINE HCL INJECTION,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J2560,HCPCS,PHENOBARBITAL SODIUM INJ,,,29,,NW,,,,,,$75.66,$0.00,1,1,1,0,0,1,20171001, J2562,HCPCS,PLERIXAFOR INJECTION,,,29,,NW,,,,,,$701.44,$0.00,1,1,1,0,0,1,20171001, J2590,HCPCS,OXYTOCIN INJECTION,,,29,,NW,,,,,,$17.74,$0.00,1,1,1,0,0,1,20171001, J2597,HCPCS,INJ DESMOPRESSIN ACETATE,,,29,,NW,,,,,,$40.27,$0.00,1,1,1,0,0,1,20171001, J2650,HCPCS,PREDNISOLONE ACETATE INJ,,,29,,NW,,,,,,$7.88,$0.00,1,1,1,0,0,1,20171001, J2670,HCPCS,TOTAZOLINE HCL INJECTION,,,29,,NW,,,,,,$13.06,$0.00,1,1,1,0,0,1,20171001, J2675,HCPCS,INJ PROGESTERONE PER 50 MG,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J2680,HCPCS,FLUPHENAZINE DECANOATE 25 MG,,,29,,NW,,,,,,$57.16,$0.00,1,1,1,0,0,1,20171001, J2690,HCPCS,PROCAINAMIDE HCL INJECTION,,,29,,NW,,,,,,$122.31,$0.00,1,1,1,0,0,1,20171001, J2700,HCPCS,OXACILLIN SODIUM INJECITON,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J2704,HCPCS,"INJ, PROPOFOL, 10 MG",,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J2710,HCPCS,NEOSTIGMINE METHYLSLFTE INJ,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J2720,HCPCS,INJ PROTAMINE SULFATE/10 MG,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J2724,HCPCS,PROTEIN C CONCENTRATE,,,29,,NW,,,,,,$42.68,$0.00,1,1,1,0,0,1,20171001, J2725,HCPCS,INJ PROTIRELIN PER 250 MCG,,,29,,NW,,,,,,$115.67,$0.00,1,1,1,0,0,1,20171001, J2730,HCPCS,PRALIDOXIME CHLORIDE INJ,,,29,,NW,,,,,,$205.16,$0.00,1,1,1,0,0,1,20171001, J2760,HCPCS,PHENTOLAINE MESYLATE INJ,,,29,,NW,,,,,,$131.16,$0.00,1,1,1,0,0,1,20171001, J2765,HCPCS,METOCLOPRAMIDE HCL INJECTION,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J2770,HCPCS,QUINUPRISTIN/DALFOPRISTIN,,,29,,NW,,,,,,$755.33,$0.00,1,1,1,0,0,1,20171001, J2778,HCPCS,RANIBIZUMAB INJECTION,,,29,,NW,,,,,,$876.78,$0.00,1,1,1,0,0,1,20171001, J2780,HCPCS,RANITIDINE HYDROCHLORIDE INJ,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J2783,HCPCS,RASBURICASE,,,29,,NW,,,,,,$552.63,$0.00,1,1,1,0,0,1,20171001, J2785,HCPCS,REGADENOSON INJECTION,,,29,,NW,,,,,,$130.35,$0.00,1,1,1,0,0,1,20171001, J2788,HCPCS,RHO D IMMUNE GLOBULIN 50 MCG,,,29,,NW,,,,,,$66.81,$0.00,1,1,1,0,0,1,20171001, J2790,HCPCS,RHO D IMMUNE GLOBULIN INJ,,,29,,NW,,,,,,$197.11,$0.00,1,1,1,0,0,1,20171001, J2791,HCPCS,RHOPHYLAC INJECTION,,,29,,NW,,,,,,$19.35,$0.00,1,1,1,0,0,1,20171001, J2792,HCPCS,"RHO(D) IMMUNE GLOBULIN H, SD",,,29,,NW,,,,,,$54.74,$0.00,1,1,1,0,0,1,20171001, J2793,HCPCS,RILONACEPT INJECTION,,,29,,NW,,,,,,$60.38,$0.00,1,1,1,0,0,1,20171001, J2794,HCPCS,"RISPERIDONE, LONG ACTING",,,29,,NW,,,,,,$24.98,$0.00,1,1,1,0,0,1,20171001, J2795,HCPCS,ROPIVACAINE HCL INJECTION,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J2796,HCPCS,ROMIPLOSTIM INJECTION,,,29,,NW,,,,,,$143.22,$0.00,1,1,1,0,0,1,20171001, J2800,HCPCS,METHOCARBAMOL INJECTION,,,29,,NW,,,,,,$99.79,$0.00,1,1,1,0,0,1,20171001, J2805,HCPCS,SINCALIDE INJECTION,,,29,,NW,,,,,,$214.81,$0.00,1,1,1,0,0,1,20171001, J2810,HCPCS,INJ THEOPHYLLINE PER 40 MG,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J2820,HCPCS,SARGRAMOSTIM INJECTION,,,29,,NW,,,,,,$87.72,$0.00,1,1,1,0,0,1,20171001, J2850,HCPCS,INJ SECRETIN SYNTHETIC HUMAN,,,29,,NW,,,,,,$86.92,$0.00,1,1,1,0,0,1,20171001, J2860,HCPCS,"INJECTION, SILTUXIMAB",,,29,,NW,,,,,,$41.24,$0.00,1,1,1,0,0,1,20171001, J2910,HCPCS,AUROTHIOGLUCOSE INJECITON,,,29,,NW,,,,,,$87.31,$0.00,1,1,1,0,0,1,20171001, J2916,HCPCS,NA FERRIC GLUCONATE COMPLEX,,,29,,NW,,,,,,$14.53,$0.00,1,1,1,0,0,1,20171001, J2920,HCPCS,METHYLPREDNISOLONE INJECTION,,,29,,NW,,,,,,$15.33,$0.00,1,1,1,0,0,1,20171001, J2930,HCPCS,METHYLPREDNISOLONE INJECTION,,,29,,NW,,,,,,$18.55,$0.00,1,1,1,0,0,1,20171001, J2940,HCPCS,SOMATREM INJECTION,,,29,,NW,,,,,,$142.14,$0.00,1,1,1,0,0,1,20171001, J2941,HCPCS,SOMATROPIN INJECTION,,,29,,NW,,,,,,$116.68,$0.00,1,1,1,0,0,1,20171001, J2950,HCPCS,PROMAZINE HCL INJECTION,,,29,,NW,,,,,,$29.23,$0.00,1,1,1,0,0,1,20171001, J2993,HCPCS,RETEPLASE INJECTION,,,29,,NW,,,,,,"$2,742.85",$0.00,1,1,1,0,0,1,20171001, J2995,HCPCS,INJ STREPTOKINASE /250000 IU,,,29,,NW,,,,,,$185.85,$0.00,1,1,1,0,0,1,20171001, J2997,HCPCS,ALTEPLASE RECOMBINANT,,,29,,NW,,,,,,$177.00,$0.00,1,1,1,0,0,1,20171001, J3000,HCPCS,STREPTOMYCIN INJECTION,,,29,,NW,,,,,,$35.44,$0.00,1,1,1,0,0,1,20171001, J3010,HCPCS,FENTANYL CITRATE INJECITON,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J3030,HCPCS,SUMATRIPTAN SUCCINATE / 6 MG,,,29,,NW,,,,,,$137.59,$0.00,1,1,1,0,0,1,20171001, J3060,HCPCS,"INJ, TALIGLUCERACE ALFA 10 U",,,29,,NW,,,,,,$95.77,$0.00,1,1,1,0,0,1,20171001, J3070,HCPCS,PENTAZOCINE INJECTION,,,29,,NW,,,,,,$290.42,$0.00,1,1,1,0,0,1,20171001, J3090,HCPCS,INJ TEDIZOLID PHOSPHATE,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J3095,HCPCS,TELAVANCIN INJECTION,,,29,,NW,,,,,,$20.96,$0.00,1,1,1,0,0,1,20171001, J3101,HCPCS,TENECTEPLASE INJECTION,,,29,,NW,,,,,,$219.63,$0.00,1,1,1,0,0,1,20171001, J3105,HCPCS,TERBUTALINE SULFATE INJ,,,29,,NW,,,,,,$12.11,$0.00,1,1,1,0,0,1,20171001, J3110,HCPCS,TERIPARATIDE INJECTION,,,29,,NW,,,,,,$28.20,$0.00,1,1,1,0,0,1,20171001, J3121,HCPCS,INJ TESTOSTERO ENANTHATE 1MG,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J3145,HCPCS,TESTOSTERONE UNDECANOATE 1MG,,,29,,NW,,,,,,$1.85,$0.00,1,1,1,0,0,1,20171001, J3230,HCPCS,CHLORPROMAZINE HCL INJECTION,,,29,,NW,,,,,,$64.40,$0.00,1,1,1,0,0,1,20171001, J3240,HCPCS,THYROTROPIN INJECTION,,,29,,NW,,,,,,"$3,284.18",$0.00,1,1,1,0,0,1,20171001, J3243,HCPCS,TIGECYCLINE INJECTION,,,29,,NW,,,,,,$14.53,$0.00,1,1,1,0,0,1,20171001, J3246,HCPCS,TIROFIBAN HCL,,,29,,NW,,,,,,$29.01,$0.00,1,1,1,0,0,1,20171001, J3250,HCPCS,TRIMETHOBENZAMIDE HCL INJ,,,29,,NW,,,,,,$61.98,$0.00,1,1,1,0,0,1,20171001, J3260,HCPCS,TOBRAMYCIN SULFATE INJECTION,,,29,,NW,,,,,,$15.33,$0.00,1,1,1,0,0,1,20171001, J3262,HCPCS,TOCILIZUMAB INJECTION,,,29,,NW,,,,,,$17.74,$0.00,1,1,1,0,0,1,20171001, J3265,HCPCS,INJECTION TORSEMIDE 10 MG/ML,,,29,,NW,,,,,,$15.76,$0.00,1,1,1,0,0,1,20171001, J3280,HCPCS,THIETHYLPERAZINE MALEATE INJ,,,29,,NW,,,,,,$20.16,$0.00,1,1,1,0,0,1,20171001, J3285,HCPCS,TREPROSTINIL INJECTION,,,29,,NW,,,,,,$146.44,$0.00,1,1,1,0,0,1,20171001, J3300,HCPCS,TRIAMCINOLONE A INJ PRS-FREE,,,29,,NW,,,,,,$16.94,$0.00,1,1,1,0,0,1,20171001, J3301,HCPCS,TRIAMCINOLONE ACET INJ NOS,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J3302,HCPCS,TRIAMCINOLONE DIACETATE INJ,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J3303,HCPCS,TRIAMCINOLONE HEXACETONL INJ,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J3305,HCPCS,INJ TRIMETREXATE GLUCORONATE,,,29,,NW,,,,,,$118.96,$0.00,1,1,1,0,0,1,20171001, J3310,HCPCS,PERPHENAZINE INJECITON,,,29,,NW,,,,,,$35.24,$0.00,1,1,1,0,0,1,20171001, J3315,HCPCS,TRIPTORELIN PAMOATE,,,29,,NW,,,,,,$536.55,$0.00,1,1,1,0,0,1,20171001, J3320,HCPCS,SPECTINOMYCN DI-HCL INJ,,,29,,NW,,,,,,$95.94,$0.00,1,1,1,0,0,1,20171001, J3350,HCPCS,UREA INJECTION,,,29,,NW,,,,,,$33.31,$0.00,1,1,1,0,0,1,20171001, J3355,HCPCS,"UROFOLLITROPIN, 75 IU",,,29,,NW,,,,,,$156.09,$0.00,1,1,1,0,0,1,20171001, J3357,HCPCS,"USTEKINUMAB SUB CU INJ, 1 MG",,,29,,NW,,,,,,$389.35,$0.00,1,1,1,0,0,1,20171001, J3360,HCPCS,DIAZEPAM INJECTION,,,29,,NW,,,,,,$23.38,$0.00,1,1,1,0,0,1,20171001, J3364,HCPCS,UROKINASE 5000 IU INJECTION,,,29,,NW,,,,,,$26.33,$0.00,1,1,1,0,0,1,20171001, J3365,HCPCS,"UROKINASE 250,000 IU INJ",,,29,,NW,,,,,,"$1,296.27",$0.00,1,1,1,0,0,1,20171001, J3370,HCPCS,VANCOMYCIN HCL INJECTION,,,29,,NW,,,,,,$15.33,$0.00,1,1,1,0,0,1,20171001, J3380,HCPCS,"INJECTION, VEDOLIZUMAB",,,29,,NW,,,,,,$47.51,$0.00,1,1,1,0,0,1,20171001, J3385,HCPCS,VELAGLUCERASE ALFA,,,29,,NW,,,,,,$777.85,$0.00,1,1,1,0,0,1,20171001, J3396,HCPCS,VERTEPORFIN INJECTION,,,29,,NW,,,,,,$33.83,$0.00,1,1,1,0,0,1,20171001, J3400,HCPCS,TRIFLUPROMAZINE HCL INJ,,,29,,NW,,,,,,$43.07,$0.00,1,1,1,0,0,1,20171001, J3410,HCPCS,HYDROXYZINE HCL INJECTION,,,29,,NW,,,,,,$14.53,$0.00,1,1,1,0,0,1,20171001, J3411,HCPCS,THIAMINE HCL 100 MG,,,29,,NW,,,,,,$16.14,$0.00,1,1,1,0,0,1,20171001, J3415,HCPCS,PYRIDOXINE HCL 100 MG,,,29,,NW,,,,,,$30.61,$0.00,1,1,1,0,0,1,20171001, J3420,HCPCS,VITAMIN B12 INJECTION,,,29,,NW,,,,,,$16.94,$0.00,1,1,1,0,0,1,20171001, J3430,HCPCS,VITAMIN K PHYTONADIONE INJ,,,29,,NW,,,,,,$15.33,$0.00,1,1,1,0,0,1,20171001, J3465,HCPCS,"INJECTION, VORICONAZOLE",,,29,,NW,,,,,,$19.35,$0.00,1,1,1,0,0,1,20171001, J3470,HCPCS,HYALURONIDASE INJECTION,,,29,,NW,,,,,,$66.01,$0.00,1,1,1,0,0,1,20171001, J3471,HCPCS,"OVINE, UP TO 999 USP UNITS",,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J3472,HCPCS,"OVINE, 1000 USP UNITS",,,29,,NW,,,,,,$273.53,$0.00,1,1,1,0,0,1,20171001, J3473,HCPCS,HYALURONIDASE RECOMBINANT,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J3475,HCPCS,INJ MAGNESIUM SULFATE,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J3480,HCPCS,INJ POTASSIUM CHLORIDE,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J3485,HCPCS,ZIDOVUDINE,,,29,,NW,,,,,,$12.11,$0.00,1,1,1,0,0,1,20171001, J3486,HCPCS,ZIPRASIDONE MESYLATE,,,29,,NW,,,,,,$43.48,$0.00,1,1,1,0,0,1,20171001, J3489,HCPCS,ZOLEDRONIC ACID 1MG,,,29,,NW,,,,,,$56.35,$0.00,1,1,1,0,0,1,20171001, J3490,HCPCS,DRUGS UNCLASSIFIED INJECTION,,,29,,NW,,,,,,$0.89,$0.00,1,1,1,0,0,1,20171001, J3520,HCPCS,EDETATE DISODIUM PER 150 MG,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J3530,HCPCS,NASAL VACCINE INHALATION,,,29,,NW,,,,,,$57.74,$0.00,1,1,1,0,1,1,20171001, J3535,HCPCS,METERED DOSE INHALER DRUG,,,29,,NW,,,,,,$13.44,$0.00,1,1,1,0,0,1,20171001, J3570,HCPCS,LAETRILE AMYGDALIN VIT B17,,,29,,NW,,,,,,$41.05,$0.00,1,1,1,0,0,1,20171001, J3590,HCPCS,UNCLASSIFIED BIOLOGICS,,,29,,NW,,,,,,$137.27,$0.00,1,1,1,0,0,1,20171001, J7030,HCPCS,NORMAL SALINE SOLUTION INFUS,,,29,,NW,,,,,,$13.72,$0.00,1,1,1,0,0,1,20171001, J7040,HCPCS,NORMAL SALINE SOLUTION INFUS,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J7042,HCPCS,5% DEXTROSE/NORMAL SALINE,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J7050,HCPCS,NORMAL SALINE SOLUTION INFUS,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J7060,HCPCS,5% DEXTROSE/WATER,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J7070,HCPCS,D5W INFUSION,,,29,,NW,,,,,,$16.14,$0.00,1,1,1,0,0,1,20171001, J7100,HCPCS,DEXTRAN 40 INFUSION,,,29,,NW,,,,,,$197.11,$0.00,1,1,1,0,0,1,20171001, J7110,HCPCS,DEXTRAN 75 INFUSION,,,29,,NW,,,,,,$123.82,$0.00,1,1,1,0,0,1,20171001, J7120,HCPCS,RINGERS LACTATE INFUSION,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J7121,HCPCS,5% DEXTROSE IN LAC RINGERS,,,29,,NW,,,,,,$27.21,$0.00,1,1,1,0,0,1,20171001, J7131,HCPCS,HYPERTONIC SALINE SOL,,,29,,NW,,,,,,$4.33,$0.00,1,1,1,0,0,1,20171001, J7178,HCPCS,HUMAN FIBRINOGEN CONC INJ,,,29,,NW,,,,,,$1.13,$0.00,1,1,1,0,0,1,20171001, J7180,HCPCS,FACTOR XIII ANTI-HEM FACTOR,,,29,,NW,,,,,,$26.59,$0.00,1,1,1,0,0,1,20171001, J7181,HCPCS,FACTOR XIII RECOMB A-SUBUNIT,,,29,,NW,,,,,,$22.27,$0.00,1,1,1,0,0,1,20171001, J7182,HCPCS,FACTOR VIII RECOMB NOVOEIGHT,,,29,,NW,,,,,,$12.11,$0.00,1,1,1,0,0,1,20171001, J7183,HCPCS,WILATE INJECTION,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J7185,HCPCS,XYNTHA INJ,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J7186,HCPCS,ANTIHEMOPHILIC VIII/VWF COMP,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J7187,HCPCS,"HUMATE-P, INJ",,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J7188,HCPCS,FACTOR VIII RECOMB OBIZUR,,,29,,NW,,,,,,$14.86,$0.00,1,1,1,0,0,1,20171001, J7189,HCPCS,FACTOR VIIA,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J7190,HCPCS,FACTOR VIII,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J7191,HCPCS,FACTOR VIII (PORCINE),,,29,,NW,,,,,,$6.95,$0.00,1,1,1,0,0,1,20171001, J7192,HCPCS,FACTOR VIII RECOMBINANT NOS,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J7193,HCPCS,FACTOR IX NON-RECOMBINANT,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J7194,HCPCS,FACTOR IX COMPLEX,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J7195,HCPCS,FACTOR IX RECOMBINANT NOS,,,29,,NW,,,,,,$12.11,$0.00,1,1,1,0,0,1,20171001, J7196,HCPCS,ANTITHROMBIN RECOMBINANT,,,29,,NW,,,,,,$9.17,$0.00,1,1,1,0,0,1,20171001, J7197,HCPCS,ANTITHROMBIN III INJECTION,,,29,,NW,,,,,,$16.94,$0.00,1,1,1,0,0,1,20171001, J7198,HCPCS,ANTI-INHIBITOR,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J7199,HCPCS,HEMOPHILIA CLOT FACTOR NOC,,,29,,NW,,,,,,$1.52,$0.00,1,1,1,0,0,1,20171001, J7200,HCPCS,FACTOR IX RECOMBINAN RIXUBIS,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J7201,HCPCS,FACTOR IX ALPROLIX RECOMB,,,29,,NW,,,,,,$15.33,$0.00,1,1,1,0,0,1,20171001, J7205,HCPCS,FACTOR VIII FC FUSION RECOMB,,,29,,NW,,,,,,$12.92,$0.00,1,1,1,0,0,1,20171001, J7297,HCPCS,"LILETTA, 52 MG",,,29,,NW,,,,,,"$1,057.99",$0.00,1,1,1,0,0,1,20171001, J7298,HCPCS,"MIRENA, 52 MG",,,29,,NW,,,,,,"$1,057.99",$0.00,1,1,1,0,0,1,20171001, J7300,HCPCS,INTRAUT COPPER CONTRACEPTIVE,,,29,,NW,,,,,,$906.54,$0.00,1,1,1,1,1,1,20171001, J7301,HCPCS,"SKYLA, 13.5 MG",,,29,,NW,,,,,,"$1,665.60",$0.00,1,1,1,1,1,1,20171001, J7303,HCPCS,CONTRACEPTIVE VAGINAL RING,,,29,,NW,,,,,,$95.77,$0.00,1,1,1,1,1,1,20171001, J7304,HCPCS,CONTRACEPTIVE HORMONE PATCH,,,29,,NW,,,,,,$76.38,$0.00,1,1,1,1,1,1,20171001, J7306,HCPCS,LEVONORGESTREL IMPLANT SYS,,,29,,NW,,,,,,$943.54,$0.00,1,1,1,1,1,1,20171001, J7307,HCPCS,ETONOGESTREL IMPLANT SYSTEM,,,29,,NW,,,,,,"$1,687.08",$0.00,1,1,1,1,1,1,20171001, J7308,HCPCS,AMINOLEVULINIC ACID HCL TOP,,,29,,NW,,,,,,$744.07,$0.00,1,1,1,0,0,1,20171001, J7309,HCPCS,"METHYL AMINOLEVULINATE, TOP",,,29,,NW,,,,,,$223.12,$0.00,1,1,1,0,0,1,20171001, J7310,HCPCS,GANCICLOVIR LONG ACT IMPLANT,,,29,,NW,,,,,,"$10,215.99",$0.00,1,1,1,0,0,1,20171001, J7311,HCPCS,FLUOCINOLONE ACETONIDE IMPLT,,,29,,NW,,,,,,"$45,245.06",$0.00,1,1,1,0,0,1,20171001, J7312,HCPCS,DEXAMETHASONE INTRA IMPLANT,,,29,,NW,,,,,,$460.94,$0.00,1,1,1,0,0,1,20171001, J7313,HCPCS,FLUOCINOL ACET INTRAVIT IMP,,,29,,NW,,,,,,"$1,111.65",$0.00,1,1,1,0,0,1,20171001, J7315,HCPCS,OPHTHALMIC MITOMYCIN,,,29,,NW,,,,,,$719.18,$0.00,1,1,1,0,0,1,20171001, J7316,HCPCS,"INJ, OCRIPLASMIN, 0.125 MG",,,29,,NW,,,,,,"$2,360.79",$0.00,1,1,1,0,0,1,20171001, J7321,HCPCS,HYALGAN/SUPARTZ INJ PER DOSE,,,29,,NW,,,,,,$207.57,$0.00,1,1,1,0,0,1,20171001, J7323,HCPCS,EUFLEXXA INJ PER DOSE,,,29,,NW,,,,,,$361.20,$0.00,1,1,1,0,0,1,20171001, J7324,HCPCS,ORTHOVISC INJ PER DOSE,,,29,,NW,,,,,,$386.13,$0.00,1,1,1,0,0,1,20171001, J7325,HCPCS,SYNVISC OR SYNVISC-ONE,,,29,,NW,,,,,,$37.85,$0.00,1,1,1,0,0,1,20171001, J7326,HCPCS,GEL-ONE,,,29,,NW,,,,,,"$1,293.43",$0.00,1,1,1,0,0,1,20171001, J7327,HCPCS,MONOVISC INJ PER DOSE,,,29,,NW,,,,,,"$2,108.23",$0.00,1,1,1,0,0,1,20171001, J7328,HCPCS,GEL-SYN INJECTION 0.1 MG,,,29,,NW,,,,,,$1.07,$0.00,1,1,1,0,0,1,20171001, J7330,HCPCS,CULTURED CHONDROCYTES IMPLNT,,,29,,NW,,,,,,"$78,747.07",$0.00,1,1,1,0,0,1,20171001, J7336,HCPCS,CAPSAICIN 8% PATCH,,,29,,NW,,,,,,$15.33,$0.00,1,1,1,0,0,1,20171001, J7340,HCPCS,CARBIDOPA LEVODOPA ENT 100ML,,,29,,NW,,,,,,$6.48,$0.00,1,1,1,0,0,1,20171001, J7342,HCPCS,CIPROFLOXACIN OTIC SUSP 6 MG,,,29,,NW,,,,,,$204.03,$0.00,1,1,1,0,0,1,20171001, J7500,HCPCS,AZATHIOPRINE ORAL 50MG,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J7501,HCPCS,AZATHIOPRINE PARENTERAL,,,29,,NW,,,,,,$163.33,$0.00,1,1,1,0,0,1,20171001, J7502,HCPCS,CYCLOSPORINE ORAL 100 MG,,,29,,NW,,,,,,$16.94,$0.00,1,1,1,0,0,1,20171001, J7503,HCPCS,TACROL ENVARSUS EX REL ORAL,,,29,,NW,,,,,,$7.01,$0.00,1,1,1,0,0,1,20171001, J7504,HCPCS,LYMPHOCYTE IMMUNE GLOBULIN,,,29,,NW,,,,,,"$2,563.49",$0.00,1,1,1,0,0,1,20171001, J7505,HCPCS,MONOCLONAL ANTIBODIES,,,29,,NW,,,,,,"$2,168.55",$0.00,1,1,1,0,0,1,20171001, J7507,HCPCS,TACROLIMUS IMME REL ORAL 1MG,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J7508,HCPCS,TACROL ASTAGRAF EX REL ORAL,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J7509,HCPCS,METHYLPREDNISOLONE ORAL,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J7510,HCPCS,PREDNISOLONE ORAL PER 5 MG,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J7511,HCPCS,ANTITHYMOCYTE GLOBULN RABBIT,,,29,,NW,,,,,,"$1,467.97",$0.00,1,1,1,0,0,1,20171001, J7512,HCPCS,PREDNISONE IR OR DR ORAL 1MG,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J7513,HCPCS,"DACLIZUMAB, PARENTERAL",,,29,,NW,,,,,,$941.13,$0.00,1,1,1,0,0,1,20171001, J7515,HCPCS,CYCLOSPORINE ORAL 25 MG,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J7516,HCPCS,CYCLOSPORIN PARENTERAL 250MG,,,29,,NW,,,,,,$98.18,$0.00,1,1,1,0,0,1,20171001, J7517,HCPCS,MYCOPHENOLATE MOFETIL ORAL,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, J7518,HCPCS,MYCOPHENOLIC ACID,,,29,,NW,,,,,,$16.14,$0.00,1,1,1,0,0,1,20171001, J7520,HCPCS,"SIROLIMUS, ORAL",,,29,,NW,,,,,,$29.81,$0.00,1,1,1,0,0,1,20171001, J7525,HCPCS,TACROLIMUS INJECTION,,,29,,NW,,,,,,$377.29,$0.00,1,1,1,0,0,1,20171001, J7527,HCPCS,ORAL EVEROLIMUS,,,29,,NW,,,,,,$25.79,$0.00,1,1,1,0,0,1,20171001, J7599,HCPCS,IMMUNOSUPPRESSIVE DRUG NOC,,,29,,NW,,,,,,$8.78,$0.00,1,1,1,0,0,1,20171001, J7604,HCPCS,ACETYLCYSTEINE COMP UNIT,,,29,,NW,,,,,,$21.76,$0.00,1,1,1,0,0,1,20171001, J7605,HCPCS,ARFORMOTEROL NON-COMP UNIT,,,29,,NW,,,,,,$28.20,$0.00,1,1,1,0,0,1,20171001, J7606,HCPCS,"FORMOTEROL FUMARATE, INH",,,29,,NW,,,,,,$30.61,$0.00,1,1,1,0,0,1,20171001, J7607,HCPCS,LEVALBUTEROL COMP CON,,,29,,NW,,,,,,$40.93,$0.00,1,1,1,0,0,1,20171001, J7608,HCPCS,ACETYLCYSTEINE NON-COMP UNIT,,,29,,NW,,,,,,$20.96,$0.00,1,1,1,0,0,1,20171001, J7609,HCPCS,ALBUTEROL COMP UNIT,,,29,,NW,,,,,,$16.40,$0.00,1,1,1,0,0,1,20171001, J7610,HCPCS,ALBUTEROL COMP CON,,,29,,NW,,,,,,$16.24,$0.00,1,1,1,0,0,1,20171001, J7611,HCPCS,ALBUTEROL NON-COMP CON,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J7612,HCPCS,LEVALBUTEROL NON-COMP CON,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J7613,HCPCS,ALBUTEROL NON-COMP UNIT,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J7614,HCPCS,LEVALBUTEROL NON-COMP UNIT,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J7615,HCPCS,LEVALBUTEROL COMP UNIT,,,29,,NW,,,,,,$13.72,$0.00,1,1,1,0,0,1,20171001, J7620,HCPCS,ALBUTEROL IPRATROP NON-COMP,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J7622,HCPCS,BECLOMETHASONE COMP UNIT,,,29,,NW,,,,,,$15.86,$0.00,1,1,1,0,0,1,20171001, J7624,HCPCS,BETAMETHASONE COMP UNIT,,,29,,NW,,,,,,$4.59,$0.00,1,1,1,0,0,1,20171001, J7626,HCPCS,BUDESONIDE NON-COMP UNIT,,,29,,NW,,,,,,$19.35,$0.00,1,1,1,0,0,1,20171001, J7627,HCPCS,BUDESONIDE COMP UNIT,,,29,,NW,,,,,,$20.16,$0.00,1,1,1,0,0,1,20171001, J7628,HCPCS,BITOLTEROL MESYLATE COMP CON,,,29,,NW,,,,,,$6.44,$0.00,1,1,1,0,0,1,20171001, J7629,HCPCS,BITOLTEROL MESYLATE COMP UNT,,,29,,NW,,,,,,$6.44,$0.00,1,1,1,0,0,1,20171001, J7631,HCPCS,CROMOLYN SODIUM NONCOMP UNIT,,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, J7632,HCPCS,CROMOLYN SODIUM COMP UNIT,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J7633,HCPCS,BUDESONIDE NON-COMP CON,,,29,,NW,,,,,,$25.36,$0.00,1,1,1,0,0,1,20171001, J7634,HCPCS,BUDESONIDE COMP CON,,,29,,NW,,,,,,$53.54,$0.00,1,1,1,0,0,1,20171001, J7635,HCPCS,ATROPINE COMP CON,,,29,,NW,,,,,,$40.09,$0.00,1,1,1,0,0,1,20171001, J7636,HCPCS,ATROPINE COMP UNIT,,,29,,NW,,,,,,$28.65,$0.00,1,1,1,0,0,1,20171001, J7637,HCPCS,DEXAMETHASONE COMP CON,,,29,,NW,,,,,,$1.39,$0.00,1,1,1,0,0,1,20171001, J7638,HCPCS,DEXAMETHASONE COMP UNIT,,,29,,NW,,,,,,$1.39,$0.00,1,1,1,0,0,1,20171001, J7639,HCPCS,DORNASE ALFA NON-COMP UNIT,,,29,,NW,,,,,,$96.57,$0.00,1,1,1,0,0,1,20171001, J7640,HCPCS,FORMOTEROL COMP UNIT,,,29,,NW,,,,,,$27.46,$0.00,1,1,1,0,0,1,20171001, J7641,HCPCS,FLUNISOLIDE COMP UNIT,,,29,,NW,,,,,,$33.83,$0.00,1,1,1,0,0,1,20171001, J7642,HCPCS,GLYCOPYRROLATE COMP CON,,,29,,NW,,,,,,$1.02,$0.00,1,1,1,0,0,1,20171001, J7643,HCPCS,GLYCOPYRROLATE COMP UNIT,,,29,,NW,,,,,,$1.02,$0.00,1,1,1,0,0,1,20171001, J7644,HCPCS,IPRATROPIUM BROMIDE NON-COMP,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J7645,HCPCS,IPRATROPIUM BROMIDE COMP,,,29,,NW,,,,,,$9.45,$0.00,1,1,1,0,0,1,20171001, J7647,HCPCS,ISOETHARINE COMP CON,,,29,,NW,,,,,,$6.99,$0.00,1,1,1,0,0,1,20171001, J7648,HCPCS,ISOETHARINE NON-COMP CON,,,29,,NW,,,,,,$2.36,$0.00,1,1,1,0,0,1,20171001, J7649,HCPCS,ISOETHARINE NON-COMP UNIT,,,29,,NW,,,,,,$2.36,$0.00,1,1,1,0,0,1,20171001, J7650,HCPCS,ISOETHARINE COMP UNIT,,,29,,NW,,,,,,$6.99,$0.00,1,1,1,0,0,1,20171001, J7657,HCPCS,ISOPROTERENOL COMP CON,,,29,,NW,,,,,,$9.51,$0.00,1,1,1,0,0,1,20171001, J7658,HCPCS,ISOPROTERENOL NON-COMP CON,,,29,,NW,,,,,,$13.06,$0.00,1,1,1,0,0,1,20171001, J7659,HCPCS,ISOPROTERENOL NON-COMP UNIT,,,29,,NW,,,,,,$13.06,$0.00,1,1,1,0,0,1,20171001, J7660,HCPCS,ISOPROTERENOL COMP UNIT,,,29,,NW,,,,,,$1.58,$0.00,1,1,1,0,0,1,20171001, J7665,HCPCS,MANNITOL FOR INHALER,,,29,,NW,,,,,,$5.85,$0.00,1,1,1,0,0,1,20171001, J7667,HCPCS,METAPROTERENOL COMP CON,,,29,,NW,,,,,,$12.68,$0.00,1,1,1,0,0,1,20171001, J7668,HCPCS,METAPROTERENOL NON-COMP CON,,,29,,NW,,,,,,$0.27,$0.00,1,1,1,0,0,1,20171001, J7669,HCPCS,METAPROTERENOL NON-COMP UNIT,,,29,,NW,,,,,,$1.30,$0.00,1,1,1,0,0,1,20171001, J7670,HCPCS,METAPROTERENOL COMP UNIT,,,29,,NW,,,,,,$8.22,$0.00,1,1,1,0,0,1,20171001, J7674,HCPCS,"METHACHOLINE CHLORIDE, NEB",,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J7676,HCPCS,PENTAMIDINE COMP UNIT DOSE,,,29,,NW,,,,,,$575.05,$0.00,1,1,1,0,0,1,20171001, J7680,HCPCS,TERBUTALINE SULF COMP CON,,,29,,NW,,,,,,$40.27,$0.00,1,1,1,0,0,1,20171001, J7681,HCPCS,TERBUTALINE SULF COMP UNIT,,,29,,NW,,,,,,$40.27,$0.00,1,1,1,0,0,1,20171001, J7682,HCPCS,TOBRAMYCIN NON-COMP UNIT,,,29,,NW,,,,,,$123.11,$0.00,1,1,1,0,0,1,20171001, J7683,HCPCS,TRIAMCINOLONE COMP CON,,,29,,NW,,,,,,$20.16,$0.00,1,1,1,0,0,1,20171001, J7684,HCPCS,TRIAMCINOLONE COMP UNIT,,,29,,NW,,,,,,$11.95,$0.00,1,1,1,0,0,1,20171001, J7685,HCPCS,TOBRAMYCIN COMP UNIT,,,29,,NW,,,,,,$152.87,$0.00,1,1,1,0,0,1,20171001, J7686,HCPCS,"TREPROSTINIL, NON-COMP UNIT",,,29,,NW,,,,,,"$1,146.24",$0.00,1,1,1,0,0,1,20171001, J7699,HCPCS,INHALATION SOLUTION FOR DME,,,29,,NW,,,,,,$5.45,$0.00,1,1,1,0,0,1,20171001, J7799,HCPCS,NON-INHALATION DRUG FOR DME,,,29,,NW,,,,,,$9.69,$0.00,1,1,1,0,0,1,20171001, J7999,HCPCS,"COMPOUNDED DRUG, NOC",,,29,,NW,,,,,,$3.05,$0.00,1,1,1,0,0,1,20171001, J8498,HCPCS,ANTIEMETIC RECTAL/SUPP NOS,,,29,,NW,,,,,,$1.52,$0.00,1,1,1,0,0,1,20171001, J8499,HCPCS,ORAL PRESCRIP DRUG NON CHEMO,,,29,,NW,,,,,,$1.52,$0.00,1,1,1,0,0,1,20171001, J8501,HCPCS,ORAL APREPITANT,,,29,,NW,,,,,,$31.42,$0.00,1,1,1,0,0,1,20171001, J8510,HCPCS,ORAL BUSULFAN,,,29,,NW,,,,,,$76.23,$0.00,1,1,1,0,0,1,20171001, J8515,HCPCS,"CABERGOLINE, ORAL 0.25MG",,,29,,NW,,,,,,$42.68,$0.00,1,1,1,0,0,1,20171001, J8520,HCPCS,"CAPECITABINE, ORAL, 150 MG",,,29,,NW,,,,,,$23.72,$0.00,1,1,1,0,0,1,20171001, J8521,HCPCS,"CAPECITABINE, ORAL, 500 MG",,,29,,NW,,,,,,$74.54,$0.00,1,1,1,0,0,1,20171001, J8530,HCPCS,CYCLOPHOSPHAMIDE ORAL 25 MG,,,29,,NW,,,,,,$16.94,$0.00,1,1,1,0,0,1,20171001, J8540,HCPCS,ORAL DEXAMETHASONE,,,29,,NW,,,,,,$5.25,$0.00,1,1,1,0,0,1,20171001, J8560,HCPCS,ETOPOSIDE ORAL 50 MG,,,29,,NW,,,,,,$264.60,$0.00,1,1,1,0,0,1,20171001, J8562,HCPCS,ORAL FLUDARABINE PHOSPHATE,,,29,,NW,,,,,,$283.59,$0.00,1,1,1,0,0,1,20171001, J8565,HCPCS,GEFITINIB ORAL,,,29,,NW,,,,,,$137.59,$0.00,1,1,1,0,0,1,20171001, J8597,HCPCS,ANTIEMETIC DRUG ORAL NOS,,,29,,NW,,,,,,$146.35,$0.00,1,1,1,0,0,1,20171001, J8600,HCPCS,MELPHALAN ORAL 2 MG,,,29,,NW,,,,,,$50.82,$0.00,1,1,1,0,0,1,20171001, J8610,HCPCS,METHOTREXATE ORAL 2.5 MG,,,29,,NW,,,,,,$5.08,$0.00,1,1,1,0,0,1,20171001, J8650,HCPCS,NABILONE ORAL,,,29,,NW,,,,,,$46.70,$0.00,1,1,1,0,0,1,20171001, J8655,HCPCS,NETUPITANT PALONOSETRON ORAL,,,29,,NW,,,,,,$897.69,$0.00,1,1,1,0,0,1,20171001, J8670,HCPCS,"ROLAPITANT, ORAL, 1MG",,,29,,NW,,,,,,$73.70,$0.00,1,1,1,0,0,1,20171001, J8700,HCPCS,TEMOZOLOMIDE,,,29,,NW,,,,,,$16.94,$0.00,1,1,1,0,0,1,20171001, J8705,HCPCS,TOPOTECAN ORAL,,,29,,NW,,,,,,$387.13,$0.00,1,1,1,0,0,1,20171001, J8999,HCPCS,ORAL PRESCRIPTION DRUG CHEMO,,,29,,NW,,,,,,$53.33,$0.00,1,1,1,0,0,1,20171001, J9000,HCPCS,DOXORUBICIN HCL INJECTION,,,29,,NW,,,,,,$13.55,$0.00,1,1,1,0,0,1,20171001, J9015,HCPCS,ALDESLEUKIN INJECTION,,,29,,NW,,,,,,"$2,068.77",$0.00,1,1,1,0,0,1,20171001, J9017,HCPCS,ARSENIC TRIOXIDE INJECTION,,,29,,NW,,,,,,$234.61,$0.00,1,1,1,0,0,1,20171001, J9019,HCPCS,ERWINAZE INJECTION,,,29,,NW,,,,,,"$1,379.10",$0.00,1,1,1,0,0,1,20171001, J9020,HCPCS,"ASPARAGINASE, NOS",,,29,,NW,,,,,,$225.49,$0.00,1,1,1,0,0,1,20171001, J9025,HCPCS,AZACITIDINE INJECTION,,,29,,NW,,,,,,$13.55,$0.00,1,1,1,0,0,1,20171001, J9027,HCPCS,CLOFARABINE INJECTION,,,29,,NW,,,,,,$319.37,$0.00,1,1,1,0,0,1,20171001, J9031,HCPCS,BCG LIVE INTRAVESICAL VAC,,,29,,NW,,,,,,$467.95,$0.00,1,1,1,0,0,1,20171001, J9032,HCPCS,"INJECTION, BELINOSTAT, 10MG",,,29,,NW,,,,,,$138.15,$0.00,1,1,1,0,0,1,20171001, J9033,HCPCS,"INJ., TREANDA 1 MG",,,29,,NW,,,,,,$109.47,$0.00,1,1,1,0,0,1,20171001, J9034,HCPCS,"INJ., BENDEKA 1 MG",,,29,,NW,,,,,,$109.47,$0.00,1,1,1,0,0,1,20171001, J9035,HCPCS,BEVACIZUMAB INJECTION,,,29,,NW,,,,,,$168.16,$0.00,1,1,1,0,0,1,20171001, J9039,HCPCS,"INJECTION, BLINATUMOMAB",,,29,,NW,,,,,,$451.99,$0.00,1,1,1,0,0,1,20171001, J9040,HCPCS,BLEOMYCIN SULFATE INJECTION,,,29,,NW,,,,,,$76.23,$0.00,1,1,1,0,0,1,20171001, J9041,HCPCS,BORTEZOMIB INJECTION,,,29,,NW,,,,,,$114.27,$0.00,1,1,1,0,0,1,20171001, J9042,HCPCS,BRENTUXIMAB VEDOTIN INJ,,,29,,NW,,,,,,$471.86,$0.00,1,1,1,0,0,1,20171001, J9043,HCPCS,CABAZITAXEL INJECTION,,,29,,NW,,,,,,$567.03,$0.00,1,1,1,0,0,1,20171001, J9045,HCPCS,CARBOPLATIN INJECTION,,,29,,NW,,,,,,$16.94,$0.00,1,1,1,0,0,1,20171001, J9047,HCPCS,"INJECTION, CARFILZOMIB, 1 MG",,,29,,NW,,,,,,$136.85,$0.00,1,1,1,0,0,1,20171001, J9050,HCPCS,CARMUSTINE INJECTION,,,29,,NW,,,,,,"$7,278.10",$0.00,1,1,1,0,0,1,20171001, J9055,HCPCS,CETUXIMAB INJECTION,,,29,,NW,,,,,,$131.16,$0.00,1,1,1,0,0,1,20171001, J9060,HCPCS,CISPLATIN 10 MG INJECTION,,,29,,NW,,,,,,$6.78,$0.00,1,1,1,0,0,1,20171001, J9065,HCPCS,INJ CLADRIBINE PER 1 MG,,,29,,NW,,,,,,$99.04,$0.00,1,1,1,0,0,1,20171001, J9070,HCPCS,CYCLOPHOSPHAMIDE 100 MG INJ,,,29,,NW,,,,,,$178.56,$0.00,1,1,1,0,0,1,20171001, J9098,HCPCS,CYTARABINE LIPOSOME INJ,,,29,,NW,,,,,,"$1,303.08",$0.00,1,1,1,0,0,1,20171001, J9100,HCPCS,CYTARABINE HCL 100 MG INJ,,,29,,NW,,,,,,$3.39,$0.00,1,1,1,0,0,1,20171001, J9120,HCPCS,DACTINOMYCIN INJECTION,,,29,,NW,,,,,,"$2,687.22",$0.00,1,1,1,0,0,1,20171001, J9130,HCPCS,DACARBAZINE 100 MG INJ,,,29,,NW,,,,,,$20.33,$0.00,1,1,1,0,0,1,20171001, J9145,HCPCS,"INJECTION, DARATUMUMAB 10 MG",,,29,,NW,,,,,,$315.20,$0.00,1,1,1,0,0,1,20171001, J9150,HCPCS,DAUNORUBICIN INJECTION,,,29,,NW,,,,,,$161.61,$0.00,1,1,1,0,0,1,20171001, J9151,HCPCS,DAUNORUBICIN CITRATE INJ,,,29,,NW,,,,,,$228.10,$0.00,1,1,1,0,0,1,20171001, J9155,HCPCS,DEGARELIX INJECTION,,,29,,NW,,,,,,$16.94,$0.00,1,1,1,0,0,1,20171001, J9160,HCPCS,DENILEUKIN DIFTITOX INJ,,,29,,NW,,,,,,"$3,139.39",$0.00,1,1,1,0,0,1,20171001, J9165,HCPCS,DIETHYLSTILBESTROL INJECTION,,,29,,NW,,,,,,$65.05,$0.00,1,1,1,0,0,1,20171001, J9171,HCPCS,DOCETAXEL INJECTION,,,29,,NW,,,,,,$14.53,$0.00,1,1,1,0,0,1,20171001, J9175,HCPCS,ELLIOTTS B SOLUTION PER ML,,,29,,NW,,,,,,$17.74,$0.00,1,1,1,0,0,1,20171001, J9176,HCPCS,"INJECTION, ELOTUZUMAB, 1MG",,,29,,NW,,,,,,$42.49,$0.00,1,1,1,0,0,1,20171001, J9178,HCPCS,"INJ, EPIRUBICIN HCL, 2 MG",,,29,,NW,,,,,,$12.11,$0.00,1,1,1,0,0,1,20171001, J9179,HCPCS,ERIBULIN MESYLATE INJECTION,,,29,,NW,,,,,,$401.47,$0.00,1,1,1,0,0,1,20171001, J9181,HCPCS,ETOPOSIDE INJECTION,,,29,,NW,,,,,,$3.39,$0.00,1,1,1,0,0,1,20171001, J9185,HCPCS,FLUDARABINE PHOSPHATE INJ,,,29,,NW,,,,,,$276.33,$0.00,1,1,1,0,0,1,20171001, J9190,HCPCS,FLUOROURACIL INJECTION,,,29,,NW,,,,,,$8.47,$0.00,1,1,1,0,0,1,20171001, J9200,HCPCS,FLOXURIDINE INJECTION,,,29,,NW,,,,,,$192.90,$0.00,1,1,1,0,0,1,20171001, J9201,HCPCS,GEMCITABINE HCL INJECTION,,,29,,NW,,,,,,$38.96,$0.00,1,1,1,0,0,1,20171001, J9202,HCPCS,GOSERELIN ACETATE IMPLANT,,,29,,NW,,,,,,"$1,049.35",$0.00,1,1,1,0,0,1,20171001, J9206,HCPCS,IRINOTECAN INJECTION,,,29,,NW,,,,,,$18.63,$0.00,1,1,1,0,0,1,20171001, J9207,HCPCS,IXABEPILONE INJECTION,,,29,,NW,,,,,,$288.06,$0.00,1,1,1,0,0,1,20171001, J9208,HCPCS,IFOSFAMIDE INJECTION,,,29,,NW,,,,,,$127.72,$0.00,1,1,1,0,0,1,20171001, J9209,HCPCS,MESNA INJECTION,,,29,,NW,,,,,,$15.25,$0.00,1,1,1,0,0,1,20171001, J9211,HCPCS,IDARUBICIN HCL INJECTION,,,29,,NW,,,,,,$153.79,$0.00,1,1,1,0,0,1,20171001, J9212,HCPCS,INTERFERON ALFACON-1 INJ,,,29,,NW,,,,,,$24.18,$0.00,1,1,1,0,0,1,20171001, J9213,HCPCS,INTERFERON ALFA-2A INJ,,,29,,NW,,,,,,$156.40,$0.00,1,1,1,0,0,1,20171001, J9214,HCPCS,INTERFERON ALFA-2B INJ,,,29,,NW,,,,,,$112.08,$0.00,1,1,1,0,0,1,20171001, J9215,HCPCS,INTERFERON ALFA-N3 INJ,,,29,,NW,,,,,,$86.01,$0.00,1,1,1,0,0,1,20171001, J9216,HCPCS,INTERFERON GAMMA 1-B INJ,,,29,,NW,,,,,,"$1,186.22",$0.00,1,1,1,0,0,1,20171001, J9217,HCPCS,LEUPROLIDE ACETATE SUSPNSION,,,29,,NW,,,,,,$862.94,$0.00,1,1,1,0,0,1,20171001, J9218,HCPCS,LEUPROLIDE ACETATE INJECITON,,,29,,NW,,,,,,$88.61,$0.00,1,1,1,0,0,1,20171001, J9219,HCPCS,LEUPROLIDE