Version 3.9 Update - Professional Services and Supplies Charge Table,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Item Code,Code Type,Decription,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 Date00100,CPT,ANESTHESIA SALIVARY GLANDS WITH BIOPSY,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00102,CPT,ANESTHESIA CLEFT LIP INVOLVING PLASTIC REPAIR,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00103,CPT,ANESTHESIA EYELID RECONSTRUCTIVE PROCEDURE,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00104,CPT,ANESTHESIA ELECTROCONVULSIVE THERAPY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00120,CPT,ANESTHESIA EXTERNAL MIDDLE & INNER EAR W/BIOPSY,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00124,CPT,ANES EXTERNAL MIDDLE & INNER EAR W/BX OTOSCOPY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00126,CPT,ANES XTRNL MID & INNER EAR W/BX TYMPANOTOMY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00140,CPT,ANESTHESIA EYE NOT OTHERWISE SPECIFIED,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00142,CPT,ANESTHESIA EYE LENS SURGERY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00144,CPT,ANESTHESIA EYE CORNEAL TRANSPLANT,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00145,CPT,ANESTHESIA EYE VITREORETINAL SURGERY,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00147,CPT,ANESTHESIA EYE IRIDECTOMY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00148,CPT,ANESTHESIA EYE OPHTHALMOSCOPY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00160,CPT,ANESTHESIA NOSE & ACCESSORY SINUSES,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00162,CPT,ANES NOSE & ACCESSORY SINUSES RADICAL SURGERY,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00164,CPT,ANES NOSE&ACCESSORY SINUSES BIOPSY SOFT TISSUE,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00170,CPT,ANESTHESIA INTRAORAL WITH BIOPSY,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00172,CPT,ANES INTRAORAL W/BIOPSY REPAIR CLEFT PALATE,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00174,CPT,ANES INTRAORAL W/BX EXC RETROPHARYNGEAL TUMOR,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00176,CPT,ANESTHESIA INTRAORAL W/BIOPSY RADICAL SURGERY,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00190,CPT,ANESTHESIA FACIAL BONES OR SKULL,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00192,CPT,ANES FACIAL BONES/SKULL RAD SURG W/PROGNATHISM,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0019T,CPT,EXTRACORPOREAL SHOCK WAVE MUSCSKEL NOS LOW ENRGY,,,21 ,,TotalUnits,,,,3.87 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,00210,CPT,ANESTHESIA INTRACRANIAL PROCEDURE NOS,,,3 ,,Anesth,,,,,11.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00211,CPT,ANES INTRACRANIAL CRANIOTOMY/CRANIECTOMY HMTMA,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00212,CPT,ANESTHESIA INTRACRANIAL PROCEDURE SUBDURAL TAPS,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00214,CPT,ANES INTRACRANIAL BURR HOLES W/VENTRICULOGRAPHY,,,3 ,,Anesth,,,,,9.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00215,CPT,ANES ICRA CRNOP/ELEVATION DEPRS SKULL FX XDRL,,,3 ,,Anesth,,,,,9.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00216,CPT,ANESTHESIA INTRACRANIAL VASCULAR PROCEDURE,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00218,CPT,ANES INTRACRANIAL PROCEDURE IN SITTING POSITION,,,3 ,,Anesth,,,,,13.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00220,CPT,ANES INTRACRANIAL CEREBROSPINAL FLUID SHUNTING,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00222,CPT,ANES INTRACRANIAL ELECTROCOAGULATION ICRA NERVE,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00300,CPT,ANES INTEG MUSC&NRV HEAD NCK&POSTERIOR TRUNK,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0030T,CPT,ANTIPROTHROMBIN ANTIBODY EACH IG CLASS,,,17 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,00320,CPT,ANES ESOPH THYR LARX TRACH&LYMPHTC NECK 1YR/>,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00322,CPT,ANES ESOPH THYR LARX TRACH&LYMPHTC NCK BX THYR,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00326,CPT,ANESTHESIA LARYNX & TRACHEA CHILDREN <1YEAR,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00350,CPT,ANESTHESIA MAJOR VESSELS NECK,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00352,CPT,ANESTHESIA MAJOR VESSELS NECK SIMPLE LIGATION,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00400,CPT,ANES INTEG EXTREMITIES ANTERIOR TRUNK PERINEUM,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00402,CPT,ANESTHESIA RECONSTRUCTIVE BREAST,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00404,CPT,ANESTHESIA RADICAL/MODIFIED RADICAL BREAST,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00406,CPT,ANES RADICAL/MODIFIED RADICAL BREAST W/NODE,,,3 ,,Anesth,,,,,13.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00410,CPT,ANES INTEG SYS ELEC CONVERSION ARRHYTHMIAS,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0042T,CPT,CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME,,,20 ,,TotalUnits,,,,2.38 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,00450,CPT,ANESTHESIA CLAVICLE AND SCAPULA,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00452,CPT,ANES CLAVICLE AND SCAPULA RADICAL SURGERY,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00454,CPT,ANES CLAVICLE AND SCAPULA W/BIOPSY CLAVICLE,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00470,CPT,ANESTHESIA PARTIAL RIB RESECTION,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00472,CPT,ANESTHESIA PARTIAL RIB RESECTION THORACOPLASTY,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00474,CPT,ANESTHESIA PARTIAL RIB RESECTION RADICAL,,,3 ,,Anesth,,,,,13.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0048T,CPT,IMPLTJ VENTR ASSIST DEV XTRCORP PRQ T-SEPTAL,,,21 ,,TotalUnits,,,,13.44 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,00500,CPT,ANESTHESIA ESOPHAGUS,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00520,CPT,ANESTHESIA CLOSED CHEST W/BRONCHOSCOPY,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00522,CPT,ANESTHESIA CLOSED CHEST NEEDLE BIOPSY PLEURA,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00524,CPT,ANESTHESIA CLOSED CHEST PNEUMOCENTESIS,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00528,CPT,ANES CLSD CHEST MEDIASTSC&THRSC W/O 1 LUNG VNTJ,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00529,CPT,ANES CLOSED CHEST MEDIASTSC&THRSC W/1 LUNG VNTJ,,,3 ,,Anesth,,,,,11.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00530,CPT,ANES PERMANENT TRANSVENOUS PACEMAKER INSERTION,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00532,CPT,ANESTHESIA ACCESS CENTRAL VENOUS CIRCULATION,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00534,CPT,ANES TRANSVENOUS INSJ/REPLACEMENT PACING CVDFB,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00537,CPT,ANES CARDIAC ELECTROPHYSIOLOGIC W/RF ABLATION,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00539,CPT,ANESTHESIA TRACHEOBRONCHIAL RECONSTRUCTION,,,3 ,,Anesth,,,,,18.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00540,CPT,ANESTHESIA THRCM LUNG PLEURA DPHRM&MED THRSC,,,3 ,,Anesth,,,,,12.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00541,CPT,ANES THRCM LUNG PLEURA DPHRM&MED THRSC 1 LUNG,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00542,CPT,ANES THRCM LUNG PLEURA DPHRM&MED THRSC DCRTCTJ,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00546,CPT,ANES THRCM LNG PLEUR DPHRM&MED THRSC PULM RESCJ,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00548,CPT,ANES THRCM LNG PLEUR DPHRM&MED THRSC TRACH&BRNCH,,,3 ,,Anesth,,,,,17.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00550,CPT,ANESTHESIA FOR STERNAL DEBRIDEMENT,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0055T,CPT,CPTR-ASST MUSCSKEL NAVIGJ ORTHO CT/MRI,,,21 ,,TotalUnits,,,,10.81 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,00560,CPT,ANES HRT PRCRD SAC&GREAT VESSEL CH W/O PMP OXTJ,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00561,CPT,ANES HRT PRCRD SAC&GREAT VSL CH W/PMP OXTJ <1YR,,,3 ,,Anesth,,,,,25.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00562,CPT,ANES HRT PRCRD&GRT VSL CH W/PMP OXTJ PT AGE 1/>,,,3 ,,Anesth,,,,,20.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00563,CPT,ANES HRT PRCRD&GREAT VSL CH W/PUMP OXTJ HYPTHRM,,,3 ,,Anesth,,,,,25.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00566,CPT,ANES DIR CAB GRFG W/O PMP OXTJ,,,3 ,,Anesth,,,,,25.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00567,CPT,ANES DIRECT CAB GRAFTING W/ PUMP OXYGENATOR,,,3 ,,Anesth,,,,,18.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00580,CPT,ANES HEART TRANSPLANT/HEART/LUNG TRANSPLANT,,,3 ,,Anesth,,,,,20.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00600,CPT,ANESTHESIA CERVICAL SPINE & CORD,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00604,CPT,ANES CERVICAL SPINE&CORD W/PATIENT SITTING,,,3 ,,Anesth,,,,,13.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00620,CPT,ANESTHESIA THORACIC SPINE & CORD,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00622,CPT,ANES THORACIC SPINE&CORD THORACOLMBR SYMPTH,,,3 ,,Anesth,,,,,13.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00625,CPT,ANES THRC SPINE & CORD ANT APPR W/O 1 LUNG VNTJ,,,3 ,,Anesth,,,,,13.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00626,CPT,ANES THORACIC SPINE & C/D ANT APPR W/1 LNG VNTJ,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00630,CPT,ANESTHESIA LUMBAR REGION,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00632,CPT,ANESTHESIA LUMBAR REGION LUMBAR SYMPATHECTOMY,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00634,CPT,ANESTHESIA LUMBAR CHEMONUCLEOLYSIS,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00635,CPT,ANES DIAGNOSTIC/THERAPEUTIC LUMBAR PUNCTURE,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00640,CPT,ANES MNPJ SPINE/CLSD CRV THORACIC/LUMBAR SPINE,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00670,CPT,ANESTHESIA EXTENSIVE SPINE & SPINAL CORD,,,3 ,,Anesth,,,,,13.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00700,CPT,ANESTHESIA UPPER ANTERIOR ABDOMINAL WALL,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00702,CPT,ANES UPR ANT ABDL WALL PERCUTANEOUS LIVER BX,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00730,CPT,ANESTHESIA UPPER POSTERIOR ABDOMINAL WALL,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0073T,CPT,COMPNSTR-BASED BEAM MODLJ TX DLVR INVERSE 3> FLD,,TC,20 ,,RBRVS,,15.29 ,15.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,00740,CPT,ANES UPPER GI ENDOSCOPIC PROXIMAL TO DUODENUM,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00750,CPT,ANESTHESIA HERNIA REPAIR UPPER ABDOMEN,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00752,CPT,ANES HRNA RPR UPR ABD LMBR&VNT HRNAS&/WND DEHSN,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00754,CPT,ANES HERNIA REPAIR UPPER ABDOMEN OMPHALOCELE,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00756,CPT,ANES HRNA REPAIR UPR ABD TABDL RPR DIPHRG HRNA,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0075T,CPT,TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL,,,21 ,,TotalUnits,,,,14.77 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,0075T,CPT,TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL,26,,21 ,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,0075T,CPT,TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL,TC,,21 ,,TotalUnits,,,,13.85 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,00770,CPT,ANESTHESIA MAJOR ABDOMINAL BLOOD VESSELS,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0078T,CPT,EVASC RPR AAA PSEUDOARYSM ABDL AORTA VISC,,,21 ,,TotalUnits,,,,26.80 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,00790,CPT,ANES INTRAPERITONEAL UPPER ABDOMEN W/LAPS,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00792,CPT,ANES IPR UPR ABD LAPS PRTL HPTC/MGMT LVR HEMRRG,,,3 ,,Anesth,,,,,13.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00794,CPT,ANES IPR UPPER ABD W/LAPS PNCRTECT PRTL/TOTAL,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00796,CPT,ANES IPR UPPER ABD W/LAPS LIVER TRANSPLANT,,,3 ,,Anesth,,,,,30.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00797,CPT,ANES IPR UPPER ABDOMEN LAPS GASTRIC RSTCV MO,,,3 ,,Anesth,,,,,11.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0079T,CPT,PLMT VISC XTN PROSTH EVASC RPR AAA EA VISC,,,21 ,,TotalUnits,,,,38.75 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,00800,CPT,ANESTHESIA LOWER ANTERIOR ABDOMINAL WALL,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00802,CPT,ANES LOWER ANT ABDOMINAL WALL PANNICULECTOMY,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0080T,CPT,EVASC RPR AAA PSEUDOARYSM ABDL AORTA VISC RS&I,,,21 ,,TotalUnits,,,,4.20 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,00810,CPT,ANES LOWER INTESTINAL NDSC DISTAL DUODENUM,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0081T,CPT,PLMT VISC XTN PROSTH EVASC RPR AAA EA VISC RS&I,,,21 ,,TotalUnits,,,,6.43 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,00820,CPT,ANESTHESIA LOWER POSTERIOR ABDOMINAL WALL,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00830,CPT,ANESTHESIA HERNIA REPAIR LOWER ABDOMEN,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00832,CPT,ANES HRNA RPR LWR ABD VENTRAL&INCAL HRNAS,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00834,CPT,ANES HERNIA REPAIR LOWER ABDOMEN NOS <1YR AGE,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00836,CPT,ANES HRNA RPR LWR ABD NOS INFTS<37WK BRTH<50WK,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00840,CPT,ANESTHESIA INTRAPERITONEAL LOWER ABD W/LAPS,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00842,CPT,ANES IPR LOWER ABDOMEN W/LAPS AMNIOCENTESIS,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00844,CPT,ANES IPR LOWER ABD W/LAPS ABDOMINOPRNL RESCJ,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00846,CPT,ANES IPR LOWER ABD W/LAPS RAD HYSTERECTOMY,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00848,CPT,ANES IPR PX LWR ABD W/LAPS PELVIC EXENTERATION,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00851,CPT,ANES IPR PX LWR ABD W/LAPS TUBAL LIG/TRNSECTION,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00860,CPT,ANES EXTRAPERITONEAL PX LWR ABD W/UR TRC NOS,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00862,CPT,ANES XTRPRTL LOWER ABD UR TRACT RENAL DON NFRCT,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00864,CPT,ANES XTRPRTL LOWER ABD W/URINARY TRACT TOT CSTC,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00865,CPT,ANES XTRPRTL LWR ABD W/UR TRC RAD PRST8ECT,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00866,CPT,ANES XTRPRTL LOWER ABD W/UR TRC ADRNLECTOMY,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00868,CPT,ANES XTRPRTL LOWER ABD W/UR TRACT RENAL TRNSPL,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00870,CPT,ANES XTRPRTL LOWER ABD W/UR TRACT CSTOLITHOTOMY,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00872,CPT,ANES LITHOTRP XTRCORP SHOCK WAVE W/WATER BATH,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00873,CPT,ANES LITHOTRP XTRCORP SHOCK WAVE W/O WATER BATH,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00880,CPT,ANESTHESIA MAJOR LOWER ABDOMINAL VESSELS,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00882,CPT,ANES MAJOR LOWER ABDOMINAL VESSELS IVC LIGATION,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00902,CPT,ANESTHESIA ANORECTAL PROCEDURE,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00904,CPT,ANESTHESIA RADICAL PERINEAL PROCEDURE,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00906,CPT,ANESTHESIA VULVECTOMY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00908,CPT,ANESTHESIA PERINEAL PROSTATECTOMY,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00910,CPT,ANESTHESIA TRANSURETHRAL W/URETHROCYSTOSCOPY,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00912,CPT,ANES TRANSURETHRAL RESECTION OF BLADDER TUMOR,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00914,CPT,ANESTHESIA TRANSURETHRAL RESECTION OF PROSTATE,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00916,CPT,ANES TRURL POST-TRURL RESECTION BLEEDING,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00918,CPT,ANES TRURL FRAGMNTJ MNPJ&/RMVL URTRL CALCULUS,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00920,CPT,ANESTHESIA MALE GENITALIA INCL OPEN URETHRAL PX,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00921,CPT,ANES VASECTOMY UNI/BI INCL OPEN URETHRAL PX,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00922,CPT,ANES SEMINAL VESICLES INCL OPEN URETHRAL PX,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00924,CPT,ANES UNDSCND TESTIS UNI/BI INCL OPEN URTL PX,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00926,CPT,ANES RAD ORCHIECTOMY INGUN INCL OPEN URTL PX,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00928,CPT,ANES RAD ORCHIECTOMY ABDOMINAL INCL OPN URTL,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0092T,CPT,TOT DISC ARTHRP ANT APPR DSKC PREP CRV EA NTRSPC,,,21 ,,RBRVS,4.04 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,00930,CPT,ANES ORCHIOPEXY UNI/BI INCL OPEN URETHRAL PX,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00932,CPT,ANES COMPLETE AMPUTATION PENIS INCL OPEN URTL,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00934,CPT,ANES RAD AMP PENIS W/BI INGUINAL NODE OPN URTL,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00936,CPT,ANES RAD AMP PNS W/BI INGUN&ILIAC INCL OPN URTL,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00938,CPT,ANES INSJ PENILE PROSTH PRNL INCL OPEN URTL,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00940,CPT,ANESTHESIA VAGINAL PROCEDURE INCL BIOPSY,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00942,CPT,ANES COLPTMY VAGNC COLPRPHY INCL BX W/OPN URTL,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00944,CPT,ANESTHESIA VAGINAL HYSTERECTOMY INCL BIOPSY,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00948,CPT,ANESTHESIA CERVICAL CERCLAGE INCLUDING BIOPSY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00950,CPT,ANESTHESIA CULDOSCOPY INCLUDING BIOPSY,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,00952,CPT,ANES HYSTEROSCOPY&/HYSTEROSALPINGOGRAPHY W/BX,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0095T,CPT,RMVL TOT DISC ARTHRP ANT APPR CRV EA NTRSPC,,,21 ,,RBRVS,4.04 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,0098T,CPT,REVJ TOT DISC ARTHRP ANT APPR CRV EA NTRSPC,,,21 ,,RBRVS,4.04 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,0099T,CPT,IMPLTJ INTRASTROMAL CORNEAL RING SEGMENTS,,,21 ,,TotalUnits,,,,5.14 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,0100T,CPT,PLMT SCJNCL RTA PROSTH&PLS&IMPLTJ INTRA-OC RTA,,,21 ,,TotalUnits,,,,12.92 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,0101T,CPT,EXTRCORPL SHOCK WAVE MUSCSKELE NOS HIGH ENERGY,,,21 ,,TotalUnits,,,,5.00 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,0102T,CPT,EXTRCRPL SHOCK WAVE W/ANES LAT HUMERL EPICONDYLE,,,21 ,,TotalUnits,,,,5.00 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,0106T,CPT,QUANT SENSORY TEST&INTERPJ/XTR W/TOUCH STIMULI,,,14 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,0107T,CPT,QUANT SENSORY TEST&INTERPJ/XTR W/VIBRJ STIMULI,,,14 ,,TotalUnits,,,,2.14 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,0108T,CPT,QUANT SENSORY TEST&INTERPJ/XTR W/COOL STIMULI,,,14 ,,TotalUnits,,,,2.14 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,01112,CPT,ANES BONE MARROW ASPIR&/BX ANT/PST ILIAC CREST,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01120,CPT,ANESTHESIA ON BONY PELVIS,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01130,CPT,ANESTHESIA BODY CAST APPLICATION OR REVISION,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01140,CPT,ANESTHESIA INTERPELVIABDOMINAL AMPUTATION,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01150,CPT,ANES RADICAL TUMOR PELVIS XCP HINDQUARTER AMP,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01160,CPT,ANES CLOSED SYMPHYSIS PUBIS/SACROILIAC JOINT,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01170,CPT,ANES OPEN SYMPHYSIS PUBIS/SACROILIAC JOINT,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01173,CPT,ANES OPN RPR DISRPJ PELVIS/COLUMN FX ACETABULUM,,,3 ,,Anesth,,,,,12.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01180,CPT,ANESTHESIA OBTURATOR NEURECTOMY EXTRAPELVIC,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01190,CPT,ANESTHESIA OBTURATOR NEURECTOMY INTRAPELVIC,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01200,CPT,ANESTHESIA HIP JOINT,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01202,CPT,ANESTHESIA ARTHROSCOPY HIP JOINT,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01210,CPT,ANESTHESIA OPEN PX HIP JOINT,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01212,CPT,ANESTHESIA OPEN HIP JOINT DISARTICULATION,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01214,CPT,ANESTHESIA OPEN TOTAL HIP ARTHROPLASTY,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01215,CPT,ANESTHESIA OPEN REVISION TOTAL HIP ARTHROPLASTY,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01220,CPT,ANESTHESIA UPPER 2/3 FEMUR CLOSED PROCEDURES,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01230,CPT,ANESTHESIA UPPER 2/3 FEMUR OPEN PROCEDURES,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01232,CPT,ANESTHESIA UPPER 2/3 FEMUR AMPUTATION,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01234,CPT,ANES UPPER 2/3 FEMUR RADICAL RESCECTION,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01250,CPT,ANES NERVE MUSC TENDON FASCIA&BURSAE UPPER LEG,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01260,CPT,ANES VEINS OF UPPER LEG INCLUDING EXPLORATION,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0126T,CPT,COMMON CAROTID INTIMA MEDIA THICKNESS STUDY,,,4 ,,TotalUnits,,,,1.75 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,01270,CPT,ANESTHESIA ARTERIES UPPER LEG INCL BYPASS GRAFT,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01272,CPT,ANES ART UPPER LEG W/BYPASS GRAFT FEM ART LIG,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01274,CPT,ANES ARTERIES UPPER LEG W/BYP GRF FEM ART EMBLC,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01320,CPT,ANES NERVE MUSC TENDON FSCA&BRS KNEE&/POP AREA,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01340,CPT,ANESTHESIA LOWER 1/3 FEMUR CLOSED PROCEDURES,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01360,CPT,ANESTHESIA LOWER 1/3 FEMUR OPEN PROCEDURES,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01380,CPT,ANESTHESIA KNEE JOINT CLOSED PROCEDURES,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01382,CPT,ANESTHESIA DIAGNOSTIC ARTHROSCOPIC KNEE JOINT,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01390,CPT,ANES UPPER ENDS TIBIA FIBULA&/PATELLA CLOSED,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01392,CPT,ANES UPPER ENDS TIBIA FIBULA&/PATELLA OPEN,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01400,CPT,ANES OPEN/SURGICAL ARTHROSCOPIC KNEE JOINT,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01402,CPT,ANESTHESIA ARTHROSCOPIC TOTAL KNEE ARTHROPLASTY,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01404,CPT,ANESTHESIA ARTHROSCOPIC KNEE DISARTICULATION,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01420,CPT,ANES CAST APPLICATION REMOVAL/REPAIR KNEE JOINT,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01430,CPT,ANESTHESIA VEINS KNEE & POPLITEAL AREA,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01432,CPT,ANESTHESIA VEINS KNEE & POPLITEAL ARVEN FISTULA,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01440,CPT,ANESTHESIA ARTERIES OF KNEE & POPLITEAL AREA,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01442,CPT,ANES ART KNEE & POP/POP TEAEC +-PATCH GRAFT,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01444,CPT,ANES ART KNE&POP/POP EXC&GRF/RPR OCCLS/ARYSM,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01462,CPT,ANESTHESIA LOWER LEG ANKLE & FOOT CLOSED PX,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01464,CPT,ANESTHESIA ANKLE &/FOOT ARTHROSCOPIC PX,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01470,CPT,ANES NRV/MUS/TND/FASC LOWER LEG/ANKLE/FOOT,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01472,CPT,ANES RPR RUPTURED ACHILLES TENDON +-PATCH GRAFT,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01474,CPT,ANESTHESIA GASTROCNEMIUS RECESSION,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01480,CPT,ANESTHESIA BONES LOWER LEG/ANKLE/FOOT OPEN PX,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01482,CPT,ANES RADICAL RESECTION INCL BELOW KNEE AMP,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01484,CPT,ANES OSTEOTOMY/OSTEOPLASTY TIBIA&/FIBULA OPEN,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01486,CPT,ANESTHESIA TOTAL ANKLE REPLACEMENT OPEN,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01490,CPT,ANES LOWER LEG CAST APPLICATION REMOVAL/REPAIR,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01500,CPT,ANESTHESIA ARTERIES LOWER LEG W/BYPASS GRAFT,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01502,CPT,ANES ART LOWER LEG W/BYP GRAFT EMBLC DIR/W/CATH,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01520,CPT,ANESTHESIA VEINS OF LOWER LEG,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01522,CPT,ANES VEINS LOWER LEG VENOUS THRMBC DIR/W/CATH,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0159T,CPT,COMPUTER AIDED DETECTION BREAST MRI,,,20 ,,TotalUnits,,,,1.84 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,0159T,CPT,COMPUTER AIDED DETECTION BREAST MRI,,PC,20 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,0159T,CPT,COMPUTER AIDED DETECTION BREAST MRI,,TC,20 ,,TotalUnits,,,,1.25 ,,$0.00,$0.00,1,1,0,0,1,0,20120101,01610,CPT,ANES NERVE MUSCLE TENDON FSCA&BRS SHO&AXILLA,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01620,CPT,ANES CLOSED HUMRL H/N STRNCLAV JOINT&SHO JOINT,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01622,CPT,ANES SHOULDER JOINT DIAGNOSTIC ARTHROSCOPIC PX,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01630,CPT,ANES ARTHRS HUMERAL H/N STRNCLAV&SHOULDER JOINT,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01634,CPT,ANESTHESIA ARTHROSCOPIC SHOULDER DISARTICULATION,,,3 ,,Anesth,,,,,9.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01636,CPT,ANES ARTHRS INTERTHORACOSCAPULAR AMPUTATION,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01638,CPT,ANES ARTHROSCOPIC TOTAL SHOULDER REPLACEMENT,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01650,CPT,ANESTHESIA ARTERIES SHOULDER & AXILLA,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01652,CPT,ANESTHESIA AXILLARY-BRACHIAL ANEURYSM,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01654,CPT,ANES ARTERIES SHOULDER & AXILLA BYPASS GRAFT,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01656,CPT,ANESTHESIA AXILLARY-FEMORAL BYPASS GRAFT,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01670,CPT,ANESTHESIA VEINS SHOULDER & AXILLA,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01680,CPT,ANES SHOULDER CAST APPLICATION REMOVAL/REPAIR,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01682,CPT,ANES SHOULDER SPICA APPLICATION REMOVAL/REPAIR,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01710,CPT,ANES NRV MUSC TDN FSCA&BRS UPR ARM/ELBOW,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01712,CPT,ANESTHESIA TENOTOMY ELBOW TO SHOULDER OPEN,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01714,CPT,ANESTHESIA TENOPLASTY ELBOW TO SHOULDER,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01716,CPT,ANESTHESIA BICEPS TENODESIS RUPTURE LONG TENDON,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0171T,CPT,PST SPINOUS PROCESS DEVICE INSERT LMBR 1 LVL,,,21 ,,TotalUnits,,,,36.04 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,0172T,CPT,PST SPINOUS PROCESS DEVICE INSERT LMBR EA LVL,,,21 ,,TotalUnits,,,,18.02 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,01730,CPT,ANESTHESIA HUMERUS & ELBOW CLOSED PX,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01732,CPT,ANESTHESIA ELBOW JOINT DIAGNOSTIC ARTHROSCOPIC,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01740,CPT,ANESTHESIA ELBOW OPEN/SURGICAL ARTHROSCOPIC,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01742,CPT,ANESTHESIA HUMERUS ARTHROSCOPIC OSTEOTOMY,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01744,CPT,ANES HUMERUS ARTHROSCOPIC REPAIR NON/MALUNION,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0174T,CPT,CAD CHEST RADIOGRAPH CONCURRENT W/INTERPRETATION,,,20 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,01756,CPT,ANESTHESIA ELBOW ARTHROSCOPIC RADICAL PX,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01758,CPT,ANES HUMERUS ARTHROSCOPIC EXCISION CYST/TUMOR,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01760,CPT,ANES ARTHROSCOPIC TOTAL ELBOW REPLACEMENT,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01770,CPT,ANESTHESIA ARTERIES UPPER ARM & ELBOW,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01772,CPT,ANESTHESIA ARTERIES UPPER ARM&ELBOW EMBOLECTOMY,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01780,CPT,ANESTHESIA VEINS UPPER ARM & ELBOW,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01782,CPT,ANESTHESIA VEINS UPPER ARM&ELBOW PHLEBORRHAPHY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01810,CPT,ANES NERVE MUSCLE TDN FSCA&BRS F/ARM WRST&HAND,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0181T,CPT,CORNEAL HYSTERESIS AIR IMPULSE STIMJ BI W/I&R,,,14 ,,TotalUnits,,,,1.75 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,01820,CPT,ANES RADIUS ULNA WRIST/HAND BONES CLOSED PX,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01829,CPT,ANESTHESIA WRIST DIAGNOSTIC ARTHROSCOPIC,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01830,CPT,ANES ARTHRS/ENDOSCOPIC DSTL RADIUS DSTL U/W/H,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01832,CPT,ANESTHESIA ARTHROSCOPIC TOTAL WRIST REPLACEMENT,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0183T,CPT,LOW FREQUENCY WOUND ULTRASOUND,,,20 ,,TotalUnits,,,,1.22 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,01840,CPT,ANESTHESIA ARTERIES FOREARM WRIST & HAND,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01842,CPT,ANES ARTERIES FOREARM WRIST&HAND EMBOLECTOMY,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01844,CPT,ANESTHESIA VASCULAR SHUNT/SHUNT REVISION,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01850,CPT,ANESTHESIA VEINS FOREARM WRIST & HAND,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01852,CPT,ANES VEINS FOREARM WRIST&HAND PHLEBORRHAPHY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01860,CPT,ANES FOREARM WRIST/HAND CAST APPL RMVL/REPAIR,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01916,CPT,ANESTHESIA DIAGNOSTIC ARTERIOGRAPHY/VENOGRAPH,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01920,CPT,ANES C-CATHJ W/C ANGIOGRAPHY&VENTRICULOGRAPHY,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01922,CPT,ANES NON-INVASIVE IMAGING/RADIATION THERAPY,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01924,CPT,ANESTHESIA THER IVNTL RADIOLOGICAL ARTERIAL,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01925,CPT,ANESTHESIA CAROTID/CORONARY THER IVNTL RAD,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01926,CPT,ANES ICRA ICAR/AORTIC THER IVNTL RAD ARTL,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0192T,CPT,ANT SEGMENT INSERTION DRAINAGE W/O RESERVOIR EXT,,,21 ,,TotalUnits,,,,27.39 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,01930,CPT,ANESTHESIA VENOUS/LYMPHATIC NOS THER IVNTL RAD,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01931,CPT,ANESTHESIA INTRAHEPATIC/PORTAL THER IVNTL RAD,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01932,CPT,ANESTHESIA INTRATHORACIC/JUGULAR THER IVNTL RAD,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01933,CPT,ANES INTRACRANIAL THER IVNTL RAD VENS/LYMPHTC,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01935,CPT,ANESTHESIA PERQ IMAGE GUIDED SPINE DIAGNOSTIC,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01936,CPT,ANESTHESIA PERQ IMAGE GUIDED SPINE THERAPEUTIC,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01951,CPT,ANES 2/3 DGR BRN EXC/DBRDMT +-GRF <4 % TBSA,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01952,CPT,ANES 2/3 DGR BRN EXC/DBRDMT +-GRF 4-9 % TBSA,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01953,CPT,ANES 2/3 DGR BRN EXC/DBRDMT +-GRF EA >9 % TBSA,,,3 ,,Anesth,,,,,1.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01958,CPT,ANESTHESIA EXTERNAL CEPHALIC VERSION,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01960,CPT,ANESTHESIA VAGINAL DELIVERY ONLY,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01961,CPT,ANESTHESIA CESAREAN DELIVERY ONLY,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01962,CPT,ANES URGENT HYSTERECTOMY FOLLOWING DELIVERY,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01963,CPT,ANESTHESIA C HYST W/O ANY LABOR ANALG/ANES CARE,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01965,CPT,ANESTHESIA INCOMPLETE/MISSED ABORTION,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01966,CPT,ANESTHESIA INDUCED ABORTION,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01967,CPT,NEURAXIAL LABOR ANALG/ANES PLND VAG DLVR,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01968,CPT,ANES C DLVR FLWG NEURAXIAL LABOR ANALG/ANES,,,3 ,,Anesth,,,,,2.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01969,CPT,ANES C HYST FLWG NEURAXIAL LABOR ANALG/ANES,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0197T,CPT,IFXJ LOCLZ&TRAKG TRGT/PT MTN DUR RADTX EA FXJ,,,20 ,,TotalUnits,,,,2.23 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,0198T,CPT,MEAS OCULAR BLOOD FLOW REPEAT IO PRES SAMP W/I&R,,,20 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,01990,CPT,PHYSIOL SUPPORT HRVG ORGAN FROM BRN-DEAD PT,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01991,CPT,ANES DX/THER NRV BLK/NJX OTH/THN PRONE POS,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01992,CPT,ANES DX/THER NERVE BLOCK/INJECTION PRONE POS,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,01996,CPT,DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN,,,3 ,,TotalUnits,,,,3.00 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,01999,CPT,UNLISTED ANESTHESIA PROCEDURE,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20120101,0228T,CPT,NJX ANES/STEROID TFRML EDRL W/US CER/THOR 1 LVL,,,21 ,,TotalUnits,,,,7.09 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,0229T,CPT,NJX ANES/STERD TFRML EDRL W/US CER/THOR EA ADDL,,,21 ,,TotalUnits,,,,3.53 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,0230T,CPT,NJX ANES/STEROID TFRML EDRL W/US LUM/SAC 1 LVL,,,21 ,,TotalUnits,,,,6.90 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,0231T,CPT,NJX ANES/STEROID TFRML EDRL W/US LUM/SAC EA ADDL,,,21 ,,TotalUnits,,,,3.48 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,0234T,CPT,TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA,,,21 ,,RBRVS,5.53 ,2.54 ,2.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,0235T,CPT,TRLUML PERIPHERAL ATHERECTOMY VISCERAL ARTERY EA,,,21 ,,RBRVS,5.53 ,2.54 ,2.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,0236T,CPT,TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA,,,21 ,,RBRVS,7.60 ,3.18 ,3.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,0237T,CPT,TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL,,,21 ,,RBRVS,10.42 ,4.80 ,4.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,0238T,CPT,TRLUML PERIPHERAL ATHERECTOMY ILIAC ARTERY EA,,,21 ,,RBRVS,6.64 ,3.19 ,3.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,0241T,CPT,ESOPH/GASTROESOPH MOTILITY W/STIM/PERFU W/I&R,,,14 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,0241T,CPT,ESOPH/GASTROESOPH MOTILITY W/STIM/PERFU W/I&R,26,,14 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,0241T,CPT,ESOPH/GASTROESOPH MOTILITY W/STIM/PERFU W/I&R,TC,,14 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,0252T,CPT,BRONCHOSCOPY REMOVAL BRONCH VALVE EA ADDL LOBE,,,21 ,,TotalUnits,,,,12.58 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,10021,CPT,FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE,,,21 ,,RBRVS,1.27 ,0.58 ,2.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,10022,CPT,FINE NEEDLE ASPIRATION WITH IMAGING GUIDANCE,,,21 ,,RBRVS,1.27 ,0.52 ,2.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,10040,CPT,ACNE SURGERY,,,21 ,,RBRVS,1.21 ,1.22 ,1.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,10060,CPT,INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE,,,21 ,,RBRVS,1.22 ,1.37 ,1.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,10061,CPT,INCISION&DRAINAGE ABSCESS COMPLICATED/MULTIPLE,,,21 ,,RBRVS,2.45 ,1.93 ,2.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,10080,CPT,INCISION & DRAINAGE PILONIDAL CYST SIMPLE,,,21 ,,RBRVS,1.22 ,1.46 ,3.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,10081,CPT,INCISION & DRAINAGE PILONIDAL CYST COMPLICATED,,,21 ,,RBRVS,2.50 ,1.97 ,4.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,10120,CPT,INCISION&REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,,,21 ,,RBRVS,1.25 ,1.25 ,2.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,10121,CPT,INCISION&REMOVAL FOREIGN BODY SUBQ TISS COMPL,,,21 ,,RBRVS,2.74 ,2.21 ,4.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,10140,CPT,I&D HEMATOMA SEROMA/FLUID COLLECTION,,,21 ,,RBRVS,1.58 ,1.63 ,2.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,10160,CPT,PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST,,,21 ,,RBRVS,1.25 ,1.36 ,2.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,10180,CPT,INCISION&DRAINAGE COMPLEX PO WOUND INFECTION,,,21 ,,RBRVS,2.30 ,2.38 ,4.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11000,CPT,DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF,,,21 ,,RBRVS,0.60 ,0.22 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11001,CPT,DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10% BDY SURF,,,21 ,,RBRVS,0.30 ,0.11 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11004,CPT,DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT&PR,,,21 ,,RBRVS,10.80 ,4.53 ,4.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11005,CPT,DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL,,,21 ,,RBRVS,14.24 ,5.87 ,5.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11006,CPT,DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT/ABDL,,,21 ,,RBRVS,13.10 ,5.57 ,5.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11008,CPT,REMOVAL PROSTHETIC MATRL ABDL WALL FOR INFECTION,,,21 ,,RBRVS,5.00 ,2.06 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11010,CPT,DBRDMT W/RMVL FM FX&/DISLC SKN&SUBQ TISS,,,21 ,,RBRVS,4.19 ,3.27 ,8.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11011,CPT,DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC,,,21 ,,RBRVS,4.94 ,2.91 ,9.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11012,CPT,DBRDMT FX&/DISLC SUBQ T/M/F BONE,,,21 ,,RBRVS,6.87 ,4.44 ,12.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11042,CPT,DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<,,,21 ,,RBRVS,0.80 ,0.49 ,1.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11043,CPT,DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<,,,21 ,,RBRVS,2.00 ,1.27 ,3.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11044,CPT,DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<,,,21 ,,RBRVS,3.60 ,2.02 ,4.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11045,CPT,DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM<,,,21 ,,RBRVS,0.33 ,0.13 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11046,CPT,DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM,,,21 ,,RBRVS,0.70 ,0.30 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11047,CPT,DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM/<,,,21 ,,RBRVS,1.20 ,0.53 ,1.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11055,CPT,PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,,,21 ,,RBRVS,0.43 ,0.14 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11056,CPT,PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4,,,21 ,,RBRVS,0.61 ,0.20 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11057,CPT,PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4,,,21 ,,RBRVS,0.79 ,0.26 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11100,CPT,BX SKIN SUBCUTANEOUS&/MUCOUS MEMBRANE 1 LESION,,,21 ,,RBRVS,0.81 ,0.54 ,2.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11101,CPT,BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESION,,,21 ,,RBRVS,0.41 ,0.28 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11200,CPT,REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UP&W/15,,,21 ,,RBRVS,0.82 ,1.14 ,1.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11201,CPT,REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10<,,,21 ,,RBRVS,0.29 ,0.16 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11300,CPT,SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<,,,21 ,,RBRVS,0.51 ,0.30 ,1.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11301,CPT,SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,,,21 ,,RBRVS,0.85 ,0.54 ,1.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11302,CPT,SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,,,21 ,,RBRVS,1.05 ,0.68 ,2.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11303,CPT,SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,,,21 ,,RBRVS,1.24 ,0.78 ,2.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11305,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<,,,21 ,,RBRVS,0.67 ,0.27 ,1.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11306,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM,,,21 ,,RBRVS,0.99 ,0.51 ,1.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11307,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,,,21 ,,RBRVS,1.14 ,0.65 ,1.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11308,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM,,,21 ,,RBRVS,1.41 ,0.68 ,2.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11310,CPT,SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<,,,21 ,,RBRVS,0.73 ,0.45 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11311,CPT,SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,,,21 ,,RBRVS,1.05 ,0.68 ,1.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11312,CPT,SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,,,21 ,,RBRVS,1.20 ,0.79 ,2.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11313,CPT,SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,,,21 ,,RBRVS,1.62 ,1.04 ,2.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11400,CPT,EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<,,,21 ,,RBRVS,0.90 ,1.23 ,2.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11401,CPT,EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM,,,21 ,,RBRVS,1.28 ,1.49 ,2.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11402,CPT,EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM,,,21 ,,RBRVS,1.45 ,1.59 ,3.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11403,CPT,EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/>,,,21 ,,RBRVS,1.84 ,2.03 ,3.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11404,CPT,EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM,,,21 ,,RBRVS,2.11 ,2.15 ,3.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11406,CPT,EXC B9 LES MRGN XCP SK TG T/A/L > 4.0 CM,,,21 ,,RBRVS,3.52 ,2.79 ,4.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11420,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,,,21 ,,RBRVS,1.03 ,1.20 ,2.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11421,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM,,,21 ,,RBRVS,1.47 ,1.52 ,2.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11422,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM,,,21 ,,RBRVS,1.68 ,1.95 ,3.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11423,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM,,,21 ,,RBRVS,2.06 ,2.14 ,3.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11424,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,,,21 ,,RBRVS,2.48 ,2.29 ,3.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11426,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM,,,21 ,,RBRVS,4.09 ,3.10 ,4.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11440,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<,,,21 ,,RBRVS,1.05 ,1.71 ,2.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11441,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM,,,21 ,,RBRVS,1.53 ,2.01 ,3.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11442,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM,,,21 ,,RBRVS,1.77 ,2.15 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11443,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM,,,21 ,,RBRVS,2.34 ,2.45 ,3.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11444,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM,,,21 ,,RBRVS,3.19 ,2.88 ,4.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11446,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM,,,21 ,,RBRVS,4.80 ,3.80 ,5.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11450,CPT,EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR,,,21 ,,RBRVS,3.22 ,3.20 ,6.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11451,CPT,EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR,,,21 ,,RBRVS,4.43 ,3.82 ,8.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11462,CPT,EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR,,,21 ,,RBRVS,3.00 ,3.19 ,6.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11463,CPT,EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR,,,21 ,,RBRVS,4.43 ,3.99 ,8.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11470,CPT,EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR,,,21 ,,RBRVS,3.74 ,3.53 ,7.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11471,CPT,EXCISION H/P/P/U COMPLEX REPAIR,,,21 ,,RBRVS,4.89 ,4.07 ,8.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11600,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<,,,21 ,,RBRVS,1.63 ,1.52 ,3.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11601,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM,,,21 ,,RBRVS,2.07 ,1.96 ,4.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11602,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM,,,21 ,,RBRVS,2.27 ,2.17 ,4.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11603,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/>,,,21 ,,RBRVS,2.82 ,2.44 ,4.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11604,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM,,,21 ,,RBRVS,3.17 ,2.56 ,5.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11606,CPT,EXCISION MALIGNANT LESION TRUNK/ARM/LEG >4.0 CM,,,21 ,,RBRVS,5.02 ,3.34 ,6.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11620,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<,,,21 ,,RBRVS,1.64 ,1.57 ,3.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11621,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM,,,21 ,,RBRVS,2.08 ,1.99 ,4.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11622,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM,,,21 ,,RBRVS,2.41 ,2.27 ,4.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11623,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/>,,,21 ,,RBRVS,3.11 ,2.61 ,5.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11624,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM,,,21 ,,RBRVS,3.62 ,2.81 ,5.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11626,CPT,EXCISION MALIGNANT LESION S/N/H/F/G > 4.0 CM,,,21 ,,RBRVS,4.61 ,3.26 ,6.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11640,CPT,EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<,,,21 ,,RBRVS,1.67 ,1.69 ,3.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11641,CPT,EXCISION MALIGNANT LES F/E/E/N/L 0.6-1.0 CM,,,21 ,,RBRVS,2.17 ,2.12 ,4.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11642,CPT,EXCISION MALIGNANT LES F/E/E/N/L 1.1-2.0 CM,,,21 ,,RBRVS,2.62 ,2.43 ,4.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11643,CPT,EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/>,,,21 ,,RBRVS,3.42 ,2.84 ,5.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11644,CPT,EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM,,,21 ,,RBRVS,4.34 ,3.38 ,6.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11646,CPT,EXCISION MALIGNANT LESION F/E/E/N/L > 4.0 CM,,,21 ,,RBRVS,6.26 ,4.44 ,7.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11719,CPT,TRIMMING NONDYSTROPHIC NAILS ANY NUMBER,,,21 ,,RBRVS,0.17 ,0.06 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11720,CPT,DEBRIDEMENT NAIL ANY METHOD 1-5,,,21 ,,RBRVS,0.32 ,0.10 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11721,CPT,DEBRIDEMENT NAIL ANY METHOD 6/>,,,21 ,,RBRVS,0.54 ,0.18 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11730,CPT,AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1,,,21 ,,RBRVS,1.10 ,0.36 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11732,CPT,AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL,,,21 ,,RBRVS,0.57 ,0.19 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11740,CPT,EVACUATION SUBUNGUAL HEMATOMA,,,21 ,,RBRVS,0.37 ,0.52 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11750,CPT,EXCISION NAIL MATRIX PERMANENT REMOVAL,,,21 ,,RBRVS,2.50 ,2.30 ,3.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11752,CPT,EXC NAIL MATRIX PRM RMVL W/AMP TUFT DSTL PHALANX,,,21 ,,RBRVS,3.63 ,3.57 ,4.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11755,CPT,BIOPSY NAIL UNIT SEPARATE PROCEDURE,,,21 ,,RBRVS,1.31 ,0.93 ,2.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11760,CPT,REPAIR NAIL BED,,,21 ,,RBRVS,1.63 ,1.94 ,4.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11762,CPT,RECONSTRUCTION NAIL BED W/GRAFT,,,21 ,,RBRVS,2.94 ,2.24 ,4.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11765,CPT,WEDGE EXCISION SKIN NAIL FOLD,,,21 ,,RBRVS,0.74 ,1.20 ,3.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11770,CPT,EXCISION PILONIDAL CYST/SINUS SIMPLE,,,21 ,,RBRVS,2.66 ,2.06 ,4.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11771,CPT,EXCISION PILONIDAL CYST/SINUS EXTENSIVE,,,21 ,,RBRVS,6.09 ,4.98 ,8.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11772,CPT,EXCISION PILONIDAL CYST/SINUS COMPLICATED,,,21 ,,RBRVS,7.35 ,7.24 ,10.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11900,CPT,INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS,,,21 ,,RBRVS,0.52 ,0.34 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11901,CPT,INJECTION INTRALESIONAL >7 LESIONS,,,21 ,,RBRVS,0.80 ,0.54 ,1.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11920,CPT,TATTOOING INCL MICROPIGMENTATION 6.0 CM/<,,,21 ,,RBRVS,1.61 ,1.48 ,3.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11921,CPT,TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM,,,21 ,,RBRVS,1.93 ,1.71 ,3.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11922,CPT,TATTOOING INCL MICROPIGMENTATION EA 20.0 CM,,,21 ,,RBRVS,0.49 ,0.31 ,1.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11950,CPT,SUBCUTANEOUS INJECTION FILLING MATERIAL 1 CC/<,,,21 ,,RBRVS,0.84 ,0.49 ,1.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11951,CPT,SUBCUTANEOUS INJECTION FILLING MATRL 1.1-5.0 CC,,,21 ,,RBRVS,1.19 ,0.69 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11952,CPT,SUBCUTANEOUS INJECTION FILLING MATRL 5.1-10.0CC,,,21 ,,RBRVS,1.69 ,0.88 ,1.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11954,CPT,SUBCUTANEOUS INJECTION FILLING MATRL > 10.0 CC,,,21 ,,RBRVS,1.85 ,1.23 ,2.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11960,CPT,INSERTION TISSUE EXPANDER INCL SBSQ XPNSJ,,,21 ,,RBRVS,11.49 ,13.02 ,13.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11970,CPT,REPLACEMENT TISS EXPANDER PERMANENT PROSTHESIS,,,21 ,,RBRVS,8.01 ,8.32 ,8.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11971,CPT,REMOVAL TISS EXPANDER W/O INSERTION PROSTHESIS,,,21 ,,RBRVS,3.41 ,5.08 ,9.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11976,CPT,REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES,,,21 ,,RBRVS,1.78 ,0.75 ,2.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11980,CPT,SUBCUTANEOUS HORMONE PELLET IMPLANTATION,,,21 ,,RBRVS,1.48 ,0.68 ,1.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11981,CPT,INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,,,21 ,,RBRVS,1.48 ,0.74 ,2.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11982,CPT,REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,,,21 ,,RBRVS,1.78 ,0.90 ,2.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,11983,CPT,RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,,,21 ,,RBRVS,3.30 ,1.55 ,2.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12001,CPT,SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<,,,21 ,,RBRVS,0.84 ,0.64 ,1.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12002,CPT,SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM,,,21 ,,RBRVS,1.14 ,0.75 ,1.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12004,CPT,SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM,,,21 ,,RBRVS,1.44 ,0.85 ,2.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12005,CPT,SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM,,,21 ,,RBRVS,1.97 ,1.03 ,2.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12006,CPT,SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM,,,21 ,,RBRVS,2.39 ,1.27 ,3.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12007,CPT,SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM,,,21 ,,RBRVS,2.90 ,1.49 ,3.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12011,CPT,SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<,,,21 ,,RBRVS,1.07 ,0.68 ,2.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12013,CPT,SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0CM,,,21 ,,RBRVS,1.22 ,0.77 ,2.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12014,CPT,SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5CM,,,21 ,,RBRVS,1.57 ,0.89 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12015,CPT,SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5CM,,,21 ,,RBRVS,1.98 ,1.03 ,2.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12016,CPT,SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0CM,,,21 ,,RBRVS,2.68 ,1.29 ,3.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12017,CPT,SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0CM,,,21 ,,RBRVS,3.18 ,1.34 ,1.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12018,CPT,SIMPLE REPAIR F/E/E/N/L/M >30.0CM,,,21 ,,RBRVS,3.61 ,1.77 ,1.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12020,CPT,TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE,,,21 ,,RBRVS,2.67 ,2.33 ,4.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12021,CPT,TX SUPERFICIAL WOUND DEHISCENCE W/PACKING,,,21 ,,RBRVS,1.89 ,1.80 ,2.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12031,CPT,REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<,,,21 ,,RBRVS,2.20 ,2.19 ,4.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12032,CPT,REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM,,,21 ,,RBRVS,2.52 ,2.83 ,5.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12034,CPT,REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM,,,21 ,,RBRVS,2.97 ,2.51 ,5.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12035,CPT,REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM,,,21 ,,RBRVS,3.47 ,2.81 ,6.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12036,CPT,REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM,,,21 ,,RBRVS,4.09 ,3.05 ,6.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12037,CPT,REPAIR INTERMEDIATE S/A/T/E > 30.0 CM,,,21 ,,RBRVS,4.71 ,3.57 ,7.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12041,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<,,,21 ,,RBRVS,2.42 ,2.24 ,4.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12042,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM,,,21 ,,RBRVS,2.79 ,2.65 ,5.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12044,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM,,,21 ,,RBRVS,3.19 ,2.51 ,6.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12045,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM,,,21 ,,RBRVS,3.68 ,2.78 ,6.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12046,CPT,RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM,,,21 ,,RBRVS,4.29 ,3.29 ,7.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12047,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM,,,21 ,,RBRVS,4.69 ,3.47 ,8.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12051,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<,,,21 ,,RBRVS,2.52 ,2.44 ,4.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12052,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-53.0 CM/>,,,21 ,,RBRVS,2.87 ,3.10 ,5.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12053,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM,,,21 ,,RBRVS,3.17 ,2.68 ,6.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12054,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM,,,21 ,,RBRVS,3.50 ,2.59 ,6.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12055,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM,,,21 ,,RBRVS,4.47 ,2.79 ,7.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12056,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30.0CM,,,21 ,,RBRVS,5.28 ,4.12 ,8.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,12057,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC > 30.0 CM,,,21 ,,RBRVS,6.00 ,4.39 ,10.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,13100,CPT,REPAIR COMPLEX TRUNK 1.1 CM-2.5 CM,,,21 ,,RBRVS,3.17 ,3.23 ,5.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,13101,CPT,REPAIR COMPLEX TRUNK 2.6 CM-7.5 CM,,,21 ,,RBRVS,3.96 ,3.84 ,7.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,13102,CPT,REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<,,,21 ,,RBRVS,1.24 ,0.76 ,1.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,13120,CPT,REPAIR COMPLEX SCALP/ARM/LEG 1.1 CM-2.5 CM,,,21 ,,RBRVS,3.35 ,3.36 ,5.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,13121,CPT,REPAIR COMPLEX SCALP/ARM/LEG 2.6 CM-7.5 CM,,,21 ,,RBRVS,4.42 ,4.56 ,7.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,13122,CPT,REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<,,,21 ,,RBRVS,1.44 ,0.85 ,1.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,13131,CPT,REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1 CM-2.5 CM,,,21 ,,RBRVS,3.83 ,3.73 ,6.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,13132,CPT,REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6 CM-7.5 CM,,,21 ,,RBRVS,6.58 ,6.34 ,9.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,13133,CPT,REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<,,,21 ,,RBRVS,2.19 ,1.41 ,2.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,13150,CPT,REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.0 CM/<,,,21 ,,RBRVS,3.85 ,3.63 ,5.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,13151,CPT,REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM,,,21 ,,RBRVS,4.49 ,4.23 ,6.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,13152,CPT,REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM,,,21 ,,RBRVS,6.37 ,5.28 ,9.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,13153,CPT,REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<,,,21 ,,RBRVS,2.38 ,1.48 ,2.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,13160,CPT,SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC,,,21 ,,RBRVS,12.04 ,9.41 ,9.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,14000,CPT,ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 CM/<,,,21 ,,RBRVS,6.37 ,7.38 ,10.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,14001,CPT,ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM,,,21 ,,RBRVS,8.78 ,9.22 ,13.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,14020,CPT,ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<,,,21 ,,RBRVS,7.22 ,8.50 ,11.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,14021,CPT,ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM,,,21 ,,RBRVS,9.72 ,10.34 ,14.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,14040,CPT,ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<,,,21 ,,RBRVS,8.60 ,9.12 ,12.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,14041,CPT,ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM,,,21 ,,RBRVS,10.83 ,11.02 ,15.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,14060,CPT,ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<,,,21 ,,RBRVS,9.23 ,9.50 ,12.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,14061,CPT,ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM,,,21 ,,RBRVS,11.48 ,11.86 ,16.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,14301,CPT,ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM,,,21 ,,RBRVS,12.65 ,12.25 ,17.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,14302,CPT,ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<,,,21 ,,RBRVS,3.73 ,2.54 ,2.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,14350,CPT,FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE,,,21 ,,RBRVS,11.05 ,8.58 ,8.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15002,CPT,PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT,,,21 ,,RBRVS,3.65 ,2.36 ,5.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15003,CPT,PREP SITE T/A/L ADDL 100 SQ CM/1PCT,,,21 ,,RBRVS,0.80 ,0.38 ,1.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15004,CPT,PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT,,,21 ,,RBRVS,4.58 ,2.80 ,6.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15005,CPT,PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT,,,21 ,,RBRVS,1.60 ,0.76 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15040,CPT,HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<,,,21 ,,RBRVS,2.00 ,1.37 ,4.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15050,CPT,PINCH GRAFT 1/MLT C> SM ULCER TIP/OTH AREA 2CM,,,21 ,,RBRVS,5.57 ,6.64 ,9.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15100,CPT,SPLIT AGRFT T/A/L 1ST 100 CM/</1% BDY INFT/CHLD,,,21 ,,RBRVS,9.90 ,9.22 ,13.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15101,CPT,SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD,,,21 ,,RBRVS,1.72 ,1.22 ,3.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15110,CPT,EPIDRM AGRFT T/A/L 1ST 100 CM/</1% BDY INFT/CHLD,,,21 ,,RBRVS,10.97 ,8.48 ,11.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15111,CPT,EPIDRM AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD,,,21 ,,RBRVS,1.85 ,0.88 ,1.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15115,CPT,EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/<,,,21 ,,RBRVS,11.28 ,9.13 ,12.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15116,CPT,EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/<,,,21 ,,RBRVS,2.50 ,1.54 ,1.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15120,CPT,SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %,,,21 ,,RBRVS,11.16 ,10.12 ,14.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15121,CPT,SPLIT AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA 1 %,,,21 ,,RBRVS,2.67 ,1.88 ,4.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15130,CPT,DERMAL AUTOGRAFT TRUNK/ARM/LEG 1ST 100 CM,,,21 ,,RBRVS,7.53 ,7.53 ,10.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15131,CPT,DERMAL AUTOGRAFT TRUNK/ARM/LEG EA 100 CM/EA,,,21 ,,RBRVS,1.50 ,0.90 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15135,CPT,DERMAL AUTOGRAFT F/S/N/H/F/G/M/D GT 1ST 100,,,21 ,,RBRVS,11.03 ,9.58 ,12.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15136,CPT,DERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA,,,21 ,,RBRVS,1.50 ,0.80 ,0.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15150,CPT,CLTR SKIN AUTOGRAFT T/A/L 1ST 25 CM/<,,,21 ,,RBRVS,9.39 ,7.14 ,8.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15151,CPT,CLTR SKIN AGRFT T/A/L ADDL 1 CM-75 CM,,,21 ,,RBRVS,2.00 ,1.17 ,1.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15152,CPT,CLTR SKIN AGRFT T/A/L EA 100 CM/EA 1%BODY AREA,,,21 ,,RBRVS,2.50 ,1.26 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15155,CPT,CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT 1ST 25CM/<,,,21 ,,RBRVS,10.14 ,6.52 ,7.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15156,CPT,CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT ADDL 1-75CM,,,21 ,,RBRVS,2.75 ,1.34 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15157,CPT,CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT EA 100 EA,,,21 ,,RBRVS,3.00 ,1.24 ,1.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15200,CPT,FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 CM/<,,,21 ,,RBRVS,9.15 ,8.81 ,13.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15201,CPT,FTH/GFT FR W/DIR CLSR TRNK EA ADDL 20 CM<,,,21 ,,RBRVS,1.32 ,0.80 ,2.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15220,CPT,FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 CM/<,,,21 ,,RBRVS,8.09 ,8.79 ,12.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15221,CPT,FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 CM<,,,21 ,,RBRVS,1.19 ,0.73 ,2.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15240,CPT,FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<,,,21 ,,RBRVS,10.41 ,11.53 ,15.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15241,CPT,FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<,,,21 ,,RBRVS,1.86 ,1.18 ,3.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15260,CPT,FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<,,,21 ,,RBRVS,11.64 ,12.15 ,16.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15261,CPT,FTH/GFT FREE W/DIR CLSR N/E/E/L EA 20 SQ CM/<,,,21 ,,RBRVS,2.23 ,1.66 ,3.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15271,CPT,APP SKN SUB GRFT T/A/L AREA/<100SCM /<1ST 25 SCM,,,21 ,,RBRVS,1.50 ,0.83 ,2.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15272,CPT,APP SKN SUB GRFT T/A/L AREA/<100SCM EA ADL 25SCM,,,21 ,,RBRVS,0.33 ,0.14 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15273,CPT,APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM,,,21 ,,RBRVS,3.50 ,2.03 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15274,CPT,APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM,,,21 ,,RBRVS,0.80 ,0.40 ,1.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15275,CPT,SUB GRFT F/S/N/H/F/G/M/D /<100SCM /<1ST 25 SCM,,,21 ,,RBRVS,1.83 ,0.85 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15276,CPT,SUB GRFT F/S/N/H/F/G/M/D /<100SCM EA ADL 25SCM,,,21 ,,RBRVS,0.50 ,0.17 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15277,CPT,SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM,,,21 ,,RBRVS,4.00 ,1.76 ,4.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15278,CPT,SUB GRFT F/S/N/H/F/G/M/D />100SCM ADL 100SCM,,,21 ,,RBRVS,1.00 ,0.48 ,1.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15570,CPT,FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK,,,21 ,,RBRVS,10.21 ,8.96 ,13.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15572,CPT,FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS,,,21 ,,RBRVS,10.12 ,9.69 ,13.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15574,CPT,FRMJ DIR/TUBE PEDCL W/WOTR FT/CH/CH/M/N/AX/G/H/F,,,21 ,,RBRVS,10.70 ,10.07 ,13.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15576,CPT,FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL,,,21 ,,RBRVS,9.37 ,8.97 ,12.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15600,CPT,DELAY FLAP/SECTIONING FLAP TRUNK,,,21 ,,RBRVS,2.01 ,3.61 ,7.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15610,CPT,DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS,,,21 ,,RBRVS,2.52 ,4.05 ,6.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15620,CPT,DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F,,,21 ,,RBRVS,3.75 ,5.09 ,8.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15630,CPT,DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS,,,21 ,,RBRVS,4.08 ,5.51 ,8.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15650,CPT,TRANSFER ANY PEDICLE FLAP ANY LOCATION,,,21 ,,RBRVS,4.77 ,5.86 ,9.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15731,CPT,FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE,,,21 ,,RBRVS,14.38 ,13.43 ,16.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15732,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP HEAD&NCK,,,21 ,,RBRVS,19.90 ,15.91 ,20.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15734,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK,,,21 ,,RBRVS,19.86 ,15.88 ,20.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15736,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR,,,21 ,,RBRVS,17.04 ,13.81 ,18.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15738,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR,,,21 ,,RBRVS,19.04 ,14.25 ,19.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15740,CPT,FLAP ISLAND PEDICLE,,,21 ,,RBRVS,11.80 ,12.12 ,16.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15750,CPT,FLAP NEUROVASCULAR PEDICLE,,,21 ,,RBRVS,12.96 ,11.71 ,11.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15756,CPT,FREE MUSCLE/MYOCUTANEOUS FLAP W/MVASC ANAST,,,21 ,,RBRVS,36.94 ,26.52 ,26.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15757,CPT,FREE SKIN FLAP W/MICROVASCULAR ANASTOMOSIS,,,21 ,,RBRVS,37.15 ,26.05 ,26.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15758,CPT,FREE FASCIAL FLAP W/MICROVASCULAR ANASTOMOSIS,,,21 ,,RBRVS,36.90 ,26.00 ,26.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15760,CPT,GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA,,,21 ,,RBRVS,9.86 ,9.57 ,13.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15770,CPT,GRAFT DERMA-FAT-FASCIA,,,21 ,,RBRVS,8.96 ,9.05 ,9.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15775,CPT,PUNCH GRAFT HAIR TRANSPLANT 1-15 PUNCH GRAFTS,,,21 ,,RBRVS,3.95 ,1.97 ,4.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15776,CPT,PUNCH GRAFT HAIR TRANSPLANT >15 PUNCH GRAFTS,,,21 ,,RBRVS,5.53 ,3.15 ,6.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15777,CPT,IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT,,,21 ,,RBRVS,3.65 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15780,CPT,DERMABRASION TOTAL FACE,,,21 ,,RBRVS,8.73 ,8.61 ,14.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15781,CPT,DERMABRASION SEGMENTAL FACE,,,21 ,,RBRVS,5.02 ,6.90 ,10.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15782,CPT,DERMABRASION REGIONAL OTHER THAN FACE,,,21 ,,RBRVS,4.44 ,6.58 ,11.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15783,CPT,DERMABRASION SUPERFICIAL ANY SITE,,,21 ,,RBRVS,4.41 ,5.98 ,9.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15786,CPT,ABRASION 1 LESION,,,21 ,,RBRVS,2.08 ,1.67 ,4.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15787,CPT,ABRASION EACH ADDITIONAL 4 LESIONS OR LESS,,,21 ,,RBRVS,0.33 ,0.15 ,1.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15788,CPT,CHEMICAL PEEL FACIAL EPIDERMAL,,,21 ,,RBRVS,2.09 ,4.77 ,10.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15789,CPT,CHEMICAL PEEL FACIAL DERMAL,,,21 ,,RBRVS,4.91 ,6.91 ,10.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15792,CPT,CHEMICAL PEEL NONFACIAL EPIDERMAL,,,21 ,,RBRVS,1.86 ,5.54 ,10.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15793,CPT,CHEMICAL PEEL NONFACIAL DERMAL,,,21 ,,RBRVS,3.96 ,6.17 ,9.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15819,CPT,CERVICOPLASTY,,,21 ,,RBRVS,10.65 ,8.13 ,8.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15820,CPT,BLEPHAROPLASTY LOWER EYELID,,,21 ,,RBRVS,6.27 ,7.33 ,8.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15821,CPT,BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD,,,21 ,,RBRVS,6.84 ,7.59 ,9.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15822,CPT,BLEPHAROPLASTY UPPER EYELID,,,21 ,,RBRVS,4.62 ,5.77 ,7.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15823,CPT,BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN,,,21 ,,RBRVS,6.81 ,8.13 ,9.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15824,CPT,RHYTIDECTOMY FOREHEAD,,,21 ,,RBRVS,15.57 ,13.67 ,13.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15825,CPT,RHYTIDECTOMY NECK W/PLATYSMAL TIGHTENING,,,21 ,,RBRVS,17.51 ,15.38 ,15.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15826,CPT,RHYTIDECTOMY GLABELLAR FROWN LINES,,,21 ,,RBRVS,12.65 ,11.11 ,11.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15828,CPT,RHYTIDECTOMY CHEEK CHIN&NECK,,,21 ,,RBRVS,33.08 ,29.06 ,29.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15829,CPT,RHYTIDECTOMY SMAS FLAP,,,21 ,,RBRVS,36.97 ,32.48 ,32.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15830,CPT,EXCISION SKIN ABD INFRAUMBILICAL PANNICULECTOMY,,,21 ,,RBRVS,17.11 ,13.76 ,13.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15832,CPT,EXCISION EXCESSIVE SKIN&SUBQ TISSUE THIGH,,,21 ,,RBRVS,12.85 ,11.70 ,11.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15833,CPT,EXCISION EXCESSIVE SKIN&SUBQ TISSUE LEG,,,21 ,,RBRVS,11.90 ,11.24 ,11.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15834,CPT,EXCISION EXCESSIVE SKIN&SUBQ TISSUE HIP,,,21 ,,RBRVS,12.17 ,11.07 ,11.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15835,CPT,EXCISION EXCESSIVE SKIN&SUBQ TISSUE BUTTOCK,,,21 ,,RBRVS,12.99 ,11.58 ,11.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15836,CPT,EXCISION EXCESSIVE SKIN&SUBQ TISSUE ARM,,,21 ,,RBRVS,10.61 ,8.49 ,8.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15837,CPT,EXC EXCESSIVE SKIN&SUBQ TISSUE FOREARM/HAND,,,21 ,,RBRVS,9.55 ,8.91 ,12.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15838,CPT,EXC EXCSV SKIN&SUBQ TISSUE SUBMENTAL FAT PAD,,,21 ,,RBRVS,8.25 ,7.62 ,7.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15839,CPT,EXCISION EXCESSIVE SKIN&SUBQ TISSUE OTHER AREA,,,21 ,,RBRVS,10.50 ,8.88 ,12.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15840,CPT,GRAFT FACIAL NERVE PARALYSIS FREE FASCIAL GRAFT,,,21 ,,RBRVS,14.99 ,12.70 ,12.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15841,CPT,GRAFT FACIAL NERVE PARALYSIS FREE MUSCLE GRAFT,,,21 ,,RBRVS,25.99 ,20.34 ,20.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15842,CPT,GRF FACIAL NRV PALYSS FR MUSCLE FLAP MICROSURG,,,21 ,,RBRVS,41.01 ,28.26 ,28.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15845,CPT,GRF FACIAL NERVE PARALYSIS REGIONAL MUSCLE TR,,,21 ,,RBRVS,14.32 ,12.58 ,12.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15847,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE ABDOMEN,,,21 ,,TotalUnits,,,,9.43 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,15850,CPT,REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON,,,21 ,,RBRVS,0.78 ,0.34 ,1.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15851,CPT,REMOVAL SUTURES UNDER ANESTHESIA OTHER SURGEON,,,21 ,,RBRVS,0.86 ,0.37 ,1.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15852,CPT,DRESSING CHANGE UNDER ANESTHESIA,,,21 ,,RBRVS,0.86 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15860,CPT,IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT,,,21 ,,RBRVS,1.95 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15876,CPT,SUCTION ASSISTED LIPECTOMY HEAD&NECK,,,21 ,,TotalUnits,,,,21.15 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,15877,CPT,SUCTION ASSISTED LIPECTOMY TRUNK,,,21 ,,TotalUnits,,,,11.22 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,15878,CPT,SUCTION ASSISTED LIPECTOMY UPPER EXTREMITY,,,21 ,,TotalUnits,,,,13.00 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,15879,CPT,SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY,,,21 ,,TotalUnits,,,,3.25 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,15920,CPT,EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/PRIM SUTR,,,21 ,,RBRVS,8.29 ,7.54 ,7.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15922,CPT,EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/FLAP CLSR,,,21 ,,RBRVS,10.38 ,10.18 ,10.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15931,CPT,EXCISION SACRAL PRESSURE ULCER W/PRIMARY SUTURE,,,21 ,,RBRVS,10.07 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15933,CPT,EXC SACRAL PRESSURE ULC W/PRIM SUTR W/OSTECTOMY,,,21 ,,RBRVS,11.77 ,10.14 ,10.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15934,CPT,EXCISION SACRAL PRESSURE ULCER W/SKIN FLAP CLSR,,,21 ,,RBRVS,13.68 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15935,CPT,EXC SACRAL PR ULCER W/SKN FLAP CLSR W/OSTECTOMY,,,21 ,,RBRVS,15.78 ,13.04 ,13.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15936,CPT,EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR,,,21 ,,RBRVS,13.16 ,10.26 ,10.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15937,CPT,EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC,,,21 ,,RBRVS,15.14 ,12.33 ,12.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15940,CPT,EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE,,,21 ,,RBRVS,10.20 ,7.96 ,7.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15941,CPT,EXC ISCHIAL PR ULC W/PRIM SUTR W/OSTC ISCHIECT,,,21 ,,RBRVS,12.41 ,11.34 ,11.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15944,CPT,EXC ISCHIAL PRESSURE ULCER W/SKIN FLAP CLOSURE,,,21 ,,RBRVS,12.44 ,11.15 ,11.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15945,CPT,EXC ISCHIAL PR ULC W/SKN FLAP CLSR W/OSTECTOMY,,,21 ,,RBRVS,13.75 ,12.47 ,12.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15946,CPT,EXC ISCHIAL PR ULCER W/OSTC MUSC/MYOQ FLAP/SKIN,,,21 ,,RBRVS,24.12 ,19.21 ,19.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15950,CPT,EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR,,,21 ,,RBRVS,8.03 ,7.01 ,7.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15951,CPT,EXC TRCHNTRIC PR ULCER W/PRIM SUTR W/OSTECTOMY,,,21 ,,RBRVS,11.58 ,11.20 ,11.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15952,CPT,EXC TROCHANTERIC PR ULCER W/SKIN FLAP CLOSURE,,,21 ,,RBRVS,12.31 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15953,CPT,EXC TRCHNTRIC PR ULC W/SKN FLAP CLSR W/OSTECTOMY,,,21 ,,RBRVS,13.57 ,10.62 ,10.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15956,CPT,EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN,,,21 ,,RBRVS,16.79 ,13.63 ,13.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15958,CPT,EXC TRCHNTRIC PR ULC MUSC/MYOQ FLAP/SKIN W/OSTC,,,21 ,,RBRVS,16.75 ,14.39 ,14.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,15999,CPT,UNLISTED PROCEDURE EXCISION PRESSURE ULCER,,,21 ,,TotalUnits,,,,23.75 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,16000,CPT,INITIAL TX 1ST DEGREE BURN LOCAL TX,,,21 ,,RBRVS,0.89 ,0.34 ,0.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,16020,CPT,DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL,,,21 ,,RBRVS,0.80 ,0.75 ,1.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,16025,CPT,DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM,,,21 ,,RBRVS,1.85 ,1.22 ,2.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,16030,CPT,DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE,,,21 ,,RBRVS,2.08 ,1.40 ,2.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,16035,CPT,ESCHAROTOMY FIRST INCISION,,,21 ,,RBRVS,3.74 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,16036,CPT,ESCHAROTOMY EACH ADDITIONAL INCISION,,,21 ,,RBRVS,1.50 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17000,CPT,DESTRUCTION PREMALIGNANT LESION 1ST,,,21 ,,RBRVS,0.65 ,0.90 ,1.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17003,CPT,DESTRUCTION PREMALIGNANT LESION 2-14 EA,,,21 ,,RBRVS,0.07 ,0.05 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17004,CPT,DESTRUCTION PREMALIGNANT LESION 15/>,,,21 ,,RBRVS,1.85 ,1.83 ,2.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17106,CPT,DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM,,,21 ,,RBRVS,3.69 ,3.92 ,5.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17107,CPT,DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM,,,21 ,,RBRVS,4.79 ,4.98 ,7.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17108,CPT,DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM,,,21 ,,RBRVS,7.49 ,6.65 ,9.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17110,CPT,DESTRUCTION BENIGN LESIONS UP TO 14,,,21 ,,RBRVS,0.70 ,1.23 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17111,CPT,DESTRUCTION BENIGN LESIONS 15/>,,,21 ,,RBRVS,0.97 ,1.41 ,2.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17250,CPT,CHEMICAL CAUTERIZATION GRANULATION TISSUE,,,21 ,,RBRVS,0.50 ,0.48 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17260,CPT,DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<,,,21 ,,RBRVS,0.96 ,0.92 ,1.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17261,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM,,,21 ,,RBRVS,1.22 ,1.32 ,2.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17262,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM,,,21 ,,RBRVS,1.63 ,1.60 ,3.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17263,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM,,,21 ,,RBRVS,1.84 ,1.73 ,3.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17264,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM,,,21 ,,RBRVS,1.99 ,1.81 ,3.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17266,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG > 4.0 CM,,,21 ,,RBRVS,2.39 ,2.03 ,4.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17270,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/<,,,21 ,,RBRVS,1.37 ,1.38 ,2.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17271,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM,,,21 ,,RBRVS,1.54 ,1.54 ,3.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17272,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 1.1-2.0CM,,,21 ,,RBRVS,1.82 ,1.73 ,3.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17273,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 2.1-3.0CM,,,21 ,,RBRVS,2.10 ,1.90 ,3.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17274,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM,,,21 ,,RBRVS,2.64 ,2.24 ,4.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17276,CPT,DSTRJ MAL LES S/N/H/F/G LES DIAM > 4.0 CM,,,21 ,,RBRVS,3.25 ,2.56 ,4.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17280,CPT,DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<,,,21 ,,RBRVS,1.22 ,1.29 ,2.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17281,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM,,,21 ,,RBRVS,1.77 ,1.69 ,3.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17282,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM,,,21 ,,RBRVS,2.09 ,1.91 ,3.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17283,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM,,,21 ,,RBRVS,2.69 ,2.29 ,4.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17284,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM,,,21 ,,RBRVS,3.26 ,2.64 ,4.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17286,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M > 4.0 CM,,,21 ,,RBRVS,4.48 ,3.36 ,5.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17311,CPT,MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS,,,21 ,,RBRVS,6.20 ,4.32 ,12.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17312,CPT,MOHS MICROGRAPHIC H/N/H/F/G EACH ADDL STAGE,,,21 ,,RBRVS,3.30 ,2.30 ,7.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17313,CPT,MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS,,,21 ,,RBRVS,5.56 ,3.88 ,11.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17314,CPT,MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE,,,21 ,,RBRVS,3.06 ,2.13 ,7.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17315,CPT,MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE,,,21 ,,RBRVS,0.87 ,0.61 ,1.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17340,CPT,CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE,,,21 ,,RBRVS,0.77 ,0.52 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17360,CPT,CHEMICAL EXFOLIATION ACNE,,,21 ,,RBRVS,1.46 ,1.31 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17380,CPT,ELECTROLYSIS EPILATION EACH 30 MINUTES,,,21 ,,RBRVS,1.08 ,0.95 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,17999,CPT,UNLISTED PX SKIN MUC MEMBRANE &SUBQ TISSUE,,,21 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,19000,CPT,PUNCTURE ASPIRATION CYST BREAST,,,21 ,,RBRVS,0.84 ,0.35 ,2.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19001,CPT,PUNCTURE ASPIRATION BREAST EACH ADDITIONAL CYST,,,21 ,,RBRVS,0.42 ,0.17 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19020,CPT,MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP,,,21 ,,RBRVS,3.83 ,3.97 ,8.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19030,CPT,INJECTION MAMMARY DUCTOGRAM/GALACTOGRAM,,,21 ,,RBRVS,1.53 ,0.63 ,3.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19100,CPT,BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX,,,21 ,,RBRVS,1.27 ,0.50 ,2.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19101,CPT,BIOPSY BREAST OPEN INCISIONAL,,,21 ,,RBRVS,3.23 ,2.43 ,5.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19102,CPT,BIOPSY BREAST NEEDLE CORE W/IMAGING GUIDANCE,,,21 ,,RBRVS,2.00 ,0.82 ,4.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19103,CPT,BREAST BIOPSY VACUUM ASSISTED/ROTATING DEVICE,,,21 ,,RBRVS,3.69 ,1.51 ,11.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19105,CPT,ABLTJ CRYOSURGICAL W/US GID EA FIBROADENOMA,,,21 ,,RBRVS,3.69 ,1.60 ,55.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19110,CPT,NIPPLE EXPLORATION,,,21 ,,RBRVS,4.44 ,4.28 ,8.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19112,CPT,EXCISION LACTIFEROUS DUCT FISTULA,,,21 ,,RBRVS,3.81 ,4.13 ,8.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19120,CPT,EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESIONS,,,21 ,,RBRVS,5.92 ,4.54 ,6.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19125,CPT,EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES,,,21 ,,RBRVS,6.69 ,4.91 ,7.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19126,CPT,EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL,,,21 ,,RBRVS,2.93 ,1.16 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19260,CPT,EXCISION CHEST WALL TUMOR INCLUDING RIBS,,,21 ,,RBRVS,17.78 ,13.56 ,13.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19271,CPT,EXC CHEST TUMOR W/RCNSTJ W/O MEDSTNL LMPHADEC,,,21 ,,RBRVS,22.19 ,20.64 ,20.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19272,CPT,EXC CHEST TUMOR W/RCNSTJ W/MEDSTNL LMPHADEC,,,21 ,,RBRVS,25.17 ,21.89 ,21.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19290,CPT,PREOP PLACEMENT LOCALIZATION WIRE BREAST,,,21 ,,RBRVS,1.27 ,0.53 ,3.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19291,CPT,PREOP PLMT LOCALIZATION WIRE BREAST EACH LESION,,,21 ,,RBRVS,0.63 ,0.26 ,1.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19295,CPT,IMG GID PLMT MTLC LOCLZJ CLIP PRQ BRST BX/ASPIR,,,21 ,,RBRVS,,2.65 ,2.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19296,CPT,PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST,,,21 ,,RBRVS,3.63 ,1.75 ,111.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19297,CPT,PLMT EXPANDABLE CATH BRST CONCURRENT PRTL MAST,,,21 ,,RBRVS,1.72 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19298,CPT,PLMT RADTHX BRACHYTX BRST FOLLOWING PRTL MAST,,,21 ,,RBRVS,6.00 ,2.81 ,28.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19300,CPT,MASTECTOMY GYNECOMASTIA,,,21 ,,RBRVS,5.31 ,5.07 ,8.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19301,CPT,MASTECTOMY PARTIAL,,,21 ,,RBRVS,10.13 ,6.23 ,6.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19302,CPT,MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY,,,21 ,,RBRVS,13.99 ,8.56 ,8.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19303,CPT,MASTECTOMY SIMPLE COMPLETE,,,21 ,,RBRVS,15.85 ,9.43 ,9.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19304,CPT,MASTECTOMY SUBCUTANEOUS,,,21 ,,RBRVS,7.95 ,6.68 ,6.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19305,CPT,MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES,,,21 ,,RBRVS,17.46 ,11.19 ,11.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19306,CPT,MAST RAD W/PECTORAL MUSC AX INT MAM LYMPH NODES,,,21 ,,RBRVS,18.13 ,12.11 ,12.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19307,CPT,MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN,,,21 ,,RBRVS,18.23 ,12.02 ,12.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19316,CPT,MASTOPEXY,,,21 ,,RBRVS,11.09 ,9.46 ,9.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19318,CPT,REDUCTION MAMMAPLASTY,,,21 ,,RBRVS,16.03 ,13.82 ,13.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19324,CPT,MAMMAPLASTY AUGMENTATION W/O PROSTHETIC IMPLANT,,,21 ,,RBRVS,6.80 ,5.84 ,5.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19325,CPT,MAMMAPLASTY AUGMENTATION W/PROSTHETIC IMPLANT,,,21 ,,RBRVS,8.64 ,8.71 ,8.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19328,CPT,REMOVAL INTACT MAMMARY IMPLANT,,,21 ,,RBRVS,6.48 ,6.76 ,6.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19330,CPT,REMOVAL MAMMARY IMPLANT MATERIAL,,,21 ,,RBRVS,8.54 ,8.35 ,8.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19340,CPT,IMMT INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ,,,21 ,,RBRVS,13.99 ,8.94 ,8.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19342,CPT,DLYD INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ,,,21 ,,RBRVS,12.63 ,12.19 ,12.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19350,CPT,NIPPLE/AREOLA RECONSTRUCTION,,,21 ,,RBRVS,9.11 ,9.02 ,13.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19355,CPT,CORRECTION INVERTED NIPPLES,,,21 ,,RBRVS,8.52 ,6.21 ,10.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19357,CPT,BRST RCNSTJ IMMT/DLYD W/TISS EXPANDER SBSQ XPNSJ,,,21 ,,RBRVS,18.50 ,21.46 ,21.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19361,CPT,BRST RCNSTJ W/LATSMS D/SI FLAP WO PRSTHC IMPL,,,21 ,,RBRVS,23.36 ,21.92 ,21.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19364,CPT,BREAST RECONSTRUCTION FREE FLAP,,,21 ,,RBRVS,42.58 ,31.56 ,31.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19366,CPT,BREAST RECONSTRUCTION OTHER TECHNIQUE,,,21 ,,RBRVS,21.84 ,14.35 ,14.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19367,CPT,BREAST RECONSTRUCTION TRAM FLAP 1 PEDICLE,,,21 ,,RBRVS,26.80 ,21.40 ,21.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19368,CPT,BREAST RECONSTRUCTION TRAM 1 PEDCL MVASC ANAST,,,21 ,,RBRVS,33.90 ,25.53 ,25.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19369,CPT,BREAST RECONSTRUCTION TRAM FLAP DOUBLE PEDICLE,,,21 ,,RBRVS,31.31 ,23.56 ,23.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19370,CPT,OPEN PERIPROSTHETIC CAPSULOTOMY BREAST,,,21 ,,RBRVS,9.17 ,9.24 ,9.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19371,CPT,PERIPROSTHETIC CAPSULECTOMY BREAST,,,21 ,,RBRVS,10.62 ,10.47 ,10.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19380,CPT,REVISION RECONSTRUCTED BREAST,,,21 ,,RBRVS,10.41 ,10.33 ,10.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19396,CPT,PREPARATION MOULAGE CUSTOM BREAST IMPLANT,,,21 ,,RBRVS,2.17 ,1.39 ,4.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,19499,CPT,UNLISTED PROCEDURE BREAST,,,21 ,,TotalUnits,,,,6.71 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,20005,CPT,I&D SOFT TISSUE ABSCESS SUBFASC,,,21 ,,RBRVS,3.58 ,2.61 ,4.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20100,CPT,EXPLORATION PENETRATING WOUND SPX NECK,,,21 ,,RBRVS,10.38 ,5.13 ,5.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20101,CPT,EXPLORATION PENETRATING WOUND SPX CHEST,,,21 ,,RBRVS,3.23 ,1.97 ,7.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20102,CPT,EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK,,,21 ,,RBRVS,3.98 ,2.57 ,8.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20103,CPT,EXPLORATION PENETRATING WOUND SPX EXTREMITY,,,21 ,,RBRVS,5.34 ,3.91 ,10.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20150,CPT,EXCISION EPIPHYSEAL BAR,,,21 ,,RBRVS,14.75 ,11.25 ,11.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20200,CPT,BIOPSY MUSCLE SUPERFICIAL,,,21 ,,RBRVS,1.46 ,0.96 ,3.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20205,CPT,BIOPSY MUSCLE DEEP,,,21 ,,RBRVS,2.35 ,1.55 ,4.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20206,CPT,BIOPSY MUSCLE PERCUTANEOUS NEEDLE,,,21 ,,RBRVS,0.99 ,0.69 ,6.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20220,CPT,BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL,,,21 ,,RBRVS,1.27 ,0.82 ,3.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20225,CPT,BIOPSY BONE TROCAR/NEEDLE DEEP,,,21 ,,RBRVS,1.87 ,1.24 ,15.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20240,CPT,BIOPSY BONE OPEN SUPERFICIAL,,,21 ,,RBRVS,3.28 ,2.76 ,2.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20245,CPT,BIOPSY BONE OPEN DEEP,,,21 ,,RBRVS,8.95 ,7.84 ,7.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20250,CPT,BIOPSY VERTEBRAL BODY OPEN THORACIC,,,21 ,,RBRVS,5.19 ,4.68 ,4.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20251,CPT,BIOPSY VERTEBRAL BODY OPEN LUMBAR/CERVICAL,,,21 ,,RBRVS,5.72 ,5.08 ,5.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20500,CPT,INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC,,,21 ,,RBRVS,1.28 ,1.20 ,1.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20501,CPT,INJECTION SINUS TRACT DIAGNOSTIC,,,21 ,,RBRVS,0.76 ,0.32 ,2.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20520,CPT,REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE,,,21 ,,RBRVS,1.90 ,1.98 ,3.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20525,CPT,RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP,,,21 ,,RBRVS,3.54 ,3.06 ,9.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20526,CPT,INJECTION THERAPEUTIC CARPAL TUNNEL,,,21 ,,RBRVS,0.94 ,0.59 ,1.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20527,CPT,INJECTION ENZYME PALMAR FASCIAL CORD,,,21 ,,RBRVS,1.00 ,0.60 ,1.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20550,CPT,INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS,,,21 ,,RBRVS,0.75 ,0.37 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20551,CPT,INJECTION SINGLE TENDON ORIGIN/INSERTION,,,21 ,,RBRVS,0.75 ,0.41 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20552,CPT,INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES,,,21 ,,RBRVS,0.66 ,0.35 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20553,CPT,INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES,,,21 ,,RBRVS,0.75 ,0.39 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20555,CPT,PLACEMENT NEEDLES MUSCLE SUBSEQUENT RADIOELEMENT,,,21 ,,RBRVS,6.00 ,2.83 ,2.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20600,CPT,ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA,,,21 ,,RBRVS,0.66 ,0.41 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20605,CPT,ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURSA,,,21 ,,RBRVS,0.68 ,0.44 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20610,CPT,ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA,,,21 ,,RBRVS,0.79 ,0.55 ,1.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20612,CPT,ASPIRATION&/INJECTION GANGLION CYST ANY LOCATION,,,21 ,,RBRVS,0.70 ,0.44 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20615,CPT,ASPIRATION&INJECTION TREATMENT BONE CYST,,,21 ,,RBRVS,2.33 ,1.99 ,3.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20650,CPT,INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX,,,21 ,,RBRVS,2.28 ,1.88 ,3.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20660,CPT,APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX,,,21 ,,RBRVS,4.00 ,2.09 ,2.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20661,CPT,APPLICATION HALO CRANIAL INCLUDING REMOVAL,,,21 ,,RBRVS,5.26 ,7.33 ,7.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20662,CPT,APPLICATION HALO PELVIC INCLUDING REMOVAL,,,21 ,,RBRVS,6.38 ,5.59 ,5.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20663,CPT,APPLICATION HALO FEMORAL INCLUDING REMOVAL,,,21 ,,RBRVS,5.74 ,6.43 ,6.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20664,CPT,APPL HALO 6/> PINS THIN SKULL OSTEOLOGY,,,21 ,,RBRVS,10.06 ,10.12 ,10.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20665,CPT,REMOVAL TONG/HALO APPLIED BY ANOTHER PHYSICIAN,,,21 ,,RBRVS,1.36 ,1.24 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20670,CPT,REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE,,,21 ,,RBRVS,1.79 ,2.23 ,9.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20680,CPT,REMOVAL IMPLANT DEEP,,,21 ,,RBRVS,5.96 ,5.34 ,10.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20690,CPT,APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM,,,21 ,,RBRVS,8.78 ,6.39 ,6.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20692,CPT,APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM,,,21 ,,RBRVS,16.27 ,12.48 ,12.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20693,CPT,ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES,,,21 ,,RBRVS,6.06 ,6.14 ,6.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20694,CPT,REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES,,,21 ,,RBRVS,4.28 ,4.76 ,7.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20696,CPT,XTRNL FIXJ W/STEREOTACTIC ADJUSTMENT 1ST&SUBQ,,,21 ,,RBRVS,17.56 ,12.64 ,12.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20697,CPT,XTRNL FIXJ W/STRTCTC ADJUSTMENT EXCHANGE STRUT,,,21 ,,RBRVS,,49.27 ,49.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,20802,CPT,REPLANTATION ARM COMPLETE AMPUTATION,,,21 ,,RBRVS,42.62 ,22.04 ,22.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20805,CPT,REPLANTATION FOREARM COMPLETE AMPUTATION,,,21 ,,RBRVS,51.46 ,22.17 ,22.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20808,CPT,REPLANTATION HAND COMPLETE AMPUTATION,,,21 ,,RBRVS,63.09 ,47.03 ,47.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20816,CPT,RPLJ DGT EXCEPT THMB MTCARPHLNGL JT COMPL AMP,,,21 ,,RBRVS,31.95 ,27.11 ,27.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20822,CPT,RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP,,,21 ,,RBRVS,26.66 ,23.80 ,23.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20824,CPT,RPLJ THMB CARP/MTCRPL JT MP JT COMPL AMPUTATION,,,21 ,,RBRVS,31.95 ,25.52 ,25.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20827,CPT,RPLJ THUMB DISTAL TIP MP JOINT COMPL AMPUTATION,,,21 ,,RBRVS,27.48 ,24.97 ,24.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20838,CPT,REPLANTATION FOOT COMPLETE AMPUTATION,,,21 ,,RBRVS,42.88 ,23.57 ,23.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20900,CPT,BONE GRAFT ANY DONOR AREA MINOR/SMALL,,,21 ,,RBRVS,3.00 ,3.23 ,8.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20902,CPT,BONE GRAFT ANY DONOR AREA MAJOR/LARGE,,,21 ,,RBRVS,4.58 ,4.15 ,4.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20910,CPT,CARTILAGE GRAFT COSTOCHONDRAL,,,21 ,,RBRVS,5.53 ,6.13 ,6.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20912,CPT,CARTILAGE GRAFT NASAL SEPTUM,,,21 ,,RBRVS,6.54 ,6.79 ,6.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20920,CPT,FASCIA LATA GRAFT BY STRIPPER,,,21 ,,RBRVS,5.51 ,5.58 ,5.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20922,CPT,FASCIA LATA GRAFT INCISION & AREA EXPOSURE,,,21 ,,RBRVS,6.93 ,6.25 ,9.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20924,CPT,TENDON GRAFT FROM A DISTANCE,,,21 ,,RBRVS,6.68 ,6.85 ,6.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20926,CPT,TISSUE GRAFTS OTHER,,,21 ,,RBRVS,5.79 ,5.80 ,5.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20930,CPT,ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED,,,21 ,,TotalUnits,,,,4.87 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,20931,CPT,ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL,,,21 ,,RBRVS,1.81 ,0.99 ,0.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20936,CPT,AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION,,,21 ,,TotalUnits,,,,6.02 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,20937,CPT,AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION,,,21 ,,RBRVS,2.79 ,1.56 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20938,CPT,AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC,,,21 ,,RBRVS,3.02 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20950,CPT,MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME,,,21 ,,RBRVS,1.26 ,1.16 ,5.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20955,CPT,BONE GRAFT MICROVASCULAR ANASTOMOSIS FIBULA,,,21 ,,RBRVS,40.26 ,28.46 ,28.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20956,CPT,BONE GRAFT MICROVASCULAR ANAST ILIAC CREST,,,21 ,,RBRVS,41.18 ,28.61 ,28.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20957,CPT,BONE GRAFT MICROVASCULAR ANAST METATARSAL,,,21 ,,RBRVS,42.61 ,24.83 ,24.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20962,CPT,BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR,,,21 ,,RBRVS,39.21 ,30.31 ,30.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20969,CPT,FREE OSTQ FLAP W/MVASC ANAST METAR/GREAT TOE,,,21 ,,RBRVS,45.43 ,31.04 ,31.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20970,CPT,FREE OSTQ FLAP W/MVASC ANASTOMOSIS ILIAC CREST,,,21 ,,RBRVS,44.58 ,29.83 ,29.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20972,CPT,FREE OSTQ FLAP W/MVASC ANASTOMOSIS METATARSAL,,,21 ,,RBRVS,44.51 ,19.65 ,19.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20973,CPT,FR OSTQ FLAP W/MVASC ANAST GRT TOE W/WEB SPACE,,,21 ,,RBRVS,47.27 ,28.38 ,28.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20974,CPT,ELECTRICAL STIMULATION BONE HEALING NONINVASIVE,,,21 ,,RBRVS,0.62 ,0.67 ,1.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20975,CPT,ELECTRICAL STIMULATION BONE HEALING INVASIVE,,,21 ,,RBRVS,2.60 ,2.01 ,2.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20979,CPT,LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE,,,21 ,,RBRVS,0.62 ,0.29 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20982,CPT,ABLATION BONE TUMOR RF PERCUTANEOUS CT GUIDANCE,,,21 ,,RBRVS,7.27 ,3.30 ,97.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20985,CPT,CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS,,,21 ,,RBRVS,2.50 ,1.39 ,1.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,20999,CPT,UNLISTED PROCEDURE MUSCSKELETAL SYSTEM GENERAL,,,21 ,,TotalUnits,,,,2.11 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,21010,CPT,ARTHROTOMY TEMPOROMANDIBULAR JOINT,,,21 ,,RBRVS,11.04 ,8.76 ,8.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21011,CPT,EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ < 2CM,,,21 ,,RBRVS,2.99 ,3.93 ,6.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21012,CPT,EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>,,,21 ,,RBRVS,4.45 ,5.02 ,5.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21013,CPT,EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL < 2CM,,,21 ,,RBRVS,5.42 ,5.63 ,8.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21014,CPT,EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>,,,21 ,,RBRVS,7.13 ,7.43 ,7.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21015,CPT,RAD RESECTION TUMOR SOFT TISS FACE/SCALP < 2CM,,,21 ,,RBRVS,9.89 ,7.56 ,7.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21016,CPT,RAD RESECTION TUMOR SOFT TISS FACE/SCALP 2 CM/>,,,21 ,,RBRVS,15.26 ,13.01 ,13.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21025,CPT,EXCISION BONE MANDIBLE,,,21 ,,RBRVS,10.03 ,10.46 ,14.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21026,CPT,EXCISION FACIAL BONE,,,21 ,,RBRVS,5.70 ,7.90 ,11.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21029,CPT,REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE,,,21 ,,RBRVS,8.39 ,8.88 ,12.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21030,CPT,EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG,,,21 ,,RBRVS,4.91 ,6.37 ,9.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21031,CPT,EXCISION TORUS MANDIBULARIS,,,21 ,,RBRVS,3.30 ,4.70 ,7.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21032,CPT,EXCISION MAXILLARY TORUS PALATINUS,,,21 ,,RBRVS,3.34 ,4.57 ,7.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21034,CPT,EXCISION MALIGNANT TUMOR MAXILLA/ZYGOMA,,,21 ,,RBRVS,17.38 ,14.74 ,19.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21040,CPT,EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL&/CURTG,,,21 ,,RBRVS,4.91 ,6.37 ,9.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21044,CPT,EXCISION MALIGNANT TUMOR MANDIBLE,,,21 ,,RBRVS,12.80 ,11.42 ,11.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21045,CPT,EXCISION MALIGNANT TUMOR MANDIBLE RADICAL,,,21 ,,RBRVS,18.37 ,15.34 ,15.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21046,CPT,EXC BENIGN TUMOR/CYST MNDBL INTRA-ORAL OSTEOT,,,21 ,,RBRVS,14.21 ,15.96 ,15.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21047,CPT,EXC B9 TUM/CST MNDBL XTR-ORAL OSTEOT&PRTL MNDBLC,,,21 ,,RBRVS,20.07 ,15.59 ,15.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21048,CPT,EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT,,,21 ,,RBRVS,14.71 ,16.11 ,16.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21049,CPT,EXC B9 TUM/CST MAXL XTR-ORAL OSTEOT&PRTL MAXLCT,,,21 ,,RBRVS,19.32 ,14.90 ,14.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21050,CPT,CONDYLECTOMY TEMPOROMANDIBULAR JOINT SPX,,,21 ,,RBRVS,11.76 ,11.75 ,11.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21060,CPT,MENISCECTOMY PRTL/COMPL TEMPOROMANDIBULAR JT SPX,,,21 ,,RBRVS,11.07 ,10.65 ,10.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21070,CPT,CORONOIDECTOMY SPX,,,21 ,,RBRVS,8.62 ,8.62 ,8.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21073,CPT,MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA,,,21 ,,RBRVS,3.45 ,3.27 ,7.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21076,CPT,IMPRESSION&PREPARATION SURG OBTURATOR PROSTHESIS,,,21 ,,RBRVS,13.40 ,9.11 ,13.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21077,CPT,IMPRESSION & PREPARATION ORBITAL PROSTHESIS,,,21 ,,RBRVS,33.70 ,23.35 ,32.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21079,CPT,IMPRESSION&PREPARATION INTERIM OBTURATOR PROSTH,,,21 ,,RBRVS,22.31 ,15.48 ,22.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21080,CPT,IMPRESSION&PREPJ DEFINITIVE OBTURATOR PROSTHESIS,,,21 ,,RBRVS,25.06 ,17.21 ,25.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21081,CPT,IMPRESSION&PREPJ MANDIBULAR RESECTION PROSTHESIS,,,21 ,,RBRVS,22.85 ,15.73 ,23.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21082,CPT,IMPRESSION&PREPJ PALATAL AUGMENTATION PROSTHESIS,,,21 ,,RBRVS,20.84 ,15.23 ,23.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21083,CPT,IMPRESSION&PREPARATION PALATAL LIFT PROSTHESIS,,,21 ,,RBRVS,19.27 ,14.18 ,22.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21084,CPT,IMPRESSION&PREPARATION SPEECH AID PROSTHESIS,,,21 ,,RBRVS,22.48 ,16.45 ,25.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21085,CPT,IMPRESSION&PREPARATION ORAL SURGICAL SPLINT,,,21 ,,RBRVS,8.99 ,6.36 ,10.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21086,CPT,IMPRESSION&PREPARATION AURICULAR PROSTHESIS,,,21 ,,RBRVS,24.88 ,16.82 ,23.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21087,CPT,IMPRESSION&PREPARATION NASAL PROSTHESIS,,,21 ,,RBRVS,24.88 ,16.67 ,23.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21088,CPT,IMPRESSION&PREPARATION FACIAL PROSTHESIS,,,21 ,,TotalUnits,,,,37.96 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,21089,CPT,UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE,,,21 ,,TotalUnits,,,,46.00 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,21100,CPT,APPL HALO APPLIANCE MAXILLOFACIAL FIXATION SPX,,,21 ,,RBRVS,4.73 ,5.45 ,13.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21110,CPT,APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC,,,21 ,,RBRVS,5.99 ,12.24 ,15.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21116,CPT,INJECTION TEMPOROMANDIBULAR JOINT ARTHROGRAPHY,,,21 ,,RBRVS,0.81 ,0.35 ,3.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21120,CPT,GENIOPLASTY AUGMENTATION,,,21 ,,RBRVS,5.10 ,8.93 ,12.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21121,CPT,GENIOPLASTY SLIDING OSTEOTOMY SINGLE PIECE,,,21 ,,RBRVS,7.81 ,10.44 ,14.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21122,CPT,GENIOPLASTY 2/> SLIDING OSTEOTOMIES,,,21 ,,RBRVS,8.71 ,11.12 ,11.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21123,CPT,GENIOP SLIDING AGMNTJ W/INTERPOSAL BONE GRAFTS,,,21 ,,RBRVS,11.34 ,13.41 ,13.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21125,CPT,AGMNTJ MNDBLR BODY/ANGLE PROSTHETIC MATERIAL,,,21 ,,RBRVS,10.80 ,10.28 ,75.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21127,CPT,AGMNTJ MNDBLR BDY/ANGL W/B1 GRF ONLAY/INTERPOSAL,,,21 ,,RBRVS,12.44 ,11.83 ,94.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21137,CPT,REDUCTION FOREHEAD CONTOURING ONLY,,,21 ,,RBRVS,10.24 ,8.87 ,8.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21138,CPT,RDCTJ FHD CNTRG&PROSTHETIC MATRL/BONE GRAFT,,,21 ,,RBRVS,12.87 ,11.39 ,11.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21139,CPT,RDCTJ FHD CNTRG&SETBACK ANT FRONTAL SINUS WALL,,,21 ,,RBRVS,15.02 ,12.87 ,12.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21141,CPT,RCNSTJ MIDFACE LEFORT I 1 PIECE W/O BONE GRAFT,,,21 ,,RBRVS,19.57 ,17.01 ,17.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21142,CPT,RCNSTJ MIDFACE LEFORT I 2 PIECES W/O BONE GRAFT,,,21 ,,RBRVS,20.28 ,16.48 ,16.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21143,CPT,RCNSTJ MIDFACE LEFORT I 3/>PIECE W/O BONE GRAFT,,,21 ,,RBRVS,21.05 ,17.66 ,17.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21145,CPT,RCNSTJ MIDFACE LEFORT I 1 PIECE W/BONE GRAFTS,,,21 ,,RBRVS,23.94 ,18.27 ,18.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21146,CPT,RCNSTJ MIDFACE LEFORT I 2 PIECES W/BONE GRAFTS,,,21 ,,RBRVS,24.87 ,20.64 ,20.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21147,CPT,RCNSTJ MIDFACE LEFORT I 3/>PIECE W/BONE GRAFTS,,,21 ,,RBRVS,26.47 ,19.77 ,19.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21150,CPT,RCNSTJ MIDFACE LEFORT II ANTERIOR INTRUSION,,,21 ,,RBRVS,25.96 ,20.40 ,20.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21151,CPT,RCNSTJ MIDFACE LEFORT II W/BONE GRAFTS,,,21 ,,RBRVS,29.02 ,24.96 ,24.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21154,CPT,RCNSTJ MIDFACE LEFORT III W/O LEFORT I,,,21 ,,RBRVS,31.29 ,27.25 ,27.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21155,CPT,RCNSTJ MIDFACE LEFORT III W/LEFORT I,,,21 ,,RBRVS,35.22 ,26.00 ,26.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21159,CPT,RCNSTJ MIDFACE LEFORT III W/FHD W/O LEFORT I,,,21 ,,RBRVS,43.14 ,33.69 ,33.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21160,CPT,RCNSTJ MIDFACE LEFORT III W/FHD W/LEFORT I,,,21 ,,RBRVS,47.19 ,28.47 ,28.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21172,CPT,RCNSTJ SUPERIOR-LATERAL ORBITAL RIM&LOWER FHD,,,21 ,,RBRVS,28.20 ,20.75 ,20.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21175,CPT,RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS&LWR FHD,,,21 ,,RBRVS,33.56 ,25.08 ,25.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21179,CPT,RCNSTJ FOREHEAD&/SUPRAORB RIMS W/ALGRF/PROSTC,,,21 ,,RBRVS,22.65 ,17.84 ,17.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21180,CPT,RCNSTJ FOREHEAD&/SUPRAORBITAL RIMS W/AUTOGRAFT,,,21 ,,RBRVS,25.58 ,20.06 ,20.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21181,CPT,RCNSTJ CONTOURING BENIGN TUMOR CRNL BONES XTRC,,,21 ,,RBRVS,10.28 ,9.35 ,9.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21182,CPT,RCNSTJ ORBIT/FHD/NASETHMD EXC B9 TUM GRF <40SQCM,,,21 ,,RBRVS,32.58 ,21.74 ,21.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21183,CPT,RCNSTJ ORBIT/FHD/NASETHMD EXC B9 GRF >40 <80SQCM,,,21 ,,RBRVS,35.70 ,23.80 ,23.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21184,CPT,RCNSTJ ORBIT/FHD/NASETHMD EXC B9 TUM GRF>80SQ CM,,,21 ,,RBRVS,38.62 ,27.00 ,27.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21188,CPT,RCNSTJ MDFC OTH/THN LEFORT OSTEOT&BONE GRAFTS,,,21 ,,RBRVS,23.15 ,21.32 ,21.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21193,CPT,RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/O GRF,,,21 ,,RBRVS,18.90 ,15.70 ,15.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21194,CPT,RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT,,,21 ,,RBRVS,21.82 ,16.51 ,16.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21195,CPT,RCNSTJ MNDBLR RAMI&/BODY SGTL SPLT W/O INT RGD,,,21 ,,RBRVS,19.16 ,17.94 ,17.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21196,CPT,RCNSTJ MNDBLR RAMI&/BDY SGTL SPLT W/INT RGD FIXJ,,,21 ,,RBRVS,20.83 ,19.78 ,19.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21198,CPT,OSTEOTOMY MANDIBLE SEGMENTAL,,,21 ,,RBRVS,15.71 ,16.30 ,16.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21199,CPT,OSTEOTOMY MANDIBLE SGMTL W/GENIOGLOSSUS ADVMNT,,,21 ,,RBRVS,16.73 ,11.25 ,11.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21206,CPT,OSTEOTOMY MAXILLA SEGMENTAL,,,21 ,,RBRVS,15.59 ,17.12 ,17.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21208,CPT,OSTEOPLASTY FACIAL BONES AUGMENTATION,,,21 ,,RBRVS,11.42 ,11.05 ,39.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21209,CPT,OSTEOPLASTY FACIAL BONES REDUCTION,,,21 ,,RBRVS,7.82 ,10.03 ,15.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21210,CPT,GRAFT BONE NASAL/MAXILLARY/MALAR AREAS,,,21 ,,RBRVS,11.69 ,11.50 ,50.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21215,CPT,GRAFT BONE MANDIBLE,,,21 ,,RBRVS,12.23 ,11.74 ,95.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21230,CPT,GRAFT RIB CRTLG AUTOGENOUS FACE/CHIN/NOSE/EAR,,,21 ,,RBRVS,11.17 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21235,CPT,GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR,,,21 ,,RBRVS,7.50 ,8.26 ,12.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21240,CPT,ARTHRP TEMPOROMANDIBULAR JOINT W/WO AUTOGRAFT,,,21 ,,RBRVS,16.07 ,14.19 ,14.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21242,CPT,ARTHROPLASTY TEMPOROMANDIBULAR JT W/ALLOGRAFT,,,21 ,,RBRVS,14.59 ,13.16 ,13.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21243,CPT,ARTHRP TMPRMAND JOINT W/PROSTHETIC REPLACEMENT,,,21 ,,RBRVS,24.53 ,21.08 ,21.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21244,CPT,RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE,,,21 ,,RBRVS,13.62 ,15.62 ,15.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21245,CPT,RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT PARTIAL,,,21 ,,RBRVS,13.12 ,11.87 ,18.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21246,CPT,RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT COMPLETE,,,21 ,,RBRVS,12.92 ,10.07 ,10.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21247,CPT,RCNSTJ MNDBLR CONDYLE W/BONE CARTLG AUTOGRAFTS,,,21 ,,RBRVS,24.37 ,18.76 ,18.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21248,CPT,RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT PARTIAL,,,21 ,,RBRVS,12.74 ,11.56 ,17.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21249,CPT,RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT COMPLETE,,,21 ,,RBRVS,18.77 ,15.61 ,22.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21255,CPT,RCNSTJ ZYGMTC ARCH/GLENOID FOSSA W/BONE CARTLG,,,21 ,,RBRVS,18.46 ,19.79 ,19.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21256,CPT,RECONSTRUCTION ORBIT W/OSTEOTOMIES&BONE GRAFTS,,,21 ,,RBRVS,17.66 ,14.90 ,14.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21260,CPT,PERIORBITAL OSTEOTOMIES BONE GRAFTS EXTRACRANIAL,,,21 ,,RBRVS,17.90 ,19.86 ,19.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21261,CPT,PERIORBITAL OSTEOTOMIES W/BONE GRAFTS ICRA&XTRC,,,21 ,,RBRVS,34.07 ,24.21 ,24.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21263,CPT,PERIORBITAL OSTEOTOMIES W/BONE GRAFTS W/FOREHEAD,,,21 ,,RBRVS,31.01 ,22.29 ,22.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21267,CPT,ORBITAL REPOSITIONING W/BONE GRAFTS EXTRACRANIAL,,,21 ,,RBRVS,20.69 ,22.45 ,22.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21268,CPT,ORBITAL REPOSITIONING W/BONE GRAFTS ICRA&XTRC,,,21 ,,RBRVS,27.07 ,21.64 ,21.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21270,CPT,MALAR AUGMENTATION PROSTHETIC MATERIAL,,,21 ,,RBRVS,10.63 ,9.26 ,15.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21275,CPT,SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ,,,21 ,,RBRVS,11.76 ,10.58 ,10.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21280,CPT,MEDIAL CANTHOPEXY SEPARATE PROCEDURE,,,21 ,,RBRVS,7.13 ,8.00 ,8.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21282,CPT,LATERAL CANTHOPEXY,,,21 ,,RBRVS,4.27 ,5.83 ,5.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21295,CPT,REDUCTION MASSETER MUSCLE&BONE EXTRAORAL,,,21 ,,RBRVS,1.90 ,2.91 ,2.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21296,CPT,REDUCTION MASSETER MUSCLE&BONE INTRAORAL,,,21 ,,RBRVS,4.78 ,6.37 ,6.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21299,CPT,UNLISTED CRANIOFACIAL&MAXILLOFACIAL PROCEDURE,,,21 ,,TotalUnits,,,,32.36 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,21310,CPT,CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,0.58 ,0.15 ,2.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21315,CPT,CLOSED TX NASAL FRACTURE W/O STABILIZATION,,,21 ,,RBRVS,1.83 ,2.32 ,5.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21320,CPT,CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION,,,21 ,,RBRVS,1.88 ,1.88 ,5.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21325,CPT,OPEN TREATMENT NASAL FRACTURE UNCOMPLICATED,,,21 ,,RBRVS,4.18 ,9.02 ,9.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21330,CPT,OPEN TX NASAL FX COMP W/INT&/XTRNL SKELETAL FIXJ,,,21 ,,RBRVS,5.79 ,10.22 ,10.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21335,CPT,OPEN TX NASAL FX W/CONCOMITANT OPTX FXD SEPTUM,,,21 ,,RBRVS,9.02 ,11.34 ,11.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21336,CPT,OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION,,,21 ,,RBRVS,6.77 ,11.39 ,11.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21337,CPT,CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION,,,21 ,,RBRVS,3.39 ,4.69 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21338,CPT,OPEN TX NASOETHMOID FX W/O EXTERNAL FIXATION,,,21 ,,RBRVS,6.87 ,13.74 ,13.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21339,CPT,OPEN TX NASOETHMOID FX W/EXTERNAL FIXATION,,,21 ,,RBRVS,8.50 ,13.51 ,13.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21340,CPT,PERCUTANEOUS TX NASOETHMOID COMPLEX FRACTURE,,,21 ,,RBRVS,11.49 ,9.93 ,9.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21343,CPT,OPEN TX DEPRESSED FRONTAL SINUS FRACTURE,,,21 ,,RBRVS,14.32 ,16.77 ,16.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21344,CPT,OPEN TX COMPLICATED FRONTAL SINUS FRACTURE,,,21 ,,RBRVS,21.57 ,19.88 ,19.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21345,CPT,CLOSED TX NASOMAXILLARY COMPLEX FRACTURE,,,21 ,,RBRVS,9.06 ,8.53 ,12.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21346,CPT,OPTX NASOMAX CPLX FX LEFT II TYPE W/WIRG&FIXJ,,,21 ,,RBRVS,11.45 ,14.46 ,14.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21347,CPT,OPTX NASOMAX CPLX FX LEFT II TYPE REQ MLT OPN,,,21 ,,RBRVS,13.53 ,17.21 ,17.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21348,CPT,OPTX NASOMAX CPLX FX LEFT II TYPE W/BONE GRAFT,,,21 ,,RBRVS,17.52 ,14.40 ,14.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21355,CPT,PERCUTANEOUS TX MALAR AREA FRACTURE,,,21 ,,RBRVS,4.45 ,4.71 ,8.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21356,CPT,OPEN TX DEPRESSED ZYGOMATIC ARCH FRACTURE,,,21 ,,RBRVS,4.83 ,5.51 ,8.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21360,CPT,OPEN TX DEPRESSED MALAR FRACTURE,,,21 ,,RBRVS,7.19 ,7.50 ,7.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21365,CPT,OPEN TX COMP FX MALAR W/INTERNAL FX&MULT SURG,,,21 ,,RBRVS,16.77 ,13.34 ,13.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21366,CPT,OPEN TX COMP FRACTURE MALAR AREA W/BONE GRAFT,,,21 ,,RBRVS,18.60 ,15.07 ,15.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21385,CPT,OPEN TX ORBITAL FLOOR BLOWOUT FX TRANSANTRAL,,,21 ,,RBRVS,9.57 ,9.74 ,9.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21386,CPT,OPEN TX ORBITAL FLOOR BLOWOUT FX PERIORBITAL,,,21 ,,RBRVS,9.57 ,8.16 ,8.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21387,CPT,OPEN TX ORBITAL FLOOR BLOWOUT FX COMBINED APPR,,,21 ,,RBRVS,10.11 ,9.99 ,9.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21390,CPT,OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC,,,21 ,,RBRVS,11.23 ,10.21 ,10.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21395,CPT,OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/BONE GRF,,,21 ,,RBRVS,14.70 ,12.08 ,12.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21400,CPT,CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIPULATION,,,21 ,,RBRVS,1.50 ,2.62 ,3.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21401,CPT,CLOSED TX FX ORBIT EXCEPT BLOWOUT W/MANIPULATION,,,21 ,,RBRVS,3.68 ,4.41 ,9.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21406,CPT,OPEN TX FX ORBIT EXCEPT BLOWOUT W/O IMPLANT,,,21 ,,RBRVS,7.42 ,7.79 ,7.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21407,CPT,OPEN TX FX ORBIT EXCEPT BLOWOUT W/IMPLANT,,,21 ,,RBRVS,9.02 ,8.47 ,8.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21408,CPT,OPEN TX FX ORBIT EXCEPT BLOWOUT W/BONE GRAFT,,,21 ,,RBRVS,12.78 ,11.30 ,11.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21421,CPT,CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT,,,21 ,,RBRVS,6.02 ,11.43 ,14.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21422,CPT,OPEN TREATMENT PALATAL/MAXILLARY FRACTURE,,,21 ,,RBRVS,8.73 ,9.63 ,9.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21423,CPT,OPEN TX PALATAL/MAXILLARY FX COMP MULTIPLE APPR,,,21 ,,RBRVS,10.85 ,11.20 ,11.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21431,CPT,CLOSED TX CRANIOFACIAL SEPARATION,,,21 ,,RBRVS,7.90 ,12.36 ,12.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21432,CPT,OPEN TX CRANIOFACIAL SEP W/WIRING&/INT FIXJ,,,21 ,,RBRVS,8.82 ,10.12 ,10.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21433,CPT,OPEN TX CRANIOFACIAL SEP COMPLICATED MLT APPR,,,21 ,,RBRVS,26.29 ,18.31 ,18.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21435,CPT,OPEN TX CRANIOFACIAL SEP COMP W/INT&/XTRNL FIXJ,,,21 ,,RBRVS,20.26 ,15.53 ,15.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21436,CPT,OPTX CRNFCL SEP LFT III TYP COMP INT FIXJ W/BONE,,,21 ,,RBRVS,30.30 ,24.22 ,24.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21440,CPT,CLTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX,,,21 ,,RBRVS,3.44 ,9.21 ,12.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21445,CPT,OPTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX,,,21 ,,RBRVS,6.26 ,11.03 ,14.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21450,CPT,CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,3.71 ,9.55 ,12.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21451,CPT,CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION,,,21 ,,RBRVS,5.65 ,12.03 ,15.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21452,CPT,PERCUTANEOUS TX MANDIBULAR FX W/EXTERNAL FIXJ,,,21 ,,RBRVS,2.40 ,7.08 ,14.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21453,CPT,CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION,,,21 ,,RBRVS,6.64 ,14.71 ,17.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21454,CPT,OPEN TX MANDIBULAR FX W/EXTERNAL FIXATION,,,21 ,,RBRVS,7.36 ,8.03 ,8.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21461,CPT,OPEN TX MANDIBULAR FX W/O INTERDENTAL FIXATION,,,21 ,,RBRVS,9.31 ,16.62 ,48.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21462,CPT,OPEN TX MANDIBULAR FX W/INTERDENTAL FIXATION,,,21 ,,RBRVS,11.01 ,17.55 ,50.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21465,CPT,OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE,,,21 ,,RBRVS,13.12 ,12.26 ,12.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21470,CPT,OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION,,,21 ,,RBRVS,17.54 ,15.09 ,15.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21480,CPT,CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ,,,21 ,,RBRVS,0.61 ,0.24 ,1.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21485,CPT,CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ,,,21 ,,RBRVS,4.77 ,11.28 ,14.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21490,CPT,OPEN TREATMENT TEMPOROMANDIBULAR DISLOCATION,,,21 ,,RBRVS,12.95 ,11.92 ,11.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21495,CPT,OPEN TREATMENT HYOID FRACTURE,,,21 ,,RBRVS,6.79 ,12.98 ,12.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21497,CPT,INTERDENTAL WIRING OTHER THAN FRACTURE,,,21 ,,RBRVS,4.64 ,11.33 ,14.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21499,CPT,UNLISTED MUSCULOSKELETAL PROCEDURE HEAD,,,21 ,,TotalUnits,,,,20.36 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,21501,CPT,I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX,,,21 ,,RBRVS,3.98 ,4.65 ,8.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21502,CPT,I&D DP ABSC/HMTMA SOFT TISS NCK/THORAX PRTL RIB,,,21 ,,RBRVS,7.55 ,5.85 ,5.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21510,CPT,INCISION DEEP OPENING BONE CORTEX THORAX,,,21 ,,RBRVS,6.20 ,6.16 ,6.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21550,CPT,BIOPSY SOFT TISSUE NECK/THORAX,,,21 ,,RBRVS,2.11 ,2.23 ,5.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21552,CPT,EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>,,,21 ,,RBRVS,6.49 ,5.61 ,5.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21554,CPT,EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>,,,21 ,,RBRVS,11.13 ,8.75 ,8.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21555,CPT,EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM,,,21 ,,RBRVS,3.96 ,4.27 ,7.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21556,CPT,EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM,,,21 ,,RBRVS,7.66 ,6.02 ,6.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21557,CPT,RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM,,,21 ,,RBRVS,14.75 ,8.69 ,8.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21558,CPT,RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>,,,21 ,,RBRVS,21.58 ,15.18 ,15.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21600,CPT,EXCISION RIB PARTIAL,,,21 ,,RBRVS,7.26 ,7.67 ,7.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21610,CPT,COSTOTRANSVERSECTOMY SEPARATE PROCEDURE,,,21 ,,RBRVS,15.91 ,12.44 ,12.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21615,CPT,EXCISION 1ST&/CERVICAL RIB,,,21 ,,RBRVS,10.45 ,6.64 ,6.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21616,CPT,EXCISION 1ST&/CERVICAL RIB W/SYMPATHECTOMY,,,21 ,,RBRVS,12.69 ,8.16 ,8.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21620,CPT,OSTECTOMY STERNUM PARTIAL,,,21 ,,RBRVS,7.28 ,6.55 ,6.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21627,CPT,STERNAL DEBRIDEMENT,,,21 ,,RBRVS,7.30 ,7.24 ,7.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21630,CPT,RADICAL RESECTION STERNUM,,,21 ,,RBRVS,19.18 ,14.23 ,14.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21632,CPT,RADICAL RESECTION STERNUM W/MEDSTNL LMPHADEC,,,21 ,,RBRVS,19.68 ,12.65 ,12.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21685,CPT,HYOID MYOTOMY & SUSPENSION,,,21 ,,RBRVS,15.26 ,12.43 ,12.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21700,CPT,DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB,,,21 ,,RBRVS,6.31 ,4.86 ,4.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21705,CPT,DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB,,,21 ,,RBRVS,9.92 ,5.67 ,5.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21720,CPT,DIVISION STERNOCLEIDOMASTOID OPEN W/O CAST,,,21 ,,RBRVS,5.80 ,5.30 ,5.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21725,CPT,DIVISION STERNOCLEIDOMASTOID OPEN W/CAST,,,21 ,,RBRVS,7.19 ,6.99 ,6.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21740,CPT,REPAIR PECTUS EXCAVATUM/CARINATUM OPEN,,,21 ,,RBRVS,17.57 ,9.76 ,9.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21742,CPT,REPAIR PECTUS EXCAVATM/CARINATM MINLY W/O THRSC,,,21 ,,TotalUnits,,,,36.84 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,21743,CPT,REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC,,,21 ,,TotalUnits,,,,48.47 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,21750,CPT,CLOSE MEDIAN STERNOTOMY SEP W/WO DEBRIDEMENT SPX,,,21 ,,RBRVS,11.40 ,6.83 ,6.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21800,CPT,CLOSED TX RIB FRACTURE UNCOMPLICATED EACH,,,21 ,,RBRVS,1.01 ,1.85 ,1.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21805,CPT,OPEN TX RIB FRACTURE W/O FIXATION EACH,,,21 ,,RBRVS,2.88 ,4.14 ,4.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21810,CPT,TX RIB FRACTURE EXTERNAL FIXATION FLAIL CHEST,,,21 ,,RBRVS,7.03 ,6.62 ,6.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21820,CPT,CLOSED TREATMENT STERNUM FRACTURE,,,21 ,,RBRVS,1.36 ,2.39 ,2.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21825,CPT,OPEN TX STERNUM FRACTURE W/WO SKELETAL FIXATION,,,21 ,,RBRVS,7.76 ,7.07 ,7.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21899,CPT,UNLISTED PROCEDURE NECK/THORAX,,,21 ,,TotalUnits,,,,9.05 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,21920,CPT,BIOPSY SOFT TISSUE BACK/FLANK SUPERFICIAL,,,21 ,,RBRVS,2.11 ,2.29 ,5.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21925,CPT,BIOPSY SOFT TISSUE BACK/FLANK DEEP,,,21 ,,RBRVS,4.63 ,4.48 ,6.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21930,CPT,EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM,,,21 ,,RBRVS,4.94 ,4.66 ,7.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21931,CPT,EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>,,,21 ,,RBRVS,6.88 ,5.68 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21932,CPT,EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM,,,21 ,,RBRVS,9.82 ,8.05 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21933,CPT,EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>,,,21 ,,RBRVS,11.13 ,8.50 ,8.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21935,CPT,RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK <5CM,,,21 ,,RBRVS,15.72 ,11.36 ,11.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,21936,CPT,RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/>,,,21 ,,RBRVS,22.55 ,15.43 ,15.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22010,CPT,I&D DEEP ABSCESS PST SPINE CRV THRC/CERVICOTHRC,,,21 ,,RBRVS,12.75 ,11.31 ,11.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22015,CPT,I&D DEEP ABSCESS PST SPINE LUMBAR SAC/LUMBOSAC,,,21 ,,RBRVS,12.64 ,11.20 ,11.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22100,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV,,,21 ,,RBRVS,11.00 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22101,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC,,,21 ,,RBRVS,11.08 ,9.94 ,9.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22102,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR,,,21 ,,RBRVS,11.08 ,10.26 ,10.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22103,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA,,,21 ,,RBRVS,2.34 ,1.31 ,1.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22110,CPT,PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM CRV,,,21 ,,RBRVS,14.00 ,12.36 ,12.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22112,CPT,PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM THRC,,,21 ,,RBRVS,14.07 ,11.84 ,11.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22114,CPT,PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM LMBR,,,21 ,,RBRVS,14.07 ,12.11 ,12.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22116,CPT,PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM EA,,,21 ,,RBRVS,2.32 ,1.27 ,1.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22206,CPT,OSTEOTOMY SPINE POSTERIOR 3 COLUMN THORACIC,,,21 ,,RBRVS,37.18 ,24.60 ,24.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22207,CPT,OSTEOTOMY SPINE POSTERIOR 3 COLUMN LUMBAR,,,21 ,,RBRVS,36.68 ,24.34 ,24.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22208,CPT,OSTEOTOMY SPINE POSTERIOR 3 COLUMN EA ADDL SGM,,,21 ,,RBRVS,9.66 ,5.25 ,5.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22210,CPT,OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM CRV,,,21 ,,RBRVS,25.38 ,19.65 ,19.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22212,CPT,OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM THRC,,,21 ,,RBRVS,20.99 ,16.96 ,16.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22214,CPT,OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM LMBR,,,21 ,,RBRVS,21.02 ,17.06 ,17.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22216,CPT,OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM,,,21 ,,RBRVS,6.03 ,3.38 ,3.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22220,CPT,OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM CRV,,,21 ,,RBRVS,22.94 ,17.77 ,17.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22222,CPT,OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM THRC,,,21 ,,RBRVS,23.09 ,16.09 ,16.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22224,CPT,OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM LMBR,,,21 ,,RBRVS,23.09 ,17.71 ,17.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22226,CPT,OSTEOT SPI W/DSKC ANT APPR 1 VRT SGM EA VRT SGM,,,21 ,,RBRVS,6.03 ,3.34 ,3.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22305,CPT,CLOSED TX VERTEBRAL PROCESS FRACTURE,,,21 ,,RBRVS,2.13 ,2.43 ,2.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22310,CPT,CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING,,,21 ,,RBRVS,3.89 ,3.40 ,4.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22315,CPT,CLTX VRT FX&/DISLC CSTING/BRACING MANJ/TRCJ,,,21 ,,RBRVS,10.11 ,9.79 ,12.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22318,CPT,OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRFG,,,21 ,,RBRVS,22.72 ,17.36 ,17.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22319,CPT,OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ GRF,,,21 ,,RBRVS,25.33 ,18.76 ,18.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22325,CPT,OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LMBR,,,21 ,,RBRVS,19.87 ,16.18 ,16.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22326,CPT,OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CRV,,,21 ,,RBRVS,20.84 ,16.22 ,16.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22327,CPT,OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM THRC,,,21 ,,RBRVS,20.77 ,16.67 ,16.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22328,CPT,OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA SGM,,,21 ,,RBRVS,4.60 ,2.51 ,2.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22505,CPT,MANIPULATION SPINE REQUIRING ANESTHESIA,,,21 ,,RBRVS,1.87 ,1.30 ,1.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22520,CPT,PERCUTANEOUS VERTEBROPLSTY THORACIC W/WO BONE BX,,,21 ,,RBRVS,9.22 ,5.13 ,55.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22521,CPT,PERCUTANEOUS VERTEBROPLASTY LUMBAR W/WO BNE BX,,,21 ,,RBRVS,8.65 ,4.91 ,54.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22522,CPT,PERCUTANEOUS VERTEBROPLASTY EA ADDL THRC/LMBR,,,21 ,,RBRVS,4.30 ,1.96 ,1.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22523,CPT,PERCUTANEOUS VERTEBRAL AUGMENTATION THORACIC,,,21 ,,RBRVS,9.26 ,6.20 ,6.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22524,CPT,PERCUTANEOUS VERTEBRAL AUGMENTATION LUMBAR,,,21 ,,RBRVS,8.86 ,6.01 ,6.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22525,CPT,PERQ VERTEBRAL AUGMENTATION EA ADDL THRC/LMBR,,,21 ,,RBRVS,4.47 ,2.34 ,2.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22526,CPT,PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY 1 LEVEL,,,21 ,,RBRVS,6.10 ,2.92 ,54.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22527,CPT,PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY ADDL LVL,,,21 ,,RBRVS,3.03 ,1.02 ,46.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22532,CPT,ARTHRODESIS LATERAL EXTRACAVITARY THORACIC,,,21 ,,RBRVS,25.99 ,18.75 ,18.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22533,CPT,ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR,,,21 ,,RBRVS,24.79 ,18.11 ,18.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22534,CPT,ARTHRODESIS LAT EXTRACAVITARY EA ADDL THRC/LMBR,,,21 ,,RBRVS,5.99 ,3.30 ,3.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22548,CPT,ARTHRD ANT TRANSORAL/XTRORAL C1-C2 W/WOEXC ODNTD,,,21 ,,RBRVS,27.06 ,20.26 ,20.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22551,CPT,ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2,,,21 ,,RBRVS,25.00 ,18.57 ,18.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22552,CPT,ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC,,,21 ,,RBRVS,6.50 ,3.64 ,3.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22554,CPT,ARTHRD ANT MIN DISCECT INTERBODY CERV BELOW C2,,,21 ,,RBRVS,17.69 ,14.22 ,14.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22556,CPT,ARTHRD ANT MIN DISCECTOMY INTERBODY THORACIC,,,21 ,,RBRVS,24.70 ,17.70 ,17.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22558,CPT,ARTHRODESIS ANTERIOR INTERBODY LUMBAR,,,21 ,,RBRVS,23.53 ,16.12 ,16.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22585,CPT,ARTHRODESIS ANTERIOR INTERBODY EA ADDL NTRSPC,,,21 ,,RBRVS,5.52 ,2.98 ,2.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22590,CPT,ARTHRODESIS POSTERIOR CRANIOCERVICAL,,,21 ,,RBRVS,21.76 ,17.30 ,17.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22595,CPT,ARTHRODESIS POSTERIOR ATLAS-AXIS C1-C2,,,21 ,,RBRVS,20.64 ,16.62 ,16.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22600,CPT,ARTHRODESIS PST/PSTLAT CERVICAL BELW C2 SGM,,,21 ,,RBRVS,17.40 ,14.71 ,14.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22610,CPT,ARTHRODESIS POSTERIOR/POSTEROLATERAL THORACIC,,,21 ,,RBRVS,17.28 ,14.53 ,14.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22612,CPT,ARTHRODESIS POSTERIOR/POSTEROLATERAL LUMBAR,,,21 ,,RBRVS,23.53 ,17.15 ,17.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22614,CPT,ARTHRODESIS POSTERIOR/POSTEROLATERAL EA ADDL,,,21 ,,RBRVS,6.43 ,3.56 ,3.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22630,CPT,ARTHRODESIS POSTERIOR INTERBODY LUMBAR,,,21 ,,RBRVS,22.09 ,16.84 ,16.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22632,CPT,ARTHRODESIS POSTERIOR INTERBODY EA ADDL,,,21 ,,RBRVS,5.22 ,2.87 ,2.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22633,CPT,ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR,,,21 ,,RBRVS,27.75 ,19.66 ,19.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22634,CPT,ARTHDSIS POST/POSTERLATRL/POSTINTRBDYADL SPC/SEG,,,21 ,,RBRVS,8.16 ,4.36 ,4.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22800,CPT,ARTHRODESIS POSTERIOR SPINAL DFRM UP 6 VRT SEG,,,21 ,,RBRVS,19.50 ,15.30 ,15.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22802,CPT,ARTHRODESIS POSTERIOR SPINAL DFRM 7-12 VRT SEG,,,21 ,,RBRVS,32.11 ,22.55 ,22.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22804,CPT,ARTHRODESIS POSTERIOR SPINAL DFRM 13/> VRT SEG,,,21 ,,RBRVS,37.50 ,25.63 ,25.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22808,CPT,ARTHRODESIS ANTERIOR SPINAL DFRM 2-3 VRT SEG,,,21 ,,RBRVS,27.51 ,19.27 ,19.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22810,CPT,ARTHRODESIS ANTERIOR SPINAL DFRM 4-7 VRT SEG,,,21 ,,RBRVS,31.50 ,20.69 ,20.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22812,CPT,ARTHRODESIS POSTERIOR SPINAL DFRM 8/> VRT SEG,,,21 ,,RBRVS,34.25 ,23.99 ,23.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22818,CPT,KYPHECTOMY SINGLE OR TWO SEGMENTS,,,21 ,,RBRVS,34.33 ,23.17 ,23.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22819,CPT,KYPHECTOMY 3 OR MORE SEGMENTS,,,21 ,,RBRVS,39.38 ,26.77 ,26.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22830,CPT,EXPLORATION SPINAL FUSION,,,21 ,,RBRVS,11.22 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22840,CPT,POSTERIOR NON-SEGMENTAL INSTRUMENTATION,,,21 ,,RBRVS,12.52 ,6.91 ,6.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22841,CPT,INTERNAL SPINAL FIXATION WIRING SPINOUS PROCESS,,,21 ,,TotalUnits,,,,17.53 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,22842,CPT,POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG,,,21 ,,RBRVS,12.56 ,6.95 ,6.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22843,CPT,POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG,,,21 ,,RBRVS,13.44 ,7.43 ,7.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22844,CPT,POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SEG,,,21 ,,RBRVS,16.42 ,9.31 ,9.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22845,CPT,ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS,,,21 ,,RBRVS,11.94 ,6.50 ,6.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22846,CPT,ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS,,,21 ,,RBRVS,12.40 ,6.76 ,6.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22847,CPT,ANTERIOR INSTRUMENTATION 8/> VERTEBRAL SEGMENTS,,,21 ,,RBRVS,13.78 ,7.48 ,7.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22848,CPT,PELVIC FIXATION OTHER THAN SACRUM,,,21 ,,RBRVS,5.99 ,3.40 ,3.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22849,CPT,REINSERTION SPINAL FIXATION DEVICE,,,21 ,,RBRVS,19.17 ,13.99 ,13.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22850,CPT,REMOVAL POSTERIOR NONSEGMENTAL INSTRUMENTATION,,,21 ,,RBRVS,9.82 ,8.58 ,8.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22851,CPT,APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE,,,21 ,,RBRVS,6.70 ,3.67 ,3.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22852,CPT,REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION,,,21 ,,RBRVS,9.37 ,8.30 ,8.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22855,CPT,REMOVAL ANTERIOR INSTRUMENTATION,,,21 ,,RBRVS,15.86 ,12.19 ,12.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22856,CPT,TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC CRV,,,21 ,,RBRVS,24.05 ,17.40 ,17.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22857,CPT,TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC LMBR,,,21 ,,RBRVS,27.13 ,16.47 ,16.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22861,CPT,REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC CRV,,,21 ,,RBRVS,33.36 ,16.97 ,16.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22862,CPT,REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC LMBR,,,21 ,,RBRVS,32.63 ,17.17 ,17.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22864,CPT,RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE CERVICAL,,,21 ,,RBRVS,29.40 ,18.37 ,18.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22865,CPT,RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE LUMBAR,,,21 ,,RBRVS,31.75 ,21.67 ,21.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22899,CPT,UNLISTED PROCEDURE SPINE,,,21 ,,TotalUnits,,,,19.43 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,22900,CPT,EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM,,,21 ,,RBRVS,8.32 ,5.46 ,5.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22901,CPT,EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/>,,,21 ,,RBRVS,10.11 ,7.36 ,7.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22902,CPT,EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM,,,21 ,,RBRVS,4.42 ,4.93 ,7.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22903,CPT,EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>,,,21 ,,RBRVS,6.39 ,5.54 ,5.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22904,CPT,RAD RESECTION TUMOR SOFT TISSUE ABDL WALL <5CM,,,21 ,,RBRVS,16.69 ,10.36 ,10.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22905,CPT,RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5 CM/>,,,21 ,,RBRVS,21.58 ,13.62 ,13.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,22999,CPT,UNLISTED PX ABDOMEN MUSCULOSKELETAL SYSTEM,,,21 ,,TotalUnits,,,,12.14 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,23000,CPT,REMOVAL SUBDELTOID CALCAREOUS DEPOSITS OPEN,,,21 ,,RBRVS,4.48 ,5.23 ,10.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23020,CPT,CAPSULAR CONTRACTURE RELEASE,,,21 ,,RBRVS,9.36 ,8.83 ,8.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23030,CPT,I&D SHOULDER DEEP ABSCESS/HEMATOMA,,,21 ,,RBRVS,3.47 ,3.30 ,8.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23031,CPT,I&D SHOULDER INFECTED BURSA,,,21 ,,RBRVS,2.79 ,2.91 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23035,CPT,INCISION BONE CORTEX SHOULDER AREA,,,21 ,,RBRVS,9.16 ,8.88 ,8.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23040,CPT,ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL FB,,,21 ,,RBRVS,9.75 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23044,CPT,ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB,,,21 ,,RBRVS,7.59 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23065,CPT,BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL,,,21 ,,RBRVS,2.30 ,2.23 ,3.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23066,CPT,BIOPSY SOFT TISSUE SHOULDER DEEP,,,21 ,,RBRVS,4.30 ,4.85 ,9.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23071,CPT,EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>,,,21 ,,RBRVS,5.91 ,5.34 ,5.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23073,CPT,EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>,,,21 ,,RBRVS,10.13 ,8.47 ,8.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23075,CPT,EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM,,,21 ,,RBRVS,4.21 ,3.35 ,6.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23076,CPT,EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM,,,21 ,,RBRVS,7.41 ,6.82 ,6.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23077,CPT,RAD RESECTION TUMOR SOFT TISSUE SHOULDER <5CM,,,21 ,,RBRVS,17.66 ,12.66 ,12.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23078,CPT,RAD RESECTION TUMOR SOFT TISSUE SHOULDER 5 CM/>,,,21 ,,RBRVS,22.55 ,14.04 ,14.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23100,CPT,ARTHROTOMY GLENOHUMERAL JOINT W/BIOPSY,,,21 ,,RBRVS,6.20 ,6.91 ,6.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23101,CPT,ARTHRT ACROMCLAV/STRNCLAV JT W/BX&/EXC CRTLG,,,21 ,,RBRVS,5.72 ,6.17 ,6.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23105,CPT,ARTHRT GLENOHUMRL JT W/SYNOVECTOMY W/WO BIOPSY,,,21 ,,RBRVS,8.48 ,8.35 ,8.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23106,CPT,ARTHRT GLENOHUMRL JT STRNCLAV JT W/SYNVCT W/WOBX,,,21 ,,RBRVS,6.13 ,6.77 ,6.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23107,CPT,ARTHRT GLENOHUMRL JT W/JT EXPL W/WORMVL LOOSE/FB,,,21 ,,RBRVS,8.87 ,8.59 ,8.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23120,CPT,CLAVICULECTOMY PARTIAL,,,21 ,,RBRVS,7.39 ,7.98 ,7.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23125,CPT,CLAVICULECTOMY TOTAL,,,21 ,,RBRVS,9.64 ,8.98 ,8.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23130,CPT,PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE,,,21 ,,RBRVS,7.77 ,8.31 ,8.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23140,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR CLAV/SCAPULA,,,21 ,,RBRVS,7.12 ,6.55 ,6.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23145,CPT,EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/AGRFT,,,21 ,,RBRVS,9.40 ,8.91 ,8.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23146,CPT,EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/ALGRFT,,,21 ,,RBRVS,8.08 ,8.06 ,8.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23150,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR PROX HUMERUS,,,21 ,,RBRVS,8.91 ,8.46 ,8.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23155,CPT,EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/AGRFT,,,21 ,,RBRVS,10.86 ,10.04 ,10.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23156,CPT,EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT,,,21 ,,RBRVS,9.11 ,8.73 ,8.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23170,CPT,SEQUESTRECTOMY CLAVICLE,,,21 ,,RBRVS,7.21 ,7.21 ,7.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23172,CPT,SEQUESTRECTOMY SCAPULA,,,21 ,,RBRVS,7.31 ,7.43 ,7.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23174,CPT,SEQUESTRECTOMY HUMERAL HEAD SURGERY NECK,,,21 ,,RBRVS,10.05 ,9.95 ,9.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23180,CPT,PARTIAL EXCISION BONE CLAVICLE,,,21 ,,RBRVS,8.99 ,8.94 ,8.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23182,CPT,PARTIAL EXCISION BONE SCAPULA,,,21 ,,RBRVS,8.61 ,8.99 ,8.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23184,CPT,PARTIAL EXCISION BONE PROXIMAL HUMERUS,,,21 ,,RBRVS,9.90 ,9.68 ,9.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23190,CPT,OSTECTOMY SCAPULA PARTIAL,,,21 ,,RBRVS,7.47 ,7.46 ,7.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23195,CPT,RESECTION HUMERAL HEAD,,,21 ,,RBRVS,10.36 ,9.53 ,9.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23200,CPT,RADICAL RESECTION TUMOR CLAVICLE,,,21 ,,RBRVS,22.71 ,14.19 ,14.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23210,CPT,RADICAL RESECTION TUMOR SCAPULA,,,21 ,,RBRVS,27.21 ,15.85 ,15.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23220,CPT,RADICAL RESECTION BONE TUMOR PROXIMAL HUMERUS,,,21 ,,RBRVS,30.21 ,17.29 ,17.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23330,CPT,REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS,,,21 ,,RBRVS,1.90 ,2.09 ,4.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23331,CPT,REMOVAL FOREIGN BODY SHOULDER DEEP,,,21 ,,RBRVS,7.63 ,7.98 ,7.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23332,CPT,REMOVAL FOREIGN BODY SHOULDER COMPLICATED,,,21 ,,RBRVS,12.37 ,10.96 ,10.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23350,CPT,INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG,,,21 ,,RBRVS,1.00 ,0.42 ,3.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23395,CPT,MUSCLE TRANSFER SHOULDER/UPPER ARM SINGLE,,,21 ,,RBRVS,18.54 ,15.44 ,15.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23397,CPT,MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE,,,21 ,,RBRVS,16.76 ,13.42 ,13.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23400,CPT,SCAPULOPEXY,,,21 ,,RBRVS,13.87 ,11.82 ,11.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23405,CPT,TENOTOMY SHOULDER AREA 1 TENDON,,,21 ,,RBRVS,8.54 ,8.06 ,8.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23406,CPT,TENOTOMY SHOULDER MULTIPLE THRU SAME INCISION,,,21 ,,RBRVS,11.01 ,9.58 ,9.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23410,CPT,OPEN REPAIR OF ROTATOR CUFF ACUTE,,,21 ,,RBRVS,11.39 ,10.42 ,10.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23412,CPT,OPEN REPAIR OF ROTATOR CUFF CHRONIC,,,21 ,,RBRVS,11.93 ,10.76 ,10.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23415,CPT,CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY,,,21 ,,RBRVS,9.23 ,9.17 ,9.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23420,CPT,RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC,,,21 ,,RBRVS,13.54 ,12.17 ,12.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23430,CPT,TENODESIS LONG TENDON BICEPS,,,21 ,,RBRVS,10.17 ,9.47 ,9.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23440,CPT,RESECTION/TRANSPLANTATION LONG TENDON BICEPS,,,21 ,,RBRVS,10.64 ,9.35 ,9.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23450,CPT,CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON,,,21 ,,RBRVS,13.70 ,11.32 ,11.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23455,CPT,CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR,,,21 ,,RBRVS,14.67 ,11.93 ,11.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23460,CPT,CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK,,,21 ,,RBRVS,15.82 ,13.05 ,13.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23462,CPT,CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR,,,21 ,,RBRVS,15.72 ,12.61 ,12.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23465,CPT,CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK,,,21 ,,RBRVS,16.30 ,13.21 ,13.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23466,CPT,CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS,,,21 ,,RBRVS,15.80 ,13.76 ,13.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23470,CPT,ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY,,,21 ,,RBRVS,17.89 ,14.12 ,14.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23472,CPT,ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER,,,21 ,,RBRVS,22.65 ,16.94 ,16.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23480,CPT,OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION,,,21 ,,RBRVS,11.54 ,10.13 ,10.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23485,CPT,OSTEOTOMY CLAV W/WO INT FIXJ W/B1 GRF NON/MAL,,,21 ,,RBRVS,13.91 ,11.48 ,11.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23490,CPT,PROPH TX W/WO METHYLMETHACRYLATE CLAVICLE,,,21 ,,RBRVS,12.16 ,10.93 ,10.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23491,CPT,PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS,,,21 ,,RBRVS,14.54 ,12.25 ,12.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23500,CPT,CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,2.21 ,3.51 ,3.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23505,CPT,CLSD TX CLAVICULAR FRACTURE W/MANIPULATION,,,21 ,,RBRVS,3.83 ,4.83 ,5.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23515,CPT,OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION,,,21 ,,RBRVS,9.69 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23520,CPT,CLSD TX STERNOCLAVICULAR DISLC W/O MANIPULATION,,,21 ,,RBRVS,2.29 ,3.75 ,3.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23525,CPT,CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION,,,21 ,,RBRVS,3.79 ,5.13 ,5.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23530,CPT,OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC,,,21 ,,RBRVS,7.48 ,7.19 ,7.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23532,CPT,OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF,,,21 ,,RBRVS,8.20 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23540,CPT,CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION,,,21 ,,RBRVS,2.36 ,3.45 ,3.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23545,CPT,CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION,,,21 ,,RBRVS,3.43 ,4.31 ,5.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23550,CPT,OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC,,,21 ,,RBRVS,7.59 ,7.52 ,7.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23552,CPT,OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF,,,21 ,,RBRVS,8.82 ,8.59 ,8.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23570,CPT,CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,2.36 ,3.83 ,3.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23575,CPT,CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION,,,21 ,,RBRVS,4.23 ,5.50 ,6.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23585,CPT,OPEN TX SCAPULAR FX W/INTERNAL FIXATION IF PFRMD,,,21 ,,RBRVS,14.23 ,11.43 ,11.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23600,CPT,CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,3.11 ,4.77 ,5.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23605,CPT,CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ,,,21 ,,RBRVS,5.06 ,6.16 ,7.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23615,CPT,OPEN TREATMENT PROXIMAL HUMERAL FRACTURE,,,21 ,,RBRVS,12.30 ,11.03 ,11.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23616,CPT,OPEN PROX HUMERAL FRACTURE PROSTHETIC RPLCMT,,,21 ,,RBRVS,18.37 ,14.80 ,14.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23620,CPT,CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ,,,21 ,,RBRVS,2.55 ,4.10 ,4.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23625,CPT,CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION,,,21 ,,RBRVS,4.10 ,5.20 ,5.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23630,CPT,OPEN TREATMENT GRTER HUMERAL TUBEROSITY FRACTURE,,,21 ,,RBRVS,10.57 ,9.84 ,9.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23650,CPT,CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES,,,21 ,,RBRVS,3.53 ,3.65 ,4.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23655,CPT,CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES,,,21 ,,RBRVS,4.76 ,5.57 ,5.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23660,CPT,OPEN TX ACUTE SHOULDER DISLOCATION,,,21 ,,RBRVS,7.66 ,7.72 ,7.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23665,CPT,CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ,,,21 ,,RBRVS,4.66 ,5.72 ,6.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23670,CPT,OPEN TX SHOULDER DISLC W/HUMERAL TUBEROSITY FX,,,21 ,,RBRVS,12.28 ,10.53 ,10.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23675,CPT,CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ,,,21 ,,RBRVS,6.27 ,6.91 ,8.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23680,CPT,OPEN TX SHOULDER DISLOCATION W/NECK FRACTURE,,,21 ,,RBRVS,13.15 ,11.18 ,11.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23700,CPT,MANJ W/ANES SHOULDER JOINT W/FIXATION APPARATUS,,,21 ,,RBRVS,2.57 ,2.57 ,2.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23800,CPT,ARTHRODESIS GLENOHUMERAL JOINT,,,21 ,,RBRVS,14.73 ,12.36 ,12.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23802,CPT,ARTHRODESIS GLENOHUMERAL JT W/AUTOGENOUS GRAFT,,,21 ,,RBRVS,18.42 ,15.08 ,15.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23900,CPT,INTERTHORACOSCAPULAR AMPUTATION,,,21 ,,RBRVS,20.72 ,14.96 ,14.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23920,CPT,DISARTICULATION SHOULDER,,,21 ,,RBRVS,16.23 ,12.87 ,12.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23921,CPT,DISRTCJ SHOULDER SECONDARY CLSR/SCAR REVISION,,,21 ,,RBRVS,5.72 ,5.73 ,5.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23929,CPT,UNLISTED PROCEDURE SHOULDER,,,21 ,,TotalUnits,,,,15.37 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,23930,CPT,I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA,,,21 ,,RBRVS,2.99 ,2.70 ,6.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23931,CPT,INCISION&DRAINAGE UPPER ARM/ELBOW BURSA,,,21 ,,RBRVS,1.84 ,2.40 ,5.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,23935,CPT,INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW,,,21 ,,RBRVS,6.38 ,6.94 ,6.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24000,CPT,ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB,,,21 ,,RBRVS,6.08 ,6.52 ,6.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24006,CPT,ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX,,,21 ,,RBRVS,9.74 ,9.12 ,9.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24065,CPT,BIOPSY SOFT TISSUE UPPER ARM/ELBOW SUPERFICIAL,,,21 ,,RBRVS,2.13 ,2.44 ,4.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24066,CPT,BIOPSY SOFT TISSUE UPPER ARM/ELBOW AREA DEEP,,,21 ,,RBRVS,5.35 ,5.33 ,10.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24071,CPT,EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>,,,21 ,,RBRVS,5.70 ,5.29 ,5.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24073,CPT,EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>,,,21 ,,RBRVS,10.13 ,8.57 ,8.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24075,CPT,EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM,,,21 ,,RBRVS,4.24 ,4.37 ,8.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24076,CPT,EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM,,,21 ,,RBRVS,7.41 ,6.47 ,6.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24077,CPT,RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW <5CM,,,21 ,,RBRVS,15.72 ,10.47 ,10.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24079,CPT,RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW 5CM/>,,,21 ,,RBRVS,20.61 ,13.20 ,13.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24100,CPT,ARTHROTOMY ELBOW W/SYNOVIAL BIOPSY ONLY,,,21 ,,RBRVS,5.07 ,5.81 ,5.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24101,CPT,ARTHRT ELBOW W/JNT EXPL W/WOBX W/WORMVL LOOSE/FB,,,21 ,,RBRVS,6.30 ,6.94 ,6.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24102,CPT,ARTHROTOMY ELBOW W/SYNOVECTOMY,,,21 ,,RBRVS,8.26 ,8.01 ,8.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24105,CPT,EXCISION OLECRANON BURSA,,,21 ,,RBRVS,3.78 ,5.41 ,5.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24110,CPT,EXCISION/CURTG BONE CYST/BENIGN TUMOR HUMERUS,,,21 ,,RBRVS,7.58 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24115,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR HUMERUS W/AGRFT,,,21 ,,RBRVS,10.12 ,9.24 ,9.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24116,CPT,EXC/CURTG BONE CYST/BENIGN TUM HUMERUS W/ALGRFT,,,21 ,,RBRVS,12.23 ,10.51 ,10.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24120,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN,,,21 ,,RBRVS,6.82 ,7.10 ,7.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24125,CPT,EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/AGRFT,,,21 ,,RBRVS,8.14 ,8.10 ,8.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24126,CPT,EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/ALGRT,,,21 ,,RBRVS,8.62 ,8.47 ,8.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24130,CPT,EXCISION RADIAL HEAD,,,21 ,,RBRVS,6.42 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24134,CPT,SEQUESTRECTOMY SHAFT/DISTAL HUMERUS,,,21 ,,RBRVS,10.22 ,9.60 ,9.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24136,CPT,SEQUESTRECTOMY RADIAL HEAD OR NECK,,,21 ,,RBRVS,8.40 ,7.76 ,7.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24138,CPT,SEQUESTRECTOMY OLECRANON PROCESS,,,21 ,,RBRVS,8.50 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24140,CPT,PARTIAL EXCISION BONE HUMERUS,,,21 ,,RBRVS,9.55 ,9.32 ,9.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24145,CPT,PARTIAL EXCISION BONE RADIAL HEAD/NECK,,,21 ,,RBRVS,7.81 ,8.02 ,8.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24147,CPT,PARTIAL EXCISION BONE OLECRANON PROCESS,,,21 ,,RBRVS,7.84 ,8.81 ,8.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24149,CPT,RAD RESCJ CAPSL TISS&HTRTPC BONE ELBW CONTRCT,,,21 ,,RBRVS,16.22 ,14.84 ,14.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24150,CPT,RADICAL RESECTION TUMOR SHAFT/DISTAL HUMERUS,,,21 ,,RBRVS,23.46 ,14.97 ,14.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24152,CPT,RADICAL RESECTION TUMOR RADIAL HEAD/NECK,,,21 ,,RBRVS,19.99 ,12.70 ,12.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24155,CPT,RESECTION ELBOW JOINT ARTHRECTOMY,,,21 ,,RBRVS,12.09 ,10.36 ,10.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24160,CPT,IMPLANT REMOVAL ELBOW JOINT,,,21 ,,RBRVS,8.00 ,8.07 ,8.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24164,CPT,IMPLANT REMOVAL RADIAL HEAD,,,21 ,,RBRVS,6.43 ,6.71 ,6.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24200,CPT,RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS,,,21 ,,RBRVS,1.81 ,1.88 ,3.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24201,CPT,REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP,,,21 ,,RBRVS,4.70 ,4.96 ,10.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24220,CPT,INJECTION ELBOW ARTHROGRAPHY,,,21 ,,RBRVS,1.31 ,0.59 ,3.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24300,CPT,MANIPULATION ELBOW UNDER ANESTHESIA,,,21 ,,RBRVS,4.04 ,6.84 ,6.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24301,CPT,MUSCLE/TENDON TRANSFER UPPER ARM/ELBOW SINGLE,,,21 ,,RBRVS,10.38 ,9.47 ,9.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24305,CPT,TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON,,,21 ,,RBRVS,7.62 ,7.81 ,7.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24310,CPT,TENOTOMY OPEN ELBOW TO SHOULDER EACH TENDON,,,21 ,,RBRVS,6.12 ,6.49 ,6.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24320,CPT,TENOPLASTY ELBOW TO SHOULDER SINGLE,,,21 ,,RBRVS,10.86 ,9.67 ,9.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24330,CPT,FLEXOR-PLASTY ELBOW,,,21 ,,RBRVS,9.79 ,9.15 ,9.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24331,CPT,FLEXOR-PLASTY ELBOW W/EXTENSOR ADVANCEMENT,,,21 ,,RBRVS,10.95 ,10.33 ,10.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24332,CPT,TENOLYSIS TRICEPS,,,21 ,,RBRVS,7.91 ,8.22 ,8.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24340,CPT,TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE,,,21 ,,RBRVS,8.08 ,8.14 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24341,CPT,REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA,,,21 ,,RBRVS,9.49 ,10.13 ,10.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24342,CPT,RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF,,,21 ,,RBRVS,10.86 ,9.78 ,9.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24343,CPT,REPAIR LATERAL COLLATERAL LIGAMENT ELBOW,,,21 ,,RBRVS,9.16 ,9.58 ,9.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24344,CPT,RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT,,,21 ,,RBRVS,15.21 ,13.73 ,13.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24345,CPT,REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW,,,21 ,,RBRVS,9.16 ,9.46 ,9.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24346,CPT,RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF,,,21 ,,RBRVS,15.21 ,13.78 ,13.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24357,CPT,TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS,,,21 ,,RBRVS,5.44 ,6.40 ,6.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24358,CPT,TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN,,,21 ,,RBRVS,6.66 ,7.24 ,7.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24359,CPT,TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR,,,21 ,,RBRVS,8.98 ,8.41 ,8.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24360,CPT,ARTHROPLASTY ELBOW W/MEMBRANE,,,21 ,,RBRVS,12.67 ,11.11 ,11.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24361,CPT,ARTHROPLASTY ELBOW W/DISTAL HUMRL PROSTC RPLCMT,,,21 ,,RBRVS,14.41 ,12.24 ,12.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24362,CPT,ARTHRP ELBOW W/IMPLT&FSCA LATA LIGAMENT RCNSTJ,,,21 ,,RBRVS,15.32 ,12.68 ,12.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24363,CPT,ARTHRP ELBOW W/DISTAL HUM&PROX UR PROSTC RPLCMT,,,21 ,,RBRVS,22.65 ,17.03 ,17.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24365,CPT,ARTHROPLASTY RADIAL HEAD,,,21 ,,RBRVS,8.62 ,8.28 ,8.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24366,CPT,ARTHROPLASTY RADIAL HEAD W/IMPLANT,,,21 ,,RBRVS,9.36 ,8.73 ,8.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24400,CPT,OSTEOTOMY HUMERUS W/WO INTERNAL FIXATION,,,21 ,,RBRVS,11.33 ,10.37 ,10.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24410,CPT,MLT OSTEOT W/RELIGNMT IMED ROD HUMERAL SHAFT,,,21 ,,RBRVS,15.11 ,12.62 ,12.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24420,CPT,OSTEOPLASTY HUMERUS,,,21 ,,RBRVS,13.73 ,12.45 ,12.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24430,CPT,REPAIR NON/MALUNION HUMERUS W/O GRAFT,,,21 ,,RBRVS,15.25 ,12.66 ,12.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24435,CPT,REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT,,,21 ,,RBRVS,14.99 ,13.47 ,13.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24470,CPT,HEMIEPIPHYSEAL ARREST,,,21 ,,RBRVS,8.93 ,8.21 ,8.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24495,CPT,DECOMPRESSION FASCT F/ARM W/BRACH ART EXPL,,,21 ,,RBRVS,8.41 ,8.94 ,8.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24498,CPT,PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT,,,21 ,,RBRVS,12.28 ,10.66 ,10.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24500,CPT,CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,3.41 ,5.00 ,5.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24505,CPT,CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ,,,21 ,,RBRVS,5.39 ,6.52 ,7.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24515,CPT,OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE,,,21 ,,RBRVS,12.12 ,11.07 ,11.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24516,CPT,TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE,,,21 ,,RBRVS,12.19 ,10.58 ,10.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24530,CPT,CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ,,,21 ,,RBRVS,3.69 ,5.29 ,6.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24535,CPT,CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ,,,21 ,,RBRVS,7.11 ,7.90 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24538,CPT,PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX,,,21 ,,RBRVS,9.77 ,9.92 ,9.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24545,CPT,OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN,,,21 ,,RBRVS,13.15 ,11.27 ,11.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24546,CPT,OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/XTN,,,21 ,,RBRVS,14.91 ,12.72 ,12.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24560,CPT,CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ,,,21 ,,RBRVS,2.98 ,4.44 ,5.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24565,CPT,CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ,,,21 ,,RBRVS,5.78 ,6.83 ,7.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24566,CPT,PRQ SKEL FIXJ HUMRL EPCNDYLR FX MEDIAL/LAT MANJ,,,21 ,,RBRVS,9.06 ,9.81 ,9.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24575,CPT,OPEN TX HUMERAL EPICONDYLAR FRACTURE,,,21 ,,RBRVS,9.71 ,9.70 ,9.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24576,CPT,CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ,,,21 ,,RBRVS,3.06 ,4.88 ,5.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24577,CPT,CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ,,,21 ,,RBRVS,6.01 ,7.01 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24579,CPT,OPEN TREATMENT HUMERAL CONDYLAR FRACTURE,,,21 ,,RBRVS,11.44 ,10.64 ,10.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24582,CPT,PRQ SKEL FIXJ HUMRL CNDYLR FX MEDIAL/LAT W/MANJ,,,21 ,,RBRVS,10.14 ,11.03 ,11.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24586,CPT,OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBOW,,,21 ,,RBRVS,15.78 ,13.02 ,13.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24587,CPT,OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHRP,,,21 ,,RBRVS,15.79 ,13.07 ,13.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24600,CPT,TREATMENT CLOSED ELBOW DISLOCATION W/O ANES,,,21 ,,RBRVS,4.37 ,4.22 ,5.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24605,CPT,TREATMENT CLOSED ELBOW DISLOCATION REQ ANES,,,21 ,,RBRVS,5.64 ,6.63 ,6.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24615,CPT,OPEN TX ACUTE/CHRONIC ELBOW DISLOCATION,,,21 ,,RBRVS,9.83 ,9.07 ,9.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24620,CPT,CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ,,,21 ,,RBRVS,7.22 ,7.39 ,7.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24635,CPT,OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW,,,21 ,,RBRVS,8.80 ,9.98 ,9.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24640,CPT,CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ,,,21 ,,RBRVS,1.25 ,1.07 ,2.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24650,CPT,CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION,,,21 ,,RBRVS,2.31 ,3.90 ,4.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24655,CPT,CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION,,,21 ,,RBRVS,4.62 ,5.80 ,6.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24665,CPT,OPEN TX RADIAL HEAD/NECK FRACTURE,,,21 ,,RBRVS,8.36 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24666,CPT,OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC,,,21 ,,RBRVS,9.86 ,9.56 ,9.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24670,CPT,CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ,,,21 ,,RBRVS,2.69 ,4.13 ,4.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24675,CPT,CLOSED TX ULNAR FRACTURE PROXIMAL END W MANJ,,,21 ,,RBRVS,4.91 ,6.08 ,7.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24685,CPT,OPEN TREATMENT ULNAR FRACTURE PROXIMAL END,,,21 ,,RBRVS,8.37 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24800,CPT,ARTHRODESIS ELBOW JOINT LOCAL,,,21 ,,RBRVS,11.41 ,10.07 ,10.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24802,CPT,ARTHRODESIS ELBOW JOINT W/AUTOGENOUS GRAFT,,,21 ,,RBRVS,14.32 ,12.08 ,12.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24900,CPT,AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE,,,21 ,,RBRVS,10.18 ,8.97 ,8.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24920,CPT,AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR,,,21 ,,RBRVS,10.13 ,8.93 ,8.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24925,CPT,AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ,,,21 ,,RBRVS,7.30 ,7.57 ,7.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24930,CPT,AMPUTATION ARM THRU HUMERUS RE-AMPUTATION,,,21 ,,RBRVS,10.83 ,9.34 ,9.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24931,CPT,AMPUTATION ARM THRU HUMERUS W/IMPLANT,,,21 ,,RBRVS,13.44 ,8.14 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24935,CPT,STUMP ELONGATION UPPER EXTREMITY,,,21 ,,RBRVS,16.45 ,8.53 ,8.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24940,CPT,CINEPLASTY UPPER EXTREMITY COMPLETE PROCEDURE,,,21 ,,RBRVS,14.70 ,12.92 ,12.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,24999,CPT,UNLISTED PROCEDURE HUMERUS/ELBOW,,,21 ,,TotalUnits,,,,13.24 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,25000,CPT,INCISION EXTENSOR TENDON SHEATH WRIST,,,21 ,,RBRVS,3.55 ,5.73 ,5.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25001,CPT,INCISION FLEXOR TENDON SHEATH WRIST,,,21 ,,RBRVS,3.79 ,5.31 ,5.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25020,CPT,DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT,,,21 ,,RBRVS,6.06 ,9.56 ,9.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25023,CPT,DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT,,,21 ,,RBRVS,13.83 ,15.54 ,15.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25024,CPT,DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DBRDMT,,,21 ,,RBRVS,10.79 ,9.72 ,9.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25025,CPT,DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT NV,,,21 ,,RBRVS,17.94 ,13.97 ,13.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25028,CPT,I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA,,,21 ,,RBRVS,5.39 ,8.54 ,8.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25031,CPT,INCISION & DRAINAGE FOREARM&/WRIST BURSA,,,21 ,,RBRVS,4.26 ,5.41 ,5.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25035,CPT,INCISION DEEP BONE CORTEX FOREARM&/WRIST,,,21 ,,RBRVS,7.65 ,8.76 ,8.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25040,CPT,ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB,,,21 ,,RBRVS,7.50 ,7.58 ,7.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25065,CPT,BIOPSY SOFT TISSUE FOREARM&/WRIST SUPERFICIAL,,,21 ,,RBRVS,2.04 ,2.48 ,4.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25066,CPT,BIOPSY SOFT TISSUE FOREARM&/WRIST DEEP,,,21 ,,RBRVS,4.27 ,5.59 ,5.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25071,CPT,EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>,,,21 ,,RBRVS,5.91 ,5.69 ,5.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25073,CPT,EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3CM/>,,,21 ,,RBRVS,7.13 ,7.47 ,7.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25075,CPT,EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM,,,21 ,,RBRVS,3.96 ,4.75 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25076,CPT,EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM,,,21 ,,RBRVS,6.74 ,7.01 ,7.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25077,CPT,RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3CM,,,21 ,,RBRVS,12.93 ,10.20 ,10.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25078,CPT,RAD RESCJ TUM SOFT TISSUE FOREARM&/WRIST 3 CM/>,,,21 ,,RBRVS,17.69 ,11.93 ,11.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25085,CPT,CAPSULOTOMY WRIST,,,21 ,,RBRVS,5.64 ,6.55 ,6.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25100,CPT,ARTHROTOMY WRIST JOINT WITH BIOPSY,,,21 ,,RBRVS,4.02 ,5.21 ,5.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25101,CPT,ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB,,,21 ,,RBRVS,4.83 ,6.01 ,6.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25105,CPT,ARTHROTOMY WRIST JOINT WITH SYNOVECTOMY,,,21 ,,RBRVS,6.02 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25107,CPT,ARTHROTOMY DSTL RADIOULNAR JOINT RPR CARTILAGE,,,21 ,,RBRVS,7.70 ,8.87 ,8.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25109,CPT,EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA,,,21 ,,RBRVS,6.94 ,7.25 ,7.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25110,CPT,EXCISION LESION TENDON SHEATH FOREARM&/WRIST,,,21 ,,RBRVS,4.04 ,5.36 ,5.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25111,CPT,EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY,,,21 ,,RBRVS,3.53 ,4.99 ,4.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25112,CPT,EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT,,,21 ,,RBRVS,4.67 ,5.61 ,5.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25115,CPT,RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS,,,21 ,,RBRVS,10.09 ,10.99 ,10.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25116,CPT,RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS,,,21 ,,RBRVS,7.56 ,9.35 ,9.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25118,CPT,SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT,,,21 ,,RBRVS,4.51 ,5.78 ,5.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25119,CPT,SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA,,,21 ,,RBRVS,6.21 ,7.17 ,7.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25120,CPT,EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA,,,21 ,,RBRVS,6.27 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25125,CPT,EXC/CURTG CYST/TUMOR RADIUS/ULNA W/AUTOGRAFT,,,21 ,,RBRVS,7.67 ,8.91 ,8.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25126,CPT,EXC/CURTG CYST/TUMOR RADIUS/ULNA W/ALLOGRAFT,,,21 ,,RBRVS,7.74 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25130,CPT,EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES,,,21 ,,RBRVS,5.43 ,6.64 ,6.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25135,CPT,EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT,,,21 ,,RBRVS,7.08 ,7.80 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25136,CPT,EXC/CURTG CYST/TUMOR CARPAL BONES W/ALLOGRAFT,,,21 ,,RBRVS,6.14 ,6.98 ,6.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25145,CPT,SEQUESTRECTOMY FOREARM &/WRIST,,,21 ,,RBRVS,6.54 ,8.00 ,8.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25150,CPT,PARTIAL EXCISION BONE ULNA,,,21 ,,RBRVS,7.38 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25151,CPT,PARTIAL EXCISION BONE RADIUS,,,21 ,,RBRVS,7.68 ,8.68 ,8.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25170,CPT,RADICAL RESECTION TUMOR RADIUS OR ULNA,,,21 ,,RBRVS,22.21 ,14.83 ,14.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25210,CPT,CARPECTOMY 1 BONE,,,21 ,,RBRVS,6.12 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25215,CPT,CARPECTOMY ALL BONES PROXIMAL ROW,,,21 ,,RBRVS,8.14 ,8.61 ,8.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25230,CPT,RADICAL STYLOIDECTOMY SEPARATE PROCEDURE,,,21 ,,RBRVS,5.37 ,6.29 ,6.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25240,CPT,EXCISION DISTAL ULNA PARTIAL/COMPLETE,,,21 ,,RBRVS,5.31 ,6.37 ,6.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25246,CPT,INJECTION WRIST ARTHROGRAPHY,,,21 ,,RBRVS,1.45 ,0.62 ,3.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25248,CPT,EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST,,,21 ,,RBRVS,5.31 ,6.07 ,6.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25250,CPT,REMOVAL WRIST PROSTHESIS SEPARATE PROCEDURE,,,21 ,,RBRVS,6.77 ,7.20 ,7.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25251,CPT,REMOVAL WRIST PROSTH COMPLICATED W/TOTAL WRIST,,,21 ,,RBRVS,9.82 ,9.17 ,9.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25259,CPT,MANIPULATION WRIST UNDER ANESTHESIA,,,21 ,,RBRVS,4.04 ,6.91 ,6.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25260,CPT,RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MUSC,,,21 ,,RBRVS,8.04 ,9.61 ,9.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25263,CPT,RPR TDN/MUSC FLXR F/ARM&/WRST SEC 1 EA TDN/MUSC,,,21 ,,RBRVS,8.04 ,9.44 ,9.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25265,CPT,RPR TDN/MUSC FLXR F/ARM&/WRST SEC FR GRF EA,,,21 ,,RBRVS,10.10 ,10.59 ,10.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25270,CPT,RPR TDN/MUSC XTNSR F/ARM&/WRST PRIM 1 EA TDN,,,21 ,,RBRVS,6.17 ,7.81 ,7.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25272,CPT,RPR TDN/MUSC XTNSR F/ARM&/WRST SEC 1 EA TDN/MUSC,,,21 ,,RBRVS,7.21 ,8.47 ,8.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25274,CPT,RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN,,,21 ,,RBRVS,8.94 ,9.65 ,9.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25275,CPT,RPR TENDON SHEATH EXTENSOR F/ARM&/WRST W/GRAFT,,,21 ,,RBRVS,8.96 ,8.89 ,8.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25280,CPT,LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRST 1 EA TDN,,,21 ,,RBRVS,7.39 ,8.57 ,8.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25290,CPT,TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA,,,21 ,,RBRVS,5.43 ,7.64 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25295,CPT,TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA,,,21 ,,RBRVS,6.72 ,8.15 ,8.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25300,CPT,TENODESIS WRIST FLEXORS FINGERS,,,21 ,,RBRVS,9.02 ,9.17 ,9.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25301,CPT,TENODESIS WRIST EXTENSORS FINGERS,,,21 ,,RBRVS,8.59 ,8.65 ,8.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25310,CPT,TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN,,,21 ,,RBRVS,8.08 ,9.32 ,9.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25312,CPT,TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GRF,,,21 ,,RBRVS,9.82 ,10.22 ,10.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25315,CPT,FLEXOR ORIGIN SLIDE FOREARM &/WRIST,,,21 ,,RBRVS,10.68 ,10.65 ,10.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25316,CPT,FLEXOR ORIGIN SLIDE F/ARM&/WRST TENDON TRANSFER,,,21 ,,RBRVS,12.90 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25320,CPT,CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS,,,21 ,,RBRVS,12.75 ,13.58 ,13.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25332,CPT,ARTHRP WRST W/WO INTERPOS W/WO XTRNL/INT FIXJ,,,21 ,,RBRVS,11.74 ,10.70 ,10.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25335,CPT,CENTRALIZATION WRST ULNA,,,21 ,,RBRVS,13.39 ,10.00 ,10.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25337,CPT,RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ,,,21 ,,RBRVS,11.73 ,12.17 ,12.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25350,CPT,OSTEOTOMY RADIUS DISTAL THIRD,,,21 ,,RBRVS,9.09 ,9.82 ,9.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25355,CPT,OSTEOTOMY RADIUS MIDDLE/PROXIMAL THIRD,,,21 ,,RBRVS,10.53 ,10.66 ,10.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25360,CPT,OSTEOTOMY ULNA,,,21 ,,RBRVS,8.74 ,9.57 ,9.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25365,CPT,OSTEOTOMY RADIUS & ULNA,,,21 ,,RBRVS,12.91 ,12.08 ,12.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25370,CPT,MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS/ULNA,,,21 ,,RBRVS,14.10 ,13.30 ,13.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25375,CPT,MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS&ULNA,,,21 ,,RBRVS,13.55 ,12.60 ,12.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25390,CPT,OSTEOPLASTY RADIUS/ULNA SHORTENING,,,21 ,,RBRVS,10.70 ,10.77 ,10.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25391,CPT,OSTEOPLASTY RADIUS/ULNA LENGTHENING W/AUTOGRAFT,,,21 ,,RBRVS,14.28 ,12.93 ,12.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25392,CPT,OSTEOPLASTY RADIUS & ULNA SHORTENING,,,21 ,,RBRVS,14.58 ,13.12 ,13.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25393,CPT,OSTEOPLASTY RADIUS&ULNA LENGTHENING W/AUTOGRAFT,,,21 ,,RBRVS,16.56 ,14.99 ,14.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25394,CPT,OSTEOPLASTY CARPAL BONE SHORTENING,,,21 ,,RBRVS,10.85 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25400,CPT,RPIR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT,,,21 ,,RBRVS,11.28 ,11.08 ,11.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25405,CPT,RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT,,,21 ,,RBRVS,15.01 ,13.52 ,13.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25415,CPT,RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAFT,,,21 ,,RBRVS,13.80 ,13.12 ,13.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25420,CPT,RPR NONUNION/MALUNION RADIUS&ULNA W/AUTOGRAFT,,,21 ,,RBRVS,17.04 ,14.84 ,14.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25425,CPT,REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA,,,21 ,,RBRVS,13.72 ,13.39 ,13.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25426,CPT,REPAIR DEFECT W/AUTOGRAFT RADIUS&ULNA,,,21 ,,RBRVS,16.45 ,13.13 ,13.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25430,CPT,INSERTION VASCULAR PEDICLE CARPAL BONE,,,21 ,,RBRVS,9.71 ,9.46 ,9.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25431,CPT,REPAIR NONUNION CARPAL BONE EACH BONE,,,21 ,,RBRVS,10.89 ,9.82 ,9.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25440,CPT,RPR NONUNION SCAPHOID CARPAL BNE W/WO RDL STYLEC,,,21 ,,RBRVS,10.68 ,9.89 ,9.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25441,CPT,ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL RADIUS,,,21 ,,RBRVS,13.29 ,12.09 ,12.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25442,CPT,ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL ULNA,,,21 ,,RBRVS,11.12 ,10.46 ,10.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25443,CPT,ARTHROPLASTY W/PROSTHETIC RPLCMT SCAPHOID CARPAL,,,21 ,,RBRVS,10.66 ,10.01 ,10.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25444,CPT,ARTHROPLASTY W/PROSTHETIC REPLACEMENT LUNATE,,,21 ,,RBRVS,11.42 ,10.88 ,10.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25445,CPT,ARTHROPLASTY W/PROSTHETIC REPLACEMENT TRAPEZIUM,,,21 ,,RBRVS,9.88 ,9.29 ,9.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25446,CPT,ARTHRP W/PROSTC RPLCMT DSTL RDS&PRTL/CARPUS,,,21 ,,RBRVS,17.30 ,14.04 ,14.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25447,CPT,ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS,,,21 ,,RBRVS,11.14 ,10.83 ,10.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25449,CPT,REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT,,,21 ,,RBRVS,14.94 ,12.64 ,12.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25450,CPT,EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/U,,,21 ,,RBRVS,8.06 ,6.80 ,6.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25455,CPT,EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS&U,,,21 ,,RBRVS,9.71 ,7.72 ,7.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25490,CPT,PROPH TX N/P/PLTWR W/WO METHYLACRYLATE RADIUS,,,21 ,,RBRVS,9.73 ,9.51 ,9.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25491,CPT,PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE ULNA,,,21 ,,RBRVS,10.15 ,10.35 ,10.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25492,CPT,PROPH TX N/P/PLTWR W/WO METHYLMECRYLATE RAD&ULNA,,,21 ,,RBRVS,12.66 ,12.08 ,12.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25500,CPT,CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,2.60 ,3.80 ,4.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25505,CPT,CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION,,,21 ,,RBRVS,5.45 ,6.64 ,7.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25515,CPT,OPEN TREATMENT RADIAL SHAFT FRACTURE,,,21 ,,RBRVS,8.80 ,8.88 ,8.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25520,CPT,CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT,,,21 ,,RBRVS,6.50 ,7.39 ,8.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25525,CPT,OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE,,,21 ,,RBRVS,10.55 ,10.41 ,10.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25526,CPT,OPEN RDL SHAFT FX OPEN RAD/ULN JT DISLOCATE,,,21 ,,RBRVS,13.15 ,12.55 ,12.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25530,CPT,CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,2.24 ,3.90 ,4.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25535,CPT,CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION,,,21 ,,RBRVS,5.36 ,6.54 ,7.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25545,CPT,OPEN TREATMENT OF ULNAR SHAFT FRACTURE,,,21 ,,RBRVS,7.94 ,8.59 ,8.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25560,CPT,CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MANJ,,,21 ,,RBRVS,2.59 ,3.78 ,4.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25565,CPT,CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ,,,21 ,,RBRVS,5.85 ,6.62 ,7.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25574,CPT,OPEN TX RADIAL & ULNAR SHAFT FX FIXJ RADIUS/ULNA,,,21 ,,RBRVS,8.80 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25575,CPT,OPEN TX RDL& ULNAR SHAFT FX FIXJ RADIUS &ULNA,,,21 ,,RBRVS,12.29 ,11.47 ,11.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25600,CPT,CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ,,,21 ,,RBRVS,2.78 ,4.14 ,4.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25605,CPT,CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF,,,21 ,,RBRVS,7.25 ,8.14 ,9.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25606,CPT,PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP,,,21 ,,RBRVS,8.31 ,9.35 ,9.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25607,CPT,OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP,,,21 ,,RBRVS,9.56 ,9.73 ,9.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25608,CPT,OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG,,,21 ,,RBRVS,11.07 ,10.58 ,10.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25609,CPT,OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG,,,21 ,,RBRVS,14.38 ,13.18 ,13.