ACETATE IMPLANT,,,29,,NW,,,,,,"$7,230.91",$0.00,1,1,1,0,0,1,20171001, J9225,HCPCS,VANTAS IMPLANT,,,29,,NW,,,,,,"$5,904.85",$0.00,1,1,1,0,0,1,20171001, J9226,HCPCS,SUPPRELIN LA IMPLANT,,,29,,NW,,,,,,"$41,633.66",$0.00,1,1,1,0,0,1,20171001, J9228,HCPCS,IPILIMUMAB INJECTION,,,29,,NW,,,,,,$531.83,$0.00,1,1,1,0,0,1,20171001, J9230,HCPCS,MECHLORETHAMINE HCL INJ,,,29,,NW,,,,,,$899.44,$0.00,1,1,1,0,0,1,20171001, J9245,HCPCS,INJ MELPHALAN HYDROCHL 50 MG,,,29,,NW,,,,,,"$3,917.42",$0.00,1,1,1,0,0,1,20171001, J9250,HCPCS,METHOTREXATE SODIUM INJ,,,29,,NW,,,,,,$1.69,$0.00,1,1,1,0,0,1,20171001, J9260,HCPCS,METHOTREXATE SODIUM INJ,,,29,,NW,,,,,,$11.86,$0.00,1,1,1,0,0,1,20171001, J9261,HCPCS,NELARABINE INJECTION,,,29,,NW,,,,,,$341.09,$0.00,1,1,1,0,0,1,20171001, J9262,HCPCS,"INJ, OMACETAXINE MEP, 0.01MG",,,29,,NW,,,,,,$27.66,$0.00,1,1,1,0,0,1,20171001, J9263,HCPCS,OXALIPLATIN,,,29,,NW,,,,,,$1.69,$0.00,1,1,1,0,0,1,20171001, J9264,HCPCS,PACLITAXEL PROTEIN BOUND,,,29,,NW,,,,,,$31.42,$0.00,1,1,1,0,0,1,20171001, J9266,HCPCS,PEGASPARGASE INJECTION,,,29,,NW,,,,,,"$24,983.63",$0.00,1,1,1,0,0,1,20171001, J9267,HCPCS,PACLITAXEL INJECTION,,,29,,NW,,,,,,$1.69,$0.00,1,1,1,0,0,1,20171001, J9268,HCPCS,PENTOSTATIN INJECTION,,,29,,NW,,,,,,"$3,487.06",$0.00,1,1,1,0,0,1,20171001, J9270,HCPCS,PLICAMYCIN (MITHRAMYCIN) INJ,,,29,,NW,,,,,,$349.18,$0.00,1,1,1,0,0,1,20171001, J9271,HCPCS,INJ PEMBROLIZUMAB,,,29,,NW,,,,,,$186.38,$0.00,1,1,1,0,0,1,20171001, J9280,HCPCS,MITOMYCIN INJECTION,,,29,,NW,,,,,,$392.35,$0.00,1,1,1,0,0,1,20171001, J9293,HCPCS,MITOXANTRONE HYDROCHL / 5 MG,,,29,,NW,,,,,,$142.06,$0.00,1,1,1,0,0,1,20171001, J9299,HCPCS,"INJECTION, NIVOLUMAB",,,29,,NW,,,,,,$113.38,$0.00,1,1,1,0,0,1,20171001, J9300,HCPCS,GEMTUZUMAB OZOGAMICIN INJ,,,29,,NW,,,,,,"$4,941.88",$0.00,1,1,1,0,0,1,20171001, J9301,HCPCS,OBINUTUZUMAB INJ,,,29,,NW,,,,,,$220.27,$0.00,1,1,1,0,0,1,20171001, J9302,HCPCS,OFATUMUMAB INJECTION,,,29,,NW,,,,,,$203.33,$0.00,1,1,1,0,0,1,20171001, J9303,HCPCS,PANITUMUMAB INJECTION,,,29,,NW,,,,,,$398.86,$0.00,1,1,1,0,0,1,20171001, J9305,HCPCS,PEMETREXED INJECTION,,,29,,NW,,,,,,$147.24,$0.00,1,1,1,0,0,1,20171001, J9306,HCPCS,"INJECTION, PERTUZUMAB, 1 MG",,,29,,NW,,,,,,$49.13,$0.00,1,1,1,0,0,1,20171001, J9307,HCPCS,PRALATREXATE INJECTION,,,29,,NW,,,,,,$823.83,$0.00,1,1,1,0,0,1,20171001, J9308,HCPCS,"INJECTION, RAMUCIRUMAB",,,29,,NW,,,,,,$216.36,$0.00,1,1,1,0,0,1,20171001, J9310,HCPCS,RITUXIMAB INJECTION,,,29,,NW,,,,,,"$2,023.11",$0.00,1,1,1,0,0,1,20171001, J9315,HCPCS,ROMIDEPSIN INJECTION,,,29,,NW,,,,,,"$1,105.40",$0.00,1,1,1,0,0,1,20171001, J9320,HCPCS,STREPTOZOCIN INJECTION,,,29,,NW,,,,,,"$1,165.37",$0.00,1,1,1,0,0,1,20171001, J9328,HCPCS,TEMOZOLOMIDE INJECTION,,,29,,NW,,,,,,$33.88,$0.00,1,1,1,0,0,1,20171001, J9330,HCPCS,TEMSIROLIMUS INJECTION,,,29,,NW,,,,,,$251.56,$0.00,1,1,1,0,0,1,20171001, J9340,HCPCS,THIOTEPA INJECTION,,,29,,NW,,,,,,$381.92,$0.00,1,1,1,0,0,1,20171001, J9351,HCPCS,TOPOTECAN INJECTION,,,29,,NW,,,,,,$10.16,$0.00,1,1,1,0,0,1,20171001, J9352,HCPCS,INJECTION TRABECTEDIN 0.1MG,,,29,,NW,,,,,,"$1,638.42",$0.00,1,1,1,0,0,1,20171001, J9354,HCPCS,"INJ, ADO-TRASTUZUMAB EMT 1MG",,,29,,NW,,,,,,$126.42,$0.00,1,1,1,0,0,1,20171001, J9355,HCPCS,TRASTUZUMAB INJECTION,,,29,,NW,,,,,,$209.98,$0.00,1,1,1,0,0,1,20171001, J9357,HCPCS,VALRUBICIN INJECTION,,,29,,NW,,,,,,"$2,557.05",$0.00,1,1,1,0,0,1,20171001, J9360,HCPCS,VINBLASTINE SULFATE INJ,,,29,,NW,,,,,,$15.25,$0.00,1,1,1,0,0,1,20171001, J9370,HCPCS,VINCRISTINE SULFATE 1 MG INJ,,,29,,NW,,,,,,$30.49,$0.00,1,1,1,0,0,1,20171001, J9371,HCPCS,"INJ, VINCRISTINE SUL LIP 1MG",,,29,,NW,,,,,,"$4,815.87",$0.00,1,1,1,0,0,1,20171001, J9390,HCPCS,VINORELBINE TARTRATE INJ,,,29,,NW,,,,,,$47.43,$0.00,1,1,1,0,0,1,20171001, J9395,HCPCS,"INJECTION, FULVESTRANT",,,29,,NW,,,,,,$220.44,$0.00,1,1,1,0,0,1,20171001, J9400,HCPCS,"INJ, ZIV-AFLIBERCEPT, 1MG",,,29,,NW,,,,,,$27.40,$0.00,1,1,1,0,0,1,20171001, J9600,HCPCS,PORFIMER SODIUM INJECTION,,,29,,NW,,,,,,"$4,854.22",$0.00,1,1,1,0,0,1,20171001, J9999,HCPCS,CHEMOTHERAPY DRUG,,,29,,NW,,,,,,$138.22,$0.00,1,1,1,0,0,1,20171001, K0001,HCPCS,STANDARD WHEELCHAIR,,,28,,NW,,,,,,$740.65,$0.00,1,1,1,1,1,1,20171001, K0001,HCPCS,STANDARD WHEELCHAIR,NU,,28,,NW,,,,,,$740.65,$0.00,1,1,1,1,1,1,20171001, K0001,HCPCS,STANDARD WHEELCHAIR,RR,,28,,NW,,,,,,$93.73,$0.00,1,1,1,1,1,1,20171001, K0001,HCPCS,STANDARD WHEELCHAIR,UE,,28,,NW,,,,,,$563.08,$0.00,1,1,1,1,1,1,20171001, K0002,HCPCS,STND HEMI (LOW SEAT) WHLCHR,,,28,,NW,,,,,,"$1,114.16",$0.00,1,1,1,1,1,1,20171001, K0002,HCPCS,STND HEMI (LOW SEAT) WHLCHR,NU,,28,,NW,,,,,,"$1,114.16",$0.00,1,1,1,1,1,1,20171001, K0002,HCPCS,STND HEMI (LOW SEAT) WHLCHR,RR,,28,,NW,,,,,,$140.99,$0.00,1,1,1,1,1,1,20171001, K0002,HCPCS,STND HEMI (LOW SEAT) WHLCHR,UE,,28,,NW,,,,,,$983.51,$0.00,1,1,1,1,1,1,20171001, K0003,HCPCS,LIGHTWEIGHT WHEELCHAIR,,,28,,NW,,,,,,$999.30,$0.00,1,1,1,1,1,1,20171001, K0003,HCPCS,LIGHTWEIGHT WHEELCHAIR,NU,,28,,NW,,,,,,$999.30,$0.00,1,1,1,1,1,1,20171001, K0003,HCPCS,LIGHTWEIGHT WHEELCHAIR,RR,,28,,NW,,,,,,$126.46,$0.00,1,1,1,1,1,1,20171001, K0003,HCPCS,LIGHTWEIGHT WHEELCHAIR,UE,,28,,NW,,,,,,"$1,073.35",$0.00,1,1,1,1,1,1,20171001, K0004,HCPCS,HIGH STRENGTH LTWT WHLCHR,,,28,,NW,,,,,,"$1,172.98",$0.00,1,1,1,1,1,1,20171001, K0004,HCPCS,HIGH STRENGTH LTWT WHLCHR,NU,,28,,NW,,,,,,"$1,172.98",$0.00,1,1,1,1,1,1,20171001, K0004,HCPCS,HIGH STRENGTH LTWT WHLCHR,RR,,28,,NW,,,,,,$148.44,$0.00,1,1,1,1,1,1,20171001, K0004,HCPCS,HIGH STRENGTH LTWT WHLCHR,UE,,28,,NW,,,,,,"$1,586.85",$0.00,1,1,1,1,1,1,20171001, K0005,HCPCS,ULTRALIGHTWEIGHT WHEELCHAIR,,,28,,NW,,,,,,"$3,773.94",$0.00,1,1,1,1,1,1,20171001, K0005,HCPCS,ULTRALIGHTWEIGHT WHEELCHAIR,NU,,28,,NW,,,,,,"$3,773.94",$0.00,1,1,1,1,1,1,20171001, K0005,HCPCS,ULTRALIGHTWEIGHT WHEELCHAIR,RR,,28,,NW,,,,,,$404.47,$0.00,1,1,1,1,1,1,20171001, K0005,HCPCS,ULTRALIGHTWEIGHT WHEELCHAIR,UE,,28,,NW,,,,,,"$2,837.97",$0.00,1,1,1,1,1,1,20171001, K0006,HCPCS,HEAVY DUTY WHEELCHAIR,,,28,,NW,,,,,,"$1,614.45",$0.00,1,1,1,1,1,1,20171001, K0006,HCPCS,HEAVY DUTY WHEELCHAIR,NU,,28,,NW,,,,,,"$1,614.45",$0.00,1,1,1,1,1,1,20171001, K0006,HCPCS,HEAVY DUTY WHEELCHAIR,RR,,28,,NW,,,,,,$204.30,$0.00,1,1,1,1,1,1,20171001, K0006,HCPCS,HEAVY DUTY WHEELCHAIR,UE,,28,,NW,,,,,,"$1,491.34",$0.00,1,1,1,1,1,1,20171001, K0007,HCPCS,EXTRA HEAVY DUTY WHEELCHAIR,,,28,,NW,,,,,,"$2,154.92",$0.00,1,1,1,1,1,1,20171001, K0007,HCPCS,EXTRA HEAVY DUTY WHEELCHAIR,NU,,28,,NW,,,,,,"$2,154.92",$0.00,1,1,1,1,1,1,20171001, K0007,HCPCS,EXTRA HEAVY DUTY WHEELCHAIR,RR,,28,,NW,,,,,,$272.70,$0.00,1,1,1,1,1,1,20171001, K0007,HCPCS,EXTRA HEAVY DUTY WHEELCHAIR,UE,,28,,NW,,,,,,"$2,109.80",$0.00,1,1,1,1,1,1,20171001, K0008,HCPCS,CSTM MANUAL WHEELCHAIR/BASE,,,28,,NW,,,,,,$597.13,$0.00,1,1,1,1,1,1,20171001, K0009,HCPCS,OTHER MANUAL WHEELCHAIR/BASE,,,28,,NW,,,,,,"$1,414.42",$0.00,1,1,1,1,1,1,20171001, K0009,HCPCS,OTHER MANUAL WHEELCHAIR/BASE,RR,,28,,NW,,,,,,$178.99,$0.00,1,1,1,1,1,1,20171001, K0010,HCPCS,STND WT FRAME POWER WHLCHR,,,28,,NW,,,,,,"$6,565.50",$0.00,1,1,1,1,1,1,20171001, K0010,HCPCS,STND WT FRAME POWER WHLCHR,NU,,28,,NW,,,,,,"$6,565.50",$0.00,1,1,1,1,1,1,20171001, K0010,HCPCS,STND WT FRAME POWER WHLCHR,RR,,28,,NW,,,,,,$830.85,$0.00,1,1,1,1,1,1,20171001, K0010,HCPCS,STND WT FRAME POWER WHLCHR,UE,,28,,NW,,,,,,"$7,959.71",$0.00,1,1,1,1,1,1,20171001, K0011,HCPCS,STND WT PWR WHLCHR W CONTROL,,,28,,NW,,,,,,"$8,368.28",$0.00,1,1,1,1,1,1,20171001, K0011,HCPCS,STND WT PWR WHLCHR W CONTROL,NU,,28,,NW,,,,,,"$8,368.28",$0.00,1,1,1,1,1,1,20171001, K0011,HCPCS,STND WT PWR WHLCHR W CONTROL,RR,,28,,NW,,,,,,"$1,058.98",$0.00,1,1,1,1,1,1,20171001, K0012,HCPCS,LTWT PORTBL POWER WHLCHR,,,28,,NW,,,,,,"$5,319.80",$0.00,1,1,1,1,1,1,20171001, K0012,HCPCS,LTWT PORTBL POWER WHLCHR,RR,,28,,NW,,,,,,$673.21,$0.00,1,1,1,1,1,1,20171001, K0013,HCPCS,CUSTOM POWER WHLCHR BASE,,,28,,NW,,,,,,"$1,033.64",$0.00,1,1,1,1,1,1,20171001, K0014,HCPCS,OTHER POWER WHLCHR BASE,,,28,,NW,,,,,,$421.98,$0.00,1,1,1,1,1,1,20171001, K0015,HCPCS,DETACH NON-ADJ HT ARMRST REP,,,28,,NW,,,,,,$406.32,$0.00,1,1,1,1,1,1,20171001, K0015,HCPCS,DETACH NON-ADJUS HGHT ARMRST,NU,,28,,NW,,,,,,$406.32,$0.00,1,1,1,1,1,1,20171001, K0015,HCPCS,DETACH NON-ADJUS HGHT ARMRST,RR,,28,,NW,,,,,,$51.42,$0.00,1,1,1,1,1,1,20171001, K0015,HCPCS,DETACH NON-ADJUS HGHT ARMRST,UE,,28,,NW,,,,,,$212.79,$0.00,1,1,1,1,1,1,20171001, K0017,HCPCS,DETACH ADJUST ARMREST BASE,,,28,,NW,,,,,,$149.47,$0.00,1,1,1,1,1,1,20171001, K0017,HCPCS,DETACH ADJUST ARMREST BASE,NU,,28,,NW,,,,,,$149.47,$0.00,1,1,1,1,1,1,20171001, K0017,HCPCS,DETACH ADJUST ARMREST BASE,RR,,28,,NW,,,,,,$11.56,$0.00,1,1,1,1,1,1,20171001, K0017,HCPCS,DETACH ADJUST ARMREST BASE,UE,,28,,NW,,,,,,$119.67,$0.00,1,1,1,1,1,1,20171001, K0018,HCPCS,DETACH ADJUST ARMRST UPPER,,,28,,NW,,,,,,$75.59,$0.00,1,1,1,1,1,1,20171001, K0018,HCPCS,DETACH ADJUST ARMRST UPPER,NU,,28,,NW,,,,,,$75.59,$0.00,1,1,1,1,1,1,20171001, K0018,HCPCS,DETACH ADJUST ARMRST UPPER,RR,,28,,NW,,,,,,$6.55,$0.00,1,1,1,1,1,1,20171001, K0018,HCPCS,DETACH ADJUST ARMRST UPPER,UE,,28,,NW,,,,,,$56.36,$0.00,1,1,1,1,1,1,20171001, K0019,HCPCS,"ARM PAD REPL, EACH",,,28,,NW,,,,,,$47.87,$0.00,1,1,1,1,1,1,20171001, K0019,HCPCS,ARM PAD EACH,NU,,28,,NW,,,,,,$47.87,$0.00,1,1,1,1,1,1,20171001, K0019,HCPCS,ARM PAD EACH,RR,,28,,NW,,,,,,$3.40,$0.00,1,1,1,1,1,1,20171001, K0019,HCPCS,ARM PAD EACH,UE,,28,,NW,,,,,,$25.48,$0.00,1,1,1,1,1,1,20171001, K0020,HCPCS,FIXED ADJUST ARMREST PAIR,,,28,,NW,,,,,,$108.82,$0.00,1,1,1,1,1,1,20171001, K0020,HCPCS,FIXED ADJUST ARMREST PAIR,NU,,28,,NW,,,,,,$108.82,$0.00,1,1,1,1,1,1,20171001, K0020,HCPCS,FIXED ADJUST ARMREST PAIR,RR,,28,,NW,,,,,,$11.31,$0.00,1,1,1,1,1,1,20171001, K0020,HCPCS,FIXED ADJUST ARMREST PAIR,UE,,28,,NW,,,,,,$89.18,$0.00,1,1,1,1,1,1,20171001, K0037,HCPCS,HI MOUNT FLIP-UP FTREST REPL,,,28,,NW,,,,,,$104.56,$0.00,1,1,1,1,1,1,20171001, K0037,HCPCS,HIGH MOUNT FLIP-UP FOOTREST,NU,,28,,NW,,,,,,$104.56,$0.00,1,1,1,1,1,1,20171001, K0037,HCPCS,HIGH MOUNT FLIP-UP FOOTREST,RR,,28,,NW,,,,,,$10.35,$0.00,1,1,1,1,1,1,20171001, K0037,HCPCS,HIGH MOUNT FLIP-UP FOOTREST,UE,,28,,NW,,,,,,$86.00,$0.00,1,1,1,1,1,1,20171001, K0038,HCPCS,LEG STRAP EACH,,,28,,NW,,,,,,$67.98,$0.00,1,1,1,1,1,1,20171001, K0038,HCPCS,LEG STRAP EACH,NU,,28,,NW,,,,,,$67.98,$0.00,1,1,1,1,1,1,20171001, K0038,HCPCS,LEG STRAP EACH,RR,,28,,NW,,,,,,$5.78,$0.00,1,1,1,1,1,1,20171001, K0038,HCPCS,LEG STRAP EACH,UE,,28,,NW,,,,,,$48.84,$0.00,1,1,1,1,1,1,20171001, K0039,HCPCS,LEG STRAP H STYLE EACH,,,28,,NW,,,,,,$116.32,$0.00,1,1,1,1,1,1,20171001, K0039,HCPCS,LEG STRAP H STYLE EACH,NU,,28,,NW,,,,,,$116.32,$0.00,1,1,1,1,1,1,20171001, K0039,HCPCS,LEG STRAP H STYLE EACH,RR,,28,,NW,,,,,,$12.41,$0.00,1,1,1,1,1,1,20171001, K0039,HCPCS,LEG STRAP H STYLE EACH,UE,,28,,NW,,,,,,$94.80,$0.00,1,1,1,1,1,1,20171001, K0040,HCPCS,ADJUSTABLE ANGLE FOOTPLATE,,,28,,NW,,,,,,$169.22,$0.00,1,1,1,1,1,1,20171001, K0040,HCPCS,ADJUSTABLE ANGLE FOOTPLATE,NU,,28,,NW,,,,,,$169.22,$0.00,1,1,1,1,1,1,20171001, K0040,HCPCS,ADJUSTABLE ANGLE FOOTPLATE,RR,,28,,NW,,,,,,$13.49,$0.00,1,1,1,1,1,1,20171001, K0040,HCPCS,ADJUSTABLE ANGLE FOOTPLATE,UE,,28,,NW,,,,,,$134.49,$0.00,1,1,1,1,1,1,20171001, K0041,HCPCS,LARGE SIZE FOOTPLATE EACH,,,28,,NW,,,,,,$152.53,$0.00,1,1,1,1,1,1,20171001, K0041,HCPCS,LARGE SIZE FOOTPLATE EACH,NU,,28,,NW,,,,,,$152.53,$0.00,1,1,1,1,1,1,20171001, K0041,HCPCS,LARGE SIZE FOOTPLATE EACH,RR,,28,,NW,,,,,,$11.88,$0.00,1,1,1,1,1,1,20171001, K0041,HCPCS,LARGE SIZE FOOTPLATE EACH,UE,,28,,NW,,,,,,$121.96,$0.00,1,1,1,1,1,1,20171001, K0042,HCPCS,STANDARD SIZE FTPLATE REP EA,,,28,,NW,,,,,,$108.74,$0.00,1,1,1,1,1,1,20171001, K0042,HCPCS,STANDARD SIZE FOOTPLATE EACH,NU,,28,,NW,,,,,,$108.74,$0.00,1,1,1,1,1,1,20171001, K0042,HCPCS,STANDARD SIZE FOOTPLATE EACH,RR,,28,,NW,,,,,,$7.63,$0.00,1,1,1,1,1,1,20171001, K0042,HCPCS,STANDARD SIZE FOOTPLATE EACH,UE,,28,,NW,,,,,,$86.33,$0.00,1,1,1,1,1,1,20171001, K0043,HCPCS,FTRST LOWR EXTEN TUBE REP EA,,,28,,NW,,,,,,$53.69,$0.00,1,1,1,1,1,1,20171001, K0043,HCPCS,FTRST LOWER EXTENSION TUBE,NU,,28,,NW,,,,,,$53.69,$0.00,1,1,1,1,1,1,20171001, K0043,HCPCS,FTRST LOWER EXTENSION TUBE,RR,,28,,NW,,,,,,$4.69,$0.00,1,1,1,1,1,1,20171001, K0043,HCPCS,FTRST LOWER EXTENSION TUBE,UE,,28,,NW,,,,,,$38.14,$0.00,1,1,1,1,1,1,20171001, K0044,HCPCS,FTRST UPR HANGER BRAC REP EA,,,28,,NW,,,,,,$45.61,$0.00,1,1,1,1,1,1,20171001, K0044,HCPCS,FTRST UPPER HANGER BRACKET,NU,,28,,NW,,,,,,$45.61,$0.00,1,1,1,1,1,1,20171001, K0044,HCPCS,FTRST UPPER HANGER BRACKET,RR,,28,,NW,,,,,,$4.11,$0.00,1,1,1,1,1,1,20171001, K0044,HCPCS,FTRST UPPER HANGER BRACKET,UE,,28,,NW,,,,,,$32.06,$0.00,1,1,1,1,1,1,20171001, K0045,HCPCS,FTRST COMPL ASSEMBLY REPL EA,,,28,,NW,,,,,,$122.97,$0.00,1,1,1,1,1,1,20171001, K0045,HCPCS,FOOTREST COMPLETE ASSEMBLY,NU,,28,,NW,,,,,,$122.97,$0.00,1,1,1,1,1,1,20171001, K0045,HCPCS,FOOTREST COMPLETE ASSEMBLY,RR,,28,,NW,,,,,,$13.42,$0.00,1,1,1,1,1,1,20171001, K0045,HCPCS,FOOTREST COMPLETE ASSEMBLY,UE,,28,,NW,,,,,,$99.79,$0.00,1,1,1,1,1,1,20171001, K0046,HCPCS,ELEV LGRST LWR EXTEN REPL EA,,,28,,NW,,,,,,$54.11,$0.00,1,1,1,1,1,1,20171001, K0046,HCPCS,ELEVAT LEGRST LOW EXTENSION,NU,,28,,NW,,,,,,$54.11,$0.00,1,1,1,1,1,1,20171001, K0046,HCPCS,ELEVAT LEGRST LOW EXTENSION,RR,,28,,NW,,,,,,$4.75,$0.00,1,1,1,1,1,1,20171001, K0046,HCPCS,ELEVAT LEGRST LOW EXTENSION,UE,,28,,NW,,,,,,$38.45,$0.00,1,1,1,1,1,1,20171001, K0047,HCPCS,ELEV LEGRST UPR HANGR REP EA,,,28,,NW,,,,,,$202.66,$0.00,1,1,1,1,1,1,20171001, K0047,HCPCS,ELEVAT LEGRST UP HANGR BRACK,NU,,28,,NW,,,,,,$202.66,$0.00,1,1,1,1,1,1,20171001, K0047,HCPCS,ELEVAT LEGRST UP HANGR BRACK,RR,,28,,NW,,,,,,$16.73,$0.00,1,1,1,1,1,1,20171001, K0047,HCPCS,ELEVAT LEGRST UP HANGR BRACK,UE,,28,,NW,,,,,,$159.58,$0.00,1,1,1,1,1,1,20171001, K0050,HCPCS,RATCHET ASSEMBLY REPLACEMENT,,,28,,NW,,,,,,$84.07,$0.00,1,1,1,1,1,1,20171001, K0050,HCPCS,RATCHET ASSEMBLY,NU,,28,,NW,,,,,,$84.07,$0.00,1,1,1,1,1,1,20171001, K0050,HCPCS,RATCHET ASSEMBLY,RR,,28,,NW,,,,,,$7.77,$0.00,1,1,1,1,1,1,20171001, K0050,HCPCS,RATCHET ASSEMBLY,UE,,28,,NW,,,,,,$68.51,$0.00,1,1,1,1,1,1,20171001, K0051,HCPCS,CAM REL ASM FT/LEGRST REP EA,,,28,,NW,,,,,,$115.38,$0.00,1,1,1,1,1,1,20171001, K0051,HCPCS,CAM RELESE ASSEM FTRST/LGRST,NU,,28,,NW,,,,,,$115.38,$0.00,1,1,1,1,1,1,20171001, K0051,HCPCS,CAM RELESE ASSEM FTRST/LGRST,RR,,28,,NW,,,,,,$12.28,$0.00,1,1,1,1,1,1,20171001, K0051,HCPCS,CAM RELESE ASSEM FTRST/LGRST,UE,,28,,NW,,,,,,$94.11,$0.00,1,1,1,1,1,1,20171001, K0052,HCPCS,SWINGAWAY DETACH FTREST REPL,,,28,,NW,,,,,,$216.08,$0.00,1,1,1,1,1,1,20171001, K0052,HCPCS,SWINGAWAY DETACH FOOTREST,NU,,28,,NW,,,,,,$216.08,$0.00,1,1,1,1,1,1,20171001, K0052,HCPCS,SWINGAWAY DETACH FOOTREST,RR,,28,,NW,,,,,,$18.03,$0.00,1,1,1,1,1,1,20171001, K0052,HCPCS,SWINGAWAY DETACH FOOTREST,UE,,28,,NW,,,,,,$169.63,$0.00,1,1,1,1,1,1,20171001, K0053,HCPCS,ELEVATE FOOTREST ARTICULATE,,,28,,NW,,,,,,$252.39,$0.00,1,1,1,1,1,1,20171001, K0053,HCPCS,ELEVATE FOOTREST ARTICULATE,NU,,28,,NW,,,,,,$252.39,$0.00,1,1,1,1,1,1,20171001, K0053,HCPCS,ELEVATE FOOTREST ARTICULATE,RR,,28,,NW,,,,,,$21.56,$0.00,1,1,1,1,1,1,20171001, K0053,HCPCS,ELEVATE FOOTREST ARTICULATE,UE,,28,,NW,,,,,,$196.87,$0.00,1,1,1,1,1,1,20171001, K0056,HCPCS,SEAT HT <17 OR >=21 LTWT WC,,,28,,NW,,,,,,$275.36,$0.00,1,1,1,1,1,1,20171001, K0056,HCPCS,SEAT HT <17 OR >=21 LTWT WC,NU,,28,,NW,,,,,,$275.36,$0.00,1,1,1,1,1,1,20171001, K0056,HCPCS,SEAT HT <17 OR >=21 LTWT WC,RR,,28,,NW,,,,,,$23.79,$0.00,1,1,1,1,1,1,20171001, K0056,HCPCS,SEAT HT <17 OR >=21 LTWT WC,UE,,28,,NW,,,,,,$214.09,$0.00,1,1,1,1,1,1,20171001, K0065,HCPCS,SPOKE PROTECTORS,,,28,,NW,,,,,,$111.95,$0.00,1,1,1,1,1,1,20171001, K0065,HCPCS,SPOKE PROTECTORS,NU,,28,,NW,,,,,,$111.95,$0.00,1,1,1,1,1,1,20171001, K0065,HCPCS,SPOKE PROTECTORS,RR,,28,,NW,,,,,,$11.79,$0.00,1,1,1,1,1,1,20171001, K0065,HCPCS,SPOKE PROTECTORS,UE,,28,,NW,,,,,,$91.53,$0.00,1,1,1,1,1,1,20171001, K0069,HCPCS,RR WHL COMPL SOL TIRE REP EA,,,28,,NW,,,,,,$279.77,$0.00,1,1,1,1,1,1,20171001, K0069,HCPCS,REAR WHL COMPLETE SOLID TIRE,NU,,28,,NW,,,,,,$279.77,$0.00,1,1,1,1,1,1,20171001, K0069,HCPCS,REAR WHL COMPLETE SOLID TIRE,RR,,28,,NW,,,,,,$24.22,$0.00,1,1,1,1,1,1,20171001, K0069,HCPCS,REAR WHL COMPLETE SOLID TIRE,UE,,28,,NW,,,,,,$217.40,$0.00,1,1,1,1,1,1,20171001, K0070,HCPCS,RR WHL COMPL PNE TIRE REP EA,,,28,,NW,,,,,,$468.33,$0.00,1,1,1,1,1,1,20171001, K0070,HCPCS,REAR WHL COMPL PNEUM TIRE,NU,,28,,NW,,,,,,$468.33,$0.00,1,1,1,1,1,1,20171001, K0070,HCPCS,REAR WHL COMPL PNEUM TIRE,RR,,28,,NW,,,,,,$59.27,$0.00,1,1,1,1,1,1,20171001, K0070,HCPCS,REAR WHL COMPL PNEUM TIRE,UE,,28,,NW,,,,,,$244.00,$0.00,1,1,1,1,1,1,20171001, K0071,HCPCS,FR CSTR COMP PNE TIRE REP EA,,,28,,NW,,,,,,$317.19,$0.00,1,1,1,1,1,1,20171001, K0071,HCPCS,FRONT CASTR COMPL PNEUM TIRE,NU,,28,,NW,,,,,,$317.19,$0.00,1,1,1,1,1,1,20171001, K0071,HCPCS,FRONT CASTR COMPL PNEUM TIRE,RR,,28,,NW,,,,,,$37.68,$0.00,1,1,1,1,1,1,20171001, K0071,HCPCS,FRONT CASTR COMPL PNEUM TIRE,UE,,28,,NW,,,,,,$245.47,$0.00,1,1,1,1,1,1,20171001, K0072,HCPCS,FR CSTR SEMI-PNE TIRE REP EA,,,28,,NW,,,,,,$207.92,$0.00,1,1,1,1,1,1,20171001, K0072,HCPCS,FRNT CSTR CMPL SEM-PNEUM TIR,NU,,28,,NW,,,,,,$207.92,$0.00,1,1,1,1,1,1,20171001, K0072,HCPCS,FRNT CSTR CMPL SEM-PNEUM TIR,RR,,28,,NW,,,,,,$17.24,$0.00,1,1,1,1,1,1,20171001, K0072,HCPCS,FRNT CSTR CMPL SEM-PNEUM TIR,UE,,28,,NW,,,,,,$163.52,$0.00,1,1,1,1,1,1,20171001, K0073,HCPCS,CASTER PIN LOCK EACH,,,28,,NW,,,,,,$123.08,$0.00,1,1,1,1,1,1,20171001, K0073,HCPCS,CASTER PIN LOCK EACH,NU,,28,,NW,,,,,,$123.08,$0.00,1,1,1,1,1,1,20171001, K0073,HCPCS,CASTER PIN LOCK EACH,RR,,28,,NW,,,,,,$9.01,$0.00,1,1,1,1,1,1,20171001, K0073,HCPCS,CASTER PIN LOCK EACH,UE,,28,,NW,,,,,,$77.09,$0.00,1,1,1,1,1,1,20171001, K0077,HCPCS,FR CSTR ASMB SOL TIRE REP EA,,,28,,NW,,,,,,$171.69,$0.00,1,1,1,1,1,1,20171001, K0077,HCPCS,FRONT CASTER ASSEM COMPLETE,NU,,28,,NW,,,,,,$171.69,$0.00,1,1,1,1,1,1,20171001, K0077,HCPCS,FRONT CASTER ASSEM COMPLETE,RR,,28,,NW,,,,,,$13.72,$0.00,1,1,1,1,1,1,20171001, K0077,HCPCS,FRONT CASTER ASSEM COMPLETE,UE,,28,,NW,,,,,,$136.34,$0.00,1,1,1,1,1,1,20171001, K0098,HCPCS,"DRIVE BELT FOR PWC, REPL",,,28,,NW,,,,,,$91.95,$0.00,1,1,1,1,1,1,20171001, K0098,HCPCS,DRIVE BELT POWER WHEELCHAIR,NU,,28,,NW,,,,,,$91.95,$0.00,1,1,1,1,1,1,20171001, K0098,HCPCS,DRIVE BELT POWER WHEELCHAIR,RR,,28,,NW,,,,,,$6.05,$0.00,1,1,1,1,1,1,20171001, K0098,HCPCS,DRIVE BELT POWER WHEELCHAIR,UE,,28,,NW,,,,,,$66.82,$0.00,1,1,1,1,1,1,20171001, K0105,HCPCS,IV HANGER,,,28,,NW,,,,,,$292.22,$0.00,1,1,1,1,1,1,20171001, K0105,HCPCS,IV HANGER,NU,,28,,NW,,,,,,$292.22,$0.00,1,1,1,1,1,1,20171001, K0105,HCPCS,IV HANGER,RR,,28,,NW,,,,,,$25.42,$0.00,1,1,1,1,1,1,20171001, K0105,HCPCS,IV HANGER,UE,,28,,NW,,,,,,$226.74,$0.00,1,1,1,1,1,1,20171001, K0108,HCPCS,W/C COMPONENT-ACCESSORY NOS,,,28,,NW,,,,,,$69.32,$0.00,1,1,1,1,1,1,20171001, K0195,HCPCS,ELEVATING WHLCHAIR LEG RESTS,,,28,,NW,,,,,,$303.00,$0.00,1,1,1,1,1,1,20171001, K0195,HCPCS,ELEVATING WHLCHAIR LEG RESTS,RR,,28,,NW,,,,,,$38.34,$0.00,1,1,1,1,1,1,20171001, K0455,HCPCS,PUMP UNINTERRUPTED INFUSION,,,28,,NW,,,,,,"$4,886.82",$0.00,1,1,1,1,1,1,20171001, K0455,HCPCS,PUMP UNINTERRUPTED INFUSION,RR,,28,,NW,,,,,,$618.41,$0.00,1,1,1,1,1,1,20171001, K0462,HCPCS,TEMPORARY REPLACEMENT EQPMNT,,,28,,NW,,,,,,$739.11,$0.00,1,1,1,1,1,1,20171001, K0552,HCPCS,SUP/EXT NON-INS INF PUMP SYR,,,28,,NW,,,,,,$23.74,$0.00,1,1,1,1,1,1,20171001, K0601,HCPCS,REPL BATT SILVER OXIDE 1.5 V,,,28,,NW,,,,,,$5.01,$0.00,1,1,1,1,1,1,20171001, K0601,HCPCS,REPL BATT SILVER OXIDE 1.5 V,NU,,28,,NW,,,,,,$5.01,$0.00,1,1,1,1,1,1,20171001, K0602,HCPCS,REPL BATT SILVER OXIDE 3 V,,,28,,NW,,,,,,$25.04,$0.00,1,1,1,1,1,1,20171001, K0602,HCPCS,REPL BATT SILVER OXIDE 3 V,NU,,28,,NW,,,,,,$25.04,$0.00,1,1,1,1,1,1,20171001, K0603,HCPCS,REPL BATT ALKALINE 1.5 V,,,28,,NW,,,,,,$2.50,$0.00,1,1,1,1,1,1,20171001, K0603,HCPCS,REPL BATT ALKALINE 1.5 V,NU,,28,,NW,,,,,,$2.50,$0.00,1,1,1,1,1,1,20171001, K0604,HCPCS,REPL BATT LITHIUM 3.6 V,,,28,,NW,,,,,,$25.04,$0.00,1,1,1,1,1,1,20171001, K0604,HCPCS,REPL BATT LITHIUM 3.6 V,NU,,28,,NW,,,,,,$25.04,$0.00,1,1,1,1,1,1,20171001, K0605,HCPCS,REPL BATT LITHIUM 4.5 V,,,28,,NW,,,,,,$64.79,$0.00,1,1,1,1,1,1,20171001, K0605,HCPCS,REPL BATT LITHIUM 4.5 V,NU,,28,,NW,,,,,,$64.79,$0.00,1,1,1,1,1,1,20171001, K0606,HCPCS,AED GARMENT W ELEC ANALYSIS,,,28,,NW,,,,,,"$43,507.09",$0.00,1,1,1,1,1,1,20171001, K0606,HCPCS,AED GARMENT W ELEC ANALYSIS,KF,,28,,NW,,,,,,"$43,507.09",$0.00,1,1,1,1,1,1,20171001, K0606,HCPCS,AED GARMENT W ELEC ANALYSIS,RR,,28,,NW,,,,,,"$5,505.71",$0.00,1,1,1,1,1,1,20171001, K0607,HCPCS,REPL BATT FOR AED,,,28,,NW,,,,,,$867.06,$0.00,1,1,1,1,1,1,20171001, K0607,HCPCS,REPL BATT FOR AED,NU,,28,,NW,,,,,,$867.06,$0.00,1,1,1,1,1,1,20171001, K0607,HCPCS,REPL BATT FOR AED,RR,,28,,NW,,,,,,$109.72,$0.00,1,1,1,1,1,1,20171001, K0607,HCPCS,REPL BATT FOR AED,UE,,28,,NW,,,,,,$642.82,$0.00,1,1,1,1,1,1,20171001, K0608,HCPCS,REPL GARMENT FOR AED,,,28,,NW,,,,,,$330.02,$0.00,1,1,1,1,1,1,20171001, K0608,HCPCS,REPL GARMENT FOR AED,NU,,28,,NW,,,,,,$330.02,$0.00,1,1,1,1,1,1,20171001, K0608,HCPCS,REPL GARMENT FOR AED,RR,,28,,NW,,,,,,$93.96,$0.00,1,1,1,1,1,1,20171001, K0608,HCPCS,REPL GARMENT FOR AED,UE,,28,,NW,,,,,,$264.44,$0.00,1,1,1,1,1,1,20171001, K0609,HCPCS,REPL ELECTRODE FOR AED,,,28,,NW,,,,,,"$1,812.49",$0.00,1,1,1,1,1,1,20171001, K0609,HCPCS,REPL ELECTRODE FOR AED,KF,,28,,NW,,,,,,"$1,812.49",$0.00,1,1,1,1,1,1,20171001, K0669,HCPCS,SEAT/BACK CUS NO DMEPDAC VER,,,28,,NW,,,,,,$743.11,$0.00,1,1,1,1,1,1,20171001, K0669,HCPCS,SEAT/BACK CUS NO DMEPDAC VER,NU,,28,,NW,,,,,,$743.11,$0.00,1,1,1,1,1,1,20171001, K0672,HCPCS,REMOVABLE SOFT INTERFACE LE,,,28,,NW,,,,,,$224.62,$0.00,1,1,1,1,1,1,20171001, K0730,HCPCS,CTRL DOSE INH DRUG DELIV SYS,,,28,,NW,,,,,,"$3,476.58",$0.00,1,1,1,1,1,1,20171001, K0730,HCPCS,CTRL DOSE INH DRUG DELIV SYS,NU,,28,,NW,,,,,,"$3,476.58",$0.00,1,1,1,1,1,1,20171001, K0730,HCPCS,CTRL DOSE INH DRUG DELIV SYS,RR,,28,,NW,,,,,,$439.95,$0.00,1,1,1,1,1,1,20171001, K0730,HCPCS,CTRL DOSE INH DRUG DELIV SYS,UE,,28,,NW,,,,,,"$1,884.99",$0.00,1,1,1,1,1,1,20171001, K0733,HCPCS,12-24HR SEALED LEAD ACID,,,28,,NW,,,,,,$79.90,$0.00,1,1,1,1,1,1,20171001, K0733,HCPCS,12-24HR SEALED LEAD ACID,NU,,28,,NW,,,,,,$79.90,$0.00,1,1,1,1,1,1,20171001, K0733,HCPCS,12-24HR SEALED LEAD ACID,RR,,28,,NW,,,,,,$7.17,$0.00,1,1,1,1,1,1,20171001, K0733,HCPCS,12-24HR SEALED LEAD ACID,UE,,28,,NW,,,,,,$62.52,$0.00,1,1,1,1,1,1,20171001, K0738,HCPCS,PORTABLE GAS OXYGEN SYSTEM,,,28,,NW,,,,,,"$1,821.40",$0.00,1,1,1,1,1,1,20171001, K0738,HCPCS,PORTABLE GAS OXYGEN SYSTEM,RR,,28,,NW,,,,,,$230.49,$0.00,1,1,1,1,1,1,20171001, K0739,HCPCS,REPAIR/SVC DME NON-OXYGEN EQ,,,28,,NW,,,,,,$35.88,$0.00,1,1,1,1,1,1,20171001, K0740,HCPCS,REPAIR/SVC OXYGEN EQUIPMENT,,,28,,NW,,,,,,$84.10,$0.00,1,1,1,1,1,1,20171001, K0743,HCPCS,PORTABLE HOME SUCTION PUMP,,,28,,NW,,,,,,$241.95,$0.00,1,1,1,1,1,1,20171001, K0744,HCPCS,ABSORP DRG <= 16 SUC PUMP,,,28,,NW,,,,,,$4.88,$0.00,1,1,1,1,1,1,20171001, K0745,HCPCS,ABSORP DRG >16<=48 SUC PUMP,,,28,,NW,,,,,,$6.42,$0.00,1,1,1,1,1,1,20171001, K0746,HCPCS,ABSORP DRG >48 SUC PUMP,,,28,,NW,,,,,,$15.87,$0.00,1,1,1,1,1,1,20171001, K0800,HCPCS,POV GROUP 1 STD UP TO 300LBS,,,28,,NW,,,,,,"$2,263.28",$0.00,1,1,1,1,1,1,20171001, K0800,HCPCS,POV GROUP 1 STD UP TO 300LBS,NU,,28,,NW,,,,,,"$2,263.28",$0.00,1,1,1,1,1,1,20171001, K0800,HCPCS,POV GROUP 1 STD UP TO 300LBS,RR,,28,,NW,,,,,,$253.58,$0.00,1,1,1,1,1,1,20171001, K0800,HCPCS,POV GROUP 1 STD UP TO 300LBS,UE,,28,,NW,,,,,,"$1,705.03",$0.00,1,1,1,1,1,1,20171001, K0801,HCPCS,POV GROUP 1 HD 301-450 LBS,,,28,,NW,,,,,,"$4,080.45",$0.00,1,1,1,1,1,1,20171001, K0801,HCPCS,POV GROUP 1 HD 301-450 LBS,NU,,28,,NW,,,,,,"$4,080.45",$0.00,1,1,1,1,1,1,20171001, K0801,HCPCS,POV GROUP 1 HD 301-450 LBS,RR,,28,,NW,,,,,,$435.30,$0.00,1,1,1,1,1,1,20171001, K0801,HCPCS,POV GROUP 1 HD 301-450 LBS,UE,,28,,NW,,,,,,"$3,067.91",$0.00,1,1,1,1,1,1,20171001, K0802,HCPCS,POV GROUP 1 VHD 451-600 LBS,,,28,,NW,,,,,,"$5,397.50",$0.00,1,1,1,1,1,1,20171001, K0802,HCPCS,POV GROUP 1 VHD 451-600 LBS,NU,,28,,NW,,,,,,"$5,397.50",$0.00,1,1,1,1,1,1,20171001, K0802,HCPCS,POV GROUP 1 VHD 451-600 LBS,RR,,28,,NW,,,,,,$567.00,$0.00,1,1,1,1,1,1,20171001, K0802,HCPCS,POV GROUP 1 VHD 451-600 LBS,UE,,28,,NW,,,,,,"$4,055.70",$0.00,1,1,1,1,1,1,20171001, K0806,HCPCS,POV GROUP 2 STD UP TO 300LBS,,,28,,NW,,,,,,"$3,563.62",$0.00,1,1,1,1,1,1,20171001, K0806,HCPCS,POV GROUP 2 STD UP TO 300LBS,NU,,28,,NW,,,,,,"$3,563.62",$0.00,1,1,1,1,1,1,20171001, K0806,HCPCS,POV GROUP 2 STD UP TO 300LBS,RR,,28,,NW,,,,,,$383.63,$0.00,1,1,1,1,1,1,20171001, K0806,HCPCS,POV GROUP 2 STD UP TO 300LBS,UE,,28,,NW,,,,,,"$2,680.28",$0.00,1,1,1,1,1,1,20171001, K0807,HCPCS,POV GROUP 2 HD 301-450 LBS,,,28,,NW,,,,,,"$5,506.08",$0.00,1,1,1,1,1,1,20171001, K0807,HCPCS,POV GROUP 2 HD 301-450 LBS,NU,,28,,NW,,,,,,"$5,506.08",$0.00,1,1,1,1,1,1,20171001, K0807,HCPCS,POV GROUP 2 HD 301-450 LBS,RR,,28,,NW,,,,,,$577.87,$0.00,1,1,1,1,1,1,20171001, K0807,HCPCS,POV GROUP 2 HD 301-450 LBS,UE,,28,,NW,,,,,,"$4,137.13",$0.00,1,1,1,1,1,1,20171001, K0808,HCPCS,POV GROUP 2 VHD 451-600 LBS,,,28,,NW,,,,,,"$8,494.97",$0.00,1,1,1,1,1,1,20171001, K0808,HCPCS,POV GROUP 2 VHD 451-600 LBS,NU,,28,,NW,,,,,,"$8,494.97",$0.00,1,1,1,1,1,1,20171001, K0808,HCPCS,POV GROUP 2 VHD 451-600 LBS,RR,,28,,NW,,,,,,$876.74,$0.00,1,1,1,1,1,1,20171001, K0808,HCPCS,POV GROUP 2 VHD 451-600 LBS,UE,,28,,NW,,,,,,"$6,378.79",$0.00,1,1,1,1,1,1,20171001, K0812,HCPCS,POWER OPERATED VEHICLE NOC,,,28,,NW,,,,,,"$1,161.04",$0.00,1,1,1,1,1,1,20171001, K0813,HCPCS,PWC GP 1 STD PORT SEAT/BACK,,,28,,NW,,,,,,"$5,732.29",$0.00,1,1,1,1,1,1,20171001, K0813,HCPCS,PWC GP 1 STD PORT SEAT/BACK,RR,,28,,NW,,,,,,$725.41,$0.00,1,1,1,1,1,1,20171001, K0814,HCPCS,PWC GP 1 STD PORT CAP CHAIR,,,28,,NW,,,,,,"$6,008.89",$0.00,1,1,1,1,1,1,20171001, K0814,HCPCS,PWC GP 1 STD PORT CAP CHAIR,RR,,28,,NW,,,,,,$760.41,$0.00,1,1,1,1,1,1,20171001, K0815,HCPCS,PWC GP 1 STD SEAT/BACK,,,28,,NW,,,,,,"$5,889.42",$0.00,1,1,1,1,1,1,20171001, K0815,HCPCS,PWC GP 1 STD SEAT/BACK,RR,,28,,NW,,,,,,$745.29,$0.00,1,1,1,1,1,1,20171001, K0816,HCPCS,PWC GP 1 STD CAP CHAIR,,,28,,NW,,,,,,"$6,192.81",$0.00,1,1,1,1,1,1,20171001, K0816,HCPCS,PWC GP 1 STD CAP CHAIR,RR,,28,,NW,,,,,,$783.68,$0.00,1,1,1,1,1,1,20171001, K0820,HCPCS,PWC GP 2 STD PORT SEAT/BACK,,,28,,NW,,,,,,"$5,889.42",$0.00,1,1,1,1,1,1,20171001, K0820,HCPCS,PWC GP 2 STD PORT SEAT/BACK,RR,,28,,NW,,,,,,$745.29,$0.00,1,1,1,1,1,1,20171001, K0821,HCPCS,PWC GP 2 STD PORT CAP CHAIR,,,28,,NW,,,,,,"$6,208.78",$0.00,1,1,1,1,1,1,20171001, K0821,HCPCS,PWC GP 2 STD PORT CAP CHAIR,RR,,28,,NW,,,,,,$785.71,$0.00,1,1,1,1,1,1,20171001, K0822,HCPCS,PWC GP 2 STD SEAT/BACK,,,28,,NW,,,,,,"$6,587.50",$0.00,1,1,1,1,1,1,20171001, K0822,HCPCS,PWC GP 2 STD SEAT/BACK,RR,,28,,NW,,,,,,$833.63,$0.00,1,1,1,1,1,1,20171001, K0823,HCPCS,PWC GP 2 STD CAP CHAIR,,,28,,NW,,,,,,"$6,221.29",$0.00,1,1,1,1,1,1,20171001, K0823,HCPCS,PWC GP 2 STD CAP CHAIR,RR,,28,,NW,,,,,,$787.29,$0.00,1,1,1,1,1,1,20171001, K0824,HCPCS,PWC GP 2 HD SEAT/BACK,,,28,,NW,,,,,,"$9,367.60",$0.00,1,1,1,1,1,1,20171001, K0824,HCPCS,PWC GP 2 HD SEAT/BACK,RR,,28,,NW,,,,,,"$1,185.44",$0.00,1,1,1,1,1,1,20171001, K0825,HCPCS,PWC GP 2 HD CAP CHAIR,,,28,,NW,,,,,,"$8,696.85",$0.00,1,1,1,1,1,1,20171001, K0825,HCPCS,PWC GP 2 HD CAP CHAIR,RR,,28,,NW,,,,,,"$1,100.56",$0.00,1,1,1,1,1,1,20171001, K0826,HCPCS,PWC GP 2 VHD SEAT/BACK,,,28,,NW,,,,,,"$15,470.82",$0.00,1,1,1,1,1,1,20171001, K0826,HCPCS,PWC GP 2 VHD SEAT/BACK,RR,,28,,NW,,,,,,"$1,957.79",$0.00,1,1,1,1,1,1,20171001, K0827,HCPCS,PWC GP VHD CAP CHAIR,,,28,,NW,,,,,,"$13,513.44",$0.00,1,1,1,1,1,1,20171001, K0827,HCPCS,PWC GP VHD CAP CHAIR,RR,,28,,NW,,,,,,"$1,710.09",$0.00,1,1,1,1,1,1,20171001, K0828,HCPCS,PWC GP 2 XTRA HD SEAT/BACK,,,28,,NW,,,,,,"$18,839.21",$0.00,1,1,1,1,1,1,20171001, K0828,HCPCS,PWC GP 2 XTRA HD SEAT/BACK,RR,,28,,NW,,,,,,"$2,384.05",$0.00,1,1,1,1,1,1,20171001, K0829,HCPCS,PWC GP 2 XTRA HD CAP CHAIR,,,28,,NW,,,,,,"$12,311.85",$0.00,1,1,1,1,1,1,20171001, K0829,HCPCS,PWC GP 2 XTRA HD CAP CHAIR,RR,,28,,NW,,,,,,"$1,558.03",$0.00,1,1,1,1,1,1,20171001, K0830,HCPCS,PWC GP2 STD SEAT ELEVATE S/B,,,28,,NW,,,,,,$474.94,$0.00,1,1,1,1,1,1,20171001, K0831,HCPCS,PWC GP2 STD SEAT ELEVATE CAP,,,28,,NW,,,,,,$999.11,$0.00,1,1,1,1,1,1,20171001, K0835,HCPCS,PWC GP2 STD SING POW OPT S/B,,,28,,NW,,,,,,"$7,413.45",$0.00,1,1,1,1,1,1,20171001, K0835,HCPCS,PWC GP2 STD SING POW OPT S/B,RR,,28,,NW,,,,,,$938.15,$0.00,1,1,1,1,1,1,20171001, K0836,HCPCS,PWC GP2 STD SING POW OPT CAP,,,28,,NW,,,,,,"$7,680.28",$0.00,1,1,1,1,1,1,20171001, K0836,HCPCS,PWC GP2 STD SING POW OPT CAP,RR,,28,,NW,,,,,,$971.92,$0.00,1,1,1,1,1,1,20171001, K0837,HCPCS,PWC GP 2 HD SING POW OPT S/B,,,28,,NW,,,,,,"$9,440.80",$0.00,1,1,1,1,1,1,20171001, K0837,HCPCS,PWC GP 2 HD SING POW OPT