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25622,CPT,CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ,,,21 ,,RBRVS,2.79 ,4.37 ,5.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25624,CPT,CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ,,,21 ,,RBRVS,4.77 ,6.28 ,7.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25628,CPT,OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE,,,21 ,,RBRVS,9.67 ,9.46 ,9.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25630,CPT,CLTX CARPAL BONE FX W/O MANJ EACH BONE,,,21 ,,RBRVS,3.03 ,4.23 ,4.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25635,CPT,CLTX CARPAL BONE FX W/MANJ EACH BONE,,,21 ,,RBRVS,4.61 ,5.96 ,7.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25645,CPT,OPEN TX CARPAL BONE FRACTURE OTH/THN SCAPHOID EA,,,21 ,,RBRVS,7.42 ,7.57 ,7.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25650,CPT,CLOSED TREATMENT ULNAR STYLOID FRACTURE,,,21 ,,RBRVS,3.23 ,4.53 ,5.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25651,CPT,PRQ SKELETAL FIXATION ULNAR STYLOID FRACTURE,,,21 ,,RBRVS,5.82 ,6.97 ,6.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25652,CPT,OPEN TREATMENT ULNAR STYLOID FRACTURE,,,21 ,,RBRVS,8.06 ,8.45 ,8.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25660,CPT,CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ,,,21 ,,RBRVS,4.98 ,5.67 ,5.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25670,CPT,OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/> BONES,,,21 ,,RBRVS,8.09 ,7.97 ,7.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25671,CPT,PRQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION,,,21 ,,RBRVS,6.46 ,7.51 ,7.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25675,CPT,CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ,,,21 ,,RBRVS,4.89 ,5.51 ,6.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25676,CPT,OPEN TX DISTAL RADIOULNAR DISLC ACUTE/CHRONIC,,,21 ,,RBRVS,8.29 ,8.47 ,8.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25680,CPT,CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MANJ,,,21 ,,RBRVS,6.23 ,5.96 ,5.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25685,CPT,OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC,,,21 ,,RBRVS,10.09 ,9.26 ,9.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25690,CPT,CLOSED TX LUNATE DISLOCATION W/MANIPULATION,,,21 ,,RBRVS,5.72 ,6.77 ,6.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25695,CPT,OPEN TREATMENT LUNATE DISLOCATION,,,21 ,,RBRVS,8.51 ,8.21 ,8.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25800,CPT,ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT,,,21 ,,RBRVS,10.07 ,9.57 ,9.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25805,CPT,ARTHRODESIS WRIST W/SLIDING GRAFT,,,21 ,,RBRVS,11.73 ,10.79 ,10.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25810,CPT,ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT,,,21 ,,RBRVS,11.95 ,11.24 ,11.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25820,CPT,ARTHRODESIS WRIST LIMITED W/O BONE GRAFT,,,21 ,,RBRVS,7.64 ,8.76 ,8.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25825,CPT,ARTHRODESIS WRIST LIMITED W/AUTOGRAFT,,,21 ,,RBRVS,9.69 ,10.56 ,10.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25830,CPT,ARTHRD DSTL RAD/ULN JT SGMTL RESCJ ULNA W/WOBONE,,,21 ,,RBRVS,10.88 ,14.60 ,14.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25900,CPT,AMPUTATION FOREARM THROUGH RADIUS & ULNA,,,21 ,,RBRVS,9.61 ,9.92 ,9.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25905,CPT,AMP FOREARM THRU RADIUS&ULNA OPEN CIRCULAR,,,21 ,,RBRVS,9.59 ,9.56 ,9.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25907,CPT,AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR REVJ,,,21 ,,RBRVS,8.09 ,8.73 ,8.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25909,CPT,AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION,,,21 ,,RBRVS,9.31 ,9.45 ,9.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25915,CPT,KRUKENBERG PROCEDURE,,,21 ,,RBRVS,17.52 ,12.55 ,12.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25920,CPT,DISARTICULATION THROUGH WRIST,,,21 ,,RBRVS,9.03 ,9.30 ,9.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25922,CPT,DISARTICULATION THRU WRIST SEC CLOSURE/SCAR REVJ,,,21 ,,RBRVS,7.65 ,6.81 ,6.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25924,CPT,DISARTICULATION THRU WRIST RE-AMPUTATION,,,21 ,,RBRVS,8.81 ,8.10 ,8.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25927,CPT,TRANSMETACARPAL AMPUTATION,,,21 ,,RBRVS,9.09 ,12.25 ,12.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25929,CPT,TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ,,,21 ,,RBRVS,7.82 ,7.79 ,7.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25931,CPT,TRANSMETACARPAL AMPUTATION RE-AMPUTATION,,,21 ,,RBRVS,8.04 ,10.43 ,10.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,25999,CPT,UNLISTED PROCEDURE FOREARM/WRIST,,,21 ,,TotalUnits,,,,15.70 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,26010,CPT,DRAINAGE FINGER ABSCESS SIMPLE,,,21 ,,RBRVS,1.59 ,2.03 ,5.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26011,CPT,DRAINAGE FINGER ABSCESS COMPLICATED,,,21 ,,RBRVS,2.24 ,2.69 ,8.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26020,CPT,DRAINAGE TENDON SHEATH DIGIT&/PALM EACH,,,21 ,,RBRVS,5.08 ,6.44 ,6.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26025,CPT,DRAINAGE OF PALMAR BURSA SINGLE BURSA,,,21 ,,RBRVS,5.08 ,6.09 ,6.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26030,CPT,DRAINAGE OF PALMAR BURSA MULTIPLE BURSA,,,21 ,,RBRVS,6.25 ,6.82 ,6.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26034,CPT,INCISION BONE CORTEX HAND/FINGER,,,21 ,,RBRVS,6.63 ,7.61 ,7.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26035,CPT,DECOMPRESSION FINGERS&/HAND INJECTION INJURY,,,21 ,,RBRVS,11.37 ,10.92 ,10.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26037,CPT,DECOMPRESSIVE FASCIOTOMY HAND,,,21 ,,RBRVS,7.57 ,7.55 ,7.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26040,CPT,FASCIOTOMY PALMAR PERCUTANEOUS,,,21 ,,RBRVS,3.46 ,4.86 ,4.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26045,CPT,FASCIOTOMY PALMAR OPEN PARTIAL,,,21 ,,RBRVS,5.73 ,6.64 ,6.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26055,CPT,TENDON SHEATH INCISION,,,21 ,,RBRVS,3.11 ,5.07 ,12.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26060,CPT,TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT,,,21 ,,RBRVS,2.91 ,4.20 ,4.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26070,CPT,ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRPL JT,,,21 ,,RBRVS,3.81 ,4.31 ,4.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26075,CPT,ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA,,,21 ,,RBRVS,3.91 ,4.63 ,4.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26080,CPT,ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA,,,21 ,,RBRVS,4.47 ,5.87 ,5.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26100,CPT,ARTHROTOMY BIOPSY CARP/MTCRPL JOINT EACH,,,21 ,,RBRVS,3.79 ,4.93 ,4.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26105,CPT,ARTHROTOMY BIOPSY MTCARPHLNGL JOINT EACH,,,21 ,,RBRVS,3.83 ,5.01 ,5.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26110,CPT,ARTHROTOMY BIOPSY INTERPHALANGEAL JOINT EACH,,,21 ,,RBRVS,3.65 ,4.89 ,4.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26111,CPT,EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>,,,21 ,,RBRVS,5.42 ,6.06 ,6.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26113,CPT,EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>,,,21 ,,RBRVS,7.13 ,7.96 ,7.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26115,CPT,EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM,,,21 ,,RBRVS,3.96 ,5.26 ,11.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26116,CPT,EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM,,,21 ,,RBRVS,6.74 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26117,CPT,RAD RESECT TUMOR SOFT TISSUE HAND/FINGER <3CM,,,21 ,,RBRVS,10.13 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26118,CPT,RAD RESCJ TUM SOFT TISSUE HAND/FINGER 3 CM/>,,,21 ,,RBRVS,14.81 ,14.22 ,14.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26121,CPT,FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT,,,21 ,,RBRVS,7.73 ,8.17 ,8.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26123,CPT,FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR,,,21 ,,RBRVS,10.88 ,11.24 ,11.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26125,CPT,FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR,,,21 ,,RBRVS,4.60 ,2.77 ,2.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26130,CPT,SYNOVECTOMY CARPOMETACARPAL JOINT,,,21 ,,RBRVS,5.59 ,6.59 ,6.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26135,CPT,SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD,,,21 ,,RBRVS,7.13 ,7.55 ,7.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26140,CPT,SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT,,,21 ,,RBRVS,6.34 ,7.10 ,7.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26145,CPT,SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN,,,21 ,,RBRVS,6.49 ,7.13 ,7.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26160,CPT,EXC LES TDN SHTH/JT CAPSL HAND/FNGR,,,21 ,,RBRVS,3.57 ,5.25 ,12.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26170,CPT,EXCISION TENDON PALM FLEXOR/EXTENSOR SINGLE EACH,,,21 ,,RBRVS,4.91 ,5.92 ,5.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26180,CPT,EXCISION TENDON FINGER FLEXOR/EXTENSOR EACH,,,21 ,,RBRVS,5.35 ,6.44 ,6.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26185,CPT,SESAMOIDECTOMY THUMB/FINGER SEPARATE PROCEDURE,,,21 ,,RBRVS,6.52 ,7.87 ,7.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26200,CPT,EXCISION/CURETTAGE CYST/TUMOR METACARPAL,,,21 ,,RBRVS,5.65 ,6.33 ,6.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26205,CPT,EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT,,,21 ,,RBRVS,7.93 ,7.98 ,7.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26210,CPT,EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER,,,21 ,,RBRVS,5.32 ,6.45 ,6.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26215,CPT,EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT,,,21 ,,RBRVS,7.27 ,7.52 ,7.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26230,CPT,PARTIAL EXCISION BONE METACARPAL,,,21 ,,RBRVS,6.47 ,6.85 ,6.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26235,CPT,PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER,,,21 ,,RBRVS,6.33 ,6.86 ,6.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26236,CPT,PARTIAL EXCISION DISTAL PHALANX FINGER,,,21 ,,RBRVS,5.46 ,6.28 ,6.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26250,CPT,RADICAL RESECTION TUMOR METACARPAL,,,21 ,,RBRVS,15.21 ,10.62 ,10.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26260,CPT,RAD RESECTION TUMOR PROX/MIDDLE PHALANX FINGER,,,21 ,,RBRVS,11.16 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26262,CPT,RADICAL RESECTION TUMOR DISTAL PHALANX FINGER,,,21 ,,RBRVS,8.29 ,7.46 ,7.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26320,CPT,REMOVAL IMPLANT FROM FINGER/HAND,,,21 ,,RBRVS,4.10 ,5.16 ,5.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26340,CPT,MANIPULATION FINGER JOINT UNDER ANES EACH JOINT,,,21 ,,RBRVS,2.80 ,6.05 ,6.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26341,CPT,MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD,,,21 ,,RBRVS,0.91 ,1.14 ,1.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26350,CPT,RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDON,,,21 ,,RBRVS,6.21 ,13.12 ,13.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26352,CPT,RPR/ADVMNT FLXR TDN N/Z/2 W/FR GRAFT EA TENDON,,,21 ,,RBRVS,7.87 ,13.95 ,13.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26356,CPT,RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON,,,21 ,,RBRVS,10.62 ,18.68 ,18.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26357,CPT,RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON,,,21 ,,RBRVS,8.77 ,14.48 ,14.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26358,CPT,RPR/ADVMNT FLXR TDN ZONE 2 W/FR GRAFT EA TENDON,,,21 ,,RBRVS,9.36 ,15.45 ,15.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26370,CPT,RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN,,,21 ,,RBRVS,7.28 ,13.39 ,13.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26372,CPT,RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/FREE GRAFT EA,,,21 ,,RBRVS,9.01 ,14.74 ,14.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26373,CPT,RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/O FREE GRF EA,,,21 ,,RBRVS,8.41 ,14.33 ,14.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26390,CPT,EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F,,,21 ,,RBRVS,9.43 ,12.71 ,12.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26392,CPT,RMVL SYNTH ROD&INSJ FLXR TDN GRF H/F EA ROD,,,21 ,,RBRVS,10.50 ,15.42 ,15.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26410,CPT,REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH,,,21 ,,RBRVS,4.77 ,10.60 ,10.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26412,CPT,REPAIR EXTENSOR TENDON HAND W/GRAFT EACH,,,21 ,,RBRVS,6.48 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26415,CPT,EXC XTNSR TDN W/IMPLTJ SYNTH ROD DLYD GRF H/F EA,,,21 ,,RBRVS,8.51 ,10.41 ,10.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26416,CPT,RMVL SYNTH ROD&INSJ XTNSR TDN GRF H/F EA ROD,,,21 ,,RBRVS,9.56 ,12.69 ,12.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26418,CPT,REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH,,,21 ,,RBRVS,4.47 ,11.19 ,11.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26420,CPT,REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH,,,21 ,,RBRVS,6.94 ,12.12 ,12.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26426,CPT,RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR,,,21 ,,RBRVS,6.32 ,8.12 ,8.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26428,CPT,RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER,,,21 ,,RBRVS,7.40 ,12.79 ,12.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26432,CPT,CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING,,,21 ,,RBRVS,4.16 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26433,CPT,REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF,,,21 ,,RBRVS,4.70 ,9.69 ,9.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26434,CPT,REPAIR EXTENSOR TENDON DISTAL INSERTION W/GRAFT,,,21 ,,RBRVS,6.26 ,10.95 ,10.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26437,CPT,REALIGNMENT EXTENSOR TENDON HAND EACH TENDON,,,21 ,,RBRVS,5.99 ,10.81 ,10.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26440,CPT,TENOLYSIS FLEXOR TENDON PALM/FINGER EACH TENDON,,,21 ,,RBRVS,5.16 ,11.80 ,11.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26442,CPT,TENOLYSIS FLEXOR TENDON PALM&FINGER EACH TENDON,,,21 ,,RBRVS,9.75 ,16.12 ,16.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26445,CPT,TENOLYSIS EXTENSOR TENDON HAND/FINGER EACH,,,21 ,,RBRVS,4.45 ,11.38 ,11.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26449,CPT,TENOLYSIS CPLX XTNSR TENDON FINGER W/FOREARM EA,,,21 ,,RBRVS,8.59 ,11.15 ,11.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26450,CPT,TENOTOMY FLEXOR PALM OPEN EACH TENDON,,,21 ,,RBRVS,3.79 ,7.10 ,7.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26455,CPT,TENOTOMY FLEXOR FINGER OPEN EACH TENDON,,,21 ,,RBRVS,3.76 ,7.08 ,7.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26460,CPT,TENOTOMY EXTENSOR HAND/FINGER OPEN EACH TENDON,,,21 ,,RBRVS,3.58 ,7.01 ,7.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26471,CPT,TENODESIS PROXIMAL INTERPHALANGEAL JOINT EACH,,,21 ,,RBRVS,5.90 ,10.69 ,10.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26474,CPT,TENODESIS DISTAL JOINT EACH,,,21 ,,RBRVS,5.49 ,10.62 ,10.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26476,CPT,LENGTHENING TENDON EXTENSOR HAND/FINGER EACH,,,21 ,,RBRVS,5.35 ,10.42 ,10.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26477,CPT,SHORTENING TENDON EXTENSOR HAND/FINGER EACH,,,21 ,,RBRVS,5.32 ,10.36 ,10.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26478,CPT,LENGTHENING TENDON FLEXOR HAND/FINGER EACH,,,21 ,,RBRVS,5.97 ,10.86 ,10.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26479,CPT,SHORTENING TENDON FLEXOR HAND/FINGER EACH,,,21 ,,RBRVS,5.91 ,10.79 ,10.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26480,CPT,TR/TRNSPL TDN CARP/MTCRPL HAND W/O FR GRF EA TDN,,,21 ,,RBRVS,6.90 ,13.51 ,13.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26483,CPT,TENDON TRANSFER TRANSPLANT CARP/MTCRPL GRAFT,,,21 ,,RBRVS,8.48 ,14.26 ,14.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26485,CPT,TRANSFER/TRANSPLANT TENDON PALMAR W/O GRAFT EACH,,,21 ,,RBRVS,7.89 ,13.99 ,13.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26489,CPT,TRANSFER/TRANSPLANT TENDON PALMAR W/GRAFT EACH,,,21 ,,RBRVS,9.86 ,14.35 ,14.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26490,CPT,OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN,,,21 ,,RBRVS,8.60 ,12.56 ,12.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26492,CPT,OPPONENSPLASTY TDN TR W/GRF EA TDN,,,21 ,,RBRVS,9.84 ,13.54 ,13.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26494,CPT,OPPONENSPLASTY HYPOTHENAR MUSC TR,,,21 ,,RBRVS,8.66 ,12.58 ,12.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26496,CPT,OPPONENSPLASTY OTHER METHODS,,,21 ,,RBRVS,9.78 ,13.22 ,13.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26497,CPT,TR TDN RESTORE INTRNSC FUNCJ RING&SM FNGR,,,21 ,,RBRVS,9.76 ,13.20 ,13.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26498,CPT,TR TDN RESTORE INTRNSC FUNCJ ALL 4 FNGRS,,,21 ,,RBRVS,14.21 ,16.05 ,16.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26499,CPT,CORRECTION CLAW FINGER OTHER METHODS,,,21 ,,RBRVS,9.17 ,12.83 ,12.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26500,CPT,RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX,,,21 ,,RBRVS,6.13 ,10.75 ,10.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26502,CPT,RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX,,,21 ,,RBRVS,7.31 ,11.76 ,11.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26508,CPT,RELEASE THENAR MUSCLE,,,21 ,,RBRVS,6.18 ,10.82 ,10.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26510,CPT,CROSS INTRINSIC TRANSFER EACH TENDON,,,21 ,,RBRVS,5.60 ,10.52 ,10.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26516,CPT,CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT,,,21 ,,RBRVS,7.32 ,11.51 ,11.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26517,CPT,CAPSULODESIS MTCARPHLNGL JOINT 2 DIGITS,,,21 ,,RBRVS,9.08 ,12.86 ,12.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26518,CPT,CAPSULODESIS MTCARPHLNGL JOINT 3/4 DIGITS,,,21 ,,RBRVS,9.27 ,13.06 ,13.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26520,CPT,CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH,,,21 ,,RBRVS,5.47 ,12.29 ,12.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26525,CPT,CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH,,,21 ,,RBRVS,5.50 ,12.31 ,12.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26530,CPT,ARTHROPLASTY METACARPOPHALANGEAL JOINT EACH,,,21 ,,RBRVS,6.88 ,7.39 ,7.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26531,CPT,ARTHRP MTCARPHLNGL JT W/PROSTC IMPLT EA JT,,,21 ,,RBRVS,8.13 ,8.51 ,8.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26535,CPT,ARTHROPLASTY INTERPHALANGEAL JOINT EACH,,,21 ,,RBRVS,5.41 ,5.53 ,5.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26536,CPT,ARTHROPLASTY INTERPHALANGEAL JT W/PROSTHETIC EA,,,21 ,,RBRVS,6.56 ,12.17 ,12.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26540,CPT,RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT,,,21 ,,RBRVS,6.60 ,11.15 ,11.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26541,CPT,RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF,,,21 ,,RBRVS,8.81 ,12.65 ,12.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26542,CPT,RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS,,,21 ,,RBRVS,6.95 ,11.39 ,11.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26545,CPT,RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT,,,21 ,,RBRVS,7.11 ,11.63 ,11.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26546,CPT,RPR NON-UNION MTCRPL/PHALANX,,,21 ,,RBRVS,10.83 ,15.66 ,15.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26548,CPT,RPR&RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL JT,,,21 ,,RBRVS,8.22 ,12.27 ,12.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26550,CPT,POLLICIZATION DIGIT,,,21 ,,RBRVS,21.68 ,19.65 ,19.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26551,CPT,TR TOE-TO-HAND W/MVASC ANAST GRT TOE WRP/ARND,,,21 ,,RBRVS,48.48 ,30.75 ,30.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26553,CPT,TR TOE-TO-HAND W/MVASC ANAST OTH/THN GRT TOE 1,,,21 ,,RBRVS,48.17 ,35.13 ,35.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26554,CPT,TR TOE-TO-HAND W/MVASC ANAST OTH/THN GRT TOE 2,,,21 ,,RBRVS,57.01 ,34.07 ,34.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26555,CPT,TR FNGR AXH POS W/O MVASC ANAST,,,21 ,,RBRVS,17.08 ,19.23 ,19.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26556,CPT,TRANSFER FREE TOE JOINT W/MVASC ANASTOMOSIS,,,21 ,,RBRVS,49.75 ,29.36 ,29.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26560,CPT,REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS,,,21 ,,RBRVS,5.52 ,10.13 ,10.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26561,CPT,REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS&GRAFTS,,,21 ,,RBRVS,11.10 ,13.86 ,13.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26562,CPT,REPAIR SYNDACTYLY EACH SPACE COMPLEX,,,21 ,,RBRVS,16.68 ,18.62 ,18.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26565,CPT,OSTEOTOMY METACARPAL EACH,,,21 ,,RBRVS,6.91 ,11.25 ,11.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26567,CPT,OSTEOTOMY PHALANX FINGER EACH,,,21 ,,RBRVS,6.99 ,11.31 ,11.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26568,CPT,OSTEOPLASTY LENGTHENING METACARPAL/PHALANX,,,21 ,,RBRVS,9.27 ,14.71 ,14.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26580,CPT,REPAIR CLEFT HAND,,,21 ,,RBRVS,19.75 ,15.82 ,15.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26587,CPT,RCNSTJ POLYDACTYLOUS DGT SOFT TISS&B1,,,21 ,,RBRVS,14.50 ,12.47 ,12.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26590,CPT,REPAIR MACRODACTYLIA EACH DIGIT,,,21 ,,RBRVS,18.67 ,14.34 ,14.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26591,CPT,REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE,,,21 ,,RBRVS,3.38 ,8.54 ,8.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26593,CPT,RELEASE INTRINSIC MUSCLES HAND EACH MUSCLE,,,21 ,,RBRVS,5.50 ,10.71 ,10.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26596,CPT,EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES,,,21 ,,RBRVS,9.14 ,10.60 ,10.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26600,CPT,CLTX METACARPAL FX W/O MANIPULATION EACH BONE,,,21 ,,RBRVS,2.60 ,4.46 ,4.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26605,CPT,CLTX METACARPAL FX W/MANIPULATION EACH BONE,,,21 ,,RBRVS,3.03 ,4.64 ,5.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26607,CPT,CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE,,,21 ,,RBRVS,5.48 ,6.35 ,6.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26608,CPT,PRQ SKELETAL FIXJ METACARPAL FX EACH BONE,,,21 ,,RBRVS,5.55 ,7.14 ,7.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26615,CPT,OPEN TX METACARPAL FRACTURE SINGLE EA BONE,,,21 ,,RBRVS,7.07 ,8.00 ,8.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26641,CPT,CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ,,,21 ,,RBRVS,4.13 ,4.50 ,5.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26645,CPT,CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ,,,21 ,,RBRVS,4.58 ,5.53 ,6.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26650,CPT,PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB,,,21 ,,RBRVS,5.35 ,7.37 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26665,CPT,OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB,,,21 ,,RBRVS,7.94 ,8.57 ,8.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26670,CPT,CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES,,,21 ,,RBRVS,3.83 ,3.95 ,4.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26675,CPT,CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES,,,21 ,,RBRVS,4.83 ,5.94 ,6.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26676,CPT,PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT,,,21 ,,RBRVS,5.74 ,7.57 ,7.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26685,CPT,OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB,,,21 ,,RBRVS,7.07 ,8.07 ,8.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26686,CPT,OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ,,,21 ,,RBRVS,8.17 ,8.24 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26700,CPT,CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES,,,21 ,,RBRVS,3.83 ,3.86 ,4.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26705,CPT,CLTX METACARPOPHALANGEAL DISLC W/MANJ W/ANES,,,21 ,,RBRVS,4.38 ,5.53 ,6.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26706,CPT,PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ,,,21 ,,RBRVS,5.31 ,6.32 ,6.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26715,CPT,OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION,,,21 ,,RBRVS,7.03 ,7.95 ,7.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26720,CPT,CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA,,,21 ,,RBRVS,1.76 ,2.96 ,3.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26725,CPT,CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA,,,21 ,,RBRVS,3.48 ,4.50 ,5.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26727,CPT,PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T,,,21 ,,RBRVS,5.42 ,7.10 ,7.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26735,CPT,OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA,,,21 ,,RBRVS,7.42 ,8.20 ,8.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26740,CPT,CLTX ARTICULAR FX INVG MTCARPHLNGL/IPHAL JT W/O,,,21 ,,RBRVS,2.07 ,3.55 ,3.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26742,CPT,CLTX ARTICULAR FX INVG MTCARPHLNGL/IPHAL JT W/,,,21 ,,RBRVS,3.99 ,4.75 ,5.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26746,CPT,OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA,,,21 ,,RBRVS,9.80 ,9.51 ,9.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26750,CPT,CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA,,,21 ,,RBRVS,1.80 ,2.90 ,2.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26755,CPT,CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA,,,21 ,,RBRVS,3.23 ,3.88 ,4.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26756,CPT,PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA,,,21 ,,RBRVS,4.58 ,6.55 ,6.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26765,CPT,OPEN TX DISTAL PHALANGEAL FRACTURE EACH,,,21 ,,RBRVS,5.86 ,7.16 ,7.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26770,CPT,CLTX IPHAL JT DISLC W/MANJ W/O ANES,,,21 ,,RBRVS,3.15 ,3.31 ,3.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26775,CPT,CLTX IPHAL JT DISLC W/MANJ REQ ANES,,,21 ,,RBRVS,3.90 ,5.12 ,6.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26776,CPT,PRQ SKEL FIXJ IPHAL JT DISLC W/MANJ,,,21 ,,RBRVS,4.99 ,6.79 ,6.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26785,CPT,OPEN TX INTERPHALANGEAL JOINT DISLOCATION,,,21 ,,RBRVS,6.60 ,7.58 ,7.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26820,CPT,FUSION OPPOSITION THUMB W/AUTOGENOUS GRAFT,,,21 ,,RBRVS,8.45 ,12.51 ,12.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26841,CPT,ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ,,,21 ,,RBRVS,7.35 ,12.22 ,12.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26842,CPT,ARTHRD CRP/MTACRPL JT THMB W/WO INT FIXJ W/AGRFT,,,21 ,,RBRVS,8.49 ,12.58 ,12.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26843,CPT,ARTHRD CARP/MTCRPL JT DGT OTHER THAN THUMB EACH,,,21 ,,RBRVS,7.78 ,11.84 ,11.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26844,CPT,ARTHRD CARP/MTCRPL JT DGT OTH/THN THMB W/AGRFT,,,21 ,,RBRVS,8.98 ,12.79 ,12.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26850,CPT,ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ,,,21 ,,RBRVS,7.14 ,11.53 ,11.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26852,CPT,ARTHRD MTCRPL JT W/WO INT FIXJ W/AGRFT,,,21 ,,RBRVS,8.71 ,12.67 ,12.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26860,CPT,ARTHRD IPHAL JT +-INT FIXJ,,,21 ,,RBRVS,4.88 ,10.39 ,10.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26861,CPT,ARTHRD IPHAL JT W/WO INT FIXJ EA IPHAL JT,,,21 ,,RBRVS,1.74 ,1.03 ,1.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26862,CPT,ARTHRD IPHAL JT W/WO INT FIXJ W/AGRFT,,,21 ,,RBRVS,7.56 ,11.96 ,11.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26863,CPT,ARTHRD IPHAL JT W/WO INT FIXJ W/AGRFT EA JT,,,21 ,,RBRVS,3.89 ,2.25 ,2.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26910,CPT,AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER,,,21 ,,RBRVS,7.79 ,11.32 ,11.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26951,CPT,AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR,,,21 ,,RBRVS,6.04 ,11.21 ,11.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26952,CPT,AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP,,,21 ,,RBRVS,6.48 ,10.94 ,10.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26989,CPT,UNLISTED PROCEDURE HANDS/FINGERS,,,21 ,,TotalUnits,,,,11.52 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,26990,CPT,I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA,,,21 ,,RBRVS,7.95 ,8.49 ,8.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26991,CPT,I&D PELVIS/HIP JOINT AREA INFECTED BURSA,,,21 ,,RBRVS,7.06 ,6.74 ,11.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,26992,CPT,INCISION BONE CORTEX PELVIS&/HIP JOINT,,,21 ,,RBRVS,13.48 ,11.88 ,11.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27000,CPT,TENOTOMY ADDUCTOR HIP PERCUTANEOUS SPX,,,21 ,,RBRVS,5.74 ,5.93 ,5.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27001,CPT,TENOTOMY ADDUCTOR HIP OPEN,,,21 ,,RBRVS,7.14 ,7.13 ,7.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27003,CPT,TX ADDUXOR SUBQ OPN W/OBTURATOR NEURECTOMY,,,21 ,,RBRVS,7.81 ,7.81 ,7.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27005,CPT,TENOTOMY HIP FLEXOR OPEN SEPARATE PROCEDURE,,,21 ,,RBRVS,10.07 ,9.13 ,9.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27006,CPT,TENOTOMY ABDUCTORS&/EXTENSOR HIP OPEN SPX,,,21 ,,RBRVS,10.11 ,9.38 ,9.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27025,CPT,FASCIOTOMY HIP/THIGH ANY TYPE,,,21 ,,RBRVS,12.89 ,11.02 ,11.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27027,CPT,DECOMPRESSION FASCIOTOMY PELVIC COMPARTMENT UNI,,,21 ,,RBRVS,13.04 ,10.35 ,10.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27030,CPT,ARTHROTOMY HIP W/DRAINAGE,,,21 ,,RBRVS,13.65 ,11.09 ,11.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27033,CPT,ARTHROTOMY HIP EXPLORATION/REMOVAL FOREIGN BODY,,,21 ,,RBRVS,14.11 ,11.64 ,11.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27035,CPT,DNRVTJ HIP JT INTRAPEL/XTRPEL INTRA-ARTCLR BRNCH,,,21 ,,RBRVS,17.37 ,12.68 ,12.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27036,CPT,CAPSLCTOMY/CAPSUL HIP W/RLS HIP FLXR MUSC,,,21 ,,RBRVS,14.38 ,12.22 ,12.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27040,CPT,BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL,,,21 ,,RBRVS,2.92 ,2.43 ,6.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27041,CPT,BIOPSY SOFT TISSUE PELVIS&HIP DEEP/SUBFSCAL/IM,,,21 ,,RBRVS,10.18 ,7.78 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27043,CPT,EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3CM/>,,,21 ,,RBRVS,6.88 ,5.68 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27045,CPT,EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5CM/>,,,21 ,,RBRVS,11.13 ,8.79 ,8.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27047,CPT,EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM,,,21 ,,RBRVS,4.94 ,5.20 ,8.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27048,CPT,EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM,,,21 ,,RBRVS,8.85 ,6.66 ,6.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27049,CPT,RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5CM,,,21 ,,RBRVS,21.55 ,12.62 ,12.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27050,CPT,ARTHROTOMY W/BIOPSY SACROILIAC JOINT,,,21 ,,RBRVS,4.74 ,5.27 ,5.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27052,CPT,ARTHROTOMY W/BIOPSY HIP JOINT,,,21 ,,RBRVS,7.42 ,7.61 ,7.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27054,CPT,ARTHROTOMY W/SYNOVECTOMY HIP JOINT,,,21 ,,RBRVS,9.21 ,8.84 ,8.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27057,CPT,DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI,,,21 ,,RBRVS,14.91 ,11.37 ,11.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27059,CPT,RAD RESECTION TUMOR SOFT TISS PELVIS&HIP 5 CM/>,,,21 ,,RBRVS,29.35 ,19.17 ,19.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27060,CPT,EXCISION ISCHIAL BURSA,,,21 ,,RBRVS,5.87 ,6.01 ,6.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27062,CPT,EXCISION TROCHANTERIC BURSA/CALCIFICATION,,,21 ,,RBRVS,5.75 ,6.27 ,6.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27065,CPT,EXCISION BONE CYST/B9 TUMOR SUPERFICIAL,,,21 ,,RBRVS,6.55 ,6.79 ,6.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27066,CPT,EXCISION BONE CYST/B9 TUMOR DEEP,,,21 ,,RBRVS,11.20 ,10.22 ,10.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27067,CPT,EXC B1 CST/B9 TUM W/AGRFT REQ SEP INC,,,21 ,,RBRVS,14.72 ,12.61 ,12.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27070,CPT,PARTIAL EXCISION SUPERFICIAL PELVIS,,,21 ,,RBRVS,11.56 ,10.95 ,10.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27071,CPT,PARTIAL EXCISION DEEP PELVIS,,,21 ,,RBRVS,12.39 ,11.71 ,11.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27075,CPT,RAD RESCT TUMOR WING OF ILIUM 1 PUBIC/ISCHIAL,,,21 ,,RBRVS,32.71 ,22.51 ,22.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27076,CPT,RAD RESCT TUMOR ILIUM ACETABULUM BOTH PUBIC,,,21 ,,RBRVS,40.21 ,22.44 ,22.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27077,CPT,RADICAL RESCTION TUMOR INNOMINATE BONE TOTAL,,,21 ,,RBRVS,45.21 ,28.61 ,28.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27078,CPT,RAD RESCT TUMOR ISCHIAL TUBEROSITY&GRT TRCHNTR,,,21 ,,RBRVS,32.21 ,17.82 ,17.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27080,CPT,COCCYGECTOMY PRIMARY,,,21 ,,RBRVS,6.89 ,6.36 ,6.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27086,CPT,RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS,,,21 ,,RBRVS,1.92 ,2.04 ,4.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27087,CPT,REMOVAL FOREIGN BODY PELVIS/HIP DEEP,,,21 ,,RBRVS,8.83 ,7.80 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27090,CPT,REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE,,,21 ,,RBRVS,11.69 ,10.25 ,10.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27091,CPT,RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA,,,21 ,,RBRVS,24.35 ,17.81 ,17.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27093,CPT,INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA,,,21 ,,RBRVS,1.30 ,0.63 ,4.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27095,CPT,INJECTION HIP ARTHROGRAPHY W/ANESTHESIA,,,21 ,,RBRVS,1.50 ,0.73 ,5.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27096,CPT,INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMAGE,,,21 ,,RBRVS,1.40 ,0.56 ,3.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27097,CPT,RELEASE/RECESSION HAMSTRING PROXIMAL,,,21 ,,RBRVS,9.27 ,8.51 ,8.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27098,CPT,TRANSFER ADDUCTOR ISCHIUM,,,21 ,,RBRVS,9.32 ,8.21 ,8.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27100,CPT,TR XTRNL OBLQ MUSC TRCHNTR W/FSCAL/TDN XTN GRF,,,21 ,,RBRVS,11.35 ,10.42 ,10.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27105,CPT,TR PARASPI MUSC HIP FASC/TDN XTN GRF,,,21 ,,RBRVS,12.04 ,10.84 ,10.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27110,CPT,TRANSFER ILIOPSOAS GREATER TROCHANTER FEMUR,,,21 ,,RBRVS,13.77 ,11.65 ,11.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27111,CPT,TRANSFER ILIOPSOAS FEMORAL NECK,,,21 ,,RBRVS,12.60 ,10.54 ,10.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27120,CPT,ACETABULOPLASTY,,,21 ,,RBRVS,19.25 ,14.91 ,14.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27122,CPT,ACETABULOPLASTY RESECTION FEMORAL HEAD,,,21 ,,RBRVS,16.09 ,13.06 ,13.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27125,CPT,HEMIARTHROPLASTY HIP PARTIAL,,,21 ,,RBRVS,16.64 ,13.24 ,13.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27130,CPT,ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT,,,21 ,,RBRVS,21.79 ,16.31 ,16.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27132,CPT,CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT,,,21 ,,RBRVS,25.69 ,18.74 ,18.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27134,CPT,REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT,,,21 ,,RBRVS,30.28 ,20.68 ,20.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27137,CPT,REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT,,,21 ,,RBRVS,22.70 ,16.41 ,16.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27138,CPT,REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT,,,21 ,,RBRVS,23.70 ,16.97 ,16.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27140,CPT,OSTEOTOMY&TRANSFER GREATER TROCHANTER SPX,,,21 ,,RBRVS,12.78 ,10.89 ,10.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27146,CPT,OSTEOTOMY ILIAC ACETABULAR/INNOMINATE BONE,,,21 ,,RBRVS,18.92 ,14.77 ,14.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27147,CPT,OSTEOTOMY ILIAC ACETABULAR/INNOMINATE HIP RDCTJ,,,21 ,,RBRVS,22.07 ,16.75 ,16.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27151,CPT,OSTEOTOMY ILIAC ACETABULAR/INNOMINATE FEM OSTEOT,,,21 ,,RBRVS,24.12 ,16.93 ,16.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27156,CPT,OSTEOT ILIAC ACTBLR/INNOMINATE B1 OSTEOT RDCTJ,,,21 ,,RBRVS,26.23 ,18.98 ,18.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27158,CPT,OSTEOTOMY PELVIS BILATERAL,,,21 ,,RBRVS,21.04 ,15.69 ,15.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27161,CPT,OSTEOTOMY FEMORAL NECK SEPARATE PROCEDURE,,,21 ,,RBRVS,17.89 ,14.27 ,14.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27165,CPT,OSTEOT INTERTRCHNTRIC/SUBTRCHNTRIC W/INT/XTRNL,,,21 ,,RBRVS,20.29 ,15.99 ,15.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27170,CPT,B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA,,,21 ,,RBRVS,17.61 ,13.53 ,13.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27175,CPT,TX SLP FEMORAL EPIPHYSIS TRCJ W/O REDUCTION,,,21 ,,RBRVS,9.38 ,8.19 ,8.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27176,CPT,TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU,,,21 ,,RBRVS,12.92 ,11.25 ,11.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27177,CPT,OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT,,,21 ,,RBRVS,16.09 ,13.32 ,13.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27178,CPT,OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN,,,21 ,,RBRVS,12.92 ,11.16 ,11.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27179,CPT,OPTX SLP FEM EPIPHYSIS OSTPL FEM NCK HEYMAN PX,,,21 ,,RBRVS,13.97 ,11.78 ,11.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27181,CPT,OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ,,,21 ,,RBRVS,16.18 ,13.34 ,13.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27185,CPT,EPIPHYSL ARRST EPIPHYSIOD/STAPLING TRCHNTR FEMUR,,,21 ,,RBRVS,9.79 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27187,CPT,PROPH TX N/P/PLTWR +-MMA FEM NCK&PROX FEMUR,,,21 ,,RBRVS,14.23 ,12.01 ,12.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27193,CPT,CLTX PEL RING FX DISLC DIAST/SUBLXTJ W/O MANJ,,,21 ,,RBRVS,6.09 ,6.43 ,6.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27194,CPT,CLTX PEL RING FX DISLC DIAST/SUBLXTJ W/MANJ ANES,,,21 ,,RBRVS,10.20 ,8.34 ,8.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27200,CPT,CLOSED TREATMENT COCCYGEAL FRACTURE,,,21 ,,RBRVS,1.92 ,2.92 ,2.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27202,CPT,OPEN TREATMENT COCCYGEAL FRACTURE,,,21 ,,RBRVS,7.31 ,8.75 ,8.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27215,CPT,OPTX ILIAC TUBRST AVLS/WING FX FIXJ IF PRFRMD,,,21 ,,RBRVS,10.45 ,7.37 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27216,CPT,PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DISLC,,,21 ,,RBRVS,15.73 ,10.56 ,10.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27217,CPT,OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFRMD,,,21 ,,RBRVS,14.65 ,10.18 ,10.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27218,CPT,OPTX POST PEL BONE FX&/DISLC INT FIXJ IF PFRMD,,,21 ,,RBRVS,20.93 ,13.01 ,13.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27220,CPT,CLTX ACETABULUM HIP/SOCKT FX W/O MANJ,,,21 ,,RBRVS,6.83 ,6.99 ,7.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27222,CPT,CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ,,,21 ,,RBRVS,14.11 ,11.68 ,11.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27226,CPT,OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ,,,21 ,,RBRVS,15.57 ,12.08 ,12.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27227,CPT,OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT,,,21 ,,RBRVS,25.41 ,18.63 ,18.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27228,CPT,OPTX ACTBLR FX INVG ANT&PST 2 COLUMNS FX W/INT,,,21 ,,RBRVS,29.33 ,20.89 ,20.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27230,CPT,CLTX FEM FX PROX END NCK W/O MANJ,,,21 ,,RBRVS,5.81 ,6.53 ,6.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27232,CPT,CLTX FEM FX PROX END NCK W/MANJ W/WO SKEL TRACJ,,,21 ,,RBRVS,11.72 ,8.46 ,8.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27235,CPT,PRQ SKEL FIXJ FEMORAL FX PROX END NECK,,,21 ,,RBRVS,13.00 ,11.08 ,11.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27236,CPT,OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT,,,21 ,,RBRVS,17.61 ,13.95 ,13.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27238,CPT,CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ,,,21 ,,RBRVS,5.75 ,6.30 ,6.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27240,CPT,CLTX INTR/PERI/SBTRCHNTC FEMORAL FX W/MANJ,,,21 ,,RBRVS,13.81 ,11.41 ,11.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27244,CPT,TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT,,,21 ,,RBRVS,18.18 ,14.29 ,14.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27245,CPT,TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW,,,21 ,,RBRVS,18.18 ,14.68 ,14.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27246,CPT,CLTX GREATER TROCHANTERIC FX W/O MANJ,,,21 ,,RBRVS,4.83 ,5.34 ,5.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27248,CPT,OPEN TREATMENT GREATER TROCHANTERIC FRACTURE,,,21 ,,RBRVS,10.78 ,8.97 ,8.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27250,CPT,CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA,,,21 ,,RBRVS,3.82 ,1.53 ,1.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27252,CPT,CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA,,,21 ,,RBRVS,11.03 ,8.88 ,8.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27253,CPT,OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ,,,21 ,,RBRVS,13.58 ,11.34 ,11.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27254,CPT,OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD FX,,,21 ,,RBRVS,18.94 ,14.52 ,14.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27256,CPT,TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES,,,21 ,,RBRVS,4.28 ,1.85 ,3.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27257,CPT,TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES,,,21 ,,RBRVS,5.38 ,3.39 ,3.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27258,CPT,OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM,,,21 ,,RBRVS,16.18 ,13.11 ,13.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27259,CPT,OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM SHRT,,,21 ,,RBRVS,23.26 ,17.73 ,17.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27265,CPT,CLTX POST HIP ARTHRP DISLC W/O ANES,,,21 ,,RBRVS,5.24 ,5.14 ,5.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27266,CPT,CLTX POST HIP ARTHRP DISLC REQ ANES,,,21 ,,RBRVS,7.78 ,7.56 ,7.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27267,CPT,CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANJ,,,21 ,,RBRVS,5.50 ,5.74 ,5.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27268,CPT,CLOSED TX FEMORAL FRACTURE PROX HEAD W MANJ,,,21 ,,RBRVS,7.12 ,6.75 ,6.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27269,CPT,OPEN TX FEMORAL FRACTURE PROXIMAL END HEAD,,,21 ,,RBRVS,18.89 ,13.34 ,13.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27275,CPT,MANIPULATION HIP JOINT GENERAL ANESTHESIA,,,21 ,,RBRVS,2.32 ,2.44 ,2.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27280,CPT,ARTHRODESIS SACROILIAC JOINT W/OBTAINING GRAFT,,,21 ,,RBRVS,14.64 ,12.42 ,12.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27282,CPT,ARTHRODESIS SYMPHYSIS PUBIS W/OBTAINING GRAFT,,,21 ,,RBRVS,11.85 ,10.10 ,10.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27284,CPT,ARTHRODESIS HIP JOINT W/OBTAINING GRAFT,,,21 ,,RBRVS,25.06 ,16.60 ,16.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27286,CPT,ARTHRD HIP JT W/OBTG GRF W/SUBTRCHNTRIC OSTEOT,,,21 ,,RBRVS,25.17 ,18.64 ,18.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27290,CPT,INTERPELVIABDOMINAL AMPUTATION,,,21 ,,RBRVS,24.55 ,17.67 ,17.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27295,CPT,DISARTICULATION HIP,,,21 ,,RBRVS,19.66 ,13.64 ,13.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27299,CPT,UNLISTED PROCEDURE PELVIS/HIP JOINT,,,21 ,,TotalUnits,,,,3.91 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,27301,CPT,I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION,,,21 ,,RBRVS,6.78 ,6.35 ,11.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27303,CPT,INC DEEP W/OPNG BONE CORTEX FEMUR/KNEE,,,21 ,,RBRVS,8.63 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27305,CPT,FASCIOTOMY ILIOTIBIAL OPEN,,,21 ,,RBRVS,6.18 ,6.33 ,6.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27306,CPT,TENOTOMY PRQ ADDUCTOR/HAMSTRING 1 TENDON SPX,,,21 ,,RBRVS,4.74 ,5.20 ,5.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27307,CPT,TENOTOMY PRQ ADDUCTOR/HAMSTRING MULTIPLE TENDON,,,21 ,,RBRVS,6.06 ,6.44 ,6.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27310,CPT,ARTHRT KNE W/EXPL DRG/RMVL FB,,,21 ,,RBRVS,10.00 ,9.27 ,9.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27323,CPT,BIOPSY SOFT TISSUE THIGH/KNEE AREA SUPERFICIAL,,,21 ,,RBRVS,2.33 ,2.49 ,5.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27324,CPT,BIOPSY SOFT TISSUE THIGH/KNEE AREA DEEP,,,21 ,,RBRVS,5.04 ,5.20 ,5.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27325,CPT,NEURECTOMY HAMSTRING MUSCLE,,,21 ,,RBRVS,7.20 ,7.15 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27326,CPT,NEURECTOMY POPLITEAL,,,21 ,,RBRVS,6.47 ,6.77 ,6.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27327,CPT,EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM,,,21 ,,RBRVS,3.96 ,4.45 ,7.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27328,CPT,EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM,,,21 ,,RBRVS,8.85 ,6.48 ,6.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27329,CPT,RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM,,,21 ,,RBRVS,15.72 ,11.56 ,11.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27330,CPT,ARTHROTOMY KNEE W/SYNOVIAL BIOPSY ONLY,,,21 ,,RBRVS,5.11 ,5.68 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27331,CPT,ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB,,,21 ,,RBRVS,6.02 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27332,CPT,ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL/LAT,,,21 ,,RBRVS,8.46 ,8.46 ,8.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27333,CPT,ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL&LAT,,,21 ,,RBRVS,7.55 ,7.87 ,7.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27334,CPT,ARTHROTOMY W/SYNOVECTOMY KNEE ANTERIOR/POSTERIOR,,,21 ,,RBRVS,9.19 ,8.82 ,8.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27335,CPT,ARTHRT W/SYNVCT KNE ANT&PST W/POP AREA,,,21 ,,RBRVS,10.55 ,9.63 ,9.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27337,CPT,EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>,,,21 ,,RBRVS,5.91 ,5.38 ,5.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27339,CPT,EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5 CM/>,,,21 ,,RBRVS,11.13 ,9.09 ,9.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27340,CPT,EXCISION PREPATELLAR BURSA,,,21 ,,RBRVS,4.32 ,5.47 ,5.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27345,CPT,EXCISION SYNOVIAL CYST POPLITEAL SPACE,,,21 ,,RBRVS,6.09 ,6.62 ,6.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27347,CPT,EXCISION LESION MENISCUS/CAPSULE KNEE,,,21 ,,RBRVS,6.73 ,7.12 ,7.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27350,CPT,PATELLECTOMY/HEMIPATELLECTOMY,,,21 ,,RBRVS,8.66 ,8.56 ,8.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27355,CPT,EXCISION/CURETTAGE CYST/TUMOR FEMUR,,,21 ,,RBRVS,8.00 ,7.92 ,7.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27356,CPT,EXCISION/CURETTAGE CYST/TUMOR FEMUR W/ALLOGRAFT,,,21 ,,RBRVS,10.09 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27357,CPT,EXCISION/CURETTAGE CYST/TUMOR FEMUR W/AUTOGRAFT,,,21 ,,RBRVS,11.16 ,10.33 ,10.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27358,CPT,EXCISION/CURETTAGE CYST/TUMOR FEMUR INT FIXATION,,,21 ,,RBRVS,4.73 ,2.72 ,2.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27360,CPT,PRTL EXC B1 FEMUR PROX TIBIA&/FIBULA,,,21 ,,RBRVS,11.46 ,11.04 ,11.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27364,CPT,RAD RESECTION TUMOR SOFT TIS THIGH/KNEE 5 CM/>,,,21 ,,RBRVS,24.49 ,17.23 ,17.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27365,CPT,RADICAL RESECTION TUMOR FEMOR OR KNEE,,,21 ,,RBRVS,32.21 ,18.72 ,18.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27370,CPT,INJECTION KNEE ARTHROGRAPHY,,,21 ,,RBRVS,0.96 ,0.47 ,3.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27372,CPT,REMOVAL FOREIGN BODY DEEP THIGH/KNEE,,,21 ,,RBRVS,5.21 ,5.51 ,11.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27380,CPT,SUTURE INFRAPATELLAR TENDON PRIMARY,,,21 ,,RBRVS,7.45 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27381,CPT,SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF,,,21 ,,RBRVS,10.76 ,10.37 ,10.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27385,CPT,SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY,,,21 ,,RBRVS,8.11 ,8.65 ,8.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27386,CPT,SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ,,,21 ,,RBRVS,11.13 ,10.86 ,10.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27390,CPT,TENOTOMY OPEN HAMSTRING KNEE HIP SINGLE TENDON,,,21 ,,RBRVS,5.53 ,6.24 ,6.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27391,CPT,TENOTOMY OPN HAMSTRING KNEE HIP MULTIPLE 1 LEG,,,21 ,,RBRVS,7.49 ,7.69 ,7.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27392,CPT,TENOTOMY OPEN HAMSTRING KNEE HIP MULTIPLE BI,,,21 ,,RBRVS,9.63 ,9.04 ,9.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27393,CPT,LENGTHENING HAMSTRING TENDON SINGLE,,,21 ,,RBRVS,6.59 ,6.78 ,6.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27394,CPT,LENGTHENING HAMSTRING TENDON MULTIPLE 1 LEG,,,21 ,,RBRVS,8.79 ,8.38 ,8.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27395,CPT,LENGTHENING HAMSTRING TENDON MULTIPLE BILATERAL,,,21 ,,RBRVS,12.24 ,10.97 ,10.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27396,CPT,TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR 1 TENDON,,,21 ,,RBRVS,8.15 ,8.11 ,8.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27397,CPT,TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR MULT TDN,,,21 ,,RBRVS,12.66 ,11.45 ,11.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27400,CPT,TRANSFER TENDON/MUSCLE HAMSTRINGS FEMUR,,,21 ,,RBRVS,9.33 ,8.95 ,8.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27403,CPT,ARTHROTOMY W/MENISCUS REPAIR KNEE,,,21 ,,RBRVS,8.62 ,8.32 ,8.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27405,CPT,RPR PRIMARY TORN LIGM&/CAPSULE KNEE COLLATERAL,,,21 ,,RBRVS,9.08 ,8.80 ,8.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27407,CPT,REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIATE,,,21 ,,RBRVS,10.85 ,9.77 ,9.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27409,CPT,RPR 1 TORN LIGM&/CAPSL KNE COLTRL&CRUCIATE LIGMS,,,21 ,,RBRVS,13.71 ,11.77 ,11.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27412,CPT,AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE,,,21 ,,RBRVS,24.74 ,18.79 ,18.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27415,CPT,OSTEOCHONDRAL ALLOGRAFT KNEE OPEN,,,21 ,,RBRVS,20.00 ,16.19 ,16.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27416,CPT,OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY,,,21 ,,RBRVS,14.16 ,11.50 ,11.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27418,CPT,ANTERIOR TIBIAL TUBERCLEPLASTY,,,21 ,,RBRVS,11.60 ,10.41 ,10.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27420,CPT,RCNSTJ DISLOCATING PATELLA,,,21 ,,RBRVS,10.26 ,9.47 ,9.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27422,CPT,RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RLS,,,21 ,,RBRVS,10.21 ,9.44 ,9.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27424,CPT,RCNSTJ DISLC PATELLA W/PATELLECTOMY,,,21 ,,RBRVS,10.24 ,9.43 ,9.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27425,CPT,LATERAL RETINACULAR RELEASE OPEN,,,21 ,,RBRVS,5.39 ,6.42 ,6.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27427,CPT,LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR,,,21 ,,RBRVS,9.79 ,9.17 ,9.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27428,CPT,LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR,,,21 ,,RBRVS,15.58 ,13.77 ,13.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27429,CPT,LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR,,,21 ,,RBRVS,17.54 ,15.28 ,15.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27430,CPT,QUADRICEPSPLASTY,,,21 ,,RBRVS,10.16 ,9.39 ,9.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27435,CPT,CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE,,,21 ,,RBRVS,10.88 ,10.36 ,10.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27437,CPT,ARTHROPLASTY PATELLA W/O PROSTHESIS,,,21 ,,RBRVS,8.93 ,8.52 ,8.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27438,CPT,ARTHROPLASTY PATELLA W/PROSTHESIS,,,21 ,,RBRVS,11.89 ,10.30 ,10.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27440,CPT,ARTHROPLASTY KNEE TIBIAL PLATEAU,,,21 ,,RBRVS,11.09 ,9.57 ,9.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27441,CPT,ARTHRP KNEE TIBIAL PLATEAU DBRDMT&PRTL SYNVCT,,,21 ,,RBRVS,11.54 ,9.78 ,9.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27442,CPT,ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE,,,21 ,,RBRVS,12.37 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27443,CPT,ARTHRP FEM CONDYLES/TIBL PLATU KNE DBRDMT&PRTL,,,21 ,,RBRVS,11.41 ,10.15 ,10.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27445,CPT,ARTHROPLASTY KNEE HINGE PROSTHESIS,,,21 ,,RBRVS,18.66 ,14.49 ,14.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27446,CPT,ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT,,,21 ,,RBRVS,16.38 ,12.93 ,12.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27447,CPT,ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT CMPRTS,,,21 ,,RBRVS,23.25 ,17.49 ,17.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27448,CPT,OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/O FIXATION,,,21 ,,RBRVS,11.60 ,10.02 ,10.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27450,CPT,OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/FIXATION,,,21 ,,RBRVS,14.61 ,12.22 ,12.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27454,CPT,OSTEOT MLT W/RELIGNMT IMED ROD FEM SHFT,,,21 ,,RBRVS,19.17 ,14.94 ,14.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27455,CPT,OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL,,,21 ,,RBRVS,13.36 ,11.54 ,11.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27457,CPT,OSTEOT PROX TIBIA FIB EXC/OSTEOT AFTER EPIPHYSL,,,21 ,,RBRVS,14.03 ,11.47 ,11.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27465,CPT,OSTEOPLASTY FEMUR SHORTENING EXCLUDING 64876,,,21 ,,RBRVS,18.60 ,14.19 ,14.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27466,CPT,OSTEOPLASTY FEMUR LENGTHENING,,,21 ,,RBRVS,17.28 ,13.87 ,13.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27468,CPT,OSTPL FEMUR CMBN LNGTH&SHRT W/FEM SGM TR,,,21 ,,RBRVS,19.97 ,15.39 ,15.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27470,CPT,RPR NON/MAL FEMUR DSTL H/N W/O GRF,,,21 ,,RBRVS,17.14 ,14.05 ,14.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27472,CPT,RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG BONE,,,21 ,,RBRVS,18.72 ,14.79 ,14.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27475,CPT,ARREST EPIPHYSEAL DISTAL FEMUR,,,21 ,,RBRVS,8.93 ,7.18 ,7.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27477,CPT,ARREST EPIPHYSEAL TIBIA&FIBULA PROXIMAL,,,21 ,,RBRVS,10.14 ,9.21 ,9.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27479,CPT,ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB,,,21 ,,RBRVS,13.16 ,11.19 ,11.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27485,CPT,ARRST HEMIEPIPHYSL DSTL FEMUR/PROX TIBIA/FIBULA,,,21 ,,RBRVS,9.13 ,8.59 ,8.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27486,CPT,REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT,,,21 ,,RBRVS,21.12 ,16.16 ,16.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27487,CPT,REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONENT,,,21 ,,RBRVS,27.11 ,19.56 ,19.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27488,CPT,RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER,,,21 ,,RBRVS,17.60 ,14.16 ,14.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27495,CPT,PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR,,,21 ,,RBRVS,16.54 ,13.34 ,13.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27496,CPT,DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT,,,21 ,,RBRVS,6.78 ,7.12 ,7.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27497,CPT,DCMPRN FASCT THIGH&/KNEE DBRDMT MUSCLE&/NERVE,,,21 ,,RBRVS,7.79 ,7.09 ,7.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27498,CPT,DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS,,,21 ,,RBRVS,8.66 ,7.84 ,7.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27499,CPT,DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&/NRV,,,21 ,,RBRVS,9.43 ,8.49 ,8.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27500,CPT,CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION,,,21 ,,RBRVS,6.30 ,6.28 ,7.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27501,CPT,CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ,,,21 ,,RBRVS,6.45 ,6.68 ,6.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27502,CPT,CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ,,,21 ,,RBRVS,11.36 ,9.27 ,9.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27503,CPT,CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ,,,21 ,,RBRVS,11.27 ,9.95 ,9.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27506,CPT,OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW,,,21 ,,RBRVS,19.65 ,15.71 ,15.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27507,CPT,OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE,,,21 ,,RBRVS,14.48 ,11.34 ,11.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27508,CPT,CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ,,,21 ,,RBRVS,6.20 ,6.77 ,7.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27509,CPT,PRQ SKELETAL FIXJ FEMORAL FX DISTAL END,,,21 ,,RBRVS,8.14 ,8.99 ,8.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27510,CPT,CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ,,,21 ,,RBRVS,9.80 ,8.51 ,8.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27511,CPT,OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/O XTN,,,21 ,,RBRVS,15.11 ,11.57 ,11.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27513,CPT,OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W XTN,,,21 ,,RBRVS,19.25 ,14.02 ,14.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27514,CPT,OPEN TX FEMORAL FRACTURE DISTAL MED/LAT CONDYLE,,,21 ,,RBRVS,14.60 ,11.63 ,11.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27516,CPT,CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,,,21 ,,RBRVS,5.59 ,6.84 ,7.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27517,CPT,CLTX DSTL FEM EPIPHYSL SEP W/MANJ W/WO SKIN/SKEL,,,21 ,,RBRVS,9.12 ,8.95 ,8.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27519,CPT,OPEN TX DISTAL FEMORAL EPIPHYSEAL SEPARATION,,,21 ,,RBRVS,13.25 ,10.77 ,10.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27520,CPT,CLOSED TX PATELLAR FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,3.04 ,4.62 ,5.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27524,CPT,OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR,,,21 ,,RBRVS,10.37 ,9.55 ,9.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27530,CPT,CLTX TIBIAL FX PROXIMAL W/O MANIPULATION,,,21 ,,RBRVS,4.09 ,5.64 ,6.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27532,CPT,CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ,,,21 ,,RBRVS,7.55 ,7.71 ,8.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27535,CPT,OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR,,,21 ,,RBRVS,13.41 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27536,CPT,OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ,,,21 ,,RBRVS,17.39 ,14.10 ,14.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27538,CPT,CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MANJ,,,21 ,,RBRVS,5.09 ,6.53 ,7.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27540,CPT,OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE,,,21 ,,RBRVS,11.30 ,10.36 ,10.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27550,CPT,CLOSED TX KNEE DISLOCATION W/O ANESTHESIA,,,21 ,,RBRVS,5.98 ,6.12 ,7.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27552,CPT,CLOSED TX KNEE DISLOCATION W/ANESTHESIA,,,21 ,,RBRVS,8.18 ,8.33 ,8.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27556,CPT,OPEN TX KNEE DISLOCATION W/O LIGAMENTOUS REPAIR,,,21 ,,RBRVS,13.00 ,10.62 ,10.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27557,CPT,OPEN TX KNEE DISLOCATION W LIGAMENTOUS REPAIR,,,21 ,,RBRVS,15.90 ,12.31 ,12.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27558,CPT,OPEN TX KNEE DISLOCATION W REPAIR/RECONSTRUCTION,,,21 ,,RBRVS,18.39 ,13.56 ,13.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27560,CPT,CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA,,,21 ,,RBRVS,3.99 ,5.10 ,5.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27562,CPT,CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA,,,21 ,,RBRVS,5.98 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27566,CPT,OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY,,,21 ,,RBRVS,12.71 ,10.85 ,10.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27570,CPT,MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA,,,21 ,,RBRVS,1.79 ,2.18 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27580,CPT,ARTHRODESIS KNEE ANY TECHNIQUE,,,21 ,,RBRVS,21.10 ,17.04 ,17.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27590,CPT,AMPUTATION THIGH THROUGH FEMUR ANY LEVEL,,,21 ,,RBRVS,13.47 ,8.08 ,8.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27591,CPT,AMP THI THRU FEMUR LVL IMMT FITG TQ W/1ST CST,,,21 ,,RBRVS,13.94 ,9.91 ,9.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27592,CPT,AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR,,,21 ,,RBRVS,10.98 ,7.48 ,7.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27594,CPT,AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION,,,21 ,,RBRVS,7.29 ,6.23 ,6.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27596,CPT,AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION,,,21 ,,RBRVS,11.29 ,8.04 ,8.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27598,CPT,DISARTICULATION KNEE,,,21 ,,RBRVS,11.22 ,8.48 ,8.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27599,CPT,UNLISTED PROCEDURE FEMUR/KNEE,,,21 ,,TotalUnits,,,,23.98 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,27600,CPT,DCMPRN FASCT LEG ANT&/LAT CMPRTS ONLY,,,21 ,,RBRVS,6.03 ,5.07 ,5.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27601,CPT,DCMPRN FASCT LEG PST CMPRT ONLY,,,21 ,,RBRVS,6.05 ,5.76 ,5.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27602,CPT,DCMPRN FASCT LEG ANT&/LAT&PST CMPRT,,,21 ,,RBRVS,7.82 ,5.63 ,5.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27603,CPT,INCISION&DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA,,,21 ,,RBRVS,5.23 ,5.21 ,9.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27604,CPT,INCISION&DRAINAGE LEG/ANKLE INFECTED BURSA,,,21 ,,RBRVS,4.59 ,4.49 ,8.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27605,CPT,TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES,,,21 ,,RBRVS,2.92 ,2.26 ,6.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27606,CPT,TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES,,,21 ,,RBRVS,4.18 ,3.58 ,3.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27607,CPT,INCISION LEG/ANKLE,,,21 ,,RBRVS,8.62 ,7.72 ,7.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27610,CPT,ARTHROTOMY ANKLE W/EXPL DRAINAGE/REMOVAL FB,,,21 ,,RBRVS,9.13 ,8.32 ,8.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27612,CPT,ARTHRT PST CAPSUL RLS ANKLE W/WO ACHLL TDN LNGTH,,,21 ,,RBRVS,8.15 ,7.07 ,7.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27613,CPT,BIOPSY SOFT TISSUE LEG/ANKLE AREA SUPERFICIAL,,,21 ,,RBRVS,2.22 ,2.30 ,4.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27614,CPT,BIOPSY SOFT TISSUE LEG/ANKLE AREA DEEP,,,21 ,,RBRVS,5.80 ,5.12 ,9.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27615,CPT,RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE <5CM,,,21 ,,RBRVS,15.72 ,10.98 ,10.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27616,CPT,RAD RESCJ TUM SOFT TISSUE LEG/ANKLE 5 CM/>,,,21 ,,RBRVS,19.63 ,14.60 ,14.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27618,CPT,EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM,,,21 ,,RBRVS,3.96 ,4.57 ,8.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27619,CPT,EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <5CM,,,21 ,,RBRVS,6.91 ,6.49 ,6.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27620,CPT,ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB,,,21 ,,RBRVS,6.15 ,6.18 ,6.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27625,CPT,ARTHROTOMY W/SYNOVECTOMY ANKLE,,,21 ,,RBRVS,8.49 ,7.15 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27626,CPT,ARTHROTOMY W/SYNOVECTOMY ANKLE TENOSYNOVECTOMY,,,21 ,,RBRVS,9.10 ,7.82 ,7.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27630,CPT,EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANKLE,,,21 ,,RBRVS,4.94 ,4.99 ,10.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27632,CPT,EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>,,,21 ,,RBRVS,5.91 ,5.33 ,5.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27634,CPT,EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5 CM/>,,,21 ,,RBRVS,10.13 ,8.13 ,8.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27635,CPT,EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA,,,21 ,,RBRVS,8.03 ,7.78 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27637,CPT,EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/AGRAFT,,,21 ,,RBRVS,10.31 ,9.82 ,9.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27638,CPT,EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/ALGRAFT,,,21 ,,RBRVS,10.99 ,9.56 ,9.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27640,CPT,PARTIAL EXCISION BONE TIBIA,,,21 ,,RBRVS,12.24 ,10.48 ,10.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27641,CPT,PARTIAL EXCISION BONE FIBULA,,,21 ,,RBRVS,9.84 ,8.34 ,8.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27645,CPT,RADICAL RESECTION OF TUMOR TIBIA,,,21 ,,RBRVS,27.21 ,16.69 ,16.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27646,CPT,RADICAL RESECTION TUMOR BONE FIBULA,,,21 ,,RBRVS,23.21 ,14.73 ,14.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27647,CPT,RADICAL RESECTION OF TUMOR TALUS OR CALCANEUS,,,21 ,,RBRVS,20.26 ,9.49 ,9.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27648,CPT,INJECTION ANKLE ARTHROGRAPHY,,,21 ,,RBRVS,0.96 ,0.46 ,3.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27650,CPT,REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON,,,21 ,,RBRVS,9.21 ,8.80 ,8.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27652,CPT,RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT,,,21 ,,RBRVS,10.78 ,8.50 ,8.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27654,CPT,REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT,,,21 ,,RBRVS,10.53 ,8.78 ,8.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27656,CPT,REPAIR FASCIAL DEFECT LEG,,,21 ,,RBRVS,4.71 ,5.29 ,11.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27658,CPT,REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH,,,21 ,,RBRVS,5.12 ,5.13 ,5.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27659,CPT,RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH,,,21 ,,RBRVS,7.10 ,6.23 ,6.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27664,CPT,RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH,,,21 ,,RBRVS,4.73 ,5.15 ,5.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27665,CPT,RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH,,,21 ,,RBRVS,5.57 ,5.58 ,5.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27675,CPT,RPR DISLOC PERONEAL TENDON W/O FIBULAR OSTEOTOMY,,,21 ,,RBRVS,7.35 ,6.08 ,6.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27676,CPT,REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT,,,21 ,,RBRVS,8.73 ,7.80 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27680,CPT,TENOLYSIS FLXR/XTNSR TENDON LEG&/ANKLE 1 EACH,,,21 ,,RBRVS,5.88 ,5.77 ,5.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27681,CPT,TNOLS FLXR/XTNSR TDN LEG&/ANKLE MLT TDN,,,21 ,,RBRVS,7.05 ,7.11 ,7.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27685,CPT,LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX,,,21 ,,RBRVS,6.69 ,6.06 ,11.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27686,CPT,LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA,,,21 ,,RBRVS,7.75 ,7.23 ,7.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27687,CPT,GASTROCNEMIUS RECESSION,,,21 ,,RBRVS,6.41 ,5.98 ,5.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27690,CPT,TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC,,,21 ,,RBRVS,9.17 ,8.08 ,8.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27691,CPT,TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP,,,21 ,,RBRVS,10.49 ,9.66 ,9.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27692,CPT,TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING EA TDN,,,21 ,,RBRVS,1.87 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27695,CPT,RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL,,,21 ,,RBRVS,6.70 ,6.39 ,6.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27696,CPT,RPR PRIM DISRUPTED LIGM ANKLE BTH COLTRL LIGMS,,,21 ,,RBRVS,8.58 ,6.88 ,6.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27698,CPT,REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL,,,21 ,,RBRVS,9.61 ,7.83 ,7.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27700,CPT,ARTHROPLASTY ANKLE,,,21 ,,RBRVS,9.66 ,6.67 ,6.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27702,CPT,ARTHROPLASTY ANKLE W/IMPLANT,,,21 ,,RBRVS,14.42 ,11.77 ,11.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27703,CPT,ARTHROPLASTY ANKLE REVISION TOTAL ANKLE,,,21 ,,RBRVS,16.94 ,13.29 ,13.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27704,CPT,REMOVAL ANKLE IMPLANT,,,21 ,,RBRVS,7.81 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27705,CPT,OSTEOTOMY TIBIA,,,21 ,,RBRVS,10.86 ,9.47 ,9.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27707,CPT,OSTEOTOMY FIBULA,,,21 ,,RBRVS,4.78 ,6.00 ,6.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27709,CPT,OSTEOTOMY TIBIA&FIBULA,,,21 ,,RBRVS,17.48 ,13.27 ,13.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27712,CPT,OSTEOT MLT W/RELIGNMT IMED ROD,,,21 ,,RBRVS,15.87 ,13.30 ,13.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27715,CPT,OSTEOPLASTY TIBIA&FIBULA LENGTHENING/SHORTENING,,,21 ,,RBRVS,15.50 ,12.54 ,12.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27720,CPT,REPAIR NONUNION/MALUNION TIBIA W/O GRAFT,,,21 ,,RBRVS,12.36 ,10.91 ,10.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27722,CPT,REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT,,,21 ,,RBRVS,12.45 ,10.96 ,10.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27724,CPT,RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT,,,21 ,,RBRVS,19.31 ,14.39 ,14.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27725,CPT,RPR NON/MAL TIBIA SYNOSTOSIS W/FIBULA ANY METH,,,21 ,,RBRVS,17.41 ,14.72 ,14.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27726,CPT,REPAIR FIBULA NONUNION/MALUNION W INT FIXATION,,,21 ,,RBRVS,14.34 ,10.88 ,10.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27727,CPT,REPAIR CONGENITAL PSEUDARTHROSIS TIBIA,,,21 ,,RBRVS,14.84 ,11.66 ,11.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27730,CPT,ARREST EPIPHYSEAL OPEN DISTAL TIBIA,,,21 ,,RBRVS,7.70 ,7.74 ,7.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27732,CPT,ARREST EPIPHYSEAL OPEN DISTAL FIBULA,,,21 ,,RBRVS,5.46 ,5.85 ,5.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27734,CPT,ARREST EPIPHYSEAL OPEN DISTAL TIBIA&FIBULA,,,21 ,,RBRVS,8.83 ,7.76 ,7.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27740,CPT,ARREST EPIPHYSEAL ANY METHOD TIBIA & FIBULA,,,21 ,,RBRVS,9.61 ,7.08 ,7.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27742,CPT,ARRST EPIPHYSL ANY METH TIBFIB&DSTL FEMUR,,,21 ,,RBRVS,10.63 ,8.07 ,8.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27745,CPT,PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA,,,21 ,,RBRVS,10.49 ,9.49 ,9.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27750,CPT,CLTX TIBIAL SHAFT FX W/O MANIPULATION,,,21 ,,RBRVS,3.37 ,4.93 ,5.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27752,CPT,CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ,,,21 ,,RBRVS,6.27 ,6.86 ,7.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27756,CPT,PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE,,,21 ,,RBRVS,7.45 ,7.73 ,7.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27758,CPT,OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE,,,21 ,,RBRVS,12.54 ,11.03 ,11.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27759,CPT,TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLAGE,,,21 ,,RBRVS,14.45 ,12.03 ,12.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27760,CPT,CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION,,,21 ,,RBRVS,3.21 ,4.77 ,5.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27762,CPT,CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ,,,21 ,,RBRVS,5.47 ,6.20 ,7.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27766,CPT,OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE,,,21 ,,RBRVS,7.89 ,8.35 ,8.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27767,CPT,CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ,,,21 ,,RBRVS,2.64 ,4.69 ,4.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27768,CPT,CLOSED TREATMENT PST MALLEOLUS FRACTURE W MANJ,,,21 ,,RBRVS,5.14 ,6.10 ,6.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27769,CPT,OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE,,,21 ,,RBRVS,10.14 ,8.80 ,8.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27780,CPT,CLTX PROX FIBULA/SHFT FX W/O MANJ,,,21 ,,RBRVS,2.83 ,4.38 ,5.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27781,CPT,CLTX PROX FIBULA/SHFT FX W/MANJ,,,21 ,,RBRVS,4.59 ,5.78 ,6.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27784,CPT,OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE,,,21 ,,RBRVS,9.67 ,9.15 ,9.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27786,CPT,CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ,,,21 ,,RBRVS,3.02 ,4.48 ,5.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27788,CPT,CLTX DSTL FIBULAR FX LAT MALLS W/MANJ,,,21 ,,RBRVS,4.64 ,5.61 ,6.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27792,CPT,OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS,,,21 ,,RBRVS,9.71 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27808,CPT,CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ,,,21 ,,RBRVS,3.03 ,4.83 ,5.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27810,CPT,CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MANJ,,,21 ,,RBRVS,5.32 ,6.04 ,7.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27814,CPT,OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,,,21 ,,RBRVS,10.62 ,9.94 ,9.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27816,CPT,CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION,,,21 ,,RBRVS,3.07 ,4.39 ,5.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27818,CPT,CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION,,,21 ,,RBRVS,5.69 ,5.82 ,7.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27822,CPT,OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP,,,21 ,,RBRVS,11.21 ,11.36 ,11.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27823,CPT,OPEN TX TRIMALLEOLAR ANKLE FX W FIXJ PST LIP,,,21 ,,RBRVS,13.16 ,12.42 ,12.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27824,CPT,CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ,,,21 ,,RBRVS,3.31 ,4.64 ,4.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27825,CPT,CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ,,,21 ,,RBRVS,6.69 ,6.45 ,7.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27826,CPT,OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA,,,21 ,,RBRVS,11.10 ,11.08 ,11.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27827,CPT,OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY,,,21 ,,RBRVS,14.79 ,14.11 ,14.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27828,CPT,OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA,,,21 ,,RBRVS,18.43 ,16.06 ,16.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27829,CPT,OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION,,,21 ,,RBRVS,8.80 ,9.24 ,9.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27830,CPT,CLTX PROX TIBFIB JT DISLC W/O ANES,,,21 ,,RBRVS,3.96 ,5.14 ,5.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27831,CPT,CLTX PROX TIBFIB JT DISLC REQ ANES,,,21 ,,RBRVS,4.73 ,5.62 ,5.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27832,CPT,OPEN TX PROX TIBFIB JOINT DISLOCATE EXC PROX FIB,,,21 ,,RBRVS,10.17 ,9.37 ,9.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27840,CPT,CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA,,,21 ,,RBRVS,4.77 ,4.68 ,4.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27842,CPT,CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ,,,21 ,,RBRVS,6.46 ,6.58 ,6.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27846,CPT,OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ,,,21 ,,RBRVS,10.28 ,9.26 ,9.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27848,CPT,OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ,,,21 ,,RBRVS,11.68 ,10.24 ,10.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27860,CPT,MANIPULATION ANKLE UNDER GENERAL ANESTHESIA,,,21 ,,RBRVS,2.39 ,2.32 ,2.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27870,CPT,ARTHRODESIS ANKLE OPEN,,,21 ,,RBRVS,15.41 ,12.40 ,12.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27871,CPT,ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL,,,21 ,,RBRVS,9.54 ,8.87 ,8.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27880,CPT,AMPUTATION LEG THROUGH TIBIA&FIBULA,,,21 ,,RBRVS,15.37 ,9.03 ,9.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27881,CPT,AMP LEG THRU TIBFIB W/IMMT FITG TQ W/1ST CST,,,21 ,,RBRVS,13.47 ,9.97 ,9.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27882,CPT,AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR,,,21 ,,RBRVS,9.79 ,6.63 ,6.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27884,CPT,AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REVJ,,,21 ,,RBRVS,8.76 ,6.77 ,6.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27886,CPT,AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION,,,21 ,,RBRVS,10.02 ,7.66 ,7.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27888,CPT,AMP ANKLE-MALLI TIBFIB W/PLSTC CLSR&RESCJ NRV,,,21 ,,RBRVS,10.37 ,8.11 ,8.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27889,CPT,ANKLE DISARTICULATION,,,21 ,,RBRVS,10.86 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27892,CPT,DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NRV,,,21 ,,RBRVS,7.94 ,6.64 ,6.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27893,CPT,DCMPRN FASCT LEG PST W/DBRDMT MUSC&/NRV,,,21 ,,RBRVS,7.90 ,7.58 ,7.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27894,CPT,DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUSC&/NRV,,,21 ,,RBRVS,12.67 ,9.97 ,9.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,27899,CPT,UNLISTED PROCEDURE LEG/ANKLE,,,21 ,,TotalUnits,,,,17.44 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,28001,CPT,INCISION&DRAINAGE BURSA FOOT,,,21 ,,RBRVS,2.78 ,2.01 ,4.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28002,CPT,I&D BELOW FASCIA FOOT 1 BURSAL SPACE,,,21 ,,RBRVS,5.93 ,4.50 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28003,CPT,I&D BELOW FASCIA FOOT MULTIPLE AREAS,,,21 ,,RBRVS,9.06 ,5.78 ,9.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28005,CPT,INCISION BONE CORTEX FOOT,,,21 ,,RBRVS,9.44 ,7.03 ,7.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28008,CPT,FASCIOTOMY FOOT&/TOE,,,21 ,,RBRVS,4.59 ,3.66 ,7.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28010,CPT,TENOTOMY PERCUTANEOUS TOE SINGLE TENDON,,,21 ,,RBRVS,2.97 ,2.91 ,3.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28011,CPT,TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDON,,,21 ,,RBRVS,4.28 ,3.92 ,4.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28020,CPT,ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT,,,21 ,,RBRVS,5.15 ,4.68 ,9.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28022,CPT,ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT,,,21 ,,RBRVS,4.81 ,4.18 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28024,CPT,ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT,,,21 ,,RBRVS,4.52 ,3.97 ,7.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28035,CPT,RELEASE TARSAL TUNNEL,,,21 ,,RBRVS,5.23 ,4.59 ,8.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28039,CPT,EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>,,,21 ,,RBRVS,5.42 ,4.04 ,8.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28041,CPT,EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>,,,21 ,,RBRVS,7.13 ,5.27 ,5.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28043,CPT,EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM,,,21 ,,RBRVS,3.96 ,3.48 ,6.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28045,CPT,EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM,,,21 ,,RBRVS,5.45 ,4.30 ,8.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28046,CPT,RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE <3CM,,,21 ,,RBRVS,12.38 ,7.91 ,7.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28047,CPT,RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE 3 CM/>,,,21 ,,RBRVS,17.45 ,8.52 ,8.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28050,CPT,ARTHRT W/BX INTERTARSAL/TARSOMETATARSAL JOINT,,,21 ,,RBRVS,4.39 ,3.81 ,7.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28052,CPT,ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT,,,21 ,,RBRVS,4.06 ,3.65 ,7.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28054,CPT,ARTHRTOMY W/BX INTERPHALANGEAL JOINT,,,21 ,,RBRVS,3.57 ,3.31 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28055,CPT,NEURECTOMY INTRINSIC MUSCULATURE OF FOOT,,,21 ,,RBRVS,6.29 ,4.36 ,4.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28060,CPT,FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,,,21 ,,RBRVS,5.40 ,4.50 ,8.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28062,CPT,FASCIOTOMY PLANTAR FASCIA RADICAL SPX,,,21 ,,RBRVS,6.69 ,4.76 ,9.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28070,CPT,SYNVCT INTERTARSAL/TARSOMETATARSAL JT EA SPX,,,21 ,,RBRVS,5.24 ,4.55 ,8.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28072,CPT,SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH,,,21 ,,RBRVS,4.72 ,4.66 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28080,CPT,EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH,,,21 ,,RBRVS,4.86 ,5.14 ,9.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28086,CPT,SYNOVECTOMY TENDON SHEATH FOOT FLEXOR,,,21 ,,RBRVS,4.92 ,4.91 ,9.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28088,CPT,SYNOVECTOMY TENDON SHEATH FOOT EXTENSOR,,,21 ,,RBRVS,3.98 ,4.37 ,9.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28090,CPT,EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT,,,21 ,,RBRVS,4.55 ,4.01 ,8.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28092,CPT,EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA,,,21 ,,RBRVS,3.78 ,3.80 ,7.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28100,CPT,EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS,,,21 ,,RBRVS,5.83 ,5.29 ,10.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28102,CPT,EXC/CURTG CST/B9 TUM TALUS/CLCNS W/ILIAC/AGRFT,,,21 ,,RBRVS,7.92 ,7.78 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28103,CPT,EXC/CURETTAGE CYST/TUMOR TALUS/CALCANEUS ALGRFT,,,21 ,,RBRVS,6.67 ,4.90 ,4.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28104,CPT,EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL,,,21 ,,RBRVS,5.26 ,4.36 ,8.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28106,CPT,EXC/CURTG CST/B9 TUM TARSAL/METAR W/ILIAC/AGRFT,,,21 ,,RBRVS,7.35 ,5.05 ,5.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28107,CPT,EXC/CURTG CST/B9 TUM TARSAL/METAR W/ALGRFT,,,21 ,,RBRVS,5.73 ,4.46 ,9.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28108,CPT,EXC/CURTG CST/B9 TUM PHALANGES FOOT,,,21 ,,RBRVS,4.30 ,3.73 ,7.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28110,CPT,OSTECTOMY PRTL 5TH METAR HEAD SPX,,,21 ,,RBRVS,4.22 ,3.82 ,8.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28111,CPT,OSTECTOMY COMPLETE 1ST METATARSAL HEAD,,,21 ,,RBRVS,5.15 ,4.13 ,8.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28112,CPT,OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4,,,21 ,,RBRVS,4.63 ,4.13 ,8.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28113,CPT,OSTECTOMY COMPLETE 5TH METATARSAL HEAD,,,21 ,,RBRVS,6.11 ,5.73 ,10.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28114,CPT,OSTC COMPL ALL METAR HEADS W/PRTL PROX PHALANGC,,,21 ,,RBRVS,12.00 ,10.73 ,16.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28116,CPT,OSTECTOMY TARSAL COALITION,,,21 ,,RBRVS,9.14 ,6.61 ,11.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28118,CPT,OSTECTOMY CALCANEUS,,,21 ,,RBRVS,6.13 ,5.21 ,9.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28119,CPT,OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS,,,21 ,,RBRVS,5.56 ,4.47 ,8.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28120,CPT,PARTIAL EXCISION BONE TALUS/CALCANEUS,,,21 ,,RBRVS,8.27 ,5.97 ,10.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28122,CPT,PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS,,,21 ,,RBRVS,7.72 ,6.06 ,10.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28124,CPT,PARTICAL EXCISION BONE PHALANX TOE,,,21 ,,RBRVS,5.00 ,4.29 ,8.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28126,CPT,RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH,,,21 ,,RBRVS,3.64 ,3.34 ,7.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28130,CPT,TALECTOMY ASTRAGALECTOMY,,,21 ,,RBRVS,9.50 ,8.91 ,8.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28140,CPT,METATARSECTOMY,,,21 ,,RBRVS,7.14 ,5.23 ,9.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28150,CPT,PHALANGECTOMY TOE EACH TOE,,,21 ,,RBRVS,4.23 ,3.74 ,7.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28153,CPT,RESECTION CONDYLE DISTAL END PHALANX EACH TOE,,,21 ,,RBRVS,3.80 ,3.57 ,7.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28160,CPT,HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXC TOE,,,21 ,,RBRVS,3.88 ,3.72 ,7.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28171,CPT,RAD RESCJ TUMOR TARSAL EXCEPT TALUS/CALCANEUS,,,21 ,,RBRVS,16.41 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28173,CPT,RADICAL RESECTION TUMOR METATARSAL,,,21 ,,RBRVS,14.16 ,6.65 ,6.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28175,CPT,RADICAL RESECTION TUMOR PHALANX OR TOE,,,21 ,,RBRVS,8.29 ,5.00 ,5.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28190,CPT,REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS,,,21 ,,RBRVS,2.01 ,1.71 ,4.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28192,CPT,REMOVAL FOREIGN BODY FOOT DEEP,,,21 ,,RBRVS,4.78 ,4.04 ,8.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28193,CPT,REMOVAL FOREIGN BODY FOOT COMPLICATED,,,21 ,,RBRVS,5.90 ,4.50 ,8.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28200,CPT,RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON,,,21 ,,RBRVS,4.74 ,4.06 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28202,CPT,RPR TENDON FLXR FOOT SEC W/FREE GRAFT EA TENDON,,,21 ,,RBRVS,7.07 ,4.85 ,9.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28208,CPT,REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,,,21 ,,RBRVS,4.51 ,4.03 ,8.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28210,CPT,RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON,,,21 ,,RBRVS,6.52 ,4.86 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28220,CPT,TENOLYSIS FLEXOR FOOT SINGLE TENDON,,,21 ,,RBRVS,4.67 ,3.82 ,7.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28222,CPT,TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS,,,21 ,,RBRVS,5.76 ,4.22 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28225,CPT,TENOLYSIS EXTENSOR FOOT SINGLE TENDON,,,21 ,,RBRVS,3.78 ,3.33 ,7.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28226,CPT,TENOLYSIS EXTENSOR FOOT MULTIPLE TENDON,,,21 ,,RBRVS,4.67 ,4.17 ,8.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28230,CPT,TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX,,,21 ,,RBRVS,4.36 ,3.64 ,7.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28232,CPT,TX OPEN TENDON FLEXOR TOE 1 TENDON SPX,,,21 ,,RBRVS,3.51 ,3.43 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28234,CPT,TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON,,,21 ,,RBRVS,3.54 ,3.90 ,7.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28238,CPT,RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR,,,21 ,,RBRVS,7.96 ,5.65 ,10.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28240,CPT,TENOTOMY LENGTHENING/RLS ABDUCTOR HALLUCIS MUSC,,,21 ,,RBRVS,4.48 ,3.72 ,7.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28250,CPT,DIVISION PLANTAR FASCIA&MUSCLE SPX,,,21 ,,RBRVS,6.06 ,4.99 ,9.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28260,CPT,CAPSULOTOMY MIDFOOT MEDIAL RELEASE ONLY SPX,,,21 ,,RBRVS,8.19 ,6.02 ,10.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28261,CPT,CAPSULOTOMY MIDFOOT W/TENDON LENGTHENING,,,21 ,,RBRVS,13.11 ,8.22 ,13.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28262,CPT,CAPSUL MIDFOOT W/PST TALOTIBL CAPSUL&TDN LNGTH,,,21 ,,RBRVS,17.21 ,12.92 ,19.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28264,CPT,CAPSULOTOMY MIDTARSAL,,,21 ,,RBRVS,10.65 ,9.12 ,14.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28270,CPT,CAPSUL MTTARPHLNGL JT W/WO TENORRHAPHY EA JT SPX,,,21 ,,RBRVS,4.93 ,4.39 ,8.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28272,CPT,CAPSULOTOMY IPHAL JOINT EACH JOINT SPX,,,21 ,,RBRVS,3.92 ,3.26 ,6.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28280,CPT,SYNDACTYLIZATION TOES,,,21 ,,RBRVS,5.33 ,4.56 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28285,CPT,CORRECTION HAMMERTOE,,,21 ,,RBRVS,4.76 ,4.20 ,8.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28286,CPT,CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE,,,21 ,,RBRVS,4.70 ,3.80 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28288,CPT,OSTC PRTL EXOSTC/CONDYLC METAR HEAD,,,21 ,,RBRVS,6.02 ,5.96 ,10.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28289,CPT,HALLUX RIGIDUS CORRECT W/CHEILECTOMY 1ST MP JT,,,21 ,,RBRVS,8.31 ,6.84 ,11.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28290,CPT,CORRJ HALLUX VALGUS W/WO SESMDC SMPL EXOSTECTOMY,,,21 ,,RBRVS,5.83 ,5.14 ,10.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28292,CPT,KELLER/MCBRIDE/MAYO PROCEDURE,,,21 ,,RBRVS,9.05 ,7.62 ,12.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28293,CPT,CORRJ HALLUX VALGUS W/WO SESMDC RESCJ JT W/IMPLT,,,21 ,,RBRVS,11.48 ,8.38 ,17.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28294,CPT,CORRJ HALLUX VALGUS W/WO SESMDC W/TDN TRNSPLS,,,21 ,,RBRVS,8.75 ,5.79 ,11.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28296,CPT,CORRJ HALLUX VALGUS W/WO SESMDC W/METAR OSTEOT,,,21 ,,RBRVS,8.35 ,6.29 ,11.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28297,CPT,CORRJ HALLUX VALGUS W/WO SESMDC LAPIDUS-TYP PX,,,21 ,,RBRVS,9.43 ,6.88 ,12.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28298,CPT,CORRJ HALLUX VALGUS W/WO SESMDC PHALANX OSTEOT,,,21 ,,RBRVS,8.13 ,5.90 ,11.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28299,CPT,CORRJ HALLUX VALGUS W/WO SESMDC 2 OSTEOT,,,21 ,,RBRVS,11.57 ,7.29 ,12.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28300,CPT,OSTEOTOMY CALCANEUS +-INTERNAL FIXATION,,,21 ,,RBRVS,9.73 ,8.12 ,8.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28302,CPT,OSTEOTOMY TALUS,,,21 ,,RBRVS,9.74 ,8.68 ,8.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28304,CPT,OSTEOTOMY TARSAL BONES OTH/THN CALCANEUS/TALUS,,,21 ,,RBRVS,9.41 ,6.84 ,12.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28305,CPT,OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT,,,21 ,,RBRVS,10.77 ,7.69 ,7.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28306,CPT,OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR,,,21 ,,RBRVS,6.00 ,5.12 ,10.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28307,CPT,OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST TOE,,,21 ,,RBRVS,6.50 ,5.92 ,12.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28308,CPT,OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA,,,21 ,,RBRVS,5.48 ,4.84 ,9.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28309,CPT,OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT,,,21 ,,RBRVS,14.16 ,9.96 ,9.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28310,CPT,OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE,,,21 ,,RBRVS,5.57 ,4.31 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28312,CPT,OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE,,,21 ,,RBRVS,4.69 ,4.14 ,8.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28313,CPT,RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY,,,21 ,,RBRVS,5.15 ,4.91 ,9.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28315,CPT,SESAMOIDECTOMY FIRST TOE SPX,,,21 ,,RBRVS,5.00 ,4.00 ,7.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28320,CPT,REPAIR NONUNION/MALUNION TARSAL BONES,,,21 ,,RBRVS,9.37 ,7.34 ,7.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28322,CPT,RPR NON/MALUNION METARSAL W/WO BONE GRAFT,,,21 ,,RBRVS,8.53 ,7.13 ,12.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28340,CPT,RCNSTJ TOE MACRODACTYLY SOFT TISSUE RESECTION,,,21 ,,RBRVS,7.15 ,4.72 ,9.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28341,CPT,RCNSTJ TOE MACRODACTYLY REQUIRING BONE RESECTION,,,21 ,,RBRVS,8.72 ,5.33 ,10.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28344,CPT,RECONSTRUCTION TOE POLYDACTYLY,,,21 ,,RBRVS,4.40 ,3.94 ,8.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28345,CPT,RCNSTJ TOE SYNDACTYLY W/WO SKIN GRAFT EACH WEB,,,21 ,,RBRVS,6.09 ,4.64 ,8.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28360,CPT,RECONSTRUCTION CLEFT FOOT,,,21 ,,RBRVS,14.92 ,12.51 ,12.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28400,CPT,CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,2.31 ,3.76 ,4.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28405,CPT,CLOSED TX CALCANEAL FRACTURE W/MANIPULATION,,,21 ,,RBRVS,4.74 ,4.94 ,5.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28406,CPT,PRQ SKELETAL FIXJ CALCANEAL FRACTURE W/MANJ,,,21 ,,RBRVS,6.56 ,7.54 ,7.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28415,CPT,OPEN TREATMENT CALCANEAL FRACTURE,,,21 ,,RBRVS,16.19 ,13.98 ,13.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28420,CPT,OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT,,,21 ,,RBRVS,17.52 ,15.10 ,15.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28430,CPT,CLOSED TX TALUS FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,2.22 ,3.31 ,4.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28435,CPT,CLOSED TX TALUS FRACTURE W/MANIPULATION,,,21 ,,RBRVS,3.54 ,4.66 ,5.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28436,CPT,PRQ SKELETAL FIXATION TALUS FRACTURE W/MANJ,,,21 ,,RBRVS,4.90 ,6.84 ,6.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28445,CPT,OPEN TREATMENT TALUS FRACTURE,,,21 ,,RBRVS,15.76 ,12.62 ,12.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28446,CPT,OPEN OSTEOCHONDRAL AUTOGRAFT TALUS,,,21 ,,RBRVS,17.71 ,14.26 ,14.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28450,CPT,TX TARSAL B1 FX XCP TALUS&CALCN W/O MANJ,,,21 ,,RBRVS,2.03 ,3.10 ,3.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28455,CPT,TX TARSAL B1 FX XCP TALUS&CALCN W/MANJ,,,21 ,,RBRVS,3.24 ,3.98 ,4.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28456,CPT,PRQ SKEL FIXJ TARSL FX XCP TALUS&CALCNS W/MANJ,,,21 ,,RBRVS,2.86 ,5.32 ,5.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28465,CPT,OPEN TX TARSAL FRACTURE XCP TALUS &CALCANEUS EA,,,21 ,,RBRVS,8.80 ,7.75 ,7.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28470,CPT,CLOSED TX METATARSAL FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,2.03 ,3.06 ,3.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28475,CPT,CLTX METAR FX W/MANJ,,,21 ,,RBRVS,3.01 ,3.29 ,3.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28476,CPT,PRQ SKEL FIXJ METAR FX W/MANJ,,,21 ,,RBRVS,3.60 ,5.80 ,5.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28485,CPT,OPEN TREATMENT METATARSAL FRACTURE EACH,,,21 ,,RBRVS,7.44 ,7.08 ,7.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28490,CPT,CLTX FX GRT TOE PHLX/PHLG W/O MANJ,,,21 ,,RBRVS,1.17 ,2.14 ,2.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28495,CPT,CLTX FX GRT TOE PHLX/PHLG W/MANJ,,,21 ,,RBRVS,1.68 ,2.42 ,3.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28496,CPT,PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ,,,21 ,,RBRVS,2.48 ,3.83 ,9.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28505,CPT,OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES,,,21 ,,RBRVS,7.44 ,6.08 ,10.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28510,CPT,CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ,,,21 ,,RBRVS,1.17 ,2.03 ,2.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28515,CPT,CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ,,,21 ,,RBRVS,1.56 ,2.31 ,2.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28525,CPT,OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE,,,21 ,,RBRVS,5.62 ,5.21 ,9.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28530,CPT,CLOSED TREATMENT SESAMOID FRACTURE,,,21 ,,RBRVS,1.11 ,1.72 ,2.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28531,CPT,OPEN TX SESAMOID FRACTURE W/WO INTERNAL FIXATION,,,21 ,,RBRVS,2.57 ,2.58 ,7.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28540,CPT,CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES,,,21 ,,RBRVS,2.19 ,2.85 ,3.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28545,CPT,CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES,,,21 ,,RBRVS,2.60 ,3.95 ,4.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28546,CPT,PRQ SKEL FIXJ TARSL DISLC XCP TALOTARSAL W/MANJ,,,21 ,,RBRVS,3.40 ,5.25 ,10.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28555,CPT,OPEN TREATMENT TARSAL BONE DISLOCATION,,,21 ,,RBRVS,9.65 ,8.18 ,13.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28570,CPT,CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,,,21 ,,RBRVS,1.76 ,2.26 ,2.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28575,CPT,CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES,,,21 ,,RBRVS,3.49 ,5.03 ,5.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28576,CPT,PRQ SKEL FIXJ TALOTARSAL JT DISLC W/MANJ,,,21 ,,RBRVS,4.60 ,5.43 ,5.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28585,CPT,OPEN TREATMENT TALOTARSAL JOINT DISLOCATION,,,21 ,,RBRVS,11.13 ,8.51 ,13.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28600,CPT,CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES,,,21 ,,RBRVS,2.02 ,3.10 ,3.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28605,CPT,CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES,,,21 ,,RBRVS,2.89 ,3.97 ,4.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28606,CPT,PRQ SKEL FIXJ TARS JT DISLC W/MANJ,,,21 ,,RBRVS,5.09 ,5.42 ,5.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28615,CPT,OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION,,,21 ,,RBRVS,10.70 ,10.50 ,10.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28630,CPT,CLTX METATARSOPHLNGL JT DISLC W/O ANES,,,21 ,,RBRVS,1.75 ,1.20 ,2.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28635,CPT,CLTX METATARSOPHLNGL JT DISLC REQ ANES,,,21 ,,RBRVS,1.96 ,1.76 ,2.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28636,CPT,PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ,,,21 ,,RBRVS,2.77 ,2.28 ,4.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28645,CPT,OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION,,,21 ,,RBRVS,7.44 ,5.63 ,9.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28660,CPT,CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES,,,21 ,,RBRVS,1.28 ,1.04 ,1.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28665,CPT,CLTX INTERPHALANGEAL JOINT DISLOCATION REQ ANES,,,21 ,,RBRVS,1.97 ,1.69 ,2.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28666,CPT,PRQ SKEL FIXJ INTERPHALANGEAL JOINT DISLC W/MANJ,,,21 ,,RBRVS,2.66 ,2.77 ,2.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28675,CPT,OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION,,,21 ,,RBRVS,5.62 ,5.48 ,10.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28705,CPT,ARTHRODESIS PANTALAR,,,21 ,,RBRVS,20.33 ,14.40 ,14.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28715,CPT,ARTHRODESIS TRIPLE,,,21 ,,RBRVS,14.60 ,11.48 ,11.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28725,CPT,ARTHRODESIS SUBTALAR,,,21 ,,RBRVS,12.18 ,9.21 ,9.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28730,CPT,ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS,,,21 ,,RBRVS,12.42 ,10.35 ,10.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28735,CPT,ARTHRD MIDTARSL/TARS MLT/TRANSVRS W/OSTEOT,,,21 ,,RBRVS,12.23 ,9.31 ,9.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28737,CPT,ARTHRD W/TDN LNGTH&ADVMNT TARSL NVCLR-CUNEIFORM,,,21 ,,RBRVS,11.03 ,7.74 ,7.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28740,CPT,ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT,,,21 ,,RBRVS,9.29 ,7.83 ,13.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28750,CPT,ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT,,,21 ,,RBRVS,8.57 ,7.78 ,13.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28755,CPT,ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT,,,21 ,,RBRVS,4.88 ,4.27 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28760,CPT,ARTHRD W/XTNSR HALLUCIS LONGUS TR 1ST METAR NCK,,,21 ,,RBRVS,9.14 ,6.89 ,12.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28800,CPT,AMPUTATION FOOT MIDTARSAL,,,21 ,,RBRVS,8.79 ,6.47 ,6.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28805,CPT,AMPUTATION FOOT TRANSMETARSAL,,,21 ,,RBRVS,12.71 ,7.53 ,7.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28810,CPT,AMPUTATION METATARSAL W/TOE SINGLE,,,21 ,,RBRVS,6.64 ,5.24 ,5.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28820,CPT,AMPUTATION TOE METATARSOPHALANGEAL JOINT,,,21 ,,RBRVS,5.00 ,4.48 ,9.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28825,CPT,AMPUTATION TOE INTERPHALANGEAL JOINT,,,21 ,,RBRVS,6.01 ,5.09 ,9.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28890,CPT,ESWT HI NRG PFRMD PHYS W/US GDN INVG PLNTAR FSCA,,,21 ,,RBRVS,3.45 ,2.84 ,6.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,28899,CPT,UNLISTED PROCEDURE FOOT/TOES,,,21 ,,TotalUnits,,,,10.68 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,29000,CPT,APPLICATION HALO TYPE BODY CAST,,,21 ,,RBRVS,2.25 ,2.46 ,5.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29010,CPT,APPLICATION RISSER JACKET LOCALIZER BODY ONLY,,,21 ,,RBRVS,2.06 ,2.30 ,5.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29015,CPT,APPLICATION RISSER JACKET LOCALIZER BODY W/HEAD,,,21 ,,RBRVS,2.41 ,1.84 ,3.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29020,CPT,APPLICATION TURNBUCKLE JACKET BODY ONLY,,,21 ,,RBRVS,2.11 ,1.58 ,3.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29025,CPT,APPLICATION TURNBUCKLE JACKET BODY W/HEAD,,,21 ,,RBRVS,2.40 ,2.05 ,4.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29035,CPT,APPLICATION BODY CAST SHOULDER HIPS,,,21 ,,RBRVS,1.77 ,2.03 ,4.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29040,CPT,APPLICATION BODY CAST SHOULDER HIPS HEAD MINERVA,,,21 ,,RBRVS,2.22 ,1.89 ,4.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29044,CPT,APPLICATION BODY CAST SHOULDER HIPS W/ONE THIGH,,,21 ,,RBRVS,2.12 ,2.29 ,5.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29046,CPT,APPLICATION BODY CAST SHOULDER HIPS BOTH THIGHS,,,21 ,,RBRVS,2.41 ,2.24 ,4.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29049,CPT,APPLICATION CAST FIGURE-OF-8,,,21 ,,RBRVS,0.89 ,0.85 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29055,CPT,APPLICATION CAST SHOULDER SPICA,,,21 ,,RBRVS,1.78 ,1.85 ,3.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29058,CPT,APPLICATION CAST PLASTER VELPEAU,,,21 ,,RBRVS,1.31 ,0.80 ,1.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29065,CPT,APPLICATION CAST SHOULDER HAND LONG ARM,,,21 ,,RBRVS,0.87 ,0.94 ,1.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29075,CPT,APPLICATION CAST ELBOW FINGER SHORT ARM,,,21 ,,RBRVS,0.77 ,0.88 ,1.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29085,CPT,APPLICATION CAST HAND&LOWER FOREARM GAUNTLET,,,21 ,,RBRVS,0.87 ,0.91 ,1.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29086,CPT,APPLICATION CAST FINGER,,,21 ,,RBRVS,0.62 ,0.74 ,1.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29105,CPT,APPLICATION LONG ARM SPLINT SHOULDER HAND,,,21 ,,RBRVS,0.87 ,0.70 ,1.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29125,CPT,APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC,,,21 ,,RBRVS,0.59 ,0.56 ,1.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29126,CPT,APPLICATION SHORT ARM SPLINT DYNAMIC,,,21 ,,RBRVS,0.77 ,0.64 ,1.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29130,CPT,APPLICATION FINGER SPLINT STATIC,,,21 ,,RBRVS,0.50 ,0.26 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29131,CPT,APPLICATION FINGER SPLINT DYNAMIC,,,21 ,,RBRVS,0.55 ,0.34 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29200,CPT,STRAPPING THORAX,,,21 ,,RBRVS,0.65 ,0.45 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29240,CPT,STRAPPING SHOULDER,,,21 ,,RBRVS,0.71 ,0.49 ,0.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29260,CPT,STRAPPING ELBOW/WRIST,,,21 ,,RBRVS,0.55 ,0.47 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29280,CPT,STRAPPING HAND/FINGER,,,21 ,,RBRVS,0.51 ,0.47 ,0.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29305,CPT,APPLICATION HIP SPICA CAST 1 LEG,,,21 ,,RBRVS,2.03 ,2.18 ,4.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29325,CPT,APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS,,,21 ,,RBRVS,2.32 ,2.41 ,4.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29345,CPT,APPLICATION LONG LEG CAST THIGH-TOE,,,21 ,,RBRVS,1.40 ,1.28 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29355,CPT,APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE,,,21 ,,RBRVS,1.53 ,1.31 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29358,CPT,APPLICATION LONG LEG CAST BRACE,,,21 ,,RBRVS,1.43 ,1.31 ,2.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29365,CPT,APPLICATION CYLINDER CAST THIGH ANKLE,,,21 ,,RBRVS,1.18 ,1.16 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29405,CPT,APPLICATION SHORT LEG CAST BELOW KNEE-TOE,,,21 ,,RBRVS,0.86 ,0.86 ,1.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29425,CPT,APPLICATION SHORT LEG CAST WALKING/AMBULATORY,,,21 ,,RBRVS,1.01 ,0.85 ,1.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29435,CPT,APPLICATION PATELLAR TENDON BEARING CAST,,,21 ,,RBRVS,1.18 ,1.08 ,1.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29440,CPT,ADDING WALKER PREVIOUSLY APPLIED CAST,,,21 ,,RBRVS,0.57 ,0.28 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29445,CPT,APPLICATION RIGID TOTAL CONTACT LEG CAST,,,21 ,,RBRVS,1.78 ,1.15 ,2.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29450,CPT,APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG,,,21 ,,RBRVS,2.08 ,1.10 ,1.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29505,CPT,APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES,,,21 ,,RBRVS,0.69 ,0.59 ,1.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29515,CPT,APPLICATION SHORT LEG SPLINT CALF FOOT,,,21 ,,RBRVS,0.73 ,0.60 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29520,CPT,STRAPPING HIP,,,21 ,,RBRVS,0.54 ,0.46 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29530,CPT,STRAPPING KNEE,,,21 ,,RBRVS,0.57 ,0.46 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29540,CPT,STRAPPING ANKLE &/FOOT,,,21 ,,RBRVS,0.32 ,0.34 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29550,CPT,STRAPPING TOES,,,21 ,,RBRVS,0.15 ,0.31 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29580,CPT,STRAPPING UNNA BOOT,,,21 ,,RBRVS,0.55 ,0.43 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29581,CPT,APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT,,,21 ,,RBRVS,0.60 ,0.27 ,2.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29582,CPT,APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE,,,21 ,,RBRVS,0.35 ,0.09 ,1.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29583,CPT,APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM,,,21 ,,RBRVS,0.25 ,0.07 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29584,CPT,APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FINGER,,,21 ,,RBRVS,0.35 ,0.09 ,1.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29590,CPT,DENIS-BROWNE SPLINT STRAPPING,,,21 ,,RBRVS,0.76 ,0.32 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29700,CPT,REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST,,,21 ,,RBRVS,0.57 ,0.34 ,1.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29705,CPT,REMOVAL/BIVALVING FULL ARM/FULL LEG CAST,,,21 ,,RBRVS,0.76 ,0.50 ,1.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29710,CPT,RMVL/BIVALV SHO/HIP SPICA MINERVA/RISSER JACKET,,,21 ,,RBRVS,1.34 ,0.85 ,1.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29715,CPT,REMOVAL/BIVALVING TURNBUCKLE JACKET,,,21 ,,RBRVS,0.94 ,0.53 ,1.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29720,CPT,REPAIR SPICA BODY CAST/JACKET,,,21 ,,RBRVS,0.68 ,0.48 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29730,CPT,WINDOWING CAST,,,21 ,,RBRVS,0.75 ,0.46 ,0.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29740,CPT,WEDGING CAST EXCEPT CLUBFOOT CASTS,,,21 ,,RBRVS,1.12 ,0.59 ,1.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29750,CPT,WEDGING CLUBFOOT CAST,,,21 ,,RBRVS,1.26 ,0.74 ,1.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29799,CPT,UNLISTED PROCEDURE CASTING/STRAPPING,,,21 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,29800,CPT,ARTHRS TEMPOROMANDIBULR JT DX W/WO SYNVAL BX SPX,,,21 ,,RBRVS,6.84 ,7.09 ,7.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29804,CPT,ARTHROSCOPY TEMPOROMANDIBULAR JOINT SURGICAL,,,21 ,,RBRVS,8.87 ,8.47 ,8.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29805,CPT,ARTHROSCOPY SHOULDER DX W/WO SYNOVIAL BIOPSY SPX,,,21 ,,RBRVS,6.03 ,6.47 ,6.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29806,CPT,ARTHROSCOPY SHOULDER SURGICAL CAPSULORRHAPHY,,,21 ,,RBRVS,15.14 ,12.96 ,12.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29807,CPT,ARTHROSCOPY SHOULDER SURGICAL REPAIR SLAP LESION,,,21 ,,RBRVS,14.67 ,12.79 ,12.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29819,CPT,ARTHROSCOPY SHOULDER SURGICAL REMOVAL LOOSE/FB,,,21 ,,RBRVS,7.79 ,7.78 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29820,CPT,ARTHROSCOPY SHOULDER SURG SYNOVECTOMY PARTIAL,,,21 ,,RBRVS,7.21 ,7.12 ,7.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29821,CPT,ARTHROSCOPY SHOULDER SURG SYNOVECTOMY COMPLETE,,,21 ,,RBRVS,7.89 ,7.78 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29822,CPT,ARTHROSCOPY SHOULDER SURG DEBRIDEMENT LIMITED,,,21 ,,RBRVS,7.60 ,7.64 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29823,CPT,ARTHROSCOPY SHOULDER SURG DEBRIDEMENT EXTENSIVE,,,21 ,,RBRVS,8.36 ,8.28 ,8.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29824,CPT,ARTHROSCOPY SHOULDER DISTAL CLAVICULECTOMY,,,21 ,,RBRVS,8.98 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29825,CPT,ARTHROSCOPY SHOULDER LYSIS&RESCJ ADHESION +-MANJ,,,21 ,,RBRVS,7.79 ,7.74 ,7.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29826,CPT,SHOULDER SCOPE BONE SHAVING,,,21 ,,RBRVS,9.16 ,8.52 ,8.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29827,CPT,ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR,,,21 ,,RBRVS,15.59 ,12.98 ,12.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29828,CPT,ARTHROSCOPY SHOULDER BICEPS TENODESIS,,,21 ,,RBRVS,13.16 ,11.09 ,11.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29830,CPT,ARTHROSCOPY ELBOW DIAG W/WO SYNOVIAL BIOPSY SPX,,,21 ,,RBRVS,5.88 ,6.16 ,6.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29834,CPT,ARTHROSCOPY ELBOW SURGICAL W/REMOVAL LOOSE/FB,,,21 ,,RBRVS,6.42 ,6.68 ,6.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29835,CPT,ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY PARTIAL,,,21 ,,RBRVS,6.62 ,6.82 ,6.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29836,CPT,ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY COMPLETE,,,21 ,,RBRVS,7.72 ,7.75 ,7.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29837,CPT,ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT LIMITED,,,21 ,,RBRVS,7.01 ,7.04 ,7.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29838,CPT,ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT EXTENSIVE,,,21 ,,RBRVS,7.88 ,7.86 ,7.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29840,CPT,ARTHROSCOPY WRIST DIAG W/WO SYNOVIAL BIOPSY SPX,,,21 ,,RBRVS,5.68 ,6.28 ,6.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29843,CPT,ARTHROSCOPY WRIST INFECTION LAVAGE&DRAINAGE,,,21 ,,RBRVS,6.15 ,6.66 ,6.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29844,CPT,ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY PARTIAL,,,21 ,,RBRVS,6.51 ,6.77 ,6.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29845,CPT,ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY COMPLETE,,,21 ,,RBRVS,7.69 ,7.64 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29846,CPT,ARTHRS WRST EXC&/RPR TRIANG FIBROCART&/JT DBRDMT,,,21 ,,RBRVS,6.89 ,7.06 ,7.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29847,CPT,ARTHROSCOPY WRIST SURG INT FIXJ FX/INSTABILITY,,,21 ,,RBRVS,7.22 ,7.18 ,7.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29848,CPT,NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM,,,21 ,,RBRVS,6.39 ,7.16 ,7.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29850,CPT,ARTHROSCOPY AID TX SPINE&/FX KNEE W/O FIXJ,,,21 ,,RBRVS,8.27 ,7.55 ,7.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29851,CPT,ARTHROSCOPY AID TX SPINE&/FX KNEE W/FIXJ,,,21 ,,RBRVS,13.26 ,11.42 ,11.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29855,CPT,ARTHRS AID TIBIAL FRACTURE PROXIMAL UNICONDYLAR,,,21 ,,RBRVS,10.76 ,10.08 ,10.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29856,CPT,ARTHRS AID TIBIAL FX PROX UNICONDYLAR BICONDYLAR,,,21 ,,RBRVS,14.28 ,12.15 ,12.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29860,CPT,ARTHROSCOPY HIP DIAGNOSTIC +-SYNOVIAL BIOPSY SPX,,,21 ,,RBRVS,9.00 ,8.49 ,8.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29861,CPT,ARTHROSCOPY HIP SURGICAL W/REMOVAL LOOSE/FB,,,21 ,,RBRVS,10.10 ,9.14 ,9.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29862,CPT,ARTHRS HIP DEBRIDEMENT/SHAVING ARTICULAR CRTLG,,,21 ,,RBRVS,11.17 ,10.44 ,10.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29863,CPT,ARTHROSCOPY HIP SURGICAL W/SYNOVECTOMY,,,21 ,,RBRVS,11.17 ,10.36 ,10.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29866,CPT,ARTHROSCOPY KNEE OSTEOCHONDRAL AGRFT MOSAICPLAST,,,21 ,,RBRVS,14.67 ,13.07 ,13.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29867,CPT,ARTHROSCOPY KNEE OSTEOCHONDRAL ALLOGRAFT,,,21 ,,RBRVS,18.39 ,15.30 ,15.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29868,CPT,ARTHROSCOPY KNEE MENISCAL TRNSPLJ MED/LAT,,,21 ,,RBRVS,25.10 ,19.12 ,19.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29870,CPT,ARTHROSCOPY KNEE DIAGNOSTIC W/WO SYNOVIAL BX SPX,,,21 ,,RBRVS,5.19 ,5.73 ,10.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29871,CPT,ARTHROSCOPY KNEE INFECTION LAVAGE & DRAINAGE,,,21 ,,RBRVS,6.69 ,6.92 ,6.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29873,CPT,ARTHROSCOPY KNEE LATERAL RELEASE,,,21 ,,RBRVS,6.24 ,7.64 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29874,CPT,ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY,,,21 ,,RBRVS,7.19 ,7.10 ,7.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29875,CPT,ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX,,,21 ,,RBRVS,6.45 ,6.70 ,6.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29876,CPT,ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS,,,21 ,,RBRVS,8.87 ,8.50 ,8.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29877,CPT,ARTHRS KNEE DEBRIDEMENT/SHAVING ARTCLR CRTLG,,,21 ,,RBRVS,8.30 ,8.18 ,8.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29879,CPT,ARTHRS KNEE ABRASION ARTHRP/MLT DRLG/MICROFX,,,21 ,,RBRVS,8.99 ,8.56 ,8.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29880,CPT,ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING,,,21 ,,RBRVS,9.45 ,8.84 ,8.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29881,CPT,ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG,,,21 ,,RBRVS,8.71 ,8.41 ,8.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29882,CPT,ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL,,,21 ,,RBRVS,9.60 ,8.86 ,8.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29883,CPT,ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL,,,21 ,,RBRVS,11.77 ,10.50 ,10.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29884,CPT,ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX,,,21 ,,RBRVS,8.28 ,8.15 ,8.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29885,CPT,ARTHRS KNEE DRILL OSTEOCHONDRITIS DISSECANS GRFG,,,21 ,,RBRVS,10.21 ,9.66 ,9.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29886,CPT,ARTHRS KNEE DRILLING OSTEOCHOND DISSECANS LESION,,,21 ,,RBRVS,8.49 ,8.31 ,8.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29887,CPT,ARTHRS KNEE DRLG OSTEOCHOND DISSECANS INT FIXJ,,,21 ,,RBRVS,10.16 ,9.58 ,9.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29888,CPT,ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ,,,21 ,,RBRVS,14.30 ,11.90 ,11.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29889,CPT,ARTHRS AIDED PST CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ,,,21 ,,RBRVS,17.41 ,14.86 ,14.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29891,CPT,ARTHRS ANKLE EXC OSTCHNDRL DFCT W/DRLG DFCT,,,21 ,,RBRVS,9.67 ,8.88 ,8.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29892,CPT,ARTHRS AID RPR LES/TALAR DOME FX/TIBL PLAFOND FX,,,21 ,,RBRVS,10.27 ,7.18 ,7.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29893,CPT,ENDOSCOPIC PLANTAR FASCIOTOMY,,,21 ,,RBRVS,6.32 ,5.59 ,10.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29894,CPT,ARTHROSCOPY ANKLE W/REMOVAL LOOSE/FOREIGN BODY,,,21 ,,RBRVS,7.35 ,6.50 ,6.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29895,CPT,ARTHROSCOPY ANKLE SURGICAL SYNOVECTOMY PARTIAL,,,21 ,,RBRVS,7.13 ,6.15 ,6.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29897,CPT,ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT LIMITED,,,21 ,,RBRVS,7.32 ,6.54 ,6.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29898,CPT,ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE,,,21 ,,RBRVS,8.49 ,7.00 ,7.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29899,CPT,ARTHROSCOPY ANKLE SURGICAL W/ANKLE ARTHRODESIS,,,21 ,,RBRVS,15.41 ,12.42 ,12.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29900,CPT,ARTHROSCOPY METACARPOPHALANGEAL SYNOVIAL BIOPSY,,,21 ,,RBRVS,5.88 ,6.83 ,6.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29901,CPT,ARTHRS METACARPOPHALANGEAL JOINT DEBRIDEMENT,,,21 ,,RBRVS,6.59 ,7.17 ,7.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29902,CPT,ARTHRS MTCARPHLNGL JT W/RDCTJ UR COLTRL LIGM,,,21 ,,RBRVS,7.16 ,6.24 ,6.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29904,CPT,ARTHRS SUBTALAR JOINT REMOVE LOOSE/FOREIGN BODY,,,21 ,,RBRVS,8.65 ,8.05 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29905,CPT,ARTHROSCOPY SUBTALAR JOINT WITH SYNOVECTOMY,,,21 ,,RBRVS,9.18 ,8.89 ,8.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29906,CPT,ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT,,,21 ,,RBRVS,9.65 ,9.38 ,9.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29907,CPT,ARTHROSCOPY SUBTALAR JOINT SUBTALAR ARTHRODESIS,,,21 ,,RBRVS,12.18 ,10.79 ,10.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29914,CPT,ARTHROSCOPY HIP W/FEMOROPLASTY,,,21 ,,RBRVS,14.67 ,12.74 ,12.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29915,CPT,ARTHROSCOPY HIP W/ACETABULOPLASTY,,,21 ,,RBRVS,15.00 ,12.94 ,12.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29916,CPT,ARTHROSCOPY HIP W/LABRAL REPAIR,,,21 ,,RBRVS,15.00 ,12.94 ,12.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,29999,CPT,UNLISTED PROCEDURE ARTHROSCOPY,,,21 ,,TotalUnits,,,,17.68 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,30000,CPT,DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH,,,21 ,,RBRVS,1.48 ,1.80 ,5.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30020,CPT,DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM,,,21 ,,RBRVS,1.48 ,1.83 ,4.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30100,CPT,BIOPSY INTRANASAL,,,21 ,,RBRVS,0.94 ,0.99 ,3.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30110,CPT,EXCISION NASAL POLYP SIMPLE,,,21 ,,RBRVS,1.68 ,1.95 ,4.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30115,CPT,EXCISION NASAL POLYP EXTENSIVE,,,21 ,,RBRVS,4.44 ,7.62 ,7.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30117,CPT,EXCISION/DESTRUCTION INTRANASAL LESION INT APPR,,,21 ,,RBRVS,3.26 ,6.19 ,21.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30118,CPT,EXCISION/DESTRUCTION INTRANASAL LESION XTRNL,,,21 ,,RBRVS,9.92 ,11.38 ,11.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30120,CPT,EXCISION/SURGICAL PLANING SKIN NOSE RHINOPHYMA,,,21 ,,RBRVS,5.39 ,6.85 ,8.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30124,CPT,EXCISION DERMOID CYST NOSE SIMPLE SUBCUTANEOUS,,,21 ,,RBRVS,3.20 ,4.41 ,4.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30125,CPT,EXC DERMOID CYST NOSE COMPLEX UNDER BONE/CRTLG,,,21 ,,RBRVS,7.30 ,9.75 ,9.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30130,CPT,EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE,,,21 ,,RBRVS,3.47 ,7.17 ,7.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30140,CPT,SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL,,,21 ,,RBRVS,3.57 ,8.75 ,8.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30150,CPT,RHINECTOMY PARTIAL,,,21 ,,RBRVS,9.55 ,11.98 ,11.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30160,CPT,RHINECTOMY TOTAL,,,21 ,,RBRVS,9.99 ,11.75 ,11.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30200,CPT,INJECTION TURBINATE THERAPEUTIC,,,21 ,,RBRVS,0.78 ,0.89 ,2.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30210,CPT,DISPLACEMENT THERAPY PROETZ TYPE,,,21 ,,RBRVS,1.13 ,1.66 ,3.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30220,CPT,INSERTION NASAL SEPTAL PROSTHESIS BUTTON,,,21 ,,RBRVS,1.59 ,1.91 ,6.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30300,CPT,REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE,,,21 ,,RBRVS,1.09 ,2.40 ,5.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30310,CPT,REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES,,,21 ,,RBRVS,2.01 ,3.75 ,3.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30320,CPT,RMVL FOREIGN BODY INTRANASAL LATERAL RHINOTOMY,,,21 ,,RBRVS,4.64 ,8.03 ,8.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30400,CPT,RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TIP,,,21 ,,RBRVS,10.86 ,17.84 ,17.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30410,CPT,RHINP PRIM COMPLETE XTRNL PARTS,,,21 ,,RBRVS,14.00 ,19.59 ,19.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30420,CPT,RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR,,,21 ,,RBRVS,16.90 ,21.20 ,21.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30430,CPT,RHINOPLASTY SECONDARY MINOR REVISION,,,21 ,,RBRVS,8.24 ,16.81 ,16.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30435,CPT,RHINOPLASTY SECONDARY INTERMEDIATE REVISION,,,21 ,,RBRVS,12.73 ,21.08 ,21.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30450,CPT,RHINOPLASTY SECONDARY MAJOR REVISION,,,21 ,,RBRVS,19.66 ,23.00 ,23.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30460,CPT,RHINP DFRM W/COLUM LNGTH TIP ONLY,,,21 ,,RBRVS,10.32 ,10.24 ,10.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30462,CPT,RHINP DFRM COLUM LNGTH TIP SEPTUM OSTEOT,,,21 ,,RBRVS,20.28 ,21.76 ,21.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30465,CPT,REPAIR NASAL VESTIBULAR STENOSIS,,,21 ,,RBRVS,12.36 ,14.83 ,14.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30520,CPT,SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF,,,21 ,,RBRVS,7.01 ,10.21 ,10.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30540,CPT,REPAIR CHOANAL ATRESIA INTRANASAL,,,21 ,,RBRVS,7.92 ,11.05 ,11.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30545,CPT,REPAIR CHOANAL ATRESIA TRANSPALATINE,,,21 ,,RBRVS,11.62 ,13.07 ,13.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30560,CPT,LYSIS INTRANASAL SYNECHIA,,,21 ,,RBRVS,1.31 ,2.59 ,6.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30580,CPT,REPAIR FISTULA OROMAXILLARY,,,21 ,,RBRVS,6.88 ,6.90 ,10.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30600,CPT,REPAIR FISTULA ORONASAL,,,21 ,,RBRVS,6.16 ,5.84 ,9.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30620,CPT,SEPTAL/OTHER INTRANASAL DERMATOPLASTY,,,21 ,,RBRVS,6.16 ,11.17 ,11.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30630,CPT,REPAIR NASAL SEPTAL PERFORATIONS,,,21 ,,RBRVS,7.29 ,10.11 ,10.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30801,CPT,ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC,,,21 ,,RBRVS,1.14 ,2.67 ,5.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30802,CPT,ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL,,,21 ,,RBRVS,2.08 ,3.22 ,6.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30901,CPT,CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE,,,21 ,,RBRVS,1.10 ,0.43 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30903,CPT,CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX,,,21 ,,RBRVS,1.54 ,0.63 ,4.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30905,CPT,CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST,,,21 ,,RBRVS,1.97 ,0.78 ,4.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30906,CPT,CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ,,,21 ,,RBRVS,2.45 ,1.21 ,5.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30915,CPT,LIGATION ARTERIES ETHMOIDAL,,,21 ,,RBRVS,7.44 ,8.57 ,8.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30920,CPT,LIGATION ARTERIES INT MAXILLARY TRANSANTRAL,,,21 ,,RBRVS,11.14 ,11.93 ,11.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30930,CPT,FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC,,,21 ,,RBRVS,1.31 ,2.12 ,2.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,30999,CPT,UNLISTED PROCEDURE NOSE,,,21 ,,TotalUnits,,,,12.32 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,31000,CPT,LAVAGE CANNULATION MAXILLARY SINUS,,,21 ,,RBRVS,1.20 ,1.74 ,3.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31002,CPT,LAVAGE CANNULATION SPHENOID SINUS,,,21 ,,RBRVS,1.96 ,3.67 ,3.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31020,CPT,SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL,,,21 ,,RBRVS,3.07 ,6.92 ,10.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31030,CPT,SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS,,,21 ,,RBRVS,6.01 ,8.51 ,13.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31032,CPT,SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS,,,21 ,,RBRVS,6.69 ,9.20 ,9.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31040,CPT,PTERYGOMAXILLARY FOSSA SURGERY ANY APPROACH,,,21 ,,RBRVS,9.77 ,10.87 ,10.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31050,CPT,SINUSOTOMY SPHENOID W/WO BIOPSY,,,21 ,,RBRVS,5.37 ,8.29 ,8.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31051,CPT,SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP,,,21 ,,RBRVS,7.25 ,10.76 ,10.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31070,CPT,SINUSOTOMY FRONTAL EXTERNAL SIMPLE,,,21 ,,RBRVS,4.40 ,7.86 ,7.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31075,CPT,SINUSOTOMY FRONTAL TRANSORBITAL UNILATERAL,,,21 ,,RBRVS,9.51 ,12.31 ,12.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31080,CPT,SINUSOTOMY FRNT OBLITERATIVE W/O FLAP BROW INC,,,21 ,,RBRVS,12.74 ,15.63 ,15.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31081,CPT,SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC,,,21 ,,RBRVS,14.19 ,21.30 ,21.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31084,CPT,SINUSOT FRNT OBLIT W/OSTPL FLAP BROW INC,,,21 ,,RBRVS,14.95 ,17.51 ,17.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31085,CPT,SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC,,,21 ,,RBRVS,15.64 ,18.10 ,18.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31086,CPT,SINUSOT FRNT NONOBLIT W/OSTPL FLAP BROW INC,,,21 ,,RBRVS,14.36 ,16.79 ,16.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31087,CPT,SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC,,,21 ,,RBRVS,14.57 ,15.66 ,15.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31090,CPT,SINUSOT UNI 3/> PARANSL SINUSES,,,21 ,,RBRVS,11.17 ,17.20 ,17.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31200,CPT,ETHMOIDECTOMY INTRANASAL ANTERIOR,,,21 ,,RBRVS,5.14 ,10.15 ,10.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31201,CPT,ETHMOIDECTOMY INTRANASAL TOTAL,,,21 ,,RBRVS,8.60 ,11.81 ,11.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31205,CPT,ETHMOIDECTOMY EXTRANASAL TOTAL,,,21 ,,RBRVS,10.58 ,13.61 ,13.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31225,CPT,MAXILLECTOMY W/O ORBITAL EXENTERATION,,,21 ,,RBRVS,26.70 ,24.55 ,24.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31230,CPT,MAXILLECTOMY W/ORBITAL EXENTERATION,,,21 ,,RBRVS,30.82 ,26.37 ,26.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31231,CPT,NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX,,,21 ,,RBRVS,1.10 ,1.06 ,4.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31233,CPT,NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY,,,21 ,,RBRVS,2.18 ,1.64 ,5.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31235,CPT,NASAL/SINUS ENDOSCOPY DX SPHENOID SINUSOSCOPY,,,21 ,,RBRVS,2.64 ,1.87 ,5.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31237,CPT,NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX,,,21 ,,RBRVS,2.98 ,2.07 ,6.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31238,CPT,NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG,,,21 ,,RBRVS,3.26 ,2.23 ,6.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31239,CPT,NASAL/SINUS NDSC SURG W/DACRYOCSTORHINOSTOMY,,,21 ,,RBRVS,9.33 ,9.33 ,9.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31240,CPT,NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION,,,21 ,,RBRVS,2.61 ,1.88 ,1.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31254,CPT,NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY PARTIAL,,,21 ,,RBRVS,4.64 ,2.99 ,2.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31255,CPT,NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY TOTAL,,,21 ,,RBRVS,6.95 ,4.23 ,4.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31256,CPT,NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY,,,21 ,,RBRVS,3.29 ,2.25 ,2.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31267,CPT,NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS,,,21 ,,RBRVS,5.45 ,3.42 ,3.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31276,CPT,NASAL/SINUS NDSC W/FRONTAL SINUS EXPLORATION,,,21 ,,RBRVS,8.84 ,5.24 ,5.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31287,CPT,NASAL/SINUS ENDOSCOPY W/SPHENOIDECTOMY,,,21 ,,RBRVS,3.91 ,2.58 ,2.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31288,CPT,NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS,,,21 ,,RBRVS,4.57 ,2.95 ,2.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31290,CPT,NASAL/SINUS NDSC RPR CEREBRSP FLUID LEAK ETHMOID,,,21 ,,RBRVS,18.61 ,13.40 ,13.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31291,CPT,NASAL/SINUS NDSC RPR CEREBSP FLUID LEAK SPHENOID,,,21 ,,RBRVS,19.56 ,14.04 ,14.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31292,CPT,NSL/SINUS NDSC SURG W/MEDIAL/INF ORB WALL DCMPRN,,,21 ,,RBRVS,15.90 ,11.88 ,11.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31293,CPT,NASAL/SINUS NDSC MEDIAL ORB&INF ORB WALL DCMPRN,,,21 ,,RBRVS,17.47 ,12.79 ,12.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31294,CPT,NASAL/SINUS NDSC SURG W/OPTIC NERVE DCMPRN,,,21 ,,RBRVS,20.31 ,14.31 ,14.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31295,CPT,NASAL/SINUS NDSC SURG W/DILAT MAXILLARY SINUS,,,21 ,,RBRVS,2.70 ,2.11 ,56.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31296,CPT,NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS,,,21 ,,RBRVS,3.29 ,2.45 ,108.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31297,CPT,NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS,,,21 ,,RBRVS,2.64 ,2.07 ,107.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31299,CPT,UNLISTED PROCEDURE ACCESSORY SINUSES,,,21 ,,TotalUnits,,,,5.36 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,31300,CPT,LARYNGOTOMY W/RMVL TUMOR/LARYNGOCELE CORDECTOMY,,,21 ,,RBRVS,15.91 ,19.36 ,19.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31320,CPT,LARYNGOTOMY THYROTOMY LARYNGOFISSURE DX,,,21 ,,RBRVS,5.73 ,12.77 ,12.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31360,CPT,LARYNGECTOMY TOTAL W/O RADICAL NECK DISSECTION,,,21 ,,RBRVS,29.91 ,26.91 ,26.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31365,CPT,LARYNGECTOMY TOTAL W/RADICAL NECK DISSECTION,,,21 ,,RBRVS,38.81 ,31.53 ,31.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31367,CPT,LARYNGECTOMY STOT SUPRAGLOTTIC W/O RAD NECK DSJ,,,21 ,,RBRVS,30.57 ,30.31 ,30.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31368,CPT,LARYNGECTOMY STOT SUPRAGLOTTIC W/RAD NCK DSJ,,,21 ,,RBRVS,34.19 ,33.45 ,33.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31370,CPT,PARTIAL LARYNGECTOMY HEMILARYGECTOMY HORIZONTAL,,,21 ,,RBRVS,27.57 ,29.81 ,29.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31375,CPT,PARTIAL LARYNGECTOMY HEMILARYNG LATEROVERTICAL,,,21 ,,RBRVS,26.07 ,28.33 ,28.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31380,CPT,PARTIAL LARYNGECTOMY HEMILARYNG ANTEROVERTICAL,,,21 ,,RBRVS,25.57 ,28.03 ,28.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31382,CPT,PARTIAL LARYNG HEMILARYNG ANTERO-LATERO-VERTICAL,,,21 ,,RBRVS,28.57 ,30.17 ,30.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31390,CPT,PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/O RCNSTJ,,,21 ,,RBRVS,42.51 ,35.48 ,35.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31395,CPT,PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/RCNSTJ,,,21 ,,RBRVS,43.80 ,39.07 ,39.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31400,CPT,ARYTENOIDECTOMY/ARYTENOIDOPEXY XTRNL APPROACH,,,21 ,,RBRVS,11.60 ,16.47 ,16.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31420,CPT,EPIGLOTTIDECTOMY,,,21 ,,RBRVS,11.43 ,11.84 ,11.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31500,CPT,INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE,,,21 ,,RBRVS,2.33 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31502,CPT,TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT,,,21 ,,RBRVS,0.65 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31505,CPT,LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX,,,21 ,,RBRVS,0.61 ,0.77 ,1.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31510,CPT,LARYNGOSCOPY INDIRECT W/BIOPSY,,,21 ,,RBRVS,1.92 ,1.44 ,4.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31511,CPT,LARYNGOSCOPY INDIRECT W/REMOVAL FOREIGN BODY,,,21 ,,RBRVS,2.16 ,1.36 ,3.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31512,CPT,LARYNGOSCOPY INDIRECT W/REMOVAL LESION,,,21 ,,RBRVS,2.07 ,1.57 ,3.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31513,CPT,LARYNGOSCOPY INDIRECT W/VOCAL CORD INJECTION,,,21 ,,RBRVS,2.10 ,1.60 ,1.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31515,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY ASPIRATION,,,21 ,,RBRVS,1.80 ,1.24 ,4.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31520,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY DX NEWBORN,,,21 ,,RBRVS,2.56 ,1.79 ,1.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31525,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN,,,21 ,,RBRVS,2.63 ,1.82 ,4.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31526,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY W/MICRO/TELESCOPE,,,21 ,,RBRVS,2.57 ,1.86 ,1.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31527,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY INSERT OBTURATOR,,,21 ,,RBRVS,3.27 ,2.18 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31528,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY W/DILATION IN,,,21 ,,RBRVS,2.37 ,1.68 ,1.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31529,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY DILATION SUBSQ,,,21 ,,RBRVS,2.68 ,1.86 ,1.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31530,CPT,LARYNGOSCOPY W/FOREIGN BODY REMOVAL,,,21 ,,RBRVS,3.38 ,2.15 ,2.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31531,CPT,LARYNGOSCOPY FOREIGN BODY RMVL MICRO/TELESCOPE,,,21 ,,RBRVS,3.58 ,2.39 ,2.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31535,CPT,LARYNGOSCOPY DIRECT OPERATIVE W/BIOPSY,,,21 ,,RBRVS,3.16 ,2.16 ,2.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31536,CPT,LARYNGOSCOPY W/BIOPSY MICROSCOPE/TELESCOPE,,,21 ,,RBRVS,3.55 ,2.39 ,2.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31540,CPT,LARYNGOSCOPY EXC TUM&/STRIPPING CORDS/EPIGLOTTIS,,,21 ,,RBRVS,4.12 ,2.69 ,2.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31541,CPT,LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP,,,21 ,,RBRVS,4.52 ,2.91 ,2.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31545,CPT,LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD FLAP,,,21 ,,RBRVS,6.30 ,3.87 ,3.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31546,CPT,LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD GRAFT,,,21 ,,RBRVS,9.73 ,5.64 ,5.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31560,CPT,LARYNGOSCOPY DIRECT OPERATIVE W/ARYTENOIDECTOMY,,,21 ,,RBRVS,5.45 ,3.36 ,3.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31561,CPT,LARGSC ARYTENOIDECTOMY MICROSCOPE/TELESCOPE,,,21 ,,RBRVS,5.99 ,3.64 ,3.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31570,CPT,LARYNGOSCOPE INJECTION VOCAL CORD THERAPEUTIC,,,21 ,,RBRVS,3.86 ,2.52 ,5.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31571,CPT,LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE,,,21 ,,RBRVS,4.26 ,2.76 ,2.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31575,CPT,LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC,,,21 ,,RBRVS,1.10 ,1.05 ,2.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31576,CPT,LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY,,,21 ,,RBRVS,1.97 ,1.50 ,4.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31577,CPT,LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY,,,21 ,,RBRVS,2.47 ,1.67 ,4.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31578,CPT,LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION,,,21 ,,RBRVS,2.84 ,1.95 ,5.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31579,CPT,LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY,,,21 ,,RBRVS,2.26 ,1.68 ,3.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31580,CPT,LARYNGOPLASTY LARYN WEB 2 STG W/KEEL INSJ&RMVL,,,21 ,,RBRVS,14.66 ,19.36 ,19.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31582,CPT,LARYNGP LARYN STENOSIS GRF/CORE MOLD W/TRACHT,,,21 ,,RBRVS,23.22 ,30.12 ,30.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31584,CPT,LARYNGOPLASTY W/OPEN REDUCTION FRACTURE,,,21 ,,RBRVS,20.47 ,21.64 ,21.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31587,CPT,LARYNGOPLASTY CRICOID SPLIT,,,21 ,,RBRVS,15.27 ,12.38 ,12.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31588,CPT,LARYNGOPLASTY NOT OTHERWISE SPECIFIED,,,21 ,,RBRVS,14.99 ,16.86 ,16.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31590,CPT,LARYNGEAL REINNERVATION NEUROMUSCULAR PEDICLE,,,21 ,,RBRVS,7.85 ,17.46 ,17.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31595,CPT,SECTION RECURRENT LARYNGEAL NERVE THER UNI SPX,,,21 ,,RBRVS,8.84 ,12.65 ,12.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31599,CPT,UNLISTED PROCEDURE LARYNX,,,21 ,,TotalUnits,,,,3.21 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,31600,CPT,TRACHEOSTOMY PLANNED SEPARATE PROCEDURE,,,21 ,,RBRVS,7.17 ,3.43 ,3.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31601,CPT,TRACHEOSTOMY PLANNED UNDER 2 YEARS SPX,,,21 ,,RBRVS,4.44 ,2.82 ,2.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31603,CPT,TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL,,,21 ,,RBRVS,4.14 ,1.86 ,1.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31605,CPT,TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE,,,21 ,,RBRVS,3.57 ,1.26 ,1.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31610,CPT,TRACHEOSTOMY FENESTRATION W/SKIN FLAPS,,,21 ,,RBRVS,9.38 ,10.34 ,10.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31611,CPT,CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH,,,21 ,,RBRVS,6.00 ,9.12 ,9.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31612,CPT,TRACHEAL PNXR PRQ W/TRANSTRACHEAL ASPIR&/NJX,,,21 ,,RBRVS,0.91 ,0.40 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31613,CPT,TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION,,,21 ,,RBRVS,4.71 ,7.81 ,7.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31614,CPT,TRACHEOSTOMA REVJ CPLX W/FLAP ROTATION,,,21 ,,RBRVS,8.63 ,12.30 ,12.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31615,CPT,TRACHEOBRNCHSC THRU EST TRACHS INC,,,21 ,,RBRVS,2.09 ,1.47 ,3.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31620,CPT,ENDOBRNCL US BRONCHOSCOPIC DX/THER IVNTJ,,,21 ,,RBRVS,1.40 ,0.49 ,6.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31622,CPT,BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX,,,21 ,,RBRVS,2.78 ,1.22 ,6.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31623,CPT,BRNCHSC BRUSHING/PROTECTED BRUSHINGS,,,21 ,,RBRVS,2.88 ,1.20 ,6.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31624,CPT,BRNCHSC W/BRNCL ALVEOLAR LAVAGE,,,21 ,,RBRVS,2.88 ,1.21 ,6.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31625,CPT,BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES,,,21 ,,RBRVS,3.36 ,1.37 ,6.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31626,CPT,BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT,,,21 ,,RBRVS,4.16 ,1.72 ,8.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31627,CPT,BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION,,,21 ,,RBRVS,2.00 ,0.88 ,35.28 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,31628,CPT,BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE,,,21 ,,RBRVS,3.80 ,1.50 ,7.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31629,CPT,BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRONCH,,,21 ,,RBRVS,4.09 ,1.61 ,13.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31630,CPT,BRNCHSC W/TRACHEAL/BRONCHIAL DILAT/CLSD RDCTJ FX,,,21 ,,RBRVS,3.81 ,1.75 ,1.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31631,CPT,BRONCHOSCOPY W/PLACEMENT TRACHEAL STENT,,,21 ,,RBRVS,4.36 ,1.94 ,1.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31632,CPT,BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE,,,21 ,,RBRVS,1.03 ,0.35 ,1.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31633,CPT,BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA LOBE,,,21 ,,RBRVS,1.32 ,0.44 ,1.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31634,CPT,BRONCHOSCOPY BALLOON OCCLUSION,,,21 ,,RBRVS,4.00 ,1.75 ,48.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31635,CPT,BRONCHOSCOPY W/REMOVAL FOREIGN BODY,,,21 ,,RBRVS,3.67 ,1.55 ,6.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31636,CPT,BRNCHSC W/PLACEMENT BRNCL STENT 1ST BRONCHUS,,,21 ,,RBRVS,4.30 ,1.82 ,1.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31637,CPT,BRONCHOSCOPY EACH MAJOR BRONCHUS STENTED,,,21 ,,RBRVS,1.58 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31638,CPT,BRNCHSC REVJ TRACHEAL/BRNCL STENT INS PREV SESS,,,21 ,,RBRVS,4.88 ,2.11 ,2.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31640,CPT,BRONCHOSCOPY W/EXCISION TUMOR,,,21 ,,RBRVS,4.93 ,2.14 ,2.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31641,CPT,BRNCHSC W/DSTRJ TUM RELIEF STENOSIS OTH/THN EXC,,,21 ,,RBRVS,5.02 ,2.08 ,2.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31643,CPT,BRNCHSC W/PLMT CATH INTRCV RADIOELMNT APPL,,,21 ,,RBRVS,3.49 ,1.40 ,1.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31645,CPT,BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST,,,21 ,,RBRVS,3.16 ,1.30 ,5.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31646,CPT,BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ,,,21 ,,RBRVS,2.72 ,1.15 ,5.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31656,CPT,BRNCHSC W/NJX CONTRAST SGMTL BRONCHOG,,,21 ,,RBRVS,2.17 ,0.92 ,6.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31715,CPT,TRANSTRACHEAL INJECTION BRONCHOGRAPHY,,,21 ,,RBRVS,1.11 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31717,CPT,CATHETERIZATION W/BRONCHIAL BRUSH BIOPSY,,,21 ,,RBRVS,2.12 ,0.97 ,6.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31720,CPT,CATHETER ASPIRATION NASOTRACHEAL SPX,,,21 ,,RBRVS,1.06 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31725,CPT,CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,,,21 ,,RBRVS,1.96 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31730,CPT,TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER,,,21 ,,RBRVS,2.85 ,1.12 ,26.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31750,CPT,TRACHEOPLASTY CERVICAL,,,21 ,,RBRVS,15.39 ,22.58 ,22.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31755,CPT,TRACHEOPLASTY TRACHEOPHARYNGEAL FSTLJ EA STG,,,21 ,,RBRVS,17.54 ,31.06 ,31.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31760,CPT,TRACHEOPLASTY INTRATHORACIC,,,21 ,,RBRVS,23.48 ,12.74 ,12.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31766,CPT,CARINAL RECONSTRUCTION,,,21 ,,RBRVS,31.67 ,14.95 ,14.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31770,CPT,BRONCHOPLASTY GRAFT REPAIR,,,21 ,,RBRVS,23.54 ,11.40 ,11.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31775,CPT,BRONCHOPLASTY EXCISION STENOSIS & ANASTOMOSIS,,,21 ,,RBRVS,24.59 ,11.06 ,11.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31780,CPT,EXCISION TRACHEAL STENOSIS&ANASTOMOSIS CERVICAL,,,21 ,,RBRVS,19.84 ,12.69 ,12.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31781,CPT,EXC TRACHEAL STENOSIS&ANAST CERVICOTHORACIC,,,21 ,,RBRVS,24.85 ,12.12 ,12.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31785,CPT,EXCISION TRACHEAL TUMOR/CARCINOMA CERVICAL,,,21 ,,RBRVS,18.35 ,11.33 ,11.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31786,CPT,EXCISION TRACHEAL TUMOR/CARCINOMA THORACIC,,,21 ,,RBRVS,25.42 ,12.98 ,12.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31800,CPT,SUTURE TRACHEAL WOUND/INJURY CERVICAL,,,21 ,,RBRVS,8.18 ,11.44 ,11.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31805,CPT,SUTURE TRACHEAL WOUND/INJURY INTRATHORACIC,,,21 ,,RBRVS,13.42 ,8.15 ,8.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31820,CPT,SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR,,,21 ,,RBRVS,4.64 ,4.46 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31825,CPT,SURG CLSR TRACHEOSTOMY/FISTULA W/PLASTIC RPR,,,21 ,,RBRVS,7.07 ,6.30 ,9.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31830,CPT,REVISION TRACHEOSTOMY SCAR,,,21 ,,RBRVS,4.62 ,4.83 ,7.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,31899,CPT,UNLISTED PROCEDURE TRACHEA BRONCHI,,,21 ,,TotalUnits,,,,4.19 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,32035,CPT,THORACOSTOMY W/RIB RESECTION EMPYEMA,,,21 ,,RBRVS,11.29 ,7.78 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32036,CPT,THORACOSTOMY OPEN FLAP DRAINAGE EMPYEMA,,,21 ,,RBRVS,12.30 ,8.18 ,8.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32096,CPT,THORACTOMY W/DX BX LUNG INFILTRATE UNILATERAL,,,21 ,,RBRVS,13.75 ,7.28 ,7.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32097,CPT,THORACTOMY W/DX BX LUNG NODULE/MASS UNILATERAL,,,21 ,,RBRVS,13.75 ,7.28 ,7.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32098,CPT,THORACOTOMY W/BIOPSY OF PLEURA,,,21 ,,RBRVS,12.91 ,6.87 ,6.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32100,CPT,THORACOTOMY WITH EXPLORATION,,,21 ,,RBRVS,16.16 ,9.05 ,9.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32110,CPT,THORCOM CTRL TRAUMTC HEMRRG&/RPR LNG TEAR,,,21 ,,RBRVS,25.28 ,13.05 ,13.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32120,CPT,THORACOTOMY POSTOPERATIVE COMPLICATIONS,,,21 ,,RBRVS,14.39 ,8.67 ,8.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32124,CPT,THORACOTOMY OPN INTRAPLEURAL PNEUMONOLYSIS,,,21 ,,RBRVS,15.45 ,8.97 ,8.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32140,CPT,THORCOM W/REMOVAL OF CYST,,,21 ,,RBRVS,16.66 ,9.39 ,9.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32141,CPT,THORACOTOMY W/RESECTION BULLAE,,,21 ,,RBRVS,27.18 ,12.70 ,12.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32150,CPT,THORCOM W/RMVL INTRAPLEURAL FB/FIBRIN DEP,,,21 ,,RBRVS,16.82 ,9.51 ,9.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32151,CPT,THORCOM W/RMVL IPUL FB,,,21 ,,RBRVS,16.94 ,9.70 ,9.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32160,CPT,THORACOTOMY W/CARDIAC MASSAGE,,,21 ,,RBRVS,13.10 ,7.36 ,7.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32200,CPT,PNEUMONOSTOMY W/OPEN DRAINAGE ABSCESS/CYST,,,21 ,,RBRVS,18.68 ,11.23 ,11.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32201,CPT,PNEUMONOSTOMY PERCUTANEOUS DRAINAGE ABSCESS/CYST,,,21 ,,RBRVS,3.99 ,1.66 ,22.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32215,CPT,PLEURAL SCARIFICATION REPEAT PNEUMOTHORAX,,,21 ,,RBRVS,13.05 ,8.12 ,8.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32220,CPT,DECORTICATION PULMONARY TOTAL SEPARATE PROCEDURE,,,21 ,,RBRVS,26.65 ,15.34 ,15.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32225,CPT,DECORTICATION PULMONARY PARTIAL SEPARATE PROC,,,21 ,,RBRVS,16.75 ,9.51 ,9.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32310,CPT,PLEURECTOMY PARIETAL SEPARATE PROCEDURE,,,21 ,,RBRVS,15.28 ,8.87 ,8.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32320,CPT,DECORTICATION & PARIETAL PLEURECTOMY,,,21 ,,RBRVS,27.25 ,14.89 ,14.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32400,CPT,BIOPSY PLEURA PERCUTANEOUS NEEDLE,,,21 ,,RBRVS,1.76 ,0.69 ,2.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32405,CPT,BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE,,,21 ,,RBRVS,1.93 ,0.80 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32420,CPT,PNEUMOCENTESIS PUNCTURE LUNG ASPIRATION,,,21 ,,RBRVS,2.18 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32421,CPT,THORACENTESIS PUNCTURE PLEURAL CAVITY ASPIRATION,,,21 ,,RBRVS,1.54 ,0.60 ,2.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32422,CPT,THORACENTESIS WITH INSERTION TUBE WATER SEAL,,,21 ,,RBRVS,2.19 ,1.26 ,3.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32440,CPT,REMOVAL OF LUNG PNEUMONECTOMY,,,21 ,,RBRVS,27.28 ,14.21 ,14.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32442,CPT,REMOVAL LUNG PNEUMONECTOMY RESXN SGMNT TRACHEA,,,21 ,,RBRVS,56.47 ,22.70 ,22.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32445,CPT,REMOVAL LUNG PNEUMONECTOMY EXTRAPLEURAL,,,21 ,,RBRVS,63.84 ,27.27 ,27.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32480,CPT,RMVL LUNG OTHER THAN PNEUMONECTOMY 1 LOBE LOBECT,,,21 ,,RBRVS,25.82 ,13.39 ,13.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32482,CPT,RMVL LUNG OTHER THAN PNEUMONECT 2 LOBES BILOBEC,,,21 ,,RBRVS,27.44 ,14.53 ,14.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32484,CPT,RMVL LUNG OTHER THAN PNEUMONECT 1 SEGMENTECTOMY,,,21 ,,RBRVS,25.38 ,12.59 ,12.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32486,CPT,RMVL LUNG XCP TOT PNEUMONECTOMY SLEEVE LOBECTOMY,,,21 ,,RBRVS,42.88 ,18.57 ,18.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32488,CPT,RMVL LUNG OTHER/THAN PNUMEC COMPLETION PNUMEC,,,21 ,,RBRVS,42.99 ,19.52 ,19.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32491,CPT,RMVL LUNG OTH/THN PNUMEC RESXN-PLCTJ EMPHY LUNG,,,21 ,,RBRVS,25.24 ,13.99 ,13.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32501,CPT,RESCJ&BRONCHOPLASTY PFRMD TM LOBEC/SGMECTOMY,,,21 ,,RBRVS,4.68 ,1.76 ,1.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32503,CPT,RESCJ APICAL LUNG TUMOR W/O CHEST WALL RCNSTJ,,,21 ,,RBRVS,31.74 ,15.93 ,15.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32504,CPT,RESCJ APICAL LUNG TUMOR W/CHEST WALL RCNSTJ,,,21 ,,RBRVS,36.54 ,17.67 ,17.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32505,CPT,THORACOTOMY W/THERAPEUTIC WEDGE RESEXN INITIAL,,,21 ,,RBRVS,15.75 ,8.62 ,8.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32506,CPT,THORACOTOMY W/THERAP WEDGE RESEXN ADDL IPSILATRL,,,21 ,,RBRVS,3.00 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32507,CPT,THORACOTOMY W/DX WEDGE RESEXN &ANTOM LUNG RESEXN,,,21 ,,RBRVS,3.00 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32540,CPT,EXTRAPLEURAL ENUCLEATION EMPYEMA EMPYEMECTOMY,,,21 ,,RBRVS,30.35 ,14.66 ,14.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32550,CPT,INSERTION INDWELLING TUNNELED PLEURAL CATHETER,,,21 ,,RBRVS,4.17 ,1.93 ,18.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32551,CPT,TUBE THORACOSTOMY INCLUDES WATER SEAL,,,21 ,,RBRVS,3.29 ,1.34 ,1.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32552,CPT,RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF,,,21 ,,RBRVS,2.53 ,1.75 ,2.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32553,CPT,PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT,,,21 ,,RBRVS,3.80 ,1.53 ,13.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32560,CPT,INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS,,,21 ,,RBRVS,1.54 ,0.68 ,5.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32561,CPT,INSTLJ VIA CH TUBE/CATH AGENT FBRNLYSIS 1ST DAY,,,21 ,,RBRVS,1.39 ,0.51 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32562,CPT,INSTLJ CH TUBE/CATH AGENT FBRNLYSIS SBSQ DAY,,,21 ,,RBRVS,1.24 ,0.46 ,1.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32601,CPT,THORSC DX LUNGS/PERICAR/MED/PLEURAL SPACE W/O BX,,,21 ,,RBRVS,5.45 ,2.69 ,2.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32604,CPT,THORACOSCOPY DX PERICARDIAL SAC W/BIOPSY SPX,,,21 ,,RBRVS,8.77 ,3.95 ,3.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32606,CPT,THORACOSCOPY DX MEDIASTINAL SPACE W/BIOPSY SPX,,,21 ,,RBRVS,8.39 ,3.82 ,3.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32607,CPT,THORACOSCOPY W/DX BX OF LUNG INFILTRATE UNILATRL,,,21 ,,RBRVS,5.50 ,2.51 ,2.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32608,CPT,THORACOSCOPY W/DX BX OF LUNG NODULES UNILATRL,,,21 ,,RBRVS,6.84 ,2.97 ,2.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32609,CPT,THORACOSCOPY WITH BIOPSYIES OF PLEURA,,,21 ,,RBRVS,4.58 ,2.20 ,2.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32650,CPT,THORACOSCOPY W/PLEURODESIS,,,21 ,,RBRVS,10.83 ,6.94 ,6.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32651,CPT,THORACOSCOPY W/PARTIAL PULMONARY DECORTICATION,,,21 ,,RBRVS,18.78 ,9.85 ,9.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32652,CPT,THRSC TOT PULM DCRTCTJ INTRAPLEURAL PNEUMONOLSS,,,21 ,,RBRVS,29.13 ,14.17 ,14.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32653,CPT,THORACOSCOPY RMVL INTRAPLEURAL FB/FIBRIN DEPOSIT,,,21 ,,RBRVS,18.17 ,9.45 ,9.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32654,CPT,THORACOSCOPY CONTROL TRAUMATIC HEMORRHAGE,,,21 ,,RBRVS,20.52 ,10.27 ,10.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32655,CPT,THORACOSCOPY W/RESECTION BULLAE W/WO PLEURAL PX,,,21 ,,RBRVS,16.17 ,8.94 ,8.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32656,CPT,THORACOSCOPY W/PARIETAL PLEURECTOMY,,,21 ,,RBRVS,13.26 ,7.97 ,7.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32658,CPT,THORACOSCOPY W/RMVL CLOT/FB FROM PERICARDIAL SAC,,,21 ,,RBRVS,11.71 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32659,CPT,THRSC CRTJ PRCRD WINDOW/PRTL RESCJ PRCRD SAC,,,21 ,,RBRVS,11.94 ,7.58 ,7.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32661,CPT,THORACOSCOPY W/EXC PERICARDIAL CYST TUMOR/MASS,,,21 ,,RBRVS,13.33 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32662,CPT,THORACOSCOPY W/EXC MEDIASTINAL CYST TUMOR/MASS,,,21 ,,RBRVS,14.99 ,8.79 ,8.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32663,CPT,THORACOSCOPY W/LOBECTOMY SINGLE LOBE,,,21 ,,RBRVS,24.64 ,12.24 ,12.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32664,CPT,THORACOSCOPY W/THORACIC SYMPATHECTOMY,,,21 ,,RBRVS,14.28 ,8.12 ,8.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32665,CPT,THORACOSCOPY W/ESOPHAGOMYOTOMY HELLER TYPE,,,21 ,,RBRVS,21.53 ,10.70 ,10.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32666,CPT,THORACOSCOPY W/THERA WEDGE RESEXN INITIAL UNILAT,,,21 ,,RBRVS,14.50 ,8.28 ,8.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32667,CPT,THORACOSCOPY W/THERA WEDGE RESEXN ADDL IPSILATRL,,,21 ,,RBRVS,3.00 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32668,CPT,THORACOSCOPY W/DX WEDGE RESEXN ANATO LUNG RESEXN,,,21 ,,RBRVS,3.00 ,1.02 ,1.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32669,CPT,THORACOSCOPY W/SEGMENTECTOMY,,,21 ,,RBRVS,23.53 ,11.29 ,11.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32670,CPT,THORACOSCOPY W/BILOBECTOMY,,,21 ,,RBRVS,28.52 ,12.99 ,12.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32671,CPT,THORACOSCOPY W/PNEUMONECTOMY,,,21 ,,RBRVS,31.92 ,13.94 ,13.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32672,CPT,THORACOSCOPY W/RESEXN-PLICAJ EMPHYSEMA LUNG UNIL,,,21 ,,RBRVS,27.00 ,12.31 ,12.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32673,CPT,THORACOSCOPY RESEXN THYMUS UNI/BILATERAL,,,21 ,,RBRVS,21.13 ,10.35 ,10.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32674,CPT,THORCOSCPY W/MEDIASTINL &REGIONL LYMPHADENECTOMY,,,21 ,,RBRVS,4.12 ,1.39 ,1.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32800,CPT,REPAIR LUNG HERNIA THROUGH CHEST WALL,,,21 ,,RBRVS,15.71 ,9.01 ,9.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32810,CPT,CLSR CH WALL FLWG OPN FLAP DRG EMPYEMA,,,21 ,,RBRVS,14.95 ,8.85 ,8.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32815,CPT,OPEN CLOSURE MAJOR BRONCHIAL FISTULA,,,21 ,,RBRVS,50.03 ,22.34 ,22.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32820,CPT,MAJOR RECONSTRUCTION CHEST WALL POSTTRAUMATIC,,,21 ,,RBRVS,22.51 ,12.87 ,12.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32851,CPT,LUNG TRANSPLANT 1 W/O CARDIOPULMONARY BYPASS,,,21 ,,RBRVS,41.61 ,27.23 ,27.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32852,CPT,LUNG TRANSPLANT 1 W/CARDIOPULMONARY BYPASS,,,21 ,,RBRVS,45.48 ,30.87 ,30.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32853,CPT,LUNG TRANSPLANT 2 W/O CARDIOPULMONARY BYPASS,,,21 ,,RBRVS,50.78 ,30.73 ,30.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32854,CPT,LUNG TRANSPLANT 2 W/CARDIOPULMONARY BYPASS,,,21 ,,RBRVS,54.74 ,34.68 ,34.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32855,CPT,BKBENCH PREPJ CADAVER DONOR LUNG ALLOGRAFT UNI,,,21 ,,TotalUnits,,,,11.48 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,32900,CPT,RESECTION RIBS EXTRAPLEURAL ALL STAGES,,,21 ,,RBRVS,23.81 ,12.70 ,12.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32905,CPT,THORACOPLASTY SCHEDE TYPE/EXTRAPLEURAL,,,21 ,,RBRVS,23.29 ,11.89 ,11.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32906,CPT,THORACOP SCHEDE TYP/XTRPLEURAL CLSR BRNCPLR FSTL,,,21 ,,RBRVS,29.30 ,14.14 ,14.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32940,CPT,PNEUMONOLYSIS XTRPRIOSTEAL W/FILLING/PACKING PX,,,21 ,,RBRVS,21.34 ,11.09 ,11.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32960,CPT,PNEUMOTHORAX THER INTRAPLEURAL INJECTION AIR,,,21 ,,RBRVS,1.84 ,0.86 ,1.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32997,CPT,TOTAL LUNG LAVAGE UNILATERAL,,,21 ,,RBRVS,7.31 ,2.35 ,2.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32998,CPT,ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI,,,21 ,,RBRVS,5.68 ,2.54 ,78.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,32999,CPT,UNLISTED PROCEDURE LUNGS & PLEURA,,,21 ,,TotalUnits,,,,2.73 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,33010,CPT,PERICARDIOCENTESIS INITIAL,,,21 ,,RBRVS,2.24 ,1.03 ,1.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33011,CPT,PERICARDIOCENTESIS SUBSEQUENT,,,21 ,,RBRVS,2.24 ,0.99 ,0.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33015,CPT,TUBE PERICARDIOSTOMY,,,21 ,,RBRVS,8.52 ,5.62 ,5.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33020,CPT,PERICARDIOTOMY REMOVAL CLOT/FOREIGN BODY PRIMARY,,,21 ,,RBRVS,14.95 ,8.24 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33025,CPT,CRTJ PERICARDIAL WINDOW/PRTL RESECJ W/DRG/BX,,,21 ,,RBRVS,13.70 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33030,CPT,PRICARDIECTOMY STOT/COMPL W/O CARDPULM BYPASS,,,21 ,,RBRVS,22.39 ,11.66 ,11.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33031,CPT,PRICARDIECTOMY STOT/COMPL W/CARDPULM BYPASS,,,21 ,,RBRVS,25.38 ,12.35 ,12.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33050,CPT,RESECTION PERICARDIAL CYST/TUMOR,,,21 ,,RBRVS,16.97 ,9.60 ,9.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33120,CPT,EXC INTRACARDIAC TUMOR RESCJ CARDIOPULMONARY BYP,,,21 ,,RBRVS,27.45 ,13.63 ,13.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33130,CPT,RESECTION EXTERNAL CARDIAC TUMOR,,,21 ,,RBRVS,24.17 ,12.22 ,12.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33140,CPT,TRANSMYOCARDIAL LASER REVASCULAR THORACOTOMY SPX,,,21 ,,RBRVS,28.34 ,13.39 ,13.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33141,CPT,TRANSMYOCRD LASER REVSC PFRMD TM OTH OPN CAR PX,,,21 ,,RBRVS,2.54 ,1.09 ,1.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33202,CPT,INSERTION EPICARDIAL ELECTRODE OPEN,,,21 ,,RBRVS,13.20 ,7.40 ,7.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33203,CPT,INSERTION EPICARDIAL ELECTRODE ENDOSCOPIC,,,21 ,,RBRVS,13.97 ,7.68 ,7.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33206,CPT,INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL,,,21 ,,RBRVS,7.39 ,5.20 ,5.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33207,CPT,INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR,,,21 ,,RBRVS,8.05 ,5.32 ,5.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33208,CPT,INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT,,,21 ,,RBRVS,8.77 ,5.66 ,5.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33210,CPT,INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH,,,21 ,,RBRVS,3.30 ,1.60 ,1.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33211,CPT,INSJ/RPLCMT TEMP TRANSVNS 2CHMBR PACG ELTRDS SPX,,,21 ,,RBRVS,3.39 ,1.56 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33212,CPT,INS PM PLS GEN W/EXIST SINGLE LEAD,,,21 ,,RBRVS,5.52 ,3.80 ,3.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33213,CPT,INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS,,,21 ,,RBRVS,6.37 ,4.24 ,4.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33214,CPT,UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS,,,21 ,,RBRVS,7.84 ,5.45 ,5.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33215,CPT,RPSG PREV IMPLTED PM/CVDFB R ATR/R VENTR ELTRD,,,21 ,,RBRVS,4.92 ,3.51 ,3.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33216,CPT,INSJ 1 TRANSVNS ELTRD PERM PACEMAKER OR CVDFB,,,21 ,,RBRVS,5.87 ,4.59 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33217,CPT,INSJ 2 TRANSVNS ELTRD PERM PACEMAKER OR CVDFB,,,21 ,,RBRVS,5.84 ,4.55 ,4.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33218,CPT,RPR 1 ELTRD PRM PM/PACING CVDFB,,,21 ,,RBRVS,6.07 ,4.85 ,4.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33220,CPT,RPR 2 ELTRDS PRM PM/PACING CVDFB,,,21 ,,RBRVS,6.15 ,4.86 ,4.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33221,CPT,INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS,,,21 ,,RBRVS,5.80 ,3.43 ,3.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33222,CPT,REVISION/RELOCATION SKIN POCKET PACEMAKER,,,21 ,,RBRVS,5.10 ,4.53 ,4.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33223,CPT,REVJ SKN POCKET FOR CARDIOVERTER-DEFIBRILLATOR,,,21 ,,RBRVS,6.55 ,4.92 ,4.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33224,CPT,INSJ ELTRD CAR VEN SYS ATTCH PM/CVDFB PLS GEN,,,21 ,,RBRVS,9.04 ,4.81 ,4.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33225,CPT,INSJ ELTRD CAR VEN SYS TM INSJ CVDFB/PM PLS GEN,,,21 ,,RBRVS,8.33 ,4.13 ,4.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33226,CPT,RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD,,,21 ,,RBRVS,8.68 ,4.66 ,4.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33227,CPT,REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD,,,21 ,,RBRVS,5.50 ,3.31 ,3.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33228,CPT,REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS,,,21 ,,RBRVS,5.77 ,3.41 ,3.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33229,CPT,REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD,,,21 ,,RBRVS,6.04 ,3.51 ,3.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33230,CPT,INS PACNG CVDFB PLS GEN ONLY W/EXIST DUAL LEADS,,,21 ,,RBRVS,6.32 ,3.59 ,3.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33231,CPT,INS PACNG CVDFB PLS GEN ONLY W/EXIST MULTI LEADS,,,21 ,,RBRVS,6.59 ,3.69 ,3.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33233,CPT,REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY,,,21 ,,RBRVS,3.39 ,3.32 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33234,CPT,RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR,,,21 ,,RBRVS,7.91 ,5.52 ,5.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33235,CPT,RMVL TRANSVNS PM ELTRD DUAL LEAD SYS,,,21 ,,RBRVS,10.15 ,7.40 ,7.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33236,CPT,RMVL PRM EPICAR PM&ELTRDS THORCOM 1 LEAD SYS,,,21 ,,RBRVS,12.73 ,8.15 ,8.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33237,CPT,RMVL PRM EPICAR PM&ELTRDS THORCOM DUAL LEAD SYS,,,21 ,,RBRVS,13.84 ,8.69 ,8.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33238,CPT,RMVL PRM TRANSVENOUS ELECTRODE THORACOTOMY,,,21 ,,RBRVS,15.40 ,9.57 ,9.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33240,CPT,INSJ 1/2 CHMBR PACING CARDIOVERTERDEFIB PLS GEN,,,21 ,,RBRVS,7.64 ,5.15 ,5.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33241,CPT,REMVL PAC CVDFB PLS GEN ONLY,,,21 ,,RBRVS,3.29 ,3.01 ,3.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33243,CPT,RMVL 1/2CHMBR PACG CARDIOVTERDEFIB ELTRD THORCOM,,,21 ,,RBRVS,23.57 ,13.01 ,13.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33244,CPT,RMVL 1/2CHMBR PACG CVDFB ELTRD TRANSVNS XTRJ,,,21 ,,RBRVS,13.99 ,9.57 ,9.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33249,CPT,INS/REP PAC PERM CVDFB TRNSVEN LEADS 1/2 CHAMBER,,,21 ,,RBRVS,15.17 ,9.84 ,9.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33250,CPT,ABLATION ARRHYTHMOGENIC FOCI/PATHWAY W/O BYPASS,,,21 ,,RBRVS,25.90 ,12.91 ,12.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33251,CPT,ABLATION ARRHYTHMOGENIC FOCI/PATHWAY W/BYPASS,,,21 ,,RBRVS,28.92 ,14.27 ,14.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33254,CPT,ABLATION & RECONSTRUCTION ATRIA LIMITED,,,21 ,,RBRVS,23.71 ,12.45 ,12.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33255,CPT,ABLATION & RCNSTJ ATRIA X10SV W/O BYPASS,,,21 ,,RBRVS,29.04 ,14.77 ,14.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33256,CPT,ABLATION & RCNSTJ ATRIA X10SV W/BYPASS,,,21 ,,RBRVS,34.90 ,17.04 ,17.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33257,CPT,ATRIA ABLATE & RCNSTJ W OTHER PROCEDURE LIMITED,,,21 ,,RBRVS,9.63 ,6.00 ,6.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33258,CPT,ATRIA ABLTJ &RCNSTJ W OTHER PX EXTENSIVE W/O BYP,,,21 ,,RBRVS,11.00 ,6.55 ,6.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33259,CPT,ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTEN W/BYPASS,,,21 ,,RBRVS,14.14 ,8.49 ,8.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33261,CPT,OPRATIVE ABLTJ VENTR ARRHYTHMOGENIC FOC W/BYPASS,,,21 ,,RBRVS,28.92 ,13.85 ,13.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33262,CPT,REM PAC CVDFB PLSE GEN &REPL PLSE GEN SNGL LEAD,,,21 ,,RBRVS,6.06 ,3.50 ,3.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33263,CPT,REM PAC CVDFB PLSE GEN &REPL PLSE GEN DUAL LEAD,,,21 ,,RBRVS,6.33 ,3.60 ,3.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33264,CPT,REM PAC CVDFB PLS GEN &REPL PLSE GEN MULTI LEAD,,,21 ,,RBRVS,6.60 ,3.70 ,3.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33265,CPT,NDSC ABLATION & RCNSTJ ATRIA LIMITED W/O BYPASS,,,21 ,,RBRVS,23.71 ,12.22 ,12.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33266,CPT,NDSC ABLATION & RCNSTJ ATRIA EXTEN W/O BYPASS,,,21 ,,RBRVS,33.04 ,15.83 ,15.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33282,CPT,IMPLANTATION PT-ACTIVATED CARDIAC EVENT RECORDER,,,21 ,,RBRVS,4.80 ,4.24 ,4.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33284,CPT,RMVL IMPLANTABLE PT-ACTIVATED CAR EVENT RECORDER,,,21 ,,RBRVS,3.14 ,3.44 ,3.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33300,CPT,REPAIR CARDIAC WOUND W/O BYPASS,,,21 ,,RBRVS,44.97 ,18.53 ,18.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33305,CPT,REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS,,,21 ,,RBRVS,76.93 ,29.49 ,29.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33310,CPT,CARDIOT EXPL W/RMVL FB ATR/VENTR THRMB W/O BYP,,,21 ,,RBRVS,20.34 ,10.73 ,10.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33315,CPT,CARDIOT EXPL RMVL FB ATR/VENTR THRMB CARD BYP,,,21 ,,RBRVS,26.17 ,13.14 ,13.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33320,CPT,SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP,,,21 ,,RBRVS,18.54 ,9.78 ,9.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33321,CPT,SUTR RPR AORTA/GREAT VESSEL W/SHUNT BYPASS,,,21 ,,RBRVS,20.81 ,10.78 ,10.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33322,CPT,SUTURE REPAIR AORTA/GREAT VESSEL W/BYPASS,,,21 ,,RBRVS,24.42 ,12.57 ,12.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33330,CPT,INSJ GRAFT AORTA/GREAT VESSEL W/O SHUNT/BYPASS,,,21 ,,RBRVS,25.29 ,12.22 ,12.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33332,CPT,INSJ GRAFT AORTA/GREAT VESSEL W/SHUN,,,21 ,,RBRVS,24.56 ,12.33 ,12.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33335,CPT,INSJ GRAFT AORTA/GREAT VESSEL W/BYPASS,,,21 ,,RBRVS,33.91 ,15.96 ,15.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33400,CPT,VALVULOPLASTY AORTIC VALVE OPEN W/BYPASS,,,21 ,,RBRVS,41.50 ,19.12 ,19.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33401,CPT,VALVULOPLASTY AORTIC VALVE OPEN W/INFLOW OCCLUS,,,21 ,,RBRVS,24.63 ,14.14 ,14.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33403,CPT,VLVP AORTIC VALVE W/TRANSVENTR DILAT W/CARD BYP,,,21 ,,RBRVS,25.61 ,14.13 ,14.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33404,CPT,CONSTRUCTION APICAL-AORTIC CONDUIT,,,21 ,,RBRVS,31.37 ,15.48 ,15.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33405,CPT,RPLCMT PROST AORTIC VALVE XCP HOMOGRF/STENT,,,21 ,,RBRVS,41.32 ,19.65 ,19.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33406,CPT,RPLCMT AORTIC VALVE ALLOGRAFT VALVE FREEHAND,,,21 ,,RBRVS,52.68 ,23.36 ,23.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33410,CPT,RPLCMT AORTIC VALVE W/STENTLESS TISSUE VALVE,,,21 ,,RBRVS,46.41 ,21.04 ,21.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33411,CPT,RPLCMT AORTIC VALVE ANNULUS ENLGMENT NONC SINUS,,,21 ,,RBRVS,62.07 ,26.47 ,26.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33412,CPT,REPLACEMENT AORTIC VALVE KONNO PROCEDURE,,,21 ,,RBRVS,43.94 ,21.28 ,21.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33413,CPT,REPLACEMENT AORTIC&PULMON VALVES ROSS PROCEDURE,,,21 ,,RBRVS,59.87 ,25.98 ,25.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33414,CPT,RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC,,,21 ,,RBRVS,39.37 ,17.80 ,17.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33415,CPT,RESECTION/INCISION SUBVALVULAR TISSUE,,,21 ,,RBRVS,37.27 ,16.37 ,16.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33416,CPT,VENTRICULOMYOTOMY-MYECTOMY,,,21 ,,RBRVS,36.56 ,17.20 ,17.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33417,CPT,AORTOPLASTY SUPRAVALVULAR STENOSIS,,,21 ,,RBRVS,29.33 ,15.13 ,15.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33420,CPT,VALVOTOMY MITRAL VALVE CLOSED HEART,,,21 ,,RBRVS,25.79 ,13.64 ,13.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33422,CPT,VALVOTOMY MITRAL VALVE OPEN HEART W/BYPASS,,,21 ,,RBRVS,29.73 ,14.95 ,14.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33425,CPT,VALVULOPLASTY MITRAL VALVE W/CARDIAC BYPASS,,,21 ,,RBRVS,49.96 ,21.63 ,21.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33426,CPT,VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING,,,21 ,,RBRVS,43.28 ,20.20 ,20.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33427,CPT,VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING,,,21 ,,RBRVS,44.83 ,20.46 ,20.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33430,CPT,REPLACEMENT MITRAL VALVE W/CARDIOPULMONARY BYP,,,21 ,,RBRVS,50.93 ,23.34 ,23.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33460,CPT,VALVECTOMY TRICUSPID VALVE W/CARDIOPULMONARY BYP,,,21 ,,RBRVS,44.70 ,18.54 ,18.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33463,CPT,VALVULOPLASTY TRICUSPID VALVE W/O RING INSERTION,,,21 ,,RBRVS,57.08 ,23.79 ,23.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33464,CPT,VALVULOPLASTY TRICUSPID VALVE W/RING INSERTION,,,21 ,,RBRVS,44.62 ,19.86 ,19.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33465,CPT,REPLACEMENT TRICUSPID VALVE W/CARD BYPASS,,,21 ,,RBRVS,50.72 ,21.54 ,21.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33468,CPT,TRICUSPID VALVE RPSG&PLCTJ EBSTEIN ANOMALY,,,21 ,,RBRVS,32.94 ,16.38 ,16.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33470,CPT,VALVOTOMY PULMONARY VALVE CLSD HEART TRANSVENTR,,,21 ,,RBRVS,21.54 ,12.11 ,12.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33471,CPT,VALVOTOMY PULM VALVE CLSD HEART VIA PULM ARTERY,,,21 ,,RBRVS,22.96 ,12.75 ,12.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33472,CPT,VALVOTOMY PULM VALVE OPEN HRT W/INFLOW OCCLUSION,,,21 ,,RBRVS,23.06 ,11.84 ,11.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33474,CPT,VALVOTOMY PULMONARY VALVE OPEN HEART W/BYPASS,,,21 ,,RBRVS,39.40 ,16.70 ,16.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33475,CPT,REPLACEMENT PULMONARY VALVE,,,21 ,,RBRVS,42.40 ,19.12 ,19.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33476,CPT,R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY,,,21 ,,RBRVS,26.57 ,13.32 ,13.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33478,CPT,OUTFLOW TRACT AGMNTJ W/WO COMMISSUR/INFUND RESCJ,,,21 ,,RBRVS,27.54 ,14.02 ,14.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33496,CPT,RPR NON-STRUCT PROSTC VALVE DYSFUNCTION W/BYPASS,,,21 ,,RBRVS,29.84 ,14.62 ,14.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33500,CPT,RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/BYPASS,,,21 ,,RBRVS,27.94 ,13.73 ,13.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33501,CPT,RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/O BYPASS,,,21 ,,RBRVS,19.51 ,10.11 ,10.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33502,CPT,RPR ANOM CORONARY ART PULM ART ORIGIN LIGATION,,,21 ,,RBRVS,21.85 ,11.88 ,11.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33503,CPT,RPR ANOM CORONARY ARTERY PULM ART ORIGIN GRAFT,,,21 ,,RBRVS,22.51 ,13.49 ,13.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33504,CPT,RPR ANOM CORONARY ART PULM ART ORIGIN GRF W/BYP,,,21 ,,RBRVS,25.46 ,13.09 ,13.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33505,CPT,RPR ANOM CORON ART W/CONSTJ INTRAPULM ART TUNNEL,,,21 ,,RBRVS,38.40 ,15.65 ,15.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33506,CPT,RPR ANOM CORONARY ART FROM PULM ART TO AORTA,,,21 ,,RBRVS,37.85 ,20.01 ,20.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33507,CPT,RPR ANOM AORTIC ORIGIN CORONARY ART UNROOF/TLCJ,,,21 ,,RBRVS,31.40 ,14.26 ,14.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33508,CPT,NDSC SURG W/VIDEO-ASSISTED HARVEST VEIN CABG,,,21 ,,RBRVS,0.31 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33510,CPT,CORONARY ARTERY BYPASS 1 CORONARY VENOUS GRAFT,,,21 ,,RBRVS,34.98 ,16.97 ,16.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33511,CPT,CORONARY ARTERY BYPASS 2 CORONARY VENOUS GRAFTS,,,21 ,,RBRVS,38.45 ,18.43 ,18.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33512,CPT,CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS,,,21 ,,RBRVS,43.98 ,20.43 ,20.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33513,CPT,CORONARY ARTERY BYPASS 4 CORONARY VENOUS GRAFTS,,,21 ,,RBRVS,45.37 ,20.53 ,20.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33514,CPT,CORONARY ARTERY BYPASS 5 CORONARY VENOUS GRAFTS,,,21 ,,RBRVS,48.08 ,21.75 ,21.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33516,CPT,CORONARY ARTERY BYPASS 6/+ CORONARY VENOUS GRAFT,,,21 ,,RBRVS,49.76 ,22.62 ,22.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33517,CPT,CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 1 VEIN,,,21 ,,RBRVS,3.61 ,1.33 ,1.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33518,CPT,CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 2 VEINS,,,21 ,,RBRVS,7.93 ,2.88 ,2.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33519,CPT,CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 3 VEINS,,,21 ,,RBRVS,10.49 ,3.85 ,3.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33521,CPT,CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 4 VEINS,,,21 ,,RBRVS,12.59 ,4.67 ,4.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33522,CPT,CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 5 VEINS,,,21 ,,RBRVS,14.14 ,5.30 ,5.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33523,CPT,CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 6 VEINS,,,21 ,,RBRVS,16.08 ,6.01 ,6.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33530,CPT,ROPRTJ CAB/VALVE PX > 1 MO AFTER ORIGINAL OPERJ,,,21 ,,RBRVS,10.13 ,3.65 ,3.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33533,CPT,CABG W/ARTERIAL GRAFT SINGLE ARTERIAL GRAFT,,,21 ,,RBRVS,33.75 ,16.52 ,16.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33534,CPT,CABG W/ARTERIAL GRAFT TWO ARTERIAL GRAFTS,,,21 ,,RBRVS,39.88 ,19.06 ,19.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33535,CPT,CABG W/ARTERIAL GRAFT THREE ARTERIAL GRAFTS,,,21 ,,RBRVS,44.75 ,20.82 ,20.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33536,CPT,CABG W/ARTERIAL GRAFT FOUR/>ARTERIAL GRAFTS,,,21 ,,RBRVS,48.43 ,21.96 ,21.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33542,CPT,MYOCARDIAL RESECTION,,,21 ,,RBRVS,48.21 ,20.83 ,20.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33545,CPT,RPR POSTINFRCJ VENTRICULAR SEPTAL DEFECT,,,21 ,,RBRVS,57.06 ,24.08 ,24.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33548,CPT,SURG VENTRICULAR RSTRJ PX W/PROSTC PATCH PFRMD,,,21 ,,RBRVS,54.14 ,24.76 ,24.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33572,CPT,CORONARY ENDARTERCOMY OPEN ANY METHOD,,,21 ,,RBRVS,4.44 ,1.69 ,1.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33600,CPT,CLOSURE ATRIOVENTRICULAR VALVE SUTURE/PATCH,,,21 ,,RBRVS,30.31 ,14.96 ,14.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33602,CPT,CLOSURE SEMILUNAR VALVE AORTIC/PULM SUTURE/PATCH,,,21 ,,RBRVS,29.34 ,14.31 ,14.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33606,CPT,ANAST PULMONARY ART AORTA DAMUS-KAYE-STANSEL PX,,,21 ,,RBRVS,31.53 ,16.46 ,16.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33608,CPT,RPR CAR ANOMAL XCP PULM ATRESIA VENTR SEPTL DFCT,,,21 ,,RBRVS,31.88 ,15.98 ,15.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33610,CPT,RPR CAR ANOMAL SURG ENLGMENT VENTR SEPTL DFCT,,,21 ,,RBRVS,31.40 ,15.46 ,15.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33611,CPT,RPR 2 OUTLET R VNTRC W/INTRAVENTR TUNNEL RPR,,,21 ,,RBRVS,35.57 ,16.04 ,16.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33612,CPT,RPR 2 OUTLET R VNTRC RPR R VENTR O/F TRC OBSTRCJ,,,21 ,,RBRVS,36.57 ,16.18 ,16.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33615,CPT,RPR CAR ANOMAL CLSR SEPTL DFCT SMPL FONTAN PX,,,21 ,,RBRVS,35.89 ,17.26 ,17.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33617,CPT,RPR COMPLEX CARDIAC ANOMALY MODIFIED FONTAN PX,,,21 ,,RBRVS,39.09 ,17.73 ,17.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33619,CPT,RPR 1 VNTRC W/O/F OBSTRCJ&AORTIC ARCH HYPOPLASIA,,,21 ,,RBRVS,48.76 ,23.63 ,23.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33620,CPT,APPLICATION RIGHT & LEFT PULMONARY ARTERY BANDS,,,21 ,,RBRVS,30.00 ,13.40 ,13.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33621,CPT,TRANSTHORACIC CATHETER INSERTION FOR STENT PLMT,,,21 ,,RBRVS,16.18 ,7.39 ,7.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33622,CPT,RECONSTRUCTION COMPLEX CARDIAC ANOMALY,,,21 ,,RBRVS,64.00 ,28.20 ,28.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33641,CPT,RPR ATRIAL SEPTAL DFCT SECUNDUM W/BYP W/WO PATCH,,,21 ,,RBRVS,29.58 ,13.70 ,13.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33645,CPT,DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG,,,21 ,,RBRVS,28.10 ,13.73 ,13.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33647,CPT,RPR ATRIAL & VENTRIC SEPTAL DFCT DIR/PATCH CLSR,,,21 ,,RBRVS,29.53 ,15.31 ,15.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33660,CPT,RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR,,,21 ,,RBRVS,31.83 ,17.56 ,17.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33665,CPT,RPR INTRM/TRANSJ AV CANAL W/WO AV VALVE RPR,,,21 ,,RBRVS,34.85 ,15.75 ,15.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33670,CPT,RPR COMPL AV CANAL W/WO PROSTC VALVE,,,21 ,,RBRVS,36.63 ,15.45 ,15.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33675,CPT,CLOSURE MULTIPLE VENTRICULAR SEPTAL DEFECTS,,,21 ,,RBRVS,35.95 ,16.00 ,16.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33676,CPT,CLOSURE MULTIPLE VSD W/RESECTION,,,21 ,,RBRVS,36.95 ,18.12 ,18.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33677,CPT,CLOSURE MULTIPLE VSD W/REMOVAL ARTERY BAND,,,21 ,,RBRVS,38.45 ,15.78 ,15.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33681,CPT,CLSR 1 VENTRICULAR SEPTAL DEFECT W/WO PATCH,,,21 ,,RBRVS,32.34 ,16.46 ,16.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33684,CPT,CLSR V-SEPTL DFCT W/PULM VLVT/INFUND RESCJ,,,21 ,,RBRVS,34.37 ,15.57 ,15.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33688,CPT,CLSR V-SEPTAL DFCT W/RMVL P-ART BAND W/WO GUSSET,,,21 ,,RBRVS,34.75 ,14.56 ,14.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33690,CPT,BANDING PULMONARY ARTERY,,,21 ,,RBRVS,20.36 ,12.29 ,12.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33692,CPT,COMPL RPR TETRALOGY FALLOT W/O PULM ATRESIA,,,21 ,,RBRVS,31.54 ,15.90 ,15.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33694,CPT,COMPL RPR T-FALLOT W/O PULM ATRESIA TANULR PATCH,,,21 ,,RBRVS,35.57 ,16.18 ,16.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33697,CPT,COMPL RPR T-FALLOT W/PULM ATRESIA,,,21 ,,RBRVS,37.57 ,18.53 ,18.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33702,CPT,RPR SINUS VALSALVA FISTULA,,,21 ,,RBRVS,27.24 ,13.52 ,13.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33710,CPT,RPR SINUS VALSALVA FISTULA W/RPR V-SEPTAL DEFECT,,,21 ,,RBRVS,30.41 ,17.03 ,17.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33720,CPT,RPR SINUS VALSALVA ANEURYSM,,,21 ,,RBRVS,27.26 ,13.71 ,13.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33722,CPT,CLOSURE AORTICO-LEFT VENTRICULAR TUNNEL,,,21 ,,RBRVS,29.21 ,14.53 ,14.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33724,CPT,REPAIR ISOLATED PARTIAL PULM VENOUS RETURN,,,21 ,,RBRVS,27.63 ,13.49 ,13.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33726,CPT,REPAIR PULMONARY VENOUS STENOSIS,,,21 ,,RBRVS,37.12 ,18.54 ,18.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33730,CPT,COMPLETE RPR ANOMALOUS PULMONARY VENOUS RETURN,,,21 ,,RBRVS,36.14 ,15.93 ,15.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33732,CPT,RPR COR TRIATM/SUPVALVR RING RESCJ L ATRIAL MEMB,,,21 ,,RBRVS,28.96 ,14.68 ,14.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33735,CPT,ATRIAL SEPTECTOMY/SEPTOSTOMY CLOSED HEART,,,21 ,,RBRVS,22.20 ,11.92 ,11.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33736,CPT,ATRIAL SEPTECTOMY/SEPTOSTOMY OPEN HEART W/BYPASS,,,21 ,,RBRVS,24.32 ,12.86 ,12.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33737,CPT,ATRIAL SEPTECT/SEPTOST OPN HRT W/INFL OCCLUSION,,,21 ,,RBRVS,22.47 ,11.89 ,11.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33750,CPT,SHUNT SUBCLAVIAN PULMONARY ARTERY,,,21 ,,RBRVS,22.22 ,12.09 ,12.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33755,CPT,SHUNT ASCENDING AORTA PULMONARY ARTERY,,,21 ,,RBRVS,22.60 ,11.96 ,11.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33762,CPT,SHUNT DESCENDING AORTA PULMONARY ARTERY,,,21 ,,RBRVS,22.60 ,12.19 ,12.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33764,CPT,SHUNT CENTRAL W/PROSTHETIC GRAFT,,,21 ,,RBRVS,22.60 ,12.34 ,12.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33766,CPT,SHUNT SUPERIOR VENA CAVA PULMONARY ART 1 LUNG,,,21 ,,RBRVS,23.57 ,12.55 ,12.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33767,CPT,SHUNT SUPERIOR VENA CAVA PULM ARTERY BOTH LUNGS,,,21 ,,RBRVS,25.30 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33768,CPT,ANASTOMOSIS CAVOPULMARY 2ND SUPRIOR VENA CAVA,,,21 ,,RBRVS,8.00 ,3.40 ,3.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33770,CPT,RPR TRPOS GREAT VSLS W/O ENLGMNT V-SEPTL DFCT,,,21 ,,RBRVS,39.07 ,16.78 ,16.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33771,CPT,RPR TRPOS GREAT VSLS W/ENLGMNT V-SEPTL DFCT,,,21 ,,RBRVS,40.63 ,18.41 ,18.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33774,CPT,RPR TRPOS GREAT VSLS ATRIAL BAFFLE PX W/BYPASS,,,21 ,,RBRVS,31.73 ,15.89 ,15.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33775,CPT,RPR TRPOS GREAT VSLS ATR BAFFLE W/RMVL PULM BAND,,,21 ,,RBRVS,32.99 ,17.45 ,17.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33776,CPT,RPR TRPOS GRT VSL ATR BAFFLE W/CLSR V-SEPTL DFCT,,,21 ,,RBRVS,34.75 ,18.53 ,18.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33777,CPT,RPR TRPOS GRT VSL ATR BAFFLE W/BYP SBPULM OBSTRC,,,21 ,,RBRVS,34.17 ,14.80 ,14.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33778,CPT,RPR TRPOS GRT VESSEL AORTIC PULMONARY ART RCNSTJ,,,21 ,,RBRVS,42.75 ,21.14 ,21.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33779,CPT,RPR TGV AORTIC PULM ART RCNSTJ W/RMVL PULM BAND,,,21 ,,RBRVS,43.23 ,20.08 ,20.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33780,CPT,RPR TGV AORTIC P-ART RCNSTJ W/CLSR V-SEPTL DFCT,,,21 ,,RBRVS,43.90 ,21.07 ,21.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33781,CPT,RPR TGV AORTIC P-ART RCNSTJ RPR SBPULMC OBSTRCJ,,,21 ,,RBRVS,43.21 ,19.52 ,19.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33782,CPT,A-ROOT TLCJ VSD PULM STNS RPR W/O C OST RIMPLTJ,,,21 ,,RBRVS,60.08 ,24.03 ,24.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33783,CPT,A-ROOT TLCJ VSD PULM STNS RPR W/RIMPLTJ C OSTIA,,,21 ,,RBRVS,65.08 ,25.79 ,25.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33786,CPT,TOTAL REPAIR TRUNCUS ARTERIOSUS,,,21 ,,RBRVS,41.87 ,18.27 ,18.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33788,CPT,REIMPLANTATION ANOMALOUS PULMONARY ARTERY,,,21 ,,RBRVS,27.42 ,13.26 ,13.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33800,CPT,AORTIC SUSPENSION TRACHEAL DECOMPRESSION SPX,,,21 ,,RBRVS,17.28 ,8.59 ,8.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33802,CPT,DIVISION ABERRANT VESSEL VASCULAR RING,,,21 ,,RBRVS,18.37 ,11.01 ,11.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33803,CPT,DIVISION ABERRANT VESSEL W/REANASTOMOSIS,,,21 ,,RBRVS,20.31 ,9.78 ,9.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33813,CPT,OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS,,,21 ,,RBRVS,21.36 ,13.02 ,13.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33814,CPT,OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/BYPASS,,,21 ,,RBRVS,26.57 ,13.72 ,13.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33820,CPT,REPAIR PATENT DUCTUS ARTERIOSUS LIGATION,,,21 ,,RBRVS,16.69 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33822,CPT,RPR PATENT DUXUS ARTERIOSUS DIV UNDER 18 YR,,,21 ,,RBRVS,17.71 ,10.08 ,10.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33824,CPT,RPR PATENT DUXUS ARTERIOSUS DIV 18 YR&OLDER,,,21 ,,RBRVS,20.23 ,11.56 ,11.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33840,CPT,EXC COARCJ AORTA W/WO PDA W/DIRECT ANASTOMOSIS,,,21 ,,RBRVS,21.34 ,12.10 ,12.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33845,CPT,EXCISION COARCTATION AORTA W/WO PDA W/GRAFT,,,21 ,,RBRVS,22.93 ,13.02 ,13.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33851,CPT,EXC COARCJ AORTA W/L SUBCLAV ART/PROSTC GUSSET,,,21 ,,RBRVS,21.98 ,15.11 ,15.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33852,CPT,RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/O BYPASS,,,21 ,,RBRVS,24.41 ,12.41 ,12.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33853,CPT,RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/BYPASS,,,21 ,,RBRVS,32.51 ,16.71 ,16.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33860,CPT,ASCENDING AORTA GRF W/CARD BYP & VALVE SSP,,,21 ,,RBRVS,59.46 ,25.06 ,25.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33863,CPT,AS-AORT GRF W/CARD BYP & AORTIC ROOT RPLCMT,,,21 ,,RBRVS,58.79 ,24.53 ,24.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33864,CPT,ASCENDING AORTA GRF VALVE SPARE ROOT REMODEL,,,21 ,,RBRVS,60.08 ,25.30 ,25.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33870,CPT,TRANSVERSE ARCH GRAFT W/CARDIOPULMONARY BYPASS,,,21 ,,RBRVS,46.06 ,20.87 ,20.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33875,CPT,DESCENDING THORACIC AORTA GRAFT W/WO BYPASS,,,21 ,,RBRVS,35.78 ,17.08 ,17.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33877,CPT,RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS,,,21 ,,RBRVS,69.03 ,26.18 ,26.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33880,CPT,EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH,,,21 ,,RBRVS,34.58 ,14.32 ,14.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33881,CPT,EVASC RPR DTA EXP COVERAGE W/O ART ORIGIN,,,21 ,,RBRVS,29.58 ,12.53 ,12.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33883,CPT,PLMT PROX XTN PROSTH EVASC RPR DTA 1ST XTN,,,21 ,,RBRVS,21.09 ,9.52 ,9.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33884,CPT,PLMT PROX XTN PROSTH EVASC RPR DTA EA PROX XTN,,,21 ,,RBRVS,8.20 ,2.83 ,2.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33886,CPT,PLMT DSTL XTN PROSTH DLYD AFTER EVASC RPR DTA,,,21 ,,RBRVS,18.09 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33889,CPT,OPN SUBCLA CRTD ART TRPOS NCK INC ULAT,,,21 ,,RBRVS,15.92 ,5.49 ,5.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33891,CPT,BYP GRF W/DESCENDING THORACIC AORTA RPR NECK INC,,,21 ,,RBRVS,20.00 ,6.36 ,6.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33910,CPT,PULMONARY ARTERY EMBOLECTOMY W/CARD BYPASS,,,21 ,,RBRVS,29.71 ,14.59 ,14.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33915,CPT,PULMONARY ARTERY EMBOLECTOMY W/O CARD BYPASS,,,21 ,,RBRVS,24.95 ,11.40 ,11.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33916,CPT,PULMONARY ENDARTERCOMY W/WO EMBOLECTOMY W/BYPASS,,,21 ,,RBRVS,28.42 ,14.93 ,14.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33917,CPT,RPR PULMONARY ART STENOSIS RCNSTJ W/PATCH/GRAFT,,,21 ,,RBRVS,25.30 ,14.10 ,14.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33920,CPT,RPR PULMONARY ATRESIA W/CONSTJ/RPLCMT CONDUIT,,,21 ,,RBRVS,32.74 ,15.15 ,15.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33922,CPT,TRANSECTION PULMONARY ARTERY W/CARD BYPASS,,,21 ,,RBRVS,24.22 ,12.42 ,12.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33924,CPT,LIG&TKDN SYSIC-TO-PULM ART SHUNT W/CGEN HEART PX,,,21 ,,RBRVS,5.49 ,1.99 ,1.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33925,CPT,RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/O BYPASS,,,21 ,,RBRVS,31.30 ,14.60 ,14.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33926,CPT,RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/BYPASS,,,21 ,,RBRVS,44.73 ,21.91 ,21.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33935,CPT,HEART-LUNG TRNSPL W/RECIPIENT CARDIECTOMY-PNUMEC,,,21 ,,RBRVS,62.01 ,29.24 ,29.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33940,CPT,DONOR CARDIECTOMY,,,21 ,,TotalUnits,,,,39.56 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,33944,CPT,BKBENCH PREPJ CADAVER DONOR HEART ALLOGRAFT,,,21 ,,TotalUnits,,,,27.63 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,33945,CPT,HEART TRANSPLANT W/WO RECIPIENT CARDIECTOMY,,,21 ,,RBRVS,89.50 ,37.02 ,37.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33960,CPT,PROLONGED EXTRACORPOREAL CIRCULATION INIT DAY,,,21 ,,RBRVS,19.33 ,7.08 ,7.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33961,CPT,PROLONGED EXTRACORPOREAL CIRCULATION EA ADDL DAY,,,21 ,,RBRVS,10.91 ,4.13 ,4.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33967,CPT,INSERTION INTRA-AORTIC BALLOON ASSIST DEV PRQ,,,21 ,,RBRVS,4.84 ,2.34 ,2.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33968,CPT,REMOVAL INTRA-AORTIC BALLOON ASSIST DEVICE PRQ,,,21 ,,RBRVS,0.64 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33970,CPT,INSJ INTRA-AORT BALO ASSIST DEV VIA FEM ART OPEN,,,21 ,,RBRVS,6.74 ,2.84 ,2.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33971,CPT,RMVL I-AORT BALO ASST DEV W/RPR FEM ART W/WO GRF,,,21 ,,RBRVS,11.99 ,7.20 ,7.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33973,CPT,INSJ I-AORT BALO ASSIST DEV VIA ASCENDING AORTA,,,21 ,,RBRVS,9.75 ,4.17 ,4.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33974,CPT,RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA,,,21 ,,RBRVS,15.03 ,8.94 ,8.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33975,CPT,INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE,,,21 ,,RBRVS,20.97 ,7.99 ,7.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33976,CPT,INSJ VENTRIC ASSIST DEV XTRCORP BIVENTRICULAR,,,21 ,,RBRVS,22.97 ,8.96 ,8.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33977,CPT,REMOVAL VENTR ASSIST DEVICE XTRCORP 1 VENTRICLE,,,21 ,,RBRVS,20.28 ,11.93 ,11.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33978,CPT,REMOVAL VENTR ASSIST DEVICE XTRCORP BIVENTR,,,21 ,,RBRVS,22.72 ,12.75 ,12.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33979,CPT,INSJ VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC,,,21 ,,RBRVS,45.93 ,17.31 ,17.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33980,CPT,RMVL VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC,,,21 ,,RBRVS,65.20 ,30.57 ,30.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,33999,CPT,UNLISTED CARDIAC SURGERY,,,21 ,,TotalUnits,,,,12.46 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,34001,CPT,EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART,,,21 ,,RBRVS,17.88 ,8.60 ,8.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34051,CPT,EMBLC/THRMBC INNOMINATE SUBCLAVIAN ARTERY,,,21 ,,RBRVS,16.99 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34101,CPT,EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART,,,21 ,,RBRVS,10.93 ,5.69 ,5.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34111,CPT,EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC,,,21 ,,RBRVS,10.93 ,5.70 ,5.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34151,CPT,EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART,,,21 ,,RBRVS,26.52 ,11.58 ,11.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34201,CPT,EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART,,,21 ,,RBRVS,19.48 ,8.36 ,8.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34203,CPT,EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC,,,21 ,,RBRVS,17.86 ,8.51 ,8.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34401,CPT,THRMBC DIR/W/CATH VENA CAVA ILIAC VEIN ABDL INC,,,21 ,,RBRVS,26.52 ,13.90 ,13.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34421,CPT,THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN LEG INC,,,21 ,,RBRVS,13.37 ,6.86 ,6.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34451,CPT,THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN ABDL&LEG,,,21 ,,RBRVS,28.52 ,11.37 ,11.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34471,CPT,THRMBC DIR/W/CATH SUBCLAVIAN VEIN NECK INC,,,21 ,,RBRVS,21.11 ,10.41 ,10.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34490,CPT,THRMBC DIR/W/CATH AXILL&SUBCLAVIAN VEIN ARM INC,,,21 ,,RBRVS,10.91 ,5.95 ,5.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34501,CPT,VALVULOPLASTY FEMORAL VEIN,,,21 ,,RBRVS,16.85 ,8.24 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34502,CPT,RECONSTRUCTION VENA CAVA ANY METHOD,,,21 ,,RBRVS,28.07 ,13.45 ,13.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34510,CPT,VENOUS VALVE TRANSPOSITION ANY VEIN DONOR,,,21 ,,RBRVS,19.91 ,10.62 ,10.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34520,CPT,CROSS-OVER VEIN GRAFT VENOUS SYSTEM,,,21 ,,RBRVS,19.18 ,8.35 ,8.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34530,CPT,SAPHENOPOPLITEAL VEIN ANASTOMOSIS,,,21 ,,RBRVS,17.93 ,8.30 ,8.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34800,CPT,EVASC RPR AAA W/AORTO-AORTIC TUBE PROSTH,,,21 ,,RBRVS,21.54 ,9.52 ,9.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34802,CPT,EVASC RPR AAA W/MDLR BFRC PROSTH 1 LIMB,,,21 ,,RBRVS,23.79 ,10.50 ,10.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34803,CPT,EVASC RPR AAA W/MDLR BFRC PROSTH 2 LIMBS,,,21 ,,RBRVS,24.82 ,10.53 ,10.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34804,CPT,EVASC RPR AAA W/UNIBDY BFRC PROSTH,,,21 ,,RBRVS,23.79 ,10.49 ,10.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34805,CPT,EVASC RPR AAA AORTO-UNIILIAC/AORTO-UNIFEM PROSTH,,,21 ,,RBRVS,22.67 ,9.77 ,9.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34806,CPT,TCAT PLACEMENT PHYSIOLOGIC SENSOR ANEURYSMAL SAC,,,21 ,,RBRVS,2.06 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34808,CPT,EVASC PLACEMENT ILIAC ARTERY OCCLUSION DEVICE,,,21 ,,RBRVS,4.12 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34812,CPT,OPN FEM ART EXPOS DLVR EVASC PROSTH UNI,,,21 ,,RBRVS,6.74 ,2.33 ,2.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34813,CPT,PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR,,,21 ,,RBRVS,4.79 ,1.61 ,1.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34820,CPT,ILIAC ART EXPOS PROSTH/ILIAC OCCLS EVASC UNI,,,21 ,,RBRVS,9.74 ,3.39 ,3.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34825,CPT,PLMT XTN PROSTH EVASC RPR ARYSM/DSJ 1ST VSL,,,21 ,,RBRVS,12.80 ,6.54 ,6.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34826,CPT,PLMT XTN PROSTH EVASC RPR ARYSM/DSJ EA VSL,,,21 ,,RBRVS,4.12 ,1.48 ,1.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34830,CPT,OPN RPR ARYSM RPR ARTL TRAUMA TUBE PROSTH,,,21 ,,RBRVS,35.23 ,13.45 ,13.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34831,CPT,OPN RPR ARYSM RPR ARTL TRMA AORTOBIILIAC PROSTH,,,21 ,,RBRVS,37.98 ,13.86 ,13.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34832,CPT,OPN RPR ARYSM RPR ARTL TRMA AORTO-BIFEM PROSTH,,,21 ,,RBRVS,37.98 ,14.33 ,14.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34833,CPT,ILIAC ART EXPOS W/CRTJ CONDUIT UNI,,,21 ,,RBRVS,11.98 ,4.48 ,4.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34834,CPT,BRACH ART EXPOS DPLMNT AORTIC/ILIAC PROSTH UNI,,,21 ,,RBRVS,5.34 ,2.12 ,2.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,34900,CPT,EVASC RPR ILIAC ART ILIO-ILIAC PROSTHESIS,,,21 ,,RBRVS,16.85 ,7.93 ,7.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35001,CPT,DIR RPR ARYSM/&GRF INSJ CAROTID SUBCLAVIAN ART,,,21 ,,RBRVS,20.81 ,10.00 ,10.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35002,CPT,DIR RPR ARYSM&GRF INSJ RPTD ARYSM CRTD SUBCLA,,,21 ,,RBRVS,22.23 ,9.52 ,9.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35005,CPT,DIR RPR ANEURYSM & GRAFT INSJ VERTEBRAL ARTERY,,,21 ,,RBRVS,19.29 ,10.75 ,10.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35011,CPT,DIR RPR ANEURYSM & GRAFT INSJ AX-BRACHIAL ARTERY,,,21 ,,RBRVS,18.58 ,8.62 ,8.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35013,CPT,DIR RPR ARYSM&GRF INSJ RPTD AX-BRACHIAL ART,,,21 ,,RBRVS,23.23 ,10.81 ,10.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35021,CPT,DIR RPR ARYSM&GRF INSJ INNOMINATE SUBCLA ART,,,21 ,,RBRVS,22.17 ,9.93 ,9.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35022,CPT,DIR RPR ARYSM&GRF RPTD ARYSM INNOM SUBCLA ART,,,21 ,,RBRVS,25.70 ,11.99 ,11.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35045,CPT,DIR RPR ARYSM&GRF INSJ RADIAL/ULNAR ART,,,21 ,,RBRVS,18.01 ,8.80 ,8.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35081,CPT,DIR RPR ARYSM&GRF INSJ ABDL AORTA,,,21 ,,RBRVS,33.53 ,14.14 ,14.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35082,CPT,DIR RPR ARYSM&GRF INSJ RPTD ARYSM ABDL AORTA,,,21 ,,RBRVS,42.09 ,17.39 ,17.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35091,CPT,DIR RPR ARYSM&GRF INSJ ABDL AORTA VISC VSL,,,21 ,,RBRVS,35.35 ,13.62 ,13.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35092,CPT,DIR RPR ARYSM&GRF RPTD ARYSM ABDL AORTA VISC VSL,,,21 ,,RBRVS,50.97 ,19.62 ,19.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35102,CPT,DIR RPR ARYSM&GRF INSJ ABDL AORTA ILIAC VSL,,,21 ,,RBRVS,36.53 ,14.90 ,14.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35103,CPT,DIR RPR ARYSM&GRF RPTD ARYSM ABDL AORTA ILIAC,,,21 ,,RBRVS,43.62 ,17.32 ,17.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35111,CPT,DIR RPR ARYSM&GRF INSJ SPLENIC ART,,,21 ,,RBRVS,26.28 ,13.01 ,13.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35112,CPT,DIR RPR ARYSM&GRF INSJ RPTD ARYSM SPLENIC ART,,,21 ,,RBRVS,32.57 ,15.60 ,15.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35121,CPT,DIR RPR ARYSM&GRF INSJ HEPATC CELIAC RNL/MSN ART,,,21 ,,RBRVS,31.52 ,13.36 ,13.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35122,CPT,DIR RPR ARYSM&GRF RPTD ARYSM HEPATC CEL RNL/MSN,,,21 ,,RBRVS,37.89 ,14.50 ,14.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35131,CPT,DIR RPR ARYSM&GRF INSJ ILIAC ART,,,21 ,,RBRVS,26.40 ,11.63 ,11.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35132,CPT,DIR RPR ARYSM&GRF INSJ RPTD ARYSM ILIAC ART,,,21 ,,RBRVS,32.57 ,12.57 ,12.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35141,CPT,DIR RPR ARYSM&GRF INSJ COMMON FEM ART,,,21 ,,RBRVS,20.91 ,9.35 ,9.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35142,CPT,DIR RPR ARYSM&GRF INSJ RPTD ARYSM COMMON FEM ART,,,21 ,,RBRVS,25.16 ,11.09 ,11.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35151,CPT,DIR RPR ARYSM&GRF INSJ POP ART,,,21 ,,RBRVS,23.72 ,10.42 ,10.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35152,CPT,DIR RPR ARYSM&GRF INSJ RPTD ARYSM POP ART,,,21 ,,RBRVS,27.66 ,11.14 ,11.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35180,CPT,REPAIR CONGENITAL ARTERIOVENOUS FISTULA HEAD&NCK,,,21 ,,RBRVS,15.10 ,10.08 ,10.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35182,CPT,RPR CONGENITAL ARTERIOVENOUS FISTULA THORAX&ABD,,,21 ,,RBRVS,31.71 ,14.96 ,14.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35184,CPT,RPR CONGENITAL ARTERIOVENOUS FISTULA EXTREMITIES,,,21 ,,RBRVS,18.82 ,9.07 ,9.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35188,CPT,RPR/TRAUMATIC ARTERIOVENOUS FISTULA HEAD & NECK,,,21 ,,RBRVS,15.16 ,7.30 ,7.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35189,CPT,RPR/TRAUMATIC ARTERIOVENOUS FISTULA THORAX & ABD,,,21 ,,RBRVS,29.98 ,14.69 ,14.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35190,CPT,RPR/TRAUMATIC ARTERIOVENOUS FISTULA EXTREMITIES,,,21 ,,RBRVS,13.42 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35201,CPT,REPAIR BLOOD VESSEL DIRECT NECK,,,21 ,,RBRVS,16.93 ,8.66 ,8.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35206,CPT,REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY,,,21 ,,RBRVS,13.84 ,7.20 ,7.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35207,CPT,REPAIR BLOOD VESSEL DIRECT HAND FINGER,,,21 ,,RBRVS,10.94 ,9.19 ,9.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35211,CPT,RPR BLOOD VESSEL DIRECT INTRATHORACIC W/BYPASS,,,21 ,,RBRVS,24.58 ,12.26 ,12.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35216,CPT,RPR BLOOD VESSEL DIRECT INTRATHORACIC W/O BYPASS,,,21 ,,RBRVS,36.61 ,16.92 ,16.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35221,CPT,RPR BLOOD VESSEL DIRECT INTRA-ABDOMINAL,,,21 ,,RBRVS,26.62 ,11.72 ,11.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35226,CPT,RPR BLOOD VESSEL DIRECT LOWER EXTREMITY,,,21 ,,RBRVS,15.30 ,7.56 ,7.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35231,CPT,REPAIR BLOOD VESSEL W/VEIN GRAFT NECK,,,21 ,,RBRVS,21.16 ,11.15 ,11.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35236,CPT,REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY,,,21 ,,RBRVS,18.02 ,8.62 ,8.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35241,CPT,RPR BLOOD VESSEL VEIN GRAFT INTRATHORACIC W/BYP,,,21 ,,RBRVS,25.58 ,13.13 ,13.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35246,CPT,RPR BLOOD VESSEL VEIN GRF INTRATHORACIC W/O BYP,,,21 ,,RBRVS,28.23 ,12.01 ,12.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35251,CPT,REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL,,,21 ,,RBRVS,31.91 ,13.41 ,13.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35256,CPT,REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY,,,21 ,,RBRVS,19.06 ,8.68 ,8.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35261,CPT,REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK,,,21 ,,RBRVS,18.96 ,9.40 ,9.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35266,CPT,RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY,,,21 ,,RBRVS,15.83 ,7.67 ,7.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35271,CPT,RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/BYP,,,21 ,,RBRVS,24.58 ,12.24 ,12.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35276,CPT,RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/O BYP,,,21 ,,RBRVS,25.83 ,12.75 ,12.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35281,CPT,RPR BLVSL W/GRFT OTHER/THAN VEIN INTRA-ABDOMINAL,,,21 ,,RBRVS,30.06 ,13.29 ,13.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35286,CPT,RPR BLVSL W/GRF OTHER/THAN VEIN LOWER EXTREMITY,,,21 ,,RBRVS,17.19 ,8.47 ,8.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35301,CPT,TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC,,,21 ,,RBRVS,19.61 ,9.05 ,9.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35302,CPT,TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY,,,21 ,,RBRVS,21.35 ,9.15 ,9.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35303,CPT,TEAEC W/GRAFT POPLITEAL ARTERY,,,21 ,,RBRVS,23.60 ,10.05 ,10.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35304,CPT,TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY,,,21 ,,RBRVS,24.60 ,10.22 ,10.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35305,CPT,TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL,,,21 ,,RBRVS,23.60 ,9.96 ,9.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35306,CPT,TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART,,,21 ,,RBRVS,9.25 ,3.50 ,3.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35311,CPT,TEAEC W/WO PATCH GRF SUBCLAV INNOM THORACIC INC,,,21 ,,RBRVS,28.60 ,12.45 ,12.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35321,CPT,TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL,,,21 ,,RBRVS,16.59 ,7.84 ,7.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35331,CPT,TEAEC W/WO PATCH GRAFT ABDOMINAL AORTA,,,21 ,,RBRVS,27.72 ,12.27 ,12.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35341,CPT,TEAEC W/WO PATCH GRAFT MESENTERIC CELIAC/RENAL,,,21 ,,RBRVS,26.21 ,11.14 ,11.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35351,CPT,TEAEC W/WO PATCH GRAFT ILIAC,,,21 ,,RBRVS,24.61 ,10.45 ,10.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35355,CPT,TEAEC W/WO PATCH GRAFT ILIOFEMORAL,,,21 ,,RBRVS,19.86 ,8.60 ,8.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35361,CPT,TEAEC W/WO PATCH GRAFT COMBINED AORTOILIAC,,,21 ,,RBRVS,30.24 ,11.89 ,11.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35363,CPT,TEAEC W/WO PATCH GRAFT COMBINED AORTOILIOFEMORAL,,,21 ,,RBRVS,32.35 ,14.57 ,14.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35371,CPT,TEAEC W/WO PATCH GRAFT COMMON FEMORAL,,,21 ,,RBRVS,15.31 ,7.24 ,7.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35372,CPT,TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL,,,21 ,,RBRVS,18.58 ,8.32 ,8.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35390,CPT,ROPRTJ CRTD TEAEC > 1 MO AFTER ORIGINAL OPRATION,,,21 ,,RBRVS,3.19 ,1.12 ,1.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35400,CPT,ANGIOSCOPY NON-CORONARY VESSEL/GRAFTS THER IVNTJ,,,21 ,,RBRVS,3.00 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35450,CPT,TRLUML BALOON ANGIOPL OPN RENAL/OTH VISCERAL ART,,,21 ,,RBRVS,10.05 ,3.91 ,3.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35452,CPT,TRLUML BALLOON ANGIOPLASTY OPEN AORTIC,,,21 ,,RBRVS,6.90 ,2.80 ,2.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35458,CPT,TRLUML BALO ANGIOP OPN BRCH/CPHLC TRNK/BRNCH EA,,,21 ,,RBRVS,9.48 ,3.78 ,3.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35460,CPT,TRLUML BALLOON ANGIOPLASTY OPEN VENOUS,,,21 ,,RBRVS,6.03 ,2.47 ,2.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35471,CPT,TRLUML BALLOON ANGIOP PRQ RENAL/VISCERAL ART,,,21 ,,RBRVS,10.05 ,4.78 ,74.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35472,CPT,TRLUML BALLOON ANGIOPLASTY PERCUTANEOUS AORTIC,,,21 ,,RBRVS,6.90 ,3.09 ,54.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35475,CPT,TRLUML BALO ANGIOP PRQ BRCH/CPHLC TRNK/BRNCH EA,,,21 ,,RBRVS,9.48 ,4.08 ,57.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35476,CPT,TRLUML BALLOON ANGIOPLASTY PERCUTANEOUS VENOUS,,,21 ,,RBRVS,6.03 ,2.70 ,44.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35500,CPT,HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX,,,21 ,,RBRVS,6.44 ,2.21 ,2.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35501,CPT,BYPASS W/VEIN COMMON-IPSILATERAL CAROTID,,,21 ,,RBRVS,29.09 ,13.89 ,13.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35506,CPT,BYPASS W/VEIN CAROTID-SUBCLV/SUBCLAVIAN CAROTID,,,21 ,,RBRVS,25.33 ,11.00 ,11.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35508,CPT,BYPASS W/VEIN CAROTID-VERTEBRAL,,,21 ,,RBRVS,26.09 ,12.11 ,12.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35509,CPT,BYPASS W/VEIN CAROTID-CONTRALATERAL CAROTID,,,21 ,,RBRVS,28.09 ,12.42 ,12.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35510,CPT,BYPASS W/VEIN CAROTID-BRACHIAL,,,21 ,,RBRVS,24.39 ,9.82 ,9.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35511,CPT,BYPASS W/VEIN SUBCLAVIAN-SUBCLAVIAN,,,21 ,,RBRVS,22.20 ,11.62 ,11.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35512,CPT,BYPASS W/VEIN SUBCLAVIAN-BRACHIAL,,,21 ,,RBRVS,23.89 ,9.53 ,9.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35515,CPT,BYPASS W/VEIN SUBCLAVIAN-VERTEBRAL,,,21 ,,RBRVS,26.09 ,10.13 ,10.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35516,CPT,BYPASS W/VEIN SUBCLAVIAN-AXILLARY,,,21 ,,RBRVS,24.21 ,9.03 ,9.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35518,CPT,BYPASS W/VEIN AXILLARY-AXILLARY,,,21 ,,RBRVS,22.65 ,9.29 ,9.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35521,CPT,BYPASS W/VEIN AXILLARY-FEMORAL,,,21 ,,RBRVS,24.13 ,12.15 ,12.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35522,CPT,BYPASS W/VEIN AXILLARY-BRACHIAL,,,21 ,,RBRVS,23.15 ,10.20 ,10.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35523,CPT,BYPASS W/VEIN BRACHIAL-ULNAR/-RADIAL,,,21 ,,RBRVS,24.13 ,11.14 ,11.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35525,CPT,BYPASS W/VEIN BRACHIAL-BRACHIAL,,,21 ,,RBRVS,21.69 ,9.67 ,9.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35526,CPT,BYPASS W/VEIN AORTOSUBCLAV/CAROTID/INNOMINATE,,,21 ,,RBRVS,31.55 ,12.76 ,12.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35531,CPT,BYPASS W/VEIN AORTOCELIAC/AORTOMESENTERIC,,,21 ,,RBRVS,39.11 ,16.07 ,16.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35533,CPT,BYPASS W/VEIN AXILLARY-FEMORAL-FEMORAL,,,21 ,,RBRVS,29.92 ,14.60 ,14.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35535,CPT,BYPASS W/VEIN HEPATORENAL,,,21 ,,RBRVS,38.13 ,14.94 ,14.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35536,CPT,BYPASS W/VEIN SPLENORENAL,,,21 ,,RBRVS,33.73 ,12.80 ,12.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35537,CPT,BYPASS W/VEIN AORTOILIAC,,,21 ,,RBRVS,41.88 ,19.21 ,19.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35538,CPT,BYPASS W/VEIN AORTOBI-ILIAC,,,21 ,,RBRVS,47.03 ,21.43 ,21.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35539,CPT,BYPASS W/VEIN AORTOFEMORAL,,,21 ,,RBRVS,44.11 ,15.96 ,15.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35540,CPT,BYPASS W/VEIN AORTOBIFEMORAL,,,21 ,,RBRVS,49.33 ,19.93 ,19.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35556,CPT,BYPASS W/VEIN FEMORAL-POPLITEAL,,,21 ,,RBRVS,26.75 ,11.46 ,11.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35558,CPT,BYPASS W/VEIN FEMORAL-FEMORAL,,,21 ,,RBRVS,23.13 ,10.66 ,10.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35560,CPT,BYPASS W/VEIN AORTORENAL,,,21 ,,RBRVS,34.03 ,13.22 ,13.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35563,CPT,BYPASS W/VEIN ILIOILIAC,,,21 ,,RBRVS,26.12 ,10.41 ,10.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35565,CPT,BYPASS W/VEIN ILIOFEMORAL,,,21 ,,RBRVS,25.13 ,11.06 ,11.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35566,CPT,BYP FEM-ANT TIBL PST TIBL PRONEAL ART/OTH DSTL,,,21 ,,RBRVS,32.35 ,13.30 ,13.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35570,CPT,BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL,,,21 ,,RBRVS,29.15 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35571,CPT,BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL,,,21 ,,RBRVS,25.52 ,11.05 ,11.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35572,CPT,HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX,,,21 ,,RBRVS,6.81 ,2.54 ,2.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35583,CPT,IN-SITU VEIN BYPASS FEMORAL-POPLITEAL,,,21 ,,RBRVS,27.75 ,11.76 ,11.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35585,CPT,IN-SITU FEM-ANT TIBL PST TIBL/PRONEAL ART,,,21 ,,RBRVS,32.35 ,13.59 ,13.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35587,CPT,IN-SITU VEIN BYP POP-TIBL PRONEAL,,,21 ,,RBRVS,26.21 ,11.67 ,11.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35600,CPT,HARVEST UPPER EXTREMITY ARTERY 1 SEGMENT CABG,,,21 ,,RBRVS,4.94 ,1.92 ,1.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35601,CPT,BYP OTH/THN VEIN COMMON-IPSILATERAL CAROTID,,,21 ,,RBRVS,27.09 ,12.78 ,12.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35606,CPT,BYP OTH/THN VEIN CAROTID-SUBCLAVIAN,,,21 ,,RBRVS,22.46 ,9.70 ,9.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35612,CPT,BYP OTH/THN VEIN SUBCLAVIAN-SUBCLAVIAN,,,21 ,,RBRVS,16.82 ,7.79 ,7.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35616,CPT,BYP OTH/THN VEIN SUBCLAVIAN-AXILLARY,,,21 ,,RBRVS,21.82 ,10.67 ,10.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35621,CPT,BYP OTH/THN VEIN AXILLARY-FEMORAL,,,21 ,,RBRVS,21.03 ,9.13 ,9.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35623,CPT,BYP OTH/THN VEIN AXILLARY-POPLITEAL/-TIBIAL,,,21 ,,RBRVS,25.92 ,12.88 ,12.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35626,CPT,BYPASS NOT VEIN AORTOSUBCLA/CAROTID/INNOMINATE,,,21 ,,RBRVS,29.14 ,13.20 ,13.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35631,CPT,BYP OTH/THN VEIN AORTOCELIAC AORTOMSN AORTORNL,,,21 ,,RBRVS,36.03 ,14.29 ,14.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35632,CPT,BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC,,,21 ,,RBRVS,36.13 ,14.27 ,14.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35633,CPT,BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC,,,21 ,,RBRVS,39.11 ,15.99 ,15.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35634,CPT,BYPASS GRAFT W/OTHER THAN VEIN ILIORENAL,,,21 ,,RBRVS,35.33 ,14.54 ,14.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35636,CPT,BYP OTH/THN VEIN SPLENORENAL,,,21 ,,RBRVS,31.75 ,15.22 ,15.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35637,CPT,BYP OTH/THN VEIN AORTOILIAC,,,21 ,,RBRVS,33.05 ,13.73 ,13.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35638,CPT,BYP OTH/THN VEIN AORTOBI-ILIAC,,,21 ,,RBRVS,33.60 ,14.21 ,14.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35642,CPT,BYP OTH/THN VEIN CAROTID-VERTEBRAL,,,21 ,,RBRVS,18.94 ,10.88 ,10.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35645,CPT,BYP OTH/THN VEIN SUBCLAVIAN-VERTEBRAL,,,21 ,,RBRVS,18.43 ,9.68 ,9.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35646,CPT,BYP OTH/THN VEIN AORTOBIFEMORAL,,,21 ,,RBRVS,32.98 ,13.98 ,13.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35647,CPT,BYP OTH/THN VEIN AORTOFEMORAL,,,21 ,,RBRVS,29.73 ,12.91 ,12.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35650,CPT,BYP OTH/THN VEIN AXILLARY-AXILLARY,,,21 ,,RBRVS,20.16 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35654,CPT,BYP OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL,,,21 ,,RBRVS,26.28 ,11.33 ,11.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35656,CPT,BYP OTH/THN VEIN FEMORAL-POPLITEAL,,,21 ,,RBRVS,20.47 ,9.23 ,9.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35661,CPT,BYP OTH/THN VEIN FEMORAL-FEMORAL,,,21 ,,RBRVS,20.35 ,9.51 ,9.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35663,CPT,BYP OTH/THN VEIN ILIOILIAC,,,21 ,,RBRVS,23.93 ,10.44 ,10.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35665,CPT,BYP OTH/THN VEIN ILIOFEMORAL,,,21 ,,RBRVS,22.35 ,9.91 ,9.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35666,CPT,BYP OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRONEAL,,,21 ,,RBRVS,23.66 ,11.32 ,11.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35671,CPT,BYP OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART,,,21 ,,RBRVS,20.77 ,10.06 ,10.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35681,CPT,BYPASS COMPOSITE GRAFT PROSTHETIC & VEIN,,,21 ,,RBRVS,1.60 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35682,CPT,BYP AUTOG COMPOSIT 2 SEG VEINS FROM 2 LOCATIONS,,,21 ,,RBRVS,7.19 ,2.41 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35683,CPT,BYP AUTOG COMPOSIT 3/> SEG FROM 2/> LOCATIONS,,,21 ,,RBRVS,8.49 ,2.70 ,2.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35685,CPT,PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT,,,21 ,,RBRVS,4.04 ,1.37 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35686,CPT,CRTJ DSTL ARVEN FSTL LXTR BYP SURG NON-HEMO,,,21 ,,RBRVS,3.34 ,1.17 ,1.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35691,CPT,TRPOS&/RIMPLTJ VERTEBRAL CAROTID ART,,,21 ,,RBRVS,18.41 ,7.94 ,7.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35693,CPT,TRPOS&/RIMPLTJ VERTEBRAL SUBCLAVIAN ART,,,21 ,,RBRVS,15.73 ,7.75 ,7.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35694,CPT,TRPOS&/RIMPLTJ SUBCLAVIAN CAROTID ART,,,21 ,,RBRVS,19.28 ,8.58 ,8.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35695,CPT,TRPOS&/RIMPLTJ CAROTID SUBCLAVIAN ART,,,21 ,,RBRVS,20.06 ,8.39 ,8.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35697,CPT,RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART,,,21 ,,RBRVS,3.00 ,1.03 ,1.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35700,CPT,ROPRTJ > 1 MO AFTER ORIGINAL OPRATION,,,21 ,,RBRVS,3.08 ,1.07 ,1.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35701,CPT,EXPL N/FLWD SURG RPR W/WO LYSIS CAROTID ARTERY,,,21 ,,RBRVS,9.19 ,6.15 ,6.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35721,CPT,EXPL N/FLWD SURG RPR W/WO LYSIS FEMORAL ARTERY,,,21 ,,RBRVS,7.72 ,4.82 ,4.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35741,CPT,EXPL N/FLWD SURG RPR W/WO LYSIS POPLITEAL ARTERY,,,21 ,,RBRVS,8.69 ,5.21 ,5.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35761,CPT,EXPL N/FLWD SURG RPR W/WO LYSIS OTHER ARTERY,,,21 ,,RBRVS,5.93 ,4.65 ,4.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35800,CPT,EXPL PO HEMRRG THROMBOSIS/INFCTJ NCK,,,21 ,,RBRVS,8.07 ,5.38 ,5.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35820,CPT,EXPL PO HEMRRG THROMBOSIS/INFCTJ CH,,,21 ,,RBRVS,36.89 ,15.46 ,15.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35840,CPT,EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD,,,21 ,,RBRVS,10.96 ,6.46 ,6.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35860,CPT,EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR,,,21 ,,RBRVS,6.80 ,4.43 ,4.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35870,CPT,RPR GRF-ENTERIC FSTL,,,21 ,,RBRVS,24.50 ,12.26 ,12.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35875,CPT,THRMBC ARTL/VEN GRF OTH/THN HEMO GRF/FSTL,,,21 ,,RBRVS,10.72 ,5.68 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35876,CPT,THRMBC ARTL/VEN GRF XCP HEMO GRF/FSTL W/REVJ GRF,,,21 ,,RBRVS,17.82 ,8.09 ,8.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35879,CPT,REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP,,,21 ,,RBRVS,17.41 ,8.05 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35881,CPT,REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS,,,21 ,,RBRVS,19.35 ,8.79 ,8.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35883,CPT,REVISION FEMORAL ANAST OPEN NONAUTOG GRAFT,,,21 ,,RBRVS,23.15 ,9.71 ,9.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35884,CPT,REVISION FEMORAL ANAST OPEN W/AUTOG GRAFT,,,21 ,,RBRVS,24.65 ,9.26 ,9.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35901,CPT,EXCISION INFECTED NECK GRAFT,,,21 ,,RBRVS,8.38 ,5.60 ,5.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35903,CPT,EXCISION INFECTED GRAFT EXTREMITY,,,21 ,,RBRVS,9.53 ,6.18 ,6.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35905,CPT,EXCISION INFECTED GRAFT THORAX,,,21 ,,RBRVS,33.52 ,12.93 ,12.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,35907,CPT,EXCISION INFECTED GRAFT ABDOMEN,,,21 ,,RBRVS,37.27 ,15.07 ,15.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36000,CPT,INTRODUCTION NEEDLE/INTRACATHETER VEIN,,,21 ,,RBRVS,0.18 ,0.08 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36002,CPT,INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM,,,21 ,,RBRVS,1.96 ,1.04 ,2.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36005,CPT,NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH,,,21 ,,RBRVS,0.95 ,0.40 ,9.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36010,CPT,INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA,,,21 ,,RBRVS,2.43 ,0.95 ,13.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36011,CPT,SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH,,,21 ,,RBRVS,3.14 ,1.25 ,23.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36012,CPT,SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANCH,,,21 ,,RBRVS,3.51 ,1.44 ,22.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36013,CPT,INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY,,,21 ,,RBRVS,2.52 ,1.01 ,21.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36014,CPT,SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY,,,21 ,,RBRVS,3.02 ,1.27 ,22.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36015,CPT,SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART,,,21 ,,RBRVS,3.51 ,1.46 ,23.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36100,CPT,INTRO NEEDLE/INTRACATH CAROTID/VERTEBRAL ARTERY,,,21 ,,RBRVS,3.02 ,1.29 ,12.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36120,CPT,INTRO NEEDLE/INTRACATH RETROGRADE BRACHIAL ART,,,21 ,,RBRVS,2.01 ,0.75 ,11.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36140,CPT,INTRO NEEDLE/INTRACATH EXTREMITY ARTERY,,,21 ,,RBRVS,2.01 ,0.81 ,11.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36147,CPT,INTRO NDL/CATH AV SHUNT IST ACCESS W/ RAD EVAL,,,21 ,,RBRVS,3.72 ,1.43 ,20.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36148,CPT,INTRO NDL/CATH AV SHUNT ADDL ACCESS THER IVNTJ,,,21 ,,RBRVS,1.00 ,0.37 ,6.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36160,CPT,INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR,,,21 ,,RBRVS,2.52 ,1.06 ,12.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36200,CPT,INTRODUCTION CATHETER AORTA,,,21 ,,RBRVS,3.02 ,1.18 ,15.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36215,CPT,SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH,,,21 ,,RBRVS,4.67 ,2.05 ,29.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36216,CPT,SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH,,,21 ,,RBRVS,5.27 ,2.33 ,31.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36217,CPT,SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH,,,21 ,,RBRVS,6.29 ,2.79 ,54.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36218,CPT,SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH,,,21 ,,RBRVS,1.01 ,0.44 ,4.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36245,CPT,SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH,,,21 ,,RBRVS,4.67 ,2.14 ,30.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36246,CPT,SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH,,,21 ,,RBRVS,5.27 ,2.21 ,30.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36247,CPT,SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH,,,21 ,,RBRVS,6.29 ,2.61 ,50.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36248,CPT,SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH,,,21 ,,RBRVS,1.01 ,0.42 ,3.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36251,CPT,SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UNI,,,21 ,,RBRVS,5.35 ,1.95 ,36.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36252,CPT,SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BILAT,,,21 ,,RBRVS,6.99 ,2.52 ,39.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36253,CPT,SUPSLCTV CATH 2ND+ORD RENL&ACCES ARTERY/S&I UNI,,,21 ,,RBRVS,7.55 ,2.59 ,57.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36254,CPT,SUPSLCTV CATH 2ND+ORD RENL&ACCES ARTER/S&I BILAT,,,21 ,,RBRVS,8.15 ,2.79 ,59.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36260,CPT,INSJ IMPLANTABLE INTRA-ARTERIAL INFUSION PUM,,,21 ,,RBRVS,9.91 ,6.52 ,6.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36261,CPT,REVJ IMPLANTED INTRA-ARTERIAL INFUSION PUMP,,,21 ,,RBRVS,5.63 ,4.59 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36262,CPT,REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP,,,21 ,,RBRVS,4.11 ,3.73 ,3.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36299,CPT,UNLISTED PROCEDURE VASCULAR INJECTION,,,21 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,36400,CPT,VNPNXR <3 YEARS PHYS SKILL FEMORAL/JUGULAR VEIN,,,21 ,,RBRVS,0.38 ,0.09 ,0.43 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,36405,CPT,VNPNXR <3 YEARS PHYS SKILL SCALP VEIN,,,21 ,,RBRVS,0.31 ,0.12 ,0.35 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,36406,CPT,VNPNXR <3 YEARS PHYS SKILL OTHER VEIN,,,21 ,,RBRVS,0.18 ,0.07 ,0.30 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,36410,CPT,VNPNXR 3 YEARS/> PHYS SKILL,,,21 ,,RBRVS,0.18 ,0.07 ,0.33 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,36415,CPT,COLLJ VEN BLD VNPNXR,,,17 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,36416,CPT,COLLECTION CAPILLARY BLOOD SPECIMEN,,,17 ,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,36420,CPT,VENIPUNCTURE CUTDOWN UNDER AGE 1 YR,,,21 ,,RBRVS,1.01 ,0.27 ,0.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36425,CPT,VENIPUNCTURE CUTDOWN AGE 1 YR/>,,,21 ,,RBRVS,0.76 ,0.31 ,0.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36430,CPT,TRANSFUSION BLOOD/BLOOD COMPONENTS,,,21 ,,RBRVS,,1.02 ,1.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36440,CPT,PUSH TRANSFUSION BLOOD 2 YR/UNDER,,,21 ,,RBRVS,1.03 ,0.42 ,0.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36450,CPT,EXCHNG TRANSFUSION BLOOD NEWBORN,,,21 ,,RBRVS,2.23 ,1.03 ,1.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36455,CPT,EXCHNG TRANSFUSION BLOOD OTHER/THAN NEW BORN,,,21 ,,RBRVS,2.43 ,0.99 ,0.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36460,CPT,TRANSFUSION INTRAUTERINE FETAL,,,21 ,,RBRVS,6.58 ,2.71 ,2.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36468,CPT,1/MLT NJXS SCLRSG SLNS SPIDER VEINS LIMB/TRUNK,,,21 ,,TotalUnits,,,,2.26 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,36469,CPT,1/MLT NJXS SCLRSG SLNS SPIDER VEINS FACE,,,21 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,36470,CPT,NJX SCLEROSING SOLUTION SINGLE VEIN,,,21 ,,RBRVS,1.10 ,0.83 ,2.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36471,CPT,NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG,,,21 ,,RBRVS,1.65 ,1.07 ,3.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36475,CPT,ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN,,,21 ,,RBRVS,6.72 ,2.73 ,46.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36476,CPT,ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS,,,21 ,,RBRVS,3.38 ,1.22 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36478,CPT,ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN,,,21 ,,RBRVS,6.72 ,2.76 ,35.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36479,CPT,ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS,,,21 ,,RBRVS,3.38 ,1.26 ,8.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36481,CPT,PRQ PORTAL VEIN CATHETERIZATION ANY METHOD,,,21 ,,RBRVS,6.98 ,3.00 ,29.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36500,CPT,VEN CATHJ SLCTV ORGAN BLD SAMPLING,,,21 ,,RBRVS,3.51 ,1.48 ,1.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36510,CPT,CATHJ UMBILICAL VEIN DX/THER NB,,,21 ,,RBRVS,1.09 ,0.50 ,1.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36511,CPT,THERAPEUTIC APHERESIS WHITE BLOOD CELLS,,,21 ,,RBRVS,1.74 ,0.82 ,0.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36512,CPT,THERAPEUTIC APHERESIS RED BLOOD CELLS,,,21 ,,RBRVS,1.74 ,0.84 ,0.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36513,CPT,THERAPEUTIC APHERESIS PLATELETS,,,21 ,,RBRVS,1.74 ,0.91 ,0.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36514,CPT,THERAPEUTIC APHERESIS PLASMA PHERESIS,,,21 ,,RBRVS,1.74 ,0.77 ,13.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36515,CPT,THER APHERESIS W/XTRCORP IMMUNODSPTJ&PLSM RENFS,,,21 ,,RBRVS,1.74 ,0.78 ,55.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36516,CPT,THER APHRS XTRCORP SLCTV ADSRPJ/FILTRJ&RENFS,,,21 ,,RBRVS,1.22 ,0.53 ,61.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36522,CPT,PHOTOPHERESIS EXTRACORPOREAL,,,21 ,,RBRVS,1.67 ,1.19 ,38.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36555,CPT,INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 YR,,,21 ,,RBRVS,2.68 ,0.74 ,5.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36556,CPT,INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>,,,21 ,,RBRVS,2.50 ,0.80 ,4.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36557,CPT,INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE<5 YR,,,21 ,,RBRVS,5.14 ,3.36 ,21.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36558,CPT,INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>,,,21 ,,RBRVS,4.84 ,2.94 ,18.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36560,CPT,INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR,,,21 ,,RBRVS,6.29 ,3.82 ,30.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36561,CPT,INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>,,,21 ,,RBRVS,6.04 ,3.52 ,27.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36563,CPT,INSJ TUNNELED CTR VAD W/SUBQ PUMP,,,21 ,,RBRVS,6.24 ,3.64 ,29.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36565,CPT,INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP,,,21 ,,RBRVS,6.04 ,3.31 ,22.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36566,CPT,INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT,,,21 ,,RBRVS,6.54 ,3.58 ,124.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36568,CPT,INSJ PRPH CVC W/O SUBQ PORT/PMP UNDER 5 YR,,,21 ,,RBRVS,1.92 ,0.76 ,6.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36569,CPT,INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>,,,21 ,,RBRVS,1.82 ,0.79 ,5.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36570,CPT,INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR,,,21 ,,RBRVS,5.36 ,3.20 ,27.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36571,CPT,INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>,,,21 ,,RBRVS,5.34 ,3.25 ,31.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36575,CPT,RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP,,,21 ,,RBRVS,0.67 ,0.30 ,4.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36576,CPT,RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT,,,21 ,,RBRVS,3.24 ,2.06 ,7.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36578,CPT,RPLCMT CATH CTR VAD SUBQ PORT/PMP,,,21 ,,RBRVS,3.54 ,2.47 ,11.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36580,CPT,RPLCMT COMPL NON-TUN CVC W/O SUBQ PORT/PMP,,,21 ,,RBRVS,1.31 ,0.55 ,5.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36581,CPT,RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP,,,21 ,,RBRVS,3.48 ,2.12 ,18.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36582,CPT,RPLCMT COMPL TUN CTR VAD W/SUBQ PORT,,,21 ,,RBRVS,5.24 ,3.17 ,26.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36583,CPT,RPLCMT COMPL TUN CTR VAD W/SUBQ PMP,,,21 ,,RBRVS,5.29 ,3.43 ,30.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36584,CPT,RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP,,,21 ,,RBRVS,1.20 ,0.71 ,5.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36585,CPT,RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT,,,21 ,,RBRVS,4.84 ,3.00 ,27.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36589,CPT,RMVL TUN CVC W/O SUBQ PORT/PMP,,,21 ,,RBRVS,2.28 ,1.57 ,2.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36590,CPT,RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ,,,21 ,,RBRVS,3.35 ,2.14 ,4.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36591,CPT,COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE,,,21 ,,RBRVS,,0.67 ,0.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36592,CPT,COLLECT BLOOD FROM CATHETER VENOUS NOS,,,21 ,,RBRVS,,0.75 ,0.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36593,CPT,DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH,,,21 ,,RBRVS,,0.84 ,0.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,36595,CPT,MCHNL RMVL PRICATH OBSTR CV DEV VIA VEN ACCESS,,,21 ,,RBRVS,3.59 ,1.68 ,13.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36596,CPT,MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN,,,21 ,,RBRVS,0.75 ,0.52 ,3.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36597,CPT,RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDN,,,21 ,,RBRVS,1.21 ,0.54 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36598,CPT,CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT,,,21 ,,RBRVS,0.74 ,0.67 ,2.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36600,CPT,ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX,,,21 ,,RBRVS,0.32 ,0.11 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36620,CPT,ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ,,,21 ,,RBRVS,1.15 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36625,CPT,ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX CUTDOWN,,,21 ,,RBRVS,2.11 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36640,CPT,ARTL CATHJ PROLNG NFS THER CHEMOTX CUTDOWN,,,21 ,,RBRVS,2.10 ,1.29 ,1.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36660,CPT,CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY,,,21 ,,RBRVS,1.40 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36680,CPT,PLACEMENT NEEDLE INTRAOSSEOUS INFUSION,,,21 ,,RBRVS,1.20 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36800,CPT,INSJ CANNULA HEMO OTH PURPOSE SPX VEIN VEIN,,,21 ,,RBRVS,2.43 ,2.00 ,2.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36810,CPT,INSJ CANNULA HEMO OTH PURPOSE SPX ARVEN XTRNL,,,21 ,,RBRVS,3.96 ,1.74 ,1.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36815,CPT,INSJ CANNULA HEMO OTH SPX ARVEN XTRNL REVJ/CLSR,,,21 ,,RBRVS,2.62 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36818,CPT,ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS,,,21 ,,RBRVS,11.89 ,6.26 ,6.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36819,CPT,ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS,,,21 ,,RBRVS,14.47 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36820,CPT,ARVEN ANAST OPN F/ARM VEIN TRPOS,,,21 ,,RBRVS,14.47 ,7.24 ,7.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36821,CPT,ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT,,,21 ,,RBRVS,12.11 ,6.43 ,6.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36822,CPT,INSJ CANNULA PROLNG XC-CIRCJ ECMO SPX,,,21 ,,RBRVS,5.57 ,4.79 ,4.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36823,CPT,INSJ CNULA ISLTD XC-CIRCJ REG CHEMOTX XTR RMVL,,,21 ,,RBRVS,22.98 ,11.91 ,11.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36825,CPT,CRTJ ARVEN FSTL XCP DIR ARVEN ANAST AUTOG GRF,,,21 ,,RBRVS,15.13 ,6.71 ,6.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36830,CPT,CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF,,,21 ,,RBRVS,12.03 ,5.68 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36831,CPT,THRMBC OPN ARVEN FSTL W/O REVJ DIAL GRF,,,21 ,,RBRVS,8.04 ,4.34 ,4.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36832,CPT,REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF,,,21 ,,RBRVS,10.53 ,5.15 ,5.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36833,CPT,REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF,,,21 ,,RBRVS,11.98 ,5.70 ,5.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36835,CPT,INSERTION THOMAS SHUNT SEPARATE PROCEDURE,,,21 ,,RBRVS,7.51 ,5.51 ,5.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36838,CPT,DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS,,,21 ,,RBRVS,21.69 ,9.52 ,9.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36860,CPT,XTRNL CANNULA DECLTNG SPX W/O BALO CATH,,,21 ,,RBRVS,2.01 ,0.94 ,3.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36861,CPT,XTRNL CANNULA DECLTNG SPX W/BALO CATH,,,21 ,,RBRVS,2.52 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,36870,CPT,THRMBC PRQ ARVEN FSTL AUTOG/NONAUTOG GRF,,,21 ,,RBRVS,5.20 ,3.35 ,49.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37140,CPT,VENOUS ANASTOMOSIS OPEN PORTOCAVAL,,,21 ,,RBRVS,25.23 ,12.88 ,12.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37145,CPT,VENOUS ANASTOMOSIS OPEN RENOPORTAL,,,21 ,,RBRVS,26.24 ,13.67 ,13.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37160,CPT,VENOUS ANASTOMOSIS OPEN CAVAL-MESENTERIC,,,21 ,,RBRVS,23.24 ,11.99 ,11.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37180,CPT,VENOUS ANASTOMOSIS OPEN SPLENORENAL PROXIMAL,,,21 ,,RBRVS,26.24 ,13.07 ,13.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37181,CPT,VENOUS ANASTOMOSIS OPEN SPLENORENAL DISTAL,,,21 ,,RBRVS,28.37 ,14.08 ,14.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37182,CPT,INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT,,,21 ,,RBRVS,16.97 ,7.31 ,7.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37183,CPT,REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT,,,21 ,,RBRVS,7.99 ,3.52 ,151.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37184,CPT,PRIM PRQ TRLUML MCHNL THRMBC 1ST VSL,,,21 ,,RBRVS,8.66 ,3.90 ,61.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37185,CPT,PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL,,,21 ,,RBRVS,3.28 ,1.32 ,19.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37186,CPT,SEC PRQ TRANSLUMINAL THROMBECTOMY NONCORONARY,,,21 ,,RBRVS,4.92 ,2.08 ,40.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37187,CPT,PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN,,,21 ,,RBRVS,8.03 ,3.57 ,58.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37188,CPT,PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX,,,21 ,,RBRVS,5.71 ,2.69 ,50.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37191,CPT,INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I,,,21 ,,RBRVS,4.71 ,1.67 ,73.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37192,CPT,REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I,,,21 ,,RBRVS,7.35 ,2.53 ,44.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37193,CPT,RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I,,,21 ,,RBRVS,7.35 ,2.52 ,41.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37195,CPT,THROMBOLYSIS CEREBRAL IV INFUSION,,,21 ,,TotalUnits,,,,9.89 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,37200,CPT,TRANSCATHETER BIOPSY,,,21 ,,RBRVS,4.55 ,1.89 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37201,CPT,TCAT THER INFUSION THROMBOLYS OTHR/THN CORONARY,,,21 ,,RBRVS,4.99 ,2.75 ,2.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37202,CPT,TCAT THER INFUSION OTH/THN THROMBOLYSIS ANY TYPE,,,21 ,,RBRVS,5.67 ,3.49 ,3.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37203,CPT,TCAT RETRIEVAL PRQ INTRAVASCULAR FOREIGN BODY,,,21 ,,RBRVS,5.02 ,2.36 ,34.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37204,CPT,TCAT OCCLS/EMBOLJ PRQ NON-CNS NON-HEAD/NCK,,,21 ,,RBRVS,18.11 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37205,CPT,TCAT PLMT IV STENT PERCUTANEOUS 1ST VESSEL,,,21 ,,RBRVS,8.27 ,3.63 ,118.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37206,CPT,TCAT PLMT IV STENT PERCUTANEOUS EACH ADDL VESSEL,,,21 ,,RBRVS,4.12 ,1.70 ,72.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37207,CPT,TCAT PLMT IV STENT OPEN 1ST VESSEL,,,21 ,,RBRVS,8.27 ,3.26 ,3.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37208,CPT,TCAT PLMT IV STENT OPEN EACH ADDL VESSEL,,,21 ,,RBRVS,4.12 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37209,CPT,EXCHNG PREV PLACED IV CATH THROMBOLYTIC THER,,,21 ,,RBRVS,2.27 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37210,CPT,UTERINE FIBROID EMBOLIZATION PERQ W/RAD GID,,,21 ,,RBRVS,10.60 ,4.66 ,94.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37215,CPT,TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ,,,21 ,,RBRVS,19.68 ,10.47 ,10.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37216,CPT,TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ,,,21 ,,RBRVS,18.95 ,10.00 ,10.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37220,CPT,REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL,,,21 ,,RBRVS,8.15 ,3.02 ,83.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37221,CPT,REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOP UNI,,,21 ,,RBRVS,10.00 ,3.73 ,126.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37222,CPT,REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL,,,21 ,,RBRVS,3.73 ,1.34 ,22.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37223,CPT,REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSI VSL,,,21 ,,RBRVS,4.25 ,1.53 ,70.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37224,CPT,REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI,,,21 ,,RBRVS,9.00 ,3.33 ,101.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37225,CPT,REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL,,,21 ,,RBRVS,12.00 ,4.53 ,302.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37226,CPT,REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL,,,21 ,,RBRVS,10.49 ,3.91 ,253.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37227,CPT,REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL,,,21 ,,RBRVS,14.50 ,5.46 ,410.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37228,CPT,REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI,,,21 ,,RBRVS,11.00 ,4.02 ,146.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37229,CPT,REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL,,,21 ,,RBRVS,14.05 ,5.28 ,296.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37230,CPT,REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL,,,21 ,,RBRVS,13.80 ,5.11 ,230.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37231,CPT,REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL,,,21 ,,RBRVS,15.00 ,5.55 ,377.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37232,CPT,REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL,,,21 ,,RBRVS,4.00 ,1.43 ,31.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37233,CPT,REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL,,,21 ,,RBRVS,6.50 ,2.40 ,35.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37234,CPT,REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL,,,21 ,,RBRVS,5.50 ,1.97 ,107.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37235,CPT,REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP EA VSL,,,21 ,,RBRVS,7.80 ,2.80 ,112.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37250,CPT,IV US NON-C VSL DX EVAL&/THER IVNTJ 1ST VSL,,,21 ,,RBRVS,2.10 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37251,CPT,IV US NON-C VSL DX EVAL&/THER IVNTJ EA VSL,,,21 ,,RBRVS,1.60 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37500,CPT,VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX,,,21 ,,RBRVS,11.67 ,7.15 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37501,CPT,UNLISTED VASCULAR ENDOSCOPY PROCEDURE,,,21 ,,TotalUnits,,,,18.82 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,37565,CPT,LIGATION INTERNAL JUGULAR VEIN,,,21 ,,RBRVS,12.05 ,7.16 ,7.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37600,CPT,LIGATION EXTERNAL CAROTID ARTERY,,,21 ,,RBRVS,12.42 ,6.88 ,6.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37605,CPT,LIGATION INTERNAL/COMMON CAROTID ARTERY,,,21 ,,RBRVS,14.28 ,7.36 ,7.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37606,CPT,LIG INT/COMMON CAROTID ART W/GRADUAL OCCLUSION,,,21 ,,RBRVS,8.81 ,4.86 ,4.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37607,CPT,LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA,,,21 ,,RBRVS,6.25 ,4.01 ,4.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37609,CPT,LIGATION/BIOPSY TEMPORAL ARTERY,,,21 ,,RBRVS,3.05 ,2.49 ,5.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37615,CPT,LIGATION MAJOR ARTERY NECK,,,21 ,,RBRVS,7.80 ,6.06 ,6.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37616,CPT,LIGATION MAJOR ARTERY CHEST,,,21 ,,RBRVS,18.97 ,10.26 ,10.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37617,CPT,LIGATION MAJOR ARTERY ABDOMEN,,,21 ,,RBRVS,23.79 ,11.05 ,11.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37618,CPT,LIGAMENT MAJOR ARTERY EXTREMITY,,,21 ,,RBRVS,6.03 ,4.39 ,4.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37619,CPT,INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I,,,21 ,,RBRVS,30.00 ,11.89 ,11.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37650,CPT,REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I,,,21 ,,RBRVS,8.49 ,4.72 ,4.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37660,CPT,RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I,,,21 ,,RBRVS,22.28 ,11.10 ,11.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37700,CPT,LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ,,,21 ,,RBRVS,3.82 ,3.11 ,3.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37718,CPT,LIG DIV&STRIPPING SHORT SAPHENOUS VEIN,,,21 ,,RBRVS,7.13 ,4.73 ,4.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37722,CPT,LIG DIV&STRIP LONG SAPH SAPHFEM JUNCT KNE/BELW,,,21 ,,RBRVS,8.16 ,4.98 ,4.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37735,CPT,LIG&DIV&COMPL STRIP LONG/SHORT SAPH RAD EXC,,,21 ,,RBRVS,10.90 ,6.12 ,6.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37760,CPT,LIG PRFRATR VEIN SUBFSCAL RAD INCL SKN GRF 1 LEG,,,21 ,,RBRVS,10.78 ,6.71 ,6.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37761,CPT,LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG,,,21 ,,RBRVS,9.13 ,6.18 ,6.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37765,CPT,STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS,,,21 ,,RBRVS,7.71 ,4.73 ,10.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37766,CPT,STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS,,,21 ,,RBRVS,9.66 ,5.49 ,12.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37780,CPT,LIG&DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX,,,21 ,,RBRVS,3.93 ,3.22 ,3.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37785,CPT,LIG DIV&/EXC VARICOSE VEIN CLUSTER 1 LEG,,,21 ,,RBRVS,3.93 ,3.24 ,6.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37788,CPT,PENILE REVASCULARIZATION ARTERY W/WO VEIN GRAFT,,,21 ,,RBRVS,23.33 ,13.68 ,13.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37790,CPT,PENILE VENOUS OCCLUSIVE PROCEDURE,,,21 ,,RBRVS,8.43 ,5.26 ,5.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,37799,CPT,UNLISTED PROCEDURE VASCULAR SURGERY,,,21 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,38100,CPT,SPLENECTOMY TOTAL SEPARATE PROCEDURE,,,21 ,,RBRVS,19.55 ,9.63 ,9.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38101,CPT,SPLENECTOMY TOTAL EN BLOC W/OTHER PROCEDURE,,,21 ,,RBRVS,19.55 ,9.81 ,9.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38102,CPT,SPLENC TOT EN BLOC X10SV DS CONJUNCT W/OTH PX,,,21 ,,RBRVS,4.79 ,1.91 ,1.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38115,CPT,RPR RPTD SPLEEN SPLENORRHAPHY W/WO PRTL SPLENECT,,,21 ,,RBRVS,21.88 ,10.55 ,10.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38120,CPT,LAPAROSCOPIC SURGICAL SPLENECTOMY,,,21 ,,RBRVS,17.07 ,9.78 ,9.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38129,CPT,UNLISTED LAPAROSCOPY PROCEDURE SPLEEN,,,21 ,,TotalUnits,,,,26.85 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,38200,CPT,INJECTION PROCEDURE SPLENOPORTOGRAPY,,,21 ,,RBRVS,2.64 ,1.17 ,1.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38204,CPT,MGMT RCP HEMATOP PROGENITOR CELL DON SEARCH&CELL,,,21 ,,RBRVS,2.00 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38205,CPT,BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC,,,21 ,,RBRVS,1.50 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38206,CPT,BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL,,,21 ,,RBRVS,1.50 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38207,CPT,TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV&STRG,,,21 ,,RBRVS,0.89 ,0.46 ,0.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,38208,CPT,TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR,,,21 ,,RBRVS,0.56 ,0.29 ,0.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,38209,CPT,TRNSP PREP HMATOP PROG THAW PREV HRV WSH PER DNR,,,21 ,,RBRVS,0.24 ,0.13 ,0.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,38210,CPT,TRNSPL PREPJ HEMATOP PROGEN DEPLJ IN HRV T-CELL,,,21 ,,RBRVS,1.57 ,0.82 ,0.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,38211,CPT,TRNSPL PREPJ HEMATOP PROGEN TUM CELL DEPLJ,,,21 ,,RBRVS,1.42 ,0.74 ,0.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,38212,CPT,TRNSPL PREPJ HEMATOP PROGEN RED BLD CELL RMVL,,,21 ,,RBRVS,0.94 ,0.49 ,0.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,38213,CPT,TRNSPL PREPJ HEMATOP PROGEN PLTLT DEPLJ,,,21 ,,RBRVS,0.24 ,0.13 ,0.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,38214,CPT,TRNSPL PREPJ HEMATOP PROGEN PLSM VOL DEPLJ,,,21 ,,RBRVS,0.81 ,0.42 ,0.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,38215,CPT,TRNSPL PREPJ HEMATOP PROGEN CONCENTRATION PLSM,,,21 ,,RBRVS,0.94 ,0.49 ,0.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,38220,CPT,MARROW ASPIRATION ONLY,,,21 ,,RBRVS,1.08 ,0.62 ,3.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38221,CPT,BONE MARROW BIOPSY NEEDLE/TROCAR,,,21 ,,RBRVS,1.37 ,0.78 ,3.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38230,CPT,BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC,,,21 ,,RBRVS,4.85 ,4.15 ,4.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38232,CPT,BONE MARROW HARVEST TRANSPLANTATION AUTOLOGOUS,,,21 ,,RBRVS,3.09 ,1.66 ,1.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38240,CPT,MARROW/BLD-DRV PRPH STEM CELL TRNSPLJ ALLOGENEIC,,,21 ,,RBRVS,2.24 ,1.29 ,1.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38241,CPT,MARROW/BLD-DRV PRPH STEM CELL TRNSPLJ AUTOL,,,21 ,,RBRVS,2.24 ,1.30 ,1.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38242,CPT,MARROW/BLD-DRV PRPH STEM CELL TRNSPLJ ALGC DON,,,21 ,,RBRVS,1.71 ,1.00 ,1.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38300,CPT,DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL,,,21 ,,RBRVS,2.36 ,2.61 ,5.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38305,CPT,DRG LYMPH NODE ABSC/LYMPHADENITIS X10SV,,,21 ,,RBRVS,6.68 ,5.47 ,5.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38308,CPT,LYMPHANGIOTOMY/OTH OPRATIONS LYMPHATIC CHANNELS,,,21 ,,RBRVS,6.81 ,4.81 ,4.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38380,CPT,SUTR&/LIG THORACIC DUCT CERVICAL APPROACH,,,21 ,,RBRVS,8.46 ,7.27 ,7.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38381,CPT,SUTR&/LIG THORACIC DUCT THORACIC APPROACH,,,21 ,,RBRVS,13.38 ,7.77 ,7.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38382,CPT,SUTR&/LIG THORACIC DUCT ABDOMINAL APPROACH,,,21 ,,RBRVS,10.65 ,6.93 ,6.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38500,CPT,BX/EXC LYMPH NODE OPEN SUPERFICIAL,,,21 ,,RBRVS,3.79 ,2.76 ,4.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38505,CPT,BX/EXC LYMPH NODE NEEDLE SUPERFICIAL,,,21 ,,RBRVS,1.14 ,0.89 ,2.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38510,CPT,BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE,,,21 ,,RBRVS,6.74 ,4.40 ,7.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38520,CPT,BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD,,,21 ,,RBRVS,7.03 ,5.16 ,5.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38525,CPT,BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE,,,21 ,,RBRVS,6.43 ,4.69 ,4.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38530,CPT,BX/EXC LYMPH NODE OPEN INT MAMMARY NODE,,,21 ,,RBRVS,8.34 ,5.78 ,5.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38542,CPT,DISSECTION DEEP JUGULAR NODE,,,21 ,,RBRVS,7.95 ,6.00 ,6.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38550,CPT,EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ,,,21 ,,RBRVS,7.11 ,5.78 ,5.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38555,CPT,EXC CSTIC HYGROMA AX/CRV W/DP NEUROVASC DSJ,,,21 ,,RBRVS,15.59 ,10.41 ,10.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38562,CPT,LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC,,,21 ,,RBRVS,11.06 ,7.44 ,7.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38564,CPT,LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC,,,21 ,,RBRVS,11.38 ,6.92 ,6.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38570,CPT,LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT,,,21 ,,RBRVS,9.34 ,5.15 ,5.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38571,CPT,LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY,,,21 ,,RBRVS,14.76 ,7.77 ,7.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38572,CPT,LAPS BI TOT PEL LMPHADEC&PRI-AORTIC LYMPH BX 1/+,,,21 ,,RBRVS,16.94 ,8.42 ,8.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38589,CPT,UNLISTED LAPAROSCOPY PX LYMPHATIC SYSTEM,,,21 ,,TotalUnits,,,,22.53 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,38700,CPT,SUPRAHYOID LYMPHADENECTOMY,,,21 ,,RBRVS,12.81 ,9.14 ,9.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38720,CPT,CERVICAL LYMPHADENECTOMY,,,21 ,,RBRVS,21.95 ,14.28 ,14.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38724,CPT,CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ,,,21 ,,RBRVS,23.95 ,15.58 ,15.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38740,CPT,AXILLARY LYMPHADENECTOMY SUPERFICIAL,,,21 ,,RBRVS,10.70 ,6.91 ,6.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38745,CPT,AXILLARY LYMPHADENECTOMY COMPLETE,,,21 ,,RBRVS,13.87 ,8.42 ,8.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38746,CPT,THORCOM THRC W/MEDSTNL & REGIONAL LMPHADEC,,,21 ,,RBRVS,4.88 ,1.86 ,1.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38747,CPT,ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC,,,21 ,,RBRVS,4.88 ,1.93 ,1.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38760,CPT,INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX,,,21 ,,RBRVS,13.62 ,8.13 ,8.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38765,CPT,INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC,,,21 ,,RBRVS,21.91 ,11.59 ,11.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38770,CPT,PEL LMPHADEC W/XTRNL ILIAC HYPOGSTR&OBTURATOR,,,21 ,,RBRVS,14.06 ,8.06 ,8.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38780,CPT,RPR TABDL LMPHADEC X10SV W/PEL AORTIC&RNL,,,21 ,,RBRVS,17.70 ,10.31 ,10.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38790,CPT,INJECTION PROCEDURE LYMPHANGIOGRAPHY,,,21 ,,RBRVS,1.29 ,0.95 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38792,CPT,INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE,,,21 ,,RBRVS,0.52 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38794,CPT,CANNULATION THORACIC DUCT,,,21 ,,RBRVS,4.62 ,3.78 ,3.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,38900,CPT,INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION,,,21 ,,RBRVS,2.50 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,38999,CPT,UNLISTED PROCEDURE HEMIC OR LYMPHATIC SYSTEM,,,21 ,,TotalUnits,,,,3.45 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,39000,CPT,MEDIAST W/EXPL DRG RMVL FB/BX CRV APPR,,,21 ,,RBRVS,7.57 ,5.67 ,5.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,39010,CPT,MEDIAST W/EXPL DRG RMVL FB/BX TTHRC APPR,,,21 ,,RBRVS,13.19 ,7.86 ,7.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,39200,CPT,RESECTION OF MEDIASTINAL CYST,,,21 ,,RBRVS,15.09 ,8.14 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,39220,CPT,RESECTION MEDIASTINAL TUMOR,,,21 ,,RBRVS,19.55 ,10.56 ,10.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,39400,CPT,MEDIASTINOSCOPY INCL BIOPSIES WHEN PERFORMED,,,21 ,,RBRVS,8.05 ,5.39 ,5.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,39499,CPT,UNLISTED PROCEDURE MEDIASTINUM,,,21 ,,TotalUnits,,,,13.44 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,39501,CPT,REPAIR LACERATION DIAPHRAGM ANY APPROACH,,,21 ,,RBRVS,13.98 ,8.00 ,8.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,39503,CPT,RPR NEONATAL DIPHRG HERNIA W/WO CHEST TUBE INSJ,,,21 ,,RBRVS,108.91 ,45.81 ,45.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,39540,CPT,RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC AQT,,,21 ,,RBRVS,14.57 ,7.87 ,7.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,39541,CPT,RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC CHRNC,,,21 ,,RBRVS,15.75 ,8.55 ,8.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,39545,CPT,IMBRICATION DIAPHRAGM EVENTRATION,,,21 ,,RBRVS,14.67 ,8.82 ,8.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,39560,CPT,RESCJ DIAPHRAGM W/SIMPLE REPAIR,,,21 ,,RBRVS,13.06 ,7.53 ,7.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,39561,CPT,RESCJ DIAPHRAGM W/COMPLEX REPAIR,,,21 ,,RBRVS,19.99 ,12.38 ,12.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,39599,CPT,UNLISTED PROCEDURE DIAPHRAGM,,,21 ,,TotalUnits,,,,22.44 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,40490,CPT,BIOPSY OF LIP,,,21 ,,RBRVS,1.22 ,0.82 ,2.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40500,CPT,VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT,,,21 ,,RBRVS,4.47 ,5.66 ,9.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40510,CPT,EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR,,,21 ,,RBRVS,4.82 ,5.02 ,8.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40520,CPT,EXC LIP V-EXC W/PRIM DIR LINR CLSR,,,21 ,,RBRVS,4.79 ,5.13 ,8.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40525,CPT,EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP,,,21 ,,RBRVS,7.72 ,7.50 ,7.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40527,CPT,EXC LIP FULL THKNS RCNSTJ W/CROSS LIP FLAP,,,21 ,,RBRVS,9.32 ,8.35 ,8.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40530,CPT,RESCJ LIP > ONE-FOURTH W/O RCNSTJ,,,21 ,,RBRVS,5.54 ,5.67 ,9.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40650,CPT,RPR LIP FULL THICKNESS VERMILION ONLY,,,21 ,,RBRVS,3.78 ,4.12 ,7.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40652,CPT,RPR LIP FULL THICKNESS HALF/< VERTICAL HEIGHT,,,21 ,,RBRVS,4.43 ,5.23 ,9.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40654,CPT,RPR LIP FULL THKNS >ONE-HALF VERT HEIGHT/COMPLEX,,,21 ,,RBRVS,5.48 ,6.21 ,10.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40700,CPT,PLSTC RPR CL LIP/NSL DFRM PRIM PRTL/COMPL UNI,,,21 ,,RBRVS,14.17 ,12.51 ,12.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40701,CPT,PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 STG PX,,,21 ,,RBRVS,17.23 ,13.53 ,13.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40702,CPT,PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 2 STGS,,,21 ,,RBRVS,14.27 ,9.15 ,9.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40720,CPT,PLSTC RPR CL LIP/NSL DFRM SEC RECRTJ DFCT&RECLSR,,,21 ,,RBRVS,14.72 ,11.55 ,11.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40761,CPT,PLSTC RPR CL LIP/NSL DFRM W/CROSS LIP PEDCL FLAP,,,21 ,,RBRVS,15.84 ,13.47 ,13.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40799,CPT,UNLISTED PROCEDURE LIPS,,,21 ,,TotalUnits,,,,3.58 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,40800,CPT,DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL,,,21 ,,RBRVS,1.23 ,2.40 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40801,CPT,DRG ABSC CST HMTMA VESTIBULE MOUTH COMP,,,21 ,,RBRVS,2.63 ,3.51 ,6.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40804,CPT,RMVL EMBEDDED FB VESTIBULE MOUTH SMPL,,,21 ,,RBRVS,1.30 ,2.38 ,4.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40805,CPT,RMVL EMBEDDED FB VESTIBULE MOUTH COMP,,,21 ,,RBRVS,2.79 ,3.51 ,6.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40806,CPT,INCISION LABIAL FRENUM FRENOTOMY,,,21 ,,RBRVS,0.31 ,0.57 ,2.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40808,CPT,BIOPSY VESTIBULE MOUTH,,,21 ,,RBRVS,1.01 ,2.04 ,4.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40810,CPT,EXC LES MUCOSA&SBMCSL VESTIBULE MOUTH W/O RPR,,,21 ,,RBRVS,1.36 ,2.22 ,4.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40812,CPT,EXC LES MUCOSA&SBMCSL VESTIBULE SMPL RPR,,,21 ,,RBRVS,2.37 ,3.10 ,5.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40814,CPT,EXC LES MUCOSA&SBMCSL VESTIBULE CPLX RPR,,,21 ,,RBRVS,3.52 ,4.96 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40816,CPT,EXC LES MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC,,,21 ,,RBRVS,3.77 ,5.08 ,7.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40818,CPT,EXC MUCOSA VESTIBULE MOUTH AS DON GRF,,,21 ,,RBRVS,2.83 ,4.79 ,7.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40819,CPT,EXC FRENUM LABIAL/BUCCAL,,,21 ,,RBRVS,2.51 ,4.04 ,6.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40820,CPT,DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS,,,21 ,,RBRVS,1.34 ,3.57 ,6.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40830,CPT,CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<,,,21 ,,RBRVS,1.82 ,2.59 ,5.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40831,CPT,CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPLX,,,21 ,,RBRVS,2.57 ,3.61 ,6.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40840,CPT,VESTIBULOPLASTY ANTERIOR,,,21 ,,RBRVS,9.15 ,8.71 ,14.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40842,CPT,VESTIBULOPLASTY POSTERIOR UNILATERAL,,,21 ,,RBRVS,9.15 ,8.27 ,13.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40843,CPT,VESTIBULOPLASTY POSTERIOR BILATERAL,,,21 ,,RBRVS,12.79 ,9.08 ,15.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40844,CPT,VESTIBULOPLASTY ENTIRE ARCH,,,21 ,,RBRVS,16.80 ,14.35 ,20.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40845,CPT,VESTIBULOPLASTY CPLX W/RIDGE XTN MUSC RPSG,,,21 ,,RBRVS,19.36 ,14.77 ,21.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,40899,CPT,UNLISTED PROCEDURE VESTIBULE MOUTH,,,21 ,,TotalUnits,,,,5.13 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,41000,CPT,INTRAORAL I&D TONGUE/FLOOR LINGUAL,,,21 ,,RBRVS,1.35 ,1.77 ,3.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41005,CPT,INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC,,,21 ,,RBRVS,1.31 ,2.30 ,5.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41006,CPT,INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD,,,21 ,,RBRVS,3.34 ,3.96 ,6.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41007,CPT,INTRAORAL I&D TONGUE/FLOOR SUBMENTAL SPACE,,,21 ,,RBRVS,3.20 ,3.76 ,6.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41008,CPT,INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE,,,21 ,,RBRVS,3.46 ,3.99 ,6.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41009,CPT,INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE,,,21 ,,RBRVS,3.71 ,4.39 ,7.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41010,CPT,INCISION LINGUAL FRENUM FRENOTOMY,,,21 ,,RBRVS,1.11 ,2.01 ,4.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41015,CPT,XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL,,,21 ,,RBRVS,4.08 ,5.42 ,8.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41016,CPT,XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMENTAL,,,21 ,,RBRVS,4.19 ,5.53 ,7.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41017,CPT,XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDBLR,,,21 ,,RBRVS,4.19 ,5.57 ,8.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41018,CPT,XTRORAL I&D FLOOR MASTICATOR SPACE,,,21 ,,RBRVS,5.22 ,5.96 ,8.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41019,CPT,PLACEMENT NEEDLE HEAD/NECK RADIOELEMENT APPLICAT,,,21 ,,RBRVS,8.84 ,4.27 ,4.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41100,CPT,BIOPSY TONGUE ANTERIOR TWO-THIRDS,,,21 ,,RBRVS,1.42 ,1.62 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41105,CPT,BIOPSY TONGUE POSTERIOR ONE-THIRD,,,21 ,,RBRVS,1.47 ,1.65 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41108,CPT,BIOPSY FLOOR MOUTH,,,21 ,,RBRVS,1.10 ,1.44 ,3.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41110,CPT,EXCISION LESION TONGUE W/O CLOSURE,,,21 ,,RBRVS,1.56 ,2.15 ,4.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41112,CPT,EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRDS,,,21 ,,RBRVS,2.83 ,4.25 ,6.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41113,CPT,EXC LES TONGUE W/CLSR POSTERIOR ONE-THIRD,,,21 ,,RBRVS,3.29 ,4.52 ,6.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41114,CPT,EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP,,,21 ,,RBRVS,8.82 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41115,CPT,EXCIISION LINGUAL FRENUM FRENECTOMY,,,21 ,,RBRVS,1.79 ,2.41 ,5.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41116,CPT,EXCISION LESION FLOOR MOUTH,,,21 ,,RBRVS,2.52 ,3.66 ,6.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41120,CPT,GLOSSECTOMY < ONE-HALF TONGUE,,,21 ,,RBRVS,11.14 ,18.61 ,18.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41130,CPT,GLOSSECTOMY HEMIGLOSSECTOMY,,,21 ,,RBRVS,15.74 ,20.82 ,20.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41135,CPT,GLOSSECTOMY PRTL W/UNI RADICAL NECK DSJ,,,21 ,,RBRVS,30.14 ,29.76 ,29.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41140,CPT,GLSSC COMPL/TOT W/WOTRACHS W/O RAD NECK DSJ,,,21 ,,RBRVS,29.15 ,32.25 ,32.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41145,CPT,GLSSC COMPL/TOT W/WO TRACHS W/UNI RAD NECK DSJ,,,21 ,,RBRVS,37.93 ,39.24 ,39.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41150,CPT,GLSSC COMPOSIT W/RESCJ FLOOR&MNDBLR RESCJ,,,21 ,,RBRVS,29.86 ,31.13 ,31.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41153,CPT,GLSSC COMPOSIT RESCJ FLOOR SUPRAHYOID NCK DSJ,,,21 ,,RBRVS,33.59 ,32.58 ,32.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41155,CPT,GLSSC COMPOSIT RESCJ FLR MNDBLR RESCJ&RAD NCK,,,21 ,,RBRVS,44.30 ,37.99 ,37.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41250,CPT,RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONGUE,,,21 ,,RBRVS,1.96 ,2.03 ,4.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41251,CPT,RPR LAC 2.5 CM/< PST ONE-THIRD TONGUE,,,21 ,,RBRVS,2.32 ,2.28 ,4.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41252,CPT,RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX,,,21 ,,RBRVS,3.02 ,2.80 ,5.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41500,CPT,FIXJ TONGUE MECHANICAL OTHER/THAN SUTURE,,,21 ,,RBRVS,3.80 ,9.04 ,9.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41510,CPT,SUTURE TONGUE LIP MICROGNATHIA,,,21 ,,RBRVS,3.51 ,7.30 ,7.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41512,CPT,TONGUE BASE SUSPENSION PERMANENT SUTURE TQ,,,21 ,,RBRVS,6.86 ,11.04 ,11.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41520,CPT,FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY,,,21 ,,RBRVS,2.83 ,4.34 ,6.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41530,CPT,SUBMUCOSAL ABLTJ TONGUE RF 1/> SITES PR SESSION,,,21 ,,RBRVS,4.51 ,7.21 ,90.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41599,CPT,UNLISTED PROCEDURE TONGUE FLOOR MOUTH,,,21 ,,TotalUnits,,,,4.62 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,41800,CPT,DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS,,,21 ,,RBRVS,1.27 ,2.56 ,5.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41805,CPT,RMVL EMBEDDED FB FROM DENTALVLR STRUXS SOFT TISS,,,21 ,,RBRVS,1.34 ,3.42 ,5.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41806,CPT,RMVL EMBEDDED FB FROM DENTOALVEOLAR STRUXS BONE,,,21 ,,RBRVS,2.79 ,4.43 ,7.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41820,CPT,GINGIVECTOMY EXC GINGIVA EACH QUADRANT,,,21 ,,TotalUnits,,,,6.04 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,41821,CPT,OPRCULECTOMY EXC PRICORONAL TISSUE,,,21 ,,TotalUnits,,,,1.36 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,41822,CPT,EXC FIBROUS TUBEROSITIES DENTOALVEOLAR STRUXS,,,21 ,,RBRVS,2.41 ,2.55 ,5.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41823,CPT,EXC OSS TUBEROSITIES DENTOALVEOLAR STRUXS,,,21 ,,RBRVS,3.77 ,5.21 ,8.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41825,CPT,EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR,,,21 ,,RBRVS,1.41 ,2.08 ,4.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41826,CPT,EXC LESION/TUMOR DENTOALVEOLAR STRUX W/SMPL RPR,,,21 ,,RBRVS,2.41 ,3.39 ,6.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41827,CPT,EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR,,,21 ,,RBRVS,3.83 ,4.69 ,8.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41828,CPT,EXC HYPRPLSTC ALVEOLAR MUCOSA EA QUADRANT SPEC,,,21 ,,RBRVS,3.14 ,2.75 ,5.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41830,CPT,ALVEOLECTOMY W/CURTG OSTEITIS/SEQUESTRECTOMY,,,21 ,,RBRVS,3.45 ,4.36 ,7.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41850,CPT,DESTRUCTION LESION DENTOALVEOLAR STRUCTURES,,,21 ,,TotalUnits,,,,3.02 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,41870,CPT,PERIODONTAL MUCOSAL GRAFTING,,,21 ,,TotalUnits,,,,7.55 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,41872,CPT,GINGIVOPLASTY EACH QUADRANT SPECIFY,,,21 ,,RBRVS,3.01 ,4.30 ,7.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41874,CPT,ALVEOLOPLASTY EACH QUADRANT SPECIFY,,,21 ,,RBRVS,3.19 ,3.86 ,7.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,41899,CPT,UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES,,,21 ,,TotalUnits,,,,10.05 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,42000,CPT,DRAINAGE ABSCESS PALATE UVULA,,,21 ,,RBRVS,1.28 ,1.63 ,3.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42100,CPT,BIOPSY PALATE UVULA,,,21 ,,RBRVS,1.36 ,1.70 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42104,CPT,EXC LESION PALATE UVULA W/O CLOSURE,,,21 ,,RBRVS,1.69 ,2.19 ,4.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42106,CPT,EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE,,,21 ,,RBRVS,2.15 ,2.85 ,5.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42107,CPT,EXC LESION PALATE UVULA W/LOCAL FLAP CLOSURE,,,21 ,,RBRVS,4.56 ,5.08 ,8.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42120,CPT,RESCJ PALATE/EXTENSIVE RESCJ LESION,,,21 ,,RBRVS,11.86 ,15.97 ,15.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42140,CPT,UVULECTOMY EXCISION UVULA,,,21 ,,RBRVS,1.70 ,2.72 ,5.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42145,CPT,PALATOPHARYNGOPLASTY,,,21 ,,RBRVS,9.78 ,10.00 ,10.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42160,CPT,DSTRJ LES PALATE/UVULA THERMAL CRYO/CHEM,,,21 ,,RBRVS,1.85 ,2.37 ,4.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42180,CPT,REPAIR LACERATION PALATE </2 CM,,,21 ,,RBRVS,2.55 ,2.39 ,4.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42182,CPT,REPAIR LACERATION PALATE >2 CM/COMPLEX,,,21 ,,RBRVS,3.87 ,3.41 ,5.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42200,CPT,PALATOP CL PALATE SOFT&/HARD PALATE ONLY,,,21 ,,RBRVS,12.53 ,11.67 ,11.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42205,CPT,PALATOPLASTY W/CLSR ALVEOLAR RIDGE SOFT TISSUE,,,21 ,,RBRVS,13.66 ,12.84 ,12.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42210,CPT,PALATOP CLSR ALVEOLAR RIDGE GRF ALVEOLAR RIDGE,,,21 ,,RBRVS,15.03 ,13.28 ,13.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42215,CPT,PALATOPLASTY CLEFT PALATE MAJOR REVJ,,,21 ,,RBRVS,8.99 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42220,CPT,PALATOPLASTY CLEFT PALATE SEC LNGTH PX,,,21 ,,RBRVS,7.16 ,7.93 ,7.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42225,CPT,PALATOP CL PALATE ATTACHMENT PHARYNGEAL FLAP,,,21 ,,RBRVS,9.77 ,16.11 ,16.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42226,CPT,LENGTHENING PALATE & PHARYNGEAL FLAP,,,21 ,,RBRVS,10.35 ,15.52 ,15.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42227,CPT,LENGTHENING PALATE W/ISLAND FLAP,,,21 ,,RBRVS,9.90 ,14.80 ,14.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42235,CPT,REPAIR ANTERIOR PALATE W/VOMER FLAP,,,21 ,,RBRVS,8.01 ,12.97 ,12.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42260,CPT,REPAIR NASOLABIAL FISTULA,,,21 ,,RBRVS,10.22 ,8.34 ,12.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42280,CPT,MAXILLARY IMPRESJ PALATAL PROSTHESIS,,,21 ,,RBRVS,1.59 ,1.36 ,2.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42281,CPT,INSJ PIN-RETAINED PALATAL PROSTHESIS,,,21 ,,RBRVS,1.98 ,2.29 ,3.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42299,CPT,UNLISTED PROCEDURE PALATE UVULA,,,21 ,,TotalUnits,,,,6.52 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,42300,CPT,DRAINAGE ABSCESS PAROTID SIMPLE,,,21 ,,RBRVS,1.98 ,2.31 ,3.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42305,CPT,DRAINAGE ABSCESS PAROTID COMPLICATED,,,21 ,,RBRVS,6.31 ,5.68 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42310,CPT,DRG ABSC SUBMAXILLARY/SUBLINGUAL INTRAORAL,,,21 ,,RBRVS,1.61 ,1.90 ,2.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42320,CPT,DRAINAGE ABSCESS SUBMAXILLARY INTRAORAL,,,21 ,,RBRVS,2.40 ,2.57 ,4.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42330,CPT,SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL,,,21 ,,RBRVS,2.26 ,2.37 ,4.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42335,CPT,SIALOLITHOTOMY SUBMNDBLR SUBMAX COMP INTRAORAL,,,21 ,,RBRVS,3.41 ,3.87 ,7.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42340,CPT,SIALOLITHOTOMY PRTD XTRORAL/COMP INTRAORAL,,,21 ,,RBRVS,4.72 ,4.75 ,8.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42400,CPT,BIOPSY SALIVARY GLAND NEEDLE,,,21 ,,RBRVS,0.78 ,0.82 ,2.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42405,CPT,BIOPSY SALIVARY GLAND INCISIONAL,,,21 ,,RBRVS,3.34 ,2.98 ,5.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42408,CPT,EXC SUBLINGUAL SALIVARY CYST RANULA,,,21 ,,RBRVS,4.66 ,4.55 ,8.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42409,CPT,MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA,,,21 ,,RBRVS,2.91 ,3.39 ,6.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42410,CPT,EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ,,,21 ,,RBRVS,9.57 ,7.58 ,7.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42415,CPT,EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NRV,,,21 ,,RBRVS,18.12 ,12.73 ,12.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42420,CPT,EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NRV,,,21 ,,RBRVS,21.00 ,14.28 ,14.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42425,CPT,EXCISION PAROTID TUMOR/GLAND TOTAL EN BLOC RMVL,,,21 ,,RBRVS,13.42 ,9.89 ,9.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42426,CPT,EXC PRTD TUM/PRTD GLND TOT W/UNI RAD NCK DSJ,,,21 ,,RBRVS,22.66 ,14.89 ,14.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42440,CPT,EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND,,,21 ,,RBRVS,7.13 ,5.88 ,5.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42450,CPT,EXISION OF SUBLINGUAL GLAND,,,21 ,,RBRVS,4.74 ,5.35 ,8.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42500,CPT,PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM,,,21 ,,RBRVS,4.42 ,5.20 ,7.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42505,CPT,PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY SEC/COMP,,,21 ,,RBRVS,6.32 ,6.44 ,9.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42507,CPT,PAROTID DUCT DIVERSION BILATERAL WILKE PX,,,21 ,,RBRVS,6.25 ,8.33 ,8.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42508,CPT,PAROTID DUCT DIVERSION BI W/EXC 1 SUBMNDBLR GLND,,,21 ,,RBRVS,9.33 ,10.55 ,10.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42509,CPT,PAROTID DUCT DVRJ BI W/EXC BOTH SUBMNDBLR GLANDS,,,21 ,,RBRVS,11.76 ,10.44 ,10.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42510,CPT,PAROTID DUCT DVRJ BILATERAL WITH LIG BOTH DUCTS,,,21 ,,RBRVS,8.35 ,9.43 ,9.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42550,CPT,INJECTION PROCEDURE SIALOGRAPHY,,,21 ,,RBRVS,1.25 ,0.52 ,2.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42600,CPT,CLOSURE SALIVARY FISTULA,,,21 ,,RBRVS,4.94 ,4.94 ,8.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42650,CPT,DILATION SALIVARY DUCT,,,21 ,,RBRVS,0.77 ,0.89 ,1.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42660,CPT,DILAT&CATHJ SALIVARY DUCT W/WO INJECTION,,,21 ,,RBRVS,1.13 ,1.05 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42665,CPT,LIGATION SALIVARY DUCT INTRAORAL,,,21 ,,RBRVS,2.63 ,3.24 ,6.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42699,CPT,UNLISTED PX SALIVARY GLANDS/DUCTS,,,21 ,,TotalUnits,,,,14.97 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,42700,CPT,I&D ABSCESS PERITONSILLAR,,,21 ,,RBRVS,1.67 ,2.17 ,3.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42720,CPT,I&D ABSC RTRPHRNGL/PARAPHARYNGEAL INTRAORAL,,,21 ,,RBRVS,6.31 ,4.65 ,6.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42725,CPT,I&D ABSC RTRPHRNGL/PARAPHARYNGEAL XTRNL APPR,,,21 ,,RBRVS,12.41 ,10.25 ,10.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42800,CPT,BIOPSY OROPHARYNX,,,21 ,,RBRVS,1.44 ,1.73 ,3.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42802,CPT,BIOPSY HYPOPHARYNX,,,21 ,,RBRVS,1.59 ,2.24 ,5.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42804,CPT,BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE,,,21 ,,RBRVS,1.29 ,1.98 ,4.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42806,CPT,BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION,,,21 ,,RBRVS,1.63 ,2.16 ,4.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42808,CPT,EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD,,,21 ,,RBRVS,2.35 ,2.24 ,4.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42809,CPT,REMOVAL FOREIGN BODY PHARYNX,,,21 ,,RBRVS,1.86 ,1.77 ,2.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42810,CPT,EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TISS,,,21 ,,RBRVS,3.38 ,4.80 ,7.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42815,CPT,EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRNX,,,21 ,,RBRVS,7.31 ,8.32 ,8.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42820,CPT,TONSILLECTOMY & ADENOIDECTOMY <AGE 12,,,21 ,,RBRVS,4.22 ,3.96 ,3.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42821,CPT,TONSILLECTOMY & ADENOIDECTOMY AGE 12/>,,,21 ,,RBRVS,4.36 ,4.15 ,4.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42825,CPT,TONSILLECTOMY ONE-HALF <AGE 12,,,21 ,,RBRVS,3.51 ,3.91 ,3.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42826,CPT,TONSILLECTOMY ONE-HALF AGE 12/>,,,21 ,,RBRVS,3.45 ,3.66 ,3.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42830,CPT,ADENOIDECTOMY PRIMARY <AGE 12,,,21 ,,RBRVS,2.65 ,3.22 ,3.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42831,CPT,ADENOIDECTOMY PRIMARY AGE 12/>,,,21 ,,RBRVS,2.81 ,3.53 ,3.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42835,CPT,ADENOIDECTOMY SECONDARY<AGE 12,,,21 ,,RBRVS,2.38 ,2.66 ,2.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42836,CPT,ADENOIDECTOMY SECONDARY AGE 12/>,,,21 ,,RBRVS,3.26 ,3.57 ,3.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42842,CPT,RADICAL RESECTION TONSIL W/O CLOSURE,,,21 ,,RBRVS,12.23 ,15.65 ,15.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42844,CPT,RADICAL RESCJ TONSIL CLOSURE W/LOCAL FLAP,,,21 ,,RBRVS,17.78 ,20.73 ,20.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42845,CPT,RADICAL RESCJ TONSIL CLOSURE W/OTHER FLAP,,,21 ,,RBRVS,32.56 ,29.54 ,29.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42860,CPT,EXCISION TONSIL TAGS,,,21 ,,RBRVS,2.30 ,3.04 ,3.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42870,CPT,EXC/DSTRJ LINGUAL TONSIL ANY METHOD SPX,,,21 ,,RBRVS,5.52 ,11.02 ,11.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42890,CPT,LIMITED PHARYNGECTOMY,,,21 ,,RBRVS,19.13 ,20.24 ,20.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42892,CPT,RESCJ LAT PHRNGL WALL/PYRIFORM SINUS DIR CLSR,,,21 ,,RBRVS,26.03 ,25.83 ,25.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42894,CPT,RESCJ PHRNGL WALL CLSR W/FLP OR FLP W/MVASC ANAS,,,21 ,,RBRVS,33.92 ,31.75 ,31.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42900,CPT,SUTURE PHARYNX WOUND/INJURY,,,21 ,,RBRVS,5.29 ,4.24 ,4.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42950,CPT,PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX,,,21 ,,RBRVS,8.27 ,14.28 ,14.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42953,CPT,PHARYNGOESOPHAGEAL REPAIR,,,21 ,,RBRVS,9.45 ,18.03 ,18.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42955,CPT,PHARYNGOSTOMY FSTLJ PHARYNX XTRNL FEEDING,,,21 ,,RBRVS,8.01 ,13.29 ,13.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42960,CPT,CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE,,,21 ,,RBRVS,2.38 ,2.38 ,2.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42961,CPT,CTRL OROPHARYNGEAL HEMORRHAGE COMP REQ HOSPITJ,,,21 ,,RBRVS,5.77 ,6.10 ,6.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42962,CPT,CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ,,,21 ,,RBRVS,7.40 ,7.19 ,7.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42970,CPT,CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS,,,21 ,,RBRVS,5.82 ,5.13 ,5.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42971,CPT,CTRL NASOPHARYNGEAL HEMRRG COMP REQ HOSPIZATION,,,21 ,,RBRVS,6.60 ,6.27 ,6.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42972,CPT,CTRL NASOPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ,,,21 ,,RBRVS,7.59 ,6.78 ,6.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,42999,CPT,UNLISTED PROCEDURE PHARYNX ADENOIDS/TONSILS,,,21 ,,TotalUnits,,,,7.11 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,43020,CPT,ESOPHAGOTOMY CERVICAL APPR W/RMVL FB,,,21 ,,RBRVS,8.23 ,6.60 ,6.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43030,CPT,CRICOPHARYNGEAL MYOTOMY,,,21 ,,RBRVS,7.99 ,6.44 ,6.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43045,CPT,ESOPHAGOTOMY THORACIC APPR W/RMVL FB,,,21 ,,RBRVS,21.88 ,12.36 ,12.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43100,CPT,EXC LESION ESOPHOGUS W/PRIM RPR CERVICAL APPR,,,21 ,,RBRVS,9.66 ,7.78 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43101,CPT,EXC LESION ESOPHAGUS W/PRIM RPR THRC/ABDL APPR,,,21 ,,RBRVS,17.07 ,9.37 ,9.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43107,CPT,TOT ESOPHAGECTOMY W/O THORCOM W/WO PYLOROPLASTY,,,21 ,,RBRVS,44.18 ,22.09 ,22.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43108,CPT,TOT ESOPHG W/O THORCOM COLON NTRPSTJ/INT RCNSTJ,,,21 ,,RBRVS,82.87 ,34.84 ,34.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43112,CPT,TOTAL ESOPHAGECTOMY W/THORCOM W/WO PYLORPLASTY,,,21 ,,RBRVS,47.48 ,22.52 ,22.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43113,CPT,TOT ESOPHG W/THORCOM W/COLON NTRPSTJ/INT RCNSTJ,,,21 ,,RBRVS,80.06 ,36.45 ,36.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43116,CPT,PRTL ESOPHAGECTOMY CERVICAL W/FREE INTSTINAL GRF,,,21 ,,RBRVS,92.99 ,47.38 ,47.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43117,CPT,PRTL ESOPHECT DSTL W/WO PROX GASTRECT/PYLORPLSTY,,,21 ,,RBRVS,43.65 ,20.55 ,20.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43118,CPT,PRTL ESOPH DSTL W/WO PROX GASTRC W/COLON NTRPSTJ,,,21 ,,RBRVS,67.07 ,29.22 ,29.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43121,CPT,PRTL ESOPHAGEC W/WO PROX GASTREC/PYLOROPLASTY,,,21 ,,RBRVS,51.43 ,22.40 ,22.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43122,CPT,PRTL ESOPHG THORACOABD W/WO PROXGASTREC/PYLOROPL,,,21 ,,RBRVS,44.18 ,21.55 ,21.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43123,CPT,PRTL ESPHG THORACOABDL/ABDL APPR NTRPSTJ/RCNSTJ,,,21 ,,RBRVS,83.12 ,35.76 ,35.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43124,CPT,TOT/PRTL ESPHG W/O RCNSTJ W/CRV ESOPHAGOSTOMY,,,21 ,,RBRVS,69.09 ,32.16 ,32.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43130,CPT,DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR,,,21 ,,RBRVS,12.53 ,9.05 ,9.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43135,CPT,DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR,,,21 ,,RBRVS,26.17 ,12.63 ,12.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43200,CPT,ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX,,,21 ,,RBRVS,1.59 ,1.31 ,4.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43201,CPT,ESPHGSC RGD/FLX W/SUBMUCOSAL INJ ANY SBST,,,21 ,,RBRVS,2.09 ,1.48 ,6.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43202,CPT,ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE,,,21 ,,RBRVS,1.89 ,1.27 ,6.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43204,CPT,ESPHGSC RGD/FLX W/NJX SCLEROSIS ESOPHGL VARC,,,21 ,,RBRVS,3.76 ,2.32 ,2.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43205,CPT,ESPHGSC RGD/FLX W/BAND LIGATION ESOPHGL VARICES,,,21 ,,RBRVS,3.78 ,2.39 ,2.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43215,CPT,ESPHGSC RGD/FLX W/RMVL FOREIGN BODY,,,21 ,,RBRVS,2.60 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43216,CPT,ESPHGSC RGD/FLX RMVL TUM HOT BX FORCEPS/CAUT,,,21 ,,RBRVS,2.40 ,1.55 ,3.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43217,CPT,ESPHGSC RGD/FLX W/RMVL TUMOR SNARE TECHNIQUE,,,21 ,,RBRVS,2.90 ,1.74 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43219,CPT,ESPHGSC RGD/FLX W/INSJ PLSTC TUBE/STENT,,,21 ,,RBRVS,2.80 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43220,CPT,ESPHGSC RGD/FLX W/BALLOON DILAT < 30 MM DIAM,,,21 ,,RBRVS,2.10 ,1.40 ,1.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43226,CPT,ESPHGSC RGD/FLX W/INSJ GUIDE WIRE DILATION,,,21 ,,RBRVS,2.34 ,1.54 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43227,CPT,ESPHGSC RGD/FLX W/CTRL BLEEDING,,,21 ,,RBRVS,3.59 ,2.18 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43228,CPT,ESPHGSC RGD/FLX ABLTJ TUM XCP HOT BX/CAUT/SNARE,,,21 ,,RBRVS,3.76 ,2.35 ,2.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43231,CPT,ESPHGSC RGD/FLX W/NDSC ULTRASOUND EXAMINATION,,,21 ,,RBRVS,3.19 ,2.05 ,2.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43232,CPT,ESPHGSC RGD/FLX W/TNDSC US-GID FINE NDL ASPIR/BX,,,21 ,,RBRVS,4.47 ,2.72 ,2.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43234,CPT,UPPER GI ENDOSCOPY SIMPLE EXAMINATION,,,21 ,,RBRVS,2.01 ,1.27 ,5.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43235,CPT,UPPER GI NDSC DX W/WO COLLECTION SPECIMEN,,,21 ,,RBRVS,2.39 ,1.60 ,6.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43236,CPT,UPPER GI NDSC W/SUBMUCOSAL INJECTION,,,21 ,,RBRVS,2.92 ,1.93 ,7.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43237,CPT,UPR GI NDSC & US NDSC EXAM LMTD ESOPHAGUS,,,21 ,,RBRVS,3.98 ,2.50 ,2.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43238,CPT,UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH,,,21 ,,RBRVS,5.02 ,3.06 ,3.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43239,CPT,UPPER NDSC BIOPSY SINGLE/MULTIPLE,,,21 ,,RBRVS,2.87 ,1.85 ,6.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43240,CPT,UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST,,,21 ,,RBRVS,6.85 ,4.04 ,4.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43241,CPT,UPR GI NDSC TNDSC INTRALUMINAL TUBE/CATH PLMT,,,21 ,,RBRVS,2.59 ,1.69 ,1.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43242,CPT,UPPER GI NDSC ULTRASOUND GUIDED BIOPSY,,,21 ,,RBRVS,7.30 ,4.35 ,4.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43243,CPT,UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICES,,,21 ,,RBRVS,4.56 ,2.80 ,2.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43244,CPT,UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES,,,21 ,,RBRVS,5.04 ,3.11 ,3.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43245,CPT,UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ,,,21 ,,RBRVS,3.18 ,1.97 ,1.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43246,CPT,UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE,,,21 ,,RBRVS,4.32 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43247,CPT,UPPER GI NDSC W/FOREIGN BODY REMOVAL,,,21 ,,RBRVS,3.38 ,2.12 ,2.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43248,CPT,UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS,,,21 ,,RBRVS,3.15 ,2.06 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43249,CPT,UPR GI NDSC BALLOON DILAT ESOPH < 30 MM DIAM,,,21 ,,RBRVS,2.90 ,1.90 ,1.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43250,CPT,UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY,,,21 ,,RBRVS,3.20 ,1.95 ,1.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43251,CPT,UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ,,,21 ,,RBRVS,3.69 ,2.30 ,2.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43255,CPT,UPR GI NDSC CONTROL BLEEDING ANY METHOD,,,21 ,,RBRVS,4.81 ,2.97 ,2.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43256,CPT,UPR GI NDSC TNDSC STENT PLMT W/PREDILAT,,,21 ,,RBRVS,4.34 ,2.64 ,2.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43257,CPT,UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA,,,21 ,,RBRVS,5.50 ,3.26 ,3.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43258,CPT,UPR GI NDSC ABLTJ LES X RMVL FORCEPS/CAUT/SNARE,,,21 ,,RBRVS,4.54 ,2.80 ,2.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43259,CPT,UPPER GI NDSC W/NDSC ULTRASOUND EXAM,,,21 ,,RBRVS,5.19 ,3.19 ,3.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43260,CPT,ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX,,,21 ,,RBRVS,5.95 ,3.60 ,3.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43261,CPT,ERCP W/BIOPSY SINGLE/MULTIPLE,,,21 ,,RBRVS,6.26 ,3.78 ,3.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43262,CPT,ERCP W/SPHINCTEROTOMY/PAPILLOTOMY,,,21 ,,RBRVS,7.38 ,4.40 ,4.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43263,CPT,ERCP W/PRESSURE MEAS SPHINCTER ODDI,,,21 ,,RBRVS,7.28 ,4.33 ,4.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43264,CPT,ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS,,,21 ,,RBRVS,8.89 ,5.25 ,5.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43265,CPT,ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD,,,21 ,,RBRVS,10.00 ,5.85 ,5.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43267,CPT,ERCP W/INSJ NASOBILIARY/NASOPNCRTC DRAINAGE TUBE,,,21 ,,RBRVS,7.38 ,4.35 ,4.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43268,CPT,ERCP W/INSJ TUBE/STENT BILE/PANCREATIC DUCT,,,21 ,,RBRVS,7.38 ,4.57 ,4.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43269,CPT,ERCP W/RTRGR RMVL FB&/CHNG TUBE/STENT,,,21 ,,RBRVS,8.20 ,4.85 ,4.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43271,CPT,ERCP W/BALO DILAT AMPULLA BILIARY&/PNCRTC DUX,,,21 ,,RBRVS,7.38 ,4.39 ,4.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43272,CPT,ERCP W/ABLTJ LES X RMVL FORCEPS/CAUT/SNARE,,,21 ,,RBRVS,7.38 ,4.40 ,4.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43273,CPT,ENDOSCOPIC PAPILLA CANNULATION BILE PANCREATIC,,,21 ,,RBRVS,2.24 ,1.28 ,1.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43279,CPT,LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED,,,21 ,,RBRVS,22.10 ,10.96 ,10.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43280,CPT,LAPS SURG ESOPG/GSTR FUNDOPLASTY,,,21 ,,RBRVS,18.10 ,9.52 ,9.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43281,CPT,LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH,,,21 ,,RBRVS,26.60 ,14.10 ,14.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43282,CPT,LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/MESH,,,21 ,,RBRVS,30.10 ,15.61 ,15.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43283,CPT,LAPS ESOPHAGEAL LENGTHENING ADDL,,,21 ,,RBRVS,2.95 ,1.28 ,1.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43289,CPT,UNLISTED LAPAROSCOPIC PROCEDURE ESOPHAGUS,,,21 ,,TotalUnits,,,,27.62 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,43300,CPT,ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL,,,21 ,,RBRVS,9.33 ,7.85 ,7.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43305,CPT,ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL,,,21 ,,RBRVS,18.10 ,12.42 ,12.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43310,CPT,ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL,,,21 ,,RBRVS,26.26 ,12.78 ,12.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43312,CPT,ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL,,,21 ,,RBRVS,29.25 ,13.17 ,13.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43313,CPT,ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL,,,21 ,,RBRVS,48.45 ,23.58 ,23.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43314,CPT,ESPHGP CGEN DFCT THRC APPR W/RPR FSTL,,,21 ,,RBRVS,53.43 ,24.78 ,24.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43320,CPT,EGST W/WO VAGOTOMY&PYLOROPLASTY TABDL/TTHRC APPR,,,21 ,,RBRVS,23.31 ,12.52 ,12.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43325,CPT,ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH,,,21 ,,RBRVS,22.60 ,11.55 ,11.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43327,CPT,ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY,,,21 ,,RBRVS,13.35 ,8.12 ,8.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43328,CPT,ESOPG/GSTR FUNDOPLASTY W/THORACOTOMY,,,21 ,,RBRVS,19.91 ,10.82 ,10.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43330,CPT,ESOPHAGOMYOTOMY HELLER TYPE ABDOMINAL APPROACH,,,21 ,,RBRVS,22.19 ,11.43 ,11.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43331,CPT,ESOPHAGOMYOTOMY HELLER TYPE THORACIC APPROACH,,,21 ,,RBRVS,23.06 ,12.36 ,12.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43332,CPT,RPR PARAESOPH HIATAL HERNIA W/LAPT W/O MESH,,,21 ,,RBRVS,19.62 ,11.02 ,11.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43333,CPT,LAPT RPR PARAESOPH HIATAL HERNIA W/MESH,,,21 ,,RBRVS,21.46 ,11.80 ,11.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43334,CPT,RPR PARAESOPH HIATAL HERNIA W/THORCOM W/O MESH,,,21 ,,RBRVS,22.12 ,11.39 ,11.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43335,CPT,RPR PARAESOPH HIATAL HERNIA W/THORCOM W/MESH,,,21 ,,RBRVS,23.97 ,12.13 ,12.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43336,CPT,RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/O MESH,,,21 ,,RBRVS,25.81 ,13.46 ,13.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43337,CPT,RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/MESH,,,21 ,,RBRVS,27.65 ,15.33 ,15.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43338,CPT,ESOPHAGUS LENGTHENING,,,21 ,,RBRVS,2.21 ,1.30 ,1.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43340,CPT,ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT ABDL APPR,,,21 ,,RBRVS,22.99 ,12.17 ,12.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43341,CPT,ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT THRC APPR,,,21 ,,RBRVS,24.23 ,14.11 ,14.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43350,CPT,ESOPHAGOSTOMY FSTLJ ESOPH XTRNL ABDL APPR,,,21 ,,RBRVS,19.49 ,12.38 ,12.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43351,CPT,ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR,,,21 ,,RBRVS,22.05 ,12.18 ,12.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43352,CPT,ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR,,,21 ,,RBRVS,17.81 ,10.27 ,10.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43360,CPT,GI RCNSTJ PREV ESPHG/EXCLUSION W/STOMACH,,,21 ,,RBRVS,40.11 ,18.95 ,18.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43361,CPT,GI RCNSTJ PREV ESPHG/EXCLUSION W/COLON SM INT,,,21 ,,RBRVS,45.68 ,20.83 ,20.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43400,CPT,LIGATION DIRECT ESOPHAGEAL VARICES,,,21 ,,RBRVS,25.60 ,15.61 ,15.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43401,CPT,TRNSXJ ESOPH W/RPR ESOPHAGEAL VARICES,,,21 ,,RBRVS,26.49 ,12.33 ,12.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43405,CPT,LIG/STAPLING G-ESOP JUNCT PRE-ESOPHGL PRF8J,,,21 ,,RBRVS,24.73 ,14.52 ,14.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43410,CPT,SUTR ESOPHGL WND/INJ CRV APPR,,,21 ,,RBRVS,16.41 ,10.61 ,10.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43415,CPT,SUTR ESOPHGL WND/INJ TTHRC/TABDL APPR,,,21 ,,RBRVS,28.91 ,15.65 ,15.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43420,CPT,CLSR ESOPHAGOSTOMY/FSTL CRV APPR,,,21 ,,RBRVS,16.78 ,11.20 ,11.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43425,CPT,CLSR ESOPHAGOSTOMY/FSTL TTHRC/TABDL APPR,,,21 ,,RBRVS,25.04 ,14.40 ,14.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43450,CPT,DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS,,,21 ,,RBRVS,1.38 ,1.08 ,3.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43453,CPT,DILATION ESOPHAGUS GUIDE WIRE,,,21 ,,RBRVS,1.51 ,1.15 ,6.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43456,CPT,DILAT ESOPHAGUS BALLOON/DILATOR RETROGRADE,,,21 ,,RBRVS,2.57 ,1.70 ,14.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43458,CPT,DILAT ESOPH BALLOON 30 MM DIAM/> ACHALASIA,,,21 ,,RBRVS,3.06 ,1.94 ,7.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43460,CPT,ESOPG/GSTR TAMPONADE W/BALO SENGSTAKEN TYPE,,,21 ,,RBRVS,3.79 ,2.31 ,2.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43496,CPT,FREE JEJUNUM TRSF W/MICROVASC ANASTOMOSIS,,,21 ,,TotalUnits,,,,3.93 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,43499,CPT,UNLISTED PROCEDURE ESOPHAGUS,,,21 ,,TotalUnits,,,,5.12 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,43500,CPT,GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL,,,21 ,,RBRVS,12.79 ,7.22 ,7.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43501,CPT,GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER,,,21 ,,RBRVS,22.60 ,11.55 ,11.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43502,CPT,GASTROTOMY W/SUTR RPR PRE-ESOPG/GASTRIC LAC,,,21 ,,RBRVS,25.69 ,12.92 ,12.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43510,CPT,GSTRT W/ESOPHGL DILAT&INSJ PRM INTRAL TUBE,,,21 ,,RBRVS,15.14 ,10.29 ,10.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43520,CPT,PYLOROMYOTOMY CUTTING PYLORIC MUSC,,,21 ,,RBRVS,11.29 ,6.52 ,6.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43605,CPT,BIOPSY STOMACH LAPAROTOMY,,,21 ,,RBRVS,13.72 ,7.68 ,7.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43610,CPT,EXC LOCAL ULCER/BENIGN TUMOR STOMACH,,,21 ,,RBRVS,16.34 ,8.59 ,8.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43611,CPT,EXC LOCAL MALIGNANT TUMOR STOMACH,,,21 ,,RBRVS,20.38 ,10.67 ,10.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43620,CPT,GSTRCT TOT W/ESOPHAGOENTEROSTOMY,,,21 ,,RBRVS,34.04 ,15.97 ,15.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43621,CPT,GSTRCT TOT W/ROUX-EN-Y RCNSTJ,,,21 ,,RBRVS,39.53 ,17.83 ,17.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43622,CPT,GSTRCT TOT W/FRMJ INTSTINAL POUCH ANY TYPE,,,21 ,,RBRVS,40.03 ,18.12 ,18.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43631,CPT,GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY,,,21 ,,RBRVS,24.51 ,12.36 ,12.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43632,CPT,GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY,,,21 ,,RBRVS,35.14 ,15.96 ,15.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43633,CPT,GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ,,,21 ,,RBRVS,33.14 ,15.31 ,15.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43634,CPT,GSTRCT PRTL DSTL W/FRMJ INTSTINAL POUCH,,,21 ,,RBRVS,36.64 ,16.89 ,16.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43635,CPT,VAGOTOMY PFRMD W/PRTL DSTL GSTRCT,,,21 ,,RBRVS,2.06 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43640,CPT,VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV,,,21 ,,RBRVS,19.56 ,10.39 ,10.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43641,CPT,VGTMY W/PYLOROPLASTY W/WO GASTROST PARIETAL CELL,,,21 ,,RBRVS,19.81 ,10.53 ,10.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43644,CPT,LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM,,,21 ,,RBRVS,29.40 ,14.69 ,14.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43645,CPT,LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ,,,21 ,,RBRVS,31.53 ,15.51 ,15.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43651,CPT,LAPS SURG TRNSXJ VAGUS NRV TRUNCAL,,,21 ,,RBRVS,10.13 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43652,CPT,LAPS SURG TRNSXJ VAGUS NRV SLCTV/HILY SLCTV,,,21 ,,RBRVS,12.13 ,7.30 ,7.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43653,CPT,LAPS SURG GASTROSTOMY W/O CONSTJ GSTR TUBE SPX,,,21 ,,RBRVS,8.48 ,6.06 ,6.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43659,CPT,UNLISTED LAPAROSCOPIC PROCEDURE STOMACH,,,21 ,,TotalUnits,,,,44.09 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,43752,CPT,NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDN,,,21 ,,RBRVS,0.81 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43753,CPT,GASTRIC INTUBAT&ASPIRA W/PHYS SKILL/LAVAGE,,,21 ,,RBRVS,0.45 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43754,CPT,GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIMEN,,,21 ,,RBRVS,0.45 ,0.44 ,1.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43755,CPT,GASTRIC INTUBATION DX & ASPIRATJ MULTIPLE SPECS,,,21 ,,RBRVS,0.94 ,0.68 ,2.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43756,CPT,DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN,,,21 ,,RBRVS,0.77 ,0.71 ,5.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43757,CPT,DUODENAL INTUBAT W/IMAG GUIDED MULTIPLE SPECIMEN,,,21 ,,RBRVS,1.26 ,0.87 ,6.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43760,CPT,CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE,,,21 ,,RBRVS,0.90 ,0.43 ,10.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43761,CPT,REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO,,,21 ,,RBRVS,2.01 ,0.87 ,1.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43770,CPT,LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE,,,21 ,,RBRVS,18.00 ,10.49 ,10.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43771,CPT,LAPS GASTRIC RESTRICTIVE PX REVISION DEVICE,,,21 ,,RBRVS,20.79 ,11.58 ,11.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43772,CPT,LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE,,,21 ,,RBRVS,15.70 ,8.67 ,8.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43773,CPT,LAPS GASTRIC RESTRICTIVE PX REMOVE&RPLCMT DEVICE,,,21 ,,RBRVS,20.79 ,11.58 ,11.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43774,CPT,LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE &PORT,,,21 ,,RBRVS,15.76 ,8.69 ,8.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43775,CPT,LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY,,,21 ,,RBRVS,21.56 ,12.08 ,12.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43800,CPT,PYLOROPLASTY,,,21 ,,RBRVS,15.43 ,8.20 ,8.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43810,CPT,GASTRODUODENOSTOMY,,,21 ,,RBRVS,16.88 ,8.85 ,8.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43820,CPT,GASTROJEJUNOSTOMY W/O VAGOTOMY,,,21 ,,RBRVS,22.53 ,11.26 ,11.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43825,CPT,GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE,,,21 ,,RBRVS,21.76 ,11.37 ,11.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43830,CPT,GASTROSTOMY OPN W/O CONSTJ GSTR TUBE SPX,,,21 ,,RBRVS,10.85 ,7.04 ,7.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43831,CPT,GASTROSTOMY OPN NEONATAL FEEDING,,,21 ,,RBRVS,8.49 ,6.71 ,6.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43832,CPT,GASTROSTOMY OPN W/CONSTJ GSTR TUBE,,,21 ,,RBRVS,17.34 ,9.63 ,9.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43840,CPT,GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ,,,21 ,,RBRVS,22.83 ,11.42 ,11.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43842,CPT,GASTRIC RSTCV W/O BYP VERTICAL-BANDED GASTROPLY,,,21 ,,RBRVS,21.03 ,11.21 ,11.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43843,CPT,GSTR RSTCV W/O BYP OTH/THN VER-BANDED GSTP,,,21 ,,RBRVS,21.21 ,11.14 ,11.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43845,CPT,GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM,,,21 ,,RBRVS,33.30 ,16.35 ,16.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43846,CPT,GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/<,,,21 ,,RBRVS,27.41 ,14.06 ,14.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43847,CPT,GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ,,,21 ,,RBRVS,30.28 ,15.17 ,15.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43848,CPT,REVISION OPEN GASTRIC RESTRICTIVE PX NOT DEVICE,,,21 ,,RBRVS,32.75 ,16.27 ,16.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43850,CPT,REVJ GASTRODUOL ANAST W/RCNSTJ W/O VAGOTOMY,,,21 ,,RBRVS,27.58 ,13.54 ,13.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43855,CPT,REVJ GASTRODUOL ANAST W/RCNSTJ W/VGTMY,,,21 ,,RBRVS,28.69 ,14.11 ,14.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43860,CPT,REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY,,,21 ,,RBRVS,27.89 ,13.64 ,13.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43865,CPT,REVJ GSTR/JJ ANAST W/RCNSTJ W/VGTMY,,,21 ,,RBRVS,29.05 ,14.22 ,14.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43870,CPT,CLOSURE GASTROSTOMY SURG,,,21 ,,RBRVS,11.44 ,6.72 ,6.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43880,CPT,CLOSURE GASTROCOLIC FISTULA,,,21 ,,RBRVS,27.18 ,13.40 ,13.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43886,CPT,GSTR RSTCV PX OPN REVJ SUBQ PORT COMPONENT ONLY,,,21 ,,RBRVS,4.64 ,4.61 ,4.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43887,CPT,GSTR RSTCV PX OPN RMVL SUBQ PORT COMPONENT ONLY,,,21 ,,RBRVS,4.32 ,4.06 ,4.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43888,CPT,GSTR RSTCV OPN RMVL&RPLCMT SUBQ PORT,,,21 ,,RBRVS,6.44 ,5.31 ,5.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,43999,CPT,UNLISTED PROCEDURE STOMACH,,,21 ,,TotalUnits,,,,4.13 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,44005,CPT,ENTEROLSS FRING INTSTINAL ADHESION SPX,,,21 ,,RBRVS,18.46 ,9.39 ,9.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44010,CPT,DUODENOTOMY EXPLORATION/BX/FOREIGN BODY REMOVAL,,,21 ,,RBRVS,14.26 ,7.79 ,7.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44015,CPT,TUBE/NEEDLE CATH JEJUNOSTOMY ANY METHOD,,,21 ,,RBRVS,2.62 ,1.03 ,1.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44020,CPT,ENTEROTOMY SM INT OTH/THN DUO EXPL BX/FB RMVL,,,21 ,,RBRVS,16.22 ,8.52 ,8.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44021,CPT,ENTEROTOMY SM INT OTH/THN DUO DCMPRN,,,21 ,,RBRVS,16.31 ,8.69 ,8.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44025,CPT,COLOTOMY EXPLORATION/BIOPSY/FOREIGN BODY REMOVAL,,,21 ,,RBRVS,16.51 ,8.65 ,8.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44050,CPT,RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT,,,21 ,,RBRVS,15.52 ,8.27 ,8.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44055,CPT,CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS,,,21 ,,RBRVS,25.63 ,12.29 ,12.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44100,CPT,BX INTESTINE CAPSULE TUBE PRORAL 1/> SPECIMENS,,,21 ,,RBRVS,2.01 ,1.09 ,1.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44110,CPT,EXC 1/> SMALL/LARGE LESIONS INTESTINE ENTEROTOMY,,,21 ,,RBRVS,14.04 ,7.61 ,7.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44111,CPT,EXC 1/> SM/LG LESIONS INTESTNE MULT ENTEROTOMIES,,,21 ,,RBRVS,16.52 ,8.56 ,8.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44120,CPT,ENTRC RESCJ SMALL INTESTINE 1 RESCJ&ANAST,,,21 ,,RBRVS,20.82 ,10.25 ,10.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44121,CPT,ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ&ANAST,,,21 ,,RBRVS,4.44 ,1.75 ,1.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44125,CPT,ENTERECTOMY RESCJ SMALL INTESTINE W/ENTEROSTOMY,,,21 ,,RBRVS,20.03 ,10.11 ,10.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44126,CPT,ENTRC RESCJ ATRESIA RESCJ&ANAST W/O TAPRING,,,21 ,,RBRVS,42.23 ,20.01 ,20.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44127,CPT,ENTRC RESCJ ATRESIA RESCJ&ANAST SGM W/TAPRING,,,21 ,,RBRVS,49.30 ,22.71 ,22.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44128,CPT,ENTRC RESCJ ATRESIA EA RESCJ&ANAST,,,21 ,,RBRVS,4.44 ,1.76 ,1.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44130,CPT,ENTEROENTEROST ANAST INT W/WO CUTAN NTRSTM SPX,,,21 ,,RBRVS,22.11 ,11.08 ,11.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44139,CPT,MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT,,,21 ,,RBRVS,2.23 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44140,CPT,COLECTOMY PARTIAL W/ANASTOMOSIS,,,21 ,,RBRVS,22.59 ,11.64 ,11.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44141,CPT,COLECTOMY PRTL W/SKIN LEVEL CECOST/COLOSTOMY,,,21 ,,RBRVS,29.91 ,16.41 ,16.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44143,CPT,COLECTOMY PRTL W/END COLOSTOMY&CLSR DSTL SGMT,,,21 ,,RBRVS,27.79 ,14.70 ,14.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44144,CPT,COLECTOMY PRTL W/COLOST/ILEOST & MUCOFISTULA,,,21 ,,RBRVS,29.91 ,15.04 ,15.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44145,CPT,COLECTOMY PRTL W/COLOPROCTOSTOMY,,,21 ,,RBRVS,28.58 ,13.98 ,13.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44146,CPT,COLECTOMY PRTL W/COLOPROCTOSTOMY & COLOSTOMY,,,21 ,,RBRVS,35.30 ,18.96 ,18.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44147,CPT,COLECTOMY PRTL ABDOMINAL & TRANSANAL APPR,,,21 ,,RBRVS,33.69 ,15.45 ,15.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44150,CPT,COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS,,,21 ,,RBRVS,30.18 ,17.64 ,17.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44151,CPT,COLCT TOT ABDL W/O PRCTECT W/CONTINENT ILEOST,,,21 ,,RBRVS,34.92 ,19.50 ,19.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44155,CPT,COLECTOMY TOT ABDL W/PROCTECTOMY W/ILEOSTOMY,,,21 ,,RBRVS,34.42 ,19.13 ,19.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44156,CPT,COLECTOMY TOT ABDL W/PROCTECTOMY W/CONTNT ILEOST,,,21 ,,RBRVS,37.42 ,21.16 ,21.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44157,CPT,COLECTOMY TOT ABD W/PROCTECTOMY ILEOANAL ANAST,,,21 ,,RBRVS,35.70 ,19.62 ,19.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44158,CPT,COLCT TTL ABD W/PRCTECT ILEOANAL ANAST & RSVR,,,21 ,,RBRVS,36.70 ,19.90 ,19.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44160,CPT,COLECTOMY PRTL W/RMVL TERMINAL ILEUM&ILEOCOLOST,,,21 ,,RBRVS,20.89 ,10.80 ,10.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44180,CPT,LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE,,,21 ,,RBRVS,15.27 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44186,CPT,LAPAROSCOPY SURGICAL JEJUNOSTOMY,,,21 ,,RBRVS,10.38 ,6.33 ,6.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44187,CPT,LAPAROSCOPY SURG ILEOSTOMY/JEJUNOSTOMY NON-TUBE,,,21 ,,RBRVS,17.40 ,11.17 ,11.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44188,CPT,LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY,,,21 ,,RBRVS,19.35 ,12.18 ,12.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44202,CPT,LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANAST,,,21 ,,RBRVS,23.39 ,11.99 ,11.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44203,CPT,LAPAROSCOPY SMALL INTESTINE RESCJ&ANASTOMOSIS,,,21 ,,RBRVS,4.44 ,1.73 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44204,CPT,LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS,,,21 ,,RBRVS,26.42 ,13.08 ,13.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44205,CPT,LAPS COLECTOMY PRTL W/RMVL TERMINAL ILEUM,,,21 ,,RBRVS,22.95 ,11.49 ,11.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44206,CPT,LAPS COLECTOMY PRTL W/END CLST&CLSR DSTL SGM,,,21 ,,RBRVS,29.79 ,15.17 ,15.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44207,CPT,LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST,,,21 ,,RBRVS,31.92 ,15.08 ,15.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44208,CPT,LAPS COLECTMY PRTL W/COLOPXTSTMY LW ANAST W/CLST,,,21 ,,RBRVS,33.99 ,17.39 ,17.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44210,CPT,LAPS COLECTOMY TOT W/O PRCTECT W/ILEOST/ILEOPXTS,,,21 ,,RBRVS,30.09 ,16.14 ,16.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44211,CPT,LAPS COLCT TTL ABD W/PRCTECT ILEOANAL ANAST&RSVR,,,21 ,,RBRVS,37.08 ,19.92 ,19.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44212,CPT,LAPS COLECTOMY ABDL W/PROCTECTOMY W/ILEOSTOMY,,,21 ,,RBRVS,34.58 ,18.72 ,18.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44213,CPT,LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY,,,21 ,,RBRVS,3.50 ,1.37 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44227,CPT,LAPS CLSR NTRSTM LG/SM INT W/RESCJ&ANAST,,,21 ,,RBRVS,28.62 ,14.08 ,14.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44238,CPT,UNLISTED LAPAROSCOPY PX INTESTINE XCP RECTUM,,,21 ,,TotalUnits,,,,35.38 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,44300,CPT,PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN,,,21 ,,RBRVS,13.75 ,7.74 ,7.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44310,CPT,ILEOSTOMY/JEJUNOSTOMY NON-TUBE,,,21 ,,RBRVS,17.59 ,9.20 ,9.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44312,CPT,REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX,,,21 ,,RBRVS,9.43 ,6.04 ,6.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44314,CPT,REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX,,,21 ,,RBRVS,16.74 ,9.35 ,9.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44316,CPT,CONTINENT ILEOSTOMY KOCK PROCEDURE SPX,,,21 ,,RBRVS,23.59 ,12.17 ,12.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44320,CPT,COLOSTOMY/SKIN LEVEL CECOSTOMY,,,21 ,,RBRVS,19.91 ,10.78 ,10.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44322,CPT,COLOSTOMY/SKN LVL CECOSTOMY W/MULT BXS SPX,,,21 ,,RBRVS,13.32 ,12.23 ,12.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44340,CPT,REVJ COLOSTOMY SMPL RLS SUPFC SCAR SPX,,,21 ,,RBRVS,9.28 ,6.66 ,6.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44345,CPT,REVJ COLOSTOMY COMP RCNSTJ IN-DEPTH SPX,,,21 ,,RBRVS,17.22 ,9.77 ,9.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44346,CPT,REVJ COLOSTOMY W/RPR PARACLST HERNIA SPX,,,21 ,,RBRVS,19.63 ,10.67 ,10.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44360,CPT,ENDOSCOPY UPPER SMALL INTESTINE,,,21 ,,RBRVS,2.59 ,1.76 ,1.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44361,CPT,ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY,,,21 ,,RBRVS,2.87 ,1.92 ,1.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44363,CPT,ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY,,,21 ,,RBRVS,3.49 ,2.19 ,2.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44364,CPT,ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE,,,21 ,,RBRVS,3.73 ,2.37 ,2.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44365,CPT,ENTEROSCOPY > 2ND PRTN W/RMVL LESION CAUTERY,,,21 ,,RBRVS,3.31 ,2.13 ,2.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44366,CPT,ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING,,,21 ,,RBRVS,4.40 ,2.77 ,2.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44369,CPT,ENTEROSCOPY > 2ND PRTN ABLTJ LESION,,,21 ,,RBRVS,4.51 ,2.82 ,2.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44370,CPT,ENTEROSCOPY > 2ND PRTN TNDSC STENT PLMT,,,21 ,,RBRVS,4.79 ,3.14 ,3.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44372,CPT,ENTEROSCOPY > 2ND PRTN W/PLMT PRQ TUBE,,,21 ,,RBRVS,4.40 ,2.58 ,2.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44373,CPT,ENTEROSCOPY > 2ND PRTN CONV GSTRST TUBE,,,21 ,,RBRVS,3.49 ,2.15 ,2.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44376,CPT,ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX,,,21 ,,RBRVS,5.25 ,3.06 ,3.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44377,CPT,ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE,,,21 ,,RBRVS,5.52 ,3.32 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44378,CPT,ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING,,,21 ,,RBRVS,7.12 ,4.23 ,4.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44379,CPT,ENTEROSCOPY > 2ND PRTN W/ILEUM W/STENT PLMT,,,21 ,,RBRVS,7.46 ,4.59 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44380,CPT,ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX,,,21 ,,RBRVS,1.05 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44382,CPT,ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE,,,21 ,,RBRVS,1.27 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44383,CPT,ILEOSCOPY STOMA W/TNDSC STENT PLMT,,,21 ,,RBRVS,2.94 ,1.78 ,1.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44385,CPT,NDSC EVAL INTSTINAL POUCH DX W/WO COLLJ SPEC SPX,,,21 ,,RBRVS,1.82 ,1.08 ,5.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44386,CPT,NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE,,,21 ,,RBRVS,2.12 ,1.31 ,7.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44388,CPT,COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX,,,21 ,,RBRVS,2.82 ,1.69 ,7.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44389,CPT,COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE,,,21 ,,RBRVS,3.13 ,1.92 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44390,CPT,COLONOSCOPY STOMA W/RMVL FOREIGN BODY,,,21 ,,RBRVS,3.82 ,2.31 ,9.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44391,CPT,COLONOSCOPY STOMA CONTROL BLEEDING,,,21 ,,RBRVS,4.31 ,2.58 ,10.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44392,CPT,COLONOSCOPY STOMA RMVL LESION CAUTERY,,,21 ,,RBRVS,3.81 ,2.12 ,8.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44393,CPT,COLONOSCOPY STOMA ABLATION LESION,,,21 ,,RBRVS,4.83 ,2.75 ,9.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44394,CPT,COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE,,,21 ,,RBRVS,4.42 ,2.57 ,9.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44397,CPT,COLONOSCOPY STOMA W/TNDSC STENT PLMT,,,21 ,,RBRVS,4.70 ,2.88 ,2.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44500,CPT,INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE,,,21 ,,RBRVS,0.49 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44602,CPT,ENTERORRHAPHY 1PERFORATION,,,21 ,,RBRVS,24.72 ,10.85 ,10.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44603,CPT,ENTERORRHAPHY MULTIPLE PERFORATIONS,,,21 ,,RBRVS,28.16 ,12.74 ,12.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44604,CPT,SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY,,,21 ,,RBRVS,18.16 ,8.79 ,8.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44605,CPT,SUTR LG INTESTINE 1/MULT PERFORAT W/COLOSTOMY,,,21 ,,RBRVS,22.08 ,11.30 ,11.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44615,CPT,INTSTINAL STRICTUROPLASTY W/WO DILAT OBSTRCJ,,,21 ,,RBRVS,18.16 ,9.35 ,9.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44620,CPT,CLOSURE ENTEROSTOMY LG/SMALL INTESTINE,,,21 ,,RBRVS,14.43 ,7.80 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44625,CPT,CLSR NTRSTM LG/SM RESCJ&ANAST OTH/THN CLRCT,,,21 ,,RBRVS,17.28 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44626,CPT,CLSR NTRSTM LG/SM RESCJ&CLRCT ANAST,,,21 ,,RBRVS,27.90 ,13.09 ,13.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44640,CPT,CLOSURE INTESTINAL CUTANEOUS FISTULA,,,21 ,,RBRVS,24.20 ,11.68 ,11.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44650,CPT,CLSR ENTEROENTERIC/ENTEROCOLIC FSTL,,,21 ,,RBRVS,25.12 ,12.03 ,12.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44660,CPT,CLSR ENTEROVES FSTL W/O INTSTINAL/BLDR RESCJ,,,21 ,,RBRVS,23.91 ,11.88 ,11.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44661,CPT,CLSR ENTEROVES FSTL W/INT&/BLDR RESCJ,,,21 ,,RBRVS,27.35 ,12.99 ,12.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44680,CPT,INTESTINAL PLICATION SEPARATE PROCEDURE,,,21 ,,RBRVS,17.96 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44700,CPT,EXCLUSION SM INT FROM PELVIS MESH/PROSTH/TISS,,,21 ,,RBRVS,17.48 ,8.96 ,8.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44701,CPT,INTRAOPERATIVE COLONIC LAVAGE,,,21 ,,RBRVS,3.10 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44720,CPT,BKBENCH RCNSTJ INT ALGRFT VEN ANAST EA,,,21 ,,RBRVS,5.00 ,2.12 ,2.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44721,CPT,BKBENCH RCNSTJ INT ALGRFT ARTL ANAST EA,,,21 ,,RBRVS,7.00 ,2.81 ,2.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44799,CPT,UNLISTED PROCEDURE INTESTINE,,,21 ,,TotalUnits,,,,17.76 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,44800,CPT,EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT,,,21 ,,RBRVS,12.05 ,7.53 ,7.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44820,CPT,EXCISION LESION MESENTERY SEPARATE PROCEDURE,,,21 ,,RBRVS,13.73 ,7.75 ,7.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44850,CPT,SUTURE MESENTERY SEPARATE PROCEDURE,,,21 ,,RBRVS,12.11 ,6.97 ,6.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44899,CPT,UNLISTED PX MECKEL'S DIVERTICULUM & MESENTERY,,,21 ,,TotalUnits,,,,19.08 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,44900,CPT,I&D APPENDICEAL ABSC OPN,,,21 ,,RBRVS,12.57 ,7.09 ,7.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44901,CPT,I&D APPENDICEAL ABSC PRQ,,,21 ,,RBRVS,3.37 ,1.38 ,24.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44950,CPT,APPENDECTOMY,,,21 ,,RBRVS,10.60 ,5.76 ,5.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44955,CPT,APPENDEC INDICATED PURPOSE OTH MAJOR PX X SPX,,,21 ,,RBRVS,1.53 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44960,CPT,APPENDEC RPTD APPENDIX ABSC/PRITONITIS,,,21 ,,RBRVS,14.50 ,7.68 ,7.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44970,CPT,LAPAROSCOPIC APPENDECTOMY,,,21 ,,RBRVS,9.45 ,5.83 ,5.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,44979,CPT,UNLISTED LAPAROSCOPY PROCEDURE APPENDIX,,,21 ,,TotalUnits,,,,15.28 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,45000,CPT,TRANSRECTAL DRAINAGE OF PELVIC ABSCESS,,,21 ,,RBRVS,6.30 ,4.72 ,4.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45005,CPT,I&D SUBMUCOSAL ABSCESS RECTUM,,,21 ,,RBRVS,2.02 ,2.09 ,5.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45020,CPT,I&D DP SUPRALEVATOR PELVIRCT/RETRORCT ABSC,,,21 ,,RBRVS,8.56 ,5.99 ,5.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45100,CPT,BX ANORECTAL WALL ANAL APPROACH,,,21 ,,RBRVS,4.04 ,3.71 ,3.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45108,CPT,ANORECTAL MYOMECTOMY,,,21 ,,RBRVS,5.12 ,4.23 ,4.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45110,CPT,PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST,,,21 ,,RBRVS,30.76 ,16.99 ,16.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45111,CPT,PRCTECT PRTL RESCJ RECTUM TABDL APPR,,,21 ,,RBRVS,18.01 ,9.98 ,9.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45112,CPT,PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX,,,21 ,,RBRVS,33.18 ,15.54 ,15.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45113,CPT,PRCTECT PRTL W/MUCOSEC ILEOANAL ANAST RSVR,,,21 ,,RBRVS,33.22 ,17.01 ,17.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45114,CPT,PRCTECT PRTL W/ANAST ABDL&TRANSSAC APPR,,,21 ,,RBRVS,30.79 ,15.03 ,15.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45116,CPT,PRCTECT PRTL W/ANAST TRANSSAC APPR ONLY,,,21 ,,RBRVS,27.72 ,13.72 ,13.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45119,CPT,PRCTECT CMBN PULL-THRU W/RSVR W/NTRSTM,,,21 ,,RBRVS,33.48 ,17.10 ,17.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45120,CPT,PRCTECT COMPL W/PULL-THRU PX&ANAST,,,21 ,,RBRVS,26.40 ,13.85 ,13.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45121,CPT,PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS,,,21 ,,RBRVS,29.08 ,14.85 ,14.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45123,CPT,PRCTECT PRTL W/O ANAST PRNL APPR,,,21 ,,RBRVS,18.86 ,10.12 ,10.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45126,CPT,PELVIC EXENTERATION COLORECTAL MALIGNANCY,,,21 ,,RBRVS,49.10 ,24.86 ,24.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45130,CPT,EXC RCT PROCIDENTIA W/ANAST PRNL APPR,,,21 ,,RBRVS,18.50 ,9.76 ,9.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45135,CPT,EXC RCT PROCIDENTIA W/ANAST ABDL&PRNL APPR,,,21 ,,RBRVS,22.36 ,12.30 ,12.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45136,CPT,EXC ILEOANAL RSVR W/ILEOSTOMY,,,21 ,,RBRVS,30.82 ,17.10 ,17.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45150,CPT,DIVISION STRICTURE RECTUM,,,21 ,,RBRVS,5.85 ,4.72 ,4.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45160,CPT,EXC RCT TUM PROCTOTOMY TRANSSAC/TRANSCOCCYGEAL,,,21 ,,RBRVS,16.33 ,9.32 ,9.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45171,CPT,EXC RCT TUM NOT INCL MUSCULARIS PROPRIA,,,21 ,,RBRVS,8.13 ,8.03 ,8.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45172,CPT,EXC RCT TUM INCL MUSCULARIS PROPRIA,,,21 ,,RBRVS,12.13 ,9.76 ,9.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45190,CPT,DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH,,,21 ,,RBRVS,10.42 ,7.41 ,7.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45300,CPT,PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX,,,21 ,,RBRVS,0.80 ,0.60 ,2.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45303,CPT,PROCTOSGMDSC RIGID W/DILATION,,,21 ,,RBRVS,1.50 ,0.86 ,24.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45305,CPT,PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE,,,21 ,,RBRVS,1.25 ,0.81 ,3.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45307,CPT,PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY,,,21 ,,RBRVS,1.70 ,0.93 ,3.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45308,CPT,PROCTOSGMDSC RIGID RMVL 1 LESION CAUTERY,,,21 ,,RBRVS,1.40 ,0.85 ,4.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45309,CPT,PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ,,,21 ,,RBRVS,1.50 ,0.97 ,4.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45315,CPT,PROCTOSGMDSC RIGID RMVL MULT TUMOR CAUTERY/SNARE,,,21 ,,RBRVS,1.80 ,1.07 ,4.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45317,CPT,PROCTOSGMDSC RIGID CONTROL BLEEDING,,,21 ,,RBRVS,2.00 ,1.07 ,4.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45320,CPT,PROCTOSGMDSC RIGID ABLATION LESION,,,21 ,,RBRVS,1.78 ,1.08 ,4.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45321,CPT,PROCTOSGMDSC RIGID DCMPRN VOLVULUS,,,21 ,,RBRVS,1.75 ,1.07 ,1.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45327,CPT,PROCTOSGMDSC RIGID TNDSC STENT PLMT,,,21 ,,RBRVS,2.00 ,1.31 ,1.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45330,CPT,SIGMOIDOSCOPY FLX DX W/WO COLLJ SPECIMENS,,,21 ,,RBRVS,0.96 ,0.76 ,2.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45331,CPT,SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE,,,21 ,,RBRVS,1.15 ,0.93 ,3.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45332,CPT,SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY,,,21 ,,RBRVS,1.79 ,1.22 ,6.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45333,CPT,SIGMOIDOSCOPY FLX W/RMVL TUMOR CAUTERY,,,21 ,,RBRVS,1.79 ,1.21 ,6.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45334,CPT,SIGMOIDOSCOPY FLX CONTROL BLEEDING,,,21 ,,RBRVS,2.73 ,1.79 ,1.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45335,CPT,SGMDSC FLX DIRED SBMCSL NJX ANY SBST,,,21 ,,RBRVS,1.46 ,1.06 ,5.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45337,CPT,SGMDSC FLX DCMPRN VOLVULUS ANY METHOD,,,21 ,,RBRVS,2.36 ,1.51 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45338,CPT,SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ,,,21 ,,RBRVS,2.34 ,1.54 ,6.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45339,CPT,SIGMOIDOSCOPY FLX ABLTJ LESION,,,21 ,,RBRVS,3.14 ,1.97 ,6.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45340,CPT,SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS,,,21 ,,RBRVS,1.89 ,1.27 ,11.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45341,CPT,SIGMOIDOSCOPY FLX NDSC US XM,,,21 ,,RBRVS,2.60 ,1.73 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45342,CPT,SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX,,,21 ,,RBRVS,4.05 ,2.54 ,2.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45345,CPT,SIGMOIDOSCOPY FLX TNDSC STENT PLMT,,,21 ,,RBRVS,2.92 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45355,CPT,COLSC RGD/FLX TABDL VIA COLOTOMY 1/MLT,,,21 ,,RBRVS,3.51 ,1.98 ,1.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45378,CPT,COLONOSCOPY FLX DX W/WO COLLJ SPECIMENS,,,21 ,,RBRVS,3.69 ,2.22 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45379,CPT,COLSC FLX PROX SPLENIC FLXR RMVL FB,,,21 ,,RBRVS,4.68 ,2.73 ,9.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45380,CPT,COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE,,,21 ,,RBRVS,4.43 ,2.69 ,8.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45381,CPT,COLSC FLX PROX SPLENIC FLXR SBMCSL NJX,,,21 ,,RBRVS,4.19 ,2.57 ,8.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45382,CPT,COLSC FLX PROX SPLENIC FLXR CTRL BLD,,,21 ,,RBRVS,5.68 ,3.42 ,11.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45383,CPT,COLSC FLX PROX SPLENIC FLXR ABLTJ LES,,,21 ,,RBRVS,5.86 ,3.28 ,9.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45384,CPT,COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT,,,21 ,,RBRVS,4.69 ,2.70 ,8.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45385,CPT,COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ,,,21 ,,RBRVS,5.30 ,3.14 ,9.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45386,CPT,COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRIX,,,21 ,,RBRVS,4.57 ,2.68 ,14.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45387,CPT,COLSC FLX PROX SPLENIC FLXR TNDSC STENT PLMT,,,21 ,,RBRVS,5.90 ,3.57 ,3.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45391,CPT,COLSC FLX PROX SPLENIC FLXR NDSC US XM,,,21 ,,RBRVS,5.09 ,3.06 ,3.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45392,CPT,COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX,,,21 ,,RBRVS,6.54 ,3.85 ,3.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45395,CPT,LAPS PROCTECTOMY ABDOMINOPERINEAL W/COLOSTOMY,,,21 ,,RBRVS,33.00 ,18.65 ,18.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45397,CPT,LAPS PROCTECTOMY COMBINED PULL-THRU W/RESERVOIR,,,21 ,,RBRVS,36.50 ,19.65 ,19.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45400,CPT,LAPAROSCOPY PROCTOPEXY PROLAPSE,,,21 ,,RBRVS,19.44 ,10.36 ,10.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45402,CPT,LAPAROSCOPY PROCTOPEXY PROLAPSE SIGMOID RESCJ,,,21 ,,RBRVS,26.51 ,13.07 ,13.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45499,CPT,UNLISTED LAPAROSCOPY PROCEDURE RECTUM,,,21 ,,TotalUnits,,,,51.65 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,45500,CPT,PROCTOPLASTY STENOSIS,,,21 ,,RBRVS,7.73 ,5.92 ,5.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45505,CPT,PROCTOPLASTY PROLAPSE MUCOUS MEMBRANE,,,21 ,,RBRVS,8.36 ,6.78 ,6.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45520,CPT,PERIRECTAL INJ SCLEROSING SOLUTION PROLAPSE,,,21 ,,RBRVS,0.55 ,0.52 ,3.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45540,CPT,PROCTOPEXY ABDOMINAL APPROACH,,,21 ,,RBRVS,18.12 ,9.33 ,9.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45541,CPT,PROCTOPEXY PERINEAL APPROACH,,,21 ,,RBRVS,14.85 ,9.19 ,9.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45550,CPT,PROCTOPEXY W/SIGMOID RESCJ ABDL APPR,,,21 ,,RBRVS,24.80 ,13.03 ,13.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45560,CPT,REPAIR RECTOCELE SEPARATE PROCEDURE,,,21 ,,RBRVS,11.50 ,7.15 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45562,CPT,EXPL RPR&PRESACRAL DRG RECTAL INJURY,,,21 ,,RBRVS,17.98 ,10.87 ,10.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45563,CPT,EXPL RPR&PRESACRAL DRG RECTAL INJ W/COLOSTOMY,,,21 ,,RBRVS,26.38 ,15.24 ,15.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45800,CPT,CLOSURE RECTOVESICAL FISTULA,,,21 ,,RBRVS,20.31 ,11.49 ,11.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45805,CPT,CLSR RECTOVESICAL FISTULA W/COLOSTOMY,,,21 ,,RBRVS,23.32 ,13.63 ,13.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45820,CPT,CLOSURE RECTOURETHRAL FISTULA,,,21 ,,RBRVS,20.37 ,11.70 ,11.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45825,CPT,CLOSURE RECTOURETHRAL FISTULA W/COLOSTOMY,,,21 ,,RBRVS,24.17 ,14.40 ,14.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45900,CPT,RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE,,,21 ,,RBRVS,2.99 ,2.22 ,2.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45905,CPT,DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL,,,21 ,,RBRVS,2.35 ,2.08 ,2.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45910,CPT,DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL,,,21 ,,RBRVS,2.85 ,2.33 ,2.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45915,CPT,RMVL FECAL IMPACTION/FB SPX UNDER ANES,,,21 ,,RBRVS,3.19 ,2.72 ,5.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45990,CPT,ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX,,,21 ,,RBRVS,1.80 ,1.02 ,1.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,45999,CPT,UNLISTED PROCEDURE RECTUM,,,21 ,,TotalUnits,,,,7.59 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,46020,CPT,PLACEMENT SETON,,,21 ,,RBRVS,3.00 ,3.03 ,4.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46030,CPT,REMOVAL ANAL SETON OTHER MARKER,,,21 ,,RBRVS,1.26 ,1.08 ,2.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46040,CPT,I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX,,,21 ,,RBRVS,5.37 ,5.25 ,8.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46045,CPT,I&D INTRAMURAL IM/ABSC TRANSANAL ANES,,,21 ,,RBRVS,5.87 ,5.13 ,5.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46050,CPT,I&D PERIANAL ABSCESS SUPERFICIAL,,,21 ,,RBRVS,1.24 ,1.27 ,3.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46060,CPT,I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON,,,21 ,,RBRVS,6.37 ,5.78 ,5.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46070,CPT,INCISION ANAL SEPTUM INFANT,,,21 ,,RBRVS,2.79 ,3.48 ,3.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46080,CPT,SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX,,,21 ,,RBRVS,2.52 ,1.58 ,3.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46083,CPT,INCISION THROMBOSED HEMORRHOID EXTERNAL,,,21 ,,RBRVS,1.45 ,1.38 ,3.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46200,CPT,FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED,,,21 ,,RBRVS,3.59 ,4.77 ,7.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46220,CPT,EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS,,,21 ,,RBRVS,1.61 ,1.47 ,3.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46221,CPT,HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS,,,21 ,,RBRVS,2.36 ,2.60 ,4.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46230,CPT,EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS,,,21 ,,RBRVS,2.62 ,1.85 ,4.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46250,CPT,HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP,,,21 ,,RBRVS,4.25 ,3.82 ,7.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46255,CPT,HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP,,,21 ,,RBRVS,4.96 ,4.11 ,8.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46257,CPT,HEMORRHOID NTRNL & XTRNL 1 COLUMN W/FISSURECTOMY,,,21 ,,RBRVS,5.76 ,5.02 ,5.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46258,CPT,HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY,,,21 ,,RBRVS,6.41 ,5.43 ,5.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46260,CPT,HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GROUP,,,21 ,,RBRVS,6.73 ,5.39 ,5.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46261,CPT,HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSURECT,,,21 ,,RBRVS,7.76 ,5.82 ,5.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46262,CPT,HRHC 2/> COL/GRP W/FSTULECTMY INCL FSSRECTMY,,,21 ,,RBRVS,7.91 ,6.28 ,6.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46270,CPT,SURG TX ANAL FISTULA SUBQ,,,21 ,,RBRVS,4.92 ,5.04 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46275,CPT,SURG TX ANAL FISTULA INTERSPHINCTERIC,,,21 ,,RBRVS,5.42 ,5.18 ,8.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46280,CPT,TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON,,,21 ,,RBRVS,6.39 ,5.62 ,5.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46285,CPT,SURG TX ANAL FISTULA 2ND STAGE,,,21 ,,RBRVS,5.42 ,5.15 ,8.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46288,CPT,CLSR ANAL FSTL W/RCT ADVMNT FLAP,,,21 ,,RBRVS,7.81 ,6.28 ,6.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46320,CPT,EXC THROMBOSED HEMORRHOID XTRNL,,,21 ,,RBRVS,1.64 ,1.22 ,3.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46500,CPT,INJECTION SCLEROSING SOLUTION HEMORRHOIDS,,,21 ,,RBRVS,1.69 ,1.68 ,4.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46505,CPT,CHEMODENERVATION INTERNAL ANAL SPHINCTER,,,21 ,,RBRVS,3.18 ,3.03 ,4.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46600,CPT,ANOSCOPY DX W/WO COLLJ SPEC BR/WA SPX,,,21 ,,RBRVS,0.55 ,0.51 ,1.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46604,CPT,ANOSCOPY W/DILATION,,,21 ,,RBRVS,1.03 ,0.72 ,14.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46606,CPT,ANOSCOPY W/BX SINGLE/MULTIPLE,,,21 ,,RBRVS,1.20 ,0.78 ,4.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46608,CPT,ANOSCOPY W/RMVL FOREIGN BODY,,,21 ,,RBRVS,1.30 ,0.80 ,4.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46610,CPT,ANOSCOPY W/RMVL LESION CAUTERY,,,21 ,,RBRVS,1.28 ,0.83 ,4.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46611,CPT,ANOSC RMVL 1 TUM POLYP/OTH LES SNARE TQ,,,21 ,,RBRVS,1.30 ,0.85 ,3.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46612,CPT,ANOSC RMVL MULT TUMORS CAUTERY/SNARE,,,21 ,,RBRVS,1.50 ,0.96 ,5.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46614,CPT,ANOSCOPY CONTROL BLEEDING,,,21 ,,RBRVS,1.00 ,0.76 ,2.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46615,CPT,ANOSCOPY ABLATION LESION,,,21 ,,RBRVS,1.50 ,0.97 ,2.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46700,CPT,ANOPLASTY PLASTIC OPERATION STRICTURE ADULT,,,21 ,,RBRVS,9.81 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46705,CPT,ANOPLASTY PLASTIC OPERATION STRICTURE INFANT,,,21 ,,RBRVS,7.43 ,5.99 ,5.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46706,CPT,REPAIR ANAL FISTULA W/FIBRIN GLUE,,,21 ,,RBRVS,2.44 ,1.94 ,1.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46707,CPT,REPAIR ANORECTAL FISTULA PLUG,,,21 ,,RBRVS,6.39 ,6.50 ,6.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46710,CPT,RPR ILEOANAL POUCH FSTL/POUCH ADVMNT TPRNL APPR,,,21 ,,RBRVS,17.14 ,10.77 ,10.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46712,CPT,RPR ILEOANAL POUCH FSTL/POUCH ADVMNT CMBN APPR,,,21 ,,RBRVS,36.45 ,19.91 ,19.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46715,CPT,RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK,,,21 ,,RBRVS,7.62 ,5.84 ,5.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46716,CPT,RPR LW IMPERFORATE ANUS W/TRPOS FISTULA,,,21 ,,RBRVS,17.54 ,14.45 ,14.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46730,CPT,RPR HI IMPRF ANUS W/O FSTL PRNL/SACROPRNL APPR,,,21 ,,RBRVS,30.65 ,18.42 ,18.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46735,CPT,RPR HI IMPRF ANUS W/O FISTULA CMBN APPR,,,21 ,,RBRVS,36.14 ,20.71 ,20.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46740,CPT,RPR HI IMPRF ANUS W/FSTL PRNL/SACROPRNL APPR,,,21 ,,RBRVS,33.90 ,20.20 ,20.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46742,CPT,RPR HI IMPRF ANUS W/FSTL TABDL&SACROPRNL,,,21 ,,RBRVS,40.14 ,22.89 ,22.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46744,CPT,RPR CLOACAL ANOMALY SACROPERINEAL,,,21 ,,RBRVS,58.94 ,30.46 ,30.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46746,CPT,RPR CLOACAL ANOMALY CMBN ABDL&SACROPRNL,,,21 ,,RBRVS,65.44 ,33.54 ,33.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46748,CPT,RPR CLOACAL ANOMALY CMBN ABDL&SACROPRNL W/GRF,,,21 ,,RBRVS,71.42 ,33.62 ,33.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46750,CPT,SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT,,,21 ,,RBRVS,12.15 ,7.84 ,7.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46751,CPT,SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD,,,21 ,,RBRVS,9.30 ,6.89 ,6.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46753,CPT,GRF THIERSCH RCT INCONTINENCE&/PROLAPSE,,,21 ,,RBRVS,8.89 ,6.28 ,6.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46754,CPT,RMVL THIERSCH WIRE/SUTURE ANAL CANAL,,,21 ,,RBRVS,3.01 ,3.01 ,4.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46760,CPT,SPHINCTEROPLASTY ANAL MUSCLE TRANSPLANT,,,21 ,,RBRVS,17.45 ,11.12 ,11.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46761,CPT,SPHNCTROP ANAL LEVATOR MUSC IMBRCJ,,,21 ,,RBRVS,15.29 ,9.09 ,9.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46762,CPT,SPHNCTROP ANAL IMPLTJ ARTIF SPHNCTR,,,21 ,,RBRVS,14.82 ,9.42 ,9.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46900,CPT,DSTRJ LESION ANUS SIMPLE CHEMICAL,,,21 ,,RBRVS,1.91 ,1.76 ,4.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46910,CPT,DSTRJ LESION ANUS SMPL ELTRDSICCATION,,,21 ,,RBRVS,1.91 ,1.59 ,4.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46916,CPT,DSTRJ LESION ANUS SIMPLE CRYOSURGERY,,,21 ,,RBRVS,1.91 ,2.04 ,4.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46917,CPT,DSTRJ LESION ANUS SIMPLE LASER SURG,,,21 ,,RBRVS,1.91 ,1.61 ,10.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46922,CPT,DSTRJ LESION ANUS SIMPLE SURG EXCISION,,,21 ,,RBRVS,1.91 ,1.60 ,5.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46924,CPT,DSTRJ LESION ANUS EXTENSIVE,,,21 ,,RBRVS,2.81 ,2.05 ,11.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46930,CPT,DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY,,,21 ,,RBRVS,1.61 ,2.48 ,4.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46940,CPT,CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX 1ST,,,21 ,,RBRVS,2.35 ,1.49 ,3.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46942,CPT,CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX SBSQ,,,21 ,,RBRVS,2.07 ,1.37 ,3.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46945,CPT,HRHC NTRNL LIG OTH THAN RBBR BAND 1 COL/GRP,,,21 ,,RBRVS,2.21 ,3.69 ,5.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46946,CPT,HRHC NTRNL LIG OTH THAN RBBR BAND 2/> COL/GRP,,,21 ,,RBRVS,2.63 ,3.32 ,5.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46947,CPT,HEMORRHOIDOPEXY STAPLING,,,21 ,,RBRVS,5.57 ,4.21 ,4.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,46999,CPT,UNLISTED PROCEDURE ANUS,,,21 ,,TotalUnits,,,,5.73 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,47000,CPT,BIOPSY LIVER NEEDLE PERCUTANEOUS,,,21 ,,RBRVS,1.90 ,0.81 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47001,CPT,BX LVR NDL DONE PURPOSE TM OTH MAJOR PX,,,21 ,,RBRVS,1.90 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47010,CPT,HEPATOTOMY OPN DRG ABSCESS/CYST 1/2 STAGES,,,21 ,,RBRVS,19.40 ,11.31 ,11.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47011,CPT,HEPATOTOMY PRQ DRG ABSCESS/CYST 1/2 STAGES,,,21 ,,RBRVS,3.69 ,1.54 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47015,CPT,LAPT W/ASPIR&/NJX HEPATC PARASITIC CYST/ABSCESS,,,21 ,,RBRVS,18.50 ,10.94 ,10.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47100,CPT,BIOPSY LIVER WEDGE,,,21 ,,RBRVS,12.91 ,8.64 ,8.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47120,CPT,HEPATECTOMY RESCJ PARTIAL LOBECTOMY,,,21 ,,RBRVS,39.01 ,20.15 ,20.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47122,CPT,HEPATECTOMY RESCJ TRISEGMENTECTOMY,,,21 ,,RBRVS,59.48 ,27.54 ,27.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47125,CPT,HEPATECTOMY RESCJ TOTAL LEFT LOBECTOMY,,,21 ,,RBRVS,53.04 ,24.99 ,24.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47130,CPT,HEPATECTOMY RESCJ TOTAL RIGHT LOBECTOMY,,,21 ,,RBRVS,57.19 ,26.56 ,26.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47135,CPT,LVR ALTRNSPLJ ORTHOTOPIC PRTL/WHL DON ANY AGE,,,21 ,,RBRVS,83.64 ,40.62 ,40.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47136,CPT,LVR ALTRNSPLJ HTRTPC PRTL/WHL DON ANY AGE,,,21 ,,RBRVS,70.74 ,34.72 ,34.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47140,CPT,DONOR HEPATECTOMY LIVING DONOR SEG II&III,,,21 ,,RBRVS,59.40 ,30.99 ,30.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47141,CPT,DONOR HEPATECTOMY LIVING DONOR SEG II III&IV,,,21 ,,RBRVS,71.50 ,35.51 ,35.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47142,CPT,DONOR HEPATECTOMY LIVING DONOR SEG V VI VII&VIII,,,21 ,,RBRVS,79.44 ,39.70 ,39.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47143,CPT,BKBENCH PREP CADAVER DONOR,,,21 ,,TotalUnits,,,,15.66 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,47146,CPT,BKBENCH RCNSTJ LVR GRF VENOUS ANAST EA,,,21 ,,RBRVS,6.00 ,2.37 ,2.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47147,CPT,BKBENCH RCNSTJ LVR GRF ARTL ANAST EA,,,21 ,,RBRVS,7.00 ,2.77 ,2.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47300,CPT,MARSUPIALIZATION CST/ABSC LVR,,,21 ,,RBRVS,18.14 ,10.67 ,10.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47350,CPT,MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ,,,21 ,,RBRVS,22.49 ,12.45 ,12.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47360,CPT,MGMT LVR HEMRRG CPLX SUTR WND/INJ,,,21 ,,RBRVS,31.31 ,16.23 ,16.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47361,CPT,MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR,,,21 ,,RBRVS,52.60 ,24.32 ,24.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47362,CPT,MGMT LVR HEMRRG RE-EXPL WND RMVL PACKING,,,21 ,,RBRVS,23.54 ,13.08 ,13.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47370,CPT,LAPS SURG ABLTJ 1/> LVR TUM RF,,,21 ,,RBRVS,20.80 ,10.86 ,10.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47371,CPT,LAPS SURG ABLTJ 1 > LVR TUM CRYOSURG,,,21 ,,RBRVS,20.80 ,11.35 ,11.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47379,CPT,UNLIS LAPAROSCOPIC PROCEDURE LIVER,,,21 ,,TotalUnits,,,,31.66 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,47380,CPT,ABLTJ OPN 1/> LVR TUM RF,,,21 ,,RBRVS,24.56 ,12.30 ,12.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47381,CPT,ABLTJ OPN 1/> LVR TUM CRYOSURG,,,21 ,,RBRVS,24.88 ,11.53 ,11.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47382,CPT,ABLTJ 1/> LVR TUM PRQ RF,,,21 ,,RBRVS,15.22 ,7.14 ,119.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47399,CPT,UNLISTED PROCEDURE LIVER,,,21 ,,TotalUnits,,,,3.18 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,47400,CPT,HEPATCOTOMY/HEPATCOSTOMY W/EXPL DRG/RMVL ST1,,,21 ,,RBRVS,36.36 ,18.26 ,18.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47420,CPT,CHOLEDOCHOT/OST W/O SPHNCTROTOMY/SPHNCTROP,,,21 ,,RBRVS,22.03 ,12.09 ,12.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47425,CPT,CHOLEDOCHOT/OST W/SPHNCTROTOMY/SPHNCTROP,,,21 ,,RBRVS,22.31 ,12.30 ,12.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47460,CPT,TRANSDUOL SPHINCTEROT/PLASTY W/WO RMVL CALCULUS,,,21 ,,RBRVS,20.52 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47480,CPT,CHOLECSTOT/CHOLECSTOST W/EXPL DRG/RMVL ST1 SPX,,,21 ,,RBRVS,13.25 ,8.99 ,8.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47490,CPT,CHOLECYSTOSTOMY PRQ W/IMAGING & CATH PLMT,,,21 ,,RBRVS,4.76 ,5.55 ,5.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47500,CPT,INJECTION PX PRQ TRANSHEPATIC CHOLANGIOGRAPHY,,,21 ,,RBRVS,1.96 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47505,CPT,INJ PX CHOLANGIOGRAPHY VIA CATHETER/T-TUBE,,,21 ,,RBRVS,0.76 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47510,CPT,INTRO PRQ TRANSHEPATC CATH BILIARY DRG,,,21 ,,RBRVS,8.03 ,5.44 ,5.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47511,CPT,INTRO PRQ TRANSHEPATC STENT BILIARY DRG,,,21 ,,RBRVS,10.77 ,5.86 ,5.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47525,CPT,CHANGE PRQ BILIARY DRAINAGE CATHETER,,,21 ,,RBRVS,1.54 ,1.22 ,13.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47530,CPT,REVJ&/RINSJ TRANSHEPATC TUBE,,,21 ,,RBRVS,6.05 ,4.08 ,35.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47550,CPT,BILIARY NDSC INTRAOPERATIVE,,,21 ,,RBRVS,3.02 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47552,CPT,BILIARY NDSC PRQ T-TUBE DX W/WO COLLJ SPEC SPX,,,21 ,,RBRVS,6.03 ,2.92 ,2.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47553,CPT,BILIARY NDSC PRQ T-TUBE W/BX SINGLE/MULTIPLE,,,21 ,,RBRVS,6.34 ,2.62 ,2.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47554,CPT,BILIARY ENDOSCOPY PRQ VIA T-TUBE W/RMVL CALCULUS,,,21 ,,RBRVS,9.05 ,4.14 ,4.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47555,CPT,BILIARY NDSC PRQ T-TUBE W/DIL DUCT W/O STENT,,,21 ,,RBRVS,7.55 ,3.13 ,3.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47556,CPT,BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT,,,21 ,,RBRVS,8.55 ,3.56 ,3.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47560,CPT,LAPS SURG W/GID TRANSHEPATC CHOLANGRPH W/O BX,,,21 ,,RBRVS,4.88 ,1.95 ,1.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47561,CPT,LAPS SURG W/GID TRANSHEPATC CHOLANGRPH W/BX,,,21 ,,RBRVS,5.17 ,2.33 ,2.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47562,CPT,LAPAROSCOPY SURG CHOLECYSTECTOMY,,,21 ,,RBRVS,11.76 ,7.29 ,7.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47563,CPT,LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY,,,21 ,,RBRVS,12.11 ,7.14 ,7.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47564,CPT,LAPS SURG CHOLECSTC W/EXPL COMMON DUCT,,,21 ,,RBRVS,14.24 ,7.74 ,7.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47570,CPT,LAPAROSCOPY SURG CHOLECYSTOENETEROSTOMY,,,21 ,,RBRVS,12.56 ,7.15 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47579,CPT,UNLISTED LAPAROSCOPY PROCEDURE BILIARY TRACT,,,21 ,,TotalUnits,,,,19.05 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,47600,CPT,CHOLECYSTECTOMY,,,21 ,,RBRVS,17.48 ,9.94 ,9.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47605,CPT,CHOLECYSTECTOMY W/CHOLANGIOGRAPHY,,,21 ,,RBRVS,15.98 ,8.98 ,8.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47610,CPT,CHOLECYSTECTOMY W/EXPLORATION COMMON DUCT,,,21 ,,RBRVS,20.92 ,10.92 ,10.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47612,CPT,CHOLECYSTECTOMY EXPL DUCT CHOLEDOCHOENTEROSTOMY,,,21 ,,RBRVS,21.21 ,10.97 ,10.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47620,CPT,CHOLECSTC EXPL DUX SPHNCTROTOMY/SPHNCTROP,,,21 ,,RBRVS,23.07 ,11.85 ,11.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47630,CPT,BILIARY DUCT STONE XTRJ PRQ VIA BASKET/SNARE,,,21 ,,RBRVS,9.65 ,5.69 ,5.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47700,CPT,EXPL CONGENITAL ATRESIA BILE DUCTS,,,21 ,,RBRVS,16.50 ,10.30 ,10.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47701,CPT,PORTOENETEROSTOMY,,,21 ,,RBRVS,28.73 ,16.14 ,16.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47711,CPT,EXC BILE DUX TUM W/WO PRIM RPR XTRHEPATC,,,21 ,,RBRVS,25.90 ,13.72 ,13.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47712,CPT,EXC BILE DUX TUM W/WO PRIM RPR INTRAHEPATC,,,21 ,,RBRVS,33.72 ,16.89 ,16.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47715,CPT,EXCISION CHOLEDOCHAL CYST,,,21 ,,RBRVS,21.55 ,12.09 ,12.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47720,CPT,CHOLECYSTOENTEROSTOMY DIRECT,,,21 ,,RBRVS,18.34 ,10.77 ,10.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47721,CPT,CHOLECYSTOENTEROSTOMY W/GASTROENTEROSTOMY,,,21 ,,RBRVS,21.99 ,12.28 ,12.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47740,CPT,CHOLECYSTOENTEROSTOMY ROUX-EN-Y,,,21 ,,RBRVS,21.23 ,11.95 ,11.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47741,CPT,CHOLECSTONTRSTM ROUX-EN-Y W/GASTRONTRSTM,,,21 ,,RBRVS,24.21 ,13.16 ,13.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47760,CPT,ANAST XTRHEPATC BILIARY DUCTS & GI TRACT,,,21 ,,RBRVS,38.32 ,18.45 ,18.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47765,CPT,ANAST INTRAHEPATC DUCTS & GI TRACT,,,21 ,,RBRVS,52.19 ,23.76 ,23.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47780,CPT,ANAST ROUX-EN-Y XTRHEPATC BILIARY DUCTS&GI,,,21 ,,RBRVS,42.32 ,19.83 ,19.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47785,CPT,ANAST ROUX-EN-Y INTRAHEPATC BILIARY DUCTS&GI,,,21 ,,RBRVS,56.19 ,25.09 ,25.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47800,CPT,RCNSTJ PLSTC BILIARY DUCTS W/END-TO-END ANAST,,,21 ,,RBRVS,26.17 ,13.93 ,13.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47801,CPT,PLACEMENT CHOLEDOCHAL STENT,,,21 ,,RBRVS,17.60 ,10.36 ,10.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47802,CPT,U-TUBE HEPATICOENTEROSTOMY,,,21 ,,RBRVS,24.93 ,13.74 ,13.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47900,CPT,SUTURE EXTRAHEPATIC BILE DUCT PRE-EXIST INJURY,,,21 ,,RBRVS,22.44 ,12.24 ,12.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,47999,CPT,UNLISTED PROCEDURE BILIARY TRACT,,,21 ,,TotalUnits,,,,19.05 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,48000,CPT,PLACE DRAIN PERIPANCREATIC ACUTE PANCREATITIS,,,21 ,,RBRVS,31.95 ,15.62 ,15.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48001,CPT,PLACE DRAIN PERIPANCREATIC W/CHOLECYSTOSTOMY,,,21 ,,RBRVS,39.69 ,18.80 ,18.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48020,CPT,REMOVAL PANCREATIC CALCULUS,,,21 ,,RBRVS,19.09 ,10.79 ,10.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48100,CPT,BIOPSY PANCREAS OPEN,,,21 ,,RBRVS,14.46 ,8.17 ,8.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48102,CPT,BIOPSY PANCREA PERCUTANEOUS NEEDLE,,,21 ,,RBRVS,4.70 ,2.24 ,10.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48105,CPT,RESECJ/DBRDMT PANCREAS NECROTIZING PANCREATITIS,,,21 ,,RBRVS,49.26 ,23.11 ,23.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48120,CPT,EXCISION LESION PANCREAS,,,21 ,,RBRVS,18.41 ,9.69 ,9.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48140,CPT,PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY,,,21 ,,RBRVS,26.32 ,13.33 ,13.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48145,CPT,PNCRTECT DSTL STOT W/PNCRTCOJEJUNOSTOMY,,,21 ,,RBRVS,27.39 ,13.91 ,13.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48146,CPT,PNCRTECT DSTL NR-TOT W/PRSRV DUO CHLD-TYP PX,,,21 ,,RBRVS,30.60 ,16.93 ,16.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48148,CPT,EXCISION AMPULLA VATER,,,21 ,,RBRVS,20.39 ,11.18 ,11.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48150,CPT,PNCRTECT PROX STOT W/PANCREATOJEJUNOSTOMY,,,21 ,,RBRVS,52.84 ,25.92 ,25.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48152,CPT,PNCRTECT WHIPPLE W/O PANCREATOJEJUNOSTOMY,,,21 ,,RBRVS,48.65 ,24.53 ,24.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48153,CPT,PNCRTECT W/PANCREATOJEJUNOSTOMY,,,21 ,,RBRVS,52.79 ,25.86 ,25.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48154,CPT,PNCRTECT PROX STOT W/O PANCREATOJEJUNOSTOMY,,,21 ,,RBRVS,48.88 ,24.53 ,24.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48155,CPT,PANCREATECTOMY TOTAL,,,21 ,,RBRVS,29.45 ,16.62 ,16.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48160,CPT,PANCREATECTOMY W/TRNSPLJ PANCREAS/ISLET CELLS,,,21 ,,RBRVS,43.68 ,38.38 ,38.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48400,CPT,INJECTION INTRAOPERATIVE PANCREATOGRAPHY,,,21 ,,RBRVS,1.95 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48500,CPT,MARSUPIALIZATION PANCREATIC CYST,,,21 ,,RBRVS,18.16 ,10.98 ,10.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48510,CPT,XTRNL DRG PSEUDOCYST PANCREAS OPEN,,,21 ,,RBRVS,17.19 ,10.48 ,10.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48511,CPT,XTRNL DRG PSEUDOCYST PANCREAS PRQ,,,21 ,,RBRVS,3.99 ,1.67 ,23.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48520,CPT,INT ANAST PANCREATIC CYST GI TRACT DIRECT,,,21 ,,RBRVS,18.15 ,9.63 ,9.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48540,CPT,INT ANAST PANCREATIC CYST GI TRACT ROUX-EN-Y,,,21 ,,RBRVS,21.94 ,10.91 ,10.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48545,CPT,PANCREATORRHAPHY INJURY,,,21 ,,RBRVS,22.23 ,11.71 ,11.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48547,CPT,DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ,,,21 ,,RBRVS,30.38 ,14.91 ,14.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48548,CPT,PANCREATICOJEJUNOSTOMY SIDE-TO-SIDE ANAST,,,21 ,,RBRVS,28.09 ,14.15 ,14.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48552,CPT,BKBENCH RCNSTJ CDVR PNCRS ALGRFT VEN ANAST EA,,,21 ,,RBRVS,4.30 ,1.73 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48554,CPT,TRANSPLANTATION PANCREATIC ALLOGRAFT,,,21 ,,RBRVS,37.80 ,27.54 ,27.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48556,CPT,RMVL TRANSPLANTED PANCREATIC ALLOGRAFT,,,21 ,,RBRVS,19.47 ,12.79 ,12.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,48999,CPT,UNLISTED PROCEDURE PANCREAS,,,21 ,,TotalUnits,,,,7.47 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,49000,CPT,EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX,,,21 ,,RBRVS,12.54 ,7.23 ,7.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49002,CPT,REOPENING RECENT LAPAROTOMY,,,21 ,,RBRVS,17.63 ,8.81 ,8.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49010,CPT,EXPL RETROPERITONEUM W/WO BX SPX,,,21 ,,RBRVS,16.06 ,8.34 ,8.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49020,CPT,DRG PERITONEAL ABSCESS/LOCAL PERITONITIS OPEN,,,21 ,,RBRVS,26.67 ,14.00 ,14.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49021,CPT,DRG PERITONEAL ABSCESS/LOCAL PERITONITIS PRQ,,,21 ,,RBRVS,3.37 ,1.40 ,22.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49040,CPT,DRG SUBDIAPHRAGMATIC/SUBPHRENIC ABSCESS OPEN,,,21 ,,RBRVS,16.52 ,9.08 ,9.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49041,CPT,DRG SUBDIAPHRAGMATIC/SUBPHRENIC ABSCESS PRQ,,,21 ,,RBRVS,3.99 ,1.66 ,22.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49060,CPT,DRG RETROPERITONEAL ABSCESS OPEN,,,21 ,,RBRVS,18.53 ,9.90 ,9.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49061,CPT,DRG RETROPERITONEAL ABSCESS PERCUTANEOUS,,,21 ,,RBRVS,3.69 ,1.54 ,22.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49062,CPT,DRG XTRAPERITONEAL LYMPHOCELE PERITON CAVITY OPN,,,21 ,,RBRVS,12.22 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49082,CPT,ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE,,,21 ,,RBRVS,1.24 ,0.70 ,3.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49083,CPT,ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE,,,21 ,,RBRVS,2.00 ,0.98 ,6.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49084,CPT,PERITONEAL LAVAGE W/WO IMAGING GUIDANCE,,,21 ,,RBRVS,2.00 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49180,CPT,BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE,,,21 ,,RBRVS,1.73 ,0.72 ,2.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49203,CPT,EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/<,,,21 ,,RBRVS,20.13 ,10.70 ,10.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49204,CPT,EXC/DESTRUCTION OPEN ABDMNL TUMORS 5.1-10.0 CM,,,21 ,,RBRVS,26.13 ,13.06 ,13.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49205,CPT,EXC/DESTRUCTION OPEN ABDOMINAL TUMORS >10.0 CM,,,21 ,,RBRVS,30.13 ,14.65 ,14.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49215,CPT,EXC PRESAC/SACROCOCCYGEAL TUMOR,,,21 ,,RBRVS,37.81 ,18.69 ,18.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49220,CPT,STAGING LAPAROTOMY HODGKINS DISEASE/LYMPHOMA,,,21 ,,RBRVS,15.79 ,8.93 ,8.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49250,CPT,UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX,,,21 ,,RBRVS,9.01 ,5.98 ,5.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49255,CPT,OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX,,,21 ,,RBRVS,12.56 ,7.71 ,7.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49320,CPT,LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX,,,21 ,,RBRVS,5.14 ,3.34 ,3.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49321,CPT,LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE,,,21 ,,RBRVS,5.44 ,3.50 ,3.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49322,CPT,LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE,,,21 ,,RBRVS,6.01 ,3.65 ,3.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49323,CPT,LAPS SURG W/DRG LYMPHOCELE PRTL CAVITY,,,21 ,,RBRVS,10.23 ,6.36 ,6.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49324,CPT,LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER,,,21 ,,RBRVS,6.32 ,3.81 ,3.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49325,CPT,LAPS W/REVISION INTRAPERITONEAL CATHETER,,,21 ,,RBRVS,6.82 ,3.98 ,3.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49326,CPT,LAPAROSCOPY W/OMENTOPEXY,,,21 ,,RBRVS,3.50 ,1.32 ,1.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49327,CPT,LAPS W/INSERTION NTRSTL DEV W/IMG GID 1/MLT,,,21 ,,RBRVS,2.38 ,1.03 ,1.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49329,CPT,UNLISTED LAPAROSCOPIC PX ABD PRTM&OMENTUM,,,21 ,,TotalUnits,,,,8.48 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,49400,CPT,INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX,,,21 ,,RBRVS,1.88 ,0.77 ,2.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49402,CPT,REMOVAL PERITONEAL FOREIGN BODY FROM CAVITY,,,21 ,,RBRVS,14.09 ,7.78 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49411,CPT,INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT,,,21 ,,RBRVS,3.82 ,1.65 ,11.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49412,CPT,PLMT INTRSTL DEV OPN W/IMG GID 1/MLT,,,21 ,,RBRVS,1.50 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49418,CPT,INSJ INTRAPERITONEAL CATHETER W/IMG GID,,,21 ,,RBRVS,4.21 ,2.07 ,39.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49419,CPT,INSERTION TUNNEL INTRAPERITONEAL CATH SUBQ PORT,,,21 ,,RBRVS,7.08 ,4.59 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49421,CPT,INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN,,,21 ,,RBRVS,4.21 ,2.89 ,2.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49422,CPT,REMOVAL TUNNELED INTRAPERITONEAL CATHETER,,,21 ,,RBRVS,6.29 ,3.61 ,3.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49423,CPT,EXCHNG ABSC/CST DRG CATH RAD GID SPX,,,21 ,,RBRVS,1.46 ,0.65 ,15.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49424,CPT,CNTRST NJX ASSMT ABSC/CST VIA DRG CATH/TUBE SPX,,,21 ,,RBRVS,0.76 ,0.35 ,3.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49425,CPT,INSERTION PERITONEAL-VENOUS SHUNT,,,21 ,,RBRVS,12.22 ,7.18 ,7.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49426,CPT,REVIS PERITONEAL-VENOUS SHUNT,,,21 ,,RBRVS,10.41 ,6.14 ,6.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49427,CPT,INJECT EVALUATE PREVIOUS PERITONEAL-VENOUS SHUNT,,,21 ,,RBRVS,0.89 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49428,CPT,LIGATION PERITONEAL-VENOUS SHUNT,,,21 ,,RBRVS,6.87 ,4.34 ,4.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49429,CPT,RMVL PERITONEAL-VENOUS SHUNT,,,21 ,,RBRVS,7.44 ,4.31 ,4.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49435,CPT,INSJ SUBQ EXTENSION INTRAPERITONEAL CATHETER,,,21 ,,RBRVS,2.25 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49436,CPT,DELAYED CREATION EXIT SITE EMBEDDED CATHETER,,,21 ,,RBRVS,2.72 ,2.09 ,2.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49440,CPT,INSERT GASTROSTOMY TUBE PERCUTANEOUS,,,21 ,,RBRVS,4.18 ,2.16 ,27.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49441,CPT,INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ,,,21 ,,RBRVS,4.77 ,2.44 ,30.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49442,CPT,INSERT CECOSTOMY/OTHER COLONIC TUBE PERCUTANEOUS,,,21 ,,RBRVS,4.00 ,2.04 ,25.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49446,CPT,CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ,,,21 ,,RBRVS,3.31 ,1.39 ,26.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49450,CPT,REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS,,,21 ,,RBRVS,1.36 ,0.54 ,19.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49451,CPT,REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ,,,21 ,,RBRVS,1.84 ,0.78 ,19.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49452,CPT,REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS,,,21 ,,RBRVS,2.86 ,1.21 ,23.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49460,CPT,OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE,,,21 ,,RBRVS,0.96 ,0.40 ,22.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49465,CPT,CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE,,,21 ,,RBRVS,0.62 ,0.26 ,4.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49491,CPT,RPR 1ST INGUN HRNA PRETERM INFT RDC,,,21 ,,RBRVS,12.53 ,7.53 ,7.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49492,CPT,RPR 1ST INGUN HRNA PRETERM INFT INCARCERATED,,,21 ,,RBRVS,15.43 ,8.82 ,8.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49495,CPT,RPR 1ST INGUN HRNA FULL TERM INFT<6 MO RDC,,,21 ,,RBRVS,6.20 ,4.11 ,4.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49496,CPT,RPR 1ST INGUN HRNA FULL TERM INFT<6 MO INCARCER,,,21 ,,RBRVS,9.42 ,6.14 ,6.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49500,CPT,RPR 1ST INGUN HRNA AGE 6 MO-5 YRS REDUCIBLE,,,21 ,,RBRVS,5.84 ,3.99 ,3.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49501,CPT,RPR 1ST INGUN HRNA AGE 6 MO-5 YRS INCARCERATED,,,21 ,,RBRVS,9.36 ,5.99 ,5.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49505,CPT,RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE,,,21 ,,RBRVS,7.96 ,5.31 ,5.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49507,CPT,RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED,,,21 ,,RBRVS,10.05 ,6.19 ,6.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49520,CPT,RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE,,,21 ,,RBRVS,9.99 ,6.10 ,6.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49521,CPT,RPR RECRT INGUN HERNIA ANY AGE INCARCERATED,,,21 ,,RBRVS,12.44 ,7.04 ,7.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49525,CPT,RPR INGUN HERNIA SLIDING ANY AGE,,,21 ,,RBRVS,8.93 ,5.68 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49540,CPT,REPAIR LUMBAR HERNIA,,,21 ,,RBRVS,10.74 ,6.49 ,6.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49550,CPT,RPR 1ST FEM HRNA ANY AGE REDUCIBLE,,,21 ,,RBRVS,8.99 ,5.69 ,5.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49553,CPT,RPR 1ST FEM HERNIA ANY AGE INCARCERATED,,,21 ,,RBRVS,9.92 ,6.14 ,6.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49555,CPT,RPR RECRT FEM HERNIA REDUCIBLE,,,21 ,,RBRVS,9.39 ,5.85 ,5.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49557,CPT,RPR RECRT FEM HRNA INCARCERATED,,,21 ,,RBRVS,11.62 ,6.81 ,6.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49560,CPT,REPAIR FIRST ABDOMINAL WALL HERNIA,,,21 ,,RBRVS,11.92 ,6.88 ,6.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49561,CPT,RPR 1ST INCAL/VNT HERNIA INCARCERATED,,,21 ,,RBRVS,15.38 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49565,CPT,RPR RECRT INCAL/VNT HERNIA REDUCIBLE,,,21 ,,RBRVS,12.37 ,7.19 ,7.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49566,CPT,RPR RECRT INCAL/VNT HERNIA INCARCERATED,,,21 ,,RBRVS,15.53 ,8.35 ,8.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49568,CPT,IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE,,,21 ,,RBRVS,4.88 ,1.93 ,1.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49570,CPT,RPR EPIGASTRIC HERNIA REDUCIBLE SPX,,,21 ,,RBRVS,6.05 ,4.55 ,4.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49572,CPT,RPR EPIGASTRIC HERNIA INCARCERATED,,,21 ,,RBRVS,7.87 ,5.22 ,5.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49580,CPT,RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE,,,21 ,,RBRVS,4.47 ,3.98 ,3.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49582,CPT,RPR UMBILICAL HERNIA <5 YRS INCARCERATED,,,21 ,,RBRVS,7.13 ,5.11 ,5.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49585,CPT,RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE,,,21 ,,RBRVS,6.59 ,4.75 ,4.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49587,CPT,RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED,,,21 ,,RBRVS,8.04 ,5.30 ,5.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49590,CPT,RPR SPIGELIAN HERNIA,,,21 ,,RBRVS,8.90 ,5.67 ,5.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49600,CPT,RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE,,,21 ,,RBRVS,11.55 ,7.15 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49605,CPT,RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH,,,21 ,,RBRVS,87.09 ,39.02 ,39.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49606,CPT,RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH,,,21 ,,RBRVS,19.00 ,9.76 ,9.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49610,CPT,RPR OMPHALOCELE GROSS TYP OPRATION 1ST STG,,,21 ,,RBRVS,10.91 ,6.64 ,6.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49611,CPT,RPR OMPHALOCELE GROSS TYP OPRATION 2ND STG,,,21 ,,RBRVS,9.34 ,6.12 ,6.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49650,CPT,LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA,,,21 ,,RBRVS,6.36 ,4.56 ,4.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49651,CPT,LAPS SURG RPR RECURRENT INGUINAL HERNIA,,,21 ,,RBRVS,8.38 ,5.79 ,5.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49652,CPT,LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE,,,21 ,,RBRVS,12.88 ,7.39 ,7.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49653,CPT,LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED,,,21 ,,RBRVS,16.21 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49654,CPT,LAPAROSCOPY REPAIR INCISIONAL HERNIA REDUCIBLE,,,21 ,,RBRVS,15.03 ,8.24 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49655,CPT,LAPS RPR INCISIONAL HERNIA NCRC8/STRANGULATED,,,21 ,,RBRVS,18.11 ,9.89 ,9.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49656,CPT,LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE,,,21 ,,RBRVS,15.08 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49657,CPT,LAPS RPR RECURRENT INCAL HRNA NCRC8/STRANGULATED,,,21 ,,RBRVS,22.11 ,11.44 ,11.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49659,CPT,UNLIS LAPS PX HRNAP HERNIORRHAPHY HERNIOTOMY,,,21 ,,TotalUnits,,,,10.92 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,49900,CPT,SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN,,,21 ,,RBRVS,12.41 ,8.57 ,8.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49904,CPT,OMENTAL FLAP EXTRA-ABDOMINAL,,,21 ,,RBRVS,22.35 ,15.78 ,15.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49905,CPT,OMENTAL FLAP INTRA-ABDOMINAL,,,21 ,,RBRVS,6.54 ,2.59 ,2.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,49999,CPT,UNLISTED PROCEDURE ABDOMEN PERITONEUM & OMENTUM,,,21 ,,TotalUnits,,,,11.34 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,50010,CPT,RNL EXPL X NECESSITATING OTH SPEC PX,,,21 ,,RBRVS,12.28 ,7.91 ,7.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50020,CPT,DRAINAGE PERIRENAL/RENAL ABSCESS OPEN,,,21 ,,RBRVS,18.08 ,10.77 ,10.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50021,CPT,DRAINAGE PERIRENAL/RENAL ABSCESS PRW,,,21 ,,RBRVS,3.37 ,1.39 ,24.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50040,CPT,NEPHROSTOMY/NEPHROTOMY W/DRAINAGE,,,21 ,,RBRVS,16.68 ,9.77 ,9.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50045,CPT,NEPHROTOMY W/EXPLORATION,,,21 ,,RBRVS,16.82 ,9.78 ,9.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50060,CPT,NEPHROLITHOTOMY REMOVAL STAGE 1,,,21 ,,RBRVS,20.95 ,11.72 ,11.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50065,CPT,NEPHROLITHOTOMY SECONDARY FOR CALCULUS,,,21 ,,RBRVS,22.32 ,12.06 ,12.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50070,CPT,NEPHROLITHOTOMY COMP CGEN KDN ABNORMALITY,,,21 ,,RBRVS,21.85 ,12.20 ,12.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50075,CPT,NEPHROLITHOTOMY RMVL LG STAGHORN STAGE 1,,,21 ,,RBRVS,27.09 ,14.72 ,14.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50080,CPT,PRQ NEPHROSTOLITHOTOMY/PYELOSTOLITHOTOMY 2 CM/<,,,21 ,,RBRVS,15.74 ,9.23 ,9.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50081,CPT,PRQ NEPHROSTOLITHOTOMY/PYELOSTOLITHOTOMY > 2 CM,,,21 ,,RBRVS,23.50 ,13.12 ,13.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50100,CPT,TRNSXJ/REPOSITIONING ABERRANT RENAL VESSEL SPX,,,21 ,,RBRVS,17.45 ,8.32 ,8.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50120,CPT,PYELOTOMY W/EXPLORATION,,,21 ,,RBRVS,17.21 ,9.90 ,9.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50125,CPT,PYELOTOMY W/DRAINAGE PYELOSTOMY,,,21 ,,RBRVS,17.82 ,11.06 ,11.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50130,CPT,PYELOTOMY W/REMOVAL CALCULUS,,,21 ,,RBRVS,18.82 ,10.83 ,10.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50135,CPT,PYELOTOMY COMPLICATED,,,21 ,,RBRVS,20.59 ,11.51 ,11.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50200,CPT,RENAL BIOPSY PRQ TROCAR/NEEDLE,,,21 ,,RBRVS,2.63 ,1.42 ,14.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50205,CPT,RENAL BIOPSY SURG EXPOSURE KIDNEY,,,21 ,,RBRVS,12.29 ,7.20 ,7.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50220,CPT,NEPHRECTOMY W/PRTL URETERECTOMY W/OPEN RIB RESCJ,,,21 ,,RBRVS,18.68 ,10.65 ,10.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50225,CPT,NEPHRECTOMY W/PRTL URETERECT OPN RIB RESCJ COMPL,,,21 ,,RBRVS,21.88 ,12.00 ,12.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50230,CPT,NEPHRECTOMY W/PRTL URETERECT OPEN RIB RESCJ RAD,,,21 ,,RBRVS,23.81 ,12.73 ,12.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50234,CPT,NEPHRECTOMY W/TOT URETERECT&BLDR CUFF SAME INC,,,21 ,,RBRVS,24.05 ,13.10 ,13.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50236,CPT,NEPHRECTOMY TOT URETEREC&BLDR CUFF SEPARATE INC,,,21 ,,RBRVS,26.94 ,15.08 ,15.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50240,CPT,NEPHRECTOMY PARTIAL,,,21 ,,RBRVS,24.21 ,13.66 ,13.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50250,CPT,OPEN ABLATION RENAL MASS CRYOSURG ULTRASOUND,,,21 ,,RBRVS,22.22 ,12.79 ,12.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50280,CPT,EXCISION/UNROOFING CYST KIDNEY,,,21 ,,RBRVS,17.09 ,10.03 ,10.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50290,CPT,EXCISION PERINEPHRIC CYST,,,21 ,,RBRVS,16.15 ,9.85 ,9.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50300,CPT,DONOR NEPHRECTOMY CADAVER DONOR UNI/BILATERAL,,,21 ,,TotalUnits,,,,23.05 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,50320,CPT,DONOR NEPHRECTOMY OPEN LIVING DONOR,,,21 ,,RBRVS,22.43 ,15.33 ,15.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50323,CPT,BKBENCH PREPJ CADAVER DONOR RENAL ALLOGRAFT,,,21 ,,TotalUnits,,,,13.12 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,50325,CPT,BKBENCH PREPJ LIVING RENAL DONOR ALLOGRAFT,,,21 ,,TotalUnits,,,,9.48 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,50327,CPT,BKBENCH RCNSTJ RENAL ALGRFT VENOUS ANAST EA,,,21 ,,RBRVS,4.00 ,1.60 ,1.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50328,CPT,BKBENCH RCNSTJ RENAL ALLOGRAFT ARTERIAL ANAST EA,,,21 ,,RBRVS,3.50 ,1.41 ,1.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50329,CPT,BKBENCH RCNSTJ ALGRFT URETERAL ANAST EA,,,21 ,,RBRVS,3.34 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50340,CPT,RECIPIENT NEPHRECTOMY SEPARATE PROCEDURE,,,21 ,,RBRVS,14.04 ,10.06 ,10.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50360,CPT,RENAL ALTRNSPLJ IMPLTJ GRF W/O RCP NEPHRECTOMY,,,21 ,,RBRVS,40.90 ,24.82 ,24.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50365,CPT,RENAL ALTRNSPLJ IMPLTJ GRF W/RCP NEPHRECTOMY,,,21 ,,RBRVS,46.13 ,27.41 ,27.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50370,CPT,RMVL TRNSPLED RENAL ALLOGRAFT,,,21 ,,RBRVS,18.88 ,11.93 ,11.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50380,CPT,RENAL AUTOTRNSPLJ REIMPLANTATION KIDNEY,,,21 ,,RBRVS,30.11 ,21.93 ,21.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50382,CPT,RMVL&RPLCMT INTLY DWELLING URETERAL STENT,,,21 ,,RBRVS,5.50 ,2.37 ,31.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50384,CPT,REMOVAL INDWELLING URETERAL STENT PRQ,,,21 ,,RBRVS,5.00 ,2.14 ,26.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50385,CPT,REMOVE & REPLACE INT DWELL URETERAL STENT TRURL,,,21 ,,RBRVS,4.44 ,2.30 ,31.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50386,CPT,REMOVE INT DWELL URETERAL STENT TRANSURETHRAL,,,21 ,,RBRVS,3.30 ,1.80 ,20.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50387,CPT,RMVL&RPLCMT XTRNLLY ACCESSIBLE URTRL STENT,,,21 ,,RBRVS,2.00 ,0.84 ,15.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50389,CPT,RMVL NFROS TUBE REQ FLUORO GUIDANCE,,,21 ,,RBRVS,1.10 ,0.46 ,8.