S/B,RR,,28,,NW,,,,,,"$1,194.71",$0.00,1,1,1,1,1,1,20171001, K0838,HCPCS,PWC GP 2 HD SING POW OPT CAP,,,28,,NW,,,,,,"$8,395.07",$0.00,1,1,1,1,1,1,20171001, K0838,HCPCS,PWC GP 2 HD SING POW OPT CAP,RR,,28,,NW,,,,,,"$1,062.37",$0.00,1,1,1,1,1,1,20171001, K0839,HCPCS,PWC GP2 VHD SING POW OPT S/B,,,28,,NW,,,,,,"$12,462.07",$0.00,1,1,1,1,1,1,20171001, K0839,HCPCS,PWC GP2 VHD SING POW OPT S/B,RR,,28,,NW,,,,,,"$1,577.04",$0.00,1,1,1,1,1,1,20171001, K0840,HCPCS,PWC GP2 XHD SING POW OPT S/B,,,28,,NW,,,,,,"$19,005.45",$0.00,1,1,1,1,1,1,20171001, K0840,HCPCS,PWC GP2 XHD SING POW OPT S/B,RR,,28,,NW,,,,,,"$2,405.09",$0.00,1,1,1,1,1,1,20171001, K0841,HCPCS,PWC GP2 STD MULT POW OPT S/B,,,28,,NW,,,,,,"$8,323.83",$0.00,1,1,1,1,1,1,20171001, K0841,HCPCS,PWC GP2 STD MULT POW OPT S/B,RR,,28,,NW,,,,,,"$1,053.36",$0.00,1,1,1,1,1,1,20171001, K0842,HCPCS,PWC GP2 STD MULT POW OPT CAP,,,28,,NW,,,,,,"$8,312.17",$0.00,1,1,1,1,1,1,20171001, K0842,HCPCS,PWC GP2 STD MULT POW OPT CAP,RR,,28,,NW,,,,,,"$1,051.88",$0.00,1,1,1,1,1,1,20171001, K0843,HCPCS,PWC GP2 HD MULT POW OPT S/B,,,28,,NW,,,,,,"$9,822.70",$0.00,1,1,1,1,1,1,20171001, K0843,HCPCS,PWC GP2 HD MULT POW OPT S/B,RR,,28,,NW,,,,,,"$1,243.04",$0.00,1,1,1,1,1,1,20171001, K0848,HCPCS,PWC GP 3 STD SEAT/BACK,,,28,,NW,,,,,,"$11,217.97",$0.00,1,1,1,1,1,1,20171001, K0848,HCPCS,PWC GP 3 STD SEAT/BACK,RR,,28,,NW,,,,,,"$1,419.60",$0.00,1,1,1,1,1,1,20171001, K0849,HCPCS,PWC GP 3 STD CAP CHAIR,,,28,,NW,,,,,,"$10,794.68",$0.00,1,1,1,1,1,1,20171001, K0849,HCPCS,PWC GP 3 STD CAP CHAIR,RR,,28,,NW,,,,,,"$1,366.04",$0.00,1,1,1,1,1,1,20171001, K0850,HCPCS,PWC GP 3 HD SEAT/BACK,,,28,,NW,,,,,,"$12,974.20",$0.00,1,1,1,1,1,1,20171001, K0850,HCPCS,PWC GP 3 HD SEAT/BACK,RR,,28,,NW,,,,,,"$1,641.85",$0.00,1,1,1,1,1,1,20171001, K0851,HCPCS,PWC GP 3 HD CAP CHAIR,,,28,,NW,,,,,,"$12,483.90",$0.00,1,1,1,1,1,1,20171001, K0851,HCPCS,PWC GP 3 HD CAP CHAIR,RR,,28,,NW,,,,,,"$1,579.81",$0.00,1,1,1,1,1,1,20171001, K0852,HCPCS,PWC GP 3 VHD SEAT/BACK,,,28,,NW,,,,,,"$14,953.57",$0.00,1,1,1,1,1,1,20171001, K0852,HCPCS,PWC GP 3 VHD SEAT/BACK,RR,,28,,NW,,,,,,"$1,892.33",$0.00,1,1,1,1,1,1,20171001, K0853,HCPCS,PWC GP 3 VHD CAP CHAIR,,,28,,NW,,,,,,"$15,354.61",$0.00,1,1,1,1,1,1,20171001, K0853,HCPCS,PWC GP 3 VHD CAP CHAIR,RR,,28,,NW,,,,,,"$1,943.09",$0.00,1,1,1,1,1,1,20171001, K0854,HCPCS,PWC GP 3 XHD SEAT/BACK,,,28,,NW,,,,,,"$20,263.83",$0.00,1,1,1,1,1,1,20171001, K0854,HCPCS,PWC GP 3 XHD SEAT/BACK,RR,,28,,NW,,,,,,"$2,564.33",$0.00,1,1,1,1,1,1,20171001, K0855,HCPCS,PWC GP 3 XHD CAP CHAIR,,,28,,NW,,,,,,"$19,155.47",$0.00,1,1,1,1,1,1,20171001, K0855,HCPCS,PWC GP 3 XHD CAP CHAIR,RR,,28,,NW,,,,,,"$2,424.07",$0.00,1,1,1,1,1,1,20171001, K0856,HCPCS,PWC GP3 STD SING POW OPT S/B,,,28,,NW,,,,,,"$12,023.70",$0.00,1,1,1,1,1,1,20171001, K0856,HCPCS,PWC GP3 STD SING POW OPT S/B,RR,,28,,NW,,,,,,"$1,521.57",$0.00,1,1,1,1,1,1,20171001, K0857,HCPCS,PWC GP3 STD SING POW OPT CAP,,,28,,NW,,,,,,"$12,259.90",$0.00,1,1,1,1,1,1,20171001, K0857,HCPCS,PWC GP3 STD SING POW OPT CAP,RR,,28,,NW,,,,,,"$1,551.46",$0.00,1,1,1,1,1,1,20171001, K0858,HCPCS,PWC GP3 HD SING POW OPT S/B,,,28,,NW,,,,,,"$14,860.39",$0.00,1,1,1,1,1,1,20171001, K0858,HCPCS,PWC GP3 HD SING POW OPT S/B,RR,,28,,NW,,,,,,"$1,880.54",$0.00,1,1,1,1,1,1,20171001, K0859,HCPCS,PWC GP3 HD SING POW OPT CAP,,,28,,NW,,,,,,"$14,183.30",$0.00,1,1,1,1,1,1,20171001, K0859,HCPCS,PWC GP3 HD SING POW OPT CAP,RR,,28,,NW,,,,,,"$1,794.86",$0.00,1,1,1,1,1,1,20171001, K0860,HCPCS,PWC GP3 VHD SING POW OPT S/B,,,28,,NW,,,,,,"$21,127.27",$0.00,1,1,1,1,1,1,20171001, K0860,HCPCS,PWC GP3 VHD SING POW OPT S/B,RR,,28,,NW,,,,,,"$2,673.60",$0.00,1,1,1,1,1,1,20171001, K0861,HCPCS,PWC GP3 STD MULT POW OPT S/B,,,28,,NW,,,,,,"$12,042.59",$0.00,1,1,1,1,1,1,20171001, K0861,HCPCS,PWC GP3 STD MULT POW OPT S/B,RR,,28,,NW,,,,,,"$1,523.96",$0.00,1,1,1,1,1,1,20171001, K0862,HCPCS,PWC GP3 HD MULT POW OPT S/B,,,28,,NW,,,,,,"$14,860.39",$0.00,1,1,1,1,1,1,20171001, K0862,HCPCS,PWC GP3 HD MULT POW OPT S/B,RR,,28,,NW,,,,,,"$1,880.54",$0.00,1,1,1,1,1,1,20171001, K0863,HCPCS,PWC GP3 VHD MULT POW OPT S/B,,,28,,NW,,,,,,"$21,127.27",$0.00,1,1,1,1,1,1,20171001, K0863,HCPCS,PWC GP3 VHD MULT POW OPT S/B,RR,,28,,NW,,,,,,"$2,673.60",$0.00,1,1,1,1,1,1,20171001, K0864,HCPCS,PWC GP3 XHD MULT POW OPT S/B,,,28,,NW,,,,,,"$25,096.16",$0.00,1,1,1,1,1,1,20171001, K0864,HCPCS,PWC GP3 XHD MULT POW OPT S/B,RR,,28,,NW,,,,,,"$3,175.85",$0.00,1,1,1,1,1,1,20171001, K0868,HCPCS,PWC GP 4 STD SEAT/BACK,,,28,,NW,,,,,,$845.18,$0.00,1,1,1,1,1,1,20171001, K0869,HCPCS,PWC GP 4 STD CAP CHAIR,,,28,,NW,,,,,,"$2,635.55",$0.00,1,1,1,1,1,1,20171001, K0870,HCPCS,PWC GP 4 HD SEAT/BACK,,,28,,NW,,,,,,"$2,773.82",$0.00,1,1,1,1,1,1,20171001, K0871,HCPCS,PWC GP 4 VHD SEAT/BACK,,,28,,NW,,,,,,"$7,213.01",$0.00,1,1,1,1,1,1,20171001, K0877,HCPCS,PWC GP4 STD SING POW OPT S/B,,,28,,NW,,,,,,$925.22,$0.00,1,1,1,1,1,1,20171001, K0878,HCPCS,PWC GP4 STD SING POW OPT CAP,,,28,,NW,,,,,,"$1,899.87",$0.00,1,1,1,1,1,1,20171001, K0879,HCPCS,PWC GP4 HD SING POW OPT S/B,,,28,,NW,,,,,,"$2,298.02",$0.00,1,1,1,1,1,1,20171001, K0880,HCPCS,PWC GP4 VHD SING POW OPT S/B,,,28,,NW,,,,,,"$2,459.48",$0.00,1,1,1,1,1,1,20171001, K0884,HCPCS,PWC GP4 STD MULT POW OPT S/B,,,28,,NW,,,,,,"$1,229.29",$0.00,1,1,1,1,1,1,20171001, K0885,HCPCS,PWC GP4 STD MULT POW OPT CAP,,,28,,NW,,,,,,"$3,509.96",$0.00,1,1,1,1,1,1,20171001, K0886,HCPCS,PWC GP4 HD MULT POW S/B,,,28,,NW,,,,,,"$2,939.09",$0.00,1,1,1,1,1,1,20171001, K0890,HCPCS,PWC GP5 PED SING POW OPT S/B,,,28,,NW,,,,,,"$2,244.99",$0.00,1,1,1,1,1,1,20171001, K0891,HCPCS,PWC GP5 PED MULT POW OPT S/B,,,28,,NW,,,,,,"$1,422.61",$0.00,1,1,1,1,1,1,20171001, K0898,HCPCS,POWER WHEELCHAIR NOC,,,28,,NW,,,,,,"$1,308.69",$0.00,1,1,1,1,1,1,20171001, K0899,HCPCS,POW MOBIL DEV NO DMEPDAC,,,28,,NW,,,,,,"$2,082.01",$0.00,1,1,1,1,1,1,20171001, L0112,HCPCS,CRANIAL CERVICAL ORTHOSIS,,,28,,NW,,,,,,"$2,209.24",$0.00,1,1,1,1,1,1,20171001, L0113,HCPCS,CRANIAL CERVICAL TORTICOLLIS,,,28,,NW,,,,,,$445.69,$0.00,1,1,1,1,1,1,20171001, L0120,HCPCS,CERV FLEX N/ADJ FOAM PRE OTS,,,28,,NW,,,,,,$41.82,$0.00,1,1,1,1,1,1,20171001, L0130,HCPCS,FLEX THERMOPLASTIC COLLAR MO,,,28,,NW,,,,,,$279.09,$0.00,1,1,1,1,1,1,20171001, L0140,HCPCS,CERVICAL SEMI-RIGID ADJUSTAB,,,28,,NW,,,,,,$98.05,$0.00,1,1,1,1,1,1,20171001, L0150,HCPCS,CERV SEMI-RIG ADJ MOLDED CHN,,,28,,NW,,,,,,$177.70,$0.00,1,1,1,1,1,1,20171001, L0160,HCPCS,CERV SR WIRE OCC/MAN PRE OTS,,,28,,NW,,,,,,$256.62,$0.00,1,1,1,1,1,1,20171001, L0170,HCPCS,CERVICAL COLLAR MOLDED TO PT,,,28,,NW,,,,,,"$1,115.35",$0.00,1,1,1,1,1,1,20171001, L0172,HCPCS,CERV COL SR FOAM 2PC PRE OTS,,,28,,NW,,,,,,$212.11,$0.00,1,1,1,1,1,1,20171001, L0174,HCPCS,CERV SR 2PC THOR EXT PRE OTS,,,28,,NW,,,,,,$440.54,$0.00,1,1,1,1,1,1,20171001, L0180,HCPCS,CER POST COL OCC/MAN SUP ADJ,,,28,,NW,,,,,,$625.16,$0.00,1,1,1,1,1,1,20171001, L0190,HCPCS,CERV COLLAR SUPP ADJ CERV BA,,,28,,NW,,,,,,$839.43,$0.00,1,1,1,1,1,1,20171001, L0200,HCPCS,CERV COL SUPP ADJ BAR & THOR,,,28,,NW,,,,,,$878.28,$0.00,1,1,1,1,1,1,20171001, L0220,HCPCS,THOR RIB BELT CUSTOM FABRICA,,,28,,NW,,,,,,$196.95,$0.00,1,1,1,1,1,1,20171001, L0450,HCPCS,TLSO FLEX TRUNK/THOR PRE OTS,,,28,,NW,,,,,,$288.72,$0.00,1,1,1,1,1,1,20171001, L0452,HCPCS,TLSO FLEX CUSTOM FAB THORACI,,,28,,NW,,,,,,$513.71,$0.00,1,1,1,1,1,1,20171001, L0454,HCPCS,TLSO TRNK SJ-T9 PRE CST,,,28,,NW,,,,,,$542.61,$0.00,1,1,1,1,1,1,20171001, L0455,HCPCS,TLSO FLEX TRNK SJ-T9 PRE OTS,,,28,,NW,,,,,,$542.61,$0.00,1,1,1,1,1,1,20171001, L0456,HCPCS,TLSO FLEX TRNK SJ-SS PRE CST,,,28,,NW,,,,,,"$1,568.04",$0.00,1,1,1,1,1,1,20171001, L0457,HCPCS,TLSO FLEX TRNK SJ-SS PRE OTS,,,28,,NW,,,,,,"$1,568.04",$0.00,1,1,1,1,1,1,20171001, L0458,HCPCS,TLSO 2MOD SYMPHIS-XIPHO PRE,,,28,,NW,,,,,,"$1,405.40",$0.00,1,1,1,1,1,1,20171001, L0460,HCPCS,TLSO 2 SHL SYMPHYS-STERN CST,,,28,,NW,,,,,,"$1,582.69",$0.00,1,1,1,1,1,1,20171001, L0462,HCPCS,TLSO 3MOD SACRO-SCAP PRE,,,28,,NW,,,,,,"$1,970.16",$0.00,1,1,1,1,1,1,20171001, L0464,HCPCS,TLSO 4MOD SACRO-SCAP PRE,,,28,,NW,,,,,,"$2,346.68",$0.00,1,1,1,1,1,1,20171001, L0466,HCPCS,TLSO R FRAM SOFT ANT PRE CST,,,28,,NW,,,,,,$618.40,$0.00,1,1,1,1,1,1,20171001, L0467,HCPCS,TLSO R FRAM SOFT PRE OTS,,,28,,NW,,,,,,$618.40,$0.00,1,1,1,1,1,1,20171001, L0468,HCPCS,TLSO RIG FRAM PELVIC PRE CST,,,28,,NW,,,,,,$780.10,$0.00,1,1,1,1,1,1,20171001, L0469,HCPCS,TLSO RIG FRAM PELVIC PRE OTS,,,28,,NW,,,,,,$780.10,$0.00,1,1,1,1,1,1,20171001, L0470,HCPCS,TLSO RIGID FRAME PRE SUBCLAV,,,28,,NW,,,,,,"$1,068.66",$0.00,1,1,1,1,1,1,20171001, L0472,HCPCS,TLSO RIGID FRAME HYPEREX PRE,,,28,,NW,,,,,,$693.59,$0.00,1,1,1,1,1,1,20171001, L0480,HCPCS,TLSO RIGID PLASTIC CUSTOM FA,,,28,,NW,,,,,,"$2,352.13",$0.00,1,1,1,1,1,1,20171001, L0482,HCPCS,TLSO RIGID LINED CUSTOM FAB,,,28,,NW,,,,,,"$2,589.03",$0.00,1,1,1,1,1,1,20171001, L0484,HCPCS,TLSO RIGID PLASTIC CUST FAB,,,28,,NW,,,,,,"$2,880.33",$0.00,1,1,1,1,1,1,20171001, L0486,HCPCS,TLSO RIGIDLINED CUST FAB TWO,,,28,,NW,,,,,,"$3,072.13",$0.00,1,1,1,1,1,1,20171001, L0488,HCPCS,TLSO RIGID LINED PRE ONE PIE,,,28,,NW,,,,,,"$1,582.69",$0.00,1,1,1,1,1,1,20171001, L0490,HCPCS,TLSO RIGID PLASTIC PRE ONE,,,28,,NW,,,,,,$441.91,$0.00,1,1,1,1,1,1,20171001, L0491,HCPCS,TLSO 2 PIECE RIGID SHELL,,,28,,NW,,,,,,"$1,209.35",$0.00,1,1,1,1,1,1,20171001, L0492,HCPCS,TLSO 3 PIECE RIGID SHELL,,,28,,NW,,,,,,$790.20,$0.00,1,1,1,1,1,1,20171001, L0621,HCPCS,SIO FLEX PELVIC/SACR PRE OTS,,,28,,NW,,,,,,$147.12,$0.00,1,1,1,1,1,1,20171001, L0622,HCPCS,SIO FLEX PELVISACRAL CUSTOM,,,28,,NW,,,,,,$425.32,$0.00,1,1,1,1,1,1,20171001, L0623,HCPCS,SIO RIG PNL PELV/SAC PRE OTS,,,28,,NW,,,,,,$63.17,$0.00,1,1,1,1,1,1,20171001, L0624,HCPCS,SIO PANEL CUSTOM,,,28,,NW,,,,,,$112.64,$0.00,1,1,1,1,1,1,20171001, L0625,HCPCS,LO FLEX L1-BELOW L5 PRE OTS,,,28,,NW,,,,,,$80.78,$0.00,1,1,1,1,1,1,20171001, L0626,HCPCS,LO SAG RIG PNL STAYS PRE CST,,,28,,NW,,,,,,$116.97,$0.00,1,1,1,1,1,1,20171001, L0627,HCPCS,LO SAG RI AN/POS PNL PRE CST,,,28,,NW,,,,,,$644.34,$0.00,1,1,1,1,1,1,20171001, L0628,HCPCS,LSO FLEX NO RI STAYS PRE OTS,,,28,,NW,,,,,,$126.38,$0.00,1,1,1,1,1,1,20171001, L0629,HCPCS,LSO FLEX W/RIGID STAYS CUST,,,28,,NW,,,,,,$121.97,$0.00,1,1,1,1,1,1,20171001, L0630,HCPCS,LSO R POST PNL SJ-T9 PRE CST,,,28,,NW,,,,,,$249.97,$0.00,1,1,1,1,1,1,20171001, L0631,HCPCS,LSO SAG R AN/POS PNL PRE CST,,,28,,NW,,,,,,"$1,618.81",$0.00,1,1,1,1,1,1,20171001, L0632,HCPCS,LSO SAG RIGID FRAME CUST,,,28,,NW,,,,,,"$2,333.75",$0.00,1,1,1,1,1,1,20171001, L0633,HCPCS,LSO SC R POS/LAT PNL PRE CST,,,28,,NW,,,,,,$447.56,$0.00,1,1,1,1,1,1,20171001, L0634,HCPCS,LSO FLEXION CONTROL CUSTOM,,,28,,NW,,,,,,$656.14,$0.00,1,1,1,1,1,1,20171001, L0635,HCPCS,LSO SAGIT RIGID PANEL PREFAB,,,28,,NW,,,,,,"$1,630.21",$0.00,1,1,1,1,1,1,20171001, L0636,HCPCS,LSO SAGITTAL RIGID PANEL CUS,,,28,,NW,,,,,,"$2,369.83",$0.00,1,1,1,1,1,1,20171001, L0637,HCPCS,LSO SC R ANT/POS PNL PRE CST,,,28,,NW,,,,,,"$1,920.09",$0.00,1,1,1,1,1,1,20171001, L0638,HCPCS,LSO SAG-CORONAL PANEL CUSTOM,,,28,,NW,,,,,,"$2,081.48",$0.00,1,1,1,1,1,1,20171001, L0639,HCPCS,LSO S/C SHELL/PANEL PREFAB,,,28,,NW,,,,,,"$1,920.09",$0.00,1,1,1,1,1,1,20171001, L0640,HCPCS,LSO S/C SHELL/PANEL CUSTOM,,,28,,NW,,,,,,"$1,650.08",$0.00,1,1,1,1,1,1,20171001, L0641,HCPCS,LO RIG POS PNL L1-L5 PRE OTS,,,28,,NW,,,,,,$116.97,$0.00,1,1,1,1,1,1,20171001, L0642,HCPCS,LO SAG RI AN/POS PNL PRE OTS,,,28,,NW,,,,,,$644.34,$0.00,1,1,1,1,1,1,20171001, L0643,HCPCS,LSO SAG CTR RIGI POS PRE OTS,,,28,,NW,,,,,,$249.97,$0.00,1,1,1,1,1,1,20171001, L0648,HCPCS,LSO SAG R AN/POS PNL PRE OTS,,,28,,NW,,,,,,"$1,618.81",$0.00,1,1,1,1,1,1,20171001, L0649,HCPCS,LSO SC R POS/LAT PNL PRE OTS,,,28,,NW,,,,,,$447.56,$0.00,1,1,1,1,1,1,20171001, L0650,HCPCS,LSO SC R ANT/POS PNL PRE OTS,,,28,,NW,,,,,,"$1,920.09",$0.00,1,1,1,1,1,1,20171001, L0651,HCPCS,LSO SAG-CO SHELL PNL PRE OTS,,,28,,NW,,,,,,"$1,920.09",$0.00,1,1,1,1,1,1,20171001, L0700,HCPCS,CTLSO A-P-L CONTROL MOLDED,,,28,,NW,,,,,,"$3,337.10",$0.00,1,1,1,1,1,1,20171001, L0710,HCPCS,CTLSO A-P-L CONTROL W/ INTER,,,28,,NW,,,,,,"$3,533.69",$0.00,1,1,1,1,1,1,20171001, L0810,HCPCS,HALO CERVICAL INTO JCKT VEST,,,28,,NW,,,,,,"$4,261.89",$0.00,1,1,1,1,1,1,20171001, L0820,HCPCS,HALO CERVICAL INTO BODY JACK,,,28,,NW,,,,,,"$3,503.14",$0.00,1,1,1,1,1,1,20171001, L0830,HCPCS,HALO CERV INTO MILWAUKEE TYP,,,28,,NW,,,,,,"$5,210.05",$0.00,1,1,1,1,1,1,20171001, L0859,HCPCS,MRI COMPATIBLE SYSTEM,,,28,,NW,,,,,,"$1,933.10",$0.00,1,1,1,1,1,1,20171001, L0861,HCPCS,HALO REPL LINER/INTERFACE,,,28,,NW,,,,,,$334.78,$0.00,1,1,1,1,1,1,20171001, L0970,HCPCS,TLSO CORSET FRONT,,,28,,NW,,,,,,$183.49,$0.00,1,1,1,1,1,1,20171001, L0972,HCPCS,LSO CORSET FRONT,,,28,,NW,,,,,,$169.11,$0.00,1,1,1,1,1,1,20171001, L0974,HCPCS,TLSO FULL CORSET,,,28,,NW,,,,,,$299.25,$0.00,1,1,1,1,1,1,20171001, L0976,HCPCS,LSO FULL CORSET,,,28,,NW,,,,,,$258.94,$0.00,1,1,1,1,1,1,20171001, L0978,HCPCS,AXILLARY CRUTCH EXTENSION,,,28,,NW,,,,,,$308.10,$0.00,1,1,1,1,1,1,20171001, L0980,HCPCS,PERONEAL STRAPS PAIR PRE OTS,,,28,,NW,,,,,,$27.00,$0.00,1,1,1,1,1,1,20171001, L0982,HCPCS,STOCKING SUP GRIPS 4 PRE OTS,,,28,,NW,,,,,,$25.65,$0.00,1,1,1,1,1,1,20171001, L0984,HCPCS,PROTECT BODY SOCK EA PRE OTS,,,28,,NW,,,,,,$92.60,$0.00,1,1,1,1,1,1,20171001, L0999,HCPCS,ADD TO SPINAL ORTHOSIS NOS,,,28,,NW,,,,,,$146.26,$0.00,1,1,1,1,1,1,20171001, L1000,HCPCS,CTLSO MILWAUKE INITIAL MODEL,,,28,,NW,,,,,,"$3,346.94",$0.00,1,1,1,1,1,1,20171001, L1001,HCPCS,CTLSO INFANT IMMOBILIZER,,,28,,NW,,,,,,$68.31,$0.00,1,1,1,1,1,1,20171001, L1005,HCPCS,TENSION BASED SCOLIOSIS ORTH,,,28,,NW,,,,,,"$5,060.37",$0.00,1,1,1,1,1,1,20171001, L1010,HCPCS,CTLSO AXILLA SLING,,,28,,NW,,,,,,$108.43,$0.00,1,1,1,1,1,1,20171001, L1020,HCPCS,KYPHOSIS PAD,,,28,,NW,,,,,,$148.67,$0.00,1,1,1,1,1,1,20171001, L1025,HCPCS,KYPHOSIS PAD FLOATING,,,28,,NW,,,,,,$212.31,$0.00,1,1,1,1,1,1,20171001, L1030,HCPCS,LUMBAR BOLSTER PAD,,,28,,NW,,,,,,$104.28,$0.00,1,1,1,1,1,1,20171001, L1040,HCPCS,LUMBAR OR LUMBAR RIB PAD,,,28,,NW,,,,,,$130.68,$0.00,1,1,1,1,1,1,20171001, L1050,HCPCS,STERNAL PAD,,,28,,NW,,,,,,$138.95,$0.00,1,1,1,1,1,1,20171001, L1060,HCPCS,THORACIC PAD,,,28,,NW,,,,,,$155.99,$0.00,1,1,1,1,1,1,20171001, L1070,HCPCS,TRAPEZIUS SLING,,,28,,NW,,,,,,$151.87,$0.00,1,1,1,1,1,1,20171001, L1080,HCPCS,OUTRIGGER,,,28,,NW,,,,,,$85.47,$0.00,1,1,1,1,1,1,20171001, L1085,HCPCS,OUTRIGGER BIL W/ VERT EXTENS,,,28,,NW,,,,,,$263.86,$0.00,1,1,1,1,1,1,20171001, L1090,HCPCS,LUMBAR SLING,,,28,,NW,,,,,,$148.82,$0.00,1,1,1,1,1,1,20171001, L1100,HCPCS,RING FLANGE PLASTIC/LEATHER,,,28,,NW,,,,,,$266.14,$0.00,1,1,1,1,1,1,20171001, L1110,HCPCS,RING FLANGE PLAS/LEATHER MOL,,,28,,NW,,,,,,$430.38,$0.00,1,1,1,1,1,1,20171001, L1120,HCPCS,COVERS FOR UPRIGHT EACH,,,28,,NW,,,,,,$61.10,$0.00,1,1,1,1,1,1,20171001, L1200,HCPCS,FURNSH INITIAL ORTHOSIS ONLY,,,28,,NW,,,,,,"$2,721.12",$0.00,1,1,1,1,1,1,20171001, L1210,HCPCS,LATERAL THORACIC EXTENSION,,,28,,NW,,,,,,$425.70,$0.00,1,1,1,1,1,1,20171001, L1220,HCPCS,ANTERIOR THORACIC EXTENSION,,,28,,NW,,,,,,$379.40,$0.00,1,1,1,1,1,1,20171001, L1230,HCPCS,MILWAUKEE TYPE SUPERSTRUCTUR,,,28,,NW,,,,,,$940.89,$0.00,1,1,1,1,1,1,20171001, L1240,HCPCS,LUMBAR DEROTATION PAD,,,28,,NW,,,,,,$129.49,$0.00,1,1,1,1,1,1,20171001, L1250,HCPCS,ANTERIOR ASIS PAD,,,28,,NW,,,,,,$118.25,$0.00,1,1,1,1,1,1,20171001, L1260,HCPCS,ANTERIOR THORACIC DEROTATION,,,28,,NW,,,,,,$126.30,$0.00,1,1,1,1,1,1,20171001, L1270,HCPCS,ABDOMINAL PAD,,,28,,NW,,,,,,$126.68,$0.00,1,1,1,1,1,1,20171001, L1280,HCPCS,RIB GUSSET (ELASTIC) EACH,,,28,,NW,,,,,,$136.98,$0.00,1,1,1,1,1,1,20171001, L1290,HCPCS,LATERAL TROCHANTERIC PAD,,,28,,NW,,,,,,$125.83,$0.00,1,1,1,1,1,1,20171001, L1300,HCPCS,BODY JACKET MOLD TO PATIENT,,,28,,NW,,,,,,"$2,856.91",$0.00,1,1,1,1,1,1,20171001, L1310,HCPCS,POST-OPERATIVE BODY JACKET,,,28,,NW,,,,,,"$2,876.65",$0.00,1,1,1,1,1,1,20171001, L1499,HCPCS,SPINAL ORTHOSIS NOS,,,28,,NW,,,,,,"$2,866.78",$0.00,1,1,1,1,1,1,20171001, L1600,HCPCS,HO FLEX FREJKA W/COV PRE CST,,,28,,NW,,,,,,$208.72,$0.00,1,1,1,1,1,1,20171001, L1610,HCPCS,HO FREJKA COV ONLY PRE CST,,,28,,NW,,,,,,$69.74,$0.00,1,1,1,1,1,1,20171001, L1620,HCPCS,HO FLEX PAVLIK HARNS PRE CST,,,28,,NW,,,,,,$220.56,$0.00,1,1,1,1,1,1,20171001, L1630,HCPCS,ABDUCT CONTROL HIP SEMI-FLEX,,,28,,NW,,,,,,$270.01,$0.00,1,1,1,1,1,1,20171001, L1640,HCPCS,PELV BAND/SPREAD BAR THIGH C,,,28,,NW,,,,,,$753.96,$0.00,1,1,1,1,1,1,20171001, L1650,HCPCS,HO ABDUCTION HIP ADJUSTABLE,,,28,,NW,,,,,,$372.38,$0.00,1,1,1,1,1,1,20171001, L1652,HCPCS,HO BI THIGHCUFFS W SPRDR BAR,,,28,,NW,,,,,,$557.89,$0.00,1,1,1,1,1,1,20171001, L1660,HCPCS,HO ABDUCTION STATIC PLASTIC,,,28,,NW,,,,,,$267.99,$0.00,1,1,1,1,1,1,20171001, L1680,HCPCS,PELVIC & HIP CONTROL THIGH C,,,28,,NW,,,,,,"$2,052.41",$0.00,1,1,1,1,1,1,20171001, L1685,HCPCS,POST-OP HIP ABDUCT CUSTOM FA,,,28,,NW,,,,,,"$1,991.41",$0.00,1,1,1,1,1,1,20171001, L1686,HCPCS,HO POST-OP HIP ABDUCTION,,,28,,NW,,,,,,"$1,568.37",$0.00,1,1,1,1,1,1,20171001, L1690,HCPCS,COMBINATION BILATERAL HO,,,28,,NW,,,,,,"$3,058.39",$0.00,1,1,1,1,1,1,20171001, L1700,HCPCS,LEG PERTHES ORTH TORONTO TYP,,,28,,NW,,,,,,"$2,569.50",$0.00,1,1,1,1,1,1,20171001, L1710,HCPCS,LEGG PERTHES ORTH NEWINGTON,,,28,,NW,,,,,,"$3,088.13",$0.00,1,1,1,1,1,1,20171001, L1720,HCPCS,LEGG PERTHES ORTHOSIS TRILAT,,,28,,NW,,,,,,"$2,250.94",$0.00,1,1,1,1,1,1,20171001, L1730,HCPCS,LEGG PERTHES ORTH SCOTTISH R,,,28,,NW,,,,,,"$1,891.03",$0.00,1,1,1,1,1,1,20171001, L1755,HCPCS,LEGG PERTHES PATTEN BOTTOM T,,,28,,NW,,,,,,"$2,656.19",$0.00,1,1,1,1,1,1,20171001, L1810,HCPCS,KO ELASTIC WITH JOINTS,,,28,,NW,,,,,,$164.50,$0.00,1,1,1,1,1,1,20171001, L1812,HCPCS,KO ELASTIC W/JOINTS PRE OTS,,,28,,NW,,,,,,$164.50,$0.00,1,1,1,1,1,1,20171001, L1820,HCPCS,KO ELAS W/ CONDYLE PADS & JO,,,28,,NW,,,,,,$210.95,$0.00,1,1,1,1,1,1,20171001, L1830,HCPCS,KO IMMOB CANVAS LONG PRE OTS,,,28,,NW,,,,,,$143.23,$0.00,1,1,1,1,1,1,20171001, L1831,HCPCS,KNEE ORTH POS LOCKING JOINT,,,28,,NW,,,,,,$459.49,$0.00,1,1,1,1,1,1,20171001, L1832,HCPCS,KO ADJ JNT POS R SUP PRE CST,,,28,,NW,,,,,,"$1,086.93",$0.00,1,1,1,1,1,1,20171001, L1833,HCPCS,KO ADJ JNT POS R SUP PRE OTS,,,28,,NW,,,,,,"$1,086.93",$0.00,1,1,1,1,1,1,20171001, L1834,HCPCS,KO W/0 JOINT RIGID MOLDED TO,,,28,,NW,,,,,,"$1,302.44",$0.00,1,1,1,1,1,1,20171001, L1836,HCPCS,KO RIGID W/O JOINTS PRE OTS,,,28,,NW,,,,,,$204.79,$0.00,1,1,1,1,1,1,20171001, L1840,HCPCS,KO DEROT ANT CRUCIATE CUSTOM,,,28,,NW,,,,,,"$1,573.76",$0.00,1,1,1,1,1,1,20171001, L1843,HCPCS,KO SINGLE UPRIGHT PRE CST,,,28,,NW,,,,,,"$1,413.99",$0.00,1,1,1,1,1,1,20171001, L1844,HCPCS,KO W/ADJ JT ROT CNTRL MOLDED,,,28,,NW,,,,,,"$2,625.99",$0.00,1,1,1,1,1,1,20171001, L1845,HCPCS,KO DOUBLE UPRIGHT PRE CST,,,28,,NW,,,,,,"$1,369.33",$0.00,1,1,1,1,1,1,20171001, L1846,HCPCS,KO W ADJ FLEX/EXT ROTAT MOLD,,,28,,NW,,,,,,"$1,907.30",$0.00,1,1,1,1,1,1,20171001, L1847,HCPCS,KO DBL UPRIGHT W/AIR PRE CST,,,28,,NW,,,,,,$905.17,$0.00,1,1,1,1,1,1,20171001, L1848,HCPCS,KO DBL UPRIGHT W/AIR PRE OTS,,,28,,NW,,,,,,$905.17,$0.00,1,1,1,1,1,1,20171001, L1850,HCPCS,KO SWEDISH TYPE PRE OTS,,,28,,NW,,,,,,$475.97,$0.00,1,1,1,1,1,1,20171001, L1851,HCPCS,KO SINGLE UPRIGHT PREFAB OTS,,,28,,NW,,,,,,"$1,281.17",$0.00,1,1,1,1,1,1,20171001, L1852,HCPCS,KO DOUBLE UPRIGHT PREFAB OTS,,,28,,NW,,,,,,"$1,240.85",$0.00,1,1,1,1,1,1,20171001, L1860,HCPCS,KO SUPRACONDYLAR SOCKET MOLD,,,28,,NW,,,,,,"$1,834.39",$0.00,1,1,1,1,1,1,20171001, L1900,HCPCS,AFO SPRNG WIR DRSFLX CALF BD,,,28,,NW,,,,,,$444.02,$0.00,1,1,1,1,1,1,20171001, L1902,HCPCS,AFO ANKLE GAUNTLET PRE OTS,,,28,,NW,,,,,,$128.24,$0.00,1,1,1,1,1,1,20171001, L1904,HCPCS,AFO MOLDED ANKLE GAUNTLET,,,28,,NW,,,,,,$763.05,$0.00,1,1,1,1,1,1,20171001, L1906,HCPCS,AFO MULTILIG ANK SUP PRE OTS,,,28,,NW,,,,,,$191.57,$0.00,1,1,1,1,1,1,20171001, L1907,HCPCS,AFO SUPRAMALLEOLAR CUSTOM,,,28,,NW,,,,,,$884.34,$0.00,1,1,1,1,1,1,20171001, L1910,HCPCS,AFO SING BAR CLASP ATTACH SH,,,28,,NW,,,,,,$449.73,$0.00,1,1,1,1,1,1,20171001, L1920,HCPCS,AFO SING UPRIGHT W/ ADJUST S,,,28,,NW,,,,,,$569.71,$0.00,1,1,1,1,1,1,20171001, L1930,HCPCS,AFO PLASTIC,,,28,,NW,,,,,,$395.72,$0.00,1,1,1,1,1,1,20171001, L1932,HCPCS,AFO RIG ANT TIB PREFAB TCF/=,,,28,,NW,,,,,,"$1,406.22",$0.00,1,1,1,1,1,1,20171001, L1940,HCPCS,AFO MOLDED TO PATIENT PLASTI,,,28,,NW,,,,,,$839.39,$0.00,1,1,1,1,1,1,20171001, L1945,HCPCS,AFO MOLDED PLAS RIG ANT TIB,,,28,,NW,,,,,,"$1,592.42",$0.00,1,1,1,1,1,1,20171001, L1950,HCPCS,AFO SPIRAL MOLDED TO PT PLAS,,,28,,NW,,,,,,"$1,261.54",$0.00,1,1,1,1,1,1,20171001, L1951,HCPCS,AFO SPIRAL PREFABRICATED,,,28,,NW,,,,,,"$1,323.06",$0.00,1,1,1,1,1,1,20171001, L1960,HCPCS,AFO POS SOLID ANK PLASTIC MO,,,28,,NW,,,,,,$947.15,$0.00,1,1,1,1,1,1,20171001, L1970,HCPCS,AFO PLASTIC MOLDED W/ANKLE J,,,28,,NW,,,,,,"$1,175.08",$0.00,1,1,1,1,1,1,20171001, L1971,HCPCS,"AFO W/ANKLE JOINT, PREFAB",,,28,,NW,,,,,,$735.60,$0.00,1,1,1,1,1,1,20171001, L1980,HCPCS,AFO SING SOLID STIRRUP CALF,,,28,,NW,,,,,,$613.37,$0.00,1,1,1,1,1,1,20171001, L1990,HCPCS,AFO DOUB SOLID STIRRUP CALF,,,28,,NW,,,,,,$757.99,$0.00,1,1,1,1,1,1,20171001, L2000,HCPCS,KAFO SING FRE STIRR THI/CALF,,,28,,NW,,,,,,"$1,693.08",$0.00,1,1,1,1,1,1,20171001, L2005,HCPCS,KAFO SNG/DBL MECHANICAL ACT,,,28,,NW,,,,,,"$6,480.96",$0.00,1,1,1,1,1,1,20171001, L2010,HCPCS,KAFO SNG SOLID STIRRUP W/O J,,,28,,NW,,,,,,"$1,551.97",$0.00,1,1,1,1,1,1,20171001, L2020,HCPCS,KAFO DBL SOLID STIRRUP BAND/,,,28,,NW,,,,,,"$1,915.45",$0.00,1,1,1,1,1,1,20171001, L2030,HCPCS,KAFO DBL SOLID STIRRUP W/O J,,,28,,NW,,,,,,"$1,718.68",$0.00,1,1,1,1,1,1,20171001, L2034,HCPCS,KAFO PLA SIN UP W/WO K/A CUS,,,28,,NW,,,,,,"$3,238.51",$0.00,1,1,1,1,1,1,20171001, L2035,HCPCS,KAFO PLASTIC PEDIATRIC SIZE,,,28,,NW,,,,,,$269.20,$0.00,1,1,1,1,1,1,20171001, L2036,HCPCS,KAFO PLAS DOUB FREE KNEE MOL,,,28,,NW,,,,,,"$3,100.62",$0.00,1,1,1,1,1,1,20171001, L2037,HCPCS,KAFO PLAS SING FREE KNEE MOL,,,28,,NW,,,,,,"$2,807.98",$0.00,1,1,1,1,1,1,20171001, L2038,HCPCS,KAFO W/O JOINT MULTI-AXIS AN,,,28,,NW,,,,,,"$2,342.17",$0.00,1,1,1,1,1,1,20171001, L2040,HCPCS,HKAFO TORSION BIL ROT STRAPS,,,28,,NW,,,,,,$283.82,$0.00,1,1,1,1,1,1,20171001, L2050,HCPCS,HKAFO TORSION CABLE HIP PELV,,,28,,NW,,,,,,$790.08,$0.00,1,1,1,1,1,1,20171001, L2060,HCPCS,HKAFO TORSION BALL BEARING J,,,28,,NW,,,,,,$971.49,$0.00,1,1,1,1,1,1,20171001, L2070,HCPCS,HKAFO TORSION UNILAT ROT STR,,,28,,NW,,,,,,$222.71,$0.00,1,1,1,1,1,1,20171001, L2080,HCPCS,HKAFO UNILAT TORSION CABLE,,,28,,NW,,,,,,$597.52,$0.00,1,1,1,1,1,1,20171001, L2090,HCPCS,HKAFO UNILAT TORSION BALL BR,,,28,,NW,,,,,,$736.51,$0.00,1,1,1,1,1,1,20171001, L2106,HCPCS,AFO TIB FX CAST PLASTER MOLD,,,28,,NW,,,,,,"$1,176.99",$0.00,1,1,1,1,1,1,20171001, L2108,HCPCS,AFO TIB FX CAST MOLDED TO PT,,,28,,NW,,,,,,"$1,782.53",$0.00,1,1,1,1,1,1,20171001, L2112,HCPCS,AFO TIBIAL FRACTURE SOFT,,,28,,NW,,,,,,$800.52,$0.00,1,1,1,1,1,1,20171001, L2114,HCPCS,AFO TIB FX SEMI-RIGID,,,28,,NW,,,,,,$999.81,$0.00,1,1,1,1,1,1,20171001, L2116,HCPCS,AFO TIBIAL FRACTURE RIGID,,,28,,NW,,,,,,"$1,219.50",$0.00,1,1,1,1,1,1,20171001, L2126,HCPCS,KAFO FEM FX CAST THERMOPLAS,,,28,,NW,,,,,,"$2,008.23",$0.00,1,1,1,1,1,1,20171001, L2128,HCPCS,KAFO FEM FX CAST MOLDED TO P,,,28,,NW,,,,,,"$2,792.03",$0.00,1,1,1,1,1,1,20171001, L2132,HCPCS,KAFO FEMORAL FX CAST SOFT,,,28,,NW,,,,,,"$1,367.32",$0.00,1,1,1,1,1,1,20171001, L2134,HCPCS,KAFO FEM FX CAST SEMI-RIGID,,,28,,NW,,,,,,"$1,694.68",$0.00,1,1,1,1,1,1,20171001, L2136,HCPCS,KAFO FEMORAL FX CAST RIGID,,,28,,NW,,,,,,"$2,021.31",$0.00,1,1,1,1,1,1,20171001, L2180,HCPCS,PLAS SHOE INSERT W ANK JOINT,,,28,,NW,,,,,,$193.94,$0.00,1,1,1,1,1,1,20171001, L2182,HCPCS,DROP LOCK KNEE,,,28,,NW,,,,,,$150.34,$0.00,1,1,1,1,1,1,20171001, L2184,HCPCS,LIMITED MOTION KNEE JOINT,,,28,,NW,,,,,,$196.17,$0.00,1,1,1,1,1,1,20171001, L2186,HCPCS,ADJ MOTION KNEE JNT LERMAN T,,,28,,NW,,,,,,$240.96,$0.00,1,1,1,1,1,1,20171001, L2188,HCPCS,QUADRILATERAL BRIM,,,28,,NW,,,,,,$502.09,$0.00,1,1,1,1,1,1,20171001, L2190,HCPCS,WAIST BELT,,,28,,NW,,,,,,$135.72,$0.00,1,1,1,1,1,1,20171001, L2192,HCPCS,PELVIC BAND & BELT THIGH FLA,,,28,,NW,,,,,,$592.71,$0.00,1,1,1,1,1,1,20171001, L2200,HCPCS,LIMITED ANKLE MOTION EA JNT,,,28,,NW,,,,,,$75.21,$0.00,1,1,1,1,1,1,20171001, L2210,HCPCS,DORSIFLEXION ASSIST EACH JOI,,,28,,NW,,,,,,$104.63,$0.00,1,1,1,1,1,1,20171001, L2220,HCPCS,DORSI & PLANTAR FLEX ASS/RES,,,28,,NW,,,,,,$130.43,$0.00,1,1,1,1,1,1,20171001, L2230,HCPCS,SPLIT FLAT CALIPER STIRR & P,,,28,,NW,,,,,,$122.74,$0.00,1,1,1,1,1,1,20171001, L2232,HCPCS,"ROCKER BOTTOM, CONTACT AFO",,,28,,NW,,,,,,$148.49,$0.00,1,1,1,1,1,1,20171001, L2240,HCPCS,ROUND CALIPER AND PLATE ATTA,,,28,,NW,,,,,,$132.16,$0.00,1,1,1,1,1,1,20171001, L2250,HCPCS,FOOT PLATE MOLDED STIRRUP AT,,,28,,NW,,,,,,$572.49,$0.00,1,1,1,1,1,1,20171001, L2260,HCPCS,REINFORCED SOLID STIRRUP,,,28,,NW,,,,,,$331.95,$0.00,1,1,1,1,1,1,20171001, L2265,HCPCS,LONG TONGUE STIRRUP,,,28,,NW,,,,,,$196.57,$0.00,1,1,1,1,1,1,20171001, L2270,HCPCS,VARUS/VALGUS STRAP PADDED/LI,,,28,,NW,,,,,,$85.06,$0.00,1,1,1,1,1,1,20171001, L2275,HCPCS,PLASTIC MOD LOW EXT PAD/LINE,,,28,,NW,,,,,,$201.06,$0.00,1,1,1,1,1,1,20171001, L2280,HCPCS,MOLDED INNER BOOT,,,28,,NW,,,,,,$766.89,$0.00,1,1,1,1,1,1,20171001, L2300,HCPCS,ABDUCTION BAR JOINTED ADJUST,,,28,,NW,,,,,,$450.59,$0.00,1,1,1,1,1,1,20171001, L2310,HCPCS,ABDUCTION BAR-STRAIGHT,,,28,,NW,,,,,,$199.79,$0.00,1,1,1,1,1,1,20171001, L2320,HCPCS,NON-MOLDED LACER,,,28,,NW,,,,,,$335.98,$0.00,1,1,1,1,1,1,20171001, L2330,HCPCS,LACER MOLDED TO PATIENT MODE,,,28,,NW,,,,,,$649.81,$0.00,1,1,1,1,1,1,20171001, L2335,HCPCS,ANTERIOR SWING BAND,,,28,,NW,,,,,,$385.51,$0.00,1,1,1,1,1,1,20171001, L2340,HCPCS,PRE-TIBIAL SHELL MOLDED TO P,,,28,,NW,,,,,,$774.06,$0.00,1,1,1,1,1,1,20171001, L2350,HCPCS,PROSTHETIC TYPE SOCKET MOLDE,,,28,,NW,,,,,,"$1,489.97",$0.00,1,1,1,1,1,1,20171001, L2360,HCPCS,EXTENDED STEEL SHANK,,,28,,NW,,,,,,$83.00,$0.00,1,1,1,1,1,1,20171001, L2370,HCPCS,PATTEN BOTTOM,,,28,,NW,,,,,,$458.22,$0.00,1,1,1,1,1,1,20171001, L2375,HCPCS,TORSION ANK & HALF SOLID STI,,,28,,NW,,,,,,$187.04,$0.00,1,1,1,1,1,1,20171001, L2380,HCPCS,TORSION STRAIGHT KNEE JOINT,,,28,,NW,,,,,,$200.91,$0.00,1,1,1,1,1,1,20171001, L2385,HCPCS,STRAIGHT KNEE JOINT HEAVY DU,,,28,,NW,,,,,,$220.06,$0.00,1,1,1,1,1,1,20171001, L2387,HCPCS,ADD LE POLY KNEE CUSTOM KAFO,,,28,,NW,,,,,,$275.90,$0.00,1,1,1,1,1,1,20171001, L2390,HCPCS,OFFSET KNEE JOINT EACH,,,28,,NW,,,,,,$170.72,$0.00,1,1,1,1,1,1,20171001, L2395,HCPCS,OFFSET KNEE JOINT HEAVY DUTY,,,28,,NW,,,,,,$251.87,$0.00,1,1,1,1,1,1,20171001, L2397,HCPCS,SUSPENSION SLEEVE LOWER EXT,,,28,,NW,,,,,,$179.34,$0.00,1,1,1,1,1,1,20171001, L2405,HCPCS,KNEE JOINT DROP LOCK EA JNT,,,28,,NW,,,,,,$131.58,$0.00,1,1,1,1,1,1,20171001, L2415,HCPCS,KNEE JOINT CAM LOCK EACH JOI,,,28,,NW,,,,,,$185.87,$0.00,1,1,1,1,1,1,20171001, L2425,HCPCS,KNEE DISC/DIAL LOCK/ADJ FLEX,,,28,,NW,,,,,,$220.49,$0.00,1,1,1,1,1,1,20171001, L2430,HCPCS,KNEE JNT RATCHET LOCK EA JNT,,,28,,NW,,,,,,$220.49,$0.00,1,1,1,1,1,1,20171001, L2492,HCPCS,KNEE LIFT LOOP DROP LOCK RIN,,,28,,NW,,,,,,$166.98,$0.00,1,1,1,1,1,1,20171001, L2500,HCPCS,THI/GLUT/ISCHIA WGT BEARING,,,28,,NW,,,,,,$511.14,$0.00,1,1,1,1,1,1,20171001, L2510,HCPCS,TH/WGHT BEAR QUAD-LAT BRIM M,,,28,,NW,,,,,,"$1,262.27",$0.00,1,1,1,1,1,1,20171001, L2520,HCPCS,TH/WGHT BEAR QUAD-LAT BRIM C,,,28,,NW,,,,,,$791.54,$0.00,1,1,1,1,1,1,20171001, L2525,HCPCS,TH/WGHT BEAR NAR M-L BRIM MO,,,28,,NW,,,,,,"$2,073.92",$0.00,1,1,1,1,1,1,20171001, L2526,HCPCS,TH/WGHT BEAR NAR M-L BRIM CU,,,28,,NW,,,,,,"$1,169.88",$0.00,1,1,1,1,1,1,20171001, L2530,HCPCS,THIGH/WGHT BEAR LACER NON-MO,,,28,,NW,,,,,,$388.55,$0.00,1,1,1,1,1,1,20171001, L2540,HCPCS,THIGH/WGHT BEAR LACER MOLDED,,,28,,NW,,,,,,$699.71,$0.00,1,1,1,1,1,1,20171001, L2550,HCPCS,THIGH/WGHT BEAR HIGH ROLL CU,,,28,,NW,,,,,,$476.15,$0.00,1,1,1,1,1,1,20171001, L2570,HCPCS,HIP CLEVIS TYPE 2 POSIT JNT,,,28,,NW,,,,,,$824.82,$0.00,1,1,1,1,1,1,20171001, L2580,HCPCS,PELVIC CONTROL PELVIC SLING,,,28,,NW,,,,,,$789.57,$0.00,1,1,1,1,1,1,20171001, L2600,HCPCS,HIP CLEVIS/THRUST BEARING FR,,,28,,NW,,,,,,$343.24,$0.00,1,1,1,1,1,1,20171001, L2610,HCPCS,HIP CLEVIS/THRUST BEARING LO,,,28,,NW,,,,,,$403.36,$0.00,1,1,1,1,1,1,20171001, L2620,HCPCS,PELVIC CONTROL HIP HEAVY DUT,,,28,,NW,,,,,,$451.30,$0.00,1,1,1,1,1,1,20171001, L2622,HCPCS,HIP JOINT ADJUSTABLE FLEXION,,,28,,NW,,,,,,$514.02,$0.00,1,1,1,1,1,1,20171001, L2624,HCPCS,HIP ADJ FLEX EXT ABDUCT CONT,,,28,,NW,,,,,,$571.80,$0.00,1,1,1,1,1,1,20171001, L2627,HCPCS,PLASTIC MOLD RECIPRO HIP & C,,,28,,NW,,,,,,"$2,822.93",$0.00,1,1,1,1,1,1,20171001, L2628,HCPCS,METAL FRAME RECIPRO HIP & CA,,,28,,NW,,,,,,"$2,755.04",$0.00,1,1,1,1,1,1,20171001, L2630,HCPCS,PELVIC CONTROL BAND & BELT U,,,28,,NW,,,,,,$415.35,$0.00,1,1,1,1,1,1,20171001, L2640,HCPCS,PELVIC CONTROL BAND & BELT B,,,28,,NW,,,,,,$566.27,$0.00,1,1,1,1,1,1,20171001, L2650,HCPCS,PELV & THOR CONTROL GLUTEAL,,,28,,NW,,,,,,$193.81,$0.00,1,1,1,1,1,1,20171001, L2660,HCPCS,THORACIC