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50390,CPT,ASPIR&/NJX RNL CYST/PELVIS NEEDLE PRQ,,,21 ,,RBRVS,1.96 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50391,CPT,INSTLJ THER AGENT RENAL PELVIS&/URETER VIA TUBE,,,21 ,,RBRVS,1.96 ,0.88 ,1.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50392,CPT,INTRO INTRACATH/CATH IN RNL PELVIS DRG&/NJX PRQ,,,21 ,,RBRVS,3.37 ,1.76 ,1.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50393,CPT,INTRO URETER CATH/STNT RENAL PELVIS DRG&/NJX PRQ,,,21 ,,RBRVS,4.15 ,2.09 ,2.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50394,CPT,INJECTION PROCEDURE PYELOGRAPHY VIA TUBE/CATH,,,21 ,,RBRVS,0.76 ,0.68 ,2.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50395,CPT,INTRO GUIDE PELVIS&/URETER W/DILAT NFROS TRACT,,,21 ,,RBRVS,3.37 ,1.80 ,1.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50396,CPT,MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH,,,21 ,,RBRVS,2.09 ,1.25 ,1.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50398,CPT,CHANGE NEPHROSTOMY/PYELOSTOMY TUBE,,,21 ,,RBRVS,1.46 ,0.65 ,14.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50400,CPT,PYELOPLASTY SIMPLE,,,21 ,,RBRVS,21.27 ,11.80 ,11.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50405,CPT,PYELOPLASTY COMPLICATED,,,21 ,,RBRVS,25.86 ,14.07 ,14.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50500,CPT,NEPHRORRHAPHY SUTURE KIDNEY WOUND/INJURY,,,21 ,,RBRVS,21.22 ,11.61 ,11.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50520,CPT,CLOSURE NEPHROCUTANEOUS/PYELOCUTANEOUS FISTULA,,,21 ,,RBRVS,18.88 ,10.66 ,10.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50525,CPT,CLSR NEPHROVISCERAL FISTULA W/VISC RPR ABDL APPR,,,21 ,,RBRVS,24.39 ,13.88 ,13.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50526,CPT,CLSR NEPHROVISCERAL FISTULA W/VISC RPR THRC APPR,,,21 ,,RBRVS,26.31 ,13.71 ,13.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50540,CPT,SYMPHYSIOTOMY HORSESHOE KDN W/WO PLOP UNI/BI,,,21 ,,RBRVS,21.10 ,11.44 ,11.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50541,CPT,LAPAROSCOPY SURG ABLATION RENAL CYSTS,,,21 ,,RBRVS,16.86 ,9.46 ,9.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50542,CPT,LAPS ABLTJ RENAL MASS LESION W/INTRAOP US,,,21 ,,RBRVS,21.36 ,12.11 ,12.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50543,CPT,LAPAROSCOPY SURG PARTIAL NEPHRECTOMY,,,21 ,,RBRVS,27.41 ,15.24 ,15.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50544,CPT,LAPAROSCOPY SURG PYELOPLASTY,,,21 ,,RBRVS,23.37 ,12.36 ,12.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50545,CPT,LAPAROSCOPY RADICAL NEPHRECTOMY,,,21 ,,RBRVS,25.06 ,13.33 ,13.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50546,CPT,LAPAROSCOPY NEPHRECTOMY W/PARTIAL URETERECT,,,21 ,,RBRVS,21.87 ,12.36 ,12.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50547,CPT,LAPAROSCOPY DONOR NEPHRECTOMY LIVING DONOR,,,21 ,,RBRVS,26.34 ,15.84 ,15.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50548,CPT,LAPAROSCOPY NEPHRECTOMY W/TOTAL URETERECTOMY,,,21 ,,RBRVS,25.36 ,13.27 ,13.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50549,CPT,UNLISTED LAPAROSCOPY PROCEDURE RENAL,,,21 ,,TotalUnits,,,,38.39 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,50551,CPT,RENAL ENDOSCOPY NEPHROSTOMY W/WO IRRIGATION,,,21 ,,RBRVS,5.59 ,2.88 ,4.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50553,CPT,RENAL NDSC NEPHROST W/URETERAL CATH W/WO DILA,,,21 ,,RBRVS,5.98 ,2.99 ,5.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50555,CPT,RENAL NDSC NEPHROS/PYELOSTOMY BIOPSY,,,21 ,,RBRVS,6.52 ,3.28 ,5.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50557,CPT,RENAL NDSC NEPHROS/PYELOSTOMY FULG&/INC W/WO BX,,,21 ,,RBRVS,6.61 ,3.33 ,5.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50561,CPT,RENAL NDSC NEPHROS/PYELOSTOMY RMVL FB/CALCULUS,,,21 ,,RBRVS,7.58 ,3.76 ,6.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50562,CPT,RENAL NDSC NEPHROS/PYELOSTOMY RESCJ TUMOR,,,21 ,,RBRVS,10.90 ,5.84 ,5.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50570,CPT,RENAL NDSC NEPHROTOMY W/WO IRRIGATION,,,21 ,,RBRVS,9.53 ,4.60 ,4.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50572,CPT,RNL NDSC NFROT W/URTRL CATHJ W/WO DILAT URETER,,,21 ,,RBRVS,10.33 ,4.96 ,4.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50574,CPT,RENAL NDSC NEPHROTOMY W/BIOPSY,,,21 ,,RBRVS,11.00 ,5.25 ,5.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50575,CPT,RNL NDSC NFROT/PLOT W/ENDOPYELOTOMY,,,21 ,,RBRVS,13.96 ,6.56 ,6.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50576,CPT,RNL NDSC NFROT FULGURATION&/INC W/WO BX,,,21 ,,RBRVS,10.97 ,5.24 ,5.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50580,CPT,RNL NDSC NFROT/PLOT W/RMVL FB/CALCULUS,,,21 ,,RBRVS,11.84 ,5.56 ,5.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50590,CPT,LITHOTRIPSY XTRCORP SHOCK WAVE,,,21 ,,RBRVS,9.77 ,6.47 ,15.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50592,CPT,ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY,,,21 ,,RBRVS,6.80 ,3.55 ,94.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50593,CPT,ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY,,,21 ,,RBRVS,9.13 ,4.30 ,129.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50600,CPT,URTROTOMY W/EXPL/DRG SEPARATE PROCEDURE,,,21 ,,RBRVS,17.17 ,9.64 ,9.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50605,CPT,URETEROTOMY INSERTION INDWELLING STENT ALL TYPES,,,21 ,,RBRVS,16.79 ,9.48 ,9.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50610,CPT,URTROLITHOTOMY UPPER ONE-THIRD URETER,,,21 ,,RBRVS,17.25 ,9.85 ,9.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50620,CPT,URTROLITHOTOMY MIDDLE ONE-THIRD URETER,,,21 ,,RBRVS,16.43 ,9.49 ,9.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50630,CPT,URTROLITHOTOMY LOWER ONE-THIRD URETER,,,21 ,,RBRVS,16.21 ,9.18 ,9.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50650,CPT,URETRECECTOMY W/BLADDER CUFF SEPARATE PROCEDURE,,,21 ,,RBRVS,18.82 ,10.78 ,10.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50660,CPT,URETERECTOMY TOT ECTOPIC URETER CMBN APPR,,,21 ,,RBRVS,21.02 ,11.65 ,11.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50684,CPT,INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH,,,21 ,,RBRVS,0.76 ,0.68 ,3.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50686,CPT,MANOMETRIC STDS THRU URTROST/NDWELLG URTRL CATH,,,21 ,,RBRVS,1.51 ,1.11 ,2.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50688,CPT,CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL,,,21 ,,RBRVS,1.20 ,1.11 ,1.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50690,CPT,NJX VISUALIZATION ILEAL CONDUIT&/URTROPLOG,,,21 ,,RBRVS,1.16 ,0.85 ,1.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50700,CPT,URETEROPLASTY PLASTIC OPERATION URETER,,,21 ,,RBRVS,16.69 ,9.76 ,9.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50715,CPT,URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS,,,21 ,,RBRVS,20.64 ,11.27 ,11.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50722,CPT,URETEROLYSIS FOR OVARIAN VEIN SYNDROME,,,21 ,,RBRVS,17.95 ,10.02 ,10.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50725,CPT,URTROLSS RETROCAVAL URTR W/REANAST,,,21 ,,RBRVS,20.20 ,11.96 ,11.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50727,CPT,REVJ URINARY-CUTANEOUS ANASTAMOSIS,,,21 ,,RBRVS,8.28 ,6.21 ,6.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50728,CPT,REVJ UR-CUTAN ANAST RPR FSCAL DFCT&HRNA,,,21 ,,RBRVS,12.18 ,7.66 ,7.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50740,CPT,URTROPYELOSTOMY ANAST URTR&RNL PELVIS,,,21 ,,RBRVS,20.07 ,11.21 ,11.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50750,CPT,URETEROCALYCOSTOMY ANAST URETER RENAL CALYX,,,21 ,,RBRVS,21.22 ,11.92 ,11.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50760,CPT,URETEROURETEROSTOMY,,,21 ,,RBRVS,20.07 ,11.19 ,11.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50770,CPT,TRANSURETEROURETEROSTOMY ANAST URETER CLAT URTR,,,21 ,,RBRVS,21.22 ,11.25 ,11.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50780,CPT,URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER,,,21 ,,RBRVS,19.95 ,11.21 ,11.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50782,CPT,URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR,,,21 ,,RBRVS,19.66 ,10.83 ,10.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50783,CPT,URETERONEOCYSTOSTOMY W/URETERAL TAILORING,,,21 ,,RBRVS,20.70 ,11.93 ,11.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50785,CPT,URTRONEOCSTOST W/VESICO-PSOAS HITCH/BLDR FLAP,,,21 ,,RBRVS,22.23 ,12.31 ,12.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50800,CPT,URETEROENTEROSTOMY ANAST URETER INTESTINE,,,21 ,,RBRVS,16.41 ,9.95 ,9.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50810,CPT,URETEROSIGMOIDOSTOMY W/SIGMOID BLADDER&COLOSTOMY,,,21 ,,RBRVS,22.61 ,12.09 ,12.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50815,CPT,URETEROCOLON CONDUIT INTESTINE ANASTOMOSIS,,,21 ,,RBRVS,22.26 ,12.71 ,12.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50820,CPT,URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS,,,21 ,,RBRVS,24.07 ,13.18 ,13.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50825,CPT,CONTINENT DVRJ W/INT ANAST W/ANY SGM SM&/LG INT,,,21 ,,RBRVS,30.68 ,16.51 ,16.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50830,CPT,URINARY UNIDIVERSION,,,21 ,,RBRVS,33.77 ,17.42 ,17.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50840,CPT,RPLCMT ALL/PART URETER INTESTINE SGM W/ANAST,,,21 ,,RBRVS,22.39 ,12.82 ,12.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50845,CPT,CUTANANEOUS APPENDICO-VESICOSTOMY,,,21 ,,RBRVS,22.46 ,13.31 ,13.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50860,CPT,URETEROSTOMY TRANSPLANTATION URETER SKIN,,,21 ,,RBRVS,17.08 ,9.93 ,9.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50900,CPT,URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE,,,21 ,,RBRVS,15.04 ,9.03 ,9.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50920,CPT,CLOSURE URETEROCUTANEOUS FISTULA,,,21 ,,RBRVS,15.81 ,9.44 ,9.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50930,CPT,CLOSURE URETEROCUTANEOUS FISTULA W/VISC RPR,,,21 ,,RBRVS,20.19 ,10.69 ,10.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50940,CPT,DELIGATION URETER,,,21 ,,RBRVS,15.93 ,9.38 ,9.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50945,CPT,LAPAROSCOPY URTROLITHOTOMY,,,21 ,,RBRVS,17.97 ,9.90 ,9.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50947,CPT,LAPS URTRONEOCSTOST W/CSTSC&URTRL STENT PLMT,,,21 ,,RBRVS,25.78 ,13.66 ,13.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50948,CPT,LAPS URTRONEOCSTOST W/O CSTSC&URTRL STENT PLMT,,,21 ,,RBRVS,23.82 ,12.80 ,12.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50949,CPT,UNLISTED LAPAROSCOPY PROCEDURE URETER,,,21 ,,TotalUnits,,,,39.44 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,50951,CPT,URETERAL ENDOSCOPY VIA URETEROSTOMY,,,21 ,,RBRVS,5.83 ,3.00 ,5.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50953,CPT,URETERAL ENDOSCOPY VIA URETEROST W/WO DIL URETER,,,21 ,,RBRVS,6.23 ,3.54 ,5.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50955,CPT,URETERAL ENDOSCOPY VIA URETEROSTOMY W/BIOPSY,,,21 ,,RBRVS,6.74 ,3.79 ,5.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50957,CPT,URETERAL ENDOSCOPY W/DEST&/INC W/WO BIOPSY,,,21 ,,RBRVS,6.78 ,3.40 ,5.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50961,CPT,URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE,,,21 ,,RBRVS,6.04 ,3.09 ,5.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50970,CPT,URETERAL ENDOSCOPY VIA URETEROTOMY W/O IMAGING,,,21 ,,RBRVS,7.13 ,3.53 ,3.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50972,CPT,NDSC URETEROTOMY URTRL CATHJ W/WO DILAT URETER,,,21 ,,RBRVS,6.88 ,3.40 ,3.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50974,CPT,URETERAL ENDOSCOPY VIA URETEROT W/O IMAGING W/BX,,,21 ,,RBRVS,9.16 ,4.44 ,4.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50976,CPT,URETERAL ENDOSC VIA URETEROT W/DEST&/INC W/WO BX,,,21 ,,RBRVS,9.03 ,4.36 ,4.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,50980,CPT,NDSC URETEROTOMY RMVL FB/CALCULUS,,,21 ,,RBRVS,6.84 ,3.41 ,3.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51020,CPT,CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL,,,21 ,,RBRVS,7.69 ,5.78 ,5.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51030,CPT,CSTOTOMY/CSTOST CRYOSURG DSTRJ INTRAVESICAL LES,,,21 ,,RBRVS,7.81 ,5.56 ,5.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51040,CPT,CYSTOSTOMY CYSTOTOMY W/DRAINAGE,,,21 ,,RBRVS,4.49 ,3.90 ,3.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51045,CPT,CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX,,,21 ,,RBRVS,7.81 ,5.85 ,5.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51050,CPT,CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS,,,21 ,,RBRVS,7.97 ,5.62 ,5.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51060,CPT,TRANSVESICAL URETROLITHOTOMY,,,21 ,,RBRVS,9.95 ,6.76 ,6.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51065,CPT,CYSTOTOMY W/CALCULUS BASKET XTRJ&/FRAGMENTATION,,,21 ,,RBRVS,9.95 ,6.65 ,6.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51080,CPT,DRG PRIVESICAL/PREVESICAL SPACE ABSC,,,21 ,,RBRVS,6.71 ,5.01 ,5.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51100,CPT,ASPIRATION BLADDER NEEDLE,,,21 ,,RBRVS,0.78 ,0.33 ,1.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51101,CPT,ASPIRATION BLADDER TROCAR/INTRACATHETER,,,21 ,,RBRVS,1.02 ,0.45 ,2.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51102,CPT,ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER,,,21 ,,RBRVS,2.70 ,1.49 ,4.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51500,CPT,EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR,,,21 ,,RBRVS,11.05 ,7.56 ,7.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51520,CPT,CYSTOTOMY SIMPLE EXCISION VESICAL NECK,,,21 ,,RBRVS,10.21 ,6.70 ,6.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51525,CPT,CYSTOTOMY EXCISE BLADDER DIVERTICULUM 1/MULTIPLE,,,21 ,,RBRVS,15.42 ,9.17 ,9.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51530,CPT,CYSTOTOMY EXCISION BLADDER TUMOR,,,21 ,,RBRVS,13.71 ,8.45 ,8.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51535,CPT,CYSTOTOMY EXCISE/INCISE/REPAIR URETEROCELE,,,21 ,,RBRVS,13.90 ,8.27 ,8.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51550,CPT,CYSTECTOMY PARTIAL SIMPLE,,,21 ,,RBRVS,17.23 ,9.88 ,9.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51555,CPT,CYSTECTOMY PARTIAL COMPLICATED,,,21 ,,RBRVS,23.18 ,12.71 ,12.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51565,CPT,CSTC PRTL W/RIMPLTJ URTR IN BLDR URTRONEOCSTOST,,,21 ,,RBRVS,23.68 ,13.12 ,13.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51570,CPT,CYSTECTOMY COMPLETE SEPARATE PROCEDURE,,,21 ,,RBRVS,27.46 ,14.60 ,14.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51575,CPT,CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY,,,21 ,,RBRVS,34.18 ,17.94 ,17.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51580,CPT,CYSTECTOMY W/URETEROSIGMOIDOSTOMY W/NODES,,,21 ,,RBRVS,35.37 ,18.97 ,18.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51585,CPT,CYSTECTOMY W/URETEROSIGMOID BI PELV LYMPH NODES,,,21 ,,RBRVS,39.64 ,20.85 ,20.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51590,CPT,CSTC COMPL W/URTROILEAL CONDUIT/BLDR W/INT ANAST,,,21 ,,RBRVS,36.33 ,18.83 ,18.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51595,CPT,CSTC COMPL W/CONDUIT/SIGMOID BLDR PEL LMPHADEC,,,21 ,,RBRVS,41.32 ,21.29 ,21.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51596,CPT,CSTC COMPL W/CONTINENT DVRJ OPN NEOBLDR,,,21 ,,RBRVS,44.26 ,23.09 ,23.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51597,CPT,PELVIC EXENTERATION COMPLETE MALIGNANCY,,,21 ,,RBRVS,42.86 ,22.31 ,22.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51600,CPT,NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY,,,21 ,,RBRVS,0.88 ,0.38 ,4.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51605,CPT,NJX&PLMT CHAIN CONTRAST&/URETHROCSTOGRAPY,,,21 ,,RBRVS,0.64 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51610,CPT,NJX RETROGRADE URETHROCSTOGRAPY,,,21 ,,RBRVS,1.05 ,0.78 ,2.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51700,CPT,BLDR IRRIGATION SMPL LAVAGE&/INSTLJ,,,21 ,,RBRVS,0.88 ,0.39 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51701,CPT,INSJ NON-NDWELLG BLADDER CATHETER,,,21 ,,RBRVS,0.50 ,0.28 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51702,CPT,INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE,,,21 ,,RBRVS,0.50 ,0.36 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51703,CPT,INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED,,,21 ,,RBRVS,1.47 ,0.87 ,2.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51705,CPT,CHANGE CYSTOSTOMY TUBE SIMPLE,,,21 ,,RBRVS,1.05 ,0.90 ,2.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51710,CPT,CHANGE CYSTOSTOMY TUBE COMPLICATED,,,21 ,,RBRVS,1.52 ,1.23 ,2.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51715,CPT,NDSC NJX IMPLT MATRL URT&/BLDR NCK,,,21 ,,RBRVS,3.73 ,1.94 ,4.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51720,CPT,BLADDER INSTILLATION ANTICARCINOGENIC AGENT,,,21 ,,RBRVS,1.50 ,0.83 ,1.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51725,CPT,SIMPLE CYSTOMETROGRAM,,,21 ,,RBRVS,1.51 ,4.57 ,4.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,51725,CPT,SIMPLE CYSTOMETROGRAM,26,,21 ,,RBRVS,1.51 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51725,CPT,SIMPLE CYSTOMETROGRAM,TC,,21 ,,RBRVS,,3.91 ,3.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,51726,CPT,BLADDER PRESSURE MEASUREMENT DURING FILLING,,,21 ,,RBRVS,1.71 ,7.19 ,7.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,51726,CPT,BLADDER PRESSURE MEASUREMENT DURING FILLING,26,,21 ,,RBRVS,1.71 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51726,CPT,BLADDER PRESSURE MEASUREMENT DURING FILLING,TC,,21 ,,RBRVS,,6.43 ,6.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,51727,CPT,COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE,,,21 ,,RBRVS,2.11 ,6.68 ,6.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,51727,CPT,COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE,26,,21 ,,RBRVS,2.11 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51727,CPT,COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE,TC,,21 ,,RBRVS,,5.78 ,5.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,51728,CPT,COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES,,,21 ,,RBRVS,2.11 ,6.63 ,6.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,51728,CPT,COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES,26,,21 ,,RBRVS,2.11 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51728,CPT,COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES,TC,,21 ,,RBRVS,,5.76 ,5.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,51729,CPT,COMPLX CYSTOMETRO W/VOID PRESS&URETHRAL PROFILE,,,21 ,,RBRVS,2.51 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,51729,CPT,COMPLX CYSTOMETRO W/VOID PRESS&URETHRAL PROFILE,26,,21 ,,RBRVS,2.51 ,1.06 ,1.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51729,CPT,COMPLX CYSTOMETRO W/VOID PRESS&URETHRAL PROFILE,TC,,21 ,,RBRVS,,5.96 ,5.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,51736,CPT,SIMPLE UROFLOMETRY,,,21 ,,RBRVS,0.17 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,51736,CPT,SIMPLE UROFLOMETRY,26,,21 ,,RBRVS,0.17 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51736,CPT,SIMPLE UROFLOMETRY,TC,,21 ,,RBRVS,,0.67 ,0.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,51741,CPT,COMPLEX UROFLOMETRY,,,21 ,,RBRVS,0.17 ,1.08 ,1.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,51741,CPT,COMPLEX UROFLOMETRY,26,,21 ,,RBRVS,0.17 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51741,CPT,COMPLEX UROFLOMETRY,TC,,21 ,,RBRVS,,0.77 ,0.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,51784,CPT,EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL,,,21 ,,RBRVS,1.53 ,4.40 ,4.40 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,51784,CPT,EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL,26,,21 ,,RBRVS,1.53 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51784,CPT,EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL,TC,,21 ,,RBRVS,,3.73 ,3.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,51785,CPT,NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ,,,21 ,,RBRVS,1.53 ,5.00 ,5.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,51785,CPT,NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ,26,,21 ,,RBRVS,1.53 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51785,CPT,NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ,TC,,21 ,,RBRVS,,4.32 ,4.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,51792,CPT,STIMULUS EVOKED RESPONSE,,,21 ,,RBRVS,1.10 ,5.65 ,5.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,51792,CPT,STIMULUS EVOKED RESPONSE,26,,21 ,,RBRVS,1.10 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51792,CPT,STIMULUS EVOKED RESPONSE,TC,,21 ,,RBRVS,,5.16 ,5.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,51797,CPT,VOID PRESSURE STUDIES INTRAABDOMINAL,,,21 ,,RBRVS,0.80 ,3.12 ,3.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,51797,CPT,VOID PRESSURE STUDIES INTRAABDOMINAL,26,,21 ,,RBRVS,0.80 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51797,CPT,VOID PRESSURE STUDIES INTRAABDOMINAL,TC,,21 ,,RBRVS,,2.73 ,2.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,51798,CPT,MEAS POST-VOIDING RESIDUAL URINE&/BLDR CAP,,,21 ,,RBRVS,,0.57 ,0.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,51800,CPT,CSTOPLASTY/CSTOURTP PLSTC ANY,,,21 ,,RBRVS,18.89 ,10.94 ,10.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51820,CPT,CSTOURTP W/UNI/BI URTRONEOCSTOST,,,21 ,,RBRVS,19.59 ,10.89 ,10.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51840,CPT,ANT VESICOURETHROPEXY/URETHROPEXY SMPL,,,21 ,,RBRVS,11.36 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51841,CPT,ANT VESICOURETHROPEXY/URETHROPEXY COMP,,,21 ,,RBRVS,13.68 ,8.14 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51845,CPT,ABDOMINO-VAG VESICAL NCK SSP W/WO NDSC CTRL,,,21 ,,RBRVS,10.15 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51860,CPT,CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE,,,21 ,,RBRVS,12.60 ,7.94 ,7.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51865,CPT,CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED,,,21 ,,RBRVS,15.80 ,9.38 ,9.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51880,CPT,CLOSURE CYSTOSTOMY SEPARATE PROCEDURE,,,21 ,,RBRVS,7.87 ,5.34 ,5.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51900,CPT,CLSR VESICOVAGINAL FISTUL AABDL APPROACH,,,21 ,,RBRVS,14.63 ,8.84 ,8.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51920,CPT,CLOSURE VESICOUTERINE FISTULA,,,21 ,,RBRVS,13.41 ,8.18 ,8.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51925,CPT,CLSR VESICOUTERINE FISTULA W/HYSTERECTOMY,,,21 ,,RBRVS,17.53 ,11.30 ,11.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51940,CPT,CLOSURE EXSTROPHY BLADDER,,,21 ,,RBRVS,30.66 ,15.48 ,15.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51960,CPT,ENTEROCYSTOPLASTY W/INTESTINAL ANASTOMOSIS,,,21 ,,RBRVS,25.40 ,14.25 ,14.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51980,CPT,CUTANEOUS VESICOSTOMY,,,21 ,,RBRVS,12.57 ,7.83 ,7.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51990,CPT,LAPAROSCOPY URETHRAL SUSPENSION STRESS INCONT,,,21 ,,RBRVS,13.36 ,7.64 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51992,CPT,LAPAROSCOPY SLING OPERATION STRESS INCONT,,,21 ,,RBRVS,14.87 ,8.39 ,8.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,51999,CPT,UNLISTED LAPAROSCOPY PROCEDURE BLADDER,,,21 ,,TotalUnits,,,,23.26 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,52000,CPT,CYSTOURETHROSCOPY,,,21 ,,RBRVS,2.23 ,1.37 ,3.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52001,CPT,CYSTO W/IRRG&EVAC MLT OBSTRUCTING CLOTS,,,21 ,,RBRVS,5.44 ,2.80 ,5.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52005,CPT,CYSTO BLADDER W/URETERAL CATHETERIZATION,,,21 ,,RBRVS,2.37 ,1.45 ,6.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52007,CPT,CYSTO W/URTRL CATHJ BRUSH BX URTR&/RNL PELVIS,,,21 ,,RBRVS,3.02 ,1.74 ,12.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52010,CPT,CYSTO W/EJACULATORY DUCT CATHETERIZATION,,,21 ,,RBRVS,3.02 ,1.65 ,8.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52204,CPT,CYSTOURETHROSCOPY WITH BIOPSY,,,21 ,,RBRVS,2.59 ,1.46 ,9.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52214,CPT,CYSTO W/DESTRUCTION OF LESIONS,,,21 ,,RBRVS,3.70 ,2.31 ,14.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52224,CPT,CYSTO W/REMOVAL OF LESIONS SMALL,,,21 ,,RBRVS,3.14 ,1.72 ,18.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52234,CPT,CYSTO W/REMOVAL OF TUMORS SMALL,,,21 ,,RBRVS,4.62 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52235,CPT,CYSTOURETHROSCOPY W/DEST&/RMVL MED BLADDER TUMOR,,,21 ,,RBRVS,5.44 ,2.85 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52240,CPT,CYSTOURETHROSCOPY W/DEST&/RMVL TUMOR LARGE,,,21 ,,RBRVS,9.71 ,4.75 ,4.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52250,CPT,CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG,,,21 ,,RBRVS,4.49 ,2.48 ,2.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52260,CPT,CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH,,,21 ,,RBRVS,3.91 ,2.11 ,2.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52265,CPT,CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA,,,21 ,,RBRVS,2.94 ,1.66 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52270,CPT,CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE,,,21 ,,RBRVS,3.36 ,1.87 ,8.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52275,CPT,CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE,,,21 ,,RBRVS,4.69 ,2.46 ,10.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52276,CPT,CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE,,,21 ,,RBRVS,4.99 ,2.64 ,2.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52277,CPT,CYSTOURETHROSCOPY W/RESECJ EXTERNAL SPHINCTER,,,21 ,,RBRVS,6.16 ,3.18 ,3.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52281,CPT,CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS,,,21 ,,RBRVS,2.60 ,1.60 ,5.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52282,CPT,CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT,,,21 ,,RBRVS,6.39 ,3.25 ,3.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52283,CPT,CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE,,,21 ,,RBRVS,3.73 ,2.05 ,4.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52285,CPT,CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME,,,21 ,,RBRVS,3.60 ,2.00 ,4.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52290,CPT,CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI,,,21 ,,RBRVS,4.58 ,2.45 ,2.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52300,CPT,CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI,,,21 ,,RBRVS,5.30 ,2.80 ,2.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52301,CPT,CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI,,,21 ,,RBRVS,5.50 ,2.92 ,2.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52305,CPT,CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT,,,21 ,,RBRVS,5.30 ,2.70 ,2.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52310,CPT,CYSTO W/SIMPLE REMOVAL STONE & STENT,,,21 ,,RBRVS,2.81 ,1.54 ,4.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52315,CPT,CYSTO W/COMPLEX REMOVAL STONE & STENT,,,21 ,,RBRVS,5.20 ,2.68 ,7.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52317,CPT,LITHOLAPAXY SMPL/SM < 2.5 CM,,,21 ,,RBRVS,6.71 ,3.27 ,19.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52318,CPT,LITHOLAPAXY COMP/LG > 2.5 CM,,,21 ,,RBRVS,9.18 ,4.42 ,4.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52320,CPT,CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS,,,21 ,,RBRVS,4.69 ,2.39 ,2.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52325,CPT,CYSTO FRAGMENTATION URETERAL STONE,,,21 ,,RBRVS,6.15 ,3.05 ,3.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52327,CPT,CYSTO W/SUBURTRIC NJX IMPLT MATRL,,,21 ,,RBRVS,5.18 ,2.32 ,2.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52330,CPT,CYSTO MANJ W/O RMVL URETERAL STONE,,,21 ,,RBRVS,5.03 ,2.54 ,14.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52332,CPT,CYSTO W/INSERT URETERAL STENT,,,21 ,,RBRVS,2.60 ,1.61 ,11.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52334,CPT,CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR,,,21 ,,RBRVS,4.82 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52341,CPT,CYSTO W/TX URETERAL STRICTURE,,,21 ,,RBRVS,5.35 ,2.99 ,2.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52342,CPT,CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE,,,21 ,,RBRVS,5.85 ,3.22 ,3.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52343,CPT,CYSTO W/TX INTRA-RENAL STRICTURE,,,21 ,,RBRVS,6.55 ,3.53 ,3.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52344,CPT,CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE,,,21 ,,RBRVS,7.05 ,3.90 ,3.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52345,CPT,CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX,,,21 ,,RBRVS,7.55 ,4.13 ,4.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52346,CPT,CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE,,,21 ,,RBRVS,8.58 ,4.59 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52351,CPT,CYSTO W/URTROSCOPY&/PYELOSCOPY DX,,,21 ,,RBRVS,5.85 ,3.18 ,3.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52352,CPT,CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES,,,21 ,,RBRVS,6.87 ,3.73 ,3.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52353,CPT,CYSTO W/URETEROSCOPY W/LITHOTRIPSY,,,21 ,,RBRVS,7.96 ,4.22 ,4.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52354,CPT,CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION,,,21 ,,RBRVS,7.33 ,3.94 ,3.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52355,CPT,CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR,,,21 ,,RBRVS,8.81 ,4.60 ,4.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52400,CPT,CYSTO INC FULG/RESCJ URTL VALVES/FOLDS,,,21 ,,RBRVS,8.69 ,5.11 ,5.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52402,CPT,CSTO W/TRURL RESCJ/INC EJACULATORY DUXS,,,21 ,,RBRVS,5.27 ,2.39 ,2.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52450,CPT,TRANSURETHRAL INCISION PROSTATE,,,21 ,,RBRVS,7.78 ,5.75 ,5.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52500,CPT,TRANSURETHRAL RESECTION PROSTATE,,,21 ,,RBRVS,8.14 ,5.93 ,5.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52601,CPT,TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE,,,21 ,,RBRVS,15.26 ,8.68 ,8.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52630,CPT,TRURL RESCJ RESIDUAL/REGROWTH OBSTR PRSTATE TISS,,,21 ,,RBRVS,7.73 ,5.02 ,5.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52640,CPT,TRURL RESCJ POSTOP BLADDER NECK CONTRACTURE,,,21 ,,RBRVS,4.79 ,3.80 ,3.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52647,CPT,LASER COAGULATION OF PROSTATE FOR URINE FLOW,,,21 ,,RBRVS,11.30 ,7.27 ,48.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52648,CPT,LASER VAPORIZATION OF PROSTATE FOR URINE FLOW,,,21 ,,RBRVS,12.15 ,7.64 ,49.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52649,CPT,LASER ENUCLEATION PROSTATE W/MORCELLATION,,,21 ,,RBRVS,17.29 ,10.47 ,10.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,52700,CPT,TRURL DRAINAGE PROSTATIC ABSCESS,,,21 ,,RBRVS,7.49 ,5.08 ,5.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53000,CPT,URTT/URTS XTRNL SPX PENDULOUS URETHRA,,,21 ,,RBRVS,2.33 ,1.96 ,1.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53010,CPT,URETHROTOMY/URETHROSTOMY XT SPX PERINEAL URETHRA,,,21 ,,RBRVS,4.45 ,4.08 ,4.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53020,CPT,MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT,,,21 ,,RBRVS,1.77 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53025,CPT,MEATOTOMY CUTTING MEATUS SPX INFANT,,,21 ,,RBRVS,1.13 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53040,CPT,DRAINAGE DEEP PERIURETHRAL ABSCESS,,,21 ,,RBRVS,6.55 ,4.73 ,4.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53060,CPT,DRG OF SKENE'S GLAND ABSCESS OR CYST,,,21 ,,RBRVS,2.68 ,1.85 ,2.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53080,CPT,DRG PERINEAL URINARY XTRVASATION UNCOMP SPX,,,21 ,,RBRVS,6.92 ,5.42 ,5.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53085,CPT,DRG PERINEAL URINARY XTRVASATION COMPLIC,,,21 ,,RBRVS,11.18 ,6.81 ,6.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53200,CPT,BIOPSY URETHRA,,,21 ,,RBRVS,2.59 ,1.43 ,1.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53210,CPT,URETHRECTOMY TOT W/CYSTOST FEMALE,,,21 ,,RBRVS,13.72 ,8.43 ,8.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53215,CPT,URETHRECTOMY TOT W/CYSTOST MALE,,,21 ,,RBRVS,16.85 ,9.81 ,9.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53220,CPT,EXC/FULGURATION CARCINOMA URETHRA,,,21 ,,RBRVS,7.63 ,5.41 ,5.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53230,CPT,EXC URETHRAL DIVERTICULUM SPX FEMALE,,,21 ,,RBRVS,10.44 ,6.87 ,6.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53235,CPT,EXC URETHRAL DIVERTICULUM SPX MALE,,,21 ,,RBRVS,10.99 ,7.27 ,7.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53240,CPT,MARSUPIALIZATION URTL DIVERTICULUM MALE/FEMALE,,,21 ,,RBRVS,7.08 ,5.21 ,5.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53250,CPT,EXCISION OF BULBOURETHRAL GLAND,,,21 ,,RBRVS,6.52 ,5.14 ,5.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53260,CPT,EXC/FULGURATION URETHRAL POLYP DSTL URETHRA,,,21 ,,RBRVS,3.03 ,2.05 ,2.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53265,CPT,EXC/FULGURATION URETHRAL CARUNCLE,,,21 ,,RBRVS,3.17 ,2.13 ,3.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53270,CPT,EXCISION OR FULGURATION SKENES GLANDS,,,21 ,,RBRVS,3.14 ,2.14 ,2.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53275,CPT,EXCISION/FULGURATION URETHRAL PROLAPSE,,,21 ,,RBRVS,4.57 ,3.00 ,3.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53400,CPT,URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX,,,21 ,,RBRVS,14.13 ,8.84 ,8.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53405,CPT,URETHROPLASTY 2ND STAGE W/URINARY DIVERSION,,,21 ,,RBRVS,15.66 ,9.47 ,9.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53410,CPT,URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA,,,21 ,,RBRVS,17.68 ,10.44 ,10.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53415,CPT,URTP TRANSPUBIC/PRNL 1 STG RCNSTJ/RPR URT,,,21 ,,RBRVS,20.70 ,11.65 ,11.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53420,CPT,URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 1ST STAGE,,,21 ,,RBRVS,15.17 ,8.31 ,8.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53425,CPT,URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 2ND STAGE,,,21 ,,RBRVS,17.07 ,9.89 ,9.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53430,CPT,URETHROPLASTY RCNSTJ FEMALE URETHRA,,,21 ,,RBRVS,17.43 ,9.84 ,9.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53431,CPT,URTP W/TUBULARIZATION POST URT&/LWR BLDR,,,21 ,,RBRVS,21.18 ,11.88 ,11.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53440,CPT,SLING OPRATION CORRJ MALE URINARY INCONTINENCE,,,21 ,,RBRVS,15.54 ,9.78 ,9.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53442,CPT,RMVL/REVJ SLING MALE URINARY INCONTINENCE,,,21 ,,RBRVS,13.49 ,8.91 ,8.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53444,CPT,INSERTION TANDEM CUFF,,,21 ,,RBRVS,14.19 ,8.62 ,8.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53445,CPT,INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER,,,21 ,,RBRVS,15.39 ,9.88 ,9.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53446,CPT,REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER,,,21 ,,RBRVS,11.02 ,7.50 ,7.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53447,CPT,RMVL&RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINCTR,,,21 ,,RBRVS,14.28 ,9.02 ,9.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53448,CPT,RMVL&RPLCMT NFLTBL NCK SPHNCTR THRU INFCT FLD,,,21 ,,RBRVS,23.44 ,13.30 ,13.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53449,CPT,RPR NFLTBL URETHRAL/BLADDER NECK SPHINCTER,,,21 ,,RBRVS,10.56 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53450,CPT,URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT,,,21 ,,RBRVS,6.77 ,5.01 ,5.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53460,CPT,URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM,,,21 ,,RBRVS,7.75 ,5.44 ,5.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53500,CPT,URETHROLSS TRVG SEC OPN W/CSTO,,,21 ,,RBRVS,13.00 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53502,CPT,URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE,,,21 ,,RBRVS,8.26 ,5.67 ,5.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53505,CPT,URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE,,,21 ,,RBRVS,8.26 ,5.74 ,5.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53510,CPT,URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PERINEAL,,,21 ,,RBRVS,10.96 ,7.20 ,7.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53515,CPT,URTORR SUTR URETHRAL WND/INJ PROSTATOMEMBRANOUS,,,21 ,,RBRVS,14.22 ,8.57 ,8.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53520,CPT,CLSR URETHROSTOMY/URETHROQ FSTL MALE SPX,,,21 ,,RBRVS,9.48 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53600,CPT,DILAT URETHRAL STRIX DILATOR MALE 1ST,,,21 ,,RBRVS,1.21 ,0.62 ,1.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53601,CPT,DILAT URETHRAL STRIX DILATOR MALE SBSQ,,,21 ,,RBRVS,0.98 ,0.56 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53605,CPT,DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES,,,21 ,,RBRVS,1.28 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53620,CPT,DILAT URETHRAL STRIX FILIFORM&FOLLWR MALE 1ST,,,21 ,,RBRVS,1.62 ,0.89 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53621,CPT,DILAT URETHRAL STRIX FILIFORM&FOLLWR MALE SBSQ,,,21 ,,RBRVS,1.35 ,0.72 ,1.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53660,CPT,DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INIT,,,21 ,,RBRVS,0.71 ,0.48 ,1.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53661,CPT,DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ,,,21 ,,RBRVS,0.72 ,0.44 ,1.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53665,CPT,DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES,,,21 ,,RBRVS,0.76 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53850,CPT,TRURL DSTRJ PRSTATE TISS MICROWAVE THERMOTH,,,21 ,,RBRVS,10.08 ,6.22 ,58.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53852,CPT,TRURL DSTRJ PRSTATE TISS RF THERMOTH,,,21 ,,RBRVS,10.83 ,7.02 ,54.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53855,CPT,INSERT TEMP PROSTATIC URETH STENT W/MEASUREMENT,,,21 ,,RBRVS,1.64 ,0.64 ,19.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53860,CPT,TRURL RF FEMALE BLADDER NECK STRS URIN INCONT,,,21 ,,RBRVS,3.97 ,2.23 ,38.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,53899,CPT,UNLISTED PROCEDURE URINARY SYSTEM,,,21 ,,TotalUnits,,,,3.09 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,54000,CPT,SLITTING PREPUCE DORSAL/LATERAL SPX NEWBORN,,,21 ,,RBRVS,1.59 ,1.53 ,2.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54001,CPT,SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN,,,21 ,,RBRVS,2.24 ,1.75 ,3.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54015,CPT,I&D PENIS DEEP,,,21 ,,RBRVS,5.36 ,3.47 ,3.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54050,CPT,DSTRJ LESION PENIS SIMPLE CHEMICAL,,,21 ,,RBRVS,1.29 ,1.64 ,2.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54055,CPT,DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION,,,21 ,,RBRVS,1.25 ,1.36 ,2.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54056,CPT,DSTRJ LESION PENIS SIMPLE CRYOSURGERY,,,21 ,,RBRVS,1.29 ,1.81 ,2.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54057,CPT,DSTRJ LESION PENIS SIMPLE LASER,,,21 ,,RBRVS,1.29 ,1.42 ,2.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54060,CPT,DSTRJ LESION PENIS SIMPLE SURG EXCISION,,,21 ,,RBRVS,1.98 ,1.74 ,3.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54065,CPT,DSTRJ LESION PENIS EXTENSIVE,,,21 ,,RBRVS,2.47 ,2.31 ,3.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54100,CPT,BIOPSY PENIS SEPARATE PROCEDURE,,,21 ,,RBRVS,1.90 ,1.62 ,3.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54105,CPT,BIOPSY PENIS DEEP STRUCTURES,,,21 ,,RBRVS,3.54 ,2.63 ,4.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54110,CPT,EXCISION OF PENILE PLAQUE,,,21 ,,RBRVS,10.92 ,7.00 ,7.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54111,CPT,EXC PENILE PLAQUE GRAFT </5 CM LENGTH,,,21 ,,RBRVS,14.42 ,8.59 ,8.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54112,CPT,EXC PENILE PLAQUE GRAFT > 5 CM LENGTH,,,21 ,,RBRVS,16.98 ,10.00 ,10.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54115,CPT,REMOVAL FOREIGN BODY DEEP PENILE TISSUE,,,21 ,,RBRVS,6.95 ,5.25 ,6.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54120,CPT,AMPUTATION PENIS PARTIAL,,,21 ,,RBRVS,11.01 ,7.14 ,7.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54125,CPT,AMPUTATION PENIS COMPLETE,,,21 ,,RBRVS,14.56 ,8.72 ,8.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54130,CPT,AMPUTAION PENIS RADW/BI INGUINOFEMORAL LMPHADE,,,21 ,,RBRVS,21.84 ,12.41 ,12.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54135,CPT,AMPUTATION PENIS RADICAL W/LYMPH NODES,,,21 ,,RBRVS,28.17 ,15.22 ,15.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54150,CPT,CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK,,,21 ,,RBRVS,1.90 ,0.86 ,2.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54160,CPT,CIRCUMCISION NEONATE,,,21 ,,RBRVS,2.53 ,1.61 ,4.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54161,CPT,CIRCUMCISION AGE >28 DAYS,,,21 ,,RBRVS,3.32 ,2.34 ,2.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54162,CPT,LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS,,,21 ,,RBRVS,3.32 ,2.38 ,4.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54163,CPT,REPAIR INCOMPLETE CIRCUMCISION,,,21 ,,RBRVS,3.32 ,3.01 ,3.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54164,CPT,FRENULOTOMY PENIS,,,21 ,,RBRVS,2.82 ,2.77 ,2.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54200,CPT,INJECTION PEYRONIE DISEASE,,,21 ,,RBRVS,1.11 ,1.36 ,2.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54205,CPT,NJX PEYRONIE W/SURG EXPOS PLAQUE,,,21 ,,RBRVS,8.97 ,6.45 ,6.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54220,CPT,IRRIGATION CORPORA CAVERNOSA PRIAPISM,,,21 ,,RBRVS,2.42 ,1.43 ,3.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54230,CPT,INJECTION CORPORA CAVERNOSOGRAPY,,,21 ,,RBRVS,1.34 ,0.96 ,1.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54231,CPT,DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS,,,21 ,,RBRVS,2.04 ,1.32 ,2.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54235,CPT,NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT,,,21 ,,RBRVS,1.19 ,0.93 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54240,CPT,PENILE PLETHYSMOGRAPY,,,21 ,,RBRVS,1.31 ,1.60 ,1.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,54240,CPT,PENILE PLETHYSMOGRAPY,26,,21 ,,RBRVS,1.31 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54240,CPT,PENILE PLETHYSMOGRAPY,TC,,21 ,,RBRVS,,1.03 ,1.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,54250,CPT,NOCTURNAL PENILE TUMESCENCE&/RGDITY TEST,,,21 ,,RBRVS,2.22 ,1.32 ,1.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,54250,CPT,NOCTURNAL PENILE TUMESCENCE&/RGDITY TEST,26,,21 ,,RBRVS,2.22 ,0.98 ,0.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54250,CPT,NOCTURNAL PENILE TUMESCENCE&/RGDITY TEST,TC,,21 ,,RBRVS,,0.34 ,0.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,54300,CPT,PENIS STRAIGHTENING CHORDEE,,,21 ,,RBRVS,11.20 ,7.37 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54304,CPT,PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR,,,21 ,,RBRVS,13.28 ,8.42 ,8.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54308,CPT,URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR < 3 CM,,,21 ,,RBRVS,12.62 ,8.45 ,8.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54312,CPT,URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR > 3 CM,,,21 ,,RBRVS,14.51 ,9.62 ,9.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54316,CPT,URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR SKIN GRF,,,21 ,,RBRVS,18.05 ,11.30 ,11.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54318,CPT,URETHROPLASTY 3RD STG HYPOSPADIAS RPR RLS PENIS,,,21 ,,RBRVS,12.43 ,8.50 ,8.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54322,CPT,1 STG DSTL HYPOSPADIAS RPR W/SMPL MEATAL ADVMNT,,,21 ,,RBRVS,13.98 ,8.59 ,8.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54324,CPT,1 STG DSTL HYPOSPADIAS RPR W/URTP SKIN FLAPS,,,21 ,,RBRVS,17.55 ,10.46 ,10.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54326,CPT,1 STG DSTL HYPOSPADIAS RPR URTP SKN FLAPS&MOB,,,21 ,,RBRVS,17.02 ,9.72 ,9.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54328,CPT,1 STAGE DSTL HYPOSPADIAS RPR W/EXTENSIVE DSJ,,,21 ,,RBRVS,16.89 ,10.06 ,10.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54332,CPT,1 STAGE PROX PENILE/PENOSCROTAL HYPOSPADIAS RPR,,,21 ,,RBRVS,18.37 ,10.86 ,10.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54336,CPT,1 STG PERINEAL HYPOSPADIAS RPR W/GRF&/FLA,,,21 ,,RBRVS,21.62 ,12.29 ,12.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54340,CPT,RPR HYPOSPADIAS COMPLCTJS CLSR INC/EXC SIMPLE,,,21 ,,RBRVS,9.71 ,6.61 ,6.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54344,CPT,RPR HYPOSPADIAS COMPLCTJS MOBLJ FLAPS&URTP,,,21 ,,RBRVS,17.06 ,10.84 ,10.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54348,CPT,RPR HYPOSPADIAS COMPLCTJS DSJ&URTP FLAP/GRF,,,21 ,,RBRVS,18.32 ,14.62 ,14.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54352,CPT,RPR HYPOSPADIAS CRIPPLE W/DSJ&EXC&GRFS/FLAPS,,,21 ,,RBRVS,26.13 ,19.75 ,19.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54360,CPT,PLASTIC RPR PENIS CORRECT ANGULATION,,,21 ,,RBRVS,12.78 ,8.06 ,8.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54380,CPT,PLASTIC RPR PENIS EPISPADIAS DSTL SPHNCTR,,,21 ,,RBRVS,14.18 ,8.92 ,8.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54385,CPT,PLASTIC PENIS EPISPADIAS DSTL SPHNCTR W/INCONT,,,21 ,,RBRVS,16.56 ,11.01 ,11.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54390,CPT,PLASTIC RPR PENIS EPISPADIAS W/EXSTROPHY BLADDER,,,21 ,,RBRVS,22.77 ,12.41 ,12.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54400,CPT,INSJ PENILE PROSTHESIS NON-INFLATABLE SEMI-RIGID,,,21 ,,RBRVS,9.17 ,6.12 ,6.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54401,CPT,INSJ PENILE PROSTHESOS INFLATABLE SELF-CONTAINED,,,21 ,,RBRVS,10.44 ,8.52 ,8.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54405,CPT,INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH,,,21 ,,RBRVS,14.52 ,8.73 ,8.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54406,CPT,RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH,,,21 ,,RBRVS,12.89 ,8.11 ,8.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54408,CPT,RPR COMPONENT INFLATABLE PENILE PROSTHESIS,,,21 ,,RBRVS,13.91 ,8.79 ,8.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54410,CPT,RMVL&RPLCMT INFLATABLE PENILE PROSTH SAME SESSN,,,21 ,,RBRVS,15.18 ,9.58 ,9.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54411,CPT,RMVL&RPLCMT NFLTBL PENILE PROSTH INFECTED FIELD,,,21 ,,RBRVS,18.35 ,11.10 ,11.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54415,CPT,RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT,,,21 ,,RBRVS,8.88 ,6.33 ,6.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54416,CPT,RMVL&RPLCMT NON-NFLTBL/NFLTBL PENILE PROSTHESIS,,,21 ,,RBRVS,12.08 ,8.35 ,8.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54417,CPT,RMVL&RPLCMT PENILE PROSTHESIS INFECTED FIELD,,,21 ,,RBRVS,16.10 ,9.69 ,9.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54420,CPT,CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT UNI/BI,,,21 ,,RBRVS,12.39 ,7.94 ,7.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54430,CPT,CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/B,,,21 ,,RBRVS,11.06 ,7.42 ,7.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54435,CPT,CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM,,,21 ,,RBRVS,6.81 ,5.25 ,5.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54440,CPT,PLASTIC OPERATION PENIS INJURY,,,21 ,,TotalUnits,,,,18.78 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,54450,CPT,FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING,,,21 ,,RBRVS,1.12 ,0.54 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54500,CPT,BIOPSY TESTIS NEEDLE SEPARATE PROCEDURE,,,21 ,,RBRVS,1.31 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54505,CPT,BIOPSY TESTIS INCISIONAL SEPARATE PROCEDURE,,,21 ,,RBRVS,3.50 ,2.59 ,2.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54512,CPT,EXC XTRPARENCHYMAL LESION TESTIS,,,21 ,,RBRVS,9.33 ,6.07 ,6.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54520,CPT,ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH,,,21 ,,RBRVS,5.30 ,4.02 ,4.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54522,CPT,ORCHIECTOMY PARTIAL,,,21 ,,RBRVS,10.25 ,6.46 ,6.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54530,CPT,ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH,,,21 ,,RBRVS,8.46 ,6.08 ,6.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54535,CPT,ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL,,,21 ,,RBRVS,13.19 ,7.97 ,7.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54550,CPT,EXPL UNDESCENDED TSTIS INGUN/SCROTAL AREA,,,21 ,,RBRVS,8.41 ,5.68 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54560,CPT,EXPL UNDESCENDED TESTIS W/ABDOMINAL EXPL,,,21 ,,RBRVS,12.10 ,7.21 ,7.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54600,CPT,RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS,,,21 ,,RBRVS,7.64 ,5.40 ,5.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54620,CPT,FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE,,,21 ,,RBRVS,5.21 ,3.45 ,3.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54640,CPT,ORCHIOPEXY INGUINAL APPROACH W/WO HERNIA RPR,,,21 ,,RBRVS,7.73 ,5.86 ,5.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54650,CPT,ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS,,,21 ,,RBRVS,12.39 ,7.91 ,7.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54660,CPT,INSJ TESTICULAR PROSTH SEPARATE PROCEDURE,,,21 ,,RBRVS,5.74 ,4.54 ,4.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54670,CPT,SUTURE/REPAIR TESTICULAR INJURY,,,21 ,,RBRVS,6.65 ,5.01 ,5.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54680,CPT,TRANSPLANTATION TESTIS TO THIGH,,,21 ,,RBRVS,14.04 ,8.38 ,8.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54690,CPT,LAPAROSCOPY SURGICAL ORCHIECTOMY,,,21 ,,RBRVS,11.70 ,6.63 ,6.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54692,CPT,LAPAROSCOPY ORCHIOPEXY INTRA-ABDOMINAL TESTIS,,,21 ,,RBRVS,13.74 ,8.09 ,8.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54699,CPT,UNLISTED LAPAROSCOPY PROCEDURE TESTIS,,,21 ,,TotalUnits,,,,18.33 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,54700,CPT,I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE,,,21 ,,RBRVS,3.47 ,2.61 ,2.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54800,CPT,BIOPSY EPIDIDYMIS NEEDLE,,,21 ,,RBRVS,2.33 ,1.81 ,1.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54830,CPT,EXCISION LOCAL LESION EPIDIDYMIS,,,21 ,,RBRVS,6.01 ,4.68 ,4.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54840,CPT,EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY,,,21 ,,RBRVS,5.27 ,4.01 ,4.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54860,CPT,EPIDIDYMECTOMY UNILATERAL,,,21 ,,RBRVS,6.95 ,5.11 ,5.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54861,CPT,EPIDIDYMECTOMY BILATERAL,,,21 ,,RBRVS,9.70 ,6.56 ,6.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54865,CPT,EXPLORATION EPIDIDYMIS W/WO BIOPSY,,,21 ,,RBRVS,5.77 ,4.55 ,4.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54900,CPT,EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS UNI,,,21 ,,RBRVS,14.20 ,7.99 ,7.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,54901,CPT,EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS BI,,,21 ,,RBRVS,19.10 ,11.82 ,11.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55000,CPT,PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED,,,21 ,,RBRVS,1.43 ,0.99 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55040,CPT,EXCISION HYDROCELE UNILATERAL,,,21 ,,RBRVS,5.45 ,4.24 ,4.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55041,CPT,EXCISION HYDROCELE BILATERAL,,,21 ,,RBRVS,8.54 ,6.06 ,6.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55060,CPT,RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE,,,21 ,,RBRVS,6.15 ,4.74 ,4.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55100,CPT,DRAINAGE SCROTAL WALL ABSCESS,,,21 ,,RBRVS,2.45 ,2.27 ,3.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55110,CPT,SCROTAL EXPLORATION,,,21 ,,RBRVS,6.33 ,4.78 ,4.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55120,CPT,REMOVAL FOREIGN BODY SCROTUM,,,21 ,,RBRVS,5.72 ,4.49 ,4.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55150,CPT,RESECTION SCROTUM,,,21 ,,RBRVS,8.14 ,5.91 ,5.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55175,CPT,SCROTOPLASTY SIMPLE,,,21 ,,RBRVS,5.87 ,4.60 ,4.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55180,CPT,SCROTOPLASTY COMPLICATED,,,21 ,,RBRVS,11.78 ,7.94 ,7.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55200,CPT,VASOTOMY CANNULIZATION W/WO VAS INC UNI/BI SPX,,,21 ,,RBRVS,4.55 ,3.42 ,9.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55250,CPT,VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS,,,21 ,,RBRVS,3.37 ,3.24 ,8.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55300,CPT,VASOTOMY VASOGRAMS UNI/BI,,,21 ,,RBRVS,3.50 ,1.72 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55400,CPT,VASOVASOSTOMY VASOVASORRHAPHY,,,21 ,,RBRVS,8.61 ,5.79 ,5.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55450,CPT,LIGATION PRQ VAS DEFERENS UNI/BI SPX,,,21 ,,RBRVS,4.43 ,2.92 ,6.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55500,CPT,EXC HYDROCELE SPRMATIC CORD UNI SPX,,,21 ,,RBRVS,6.22 ,4.78 ,4.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55520,CPT,EXC LESION SPERMATIC CORD SEPARATE PROCEDURE,,,21 ,,RBRVS,6.66 ,4.98 ,4.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55530,CPT,EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX,,,21 ,,RBRVS,5.75 ,4.39 ,4.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55535,CPT,EXC VARICOCELE/LIGATION SPERMATIC VEINS ABDL,,,21 ,,RBRVS,7.19 ,5.14 ,5.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55540,CPT,EXC VARICOCELE/LIGATION VEINS W/HERNIA RPR,,,21 ,,RBRVS,8.30 ,5.66 ,5.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55550,CPT,LAPS LIGATION SPERMATIC VEINS VARICOCELE,,,21 ,,RBRVS,7.20 ,4.99 ,4.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55559,CPT,UNLISTED LAPROSCOPY PROCEDURE SPERMATIC CORD,,,21 ,,TotalUnits,,,,12.19 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,55600,CPT,VESICULOTOMY,,,21 ,,RBRVS,7.01 ,5.15 ,5.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55605,CPT,VESICULOTOMY COMPLICATED,,,21 ,,RBRVS,8.76 ,6.21 ,6.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55650,CPT,VESICULECTOMY ANY APPROACH,,,21 ,,RBRVS,12.65 ,7.84 ,7.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55680,CPT,EXCISION MULLERIAN DUCT CYST,,,21 ,,RBRVS,5.67 ,4.15 ,4.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55700,CPT,PROSTATE NEEDLE BIOPSY ANY APPROACH,,,21 ,,RBRVS,2.58 ,1.38 ,4.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55705,CPT,BIOPSY PROSTATE INCISIONAL ANY APPROACH,,,21 ,,RBRVS,4.61 ,3.09 ,3.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55706,CPT,BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID,,,21 ,,RBRVS,6.28 ,4.67 ,4.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55720,CPT,PROSTATOTOMY EXTERNAL DRG ABSCESS SIMPLE,,,21 ,,RBRVS,7.73 ,5.26 ,5.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55725,CPT,PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED,,,21 ,,RBRVS,10.05 ,6.93 ,6.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55801,CPT,PROSTATECTOMY PERINEAL SUBTOTAL,,,21 ,,RBRVS,19.80 ,11.43 ,11.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55810,CPT,PROSTATECTOMY PERINEAL RADICAL,,,21 ,,RBRVS,24.29 ,13.32 ,13.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55812,CPT,PROSTATECTOMY PERINEAL RADICAL W/LYMPH NODE BX,,,21 ,,RBRVS,29.89 ,16.20 ,16.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55815,CPT,PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC,,,21 ,,RBRVS,32.95 ,17.59 ,17.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55821,CPT,PROSTATECTOMY SUPRAPUBIC SUBTOTAL 1/2 STAGES,,,21 ,,RBRVS,15.76 ,9.33 ,9.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55831,CPT,PROSTATECTOMY RETROPUBIC SUBTOTAL,,,21 ,,RBRVS,17.19 ,9.96 ,9.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55840,CPT,PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING,,,21 ,,RBRVS,24.63 ,13.74 ,13.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55842,CPT,PROSTECT RETROPUBIC RAD W/WO NRV SPAR W/LYMPH BX,,,21 ,,RBRVS,26.49 ,14.57 ,14.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55845,CPT,PROSTECT RETROPUB RAD W/WO NRV SPAR&BI PLV LYMPH,,,21 ,,RBRVS,30.67 ,16.18 ,16.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55860,CPT,EXPOS PROSTATE ANY APPROACH INSJ RADIOACT SUBST,,,21 ,,RBRVS,15.84 ,9.28 ,9.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55862,CPT,EXPOS PROSTATE INSJ RADIOACT SBST W/LYMPH BX,,,21 ,,RBRVS,20.04 ,11.50 ,11.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55865,CPT,EXPOS PROSTATE INSJ RADIOAC SBST W/BI PELV LYMPH,,,21 ,,RBRVS,24.57 ,13.76 ,13.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55866,CPT,LAPS PROSTECT RETROPUBIC RAD W/NRV SPARING ROBOT,,,21 ,,RBRVS,32.06 ,17.57 ,17.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55870,CPT,ELECTROEJACULATION,,,21 ,,RBRVS,2.58 ,1.53 ,2.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55873,CPT,CRYOSURGICAL ABLATION PROSTATE W/US & MONITORING,,,21 ,,RBRVS,13.60 ,10.53 ,171.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55875,CPT,TRANSPERINEAL PLMT NDL/CATHS PROSTATE RADJ INSJ,,,21 ,,RBRVS,13.46 ,8.45 ,8.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55876,CPT,PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT,,,21 ,,RBRVS,1.73 ,1.19 ,2.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,55899,CPT,UNLISTED PROCEDURE MALE GENITAL SYSTEM,,,21 ,,TotalUnits,,,,6.08 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,55920,CPT,PLACEMENT NEEDLE PELVIC ORGAN RADIOELEMENT APPL,,,21 ,,RBRVS,8.31 ,4.11 ,4.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56405,CPT,I&D VULVA/PERINEAL ABSCESS,,,21 ,,RBRVS,1.49 ,1.45 ,1.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56420,CPT,I&D OF BARTHOLINS GLAND ABSCESS,,,21 ,,RBRVS,1.44 ,1.05 ,1.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56440,CPT,MARSUPIALIZATION BARTHOLINS GLAND CYST,,,21 ,,RBRVS,2.89 ,2.06 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56441,CPT,LYSIS LABIAL ADHESIONS,,,21 ,,RBRVS,2.02 ,1.83 ,2.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56442,CPT,HYMENOTOMY SIMPLE INCISION,,,21 ,,RBRVS,0.68 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56501,CPT,DESTRUCTION LESIONS VULVA SIMPLE,,,21 ,,RBRVS,1.58 ,1.54 ,2.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56515,CPT,DESTRUCTION LESIONS VULVA EXTENSIVE,,,21 ,,RBRVS,3.08 ,2.31 ,3.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56605,CPT,BIOPSY VULVA/PERINEUM 1 LESION SPX,,,21 ,,RBRVS,1.10 ,0.52 ,1.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56606,CPT,BIOPSY VULVA/PERINEUM EACH ADDL LESION,,,21 ,,RBRVS,0.55 ,0.24 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56620,CPT,VULVECTOMY SIMPLE PARTIAL,,,21 ,,RBRVS,7.53 ,6.03 ,6.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56625,CPT,VULVECTOMY SIMPLE COMPLETE,,,21 ,,RBRVS,9.68 ,6.50 ,6.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56630,CPT,VULVECTOMY RADICAL PARTIAL,,,21 ,,RBRVS,14.80 ,8.79 ,8.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56631,CPT,VULVECTOMY RAD PRTL UNI INGUINOFEM LMPHADEC,,,21 ,,RBRVS,18.99 ,10.94 ,10.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56632,CPT,VULVECTOMY RAD PRTL BI INGUINOFEM LMPHADEC,,,21 ,,RBRVS,21.86 ,12.95 ,12.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56633,CPT,VULVECTOMY RADICAL COMPLETE,,,21 ,,RBRVS,19.62 ,11.05 ,11.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56634,CPT,VULVECTOMY RAD COMPL UNI INGUINOFEM LMPHADEC,,,21 ,,RBRVS,20.66 ,11.77 ,11.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56637,CPT,VULVECTOMY RAD COMPL BI INGUINOFEM LMPHADEC,,,21 ,,RBRVS,24.75 ,13.36 ,13.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56640,CPT,VULVECTOMY RAD COMPL ILIAC&PEL LMPHADEC,,,21 ,,RBRVS,24.78 ,12.74 ,12.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56700,CPT,PRTL HYMENECTOMY/REVJ HYMENAL RING,,,21 ,,RBRVS,2.84 ,2.24 ,2.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56740,CPT,EXC BARTHOLINS GLAND/CYST,,,21 ,,RBRVS,4.88 ,3.12 ,3.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56800,CPT,PLASTIC REPAIR INTROITUS,,,21 ,,RBRVS,3.93 ,2.61 ,2.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56805,CPT,CLITOROPLASTY INTERSEX STATE,,,21 ,,RBRVS,19.88 ,10.79 ,10.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56810,CPT,PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX,,,21 ,,RBRVS,4.29 ,2.74 ,2.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56820,CPT,COLPOSCOPY VULVA,,,21 ,,RBRVS,1.50 ,0.77 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,56821,CPT,COLPOSCOPY VULVA W/BIOPSY,,,21 ,,RBRVS,2.05 ,1.01 ,1.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57000,CPT,COLPOTOMY W/EXPLORATION,,,21 ,,RBRVS,3.02 ,2.13 ,2.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57010,CPT,COLPOTOMY W/DRAINAGE PELVIC ABSCESS,,,21 ,,RBRVS,6.84 ,4.88 ,4.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57020,CPT,COLPOCENTESIS SEPARATE PROCEDURE,,,21 ,,RBRVS,1.50 ,0.67 ,1.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57022,CPT,I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM,,,21 ,,RBRVS,2.73 ,1.80 ,1.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57023,CPT,I&D VAGINAL HEMATOMA NON-OBSTETRICAL,,,21 ,,RBRVS,5.18 ,3.20 ,3.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57061,CPT,DESTRUCTION VAGINAL LESIONS SIMPLE,,,21 ,,RBRVS,1.30 ,1.38 ,1.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57065,CPT,DESTRUCTION VAGINAL LESIONS EXTENSIVE,,,21 ,,RBRVS,2.66 ,1.97 ,2.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57100,CPT,BIOPSY VAGINAL MUCOSA SIMPLE,,,21 ,,RBRVS,1.20 ,0.55 ,1.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57105,CPT,BIOPSY VAGINAL MUCOSA EXTENSIVE,,,21 ,,RBRVS,1.74 ,1.67 ,1.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57106,CPT,VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL,,,21 ,,RBRVS,7.50 ,5.52 ,5.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57107,CPT,VAGINECTOMY PRTL RMVL VAG WALL & PARAVAGINAL TIS,,,21 ,,RBRVS,24.56 ,12.94 ,12.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57109,CPT,VAGNC PRTL RMVL VAG WALL W/BI TOT PEL LMPHADEC,,,21 ,,RBRVS,28.40 ,14.40 ,14.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57110,CPT,VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL,,,21 ,,RBRVS,15.48 ,8.63 ,8.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57111,CPT,VAGINECTOMY COMPL RMVL VAG WALL & PARAVAG TISS,,,21 ,,RBRVS,28.40 ,14.69 ,14.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57112,CPT,VAGNC COMPL RMVL VAG WALL TOT PEL LMPHADEC BX,,,21 ,,RBRVS,30.52 ,11.96 ,11.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57120,CPT,COLPOCLEISIS LE FORT TYPE,,,21 ,,RBRVS,8.28 ,5.55 ,5.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57130,CPT,EXCISION VAGINAL SEPTUM,,,21 ,,RBRVS,2.46 ,1.88 ,2.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57135,CPT,EXCISION VAGINAL CYST/TUMOR,,,21 ,,RBRVS,2.70 ,1.98 ,2.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57150,CPT,IRRIGATION VAGINA&/APPL MEDICAMENT TX DISEASE,,,21 ,,RBRVS,0.55 ,0.24 ,0.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57155,CPT,INSERTION UTERINE TANDEM&/VAGINAL OVOIDS,,,21 ,,RBRVS,3.37 ,1.66 ,5.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57156,CPT,INSERTION VAGINAL RADIATION DEVICE,,,21 ,,RBRVS,1.87 ,0.99 ,2.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57160,CPT,FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVICE,,,21 ,,RBRVS,0.89 ,0.38 ,1.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57170,CPT,DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS,,,21 ,,RBRVS,0.91 ,0.38 ,0.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57180,CPT,INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX,,,21 ,,RBRVS,1.63 ,1.25 ,2.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57200,CPT,COLPORRHAPHY SUTURE INJURY VAGINA,,,21 ,,RBRVS,4.42 ,3.70 ,3.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57210,CPT,COLPOPERINEORRHAPHY SUTURE INJ VAGINA&/PERINEUM,,,21 ,,RBRVS,5.71 ,4.24 ,4.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57220,CPT,PLASTIC URETHRAL SPHINCTER VAGINAL APPROACH,,,21 ,,RBRVS,4.85 ,3.86 ,3.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57230,CPT,PLASTIC REPAIR URETHROCELE,,,21 ,,RBRVS,6.30 ,4.53 ,4.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57240,CPT,ANT COLPORRHAPHY CYSTOCELE W/WO RPR URETHROCELE,,,21 ,,RBRVS,11.50 ,6.66 ,6.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57250,CPT,POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY,,,21 ,,RBRVS,11.50 ,6.50 ,6.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57260,CPT,COMBINED ANTEROPOSTERIOR COLPORRHAPHY,,,21 ,,RBRVS,14.44 ,7.76 ,7.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57265,CPT,CMBND ANTEROPOST COLPORRHAPHY W/ENTEROCELE RPR,,,21 ,,RBRVS,15.94 ,8.53 ,8.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57267,CPT,INSJ MESH/PROSTH PELVIC FLOOR DEFECT EACH SITE,,,21 ,,RBRVS,4.88 ,2.13 ,2.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57268,CPT,REPAIR ENTEROCELE VAGINAL APPROACH SPX,,,21 ,,RBRVS,7.57 ,5.51 ,5.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57270,CPT,REPAIR ENTEROCELE ABDOMINAL APPROACH SPX,,,21 ,,RBRVS,13.67 ,7.79 ,7.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57280,CPT,COLPOPEXY ABDOMINAL APPROACH,,,21 ,,RBRVS,16.72 ,9.15 ,9.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57282,CPT,COLPOPEXY VAGINAL EXTRAPERITONEAL APPROACH,,,21 ,,RBRVS,7.97 ,5.72 ,5.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57283,CPT,COLPOPEXY VAGINAL INTRAPERITONEAL APPROACH,,,21 ,,RBRVS,11.66 ,6.97 ,6.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57284,CPT,PARAVAGINAL DEFECT REPAIR OPEN ABDOMINAL APPR,,,21 ,,RBRVS,14.33 ,7.98 ,7.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57285,CPT,PARAVAGINAL DEFECT REPAIR VAGINAL APPROACH,,,21 ,,RBRVS,11.60 ,6.75 ,6.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57287,CPT,RMVL/REVJ SLING STRESS INCONTINENCE,,,21 ,,RBRVS,11.15 ,7.82 ,7.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57288,CPT,SLING OPERATION STRESS INCONTINENCE,,,21 ,,RBRVS,12.13 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57289,CPT,PEREYRA PX W/ANTERIOR COLPORRHAPHY,,,21 ,,RBRVS,12.80 ,7.69 ,7.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57291,CPT,CONSTRUCTION ARTIFICIAL VAGINA W/O GRAFT,,,21 ,,RBRVS,8.64 ,7.51 ,7.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57292,CPT,CONSTRUCTION ARTIFICIAL VAGINA W/GRAFT,,,21 ,,RBRVS,14.01 ,8.13 ,8.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57295,CPT,REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP,,,21 ,,RBRVS,7.82 ,5.33 ,5.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57296,CPT,REVJ W/RMVL PROSTHETIC VAGINAL GRAFT ABDML APPR,,,21 ,,RBRVS,16.56 ,8.94 ,8.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57300,CPT,CLSR RECTOVAGINAL FISTULA VAGINAL/TRANSANAL APPR,,,21 ,,RBRVS,8.71 ,6.01 ,6.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57305,CPT,CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH,,,21 ,,RBRVS,15.35 ,8.75 ,8.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57307,CPT,CLSR RECTOVAG FSTL ABDL APPR W/CONCOMITANT CLST,,,21 ,,RBRVS,17.17 ,9.90 ,9.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57308,CPT,CLSR RECTOVAG FSTL TPRNL PRNL BDY RCNSTJ,,,21 ,,RBRVS,10.59 ,6.81 ,6.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57310,CPT,CLOSURE URETHROVAGINAL FISTULA,,,21 ,,RBRVS,7.65 ,5.48 ,5.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57311,CPT,CLSR URETHROVAG FSTL W/BULBOCAVERNOSUS TRNSPL,,,21 ,,RBRVS,8.91 ,6.01 ,6.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57320,CPT,CLOSURE VESICOVAGINAL FISTULA VAGINAL APPROACH,,,21 ,,RBRVS,8.88 ,6.10 ,6.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57330,CPT,CLSR VESICOVAG FSTL TRANSVESICAL&VAG APPR,,,21 ,,RBRVS,13.21 ,7.72 ,7.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57335,CPT,VAGINOPLASTY INTERSEX STATE,,,21 ,,RBRVS,20.02 ,11.27 ,11.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57400,CPT,DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL,,,21 ,,RBRVS,2.27 ,1.34 ,1.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57410,CPT,PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL,,,21 ,,RBRVS,1.75 ,1.14 ,1.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57415,CPT,REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL,,,21 ,,RBRVS,2.49 ,1.88 ,1.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57420,CPT,COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT,,,21 ,,RBRVS,1.60 ,0.81 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57421,CPT,COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX,,,21 ,,RBRVS,2.20 ,1.07 ,2.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57423,CPT,PARAVAGINAL DEFECT REPAIR LAPAROSCOPIC APPROACH,,,21 ,,RBRVS,16.08 ,8.63 ,8.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57425,CPT,LAPAROSCOPY COLPOPEXY SUSPENSION VAGINAL APEX,,,21 ,,RBRVS,17.03 ,9.17 ,9.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57426,CPT,REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC,,,21 ,,RBRVS,14.30 ,8.32 ,8.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57452,CPT,COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA,,,21 ,,RBRVS,1.50 ,0.97 ,1.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57454,CPT,COLPOSCOPY CERVIX BX CERVIX&ENDOCRV CURTG,,,21 ,,RBRVS,2.33 ,1.33 ,1.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57455,CPT,COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX,,,21 ,,RBRVS,1.99 ,0.98 ,1.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57456,CPT,COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE,,,21 ,,RBRVS,1.85 ,0.92 ,1.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57460,CPT,COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX,,,21 ,,RBRVS,2.83 ,1.55 ,5.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57461,CPT,COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX,,,21 ,,RBRVS,3.43 ,1.60 ,5.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57500,CPT,BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX,,,21 ,,RBRVS,1.20 ,0.84 ,2.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57505,CPT,ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE,,,21 ,,RBRVS,1.19 ,1.32 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57510,CPT,CAUTERY CERVIX ELECTRO/THERMAL,,,21 ,,RBRVS,1.90 ,1.22 ,1.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57511,CPT,CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT,,,21 ,,RBRVS,1.95 ,1.64 ,2.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57513,CPT,CAUTERY CERVIX LASER ABLATION,,,21 ,,RBRVS,1.95 ,1.65 ,1.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57520,CPT,CONIZATION CERVIX +-D&C RPR KNIFE/LASER,,,21 ,,RBRVS,4.11 ,3.28 ,4.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57522,CPT,CONIZATION CERVIX +-D&C RPR ELTRD EXC,,,21 ,,RBRVS,3.67 ,2.92 ,3.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57530,CPT,TRACHELECTOMY CERVICECTOMY AMP CERVIX SPX,,,21 ,,RBRVS,5.27 ,4.07 ,4.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57531,CPT,RAD TRACHELECTOMY W/BI PEL LMPHADEC,,,21 ,,RBRVS,29.95 ,15.82 ,15.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57540,CPT,EXCISION CERVICAL STUMP ABDOMINAL APPROACH,,,21 ,,RBRVS,13.29 ,7.62 ,7.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57545,CPT,EXC CERVICAL STUMP ABDL APPR W/PELVIC FLOOR RPR,,,21 ,,RBRVS,14.10 ,7.97 ,7.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57550,CPT,EXCISION CERVICAL STUMP VAGINAL APPROACH,,,21 ,,RBRVS,6.34 ,4.71 ,4.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57555,CPT,EXC CRV STUMP VAG APPR W/ANT&/POST RPR,,,21 ,,RBRVS,9.94 ,6.23 ,6.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57556,CPT,EXC CRV STUMP VAG APPR W/RPR NTRCL,,,21 ,,RBRVS,9.36 ,6.03 ,6.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57558,CPT,DILATION & CURETTAGE CERVICAL STUMP,,,21 ,,RBRVS,1.72 ,1.36 ,1.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57700,CPT,CERCLAGE UTERINE CERVIX NONOBSTETRICAL,,,21 ,,RBRVS,4.35 ,4.15 ,4.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57720,CPT,TRACHELORRHAPHY PLSTC RPR UTERINE CERVIX VAG,,,21 ,,RBRVS,4.61 ,3.75 ,3.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,57800,CPT,DILATION CERVICAL CANAL INSTRUMENTAL SPX,,,21 ,,RBRVS,0.77 ,0.54 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58100,CPT,ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX,,,21 ,,RBRVS,1.53 ,0.82 ,1.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58110,CPT,ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY,,,21 ,,RBRVS,0.77 ,0.33 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58120,CPT,DILATION & CURETTAGE DX&/THER NONOBSTETRICAL,,,21 ,,RBRVS,3.59 ,2.26 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58140,CPT,MYOMECTOMY 1-4 MYOMAS W/250 GM/< ABDOMINAL APPR,,,21 ,,RBRVS,15.79 ,8.66 ,8.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58145,CPT,MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR,,,21 ,,RBRVS,8.91 ,5.73 ,5.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58146,CPT,MYOMECTOMY 5/> MYOMAS &/>250 GM ABDOMINAL APPR,,,21 ,,RBRVS,20.34 ,10.61 ,10.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58150,CPT,TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY,,,21 ,,RBRVS,17.31 ,9.27 ,9.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58152,CPT,TOT ABD HYST W/WO RMVL TUBE OVARY W/COLPURETHRXY,,,21 ,,RBRVS,21.86 ,11.46 ,11.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58180,CPT,SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY,,,21 ,,RBRVS,16.60 ,8.98 ,8.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58200,CPT,TOT ABD HYST W/PARAORTIC&PELVIC LYMPH NODE SAMPL,,,21 ,,RBRVS,23.10 ,11.92 ,11.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58210,CPT,RAD ABDL HYSTERECTOMY W/BI PELVIC LMPHADENECTOMY,,,21 ,,RBRVS,30.91 ,15.82 ,15.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58240,CPT,PEL EXNTJ GYNECOLOGIC MAL,,,21 ,,RBRVS,49.33 ,24.85 ,24.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58260,CPT,VAGINAL HYSTERECTOMY UTERUS 250 GM/<,,,21 ,,RBRVS,14.15 ,8.05 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58262,CPT,VAG HYST 250 GM/< W/RMVL TUBE&/OVARY,,,21 ,,RBRVS,15.94 ,8.79 ,8.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58263,CPT,VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL,,,21 ,,RBRVS,17.23 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58267,CPT,VAG HYST 250 GM/< W/COLPO-URTCSTOPEXY,,,21 ,,RBRVS,18.36 ,9.90 ,9.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58270,CPT,VAGINAL HYSTERECTOMY 250 GM/< W/RPR ENTEROCELE,,,21 ,,RBRVS,15.30 ,8.35 ,8.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58275,CPT,VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY,,,21 ,,RBRVS,17.03 ,9.32 ,9.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58280,CPT,VAG HYSTER W/TOT/PRTL VAGINECT W/RPR ENTEROCELE,,,21 ,,RBRVS,18.33 ,9.87 ,9.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58285,CPT,VAGINAL HYSTERECTOMY RADICAL SCHAUTA OPERATION,,,21 ,,RBRVS,23.38 ,11.73 ,11.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58290,CPT,VAGINAL HYSTERECTOMY UTERUS > 250 GM,,,21 ,,RBRVS,20.27 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58291,CPT,VAG HYST > 250 GM RMVL TUBE&/OVARY,,,21 ,,RBRVS,22.06 ,11.38 ,11.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58292,CPT,VAG HYST > 250 GM RMVL TUBE&/OVARY W/RPR NTRCL,,,21 ,,RBRVS,23.35 ,11.89 ,11.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58293,CPT,VAG HYST >250 GM COLPOURTCSTOPEXY W/WO NDSC CTRL,,,21 ,,RBRVS,24.33 ,12.27 ,12.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58294,CPT,VAGINAL HYSTERECTOMY >250 GM RPR ENTEROCELE,,,21 ,,RBRVS,21.55 ,11.06 ,11.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58300,CPT,INSERTION INTRAUTERINE DEVICE IUD,,,21 ,,RBRVS,1.01 ,0.44 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58301,CPT,REMOVAL INTRAUTERINE DEVICE IUD,,,21 ,,RBRVS,1.27 ,0.54 ,1.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58321,CPT,ARTIFICIAL INSEMINATION INTRA-CERVICAL,,,21 ,,RBRVS,0.92 ,0.40 ,1.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58322,CPT,ARTIFICIAL INSEMINATION INTRA-UTERINE,,,21 ,,RBRVS,1.10 ,0.47 ,1.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58323,CPT,SPERM WASHING ARTIFICIAL INSEMINATION,,,21 ,,RBRVS,0.23 ,0.10 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58340,CPT,CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPING,,,21 ,,RBRVS,0.88 ,0.72 ,2.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58345,CPT,TRANSCERV FALLOPIAN TUBE CATH W/WO HYSTOSALPING,,,21 ,,RBRVS,4.70 ,2.84 ,2.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58346,CPT,INSERTION HEYMAN CAPSULES CLINICAL BRACHYTHERAPY,,,21 ,,RBRVS,7.56 ,4.73 ,4.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58350,CPT,CHROMOTUBATION OVIDUCT W/MATERIALS,,,21 ,,RBRVS,1.06 ,1.10 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58353,CPT,ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GID,,,21 ,,RBRVS,3.60 ,2.33 ,27.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58356,CPT,ENDOMETRIAL CRYOABLATION W/US & ENDOMETRIAL CRTG,,,21 ,,RBRVS,6.41 ,2.85 ,51.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58400,CPT,UTERINE SUSPENSION W/WO SHORTENING LIGAMENTS SPX,,,21 ,,RBRVS,7.14 ,4.89 ,4.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58410,CPT,UTERINE SUSP W/WO SHORT LIGAMNTS W/SYMPATHECTOMY,,,21 ,,RBRVS,13.80 ,7.77 ,7.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58520,CPT,HYSTERORRHAPHY REPAIR RUPT UTERUS NONOBSTETRICAL,,,21 ,,RBRVS,13.48 ,7.58 ,7.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58540,CPT,HYSTEROPLASTY RPR UTERINE ANOMALY,,,21 ,,RBRVS,15.71 ,8.62 ,8.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58541,CPT,LAPAROSCOPY SUPRACERVICAL HYSTERECTOMY 250 GM/<,,,21 ,,RBRVS,14.70 ,8.39 ,8.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58542,CPT,LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVARY,,,21 ,,RBRVS,16.56 ,9.18 ,9.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58543,CPT,LAPS SUPRACERVICAL HYSTERECTOMY >250,,,21 ,,RBRVS,16.87 ,9.30 ,9.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58544,CPT,LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY,,,21 ,,RBRVS,18.37 ,9.89 ,9.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58545,CPT,LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/<,,,21 ,,RBRVS,15.55 ,8.37 ,8.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58546,CPT,LAPS MYOMECTOMY EXC 5/> MYOMAS >250 GRAMS,,,21 ,,RBRVS,19.94 ,10.23 ,10.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58548,CPT,LAPS W/RAD HYST W/BILAT LMPHADEC RMVL TUBE/OVARY,,,21 ,,RBRVS,31.63 ,16.09 ,16.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58550,CPT,LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/<,,,21 ,,RBRVS,15.10 ,8.58 ,8.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58552,CPT,LAPS W/VAG HYSTERECT 250 GM/< RMVL TUBE&/OVARY,,,21 ,,RBRVS,16.91 ,9.33 ,9.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58553,CPT,LAPS W/VAGINAL HYSTERECTOMY > 250 GRAMS,,,21 ,,RBRVS,20.06 ,10.30 ,10.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58554,CPT,LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVARY,,,21 ,,RBRVS,23.11 ,12.01 ,12.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58555,CPT,HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE,,,21 ,,RBRVS,3.33 ,1.76 ,4.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58558,CPT,HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C,,,21 ,,RBRVS,4.74 ,2.41 ,5.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58559,CPT,HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS,,,21 ,,RBRVS,6.16 ,3.02 ,3.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58560,CPT,HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM,,,21 ,,RBRVS,6.99 ,3.38 ,3.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58561,CPT,HYSTEROSCOPY REMOVAL LEIOMYOMATA,,,21 ,,RBRVS,9.99 ,4.67 ,4.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58562,CPT,HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY,,,21 ,,RBRVS,5.20 ,2.58 ,5.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58563,CPT,HYSTEROSCOPY ENDOMETRIAL ABLATION,,,21 ,,RBRVS,6.16 ,3.02 ,44.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58565,CPT,HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS,,,21 ,,RBRVS,7.12 ,4.58 ,48.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58570,CPT,LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/<,,,21 ,,RBRVS,15.88 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58571,CPT,LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY,,,21 ,,RBRVS,17.69 ,9.73 ,9.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58572,CPT,LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM,,,21 ,,RBRVS,20.09 ,10.65 ,10.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58573,CPT,LAPAROSCOPY TOT HYSTERECTOMY >250 G W TUBE/OVARY,,,21 ,,RBRVS,23.11 ,11.97 ,11.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58578,CPT,UNLISTED LAPAROSCOPY PROCEDURE UTERUS,,,21 ,,TotalUnits,,,,26.17 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,58579,CPT,UNLISTED HYSTEROSCOPY PROCEDURE UTERUS,,,21 ,,TotalUnits,,,,8.91 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,58600,CPT,LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI,,,21 ,,RBRVS,5.91 ,3.90 ,3.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58605,CPT,LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX,,,21 ,,RBRVS,5.28 ,3.62 ,3.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58611,CPT,LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG,,,21 ,,RBRVS,1.45 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58615,CPT,OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR,,,21 ,,RBRVS,3.94 ,2.71 ,2.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58660,CPT,LAPAROSCOPY W/LYSIS OF ADHESIONS,,,21 ,,RBRVS,11.59 ,6.33 ,6.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58661,CPT,LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES,,,21 ,,RBRVS,11.35 ,5.83 ,5.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58662,CPT,LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE,,,21 ,,RBRVS,12.15 ,6.72 ,6.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58670,CPT,LAPAROSCOPY FULGURATION OVIDUCTS,,,21 ,,RBRVS,5.91 ,3.94 ,3.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58671,CPT,LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS,,,21 ,,RBRVS,5.91 ,3.93 ,3.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58672,CPT,LAPAROSCOPY FIMBRIOPLASTY,,,21 ,,RBRVS,12.91 ,6.81 ,6.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58673,CPT,LAPAROSCOPY SALPINGOSTOMY,,,21 ,,RBRVS,14.04 ,7.43 ,7.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58679,CPT,UNLISTED LAPAROSCOPY PROCEDURE OVIDUCT/OVARY,,,21 ,,TotalUnits,,,,17.18 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,58700,CPT,SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX,,,21 ,,RBRVS,12.95 ,7.58 ,7.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58720,CPT,SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX,,,21 ,,RBRVS,12.16 ,7.08 ,7.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58740,CPT,LYSIS OF ADHESIONS SALPINX/OVARY,,,21 ,,RBRVS,14.90 ,8.45 ,8.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58750,CPT,TUBOTUBAL ANASTATOMOSIS,,,21 ,,RBRVS,15.64 ,8.56 ,8.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58752,CPT,TUBOUTERINE IMPLANTATION,,,21 ,,RBRVS,15.64 ,8.57 ,8.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58760,CPT,FIMBRIOPLASTY,,,21 ,,RBRVS,13.93 ,7.87 ,7.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58770,CPT,SALPINGOSTOMY,,,21 ,,RBRVS,14.77 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58800,CPT,DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR,,,21 ,,RBRVS,4.62 ,3.51 ,4.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58805,CPT,DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL,,,21 ,,RBRVS,6.42 ,4.46 ,4.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58820,CPT,DRAINAGE OVARIAN ABSCESS VAGINAL APPR OPEN,,,21 ,,RBRVS,4.70 ,4.19 ,4.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58822,CPT,DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH,,,21 ,,RBRVS,11.81 ,7.14 ,7.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58823,CPT,DRG PELVIC ABSCESS TRANSVAG/TRANSRECTAL APPR,,,21 ,,RBRVS,3.37 ,1.39 ,23.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58825,CPT,TRANSPOSITION OVARY,,,21 ,,RBRVS,11.78 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58900,CPT,BIOPSY OVARY UNI/BI SEPARATE PROCEDURE,,,21 ,,RBRVS,6.59 ,4.95 ,4.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58920,CPT,WEDGE RESCJ/BISCTJ OVARY UNI/BI,,,21 ,,RBRVS,11.95 ,6.81 ,6.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58925,CPT,OVARIAN CYSTECTOMY UNI/BI,,,21 ,,RBRVS,12.43 ,7.25 ,7.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58940,CPT,OOPHORECTOMY PARTIAL/TOTAL UNI/BI,,,21 ,,RBRVS,8.22 ,5.47 ,5.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58943,CPT,OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY,,,21 ,,RBRVS,19.52 ,10.39 ,10.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58950,CPT,RESCJ OVARIAN/TUBAL/PERITONEAL MALIGNANCY W/BSO,,,21 ,,RBRVS,18.37 ,10.32 ,10.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58951,CPT,RESCJ PRIM PRTL MAL W/BSO&OMNTC TAH&LMPHADEC,,,21 ,,RBRVS,24.26 ,12.60 ,12.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58952,CPT,RESCJ PRIM PRTL MAL W/BSO&OMNTC RAD DEBULKING,,,21 ,,RBRVS,27.29 ,14.29 ,14.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58953,CPT,BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION,,,21 ,,RBRVS,34.13 ,17.30 ,17.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58954,CPT,BSO W/OMENTECTOMY TAH DEBULKING W/LMPHADECTOMY,,,21 ,,RBRVS,37.13 ,18.63 ,18.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58956,CPT,BSO W/TOT OMENTECTOMY & HYSTERECTOMY MALIGNANCY,,,21 ,,RBRVS,22.80 ,12.38 ,12.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58957,CPT,RESECJ RECUR OVARIAN/TUBAL/PERITONEAL MALIGNANCY,,,21 ,,RBRVS,26.22 ,13.65 ,13.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58958,CPT,RESECTION RECRT MAL W/OMENTECTOMY PEL LMPHADEC,,,21 ,,RBRVS,29.22 ,14.95 ,14.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58960,CPT,LAPT STG/RESTG OVARIAN TUBAL/PRIM MAL 2ND LOOK,,,21 ,,RBRVS,15.79 ,8.92 ,8.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58970,CPT,FOLLICLE PUNCTURE OOCYTE RETRIEVAL ANY METHOD,,,21 ,,RBRVS,3.52 ,1.83 ,2.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58974,CPT,EMBRYO TRANSFER INTRAUTERINE,,,21 ,,TotalUnits,,,,5.00 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,58976,CPT,GAMETE ZYGOTE/EMBRYO FALLOPIAN TRANSFER ANY METH,,,21 ,,RBRVS,3.82 ,2.07 ,3.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,58999,CPT,UNLISTED PX FEMALE GENITAL SYSTEM NONOBSTETRICAL,,,21 ,,TotalUnits,,,,2.98 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,59000,CPT,AMNIOCENTESIS DIAGNOSIC,,,12 ,,RBRVS,1.30 ,0.76 ,2.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59001,CPT,AMNIOCENTESISS THER AMNIOTIC FLUID RDCTJ US GID,,,12 ,,RBRVS,3.00 ,1.63 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59012,CPT,CORDOCENTESIS INTRAUTERINE,,,12 ,,RBRVS,3.44 ,1.69 ,1.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59015,CPT,CHORIONIC VILLUS SAMPLING,,,12 ,,RBRVS,2.20 ,1.15 ,1.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59020,CPT,FETAL CONTRACTION STRESS TEST,,,12 ,,RBRVS,0.66 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,59020,CPT,FETAL CONTRACTION STRESS TEST,26,,12 ,,RBRVS,0.66 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59020,CPT,FETAL CONTRACTION STRESS TEST,TC,,12 ,,RBRVS,,0.93 ,0.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,59025,CPT,FETAL NONSTRESS TEST,,,12 ,,RBRVS,0.53 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,59025,CPT,FETAL NONSTRESS TEST,26,,12 ,,RBRVS,0.53 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59025,CPT,FETAL NONSTRESS TEST,TC,,12 ,,RBRVS,,0.50 ,0.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,59030,CPT,FETAL SCALP BLOOD SAMPLING,,,12 ,,RBRVS,1.99 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59050,CPT,FETAL MONITORING LABOR PHYS WRTTN REPRT S&I,,,12 ,,RBRVS,0.89 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59051,CPT,FETAL MONITR LABOR PHYS WRTTN REPRT INTERPJ ONLY,,,12 ,,RBRVS,0.74 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59070,CPT,TRANSABDOMINAL AMNIOINFUSION W/ULTRSND GUIDANCE,,,12 ,,RBRVS,5.24 ,2.64 ,5.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59072,CPT,FETAL UMBILICAL CORD OCCLUSION W/ULTRSND GUIDNCE,,,12 ,,RBRVS,8.99 ,4.20 ,4.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59074,CPT,FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE,,,12 ,,RBRVS,5.24 ,2.75 ,5.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59076,CPT,FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE,,,12 ,,RBRVS,8.99 ,4.03 ,4.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59100,CPT,HYSTEROTOMY ABDOMINAL,,,12 ,,RBRVS,13.37 ,7.70 ,7.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59120,CPT,TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPR,,,12 ,,RBRVS,12.67 ,7.48 ,7.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59121,CPT,TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY,,,12 ,,RBRVS,12.74 ,7.43 ,7.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59130,CPT,TX ECTOPIC PREGNANCY ABDL PREGNANCY,,,12 ,,RBRVS,15.08 ,8.37 ,8.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59135,CPT,TX ECTOPIC PREGNANCY NTRSTL REQ TOT HYST,,,12 ,,RBRVS,14.92 ,8.54 ,8.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59136,CPT,TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER,,,12 ,,RBRVS,14.25 ,7.97 ,7.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59140,CPT,TX ECTOPIC PREGNANCY CERVICAL W/EVACUATION,,,12 ,,RBRVS,5.94 ,4.26 ,4.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59150,CPT,LAPS TX ECTOPIC PREG W/O SALPING&/OOPHORECTOMY,,,12 ,,RBRVS,12.29 ,7.20 ,7.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59151,CPT,LAPS TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY,,,12 ,,RBRVS,12.11 ,6.87 ,6.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59160,CPT,CURETTAGE POSTPARTUM,,,12 ,,RBRVS,2.76 ,1.76 ,2.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59200,CPT,INSERTION CERVICAL DILATOR SEPARATE PROCEDURE,,,12 ,,RBRVS,0.79 ,0.34 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59300,CPT,EPISIOTOMY/VAG RPR OTH/THN ATTENDING PHYS,,,12 ,,RBRVS,2.41 ,1.33 ,2.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59320,CPT,CERCLAGE CERVIX PREGNANCY VAGINAL,,,12 ,,RBRVS,2.48 ,1.40 ,1.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59325,CPT,CERCLAGE CERVIX PREGNANCY ABDOMINAL,,,12 ,,RBRVS,4.06 ,2.08 ,2.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59350,CPT,HYSTERORRHAPHY RUPTURED UTERUS,,,12 ,,RBRVS,4.94 ,2.05 ,2.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59400,CPT,OB CARE ANTEPARTUM VAG DLVR&POSTPARTUM,,,13 ,,RBRVS,28.69 ,19.32 ,19.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59409,CPT,VAGINAL DELIVERY ONLY,,,13 ,,RBRVS,12.82 ,5.63 ,5.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59410,CPT,VAGINAL DELIVERY ONLY W/POSTPARTUM CARE,,,13 ,,RBRVS,16.07 ,7.37 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59412,CPT,EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS,,,13 ,,RBRVS,1.53 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59414,CPT,DELIVERY PLACENTA SEPARATE PROCEDURE,,,13 ,,RBRVS,1.44 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59425,CPT,ANTEPARTUM CARE ONLY 4-6 VISITS,,,13 ,,RBRVS,5.63 ,2.42 ,5.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59426,CPT,ANTEPARTUM CARE ONLY 7/> VISITS,,,13 ,,RBRVS,9.96 ,4.28 ,9.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59430,CPT,POSTPARTUM CARE ONLY SEPARATE PROCEDURE,,,13 ,,RBRVS,2.20 ,0.99 ,1.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59510,CPT,OB ANTEPARTUM CARE CESAREAN DLVR&POSTPARTUM,,,11 ,,RBRVS,31.80 ,21.50 ,21.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59514,CPT,CESAREAN DELIVERY ONLY,,,11 ,,RBRVS,14.39 ,6.50 ,6.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59515,CPT,CESAREAN DELIVERY ONLY W/POSTPARTUM CARE,,,11 ,,RBRVS,19.15 ,9.21 ,9.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59525,CPT,STOT/TOT HYSTERECTOMY AFTER CESAREN DELIVERY,,,21 ,,RBRVS,8.53 ,3.65 ,3.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59610,CPT,ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VBAC,,,13 ,,RBRVS,30.22 ,20.09 ,20.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59612,CPT,VAGINAL DELIVERY AFTER CESAREAN DELIVERY,,,13 ,,RBRVS,14.35 ,6.33 ,6.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59614,CPT,VAGINAL DELIVERY & POSTPARTUM CARE VBAC,,,13 ,,RBRVS,17.60 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59618,CPT,ROUTINE OBSTETRICAL CARE ATTEMPTED VBAC,,,11 ,,RBRVS,32.26 ,21.98 ,21.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59620,CPT,CESAREAN DELIVERY ATTEMPTED VBAC,,,11 ,,RBRVS,14.86 ,6.88 ,6.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59622,CPT,CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBAC,,,11 ,,RBRVS,19.63 ,9.74 ,9.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59812,CPT,TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL,,,12 ,,RBRVS,4.44 ,3.12 ,3.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59820,CPT,TX MISSED ABORTION FIRST TRIMESTER SURGICAL,,,12 ,,RBRVS,4.84 ,4.38 ,5.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59821,CPT,TX MISSED ABORTION SECOND TRIMESTER SURGICAL,,,12 ,,RBRVS,5.09 ,4.10 ,4.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59830,CPT,TX SEPTIC ABORTION SURGICAL,,,12 ,,RBRVS,6.59 ,4.59 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59840,CPT,INDUCED ABORTION DILATION AND CURETTAGE,,,12 ,,RBRVS,3.01 ,2.37 ,2.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59841,CPT,INDUCED ABORTION DILATION & EVAUCATION,,,12 ,,RBRVS,5.65 ,3.51 ,4.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59850,CPT,INDUCED ABORTION 1/> AMNIOTIC INJX W/D&C/EVAC,,,12 ,,RBRVS,5.90 ,3.93 ,3.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59851,CPT,INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS D&C&EVAC,,,12 ,,RBRVS,5.92 ,4.32 ,4.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59852,CPT,INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS HYSTOTMY,,,12 ,,RBRVS,8.23 ,6.01 ,6.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59855,CPT,INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS,,,12 ,,RBRVS,6.43 ,4.16 ,4.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59856,CPT,INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C&/EVAC,,,12 ,,RBRVS,7.79 ,4.61 ,4.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59857,CPT,INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT,,,12 ,,RBRVS,9.33 ,5.37 ,5.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59866,CPT,MULTIFETAL PREGNANCY REDUCTION,,,12 ,,RBRVS,3.99 ,2.07 ,2.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59870,CPT,UTERINE EVACUATION&CURETTAGE HYDATIDIFORM MOLE,,,12 ,,RBRVS,6.57 ,5.69 ,5.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59871,CPT,REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA,,,12 ,,RBRVS,2.13 ,1.28 ,1.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,59897,CPT,UNLISTED FETAL INVASIVE PX W/ULTRASOUND,,,12 ,,TotalUnits,,,,3.03 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,59898,CPT,UNLISTED LAPAROSCOPY PX MATERNITY CARE&DELVRY,,,12 ,,TotalUnits,,,,18.98 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,59899,CPT,UNLISTED PROCEDURE MATERNITY CARE & DELIVERY,,,12 ,,TotalUnits,,,,11.57 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,60000,CPT,I&D THYROGLOSSAL DUCT CYST INFECTED,,,21 ,,RBRVS,1.81 ,2.27 ,2.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60100,CPT,BIOPSY THYROID PERCUTANEOUS CORE NEEDLE,,,21 ,,RBRVS,1.56 ,0.65 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60200,CPT,EXC CYST/ADENOMA THYROID/TRANSECTION ISTHMUS,,,21 ,,RBRVS,10.02 ,7.64 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60210,CPT,PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY,,,21 ,,RBRVS,11.23 ,7.42 ,7.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60212,CPT,PRTL THYROID LOBEC UNI W/CONTRATLAT STOT LOBEC,,,21 ,,RBRVS,16.43 ,10.26 ,10.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60220,CPT,TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY,,,21 ,,RBRVS,12.37 ,8.10 ,8.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60225,CPT,TOTAL THYROID LOBEC UNI W/CONTRALAT STOT LOBEC,,,21 ,,RBRVS,14.79 ,9.78 ,9.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60240,CPT,THYROIDECTOMY TOTAL/COMPLETE,,,21 ,,RBRVS,16.22 ,9.39 ,9.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60252,CPT,THYROIDECTOMY TOTAL/SUBTOTAL LMTD NECK DISSECT,,,21 ,,RBRVS,22.01 ,12.86 ,12.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60254,CPT,THYROIDECTOMY TOTAL/SUBTOTAL RAD NECK DISSECT,,,21 ,,RBRVS,28.42 ,16.76 ,16.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60260,CPT,THYROIDECTOMY RMVL REMAINING TISS FLWG PRTL RMVL,,,21 ,,RBRVS,18.26 ,10.85 ,10.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60270,CPT,THYROIDECT W/SUBSTERNAL SPLIT/TRANSTHORACIC,,,21 ,,RBRVS,23.20 ,13.11 ,13.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60271,CPT,THYROIDECTOMY SUBSTERNAL CERVICAL APPROACH,,,21 ,,RBRVS,17.62 ,10.50 ,10.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60280,CPT,EXCISION THYROGLOSSAL DUCT CYST/SINUS,,,21 ,,RBRVS,6.16 ,6.07 ,6.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60281,CPT,EXCISION THYROGLOSSAL DUCT CYST/SINUS RECURRENT,,,21 ,,RBRVS,8.82 ,7.46 ,7.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60300,CPT,ASPIRATION AND/OR INJECTION THYROID CYST,,,21 ,,RBRVS,0.97 ,0.39 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60500,CPT,PARATHYROIDECTOMY/EXPLORATION PARATHYROIDS,,,21 ,,RBRVS,16.78 ,9.83 ,9.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60502,CPT,PARATHYROIDECTOMY/EXPLOR PARATHYROIDS RE-EXPLOR,,,21 ,,RBRVS,21.15 ,12.20 ,12.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60505,CPT,PARATHYRDEC/EXPL PARATHYR MEDSTNL STERNAL/TTHRC,,,21 ,,RBRVS,23.06 ,13.56 ,13.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60512,CPT,PARATHYROID AUTOTRANSPLANTATION ADD-ON,,,21 ,,RBRVS,4.44 ,1.89 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60520,CPT,THYMECTOMY PRTL/TOT TRANSCERVICAL APPR SPX,,,21 ,,RBRVS,17.16 ,9.84 ,9.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60521,CPT,THYMECTOMY PRTL/TOT W/O RAD MEDSTNL DSJ SPX,,,21 ,,RBRVS,19.18 ,10.62 ,10.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60522,CPT,THYMECTOMY PRTL/TOT RAD MEDSTNL DSJ SPX,,,21 ,,RBRVS,23.48 ,12.64 ,12.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60540,CPT,ADRENALECTOMY W/EXPL W/WO BX ABDL/LMBR/DRSAL SPX,,,21 ,,RBRVS,18.02 ,10.21 ,10.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60545,CPT,ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR,,,21 ,,RBRVS,20.93 ,11.30 ,11.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60600,CPT,EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY,,,21 ,,RBRVS,25.09 ,12.44 ,12.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60605,CPT,EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY,,,21 ,,RBRVS,31.96 ,16.77 ,16.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60650,CPT,LAPAROSCOPY ADRENALECTOMY PRTL/COMPL TABDL,,,21 ,,RBRVS,20.73 ,10.69 ,10.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,60659,CPT,UNLISTED LAPAROSCOPY PROCEDURE ENDOCRINE SYSTEM,,,21 ,,TotalUnits,,,,31.42 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,60699,CPT,UNLISTED PROCEDURE ENDOCRINE SYSTEM,,,21 ,,TotalUnits,,,,15.98 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,61000,CPT,SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT,,,21 ,,RBRVS,1.58 ,1.46 ,1.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61001,CPT,SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI SBSQ,,,21 ,,RBRVS,1.49 ,1.36 ,1.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61020,CPT,VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX,,,21 ,,RBRVS,1.51 ,1.98 ,1.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61026,CPT,VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/INJ,,,21 ,,RBRVS,1.69 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61050,CPT,CISTERNAL/LATERAL C1-C2 PUNCTURE W/O INJ SPX,,,21 ,,RBRVS,1.51 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61055,CPT,CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION,,,21 ,,RBRVS,2.10 ,1.61 ,1.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61070,CPT,PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX,,,21 ,,RBRVS,0.89 ,1.36 ,1.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61105,CPT,TWIST DRILL HOLE SUBDURAL/VENTRICULAR PUNCTURE,,,21 ,,RBRVS,5.45 ,5.88 ,5.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61107,CPT,TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE,,,21 ,,RBRVS,4.99 ,2.66 ,2.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61108,CPT,TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA,,,21 ,,RBRVS,11.64 ,10.51 ,10.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61120,CPT,BURR HOLE VENTRICULAR PUNCTURE,,,21 ,,RBRVS,9.60 ,8.60 ,8.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61140,CPT,BURR HOLE/TREPHINE W/BX BRAIN/INTRACRNIAL LESION,,,21 ,,RBRVS,17.23 ,13.48 ,13.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61150,CPT,BURR HOLE/TREPHINE W/DRG BRAIN ABSCESS/CYST,,,21 ,,RBRVS,18.90 ,13.98 ,13.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61151,CPT,BURR HOLE/TREPHINE W/SBSQ TAPPING ICRA ABSC/CST,,,21 ,,RBRVS,13.49 ,10.60 ,10.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61154,CPT,BURR HOLE W/EVAC&/DRG HEMATOMA XDRL/SDRL,,,21 ,,RBRVS,17.07 ,13.80 ,13.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61156,CPT,BURR HOLE W/ASPIR HEMATOMA/CYST INTRACEREBRAL,,,21 ,,RBRVS,17.45 ,12.87 ,12.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61210,CPT,BURR HOLE IMPLANT VENTRICULAR CATH/OTHER DEVICE,,,21 ,,RBRVS,5.83 ,3.10 ,3.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61215,CPT,INSJ SUBQ RSVR PUMP/INFUSION SYSTEM VENTRIC CATH,,,21 ,,RBRVS,5.85 ,6.59 ,6.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61250,CPT,BURR HOLE/TREPHINE SUPRATENTORIAL W/O OTH SURG,,,21 ,,RBRVS,11.49 ,9.51 ,9.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61253,CPT,BURR HOLE/TREPHINE INFRATENTORIAL UNI/BI,,,21 ,,RBRVS,13.49 ,9.56 ,9.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61304,CPT,CRANIECTOMY/CRANIOTOMY EXPL SUPRATENTORIAL,,,21 ,,RBRVS,23.41 ,16.63 ,16.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61305,CPT,CRANIECTOMY/CRANIOTOMY EXPL INFRATENTORIAL,,,21 ,,RBRVS,28.64 ,20.15 ,20.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61312,CPT,CRANIECTOMY HMTMA SUPRATENTORIAL EXTRA/SUBDURAL,,,21 ,,RBRVS,30.17 ,20.19 ,20.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61313,CPT,CRANIECTOMY HMTMA SUPRATENTORIAL INTRACEREBRAL,,,21 ,,RBRVS,28.09 ,20.05 ,20.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61314,CPT,CRANIECTOMY HMTMA INFRATENTORIAL EXTRA/SUBDURAL,,,21 ,,RBRVS,25.90 ,18.43 ,18.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61315,CPT,CRANIECTOMY HMTMA SUPRATENTORIAL INTRACEREBRAL,,,21 ,,RBRVS,29.65 ,20.56 ,20.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61316,CPT,INCISION & SUBCUTANEOUS PLMT CRANIAL BONE GRAFT,,,21 ,,RBRVS,1.39 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61320,CPT,CRANIECTOMY/CRANIOTMY DRG ABSCESS SUPRATENTORIAL,,,21 ,,RBRVS,27.42 ,18.89 ,18.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61321,CPT,CRANIECTOMY/CRANIOTMY DRG ABSCESS INFRATENTORIAL,,,21 ,,RBRVS,30.53 ,20.83 ,20.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61322,CPT,CRANIECT/CRANIOT W/WO DURAPLASTY W/O LOBECTOMY,,,21 ,,RBRVS,34.26 ,22.94 ,22.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61323,CPT,CRANIECT/CRANIOT W/WO DURAPLASTY W/LOBECTOMY,,,21 ,,RBRVS,35.06 ,22.69 ,22.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61330,CPT,DECOMPRESSION ORBIT ONLY TRANSCRANIAL APPROACH,,,21 ,,RBRVS,25.30 ,17.48 ,17.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61332,CPT,EXPLORATION ORBIT TRANSCRANIAL APPROACH W/BIOPSY,,,21 ,,RBRVS,28.60 ,18.89 ,18.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61333,CPT,EXPL ORBIT TRANSCRANIAL APPROACH W/RMVL LESION,,,21 ,,RBRVS,29.27 ,20.44 ,20.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61334,CPT,EXPL ORBIT TRANSCRANIAL W/RMVL FOREIGN BODY,,,21 ,,RBRVS,19.60 ,12.81 ,12.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61340,CPT,SUBTEMPORAL CRANIAL DECOMPRESSION,,,21 ,,RBRVS,20.11 ,14.92 ,14.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61343,CPT,CRNEC SUBOCCIPITAL CRV LAM DCMPRN MEDULLA & CORD,,,21 ,,RBRVS,31.86 ,21.47 ,21.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61345,CPT,OTHER CRANIAL DECOMPRESSION POSTERIOR FOSSA,,,21 ,,RBRVS,29.23 ,20.32 ,20.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61440,CPT,CRANIOTOMY SECTION TENTORIUM CEREBELLI SPX,,,21 ,,RBRVS,28.66 ,19.93 ,19.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61450,CPT,CRNEC STPL SCTJ COMPRESSION/DCMPRN GANGLION,,,21 ,,RBRVS,27.69 ,18.85 ,18.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61458,CPT,CRNEC SOPL EXPL/DCMPRN CRNL NRV,,,21 ,,RBRVS,28.84 ,20.01 ,20.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61460,CPT,CRANIECTOMY SUBOCCIPITAL SECTION 1/> CRANIAL NRV,,,21 ,,RBRVS,30.24 ,20.46 ,20.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61470,CPT,CRANIECTOMY SUBOCCIPITAL MEDULLARY TRACTOTOMY,,,21 ,,RBRVS,27.62 ,18.91 ,18.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61480,CPT,CRNEC SUBOCPTL MESENCEPHAL TRCOTOMY/PEDUNCULOTMY,,,21 ,,RBRVS,28.05 ,14.71 ,14.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61490,CPT,CRANIOTOMY LOBOTOMY W/CINGULOTOMY,,,21 ,,RBRVS,27.22 ,18.80 ,18.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61500,CPT,CRANIECTOMY W/EXCISION TUMOR/LESION SKULL,,,21 ,,RBRVS,19.18 ,14.35 ,14.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61501,CPT,CRANIECTOMY OSTEOMYELITIS,,,21 ,,RBRVS,16.35 ,12.78 ,12.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61510,CPT,CRANIEC TREPHINE BONE FLP BRAIN TUMOR SUPRTENTOR,,,21 ,,RBRVS,30.83 ,22.26 ,22.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61512,CPT,CRNEC TREPHINE BONE FLAP MENINGIOMA SUPRATENTOR,,,21 ,,RBRVS,37.14 ,24.76 ,24.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61514,CPT,CRNEC TREPHINE BONE FLAP BRAIN ABSC SUPRATENTOR,,,21 ,,RBRVS,27.23 ,18.97 ,18.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61516,CPT,CRNEC TREPHINE BONE FLAP FENEST CYST SUPRATENTOR,,,21 ,,RBRVS,26.58 ,18.63 ,18.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61517,CPT,IMPLTJ BRAIN INTRACAVITARY CHEMOTHERAPY AGENT,,,21 ,,RBRVS,1.38 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61518,CPT,CRNEC EXC BRAIN TUMOR INFRATENTORIAL/POST FOSSA,,,21 ,,RBRVS,39.89 ,26.99 ,26.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61519,CPT,CRNEC EXC TUM INFRATENTOR/POST FOSSA MENINGIOMA,,,21 ,,RBRVS,43.43 ,28.12 ,28.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61520,CPT,CRNEC TUM INFRATTL/POSTFOSSA CRBLOPNT ANGLE TUM,,,21 ,,RBRVS,57.09 ,35.97 ,35.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61521,CPT,CRNEC TUM INFRATTL/PFOSSA MIDLINE TUM BASE SKULL,,,21 ,,RBRVS,46.99 ,30.05 ,30.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61522,CPT,CRNEC INFRATNTORIAL/POST FOSSA EXC BRAIN ABSCESS,,,21 ,,RBRVS,31.54 ,21.59 ,21.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61524,CPT,CRNEC INFRATNTOR/POSTFOSSA EXC/FENESTRATION CYST,,,21 ,,RBRVS,29.89 ,20.51 ,20.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61526,CPT,CRNEC TRANSTEMPOR EXC CEREBELLOPONTINE ANGLE TUM,,,21 ,,RBRVS,54.08 ,33.50 ,33.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61530,CPT,CRNEC EXC CEREBELLOPNTIN ANGLE TUM MID/POSTFOSSA,,,21 ,,RBRVS,45.56 ,28.51 ,28.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61531,CPT,SUBDURAL IMPLTJ ELECTRODES SEIZURE MONITORING,,,21 ,,RBRVS,16.41 ,13.40 ,13.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61533,CPT,CRANIOT SUBDURAL IMPLT ELCTRD SEIZURE MONITORING,,,21 ,,RBRVS,21.46 ,15.57 ,15.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61534,CPT,CRANIOT EPILEPTOGENIC FOC W/O ELECTRCORTICOGRPHY,,,21 ,,RBRVS,23.01 ,17.00 ,17.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61535,CPT,CRANIOT RMVL EPID/SUBDURL ELCTRD W/O EXC TIS SPX,,,21 ,,RBRVS,13.15 ,11.25 ,11.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61536,CPT,CRANIOT EPILEPTOGENIC FOCUS W/ELECTROCORTCOGRPHY,,,21 ,,RBRVS,37.72 ,24.95 ,24.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61537,CPT,CRANIOT TEMPORAL LOBE W/O ELECTROCORTICOGRAPHY,,,21 ,,RBRVS,36.45 ,22.79 ,22.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61538,CPT,CRANIOT LOBEC TEMPORAL LOBE W/ELECTROCORTCOGRPHY,,,21 ,,RBRVS,39.45 ,24.53 ,24.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61539,CPT,CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/ECOG,,,21 ,,RBRVS,34.28 ,22.81 ,22.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61540,CPT,CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/O ECOG,,,21 ,,RBRVS,31.43 ,21.64 ,21.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61541,CPT,CRANIOTOMY TRANSECTION CORPUS CALLOSUM,,,21 ,,RBRVS,30.94 ,21.14 ,21.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61542,CPT,CRANIOTOMY TOTAL HEMISPHERECTOMY,,,21 ,,RBRVS,33.16 ,20.88 ,20.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61543,CPT,CRANIOTOMY PARTIAL/SUBTOTAL HEMISPHERECTOMY,,,21 ,,RBRVS,31.31 ,21.06 ,21.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61544,CPT,CRANIOTOMY EXCISION/COAGULATION CHOROID PLEXUS,,,21 ,,RBRVS,27.36 ,17.16 ,17.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61545,CPT,CRANIOTOMY EXCISION CRANIOPHARYNGIOMA,,,21 ,,RBRVS,46.43 ,30.64 ,30.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61546,CPT,CRANIOT HYPOPHYSEC/EXC PITUITARY TUMOR ICRL APPR,,,21 ,,RBRVS,33.44 ,22.46 ,22.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61548,CPT,HYPOPHYSEC/EXC PITUITARY TUM TRANSNASAL/SEPTAL,,,21 ,,RBRVS,23.37 ,15.91 ,15.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61550,CPT,CRANIECTOMY CRANIOSYNOSTOSIS 1 CRANIAL SUTURE,,,21 ,,RBRVS,15.59 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61552,CPT,CRANIECT CRANIOSYNOSTOSIS MULT CRANIAL SUTURES,,,21 ,,RBRVS,20.40 ,12.76 ,12.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61556,CPT,CRANIEC CRANIOSYNOSTOSIS FRONT/PARIET BONE FLAP,,,21 ,,RBRVS,24.09 ,15.64 ,15.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61557,CPT,CRANIECTOMY CRANIOSYNOSTOSIS BIFRONTAL BONE FLAP,,,21 ,,RBRVS,23.31 ,17.77 ,17.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61558,CPT,XTN CRANIECT MULTIPLE SUTURE CRANIOSYNOSTOSIS,,,21 ,,RBRVS,26.50 ,16.17 ,16.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61559,CPT,XTN CRNEC MLT SUTR CRANIOSYNOSTOSIS W/BONE GRAFT,,,21 ,,RBRVS,34.02 ,24.32 ,24.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61563,CPT,EXC BENIGN TUM CRANIAL BONE W/O OPTIC NRV DCMPRN,,,21 ,,RBRVS,28.44 ,19.67 ,19.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61564,CPT,EXC BENIGN TUM CRANIAL BONE W/OPTIC NRV DCMPRN,,,21 ,,RBRVS,34.74 ,23.76 ,23.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61566,CPT,CRANIOTOMY SELECTIVE AMYGDALOHIPPOCAMPECTOMY,,,21 ,,RBRVS,32.45 ,22.30 ,22.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61567,CPT,CRANIOTOMY MULTIPLE SUBPIAL TRANSECTIONS W/ECOG,,,21 ,,RBRVS,37.00 ,25.48 ,25.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61570,CPT,CRANIECTOMY/CRANIOTOMY EXC FOREIGN BODY BRAIN,,,21 ,,RBRVS,26.51 ,18.62 ,18.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61571,CPT,CRANIECTOMY/CRANIOTOMY TX PENETRATNG WOUND BRAIN,,,21 ,,RBRVS,28.42 ,19.95 ,19.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61575,CPT,TRNSRAL SKULL BSE/BR STEM/CORD BX/DCOMPR/EXC LES,,,21 ,,RBRVS,36.56 ,23.50 ,23.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61576,CPT,TRNSRL SKUL BSE/BR STM/CORD BX/DCMP/ SPLT TONGUE,,,21 ,,RBRVS,55.31 ,42.09 ,42.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61580,CPT,CRANIOFACIAL ANT CRANIAL FOSSA W/O ORBITAL EXNTJ,,,21 ,,RBRVS,34.51 ,31.81 ,31.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61581,CPT,CRANIOFACIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ,,,21 ,,RBRVS,39.13 ,35.43 ,35.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61582,CPT,CRANFCL ANT CRANIAL FOSSA UNI/BI CRANIOT/OSTEOT,,,21 ,,RBRVS,35.14 ,39.60 ,39.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61583,CPT,CRANFCL ANT CRANIAL FOSSA UNI/BIFRNTL ELEV LOBE,,,21 ,,RBRVS,38.50 ,33.29 ,33.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61584,CPT,ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ,,,21 ,,RBRVS,37.70 ,32.92 ,32.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61585,CPT,ORBITOCRANIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ,,,21 ,,RBRVS,42.57 ,35.04 ,35.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61586,CPT,BICORONAL TRANSZYGMTC&/LEFORT I W/O BONE GRFT,,,21 ,,RBRVS,27.48 ,31.16 ,31.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61590,CPT,INFRATEMPORAL MID CRANIAL FOSSA W/WO DISARTICLTN,,,21 ,,RBRVS,47.04 ,35.52 ,35.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61591,CPT,INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBIL,,,21 ,,RBRVS,47.02 ,35.53 ,35.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61592,CPT,ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE,,,21 ,,RBRVS,43.08 ,35.27 ,35.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61595,CPT,TRANSTEMP APPR POST CRAN FOSSA DCOMPR SINUS/NRV,,,21 ,,RBRVS,33.74 ,28.83 ,28.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61596,CPT,TRANSCOCHLR POST CRNL FOSSA W/WO MOBIL NRV/ART,,,21 ,,RBRVS,39.43 ,29.50 ,29.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61597,CPT,TRNSCONDLR POST CRNL FOSSA DCOMPR ART W/WO MOBIL,,,21 ,,RBRVS,40.82 ,29.89 ,29.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61598,CPT,TRANSPTRSAL POST CRNL FOSSA CLIVUS/FORAMN MAGNUM,,,21 ,,RBRVS,36.53 ,30.82 ,30.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61600,CPT,RESCJ/EXC LES BASE ANT CRANIAL FOSSA EXTRADURAL,,,21 ,,RBRVS,30.01 ,26.70 ,26.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61601,CPT,RESCJ/EXC LES BASE ANT CRNL FOSSA INDRL W/WO GRF,,,21 ,,RBRVS,31.14 ,28.27 ,28.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61605,CPT,RESCJ/EXC LES INFRATEMPOR FOSSA SPACE APEX XDRL,,,21 ,,RBRVS,32.57 ,27.47 ,27.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61606,CPT,RESCJ/EXC LES ITPRL FOSSA SPACE APEX IDRL W/RPR,,,21 ,,RBRVS,42.05 ,32.50 ,32.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61607,CPT,RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB XDRL,,,21 ,,RBRVS,40.93 ,29.85 ,29.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61608,CPT,RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB IDRL,,,21 ,,RBRVS,45.54 ,34.28 ,34.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61609,CPT,TRNSXJ/LIGATION CAROTID ARTERY SINUS W/O REPAIR,,,21 ,,RBRVS,9.88 ,4.43 ,4.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61610,CPT,TRNSXJ/LIG CAROTID ARTERY SINUS W/RPR ANAST/GRFT,,,21 ,,RBRVS,29.63 ,15.68 ,15.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61611,CPT,TRNSXJ/LIG CAROTID ARTERY PETROUS CANAL W/O RPR,,,21 ,,RBRVS,7.41 ,3.55 ,3.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61612,CPT,TRNSXJ/LIG CRTD ART PETROUS CANAL RPR ANAST/GRF,,,21 ,,RBRVS,27.84 ,12.79 ,12.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61613,CPT,OBLTRJ CAROTID ARYSM ARTVEN CAROTID FISTULA DSJ,,,21 ,,RBRVS,45.03 ,34.66 ,34.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61615,CPT,RESCJ/EXC LES BASE POST CRNL FOSSA JUG FRMN XDRL,,,21 ,,RBRVS,35.77 ,28.31 ,28.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61616,CPT,RESCJ/EXC LES BASE PCF FORAMEN VRT BODIES IDRL,,,21 ,,RBRVS,46.74 ,36.19 ,36.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61618,CPT,SECONDARY RPR DURA CSF LEAK FREE TISSUE GRAFT,,,21 ,,RBRVS,18.69 ,13.80 ,13.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61619,CPT,SEC RPR DURA CSF LEAK LOCAL/REGIONALIZED FLAP,,,21 ,,RBRVS,22.10 ,15.51 ,15.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61623,CPT,EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK,,,21 ,,RBRVS,9.95 ,4.68 ,4.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61624,CPT,TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS,,,21 ,,RBRVS,20.12 ,9.10 ,9.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61626,CPT,TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS,,,21 ,,RBRVS,16.60 ,7.07 ,7.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61630,CPT,BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS,,,21 ,,RBRVS,22.07 ,11.59 ,11.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61635,CPT,TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD,,,21 ,,RBRVS,24.28 ,12.54 ,12.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61640,CPT,BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL,,,21 ,,RBRVS,12.32 ,5.23 ,5.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61641,CPT,BALLOON DILAT INCRNL VASOSPSM PRQ EA VESSEL,,,21 ,,RBRVS,4.33 ,1.84 ,1.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61642,CPT,BALLOON DILAT INCRNL VASOSPSM PRQ EA VESSEL,,,21 ,,RBRVS,8.66 ,3.67 ,3.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61680,CPT,INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL SMPL,,,21 ,,RBRVS,32.55 ,22.40 ,22.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61682,CPT,INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL CMPL,,,21 ,,RBRVS,63.41 ,37.99 ,37.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61684,CPT,INTRACRANIAL ARVEN MALFRMJ INFRATENTRL SMPL,,,21 ,,RBRVS,41.64 ,27.01 ,27.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61686,CPT,INTRACRANIAL ARVEN MALFRMJ INFRATENTRL CMPL,,,21 ,,RBRVS,67.50 ,41.67 ,41.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61690,CPT,INTRACRANIAL ARVEN MALFRMJ DURAL SMPL,,,21 ,,RBRVS,31.34 ,21.65 ,21.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61692,CPT,INTRACRANIAL ARVEN MALFRMJ DURAL CMPL,,,21 ,,RBRVS,54.59 ,33.97 ,33.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61697,CPT,COMPLX INTRACRANIAL ARYSM CAROTID CIRCULATION,,,21 ,,RBRVS,63.40 ,38.60 ,38.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61698,CPT,CPLX INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ,,,21 ,,RBRVS,69.63 ,41.53 ,41.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61700,CPT,SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION,,,21 ,,RBRVS,50.62 ,32.61 ,32.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61702,CPT,SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ,,,21 ,,RBRVS,60.04 ,36.78 ,36.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61703,CPT,ICRA CRV APPL OCCLUDING CLAMP CRV CRTD ART,,,21 ,,RBRVS,18.80 ,14.33 ,14.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61705,CPT,ARYSM VASC MALFRMJ/CRTD-OCCLUSION CRTD ART,,,21 ,,RBRVS,38.10 ,24.49 ,24.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61708,CPT,ARYSM VASC MALFRMJ/ICRA ELECTROTHROMBOSIS,,,21 ,,RBRVS,37.20 ,20.59 ,20.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61710,CPT,ARYSM VASC MALFRMJ IA EMBOLIZATION,,,21 ,,RBRVS,31.29 ,17.11 ,17.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61711,CPT,ANAST ARTL EXTRACRANIAL-INTRACRANIAL ARTERIES,,,21 ,,RBRVS,38.23 ,24.90 ,24.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61720,CPT,CRTJ LES STRTCTC BURR GLOBUS PALLIDUS/THALAMUS,,,21 ,,RBRVS,17.62 ,12.53 ,12.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61735,CPT,CRTJ LES STRTCTC BURR SUBCORTICAL STRUX OTH/THN,,,21 ,,RBRVS,22.35 ,14.10 ,14.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61750,CPT,STEREOTACTIC BX ASPIR/EXC BURR INTRACRANIAL LES,,,21 ,,RBRVS,19.83 ,14.39 ,14.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61751,CPT,STRTCTC BX ASPIR/EXC BURR ICRA LES W/CT&/MR,,,21 ,,RBRVS,18.79 ,14.78 ,14.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61760,CPT,STRTCTC IMPLTJ ELTRD CEREBRUM SEIZURE MONITORING,,,21 ,,RBRVS,22.39 ,15.52 ,15.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61770,CPT,STRTCTC LOCLZJ INSJ CATH/PRB PLMT RADJ SRC,,,21 ,,RBRVS,23.19 ,15.60 ,15.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61781,CPT,STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL,,,21 ,,RBRVS,3.75 ,2.13 ,2.13 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,61782,CPT,STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL,,,21 ,,RBRVS,3.18 ,1.80 ,1.80 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,61783,CPT,STEREOTACTIC COMPUTER ASSISTED PX SPINAL,,,21 ,,RBRVS,3.75 ,2.13 ,2.13 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,61790,CPT,CREATE LES STRTCTC PRQ NEUROLYTIC GASSERIAN,,,21 ,,RBRVS,11.60 ,9.62 ,9.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61791,CPT,CREATE LES STRTCTC PRQ NEUROLYTIC TRIGEMINAL TRC,,,21 ,,RBRVS,15.41 ,11.88 ,11.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61796,CPT,STEREOTACTIC RADIOSURGERY 1 SIMPLE CRANIAL LES,,,21 ,,RBRVS,13.93 ,9.90 ,9.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61797,CPT,STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE,,,21 ,,RBRVS,3.48 ,1.79 ,1.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61798,CPT,STEREOTACTIC RADIOSURGERY 1 COMPLEX CRANIAL LES,,,21 ,,RBRVS,19.85 ,11.56 ,11.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61799,CPT,STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX,,,21 ,,RBRVS,4.81 ,2.47 ,2.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61800,CPT,APPL STRTCTC HEADFRAME STEREOTACTIC RADIOSURGERY,,,21 ,,RBRVS,2.25 ,1.47 ,1.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61850,CPT,TWIST/BURR HOLE IMPLTJ NSTIM ELTRD CORTICAL,,,21 ,,RBRVS,13.34 ,9.14 ,9.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61860,CPT,CRNEC/CRX IMPLTJ NSTIM ELTRD CERE CORTICAL,,,21 ,,RBRVS,22.26 ,15.80 ,15.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61863,CPT,STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD 1ST ARRAY,,,21 ,,RBRVS,20.71 ,15.92 ,15.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61864,CPT,STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD EA ARRAY,,,21 ,,RBRVS,4.49 ,2.41 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61867,CPT,STRTCTC IMPLTJ NSTIM ELTRD W/RECORD 1ST ARRAY,,,21 ,,RBRVS,33.03 ,22.45 ,22.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61868,CPT,STRTCTC IMPLTJ NSTIM ELTRD W/RECORD EA ARRAY,,,21 ,,RBRVS,7.91 ,4.24 ,4.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61870,CPT,CRNEC IMPLTJ NSTIM ELTRD CEREBELLAR CORTICAL,,,21 ,,RBRVS,16.34 ,12.60 ,12.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61875,CPT,CRNEC IMPLTJ NSTIM ELTRD CEREBELLAR SUBCORTICAL,,,21 ,,RBRVS,16.46 ,12.49 ,12.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61880,CPT,REVJ/RMVL INTRACRANIAL NEUROSTIMULATOR ELTRDS,,,21 ,,RBRVS,6.95 ,6.92 ,6.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61885,CPT,INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR,,,21 ,,RBRVS,6.05 ,7.79 ,7.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61886,CPT,INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS,,,21 ,,RBRVS,9.93 ,10.83 ,10.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,61888,CPT,REVJ/RMVL NEUROSTIMULATOR PULSE GENERATOR,,,21 ,,RBRVS,5.23 ,4.52 ,4.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62000,CPT,ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL,,,21 ,,RBRVS,13.93 ,10.06 ,10.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62005,CPT,ELVTN DEPRS SKL FX COMPOUND/COMMIND XDRL,,,21 ,,RBRVS,17.63 ,13.08 ,13.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62010,CPT,ELVTN DEPRS SKL FX W/RPR DURA&/DBRDMT BRN,,,21 ,,RBRVS,21.43 ,15.65 ,15.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62100,CPT,CRX RPR DURAL/CSF LEAK RHINORRHEA/OTORRHEA,,,21 ,,RBRVS,23.53 ,16.18 ,16.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62115,CPT,RDCTJ CRANIOMEGALIC SKULL W/O GRAFT/CRANIOPLASTY,,,21 ,,RBRVS,22.91 ,11.57 ,11.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62116,CPT,RDCTJ CRANIOMEGALIC SKULL W/SIMPLE CRANIOPLASTY,,,21 ,,RBRVS,25.02 ,18.12 ,18.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62117,CPT,RDCTJ CRANIOMEGALIC CRANIO&RECNSTJ W/WO GRAFT,,,21 ,,RBRVS,28.35 ,19.42 ,19.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62120,CPT,RPR ENCEPHALOCELE SKULL VAULT W/CRANIOPLASTY,,,21 ,,RBRVS,24.59 ,22.72 ,22.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62121,CPT,CRANIOTOMY FOR ENCEPHALOCELE REPAIR SKULL BASE,,,21 ,,RBRVS,23.03 ,18.71 ,18.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62140,CPT,CRANIOPLASTY SKULL DEFECT < 5 CM DIAMETER,,,21 ,,RBRVS,14.55 ,11.23 ,11.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62141,CPT,CRANIOPLASTY SKULL DEFECT >5 CM DIAMETER,,,21 ,,RBRVS,16.07 ,12.16 ,12.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62142,CPT,RMVL BONE FLAP/PROSTHETIC PLATE SKULL,,,21 ,,RBRVS,11.83 ,9.98 ,9.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62143,CPT,RPLCMT BONE FLAP/PROSTHETIC PLATE SKULL,,,21 ,,RBRVS,14.15 ,11.17 ,11.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62145,CPT,CRANIOPLASTY SKULL DEFECT REPARATIVE BRAIN SURG,,,21 ,,RBRVS,20.09 ,14.29 ,14.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62146,CPT,CRANIOPLASTY W/AUTOGRAFT < 5 CM DIAMETER,,,21 ,,RBRVS,17.28 ,12.84 ,12.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62147,CPT,CRANIOPLASTY W/AUTOGRAFT > 5 CM DIAMETER,,,21 ,,RBRVS,20.67 ,14.78 ,14.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62148,CPT,INCISE&RETRIEVAL SUBQ CRANIOPLASTY BONE GRAFT,,,21 ,,RBRVS,2.00 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62160,CPT,NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS,,,21 ,,RBRVS,3.00 ,1.61 ,1.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62161,CPT,NUNDSC ICRA DSJ ADS FENESTRATION SEPTUM CSTS,,,21 ,,RBRVS,21.23 ,15.67 ,15.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62162,CPT,NUNDSC ICRA FENESTEXC CYST W/VENTRIC CATH DRG,,,21 ,,RBRVS,26.80 ,19.27 ,19.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62163,CPT,NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY,,,21 ,,RBRVS,16.53 ,13.44 ,13.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62164,CPT,NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY,,,21 ,,RBRVS,29.43 ,20.93 ,20.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62165,CPT,NUNDSC ICRA EXC PITUITRY TUM TRNSNSL/SPHENOID,,,21 ,,RBRVS,23.23 ,16.38 ,16.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62180,CPT,VENTRICULOCISTERNOSTOMY,,,21 ,,RBRVS,22.58 ,16.36 ,16.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62190,CPT,CRTJ SHUNT SARACH/SDRL-ATR-JUG-AUR,,,21 ,,RBRVS,12.17 ,10.35 ,10.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62192,CPT,CRTJ SHUNT SARACH/SDRL-PRTL-PLEURAL OTH,,,21 ,,RBRVS,13.35 ,10.51 ,10.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62194,CPT,RPLCMT/IRRG SUBARACHNOID/SUBDURAL CATHETER,,,21 ,,RBRVS,5.78 ,5.26 ,5.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62200,CPT,VENTRICULOCISTERNOSTOMY 3RD VENTRICLE,,,21 ,,RBRVS,19.29 ,14.18 ,14.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62201,CPT,VENTRICULOCISTERNOSTOMY 3RD VNTRC NEURONDSC,,,21 ,,RBRVS,16.04 ,13.29 ,13.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62220,CPT,CRTJ SHUNT VENTRICULO-ATR-JUG-AUR,,,21 ,,RBRVS,14.10 ,10.79 ,10.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62223,CPT,CRTJ SHUNT VENTRICULO-PERITNEAL-PLEURAL TERMINUS,,,21 ,,RBRVS,14.05 ,11.84 ,11.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62225,CPT,RPLCMT/IRRIGATION VENTRICULAR CATHETER,,,21 ,,RBRVS,6.19 ,6.55 ,6.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62230,CPT,RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS,,,21 ,,RBRVS,11.43 ,9.17 ,9.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62252,CPT,REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT,,,21 ,,RBRVS,0.74 ,1.71 ,1.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,62252,CPT,REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT,26,,21 ,,RBRVS,0.74 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62252,CPT,REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT,TC,,21 ,,RBRVS,,1.32 ,1.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,62256,CPT,RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT,,,21 ,,RBRVS,7.38 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62258,CPT,RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT,,,21 ,,RBRVS,15.64 ,11.82 ,11.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62263,CPT,PRQ LYSIS EPIDURAL ADHESIONS MULT SESS 2/> DAYS,,,21 ,,RBRVS,6.54 ,4.70 ,13.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62264,CPT,PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY,,,21 ,,RBRVS,4.42 ,2.07 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62267,CPT,PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS,,,21 ,,RBRVS,3.00 ,1.39 ,3.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62268,CPT,PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX,,,21 ,,RBRVS,4.73 ,2.45 ,5.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62269,CPT,BIOPSY SPINAL CORD PERCUTANEOUS NEEDLE,,,21 ,,RBRVS,5.01 ,2.26 ,5.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62270,CPT,SPINAL PUNCTURE LUMBAR DIAGNOSTIC,,,21 ,,RBRVS,1.37 ,0.72 ,2.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62272,CPT,SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID,,,21 ,,RBRVS,1.35 ,0.82 ,3.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62273,CPT,INJECTION EPIDURAL BLOOD/CLOT PATCH,,,21 ,,RBRVS,2.15 ,0.93 ,2.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62280,CPT,INJX/INFUSION NEUROLYTIC SUBSTANCE SUBARACHNOID,,,21 ,,RBRVS,2.63 ,1.64 ,6.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62281,CPT,INJX/INFUS NEUROLYT SUBST EPIDURAL CERV/THORACIC,,,21 ,,RBRVS,2.66 ,1.48 ,4.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62282,CPT,INJX/INFUS NEUROLYT SBST EPIDURAL LUMBAR/SACRAL,,,21 ,,RBRVS,2.33 ,1.49 ,6.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62284,CPT,INJECTION PROCEDURE MYELOGRAPHY/CT SPINAL,,,21 ,,RBRVS,1.54 ,0.85 ,4.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62287,CPT,DCMPRN PERQ NUCLEUS PULPOSUS 1/> LEVELS LUMBAR,,,21 ,,RBRVS,9.03 ,6.32 ,6.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62290,CPT,INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR,,,21 ,,RBRVS,3.00 ,1.72 ,6.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62291,CPT,INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC,,,21 ,,RBRVS,2.91 ,1.66 ,6.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62292,CPT,INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC,,,21 ,,RBRVS,9.24 ,6.03 ,6.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62294,CPT,NJX ARTERIAL OCCLUSION ARVEN MALFRMJ SPINAL,,,21 ,,RBRVS,12.87 ,6.31 ,6.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62310,CPT,NJX DX/THER SBST EPIDURAL/SUBRACH CERV/THORACIC,,,21 ,,RBRVS,1.91 ,0.97 ,4.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62311,CPT,NJX DX/THER SBST EPIDURAL/SUBARACH LUMBAR/SACRAL,,,21 ,,RBRVS,1.54 ,0.84 ,4.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62318,CPT,NJXS INFUS/BOLUS DX/SBST EDRL/SUBARACH CRV/THRC,,,21 ,,RBRVS,2.04 ,0.72 ,4.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62319,CPT,NJX INFUS/BOLUS DX/SBST EDRL/SUBARACH LUM/SACRAL,,,21 ,,RBRVS,1.87 ,0.74 ,3.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62350,CPT,IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM,,,21 ,,RBRVS,6.05 ,4.37 ,4.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62351,CPT,IMPLTJ REVJ/RPSG ITHCL/EDRL CATH W/LAM,,,21 ,,RBRVS,11.66 ,10.06 ,10.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62355,CPT,RMVL PREVIOUSLY IMPLTED ITHCL/EDRL CATH,,,21 ,,RBRVS,4.35 ,3.58 ,3.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62360,CPT,IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS SUBQ RSVR,,,21 ,,RBRVS,4.33 ,3.65 ,3.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62361,CPT,IMPLTJ/RPLCMT FS NON-PRGRBL PUMP,,,21 ,,RBRVS,5.65 ,4.67 ,4.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62362,CPT,IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP,,,21 ,,RBRVS,6.10 ,4.65 ,4.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62365,CPT,RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS,,,21 ,,RBRVS,4.65 ,4.01 ,4.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62367,CPT,ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL,,,21 ,,RBRVS,0.48 ,0.19 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62368,CPT,ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG,,,21 ,,RBRVS,0.75 ,0.30 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62369,CPT,ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFILL,,,21 ,,RBRVS,0.67 ,0.32 ,2.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,62370,CPT,ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR&REF PHYS,,,21 ,,RBRVS,0.90 ,0.42 ,2.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63001,CPT,LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG CRV,,,21 ,,RBRVS,17.61 ,12.91 ,12.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63003,CPT,LAMINECTOMY W/O FFD 1/2 VERT SEG THORACIC,,,21 ,,RBRVS,17.74 ,13.00 ,13.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63005,CPT,LAMINECTOMY W/O FFD 1/2 VERT SEG LUMBAR,,,21 ,,RBRVS,16.43 ,13.02 ,13.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63011,CPT,LAMINECTOMY W/O FFD 1/2 VERT SEG SACRAL,,,21 ,,RBRVS,15.91 ,11.88 ,11.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63012,CPT,LAMINECTOMY W/RMVL ABNORMAL FACETS LUMBAR,,,21 ,,RBRVS,16.85 ,12.90 ,12.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63015,CPT,LAMINECTOMY W/O FFD > 2 VERT SEG CERVICAL,,,21 ,,RBRVS,20.85 ,15.62 ,15.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63016,CPT,LAMINECTOMY W/O FFD > 2 VERT SEG THORACIC,,,21 ,,RBRVS,22.03 ,15.67 ,15.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63017,CPT,LAMINECTOMY W/O FFD > 2 VERT SEG LUMBAR,,,21 ,,RBRVS,17.33 ,13.65 ,13.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63020,CPT,LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC CERVC,,,21 ,,RBRVS,16.20 ,12.92 ,12.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63030,CPT,LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR,,,21 ,,RBRVS,13.18 ,11.25 ,11.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63035,CPT,LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR,,,21 ,,RBRVS,3.15 ,1.73 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63040,CPT,LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC CERVICAL,,,21 ,,RBRVS,20.31 ,14.67 ,14.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63042,CPT,LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR,,,21 ,,RBRVS,18.76 ,14.21 ,14.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63043,CPT,LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC EA CRV,,,21 ,,TotalUnits,,,,19.42 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,63044,CPT,LAMOT W/PRTL FFD HRNA8 REEXPL 1 NTRSPC EA LMBR,,,21 ,,TotalUnits,,,,18.45 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,63045,CPT,LAM FACETEC&FORAMOT 1 SEGMENT CERVICAL,,,21 ,,RBRVS,17.95 ,13.60 ,13.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63046,CPT,LAM FACETEC&FORAMOT 1 SEGMENT THORACIC,,,21 ,,RBRVS,17.25 ,13.11 ,13.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63047,CPT,LAM FACETEC&FORAMOT 1 SEGMENT LUMBAR,,,21 ,,RBRVS,15.37 ,12.45 ,12.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63048,CPT,LAM FACETEC&FORAMOT 1 SGM EA CRV THRC/LMBR,,,21 ,,RBRVS,3.47 ,1.89 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63050,CPT,LAMOP CERVICAL W/DCMPRN SPI CORD 2/> VERT SEG,,,21 ,,RBRVS,22.01 ,16.20 ,16.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63051,CPT,LAMOPLASTY CERVICAL DCMPRN CORD 2/> SEG RCNSTJ,,,21 ,,RBRVS,25.51 ,17.68 ,17.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63055,CPT,TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC,,,21 ,,RBRVS,23.55 ,16.67 ,16.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63056,CPT,TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR,,,21 ,,RBRVS,21.86 ,15.46 ,15.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63057,CPT,TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR,,,21 ,,RBRVS,5.25 ,2.87 ,2.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63064,CPT,COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG,,,21 ,,RBRVS,26.22 ,17.85 ,17.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63066,CPT,COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG,,,21 ,,RBRVS,3.26 ,1.77 ,1.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63075,CPT,DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC,,,21 ,,RBRVS,19.60 ,14.72 ,14.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63076,CPT,DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC,,,21 ,,RBRVS,4.04 ,2.20 ,2.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63077,CPT,DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC,,,21 ,,RBRVS,22.88 ,15.43 ,15.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63078,CPT,DISCECTOMY ANT DCMPRN CORD THORACIC EA NTRSPC,,,21 ,,RBRVS,3.28 ,1.78 ,1.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63081,CPT,VERTEBRAL CORPECTOMY ANT DCMPRN CERVICAL 1 SEG,,,21 ,,RBRVS,26.10 ,18.18 ,18.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63082,CPT,VERTEBRAL CORPECTOMY DCMPRN CERVICAL EA SEG,,,21 ,,RBRVS,4.36 ,2.38 ,2.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63085,CPT,VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC 1 SEG,,,21 ,,RBRVS,29.47 ,18.57 ,18.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63086,CPT,VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC EA SEG,,,21 ,,RBRVS,3.19 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63087,CPT,VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR 1 SEG,,,21 ,,RBRVS,37.53 ,23.34 ,23.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63088,CPT,VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR EA SEG,,,21 ,,RBRVS,4.32 ,2.37 ,2.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63090,CPT,VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC 1 SEG,,,21 ,,RBRVS,30.93 ,19.88 ,19.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63091,CPT,VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC EA SEG,,,21 ,,RBRVS,3.03 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63101,CPT,VERTEB CORPECT LAT XTRCAVITARY DCMPRN THRC 1 SEG,,,21 ,,RBRVS,34.10 ,23.63 ,23.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63102,CPT,VERTEB CORPECT LAT XTRCAVITARY DCMPRN LMBR 1 SEG,,,21 ,,RBRVS,34.10 ,23.31 ,23.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63103,CPT,VCRPEC LAT XTRCAVITARY DCMPRN THRC/LMBR EA SEG,,,21 ,,RBRVS,4.82 ,2.66 ,2.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63170,CPT,LAM W/MYELOTOMY CERVICAL/THORACIC/THORACOLUMBAR,,,21 ,,RBRVS,22.21 ,16.18 ,16.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63172,CPT,LAM W/DRG INTRMEDULLARY CYST/SYRINX SUBARACHNOID,,,21 ,,RBRVS,19.76 ,14.44 ,14.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63173,CPT,LAM W/DRG INTRMEDULRY CYST/SYRINX PRTL/PLEURAL,,,21 ,,RBRVS,24.31 ,17.66 ,17.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63180,CPT,LAM&SCTJ DENTATE LIG W/WO DURAL GRF CRV 1/2 SEG,,,21 ,,RBRVS,20.53 ,14.93 ,14.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63182,CPT,LAM&SCTJ DENTATE LIG W/WO DURAL GRF CRV >2 SEG,,,21 ,,RBRVS,22.82 ,15.09 ,15.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63185,CPT,LAMINECTOMY W/RHIZOTOMY 1/2 SEGMENTS,,,21 ,,RBRVS,16.49 ,12.41 ,12.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63190,CPT,LAMINECTOMY W/RHIZOTOMY > 2 SEGMENTS,,,21 ,,RBRVS,18.89 ,14.06 ,14.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63191,CPT,LAMINECTOMY W/SECTION SPINAL ACCESSORY NERVE,,,21 ,,RBRVS,18.92 ,12.18 ,12.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63194,CPT,LAM CORDOTOMY SCTJ 1 SPINOTHALMIC TRACT CERVICAL,,,21 ,,RBRVS,22.10 ,15.35 ,15.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63195,CPT,LAM CORDOTOMY SCTJ 1 SPINOTHALMIC TRACT THORACIC,,,21 ,,RBRVS,21.64 ,15.47 ,15.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63196,CPT,LAM CORDOTOMY SCTJ BOTH SPINOTHALMIC TRACTS CRV,,,21 ,,RBRVS,25.27 ,15.23 ,15.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63197,CPT,LAM CORDOTOMY SCTJ BOTH SPINOTHALMIC TRACT THRC,,,21 ,,RBRVS,24.08 ,17.46 ,17.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63198,CPT,LAM CORDOTOMY SCTJ BOTH TRACTS 2 STAGES CERVICAL,,,21 ,,RBRVS,29.90 ,14.78 ,14.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63199,CPT,LAM CORDOTOMY SCTJ BOTH TRACTS 2 STAGES THORACIC,,,21 ,,RBRVS,31.47 ,17.88 ,17.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63200,CPT,LAMINECTOMY RELEASE TETHERED SPINAL CORD LUMBAR,,,21 ,,RBRVS,21.44 ,15.63 ,15.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63250,CPT,LAM EXC/OCCLUSION AVM SPINAL CORD CERVICAL,,,21 ,,RBRVS,43.86 ,27.81 ,27.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63251,CPT,LAM EXC/OCCLUSION AVM SPINAL CORD THORACIC,,,21 ,,RBRVS,44.64 ,28.87 ,28.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63252,CPT,LAM EXC/OCCLUSION AVM SPI CORD THORACOLMBR,,,21 ,,RBRVS,44.63 ,28.81 ,28.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63265,CPT,LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL CRV,,,21 ,,RBRVS,23.82 ,17.11 ,17.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63266,CPT,LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL THRC,,,21 ,,RBRVS,24.68 ,17.41 ,17.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63267,CPT,LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL LMBR,,,21 ,,RBRVS,19.45 ,14.64 ,14.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63268,CPT,LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL SAC,,,21 ,,RBRVS,20.02 ,15.10 ,15.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63270,CPT,LAM EXC ISPI LES OTH/THN NEO IDRL CERVICAL,,,21 ,,RBRVS,29.80 ,20.47 ,20.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63271,CPT,LAM EXC ISPI LES OTH/THN NEO IDRL THORACIC,,,21 ,,RBRVS,29.92 ,20.44 ,20.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63272,CPT,LAM EXC ISPI LES OTH/THN NEO IDRL LUMBAR,,,21 ,,RBRVS,27.50 ,19.02 ,19.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63273,CPT,LAM EXC ISPI LES OTH/THN NEO IDRL SACRAL,,,21 ,,RBRVS,26.47 ,18.21 ,18.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63275,CPT,LAMINECTOMY BX/EXC ISPI NEO XDRL CERVICAL,,,21 ,,RBRVS,25.86 ,18.08 ,18.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63276,CPT,LAMINECTOMY BX/EXC ISPI NEO XDRL THORACIC,,,21 ,,RBRVS,25.69 ,18.06 ,18.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63277,CPT,LAMINECTOMY BX/EXC ISPI NEO XDRL LUMBAR,,,21 ,,RBRVS,22.39 ,16.18 ,16.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63278,CPT,LAMINECTOMY BX/EXC ISPI NEO XDRL SACRAL,,,21 ,,RBRVS,22.12 ,16.24 ,16.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63280,CPT,LAM BX/EXC ISPI NEO IDRL XMED CERVICAL,,,21 ,,RBRVS,30.29 ,21.14 ,21.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63281,CPT,LAM BX/EXC ISPI NEO IDRL XMED THORACIC,,,21 ,,RBRVS,29.99 ,20.99 ,20.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63282,CPT,LAM BX/EXC ISPI NEO IDRL XMED LUMBAR,,,21 ,,RBRVS,28.15 ,19.97 ,19.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63283,CPT,LAM BX/EXC ISPI NEO IDRL SACRAL,,,21 ,,RBRVS,26.76 ,19.27 ,19.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63285,CPT,LAM BX/EXC ISPI NEO IDRL IMED CERVICAL,,,21 ,,RBRVS,38.05 ,24.99 ,24.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63286,CPT,LAM BX/EXC ISPI NEO IDRL IMED THORACIC,,,21 ,,RBRVS,37.62 ,24.95 ,24.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63287,CPT,LAM BX/EXC ISPI NEO IDRL IMED THORACOLMBR,,,21 ,,RBRVS,40.08 ,26.35 ,26.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63290,CPT,LAM BX/EXC ISPI NEO XDRL-IDRL LES ANY LVL,,,21 ,,RBRVS,40.82 ,26.53 ,26.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63295,CPT,OSTPL RCNSTJ DORSAL SPI ELMNTS FLWG ISPI PX,,,21 ,,RBRVS,5.25 ,2.73 ,2.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63300,CPT,VCRPEC LES 1 SGM XDRL CERVICAL,,,21 ,,RBRVS,26.80 ,18.43 ,18.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63301,CPT,VCRPEC LES 1 SGM XDRL THORACIC TTHRC,,,21 ,,RBRVS,31.57 ,20.98 ,20.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63302,CPT,VCRPEC LES 1 SEG XDRL THRC THORACOLMBR,,,21 ,,RBRVS,31.15 ,20.88 ,20.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63303,CPT,VCRPEC LES 1 SEG XDRL LMBR/SAC TRANSPRTL/RPR,,,21 ,,RBRVS,33.55 ,21.57 ,21.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63304,CPT,VERTEBRAL CORPECTOMY EXC LES 1 SEG IDRL CERVICAL,,,21 ,,RBRVS,33.85 ,22.98 ,22.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63305,CPT,VERTEBRAL CORPECTOMY LES 1 SEG IDRL THRC TTHRC,,,21 ,,RBRVS,36.24 ,23.12 ,23.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63306,CPT,VERTEBRL CORPECT LES 1 SEG IDRL THRC THORACOLMBR,,,21 ,,RBRVS,35.55 ,19.22 ,19.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63307,CPT,VCRPEC LES 1 SEG IDRL LMBR/SAC TRANSPRTL/RPR,,,21 ,,RBRVS,34.96 ,22.97 ,22.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63308,CPT,VERTEBRAL CORPECTOMY EXC INDRL LES EACH SEG,,,21 ,,RBRVS,5.24 ,2.81 ,2.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63600,CPT,CREATION LES SPINAL CORD STEREOTACTIC METHOD PRQ,,,21 ,,RBRVS,15.12 ,8.18 ,8.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63610,CPT,STRTCTC STIMJ SPI CORD PRQ SPX N/FLWD OTH SURG,,,21 ,,RBRVS,8.72 ,2.32 ,15.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63615,CPT,STRTCTC BX ASPIRAT/EXC LESION SPINAL CORD,,,21 ,,RBRVS,17.32 ,12.20 ,12.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63620,CPT,STEREOTACTIC RADIOSURGERY 1 SPINAL LESION,,,21 ,,RBRVS,15.60 ,10.29 ,10.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63621,CPT,STEREOTACTIC RADIOSURGERY EA ADDL SPINAL LESION,,,21 ,,RBRVS,4.00 ,2.06 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63650,CPT,PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL,,,21 ,,RBRVS,7.20 ,4.37 ,4.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63655,CPT,LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL,,,21 ,,RBRVS,11.56 ,10.00 ,10.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63661,CPT,RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR,,,21 ,,RBRVS,5.08 ,3.93 ,11.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63662,CPT,RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR,,,21 ,,RBRVS,11.00 ,8.54 ,8.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63663,CPT,REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR,,,21 ,,RBRVS,7.75 ,5.27 ,16.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63664,CPT,REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR,,,21 ,,RBRVS,11.52 ,8.80 ,8.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63685,CPT,INSJ/RPLCMT SPI NPGR DIR/INDUXIVE COUPLING,,,21 ,,RBRVS,6.05 ,4.52 ,4.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63688,CPT,REVJ/RMVL IMPLANTED SPINAL NEUROSTIM GENERATOR,,,21 ,,RBRVS,5.30 ,4.24 ,4.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63700,CPT,REPAIR MENINGOCELE < 5 CM DIAMETER,,,21 ,,RBRVS,17.47 ,13.80 ,13.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63702,CPT,REPAIR MENINGOCELE > 5 CM DIAMETER,,,21 ,,RBRVS,19.41 ,15.19 ,15.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63704,CPT,REPAIR MYELOMENINGOCELE < 5 CM DIAMETER,,,21 ,,RBRVS,22.43 ,16.88 ,16.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63706,CPT,REPAIR MYELOMENINGOCELE > 5 CM DIAMETER,,,21 ,,RBRVS,25.35 ,19.02 ,19.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63707,CPT,RPR DURAL/CEREBROSPINAL FLUID LEAK X REQ LAM,,,21 ,,RBRVS,12.65 ,10.38 ,10.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63709,CPT,RPR DURAL/CSF LEAK/PSEUDOMENINGOCELE W/LAM,,,21 ,,RBRVS,15.65 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63710,CPT,DURAL GRAFT SPINAL,,,21 ,,RBRVS,15.40 ,12.08 ,12.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63740,CPT,CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL/OTH W/LAM,,,21 ,,RBRVS,12.63 ,10.60 ,10.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63741,CPT,CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL PRQ X LAM,,,21 ,,RBRVS,9.12 ,6.67 ,6.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63744,CPT,RPLCMT IRRIGATION/REVJ LUMBOSARACH SHUNT,,,21 ,,RBRVS,8.94 ,7.36 ,7.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,63746,CPT,RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT,,,21 ,,RBRVS,7.33 ,7.17 ,7.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64400,CPT,NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH,,,21 ,,RBRVS,1.11 ,0.67 ,2.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64402,CPT,INJECTION ANESTHETIC AGENT FACIAL NERVE,,,21 ,,RBRVS,1.25 ,0.71 ,1.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64405,CPT,INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV,,,21 ,,RBRVS,1.32 ,0.76 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64408,CPT,INJECTION ANESTHETIC AGENT VAGUS NERVE,,,21 ,,RBRVS,1.41 ,1.10 ,2.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64410,CPT,INJECTION ANESTHETIC AGENT PHRENIC NERVE,,,21 ,,RBRVS,1.43 ,0.70 ,2.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64412,CPT,INJECTION ANESTHETIC AGENT SPINAL ACCESSORY NRV,,,21 ,,RBRVS,1.18 ,0.80 ,3.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64413,CPT,INJECTION ANESTHETIC AGENT CERVICAL PLEXUS,,,21 ,,RBRVS,1.40 ,0.72 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64415,CPT,SINGLE NERVE BLOCK INJECTION ARM NERVE,,,21 ,,RBRVS,1.48 ,0.39 ,2.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64416,CPT,INJECTION ANES BRACHIAL PLEXUS CONT NFS CATH,,,21 ,,RBRVS,1.81 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64417,CPT,INJECTION ANESTHETIC AGENT AXILLARY NERVE,,,21 ,,RBRVS,1.44 ,0.50 ,2.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64418,CPT,INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE,,,21 ,,RBRVS,1.32 ,0.72 ,2.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64420,CPT,INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE,,,21 ,,RBRVS,1.18 ,0.66 ,2.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64421,CPT,MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES,,,21 ,,RBRVS,1.68 ,0.82 ,3.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64425,CPT,INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS,,,21 ,,RBRVS,1.75 ,0.82 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64430,CPT,INJECTION ANESTHETIC AGENT PUDENDAL NERVE,,,21 ,,RBRVS,1.46 ,0.84 ,2.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64435,CPT,INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE,,,21 ,,RBRVS,1.45 ,0.77 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64445,CPT,INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE,,,21 ,,RBRVS,1.48 ,0.58 ,2.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64446,CPT,INJECTION ANES SCIATIC NERVE CONT INFUSION CATH,,,21 ,,RBRVS,1.81 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64447,CPT,INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE,,,21 ,,RBRVS,1.50 ,0.33 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64448,CPT,INJECTION ANES FEMORAL NERVE CONT INFUSION CATH,,,21 ,,RBRVS,1.63 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64449,CPT,INJECTION ANES LUMBAR PLEXUS POST CONT NFS CATH,,,21 ,,RBRVS,1.81 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64450,CPT,INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH,,,21 ,,RBRVS,1.27 ,0.64 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64455,CPT,NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE,,,21 ,,RBRVS,0.75 ,0.26 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64479,CPT,NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC 1 LVL,,,21 ,,RBRVS,2.29 ,1.30 ,5.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64480,CPT,NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC EA LVL,,,21 ,,RBRVS,1.20 ,0.59 ,2.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64483,CPT,NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL,,,21 ,,RBRVS,1.75 ,1.12 ,5.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64484,CPT,NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LVL,,,21 ,,RBRVS,1.00 ,0.48 ,2.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64490,CPT,NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL,,,21 ,,RBRVS,1.82 ,1.26 ,3.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64491,CPT,NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL,,,21 ,,RBRVS,1.16 ,0.58 ,1.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64492,CPT,NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL,,,21 ,,RBRVS,1.16 ,0.61 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64493,CPT,NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL,,,21 ,,RBRVS,1.52 ,1.10 ,3.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64494,CPT,NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL,,,21 ,,RBRVS,1.00 ,0.49 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64495,CPT,NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL,,,21 ,,RBRVS,1.00 ,0.51 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64505,CPT,INJECTION ANES AGENT SPHENOPALATINE GANGLION,,,21 ,,RBRVS,1.36 ,0.95 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64508,CPT,INJECTION ANESTHETIC AGENT CAROTID SINUS SPX,,,21 ,,RBRVS,1.12 ,0.84 ,1.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64510,CPT,NJX ANES STELLATE GANGLION CRV SYMPATHETIC,,,21 ,,RBRVS,1.22 ,0.73 ,2.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64517,CPT,INJECTION ANES SUPERIOR HYPOGASTRIC PLEXUS,,,21 ,,RBRVS,2.20 ,1.14 ,2.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64520,CPT,INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC,,,21 ,,RBRVS,1.35 ,0.84 ,4.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64530,CPT,INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG,,,21 ,,RBRVS,1.58 ,0.94 ,3.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64550,CPT,APPLICATION SURFACE NEUROSTIMULATOR,,,21 ,,RBRVS,0.18 ,0.07 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64553,CPT,PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE,,,21 ,,RBRVS,2.36 ,1.96 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64555,CPT,PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV,,,21 ,,RBRVS,2.32 ,1.79 ,3.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64561,CPT,PRQ IMPLTJ NEUROSTIMULATOR ELTRD SACRAL NERVE,,,21 ,,RBRVS,7.15 ,4.15 ,20.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64565,CPT,PRQ IMPLTJ NSTIM ELTRD NEUROMUSCULAR,,,21 ,,RBRVS,1.81 ,1.61 ,3.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64566,CPT,POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE,,,21 ,,RBRVS,0.60 ,0.23 ,3.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64568,CPT,INC IMPLTJ CRNL NRV NSTIM ELTRDS & PULSE GENER,,,21 ,,RBRVS,9.00 ,8.64 ,8.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64569,CPT,REVISION/REPLMT NEUROSTIMLATOR ELTRD CRANIAL NRV,,,21 ,,RBRVS,11.00 ,4.49 ,4.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64570,CPT,REMOVAL CRNL NRV NSTIM ELTRDS & PULSE GENERATOR,,,21 ,,RBRVS,9.10 ,4.05 ,4.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64575,CPT,INC IMPLTJ PERIPH NERVE NEUROSTIMULATOR ELTRD,,,21 ,,RBRVS,4.42 ,3.57 ,3.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64580,CPT,INC IMPLTJ NSTIM ELTRD NEUROMUSCULAR,,,21 ,,RBRVS,4.19 ,3.81 ,3.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64581,CPT,INC IMPLTJ NEUROSTIMULATOR ELTRD SACRAL NERVE,,,21 ,,RBRVS,12.20 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64585,CPT,REVJ/RMVL PERIPHERAL NEUROSTIMULATOR ELECTRODE,,,21 ,,RBRVS,2.11 ,2.09 ,6.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64590,CPT,INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR,,,21 ,,RBRVS,2.45 ,2.21 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64595,CPT,REVISION/RMVL PERIPHERAL/GASTRIC NPGR,,,21 ,,RBRVS,1.78 ,1.91 ,6.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64600,CPT,DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH,,,21 ,,RBRVS,3.49 ,2.45 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64605,CPT,DSTRJ NEUROLYTIC TRIGEMINAL NRV 2/3 DIV BRANCH,,,21 ,,RBRVS,5.65 ,3.92 ,12.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64610,CPT,DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR,,,21 ,,RBRVS,7.20 ,4.98 ,12.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64611,CPT,CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS BI,,,21 ,,RBRVS,1.03 ,1.35 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64612,CPT,CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV,,,21 ,,RBRVS,2.01 ,1.93 ,2.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64613,CPT,CHEMODENERVATION NECK MUSCLE,,,21 ,,RBRVS,2.01 ,1.68 ,2.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64614,CPT,CHEMODENERVATION EXTREMITY&/TRUNK MUSCLE,,,21 ,,RBRVS,2.20 ,1.85 ,2.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64620,CPT,DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE,,,21 ,,RBRVS,2.89 ,1.81 ,3.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64630,CPT,DSTRJ NEUROLYTIC AGENT PUDENDAL NERVE,,,21 ,,RBRVS,3.05 ,2.14 ,3.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64632,CPT,DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE,,,21 ,,RBRVS,1.23 ,0.74 ,1.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64633,CPT,DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA,,,21 ,,RBRVS,3.84 ,2.75 ,9.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64634,CPT,DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA,,,21 ,,RBRVS,1.32 ,0.64 ,4.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64635,CPT,DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL,,,21 ,,RBRVS,3.78 ,2.68 ,8.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64636,CPT,DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL,,,21 ,,RBRVS,1.16 ,0.55 ,4.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64640,CPT,DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE,,,21 ,,RBRVS,2.81 ,1.90 ,3.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64650,CPT,CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE,,,21 ,,RBRVS,0.70 ,0.37 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64653,CPT,CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY,,,21 ,,RBRVS,0.88 ,0.44 ,2.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64680,CPT,DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS,,,21 ,,RBRVS,2.67 ,1.83 ,6.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64681,CPT,DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS,,,21 ,,RBRVS,3.78 ,1.78 ,6.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64702,CPT,NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT,,,21 ,,RBRVS,6.26 ,6.77 ,6.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64704,CPT,NEUROPLASTY NERVE HAND/FOOT,,,21 ,,RBRVS,4.69 ,4.23 ,4.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64708,CPT,NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC,,,21 ,,RBRVS,6.36 ,6.60 ,6.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64712,CPT,NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV,,,21 ,,RBRVS,8.07 ,6.69 ,6.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64713,CPT,NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS,,,21 ,,RBRVS,11.40 ,8.52 ,8.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64714,CPT,NEURP MAJOR PRPH NRV OPN ARM/LEG LMBR PLEXUS,,,21 ,,RBRVS,10.55 ,7.42 ,7.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64716,CPT,NEUROPLASTY &/TRANSPOSITION CRANIAL NERVE,,,21 ,,RBRVS,6.99 ,7.46 ,7.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64718,CPT,NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW,,,21 ,,RBRVS,7.26 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64719,CPT,NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST,,,21 ,,RBRVS,4.97 ,5.62 ,5.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64721,CPT,NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNEL,,,21 ,,RBRVS,4.97 ,6.31 ,6.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64722,CPT,DECOMPRESSION UNSPECIFIED NERVE,,,21 ,,RBRVS,4.82 ,4.39 ,4.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64726,CPT,DECOMPRESSION PLANTAR DIGITAL NERVE,,,21 ,,RBRVS,4.27 ,3.45 ,3.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64727,CPT,INTERNAL NEUROLYSIS REQ OPERATING MICROSCOPE,,,21 ,,RBRVS,3.10 ,1.77 ,1.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64732,CPT,TRANSECTION/AVULSION SUPRAORBITAL NERVE,,,21 ,,RBRVS,4.89 ,5.63 ,5.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64734,CPT,TRANSECTION/AVULSION INFRAORBITAL NERVE,,,21 ,,RBRVS,5.55 ,6.15 ,6.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64736,CPT,TRANSECTION/AVULSION MENTAL NERVE,,,21 ,,RBRVS,5.23 ,5.56 ,5.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64738,CPT,TRANSECTION/AVULSION INF ALVEOLAR NRV W/OSTEO,,,21 ,,RBRVS,6.36 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64740,CPT,TRANSECTION/AVULSION LINGUAL NERVE,,,21 ,,RBRVS,6.22 ,6.46 ,6.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64742,CPT,TRANSECTION/AVULSION FACIAL NRV DIFFERENT/CMPL,,,21 ,,RBRVS,6.85 ,6.27 ,6.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64744,CPT,TRANSECTION/AVULSION GREATER OCCIPITAL NERVE,,,21 ,,RBRVS,5.72 ,5.75 ,5.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64746,CPT,TRANSECTION/AVULSION PHRENIC NERVE,,,21 ,,RBRVS,6.56 ,4.86 ,4.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64752,CPT,TRANSECTION/AVULSION VAGUS NRV TRANSTHORACIC,,,21 ,,RBRVS,7.69 ,5.65 ,5.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64755,CPT,TRANSECTION/AVULSION VAGUS NERVES,,,21 ,,RBRVS,15.05 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64760,CPT,TRANSECTION/AVULSION VAGUS NERVE ABDOMINAL,,,21 ,,RBRVS,7.59 ,5.32 ,5.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64761,CPT,TRANSECTION/AVULSION PUDENDAL NERVE,,,21 ,,RBRVS,7.04 ,5.09 ,5.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64763,CPT,TRNSXJ/AVLSN OBTURAT NRV XPELV W/WO TENOTOMY,,,21 ,,RBRVS,7.56 ,6.28 ,6.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64766,CPT,TRNSXJ/AVLSN OBTURAT NRV INPELV W/WO TENOTOMY,,,21 ,,RBRVS,9.47 ,6.93 ,6.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64771,CPT,TRANSECTION/AVULSION OTH CRANIAL NRV XDRL,,,21 ,,RBRVS,8.15 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64772,CPT,TRANSECTION/AVULSION OTH SPINAL NRV XDRL,,,21 ,,RBRVS,7.84 ,7.15 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64774,CPT,EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE,,,21 ,,RBRVS,5.80 ,5.25 ,5.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64776,CPT,EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT,,,21 ,,RBRVS,5.60 ,4.94 ,4.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64778,CPT,EXCISION NEUROMA DIGITAL NRV EA ADDL DIGIT,,,21 ,,RBRVS,3.11 ,1.93 ,1.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64782,CPT,EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE,,,21 ,,RBRVS,6.86 ,5.43 ,5.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64783,CPT,EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT,,,21 ,,RBRVS,3.71 ,2.27 ,2.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64784,CPT,EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC,,,21 ,,RBRVS,10.62 ,8.72 ,8.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64786,CPT,EXCISION NEUROMA SCIATIC NERVE,,,21 ,,RBRVS,16.25 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64787,CPT,IMPLANTATION NERVE END BONE/MUSCLE,,,21 ,,RBRVS,4.29 ,2.25 ,2.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64788,CPT,EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV,,,21 ,,RBRVS,5.24 ,5.24 ,5.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64790,CPT,EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV,,,21 ,,RBRVS,12.10 ,9.51 ,9.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64792,CPT,EXC NEUROFIBROMA/NEUROLEMMOMA X10SV,,,21 ,,RBRVS,15.86 ,11.73 ,11.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64795,CPT,BIOPSY NERVE,,,21 ,,RBRVS,3.01 ,1.99 ,1.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64802,CPT,SYMPATHECTOMY CERVICAL,,,21 ,,RBRVS,10.37 ,6.86 ,6.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64804,CPT,SYMPATHECTOMY CERVICOTHORACIC,,,21 ,,RBRVS,15.91 ,6.80 ,6.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64809,CPT,SYMPATHECTOMY THORACOLUMBAR,,,21 ,,RBRVS,14.71 ,9.05 ,9.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64818,CPT,SYMPATHECTOMY LUMBAR,,,21 ,,RBRVS,11.34 ,6.20 ,6.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64820,CPT,SYMPATHECTOMY DIGITAL ARTERIES EACH DIGIT,,,21 ,,RBRVS,10.74 ,9.62 ,9.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64821,CPT,SYMPATHECTOMY ULNAR ARTERY,,,21 ,,RBRVS,9.33 ,8.96 ,8.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64822,CPT,SYMPATHECTOMY ULNAR ARTERY,,,21 ,,RBRVS,9.33 ,8.81 ,8.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64823,CPT,SYMPATHECTOMY SUPERFICIAL PALMAR ARCH,,,21 ,,RBRVS,10.94 ,9.58 ,9.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64831,CPT,SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE,,,21 ,,RBRVS,9.16 ,9.09 ,9.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64832,CPT,SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV,,,21 ,,RBRVS,5.65 ,3.43 ,3.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64834,CPT,SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE,,,21 ,,RBRVS,10.81 ,9.07 ,9.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64835,CPT,SUTURE 1 NERVE MEDIAN MOTOR THENAR,,,21 ,,RBRVS,11.73 ,9.68 ,9.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64836,CPT,SUTURE 1 NERVE ULNAR MOTOR,,,21 ,,RBRVS,11.73 ,9.70 ,9.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64837,CPT,SUTURE EACH ADDITIONAL NERVE HAND/FOOT,,,21 ,,RBRVS,6.25 ,3.61 ,3.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64840,CPT,SUTURE POSTERIOR TIBIAL NERVE,,,21 ,,RBRVS,14.02 ,10.55 ,10.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64856,CPT,SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS,,,21 ,,RBRVS,15.07 ,11.86 ,11.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64857,CPT,SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS,,,21 ,,RBRVS,15.82 ,12.26 ,12.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64858,CPT,SUTURE SCIATIC NERVE,,,21 ,,RBRVS,17.82 ,14.44 ,14.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64859,CPT,SUTURE EACH ADDITIONAL PERIPHERAL NERVE,,,21 ,,RBRVS,4.25 ,2.71 ,2.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64861,CPT,SUTURE BRACHIAL PLEXUS,,,21 ,,RBRVS,20.89 ,12.89 ,12.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64862,CPT,SUTURE LUMBAR PLEXUS,,,21 ,,RBRVS,21.09 ,14.47 ,14.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64864,CPT,SUTURE FACIAL NERVE EXTRACRANIAL,,,21 ,,RBRVS,13.41 ,10.31 ,10.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64865,CPT,SUTURE FACIAL NERVE INFRATEMPORAL W/WO GRAFT,,,21 ,,RBRVS,16.09 ,15.42 ,15.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64866,CPT,ANASTOMOSIS FACIAL-SPINAL ACCESSORY,,,21 ,,RBRVS,16.83 ,14.74 ,14.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64868,CPT,ANASTOMOSIS FACIAL HYPOGLOSSAL,,,21 ,,RBRVS,14.90 ,13.79 ,13.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64870,CPT,ANASTOMOSIS FACIAL-PHRENIC,,,21 ,,RBRVS,17.08 ,10.94 ,10.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64872,CPT,SUTURE NERVE REQ SECONDARY/DELAYED SUTURE,,,21 ,,RBRVS,1.99 ,1.16 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64874,CPT,SUTURE NERVE REQ XTNSV MOBIL/TRPOS NERVE,,,21 ,,RBRVS,2.98 ,1.83 ,1.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64876,CPT,SUTURE NERVE REQ SHORTENING BONE EXTREMITY,,,21 ,,RBRVS,3.37 ,1.73 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64885,CPT,NERVE GRAFT HEAD/NECK < 4 CM,,,21 ,,RBRVS,17.60 ,13.03 ,13.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64886,CPT,NERVE GRAFT HEAD/NECK >4 CM,,,21 ,,RBRVS,20.82 ,15.10 ,15.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64890,CPT,NERVE GRAFT 1 STRAND HAND/FOOT <4 CM,,,21 ,,RBRVS,16.24 ,12.40 ,12.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64891,CPT,NRV GRF 1 STRAND HAND/FOOT >4 CM,,,21 ,,RBRVS,17.35 ,13.80 ,13.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64892,CPT,NERVE GRAFT 1 STRAND ARM/LEG <4 CM,,,21 ,,RBRVS,15.74 ,12.03 ,12.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64893,CPT,NERVE GRAFT 1 STRAND ARM/LEG >4 CM,,,21 ,,RBRVS,16.87 ,12.85 ,12.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64895,CPT,NERVE GRAFT MLT STRANDS HAND/FOOT <4 CM,,,21 ,,RBRVS,20.39 ,15.47 ,15.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64896,CPT,NERVE GRAFT MLT STRANDS HAND/FOOT > 4 CM,,,21 ,,RBRVS,21.96 ,15.41 ,15.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64897,CPT,NERVE GRAFT MLT STRANDS ARM/LEG <4 CM,,,21 ,,RBRVS,19.38 ,14.35 ,14.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64898,CPT,NERVE GRAFT MLT STRANDS ARM/LEG >4 CM,,,21 ,,RBRVS,20.97 ,15.43 ,15.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64901,CPT,NERVE GRAFT EACH NERVE 1 STRAND,,,21 ,,RBRVS,10.20 ,6.38 ,6.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64902,CPT,NERVE GRAFT EACH NERVE MULTIPLE STRANDS,,,21 ,,RBRVS,11.81 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64905,CPT,NERVE PEDICLE TRANSFER FIRST STAGE,,,21 ,,RBRVS,15.11 ,12.04 ,12.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64907,CPT,NERVE PEDICAL TRANSFER SECOND STAGE,,,21 ,,RBRVS,20.03 ,12.38 ,12.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64910,CPT,NERVE REPAIR W/CONDUIT EACH NERVE,,,21 ,,RBRVS,11.39 ,10.66 ,10.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64911,CPT,NERVE REPAIR W/AUTOGENOUS VEIN GRAFT EA NERVE,,,21 ,,RBRVS,14.39 ,12.74 ,12.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,64999,CPT,UNLISTED PROCEDURE NERVOUS SYSTEM,,,21 ,,TotalUnits,,,,3.44 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,65091,CPT,EVISCERATION OCULAR CONTENTS W/O IMPLANT,,,21 ,,RBRVS,7.26 ,9.65 ,9.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65093,CPT,EVISCERATION OCULAR CONTENTS W/IMPLANT,,,21 ,,RBRVS,7.04 ,9.75 ,9.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65101,CPT,ENUCLEATION OF EYE W/O IMPLANT,,,21 ,,RBRVS,8.30 ,11.32 ,11.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65103,CPT,ENUCLEATION EYE IMPLT MUSC X ATTACHED IMPLT,,,21 ,,RBRVS,8.84 ,11.63 ,11.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65105,CPT,ENUCLEATION EYE IMPLT MUSC ATTACHED IMPLT,,,21 ,,RBRVS,9.93 ,12.63 ,12.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65110,CPT,EXENTERATION ORBIT REMVL ORBITAL CONTENTS ONLY,,,21 ,,RBRVS,15.70 ,16.70 ,16.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65112,CPT,EXENTERATION ORBIT RMVL ORBIT CONTENTS & BONE,,,21 ,,RBRVS,18.51 ,19.32 ,19.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65114,CPT,EXNTJ ORBIT RMVL ORB CNTS W/MUSC/MYOQ FLAP,,,21 ,,RBRVS,19.65 ,19.94 ,19.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65125,CPT,MODIFICAJ OC IMPLT W/PLMT/RPLCMT PEGS SPX,,,21 ,,RBRVS,3.27 ,4.45 ,8.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65130,CPT,INSJ OC IMPLT SEC AFTER EVSC SCLL SHELL,,,21 ,,RBRVS,8.42 ,11.00 ,11.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65135,CPT,INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED,,,21 ,,RBRVS,8.60 ,11.14 ,11.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65140,CPT,INSJ OC IMPLT AFTER ENCL MUSC ATTACHED,,,21 ,,RBRVS,9.46 ,12.03 ,12.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65150,CPT,REINSERTION OCULAR IMPLT W/WO CONJUNCTIVAL GRAFT,,,21 ,,RBRVS,6.43 ,9.02 ,9.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65155,CPT,REINSERTION OCULAR IMPLT RNFCMT&/ATTACHMENT MUSC,,,21 ,,RBRVS,10.10 ,12.44 ,12.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65175,CPT,REMOVAL OCULAR IMPLANT,,,21 ,,RBRVS,7.40 ,10.10 ,10.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65205,CPT,REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL,,,21 ,,RBRVS,0.71 ,0.45 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65210,CPT,RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR,,,21 ,,RBRVS,0.84 ,0.58 ,1.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65220,CPT,RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP,,,21 ,,RBRVS,0.71 ,0.40 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65222,CPT,RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP,,,21 ,,RBRVS,0.93 ,0.62 ,1.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65235,CPT,RMVL FB INTRAOCULAR ANT CHAMBER EYE/LENS,,,21 ,,RBRVS,9.01 ,9.74 ,9.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65260,CPT,RMVL FB IO FROM POST SEG MAG XTRJ ANT/POST ROUTE,,,21 ,,RBRVS,12.54 ,12.85 ,12.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65265,CPT,RMVL FB IO FROM POST SEG NONMAGNETIC XTRJ,,,21 ,,RBRVS,14.34 ,14.23 ,14.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65270,CPT,RPR LAC CJNC W/WO NONPERFOR LAC SCLERA DIR CLSR,,,21 ,,RBRVS,1.95 ,1.78 ,5.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65272,CPT,RPR LAC CJNC MOBLJ&REARGMT W/O HOSPIZATION,,,21 ,,RBRVS,4.62 ,4.66 ,8.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65273,CPT,RPR LAC CJNC MOBLJ&REARGMT W/HOSPIZATION,,,21 ,,RBRVS,5.16 ,4.95 ,4.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65275,CPT,RPR LAC CORNEA NONPERFOR W/WO RMVL FOREIGN BODY,,,21 ,,RBRVS,6.29 ,5.84 ,8.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65280,CPT,RPR LAC CORNEA&/SCLERA PERFOR X INVG UVEAL TISS,,,21 ,,RBRVS,9.10 ,8.59 ,8.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65285,CPT,RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL TIS,,,21 ,,RBRVS,14.71 ,12.73 ,12.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65286,CPT,RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA,,,21 ,,RBRVS,6.63 ,6.47 ,12.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65290,CPT,RPR WND EXTRAOCULAR MUSCLE TENDON&/TENON CAPSULE,,,21 ,,RBRVS,6.53 ,6.49 ,6.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65400,CPT,EXCISION LESION CORNEA XCP PTERYGIUM,,,21 ,,RBRVS,7.50 ,8.43 ,10.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65410,CPT,BIOPSY CORNEA,,,21 ,,RBRVS,1.47 ,1.30 ,2.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65420,CPT,EXCISION/TRANSPOSITION PTERYGIUM W/O GRAFT,,,21 ,,RBRVS,4.36 ,5.64 ,9.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65426,CPT,EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG,,,21 ,,RBRVS,6.05 ,6.62 ,11.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65430,CPT,CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE,,,21 ,,RBRVS,1.47 ,1.28 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65435,CPT,RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION,,,21 ,,RBRVS,0.92 ,0.94 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65436,CPT,RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT,,,21 ,,RBRVS,4.82 ,5.01 ,5.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65450,CPT,DSTRJ LESION CRYOTHER PHOTO/THERMOCAUTZATION,,,21 ,,RBRVS,3.47 ,5.04 ,5.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65600,CPT,MULTIPLE PUNCTURES ANTERIOR CORNEA,,,21 ,,RBRVS,4.20 ,4.86 ,6.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65710,CPT,KERATOPLASTY ANTERIOR LAMELLAR,,,21 ,,RBRVS,14.45 ,14.92 ,14.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65730,CPT,KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA,,,21 ,,RBRVS,16.35 ,16.21 ,16.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65750,CPT,KERATOPLASTY PENETRAING APHAKIA,,,21 ,,RBRVS,16.90 ,15.89 ,15.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65755,CPT,KERATOPLASTY PENETRATING PSEUDOPHAKIA,,,21 ,,RBRVS,16.79 ,15.83 ,15.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65756,CPT,KERATOPLASTY ENDOTHELIAL,,,21 ,,RBRVS,16.84 ,14.50 ,14.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65757,CPT,BACKBENCH PREPJ CORNEAL ENDOTHELIAL ALLOGRAFT,,,21 ,,TotalUnits,,,,10.81 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,65760,CPT,KERATOMILEUSIS,,,21 ,,TotalUnits,,,,22.94 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,65765,CPT,KERATOPHAKIA,,,21 ,,RBRVS,23.41 ,20.56 ,20.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65767,CPT,EPIKERATOPLASTY,,,21 ,,RBRVS,21.79 ,19.15 ,19.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65770,CPT,KERATOPROSTHESIS,,,21 ,,RBRVS,19.74 ,17.60 ,17.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65771,CPT,RADIAL KERATOTOMY,,,21 ,,TotalUnits,,,,12.62 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,65772,CPT,CRNL RELAXING INC CORRJ INDUCED ASTIGMATISM,,,21 ,,RBRVS,5.09 ,5.66 ,6.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65775,CPT,CRNL WEDGE RESCJ CORRJ INDUCED ASTIGMATISM,,,21 ,,RBRVS,6.91 ,7.73 ,7.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65778,CPT,PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN,,,21 ,,RBRVS,1.19 ,0.84 ,35.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65779,CPT,PLACE AMNIOTIC MEMBRANE OCULAR SURFACE SUTURED,,,21 ,,RBRVS,3.92 ,4.07 ,28.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65780,CPT,OCULAR SURFACE RECONSTRUCTION AMNIOTIC MEMBRANE,,,21 ,,RBRVS,10.73 ,12.89 ,12.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65781,CPT,OCULAR SURFACE RECONSTRUCTION LIMBAL ALLOGRAFT,,,21 ,,RBRVS,18.14 ,17.39 ,17.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65782,CPT,OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT,,,21 ,,RBRVS,15.43 ,15.23 ,15.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65800,CPT,PARACENTSIS ANT CHAMB EYE W/DX ASPIR AQUEOUS SPX,,,21 ,,RBRVS,1.91 ,1.57 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65805,CPT,PARACENTSIS ANT CHAM EYE W/THER REL AQUEOUS SPX,,,21 ,,RBRVS,1.91 ,1.57 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65810,CPT,PARACENTSIS ANT CHAM RMVL VITREOUS W/WO AIR INJX,,,21 ,,RBRVS,5.82 ,6.67 ,6.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65815,CPT,PARACEN ANT CHAM RMVL BLOOD W/WO IRRIG&/AIR INJX,,,21 ,,RBRVS,6.00 ,6.62 ,11.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65820,CPT,GONIOTOMY,,,21 ,,RBRVS,8.91 ,10.99 ,10.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65850,CPT,TRABECULOTOMY AB EXTERNO,,,21 ,,RBRVS,11.39 ,10.94 ,10.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65855,CPT,TRABECULOPLASTY LASER SURG 1/> SESSIONS,,,21 ,,RBRVS,3.99 ,3.93 ,5.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65860,CPT,SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX,,,21 ,,RBRVS,3.59 ,3.17 ,4.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65865,CPT,SEVERING ADS ANT SEG INCAL TQ SPX GONIOSYNECHIAE,,,21 ,,RBRVS,5.77 ,6.82 ,6.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65870,CPT,SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE,,,21 ,,RBRVS,7.39 ,8.29 ,8.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65875,CPT,SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE,,,21 ,,RBRVS,7.81 ,8.89 ,8.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65880,CPT,SEVERING ADS ANT SEG INCAL SPX CORNEOVITREAL,,,21 ,,RBRVS,8.36 ,9.20 ,9.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65900,CPT,RMVL EPITHELIAL DOWNGROWTH ANT CHAMBER EYE,,,21 ,,RBRVS,12.51 ,13.09 ,13.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65920,CPT,RMVL IMPLANTED MATERIAL ANTERIO SEGMENT EYE,,,21 ,,RBRVS,9.99 ,10.88 ,10.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,65930,CPT,RMVL BLOOD CLOT ANTERIOR SEGMENT EYE,,,21 ,,RBRVS,8.39 ,8.57 ,8.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66020,CPT,INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX,,,21 ,,RBRVS,1.64 ,1.85 ,3.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66030,CPT,INJX ANTERIOR CHAMBER EYE MEDICATION SPX,,,21 ,,RBRVS,1.30 ,1.64 ,3.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66130,CPT,EXCISION LESION SCLERA,,,21 ,,RBRVS,7.83 ,7.31 ,10.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66150,CPT,FSTLJ SCLERA GLAUCOMA TREPHIN W/IRIDECTOMY,,,21 ,,RBRVS,10.53 ,12.63 ,12.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66155,CPT,FSTLJ SCLERA GLAUCOMA THERMOCAUT IRRIDEC,,,21 ,,RBRVS,10.52 ,12.62 ,12.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66160,CPT,FSTLJ SCLERA SCLERECTOMY PUNCH/SCISSORS IRIDECT,,,21 ,,RBRVS,12.39 ,13.75 ,13.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66165,CPT,FSTLJ SCLERA GLAUCOMA IRIDENCLEISIS/IRIDOTASIS,,,21 ,,RBRVS,10.24 ,12.45 ,12.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66170,CPT,FSTLJ SCLERA GLAUCOMA TRABECULECT AB EXTERNO,,,21 ,,RBRVS,15.02 ,16.71 ,16.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66172,CPT,FSTLJ SCLERA GLC TRBEC AB EXTERNO SCARRING,,,21 ,,RBRVS,18.86 ,21.13 ,21.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66174,CPT,TRLUML DILAT AQUEOUS CANAL W/O DEVICE/STENT,,,21 ,,RBRVS,12.85 ,13.79 ,13.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66175,CPT,TRLUML DILAT AQUEOUS CANAL W/DEVICE/STENT,,,21 ,,RBRVS,13.60 ,14.31 ,14.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66180,CPT,AQUEOUS SHUNT EXTRAOCULAR RESERVOIR,,,21 ,,RBRVS,16.30 ,14.61 ,14.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66185,CPT,REVISION AQUEOUS SHUNT EXTRAOCULAR RESERVOIR,,,21 ,,RBRVS,9.58 ,10.24 ,10.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66220,CPT,REPAIR SCLERAL STAPHYLOMA W/O GRAFT,,,21 ,,RBRVS,9.21 ,10.31 ,10.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66225,CPT,REPAIR SCLERAL STAPHYLOMA W/GRAFT,,,21 ,,RBRVS,12.63 ,12.04 ,12.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66250,CPT,REVJ/RPR OPRATIVE WOUND ANTERIOR SEGMENT,,,21 ,,RBRVS,7.10 ,7.62 ,12.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66500,CPT,IRIDOTOMY STAB INC SPX XCP TRANSFIXION,,,21 ,,RBRVS,3.83 ,5.57 ,5.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66505,CPT,IRIDOTOMY STAB INC SPX TRANSFIXION,,,21 ,,RBRVS,4.22 ,6.08 ,6.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66600,CPT,IRDEC CRNLSCLRL/CRNL SCTJ RMVL LES,,,21 ,,RBRVS,10.12 ,11.79 ,11.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66605,CPT,IRDEC CRNLSCLRL/CRNL SCTJ CYCLECTOMY,,,21 ,,RBRVS,14.22 ,13.73 ,13.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66625,CPT,IRDEC CRNLSCLRL/CRNL SCTJ PRPH GLC SPX,,,21 ,,RBRVS,5.30 ,6.09 ,6.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66630,CPT,IRDEC CRNLSCLRL/CRNL SCTJ SECTOR GLC SPX,,,21 ,,RBRVS,7.28 ,7.78 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66635,CPT,IRDEC CRNLSCLRL/CRNL SCTJ OPTICAL SPX,,,21 ,,RBRVS,7.37 ,7.84 ,7.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66680,CPT,REPAIR IRIS CILIARY BODY,,,21 ,,RBRVS,6.39 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66682,CPT,SUTURE IRIS CILIARY BODY SPX RETRIEVAL SUTURE,,,21 ,,RBRVS,7.33 ,9.42 ,9.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66700,CPT,CILIARY BODY DESTRUCTION DIATHERMY,,,21 ,,RBRVS,5.14 ,5.28 ,6.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66710,CPT,CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL,,,21 ,,RBRVS,5.14 ,5.27 ,6.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66711,CPT,CILIARY BODY DSTRJ CYCLOPHOTOCOAG ENDOSCOPIC,,,21 ,,RBRVS,7.93 ,9.05 ,9.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66720,CPT,CILIARY BODY DESTRUCTION CRYOTHERAPY,,,21 ,,RBRVS,5.00 ,6.15 ,7.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66740,CPT,CILIARY BODY DESTRUCTION CYCLODIAL,,,21 ,,RBRVS,5.14 ,5.30 ,6.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66761,CPT,IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION,,,21 ,,RBRVS,3.00 ,4.44 ,5.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66762,CPT,IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS,,,21 ,,RBRVS,5.38 ,5.89 ,7.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66770,CPT,DSTRJ CYST/LESION IRIS/CILIARY BODY,,,21 ,,RBRVS,6.13 ,6.64 ,7.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66820,CPT,DISCISSION SECONDARY MEMBRANOUS CATARACT,,,21 ,,RBRVS,4.01 ,6.51 ,6.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66821,CPT,POST-CATARACT LASER SURGERY,,,21 ,,RBRVS,3.42 ,4.79 ,5.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66825,CPT,REPOSITIONING IO LENS PROSTHESIS REQ INC SPX,,,21 ,,RBRVS,9.01 ,11.18 ,11.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66830,CPT,RMVL SEC MEMBRANOUS CTRC CORNEO-SCLL SCTJ,,,21 ,,RBRVS,9.47 ,9.42 ,9.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66840,CPT,RMVL LENS MATERIAL ASPIR TQ 1/> STAGES,,,21 ,,RBRVS,9.18 ,9.24 ,9.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66850,CPT,RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR,,,21 ,,RBRVS,10.55 ,10.44 ,10.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66852,CPT,RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY,,,21 ,,RBRVS,11.41 ,10.98 ,10.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66920,CPT,RMVL LENS MATERIAL INTRACAPSULAR,,,21 ,,RBRVS,10.13 ,9.86 ,9.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66930,CPT,REMOVAL LENS MATRL INTRACAPSULAR DISLOCATED LENS,,,21 ,,RBRVS,11.61 ,11.10 ,11.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66940,CPT,REMOVAL LENS MATERIAL EXTRACAPSULAR,,,21 ,,RBRVS,10.37 ,10.33 ,10.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66982,CPT,XCAPSULAR CATARACT RMVL INSJ LENS PROSTH 1 STG,,,21 ,,RBRVS,15.02 ,13.01 ,13.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66983,CPT,ICAPSULAR CATARACT XTRJ INSJ IO LENS PRSTH 1 STG,,,21 ,,RBRVS,10.43 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66984,CPT,CATARACT REMOVAL INSERTION OF LENS,,,21 ,,RBRVS,10.52 ,9.68 ,9.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66985,CPT,INSJ IO LENS PROSTHESIS X W/CONCURRENT RMVL,,,21 ,,RBRVS,9.98 ,10.38 ,10.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66986,CPT,EXCHANGE INTRAOCULAR LENS,,,21 ,,RBRVS,12.26 ,11.94 ,11.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66990,CPT,USE OPHTHALMIC ENDOSCOPE,,,21 ,,RBRVS,1.51 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,66999,CPT,UNLISTED PROCEDURE ANTERIOR SEGMENT EYE,,,21 ,,TotalUnits,,,,20.20 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,67005,CPT,RMVL VITREOUS ANT APPR PARTIAL REMOVAL,,,21 ,,RBRVS,5.89 ,6.60 ,6.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67010,CPT,RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT,,,21 ,,RBRVS,7.06 ,7.30 ,7.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67015,CPT,ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL,,,21 ,,RBRVS,7.14 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67025,CPT,INJ SUBSTITUTE PARS PLANA/LIMBL W/WO ASPIR SPX,,,21 ,,RBRVS,8.11 ,8.61 ,11.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67027,CPT,IMPLTJ INTRAVITREAL DRUG DLVR SYS RMVL VTS,,,21 ,,RBRVS,11.62 ,10.93 ,10.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67028,CPT,INTRAVITREAL NJX PHARMACOLOGIC AGT SPX,,,21 ,,RBRVS,1.44 ,1.52 ,2.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67030,CPT,DISCISSION VITREOUS STRANS PARS PLANA APPROACH,,,21 ,,RBRVS,6.11 ,7.92 ,7.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67031,CPT,SEVERING VITREOUS STRANS LASER 1/> STAGES,,,21 ,,RBRVS,4.47 ,4.96 ,5.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67036,CPT,VITRECTOMY MECHANICAL PARS PLANA,,,21 ,,RBRVS,13.32 ,12.15 ,12.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67039,CPT,VITRECTOMY MCHNL PARS PLNA FOCAL ENDOLASER PC,,,21 ,,RBRVS,16.74 ,16.01 ,16.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67040,CPT,VTRECTOMY MCHNL PARS PLNA ENDOLASER PANRTA PC,,,21 ,,RBRVS,19.61 ,18.09 ,18.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67041,CPT,VITRECTOMY PARS PLANA REMOVE PRERETINAL MEMBRANE,,,21 ,,RBRVS,19.25 ,15.81 ,15.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67042,CPT,VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA,,,21 ,,RBRVS,22.38 ,17.66 ,17.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67043,CPT,VITRECTOMY PARS PLANA REMOVE SUBRETINAL MEMBRANE,,,21 ,,RBRVS,23.24 ,18.87 ,18.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67101,CPT,RPR RETINAL DTCHMNT 1/>SES CRYOTX/DTHRM W/WO DRG,,,21 ,,RBRVS,8.80 ,9.03 ,11.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67105,CPT,RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETIN,,,21 ,,RBRVS,8.53 ,8.52 ,10.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67107,CPT,RPR RETINAL DTCHMNT SCLERAL BUCKLING W/WO IMPLT,,,21 ,,RBRVS,16.71 ,15.50 ,15.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67108,CPT,RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH,,,21 ,,RBRVS,22.89 ,19.69 ,19.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67110,CPT,RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS,,,21 ,,RBRVS,10.25 ,10.25 ,12.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67112,CPT,RPR RETINAL DTCHMNT SCLERAL BUCKLING/VITRECTOMY,,,21 ,,RBRVS,18.75 ,16.40 ,16.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67113,CPT,RPR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL,,,21 ,,RBRVS,25.35 ,20.82 ,20.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67115,CPT,RELEASE ENCIRCLING MATERIAL POSTERIOR SEGMENT,,,21 ,,RBRVS,6.11 ,7.07 ,7.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67120,CPT,RMVL IMPLNT MATL POSTERIOR SEGMENT EXTRAOCULAR,,,21 ,,RBRVS,7.10 ,7.66 ,10.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67121,CPT,RMVL IMPLT MATRL POSTERIOR SEGMENT INTRAOCULAR,,,21 ,,RBRVS,12.25 ,11.80 ,11.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67141,CPT,PROPH RTA DTCHMNT W/O DRG 1/> SESS CRTX DTHRM,,,21 ,,RBRVS,6.15 ,6.73 ,7.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67145,CPT,PROPH RTA DTCHMNT W/O DRG 1/> SESS,,,21 ,,RBRVS,6.32 ,6.83 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67208,CPT,DSTRJ LOCLZD LES RETINA 1/> SESS CRTX DTHRM,,,21 ,,RBRVS,7.65 ,7.65 ,8.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67210,CPT,DSTRJ LOCLZD LES RETINA 1/> SESS PC,,,21 ,,RBRVS,9.45 ,8.21 ,8.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67218,CPT,DSTRJ LES RETINA 1/> SESS RADJ IMPLTJ,,,21 ,,RBRVS,20.36 ,16.41 ,16.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67220,CPT,DSTRJ LES CHOROID PC 1/> SESS,,,21 ,,RBRVS,14.39 ,12.39 ,13.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67221,CPT,DSTRJ LES CHOROID PDT,,,21 ,,RBRVS,3.45 ,2.28 ,4.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67225,CPT,DSTRJ LES CHOROID PDT 2ND EYE 1 SESS,,,21 ,,RBRVS,0.47 ,0.28 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67227,CPT,DESTRUCTION RETINOPATHY 1/> SESS DIATHERMY,,,21 ,,RBRVS,7.53 ,7.58 ,8.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67228,CPT,EXTENSIVE RETINOPATHY 1/> SESS PHOTOCOAGULATION,,,21 ,,RBRVS,13.82 ,14.18 ,17.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67229,CPT,EXTENSIVE RETINOPATHY 1/> SESS PRETERM INFANT,,,21 ,,RBRVS,16.30 ,13.92 ,13.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67250,CPT,SCLERAL REINFORCEMENT SPX W/O GRAFT,,,21 ,,RBRVS,9.61 ,11.17 ,11.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67255,CPT,SCLERAL REINFORCEMENT SPX W/GRAFT,,,21 ,,RBRVS,10.17 ,12.20 ,12.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67299,CPT,UNLISTED PROCEDURE POSTERIOR SEGMENT,,,21 ,,TotalUnits,,,,8.69 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,67311,CPT,STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC,,,21 ,,RBRVS,7.77 ,8.08 ,8.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67312,CPT,STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC,,,21 ,,RBRVS,9.66 ,9.19 ,9.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67314,CPT,STRABISMUS RECESSION/RESCJ 1 VER MUSC,,,21 ,,RBRVS,8.79 ,9.01 ,9.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67316,CPT,STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC,,,21 ,,RBRVS,10.93 ,10.25 ,10.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67318,CPT,STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE,,,21 ,,RBRVS,9.12 ,9.53 ,9.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67320,CPT,TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC,,,21 ,,RBRVS,5.40 ,3.17 ,3.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67331,CPT,STRABISMUS PREVIOUS EYE X INVOLVE EO MUSC,,,21 ,,RBRVS,5.13 ,2.98 ,2.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67332,CPT,STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY,,,21 ,,RBRVS,5.56 ,3.26 ,3.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67334,CPT,STRABISMUS POST FIXJ SUTR TQ W/WO MUSC RECESSION,,,21 ,,RBRVS,5.05 ,2.97 ,2.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67335,CPT,PLACEMENT ADJUSTABLE SUTURE STRABISMUS,,,21 ,,RBRVS,2.49 ,1.49 ,1.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67340,CPT,STRABISMUS EXPL&/RPR DETACHED EXTROCULAR MUSC,,,21 ,,RBRVS,6.00 ,3.54 ,3.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67343,CPT,RLS XTNSV SCAR TISS W/O DETACHING EO MUSC SPX,,,21 ,,RBRVS,8.47 ,8.82 ,8.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67345,CPT,CHEMODENERVATION EXTRAOCULAR MUSCLE,,,21 ,,RBRVS,3.01 ,2.59 ,3.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67346,CPT,BIOPSY EXTRAOCULAR MUSCLE,,,21 ,,RBRVS,2.87 ,2.47 ,2.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67399,CPT,UNLISTED PROCEDURE OCULAR MUSCLE,,,21 ,,TotalUnits,,,,15.85 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,67400,CPT,ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY,,,21 ,,RBRVS,11.20 ,13.59 ,13.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67405,CPT,ORBITOTOMY W/O BONE FLAP EXPL W/DRAINAGE ONLY,,,21 ,,RBRVS,9.20 ,11.95 ,11.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67412,CPT,ORBITOTOMY W/O BONE FLAP W/REMOVAL LESION,,,21 ,,RBRVS,10.30 ,12.47 ,12.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67413,CPT,ORBITOTOMY W/O BONE FLAP W/RMVL FOREIGN BODY,,,21 ,,RBRVS,10.24 ,12.60 ,12.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67414,CPT,ORBITOTOMY W/O BONE FLAP W/RMVL BONE DCMPRN,,,21 ,,RBRVS,17.94 ,17.12 ,17.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67415,CPT,FINE NEEDLE ASPIRATION ORBITAL CONTENTS,,,21 ,,RBRVS,1.76 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67420,CPT,ORBITOTOMY BONE FLAP/WINDOW LAT RMVL LESION,,,21 ,,RBRVS,21.87 ,21.29 ,21.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67430,CPT,ORBITOTOMY BONE FLAP/WINDOW LATERAL RMVL FB,,,21 ,,RBRVS,15.29 ,17.91 ,17.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67440,CPT,ORBITOTOMY BONE FLAP/WINDOW LATERAL W/DRG,,,21 ,,RBRVS,14.84 ,17.26 ,17.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67445,CPT,ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN,,,21 ,,RBRVS,19.12 ,18.14 ,18.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67450,CPT,ORBITOTOMY BONE FLAP/WINDOW LAT EXPL W/WO BX,,,21 ,,RBRVS,15.41 ,17.96 ,17.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67500,CPT,RETROBULBAR INJECTION MEDICATION SPX,,,21 ,,RBRVS,1.44 ,0.62 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67505,CPT,RETROBULBAR INJECTION ALCOHOL,,,21 ,,RBRVS,1.27 ,0.85 ,1.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67515,CPT,INJECTION MEDICATION/OTHER SUBST TENON CAPSULE,,,21 ,,RBRVS,1.40 ,0.93 ,1.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67550,CPT,ORBITAL IMPLANT INSERTION,,,21 ,,RBRVS,11.77 ,13.95 ,13.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67560,CPT,ORBITAL IMPLANT REMOVAL/REVISION,,,21 ,,RBRVS,12.18 ,14.15 ,14.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67570,CPT,OPTIC NERVE DECOMPRESSION,,,21 ,,RBRVS,14.40 ,16.11 ,16.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67599,CPT,UNLISTED PROCEDURE ORBIT,,,21 ,,TotalUnits,,,,2.51 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,67700,CPT,BLEPHAROTOMY DRAINAGE ABSCESS EYELID,,,21 ,,RBRVS,1.40 ,1.67 ,5.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67710,CPT,SEVERING TARSORRHAPHY,,,21 ,,RBRVS,1.07 ,1.51 ,5.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67715,CPT,CANTHOTOMY SEPARATE PROCEDURE,,,21 ,,RBRVS,1.27 ,1.63 ,5.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67800,CPT,EXCISION CHALAZION SINGLE,,,21 ,,RBRVS,1.41 ,1.35 ,1.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67801,CPT,EXCISION CHALAZION MULTIPLE SAME LID,,,21 ,,RBRVS,1.91 ,1.65 ,2.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67805,CPT,EXCISION CHALAZION MULTIPLE DIFFERENT LIDS,,,21 ,,RBRVS,2.27 ,2.12 ,3.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67808,CPT,EXC CHALAZION ANES REQ HOSPIZATION SINGLE/MULT,,,21 ,,RBRVS,4.60 ,5.15 ,5.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67810,CPT,BIOPSY EYELID,,,21 ,,RBRVS,1.48 ,0.98 ,4.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67820,CPT,CORRECTION TRICHIASIS EPILATION FORCEPS ONLY,,,21 ,,RBRVS,0.71 ,0.72 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67825,CPT,CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS,,,21 ,,RBRVS,1.43 ,1.80 ,2.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67830,CPT,CORRECTION TRICHIASIS INCCISION LID MARGIN,,,21 ,,RBRVS,1.75 ,1.92 ,5.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67835,CPT,CORRJ TRICHIASIS INC LID MRGN W/FR MUC MEMB GRF,,,21 ,,RBRVS,5.70 ,5.96 ,5.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67840,CPT,EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE,,,21 ,,RBRVS,2.09 ,2.13 ,5.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67850,CPT,DESTRUCTION LESION LID MRGN < 1 CM,,,21 ,,RBRVS,1.74 ,1.99 ,4.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67875,CPT,TEMPORARY CLOSURE EYELIDS SUTURE,,,21 ,,RBRVS,1.35 ,1.24 ,3.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67880,CPT,CONSTJ INTERMARGIN ADHES/TARSORRH/CANTHORRHAPY,,,21 ,,RBRVS,4.60 ,5.15 ,7.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67882,CPT,CONSTJ INTERMARGIN ADHES/TARSOR/CANTHOR W/TRPOS,,,21 ,,RBRVS,6.02 ,6.49 ,8.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67900,CPT,REPAIR BROW PTOSIS,,,21 ,,RBRVS,6.82 ,6.76 ,10.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67901,CPT,RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL,,,21 ,,RBRVS,7.59 ,7.65 ,11.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67902,CPT,RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING,,,21 ,,RBRVS,9.82 ,9.20 ,9.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67903,CPT,RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL,,,21 ,,RBRVS,6.51 ,6.47 ,9.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67904,CPT,RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL,,,21 ,,RBRVS,7.97 ,7.80 ,11.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67906,CPT,RPR BLEPHAROPTOSIS SUPERIOR RECTUS FASCIAL SLING,,,21 ,,RBRVS,6.93 ,6.61 ,6.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67908,CPT,RPR BLPOS CONJUNCTIVO-TARSO-MUSC-LEVATOR RESCJ,,,21 ,,RBRVS,5.30 ,6.09 ,7.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67909,CPT,REDUCTION OVERCORRECTION PTOSIS,,,21 ,,RBRVS,5.57 ,6.11 ,8.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67911,CPT,CORRECTION LID RETRACTION,,,21 ,,RBRVS,7.50 ,7.31 ,7.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67912,CPT,CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD,,,21 ,,RBRVS,6.36 ,6.82 ,17.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67914,CPT,REPAIR ECTROPION SUTURE,,,21 ,,RBRVS,3.75 ,3.92 ,6.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67915,CPT,REPAIR ECTROPION THERMOCAUTERIZATION,,,21 ,,RBRVS,3.26 ,3.51 ,6.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67916,CPT,REPAIR ECTROPION EXCISION TARSAL WEDGE,,,21 ,,RBRVS,5.48 ,6.03 ,8.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67917,CPT,REPAIR ECTROPION EXTENSIVE,,,21 ,,RBRVS,6.19 ,6.46 ,9.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67921,CPT,REPAIR ENTROPION SUTURE,,,21 ,,RBRVS,3.47 ,3.73 ,6.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67922,CPT,REPAIR ENTROPION THERMOCAUTERIZATION,,,21 ,,RBRVS,3.14 ,3.38 ,5.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67923,CPT,REPAIR ENTROPION EXCISION TARSAL WEDGE,,,21 ,,RBRVS,6.05 ,6.35 ,9.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67924,CPT,REPAIR ENTROPION EXTENSIVE,,,21 ,,RBRVS,5.93 ,6.01 ,9.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67930,CPT,SUTR WND EYELID/MARGIN/TARSUS/CONJUNC PRTL THICK,,,21 ,,RBRVS,3.65 ,2.79 ,6.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67935,CPT,SUTR WND EYELID/MARGIN/TARSUS/CONJUNC FULL THICK,,,21 ,,RBRVS,6.36 ,5.48 ,9.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67938,CPT,REMOVAL EMBEDDED FOREIGN BODY EYELID,,,21 ,,RBRVS,1.38 ,1.70 ,5.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67950,CPT,CANTHOPLASTY,,,21 ,,RBRVS,5.99 ,6.40 ,9.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67961,CPT,EXCISION & REPAIR EYELID > ONE-FOURTH LID MARGIN,,,21 ,,RBRVS,5.86 ,6.28 ,9.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67966,CPT,EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN/>,,,21 ,,RBRVS,8.97 ,8.39 ,11.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67971,CPT,RCNSTJ EYELID FULL THICKNESS < TWO-THIRDS 1 STG,,,21 ,,RBRVS,10.01 ,9.29 ,9.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67973,CPT,RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG,,,21 ,,RBRVS,13.13 ,11.75 ,11.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67974,CPT,RCNSTJ EYELID FULL THICKNESS UPPER EYELID 1 STG,,,21 ,,RBRVS,13.10 ,11.70 ,11.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67975,CPT,RCNSTJ EYELID FULL THICKNESS SECOND STAGE,,,21 ,,RBRVS,9.35 ,8.91 ,8.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,67999,CPT,UNLISTED PROCEDURE EYELIDS,,,21 ,,TotalUnits,,,,5.94 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,68020,CPT,INCISION CONJUNCTIVA DRAINAGE OF CYST,,,21 ,,RBRVS,1.42 ,1.53 ,1.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68040,CPT,EXPRESSION CONJUNCTIVAL FOLLICLES,,,21 ,,RBRVS,0.85 ,0.56 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68100,CPT,BIOPSY CONJUNCTIVA,,,21 ,,RBRVS,1.35 ,1.26 ,3.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68110,CPT,EXCISION LESION CONJUNCTIVA < 1 CM,,,21 ,,RBRVS,1.82 ,2.13 ,4.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68115,CPT,EXCISION LESION CONJUNCTIVA > 1 CM,,,21 ,,RBRVS,2.41 ,2.48 ,5.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68130,CPT,EXCISION LESION CONJUNCTIVA ADJACENT SCLERA,,,21 ,,RBRVS,5.10 ,5.86 ,9.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68135,CPT,DESTRUCTION LESION CONJUNCTIVA,,,21 ,,RBRVS,1.89 ,2.12 ,2.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68200,CPT,SUBCONJUNCTIVAL INJECTION,,,21 ,,RBRVS,0.49 ,0.43 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68320,CPT,CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT,,,21 ,,RBRVS,6.64 ,7.62 ,12.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68325,CPT,CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT,,,21 ,,RBRVS,8.63 ,8.84 ,8.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68326,CPT,CJP RCNSTJ CUL-DE-SAC BUCCAL GRF/XTNSV REARRGMT,,,21 ,,RBRVS,8.42 ,8.69 ,8.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68328,CPT,CONJUNCTPL CUL-DE-SAC W/BUCCAL MUC MEMB GRAFT,,,21 ,,RBRVS,9.45 ,9.44 ,9.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68330,CPT,RPR SYMBLEPHARON CONJUNCTIVOPLASTY W/O GRAFT,,,21 ,,RBRVS,5.78 ,6.42 ,10.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68335,CPT,RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB,,,21 ,,RBRVS,8.46 ,8.68 ,8.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68340,CPT,RPR & DIV SYMBLEPHARON W/WO CONFORM/CONTACT LENS,,,21 ,,RBRVS,4.97 ,5.58 ,9.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68360,CPT,CONJUNCTIVAL FLAP BRIDGE/PARTIAL SPX,,,21 ,,RBRVS,5.17 ,5.70 ,8.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68362,CPT,CONJUNCTIVAL FLAP TOTAL,,,21 ,,RBRVS,8.61 ,8.77 ,8.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68371,CPT,HARVESTING CONJUNCIVAL ALLOGRAPHY LIVING DONOR,,,21 ,,RBRVS,5.09 ,5.90 ,5.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68399,CPT,UNLISTED PROCEDURE CONJUNCTIVA,,,21 ,,TotalUnits,,,,2.60 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,68400,CPT,INCISION DRAINAGE LACRIMAL GLAND,,,21 ,,RBRVS,1.74 ,1.83 ,5.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68420,CPT,INCISION DRAINAGE LACRIMAL SAC,,,21 ,,RBRVS,2.35 ,2.20 ,6.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68440,CPT,SNIP INCISION LACRIMAL PUNCTUM,,,21 ,,RBRVS,0.99 ,1.63 ,1.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68500,CPT,EXCISION LACRIMAL GLAND XCPT TUMOR TOTAL,,,21 ,,RBRVS,12.77 ,13.07 ,13.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68505,CPT,EXCISION LACRIMAL GLAND XCPT TUMOR PRTL,,,21 ,,RBRVS,12.69 ,13.18 ,13.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68510,CPT,BIOPSY LACRIMAL GLAND,,,21 ,,RBRVS,4.60 ,3.18 ,7.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68520,CPT,EXCISION LACRIMAL SAC,,,21 ,,RBRVS,8.78 ,9.48 ,9.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68525,CPT,BIOPSY LACRIMAL SAC,,,21 ,,RBRVS,4.42 ,2.65 ,2.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68530,CPT,RMVL FB/DACRYOLITH LACRIMAL PASSAGES,,,21 ,,RBRVS,3.70 ,3.19 ,7.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68540,CPT,EXC LACRIMAL GLAND TUMOR FRONTAL APPROACH,,,21 ,,RBRVS,12.18 ,12.48 ,12.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68550,CPT,EXC LACRIMAL GLAND TUMOR W/OSTEOTOMY,,,21 ,,RBRVS,15.16 ,15.03 ,15.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68700,CPT,PLASTIC REPAIR CANALICULI,,,21 ,,RBRVS,7.87 ,8.14 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68705,CPT,CORRECTION EVERTED PUNCTUM CAUTERY,,,21 ,,RBRVS,2.11 ,2.31 ,4.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68720,CPT,DACRYOCSTORHINOSTOMY,,,21 ,,RBRVS,9.96 ,10.16 ,10.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68745,CPT,CONJUNCTIVORHINOSTOMY W/O TUBE,,,21 ,,RBRVS,9.90 ,10.29 ,10.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68750,CPT,CONJUNCTIVORHINOSTOMY INSJ TUBE/STENT,,,21 ,,RBRVS,10.10 ,10.80 ,10.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68760,CPT,CLSR LACRIMAL PUNCTUM THERMOCAUT LIG/LASER,,,21 ,,RBRVS,1.78 ,2.10 ,3.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68761,CPT,CLSR LACRIMAL PUNCTUM PLUG EACH,,,21 ,,RBRVS,1.41 ,1.76 ,2.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68770,CPT,CLOSURE LACRIMAL FISTULA SPX,,,21 ,,RBRVS,8.29 ,7.92 ,7.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68801,CPT,DILATION LACRIMAL PUNCTUM W/WO IRRGATION,,,21 ,,RBRVS,1.00 ,1.88 ,2.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68810,CPT,PROBE NASOLACRIMAL DUCT W/WO IRRIGATION,,,21 ,,RBRVS,2.15 ,2.89 ,4.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68811,CPT,PROBE NASOLACRIMAL DUCT W/WO IRRIG REQ GEN ANES,,,21 ,,RBRVS,2.45 ,3.04 ,3.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68815,CPT,PROBE NASOLACRIMAL DUCT W/WO IRRG INSJ TUBE/STNT,,,21 ,,RBRVS,3.30 ,3.56 ,8.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68816,CPT,PROBE NASOLACRIMAL DUCT WITH CATHETER DILATION,,,21 ,,RBRVS,3.06 ,3.59 ,16.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68840,CPT,PROBE LACRIMAL CANALICULI W/WO IRRIGATION,,,21 ,,RBRVS,1.30 ,1.75 ,2.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68850,CPT,INJECTION CONTRAST MEDIUM DACRYOCYSTOGRAPY,,,21 ,,RBRVS,0.80 ,0.74 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,68899,CPT,UNLISTED PROCEDURE LACRIMAL SYSTEM,,,21 ,,TotalUnits,,,,3.94 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,69000,CPT,DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE,,,21 ,,RBRVS,1.50 ,1.77 ,3.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69005,CPT,DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX,,,21 ,,RBRVS,2.16 ,2.21 ,3.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69020,CPT,DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS,,,21 ,,RBRVS,1.53 ,2.50 ,5.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69090,CPT,EAR PIERCING,,,14 ,,TotalUnits,,,,1.10 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,69100,CPT,BIOPSY EXTERNAL EAR,,,21 ,,RBRVS,0.81 ,0.55 ,2.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69105,CPT,BIOPSY EXTERNAL AUDITORY CANAL,,,21 ,,RBRVS,0.85 ,0.94 ,3.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69110,CPT,EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR,,,21 ,,RBRVS,3.53 ,5.64 ,9.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69120,CPT,EXCISION EXTERNAL EAR COMPLETE AMPUTATION,,,21 ,,RBRVS,4.14 ,7.17 ,7.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69140,CPT,EXCISION EXOSTOSIS EXTERNAL AUDITORY CANAL,,,21 ,,RBRVS,8.14 ,16.74 ,16.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69145,CPT,EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL,,,21 ,,RBRVS,2.70 ,4.33 ,8.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69150,CPT,RAD EXC XTRNL AUDITORY CANAL LES W/O NCK DSJ,,,21 ,,RBRVS,13.61 ,15.52 ,15.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69155,CPT,RAD EXC XTRNL AUDITORY CANAL LES NCK DSJ,,,21 ,,RBRVS,23.35 ,23.53 ,23.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69200,CPT,RMVL FB XTRNL AUDITORY CANAL W/O ANES,,,21 ,,RBRVS,0.77 ,0.81 ,2.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69205,CPT,RMVL FB XTRNL AUDITORY CANAL ANES,,,21 ,,RBRVS,1.21 ,1.64 ,1.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69210,CPT,RMVL IMPACTED CERUMEN SPX 1/BOTH EARS,,,21 ,,RBRVS,0.61 ,0.28 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69220,CPT,DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE,,,21 ,,RBRVS,0.83 ,0.91 ,3.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69222,CPT,DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX,,,21 ,,RBRVS,1.45 ,2.45 ,4.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69300,CPT,OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ,,,21 ,,RBRVS,6.69 ,6.57 ,12.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69310,CPT,RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX,,,21 ,,RBRVS,10.97 ,19.83 ,19.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69320,CPT,RCNSTJ XTRNL AUD CANAL CONGENITAL ATRESIA 1 STG,,,21 ,,RBRVS,17.18 ,26.20 ,26.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69399,CPT,UNLISTED PROCEDURE EXTERNAL EAR,,,21 ,,TotalUnits,,,,1.39 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,69400,CPT,EUSTACHIAN TUBE NFLTJ TRANSNSL CATHJ,,,21 ,,RBRVS,0.83 ,0.91 ,3.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69401,CPT,EUSTACHIAN TUBE NFLTJ TRANSNSL W/O CATHJ,,,21 ,,RBRVS,0.63 ,0.76 ,1.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69405,CPT,EUSTACHIAN TUBE CATHJ TRANSTYMPANIC,,,21 ,,RBRVS,2.68 ,2.72 ,4.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69420,CPT,MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ,,,21 ,,RBRVS,1.38 ,2.02 ,4.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69421,CPT,MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ ANES,,,21 ,,RBRVS,1.78 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69424,CPT,VENTILATING TUBE RMVL REQUIRING GENERAL ANES,,,21 ,,RBRVS,0.85 ,0.89 ,2.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69433,CPT,TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA,,,21 ,,RBRVS,1.57 ,2.09 ,4.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69436,CPT,TYMPANOSTOMY GENERAL ANESTHESIA,,,21 ,,RBRVS,2.01 ,2.56 ,2.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69440,CPT,MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC,,,21 ,,RBRVS,7.71 ,11.70 ,11.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69450,CPT,TYMPANOLYSIS TRANSCANAL,,,21 ,,RBRVS,5.69 ,9.67 ,9.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69501,CPT,TRANSMASTOID ANTROTOMY,,,21 ,,RBRVS,9.21 ,11.35 ,11.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69502,CPT,MASTOIDECTOMY COMPLETE,,,21 ,,RBRVS,12.56 ,14.66 ,14.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69505,CPT,MASTOIDECTOMY MODIFIED RADICAL,,,21 ,,RBRVS,13.17 ,20.91 ,20.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69511,CPT,MASTOIDECTOMY RADICAL,,,21 ,,RBRVS,13.70 ,21.24 ,21.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69530,CPT,PETROUS APICECTOMY RADICAL MASTOIDECTOMY,,,21 ,,RBRVS,20.38 ,26.27 ,26.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69535,CPT,RESCJ TEMPORAL BONE EXTERNAL APPROACH,,,21 ,,RBRVS,37.42 ,37.20 ,37.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69540,CPT,EXCISION AURAL POLYP,,,21 ,,RBRVS,1.25 ,2.38 ,4.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69550,CPT,EXCISION AURAL GLOMUS TUMOR TRANSCANAL,,,21 ,,RBRVS,11.15 ,18.36 ,18.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69552,CPT,EXCISION AURAL GLOMUS TUMOR TRANSMASTOID,,,21 ,,RBRVS,19.81 ,24.44 ,24.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69554,CPT,EXCISION AURAL GLOMUS TUMOR EXTENDED,,,21 ,,RBRVS,35.97 ,34.02 ,34.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69601,CPT,REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY,,,21 ,,RBRVS,13.45 ,15.97 ,15.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69602,CPT,REVJ MASTOIDECTOMY RSLTG MODF RAD MSTDC,,,21 ,,RBRVS,13.76 ,16.86 ,16.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69603,CPT,REVJ MASTOIDECTOMY RSLTG RAD MASTOIDECTOMY,,,21 ,,RBRVS,14.20 ,21.60 ,21.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69604,CPT,REVJ MASTOIDECTOMY RSLTG TYMPANOPLASTY,,,21 ,,RBRVS,14.20 ,17.23 ,17.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69605,CPT,REVJ MASTOIDECTOMY W/APICECTOMY,,,21 ,,RBRVS,18.69 ,25.40 ,25.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69610,CPT,TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH,,,21 ,,RBRVS,4.47 ,3.71 ,6.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69620,CPT,MYRINGOPLASTY,,,21 ,,RBRVS,6.03 ,7.72 ,13.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69631,CPT,TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ,,,21 ,,RBRVS,10.05 ,14.87 ,14.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69632,CPT,TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ,,,21 ,,RBRVS,12.96 ,17.42 ,17.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69633,CPT,TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP,,,21 ,,RBRVS,12.31 ,17.02 ,17.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69635,CPT,TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ,,,21 ,,RBRVS,13.51 ,21.06 ,21.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69636,CPT,TYMPP ANTRT/MASTOID W/OSSICULAR CHAIN RECNSTJ,,,21 ,,RBRVS,15.43 ,23.64 ,23.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69637,CPT,TMPP ANTRT/MASTOIDOTOMY PROSTHESIS TORP,,,21 ,,RBRVS,15.32 ,23.60 ,23.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69641,CPT,TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ,,,21 ,,RBRVS,12.89 ,16.39 ,16.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69642,CPT,TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ,,,21 ,,RBRVS,17.06 ,20.58 ,20.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69643,CPT,TMPP MASTOIDECT NTC/RCNSTED WALL W/O OCR,,,21 ,,RBRVS,15.59 ,18.81 ,18.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69644,CPT,TMPP MASTOIDECT NTC/RCNSTED CANAL WALL OCR,,,21 ,,RBRVS,17.23 ,24.59 ,24.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69645,CPT,TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR,,,21 ,,RBRVS,16.71 ,24.34 ,24.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69646,CPT,TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR,,,21 ,,RBRVS,18.37 ,25.14 ,25.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69650,CPT,STAPES MOBILIZATION,,,21 ,,RBRVS,9.80 ,12.69 ,12.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69660,CPT,STAPEDECTOMY/STAPEDOTOMY,,,21 ,,RBRVS,12.03 ,14.04 ,14.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69661,CPT,STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT,,,21 ,,RBRVS,15.92 ,18.09 ,18.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69662,CPT,REVISION STAPEDECTOMY/STAPEDOTOMY,,,21 ,,RBRVS,15.60 ,16.89 ,16.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69666,CPT,REPAIR OVAL WINDOW FISTULA,,,21 ,,RBRVS,9.89 ,12.83 ,12.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69667,CPT,REPAIR ROUND WINDOW FISTULA,,,21 ,,RBRVS,9.90 ,12.86 ,12.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69670,CPT,MASTOID OBLITERATION SEPARATE PROCEDURE,,,21 ,,RBRVS,11.73 ,14.80 ,14.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69676,CPT,TYMPANIC NEURECTOMY,,,21 ,,RBRVS,9.69 ,13.79 ,13.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69700,CPT,CLOSURE POSTAURICULAR FISTULA MASTOID SPX,,,21 ,,RBRVS,8.37 ,11.05 ,11.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69710,CPT,IMPLTJ/RPLCMT EMGNT BONE CNDJ DEV TEMPORAL BONE,,,21 ,,TotalUnits,,,,19.59 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,69711,CPT,RMVL/RPR EMGNT BONE CNDJ DEV TEMPORAL BONE,,,21 ,,RBRVS,10.62 ,13.74 ,13.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69714,CPT,IMPLTJ OSSEOINTEGRATED TEMPORAL BONE W/MASTOID,,,21 ,,RBRVS,14.45 ,15.76 ,15.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69715,CPT,IMPLJ OSSEOINTEGRATED TEMPORAL BONE W/O MASTOID,,,21 ,,RBRVS,18.96 ,18.35 ,18.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69717,CPT,RPLMCT OSSEOINTEGRATE IMPLNT W/O MASTOIDECTOMY,,,21 ,,RBRVS,15.43 ,16.51 ,16.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69718,CPT,RPLMCT OSSEOINTEGRATE IMPLNT W/MASTOIDECTOMY,,,21 ,,RBRVS,19.21 ,18.51 ,18.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69720,CPT,DCMPRN FACIAL NRV INTRATEMPORAL LAT GANGLION,,,21 ,,RBRVS,14.71 ,18.35 ,18.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69725,CPT,DCMPRN NRV INTRATEMPORAL MEDIAL GENICULATE,,,21 ,,RBRVS,27.64 ,25.02 ,25.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69740,CPT,SUTR NRV ITPRL W/WO GRF/DCMPRN LAT GENICULATE,,,21 ,,RBRVS,16.27 ,16.53 ,16.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69745,CPT,SUTR NRV ITPRL W/WO GRF/DCMPRN MEDIAL GENICULATE,,,21 ,,RBRVS,17.02 ,17.98 ,17.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69799,CPT,UNLISTED PROCEDURE MIDDLE EAR,,,21 ,,TotalUnits,,,,5.56 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,69801,CPT,LABYRINTHOTOMY TRANSCANAL,,,21 ,,RBRVS,2.06 ,6.59 ,3.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69805,CPT,ENDOLYMPHATIC SAC W/O SHUNT,,,21 ,,RBRVS,14.71 ,14.84 ,14.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69806,CPT,ENDOLYMPHATIC SAC SHUNT,,,21 ,,RBRVS,12.63 ,13.92 ,13.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69820,CPT,FENESTRATION SEMICIRCULAR CANAL,,,21 ,,RBRVS,10.52 ,13.71 ,13.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69840,CPT,REVISION FENESTRATION OPERATION,,,21 ,,RBRVS,10.44 ,13.62 ,13.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69905,CPT,LABYRINTHECTOMY TRANSCANAL,,,21 ,,RBRVS,11.26 ,14.64 ,14.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69910,CPT,LABYRINTHECTOMY W/MASTOIDECTOMY,,,21 ,,RBRVS,13.91 ,14.71 ,14.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69915,CPT,VESTIBULAR NRV SECTION TRANSLABYRINTHINE APPR,,,21 ,,RBRVS,22.77 ,20.27 ,20.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69930,CPT,COCHLEAR DEVICE IMPLANTATION W/WO MASTOIDECTOMY,,,21 ,,RBRVS,17.73 ,16.73 ,16.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69949,CPT,UNLISTED PROCEDURE INNER EAR,,,21 ,,TotalUnits,,,,34.46 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,69950,CPT,VESTIBULAR NRV SECTION TRANSCRANIAL APPROACH,,,21 ,,RBRVS,27.63 ,25.02 ,25.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69955,CPT,TOTAL FACIAL NERVE DECOMPRESSION &/REPAIR,,,21 ,,RBRVS,29.42 ,26.04 ,26.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69960,CPT,DECOMPRESSION INTERNAL AUDITORY CANAL,,,21 ,,RBRVS,29.42 ,24.42 ,24.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69970,CPT,REMOVAL TUMOR TEMPORAL BONE,,,21 ,,RBRVS,32.41 ,27.67 ,27.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,69979,CPT,UNLISTED PROCEDURE TEMPORAL BONE MIDDLE FOSSA,,,21 ,,TotalUnits,,,,60.08 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,69990,CPT,MICROSURG TQS REQ USE OPERATING MICROSCOPE,,,21 ,,RBRVS,3.46 ,1.86 ,1.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70010,CPT,MYELOGRAPY POST FOSSA RS&I,,,20 ,,RBRVS,1.19 ,2.39 ,2.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70010,CPT,MYELOGRAPY POST FOSSA RS&I,26,,20 ,,RBRVS,0.31 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70010,CPT,MYELOGRAPY POST FOSSA RS&I,TC,,20 ,,RBRVS,0.88 ,1.77 ,1.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70015,CPT,CISTERNOGRAPHY POSITIVE CONTRAST RS&I,,,20 ,,RBRVS,1.19 ,3.09 ,3.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70015,CPT,CISTERNOGRAPHY POSITIVE CONTRAST RS&I,26,,20 ,,RBRVS,1.19 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70015,CPT,CISTERNOGRAPHY POSITIVE CONTRAST RS&I,TC,,20 ,,RBRVS,,2.59 ,2.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70030,CPT,RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY,,,20 ,,RBRVS,0.17 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70030,CPT,RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70030,CPT,RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY,TC,,20 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70100,CPT,RADIOLOGIC EXAMINATION MANDIPLE PRTL < 4 VIEWS,,,20 ,,RBRVS,0.18 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70100,CPT,RADIOLOGIC EXAMINATION MANDIPLE PRTL < 4 VIEWS,26,,20 ,,RBRVS,0.18 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70100,CPT,RADIOLOGIC EXAMINATION MANDIPLE PRTL < 4 VIEWS,TC,,20 ,,RBRVS,,0.70 ,0.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70110,CPT,RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS,,,20 ,,RBRVS,0.25 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70110,CPT,RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS,26,,20 ,,RBRVS,0.25 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70110,CPT,RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS,TC,,20 ,,RBRVS,,0.80 ,0.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70120,CPT,RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE,,,20 ,,RBRVS,0.18 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70120,CPT,RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE,26,,20 ,,RBRVS,0.18 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70120,CPT,RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE,TC,,20 ,,RBRVS,,0.76 ,0.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70130,CPT,RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE,,,20 ,,RBRVS,0.34 ,1.30 ,1.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70130,CPT,RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE,26,,20 ,,RBRVS,0.34 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70130,CPT,RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE,TC,,20 ,,RBRVS,,1.16 ,1.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70134,CPT,RADEX INTERNAL AUDITORY MEATI COMPLETE,,,20 ,,RBRVS,0.34 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70134,CPT,RADEX INTERNAL AUDITORY MEATI COMPLETE,26,,20 ,,RBRVS,0.34 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70134,CPT,RADEX INTERNAL AUDITORY MEATI COMPLETE,TC,,20 ,,RBRVS,,0.87 ,0.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70140,CPT,RADEX FACIAL BONES < 3 VIEWS,,,20 ,,RBRVS,0.19 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70140,CPT,RADEX FACIAL BONES < 3 VIEWS,26,,20 ,,RBRVS,0.19 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70140,CPT,RADEX FACIAL BONES < 3 VIEWS,TC,,20 ,,RBRVS,,0.60 ,0.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70150,CPT,RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.26 ,0.99 ,0.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70150,CPT,RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.26 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70150,CPT,RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.88 ,0.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70160,CPT,RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.17 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70160,CPT,RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70160,CPT,RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.72 ,0.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70170,CPT,DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I,,,20 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,70170,CPT,DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I,26,,20 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,70170,CPT,DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I,TC,,20 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,70190,CPT,RADEX OPTIC FORAMINA,,,20 ,,RBRVS,0.21 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70190,CPT,RADEX OPTIC FORAMINA,26,,20 ,,RBRVS,0.21 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70190,CPT,RADEX OPTIC FORAMINA,TC,,20 ,,RBRVS,,0.74 ,0.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70200,CPT,RADEX ORBITS COMPLETE MINIMUM 4 VIEWS,,,20 ,,RBRVS,0.28 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70200,CPT,RADEX ORBITS COMPLETE MINIMUM 4 VIEWS,26,,20 ,,RBRVS,0.28 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70200,CPT,RADEX ORBITS COMPLETE MINIMUM 4 VIEWS,TC,,20 ,,RBRVS,,0.89 ,0.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70210,CPT,RADEX SINUSES PARANASAL < 3 VIEWS,,,20 ,,RBRVS,0.17 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70210,CPT,RADEX SINUSES PARANASAL < 3 VIEWS,26,,20 ,,RBRVS,0.17 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70210,CPT,RADEX SINUSES PARANASAL < 3 VIEWS,TC,,20 ,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70220,CPT,RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.25 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70220,CPT,RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.25 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70220,CPT,RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.78 ,0.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70240,CPT,RADIOLOGIC EXAMINATION SELLA TURCICA,,,20 ,,RBRVS,0.19 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70240,CPT,RADIOLOGIC EXAMINATION SELLA TURCICA,26,,20 ,,RBRVS,0.19 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70240,CPT,RADIOLOGIC EXAMINATION SELLA TURCICA,TC,,20 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70250,CPT,RADIOLOGIC EXAMINATION SKULL < 4 VIEWS,,,20 ,,RBRVS,0.24 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70250,CPT,RADIOLOGIC EXAMINATION SKULL < 4 VIEWS,26,,20 ,,RBRVS,0.24 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70250,CPT,RADIOLOGIC EXAMINATION SKULL < 4 VIEWS,TC,,20 ,,RBRVS,,0.73 ,0.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70260,CPT,RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS,,,20 ,,RBRVS,0.34 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70260,CPT,RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS,26,,20 ,,RBRVS,0.34 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70260,CPT,RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS,TC,,20 ,,RBRVS,,0.90 ,0.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70300,CPT,RADIOLOGIC EXAMINATION TEETH 1 VIEW,,,20 ,,RBRVS,0.10 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70300,CPT,RADIOLOGIC EXAMINATION TEETH 1 VIEW,26,,20 ,,RBRVS,0.10 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70300,CPT,RADIOLOGIC EXAMINATION TEETH 1 VIEW,TC,,20 ,,RBRVS,,0.25 ,0.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70310,CPT,RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH,,,20 ,,RBRVS,0.16 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70310,CPT,RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH,26,,20 ,,RBRVS,0.16 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70310,CPT,RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH,TC,,20 ,,RBRVS,,0.84 ,0.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70320,CPT,RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH,,,20 ,,RBRVS,0.22 ,1.25 ,1.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70320,CPT,RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH,26,,20 ,,RBRVS,0.22 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70320,CPT,RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH,TC,,20 ,,RBRVS,,1.14 ,1.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70328,CPT,RADEX TEMPOROMANDBLE JT OPN&CLSD MOUTH UNI,,,20 ,,RBRVS,0.18 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70328,CPT,RADEX TEMPOROMANDBLE JT OPN&CLSD MOUTH UNI,26,,20 ,,RBRVS,0.18 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70328,CPT,RADEX TEMPOROMANDBLE JT OPN&CLSD MOUTH UNI,TC,,20 ,,RBRVS,,0.64 ,0.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70330,CPT,RADEX TEMPOROMANDBLE JT OPN&CLSD MOUTH BI,,,20 ,,RBRVS,0.24 ,1.17 ,1.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70330,CPT,RADEX TEMPOROMANDBLE JT OPN&CLSD MOUTH BI,26,,20 ,,RBRVS,0.24 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70330,CPT,RADEX TEMPOROMANDBLE JT OPN&CLSD MOUTH BI,TC,,20 ,,RBRVS,,1.06 ,1.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70332,CPT,TEMPOROMANDBLE JT ARTHROGRAPHY RS&I,,,20 ,,RBRVS,0.54 ,1.95 ,1.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70332,CPT,TEMPOROMANDBLE JT ARTHROGRAPHY RS&I,26,,20 ,,RBRVS,0.54 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70332,CPT,TEMPOROMANDBLE JT ARTHROGRAPHY RS&I,TC,,20 ,,RBRVS,,1.68 ,1.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70336,CPT,MRI TEMPOROMANDIBULAR JOINT,,,20 ,,RBRVS,1.48 ,11.75 ,11.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70336,CPT,MRI TEMPOROMANDIBULAR JOINT,26,,20 ,,RBRVS,1.48 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70336,CPT,MRI TEMPOROMANDIBULAR JOINT,TC,,20 ,,RBRVS,,11.15 ,11.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70350,CPT,CEPHALOGRAM ORTHODONTIC,,,20 ,,RBRVS,0.17 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70350,CPT,CEPHALOGRAM ORTHODONTIC,26,,20 ,,RBRVS,0.17 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70350,CPT,CEPHALOGRAM ORTHODONTIC,TC,,20 ,,RBRVS,,0.34 ,0.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70355,CPT,ORTHOPANTOGRAM,,,20 ,,RBRVS,0.20 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70355,CPT,ORTHOPANTOGRAM,26,,20 ,,RBRVS,0.20 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70355,CPT,ORTHOPANTOGRAM,TC,,20 ,,RBRVS,,0.32 ,0.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70360,CPT,RADIOLOGIC EXAMINATION NECK SOFT TISSUE,,,20 ,,RBRVS,0.17 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70360,CPT,RADIOLOGIC EXAMINATION NECK SOFT TISSUE,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70360,CPT,RADIOLOGIC EXAMINATION NECK SOFT TISSUE,TC,,20 ,,RBRVS,,0.56 ,0.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70370,CPT,RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ,,,20 ,,RBRVS,0.32 ,2.07 ,2.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70370,CPT,RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ,26,,20 ,,RBRVS,0.32 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70370,CPT,RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ,TC,,20 ,,RBRVS,,1.93 ,1.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70371,CPT,CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC,,,20 ,,RBRVS,0.84 ,1.91 ,1.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70371,CPT,CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC,26,,20 ,,RBRVS,0.84 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70371,CPT,CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC,TC,,20 ,,RBRVS,,1.57 ,1.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70373,CPT,LARYNGOGRAPY CONTRAST RS&I,,,20 ,,RBRVS,0.44 ,1.97 ,1.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70373,CPT,LARYNGOGRAPY CONTRAST RS&I,26,,20 ,,RBRVS,0.44 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70373,CPT,LARYNGOGRAPY CONTRAST RS&I,TC,,20 ,,RBRVS,,1.80 ,1.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70380,CPT,RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS,,,20 ,,RBRVS,0.17 ,0.98 ,0.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70380,CPT,RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS,26,,20 ,,RBRVS,0.17 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70380,CPT,RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS,TC,,20 ,,RBRVS,,0.89 ,0.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70390,CPT,SIALOGRAPY RS&I,,,20 ,,RBRVS,0.38 ,2.59 ,2.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70390,CPT,SIALOGRAPY RS&I,26,,20 ,,RBRVS,0.38 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70390,CPT,SIALOGRAPY RS&I,TC,,20 ,,RBRVS,,2.43 ,2.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70450,CPT,CT HEAD/BRAIN W/O CONTRAST MATERIAL,,,20 ,,RBRVS,0.85 ,4.91 ,4.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70450,CPT,CT HEAD/BRAIN W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,0.85 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70450,CPT,CT HEAD/BRAIN W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,4.56 ,4.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70460,CPT,CT HEAD/BRAIN W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.13 ,6.38 ,6.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70460,CPT,CT HEAD/BRAIN W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.13 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70460,CPT,CT HEAD/BRAIN W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.91 ,5.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70470,CPT,CT HEAD/BRAIN W/O&W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.27 ,7.81 ,7.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70470,CPT,CT HEAD/BRAIN W/O&W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.27 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70470,CPT,CT HEAD/BRAIN W/O&W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,7.28 ,7.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70480,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL,,,20 ,,RBRVS,1.28 ,7.94 ,7.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70480,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL,26,,20 ,,RBRVS,1.28 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70480,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL,TC,,20 ,,RBRVS,,7.41 ,7.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70481,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL,,,20 ,,RBRVS,1.38 ,9.33 ,9.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70481,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL,26,,20 ,,RBRVS,1.38 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70481,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL,TC,,20 ,,RBRVS,,8.76 ,8.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70482,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O&W/CONTR MATRL,,,20 ,,RBRVS,1.45 ,10.65 ,10.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70482,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O&W/CONTR MATRL,26,,20 ,,RBRVS,1.45 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70482,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O&W/CONTR MATRL,TC,,20 ,,RBRVS,,10.06 ,10.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70486,CPT,CT MAXILLOFACIAL W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.14 ,6.55 ,6.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70486,CPT,CT MAXILLOFACIAL W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.14 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70486,CPT,CT MAXILLOFACIAL W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,6.07 ,6.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70487,CPT,CT MAXILLOFACIAL W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.30 ,7.96 ,7.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70487,CPT,CT MAXILLOFACIAL W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.30 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70487,CPT,CT MAXILLOFACIAL W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,7.42 ,7.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70488,CPT,CT MAXILLOFACIAL W/O &W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.42 ,9.84 ,9.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70488,CPT,CT MAXILLOFACIAL W/O &W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.42 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70488,CPT,CT MAXILLOFACIAL W/O &W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,9.26 ,9.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70490,CPT,CT SOFT TISSUE NECK W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.28 ,6.24 ,6.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70490,CPT,CT SOFT TISSUE NECK W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.28 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70490,CPT,CT SOFT TISSUE NECK W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.71 ,5.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70491,CPT,CT SOFT TISSUE NECK W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.38 ,7.69 ,7.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70491,CPT,CT SOFT TISSUE NECK W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.38 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70491,CPT,CT SOFT TISSUE NECK W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,7.12 ,7.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70492,CPT,CT SOFT TISSUE NECK W/O &W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.45 ,9.51 ,9.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70492,CPT,CT SOFT TISSUE NECK W/O &W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.45 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70492,CPT,CT SOFT TISSUE NECK W/O &W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,8.92 ,8.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70496,CPT,CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST,,,20 ,,RBRVS,1.75 ,15.69 ,15.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70496,CPT,CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST,26,,20 ,,RBRVS,1.75 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70496,CPT,CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST,TC,,20 ,,RBRVS,,14.96 ,14.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70498,CPT,CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST,,,20 ,,RBRVS,1.75 ,15.99 ,15.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70498,CPT,CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST,26,,20 ,,RBRVS,1.75 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70498,CPT,CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST,TC,,20 ,,RBRVS,,15.26 ,15.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70540,CPT,MRI ORBIT FACE &/NECK W/O CONTRAST,,,20 ,,RBRVS,1.35 ,13.33 ,13.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70540,CPT,MRI ORBIT FACE &/NECK W/O CONTRAST,26,,20 ,,RBRVS,1.35 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70540,CPT,MRI ORBIT FACE &/NECK W/O CONTRAST,TC,,20 ,,RBRVS,,12.78 ,12.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70542,CPT,MRI ORBIT FACE & NECK W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.62 ,14.78 ,14.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70542,CPT,MRI ORBIT FACE & NECK W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.62 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70542,CPT,MRI ORBIT FACE & NECK W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,14.12 ,14.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70543,CPT,MRI ORBIT FACE & NCK W/O &W/CONTRAST MATRL,,,20 ,,RBRVS,2.15 ,19.29 ,19.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70543,CPT,MRI ORBIT FACE & NCK W/O &W/CONTRAST MATRL,26,,20 ,,RBRVS,2.15 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70543,CPT,MRI ORBIT FACE & NCK W/O &W/CONTRAST MATRL,TC,,20 ,,RBRVS,,18.42 ,18.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70544,CPT,MRA HEAD W/O CONTRST MATERIAL,,,20 ,,RBRVS,1.20 ,14.87 ,14.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70544,CPT,MRA HEAD W/O CONTRST MATERIAL,26,,20 ,,RBRVS,1.20 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70544,CPT,MRA HEAD W/O CONTRST MATERIAL,TC,,20 ,,RBRVS,,14.38 ,14.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70545,CPT,MRA HEAD W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.20 ,14.77 ,14.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70545,CPT,MRA HEAD W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.20 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70545,CPT,MRA HEAD W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,14.28 ,14.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70546,CPT,MRA HEAD W/O &W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.80 ,23.36 ,23.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70546,CPT,MRA HEAD W/O &W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.80 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70546,CPT,MRA HEAD W/O &W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,22.62 ,22.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70547,CPT,MRA NECK W/O CONTRST MATERIAL,,,20 ,,RBRVS,1.20 ,14.84 ,14.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70547,CPT,MRA NECK W/O CONTRST MATERIAL,26,,20 ,,RBRVS,1.20 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70547,CPT,MRA NECK W/O CONTRST MATERIAL,TC,,20 ,,RBRVS,,14.35 ,14.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70548,CPT,MRA NECK W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.20 ,15.64 ,15.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70548,CPT,MRA NECK W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.20 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70548,CPT,MRA NECK W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,15.15 ,15.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70549,CPT,MRA NECK W/O &W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.80 ,23.38 ,23.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70549,CPT,MRA NECK W/O &W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.80 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70549,CPT,MRA NECK W/O &W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,22.64 ,22.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70551,CPT,MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.48 ,13.71 ,13.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70551,CPT,MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.48 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70551,CPT,MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,13.10 ,13.10 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70552,CPT,MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.78 ,15.15 ,15.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70552,CPT,MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.78 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70552,CPT,MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,14.41 ,14.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70553,CPT,MRI BRAIN BRAIN STEM W/O &W/CONTRAST MATERIAL,,,20 ,,RBRVS,2.36 ,18.91 ,18.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70553,CPT,MRI BRAIN BRAIN STEM W/O &W/CONTRAST MATERIAL,26,,20 ,,RBRVS,2.36 ,0.97 ,0.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70553,CPT,MRI BRAIN BRAIN STEM W/O &W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,17.94 ,17.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70554,CPT,MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION,,,20 ,,RBRVS,2.11 ,14.61 ,14.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70554,CPT,MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION,26,,20 ,,RBRVS,2.11 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70554,CPT,MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION,TC,,20 ,,RBRVS,,13.72 ,13.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70555,CPT,MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION,,,20 ,,TotalUnits,,,,22.09 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,70555,CPT,MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION,26,,20 ,,TotalUnits,,,,3.60 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,70555,CPT,MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION,TC,,20 ,,TotalUnits,,,,18.49 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,70557,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL,,,20 ,,TotalUnits,,,,40.95 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,70557,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL,26,,20 ,,TotalUnits,,,,4.41 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,70557,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL,TC,,20 ,,TotalUnits,,,,36.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,70558,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL,,,20 ,,RBRVS,3.20 ,38.46 ,38.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,70558,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL,26,,20 ,,RBRVS,3.20 ,1.33 ,1.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,70558,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL,TC,,20 ,,RBRVS,,37.13 ,37.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,70559,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O &W/CONTRAST,,,20 ,,TotalUnits,,,,53.91 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,70559,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O &W/CONTRAST,26,,20 ,,TotalUnits,,,,4.59 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,70559,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O &W/CONTRAST,TC,,20 ,,TotalUnits,,,,49.32 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,71010,CPT,RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL,,,20 ,,RBRVS,0.18 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71010,CPT,RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL,26,,20 ,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71010,CPT,RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL,TC,,20 ,,RBRVS,,0.43 ,0.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71015,CPT,RADIOLOGIC EXAMINATION CHEST STERO FRONTAL,,,20 ,,RBRVS,0.21 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71015,CPT,RADIOLOGIC EXAMINATION CHEST STERO FRONTAL,26,,20 ,,RBRVS,0.21 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71015,CPT,RADIOLOGIC EXAMINATION CHEST STERO FRONTAL,TC,,20 ,,RBRVS,,0.58 ,0.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71020,CPT,RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL,,,20 ,,RBRVS,0.22 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71020,CPT,RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71020,CPT,RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL,TC,,20 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71021,CPT,RADEX CH 2 VIEWS FRNT&LAT APICAL LORDOTIC PX,,,20 ,,RBRVS,0.27 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71021,CPT,RADEX CH 2 VIEWS FRNT&LAT APICAL LORDOTIC PX,26,,20 ,,RBRVS,0.27 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71021,CPT,RADEX CH 2 VIEWS FRNT&LAT APICAL LORDOTIC PX,TC,,20 ,,RBRVS,,0.73 ,0.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71022,CPT,RADEX CH 2 VIEWS FRONTAL&LATERAL OBLIQUE PRJCJ,,,20 ,,RBRVS,0.31 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71022,CPT,RADEX CH 2 VIEWS FRONTAL&LATERAL OBLIQUE PRJCJ,26,,20 ,,RBRVS,0.31 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71022,CPT,RADEX CH 2 VIEWS FRONTAL&LATERAL OBLIQUE PRJCJ,TC,,20 ,,RBRVS,,0.92 ,0.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71023,CPT,RADEX CH 2 VIEWS FRONTAL&LATERAL W/FLUORO,,,20 ,,RBRVS,0.38 ,1.65 ,1.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71023,CPT,RADEX CH 2 VIEWS FRONTAL&LATERAL W/FLUORO,26,,20 ,,RBRVS,0.38 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71023,CPT,RADEX CH 2 VIEWS FRONTAL&LATERAL W/FLUORO,TC,,20 ,,RBRVS,,1.48 ,1.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71030,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS,,,20 ,,RBRVS,0.31 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71030,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS,26,,20 ,,RBRVS,0.31 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71030,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS,TC,,20 ,,RBRVS,,0.91 ,0.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71034,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS W/FLUORO,,,20 ,,RBRVS,0.46 ,2.15 ,2.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71034,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS W/FLUORO,26,,20 ,,RBRVS,0.46 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71034,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS W/FLUORO,TC,,20 ,,RBRVS,,1.93 ,1.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71035,CPT,RADEX CHEST SPECIAL VIEWS,,,20 ,,RBRVS,0.18 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71035,CPT,RADEX CHEST SPECIAL VIEWS,26,,20 ,,RBRVS,0.18 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71035,CPT,RADEX CHEST SPECIAL VIEWS,TC,,20 ,,RBRVS,,0.77 ,0.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71040,CPT,BRONCHOGRAPY UNILATERAL RS&I,,,20 ,,RBRVS,0.58 ,2.26 ,2.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71040,CPT,BRONCHOGRAPY UNILATERAL RS&I,26,,20 ,,RBRVS,0.58 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71040,CPT,BRONCHOGRAPY UNILATERAL RS&I,TC,,20 ,,RBRVS,,2.03 ,2.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71060,CPT,BRONCHOGRAPY BILATERAL RS&I,,,20 ,,RBRVS,0.74 ,3.39 ,3.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71060,CPT,BRONCHOGRAPY BILATERAL RS&I,26,,20 ,,RBRVS,0.74 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71060,CPT,BRONCHOGRAPY BILATERAL RS&I,TC,,20 ,,RBRVS,,3.09 ,3.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71100,CPT,RADEX RIBS UNILATERAL 2 VIEWS,,,20 ,,RBRVS,0.22 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71100,CPT,RADEX RIBS UNILATERAL 2 VIEWS,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71100,CPT,RADEX RIBS UNILATERAL 2 VIEWS,TC,,20 ,,RBRVS,,0.63 ,0.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71101,CPT,RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.27 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71101,CPT,RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.27 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71101,CPT,RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.77 ,0.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71110,CPT,RADEX RIBS BILATERAL 3 VIEWS,,,20 ,,RBRVS,0.27 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71110,CPT,RADEX RIBS BILATERAL 3 VIEWS,26,,20 ,,RBRVS,0.27 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71110,CPT,RADEX RIBS BILATERAL 3 VIEWS,TC,,20 ,,RBRVS,,0.81 ,0.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71111,CPT,RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS,,,20 ,,RBRVS,0.32 ,1.22 ,1.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71111,CPT,RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS,26,,20 ,,RBRVS,0.32 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71111,CPT,RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS,TC,,20 ,,RBRVS,,1.09 ,1.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71120,CPT,RADEX STERNUM MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.20 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71120,CPT,RADEX STERNUM MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.20 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71120,CPT,RADEX STERNUM MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71130,CPT,RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.22 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71130,CPT,RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71130,CPT,RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.78 ,0.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71250,CPT,CT THORAX W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.00 ,6.35 ,6.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71250,CPT,CT THORAX W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.00 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71250,CPT,CT THORAX W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.90 ,5.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71260,CPT,CT THORAX W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.24 ,7.87 ,7.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71260,CPT,CT THORAX W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.24 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71260,CPT,CT THORAX W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,7.35 ,7.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71270,CPT,CT THORAX W/O &W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.38 ,9.82 ,9.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71270,CPT,CT THORAX W/O &W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.38 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71270,CPT,CT THORAX W/O &W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,9.25 ,9.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71275,CPT,CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,,,20 ,,RBRVS,1.92 ,12.00 ,12.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71275,CPT,CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,26,,20 ,,RBRVS,1.92 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71275,CPT,CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,TC,,20 ,,RBRVS,,11.20 ,11.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71550,CPT,MRI CHEST W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.46 ,15.14 ,15.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71550,CPT,MRI CHEST W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.46 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71550,CPT,MRI CHEST W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,14.55 ,14.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71551,CPT,MRI CHEST W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.73 ,16.97 ,16.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71551,CPT,MRI CHEST W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.73 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71551,CPT,MRI CHEST W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,16.27 ,16.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71552,CPT,MRI CHEST W/O &W/CONTRAST MATERIAL,,,20 ,,RBRVS,2.26 ,22.39 ,22.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71552,CPT,MRI CHEST W/O &W/CONTRAST MATERIAL,26,,20 ,,RBRVS,2.26 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71552,CPT,MRI CHEST W/O &W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,21.45 ,21.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,71555,CPT,MRA CHEST W/O &W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.81 ,14.47 ,14.47 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,71555,CPT,MRA CHEST W/O &W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.81 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,71555,CPT,MRA CHEST W/O &W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,13.71 ,13.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72010,CPT,RADEX SPINE ENTIRE SURVEY STD ANTEROPOST&LAT,,,20 ,,RBRVS,0.45 ,1.71 ,1.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72010,CPT,RADEX SPINE ENTIRE SURVEY STD ANTEROPOST&LAT,26,,20 ,,RBRVS,0.45 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72010,CPT,RADEX SPINE ENTIRE SURVEY STD ANTEROPOST&LAT,TC,,20 ,,RBRVS,,1.52 ,1.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72020,CPT,RADEX SPINE 1 VIEW SPECIFY LEVEL,,,20 ,,RBRVS,0.15 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72020,CPT,RADEX SPINE 1 VIEW SPECIFY LEVEL,26,,20 ,,RBRVS,0.15 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72020,CPT,RADEX SPINE 1 VIEW SPECIFY LEVEL,TC,,20 ,,RBRVS,,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72040,CPT,RADEX SPINE CERVICAL 2/3 VIEWS,,,20 ,,RBRVS,0.22 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72040,CPT,RADEX SPINE CERVICAL 2/3 VIEWS,26,,20 ,,RBRVS,0.22 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72040,CPT,RADEX SPINE CERVICAL 2/3 VIEWS,TC,,20 ,,RBRVS,,0.80 ,0.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72050,CPT,RADEX SPINE CERVICAL MINIMUM 4 VIEWS,,,20 ,,RBRVS,0.31 ,1.22 ,1.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72050,CPT,RADEX SPINE CERVICAL MINIMUM 4 VIEWS,26,,20 ,,RBRVS,0.31 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72050,CPT,RADEX SPINE CERVICAL MINIMUM 4 VIEWS,TC,,20 ,,RBRVS,,1.09 ,1.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72052,CPT,RADEX SPINE CRV COMPL W/OBLQ&FLEX&/XTN STDS,,,20 ,,RBRVS,0.36 ,1.59 ,1.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72052,CPT,RADEX SPINE CRV COMPL W/OBLQ&FLEX&/XTN STDS,26,,20 ,,RBRVS,0.36 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72052,CPT,RADEX SPINE CRV COMPL W/OBLQ&FLEX&/XTN STDS,TC,,20 ,,RBRVS,,1.44 ,1.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72069,CPT,RADEX SPINE THORACOLMBR STANDING SCOLIOSIS,,,20 ,,RBRVS,0.22 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72069,CPT,RADEX SPINE THORACOLMBR STANDING SCOLIOSIS,26,,20 ,,RBRVS,0.22 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72069,CPT,RADEX SPINE THORACOLMBR STANDING SCOLIOSIS,TC,,20 ,,RBRVS,,0.75 ,0.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72070,CPT,RADEX SPINE THORACIC 2 VIEWS,,,20 ,,RBRVS,0.22 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72070,CPT,RADEX SPINE THORACIC 2 VIEWS,26,,20 ,,RBRVS,0.22 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72070,CPT,RADEX SPINE THORACIC 2 VIEWS,TC,,20 ,,RBRVS,,0.67 ,0.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72072,CPT,RADEX SPINE THORACIC 3 VIEWS,,,20 ,,RBRVS,0.22 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72072,CPT,RADEX SPINE THORACIC 3 VIEWS,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72072,CPT,RADEX SPINE THORACIC 3 VIEWS,TC,,20 ,,RBRVS,,0.79 ,0.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72074,CPT,RADEX SPINE THORACIC MINIMUM 4 VIEWS,,,20 ,,RBRVS,0.22 ,1.08 ,1.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72074,CPT,RADEX SPINE THORACIC MINIMUM 4 VIEWS,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72074,CPT,RADEX SPINE THORACIC MINIMUM 4 VIEWS,TC,,20 ,,RBRVS,,0.99 ,0.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72080,CPT,RADEX SPINE THORACOLUMBAR 2 VIEWS,,,20 ,,RBRVS,0.22 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72080,CPT,RADEX SPINE THORACOLUMBAR 2 VIEWS,26,,20 ,,RBRVS,0.22 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72080,CPT,RADEX SPINE THORACOLUMBAR 2 VIEWS,TC,,20 ,,RBRVS,,0.73 ,0.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72090,CPT,RADEX SPINE SCOLIOS STUDY W/SUPINE&ERECT STUDIES,,,20 ,,RBRVS,0.28 ,1.14 ,1.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72090,CPT,RADEX SPINE SCOLIOS STUDY W/SUPINE&ERECT STUDIES,26,,20 ,,RBRVS,0.28 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72090,CPT,RADEX SPINE SCOLIOS STUDY W/SUPINE&ERECT STUDIES,TC,,20 ,,RBRVS,,1.01 ,1.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72100,CPT,RADEX SPINE LUMBOSACRAL 2/3 VIEWS,,,20 ,,RBRVS,0.22 ,0.95 ,0.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72100,CPT,RADEX SPINE LUMBOSACRAL 2/3 VIEWS,26,,20 ,,RBRVS,0.22 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72100,CPT,RADEX SPINE LUMBOSACRAL 2/3 VIEWS,TC,,20 ,,RBRVS,,0.85 ,0.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72110,CPT,RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS,,,20 ,,RBRVS,0.31 ,1.30 ,1.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72110,CPT,RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS,26,,20 ,,RBRVS,0.31 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72110,CPT,RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS,TC,,20 ,,RBRVS,,1.17 ,1.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72114,CPT,RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6,,,20 ,,RBRVS,0.36 ,1.80 ,1.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72114,CPT,RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6,26,,20 ,,RBRVS,0.36 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72114,CPT,RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6,TC,,20 ,,RBRVS,,1.64 ,1.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72120,CPT,RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS,,,20 ,,RBRVS,0.22 ,1.27 ,1.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72120,CPT,RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS,26,,20 ,,RBRVS,0.22 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72120,CPT,RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS,TC,,20 ,,RBRVS,,1.17 ,1.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72125,CPT,CT CERVICAL SPINE W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.00 ,6.39 ,6.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72125,CPT,CT CERVICAL SPINE W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.00 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72125,CPT,CT CERVICAL SPINE W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.94 ,5.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72126,CPT,CT CERVICAL SPINE W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.22 ,7.87 ,7.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72126,CPT,CT CERVICAL SPINE W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.22 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72126,CPT,CT CERVICAL SPINE W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,7.37 ,7.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72127,CPT,CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.27 ,9.76 ,9.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72127,CPT,CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.27 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72127,CPT,CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,9.24 ,9.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72128,CPT,CT THORACIC SPINE W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.00 ,6.38 ,6.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72128,CPT,CT THORACIC SPINE W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.00 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72128,CPT,CT THORACIC SPINE W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.93 ,5.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72129,CPT,CT THORACIC SPINE W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.22 ,7.89 ,7.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72129,CPT,CT THORACIC SPINE W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.22 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72129,CPT,CT THORACIC SPINE W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,7.38 ,7.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72130,CPT,CT THORACIC SPINE W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.27 ,9.77 ,9.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72130,CPT,CT THORACIC SPINE W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.27 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72130,CPT,CT THORACIC SPINE W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,9.25 ,9.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72131,CPT,CT LUMBAR SPINE W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.00 ,6.36 ,6.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72131,CPT,CT LUMBAR SPINE W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.00 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72131,CPT,CT LUMBAR SPINE W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.91 ,5.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72132,CPT,CT LUMBAR SPINE W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.22 ,7.87 ,7.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72132,CPT,CT LUMBAR SPINE W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.22 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72132,CPT,CT LUMBAR SPINE W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,7.36 ,7.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72133,CPT,CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.27 ,9.76 ,9.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72133,CPT,CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.27 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72133,CPT,CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,9.24 ,9.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72141,CPT,MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL,,,20 ,,RBRVS,1.60 ,12.08 ,12.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72141,CPT,MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL,26,,20 ,,RBRVS,1.60 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72141,CPT,MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL,TC,,20 ,,RBRVS,,11.42 ,11.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72142,CPT,MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL,,,20 ,,RBRVS,1.92 ,15.21 ,15.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72142,CPT,MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL,26,,20 ,,RBRVS,1.92 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72142,CPT,MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL,TC,,20 ,,RBRVS,,14.42 ,14.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72146,CPT,MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL,,,20 ,,RBRVS,1.60 ,12.28 ,12.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72146,CPT,MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL,26,,20 ,,RBRVS,1.60 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72146,CPT,MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL,TC,,20 ,,RBRVS,,11.62 ,11.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72147,CPT,MRI SPINAL CANAL THORACIC W/CONTRAST MATRL,,,20 ,,RBRVS,1.92 ,13.52 ,13.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72147,CPT,MRI SPINAL CANAL THORACIC W/CONTRAST MATRL,26,,20 ,,RBRVS,1.92 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72147,CPT,MRI SPINAL CANAL THORACIC W/CONTRAST MATRL,TC,,20 ,,RBRVS,,12.72 ,12.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72148,CPT,MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.48 ,12.21 ,12.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72148,CPT,MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.48 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72148,CPT,MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,11.60 ,11.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72149,CPT,MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.78 ,15.07 ,15.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72149,CPT,MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.78 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72149,CPT,MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,14.33 ,14.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72156,CPT,MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL,,,20 ,,RBRVS,2.57 ,18.69 ,18.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72156,CPT,MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL,26,,20 ,,RBRVS,2.57 ,1.06 ,1.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72156,CPT,MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL,TC,,20 ,,RBRVS,,17.63 ,17.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72157,CPT,MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL,,,20 ,,RBRVS,2.57 ,17.42 ,17.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72157,CPT,MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL,26,,20 ,,RBRVS,2.57 ,1.06 ,1.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72157,CPT,MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL,TC,,20 ,,RBRVS,,16.36 ,16.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72158,CPT,MRI SPINAL CANAL LUMBAR W/O &W/CONTR MATRL,,,20 ,,RBRVS,2.36 ,18.56 ,18.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72158,CPT,MRI SPINAL CANAL LUMBAR W/O &W/CONTR MATRL,26,,20 ,,RBRVS,2.36 ,0.97 ,0.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72158,CPT,MRI SPINAL CANAL LUMBAR W/O &W/CONTR MATRL,TC,,20 ,,RBRVS,,17.59 ,17.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72159,CPT,MRA SPINAL CANAL W/WO CONTRAST MATERIAL,,,20 ,,RBRVS,1.80 ,16.23 ,16.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72159,CPT,MRA SPINAL CANAL W/WO CONTRAST MATERIAL,26,,20 ,,RBRVS,1.80 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72159,CPT,MRA SPINAL CANAL W/WO CONTRAST MATERIAL,TC,,20 ,,RBRVS,,15.45 ,15.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72170,CPT,RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS,,,20 ,,RBRVS,0.17 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72170,CPT,RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS,26,,20 ,,RBRVS,0.17 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72170,CPT,RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS,TC,,20 ,,RBRVS,,0.52 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72190,CPT,RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.21 ,1.00 ,1.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72190,CPT,RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.21 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72190,CPT,RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.90 ,0.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72191,CPT,CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST,,,20 ,,RBRVS,1.81 ,11.52 ,11.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72191,CPT,CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST,26,,20 ,,RBRVS,1.81 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72191,CPT,CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST,TC,,20 ,,RBRVS,,10.77 ,10.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72192,CPT,CT PELVIS W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.09 ,6.03 ,6.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72192,CPT,CT PELVIS W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.09 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72192,CPT,CT PELVIS W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.58 ,5.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72193,CPT,CT PELVIS W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.16 ,7.46 ,7.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72193,CPT,CT PELVIS W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.16 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72193,CPT,CT PELVIS W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,6.98 ,6.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72194,CPT,CT PELVIS W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.22 ,9.84 ,9.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72194,CPT,CT PELVIS W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.22 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72194,CPT,CT PELVIS W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,9.34 ,9.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72195,CPT,MRI PELVIS W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.46 ,13.63 ,13.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72195,CPT,MRI PELVIS W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.46 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72195,CPT,MRI PELVIS W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,13.03 ,13.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72196,CPT,MRI PELVIS W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.73 ,14.99 ,14.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72196,CPT,MRI PELVIS W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.73 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72196,CPT,MRI PELVIS W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,14.27 ,14.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72197,CPT,MRI PELVIS W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,2.26 ,19.54 ,19.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72197,CPT,MRI PELVIS W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,2.26 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72197,CPT,MRI PELVIS W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,18.61 ,18.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72198,CPT,MRA PELVIS W/WO CONTRAST MATERIAL,,,20 ,,RBRVS,1.80 ,14.41 ,14.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72198,CPT,MRA PELVIS W/WO CONTRAST MATERIAL,26,,20 ,,RBRVS,1.80 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72198,CPT,MRA PELVIS W/WO CONTRAST MATERIAL,TC,,20 ,,RBRVS,,13.67 ,13.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72200,CPT,RADIOLOGIC EXAMINATION SACROILIAC JNTS < 3 VIEWS,,,20 ,,RBRVS,0.17 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72200,CPT,RADIOLOGIC EXAMINATION SACROILIAC JNTS < 3 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72200,CPT,RADIOLOGIC EXAMINATION SACROILIAC JNTS < 3 VIEWS,TC,,20 ,,RBRVS,,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72202,CPT,RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS,,,20 ,,RBRVS,0.19 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72202,CPT,RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS,26,,20 ,,RBRVS,0.19 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72202,CPT,RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS,TC,,20 ,,RBRVS,,0.74 ,0.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72220,CPT,RADEX SACRUM & COCCYX MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.17 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72220,CPT,RADEX SACRUM & COCCYX MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72220,CPT,RADEX SACRUM & COCCYX MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72240,CPT,MYELOGRAPY CERVICAL RS&I,,,20 ,,RBRVS,0.91 ,3.31 ,3.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72240,CPT,MYELOGRAPY CERVICAL RS&I,26,,20 ,,RBRVS,0.91 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72240,CPT,MYELOGRAPY CERVICAL RS&I,TC,,20 ,,RBRVS,,2.93 ,2.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72255,CPT,MYELOGRAPY THORACIC RS&I,,,20 ,,RBRVS,0.91 ,3.06 ,3.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72255,CPT,MYELOGRAPY THORACIC RS&I,26,,20 ,,RBRVS,0.91 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72255,CPT,MYELOGRAPY THORACIC RS&I,TC,,20 ,,RBRVS,,2.69 ,2.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72265,CPT,MYELOGRAPY LUMBOSACRAL RS&I,,,20 ,,RBRVS,0.83 ,3.20 ,3.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72265,CPT,MYELOGRAPY LUMBOSACRAL RS&I,26,,20 ,,RBRVS,0.83 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72265,CPT,MYELOGRAPY LUMBOSACRAL RS&I,TC,,20 ,,RBRVS,,2.85 ,2.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72270,CPT,MYELOGRAPY 2/MORE REGIONS RS&I,,,20 ,,RBRVS,1.33 ,4.94 ,4.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72270,CPT,MYELOGRAPY 2/MORE REGIONS RS&I,26,,20 ,,RBRVS,1.33 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72270,CPT,MYELOGRAPY 2/MORE REGIONS RS&I,TC,,20 ,,RBRVS,,4.39 ,4.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72275,CPT,EPIDUROGRAPY RS&I,,,20 ,,RBRVS,0.76 ,2.49 ,2.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72275,CPT,EPIDUROGRAPY RS&I,26,,20 ,,RBRVS,0.76 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72275,CPT,EPIDUROGRAPY RS&I,TC,,20 ,,RBRVS,,2.17 ,2.17 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,72285,CPT,DISKOGRAPY CERVICAL/THORACIC RS&I,,,20 ,,RBRVS,1.16 ,3.14 ,3.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72285,CPT,DISKOGRAPY CERVICAL/THORACIC RS&I,26,,20 ,,RBRVS,1.16 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72285,CPT,DISKOGRAPY CERVICAL/THORACIC RS&I,TC,,20 ,,RBRVS,,2.63 ,2.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,72291,CPT,RAD S&I PERQ VRTPLS/SACRPLSTY PR VRT BODY FLUOR,,,20 ,,TotalUnits,,,,9.87 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,72291,CPT,RAD S&I PERQ VRTPLS/SACRPLSTY PR VRT BODY FLUOR,26,,20 ,,TotalUnits,,,,2.25 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,72291,CPT,RAD S&I PERQ VRTPLS/SACRPLSTY PR VRT BODY FLUOR,TC,,20 ,,TotalUnits,,,,7.62 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,72292,CPT,RAD S&I PERQ VRTPLS/SACRPLSTY PER VRT BODY CT,,,20 ,,TotalUnits,,,,10.09 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,72292,CPT,RAD S&I PERQ VRTPLS/SACRPLSTY PER VRT BODY CT,26,,20 ,,TotalUnits,,,,2.32 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,72292,CPT,RAD S&I PERQ VRTPLS/SACRPLSTY PER VRT BODY CT,TC,,20 ,,TotalUnits,,,,7.77 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,72295,CPT,DISKOGRAPY LUMBAR RS&I,,,20 ,,RBRVS,0.83 ,2.96 ,2.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,72295,CPT,DISKOGRAPY LUMBAR RS&I,26,,20 ,,RBRVS,0.83 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,72295,CPT,DISKOGRAPY LUMBAR RS&I,TC,,20 ,,RBRVS,,2.59 ,2.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73000,CPT,RADEX CLAVICLE COMPLETE,,,20 ,,RBRVS,0.16 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73000,CPT,RADEX CLAVICLE COMPLETE,26,,20 ,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73000,CPT,RADEX CLAVICLE COMPLETE,TC,,20 ,,RBRVS,,0.60 ,0.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73010,CPT,RADEX SCAPULA COMPLETE,,,20 ,,RBRVS,0.17 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73010,CPT,RADEX SCAPULA COMPLETE,26,,20 ,,RBRVS,0.17 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73010,CPT,RADEX SCAPULA COMPLETE,TC,,20 ,,RBRVS,,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73020,CPT,RADEX SHOULDER 1 VIEW,,,20 ,,RBRVS,0.15 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73020,CPT,RADEX SHOULDER 1 VIEW,26,,20 ,,RBRVS,0.15 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73020,CPT,RADEX SHOULDER 1 VIEW,TC,,20 ,,RBRVS,,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73030,CPT,RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.18 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73030,CPT,RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.18 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73030,CPT,RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73040,CPT,RADEX SHOULDER ARTHROGRAPHY RS&I,,,20 ,,RBRVS,0.54 ,2.60 ,2.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73040,CPT,RADEX SHOULDER ARTHROGRAPHY RS&I,26,,20 ,,RBRVS,0.54 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73040,CPT,RADEX SHOULDER ARTHROGRAPHY RS&I,TC,,20 ,,RBRVS,,2.37 ,2.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73050,CPT,RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ,,,20 ,,RBRVS,0.20 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73050,CPT,RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ,26,,20 ,,RBRVS,0.20 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73050,CPT,RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ,TC,,20 ,,RBRVS,,0.80 ,0.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73060,CPT,RADEX HUMERUS MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.17 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73060,CPT,RADEX HUMERUS MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.17 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73060,CPT,RADEX HUMERUS MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.60 ,0.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73070,CPT,RADEX ELBOW 2 VIEWS,,,20 ,,RBRVS,0.15 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73070,CPT,RADEX ELBOW 2 VIEWS,26,,20 ,,RBRVS,0.15 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73070,CPT,RADEX ELBOW 2 VIEWS,TC,,20 ,,RBRVS,,0.60 ,0.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73080,CPT,RADEX ELBOW COMPLETE MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.17 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73080,CPT,RADEX ELBOW COMPLETE MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73080,CPT,RADEX ELBOW COMPLETE MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.75 ,0.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73085,CPT,RADEX ELBOW ARTHROGRAPHY RS&I,,,20 ,,RBRVS,0.54 ,2.31 ,2.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73085,CPT,RADEX ELBOW ARTHROGRAPHY RS&I,26,,20 ,,RBRVS,0.54 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73085,CPT,RADEX ELBOW ARTHROGRAPHY RS&I,TC,,20 ,,RBRVS,,2.07 ,2.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73090,CPT,RADEX FOREARM 2 VIEWS,,,20 ,,RBRVS,0.16 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73090,CPT,RADEX FOREARM 2 VIEWS,26,,20 ,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73090,CPT,RADEX FOREARM 2 VIEWS,TC,,20 ,,RBRVS,,0.58 ,0.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73092,CPT,RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.16 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73092,CPT,RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73092,CPT,RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.66 ,0.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73100,CPT,RADEX WRIST 2 VIEWS,,,20 ,,RBRVS,0.16 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73100,CPT,RADEX WRIST 2 VIEWS,26,,20 ,,RBRVS,0.16 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73100,CPT,RADEX WRIST 2 VIEWS,TC,,20 ,,RBRVS,,0.64 ,0.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73110,CPT,RADEX WRIST COMPLETE MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.17 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73110,CPT,RADEX WRIST COMPLETE MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.17 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73110,CPT,RADEX WRIST COMPLETE MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.81 ,0.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73115,CPT,RADEX WRIST ARTHROGRAPHY RS&I,,,20 ,,RBRVS,0.54 ,2.64 ,2.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73115,CPT,RADEX WRIST ARTHROGRAPHY RS&I,26,,20 ,,RBRVS,0.54 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73115,CPT,RADEX WRIST ARTHROGRAPHY RS&I,TC,,20 ,,RBRVS,,2.39 ,2.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73120,CPT,RADEX HAND 2 VIEWS,,,20 ,,RBRVS,0.16 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73120,CPT,RADEX HAND 2 VIEWS,26,,20 ,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73120,CPT,RADEX HAND 2 VIEWS,TC,,20 ,,RBRVS,,0.57 ,0.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73130,CPT,RADEX HAND MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.17 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73130,CPT,RADEX HAND MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73130,CPT,RADEX HAND MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.69 ,0.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73140,CPT,RADEX FINGR MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.13 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73140,CPT,RADEX FINGR MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.13 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73140,CPT,RADEX FINGR MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.72 ,0.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73200,CPT,CT UPPER EXTREMITY W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.00 ,6.17 ,6.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73200,CPT,CT UPPER EXTREMITY W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.00 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73200,CPT,CT UPPER EXTREMITY W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.74 ,5.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73201,CPT,CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.16 ,7.61 ,7.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73201,CPT,CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.16 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73201,CPT,CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,7.13 ,7.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73202,CPT,CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.22 ,10.02 ,10.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73202,CPT,CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.22 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73202,CPT,CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,9.52 ,9.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73206,CPT,CT ANGIOGRAPHY UPPER EXTREMITY,,,20 ,,RBRVS,1.81 ,10.93 ,10.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73206,CPT,CT ANGIOGRAPHY UPPER EXTREMITY,26,,20 ,,RBRVS,1.81 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73206,CPT,CT ANGIOGRAPHY UPPER EXTREMITY,TC,,20 ,,RBRVS,,10.17 ,10.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73218,CPT,MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL,,,20 ,,RBRVS,1.35 ,13.86 ,13.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73218,CPT,MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL,26,,20 ,,RBRVS,1.35 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73218,CPT,MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL,TC,,20 ,,RBRVS,,13.30 ,13.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73219,CPT,MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL,,,20 ,,RBRVS,1.62 ,14.82 ,14.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73219,CPT,MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL,26,,20 ,,RBRVS,1.62 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73219,CPT,MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL,TC,,20 ,,RBRVS,,14.15 ,14.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73220,CPT,MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAST,,,20 ,,RBRVS,2.15 ,19.58 ,19.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73220,CPT,MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAST,26,,20 ,,RBRVS,2.15 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73220,CPT,MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAST,TC,,20 ,,RBRVS,,18.69 ,18.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73221,CPT,MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL,,,20 ,,RBRVS,1.35 ,12.95 ,12.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73221,CPT,MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL,26,,20 ,,RBRVS,1.35 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73221,CPT,MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL,TC,,20 ,,RBRVS,,12.38 ,12.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73222,CPT,MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL,,,20 ,,RBRVS,1.62 ,13.97 ,13.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73222,CPT,MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL,26,,20 ,,RBRVS,1.62 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73222,CPT,MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL,TC,,20 ,,RBRVS,,13.30 ,13.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73223,CPT,MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL,,,20 ,,RBRVS,2.15 ,18.47 ,18.47 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73223,CPT,MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL,26,,20 ,,RBRVS,2.15 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73223,CPT,MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL,TC,,20 ,,RBRVS,,17.59 ,17.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73225,CPT,MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL,,,20 ,,RBRVS,1.73 ,16.01 ,16.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73225,CPT,MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL,26,,20 ,,RBRVS,1.73 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73225,CPT,MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL,TC,,20 ,,RBRVS,,15.26 ,15.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73500,CPT,RADEX HIP UNILATERAL 1 VIEW,,,20 ,,RBRVS,0.17 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73500,CPT,RADEX HIP UNILATERAL 1 VIEW,26,,20 ,,RBRVS,0.17 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73500,CPT,RADEX HIP UNILATERAL 1 VIEW,TC,,20 ,,RBRVS,,0.51 ,0.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73510,CPT,RADEX HIP UNILATERAL COMPLETE MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.21 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73510,CPT,RADEX HIP UNILATERAL COMPLETE MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.21 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73510,CPT,RADEX HIP UNILATERAL COMPLETE MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.80 ,0.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73520,CPT,RADEX HIPS BILATERAL 2 VIEWS ANTEROPOST PELVIS,,,20 ,,RBRVS,0.26 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73520,CPT,RADEX HIPS BILATERAL 2 VIEWS ANTEROPOST PELVIS,26,,20 ,,RBRVS,0.26 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73520,CPT,RADEX HIPS BILATERAL 2 VIEWS ANTEROPOST PELVIS,TC,,20 ,,RBRVS,,0.80 ,0.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73525,CPT,RADEX HIP ARTHROGRAPHY RS&I,,,20 ,,RBRVS,0.54 ,2.38 ,2.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73525,CPT,RADEX HIP ARTHROGRAPHY RS&I,26,,20 ,,RBRVS,0.54 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73525,CPT,RADEX HIP ARTHROGRAPHY RS&I,TC,,20 ,,RBRVS,,2.13 ,2.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73530,CPT,RADEX HIP OPERATIVE PROCEDURE,,,20 ,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,73530,CPT,RADEX HIP OPERATIVE PROCEDURE,26,,20 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,73530,CPT,RADEX HIP OPERATIVE PROCEDURE,TC,,20 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,73540,CPT,RADEX PELVIS&HIPS INFT/CHLD MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.20 ,0.97 ,0.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73540,CPT,RADEX PELVIS&HIPS INFT/CHLD MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.20 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73540,CPT,RADEX PELVIS&HIPS INFT/CHLD MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.88 ,0.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73550,CPT,RADIOLOGIC EXAMINATION FEMUR 2 VIEWS,,,20 ,,RBRVS,0.17 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73550,CPT,RADIOLOGIC EXAMINATION FEMUR 2 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73550,CPT,RADIOLOGIC EXAMINATION FEMUR 2 VIEWS,TC,,20 ,,RBRVS,,0.57 ,0.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73560,CPT,RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS,,,20 ,,RBRVS,0.17 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73560,CPT,RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS,26,,20 ,,RBRVS,0.17 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73560,CPT,RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS,TC,,20 ,,RBRVS,,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73562,CPT,RADIOLOGIC EXAMINATION KNEE 3 VIEWS,,,20 ,,RBRVS,0.18 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73562,CPT,RADIOLOGIC EXAMINATION KNEE 3 VIEWS,26,,20 ,,RBRVS,0.18 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73562,CPT,RADIOLOGIC EXAMINATION KNEE 3 VIEWS,TC,,20 ,,RBRVS,,0.78 ,0.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73564,CPT,RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS,,,20 ,,RBRVS,0.22 ,0.99 ,0.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73564,CPT,RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS,26,,20 ,,RBRVS,0.22 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73564,CPT,RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS,TC,,20 ,,RBRVS,,0.89 ,0.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73565,CPT,RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST,,,20 ,,RBRVS,0.17 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73565,CPT,RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST,26,,20 ,,RBRVS,0.17 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73565,CPT,RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST,TC,,20 ,,RBRVS,,0.71 ,0.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73580,CPT,RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I,,,20 ,,RBRVS,0.54 ,3.30 ,3.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73580,CPT,RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I,26,,20 ,,RBRVS,0.54 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73580,CPT,RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I,TC,,20 ,,RBRVS,,3.03 ,3.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73590,CPT,RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS,,,20 ,,RBRVS,0.17 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73590,CPT,RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73590,CPT,RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS,TC,,20 ,,RBRVS,,0.56 ,0.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73592,CPT,RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.16 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73592,CPT,RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73592,CPT,RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.67 ,0.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73600,CPT,RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,,,20 ,,RBRVS,0.16 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73600,CPT,RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,26,,20 ,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73600,CPT,RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,TC,,20 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73610,CPT,RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.17 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73610,CPT,RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73610,CPT,RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.70 ,0.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73615,CPT,RADEX ANKLE ARTHROGGRAPHY RS&I,,,20 ,,RBRVS,0.54 ,2.49 ,2.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73615,CPT,RADEX ANKLE ARTHROGGRAPHY RS&I,26,,20 ,,RBRVS,0.54 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73615,CPT,RADEX ANKLE ARTHROGGRAPHY RS&I,TC,,20 ,,RBRVS,,2.24 ,2.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73620,CPT,RADIOLOGIC EXAMINATION FOOT 2 VIEWS,,,20 ,,RBRVS,0.16 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73620,CPT,RADIOLOGIC EXAMINATION FOOT 2 VIEWS,26,,20 ,,RBRVS,0.16 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73620,CPT,RADIOLOGIC EXAMINATION FOOT 2 VIEWS,TC,,20 ,,RBRVS,,0.57 ,0.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73630,CPT,RADEX FOOT COMPLETE MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.17 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73630,CPT,RADEX FOOT COMPLETE MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73630,CPT,RADEX FOOT COMPLETE MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.68 ,0.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73650,CPT,RADEX CALCANEUS MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.16 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73650,CPT,RADEX CALCANEUS MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73650,CPT,RADEX CALCANEUS MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.58 ,0.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73660,CPT,RADEX TOE MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.13 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73660,CPT,RADEX TOE MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.13 ,0.05 ,0.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73660,CPT,RADEX TOE MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.67 ,0.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73700,CPT,CT LOWER EXTREMITY W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.00 ,6.18 ,6.18 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73700,CPT,CT LOWER EXTREMITY W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.00 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73700,CPT,CT LOWER EXTREMITY W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.75 ,5.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73701,CPT,CT LOWER EXTREMITY W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.16 ,7.69 ,7.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73701,CPT,CT LOWER EXTREMITY W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.16 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73701,CPT,CT LOWER EXTREMITY W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,7.21 ,7.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73702,CPT,CT LOWER EXTREMITY W/O & W/CONTRAST MATRL,,,20 ,,RBRVS,1.22 ,10.08 ,10.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73702,CPT,CT LOWER EXTREMITY W/O & W/CONTRAST MATRL,26,,20 ,,RBRVS,1.22 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73702,CPT,CT LOWER EXTREMITY W/O & W/CONTRAST MATRL,TC,,20 ,,RBRVS,,9.57 ,9.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73706,CPT,CT ANGIOGRAPHY LOWER EXTREMITY,,,20 ,,RBRVS,1.90 ,12.10 ,12.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73706,CPT,CT ANGIOGRAPHY LOWER EXTREMITY,26,,20 ,,RBRVS,1.90 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73706,CPT,CT ANGIOGRAPHY LOWER EXTREMITY,TC,,20 ,,RBRVS,,11.30 ,11.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73718,CPT,MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL,,,20 ,,RBRVS,1.35 ,13.54 ,13.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73718,CPT,MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL,26,,20 ,,RBRVS,1.35 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73718,CPT,MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL,TC,,20 ,,RBRVS,,12.99 ,12.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73719,CPT,MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL,,,20 ,,RBRVS,1.62 ,14.77 ,14.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73719,CPT,MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL,26,,20 ,,RBRVS,1.62 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73719,CPT,MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL,TC,,20 ,,RBRVS,,14.11 ,14.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73720,CPT,MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATRL,,,20 ,,RBRVS,2.15 ,19.60 ,19.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73720,CPT,MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATRL,26,,20 ,,RBRVS,2.15 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73720,CPT,MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATRL,TC,,20 ,,RBRVS,,18.72 ,18.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73721,CPT,MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL,,,20 ,,RBRVS,1.35 ,13.22 ,13.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73721,CPT,MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL,26,,20 ,,RBRVS,1.35 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73721,CPT,MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL,TC,,20 ,,RBRVS,,12.66 ,12.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73722,CPT,MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.62 ,14.22 ,14.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73722,CPT,MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.62 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73722,CPT,MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,13.54 ,13.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73723,CPT,MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL,,,20 ,,RBRVS,2.15 ,18.43 ,18.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73723,CPT,MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL,26,,20 ,,RBRVS,2.15 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73723,CPT,MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL,TC,,20 ,,RBRVS,,17.55 ,17.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,73725,CPT,MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL,,,20 ,,RBRVS,1.82 ,14.43 ,14.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,73725,CPT,MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL,26,,20 ,,RBRVS,1.82 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,73725,CPT,MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL,TC,,20 ,,RBRVS,,13.68 ,13.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74000,CPT,RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW,,,20 ,,RBRVS,0.18 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74000,CPT,RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW,26,,20 ,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74000,CPT,RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW,TC,,20 ,,RBRVS,,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74010,CPT,RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS,,,20 ,,RBRVS,0.23 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74010,CPT,RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS,26,,20 ,,RBRVS,0.23 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74010,CPT,RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS,TC,,20 ,,RBRVS,,0.79 ,0.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74020,CPT,RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS,,,20 ,,RBRVS,0.27 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74020,CPT,RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS,26,,20 ,,RBRVS,0.27 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74020,CPT,RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS,TC,,20 ,,RBRVS,,0.79 ,0.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74022,CPT,RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH,,,20 ,,RBRVS,0.32 ,1.09 ,1.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74022,CPT,RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH,26,,20 ,,RBRVS,0.32 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74022,CPT,RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH,TC,,20 ,,RBRVS,,0.96 ,0.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74150,CPT,CT ABDOMEN W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.19 ,6.03 ,6.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74150,CPT,CT ABDOMEN W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.19 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74150,CPT,CT ABDOMEN W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.54 ,5.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74160,CPT,CT ABDOMEN W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.27 ,8.52 ,8.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74160,CPT,CT ABDOMEN W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.27 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74160,CPT,CT ABDOMEN W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,7.99 ,7.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74170,CPT,CT ABDOMEN W/O &W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.40 ,11.55 ,11.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74170,CPT,CT ABDOMEN W/O &W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.40 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74170,CPT,CT ABDOMEN W/O &W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,10.97 ,10.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74174,CPT,CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES,,,20 ,,RBRVS,2.20 ,14.16 ,14.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74174,CPT,CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES,26,,20 ,,RBRVS,2.20 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74174,CPT,CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES,TC,,20 ,,RBRVS,,13.40 ,13.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74175,CPT,CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST,,,20 ,,RBRVS,1.90 ,12.26 ,12.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74175,CPT,CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST,26,,20 ,,RBRVS,1.90 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74175,CPT,CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST,TC,,20 ,,RBRVS,,11.47 ,11.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74176,CPT,CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.74 ,4.52 ,4.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74176,CPT,CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.74 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74176,CPT,CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,3.87 ,3.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74177,CPT,CT ABDOEN & PELVIS W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.82 ,8.08 ,8.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74177,CPT,CT ABDOEN & PELVIS W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.82 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74177,CPT,CT ABDOEN & PELVIS W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,7.39 ,7.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74178,CPT,CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY REGIONS,,,20 ,,RBRVS,2.01 ,10.53 ,10.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74178,CPT,CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY REGIONS,26,,20 ,,RBRVS,2.01 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74178,CPT,CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY REGIONS,TC,,20 ,,RBRVS,,9.77 ,9.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74181,CPT,MRI ABDOMEN W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.46 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74181,CPT,MRI ABDOMEN W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.46 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74181,CPT,MRI ABDOMEN W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,11.45 ,11.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74182,CPT,MRI ABDOMEN W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.73 ,16.56 ,16.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74182,CPT,MRI ABDOMEN W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.73 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74182,CPT,MRI ABDOMEN W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,15.85 ,15.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74183,CPT,MRI ABDOMEN W/O &W/CONTRAST MATERIAL,,,20 ,,RBRVS,2.26 ,19.57 ,19.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74183,CPT,MRI ABDOMEN W/O &W/CONTRAST MATERIAL,26,,20 ,,RBRVS,2.26 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74183,CPT,MRI ABDOMEN W/O &W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,18.65 ,18.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74185,CPT,MRA ABDOMEN W/WO CONTRAST MATERIAL,,,20 ,,RBRVS,1.80 ,14.38 ,14.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74185,CPT,MRA ABDOMEN W/WO CONTRAST MATERIAL,26,,20 ,,RBRVS,1.80 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74185,CPT,MRA ABDOMEN W/WO CONTRAST MATERIAL,TC,,20 ,,RBRVS,,13.64 ,13.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74190,CPT,PERITONEOGRAM RS&I,,,20 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74190,CPT,PERITONEOGRAM RS&I,26,,20 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74190,CPT,PERITONEOGRAM RS&I,TC,,20 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,74210,CPT,RADEX PHARYNX&/CERVICAL ESOPHAGUS,,,20 ,,RBRVS,0.36 ,1.94 ,1.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74210,CPT,RADEX PHARYNX&/CERVICAL ESOPHAGUS,26,,20 ,,RBRVS,0.36 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74210,CPT,RADEX PHARYNX&/CERVICAL ESOPHAGUS,TC,,20 ,,RBRVS,,1.79 ,1.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74220,CPT,RADEX ESOPHAGUS,,,20 ,,RBRVS,0.46 ,2.17 ,2.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74220,CPT,RADEX ESOPHAGUS,26,,20 ,,RBRVS,0.46 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74220,CPT,RADEX ESOPHAGUS,TC,,20 ,,RBRVS,,1.98 ,1.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74230,CPT,SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG,,,20 ,,RBRVS,0.53 ,2.14 ,2.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74230,CPT,SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG,26,,20 ,,RBRVS,0.53 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74230,CPT,SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG,TC,,20 ,,RBRVS,,1.92 ,1.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74235,CPT,RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I,,,20 ,,TotalUnits,,,,4.15 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74235,CPT,RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I,26,,20 ,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74235,CPT,RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I,TC,,20 ,,TotalUnits,,,,2.33 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,74240,CPT,RADEX GI TRACT UPPER W/WO DELAYED FILMS W/O KUB,,,20 ,,RBRVS,0.69 ,2.57 ,2.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74240,CPT,RADEX GI TRACT UPPER W/WO DELAYED FILMS W/O KUB,26,,20 ,,RBRVS,0.69 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74240,CPT,RADEX GI TRACT UPPER W/WO DELAYED FILMS W/O KUB,TC,,20 ,,RBRVS,,2.28 ,2.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74241,CPT,RADEX GI TRACT UPPER W/WO DELAYED FILMS W/KUB,,,20 ,,RBRVS,0.69 ,2.78 ,2.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74241,CPT,RADEX GI TRACT UPPER W/WO DELAYED FILMS W/KUB,26,,20 ,,RBRVS,0.69 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74241,CPT,RADEX GI TRACT UPPER W/WO DELAYED FILMS W/KUB,TC,,20 ,,RBRVS,,2.50 ,2.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74245,CPT,RADEX GI TRACT UPR W/SM INT W/MULT SERIAL FLMS,,,20 ,,RBRVS,0.91 ,4.27 ,4.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74245,CPT,RADEX GI TRACT UPR W/SM INT W/MULT SERIAL FLMS,26,,20 ,,RBRVS,0.91 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74245,CPT,RADEX GI TRACT UPR W/SM INT W/MULT SERIAL FLMS,TC,,20 ,,RBRVS,,3.89 ,3.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74246,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY FILMS W/O KUB,,,20 ,,RBRVS,0.69 ,3.02 ,3.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74246,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY FILMS W/O KUB,26,,20 ,,RBRVS,0.69 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74246,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY FILMS W/O KUB,TC,,20 ,,RBRVS,,2.73 ,2.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74247,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY FLMS W/KUB,,,20 ,,RBRVS,0.69 ,3.44 ,3.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74247,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY FLMS W/KUB,26,,20 ,,RBRVS,0.69 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74247,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY FLMS W/KUB,TC,,20 ,,RBRVS,,3.15 ,3.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74249,CPT,RADEX GI UPR W/WO GLUCOSE W/SM INTEST FOLLW-THRU,,,20 ,,RBRVS,0.91 ,4.68 ,4.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74249,CPT,RADEX GI UPR W/WO GLUCOSE W/SM INTEST FOLLW-THRU,26,,20 ,,RBRVS,0.91 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74249,CPT,RADEX GI UPR W/WO GLUCOSE W/SM INTEST FOLLW-THRU,TC,,20 ,,RBRVS,,4.30 ,4.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74250,CPT,RADEX SMALL INTESTINE W/MULTIPLE SERIAL FILMS,,,20 ,,RBRVS,0.47 ,2.64 ,2.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74250,CPT,RADEX SMALL INTESTINE W/MULTIPLE SERIAL FILMS,26,,20 ,,RBRVS,0.47 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74250,CPT,RADEX SMALL INTESTINE W/MULTIPLE SERIAL FILMS,TC,,20 ,,RBRVS,,2.45 ,2.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74251,CPT,RADEX SM INT W/MLT SRL FLMS VIA ENTEROCLSS TUBE,,,20 ,,RBRVS,0.69 ,10.08 ,10.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74251,CPT,RADEX SM INT W/MLT SRL FLMS VIA ENTEROCLSS TUBE,26,,20 ,,RBRVS,0.69 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74251,CPT,RADEX SM INT W/MLT SRL FLMS VIA ENTEROCLSS TUBE,TC,,20 ,,RBRVS,,9.79 ,9.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74260,CPT,DUODENOGRAPY HYPOTONIC,,,20 ,,RBRVS,0.50 ,8.39 ,8.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74260,CPT,DUODENOGRAPY HYPOTONIC,26,,20 ,,RBRVS,0.50 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74260,CPT,DUODENOGRAPY HYPOTONIC,TC,,20 ,,RBRVS,,8.19 ,8.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74261,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST,,,20 ,,RBRVS,2.40 ,12.70 ,12.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74261,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST,26,,20 ,,RBRVS,2.40 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74261,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST,TC,,20 ,,RBRVS,,11.80 ,11.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74262,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST,,,20 ,,RBRVS,2.50 ,14.27 ,14.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74262,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST,26,,20 ,,RBRVS,2.50 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74262,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST,TC,,20 ,,RBRVS,,13.33 ,13.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74263,CPT,CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING,,,20 ,,RBRVS,2.28 ,20.09 ,20.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74263,CPT,CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING,26,,20 ,,RBRVS,2.28 ,1.00 ,1.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74263,CPT,CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING,TC,,20 ,,RBRVS,,19.09 ,19.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74270,CPT,RADEX COLON BARIUM ENEMA W/WOKUB,,,20 ,,RBRVS,0.69 ,3.79 ,3.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74270,CPT,RADEX COLON BARIUM ENEMA W/WOKUB,26,,20 ,,RBRVS,0.69 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74270,CPT,RADEX COLON BARIUM ENEMA W/WOKUB,TC,,20 ,,RBRVS,,3.50 ,3.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74280,CPT,RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON,,,20 ,,RBRVS,0.99 ,5.23 ,5.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74280,CPT,RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON,26,,20 ,,RBRVS,0.99 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74280,CPT,RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON,TC,,20 ,,RBRVS,,4.82 ,4.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74283,CPT,THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ,,,20 ,,RBRVS,2.02 ,3.98 ,3.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74283,CPT,THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ,26,,20 ,,RBRVS,2.02 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74283,CPT,THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ,TC,,20 ,,RBRVS,,3.14 ,3.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74290,CPT,CHOLECYSTOGRAPHY ORAL CONTRST,,,20 ,,RBRVS,0.32 ,1.68 ,1.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74290,CPT,CHOLECYSTOGRAPHY ORAL CONTRST,26,,20 ,,RBRVS,0.32 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74290,CPT,CHOLECYSTOGRAPHY ORAL CONTRST,TC,,20 ,,RBRVS,,1.55 ,1.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74291,CPT,CHOLECYST ORAL CNTRST ADDL/REPEAT XM/MULT DAY XM,,,20 ,,RBRVS,0.20 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74291,CPT,CHOLECYST ORAL CNTRST ADDL/REPEAT XM/MULT DAY XM,26,,20 ,,RBRVS,0.20 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74291,CPT,CHOLECYST ORAL CNTRST ADDL/REPEAT XM/MULT DAY XM,TC,,20 ,,RBRVS,,1.59 ,1.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74300,CPT,CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I,,,20 ,,TotalUnits,,,,1.60 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74300,CPT,CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I,26,,20 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74300,CPT,CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I,TC,,20 ,,TotalUnits,,,,1.09 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,74301,CPT,CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS&I,,,20 ,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74301,CPT,CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS&I,26,,20 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74301,CPT,CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS&I,TC,,20 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,74305,CPT,CHOLANGIO&/PANCREATOGRAPHY THRU CATH RS&I,,,20 ,,TotalUnits,,,,1.60 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74305,CPT,CHOLANGIO&/PANCREATOGRAPHY THRU CATH RS&I,26,,20 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74305,CPT,CHOLANGIO&/PANCREATOGRAPHY THRU CATH RS&I,TC,,20 ,,TotalUnits,,,,1.01 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,74320,CPT,CHOLANGIO&/PANCREATOGRAPHY TRANSHEPATC RS&I,,,20 ,,RBRVS,0.54 ,2.62 ,2.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74320,CPT,CHOLANGIO&/PANCREATOGRAPHY TRANSHEPATC RS&I,26,,20 ,,RBRVS,0.54 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74320,CPT,CHOLANGIO&/PANCREATOGRAPHY TRANSHEPATC RS&I,TC,,20 ,,RBRVS,,2.39 ,2.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74327,CPT,POSTOP BILIARY STONE RMVL PRQ T-TUBE RS&I,,,20 ,,RBRVS,0.70 ,3.25 ,3.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74327,CPT,POSTOP BILIARY STONE RMVL PRQ T-TUBE RS&I,26,,20 ,,RBRVS,0.70 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74327,CPT,POSTOP BILIARY STONE RMVL PRQ T-TUBE RS&I,TC,,20 ,,RBRVS,,2.96 ,2.96 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,74328,CPT,ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I,,,20 ,,TotalUnits,,,,3.77 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74328,CPT,ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I,26,,20 ,,TotalUnits,,,,1.01 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74328,CPT,ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I,TC,,20 ,,TotalUnits,,,,2.76 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,74329,CPT,ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I,,,20 ,,TotalUnits,,,,3.07 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74329,CPT,ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I,26,,20 ,,TotalUnits,,,,1.01 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74329,CPT,ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I,TC,,20 ,,TotalUnits,,,,2.06 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,74330,CPT,CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I,,,20 ,,TotalUnits,,,,4.62 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74330,CPT,CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I,26,,20 ,,TotalUnits,,,,1.29 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74330,CPT,CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I,TC,,20 ,,TotalUnits,,,,3.33 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,74340,CPT,INTRO LONG GI TUBE W/MULT FLUORO&FILMS RS&I,,,20 ,,TotalUnits,,,,2.26 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74340,CPT,INTRO LONG GI TUBE W/MULT FLUORO&FILMS RS&I,26,,20 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74340,CPT,INTRO LONG GI TUBE W/MULT FLUORO&FILMS RS&I,TC,,20 ,,TotalUnits,,,,1.49 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,74355,CPT,PERCUTANEOUS PLACEMENT ENTEROCLYSIS TUBE RS&I,,,20 ,,TotalUnits,,,,3.39 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74355,CPT,PERCUTANEOUS PLACEMENT ENTEROCLYSIS TUBE RS&I,26,,20 ,,TotalUnits,,,,1.09 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74355,CPT,PERCUTANEOUS PLACEMENT ENTEROCLYSIS TUBE RS&I,TC,,20 ,,TotalUnits,,,,2.30 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,74360,CPT,INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I,,,20 ,,TotalUnits,,,,3.58 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74360,CPT,INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I,26,,20 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74360,CPT,INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I,TC,,20 ,,TotalUnits,,,,2.76 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,74363,CPT,PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I,,,20 ,,TotalUnits,,,,3.39 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74363,CPT,PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I,26,,20 ,,TotalUnits,,,,1.25 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74363,CPT,PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I,TC,,20 ,,TotalUnits,,,,2.14 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,74400,CPT,UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY,,,20 ,,RBRVS,0.49 ,2.78 ,2.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74400,CPT,UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY,26,,20 ,,RBRVS,0.49 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74400,CPT,UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY,TC,,20 ,,RBRVS,,2.58 ,2.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74410,CPT,UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE,,,20 ,,RBRVS,0.49 ,2.88 ,2.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74410,CPT,UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE,26,,20 ,,RBRVS,0.49 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74410,CPT,UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE,TC,,20 ,,RBRVS,,2.67 ,2.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74415,CPT,UROGRAPY INFUSION DRIP &/BOLUS TECHQ W/WO TOMO,,,20 ,,RBRVS,0.49 ,3.50 ,3.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74415,CPT,UROGRAPY INFUSION DRIP &/BOLUS TECHQ W/WO TOMO,26,,20 ,,RBRVS,0.49 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74415,CPT,UROGRAPY INFUSION DRIP &/BOLUS TECHQ W/WO TOMO,TC,,20 ,,RBRVS,,3.30 ,3.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74420,CPT,X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL,,,20 ,,TotalUnits,,,,2.48 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74420,CPT,X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL,26,,20 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74420,CPT,X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL,TC,,20 ,,TotalUnits,,,,2.00 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,74425,CPT,UROGRAPHY ANTEGRADE RS&I,,,20 ,,TotalUnits,,,,2.48 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74425,CPT,UROGRAPHY ANTEGRADE RS&I,26,,20 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74425,CPT,UROGRAPHY ANTEGRADE RS&I,TC,,20 ,,TotalUnits,,,,1.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,74430,CPT,CYSTOGRAPHY MINIMUM 3 VIEWS RS&I,,,20 ,,RBRVS,0.32 ,1.46 ,1.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74430,CPT,CYSTOGRAPHY MINIMUM 3 VIEWS RS&I,26,,20 ,,RBRVS,0.32 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74430,CPT,CYSTOGRAPHY MINIMUM 3 VIEWS RS&I,TC,,20 ,,RBRVS,,1.33 ,1.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74440,CPT,VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I,,,20 ,,RBRVS,0.38 ,2.14 ,2.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74440,CPT,VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I,26,,20 ,,RBRVS,0.38 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74440,CPT,VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I,TC,,20 ,,RBRVS,,1.98 ,1.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74445,CPT,CORPORA CAVERNOSOGRAPY RS&I,,,20 ,,TotalUnits,,,,3.98 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74445,CPT,CORPORA CAVERNOSOGRAPY RS&I,26,,20 ,,TotalUnits,,,,2.17 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74445,CPT,CORPORA CAVERNOSOGRAPY RS&I,TC,,20 ,,TotalUnits,,,,1.81 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,74450,CPT,URETHROCYSTOGRAPHY RETROGRADE RS&I,,,20 ,,TotalUnits,,,,2.93 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74450,CPT,URETHROCYSTOGRAPHY RETROGRADE RS&I,26,,20 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74450,CPT,URETHROCYSTOGRAPHY RETROGRADE RS&I,TC,,20 ,,TotalUnits,,,,2.29 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,74455,CPT,URETHROCYSTOGRAPHY VOIDING RS&I,,,20 ,,RBRVS,0.33 ,2.30 ,2.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74455,CPT,URETHROCYSTOGRAPHY VOIDING RS&I,26,,20 ,,RBRVS,0.33 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74455,CPT,URETHROCYSTOGRAPHY VOIDING RS&I,TC,,20 ,,RBRVS,,2.16 ,2.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74470,CPT,RADEX RENAL CYST STUDY TRANSLUMBAR RS&I,,,20 ,,TotalUnits,,,,2.98 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74470,CPT,RADEX RENAL CYST STUDY TRANSLUMBAR RS&I,26,,20 ,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74470,CPT,RADEX RENAL CYST STUDY TRANSLUMBAR RS&I,TC,,20 ,,TotalUnits,,,,1.96 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,74475,CPT,INTRO CATH IN RENAL PELVIS DRG&/NJX PRQ RS&I,,,20 ,,RBRVS,0.54 ,2.73 ,2.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74475,CPT,INTRO CATH IN RENAL PELVIS DRG&/NJX PRQ RS&I,26,,20 ,,RBRVS,0.54 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74475,CPT,INTRO CATH IN RENAL PELVIS DRG&/NJX PRQ RS&I,TC,,20 ,,RBRVS,,2.50 ,2.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74480,CPT,INTRO URETERAL CATH/STENT PRQ RS&I,,,20 ,,RBRVS,0.54 ,2.74 ,2.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74480,CPT,INTRO URETERAL CATH/STENT PRQ RS&I,26,,20 ,,RBRVS,0.54 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74480,CPT,INTRO URETERAL CATH/STENT PRQ RS&I,TC,,20 ,,RBRVS,,2.51 ,2.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74485,CPT,DILATION NEPHROSTOMY/URETER/URETHRA RS&I,,,20 ,,RBRVS,0.54 ,2.69 ,2.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74485,CPT,DILATION NEPHROSTOMY/URETER/URETHRA RS&I,26,,20 ,,RBRVS,0.54 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74485,CPT,DILATION NEPHROSTOMY/URETER/URETHRA RS&I,TC,,20 ,,RBRVS,,2.46 ,2.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74710,CPT,PELVIMETRY W/WOPLACENTAL LOCALIZATION,,,20 ,,RBRVS,0.34 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74710,CPT,PELVIMETRY W/WOPLACENTAL LOCALIZATION,26,,20 ,,RBRVS,0.34 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74710,CPT,PELVIMETRY W/WOPLACENTAL LOCALIZATION,TC,,20 ,,RBRVS,,0.67 ,0.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74740,CPT,HYSTEROSALPINGOGRAPHY RS&I,,,20 ,,RBRVS,0.38 ,1.94 ,1.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,74740,CPT,HYSTEROSALPINGOGRAPHY RS&I,26,,20 ,,RBRVS,0.38 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,74740,CPT,HYSTEROSALPINGOGRAPHY RS&I,TC,,20 ,,RBRVS,,1.78 ,1.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,74742,CPT,TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I,,,20 ,,TotalUnits,,,,3.35 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74742,CPT,TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I,26,,20 ,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74742,CPT,TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I,TC,,20 ,,TotalUnits,,,,2.22 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,74775,CPT,PERINEOGRAM,,,20 ,,TotalUnits,,,,3.85 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,74775,CPT,PERINEOGRAM,26,,20 ,,TotalUnits,,,,1.26 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,74775,CPT,PERINEOGRAM,TC,,20 ,,TotalUnits,,,,2.59 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,75557,CPT,CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST,,,20 ,,RBRVS,2.35 ,10.76 ,10.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75557,CPT,CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST,26,,20 ,,RBRVS,2.35 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75557,CPT,CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST,TC,,20 ,,RBRVS,,9.71 ,9.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75559,CPT,CARDIAC MRI W/O CONTRAST W STRESS IMAGING,,,20 ,,RBRVS,2.95 ,16.04 ,16.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75559,CPT,CARDIAC MRI W/O CONTRAST W STRESS IMAGING,26,,20 ,,RBRVS,2.95 ,1.38 ,1.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75559,CPT,CARDIAC MRI W/O CONTRAST W STRESS IMAGING,TC,,20 ,,RBRVS,,14.66 ,14.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75561,CPT,CARDIAC MRI W/W/O CONTRAST & FURTHER SEQ,,,20 ,,RBRVS,2.60 ,15.18 ,15.18 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75561,CPT,CARDIAC MRI W/W/O CONTRAST & FURTHER SEQ,26,,20 ,,RBRVS,2.60 ,1.17 ,1.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75561,CPT,CARDIAC MRI W/W/O CONTRAST & FURTHER SEQ,TC,,20 ,,RBRVS,,14.01 ,14.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75563,CPT,CARDIAC MRI W/W/O CONTRAST W STRESS,,,20 ,,RBRVS,3.00 ,18.67 ,18.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75563,CPT,CARDIAC MRI W/W/O CONTRAST W STRESS,26,,20 ,,RBRVS,3.00 ,1.46 ,1.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75563,CPT,CARDIAC MRI W/W/O CONTRAST W STRESS,TC,,20 ,,RBRVS,,17.21 ,17.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75565,CPT,CARDIAC MRI FOR VELOCITY FLOW MAPPING,,,20 ,,RBRVS,0.25 ,1.92 ,1.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75565,CPT,CARDIAC MRI FOR VELOCITY FLOW MAPPING,26,,20 ,,RBRVS,0.25 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75565,CPT,CARDIAC MRI FOR VELOCITY FLOW MAPPING,TC,,20 ,,RBRVS,,1.81 ,1.81 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,75571,CPT,CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM,,,20 ,,RBRVS,0.58 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75571,CPT,CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM,26,,20 ,,RBRVS,0.58 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75571,CPT,CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM,TC,,20 ,,RBRVS,,2.33 ,2.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75572,CPT,CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH,,,20 ,,RBRVS,1.75 ,6.82 ,6.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75572,CPT,CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH,26,,20 ,,RBRVS,1.75 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75572,CPT,CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH,TC,,20 ,,RBRVS,,6.15 ,6.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75573,CPT,CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT DX,,,20 ,,RBRVS,2.55 ,9.10 ,9.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75573,CPT,CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT DX,26,,20 ,,RBRVS,2.55 ,0.99 ,0.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75573,CPT,CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT DX,TC,,20 ,,RBRVS,,8.11 ,8.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75574,CPT,CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST,,,20 ,,RBRVS,2.40 ,10.63 ,10.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75574,CPT,CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST,26,,20 ,,RBRVS,2.40 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75574,CPT,CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST,TC,,20 ,,RBRVS,,9.71 ,9.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75600,CPT,AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,,,20 ,,RBRVS,0.49 ,7.45 ,7.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75600,CPT,AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,26,,20 ,,RBRVS,0.49 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75600,CPT,AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,TC,,20 ,,RBRVS,,7.22 ,7.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75605,CPT,AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I,,,20 ,,RBRVS,1.14 ,5.13 ,5.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75605,CPT,AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I,26,,20 ,,RBRVS,1.14 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75605,CPT,AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I,TC,,20 ,,RBRVS,,4.63 ,4.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75625,CPT,AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I,,,20 ,,RBRVS,1.14 ,5.11 ,5.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75625,CPT,AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I,26,,20 ,,RBRVS,1.14 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75625,CPT,AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I,TC,,20 ,,RBRVS,,4.64 ,4.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75630,CPT,AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I,,,20 ,,RBRVS,1.79 ,5.51 ,5.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75630,CPT,AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I,26,,20 ,,RBRVS,1.79 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75630,CPT,AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I,TC,,20 ,,RBRVS,,4.75 ,4.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75635,CPT,CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTPROCESS,,,20 ,,RBRVS,2.40 ,13.46 ,13.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75635,CPT,CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTPROCESS,26,,20 ,,RBRVS,2.40 ,1.03 ,1.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75635,CPT,CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTPROCESS,TC,,20 ,,RBRVS,,12.43 ,12.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75650,CPT,ANGIOGRAPHY CERVICOCEREBRAL CATHETER RS&I,,,20 ,,RBRVS,1.49 ,5.30 ,5.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75650,CPT,ANGIOGRAPHY CERVICOCEREBRAL CATHETER RS&I,26,,20 ,,RBRVS,1.49 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75650,CPT,ANGIOGRAPHY CERVICOCEREBRAL CATHETER RS&I,TC,,20 ,,RBRVS,,4.67 ,4.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75658,CPT,ANIOGRAPHY BRACHIAL RETROGRADE RS&I,,,20 ,,RBRVS,1.31 ,5.67 ,5.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75658,CPT,ANIOGRAPHY BRACHIAL RETROGRADE RS&I,26,,20 ,,RBRVS,1.31 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75658,CPT,ANIOGRAPHY BRACHIAL RETROGRADE RS&I,TC,,20 ,,RBRVS,,5.16 ,5.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75660,CPT,ANGIOGRAPHY EXTERNAL CAROTID UNI SLCTV RS&I,,,20 ,,RBRVS,1.31 ,5.81 ,5.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75660,CPT,ANGIOGRAPHY EXTERNAL CAROTID UNI SLCTV RS&I,26,,20 ,,RBRVS,1.31 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75660,CPT,ANGIOGRAPHY EXTERNAL CAROTID UNI SLCTV RS&I,TC,,20 ,,RBRVS,,5.24 ,5.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75662,CPT,ANGIOGRAPHY EXTERNAL CAROTID BI SLCTV RS&I,,,20 ,,RBRVS,1.66 ,6.77 ,6.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75662,CPT,ANGIOGRAPHY EXTERNAL CAROTID BI SLCTV RS&I,26,,20 ,,RBRVS,1.66 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75662,CPT,ANGIOGRAPHY EXTERNAL CAROTID BI SLCTV RS&I,TC,,20 ,,RBRVS,,6.01 ,6.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75665,CPT,ANGIOGRAPHY CAROTID CEREBRAL UNILATERAL RS&I,,,20 ,,RBRVS,1.31 ,6.05 ,6.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75665,CPT,ANGIOGRAPHY CAROTID CEREBRAL UNILATERAL RS&I,26,,20 ,,RBRVS,1.31 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75665,CPT,ANGIOGRAPHY CAROTID CEREBRAL UNILATERAL RS&I,TC,,20 ,,RBRVS,,5.48 ,5.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75671,CPT,ANGIOGRAPHY CAROTID CEREBRAL BILATERAL RS&I,,,20 ,,RBRVS,1.66 ,6.93 ,6.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75671,CPT,ANGIOGRAPHY CAROTID CEREBRAL BILATERAL RS&I,26,,20 ,,RBRVS,1.66 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75671,CPT,ANGIOGRAPHY CAROTID CEREBRAL BILATERAL RS&I,TC,,20 ,,RBRVS,,6.21 ,6.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75676,CPT,ANGIOGRAPHY CAROTID CERVICAL UNILATERAL RS&I,,,20 ,,RBRVS,1.31 ,5.75 ,5.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75676,CPT,ANGIOGRAPHY CAROTID CERVICAL UNILATERAL RS&I,26,,20 ,,RBRVS,1.31 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75676,CPT,ANGIOGRAPHY CAROTID CERVICAL UNILATERAL RS&I,TC,,20 ,,RBRVS,,5.19 ,5.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75680,CPT,ANGIOGRAPHY CAROTID CERVICAL BILATERAL RS&I,,,20 ,,RBRVS,1.66 ,6.36 ,6.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75680,CPT,ANGIOGRAPHY CAROTID CERVICAL BILATERAL RS&I,26,,20 ,,RBRVS,1.66 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75680,CPT,ANGIOGRAPHY CAROTID CERVICAL BILATERAL RS&I,TC,,20 ,,RBRVS,,5.64 ,5.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75685,CPT,ANGIOGRAPHY VERTEBRAL/CERVICAL/&/INTRACRAN RS&I,,,20 ,,RBRVS,1.31 ,5.81 ,5.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75685,CPT,ANGIOGRAPHY VERTEBRAL/CERVICAL/&/INTRACRAN RS&I,26,,20 ,,RBRVS,1.31 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75685,CPT,ANGIOGRAPHY VERTEBRAL/CERVICAL/&/INTRACRAN RS&I,TC,,20 ,,RBRVS,,5.24 ,5.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75705,CPT,ANGIOGRAPHY SPINAL SELECTIVE RS&I,,,20 ,,RBRVS,2.18 ,6.14 ,6.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75705,CPT,ANGIOGRAPHY SPINAL SELECTIVE RS&I,26,,20 ,,RBRVS,2.18 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75705,CPT,ANGIOGRAPHY SPINAL SELECTIVE RS&I,TC,,20 ,,RBRVS,,5.20 ,5.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75710,CPT,ANGIOGRAPHY EXTREMITY UNILATERAL RS&I,,,20 ,,RBRVS,1.14 ,5.69 ,5.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75710,CPT,ANGIOGRAPHY EXTREMITY UNILATERAL RS&I,26,,20 ,,RBRVS,1.14 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75710,CPT,ANGIOGRAPHY EXTREMITY UNILATERAL RS&I,TC,,20 ,,RBRVS,,5.22 ,5.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75716,CPT,ANGIOGRAPHY EXTREMITY BILATERAL RS&I,,,20 ,,RBRVS,1.31 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75716,CPT,ANGIOGRAPHY EXTREMITY BILATERAL RS&I,26,,20 ,,RBRVS,1.31 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75716,CPT,ANGIOGRAPHY EXTREMITY BILATERAL RS&I,TC,,20 ,,RBRVS,,5.99 ,5.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75726,CPT,ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I,,,20 ,,RBRVS,1.14 ,5.61 ,5.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75726,CPT,ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I,26,,20 ,,RBRVS,1.14 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75726,CPT,ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I,TC,,20 ,,RBRVS,,5.14 ,5.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75731,CPT,ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I,,,20 ,,RBRVS,1.14 ,5.75 ,5.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75731,CPT,ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I,26,,20 ,,RBRVS,1.14 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75731,CPT,ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I,TC,,20 ,,RBRVS,,5.22 ,5.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75733,CPT,ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I,,,20 ,,RBRVS,1.31 ,6.61 ,6.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75733,CPT,ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I,26,,20 ,,RBRVS,1.31 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75733,CPT,ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I,TC,,20 ,,RBRVS,,5.97 ,5.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75736,CPT,ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I,,,20 ,,RBRVS,1.14 ,5.61 ,5.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75736,CPT,ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I,26,,20 ,,RBRVS,1.14 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75736,CPT,ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I,TC,,20 ,,RBRVS,,5.13 ,5.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75741,CPT,ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I,,,20 ,,RBRVS,1.31 ,5.07 ,5.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75741,CPT,ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I,26,,20 ,,RBRVS,1.31 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75741,CPT,ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I,TC,,20 ,,RBRVS,,4.52 ,4.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75743,CPT,ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I,,,20 ,,RBRVS,1.66 ,5.47 ,5.47 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75743,CPT,ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I,26,,20 ,,RBRVS,1.66 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75743,CPT,ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I,TC,,20 ,,RBRVS,,4.77 ,4.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75746,CPT,ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I,,,20 ,,RBRVS,1.14 ,5.40 ,5.40 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75746,CPT,ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I,26,,20 ,,RBRVS,1.14 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75746,CPT,ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I,TC,,20 ,,RBRVS,,4.92 ,4.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75756,CPT,ANGIOGRAPHY INTERNAL MAMMARY RS&I,,,20 ,,RBRVS,1.14 ,5.77 ,5.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75756,CPT,ANGIOGRAPHY INTERNAL MAMMARY RS&I,26,,20 ,,RBRVS,1.14 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75756,CPT,ANGIOGRAPHY INTERNAL MAMMARY RS&I,TC,,20 ,,RBRVS,,5.23 ,5.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75774,CPT,ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I,,,20 ,,RBRVS,0.36 ,4.30 ,4.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75774,CPT,ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I,26,,20 ,,RBRVS,0.36 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75774,CPT,ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I,TC,,20 ,,RBRVS,,4.15 ,4.15 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,75791,CPT,ANGIOGRPHY AV SHUNT COMPLETE EVAL FLUOR S&I,,,20 ,,RBRVS,1.71 ,7.84 ,7.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75791,CPT,ANGIOGRPHY AV SHUNT COMPLETE EVAL FLUOR S&I,26,,20 ,,RBRVS,1.71 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75791,CPT,ANGIOGRPHY AV SHUNT COMPLETE EVAL FLUOR S&I,TC,,20 ,,RBRVS,,7.22 ,7.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75801,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I,,,20 ,,RBRVS,0.81 ,6.45 ,6.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75801,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I,26,,20 ,,RBRVS,0.81 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75801,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I,TC,,20 ,,RBRVS,,6.12 ,6.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75803,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I,,,20 ,,RBRVS,1.17 ,6.46 ,6.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75803,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I,26,,20 ,,RBRVS,1.17 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75803,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I,TC,,20 ,,RBRVS,,5.97 ,5.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75805,CPT,ANGRPH CATH F/U STUDY THER/EMBOLIZATION/INFUSION,,,20 ,,RBRVS,0.81 ,6.90 ,6.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75805,CPT,ANGRPH CATH F/U STUDY THER/EMBOLIZATION/INFUSION,26,,20 ,,RBRVS,0.81 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75805,CPT,ANGRPH CATH F/U STUDY THER/EMBOLIZATION/INFUSION,TC,,20 ,,RBRVS,,6.56 ,6.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75807,CPT,LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I,,,20 ,,RBRVS,1.17 ,7.23 ,7.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75807,CPT,LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I,26,,20 ,,RBRVS,1.17 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75807,CPT,LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I,TC,,20 ,,RBRVS,,6.73 ,6.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75809,CPT,SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I,,,20 ,,RBRVS,0.47 ,2.38 ,2.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75809,CPT,SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I,26,,20 ,,RBRVS,0.47 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75809,CPT,SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I,TC,,20 ,,RBRVS,,2.18 ,2.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75810,CPT,SPLENOPORTOGRAPY RS&I,,,20 ,,TotalUnits,,,,13.40 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,75810,CPT,SPLENOPORTOGRAPY RS&I,26,,20 ,,TotalUnits,,,,1.63 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,75810,CPT,SPLENOPORTOGRAPY RS&I,TC,,20 ,,TotalUnits,,,,11.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,75820,CPT,VENOGRAPHY EXTREMITY UNILATERAL RS&I,,,20 ,,RBRVS,0.70 ,2.96 ,2.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75820,CPT,VENOGRAPHY EXTREMITY UNILATERAL RS&I,26,,20 ,,RBRVS,0.70 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75820,CPT,VENOGRAPHY EXTREMITY UNILATERAL RS&I,TC,,20 ,,RBRVS,,2.66 ,2.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75822,CPT,VENOGRAPHY EXTREMITY BILATERAL RS&I,,,20 ,,RBRVS,1.06 ,3.41 ,3.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75822,CPT,VENOGRAPHY EXTREMITY BILATERAL RS&I,26,,20 ,,RBRVS,1.06 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75822,CPT,VENOGRAPHY EXTREMITY BILATERAL RS&I,TC,,20 ,,RBRVS,,2.98 ,2.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75825,CPT,VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I,,,20 ,,RBRVS,1.14 ,4.86 ,4.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75825,CPT,VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I,26,,20 ,,RBRVS,1.14 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75825,CPT,VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I,TC,,20 ,,RBRVS,,4.41 ,4.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75827,CPT,VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I,,,20 ,,RBRVS,1.14 ,4.94 ,4.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75827,CPT,VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I,26,,20 ,,RBRVS,1.14 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75827,CPT,VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I,TC,,20 ,,RBRVS,,4.50 ,4.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75831,CPT,VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I,,,20 ,,RBRVS,1.14 ,4.97 ,4.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75831,CPT,VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I,26,,20 ,,RBRVS,1.14 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75831,CPT,VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I,TC,,20 ,,RBRVS,,4.51 ,4.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75833,CPT,VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I,,,20 ,,RBRVS,1.49 ,5.56 ,5.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75833,CPT,VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I,26,,20 ,,RBRVS,1.49 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75833,CPT,VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I,TC,,20 ,,RBRVS,,4.99 ,4.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75840,CPT,VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I,,,20 ,,RBRVS,1.14 ,4.85 ,4.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75840,CPT,VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I,26,,20 ,,RBRVS,1.14 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75840,CPT,VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I,TC,,20 ,,RBRVS,,4.42 ,4.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75842,CPT,VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I,,,20 ,,RBRVS,1.49 ,5.58 ,5.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75842,CPT,VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I,26,,20 ,,RBRVS,1.49 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75842,CPT,VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I,TC,,20 ,,RBRVS,,4.96 ,4.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75860,CPT,VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I,,,20 ,,RBRVS,1.14 ,5.06 ,5.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75860,CPT,VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I,26,,20 ,,RBRVS,1.14 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75860,CPT,VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I,TC,,20 ,,RBRVS,,4.56 ,4.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75870,CPT,VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I,,,20 ,,RBRVS,1.14 ,4.99 ,4.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75870,CPT,VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I,26,,20 ,,RBRVS,1.14 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75870,CPT,VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I,TC,,20 ,,RBRVS,,4.52 ,4.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75872,CPT,VENOGRAPHY EPIDURAL RS&I,,,20 ,,RBRVS,1.14 ,7.16 ,7.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75872,CPT,VENOGRAPHY EPIDURAL RS&I,26,,20 ,,RBRVS,1.14 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75872,CPT,VENOGRAPHY EPIDURAL RS&I,TC,,20 ,,RBRVS,,6.57 ,6.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75880,CPT,VENOGRAPHY ORBITAL RS&I,,,20 ,,RBRVS,0.70 ,4.32 ,4.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75880,CPT,VENOGRAPHY ORBITAL RS&I,26,,20 ,,RBRVS,0.70 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75880,CPT,VENOGRAPHY ORBITAL RS&I,TC,,20 ,,RBRVS,,4.00 ,4.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75885,CPT,PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I,,,20 ,,RBRVS,1.44 ,5.11 ,5.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75885,CPT,PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I,26,,20 ,,RBRVS,1.44 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75885,CPT,PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I,TC,,20 ,,RBRVS,,4.51 ,4.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75887,CPT,PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVAL RS&I,,,20 ,,RBRVS,1.44 ,5.19 ,5.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75887,CPT,PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVAL RS&I,26,,20 ,,RBRVS,1.44 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75887,CPT,PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVAL RS&I,TC,,20 ,,RBRVS,,4.58 ,4.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75889,CPT,HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I,,,20 ,,RBRVS,1.14 ,4.98 ,4.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75889,CPT,HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I,26,,20 ,,RBRVS,1.14 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75889,CPT,HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I,TC,,20 ,,RBRVS,,4.51 ,4.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75891,CPT,HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I,,,20 ,,RBRVS,1.14 ,4.99 ,4.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75891,CPT,HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I,26,,20 ,,RBRVS,1.14 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75891,CPT,HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I,TC,,20 ,,RBRVS,,4.52 ,4.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75893,CPT,VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&I,,,20 ,,RBRVS,0.54 ,4.70 ,4.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75893,CPT,VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&I,26,,20 ,,RBRVS,0.54 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75893,CPT,VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&I,TC,,20 ,,RBRVS,,4.48 ,4.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75894,CPT,TRANSCATHETER EMBOLIZATION ANY METH RS&I,,,20 ,,TotalUnits,,,,28.03 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,75894,CPT,TRANSCATHETER EMBOLIZATION ANY METH RS&I,26,,20 ,,TotalUnits,,,,1.85 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,75894,CPT,TRANSCATHETER EMBOLIZATION ANY METH RS&I,TC,,20 ,,TotalUnits,,,,26.18 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,75896,CPT,TRANSCATHETER INFUSION ANY METHOD RS&I,,,20 ,,TotalUnits,,,,27.29 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,75896,CPT,TRANSCATHETER INFUSION ANY METHOD RS&I,26,,20 ,,TotalUnits,,,,1.87 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,75896,CPT,TRANSCATHETER INFUSION ANY METHOD RS&I,TC,,20 ,,TotalUnits,,,,25.42 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,75898,CPT,ANGRPH CATH F-UP STD TCAT THER EMBOLIZATION/NFS,,,20 ,,TotalUnits,,,,4.66 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,75898,CPT,ANGRPH CATH F-UP STD TCAT THER EMBOLIZATION/NFS,26,,20 ,,TotalUnits,,,,2.89 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,75898,CPT,ANGRPH CATH F-UP STD TCAT THER EMBOLIZATION/NFS,TC,,20 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,75900,CPT,EXCHNG CATH THROMBOLYTIC THERAPY W/CONTRAST RS&I,,,20 ,,TotalUnits,,,,10.33 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,75900,CPT,EXCHNG CATH THROMBOLYTIC THERAPY W/CONTRAST RS&I,26,,20 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,75900,CPT,EXCHNG CATH THROMBOLYTIC THERAPY W/CONTRAST RS&I,TC,,20 ,,TotalUnits,,,,9.64 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,75901,CPT,MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I,,,20 ,,RBRVS,0.49 ,4.41 ,4.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75901,CPT,MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I,26,,20 ,,RBRVS,0.49 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75901,CPT,MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I,TC,,20 ,,RBRVS,,4.21 ,4.21 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,75902,CPT,MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I,,,20 ,,RBRVS,0.39 ,1.84 ,1.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75902,CPT,MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I,26,,20 ,,RBRVS,0.39 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75902,CPT,MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I,TC,,20 ,,RBRVS,,1.69 ,1.69 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,75945,CPT,IV ULTRASOUND RS&I INITIAL VESSEL,,,20 ,,TotalUnits,,,,8.30 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,75945,CPT,IV ULTRASOUND RS&I INITIAL VESSEL,26,,20 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,75945,CPT,IV ULTRASOUND RS&I INITIAL VESSEL,TC,,20 ,,TotalUnits,,,,7.74 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,75946,CPT,IV ULTRASOUND RS&I EACH NON-CORONARY VESSEL,,,20 ,,TotalUnits,,,,4.52 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,75946,CPT,IV ULTRASOUND RS&I EACH NON-CORONARY VESSEL,26,,20 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,75946,CPT,IV ULTRASOUND RS&I EACH NON-CORONARY VESSEL,TC,,20 ,,TotalUnits,,,,3.97 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,75952,CPT,EVASC RPR INFRARENAL AAA/DISSECTION RS&I,,,20 ,,TotalUnits,,,,11.85 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,75952,CPT,EVASC RPR INFRARENAL AAA/DISSECTION RS&I,26,,20 ,,TotalUnits,,,,6.13 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,75952,CPT,EVASC RPR INFRARENAL AAA/DISSECTION RS&I,TC,,20 ,,TotalUnits,,,,5.72 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,75953,CPT,PLMT XTN PROSTH EVASC RPR INFRARENAL RS&I,,,20 ,,TotalUnits,,,,3.34 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,75953,CPT,PLMT XTN PROSTH EVASC RPR INFRARENAL RS&I,26,,20 ,,TotalUnits,,,,1.86 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,75953,CPT,PLMT XTN PROSTH EVASC RPR INFRARENAL RS&I,TC,,20 ,,TotalUnits,,,,1.48 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,75954,CPT,EVASC RPR ILIAC ART W/ILIO-ILIAC PROSTH RS&I,,,20 ,,TotalUnits,,,,7.58 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,75954,CPT,EVASC RPR ILIAC ART W/ILIO-ILIAC PROSTH RS&I,26,,20 ,,TotalUnits,,,,3.08 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,75954,CPT,EVASC RPR ILIAC ART W/ILIO-ILIAC PROSTH RS&I,TC,,20 ,,TotalUnits,,,,4.50 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,75956,CPT,EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I,,,20 ,,RBRVS,7.00 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75956,CPT,EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I,26,,20 ,,RBRVS,7.00 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75957,CPT,EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I,,,20 ,,RBRVS,6.00 ,2.19 ,2.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75957,CPT,EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I,26,,20 ,,RBRVS,6.00 ,2.19 ,2.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75958,CPT,PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&I,,,20 ,,RBRVS,4.00 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75958,CPT,PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&I,26,,20 ,,RBRVS,4.00 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75959,CPT,PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I,,,20 ,,RBRVS,3.50 ,1.20 ,1.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75959,CPT,PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I,26,,20 ,,RBRVS,3.50 ,1.20 ,1.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75960,CPT,TCAT STENT ILIAC/LOW EXT ART PRQ/OPN RSI EA VSL,,,20 ,,RBRVS,0.82 ,4.84 ,4.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75960,CPT,TCAT STENT ILIAC/LOW EXT ART PRQ/OPN RSI EA VSL,26,,20 ,,RBRVS,0.82 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75960,CPT,TCAT STENT ILIAC/LOW EXT ART PRQ/OPN RSI EA VSL,TC,,20 ,,RBRVS,,4.50 ,4.50 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,75961,CPT,TCAT RETRIEVAL PRQ IV FOREIGN BODY RS&I,,,20 ,,RBRVS,4.24 ,6.38 ,6.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75961,CPT,TCAT RETRIEVAL PRQ IV FOREIGN BODY RS&I,26,,20 ,,RBRVS,4.24 ,1.73 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75961,CPT,TCAT RETRIEVAL PRQ IV FOREIGN BODY RS&I,TC,,20 ,,RBRVS,,4.65 ,4.65 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,75962,CPT,TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI,,,20 ,,RBRVS,0.54 ,5.69 ,5.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75962,CPT,TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI,26,,20 ,,RBRVS,0.54 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75962,CPT,TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI,TC,,20 ,,RBRVS,,5.47 ,5.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75964,CPT,TRLUML BALOON ANGIOP PERIPHER EA ADDL ARTERY RSI,,,20 ,,RBRVS,0.36 ,3.50 ,3.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75964,CPT,TRLUML BALOON ANGIOP PERIPHER EA ADDL ARTERY RSI,26,,20 ,,RBRVS,0.36 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75964,CPT,TRLUML BALOON ANGIOP PERIPHER EA ADDL ARTERY RSI,TC,,20 ,,RBRVS,,3.36 ,3.36 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,75966,CPT,TRLUML BALO ANGIOPLASTY RENAL/OTH VISC ART RS&I,,,20 ,,RBRVS,1.31 ,6.15 ,6.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75966,CPT,TRLUML BALO ANGIOPLASTY RENAL/OTH VISC ART RS&I,26,,20 ,,RBRVS,1.31 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75966,CPT,TRLUML BALO ANGIOPLASTY RENAL/OTH VISC ART RS&I,TC,,20 ,,RBRVS,,5.57 ,5.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75968,CPT,TRLUML BALO ANGIOPLASTY EA VISCERAL ART RS&I,,,20 ,,RBRVS,0.36 ,3.45 ,3.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75968,CPT,TRLUML BALO ANGIOPLASTY EA VISCERAL ART RS&I,26,,20 ,,RBRVS,0.36 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75968,CPT,TRLUML BALO ANGIOPLASTY EA VISCERAL ART RS&I,TC,,20 ,,RBRVS,,3.29 ,3.29 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,75970,CPT,TRANSCATHETER BIOPSY RS&I,,,20 ,,TotalUnits,,,,14.94 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,75970,CPT,TRANSCATHETER BIOPSY RS&I,26,,20 ,,TotalUnits,,,,1.18 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,75970,CPT,TRANSCATHETER BIOPSY RS&I,TC,,20 ,,TotalUnits,,,,13.76 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,75978,CPT,TRANSLUMINAL BALLOON ANGIOPLASTY VENOUS RS&I,,,20 ,,RBRVS,0.54 ,5.70 ,5.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75978,CPT,TRANSLUMINAL BALLOON ANGIOPLASTY VENOUS RS&I,26,,20 ,,RBRVS,0.54 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75978,CPT,TRANSLUMINAL BALLOON ANGIOPLASTY VENOUS RS&I,TC,,20 ,,RBRVS,,5.49 ,5.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,75980,CPT,PRQ TRANSHEPATC BILIARY DRG W/CONTRAST MNTR RS&I,,,20 ,,TotalUnits,,,,9.59 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,75980,CPT,PRQ TRANSHEPATC BILIARY DRG W/CONTRAST MNTR RS&I,26,,20 ,,TotalUnits,,,,2.04 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,75980,CPT,PRQ TRANSHEPATC BILIARY DRG W/CONTRAST MNTR RS&I,TC,,20 ,,TotalUnits,,,,7.55 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,75982,CPT,PRQ PLMT INT/EXT BILIARY DRNG CATH/STENT RS&I,,,20 ,,TotalUnits,,,,10.14 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,75982,CPT,PRQ PLMT INT/EXT BILIARY DRNG CATH/STENT RS&I,26,,20 ,,TotalUnits,,,,2.04 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,75982,CPT,PRQ PLMT INT/EXT BILIARY DRNG CATH/STENT RS&I,TC,,20 ,,TotalUnits,,,,8.10 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,75984,CPT,CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I,,,20 ,,RBRVS,0.72 ,2.63 ,2.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75984,CPT,CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I,26,,20 ,,RBRVS,0.72 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75984,CPT,CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I,TC,,20 ,,RBRVS,,2.33 ,2.33 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,75989,CPT,RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I,,,20 ,,RBRVS,1.19 ,2.76 ,2.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,75989,CPT,RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I,26,,20 ,,RBRVS,1.19 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,75989,CPT,RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I,TC,,20 ,,RBRVS,,2.27 ,2.27 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,76000,CPT,FLUOROSCOPY SPX <1 HOUR PHYSICIAN TIME,,,20 ,,RBRVS,0.17 ,2.10 ,2.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76000,CPT,FLUOROSCOPY SPX <1 HOUR PHYSICIAN TIME,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76000,CPT,FLUOROSCOPY SPX <1 HOUR PHYSICIAN TIME,TC,,20 ,,RBRVS,,2.03 ,2.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76001,CPT,FLUOROSCOPY SPX > 1 HOUR PHYSICIAN TIME,,,20 ,,RBRVS,0.67 ,3.29 ,3.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76001,CPT,FLUOROSCOPY SPX > 1 HOUR PHYSICIAN TIME,26,,20 ,,RBRVS,0.67 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76001,CPT,FLUOROSCOPY SPX > 1 HOUR PHYSICIAN TIME,TC,,20 ,,RBRVS,,2.99 ,2.99 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,76010,CPT,RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD,,,20 ,,RBRVS,0.18 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76010,CPT,RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD,,PC,20 ,,RBRVS,0.18 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,76010,CPT,RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD,,TC,20 ,,RBRVS,,0.54 ,0.54 ,,,$0.00,$0.00,1,1,1,0,1,0,20120101,76080,CPT,RADEX ABSCESS/FISTULA/SINUS TRACT RS&I,,,20 ,,RBRVS,0.54 ,1.27 ,1.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76080,CPT,RADEX ABSCESS/FISTULA/SINUS TRACT RS&I,,PC,20 ,,RBRVS,0.54 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,76080,CPT,RADEX ABSCESS/FISTULA/SINUS TRACT RS&I,,TC,20 ,,RBRVS,,1.04 ,1.04 ,,,$0.00,$0.00,1,1,1,0,1,0,20120101,76098,CPT,RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN,,,20 ,,RBRVS,0.16 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76098,CPT,RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN,,PC,20 ,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,76098,CPT,RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN,,TC,20 ,,RBRVS,,0.32 ,0.32 ,,,$0.00,$0.00,1,1,1,0,1,0,20120101,76100,CPT,RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY,,,20 ,,RBRVS,0.58 ,2.99 ,2.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76100,CPT,RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY,,PC,20 ,,RBRVS,0.58 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,76100,CPT,RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY,,TC,20 ,,RBRVS,,2.71 ,2.71 ,,,$0.00,$0.00,1,1,1,0,1,0,20120101,76101,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY UNI,,,20 ,,RBRVS,0.58 ,4.55 ,4.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76101,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY UNI,,PC,20 ,,RBRVS,0.58 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,76101,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY UNI,,TC,20 ,,RBRVS,,4.22 ,4.22 ,,,$0.00,$0.00,1,1,1,0,1,0,20120101,76102,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY BI,,,20 ,,RBRVS,0.58 ,6.32 ,6.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76102,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY BI,,PC,20 ,,RBRVS,0.58 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,76102,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY BI,,TC,20 ,,RBRVS,,5.99 ,5.99 ,,,$0.00,$0.00,1,1,1,0,1,0,20120101,76120,CPT,CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC,,,20 ,,RBRVS,0.38 ,1.85 ,1.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76120,CPT,CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC,,PC,20 ,,RBRVS,0.38 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,76120,CPT,CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC,,TC,20 ,,RBRVS,,1.70 ,1.70 ,,,$0.00,$0.00,1,1,1,0,1,0,20120101,76125,CPT,CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION,,,20 ,,TotalUnits,,,,1.22 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,76125,CPT,CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION,,PC,20 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,76125,CPT,CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION,,TC,20 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,0,0,1,0,20120101,76140,CPT,CONSLTJ X-RAY XM MADE ELSEWHERE WRTTN REPRT,,,20 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,76376,CPT,3D RENDERING W/INTERP CT/MRI/US/OTHER TOMOGRAPHY,,,20 ,,RBRVS,0.20 ,1.90 ,1.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76376,CPT,3D RENDERING W/INTERP CT/MRI/US/OTHER TOMOGRAPHY,26,,20 ,,RBRVS,0.20 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76376,CPT,3D RENDERING W/INTERP CT/MRI/US/OTHER TOMOGRAPHY,TC,,20 ,,RBRVS,,1.81 ,1.81 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,76377,CPT,3D RENDER W/INTERP CT/MRI/US/OTH TOMO W/POSTPROC,,,20 ,,RBRVS,0.79 ,1.92 ,1.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76377,CPT,3D RENDER W/INTERP CT/MRI/US/OTH TOMO W/POSTPROC,26,,20 ,,RBRVS,0.79 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76377,CPT,3D RENDER W/INTERP CT/MRI/US/OTH TOMO W/POSTPROC,TC,,20 ,,RBRVS,,1.59 ,1.59 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,76380,CPT,CT LIMITED/LOCALIZED FOLLOW UP STUDY,,,20 ,,RBRVS,0.98 ,4.57 ,4.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76380,CPT,CT LIMITED/LOCALIZED FOLLOW UP STUDY,26,,20 ,,RBRVS,0.98 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76380,CPT,CT LIMITED/LOCALIZED FOLLOW UP STUDY,TC,,20 ,,RBRVS,,4.16 ,4.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76390,CPT,MRI SPECTROSCOPY,,,20 ,,RBRVS,1.40 ,12.50 ,12.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76390,CPT,MRI SPECTROSCOPY,26,,20 ,,RBRVS,1.40 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76390,CPT,MRI SPECTROSCOPY,TC,,20 ,,RBRVS,,11.91 ,11.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76496,CPT,UNLISTED FLUOROSCOPIC PROCEDURE,,,20 ,,TotalUnits,,,,2.03 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,76496,CPT,UNLISTED FLUOROSCOPIC PROCEDURE,26,,20 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,76496,CPT,UNLISTED FLUOROSCOPIC PROCEDURE,TC,,20 ,,TotalUnits,,,,1.85 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,76497,CPT,UNLISTED COMPUTED TOMOGRAPHY PROCEDURE,,,20 ,,TotalUnits,,,,5.69 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,76497,CPT,UNLISTED COMPUTED TOMOGRAPHY PROCEDURE,26,,20 ,,TotalUnits,,,,1.64 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,76497,CPT,UNLISTED COMPUTED TOMOGRAPHY PROCEDURE,TC,,20 ,,TotalUnits,,,,4.05 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,76498,CPT,UNLISTED MAGNETIC RESONANCE PROCEDURE,,,20 ,,TotalUnits,,,,8.10 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,76498,CPT,UNLISTED MAGNETIC RESONANCE PROCEDURE,26,,20 ,,TotalUnits,,,,1.17 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,76498,CPT,UNLISTED MAGNETIC RESONANCE PROCEDURE,TC,,20 ,,TotalUnits,,,,6.93 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,76499,CPT,UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE,,,20 ,,TotalUnits,,,,1.93 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,76499,CPT,UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE,26,,20 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,76499,CPT,UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE,TC,,20 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,76506,CPT,ECHOENCEPHALOGRAPY REAL TIME IMAGING,,,20 ,,RBRVS,0.63 ,2.89 ,2.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76506,CPT,ECHOENCEPHALOGRAPY REAL TIME IMAGING,26,,20 ,,RBRVS,0.63 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76506,CPT,ECHOENCEPHALOGRAPY REAL TIME IMAGING,TC,,20 ,,RBRVS,,2.63 ,2.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76510,CPT,OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR,,,20 ,,RBRVS,1.55 ,3.11 ,3.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76510,CPT,OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR,26,,20 ,,RBRVS,1.55 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76510,CPT,OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR,TC,,20 ,,RBRVS,,2.18 ,2.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76511,CPT,OPHTHALMIC ULTRASOUND DX QUAN A-SCAN ONLY,,,20 ,,RBRVS,0.94 ,1.97 ,1.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76511,CPT,OPHTHALMIC ULTRASOUND DX QUAN A-SCAN ONLY,26,,20 ,,RBRVS,0.94 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76511,CPT,OPHTHALMIC ULTRASOUND DX QUAN A-SCAN ONLY,TC,,20 ,,RBRVS,,1.42 ,1.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76512,CPT,OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN,,,20 ,,RBRVS,0.94 ,1.73 ,1.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76512,CPT,OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN,26,,20 ,,RBRVS,0.94 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76512,CPT,OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN,TC,,20 ,,RBRVS,,1.18 ,1.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76513,CPT,OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM,,,20 ,,RBRVS,0.66 ,1.91 ,1.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76513,CPT,OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM,26,,20 ,,RBRVS,0.66 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76513,CPT,OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM,TC,,20 ,,RBRVS,,1.58 ,1.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76514,CPT,OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI,,,20 ,,RBRVS,0.17 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76514,CPT,OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI,26,,20 ,,RBRVS,0.17 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76514,CPT,OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI,TC,,20 ,,RBRVS,,0.12 ,0.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76516,CPT,OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN,,,20 ,,RBRVS,0.54 ,1.56 ,1.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76516,CPT,OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN,26,,20 ,,RBRVS,0.54 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76516,CPT,OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN,TC,,20 ,,RBRVS,,1.25 ,1.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76519,CPT,OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL,,,20 ,,RBRVS,0.54 ,1.72 ,1.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76519,CPT,OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL,26,,20 ,,RBRVS,0.54 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76519,CPT,OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL,TC,,20 ,,RBRVS,,1.40 ,1.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76529,CPT,OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION,,,20 ,,RBRVS,0.57 ,1.56 ,1.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76529,CPT,OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION,26,,20 ,,RBRVS,0.57 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76529,CPT,OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION,TC,,20 ,,RBRVS,,1.22 ,1.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76536,CPT,US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCMTN,,,20 ,,RBRVS,0.56 ,2.90 ,2.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76536,CPT,US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCMTN,26,,20 ,,RBRVS,0.56 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76536,CPT,US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCMTN,TC,,20 ,,RBRVS,,2.67 ,2.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76604,CPT,US CHEST REAL TIME W/IMAGE DOCUMENTATION,,,20 ,,RBRVS,0.55 ,2.01 ,2.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76604,CPT,US CHEST REAL TIME W/IMAGE DOCUMENTATION,26,,20 ,,RBRVS,0.55 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76604,CPT,US CHEST REAL TIME W/IMAGE DOCUMENTATION,TC,,20 ,,RBRVS,,1.79 ,1.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76645,CPT,US BREAST REAL TIME W/IMAGE DOCUMENTATION,,,20 ,,RBRVS,0.54 ,2.25 ,2.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76645,CPT,US BREAST REAL TIME W/IMAGE DOCUMENTATION,26,,20 ,,RBRVS,0.54 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76645,CPT,US BREAST REAL TIME W/IMAGE DOCUMENTATION,TC,,20 ,,RBRVS,,2.03 ,2.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76700,CPT,US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION,,,20 ,,RBRVS,0.81 ,3.30 ,3.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76700,CPT,US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION,26,,20 ,,RBRVS,0.81 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76700,CPT,US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION,TC,,20 ,,RBRVS,,2.97 ,2.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76705,CPT,ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED,,,20 ,,RBRVS,0.59 ,2.53 ,2.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76705,CPT,ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED,26,,20 ,,RBRVS,0.59 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76705,CPT,ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED,TC,,20 ,,RBRVS,,2.29 ,2.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76770,CPT,US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE,,,20 ,,RBRVS,0.74 ,3.16 ,3.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76770,CPT,US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE,26,,20 ,,RBRVS,0.74 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76770,CPT,US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE,TC,,20 ,,RBRVS,,2.86 ,2.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76775,CPT,US RETROPERITONEAL REAL TIME W/IMAGE LIMITED,,,20 ,,RBRVS,0.58 ,2.68 ,2.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76775,CPT,US RETROPERITONEAL REAL TIME W/IMAGE LIMITED,26,,20 ,,RBRVS,0.58 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76775,CPT,US RETROPERITONEAL REAL TIME W/IMAGE LIMITED,TC,,20 ,,RBRVS,,2.43 ,2.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76776,CPT,US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN,,,20 ,,RBRVS,0.76 ,3.67 ,3.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76776,CPT,US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN,26,,20 ,,RBRVS,0.76 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76776,CPT,US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN,TC,,20 ,,RBRVS,,3.36 ,3.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76800,CPT,ULTRASOUND SPINAL CANAL & CONTENTS,,,20 ,,RBRVS,1.13 ,2.76 ,2.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76800,CPT,ULTRASOUND SPINAL CANAL & CONTENTS,26,,20 ,,RBRVS,1.13 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76800,CPT,ULTRASOUND SPINAL CANAL & CONTENTS,TC,,20 ,,RBRVS,,2.31 ,2.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76801,CPT,US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT,,,20 ,,RBRVS,0.99 ,2.82 ,2.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76801,CPT,US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT,26,,20 ,,RBRVS,0.99 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76801,CPT,US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT,TC,,20 ,,RBRVS,,2.40 ,2.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76802,CPT,US PREG UTERUS 14 WK TRANSABDL EACH GESTATION,,,20 ,,RBRVS,0.83 ,1.20 ,1.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76802,CPT,US PREG UTERUS 14 WK TRANSABDL EACH GESTATION,26,,20 ,,RBRVS,0.83 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76802,CPT,US PREG UTERUS 14 WK TRANSABDL EACH GESTATION,TC,,20 ,,RBRVS,,0.85 ,0.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76805,CPT,US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION,,,20 ,,RBRVS,0.99 ,3.38 ,3.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76805,CPT,US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION,26,,20 ,,RBRVS,0.99 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76805,CPT,US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION,TC,,20 ,,RBRVS,,2.96 ,2.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76810,CPT,US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATION,,,20 ,,RBRVS,0.98 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76810,CPT,US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATION,26,,20 ,,RBRVS,0.98 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76810,CPT,US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATION,TC,,20 ,,RBRVS,,1.46 ,1.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76811,CPT,US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION,,,20 ,,RBRVS,1.90 ,3.75 ,3.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76811,CPT,US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION,26,,20 ,,RBRVS,1.90 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76811,CPT,US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION,TC,,20 ,,RBRVS,,2.94 ,2.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76812,CPT,US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT,,,20 ,,RBRVS,1.78 ,4.21 ,4.