CONTROL THORACIC BA,,,28,,NW,,,,,,$299.83,$0.00,1,1,1,1,1,1,20171001, L2670,HCPCS,THORAC CONT PARASPINAL UPRIG,,,28,,NW,,,,,,$274.33,$0.00,1,1,1,1,1,1,20171001, L2680,HCPCS,THORAC CONT LAT SUPPORT UPRI,,,28,,NW,,,,,,$252.94,$0.00,1,1,1,1,1,1,20171001, L2750,HCPCS,PLATING CHROME/NICKEL PR BAR,,,28,,NW,,,,,,$127.48,$0.00,1,1,1,1,1,1,20171001, L2755,HCPCS,CARBON GRAPHITE LAMINATION,,,28,,NW,,,,,,$200.50,$0.00,1,1,1,1,1,1,20171001, L2760,HCPCS,EXTENSION PER EXTENSION PER,,,28,,NW,,,,,,$95.80,$0.00,1,1,1,1,1,1,20171001, L2768,HCPCS,ORTHO SIDEBAR DISCONNECT,,,28,,NW,,,,,,$199.82,$0.00,1,1,1,1,1,1,20171001, L2780,HCPCS,NON-CORROSIVE FINISH,,,28,,NW,,,,,,$105.24,$0.00,1,1,1,1,1,1,20171001, L2785,HCPCS,DROP LOCK RETAINER EACH,,,28,,NW,,,,,,$50.36,$0.00,1,1,1,1,1,1,20171001, L2795,HCPCS,KNEE CONTROL FULL KNEECAP,,,28,,NW,,,,,,$134.53,$0.00,1,1,1,1,1,1,20171001, L2800,HCPCS,KNEE CAP MEDIAL OR LATERAL P,,,28,,NW,,,,,,$168.83,$0.00,1,1,1,1,1,1,20171001, L2810,HCPCS,KNEE CONTROL CONDYLAR PAD,,,28,,NW,,,,,,$125.84,$0.00,1,1,1,1,1,1,20171001, L2820,HCPCS,SOFT INTERFACE BELOW KNEE SE,,,28,,NW,,,,,,$140.64,$0.00,1,1,1,1,1,1,20171001, L2830,HCPCS,SOFT INTERFACE ABOVE KNEE SE,,,28,,NW,,,,,,$153.80,$0.00,1,1,1,1,1,1,20171001, L2840,HCPCS,TIBIAL LENGTH SOCK FX OR EQU,,,28,,NW,,,,,,$68.52,$0.00,1,1,1,1,1,1,20171001, L2850,HCPCS,FEMORAL LGTH SOCK FX OR EQUA,,,28,,NW,,,,,,$94.62,$0.00,1,1,1,1,1,1,20171001, L2861,HCPCS,TORSION MECHANISM KNEE/ANKLE,,,28,,NW,,,,,,$754.04,$0.00,1,1,1,1,1,1,20171001, L2999,HCPCS,LOWER EXTREMITY ORTHOSIS NOS,,,28,,NW,,,,,,$80.81,$0.00,1,1,1,1,1,1,20171001, L3000,HCPCS,FT INSERT UCB BERKELEY SHELL,,,28,,NW,,,,,,$490.86,$0.00,1,1,1,1,1,1,20171001, L3001,HCPCS,FOOT INSERT REMOV MOLDED SPE,,,28,,NW,,,,,,$202.96,$0.00,1,1,1,1,1,1,20171001, L3002,HCPCS,FOOT INSERT PLASTAZOTE OR EQ,,,28,,NW,,,,,,$249.24,$0.00,1,1,1,1,1,1,20171001, L3003,HCPCS,FOOT INSERT SILICONE GEL EAC,,,28,,NW,,,,,,$269.41,$0.00,1,1,1,1,1,1,20171001, L3010,HCPCS,FOOT LONGITUDINAL ARCH SUPPO,,,28,,NW,,,,,,$269.41,$0.00,1,1,1,1,1,1,20171001, L3020,HCPCS,FOOT LONGITUD/METATARSAL SUP,,,28,,NW,,,,,,$307.65,$0.00,1,1,1,1,1,1,20171001, L3030,HCPCS,FOOT ARCH SUPPORT REMOV PREM,,,28,,NW,,,,,,$114.38,$0.00,1,1,1,1,1,1,20171001, L3031,HCPCS,FOOT LAMIN/PREPREG COMPOSITE,,,28,,NW,,,,,,$187.75,$0.00,1,1,1,1,1,1,20171001, L3040,HCPCS,FT ARCH SUPRT PREMOLD LONGIT,,,28,,NW,,,,,,$68.45,$0.00,1,1,1,1,1,1,20171001, L3050,HCPCS,FOOT ARCH SUPP PREMOLD METAT,,,28,,NW,,,,,,$68.45,$0.00,1,1,1,1,1,1,20171001, L3060,HCPCS,FOOT ARCH SUPP LONGITUD/META,,,28,,NW,,,,,,$110.33,$0.00,1,1,1,1,1,1,20171001, L3070,HCPCS,ARCH SUPRT ATT TO SHO LONGIT,,,28,,NW,,,,,,$46.65,$0.00,1,1,1,1,1,1,20171001, L3080,HCPCS,ARCH SUPP ATT TO SHOE METATA,,,28,,NW,,,,,,$46.65,$0.00,1,1,1,1,1,1,20171001, L3090,HCPCS,ARCH SUPP ATT TO SHOE LONG/M,,,28,,NW,,,,,,$59.38,$0.00,1,1,1,1,1,1,20171001, L3100,HCPCS,HALLUS-VALGUS NT DYN PRE OTS,,,28,,NW,,,,,,$62.99,$0.00,1,1,1,1,1,1,20171001, L3140,HCPCS,ABDUCTION ROTATION BAR SHOE,,,28,,NW,,,,,,$134.52,$0.00,1,1,1,1,1,1,20171001, L3150,HCPCS,ABDUCT ROTATION BAR W/O SHOE,,,28,,NW,,,,,,$122.44,$0.00,1,1,1,1,1,1,20171001, L3160,HCPCS,SHOE STYLED POSITIONING DEV,,,28,,NW,,,,,,$27.67,$0.00,1,1,1,1,1,1,20171001, L3170,HCPCS,FOOT PLAS HEEL STABI PRE OTS,,,28,,NW,,,,,,$74.13,$0.00,1,1,1,1,1,1,20171001, L3201,HCPCS,OXFORD W SUPINAT/PRONAT INF,,,28,,NW,,,,,,$65.77,$0.00,1,1,1,1,1,1,20171001, L3202,HCPCS,OXFORD W/ SUPINAT/PRONATOR C,,,28,,NW,,,,,,$64.55,$0.00,1,1,1,1,1,1,20171001, L3203,HCPCS,OXFORD W/ SUPINATOR/PRONATOR,,,28,,NW,,,,,,$62.73,$0.00,1,1,1,1,1,1,20171001, L3204,HCPCS,HIGHTOP W/ SUPP/PRONATOR INF,,,28,,NW,,,,,,$62.73,$0.00,1,1,1,1,1,1,20171001, L3206,HCPCS,HIGHTOP W/ SUPP/PRONATOR CHI,,,28,,NW,,,,,,$65.16,$0.00,1,1,1,1,1,1,20171001, L3207,HCPCS,HIGHTOP W/ SUPP/PRONATOR JUN,,,28,,NW,,,,,,$66.37,$0.00,1,1,1,1,1,1,20171001, L3208,HCPCS,SURGICAL BOOT EACH INFANT,,,28,,NW,,,,,,$35.36,$0.00,1,1,1,1,1,1,20171001, L3209,HCPCS,SURGICAL BOOT EACH CHILD,,,28,,NW,,,,,,$49.96,$0.00,1,1,1,1,1,1,20171001, L3211,HCPCS,SURGICAL BOOT EACH JUNIOR,,,28,,NW,,,,,,$53.00,$0.00,1,1,1,1,1,1,20171001, L3212,HCPCS,BENESCH BOOT PAIR INFANT,,,28,,NW,,,,,,$73.19,$0.00,1,1,1,1,1,1,20171001, L3213,HCPCS,BENESCH BOOT PAIR CHILD,,,28,,NW,,,,,,$90.05,$0.00,1,1,1,1,1,1,20171001, L3214,HCPCS,BENESCH BOOT PAIR JUNIOR,,,28,,NW,,,,,,$96.13,$0.00,1,1,1,1,1,1,20171001, L3215,HCPCS,ORTHOPEDIC FTWEAR LADIES OXF,,,28,,NW,,,,,,$123.79,$0.00,1,1,1,1,1,1,20171001, L3216,HCPCS,ORTHOPED LADIES SHOES DPTH I,,,28,,NW,,,,,,$151.45,$0.00,1,1,1,1,1,1,20171001, L3217,HCPCS,LADIES SHOES HIGHTOP DEPTH I,,,28,,NW,,,,,,$164.27,$0.00,1,1,1,1,1,1,20171001, L3219,HCPCS,ORTHOPEDIC MENS SHOES OXFORD,,,28,,NW,,,,,,$139.98,$0.00,1,1,1,1,1,1,20171001, L3221,HCPCS,ORTHOPEDIC MENS SHOES DPTH I,,,28,,NW,,,,,,$168.99,$0.00,1,1,1,1,1,1,20171001, L3222,HCPCS,MENS SHOES HIGHTOP DEPTH INL,,,28,,NW,,,,,,$187.89,$0.00,1,1,1,1,1,1,20171001, L3224,HCPCS,WOMAN'S SHOE OXFORD BRACE,,,28,,NW,,,,,,$94.65,$0.00,1,1,1,1,1,1,20171001, L3225,HCPCS,MAN'S SHOE OXFORD BRACE,,,28,,NW,,,,,,$108.01,$0.00,1,1,1,1,1,1,20171001, L3230,HCPCS,CUSTOM SHOES DEPTH INLAY,,,28,,NW,,,,,,$222.29,$0.00,1,1,1,1,1,1,20171001, L3250,HCPCS,CUSTOM MOLD SHOE REMOV PROST,,,28,,NW,,,,,,$438.20,$0.00,1,1,1,1,1,1,20171001, L3251,HCPCS,SHOE MOLDED TO PT SILICONE S,,,28,,NW,,,,,,$56.65,$0.00,1,1,1,1,1,1,20171001, L3252,HCPCS,SHOE MOLDED PLASTAZOTE CUST,,,28,,NW,,,,,,$237.14,$0.00,1,1,1,1,1,1,20171001, L3253,HCPCS,SHOE MOLDED PLASTAZOTE CUST,,,28,,NW,,,,,,$56.04,$0.00,1,1,1,1,1,1,20171001, L3254,HCPCS,ORTH FOOT NON-STNDARD SIZE/W,,,28,,NW,,,,,,$27.54,$0.00,1,1,1,1,1,1,20171001, L3255,HCPCS,ORTH FOOT NON-STANDARD SIZE/,,,28,,NW,,,,,,$166.36,$0.00,1,1,1,1,1,1,20171001, L3257,HCPCS,ORTH FOOT ADD CHARGE SPLIT S,,,28,,NW,,,,,,$40.84,$0.00,1,1,1,1,1,1,20171001, L3260,HCPCS,AMBULATORY SURGICAL BOOT EAC,,,28,,NW,,,,,,$23.81,$0.00,1,1,1,1,1,1,20171001, L3265,HCPCS,PLASTAZOTE SANDAL EACH,,,28,,NW,,,,,,$25.63,$0.00,1,1,1,1,1,1,20171001, L3300,HCPCS,SHO LIFT TAPER TO METATARSAL,,,28,,NW,,,,,,$76.11,$0.00,1,1,1,1,1,1,20171001, L3310,HCPCS,SHOE LIFT ELEV HEEL/SOLE NEO,,,28,,NW,,,,,,$122.44,$0.00,1,1,1,1,1,1,20171001, L3320,HCPCS,SHOE LIFT ELEV HEEL/SOLE COR,,,28,,NW,,,,,,$158.20,$0.00,1,1,1,1,1,1,20171001, L3330,HCPCS,LIFTS ELEVATION METAL EXTENS,,,28,,NW,,,,,,$889.49,$0.00,1,1,1,1,1,1,20171001, L3332,HCPCS,SHOE LIFTS TAPERED TO ONE-HA,,,28,,NW,,,,,,$110.33,$0.00,1,1,1,1,1,1,20171001, L3334,HCPCS,SHOE LIFTS ELEVATION HEEL /I,,,28,,NW,,,,,,$55.75,$0.00,1,1,1,1,1,1,20171001, L3340,HCPCS,SHOE WEDGE SACH,,,28,,NW,,,,,,$128.50,$0.00,1,1,1,1,1,1,20171001, L3350,HCPCS,SHOE HEEL WEDGE,,,28,,NW,,,,,,$33.97,$0.00,1,1,1,1,1,1,20171001, L3360,HCPCS,SHOE SOLE WEDGE OUTSIDE SOLE,,,28,,NW,,,,,,$52.11,$0.00,1,1,1,1,1,1,20171001, L3370,HCPCS,SHOE SOLE WEDGE BETWEEN SOLE,,,28,,NW,,,,,,$72.07,$0.00,1,1,1,1,1,1,20171001, L3380,HCPCS,SHOE CLUBFOOT WEDGE,,,28,,NW,,,,,,$72.07,$0.00,1,1,1,1,1,1,20171001, L3390,HCPCS,SHOE OUTFLARE WEDGE,,,28,,NW,,,,,,$72.07,$0.00,1,1,1,1,1,1,20171001, L3400,HCPCS,SHOE METATARSAL BAR WEDGE RO,,,28,,NW,,,,,,$59.38,$0.00,1,1,1,1,1,1,20171001, L3410,HCPCS,SHOE METATARSAL BAR BETWEEN,,,28,,NW,,,,,,$140.55,$0.00,1,1,1,1,1,1,20171001, L3420,HCPCS,FULL SOLE/HEEL WEDGE BTWEEN,,,28,,NW,,,,,,$80.15,$0.00,1,1,1,1,1,1,20171001, L3430,HCPCS,SHO HEEL COUNT PLAST REINFOR,,,28,,NW,,,,,,$247.26,$0.00,1,1,1,1,1,1,20171001, L3440,HCPCS,HEEL LEATHER REINFORCED,,,28,,NW,,,,,,$114.38,$0.00,1,1,1,1,1,1,20171001, L3450,HCPCS,SHOE HEEL SACH CUSHION TYPE,,,28,,NW,,,,,,$160.66,$0.00,1,1,1,1,1,1,20171001, L3455,HCPCS,SHOE HEEL NEW LEATHER STANDA,,,28,,NW,,,,,,$59.38,$0.00,1,1,1,1,1,1,20171001, L3460,HCPCS,SHOE HEEL NEW RUBBER STANDAR,,,28,,NW,,,,,,$50.29,$0.00,1,1,1,1,1,1,20171001, L3465,HCPCS,SHOE HEEL THOMAS WITH WEDGE,,,28,,NW,,,,,,$86.20,$0.00,1,1,1,1,1,1,20171001, L3470,HCPCS,SHOE HEEL THOMAS EXTEND TO B,,,28,,NW,,,,,,$92.21,$0.00,1,1,1,1,1,1,20171001, L3480,HCPCS,SHOE HEEL PAD & DEPRESS FOR,,,28,,NW,,,,,,$92.21,$0.00,1,1,1,1,1,1,20171001, L3485,HCPCS,SHOE HEEL PAD REMOVABLE FOR,,,28,,NW,,,,,,$23.81,$0.00,1,1,1,1,1,1,20171001, L3500,HCPCS,ORTHO SHOE ADD LEATHER INSOL,,,28,,NW,,,,,,$43.05,$0.00,1,1,1,1,1,1,20171001, L3510,HCPCS,ORTHOPEDIC SHOE ADD RUB INSL,,,28,,NW,,,,,,$43.05,$0.00,1,1,1,1,1,1,20171001, L3520,HCPCS,O SHOE ADD FELT W LEATH INSL,,,28,,NW,,,,,,$46.65,$0.00,1,1,1,1,1,1,20171001, L3530,HCPCS,ORTHO SHOE ADD HALF SOLE,,,28,,NW,,,,,,$46.65,$0.00,1,1,1,1,1,1,20171001, L3540,HCPCS,ORTHO SHOE ADD FULL SOLE,,,28,,NW,,,,,,$74.13,$0.00,1,1,1,1,1,1,20171001, L3550,HCPCS,O SHOE ADD STANDARD TOE TAP,,,28,,NW,,,,,,$14.02,$0.00,1,1,1,1,1,1,20171001, L3560,HCPCS,O SHOE ADD HORSESHOE TOE TAP,,,28,,NW,,,,,,$33.97,$0.00,1,1,1,1,1,1,20171001, L3570,HCPCS,O SHOE ADD INSTEP EXTENSION,,,28,,NW,,,,,,$128.50,$0.00,1,1,1,1,1,1,20171001, L3580,HCPCS,O SHOE ADD INSTEP VELCRO CLO,,,28,,NW,,,,,,$96.25,$0.00,1,1,1,1,1,1,20171001, L3590,HCPCS,O SHOE CONVERT TO SOF COUNTE,,,28,,NW,,,,,,$78.13,$0.00,1,1,1,1,1,1,20171001, L3595,HCPCS,ORTHO SHOE ADD MARCH BAR,,,28,,NW,,,,,,$61.17,$0.00,1,1,1,1,1,1,20171001, L3600,HCPCS,TRANS SHOE CALIP PLATE EXIST,,,28,,NW,,,,,,$114.38,$0.00,1,1,1,1,1,1,20171001, L3610,HCPCS,TRANS SHOE CALIPER PLATE NEW,,,28,,NW,,,,,,$152.62,$0.00,1,1,1,1,1,1,20171001, L3620,HCPCS,TRANS SHOE SOLID STIRRUP EXI,,,28,,NW,,,,,,$114.38,$0.00,1,1,1,1,1,1,20171001, L3630,HCPCS,TRANS SHOE SOLID STIRRUP NEW,,,28,,NW,,,,,,$152.62,$0.00,1,1,1,1,1,1,20171001, L3640,HCPCS,SHOE DENNIS BROWNE SPLINT BO,,,28,,NW,,,,,,$62.99,$0.00,1,1,1,1,1,1,20171001, L3649,HCPCS,ORTHOPEDIC SHOE MODIFICA NOS,,,28,,NW,,,,,,$79.21,$0.00,1,1,1,1,1,1,20171001, L3650,HCPCS,SO 8 ABD RESTRAINT PRE OTS,,,28,,NW,,,,,,$93.57,$0.00,1,1,1,1,1,1,20171001, L3660,HCPCS,SO 8 AB RSTR CAN/WEB PRE OTS,,,28,,NW,,,,,,$153.70,$0.00,1,1,1,1,1,1,20171001, L3670,HCPCS,SO ACRO/CLAV CAN WEB PRE OTS,,,28,,NW,,,,,,$185.70,$0.00,1,1,1,1,1,1,20171001, L3671,HCPCS,SO CAP DESIGN W/O JNTS CF,,,28,,NW,,,,,,"$1,291.76",$0.00,1,1,1,1,1,1,20171001, L3674,HCPCS,SO AIRPLANE W/WO JOINT CF,,,28,,NW,,,,,,"$1,696.56",$0.00,1,1,1,1,1,1,20171001, L3675,HCPCS,SO VEST CANVAS/WEB PRE OTS,,,28,,NW,,,,,,$246.71,$0.00,1,1,1,1,1,1,20171001, L3677,HCPCS,SO HARD PLAS STABILI PRE CST,,,28,,NW,,,,,,$173.72,$0.00,1,1,1,1,1,1,20171001, L3678,HCPCS,SO HARD PLAS STABILI PRE OTS,,,28,,NW,,,,,,$141.98,$0.00,1,1,1,1,1,1,20171001, L3702,HCPCS,EO W/O JOINTS CF,,,28,,NW,,,,,,$409.59,$0.00,1,1,1,1,1,1,20171001, L3710,HCPCS,EO ELAS W/METAL JNTS PRE OTS,,,28,,NW,,,,,,$198.46,$0.00,1,1,1,1,1,1,20171001, L3720,HCPCS,FOREARM/ARM CUFFS FREE MOTIO,,,28,,NW,,,,,,"$1,084.99",$0.00,1,1,1,1,1,1,20171001, L3730,HCPCS,FOREARM/ARM CUFFS EXT/FLEX A,,,28,,NW,,,,,,"$1,498.20",$0.00,1,1,1,1,1,1,20171001, L3740,HCPCS,CUFFS ADJ LOCK W/ ACTIVE CON,,,28,,NW,,,,,,"$1,767.04",$0.00,1,1,1,1,1,1,20171001, L3760,HCPCS,"EO WITHJOINT, PREFABRICATED",,,28,,NW,,,,,,$714.91,$0.00,1,1,1,1,1,1,20171001, L3762,HCPCS,EO RIGID W/O JOINTS PRE OTS,,,28,,NW,,,,,,$148.49,$0.00,1,1,1,1,1,1,20171001, L3763,HCPCS,EWHO RIGID W/O JNTS CF,,,28,,NW,,,,,,"$1,078.46",$0.00,1,1,1,1,1,1,20171001, L3764,HCPCS,EWHO W/JOINT(S) CF,,,28,,NW,,,,,,"$1,209.47",$0.00,1,1,1,1,1,1,20171001, L3765,HCPCS,EWHFO RIGID W/O JNTS CF,,,28,,NW,,,,,,"$1,840.93",$0.00,1,1,1,1,1,1,20171001, L3766,HCPCS,EWHFO W/JOINT(S) CF,,,28,,NW,,,,,,"$1,949.79",$0.00,1,1,1,1,1,1,20171001, L3806,HCPCS,WHFO W/JOINT(S) CUSTOM FAB,,,28,,NW,,,,,,$648.01,$0.00,1,1,1,1,1,1,20171001, L3807,HCPCS,WHFO W/O JOINTS PRE CST,,,28,,NW,,,,,,$354.25,$0.00,1,1,1,1,1,1,20171001, L3808,HCPCS,"WHFO, RIGID W/O JOINTS",,,28,,NW,,,,,,$532.80,$0.00,1,1,1,1,1,1,20171001, L3809,HCPCS,WHFO W/O JOINTS PRE OTS,,,28,,NW,,,,,,$354.25,$0.00,1,1,1,1,1,1,20171001, L3891,HCPCS,TORSION MECHANISM WRIST/ELBO,,,28,,NW,,,,,,$280.90,$0.00,1,1,1,1,1,1,20171001, L3900,HCPCS,HINGE EXTENSION/FLEX WRIST/F,,,28,,NW,,,,,,"$2,143.22",$0.00,1,1,1,1,1,1,20171001, L3901,HCPCS,HINGE EXT/FLEX WRIST FINGER,,,28,,NW,,,,,,"$2,645.39",$0.00,1,1,1,1,1,1,20171001, L3904,HCPCS,WHFO ELECTRIC CUSTOM FITTED,,,28,,NW,,,,,,"$4,834.32",$0.00,1,1,1,1,1,1,20171001, L3905,HCPCS,WHO W/NONTORSION JNT(S) CF,,,28,,NW,,,,,,"$1,422.34",$0.00,1,1,1,1,1,1,20171001, L3906,HCPCS,WHO W/O JOINTS CF,,,28,,NW,,,,,,$646.63,$0.00,1,1,1,1,1,1,20171001, L3908,HCPCS,WHO COCK-UP NONMOLDE PRE OTS,,,28,,NW,,,,,,$94.87,$0.00,1,1,1,1,1,1,20171001, L3912,HCPCS,HFO FLEXION GLOVE PRE OTS,,,28,,NW,,,,,,$153.08,$0.00,1,1,1,1,1,1,20171001, L3913,HCPCS,HFO W/O JOINTS CF,,,28,,NW,,,,,,$383.78,$0.00,1,1,1,1,1,1,20171001, L3915,HCPCS,WHO NONTORSION JNTS PRE CST,,,28,,NW,,,,,,$759.41,$0.00,1,1,1,1,1,1,20171001, L3916,HCPCS,WHO NONTORSION JNTS PRE OTS,,,28,,NW,,,,,,$759.41,$0.00,1,1,1,1,1,1,20171001, L3917,HCPCS,METACARP FX ORTHOSIS PRE CST,,,28,,NW,,,,,,$145.77,$0.00,1,1,1,1,1,1,20171001, L3918,HCPCS,METACARP FX ORTHOSIS PRE OTS,,,28,,NW,,,,,,$145.77,$0.00,1,1,1,1,1,1,20171001, L3919,HCPCS,HO W/O JOINTS CF,,,28,,NW,,,,,,$383.78,$0.00,1,1,1,1,1,1,20171001, L3921,HCPCS,HFO W/JOINT(S) CF,,,28,,NW,,,,,,$456.33,$0.00,1,1,1,1,1,1,20171001, L3923,HCPCS,HFO WITHOUT JOINTS PRE CST,,,28,,NW,,,,,,$125.75,$0.00,1,1,1,1,1,1,20171001, L3924,HCPCS,HFO WITHOUT JOINTS PRE OTS,,,28,,NW,,,,,,$125.75,$0.00,1,1,1,1,1,1,20171001, L3925,HCPCS,FO PIP DIP JNT/SPRNG PRE OTS,,,28,,NW,,,,,,$76.30,$0.00,1,1,1,1,1,1,20171001, L3927,HCPCS,FO PIP DIP NO JT SPR PRE OTS,,,28,,NW,,,,,,$46.73,$0.00,1,1,1,1,1,1,20171001, L3929,HCPCS,HFO NONTORSION JNTS PRE CST,,,28,,NW,,,,,,$124.82,$0.00,1,1,1,1,1,1,20171001, L3930,HCPCS,HFO NONTORSION JNTS PRE OTS,,,28,,NW,,,,,,$124.82,$0.00,1,1,1,1,1,1,20171001, L3931,HCPCS,WHFO NONTORSION JOINT PREFAB,,,28,,NW,,,,,,$292.87,$0.00,1,1,1,1,1,1,20171001, L3933,HCPCS,FO W/O JOINTS CF,,,28,,NW,,,,,,$300.97,$0.00,1,1,1,1,1,1,20171001, L3935,HCPCS,FO NONTORSION JOINT CF,,,28,,NW,,,,,,$311.87,$0.00,1,1,1,1,1,1,20171001, L3956,HCPCS,ADD JOINT UPPER EXT ORTHOSIS,,,28,,NW,,,,,,$108.57,$0.00,1,1,1,1,1,1,20171001, L3960,HCPCS,SEWHO AIRPLAN DESIG ABDU POS,,,28,,NW,,,,,,"$1,211.17",$0.00,1,1,1,1,1,1,20171001, L3961,HCPCS,SEWHO CAP DESIGN W/O JNTS CF,,,28,,NW,,,,,,"$2,414.16",$0.00,1,1,1,1,1,1,20171001, L3962,HCPCS,SEWHO ERBS PALSEY DESIGN ABD,,,28,,NW,,,,,,"$1,165.57",$0.00,1,1,1,1,1,1,20171001, L3967,HCPCS,SEWHO AIRPLANE W/O JNTS CF,,,28,,NW,,,,,,"$2,851.46",$0.00,1,1,1,1,1,1,20171001, L3971,HCPCS,SEWHO CAP DESIGN W/JNT(S) CF,,,28,,NW,,,,,,"$2,706.37",$0.00,1,1,1,1,1,1,20171001, L3973,HCPCS,SEWHO AIRPLANE W/JNT(S) CF,,,28,,NW,,,,,,"$2,851.46",$0.00,1,1,1,1,1,1,20171001, L3975,HCPCS,SEWHFO CAP DESIGN W/O JNT CF,,,28,,NW,,,,,,"$2,414.16",$0.00,1,1,1,1,1,1,20171001, L3976,HCPCS,SEWHFO AIRPLANE W/O JNTS CF,,,28,,NW,,,,,,"$2,414.16",$0.00,1,1,1,1,1,1,20171001, L3977,HCPCS,SEWHFO CAP DESGN W/JNT(S) CF,,,28,,NW,,,,,,"$2,706.37",$0.00,1,1,1,1,1,1,20171001, L3978,HCPCS,SEWHFO AIRPLANE W/JNT(S) CF,,,28,,NW,,,,,,"$2,851.46",$0.00,1,1,1,1,1,1,20171001, L3980,HCPCS,UP EXT FX ORTHOS HUMERAL NOS,,,28,,NW,,,,,,$530.45,$0.00,1,1,1,1,1,1,20171001, L3981,HCPCS,UE FX ORTH SHOUL CAP FOREARM,,,28,,NW,,,,,,"$1,443.85",$0.00,1,1,1,1,1,1,20171001, L3982,HCPCS,UPPER EXT FX ORTHOSIS RAD/UL,,,28,,NW,,,,,,$618.90,$0.00,1,1,1,1,1,1,20171001, L3984,HCPCS,UPPER EXT FX ORTHOSIS WRIST,,,28,,NW,,,,,,$557.70,$0.00,1,1,1,1,1,1,20171001, L3995,HCPCS,SOCK FRACTURE OR EQUAL EACH,,,28,,NW,,,,,,$52.01,$0.00,1,1,1,1,1,1,20171001, L3999,HCPCS,UPPER LIMB ORTHOSIS NOS,,,28,,NW,,,,,,$46.43,$0.00,1,1,1,1,1,1,20171001, L4000,HCPCS,REPL GIRDLE MILWAUKEE ORTH,,,28,,NW,,,,,,"$2,109.11",$0.00,1,1,1,1,1,1,20171001, L4002,HCPCS,"REPLACE STRAP, ANY ORTHOSIS",,,28,,NW,,,,,,$40.81,$0.00,1,1,1,1,1,1,20171001, L4010,HCPCS,REPLACE TRILATERAL SOCKET BR,,,28,,NW,,,,,,"$1,153.66",$0.00,1,1,1,1,1,1,20171001, L4020,HCPCS,REPLACE QUADLAT SOCKET BRIM,,,28,,NW,,,,,,"$1,493.03",$0.00,1,1,1,1,1,1,20171001, L4030,HCPCS,REPLACE SOCKET BRIM CUST FIT,,,28,,NW,,,,,,$893.29,$0.00,1,1,1,1,1,1,20171001, L4040,HCPCS,REPLACE MOLDED THIGH LACER,,,28,,NW,,,,,,$685.53,$0.00,1,1,1,1,1,1,20171001, L4045,HCPCS,REPLACE NON-MOLDED THIGH LAC,,,28,,NW,,,,,,$523.53,$0.00,1,1,1,1,1,1,20171001, L4050,HCPCS,REPLACE MOLDED CALF LACER,,,28,,NW,,,,,,$694.76,$0.00,1,1,1,1,1,1,20171001, L4055,HCPCS,REPLACE NON-MOLDED CALF LACE,,,28,,NW,,,,,,$426.93,$0.00,1,1,1,1,1,1,20171001, L4060,HCPCS,REPLACE HIGH ROLL CUFF,,,28,,NW,,,,,,$512.13,$0.00,1,1,1,1,1,1,20171001, L4070,HCPCS,REPLACE PROX & DIST UPRIGHT,,,28,,NW,,,,,,$466.46,$0.00,1,1,1,1,1,1,20171001, L4080,HCPCS,REPL MET BAND KAFO-AFO PROX,,,28,,NW,,,,,,$158.24,$0.00,1,1,1,1,1,1,20171001, L4090,HCPCS,REPL MET BAND KAFO-AFO CALF/,,,28,,NW,,,,,,$145.93,$0.00,1,1,1,1,1,1,20171001, L4100,HCPCS,REPL LEATH CUFF KAFO PROX TH,,,28,,NW,,,,,,$171.06,$0.00,1,1,1,1,1,1,20171001, L4110,HCPCS,REPL LEATH CUFF KAFO-AFO CAL,,,28,,NW,,,,,,$137.24,$0.00,1,1,1,1,1,1,20171001, L4130,HCPCS,REPLACE PRETIBIAL SHELL,,,28,,NW,,,,,,$833.94,$0.00,1,1,1,1,1,1,20171001, L4205,HCPCS,ORTHO DVC REPAIR PER 15 MIN,,,28,,NW,,,,,,$45.32,$0.00,1,1,1,1,1,1,20171001, L4210,HCPCS,ORTH DEV REPAIR/REPL MINOR P,,,28,,NW,,,,,,$34.01,$0.00,1,1,1,1,1,1,20171001, L4350,HCPCS,ANKLE CONTROL ORTHO PRE OTS,,,28,,NW,,,,,,$145.55,$0.00,1,1,1,1,1,1,20171001, L4360,HCPCS,PNEUMAT WALKING BOOT PRE CST,,,28,,NW,,,,,,$441.77,$0.00,1,1,1,1,1,1,20171001, L4361,HCPCS,PNEUMA/VAC WALK BOOT PRE OTS,,,28,,NW,,,,,,$441.77,$0.00,1,1,1,1,1,1,20171001, L4370,HCPCS,PNEUM FULL LEG SPLNT PRE OTS,,,28,,NW,,,,,,$301.57,$0.00,1,1,1,1,1,1,20171001, L4386,HCPCS,NON-PNEUM WALK BOOT PRE CST,,,28,,NW,,,,,,$244.57,$0.00,1,1,1,1,1,1,20171001, L4387,HCPCS,NON-PNEUM WALK BOOT PRE OTS,,,28,,NW,,,,,,$244.57,$0.00,1,1,1,1,1,1,20171001, L4392,HCPCS,REPLACE AFO SOFT INTERFACE,,,28,,NW,,,,,,$34.81,$0.00,1,1,1,1,1,1,20171001, L4394,HCPCS,REPLACE FOOT DROP SPINT,,,28,,NW,,,,,,$25.76,$0.00,1,1,1,1,1,1,20171001, L4396,HCPCS,STATIC OR DYNAMI AFO PRE CST,,,28,,NW,,,,,,$258.66,$0.00,1,1,1,1,1,1,20171001, L4397,HCPCS,STATIC OR DYNAMI AFO PRE OTS,,,28,,NW,,,,,,$258.66,$0.00,1,1,1,1,1,1,20171001, L4398,HCPCS,FOOT DROP SPLINT PRE OTS,,,28,,NW,,,,,,$115.60,$0.00,1,1,1,1,1,1,20171001, L4631,HCPCS,"AFO, WALK BOOT TYPE, CUS FAB",,,28,,NW,,,,,,"$2,522.33",$0.00,1,1,1,1,1,1,20171001, L5000,HCPCS,SHO INSERT W ARCH TOE FILLER,,,28,,NW,,,,,,$894.45,$0.00,1,1,1,1,1,1,20171001, L5010,HCPCS,MOLD SOCKET ANK HGT W/ TOE F,,,28,,NW,,,,,,"$2,203.75",$0.00,1,1,1,1,1,1,20171001, L5020,HCPCS,TIBIAL TUBERCLE HGT W/ TOE F,,,28,,NW,,,,,,"$3,598.66",$0.00,1,1,1,1,1,1,20171001, L5050,HCPCS,ANK SYMES MOLD SCKT SACH FT,,,28,,NW,,,,,,"$4,107.81",$0.00,1,1,1,1,1,1,20171001, L5060,HCPCS,SYMES MET FR LEATH SOCKET AR,,,28,,NW,,,,,,"$5,075.07",$0.00,1,1,1,1,1,1,20171001, L5100,HCPCS,MOLDED SOCKET SHIN SACH FOOT,,,28,,NW,,,,,,"$4,153.60",$0.00,1,1,1,1,1,1,20171001, L5105,HCPCS,PLAST SOCKET JTS/THGH LACER,,,28,,NW,,,,,,"$6,227.72",$0.00,1,1,1,1,1,1,20171001, L5150,HCPCS,MOLD SCKT EXT KNEE SHIN SACH,,,28,,NW,,,,,,"$6,393.80",$0.00,1,1,1,1,1,1,20171001, L5160,HCPCS,MOLD SOCKET BENT KNEE SHIN S,,,28,,NW,,,,,,"$6,925.15",$0.00,1,1,1,1,1,1,20171001, L5200,HCPCS,KNE SING AXIS FRIC SHIN SACH,,,28,,NW,,,,,,"$5,875.60",$0.00,1,1,1,1,1,1,20171001, L5210,HCPCS,NO KNEE/ANKLE JOINTS W/ FT B,,,28,,NW,,,,,,"$4,425.09",$0.00,1,1,1,1,1,1,20171001, L5220,HCPCS,NO KNEE JOINT WITH ARTIC ALI,,,28,,NW,,,,,,"$5,028.68",$0.00,1,1,1,1,1,1,20171001, L5230,HCPCS,FEM FOCAL DEFIC CONSTANT FRI,,,28,,NW,,,,,,"$6,859.55",$0.00,1,1,1,1,1,1,20171001, L5250,HCPCS,HIP CANAD SING AXI CONS FRIC,,,28,,NW,,,,,,"$9,253.05",$0.00,1,1,1,1,1,1,20171001, L5270,HCPCS,TILT TABLE LOCKING HIP SING,,,28,,NW,,,,,,"$9,213.86",$0.00,1,1,1,1,1,1,20171001, L5280,HCPCS,HEMIPELVECT CANAD SING AXIS,,,28,,NW,,,,,,"$9,383.22",$0.00,1,1,1,1,1,1,20171001, L5301,HCPCS,BK MOLD SOCKET SACH FT ENDO,,,28,,NW,,,,,,"$4,255.59",$0.00,1,1,1,1,1,1,20171001, L5312,HCPCS,"KNEE DISART, SACH FT, ENDO",,,28,,NW,,,,,,"$6,053.66",$0.00,1,1,1,1,1,1,20171001, L5321,HCPCS,AK OPEN END SACH,,,28,,NW,,,,,,"$6,020.19",$0.00,1,1,1,1,1,1,20171001, L5331,HCPCS,HIP DISART CANADIAN SACH FT,,,28,,NW,,,,,,"$8,420.77",$0.00,1,1,1,1,1,1,20171001, L5341,HCPCS,HEMIPELVECTOMY CANADIAN SACH,,,28,,NW,,,,,,"$9,070.20",$0.00,1,1,1,1,1,1,20171001, L5400,HCPCS,POSTOP DRESS & 1 CAST CHG BK,,,28,,NW,,,,,,"$2,210.31",$0.00,1,1,1,1,1,1,20171001, L5410,HCPCS,POSTOP DSG BK EA ADD CAST CH,,,28,,NW,,,,,,$718.27,$0.00,1,1,1,1,1,1,20171001, L5420,HCPCS,POSTOP DSG & 1 CAST CHG AK/D,,,28,,NW,,,,,,"$2,803.20",$0.00,1,1,1,1,1,1,20171001, L5430,HCPCS,POSTOP DSG AK EA ADD CAST CH,,,28,,NW,,,,,,$916.16,$0.00,1,1,1,1,1,1,20171001, L5450,HCPCS,POSTOP APP NON-WGT BEAR DSG,,,28,,NW,,,,,,$705.61,$0.00,1,1,1,1,1,1,20171001, L5460,HCPCS,POSTOP APP NON-WGT BEAR DSG,,,28,,NW,,,,,,$939.42,$0.00,1,1,1,1,1,1,20171001, L5500,HCPCS,INIT BK PTB PLASTER DIRECT,,,28,,NW,,,,,,"$2,294.80",$0.00,1,1,1,1,1,1,20171001, L5505,HCPCS,INIT AK ISCHAL PLSTR DIRECT,,,28,,NW,,,,,,"$3,196.89",$0.00,1,1,1,1,1,1,20171001, L5510,HCPCS,PREP BK PTB PLASTER MOLDED,,,28,,NW,,,,,,"$2,599.72",$0.00,1,1,1,1,1,1,20171001, L5520,HCPCS,PERP BK PTB THERMOPLS DIRECT,,,28,,NW,,,,,,"$2,651.68",$0.00,1,1,1,1,1,1,20171001, L5530,HCPCS,PREP BK PTB THERMOPLS MOLDED,,,28,,NW,,,,,,"$3,087.17",$0.00,1,1,1,1,1,1,20171001, L5535,HCPCS,PREP BK PTB OPEN END SOCKET,,,28,,NW,,,,,,"$3,098.29",$0.00,1,1,1,1,1,1,20171001, L5540,HCPCS,PREP BK PTB LAMINATED SOCKET,,,28,,NW,,,,,,"$3,260.53",$0.00,1,1,1,1,1,1,20171001, L5560,HCPCS,PREP AK ISCHIAL PLAST MOLDED,,,28,,NW,,,,,,"$3,545.31",$0.00,1,1,1,1,1,1,20171001, L5570,HCPCS,PREP AK ISCHIAL DIRECT FORM,,,28,,NW,,,,,,"$3,628.09",$0.00,1,1,1,1,1,1,20171001, L5580,HCPCS,PREP AK ISCHIAL THERMO MOLD,,,28,,NW,,,,,,"$4,231.38",$0.00,1,1,1,1,1,1,20171001, L5585,HCPCS,PREP AK ISCHIAL OPEN END,,,28,,NW,,,,,,"$4,561.91",$0.00,1,1,1,1,1,1,20171001, L5590,HCPCS,PREP AK ISCHIAL LAMINATED,,,28,,NW,,,,,,"$4,390.89",$0.00,1,1,1,1,1,1,20171001, L5595,HCPCS,HIP DISARTIC SACH THERMOPLS,,,28,,NW,,,,,,"$7,209.67",$0.00,1,1,1,1,1,1,20171001, L5600,HCPCS,HIP DISART SACH LAMINAT MOLD,,,28,,NW,,,,,,"$8,015.06",$0.00,1,1,1,1,1,1,20171001, L5610,HCPCS,ABOVE KNEE HYDRACADENCE,,,28,,NW,,,,,,"$3,730.50",$0.00,1,1,1,1,1,1,20171001, L5611,HCPCS,AK 4 BAR LINK W/FRIC SWING,,,28,,NW,,,,,,"$2,742.22",$0.00,1,1,1,1,1,1,20171001, L5613,HCPCS,AK 4 BAR LING W/HYDRAUL SWIG,,,28,,NW,,,,,,"$4,243.62",$0.00,1,1,1,1,1,1,20171001, L5614,HCPCS,4-BAR LINK ABOVE KNEE W/SWNG,,,28,,NW,,,,,,"$2,671.10",$0.00,1,1,1,1,1,1,20171001, L5616,HCPCS,AK UNIV MULTIPLEX SYS FRICT,,,28,,NW,,,,,,"$2,334.88",$0.00,1,1,1,1,1,1,20171001, L5617,HCPCS,AK/BK SELF-ALIGNING UNIT EA,,,28,,NW,,,,,,$884.83,$0.00,1,1,1,1,1,1,20171001, L5618,HCPCS,TEST SOCKET SYMES,,,28,,NW,,,,,,$483.52,$0.00,1,1,1,1,1,1,20171001, L5620,HCPCS,TEST SOCKET BELOW KNEE,,,28,,NW,,,,,,$480.21,$0.00,1,1,1,1,1,1,20171001, L5622,HCPCS,TEST SOCKET KNEE DISARTICULA,,,28,,NW,,,,,,$656.89,$0.00,1,1,1,1,1,1,20171001, L5624,HCPCS,TEST SOCKET ABOVE KNEE,,,28,,NW,,,,,,$645.80,$0.00,1,1,1,1,1,1,20171001, L5626,HCPCS,TEST SOCKET HIP DISARTICULAT,,,28,,NW,,,,,,$862.14,$0.00,1,1,1,1,1,1,20171001, L5628,HCPCS,TEST SOCKET HEMIPELVECTOMY,,,28,,NW,,,,,,$864.98,$0.00,1,1,1,1,1,1,20171001, L5629,HCPCS,BELOW KNEE ACRYLIC SOCKET,,,28,,NW,,,,,,$558.53,$0.00,1,1,1,1,1,1,20171001, L5630,HCPCS,SYME TYP EXPANDABL WALL SCKT,,,28,,NW,,,,,,$789.90,$0.00,1,1,1,1,1,1,20171001, L5631,HCPCS,AK/KNEE DISARTIC ACRYLIC SOC,,,28,,NW,,,,,,$771.86,$0.00,1,1,1,1,1,1,20171001, L5632,HCPCS,SYMES TYPE PTB BRIM DESIGN S,,,28,,NW,,,,,,$382.05,$0.00,1,1,1,1,1,1,20171001, L5634,HCPCS,SYMES TYPE POSTER OPENING SO,,,28,,NW,,,,,,$533.12,$0.00,1,1,1,1,1,1,20171001, L5636,HCPCS,SYMES TYPE MEDIAL OPENING SO,,,28,,NW,,,,,,$423.32,$0.00,1,1,1,1,1,1,20171001, L5637,HCPCS,BELOW KNEE TOTAL CONTACT,,,28,,NW,,,,,,$556.74,$0.00,1,1,1,1,1,1,20171001, L5638,HCPCS,BELOW KNEE LEATHER SOCKET,,,28,,NW,,,,,,$879.40,$0.00,1,1,1,1,1,1,20171001, L5639,HCPCS,BELOW KNEE WOOD SOCKET,,,28,,NW,,,,,,"$2,010.90",$0.00,1,1,1,1,1,1,20171001, L5640,HCPCS,KNEE DISARTICULAT LEATHER SO,,,28,,NW,,,,,,"$1,126.93",$0.00,1,1,1,1,1,1,20171001, L5642,HCPCS,ABOVE KNEE LEATHER SOCKET,,,28,,NW,,,,,,"$1,033.97",$0.00,1,1,1,1,1,1,20171001, L5643,HCPCS,HIP FLEX INNER SOCKET EXT FR,,,28,,NW,,,,,,"$2,683.41",$0.00,1,1,1,1,1,1,20171001, L5644,HCPCS,ABOVE KNEE WOOD SOCKET,,,28,,NW,,,,,,$981.59,$0.00,1,1,1,1,1,1,20171001, L5645,HCPCS,BK FLEX INNER SOCKET EXT FRA,,,28,,NW,,,,,,"$1,355.14",$0.00,1,1,1,1,1,1,20171001, L5646,HCPCS,BELOW KNEE CUSHION SOCKET,,,28,,NW,,,,,,$943.52,$0.00,1,1,1,1,1,1,20171001, L5647,HCPCS,BELOW KNEE SUCTION SOCKET,,,28,,NW,,,,,,"$1,377.06",$0.00,1,1,1,1,1,1,20171001, L5648,HCPCS,ABOVE KNEE CUSHION SOCKET,,,28,,NW,,,,,,"$1,107.11",$0.00,1,1,1,1,1,1,20171001, L5649,HCPCS,ISCH CONTAINMT/NARROW M-L SO,,,28,,NW,,,,,,"$3,449.10",$0.00,1,1,1,1,1,1,20171001, L5650,HCPCS,TOT CONTACT AK/KNEE DISART S,,,28,,NW,,,,,,$875.27,$0.00,1,1,1,1,1,1,20171001, L5651,HCPCS,AK FLEX INNER SOCKET EXT FRA,,,28,,NW,,,,,,"$2,088.42",$0.00,1,1,1,1,1,1,20171001, L5652,HCPCS,SUCTION SUSP AK/KNEE DISART,,,28,,NW,,,,,,$727.60,$0.00,1,1,1,1,1,1,20171001, L5653,HCPCS,KNEE DISART EXPAND WALL SOCK,,,28,,NW,,,,,,"$1,009.83",$0.00,1,1,1,1,1,1,20171001, L5654,HCPCS,SOCKET INSERT SYMES,,,28,,NW,,,,,,$585.13,$0.00,1,1,1,1,1,1,20171001, L5655,HCPCS,SOCKET INSERT BELOW KNEE,,,28,,NW,,,,,,$488.20,$0.00,1,1,1,1,1,1,20171001, L5656,HCPCS,SOCKET INSERT KNEE ARTICULAT,,,28,,NW,,,,,,$668.68,$0.00,1,1,1,1,1,1,20171001, L5658,HCPCS,SOCKET INSERT ABOVE KNEE,,,28,,NW,,,,,,$635.38,$0.00,1,1,1,1,1,1,20171001, L5661,HCPCS,MULTI-DUROMETER SYMES,,,28,,NW,,,,,,"$1,037.56",$0.00,1,1,1,1,1,1,20171001, L5665,HCPCS,MULTI-DUROMETER BELOW KNEE,,,28,,NW,,,,,,$900.60,$0.00,1,1,1,1,1,1,20171001, L5666,HCPCS,BELOW KNEE CUFF SUSPENSION,,,28,,NW,,,,,,$121.05,$0.00,1,1,1,1,1,1,20171001, L5668,HCPCS,BK MOLDED DISTAL CUSHION,,,28,,NW,,,,,,$179.61,$0.00,1,1,1,1,1,1,20171001, L5670,HCPCS,BK MOLDED SUPRACONDYLAR SUSP,,,28,,NW,,,,,,$477.69,$0.00,1,1,1,1,1,1,20171001, L5671,HCPCS,BK/AK LOCKING MECHANISM,,,28,,NW,,,,,,$904.92,$0.00,1,1,1,1,1,1,20171001, L5672,HCPCS,BK REMOVABLE MEDIAL BRIM SUS,,,28,,NW,,,,,,$508.70,$0.00,1,1,1,1,1,1,20171001, L5673,HCPCS,SOCKET INSERT W LOCK MECH,,,28,,NW,,,,,,"$1,169.94",$0.00,1,1,1,1,1,1,20171001, L5676,HCPCS,BK KNEE JOINTS SINGLE AXIS P,,,28,,NW,,,,,,$644.68,$0.00,1,1,1,1,1,1,20171001, L5677,HCPCS,BK KNEE JOINTS POLYCENTRIC P,,,28,,NW,,,,,,$879.74,$0.00,1,1,1,1,1,1,20171001, L5678,HCPCS,BK JOINT COVERS PAIR,,,28,,NW,,,,,,$64.66,$0.00,1,1,1,1,1,1,20171001, L5679,HCPCS,SOCKET INSERT W/O LOCK MECH,,,28,,NW,,,,,,$973.86,$0.00,1,1,1,1,1,1,20171001, L5680,HCPCS,BK THIGH LACER NON-MOLDED,,,28,,NW,,,,,,$524.21,$0.00,1,1,1,1,1,1,20171001, L5681,HCPCS,INTL CUSTM CONG/LATYP INSERT,,,28,,NW,,,,,,"$2,080.13",$0.00,1,1,1,1,1,1,20171001, L5682,HCPCS,BK THIGH LACER GLUT/ISCHIA M,,,28,,NW,,,,,,"$1,064.73",$0.00,1,1,1,1,1,1,20171001, L5683,HCPCS,INITIAL CUSTOM SOCKET INSERT,,,28,,NW,,,,,,"$2,080.13",$0.00,1,1,1,1,1,1,20171001, L5684,HCPCS,BK FORK STRAP,,,28,,NW,,,,,,$77.65,$0.00,1,1,1,1,1,1,20171001, L5685,HCPCS,BELOW KNEE SUS/SEAL SLEEVE,,,28,,NW,,,,,,$196.73,$0.00,1,1,1,1,1,1,20171001, L5686,HCPCS,BK BACK CHECK,,,28,,NW,,,,,,$86.28,$0.00,1,1,1,1,1,1,20171001, L5688,HCPCS,BK WAIST BELT WEBBING,,,28,,NW,,,,,,$104.67,$0.00,1,1,1,1,1,1,20171001, L5690,HCPCS,BK WAIST BELT PADDED AND LIN,,,28,,NW,,,,,,$173.27,$0.00,1,1,1,1,1,1,20171001, L5692,HCPCS,AK PELVIC CONTROL BELT LIGHT,,,28,,NW,,,,,,$230.08,$0.00,1,1,1,1,1,1,20171001, L5694,HCPCS,AK PELVIC CONTROL BELT PAD/L,,,28,,NW,,,,,,$318.71,$0.00,1,1,1,1,1,1,20171001, L5695,HCPCS,AK SLEEVE SUSP NEOPRENE/EQUA,,,28,,NW,,,,,,$289.30,$0.00,1,1,1,1,1,1,20171001, L5696,HCPCS,AK/KNEE DISARTIC PELVIC JOIN,,,28,,NW,,,,,,$327.61,$0.00,1,1,1,1,1,1,20171001, L5697,HCPCS,AK/KNEE DISARTIC PELVIC BAND,,,28,,NW,,,,,,$136.03,$0.00,1,1,1,1,1,1,20171001, L5698,HCPCS,AK/KNEE DISARTIC SILESIAN BA,,,28,,NW,,,,,,$191.26,$0.00,1,1,1,1,1,1,20171001, L5699,HCPCS,SHOULDER HARNESS,,,28,,NW,,,,,,$332.79,$0.00,1,1,1,1,1,1,20171001, L5700,HCPCS,REPLACE SOCKET BELOW KNEE,,,28,,NW,,,,,,"$4,881.78",$0.00,1,1,1,1,1,1,20171001, L5701,HCPCS,REPLACE SOCKET ABOVE KNEE,,,28,,NW,,,,,,"$5,996.26",$0.00,1,1,1,1,1,1,20171001, L5702,HCPCS,REPLACE SOCKET HIP,,,28,,NW,,,,,,"$7,660.00",$0.00,1,1,1,1,1,1,20171001, L5703,HCPCS,SYMES ANKLE W/O (SACH) FOOT,,,28,,NW,,,,,,"$3,774.84",$0.00,1,1,1,1,1,1,20171001, L5704,HCPCS,CUSTOM SHAPE COVER BK,,,28,,NW,,,,,,$920.94,$0.00,1,1,1,1,1,1,20171001, L5705,HCPCS,CUSTOM SHAPE COVER AK,,,28,,NW,,,,,,"$1,631.51",$0.00,1,1,1,1,1,1,20171001, L5706,HCPCS,CUSTOM SHAPE CVR KNEE DISART,,,28,,NW,,,,,,"$1,600.24",$0.00,1,1,1,1,1,1,20171001, L5707,HCPCS,CUSTOM