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76812,CPT,US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT,26,,20 ,,RBRVS,1.78 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76812,CPT,US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT,TC,,20 ,,RBRVS,,3.46 ,3.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76813,CPT,US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION,,,20 ,,RBRVS,1.18 ,2.52 ,2.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76813,CPT,US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION,26,,20 ,,RBRVS,1.18 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76813,CPT,US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION,TC,,20 ,,RBRVS,,2.03 ,2.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76814,CPT,US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION,,,20 ,,RBRVS,0.99 ,1.36 ,1.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76814,CPT,US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION,26,,20 ,,RBRVS,0.99 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76814,CPT,US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION,TC,,20 ,,RBRVS,,0.95 ,0.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76815,CPT,US PREGNANT UTERUS LIMITED 1/> FETUSES,,,20 ,,RBRVS,0.65 ,2.03 ,2.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76815,CPT,US PREGNANT UTERUS LIMITED 1/> FETUSES,26,,20 ,,RBRVS,0.65 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76815,CPT,US PREGNANT UTERUS LIMITED 1/> FETUSES,TC,,20 ,,RBRVS,,1.76 ,1.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76816,CPT,US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS,,,20 ,,RBRVS,0.85 ,2.57 ,2.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76816,CPT,US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS,26,,20 ,,RBRVS,0.85 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76816,CPT,US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS,TC,,20 ,,RBRVS,,2.21 ,2.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76817,CPT,US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG,,,20 ,,RBRVS,0.75 ,2.27 ,2.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76817,CPT,US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG,26,,20 ,,RBRVS,0.75 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76817,CPT,US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG,TC,,20 ,,RBRVS,,1.96 ,1.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76818,CPT,FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING,,,20 ,,RBRVS,1.05 ,2.53 ,2.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76818,CPT,FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING,26,,20 ,,RBRVS,1.05 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76818,CPT,FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING,TC,,20 ,,RBRVS,,2.08 ,2.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76819,CPT,FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING,,,20 ,,RBRVS,0.77 ,1.91 ,1.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76819,CPT,FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING,26,,20 ,,RBRVS,0.77 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76819,CPT,FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING,TC,,20 ,,RBRVS,,1.58 ,1.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76820,CPT,DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY,,,20 ,,RBRVS,0.50 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76820,CPT,DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY,26,,20 ,,RBRVS,0.50 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76820,CPT,DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY,TC,,20 ,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76821,CPT,DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART,,,20 ,,RBRVS,0.70 ,2.14 ,2.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76821,CPT,DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART,26,,20 ,,RBRVS,0.70 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76821,CPT,DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART,TC,,20 ,,RBRVS,,1.84 ,1.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76825,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING,,,20 ,,RBRVS,1.67 ,4.70 ,4.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76825,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING,26,,20 ,,RBRVS,1.67 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76825,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING,TC,,20 ,,RBRVS,,4.00 ,4.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76826,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD,,,20 ,,RBRVS,0.83 ,2.83 ,2.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76826,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD,26,,20 ,,RBRVS,0.83 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76826,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD,TC,,20 ,,RBRVS,,2.49 ,2.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76827,CPT,DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE,,,20 ,,RBRVS,0.58 ,1.36 ,1.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76827,CPT,DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE,26,,20 ,,RBRVS,0.58 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76827,CPT,DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE,TC,,20 ,,RBRVS,,1.12 ,1.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76828,CPT,DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT,,,20 ,,RBRVS,0.56 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76828,CPT,DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT,26,,20 ,,RBRVS,0.56 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76828,CPT,DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT,TC,,20 ,,RBRVS,,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76830,CPT,ULTRASOUND TRANSVAGINAL,,,20 ,,RBRVS,0.69 ,2.97 ,2.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76830,CPT,ULTRASOUND TRANSVAGINAL,26,,20 ,,RBRVS,0.69 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76830,CPT,ULTRASOUND TRANSVAGINAL,TC,,20 ,,RBRVS,,2.68 ,2.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76831,CPT,SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER,,,20 ,,RBRVS,0.72 ,2.95 ,2.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76831,CPT,SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER,26,,20 ,,RBRVS,0.72 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76831,CPT,SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER,TC,,20 ,,RBRVS,,2.65 ,2.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76856,CPT,US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE,,,20 ,,RBRVS,0.69 ,2.96 ,2.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76856,CPT,US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE,26,,20 ,,RBRVS,0.69 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76856,CPT,US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE,TC,,20 ,,RBRVS,,2.67 ,2.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76857,CPT,US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U,,,20 ,,RBRVS,0.38 ,2.58 ,2.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76857,CPT,US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U,26,,20 ,,RBRVS,0.38 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76857,CPT,US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U,TC,,20 ,,RBRVS,,2.41 ,2.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76870,CPT,ULTRASOUND SCROTUM & CONTENTS,,,20 ,,RBRVS,0.64 ,2.98 ,2.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76870,CPT,ULTRASOUND SCROTUM & CONTENTS,26,,20 ,,RBRVS,0.64 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76870,CPT,ULTRASOUND SCROTUM & CONTENTS,TC,,20 ,,RBRVS,,2.71 ,2.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76872,CPT,ULTRASOUND TRANSRECTAL,,,20 ,,RBRVS,0.69 ,3.42 ,3.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76872,CPT,ULTRASOUND TRANSRECTAL,26,,20 ,,RBRVS,0.69 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76872,CPT,ULTRASOUND TRANSRECTAL,TC,,20 ,,RBRVS,,3.11 ,3.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76873,CPT,US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX,,,20 ,,RBRVS,1.55 ,3.63 ,3.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76873,CPT,US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX,26,,20 ,,RBRVS,1.55 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76873,CPT,US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX,TC,,20 ,,RBRVS,,2.96 ,2.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76881,CPT,US EXTREMITY NON-VASC REAL-TIME IMG COMPL,,,20 ,,RBRVS,0.59 ,2.75 ,2.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76881,CPT,US EXTREMITY NON-VASC REAL-TIME IMG COMPL,26,,20 ,,RBRVS,0.59 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76881,CPT,US EXTREMITY NON-VASC REAL-TIME IMG COMPL,TC,,20 ,,RBRVS,,2.53 ,2.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76882,CPT,US EXTREMITY NON-VASC REAL-TIME IMG LMTD,,,20 ,,RBRVS,0.41 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76882,CPT,US EXTREMITY NON-VASC REAL-TIME IMG LMTD,26,,20 ,,RBRVS,0.41 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76882,CPT,US EXTREMITY NON-VASC REAL-TIME IMG LMTD,TC,,20 ,,RBRVS,,0.29 ,0.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76885,CPT,US INFT HIPS R-T IMG DYNAMIC REQ PHYS MANJ,,,20 ,,RBRVS,0.74 ,3.51 ,3.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76885,CPT,US INFT HIPS R-T IMG DYNAMIC REQ PHYS MANJ,26,,20 ,,RBRVS,0.74 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76885,CPT,US INFT HIPS R-T IMG DYNAMIC REQ PHYS MANJ,TC,,20 ,,RBRVS,,3.20 ,3.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76886,CPT,US INFT HIPS R-T IMG LMTD STATIC X PHYS MANJ,,,20 ,,RBRVS,0.62 ,2.77 ,2.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76886,CPT,US INFT HIPS R-T IMG LMTD STATIC X PHYS MANJ,26,,20 ,,RBRVS,0.62 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76886,CPT,US INFT HIPS R-T IMG LMTD STATIC X PHYS MANJ,TC,,20 ,,RBRVS,,2.49 ,2.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76930,CPT,US GUIDANCE PERICARDIOCENTESIS RS&I,,,20 ,,RBRVS,0.67 ,1.99 ,1.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76930,CPT,US GUIDANCE PERICARDIOCENTESIS RS&I,26,,20 ,,RBRVS,0.67 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76930,CPT,US GUIDANCE PERICARDIOCENTESIS RS&I,TC,,20 ,,RBRVS,,1.67 ,1.67 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,76932,CPT,US ENDOMYOCARDIAL BIOPSY RS&I,,,20 ,,TotalUnits,,,,2.74 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,76932,CPT,US ENDOMYOCARDIAL BIOPSY RS&I,26,,20 ,,TotalUnits,,,,1.00 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,76932,CPT,US ENDOMYOCARDIAL BIOPSY RS&I,TC,,20 ,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,76936,CPT,US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,,,20 ,,RBRVS,1.99 ,6.95 ,6.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76936,CPT,US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,26,,20 ,,RBRVS,1.99 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76936,CPT,US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,TC,,20 ,,RBRVS,,6.15 ,6.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76937,CPT,US VASC ACCESS SITS VSL PATENCY NDL ENTRY,,,20 ,,RBRVS,0.30 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76937,CPT,US VASC ACCESS SITS VSL PATENCY NDL ENTRY,26,,20 ,,RBRVS,0.30 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76937,CPT,US VASC ACCESS SITS VSL PATENCY NDL ENTRY,TC,,20 ,,RBRVS,,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,76940,CPT,US &MNTR PARENCHYMAL TISSUE ABLATION,,,20 ,,TotalUnits,,,,4.76 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,76940,CPT,US &MNTR PARENCHYMAL TISSUE ABLATION,26,,20 ,,TotalUnits,,,,2.97 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,76940,CPT,US &MNTR PARENCHYMAL TISSUE ABLATION,TC,,20 ,,TotalUnits,,,,1.79 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,76941,CPT,US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I,,,20 ,,TotalUnits,,,,2.65 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,76941,CPT,US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I,26,,20 ,,TotalUnits,,,,1.71 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,76941,CPT,US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I,TC,,20 ,,TotalUnits,,,,0.94 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,76942,CPT,US GUIDANCE NEEDLE PLACEMENT RS&I,,,20 ,,RBRVS,0.67 ,5.11 ,5.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76942,CPT,US GUIDANCE NEEDLE PLACEMENT RS&I,26,,20 ,,RBRVS,0.67 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76942,CPT,US GUIDANCE NEEDLE PLACEMENT RS&I,TC,,20 ,,RBRVS,,4.83 ,4.83 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,76945,CPT,US GUIDANCE CHORIONIC VILLUS SAMPLING RS&I,,,20 ,,TotalUnits,,,,2.71 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,76945,CPT,US GUIDANCE CHORIONIC VILLUS SAMPLING RS&I,26,,20 ,,TotalUnits,,,,0.96 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,76945,CPT,US GUIDANCE CHORIONIC VILLUS SAMPLING RS&I,TC,,20 ,,TotalUnits,,,,1.75 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,76946,CPT,US GUIDANCE AMNIOCENTESIS RS&I,,,20 ,,RBRVS,0.38 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76946,CPT,US GUIDANCE AMNIOCENTESIS RS&I,26,,20 ,,RBRVS,0.38 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76946,CPT,US GUIDANCE AMNIOCENTESIS RS&I,TC,,20 ,,RBRVS,,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,76948,CPT,US GUIDANCE ASPIRATION OVA RS&I,,,20 ,,RBRVS,0.38 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76948,CPT,US GUIDANCE ASPIRATION OVA RS&I,26,,20 ,,RBRVS,0.38 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76948,CPT,US GUIDANCE ASPIRATION OVA RS&I,TC,,20 ,,RBRVS,,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,76950,CPT,US GUIDANCE PLACEMENT RADIATION THERAPY FIELDS,,,20 ,,RBRVS,0.58 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76950,CPT,US GUIDANCE PLACEMENT RADIATION THERAPY FIELDS,26,,20 ,,RBRVS,0.58 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76950,CPT,US GUIDANCE PLACEMENT RADIATION THERAPY FIELDS,TC,,20 ,,RBRVS,,1.17 ,1.17 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,76965,CPT,US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION,,,20 ,,RBRVS,1.34 ,2.06 ,2.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76965,CPT,US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION,26,,20 ,,RBRVS,1.34 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76965,CPT,US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION,TC,,20 ,,RBRVS,,1.47 ,1.47 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,76970,CPT,US STUDY FOLLOW UP,,,20 ,,RBRVS,0.40 ,2.39 ,2.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76970,CPT,US STUDY FOLLOW UP,26,,20 ,,RBRVS,0.40 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76970,CPT,US STUDY FOLLOW UP,TC,,20 ,,RBRVS,,2.23 ,2.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76975,CPT,GI ENDOSCOPIC ULTRASOUND RS&I,,,20 ,,TotalUnits,,,,4.54 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,76975,CPT,GI ENDOSCOPIC ULTRASOUND RS&I,26,,20 ,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,76975,CPT,GI ENDOSCOPIC ULTRASOUND RS&I,TC,,20 ,,TotalUnits,,,,3.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,76977,CPT,US BONE DENSITY MEAS & INTERP PERIPH ANY METHOD,,,20 ,,RBRVS,0.05 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76977,CPT,US BONE DENSITY MEAS & INTERP PERIPH ANY METHOD,26,,20 ,,RBRVS,0.05 ,0.02 ,0.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76977,CPT,US BONE DENSITY MEAS & INTERP PERIPH ANY METHOD,TC,,20 ,,RBRVS,,0.22 ,0.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,76998,CPT,ULTRASONIC GUIDANCE INTRAOPERATIVE,,,20 ,,RBRVS,1.20 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,76998,CPT,ULTRASONIC GUIDANCE INTRAOPERATIVE,26,,20 ,,RBRVS,1.20 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,76999,CPT,UNLISTED ULTRASOUND PROCEDURE,,,20 ,,TotalUnits,,,,1.99 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,76999,CPT,UNLISTED ULTRASOUND PROCEDURE,,PC,20 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,76999,CPT,UNLISTED ULTRASOUND PROCEDURE,,TC,20 ,,TotalUnits,,,,1.51 ,,$0.00,$0.00,1,1,1,0,1,0,20120101,77001,CPT,FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT,,,20 ,,RBRVS,0.38 ,2.96 ,2.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77001,CPT,FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT,26,,20 ,,RBRVS,0.38 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77001,CPT,FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT,TC,,20 ,,RBRVS,,2.80 ,2.80 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,77002,CPT,FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT,,,20 ,,RBRVS,0.54 ,1.65 ,1.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77002,CPT,FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT,26,,20 ,,RBRVS,0.54 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77002,CPT,FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT,TC,,20 ,,RBRVS,,1.41 ,1.41 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,77003,CPT,FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER,,,20 ,,RBRVS,0.60 ,1.20 ,1.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77003,CPT,FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER,26,,20 ,,RBRVS,0.60 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77003,CPT,FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER,TC,,20 ,,RBRVS,,0.96 ,0.96 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,77011,CPT,CT GUIDANCE STEREOTACTIC LOCALIZATION,,,20 ,,RBRVS,1.21 ,12.98 ,12.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77011,CPT,CT GUIDANCE STEREOTACTIC LOCALIZATION,,PC,20 ,,RBRVS,1.21 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,77011,CPT,CT GUIDANCE STEREOTACTIC LOCALIZATION,,TC,20 ,,RBRVS,,12.44 ,12.44 ,,,$0.00,$0.00,1,1,0,0,1,0,20120101,77012,CPT,CT GUIDANCE NEEDLE PLACEMENT,,,20 ,,RBRVS,1.16 ,3.61 ,3.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77012,CPT,CT GUIDANCE NEEDLE PLACEMENT,,PC,20 ,,RBRVS,1.16 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,77012,CPT,CT GUIDANCE NEEDLE PLACEMENT,,TC,20 ,,RBRVS,,3.13 ,3.13 ,,,$0.00,$0.00,1,1,0,0,1,0,20120101,77013,CPT,CT GUIDANCE &MONITORING VISC TISS ABLATION,,,20 ,,TotalUnits,,,,24.50 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,77013,CPT,CT GUIDANCE &MONITORING VISC TISS ABLATION,,PC,20 ,,TotalUnits,,,,5.64 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,77013,CPT,CT GUIDANCE &MONITORING VISC TISS ABLATION,,TC,20 ,,TotalUnits,,,,18.86 ,,$0.00,$0.00,1,1,0,0,1,0,20120101,77014,CPT,CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT,,,20 ,,RBRVS,0.85 ,4.75 ,4.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77014,CPT,CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT,,PC,20 ,,RBRVS,0.85 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,77014,CPT,CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT,,TC,20 ,,RBRVS,,4.39 ,4.39 ,,,$0.00,$0.00,1,1,0,0,1,0,20120101,77021,CPT,MR GUIDANCE NEEDLE PLACEMENT,,,20 ,,RBRVS,1.50 ,11.16 ,11.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77021,CPT,MR GUIDANCE NEEDLE PLACEMENT,26,,20 ,,RBRVS,1.50 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77021,CPT,MR GUIDANCE NEEDLE PLACEMENT,TC,,20 ,,RBRVS,,10.54 ,10.54 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,77022,CPT,MR GUIDANCE &MONITORING TISSUE ABLATION,,,20 ,,TotalUnits,,,,29.66 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,77022,CPT,MR GUIDANCE &MONITORING TISSUE ABLATION,26,,20 ,,TotalUnits,,,,5.97 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,77022,CPT,MR GUIDANCE &MONITORING TISSUE ABLATION,TC,,20 ,,TotalUnits,,,,23.69 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,77031,CPT,STRTCTC LOCLZJ GID BREAST BX/NEEDLE PLACEMENT,,,20 ,,RBRVS,1.59 ,3.04 ,3.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77031,CPT,STRTCTC LOCLZJ GID BREAST BX/NEEDLE PLACEMENT,26,,20 ,,RBRVS,1.59 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77031,CPT,STRTCTC LOCLZJ GID BREAST BX/NEEDLE PLACEMENT,TC,,20 ,,RBRVS,,2.39 ,2.39 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,77032,CPT,MAMMOGRAPHIC GID NEEDLE PLACEMENTT BREAST,,,20 ,,RBRVS,0.56 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77032,CPT,MAMMOGRAPHIC GID NEEDLE PLACEMENTT BREAST,26,,20 ,,RBRVS,0.56 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77032,CPT,MAMMOGRAPHIC GID NEEDLE PLACEMENTT BREAST,TC,,20 ,,RBRVS,,0.82 ,0.82 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,77051,CPT,COMPUTER-AIDED DETECTION DX MAMMOGRAPHY,,,20 ,,RBRVS,0.06 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77051,CPT,COMPUTER-AIDED DETECTION DX MAMMOGRAPHY,26,,20 ,,RBRVS,0.06 ,0.02 ,0.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77051,CPT,COMPUTER-AIDED DETECTION DX MAMMOGRAPHY,TC,,20 ,,RBRVS,,0.24 ,0.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77052,CPT,COMPUTER-AIDED DETECTION SCREENING MAMMOGRAPHY,,,20 ,,RBRVS,0.06 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77052,CPT,COMPUTER-AIDED DETECTION SCREENING MAMMOGRAPHY,26,,20 ,,RBRVS,0.06 ,0.02 ,0.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77052,CPT,COMPUTER-AIDED DETECTION SCREENING MAMMOGRAPHY,TC,,20 ,,RBRVS,,0.24 ,0.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77053,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE,,,20 ,,RBRVS,0.36 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77053,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE,26,,20 ,,RBRVS,0.36 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77053,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE,TC,,20 ,,RBRVS,,1.47 ,1.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77054,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE,,,20 ,,RBRVS,0.45 ,2.22 ,2.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77054,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE,26,,20 ,,RBRVS,0.45 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77054,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE,TC,,20 ,,RBRVS,,2.03 ,2.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77055,CPT,MAMMOGRAPHY UNILATERAL,,,20 ,,RBRVS,0.70 ,1.80 ,1.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77055,CPT,MAMMOGRAPHY UNILATERAL,26,,20 ,,RBRVS,0.70 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77055,CPT,MAMMOGRAPHY UNILATERAL,TC,,20 ,,RBRVS,,1.51 ,1.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77056,CPT,MAMMOGRAPHY BILATERAL,,,20 ,,RBRVS,0.87 ,2.33 ,2.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77056,CPT,MAMMOGRAPHY BILATERAL,26,,20 ,,RBRVS,0.87 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77056,CPT,MAMMOGRAPHY BILATERAL,TC,,20 ,,RBRVS,,1.97 ,1.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77057,CPT,SCREENING MAMMOGRAPHY BILATERAL,,,20 ,,RBRVS,0.70 ,1.64 ,1.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77057,CPT,SCREENING MAMMOGRAPHY BILATERAL,26,,20 ,,RBRVS,0.70 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77057,CPT,SCREENING MAMMOGRAPHY BILATERAL,TC,,20 ,,RBRVS,,1.35 ,1.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77058,CPT,MRI BREAST UNILATERAL,,,20 ,,RBRVS,1.63 ,20.59 ,20.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77058,CPT,MRI BREAST UNILATERAL,26,,20 ,,RBRVS,1.63 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77058,CPT,MRI BREAST UNILATERAL,TC,,20 ,,RBRVS,,19.92 ,19.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77059,CPT,MRI BREAST BILATERAL,,,20 ,,RBRVS,1.63 ,21.43 ,21.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77059,CPT,MRI BREAST BILATERAL,26,,20 ,,RBRVS,1.63 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77059,CPT,MRI BREAST BILATERAL,TC,,20 ,,RBRVS,,20.76 ,20.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77071,CPT,MANUAL APPL STRESS PFRMD PHYS JOINT RADIOGRAPHY,,PC,20 ,,RBRVS,0.41 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77072,CPT,BONE AGE STUDIES,,,20 ,,RBRVS,0.19 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77072,CPT,BONE AGE STUDIES,26,,20 ,,RBRVS,0.19 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77072,CPT,BONE AGE STUDIES,TC,,20 ,,RBRVS,,0.41 ,0.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77073,CPT,BONE LENGTH STUDIES,,,20 ,,RBRVS,0.27 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77073,CPT,BONE LENGTH STUDIES,26,,20 ,,RBRVS,0.27 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77073,CPT,BONE LENGTH STUDIES,TC,,20 ,,RBRVS,,0.71 ,0.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77074,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED,,,20 ,,RBRVS,0.45 ,1.58 ,1.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77074,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED,26,,20 ,,RBRVS,0.45 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77074,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED,TC,,20 ,,RBRVS,,1.39 ,1.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77075,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL,,,20 ,,RBRVS,0.54 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77075,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL,26,,20 ,,RBRVS,0.54 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77075,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL,TC,,20 ,,RBRVS,,2.24 ,2.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77076,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT,,,20 ,,RBRVS,0.70 ,2.22 ,2.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77076,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT,26,,20 ,,RBRVS,0.70 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77076,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT,TC,,20 ,,RBRVS,,1.95 ,1.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77077,CPT,JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS,,,20 ,,RBRVS,0.31 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77077,CPT,JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS,26,,20 ,,RBRVS,0.31 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77077,CPT,JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS,TC,,20 ,,RBRVS,,0.75 ,0.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77078,CPT,CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKEL,,,20 ,,RBRVS,0.25 ,4.38 ,4.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77078,CPT,CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKEL,26,,20 ,,RBRVS,0.25 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77078,CPT,CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKEL,TC,,20 ,,RBRVS,,4.28 ,4.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77080,CPT,DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL,,,20 ,,RBRVS,0.23 ,2.50 ,2.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77080,CPT,DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL,26,,20 ,,RBRVS,0.23 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77080,CPT,DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL,TC,,20 ,,RBRVS,,2.42 ,2.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77081,CPT,DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL,,,20 ,,RBRVS,0.22 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77081,CPT,DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL,26,,20 ,,RBRVS,0.22 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77081,CPT,DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL,TC,,20 ,,RBRVS,,0.55 ,0.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77082,CPT,DXA BONE DENSITY STUDY VERTEBRAL FRACTURE,,,20 ,,RBRVS,0.13 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77082,CPT,DXA BONE DENSITY STUDY VERTEBRAL FRACTURE,26,,20 ,,RBRVS,0.13 ,0.05 ,0.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77082,CPT,DXA BONE DENSITY STUDY VERTEBRAL FRACTURE,TC,,20 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77084,CPT,BONE MARROW BLOOD SUPPLY,,,20 ,,RBRVS,1.60 ,13.88 ,13.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77084,CPT,BONE MARROW BLOOD SUPPLY,26,,20 ,,RBRVS,1.60 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77084,CPT,BONE MARROW BLOOD SUPPLY,TC,,20 ,,RBRVS,,13.21 ,13.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77261,CPT,THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE,,PC,20 ,,RBRVS,1.39 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77262,CPT,THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE,,PC,20 ,,RBRVS,2.11 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77263,CPT,THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX,,PC,20 ,,RBRVS,3.14 ,1.36 ,1.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77280,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE,,,20 ,,RBRVS,0.70 ,4.82 ,4.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77280,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE,26,,20 ,,RBRVS,0.70 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77280,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE,TC,,20 ,,RBRVS,,4.52 ,4.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77285,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED,,,20 ,,RBRVS,1.05 ,8.64 ,8.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77285,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED,26,,20 ,,RBRVS,1.05 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77285,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED,TC,,20 ,,RBRVS,,8.19 ,8.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77290,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX,,,20 ,,RBRVS,1.56 ,13.96 ,13.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77290,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX,26,,20 ,,RBRVS,1.56 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77290,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX,TC,,20 ,,RBRVS,,13.29 ,13.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77295,CPT,THER RAD SIMULAJ-AIDED FLD SETTING 3-DIMENSIONAL,,,20 ,,RBRVS,4.56 ,11.78 ,11.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77295,CPT,THER RAD SIMULAJ-AIDED FLD SETTING 3-DIMENSIONAL,26,,20 ,,RBRVS,4.56 ,1.95 ,1.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77295,CPT,THER RAD SIMULAJ-AIDED FLD SETTING 3-DIMENSIONAL,TC,,20 ,,RBRVS,,9.83 ,9.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77299,CPT,UNLIS PX THER RADIOL CLINICAL TX PLANNING,,,20 ,,TotalUnits,,,,12.06 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,77299,CPT,UNLIS PX THER RADIOL CLINICAL TX PLANNING,26,,20 ,,TotalUnits,,,,2.23 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,77299,CPT,UNLIS PX THER RADIOL CLINICAL TX PLANNING,TC,,20 ,,TotalUnits,,,,9.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,77300,CPT,BASIC RADIATION DOSIMETRY CALCULATION,,,20 ,,RBRVS,0.62 ,1.40 ,1.40 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77300,CPT,BASIC RADIATION DOSIMETRY CALCULATION,26,,20 ,,RBRVS,0.62 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77300,CPT,BASIC RADIATION DOSIMETRY CALCULATION,TC,,20 ,,RBRVS,,1.13 ,1.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77301,CPT,NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS,,,20 ,,RBRVS,7.99 ,52.84 ,52.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77301,CPT,NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS,26,,20 ,,RBRVS,7.99 ,3.42 ,3.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77301,CPT,NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS,TC,,20 ,,RBRVS,,49.42 ,49.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77305,CPT,TELETHERAPY ISODOSE PLAN SIMPLE,,,20 ,,RBRVS,0.70 ,1.22 ,1.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77305,CPT,TELETHERAPY ISODOSE PLAN SIMPLE,26,,20 ,,RBRVS,0.70 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77305,CPT,TELETHERAPY ISODOSE PLAN SIMPLE,TC,,20 ,,RBRVS,,0.92 ,0.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77310,CPT,TELETHERAPY ISODOSE PLAN INTERMEDIATE,,,20 ,,RBRVS,1.05 ,1.66 ,1.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77310,CPT,TELETHERAPY ISODOSE PLAN INTERMEDIATE,26,,20 ,,RBRVS,1.05 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77310,CPT,TELETHERAPY ISODOSE PLAN INTERMEDIATE,TC,,20 ,,RBRVS,,1.21 ,1.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77315,CPT,TELETHERAPY ISODOSE PLAN COMPLETE,,,20 ,,RBRVS,1.56 ,2.56 ,2.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77315,CPT,TELETHERAPY ISODOSE PLAN COMPLETE,26,,20 ,,RBRVS,1.56 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77315,CPT,TELETHERAPY ISODOSE PLAN COMPLETE,TC,,20 ,,RBRVS,,1.89 ,1.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77321,CPT,SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY,,,20 ,,RBRVS,0.95 ,2.15 ,2.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77321,CPT,SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY,26,,20 ,,RBRVS,0.95 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77321,CPT,SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY,TC,,20 ,,RBRVS,,1.75 ,1.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77326,CPT,BRACHYTHERAPY ISODOSE PLAN SIMPLE,,,20 ,,RBRVS,0.93 ,3.27 ,3.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77326,CPT,BRACHYTHERAPY ISODOSE PLAN SIMPLE,26,,20 ,,RBRVS,0.93 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77326,CPT,BRACHYTHERAPY ISODOSE PLAN SIMPLE,TC,,20 ,,RBRVS,,2.88 ,2.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77327,CPT,BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE,,,20 ,,RBRVS,1.39 ,4.56 ,4.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77327,CPT,BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE,26,,20 ,,RBRVS,1.39 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77327,CPT,BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE,TC,,20 ,,RBRVS,,3.97 ,3.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77328,CPT,BRACHYTHERAPY ISODOSE PLAN COMPLEX,,,20 ,,RBRVS,2.09 ,5.94 ,5.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77328,CPT,BRACHYTHERAPY ISODOSE PLAN COMPLEX,26,,20 ,,RBRVS,2.09 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77328,CPT,BRACHYTHERAPY ISODOSE PLAN COMPLEX,TC,,20 ,,RBRVS,,5.05 ,5.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77331,CPT,SPEC DOSIM ONLY PRESCRIBED TREATING PHYS,,,20 ,,RBRVS,0.87 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77331,CPT,SPEC DOSIM ONLY PRESCRIBED TREATING PHYS,26,,20 ,,RBRVS,0.87 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77331,CPT,SPEC DOSIM ONLY PRESCRIBED TREATING PHYS,TC,,20 ,,RBRVS,,0.56 ,0.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77332,CPT,TX DEVICES DESIGN & CONSTRUCTION SIMPLE,,,20 ,,RBRVS,0.54 ,1.74 ,1.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77332,CPT,TX DEVICES DESIGN & CONSTRUCTION SIMPLE,26,,20 ,,RBRVS,0.54 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77332,CPT,TX DEVICES DESIGN & CONSTRUCTION SIMPLE,TC,,20 ,,RBRVS,,1.51 ,1.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77333,CPT,TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE,,,20 ,,RBRVS,0.84 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77333,CPT,TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE,26,,20 ,,RBRVS,0.84 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77333,CPT,TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE,TC,,20 ,,RBRVS,,0.51 ,0.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77334,CPT,TX DEVICES DESIGN & CONSTRUCTION COMPLEX,,,20 ,,RBRVS,1.24 ,3.22 ,3.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77334,CPT,TX DEVICES DESIGN & CONSTRUCTION COMPLEX,26,,20 ,,RBRVS,1.24 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77334,CPT,TX DEVICES DESIGN & CONSTRUCTION COMPLEX,TC,,20 ,,RBRVS,,2.69 ,2.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77336,CPT,CONTINUING MEDICAL PHYSICS CONSLTJ PR WK,,TC,20 ,,RBRVS,,1.53 ,1.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77338,CPT,MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN,,,20 ,,RBRVS,4.29 ,9.55 ,9.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77338,CPT,MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN,,PC,20 ,,RBRVS,4.29 ,1.89 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,77338,CPT,MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN,,TC,20 ,,RBRVS,,7.66 ,7.66 ,,,$0.00,$0.00,1,1,1,0,1,0,20120101,77370,CPT,SPEC MEDICAL RADJ PHYSICS CONSLTJ,,TC,20 ,,RBRVS,,3.39 ,3.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77371,CPT,RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT,,TC,20 ,,RBRVS,6.59 ,34.66 ,34.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77372,CPT,RADIATION DELIVERY STEREOTACTIC CRANIAL LINEAR,,TC,20 ,,RBRVS,,25.02 ,25.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77373,CPT,STEREOTACTIC BODY RADIATION DELIVERY,,TC,20 ,,RBRVS,,46.74 ,46.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77399,CPT,UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS,,,20 ,,TotalUnits,,,,7.83 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,77399,CPT,UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS,,PC,20 ,,TotalUnits,,,,3.11 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,77399,CPT,UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS,,TC,20 ,,TotalUnits,,,,4.72 ,,$0.00,$0.00,1,1,1,0,1,0,20120101,77401,CPT,RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTAGE,,TC,20 ,,RBRVS,,0.74 ,0.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77402,CPT,RADJ DLVR 1 AREA 1/PRLL OPSD PORTS SMPL <5MEV,,TC,20 ,,RBRVS,,5.18 ,5.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77403,CPT,RADJ DLVR 1 AREA 1/PRLL OPSD PORTS SMPL 6-10MEV,,TC,20 ,,RBRVS,,3.85 ,3.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77404,CPT,RADJ DLVR 1 AREA 1/PRLL OPSD PORTS SMPL 11-19MEV,,TC,20 ,,RBRVS,,4.28 ,4.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77406,CPT,RADJ DLVR 1 AREA 1/PRLL OPSD PORTS SMPL 20MEV/<,,TC,20 ,,RBRVS,,4.32 ,4.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77407,CPT,RADJ DLVR 2 AREAS 3/>PORTS 1 MLT BLKS <5MEV,,TC,20 ,,RBRVS,,7.51 ,7.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77408,CPT,RADJ DLVR 2 AREAS 3/>PORTS 1 MLT BLKS 6-1MEV,,TC,20 ,,RBRVS,,5.24 ,5.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77409,CPT,RADJ DLVR 2 AREAS 3/>PORTS 1 MLT BLKS 11-19MEV,,TC,20 ,,RBRVS,,5.83 ,5.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77411,CPT,RADJ DLVR 2 AREAS 3/> PORTS 1 TX AREA 20 MEV/<,,TC,20 ,,RBRVS,,5.80 ,5.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77412,CPT,RADJ DLVR 3/> AREAS CUSTOM BLKING <5MEV,,TC,20 ,,RBRVS,,6.84 ,6.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77413,CPT,RADJ DLVR 3/> AREAS CUSTOM BLKING 6-10MEV,,TC,20 ,,RBRVS,,6.89 ,6.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77414,CPT,RADJ DLVR 3/> AREAS CUSTOM BLKING 11-19MEV,,TC,20 ,,RBRVS,,7.71 ,7.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77416,CPT,RADJ DLVR 3/> AREAS CUSTOM BLKING 20MEV/<,,TC,20 ,,RBRVS,,7.75 ,7.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77417,CPT,THERAPEUTIC RADIOLOGY PORT FILMS,,TC,20 ,,RBRVS,,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,77418,CPT,NTSTY MODUL DLVR 1/MLT FLDS/ARCS PR TX SESSION,,TC,20 ,,RBRVS,,15.29 ,15.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77421,CPT,STRSC X-RAY GDN LOCLZJ TARGET VOL DLVR RADJ THER,,,20 ,,RBRVS,0.39 ,2.83 ,2.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77421,CPT,STRSC X-RAY GDN LOCLZJ TARGET VOL DLVR RADJ THER,26,,20 ,,RBRVS,0.39 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77421,CPT,STRSC X-RAY GDN LOCLZJ TARGET VOL DLVR RADJ THER,TC,,20 ,,RBRVS,,2.66 ,2.66 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,77422,CPT,HIGH ENERGY NEUTRON RADJ TX DLVR 1 TX AREA,,TC,20 ,,RBRVS,,5.85 ,5.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77423,CPT,HIGH ENERGY NEUTRON RADJ TX DLVR 1/> ISOCENTER,,TC,20 ,,RBRVS,,7.44 ,7.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77427,CPT,RADIATION TREATMENT MANAGEMENT 5 TREATMENTS,,PC,20 ,,RBRVS,3.37 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77431,CPT,RADIATION THERAPY MGMT 1/2 FRACTIONS ONLY,,PC,20 ,,RBRVS,1.81 ,0.96 ,0.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77432,CPT,STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION,,PC,20 ,,RBRVS,7.92 ,3.46 ,3.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77435,CPT,STEREOTACTIC BODY RADIATION MANAGEMENT,,PC,20 ,,RBRVS,13.00 ,5.87 ,5.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77469,CPT,INTRAOPERATIVE RADIATION TREATMENT MANAGEMENT,,,20 ,,RBRVS,5.75 ,2.52 ,2.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77470,CPT,SPECIAL TREATMENT PROCEDURE,,,20 ,,RBRVS,2.09 ,3.75 ,3.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77470,CPT,SPECIAL TREATMENT PROCEDURE,26,,20 ,,RBRVS,2.09 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77470,CPT,SPECIAL TREATMENT PROCEDURE,TC,,20 ,,RBRVS,,2.85 ,2.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77499,CPT,UNLISTED PROCEDURE THERAPEUTIC RADIOLOGY TX MGMT,,,20 ,,TotalUnits,,,,7.71 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,77499,CPT,UNLISTED PROCEDURE THERAPEUTIC RADIOLOGY TX MGMT,,PC,20 ,,TotalUnits,,,,1.32 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,77499,CPT,UNLISTED PROCEDURE THERAPEUTIC RADIOLOGY TX MGMT,,TC,20 ,,TotalUnits,,,,6.39 ,,$0.00,$0.00,1,1,1,0,1,0,20120101,77520,CPT,PROTON TX DELIVERY SIMPLE W/O COMPENSATION,,TC,20 ,,TotalUnits,,,,17.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,77522,CPT,PROTON TX DELIVERY SIMPLE W/COMPENSATION,,TC,20 ,,TotalUnits,,,,17.39 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,77523,CPT,PROTON TX DELIVERY INTERMEDIATE,,TC,20 ,,TotalUnits,,,,23.93 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,77525,CPT,PROTON TX DELIVERY COMPLEX,,TC,20 ,,TotalUnits,,,,23.93 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,77600,CPT,HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL,,,20 ,,RBRVS,1.56 ,10.34 ,10.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77600,CPT,HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL,26,,20 ,,RBRVS,1.56 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77600,CPT,HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL,TC,,20 ,,RBRVS,,9.67 ,9.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77605,CPT,HYPERTHERMIA EXTERNAL GENERATED DEEP,,,20 ,,RBRVS,2.09 ,24.92 ,24.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77605,CPT,HYPERTHERMIA EXTERNAL GENERATED DEEP,26,,20 ,,RBRVS,2.09 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77605,CPT,HYPERTHERMIA EXTERNAL GENERATED DEEP,TC,,20 ,,RBRVS,,24.10 ,24.10 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77610,CPT,HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS,,,20 ,,RBRVS,1.56 ,23.31 ,23.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77610,CPT,HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS,26,,20 ,,RBRVS,1.56 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77610,CPT,HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS,TC,,20 ,,RBRVS,,22.68 ,22.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77615,CPT,HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS,,,20 ,,RBRVS,2.09 ,26.37 ,26.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77615,CPT,HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS,26,,20 ,,RBRVS,2.09 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77615,CPT,HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS,TC,,20 ,,RBRVS,,25.48 ,25.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77620,CPT,HYPERTHERMIA INTRACAVITARY PROBES,,,20 ,,RBRVS,1.56 ,12.52 ,12.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77620,CPT,HYPERTHERMIA INTRACAVITARY PROBES,26,,20 ,,RBRVS,1.56 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77620,CPT,HYPERTHERMIA INTRACAVITARY PROBES,TC,,20 ,,RBRVS,,11.90 ,11.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77750,CPT,NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE,,,20 ,,RBRVS,5.00 ,5.09 ,5.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77750,CPT,NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE,26,,20 ,,RBRVS,5.00 ,2.13 ,2.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77750,CPT,NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE,TC,,20 ,,RBRVS,,2.96 ,2.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77761,CPT,INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE,,,20 ,,RBRVS,3.85 ,6.75 ,6.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77761,CPT,INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE,26,,20 ,,RBRVS,3.85 ,1.61 ,1.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77761,CPT,INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE,TC,,20 ,,RBRVS,,5.14 ,5.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77762,CPT,INTRACAVITARY RADIATION SOURCE APPLIC INTERMED,,,20 ,,RBRVS,5.76 ,8.46 ,8.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77762,CPT,INTRACAVITARY RADIATION SOURCE APPLIC INTERMED,26,,20 ,,RBRVS,5.76 ,2.45 ,2.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77762,CPT,INTRACAVITARY RADIATION SOURCE APPLIC INTERMED,TC,,20 ,,RBRVS,,6.01 ,6.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77763,CPT,INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX,,,20 ,,RBRVS,8.66 ,11.45 ,11.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77763,CPT,INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX,26,,20 ,,RBRVS,8.66 ,3.68 ,3.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77763,CPT,INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX,TC,,20 ,,RBRVS,,7.77 ,7.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77776,CPT,INTERSTITIAL RADIATION SOURCE APPLIC SIMPLE,,,20 ,,RBRVS,4.70 ,7.36 ,7.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77776,CPT,INTERSTITIAL RADIATION SOURCE APPLIC SIMPLE,26,,20 ,,RBRVS,4.70 ,2.00 ,2.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77776,CPT,INTERSTITIAL RADIATION SOURCE APPLIC SIMPLE,TC,,20 ,,RBRVS,,5.36 ,5.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77777,CPT,INTERSTITIAL RADIATION SOURCE APPLIC INTERMED,,,20 ,,RBRVS,7.52 ,9.15 ,9.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77777,CPT,INTERSTITIAL RADIATION SOURCE APPLIC INTERMED,26,,20 ,,RBRVS,7.52 ,3.29 ,3.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77777,CPT,INTERSTITIAL RADIATION SOURCE APPLIC INTERMED,TC,,20 ,,RBRVS,,5.86 ,5.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77778,CPT,INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX,,,20 ,,RBRVS,11.32 ,12.78 ,12.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77778,CPT,INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX,26,,20 ,,RBRVS,11.32 ,4.81 ,4.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77778,CPT,INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX,TC,,20 ,,RBRVS,,7.97 ,7.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77785,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX 1 CHANNEL,,,20 ,,RBRVS,1.42 ,4.95 ,4.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77785,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX 1 CHANNEL,26,,20 ,,RBRVS,1.42 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77785,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX 1 CHANNEL,TC,,20 ,,RBRVS,,4.34 ,4.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77786,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX 2-12 CHANNEL,,,20 ,,RBRVS,3.25 ,13.35 ,13.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77786,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX 2-12 CHANNEL,26,,20 ,,RBRVS,3.25 ,1.35 ,1.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77786,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX 2-12 CHANNEL,TC,,20 ,,RBRVS,,12.00 ,12.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77787,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX > 12 CHANNEL,,,20 ,,RBRVS,4.89 ,21.58 ,21.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77787,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX > 12 CHANNEL,26,,20 ,,RBRVS,4.89 ,2.13 ,2.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77787,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX > 12 CHANNEL,TC,,20 ,,RBRVS,,19.45 ,19.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77789,CPT,SURFACE APPLICATION RADIATION SOURCE,,,20 ,,RBRVS,1.14 ,2.07 ,2.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77789,CPT,SURFACE APPLICATION RADIATION SOURCE,26,,20 ,,RBRVS,1.14 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77789,CPT,SURFACE APPLICATION RADIATION SOURCE,TC,,20 ,,RBRVS,,1.57 ,1.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,77790,CPT,SUPERVISION HANDLING LOADING RADIATION SOURCE,,,20 ,,RBRVS,1.05 ,1.58 ,1.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,77790,CPT,SUPERVISION HANDLING LOADING RADIATION SOURCE,26,,20 ,,RBRVS,1.05 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,77790,CPT,SUPERVISION HANDLING LOADING RADIATION SOURCE,TC,,20 ,,RBRVS,,1.13 ,1.13 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,77799,CPT,UNLISTED PROCEDURE CLINICAL BRACHYTHERAPY,,,20 ,,TotalUnits,,,,7.18 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,77799,CPT,UNLISTED PROCEDURE CLINICAL BRACHYTHERAPY,26,,20 ,,TotalUnits,,,,3.36 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,77799,CPT,UNLISTED PROCEDURE CLINICAL BRACHYTHERAPY,TC,,20 ,,TotalUnits,,,,3.82 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78000,CPT,THYROID UPTAKE SINGLE DETERMINATION,,,20 ,,RBRVS,0.19 ,1.91 ,1.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78000,CPT,THYROID UPTAKE SINGLE DETERMINATION,26,,20 ,,RBRVS,0.19 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78000,CPT,THYROID UPTAKE SINGLE DETERMINATION,TC,,20 ,,RBRVS,,1.83 ,1.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78001,CPT,THYROID UPTAKE MULTIPLE DETERMINATIONS,,,20 ,,RBRVS,0.26 ,2.42 ,2.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78001,CPT,THYROID UPTAKE MULTIPLE DETERMINATIONS,26,,20 ,,RBRVS,0.26 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78001,CPT,THYROID UPTAKE MULTIPLE DETERMINATIONS,TC,,20 ,,RBRVS,,2.31 ,2.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78003,CPT,PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE,,,20 ,,RBRVS,0.33 ,2.01 ,2.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78003,CPT,PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE,26,,20 ,,RBRVS,0.33 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78003,CPT,PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE,TC,,20 ,,RBRVS,,1.87 ,1.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78006,CPT,THYROID IMAGING W/UPTAKE SINGLE DETERMINATION,,,20 ,,RBRVS,0.49 ,6.39 ,6.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78006,CPT,THYROID IMAGING W/UPTAKE SINGLE DETERMINATION,26,,20 ,,RBRVS,0.49 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78006,CPT,THYROID IMAGING W/UPTAKE SINGLE DETERMINATION,TC,,20 ,,RBRVS,,6.19 ,6.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78007,CPT,THYROID IMAGING W/UPTAKE MULT DETERMINATIONS,,,20 ,,RBRVS,0.50 ,5.19 ,5.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78007,CPT,THYROID IMAGING W/UPTAKE MULT DETERMINATIONS,26,,20 ,,RBRVS,0.50 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78007,CPT,THYROID IMAGING W/UPTAKE MULT DETERMINATIONS,TC,,20 ,,RBRVS,,4.99 ,4.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78010,CPT,THYROID IMAGING ONLY,,,20 ,,RBRVS,0.39 ,4.36 ,4.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78010,CPT,THYROID IMAGING ONLY,26,,20 ,,RBRVS,0.39 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78010,CPT,THYROID IMAGING ONLY,TC,,20 ,,RBRVS,,4.21 ,4.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78011,CPT,THYROID IMAGING W/VASCULAR FLOW,,,20 ,,RBRVS,0.45 ,4.78 ,4.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78011,CPT,THYROID IMAGING W/VASCULAR FLOW,26,,20 ,,RBRVS,0.45 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78011,CPT,THYROID IMAGING W/VASCULAR FLOW,TC,,20 ,,RBRVS,,4.59 ,4.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78015,CPT,THYROID CARCINOMA METASTASES IMG LMTD AREA,,,20 ,,RBRVS,0.67 ,5.60 ,5.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78015,CPT,THYROID CARCINOMA METASTASES IMG LMTD AREA,26,,20 ,,RBRVS,0.67 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78015,CPT,THYROID CARCINOMA METASTASES IMG LMTD AREA,TC,,20 ,,RBRVS,,5.34 ,5.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78016,CPT,THYROID CARCINOMA METASTASES IMG ADDL STUDY,,,20 ,,RBRVS,0.82 ,8.09 ,8.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78016,CPT,THYROID CARCINOMA METASTASES IMG ADDL STUDY,26,,20 ,,RBRVS,0.82 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78016,CPT,THYROID CARCINOMA METASTASES IMG ADDL STUDY,TC,,20 ,,RBRVS,,7.83 ,7.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78018,CPT,THYROID CARCINOMA METASTASES IMG WHOLE BODY,,,20 ,,RBRVS,0.86 ,8.45 ,8.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78018,CPT,THYROID CARCINOMA METASTASES IMG WHOLE BODY,26,,20 ,,RBRVS,0.86 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78018,CPT,THYROID CARCINOMA METASTASES IMG WHOLE BODY,TC,,20 ,,RBRVS,,8.12 ,8.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78020,CPT,THYROID CARCINOMA METASTASES UPTAKE,,,20 ,,RBRVS,0.60 ,1.90 ,1.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78020,CPT,THYROID CARCINOMA METASTASES UPTAKE,26,,20 ,,RBRVS,0.60 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78020,CPT,THYROID CARCINOMA METASTASES UPTAKE,TC,,20 ,,RBRVS,,1.68 ,1.68 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,78070,CPT,PARATHYROID IMAGING,,,20 ,,RBRVS,0.82 ,3.99 ,3.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78070,CPT,PARATHYROID IMAGING,26,,20 ,,RBRVS,0.82 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78070,CPT,PARATHYROID IMAGING,TC,,20 ,,RBRVS,,3.66 ,3.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78075,CPT,ADRENAL IMAGING CORTEX &/MEDULLA,,,20 ,,RBRVS,0.74 ,11.72 ,11.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78075,CPT,ADRENAL IMAGING CORTEX &/MEDULLA,26,,20 ,,RBRVS,0.74 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78075,CPT,ADRENAL IMAGING CORTEX &/MEDULLA,TC,,20 ,,RBRVS,,11.44 ,11.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78099,CPT,UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE,,,20 ,,TotalUnits,,,,2.10 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78099,CPT,UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE,26,,20 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78099,CPT,UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE,TC,,20 ,,TotalUnits,,,,1.76 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78102,CPT,BONE MARROW IMAGING LIMITED AREA,,,20 ,,RBRVS,0.55 ,4.29 ,4.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78102,CPT,BONE MARROW IMAGING LIMITED AREA,26,,20 ,,RBRVS,0.55 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78102,CPT,BONE MARROW IMAGING LIMITED AREA,TC,,20 ,,RBRVS,,4.08 ,4.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78103,CPT,BONE MARROW IMAGING MULTIPLE AREAS,,,20 ,,RBRVS,0.75 ,5.64 ,5.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78103,CPT,BONE MARROW IMAGING MULTIPLE AREAS,26,,20 ,,RBRVS,0.75 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78103,CPT,BONE MARROW IMAGING MULTIPLE AREAS,TC,,20 ,,RBRVS,,5.36 ,5.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78104,CPT,BONE MARROW IMAGING WHOLE BODY,,,20 ,,RBRVS,0.80 ,6.47 ,6.47 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78104,CPT,BONE MARROW IMAGING WHOLE BODY,26,,20 ,,RBRVS,0.80 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78104,CPT,BONE MARROW IMAGING WHOLE BODY,TC,,20 ,,RBRVS,,6.16 ,6.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78110,CPT,PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE,,,20 ,,RBRVS,0.19 ,2.21 ,2.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78110,CPT,PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE,26,,20 ,,RBRVS,0.19 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78110,CPT,PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE,TC,,20 ,,RBRVS,,2.13 ,2.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78111,CPT,PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES,,,20 ,,RBRVS,0.22 ,2.32 ,2.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78111,CPT,PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES,26,,20 ,,RBRVS,0.22 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78111,CPT,PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES,TC,,20 ,,RBRVS,,2.24 ,2.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78120,CPT,RED CELL VOLUME DETERMINATION SPX 1 SAMPLING,,,20 ,,RBRVS,0.23 ,2.32 ,2.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78120,CPT,RED CELL VOLUME DETERMINATION SPX 1 SAMPLING,26,,20 ,,RBRVS,0.23 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78120,CPT,RED CELL VOLUME DETERMINATION SPX 1 SAMPLING,TC,,20 ,,RBRVS,,2.22 ,2.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78121,CPT,RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS,,,20 ,,RBRVS,0.32 ,2.61 ,2.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78121,CPT,RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS,26,,20 ,,RBRVS,0.32 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78121,CPT,RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS,TC,,20 ,,RBRVS,,2.48 ,2.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78122,CPT,WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLUME,,,20 ,,RBRVS,0.45 ,2.82 ,2.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78122,CPT,WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLUME,26,,20 ,,RBRVS,0.45 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78122,CPT,WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLUME,TC,,20 ,,RBRVS,,2.65 ,2.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78130,CPT,RED CELL SURVIVAL STUDY,,,20 ,,RBRVS,0.61 ,3.88 ,3.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78130,CPT,RED CELL SURVIVAL STUDY,26,,20 ,,RBRVS,0.61 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78130,CPT,RED CELL SURVIVAL STUDY,TC,,20 ,,RBRVS,,3.62 ,3.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78135,CPT,RBC SURVIVAL STUDY DIFFERNTL ORGAN/TISS KINETICS,,,20 ,,RBRVS,0.64 ,9.40 ,9.40 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78135,CPT,RBC SURVIVAL STUDY DIFFERNTL ORGAN/TISS KINETICS,26,,20 ,,RBRVS,0.64 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78135,CPT,RBC SURVIVAL STUDY DIFFERNTL ORGAN/TISS KINETICS,TC,,20 ,,RBRVS,,9.13 ,9.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78140,CPT,LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE,,,20 ,,RBRVS,0.61 ,3.42 ,3.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78140,CPT,LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE,26,,20 ,,RBRVS,0.61 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78140,CPT,LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE,TC,,20 ,,RBRVS,,3.17 ,3.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78185,CPT,SPLEEN IMAGING ONLY W/WO VASCULAR FLOW,,,20 ,,RBRVS,0.40 ,5.48 ,5.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78185,CPT,SPLEEN IMAGING ONLY W/WO VASCULAR FLOW,26,,20 ,,RBRVS,0.40 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78185,CPT,SPLEEN IMAGING ONLY W/WO VASCULAR FLOW,TC,,20 ,,RBRVS,,5.31 ,5.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78190,CPT,KINETICS PLATELET W/WO DIFFRNTL ORGAN/TIS LOCLZJ,,,20 ,,RBRVS,1.09 ,9.98 ,9.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78190,CPT,KINETICS PLATELET W/WO DIFFRNTL ORGAN/TIS LOCLZJ,26,,20 ,,RBRVS,1.09 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78190,CPT,KINETICS PLATELET W/WO DIFFRNTL ORGAN/TIS LOCLZJ,TC,,20 ,,RBRVS,,9.54 ,9.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78191,CPT,PLATELET SURVIVAL STUDY,,,20 ,,RBRVS,0.61 ,4.53 ,4.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78191,CPT,PLATELET SURVIVAL STUDY,26,,20 ,,RBRVS,0.61 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78191,CPT,PLATELET SURVIVAL STUDY,TC,,20 ,,RBRVS,,4.28 ,4.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78195,CPT,LYMPHATICS & LYMPH NODES IMAGING,,,20 ,,RBRVS,1.20 ,9.08 ,9.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78195,CPT,LYMPHATICS & LYMPH NODES IMAGING,26,,20 ,,RBRVS,1.20 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78195,CPT,LYMPHATICS & LYMPH NODES IMAGING,TC,,20 ,,RBRVS,,8.60 ,8.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78199,CPT,UNLIS HEMATOP RET/ENDO&LYMPHATIC DX NUC MED,,,20 ,,TotalUnits,,,,2.40 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78199,CPT,UNLIS HEMATOP RET/ENDO&LYMPHATIC DX NUC MED,26,,20 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78199,CPT,UNLIS HEMATOP RET/ENDO&LYMPHATIC DX NUC MED,TC,,20 ,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78201,CPT,LIVER IMAGING STATIC ONLY,,,20 ,,RBRVS,0.44 ,4.96 ,4.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78201,CPT,LIVER IMAGING STATIC ONLY,26,,20 ,,RBRVS,0.44 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78201,CPT,LIVER IMAGING STATIC ONLY,TC,,20 ,,RBRVS,,4.80 ,4.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78202,CPT,LIVER IMAGING W/VASCULAR FLOW,,,20 ,,RBRVS,0.51 ,5.41 ,5.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78202,CPT,LIVER IMAGING W/VASCULAR FLOW,26,,20 ,,RBRVS,0.51 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78202,CPT,LIVER IMAGING W/VASCULAR FLOW,TC,,20 ,,RBRVS,,5.23 ,5.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78205,CPT,LIVER IMAGING SPECT,,,20 ,,RBRVS,0.71 ,5.92 ,5.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78205,CPT,LIVER IMAGING SPECT,26,,20 ,,RBRVS,0.71 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78205,CPT,LIVER IMAGING SPECT,TC,,20 ,,RBRVS,,5.64 ,5.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78206,CPT,LIVER IMAGING SPECT W/VASCULAR FLOW,,,20 ,,RBRVS,0.96 ,9.21 ,9.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78206,CPT,LIVER IMAGING SPECT W/VASCULAR FLOW,26,,20 ,,RBRVS,0.96 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78206,CPT,LIVER IMAGING SPECT W/VASCULAR FLOW,TC,,20 ,,RBRVS,,8.83 ,8.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78215,CPT,LIVER & SPLEEN IMAGING STATIC ONLY,,,20 ,,RBRVS,0.49 ,5.11 ,5.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78215,CPT,LIVER & SPLEEN IMAGING STATIC ONLY,26,,20 ,,RBRVS,0.49 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78215,CPT,LIVER & SPLEEN IMAGING STATIC ONLY,TC,,20 ,,RBRVS,,4.91 ,4.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78216,CPT,LIVER & SPLEEN IMAGING W/VASCULAR FLOW,,,20 ,,RBRVS,0.57 ,3.22 ,3.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78216,CPT,LIVER & SPLEEN IMAGING W/VASCULAR FLOW,26,,20 ,,RBRVS,0.57 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78216,CPT,LIVER & SPLEEN IMAGING W/VASCULAR FLOW,TC,,20 ,,RBRVS,,3.00 ,3.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78226,CPT,HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER,,,20 ,,RBRVS,0.74 ,8.84 ,8.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78226,CPT,HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER,26,,20 ,,RBRVS,0.74 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78226,CPT,HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER,TC,,20 ,,RBRVS,,8.59 ,8.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78227,CPT,HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ,,,20 ,,RBRVS,0.90 ,12.23 ,12.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78227,CPT,HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ,26,,20 ,,RBRVS,0.90 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78227,CPT,HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ,TC,,20 ,,RBRVS,,11.93 ,11.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78230,CPT,SALIVARY GLAND IMAGING,,,20 ,,RBRVS,0.45 ,4.38 ,4.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78230,CPT,SALIVARY GLAND IMAGING,26,,20 ,,RBRVS,0.45 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78230,CPT,SALIVARY GLAND IMAGING,TC,,20 ,,RBRVS,,4.20 ,4.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78231,CPT,SALIVARY GLAND IMAGING SERIAL IMAGES,,,20 ,,RBRVS,0.52 ,3.23 ,3.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78231,CPT,SALIVARY GLAND IMAGING SERIAL IMAGES,26,,20 ,,RBRVS,0.52 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78231,CPT,SALIVARY GLAND IMAGING SERIAL IMAGES,TC,,20 ,,RBRVS,,3.02 ,3.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78232,CPT,SALIVARY GLAND FUNCTION STUDY,,,20 ,,RBRVS,0.47 ,2.93 ,2.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78232,CPT,SALIVARY GLAND FUNCTION STUDY,26,,20 ,,RBRVS,0.47 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78232,CPT,SALIVARY GLAND FUNCTION STUDY,TC,,20 ,,RBRVS,,2.78 ,2.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78258,CPT,ESOPHAGEAL MOTILITY,,,20 ,,RBRVS,0.74 ,5.92 ,5.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78258,CPT,ESOPHAGEAL MOTILITY,26,,20 ,,RBRVS,0.74 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78258,CPT,ESOPHAGEAL MOTILITY,TC,,20 ,,RBRVS,,5.61 ,5.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78261,CPT,GASTRIC MUCOSA IMAGING,,,20 ,,RBRVS,0.69 ,6.60 ,6.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78261,CPT,GASTRIC MUCOSA IMAGING,26,,20 ,,RBRVS,0.69 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78261,CPT,GASTRIC MUCOSA IMAGING,TC,,20 ,,RBRVS,,6.31 ,6.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78262,CPT,GASTROESOPHAGEAL REFLUX STUDY,,,20 ,,RBRVS,0.68 ,6.49 ,6.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78262,CPT,GASTROESOPHAGEAL REFLUX STUDY,26,,20 ,,RBRVS,0.68 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78262,CPT,GASTROESOPHAGEAL REFLUX STUDY,TC,,20 ,,RBRVS,,6.22 ,6.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78264,CPT,GASTRIC EMPTYING STUDY,,,20 ,,RBRVS,0.78 ,7.56 ,7.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78264,CPT,GASTRIC EMPTYING STUDY,26,,20 ,,RBRVS,0.78 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78264,CPT,GASTRIC EMPTYING STUDY,TC,,20 ,,RBRVS,,7.25 ,7.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78267,CPT,BREATH TST ATTAIN/ANAL C-14,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78268,CPT,BREATH TEST ANALYSIS C-14,,,17 ,,TotalUnits,,,,2.79 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78270,CPT,VITAMIN B-12 ABSRPJ STUDY W/O INTRINSIC FACTOR,,,20 ,,RBRVS,0.20 ,2.17 ,2.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78270,CPT,VITAMIN B-12 ABSRPJ STUDY W/O INTRINSIC FACTOR,26,,20 ,,RBRVS,0.20 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78270,CPT,VITAMIN B-12 ABSRPJ STUDY W/O INTRINSIC FACTOR,TC,,20 ,,RBRVS,,2.09 ,2.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78271,CPT,VITAMIN B-12 ABSRPJ STUDY W/INTRINSIC FACTOR,,,20 ,,RBRVS,0.20 ,2.30 ,2.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78271,CPT,VITAMIN B-12 ABSRPJ STUDY W/INTRINSIC FACTOR,26,,20 ,,RBRVS,0.20 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78271,CPT,VITAMIN B-12 ABSRPJ STUDY W/INTRINSIC FACTOR,TC,,20 ,,RBRVS,,2.22 ,2.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78272,CPT,VITAMIN B-12 ABSRPJ STDY W/&W/O INTRINSIC FACTOR,,,20 ,,RBRVS,0.27 ,2.37 ,2.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78272,CPT,VITAMIN B-12 ABSRPJ STDY W/&W/O INTRINSIC FACTOR,26,,20 ,,RBRVS,0.27 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78272,CPT,VITAMIN B-12 ABSRPJ STDY W/&W/O INTRINSIC FACTOR,TC,,20 ,,RBRVS,,2.27 ,2.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78278,CPT,ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING,,,20 ,,RBRVS,0.99 ,9.10 ,9.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78278,CPT,ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING,26,,20 ,,RBRVS,0.99 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78278,CPT,ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING,TC,,20 ,,RBRVS,,8.70 ,8.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78282,CPT,GASTROINTESTINAL PROTEIN LOSS,,,20 ,,RBRVS,0.38 ,1.78 ,1.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78282,CPT,GASTROINTESTINAL PROTEIN LOSS,26,,20 ,,RBRVS,0.38 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78282,CPT,GASTROINTESTINAL PROTEIN LOSS,TC,,20 ,,RBRVS,,1.62 ,1.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78290,CPT,INTESTINE IMAGING,,,20 ,,RBRVS,0.68 ,8.71 ,8.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78290,CPT,INTESTINE IMAGING,26,,20 ,,RBRVS,0.68 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78290,CPT,INTESTINE IMAGING,TC,,20 ,,RBRVS,,8.43 ,8.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78291,CPT,PERITONEAL-VENOUS SHUNT PATENCY TEST,,,20 ,,RBRVS,0.88 ,6.48 ,6.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78291,CPT,PERITONEAL-VENOUS SHUNT PATENCY TEST,26,,20 ,,RBRVS,0.88 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78291,CPT,PERITONEAL-VENOUS SHUNT PATENCY TEST,TC,,20 ,,RBRVS,,6.13 ,6.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78299,CPT,UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE,,,20 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78299,CPT,UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE,26,,20 ,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78299,CPT,UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE,TC,,20 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78300,CPT,BONE &/JOINT IMAGING LIMITED AREA,,,20 ,,RBRVS,0.62 ,4.51 ,4.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78300,CPT,BONE &/JOINT IMAGING LIMITED AREA,26,,20 ,,RBRVS,0.62 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78300,CPT,BONE &/JOINT IMAGING LIMITED AREA,TC,,20 ,,RBRVS,,4.25 ,4.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78305,CPT,BONE &/JOINT IMAGING MULTIPLE AREAS,,,20 ,,RBRVS,0.83 ,5.95 ,5.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78305,CPT,BONE &/JOINT IMAGING MULTIPLE AREAS,26,,20 ,,RBRVS,0.83 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78305,CPT,BONE &/JOINT IMAGING MULTIPLE AREAS,TC,,20 ,,RBRVS,,5.62 ,5.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78306,CPT,BONE &/JOINT IMAGING WHOLE BODY,,,20 ,,RBRVS,0.86 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78306,CPT,BONE &/JOINT IMAGING WHOLE BODY,26,,20 ,,RBRVS,0.86 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78306,CPT,BONE &/JOINT IMAGING WHOLE BODY,TC,,20 ,,RBRVS,,6.18 ,6.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78315,CPT,BONE &/JOINT IMAGING 3 PHASE STUDY,,,20 ,,RBRVS,1.02 ,9.06 ,9.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78315,CPT,BONE &/JOINT IMAGING 3 PHASE STUDY,26,,20 ,,RBRVS,1.02 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78315,CPT,BONE &/JOINT IMAGING 3 PHASE STUDY,TC,,20 ,,RBRVS,,8.65 ,8.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78320,CPT,BONE &/JOINT IMAGING TOMOGRAPHIC SPECT,,,20 ,,RBRVS,1.04 ,6.07 ,6.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78320,CPT,BONE &/JOINT IMAGING TOMOGRAPHIC SPECT,26,,20 ,,RBRVS,1.04 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78320,CPT,BONE &/JOINT IMAGING TOMOGRAPHIC SPECT,TC,,20 ,,RBRVS,,5.66 ,5.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78350,CPT,BONE DENSITY 1/> SITES 1 PHOTON ABSORPTIOMETRY,,,20 ,,RBRVS,0.22 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78350,CPT,BONE DENSITY 1/> SITES 1 PHOTON ABSORPTIOMETRY,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78350,CPT,BONE DENSITY 1/> SITES 1 PHOTON ABSORPTIOMETRY,TC,,20 ,,RBRVS,,0.64 ,0.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78351,CPT,BONE DENSTY 1/> SITES DUAL PHOTON ABSORPTIOMETRY,,,20 ,,RBRVS,0.30 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78399,CPT,UNLISTED MUSCULOSKELETAL PX DX NUCLEAR MEDICINE,,,20 ,,TotalUnits,,,,8.91 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78399,CPT,UNLISTED MUSCULOSKELETAL PX DX NUCLEAR MEDICINE,,PC,20 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,78399,CPT,UNLISTED MUSCULOSKELETAL PX DX NUCLEAR MEDICINE,,TC,20 ,,TotalUnits,,,,7.45 ,,$0.00,$0.00,1,1,1,0,1,0,20120101,78414,CPT,CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM,,,20 ,,TotalUnits,,,,1.75 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78414,CPT,CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM,26,,20 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78414,CPT,CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM,TC,,20 ,,TotalUnits,,,,1.14 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78428,CPT,CARDIAC SHUNT DETECTION,,,20 ,,RBRVS,0.78 ,4.87 ,4.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78428,CPT,CARDIAC SHUNT DETECTION,26,,20 ,,RBRVS,0.78 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78428,CPT,CARDIAC SHUNT DETECTION,TC,,20 ,,RBRVS,,4.52 ,4.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78445,CPT,NONCARDIAC VASCULAR FLOW IMAGING,,,20 ,,RBRVS,0.49 ,4.51 ,4.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78445,CPT,NONCARDIAC VASCULAR FLOW IMAGING,26,,20 ,,RBRVS,0.49 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78445,CPT,NONCARDIAC VASCULAR FLOW IMAGING,TC,,20 ,,RBRVS,,4.32 ,4.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78451,CPT,MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS,,,20 ,,RBRVS,1.38 ,8.58 ,8.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78451,CPT,MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS,26,,20 ,,RBRVS,1.38 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78451,CPT,MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS,TC,,20 ,,RBRVS,,8.07 ,8.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78452,CPT,MYOCARDIAL SPECT MULTIPLE STUDIES,,,20 ,,RBRVS,1.62 ,12.35 ,12.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78452,CPT,MYOCARDIAL SPECT MULTIPLE STUDIES,26,,20 ,,RBRVS,1.62 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78452,CPT,MYOCARDIAL SPECT MULTIPLE STUDIES,TC,,20 ,,RBRVS,,11.73 ,11.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78453,CPT,MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS,,,20 ,,RBRVS,1.00 ,7.55 ,7.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78453,CPT,MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS,26,,20 ,,RBRVS,1.00 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78453,CPT,MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS,TC,,20 ,,RBRVS,,7.18 ,7.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78454,CPT,MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES,,,20 ,,RBRVS,1.34 ,11.03 ,11.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78454,CPT,MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES,26,,20 ,,RBRVS,1.34 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78454,CPT,MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES,TC,,20 ,,RBRVS,,10.53 ,10.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78456,CPT,ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE,,,20 ,,RBRVS,1.00 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78456,CPT,ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE,26,,20 ,,RBRVS,1.00 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78456,CPT,ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE,TC,,20 ,,RBRVS,,8.89 ,8.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78457,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL,,,20 ,,RBRVS,0.77 ,4.91 ,4.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78457,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL,26,,20 ,,RBRVS,0.77 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78457,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL,TC,,20 ,,RBRVS,,4.60 ,4.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78458,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL,,,20 ,,RBRVS,0.90 ,4.80 ,4.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78458,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL,26,,20 ,,RBRVS,0.90 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78458,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL,TC,,20 ,,RBRVS,,4.49 ,4.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78459,CPT,MYOCARDIAL IMAGING PET METABOLIC EVALUATION,,,20 ,,TotalUnits,,,,10.19 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78459,CPT,MYOCARDIAL IMAGING PET METABOLIC EVALUATION,26,,20 ,,TotalUnits,,,,2.08 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78459,CPT,MYOCARDIAL IMAGING PET METABOLIC EVALUATION,TC,,20 ,,TotalUnits,,,,8.11 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78466,CPT,MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN,,,20 ,,RBRVS,0.69 ,4.57 ,4.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78466,CPT,MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN,26,,20 ,,RBRVS,0.69 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78466,CPT,MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN,TC,,20 ,,RBRVS,,4.26 ,4.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78468,CPT,MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ,,,20 ,,RBRVS,0.80 ,5.59 ,5.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78468,CPT,MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ,26,,20 ,,RBRVS,0.80 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78468,CPT,MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ,TC,,20 ,,RBRVS,,5.21 ,5.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78469,CPT,MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ,,,20 ,,RBRVS,0.92 ,6.61 ,6.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78469,CPT,MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ,26,,20 ,,RBRVS,0.92 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78469,CPT,MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ,TC,,20 ,,RBRVS,,6.16 ,6.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78472,CPT,CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS,,,20 ,,RBRVS,0.98 ,6.37 ,6.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78472,CPT,CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS,26,,20 ,,RBRVS,0.98 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78472,CPT,CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS,TC,,20 ,,RBRVS,,5.94 ,5.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78473,CPT,CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT,,,20 ,,RBRVS,1.47 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78473,CPT,CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT,26,,20 ,,RBRVS,1.47 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78473,CPT,CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT,TC,,20 ,,RBRVS,,7.58 ,7.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78481,CPT,CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT,,,20 ,,RBRVS,0.98 ,5.17 ,5.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78481,CPT,CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT,26,,20 ,,RBRVS,0.98 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78481,CPT,CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT,TC,,20 ,,RBRVS,,4.69 ,4.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78483,CPT,CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT,,,20 ,,RBRVS,1.47 ,7.04 ,7.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78483,CPT,CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT,26,,20 ,,RBRVS,1.47 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78483,CPT,CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT,TC,,20 ,,RBRVS,,6.31 ,6.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78491,CPT,MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS,,,20 ,,TotalUnits,,,,10.33 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78491,CPT,MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS,26,,20 ,,TotalUnits,,,,2.05 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78491,CPT,MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS,TC,,20 ,,TotalUnits,,,,8.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78492,CPT,MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS,,,20 ,,TotalUnits,,,,13.02 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78492,CPT,MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS,26,,20 ,,TotalUnits,,,,2.58 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78492,CPT,MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS,TC,,20 ,,TotalUnits,,,,10.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78494,CPT,CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT,,,20 ,,RBRVS,1.19 ,6.64 ,6.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78494,CPT,CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT,26,,20 ,,RBRVS,1.19 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78494,CPT,CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT,TC,,20 ,,RBRVS,,6.09 ,6.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78496,CPT,CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT,,,20 ,,RBRVS,0.50 ,1.86 ,1.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78496,CPT,CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT,26,,20 ,,RBRVS,0.50 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78496,CPT,CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT,TC,,20 ,,RBRVS,,1.63 ,1.63 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,78499,CPT,UNLISTED CARDIOVASCULAR PX DX NUCLEAR MEDICINE,,,20 ,,TotalUnits,,,,5.57 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78499,CPT,UNLISTED CARDIOVASCULAR PX DX NUCLEAR MEDICINE,26,,20 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78499,CPT,UNLISTED CARDIOVASCULAR PX DX NUCLEAR MEDICINE,TC,,20 ,,TotalUnits,,,,3.80 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78579,CPT,PULMONARY VENTILATION IMAGING,,,20 ,,RBRVS,0.49 ,4.59 ,4.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78579,CPT,PULMONARY VENTILATION IMAGING,26,,20 ,,RBRVS,0.49 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78579,CPT,PULMONARY VENTILATION IMAGING,TC,,20 ,,RBRVS,,4.43 ,4.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78580,CPT,PULMONARY PERFUSION IMAGING PARTICULATE,,,20 ,,RBRVS,0.74 ,5.46 ,5.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78580,CPT,PULMONARY PERFUSION IMAGING PARTICULATE,26,,20 ,,RBRVS,0.74 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78580,CPT,PULMONARY PERFUSION IMAGING PARTICULATE,TC,,20 ,,RBRVS,,5.16 ,5.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78582,CPT,PULMONARY VENTILATION & PERFUSION IMAGING,,,20 ,,RBRVS,1.07 ,8.30 ,8.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78582,CPT,PULMONARY VENTILATION & PERFUSION IMAGING,26,,20 ,,RBRVS,1.07 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78582,CPT,PULMONARY VENTILATION & PERFUSION IMAGING,TC,,20 ,,RBRVS,,7.95 ,7.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78597,CPT,QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING,,,20 ,,RBRVS,0.75 ,4.99 ,4.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78597,CPT,QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING,26,,20 ,,RBRVS,0.75 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78597,CPT,QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING,TC,,20 ,,RBRVS,,4.75 ,4.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78598,CPT,QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGING,,,20 ,,RBRVS,0.85 ,7.97 ,7.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78598,CPT,QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGING,26,,20 ,,RBRVS,0.85 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78598,CPT,QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGING,TC,,20 ,,RBRVS,,7.70 ,7.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78599,CPT,UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE,,,20 ,,TotalUnits,,,,4.42 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78599,CPT,UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE,26,,20 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78599,CPT,UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE,TC,,20 ,,TotalUnits,,,,3.64 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78600,CPT,BRAIN IMAGING <4 STATIC VIEWS,,,20 ,,RBRVS,0.44 ,4.81 ,4.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78600,CPT,BRAIN IMAGING <4 STATIC VIEWS,26,,20 ,,RBRVS,0.44 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78600,CPT,BRAIN IMAGING <4 STATIC VIEWS,TC,,20 ,,RBRVS,,4.62 ,4.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78601,CPT,BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW,,,20 ,,RBRVS,0.51 ,5.71 ,5.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78601,CPT,BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW,26,,20 ,,RBRVS,0.51 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78601,CPT,BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW,TC,,20 ,,RBRVS,,5.51 ,5.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78605,CPT,BRAIN IMAGING MINIMUM 4 STATIC VIEWS,,,20 ,,RBRVS,0.53 ,5.22 ,5.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78605,CPT,BRAIN IMAGING MINIMUM 4 STATIC VIEWS,26,,20 ,,RBRVS,0.53 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78605,CPT,BRAIN IMAGING MINIMUM 4 STATIC VIEWS,TC,,20 ,,RBRVS,,4.99 ,4.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78606,CPT,BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW,,,20 ,,RBRVS,0.64 ,8.85 ,8.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78606,CPT,BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW,26,,20 ,,RBRVS,0.64 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78606,CPT,BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW,TC,,20 ,,RBRVS,,8.59 ,8.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78607,CPT,BRAIN IMAGING TOMOGRAPHIC SPECT,,,20 ,,RBRVS,1.23 ,9.37 ,9.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78607,CPT,BRAIN IMAGING TOMOGRAPHIC SPECT,26,,20 ,,RBRVS,1.23 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78607,CPT,BRAIN IMAGING TOMOGRAPHIC SPECT,TC,,20 ,,RBRVS,,8.90 ,8.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78608,CPT,BRAIN IMAGING PET METABOLIC EVALUATION,,,20 ,,TotalUnits,,,,13.18 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78608,CPT,BRAIN IMAGING PET METABOLIC EVALUATION,,PC,20 ,,TotalUnits,,,,2.08 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,78608,CPT,BRAIN IMAGING PET METABOLIC EVALUATION,,TC,20 ,,TotalUnits,,,,11.10 ,,$0.00,$0.00,1,1,1,0,1,0,20120101,78609,CPT,BRAIN IMAGING PET PERFUSION EVALUATION,,,20 ,,TotalUnits,,,,8.52 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78609,CPT,BRAIN IMAGING PET PERFUSION EVALUATION,,PC,20 ,,TotalUnits,,,,2.13 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,78609,CPT,BRAIN IMAGING PET PERFUSION EVALUATION,,TC,20 ,,TotalUnits,,,,6.39 ,,$0.00,$0.00,1,1,1,0,1,0,20120101,78610,CPT,BRAIN IMAGING VASCULAR FLOW ONLY,,,20 ,,RBRVS,0.30 ,4.88 ,4.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78610,CPT,BRAIN IMAGING VASCULAR FLOW ONLY,26,,20 ,,RBRVS,0.30 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78610,CPT,BRAIN IMAGING VASCULAR FLOW ONLY,TC,,20 ,,RBRVS,,4.75 ,4.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78630,CPT,CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY,,,20 ,,RBRVS,0.68 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78630,CPT,CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY,26,,20 ,,RBRVS,0.68 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78630,CPT,CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY,TC,,20 ,,RBRVS,,8.88 ,8.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78635,CPT,CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY,,,20 ,,RBRVS,0.61 ,8.79 ,8.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78635,CPT,CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY,26,,20 ,,RBRVS,0.61 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78635,CPT,CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY,TC,,20 ,,RBRVS,,8.53 ,8.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78645,CPT,CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ,,,20 ,,RBRVS,0.57 ,8.68 ,8.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78645,CPT,CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ,26,,20 ,,RBRVS,0.57 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78645,CPT,CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ,TC,,20 ,,RBRVS,,8.45 ,8.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78647,CPT,CEREBROSPINAL FLUID FLOW W/O MATL TOMOG SPECT,,,20 ,,RBRVS,0.90 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78647,CPT,CEREBROSPINAL FLUID FLOW W/O MATL TOMOG SPECT,26,,20 ,,RBRVS,0.90 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78647,CPT,CEREBROSPINAL FLUID FLOW W/O MATL TOMOG SPECT,TC,,20 ,,RBRVS,,8.91 ,8.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78650,CPT,CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATION,,,20 ,,RBRVS,0.61 ,9.02 ,9.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78650,CPT,CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATION,26,,20 ,,RBRVS,0.61 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78650,CPT,CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATION,TC,,20 ,,RBRVS,,8.78 ,8.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78660,CPT,RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY,,,20 ,,RBRVS,0.53 ,4.62 ,4.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78660,CPT,RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY,26,,20 ,,RBRVS,0.53 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78660,CPT,RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY,TC,,20 ,,RBRVS,,4.39 ,4.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78699,CPT,UNLISTED NERVOUS SYSTEM PX DX NUCLEAR MEDICINE,,,20 ,,TotalUnits,,,,2.13 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78699,CPT,UNLISTED NERVOUS SYSTEM PX DX NUCLEAR MEDICINE,26,,20 ,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78699,CPT,UNLISTED NERVOUS SYSTEM PX DX NUCLEAR MEDICINE,TC,,20 ,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78700,CPT,KIDNEY IMAGING MORPHOLOGY,,,20 ,,RBRVS,0.45 ,4.68 ,4.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78700,CPT,KIDNEY IMAGING MORPHOLOGY,26,,20 ,,RBRVS,0.45 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78700,CPT,KIDNEY IMAGING MORPHOLOGY,TC,,20 ,,RBRVS,,4.49 ,4.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78701,CPT,KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW,,,20 ,,RBRVS,0.49 ,5.72 ,5.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78701,CPT,KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW,26,,20 ,,RBRVS,0.49 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78701,CPT,KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW,TC,,20 ,,RBRVS,,5.52 ,5.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78707,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX,,,20 ,,RBRVS,0.96 ,5.97 ,5.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78707,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX,26,,20 ,,RBRVS,0.96 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78707,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX,TC,,20 ,,RBRVS,,5.59 ,5.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78708,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W RX,,,20 ,,RBRVS,1.21 ,4.03 ,4.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78708,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W RX,26,,20 ,,RBRVS,1.21 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78708,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W RX,TC,,20 ,,RBRVS,,3.54 ,3.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78709,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE,,,20 ,,RBRVS,1.41 ,9.28 ,9.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78709,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE,26,,20 ,,RBRVS,1.41 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78709,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE,TC,,20 ,,RBRVS,,8.72 ,8.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78710,CPT,KIDNEY IMAGING MORPHOLOGY TOMOGRAPHIC,,,20 ,,RBRVS,0.66 ,5.85 ,5.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78710,CPT,KIDNEY IMAGING MORPHOLOGY TOMOGRAPHIC,26,,20 ,,RBRVS,0.66 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78710,CPT,KIDNEY IMAGING MORPHOLOGY TOMOGRAPHIC,TC,,20 ,,RBRVS,,5.60 ,5.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78725,CPT,KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY,,,20 ,,RBRVS,0.38 ,2.60 ,2.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78725,CPT,KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY,26,,20 ,,RBRVS,0.38 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78725,CPT,KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY,TC,,20 ,,RBRVS,,2.45 ,2.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78730,CPT,URINARY BLADDER RESIDUAL STUDY,,,20 ,,RBRVS,0.15 ,2.03 ,2.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78730,CPT,URINARY BLADDER RESIDUAL STUDY,26,,20 ,,RBRVS,0.15 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78730,CPT,URINARY BLADDER RESIDUAL STUDY,TC,,20 ,,RBRVS,,1.95 ,1.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78740,CPT,URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,,,20 ,,RBRVS,0.57 ,5.89 ,5.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78740,CPT,URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,26,,20 ,,RBRVS,0.57 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78740,CPT,URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,TC,,20 ,,RBRVS,,5.64 ,5.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78761,CPT,TESTICULAR IMAGING WITH VASCULAR FLOW,,,20 ,,RBRVS,0.71 ,5.48 ,5.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78761,CPT,TESTICULAR IMAGING WITH VASCULAR FLOW,26,,20 ,,RBRVS,0.71 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78761,CPT,TESTICULAR IMAGING WITH VASCULAR FLOW,TC,,20 ,,RBRVS,,5.18 ,5.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78799,CPT,UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE,,,20 ,,TotalUnits,,,,7.71 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78799,CPT,UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE,26,,20 ,,TotalUnits,,,,1.89 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78799,CPT,UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE,TC,,20 ,,TotalUnits,,,,5.82 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78800,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT LIMITED AREA,,,20 ,,RBRVS,0.66 ,4.78 ,4.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78800,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT LIMITED AREA,26,,20 ,,RBRVS,0.66 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78800,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT LIMITED AREA,TC,,20 ,,RBRVS,,4.52 ,4.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78801,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT MULTIPLE AREAS,,,20 ,,RBRVS,0.79 ,6.58 ,6.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78801,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT MULTIPLE AREAS,26,,20 ,,RBRVS,0.79 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78801,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT MULTIPLE AREAS,TC,,20 ,,RBRVS,,6.26 ,6.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78802,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY,,,20 ,,RBRVS,0.86 ,8.69 ,8.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78802,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY,26,,20 ,,RBRVS,0.86 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78802,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY,TC,,20 ,,RBRVS,,8.35 ,8.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78803,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT,,,20 ,,RBRVS,1.09 ,9.17 ,9.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78803,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT,26,,20 ,,RBRVS,1.09 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78803,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT,TC,,20 ,,RBRVS,,8.75 ,8.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78804,CPT,RP LOCLZJ TUMOR/DSTRBJ AGT WHOL BDY REQ 2/> DAYS,,,20 ,,RBRVS,1.07 ,15.92 ,15.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78804,CPT,RP LOCLZJ TUMOR/DSTRBJ AGT WHOL BDY REQ 2/> DAYS,26,,20 ,,RBRVS,1.07 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78804,CPT,RP LOCLZJ TUMOR/DSTRBJ AGT WHOL BDY REQ 2/> DAYS,TC,,20 ,,RBRVS,,15.50 ,15.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78805,CPT,RP LOCLZJ INFLAMMATORY PROCESS LIMITED AREA,,,20 ,,RBRVS,0.73 ,4.63 ,4.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78805,CPT,RP LOCLZJ INFLAMMATORY PROCESS LIMITED AREA,26,,20 ,,RBRVS,0.73 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78805,CPT,RP LOCLZJ INFLAMMATORY PROCESS LIMITED AREA,TC,,20 ,,RBRVS,,4.34 ,4.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78806,CPT,RP LOCLZJ INFLAMMATORY PROCESS WHOLE BODY,,,20 ,,RBRVS,0.86 ,9.03 ,9.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78806,CPT,RP LOCLZJ INFLAMMATORY PROCESS WHOLE BODY,26,,20 ,,RBRVS,0.86 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78806,CPT,RP LOCLZJ INFLAMMATORY PROCESS WHOLE BODY,TC,,20 ,,RBRVS,,8.69 ,8.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78807,CPT,RP LOCLZJ INFLAMMATORY PROCESS TOMOG SPECT,,,20 ,,RBRVS,1.09 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,78807,CPT,RP LOCLZJ INFLAMMATORY PROCESS TOMOG SPECT,26,,20 ,,RBRVS,1.09 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78807,CPT,RP LOCLZJ INFLAMMATORY PROCESS TOMOG SPECT,TC,,20 ,,RBRVS,,8.75 ,8.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,78808,CPT,NJX RP LOCLZJ NON-IMG PROBE STUDY INTRAVENOUS,,,20 ,,RBRVS,0.18 ,1.06 ,1.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,78811,CPT,PET IMAGING LIMITED AREA CHEST HEAD/NECK,,,20 ,,TotalUnits,,,,17.43 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78811,CPT,PET IMAGING LIMITED AREA CHEST HEAD/NECK,26,,20 ,,TotalUnits,,,,2.17 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78811,CPT,PET IMAGING LIMITED AREA CHEST HEAD/NECK,TC,,20 ,,TotalUnits,,,,15.26 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78812,CPT,PET IMAGING SKULL BASE TO MID-THIGH,,,20 ,,TotalUnits,,,,21.59 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78812,CPT,PET IMAGING SKULL BASE TO MID-THIGH,26,,20 ,,TotalUnits,,,,2.71 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78812,CPT,PET IMAGING SKULL BASE TO MID-THIGH,TC,,20 ,,TotalUnits,,,,18.88 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78813,CPT,PET IMAGING WHOLE BODY,,,20 ,,TotalUnits,,,,22.37 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78813,CPT,PET IMAGING WHOLE BODY,26,,20 ,,TotalUnits,,,,2.82 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78813,CPT,PET IMAGING WHOLE BODY,TC,,20 ,,TotalUnits,,,,19.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78814,CPT,PET IMAGING CT FOR ATTENUATION LIMITED AREA,,,20 ,,TotalUnits,,,,24.45 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78814,CPT,PET IMAGING CT FOR ATTENUATION LIMITED AREA,26,,20 ,,TotalUnits,,,,3.07 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78814,CPT,PET IMAGING CT FOR ATTENUATION LIMITED AREA,TC,,20 ,,TotalUnits,,,,21.38 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78815,CPT,PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH,,,20 ,,TotalUnits,,,,26.92 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78815,CPT,PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH,26,,20 ,,TotalUnits,,,,3.42 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78815,CPT,PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH,TC,,20 ,,TotalUnits,,,,23.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78816,CPT,PET IMAGING FOR CT ATTENUATION WHOLE BODY,,,20 ,,TotalUnits,,,,27.65 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78816,CPT,PET IMAGING FOR CT ATTENUATION WHOLE BODY,26,,20 ,,TotalUnits,,,,3.48 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78816,CPT,PET IMAGING FOR CT ATTENUATION WHOLE BODY,TC,,20 ,,TotalUnits,,,,24.17 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,78999,CPT,UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE,,,20 ,,TotalUnits,,,,3.49 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,78999,CPT,UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE,26,,20 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,78999,CPT,UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE,TC,,20 ,,TotalUnits,,,,3.05 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,79005,CPT,RP THERAPY ORAL ADMINISTRATION,,,20 ,,RBRVS,1.80 ,2.32 ,2.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,79005,CPT,RP THERAPY ORAL ADMINISTRATION,26,,20 ,,RBRVS,1.80 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,79005,CPT,RP THERAPY ORAL ADMINISTRATION,TC,,20 ,,RBRVS,,1.60 ,1.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,79101,CPT,RP THERAPY INTRAVENOUS ADMINISTRATION,,,20 ,,RBRVS,1.96 ,2.71 ,2.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,79101,CPT,RP THERAPY INTRAVENOUS ADMINISTRATION,26,,20 ,,RBRVS,1.96 ,0.97 ,0.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,79101,CPT,RP THERAPY INTRAVENOUS ADMINISTRATION,TC,,20 ,,RBRVS,,1.74 ,1.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,79200,CPT,RP THERAPY INRACAVITARY ADMINISTRATION,,,20 ,,RBRVS,1.99 ,2.82 ,2.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,79200,CPT,RP THERAPY INRACAVITARY ADMINISTRATION,26,,20 ,,RBRVS,1.99 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,79200,CPT,RP THERAPY INRACAVITARY ADMINISTRATION,TC,,20 ,,RBRVS,,1.98 ,1.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,79300,CPT,RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN,,,20 ,,RBRVS,1.60 ,2.18 ,2.18 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,79300,CPT,RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN,26,,20 ,,RBRVS,1.60 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,79300,CPT,RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN,TC,,20 ,,RBRVS,,1.52 ,1.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,79403,CPT,RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS,,,20 ,,RBRVS,2.25 ,3.61 ,3.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,79403,CPT,RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS,26,,20 ,,RBRVS,2.25 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,79403,CPT,RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS,TC,,20 ,,RBRVS,,2.68 ,2.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,79440,CPT,RP THERAPY INTRA-ARTICULAR ADMINISTRATION,,,20 ,,RBRVS,1.99 ,2.58 ,2.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,79440,CPT,RP THERAPY INTRA-ARTICULAR ADMINISTRATION,26,,20 ,,RBRVS,1.99 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,79440,CPT,RP THERAPY INTRA-ARTICULAR ADMINISTRATION,TC,,20 ,,RBRVS,,1.66 ,1.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,79445,CPT,RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN,,,20 ,,TotalUnits,,,,10.09 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,79445,CPT,RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN,26,,20 ,,TotalUnits,,,,3.34 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,79445,CPT,RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN,TC,,20 ,,TotalUnits,,,,6.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,79999,CPT,RP THERAPY UNLISTED PROCEDURE,,,20 ,,TotalUnits,,,,3.78 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,79999,CPT,RP THERAPY UNLISTED PROCEDURE,,PC,20 ,,TotalUnits,,,,2.28 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,79999,CPT,RP THERAPY UNLISTED PROCEDURE,,TC,20 ,,TotalUnits,,,,1.50 ,,$0.00,$0.00,1,1,1,0,1,0,20120101,80047,CPT,METABOLIC PANEL IONIZED CA,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80048,CPT,METABOLIC PANEL TOTAL CA,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80050,CPT,GENERAL HEALTH PANEL,,,17 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80051,CPT,ELECTROLYTE PANEL,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80053,CPT,COMPREHEN METABOLIC PANEL,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80055,CPT,OBSTETRIC PANEL,,,17 ,,TotalUnits,,,,1.43 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80061,CPT,LIPID PANEL,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80069,CPT,RENAL FUNCTION PANEL,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80074,CPT,ACUTE HEPATITIS PANEL,,,17 ,,TotalUnits,,,,1.97 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80076,CPT,HEPATIC FUNCTION PANEL,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80100,CPT,DRUG SCREEN QUALITATE/MULTI,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80101,CPT,DRUG SCREEN SINGLE,,,17 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80102,CPT,DRUG CONFIRMATION,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80103,CPT,DRUG ANALYSIS TISSUE PREP,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80104,CPT,DRUG SCRN 1+ CLASS NONCHROMO,,,17 ,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80150,CPT,ASSAY OF AMIKACIN,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80152,CPT,ASSAY OF AMITRIPTYLINE,,,17 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80154,CPT,ASSAY OF BENZODIAZEPINES,,,17 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80156,CPT,ASSAY CARBAMAZEPINE TOTAL,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80157,CPT,ASSAY CARBAMAZEPINE FREE,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80158,CPT,ASSAY OF CYCLOSPORINE,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80160,CPT,ASSAY OF DESIPRAMINE,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80162,CPT,ASSAY OF DIGOXIN,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80164,CPT,ASSAY DIPROPYLACETIC ACID,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80166,CPT,ASSAY OF DOXEPIN,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80168,CPT,ASSAY OF ETHOSUXIMIDE,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80170,CPT,ASSAY OF GENTAMICIN,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80172,CPT,ASSAY OF GOLD,,,17 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80173,CPT,ASSAY OF HALOPERIDOL,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80174,CPT,ASSAY OF IMIPRAMINE,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80176,CPT,ASSAY OF LIDOCAINE,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80178,CPT,ASSAY OF LITHIUM,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80182,CPT,ASSAY OF NORTRIPTYLINE,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80184,CPT,ASSAY OF PHENOBARBITAL,,,17 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80185,CPT,ASSAY OF PHENYTOIN TOTAL,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80186,CPT,ASSAY OF PHENYTOIN FREE,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80188,CPT,ASSAY OF PRIMIDONE,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80190,CPT,ASSAY OF PROCAINAMIDE,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80192,CPT,ASSAY OF PROCAINAMIDE,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80194,CPT,ASSAY OF QUINIDINE,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80195,CPT,ASSAY OF SIROLIMUS,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80196,CPT,ASSAY OF SALICYLATE,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80197,CPT,ASSAY OF TACROLIMUS,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80198,CPT,ASSAY OF THEOPHYLLINE,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80200,CPT,ASSAY OF TOBRAMYCIN,,,17 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80201,CPT,ASSAY OF TOPIRAMATE,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80202,CPT,ASSAY OF VANCOMYCIN,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80299,CPT,QUANTITATIVE ASSAY DRUG,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80400,CPT,ACTH STIMULATION PANEL,,,17 ,,TotalUnits,,,,1.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80402,CPT,ACTH STIMULATION PANEL,,,17 ,,TotalUnits,,,,3.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80406,CPT,ACTH STIMULATION PANEL,,,17 ,,TotalUnits,,,,3.24 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80408,CPT,ALDOSTERONE SUPPRESSION EVAL,,,17 ,,TotalUnits,,,,5.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80410,CPT,CALCITONIN STIMUL PANEL,,,17 ,,TotalUnits,,,,3.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80412,CPT,CRH STIMULATION PANEL,,,17 ,,TotalUnits,,,,13.65 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80414,CPT,TESTOSTERONE RESPONSE,,,17 ,,TotalUnits,,,,2.14 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80415,CPT,ESTRADIOL RESPONSE PANEL,,,17 ,,TotalUnits,,,,2.31 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80416,CPT,RENIN STIMULATION PANEL,,,17 ,,TotalUnits,,,,5.47 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80417,CPT,RENIN STIMULATION PANEL,,,17 ,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80418,CPT,PITUITARY EVALUATION PANEL,,,17 ,,TotalUnits,,,,24.00 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80420,CPT,DEXAMETHASONE PANEL,,,17 ,,TotalUnits,,,,2.98 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80422,CPT,GLUCAGON TOLERANCE PANEL,,,17 ,,TotalUnits,,,,1.91 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80424,CPT,GLUCAGON TOLERANCE PANEL,,,17 ,,TotalUnits,,,,2.09 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80426,CPT,GONADOTROPIN HORMONE PANEL,,,17 ,,TotalUnits,,,,6.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80428,CPT,GROWTH HORMONE PANEL,,,17 ,,TotalUnits,,,,2.76 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80430,CPT,GROWTH HORMONE PANEL,,,17 ,,TotalUnits,,,,3.25 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80432,CPT,INSULIN SUPPRESSION PANEL,,,17 ,,TotalUnits,,,,5.59 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80434,CPT,INSULIN TOLERANCE PANEL,,,17 ,,TotalUnits,,,,4.19 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80435,CPT,INSULIN TOLERANCE PANEL,,,17 ,,TotalUnits,,,,4.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80436,CPT,METYRAPONE PANEL,,,17 ,,TotalUnits,,,,3.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80438,CPT,TRH STIMULATION PANEL,,,17 ,,TotalUnits,,,,2.09 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80439,CPT,TRH STIMULATION PANEL,,,17 ,,TotalUnits,,,,2.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80440,CPT,TRH STIMULATION PANEL,,,17 ,,TotalUnits,,,,2.41 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,80500,CPT,CLINICAL PATHOLOGY CONSULTATION LIMITED,,,17 ,,RBRVS,0.37 ,0.14 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,80502,CPT,CLINICAL PATHOLOGY CONSULTATION COMPREHENSIVE,,,17 ,,RBRVS,1.33 ,0.43 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,81000,CPT,URINALYSIS NONAUTO W/SCOPE,,,17 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,81001,CPT,URINALYSIS AUTO W/SCOPE,,,17 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,81002,CPT,URINALYSIS NONAUTO W/O SCOPE,,,17 ,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,81003,CPT,URINALYSIS AUTO W/O SCOPE,,,17 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,81005,CPT,URINALYSIS,,,17 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,81007,CPT,URINE SCREEN FOR BACTERIA,,,17 ,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,81015,CPT,MICROSCOPIC EXAM OF URINE,,,17 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,81020,CPT,URINALYSIS GLASS TEST,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,81025,CPT,URINE PREGNANCY TEST,,,17 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,81050,CPT,URINALYSIS VOLUME MEASURE,,,17 ,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,81099,CPT,URINALYSIS TEST PROCEDURE,,,17 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82000,CPT,ASSAY OF BLOOD ACETALDEHYDE,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82003,CPT,ASSAY OF ACETAMINOPHEN,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82009,CPT,TEST FOR ACETONE/KETONES,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82010,CPT,ACETONE ASSAY,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82013,CPT,ACETYLCHOLINESTERASE ASSAY,,,17 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82016,CPT,ACYLCARNITINES QUAL,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82017,CPT,ACYLCARNITINES QUANT,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82024,CPT,ASSAY OF ACTH,,,17 ,,TotalUnits,,,,1.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82030,CPT,ASSAY OF ADP & AMP,,,17 ,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82040,CPT,ASSAY OF SERUM ALBUMIN,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82042,CPT,ASSAY OF URINE ALBUMIN,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82043,CPT,MICROALBUMIN QUANTITATIVE,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82044,CPT,MICROALBUMIN SEMIQUANT,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82045,CPT,ALBUMIN ISCHEMIA MODIFIED,,,17 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82055,CPT,ASSAY OF ETHANOL,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82075,CPT,ASSAY OF BREATH ETHANOL,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82085,CPT,ASSAY OF ALDOLASE,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82088,CPT,ASSAY OF ALDOSTERONE,,,17 ,,TotalUnits,,,,1.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82101,CPT,ASSAY OF URINE ALKALOIDS,,,17 ,,TotalUnits,,,,1.24 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82103,CPT,ALPHA-1-ANTITRYPSIN TOTAL,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82104,CPT,ALPHA-1-ANTITRYPSIN PHENO,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82105,CPT,ALPHA-FETOPROTEIN SERUM,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82106,CPT,ALPHA-FETOPROTEIN AMNIOTIC,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82107,CPT,ALPHA-FETOPROTEIN L3,,,17 ,,TotalUnits,,,,2.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82108,CPT,ASSAY OF ALUMINUM,,,17 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82120,CPT,AMINES VAGINAL FLUID QUAL,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82127,CPT,AMINO ACID SINGLE QUAL,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82128,CPT,AMINO ACIDS MULT QUAL,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82131,CPT,AMINO ACIDS SINGLE QUANT,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82135,CPT,ASSAY AMINOLEVULINIC ACID,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82136,CPT,AMINO ACIDS QUANT 2-5,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82139,CPT,AMINO ACIDS QUAN 6 OR MORE,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82140,CPT,ASSAY OF AMMONIA,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82143,CPT,AMNIOTIC FLUID SCAN,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82145,CPT,ASSAY OF AMPHETAMINES,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82150,CPT,ASSAY OF AMYLASE,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82154,CPT,ANDROSTANEDIOL GLUCURONIDE,,,17 ,,TotalUnits,,,,1.19 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82157,CPT,ASSAY OF ANDROSTENEDIONE,,,17 ,,TotalUnits,,,,1.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82160,CPT,ASSAY OF ANDROSTERONE,,,17 ,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82163,CPT,ASSAY OF ANGIOTENSIN II,,,17 ,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82164,CPT,ANGIOTENSIN I ENZYME TEST,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82172,CPT,ASSAY OF APOLIPOPROTEIN,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82175,CPT,ASSAY OF ARSENIC,,,17 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82180,CPT,ASSAY OF ASCORBIC ACID,,,17 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82190,CPT,ATOMIC ABSORPTION,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82205,CPT,ASSAY OF BARBITURATES,,,17 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82232,CPT,ASSAY OF BETA-2 PROTEIN,,,17 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82239,CPT,BILE ACIDS TOTAL,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82240,CPT,BILE ACIDS CHOLYLGLYCINE,,,17 ,,TotalUnits,,,,1.10 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82247,CPT,BILIRUBIN TOTAL,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82248,CPT,BILIRUBIN DIRECT,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82252,CPT,FECAL BILIRUBIN TEST,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82261,CPT,ASSAY OF BIOTINIDASE,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82270,CPT,OCCULT BLOOD FECES,,,17 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82271,CPT,OCCULT BLOOD OTHER SOURCES,,,17 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82272,CPT,OCCULT BLD FECES 1-3 TESTS,,,17 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82274,CPT,ASSAY TEST FOR BLOOD FECAL,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82286,CPT,ASSAY OF BRADYKININ,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82300,CPT,ASSAY OF CADMIUM,,,17 ,,TotalUnits,,,,0.96 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82306,CPT,VITAMIN D 25 HYDROXY,,,17 ,,TotalUnits,,,,1.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82308,CPT,ASSAY OF CALCITONIN,,,17 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82310,CPT,ASSAY OF CALCIUM,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82330,CPT,ASSAY OF CALCIUM,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82331,CPT,CALCIUM INFUSION TEST,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82340,CPT,ASSAY OF CALCIUM IN URINE,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82355,CPT,CALCULUS ANALYSIS QUAL,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82360,CPT,CALCULUS ASSAY QUANT,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82365,CPT,CALCULUS SPECTROSCOPY,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82370,CPT,X-RAY ASSAY CALCULUS,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82373,CPT,ASSAY C-D TRANSFER MEASURE,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82374,CPT,ASSAY BLOOD CARBON DIOXIDE,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82375,CPT,ASSAY CARBOXYHB QUANT,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82376,CPT,ASSAY CARBOXYHB QUAL,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82378,CPT,CARCINOEMBRYONIC ANTIGEN,,,17 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82379,CPT,ASSAY OF CARNITINE,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82380,CPT,ASSAY OF CAROTENE,,,17 ,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82382,CPT,ASSAY URINE CATECHOLAMINES,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82383,CPT,ASSAY BLOOD CATECHOLAMINES,,,17 ,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82384,CPT,ASSAY THREE CATECHOLAMINES,,,17 ,,TotalUnits,,,,1.05 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82387,CPT,ASSAY OF CATHEPSIN-D,,,17 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82390,CPT,ASSAY OF CERULOPLASMIN,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82397,CPT,CHEMILUMINESCENT ASSAY,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82415,CPT,ASSAY OF CHLORAMPHENICOL,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82435,CPT,ASSAY OF BLOOD CHLORIDE,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82436,CPT,ASSAY OF URINE CHLORIDE,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82438,CPT,ASSAY OTHER FLUID CHLORIDES,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82441,CPT,TEST FOR CHLOROHYDROCARBONS,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82465,CPT,ASSAY BLD/SERUM CHOLESTEROL,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82480,CPT,ASSAY SERUM CHOLINESTERASE,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82482,CPT,ASSAY RBC CHOLINESTERASE,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82485,CPT,ASSAY CHONDROITIN SULFATE,,,17 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82486,CPT,GAS/LIQUID CHROMATOGRAPHY,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82487,CPT,PAPER CHROMATOGRAPHY,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82488,CPT,PAPER CHROMATOGRAPHY,,,17 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82489,CPT,THIN LAYER CHROMATOGRAPHY,,,17 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82491,CPT,CHROMOTOGRAPHY QUANT SING,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82492,CPT,CHROMOTOGRAPHY QUANT MULT,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82495,CPT,ASSAY OF CHROMIUM,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82507,CPT,ASSAY OF CITRATE,,,17 ,,TotalUnits,,,,1.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82520,CPT,ASSAY OF COCAINE,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82523,CPT,COLLAGEN CROSSLINKS,,,17 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82525,CPT,ASSAY OF COPPER,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82528,CPT,ASSAY OF CORTICOSTERONE,,,17 ,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82530,CPT,CORTISOL FREE,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82533,CPT,TOTAL CORTISOL,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82540,CPT,ASSAY OF CREATINE,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82541,CPT,COLUMN CHROMOTOGRAPHY QUAL,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82542,CPT,COLUMN CHROMOTOGRAPHY QUANT,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82543,CPT,COLUMN CHROMOTOGRAPH/ISOTOPE,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82544,CPT,COLUMN CHROMOTOGRAPH/ISOTOPE,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82550,CPT,ASSAY OF CK (CPK),,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82552,CPT,ASSAY OF CPK IN BLOOD,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82553,CPT,CREATINE MB FRACTION,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82554,CPT,CREATINE ISOFORMS,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82565,CPT,ASSAY OF CREATININE,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82570,CPT,ASSAY OF URINE CREATININE,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82575,CPT,CREATININE CLEARANCE TEST,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82585,CPT,ASSAY OF CRYOFIBRINOGEN,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82595,CPT,ASSAY OF CRYOGLOBULIN,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82600,CPT,ASSAY OF CYANIDE,,,17 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82607,CPT,VITAMIN B-12,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82608,CPT,B-12 BINDING CAPACITY,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82610,CPT,CYSTATIN C,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82615,CPT,TEST FOR URINE CYSTINES,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82626,CPT,DEHYDROEPIANDROSTERONE,,,17 ,,TotalUnits,,,,1.05 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82627,CPT,DEHYDROEPIANDROSTERONE,,,17 ,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82633,CPT,DESOXYCORTICOSTERONE,,,17 ,,TotalUnits,,,,1.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82634,CPT,DEOXYCORTISOL,,,17 ,,TotalUnits,,,,1.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82638,CPT,ASSAY OF DIBUCAINE NUMBER,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82646,CPT,ASSAY OF DIHYDROCODEINONE,,,17 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82649,CPT,ASSAY OF DIHYDROMORPHINONE,,,17 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82651,CPT,ASSAY OF DIHYDROTESTOSTERONE,,,17 ,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82652,CPT,VIT D 1 25-DIHYDROXY,,,17 ,,TotalUnits,,,,1.59 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82654,CPT,ASSAY OF DIMETHADIONE,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82656,CPT,PANCREATIC ELASTASE FECAL,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82657,CPT,ENZYME CELL ACTIVITY,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82658,CPT,ENZYME CELL ACTIVITY RA,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82664,CPT,ELECTROPHORETIC TEST,,,17 ,,TotalUnits,,,,1.42 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82666,CPT,ASSAY OF EPIANDROSTERONE,,,17 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82668,CPT,ASSAY OF ERYTHROPOIETIN,,,17 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82670,CPT,ASSAY OF ESTRADIOL,,,17 ,,TotalUnits,,,,1.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82671,CPT,ASSAY OF ESTROGENS,,,17 ,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82672,CPT,ASSAY OF ESTROGEN,,,17 ,,TotalUnits,,,,0.90 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82677,CPT,ASSAY OF ESTRIOL,,,17 ,,TotalUnits,,,,1.00 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82679,CPT,ASSAY OF ESTRONE,,,17 ,,TotalUnits,,,,1.03 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82690,CPT,ASSAY OF ETHCHLORVYNOL,,,17 ,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82693,CPT,ASSAY OF ETHYLENE GLYCOL,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82696,CPT,ASSAY OF ETIOCHOLANOLONE,,,17 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82705,CPT,FATS/LIPIDS FECES QUAL,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82710,CPT,FATS/LIPIDS FECES QUANT,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82715,CPT,ASSAY OF FECAL FAT,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82725,CPT,ASSAY OF BLOOD FATTY ACIDS,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82726,CPT,LONG CHAIN FATTY ACIDS,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82728,CPT,ASSAY OF FERRITIN,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82731,CPT,ASSAY OF FETAL FIBRONECTIN,,,17 ,,TotalUnits,,,,2.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82735,CPT,ASSAY OF FLUORIDE,,,17 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82742,CPT,ASSAY OF FLURAZEPAM,,,17 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82746,CPT,BLOOD FOLIC ACID SERUM,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82747,CPT,ASSAY OF FOLIC ACID RBC,,,17 ,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82757,CPT,ASSAY OF SEMEN FRUCTOSE,,,17 ,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82759,CPT,ASSAY OF RBC GALACTOKINASE,,,17 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82760,CPT,ASSAY OF GALACTOSE,,,17 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82775,CPT,ASSAY GALACTOSE TRANSFERASE,,,17 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82776,CPT,GALACTOSE TRANSFERASE TEST,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82784,CPT,ASSAY IGA/IGD/IGG/IGM EACH,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82785,CPT,ASSAY OF IGE,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82787,CPT,IGG 1 2 3 OR 4 EACH,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82800,CPT,BLOOD PH,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82803,CPT,BLOOD GASES ANY COMBINATION,,,17 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82805,CPT,BLOOD GASES W/O2 SATURATION,,,17 ,,TotalUnits,,,,1.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82810,CPT,BLOOD GASES O2 SAT ONLY,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82820,CPT,HEMOGLOBIN-OXYGEN AFFINITY,,,17 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82930,CPT,GASTRIC ANALY W/PH EA SPEC,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82938,CPT,GASTRIN TEST,,,17 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82941,CPT,ASSAY OF GASTRIN,,,17 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82943,CPT,ASSAY OF GLUCAGON,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82945,CPT,GLUCOSE OTHER FLUID,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82946,CPT,GLUCAGON TOLERANCE TEST,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82947,CPT,ASSAY GLUCOSE BLOOD QUANT,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82948,CPT,REAGENT STRIP/BLOOD GLUCOSE,,,17 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82950,CPT,GLUCOSE TEST,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82951,CPT,GLUCOSE TOLERANCE TEST (GTT),,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82952,CPT,GTT-ADDED SAMPLES,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82953,CPT,GLUCOSE-TOLBUTAMIDE TEST,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82955,CPT,ASSAY OF G6PD ENZYME,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82960,CPT,TEST FOR G6PD ENZYME,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82962,CPT,GLUCOSE BLOOD TEST,,,17 ,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82963,CPT,ASSAY OF GLUCOSIDASE,,,17 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82965,CPT,ASSAY OF GDH ENZYME,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82975,CPT,ASSAY OF GLUTAMINE,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82977,CPT,ASSAY OF GGT,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82978,CPT,ASSAY OF GLUTATHIONE,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82979,CPT,ASSAY RBC GLUTATHIONE,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82980,CPT,ASSAY OF GLUTETHIMIDE,,,17 ,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,82985,CPT,GLYCATED PROTEIN,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83001,CPT,GONADOTROPIN (FSH),,,17 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83002,CPT,GONADOTROPIN (LH),,,17 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83003,CPT,ASSAY GROWTH HORMONE (HGH),,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83008,CPT,ASSAY OF GUANOSINE,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83009,CPT,H PYLORI (C-13) BLOOD,,,17 ,,TotalUnits,,,,2.79 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83010,CPT,ASSAY OF HAPTOGLOBIN QUANT,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83012,CPT,ASSAY OF HAPTOGLOBINS,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83013,CPT,H PYLORI (C-13) BREATH,,,17 ,,TotalUnits,,,,2.79 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83014,CPT,H PYLORI DRUG ADMIN,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83015,CPT,HEAVY METAL SCREEN,,,17 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83018,CPT,QUANTITATIVE SCREEN METALS,,,17 ,,TotalUnits,,,,0.91 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83020,CPT,HEMOGLOBIN ELECTROPHORESIS,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,83020,CPT,HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS,26,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,83021,CPT,HEMOGLOBIN CHROMOTOGRAPHY,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83026,CPT,HEMOGLOBIN COPPER SULFATE,,,17 ,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83030,CPT,FETAL HEMOGLOBIN CHEMICAL,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83033,CPT,FETAL HEMOGLOBIN ASSAY QUAL,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83036,CPT,GLYCOSYLATED HEMOGLOBIN TEST,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83037,CPT,GLYCOSYLATED HB HOME DEVICE,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83045,CPT,BLOOD METHEMOGLOBIN TEST,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83050,CPT,BLOOD METHEMOGLOBIN ASSAY,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83051,CPT,ASSAY OF PLASMA HEMOGLOBIN,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83055,CPT,BLOOD SULFHEMOGLOBIN TEST,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83060,CPT,BLOOD SULFHEMOGLOBIN ASSAY,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83065,CPT,ASSAY OF HEMOGLOBIN HEAT,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83068,CPT,HEMOGLOBIN STABILITY SCREEN,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83069,CPT,ASSAY OF URINE HEMOGLOBIN,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83070,CPT,ASSAY OF HEMOSIDERIN QUAL,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83071,CPT,ASSAY OF HEMOSIDERIN QUANT,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83080,CPT,ASSAY OF B HEXOSAMINIDASE,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83088,CPT,ASSAY OF HISTAMINE,,,17 ,,TotalUnits,,,,1.22 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83090,CPT,ASSAY OF HOMOCYSTINE,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83150,CPT,ASSAY OF FOR HVA,,,17 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83491,CPT,ASSAY OF CORTICOSTEROIDS,,,17 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83497,CPT,ASSAY OF 5-HIAA,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83498,CPT,ASSAY OF PROGESTERONE,,,17 ,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83499,CPT,ASSAY OF PROGESTERONE,,,17 ,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83500,CPT,ASSAY FREE HYDROXYPROLINE,,,17 ,,TotalUnits,,,,0.94 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83505,CPT,ASSAY TOTAL HYDROXYPROLINE,,,17 ,,TotalUnits,,,,1.01 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83516,CPT,IMMUNOASSAY NONANTIBODY,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83518,CPT,IMMUNOASSAY DIPSTICK,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83519,CPT,RIA NONANTIBODY,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83520,CPT,IMMUNOASSAY QUANT NOS NONAB,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83525,CPT,ASSAY OF INSULIN,,,17 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83527,CPT,ASSAY OF INSULIN,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83528,CPT,ASSAY OF INTRINSIC FACTOR,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83540,CPT,ASSAY OF IRON,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83550,CPT,IRON BINDING TEST,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83570,CPT,ASSAY OF IDH ENZYME,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83582,CPT,ASSAY OF KETOGENIC STEROIDS,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83586,CPT,ASSAY 17- KETOSTEROIDS,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83593,CPT,FRACTIONATION KETOSTEROIDS,,,17 ,,TotalUnits,,,,1.09 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83605,CPT,ASSAY OF LACTIC ACID,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83615,CPT,LACTATE (LD) (LDH) ENZYME,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83625,CPT,ASSAY OF LDH ENZYMES,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83630,CPT,LACTOFERRIN FECAL (QUAL),,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83631,CPT,LACTOFERRIN FECAL (QUANT),,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83632,CPT,PLACENTAL LACTOGEN,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83633,CPT,TEST URINE FOR LACTOSE,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83634,CPT,ASSAY OF URINE FOR LACTOSE,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83655,CPT,ASSAY OF LEAD,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83661,CPT,L/S RATIO FETAL LUNG,,,17 ,,TotalUnits,,,,0.91 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83662,CPT,FOAM STABILITY FETAL LUNG,,,17 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83663,CPT,FLUORO POLARIZE FETAL LUNG,,,17 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83664,CPT,LAMELLAR BDY FETAL LUNG,,,17 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83670,CPT,ASSAY OF LAP ENZYME,,,17 ,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83690,CPT,ASSAY OF LIPASE,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83695,CPT,ASSAY OF LIPOPROTEIN(A),,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83698,CPT,ASSAY LIPOPROTEIN PLA2,,,17 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83700,CPT,LIPOPRO BLD ELECTROPHORETIC,,,17 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83701,CPT,LIPOPROTEIN BLD HR FRACTION,,,17 ,,TotalUnits,,,,1.03 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83704,CPT,LIPOPROTEIN BLD BY NMR,,,17 ,,TotalUnits,,,,1.31 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83718,CPT,ASSAY OF LIPOPROTEIN,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83719,CPT,ASSAY OF BLOOD LIPOPROTEIN,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83721,CPT,ASSAY OF BLOOD LIPOPROTEIN,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83727,CPT,ASSAY OF LRH HORMONE,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83735,CPT,ASSAY OF MAGNESIUM,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83775,CPT,ASSAY OF MD ENZYME,,,17 ,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83785,CPT,ASSAY OF MANGANESE,,,17 ,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83788,CPT,MASS SPECTROMETRY QUAL,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83789,CPT,MASS SPECTROMETRY QUANT,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83805,CPT,ASSAY OF MEPROBAMATE,,,17 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83825,CPT,ASSAY OF MERCURY,,,17 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83835,CPT,ASSAY OF METANEPHRINES,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83840,CPT,ASSAY OF METHADONE,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83857,CPT,ASSAY OF METHEMALBUMIN,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83858,CPT,ASSAY OF METHSUXIMIDE,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83861,CPT,MICROFLUID ANALY TEARS,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83864,CPT,MUCOPOLYSACCHARIDES,,,17 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83866,CPT,MUCOPOLYSACCHARIDES SCREEN,,,17 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83872,CPT,ASSAY SYNOVIAL FLUID MUCIN,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83873,CPT,ASSAY OF CSF PROTEIN,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83874,CPT,ASSAY OF MYOGLOBIN,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83876,CPT,ASSAY MYELOPEROXIDASE,,,17 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83880,CPT,NATRIURETIC PEPTIDE,,,17 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83883,CPT,ASSAY NEPHELOMETRY NOT SPEC,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83885,CPT,ASSAY OF NICKEL,,,17 ,,TotalUnits,,,,1.01 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83887,CPT,ASSAY OF NICOTINE,,,17 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83890,CPT,MOLECULE ISOLATE,,,17 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83891,CPT,MOLECULE ISOLATE NUCLEIC,,,17 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83892,CPT,MOLECULAR DIAGNOSTICS,,,17 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83893,CPT,MOLECULE DOT/SLOT/BLOT,,,17 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83894,CPT,MOLECULE GEL ELECTROPHOR,,,17 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83896,CPT,MOLECULAR DIAGNOSTICS,,,17 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83897,CPT,MOLECULE NUCLEIC TRANSFER,,,17 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83898,CPT,MOLECULE NUCLEIC AMPLI EACH,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83900,CPT,MOLECULE NUCLEIC AMPLI 2 SEQ,,,17 ,,TotalUnits,,,,1.39 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83901,CPT,MOLECULE NUCLEIC AMPLI ADDON,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83902,CPT,MOLECULAR DIAGNOSTICS,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83903,CPT,MOLECULE MUTATION SCAN,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83904,CPT,MOLECULE MUTATION IDENTIFY,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83905,CPT,MOLECULE MUTATION IDENTIFY,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83906,CPT,MOLECULE MUTATION IDENTIFY,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83907,CPT,LYSE CELLS FOR NUCLEIC EXT,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83908,CPT,NUCLEIC ACID SIGNAL AMPLI,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83909,CPT,NUCLEIC ACID HIGH RESOLUTE,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83912,CPT,GENETIC EXAMINATION,,,17 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,83912,CPT,MOLECULAR DIAGNOSTICS INTERPRETATION & REPORT,26,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,83913,CPT,MOLECULAR RNA STABILIZATION,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83914,CPT,MUTATION IDENT OLA/SBCE/ASPE,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83915,CPT,ASSAY OF NUCLEOTIDASE,,,17 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83916,CPT,OLIGOCLONAL BANDS,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83918,CPT,ORGANIC ACIDS TOTAL QUANT,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83919,CPT,ORGANIC ACIDS QUAL EACH,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83921,CPT,ORGANIC ACID SINGLE QUANT,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83925,CPT,ASSAY OF OPIATES,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83930,CPT,ASSAY OF BLOOD OSMOLALITY,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83935,CPT,ASSAY OF URINE OSMOLALITY,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83937,CPT,ASSAY OF OSTEOCALCIN,,,17 ,,TotalUnits,,,,1.24 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83945,CPT,ASSAY OF OXALATE,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83950,CPT,ONCOPROTEIN HER-2/NEU,,,17 ,,TotalUnits,,,,2.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83951,CPT,ONCOPROTEIN DCP,,,17 ,,TotalUnits,,,,2.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83970,CPT,ASSAY OF PARATHORMONE,,,17 ,,TotalUnits,,,,1.71 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83986,CPT,ASSAY PH BODY FLUID NOS,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83987,CPT,EXHALED BREATH CONDENSATE,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83992,CPT,ASSAY FOR PHENCYCLIDINE,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,83993,CPT,ASSAY FOR CALPROTECTIN FECAL,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84022,CPT,ASSAY OF PHENOTHIAZINE,,,17 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84030,CPT,ASSAY OF BLOOD PKU,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84035,CPT,ASSAY OF PHENYLKETONES,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84060,CPT,ASSAY ACID PHOSPHATASE,,,17 ,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84061,CPT,PHOSPHATASE FORENSIC EXAM,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84066,CPT,ASSAY PROSTATE PHOSPHATASE,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84075,CPT,ASSAY ALKALINE PHOSPHATASE,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84078,CPT,ASSAY ALKALINE PHOSPHATASE,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84080,CPT,ASSAY ALKALINE PHOSPHATASES,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84081,CPT,AMNIOTIC FLUID ENZYME TEST,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84085,CPT,ASSAY OF RBC PG6D ENZYME,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84087,CPT,ASSAY PHOSPHOHEXOSE ENZYMES,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84100,CPT,ASSAY OF PHOSPHORUS,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84105,CPT,ASSAY OF URINE PHOSPHORUS,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84106,CPT,TEST FOR PORPHOBILINOGEN,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84110,CPT,ASSAY OF PORPHOBILINOGEN,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84112,CPT,PLACENTA ALPHA MICRO IG C/V,,,17 ,,TotalUnits,,,,2.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84119,CPT,TEST URINE FOR PORPHYRINS,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84120,CPT,ASSAY OF URINE PORPHYRINS,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84126,CPT,ASSAY OF FECES PORPHYRINS,,,17 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84127,CPT,ASSAY OF FECES PORPHYRINS,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84132,CPT,ASSAY OF SERUM POTASSIUM,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84133,CPT,ASSAY OF URINE POTASSIUM,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84134,CPT,ASSAY OF PREALBUMIN,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84135,CPT,ASSAY OF PREGNANEDIOL,,,17 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84138,CPT,ASSAY OF PREGNANETRIOL,,,17 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84140,CPT,ASSAY OF PREGNENOLONE,,,17 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84143,CPT,ASSAY OF 17-HYDROXYPREGNENO,,,17 ,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84144,CPT,ASSAY OF PROGESTERONE,,,17 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84145,CPT,PROCALCITONIN (PCT),,,17 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84146,CPT,ASSAY OF PROLACTIN,,,17 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84150,CPT,ASSAY OF PROSTAGLANDIN,,,17 ,,TotalUnits,,,,1.03 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84152,CPT,ASSAY OF PSA COMPLEXED,,,17 ,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84153,CPT,ASSAY OF PSA TOTAL,,,17 ,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84154,CPT,ASSAY OF PSA FREE,,,17 ,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84155,CPT,ASSAY OF PROTEIN SERUM,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84156,CPT,ASSAY OF PROTEIN URINE,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84157,CPT,ASSAY OF PROTEIN OTHER,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84160,CPT,ASSAY OF PROTEIN ANY SOURCE,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84163,CPT,PAPPA SERUM,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84165,CPT,PROTEIN E-PHORESIS SERUM,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,84165,CPT,PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM,26,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,84166,CPT,PROTEIN E-PHORESIS/URINE/CSF,,,17 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,84166,CPT,PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATION,26,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,84181,CPT,WESTERN BLOT TEST,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,84181,CPT,PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID,26,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,84182,CPT,PROTEIN WESTERN BLOT TEST,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,84182,CPT,PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL,26,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,84202,CPT,ASSAY RBC PROTOPORPHYRIN,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84203,CPT,TEST RBC PROTOPORPHYRIN,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84206,CPT,ASSAY OF PROINSULIN,,,17 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84207,CPT,ASSAY OF VITAMIN B-6,,,17 ,,TotalUnits,,,,1.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84210,CPT,ASSAY OF PYRUVATE,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84220,CPT,ASSAY OF PYRUVATE KINASE,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84228,CPT,ASSAY OF QUININE,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84233,CPT,ASSAY OF ESTROGEN,,,17 ,,TotalUnits,,,,2.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84234,CPT,ASSAY OF PROGESTERONE,,,17 ,,TotalUnits,,,,2.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84235,CPT,ASSAY OF ENDOCRINE HORMONE,,,17 ,,TotalUnits,,,,2.17 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84238,CPT,ASSAY NONENDOCRINE RECEPTOR,,,17 ,,TotalUnits,,,,1.51 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84244,CPT,ASSAY OF RENIN,,,17 ,,TotalUnits,,,,0.91 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84252,CPT,ASSAY OF VITAMIN B-2,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84255,CPT,ASSAY OF SELENIUM,,,17 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84260,CPT,ASSAY OF SEROTONIN,,,17 ,,TotalUnits,,,,1.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84270,CPT,ASSAY OF SEX HORMONE GLOBUL,,,17 ,,TotalUnits,,,,0.90 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84275,CPT,ASSAY OF SIALIC ACID,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84285,CPT,ASSAY OF SILICA,,,17 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84295,CPT,ASSAY OF SERUM SODIUM,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84300,CPT,ASSAY OF URINE SODIUM,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84302,CPT,ASSAY OF SWEAT SODIUM,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84305,CPT,ASSAY OF SOMATOMEDIN,,,17 ,,TotalUnits,,,,0.88 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84307,CPT,ASSAY OF SOMATOSTATIN,,,17 ,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84311,CPT,SPECTROPHOTOMETRY,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84315,CPT,BODY FLUID SPECIFIC GRAVITY,,,17 ,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84375,CPT,CHROMATOGRAM ASSAY SUGARS,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84376,CPT,SUGARS SINGLE QUAL,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84377,CPT,SUGARS MULTIPLE QUAL,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84378,CPT,SUGARS SINGLE QUANT,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84379,CPT,SUGARS MULTIPLE QUANT,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84392,CPT,ASSAY OF URINE SULFATE,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84402,CPT,ASSAY OF TESTOSTERONE,,,17 ,,TotalUnits,,,,1.05 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84403,CPT,ASSAY OF TOTAL TESTOSTERONE,,,17 ,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84425,CPT,ASSAY OF VITAMIN B-1,,,17 ,,TotalUnits,,,,0.88 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84430,CPT,ASSAY OF THIOCYANATE,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84431,CPT,THROMBOXANE URINE,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84432,CPT,ASSAY OF THYROGLOBULIN,,,17 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84436,CPT,ASSAY OF TOTAL THYROXINE,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84437,CPT,ASSAY OF NEONATAL THYROXINE,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84439,CPT,ASSAY OF FREE THYROXINE,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84442,CPT,ASSAY OF THYROID ACTIVITY,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84443,CPT,ASSAY THYROID STIM HORMONE,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84445,CPT,ASSAY OF TSI,,,17 ,,TotalUnits,,,,2.11 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84446,CPT,ASSAY OF VITAMIN E,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84449,CPT,ASSAY OF TRANSCORTIN,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84450,CPT,TRANSFERASE (AST) (SGOT),,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84460,CPT,ALANINE AMINO (ALT) (SGPT),,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84466,CPT,ASSAY OF TRANSFERRIN,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84478,CPT,ASSAY OF TRIGLYCERIDES,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84479,CPT,ASSAY OF THYROID (T3 OR T4),,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84480,CPT,ASSAY TRIIODOTHYRONINE (T3),,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84481,CPT,FREE ASSAY (FT-3),,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84482,CPT,T3 REVERSE,,,17 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84484,CPT,ASSAY OF TROPONIN QUANT,,,17 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84485,CPT,ASSAY DUODENAL FLUID TRYPSIN,,,17 ,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84488,CPT,TEST FECES FOR TRYPSIN,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84490,CPT,ASSAY OF FECES FOR TRYPSIN,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84510,CPT,ASSAY OF TYROSINE,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84512,CPT,ASSAY OF TROPONIN QUAL,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84520,CPT,ASSAY OF UREA NITROGEN,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84525,CPT,UREA NITROGEN SEMI-QUANT,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84540,CPT,ASSAY OF URINE/UREA-N,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84545,CPT,UREA-N CLEARANCE TEST,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84550,CPT,ASSAY OF BLOOD/URIC ACID,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84560,CPT,ASSAY OF URINE/URIC ACID,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84577,CPT,ASSAY OF FECES/UROBILINOGEN,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84578,CPT,TEST URINE UROBILINOGEN,,,17 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84580,CPT,ASSAY OF URINE UROBILINOGEN,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84583,CPT,ASSAY OF URINE UROBILINOGEN,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84585,CPT,ASSAY OF URINE VMA,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84586,CPT,ASSAY OF VIP,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84588,CPT,ASSAY OF VASOPRESSIN,,,17 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84590,CPT,ASSAY OF VITAMIN A,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84591,CPT,ASSAY OF NOS VITAMIN,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84597,CPT,ASSAY OF VITAMIN K,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84600,CPT,ASSAY OF VOLATILES,,,17 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84620,CPT,XYLOSE TOLERANCE TEST,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84630,CPT,ASSAY OF ZINC,,,17 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84681,CPT,ASSAY OF C-PEPTIDE,,,17 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84702,CPT,CHORIONIC GONADOTROPIN TEST,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84703,CPT,CHORIONIC GONADOTROPIN ASSAY,,,17 ,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84704,CPT,HCG FREE BETACHAIN TEST,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84830,CPT,OVULATION TESTS,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,84999,CPT,CLINICAL CHEMISTRY TEST,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85002,CPT,BLEEDING TIME TEST,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85004,CPT,AUTOMATED DIFF WBC COUNT,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85007,CPT,BL SMEAR W/DIFF WBC COUNT,,,17 ,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85008,CPT,BL SMEAR W/O DIFF WBC COUNT,,,17 ,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85009,CPT,MANUAL DIFF WBC COUNT B-COAT,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85013,CPT,SPUN MICROHEMATOCRIT,,,17 ,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85014,CPT,HEMATOCRIT,,,17 ,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85018,CPT,HEMOGLOBIN,,,17 ,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85025,CPT,COMPLETE CBC W/AUTO DIFF WBC,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85027,CPT,COMPLETE CBC AUTOMATED,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85032,CPT,MANUAL CELL COUNT EACH,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85041,CPT,AUTOMATED RBC COUNT,,,17 ,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85044,CPT,MANUAL RETICULOCYTE COUNT,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85045,CPT,AUTOMATED RETICULOCYTE COUNT,,,17 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85046,CPT,RETICYTE/HGB CONCENTRATE,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85048,CPT,AUTOMATED LEUKOCYTE COUNT,,,17 ,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85049,CPT,AUTOMATED PLATELET COUNT,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85055,CPT,RETICULATED PLATELET ASSAY,,,17 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85060,CPT,BLOOD SMEAR PERIPHERAL INTERP PHYS W/WRIT REPORT,,,17 ,,RBRVS,0.45 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,85097,CPT,BONE MARROW SMEAR INTERPRETATION,,,17 ,,RBRVS,0.94 ,0.39 ,1.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,85130,CPT,CHROMOGENIC SUBSTRATE ASSAY,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85170,CPT,BLOOD CLOT RETRACTION,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85175,CPT,BLOOD CLOT LYSIS TIME,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85210,CPT,BLOOD CLOT FACTOR II TEST,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85220,CPT,BLOOD CLOT FACTOR V TEST,,,17 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85230,CPT,BLOOD CLOT FACTOR VII TEST,,,17 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85240,CPT,BLOOD CLOT FACTOR VIII TEST,,,17 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85244,CPT,BLOOD CLOT FACTOR VIII TEST,,,17 ,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85245,CPT,BLOOD CLOT FACTOR VIII TEST,,,17 ,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85246,CPT,BLOOD CLOT FACTOR VIII TEST,,,17 ,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85247,CPT,BLOOD CLOT FACTOR VIII TEST,,,17 ,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85250,CPT,BLOOD CLOT FACTOR IX TEST,,,17 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85260,CPT,BLOOD CLOT FACTOR X TEST,,,17 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85270,CPT,BLOOD CLOT FACTOR XI TEST,,,17 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85280,CPT,BLOOD CLOT FACTOR XII TEST,,,17 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85290,CPT,BLOOD CLOT FACTOR XIII TEST,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85291,CPT,BLOOD CLOT FACTOR XIII TEST,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85292,CPT,BLOOD CLOT FACTOR ASSAY,,,17 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85293,CPT,BLOOD CLOT FACTOR ASSAY,,,17 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85300,CPT,ANTITHROMBIN III TEST,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85301,CPT,ANTITHROMBIN III TEST,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85302,CPT,BLOOD CLOT INHIBITOR ANTIGEN,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85303,CPT,BLOOD CLOT INHIBITOR TEST,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85305,CPT,BLOOD CLOT INHIBITOR ASSAY,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85306,CPT,BLOOD CLOT INHIBITOR TEST,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85307,CPT,ASSAY ACTIVATED PROTEIN C,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85335,CPT,FACTOR INHIBITOR TEST,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85337,CPT,THROMBOMODULIN,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85345,CPT,COAGULATION TIME,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85347,CPT,COAGULATION TIME,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85348,CPT,COAGULATION TIME,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85360,CPT,EUGLOBULIN LYSIS,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85362,CPT,FIBRIN DEGRADATION PRODUCTS,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85366,CPT,FIBRINOGEN TEST,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85370,CPT,FIBRINOGEN TEST,,,17 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85378,CPT,FIBRIN DEGRADE SEMIQUANT,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85379,CPT,FIBRIN DEGRADATION QUANT,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85380,CPT,FIBRIN DEGRADATION VTE,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85384,CPT,FIBRINOGEN,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85385,CPT,FIBRINOGEN,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85390,CPT,FIBRINOLYSINS SCREEN,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,85390,CPT,FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPORT,26,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,85396,CPT,COAGJ/FBRNLYS ASSAY WHOLE BLOOD ADDITIVE PER DAY,,,17 ,,RBRVS,0.37 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,85397,CPT,CLOTTING FUNCT ACTIVITY,,,17 ,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85400,CPT,FIBRINOLYTIC PLASMIN,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85410,CPT,FIBRINOLYTIC ANTIPLASMIN,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85415,CPT,FIBRINOLYTIC PLASMINOGEN,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85420,CPT,FIBRINOLYTIC PLASMINOGEN,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85421,CPT,FIBRINOLYTIC PLASMINOGEN,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85441,CPT,HEINZ BODIES DIRECT,,,17 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85445,CPT,HEINZ BODIES INDUCED,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85460,CPT,HEMOGLOBIN FETAL,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85461,CPT,HEMOGLOBIN FETAL,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85475,CPT,HEMOLYSIN,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85520,CPT,HEPARIN ASSAY,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85525,CPT,HEPARIN NEUTRALIZATION,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85530,CPT,HEPARIN-PROTAMINE TOLERANCE,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85536,CPT,IRON STAIN PERIPHERAL BLOOD,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85540,CPT,WBC ALKALINE PHOSPHATASE,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85547,CPT,RBC MECHANICAL FRAGILITY,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85549,CPT,MURAMIDASE,,,17 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85555,CPT,RBC OSMOTIC FRAGILITY,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85557,CPT,RBC OSMOTIC FRAGILITY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85576,CPT,BLOOD PLATELET AGGREGATION,,,17 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,85576,CPT,PLATELET AGGREGATION IN VITRO EACH AGENT,26,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,85597,CPT,PHOSPHOLIPID PLTLT NEUTRALIZ,,,17 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85598,CPT,HEXAGNAL PHOSPH PLTLT NEUTRL,,,17 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85610,CPT,PROTHROMBIN TIME,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85611,CPT,PROTHROMBIN TEST,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85612,CPT,VIPER VENOM PROTHROMBIN TIME,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85613,CPT,RUSSELL VIPER VENOM DILUTED,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85635,CPT,REPTILASE TEST,,,17 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85651,CPT,RBC SED RATE NONAUTOMATED,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85652,CPT,RBC SED RATE AUTOMATED,,,17 ,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85660,CPT,RBC SICKLE CELL TEST,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85670,CPT,THROMBIN TIME PLASMA,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85675,CPT,THROMBIN TIME TITER,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85705,CPT,THROMBOPLASTIN INHIBITION,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85730,CPT,THROMBOPLASTIN TIME PARTIAL,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85732,CPT,THROMBOPLASTIN TIME PARTIAL,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85810,CPT,BLOOD VISCOSITY EXAMINATION,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,85999,CPT,HEMATOLOGY PROCEDURE,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86000,CPT,AGGLUTININS FEBRILE,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86001,CPT,ALLERGEN SPECIFIC IGG,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86003,CPT,ALLERGEN SPECIFIC IGE,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86005,CPT,ALLERGEN SPECIFIC IGE,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86021,CPT,WBC ANTIBODY IDENTIFICATION,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86022,CPT,PLATELET ANTIBODIES,,,17 ,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86023,CPT,IMMUNOGLOBULIN ASSAY,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86038,CPT,ANTINUCLEAR ANTIBODIES,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86039,CPT,ANTINUCLEAR ANTIBODIES (ANA),,,17 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86060,CPT,ANTISTREPTOLYSIN O TITER,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86063,CPT,ANTISTREPTOLYSIN O SCREEN,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86077,CPT,BLD BANK PHYS SVCS DIFFC CROSS MATCH&/EVAL REPRT,,,17 ,,RBRVS,0.94 ,0.42 ,0.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,86078,CPT,BLD BANK PHYS SVCS INVSTGJ TFUJ RXN REPRT,,,17 ,,RBRVS,0.94 ,0.43 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,86079,CPT,BLD BANK PHYS SVCS AUTHJ DEVIJ STANDARD REPRT,,,17 ,,RBRVS,0.94 ,0.43 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,86140,CPT,C-REACTIVE PROTEIN,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86141,CPT,C-REACTIVE PROTEIN HS,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86146,CPT,GLYCOPROTEIN ANTIBODY,,,17 ,,TotalUnits,,,,1.05 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86147,CPT,CARDIOLIPIN ANTIBODY,,,17 ,,TotalUnits,,,,1.05 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86148,CPT,PHOSPHOLIPID ANTIBODY,,,17 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86155,CPT,CHEMOTAXIS ASSAY,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86156,CPT,COLD AGGLUTININ SCREEN,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86157,CPT,COLD AGGLUTININ TITER,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86160,CPT,COMPLEMENT ANTIGEN,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86161,CPT,COMPLEMENT/FUNCTION ACTIVITY,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86162,CPT,COMPLEMENT TOTAL (CH50),,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86171,CPT,COMPLEMENT FIXATION EACH,,,17 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86185,CPT,COUNTERIMMUNOELECTROPHORESIS,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86200,CPT,CCP ANTIBODY,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86215,CPT,DEOXYRIBONUCLEASE ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86225,CPT,DNA ANTIBODY,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86226,CPT,DNA ANTIBODY SINGLE STRAND,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86235,CPT,NUCLEAR ANTIGEN ANTIBODY,,,17 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86243,CPT,FC RECEPTOR,,,17 ,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86255,CPT,FLUORESCENT ANTIBODY SCREEN,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,86255,CPT,FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY,26,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,86256,CPT,FLUORESCENT ANTIBODY TITER,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,86256,CPT,FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY,26,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,86277,CPT,GROWTH HORMONE ANTIBODY,,,17 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86280,CPT,HEMAGGLUTINATION INHIBITION,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86294,CPT,IMMUNOASSAY TUMOR QUAL,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86300,CPT,IMMUNOASSAY TUMOR CA 15-3,,,17 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86301,CPT,IMMUNOASSAY TUMOR CA 19-9,,,17 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86304,CPT,IMMUNOASSAY TUMOR CA 125,,,17 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86305,CPT,HUMAN EPIDIDYMIS PROTEIN 4,,,17 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86308,CPT,HETEROPHILE ANTIBODIES,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86309,CPT,HETEROPHILE ANTIBODIES,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86310,CPT,HETEROPHILE ANTIBODIES,,,17 ,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86316,CPT,IMMUNOASSAY TUMOR OTHER,,,17 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86317,CPT,IMMUNOASSAY INFECTIOUS AGENT,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86318,CPT,IMMUNOASSAY INFECTIOUS AGENT,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86320,CPT,SERUM IMMUNOELECTROPHORESIS,,,17 ,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,86320,CPT,IMMUNOELECTROPHORESIS SERUM,26,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,86325,CPT,OTHER IMMUNOELECTROPHORESIS,,,17 ,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,86325,CPT,IMMUNOELECTROPHORESIS OTHER FLUIDS CONCENTRATION,26,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,86327,CPT,IMMUNOELECTROPHORESIS ASSAY,,,17 ,,TotalUnits,,,,0.94 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,86327,CPT,IMMUNOELECTROPHORESIS CROSSED,26,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,86329,CPT,IMMUNODIFFUSION,,,17 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86331,CPT,IMMUNODIFFUSION OUCHTERLONY,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86332,CPT,IMMUNE COMPLEX ASSAY,,,17 ,,TotalUnits,,,,1.01 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86334,CPT,IMMUNOFIX E-PHORESIS SERUM,,,17 ,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,86334,CPT,IMMUNOFIXJ ELECTROPHORESIS SERUM,26,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,86335,CPT,IMMUNFIX E-PHORSIS/URINE/CSF,,,17 ,,TotalUnits,,,,1.22 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,86335,CPT,IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS,26,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,86336,CPT,INHIBIN A,,,17 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86337,CPT,INSULIN ANTIBODIES,,,17 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86340,CPT,INTRINSIC FACTOR ANTIBODY,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86341,CPT,ISLET CELL ANTIBODY,,,17 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86343,CPT,LEUKOCYTE HISTAMINE RELEASE,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86344,CPT,LEUKOCYTE PHAGOCYTOSIS,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86352,CPT,CELL FUNCTION ASSAY W/STIM,,,17 ,,TotalUnits,,,,5.63 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86353,CPT,LYMPHOCYTE TRANSFORMATION,,,17 ,,TotalUnits,,,,2.03 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86355,CPT,B CELLS TOTAL COUNT,,,17 ,,TotalUnits,,,,1.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86356,CPT,MONONUCLEAR CELL ANTIGEN,,,17 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86357,CPT,NK CELLS TOTAL COUNT,,,17 ,,TotalUnits,,,,1.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86359,CPT,T CELLS TOTAL COUNT,,,17 ,,TotalUnits,,,,1.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86360,CPT,T CELL ABSOLUTE COUNT/RATIO,,,17 ,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86361,CPT,T CELL ABSOLUTE COUNT,,,17 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86367,CPT,STEM CELLS TOTAL COUNT,,,17 ,,TotalUnits,,,,1.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86376,CPT,MICROSOMAL ANTIBODY,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86378,CPT,MIGRATION INHIBITORY FACTOR,,,17 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86382,CPT,NEUTRALIZATION TEST VIRAL,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86384,CPT,NITROBLUE TETRAZOLIUM DYE,,,17 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86403,CPT,PARTICLE AGGLUTINATION TEST,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86406,CPT,PARTICLE AGGLUTINATION TEST,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86430,CPT,RHEUMATOID FACTOR TEST,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86431,CPT,RHEUMATOID FACTOR QUANT,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86480,CPT,TB TEST CELL IMMUN MEASURE,,,17 ,,TotalUnits,,,,2.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86481,CPT,TB AG RESPONSE T-CELL SUSP,,,17 ,,TotalUnits,,,,2.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86485,CPT,SKIN TEST CANDIDA,,TC,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86486,CPT,SKIN TEST UNLISTED ANTIGEN EACH,,TC,17 ,,RBRVS,,0.14 ,0.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,86490,CPT,SKIN TEST COCCIDIOIDOMYCOSIS,,TC,17 ,,RBRVS,,0.19 ,0.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,86510,CPT,SKIN TEST HISTOPLASMOSIS,,TC,17 ,,RBRVS,,0.18 ,0.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,86580,CPT,SKIN TEST TUBERCULOSIS INTRADERMAL,,TC,17 ,,RBRVS,,0.21 ,0.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,86590,CPT,STREPTOKINASE ANTIBODY,,,17 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86592,CPT,SYPHILIS TEST NON-TREP QUAL,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86593,CPT,SYPHILIS TEST NON-TREP QUANT,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86602,CPT,ANTINOMYCES ANTIBODY,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86603,CPT,ADENOVIRUS ANTIBODY,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86606,CPT,ASPERGILLUS ANTIBODY,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86609,CPT,BACTERIUM ANTIBODY,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86611,CPT,BARTONELLA ANTIBODY,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86612,CPT,BLASTOMYCES ANTIBODY,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86615,CPT,BORDETELLA ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86617,CPT,LYME DISEASE ANTIBODY,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86618,CPT,LYME DISEASE ANTIBODY,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86619,CPT,BORRELIA ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86622,CPT,BRUCELLA ANTIBODY,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86625,CPT,CAMPYLOBACTER ANTIBODY,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86628,CPT,CANDIDA ANTIBODY,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86631,CPT,CHLAMYDIA ANTIBODY,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86632,CPT,CHLAMYDIA IGM ANTIBODY,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86635,CPT,COCCIDIOIDES ANTIBODY,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86638,CPT,Q FEVER ANTIBODY,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86641,CPT,CRYPTOCOCCUS ANTIBODY,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86644,CPT,CMV ANTIBODY,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86645,CPT,CMV ANTIBODY IGM,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86648,CPT,DIPHTHERIA ANTIBODY,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86651,CPT,ENCEPHALITIS ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86652,CPT,ENCEPHALITIS ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86653,CPT,ENCEPHALITIS ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86654,CPT,ENCEPHALITIS ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86658,CPT,ENTEROVIRUS ANTIBODY,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86663,CPT,EPSTEIN-BARR ANTIBODY,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86664,CPT,EPSTEIN-BARR ANTIBODY,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86665,CPT,EPSTEIN-BARR ANTIBODY,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86666,CPT,EHRLICHIA ANTIBODY,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86668,CPT,FRANCISELLA TULARENSIS,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86671,CPT,FUNGUS ANTIBODY,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86674,CPT,GIARDIA LAMBLIA ANTIBODY,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86677,CPT,HELICOBACTER PYLORI,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86682,CPT,HELMINTH ANTIBODY,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86684,CPT,HEMOPHILUS INFLUENZA,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86687,CPT,HTLV-I ANTIBODY,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86688,CPT,HTLV-II ANTIBODY,,,17 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86689,CPT,HTLV/HIV CONFIRMATORY TEST,,,17 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86692,CPT,HEPATITIS DELTA AGENT,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86694,CPT,HERPES SIMPLEX TEST,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86695,CPT,HERPES SIMPLEX TEST,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86696,CPT,HERPES SIMPLEX TYPE 2,,,17 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86698,CPT,HISTOPLASMA,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86701,CPT,HIV-1,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86702,CPT,HIV-2,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86703,CPT,HIV-1/HIV-2 SINGLE ASSAY,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86704,CPT,HEP B CORE ANTIBODY TOTAL,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86705,CPT,HEP B CORE ANTIBODY IGM,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86706,CPT,HEP B SURFACE ANTIBODY,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86707,CPT,HEP BE ANTIBODY,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86708,CPT,HEP A ANTIBODY TOTAL,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86709,CPT,HEP A ANTIBODY IGM,,,17 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86710,CPT,INFLUENZA VIRUS ANTIBODY,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86713,CPT,LEGIONELLA ANTIBODY,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86717,CPT,LEISHMANIA ANTIBODY,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86720,CPT,LEPTOSPIRA ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86723,CPT,LISTERIA MONOCYTOGENES AB,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86727,CPT,LYMPH CHORIOMENINGITIS AB,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86729,CPT,LYMPHO VENEREUM ANTIBODY,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86732,CPT,MUCORMYCOSIS ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86735,CPT,MUMPS ANTIBODY,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86738,CPT,MYCOPLASMA ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86741,CPT,NEISSERIA MENINGITIDIS,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86744,CPT,NOCARDIA ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86747,CPT,PARVOVIRUS ANTIBODY,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86750,CPT,MALARIA ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86753,CPT,PROTOZOA ANTIBODY NOS,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86756,CPT,RESPIRATORY VIRUS ANTIBODY,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86757,CPT,RICKETTSIA ANTIBODY,,,17 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86759,CPT,ROTAVIRUS ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86762,CPT,RUBELLA ANTIBODY,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86765,CPT,RUBEOLA ANTIBODY,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86768,CPT,SALMONELLA ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86771,CPT,SHIGELLA ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86774,CPT,TETANUS ANTIBODY,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86777,CPT,TOXOPLASMA ANTIBODY,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86778,CPT,TOXOPLASMA ANTIBODY IGM,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86780,CPT,TREPONEMA PALLIDUM,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86784,CPT,TRICHINELLA ANTIBODY,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86787,CPT,VARICELLA-ZOSTER ANTIBODY,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86788,CPT,WEST NILE VIRUS AB IGM,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86789,CPT,WEST NILE VIRUS ANTIBODY,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86790,CPT,VIRUS ANTIBODY NOS,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86793,CPT,YERSINIA ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86800,CPT,THYROGLOBULIN ANTIBODY,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86803,CPT,HEPATITIS C AB TEST,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86804,CPT,HEP C AB TEST CONFIRM,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86805,CPT,LYMPHOCYTOTOXICITY ASSAY,,,17 ,,TotalUnits,,,,2.17 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86806,CPT,LYMPHOCYTOTOXICITY ASSAY,,,17 ,,TotalUnits,,,,1.97 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86807,CPT,CYTOTOXIC ANTIBODY SCREENING,,,17 ,,TotalUnits,,,,1.64 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86808,CPT,CYTOTOXIC ANTIBODY SCREENING,,,17 ,,TotalUnits,,,,1.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86812,CPT,HLA TYPING A B OR C,,,17 ,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86813,CPT,HLA TYPING A B OR C,,,17 ,,TotalUnits,,,,2.40 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86816,CPT,HLA TYPING DR/DQ,,,17 ,,TotalUnits,,,,1.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86817,CPT,HLA TYPING DR/DQ,,,17 ,,TotalUnits,,,,2.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86821,CPT,LYMPHOCYTE CULTURE MIXED,,,17 ,,TotalUnits,,,,2.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86822,CPT,LYMPHOCYTE CULTURE PRIMED,,,17 ,,TotalUnits,,,,1.51 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86825,CPT,HLA X-MATH NON-CYTOTOXIC,,,17 ,,TotalUnits,,,,3.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86826,CPT,HLA X-MATCH NONCYTOTOXC ADDL,,,17 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86849,CPT,IMMUNOLOGY PROCEDURE,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86850,CPT,RBC ANTIBODY SCREEN,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86860,CPT,RBC ANTIBODY ELUTION,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86870,CPT,RBC ANTIBODY IDENTIFICATION,,,17 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86880,CPT,COOMBS TEST DIRECT,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86885,CPT,COOMBS TEST INDIRECT QUAL,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86886,CPT,COOMBS TEST INDIRECT TITER,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86890,CPT,AUTOLOGOUS BLOOD PROCESS,,,17 ,,TotalUnits,,,,1.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86891,CPT,AUTOLOGOUS BLOOD OP SALVAGE,,,17 ,,TotalUnits,,,,2.12 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86900,CPT,BLOOD TYPING ABO,,,17 ,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86901,CPT,BLOOD TYPING RH (D),,,17 ,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86902,CPT,BLOOD TYPE ANTIGEN DONOR EA,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86904,CPT,BLOOD TYPING PATIENT SERUM,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86905,CPT,BLOOD TYPING RBC ANTIGENS,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86906,CPT,BLOOD TYPING RH PHENOTYPE,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86910,CPT,BLOOD TYPING PATERNITY TEST,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86911,CPT,BLOOD TYPING ANTIGEN SYSTEM,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86920,CPT,COMPATIBILITY TEST SPIN,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86921,CPT,COMPATIBILITY TEST INCUBATE,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86922,CPT,COMPATIBILITY TEST ANTIGLOB,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86923,CPT,COMPATIBILITY TEST ELECTRIC,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86927,CPT,PLASMA FRESH FROZEN,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86930,CPT,FROZEN BLOOD PREP,,,17 ,,TotalUnits,,,,2.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86931,CPT,FROZEN BLOOD THAW,,,17 ,,TotalUnits,,,,1.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86932,CPT,FROZEN BLOOD FREEZE/THAW,,,17 ,,TotalUnits,,,,1.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86940,CPT,HEMOLYSINS/AGGLUTININS AUTO,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86941,CPT,HEMOLYSINS/AGGLUTININS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86945,CPT,BLOOD PRODUCT/IRRADIATION,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86950,CPT,LEUKACYTE TRANSFUSION,,,17 ,,TotalUnits,,,,1.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86960,CPT,VOL REDUCTION OF BLOOD/PROD,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86965,CPT,POOLING BLOOD PLATELETS,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86970,CPT,RBC PRETREATMENT,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86971,CPT,RBC PRETREATMENT,,,17 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86972,CPT,RBC PRETREATMENT,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86975,CPT,RBC PRETREATMENT SERUM,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86976,CPT,RBC PRETREATMENT SERUM,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86977,CPT,RBC PRETREATMENT SERUM,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86978,CPT,RBC PRETREATMENT SERUM,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86985,CPT,SPLIT BLOOD OR PRODUCTS,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,86999,CPT,TRANSFUSION PROCEDURE,,,17 ,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87001,CPT,SMALL ANIMAL INOCULATION,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87003,CPT,SMALL ANIMAL INOCULATION,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87015,CPT,SPECIMEN CONCENTRATION,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87040,CPT,BLOOD CULTURE FOR BACTERIA,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87045,CPT,FECES CULTURE BACTERIA,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87046,CPT,STOOL CULTR BACTERIA EACH,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87070,CPT,CULTURE BACTERIA OTHER,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87071,CPT,CULTURE BACTERI AEROBIC OTHR,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87073,CPT,CULTURE BACTERIA ANAEROBIC,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87075,CPT,CULTR BACTERIA EXCEPT BLOOD,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87076,CPT,CULTURE ANAEROBE IDENT EACH,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87077,CPT,CULTURE AEROBIC IDENTIFY,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87081,CPT,CULTURE SCREEN ONLY,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87084,CPT,CULTURE OF SPECIMEN BY KIT,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87086,CPT,URINE CULTURE/COLONY COUNT,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87088,CPT,URINE BACTERIA CULTURE,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87101,CPT,SKIN FUNGI CULTURE,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87102,CPT,FUNGUS ISOLATION CULTURE,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87103,CPT,BLOOD FUNGUS CULTURE,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87106,CPT,FUNGI IDENTIFICATION YEAST,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87107,CPT,FUNGI IDENTIFICATION MOLD,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87109,CPT,MYCOPLASMA,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87110,CPT,CHLAMYDIA CULTURE,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87116,CPT,MYCOBACTERIA CULTURE,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87118,CPT,MYCOBACTERIC IDENTIFICATION,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87140,CPT,CULTURE TYPE IMMUNOFLUORESC,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87143,CPT,CULTURE TYPING GLC/HPLC,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87147,CPT,CULTURE TYPE IMMUNOLOGIC,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87149,CPT,DNA/RNA DIRECT PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87150,CPT,DNA/RNA AMPLIFIED PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87152,CPT,CULTURE TYPE PULSE FIELD GEL,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87153,CPT,DNA/RNA SEQUENCING,,,17 ,,TotalUnits,,,,4.