SHAPE CVR HIP DISART,,,28,,NW,,,,,,"$2,170.06",$0.00,1,1,1,1,1,1,20171001, L5710,HCPCS,KNE-SHIN EXO SNG AXI MNL LOC,,,28,,NW,,,,,,$636.88,$0.00,1,1,1,1,1,1,20171001, L5711,HCPCS,KNEE-SHIN EXO MNL LOCK ULTRA,,,28,,NW,,,,,,$923.45,$0.00,1,1,1,1,1,1,20171001, L5712,HCPCS,KNEE-SHIN EXO FRICT SWG & ST,,,28,,NW,,,,,,$771.09,$0.00,1,1,1,1,1,1,20171001, L5714,HCPCS,KNEE-SHIN EXO VARIABLE FRICT,,,28,,NW,,,,,,$721.54,$0.00,1,1,1,1,1,1,20171001, L5716,HCPCS,KNEE-SHIN EXO MECH STANCE PH,,,28,,NW,,,,,,"$1,295.79",$0.00,1,1,1,1,1,1,20171001, L5718,HCPCS,KNEE-SHIN EXO FRCT SWG & STA,,,28,,NW,,,,,,"$1,562.41",$0.00,1,1,1,1,1,1,20171001, L5722,HCPCS,KNEE-SHIN PNEUM SWG FRCT EXO,,,28,,NW,,,,,,"$1,591.06",$0.00,1,1,1,1,1,1,20171001, L5724,HCPCS,KNEE-SHIN EXO FLUID SWING PH,,,28,,NW,,,,,,"$2,768.58",$0.00,1,1,1,1,1,1,20171001, L5726,HCPCS,KNEE-SHIN EXT JNTS FLD SWG E,,,28,,NW,,,,,,"$3,114.59",$0.00,1,1,1,1,1,1,20171001, L5728,HCPCS,KNEE-SHIN FLUID SWG & STANCE,,,28,,NW,,,,,,"$4,171.66",$0.00,1,1,1,1,1,1,20171001, L5780,HCPCS,KNEE-SHIN PNEUM/HYDRA PNEUM,,,28,,NW,,,,,,"$2,025.09",$0.00,1,1,1,1,1,1,20171001, L5781,HCPCS,LOWER LIMB PROS VACUUM PUMP,,,28,,NW,,,,,,"$6,340.02",$0.00,1,1,1,1,1,1,20171001, L5782,HCPCS,HD LOW LIMB PROS VACUUM PUMP,,,28,,NW,,,,,,"$6,684.16",$0.00,1,1,1,1,1,1,20171001, L5785,HCPCS,EXOSKELETAL BK ULTRALT MATER,,,28,,NW,,,,,,$897.03,$0.00,1,1,1,1,1,1,20171001, L5790,HCPCS,EXOSKELETAL AK ULTRA-LIGHT M,,,28,,NW,,,,,,"$1,256.86",$0.00,1,1,1,1,1,1,20171001, L5795,HCPCS,EXOSKEL HIP ULTRA-LIGHT MATE,,,28,,NW,,,,,,"$1,921.33",$0.00,1,1,1,1,1,1,20171001, L5810,HCPCS,ENDOSKEL KNEE-SHIN MNL LOCK,,,28,,NW,,,,,,$863.54,$0.00,1,1,1,1,1,1,20171001, L5811,HCPCS,ENDO KNEE-SHIN MNL LCK ULTRA,,,28,,NW,,,,,,"$1,284.56",$0.00,1,1,1,1,1,1,20171001, L5812,HCPCS,ENDO KNEE-SHIN FRCT SWG & ST,,,28,,NW,,,,,,$985.54,$0.00,1,1,1,1,1,1,20171001, L5814,HCPCS,ENDO KNEE-SHIN HYDRAL SWG PH,,,28,,NW,,,,,,"$5,886.45",$0.00,1,1,1,1,1,1,20171001, L5816,HCPCS,ENDO KNEE-SHIN POLYC MCH STA,,,28,,NW,,,,,,"$1,458.39",$0.00,1,1,1,1,1,1,20171001, L5818,HCPCS,ENDO KNEE-SHIN FRCT SWG & ST,,,28,,NW,,,,,,"$1,669.56",$0.00,1,1,1,1,1,1,20171001, L5822,HCPCS,ENDO KNEE-SHIN PNEUM SWG FRC,,,28,,NW,,,,,,"$2,837.89",$0.00,1,1,1,1,1,1,20171001, L5824,HCPCS,ENDO KNEE-SHIN FLUID SWING P,,,28,,NW,,,,,,"$2,757.60",$0.00,1,1,1,1,1,1,20171001, L5826,HCPCS,MINIATURE KNEE JOINT,,,28,,NW,,,,,,"$4,972.04",$0.00,1,1,1,1,1,1,20171001, L5828,HCPCS,ENDO KNEE-SHIN FLUID SWG/STA,,,28,,NW,,,,,,"$4,956.57",$0.00,1,1,1,1,1,1,20171001, L5830,HCPCS,ENDO KNEE-SHIN PNEUM/SWG PHA,,,28,,NW,,,,,,"$3,373.39",$0.00,1,1,1,1,1,1,20171001, L5840,HCPCS,MULTI-AXIAL KNEE/SHIN SYSTEM,,,28,,NW,,,,,,"$5,960.79",$0.00,1,1,1,1,1,1,20171001, L5845,HCPCS,KNEE-SHIN SYS STANCE FLEXION,,,28,,NW,,,,,,"$2,836.54",$0.00,1,1,1,1,1,1,20171001, L5848,HCPCS,KNEE-SHIN SYS HYDRAUL STANCE,,,28,,NW,,,,,,"$1,699.18",$0.00,1,1,1,1,1,1,20171001, L5850,HCPCS,ENDO AK/HIP KNEE EXTENS ASSI,,,28,,NW,,,,,,$208.66,$0.00,1,1,1,1,1,1,20171001, L5855,HCPCS,MECH HIP EXTENSION ASSIST,,,28,,NW,,,,,,$548.14,$0.00,1,1,1,1,1,1,20171001, L5856,HCPCS,ELEC KNEE-SHIN SWING/STANCE,,,28,,NW,,,,,,"$38,107.18",$0.00,1,1,1,1,1,1,20171001, L5857,HCPCS,ELEC KNEE-SHIN SWING ONLY,,,28,,NW,,,,,,"$13,541.48",$0.00,1,1,1,1,1,1,20171001, L5858,HCPCS,STANCE PHASE ONLY,,,28,,NW,,,,,,"$29,472.41",$0.00,1,1,1,1,1,1,20171001, L5859,HCPCS,KNEE-SHIN PRO FLEX/EXT CONT,,,28,,NW,,,,,,"$23,059.88",$0.00,1,1,1,1,1,1,20171001, L5910,HCPCS,ENDO BELOW KNEE ALIGNABLE SY,,,28,,NW,,,,,,$619.35,$0.00,1,1,1,1,1,1,20171001, L5920,HCPCS,ENDO AK/HIP ALIGNABLE SYSTEM,,,28,,NW,,,,,,$909.95,$0.00,1,1,1,1,1,1,20171001, L5925,HCPCS,ABOVE KNEE MANUAL LOCK,,,28,,NW,,,,,,$634.03,$0.00,1,1,1,1,1,1,20171001, L5930,HCPCS,HIGH ACTIVITY KNEE FRAME,,,28,,NW,,,,,,"$5,355.26",$0.00,1,1,1,1,1,1,20171001, L5940,HCPCS,ENDO BK ULTRA-LIGHT MATERIAL,,,28,,NW,,,,,,$873.73,$0.00,1,1,1,1,1,1,20171001, L5950,HCPCS,ENDO AK ULTRA-LIGHT MATERIAL,,,28,,NW,,,,,,"$1,340.18",$0.00,1,1,1,1,1,1,20171001, L5960,HCPCS,ENDO HIP ULTRA-LIGHT MATERIA,,,28,,NW,,,,,,"$1,730.40",$0.00,1,1,1,1,1,1,20171001, L5961,HCPCS,"ENDO POLY HIP, PNEU/HYD/ROT",,,28,,NW,,,,,,"$7,536.36",$0.00,1,1,1,1,1,1,20171001, L5962,HCPCS,BELOW KNEE FLEX COVER SYSTEM,,,28,,NW,,,,,,"$1,036.98",$0.00,1,1,1,1,1,1,20171001, L5964,HCPCS,ABOVE KNEE FLEX COVER SYSTEM,,,28,,NW,,,,,,"$1,654.89",$0.00,1,1,1,1,1,1,20171001, L5966,HCPCS,HIP FLEXIBLE COVER SYSTEM,,,28,,NW,,,,,,"$2,128.22",$0.00,1,1,1,1,1,1,20171001, L5968,HCPCS,MULTIAXIAL ANKLE W DORSIFLEX,,,28,,NW,,,,,,"$5,764.24",$0.00,1,1,1,1,1,1,20171001, L5969,HCPCS,AK/FT POWER ASST INCL MOTORS,,,28,,NW,,,,,,"$17,986.48",$0.00,1,1,1,1,1,1,20171001, L5970,HCPCS,FOOT EXTERNAL KEEL SACH FOOT,,,28,,NW,,,,,,$351.38,$0.00,1,1,1,1,1,1,20171001, L5971,HCPCS,"SACH FOOT, REPLACEMENT",,,28,,NW,,,,,,$351.38,$0.00,1,1,1,1,1,1,20171001, L5972,HCPCS,FLEXIBLE KEEL FOOT,,,28,,NW,,,,,,$631.53,$0.00,1,1,1,1,1,1,20171001, L5973,HCPCS,ANK-FOOT SYS DORS-PLANT FLEX,,,28,,NW,,,,,,"$27,667.93",$0.00,1,1,1,1,1,1,20171001, L5974,HCPCS,FOOT SINGLE AXIS ANKLE/FOOT,,,28,,NW,,,,,,$414.69,$0.00,1,1,1,1,1,1,20171001, L5975,HCPCS,COMBO ANKLE/FOOT PROSTHESIS,,,28,,NW,,,,,,$729.76,$0.00,1,1,1,1,1,1,20171001, L5976,HCPCS,ENERGY STORING FOOT,,,28,,NW,,,,,,$995.40,$0.00,1,1,1,1,1,1,20171001, L5978,HCPCS,FT PROSTH MULTIAXIAL ANKL/FT,,,28,,NW,,,,,,$512.12,$0.00,1,1,1,1,1,1,20171001, L5979,HCPCS,MULTI-AXIAL ANKLE/FT PROSTH,,,28,,NW,,,,,,"$4,005.66",$0.00,1,1,1,1,1,1,20171001, L5980,HCPCS,FLEX FOOT SYSTEM,,,28,,NW,,,,,,"$6,455.82",$0.00,1,1,1,1,1,1,20171001, L5981,HCPCS,FLEX-WALK SYS LOW EXT PROSTH,,,28,,NW,,,,,,"$5,068.94",$0.00,1,1,1,1,1,1,20171001, L5982,HCPCS,EXOSKELETAL AXIAL ROTATION U,,,28,,NW,,,,,,"$1,024.08",$0.00,1,1,1,1,1,1,20171001, L5984,HCPCS,ENDOSKELETAL AXIAL ROTATION,,,28,,NW,,,,,,"$1,012.07",$0.00,1,1,1,1,1,1,20171001, L5985,HCPCS,LWR EXT DYNAMIC PROSTH PYLON,,,28,,NW,,,,,,$443.39,$0.00,1,1,1,1,1,1,20171001, L5986,HCPCS,MULTI-AXIAL ROTATION UNIT,,,28,,NW,,,,,,"$1,120.46",$0.00,1,1,1,1,1,1,20171001, L5987,HCPCS,SHANK FT W VERT LOAD PYLON,,,28,,NW,,,,,,"$11,408.06",$0.00,1,1,1,1,1,1,20171001, L5988,HCPCS,VERTICAL SHOCK REDUCING PYLO,,,28,,NW,,,,,,"$3,165.93",$0.00,1,1,1,1,1,1,20171001, L5990,HCPCS,USER ADJUSTABLE HEEL HEIGHT,,,28,,NW,,,,,,"$2,871.16",$0.00,1,1,1,1,1,1,20171001, L5999,HCPCS,LOWR EXTREMITY PROSTHES NOS,,,28,,NW,,,,,,"$1,116.86",$0.00,1,1,1,1,1,1,20171001, L6000,HCPCS,PART HAND THUMB REM,,,28,,NW,,,,,,"$2,420.69",$0.00,1,1,1,1,1,1,20171001, L6010,HCPCS,PART HAND LITTLE/RING,,,28,,NW,,,,,,"$2,673.34",$0.00,1,1,1,1,1,1,20171001, L6020,HCPCS,PART HAND NO FINGERS,,,28,,NW,,,,,,"$2,501.33",$0.00,1,1,1,1,1,1,20171001, L6026,HCPCS,PART HAND MYO EXCLU TERM DEV,,,28,,NW,,,,,,"$7,029.30",$0.00,1,1,1,1,1,1,20171001, L6050,HCPCS,WRST MLD SCK FLX HNG TRI PAD,,,28,,NW,,,,,,"$3,498.60",$0.00,1,1,1,1,1,1,20171001, L6055,HCPCS,WRST MOLD SOCK W/EXP INTERFA,,,28,,NW,,,,,,"$4,728.42",$0.00,1,1,1,1,1,1,20171001, L6100,HCPCS,ELB MOLD SOCK FLEX HINGE PAD,,,28,,NW,,,,,,"$3,492.95",$0.00,1,1,1,1,1,1,20171001, L6110,HCPCS,ELBOW MOLD SOCK SUSPENSION T,,,28,,NW,,,,,,"$3,810.29",$0.00,1,1,1,1,1,1,20171001, L6120,HCPCS,ELBOW MOLD DOUB SPLT SOC STE,,,28,,NW,,,,,,"$4,375.19",$0.00,1,1,1,1,1,1,20171001, L6130,HCPCS,ELBOW STUMP ACTIVATED LOCK H,,,28,,NW,,,,,,"$4,673.13",$0.00,1,1,1,1,1,1,20171001, L6200,HCPCS,ELBOW MOLD OUTSID LOCK HINGE,,,28,,NW,,,,,,"$4,920.83",$0.00,1,1,1,1,1,1,20171001, L6205,HCPCS,ELBOW MOLDED W/ EXPAND INTER,,,28,,NW,,,,,,"$6,553.34",$0.00,1,1,1,1,1,1,20171001, L6250,HCPCS,ELBOW INTER LOC ELBOW FORARM,,,28,,NW,,,,,,"$4,886.47",$0.00,1,1,1,1,1,1,20171001, L6300,HCPCS,SHLDER DISART INT LOCK ELBOW,,,28,,NW,,,,,,"$6,747.25",$0.00,1,1,1,1,1,1,20171001, L6310,HCPCS,SHOULDER PASSIVE RESTOR COMP,,,28,,NW,,,,,,"$5,515.85",$0.00,1,1,1,1,1,1,20171001, L6320,HCPCS,SHOULDER PASSIVE RESTOR CAP,,,28,,NW,,,,,,"$3,046.41",$0.00,1,1,1,1,1,1,20171001, L6350,HCPCS,THORACIC INTERN LOCK ELBOW,,,28,,NW,,,,,,"$7,123.04",$0.00,1,1,1,1,1,1,20171001, L6360,HCPCS,THORACIC PASSIVE RESTOR COMP,,,28,,NW,,,,,,"$5,753.13",$0.00,1,1,1,1,1,1,20171001, L6370,HCPCS,THORACIC PASSIVE RESTOR CAP,,,28,,NW,,,,,,"$3,721.68",$0.00,1,1,1,1,1,1,20171001, L6380,HCPCS,POSTOP DSG CAST CHG WRST/ELB,,,28,,NW,,,,,,"$2,076.64",$0.00,1,1,1,1,1,1,20171001, L6382,HCPCS,POSTOP DSG CAST CHG ELB DIS/,,,28,,NW,,,,,,"$2,693.34",$0.00,1,1,1,1,1,1,20171001, L6384,HCPCS,POSTOP DSG CAST CHG SHLDER/T,,,28,,NW,,,,,,"$3,481.12",$0.00,1,1,1,1,1,1,20171001, L6386,HCPCS,POSTOP EA CAST CHG & REALIGN,,,28,,NW,,,,,,$745.24,$0.00,1,1,1,1,1,1,20171001, L6388,HCPCS,POSTOP APPLICAT RIGID DSG ON,,,28,,NW,,,,,,$770.67,$0.00,1,1,1,1,1,1,20171001, L6400,HCPCS,BELOW ELBOW PROSTH TISS SHAP,,,28,,NW,,,,,,"$4,125.53",$0.00,1,1,1,1,1,1,20171001, L6450,HCPCS,ELB DISART PROSTH TISS SHAP,,,28,,NW,,,,,,"$5,355.19",$0.00,1,1,1,1,1,1,20171001, L6500,HCPCS,ABOVE ELBOW PROSTH TISS SHAP,,,28,,NW,,,,,,"$5,295.39",$0.00,1,1,1,1,1,1,20171001, L6550,HCPCS,SHLDR DISAR PROSTH TISS SHAP,,,28,,NW,,,,,,"$6,730.31",$0.00,1,1,1,1,1,1,20171001, L6570,HCPCS,SCAP THORAC PROSTH TISS SHAP,,,28,,NW,,,,,,"$7,745.95",$0.00,1,1,1,1,1,1,20171001, L6580,HCPCS,WRIST/ELBOW BOWDEN CABLE MOL,,,28,,NW,,,,,,"$2,759.20",$0.00,1,1,1,1,1,1,20171001, L6582,HCPCS,WRIST/ELBOW BOWDEN CBL DIR F,,,28,,NW,,,,,,"$2,392.38",$0.00,1,1,1,1,1,1,20171001, L6584,HCPCS,ELBOW FAIR LEAD CABLE MOLDED,,,28,,NW,,,,,,"$3,655.15",$0.00,1,1,1,1,1,1,20171001, L6586,HCPCS,ELBOW FAIR LEAD CABLE DIR FO,,,28,,NW,,,,,,"$3,316.53",$0.00,1,1,1,1,1,1,20171001, L6588,HCPCS,SHDR FAIR LEAD CABLE MOLDED,,,28,,NW,,,,,,"$5,026.83",$0.00,1,1,1,1,1,1,20171001, L6590,HCPCS,SHDR FAIR LEAD CABLE DIRECT,,,28,,NW,,,,,,"$4,606.80",$0.00,1,1,1,1,1,1,20171001, L6600,HCPCS,POLYCENTRIC HINGE PAIR,,,28,,NW,,,,,,$341.18,$0.00,1,1,1,1,1,1,20171001, L6605,HCPCS,SINGLE PIVOT HINGE PAIR,,,28,,NW,,,,,,$336.95,$0.00,1,1,1,1,1,1,20171001, L6610,HCPCS,FLEXIBLE METAL HINGE PAIR,,,28,,NW,,,,,,$298.23,$0.00,1,1,1,1,1,1,20171001, L6611,HCPCS,"ADDITIONAL SWITCH, EXT POWER",,,28,,NW,,,,,,$646.62,$0.00,1,1,1,1,1,1,20171001, L6615,HCPCS,DISCONNECT LOCKING WRIST UNI,,,28,,NW,,,,,,$302.18,$0.00,1,1,1,1,1,1,20171001, L6616,HCPCS,DISCONNECT INSERT LOCKING WR,,,28,,NW,,,,,,$108.08,$0.00,1,1,1,1,1,1,20171001, L6620,HCPCS,FLEXION/EXTENSION WRIST UNIT,,,28,,NW,,,,,,$533.67,$0.00,1,1,1,1,1,1,20171001, L6621,HCPCS,FLEX/EXT WRIST W/WO FRICTION,,,28,,NW,,,,,,"$3,621.56",$0.00,1,1,1,1,1,1,20171001, L6623,HCPCS,SPRING-ASS ROT WRST W/ LATCH,,,28,,NW,,,,,,"$1,124.91",$0.00,1,1,1,1,1,1,20171001, L6624,HCPCS,FLEX/EXT/ROTATION WRIST UNIT,,,28,,NW,,,,,,"$5,967.15",$0.00,1,1,1,1,1,1,20171001, L6625,HCPCS,ROTATION WRST W/ CABLE LOCK,,,28,,NW,,,,,,$956.21,$0.00,1,1,1,1,1,1,20171001, L6628,HCPCS,QUICK DISCONN HOOK ADAPTER O,,,28,,NW,,,,,,$817.31,$0.00,1,1,1,1,1,1,20171001, L6629,HCPCS,LAMINATION COLLAR W/ COUPLIN,,,28,,NW,,,,,,$257.86,$0.00,1,1,1,1,1,1,20171001, L6630,HCPCS,STAINLESS STEEL ANY WRIST,,,28,,NW,,,,,,$370.38,$0.00,1,1,1,1,1,1,20171001, L6632,HCPCS,LATEX SUSPENSION SLEEVE EACH,,,28,,NW,,,,,,$102.66,$0.00,1,1,1,1,1,1,20171001, L6635,HCPCS,LIFT ASSIST FOR ELBOW,,,28,,NW,,,,,,$315.89,$0.00,1,1,1,1,1,1,20171001, L6637,HCPCS,NUDGE CONTROL ELBOW LOCK,,,28,,NW,,,,,,$634.39,$0.00,1,1,1,1,1,1,20171001, L6638,HCPCS,ELEC LOCK ON MANUAL PW ELBOW,,,28,,NW,,,,,,"$3,960.10",$0.00,1,1,1,1,1,1,20171001, L6640,HCPCS,SHOULDER ABDUCTION JOINT PAI,,,28,,NW,,,,,,$502.55,$0.00,1,1,1,1,1,1,20171001, L6641,HCPCS,EXCURSION AMPLIFIER PULLEY T,,,28,,NW,,,,,,$294.34,$0.00,1,1,1,1,1,1,20171001, L6642,HCPCS,EXCURSION AMPLIFIER LEVER TY,,,28,,NW,,,,,,$403.88,$0.00,1,1,1,1,1,1,20171001, L6645,HCPCS,SHOULDER FLEXION-ABDUCTION J,,,28,,NW,,,,,,$588.48,$0.00,1,1,1,1,1,1,20171001, L6646,HCPCS,MULTIPO LOCKING SHOULDER JNT,,,28,,NW,,,,,,"$4,996.27",$0.00,1,1,1,1,1,1,20171001, L6647,HCPCS,SHOULDER LOCK ACTUATOR,,,28,,NW,,,,,,$817.16,$0.00,1,1,1,1,1,1,20171001, L6648,HCPCS,EXT PWRD SHLDER LOCK/UNLOCK,,,28,,NW,,,,,,"$5,153.13",$0.00,1,1,1,1,1,1,20171001, L6650,HCPCS,SHOULDER UNIVERSAL JOINT,,,28,,NW,,,,,,$625.58,$0.00,1,1,1,1,1,1,20171001, L6655,HCPCS,STANDARD CONTROL CABLE EXTRA,,,28,,NW,,,,,,$129.22,$0.00,1,1,1,1,1,1,20171001, L6660,HCPCS,HEAVY DUTY CONTROL CABLE,,,28,,NW,,,,,,$156.84,$0.00,1,1,1,1,1,1,20171001, L6665,HCPCS,TEFLON OR EQUAL CABLE LINING,,,28,,NW,,,,,,$73.09,$0.00,1,1,1,1,1,1,20171001, L6670,HCPCS,HOOK TO HAND CABLE ADAPTER,,,28,,NW,,,,,,$80.88,$0.00,1,1,1,1,1,1,20171001, L6672,HCPCS,HARNESS CHEST/SHLDER SADDLE,,,28,,NW,,,,,,$315.71,$0.00,1,1,1,1,1,1,20171001, L6675,HCPCS,HARNESS FIGURE OF 8 SING CON,,,28,,NW,,,,,,$199.31,$0.00,1,1,1,1,1,1,20171001, L6676,HCPCS,HARNESS FIGURE OF 8 DUAL CON,,,28,,NW,,,,,,$212.81,$0.00,1,1,1,1,1,1,20171001, L6677,HCPCS,UE TRIPLE CONTROL HARNESS,,,28,,NW,,,,,,$464.11,$0.00,1,1,1,1,1,1,20171001, L6680,HCPCS,TEST SOCK WRIST DISART/BEL E,,,28,,NW,,,,,,$435.57,$0.00,1,1,1,1,1,1,20171001, L6682,HCPCS,TEST SOCK ELBW DISART/ABOVE,,,28,,NW,,,,,,$470.41,$0.00,1,1,1,1,1,1,20171001, L6684,HCPCS,TEST SOCKET SHLDR DISART/THO,,,28,,NW,,,,,,$640.05,$0.00,1,1,1,1,1,1,20171001, L6686,HCPCS,SUCTION SOCKET,,,28,,NW,,,,,,"$1,118.15",$0.00,1,1,1,1,1,1,20171001, L6687,HCPCS,FRAME TYP SOCKET BEL ELBOW/W,,,28,,NW,,,,,,$936.73,$0.00,1,1,1,1,1,1,20171001, L6688,HCPCS,FRAME TYP SOCK ABOVE ELB/DIS,,,28,,NW,,,,,,$967.61,$0.00,1,1,1,1,1,1,20171001, L6689,HCPCS,FRAME TYP SOCKET SHOULDER DI,,,28,,NW,,,,,,"$1,184.17",$0.00,1,1,1,1,1,1,20171001, L6690,HCPCS,FRAME TYP SOCK INTERSCAP-THO,,,28,,NW,,,,,,"$1,267.27",$0.00,1,1,1,1,1,1,20171001, L6691,HCPCS,REMOVABLE INSERT EACH,,,28,,NW,,,,,,$612.40,$0.00,1,1,1,1,1,1,20171001, L6692,HCPCS,SILICONE GEL INSERT OR EQUAL,,,28,,NW,,,,,,"$1,002.01",$0.00,1,1,1,1,1,1,20171001, L6693,HCPCS,LOCKINGELBOW FOREARM CNTRBAL,,,28,,NW,,,,,,"$4,501.91",$0.00,1,1,1,1,1,1,20171001, L6694,HCPCS,ELBOW SOCKET INS USE W/LOCK,,,28,,NW,,,,,,"$1,169.94",$0.00,1,1,1,1,1,1,20171001, L6695,HCPCS,ELBOW SOCKET INS USE W/O LCK,,,28,,NW,,,,,,$973.86,$0.00,1,1,1,1,1,1,20171001, L6696,HCPCS,CUS ELBO SKT IN FOR CON/ATYP,,,28,,NW,,,,,,"$2,080.13",$0.00,1,1,1,1,1,1,20171001, L6697,HCPCS,CUS ELBO SKT IN NOT CON/ATYP,,,28,,NW,,,,,,"$2,080.13",$0.00,1,1,1,1,1,1,20171001, L6698,HCPCS,BELOW/ABOVE ELBOW LOCK MECH,,,28,,NW,,,,,,$904.92,$0.00,1,1,1,1,1,1,20171001, L6703,HCPCS,"TERM DEV, PASSIVE HAND MITT",,,28,,NW,,,,,,$567.94,$0.00,1,1,1,1,1,1,20171001, L6704,HCPCS,"TERM DEV, SPORT/REC/WORK ATT",,,28,,NW,,,,,,"$1,045.87",$0.00,1,1,1,1,1,1,20171001, L6706,HCPCS,TERM DEV MECH HOOK VOL OPEN,,,28,,NW,,,,,,$613.88,$0.00,1,1,1,1,1,1,20171001, L6707,HCPCS,TERM DEV MECH HOOK VOL CLOSE,,,28,,NW,,,,,,"$2,294.05",$0.00,1,1,1,1,1,1,20171001, L6708,HCPCS,TERM DEV MECH HAND VOL OPEN,,,28,,NW,,,,,,"$1,508.65",$0.00,1,1,1,1,1,1,20171001, L6709,HCPCS,TERM DEV MECH HAND VOL CLOSE,,,28,,NW,,,,,,"$2,181.60",$0.00,1,1,1,1,1,1,20171001, L6711,HCPCS,"PED TERM DEV, HOOK, VOL OPEN",,,28,,NW,,,,,,"$1,059.95",$0.00,1,1,1,1,1,1,20171001, L6712,HCPCS,"PED TERM DEV, HOOK, VOL CLOS",,,28,,NW,,,,,,"$1,957.01",$0.00,1,1,1,1,1,1,20171001, L6713,HCPCS,"PED TERM DEV, HAND, VOL OPEN",,,28,,NW,,,,,,"$2,471.61",$0.00,1,1,1,1,1,1,20171001, L6714,HCPCS,"PED TERM DEV, HAND, VOL CLOS",,,28,,NW,,,,,,"$2,092.46",$0.00,1,1,1,1,1,1,20171001, L6715,HCPCS,"TERM DEVICE, MULTI ART DIGIT",,,28,,NW,,,,,,"$5,001.62",$0.00,1,1,1,1,1,1,20171001, L6721,HCPCS,"HOOK/HAND, HVY DTY, VOL OPEN",,,28,,NW,,,,,,"$3,724.13",$0.00,1,1,1,1,1,1,20171001, L6722,HCPCS,"HOOK/HAND, HVY DTY, VOL CLOS",,,28,,NW,,,,,,"$3,209.59",$0.00,1,1,1,1,1,1,20171001, L6805,HCPCS,TERM DEV MODIFIER WRIST UNIT,,,28,,NW,,,,,,$607.24,$0.00,1,1,1,1,1,1,20171001, L6810,HCPCS,TERM DEV PRECISION PINCH DEV,,,28,,NW,,,,,,$322.18,$0.00,1,1,1,1,1,1,20171001, L6880,HCPCS,ELEC HAND IND ART DIGITS,,,28,,NW,,,,,,"$37,893.24",$0.00,1,1,1,1,1,1,20171001, L6881,HCPCS,TERM DEV AUTO GRASP FEATURE,,,28,,NW,,,,,,"$6,478.12",$0.00,1,1,1,1,1,1,20171001, L6882,HCPCS,MICROPROCESSOR CONTROL UPLMB,,,28,,NW,,,,,,"$4,912.42",$0.00,1,1,1,1,1,1,20171001, L6883,HCPCS,REPLC SOCKT BELOW E/W DISA,,,28,,NW,,,,,,"$2,846.18",$0.00,1,1,1,1,1,1,20171001, L6884,HCPCS,REPLC SOCKT ABOVE ELBOW DISA,,,28,,NW,,,,,,"$4,072.13",$0.00,1,1,1,1,1,1,20171001, L6885,HCPCS,REPLC SOCKT SHLDR DIS/INTERC,,,28,,NW,,,,,,"$5,753.13",$0.00,1,1,1,1,1,1,20171001, L6890,HCPCS,PREFAB GLOVE FOR TERM DEVICE,,,28,,NW,,,,,,$313.77,$0.00,1,1,1,1,1,1,20171001, L6895,HCPCS,CUSTOM GLOVE FOR TERM DEVICE,,,28,,NW,,,,,,$958.94,$0.00,1,1,1,1,1,1,20171001, L6900,HCPCS,HAND RESTORAT THUMB/1 FINGER,,,28,,NW,,,,,,"$2,841.56",$0.00,1,1,1,1,1,1,20171001, L6905,HCPCS,HAND RESTORATION MULTIPLE FI,,,28,,NW,,,,,,"$2,767.46",$0.00,1,1,1,1,1,1,20171001, L6910,HCPCS,HAND RESTORATION NO FINGERS,,,28,,NW,,,,,,"$2,702.31",$0.00,1,1,1,1,1,1,20171001, L6915,HCPCS,HAND RESTORATION REPLACMNT G,,,28,,NW,,,,,,"$1,154.65",$0.00,1,1,1,1,1,1,20171001, L6920,HCPCS,WRIST DISARTICUL SWITCH CTRL,,,28,,NW,,,,,,"$11,850.65",$0.00,1,1,1,1,1,1,20171001, L6925,HCPCS,WRIST DISART MYOELECTRONIC C,,,28,,NW,,,,,,"$13,517.76",$0.00,1,1,1,1,1,1,20171001, L6930,HCPCS,BELOW ELBOW SWITCH CONTROL,,,28,,NW,,,,,,"$11,690.54",$0.00,1,1,1,1,1,1,20171001, L6935,HCPCS,BELOW ELBOW MYOELECTRONIC CT,,,28,,NW,,,,,,"$13,705.21",$0.00,1,1,1,1,1,1,20171001, L6940,HCPCS,ELBOW DISARTICULATION SWITCH,,,28,,NW,,,,,,"$15,123.33",$0.00,1,1,1,1,1,1,20171001, L6945,HCPCS,ELBOW DISART MYOELECTRONIC C,,,28,,NW,,,,,,"$17,411.96",$0.00,1,1,1,1,1,1,20171001, L6950,HCPCS,ABOVE ELBOW SWITCH CONTROL,,,28,,NW,,,,,,"$16,382.77",$0.00,1,1,1,1,1,1,20171001, L6955,HCPCS,ABOVE ELBOW MYOELECTRONIC CT,,,28,,NW,,,,,,"$19,583.75",$0.00,1,1,1,1,1,1,20171001, L6960,HCPCS,SHLDR DISARTIC SWITCH CONTRO,,,28,,NW,,,,,,"$20,739.74",$0.00,1,1,1,1,1,1,20171001, L6965,HCPCS,SHLDR DISARTIC MYOELECTRONIC,,,28,,NW,,,,,,"$24,386.81",$0.00,1,1,1,1,1,1,20171001, L6970,HCPCS,INTERSCAPULAR-THOR SWITCH CT,,,28,,NW,,,,,,"$25,497.54",$0.00,1,1,1,1,1,1,20171001, L6975,HCPCS,INTERSCAP-THOR MYOELECTRONIC,,,28,,NW,,,,,,"$27,994.54",$0.00,1,1,1,1,1,1,20171001, L7007,HCPCS,ADULT ELECTRIC HAND,,,28,,NW,,,,,,"$5,871.83",$0.00,1,1,1,1,1,1,20171001, L7008,HCPCS,PEDIATRIC ELECTRIC HAND,,,28,,NW,,,,,,"$9,464.82",$0.00,1,1,1,1,1,1,20171001, L7009,HCPCS,ADULT ELECTRIC HOOK,,,28,,NW,,,,,,"$5,972.97",$0.00,1,1,1,1,1,1,20171001, L7040,HCPCS,PREHENSILE ACTUATOR,,,28,,NW,,,,,,"$4,798.67",$0.00,1,1,1,1,1,1,20171001, L7045,HCPCS,PEDIATRIC ELECTRIC HOOK,,,28,,NW,,,,,,"$2,662.93",$0.00,1,1,1,1,1,1,20171001, L7170,HCPCS,ELECTRONIC ELBOW HOSMER SWIT,,,28,,NW,,,,,,"$10,265.57",$0.00,1,1,1,1,1,1,20171001, L7180,HCPCS,ELECTRONIC ELBOW SEQUENTIAL,,,28,,NW,,,,,,"$57,587.98",$0.00,1,1,1,1,1,1,20171001, L7181,HCPCS,ELECTRONIC ELBO SIMULTANEOUS,,,28,,NW,,,,,,"$63,547.38",$0.00,1,1,1,1,1,1,20171001, L7185,HCPCS,ELECTRON ELBOW ADOLESCENT SW,,,28,,NW,,,,,,"$10,659.78",$0.00,1,1,1,1,1,1,20171001, L7186,HCPCS,ELECTRON ELBOW CHILD SWITCH,,,28,,NW,,,,,,"$15,781.80",$0.00,1,1,1,1,1,1,20171001, L7190,HCPCS,ELBOW ADOLESCENT MYOELECTRON,,,28,,NW,,,,,,"$13,423.42",$0.00,1,1,1,1,1,1,20171001, L7191,HCPCS,ELBOW CHILD MYOELECTRONIC CT,,,28,,NW,,,,,,"$16,508.75",$0.00,1,1,1,1,1,1,20171001, L7259,HCPCS,ELECTRONIC WRIST ROTATOR ANY,,,28,,NW,,,,,,"$6,000.54",$0.00,1,1,1,1,1,1,20171001, L7360,HCPCS,SIX VOLT BAT OTTO BOCK/EQ EA,,,28,,NW,,,,,,$405.51,$0.00,1,1,1,1,1,1,20171001, L7362,HCPCS,BATTERY CHRGR SIX VOLT OTTO,,,28,,NW,,,,,,$436.75,$0.00,1,1,1,1,1,1,20171001, L7364,HCPCS,TWELVE VOLT BATTERY UTAH/EQU,,,28,,NW,,,,,,$762.84,$0.00,1,1,1,1,1,1,20171001, L7366,HCPCS,BATTERY CHRGR 12 VOLT UTAH/E,,,28,,NW,,,,,,"$1,020.39",$0.00,1,1,1,1,1,1,20171001, L7367,HCPCS,REPLACEMNT LITHIUM IONBATTER,,,28,,NW,,,,,,$611.10,$0.00,1,1,1,1,1,1,20171001, L7368,HCPCS,LITHIUM ION BATTERY CHARGER,,,28,,NW,,,,,,$794.09,$0.00,1,1,1,1,1,1,20171001, L7400,HCPCS,"ADD UE PROST BE/WD, ULTLITE",,,28,,NW,,,,,,$479.71,$0.00,1,1,1,1,1,1,20171001, L7401,HCPCS,ADD UE PROST A/E ULTLITE MAT,,,28,,NW,,,,,,$537.80,$0.00,1,1,1,1,1,1,20171001, L7402,HCPCS,ADD UE PROST S/D ULTLITE MAT,,,28,,NW,,,,,,$581.29,$0.00,1,1,1,1,1,1,20171001, L7403,HCPCS,ADD UE PROST B/E ACRYLIC,,,28,,NW,,,,,,$577.69,$0.00,1,1,1,1,1,1,20171001, L7404,HCPCS,ADD UE PROST A/E ACRYLIC,,,28,,NW,,,,,,$875.18,$0.00,1,1,1,1,1,1,20171001, L7405,HCPCS,ADD UE PROST S/D ACRYLIC,,,28,,NW,,,,,,"$1,146.58",$0.00,1,1,1,1,1,1,20171001, L7499,HCPCS,UPPER EXTREMITY PROSTHES NOS,,,28,,NW,,,,,,"$1,786.38",$0.00,1,1,1,1,1,1,20171001, L7510,HCPCS,PROSTHETIC DEVICE REPAIR REP,,,28,,NW,,,,,,$46.97,$0.00,1,1,1,1,1,1,20171001, L7520,HCPCS,REPAIR PROSTHESIS PER 15 MIN,,,28,,NW,,,,,,$53.14,$0.00,1,1,1,1,1,1,20171001, L7600,HCPCS,PROSTHETIC DONNING SLEEVE,,,28,,NW,,,,,,$70.23,$0.00,1,1,1,1,1,1,20171001, L7900,HCPCS,MALE VACUUM ERECTION SYSTEM,,,28,,NW,,,,,,$533.33,$0.00,1,1,1,1,1,1,20171001, L7902,HCPCS,"TENSION RING, VAC ERECT DEV",,,28,,NW,,,,,,$35.13,$0.00,1,1,1,1,1,1,20171001, L8000,HCPCS,MASTECTOMY BRA,,,28,,NW,,,,,,$60.96,$0.00,1,1,1,1,1,1,20171001, L8001,HCPCS,BREAST PROSTHESIS BRA & FORM,,,28,,NW,,,,,,$192.53,$0.00,1,1,1,1,1,1,20171001, L8002,HCPCS,BRST PRSTH BRA & BILAT FORM,,,28,,NW,,,,,,$255.26,$0.00,1,1,1,1,1,1,20171001, L8010,HCPCS,MASTECTOMY SLEEVE,,,28,,NW,,,,,,$51.78,$0.00,1,1,1,1,1,1,20171001, L8015,HCPCS,EXT BREASTPROSTHESIS GARMENT,,,28,,NW,,,,,,$88.79,$0.00,1,1,1,1,1,1,20171001, L8020,HCPCS,MASTECTOMY FORM,,,28,,NW,,,,,,$355.29,$0.00,1,1,1,1,1,1,20171001, L8030,HCPCS,BREAST PROSTHES W/O ADHESIVE,,,28,,NW,,,,,,$544.52,$0.00,1,1,1,1,1,1,20171001, L8031,HCPCS,BREAST PROSTHESIS W ADHESIVE,,,28,,NW,,,,,,$544.52,$0.00,1,1,1,1,1,1,20171001, L8032,HCPCS,REUSABLE NIPPLE PROSTHESIS,,,28,,NW,,,,,,$57.39,$0.00,1,1,1,1,1,1,20171001, L8035,HCPCS,CUSTOM BREAST PROSTHESIS,,,28,,NW,,,,,,"$5,811.43",$0.00,1,1,1,1,1,1,20171001, L8039,HCPCS,BREAST PROSTHESIS NOS,,,28,,NW,,,,,,$52.98,$0.00,1,1,1,1,1,1,20171001, L8040,HCPCS,NASAL PROSTHESIS,,,28,,NW,,,,,,"$3,961.48",$0.00,1,1,1,1,1,1,20171001, L8040,HCPCS,NASAL PROSTHESIS,KM,,28,,NW,,,,,,"$3,763.08",$0.00,1,1,1,1,1,1,20171001, L8040,HCPCS,NASAL PROSTHESIS,KN,,28,,NW,,,,,,"$1,580.73",$0.00,1,1,1,1,1,1,20171001, L8041,HCPCS,MIDFACIAL PROSTHESIS,,,28,,NW,,,,,,"$4,776.19",$0.00,1,1,1,1,1,1,20171001, L8041,HCPCS,MIDFACIAL PROSTHESIS,KM,,28,,NW,,,,,,"$4,537.04",$0.00,1,1,1,1,1,1,20171001, L8041,HCPCS,MIDFACIAL PROSTHESIS,KN,,28,,NW,,,,,,"$1,906.64",$0.00,1,1,1,1,1,1,20171001, L8042,HCPCS,ORBITAL PROSTHESIS,,,28,,NW,,,,,,"$5,367.29",$0.00,1,1,1,1,1,1,20171001, L8042,HCPCS,ORBITAL PROSTHESIS,KM,,28,,NW,,,,,,"$5,098.59",$0.00,1,1,1,1,1,1,20171001, L8042,HCPCS,ORBITAL PROSTHESIS,KN,,28,,NW,,,,,,"$2,143.06",$0.00,1,1,1,1,1,1,20171001, L8043,HCPCS,UPPER FACIAL PROSTHESIS,,,28,,NW,,,,,,"$6,012.16",$0.00,1,1,1,1,1,1,20171001, L8043,HCPCS,UPPER FACIAL PROSTHESIS,KM,,28,,NW,,,,,,"$5,711.21",$0.00,1,1,1,1,1,1,20171001, L8043,HCPCS,UPPER FACIAL PROSTHESIS,KN,,28,,NW,,,,,,"$2,401.00",$0.00,1,1,1,1,1,1,20171001, L8044,HCPCS,HEMI-FACIAL PROSTHESIS,,,28,,NW,,,,,,"$6,656.98",$0.00,1,1,1,1,1,1,20171001, L8044,HCPCS,HEMI-FACIAL PROSTHESIS,KM,,28,,NW,,,,,,"$6,323.82",$0.00,1,1,1,1,1,1,20171001, L8044,HCPCS,HEMI-FACIAL PROSTHESIS,KN,,28,,NW,,,,,,"$2,658.94",$0.00,1,1,1,1,1,1,20171001, L8045,HCPCS,AURICULAR PROSTHESIS,,,28,,NW,,,,,,"$4,392.91",$0.00,1,1,1,1,1,1,20171001, L8045,HCPCS,AURICULAR PROSTHESIS,KM,,28,,NW,,,,,,"$4,172.95",$0.00,1,1,1,1,1,1,20171001, L8045,HCPCS,AURICULAR PROSTHESIS,KN,,28,,NW,,,,,,"$1,753.31",$0.00,1,1,1,1,1,1,20171001, L8046,HCPCS,PARTIAL FACIAL PROSTHESIS,,,28,,NW,,,,,,"$4,292.55",$0.00,1,1,1,1,1,1,20171001, L8046,HCPCS,PARTIAL FACIAL PROSTHESIS,KM,,28,,NW,,,,,,"$4,077.60",$0.00,1,1,1,1,1,1,20171001, L8046,HCPCS,PARTIAL FACIAL PROSTHESIS,KN,,28,,NW,,,,,,"$1,713.15",$0.00,1,1,1,1,1,1,20171001, L8047,HCPCS,NASAL SEPTAL PROSTHESIS,,,28,,NW,,,,,,"$2,196.79",$0.00,1,1,1,1,1,1,20171001, L8047,HCPCS,NASAL SEPTAL PROSTHESIS,KM,,28,,NW,,,,,,"$2,086.64",$0.00,1,1,1,1,1,1,20171001, L8047,HCPCS,NASAL SEPTAL PROSTHESIS,KN,,28,,NW,,,,,,$874.87,$0.00,1,1,1,1,1,1,20171001, L8048,HCPCS,UNSPEC MAXILLOFACIAL PROSTH,,,28,,NW,,,,,,$970.27,$0.00,1,1,1,1,1,1,20171001, L8049,HCPCS,REPAIR MAXILLOFACIAL PROSTH,,,28,,NW,,,,,,$66.39,$0.00,1,1,1,1,1,1,20171001, L8300,HCPCS,TRUSS SINGLE W/ STANDARD PAD,,,28,,NW,,,,,,$144.50,$0.00,1,1,1,1,1,1,20171001, L8310,HCPCS,TRUSS DOUBLE W/ STANDARD PAD,,,28,,NW,,,,,,$238.47,$0.00,1,1,1,1,1,1,20171001, L8320,HCPCS,TRUSS ADDITION TO STD PAD WA,,,28,,NW,,,,,,$92.66,$0.00,1,1,1,1,1,1,20171001, L8330,HCPCS,TRUSS ADD TO STD PAD SCROTAL,,,28,,NW,,,,,,$85.52,$0.00,1,1,1,1,1,1,20171001, L8400,HCPCS,SHEATH BELOW KNEE,,,28,,NW,,,,,,$27.47,$0.00,1,1,1,1,1,1,20171001, L8410,HCPCS,SHEATH ABOVE KNEE,,,28,,NW,,,,,,$34.96,$0.00,1,1,1,1,1,1,20171001, L8415,HCPCS,SHEATH UPPER LIMB,,,28,,NW,,,,,,$34.60,$0.00,1,1,1,1,1,1,20171001, L8417,HCPCS,PROS SHEATH/SOCK W GEL CUSHN,,,28,,NW,,,,,,$112.86,$0.00,1,1,1,1,1,1,20171001, L8420,HCPCS,PROSTHETIC SOCK MULTI PLY BK,,,28,,NW,,,,,,$33.91,$0.00,1,1,1,1,1,1,20171001, L8430,HCPCS,PROSTHETIC SOCK MULTI PLY AK,,,28,,NW,,,,,,$37.56,$0.00,1,1,1,1,1,1,20171001, L8435,HCPCS,PROS SOCK MULTI PLY UPPER LM,,,28,,NW,,,,,,$35.59,$0.00,1,1,1,1,1,1,20171001, L8440,HCPCS,SHRINKER BELOW KNEE,,,28,,NW,,,,,,$71.17,$0.00,1,1,1,1,1,1,20171001, L8460,HCPCS,SHRINKER ABOVE KNEE,,,28,,NW,,,,,,$112.31,$0.00,1,1,1,1,1,1,20171001, L8465,HCPCS,SHRINKER UPPER LIMB,,,28,,NW,,,,,,$82.02,$0.00,1,1,1,1,1,1,20171001, L8470,HCPCS,PROS SOCK SINGLE PLY BK,,,28,,NW,,,,,,$11.47,$0.00,1,1,1,1,1,1,20171001, L8480,HCPCS,PROS SOCK SINGLE PLY AK,,,28,,NW,,,,,,$15.46,$0.00,1,1,1,1,1,1,20171001, L8485,HCPCS,PROS SOCK SINGLE PLY UPPER L,,,28,,NW,,,,,,$18.92,$0.00,1,1,1,1,1,1,20171001, L8499,HCPCS,UNLISTED MISC PROSTHETIC SER,,,28,,NW,,,,,,$6.99,$0.00,1,1,1,1,1,1,20171001, L8500,HCPCS,ARTIFICIAL LARYNX,,,28,,NW,,,,,,"$1,133.26",$0.00,1,1,1,1,1,1,20171001, L8501,HCPCS,TRACHEOSTOMY SPEAKING VALVE,,,28,,NW,,,,,,$196.22,$0.00,1,1,1,1,1,1,20171001, L8505,HCPCS,"ARTIFICIAL LARYNX, ACCESSORY",,,28,,NW,,,,,,$87.77,$0.00,1,1,1,1,1,1,20171001, L8507,HCPCS,TRACH-ESOPH VOICE PROS PT IN,,,28,,NW,,,,,,$61.19,$0.00,1,1,1,1,1,1,20171001, L8509,HCPCS,TRACH-ESOPH VOICE PROS MD IN,,,28,,NW,,,,,,$166.80,$0.00,1,1,1,1,1,1,20171001, L8510,HCPCS,VOICE AMPLIFIER,,,28,,NW,,,,,,$394.39,$0.00,1,1,1,1,1,1,20171001, L8511,HCPCS,INDWELLING TRACH INSERT,,,28,,NW,,,,,,$109.07,$0.00,1,1,1,1,1,1,20171001, L8512,HCPCS,GEL CAP FOR TRACH VOICE PROS,,,28,,NW,,,,,,$3.46,$0.00,1,1,1,1,1,1,20171001, L8513,HCPCS,TRACH PROS CLEANING DEVICE,,,28,,NW,,,,,,$8.25,$0.00,1,1,1,1,1,1,20171001, L8514,HCPCS,REPL TRACH PUNCTURE DILATOR,,,28,,NW,,,,,,$143.32,$0.00,1,1,1,1,1,1,20171001, L8515,HCPCS,GEL CAP APP DEVICE FOR TRACH,,,28,,NW,,,,,,$93.68,$0.00,1,1,1,1,1,1,20171001, L8600,HCPCS,IMPLANT BREAST SILICONE/EQ,,,28,,NW,,,,,,"$1,073.86",$0.00,1,1,1,1,1,1,20171001, L8603,HCPCS,COLLAGEN IMP URINARY 2.5 ML,,,28,,NW,,,,,,$689.64,$0.00,1,1,1,1,1,1,20171001, L8605,HCPCS,INJ BULKING AGENT ANAL CANAL,,,28,,NW,,,,,,"$1,129.70",$0.00,1,1,1,1,1,1,20171001, L8606,HCPCS,SYNTHETIC IMPLNT URINARY 1ML,,,28,,NW,,,,,,$343.42,$0.00,1,1,1,1,1,1,20171001, L8607,HCPCS,INJ VOCAL CORD BULKING AGENT,,,28,,NW,,,,,,$62.63,$0.00,1,1,1,0,0,1,20171001, L8609,HCPCS,ARTIFICIAL CORNEA,,,28,,NW,,,,,,"$10,319.67",$0.00,1,1,1,1,1,1,20171001, L8610,HCPCS,OCULAR IMPLANT,,,28,,NW,,,,,,"$1,014.98",$0.00,1,1,1,1,1,1,20171001, L8612,HCPCS,AQUEOUS SHUNT PROSTHESIS,,,28,,NW,,,,,,"$1,111.50",$0.00,1,1,1,1,1,1,20171001, L8613,HCPCS,OSSICULAR IMPLANT,,,28,,NW,,,,,,$483.92,$0.00,1,1,1,1,1,1,20171001, L8614,HCPCS,COCHLEAR DEVICE,,,28,,NW,,,,,,"$30,777.52",$0.00,1,1,1,1,1,1,20171001, L8615,HCPCS,COCH IMPLANT HEADSET REPLACE,,,28,,NW,,,,,,$708.37,$0.00,1,1,1,1,1,1,20171001, L8616,HCPCS,COCH IMPLANT MICROPHONE REPL,,,28,,NW,,,,,,$160.05,$0.00,1,1,1,1,1,1,20171001, L8617,HCPCS,COCH IMPLANT TRANS COIL REPL,,,28,,NW,,,,,,$138.99,$0.00,1,1,1,1,1,1,20171001, L8618,HCPCS,COCH IMPLANT TRAN CABLE REPL,,,28,,NW,,,,,,$38.76,$0.00,1,1,1,1,1,1,20171001, L8619,HCPCS,COCH IMP EXT PROC/CONTR RPLC,,,28,,NW,,,,,,"$13,206.88",$0.00,1,1,1,1,1,1,20171001, L8621,HCPCS,REPL ZINC AIR BATTERY,,,28,,NW,,,,,,$0.98,$0.00,1,1,1,1,1,1,20171001, L8622,HCPCS,REPL ALKALINE BATTERY,,,28,,NW,,,,,,$0.51,$0.00,1,1,1,1,1,1,20171001, L8623,HCPCS,"LITH ION BATT CID,NON-EARLVL",,,28,,NW,,,,,,$96.09,$0.00,1,1,1,1,1,1,20171001, L8624,HCPCS,"LITH ION BATT CID, EAR LEVEL",,,28,,NW,,,,,,$249.14,$0.00,1,1,1,1,1,1,20171001, L8627,HCPCS,CID EXT SPEECH PROCESS REPL,,,28,,NW,,,,,,"$11,208.99",$0.00,1,1,1,1,1,1,20171001, L8628,HCPCS,CID EXT CONTROLLER REPL,,,28,,NW,,,,,,"$1,984.04",$0.00,1,1,1,1,1,1,20171001, L8629,HCPCS,CID TRANSMIT COIL AND CABLE,,,28,,NW,,,,,,$277.60,$0.00,1,1,1,1,1,1,20171001, L8630,HCPCS,METACARPOPHALANGEAL IMPLANT,,,28,,NW,,,,,,$573.30,$0.00,1,1,1,1,1,1,20171001, L8631,HCPCS,MCP JOINT REPL 2 PC OR MORE,,,28,,NW,,,,,,"$3,498.25",$0.00,1,1,1,1,1,1,20171001, L8641,HCPCS,METATARSAL JOINT IMPLANT,,,28,,NW,,,,,,$578.24,$0.00,1,1,1,1,1,1,20171001, L8642,HCPCS,HALLUX IMPLANT,,,28,,NW,,,,,,$493.41,$0.00,1,1,1,1,1,1,20171001, L8658,HCPCS,INTERPHALANGEAL JOINT SPACER,,,28,,NW,,,,,,$504.60,$0.00,1,1,1,1,1,1,20171001, L8659,HCPCS,INTERPHALANGEAL JOINT REPL,,,28,,NW,,,,,,"$3,051.86",$0.00,1,1,1,1,1,1,20171001, L8670,HCPCS,"VASCULAR GRAFT, SYNTHETIC",,,28,,NW,,,,,,$877.99,$0.00,1,1,1,1,1,1,20171001, L8679,HCPCS,IMP NEUROSTI PLS GN ANY TYPE,,,28,,NW,,,,,,"$13,412.90",$0.00,1,1,1,1,1,1,20171001, L8680,HCPCS,IMPLT NEUROSTIM ELCTR EACH,,,28,,NW,,,,,,$461.14,$0.00,1,1,1,1,1,1,20171001, L8681,HCPCS,PT PRGRM FOR IMPLT NEUROSTIM,,,28,,NW,,,,,,"$1,823.98",$0.00,1,1,1,1,1,1,20171001, L8682,HCPCS,IMPLT NEUROSTIM RADIOFQ REC,,,28,,NW,,,,,,"$9,581.42",$0.00,1,1,1,1,1,1,20171001, L8683,HCPCS,RADIOFQ TRSMTR FOR IMPLT NEU,,,28,,NW,,,,,,"$8,433.06",$0.00,1,1,1,1,1,1,20171001, L8684,HCPCS,RADIOF TRSMTR IMPLT SCRL NEU,,,28,,NW,,,,,,"$1,214.53",$0.00,1,1,1,1,1,1,20171001, L8685,HCPCS,IMPLT NROSTM PLS GEN SNG REC,,,28,,NW,,,,,,"$13,302.71",$0.00,1,1,1,1,1,1,20171001, L8686,HCPCS,IMPLT NROSTM PLS GEN SNG NON,,,28,,NW,,,,,,"$8,486.03",$0.00,1,1,1,1,1,1,20171001, L8687,HCPCS,IMPLT NROSTM PLS GEN DUA REC,,,28,,NW,,,,,,"$17,314.48",$0.00,1,1,1,1,1,1,20171001, L8688,HCPCS,IMPLT NROSTM PLS GEN DUA NON,,,28,,NW,,,,,,"$11,045.84",$0.00,1,1,1,1,1,1,20171001, L8689,HCPCS,EXTERNAL RECHARG SYS INTERN,,,28,,NW,,,,,,"$2,729.78",$0.00,1,1,1,1,1,1,20171001, L8690,HCPCS,"AUD OSSEO DEV, INT/EXT COMP",,,28,,NW,,,,,,"$7,539.66",$0.00,1,1,1,1,1,1,20171001, L8691,HCPCS,OSSEOINTEGRATED SND PROC RPL,,,28,,NW,,,,,,"$4,223.41",$0.00,1,1,1,1,1,1,20171001, L8692,HCPCS,NON-OSSEOINTEGRATED SND PROC,,,28,,NW,,,,,,$317.53,$0.00,1,1,1,1,1,1,20171001, L8693,HCPCS,"AUD OSSEO DEV, ABUTMENT",,,28,,NW,,,,,,"$2,396.75",$0.00,1,1,1,1,1,1,20171001, L8695,HCPCS,EXTERNAL RECHARG SYS EXTERN,,,28,,NW,,,,,,$25.11,$0.00,1,1,1,1,1,1,20171001, L8696,HCPCS,EXT ANTENNA PHREN NERVE STIM,,,28,,NW,,,,,,$337.39,$0.00,1,1,1,1,1,1,20171001, L8699,HCPCS,PROSTHETIC IMPLANT NOS,,,28,,NW,,,,,,$257.20,$0.00,1,1,1,1,1,1,20171001, L9900,HCPCS,O&P SUPPLY/ACCESSORY/SERVICE,,,28,,NW,,,,,,$305.90,$0.00,1,1,1,1,1,1,20171001, M0076,HCPCS,PROLOTHERAPY,,,14,,TotalUnits,,,,1.