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87158,CPT,CULTURE TYPING ADDED METHOD,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87164,CPT,DARK FIELD EXAMINATION,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,87164,CPT,DARK FIELD EXAM ANY SOURCE W/SPECIMEN COLLECTION,26,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,87166,CPT,DARK FIELD EXAMINATION,,,17 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87168,CPT,MACROSCOPIC EXAM ARTHROPOD,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87169,CPT,MACROSCOPIC EXAM PARASITE,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87172,CPT,PINWORM EXAM,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87176,CPT,TISSUE HOMOGENIZATION CULTR,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87177,CPT,OVA AND PARASITES SMEARS,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87181,CPT,MICROBE SUSCEPTIBLE DIFFUSE,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87184,CPT,MICROBE SUSCEPTIBLE DISK,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87185,CPT,MICROBE SUSCEPTIBLE ENZYME,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87186,CPT,MICROBE SUSCEPTIBLE MIC,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87187,CPT,MICROBE SUSCEPTIBLE MLC,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87188,CPT,MICROBE SUSCEPT MACROBROTH,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87190,CPT,MICROBE SUSCEPT MYCOBACTERI,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87197,CPT,BACTERICIDAL LEVEL SERUM,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87205,CPT,SMEAR GRAM STAIN,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87206,CPT,SMEAR FLUORESCENT/ACID STAI,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87207,CPT,SMEAR SPECIAL STAIN,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,87207,CPT,SMR PRIM SRC SPEC STAIN BODIES/PARASITS,26,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,87209,CPT,SMEAR COMPLEX STAIN,,,17 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87210,CPT,SMEAR WET MOUNT SALINE/INK,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87220,CPT,TISSUE EXAM FOR FUNGI,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87230,CPT,ASSAY TOXIN OR ANTITOXIN,,,17 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87250,CPT,VIRUS INOCULATE EGGS/ANIMAL,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87252,CPT,VIRUS INOCULATION TISSUE,,,17 ,,TotalUnits,,,,1.08 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87253,CPT,VIRUS INOCULATE TISSUE ADDL,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87254,CPT,VIRUS INOCULATION SHELL VIA,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87255,CPT,GENET VIRUS ISOLATE HSV,,,17 ,,TotalUnits,,,,1.40 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87260,CPT,ADENOVIRUS AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87265,CPT,PERTUSSIS AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87267,CPT,ENTEROVIRUS ANTIBODY DFA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87269,CPT,GIARDIA AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87270,CPT,CHLAMYDIA TRACHOMATIS AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87271,CPT,CYTOMEGALOVIRUS DFA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87272,CPT,CRYPTOSPORIDIUM AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87273,CPT,HERPES SIMPLEX 2 AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87274,CPT,HERPES SIMPLEX 1 AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87275,CPT,INFLUENZA B AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87276,CPT,INFLUENZA A AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87277,CPT,LEGIONELLA MICDADEI AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87278,CPT,LEGION PNEUMOPHILIA AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87279,CPT,PARAINFLUENZA AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87280,CPT,RESPIRATORY SYNCYTIAL AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87281,CPT,PNEUMOCYSTIS CARINII AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87283,CPT,RUBEOLA AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87285,CPT,TREPONEMA PALLIDUM AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87290,CPT,VARICELLA ZOSTER AG IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87299,CPT,ANTIBODY DETECTION NOS IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87300,CPT,AG DETECTION POLYVAL IF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87301,CPT,ADENOVIRUS AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87305,CPT,ASPERGILLUS AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87320,CPT,CHYLMD TRACH AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87324,CPT,CLOSTRIDIUM AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87327,CPT,CRYPTOCOCCUS NEOFORM AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87328,CPT,CRYPTOSPORIDIUM AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87329,CPT,GIARDIA AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87332,CPT,CYTOMEGALOVIRUS AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87335,CPT,E COLI 0157 AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87336,CPT,ENTAMOEB HIST DISPR AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87337,CPT,ENTAMOEB HIST GROUP AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87338,CPT,HPYLORI STOOL EIA,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87339,CPT,H PYLORI AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87340,CPT,HEPATITIS B SURFACE AG EIA,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87341,CPT,HEPATITIS B SURFACE AG EIA,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87350,CPT,HEPATITIS BE AG EIA,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87380,CPT,HEPATITIS DELTA AG EIA,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87385,CPT,HISTOPLASMA CAPSUL AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87390,CPT,HIV-1 AG EIA,,,17 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87391,CPT,HIV-2 AG EIA,,,17 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87400,CPT,INFLUENZA A/B AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87420,CPT,RESP SYNCYTIAL AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87425,CPT,ROTAVIRUS AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87427,CPT,SHIGA-LIKE TOXIN AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87430,CPT,STREP A AG EIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87449,CPT,AG DETECT NOS EIA MULT,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87450,CPT,AG DETECT NOS EIA SINGLE,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87451,CPT,AG DETECT POLYVAL EIA MULT,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87470,CPT,BARTONELLA DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87471,CPT,BARTONELLA DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87472,CPT,BARTONELLA DNA QUANT,,,17 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87475,CPT,LYME DIS DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87476,CPT,LYME DIS DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87477,CPT,LYME DIS DNA QUANT,,,17 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87480,CPT,CANDIDA DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87481,CPT,CANDIDA DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87482,CPT,CANDIDA DNA QUANT,,,17 ,,TotalUnits,,,,1.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87485,CPT,CHYLMD PNEUM DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87486,CPT,CHYLMD PNEUM DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87487,CPT,CHYLMD PNEUM DNA QUANT,,,17 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87490,CPT,CHYLMD TRACH DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87491,CPT,CHYLMD TRACH DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87492,CPT,CHYLMD TRACH DNA QUANT,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87493,CPT,C DIFF AMPLIFIED PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87495,CPT,CYTOMEG DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87496,CPT,CYTOMEG DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87497,CPT,CYTOMEG DNA QUANT,,,17 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87498,CPT,ENTEROVIRUS DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87500,CPT,VANOMYCIN DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87501,CPT,INFLUENZA DNA AMP PROB 1+,,,17 ,,TotalUnits,,,,2.13 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87502,CPT,INFLUENZA DNA AMP PROBE,,,17 ,,TotalUnits,,,,3.52 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87503,CPT,INFLUENZA DNA AMP PROB ADDL,,,17 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87510,CPT,GARDNER VAG DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87511,CPT,GARDNER VAG DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87512,CPT,GARDNER VAG DNA QUANT,,,17 ,,TotalUnits,,,,1.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87515,CPT,HEPATITIS B DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87516,CPT,HEPATITIS B DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87517,CPT,HEPATITIS B DNA QUANT,,,17 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87520,CPT,HEPATITIS C RNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87521,CPT,HEPATITIS C RNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87522,CPT,HEPATITIS C RNA QUANT,,,17 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87525,CPT,HEPATITIS G DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87526,CPT,HEPATITIS G DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87527,CPT,HEPATITIS G DNA QUANT,,,17 ,,TotalUnits,,,,1.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87528,CPT,HSV DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87529,CPT,HSV DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87530,CPT,HSV DNA QUANT,,,17 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87531,CPT,HHV-6 DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87532,CPT,HHV-6 DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87533,CPT,HHV-6 DNA QUANT,,,17 ,,TotalUnits,,,,1.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87534,CPT,HIV-1 DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87535,CPT,HIV-1 DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87536,CPT,HIV-1 DNA QUANT,,,17 ,,TotalUnits,,,,3.52 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87537,CPT,HIV-2 DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87538,CPT,HIV-2 DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87539,CPT,HIV-2 DNA QUANT,,,17 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87540,CPT,LEGION PNEUMO DNA DIR PROB,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87541,CPT,LEGION PNEUMO DNA AMP PROB,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87542,CPT,LEGION PNEUMO DNA QUANT,,,17 ,,TotalUnits,,,,1.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87550,CPT,MYCOBACTERIA DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87551,CPT,MYCOBACTERIA DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87552,CPT,MYCOBACTERIA DNA QUANT,,,17 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87555,CPT,M.TUBERCULO DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87556,CPT,M.TUBERCULO DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87557,CPT,M.TUBERCULO DNA QUANT,,,17 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87560,CPT,M.AVIUM-INTRA DNA DIR PROB,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87561,CPT,M.AVIUM-INTRA DNA AMP PROB,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87562,CPT,M.AVIUM-INTRA DNA QUANT,,,17 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87580,CPT,M.PNEUMON DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87581,CPT,M.PNEUMON DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87582,CPT,M.PNEUMON DNA QUANT,,,17 ,,TotalUnits,,,,1.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87590,CPT,N.GONORRHOEAE DNA DIR PROB,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87591,CPT,N.GONORRHOEAE DNA AMP PROB,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87592,CPT,N.GONORRHOEAE DNA QUANT,,,17 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87620,CPT,HPV DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87621,CPT,HPV DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87622,CPT,HPV DNA QUANT,,,17 ,,TotalUnits,,,,1.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87640,CPT,STAPH A DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87641,CPT,MR-STAPH DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87650,CPT,STREP A DNA DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87651,CPT,STREP A DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87652,CPT,STREP A DNA QUANT,,,17 ,,TotalUnits,,,,1.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87653,CPT,STREP B DNA AMP PROBE,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87660,CPT,TRICHOMONAS VAGIN DIR PROBE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87797,CPT,DETECT AGENT NOS DNA DIR,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87798,CPT,DETECT AGENT NOS DNA AMP,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87799,CPT,DETECT AGENT NOS DNA QUANT,,,17 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87800,CPT,DETECT AGNT MULT DNA DIREC,,,17 ,,TotalUnits,,,,1.66 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87801,CPT,DETECT AGNT MULT DNA AMPLI,,,17 ,,TotalUnits,,,,2.91 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87802,CPT,STREP B ASSAY W/OPTIC,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87803,CPT,CLOSTRIDIUM TOXIN A W/OPTIC,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87804,CPT,INFLUENZA ASSAY W/OPTIC,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87807,CPT,RSV ASSAY W/OPTIC,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87808,CPT,TRICHOMONAS ASSAY W/OPTIC,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87809,CPT,ADENOVIRUS ASSAY W/OPTIC,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87810,CPT,CHYLMD TRACH ASSAY W/OPTIC,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87850,CPT,N. GONORRHOEAE ASSAY W/OPTIC,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87880,CPT,STREP A ASSAY W/OPTIC,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87899,CPT,AGENT NOS ASSAY W/OPTIC,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87900,CPT,PHENOTYPE INFECT AGENT DRUG,,,17 ,,TotalUnits,,,,5.40 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87901,CPT,GENOTYPE DNA HIV REVERSE T,,,17 ,,TotalUnits,,,,10.66 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87902,CPT,GENOTYPE DNA HEPATITIS C,,,17 ,,TotalUnits,,,,10.66 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87903,CPT,PHENOTYPE DNA HIV W/CULTURE,,,17 ,,TotalUnits,,,,20.24 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87904,CPT,PHENOTYPE DNA HIV W/CLT ADD,,,17 ,,TotalUnits,,,,1.08 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87905,CPT,SIALIDASE ENZYME ASSAY,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87906,CPT,GENOTYPE DNA HIV REVERSE T,,,17 ,,TotalUnits,,,,5.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,87999,CPT,MICROBIOLOGY PROCEDURE,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88000,CPT,AUTOPSY (NECROPSY) GROSS,,,17 ,,TotalUnits,,,,5.74 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,88005,CPT,AUTOPSY (NECROPSY) GROSS,,,17 ,,TotalUnits,,,,6.70 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,88007,CPT,AUTOPSY (NECROPSY) GROSS,,,17 ,,TotalUnits,,,,7.02 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,88012,CPT,AUTOPSY (NECROPSY) GROSS,,,17 ,,TotalUnits,,,,5.74 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,88014,CPT,AUTOPSY (NECROPSY) GROSS,,,17 ,,TotalUnits,,,,5.26 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,88016,CPT,AUTOPSY (NECROPSY) GROSS,,,17 ,,TotalUnits,,,,7.34 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,88020,CPT,AUTOPSY (NECROPSY) COMPLETE,,,17 ,,TotalUnits,,,,9.89 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,88025,CPT,AUTOPSY (NECROPSY) COMPLETE,,,17 ,,TotalUnits,,,,9.57 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,88027,CPT,AUTOPSY (NECROPSY) COMPLETE,,,17 ,,TotalUnits,,,,10.21 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,88028,CPT,AUTOPSY (NECROPSY) COMPLETE,,,17 ,,TotalUnits,,,,5.74 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,88029,CPT,AUTOPSY (NECROPSY) COMPLETE,,,17 ,,TotalUnits,,,,5.74 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,88036,CPT,LIMITED AUTOPSY,,,17 ,,TotalUnits,,,,2.87 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,88037,CPT,LIMITED AUTOPSY,,,17 ,,TotalUnits,,,,2.55 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,88040,CPT,FORENSIC AUTOPSY (NECROPSY),,,17 ,,TotalUnits,,,,15.95 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,88045,CPT,CORONERS AUTOPSY (NECROPSY),,,17 ,,TotalUnits,,,,1.60 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,88099,CPT,NECROPSY (AUTOPSY) PROCEDURE,,,17 ,,TotalUnits,,,,9.89 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,88104,CPT,CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ,,,17 ,,RBRVS,0.56 ,1.34 ,1.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88104,CPT,CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ,26,,17 ,,RBRVS,0.56 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88104,CPT,CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ,TC,,17 ,,RBRVS,,1.10 ,1.10 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88106,CPT,CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ,,,17 ,,RBRVS,0.56 ,1.77 ,1.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88106,CPT,CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ,26,,17 ,,RBRVS,0.56 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88106,CPT,CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ,TC,,17 ,,RBRVS,,1.54 ,1.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88108,CPT,CYTP CONCENTRATION SMEARS & INTERPRETATION,,,17 ,,RBRVS,0.56 ,1.64 ,1.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88108,CPT,CYTP CONCENTRATION SMEARS & INTERPRETATION,26,,17 ,,RBRVS,0.56 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88108,CPT,CYTP CONCENTRATION SMEARS & INTERPRETATION,TC,,17 ,,RBRVS,,1.41 ,1.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88112,CPT,CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V,,,17 ,,RBRVS,1.18 ,1.79 ,1.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88112,CPT,CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V,26,,17 ,,RBRVS,1.18 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88112,CPT,CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V,TC,,17 ,,RBRVS,,1.35 ,1.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88120,CPT,CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL,,,17 ,,RBRVS,1.20 ,12.17 ,12.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88120,CPT,CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL,26,,17 ,,RBRVS,1.20 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88120,CPT,CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL,TC,,17 ,,RBRVS,,11.86 ,11.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88121,CPT,CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA,,,17 ,,RBRVS,1.00 ,10.30 ,10.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88121,CPT,CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA,26,,17 ,,RBRVS,1.00 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88121,CPT,CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA,TC,,17 ,,RBRVS,,9.96 ,9.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88125,CPT,CYTOPATHOLOGY FORENSIC,,,17 ,,RBRVS,0.26 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88125,CPT,CYTOPATHOLOGY FORENSIC,26,,17 ,,RBRVS,0.26 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88125,CPT,CYTOPATHOLOGY FORENSIC,TC,,17 ,,RBRVS,,0.25 ,0.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88130,CPT,SEX CHROMATIN IDENTIFICATION,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88140,CPT,SEX CHROMATIN IDENTIFICATION,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88141,CPT,CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN,,PC,17 ,,RBRVS,0.42 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88142,CPT,CYTOPATH C/V THIN LAYER,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88143,CPT,CYTOPATH C/V THIN LAYER REDO,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88147,CPT,CYTOPATH C/V AUTOMATED,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88148,CPT,CYTOPATH C/V AUTO RESCREEN,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88150,CPT,CYTOPATH C/V MANUAL,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88152,CPT,CYTOPATH C/V AUTO REDO,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88153,CPT,CYTOPATH C/V REDO,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88154,CPT,CYTOPATH C/V SELECT,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88155,CPT,CYTOPATH C/V INDEX ADD-ON,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88160,CPT,CYTP SMRS ANY OTH SRC SCR&INTERPJ,,,17 ,,RBRVS,0.50 ,1.08 ,1.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88160,CPT,CYTP SMRS ANY OTH SRC SCR&INTERPJ,26,,17 ,,RBRVS,0.50 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88160,CPT,CYTP SMRS ANY OTH SRC SCR&INTERPJ,TC,,17 ,,RBRVS,,0.87 ,0.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88161,CPT,CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ,,,17 ,,RBRVS,0.50 ,1.08 ,1.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88161,CPT,CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ,26,,17 ,,RBRVS,0.50 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88161,CPT,CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ,TC,,17 ,,RBRVS,,0.89 ,0.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88162,CPT,CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES,,,17 ,,RBRVS,0.76 ,1.50 ,1.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88162,CPT,CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES,26,,17 ,,RBRVS,0.76 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88162,CPT,CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES,TC,,17 ,,RBRVS,,1.20 ,1.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88164,CPT,CYTOPATH TBS C/V MANUAL,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88165,CPT,CYTOPATH TBS C/V REDO,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88166,CPT,CYTOPATH TBS C/V AUTO REDO,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88167,CPT,CYTOPATH TBS C/V SELECT,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88172,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST,,,17 ,,RBRVS,0.60 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88172,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST,26,,17 ,,RBRVS,0.60 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88172,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST,TC,,17 ,,RBRVS,,0.60 ,0.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88173,CPT,CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT,,,17 ,,RBRVS,1.39 ,2.61 ,2.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88173,CPT,CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT,26,,17 ,,RBRVS,1.39 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88173,CPT,CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT,TC,,17 ,,RBRVS,,2.03 ,2.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88174,CPT,CYTOPATH C/V AUTO IN FLUID,,,17 ,,TotalUnits,,,,0.88 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88175,CPT,CYTOPATH C/V AUTO FLUID REDO,,,17 ,,TotalUnits,,,,1.10 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88177,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL,,,17 ,,RBRVS,0.42 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88177,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL,26,,17 ,,RBRVS,0.42 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88177,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL,TC,,17 ,,RBRVS,,0.18 ,0.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88182,CPT,FLOW CYTOMETRY CELL CYCLE/DNA ALYS,,,17 ,,RBRVS,0.77 ,2.23 ,2.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88182,CPT,FLOW CYTOMETRY CELL CYCLE/DNA ALYS,26,,17 ,,RBRVS,0.77 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88182,CPT,FLOW CYTOMETRY CELL CYCLE/DNA ALYS,TC,,17 ,,RBRVS,,2.01 ,2.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88184,CPT,FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST,,TC,17 ,,RBRVS,,2.46 ,2.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88185,CPT,FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA,,TC,17 ,,RBRVS,,1.47 ,1.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88187,CPT,FLOW CYTOMETRY INTERPJ 2-8 MARKERS,,PC,17 ,,RBRVS,1.36 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88188,CPT,FLOW CYTOMETRY INTERPJ 9-15 MARKERS,,PC,17 ,,RBRVS,1.69 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88189,CPT,FLOW CYTOMETRY INTERPJ 16/> MARKERS,,PC,17 ,,RBRVS,2.23 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88199,CPT,CYTOPATHOLOGY PROCEDURE,,,17 ,,TotalUnits,,,,2.34 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,88199,CPT,CYTOPATHOLOGY PROCEDURE,,PC,17 ,,TotalUnits,,,,0.99 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,88199,CPT,CYTOPATHOLOGY PROCEDURE,,TC,17 ,,TotalUnits,,,,1.35 ,,$0.00,$0.00,1,1,1,0,1,0,20120101,88230,CPT,TISSUE CULTURE LYMPHOCYTE,,,17 ,,TotalUnits,,,,4.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88233,CPT,TISSUE CULTURE SKIN/BIOPSY,,,17 ,,TotalUnits,,,,5.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88235,CPT,TISSUE CULTURE PLACENTA,,,17 ,,TotalUnits,,,,6.10 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88237,CPT,TISSUE CULTURE BONE MARROW,,,17 ,,TotalUnits,,,,5.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88239,CPT,TISSUE CULTURE TUMOR,,,17 ,,TotalUnits,,,,6.11 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88240,CPT,CELL CRYOPRESERVE/STORAGE,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88241,CPT,FROZEN CELL PREPARATION,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88245,CPT,CHROMOSOME ANALYSIS 20-25,,,17 ,,TotalUnits,,,,6.17 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88248,CPT,CHROMOSOME ANALYSIS 50-100,,,17 ,,TotalUnits,,,,7.17 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88249,CPT,CHROMOSOME ANALYSIS 100,,,17 ,,TotalUnits,,,,7.17 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88261,CPT,CHROMOSOME ANALYSIS 5,,,17 ,,TotalUnits,,,,7.32 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88262,CPT,CHROMOSOME ANALYSIS 15-20,,,17 ,,TotalUnits,,,,5.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88263,CPT,CHROMOSOME ANALYSIS 45,,,17 ,,TotalUnits,,,,6.22 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88264,CPT,CHROMOSOME ANALYSIS 20-25,,,17 ,,TotalUnits,,,,5.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88267,CPT,CHROMOSOME ANALYS PLACENTA,,,17 ,,TotalUnits,,,,7.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88269,CPT,CHROMOSOME ANALYS AMNIOTIC,,,17 ,,TotalUnits,,,,6.89 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88271,CPT,CYTOGENETICS DNA PROBE,,,17 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88272,CPT,CYTOGENETICS 3-5,,,17 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88273,CPT,CYTOGENETICS 10-30,,,17 ,,TotalUnits,,,,1.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88274,CPT,CYTOGENETICS 25-99,,,17 ,,TotalUnits,,,,1.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88275,CPT,CYTOGENETICS 100-300,,,17 ,,TotalUnits,,,,1.66 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88280,CPT,CHROMOSOME KARYOTYPE STUDY,,,17 ,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88283,CPT,CHROMOSOME BANDING STUDY,,,17 ,,TotalUnits,,,,2.84 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88285,CPT,CHROMOSOME COUNT ADDITIONAL,,,17 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88289,CPT,CHROMOSOME STUDY ADDITIONAL,,,17 ,,TotalUnits,,,,1.43 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88291,CPT,CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REPORT,,PC,17 ,,RBRVS,0.52 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88299,CPT,CYTOGENETIC STUDY,,,17 ,,TotalUnits,,,,1.22 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88300,CPT,LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY,,,17 ,,RBRVS,0.08 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88300,CPT,LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY,26,,17 ,,RBRVS,0.08 ,0.04 ,0.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88300,CPT,LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY,TC,,17 ,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88302,CPT,LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,,17 ,,RBRVS,0.13 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88302,CPT,LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,26,,17 ,,RBRVS,0.13 ,0.05 ,0.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88302,CPT,LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,TC,,17 ,,RBRVS,,1.37 ,1.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88304,CPT,LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,,17 ,,RBRVS,0.22 ,1.60 ,1.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88304,CPT,LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,26,,17 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88304,CPT,LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,TC,,17 ,,RBRVS,,1.51 ,1.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88305,CPT,LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,,17 ,,RBRVS,0.75 ,2.35 ,2.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88305,CPT,LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,26,,17 ,,RBRVS,0.75 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88305,CPT,LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,TC,,17 ,,RBRVS,,2.04 ,2.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88307,CPT,LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,,17 ,,RBRVS,1.59 ,5.02 ,5.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88307,CPT,LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,26,,17 ,,RBRVS,1.59 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88307,CPT,LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,TC,,17 ,,RBRVS,,4.31 ,4.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88309,CPT,LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,,17 ,,RBRVS,2.80 ,7.18 ,7.18 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88309,CPT,LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,26,,17 ,,RBRVS,2.80 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88309,CPT,LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,TC,,17 ,,RBRVS,,5.97 ,5.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88311,CPT,DECALCIFICATION PROCEDURE,,,17 ,,RBRVS,0.24 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88311,CPT,DECALCIFICATION PROCEDURE,26,,17 ,,RBRVS,0.24 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88311,CPT,DECALCIFICATION PROCEDURE,TC,,17 ,,RBRVS,,0.19 ,0.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88312,CPT,SPECIAL STAIN GROUP 1 MICROORGANISMS I&R,,,17 ,,RBRVS,0.54 ,2.58 ,2.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88312,CPT,SPECIAL STAIN GROUP 1 MICROORGANISMS I&R,26,,17 ,,RBRVS,0.54 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88312,CPT,SPECIAL STAIN GROUP 1 MICROORGANISMS I&R,TC,,17 ,,RBRVS,,2.36 ,2.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88313,CPT,SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT&IMHIS,,,17 ,,RBRVS,0.24 ,2.03 ,2.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88313,CPT,SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT&IMHIS,26,,17 ,,RBRVS,0.24 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88313,CPT,SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT&IMHIS,TC,,17 ,,RBRVS,,1.94 ,1.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88314,CPT,SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSUE,,,17 ,,RBRVS,0.45 ,2.18 ,2.18 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88314,CPT,SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSUE,26,,17 ,,RBRVS,0.45 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88314,CPT,SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSUE,TC,,17 ,,RBRVS,,1.98 ,1.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88319,CPT,SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS,,,17 ,,RBRVS,0.53 ,3.74 ,3.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88319,CPT,SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS,26,,17 ,,RBRVS,0.53 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88319,CPT,SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS,TC,,17 ,,RBRVS,,3.52 ,3.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88321,CPT,CONSLTJ&REPRT SLIDES PREPARED ELSEWHERE,,,17 ,,RBRVS,1.63 ,0.66 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88323,CPT,CONSLTJ&REPRT MATERIAL REQUIRING PREPJ SLIDES,,,17 ,,RBRVS,1.83 ,2.32 ,2.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88323,CPT,CONSLTJ&REPRT MATERIAL REQUIRING PREPJ SLIDES,26,,17 ,,RBRVS,1.83 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88323,CPT,CONSLTJ&REPRT MATERIAL REQUIRING PREPJ SLIDES,TC,,17 ,,RBRVS,,1.72 ,1.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88325,CPT,CONSLTJ COMPRE REVIEW REPRT REFERRED MATRL,,,17 ,,RBRVS,2.50 ,1.14 ,3.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88329,CPT,PATHOLOGY CONSULTATION DURING SURGERY,,,17 ,,RBRVS,0.67 ,0.30 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88331,CPT,PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC,,,17 ,,RBRVS,1.19 ,1.48 ,1.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88331,CPT,PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC,26,,17 ,,RBRVS,1.19 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88331,CPT,PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC,TC,,17 ,,RBRVS,,0.93 ,0.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88332,CPT,PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION,,,17 ,,RBRVS,0.59 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88332,CPT,PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION,26,,17 ,,RBRVS,0.59 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88332,CPT,PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION,TC,,17 ,,RBRVS,,0.32 ,0.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88333,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE,,,17 ,,RBRVS,1.20 ,1.55 ,1.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88333,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE,26,,17 ,,RBRVS,1.20 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88333,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE,TC,,17 ,,RBRVS,,1.02 ,1.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88334,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM ADDL SITE,,,17 ,,RBRVS,0.73 ,0.96 ,0.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88334,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM ADDL SITE,26,,17 ,,RBRVS,0.73 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88334,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM ADDL SITE,TC,,17 ,,RBRVS,,0.64 ,0.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88342,CPT,IMCYTCHM TISS IMMUNOPROXIDASE EA ANTIBODY,,,17 ,,RBRVS,0.85 ,2.17 ,2.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88342,CPT,IMCYTCHM TISS IMMUNOPROXIDASE EA ANTIBODY,26,,17 ,,RBRVS,0.85 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88342,CPT,IMCYTCHM TISS IMMUNOPROXIDASE EA ANTIBODY,TC,,17 ,,RBRVS,,1.84 ,1.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88346,CPT,IMMUNOFLUORESCENT STUDY EA ANTIBODY DIR METHOD,,,17 ,,RBRVS,0.86 ,2.12 ,2.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88346,CPT,IMMUNOFLUORESCENT STUDY EA ANTIBODY DIR METHOD,26,,17 ,,RBRVS,0.86 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88346,CPT,IMMUNOFLUORESCENT STUDY EA ANTIBODY DIR METHOD,TC,,17 ,,RBRVS,,1.78 ,1.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88347,CPT,IMMUNOFLUORESCENT STUDY EA ANTIBODY INDIR METHOD,,,17 ,,RBRVS,0.86 ,1.39 ,1.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88347,CPT,IMMUNOFLUORESCENT STUDY EA ANTIBODY INDIR METHOD,26,,17 ,,RBRVS,0.86 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88347,CPT,IMMUNOFLUORESCENT STUDY EA ANTIBODY INDIR METHOD,TC,,17 ,,RBRVS,,1.14 ,1.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88348,CPT,ELECTRON MICROSCOPY DIAGNOSTIC,,,17 ,,RBRVS,1.51 ,18.41 ,18.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88348,CPT,ELECTRON MICROSCOPY DIAGNOSTIC,26,,17 ,,RBRVS,1.51 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88348,CPT,ELECTRON MICROSCOPY DIAGNOSTIC,TC,,17 ,,RBRVS,,17.81 ,17.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88349,CPT,ELECTRON MICROSCOPY SCANNING,,,17 ,,RBRVS,0.76 ,9.74 ,9.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88349,CPT,ELECTRON MICROSCOPY SCANNING,26,,17 ,,RBRVS,0.76 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88349,CPT,ELECTRON MICROSCOPY SCANNING,TC,,17 ,,RBRVS,,9.39 ,9.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88355,CPT,MORPHOMETRIC ANALYSIS SKELETAL MUSCLE,,,17 ,,RBRVS,1.85 ,4.38 ,4.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88355,CPT,MORPHOMETRIC ANALYSIS SKELETAL MUSCLE,26,,17 ,,RBRVS,1.85 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88355,CPT,MORPHOMETRIC ANALYSIS SKELETAL MUSCLE,TC,,17 ,,RBRVS,,3.82 ,3.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88356,CPT,MORPHOMETRIC ANALYSIS NERVE,,,17 ,,RBRVS,3.02 ,5.13 ,5.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88356,CPT,MORPHOMETRIC ANALYSIS NERVE,26,,17 ,,RBRVS,3.02 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88356,CPT,MORPHOMETRIC ANALYSIS NERVE,TC,,17 ,,RBRVS,,4.43 ,4.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88358,CPT,MORPHOMETRIC ANALYSIS TUMOR,,,17 ,,RBRVS,0.95 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88358,CPT,MORPHOMETRIC ANALYSIS TUMOR,26,,17 ,,RBRVS,0.95 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88358,CPT,MORPHOMETRIC ANALYSIS TUMOR,TC,,17 ,,RBRVS,,0.95 ,0.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88360,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL,,,17 ,,RBRVS,1.10 ,2.49 ,2.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88360,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL,26,,17 ,,RBRVS,1.10 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88360,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL,TC,,17 ,,RBRVS,,2.08 ,2.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88361,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST,,,17 ,,RBRVS,1.18 ,3.23 ,3.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88361,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST,26,,17 ,,RBRVS,1.18 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88361,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST,TC,,17 ,,RBRVS,,2.81 ,2.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88362,CPT,NERVE TEASING PREPARATIONS,,,17 ,,RBRVS,2.17 ,6.00 ,6.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88362,CPT,NERVE TEASING PREPARATIONS,26,,17 ,,RBRVS,2.17 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88362,CPT,NERVE TEASING PREPARATIONS,TC,,17 ,,RBRVS,,5.12 ,5.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88363,CPT,EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSIS,,,17 ,,RBRVS,0.37 ,0.10 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88365,CPT,IN SITU HYBRIDIZATION EACH PROBE,,,17 ,,RBRVS,1.20 ,3.63 ,3.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88365,CPT,IN SITU HYBRIDIZATION EACH PROBE,26,,17 ,,RBRVS,1.20 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88365,CPT,IN SITU HYBRIDIZATION EACH PROBE,TC,,17 ,,RBRVS,,3.18 ,3.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88367,CPT,M/PHMTRC ALYS ISH EA PRB CPTR-ASST TECHNOLOGY,,,17 ,,RBRVS,1.30 ,6.18 ,6.18 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88367,CPT,M/PHMTRC ALYS ISH EA PRB CPTR-ASST TECHNOLOGY,26,,17 ,,RBRVS,1.30 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88367,CPT,M/PHMTRC ALYS ISH EA PRB CPTR-ASST TECHNOLOGY,TC,,17 ,,RBRVS,,5.74 ,5.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88368,CPT,M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL,,,17 ,,RBRVS,1.40 ,5.02 ,5.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88368,CPT,M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL,26,,17 ,,RBRVS,1.40 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88368,CPT,M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL,TC,,17 ,,RBRVS,,4.63 ,4.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88371,CPT,PROTEIN WESTERN BLOT TISSUE,,,17 ,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,88371,CPT,PROTEIN ANAL TISSUE WESTERN BLOT W/INTERP&REPORT,26,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,88372,CPT,PROTEIN ANALYSIS W/PROBE,,,17 ,,TotalUnits,,,,0.94 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,88372,CPT,PROTEIN ALYS WSTRN BLOT I&R IMMUNOLOGICAL EA,26,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,88380,CPT,MICRODISSECTION PREP IDENTIFIED TARGET LASER,,,17 ,,RBRVS,1.56 ,3.54 ,3.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88380,CPT,MICRODISSECTION PREP IDENTIFIED TARGET LASER,26,,17 ,,RBRVS,1.56 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88380,CPT,MICRODISSECTION PREP IDENTIFIED TARGET LASER,TC,,17 ,,RBRVS,,3.01 ,3.01 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,88381,CPT,MICRODISSECTION PREP IDENTIFIED TARGET MANUAL,,,17 ,,RBRVS,1.18 ,4.20 ,4.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88381,CPT,MICRODISSECTION PREP IDENTIFIED TARGET MANUAL,26,,17 ,,RBRVS,1.18 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88381,CPT,MICRODISSECTION PREP IDENTIFIED TARGET MANUAL,TC,,17 ,,RBRVS,,3.84 ,3.84 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,88384,CPT,RA-BASED EVAL MLT MOLEC PROBES 11 THRU 50 PROBES,,,17 ,,TotalUnits,,,,7.18 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,88384,CPT,RA-BASED EVAL MLT MOLEC PROBES 11 THRU 50 PROBES,26,,17 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,88384,CPT,RA-BASED EVAL MLT MOLEC PROBES 11 THRU 50 PROBES,TC,,17 ,,TotalUnits,,,,6.39 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88385,CPT,RA-BASED EVL MLT MOLEC PROBES 51 THRU 250 PROBES,,,17 ,,RBRVS,1.50 ,15.33 ,15.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88385,CPT,RA-BASED EVL MLT MOLEC PROBES 51 THRU 250 PROBES,26,,17 ,,RBRVS,1.50 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88385,CPT,RA-BASED EVL MLT MOLEC PROBES 51 THRU 250 PROBES,TC,,17 ,,RBRVS,,14.94 ,14.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88386,CPT,RA-BASED EVAL MLT MOLEC PROBES 251 THRU 500 PRBS,,,17 ,,RBRVS,1.88 ,16.89 ,16.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88386,CPT,RA-BASED EVAL MLT MOLEC PROBES 251 THRU 500 PRBS,26,,17 ,,RBRVS,1.88 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,88386,CPT,RA-BASED EVAL MLT MOLEC PROBES 251 THRU 500 PRBS,TC,,17 ,,RBRVS,,16.28 ,16.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,88387,CPT,MACRO EXAM DISSECT&PREP TISS NONMICRO STD EA,,,17 ,,RBRVS,0.62 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88387,CPT,MACRO EXAM DISSECT&PREP TISS NONMICRO STD EA,,PC,17 ,,RBRVS,0.62 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,88387,CPT,MACRO EXAM DISSECT&PREP TISS NONMICRO STD EA,,TC,17 ,,RBRVS,,0.25 ,0.25 ,,,$0.00,$0.00,1,1,0,0,1,0,20120101,88388,CPT,MACR EXM DISS&PRP NONMICR IMPRNT/CONSLT/FRZ SEC,,,17 ,,RBRVS,0.45 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,88388,CPT,MACR EXM DISS&PRP NONMICR IMPRNT/CONSLT/FRZ SEC,,PC,17 ,,RBRVS,0.45 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,88388,CPT,MACR EXM DISS&PRP NONMICR IMPRNT/CONSLT/FRZ SEC,,TC,17 ,,RBRVS,,0.12 ,0.12 ,,,$0.00,$0.00,1,1,0,0,1,0,20120101,88399,CPT,SURGICAL PATHOLOGY PROCEDURE,,,17 ,,TotalUnits,,,,3.84 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,88399,CPT,SURGICAL PATHOLOGY PROCEDURE,,PC,17 ,,TotalUnits,,,,1.35 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,88399,CPT,SURGICAL PATHOLOGY PROCEDURE,,TC,17 ,,TotalUnits,,,,2.49 ,,$0.00,$0.00,1,1,1,0,1,0,20120101,88720,CPT,BILIRUBIN TOTAL TRANSCUT,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88738,CPT,HGB QUANT TRANSCUTANEOUS,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88740,CPT,TRANSCUTANEOUS CARBOXYHB,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88741,CPT,TRANSCUTANEOUS METHB,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,88749,CPT,IN VIVO LAB SERVICE,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89049,CPT,CAFFEINE HALOTHANE CONTRACTURE TEST,,,17 ,,RBRVS,1.40 ,0.45 ,6.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,89050,CPT,BODY FLUID CELL COUNT,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89051,CPT,BODY FLUID CELL COUNT,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89055,CPT,LEUKOCYTE ASSESSMENT FECAL,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89060,CPT,EXAM SYNOVIAL FLUID CRYSTALS,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,89060,CPT,CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID,26,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,89125,CPT,SPECIMEN FAT STAIN,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89160,CPT,EXAM FECES FOR MEAT FIBERS,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89190,CPT,NASAL SMEAR FOR EOSINOPHILS,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89220,CPT,SPUTUM OBTAINING SPEC AEROSOL INDUCED TX SPX,,TC,17 ,,RBRVS,,0.46 ,0.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,89230,CPT,SWEAT COLLECTION IONTOPHORESIS,,TC,17 ,,RBRVS,,0.08 ,0.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,89240,CPT,PATHOLOGY LAB PROCEDURE,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89250,CPT,CULTR OOCYTE/EMBRYO <4 DAYS,,,17 ,,TotalUnits,,,,12.43 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89251,CPT,CULTR OOCYTE/EMBRYO <4 DAYS,,,17 ,,TotalUnits,,,,12.93 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89253,CPT,EMBRYO HATCHING,,,17 ,,TotalUnits,,,,5.58 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89254,CPT,OOCYTE IDENTIFICATION,,,17 ,,TotalUnits,,,,6.11 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89255,CPT,PREPARE EMBRYO FOR TRANSFER,,,17 ,,TotalUnits,,,,4.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89257,CPT,SPERM IDENTIFICATION,,,17 ,,TotalUnits,,,,5.63 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89258,CPT,CRYOPRESERVATION EMBRYO(S),,,17 ,,TotalUnits,,,,5.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89259,CPT,CRYOPRESERVATION SPERM,,,17 ,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89260,CPT,SPERM ISOLATION SIMPLE,,,17 ,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89261,CPT,SPERM ISOLATION COMPLEX,,,17 ,,TotalUnits,,,,2.02 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89264,CPT,IDENTIFY SPERM TISSUE,,,17 ,,TotalUnits,,,,5.04 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89268,CPT,INSEMINATION OF OOCYTES,,,17 ,,TotalUnits,,,,4.98 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89272,CPT,EXTENDED CULTURE OF OOCYTES,,,17 ,,TotalUnits,,,,8.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89280,CPT,ASSIST OOCYTE FERTILIZATION,,,17 ,,TotalUnits,,,,12.96 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89281,CPT,ASSIST OOCYTE FERTILIZATION,,,17 ,,TotalUnits,,,,14.91 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89290,CPT,BIOPSY OOCYTE POLAR BODY,,,17 ,,TotalUnits,,,,22.24 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89291,CPT,BIOPSY OOCYTE POLAR BODY,,,17 ,,TotalUnits,,,,14.66 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89300,CPT,SEMEN ANALYSIS W/HUHNER,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89310,CPT,SEMEN ANALYSIS W/COUNT,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89320,CPT,SEMEN ANAL VOL/COUNT/MOT,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89321,CPT,SEMEN ANAL SPERM DETECTION,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89322,CPT,SEMEN ANAL STRICT CRITERIA,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89325,CPT,SPERM ANTIBODY TEST,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89329,CPT,SPERM EVALUATION TEST,,,17 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89330,CPT,EVALUATION CERVICAL MUCUS,,,17 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89331,CPT,RETROGRADE EJACULATION ANAL,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89342,CPT,STORAGE/YEAR EMBRYO(S),,,17 ,,TotalUnits,,,,2.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89343,CPT,STORAGE/YEAR SPERM/SEMEN,,,17 ,,TotalUnits,,,,1.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89352,CPT,THAWING CRYOPRESRVED EMBRYO,,,17 ,,TotalUnits,,,,5.12 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89353,CPT,THAWING CRYOPRESRVED SPERM,,,17 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,89398,CPT,UNLISTED REPROD MED LAB PROC,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90281,CPT,IMMUNE GLOBULIN IG HUMAN IM USE,,,22 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90283,CPT,IMMUNE GLOBULIN IGIV HUMAN IV USE,,,22 ,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90284,CPT,IMMUNE GLOBULIN HUMAN SUBQ INFUSION 100 MG EA,,,22 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90287,CPT,BOTULINUM ANTITOXIN EQUINE ANY ROUTE,,,22 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90296,CPT,DIPHTHERIA ANTITOXIN EQUINE ANY ROUTE,,,22 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90371,CPT,HEPATITIS B IMMUNE GLOBULIN HBIG HUMAN IM,,,22 ,,TotalUnits,,,,2.85 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90375,CPT,RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ,,,22 ,,TotalUnits,,,,3.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90376,CPT,RABIES IG HEAT-TREATED HUMAN IM/SUBQ,,,22 ,,TotalUnits,,,,3.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90378,CPT,RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E,,,22 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90384,CPT,RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM,,,22 ,,TotalUnits,,,,2.10 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90385,CPT,RHO(D) IMMUNE GLOBULIN HUMAN MINI-DOSE IM,,,22 ,,TotalUnits,,,,0.96 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90386,CPT,RHO(D) IMMUNE GLOBULIN HUMAN IV,,,22 ,,RBRVS,,2.61 ,2.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,90389,CPT,TETANUS IMMUNE GLOBULIN TIG HUMAN IM,,,22 ,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90396,CPT,VARICELLA-ZOSTER IMMUNE GLOBULIN HUMAN IM,,,22 ,,TotalUnits,,,,2.16 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90399,CPT,UNLISTED IMMUNE GLOBULIN,,,22 ,,TotalUnits,,,,1.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90460,CPT,IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX,,,9 ,,RBRVS,0.17 ,0.50 ,0.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,90461,CPT,IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT,,,9 ,,RBRVS,0.15 ,0.18 ,0.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,90471,CPT,IMADM PRQ ID SUBQ/IM NJXS 1 VACCINE,,,9 ,,RBRVS,0.17 ,0.50 ,0.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,90472,CPT,IMADM PRQ ID SUBQ/IM NJXS EA VACCINE,,,9 ,,RBRVS,0.15 ,0.18 ,0.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,90473,CPT,IMADM INTRANSL/ORAL 1 VACCINE,,,9 ,,RBRVS,0.17 ,0.50 ,0.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,90474,CPT,IMADM INTRANSL/ORAL EA VACCINE,,,9 ,,RBRVS,0.15 ,0.18 ,0.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,90476,CPT,ADENOVIRUS VACCINE TYPE 4 LIVE ORAL,,,9 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90477,CPT,ADENOVIRUS VACCINE TYPE 7 LIVE FOR ORAL,,,9 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90581,CPT,ANTHRAX VACCINE SUBCUTANEOUS/IM USE,,,9 ,,RBRVS,,2.90 ,2.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,90585,CPT,BACILLUS CALMETTE-GUERIN VACC FOR TB LIVE PERQ,,,9 ,,TotalUnits,,,,4.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90586,CPT,BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL,,,9 ,,TotalUnits,,,,6.63 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90632,CPT,HEPATITIS A VACCINE ADULT FOR INTRAMUSCULAR USE,,,9 ,,TotalUnits,,,,2.37 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90633,CPT,HEPATITIS A VACCINE PEDIATRIC 2 DOSE SCHEDULE IM,,,9 ,,TotalUnits,,,,1.15 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90634,CPT,HEPATITIS A VACCINE PEDIATRIC 3 DOSE SCHEDULE IM,,,9 ,,TotalUnits,,,,1.21 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90636,CPT,HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM,,,9 ,,TotalUnits,,,,3.17 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90644,CPT,MENINGOCOCCAL & HIB-MENCY VACCINE 4 DOSE IM,,,9 ,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90645,CPT,HEMOPHILUS INFLUENZA B VACC HBOC CONJ 4 DOSE IM,,,9 ,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90646,CPT,HEMOPHILUS INFLUENZA B VACCINE PRP-D BOOSTER IM,,,9 ,,TotalUnits,,,,1.19 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90647,CPT,HEMOPHILUS INFLUENZA B VACCINE PRP-OMP 3 DOSE IM,,,9 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90648,CPT,HEMOPHILUS INFLUENZA B VACCINE PRP-T 4 DOSE IM,,,9 ,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90649,CPT,HUMAN PAPILLOMA VIRUS VACCINE QUADRIV 3 DOSE IM,,,9 ,,TotalUnits,,,,4.38 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90650,CPT,HUMAN PAPILLOMA VIRUS BIVALENT VACCINE 3 DOSE IM,,,9 ,,TotalUnits,,,,2.14 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90654,CPT,INFLUENZA VACCINE SPLIT VIRUS PRSRV FREE ID,,,9 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90655,CPT,INFLUENZA VIRUS VACC SPLIT PRSRV FREE 6-35 MO IM,,,9 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90656,CPT,INFLUENZA VIRUS VACC SPLIT PRSRV FREE 3 YRS/> IM,,,9 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90657,CPT,INFLUENZA VIRUS VACCINE SPLIT VIRUS 6-35 MO IM,,,9 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90658,CPT,INFLUENZA VIRUS VACCINE SPLIT VIRUS 3/> YRS IM,,,9 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90660,CPT,INFLUENZA VIRUS VACCINE LIVE INTRANASAL,,,9 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90661,CPT,INFLUENZA VACCINE CELL CULT PRSRV FREE IM,,,9 ,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90662,CPT,INFLUENZA VACCINE SPLT PRSRV FREE INC ANTIGEN IM,,,9 ,,RBRVS,,0.79 ,0.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,90664,CPT,INFLUENZA VAC PANDEMIC FORMULA LIVE INTRANASAL,,,9 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90665,CPT,LYME DISEASE VACCINE ADULT IM,,,9 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90666,CPT,INFLUENZA VACCINE PANDEMIC SPLT PRSRV FREE IM,,,9 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90667,CPT,INFLUENZA VACCINE PANDEMIC SPLT ADJUVANT IM,,,9 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90668,CPT,INFLUENZA VACCINE PANDEMIC SPLT IM,,,9 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90669,CPT,PNEUMOCOCCAL CONJ VACCINE 7 VALENT IM,,,9 ,,TotalUnits,,,,2.74 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90670,CPT,PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,,,9 ,,RBRVS,,3.36 ,3.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,90675,CPT,RABIES VACCINE INTRAMUSCULAR,,,9 ,,TotalUnits,,,,6.58 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90676,CPT,RABIES VACCINE INTRADERMAL,,,9 ,,TotalUnits,,,,2.94 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90680,CPT,ROTAVIRUS VACCINE PENTAVALENT 3 DOSE LIVE ORAL,,,9 ,,TotalUnits,,,,2.60 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90681,CPT,ROTAVIRUS VACC HUMAN ATTENUATED 2 DOSE LIVE ORAL,,,9 ,,TotalUnits,,,,2.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90690,CPT,TYPHOID VACCINE LIVE ORAL,,,9 ,,TotalUnits,,,,1.33 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90691,CPT,TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM,,,9 ,,TotalUnits,,,,1.89 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90692,CPT,TYPHOID VACC H-P INACTIVATED SUBQ/INTRADERMAL,,,9 ,,TotalUnits,,,,1.10 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90693,CPT,TYPHOID VACCINE AKD SUBQ U.S. MILITARY,,,9 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90696,CPT,DTAP-IPV INACTIVATED ADMIN PTS AGE 4-6 YRS IM,,,9 ,,TotalUnits,,,,1.39 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90698,CPT,DTAP-HIB-IPV INACTIVATED VACCINE IM,,,9 ,,TotalUnits,,,,2.60 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90700,CPT,DIPHTH TETANUS TOX ACELL PERTUSSIS VACC <7 YR IM,,,9 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90701,CPT,DIPHTHERA TETANUS TOXOID PERTUSSIS VACCINE IM,,,9 ,,TotalUnits,,,,0.94 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90702,CPT,DIPHTHERIA TETANUS TOXOID ADSORBED < 7 YR IM,,,9 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90703,CPT,TETANUS TOXOID ADSORBED INTRAMUSCULAR,,,9 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90704,CPT,MUMPS VIRUS VACCINE LIVE SUBCUTANEOUS,,,9 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90705,CPT,MEASLES VIRUS VACCINE LIVE SUBCUTANEOUS,,,9 ,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90706,CPT,RUBELLA VIRUS VACCINE LIVE SUBCUTANEOUS,,,9 ,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90707,CPT,MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ,,,9 ,,TotalUnits,,,,1.73 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90708,CPT,MEASLES & RUBELLA VIRUS VACCINE LIVE SUBQ,,,9 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90710,CPT,MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ,,,9 ,,TotalUnits,,,,4.62 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90712,CPT,POLIOVIRUS VACCINE ANY LIVE ORAL,,,9 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90713,CPT,POLIOVIRUS VACCINE INACTIVATED SUBQ/IM,,,9 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90714,CPT,TD TOXOIDS ADSORBED PRSRV FR 7/> YR IM,,,9 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90715,CPT,TDAP VACCINE 7/> YR IM,,,9 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90716,CPT,VARICELLA VIRUS VACCINE LIVE SUBQ,,,9 ,,TotalUnits,,,,2.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90717,CPT,YELLOW FEVER VACCINE LIVE SUBQ,,,9 ,,TotalUnits,,,,2.94 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90718,CPT,TETANUS & DIPHTHERIA TOXOIDS ADSORBED 7/>YR IM,,,9 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90719,CPT,DIPHTHERIA TOXOID INTRAMUSCULAR,,,9 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90720,CPT,DTP-HIB VACCINE INTRAMUSCULAR,,,9 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90721,CPT,DTAP-HIB VACCINE INTRAMUSCULAR,,,9 ,,TotalUnits,,,,0.90 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90723,CPT,DTAP-HEPB-IPV VACCINE INTRAMUSCULAR,,,9 ,,TotalUnits,,,,2.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90725,CPT,CHOLERA VACCINE INJECTABLE,,,9 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90727,CPT,PLAGUE VACCINE INTRAMUSCULAR,,,9 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90732,CPT,PNEUMOCOCCAL POLYSAC VACCINE 23-V 2 />YR SUBQ/IM,,,9 ,,TotalUnits,,,,1.12 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90733,CPT,MENINGOCOCCAL POLYSAC VACCINE SUBCUTANEOUS,,,9 ,,TotalUnits,,,,3.46 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90734,CPT,MENINGOCOCCAL CONJ VACCINE TETRAVALENT IM,,,9 ,,TotalUnits,,,,3.29 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90735,CPT,JAPANESE ENCEPHALITIS VIRUS VACCINE SUBCUTANEOUS,,,9 ,,TotalUnits,,,,3.58 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90736,CPT,ZOSTER SHINGLES VACCINE LIVE SUBCUTANEOUS,,,9 ,,TotalUnits,,,,5.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90738,CPT,JAPANESE ENCEPHALITIS VACCINE INACTIVATED IM,,,9 ,,TotalUnits,,,,2.29 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90740,CPT,HEPATITIS B VACCINE DIALYSIS DOSAGE 3 DOSE IM,,,9 ,,TotalUnits,,,,6.63 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90743,CPT,HEPATITIS B VACCINE ADOLESCENT 2 DOSE IM,,,9 ,,TotalUnits,,,,1.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90744,CPT,HEPATITIS B VACCINE PEDIATRIC3 DOSE IM,,,9 ,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90746,CPT,HEPATITIS B VACCINE ADULT DOSAGE INTRAMUSCULAR,,,9 ,,TotalUnits,,,,2.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90747,CPT,HEPATITIS B VACCINE DIALYSIS DOSAGE 4 DOSE IM,,,9 ,,TotalUnits,,,,7.47 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90748,CPT,HEPB-HIB VACCINE INTRAMUSCULAR,,,9 ,,TotalUnits,,,,1.93 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,90749,CPT,UNLISTED VACCINE/TOXOID,,,9 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,90801,CPT,PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION,,,16 ,,RBRVS,2.80 ,0.72 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90802,CPT,INTERACTIVE PSYCH DX INTERVIEW EXAM W/PLAY,,,16 ,,RBRVS,3.01 ,0.84 ,1.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90804,CPT,INDIV PSYCTX OFFICE/OUTPATIENT 20-30 MIN,,,16 ,,RBRVS,1.21 ,0.25 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90805,CPT,INDIV PSYCTX OFFICE/OUTPT 20-30 MIN W/MED E/M,,,16 ,,RBRVS,1.37 ,0.32 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90806,CPT,INDIV PSYCTX OFFICE/OUTPATIENT 45-50 MIN,,,16 ,,RBRVS,1.86 ,0.37 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90807,CPT,INDIV PSYCTX OFFICE/OUTPT 45-50 MIN W/MED E/M,,,16 ,,RBRVS,2.02 ,0.47 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90808,CPT,INDIV PSYCTX OFFICE/OUTPATIENT 75-80 MIN,,,16 ,,RBRVS,2.79 ,0.59 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90809,CPT,INDIV PSYCTX OFFICE/OUTPT 75-80 MIN W/MED E/M,,,16 ,,RBRVS,2.95 ,0.71 ,1.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90810,CPT,INDIV PSYCTX INTERACTIVE OFFICE/OUTPT 20-30 MIN,,,16 ,,RBRVS,1.32 ,0.27 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90811,CPT,INDIV PSYCTX INTERACT OFF/OP 20-30 MIN MED E/M,,,16 ,,RBRVS,1.48 ,0.36 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90812,CPT,INDIV PSYCTX INTERACTIVE OFFICE/OUTPT 45-50 MIN,,,16 ,,RBRVS,1.97 ,0.39 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90813,CPT,INDIV PSYCTX INTERACT OFF/OP 45-50 MIN MED E/M,,,16 ,,RBRVS,2.13 ,0.50 ,0.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90814,CPT,INDIV PSYCTX INTERACTIVE OFFICE/OUTPT 75 MIN,,,16 ,,RBRVS,2.90 ,0.62 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90815,CPT,INDIV PSYCTX INTERACT OFF/OP 75-80 MIN MED E/M,,,16 ,,RBRVS,3.06 ,0.81 ,1.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90816,CPT,INDIV PSYCTX INPT/PRTL HOSP/RESDNTL 20-30 MIN,,,16 ,,RBRVS,1.25 ,0.35 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90817,CPT,IND PSYCTX INPT/PRTL HOSP/RES 20-30 MIN MED E/M,,,16 ,,RBRVS,1.41 ,0.44 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90818,CPT,INDIV PSYCTX INPT/PRTL HOSP/RESDNTL 45-50 MIN,,,16 ,,RBRVS,1.89 ,0.48 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90819,CPT,IND PSYCTX INPT/PRTL HOSP/RES 45-50 MIN MED E/M,,,16 ,,RBRVS,2.05 ,0.59 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90821,CPT,INDIV PSYCTX INPT/PRTL HOSP/RESDNTL 75-80 MIN,,,16 ,,RBRVS,2.83 ,0.67 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90822,CPT,IND PSYCTX INPT/PRTL HOSP/RES 75-80 MIN MED E/M,,,16 ,,RBRVS,2.99 ,0.81 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90823,CPT,INDIV PSYCTX IA INPT/PRTL HOSP/RESDNTL 20-30 MIN,,,16 ,,RBRVS,1.36 ,0.37 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90824,CPT,IND PSYCTX IA INPT/PRTL HOS/RESDNT 20-30 MIN E/M,,,16 ,,RBRVS,1.52 ,0.47 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90826,CPT,INDIV PSYCTX IA INPT/PRTL HOSP/RESDNTL 45-50 MIN,,,16 ,,RBRVS,2.01 ,0.51 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90827,CPT,IND PSYCTX IA INPT/PRTL HOS/RESDNT 45-50 MIN E/M,,,16 ,,RBRVS,2.16 ,0.61 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90828,CPT,INDIV PSYCTX IA INPT/PRTL HOSP/RESDNTL 75-80 MIN,,,16 ,,RBRVS,2.94 ,0.71 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90829,CPT,IND PSYCTX IA INPT/PRTL HOS/RESDNT 75-80 MIN E/M,,,16 ,,RBRVS,3.10 ,0.83 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90845,CPT,PSYCHOANALYSIS,,,16 ,,RBRVS,1.79 ,0.41 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90846,CPT,FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT,,,16 ,,RBRVS,1.83 ,0.50 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90847,CPT,FAMILY PSYCHOTHERAPY W/PATIENT PRESENT,,,16 ,,RBRVS,2.21 ,0.56 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90849,CPT,MULTIPLE FAMILY GROUP PSYCHOTHERAPY,,,16 ,,RBRVS,0.59 ,0.25 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90853,CPT,GROUP PSYCHOTHERAPY,,,16 ,,RBRVS,0.59 ,0.25 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90857,CPT,INTERACTIVE GROUP PSYCHOTHERAPY,,,16 ,,RBRVS,0.63 ,0.28 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90862,CPT,PHARMACOLOGIC MGMT MIN MEDICAL PSYCHOTHERAPY,,,16 ,,RBRVS,0.95 ,0.33 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90865,CPT,NARCOSYNTHESIS PSYC DX&THER PURPOSES,,,16 ,,RBRVS,2.84 ,0.79 ,1.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90869,CPT,REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MNGT,,,16 ,,RBRVS,3.00 ,0.27 ,9.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90870,CPT,ELECTROCONVULSIVE THERAPY,,,16 ,,RBRVS,2.50 ,0.56 ,2.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90875,CPT,INDIV PSYCHOPHYS BIOFEEDBACK TRAINING 20-30 MIN,,,16 ,,RBRVS,1.20 ,0.52 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90876,CPT,INDIV PSYCHOPHYS BIOFEEDBACK TRAINING 45-50 MIN,,,16 ,,RBRVS,1.90 ,0.82 ,1.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90880,CPT,HYPNOTHERAPY,,,16 ,,RBRVS,2.19 ,0.47 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90882,CPT,ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC PT,,,16 ,,TotalUnits,,,,2.32 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,90885,CPT,PSYCHIATRIC EVAL HOSPITAL RECORDS DX PURPOSES,,,16 ,,RBRVS,0.97 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90887,CPT,INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY,,,16 ,,RBRVS,1.48 ,0.64 ,0.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90889,CPT,PREP REPORT PT PSYCH STATUS PHYS/AGENCY/PAYER,,,16 ,,TotalUnits,,,,1.96 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,90899,CPT,UNLISTED PSYCHIATRIC SERVICE/PROCEDURE,,,16 ,,TotalUnits,,,,1.76 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,90901,CPT,BIOFEEDBACK TRAINING ANY MODALITY,,,14 ,,RBRVS,0.41 ,0.17 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90911,CPT,BIOFDBK TRNG PERINL MUSC ANORECT/URO SPHX W/EMG,,,14 ,,RBRVS,0.89 ,0.38 ,1.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90935,CPT,HEMODIALYSIS PROCEDURE W/1 PHYSICIAN EVALUATION,,,14 ,,RBRVS,1.48 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90937,CPT,HEMODIALYSIS PX REPEAT EVAL W/WO REVJ DIALYS RX,,,14 ,,RBRVS,2.11 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90940,CPT,HEMODIALYSIS ACCESS FLOW STUDY,,,14 ,,TotalUnits,,,,1.40 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,90945,CPT,DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS EVAL,,,14 ,,RBRVS,1.56 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90947,CPT,DIALYSIS OTH/THN HEMODIALYSIS REPEAT PHYS EVALS,,,14 ,,RBRVS,2.52 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90951,CPT,ESRD RELATED SVC MONTHLY <2 YR OLD 4/>VISITS,,,14 ,,RBRVS,18.46 ,8.64 ,8.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90952,CPT,ESRD RELATED SVC MONTHLY <2 YR OLD 2/3 VISITS,,,14 ,,RBRVS,6.21 ,14.40 ,14.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90953,CPT,ESRD RELATED SVC MONTHLY <2 YR OLD 1 VISIT,,,14 ,,RBRVS,4.14 ,9.60 ,9.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90954,CPT,ESRD RELATED SVC MONTHLY 2-11 YR OLD 4/>VISITS,,,14 ,,RBRVS,15.98 ,6.71 ,6.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90955,CPT,ESRD RELATED SVC MONTHLY 2-11 YR OLD 2/3 VISITS,,,14 ,,RBRVS,8.79 ,4.05 ,4.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90956,CPT,ESRD RELATED SVC MONTHLY 2-11 YR OLD 1 VISIT,,,14 ,,RBRVS,5.95 ,2.86 ,2.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90957,CPT,ESRD RELATED SVC MONTHLY 12-19 YR OLD 4/>VISITS,,,14 ,,RBRVS,12.52 ,5.63 ,5.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90958,CPT,ESRD RELATED SVC MONTHLY 12-19 YR OLD 2/3 VISITS,,,14 ,,RBRVS,8.34 ,3.96 ,3.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90959,CPT,ESRD RELATED SVC MONTHLY 12-19 YR OLD 1 VISIT,,,14 ,,RBRVS,5.50 ,2.70 ,2.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90960,CPT,ESRD RELATED SVC MONTHLY 20&> YR OLD 4/> VISITS,,,14 ,,RBRVS,5.18 ,2.90 ,2.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90961,CPT,ESRD RELATED SVC MONTHLY 20&> YR OLD 2/3 VISITS,,,14 ,,RBRVS,4.26 ,2.38 ,2.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90962,CPT,ESRD RELATED SVC MONTHLY 20&> YR OLD 1 VISIT,,,14 ,,RBRVS,3.15 ,1.81 ,1.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90963,CPT,ESRD SVC HOME DIALYSIS FULL MONTH <2YR OLD,,,14 ,,RBRVS,10.56 ,4.91 ,4.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90964,CPT,ESRD SVC HOME DIALYSIS FULL MONTH 2-11 YR OLD,,,14 ,,RBRVS,9.14 ,3.99 ,3.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90965,CPT,ESRD SVC HOME DIALYSIS FULL MONTH 12-19 YR OLD,,,14 ,,RBRVS,8.69 ,3.83 ,3.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90966,CPT,ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD,,,14 ,,RBRVS,4.26 ,2.34 ,2.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90967,CPT,ESRD RELATED SVC <FULL MONTH < 2 YR OLD,,,14 ,,RBRVS,0.35 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90968,CPT,ESRD RELATED SVC <FULL MONTH 2-11 YR OLD,,,14 ,,RBRVS,0.30 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90969,CPT,ESRD RELATED SVC <FULL MONTH 12-19 YR OLD,,,14 ,,RBRVS,0.29 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90970,CPT,ESRD RELATED SVC <FULL MONTH 20&> YR OLD,,,14 ,,RBRVS,0.14 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90989,CPT,DIALYSIS TRAINING PATIENT COMPLETED COURSE,,,14 ,,TotalUnits,,,,8.77 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,90993,CPT,DIALYSIS TRAINING PATIENT PER TRAINING SESSION,,,14 ,,TotalUnits,,,,1.90 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,90997,CPT,HEMOPERFUSION,,,14 ,,RBRVS,1.84 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,90999,CPT,UNLISTED DIALYSIS PROCEDURE INPATIENT/OUTPATIENT,,,14 ,,TotalUnits,,,,2.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,91010,CPT,ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT,,,14 ,,RBRVS,1.28 ,4.16 ,4.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91010,CPT,ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT,26,,14 ,,RBRVS,1.28 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91010,CPT,ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT,TC,,14 ,,RBRVS,,3.48 ,3.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91013,CPT,ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION,,,14 ,,RBRVS,0.18 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91013,CPT,ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION,26,,14 ,,RBRVS,0.18 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91013,CPT,ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION,TC,,14 ,,RBRVS,,0.38 ,0.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91020,CPT,GASTRIC MOTILITY MANOMETRIC STUDIES,,,14 ,,RBRVS,1.44 ,5.46 ,5.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91020,CPT,GASTRIC MOTILITY MANOMETRIC STUDIES,26,,14 ,,RBRVS,1.44 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91020,CPT,GASTRIC MOTILITY MANOMETRIC STUDIES,TC,,14 ,,RBRVS,,4.70 ,4.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91022,CPT,DUODENAL MOTILITY MANOMETRIC STUDY,,,14 ,,RBRVS,1.44 ,3.89 ,3.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91022,CPT,DUODENAL MOTILITY MANOMETRIC STUDY,26,,14 ,,RBRVS,1.44 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91022,CPT,DUODENAL MOTILITY MANOMETRIC STUDY,TC,,14 ,,RBRVS,,3.08 ,3.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91030,CPT,ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS,,,14 ,,RBRVS,0.91 ,3.19 ,3.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91030,CPT,ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS,26,,14 ,,RBRVS,0.91 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91030,CPT,ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS,TC,,14 ,,RBRVS,,2.68 ,2.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91034,CPT,GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT,,,14 ,,RBRVS,0.97 ,4.80 ,4.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91034,CPT,GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT,26,,14 ,,RBRVS,0.97 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91034,CPT,GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT,TC,,14 ,,RBRVS,,4.29 ,4.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91035,CPT,GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD,,,14 ,,RBRVS,1.59 ,12.65 ,12.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91035,CPT,GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD,26,,14 ,,RBRVS,1.59 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91035,CPT,GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD,TC,,14 ,,RBRVS,,11.80 ,11.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91037,CPT,GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD,,,14 ,,RBRVS,0.97 ,3.77 ,3.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91037,CPT,GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD,26,,14 ,,RBRVS,0.97 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91037,CPT,GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD,TC,,14 ,,RBRVS,,3.24 ,3.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91038,CPT,ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG,,,14 ,,RBRVS,1.10 ,7.64 ,7.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91038,CPT,ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG,26,,14 ,,RBRVS,1.10 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91038,CPT,ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG,TC,,14 ,,RBRVS,,7.04 ,7.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91040,CPT,ESOPHGL BALO DISTENSION PROVOCATION STD,,,14 ,,RBRVS,0.97 ,9.08 ,9.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91040,CPT,ESOPHGL BALO DISTENSION PROVOCATION STD,26,,14 ,,RBRVS,0.97 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91040,CPT,ESOPHGL BALO DISTENSION PROVOCATION STD,TC,,14 ,,RBRVS,,8.61 ,8.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91065,CPT,BREATH HYDROGEN TEST,,,14 ,,RBRVS,0.20 ,2.12 ,2.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91065,CPT,BREATH HYDROGEN TEST,26,,14 ,,RBRVS,0.20 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91065,CPT,BREATH HYDROGEN TEST,TC,,14 ,,RBRVS,,2.02 ,2.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91110,CPT,GI IMAG INTRALUMIN ESOPH-ILEUM PHYS INTERP/RPT,,,14 ,,RBRVS,3.64 ,23.27 ,23.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91110,CPT,GI IMAG INTRALUMIN ESOPH-ILEUM PHYS INTERP/RPT,26,,14 ,,RBRVS,3.64 ,2.00 ,2.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91110,CPT,GI IMAG INTRALUMIN ESOPH-ILEUM PHYS INTERP/RPT,TC,,14 ,,RBRVS,,21.27 ,21.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91111,CPT,GASTROINTESTINAL TRACT IMAGING ESOPHAGUS,,,21 ,,RBRVS,1.00 ,20.63 ,20.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91111,CPT,GASTROINTESTINAL TRACT IMAGING ESOPHAGUS,26,,21 ,,RBRVS,1.00 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91111,CPT,GASTROINTESTINAL TRACT IMAGING ESOPHAGUS,TC,,21 ,,RBRVS,,20.07 ,20.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91117,CPT,COLON MOTILITY STDY MIN 6 HR CONT RECORD W/I&R,,,14 ,,RBRVS,2.45 ,1.63 ,1.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91120,CPT,RECTAL SESATION TONE & COMPLIANCE TEST,,,14 ,,RBRVS,0.97 ,10.27 ,10.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91120,CPT,RECTAL SESATION TONE & COMPLIANCE TEST,26,,14 ,,RBRVS,0.97 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91120,CPT,RECTAL SESATION TONE & COMPLIANCE TEST,TC,,14 ,,RBRVS,,9.85 ,9.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91122,CPT,ANORECTAL MANOMETRY,,,14 ,,RBRVS,1.77 ,4.85 ,4.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91122,CPT,ANORECTAL MANOMETRY,26,,14 ,,RBRVS,1.77 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91122,CPT,ANORECTAL MANOMETRY,TC,,14 ,,RBRVS,,4.08 ,4.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91132,CPT,ELECTROGASTROGRAPHY DX TRANSCUTANEOUS,,,14 ,,RBRVS,0.52 ,3.60 ,3.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91132,CPT,ELECTROGASTROGRAPHY DX TRANSCUTANEOUS,26,,14 ,,RBRVS,0.52 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91132,CPT,ELECTROGASTROGRAPHY DX TRANSCUTANEOUS,TC,,14 ,,RBRVS,,3.32 ,3.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91133,CPT,ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG,,,14 ,,RBRVS,0.66 ,4.37 ,4.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,91133,CPT,ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG,26,,14 ,,RBRVS,0.66 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,91133,CPT,ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG,TC,,14 ,,RBRVS,,4.00 ,4.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,91299,CPT,UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE,,,14 ,,TotalUnits,,,,21.26 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,91299,CPT,UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE,,PC,14 ,,TotalUnits,,,,6.67 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,91299,CPT,UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE,,TC,14 ,,TotalUnits,,,,14.59 ,,$0.00,$0.00,1,1,1,0,1,0,20120101,92002,CPT,OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT,,,23 ,,RBRVS,0.88 ,0.43 ,1.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92004,CPT,OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST,,,23 ,,RBRVS,1.82 ,0.91 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92012,CPT,OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT,,,23 ,,RBRVS,0.92 ,0.50 ,1.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92014,CPT,OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/> VST,,,23 ,,RBRVS,1.42 ,0.75 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92015,CPT,DETERMINATION REFRACTIVE STATE,,,23 ,,RBRVS,0.38 ,0.16 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92018,CPT,OPHTH XM&EVAL ANES W/WO MANJ GLOBE COMPL,,,14 ,,RBRVS,2.50 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92019,CPT,OPHTH XM&EVAL ANES W/WO MANJ GLOBE LMTD,,,14 ,,RBRVS,1.31 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92020,CPT,GONIOSCOPY SEPARATE PROCEDURE,,,14 ,,RBRVS,0.37 ,0.21 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92025,CPT,COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI,,,14 ,,RBRVS,0.35 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92025,CPT,COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI,26,,14 ,,RBRVS,0.35 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92025,CPT,COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI,TC,,14 ,,RBRVS,,0.46 ,0.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92060,CPT,SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX,,,14 ,,RBRVS,0.69 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92060,CPT,SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX,26,,14 ,,RBRVS,0.69 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92060,CPT,SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX,TC,,14 ,,RBRVS,,0.67 ,0.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92065,CPT,ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIR&EVAL,,,14 ,,RBRVS,0.37 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92065,CPT,ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIR&EVAL,26,,14 ,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92065,CPT,ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIR&EVAL,TC,,14 ,,RBRVS,,0.90 ,0.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92071,CPT,FIT CONTACT LENS TX OCULAR SURFACE DISEASE,,,14 ,,RBRVS,0.61 ,0.34 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92072,CPT,FITTING CONTACT LENS FOR MNGT OF KERATOCONUS,,,14 ,,RBRVS,1.97 ,0.73 ,1.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92081,CPT,VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM,,,14 ,,RBRVS,0.30 ,1.09 ,1.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92081,CPT,VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM,26,,14 ,,RBRVS,0.30 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92081,CPT,VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM,TC,,14 ,,RBRVS,,0.93 ,0.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92082,CPT,VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM,,,14 ,,RBRVS,0.40 ,1.54 ,1.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92082,CPT,VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM,26,,14 ,,RBRVS,0.40 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92082,CPT,VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM,TC,,14 ,,RBRVS,,1.33 ,1.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92083,CPT,VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM,,,14 ,,RBRVS,0.50 ,1.94 ,1.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92083,CPT,VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM,26,,14 ,,RBRVS,0.50 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92083,CPT,VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM,TC,,14 ,,RBRVS,,1.66 ,1.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92100,CPT,SERIAL TONOMETRY SPX W/MLT MEAS INTRAOCULAR PRES,,,14 ,,RBRVS,0.92 ,0.47 ,1.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92132,CPT,CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI,,,14 ,,RBRVS,0.35 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92132,CPT,CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI,26,,14 ,,RBRVS,0.35 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92132,CPT,CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI,TC,,14 ,,RBRVS,,0.44 ,0.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92133,CPT,COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE,,,14 ,,RBRVS,0.50 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92133,CPT,COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE,26,,14 ,,RBRVS,0.50 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92133,CPT,COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE,TC,,14 ,,RBRVS,,0.44 ,0.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92134,CPT,COMPUTERIZED OPHTHALMIC IMAGING RETINA,,,14 ,,RBRVS,0.50 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92134,CPT,COMPUTERIZED OPHTHALMIC IMAGING RETINA,26,,14 ,,RBRVS,0.50 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92134,CPT,COMPUTERIZED OPHTHALMIC IMAGING RETINA,TC,,14 ,,RBRVS,,0.44 ,0.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92136,CPT,OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL,,,14 ,,RBRVS,0.54 ,1.88 ,1.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92136,CPT,OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL,26,,14 ,,RBRVS,0.54 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92136,CPT,OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL,TC,,14 ,,RBRVS,,1.56 ,1.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92140,CPT,PROVOCATIVE TESTS GLAUCOMA I&R W/O TONOGRAPHY,,,14 ,,RBRVS,0.50 ,0.24 ,1.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92225,CPT,OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R 1ST,,,14 ,,RBRVS,0.38 ,0.21 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92226,CPT,OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R SBSQ,,,14 ,,RBRVS,0.33 ,0.19 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92227,CPT,REMOTE IMG DX RETINL DIS W/ALYS & REPORT UNI/BI,,,14 ,,RBRVS,,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92228,CPT,REMOTE IMAGING MGT RETINAL DISEASE W/I&R UNI/BI,,,14 ,,RBRVS,0.30 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92228,CPT,REMOTE IMAGING MGT RETINAL DISEASE W/I&R UNI/BI,26,,14 ,,RBRVS,0.30 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92228,CPT,REMOTE IMAGING MGT RETINAL DISEASE W/I&R UNI/BI,TC,,14 ,,RBRVS,,0.36 ,0.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92230,CPT,FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT,,,14 ,,RBRVS,0.60 ,0.31 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92235,CPT,FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT,,,14 ,,RBRVS,0.81 ,2.99 ,2.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92235,CPT,FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT,26,,14 ,,RBRVS,0.81 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92235,CPT,FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT,TC,,14 ,,RBRVS,,2.50 ,2.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92240,CPT,INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPORT,,,14 ,,RBRVS,1.10 ,5.87 ,5.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92240,CPT,INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPORT,26,,14 ,,RBRVS,1.10 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92240,CPT,INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPORT,TC,,14 ,,RBRVS,,5.21 ,5.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92250,CPT,FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT,,,14 ,,RBRVS,0.44 ,1.70 ,1.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92250,CPT,FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT,26,,14 ,,RBRVS,0.44 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92250,CPT,FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT,TC,,14 ,,RBRVS,,1.47 ,1.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92260,CPT,OPHTHALMODYNAMOMETRY,,,14 ,,RBRVS,0.20 ,0.11 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92265,CPT,NEEDLE OCULOGRAPHY 1/> XOC MUSC 1/BOTH EYE W/I&R,,,14 ,,RBRVS,0.81 ,1.47 ,1.47 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92265,CPT,NEEDLE OCULOGRAPHY 1/> XOC MUSC 1/BOTH EYE W/I&R,26,,14 ,,RBRVS,0.81 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92265,CPT,NEEDLE OCULOGRAPHY 1/> XOC MUSC 1/BOTH EYE W/I&R,TC,,14 ,,RBRVS,,1.03 ,1.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92270,CPT,ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT,,,14 ,,RBRVS,0.81 ,1.72 ,1.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92270,CPT,ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT,26,,14 ,,RBRVS,0.81 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92270,CPT,ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT,TC,,14 ,,RBRVS,,1.36 ,1.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92275,CPT,ELECTRORETINOGRAPY W/INTERPRETATION & REPORT,,,14 ,,RBRVS,1.01 ,3.11 ,3.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92275,CPT,ELECTRORETINOGRAPY W/INTERPRETATION & REPORT,26,,14 ,,RBRVS,1.01 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92275,CPT,ELECTRORETINOGRAPY W/INTERPRETATION & REPORT,TC,,14 ,,RBRVS,,2.52 ,2.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92283,CPT,COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV,,,14 ,,RBRVS,0.17 ,1.24 ,1.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92283,CPT,COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV,26,,14 ,,RBRVS,0.17 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92283,CPT,COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV,TC,,14 ,,RBRVS,,1.16 ,1.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92284,CPT,DARK ADAPTATION XM W/INTERPRETATION & REPORT,,,14 ,,RBRVS,0.24 ,1.48 ,1.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92284,CPT,DARK ADAPTATION XM W/INTERPRETATION & REPORT,26,,14 ,,RBRVS,0.24 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92284,CPT,DARK ADAPTATION XM W/INTERPRETATION & REPORT,TC,,14 ,,RBRVS,,1.38 ,1.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92285,CPT,XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRESS,,,14 ,,RBRVS,0.05 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92285,CPT,XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRESS,26,,14 ,,RBRVS,0.05 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92285,CPT,XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRESS,TC,,14 ,,RBRVS,,0.69 ,0.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92286,CPT,SPEC ANT SGM PHTGRPHY I&R SPECLR ENDOTHELIAL,,,14 ,,RBRVS,0.66 ,2.81 ,2.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92286,CPT,SPEC ANT SGM PHTGRPHY I&R SPECLR ENDOTHELIAL,26,,14 ,,RBRVS,0.66 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92286,CPT,SPEC ANT SGM PHTGRPHY I&R SPECLR ENDOTHELIAL,TC,,14 ,,RBRVS,,2.45 ,2.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92287,CPT,SPEC ANT SGM PHTGRPHY I&R FLUORESCEIN ANGRPH,,,14 ,,RBRVS,0.81 ,0.47 ,2.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92310,CPT,RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK,,,23 ,,RBRVS,1.17 ,0.51 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92311,CPT,RX&FITG CONTACT CORNEAL LENS APHAKIA 1 EYE,,,14 ,,RBRVS,1.08 ,0.49 ,1.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92312,CPT,RX&FITG CONTACT CORNEAL LENS APHAKIA BOTH EYES,,,14 ,,RBRVS,1.26 ,0.57 ,1.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92313,CPT,RX&FITG CORNEOSCLERAL LENS,,,14 ,,RBRVS,0.92 ,0.49 ,1.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92314,CPT,RX&FTG CONTACT CORNEAL LENS EYES XCPT APHAKIA,,,23 ,,RBRVS,0.69 ,0.30 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92315,CPT,RX CONTACT CORNEAL LENS APHAKIA 1 EYE,,,14 ,,RBRVS,0.45 ,0.19 ,1.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92316,CPT,RX CONTACT CORNEAL LENS APHAKIA BOTH EYES,,,14 ,,RBRVS,0.68 ,0.39 ,2.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92317,CPT,RX CONTACT CORNEOSCLERAL LENS,,,14 ,,RBRVS,0.45 ,0.17 ,1.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92325,CPT,MODIFICAJ CONTACT LENX SPX SUPVJ ADAPTATION,,,14 ,,RBRVS,,0.98 ,0.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92326,CPT,REPLACEMENT CONTACT LENS,,,14 ,,RBRVS,,1.04 ,1.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92340,CPT,FITTING SPECTACLES XCPT APHAKIA MONOFOCAL,,,14 ,,RBRVS,0.37 ,0.16 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92341,CPT,FITTING SPECTACLES XCPT APHAKIA BIFOCAL,,,14 ,,RBRVS,0.47 ,0.20 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92342,CPT,FITTING SPECTACLES XCPT APHAKIA MULTIFOCAL,,,14 ,,RBRVS,0.53 ,0.23 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92352,CPT,FITTING SPECTACLE PROSTH APHAKIA MONOFOCAL,,,14 ,,RBRVS,0.37 ,0.16 ,0.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92353,CPT,FITTING SPECTACLE PROSTH APHAKIA MULTIFOCAL,,,14 ,,RBRVS,0.50 ,0.21 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92354,CPT,FITTING SPECTACLE MOUNTED LW VIS AID 1 ELMNT,,,14 ,,RBRVS,,1.66 ,1.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92355,CPT,FITTING SPECTACLE MOUNTED LW VIS AID TLSCP,,,14 ,,RBRVS,,1.16 ,1.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92358,CPT,PROSTHESIS SERVICE APHAKIA TEMPORARY,,,14 ,,RBRVS,,0.41 ,0.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92370,CPT,RPR&REFITG SPECTACLES EXCEPT APHAKIA,,,14 ,,RBRVS,0.32 ,0.14 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92371,CPT,RPR&REFITG SPECTACLE PROSTHESIS APHAKIA,,,14 ,,RBRVS,,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92499,CPT,UNLIVSTED OPHTHALMOLOGICAL SERVICE/PROCEDURE,,,14 ,,TotalUnits,,,,1.03 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,92499,CPT,UNLIVSTED OPHTHALMOLOGICAL SERVICE/PROCEDURE,,PC,14 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,92499,CPT,UNLIVSTED OPHTHALMOLOGICAL SERVICE/PROCEDURE,,TC,14 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,0,20120101,92502,CPT,OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA,,,14 ,,RBRVS,1.51 ,1.27 ,1.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92504,CPT,BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE,,,14 ,,RBRVS,0.18 ,0.10 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92506,CPT,EVAL SPEECH LANG VOICE COMMUNJ &/AUDITORY PROCES,,,8 ,,RBRVS,0.86 ,4.01 ,4.01 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92507,CPT,TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC INDIV,,,8 ,,RBRVS,1.30 ,1.05 ,1.05 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92508,CPT,TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC 2/>,,,8 ,,RBRVS,0.33 ,0.45 ,0.45 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92511,CPT,NASOPHARYNGOSCOPY W/ENDOSCOPE SPX,,,14 ,,RBRVS,0.84 ,0.90 ,3.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92512,CPT,NASAL FUNCTION STUDIES,,,14 ,,RBRVS,0.55 ,0.27 ,1.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92516,CPT,FACIAL NERVE FUNCTION STUDIES,,,14 ,,RBRVS,0.43 ,0.23 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92520,CPT,LARYNGEAL FUNCTION STUDIES,,,14 ,,RBRVS,0.75 ,0.42 ,1.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92526,CPT,TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING,,,14 ,,RBRVS,1.34 ,1.36 ,1.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92531,CPT,SPONTANEOUS NYSTAGMUS W/GAZE,,,14 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,92532,CPT,POSITIONAL NYSTAGMUS TEST,,,14 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,92533,CPT,CALORIC VESTIBULAR TEST EACH IRRIGATION,,,14 ,,TotalUnits,,,,0.97 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,92534,CPT,OPTOKINETIC NYSTAGMUS TEST,,,14 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,92540,CPT,VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRKG,,,14 ,,RBRVS,1.50 ,1.31 ,1.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92540,CPT,VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRKG,,PC,14 ,,RBRVS,1.50 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,92540,CPT,VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRKG,,TC,14 ,,RBRVS,,0.54 ,0.54 ,,,$0.00,$0.00,1,1,1,0,1,0,20120101,92541,CPT,SPONTANEOUS NYSTAGMUS TEST,,,14 ,,RBRVS,0.40 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92541,CPT,SPONTANEOUS NYSTAGMUS TEST,26,,14 ,,RBRVS,0.40 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92541,CPT,SPONTANEOUS NYSTAGMUS TEST,TC,,14 ,,RBRVS,,0.73 ,0.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92542,CPT,POSITIONAL NYSTAGMUS TEST,,,14 ,,RBRVS,0.33 ,0.98 ,0.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92542,CPT,POSITIONAL NYSTAGMUS TEST,26,,14 ,,RBRVS,0.33 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92542,CPT,POSITIONAL NYSTAGMUS TEST,TC,,14 ,,RBRVS,,0.82 ,0.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92543,CPT,CALORIC VESTIBULAR TEST EA IRRIGATION W/RECORD,,,14 ,,RBRVS,0.10 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92543,CPT,CALORIC VESTIBULAR TEST EA IRRIGATION W/RECORD,26,,14 ,,RBRVS,0.10 ,0.05 ,0.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92543,CPT,CALORIC VESTIBULAR TEST EA IRRIGATION W/RECORD,TC,,14 ,,RBRVS,,0.49 ,0.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92544,CPT,OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC,,,14 ,,RBRVS,0.26 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92544,CPT,OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC,26,,14 ,,RBRVS,0.26 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92544,CPT,OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC,TC,,14 ,,RBRVS,,0.69 ,0.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92545,CPT,OSCILLATING TRACKING TEST W/RECORDING,,,14 ,,RBRVS,0.23 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92545,CPT,OSCILLATING TRACKING TEST W/RECORDING,26,,14 ,,RBRVS,0.23 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92545,CPT,OSCILLATING TRACKING TEST W/RECORDING,TC,,14 ,,RBRVS,,0.66 ,0.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92546,CPT,SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING,,,14 ,,RBRVS,0.29 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92546,CPT,SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING,26,,14 ,,RBRVS,0.29 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92546,CPT,SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING,TC,,14 ,,RBRVS,,2.33 ,2.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92547,CPT,USE VERTICAL ELECTRODES,,TC,14 ,,RBRVS,,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,92548,CPT,COMPUTERIZED DYNAMIC POSTUROGRAPY,,,14 ,,RBRVS,0.50 ,2.49 ,2.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92548,CPT,COMPUTERIZED DYNAMIC POSTUROGRAPY,26,,14 ,,RBRVS,0.50 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92548,CPT,COMPUTERIZED DYNAMIC POSTUROGRAPY,TC,,14 ,,RBRVS,,2.25 ,2.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92550,CPT,TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS,,,8 ,,RBRVS,0.35 ,0.25 ,0.25 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92551,CPT,SCREENING TEST PURE TONE AIR ONLY,,,8 ,,RBRVS,,0.33 ,0.33 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92552,CPT,PURE TONE AUDIOMETRY AIR ONLY,,TC,8 ,,RBRVS,,0.74 ,0.74 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92553,CPT,PURE TONE AUDIOMETRY AIR & BONE,,TC,8 ,,RBRVS,,0.94 ,0.94 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92555,CPT,SPEECH AUDIOMETRY THRESHOLD,,TC,8 ,,RBRVS,,0.54 ,0.54 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92556,CPT,SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ,,TC,8 ,,RBRVS,,0.84 ,0.84 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92557,CPT,COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ,,,8 ,,RBRVS,0.60 ,0.44 ,0.56 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92559,CPT,AUDIOMETRIC TESTING GROUPS,,,8 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,92560,CPT,BEKESY AUDIOMETRY SCREENING,,,8 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,92561,CPT,BEKESY AUDIOMETRY DIAGNOSTIC,,TC,8 ,,RBRVS,,0.95 ,0.95 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92562,CPT,LOUDNESS BALANCE BINAURAL/MONAURAL,,TC,8 ,,RBRVS,,0.92 ,0.92 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92563,CPT,TONE DECAY TEST,,TC,8 ,,RBRVS,,0.72 ,0.72 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92564,CPT,SHORT INCREMENT SENSITIVITY INDEX,,TC,8 ,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92565,CPT,STENGER TEST PURE TONE,,TC,8 ,,RBRVS,,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92567,CPT,TYMPANOMETRY,,,8 ,,RBRVS,0.20 ,0.16 ,0.24 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92568,CPT,ACOUSTIC REFLEX THRESHOLD,,,8 ,,RBRVS,0.29 ,0.18 ,0.19 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92570,CPT,ACOUSTIC IMMIT TEST TYMPANOM/ACOUST REFLX/DECAY,,,8 ,,RBRVS,0.55 ,0.30 ,0.36 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92571,CPT,FILTERED SPEECH TEST,,TC,8 ,,RBRVS,,0.58 ,0.58 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92572,CPT,STAGGERED SPONDAIC WORD,,TC,8 ,,RBRVS,,0.92 ,0.92 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92575,CPT,SENSORINEURAL ACUITY LEVEL,,TC,8 ,,RBRVS,,1.44 ,1.44 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92576,CPT,SYNTHETIC SENTENCE IDENTIFICATION TEST,,TC,8 ,,RBRVS,,0.77 ,0.77 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92577,CPT,STENGER TEST SPEECH,,TC,8 ,,RBRVS,,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92579,CPT,VISUAL REINFORCEMENT AUDIOMETRY,,,8 ,,RBRVS,0.70 ,0.43 ,0.55 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92582,CPT,CONDITIONING PLAY AUDIOMETRY,,TC,8 ,,RBRVS,,1.50 ,1.50 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92583,CPT,SELECT PICTURE AUDIOMETRY,,TC,8 ,,RBRVS,,1.04 ,1.04 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92584,CPT,ELECTROCOCHLEOGRAPY,,TC,8 ,,RBRVS,,1.95 ,1.95 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92585,CPT,AUDITORY EVOKED POTENTIALS COMPREHENSIVE,,,8 ,,RBRVS,0.50 ,2.81 ,2.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92585,CPT,AUDITORY EVOKED POTENTIALS COMPREHENSIVE,26,,8 ,,RBRVS,0.50 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92585,CPT,AUDITORY EVOKED POTENTIALS COMPREHENSIVE,TC,,8 ,,RBRVS,,2.57 ,2.57 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92586,CPT,AUDITORY EVOKED POTENTIALS LIMITED,,TC,8 ,,RBRVS,,2.06 ,2.06 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92587,CPT,DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD,,,8 ,,RBRVS,0.13 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92587,CPT,DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD,26,,8 ,,RBRVS,0.13 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92587,CPT,DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD,TC,,8 ,,RBRVS,,0.87 ,0.87 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92588,CPT,DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL,,,8 ,,RBRVS,0.36 ,1.57 ,1.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,92588,CPT,DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL,26,,8 ,,RBRVS,0.36 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92588,CPT,DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL,TC,,8 ,,RBRVS,,1.39 ,1.39 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92590,CPT,HEARING AID EXAMINATION & SELECTION MONAURAL,,,8 ,,TotalUnits,,,,1.58 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,92591,CPT,HEARING AID EXAMINATION & SELECTION BINAURAL,,,8 ,,TotalUnits,,,,2.01 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,92592,CPT,HEARING AID CHECK MONAURAL,,,8 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,92593,CPT,HEARING AID CHECK BINAURAL,,,8 ,,TotalUnits,,,,1.03 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,92594,CPT,ELECTROACOUS EVAL HEARING AID MONAURAL,,,8 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,92595,CPT,ELECTROACOUS EVAL HEARING AID BINAURAL,,,8 ,,TotalUnits,,,,1.29 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,92596,CPT,EAR PROTECTOR ATTENUATION MEASUREMENTS,,TC,8 ,,RBRVS,,1.16 ,1.16 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92597,CPT,EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEECH,,,8 ,,RBRVS,1.26 ,1.55 ,1.55 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92601,CPT,ANALYSIS COCHLEAR IMPLT PT <7 YR PRGRMG,,,14 ,,RBRVS,2.30 ,1.40 ,1.88 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92602,CPT,ANALYSIS COCHLEAR IMPLT PT <7 YR SBSQ REPRGRMG,,,14 ,,RBRVS,1.30 ,0.86 ,1.28 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92603,CPT,ANALYSIS COCHLEAR IMPLT 7 YR/> PRGRMG,,,14 ,,RBRVS,2.25 ,1.30 ,1.83 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92604,CPT,ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG,,,14 ,,RBRVS,1.25 ,0.75 ,1.18 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92606,CPT,THER SVC N-SP-GENRATJ DEV PRGRMG&MODIFICAJ,,,14 ,,RBRVS,1.40 ,0.61 ,0.93 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92607,CPT,RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR,,,14 ,,RBRVS,1.85 ,3.24 ,3.24 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92608,CPT,RX SP-GENRATJ AUGMNT&COMUNICAJ DEV EA 30 MIN,,,14 ,,RBRVS,0.70 ,0.80 ,0.80 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92609,CPT,THER SP-GENRATJ DEV PRGRMG&MODIFICAJ,,,14 ,,RBRVS,1.50 ,1.84 ,1.84 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92610,CPT,EVAL ORAL&PHARYNGEAL SWLNG FUNCJ,,,14 ,,RBRVS,1.30 ,0.67 ,1.72 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92611,CPT,MOTION FLUOR EVAL SWLNG FUNCJ C/V REC,,,14 ,,RBRVS,1.34 ,1.92 ,1.92 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92612,CPT,FLX FIBOPT NDSC EVAL SWLNG C/V REC,,,14 ,,RBRVS,1.27 ,0.66 ,3.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92613,CPT,FLX FIBOPT NDSC EVAL SWLNG C/V REC PHYS I&R,,,14 ,,RBRVS,0.71 ,0.37 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92614,CPT,FLX FIBOPT NDSC EVAL LARYN SENS C/V REC,,,14 ,,RBRVS,1.27 ,0.67 ,3.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92615,CPT,FLX FIBOPT NDSC EVAL LARYN SENS PHYS I&R,,,14 ,,RBRVS,0.63 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92616,CPT,FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS C/V REC,,,14 ,,RBRVS,1.88 ,0.97 ,3.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,92617,CPT,FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS PHYS I&R,,,14 ,,RBRVS,0.79 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92618,CPT,EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV ADD 30 MIN,,,14 ,,RBRVS,0.65 ,0.26 ,0.28 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,92620,CPT,EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN,,,14 ,,RBRVS,1.50 ,0.71 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92621,CPT,EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN,,,14 ,,RBRVS,0.35 ,0.15 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92625,CPT,ASSESSMENT TINNITUS,,,14 ,,RBRVS,1.15 ,0.55 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92626,CPT,EVALUATION AUDITORY REHAB STATUS 1ST HR,,,14 ,,RBRVS,1.40 ,0.81 ,1.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92627,CPT,EVALUATION AUDITORY REHAB STATUS EA 15 MIN,,,14 ,,RBRVS,0.33 ,0.20 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92630,CPT,AUDITORY REHABILITATION PRELINGUAL HEARING LOSS,,,14 ,,TotalUnits,,,,1.18 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,92633,CPT,AUDITORY REHABILITATION POSTLINGUAL HEARING LOSS,,,14 ,,TotalUnits,,,,1.19 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,92640,CPT,ANALYSIS W/PRGRMG AUD BRAINSTEM IMPLANT PR HR,,,14 ,,RBRVS,1.76 ,0.62 ,0.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92700,CPT,UNLISTED OTORHINOLARYNGOLOGICAL SERVICE,,,14 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,92950,CPT,CARDIOPULMONARY RESUSCITATION,,,4 ,,RBRVS,3.79 ,1.05 ,4.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92953,CPT,TEMPORARY TRANSCUTANEOUS PACING,,,4 ,,RBRVS,0.23 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92960,CPT,CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL,,,4 ,,RBRVS,2.25 ,1.40 ,4.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92961,CPT,CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX,,,4 ,,RBRVS,4.59 ,2.47 ,2.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92970,CPT,CARDIOASSIST-METH CIRCULATORY ASSIST INTERNAL,,,4 ,,RBRVS,3.51 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92971,CPT,CARDIOASSIST-METH CIRCULATORY ASSIST EXTERNAL,,,4 ,,RBRVS,1.77 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92973,CPT,PRQ TRANSLUMINAL CORONARY THROMBECTOMY,,,21 ,,RBRVS,3.28 ,1.64 ,1.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92974,CPT,TCAT PLMT RADJ DLVR DEV SBSQ C IV BRACHYTX,,,21 ,,RBRVS,3.00 ,1.51 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92975,CPT,THROMBOLYSIS INTRACORONARY NFS SLCTV ANGRPH,,,4 ,,RBRVS,7.24 ,3.62 ,3.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92977,CPT,THROMBOLYSIS CORONARY INTRAVENOUS INFUSION,,,4 ,,RBRVS,,2.69 ,2.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92978,CPT,INTRAVASC US CORONARY INTERP&RPT INITIAL VESSEL,,,4 ,,TotalUnits,,,,8.31 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,92978,CPT,INTRAVASC US CORONARY INTERP&RPT INITIAL VESSEL,26,,4 ,,TotalUnits,,,,2.70 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,92978,CPT,INTRAVASC US CORONARY INTERP&RPT INITIAL VESSEL,TC,,4 ,,TotalUnits,,,,5.61 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,92979,CPT,INTRAVASC US CORONARY INTERP&RPT ADDL VESSEL,,,4 ,,TotalUnits,,,,4.44 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,92979,CPT,INTRAVASC US CORONARY INTERP&RPT ADDL VESSEL,26,,4 ,,TotalUnits,,,,2.16 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,92979,CPT,INTRAVASC US CORONARY INTERP&RPT ADDL VESSEL,TC,,4 ,,TotalUnits,,,,2.28 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,92980,CPT,TCAT PLMT INTRACORONARY STENT PRQ 1 VESSEL,,,21 ,,RBRVS,14.82 ,7.64 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92981,CPT,TCAT PLMT INTRACORONARY STENT PRQ EA VESSEL,,,21 ,,RBRVS,4.16 ,2.08 ,2.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92982,CPT,PRQ TRLUML CORONARY BALLOON ANGIOPLASTY 1 VSL,,,21 ,,RBRVS,10.96 ,5.70 ,5.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92984,CPT,PRQ TRLUML CORONARY BALLOON ANGIOPLASTY EA VSL,,,21 ,,RBRVS,2.97 ,1.48 ,1.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92986,CPT,PRQ BALLOON VALVULOPLASTY AORTIC VALVE,,,21 ,,RBRVS,22.85 ,14.58 ,14.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92987,CPT,PRQ BALLOON VALVULOPLASTY MITRAL VALVE,,,21 ,,RBRVS,23.63 ,15.00 ,15.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92990,CPT,PRQ BALLOON VALVULOPLASTY PULMONARY VALVE,,,21 ,,RBRVS,18.27 ,11.80 ,11.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92992,CPT,ATRIAL SEPTECT/SEPTOST TRANSVENOUS BALLOON,,,21 ,,TotalUnits,,,,34.07 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,92993,CPT,ATRIAL SEPTECT/SEPTOSTOMY BLADE METHOD,,,21 ,,RBRVS,7.07 ,16.39 ,16.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92995,CPT,PRQ TRLUML CORON ATHERECT W/WO ANGIOP 1 VESSEL,,,21 ,,RBRVS,12.07 ,6.27 ,6.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92996,CPT,PRQ TRLUML CORON ATHERECT W/WO ANGIOP EA VESSEL,,,21 ,,RBRVS,3.26 ,1.64 ,1.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92997,CPT,PRQ TRLUML PULMONARY ART BALLOON ANGIOP 1 VSL,,,21 ,,RBRVS,11.98 ,5.61 ,5.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,92998,CPT,PRQ TRLUML PULMONARY ART BALLOON ANGIOP EA VSL,,,21 ,,RBRVS,5.99 ,2.86 ,2.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93000,CPT,ECG ROUTINE ECG W/LEAST 12 LDS W/I&R,,,4 ,,RBRVS,0.17 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93005,CPT,ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R,,TC,4 ,,RBRVS,,0.31 ,0.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93010,CPT,ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY,,PC,4 ,,RBRVS,0.17 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93015,CPT,CV STRS TST XERS&/OR RX CONT ECG PHYS SI&R,,,4 ,,RBRVS,0.75 ,1.94 ,1.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93016,CPT,CV STRS TST XERS&/OR RX CONT ECG PHYS SUPVJ,,PC,4 ,,RBRVS,0.45 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93017,CPT,CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY,,TC,4 ,,RBRVS,,1.58 ,1.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93018,CPT,CV STRS TST XERS&/OR RX CONT ECG I&R ONLY,,PC,4 ,,RBRVS,0.30 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93024,CPT,ERGONOVINE PROVOCATION TST,,,4 ,,RBRVS,1.17 ,2.22 ,2.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93024,CPT,ERGONOVINE PROVOCATION TST,26,,4 ,,RBRVS,1.17 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93024,CPT,ERGONOVINE PROVOCATION TST,TC,,4 ,,RBRVS,,1.66 ,1.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93025,CPT,MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS,,,4 ,,RBRVS,0.75 ,4.89 ,4.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93025,CPT,MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS,26,,4 ,,RBRVS,0.75 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93025,CPT,MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS,TC,,4 ,,RBRVS,,4.52 ,4.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93040,CPT,RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT,,,4 ,,RBRVS,0.15 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93041,CPT,RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R,,TC,4 ,,RBRVS,,0.16 ,0.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93042,CPT,RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ONLY,,PC,4 ,,RBRVS,0.15 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93224,CPT,XTRNL ECG < 48 HR RECORD SCAN STOR W/PHY R&I,,,4 ,,RBRVS,0.52 ,2.53 ,2.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93225,CPT,XTRNL ECG < 48 HR RECORDING,,TC,4 ,,RBRVS,,0.91 ,0.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93226,CPT,EXTERNAL ECG SCANNING ANALYSIS REPORT,,TC,4 ,,RBRVS,,1.35 ,1.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93227,CPT,XTRNL ECG CONTINUOUS RHYTHM PHYS REVIEW&INTERPJ,,PC,4 ,,RBRVS,0.52 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93228,CPT,XTRNL MOBILE CV TELEMETRY W/PHYS R&I W/REPORT,,PC,4 ,,RBRVS,0.52 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93229,CPT,XTRNL MOBILE CV TELEMETRY W/TECHNICAL SUPPORT,,TC,4 ,,RBRVS,,20.04 ,20.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93268,CPT,XTRNL PT ACTIV ECG TRANSMIS PHYS R&I 30 DAYS,,,4 ,,RBRVS,0.52 ,6.83 ,6.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93270,CPT,XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS,,TC,4 ,,RBRVS,,0.44 ,0.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93271,CPT,XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS,,TC,4 ,,RBRVS,,6.16 ,6.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93272,CPT,XTRNL PT ACTIVTD ECG DWNLD 30 DAYS PHYS R&I,,PC,4 ,,RBRVS,0.52 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93278,CPT,SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG,,,4 ,,RBRVS,0.25 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93278,CPT,SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG,26,,4 ,,RBRVS,0.25 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93278,CPT,SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG,TC,,4 ,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93279,CPT,PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER,,,4 ,,RBRVS,0.65 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93279,CPT,PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER,26,,4 ,,RBRVS,0.65 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93279,CPT,PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER,TC,,4 ,,RBRVS,,0.53 ,0.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93280,CPT,PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER,,,4 ,,RBRVS,0.77 ,1.02 ,1.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93280,CPT,PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER,26,,4 ,,RBRVS,0.77 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93280,CPT,PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER,TC,,4 ,,RBRVS,,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93281,CPT,PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER,,,4 ,,RBRVS,0.90 ,1.19 ,1.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93281,CPT,PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER,26,,4 ,,RBRVS,0.90 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93281,CPT,PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER,TC,,4 ,,RBRVS,,0.72 ,0.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93282,CPT,PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB,,,4 ,,RBRVS,0.85 ,1.07 ,1.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93282,CPT,PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB,26,,4 ,,RBRVS,0.85 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93282,CPT,PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB,TC,,4 ,,RBRVS,,0.64 ,0.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93283,CPT,PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB,,,4 ,,RBRVS,1.15 ,1.31 ,1.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93283,CPT,PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB,26,,4 ,,RBRVS,1.15 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93283,CPT,PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB,TC,,4 ,,RBRVS,,0.74 ,0.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93284,CPT,PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB,,,4 ,,RBRVS,1.25 ,1.49 ,1.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93284,CPT,PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB,26,,4 ,,RBRVS,1.25 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93284,CPT,PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB,TC,,4 ,,RBRVS,,0.84 ,0.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93285,CPT,PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM,,,4 ,,RBRVS,0.52 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93285,CPT,PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM,26,,4 ,,RBRVS,0.52 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93285,CPT,PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM,TC,,4 ,,RBRVS,,0.49 ,0.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93286,CPT,PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM,,,4 ,,RBRVS,0.30 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93286,CPT,PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM,26,,4 ,,RBRVS,0.30 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93286,CPT,PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM,TC,,4 ,,RBRVS,,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,93287,CPT,PERI-PX EVAL&PROGRAM CARDIOVERTER/DEFIBRILLATOR,,,4 ,,RBRVS,0.45 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93287,CPT,PERI-PX EVAL&PROGRAM CARDIOVERTER/DEFIBRILLATOR,26,,4 ,,RBRVS,0.45 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93287,CPT,PERI-PX EVAL&PROGRAM CARDIOVERTER/DEFIBRILLATOR,TC,,4 ,,RBRVS,,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,93288,CPT,INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM,,,4 ,,RBRVS,0.43 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93288,CPT,INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM,26,,4 ,,RBRVS,0.43 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93288,CPT,INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM,TC,,4 ,,RBRVS,,0.50 ,0.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93289,CPT,INTERROGATION EVAL F2F 1/DUAL/MLT LEADS CVDFB,,,4 ,,RBRVS,0.92 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93289,CPT,INTERROGATION EVAL F2F 1/DUAL/MLT LEADS CVDFB,26,,4 ,,RBRVS,0.92 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93289,CPT,INTERROGATION EVAL F2F 1/DUAL/MLT LEADS CVDFB,TC,,4 ,,RBRVS,,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93290,CPT,INTERROGATION EVAL F2F IMPLANTABLE CV MNTR SYS,,,4 ,,RBRVS,0.43 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93290,CPT,INTERROGATION EVAL F2F IMPLANTABLE CV MNTR SYS,26,,4 ,,RBRVS,0.43 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93290,CPT,INTERROGATION EVAL F2F IMPLANTABLE CV MNTR SYS,TC,,4 ,,RBRVS,,0.28 ,0.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93291,CPT,INTERROGATION EVALUATION IN PERSON ILR SYSTEM,,,4 ,,RBRVS,0.43 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93291,CPT,INTERROGATION EVALUATION IN PERSON ILR SYSTEM,26,,4 ,,RBRVS,0.43 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93291,CPT,INTERROGATION EVALUATION IN PERSON ILR SYSTEM,TC,,4 ,,RBRVS,,0.45 ,0.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93292,CPT,INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR,,,4 ,,RBRVS,0.43 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93292,CPT,INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR,26,,4 ,,RBRVS,0.43 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93292,CPT,INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR,TC,,4 ,,RBRVS,,0.34 ,0.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93293,CPT,TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL,,,4 ,,RBRVS,0.32 ,1.31 ,1.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93293,CPT,TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL,26,,4 ,,RBRVS,0.32 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93293,CPT,TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL,TC,,4 ,,RBRVS,,1.17 ,1.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93294,CPT,INTERROGATION EVAL REMOTE </90 D 1/2/MLT LEAD PM,,PC,4 ,,RBRVS,0.65 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93295,CPT,INTERROGATION EVAL REMOTE </90 D 1/2/> LD CVDFB,,PC,4 ,,RBRVS,1.29 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93296,CPT,INTERROGATION REMOTE </90 D TECHNICIAN REVIEW,,TC,4 ,,RBRVS,,0.95 ,0.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93297,CPT,INTERROGATION EVAL REMOTE </30 D CV MNTR SYS,,PC,4 ,,RBRVS,0.52 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93298,CPT,INTERROGATION EVALUATION REMOTE </30 D ILR SYS,,PC,4 ,,RBRVS,0.52 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93299,CPT,INTERROGATION EVAL REMOTE </30 D TECH REVIEW,,TC,4 ,,TotalUnits,,,,2.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93303,CPT,COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY,,,4 ,,RBRVS,1.30 ,4.84 ,4.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93303,CPT,COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY,26,,4 ,,RBRVS,1.30 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93303,CPT,COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY,TC,,4 ,,RBRVS,,4.23 ,4.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93304,CPT,F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY,,,4 ,,RBRVS,0.75 ,3.16 ,3.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93304,CPT,F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY,26,,4 ,,RBRVS,0.75 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93304,CPT,F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY,TC,,4 ,,RBRVS,,2.82 ,2.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93306,CPT,ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR DOP,,,4 ,,RBRVS,1.30 ,5.50 ,5.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93306,CPT,ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR DOP,26,,4 ,,RBRVS,1.30 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93306,CPT,ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR DOP,TC,,4 ,,RBRVS,,4.85 ,4.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93307,CPT,ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP,,,4 ,,RBRVS,0.92 ,3.40 ,3.40 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93307,CPT,ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP,26,,4 ,,RBRVS,0.92 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93307,CPT,ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP,TC,,4 ,,RBRVS,,2.95 ,2.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93308,CPT,ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD,,,4 ,,RBRVS,0.53 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93308,CPT,ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD,26,,4 ,,RBRVS,0.53 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93308,CPT,ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD,TC,,4 ,,RBRVS,,2.29 ,2.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93312,CPT,ECG TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R,,,4 ,,RBRVS,2.20 ,7.23 ,7.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93312,CPT,ECG TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R,26,,4 ,,RBRVS,2.20 ,0.97 ,0.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93312,CPT,ECG TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R,TC,,4 ,,RBRVS,,6.26 ,6.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93313,CPT,ECHO R-T 2D W/PROBE PLACEMENT ONLY,,,4 ,,RBRVS,0.95 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93314,CPT,ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY,,,4 ,,RBRVS,1.25 ,7.08 ,7.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93314,CPT,ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY,26,,4 ,,RBRVS,1.25 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93314,CPT,ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY,TC,,4 ,,RBRVS,,6.52 ,6.52 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,93315,CPT,ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R,,,4 ,,TotalUnits,,,,6.99 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93315,CPT,ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R,26,,4 ,,TotalUnits,,,,4.05 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93315,CPT,ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R,TC,,4 ,,TotalUnits,,,,2.94 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93316,CPT,ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY,,,4 ,,RBRVS,0.95 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93317,CPT,ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT,,,4 ,,TotalUnits,,,,4.51 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93317,CPT,ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT,26,,4 ,,TotalUnits,,,,2.57 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93317,CPT,ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT,TC,,4 ,,TotalUnits,,,,1.94 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,93318,CPT,ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ,,,4 ,,TotalUnits,,,,5.28 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93318,CPT,ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ,26,,4 ,,TotalUnits,,,,3.05 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93318,CPT,ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ,TC,,4 ,,TotalUnits,,,,2.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93320,CPT,DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY,,,4 ,,RBRVS,0.38 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93320,CPT,DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY,26,,4 ,,RBRVS,0.38 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93320,CPT,DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY,TC,,4 ,,RBRVS,,1.26 ,1.26 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,93321,CPT,DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD,,,4 ,,RBRVS,0.15 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93321,CPT,DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD,26,,4 ,,RBRVS,0.15 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93321,CPT,DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD,TC,,4 ,,RBRVS,,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,93325,CPT,DOP ECHOCARD COLOR FLOW VELOCITY MAPPING,,,4 ,,RBRVS,0.07 ,0.96 ,0.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93325,CPT,DOP ECHOCARD COLOR FLOW VELOCITY MAPPING,26,,4 ,,RBRVS,0.07 ,0.03 ,0.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93325,CPT,DOP ECHOCARD COLOR FLOW VELOCITY MAPPING,TC,,4 ,,RBRVS,,0.93 ,0.93 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,93350,CPT,ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&STRS,,,4 ,,RBRVS,1.46 ,4.67 ,4.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93350,CPT,ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&STRS,26,,4 ,,RBRVS,1.46 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93350,CPT,ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&STRS,TC,,4 ,,RBRVS,,3.94 ,3.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93351,CPT,ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG,,,4 ,,RBRVS,1.75 ,5.46 ,5.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93351,CPT,ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG,26,,4 ,,RBRVS,1.75 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93351,CPT,ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG,TC,,4 ,,RBRVS,,4.56 ,4.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93352,CPT,USE OF ECHO CONTRAST AGENT DURING STRESS ECHO,,,4 ,,RBRVS,0.19 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93451,CPT,RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT,,,21 ,,RBRVS,2.72 ,19.13 ,19.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93451,CPT,RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT,26,,21 ,,RBRVS,2.72 ,1.06 ,1.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93451,CPT,RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT,TC,,21 ,,RBRVS,,18.07 ,18.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93452,CPT,L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I,,,21 ,,RBRVS,4.75 ,19.11 ,19.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93452,CPT,L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I,26,,21 ,,RBRVS,4.75 ,1.85 ,1.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93452,CPT,L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I,TC,,21 ,,RBRVS,,17.26 ,17.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93453,CPT,R & L HRT CATH W/NJX L VENTRICULOG IMG S&I,,,21 ,,RBRVS,6.24 ,25.00 ,25.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93453,CPT,R & L HRT CATH W/NJX L VENTRICULOG IMG S&I,26,,21 ,,RBRVS,6.24 ,2.43 ,2.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93453,CPT,R & L HRT CATH W/NJX L VENTRICULOG IMG S&I,TC,,21 ,,RBRVS,,22.57 ,22.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93454,CPT,CATH PLMT & NJX CORONARY ART ANGIO IMG S&I,,,21 ,,RBRVS,4.79 ,19.85 ,19.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93454,CPT,CATH PLMT & NJX CORONARY ART ANGIO IMG S&I,26,,21 ,,RBRVS,4.79 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93454,CPT,CATH PLMT & NJX CORONARY ART ANGIO IMG S&I,TC,,21 ,,RBRVS,,17.98 ,17.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93455,CPT,CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I,,,21 ,,RBRVS,5.54 ,23.23 ,23.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93455,CPT,CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I,26,,21 ,,RBRVS,5.54 ,2.16 ,2.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93455,CPT,CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I,TC,,21 ,,RBRVS,,21.07 ,21.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93456,CPT,CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I,,,21 ,,RBRVS,6.15 ,24.68 ,24.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93456,CPT,CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I,26,,21 ,,RBRVS,6.15 ,2.40 ,2.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93456,CPT,CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I,TC,,21 ,,RBRVS,,22.28 ,22.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93457,CPT,CATH PLMT R HRT/ARTS/GRFTS W/NJX&ANGIO IMG S&I,,,21 ,,RBRVS,6.89 ,28.06 ,28.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93457,CPT,CATH PLMT R HRT/ARTS/GRFTS W/NJX&ANGIO IMG S&I,26,,21 ,,RBRVS,6.89 ,2.69 ,2.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93457,CPT,CATH PLMT R HRT/ARTS/GRFTS W/NJX&ANGIO IMG S&I,TC,,21 ,,RBRVS,,25.37 ,25.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93458,CPT,CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I,,,21 ,,RBRVS,5.85 ,23.87 ,23.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93458,CPT,CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I,26,,21 ,,RBRVS,5.85 ,2.28 ,2.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93458,CPT,CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I,TC,,21 ,,RBRVS,,21.59 ,21.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93459,CPT,CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I,,,21 ,,RBRVS,6.60 ,26.22 ,26.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93459,CPT,CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I,26,,21 ,,RBRVS,6.60 ,2.57 ,2.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93459,CPT,CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I,TC,,21 ,,RBRVS,,23.65 ,23.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93460,CPT,R & L HRT CATH WINJX HRT ART& L VENTR IMG S&I,,,21 ,,RBRVS,7.35 ,27.72 ,27.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93460,CPT,R & L HRT CATH WINJX HRT ART& L VENTR IMG S&I,26,,21 ,,RBRVS,7.35 ,2.87 ,2.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93460,CPT,R & L HRT CATH WINJX HRT ART& L VENTR IMG S&I,TC,,21 ,,RBRVS,,24.85 ,24.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93461,CPT,R&L HRT CATH W/INJEC HRT ART/GRFT&L VENT IMG S&I,,,21 ,,RBRVS,8.10 ,32.13 ,32.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93461,CPT,R&L HRT CATH W/INJEC HRT ART/GRFT&L VENT IMG S&I,26,,21 ,,RBRVS,8.10 ,3.16 ,3.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93461,CPT,R&L HRT CATH W/INJEC HRT ART/GRFT&L VENT IMG S&I,TC,,21 ,,RBRVS,,28.97 ,28.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93462,CPT,LEFT HEART CATH BY TRANSEPTAL PUNCTURE,,,21 ,,RBRVS,3.73 ,1.47 ,1.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93463,CPT,MEDICATION ADMIN & HEMODYNAMIC MEASURMENT,,,21 ,,RBRVS,2.00 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,93464,CPT,PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASURE,,,21 ,,RBRVS,1.80 ,5.26 ,5.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93464,CPT,PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASURE,26,,21 ,,RBRVS,1.80 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93464,CPT,PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASURE,TC,,21 ,,RBRVS,,4.61 ,4.61 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,93503,CPT,INSERTION FLOW DIRECTED CATHETER FOR MONITORING,,,21 ,,RBRVS,2.91 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93505,CPT,ENDOMYOCARDIAL BIOPSY,,,21 ,,RBRVS,4.37 ,18.38 ,18.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93505,CPT,ENDOMYOCARDIAL BIOPSY,26,,21 ,,RBRVS,4.37 ,2.16 ,2.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93505,CPT,ENDOMYOCARDIAL BIOPSY,TC,,21 ,,RBRVS,,16.22 ,16.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93530,CPT,R HRT CATHETERIZATION CONGENITAL CARDIAC ANOMALY,,,21 ,,TotalUnits,,,,37.71 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93530,CPT,R HRT CATHETERIZATION CONGENITAL CARDIAC ANOMALY,26,,21 ,,TotalUnits,,,,6.27 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93530,CPT,R HRT CATHETERIZATION CONGENITAL CARDIAC ANOMALY,TC,,21 ,,TotalUnits,,,,31.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93531,CPT,CMBN R HRT & RETROGRADE L HRT CATHJ CGEN ANOMALY,,,21 ,,TotalUnits,,,,98.66 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93531,CPT,CMBN R HRT & RETROGRADE L HRT CATHJ CGEN ANOMALY,26,,21 ,,TotalUnits,,,,12.30 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93531,CPT,CMBN R HRT & RETROGRADE L HRT CATHJ CGEN ANOMALY,TC,,21 ,,TotalUnits,,,,86.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93532,CPT,CMBN R HRT T-SEPTAL L HRT CATHJ NTC SEPTUM CGEN,,,21 ,,TotalUnits,,,,105.08 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93532,CPT,CMBN R HRT T-SEPTAL L HRT CATHJ NTC SEPTUM CGEN,26,,21 ,,TotalUnits,,,,14.61 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93532,CPT,CMBN R HRT T-SEPTAL L HRT CATHJ NTC SEPTUM CGEN,TC,,21 ,,TotalUnits,,,,90.47 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93533,CPT,CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN,,,21 ,,TotalUnits,,,,99.24 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93533,CPT,CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN,26,,21 ,,TotalUnits,,,,9.81 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93533,CPT,CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN,TC,,21 ,,TotalUnits,,,,89.43 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93561,CPT,INDIC DIL STD ARTL&/OR VEN CATHJ W/OUTP MEAS,,,4 ,,TotalUnits,,,,2.37 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93561,CPT,INDIC DIL STD ARTL&/OR VEN CATHJ W/OUTP MEAS,26,,4 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93561,CPT,INDIC DIL STD ARTL&/OR VEN CATHJ W/OUTP MEAS,TC,,4 ,,TotalUnits,,,,1.68 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,93562,CPT,INDIC DIL STD ARTL&/OR VEN CATHJ SBSQ OUTP MEAS,,,4 ,,TotalUnits,,,,1.14 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93562,CPT,INDIC DIL STD ARTL&/OR VEN CATHJ SBSQ OUTP MEAS,26,,4 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93562,CPT,INDIC DIL STD ARTL&/OR VEN CATHJ SBSQ OUTP MEAS,TC,,4 ,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,93563,CPT,NJX SEL HRT ART CONGENITAL HRT CATH W/S&I,,,4 ,,RBRVS,1.11 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,93564,CPT,NJX SEL HRT ART/GRFT CONGENITAL HRT CATH W/S&I,,,4 ,,RBRVS,1.13 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,93565,CPT,NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I,,,4 ,,RBRVS,0.86 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,93566,CPT,NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I,,,4 ,,RBRVS,0.86 ,0.33 ,4.04 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,93567,CPT,NJX SUPRAVALV AORTOG HRT CATH W/S&I,,,4 ,,RBRVS,0.97 ,0.38 ,3.06 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,93568,CPT,NJX PULMONARY ANGIO HRT CATH W/S&I,,,4 ,,RBRVS,0.88 ,0.34 ,3.54 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,93571,CPT,IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL,,,4 ,,TotalUnits,,,,9.19 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93571,CPT,IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL,26,,4 ,,TotalUnits,,,,2.69 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93571,CPT,IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL,TC,,4 ,,TotalUnits,,,,6.50 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,93572,CPT,IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL,,,4 ,,TotalUnits,,,,5.63 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93572,CPT,IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL,26,,4 ,,TotalUnits,,,,2.13 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93572,CPT,IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL,TC,,4 ,,TotalUnits,,,,3.50 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,93580,CPT,PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT,,,21 ,,RBRVS,17.97 ,9.19 ,9.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93581,CPT,PRQ TCAT CLSR CGEN VENTR SEPTAL DFCT W/IMPLT,,,21 ,,RBRVS,24.39 ,11.53 ,11.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93600,CPT,BUNDLE OF HIS RECORDING,,,4 ,,TotalUnits,,,,4.44 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93600,CPT,BUNDLE OF HIS RECORDING,26,,4 ,,TotalUnits,,,,3.04 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93600,CPT,BUNDLE OF HIS RECORDING,TC,,4 ,,TotalUnits,,,,1.40 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93602,CPT,INTRA-ATRIAL RECORDING,,,4 ,,TotalUnits,,,,4.38 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93602,CPT,INTRA-ATRIAL RECORDING,26,,4 ,,TotalUnits,,,,3.15 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93602,CPT,INTRA-ATRIAL RECORDING,TC,,4 ,,TotalUnits,,,,1.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93603,CPT,RIGHT VENTRICULAR RECORDING,,,4 ,,TotalUnits,,,,5.00 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93603,CPT,RIGHT VENTRICULAR RECORDING,26,,4 ,,TotalUnits,,,,3.15 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93603,CPT,RIGHT VENTRICULAR RECORDING,TC,,4 ,,TotalUnits,,,,1.85 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93609,CPT,INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MANJ,,,4 ,,TotalUnits,,,,9.97 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93609,CPT,INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MANJ,26,,4 ,,TotalUnits,,,,7.63 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93609,CPT,INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MANJ,TC,,4 ,,TotalUnits,,,,2.34 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,93610,CPT,INTRA-ATRIAL PACING,,,4 ,,TotalUnits,,,,4.53 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93610,CPT,INTRA-ATRIAL PACING,26,,4 ,,TotalUnits,,,,4.47 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93610,CPT,INTRA-ATRIAL PACING,TC,,4 ,,TotalUnits,,,,0.06 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93612,CPT,INTRAVENTRICULAR PACING,,,4 ,,TotalUnits,,,,6.18 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93612,CPT,INTRAVENTRICULAR PACING,26,,4 ,,TotalUnits,,,,4.45 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93612,CPT,INTRAVENTRICULAR PACING,TC,,4 ,,TotalUnits,,,,1.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93613,CPT,INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING,,,4 ,,RBRVS,6.99 ,3.48 ,3.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93615,CPT,ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS,,,4 ,,TotalUnits,,,,1.86 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93615,CPT,ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS,26,,4 ,,TotalUnits,,,,1.47 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93615,CPT,ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS,TC,,4 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93616,CPT,ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG,,,4 ,,TotalUnits,,,,2.51 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93616,CPT,ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG,26,,4 ,,TotalUnits,,,,1.88 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93616,CPT,ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG,TC,,4 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93618,CPT,INDUCTION ARRHYTHMIA ELECTRICAL PACING,,,4 ,,TotalUnits,,,,10.84 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93618,CPT,INDUCTION ARRHYTHMIA ELECTRICAL PACING,26,,4 ,,TotalUnits,,,,6.38 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93618,CPT,INDUCTION ARRHYTHMIA ELECTRICAL PACING,TC,,4 ,,TotalUnits,,,,4.46 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93619,CPT,COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION,,,4 ,,TotalUnits,,,,17.66 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93619,CPT,COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION,26,,4 ,,TotalUnits,,,,11.01 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93619,CPT,COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION,TC,,4 ,,TotalUnits,,,,6.65 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93620,CPT,COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION,,,4 ,,TotalUnits,,,,20.45 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93620,CPT,COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION,26,,4 ,,TotalUnits,,,,17.07 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93620,CPT,COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION,TC,,4 ,,TotalUnits,,,,3.38 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93621,CPT,COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC,,,4 ,,TotalUnits,,,,5.13 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93621,CPT,COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC,26,,4 ,,TotalUnits,,,,3.14 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93621,CPT,COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC,TC,,4 ,,TotalUnits,,,,1.99 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,93622,CPT,COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC,,,4 ,,TotalUnits,,,,6.15 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93622,CPT,COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC,26,,4 ,,TotalUnits,,,,4.61 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93622,CPT,COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC,TC,,4 ,,TotalUnits,,,,1.54 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,93623,CPT,PROGRAMMED STIMJ&PACG AFTER IV DRUG NFS,,,4 ,,TotalUnits,,,,5.68 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93623,CPT,PROGRAMMED STIMJ&PACG AFTER IV DRUG NFS,26,,4 ,,TotalUnits,,,,4.26 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93623,CPT,PROGRAMMED STIMJ&PACG AFTER IV DRUG NFS,TC,,4 ,,TotalUnits,,,,1.42 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,93624,CPT,ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT,,,4 ,,TotalUnits,,,,9.44 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93624,CPT,ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT,26,,4 ,,TotalUnits,,,,7.62 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93624,CPT,ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT,TC,,4 ,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93631,CPT,INTRAOP EPICAR&ENDOCAR PACG&MAPG,,,4 ,,TotalUnits,,,,14.93 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93631,CPT,INTRAOP EPICAR&ENDOCAR PACG&MAPG,26,,4 ,,TotalUnits,,,,11.32 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93631,CPT,INTRAOP EPICAR&ENDOCAR PACG&MAPG,TC,,4 ,,TotalUnits,,,,3.61 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,93640,CPT,EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE,,,4 ,,TotalUnits,,,,12.83 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93640,CPT,EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE,26,,4 ,,TotalUnits,,,,5.25 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93640,CPT,EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE,TC,,4 ,,TotalUnits,,,,7.58 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,93641,CPT,EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN,,,4 ,,TotalUnits,,,,14.75 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93641,CPT,EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN,26,,4 ,,TotalUnits,,,,8.86 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93641,CPT,EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN,TC,,4 ,,TotalUnits,,,,5.89 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,93642,CPT,EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS,,,4 ,,RBRVS,4.88 ,7.50 ,7.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93642,CPT,EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS,26,,4 ,,RBRVS,4.88 ,2.48 ,2.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93642,CPT,EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS,TC,,4 ,,RBRVS,,5.02 ,5.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93650,CPT,ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION,,,4 ,,RBRVS,10.49 ,5.51 ,5.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93651,CPT,ICAR CATH ABLTJ ARRHYTGNIC FOC SUPVENTR TCHYCAR,,,4 ,,RBRVS,16.23 ,8.05 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93652,CPT,ICAR CATH ABLATION ARRHYTGNIC FOC VENTR TCHYCAR,,,4 ,,RBRVS,17.65 ,8.78 ,8.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93660,CPT,CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR,,,4 ,,RBRVS,1.89 ,2.87 ,2.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93660,CPT,CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR,26,,4 ,,RBRVS,1.89 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93660,CPT,CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR,TC,,4 ,,RBRVS,,1.93 ,1.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93662,CPT,INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I,,,4 ,,TotalUnits,,,,6.29 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93662,CPT,INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I,26,,4 ,,TotalUnits,,,,4.63 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93662,CPT,INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I,TC,,4 ,,TotalUnits,,,,1.66 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,93668,CPT,PERIPHERAL ARTERIAL DISEASE REHAB PER SESSION,,,4 ,,RBRVS,,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93701,CPT,BIOMPEDANCE-DERIVED PHYSIOLOGIC CV ANALYSIS,,TC,4 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,0,0,0,1,20120101,93701,CPT,BIOMPEDANCE-DERIVED PHYSIOLOGIC CV ANALYSIS,26,,4 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,93701,CPT,BIOMPEDANCE-DERIVED PHYSIOLOGIC CV ANALYSIS,TC,,4 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,93724,CPT,ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM,,,4 ,,RBRVS,4.88 ,3.77 ,3.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93724,CPT,ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM,26,,4 ,,RBRVS,4.88 ,2.42 ,2.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93724,CPT,ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM,TC,,4 ,,RBRVS,,1.35 ,1.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93740,CPT,TEMPRATURE GRADIENT STUDY,,,4 ,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93740,CPT,TEMPRATURE GRADIENT STUDY,26,,4 ,,RBRVS,0.16 ,0.04 ,0.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93740,CPT,TEMPRATURE GRADIENT STUDY,TC,,4 ,,RBRVS,,0.03 ,0.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93750,CPT,INTERROGATION VAD IN PRSON W/PHYSICIAN ANALYSIS,,,4 ,,RBRVS,0.92 ,0.34 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93770,CPT,DERMINATION OF VENOUS PRESSUE,,,4 ,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93770,CPT,DERMINATION OF VENOUS PRESSUE,26,,4 ,,RBRVS,0.16 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93770,CPT,DERMINATION OF VENOUS PRESSUE,TC,,4 ,,RBRVS,,0.01 ,0.01 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,93784,CPT,AMBL BLD PRESS W/TAPE&/DISK 24/> HR ALYS I&R,,,4 ,,RBRVS,0.38 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93786,CPT,AMBL BLD PRESS W/TAPE&/DISK 24/> HR REC ONLY,,TC,4 ,,RBRVS,,0.91 ,0.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93788,CPT,AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT,,TC,4 ,,RBRVS,,0.34 ,0.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93790,CPT,AMBL BLD PRESS TAPE&/DISK 24/> HR PHYS REV W/I&R,,PC,4 ,,RBRVS,0.38 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93797,CPT,OUTPATIENT CARDIAC REHAB W/O CONT ECG MONITOR,,,4 ,,RBRVS,0.18 ,0.09 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93798,CPT,OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING,,,4 ,,RBRVS,0.28 ,0.14 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93799,CPT,UNLISTED CARDIOVASCULAR SERVICE/PROCEDURE,,,4 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,93799,CPT,UNLISTED CARDIOVASCULAR SERVICE/PROCEDURE,,PC,4 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,93799,CPT,UNLISTED CARDIOVASCULAR SERVICE/PROCEDURE,,TC,4 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,0,20120101,93880,CPT,DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,,,14 ,,RBRVS,0.60 ,6.72 ,6.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93880,CPT,DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,26,,14 ,,RBRVS,0.60 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93880,CPT,DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,TC,,14 ,,RBRVS,,6.47 ,6.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93882,CPT,DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY,,,14 ,,RBRVS,0.40 ,4.65 ,4.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93882,CPT,DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY,26,,14 ,,RBRVS,0.40 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93882,CPT,DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY,TC,,14 ,,RBRVS,,4.50 ,4.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93886,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL,,,14 ,,RBRVS,0.94 ,8.76 ,8.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93886,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL,26,,14 ,,RBRVS,0.94 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93886,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL,TC,,14 ,,RBRVS,,8.36 ,8.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93888,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD,,,14 ,,RBRVS,0.62 ,5.54 ,5.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93888,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD,26,,14 ,,RBRVS,0.62 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93888,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD,TC,,14 ,,RBRVS,,5.28 ,5.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93890,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY,,,14 ,,RBRVS,1.00 ,6.92 ,6.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93890,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY,26,,14 ,,RBRVS,1.00 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93890,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY,TC,,14 ,,RBRVS,,6.51 ,6.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93892,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT,,,14 ,,RBRVS,1.15 ,8.19 ,8.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93892,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT,26,,14 ,,RBRVS,1.15 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93892,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT,TC,,14 ,,RBRVS,,7.71 ,7.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93893,CPT,TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ,,,14 ,,RBRVS,1.15 ,8.61 ,8.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93893,CPT,TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ,26,,14 ,,RBRVS,1.15 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93893,CPT,TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ,TC,,14 ,,RBRVS,,8.12 ,8.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93922,CPT,NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL,,,14 ,,RBRVS,0.25 ,2.98 ,2.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93922,CPT,NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL,26,,14 ,,RBRVS,0.25 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93922,CPT,NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL,TC,,14 ,,RBRVS,,2.88 ,2.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93923,CPT,NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS,,,14 ,,RBRVS,0.45 ,4.53 ,4.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93923,CPT,NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS,26,,14 ,,RBRVS,0.45 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93923,CPT,NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS,TC,,14 ,,RBRVS,,4.35 ,4.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93924,CPT,N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI,,,14 ,,RBRVS,0.50 ,5.73 ,5.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93924,CPT,N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI,26,,14 ,,RBRVS,0.50 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93924,CPT,N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI,TC,,14 ,,RBRVS,,5.53 ,5.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93925,CPT,DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY,,,14 ,,RBRVS,0.58 ,8.67 ,8.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93925,CPT,DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY,26,,14 ,,RBRVS,0.58 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93925,CPT,DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY,TC,,14 ,,RBRVS,,8.44 ,8.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93926,CPT,DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY,,,14 ,,RBRVS,0.39 ,5.61 ,5.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93926,CPT,DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY,26,,14 ,,RBRVS,0.39 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93926,CPT,DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY,TC,,14 ,,RBRVS,,5.46 ,5.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93930,CPT,DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY,,,14 ,,RBRVS,0.46 ,6.83 ,6.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93930,CPT,DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY,26,,14 ,,RBRVS,0.46 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93930,CPT,DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY,TC,,14 ,,RBRVS,,6.65 ,6.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93931,CPT,DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY,,,14 ,,RBRVS,0.31 ,4.56 ,4.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93931,CPT,DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY,26,,14 ,,RBRVS,0.31 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93931,CPT,DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY,TC,,14 ,,RBRVS,,4.44 ,4.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93965,CPT,N-INVAS PHYSIOLOGIC STD XTR VEINS COMPL BI STD,,,14 ,,RBRVS,0.35 ,3.34 ,3.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93965,CPT,N-INVAS PHYSIOLOGIC STD XTR VEINS COMPL BI STD,26,,14 ,,RBRVS,0.35 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93965,CPT,N-INVAS PHYSIOLOGIC STD XTR VEINS COMPL BI STD,TC,,14 ,,RBRVS,,3.20 ,3.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93970,CPT,DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,,,14 ,,RBRVS,0.68 ,6.84 ,6.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93970,CPT,DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,26,,14 ,,RBRVS,0.68 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93970,CPT,DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,TC,,14 ,,RBRVS,,6.57 ,6.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93971,CPT,DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY,,,14 ,,RBRVS,0.45 ,4.49 ,4.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93971,CPT,DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY,26,,14 ,,RBRVS,0.45 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93971,CPT,DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY,TC,,14 ,,RBRVS,,4.31 ,4.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93975,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COMPL,,,14 ,,RBRVS,1.80 ,9.22 ,9.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93975,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COMPL,26,,14 ,,RBRVS,1.80 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93975,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COMPL,TC,,14 ,,RBRVS,,8.49 ,8.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93976,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMTD,,,14 ,,RBRVS,1.21 ,5.11 ,5.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93976,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMTD,26,,14 ,,RBRVS,1.21 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93976,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMTD,TC,,14 ,,RBRVS,,4.61 ,4.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93978,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE,,,14 ,,RBRVS,0.65 ,6.42 ,6.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93978,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE,26,,14 ,,RBRVS,0.65 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93978,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE,TC,,14 ,,RBRVS,,6.16 ,6.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93979,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD,,,14 ,,RBRVS,0.44 ,4.46 ,4.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93979,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD,26,,14 ,,RBRVS,0.44 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93979,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD,TC,,14 ,,RBRVS,,4.29 ,4.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93980,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL,,,14 ,,RBRVS,1.25 ,3.86 ,3.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93980,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL,26,,14 ,,RBRVS,1.25 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93980,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL,TC,,14 ,,RBRVS,,3.32 ,3.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93981,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD STD,,,14 ,,RBRVS,0.44 ,3.07 ,3.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93981,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD STD,26,,14 ,,RBRVS,0.44 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93981,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD STD,TC,,14 ,,RBRVS,,2.89 ,2.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,93982,CPT,IMPLANT WIRELESS PRESS SENSOR STUDY ANEURYSM SAC,,,14 ,,RBRVS,0.30 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93990,CPT,DUPLEX SCAN HEMODIALYSIS ACCESS,,,14 ,,RBRVS,0.25 ,5.90 ,5.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,93990,CPT,DUPLEX SCAN HEMODIALYSIS ACCESS,26,,14 ,,RBRVS,0.25 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,93990,CPT,DUPLEX SCAN HEMODIALYSIS ACCESS,TC,,14 ,,RBRVS,,5.81 ,5.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94002,CPT,VENTILATION ASSIST & MGMT INPATIENT 1ST DAY,,,14 ,,RBRVS,1.99 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94003,CPT,VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DAY,,,14 ,,RBRVS,1.37 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94004,CPT,VENTILATION ASSIST & MGMT NURSING FAC PR DAY,,,14 ,,RBRVS,1.00 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94005,CPT,HOME VENTILATOR MGMT CARE OVERSIGHT 30 MIN/>,,,14 ,,RBRVS,1.50 ,1.09 ,1.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94010,CPT,SPMTRY W/VC EXPIRATORY FLO +-MXML VOL VNTJ,,,14 ,,RBRVS,0.17 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94010,CPT,SPMTRY W/VC EXPIRATORY FLO +-MXML VOL VNTJ,26,,14 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94010,CPT,SPMTRY W/VC EXPIRATORY FLO +-MXML VOL VNTJ,TC,,14 ,,RBRVS,,0.78 ,0.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94011,CPT,MEAS SPIROMTRC FORCD EXPIRATORY FLO INFANT</2 YR,,,14 ,,RBRVS,2.00 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94012,CPT,MEAS SPIRO FRCD EXP FLO PRE&POST BRONCH INF </2Y,,,14 ,,RBRVS,3.10 ,1.16 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94013,CPT,MEASUREMENT LUNG VOLUMES INFANT/CHILD </2 YRS,,,14 ,,RBRVS,0.66 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94014,CPT,PT-INITIATE SPIROMETRIC RECORDING&PHYS R&I,,,14 ,,RBRVS,0.52 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94015,CPT,PATIENT-INITIATED SPIROMETRIC RECORDING,,TC,14 ,,RBRVS,,0.71 ,0.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94016,CPT,PATIENT-INITIATED SPIROMETRIC PHYS R&I ONLY,,PC,14 ,,RBRVS,0.52 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94060,CPT,BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN,,,14 ,,RBRVS,0.31 ,1.46 ,1.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94060,CPT,BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN,26,,14 ,,RBRVS,0.31 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94060,CPT,BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN,TC,,14 ,,RBRVS,,1.35 ,1.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94070,CPT,BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT,,,14 ,,RBRVS,0.60 ,1.12 ,1.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94070,CPT,BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT,26,,14 ,,RBRVS,0.60 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94070,CPT,BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT,TC,,14 ,,RBRVS,,0.91 ,0.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94150,CPT,VITAL CAPACITY TOTAL SEPARATE PROCEDURE,,,14 ,,RBRVS,0.07 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94150,CPT,VITAL CAPACITY TOTAL SEPARATE PROCEDURE,26,,14 ,,RBRVS,0.07 ,0.03 ,0.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94150,CPT,VITAL CAPACITY TOTAL SEPARATE PROCEDURE,TC,,14 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94200,CPT,MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ,,,14 ,,RBRVS,0.11 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94200,CPT,MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ,26,,14 ,,RBRVS,0.11 ,0.04 ,0.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94200,CPT,MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ,TC,,14 ,,RBRVS,,0.54 ,0.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94250,CPT,EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX,,,14 ,,RBRVS,0.11 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94250,CPT,EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX,26,,14 ,,RBRVS,0.11 ,0.04 ,0.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94250,CPT,EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX,TC,,14 ,,RBRVS,,0.58 ,0.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94375,CPT,RESPIRATORY FLOW VOLUME LOOP,,,14 ,,RBRVS,0.31 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94375,CPT,RESPIRATORY FLOW VOLUME LOOP,26,,14 ,,RBRVS,0.31 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94375,CPT,RESPIRATORY FLOW VOLUME LOOP,TC,,14 ,,RBRVS,,0.69 ,0.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94400,CPT,BREATHING RESPONSE TO CO2,,,14 ,,RBRVS,0.40 ,1.16 ,1.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94400,CPT,BREATHING RESPONSE TO CO2,26,,14 ,,RBRVS,0.40 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94400,CPT,BREATHING RESPONSE TO CO2,TC,,14 ,,RBRVS,,1.02 ,1.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94450,CPT,BREATHING RESPONSE TO HYPOXIA,,,14 ,,RBRVS,0.40 ,1.32 ,1.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94450,CPT,BREATHING RESPONSE TO HYPOXIA,26,,14 ,,RBRVS,0.40 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94450,CPT,BREATHING RESPONSE TO HYPOXIA,TC,,14 ,,RBRVS,,1.17 ,1.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94452,CPT,HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT,,,14 ,,RBRVS,0.31 ,1.36 ,1.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94452,CPT,HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT,26,,14 ,,RBRVS,0.31 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94452,CPT,HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT,TC,,14 ,,RBRVS,,1.26 ,1.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94453,CPT,HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION,,,14 ,,RBRVS,0.40 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94453,CPT,HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION,26,,14 ,,RBRVS,0.40 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94453,CPT,HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION,TC,,14 ,,RBRVS,,1.73 ,1.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94610,CPT,INTRAPULMONARY SURFACTANT ADMINISTRATION,,,14 ,,RBRVS,1.16 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94620,CPT,PULMONARY STRESS TESTING SIMPLE,,,14 ,,RBRVS,0.64 ,1.19 ,1.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94620,CPT,PULMONARY STRESS TESTING SIMPLE,26,,14 ,,RBRVS,0.64 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94620,CPT,PULMONARY STRESS TESTING SIMPLE,TC,,14 ,,RBRVS,,0.96 ,0.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94621,CPT,PULMONARY STRESS TESTING COMPLEX,,,14 ,,RBRVS,1.42 ,3.31 ,3.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94621,CPT,PULMONARY STRESS TESTING COMPLEX,26,,14 ,,RBRVS,1.42 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94621,CPT,PULMONARY STRESS TESTING COMPLEX,TC,,14 ,,RBRVS,,2.76 ,2.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94640,CPT,PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT,,,14 ,,RBRVS,,0.46 ,0.46 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,94642,CPT,PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH,,,14 ,,TotalUnits,,,,1.43 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,94644,CPT,CONTINUOUS INHALATION TREATMENT 1ST HR,,,14 ,,RBRVS,,1.17 ,1.17 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,94645,CPT,CONTINUOUS INHALATION TREATMENT EA ADDL HR,,,14 ,,RBRVS,,0.42 ,0.42 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,94660,CPT,CPAP VENTILATION CPAP INITIATION&MGMT,,,14 ,,RBRVS,0.76 ,0.27 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94662,CPT,CONTINUOUS NEGATIVE PRESSURE VENTJ INITIAT&MGMT,,,14 ,,RBRVS,0.76 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94664,CPT,DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IPPB,,,14 ,,RBRVS,,0.46 ,0.46 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,94667,CPT,MANJ CH WALL FACILITATE LNG FUNCJ 1 DEMO&/EVAL,,,14 ,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,94668,CPT,MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ,,,14 ,,RBRVS,,0.63 ,0.63 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,94680,CPT,O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMPLE,,,14 ,,RBRVS,0.26 ,1.45 ,1.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94680,CPT,O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMPLE,26,,14 ,,RBRVS,0.26 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94680,CPT,O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMPLE,TC,,14 ,,RBRVS,,1.35 ,1.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94681,CPT,O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC,,,14 ,,RBRVS,0.20 ,1.46 ,1.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94681,CPT,O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC,26,,14 ,,RBRVS,0.20 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94681,CPT,O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC,TC,,14 ,,RBRVS,,1.39 ,1.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94690,CPT,O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX,,,14 ,,RBRVS,0.07 ,1.43 ,1.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94690,CPT,O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX,26,,14 ,,RBRVS,0.07 ,0.03 ,0.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94690,CPT,O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX,TC,,14 ,,RBRVS,,1.40 ,1.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94726,CPT,PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST,,,14 ,,RBRVS,0.26 ,1.29 ,1.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94726,CPT,PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST,26,,14 ,,RBRVS,0.26 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94726,CPT,PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST,TC,,14 ,,RBRVS,,1.20 ,1.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94727,CPT,GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL,,,14 ,,RBRVS,0.26 ,0.96 ,0.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94727,CPT,GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL,26,,14 ,,RBRVS,0.26 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94727,CPT,GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL,TC,,14 ,,RBRVS,,0.87 ,0.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94728,CPT,AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY,,,14 ,,RBRVS,0.26 ,0.96 ,0.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94728,CPT,AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY,26,,14 ,,RBRVS,0.26 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94728,CPT,AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY,TC,,14 ,,RBRVS,,0.87 ,0.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94729,CPT,DIFFUSING CAPACITY,,,14 ,,RBRVS,0.17 ,1.38 ,1.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94729,CPT,DIFFUSING CAPACITY,26,,14 ,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94729,CPT,DIFFUSING CAPACITY,TC,,14 ,,RBRVS,,1.32 ,1.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94750,CPT,PULMONARY COMPLIANCE STUDY,,,14 ,,RBRVS,0.23 ,2.04 ,2.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94750,CPT,PULMONARY COMPLIANCE STUDY,26,,14 ,,RBRVS,0.23 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94750,CPT,PULMONARY COMPLIANCE STUDY,TC,,14 ,,RBRVS,,1.96 ,1.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94760,CPT,NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER,,TC,14 ,,RBRVS,,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,94761,CPT,NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER,,TC,14 ,,RBRVS,,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,94762,CPT,NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR,,TC,14 ,,RBRVS,,0.58 ,0.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94770,CPT,CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER,,,14 ,,RBRVS,0.15 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,94770,CPT,CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER,26,,14 ,,RBRVS,0.15 ,0.04 ,0.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,94770,CPT,CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER,TC,,14 ,,RBRVS,,0.74 ,0.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94772,CPT,CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT,,,14 ,,TotalUnits,,,,3.43 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,94772,CPT,CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT,26,,14 ,,TotalUnits,,,,1.37 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,94772,CPT,CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT,TC,,14 ,,TotalUnits,,,,2.06 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,94774,CPT,PEDIATRIC APNEA MONITOR ATTACHMENT PHYS I&R,,,14 ,,TotalUnits,,,,2.71 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,94776,CPT,PEDIATRIC APNEA MONITOR ANALYSES COMPUTER,,TC,14 ,,TotalUnits,,,,1.72 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,94777,CPT,PEDIATRIC APNEA MONITOR PHYSICIAN REVIEW,,PC,14 ,,TotalUnits,,,,1.50 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,94780,CPT,CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN,,,14 ,,RBRVS,0.48 ,0.18 ,0.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94781,CPT,CAR SEAT/BED TESTNG W/INTERP & REPORT +30MIN,,,14 ,,RBRVS,0.17 ,0.06 ,0.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,94799,CPT,UNLISTED PULMONARY SERVICE/PROCEDURE,,,14 ,,TotalUnits,,,,1.16 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,94799,CPT,UNLISTED PULMONARY SERVICE/PROCEDURE,,PC,14 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,94799,CPT,UNLISTED PULMONARY SERVICE/PROCEDURE,,TC,14 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,0,20120101,95004,CPT,PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS,,,2 ,,RBRVS,0.01 ,0.17 ,0.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95010,CPT,PERQ TSTS SEQL&INCRL RX/BIOLOGIC/VNM IMMT RXN,,,2 ,,RBRVS,0.15 ,0.38 ,0.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95012,CPT,NITRIC OXIDE EXPIRED GAS DETERMINATION,,,2 ,,RBRVS,,0.60 ,0.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95015,CPT,IQ TSTS SEQL&INCRL RX/BIOLOGIC/VNM IMMT RXN,,,2 ,,RBRVS,0.15 ,0.07 ,0.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95024,CPT,INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS,,,2 ,,RBRVS,0.01 ,0.20 ,0.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95027,CPT,INTRACUTANEOUS TESTS W/ALLERGENIC XTRCS AIRBORNE,,,2 ,,RBRVS,0.01 ,0.12 ,0.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95028,CPT,IQ TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING,,TC,2 ,,RBRVS,,0.36 ,0.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95044,CPT,PATCH/APPLICATION TEST SPECIFY NUMBER TESTS,,,2 ,,RBRVS,,0.17 ,0.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95052,CPT,PHOTO PATCH TEST SPECIFY NUMBER TSTS,,,2 ,,RBRVS,,0.20 ,0.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95056,CPT,PHOTO TESTS,,,2 ,,RBRVS,,1.19 ,1.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95060,CPT,OPHTHALMIC MUCOUS MEMBRANE TESTS,,TC,2 ,,RBRVS,,0.83 ,0.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95065,CPT,DIRECT NASAL MUCOUS MEMBRANE TEST,,TC,2 ,,RBRVS,,0.71 ,0.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95070,CPT,INHLJ BRNCL CHALLENGE TSTG W/HISTAM/METHACHOL,,TC,2 ,,RBRVS,,1.11 ,1.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95071,CPT,INHLJ BRNCL CHALLENGE TSTG W/AGS/GASES,,TC,2 ,,RBRVS,,1.49 ,1.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95075,CPT,INGESTION CHALLENGE TEST,,,2 ,,RBRVS,0.95 ,0.42 ,0.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95115,CPT,PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX,,,1 ,,RBRVS,,0.29 ,0.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95117,CPT,PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS,,,1 ,,RBRVS,,0.36 ,0.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95120,CPT,PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX,,,1 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,95125,CPT,PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJXS,,,1 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,95130,CPT,PROF SVCS ALLG IMMNTX W/PRV XTRC 1 STING INSECT,,,1 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,95131,CPT,PROF SVCS ALLG IMMNTX W/PRV XTRC 2 STING INSECT,,,1 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,95132,CPT,PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 3 INSECT,,,1 ,,TotalUnits,,,,0.94 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,95133,CPT,PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 4 INSECT,,,1 ,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,95134,CPT,PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 5 INSECT,,,1 ,,TotalUnits,,,,1.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,95144,CPT,PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DOSE,,,1 ,,RBRVS,0.06 ,0.03 ,0.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95145,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT,,,1 ,,RBRVS,0.06 ,0.03 ,0.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95146,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECTS,,,1 ,,RBRVS,0.06 ,0.03 ,0.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95147,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 3 INSECTS,,,1 ,,RBRVS,0.06 ,0.03 ,0.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95148,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECTS,,,1 ,,RBRVS,0.06 ,0.03 ,1.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95149,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECTS,,,1 ,,RBRVS,0.06 ,0.03 ,1.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95165,CPT,PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN,,,1 ,,RBRVS,0.06 ,0.03 ,0.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95170,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSECT,,,1 ,,RBRVS,0.06 ,0.03 ,0.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95180,CPT,RAPID DESENSITIZATION PROCEDURE EACH HOUR,,,1 ,,RBRVS,2.01 ,1.02 ,2.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95199,CPT,UNLISTED ALLERGY/CLINICAL IMMUNOLOGIC SRVC/PX,,,1 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,95250,CPT,GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID,,TC,14 ,,RBRVS,,4.35 ,4.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95251,CPT,GLUC MNTR CONT REC FROM NTRSTL TISS FLU I&R,,PC,14 ,,RBRVS,0.85 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95800,CPT,SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME,,,14 ,,RBRVS,1.05 ,4.95 ,4.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95800,CPT,SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME,26,,14 ,,RBRVS,1.05 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95800,CPT,SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME,TC,,14 ,,RBRVS,,4.33 ,4.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95801,CPT,SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL,,,14 ,,RBRVS,1.00 ,1.80 ,1.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95801,CPT,SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL,26,,14 ,,RBRVS,1.00 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95801,CPT,SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL,TC,,14 ,,RBRVS,,1.33 ,1.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95803,CPT,ACTIGRAPHY TESTING RECORDING ANALYSIS I&R,,,14 ,,RBRVS,0.90 ,3.83 ,3.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95803,CPT,ACTIGRAPHY TESTING RECORDING ANALYSIS I&R,26,,14 ,,RBRVS,0.90 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95803,CPT,ACTIGRAPHY TESTING RECORDING ANALYSIS I&R,TC,,14 ,,RBRVS,,3.39 ,3.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95805,CPT,MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG,,,14 ,,RBRVS,1.20 ,10.80 ,10.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95805,CPT,MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG,26,,14 ,,RBRVS,1.20 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95805,CPT,MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG,TC,,14 ,,RBRVS,,10.22 ,10.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95806,CPT,SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATTN,,,14 ,,RBRVS,1.25 ,4.03 ,4.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95806,CPT,SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATTN,26,,14 ,,RBRVS,1.25 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95806,CPT,SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATTN,TC,,14 ,,RBRVS,,3.48 ,3.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95807,CPT,SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN,,,14 ,,RBRVS,1.28 ,12.40 ,12.40 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95807,CPT,SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN,26,,14 ,,RBRVS,1.28 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95807,CPT,SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN,TC,,14 ,,RBRVS,,11.87 ,11.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95808,CPT,POLYSOMNOGRAPHY SLEEP STAGING 1-3 ADDL PARAM,,,14 ,,RBRVS,1.74 ,17.21 ,17.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95808,CPT,POLYSOMNOGRAPHY SLEEP STAGING 1-3 ADDL PARAM,26,,14 ,,RBRVS,1.74 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95808,CPT,POLYSOMNOGRAPHY SLEEP STAGING 1-3 ADDL PARAM,TC,,14 ,,RBRVS,,16.37 ,16.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95810,CPT,POLYSOMNOGRAPHY SLEEP STAGING 4/> ADDL PARAM,,,14 ,,RBRVS,2.50 ,17.72 ,17.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95810,CPT,POLYSOMNOGRAPHY SLEEP STAGING 4/> ADDL PARAM,26,,14 ,,RBRVS,2.50 ,1.09 ,1.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95810,CPT,POLYSOMNOGRAPHY SLEEP STAGING 4/> ADDL PARAM,TC,,14 ,,RBRVS,,16.63 ,16.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95811,CPT,POLYSM SLEEP STAGING 4/> ADDL PARAM W/CPAP TX,,,14 ,,RBRVS,2.60 ,19.22 ,19.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95811,CPT,POLYSM SLEEP STAGING 4/> ADDL PARAM W/CPAP TX,26,,14 ,,RBRVS,2.60 ,1.15 ,1.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95811,CPT,POLYSM SLEEP STAGING 4/> ADDL PARAM W/CPAP TX,TC,,14 ,,RBRVS,,18.07 ,18.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95812,CPT,ELECTROENCEPHALOGRAM EXTND MNTR 41-60 MIN,,,14 ,,RBRVS,1.08 ,8.12 ,8.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95812,CPT,ELECTROENCEPHALOGRAM EXTND MNTR 41-60 MIN,26,,14 ,,RBRVS,1.08 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95812,CPT,ELECTROENCEPHALOGRAM EXTND MNTR 41-60 MIN,TC,,14 ,,RBRVS,,7.65 ,7.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95813,CPT,ELECTROENCEPHALOGRAM EXTND MNTR > 1 HR,,,14 ,,RBRVS,1.73 ,8.61 ,8.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95813,CPT,ELECTROENCEPHALOGRAM EXTND MNTR > 1 HR,26,,14 ,,RBRVS,1.73 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95813,CPT,ELECTROENCEPHALOGRAM EXTND MNTR > 1 HR,TC,,14 ,,RBRVS,,7.87 ,7.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95816,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY,,,14 ,,RBRVS,1.08 ,7.43 ,7.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95816,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY,26,,14 ,,RBRVS,1.08 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95816,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY,TC,,14 ,,RBRVS,,6.95 ,6.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95819,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP,,,14 ,,RBRVS,1.08 ,8.43 ,8.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95819,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP,26,,14 ,,RBRVS,1.08 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95819,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP,TC,,14 ,,RBRVS,,7.95 ,7.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95822,CPT,ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY,,,14 ,,RBRVS,1.08 ,7.81 ,7.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95822,CPT,ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY,26,,14 ,,RBRVS,1.08 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95822,CPT,ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY,TC,,14 ,,RBRVS,,7.33 ,7.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95824,CPT,ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY,,,14 ,,TotalUnits,,,,7.40 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,95824,CPT,ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY,26,,14 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,95824,CPT,ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY,TC,,14 ,,TotalUnits,,,,6.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,95827,CPT,ELECTROENCEPHALOGRAM ALL NIGHT RECORDING,,,14 ,,RBRVS,1.08 ,15.25 ,15.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95827,CPT,ELECTROENCEPHALOGRAM ALL NIGHT RECORDING,26,,14 ,,RBRVS,1.08 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95827,CPT,ELECTROENCEPHALOGRAM ALL NIGHT RECORDING,TC,,14 ,,RBRVS,,14.78 ,14.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95829,CPT,ELECTROCORTICOGRAM SURGERY SPX,,,14 ,,RBRVS,6.20 ,37.55 ,37.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95829,CPT,ELECTROCORTICOGRAM SURGERY SPX,26,,14 ,,RBRVS,6.20 ,2.74 ,2.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95829,CPT,ELECTROCORTICOGRAM SURGERY SPX,TC,,14 ,,RBRVS,,34.81 ,34.81 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,95830,CPT,INSERTION SPHENOIDAL ELECTRODES EEG RECORDING,,,14 ,,RBRVS,1.70 ,0.70 ,3.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95831,CPT,MUSC TSTG MNL W/REPRT XTR EX HAND/TRNK,,,14 ,,RBRVS,0.28 ,0.13 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95832,CPT,MUSC TSTG MNL W/REPRT HAND W/WO CMPRSN NRML SIDE,,,14 ,,RBRVS,0.29 ,0.14 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95833,CPT,MUSC TSTG MNL W/REPRT TOTAL EVAL BODY EX HANDS,,,14 ,,RBRVS,0.47 ,0.18 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95834,CPT,MUSC TSTG MNL W/REPRT TOTAL EVAL BODY W/HANDS,,,14 ,,RBRVS,0.60 ,0.24 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95851,CPT,ROM MEAS&REPRT EA XTR EX HAND/EA TRNK SCTJ SPINE,,,14 ,,RBRVS,0.16 ,0.06 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95852,CPT,ROM MEAS&REPRT HAND W/WO COMPARISON NORMAL SIDE,,,14 ,,RBRVS,0.11 ,0.05 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95857,CPT,CHOLINESTERASE INHIBITOR CHALLENGE TEST,,,14 ,,RBRVS,0.53 ,0.27 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95860,CPT,NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS,,,14 ,,RBRVS,0.96 ,1.66 ,1.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95860,CPT,NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS,26,,14 ,,RBRVS,0.96 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95860,CPT,NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS,TC,,14 ,,RBRVS,,1.19 ,1.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95861,CPT,NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS,,,14 ,,RBRVS,1.54 ,2.26 ,2.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95861,CPT,NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS,26,,14 ,,RBRVS,1.54 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95861,CPT,NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS,TC,,14 ,,RBRVS,,1.52 ,1.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95863,CPT,NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS,,,14 ,,RBRVS,1.87 ,2.71 ,2.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95863,CPT,NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS,26,,14 ,,RBRVS,1.87 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95863,CPT,NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS,TC,,14 ,,RBRVS,,1.85 ,1.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95864,CPT,NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS,,,14 ,,RBRVS,1.99 ,3.05 ,3.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95864,CPT,NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS,26,,14 ,,RBRVS,1.99 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95864,CPT,NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS,TC,,14 ,,RBRVS,,2.12 ,2.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95865,CPT,NEEDLE ELECTROMYOGRAPHY LARYNX,,,14 ,,RBRVS,1.57 ,1.90 ,1.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95865,CPT,NEEDLE ELECTROMYOGRAPHY LARYNX,26,,14 ,,RBRVS,1.57 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95865,CPT,NEEDLE ELECTROMYOGRAPHY LARYNX,TC,,14 ,,RBRVS,,1.12 ,1.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95866,CPT,NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM,,,14 ,,RBRVS,1.25 ,1.74 ,1.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95866,CPT,NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM,26,,14 ,,RBRVS,1.25 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95866,CPT,NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM,TC,,14 ,,RBRVS,,1.16 ,1.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95867,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI,,,14 ,,RBRVS,0.79 ,1.53 ,1.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95867,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI,26,,14 ,,RBRVS,0.79 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95867,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI,TC,,14 ,,RBRVS,,1.15 ,1.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95868,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI,,,14 ,,RBRVS,1.18 ,1.97 ,1.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95868,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI,26,,14 ,,RBRVS,1.18 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95868,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI,TC,,14 ,,RBRVS,,1.42 ,1.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95869,CPT,NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12,,,14 ,,RBRVS,0.37 ,1.33 ,1.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95869,CPT,NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12,26,,14 ,,RBRVS,0.37 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95869,CPT,NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12,TC,,14 ,,RBRVS,,1.15 ,1.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95870,CPT,NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI,,,14 ,,RBRVS,0.37 ,1.29 ,1.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95870,CPT,NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI,26,,14 ,,RBRVS,0.37 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95870,CPT,NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI,TC,,14 ,,RBRVS,,1.12 ,1.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95872,CPT,NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER,,,14 ,,RBRVS,2.88 ,2.23 ,2.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95872,CPT,NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER,26,,14 ,,RBRVS,2.88 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95872,CPT,NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER,TC,,14 ,,RBRVS,,1.02 ,1.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95873,CPT,ELECTRICAL STIMULATION GUID W/CHEMODENERVATION,,,14 ,,RBRVS,0.37 ,1.32 ,1.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95873,CPT,ELECTRICAL STIMULATION GUID W/CHEMODENERVATION,26,,14 ,,RBRVS,0.37 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95873,CPT,ELECTRICAL STIMULATION GUID W/CHEMODENERVATION,TC,,14 ,,RBRVS,,1.12 ,1.12 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,95874,CPT,NEEDLE EMG GUID W/CHEMODENERVATION,,,14 ,,RBRVS,0.37 ,1.24 ,1.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95874,CPT,NEEDLE EMG GUID W/CHEMODENERVATION,26,,14 ,,RBRVS,0.37 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95874,CPT,NEEDLE EMG GUID W/CHEMODENERVATION,TC,,14 ,,RBRVS,,1.06 ,1.06 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,95875,CPT,ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB,,,14 ,,RBRVS,1.10 ,1.93 ,1.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95875,CPT,ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB,26,,14 ,,RBRVS,1.10 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95875,CPT,ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB,TC,,14 ,,RBRVS,,1.44 ,1.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95885,CPT,NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED,,,14 ,,RBRVS,0.35 ,1.27 ,1.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95885,CPT,NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED,26,,14 ,,RBRVS,0.35 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95885,CPT,NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED,TC,,14 ,,RBRVS,,1.11 ,1.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95886,CPT,NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE,,,14 ,,RBRVS,0.92 ,1.61 ,1.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95886,CPT,NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE,26,,14 ,,RBRVS,0.92 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95886,CPT,NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE,TC,,14 ,,RBRVS,,1.17 ,1.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95887,CPT,NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION,,,14 ,,RBRVS,0.73 ,1.53 ,1.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95887,CPT,NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION,26,,14 ,,RBRVS,0.73 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95887,CPT,NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION,TC,,14 ,,RBRVS,,1.19 ,1.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95900,CPT,NRV CNDJ AMPLT&LATNCY EA NRV MOTR W/O F-WAVE STD,,,14 ,,RBRVS,0.42 ,1.33 ,1.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95900,CPT,NRV CNDJ AMPLT&LATNCY EA NRV MOTR W/O F-WAVE STD,26,,14 ,,RBRVS,0.42 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95900,CPT,NRV CNDJ AMPLT&LATNCY EA NRV MOTR W/O F-WAVE STD,TC,,14 ,,RBRVS,,1.13 ,1.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95903,CPT,NRV CNDJ AMPLT&LATENCY EA NRV MOTOR W/F-WAVE STD,,,14 ,,RBRVS,0.60 ,1.41 ,1.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95903,CPT,NRV CNDJ AMPLT&LATENCY EA NRV MOTOR W/F-WAVE STD,26,,14 ,,RBRVS,0.60 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95903,CPT,NRV CNDJ AMPLT&LATENCY EA NRV MOTOR W/F-WAVE STD,TC,,14 ,,RBRVS,,1.14 ,1.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95904,CPT,NRV CNDJ AMPLITUDE & LATENCY EACH NERVE SENSORY,,,14 ,,RBRVS,0.34 ,1.20 ,1.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95904,CPT,NRV CNDJ AMPLITUDE & LATENCY EACH NERVE SENSORY,26,,14 ,,RBRVS,0.34 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95904,CPT,NRV CNDJ AMPLITUDE & LATENCY EACH NERVE SENSORY,TC,,14 ,,RBRVS,,1.04 ,1.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95905,CPT,MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB,,,14 ,,RBRVS,0.05 ,2.41 ,2.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95905,CPT,MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB,26,,14 ,,RBRVS,0.05 ,0.03 ,0.