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, M0300,HCPCS,IV CHELATIONTHERAPY,,,4,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P2031,HCPCS,HAIR ANALYSIS,,,17,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P2038,HCPCS,BLOOD MUCOPROTEIN,,,17,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P3000,HCPCS,SCREEN PAP BY TECH W MD SUPV,,,17,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P3001,HCPCS,SCREENING PAP SMEAR BY PHYS,,,17,,RBRVS,0.42 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, P7001,HCPCS,CULTURE BACTERIAL URINE,,,17,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9010,HCPCS,WHOLE BLOOD FOR TRANSFUSION,,,14,,TotalUnits,,,,1.96 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9011,HCPCS,BLOOD SPLIT UNIT,,,14,,TotalUnits,,,,2.80 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9012,HCPCS,CRYOPRECIPITATE EACH UNIT,,,14,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9016,HCPCS,RBC LEUKOCYTES REDUCED,,,14,,TotalUnits,,,,5.35 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9017,HCPCS,PLASMA 1 DONOR FRZ W/IN 8 HR,,,14,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9019,HCPCS,"PLATELETS, EACH UNIT",,,14,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9020,HCPCS,PLAELET RICH PLASMA UNIT,,,14,,TotalUnits,,,,5.25 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9021,HCPCS,RED BLOOD CELLS UNIT,,,14,,TotalUnits,,,,3.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9022,HCPCS,WASHED RED BLOOD CELLS UNIT,,,14,,TotalUnits,,,,1.75 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9031,HCPCS,PLATELETS LEUKOCYTES REDUCED,,,14,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9032,HCPCS,"PLATELETS, IRRADIATED",,,14,,TotalUnits,,,,1.38 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9033,HCPCS,PLATELETS LEUKOREDUCED IRRAD,,,14,,TotalUnits,,,,11.83 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9034,HCPCS,"PLATELETS, PHERESIS",,,14,,TotalUnits,,,,6.94 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9035,HCPCS,PLATELET PHERES LEUKOREDUCED,,,14,,TotalUnits,,,,14.69 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9037,HCPCS,PLATE PHERES LEUKOREDU IRRAD,,,14,,TotalUnits,,,,17.10 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9040,HCPCS,RBC LEUKOREDUCED IRRADIATED,,,14,,TotalUnits,,,,8.02 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9041,HCPCS,"ALBUMIN (HUMAN),5%, 50ML",,,14,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9043,HCPCS,"PLASMA PROTEIN FRACT,5%,50ML",,,14,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9045,HCPCS,"ALBUMIN (HUMAN), 5%, 250 ML",,,14,,TotalUnits,,,,3.31 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9046,HCPCS,"ALBUMIN (HUMAN), 25%, 20 ML",,,14,,TotalUnits,,,,1.08 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9047,HCPCS,"ALBUMIN (HUMAN), 25%, 50ML",,,14,,TotalUnits,,,,2.70 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9048,HCPCS,"PLASMAPROTEIN FRACT,5%,250ML",,,14,,TotalUnits,,,,1.30 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9053,HCPCS,"PLT, PHER, L/R CMV-NEG, IRR",,,14,,TotalUnits,,,,14.03 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9058,HCPCS,"RBC, L/R, CMV-NEG, IRRAD",,,14,,TotalUnits,,,,7.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9059,HCPCS,"PLASMA, FRZ BETWEEN 8-24HOUR",,,14,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9070,HCPCS,PATHOGEN REDUCED PLASMA POOL,,,14,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9071,HCPCS,PATHOGEN REDUCED PLASMA SING,,,14,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9072,HCPCS,PATHOGEN REDUCED PLATELETS,,,14,,TotalUnits,,,,13.34 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9603,HCPCS,ONE-WAY ALLOW PRORATED MILES,,,17,,TotalUnits,,,,0.01 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9604,HCPCS,ONE-WAY ALLOW PRORATED TRIP,,,17,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9612,HCPCS,CATHETERIZE FOR URINE SPEC,,,17,,TotalUnits,,,,0.08 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, P9615,HCPCS,URINE SPECIMEN COLLECT MULT,,,17,,TotalUnits,,,,0.08 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q0035,HCPCS,CARDIOKYMOGRAPHY,,,4,,RBRVS,0.17 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, Q0035,HCPCS,CARDIOKYMOGRAPHY,26,,4,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, Q0035,HCPCS,CARDIOKYMOGRAPHY,TC,,4,,RBRVS,,0.33 ,0.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q0081,HCPCS,INFUSION THER OTHER THAN CHE,,,22,,TotalUnits,,,,1.89 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, Q0083,HCPCS,CHEMO BY OTHER THAN INFUSION,,,14,,TotalUnits,,,,0.91 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q0084,HCPCS,CHEMOTHERAPY BY INFUSION,,,14,,TotalUnits,,,,1.28 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q0085,HCPCS,CHEMO BY BOTH INFUSION AND O,,,14,,TotalUnits,,,,6.14 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q0091,HCPCS,OBTAINING SCREEN PAP SMEAR,,,17,,RBRVS,0.37 ,0.15 ,0.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q0092,HCPCS,SET UP PORT XRAY EQUIPMENT,,TC,20,,RBRVS,,0.70 ,0.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q0111,HCPCS,WET MOUNTS/ W PREPARATIONS,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q0112,HCPCS,POTASSIUM HYDROXIDE PREPS,,,17,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q0113,HCPCS,PINWORM EXAMINATIONS,,,17,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q0114,HCPCS,FERN TEST,,,17,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q0115,HCPCS,POST-COITAL MUCOUS EXAM,,,17,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q0138,HCPCS,"FERUMOXYTOL, NON-ESRD",,,29,,NW,,,,,,$10.51,$0.00,1,1,1,0,0,1,20171001, Q0139,HCPCS,"FERUMOXYTOL, ESRD USE",,,28,,NW,,,,,,$2.36,$0.00,1,1,1,0,0,1,20171001, Q0144,HCPCS,"AZITHROMYCIN DIHYDRATE, ORAL",,,29,,NW,,,,,,$40.27,$0.00,1,1,1,0,0,1,20171001, Q0161,HCPCS,CHLORPROMAZINE HCL 5MG ORAL,,,29,,NW,,,,,,$1.67,$0.00,1,1,1,0,0,1,20171001, Q0162,HCPCS,ONDANSETRON ORAL,,,29,,NW,,,,,,$1.69,$0.00,1,1,1,0,0,1,20171001, Q0163,HCPCS,DIPHENHYDRAMINE HCL 50MG,,,29,,NW,,,,,,$1.69,$0.00,1,1,1,0,0,1,20171001, Q0164,HCPCS,PROCHLORPERAZINE MALEATE 5MG,,,29,,NW,,,,,,$1.69,$0.00,1,1,1,0,0,1,20171001, Q0166,HCPCS,GRANISETRON HCL 1 MG ORAL,,,29,,NW,,,,,,$5.08,$0.00,1,1,1,0,0,1,20171001, Q0167,HCPCS,DRONABINOL 2.5MG ORAL,,,29,,NW,,,,,,$10.16,$0.00,1,1,1,0,0,1,20171001, Q0169,HCPCS,PROMETHAZINE HCL 12.5MG ORAL,,,29,,NW,,,,,,$1.69,$0.00,1,1,1,0,0,1,20171001, Q0173,HCPCS,TRIMETHOBENZAMIDE HCL 250MG,,,29,,NW,,,,,,$3.39,$0.00,1,1,1,0,0,1,20171001, Q0174,HCPCS,THIETHYLPERAZINE MALEATE10MG,,,29,,NW,,,,,,$3.39,$0.00,1,1,1,0,0,1,20171001, Q0175,HCPCS,PERPHENAZINE 4MG ORAL,,,29,,NW,,,,,,$3.39,$0.00,1,1,1,0,0,1,20171001, Q0177,HCPCS,HYDROXYZINE PAMOATE 25MG,,,29,,NW,,,,,,$10.16,$0.00,1,1,1,0,0,1,20171001, Q0180,HCPCS,DOLASETRON MESYLATE ORAL,,,29,,NW,,,,,,$372.79,$0.00,1,1,1,0,0,1,20171001, Q0181,HCPCS,UNSPECIFIED ORAL ANTI-EMETIC,,,29,,NW,,,,,,$52.79,$0.00,1,1,1,0,0,1,20171001, Q0478,HCPCS,"POWER ADAPTER, COMBO VAD",,,28,,NW,,,,,,$284.81,$0.00,1,1,1,0,0,1,20171001, Q0479,HCPCS,"POWER MODULE COMBO VAD, REP",,,28,,NW,,,,,,"$19,135.12",$0.00,1,1,1,0,0,1,20171001, Q0480,HCPCS,"DRIVER PNEUMATIC VAD, REP",,,28,,NW,,,,,,"$142,859.19",$0.00,1,1,1,0,0,1,20171001, Q0481,HCPCS,"MICROPRCSR CU ELEC VAD, REP",,,28,,NW,,,,,,"$23,043.28",$0.00,1,1,1,0,0,1,20171001, Q0482,HCPCS,"MICROPRCSR CU COMBO VAD, REP",,,28,,NW,,,,,,"$7,213.18",$0.00,1,1,1,0,0,1,20171001, Q0483,HCPCS,"MONITOR ELEC VAD, REP",,,28,,NW,,,,,,"$29,735.09",$0.00,1,1,1,0,0,1,20171001, Q0484,HCPCS,MONITOR ELEC OR COMB VAD REP,,,28,,NW,,,,,,"$5,769.28",$0.00,1,1,1,0,0,1,20171001, Q0485,HCPCS,"MONITOR CABLE ELEC VAD, REP",,,28,,NW,,,,,,$551.21,$0.00,1,1,1,0,0,1,20171001, Q0486,HCPCS,MON CABLE ELEC/PNEUM VAD REP,,,28,,NW,,,,,,$457.68,$0.00,1,1,1,0,0,1,20171001, Q0487,HCPCS,"LEADS ANY TYPE VAD, REP ONLY",,,28,,NW,,,,,,$535.04,$0.00,1,1,1,0,0,1,20171001, Q0488,HCPCS,"PWR PACK BASE ELEC VAD, REP",,,28,,NW,,,,,,"$24,415.53",$0.00,1,1,1,0,0,1,20171001, Q0489,HCPCS,"PWR PCK BASE COMBO VAD, REP",,,28,,NW,,,,,,"$25,777.85",$0.00,1,1,1,0,0,1,20171001, Q0490,HCPCS,"EMR PWR SOURCE ELEC VAD, REP",,,28,,NW,,,,,,"$1,108.89",$0.00,1,1,1,0,0,1,20171001, Q0491,HCPCS,EMR PWR SOURCE COMBO VAD REP,,,28,,NW,,,,,,"$1,746.94",$0.00,1,1,1,0,0,1,20171001, Q0492,HCPCS,"EMR PWR CBL ELEC VAD, REP",,,28,,NW,,,,,,$134.84,$0.00,1,1,1,0,0,1,20171001, Q0493,HCPCS,"EMR PWR CBL COMBO VAD, REP",,,28,,NW,,,,,,$395.78,$0.00,1,1,1,0,0,1,20171001, Q0494,HCPCS,"EMR HD PMP ELEC/COMBO, REP",,,28,,NW,,,,,,$333.93,$0.00,1,1,1,0,0,1,20171001, Q0495,HCPCS,"CHARGER ELEC/COMBO VAD, REP",,,28,,NW,,,,,,"$6,619.48",$0.00,1,1,1,0,0,1,20171001, Q0496,HCPCS,"BATTERY ELEC/COMBO VAD, REP",,,28,,NW,,,,,,"$2,371.72",$0.00,1,1,1,0,0,1,20171001, Q0497,HCPCS,"BAT CLPS ELEC/COMB VAD, REP",,,28,,NW,,,,,,$736.16,$0.00,1,1,1,0,0,1,20171001, Q0498,HCPCS,"HOLSTER ELEC/COMBO VAD, REP",,,28,,NW,,,,,,$808.36,$0.00,1,1,1,0,0,1,20171001, Q0499,HCPCS,BELT/VEST ELEC/COMBO VAD REP,,,28,,NW,,,,,,$258.30,$0.00,1,1,1,0,0,1,20171001, Q0500,HCPCS,"FILTERS ELEC/COMBO VAD, REP",,,28,,NW,,,,,,$44.97,$0.00,1,1,1,0,0,1,20171001, Q0501,HCPCS,"SHWR COV ELEC/COMBO VAD, REP",,,28,,NW,,,,,,$803.66,$0.00,1,1,1,0,0,1,20171001, Q0502,HCPCS,"MOBILITY CART PNEUM VAD, REP",,,28,,NW,,,,,,"$1,024.92",$0.00,1,1,1,0,0,1,20171001, Q0503,HCPCS,BATTERY PNEUM VAD REPLACEMNT,,,28,,NW,,,,,,"$2,056.30",$0.00,1,1,1,0,0,1,20171001, Q0504,HCPCS,"PWR ADPT PNEUM VAD, REP VEH",,,28,,NW,,,,,,"$1,082.02",$0.00,1,1,1,0,0,1,20171001, Q0506,HCPCS,LITH-ION BATT ELEC/PNEUM VAD,,,28,,NW,,,,,,"$1,348.44",$0.00,1,1,1,0,0,1,20171001, Q0507,HCPCS,MISC SUP/ACC EXT VAD,,,28,,NW,,,,,,$324.96,$0.00,1,1,1,0,0,1,20171001, Q0508,HCPCS,MIS SUP/ACC IMP VAD,,,28,,NW,,,,,,$15.60,$0.00,1,1,1,0,0,1,20171001, Q0509,HCPCS,MIS SUP/AC IMP VAD NOPAY MED,,,28,,NW,,,,,,$192.47,$0.00,1,1,1,0,0,1,20171001, Q0510,HCPCS,DISPENS FEE IMMUNOSUPRESSIVE,,,29,,NW,,,,,,$80.75,$0.00,1,1,1,0,0,1,20171001, Q0511,HCPCS,"SUP FEE ANTIEM,ANTICA,IMMUNO",,,29,,NW,,,,,,$38.76,$0.00,1,1,1,0,0,1,20171001, Q0512,HCPCS,PX SUP FEE ANTI-CAN SUB PRES,,,29,,NW,,,,,,$25.84,$0.00,1,1,1,0,0,1,20171001, Q0513,HCPCS,DISP FEE INHAL DRUGS/30 DAYS,,,29,,NW,,,,,,$53.29,$0.00,1,1,1,0,0,1,20171001, Q0514,HCPCS,DISP FEE INHAL DRUGS/90 DAYS,,,29,,NW,,,,,,$106.59,$0.00,1,1,1,0,0,1,20171001, Q0515,HCPCS,SERMORELIN ACETATE INJECTION,,,29,,NW,,,,,,$12.11,$0.00,1,1,1,0,0,1,20171001, Q2004,HCPCS,BLADDER CALCULI IRRIG SOL,,,29,,NW,,,,,,$43.48,$0.00,1,1,1,0,0,1,20171001, Q2009,HCPCS,FOSPHENYTOIN INJ PE,,,29,,NW,,,,,,$15.33,$0.00,1,1,1,0,0,1,20171001, Q2017,HCPCS,"TENIPOSIDE, 50 MG",,,29,,NW,,,,,,$882.49,$0.00,1,1,1,0,0,1,20171001, Q2026,HCPCS,RADIESSE INJECTION,,,14,,TotalUnits,,,,3.77 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q2028,HCPCS,"INJ, SCULPTRA, 0.5MG",,,14,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q2034,HCPCS,AGRIFLU VACCINE,,,29,,NW,,,,,,$40.82,$0.00,1,1,1,0,1,1,20171001, Q2035,HCPCS,"AFLURIA VACC, 3 YRS & >, IM",,,9,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q2036,HCPCS,"FLULAVAL VACC, 3 YRS & >, IM",,,9,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q2037,HCPCS,"FLUVIRIN VACC, 3 YRS & >, IM",,,9,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q2038,HCPCS,"FLUZONE VACC, 3 YRS & >, IM",,,9,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q2039,HCPCS,"NOS FLU VACC, 3 YRS & >, IM",,,9,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, Q2043,HCPCS,SIPULEUCEL-T AUTO CD54+,,,29,,NW,,,,,,"$86,156.27",$0.00,1,1,1,0,0,1,20171001, Q2049,HCPCS,IMPORTED LIPODOX INJ,,,29,,NW,,,,,,"$1,539.48",$0.00,1,1,1,0,0,1,20171001, Q2050,HCPCS,DOXORUBICIN INJ 10MG,,,29,,NW,,,,,,"$1,455.80",$0.00,1,1,1,0,0,1,20171001, Q3001,HCPCS,BRACHYTHERAPY RADIOELEMENTS,,,28,,NW,,,,,,$101.51,$0.00,1,1,1,0,0,1,20171001, Q3014,HCPCS,TELEHEALTH FACILITY FEE,,,14,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,0,0,20171001, Q3027,HCPCS,INJ BETA INTERFERON IM 1 MCG,,,29,,NW,,,,,,$106.22,$0.00,1,1,1,0,0,1,20171001, Q3028,HCPCS,INJ BETA INTERFERON SQ 1 MCG,,,29,,NW,,,,,,$17.34,$0.00,1,1,1,0,0,1,20171001, Q4001,HCPCS,CAST SUP BODY CAST PLASTER,,,28,,NW,,,,,,$83.71,$0.00,1,1,1,0,0,1,20171001, Q4002,HCPCS,CAST SUP BODY CAST FIBERGLAS,,,28,,NW,,,,,,$313.06,$0.00,1,1,1,0,0,1,20171001, Q4003,HCPCS,CAST SUP SHOULDER CAST PLSTR,,,28,,NW,,,,,,$60.43,$0.00,1,1,1,0,0,1,20171001, Q4004,HCPCS,CAST SUP SHOULDER CAST FBRGL,,,28,,NW,,,,,,$206.35,$0.00,1,1,1,0,0,1,20171001, Q4005,HCPCS,CAST SUP LONG ARM ADULT PLST,,,28,,NW,,,,,,$23.02,$0.00,1,1,1,0,0,1,20171001, Q4006,HCPCS,CAST SUP LONG ARM ADULT FBRG,,,28,,NW,,,,,,$50.40,$0.00,1,1,1,0,0,1,20171001, Q4007,HCPCS,CAST SUP LONG ARM PED PLSTER,,,28,,NW,,,,,,$12.10,$0.00,1,1,1,0,0,1,20171001, Q4008,HCPCS,CAST SUP LONG ARM PED FBRGLS,,,28,,NW,,,,,,$25.76,$0.00,1,1,1,0,0,1,20171001, Q4009,HCPCS,CAST SUP SHT ARM ADULT PLSTR,,,28,,NW,,,,,,$15.77,$0.00,1,1,1,0,0,1,20171001, Q4010,HCPCS,CAST SUP SHT ARM ADULT FBRGL,,,28,,NW,,,,,,$34.00,$0.00,1,1,1,0,0,1,20171001, Q4011,HCPCS,CAST SUP SHT ARM PED PLASTER,,,28,,NW,,,,,,$8.43,$0.00,1,1,1,0,0,1,20171001, Q4012,HCPCS,CAST SUP SHT ARM PED FBRGLAS,,,28,,NW,,,,,,$17.59,$0.00,1,1,1,0,0,1,20171001, Q4013,HCPCS,CAST SUP GAUNTLET PLASTER,,,28,,NW,,,,,,$27.73,$0.00,1,1,1,0,0,1,20171001, Q4014,HCPCS,CAST SUP GAUNTLET FIBERGLASS,,,28,,NW,,,,,,$45.95,$0.00,1,1,1,0,0,1,20171001, Q4015,HCPCS,CAST SUP GAUNTLET PED PLSTER,,,28,,NW,,,,,,$14.47,$0.00,1,1,1,0,0,1,20171001, Q4016,HCPCS,CAST SUP GAUNTLET PED FBRGLS,,,28,,NW,,,,,,$23.55,$0.00,1,1,1,0,0,1,20171001, Q4017,HCPCS,CAST SUP LNG ARM SPLINT PLST,,,28,,NW,,,,,,$16.52,$0.00,1,1,1,0,0,1,20171001, Q4018,HCPCS,CAST SUP LNG ARM SPLINT FBRG,,,28,,NW,,,,,,$25.63,$0.00,1,1,1,0,0,1,20171001, Q4019,HCPCS,CAST SUP LNG ARM SPLNT PED P,,,28,,NW,,,,,,$8.85,$0.00,1,1,1,0,0,1,20171001, Q4020,HCPCS,CAST SUP LNG ARM SPLNT PED F,,,28,,NW,,,,,,$13.43,$0.00,1,1,1,0,0,1,20171001, Q4021,HCPCS,CAST SUP SHT ARM SPLINT PLST,,,28,,NW,,,,,,$12.52,$0.00,1,1,1,0,0,1,20171001, Q4022,HCPCS,CAST SUP SHT ARM SPLINT FBRG,,,28,,NW,,,,,,$21.67,$0.00,1,1,1,0,0,1,20171001, Q4023,HCPCS,CAST SUP SHT ARM SPLNT PED P,,,28,,NW,,,,,,$6.88,$0.00,1,1,1,0,0,1,20171001, Q4024,HCPCS,CAST SUP SHT ARM SPLNT PED F,,,28,,NW,,,,,,$11.43,$0.00,1,1,1,0,0,1,20171001, Q4025,HCPCS,CAST SUP HIP SPICA PLASTER,,,28,,NW,,,,,,$64.87,$0.00,1,1,1,0,0,1,20171001, Q4026,HCPCS,CAST SUP HIP SPICA FIBERGLAS,,,28,,NW,,,,,,$200.11,$0.00,1,1,1,0,0,1,20171001, Q4027,HCPCS,CAST SUP HIP SPICA PED PLSTR,,,28,,NW,,,,,,$33.03,$0.00,1,1,1,0,0,1,20171001, Q4028,HCPCS,CAST SUP HIP SPICA PED FBRGL,,,28,,NW,,,,,,$100.68,$0.00,1,1,1,0,0,1,20171001, Q4029,HCPCS,CAST SUP LONG LEG PLASTER,,,28,,NW,,,,,,$49.89,$0.00,1,1,1,0,0,1,20171001, Q4030,HCPCS,CAST SUP LONG LEG FIBERGLASS,,,28,,NW,,,,,,$129.43,$0.00,1,1,1,0,0,1,20171001, Q4031,HCPCS,CAST SUP LNG LEG PED PLASTER,,,28,,NW,,,,,,$25.51,$0.00,1,1,1,0,0,1,20171001, Q4032,HCPCS,CAST SUP LNG LEG PED FBRGLS,,,28,,NW,,,,,,$65.30,$0.00,1,1,1,0,0,1,20171001, Q4033,HCPCS,CAST SUP LNG LEG CYLINDER PL,,,28,,NW,,,,,,$46.61,$0.00,1,1,1,0,0,1,20171001, Q4034,HCPCS,CAST SUP LNG LEG CYLINDER FB,,,28,,NW,,,,,,$114.20,$0.00,1,1,1,0,0,1,20171001, Q4035,HCPCS,CAST SUP LNGLEG CYLNDR PED P,,,28,,NW,,,,,,$23.89,$0.00,1,1,1,0,0,1,20171001, Q4036,HCPCS,CAST SUP LNGLEG CYLNDR PED F,,,28,,NW,,,,,,$57.70,$0.00,1,1,1,0,0,1,20171001, Q4037,HCPCS,CAST SUP SHRT LEG PLASTER,,,28,,NW,,,,,,$28.87,$0.00,1,1,1,0,0,1,20171001, Q4038,HCPCS,CAST SUP SHRT LEG FIBERGLASS,,,28,,NW,,,,,,$70.62,$0.00,1,1,1,0,0,1,20171001, Q4039,HCPCS,CAST SUP SHRT LEG PED PLSTER,,,28,,NW,,,,,,$15.05,$0.00,1,1,1,0,0,1,20171001, Q4040,HCPCS,CAST SUP SHRT LEG PED FBRGLS,,,28,,NW,,,,,,$35.88,$0.00,1,1,1,0,0,1,20171001, Q4041,HCPCS,CAST SUP LNG LEG SPLNT PLSTR,,,28,,NW,,,,,,$34.87,$0.00,1,1,1,0,0,1,20171001, Q4042,HCPCS,CAST SUP LNG LEG SPLNT FBRGL,,,28,,NW,,,,,,$58.71,$0.00,1,1,1,0,0,1,20171001, Q4043,HCPCS,CAST SUP LNG LEG SPLNT PED P,,,28,,NW,,,,,,$18.03,$0.00,1,1,1,0,0,1,20171001, Q4044,HCPCS,CAST SUP LNG LEG SPLNT PED F,,,28,,NW,,,,,,$29.94,$0.00,1,1,1,0,0,1,20171001, Q4045,HCPCS,CAST SUP SHT LEG SPLNT PLSTR,,,28,,NW,,,,,,$20.73,$0.00,1,1,1,0,0,1,20171001, Q4046,HCPCS,CAST SUP SHT LEG SPLNT FBRGL,,,28,,NW,,,,,,$32.64,$0.00,1,1,1,0,0,1,20171001, Q4047,HCPCS,CAST SUP SHT LEG SPLNT PED P,,,28,,NW,,,,,,$10.92,$0.00,1,1,1,0,0,1,20171001, Q4048,HCPCS,CAST SUP SHT LEG SPLNT PED F,,,28,,NW,,,,,,$16.91,$0.00,1,1,1,0,0,1,20171001, Q4049,HCPCS,"FINGER SPLINT, STATIC",,,28,,NW,,,,,,$4.73,$0.00,1,1,1,0,0,1,20171001, Q4050,HCPCS,CAST SUPPLIES UNLISTED,,,28,,NW,,,,,,$36.28,$0.00,1,1,1,0,0,1,20171001, Q4051,HCPCS,SPLINT SUPPLIES MISC,,,28,,NW,,,,,,$34.89,$0.00,1,1,1,0,0,1,20171001, Q4074,HCPCS,ILOPROST NON-COMP UNIT DOSE,,,29,,NW,,,,,,$263.87,$0.00,1,1,1,0,0,1,20171001, Q4081,HCPCS,"EPOETIN ALFA, 100 UNITS ESRD",,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, Q4082,HCPCS,DRUG/BIO NOC PART B DRUG CAP,,,29,,NW,,,,,,"$3,129.60",$0.00,1,1,1,0,0,1,20171001, Q4100,HCPCS,"SKIN SUBSTITUTE, NOS",,,29,,NW,,,,,,"$2,211.52",$0.00,1,1,1,0,0,1,20171001, Q4101,HCPCS,APLIGRAF,,,29,,NW,,,,,,$78.87,$0.00,1,1,1,0,0,1,20171001, Q4102,HCPCS,OASIS WOUND MATRIX,,,29,,NW,,,,,,$32.22,$0.00,1,1,1,0,0,1,20171001, Q4103,HCPCS,OASIS BURN MATRIX,,,29,,NW,,,,,,$32.22,$0.00,1,1,1,0,0,1,20171001, Q4104,HCPCS,INTEGRA BMWD,,,29,,NW,,,,,,$86.11,$0.00,1,1,1,0,0,1,20171001, Q4105,HCPCS,INTEGRA DRT OR OMNIGRAFT,,,29,,NW,,,,,,$66.01,$0.00,1,1,1,0,0,1,20171001, Q4106,HCPCS,DERMAGRAFT,,,29,,NW,,,,,,$82.90,$0.00,1,1,1,0,0,1,20171001, Q4107,HCPCS,GRAFTJACKET,,,29,,NW,,,,,,$225.27,$0.00,1,1,1,0,0,1,20171001, Q4108,HCPCS,INTEGRA MATRIX,,,29,,NW,,,,,,$80.48,$0.00,1,1,1,0,0,1,20171001, Q4110,HCPCS,PRIMATRIX,,,29,,NW,,,,,,$92.55,$0.00,1,1,1,0,0,1,20171001, Q4111,HCPCS,GAMMAGRAFT,,,29,,NW,,,,,,$24.98,$0.00,1,1,1,0,0,1,20171001, Q4112,HCPCS,CYMETRA INJECTABLE,,,29,,NW,,,,,,$578.37,$0.00,1,1,1,0,0,1,20171001, Q4113,HCPCS,GRAFTJACKET XPRESS,,,29,,NW,,,,,,$578.37,$0.00,1,1,1,0,0,1,20171001, Q4114,HCPCS,INTEGRA FLOWABLE WOUND MATRI,,,29,,NW,,,,,,"$3,408.03",$0.00,1,1,1,0,0,1,20171001, Q4115,HCPCS,ALLOSKIN,,,29,,NW,,,,,,$41.88,$0.00,1,1,1,0,0,1,20171001, Q4116,HCPCS,ALLODERM,,,29,,NW,,,,,,$81.29,$0.00,1,1,1,0,0,1,20171001, Q4118,HCPCS,MATRISTEM MICROMATRIX,,,29,,NW,,,,,,$7.60,$0.00,1,1,1,0,0,1,20171001, Q4121,HCPCS,THERASKIN,,,29,,NW,,,,,,$98.18,$0.00,1,1,1,0,0,1,20171001, Q4122,HCPCS,DERMACELL,,,29,,NW,,,,,,"$1,978.01",$0.00,1,1,1,0,0,1,20171001, Q4123,HCPCS,ALLOSKIN,,,29,,NW,,,,,,$37.05,$0.00,1,1,1,0,0,1,20171001, Q4125,HCPCS,ARTHROFLEX,,,29,,NW,,,,,,"$2,632.09",$0.00,1,1,1,0,0,1,20171001, Q4126,HCPCS,MEMODERM/DERMA/TRANZ/INTEGUP,,,29,,NW,,,,,,$408.39,$0.00,1,1,1,0,0,1,20171001, Q4127,HCPCS,TALYMED,,,29,,NW,,,,,,$3.06,$0.00,1,1,1,0,0,1,20171001, Q4128,HCPCS,FLEXHD/ALLOPATCHHD/MATRIXHD,,,29,,NW,,,,,,$321.31,$0.00,1,1,1,0,0,1,20171001, Q4130,HCPCS,STRATTICE TM,,,29,,NW,,,,,,"$19,828.73",$0.00,1,1,1,0,0,1,20171001, Q4131,HCPCS,EPIFIX OR EPICORD,,,29,,NW,,,,,,$411.87,$0.00,1,1,1,0,0,1,20171001, Q4132,HCPCS,GRAFIX CORE,,,29,,NW,,,,,,"$3,327.89",$0.00,1,1,1,0,0,1,20171001, Q4133,HCPCS,GRAFIX PRIME,,,29,,NW,,,,,,"$3,173.12",$0.00,1,1,1,0,0,1,20171001, Q4134,HCPCS,HMATRIX,,,29,,NW,,,,,,"$4,244.80",$0.00,1,1,1,0,0,1,20171001, Q4137,HCPCS,"AMNIOEXCEL OR BIODEXCEL, 1CM",,,29,,NW,,,,,,"$1,281.32",$0.00,1,1,1,0,0,1,20171001, Q4139,HCPCS,"AMNIO OR BIODMATRIX, INJ 1CC",,,29,,NW,,,,,,"$3,279.00",$0.00,1,1,1,0,0,1,20171001, Q4140,HCPCS,BIODFENCE 1CM,,,29,,NW,,,,,,"$4,091.18",$0.00,1,1,1,0,0,1,20171001, Q4141,HCPCS,"ALLOSKIN AC, 1 CM",,,29,,NW,,,,,,$28.97,$0.00,1,1,1,0,0,1,20171001, Q4142,HCPCS,XCM BIOLOGIC TISS MATRIX 1CM,,,29,,NW,,,,,,"$2,856.63",$0.00,1,1,1,0,0,1,20171001, Q4145,HCPCS,"EPIFIX, INJ, 1MG",,,29,,NW,,,,,,$61.58,$0.00,1,1,1,0,0,1,20171001, Q4146,HCPCS,"TENSIX, 1CM",,,29,,NW,,,,,,$224.59,$0.00,1,1,1,0,0,1,20171001, Q4147,HCPCS,ARCHITECT ECM PX FX 1 SQ CM,,,29,,NW,,,,,,"$3,917.87",$0.00,1,1,1,0,0,1,20171001, Q4148,HCPCS,"NEOX 1K, 1CM",,,29,,NW,,,,,,$249.32,$0.00,1,1,1,0,0,1,20171001, Q4155,HCPCS,NEOXFLO OR CLARIXFLO 1 MG,,,29,,NW,,,,,,$40.72,$0.00,1,1,1,0,0,1,20171001, Q4156,HCPCS,NEOX 100 1 SQUARE CM,,,29,,NW,,,,,,$241.71,$0.00,1,1,1,0,0,1,20171001, Q4172,HCPCS,PURAPLY OR PURAPLY AM,,,29,,NW,,,,,,$460.30,$0.00,1,1,1,0,0,1,20171001, Q5001,HCPCS,HOSPICE OR HOME HLTH IN HOME,,,14,,TotalUnits,,,,1.35 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, Q5002,HCPCS,HOSPICE/HOME HLTH IN ASST LV,,,14,,TotalUnits,,,,1.61 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, Q5003,HCPCS,HOSPICE IN LT/NON-SKILLED NF,,,14,,TotalUnits,,,,0.06 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, Q5004,HCPCS,HOSPICE IN SNF,,,14,,TotalUnits,,,,1.52 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, Q5005,HCPCS,"HOSPICE, INPATIENT HOSPITAL",,,14,,TotalUnits,,,,5.03 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, Q5006,HCPCS,HOSPICE IN HOSPICE FACILITY,,,14,,TotalUnits,,,,6.27 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, Q5010,HCPCS,HOSPICE HOME CARE IN HOSPICE,,,14,,TotalUnits,,,,6.27 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, Q5101,HCPCS,INJ FILGRASTIM GCSF BIOSIMIL,,,29,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20171001, Q9951,HCPCS,"LOCM >= 400 MG/ML IODINE,1ML",,,28,,NW,,,,,,$5.92,$0.00,1,1,1,0,0,1,20171001, Q9953,HCPCS,"INJ FE-BASED MR CONTRAST,1ML",,,28,,NW,,,,,,$44.40,$0.00,1,1,1,0,0,1,20171001, Q9954,HCPCS,"ORAL MR CONTRAST, 100 ML",,,28,,NW,,,,,,$14.84,$0.00,1,1,1,0,0,1,20171001, Q9955,HCPCS,"INJ PERFLEXANE LIP MICROS,ML",,,28,,NW,,,,,,$4.59,$0.00,1,1,1,0,0,1,20171001, Q9956,HCPCS,"INJ OCTAFLUOROPROPANE MIC,ML",,,28,,NW,,,,,,$111.00,$0.00,1,1,1,0,0,1,20171001, Q9957,HCPCS,"INJ PERFLUTREN LIP MICROS,ML",,,28,,NW,,,,,,$269.08,$0.00,1,1,1,0,0,1,20171001, Q9958,HCPCS,"HOCM <=149 MG/ML IODINE, 1ML",,,28,,NW,,,,,,$0.27,$0.00,1,1,1,0,0,1,20171001, Q9959,HCPCS,"HOCM 150-199MG/ML IODINE,1ML",,,28,,NW,,,,,,$0.58,$0.00,1,1,1,0,0,1,20171001, Q9960,HCPCS,"HOCM 200-249MG/ML IODINE,1ML",,,28,,NW,,,,,,$1.15,$0.00,1,1,1,0,0,1,20171001, Q9961,HCPCS,"HOCM 250-299MG/ML IODINE,1ML",,,28,,NW,,,,,,$1.69,$0.00,1,1,1,0,0,1,20171001, Q9962,HCPCS,"HOCM 300-349MG/ML IODINE,1ML",,,28,,NW,,,,,,$1.78,$0.00,1,1,1,0,0,1,20171001, Q9963,HCPCS,"HOCM 350-399MG/ML IODINE,1ML",,,28,,NW,,,,,,$2.26,$0.00,1,1,1,0,0,1,20171001, Q9964,HCPCS,"HOCM>= 400MG/ML IODINE, 1ML",,,28,,NW,,,,,,$2.72,$0.00,1,1,1,0,0,1,20171001, Q9965,HCPCS,"LOCM 100-199MG/ML IODINE,1ML",,,28,,NW,,,,,,$3.37,$0.00,1,1,1,0,0,1,20171001, Q9966,HCPCS,"LOCM 200-299MG/ML IODINE,1ML",,,28,,NW,,,,,,$3.37,$0.00,1,1,1,0,0,1,20171001, Q9967,HCPCS,"LOCM 300-399MG/ML IODINE,1ML",,,28,,NW,,,,,,$2.80,$0.00,1,1,1,0,0,1,20171001, Q9982,HCPCS,FLUTEMETAMOL F18 DIAGNOSTIC,,,29,,NW,,,,,,"$17,336.40",$0.00,1,1,1,0,0,1,20171001, Q9983,HCPCS,FLORBETABEN F18 DIAGNOSTIC,,,29,,NW,,,,,,"$6,276.10",$0.00,1,1,1,0,0,1,20171001, R0070,HCPCS,TRANSPORT PORTABLE X-RAY,,TC,20,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, R0075,HCPCS,TRANSPORT PORT X-RAY MULTIPL,,TC,20,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, R0076,HCPCS,TRANSPORT PORTABLE EKG,,,20,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, S0012,HCPCS,"BUTORPHANOL TARTRATE, NASAL",,,28,,NW,,,,,,$378.54,$0.00,1,1,1,0,0,1,20171001, S0014,HCPCS,"TACRINE HYDROCHLORIDE, 10 MG",,,28,,NW,,,,,,$12.96,$0.00,1,1,1,0,0,1,20171001, S0017,HCPCS,"INJECTION, AMINOCAPROIC ACID",,,28,,NW,,,,,,$31.72,$0.00,1,1,1,0,0,1,20171001, S0020,HCPCS,"INJECTION, BUPIVICAINE HYDRO",,,28,,NW,,,,,,$19.17,$0.00,1,1,1,0,0,1,20171001, S0021,HCPCS,"INJECTION, CEFOPERAZONE SOD",,,28,,NW,,,,,,$7.70,$0.00,1,1,1,0,0,1,20171001, S0023,HCPCS,"INJECTION, CIMETIDINE HYDROC",,,28,,NW,,,,,,$13.49,$0.00,1,1,1,0,0,1,20171001, S0028,HCPCS,"INJECTION, FAMOTIDINE, 20 MG",,,28,,NW,,,,,,$16.73,$0.00,1,1,1,0,0,1,20171001, S0030,HCPCS,"INJECTION, METRONIDAZOLE",,,28,,NW,,,,,,$49.87,$0.00,1,1,1,0,0,1,20171001, S0032,HCPCS,"INJECTION, NAFCILLIN SODIUM",,,28,,NW,,,,,,$115.52,$0.00,1,1,1,0,0,1,20171001, S0034,HCPCS,"INJECTION, OFLOXACIN, 400 MG",,,28,,NW,,,,,,$34.55,$0.00,1,1,1,0,0,1,20171001, S0039,HCPCS,"INJECTION, SULFAMETHOXAZOLE",,,28,,NW,,,,,,$18.19,$0.00,1,1,1,0,0,1,20171001, S0040,HCPCS,"INJECTION, TICARCILLIN DISOD",,,28,,NW,,,,,,$71.70,$0.00,1,1,1,0,0,1,20171001, S0073,HCPCS,"INJECTION, AZTREONAM, 500 MG",,,28,,NW,,,,,,$88.56,$0.00,1,1,1,0,0,1,20171001, S0074,HCPCS,"INJECTION, CEFOTETAN DISODIU",,,28,,NW,,,,,,$59.98,$0.00,1,1,1,0,0,1,20171001, S0077,HCPCS,"INJECTION, CLINDAMYCIN PHOSP",,,28,,NW,,,,,,$18.54,$0.00,1,1,1,0,0,1,20171001, S0078,HCPCS,"INJECTION, FOSPHENYTOIN SODI",,,28,,NW,,,,,,$868.52,$0.00,1,1,1,0,0,1,20171001, S0080,HCPCS,"INJECTION, PENTAMIDINE ISETH",,,28,,NW,,,,,,$337.63,$0.00,1,1,1,0,0,1,20171001, S0081,HCPCS,"INJECTION, PIPERACILLIN SODI",,,28,,NW,,,,,,$9.27,$0.00,1,1,1,0,0,1,20171001, S0088,HCPCS,IMATINIB 100 MG,,,28,,NW,,,,,,$113.83,$0.00,1,1,1,0,0,1,20171001, S0090,HCPCS,"SILDENAFIL CITRATE, 25 MG",,,28,,NW,,,,,,$83.81,$0.00,1,1,1,0,0,1,20171001, S0091,HCPCS,GRANISETRON 1MG,,,28,,NW,,,,,,$409.15,$0.00,1,1,1,0,0,1,20171001, S0092,HCPCS,HYDROMORPHONE 250 MG,,,28,,NW,,,,,,$509.33,$0.00,1,1,1,0,0,1,20171001, S0093,HCPCS,MORPHINE 500 MG,,,28,,NW,,,,,,$719.86,$0.00,1,1,1,0,0,1,20171001, S0104,HCPCS,"ZIDOVUDINE, ORAL, 100 MG",,,28,,NW,,,,,,$8.96,$0.00,1,1,1,0,0,1,20171001, S0106,HCPCS,BUPROPION HCL SR 60 TABLETS,,,28,,NW,,,,,,$538.79,$0.00,1,1,1,0,0,1,20171001, S0108,HCPCS,MERCAPTOPURINE 50 MG,,,28,,NW,,,,,,$18.59,$0.00,1,1,1,0,0,1,20171001, S0109,HCPCS,METHADONE ORAL 5MG,,,28,,NW,,,,,,$1.38,$0.00,1,1,1,0,0,1,20171001, S0119,HCPCS,ONDANSETRON 4 MG,,,28,,NW,,,,,,$48.59,$0.00,1,1,1,0,0,1,20171001, S0122,HCPCS,INJ MENOTROPINS 75 IU,,,28,,NW,,,,,,$346.06,$0.00,1,1,1,0,0,1,20171001, S0126,HCPCS,INJ FOLLITROPIN ALFA 75 IU,,,28,,NW,,,,,,$395.04,$0.00,1,1,1,0,0,1,20171001, S0128,HCPCS,INJ FOLLITROPIN BETA 75 IU,,,28,,NW,,,,,,$375.87,$0.00,1,1,1,0,0,1,20171001, S0132,HCPCS,INJ GANIRELIX ACETAT 250 MCG,,,28,,NW,,,,,,$520.46,$0.00,1,1,1,0,0,1,20171001, S0136,HCPCS,"CLOZAPINE, 25 MG",,,28,,NW,,,,,,$6.39,$0.00,1,1,1,0,0,1,20171001, S0137,HCPCS,"DIDANOSINE, 25 MG",,,28,,NW,,,,,,$17.29,$0.00,1,1,1,0,0,1,20171001, S0138,HCPCS,"FINASTERIDE, 5 MG",,,28,,NW,,,,,,$13.89,$0.00,1,1,1,0,0,1,20171001, S0139,HCPCS,"MINOXIDIL, 10 MG",,,28,,NW,,,,,,$5.50,$0.00,1,1,1,0,0,1,20171001, S0140,HCPCS,"SAQUINAVIR, 200 MG",,,28,,NW,,,,,,$9.27,$0.00,1,1,1,0,0,1,20171001, S0142,HCPCS,COLISTIMETHATE INH SOL MG,,,28,,NW,,,,,,$15.79,$0.00,1,1,1,0,0,1,20171001, S0145,HCPCS,PEG INTERFERON ALFA-2A/180,,,28,,NW,,,,,,$57.87,$0.00,1,1,1,0,0,1,20171001, S0148,HCPCS,PEG INTERFERON ALFA-2B/10,,,28,,NW,,,,,,$391.09,$0.00,1,1,1,0,0,1,20171001, S0155,HCPCS,EPOPROSTENOL DILUTANT,,,28,,NW,,,,,,$23.23,$0.00,1,1,1,0,0,1,20171001, S0156,HCPCS,"EXEMESTANE, 25 MG",,,28,,NW,,,,,,$41.44,$0.00,1,1,1,0,0,1,20171001, S0157,HCPCS,"BECAPLERMIN GEL 1%, 0.5 GM",,,28,,NW,,,,,,$86.65,$0.00,1,1,1,0,0,1,20171001, S0160,HCPCS,DEXTROAMPHETAMINE,,,28,,NW,,,,,,$1.95,$0.00,1,1,1,0,0,1,20171001, S0164,HCPCS,INJECTION PANTROPRAZOLE,,,28,,NW,,,,,,$63.89,$0.00,1,1,1,0,0,1,20171001, S0166,HCPCS,INJ OLANZAPINE 2.5MG,,,28,,NW,,,,,,$29.02,$0.00,1,1,1,0,0,1,20171001, S0170,HCPCS,ANASTROZOLE 1 MG,,,28,,NW,,,,,,$39.84,$0.00,1,1,1,0,0,1,20171001, S0171,HCPCS,BUMETANIDE 0.5 MG,,,28,,NW,,,,,,$5.86,$0.00,1,1,1,0,0,1,20171001, S0172,HCPCS,CHLORAMBUCIL 2 MG,,,28,,NW,,,,,,$10.91,$0.00,1,1,1,0,0,1,20171001, S0174,HCPCS,DOLASETRON 50 MG,,,28,,NW,,,,,,$255.20,$0.00,1,1,1,0,0,1,20171001, S0175,HCPCS,FLUTAMIDE 125 MG,,,28,,NW,,,,,,$10.56,$0.00,1,1,1,0,0,1,20171001, S0176,HCPCS,HYDROXYUREA 500 MG,,,28,,NW,,,,,,$5.63,$0.00,1,1,1,0,0,1,20171001, S0177,HCPCS,LEVAMISOLE 50 MG,,,28,,NW,,,,,,$24.53,$0.00,1,1,1,0,0,1,20171001, S0178,HCPCS,LOMUSTINE 10 MG,,,28,,NW,,,,,,$129.02,$0.00,1,1,1,0,0,1,20171001, S0179,HCPCS,MEGESTROL 20 MG,,,28,,NW,,,,,,$2.90,$0.00,1,1,1,0,0,1,20171001, S0182,HCPCS,"PROCARBAZINE, ORAL",,,28,,NW,,,,,,$254.44,$0.00,1,1,1,0,0,1,20171001, S0183,HCPCS,PROCHLORPERAZINE 5 MG,,,28,,NW,,,,,,$3.24,$0.00,1,1,1,0,0,1,20171001, S0187,HCPCS,TAMOXIFEN 10 MG,,,28,,NW,,,,,,$10.77,$0.00,1,1,1,0,0,1,20171001, S0189,HCPCS,TESTOSTERONE PELLET 75 MG,,,28,,NW,,,,,,$136.64,$0.00,1,1,1,0,0,1,20171001, S0190,HCPCS,"MIFEPRISTONE, ORAL, 200 MG",,,28,,NW,,,,,,$334.27,$0.00,1,1,1,0,0,1,20171001, S0191,HCPCS,"MISOPROSTOL, ORAL, 200 MCG",,,28,,NW,,,,,,$12.09,$0.00,1,1,1,0,0,1,20171001, S0199,HCPCS,MED ABORTION INC ALL EX DRUG,,,12,,TotalUnits,,,,4.65 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0201,HCPCS,PARTIAL HOSPITALIZATION SERV,,,14,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S0207,HCPCS,PARAMEDICINTERCEP NONHOSPALS,,,14,,TotalUnits,,,,7.09 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S0208,HCPCS,PARAMED INTRCEPT NONVOL,,,14,,TotalUnits,,,,4.56 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S0209,HCPCS,WC VAN MILEAGE PER MI,,,14,,TotalUnits,,,,0.03 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S0220,HCPCS,MEDICAL CONFERENCE BY PHYSIC,,,15,,TotalUnits,,,,2.81 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0221,HCPCS,"MEDICAL CONFERENCE, 60 MIN",,,15,,RBRVS,1.42 ,0.44 ,1.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0255,HCPCS,HOSPICE REFER VISIT NONMD,,,15,,RBRVS,0.48 ,0.11 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0257,HCPCS,END OF LIFE COUNSELING,,,15,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0260,HCPCS,H&P FOR SURGERY,,,15,,TotalUnits,,,,4.14 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0265,HCPCS,GENETIC COUNSEL 15 MINS,,,14,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0280,HCPCS,"MEDICAL HOME, INITIAL PLAN",,,14,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0281,HCPCS,"MEDICAL HOME, MAINTENANCE",,,14,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0302,HCPCS,COMPLETED EPSDT,,,18,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0315,HCPCS,DISEASE MANAGEMENT PROGRAM,,,14,,TotalUnits,,,,1.12 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0316,HCPCS,FOLLOW-UP/REASSESSMENT,,,14,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0317,HCPCS,DISEASE MGMT PER DIEM,,,14,,TotalUnits,,,,1.47 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0390,HCPCS,ROUT FOOT CARE PER VISIT,,,14,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0395,HCPCS,IMPRESSION CASTING FT,,,28,,NW,,,,,,$140.99,$0.00,1,1,1,0,0,1,20171001, S0400,HCPCS,GLOBAL ESWL KIDNEY,,,21,,RBRVS,9.64 ,6.13 ,17.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20171001, S0500,HCPCS,DISPOS CONT LENS,,,28,,NW,,,,,,$117.30,$0.00,1,1,1,1,1,1,20171001, S0504,HCPCS,SINGL PRSCRP LENS,,,28,,NW,,,,,,$152.51,$0.00,1,1,1,1,1,1,20171001, S0506,HCPCS,BIFOC PRSCP LENS,,,28,,NW,,,,,,$152.56,$0.00,1,1,1,1,1,1,20171001, S0508,HCPCS,TRIFOC PRSCRP LENS,,,28,,NW,,,,,,$106.47,$0.00,1,1,1,1,1,1,20171001, S0510,HCPCS,NON-PRSCRP LENS,,,28,,NW,,,,,,$66.41,$0.00,1,1,1,1,1,1,20171001, S0512,HCPCS,DAILY CONT LENS,,,28,,NW,,,,,,$85.65,$0.00,1,1,1,1,1,1,20171001, S0514,HCPCS,COLOR CONT LENS,,,28,,NW,,,,,,$211.67,$0.00,1,1,1,1,1,1,20171001, S0515,HCPCS,SCLERAL LENS LIQUID BANDAGE,,,28,,NW,,,,,,$421.44,$0.00,1,1,1,1,1,1,20171001, S0516,HCPCS,SAFETY FRAMES,,,28,,NW,,,,,,$109.64,$0.00,1,1,1,1,1,1,20171001, S0518,HCPCS,SUNGLASS FRAMES,,,28,,NW,,,,,,$87.07,$0.00,1,1,1,1,1,1,20171001, S0580,HCPCS,POLYCARB LENS,,,28,,NW,,,,,,$87.77,$0.00,1,1,1,1,1,1,20171001, S0581,HCPCS,NONSTND LENS,,,28,,NW,,,,,,$794.04,$0.00,1,1,1,1,1,1,20171001, S0592,HCPCS,COMP CONT LENS EVAL,,,23,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0595,HCPCS,NEW LENSES IN PTS OLD FRAME,,,28,,NW,,,,,,$8.14,$0.00,1,1,1,1,1,1,20171001, S0601,HCPCS,SCREENING PROCTOSCOPY,,,21,,RBRVS,0.55 ,0.38 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0610,HCPCS,ANNUAL GYNECOLOGICAL EXAMINA,,,18,,TotalUnits,,,,2.79 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0612,HCPCS,ANNUAL GYNECOLOGICAL EXAMINA,,,18,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0613,HCPCS,ANN BREAST EXAM,,,18,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0618,HCPCS,AUDIOMETRY FOR HEARING AID,,,8,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S0620,HCPCS,ROUTINE OPHTHALMOLOGICAL EXA,,,23,,TotalUnits,,,,1.25 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0621,HCPCS,ROUTINE OPHTHALMOLOGICAL EXA,,,23,,TotalUnits,,,,1.40 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0622,HCPCS,PHYS EXAM FOR COLLEGE,,,14,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0630,HCPCS,REMOVAL OF SUTURES,,,14,,TotalUnits,,,,2.57 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0800,HCPCS,LASER IN SITU KERATOMILEUSIS,,,14,,TotalUnits,,,,15.46 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0810,HCPCS,PHOTOREFRACTIVE KERATECTOMY,,,14,,TotalUnits,,,,16.09 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S0812,HCPCS,PHOTOTHERAP KERATECT,,,14,,RBRVS,0.92 ,0.64 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S1001,HCPCS,DELUXE ITEM,,,28,,NW,,,,,,$25.56,$0.00,1,1,1,1,1,1,20171001, S1002,HCPCS,CUSTOM ITEM,,,28,,NW,,,,,,$25.93,$0.00,1,1,1,1,1,1,20171001, S1015,HCPCS,IV TUBING EXTENSION SET,,,28,,NW,,,,,,$41.41,$0.00,1,1,1,0,0,1,20171001, S1016,HCPCS,NON-PVC INTRAVENOUS ADMINIST,,,28,,NW,,,,,,$58.12,$0.00,1,1,1,0,0,1,20171001, S1040,HCPCS,CRANIAL REMOLDING ORTHOSIS,,,28,,NW,,,,,,$446.48,$0.00,1,1,1,0,0,1,20171001, S2053,HCPCS,TRANSPLANTATION OF SMALL INT,,,21,,RBRVS,83.29 ,27.76 ,27.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2054,HCPCS,TRANSPLANTATION OF MULTIVISC,,,21,,RBRVS,61.68 ,22.96 ,22.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2055,HCPCS,HARVESTING OF DONOR MULTIVIS,,,21,,RBRVS,61.68 ,22.96 ,22.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2060,HCPCS,LOBAR LUNG TRANSPLANTATION,,,21,,RBRVS,40.94 ,20.19 ,20.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2065,HCPCS,SIMULT PANC KIDN TRANS,,,21,,RBRVS,61.68 ,22.96 ,22.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2068,HCPCS,BREAST DIEP OR SIEA FLAP,,,21,,TotalUnits,,,,211.74 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2070,HCPCS,CYSTO LASER TX URETERAL CALC,,,21,,RBRVS,6.87 ,3.46 ,3.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2080,HCPCS,LAUP,,,21,,RBRVS,9.63 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2083,HCPCS,ADJUSTMENT GASTRIC BAND,,,21,,TotalUnits,,,,2.31 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2095,HCPCS,TRANSCATH EMBOLIZ MICROSPHER,,,21,,RBRVS,18.11 ,6.24 ,6.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2102,HCPCS,ISLET CELL TISSUE TRANSPLANT,,,21,,TotalUnits,,,,48.84 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2115,HCPCS,PERIACETABULAR OSTEOTOMY,,,21,,RBRVS,21.87 ,12.02 ,12.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2120,HCPCS,LOW DENSITY LIPOPROTEIN(LDL),,,17,,TotalUnits,,,,41.06 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2140,HCPCS,CORD BLOOD HARVESTING,,,21,,TotalUnits,,,,1.86 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2142,HCPCS,CORD BLOOD-DERIVED STEM-CELL,,,21,,TotalUnits,,,,1.62 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2150,HCPCS,BMT HARV/TRANSPL 28D PKG,,,21,,RBRVS,2.24 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2202,HCPCS,ECHOSCLEROTHERAPY,,,14,,RBRVS,1.09 ,0.64 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2205,HCPCS,MINIMALLY INVASIVE DIRECT CO,,,21,,RBRVS,33.64 ,12.57 ,12.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2206,HCPCS,MINIMALLY INVASIVE DIRECT CO,,,21,,RBRVS,39.77 ,14.75 ,14.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2207,HCPCS,MINIMALLY INVASIVE DIRECT CO,,,21,,RBRVS,34.87 ,12.92 ,12.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2225,HCPCS,MYRINGOTOMY LASER-ASSIST,,,21,,RBRVS,1.35 ,1.56 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2230,HCPCS,IMPLANT SEMI-IMP HEAR,,,21,,TotalUnits,,,,15.48 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2235,HCPCS,IMPLANT AUDITORY BRAIN IMP,,,21,,RBRVS,0.73 ,8.52 ,8.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2260,HCPCS,INDUCED ABORTION 17-24 WEEKS,,,12,,RBRVS,5.90 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2265,HCPCS,INDUCED ABORTION 25-28 WKS,,,12,,RBRVS,5.90 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2266,HCPCS,INDUCED ABORTION 29-31 WKS,,,12,,RBRVS,5.90 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2267,HCPCS,INDUCED ABORTION 32 OR MORE,,,12,,RBRVS,5.90 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2300,HCPCS,"ARTHROSCOPY, SHOULDER, SURGI",,,21,,TotalUnits,,,,12.49 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2340,HCPCS,CHEMODENERVATION OF ABDUCTOR,,,21,,RBRVS,3.86 ,1.65 ,4.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2341,HCPCS,CHEMODENERV ADDUCT VOCAL,,,21,,RBRVS,3.86 ,1.65 ,4.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2342,HCPCS,NASAL ENDOSCOP PO DEBRID,,,21,,RBRVS,2.98 ,1.39 ,4.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2348,HCPCS,DECOMPRESS DISC RF LUMBAR,,,21,,RBRVS,8.88 ,4.30 ,4.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2350,HCPCS,"DISKECTOMY, ANTERIOR, WITH D",,,21,,RBRVS,22.75 ,11.08 ,11.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2351,HCPCS,"DISKECTOMY, ANTERIOR, WITH D",,,21,,RBRVS,3.28 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S2900,HCPCS,ROBOTIC SURGICAL SYSTEM,,,21,,TotalUnits,,,,17.16 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S3005,HCPCS,EVAL SELF-ASSESS DEPRESSION,,,16,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S3600,HCPCS,STAT LAB,,,17,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S3601,HCPCS,STAT LAB HOME/NF,,,17,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S3620,HCPCS,NEWBORN METABOLIC SCREENING,,,17,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, S3630,HCPCS,EOSINOPHIL BLOOD COUNT,,,17,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S3645,HCPCS,HIV-1 ANTIBODY TESTING OF OR,,,17,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S3650,HCPCS,"SALIVA TEST, HORMONE LEVEL;",,,17,,TotalUnits,,,,3.09 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S3652,HCPCS,"SALIVA TEST, HORMONE LEVEL;",,,17,,TotalUnits,,,,2.51 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S3655,HCPCS,ANTISPERM ANTIBODIES TEST,,,17,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S3900,HCPCS,SURFACE EMG,,,17,,TotalUnits,,,,1.27 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S4005,HCPCS,INTERIM LABOR FACILITY GLOBA,,,12,,TotalUnits,,,,13.24 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S4011,HCPCS,IVF PACKAGE,,,14,,TotalUnits,,,,66.38 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S4015,HCPCS,COMPLETE IVF NOS CASE RATE,,,14,,TotalUnits,,,,71.73 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S4016,HCPCS,FROZEN IVF CASE RATE,,,14,,TotalUnits,,,,20.87 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S4022,HCPCS,ASST OOCYTE FERT CASE RATE,,,14,,TotalUnits,,,,14.68 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S4035,HCPCS,STIMULATED IUI CASE RATE,,,14,,TotalUnits,,,,17.70 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S4040,HCPCS,MONIT STORE CRYO EMBRYO 30 D,,,14,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S4042,HCPCS,OVULATION MGMT PER CYCLE,,,14,,TotalUnits,,,,3.70 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S4981,HCPCS,INSERT LEVONORGESTREL IUS,,,14,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S4989,HCPCS,CONTRACEPT IUD,,,28,,NW,,,,,,$765.58,$0.00,1,1,1,1,1,1,20171001, S4990,HCPCS,NICOTINE PATCH LEGEND,,,28,,NW,,,,,,$33.15,$0.00,1,1,1,0,0,1,20171001, S4993,HCPCS,CONTRACEPTIVE PILLS FOR BC,,,28,,NW,,,,,,$35.96,$0.00,1,1,1,1,1,1,20171001, S4995,HCPCS,SMOKING CESSATION GUM,,,28,,NW,,,,,,$70.60,$0.00,1,1,1,0,0,1,20171001, S5000,HCPCS,"PRESCRIPTION DRUG, GENERIC",,,28,,NW,,,,,,$24.68,$0.00,1,1,1,0,0,1,20171001, S5001,HCPCS,"PRESCRIPTION DRUG,BRAND NAME",,,28,,NW,,,,,,$105.48,$0.00,1,1,1,0,0,1,20171001, S5010,HCPCS,5% DEXTROSE AND 0.45% SALINE,,,28,,NW,,,,,,$25.27,$0.00,1,1,1,0,0,1,20171001, S5012,HCPCS,5% DEXTROSE WITH POTASSIUM,,,28,,NW,,,,,,$87.87,$0.00,1,1,1,0,0,1,20171001, S5013,HCPCS,5%DEXTROSE/0.45%SALINE1000ML,,,28,,NW,,,,,,$24.51,$0.00,1,1,1,0,0,1,20171001, S5014,HCPCS,D5W/0.45NS W KCL AND MGS04,,,28,,NW,,,,,,$14.77,$0.00,1,1,1,0,0,1,20171001, S5035,HCPCS,HIT ROUTINE DEVICE MAINT,,,14,,RBRVS,0.18 ,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5100,HCPCS,ADULT DAYCARE SERVICES 15MIN,,,14,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5105,HCPCS,CENTERBASED DAY CARE PERDIEM,,,14,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5108,HCPCS,HOMECARE TRAIN PT 15 MIN,,,14,,RBRVS,0.45 ,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5109,HCPCS,HOMECARE TRAIN PT SESSION,,,14,,TotalUnits,,,,1.08 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5110,HCPCS,FAMILY HOMECARE TRAINING 15M,,,14,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5111,HCPCS,FAMILY HOMECARE TRAIN/SESSIO,,,14,,TotalUnits,,,,1.68 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5115,HCPCS,NONFAMILY HOMECARE TRAIN/15M,,,14,,TotalUnits,,,,1.68 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5116,HCPCS,NONFAMILY HC TRAIN/SESSION,,,14,,TotalUnits,,,,1.68 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5126,HCPCS,ATTENDANT CARE SERVICE /DIEM,,,14,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5136,HCPCS,ADULT COMPANIONCARE PER DIEM,,,14,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5140,HCPCS,ADULT FOSTER CARE PER DIEM,,,14,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5145,HCPCS,CHILD FOSTERCARE TH PER DIEM,,,14,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5151,HCPCS,UNSKILLED RESPITECARE /DIEM,,,14,,TotalUnits,,,,1.59 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5161,HCPCS,EMER RSPNS SYS SERV PERMONTH,,,14,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5180,HCPCS,HH RESPIRATORY THRPY IN EVAL,,,14,,TotalUnits,,,,1.47 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5181,HCPCS,HH RESPIRATORY THRPY NOS/DAY,,,14,,TotalUnits,,,,1.47 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5190,HCPCS,WELLNESS ASSESSMENT BY NONPH,,,14,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S5199,HCPCS,PERSONAL CARE ITEM NOS EACH,,,28,,NW,,,,,,$59.19,$0.00,1,1,1,0,0,1,20171001, S5497,HCPCS,HIT CATH CARE NOC,,,28,,NW,,,,,,$59.19,$0.00,1,1,1,1,1,1,20171001, S5498,HCPCS,HIT SIMPLE CATH CARE,,,28,,NW,,,,,,$42.79,$0.00,1,1,1,1,1,1,20171001, S5501,HCPCS,HIT COMPLEX CATH CARE,,,28,,NW,,,,,,$46.13,$0.00,1,1,1,1,1,1,20171001, S5502,HCPCS,HIT INTERIM CATH CARE,,,28,,NW,,,,,,$81.26,$0.00,1,1,1,1,1,1,20171001, S5517,HCPCS,HIT DECLOTTING KIT,,,28,,NW,,,,,,$93.95,$0.00,1,1,1,1,1,1,20171001, S5520,HCPCS,HIT PICC INSERT KIT,,,28,,NW,,,,,,$113.74,$0.00,1,1,1,1,1,1,20171001, S5521,HCPCS,HIT MIDLINE CATH INSERT KIT,,,28,,NW,,,,,,$168.21,$0.00,1,1,1,1,1,1,20171001, S5522,HCPCS,HIT PICC INSERT NO SUPP,,,14,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5523,HCPCS,HIP MIDLINE CATH INSERT KIT,,,14,,TotalUnits,,,,1.53 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S5550,HCPCS,INSULIN RAPID 5 U,,,28,,NW,,,,,,$0.16,$0.00,1,1,1,0,0,1,20171001, S5551,HCPCS,INSULIN MOST RAPID 5 U,,,28,,NW,,,,,,$0.16,$0.00,1,1,1,0,0,1,20171001, S5552,HCPCS,INSULIN INTERMED 5 U,,,28,,NW,,,,,,$0.16,$0.00,1,1,1,0,0,1,20171001, S5553,HCPCS,INSULIN LONG ACTING 5 U,,,28,,NW,,,,,,$0.16,$0.00,1,1,1,0,0,1,20171001, S5560,HCPCS,INSULIN REUSE PEN 1.5 ML,,,28,,NW,,,,,,$4.08,$0.00,1,1,1,1,1,1,20171001, S8030,HCPCS,TANTALUM RING APPLICATION,,,20,,RBRVS,9.46 ,7.66 ,7.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S8037,HCPCS,MRCP,,,20,,TotalUnits,,,,5.26 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S8040,HCPCS,TOPOGRAPHIC BRAIN MAPPING,,,14,,RBRVS,2.97 ,3.05 ,3.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20171001, S8080,HCPCS,SCINTIMAMMOGRAPHY,,,20,,TotalUnits,,,,3.57 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S8085,HCPCS,FLUORINE-18 FLUORODEOXYGLUCO,,,20,,TotalUnits,,,,2.91 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, S8092,HCPCS,ELECTRON BEAM COMPUTED TOMOG,,,20,,TotalUnits,,,,2.28 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, S8096,HCPCS,PORTABLE PEAK FLOW METER,,,28,,NW,,,,,,$61.58,$0.00,1,1,1,1,1,1,20171001, S8097,HCPCS,ASTHMA KIT,,,28,,NW,,,,,,$63.81,$0.00,1,1,1,0,0,1,20171001, S8100,HCPCS,SPACER WITHOUT MASK,,,28,,NW,,,,,,$63.48,$0.00,1,1,1,0,0,1,20171001, S8101,HCPCS,SPACER WITH MASK,,,28,,NW,,,,,,$207.01,$0.00,1,1,1,0,0,1,20171001, S8110,HCPCS,PEAK EXPIRATORY FLOW RATE (P,,,14,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S8130,HCPCS,INTERFERENTIAL STIM 2 CHAN,,,28,,NW,,,,,,"$5,794.54",$0.00,1,1,1,0,0,1,20171001, S8131,HCPCS,INTERFERENTIAL STIM 4 CHAN,,,28,,NW,,,,,,"$1,675.23",$0.00,1,1,1,0,0,1,20171001, S8185,HCPCS,FLUTTER DEVICE,,,28,,NW,,,,,,$81.30,$0.00,1,1,1,0,0,1,20171001, S8186,HCPCS,SWIVEL ADAPTOR,,,28,,NW,,,,,,$5.76,$0.00,1,1,1,0,0,1,20171001, S8189,HCPCS,TRACH SUPPLY NOC,,,28,,NW,,,,,,$59.19,$0.00,1,1,1,0,0,1,20171001, S8210,HCPCS,MUCUS TRAP,,,28,,NW,,,,,,$1.44,$0.00,1,1,1,0,0,1,20171001, S8265,HCPCS,HABERMAN FEEDER,,,28,,NW,,,,,,$75.15,$0.00,1,1,1,0,0,1,20171001, S8301,HCPCS,INFECT CONTROL SUPPLIES NOS,,,28,,NW,,,,,,$59.19,$0.00,1,1,1,0,0,1,20171001, S8415,HCPCS,SUPPLIES FOR HOME DELIVERY,,,28,,NW,,,,,,$177.12,$0.00,1,1,1,0,0,1,20171001, S8420,HCPCS,CUSTOM GRADIENT SLEEV/GLOV,,,28,,NW,,,,,,$129.05,$0.00,1,1,1,0,0,1,20171001, S8421,HCPCS,READY GRADIENT SLEEV/GLOV,,,28,,NW,,,,,,$59.19,$0.00,1,1,1,0,0,1,20171001, S8422,HCPCS,CUSTOM GRAD SLEEVE MED,,,28,,NW,,,,,,$165.55,$0.00,1,1,1,0,0,1,20171001, S8423,HCPCS,CUSTOM GRAD SLEEVE HEAVY,,,28,,NW,,,,,,$235.39,$0.00,1,1,1,0,0,1,20171001, S8424,HCPCS,READY GRADIENT SLEEVE,,,28,,NW,,,,,,$79.73,$0.00,1,1,1,0,0,1,20171001, S8425,HCPCS,CUSTOM GRAD GLOVE MED,,,28,,NW,,,,,,$116.30,$0.00,1,1,1,0,0,1,20171001, S8426,HCPCS,CUSTOM GRAD GLOVE HEAVY,,,28,,NW,,,,,,$144.50,$0.00,1,1,1,0,0,1,20171001, S8427,HCPCS,READY GRADIENT GLOVE,,,28,,NW,,,,,,$30.21,$0.00,1,1,1,0,0,1,20171001, S8428,HCPCS,READY GRADIENT GAUNTLET,,,28,,NW,,,,,,$81.06,$0.00,1,1,1,0,0,1,20171001, S8429,HCPCS,GRADIENT PRESSURE WRAP,,,28,,NW,,,,,,$105.44,$0.00,1,1,1,0,0,1,20171001, S8430,HCPCS,PADDING FOR COMPRSSN BDG,,,28,,NW,,,,,,$25.73,$0.00,1,1,1,0,0,1,20171001, S8431,HCPCS,COMPRESSION BANDAGE,,,28,,NW,,,,,,$18.23,$0.00,1,1,1,0,0,1,20171001, S8450,HCPCS,SPLINT DIGIT,,,28,,NW,,,,,,$36.36,$0.00,1,1,1,0,0,1,20171001, S8451,HCPCS,SPLINT WRIST OR ANKLE,,,28,,NW,,,,,,$51.72,$0.00,1,1,1,0,0,1,20171001, S8452,HCPCS,SPLINT ELBOW,,,28,,NW,,,,,,$45.53,$0.00,1,1,1,0,0,1,20171001, S8460,HCPCS,CAMISOLE POST-MAST,,,28,,NW,,,,,,$96.32,$0.00,1,1,1,0,0,1,20171001, S8490,HCPCS,100 INSULIN SYRINGES,,,28,,NW,,,,,,$1.44,$0.00,1,1,1,1,1,1,20171001, S8930,HCPCS,AURICULAR ELECTROSTIMULATION,,,14,,TotalUnits,,,,1.03 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S8940,HCPCS,HIPPOTHERAPY PER SESSION,,,19,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S8948,HCPCS,LOW-LEVEL LASER TRMT 15 MIN,,,14,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S8950,HCPCS,"COMPLEX LYMPHEDEMA THERAPY,",,,14,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S8990,HCPCS,PT OR MANIP FOR MAINT,,,19,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S8999,HCPCS,RESUSCITATION BAG,,,28,,NW,,,,,,$260.11,$0.00,1,1,1,0,0,1,20171001, S9001,HCPCS,HOME UTERINE MONITOR WITH OR,,,28,,NW,,,,,,$132.37,$0.00,1,1,1,0,0,1,20171001, S9024,HCPCS,PARANASAL SINUS ULTRASOUND,,,20,,TotalUnits,,,,2.17 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9034,HCPCS,ESWL FOR GALLSTONES,,,21,,RBRVS,9.64 ,6.13 ,17.10 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9061,HCPCS,MEDICAL SUPPLIES AND EQUIPME,,,28,,NW,,,,,,$76.96,$0.00,1,1,1,0,0,1,20171001, S9083,HCPCS,URGENT CARE CENTER GLOBAL,,,15,,TotalUnits,,,,2.28 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9088,HCPCS,SERVICES PROVIDED IN URGENT,,,15,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9090,HCPCS,VERTEBRAL AXIAL DECOMPRESSIO,,,14,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9097,HCPCS,HOME VISIT WOUND CARE,,,14,,TotalUnits,,,,1.15 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S9098,HCPCS,HOME PHOTOTHERAPY VISIT,,,14,,TotalUnits,,,,1.89 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S9117,HCPCS,BACK SCHOOL VISIT,,,14,,RBRVS,0.17 ,0.06 ,0.32 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9122,HCPCS,HOME HEALTH AIDE OR CERTIFIE,,,14,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S9123,HCPCS,NURSING CARE IN HOME RN,,,14,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S9124,HCPCS,"NURSING CARE, IN THE HOME; B",,,14,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S9125,HCPCS,"RESPITE CARE, IN THE HOME, P",,,14,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S9126,HCPCS,"HOSPICE CARE, IN THE HOME, P",,,14,,TotalUnits,,,,1.38 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S9127,HCPCS,"SOCIAL WORK VISIT, IN THE HO",,,14,,TotalUnits,,,,1.64 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9128,HCPCS,"SPEECH THERAPY, IN THE HOME,",,,14,,TotalUnits,,,,1.21 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9129,HCPCS,"OCCUPATIONAL THERAPY, IN THE",,,14,,TotalUnits,,,,1.19 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9131,HCPCS,PT IN THE HOME PER DIEM,,,14,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9140,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,,14,,TotalUnits,,,,1.36 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S9141,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,,14,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,1,1,1,20171001, S9145,HCPCS,INSULIN PUMP INITIATION,,,14,,TotalUnits,,,,3.81 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S9152,HCPCS,"SPEECH THERAPY, RE-EVAL",,,8,,TotalUnits,,,,2.94 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9208,HCPCS,HOME MGMT PRETERM LABOR,,,28,,NW,,,,,,$287.66,$0.00,1,1,1,1,1,1,20171001, S9211,HCPCS,HOME MGMT GEST HYPERTENSION,,,28,,NW,,,,,,$121.92,$0.00,1,1,1,1,1,1,20171001, S9212,HCPCS,HM POSTPAR HYPER PER DIEM,,,28,,NW,,,,,,$144.10,$0.00,1,1,1,1,1,1,20171001, S9213,HCPCS,HM PREECLAMP PER DIEM,,,28,,NW,,,,,,$284.43,$0.00,1,1,1,1,1,1,20171001, S9214,HCPCS,HM GEST DM PER DIEM,,,28,,NW,,,,,,$263.38,$0.00,1,1,1,1,1,1,20171001, S9325,HCPCS,HIT PAIN MGMT PER DIEM,,,28,,NW,,,,,,$146.93,$0.00,1,1,1,1,1,1,20171001, S9326,HCPCS,HIT CONT PAIN PER DIEM,,,28,,NW,,,,,,$208.61,$0.00,1,1,1,1,1,1,20171001, S9327,HCPCS,HIT INT PAIN PER DIEM,,,28,,NW,,,,,,$206.99,$0.00,1,1,1,1,1,1,20171001, S9328,HCPCS,HIT PAIN IMP PUMP DIEM,,,28,,NW,,,,,,$150.32,$0.00,1,1,1,1,1,1,20171001, S9329,HCPCS,HIT CHEMO PER DIEM,,,28,,NW,,,,,,$224.32,$0.00,1,1,1,1,1,1,20171001, S9330,HCPCS,HIT CONT CHEM DIEM,,,28,,NW,,,,,,$220.62,$0.00,1,1,1,1,1,1,20171001, S9331,HCPCS,HIT INTERMIT CHEMO DIEM,,,28,,NW,,,,,,$245.67,$0.00,1,1,1,1,1,1,20171001, S9335,HCPCS,HT HEMODIALYSIS DIEM,,,28,,NW,,,,,,$673.64,$0.00,1,1,1,1,1,1,20171001, S9336,HCPCS,HIT CONT ANTICOAG DIEM,,,28,,NW,,,,,,$210.99,$0.00,1,1,1,1,1,1,20171001, S9338,HCPCS,HIT IMMUNOTHERAPY DIEM,,,28,,NW,,,,,,$261.42,$0.00,1,1,1,1,1,1,20171001, S9339,HCPCS,HIT PERITON DIALYSIS DIEM,,,28,,NW,,,,,,$542.93,$0.00,1,1,1,1,1,1,20171001, S9340,HCPCS,HIT ENTERAL PER DIEM,,,28,,NW,,,,,,$87.19,$0.00,1,1,1,1,1,1,20171001, S9341,HCPCS,HIT ENTERAL GRAV DIEM,,,28,,NW,,,,,,$59.85,$0.00,1,1,1,1,1,1,20171001, S9342,HCPCS,HIT ENTERAL PUMP DIEM,,,28,,NW,,,,,,$64.29,$0.00,1,1,1,1,1,1,20171001, S9343,HCPCS,HIT ENTERAL BOLUS NURS,,,28,,NW,,,,,,$39.88,$0.00,1,1,1,1,1,1,20171001, S9345,HCPCS,HIT ANTI-HEMOPHIL DIEM,,,28,,NW,,,,,,$133.07,$0.00,1,1,1,1,1,1,20171001, S9346,HCPCS,HIT ALPHA-1-PROTEINAS DIEM,,,28,,NW,,,,,,$93.12,$0.00,1,1,1,1,1,1,20171001, S9347,HCPCS,HIT LONGTERM INFUSION DIEM,,,28,,NW,,,,,,$103.82,$0.00,1,1,1,1,1,1,20171001, S9348,HCPCS,HIT SYMPATHOMIM DIEM,,,28,,NW,,,,,,$230.32,$0.00,1,1,1,1,1,1,20171001, S9349,HCPCS,HIT TOCOLYSIS DIEM,,,28,,NW,,,,,,$332.21,$0.00,1,1,1,1,1,1,20171001, S9351,HCPCS,HIT CONT ANTIEMETIC DIEM,,,28,,NW,,,,,,$422.63,$0.00,1,1,1,1,1,1,20171001, S9353,HCPCS,HIT CONT INSULIN DIEM,,,28,,NW,,,,,,$577.88,$0.00,1,1,1,1,1,1,20171001, S9355,HCPCS,HIT CHELATION DIEM,,,28,,NW,,,,,,$172.58,$0.00,1,1,1,1,1,1,20171001, S9357,HCPCS,HIT ENZYME REPLACE DIEM,,,28,,NW,,,,,,$187.52,$0.00,1,1,1,1,1,1,20171001, S9359,HCPCS,HIT ANTI-TNF PER DIEM,,,28,,NW,,,,,,$343.18,$0.00,1,1,1,1,1,1,20171001, S9361,HCPCS,HIT DIURETIC INFUS DIEM,,,28,,NW,,,,,,$124.93,$0.00,1,1,1,1,1,1,20171001, S9363,HCPCS,HIT ANTI-SPASMOTIC DIEM,,,28,,NW,,,,,,$251.93,$0.00,1,1,1,1,1,1,20171001, S9364,HCPCS,HIT TPN TOTAL DIEM,,,28,,NW,,,,,,$392.81,$0.00,1,1,1,1,1,1,20171001, S9365,HCPCS,HIT TPN 1 LITER DIEM,,,28,,NW,,,,,,$452.72,$0.00,1,1,1,1,1,1,20171001, S9366,HCPCS,HIT TPN 2 LITER DIEM,,,28,,NW,,,,,,$552.46,$0.00,1,1,1,1,1,1,20171001, S9367,HCPCS,HIT TPN 3 LITER DIEM,,,28,,NW,,,,,,$615.14,$0.00,1,1,1,1,1,1,20171001, S9368,HCPCS,HIT TPN OVER 3L DIEM,,,28,,NW,,,,,,$788.07,$0.00,1,1,1,1,1,1,20171001, S9370,HCPCS,HT INJ ANTIEMETIC DIEM,,,28,,NW,,,,,,$159.64,$0.00,1,1,1,1,1,1,20171001, S9372,HCPCS,HT INJ ANTICOAG DIEM,,,28,,NW,,,,,,$108.25,$0.00,1,1,1,1,1,1,20171001, S9373,HCPCS,HIT HYDRA TOTAL DIEM,,,28,,NW,,,,,,$121.21,$0.00,1,1,1,1,1,1,20171001, S9374,HCPCS,HIT HYDRA 1 LITER DIEM,,,28,,NW,,,,,,$175.19,$0.00,1,1,1,1,1,1,20171001, S9375,HCPCS,HIT HYDRA 2 LITER DIEM,,,28,,NW,,,,,,$224.43,$0.00,1,1,1,1,1,1,20171001, S9376,HCPCS,HIT HYDRA 3 LITER DIEM,,,28,,NW,,,,,,$244.61,$0.00,1,1,1,1,1,1,20171001, S9377,HCPCS,HIT HYDRA OVER 3L DIEM,,,28,,NW,,,,,,$264.79,$0.00,1,1,1,1,1,1,20171001, S9379,HCPCS,HIT NOC PER DIEM,,,28,,NW,,,,,,$59.19,$0.00,1,1,1,1,1,1,20171001, S9401,HCPCS,ANTICOAG CLINIC PER SESSION,,,14,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9430,HCPCS,PHARMACY COMP/DISP SERV,,,14,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9433,HCPCS,MEDICAL FOOD ORAL 100% NUTR,,,28,,NW,,,,,,$37.46,$0.00,1,1,1,0,1,1,20171001, S9434,HCPCS,MOD SOLID FOOD SUPPL,,,28,,NW,,,,,,$57.33,$0.00,1,1,1,0,1,1,20171001, S9435,HCPCS,MEDICAL FOODS FOR INBORN ERR,,,28,,NW,,,,,,$36.10,$0.00,1,1,1,0,1,1,20171001, S9436,HCPCS,LAMAZE CLASS,,,14,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9441,HCPCS,ASTHMA EDUCATION,,,14,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9442,HCPCS,BIRTHING CLASS,,,14,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9443,HCPCS,LACTATION CLASS,,,14,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9449,HCPCS,WEIGHT MGMT CLASS,,,14,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9451,HCPCS,EXERCISE CLASS,,,14,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9452,HCPCS,NUTRITION CLASS,,,14,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9453,HCPCS,SMOKING CESSATION CLASS,,,14,,TotalUnits,,,,1.53 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9455,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,,14,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S9460,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,,14,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S9465,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,,14,,TotalUnits,,,,1.26 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, S9470,HCPCS,"NUTRITIONAL COUNSELING, DIET",,,14,,TotalUnits,,,,0.96 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, S9474,HCPCS,ENTEROSTOMAL THERAPY BY A RE,,,14,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, S9475,HCPCS,AMBULATORY SETTING SUBSTANCE,,,16,,TotalUnits,,,,1.79 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, S9480,HCPCS,INTENSIVE OUTPATIENT PSYCHIA,,,16,,TotalUnits,,,,2.14 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S9484,HCPCS,CRISIS INTERVENTION PER HOUR,,,16,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S9485,HCPCS,CRISIS INTERVENTION MENTAL H,,,16,,TotalUnits,,,,4.63 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, S9490,HCPCS,HIT CORTICOSTEROID/DIEM,,,28,,NW,,,,,,$271.57,$0.00,1,1,1,1,1,1,20171001, S9494,HCPCS,HIT ANTIBIOTIC TOTAL DIEM,,,28,,NW,,,,,,$216.73,$0.00,1,1,1,1,1,1,20171001, S9497,HCPCS,HIT ANTIBIOTIC Q3H DIEM,,,28,,NW,,,,,,$270.25,$0.00,1,1,1,1,1,1,20171001, S9500,HCPCS,HIT ANTIBIOTIC Q24H DIEM,,,28,,NW,,,,,,$310.20,$0.00,1,1,1,1,1,1,20171001, S9501,HCPCS,HIT ANTIBIOTIC Q12H DIEM,,,28,,NW,,,,,,$303.18,$0.00,1,1,1,1,1,1,20171001, S9502,HCPCS,HIT ANTIBIOTIC Q8H DIEM,,,28,,NW,,,,,,$378.38,$0.00,1,1,1,1,1,1,20171001, S9503,HCPCS,HIT ANTIBIOTIC Q6H DIEM,,,28,,NW,,,,,,$348.87,$0.00,1,1,1,1,1,1,20171001, S9504,HCPCS,HIT ANTIBIOTIC Q4H DIEM,,,28,,NW,,,,,,$321.67,$0.00,1,1,1,1,1,1,20171001, S9529,HCPCS,VENIPUNCTURE HOME/SNF,,,28,,NW,,,,,,$108.08,$0.00,1,1,1,0,1,1,20171001, S9537,HCPCS,HT HEM HORM INJ DIEM,,,28,,NW,,,,,,$89.99,$0.00,1,1,1,1,1,1,20171001, S9538,HCPCS,HIT BLOOD PRODUCTS DIEM,,,28,,NW,,,,,,$291.82,$0.00,1,1,1,1,1,1,20171001, S9542,HCPCS,HT INJ NOC PER DIEM,,,28,,NW,,,,,,$59.19,$0.00,1,1,1,1,1,1,20171001, S9558,HCPCS,HT INJ GROWTH HORM DIEM,,,28,,NW,,,,,,$39.10,$0.00,1,1,1,1,1,1,20171001, S9559,HCPCS,HIT INJ INTERFERON DIEM,,,28,,NW,,,,,,$367.46,$0.00,1,1,1,1,1,1,20171001, S9560,HCPCS,HT INJ HORMONE DIEM,,,28,,NW,,,,,,$100.07,$0.00,1,1,1,1,1,1,20171001, S9562,HCPCS,HT INJ PALIVIZUMAB DIEM,,,28,,NW,,,,,,$100.07,$0.00,1,1,1,1,1,1,20171001, S9590,HCPCS,HT IRRIGATION DIEM,,,28,,NW,,,,,,$143.61,$0.00,1,1,1,1,1,1,20171001, S9810,HCPCS,HT PHARM PER HOUR,,,28,,NW,,,,,,$85.12,$0.00,1,1,1,0,0,1,20171001, S9900,HCPCS,CHRISTIAN SCI PRACT VISIT,,,14,,TotalUnits,,,,0.08 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9970,HCPCS,HEALTH CLUB MEMBERSHIP YR,,,14,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9981,HCPCS,MED RECORD COPY ADMIN,,,14,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9986,HCPCS,NOT MEDICALLY NECESSARY SVC,,,14,,TotalUnits,,,,4.30 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9988,HCPCS,SERV PART OF PHASE I TRIAL,,,14,,TotalUnits,,,,0.06 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9990,HCPCS,SERVICES PROVIDED AS PART OF,,,14,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, S9999,HCPCS,SALES TAX,,,14,,TotalUnits,,,,1.05 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, T1000,HCPCS,PRIVATE DUTY/INDEPENDENT NSG,,,15,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T1001,HCPCS,NURSING ASSESSMENT/EVALUATN,,,15,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T1002,HCPCS,RN SERVICES UP TO 15 MINUTES,,,15,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T1003,HCPCS,LPN/LVN SERVICES UP TO 15MIN,,,15,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T1004,HCPCS,NSG AIDE SERVICE UP TO 15MIN,,,15,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T1005,HCPCS,RESPITE CARE SERVICE 15 MIN,,,15,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T1006,HCPCS,FAMILY/COUPLE COUNSELING,,,16,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, T1007,HCPCS,TREATMENT PLAN DEVELOPMENT,,,16,,TotalUnits,,,,3.02 ,,$0.00,$0.00,1,1,1,0,1,1,20171001, T1009,HCPCS,CHILD SITTING SERVICES,,,14,,TotalUnits,,,,0.06 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, T1012,HCPCS,ALCOHOL/SUBSTANCE ABUSE SKIL,,,16,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, T1013,HCPCS,SIGN LANG/ORAL INTERPRETER,,,14,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, T1015,HCPCS,CLINIC SERVICE,,,15,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, T1016,HCPCS,CASE MANAGEMENT,,,15,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, T1019,HCPCS,PERSONAL CARE SER PER 15 MIN,,,15,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T1020,HCPCS,PERSONAL CARE SER PER DIEM,,,15,,TotalUnits,,,,1.88 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T1021,HCPCS,HH AIDE OR CN AIDE PER VISIT,,,15,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T1023,HCPCS,PROGRAM INTAKE ASSESSMENT,,,15,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, T1024,HCPCS,TEAM EVALUATION & MANAGEMENT,,,15,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, T1026,HCPCS,"PED COMPR CARE PKG, PER HOUR",,,15,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, T1027,HCPCS,FAMILY TRAINING & COUNSELING,,,16,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, T1028,HCPCS,HOME ENVIRONMENT ASSESSMENT,,,16,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T1030,HCPCS,RN HOME CARE PER DIEM,,,15,,TotalUnits,,,,1.99 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, T1031,HCPCS,LPN HOME CARE PER DIEM,,,15,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, T1502,HCPCS,MEDICATION ADMIN VISIT,,,15,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, T2001,HCPCS,N-ET; PATIENT ATTEND/ESCORT,,,14,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T2002,HCPCS,N-ET; PER DIEM,,,14,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, T2003,HCPCS,N-ET; ENCOUNTER/TRIP,,,14,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T2004,HCPCS,N-ET; COMMERC CARRIER PASS,,,14,,TotalUnits,,,,0.07 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T2005,HCPCS,N-ET; STRETCHER VAN,,,14,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T2007,HCPCS,NON-EMER TRANSPORT WAIT TIME,,,14,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T2013,HCPCS,HABIL ED WAIVER PER HOUR,,,14,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, T2014,HCPCS,"HABIL PREVOC WAIVER, PER D",,,14,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, T2016,HCPCS,HABIL RES WAIVER PER DIEM,,,14,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, T2017,HCPCS,HABIL RES WAIVER 15 MIN,,,14,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, T2018,HCPCS,HABIL SUP EMPL WAIVER/DIEM,,,14,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, T2020,HCPCS,DAY HABIL WAIVER PER DIEM,,,14,,TotalUnits,,,,1.05 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, T2022,HCPCS,"CASE MANAGEMENT, PER MONTH",,,14,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, T2023,HCPCS,TARGETED CASE MGMT PER MONTH,,,14,,TotalUnits,,,,1.51 ,,$0.00,$0.00,1,0,1,1,1,1,20171001, T2025,HCPCS,"WAIVER SERVICE, NOS",,,14,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, T2031,HCPCS,ASSIST LIVING WAIVER/DIEM,,,14,,TotalUnits,,,,2.47 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T2032,HCPCS,"RES CARE, NOS WAIVER/MONTH",,,14,,TotalUnits,,,,2.48 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T2033,HCPCS,"RES, NOS WAIVER PER DIEM",,,14,,TotalUnits,,,,1.65 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T2040,HCPCS,FINANCIAL MGT WAIVER/15MIN,,,14,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T2042,HCPCS,HOSPICE ROUTINE HOME CARE,,,14,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T2043,HCPCS,HOSPICE CONTINUOUS HOME CARE,,,14,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T2045,HCPCS,HOSPICE GENERAL CARE,,,14,,TotalUnits,,,,5.70 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T2046,HCPCS,"HOSPICE LONG TERM CARE, R&B",,,14,,TotalUnits,,,,1.37 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T2048,HCPCS,"BH LTC RES R&B, PER DIEM",,,14,,TotalUnits,,,,1.67 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T2049,HCPCS,"N-ET; STRETCHER VAN, MILEAGE",,,14,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,1,1,1,20171001, T4521,HCPCS,ADULT SIZE BRIEF/DIAPER SM,,,28,,NW,,,,,,$1.52,$0.00,1,1,1,0,0,1,20171001, T4522,HCPCS,ADULT SIZE BRIEF/DIAPER MED,,,28,,NW,,,,,,$1.55,$0.00,1,1,1,0,0,1,20171001, T4523,HCPCS,ADULT SIZE BRIEF/DIAPER LG,,,28,,NW,,,,,,$1.67,$0.00,1,1,1,0,0,1,20171001, T4524,HCPCS,ADULT SIZE BRIEF/DIAPER XL,,,28,,NW,,,,,,$2.04,$0.00,1,1,1,0,0,1,20171001, T4525,HCPCS,ADULT SIZE PULL-ON SM,,,28,,NW,,,,,,$1.85,$0.00,1,1,1,0,0,1,20171001, T4526,HCPCS,ADULT SIZE PULL-ON MED,,,28,,NW,,,,,,$1.86,$0.00,1,1,1,0,0,1,20171001, T4527,HCPCS,ADULT SIZE PULL-ON LG,,,28,,NW,,,,,,$1.88,$0.00,1,1,1,0,0,1,20171001, T4528,HCPCS,ADULT SIZE PULL-ON XL,,,28,,NW,,,,,,$2.03,$0.00,1,1,1,0,0,1,20171001, T4529,HCPCS,PED SIZE BRIEF/DIAPER SM/MED,,,28,,NW,,,,,,$1.51,$0.00,1,1,1,0,0,1,20171001, T4530,HCPCS,PED SIZE BRIEF/DIAPER LG,,,28,,NW,,,,,,$1.73,$0.00,1,1,1,0,0,1,20171001, T4531,HCPCS,PED SIZE PULL-ON SM/MED,,,28,,NW,,,,,,$1.98,$0.00,1,1,1,0,0,1,20171001, T4532,HCPCS,PED SIZE PULL-ON LG,,,28,,NW,,,,,,$2.25,$0.00,1,1,1,0,0,1,20171001, T4533,HCPCS,YOUTH SIZE BRIEF/DIAPER,,,28,,NW,,,,,,$1.62,$0.00,1,1,1,0,0,1,20171001, T4534,HCPCS,YOUTH SIZE PULL-ON,,,28,,NW,,,,,,$2.00,$0.00,1,1,1,0,0,1,20171001, T4535,HCPCS,DISPOSABLE LINER/SHIELD/PAD,,,28,,NW,,,,,,$1.38,$0.00,1,1,1,0,0,1,20171001, T4536,HCPCS,REUSABLE PULL-ON ANY SIZE,,,28,,NW,,,,,,$1.58,$0.00,1,1,1,0,0,1,20171001, T4537,HCPCS,REUSABLE UNDERPAD BED SIZE,,,28,,NW,,,,,,$26.22,$0.00,1,1,1,0,0,1,20171001, T4539,HCPCS,REUSE DIAPER/BRIEF ANY SIZE,,,28,,NW,,,,,,$11.10,$0.00,1,1,1,0,0,1,20171001, T4540,HCPCS,REUSABLE UNDERPAD CHAIR SIZE,,,28,,NW,,,,,,$10.13,$0.00,1,1,1,0,0,1,20171001, T4541,HCPCS,LARGE DISPOSABLE UNDERPAD,,,28,,NW,,,,,,$1.31,$0.00,1,1,1,0,0,1,20171001, T4542,HCPCS,SMALL DISPOSABLE UNDERPAD,,,28,,NW,,,,,,$1.51,$0.00,1,1,1,0,0,1,20171001, T4543,HCPCS,ADULT DISP BRIEF/DIAP ABV XL,,,28,,NW,,,,,,$2.34,$0.00,1,1,1,0,0,1,20171001, T4544,HCPCS,ADLT DISP UND/PULL ON ABV XL,,,28,,NW,,,,,,$2.53,$0.00,1,1,1,0,0,1,20171001, T5001,HCPCS,POSITION SEAT SPEC ORTH NEED,,,28,,NW,,,,,,$774.28,$0.00,1,1,1,1,1,1,20171001, T5999,HCPCS,"SUPPLY, NOS",,,28,,NW,,,,,,$25.61,$0.00,1,1,1,0,0,1,20171001, V2020,HCPCS,VISION SVCS FRAMES PURCHASES,,,28,,NW,,,,,,$112.88,$0.00,1,1,1,1,1,1,20171001, V2025,HCPCS,EYEGLASSES DELUX FRAMES,,,28,,NW,,,,,,$107.82,$0.00,1,1,1,1,1,1,20171001, V2100,HCPCS,LENS SPHER SINGLE PLANO 4.00,,,28,,NW,,,,,,$76.91,$0.00,1,1,1,1,1,1,20171001, V2101,HCPCS,SINGLE VISN SPHERE 4.12-7.00,,,28,,NW,,,,,,$81.21,$0.00,1,1,1,1,1,1,20171001, V2102,HCPCS,SINGL VISN SPHERE 7.12-20.00,,,28,,NW,,,,,,$99.84,$0.00,1,1,1,1,1,1,20171001, V2103,HCPCS,SPHEROCYLINDR 4.00D/12-2.00D,,,28,,NW,,,,,,$70.59,$0.00,1,1,1,1,1,1,20171001, V2104,HCPCS,SPHEROCYLINDR 4.00D/2.12-4D,,,28,,NW,,,,,,$74.41,$0.00,1,1,1,1,1,1,20171001, V2105,HCPCS,SPHEROCYLINDER 4.00D/4.25-6D,,,28,,NW,,,,,,$79.51,$0.00,1,1,1,1,1,1,20171001, V2106,HCPCS,SPHEROCYLINDER 4.00D/>6.00D,,,28,,NW,,,,,,$85.36,$0.00,1,1,1,1,1,1,20171001, V2107,HCPCS,SPHEROCYLINDER 4.25D/12-2D,,,28,,NW,,,,,,$84.64,$0.00,1,1,1,1,1,1,20171001, V2108,HCPCS,SPHEROCYLINDER 4.25D/2.12-4D,,,28,,NW,,,,,,$84.56,$0.00,1,1,1,1,1,1,20171001, V2109,HCPCS,SPHEROCYLINDER 4.25D/4.25-6D,,,28,,NW,,,,,,$92.29,$0.00,1,1,1,1,1,1,20171001, V2110,HCPCS,SPHEROCYLINDER 4.25D/OVER 6D,,,28,,NW,,,,,,$89.96,$0.00,1,1,1,1,1,1,20171001, V2111,HCPCS,SPHEROCYLINDR 7.25D/.25-2.25,,,28,,NW,,,,,,$94.02,$0.00,1,1,1,1,1,1,20171001, V2112,HCPCS,SPHEROCYLINDR 7.25D/2.25-4D,,,28,,NW,,,,,,$100.26,$0.00,1,1,1,1,1,1,20171001, V2113,HCPCS,SPHEROCYLINDR 7.25D/4.25-6D,,,28,,NW,,,,,,$107.90,$0.00,1,1,1,1,1,1,20171001, V2114,HCPCS,SPHEROCYLINDER OVER 12.00D,,,28,,NW,,,,,,$114.40,$0.00,1,1,1,1,1,1,20171001, V2115,HCPCS,LENS LENTICULAR BIFOCAL,,,28,,NW,,,,,,$120.46,$0.00,1,1,1,1,1,1,20171001, V2118,HCPCS,LENS ANISEIKONIC SINGLE,,,28,,NW,,,,,,$121.40,$0.00,1,1,1,1,1,1,20171001, V2121,HCPCS,"LENTICULAR LENS, SINGLE",,,28,,NW,,,,,,$123.31,$0.00,1,1,1,1,1,1,20171001, V2199,HCPCS,LENS SINGLE VISION NOT OTH C,,,28,,NW,,,,,,$76.91,$0.00,1,1,1,1,1,1,20171001, V2200,HCPCS,LENS SPHER BIFOC PLANO 4.00D,,,28,,NW,,,,,,$91.56,$0.00,1,1,1,1,1,1,20171001, V2201,HCPCS,LENS SPHERE BIFOCAL 4.12-7.0,,,28,,NW,,,,,,$97.71,$0.00,1,1,1,1,1,1,20171001, V2202,HCPCS,LENS SPHERE BIFOCAL 7.12-20.,,,28,,NW,,,,,,$106.60,$0.00,1,1,1,1,1,1,20171001, V2203,HCPCS,LENS SPHCYL BIFOCAL 4.00D/.1,,,28,,NW,,,,,,$92.83,$0.00,1,1,1,1,1,1,20171001, V2204,HCPCS,LENS SPHCY BIFOCAL 4.00D/2.1,,,28,,NW,,,,,,$95.21,$0.00,1,1,1,1,1,1,20171001, V2205,HCPCS,LENS SPHCY BIFOCAL 4.00D/4.2,,,28,,NW,,,,,,$99.63,$0.00,1,1,1,1,1,1,20171001, V2206,HCPCS,LENS SPHCY BIFOCAL 4.00D/OVE,,,28,,NW,,,,,,$106.67,$0.00,1,1,1,1,1,1,20171001, V2207,HCPCS,LENS SPHCY BIFOCAL 4.25-7D/.,,,28,,NW,,,,,,$99.14,$0.00,1,1,1,1,1,1,20171001, V2208,HCPCS,LENS SPHCY BIFOCAL 4.25-7/2.,,,28,,NW,,,,,,$102.36,$0.00,1,1,1,1,1,1,20171001, V2209,HCPCS,LENS SPHCY BIFOCAL 4.25-7/4.,,,28,,NW,,,,,,$106.61,$0.00,1,1,1,1,1,1,20171001, V2210,HCPCS,LENS SPHCY BIFOCAL 4.25-7/OV,,,28,,NW,,,,,,$115.79,$0.00,1,1,1,1,1,1,20171001, V2211,HCPCS,LENS SPHCY BIFO 7.25-12/.25-,,,28,,NW,,,,,,$116.97,$0.00,1,1,1,1,1,1,20171001, V2212,HCPCS,LENS SPHCYL BIFO 7.25-12/2.2,,,28,,NW,,,,,,$119.47,$0.00,1,1,1,1,1,1,20171001, V2213,HCPCS,LENS SPHCYL BIFO 7.25-12/4.2,,,28,,NW,,,,,,$119.67,$0.00,1,1,1,1,1,1,20171001, V2214,HCPCS,LENS SPHCYL BIFOCAL OVER 12.,,,28,,NW,,,,,,$128.67,$0.00,1,1,1,1,1,1,20171001, V2215,HCPCS,LENS LENTICULAR BIFOCAL,,,28,,NW,,,,,,$137.17,$0.00,1,1,1,1,1,1,20171001, V2218,HCPCS,LENS ANISEIKONIC BIFOCAL,,,28,,NW,,,,,,$149.15,$0.00,1,1,1,1,1,1,20171001, V2219,HCPCS,LENS BIFOCAL SEG WIDTH OVER,,,28,,NW,,,,,,$82.09,$0.00,1,1,1,1,1,1,20171001, V2220,HCPCS,LENS BIFOCAL ADD OVER 3.25D,,,28,,NW,,,,,,$75.57,$0.00,1,1,1,1,1,1,20171001, V2221,HCPCS,"LENTICULAR LENS, BIFOCAL",,,28,,NW,,,,,,$136.09,$0.00,1,1,1,1,1,1,20171001, V2299,HCPCS,LENS BIFOCAL SPECIALITY,,,28,,NW,,,,,,$73.42,$0.00,1,1,1,1,1,1,20171001, V2300,HCPCS,LENS SPHERE TRIFOCAL 4.00D,,,28,,NW,,,,,,$108.54,$0.00,1,1,1,1,1,1,20171001, V2301,HCPCS,LENS SPHERE TRIFOCAL 4.12-7.,,,28,,NW,,,,,,$122.85,$0.00,1,1,1,1,1,1,20171001, V2302,HCPCS,LENS SPHERE TRIFOCAL 7.12-20,,,28,,NW,,,,,,$124.96,$0.00,1,1,1,1,1,1,20171001, V2303,HCPCS,LENS SPHCY TRIFOCAL 4.0/.12-,,,28,,NW,,,,,,$108.03,$0.00,1,1,1,1,1,1,20171001, V2304,HCPCS,LENS SPHCY TRIFOCAL 4.0/2.25,,,28,,NW,,,,,,$111.16,$0.00,1,1,1,1,1,1,20171001, V2305,HCPCS,LENS SPHCY TRIFOCAL 4.0/4.25,,,28,,NW,,,,,,$122.12,$0.00,1,1,1,1,1,1,20171001, V2306,HCPCS,LENS SPHCYL TRIFOCAL 4.00/>6,,,28,,NW,,,,,,$124.97,$0.00,1,1,1,1,1,1,20171001, V2307,HCPCS,LENS SPHCY TRIFOCAL 4.25-7/.,,,28,,NW,,,,,,$120.21,$0.00,1,1,1,1,1,1,20171001, V2308,HCPCS,LENS SPHC TRIFOCAL 4.25-7/2.,,,28,,NW,,,,,,$123.89,$0.00,1,1,1,1,1,1,20171001, V2309,HCPCS,LENS SPHC TRIFOCAL 4.25-7/4.,,,28,,NW,,,,,,$134.09,$0.00,1,1,1,1,1,1,20171001, V2310,HCPCS,LENS SPHC TRIFOCAL 4.25-7/>6,,,28,,NW,,,,,,$132.87,$0.00,1,1,1,1,1,1,20171001, V2311,HCPCS,LENS SPHC TRIFO 7.25-12/.25-,,,28,,NW,,,,,,$140.13,$0.00,1,1,1,1,1,1,20171001, V2312,HCPCS,LENS SPHC TRIFO 7.25-12/2.25,,,28,,NW,,,,,,$137.92,$0.00,1,1,1,1,1,1,20171001, V2313,HCPCS,LENS SPHC TRIFO 7.25-12/4.25,,,28,,NW,,,,,,$153.00,$0.00,1,1,1,1,1,1,20171001, V2314,HCPCS,LENS SPHCYL TRIFOCAL OVER 12,,,28,,NW,,,,,,$158.67,$0.00,1,1,1,1,1,1,20171001, V2315,HCPCS,LENS LENTICULAR TRIFOCAL,,,28,,NW,,,,,,$176.78,$0.00,1,1,1,1,1,1,20171001, V2318,HCPCS,LENS ANISEIKONIC TRIFOCAL,,,28,,NW,,,,,,$208.71,$0.00,1,1,1,1,1,1,20171001, V2319,HCPCS,LENS TRIFOCAL SEG WIDTH > 28,,,28,,NW,,,,,,$89.15,$0.00,1,1,1,1,1,1,20171001, V2320,HCPCS,LENS TRIFOCAL ADD OVER 3.25D,,,28,,NW,,,,,,$96.34,$0.00,1,1,1,1,1,1,20171001, V2321,HCPCS,"LENTICULAR LENS, TRIFOCAL",,,28,,NW,,,,,,$173.75,$0.00,1,1,1,1,1,1,20171001, V2399,HCPCS,LENS TRIFOCAL SPECIALITY,,,28,,NW,,,,,,$178.87,$0.00,1,1,1,1,1,1,20171001, V2410,HCPCS,LENS VARIAB ASPHERICITY SING,,,28,,NW,,,,,,$141.36,$0.00,1,1,1,1,1,1,20171001, V2430,HCPCS,LENS VARIABLE ASPHERICITY BI,,,28,,NW,,,,,,$162.07,$0.00,1,1,1,1,1,1,20171001, V2499,HCPCS,VARIABLE ASPHERICITY LENS,,,28,,NW,,,,,,$132.01,$0.00,1,1,1,1,1,1,20171001, V2500,HCPCS,CONTACT LENS PMMA SPHERICAL,,,28,,NW,,,,,,$132.67,$0.00,1,1,1,1,1,1,20171001, V2501,HCPCS,CNTCT LENS PMMA-TORIC/PRISM,,,28,,NW,,,,,,$180.57,$0.00,1,1,1,1,1,1,20171001, V2502,HCPCS,CONTACT LENS PMMA BIFOCAL,,,28,,NW,,,,,,$221.92,$0.00,1,1,1,1,1,1,20171001, V2503,HCPCS,CNTCT LENS PMMA COLOR VISION,,,28,,NW,,,,,,$199.50,$0.00,1,1,1,1,1,1,20171001, V2510,HCPCS,CNTCT GAS PERMEABLE SPHERICL,,,28,,NW,,,,,,$167.36,$0.00,1,1,1,1,1,1,20171001, V2511,HCPCS,CNTCT TORIC PRISM BALLAST,,,28,,NW,,,,,,$228.93,$0.00,1,1,1,1,1,1,20171001, V2512,HCPCS,CNTCT LENS GAS PERMBL BIFOCL,,,28,,NW,,,,,,$265.60,$0.00,1,1,1,1,1,1,20171001, V2513,HCPCS,CONTACT LENS EXTENDED WEAR,,,28,,NW,,,,,,$235.15,$0.00,1,1,1,1,1,1,20171001, V2520,HCPCS,CONTACT LENS HYDROPHILIC,,,28,,NW,,,,,,$159.17,$0.00,1,1,1,1,1,1,20171001, V2521,HCPCS,CNTCT LENS HYDROPHILIC TORIC,,,28,,NW,,,,,,$250.47,$0.00,1,1,1,1,1,1,20171001, V2522,HCPCS,CNTCT LENS HYDROPHIL BIFOCL,,,28,,NW,,,,,,$252.04,$0.00,1,1,1,1,1,1,20171001, V2523,HCPCS,CNTCT LENS HYDROPHIL EXTEND,,,28,,NW,,,,,,$213.74,$0.00,1,1,1,1,1,1,20171001, V2530,HCPCS,CONTACT LENS GAS IMPERMEABLE,,,28,,NW,,,,,,$296.43,$0.00,1,1,1,1,1,1,20171001, V2531,HCPCS,CONTACT LENS GAS PERMEABLE,,,28,,NW,,,,,,$610.37,$0.00,1,1,1,1,1,1,20171001, V2599,HCPCS,CONTACT LENS/ES OTHER TYPE,,,28,,NW,,,,,,$87.13,$0.00,1,1,1,1,1,1,20171001, V2600,HCPCS,HAND HELD LOW VISION AIDS,,,28,,NW,,,,,,$145.18,$0.00,1,1,1,1,1,1,20171001, V2610,HCPCS,SINGLE LENS SPECTACLE MOUNT,,,28,,NW,,,,,,$156.75,$0.00,1,1,1,1,1,1,20171001, V2615,HCPCS,TELESCOP/OTHR COMPOUND LENS,,,28,,NW,,,,,,$417.71,$0.00,1,1,1,1,1,1,20171001, V2623,HCPCS,PLASTIC EYE PROSTH CUSTOM,,,28,,NW,,,,,,"$2,998.21",$0.00,1,1,1,1,1,1,20171001, V2624,HCPCS,POLISHING ARTIFICAL EYE,,,28,,NW,,,,,,$52.95,$0.00,1,1,1,1,1,1,20171001, V2625,HCPCS,ENLARGEMNT OF EYE PROSTHESIS,,,28,,NW,,,,,,"$1,414.59",$0.00,1,1,1,1,1,1,20171001, V2626,HCPCS,REDUCTION OF EYE PROSTHESIS,,,28,,NW,,,,,,$933.30,$0.00,1,1,1,1,1,1,20171001, V2627,HCPCS,SCLERAL COVER SHELL,,,28,,NW,,,,,,"$4,005.52",$0.00,1,1,1,1,1,1,20171001, V2628,HCPCS,FABRICATION & FITTING,,,28,,NW,,,,,,"$1,199.98",$0.00,1,1,1,1,1,1,20171001, V2629,HCPCS,PROSTHETIC EYE OTHER TYPE,,,28,,NW,,,,,,"$1,268.63",$0.00,1,1,1,1,1,1,20171001, V2630,HCPCS,ANTER CHAMBER INTRAOCUL LENS,,,28,,NW,,,,,,$527.58,$0.00,1,1,1,0,1,1,20171001, V2631,HCPCS,IRIS SUPPORT INTRAOCLR LENS,,,28,,NW,,,,,,$527.58,$0.00,1,1,1,0,1,1,20171001, V2632,HCPCS,POST CHMBR INTRAOCULAR LENS,,,28,,NW,,,,,,$527.58,$0.00,1,1,1,0,1,1,20171001, V2700,HCPCS,BALANCE LENS,,,28,,NW,,,,,,$82.80,$0.00,1,1,1,1,1,1,20171001, V2702,HCPCS,DELUXE LENS FEATURE,,,28,,NW,,,,,,$28.41,$0.00,1,1,1,1,1,1,20171001, V2710,HCPCS,GLASS/PLASTIC SLAB OFF PRISM,,,28,,NW,,,,,,$110.20,$0.00,1,1,1,1,1,1,20171001, V2715,HCPCS,PRISM LENS/ES,,,28,,NW,,,,,,$43.76,$0.00,1,1,1,1,1,1,20171001, V2718,HCPCS,FRESNELL PRISM PRESS-ON LENS,,,28,,NW,,,,,,$63.83,$0.00,1,1,1,1,1,1,20171001, V2730,HCPCS,SPECIAL BASE CURVE,,,28,,NW,,,,,,$54.03,$0.00,1,1,1,1,1,1,20171001, V2744,HCPCS,TINT PHOTOCHROMATIC LENS/ES,,,28,,NW,,,,,,$48.13,$0.00,1,1,1,1,1,1,20171001, V2745,HCPCS,"TINT, ANY COLOR/SOLID/GRAD",,,28,,NW,,,,,,$18.55,$0.00,1,1,1,1,1,1,20171001, V2750,HCPCS,ANTI-REFLECTIVE COATING,,,28,,NW,,,,,,$53.04,$0.00,1,1,1,1,1,1,20171001, V2755,HCPCS,UV LENS/ES,,,28,,NW,,,,,,$47.74,$0.00,1,1,1,1,1,1,20171001, V2756,HCPCS,EYE GLASS CASE,,,28,,NW,,,,,,$3.53,$0.00,1,1,1,1,1,1,20171001, V2760,HCPCS,SCRATCH RESISTANT COATING,,,28,,NW,,,,,,$47.64,$0.00,1,1,1,1,1,1,20171001, V2761,HCPCS,MIRROR COATING,,,28,,NW,,,,,,$43.45,$0.00,1,1,1,1,1,1,20171001, V2762,HCPCS,"POLARIZATION, ANY LENS",,,28,,NW,,,,,,$93.69,$0.00,1,1,1,1,1,1,20171001, V2770,HCPCS,OCCLUDER LENS/ES,,,28,,NW,,,,,,$52.47,$0.00,1,1,1,1,1,1,20171001, V2780,HCPCS,OVERSIZE LENS/ES,,,28,,NW,,,,,,$43.73,$0.00,1,1,1,1,1,1,20171001, V2781,HCPCS,PROGRESSIVE LENS PER LENS,,,28,,NW,,,,,,$99.12,$0.00,1,1,1,1,1,1,20171001, V2782,HCPCS,"LENS, 1.54-1.65 P/1.60-1.79G",,,28,,NW,,,,,,$98.78,$0.00,1,1,1,1,1,1,20171001, V2783,HCPCS,"LENS, >= 1.66 P/>=1.80 G",,,28,,NW,,,,,,$107.54,$0.00,1,1,1,1,1,1,20171001, V2784,HCPCS,LENS POLYCARB OR EQUAL,,,28,,NW,,,,,,$80.06,$0.00,1,1,1,1,1,1,20171001, V2785,HCPCS,CORNEAL TISSUE PROCESSING,,,28,,NW,,,,,,"$5,735.17",$0.00,1,1,1,1,1,1,20171001, V2786,HCPCS,OCCUPATIONAL MULTIFOCAL LENS,,,28,,NW,,,,,,$134.44,$0.00,1,1,1,1,1,1,20171001, V2787,HCPCS,ASTIGMATISM-CORRECT FUNCTION,,,28,,NW,,,,,,$892.07,$0.00,1,1,1,1,1,1,20171001, V2788,HCPCS,PRESBYOPIA-CORRECT FUNCTION,,,28,,NW,,,,,,"$1,569.38",$0.00,1,1,1,1,1,1,20171001, V2790,HCPCS,AMNIOTIC MEMBRANE,,,28,,NW,,,,,,"$1,071.33",$0.00,1,1,1,0,1,1,20171001, V2797,HCPCS,VIS ITEM/SVC IN OTHER CODE,,,28,,NW,,,,,,$259.46,$0.00,1,1,1,1,1,1,20171001, V2799,HCPCS,MISC VISION ITEM OR SERVICE,,,28,,NW,,,,,,$54.04,$0.00,1,1,1,0,1,1,20171001, V5008,HCPCS,HEARING SCREENING,,,8,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, V5010,HCPCS,ASSESSMENT FOR HEARING AID,,,8,,TotalUnits,,,,1.48 ,,$0.00,$0.00,1,1,1,0,0,1,20171001, V5011,HCPCS,HEARING AID FITTING/CHECKING,,,28,,NW,,,,,,$198.65,$0.00,1,1,1,1,1,1,20171001, V5014,HCPCS,HEARING AID REPAIR/MODIFYING,,,28,,NW,,,,,,$239.92,$0.00,1,1,1,1,1,1,20171001, V5020,HCPCS,CONFORMITY EVALUATION,,,28,,NW,,,,,,$111.79,$0.00,1,1,1,1,1,1,20171001, V5030,HCPCS,BODY-WORN HEARING AID AIR,,,28,,NW,,,,,,"$2,505.66",$0.00,1,1,1,1,1,1,20171001, V5040,HCPCS,BODY-WORN HEARING AID BONE,,,28,,NW,,,,,,"$1,847.22",$0.00,1,1,1,1,1,1,20171001, V5050,HCPCS,HEARING AID MONAURAL IN EAR,,,28,,NW,,,,,,"$2,172.43",$0.00,1,1,1,1,1,1,20171001, V5060,HCPCS,BEHIND EAR HEARING AID,,,28,,NW,,,,,,"$1,776.29",$0.00,1,1,1,1,1,1,20171001, V5070,HCPCS,GLASSES AIR CONDUCTION,,,28,,NW,,,,,,$880.98,$0.00,1,1,1,1,1,1,20171001, V5080,HCPCS,GLASSES BONE CONDUCTION,,,28,,NW,,,,,,"$2,575.25",$0.00,1,1,1,1,1,1,20171001, V5090,HCPCS,HEARING AID DISPENSING FEE,,,28,,NW,,,,,,$761.87,$0.00,1,1,1,1,1,1,20171001, V5100,HCPCS,BODY-WORN BILAT HEARING AID,,,28,,NW,,,,,,"$7,020.67",$0.00,1,1,1,1,1,1,20171001, V5110,HCPCS,HEARING AID DISPENSING FEE,,,28,,NW,,,,,,$779.27,$0.00,1,1,1,1,1,1,20171001, V5120,HCPCS,BODY-WORN BINAUR HEARING AID,,,28,,NW,,,,,,"$4,419.86",$0.00,1,1,1,1,1,1,20171001, V5130,HCPCS,IN EAR BINAURAL HEARING AID,,,28,,NW,,,,,,"$5,576.45",$0.00,1,1,1,1,1,1,20171001, V5140,HCPCS,BEHIND EAR BINAUR HEARING AI,,,28,,NW,,,,,,"$6,341.40",$0.00,1,1,1,1,1,1,20171001, V5150,HCPCS,GLASSES BINAURAL HEARING AID,,,28,,NW,,,,,,"$7,693.82",$0.00,1,1,1,1,1,1,20171001, V5160,HCPCS,DISPENSING FEE BINAURAL,,,28,,NW,,,,,,$980.01,$0.00,1,1,1,1,1,1,20171001, V5170,HCPCS,WITHIN EAR CROS HEARING AID,,,28,,NW,,,,,,"$3,003.51",$0.00,1,1,1,1,1,1,20171001, V5180,HCPCS,BEHIND EAR CROS HEARING AID,,,28,,NW,,,,,,"$2,505.66",$0.00,1,1,1,1,1,1,20171001, V5190,HCPCS,GLASSES CROS HEARING AID,,,28,,NW,,,,,,"$2,968.71",$0.00,1,1,1,1,1,1,20171001, V5200,HCPCS,CROS HEARING AID DISPENS FEE,,,28,,NW,,,,,,$769.90,$0.00,1,1,1,1,1,1,20171001, V5210,HCPCS,IN EAR BICROS HEARING AID,,,28,,NW,,,,,,"$3,284.55",$0.00,1,1,1,1,1,1,20171001, V5220,HCPCS,BEHIND EAR BICROS HEARING AI,,,28,,NW,,,,,,"$3,146.70",$0.00,1,1,1,1,1,1,20171001, V5230,HCPCS,GLASSES BICROS HEARING AID,,,28,,NW,,,,,,"$3,260.46",$0.00,1,1,1,1,1,1,20171001, V5240,HCPCS,DISPENSING FEE BICROS,,,28,,NW,,,,,,$806.03,$0.00,1,1,1,1,1,1,20171001, V5241,HCPCS,"DISPENSING FEE, MONAURAL",,,28,,NW,,,,,,$481.75,$0.00,1,1,1,1,1,1,20171001, V5242,HCPCS,"HEARING AID, MONAURAL, CIC",,,28,,NW,,,,,,"$2,053.90",$0.00,1,1,1,1,1,1,20171001, V5243,HCPCS,"HEARING AID, MONAURAL, ITC",,,28,,NW,,,,,,"$2,163.37",$0.00,1,1,1,1,1,1,20171001, V5244,HCPCS,"HEARING AID, PROG, MON, CIC",,,28,,NW,,,,,,"$2,845.17",$0.00,1,1,1,1,1,1,20171001, V5245,HCPCS,"HEARING AID, PROG, MON, ITC",,,28,,NW,,,,,,"$3,305.28",$0.00,1,1,1,1,1,1,20171001, V5246,HCPCS,"HEARING AID, PROG, MON, ITE",,,28,,NW,,,,,,"$2,402.78",$0.00,1,1,1,1,1,1,20171001, V5247,HCPCS,"HEARING AID, PROG, MON, BTE",,,28,,NW,,,,,,"$2,862.27",$0.00,1,1,1,1,1,1,20171001, V5248,HCPCS,"HEARING AID, BINAURAL, CIC",,,28,,NW,,,,,,"$2,644.38",$0.00,1,1,1,1,1,1,20171001, V5249,HCPCS,"HEARING AID, BINAURAL, ITC",,,28,,NW,,,,,,"$2,120.25",$0.00,1,1,1,1,1,1,20171001, V5250,HCPCS,"HEARING AID, PROG, BIN, CIC",,,28,,NW,,,,,,"$6,872.14",$0.00,1,1,1,1,1,1,20171001, V5251,HCPCS,"HEARING AID, PROG, BIN, ITC",,,28,,NW,,,,,,"$6,146.02",$0.00,1,1,1,1,1,1,20171001, V5252,HCPCS,"HEARING AID, PROG, BIN, ITE",,,28,,NW,,,,,,"$8,780.26",$0.00,1,1,1,1,1,1,20171001, V5253,HCPCS,"HEARING AID, PROG, BIN, BTE",,,28,,NW,,,,,,"$4,079.77",$0.00,1,1,1,1,1,1,20171001, V5254,HCPCS,"HEARING ID, DIGIT, MON, CIC",,,28,,NW,,,,,,"$3,071.98",$0.00,1,1,1,1,1,1,20171001, V5255,HCPCS,"HEARING AID, DIGIT, MON, ITC",,,28,,NW,,,,,,"$1,958.61",$0.00,1,1,1,1,1,1,20171001, V5256,HCPCS,"HEARING AID, DIGIT, MON, ITE",,,28,,NW,,,,,,"$1,612.03",$0.00,1,1,1,1,1,1,20171001, V5257,HCPCS,"HEARING AID, DIGIT, MON, BTE",,,28,,NW,,,,,,"$3,916.59",$0.00,1,1,1,1,1,1,20171001, V5258,HCPCS,"HEARING AID, DIGIT, BIN, CIC",,,28,,NW,,,,,,"$6,407.30",$0.00,1,1,1,1,1,1,20171001, V5259,HCPCS,"HEARING AID, DIGIT, BIN, ITC",,,28,,NW,,,,,,"$4,817.52",$0.00,1,1,1,1,1,1,20171001, V5260,HCPCS,"HEARING AID, DIGIT, BIN, ITE",,,28,,NW,,,,,,"$4,496.35",$0.00,1,1,1,1,1,1,20171001, V5261,HCPCS,"HEARING AID, DIGIT, BIN, BTE",,,28,,NW,,,,,,"$6,188.10",$0.00,1,1,1,1,1,1,20171001, V5262,HCPCS,"HEARING AID, DISP, MONAURAL",,,28,,NW,,,,,,$289.94,$0.00,1,1,1,1,1,1,20171001, V5263,HCPCS,"HEARING AID, DISP, BINAURAL",,,28,,NW,,,,,,$221.16,$0.00,1,1,1,1,1,1,20171001, V5264,HCPCS,EAR MOLD/INSERT,,,28,,NW,,,,,,$130.55,$0.00,1,1,1,1,1,1,20171001, V5265,HCPCS,"EAR MOLD/INSERT, DISP",,,28,,NW,,,,,,$79.83,$0.00,1,1,1,1,1,1,20171001, V5266,HCPCS,BATTERY FOR HEARING DEVICE,,,28,,NW,,,,,,$2.18,$0.00,1,1,1,1,1,1,20171001, V5267,HCPCS,HEARING AID SUP/ACCESS/DEV,,,28,,NW,,,,,,$13.97,$0.00,1,1,1,1,1,1,20171001, V5268,HCPCS,ALD TELEPHONE AMPLIFIER,,,28,,NW,,,,,,$124.02,$0.00,1,1,1,1,1,1,20171001, V5269,HCPCS,"ALERTING DEVICE, ANY TYPE",,,28,,NW,,,,,,$115.29,$0.00,1,1,1,1,1,1,20171001, V5270,HCPCS,"ALD, TV AMPLIFIER, ANY TYPE",,,28,,NW,,,,,,$301.74,$0.00,1,1,1,1,1,1,20171001, V5271,HCPCS,"ALD, TV CAPTION DECODER",,,28,,NW,,,,,,$506.28,$0.00,1,1,1,1,1,1,20171001, V5272,HCPCS,TDD,,,28,,NW,,,,,,$359.09,$0.00,1,1,1,1,1,1,20171001, V5273,HCPCS,ALD FOR COCHLEAR IMPLANT,,,28,,NW,,,,,,$819.03,$0.00,1,1,1,1,1,1,20171001, V5274,HCPCS,ALD UNSPECIFIED,,,28,,NW,,,,,,$181.56,$0.00,1,1,1,1,1,1,20171001, V5275,HCPCS,EAR IMPRESSION,,,28,,NW,,,,,,$59.87,$0.00,1,1,1,1,1,1,20171001, V5281,HCPCS,"ALD FM/DM SYSTEM, MONAURAL",,,28,,NW,,,,,,$165.84,$0.00,1,1,1,1,1,1,20171001, V5282,HCPCS,ALD FM/DM SYSTEM BINAURAL,,,28,,NW,,,,,,$588.95,$0.00,1,1,1,1,1,1,20171001, V5283,HCPCS,"ALD NECK, LOOP IND RECEIVER",,,28,,NW,,,,,,$412.06,$0.00,1,1,1,1,1,1,20171001, V5284,HCPCS,ALD FM/DM EAR LEVEL RECEIVER,,,28,,NW,,,,,,$574.62,$0.00,1,1,1,1,1,1,20171001, V5285,HCPCS,ALD FM/DM AUD INPUT RECEIVER,,,28,,NW,,,,,,$762.03,$0.00,1,1,1,1,1,1,20171001, V5286,HCPCS,ALD BLU TOOTH FM/DM RECEIVER,,,28,,NW,,,,,,$238.07,$0.00,1,1,1,1,1,1,20171001, V5287,HCPCS,"ALD FM/DM RECEIVER, NOS",,,28,,NW,,,,,,$433.27,$0.00,1,1,1,1,1,1,20171001, V5288,HCPCS,ALD FM/DM TRANSMITTER ALD,,,28,,NW,,,,,,$314.44,$0.00,1,1,1,1,1,1,20171001, V5289,HCPCS,ALD FM/DM ADAPT/BOOT COUPLIN,,,28,,NW,,,,,,$130.83,$0.00,1,1,1,1,1,1,20171001, V5290,HCPCS,ALD TRANSMITTER MICROPHONE,,,28,,NW,,,,,,$410.37,$0.00,1,1,1,1,1,1,20171001, V5298,HCPCS,HEARING AID NOC,,,28,,NW,,,,,,"$1,433.72",$0.00,1,1,1,1,1,1,20171001, V5299,HCPCS,HEARING SERVICE,,,28,,NW,,,,,,$110.56,$0.00,1,1,1,0,0,1,20171001, V5362,HCPCS,SPEECH SCREENING,,,8,,RBRVS,0.86 ,0.28 ,3.50 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, V5363,HCPCS,LANGUAGE SCREENING,,,8,,RBRVS,0.86 ,0.28 ,3.50 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, V5364,HCPCS,DYSPHAGIA SCREENING,,,8,,RBRVS,,1.70 ,1.70 ,,,$0.00,$0.00,1,1,1,0,0,1,20171001, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,