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95905,CPT,MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB,TC,,14 ,,RBRVS,,2.38 ,2.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95920,CPT,INTRAOP NEUROPHYSIOLOGY TSTG PR HR,,,14 ,,RBRVS,2.11 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95920,CPT,INTRAOP NEUROPHYSIOLOGY TSTG PR HR,26,,14 ,,RBRVS,2.11 ,0.95 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95920,CPT,INTRAOP NEUROPHYSIOLOGY TSTG PR HR,TC,,14 ,,RBRVS,,1.51 ,1.51 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,95921,CPT,TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP,,,14 ,,RBRVS,0.90 ,1.41 ,1.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95921,CPT,TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP,26,,14 ,,RBRVS,0.90 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95921,CPT,TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP,TC,,14 ,,RBRVS,,1.03 ,1.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95922,CPT,TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ,,,14 ,,RBRVS,0.96 ,1.90 ,1.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95922,CPT,TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ,26,,14 ,,RBRVS,0.96 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95922,CPT,TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ,TC,,14 ,,RBRVS,,1.49 ,1.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95923,CPT,TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION,,,14 ,,RBRVS,0.90 ,3.31 ,3.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95923,CPT,TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION,26,,14 ,,RBRVS,0.90 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95923,CPT,TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION,TC,,14 ,,RBRVS,,2.91 ,2.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95925,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS,,,14 ,,RBRVS,0.54 ,4.05 ,4.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95925,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS,26,,14 ,,RBRVS,0.54 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95925,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS,TC,,14 ,,RBRVS,,3.81 ,3.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95926,CPT,SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS,,,14 ,,RBRVS,0.54 ,3.89 ,3.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95926,CPT,SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS,26,,14 ,,RBRVS,0.54 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95926,CPT,SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS,TC,,14 ,,RBRVS,,3.65 ,3.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95927,CPT,SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD,,,14 ,,RBRVS,0.54 ,3.63 ,3.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95927,CPT,SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD,26,,14 ,,RBRVS,0.54 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95927,CPT,SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD,TC,,14 ,,RBRVS,,3.38 ,3.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95928,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS,,,14 ,,RBRVS,1.50 ,5.28 ,5.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95928,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS,26,,14 ,,RBRVS,1.50 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95928,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS,TC,,14 ,,RBRVS,,4.62 ,4.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95929,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS,,,14 ,,RBRVS,1.50 ,5.69 ,5.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95929,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS,26,,14 ,,RBRVS,1.50 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95929,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS,TC,,14 ,,RBRVS,,5.02 ,5.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95930,CPT,VISUAL EP TSTG CNS CHECKERBOARD/FLASH,,,14 ,,RBRVS,0.35 ,3.55 ,3.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95930,CPT,VISUAL EP TSTG CNS CHECKERBOARD/FLASH,26,,14 ,,RBRVS,0.35 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95930,CPT,VISUAL EP TSTG CNS CHECKERBOARD/FLASH,TC,,14 ,,RBRVS,,3.39 ,3.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95933,CPT,ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST,,,14 ,,RBRVS,0.59 ,1.55 ,1.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95933,CPT,ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST,26,,14 ,,RBRVS,0.59 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95933,CPT,ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST,TC,,14 ,,RBRVS,,1.28 ,1.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95934,CPT,H-REFLEX AMPLT&LATENCY GASTRCN/SOLEUS MUSC,,,14 ,,RBRVS,0.51 ,1.12 ,1.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95934,CPT,H-REFLEX AMPLT&LATENCY GASTRCN/SOLEUS MUSC,26,,14 ,,RBRVS,0.51 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95934,CPT,H-REFLEX AMPLT&LATENCY GASTRCN/SOLEUS MUSC,TC,,14 ,,RBRVS,,0.88 ,0.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95936,CPT,H-REFLEX AMPLT&LATENCY OTH/THN GASTRCN/SOLEUS,,,14 ,,RBRVS,0.55 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95936,CPT,H-REFLEX AMPLT&LATENCY OTH/THN GASTRCN/SOLEUS,26,,14 ,,RBRVS,0.55 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95936,CPT,H-REFLEX AMPLT&LATENCY OTH/THN GASTRCN/SOLEUS,TC,,14 ,,RBRVS,,0.54 ,0.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95937,CPT,NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH,,,14 ,,RBRVS,0.65 ,1.20 ,1.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95937,CPT,NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH,26,,14 ,,RBRVS,0.65 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95937,CPT,NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH,TC,,14 ,,RBRVS,,0.91 ,0.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95938,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMBS,,,14 ,,RBRVS,0.86 ,7.76 ,7.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95938,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMBS,26,,14 ,,RBRVS,0.86 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95938,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMBS,TC,,14 ,,RBRVS,,7.38 ,7.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95939,CPT,CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LIMB,,,14 ,,RBRVS,2.25 ,11.20 ,11.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95939,CPT,CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LIMB,26,,14 ,,RBRVS,2.25 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95939,CPT,CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LIMB,TC,,14 ,,RBRVS,,10.19 ,10.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95950,CPT,MONITOR ID& LATERALIZATION SEIZURE FOCUS EEG,,,14 ,,RBRVS,1.51 ,6.35 ,6.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95950,CPT,MONITOR ID& LATERALIZATION SEIZURE FOCUS EEG,26,,14 ,,RBRVS,1.51 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95950,CPT,MONITOR ID& LATERALIZATION SEIZURE FOCUS EEG,TC,,14 ,,RBRVS,,5.69 ,5.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95951,CPT,LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO,,,14 ,,TotalUnits,,,,15.42 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,95951,CPT,LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO,26,,14 ,,TotalUnits,,,,8.64 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,95951,CPT,LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO,TC,,14 ,,TotalUnits,,,,6.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,95953,CPT,LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG,,,14 ,,RBRVS,3.08 ,8.89 ,8.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95953,CPT,LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG,26,,14 ,,RBRVS,3.08 ,1.39 ,1.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95953,CPT,LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG,TC,,14 ,,RBRVS,,7.50 ,7.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95954,CPT,RX/PHYSICAL ACTIVAJ PHYS ATTN DURING EEG ACTIVAJ,,,14 ,,RBRVS,2.45 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95954,CPT,RX/PHYSICAL ACTIVAJ PHYS ATTN DURING EEG ACTIVAJ,26,,14 ,,RBRVS,2.45 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95954,CPT,RX/PHYSICAL ACTIVAJ PHYS ATTN DURING EEG ACTIVAJ,TC,,14 ,,RBRVS,,5.74 ,5.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95955,CPT,EEG NONINTRACRANIAL SURGERY,,,14 ,,RBRVS,1.01 ,3.88 ,3.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95955,CPT,EEG NONINTRACRANIAL SURGERY,26,,14 ,,RBRVS,1.01 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95955,CPT,EEG NONINTRACRANIAL SURGERY,TC,,14 ,,RBRVS,,3.45 ,3.45 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,95956,CPT,MNTR SEIZURE CMPTR 16>CHAN EEG ATND EA 24 HR,,,14 ,,RBRVS,3.61 ,25.78 ,25.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95956,CPT,MNTR SEIZURE CMPTR 16>CHAN EEG ATND EA 24 HR,26,,14 ,,RBRVS,3.61 ,1.45 ,1.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95956,CPT,MNTR SEIZURE CMPTR 16>CHAN EEG ATND EA 24 HR,TC,,14 ,,RBRVS,,24.33 ,24.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95957,CPT,DIGITAL ANALYSIS ELECTROENCEPHALOGRAM,,,14 ,,RBRVS,1.98 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95957,CPT,DIGITAL ANALYSIS ELECTROENCEPHALOGRAM,26,,14 ,,RBRVS,1.98 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95957,CPT,DIGITAL ANALYSIS ELECTROENCEPHALOGRAM,TC,,14 ,,RBRVS,,7.01 ,7.01 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,95958,CPT,WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG,,,14 ,,RBRVS,4.24 ,8.85 ,8.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95958,CPT,WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG,26,,14 ,,RBRVS,4.24 ,1.84 ,1.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95958,CPT,WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG,TC,,14 ,,RBRVS,,7.01 ,7.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95961,CPT,FUNCJAL CORT&SUBCORT MAPG ELTRDS 1 HR PHYS ATTN,,,14 ,,RBRVS,2.97 ,4.27 ,4.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95961,CPT,FUNCJAL CORT&SUBCORT MAPG ELTRDS 1 HR PHYS ATTN,26,,14 ,,RBRVS,2.97 ,1.36 ,1.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95961,CPT,FUNCJAL CORT&SUBCORT MAPG ELTRDS 1 HR PHYS ATTN,TC,,14 ,,RBRVS,,2.91 ,2.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95962,CPT,FUNCJAL CORT&SUBCORT MAPG ELTRDS EA HR PHYS ATTN,,,14 ,,RBRVS,3.21 ,3.29 ,3.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95962,CPT,FUNCJAL CORT&SUBCORT MAPG ELTRDS EA HR PHYS ATTN,26,,14 ,,RBRVS,3.21 ,1.43 ,1.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95962,CPT,FUNCJAL CORT&SUBCORT MAPG ELTRDS EA HR PHYS ATTN,TC,,14 ,,RBRVS,,1.86 ,1.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95965,CPT,MAGNETOENCEPHALOGRAPHY SPON BRAIN ACTIVITY,,,14 ,,RBRVS,7.99 ,50.58 ,50.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95965,CPT,MAGNETOENCEPHALOGRAPHY SPON BRAIN ACTIVITY,26,,14 ,,RBRVS,7.99 ,3.69 ,3.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95965,CPT,MAGNETOENCEPHALOGRAPHY SPON BRAIN ACTIVITY,TC,,14 ,,RBRVS,,46.89 ,46.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95966,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS 1 MODALITY,,,14 ,,RBRVS,3.99 ,25.26 ,25.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95966,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS 1 MODALITY,26,,14 ,,RBRVS,3.99 ,1.85 ,1.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95966,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS 1 MODALITY,TC,,14 ,,RBRVS,,23.41 ,23.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95967,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS EACH ADDL,,,14 ,,RBRVS,3.49 ,21.85 ,21.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,95967,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS EACH ADDL,26,,14 ,,RBRVS,3.49 ,1.56 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95967,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS EACH ADDL,TC,,14 ,,RBRVS,,20.29 ,20.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,95970,CPT,ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM,,,14 ,,RBRVS,0.45 ,0.19 ,1.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95971,CPT,ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG,,,14 ,,RBRVS,0.78 ,0.33 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95972,CPT,ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR,,,14 ,,RBRVS,1.50 ,0.64 ,1.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95973,CPT,ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH EA 30 MIN,,,14 ,,RBRVS,0.92 ,0.39 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95974,CPT,ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV 1ST HR,,,14 ,,RBRVS,3.00 ,1.28 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95975,CPT,ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV EA 30 MIN,,,14 ,,RBRVS,1.70 ,0.75 ,1.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95978,CPT,ELEC ALYS NSTIM PLS GEN CPLX DP BRN 1ST HR,,,14 ,,RBRVS,3.50 ,1.56 ,2.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95979,CPT,ELEC ALYS NSTIM PLS GEN CPLX DP BRN EA 30 MIN,,,14 ,,RBRVS,1.64 ,0.73 ,1.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95980,CPT,ELEC ALYS NSTIM PLS GEN GASTRIC INTRAOP W/PRGRMG,,,14 ,,RBRVS,0.80 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95981,CPT,ELEC ALYS NSTIM GEN GASTRIC SBSQ W/O REPRGRMG,,,14 ,,RBRVS,0.30 ,0.17 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95982,CPT,ELEC ALYS NSTIM PLS GEN GASTRIC SBSQ W/REPRGRMG,,,14 ,,RBRVS,0.65 ,0.30 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95990,CPT,REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN,,,14 ,,RBRVS,,2.19 ,2.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95991,CPT,RFL&MAIN IMPLT PMP/RSVR RX DLVR SPI/BRN BY PHYS,,,14 ,,RBRVS,0.77 ,0.29 ,2.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95992,CPT,CANALITH REPOSITIONING PROCEDURE,,,14 ,,RBRVS,0.75 ,0.32 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,95999,CPT,UNLIS NEUROLOGICAL/NEUROMUSCULAR DX PX,,,14 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,96000,CPT,COMPRE CPTR MTN ALYS VIDEO TAPING 3-D KINEMATICS,,,14 ,,RBRVS,1.80 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,96001,CPT,COMPRE CPTR MTN ALYS W/DYN PLNTR PRES MEAS WALKG,,,14 ,,RBRVS,2.15 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,96002,CPT,DYN SURF EMG WALKG/FUNCJAL ACTV 1-12 MUSC,,,14 ,,RBRVS,0.41 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,96003,CPT,DYN FINE WIRE EMG WALKG/FUNCJAL ACTV 1 MUSC,,,14 ,,RBRVS,0.37 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,96004,CPT,PHYS R&I CPTR MTN ALYS WALKG/FUNCJAL ACTV REPRT,,PC,14 ,,RBRVS,2.14 ,1.00 ,1.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,96020,CPT,TEST SELECTION & ADMN FUNCTIONAL BRAIN MAPPING,26,,14 ,,TotalUnits,,,,4.88 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,96040,CPT,MEDICAL GENETICS COUNSELING EACH 30 MINUTES,,,14 ,,RBRVS,,1.29 ,1.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,96101,CPT,PSYCHOLOGICAL TESTING PR HR WITH PATIENT,,,16 ,,RBRVS,1.86 ,0.40 ,0.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96102,CPT,PSYCHOLOGICAL TESTING ADMN BY TECH PR HR,,,16 ,,RBRVS,0.50 ,0.16 ,1.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96103,CPT,PSYCHOLOGICAL TESTING COMPUTER W/PROF I&R,,,16 ,,RBRVS,0.51 ,0.18 ,1.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96105,CPT,ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR,,,16 ,,RBRVS,1.75 ,1.35 ,1.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96110,CPT,DEVELOPMENTAL SCREENING W/INTERP&REPRT STD FORM,,,16 ,,RBRVS,,0.23 ,0.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96111,CPT,DEVELOPMENTAL TESTING W/INTERP & REPORT,,,16 ,,RBRVS,2.60 ,0.79 ,0.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96116,CPT,NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ,,,16 ,,RBRVS,1.86 ,0.56 ,0.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96118,CPT,NUROPSYC TESTING PR HR W/PT & INTERPJ TIME,,,16 ,,RBRVS,1.86 ,0.38 ,0.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96119,CPT,NUROPSYC TSTG WPROF I&R ADMN BY TECH PR HR,,,16 ,,RBRVS,0.55 ,0.12 ,1.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96120,CPT,NEUROPSYCHOLOG TESTING COMPUTER W/PROF I&R,,,16 ,,RBRVS,0.51 ,0.17 ,1.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96125,CPT,STANDARDIZED COGNITIVE PERFORMANCE TESTING,,,16 ,,RBRVS,1.70 ,0.99 ,0.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96150,CPT,HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT 1ST ASSMT,,,16 ,,RBRVS,0.50 ,0.10 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,96151,CPT,HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT RE-ASSMT,,,16 ,,RBRVS,0.48 ,0.10 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,96152,CPT,HLTH&BEHAVIOR IVNTJ EA 15 MIN INDIV,,,16 ,,RBRVS,0.46 ,0.09 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,96153,CPT,HLTH&BEHAVIOR IVNTJ EA 15 MIN GRP 2/> PTS,,,16 ,,RBRVS,0.10 ,0.02 ,0.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,96154,CPT,HLTH&BEHAVIOR IVNTJ EA 15 MIN FAM W/PT,,,16 ,,RBRVS,0.45 ,0.09 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,96155,CPT,HLTH&BEHAVIOR IVNTJ EA 15 MIN FAM W/O PT,,,16 ,,RBRVS,0.44 ,0.19 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,96360,CPT,IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,,,22 ,,RBRVS,0.17 ,1.48 ,1.48 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,96361,CPT,IV INFUSION HYDRATION EACH ADDITIONAL HOUR,,,22 ,,RBRVS,0.09 ,0.35 ,0.35 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,96365,CPT,IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR,,,22 ,,RBRVS,0.21 ,1.85 ,1.85 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,96366,CPT,IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR,,,22 ,,RBRVS,0.18 ,0.45 ,0.45 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,96367,CPT,IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR,,,22 ,,RBRVS,0.19 ,0.77 ,0.77 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,96368,CPT,IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS,,,22 ,,RBRVS,0.17 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,0,0,1,20120101,96369,CPT,SUBCUTANEOUS INFUSION INITIAL 1 HR W/PUMP SET-UP,,,22 ,,RBRVS,0.21 ,4.79 ,4.79 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,96370,CPT,SUBCUTANEOUS INFUSION EACH ADDITIONAL HOUR,,,22 ,,RBRVS,0.18 ,0.26 ,0.26 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,96371,CPT,SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE,,,22 ,,RBRVS,,2.35 ,2.35 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,96372,CPT,THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM,,,22 ,,RBRVS,0.17 ,0.50 ,0.50 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,96373,CPT,THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL,,,22 ,,RBRVS,0.17 ,0.38 ,0.38 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,96374,CPT,THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG,,,22 ,,RBRVS,0.18 ,1.43 ,1.43 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,96375,CPT,THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG,,,22 ,,RBRVS,0.10 ,0.56 ,0.56 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,96376,CPT,THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC,,,22 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,0,1,0,0,1,20120101,96379,CPT,UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,,,22 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,96401,CPT,CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO,,,14 ,,RBRVS,0.21 ,1.89 ,1.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96402,CPT,CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO,,,14 ,,RBRVS,0.19 ,0.83 ,0.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96405,CPT,CHEMOTHERAPY ADMINISTRATION INTRALESIONAL </7,,,14 ,,RBRVS,0.52 ,0.34 ,1.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96406,CPT,CHEMOTHERAPY ADMINISTRATION INTRALESIONAL > 7,,,14 ,,RBRVS,0.80 ,0.45 ,2.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96409,CPT,CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG,,,14 ,,RBRVS,0.24 ,3.03 ,3.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96411,CPT,CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG,,,14 ,,RBRVS,0.20 ,1.63 ,1.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96413,CPT,CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG,,,14 ,,RBRVS,0.28 ,3.98 ,3.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96415,CPT,CHEMOTHERAPY ADMN IV INFUSION TQ EA HR,,,14 ,,RBRVS,0.19 ,0.72 ,0.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96416,CPT,CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP,,,14 ,,RBRVS,0.21 ,4.47 ,4.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96417,CPT,CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR,,,14 ,,RBRVS,0.21 ,1.89 ,1.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96420,CPT,CHEMOTHERAPY ADMIN INTRA-ARTERIAL PUSH TQ,,,14 ,,RBRVS,0.17 ,2.96 ,2.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96422,CPT,CHEMOTHERAPY ADMIN INTRA-ARTERIAL INFUS </1 HR,,,14 ,,RBRVS,0.17 ,4.91 ,4.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96423,CPT,CHEMOTHERAPY ADMN INTRAARTERIAL INFUSION EA HR,,,14 ,,RBRVS,0.17 ,2.14 ,2.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96425,CPT,CHEMOTX ADMN IA NFS > 8 HR PRTBLE IMPLTBL PMP,,,14 ,,RBRVS,0.17 ,5.02 ,5.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96440,CPT,CHEMOTX ADMN PLEURAL CAVITY REQ&W/THORACNTS,,,14 ,,RBRVS,2.37 ,1.45 ,18.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96446,CPT,CHEMOTX ADMN PRTL CAVITY PORT/CATH,,,14 ,,RBRVS,0.37 ,0.19 ,4.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96450,CPT,CHEMOTX ADMN CNS REQ SPINAL PUNCTURE,,,14 ,,RBRVS,1.53 ,0.88 ,4.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96521,CPT,REFILLING & MAINTENANCE PORTABLE PUMP,,,14 ,,RBRVS,0.21 ,3.66 ,3.66 ,,,$0.00,$0.00,1,1,1,1,1,1,20120101,96522,CPT,REFILL&MAINTENANCE PUMP DRUG DLVR SYSTEMIC,,,14 ,,RBRVS,0.21 ,3.01 ,3.01 ,,,$0.00,$0.00,1,1,1,1,1,1,20120101,96523,CPT,IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST,,,14 ,,RBRVS,0.04 ,0.70 ,0.70 ,,,$0.00,$0.00,1,1,1,1,1,1,20120101,96542,CPT,CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT,,,14 ,,RBRVS,0.75 ,0.50 ,2.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96549,CPT,UNLISTED CHEMOTHERAPY PROCEDURE,,,14 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,96567,CPT,PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX,,,14 ,,RBRVS,,3.84 ,3.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96570,CPT,PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX 30 MIN,,,14 ,,RBRVS,1.10 ,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96571,CPT,PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX A 15 MIN,,,14 ,,RBRVS,0.55 ,0.21 ,0.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96900,CPT,ACTINOTHERAPY ULTRAVIOLET LIGHT,,,14 ,,RBRVS,,0.60 ,0.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96902,CPT,MCRSCP XM HAIR PLUCK/CLIP FOR CNTS/STRUCT ABNORM,,,14 ,,RBRVS,0.41 ,0.18 ,0.20 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,96904,CPT,WHOLE BODY INTEGUMENTARY PHOTOGRAPHY,,,14 ,,RBRVS,,1.99 ,1.99 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,96910,CPT,PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB,,,14 ,,RBRVS,,2.03 ,2.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96912,CPT,PHOTOCHEMOTX PSORALENS&ULTRAVIOLET PUVA,,,14 ,,RBRVS,,2.61 ,2.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96913,CPT,PHOTOCHEMOTHERAPY DERMATOSES 4-8 HRS SUPERVISION,,,14 ,,RBRVS,,3.63 ,3.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96920,CPT,LASER SKIN DISEASE PSORIASIS TOT AREA <250 SQ CM,,,14 ,,RBRVS,1.15 ,0.79 ,3.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96921,CPT,LASER SKIN DISEASE PSORIASIS 250-500 SQ CM,,,14 ,,RBRVS,1.17 ,0.76 ,3.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96922,CPT,LASER SKIN DISEASE PSORIASIS >500 SQ CM,,,14 ,,RBRVS,2.10 ,1.38 ,5.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,96999,CPT,UNLISTED SPECIAL DERMATOLOGICAL SERVICE/PROCED,,,14 ,,TotalUnits,,,,2.03 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,97001,CPT,PHYSICAL THERAPY EVALUATION,,,19 ,,RBRVS,1.20 ,0.88 ,0.88 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97002,CPT,PHYSICAL THERAPY RE-EVALUATION,,,19 ,,RBRVS,0.60 ,0.55 ,0.55 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97003,CPT,OCCUPATIONAL THERAPY EVALUATION,,,19 ,,RBRVS,1.20 ,1.10 ,1.10 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97004,CPT,OCCUPATIONAL THERAPY RE-EVALUATION,,,19 ,,RBRVS,0.60 ,0.80 ,0.80 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97005,CPT,ATHLETIC TRAINING EVALUATION,,,19 ,,TotalUnits,,,,1.67 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,97006,CPT,ATHLETIC TRAINING RE-EVALUATION,,,19 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,97010,CPT,APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS,,,19 ,,RBRVS,0.06 ,0.09 ,0.09 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97012,CPT,APPL MODALITY 1/> AREAS TRACTION MECHANICAL,,,19 ,,RBRVS,0.25 ,0.19 ,0.19 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97014,CPT,APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED,,,19 ,,RBRVS,0.18 ,0.24 ,0.24 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97016,CPT,APPL MODALITY 1/> AREAS VASOPNEUMATIC DEVICES,,,19 ,,RBRVS,0.18 ,0.32 ,0.32 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97018,CPT,APPL MODALITY 1/> AREAS PARAFFIN BATH,,,19 ,,RBRVS,0.06 ,0.21 ,0.21 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97022,CPT,APPLICATION MODALITY 1/> AREAS WHIRLPOOL,,,19 ,,RBRVS,0.17 ,0.42 ,0.42 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97024,CPT,APPLICATION MODALITY 1/> AREAS DIATHERMY,,,19 ,,RBRVS,0.06 ,0.11 ,0.11 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97026,CPT,APPLICATION MODALITY 1/> AREAS INFRARED,,,19 ,,RBRVS,0.06 ,0.09 ,0.09 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97028,CPT,APPL MODALITY 1/> AREAS ULTRAVIOLET,,,19 ,,RBRVS,0.08 ,0.11 ,0.11 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97032,CPT,APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN,,,19 ,,RBRVS,0.25 ,0.26 ,0.26 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97033,CPT,APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN,,,19 ,,RBRVS,0.26 ,0.56 ,0.56 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97034,CPT,APPL MODALITY 1/> AREAS CONTRAST BATHS EA 15 MIN,,,19 ,,RBRVS,0.21 ,0.26 ,0.26 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97035,CPT,APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN,,,19 ,,RBRVS,0.21 ,0.13 ,0.13 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97036,CPT,APPL MODALITY 1/> AREAS HUBBARD TANK EA 15 MIN,,,19 ,,RBRVS,0.28 ,0.57 ,0.57 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97039,CPT,UNLIST MODALITY SPEC TYPE&TIME CONSTANT ATTENDCE,,,19 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,97110,CPT,THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES,,,19 ,,RBRVS,0.45 ,0.41 ,0.41 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97112,CPT,THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCAJ,,,19 ,,RBRVS,0.45 ,0.45 ,0.45 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97113,CPT,THER PX 1/> AREAS EACH 15 MIN AQUA THER W/XERSS,,,19 ,,RBRVS,0.44 ,0.69 ,0.69 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97116,CPT,THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR,,,19 ,,RBRVS,0.40 ,0.36 ,0.36 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97124,CPT,THER PX 1/> AREAS EACH 15 MINUTES MASSAGE,,,19 ,,RBRVS,0.35 ,0.35 ,0.35 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97139,CPT,UNLISTED THERAPEUTIC PROCEDURE SPECIFY,,,19 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,97140,CPT,MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES,,,19 ,,RBRVS,0.43 ,0.38 ,0.38 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97150,CPT,THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS,,,19 ,,RBRVS,0.27 ,0.28 ,0.28 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97530,CPT,THER ACTV DIR PT CONTACT BY PROVIDER EACH 15 MIN,,,19 ,,RBRVS,0.44 ,0.50 ,0.50 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97532,CPT,DEVELOPMENT OF COGNITIVE SKILLS EACH 15 MINUTES,,,19 ,,RBRVS,0.44 ,0.29 ,0.29 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97533,CPT,SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES,,,19 ,,RBRVS,0.44 ,0.36 ,0.36 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97535,CPT,SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES,,,19 ,,RBRVS,0.45 ,0.49 ,0.49 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97537,CPT,COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN,,,19 ,,RBRVS,0.45 ,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97542,CPT,WHEELCHAIR MGMT EA 15 MIN,,,19 ,,RBRVS,0.45 ,0.38 ,0.38 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97545,CPT,WORK HARDENING/CONDITIONING 1ST 2 HR,,,19 ,,TotalUnits,,,,3.05 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,97546,CPT,WORK HARDENING/CONDITIONING EACH HOUR,,,19 ,,TotalUnits,,,,1.21 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,97597,CPT,DEBRIDEMENT OPEN WOUND 20 SQ CM/<,,,14 ,,RBRVS,0.51 ,0.15 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,97598,CPT,DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM,,,14 ,,RBRVS,0.24 ,0.07 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,97602,CPT,RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS,,,14 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,97605,CPT,NEGATIVE PRESSURE WOUND THERAPY </EQUAL 50 SQ CM,,,14 ,,RBRVS,0.55 ,0.17 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,97606,CPT,NEGATIVE PRESSURE WOUND THERAPY > 50 SQ CM,,,14 ,,RBRVS,0.60 ,0.18 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,97750,CPT,PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN,,,19 ,,RBRVS,0.45 ,0.44 ,0.44 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97755,CPT,ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN,,,19 ,,RBRVS,0.62 ,0.36 ,0.36 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97760,CPT,ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15 MIN,,,19 ,,RBRVS,0.45 ,0.55 ,0.55 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97761,CPT,PROSTHETIC TRAINING UPPR&/LOWER EXTREM EA 15 MIN,,,19 ,,RBRVS,0.45 ,0.43 ,0.43 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97762,CPT,CHECKOUT ORTHOTIC/PROSTHETIC ESTAB PT EA 15 MIN,,,19 ,,RBRVS,0.25 ,0.93 ,0.93 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,97799,CPT,UNLISTED PHYSICAL MEDICINE/REHAB SERVICE/PROC,,,19 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,97802,CPT,MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MIN,,,14 ,,RBRVS,0.53 ,0.32 ,0.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,97803,CPT,MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 MIN,,,14 ,,RBRVS,0.45 ,0.28 ,0.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,97804,CPT,MEDICAL NUTRITION THERAPY GRP2/> INDIV EA 30 MIN,,,14 ,,RBRVS,0.25 ,0.15 ,0.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,97810,CPT,ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN,,,14 ,,RBRVS,0.60 ,0.26 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,97811,CPT,ACUPUNCTURE 1/> NDLS W/O ELEC STIMJ EA 15 MIN,,,14 ,,RBRVS,0.50 ,0.21 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,97813,CPT,ACUPUNCTURE 1/> NDLS W/ELEC STIMJ 1ST 15 MIN,,,14 ,,RBRVS,0.65 ,0.28 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,97814,CPT,ACUP 1/> NDLS W/ELEC STIMJ EA 15 MIN W/RE-INSJ,,,14 ,,RBRVS,0.55 ,0.24 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,98925,CPT,OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS,,,19 ,,RBRVS,0.45 ,0.18 ,0.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,98926,CPT,OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS,,,19 ,,RBRVS,0.65 ,0.26 ,0.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,98927,CPT,OSTEOPATHIC MANIPULATIVE TX 5-6 BODY REGIONS,,,19 ,,RBRVS,0.87 ,0.33 ,0.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,98928,CPT,OSTEOPATHIC MANIPULATIVE TX 7-8 BODY REGIONS,,,19 ,,RBRVS,1.03 ,0.38 ,0.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,98929,CPT,OSTEOPATHIC MANIPULATIVE TX 9-10 BODY REGIONS,,,19 ,,RBRVS,1.19 ,0.45 ,0.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,98940,CPT,CHIROPRACTIC MANIPULATIVE TX SPINAL 1-2 REGIONS,,,5 ,,RBRVS,0.45 ,0.15 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,98941,CPT,CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS,,,5 ,,RBRVS,0.65 ,0.23 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,98942,CPT,CHIROPRACTIC MANIPULATIVE TX SPINAL 5 REGIONS,,,5 ,,RBRVS,0.87 ,0.30 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,98943,CPT,CHIROPRACTIC MANIPLTV TX EXTRASPINAL 1/> REGIONS,,,5 ,,RBRVS,0.40 ,0.17 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,98960,CPT,EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT,,,14 ,,RBRVS,,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,98961,CPT,EDUCATION&TRAINING SELF-MGMT NONPHYS 2-4 PTS,,,14 ,,RBRVS,,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,98962,CPT,EDUCATION&TRAINING SELF-MGMT NONPHYS 5-8 PTS,,,14 ,,RBRVS,,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,98966,CPT,NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN,,,15 ,,RBRVS,0.25 ,0.10 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,98967,CPT,NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN,,,15 ,,RBRVS,0.50 ,0.21 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,98968,CPT,NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN,,,15 ,,RBRVS,0.75 ,0.32 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,98969,CPT,NONPHYSICIAN ONLINE ASSESSMENT AND MANAGEMENT,,,15 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99000,CPT,HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB,,,14 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,99001,CPT,HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB,,,14 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,99002,CPT,HANDLING CONVEY/ANY OTH SVC INVG DEV FIT BY PHYS,,,14 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,99024,CPT,POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX,,,14 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99026,CPT,HOSPITAL MANDATED CALL SERVICE IN-HOSPITAL EA HR,,,14 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99027,CPT,HOSPITAL MANDATED CALL SVC OUT-OF-HOSPITAL EA HR,,,14 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99050,CPT,SERVICES PROVIDED OFFICE OTH/THN REG SCHED HOURS,,,15 ,,TotalUnits,,,,1.05 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99051,CPT,SVC PRV OFFICE REG SCHEDD EVN WKEND/HOLIDAY HRS,,,15 ,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99053,CPT,SERVICES PROVIDED BTW 10 PM&8 AM AT 24-HR FACIL,,,15 ,,TotalUnits,,,,1.24 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99056,CPT,SVC TYPICAL PRV OFFICE PRV OUT OFFICE REQUEST PT,,,15 ,,TotalUnits,,,,1.00 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99058,CPT,SVC PRV EMER BASIS IN OFFICE DISRUPTING SVCS,,,15 ,,TotalUnits,,,,1.25 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99060,CPT,SVC PRV EMER OUT OFFICE DISRUPTS OFFICE SVC,,,15 ,,TotalUnits,,,,1.40 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99070,CPT,SUPPLIES&MATERIALS PRV BY PHYS >&ABOVE,,,14 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,99071,CPT,EDUCATIONAL SUPPLIES PRV BY THE PHYS AT COST,,,14 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,99075,CPT,MEDICAL TESTIMONY,,,14 ,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99078,CPT,PHYS EDUCATIONAL SVCS RENDERED PTS GRP SETTING,,,14 ,,TotalUnits,,,,1.42 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99080,CPT,SPEC REPORTS > USUAL MED COMUNICAJ/STAND RPRTG,,,14 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99082,CPT,UNUSUAL TRAVEL,,,14 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99090,CPT,ANALYSIS CLINICAL DATA STORED IN COMPUTERS,,,14 ,,TotalUnits,,,,1.00 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99091,CPT,COLLJ&INTERPJ PHYSIO DATA DIG STRD/TRANS 30 MIN,,,14 ,,RBRVS,1.10 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99100,CPT,ANESTHESIA EXTREME AGE PATIENT UNDER 1 YR&> 70,,,14 ,,TotalUnits,,,,1.05 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99116,CPT,ANES COMPLICJ UTILIZATION TOTAL BODY HYPOTHERMIA,,,14 ,,TotalUnits,,,,2.80 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99135,CPT,ANES COMPLICJ UTILIZATION CONTROLLED HYPOTENSION,,,14 ,,TotalUnits,,,,5.06 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99140,CPT,ANES COMPLICJ EMERGENCY CONDITIONS SPECIFY,,,14 ,,TotalUnits,,,,1.75 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99143,CPT,MODERATE SEDATION PHYS PERF DX/THER SVC < 5 YRS,,,14 ,,TotalUnits,,,,1.75 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99144,CPT,MODERATE SEDATION PHYS PERF DX/THER SVC 5/> YRS,,,14 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99145,CPT,MODERAT SEDATION PHYS PERF DX/THER SVC EA 15 MIN,,,14 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99148,CPT,MOD SEDATJ PHYS OTH/THN PERF DX/THER SVC <5 YRS,,,14 ,,TotalUnits,,,,1.60 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99149,CPT,MOD SEDATJ PHYS OTH/THN PERF DX/THER SVC 5/> YRS,,,14 ,,TotalUnits,,,,1.31 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99150,CPT,MOD SEDATJ PHY OTH/THN PER DX/THER SVC EA 15 MIN,,,14 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99170,CPT,ANOGENITAL XM W/COLPOSCOPY CHILD/SUSPECT TRAUMA,,,14 ,,RBRVS,1.75 ,0.91 ,2.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99172,CPT,VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM,,,23 ,,TotalUnits,,,,1.28 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,99172,CPT,VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM,,PC,23 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,99172,CPT,VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM,,TC,23 ,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,1,0,0,1,0,20120101,99173,CPT,SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT,,,23 ,,RBRVS,,0.07 ,0.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,99174,CPT,OCULAR PHOTOSCREENING INTERPRETATION BILATERAL,,,23 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,99174,CPT,OCULAR PHOTOSCREENING INTERPRETATION BILATERAL,,PC,23 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,99174,CPT,OCULAR PHOTOSCREENING INTERPRETATION BILATERAL,,TC,23 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,0,20120101,99175,CPT,IPECAC/SIMILAR ADMN EMESIS&OBS STOMACH EMPTIED,,,14 ,,RBRVS,,0.71 ,0.71 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,99183,CPT,PHYS ATTN&SUPVJ HYPRBARIC OXYGEN THER PR SESS,,,14 ,,RBRVS,2.34 ,0.89 ,3.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99190,CPT,ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH EA HR,,,14 ,,TotalUnits,,,,14.56 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,99191,CPT,ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH 45 MIN,,,14 ,,TotalUnits,,,,10.20 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,99192,CPT,ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH 30 MIN,,,14 ,,TotalUnits,,,,7.28 ,,$0.00,$0.00,1,0,1,0,1,1,20120101,99195,CPT,PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE,,,14 ,,RBRVS,,2.49 ,2.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,99199,CPT,UNLISTED SPECIAL SERVICE PROCEDURE/REPORT,,,14 ,,TotalUnits,,,,2.49 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,99201,CPT,OFFICE OUTPATIENT NEW 10 MINUTES,,,15 ,,RBRVS,0.48 ,0.24 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99202,CPT,OFFICE OUTPATIENT NEW 20 MINUTES,,,15 ,,RBRVS,0.93 ,0.44 ,1.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99203,CPT,OFFICE OUTPATIENT NEW 30 MINUTES,,,15 ,,RBRVS,1.42 ,0.64 ,1.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99204,CPT,OFFICE OUTPATIENT NEW 45 MINUTES,,,15 ,,RBRVS,2.43 ,1.06 ,2.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99205,CPT,OFFICE OUTPATIENT NEW 60 MINUTES,,,15 ,,RBRVS,3.17 ,1.34 ,2.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99211,CPT,OFFICE OUTPATIENT VISIT 5 MINUTES,,,15 ,,RBRVS,0.18 ,0.08 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99212,CPT,OFFICE OUTPATIENT VISIT 10 MINUTES,,,15 ,,RBRVS,0.48 ,0.22 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99213,CPT,OFFICE OUTPATIENT VISIT 15 MINUTES,,,15 ,,RBRVS,0.97 ,0.41 ,0.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99214,CPT,OFFICE OUTPATIENT VISIT 25 MINUTES,,,15 ,,RBRVS,1.50 ,0.63 ,1.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99215,CPT,OFFICE OUTPATIENT VISIT 40 MINUTES,,,15 ,,RBRVS,2.11 ,0.90 ,1.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99217,CPT,OBSERVATION CARE DISCHARGE MANAGEMENT,,,10 ,,RBRVS,1.28 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99218,CPT,INITIAL OBSERVATION CARE/DAY LOW SEVERITY,,,10 ,,RBRVS,1.28 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99219,CPT,INITIAL OBSERVATION CARE/DAY MODERATE SEVERITY,,,10 ,,RBRVS,2.14 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99220,CPT,INITIAL OBSERVATION CARE/DAY HIGH SEVERITY,,,10 ,,RBRVS,2.99 ,1.23 ,1.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99221,CPT,INITIAL HOSPITAL CARE/DAY 30 MINUTES,,,10 ,,RBRVS,1.92 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99222,CPT,INITIAL HOSPITAL CARE/DAY 50 MINUTES,,,10 ,,RBRVS,2.61 ,1.06 ,1.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99223,CPT,INITIAL HOSPITAL CARE/DAY 70 MINUTES,,,10 ,,RBRVS,3.86 ,1.56 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99224,CPT,SBSQ OBSERVATION CARE/DAY LOW SEVERITY,,,10 ,,RBRVS,0.54 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99225,CPT,SBSQ OBSERVATION CARE/DAY MODERATE SEVERITY,,,10 ,,RBRVS,0.96 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99226,CPT,SBSQ OBSERVATION CARE/DAY HIGH SEVERITY,,,10 ,,RBRVS,1.44 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99231,CPT,SBSQ HOSPITAL CARE/DAY 15 MINUTES,,,10 ,,RBRVS,0.76 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99232,CPT,SBSQ HOSPITAL CARE/DAY 25 MINUTES,,,10 ,,RBRVS,1.39 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99233,CPT,SBSQ HOSPITAL CARE/DAY 35 MINUTES,,,10 ,,RBRVS,2.00 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99234,CPT,OBSERVATION/INPATIENT HOSPITAL CARE LOW SEVERITY,,,10 ,,RBRVS,2.56 ,1.09 ,1.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99235,CPT,OBSERVATION/INPATIENT HOSPITAL CARE MOD SEVERITY,,,10 ,,RBRVS,3.41 ,1.43 ,1.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99236,CPT,OBSERVATION/INPATIENT HOSPITAL CARE HI SEVERITY,,,10 ,,RBRVS,4.26 ,1.75 ,1.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99238,CPT,HOSPITAL DISCHARGE DAY MANAGEMENT 30 MIN/<,,,10 ,,RBRVS,1.28 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99239,CPT,HOSPITAL DISCHARGE DAY MANAGEMENT > 30 MIN,,,10 ,,RBRVS,1.90 ,0.97 ,0.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99241,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN,,,6 ,,RBRVS,0.64 ,0.24 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99242,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN,,,6 ,,RBRVS,1.34 ,0.51 ,1.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99243,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN,,,6 ,,RBRVS,1.88 ,0.71 ,1.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99244,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN,,,6 ,,RBRVS,3.02 ,1.14 ,1.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99245,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN,,,6 ,,RBRVS,3.77 ,1.38 ,2.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99251,CPT,INITL INPATIENT CONSULT NEW/ESTAB PT 20 MIN,,,6 ,,RBRVS,1.00 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99252,CPT,INITL INPATIENT CONSULT NEW/ESTAB PT 40 MIN,,,6 ,,RBRVS,1.50 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99253,CPT,INITL INPATIENT CONSULT NEW/ESTAB PT 55 MIN,,,6 ,,RBRVS,2.27 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99254,CPT,INITL INPATIENT CONSULT NEW/ESTAB PT 80 MIN,,,6 ,,RBRVS,3.29 ,1.23 ,1.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99255,CPT,INITIAL INPATIENT CONSULT NEW/ESTAB PT 110 MIN,,,6 ,,RBRVS,4.00 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99281,CPT,EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB,,,7 ,,RBRVS,0.45 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99282,CPT,EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY,,,7 ,,RBRVS,0.88 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99283,CPT,EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY,,,7 ,,RBRVS,1.34 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99284,CPT,EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY,,,7 ,,RBRVS,2.56 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99285,CPT,EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ,,,7 ,,RBRVS,3.80 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99288,CPT,PHYSICIAN DIRECTION EMERGENCY MEDICAL SYSTEMS,,,7 ,,TotalUnits,,,,1.53 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99291,CPT,CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN,,,10 ,,RBRVS,4.50 ,1.55 ,2.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99292,CPT,CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN,,,10 ,,RBRVS,2.25 ,0.78 ,1.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99304,CPT,INITIAL NURSING FACILITY CARE/DAY LOW SEVERITY,,,10 ,,RBRVS,1.64 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99305,CPT,INITIAL NURSING FACILITY CARE/DAY MODER SEVERITY,,,10 ,,RBRVS,2.35 ,1.09 ,1.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99306,CPT,INITIAL NURSING FACILITY CARE/DAY HIGH SEVERITY,,,10 ,,RBRVS,3.06 ,1.34 ,1.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99307,CPT,SBSQ NURSING FACILITY CARE/DAY E/M STABLE 10 MIN,,,10 ,,RBRVS,0.76 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99308,CPT,SBSQ NURSING FACIL CARE/DAY MINOR COMPLJ 15 MIN,,,10 ,,RBRVS,1.16 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99309,CPT,SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 25 MIN,,,10 ,,RBRVS,1.55 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99310,CPT,SBSQ NURS FACIL CARE/DAY UNSTABL/NEW PROB 35 MIN,,,10 ,,RBRVS,2.35 ,1.23 ,1.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99315,CPT,NURSING FACILITY DISCHARGE MANAGEMENT 30 MIN/<,,,10 ,,RBRVS,1.13 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99316,CPT,NURSING FACILITY DISCHARGE MANAGEMENT > 30 MIN,,,10 ,,RBRVS,1.50 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99318,CPT,E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN,,,10 ,,RBRVS,1.71 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99324,CPT,DOMICIL/REST HOME NEW PT VISIT LOW SEVER 20 MIN,,,15 ,,RBRVS,1.01 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99325,CPT,DOMICIL/REST HOME NEW PT VISIT MOD SEVER 30 MIN,,,15 ,,RBRVS,1.52 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99326,CPT,DOMICIL/REST HOME NEW PT HI-MOD SEVER 45 MIN,,,15 ,,RBRVS,2.63 ,1.18 ,1.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99327,CPT,DOMICIL/REST HOME NEW PT VISIT HI SEVER 60 MIN,,,15 ,,RBRVS,3.46 ,1.54 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99328,CPT,DOM/R-HOME E/M NEW PT SIGNIFICANT NEW PROBLEM,,,15 ,,RBRVS,4.09 ,1.77 ,1.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99334,CPT,DOM/R-HOME E/M EST PT SELF-LMTD/MINOR,,,15 ,,RBRVS,1.07 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99335,CPT,DOM/R-HOME E/M EST PT LW MOD SEVERITY,,,15 ,,RBRVS,1.72 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99336,CPT,DOM/R-HOME E/M EST PT MOD HI SEVERITY,,,15 ,,RBRVS,2.46 ,1.15 ,1.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99337,CPT,DOM/R-HOME E/M EST PT SIGNIFICANT NEW PROBLEM,,,15 ,,RBRVS,3.58 ,1.59 ,1.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99339,CPT,INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 15-29 MIN,,,15 ,,RBRVS,1.25 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99340,CPT,INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 30 MIN/>,,,15 ,,RBRVS,1.80 ,1.22 ,1.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99341,CPT,HOME VISIT NEW PATIENT LOW SEVERITY 20 MIN,,,15 ,,RBRVS,1.01 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99342,CPT,HOME VISIT NEW PATIENT MOD SEVERITY 30 MIN,,,15 ,,RBRVS,1.52 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99343,CPT,HOME VST NEW PATIENT MOD-HI SEVERITY 45 MIN,,,15 ,,RBRVS,2.53 ,1.11 ,1.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99344,CPT,HOME VISIT NEW PATIENT HI SEVERITY60 MIN,,,15 ,,RBRVS,3.38 ,1.53 ,1.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99345,CPT,HOME VISIT NEW PT UNSTABL/SIGNIF NEW PROB 75 MIN,,,15 ,,RBRVS,4.09 ,1.81 ,1.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99347,CPT,HOME VISIT EST PT SELF LIMITED/MINOR 15 MIN,,,15 ,,RBRVS,1.00 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99348,CPT,HOME VISIT EST PT LOW-MOD SEVERITY 25 MIN,,,15 ,,RBRVS,1.56 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99349,CPT,HOME VISIT EST PT MOD-HI SEVERITY 40 MIN,,,15 ,,RBRVS,2.33 ,1.11 ,1.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99350,CPT,HOME VST EST PT UNSTABLE/SIGNIFICANT NEW PROBLEM,,,15 ,,RBRVS,3.28 ,1.49 ,1.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99354,CPT,PROLNG SVC OFFICE O/P DIR CONTACT 1ST HR,,,15 ,,RBRVS,1.77 ,0.75 ,0.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99355,CPT,PROLNG SVC OFFICE O/P DIR CONTACT EA 30 MIN,,,15 ,,RBRVS,1.77 ,0.72 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99356,CPT,PROLONGED SERVICE I/P REQ UNIT/FLOOR TIME 1ST HR,,,10 ,,RBRVS,1.71 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99357,CPT,PROLONGED SVC I/P REQ UNIT/FLOOR TIME EA 30 MIN,,,10 ,,RBRVS,1.71 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99358,CPT,PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR,,,15 ,,RBRVS,2.10 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99359,CPT,PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MIN,,,15 ,,RBRVS,1.00 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99360,CPT,PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MIN,,,14 ,,RBRVS,1.20 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99363,CPT,ANTICOAGULANT MGMT OUTPATIENT INIT 90 DAYS,,,14 ,,RBRVS,1.65 ,0.70 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99364,CPT,ANTICOAGULANT MGMT OUTPATIENT EA SBSQ 90 DAYS,,,14 ,,RBRVS,0.63 ,0.27 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99366,CPT,TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN,,,15 ,,RBRVS,0.82 ,0.35 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99367,CPT,TEAM CONFERENCE NON-FACE-TO-FACE PHYSICIAN,,,15 ,,RBRVS,1.10 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99368,CPT,TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN,,,15 ,,RBRVS,0.72 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99374,CPT,PHYS SUPVJ PT HOME HLTH AGENCY MO 15-29 MINUTES,,,15 ,,RBRVS,1.10 ,0.47 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99375,CPT,PHYS SUPVJ PT HOME HLTH AGENCY MO 30 MIN/>,,,15 ,,RBRVS,1.73 ,0.88 ,1.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99377,CPT,PHYS SUPVJ HOSPICE PT MO 15-29 MIN,,,15 ,,RBRVS,1.10 ,0.47 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99378,CPT,PHYS SUPVJ HOSPICE PT MO 30 MIN/>,,,15 ,,RBRVS,1.73 ,0.94 ,1.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99379,CPT,PHYS SUPVJ NF PT MO 15-29 MIN,,,15 ,,RBRVS,1.10 ,0.47 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99380,CPT,PHYS SUPVJ NF PT MO 30 MIN/>,,,15 ,,RBRVS,1.73 ,0.75 ,1.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99381,CPT,INITIAL PREVENTIVE MEDICINE NEW PATIENT < 1YR,,,24 ,,RBRVS,1.19 ,0.51 ,1.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99382,CPT,INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS,,,24 ,,RBRVS,1.36 ,0.59 ,1.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99383,CPT,INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS,,,18 ,,RBRVS,1.36 ,0.59 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99384,CPT,INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR,,,18 ,,RBRVS,1.53 ,0.66 ,1.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99385,CPT,INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS,,,18 ,,RBRVS,1.53 ,0.66 ,1.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99386,CPT,INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS,,,18 ,,RBRVS,1.88 ,0.81 ,1.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99387,CPT,INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>,,,18 ,,RBRVS,2.06 ,0.89 ,1.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99391,CPT,PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1YR,,,24 ,,RBRVS,1.02 ,0.44 ,1.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99392,CPT,PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS,,,24 ,,RBRVS,1.19 ,0.51 ,1.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99393,CPT,PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS,,,18 ,,RBRVS,1.19 ,0.51 ,1.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99394,CPT,PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS,,,18 ,,RBRVS,1.36 ,0.59 ,1.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99395,CPT,PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS,,,18 ,,RBRVS,1.36 ,0.59 ,1.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99396,CPT,PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS,,,18 ,,RBRVS,1.53 ,0.66 ,1.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99397,CPT,PERIODIC PREVENTIVE MED EST PATIENT 65YRS&>,,,18 ,,RBRVS,1.71 ,0.74 ,1.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99401,CPT,PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 15 MIN,,,18 ,,RBRVS,0.48 ,0.21 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99402,CPT,PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 MIN,,,18 ,,RBRVS,0.98 ,0.42 ,0.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99403,CPT,PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN,,,18 ,,RBRVS,1.46 ,0.63 ,0.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99404,CPT,PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN,,,18 ,,RBRVS,1.95 ,0.84 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99406,CPT,TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES,,,14 ,,RBRVS,0.24 ,0.10 ,0.15 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,99407,CPT,TOBACCO USE CESSATION INTENSIVE >10 MINUTES,,,14 ,,RBRVS,0.50 ,0.20 ,0.25 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,99408,CPT,ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN,,,16 ,,RBRVS,0.65 ,0.28 ,0.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,99409,CPT,ALCOHOL/SUBSTANCE SCREEN & INTERVEN >30 MIN,,,16 ,,RBRVS,1.30 ,0.55 ,0.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,99411,CPT,PREV MED COUNSEL&RISK FACTOR REDJ GRP SPX 30 MIN,,,18 ,,RBRVS,0.15 ,0.06 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99412,CPT,PREV MED COUNSEL&RISK FACTOR REDJ GRP SPX 60 MIN,,,18 ,,RBRVS,0.25 ,0.11 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99420,CPT,ADMN&INTERPJ HEALTH RISK ASSESSMENT INSTRUMENT,,,18 ,,RBRVS,,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99429,CPT,UNLISTED PREVENTIVE MEDICINE SERVICE,,,18 ,,TotalUnits,,,,0.99 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99441,CPT,PHYSICIAN TELEPHONE EVALUATION 5-10 MIN,,,15 ,,RBRVS,0.25 ,0.10 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99442,CPT,PHYSICIAN TELEPHONE EVALUATION 11-20 MIN,,,15 ,,RBRVS,0.50 ,0.21 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99443,CPT,PHYSICIAN TELEPHONE EVALUATION 21-30 MIN,,,15 ,,RBRVS,0.75 ,0.32 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99444,CPT,PHYSICIAN ONLINE EVALUATION & MANAGEMENT SERVICE,,,15 ,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99450,CPT,BASIC LIFE AND/OR DISABILITY EXAMINATION,,,14 ,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99455,CPT,WORK RELATED/MED DBLT XM TREATING PHYS,,,14 ,,TotalUnits,,,,2.18 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99456,CPT,WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,,,14 ,,TotalUnits,,,,5.02 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99460,CPT,1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB,,,10 ,,RBRVS,1.17 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99461,CPT,1ST CARE PR DAY NML NB XCPT HOSP/BIRTHING CENTER,,,24 ,,RBRVS,1.26 ,0.53 ,1.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99462,CPT,SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN,,,10 ,,RBRVS,0.62 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99463,CPT,1ST HOSP/BIRTHING CENTER NB ADMIT&DSCHG SM DATE,,,10 ,,RBRVS,1.50 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99464,CPT,ATTN AT DELIVERY& 1ST STABILIZATION OF NEWBORN,,,10 ,,RBRVS,1.50 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99465,CPT,DELIVERY/BIRTHING ROOM RESUSCITATION,,,10 ,,RBRVS,2.93 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99466,CPT,CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN,,,10 ,,RBRVS,4.79 ,1.98 ,1.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99467,CPT,CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN,,,10 ,,RBRVS,2.40 ,0.95 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99468,CPT,1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/<,,,10 ,,RBRVS,18.46 ,6.47 ,6.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99469,CPT,SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<,,,10 ,,RBRVS,7.99 ,3.11 ,3.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99471,CPT,INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS,,,10 ,,RBRVS,15.98 ,5.94 ,5.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99472,CPT,SUBSQ PED CRITICAL CARE 29 DAYS THRU 24 MO,,,10 ,,RBRVS,7.99 ,3.00 ,3.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99475,CPT,INITIAL PED CRITICAL CARE 2 THRU 5 YEARS,,,10 ,,RBRVS,11.25 ,4.00 ,4.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99476,CPT,SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS,,,10 ,,RBRVS,6.75 ,2.49 ,2.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99477,CPT,INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL,,,10 ,,RBRVS,7.00 ,2.79 ,2.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99478,CPT,SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS,,,10 ,,RBRVS,2.75 ,1.11 ,1.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99479,CPT,SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS,,,10 ,,RBRVS,2.50 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99480,CPT,SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS,,,10 ,,RBRVS,2.40 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,99499,CPT,UNLISTED EVALUATION AND MANAGEMENT SERVICE,,,15 ,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,99500,CPT,HOME VISIT PRENATAL MONITORING & ASSESSMENT,,,14 ,,TotalUnits,,,,1.66 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,99501,CPT,HOME VISIT POSTNATAL ASSMT&F-UP CARE,,,14 ,,TotalUnits,,,,1.21 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,99502,CPT,HOME VISIT NEWBORN CARE & ASSESSMENT,,,14 ,,TotalUnits,,,,1.21 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,99503,CPT,HOME VISIT RESPIRATORY THERAPY CARE,,,14 ,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,99504,CPT,HOME VISIT MECHANICAL VENTILATION CARE,,,14 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,99505,CPT,HOME VISIT STOMA CARE&MAINT CLST&CSTOST,,,14 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,99506,CPT,HOME VISIT INTRAMUSCULAR INJECTIONS,,,14 ,,TotalUnits,,,,1.18 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,99507,CPT,HOME VISIT CARE&MAINT CATH,,,14 ,,TotalUnits,,,,0.88 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,99509,CPT,HOME VISIT ASSISTANCE DAILY LIV&PRSONAL CARE,,,14 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,99510,CPT,HOME VISIT INDIV FAM/MARRIAGE COUNSELING,,,14 ,,TotalUnits,,,,1.27 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,99511,CPT,HOME VISIT FECAL IMPACTION MGMT&ENEMA ADMN,,,14 ,,TotalUnits,,,,0.99 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,99512,CPT,HOME VISIT HEMODIALYSIS,,,14 ,,TotalUnits,,,,5.35 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,99600,CPT,UNLISTED HOME VISIT SERVICE/PROCEDURE,,,14 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,99601,CPT,HOME NFS/SPECTY DRUG ADMN PR VST <2 HR,,,14 ,,TotalUnits,,,,2.11 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,99602,CPT,HOME NFS/SPECTY DRUG ADMN PR VST <2 HR EA HR,,,14 ,,TotalUnits,,,,1.15 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,99605,CPT,MEDICATION THERAPY INITIAL 15 MIN NEW PATIENT,,,14 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,99606,CPT,MEDICATION THERAPY INITIAL 15 MIN ESTABLISHED PT,,,14 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,99607,CPT,MEDICATION THERAPY EACH ADDITIONAL 15 MIN,,,14 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,A4206,HCPCS,1 CC STERILE SYRINGE&NEEDLE,,,28 ,,NW,,,,,,$0.88,$0.00,1,1,1,0,0,1,20120101,A4207,HCPCS,2 CC STERILE SYRINGE&NEEDLE,,,28 ,,NW,,,,,,$0.88,$0.00,1,1,1,0,0,1,20120101,A4208,HCPCS,3 CC STERILE SYRINGE&NEEDLE,,,28 ,,NW,,,,,,$0.88,$0.00,1,1,1,0,0,1,20120101,A4209,HCPCS,5+ CC STERILE SYRINGE&NEEDLE,,,28 ,,NW,,,,,,$0.88,$0.00,1,1,1,0,0,1,20120101,A4210,HCPCS,NONNEEDLE INJECTION DEVICE,,,28 ,,NW,,,,,,$887.99,$0.00,1,1,1,0,0,1,20120101,A4211,HCPCS,SUPP FOR SELF-ADM INJECTIONS,,,28 ,,NW,,,,,,$48.91,$0.00,1,1,1,0,0,1,20120101,A4212,HCPCS,NON CORING NEEDLE OR STYLET,,,28 ,,NW,,,,,,$14.53,$0.00,1,1,1,0,0,1,20120101,A4213,HCPCS,20+ CC SYRINGE ONLY,,,28 ,,NW,,,,,,$1.77,$0.00,1,1,1,0,0,1,20120101,A4215,HCPCS,STERILE NEEDLE,,,28 ,,NW,,,,,,$1.08,$0.00,1,1,1,0,0,1,20120101,A4216,HCPCS,"STERILE WATER/SALINE, 10 ML",,,28 ,,NW,,,,,,$0.69,$0.00,1,1,1,0,0,1,20120101,A4217,HCPCS,"STERILE WATER/SALINE, 500 ML",,,28 ,,NW,,,,,,$4.88,$0.00,1,1,1,0,0,1,20120101,A4217,HCPCS,"STERILE WATER/SALINE, 500 ML",AU,,28 ,,NW,,,,,,$4.88,$0.00,1,1,1,0,0,1,20120101,A4218,HCPCS,STERILE SALINE OR WATER,,,28 ,,NW,,,,,,$3.27,$0.00,1,1,1,0,0,1,20120101,A4220,HCPCS,INFUSION PUMP REFILL KIT,,,28 ,,NW,,,,,,$72.87,$0.00,1,1,1,0,0,1,20120101,A4221,HCPCS,MAINT DRUG INFUS CATH PER WK,,,28 ,,NW,,,,,,$46.82,$0.00,1,1,1,0,0,1,20120101,A4222,HCPCS,INFUSION SUPPLIES WITH PUMP,,,28 ,,NW,,,,,,$89.46,$0.00,1,1,1,0,0,1,20120101,A4223,HCPCS,INFUSION SUPPLIES W/O PUMP,,,28 ,,NW,,,,,,$108.00,$0.00,1,1,1,0,0,1,20120101,A4230,HCPCS,INFUS INSULIN PUMP NON NEEDL,,,28 ,,NW,,,,,,$27.26,$0.00,1,1,1,0,0,1,20120101,A4231,HCPCS,INFUSION INSULIN PUMP NEEDLE,,,28 ,,NW,,,,,,$10.72,$0.00,1,1,1,0,0,1,20120101,A4232,HCPCS,SYRINGE W/NEEDLE INSULIN 3CC,,,28 ,,NW,,,,,,$4.87,$0.00,1,1,1,0,0,1,20120101,A4233,HCPCS,ALKALIN BATT FOR GLUCOSE MON,,,28 ,,NW,,,,,,$4.54,$0.00,1,1,1,1,1,1,20120101,A4233,HCPCS,ALKALIN BATT FOR GLUCOSE MON,NU,,28 ,,NW,,,,,,$4.54,$0.00,1,1,1,1,1,1,20120101,A4234,HCPCS,J-CELL BATT FOR GLUCOSE MON,,,28 ,,NW,,,,,,$18.18,$0.00,1,1,1,1,1,1,20120101,A4234,HCPCS,J-CELL BATT FOR GLUCOSE MON,NU,,28 ,,NW,,,,,,$18.18,$0.00,1,1,1,1,1,1,20120101,A4235,HCPCS,LITHIUM BATT FOR GLUCOSE MON,,,28 ,,NW,,,,,,$13.33,$0.00,1,1,1,1,1,1,20120101,A4235,HCPCS,LITHIUM BATT FOR GLUCOSE MON,NU,,28 ,,NW,,,,,,$13.33,$0.00,1,1,1,1,1,1,20120101,A4236,HCPCS,SILVR OXIDE BATT GLUCOSE MON,,,28 ,,NW,,,,,,$9.55,$0.00,1,1,1,1,1,1,20120101,A4236,HCPCS,SILVR OXIDE BATT GLUCOSE MON,NU,,28 ,,NW,,,,,,$9.55,$0.00,1,1,1,1,1,1,20120101,A4244,HCPCS,ALCOHOL OR PEROXIDE PER PINT,,,28 ,,NW,,,,,,$1.77,$0.00,1,1,1,0,0,1,20120101,A4245,HCPCS,ALCOHOL WIPES PER BOX,,,28 ,,NW,,,,,,$4.50,$0.00,1,1,1,0,0,1,20120101,A4246,HCPCS,BETADINE/PHISOHEX SOLUTION,,,28 ,,NW,,,,,,$5.41,$0.00,1,1,1,0,0,1,20120101,A4247,HCPCS,BETADINE/IODINE SWABS/WIPES,,,28 ,,NW,,,,,,$8.15,$0.00,1,1,1,0,0,1,20120101,A4248,HCPCS,CHLORHEXIDINE ANTISEPT,,,28 ,,NW,,,,,,$5.58,$0.00,1,1,1,0,0,1,20120101,A4250,HCPCS,URINE REAGENT STRIPS/TABLETS,,,28 ,,NW,,,,,,$24.61,$0.00,1,1,1,0,0,1,20120101,A4252,HCPCS,BLOOD KETONE TEST OR STRIP,,,28 ,,NW,,,,,,$10.05,$0.00,1,1,1,0,0,1,20120101,A4253,HCPCS,BLOOD GLUCOSE/REAGENT STRIPS,,,28 ,,NW,,,,,,$71.84,$0.00,1,1,1,0,0,1,20120101,A4253,HCPCS,BLOOD GLUCOSE/REAGENT STRIPS,NU,,28 ,,NW,,,,,,$71.84,$0.00,1,1,1,0,0,1,20120101,A4255,HCPCS,GLUCOSE MONITOR PLATFORMS,,,28 ,,NW,,,,,,$12.28,$0.00,1,1,1,0,0,1,20120101,A4256,HCPCS,CALIBRATOR SOLUTION/CHIPS,,,28 ,,NW,,,,,,$25.14,$0.00,1,1,1,0,0,1,20120101,A4256,HCPCS,CALIBRATOR SOLUTION/CHIPS,KL,,28 ,,NW,,,,,,$22.48,$0.00,1,1,1,0,0,1,20120101,A4257,HCPCS,REPLACE LENSSHIELD CARTRIDGE,,,28 ,,NW,,,,,,$29.05,$0.00,1,1,1,0,0,1,20120101,A4258,HCPCS,LANCET DEVICE EACH,,,28 ,,NW,,,,,,$38.53,$0.00,1,1,1,0,0,1,20120101,A4258,HCPCS,LANCET DEVICE EACH,KL,,28 ,,NW,,,,,,$34.03,$0.00,1,1,1,0,0,1,20120101,A4259,HCPCS,LANCETS PER BOX,,,28 ,,NW,,,,,,$27.29,$0.00,1,1,1,0,0,1,20120101,A4259,HCPCS,LANCETS PER BOX,KL,,28 ,,NW,,,,,,$24.33,$0.00,1,1,1,0,0,1,20120101,A4261,HCPCS,CERVICAL CAP CONTRACEPTIVE,,,28 ,,NW,,,,,,$65.37,$0.00,1,1,1,1,1,1,20120101,A4262,HCPCS,TEMPORARY TEAR DUCT PLUG,,,28 ,,NW,,,,,,$0.88,$0.00,1,1,1,0,0,1,20120101,A4263,HCPCS,PERMANENT TEAR DUCT PLUG,,,28 ,,NW,,,,,,$47.23,$0.00,1,1,1,0,0,1,20120101,A4264,HCPCS,INTRATUBAL OCCLUSION DEVICE,,,28 ,,NW,,,,,,"$1,779.76",$0.00,1,1,1,1,1,1,20120101,A4265,HCPCS,PARAFFIN,,,28 ,,NW,,,,,,$5.64,$0.00,1,1,1,0,0,1,20120101,A4266,HCPCS,DIAPHRAGM,,,28 ,,NW,,,,,,$38.52,$0.00,1,1,1,1,1,1,20120101,A4267,HCPCS,MALE CONDOM,,,28 ,,NW,,,,,,$0.88,$0.00,1,1,1,1,1,1,20120101,A4268,HCPCS,FEMALE CONDOM,,,28 ,,NW,,,,,,$1.92,$0.00,1,1,1,1,1,1,20120101,A4269,HCPCS,SPERMICIDE,,,28 ,,NW,,,,,,$1.77,$0.00,1,1,1,1,1,1,20120101,A4270,HCPCS,DISPOSABLE ENDOSCOPE SHEATH,,,28 ,,NW,,,,,,$31.58,$0.00,1,1,1,0,0,1,20120101,A4280,HCPCS,BRST PRSTHS ADHSV ATTCHMNT,,,28 ,,NW,,,,,,$9.33,$0.00,1,1,1,0,0,1,20120101,A4281,HCPCS,REPLACEMENT BREASTPUMP TUBE,,,28 ,,NW,,,,,,$22.23,$0.00,1,1,1,1,1,1,20120101,A4282,HCPCS,REPLACEMENT BREASTPUMP ADPT,,,28 ,,NW,,,,,,$3.92,$0.00,1,1,1,1,1,1,20120101,A4284,HCPCS,REPLCMNT BREAST PUMP SHIELD,,,28 ,,NW,,,,,,$24.61,$0.00,1,1,1,1,1,1,20120101,A4285,HCPCS,REPLCMNT BREAST PUMP BOTTLE,,,28 ,,NW,,,,,,$9.39,$0.00,1,1,1,1,1,1,20120101,A4290,HCPCS,SACRAL NERVE STIM TEST LEAD,,,28 ,,NW,,,,,,$546.54,$0.00,1,1,1,0,0,1,20120101,A4300,HCPCS,CATH IMPL VASC ACCESS PORTAL,,,28 ,,NW,,,,,,$24.29,$0.00,1,1,1,0,0,1,20120101,A4301,HCPCS,IMPLANTABLE ACCESS SYST PERC,,,28 ,,NW,,,,,,$20.40,$0.00,1,1,1,0,0,1,20120101,A4305,HCPCS,DRUG DELIVERY SYSTEM >=50 ML,,,28 ,,NW,,,,,,$20.40,$0.00,1,1,1,0,0,1,20120101,A4306,HCPCS,DRUG DELIVERY SYSTEM <=50 ML,,,28 ,,NW,,,,,,$25.13,$0.00,1,1,1,0,0,1,20120101,A4310,HCPCS,INSERT TRAY W/O BAG/CATH,,,28 ,,NW,,,,,,$12.30,$0.00,1,1,1,0,0,1,20120101,A4311,HCPCS,CATHETER W/O BAG 2-WAY LATEX,,,28 ,,NW,,,,,,$20.29,$0.00,1,1,1,0,0,1,20120101,A4312,HCPCS,CATH W/O BAG 2-WAY SILICONE,,,28 ,,NW,,,,,,$23.39,$0.00,1,1,1,0,0,1,20120101,A4313,HCPCS,CATHETER W/BAG 3-WAY,,,28 ,,NW,,,,,,$23.98,$0.00,1,1,1,0,0,1,20120101,A4314,HCPCS,CATH W/DRAINAGE 2-WAY LATEX,,,28 ,,NW,,,,,,$30.23,$0.00,1,1,1,0,0,1,20120101,A4315,HCPCS,CATH W/DRAINAGE 2-WAY SILCNE,,,28 ,,NW,,,,,,$31.35,$0.00,1,1,1,0,0,1,20120101,A4316,HCPCS,CATH W/DRAINAGE 3-WAY,,,28 ,,NW,,,,,,$33.37,$0.00,1,1,1,0,0,1,20120101,A4320,HCPCS,IRRIGATION TRAY,,,28 ,,NW,,,,,,$8.29,$0.00,1,1,1,0,0,1,20120101,A4321,HCPCS,CATH THERAPEUTIC IRRIG AGENT,,,28 ,,NW,,,,,,$6.80,$0.00,1,1,1,0,0,1,20120101,A4322,HCPCS,IRRIGATION SYRINGE,,,28 ,,NW,,,,,,$4.93,$0.00,1,1,1,0,0,1,20120101,A4326,HCPCS,MALE EXTERNAL CATHETER,,,28 ,,NW,,,,,,$16.67,$0.00,1,1,1,0,0,1,20120101,A4327,HCPCS,FEM URINARY COLLECT DEV CUP,,,28 ,,NW,,,,,,$49.14,$0.00,1,1,1,0,0,1,20120101,A4328,HCPCS,FEM URINARY COLLECT POUCH,,,28 ,,NW,,,,,,$16.52,$0.00,1,1,1,0,0,1,20120101,A4330,HCPCS,STOOL COLLECTION POUCH,,,28 ,,NW,,,,,,$11.44,$0.00,1,1,1,0,0,1,20120101,A4331,HCPCS,EXTENSION DRAINAGE TUBING,,,28 ,,NW,,,,,,$5.29,$0.00,1,1,1,0,0,1,20120101,A4332,HCPCS,LUBE STERILE PACKET,,,28 ,,NW,,,,,,$0.20,$0.00,1,1,1,0,0,1,20120101,A4333,HCPCS,URINARY CATH ANCHOR DEVICE,,,28 ,,NW,,,,,,$3.90,$0.00,1,1,1,0,0,1,20120101,A4334,HCPCS,URINARY CATH LEG STRAP,,,28 ,,NW,,,,,,$8.68,$0.00,1,1,1,0,0,1,20120101,A4335,HCPCS,INCONTINENCE SUPPLY,,,28 ,,NW,,,,,,$5.29,$0.00,1,1,1,0,0,1,20120101,A4336,HCPCS,URETHRAL INSERT,,,28 ,,NW,,,,,,$2.36,$0.00,1,1,1,0,0,1,20120101,A4338,HCPCS,INDWELLING CATHETER LATEX,,,28 ,,NW,,,,,,$18.18,$0.00,1,1,1,0,0,1,20120101,A4340,HCPCS,INDWELLING CATHETER SPECIAL,,,28 ,,NW,,,,,,$35.56,$0.00,1,1,1,0,0,1,20120101,A4344,HCPCS,CATH INDW FOLEY 2 WAY SILICN,,,28 ,,NW,,,,,,$21.47,$0.00,1,1,1,0,0,1,20120101,A4346,HCPCS,CATH INDW FOLEY 3 WAY,,,28 ,,NW,,,,,,$24.66,$0.00,1,1,1,0,0,1,20120101,A4349,HCPCS,DISPOSABLE MALE EXTERNAL CAT,,,28 ,,NW,,,,,,$3.34,$0.00,1,1,1,0,0,1,20120101,A4351,HCPCS,STRAIGHT TIP URINE CATHETER,,,28 ,,NW,,,,,,$2.81,$0.00,1,1,1,0,0,1,20120101,A4352,HCPCS,COUDE TIP URINARY CATHETER,,,28 ,,NW,,,,,,$10.19,$0.00,1,1,1,0,0,1,20120101,A4353,HCPCS,INTERMITTENT URINARY CATH,,,28 ,,NW,,,,,,$11.70,$0.00,1,1,1,0,0,1,20120101,A4354,HCPCS,CATH INSERTION TRAY W/BAG,,,28 ,,NW,,,,,,$17.69,$0.00,1,1,1,0,0,1,20120101,A4355,HCPCS,BLADDER IRRIGATION TUBING,,,28 ,,NW,,,,,,$14.50,$0.00,1,1,1,0,0,1,20120101,A4356,HCPCS,EXT URETH CLMP OR COMPR DVC,,,28 ,,NW,,,,,,$48.96,$0.00,1,1,1,0,0,1,20120101,A4357,HCPCS,BEDSIDE DRAINAGE BAG,,,28 ,,NW,,,,,,$15.58,$0.00,1,1,1,0,0,1,20120101,A4358,HCPCS,URINARY LEG OR ABDOMEN BAG,,,28 ,,NW,,,,,,$10.57,$0.00,1,1,1,0,0,1,20120101,A4360,HCPCS,DISPOSABLE EXT URETHRAL DEV,,,28 ,,NW,,,,,,$0.75,$0.00,1,1,1,0,0,1,20120101,A4361,HCPCS,OSTOMY FACE PLATE,,,28 ,,NW,,,,,,$23.97,$0.00,1,1,1,0,0,1,20120101,A4362,HCPCS,SOLID SKIN BARRIER,,,28 ,,NW,,,,,,$5.46,$0.00,1,1,1,0,0,1,20120101,A4363,HCPCS,"OSTOMY CLAMP, REPLACEMENT",,,28 ,,NW,,,,,,$3.76,$0.00,1,1,1,0,0,1,20120101,A4364,HCPCS,"ADHESIVE, LIQUID OR EQUAL",,,28 ,,NW,,,,,,$4.83,$0.00,1,1,1,0,0,1,20120101,A4366,HCPCS,OSTOMY VENT,,,28 ,,NW,,,,,,$2.31,$0.00,1,1,1,0,0,1,20120101,A4367,HCPCS,OSTOMY BELT,,,28 ,,NW,,,,,,$11.74,$0.00,1,1,1,0,0,1,20120101,A4368,HCPCS,OSTOMY FILTER,,,28 ,,NW,,,,,,$0.42,$0.00,1,1,1,0,0,1,20120101,A4369,HCPCS,SKIN BARRIER LIQUID PER OZ,,,28 ,,NW,,,,,,$3.85,$0.00,1,1,1,0,0,1,20120101,A4371,HCPCS,SKIN BARRIER POWDER PER OZ,,,28 ,,NW,,,,,,$6.06,$0.00,1,1,1,0,0,1,20120101,A4372,HCPCS,SKIN BARRIER SOLID 4X4 EQUIV,,,28 ,,NW,,,,,,$6.98,$0.00,1,1,1,0,0,1,20120101,A4373,HCPCS,SKIN BARRIER WITH FLANGE,,,28 ,,NW,,,,,,$10.48,$0.00,1,1,1,0,0,1,20120101,A4375,HCPCS,DRAINABLE PLASTIC PCH W FCPL,,,28 ,,NW,,,,,,$23.37,$0.00,1,1,1,0,0,1,20120101,A4376,HCPCS,DRAINABLE RUBBER PCH W FCPLT,,,28 ,,NW,,,,,,$52.85,$0.00,1,1,1,0,0,1,20120101,A4377,HCPCS,DRAINABLE PLSTIC PCH W/O FP,,,28 ,,NW,,,,,,$7.15,$0.00,1,1,1,0,0,1,20120101,A4378,HCPCS,DRAINABLE RUBBER PCH W/O FP,,,28 ,,NW,,,,,,$36.54,$0.00,1,1,1,0,0,1,20120101,A4379,HCPCS,URINARY PLASTIC POUCH W FCPL,,,28 ,,NW,,,,,,$21.28,$0.00,1,1,1,0,0,1,20120101,A4380,HCPCS,URINARY RUBBER POUCH W FCPLT,,,28 ,,NW,,,,,,$42.91,$0.00,1,1,1,0,0,1,20120101,A4381,HCPCS,URINARY PLASTIC POUCH W/O FP,,,28 ,,NW,,,,,,$7.70,$0.00,1,1,1,0,0,1,20120101,A4382,HCPCS,URINARY HVY PLSTC PCH W/O FP,,,28 ,,NW,,,,,,$30.58,$0.00,1,1,1,0,0,1,20120101,A4383,HCPCS,URINARY RUBBER POUCH W/O FP,,,28 ,,NW,,,,,,$34.05,$0.00,1,1,1,0,0,1,20120101,A4384,HCPCS,OSTOMY FACEPLT/SILICONE RING,,,28 ,,NW,,,,,,$16.05,$0.00,1,1,1,0,0,1,20120101,A4385,HCPCS,OST SKN BARRIER SLD EXT WEAR,,,28 ,,NW,,,,,,$8.51,$0.00,1,1,1,0,0,1,20120101,A4387,HCPCS,OST CLSD POUCH W ATT ST BARR,,,28 ,,NW,,,,,,$6.09,$0.00,1,1,1,0,0,1,20120101,A4388,HCPCS,DRAINABLE PCH W EX WEAR BARR,,,28 ,,NW,,,,,,$7.28,$0.00,1,1,1,0,0,1,20120101,A4389,HCPCS,DRAINABLE PCH W ST WEAR BARR,,,28 ,,NW,,,,,,$10.39,$0.00,1,1,1,0,0,1,20120101,A4390,HCPCS,DRAINABLE PCH EX WEAR CONVEX,,,28 ,,NW,,,,,,$16.04,$0.00,1,1,1,0,0,1,20120101,A4391,HCPCS,URINARY POUCH W EX WEAR BARR,,,28 ,,NW,,,,,,$11.82,$0.00,1,1,1,0,0,1,20120101,A4392,HCPCS,URINARY POUCH W ST WEAR BARR,,,28 ,,NW,,,,,,$13.68,$0.00,1,1,1,0,0,1,20120101,A4393,HCPCS,URINE PCH W EX WEAR BAR CONV,,,28 ,,NW,,,,,,$15.13,$0.00,1,1,1,0,0,1,20120101,A4394,HCPCS,OSTOMY POUCH LIQ DEODORANT,,,28 ,,NW,,,,,,$4.28,$0.00,1,1,1,0,0,1,20120101,A4395,HCPCS,OSTOMY POUCH SOLID DEODORANT,,,28 ,,NW,,,,,,$0.08,$0.00,1,1,1,0,0,1,20120101,A4396,HCPCS,PERISTOMAL HERNIA SUPPRT BLT,,,28 ,,NW,,,,,,$45.95,$0.00,1,1,1,0,0,1,20120101,A4397,HCPCS,IRRIGATION SUPPLY SLEEVE,,,28 ,,NW,,,,,,$7.37,$0.00,1,1,1,0,0,1,20120101,A4398,HCPCS,OSTOMY IRRIGATION BAG,,,28 ,,NW,,,,,,$19.84,$0.00,1,1,1,0,0,1,20120101,A4399,HCPCS,OSTOMY IRRIG CONE/CATH W BRS,,,28 ,,NW,,,,,,$17.92,$0.00,1,1,1,0,0,1,20120101,A4400,HCPCS,OSTOMY IRRIGATION SET,,,28 ,,NW,,,,,,$51.13,$0.00,1,1,1,0,0,1,20120101,A4402,HCPCS,LUBRICANT PER OUNCE,,,28 ,,NW,,,,,,$2.52,$0.00,1,1,1,0,0,1,20120101,A4404,HCPCS,OSTOMY RING EACH,,,28 ,,NW,,,,,,$2.69,$0.00,1,1,1,0,0,1,20120101,A4405,HCPCS,NONPECTIN BASED OSTOMY PASTE,,,28 ,,NW,,,,,,$5.66,$0.00,1,1,1,0,0,1,20120101,A4406,HCPCS,PECTIN BASED OSTOMY PASTE,,,28 ,,NW,,,,,,$9.58,$0.00,1,1,1,0,0,1,20120101,A4407,HCPCS,"EXT WEAR OST SKN BARR <=4SQ""",,,28 ,,NW,,,,,,$14.66,$0.00,1,1,1,0,0,1,20120101,A4408,HCPCS,"EXT WEAR OST SKN BARR >4SQ""",,,28 ,,NW,,,,,,$16.28,$0.00,1,1,1,0,0,1,20120101,A4409,HCPCS,OST SKN BARR CONVEX <=4 SQ I,,,28 ,,NW,,,,,,$10.39,$0.00,1,1,1,0,0,1,20120101,A4410,HCPCS,OST SKN BARR EXTND >4 SQ,,,28 ,,NW,,,,,,$15.13,$0.00,1,1,1,0,0,1,20120101,A4411,HCPCS,OST SKN BARR EXTND =4SQ,,,28 ,,NW,,,,,,$8.51,$0.00,1,1,1,0,0,1,20120101,A4412,HCPCS,OST POUCH DRAIN HIGH OUTPUT,,,28 ,,NW,,,,,,$4.49,$0.00,1,1,1,0,0,1,20120101,A4413,HCPCS,2 PC DRAINABLE OST POUCH,,,28 ,,NW,,,,,,$9.18,$0.00,1,1,1,0,0,1,20120101,A4414,HCPCS,OST SKNBAR W/O CONV<=4 SQ IN,,,28 ,,NW,,,,,,$8.22,$0.00,1,1,1,0,0,1,20120101,A4415,HCPCS,OST SKN BARR W/O CONV >4 SQI,,,28 ,,NW,,,,,,$10.02,$0.00,1,1,1,0,0,1,20120101,A4416,HCPCS,OST PCH CLSD W BARRIER/FILTR,,,28 ,,NW,,,,,,$4.87,$0.00,1,1,1,0,0,1,20120101,A4417,HCPCS,OST PCH W BAR/BLTINCONV/FLTR,,,28 ,,NW,,,,,,$6.58,$0.00,1,1,1,0,0,1,20120101,A4418,HCPCS,OST PCH CLSD W/O BAR W FILTR,,,28 ,,NW,,,,,,$3.20,$0.00,1,1,1,0,0,1,20120101,A4419,HCPCS,OST PCH FOR BAR W FLANGE/FLT,,,28 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,A4420,HCPCS,OST PCH CLSD FOR BAR W LK FL,,,28 ,,NW,,,,,,$3.26,$0.00,1,1,1,0,0,1,20120101,A4421,HCPCS,OSTOMY SUPPLY MISC,,,28 ,,NW,,,,,,$4.83,$0.00,1,1,1,0,0,1,20120101,A4422,HCPCS,OST POUCH ABSORBENT MATERIAL,,,28 ,,NW,,,,,,$0.20,$0.00,1,1,1,0,0,1,20120101,A4423,HCPCS,OST PCH FOR BAR W LK FL/FLTR,,,28 ,,NW,,,,,,$3.28,$0.00,1,1,1,0,0,1,20120101,A4424,HCPCS,OST PCH DRAIN W BAR & FILTER,,,28 ,,NW,,,,,,$8.40,$0.00,1,1,1,0,0,1,20120101,A4425,HCPCS,OST PCH DRAIN FOR BARRIER FL,,,28 ,,NW,,,,,,$6.33,$0.00,1,1,1,0,0,1,20120101,A4426,HCPCS,OST PCH DRAIN 2 PIECE SYSTEM,,,28 ,,NW,,,,,,$4.83,$0.00,1,1,1,0,0,1,20120101,A4427,HCPCS,OST PCH DRAIN/BARR LK FLNG/F,,,28 ,,NW,,,,,,$4.92,$0.00,1,1,1,0,0,1,20120101,A4428,HCPCS,URINE OST POUCH W FAUCET/TAP,,,28 ,,NW,,,,,,$11.50,$0.00,1,1,1,0,0,1,20120101,A4429,HCPCS,URINE OST POUCH W BLTINCONV,,,28 ,,NW,,,,,,$14.39,$0.00,1,1,1,0,0,1,20120101,A4430,HCPCS,OST URINE PCH W B/BLTIN CONV,,,28 ,,NW,,,,,,$14.80,$0.00,1,1,1,0,0,1,20120101,A4431,HCPCS,OST PCH URINE W BARRIER/TAPV,,,28 ,,NW,,,,,,$10.98,$0.00,1,1,1,0,0,1,20120101,A4432,HCPCS,OS PCH URINE W BAR/FANGE/TAP,,,28 ,,NW,,,,,,$6.35,$0.00,1,1,1,0,0,1,20120101,A4433,HCPCS,URINE OST PCH BAR W LOCK FLN,,,28 ,,NW,,,,,,$5.91,$0.00,1,1,1,0,0,1,20120101,A4434,HCPCS,OST PCH URINE W LOCK FLNG/FT,,,28 ,,NW,,,,,,$6.65,$0.00,1,1,1,0,0,1,20120101,A4450,HCPCS,NON-WATERPROOF TAPE,,,28 ,,NW,,,,,,$0.14,$0.00,1,1,1,0,0,1,20120101,A4450,HCPCS,NON-WATERPROOF TAPE,AU,,28 ,,NW,,,,,,$0.14,$0.00,1,1,1,0,0,1,20120101,A4450,HCPCS,NON-WATERPROOF TAPE,AV,,28 ,,NW,,,,,,$0.14,$0.00,1,1,1,0,0,1,20120101,A4450,HCPCS,NON-WATERPROOF TAPE,AW,,28 ,,NW,,,,,,$0.19,$0.00,1,1,1,0,0,1,20120101,A4452,HCPCS,WATERPROOF TAPE,,,28 ,,NW,,,,,,$0.59,$0.00,1,1,1,0,0,1,20120101,A4452,HCPCS,WATERPROOF TAPE,AU,,28 ,,NW,,,,,,$0.59,$0.00,1,1,1,0,0,1,20120101,A4452,HCPCS,WATERPROOF TAPE,AV,,28 ,,NW,,,,,,$0.59,$0.00,1,1,1,0,0,1,20120101,A4452,HCPCS,WATERPROOF TAPE,AW,,28 ,,NW,,,,,,$0.65,$0.00,1,1,1,0,0,1,20120101,A4455,HCPCS,ADHESIVE REMOVER PER OUNCE,,,28 ,,NW,,,,,,$2.20,$0.00,1,1,1,0,0,1,20120101,A4456,HCPCS,"ADHESIVE REMOVER, WIPES",,,28 ,,NW,,,,,,$0.40,$0.00,1,1,1,0,0,1,20120101,A4458,HCPCS,REUSABLE ENEMA BAG,,,28 ,,NW,,,,,,$20.54,$0.00,1,1,1,0,0,1,20120101,A4461,HCPCS,SURGICL DRESS HOLD NON-REUSE,,,28 ,,NW,,,,,,$5.47,$0.00,1,1,1,0,0,1,20120101,A4463,HCPCS,SURGICAL DRESS HOLDER REUSE,,,28 ,,NW,,,,,,$19.63,$0.00,1,1,1,0,0,1,20120101,A4465,HCPCS,NON-ELASTIC EXTREMITY BINDER,,,28 ,,NW,,,,,,$16.19,$0.00,1,1,1,0,0,1,20120101,A4466,HCPCS,ELASTIC GARMENT/COVERING,,,28 ,,NW,,,,,,$59.60,$0.00,1,1,1,0,0,1,20120101,A4470,HCPCS,GRAVLEE JET WASHER,,,28 ,,NW,,,,,,$10.89,$0.00,1,1,1,0,0,1,20120101,A4480,HCPCS,VABRA ASPIRATOR,,,28 ,,NW,,,,,,$9.06,$0.00,1,1,1,0,0,1,20120101,A4481,HCPCS,TRACHEOSTOMA FILTER,,,28 ,,NW,,,,,,$1.15,$0.00,1,1,1,0,0,1,20120101,A4483,HCPCS,MOISTURE EXCHANGER,,,28 ,,NW,,,,,,$9.05,$0.00,1,1,1,0,0,1,20120101,A4490,HCPCS,ABOVE KNEE SURGICAL STOCKING,,,28 ,,NW,,,,,,$11.80,$0.00,1,1,1,0,0,1,20120101,A4495,HCPCS,THIGH LENGTH SURG STOCKING,,,28 ,,NW,,,,,,$11.80,$0.00,1,1,1,0,0,1,20120101,A4500,HCPCS,BELOW KNEE SURGICAL STOCKING,,,28 ,,NW,,,,,,$9.06,$0.00,1,1,1,0,0,1,20120101,A4510,HCPCS,FULL LENGTH SURG STOCKING,,,28 ,,NW,,,,,,$19.35,$0.00,1,1,1,0,0,1,20120101,A4520,HCPCS,INCONTINENCE GARMENT ANYTYPE,,,28 ,,NW,,,,,,$1.09,$0.00,1,1,1,0,0,1,20120101,A4550,HCPCS,SURGICAL TRAYS,,,28 ,,NW,,,,,,$36.71,$0.00,1,1,1,0,0,1,20120101,A4554,HCPCS,DISPOSABLE UNDERPADS,,,28 ,,NW,,,,,,$5.41,$0.00,1,1,1,0,0,1,20120101,A4556,HCPCS,"ELECTRODES, PAIR",,,28 ,,NW,,,,,,$26.35,$0.00,1,1,1,0,0,1,20120101,A4557,HCPCS,"LEAD WIRES, PAIR",,,28 ,,NW,,,,,,$41.11,$0.00,1,1,1,0,0,1,20120101,A4558,HCPCS,CONDUCTIVE GEL OR PASTE,,,28 ,,NW,,,,,,$15.22,$0.00,1,1,1,0,0,1,20120101,A4559,HCPCS,COUPLING GEL OR PASTE,,,28 ,,NW,,,,,,$0.32,$0.00,1,1,1,0,0,1,20120101,A4561,HCPCS,"PESSARY RUBBER, ANY TYPE",,,28 ,,NW,,,,,,$26.25,$0.00,1,1,1,0,0,1,20120101,A4562,HCPCS,"PESSARY, NON RUBBER,ANY TYPE",,,28 ,,NW,,,,,,$55.32,$0.00,1,1,1,0,0,1,20120101,A4565,HCPCS,SLINGS,,,28 ,,NW,,,,,,$12.71,$0.00,1,1,1,0,0,1,20120101,A4570,HCPCS,SPLINT,,,28 ,,NW,,,,,,$24.08,$0.00,1,1,1,0,0,1,20120101,A4575,HCPCS,HYPERBARIC O2 CHAMBER DISPS,,,28 ,,NW,,,,,,"$1,013.16",$0.00,1,1,1,0,0,1,20120101,A4580,HCPCS,CAST SUPPLIES (PLASTER),,,28 ,,NW,,,,,,$78.95,$0.00,1,1,1,0,0,1,20120101,A4590,HCPCS,SPECIAL CASTING MATERIAL,,,28 ,,NW,,,,,,$46.18,$0.00,1,1,1,0,0,1,20120101,A4595,HCPCS,TENS SUPPL 2 LEAD PER MONTH,,,28 ,,NW,,,,,,$58.00,$0.00,1,1,1,0,0,1,20120101,A4600,HCPCS,"SLEEVE, INTER LIMB COMP DEV",,,28 ,,NW,,,,,,$117.99,$0.00,1,1,1,1,1,1,20120101,A4601,HCPCS,"LITH ION BATT, NON-PROS USE",,,28 ,,NW,,,,,,$2.64,$0.00,1,1,1,1,1,1,20120101,A4604,HCPCS,TUBING WITH HEATING ELEMENT,,,28 ,,NW,,,,,,$119.44,$0.00,1,1,1,1,1,1,20120101,A4604,HCPCS,TUBING WITH HEATING ELEMENT,NU,,28 ,,NW,,,,,,$119.44,$0.00,1,1,1,1,1,1,20120101,A4605,HCPCS,TRACH SUCTION CATH CLOSE SYS,,,28 ,,NW,,,,,,$35.65,$0.00,1,1,1,1,1,1,20120101,A4605,HCPCS,TRACH SUCTION CATH CLOSE SYS,NU,,28 ,,NW,,,,,,$35.65,$0.00,1,1,1,1,1,1,20120101,A4606,HCPCS,OXYGEN PROBE USED W OXIMETER,,,28 ,,NW,,,,,,$59.81,$0.00,1,1,1,1,1,1,20120101,A4608,HCPCS,TRANSTRACHEAL OXYGEN CATH,,,28 ,,NW,,,,,,$100.82,$0.00,1,1,1,1,1,1,20120101,A4611,HCPCS,HEAVY DUTY BATTERY,,,28 ,,NW,,,,,,$428.05,$0.00,1,1,1,1,1,1,20120101,A4611,HCPCS,HEAVY DUTY BATTERY,NU,,28 ,,NW,,,,,,$428.05,$0.00,1,1,1,1,1,1,20120101,A4611,HCPCS,HEAVY DUTY BATTERY,RR,,28 ,,NW,,,,,,$39.91,$0.00,1,1,1,1,1,1,20120101,A4611,HCPCS,HEAVY DUTY BATTERY,UE,,28 ,,NW,,,,,,$314.97,$0.00,1,1,1,1,1,1,20120101,A4612,HCPCS,BATTERY CABLES,,,28 ,,NW,,,,,,$164.01,$0.00,1,1,1,1,1,1,20120101,A4612,HCPCS,BATTERY CABLES,NU,,28 ,,NW,,,,,,$164.01,$0.00,1,1,1,1,1,1,20120101,A4612,HCPCS,BATTERY CABLES,RR,,28 ,,NW,,,,,,$19.80,$0.00,1,1,1,1,1,1,20120101,A4612,HCPCS,BATTERY CABLES,UE,,28 ,,NW,,,,,,$118.86,$0.00,1,1,1,1,1,1,20120101,A4613,HCPCS,BATTERY CHARGER,,,28 ,,NW,,,,,,$310.07,$0.00,1,1,1,1,1,1,20120101,A4613,HCPCS,BATTERY CHARGER,NU,,28 ,,NW,,,,,,$310.07,$0.00,1,1,1,1,1,1,20120101,A4613,HCPCS,BATTERY CHARGER,RR,,28 ,,NW,,,,,,$30.20,$0.00,1,1,1,1,1,1,20120101,A4613,HCPCS,BATTERY CHARGER,UE,,28 ,,NW,,,,,,$217.63,$0.00,1,1,1,1,1,1,20120101,A4614,HCPCS,HAND-HELD PEFR METER,,,28 ,,NW,,,,,,$29.77,$0.00,1,1,1,1,1,1,20120101,A4615,HCPCS,CANNULA NASAL,,,28 ,,NW,,,,,,$1.29,$0.00,1,1,1,1,1,1,20120101,A4616,HCPCS,TUBING (OXYGEN) PER FOOT,,,28 ,,NW,,,,,,$1.56,$0.00,1,1,1,1,1,1,20120101,A4617,HCPCS,MOUTH PIECE,,,28 ,,NW,,,,,,$3.43,$0.00,1,1,1,1,1,1,20120101,A4618,HCPCS,BREATHING CIRCUITS,,,28 ,,NW,,,,,,$14.11,$0.00,1,1,1,1,1,1,20120101,A4618,HCPCS,BREATHING CIRCUITS,NU,,28 ,,NW,,,,,,$14.11,$0.00,1,1,1,1,1,1,20120101,A4618,HCPCS,BREATHING CIRCUITS,RR,,28 ,,NW,,,,,,$1.55,$0.00,1,1,1,1,1,1,20120101,A4618,HCPCS,BREATHING CIRCUITS,UE,,28 ,,NW,,,,,,$10.57,$0.00,1,1,1,1,1,1,20120101,A4619,HCPCS,FACE TENT,,,28 ,,NW,,,,,,$2.57,$0.00,1,1,1,1,1,1,20120101,A4619,HCPCS,FACE TENT,NU,,28 ,,NW,,,,,,$2.57,$0.00,1,1,1,1,1,1,20120101,A4620,HCPCS,VARIABLE CONCENTRATION MASK,,,28 ,,NW,,,,,,$2.29,$0.00,1,1,1,1,1,1,20120101,A4623,HCPCS,TRACHEOSTOMY INNER CANNULA,,,28 ,,NW,,,,,,$10.06,$0.00,1,1,1,1,1,1,20120101,A4624,HCPCS,TRACHEAL SUCTION TUBE,,,28 ,,NW,,,,,,$7.61,$0.00,1,1,1,1,1,1,20120101,A4624,HCPCS,TRACHEAL SUCTION TUBE,NU,,28 ,,NW,,,,,,$7.61,$0.00,1,1,1,1,1,1,20120101,A4625,HCPCS,TRACH CARE KIT FOR NEW TRACH,,,28 ,,NW,,,,,,$11.03,$0.00,1,1,1,1,1,1,20120101,A4626,HCPCS,TRACHEOSTOMY CLEANING BRUSH,,,28 ,,NW,,,,,,$4.87,$0.00,1,1,1,1,1,1,20120101,A4627,HCPCS,SPACER BAG/RESERVOIR,,,28 ,,NW,,,,,,$32.67,$0.00,1,1,1,1,1,1,20120101,A4628,HCPCS,OROPHARYNGEAL SUCTION CATH,,,28 ,,NW,,,,,,$6.16,$0.00,1,1,1,1,1,1,20120101,A4628,HCPCS,OROPHARYNGEAL SUCTION CATH,NU,,28 ,,NW,,,,,,$6.16,$0.00,1,1,1,1,1,1,20120101,A4629,HCPCS,TRACHEOSTOMY CARE KIT,,,28 ,,NW,,,,,,$7.72,$0.00,1,1,1,1,1,1,20120101,A4630,HCPCS,REPL BAT T.E.N.S. OWN BY PT,,,28 ,,NW,,,,,,$16.33,$0.00,1,1,1,1,1,1,20120101,A4630,HCPCS,REPL BAT T.E.N.S. OWN BY PT,NU,,28 ,,NW,,,,,,$16.33,$0.00,1,1,1,1,1,1,20120101,A4633,HCPCS,UVL REPLACEMENT BULB,,,28 ,,NW,,,,,,$80.37,$0.00,1,1,1,1,1,1,20120101,A4633,HCPCS,UVL REPLACEMENT BULB,NU,,28 ,,NW,,,,,,$80.37,$0.00,1,1,1,1,1,1,20120101,A4634,HCPCS,REPLACEMENT BULB TH LIGHTBOX,,,28 ,,NW,,,,,,$123.43,$0.00,1,1,1,1,1,1,20120101,A4635,HCPCS,UNDERARM CRUTCH PAD,,,28 ,,NW,,,,,,$14.52,$0.00,1,1,1,1,1,1,20120101,A4635,HCPCS,UNDERARM CRUTCH PAD,NU,,28 ,,NW,,,,,,$14.52,$0.00,1,1,1,1,1,1,20120101,A4635,HCPCS,UNDERARM CRUTCH PAD,RR,,28 ,,NW,,,,,,$1.96,$0.00,1,1,1,1,1,1,20120101,A4635,HCPCS,UNDERARM CRUTCH PAD,UE,,28 ,,NW,,,,,,$9.72,$0.00,1,1,1,1,1,1,20120101,A4636,HCPCS,HANDGRIP FOR CANE ETC,,,28 ,,NW,,,,,,$19.12,$0.00,1,1,1,1,1,1,20120101,A4636,HCPCS,HANDGRIP FOR CANE ETC,NU,,28 ,,NW,,,,,,$19.12,$0.00,1,1,1,1,1,1,20120101,A4636,HCPCS,HANDGRIP FOR CANE ETC,RR,,28 ,,NW,,,,,,$2.24,$0.00,1,1,1,1,1,1,20120101,A4636,HCPCS,HANDGRIP FOR CANE ETC,UE,,28 ,,NW,,,,,,$15.57,$0.00,1,1,1,1,1,1,20120101,A4637,HCPCS,REPL TIP CANE/CRUTCH/WALKER,,,28 ,,NW,,,,,,$11.40,$0.00,1,1,1,1,1,1,20120101,A4637,HCPCS,REPL TIP CANE/CRUTCH/WALKER,NU,,28 ,,NW,,,,,,$11.40,$0.00,1,1,1,1,1,1,20120101,A4637,HCPCS,REPL TIP CANE/CRUTCH/WALKER,RR,,28 ,,NW,,,,,,$1.60,$0.00,1,1,1,1,1,1,20120101,A4637,HCPCS,REPL TIP CANE/CRUTCH/WALKER,UE,,28 ,,NW,,,,,,$8.61,$0.00,1,1,1,1,1,1,20120101,A4638,HCPCS,REPL BATT PULSE GEN SYS,,,28 ,,NW,,,,,,"$18,747.03",$0.00,1,1,1,1,1,1,20120101,A4638,HCPCS,REPL BATT PULSE GEN SYS,NU,,28 ,,NW,,,,,,"$18,747.03",$0.00,1,1,1,1,1,1,20120101,A4638,HCPCS,REPL BATT PULSE GEN SYS,RR,,28 ,,NW,,,,,,"$1,963.37",$0.00,1,1,1,1,1,1,20120101,A4638,HCPCS,REPL BATT PULSE GEN SYS,UE,,28 ,,NW,,,,,,"$14,085.36",$0.00,1,1,1,1,1,1,20120101,A4639,HCPCS,INFRARED HT SYS REPLCMNT PAD,,,28 ,,NW,,,,,,$693.07,$0.00,1,1,1,1,1,1,20120101,A4639,HCPCS,INFRARED HT SYS REPLCMNT PAD,NU,,28 ,,NW,,,,,,$693.07,$0.00,1,1,1,1,1,1,20120101,A4640,HCPCS,ALTERNATING PRESSURE PAD,,,28 ,,NW,,,,,,$120.35,$0.00,1,1,1,1,1,1,20120101,A4640,HCPCS,ALTERNATING PRESSURE PAD,NU,,28 ,,NW,,,,,,$120.35,$0.00,1,1,1,1,1,1,20120101,A4640,HCPCS,ALTERNATING PRESSURE PAD,RR,,28 ,,NW,,,,,,$16.57,$0.00,1,1,1,1,1,1,20120101,A4640,HCPCS,ALTERNATING PRESSURE PAD,UE,,28 ,,NW,,,,,,$81.69,$0.00,1,1,1,1,1,1,20120101,A4641,HCPCS,RADIOPHARM DX AGENT NOC,,,28 ,,NW,,,,,,$30.00,$0.00,1,1,1,0,0,1,20120101,A4642,HCPCS,IN111 SATUMOMAB,,,28 ,,NW,,,,,,$25.30,$0.00,1,1,1,0,0,1,20120101,A4648,HCPCS,IMPLANTABLE TISSUE MARKER,,,28 ,,NW,,,,,,$242.58,$0.00,1,1,1,0,0,1,20120101,A4649,HCPCS,SURGICAL SUPPLIES,,,28 ,,NW,,,,,,$0.80,$0.00,1,1,1,0,0,1,20120101,A4651,HCPCS,CALIBRATED MICROCAP TUBE,,,28 ,,NW,,,,,,$4.12,$0.00,1,1,1,0,0,1,20120101,A4652,HCPCS,MICROCAPILLARY TUBE SEALANT,,,28 ,,NW,,,,,,$1.38,$0.00,1,1,1,0,0,1,20120101,A4653,HCPCS,PD CATHETER ANCHOR BELT,,,28 ,,NW,,,,,,$67.33,$0.00,1,1,1,0,0,1,20120101,A4657,HCPCS,SYRINGE W/WO NEEDLE,,,28 ,,NW,,,,,,$1.11,$0.00,1,1,1,0,0,1,20120101,A4660,HCPCS,SPHYG/BP APP W CUFF AND STET,,,28 ,,NW,,,,,,$43.43,$0.00,1,1,1,0,0,1,20120101,A4663,HCPCS,DIALYSIS BLOOD PRESSURE CUFF,,,28 ,,NW,,,,,,$47.36,$0.00,1,1,1,0,0,1,20120101,A4670,HCPCS,"AUTOMATIC BP MONITOR, DIAL",,,28 ,,NW,,,,,,$116.59,$0.00,1,1,1,0,0,1,20120101,A4671,HCPCS,DISPOSABLE CYCLER SET,,,28 ,,NW,,,,,,$50.48,$0.00,1,1,1,0,0,1,20120101,A4672,HCPCS,"DRAINAGE EXT LINE, DIALYSIS",,,28 ,,NW,,,,,,$20.13,$0.00,1,1,1,0,0,1,20120101,A4673,HCPCS,EXT LINE W EASY LOCK CONNECT,,,28 ,,NW,,,,,,$14.21,$0.00,1,1,1,0,0,1,20120101,A4674,HCPCS,"CHEM/ANTISEPT SOLUTION, 8OZ",,,28 ,,NW,,,,,,$2.69,$0.00,1,1,1,0,0,1,20120101,A4680,HCPCS,"ACTIVATED CARBON FILTER, EA",,,28 ,,NW,,,,,,$123.14,$0.00,1,1,1,0,0,1,20120101,A4690,HCPCS,"DIALYZER, EACH",,,28 ,,NW,,,,,,"$1,161.99",$0.00,1,1,1,0,0,1,20120101,A4706,HCPCS,BICARBONATE CONC SOL PER GAL,,,28 ,,NW,,,,,,$25.88,$0.00,1,1,1,0,0,1,20120101,A4707,HCPCS,BICARBONATE CONC POW PER PAC,,,28 ,,NW,,,,,,$16.01,$0.00,1,1,1,0,0,1,20120101,A4708,HCPCS,ACETATE CONC SOL PER GALLON,,,28 ,,NW,,,,,,$19.85,$0.00,1,1,1,0,0,1,20120101,A4709,HCPCS,ACID CONC SOL PER GALLON,,,28 ,,NW,,,,,,$38.00,$0.00,1,1,1,0,0,1,20120101,A4714,HCPCS,TREATED WATER PER GALLON,,,28 ,,NW,,,,,,$6.91,$0.00,1,1,1,0,0,1,20120101,A4719,HCPCS,"""Y SET"" TUBING",,,28 ,,NW,,,,,,$33.61,$0.00,1,1,1,0,0,1,20120101,A4720,HCPCS,DIALYSAT SOL FLD VOL > 249CC,,,28 ,,NW,,,,,,$28.15,$0.00,1,1,1,0,0,1,20120101,A4721,HCPCS,DIALYSAT SOL FLD VOL > 999CC,,,28 ,,NW,,,,,,$34.65,$0.00,1,1,1,0,0,1,20120101,A4722,HCPCS,DIALYS SOL FLD VOL > 1999CC,,,28 ,,NW,,,,,,$41.16,$0.00,1,1,1,0,0,1,20120101,A4723,HCPCS,DIALYS SOL FLD VOL > 2999CC,,,28 ,,NW,,,,,,$47.66,$0.00,1,1,1,0,0,1,20120101,A4724,HCPCS,DIALYS SOL FLD VOL > 3999CC,,,28 ,,NW,,,,,,$54.17,$0.00,1,1,1,0,0,1,20120101,A4725,HCPCS,DIALYS SOL FLD VOL > 4999CC,,,28 ,,NW,,,,,,$60.67,$0.00,1,1,1,0,0,1,20120101,A4726,HCPCS,DIALYS SOL FLD VOL > 5999CC,,,28 ,,NW,,,,,,$67.43,$0.00,1,1,1,0,0,1,20120101,A4728,HCPCS,"DIALYSATE SOLUTION, NON-DEX",,,28 ,,NW,,,,,,$17.40,$0.00,1,1,1,0,0,1,20120101,A4730,HCPCS,"FISTULA CANNULATION SET, EA",,,28 ,,NW,,,,,,$3.40,$0.00,1,1,1,0,0,1,20120101,A4736,HCPCS,"TOPICAL ANESTHETIC, PER GRAM",,,28 ,,NW,,,,,,$39.44,$0.00,1,1,1,0,0,1,20120101,A4737,HCPCS,INJ ANESTHETIC PER 10 ML,,,28 ,,NW,,,,,,$3.92,$0.00,1,1,1,0,0,1,20120101,A4740,HCPCS,SHUNT ACCESSORY,,,28 ,,NW,,,,,,$44.88,$0.00,1,1,1,0,0,1,20120101,A4750,HCPCS,ART OR VENOUS BLOOD TUBING,,,28 ,,NW,,,,,,$28.21,$0.00,1,1,1,0,0,1,20120101,A4755,HCPCS,COMB ART/VENOUS BLOOD TUBING,,,28 ,,NW,,,,,,$32.92,$0.00,1,1,1,0,0,1,20120101,A4760,HCPCS,"DIALYSATE SOL TEST KIT, EACH",,,28 ,,NW,,,,,,$161.09,$0.00,1,1,1,0,0,1,20120101,A4765,HCPCS,DIALYSATE CONC POW PER PACK,,,28 ,,NW,,,,,,$36.14,$0.00,1,1,1,0,0,1,20120101,A4766,HCPCS,DIALYSATE CONC SOL ADD 10 ML,,,28 ,,NW,,,,,,$38.80,$0.00,1,1,1,0,0,1,20120101,A4770,HCPCS,BLOOD COLLECTION TUBE/VACUUM,,,28 ,,NW,,,,,,$32.92,$0.00,1,1,1,0,0,1,20120101,A4771,HCPCS,SERUM CLOTTING TIME TUBE,,,28 ,,NW,,,,,,$10.77,$0.00,1,1,1,0,0,1,20120101,A4772,HCPCS,BLOOD GLUCOSE TEST STRIPS,,,28 ,,NW,,,,,,$49.26,$0.00,1,1,1,0,0,1,20120101,A4773,HCPCS,OCCULT BLOOD TEST STRIPS,,,28 ,,NW,,,,,,$31.24,$0.00,1,1,1,0,0,1,20120101,A4774,HCPCS,AMMONIA TEST STRIPS,,,28 ,,NW,,,,,,$13.46,$0.00,1,1,1,0,0,1,20120101,A4802,HCPCS,PROTAMINE SULFATE PER 50 MG,,,28 ,,NW,,,,,,$8.88,$0.00,1,1,1,0,0,1,20120101,A4860,HCPCS,DISPOSABLE CATHETER TIPS,,,28 ,,NW,,,,,,$7.31,$0.00,1,1,1,0,0,1,20120101,A4870,HCPCS,PLUMB/ELEC WK HM HEMO EQUIP,,,28 ,,NW,,,,,,$217.38,$0.00,1,1,1,0,0,1,20120101,A4890,HCPCS,REPAIR/MAINT CONT HEMO EQUIP,,,28 ,,NW,,,,,,$27.60,$0.00,1,1,1,0,0,1,20120101,A4911,HCPCS,DRAIN BAG/BOTTLE,,,28 ,,NW,,,,,,$14.20,$0.00,1,1,1,0,0,1,20120101,A4913,HCPCS,MISC DIALYSIS SUPPLIES NOC,,,28 ,,NW,,,,,,$116.59,$0.00,1,1,1,0,0,1,20120101,A4918,HCPCS,VENOUS PRESSURE CLAMP,,,28 ,,NW,,,,,,$6.91,$0.00,1,1,1,0,0,1,20120101,A4927,HCPCS,NON-STERILE GLOVES,,,28 ,,NW,,,,,,$7.58,$0.00,1,1,1,0,0,1,20120101,A4928,HCPCS,SURGICAL MASK,,,28 ,,NW,,,,,,$0.85,$0.00,1,1,1,0,0,1,20120101,A4929,HCPCS,"TOURNIQUET FOR DIALYSIS, EA",,,28 ,,NW,,,,,,$0.27,$0.00,1,1,1,0,0,1,20120101,A4930,HCPCS,"STERILE, GLOVES PER PAIR",,,28 ,,NW,,,,,,$1.43,$0.00,1,1,1,0,0,1,20120101,A4931,HCPCS,REUSABLE ORAL THERMOMETER,,,28 ,,NW,,,,,,$9.43,$0.00,1,1,1,0,0,1,20120101,A5051,HCPCS,POUCH CLSD W BARR ATTACHED,,,28 ,,NW,,,,,,$3.42,$0.00,1,1,1,0,0,1,20120101,A5052,HCPCS,CLSD OSTOMY POUCH W/O BARR,,,28 ,,NW,,,,,,$2.44,$0.00,1,1,1,0,0,1,20120101,A5053,HCPCS,CLSD OSTOMY POUCH FACEPLATE,,,28 ,,NW,,,,,,$2.73,$0.00,1,1,1,0,0,1,20120101,A5054,HCPCS,CLSD OSTOMY POUCH W/FLANGE,,,28 ,,NW,,,,,,$2.95,$0.00,1,1,1,0,0,1,20120101,A5055,HCPCS,STOMA CAP,,,28 ,,NW,,,,,,$2.30,$0.00,1,1,1,0,0,1,20120101,A5061,HCPCS,POUCH DRAINABLE W BARRIER AT,,,28 ,,NW,,,,,,$5.87,$0.00,1,1,1,0,0,1,20120101,A5062,HCPCS,DRNBLE OSTOMY POUCH W/O BARR,,,28 ,,NW,,,,,,$3.56,$0.00,1,1,1,0,0,1,20120101,A5063,HCPCS,DRAIN OSTOMY POUCH W/FLANGE,,,28 ,,NW,,,,,,$4.49,$0.00,1,1,1,0,0,1,20120101,A5071,HCPCS,URINARY POUCH W/BARRIER,,,28 ,,NW,,,,,,$10.03,$0.00,1,1,1,0,0,1,20120101,A5072,HCPCS,URINARY POUCH W/O BARRIER,,,28 ,,NW,,,,,,$5.66,$0.00,1,1,1,0,0,1,20120101,A5073,HCPCS,URINARY POUCH ON BARR W/FLNG,,,28 ,,NW,,,,,,$5.18,$0.00,1,1,1,0,0,1,20120101,A5081,HCPCS,CONTINENT STOMA PLUG,,,28 ,,NW,,,,,,$5.19,$0.00,1,1,1,0,0,1,20120101,A5082,HCPCS,CONTINENT STOMA CATHETER,,,28 ,,NW,,,,,,$17.42,$0.00,1,1,1,0,0,1,20120101,A5083,HCPCS,STOMA ABSORPTIVE COVER,,,28 ,,NW,,,,,,$1.02,$0.00,1,1,1,0,0,1,20120101,A5093,HCPCS,OSTOMY ACCESSORY CONVEX INSE,,,28 ,,NW,,,,,,$3.11,$0.00,1,1,1,0,0,1,20120101,A5102,HCPCS,BEDSIDE DRAIN BTL W/WO TUBE,,,28 ,,NW,,,,,,$28.47,$0.00,1,1,1,0,0,1,20120101,A5105,HCPCS,URINARY SUSPENSORY,,,28 ,,NW,,,,,,$45.03,$0.00,1,1,1,0,0,1,20120101,A5112,HCPCS,URINARY LEG BAG,,,28 ,,NW,,,,,,$38.73,$0.00,1,1,1,0,0,1,20120101,A5113,HCPCS,LATEX LEG STRAP,,,28 ,,NW,,,,,,$7.33,$0.00,1,1,1,0,0,1,20120101,A5114,HCPCS,FOAM/FABRIC LEG STRAP,,,28 ,,NW,,,,,,$14.15,$0.00,1,1,1,0,0,1,20120101,A5120,HCPCS,"SKIN BARRIER, WIPE OR SWAB",,,28 ,,NW,,,,,,$0.39,$0.00,1,1,1,0,0,1,20120101,A5120,HCPCS,"SKIN BARRIER, WIPE OR SWAB",AU,,28 ,,NW,,,,,,$0.39,$0.00,1,1,1,0,0,1,20120101,A5120,HCPCS,"SKIN BARRIER, WIPE OR SWAB",AV,,28 ,,NW,,,,,,$0.39,$0.00,1,1,1,0,0,1,20120101,A5121,HCPCS,SOLID SKIN BARRIER 6X6,,,28 ,,NW,,,,,,$11.82,$0.00,1,1,1,0,0,1,20120101,A5122,HCPCS,SOLID SKIN BARRIER 8X8,,,28 ,,NW,,,,,,$18.54,$0.00,1,1,1,0,0,1,20120101,A5126,HCPCS,DISK/FOAM PAD +OR- ADHESIVE,,,28 ,,NW,,,,,,$1.98,$0.00,1,1,1,0,0,1,20120101,A5131,HCPCS,APPLIANCE CLEANER,,,28 ,,NW,,,,,,$21.19,$0.00,1,1,1,0,0,1,20120101,A5200,HCPCS,PERCUTANEOUS CATHETER ANCHOR,,,28 ,,NW,,,,,,$17.67,$0.00,1,1,1,0,0,1,20120101,A5500,HCPCS,DIAB SHOE FOR DENSITY INSERT,,,28 ,,NW,,,,,,$96.70,$0.00,1,1,1,0,0,1,20120101,A5501,HCPCS,DIABETIC CUSTOM MOLDED SHOE,,,28 ,,NW,,,,,,$290.54,$0.00,1,1,1,0,0,1,20120101,A5503,HCPCS,DIABETIC SHOE W/ROLLER/ROCKR,,,28 ,,NW,,,,,,$48.36,$0.00,1,1,1,0,0,1,20120101,A5504,HCPCS,DIABETIC SHOE WITH WEDGE,,,28 ,,NW,,,,,,$48.36,$0.00,1,1,1,0,0,1,20120101,A5505,HCPCS,DIAB SHOE W/METATARSAL BAR,,,28 ,,NW,,,,,,$48.36,$0.00,1,1,1,0,0,1,20120101,A5506,HCPCS,DIABETIC SHOE W/OFF SET HEEL,,,28 ,,NW,,,,,,$48.36,$0.00,1,1,1,0,0,1,20120101,A5507,HCPCS,MODIFICATION DIABETIC SHOE,,,28 ,,NW,,,,,,$48.36,$0.00,1,1,1,0,0,1,20120101,A5508,HCPCS,DIABETIC DELUXE SHOE,,,28 ,,NW,,,,,,$48.36,$0.00,1,1,1,0,0,1,20120101,A5510,HCPCS,COMPRESSION FORM SHOE INSERT,,,28 ,,NW,,,,,,$46.62,$0.00,1,1,1,0,0,1,20120101,A5512,HCPCS,MULTI DEN INSERT DIRECT FORM,,,28 ,,NW,,,,,,$40.71,$0.00,1,1,1,0,0,1,20120101,A5513,HCPCS,MULTI DEN INSERT CUSTOM MOLD,,,28 ,,NW,,,,,,$59.72,$0.00,1,1,1,0,0,1,20120101,A6000,HCPCS,WOUND WARMING WOUND COVER,,,28 ,,NW,,,,,,$80.60,$0.00,1,1,1,0,0,1,20120101,A6010,HCPCS,COLLAGEN BASED WOUND FILLER,,,28 ,,NW,,,,,,$36.73,$0.00,1,1,1,0,0,1,20120101,A6011,HCPCS,COLLAGEN GEL/PASTE WOUND FIL,,,28 ,,NW,,,,,,$3.77,$0.00,1,1,1,0,0,1,20120101,A6021,HCPCS,COLLAGEN DRESSING <=16 SQ IN,,,28 ,,NW,,,,,,$27.09,$0.00,1,1,1,0,0,1,20120101,A6022,HCPCS,COLLAGEN DRSG>16<=48 SQ IN,,,28 ,,NW,,,,,,$27.09,$0.00,1,1,1,0,0,1,20120101,A6023,HCPCS,COLLAGEN DRESSING >48 SQ IN,,,28 ,,NW,,,,,,$191.16,$0.00,1,1,1,0,0,1,20120101,A6024,HCPCS,COLLAGEN DSG WOUND FILLER,,,28 ,,NW,,,,,,$10.34,$0.00,1,1,1,0,0,1,20120101,A6025,HCPCS,"SILICONE GEL SHEET, EACH",,,28 ,,NW,,,,,,$31.45,$0.00,1,1,1,0,0,1,20120101,A6154,HCPCS,WOUND POUCH EACH,,,28 ,,NW,,,,,,$20.54,$0.00,1,1,1,0,0,1,20120101,A6196,HCPCS,ALGINATE DRESSING <=16 SQ IN,,,28 ,,NW,,,,,,$12.30,$0.00,1,1,1,0,0,1,20120101,A6197,HCPCS,ALGINATE DRSG >16 <=48 SQ IN,,,28 ,,NW,,,,,,$22.65,$0.00,1,1,1,0,0,1,20120101,A6198,HCPCS,ALGINATE DRESSING > 48 SQ IN,,,28 ,,NW,,,,,,$32.99,$0.00,1,1,1,0,0,1,20120101,A6199,HCPCS,ALGINATE DRSG WOUND FILLER,,,28 ,,NW,,,,,,$8.82,$0.00,1,1,1,0,0,1,20120101,A6203,HCPCS,COMPOSITE DRSG <= 16 SQ IN,,,28 ,,NW,,,,,,$5.59,$0.00,1,1,1,0,0,1,20120101,A6204,HCPCS,COMPOSITE DRSG >16<=48 SQ IN,,,28 ,,NW,,,,,,$10.41,$0.00,1,1,1,0,0,1,20120101,A6205,HCPCS,COMPOSITE DRSG > 48 SQ IN,,,28 ,,NW,,,,,,$16.67,$0.00,1,1,1,0,0,1,20120101,A6206,HCPCS,CONTACT LAYER <= 16 SQ IN,,,28 ,,NW,,,,,,$8.15,$0.00,1,1,1,0,0,1,20120101,A6207,HCPCS,CONTACT LAYER >16<= 48 SQ IN,,,28 ,,NW,,,,,,$12.28,$0.00,1,1,1,0,0,1,20120101,A6208,HCPCS,CONTACT LAYER > 48 SQ IN,,,28 ,,NW,,,,,,$76.74,$0.00,1,1,1,0,0,1,20120101,A6209,HCPCS,FOAM DRSG <=16 SQ IN W/O BDR,,,28 ,,NW,,,,,,$12.50,$0.00,1,1,1,0,0,1,20120101,A6210,HCPCS,FOAM DRG >16<=48 SQ IN W/O B,,,28 ,,NW,,,,,,$26.04,$0.00,1,1,1,0,0,1,20120101,A6211,HCPCS,FOAM DRG > 48 SQ IN W/O BRDR,,,28 ,,NW,,,,,,$35.20,$0.00,1,1,1,0,0,1,20120101,A6212,HCPCS,FOAM DRG <=16 SQ IN W/BORDER,,,28 ,,NW,,,,,,$16.13,$0.00,1,1,1,0,0,1,20120101,A6213,HCPCS,FOAM DRG >16<=48 SQ IN W/BDR,,,28 ,,NW,,,,,,$28.29,$0.00,1,1,1,0,0,1,20120101,A6214,HCPCS,FOAM DRG > 48 SQ IN W/BORDER,,,28 ,,NW,,,,,,$38.24,$0.00,1,1,1,0,0,1,20120101,A6215,HCPCS,FOAM DRESSING WOUND FILLER,,,28 ,,NW,,,,,,$5.76,$0.00,1,1,1,0,0,1,20120101,A6216,HCPCS,NON-STERILE GAUZE<=16 SQ IN,,,28 ,,NW,,,,,,$0.08,$0.00,1,1,1,0,0,1,20120101,A6217,HCPCS,NON-STERILE GAUZE>16<=48 SQ,,,28 ,,NW,,,,,,$0.30,$0.00,1,1,1,0,0,1,20120101,A6218,HCPCS,NON-STERILE GAUZE > 48 SQ IN,,,28 ,,NW,,,,,,$0.88,$0.00,1,1,1,0,0,1,20120101,A6219,HCPCS,GAUZE <= 16 SQ IN W/BORDER,,,28 ,,NW,,,,,,$1.54,$0.00,1,1,1,0,0,1,20120101,A6220,HCPCS,GAUZE >16 <=48 SQ IN W/BORDR,,,28 ,,NW,,,,,,$4.28,$0.00,1,1,1,0,0,1,20120101,A6221,HCPCS,GAUZE > 48 SQ IN W/BORDER,,,28 ,,NW,,,,,,$7.08,$0.00,1,1,1,0,0,1,20120101,A6222,HCPCS,GAUZE <=16 IN NO W/SAL W/O B,,,28 ,,NW,,,,,,$3.53,$0.00,1,1,1,0,0,1,20120101,A6223,HCPCS,GAUZE >16<=48 NO W/SAL W/O B,,,28 ,,NW,,,,,,$4.01,$0.00,1,1,1,0,0,1,20120101,A6224,HCPCS,GAUZE > 48 IN NO W/SAL W/O B,,,28 ,,NW,,,,,,$6.01,$0.00,1,1,1,0,0,1,20120101,A6228,HCPCS,GAUZE <= 16 SQ IN WATER/SAL,,,28 ,,NW,,,,,,$3.59,$0.00,1,1,1,0,0,1,20120101,A6229,HCPCS,GAUZE >16<=48 SQ IN WATR/SAL,,,28 ,,NW,,,,,,$6.01,$0.00,1,1,1,0,0,1,20120101,A6230,HCPCS,GAUZE > 48 SQ IN WATER/SALNE,,,28 ,,NW,,,,,,$5.41,$0.00,1,1,1,0,0,1,20120101,A6231,HCPCS,HYDROGEL DSG<=16 SQ IN,,,28 ,,NW,,,,,,$7.79,$0.00,1,1,1,0,0,1,20120101,A6232,HCPCS,HYDROGEL DSG>16<=48 SQ IN,,,28 ,,NW,,,,,,$11.49,$0.00,1,1,1,0,0,1,20120101,A6233,HCPCS,HYDROGEL DRESSING >48 SQ IN,,,28 ,,NW,,,,,,$25.32,$0.00,1,1,1,0,0,1,20120101,A6234,HCPCS,HYDROCOLLD DRG <=16 W/O BDR,,,28 ,,NW,,,,,,$10.93,$0.00,1,1,1,0,0,1,20120101,A6235,HCPCS,HYDROCOLLD DRG >16<=48 W/O B,,,28 ,,NW,,,,,,$23.02,$0.00,1,1,1,0,0,1,20120101,A6236,HCPCS,HYDROCOLLD DRG > 48 IN W/O B,,,28 ,,NW,,,,,,$33.14,$0.00,1,1,1,0,0,1,20120101,A6237,HCPCS,HYDROCOLLD DRG <=16 IN W/BDR,,,28 ,,NW,,,,,,$13.24,$0.00,1,1,1,0,0,1,20120101,A6238,HCPCS,HYDROCOLLD DRG >16<=48 W/BDR,,,28 ,,NW,,,,,,$28.82,$0.00,1,1,1,0,0,1,20120101,A6239,HCPCS,HYDROCOLLD DRG > 48 IN W/BDR,,,28 ,,NW,,,,,,$39.90,$0.00,1,1,1,0,0,1,20120101,A6240,HCPCS,HYDROCOLLD DRG FILLER PASTE,,,28 ,,NW,,,,,,$18.59,$0.00,1,1,1,0,0,1,20120101,A6241,HCPCS,HYDROCOLLOID DRG FILLER DRY,,,28 ,,NW,,,,,,$4.27,$0.00,1,1,1,0,0,1,20120101,A6242,HCPCS,HYDROGEL DRG <=16 IN W/O BDR,,,28 ,,NW,,,,,,$10.13,$0.00,1,1,1,0,0,1,20120101,A6243,HCPCS,HYDROGEL DRG >16<=48 W/O BDR,,,28 ,,NW,,,,,,$18.66,$0.00,1,1,1,0,0,1,20120101,A6244,HCPCS,HYDROGEL DRG >48 IN W/O BDR,,,28 ,,NW,,,,,,$44.80,$0.00,1,1,1,0,0,1,20120101,A6245,HCPCS,HYDROGEL DRG <= 16 IN W/BDR,,,28 ,,NW,,,,,,$12.15,$0.00,1,1,1,0,0,1,20120101,A6246,HCPCS,HYDROGEL DRG >16<=48 IN W/B,,,28 ,,NW,,,,,,$16.34,$0.00,1,1,1,0,0,1,20120101,A6247,HCPCS,HYDROGEL DRG > 48 SQ IN W/B,,,28 ,,NW,,,,,,$29.78,$0.00,1,1,1,0,0,1,20120101,A6248,HCPCS,HYDROGEL DRSG GEL FILLER,,,28 ,,NW,,,,,,$22.46,$0.00,1,1,1,0,0,1,20120101,A6250,HCPCS,SKIN SEAL PROTECT MOISTURIZR,,,28 ,,NW,,,,,,$3.12,$0.00,1,1,1,0,0,1,20120101,A6251,HCPCS,ABSORPT DRG <=16 SQ IN W/O B,,,28 ,,NW,,,,,,$3.29,$0.00,1,1,1,0,0,1,20120101,A6252,HCPCS,ABSORPT DRG >16 <=48 W/O BDR,,,28 ,,NW,,,,,,$5.41,$0.00,1,1,1,0,0,1,20120101,A6253,HCPCS,ABSORPT DRG > 48 SQ IN W/O B,,,28 ,,NW,,,,,,$10.61,$0.00,1,1,1,0,0,1,20120101,A6254,HCPCS,ABSORPT DRG <=16 SQ IN W/BDR,,,28 ,,NW,,,,,,$1.98,$0.00,1,1,1,0,0,1,20120101,A6255,HCPCS,ABSORPT DRG >16<=48 IN W/BDR,,,28 ,,NW,,,,,,$5.04,$0.00,1,1,1,0,0,1,20120101,A6256,HCPCS,ABSORPT DRG > 48 SQ IN W/BDR,,,28 ,,NW,,,,,,$12.62,$0.00,1,1,1,0,0,1,20120101,A6257,HCPCS,TRANSPARENT FILM <= 16 SQ IN,,,28 ,,NW,,,,,,$2.52,$0.00,1,1,1,0,0,1,20120101,A6258,HCPCS,TRANSPARENT FILM >16<=48 IN,,,28 ,,NW,,,,,,$7.18,$0.00,1,1,1,0,0,1,20120101,A6259,HCPCS,TRANSPARENT FILM > 48 SQ IN,,,28 ,,NW,,,,,,$17.33,$0.00,1,1,1,0,0,1,20120101,A6260,HCPCS,WOUND CLEANSER ANY TYPE/SIZE,,,28 ,,NW,,,,,,$1.77,$0.00,1,1,1,0,0,1,20120101,A6261,HCPCS,WOUND FILLER GEL/PASTE /OZ,,,28 ,,NW,,,,,,$7.24,$0.00,1,1,1,0,0,1,20120101,A6262,HCPCS,WOUND FILLER DRY FORM / GRAM,,,28 ,,NW,,,,,,$1.77,$0.00,1,1,1,0,0,1,20120101,A6266,HCPCS,IMPREG GAUZE NO H20/SAL/YARD,,,28 ,,NW,,,,,,$3.18,$0.00,1,1,1,0,0,1,20120101,A6402,HCPCS,STERILE GAUZE <= 16 SQ IN,,,28 ,,NW,,,,,,$0.20,$0.00,1,1,1,0,0,1,20120101,A6403,HCPCS,STERILE GAUZE>16 <= 48 SQ IN,,,28 ,,NW,,,,,,$0.70,$0.00,1,1,1,0,0,1,20120101,A6404,HCPCS,STERILE GAUZE > 48 SQ IN,,,28 ,,NW,,,,,,$0.88,$0.00,1,1,1,0,0,1,20120101,A6407,HCPCS,"PACKING STRIPS, NON-IMPREG",,,28 ,,NW,,,,,,$3.10,$0.00,1,1,1,0,0,1,20120101,A6410,HCPCS,STERILE EYE PAD,,,28 ,,NW,,,,,,$0.63,$0.00,1,1,1,0,0,1,20120101,A6411,HCPCS,NON-STERILE EYE PAD,,,28 ,,NW,,,,,,$0.66,$0.00,1,1,1,0,0,1,20120101,A6412,HCPCS,OCCLUSIVE EYE PATCH,,,28 ,,NW,,,,,,$0.88,$0.00,1,1,1,0,0,1,20120101,A6413,HCPCS,"ADHESIVE BANDAGE, FIRST-AID",,,28 ,,NW,,,,,,$1.92,$0.00,1,1,1,0,0,1,20120101,A6441,HCPCS,"PAD BAND W>=3"" <5""/YD",,,28 ,,NW,,,,,,$1.08,$0.00,1,1,1,0,0,1,20120101,A6442,HCPCS,"CONFORM BAND N/S W<3""/YD",,,28 ,,NW,,,,,,$0.28,$0.00,1,1,1,0,0,1,20120101,A6443,HCPCS,"CONFORM BAND N/S W>=3""<5""/YD",,,28 ,,NW,,,,,,$0.46,$0.00,1,1,1,0,0,1,20120101,A6444,HCPCS,"CONFORM BAND N/S W>=5""/YD",,,28 ,,NW,,,,,,$0.91,$0.00,1,1,1,0,0,1,20120101,A6445,HCPCS,"CONFORM BAND S W <3""/YD",,,28 ,,NW,,,,,,$0.52,$0.00,1,1,1,0,0,1,20120101,A6446,HCPCS,"CONFORM BAND S W>=3"" <5""/YD",,,28 ,,NW,,,,,,$0.66,$0.00,1,1,1,0,0,1,20120101,A6447,HCPCS,"CONFORM BAND S W >=5""/YD",,,28 ,,NW,,,,,,$1.08,$0.00,1,1,1,0,0,1,20120101,A6448,HCPCS,"LT COMPRES BAND <3""/YD",,,28 ,,NW,,,,,,$1.90,$0.00,1,1,1,0,0,1,20120101,A6449,HCPCS,"LT COMPRES BAND >=3"" <5""/YD",,,28 ,,NW,,,,,,$2.89,$0.00,1,1,1,0,0,1,20120101,A6450,HCPCS,"LT COMPRES BAND >=5""/YD",,,28 ,,NW,,,,,,$5.56,$0.00,1,1,1,0,0,1,20120101,A6451,HCPCS,"MOD COMPRES BAND W>=3""<5""/YD",,,28 ,,NW,,,,,,$6.66,$0.00,1,1,1,0,0,1,20120101,A6452,HCPCS,"HIGH COMPRES BAND W>=3""<5""YD",,,28 ,,NW,,,,,,$9.87,$0.00,1,1,1,0,0,1,20120101,A6453,HCPCS,"SELF-ADHER BAND W <3""/YD",,,28 ,,NW,,,,,,$0.99,$0.00,1,1,1,0,0,1,20120101,A6454,HCPCS,"SELF-ADHER BAND W>=3"" <5""/YD",,,28 ,,NW,,,,,,$1.25,$0.00,1,1,1,0,0,1,20120101,A6455,HCPCS,"SELF-ADHER BAND >=5""/YD",,,28 ,,NW,,,,,,$2.28,$0.00,1,1,1,0,0,1,20120101,A6456,HCPCS,"ZINC PASTE BAND W >=3""<5""/YD",,,28 ,,NW,,,,,,$2.09,$0.00,1,1,1,0,0,1,20120101,A6457,HCPCS,TUBULAR DRESSING,,,28 ,,NW,,,,,,$1.86,$0.00,1,1,1,0,0,1,20120101,A6504,HCPCS,CMPRSBURNGARMENT GLOVE-WRIST,,,28 ,,NW,,,,,,$352.95,$0.00,1,1,1,0,0,1,20120101,A6505,HCPCS,CMPRSBURNGARMENT GLOVE-ELBOW,,,28 ,,NW,,,,,,$184.13,$0.00,1,1,1,0,0,1,20120101,A6506,HCPCS,CMPRSBURNGRMNT GLOVE-AXILLA,,,28 ,,NW,,,,,,$104.58,$0.00,1,1,1,0,0,1,20120101,A6507,HCPCS,CMPRS BURNGARMENT FOOT-KNEE,,,28 ,,NW,,,,,,$143.30,$0.00,1,1,1,0,0,1,20120101,A6509,HCPCS,COMPRES BURN GARMENT JACKET,,,28 ,,NW,,,,,,$674.86,$0.00,1,1,1,0,0,1,20120101,A6510,HCPCS,COMPRES BURN GARMENT LEOTARD,,,28 ,,NW,,,,,,$289.91,$0.00,1,1,1,0,0,1,20120101,A6511,HCPCS,COMPRES BURN GARMENT PANTY,,,28 ,,NW,,,,,,$625.97,$0.00,1,1,1,0,0,1,20120101,A6512,HCPCS,"COMPRES BURN GARMENT, NOC",,,28 ,,NW,,,,,,$16.78,$0.00,1,1,1,0,0,1,20120101,A6530,HCPCS,COMPRESSION STOCKING BK18-30,,,28 ,,NW,,,,,,$42.51,$0.00,1,1,1,0,0,1,20120101,A6531,HCPCS,COMPRESSION STOCKING BK30-40,,,28 ,,NW,,,,,,$48.65,$0.00,1,1,1,0,0,1,20120101,A6531,HCPCS,COMPRESSION STOCKING BK30-40,AW,,28 ,,NW,,,,,,$48.65,$0.00,1,1,1,0,0,1,20120101,A6532,HCPCS,COMPRESSION STOCKING BK40-50,,,28 ,,NW,,,,,,$65.81,$0.00,1,1,1,0,0,1,20120101,A6532,HCPCS,COMPRESSION STOCKING BK40-50,AW,,28 ,,NW,,,,,,$65.81,$0.00,1,1,1,0,0,1,20120101,A6533,HCPCS,GC STOCKING THIGHLNGTH 18-30,,,28 ,,NW,,,,,,$60.08,$0.00,1,1,1,0,0,1,20120101,A6534,HCPCS,GC STOCKING THIGHLNGTH 30-40,,,28 ,,NW,,,,,,$72.69,$0.00,1,1,1,0,0,1,20120101,A6535,HCPCS,GC STOCKING THIGHLNGTH 40-50,,,28 ,,NW,,,,,,$79.87,$0.00,1,1,1,0,0,1,20120101,A6536,HCPCS,GC STOCKING FULL LNGTH 18-30,,,28 ,,NW,,,,,,$67.77,$0.00,1,1,1,0,0,1,20120101,A6537,HCPCS,GC STOCKING FULL LNGTH 30-40,,,28 ,,NW,,,,,,$84.06,$0.00,1,1,1,0,0,1,20120101,A6538,HCPCS,GC STOCKING FULL LNGTH 40-50,,,28 ,,NW,,,,,,$113.41,$0.00,1,1,1,0,0,1,20120101,A6539,HCPCS,GC STOCKING WAISTLNGTH 18-30,,,28 ,,NW,,,,,,$141.01,$0.00,1,1,1,0,0,1,20120101,A6540,HCPCS,GC STOCKING WAISTLNGTH 30-40,,,28 ,,NW,,,,,,$161.38,$0.00,1,1,1,0,0,1,20120101,A6541,HCPCS,GC STOCKING WAISTLNGTH 40-50,,,28 ,,NW,,,,,,$186.58,$0.00,1,1,1,0,0,1,20120101,A6544,HCPCS,GC STOCKING GARTER BELT,,,28 ,,NW,,,,,,$70.78,$0.00,1,1,1,0,0,1,20120101,A6545,HCPCS,GRAD COMP NON-ELASTIC BK,,,28 ,,NW,,,,,,$89.29,$0.00,1,1,1,0,0,1,20120101,A6545,HCPCS,GRAD COMP NON-ELASTIC BK,AW,,28 ,,NW,,,,,,$89.29,$0.00,1,1,1,0,0,1,20120101,A6549,HCPCS,G COMPRESSION STOCKING,,,28 ,,NW,,,,,,$136.71,$0.00,1,1,1,0,0,1,20120101,A6550,HCPCS,NEG PRES WOUND THER DRSG SET,,,28 ,,NW,,,,,,$48.80,$0.00,1,1,1,0,0,1,20120101,A7000,HCPCS,DISPOSABLE CANISTER FOR PUMP,,,28 ,,NW,,,,,,$36.56,$0.00,1,1,1,0,0,1,20120101,A7000,HCPCS,DISPOSABLE CANISTER FOR PUMP,NU,,28 ,,NW,,,,,,$36.56,$0.00,1,1,1,0,0,1,20120101,A7001,HCPCS,NONDISPOSABLE PUMP CANISTER,,,28 ,,NW,,,,,,$62.40,$0.00,1,1,1,0,0,1,20120101,A7001,HCPCS,NONDISPOSABLE PUMP CANISTER,NU,,28 ,,NW,,,,,,$62.40,$0.00,1,1,1,0,0,1,20120101,A7002,HCPCS,TUBING USED W SUCTION PUMP,,,28 ,,NW,,,,,,$10.93,$0.00,1,1,1,0,0,1,20120101,A7002,HCPCS,TUBING USED W SUCTION PUMP,NU,,28 ,,NW,,,,,,$10.93,$0.00,1,1,1,0,0,1,20120101,A7003,HCPCS,NEBULIZER ADMINISTRATION SET,,,28 ,,NW,,,,,,$8.02,$0.00,1,1,1,0,0,1,20120101,A7003,HCPCS,NEBULIZER ADMINISTRATION SET,NU,,28 ,,NW,,,,,,$8.02,$0.00,1,1,1,0,0,1,20120101,A7004,HCPCS,DISPOSABLE NEBULIZER SML VOL,,,28 ,,NW,,,,,,$5.08,$0.00,1,1,1,0,0,1,20120101,A7004,HCPCS,DISPOSABLE NEBULIZER SML VOL,NU,,28 ,,NW,,,,,,$5.08,$0.00,1,1,1,0,0,1,20120101,A7005,HCPCS,NONDISPOSABLE NEBULIZER SET,,,28 ,,NW,,,,,,$58.14,$0.00,1,1,1,0,0,1,20120101,A7005,HCPCS,NONDISPOSABLE NEBULIZER SET,NU,,28 ,,NW,,,,,,$58.14,$0.00,1,1,1,0,0,1,20120101,A7006,HCPCS,FILTERED NEBULIZER ADMIN SET,,,28 ,,NW,,,,,,$22.82,$0.00,1,1,1,0,0,1,20120101,A7006,HCPCS,FILTERED NEBULIZER ADMIN SET,NU,,28 ,,NW,,,,,,$22.82,$0.00,1,1,1,0,0,1,20120101,A7007,HCPCS,LG VOL NEBULIZER DISPOSABLE,,,28 ,,NW,,,,,,$13.44,$0.00,1,1,1,0,0,1,20120101,A7007,HCPCS,LG VOL NEBULIZER DISPOSABLE,NU,,28 ,,NW,,,,,,$13.44,$0.00,1,1,1,0,0,1,20120101,A7008,HCPCS,DISPOSABLE NEBULIZER PREFILL,,,28 ,,NW,,,,,,$24.89,$0.00,1,1,1,0,0,1,20120101,A7008,HCPCS,DISPOSABLE NEBULIZER PREFILL,NU,,28 ,,NW,,,,,,$24.89,$0.00,1,1,1,0,0,1,20120101,A7009,HCPCS,NEBULIZER RESERVOIR BOTTLE,,,28 ,,NW,,,,,,$79.87,$0.00,1,1,1,0,0,1,20120101,A7009,HCPCS,NEBULIZER RESERVOIR BOTTLE,NU,,28 ,,NW,,,,,,$79.87,$0.00,1,1,1,0,0,1,20120101,A7010,HCPCS,DISPOSABLE CORRUGATED TUBING,,,28 ,,NW,,,,,,$46.50,$0.00,1,1,1,0,0,1,20120101,A7010,HCPCS,DISPOSABLE CORRUGATED TUBING,NU,,28 ,,NW,,,,,,$46.50,$0.00,1,1,1,0,0,1,20120101,A7011,HCPCS,NONDISPOS CORRUGATED TUBING,,,28 ,,NW,,,,,,$44.23,$0.00,1,1,1,0,0,1,20120101,A7012,HCPCS,NEBULIZER WATER COLLEC DEVIC,,,28 ,,NW,,,,,,$10.97,$0.00,1,1,1,0,0,1,20120101,A7012,HCPCS,NEBULIZER WATER COLLEC DEVIC,NU,,28 ,,NW,,,,,,$10.97,$0.00,1,1,1,0,0,1,20120101,A7013,HCPCS,DISPOSABLE COMPRESSOR FILTER,,,28 ,,NW,,,,,,$2.37,$0.00,1,1,1,0,0,1,20120101,A7013,HCPCS,DISPOSABLE COMPRESSOR FILTER,NU,,28 ,,NW,,,,,,$2.37,$0.00,1,1,1,0,0,1,20120101,A7014,HCPCS,COMPRESSOR NONDISPOS FILTER,,,28 ,,NW,,,,,,$13.41,$0.00,1,1,1,0,0,1,20120101,A7014,HCPCS,COMPRESSOR NONDISPOS FILTER,NU,,28 ,,NW,,,,,,$13.41,$0.00,1,1,1,0,0,1,20120101,A7015,HCPCS,AEROSOL MASK USED W NEBULIZE,,,28 ,,NW,,,,,,$5.46,$0.00,1,1,1,0,0,1,20120101,A7015,HCPCS,AEROSOL MASK USED W NEBULIZE,NU,,28 ,,NW,,,,,,$5.46,$0.00,1,1,1,0,0,1,20120101,A7016,HCPCS,NEBULIZER DOME & MOUTHPIECE,,,28 ,,NW,,,,,,$18.58,$0.00,1,1,1,0,0,1,20120101,A7016,HCPCS,NEBULIZER DOME & MOUTHPIECE,NU,,28 ,,NW,,,,,,$18.58,$0.00,1,1,1,0,0,1,20120101,A7017,HCPCS,NEBULIZER NOT USED W OXYGEN,,,28 ,,NW,,,,,,$310.44,$0.00,1,1,1,0,0,1,20120101,A7017,HCPCS,NEBULIZER NOT USED W OXYGEN,NU,,28 ,,NW,,,,,,$310.44,$0.00,1,1,1,0,0,1,20120101,A7017,HCPCS,NEBULIZER NOT USED W OXYGEN,RR,,28 ,,NW,,,,,,$30.22,$0.00,1,1,1,0,0,1,20120101,A7017,HCPCS,NEBULIZER NOT USED W OXYGEN,UE,,28 ,,NW,,,,,,$226.71,$0.00,1,1,1,0,0,1,20120101,A7018,HCPCS,WATER DISTILLED W/NEBULIZER,,,28 ,,NW,,,,,,$1.11,$0.00,1,1,1,0,0,1,20120101,A7020,HCPCS,"INTERFACE, COUGH STIM DEVICE",,,28 ,,NW,,,,,,$31.75,$0.00,1,1,1,0,0,1,20120101,A7020,HCPCS,"INTERFACE, COUGH STIM DEVICE",NU,,28 ,,NW,,,,,,$31.75,$0.00,1,1,1,0,0,1,20120101,A7020,HCPCS,"INTERFACE, COUGH STIM DEVICE",RR,,28 ,,NW,,,,,,$3.32,$0.00,1,1,1,0,0,1,20120101,A7020,HCPCS,"INTERFACE, COUGH STIM DEVICE",UE,,28 ,,NW,,,,,,$23.85,$0.00,1,1,1,0,0,1,20120101,A7025,HCPCS,REPLACE CHEST COMPRESS VEST,,,28 ,,NW,,,,,,"$1,062.10",$0.00,1,1,1,0,0,1,20120101,A7025,HCPCS,REPLACE CHEST COMPRESS VEST,NU,,28 ,,NW,,,,,,"$1,062.10",$0.00,1,1,1,0,0,1,20120101,A7026,HCPCS,REPLACE CHST CMPRSS SYS HOSE,,,28 ,,NW,,,,,,$58.07,$0.00,1,1,1,0,0,1,20120101,A7026,HCPCS,REPLACE CHST CMPRSS SYS HOSE,NU,,28 ,,NW,,,,,,$58.07,$0.00,1,1,1,0,0,1,20120101,A7027,HCPCS,COMBINATION ORAL/NASAL MASK,,,28 ,,NW,,,,,,$433.65,$0.00,1,1,1,0,0,1,20120101,A7027,HCPCS,COMBINATION ORAL/NASAL MASK,NU,,28 ,,NW,,,,,,$433.65,$0.00,1,1,1,0,0,1,20120101,A7028,HCPCS,REPL ORAL CUSHION COMBO MASK,,,28 ,,NW,,,,,,$99.37,$0.00,1,1,1,0,0,1,20120101,A7028,HCPCS,REPL ORAL CUSHION COMBO MASK,NU,,28 ,,NW,,,,,,$99.37,$0.00,1,1,1,0,0,1,20120101,A7029,HCPCS,REPL NASAL PILLOW COMB MASK,,,28 ,,NW,,,,,,$42.63,$0.00,1,1,1,0,0,1,20120101,A7029,HCPCS,REPL NASAL PILLOW COMB MASK,NU,,28 ,,NW,,,,,,$42.63,$0.00,1,1,1,0,0,1,20120101,A7030,HCPCS,CPAP FULL FACE MASK,,,28 ,,NW,,,,,,$381.76,$0.00,1,1,1,0,0,1,20120101,A7030,HCPCS,CPAP FULL FACE MASK,NU,,28 ,,NW,,,,,,$381.76,$0.00,1,1,1,0,0,1,20120101,A7031,HCPCS,REPLACEMENT FACEMASK INTERFA,,,28 ,,NW,,,,,,$125.83,$0.00,1,1,1,0,0,1,20120101,A7031,HCPCS,REPLACEMENT FACEMASK INTERFA,NU,,28 ,,NW,,,,,,$125.83,$0.00,1,1,1,0,0,1,20120101,A7032,HCPCS,REPLACEMENT NASAL CUSHION,,,28 ,,NW,,,,,,$69.28,$0.00,1,1,1,0,0,1,20120101,A7032,HCPCS,REPLACEMENT NASAL CUSHION,NU,,28 ,,NW,,,,,,$69.28,$0.00,1,1,1,0,0,1,20120101,A7033,HCPCS,REPLACEMENT NASAL PILLOWS,,,28 ,,NW,,,,,,$50.32,$0.00,1,1,1,0,0,1,20120101,A7033,HCPCS,REPLACEMENT NASAL PILLOWS,NU,,28 ,,NW,,,,,,$50.32,$0.00,1,1,1,0,0,1,20120101,A7034,HCPCS,NASAL APPLICATION DEVICE,,,28 ,,NW,,,,,,$228.87,$0.00,1,1,1,0,0,1,20120101,A7034,HCPCS,NASAL APPLICATION DEVICE,NU,,28 ,,NW,,,,,,$228.87,$0.00,1,1,1,0,0,1,20120101,A7035,HCPCS,POS AIRWAY PRESS HEADGEAR,,,28 ,,NW,,,,,,$64.91,$0.00,1,1,1,0,0,1,20120101,A7035,HCPCS,POS AIRWAY PRESS HEADGEAR,NU,,28 ,,NW,,,,,,$64.91,$0.00,1,1,1,0,0,1,20120101,A7036,HCPCS,POS AIRWAY PRESS CHINSTRAP,,,28 ,,NW,,,,,,$32.02,$0.00,1,1,1,0,0,1,20120101,A7036,HCPCS,POS AIRWAY PRESS CHINSTRAP,NU,,28 ,,NW,,,,,,$32.02,$0.00,1,1,1,0,0,1,20120101,A7037,HCPCS,POS AIRWAY PRESSURE TUBING,,,28 ,,NW,,,,,,$68.80,$0.00,1,1,1,0,0,1,20120101,A7037,HCPCS,POS AIRWAY PRESSURE TUBING,NU,,28 ,,NW,,,,,,$68.80,$0.00,1,1,1,0,0,1,20120101,A7038,HCPCS,POS AIRWAY PRESSURE FILTER,,,28 ,,NW,,,,,,$13.19,$0.00,1,1,1,0,0,1,20120101,A7038,HCPCS,POS AIRWAY PRESSURE FILTER,NU,,28 ,,NW,,,,,,$13.19,$0.00,1,1,1,0,0,1,20120101,A7039,HCPCS,"FILTER, NON DISPOSABLE W PAP",,,28 ,,NW,,,,,,$28.29,$0.00,1,1,1,0,0,1,20120101,A7039,HCPCS,"FILTER, NON DISPOSABLE W PAP",NU,,28 ,,NW,,,,,,$28.29,$0.00,1,1,1,0,0,1,20120101,A7040,HCPCS,ONE WAY CHEST DRAIN VALVE,,,28 ,,NW,,,,,,$45.34,$0.00,1,1,1,0,0,1,20120101,A7041,HCPCS,WATER SEAL DRAIN CONTAINER,,,28 ,,NW,,,,,,$79.29,$0.00,1,1,1,0,0,1,20120101,A7042,HCPCS,IMPLANTED PLEURAL CATHETER,,,28 ,,NW,,,,,,$181.43,$0.00,1,1,1,0,0,1,20120101,A7043,HCPCS,VACUUM DRAINAGEBOTTLE/TUBING,,,28 ,,NW,,,,,,$34.39,$0.00,1,1,1,0,0,1,20120101,A7044,HCPCS,PAP ORAL INTERFACE,,,28 ,,NW,,,,,,$235.92,$0.00,1,1,1,0,0,1,20120101,A7044,HCPCS,PAP ORAL INTERFACE,NU,,28 ,,NW,,,,,,$235.92,$0.00,1,1,1,0,0,1,20120101,A7045,HCPCS,REPL EXHALATION PORT FOR PAP,,,28 ,,NW,,,,,,$36.35,$0.00,1,1,1,0,0,1,20120101,A7045,HCPCS,REPL EXHALATION PORT FOR PAP,NU,,28 ,,NW,,,,,,$36.35,$0.00,1,1,1,0,0,1,20120101,A7045,HCPCS,REPL EXHALATION PORT FOR PAP,RR,,28 ,,NW,,,,,,$5.12,$0.00,1,1,1,0,0,1,20120101,A7045,HCPCS,REPL EXHALATION PORT FOR PAP,UE,,28 ,,NW,,,,,,$28.74,$0.00,1,1,1,0,0,1,20120101,A7046,HCPCS,"REPL WATER CHAMBER, PAP DEV",,,28 ,,NW,,,,,,$36.42,$0.00,1,1,1,0,0,1,20120101,A7046,HCPCS,"REPL WATER CHAMBER, PAP DEV",NU,,28 ,,NW,,,,,,$36.42,$0.00,1,1,1,0,0,1,20120101,A7501,HCPCS,TRACHEOSTOMA VALVE W DIAPHRA,,,28 ,,NW,,,,,,$108.51,$0.00,1,1,1,0,0,1,20120101,A7502,HCPCS,REPLACEMENT DIAPHRAGM/FPLATE,,,28 ,,NW,,,,,,$55.10,$0.00,1,1,1,0,0,1,20120101,A7503,HCPCS,HMES FILTER HOLDER OR CAP,,,28 ,,NW,,,,,,$17.71,$0.00,1,1,1,0,0,1,20120101,A7504,HCPCS,TRACHEOSTOMA HMES FILTER,,,28 ,,NW,,,,,,$1.08,$0.00,1,1,1,0,0,1,20120101,A7505,HCPCS,HMES OR TRACH VALVE HOUSING,,,28 ,,NW,,,,,,$7.81,$0.00,1,1,1,0,0,1,20120101,A7506,HCPCS,HMES/TRACHVALVE ADHESIVEDISK,,,28 ,,NW,,,,,,$0.54,$0.00,1,1,1,0,0,1,20120101,A7507,HCPCS,INTEGRATED FILTER & HOLDER,,,28 ,,NW,,,,,,$4.12,$0.00,1,1,1,0,0,1,20120101,A7508,HCPCS,HOUSING & INTEGRATED ADHESIV,,,28 ,,NW,,,,,,$4.76,$0.00,1,1,1,0,0,1,20120101,A7509,HCPCS,HEAT & MOISTURE EXCHANGE SYS,,,28 ,,NW,,,,,,$2.31,$0.00,1,1,1,0,0,1,20120101,A7520,HCPCS,TRACH/LARYN TUBE NON-CUFFED,,,28 ,,NW,,,,,,$72.75,$0.00,1,1,1,0,0,1,20120101,A7521,HCPCS,TRACH/LARYN TUBE CUFFED,,,28 ,,NW,,,,,,$72.11,$0.00,1,1,1,0,0,1,20120101,A7522,HCPCS,TRACH/LARYN TUBE STAINLESS,,,28 ,,NW,,,,,,$69.30,$0.00,1,1,1,0,0,1,20120101,A7523,HCPCS,TRACHEOSTOMY SHOWER PROTECT,,,28 ,,NW,,,,,,$9.09,$0.00,1,1,1,0,0,1,20120101,A7524,HCPCS,TRACHEOSTOMA STENT/STUD/BTTN,,,28 ,,NW,,,,,,$117.26,$0.00,1,1,1,0,0,1,20120101,A7525,HCPCS,TRACHEOSTOMY MASK,,,28 ,,NW,,,,,,$3.65,$0.00,1,1,1,0,0,1,20120101,A7526,HCPCS,TRACHEOSTOMY TUBE COLLAR,,,28 ,,NW,,,,,,$5.96,$0.00,1,1,1,0,0,1,20120101,A7527,HCPCS,TRACH/LARYN TUBE PLUG/STOP,,,28 ,,NW,,,,,,$6.33,$0.00,1,1,1,0,0,1,20120101,A8000,HCPCS,SOFT PROTECT HELMET PREFAB,,,28 ,,NW,,,,,,$358.69,$0.00,1,1,1,1,1,1,20120101,A8000,HCPCS,SOFT PROTECT HELMET PREFAB,NU,,28 ,,NW,,,,,,$358.69,$0.00,1,1,1,1,1,1,20120101,A8000,HCPCS,SOFT PROTECT HELMET PREFAB,RR,,28 ,,NW,,,,,,$33.72,$0.00,1,1,1,1,1,1,20120101,A8000,HCPCS,SOFT PROTECT HELMET PREFAB,UE,,28 ,,NW,,,,,,$262.95,$0.00,1,1,1,1,1,1,20120101,A8001,HCPCS,HARD PROTECT HELMET PREFAB,,,28 ,,NW,,,,,,$358.69,$0.00,1,1,1,1,1,1,20120101,A8001,HCPCS,HARD PROTECT HELMET PREFAB,NU,,28 ,,NW,,,,,,$358.69,$0.00,1,1,1,1,1,1,20120101,A8001,HCPCS,HARD PROTECT HELMET PREFAB,RR,,28 ,,NW,,,,,,$33.72,$0.00,1,1,1,1,1,1,20120101,A8001,HCPCS,HARD PROTECT HELMET PREFAB,UE,,28 ,,NW,,,,,,$262.95,$0.00,1,1,1,1,1,1,20120101,A8002,HCPCS,SOFT PROTECT HELMET CUSTOM,,,28 ,,NW,,,,,,$904.35,$0.00,1,1,1,1,1,1,20120101,A8002,HCPCS,SOFT PROTECT HELMET CUSTOM,NU,,28 ,,NW,,,,,,$904.35,$0.00,1,1,1,1,1,1,20120101,A8002,HCPCS,SOFT PROTECT HELMET CUSTOM,RR,,28 ,,NW,,,,,,$94.51,$0.00,1,1,1,1,1,1,20120101,A8002,HCPCS,SOFT PROTECT HELMET CUSTOM,UE,,28 ,,NW,,,,,,$679.37,$0.00,1,1,1,1,1,1,20120101,A8003,HCPCS,HARD PROTECT HELMET CUSTOM,,,28 ,,NW,,,,,,$904.35,$0.00,1,1,1,1,1,1,20120101,A8003,HCPCS,HARD PROTECT HELMET CUSTOM,NU,,28 ,,NW,,,,,,$904.35,$0.00,1,1,1,1,1,1,20120101,A8003,HCPCS,HARD PROTECT HELMET CUSTOM,RR,,28 ,,NW,,,,,,$74.58,$0.00,1,1,1,1,1,1,20120101,A8003,HCPCS,HARD PROTECT HELMET CUSTOM,UE,,28 ,,NW,,,,,,$679.37,$0.00,1,1,1,1,1,1,20120101,A8004,HCPCS,"REPL SOFT INTERFACE, HELMET",,,28 ,,NW,,,,,,$131.45,$0.00,1,1,1,1,1,1,20120101,A8004,HCPCS,"REPL SOFT INTERFACE, HELMET",NU,,28 ,,NW,,,,,,$131.45,$0.00,1,1,1,1,1,1,20120101,A8004,HCPCS,"REPL SOFT INTERFACE, HELMET",RR,,28 ,,NW,,,,,,$13.81,$0.00,1,1,1,1,1,1,20120101,A8004,HCPCS,"REPL SOFT INTERFACE, HELMET",UE,,28 ,,NW,,,,,,$98.79,$0.00,1,1,1,1,1,1,20120101,A9150,HCPCS,MISC/EXPER NON-PRESCRIPT DRU,,,29 ,,NW,,,,,,$13.65,$0.00,1,1,1,0,0,1,20120101,A9152,HCPCS,SINGLE VITAMIN NOS,,,29 ,,NW,,,,,,$36.64,$0.00,1,1,1,0,0,1,20120101,A9153,HCPCS,MULTI-VITAMIN NOS,,,29 ,,NW,,,,,,$31.12,$0.00,1,1,1,0,0,1,20120101,A9155,HCPCS,ARTIFICIAL SALIVA,,,29 ,,NW,,,,,,$7.21,$0.00,1,1,1,0,0,1,20120101,A9180,HCPCS,"LICE TREATMENT, TOPICAL",,,29 ,,NW,,,,,,$165.32,$0.00,1,1,1,0,0,1,20120101,A9270,HCPCS,NON-COVERED ITEM OR SERVICE,,,28 ,,NW,,,,,,$56.80,$0.00,1,1,1,0,0,1,20120101,A9273,HCPCS,HOT/COLD H2OBOT/CAP/COL/WRAP,,,28 ,,NW,,,,,,$19.63,$0.00,1,1,1,1,1,1,20120101,A9274,HCPCS,EXT AMB INSULIN DELIVERY SYS,,,28 ,,NW,,,,,,$48.58,$0.00,1,1,1,1,1,1,20120101,A9275,HCPCS,DISP HOME GLUCOSE MONITOR,,,28 ,,NW,,,,,,$17.16,$0.00,1,1,1,1,1,1,20120101,A9276,HCPCS,"DISPOSABLE SENSOR, CGM SYS",,,28 ,,NW,,,,,,$15.10,$0.00,1,1,1,1,1,1,20120101,A9277,HCPCS,"EXTERNAL TRANSMITTER, CGM",,,28 ,,NW,,,,,,$840.02,$0.00,1,1,1,1,1,1,20120101,A9278,HCPCS,"EXTERNAL RECEIVER, CGM SYS",,,28 ,,NW,,,,,,"$1,199.56",$0.00,1,1,1,1,1,1,20120101,A9279,HCPCS,MONITORING FEATURE/DEVICENOC,,,28 ,,NW,,,,,,$46.25,$0.00,1,1,1,1,1,1,20120101,A9280,HCPCS,"ALERT DEVICE, NOC",,,28 ,,NW,,,,,,$46.25,$0.00,1,1,1,1,1,1,20120101,A9281,HCPCS,REACHING/GRABBING DEVICE,,,28 ,,NW,,,,,,$50.96,$0.00,1,1,1,1,1,1,20120101,A9282,HCPCS,WIG ANY TYPE,,,28 ,,NW,,,,,,$361.98,$0.00,1,1,1,1,1,1,20120101,A9284,HCPCS,NON-ELECTRONIC SPIROMETER,,,28 ,,NW,,,,,,$110.63,$0.00,1,1,1,1,1,1,20120101,A9300,HCPCS,EXERCISE EQUIPMENT,,,28 ,,NW,,,,,,$12.68,$0.00,1,1,1,1,1,1,20120101,A9500,HCPCS,TC99M SESTAMIBI,,,28 ,,NW,,,,,,$191.51,$0.00,1,1,1,0,0,1,20120101,A9501,HCPCS,TECHNETIUM TC-99M TEBOROXIME,,,28 ,,NW,,,,,,$398.38,$0.00,1,1,1,0,0,1,20120101,A9502,HCPCS,TC99M TETROFOSMIN,,,28 ,,NW,,,,,,$223.42,$0.00,1,1,1,0,0,1,20120101,A9503,HCPCS,TC99M MEDRONATE,,,28 ,,NW,,,,,,$47.24,$0.00,1,1,1,0,0,1,20120101,A9504,HCPCS,TC99M APCITIDE,,,28 ,,NW,,,,,,$284.80,$0.00,1,1,1,0,0,1,20120101,A9505,HCPCS,TL201 THALLIUM,,,28 ,,NW,,,,,,$89.37,$0.00,1,1,1,0,0,1,20120101,A9507,HCPCS,IN111 CAPROMAB,,,28 ,,NW,,,,,,"$4,705.96",$0.00,1,1,1,0,0,1,20120101,A9508,HCPCS,"I131 IODOBENGUATE, DX",,,28 ,,NW,,,,,,$42.89,$0.00,1,1,1,0,0,1,20120101,A9509,HCPCS,IODINE I-123 SOD IODIDE MIL,,,28 ,,NW,,,,,,$98.30,$0.00,1,1,1,0,0,1,20120101,A9510,HCPCS,TC99M DISOFENIN,,,28 ,,NW,,,,,,$82.99,$0.00,1,1,1,0,0,1,20120101,A9512,HCPCS,TC99M PERTECHNETATE,,,28 ,,NW,,,,,,$3.83,$0.00,1,1,1,0,0,1,20120101,A9516,HCPCS,IODINE I-123 SOD IODIDE MIC,,,28 ,,NW,,,,,,$1.24,$0.00,1,1,1,0,0,1,20120101,A9517,HCPCS,"I131 IODIDE CAP, RX",,,28 ,,NW,,,,,,$50.06,$0.00,1,1,1,0,0,1,20120101,A9521,HCPCS,TC99M EXAMETAZIME,,,28 ,,NW,,,,,,"$1,088.10",$0.00,1,1,1,0,0,1,20120101,A9524,HCPCS,"I131 SERUM ALBUMIN, DX",,,28 ,,NW,,,,,,$219.11,$0.00,1,1,1,0,0,1,20120101,A9526,HCPCS,NITROGEN N-13 AMMONIA,,,28 ,,NW,,,,,,$407.59,$0.00,1,1,1,0,0,1,20120101,A9527,HCPCS,IODINE I-125 SODIUM IODIDE,,,28 ,,NW,,,,,,$132.79,$0.00,1,1,1,0,0,1,20120101,A9528,HCPCS,"IODINE I-131 IODIDE CAP, DX",,,28 ,,NW,,,,,,$238.18,$0.00,1,1,1,0,0,1,20120101,A9529,HCPCS,"I131 IODIDE SOL, DX",,,28 ,,NW,,,,,,$67.73,$0.00,1,1,1,0,0,1,20120101,A9530,HCPCS,"I131 IODIDE SOL, RX",,,28 ,,NW,,,,,,$37.39,$0.00,1,1,1,0,0,1,20120101,A9531,HCPCS,I131 MAX 100UCI,,,28 ,,NW,,,,,,$16.11,$0.00,1,1,1,0,0,1,20120101,A9532,HCPCS,"I125 SERUM ALBUMIN, DX",,,28 ,,NW,,,,,,$573.17,$0.00,1,1,1,0,0,1,20120101,A9536,HCPCS,TC99M DEPREOTIDE,,,28 ,,NW,,,,,,$730.36,$0.00,1,1,1,0,0,1,20120101,A9537,HCPCS,TC99M MEBROFENIN,,,28 ,,NW,,,,,,$80.51,$0.00,1,1,1,0,0,1,20120101,A9538,HCPCS,TC99M PYROPHOSPHATE,,,28 ,,NW,,,,,,$52.74,$0.00,1,1,1,0,0,1,20120101,A9539,HCPCS,TC99M PENTETATE,,,28 ,,NW,,,,,,$49.79,$0.00,1,1,1,0,0,1,20120101,A9540,HCPCS,TC99M MAA,,,28 ,,NW,,,,,,$51.94,$0.00,1,1,1,0,0,1,20120101,A9541,HCPCS,TC99M SULFUR COLLOID,,,28 ,,NW,,,,,,$79.16,$0.00,1,1,1,0,0,1,20120101,A9546,HCPCS,CO57/58,,,28 ,,NW,,,,,,$27.52,$0.00,1,1,1,0,0,1,20120101,A9547,HCPCS,IN111 OXYQUINOLINE,,,28 ,,NW,,,,,,$826.47,$0.00,1,1,1,0,0,1,20120101,A9548,HCPCS,IN111 PENTETATE,,,28 ,,NW,,,,,,$495.88,$0.00,1,1,1,0,0,1,20120101,A9550,HCPCS,TC99M GLUCEPTATE,,,28 ,,NW,,,,,,$45.15,$0.00,1,1,1,0,0,1,20120101,A9551,HCPCS,TC99M SUCCIMER,,,28 ,,NW,,,,,,$371.82,$0.00,1,1,1,0,0,1,20120101,A9552,HCPCS,F18 FDG,,,28 ,,NW,,,,,,$638.36,$0.00,1,1,1,0,0,1,20120101,A9554,HCPCS,"I125 IOTHALAMATE, DX",,,28 ,,NW,,,,,,$957.53,$0.00,1,1,1,0,0,1,20120101,A9555,HCPCS,RB82 RUBIDIUM,,,28 ,,NW,,,,,,$555.37,$0.00,1,1,1,0,0,1,20120101,A9556,HCPCS,GA67 GALLIUM,,,28 ,,NW,,,,,,$61.95,$0.00,1,1,1,0,0,1,20120101,A9557,HCPCS,TC99M BICISATE,,,28 ,,NW,,,,,,$331.98,$0.00,1,1,1,0,0,1,20120101,A9558,HCPCS,XE133 XENON 10MCI,,,28 ,,NW,,,,,,$148.10,$0.00,1,1,1,0,0,1,20120101,A9560,HCPCS,TC99M LABELED RBC,,,28 ,,NW,,,,,,$114.90,$0.00,1,1,1,0,0,1,20120101,A9561,HCPCS,TC99M OXIDRONATE,,,28 ,,NW,,,,,,$61.28,$0.00,1,1,1,0,0,1,20120101,A9562,HCPCS,TC99M MERTIATIDE,,,28 ,,NW,,,,,,$402.16,$0.00,1,1,1,0,0,1,20120101,A9564,HCPCS,P32 CHROMIC PHOSPHATE,,,28 ,,NW,,,,,,$423.15,$0.00,1,1,1,0,0,1,20120101,A9567,HCPCS,TECHNETIUM TC-99M AEROSOL,,,28 ,,NW,,,,,,$62.22,$0.00,1,1,1,0,0,1,20120101,A9569,HCPCS,TECHNETIUM TC-99M AUTO WBC,,,28 ,,NW,,,,,,$2.66,$0.00,1,1,1,0,0,1,20120101,A9570,HCPCS,INDIUM IN-111 AUTO WBC,,,28 ,,NW,,,,,,$307.64,$0.00,1,1,1,0,0,1,20120101,A9571,HCPCS,INDIUM IN-111 AUTO PLATELET,,,28 ,,NW,,,,,,$13.75,$0.00,1,1,1,0,0,1,20120101,A9572,HCPCS,INDIUM IN-111 PENTETREOTIDE,,,28 ,,NW,,,,,,"$1,827.03",$0.00,1,1,1,0,0,1,20120101,A9576,HCPCS,INJ PROHANCE MULTIPACK,,,28 ,,NW,,,,,,$9.58,$0.00,1,1,1,0,0,1,20120101,A9577,HCPCS,INJ MULTIHANCE,,,28 ,,NW,,,,,,$6.38,$0.00,1,1,1,0,0,1,20120101,A9578,HCPCS,INJ MULTIHANCE MULTIPACK,,,28 ,,NW,,,,,,$10.65,$0.00,1,1,1,0,0,1,20120101,A9579,HCPCS,"GAD-BASE MR CONTRAST NOS,1ML",,,28 ,,NW,,,,,,$12.68,$0.00,1,1,1,0,0,1,20120101,A9580,HCPCS,SODIUM FLUORIDE F-18,,,28 ,,NW,,,,,,$510.69,$0.00,1,1,1,0,0,1,20120101,A9581,HCPCS,GADOXETATE DISODIUM INJ,,,28 ,,NW,,,,,,$52.16,$0.00,1,1,1,0,0,1,20120101,A9582,HCPCS,IODINE I-123 IOBENGUANE,,,28 ,,NW,,,,,,$2.87,$0.00,1,1,1,0,0,1,20120101,A9583,HCPCS,GADOFOSVESET TRISODIUM INJ,,,28 ,,NW,,,,,,"$6,060.78",$0.00,1,1,1,0,0,1,20120101,A9600,HCPCS,SR89 STRONTIUM,,,28 ,,NW,,,,,,"$1,069.45",$0.00,1,1,1,0,0,1,20120101,A9604,HCPCS,SM 153 LEXIDRONAM,,,28 ,,NW,,,,,,"$10,015.38",$0.00,1,1,1,0,0,1,20120101,A9698,HCPCS,NON-RAD CONTRAST MATERIALNOC,,,28 ,,NW,,,,,,$29.47,$0.00,1,1,1,0,0,1,20120101,A9699,HCPCS,RADIOPHARM RX AGENT NOC,,,28 ,,NW,,,,,,$29.47,$0.00,1,1,1,0,0,1,20120101,A9700,HCPCS,ECHOCARDIOGRAPHY CONTRAST,,,28 ,,NW,,,,,,$190.36,$0.00,1,1,1,0,0,1,20120101,A9900,HCPCS,SUPPLY/ACCESSORY/SERVICE,,,28 ,,NW,,,,,,$56.27,$0.00,1,1,1,0,0,1,20120101,A9901,HCPCS,DELIVERY/SET UP/DISPENSING,,,28 ,,NW,,,,,,$175.98,$0.00,1,1,1,0,0,1,20120101,A9999,HCPCS,"DME SUPPLY OR ACCESSORY, NOS",,,28 ,,NW,,,,,,$29.47,$0.00,1,1,1,0,0,1,20120101,B4034,HCPCS,ENTER FEED SUPKIT SYR BY DAY,,,28 ,,NW,,,,,,$11.55,$0.00,1,1,1,0,0,1,20120101,B4035,HCPCS,ENTERAL FEED SUPP PUMP PER D,,,28 ,,NW,,,,,,$22.10,$0.00,1,1,1,0,0,1,20120101,B4036,HCPCS,ENTERAL FEED SUP KIT GRAV BY,,,28 ,,NW,,,,,,$15.15,$0.00,1,1,1,0,0,1,20120101,B4081,HCPCS,ENTERAL NG TUBING W/ STYLET,,,28 ,,NW,,,,,,$43.05,$0.00,1,1,1,0,0,1,20120101,B4082,HCPCS,ENTERAL NG TUBING W/O STYLET,,,28 ,,NW,,,,,,$30.58,$0.00,1,1,1,0,0,1,20120101,B4083,HCPCS,ENTERAL STOMACH TUBE LEVINE,,,28 ,,NW,,,,,,$4.61,$0.00,1,1,1,0,0,1,20120101,B4087,HCPCS,"GASTRO/JEJUNO TUBE, STD",,,28 ,,NW,,,,,,$74.66,$0.00,1,1,1,0,0,1,20120101,B4088,HCPCS,"GASTRO/JEJUNO TUBE, LOW-PRO",,,28 ,,NW,,,,,,$74.66,$0.00,1,1,1,0,0,1,20120101,B4100,HCPCS,FOOD THICKENER ORAL,,,28 ,,NW,,,,,,$1.05,$0.00,1,1,1,0,0,1,20120101,B4102,HCPCS,EF ADULT FLUIDS AND ELECTRO,,,28 ,,NW,,,,,,$10.69,$0.00,1,1,1,0,0,1,20120101,B4103,HCPCS,EF PED FLUID AND ELECTROLYTE,,,28 ,,NW,,,,,,$11.77,$0.00,1,1,1,0,0,1,20120101,B4104,HCPCS,ADDITIVE FOR ENTERAL FORMULA,,,28 ,,NW,,,,,,$9.12,$0.00,1,1,1,0,0,1,20120101,B4149,HCPCS,EF BLENDERIZED FOODS,,,28 ,,NW,,,,,,$2.90,$0.00,1,1,1,0,0,1,20120101,B4150,HCPCS,EF COMPLET W/INTACT NUTRIENT,,,28 ,,NW,,,,,,$1.19,$0.00,1,1,1,0,0,1,20120101,B4152,HCPCS,EF CALORIE DENSE>/=1.5KCAL,,,28 ,,NW,,,,,,$0.98,$0.00,1,1,1,0,0,1,20120101,B4153,HCPCS,EF HYDROLYZED/AMINO ACIDS,,,28 ,,NW,,,,,,$3.55,$0.00,1,1,1,0,0,1,20120101,B4154,HCPCS,EF SPEC METABOLIC NONINHERIT,,,28 ,,NW,,,,,,$2.24,$0.00,1,1,1,0,0,1,20120101,B4155,HCPCS,EF INCOMPLETE/MODULAR,,,28 ,,NW,,,,,,$1.72,$0.00,1,1,1,0,0,1,20120101,B4157,HCPCS,EF SPECIAL METABOLIC INHERIT,,,28 ,,NW,,,,,,$9.21,$0.00,1,1,1,0,0,1,20120101,B4158,HCPCS,EF PED COMPLETE INTACT NUT,,,28 ,,NW,,,,,,$4.06,$0.00,1,1,1,0,0,1,20120101,B4159,HCPCS,EF PED COMPLETE SOY BASED,,,28 ,,NW,,,,,,$4.51,$0.00,1,1,1,0,0,1,20120101,B4160,HCPCS,EF PED CALORIC DENSE>/=0.7KC,,,28 ,,NW,,,,,,$3.80,$0.00,1,1,1,0,0,1,20120101,B4161,HCPCS,EF PED HYDROLYZED/AMINO ACID,,,28 ,,NW,,,,,,$9.91,$0.00,1,1,1,0,0,1,20120101,B4162,HCPCS,EF PED SPECMETABOLIC INHERIT,,,28 ,,NW,,,,,,$14.02,$0.00,1,1,1,0,0,1,20120101,B4164,HCPCS,PARENTERAL 50% DEXTROSE SOLU,,,28 ,,NW,,,,,,$37.41,$0.00,1,1,1,0,0,1,20120101,B4168,HCPCS,PARENTERAL SOL AMINO ACID 3.,,,28 ,,NW,,,,,,$57.07,$0.00,1,1,1,0,0,1,20120101,B4172,HCPCS,PARENTERAL SOL AMINO ACID 5.,,,28 ,,NW,,,,,,$117.69,$0.00,1,1,1,0,0,1,20120101,B4176,HCPCS,PARENTERAL SOL AMINO ACID 7-,,,28 ,,NW,,,,,,$128.81,$0.00,1,1,1,0,0,1,20120101,B4178,HCPCS,PARENTERAL SOL AMINO ACID >,,,28 ,,NW,,,,,,$139.93,$0.00,1,1,1,0,0,1,20120101,B4180,HCPCS,PARENTERAL SOL CARB > 50%,,,28 ,,NW,,,,,,$56.09,$0.00,1,1,1,0,0,1,20120101,B4185,HCPCS,PARENTERAL SOL 10 GM LIPIDS,,,28 ,,NW,,,,,,$23.97,$0.00,1,1,1,0,0,1,20120101,B4189,HCPCS,PARENTERAL SOL AMINO ACID &,,,28 ,,NW,,,,,,$443.82,$0.00,1,1,1,0,0,1,20120101,B4193,HCPCS,PARENTERAL SOL 52-73 GM PROT,,,28 ,,NW,,,,,,$575.14,$0.00,1,1,1,0,0,1,20120101,B4197,HCPCS,PARENTERAL SOL 74-100 GM PRO,,,28 ,,NW,,,,,,$701.40,$0.00,1,1,1,0,0,1,20120101,B4199,HCPCS,PARENTERAL SOL > 100GM PROTE,,,28 ,,NW,,,,,,$802.27,$0.00,1,1,1,0,0,1,20120101,B4216,HCPCS,PARENTERAL NUTRITION ADDITIV,,,28 ,,NW,,,,,,$16.44,$0.00,1,1,1,0,0,1,20120101,B4220,HCPCS,PARENTERAL SUPPLY KIT PREMIX,,,28 ,,NW,,,,,,$17.05,$0.00,1,1,1,0,0,1,20120101,B4222,HCPCS,PARENTERAL SUPPLY KIT HOMEMI,,,28 ,,NW,,,,,,$21.04,$0.00,1,1,1,0,0,1,20120101,B4224,HCPCS,PARENTERAL ADMINISTRATION KI,,,28 ,,NW,,,,,,$57.67,$0.00,1,1,1,0,0,1,20120101,B5000,HCPCS,PARENTERAL SOL RENAL-AMIROSY,,,28 ,,NW,,,,,,$25.37,$0.00,1,1,1,0,0,1,20120101,B5100,HCPCS,PARENTERAL SOL HEPATIC-FREAM,,,28 ,,NW,,,,,,$9.86,$0.00,1,1,1,0,0,1,20120101,B5200,HCPCS,PARENTERAL SOL STRES-BRNCH C,,,28 ,,NW,,,,,,$549.02,$0.00,1,1,1,0,0,1,20120101,B9000,HCPCS,ENTER INFUSION PUMP W/O ALRM,,,28 ,,NW,,,,,,"$2,750.75",$0.00,1,1,1,0,0,1,20120101,B9000,HCPCS,ENTER INFUSION PUMP W/O ALRM,NU,,28 ,,NW,,,,,,"$2,750.75",$0.00,1,1,1,0,0,1,20120101,B9000,HCPCS,ENTER INFUSION PUMP W/O ALRM,RR,,28 ,,NW,,,,,,$247.71,$0.00,1,1,1,0,0,1,20120101,B9000,HCPCS,ENTER INFUSION PUMP W/O ALRM,UE,,28 ,,NW,,,,,,"$2,061.67",$0.00,1,1,1,0,0,1,20120101,B9002,HCPCS,ENTERAL INFUSION PUMP W/ ALA,,,28 ,,NW,,,,,,"$2,750.75",$0.00,1,1,1,0,0,1,20120101,B9002,HCPCS,ENTERAL INFUSION PUMP W/ ALA,NU,,28 ,,NW,,,,,,"$2,750.75",$0.00,1,1,1,0,0,1,20120101,B9002,HCPCS,ENTERAL INFUSION PUMP W/ ALA,RR,,28 ,,NW,,,,,,$261.38,$0.00,1,1,1,0,0,1,20120101,B9002,HCPCS,ENTERAL INFUSION PUMP W/ ALA,UE,,28 ,,NW,,,,,,"$2,061.67",$0.00,1,1,1,0,0,1,20120101,B9004,HCPCS,PARENTERAL INFUS PUMP PORTAB,,,28 ,,NW,,,,,,"$6,373.39",$0.00,1,1,1,0,0,1,20120101,B9004,HCPCS,PARENTERAL INFUS PUMP PORTAB,NU,,28 ,,NW,,,,,,"$6,373.39",$0.00,1,1,1,0,0,1,20120101,B9004,HCPCS,PARENTERAL INFUS PUMP PORTAB,RR,,28 ,,NW,,,,,,"$1,004.27",$0.00,1,1,1,0,0,1,20120101,B9004,HCPCS,PARENTERAL INFUS PUMP PORTAB,UE,,28 ,,NW,,,,,,"$4,778.63",$0.00,1,1,1,0,0,1,20120101,B9006,HCPCS,PARENTERAL INFUS PUMP STATIO,,,28 ,,NW,,,,,,"$6,373.39",$0.00,1,1,1,0,0,1,20120101,B9006,HCPCS,PARENTERAL INFUS PUMP STATIO,NU,,28 ,,NW,,,,,,"$6,373.39",$0.00,1,1,1,0,0,1,20120101,B9006,HCPCS,PARENTERAL INFUS PUMP STATIO,RR,,28 ,,NW,,,,,,"$1,004.27",$0.00,1,1,1,0,0,1,20120101,B9006,HCPCS,PARENTERAL INFUS PUMP STATIO,UE,,28 ,,NW,,,,,,"$4,778.63",$0.00,1,1,1,0,0,1,20120101,B9998,HCPCS,ENTERAL SUPP NOT OTHERWISE C,,,28 ,,NW,,,,,,$261.38,$0.00,1,1,1,0,0,1,20120101,B9999,HCPCS,PARENTERAL SUPP NOT OTHRWS C,,,28 ,,NW,,,,,,$261.38,$0.00,1,1,1,0,0,1,20120101,C1300,HCPCS,HYPERBARIC OXYGEN,,,28 ,,NW,,,,,,$592.53,$0.00,1,1,1,1,1,1,20120101,C1713,HCPCS,"ANCHOR/SCREW BN/BN,TIS/BN",,,28 ,,NW,,,,,,"$1,145.97",$0.00,1,1,1,1,1,1,20120101,C1714,HCPCS,"CATH, TRANS ATHERECTOMY, DIR",,,28 ,,NW,,,,,,$243.35,$0.00,1,1,1,1,1,1,20120101,C1715,HCPCS,BRACHYTHERAPY NEEDLE,,,28 ,,NW,,,,,,$41.27,$0.00,1,1,1,1,1,1,20120101,C1717,HCPCS,"BRACHYTX, NON-STR,HDR IR-192",,,28 ,,NW,,,,,,$915.12,$0.00,1,1,1,1,1,1,20120101,C1721,HCPCS,"AICD, DUAL CHAMBER",,,28 ,,NW,,,,,,"$26,885.90",$0.00,1,1,1,1,1,1,20120101,C1722,HCPCS,"AICD, SINGLE CHAMBER",,,28 ,,NW,,,,,,"$22,206.96",$0.00,1,1,1,1,1,1,20120101,C1724,HCPCS,"CATH, TRANS ATHEREC,ROTATION",,,28 ,,NW,,,,,,"$2,719.45",$0.00,1,1,1,1,1,1,20120101,C1725,HCPCS,"CATH, TRANSLUMIN NON-LASER",,,28 ,,NW,,,,,,"$1,152.29",$0.00,1,1,1,1,1,1,20120101,C1726,HCPCS,"CATH, BAL DIL, NON-VASCULAR",,,28 ,,NW,,,,,,$443.70,$0.00,1,1,1,1,1,1,20120101,C1727,HCPCS,"CATH, BAL TIS DIS, NON-VAS",,,28 ,,NW,,,,,,$819.63,$0.00,1,1,1,1,1,1,20120101,C1729,HCPCS,"CATH, DRAINAGE",,,28 ,,NW,,,,,,$203.38,$0.00,1,1,1,1,1,1,20120101,C1730,HCPCS,"CATH, EP, 19 OR FEW ELECT",,,28 ,,NW,,,,,,"$1,662.57",$0.00,1,1,1,1,1,1,20120101,C1731,HCPCS,"CATH, EP, 20 OR MORE ELEC",,,28 ,,NW,,,,,,"$4,585.41",$0.00,1,1,1,1,1,1,20120101,C1732,HCPCS,"CATH, EP, DIAG/ABL, 3D/VECT",,,28 ,,NW,,,,,,"$4,585.41",$0.00,1,1,1,1,1,1,20120101,C1733,HCPCS,"CATH, EP, OTHR THAN COOL-TIP",,,28 ,,NW,,,,,,"$1,662.57",$0.00,1,1,1,1,1,1,20120101,C1750,HCPCS,"CATH, HEMODIALYSIS,LONG-TERM",,,28 ,,NW,,,,,,$711.61,$0.00,1,1,1,1,1,1,20120101,C1751,HCPCS,"CATH, INF, PER/CENT/MIDLINE",,,28 ,,NW,,,,,,$302.25,$0.00,1,1,1,1,1,1,20120101,C1752,HCPCS,"CATH,HEMODIALYSIS,SHORT-TERM",,,28 ,,NW,,,,,,$575.52,$0.00,1,1,1,1,1,1,20120101,C1753,HCPCS,"CATH, INTRAVAS ULTRASOUND",,,28 ,,NW,,,,,,"$1,289.59",$0.00,1,1,1,1,1,1,20120101,C1754,HCPCS,"CATHETER, INTRADISCAL",,,28 ,,NW,,,,,,$542.25,$0.00,1,1,1,1,1,1,20120101,C1755,HCPCS,"CATHETER, INTRASPINAL",,,28 ,,NW,,,,,,$861.92,$0.00,1,1,1,1,1,1,20120101,C1756,HCPCS,"CATH, PACING, TRANSESOPH",,,28 ,,NW,,,,,,"$1,096.91",$0.00,1,1,1,1,1,1,20120101,C1757,HCPCS,"CATH, THROMBECTOMY/EMBOLECT",,,28 ,,NW,,,,,,"$2,712.62",$0.00,1,1,1,1,1,1,20120101,C1758,HCPCS,"CATHETER, URETERAL",,,28 ,,NW,,,,,,$346.49,$0.00,1,1,1,1,1,1,20120101,C1759,HCPCS,"CATH, INTRA ECHOCARDIOGRAPHY",,,28 ,,NW,,,,,,"$3,640.16",$0.00,1,1,1,1,1,1,20120101,C1760,HCPCS,"CLOSURE DEV, VASC",,,28 ,,NW,,,,,,"$1,100.11",$0.00,1,1,1,1,1,1,20120101,C1762,HCPCS,"CONN TISS, HUMAN(INC FASCIA)",,,28 ,,NW,,,,,,"$2,546.16",$0.00,1,1,1,1,1,1,20120101,C1763,HCPCS,"CONN TISS, NON-HUMAN",,,28 ,,NW,,,,,,"$2,150.04",$0.00,1,1,1,1,1,1,20120101,C1764,HCPCS,"EVENT RECORDER, CARDIAC",,,28 ,,NW,,,,,,"$3,123.85",$0.00,1,1,1,1,1,1,20120101,C1765,HCPCS,ADHESION BARRIER,,,28 ,,NW,,,,,,$388.26,$0.00,1,1,1,1,1,1,20120101,C1766,HCPCS,"INTRO/SHEATH,STRBLE,NON-PEEL",,,28 ,,NW,,,,,,$543.50,$0.00,1,1,1,1,1,1,20120101,C1767,HCPCS,"GENERATOR, NEURO NON-RECHARG",,,28 ,,NW,,,,,,"$14,740.95",$0.00,1,1,1,1,1,1,20120101,C1768,HCPCS,"GRAFT, VASCULAR",,,28 ,,NW,,,,,,"$2,396.51",$0.00,1,1,1,1,1,1,20120101,C1769,HCPCS,GUIDE WIRE,,,28 ,,NW,,,,,,$408.73,$0.00,1,1,1,1,1,1,20120101,C1770,HCPCS,"IMAGING COIL, MR, INSERTABLE",,,28 ,,NW,,,,,,$316.42,$0.00,1,1,1,1,1,1,20120101,C1771,HCPCS,"REP DEV, URINARY, W/SLING",,,28 ,,NW,,,,,,"$3,625.84",$0.00,1,1,1,1,1,1,20120101,C1772,HCPCS,"INFUSION PUMP, PROGRAMMABLE",,,28 ,,NW,,,,,,$315.43,$0.00,1,1,1,1,1,1,20120101,C1776,HCPCS,JOINT DEVICE (IMPLANTABLE),,,28 ,,NW,,,,,,"$4,239.33",$0.00,1,1,1,1,1,1,20120101,C1777,HCPCS,"LEAD, AICD, ENDO SINGLE COIL",,,28 ,,NW,,,,,,"$6,943.40",$0.00,1,1,1,1,1,1,20120101,C1778,HCPCS,"LEAD, NEUROSTIMULATOR",,,28 ,,NW,,,,,,"$2,542.31",$0.00,1,1,1,1,1,1,20120101,C1779,HCPCS,"LEAD, PMKR, TRANSVENOUS VDD",,,28 ,,NW,,,,,,"$3,004.23",$0.00,1,1,1,1,1,1,20120101,C1780,HCPCS,"LENS, INTRAOCULAR (NEW TECH)",,,28 ,,NW,,,,,,$428.73,$0.00,1,1,1,1,1,1,20120101,C1781,HCPCS,MESH (IMPLANTABLE),,,28 ,,NW,,,,,,$418.66,$0.00,1,1,1,1,1,1,20120101,C1782,HCPCS,MORCELLATOR,,,28 ,,NW,,,,,,$354.95,$0.00,1,1,1,1,1,1,20120101,C1783,HCPCS,"OCULAR IMP, AQUEOUS DRAIN DE",,,28 ,,NW,,,,,,"$1,658.94",$0.00,1,1,1,1,1,1,20120101,C1784,HCPCS,"OCULAR DEV, INTRAOP, DET RET",,,28 ,,NW,,,,,,"$1,556.98",$0.00,1,1,1,1,1,1,20120101,C1785,HCPCS,"PMKR, DUAL, RATE-RESP",,,28 ,,NW,,,,,,"$7,699.18",$0.00,1,1,1,1,1,1,20120101,C1786,HCPCS,"PMKR, SINGLE, RATE-RESP",,,28 ,,NW,,,,,,"$7,316.92",$0.00,1,1,1,1,1,1,20120101,C1787,HCPCS,"PATIENT PROGR, NEUROSTIM",,,28 ,,NW,,,,,,"$4,591.57",$0.00,1,1,1,1,1,1,20120101,C1788,HCPCS,"PORT, INDWELLING, IMP",,,28 ,,NW,,,,,,$867.38,$0.00,1,1,1,1,1,1,20120101,C1789,HCPCS,"PROSTHESIS, BREAST, IMP",,,28 ,,NW,,,,,,"$1,165.12",$0.00,1,1,1,1,1,1,20120101,C1813,HCPCS,"PROSTHESIS, PENILE, INFLATAB",,,28 ,,NW,,,,,,"$4,270.08",$0.00,1,1,1,1,1,1,20120101,C1815,HCPCS,"PROS, URINARY SPH, IMP",,,28 ,,NW,,,,,,"$3,627.59",$0.00,1,1,1,1,1,1,20120101,C1816,HCPCS,"RECEIVER/TRANSMITTER, NEURO",,,28 ,,NW,,,,,,"$1,338.96",$0.00,1,1,1,1,1,1,20120101,C1817,HCPCS,SEPTAL DEFECT IMP SYS,,,28 ,,NW,,,,,,"$5,208.87",$0.00,1,1,1,1,1,1,20120101,C1818,HCPCS,INTEGRATED KERATOPROSTHESIS,,,28 ,,NW,,,,,,"$4,315.43",$0.00,1,1,1,1,1,1,20120101,C1820,HCPCS,GENERATOR NEURO RECHG BAT SY,,,28 ,,NW,,,,,,"$14,110.60",$0.00,1,1,1,1,1,1,20120101,C1821,HCPCS,INTERSPINOUS IMPLANT,,,28 ,,NW,,,,,,"$2,691.62",$0.00,1,1,1,1,1,1,20120101,C1874,HCPCS,"STENT, COATED/COV W/DEL SYS",,,28 ,,NW,,,,,,"$3,135.09",$0.00,1,1,1,1,1,1,20120101,C1875,HCPCS,"STENT, COATED/COV W/O DEL SY",,,28 ,,NW,,,,,,"$3,078.65",$0.00,1,1,1,1,1,1,20120101,C1876,HCPCS,"STENT, NON-COA/NON-COV W/DEL",,,28 ,,NW,,,,,,"$2,724.29",$0.00,1,1,1,1,1,1,20120101,C1877,HCPCS,"STENT, NON-COAT/COV W/O DEL",,,28 ,,NW,,,,,,"$2,470.62",$0.00,1,1,1,1,1,1,20120101,C1878,HCPCS,MATRL FOR VOCAL CORD,,,28 ,,NW,,,,,,$827.77,$0.00,1,1,1,1,1,1,20120101,C1879,HCPCS,"TISSUE MARKER, IMPLANTABLE",,,28 ,,NW,,,,,,$183.73,$0.00,1,1,1,1,1,1,20120101,C1880,HCPCS,VENA CAVA FILTER,,,28 ,,NW,,,,,,"$2,063.65",$0.00,1,1,1,1,1,1,20120101,C1881,HCPCS,DIALYSIS ACCESS SYSTEM,,,28 ,,NW,,,,,,$452.31,$0.00,1,1,1,1,1,1,20120101,C1882,HCPCS,"AICD, OTHER THAN SING/DUAL",,,28 ,,NW,,,,,,"$43,057.92",$0.00,1,1,1,1,1,1,20120101,C1883,HCPCS,"ADAPT/EXT, PACING/NEURO LEAD",,,28 ,,NW,,,,,,"$2,243.33",$0.00,1,1,1,1,1,1,20120101,C1884,HCPCS,EMBOLIZATION PROTECT SYST,,,28 ,,NW,,,,,,$265.56,$0.00,1,1,1,1,1,1,20120101,C1885,HCPCS,"CATH, TRANSLUMIN ANGIO LASER",,,28 ,,NW,,,,,,$302.66,$0.00,1,1,1,1,1,1,20120101,C1887,HCPCS,"CATHETER, GUIDING",,,28 ,,NW,,,,,,$57.89,$0.00,1,1,1,1,1,1,20120101,C1888,HCPCS,ENDOVAS NON-CARDIAC ABL CATH,,,28 ,,NW,,,,,,$761.43,$0.00,1,1,1,1,1,1,20120101,C1891,HCPCS,"INFUSION PUMP,NON-PROG, PERM",,,28 ,,NW,,,,,,"$5,214.24",$0.00,1,1,1,1,1,1,20120101,C1892,HCPCS,"INTRO/SHEATH,FIXED,PEEL-AWAY",,,28 ,,NW,,,,,,"$1,049.29",$0.00,1,1,1,1,1,1,20120101,C1893,HCPCS,"INTRO/SHEATH, FIXED,NON-PEEL",,,28 ,,NW,,,,,,$560.35,$0.00,1,1,1,1,1,1,20120101,C1894,HCPCS,"INTRO/SHEATH, NON-LASER",,,28 ,,NW,,,,,,$145.81,$0.00,1,1,1,1,1,1,20120101,C1895,HCPCS,"LEAD, AICD, ENDO DUAL COIL",,,28 ,,NW,,,,,,"$6,900.41",$0.00,1,1,1,1,1,1,20120101,C1896,HCPCS,"LEAD, AICD, NON SING/DUAL",,,28 ,,NW,,,,,,"$3,935.40",$0.00,1,1,1,1,1,1,20120101,C1897,HCPCS,"LEAD, NEUROSTIM TEST KIT",,,28 ,,NW,,,,,,"$2,884.77",$0.00,1,1,1,1,1,1,20120101,C1898,HCPCS,"LEAD, PMKR, OTHER THAN TRANS",,,28 ,,NW,,,,,,"$1,040.86",$0.00,1,1,1,1,1,1,20120101,C1899,HCPCS,"LEAD, PMKR/AICD COMBINATION",,,28 ,,NW,,,,,,"$6,880.93",$0.00,1,1,1,1,1,1,20120101,C1900,HCPCS,"LEAD, CORONARY VENOUS",,,28 ,,NW,,,,,,"$5,015.53",$0.00,1,1,1,1,1,1,20120101,C2614,HCPCS,"PROBE, PERC LUMB DISC",,,28 ,,NW,,,,,,$741.24,$0.00,1,1,1,1,1,1,20120101,C2615,HCPCS,"SEALANT, PULMONARY, LIQUID",,,28 ,,NW,,,,,,$824.49,$0.00,1,1,1,1,1,1,20120101,C2617,HCPCS,"STENT, NON-COR, TEM W/O DEL",,,28 ,,NW,,,,,,"$2,787.66",$0.00,1,1,1,1,1,1,20120101,C2618,HCPCS,"PROBE, CRYOABLATION",,,28 ,,NW,,,,,,"$2,315.64",$0.00,1,1,1,1,1,1,20120101,C2619,HCPCS,"PMKR, DUAL, NON RATE-RESP",,,28 ,,NW,,,,,,"$6,943.66",$0.00,1,1,1,1,1,1,20120101,C2620,HCPCS,"PMKR, SINGLE, NON RATE-RESP",,,28 ,,NW,,,,,,"$10,423.78",$0.00,1,1,1,1,1,1,20120101,C2621,HCPCS,"PMKR, OTHER THAN SING/DUAL",,,28 ,,NW,,,,,,"$18,780.79",$0.00,1,1,1,1,1,1,20120101,C2622,HCPCS,"PROSTHESIS, PENILE, NON-INF",,,28 ,,NW,,,,,,"$4,841.88",$0.00,1,1,1,1,1,1,20120101,C2625,HCPCS,"STENT, NON-COR, TEM W/DEL SY",,,28 ,,NW,,,,,,"$2,228.17",$0.00,1,1,1,1,1,1,20120101,C2626,HCPCS,"INFUSION PUMP, NON-PROG,TEMP",,,28 ,,NW,,,,,,"$1,056.01",$0.00,1,1,1,1,1,1,20120101,C2627,HCPCS,"CATH, SUPRAPUBIC/CYSTOSCOPIC",,,28 ,,NW,,,,,,$893.13,$0.00,1,1,1,1,1,1,20120101,C2628,HCPCS,"CATHETER, OCCLUSION",,,28 ,,NW,,,,,,"$1,633.42",$0.00,1,1,1,1,1,1,20120101,C2631,HCPCS,"REP DEV, URINARY, W/O SLING",,,28 ,,NW,,,,,,"$2,924.86",$0.00,1,1,1,1,1,1,20120101,C2638,HCPCS,"BRACHYTX, STRANDED, I-125",,,28 ,,NW,,,,,,$84.63,$0.00,1,1,1,1,1,1,20120101,C2639,HCPCS,"BRACHYTX, NON-STRANDED,I-125",,,28 ,,NW,,,,,,$53.28,$0.00,1,1,1,1,1,1,20120101,C2641,HCPCS,"BRACHYTX, NON-STRANDED,P-103",,,28 ,,NW,,,,,,$67.26,$0.00,1,1,1,1,1,1,20120101,C2698,HCPCS,"BRACHYTX, STRANDED, NOS",,,28 ,,NW,,,,,,"$2,588.04",$0.00,1,1,1,1,1,1,20120101,C2699,HCPCS,"BRACHYTX, NON-STRANDED, NOS",,,28 ,,NW,,,,,,"$2,588.04",$0.00,1,1,1,1,1,1,20120101,C8908,HCPCS,"MRI W/O FOL W/CONT, BREAST,",,,20 ,,TotalUnits,,,,16.38 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,C9113,HCPCS,"INJ PANTOPRAZOLE SODIUM, VIA",,,29 ,,NW,,,,,,$167.04,$0.00,1,1,1,0,0,1,20120101,C9121,HCPCS,"INJECTION, ARGATROBAN",,,29 ,,NW,,,,,,$193.46,$0.00,1,1,1,0,0,1,20120101,C9248,HCPCS,"INJ, CLEVIDIPINE BUTYRATE",,,29 ,,NW,,,,,,$10.25,$0.00,1,1,1,0,0,1,20120101,C9250,HCPCS,ARTISS FIBRIN SEALANT,,,29 ,,NW,,,,,,$704.34,$0.00,1,1,1,0,0,1,20120101,C9254,HCPCS,"INJECTION, LACOSAMIDE",,,29 ,,NW,,,,,,$1.10,$0.00,1,1,1,0,0,1,20120101,C9257,HCPCS,BEVACIZUMAB INJECTION,,,29 ,,NW,,,,,,$70.25,$0.00,1,1,1,0,0,1,20120101,C9285,HCPCS,"PATCH, LIDOCAINE/TETRACAINE",,,29 ,,NW,,,,,,$90.94,$0.00,1,1,1,0,0,1,20120101,C9359,HCPCS,"IMPLNT,BON VOID FILLER-PUTTY",,,28 ,,NW,,,,,,"$1,245.01",$0.00,1,1,1,1,1,1,20120101,C9360,HCPCS,"SURGIMEND, NEONATAL",,,28 ,,NW,,,,,,$58.49,$0.00,1,1,1,1,1,1,20120101,C9361,HCPCS,NEUROMEND NERVE WRAP,,,28 ,,NW,,,,,,"$1,259.21",$0.00,1,1,1,1,1,1,20120101,C9362,HCPCS,"IMPLNT,BON VOID FILLER-STRIP",,,28 ,,NW,,,,,,$260.26,$0.00,1,1,1,1,1,1,20120101,C9363,HCPCS,INTEGRA MESHED BIL WOUND MAT,,,28 ,,NW,,,,,,$102.75,$0.00,1,1,1,1,1,1,20120101,C9364,HCPCS,"PORCINE IMPLANT, PERMACOL",,,28 ,,NW,,,,,,$90.39,$0.00,1,1,1,1,1,1,20120101,C9367,HCPCS,ENDOFORM DERMAL TEMPLATE,,,28 ,,NW,,,,,,$22.50,$0.00,1,1,1,0,0,1,20120101,C9800,HCPCS,DERMAL FILLER INJ PX/SUPPL,,,28 ,,NW,,,,,,"$1,557.70",$0.00,1,1,1,0,0,1,20120101,D0120,HCPCS,PERIODIC ORAL EVALUATION,,,25 ,,NW,,,,,,$52.59,$0.00,1,0,1,1,1,1,20120101,D0140,HCPCS,LIMIT ORAL EVAL PROBLM FOCUS,,,25 ,,NW,,,,,,$81.85,$0.00,1,0,1,1,1,1,20120101,D0145,HCPCS,"ORAL EVALUATION, PT < 3YRS",,,25 ,,NW,,,,,,$75.53,$0.00,1,0,1,1,1,1,20120101,D0150,HCPCS,COMPREHENSVE ORAL EVALUATION,,,25 ,,NW,,,,,,$88.97,$0.00,1,0,1,1,1,1,20120101,D0160,HCPCS,EXTENSV ORAL EVAL PROB FOCUS,,,25 ,,NW,,,,,,$172.52,$0.00,1,0,1,1,1,1,20120101,D0170,HCPCS,"RE-EVAL,EST PT,PROBLEM FOCUS",,,25 ,,NW,,,,,,$73.24,$0.00,1,0,1,1,1,1,20120101,D0180,HCPCS,COMP PERIODONTAL EVALUATION,,,25 ,,NW,,,,,,$105.58,$0.00,1,0,1,1,1,1,20120101,D0210,HCPCS,INTRAOR COMPLETE FILM SERIES,,,25 ,,NW,,,,,,$139.53,$0.00,1,0,1,1,1,1,20120101,D0220,HCPCS,INTRAORAL PERIAPICAL FIRST F,,,25 ,,NW,,,,,,$30.13,$0.00,1,0,1,1,1,1,20120101,D0230,HCPCS,INTRAORAL PERIAPICAL EA ADD,,,25 ,,NW,,,,,,$25.24,$0.00,1,0,1,1,1,1,20120101,D0240,HCPCS,INTRAORAL OCCLUSAL FILM,,,25 ,,NW,,,,,,$44.02,$0.00,1,0,1,1,1,1,20120101,D0250,HCPCS,EXTRAORAL FIRST FILM,,,25 ,,NW,,,,,,$65.92,$0.00,1,0,1,1,1,1,20120101,D0260,HCPCS,EXTRAORAL EA ADDITIONAL FILM,,,25 ,,NW,,,,,,$58.93,$0.00,1,0,1,1,1,1,20120101,D0270,HCPCS,DENTAL BITEWING SINGLE FILM,,,25 ,,NW,,,,,,$29.94,$0.00,1,0,1,1,1,1,20120101,D0272,HCPCS,DENTAL BITEWINGS TWO FILMS,,,25 ,,NW,,,,,,$46.88,$0.00,1,0,1,1,1,1,20120101,D0273,HCPCS,BITEWINGS - THREE FILMS,,,25 ,,NW,,,,,,$57.96,$0.00,1,0,1,1,1,1,20120101,D0274,HCPCS,DENTAL BITEWINGS FOUR FILMS,,,25 ,,NW,,,,,,$67.86,$0.00,1,0,1,1,1,1,20120101,D0277,HCPCS,VERT BITEWINGS-SEV TO EIGHT,,,25 ,,NW,,,,,,$101.66,$0.00,1,0,1,1,1,1,20120101,D0290,HCPCS,DENTAL FILM SKULL/FACIAL BON,,,25 ,,NW,,,,,,$133.91,$0.00,1,0,1,1,1,1,20120101,D0310,HCPCS,DENTAL SALIOGRAPHY,,,25 ,,NW,,,,,,$334.10,$0.00,1,0,1,1,1,1,20120101,D0320,HCPCS,DENTAL TMJ ARTHROGRAM INCL I,,,25 ,,NW,,,,,,$711.77,$0.00,1,0,1,1,1,1,20120101,D0321,HCPCS,DENTAL OTHER TMJ FILMS,,,25 ,,NW,,,,,,$221.74,$0.00,1,0,1,1,1,1,20120101,D0322,HCPCS,DENTAL TOMOGRAPHIC SURVEY,,,25 ,,NW,,,,,,$514.79,$0.00,1,0,1,1,1,1,20120101,D0330,HCPCS,DENTAL PANORAMIC FILM,,,25 ,,NW,,,,,,$116.75,$0.00,1,0,1,1,1,1,20120101,D0340,HCPCS,DENTAL CEPHALOMETRIC FILM,,,25 ,,NW,,,,,,$127.92,$0.00,1,0,1,1,1,1,20120101,D0350,HCPCS,ORAL/FACIAL PHOTO IMAGES,,,25 ,,NW,,,,,,$70.09,$0.00,1,0,1,1,1,1,20120101,D0360,HCPCS,CONE BEAM CT,,,25 ,,NW,,,,,,$594.09,$0.00,1,0,1,1,1,1,20120101,D0362,HCPCS,"CONE BEAM, TWO DIMENSIONAL",,,25 ,,NW,,,,,,$425.30,$0.00,1,0,1,1,1,1,20120101,D0363,HCPCS,"CONE BEAM, THREE DIMENSIONAL",,,25 ,,NW,,,,,,$480.07,$0.00,1,0,1,1,1,1,20120101,D0415,HCPCS,COLLECTION OF MICROORGANISMS,,,25 ,,NW,,,,,,$43.56,$0.00,1,0,1,1,1,1,20120101,D0416,HCPCS,VIRAL CULTURE,,,25 ,,NW,,,,,,$62.62,$0.00,1,0,1,1,1,1,20120101,D0417,HCPCS,COLLECT & PREP SALIVA SAMPLE,,,25 ,,NW,,,,,,$78.04,$0.00,1,0,1,1,1,1,20120101,D0418,HCPCS,ANALYSIS OF SALIVA SAMPLE,,,25 ,,NW,,,,,,$103.08,$0.00,1,0,1,1,1,1,20120101,D0421,HCPCS,GEN TST SUSCEPT ORAL DISEASE,,,25 ,,NW,,,,,,$63.44,$0.00,1,0,1,1,1,1,20120101,D0425,HCPCS,CARIES SUSCEPTIBILITY TEST,,,25 ,,NW,,,,,,$35.14,$0.00,1,0,1,1,1,1,20120101,D0431,HCPCS,DIAG TST DETECT MUCOS ABNORM,,,25 ,,NW,,,,,,$70.12,$0.00,1,0,1,1,1,1,20120101,D0460,HCPCS,PULP VITALITY TEST,,,25 ,,NW,,,,,,$60.67,$0.00,1,0,1,1,1,1,20120101,D0470,HCPCS,DIAGNOSTIC CASTS,,,25 ,,NW,,,,,,$125.63,$0.00,1,0,1,1,1,1,20120101,D0472,HCPCS,"GROSS EXAM, PREP & REPORT",,,25 ,,NW,,,,,,$118.26,$0.00,1,0,1,1,1,1,20120101,D0473,HCPCS,"MICRO EXAM, PREP & REPORT",,,25 ,,NW,,,,,,$181.44,$0.00,1,0,1,1,1,1,20120101,D0474,HCPCS,MICRO W EXAM OF SURG MARGINS,,,25 ,,NW,,,,,,$225.20,$0.00,1,0,1,1,1,1,20120101,D0475,HCPCS,DECALCIFICATION PROCEDURE,,,25 ,,NW,,,,,,$88.73,$0.00,1,0,1,1,1,1,20120101,D0476,HCPCS,SPEC STAINS FOR MICROORGANIS,,,25 ,,NW,,,,,,$83.98,$0.00,1,0,1,1,1,1,20120101,D0477,HCPCS,SPEC STAINS NOT FOR MICROORG,,,25 ,,NW,,,,,,$222.37,$0.00,1,0,1,1,1,1,20120101,D0478,HCPCS,IMMUNOHISTOCHEMICAL STAINS,,,25 ,,NW,,,,,,$176.12,$0.00,1,0,1,1,1,1,20120101,D0479,HCPCS,TISSUE IN-SITU HYBRIDIZATION,,,25 ,,NW,,,,,,$233.89,$0.00,1,0,1,1,1,1,20120101,D0480,HCPCS,CYTOPATH SMEAR PREP & REPORT,,,25 ,,NW,,,,,,$135.14,$0.00,1,0,1,1,1,1,20120101,D0481,HCPCS,ELECTRON MICROSCOPY DIAGNOST,,,25 ,,NW,,,,,,$138.34,$0.00,1,0,1,1,1,1,20120101,D0482,HCPCS,DIRECT IMMUNOFLUORESCENCE,,,25 ,,NW,,,,,,$134.51,$0.00,1,0,1,1,1,1,20120101,D0483,HCPCS,INDIRECT IMMUNOFLUORESCENCE,,,25 ,,NW,,,,,,$142.26,$0.00,1,0,1,1,1,1,20120101,D0484,HCPCS,CONSULT SLIDES PREP ELSEWHER,,,25 ,,NW,,,,,,$180.43,$0.00,1,0,1,1,1,1,20120101,D0485,HCPCS,CONSULT INC PREP OF SLIDES,,,25 ,,NW,,,,,,$224.22,$0.00,1,0,1,1,1,1,20120101,D0486,HCPCS,ACCESS OF TRANSEP CYTOL SAMP,,,25 ,,NW,,,,,,$175.49,$0.00,1,0,1,1,1,1,20120101,D0502,HCPCS,OTHER ORAL PATHOLOGY PROCEDU,,,25 ,,NW,,,,,,$173.67,$0.00,1,0,1,1,1,1,20120101,D0999,HCPCS,UNSPECIFIED DIAGNOSTIC PROCE,,,25 ,,NW,,,,,,$52.59,$0.00,1,0,1,1,1,1,20120101,D1110,HCPCS,DENTAL PROPHYLAXIS ADULT,,,25 ,,NW,,,,,,$96.15,$0.00,1,0,1,1,1,1,20120101,D1120,HCPCS,DENTAL PROPHYLAXIS CHILD,,,25 ,,NW,,,,,,$71.41,$0.00,1,0,1,1,1,1,20120101,D1203,HCPCS,TOPICAL APP FLUORIDE CHILD,,,25 ,,NW,,,,,,$39.15,$0.00,1,0,1,1,1,1,20120101,D1204,HCPCS,TOPICAL APP FLUORIDE ADULT,,,25 ,,NW,,,,,,$38.81,$0.00,1,0,1,1,1,1,20120101,D1206,HCPCS,TOPICAL FLUORIDE VARNISH,,,25 ,,NW,,,,,,$51.09,$0.00,1,0,1,1,1,1,20120101,D1310,HCPCS,NUTRI COUNSEL-CONTROL CARIES,,,25 ,,NW,,,,,,$59.78,$0.00,1,0,1,1,1,1,20120101,D1320,HCPCS,TOBACCO COUNSELING,,,25 ,,NW,,,,,,$64.61,$0.00,1,0,1,1,1,1,20120101,D1330,HCPCS,ORAL HYGIENE INSTRUCTION,,,25 ,,NW,,,,,,$60.44,$0.00,1,0,1,1,1,1,20120101,D1351,HCPCS,DENTAL SEALANT PER TOOTH,,,25 ,,NW,,,,,,$57.40,$0.00,1,0,1,1,1,1,20120101,D1352,HCPCS,"PREV RESIN REST, PERM TOOTH",,,25 ,,NW,,,,,,$57.40,$0.00,1,0,1,1,1,1,20120101,D1510,HCPCS,SPACE MAINTAINER FXD UNILAT,,,26 ,,NW,,,,,,$350.60,$0.00,1,0,1,1,1,1,20120101,D1515,HCPCS,FIXED BILAT SPACE MAINTAINER,,,26 ,,NW,,,,,,$502.76,$0.00,1,0,1,1,1,1,20120101,D1520,HCPCS,REMOVE UNILAT SPACE MAINTAIN,,,26 ,,NW,,,,,,$410.97,$0.00,1,0,1,1,1,1,20120101,D1525,HCPCS,REMOVE BILAT SPACE MAINTAIN,,,26 ,,NW,,,,,,$586.48,$0.00,1,0,1,1,1,1,20120101,D1550,HCPCS,RECEMENT SPACE MAINTAINER,,,26 ,,NW,,,,,,$83.68,$0.00,1,0,1,1,1,1,20120101,D1555,HCPCS,REMOVE FIX SPACE MAINTAINER,,,26 ,,NW,,,,,,$80.67,$0.00,1,0,1,1,1,1,20120101,D2140,HCPCS,AMALGAM ONE SURFACE PERMANEN,,,26 ,,NW,,,,,,$155.37,$0.00,1,0,1,1,1,1,20120101,D2150,HCPCS,AMALGAM TWO SURFACES PERMANE,,,26 ,,NW,,,,,,$191.93,$0.00,1,0,1,1,1,1,20120101,D2160,HCPCS,AMALGAM THREE SURFACES PERMA,,,26 ,,NW,,,,,,$233.88,$0.00,1,0,1,1,1,1,20120101,D2161,HCPCS,AMALGAM 4 OR > SURFACES PERM,,,26 ,,NW,,,,,,$278.30,$0.00,1,0,1,1,1,1,20120101,D2330,HCPCS,RESIN ONE SURFACE-ANTERIOR,,,26 ,,NW,,,,,,$167.25,$0.00,1,0,1,1,1,1,20120101,D2331,HCPCS,RESIN TWO SURFACES-ANTERIOR,,,26 ,,NW,,,,,,$204.33,$0.00,1,0,1,1,1,1,20120101,D2332,HCPCS,RESIN THREE SURFACES-ANTERIO,,,26 ,,NW,,,,,,$250.88,$0.00,1,0,1,1,1,1,20120101,D2335,HCPCS,RESIN 4/> SURF OR W INCIS AN,,,26 ,,NW,,,,,,$304.03,$0.00,1,0,1,1,1,1,20120101,D2390,HCPCS,ANT RESIN-BASED CMPST CROWN,,,26 ,,NW,,,,,,$396.48,$0.00,1,0,1,1,1,1,20120101,D2391,HCPCS,POST 1 SRFC RESINBASED CMPST,,,26 ,,NW,,,,,,$183.63,$0.00,1,0,1,1,1,1,20120101,D2392,HCPCS,POST 2 SRFC RESINBASED CMPST,,,26 ,,NW,,,,,,$238.70,$0.00,1,0,1,1,1,1,20120101,D2393,HCPCS,POST 3 SRFC RESINBASED CMPST,,,26 ,,NW,,,,,,$296.92,$0.00,1,0,1,1,1,1,20120101,D2394,HCPCS,POST >=4SRFC RESINBASE CMPST,,,26 ,,NW,,,,,,$353.74,$0.00,1,0,1,1,1,1,20120101,D2410,HCPCS,DENTAL GOLD FOIL ONE SURFACE,,,27 ,,NW,,,,,,$352.42,$0.00,1,0,1,1,1,1,20120101,D2420,HCPCS,DENTAL GOLD FOIL TWO SURFACE,,,27 ,,NW,,,,,,$694.16,$0.00,1,0,1,1,1,1,20120101,D2430,HCPCS,DENTAL GOLD FOIL THREE SURFA,,,27 ,,NW,,,,,,$884.68,$0.00,1,0,1,1,1,1,20120101,D2510,HCPCS,DENTAL INLAY METALIC 1 SURF,,,27 ,,NW,,,,,,$927.74,$0.00,1,0,1,1,1,1,20120101,D2520,HCPCS,DENTAL INLAY METALLIC 2 SURF,,,27 ,,NW,,,,,,"$1,018.23",$0.00,1,0,1,1,1,1,20120101,D2530,HCPCS,DENTAL INLAY METL 3/MORE SUR,,,27 ,,NW,,,,,,"$1,110.66",$0.00,1,0,1,1,1,1,20120101,D2542,HCPCS,DENTAL ONLAY METALLIC 2 SURF,,,27 ,,NW,,,,,,"$1,149.36",$0.00,1,0,1,1,1,1,20120101,D2543,HCPCS,DENTAL ONLAY METALLIC 3 SURF,,,27 ,,NW,,,,,,"$1,167.87",$0.00,1,0,1,1,1,1,20120101,D2544,HCPCS,DENTAL ONLAY METL 4/MORE SUR,,,27 ,,NW,,,,,,"$1,190.27",$0.00,1,0,1,1,1,1,20120101,D2610,HCPCS,INLAY PORCELAIN/CERAMIC 1 SU,,,27 ,,NW,,,,,,"$1,008.71",$0.00,1,0,1,1,1,1,20120101,D2620,HCPCS,INLAY PORCELAIN/CERAMIC 2 SU,,,27 ,,NW,,,,,,"$1,059.56",$0.00,1,0,1,1,1,1,20120101,D2630,HCPCS,DENTAL ONLAY PORC 3/MORE SUR,,,27 ,,NW,,,,,,"$1,127.09",$0.00,1,0,1,1,1,1,20120101,D2642,HCPCS,DENTAL ONLAY PORCELIN 2 SURF,,,27 ,,NW,,,,,,"$1,157.69",$0.00,1,0,1,1,1,1,20120101,D2643,HCPCS,DENTAL ONLAY PORCELIN 3 SURF,,,27 ,,NW,,,,,,"$1,185.19",$0.00,1,0,1,1,1,1,20120101,D2644,HCPCS,DENTAL ONLAY PORC 4/MORE SUR,,,27 ,,NW,,,,,,"$1,233.10",$0.00,1,0,1,1,1,1,20120101,D2650,HCPCS,INLAY COMPOSITE/RESIN ONE SU,,,27 ,,NW,,,,,,$783.64,$0.00,1,0,1,1,1,1,20120101,D2651,HCPCS,INLAY COMPOSITE/RESIN TWO SU,,,27 ,,NW,,,,,,$895.70,$0.00,1,0,1,1,1,1,20120101,D2652,HCPCS,DENTAL INLAY RESIN 3/MRE SUR,,,27 ,,NW,,,,,,$947.59,$0.00,1,0,1,1,1,1,20120101,D2662,HCPCS,DENTAL ONLAY RESIN 2 SURFACE,,,27 ,,NW,,,,,,$932.68,$0.00,1,0,1,1,1,1,20120101,D2663,HCPCS,DENTAL ONLAY RESIN 3 SURFACE,,,27 ,,NW,,,,,,$995.42,$0.00,1,0,1,1,1,1,20120101,D2664,HCPCS,DENTAL ONLAY RESIN 4/MRE SUR,,,27 ,,NW,,,,,,"$1,050.75",$0.00,1,0,1,1,1,1,20120101,D2710,HCPCS,CROWN RESIN-BASED INDIRECT,,,27 ,,NW,,,,,,$585.24,$0.00,1,0,1,1,1,1,20120101,D2712,HCPCS,CROWN 3/4 RESIN-BASED COMPOS,,,27 ,,NW,,,,,,$763.17,$0.00,1,0,1,1,1,1,20120101,D2720,HCPCS,CROWN RESIN W/ HIGH NOBLE ME,,,27 ,,NW,,,,,,"$1,117.82",$0.00,1,0,1,1,1,1,20120101,D2721,HCPCS,CROWN RESIN W/ BASE METAL,,,27 ,,NW,,,,,,"$1,040.66",$0.00,1,0,1,1,1,1,20120101,D2722,HCPCS,CROWN RESIN W/ NOBLE METAL,,,27 ,,NW,,,,,,"$1,065.72",$0.00,1,0,1,1,1,1,20120101,D2740,HCPCS,CROWN PORCELAIN/CERAMIC SUBS,,,27 ,,NW,,,,,,"$1,220.46",$0.00,1,0,1,1,1,1,20120101,D2750,HCPCS,CROWN PORCELAIN W/ H NOBLE M,,,27 ,,NW,,,,,,"$1,162.61",$0.00,1,0,1,1,1,1,20120101,D2751,HCPCS,CROWN PORCELAIN FUSED BASE M,,,27 ,,NW,,,,,,"$1,082.93",$0.00,1,0,1,1,1,1,20120101,D2752,HCPCS,CROWN PORCELAIN W/ NOBLE MET,,,27 ,,NW,,,,,,"$1,101.09",$0.00,1,0,1,1,1,1,20120101,D2780,HCPCS,CROWN 3/4 CAST HI NOBLE MET,,,27 ,,NW,,,,,,"$1,171.61",$0.00,1,0,1,1,1,1,20120101,D2781,HCPCS,CROWN 3/4 CAST BASE METAL,,,27 ,,NW,,,,,,"$1,117.10",$0.00,1,0,1,1,1,1,20120101,D2782,HCPCS,CROWN 3/4 CAST NOBLE METAL,,,27 ,,NW,,,,,,"$1,138.34",$0.00,1,0,1,1,1,1,20120101,D2783,HCPCS,CROWN 3/4 PORCELAIN/CERAMIC,,,27 ,,NW,,,,,,"$1,194.87",$0.00,1,0,1,1,1,1,20120101,D2790,HCPCS,CROWN FULL CAST HIGH NOBLE M,,,27 ,,NW,,,,,,"$1,150.86",$0.00,1,0,1,1,1,1,20120101,D2791,HCPCS,CROWN FULL CAST BASE METAL,,,27 ,,NW,,,,,,"$1,083.69",$0.00,1,0,1,1,1,1,20120101,D2792,HCPCS,CROWN FULL CAST NOBLE METAL,,,27 ,,NW,,,,,,"$1,122.06",$0.00,1,0,1,1,1,1,20120101,D2794,HCPCS,CROWN-TITANIUM,,,27 ,,NW,,,,,,"$1,150.72",$0.00,1,0,1,1,1,1,20120101,D2799,HCPCS,PROVISIONAL CROWN,,,27 ,,NW,,,,,,$454.22,$0.00,1,0,1,1,1,1,20120101,D2910,HCPCS,RECEMENT INLAY ONLAY OR PART,,,27 ,,NW,,,,,,$112.34,$0.00,1,0,1,1,1,1,20120101,D2915,HCPCS,RECEMENT CAST OR PREFAB POST,,,27 ,,NW,,,,,,$111.57,$0.00,1,0,1,1,1,1,20120101,D2920,HCPCS,DENTAL RECEMENT CROWN,,,27 ,,NW,,,,,,$110.67,$0.00,1,0,1,1,1,1,20120101,D2930,HCPCS,PREFAB STNLSS STEEL CRWN PRI,,,27 ,,NW,,,,,,$284.25,$0.00,1,0,1,1,1,1,20120101,D2931,HCPCS,PREFAB STNLSS STEEL CROWN PE,,,27 ,,NW,,,,,,$333.50,$0.00,1,0,1,1,1,1,20120101,D2932,HCPCS,PREFABRICATED RESIN CROWN,,,27 ,,NW,,,,,,$353.55,$0.00,1,0,1,1,1,1,20120101,D2933,HCPCS,PREFAB STAINLESS STEEL CROWN,,,27 ,,NW,,,,,,$386.46,$0.00,1,0,1,1,1,1,20120101,D2934,HCPCS,PREFAB STEEL CROWN PRIMARY,,,27 ,,NW,,,,,,$385.12,$0.00,1,0,1,1,1,1,20120101,D2940,HCPCS,PROTECTIVE RESTORATION,,,27 ,,NW,,,,,,$119.44,$0.00,1,0,1,1,1,1,20120101,D2950,HCPCS,CORE BUILD-UP INCL ANY PINS,,,27 ,,NW,,,,,,$284.25,$0.00,1,0,1,1,1,1,20120101,D2951,HCPCS,TOOTH PIN RETENTION,,,27 ,,NW,,,,,,$67.46,$0.00,1,0,1,1,1,1,20120101,D2952,HCPCS,POST AND CORE CAST + CROWN,,,27 ,,NW,,,,,,$441.33,$0.00,1,0,1,1,1,1,20120101,D2953,HCPCS,EACH ADDTNL CAST POST,,,27 ,,NW,,,,,,$270.60,$0.00,1,0,1,1,1,1,20120101,D2954,HCPCS,PREFAB POST/CORE + CROWN,,,27 ,,NW,,,,,,$354.51,$0.00,1,0,1,1,1,1,20120101,D2955,HCPCS,POST REMOVAL,,,27 ,,NW,,,,,,$305.16,$0.00,1,0,1,1,1,1,20120101,D2957,HCPCS,EACH ADDTNL PREFAB POST,,,27 ,,NW,,,,,,$190.86,$0.00,1,0,1,1,1,1,20120101,D2960,HCPCS,LAMINATE LABIAL VENEER,,,27 ,,NW,,,,,,$736.66,$0.00,1,0,1,1,1,1,20120101,D2961,HCPCS,LAB LABIAL VENEER RESIN,,,27 ,,NW,,,,,,"$1,037.85",$0.00,1,0,1,1,1,1,20120101,D2962,HCPCS,LAB LABIAL VENEER PORCELAIN,,,27 ,,NW,,,,,,"$1,189.12",$0.00,1,0,1,1,1,1,20120101,D2970,HCPCS,TEMP CROWN (FRACTURED TOOTH),,,27 ,,NW,,,,,,$331.26,$0.00,1,0,1,1,1,1,20120101,D2971,HCPCS,ADD PROC CONSTRUCT NEW CROWN,,,27 ,,NW,,,,,,$173.58,$0.00,1,0,1,1,1,1,20120101,D2975,HCPCS,COPING,,,27 ,,NW,,,,,,$566.52,$0.00,1,0,1,1,1,1,20120101,D2980,HCPCS,CROWN REPAIR,,,27 ,,NW,,,,,,$296.18,$0.00,1,0,1,1,1,1,20120101,D2999,HCPCS,DENTAL UNSPEC RESTORATIVE PR,,,27 ,,NW,,,,,,$238.70,$0.00,1,0,1,1,1,1,20120101,D3110,HCPCS,PULP CAP DIRECT,,,26 ,,NW,,,,,,$88.75,$0.00,1,0,1,1,1,1,20120101,D3120,HCPCS,PULP CAP INDIRECT,,,26 ,,NW,,,,,,$82.54,$0.00,1,0,1,1,1,1,20120101,D3220,HCPCS,THERAPEUTIC PULPOTOMY,,,26 ,,NW,,,,,,$200.07,$0.00,1,0,1,1,1,1,20120101,D3221,HCPCS,GROSS PULPAL DEBRIDEMENT,,,26 ,,NW,,,,,,$227.87,$0.00,1,0,1,1,1,1,20120101,D3222,HCPCS,PART PULP FOR APEXOGENESIS,,,26 ,,NW,,,,,,$269.26,$0.00,1,0,1,1,1,1,20120101,D3230,HCPCS,PULPAL THERAPY ANTERIOR PRIM,,,26 ,,NW,,,,,,$253.81,$0.00,1,0,1,1,1,1,20120101,D3240,HCPCS,PULPAL THERAPY POSTERIOR PRI,,,26 ,,NW,,,,,,$296.51,$0.00,1,0,1,1,1,1,20120101,D3310,HCPCS,"END THXPY, ANTERIOR TOOTH",,,26 ,,NW,,,,,,$804.81,$0.00,1,0,1,1,1,1,20120101,D3320,HCPCS,"END THXPY, BICUSPID TOOTH",,,26 ,,NW,,,,,,$940.09,$0.00,1,0,1,1,1,1,20120101,D3330,HCPCS,"END THXPY, MOLAR",,,26 ,,NW,,,,,,"$1,152.69",$0.00,1,0,1,1,1,1,20120101,D3331,HCPCS,NON-SURG TX ROOT CANAL OBS,,,26 ,,NW,,,,,,$446.28,$0.00,1,0,1,1,1,1,20120101,D3332,HCPCS,INCOMPLETE ENDODONTIC TX,,,26 ,,NW,,,,,,$506.81,$0.00,1,0,1,1,1,1,20120101,D3333,HCPCS,INTERNAL ROOT REPAIR,,,26 ,,NW,,,,,,$343.96,$0.00,1,0,1,1,1,1,20120101,D3346,HCPCS,RETREAT ROOT CANAL ANTERIOR,,,26 ,,NW,,,,,,"$1,018.49",$0.00,1,0,1,1,1,1,20120101,D3347,HCPCS,RETREAT ROOT CANAL BICUSPID,,,26 ,,NW,,,,,,"$1,173.28",$0.00,1,0,1,1,1,1,20120101,D3348,HCPCS,RETREAT ROOT CANAL MOLAR,,,26 ,,NW,,,,,,"$1,407.62",$0.00,1,0,1,1,1,1,20120101,D3351,HCPCS,APEXIFICATION/RECALC INITIAL,,,26 ,,NW,,,,,,$407.16,$0.00,1,0,1,1,1,1,20120101,D3352,HCPCS,APEXIFICATION/RECALC INTERIM,,,26 ,,NW,,,,,,$237.79,$0.00,1,0,1,1,1,1,20120101,D3353,HCPCS,APEXIFICATION/RECALC FINAL,,,26 ,,NW,,,,,,$625.47,$0.00,1,0,1,1,1,1,20120101,D3354,HCPCS,PULPAL REGENERATION,,,26 ,,NW,,,,,,$625.47,$0.00,1,0,1,1,1,1,20120101,D3410,HCPCS,APICOECT/PERIRAD SURG ANTER,,,26 ,,NW,,,,,,$880.46,$0.00,1,0,1,1,1,1,20120101,D3421,HCPCS,ROOT SURGERY BICUSPID,,,26 ,,NW,,,,,,$970.57,$0.00,1,0,1,1,1,1,20120101,D3425,HCPCS,ROOT SURGERY MOLAR,,,26 ,,NW,,,,,,"$1,084.05",$0.00,1,0,1,1,1,1,20120101,D3426,HCPCS,ROOT SURGERY EA ADD ROOT,,,26 ,,NW,,,,,,$400.05,$0.00,1,0,1,1,1,1,20120101,D3430,HCPCS,RETROGRADE FILLING,,,26 ,,NW,,,,,,$286.61,$0.00,1,0,1,1,1,1,20120101,D3450,HCPCS,ROOT AMPUTATION,,,26 ,,NW,,,,,,$592.51,$0.00,1,0,1,1,1,1,20120101,D3460,HCPCS,ENDODONTIC ENDOSSEOUS IMPLAN,,,26 ,,NW,,,,,,"$2,051.22",$0.00,1,0,1,1,1,1,20120101,D3470,HCPCS,INTENTIONAL REPLANTATION,,,26 ,,NW,,,,,,$977.64,$0.00,1,0,1,1,1,1,20120101,D3910,HCPCS,ISOLATION- TOOTH W RUBB DAM,,,26 ,,NW,,,,,,$198.45,$0.00,1,0,1,1,1,1,20120101,D3920,HCPCS,TOOTH SPLITTING,,,26 ,,NW,,,,,,$469.07,$0.00,1,0,1,1,1,1,20120101,D3950,HCPCS,CANAL PREP/FITTING OF DOWEL,,,26 ,,NW,,,,,,$218.06,$0.00,1,0,1,1,1,1,20120101,D3999,HCPCS,ENDODONTIC PROCEDURE,,,26 ,,NW,,,,,,$940.09,$0.00,1,0,1,1,1,1,20120101,D4210,HCPCS,GINGIVECTOMY/PLASTY PER QUAD,,,26 ,,NW,,,,,,$688.20,$0.00,1,0,1,1,1,1,20120101,D4211,HCPCS,GINGIVECTOMY/PLASTY PER TOOT,,,26 ,,NW,,,,,,$317.13,$0.00,1,0,1,1,1,1,20120101,D4230,HCPCS,ANA CROWN EXP 4 OR> PER QUAD,,,26 ,,NW,,,,,,$966.46,$0.00,1,0,1,1,1,1,20120101,D4231,HCPCS,ANA CROWN EXP 1-3 PER QUAD,,,26 ,,NW,,,,,,$533.13,$0.00,1,0,1,1,1,1,20120101,D4240,HCPCS,GINGIVAL FLAP PROC W/ PLANIN,,,26 ,,NW,,,,,,$860.83,$0.00,1,0,1,1,1,1,20120101,D4241,HCPCS,GNGVL FLAP W ROOTPLAN 1-3 TH,,,26 ,,NW,,,,,,$632.24,$0.00,1,0,1,1,1,1,20120101,D4245,HCPCS,APICALLY POSITIONED FLAP,,,26 ,,NW,,,,,,$752.79,$0.00,1,0,1,1,1,1,20120101,D4249,HCPCS,CROWN LENGTHEN HARD TISSUE,,,26 ,,NW,,,,,,$940.41,$0.00,1,0,1,1,1,1,20120101,D4260,HCPCS,OSSEOUS SURGERY PER QUADRANT,,,26 ,,NW,,,,,,"$1,338.46",$0.00,1,0,1,1,1,1,20120101,D4261,HCPCS,OSSEOUS SURGL-3TEETHPERQUAD,,,26 ,,NW,,,,,,$965.71,$0.00,1,0,1,1,1,1,20120101,D4263,HCPCS,BONE REPLCE GRAFT FIRST SITE,,,26 ,,NW,,,,,,$645.40,$0.00,1,0,1,1,1,1,20120101,D4264,HCPCS,BONE REPLCE GRAFT EACH ADD,,,26 ,,NW,,,,,,$506.46,$0.00,1,0,1,1,1,1,20120101,D4265,HCPCS,BIO MTRLS TO AID SOFT/OS REG,,,26 ,,NW,,,,,,$582.01,$0.00,1,0,1,1,1,1,20120101,D4266,HCPCS,GUIDED TISS REGEN RESORBLE,,,26 ,,NW,,,,,,$706.88,$0.00,1,0,1,1,1,1,20120101,D4267,HCPCS,GUIDED TISS REGEN NONRESORB,,,26 ,,NW,,,,,,$827.30,$0.00,1,0,1,1,1,1,20120101,D4268,HCPCS,SURGICAL REVISION PROCEDURE,,,26 ,,NW,,,,,,$734.31,$0.00,1,0,1,1,1,1,20120101,D4270,HCPCS,PEDICLE SOFT TISSUE GRAFT PR,,,26 ,,NW,,,,,,"$1,010.47",$0.00,1,0,1,1,1,1,20120101,D4271,HCPCS,FREE SOFT TISSUE GRAFT PROC,,,26 ,,NW,,,,,,"$1,074.62",$0.00,1,0,1,1,1,1,20120101,D4273,HCPCS,SUBEPITHELIAL TISSUE GRAFT,,,26 ,,NW,,,,,,"$1,273.40",$0.00,1,0,1,1,1,1,20120101,D4274,HCPCS,DISTAL/PROXIMAL WEDGE PROC,,,26 ,,NW,,,,,,$733.50,$0.00,1,0,1,1,1,1,20120101,D4275,HCPCS,SOFT TISSUE ALLOGRAFT,,,26 ,,NW,,,,,,"$1,087.73",$0.00,1,0,1,1,1,1,20120101,D4276,HCPCS,CON TISSUE W DBLE PED GRAFT,,,26 ,,NW,,,,,,"$1,550.25",$0.00,1,0,1,1,1,1,20120101,D4320,HCPCS,PROVISION SPLNT INTRACORONAL,,,26 ,,NW,,,,,,$475.57,$0.00,1,0,1,1,1,1,20120101,D4321,HCPCS,PROVISIONAL SPLINT EXTRACORO,,,26 ,,NW,,,,,,$440.74,$0.00,1,0,1,1,1,1,20120101,D4341,HCPCS,PERIODONTAL SCALING & ROOT,,,26 ,,NW,,,,,,$267.49,$0.00,1,0,1,1,1,1,20120101,D4342,HCPCS,PERIODONTAL SCALING 1-3TEETH,,,26 ,,NW,,,,,,$181.33,$0.00,1,0,1,1,1,1,20120101,D4355,HCPCS,FULL MOUTH DEBRIDEMENT,,,26 ,,NW,,,,,,$184.44,$0.00,1,0,1,1,1,1,20120101,D4381,HCPCS,LOCALIZED DELIVERY ANTIMICRO,,,26 ,,NW,,,,,,$123.03,$0.00,1,0,1,1,1,1,20120101,D4910,HCPCS,PERIODONTAL MAINT PROCEDURES,,,26 ,,NW,,,,,,$149.80,$0.00,1,0,1,1,1,1,20120101,D4920,HCPCS,UNSCHEDULED DRESSING CHANGE,,,26 ,,NW,,,,,,$106.41,$0.00,1,0,1,1,1,1,20120101,D4999,HCPCS,UNSPECIFIED PERIODONTAL PROC,,,26 ,,NW,,,,,,$181.33,$0.00,1,0,1,1,1,1,20120101,D5110,HCPCS,DENTURES COMPLETE MAXILLARY,,,27 ,,NW,,,,,,"$1,668.66",$0.00,1,0,1,1,1,1,20120101,D5120,HCPCS,DENTURES COMPLETE MANDIBLE,,,27 ,,NW,,,,,,"$1,658.58",$0.00,1,0,1,1,1,1,20120101,D5130,HCPCS,DENTURES IMMEDIAT MAXILLARY,,,27 ,,NW,,,,,,"$1,802.01",$0.00,1,0,1,1,1,1,20120101,D5140,HCPCS,DENTURES IMMEDIAT MANDIBLE,,,27 ,,NW,,,,,,"$1,793.77",$0.00,1,0,1,1,1,1,20120101,D5211,HCPCS,DENTURES MAXILL PART RESIN,,,27 ,,NW,,,,,,"$1,333.14",$0.00,1,0,1,1,1,1,20120101,D5212,HCPCS,DENTURES MAND PART RESIN,,,27 ,,NW,,,,,,"$1,438.78",$0.00,1,0,1,1,1,1,20120101,D5213,HCPCS,DENTURES MAXILL PART METAL,,,27 ,,NW,,,,,,"$1,794.86",$0.00,1,0,1,1,1,1,20120101,D5214,HCPCS,DENTURES MANDIBL PART METAL,,,27 ,,NW,,,,,,"$1,795.58",$0.00,1,0,1,1,1,1,20120101,D5225,HCPCS,MAXILLARY PART DENTURE FLEX,,,27 ,,NW,,,,,,"$1,542.49",$0.00,1,0,1,1,1,1,20120101,D5226,HCPCS,MANDIBULAR PART DENTURE FLEX,,,27 ,,NW,,,,,,"$1,624.50",$0.00,1,0,1,1,1,1,20120101,D5281,HCPCS,REMOVABLE PARTIAL DENTURE,,,27 ,,NW,,,,,,"$1,013.83",$0.00,1,0,1,1,1,1,20120101,D5410,HCPCS,DENTURES ADJUST CMPLT MAXIL,,,27 ,,NW,,,,,,$91.47,$0.00,1,0,1,1,1,1,20120101,D5411,HCPCS,DENTURES ADJUST CMPLT MAND,,,27 ,,NW,,,,,,$90.05,$0.00,1,0,1,1,1,1,20120101,D5421,HCPCS,DENTURES ADJUST PART MAXILL,,,27 ,,NW,,,,,,$91.84,$0.00,1,0,1,1,1,1,20120101,D5422,HCPCS,DENTURES ADJUST PART MANDBL,,,27 ,,NW,,,,,,$91.84,$0.00,1,0,1,1,1,1,20120101,D5510,HCPCS,DENTUR REPR BROKEN COMPL BAS,,,27 ,,NW,,,,,,$201.12,$0.00,1,0,1,1,1,1,20120101,D5520,HCPCS,REPLACE DENTURE TEETH COMPLT,,,27 ,,NW,,,,,,$172.58,$0.00,1,0,1,1,1,1,20120101,D5610,HCPCS,DENTURES REPAIR RESIN BASE,,,27 ,,NW,,,,,,$202.79,$0.00,1,0,1,1,1,1,20120101,D5620,HCPCS,REP PART DENTURE CAST FRAME,,,27 ,,NW,,,,,,$258.62,$0.00,1,0,1,1,1,1,20120101,D5630,HCPCS,REP PARTIAL DENTURE CLASP,,,27 ,,NW,,,,,,$260.42,$0.00,1,0,1,1,1,1,20120101,D5640,HCPCS,REPLACE PART DENTURE TEETH,,,27 ,,NW,,,,,,$178.84,$0.00,1,0,1,1,1,1,20120101,D5650,HCPCS,ADD TOOTH TO PARTIAL DENTURE,,,27 ,,NW,,,,,,$224.58,$0.00,1,0,1,1,1,1,20120101,D5660,HCPCS,ADD CLASP TO PARTIAL DENTURE,,,27 ,,NW,,,,,,$267.60,$0.00,1,0,1,1,1,1,20120101,D5670,HCPCS,REPLC TTH&ACRLC ON MTL FRMWK,,,27 ,,NW,,,,,,$692.62,$0.00,1,0,1,1,1,1,20120101,D5671,HCPCS,REPLC TTH&ACRLC MANDIBULAR,,,27 ,,NW,,,,,,$715.77,$0.00,1,0,1,1,1,1,20120101,D5710,HCPCS,DENTURES REBASE CMPLT MAXIL,,,27 ,,NW,,,,,,$607.49,$0.00,1,0,1,1,1,1,20120101,D5711,HCPCS,DENTURES REBASE CMPLT MAND,,,27 ,,NW,,,,,,$592.63,$0.00,1,0,1,1,1,1,20120101,D5720,HCPCS,DENTURES REBASE PART MAXILL,,,27 ,,NW,,,,,,$584.73,$0.00,1,0,1,1,1,1,20120101,D5721,HCPCS,DENTURES REBASE PART MANDBL,,,27 ,,NW,,,,,,$590.10,$0.00,1,0,1,1,1,1,20120101,D5730,HCPCS,DENTURE RELN CMPLT MAXIL CH,,,27 ,,NW,,,,,,$376.38,$0.00,1,0,1,1,1,1,20120101,D5731,HCPCS,DENTURE RELN CMPLT MAND CHR,,,27 ,,NW,,,,,,$372.81,$0.00,1,0,1,1,1,1,20120101,D5740,HCPCS,DENTURE RELN PART MAXIL CHR,,,27 ,,NW,,,,,,$353.57,$0.00,1,0,1,1,1,1,20120101,D5741,HCPCS,DENTURE RELN PART MAND CHR,,,27 ,,NW,,,,,,$357.77,$0.00,1,0,1,1,1,1,20120101,D5750,HCPCS,DENTURE RELN CMPLT MAX LAB,,,27 ,,NW,,,,,,$485.57,$0.00,1,0,1,1,1,1,20120101,D5751,HCPCS,DENTURE RELN CMPLT MAND LAB,,,27 ,,NW,,,,,,$484.84,$0.00,1,0,1,1,1,1,20120101,D5760,HCPCS,DENTURE RELN PART MAXIL LAB,,,27 ,,NW,,,,,,$484.67,$0.00,1,0,1,1,1,1,20120101,D5761,HCPCS,DENTURE RELN PART MAND LAB,,,27 ,,NW,,,,,,$483.95,$0.00,1,0,1,1,1,1,20120101,D5810,HCPCS,DENTURE INTERM CMPLT MAXILL,,,27 ,,NW,,,,,,$837.44,$0.00,1,0,1,1,1,1,20120101,D5811,HCPCS,DENTURE INTERM CMPLT MANDBL,,,27 ,,NW,,,,,,$861.03,$0.00,1,0,1,1,1,1,20120101,D5820,HCPCS,DENTURE INTERM PART MAXILL,,,27 ,,NW,,,,,,$663.21,$0.00,1,0,1,1,1,1,20120101,D5821,HCPCS,DENTURE INTERM PART MANDBL,,,27 ,,NW,,,,,,$681.60,$0.00,1,0,1,1,1,1,20120101,D5850,HCPCS,DENTURE TISS CONDITN MAXILL,,,27 ,,NW,,,,,,$186.48,$0.00,1,0,1,1,1,1,20120101,D5851,HCPCS,DENTURE TISS CONDTIN MANDBL,,,27 ,,NW,,,,,,$185.04,$0.00,1,0,1,1,1,1,20120101,D5860,HCPCS,OVERDENTURE COMPLETE,,,27 ,,NW,,,,,,"$2,332.43",$0.00,1,0,1,1,1,1,20120101,D5861,HCPCS,OVERDENTURE PARTIAL,,,27 ,,NW,,,,,,"$2,121.80",$0.00,1,0,1,1,1,1,20120101,D5862,HCPCS,PRECISION ATTACHMENT,,,27 ,,NW,,,,,,$713.82,$0.00,1,0,1,1,1,1,20120101,D5867,HCPCS,REPLACEMENT OF PRECISION ATT,,,27 ,,NW,,,,,,$293.62,$0.00,1,0,1,1,1,1,20120101,D5875,HCPCS,PROSTHESIS MODIFICATION,,,27 ,,NW,,,,,,$456.91,$0.00,1,0,1,1,1,1,20120101,D5899,HCPCS,REMOVABLE PROSTHODONTIC PROC,,,27 ,,NW,,,,,,$663.21,$0.00,1,0,1,1,1,1,20120101,D5911,HCPCS,FACIAL MOULAGE SECTIONAL,,,27 ,,NW,,,,,,$398.16,$0.00,1,0,1,1,1,1,20120101,D5912,HCPCS,FACIAL MOULAGE COMPLETE,,,27 ,,NW,,,,,,$378.35,$0.00,1,0,1,1,1,1,20120101,D5913,HCPCS,NASAL PROSTHESIS,,,27 ,,NW,,,,,,"$7,967.22",$0.00,1,0,1,1,1,1,20120101,D5914,HCPCS,AURICULAR PROSTHESIS,,,27 ,,NW,,,,,,"$7,967.22",$0.00,1,0,1,1,1,1,20120101,D5915,HCPCS,ORBITAL PROSTHESIS,,,27 ,,NW,,,,,,"$10,781.74",$0.00,1,0,1,1,1,1,20120101,D5916,HCPCS,OCULAR PROSTHESIS,,,27 ,,NW,,,,,,"$2,875.76",$0.00,1,0,1,1,1,1,20120101,D5919,HCPCS,FACIAL PROSTHESIS,,,27 ,,NW,,,,,,"$1,346.37",$0.00,1,0,1,1,1,1,20120101,D5922,HCPCS,NASAL SEPTAL PROSTHESIS,,,27 ,,NW,,,,,,"$1,346.37",$0.00,1,0,1,1,1,1,20120101,D5923,HCPCS,OCULAR PROSTHESIS INTERIM,,,27 ,,NW,,,,,,"$1,346.37",$0.00,1,0,1,1,1,1,20120101,D5924,HCPCS,CRANIAL PROSTHESIS,,,27 ,,NW,,,,,,"$1,025.60",$0.00,1,0,1,1,1,1,20120101,D5925,HCPCS,FACIAL AUGMENTATION IMPLANT,,,27 ,,NW,,,,,,$329.92,$0.00,1,0,1,1,1,1,20120101,D5926,HCPCS,REPLACEMENT NASAL PROSTHESIS,,,27 ,,NW,,,,,,"$1,346.37",$0.00,1,0,1,1,1,1,20120101,D5927,HCPCS,AURICULAR REPLACEMENT,,,27 ,,NW,,,,,,"$1,346.37",$0.00,1,0,1,1,1,1,20120101,D5928,HCPCS,ORBITAL REPLACEMENT,,,27 ,,NW,,,,,,"$1,346.37",$0.00,1,0,1,1,1,1,20120101,D5929,HCPCS,FACIAL REPLACEMENT,,,27 ,,NW,,,,,,"$1,346.37",$0.00,1,0,1,1,1,1,20120101,D5931,HCPCS,SURGICAL OBTURATOR,,,27 ,,NW,,,,,,"$3,812.42",$0.00,1,0,1,1,1,1,20120101,D5932,HCPCS,POSTSURGICAL OBTURATOR,,,27 ,,NW,,,,,,"$6,801.00",$0.00,1,0,1,1,1,1,20120101,D5933,HCPCS,REFITTING OF OBTURATOR,,,27 ,,NW,,,,,,$268.69,$0.00,1,0,1,1,1,1,20120101,D5934,HCPCS,MANDIBULAR FLANGE PROSTHESIS,,,27 ,,NW,,,,,,"$7,312.58",$0.00,1,0,1,1,1,1,20120101,D5935,HCPCS,MANDIBULAR DENTURE PROSTH,,,27 ,,NW,,,,,,"$6,362.61",$0.00,1,0,1,1,1,1,20120101,D5936,HCPCS,TEMP OBTURATOR PROSTHESIS,,,27 ,,NW,,,,,,"$7,520.71",$0.00,1,0,1,1,1,1,20120101,D5937,HCPCS,TRISMUS APPLIANCE,,,27 ,,NW,,,,,,$765.14,$0.00,1,0,1,1,1,1,20120101,D5951,HCPCS,FEEDING AID,,,27 ,,NW,,,,,,"$1,095.25",$0.00,1,0,1,1,1,1,20120101,D5952,HCPCS,PEDIATRIC SPEECH AID,,,27 ,,NW,,,,,,"$3,791.71",$0.00,1,0,1,1,1,1,20120101,D5953,HCPCS,ADULT SPEECH AID,,,27 ,,NW,,,,,,"$7,578.00",$0.00,1,0,1,1,1,1,20120101,D5954,HCPCS,SUPERIMPOSED PROSTHESIS,,,27 ,,NW,,,,,,"$7,022.29",$0.00,1,0,1,1,1,1,20120101,D5955,HCPCS,PALATAL LIFT PROSTHESIS,,,27 ,,NW,,,,,,"$6,495.23",$0.00,1,0,1,1,1,1,20120101,D5958,HCPCS,INTRAORAL CON DEF INTER PLT,,,27 ,,NW,,,,,,"$1,346.37",$0.00,1,0,1,1,1,1,20120101,D5959,HCPCS,INTRAORAL CON DEF MOD PALAT,,,27 ,,NW,,,,,,"$1,346.37",$0.00,1,0,1,1,1,1,20120101,D5960,HCPCS,MODIFY SPEECH AID PROSTHESIS,,,27 ,,NW,,,,,,$485.63,$0.00,1,0,1,1,1,1,20120101,D5982,HCPCS,SURGICAL STENT,,,27 ,,NW,,,,,,$518.10,$0.00,1,0,1,1,1,1,20120101,D5983,HCPCS,RADIATION APPLICATOR,,,27 ,,NW,,,,,,"$1,172.90",$0.00,1,0,1,1,1,1,20120101,D5984,HCPCS,RADIATION SHIELD,,,27 ,,NW,,,,,,"$1,432.24",$0.00,1,0,1,1,1,1,20120101,D5985,HCPCS,RADIATION CONE LOCATOR,,,27 ,,NW,,,,,,"$1,432.24",$0.00,1,0,1,1,1,1,20120101,D5986,HCPCS,FLUORIDE APPLICATOR,,,27 ,,NW,,,,,,$191.44,$0.00,1,0,1,1,1,1,20120101,D5987,HCPCS,COMMISSURE SPLINT,,,27 ,,NW,,,,,,"$1,810.45",$0.00,1,0,1,1,1,1,20120101,D5988,HCPCS,SURGICAL SPLINT,,,27 ,,NW,,,,,,$528.75,$0.00,1,0,1,1,1,1,20120101,D5991,HCPCS,TOPICAL MEDICAMENT CARRIER,,,27 ,,NW,,,,,,$214.24,$0.00,1,0,1,1,1,1,20120101,D5992,HCPCS,ADJUST MAX PROST APPLIANCE,,,27 ,,NW,,,,,,$518.10,$0.00,1,0,1,1,1,1,20120101,D5993,HCPCS,MAIN/CLEAN MAX PROSTHESIS,,,27 ,,NW,,,,,,$518.10,$0.00,1,0,1,1,1,1,20120101,D5999,HCPCS,MAXILLOFACIAL PROSTHESIS,,,27 ,,NW,,,,,,$518.10,$0.00,1,0,1,1,1,1,20120101,D6010,HCPCS,ODONTICS ENDOSTEAL IMPLANT,,,27 ,,NW,,,,,,"$2,356.52",$0.00,1,0,1,1,1,1,20120101,D6012,HCPCS,ENDOSTEAL IMPLANT,,,27 ,,NW,,,,,,"$1,866.94",$0.00,1,0,1,1,1,1,20120101,D6040,HCPCS,ODONTICS EPOSTEAL IMPLANT,,,27 ,,NW,,,,,,"$9,035.52",$0.00,1,0,1,1,1,1,20120101,D6050,HCPCS,ODONTICS TRANSOSTEAL IMPLNT,,,27 ,,NW,,,,,,"$6,538.23",$0.00,1,0,1,1,1,1,20120101,D6053,HCPCS,IMPLNT/ABTMNT SPPRT REMV DNT,,,27 ,,NW,,,,,,"$2,587.46",$0.00,1,0,1,1,1,1,20120101,D6054,HCPCS,IMPLNT/ABTMNT SPPRT REMVPRTL,,,27 ,,NW,,,,,,"$2,461.05",$0.00,1,0,1,1,1,1,20120101,D6055,HCPCS,IMPLANT CONNECTING BAR,,,27 ,,NW,,,,,,$984.99,$0.00,1,0,1,1,1,1,20120101,D6056,HCPCS,PREFABRICATED ABUTMENT,,,27 ,,NW,,,,,,$709.68,$0.00,1,0,1,1,1,1,20120101,D6057,HCPCS,CUSTOM ABUTMENT,,,27 ,,NW,,,,,,$894.60,$0.00,1,0,1,1,1,1,20120101,D6058,HCPCS,ABUTMENT SUPPORTED CROWN,,,27 ,,NW,,,,,,"$1,571.05",$0.00,1,0,1,1,1,1,20120101,D6059,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27 ,,NW,,,,,,"$1,566.43",$0.00,1,0,1,1,1,1,20120101,D6060,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27 ,,NW,,,,,,"$1,470.30",$0.00,1,0,1,1,1,1,20120101,D6061,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27 ,,NW,,,,,,"$1,504.26",$0.00,1,0,1,1,1,1,20120101,D6062,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27 ,,NW,,,,,,"$1,535.83",$0.00,1,0,1,1,1,1,20120101,D6063,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27 ,,NW,,,,,,"$1,403.95",$0.00,1,0,1,1,1,1,20120101,D6064,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27 ,,NW,,,,,,"$1,506.42",$0.00,1,0,1,1,1,1,20120101,D6065,HCPCS,IMPLANT SUPPORTED CROWN,,,27 ,,NW,,,,,,"$1,628.40",$0.00,1,0,1,1,1,1,20120101,D6066,HCPCS,IMPLANT SUPPORTED MTL CROWN,,,27 ,,NW,,,,,,"$1,619.99",$0.00,1,0,1,1,1,1,20120101,D6067,HCPCS,IMPLANT SUPPORTED MTL CROWN,,,27 ,,NW,,,,,,"$1,611.91",$0.00,1,0,1,1,1,1,20120101,D6068,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,527.30",$0.00,1,0,1,1,1,1,20120101,D6069,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,569.01",$0.00,1,0,1,1,1,1,20120101,D6070,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,475.13",$0.00,1,0,1,1,1,1,20120101,D6071,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,487.17",$0.00,1,0,1,1,1,1,20120101,D6072,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,549.75",$0.00,1,0,1,1,1,1,20120101,D6073,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,482.15",$0.00,1,0,1,1,1,1,20120101,D6074,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,535.67",$0.00,1,0,1,1,1,1,20120101,D6075,HCPCS,IMPLANT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,607.39",$0.00,1,0,1,1,1,1,20120101,D6076,HCPCS,IMPLANT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,605.11",$0.00,1,0,1,1,1,1,20120101,D6077,HCPCS,IMPLANT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,544.01",$0.00,1,0,1,1,1,1,20120101,D6078,HCPCS,IMPLNT/ABUT SUPRTD FIXD DENT,,,27 ,,NW,,,,,,"$7,457.02",$0.00,1,0,1,1,1,1,20120101,D6079,HCPCS,IMPLNT/ABUT SUPRTD FIXD DENT,,,27 ,,NW,,,,,,"$4,614.25",$0.00,1,0,1,1,1,1,20120101,D6080,HCPCS,IMPLANT MAINTENANCE,,,27 ,,NW,,,,,,$130.91,$0.00,1,0,1,1,1,1,20120101,D6090,HCPCS,REPAIR IMPLANT,,,27 ,,NW,,,,,,$589.51,$0.00,1,0,1,1,1,1,20120101,D6091,HCPCS,REPL SEMI/PRECISION ATTACH,,,27 ,,NW,,,,,,$558.04,$0.00,1,0,1,1,1,1,20120101,D6092,HCPCS,RECEMENT SUPP CROWN,,,27 ,,NW,,,,,,$141.36,$0.00,1,0,1,1,1,1,20120101,D6093,HCPCS,RECEMENT SUPP PART DENTURE,,,27 ,,NW,,,,,,$180.89,$0.00,1,0,1,1,1,1,20120101,D6094,HCPCS,ABUT SUPPORT CROWN TITANIUM,,,27 ,,NW,,,,,,"$1,455.49",$0.00,1,0,1,1,1,1,20120101,D6095,HCPCS,ODONTICS REPR ABUTMENT,,,27 ,,NW,,,,,,$585.68,$0.00,1,0,1,1,1,1,20120101,D6100,HCPCS,REMOVAL OF IMPLANT,,,27 ,,NW,,,,,,$739.15,$0.00,1,0,1,1,1,1,20120101,D6190,HCPCS,RADIO/SURGICAL IMPLANT INDEX,,,27 ,,NW,,,,,,$338.80,$0.00,1,0,1,1,1,1,20120101,D6194,HCPCS,ABUT SUPPORT RETAINER TITANI,,,27 ,,NW,,,,,,"$1,462.63",$0.00,1,0,1,1,1,1,20120101,D6199,HCPCS,IMPLANT PROCEDURE,,,27 ,,NW,,,,,,"$1,571.05",$0.00,1,0,1,1,1,1,20120101,D6205,HCPCS,PONTIC-INDIRECT RESIN BASED,,,27 ,,NW,,,,,,$884.08,$0.00,1,0,1,1,1,1,20120101,D6210,HCPCS,PROSTHODONT HIGH NOBLE METAL,,,27 ,,NW,,,,,,"$1,139.58",$0.00,1,0,1,1,1,1,20120101,D6211,HCPCS,BRIDGE BASE METAL CAST,,,27 ,,NW,,,,,,"$1,067.27",$0.00,1,0,1,1,1,1,20120101,D6212,HCPCS,BRIDGE NOBLE METAL CAST,,,27 ,,NW,,,,,,"$1,133.16",$0.00,1,0,1,1,1,1,20120101,D6214,HCPCS,PONTIC TITANIUM,,,27 ,,NW,,,,,,"$1,360.86",$0.00,1,0,1,1,1,1,20120101,D6240,HCPCS,BRIDGE PORCELAIN HIGH NOBLE,,,27 ,,NW,,,,,,"$1,157.93",$0.00,1,0,1,1,1,1,20120101,D6241,HCPCS,BRIDGE PORCELAIN BASE METAL,,,27 ,,NW,,,,,,"$1,053.12",$0.00,1,0,1,1,1,1,20120101,D6242,HCPCS,BRIDGE PORCELAIN NOBEL METAL,,,27 ,,NW,,,,,,"$1,097.54",$0.00,1,0,1,1,1,1,20120101,D6245,HCPCS,BRIDGE PORCELAIN/CERAMIC,,,27 ,,NW,,,,,,"$1,216.39",$0.00,1,0,1,1,1,1,20120101,D6250,HCPCS,BRIDGE RESIN W/HIGH NOBLE,,,27 ,,NW,,,,,,"$1,116.05",$0.00,1,0,1,1,1,1,20120101,D6251,HCPCS,BRIDGE RESIN BASE METAL,,,27 ,,NW,,,,,,"$1,073.88",$0.00,1,0,1,1,1,1,20120101,D6252,HCPCS,BRIDGE RESIN W/NOBLE METAL,,,27 ,,NW,,,,,,"$1,079.78",$0.00,1,0,1,1,1,1,20120101,D6253,HCPCS,PROVISIONAL PONTIC,,,27 ,,NW,,,,,,$578.57,$0.00,1,0,1,1,1,1,20120101,D6254,HCPCS,INTERIM PONTIC,,,27 ,,NW,,,,,,$578.57,$0.00,1,0,1,1,1,1,20120101,D6545,HCPCS,DENTAL RETAINR CAST METL,,,27 ,,NW,,,,,,$633.83,$0.00,1,0,1,1,1,1,20120101,D6548,HCPCS,PORCELAIN/CERAMIC RETAINER,,,27 ,,NW,,,,,,$702.50,$0.00,1,0,1,1,1,1,20120101,D6600,HCPCS,PORCELAIN/CERAMIC INLAY 2SRF,,,27 ,,NW,,,,,,$967.49,$0.00,1,0,1,1,1,1,20120101,D6601,HCPCS,PORC/CERAM INLAY >= 3 SURFAC,,,27 ,,NW,,,,,,"$1,061.83",$0.00,1,0,1,1,1,1,20120101,D6602,HCPCS,CST HGH NBLE MTL INLAY 2 SRF,,,27 ,,NW,,,,,,$959.89,$0.00,1,0,1,1,1,1,20120101,D6603,HCPCS,CST HGH NBLE MTL INLAY >=3SR,,,27 ,,NW,,,,,,"$1,084.66",$0.00,1,0,1,1,1,1,20120101,D6604,HCPCS,CST BSE MTL INLAY 2 SURFACES,,,27 ,,NW,,,,,,$923.23,$0.00,1,0,1,1,1,1,20120101,D6605,HCPCS,CST BSE MTL INLAY >= 3 SURFA,,,27 ,,NW,,,,,,"$1,151.97",$0.00,1,0,1,1,1,1,20120101,D6606,HCPCS,CAST NOBLE METAL INLAY 2 SUR,,,27 ,,NW,,,,,,$917.98,$0.00,1,0,1,1,1,1,20120101,D6607,HCPCS,CST NOBLE MTL INLAY >=3 SURF,,,27 ,,NW,,,,,,"$1,083.54",$0.00,1,0,1,1,1,1,20120101,D6608,HCPCS,ONLAY PORC/CRMC 2 SURFACES,,,27 ,,NW,,,,,,"$1,042.99",$0.00,1,0,1,1,1,1,20120101,D6609,HCPCS,ONLAY PORC/CRMC >=3 SURFACES,,,27 ,,NW,,,,,,"$1,121.39",$0.00,1,0,1,1,1,1,20120101,D6610,HCPCS,ONLAY CST HGH NBL MTL 2 SRFC,,,27 ,,NW,,,,,,"$1,016.26",$0.00,1,0,1,1,1,1,20120101,D6611,HCPCS,ONLAY CST HGH NBL MTL >=3SRF,,,27 ,,NW,,,,,,"$1,170.15",$0.00,1,0,1,1,1,1,20120101,D6612,HCPCS,ONLAY CST BASE MTL 2 SURFACE,,,27 ,,NW,,,,,,$980.88,$0.00,1,0,1,1,1,1,20120101,D6613,HCPCS,ONLAY CST BASE MTL >=3 SURFA,,,27 ,,NW,,,,,,"$1,073.31",$0.00,1,0,1,1,1,1,20120101,D6614,HCPCS,ONLAY CST NBL MTL 2 SURFACES,,,27 ,,NW,,,,,,"$1,002.98",$0.00,1,0,1,1,1,1,20120101,D6615,HCPCS,ONLAY CST NBL MTL >=3 SURFAC,,,27 ,,NW,,,,,,"$1,145.91",$0.00,1,0,1,1,1,1,20120101,D6624,HCPCS,INLAY TITANIUM,,,27 ,,NW,,,,,,"$1,096.65",$0.00,1,0,1,1,1,1,20120101,D6634,HCPCS,ONLAY TITANIUM,,,27 ,,NW,,,,,,"$1,056.50",$0.00,1,0,1,1,1,1,20120101,D6710,HCPCS,CROWN-INDIRECT RESIN BASED,,,27 ,,NW,,,,,,"$1,015.32",$0.00,1,0,1,1,1,1,20120101,D6720,HCPCS,RETAIN CROWN RESIN W HI NBLE,,,27 ,,NW,,,,,,"$1,123.68",$0.00,1,0,1,1,1,1,20120101,D6721,HCPCS,CROWN RESIN W/BASE METAL,,,27 ,,NW,,,,,,"$1,065.77",$0.00,1,0,1,1,1,1,20120101,D6722,HCPCS,CROWN RESIN W/NOBLE METAL,,,27 ,,NW,,,,,,"$1,090.93",$0.00,1,0,1,1,1,1,20120101,D6740,HCPCS,CROWN PORCELAIN/CERAMIC,,,27 ,,NW,,,,,,"$1,228.40",$0.00,1,0,1,1,1,1,20120101,D6750,HCPCS,CROWN PORCELAIN HIGH NOBLE,,,27 ,,NW,,,,,,"$1,166.57",$0.00,1,0,1,1,1,1,20120101,D6751,HCPCS,CROWN PORCELAIN BASE METAL,,,27 ,,NW,,,,,,"$1,069.28",$0.00,1,0,1,1,1,1,20120101,D6752,HCPCS,CROWN PORCELAIN NOBLE METAL,,,27 ,,NW,,,,,,"$1,095.49",$0.00,1,0,1,1,1,1,20120101,D6780,HCPCS,CROWN 3/4 HIGH NOBLE METAL,,,27 ,,NW,,,,,,"$1,127.16",$0.00,1,0,1,1,1,1,20120101,D6781,HCPCS,CROWN 3/4 CAST BASED METAL,,,27 ,,NW,,,,,,"$1,136.05",$0.00,1,0,1,1,1,1,20120101,D6782,HCPCS,CROWN 3/4 CAST NOBLE METAL,,,27 ,,NW,,,,,,"$1,137.72",$0.00,1,0,1,1,1,1,20120101,D6783,HCPCS,CROWN 3/4 PORCELAIN/CERAMIC,,,27 ,,NW,,,,,,"$1,161.58",$0.00,1,0,1,1,1,1,20120101,D6790,HCPCS,CROWN FULL HIGH NOBLE METAL,,,27 ,,NW,,,,,,"$1,133.33",$0.00,1,0,1,1,1,1,20120101,D6791,HCPCS,CROWN FULL BASE METAL CAST,,,27 ,,NW,,,,,,"$1,066.43",$0.00,1,0,1,1,1,1,20120101,D6792,HCPCS,CROWN FULL NOBLE METAL CAST,,,27 ,,NW,,,,,,"$1,116.08",$0.00,1,0,1,1,1,1,20120101,D6793,HCPCS,PROVISIONAL RETAINER CROWN,,,27 ,,NW,,,,,,$490.89,$0.00,1,0,1,1,1,1,20120101,D6794,HCPCS,CROWN TITANIUM,,,27 ,,NW,,,,,,"$1,327.25",$0.00,1,0,1,1,1,1,20120101,D6795,HCPCS,INTERIM RETAINER CROWN,,,27 ,,NW,,,,,,$490.89,$0.00,1,0,1,1,1,1,20120101,D6920,HCPCS,DENTAL CONNECTOR BAR,,,27 ,,NW,,,,,,$266.09,$0.00,1,0,1,1,1,1,20120101,D6930,HCPCS,DENTAL RECEMENT BRIDGE,,,27 ,,NW,,,,,,$167.84,$0.00,1,0,1,1,1,1,20120101,D6940,HCPCS,STRESS BREAKER,,,27 ,,NW,,,,,,$398.39,$0.00,1,0,1,1,1,1,20120101,D6950,HCPCS,PRECISION ATTACHMENT,,,27 ,,NW,,,,,,$662.89,$0.00,1,0,1,1,1,1,20120101,D6970,HCPCS,POST & CORE PLUS RETAINER,,,27 ,,NW,,,,,,$443.12,$0.00,1,0,1,1,1,1,20120101,D6972,HCPCS,PREFAB POST & CORE PLUS RETA,,,27 ,,NW,,,,,,$355.89,$0.00,1,0,1,1,1,1,20120101,D6973,HCPCS,CORE BUILD UP FOR RETAINER,,,27 ,,NW,,,,,,$282.59,$0.00,1,0,1,1,1,1,20120101,D6975,HCPCS,COPING METAL,,,27 ,,NW,,,,,,$771.93,$0.00,1,0,1,1,1,1,20120101,D6976,HCPCS,EACH ADDTNL CAST POST,,,27 ,,NW,,,,,,$256.61,$0.00,1,0,1,1,1,1,20120101,D6977,HCPCS,EACH ADDTL PREFAB POST,,,27 ,,NW,,,,,,$185.75,$0.00,1,0,1,1,1,1,20120101,D6980,HCPCS,BRIDGE REPAIR,,,27 ,,NW,,,,,,$371.13,$0.00,1,0,1,1,1,1,20120101,D6985,HCPCS,PEDIATRIC PARTIAL DENTURE FX,,,27 ,,NW,,,,,,$756.76,$0.00,1,0,1,1,1,1,20120101,D6999,HCPCS,FIXED PROSTHODONTIC PROC,,,27 ,,NW,,,,,,"$1,157.93",$0.00,1,0,1,1,1,1,20120101,D7111,HCPCS,EXTRACTION CORONAL REMNANTS,,,26 ,,NW,,,,,,$134.22,$0.00,1,0,1,1,1,1,20120101,D7140,HCPCS,EXTRACTION ERUPTED TOOTH/EXR,,,26 ,,NW,,,,,,$174.92,$0.00,1,0,1,1,1,1,20120101,D7210,HCPCS,REM IMP TOOTH W MUCOPER FLP,,,26 ,,NW,,,,,,$294.99,$0.00,1,0,1,1,1,1,20120101,D7220,HCPCS,IMPACT TOOTH REMOV SOFT TISS,,,26 ,,NW,,,,,,$345.76,$0.00,1,0,1,1,1,1,20120101,D7230,HCPCS,IMPACT TOOTH REMOV PART BONY,,,26 ,,NW,,,,,,$441.92,$0.00,1,0,1,1,1,1,20120101,D7240,HCPCS,IMPACT TOOTH REMOV COMP BONY,,,26 ,,NW,,,,,,$528.32,$0.00,1,0,1,1,1,1,20120101,D7241,HCPCS,IMPACT TOOTH REM BONY W/COMP,,,26 ,,NW,,,,,,$645.77,$0.00,1,0,1,1,1,1,20120101,D7250,HCPCS,TOOTH ROOT REMOVAL,,,26 ,,NW,,,,,,$317.06,$0.00,1,0,1,1,1,1,20120101,D7251,HCPCS,CORONECTOMY,,,26 ,,NW,,,,,,$441.92,$0.00,1,0,1,1,1,1,20120101,D7260,HCPCS,ORAL ANTRAL FISTULA CLOSURE,,,26 ,,NW,,,,,,"$1,485.18",$0.00,1,0,1,1,1,1,20120101,D7261,HCPCS,PRIMARY CLOSURE SINUS PERF,,,26 ,,NW,,,,,,$794.69,$0.00,1,0,1,1,1,1,20120101,D7270,HCPCS,TOOTH REIMPLANTATION,,,26 ,,NW,,,,,,$577.46,$0.00,1,0,1,1,1,1,20120101,D7272,HCPCS,TOOTH TRANSPLANTATION,,,26 ,,NW,,,,,,$749.81,$0.00,1,0,1,1,1,1,20120101,D7280,HCPCS,EXPOSURE IMPACT TOOTH ORTHOD,,,26 ,,NW,,,,,,$549.58,$0.00,1,0,1,1,1,1,20120101,D7282,HCPCS,MOBILIZE ERUPTED/MALPOS TOOT,,,26 ,,NW,,,,,,$396.80,$0.00,1,0,1,1,1,1,20120101,D7283,HCPCS,PLACE DEVICE IMPACTED TOOTH,,,26 ,,NW,,,,,,$228.34,$0.00,1,0,1,1,1,1,20120101,D7285,HCPCS,BIOPSY OF ORAL TISSUE HARD,,,26 ,,NW,,,,,,$751.81,$0.00,1,0,1,1,1,1,20120101,D7286,HCPCS,BIOPSY OF ORAL TISSUE SOFT,,,26 ,,NW,,,,,,$414.39,$0.00,1,0,1,1,1,1,20120101,D7287,HCPCS,EXFOLIATIVE CYTOLOG COLLECT,,,26 ,,NW,,,,,,$193.70,$0.00,1,0,1,1,1,1,20120101,D7288,HCPCS,BRUSH BIOPSY,,,26 ,,NW,,,,,,$197.83,$0.00,1,0,1,1,1,1,20120101,D7290,HCPCS,REPOSITIONING OF TEETH,,,26 ,,NW,,,,,,$515.43,$0.00,1,0,1,1,1,1,20120101,D7291,HCPCS,TRANSSEPTAL FIBEROTOMY,,,26 ,,NW,,,,,,$258.05,$0.00,1,0,1,1,1,1,20120101,D7292,HCPCS,SCREW RETAINED PLATE,,,26 ,,NW,,,,,,$797.76,$0.00,1,0,1,1,1,1,20120101,D7293,HCPCS,TEMP ANCHORAGE DEV W FLAP,,,26 ,,NW,,,,,,$498.60,$0.00,1,0,1,1,1,1,20120101,D7294,HCPCS,TEMP ANCHORAGE DEV W/O FLAP,,,26 ,,NW,,,,,,$406.54,$0.00,1,0,1,1,1,1,20120101,D7295,HCPCS,"BONE HARVEST,AUTO GRAFT PROC",,,26 ,,NW,,,,,,$645.40,$0.00,1,0,1,1,1,1,20120101,D7310,HCPCS,ALVEOPLASTY W/ EXTRACTION,,,26 ,,NW,,,,,,$327.73,$0.00,1,0,1,1,1,1,20120101,D7311,HCPCS,ALVEOLOPLASTY W/EXTRACT 1-3,,,26 ,,NW,,,,,,$312.41,$0.00,1,0,1,1,1,1,20120101,D7320,HCPCS,ALVEOPLASTY W/O EXTRACTION,,,26 ,,NW,,,,,,$503.20,$0.00,1,0,1,1,1,1,20120101,D7321,HCPCS,ALVEOLOPLASTY NOT W/EXTRACTS,,,26 ,,NW,,,,,,$448.22,$0.00,1,0,1,1,1,1,20120101,D7340,HCPCS,VESTIBULOPLASTY RIDGE EXTENS,,,26 ,,NW,,,,,,"$1,441.35",$0.00,1,0,1,1,1,1,20120101,D7350,HCPCS,VESTIBULOPLASTY EXTEN GRAFT,,,26 ,,NW,,,,,,"$2,368.40",$0.00,1,0,1,1,1,1,20120101,D7410,HCPCS,RAD EXC LESION UP TO 1.25 CM,,,26 ,,NW,,,,,,$499.29,$0.00,1,0,1,1,1,1,20120101,D7411,HCPCS,EXCISION BENIGN LESION>1.25C,,,26 ,,NW,,,,,,$772.19,$0.00,1,0,1,1,1,1,20120101,D7412,HCPCS,EXCISION BENIGN LESION COMPL,,,26 ,,NW,,,,,,"$1,378.69",$0.00,1,0,1,1,1,1,20120101,D7413,HCPCS,EXCISION MALIG LESION<=1.25C,,,26 ,,NW,,,,,,$981.51,$0.00,1,0,1,1,1,1,20120101,D7414,HCPCS,EXCISION MALIG LESION>1.25CM,,,26 ,,NW,,,,,,"$1,458.07",$0.00,1,0,1,1,1,1,20120101,D7415,HCPCS,EXCISION MALIG LES COMPLICAT,,,26 ,,NW,,,,,,"$1,528.45",$0.00,1,0,1,1,1,1,20120101,D7440,HCPCS,MALIG TUMOR EXC TO 1.25 CM,,,26 ,,NW,,,,,,$731.92,$0.00,1,0,1,1,1,1,20120101,D7441,HCPCS,MALIG TUMOR > 1.25 CM,,,26 ,,NW,,,,,,"$1,739.65",$0.00,1,0,1,1,1,1,20120101,D7450,HCPCS,REM ODONTOGEN CYST TO 1.25CM,,,26 ,,NW,,,,,,$818.46,$0.00,1,0,1,1,1,1,20120101,D7451,HCPCS,REM ODONTOGEN CYST > 1.25 CM,,,26 ,,NW,,,,,,"$1,191.54",$0.00,1,0,1,1,1,1,20120101,D7460,HCPCS,REM NONODONTO CYST TO 1.25CM,,,26 ,,NW,,,,,,$780.21,$0.00,1,0,1,1,1,1,20120101,D7461,HCPCS,REM NONODONTO CYST > 1.25 CM,,,26 ,,NW,,,,,,"$1,218.56",$0.00,1,0,1,1,1,1,20120101,D7465,HCPCS,LESION DESTRUCTION,,,26 ,,NW,,,,,,$492.60,$0.00,1,0,1,1,1,1,20120101,D7471,HCPCS,REM EXOSTOSIS ANY SITE,,,26 ,,NW,,,,,,$966.63,$0.00,1,0,1,1,1,1,20120101,D7472,HCPCS,REMOVAL OF TORUS PALATINUS,,,26 ,,NW,,,,,,"$1,176.65",$0.00,1,0,1,1,1,1,20120101,D7473,HCPCS,REMOVE TORUS MANDIBULARIS,,,26 ,,NW,,,,,,"$1,079.31",$0.00,1,0,1,1,1,1,20120101,D7485,HCPCS,SURG REDUCT OSSEOUSTUBEROSIT,,,26 ,,NW,,,,,,$978.02,$0.00,1,0,1,1,1,1,20120101,D7490,HCPCS,MAXILLA OR MANDIBLE RESECTIO,,,26 ,,NW,,,,,,"$9,478.35",$0.00,1,0,1,1,1,1,20120101,D7510,HCPCS,I&D ABSC INTRAORAL SOFT TISS,,,26 ,,NW,,,,,,$306.47,$0.00,1,0,1,1,1,1,20120101,D7511,HCPCS,INCISION/DRAIN ABSCESS INTRA,,,26 ,,NW,,,,,,$473.56,$0.00,1,0,1,1,1,1,20120101,D7520,HCPCS,I&D ABSCESS EXTRAORAL,,,26 ,,NW,,,,,,$711.91,$0.00,1,0,1,1,1,1,20120101,D7521,HCPCS,INCISION/DRAIN ABSCESS EXTRA,,,26 ,,NW,,,,,,$823.87,$0.00,1,0,1,1,1,1,20120101,D7530,HCPCS,REMOVAL FB SKIN/AREOLAR TISS,,,26 ,,NW,,,,,,$480.60,$0.00,1,0,1,1,1,1,20120101,D7540,HCPCS,REMOVAL OF FB REACTION,,,26 ,,NW,,,,,,$699.84,$0.00,1,0,1,1,1,1,20120101,D7550,HCPCS,REMOVAL OF SLOUGHED OFF BONE,,,26 ,,NW,,,,,,$520.56,$0.00,1,0,1,1,1,1,20120101,D7560,HCPCS,MAXILLARY SINUSOTOMY,,,26 ,,NW,,,,,,"$2,488.17",$0.00,1,0,1,1,1,1,20120101,D7610,HCPCS,MAXILLA OPEN REDUCT SIMPLE,,,26 ,,NW,,,,,,"$5,202.66",$0.00,1,0,1,1,1,1,20120101,D7620,HCPCS,CLSD REDUCT SIMPL MAXILLA FX,,,26 ,,NW,,,,,,"$4,112.98",$0.00,1,0,1,1,1,1,20120101,D7630,HCPCS,OPEN RED SIMPL MANDIBLE FX,,,26 ,,NW,,,,,,"$5,615.86",$0.00,1,0,1,1,1,1,20120101,D7640,HCPCS,CLSD RED SIMPL MANDIBLE FX,,,26 ,,NW,,,,,,"$4,048.55",$0.00,1,0,1,1,1,1,20120101,D7650,HCPCS,OPEN RED SIMP MALAR/ZYGOM FX,,,26 ,,NW,,,,,,"$3,991.02",$0.00,1,0,1,1,1,1,20120101,D7660,HCPCS,CLSD RED SIMP MALAR/ZYGOM FX,,,26 ,,NW,,,,,,"$2,874.72",$0.00,1,0,1,1,1,1,20120101,D7670,HCPCS,CLOSD RDUCTN SPLINT ALVEOLUS,,,26 ,,NW,,,,,,"$1,773.45",$0.00,1,0,1,1,1,1,20120101,D7671,HCPCS,ALVEOLUS OPEN REDUCTION,,,26 ,,NW,,,,,,"$1,503.03",$0.00,1,0,1,1,1,1,20120101,D7680,HCPCS,REDUCT SIMPLE FACIAL BONE FX,,,26 ,,NW,,,,,,"$9,146.50",$0.00,1,0,1,1,1,1,20120101,D7710,HCPCS,MAXILLA OPEN REDUCT COMPOUND,,,26 ,,NW,,,,,,"$5,916.05",$0.00,1,0,1,1,1,1,20120101,D7720,HCPCS,CLSD REDUCT COMPD MAXILLA FX,,,26 ,,NW,,,,,,"$3,799.48",$0.00,1,0,1,1,1,1,20120101,D7730,HCPCS,OPEN REDUCT COMPD MANDBLE FX,,,26 ,,NW,,,,,,"$6,772.45",$0.00,1,0,1,1,1,1,20120101,D7740,HCPCS,CLSD REDUCT COMPD MANDBLE FX,,,26 ,,NW,,,,,,"$4,232.89",$0.00,1,0,1,1,1,1,20120101,D7750,HCPCS,OPEN RED COMP MALAR/ZYGMA FX,,,26 ,,NW,,,,,,"$4,718.17",$0.00,1,0,1,1,1,1,20120101,D7760,HCPCS,CLSD RED COMP MALAR/ZYGMA FX,,,26 ,,NW,,,,,,"$2,329.32",$0.00,1,0,1,1,1,1,20120101,D7770,HCPCS,OPEN REDUC COMPD ALVEOLUS FX,,,26 ,,NW,,,,,,"$2,908.38",$0.00,1,0,1,1,1,1,20120101,D7771,HCPCS,ALVEOLUS CLSD REDUC STBLZ TE,,,26 ,,NW,,,,,,"$2,236.49",$0.00,1,0,1,1,1,1,20120101,D7780,HCPCS,REDUCT COMPND FACIAL BONE FX,,,26 ,,NW,,,,,,"$12,095.72",$0.00,1,0,1,1,1,1,20120101,D7810,HCPCS,TMJ OPEN REDUCT-DISLOCATION,,,26 ,,NW,,,,,,"$5,518.33",$0.00,1,0,1,1,1,1,20120101,D7820,HCPCS,CLOSED TMP MANIPULATION,,,26 ,,NW,,,,,,$885.03,$0.00,1,0,1,1,1,1,20120101,D7830,HCPCS,TMJ MANIPULATION UNDER ANEST,,,26 ,,NW,,,,,,$734.54,$0.00,1,0,1,1,1,1,20120101,D7840,HCPCS,REMOVAL OF TMJ CONDYLE,,,26 ,,NW,,,,,,"$7,414.86",$0.00,1,0,1,1,1,1,20120101,D7850,HCPCS,TMJ MENISCECTOMY,,,26 ,,NW,,,,,,"$6,708.21",$0.00,1,0,1,1,1,1,20120101,D7852,HCPCS,TMJ REPAIR OF JOINT DISC,,,26 ,,NW,,,,,,"$7,392.01",$0.00,1,0,1,1,1,1,20120101,D7854,HCPCS,TMJ EXCISN OF JOINT MEMBRANE,,,26 ,,NW,,,,,,"$7,419.47",$0.00,1,0,1,1,1,1,20120101,D7856,HCPCS,TMJ CUTTING OF A MUSCLE,,,26 ,,NW,,,,,,"$5,213.07",$0.00,1,0,1,1,1,1,20120101,D7858,HCPCS,TMJ RECONSTRUCTION,,,26 ,,NW,,,,,,"$16,787.32",$0.00,1,0,1,1,1,1,20120101,D7860,HCPCS,TMJ CUTTING INTO JOINT,,,26 ,,NW,,,,,,"$7,837.36",$0.00,1,0,1,1,1,1,20120101,D7865,HCPCS,TMJ RESHAPING COMPONENTS,,,26 ,,NW,,,,,,"$10,921.33",$0.00,1,0,1,1,1,1,20120101,D7870,HCPCS,TMJ ASPIRATION JOINT FLUID,,,26 ,,NW,,,,,,$472.63,$0.00,1,0,1,1,1,1,20120101,D7871,HCPCS,LYSIS + LAVAGE W CATHETERS,,,26 ,,NW,,,,,,$820.40,$0.00,1,0,1,1,1,1,20120101,D7872,HCPCS,TMJ DIAGNOSTIC ARTHROSCOPY,,,26 ,,NW,,,,,,"$4,067.19",$0.00,1,0,1,1,1,1,20120101,D7873,HCPCS,TMJ ARTHROSCOPY LYSIS ADHESN,,,26 ,,NW,,,,,,"$5,364.03",$0.00,1,0,1,1,1,1,20120101,D7874,HCPCS,TMJ ARTHROSCOPY DISC REPOSIT,,,26 ,,NW,,,,,,"$7,024.40",$0.00,1,0,1,1,1,1,20120101,D7875,HCPCS,TMJ ARTHROSCOPY SYNOVECTOMY,,,26 ,,NW,,,,,,"$7,695.36",$0.00,1,0,1,1,1,1,20120101,D7876,HCPCS,TMJ ARTHROSCOPY DISCECTOMY,,,26 ,,NW,,,,,,"$8,296.74",$0.00,1,0,1,1,1,1,20120101,D7877,HCPCS,TMJ ARTHROSCOPY DEBRIDEMENT,,,26 ,,NW,,,,,,"$7,322.61",$0.00,1,0,1,1,1,1,20120101,D7880,HCPCS,OCCLUSAL ORTHOTIC APPLIANCE,,,26 ,,NW,,,,,,"$1,022.94",$0.00,1,0,1,1,1,1,20120101,D7899,HCPCS,TMJ UNSPECIFIED THERAPY,,,26 ,,NW,,,,,,"$1,022.94",$0.00,1,0,1,1,1,1,20120101,D7910,HCPCS,DENT SUTUR RECENT WND TO 5CM,,,26 ,,NW,,,,,,$417.14,$0.00,1,0,1,1,1,1,20120101,D7911,HCPCS,DENTAL SUTURE WOUND TO 5 CM,,,26 ,,NW,,,,,,$523.08,$0.00,1,0,1,1,1,1,20120101,D7912,HCPCS,SUTURE COMPLICATE WND > 5 CM,,,26 ,,NW,,,,,,$979.96,$0.00,1,0,1,1,1,1,20120101,D7920,HCPCS,DENTAL SKIN GRAFT,,,26 ,,NW,,,,,,"$3,623.83",$0.00,1,0,1,1,1,1,20120101,D7940,HCPCS,RESHAPING BONE ORTHOGNATHIC,,,26 ,,NW,,,,,,"$2,718.19",$0.00,1,0,1,1,1,1,20120101,D7941,HCPCS,BONE CUTTING RAMUS CLOSED,,,26 ,,NW,,,,,,"$9,674.84",$0.00,1,0,1,1,1,1,20120101,D7943,HCPCS,CUTTING RAMUS OPEN W/GRAFT,,,26 ,,NW,,,,,,"$8,269.08",$0.00,1,0,1,1,1,1,20120101,D7944,HCPCS,BONE CUTTING SEGMENTED,,,26 ,,NW,,,,,,"$6,940.01",$0.00,1,0,1,1,1,1,20120101,D7945,HCPCS,BONE CUTTING BODY MANDIBLE,,,26 ,,NW,,,,,,"$9,199.65",$0.00,1,0,1,1,1,1,20120101,D7946,HCPCS,RECONSTRUCTION MAXILLA TOTAL,,,26 ,,NW,,,,,,"$10,633.18",$0.00,1,0,1,1,1,1,20120101,D7947,HCPCS,RECONSTRUCT MAXILLA SEGMENT,,,26 ,,NW,,,,,,"$10,774.78",$0.00,1,0,1,1,1,1,20120101,D7948,HCPCS,RECONSTRUCT MIDFACE NO GRAFT,,,26 ,,NW,,,,,,"$13,517.74",$0.00,1,0,1,1,1,1,20120101,D7949,HCPCS,RECONSTRUCT MIDFACE W/GRAFT,,,26 ,,NW,,,,,,"$17,099.27",$0.00,1,0,1,1,1,1,20120101,D7950,HCPCS,MANDIBLE GRAFT,,,26 ,,NW,,,,,,"$2,575.34",$0.00,1,0,1,1,1,1,20120101,D7951,HCPCS,SINUS AUG W BONE/BONE SUP,,,26 ,,NW,,,,,,"$3,116.43",$0.00,1,0,1,1,1,1,20120101,D7953,HCPCS,BONE REPLACEMENT GRAFT,,,26 ,,NW,,,,,,$382.63,$0.00,1,0,1,1,1,1,20120101,D7955,HCPCS,REPAIR MAXILLOFACIAL DEFECTS,,,26 ,,NW,,,,,,"$2,797.40",$0.00,1,0,1,1,1,1,20120101,D7960,HCPCS,FRENULECTOMY/FRENECTOMY,,,26 ,,NW,,,,,,$506.99,$0.00,1,0,1,1,1,1,20120101,D7963,HCPCS,FRENULOPLASTY,,,26 ,,NW,,,,,,$643.31,$0.00,1,0,1,1,1,1,20120101,D7970,HCPCS,EXCISION HYPERPLASTIC TISSUE,,,26 ,,NW,,,,,,$592.53,$0.00,1,0,1,1,1,1,20120101,D7971,HCPCS,EXCISION PERICORONAL GINGIVA,,,26 ,,NW,,,,,,$276.46,$0.00,1,0,1,1,1,1,20120101,D7972,HCPCS,SURG REDCT FIBROUS TUBEROSIT,,,26 ,,NW,,,,,,$838.86,$0.00,1,0,1,1,1,1,20120101,D7980,HCPCS,SIALOLITHOTOMY,,,26 ,,NW,,,,,,$947.57,$0.00,1,0,1,1,1,1,20120101,D7981,HCPCS,EXCISION OF SALIVARY GLAND,,,26 ,,NW,,,,,,$628.74,$0.00,1,0,1,1,1,1,20120101,D7982,HCPCS,SIALODOCHOPLASTY,,,26 ,,NW,,,,,,"$1,879.27",$0.00,1,0,1,1,1,1,20120101,D7983,HCPCS,CLOSURE OF SALIVARY FISTULA,,,26 ,,NW,,,,,,"$2,110.73",$0.00,1,0,1,1,1,1,20120101,D7990,HCPCS,EMERGENCY TRACHEOTOMY,,,26 ,,NW,,,,,,"$1,906.01",$0.00,1,0,1,1,1,1,20120101,D7991,HCPCS,DENTAL CORONOIDECTOMY,,,26 ,,NW,,,,,,"$4,949.27",$0.00,1,0,1,1,1,1,20120101,D7995,HCPCS,SYNTHETIC GRAFT FACIAL BONES,,,26 ,,NW,,,,,,$472.90,$0.00,1,0,1,1,1,1,20120101,D7996,HCPCS,IMPLANT MANDIBLE FOR AUGMENT,,,26 ,,NW,,,,,,"$1,988.33",$0.00,1,0,1,1,1,1,20120101,D7997,HCPCS,APPLIANCE REMOVAL,,,26 ,,NW,,,,,,$373.66,$0.00,1,0,1,1,1,1,20120101,D7998,HCPCS,INTRAORAL PLACE OF FIX DEV,,,26 ,,NW,,,,,,"$2,405.33",$0.00,1,0,1,1,1,1,20120101,D7999,HCPCS,ORAL SURGERY PROCEDURE,,,26 ,,NW,,,,,,$382.63,$0.00,1,0,1,1,1,1,20120101,D8010,HCPCS,LIMITED DENTAL TX PRIMARY,,,27 ,,NW,,,,,,"$2,378.31",$0.00,1,0,1,1,1,1,20120101,D8020,HCPCS,LIMITED DENTAL TX TRANSITION,,,27 ,,NW,,,,,,"$2,896.37",$0.00,1,0,1,1,1,1,20120101,D8030,HCPCS,LIMITED DENTAL TX ADOLESCENT,,,27 ,,NW,,,,,,"$3,456.82",$0.00,1,0,1,1,1,1,20120101,D8040,HCPCS,LIMITED DENTAL TX ADULT,,,27 ,,NW,,,,,,"$3,747.39",$0.00,1,0,1,1,1,1,20120101,D8050,HCPCS,INTERCEP DENTAL TX PRIMARY,,,27 ,,NW,,,,,,"$2,782.62",$0.00,1,0,1,1,1,1,20120101,D8060,HCPCS,INTERCEP DENTAL TX TRANSITN,,,27 ,,NW,,,,,,"$3,025.62",$0.00,1,0,1,1,1,1,20120101,D8070,HCPCS,COMPRE DENTAL TX TRANSITION,,,27 ,,NW,,,,,,"$5,685.19",$0.00,1,0,1,1,1,1,20120101,D8080,HCPCS,COMPRE DENTAL TX ADOLESCENT,,,27 ,,NW,,,,,,"$5,733.79",$0.00,1,0,1,1,1,1,20120101,D8090,HCPCS,COMPRE DENTAL TX ADULT,,,27 ,,NW,,,,,,"$5,848.57",$0.00,1,0,1,1,1,1,20120101,D8210,HCPCS,ORTHODONTIC REM APPLIANCE TX,,,27 ,,NW,,,,,,$952.36,$0.00,1,0,1,1,1,1,20120101,D8220,HCPCS,FIXED APPLIANCE THERAPY HABT,,,27 ,,NW,,,,,,"$1,081.61",$0.00,1,0,1,1,1,1,20120101,D8660,HCPCS,PREORTHODONTIC TX VISIT,,,27 ,,NW,,,,,,$469.46,$0.00,1,0,1,1,1,1,20120101,D8670,HCPCS,PERIODIC ORTHODONTC TX VISIT,,,27 ,,NW,,,,,,$301.94,$0.00,1,0,1,1,1,1,20120101,D8680,HCPCS,ORTHODONTIC RETENTION,,,27 ,,NW,,,,,,$603.88,$0.00,1,0,1,1,1,1,20120101,D8690,HCPCS,ORTHODONTIC TREATMENT,,,27 ,,NW,,,,,,$313.32,$0.00,1,0,1,1,1,1,20120101,D8691,HCPCS,REPAIR ORTHO APPLIANCE,,,27 ,,NW,,,,,,$234.73,$0.00,1,0,1,1,1,1,20120101,D8692,HCPCS,REPLACEMENT RETAINER,,,27 ,,NW,,,,,,$373.29,$0.00,1,0,1,1,1,1,20120101,D8693,HCPCS,REBOND/CEMENT/REPAIR RETAIN,,,27 ,,NW,,,,,,$375.36,$0.00,1,0,1,1,1,1,20120101,D8999,HCPCS,ORTHODONTIC PROCEDURE,,,27 ,,NW,,,,,,$301.94,$0.00,1,0,1,1,1,1,20120101,D9110,HCPCS,TX DENTAL PAIN MINOR PROC,,,26 ,,NW,,,,,,$130.50,$0.00,1,0,1,1,1,1,20120101,D9120,HCPCS,FIX PARTIAL DENTURE SECTION,,,27 ,,NW,,,,,,$189.22,$0.00,1,0,1,1,1,1,20120101,D9210,HCPCS,DENT ANESTHESIA W/O SURGERY,,,26 ,,NW,,,,,,$58.55,$0.00,1,0,1,1,1,1,20120101,D9211,HCPCS,REGIONAL BLOCK ANESTHESIA,,,26 ,,NW,,,,,,$45.51,$0.00,1,0,1,1,1,1,20120101,D9212,HCPCS,TRIGEMINAL BLOCK ANESTHESIA,,,26 ,,NW,,,,,,$75.15,$0.00,1,0,1,1,1,1,20120101,D9215,HCPCS,LOCAL ANESTHESIA,,,26 ,,NW,,,,,,$49.02,$0.00,1,0,1,1,1,1,20120101,D9220,HCPCS,GENERAL ANESTHESIA,,,26 ,,NW,,,,,,$435.94,$0.00,1,0,1,1,1,1,20120101,D9221,HCPCS,GENERAL ANESTHESIA EA AD 15M,,,26 ,,NW,,,,,,$185.45,$0.00,1,0,1,1,1,1,20120101,D9230,HCPCS,ANALGESIA,,,26 ,,NW,,,,,,$76.59,$0.00,1,0,1,1,1,1,20120101,D9241,HCPCS,INTRAVENOUS SEDATION,,,26 ,,NW,,,,,,$403.42,$0.00,1,0,1,1,1,1,20120101,D9242,HCPCS,IV SEDATION EA AD 30 M,,,26 ,,NW,,,,,,$168.33,$0.00,1,0,1,1,1,1,20120101,D9248,HCPCS,SEDATION (NON-IV),,,26 ,,NW,,,,,,$130.46,$0.00,1,0,1,1,1,1,20120101,D9310,HCPCS,DENTAL CONSULTATION,,,25 ,,NW,,,,,,$144.46,$0.00,1,0,1,1,1,1,20120101,D9410,HCPCS,DENTAL HOUSE CALL,,,25 ,,NW,,,,,,$116.71,$0.00,1,0,1,1,1,1,20120101,D9420,HCPCS,HOSPITAL/ASC CALL,,,25 ,,NW,,,,,,$302.96,$0.00,1,0,1,1,1,1,20120101,D9430,HCPCS,OFFICE VISIT DURING HOURS,,,25 ,,NW,,,,,,$79.97,$0.00,1,0,1,1,1,1,20120101,D9440,HCPCS,OFFICE VISIT AFTER HOURS,,,25 ,,NW,,,,,,$147.11,$0.00,1,0,1,1,1,1,20120101,D9450,HCPCS,CASE PRESENTATION TX PLAN,,,25 ,,NW,,,,,,$58.30,$0.00,1,0,1,1,1,1,20120101,D9610,HCPCS,DENT THERAPEUTIC DRUG INJECT,,,27 ,,NW,,,,,,$97.03,$0.00,1,0,1,1,1,1,20120101,D9612,HCPCS,THERA PAR DRUGS 2 OR > ADMIN,,,27 ,,NW,,,,,,$150.12,$0.00,1,0,1,1,1,1,20120101,D9630,HCPCS,OTHER DRUGS/MEDICAMENTS,,,27 ,,NW,,,,,,$50.99,$0.00,1,0,1,1,1,1,20120101,D9910,HCPCS,DENT APPL DESENSITIZING MED,,,27 ,,NW,,,,,,$64.05,$0.00,1,0,1,1,1,1,20120101,D9911,HCPCS,APPL DESENSITIZING RESIN,,,27 ,,NW,,,,,,$81.75,$0.00,1,0,1,1,1,1,20120101,D9920,HCPCS,BEHAVIOR MANAGEMENT,,,27 ,,NW,,,,,,$158.69,$0.00,1,0,1,1,1,1,20120101,D9930,HCPCS,TREATMENT OF COMPLICATIONS,,,27 ,,NW,,,,,,$127.71,$0.00,1,0,1,1,1,1,20120101,D9940,HCPCS,DENTAL OCCLUSAL GUARD,,,27 ,,NW,,,,,,$594.58,$0.00,1,0,1,1,1,1,20120101,D9941,HCPCS,FABRICATION ATHLETIC GUARD,,,27 ,,NW,,,,,,$219.00,$0.00,1,0,1,1,1,1,20120101,D9942,HCPCS,REPAIR/RELINE OCCLUSAL GUARD,,,27 ,,NW,,,,,,$228.77,$0.00,1,0,1,1,1,1,20120101,D9950,HCPCS,OCCLUSION ANALYSIS,,,27 ,,NW,,,,,,$360.01,$0.00,1,0,1,1,1,1,20120101,D9951,HCPCS,LIMITED OCCLUSAL ADJUSTMENT,,,27 ,,NW,,,,,,$169.11,$0.00,1,0,1,1,1,1,20120101,D9952,HCPCS,COMPLETE OCCLUSAL ADJUSTMENT,,,27 ,,NW,,,,,,$724.13,$0.00,1,0,1,1,1,1,20120101,D9970,HCPCS,ENAMEL MICROABRASION,,,27 ,,NW,,,,,,$80.55,$0.00,1,0,1,1,1,1,20120101,D9971,HCPCS,ODONTOPLASTY 1-2 TEETH,,,27 ,,NW,,,,,,$100.62,$0.00,1,0,1,1,1,1,20120101,D9972,HCPCS,EXTRNL BLEACHING PER ARCH,,,27 ,,NW,,,,,,$353.01,$0.00,1,0,1,1,1,1,20120101,D9973,HCPCS,EXTRNL BLEACHING PER TOOTH,,,27 ,,NW,,,,,,$62.97,$0.00,1,0,1,1,1,1,20120101,D9974,HCPCS,INTRNL BLEACHING PER TOOTH,,,27 ,,NW,,,,,,$308.98,$0.00,1,0,1,1,1,1,20120101,D9999,HCPCS,ADJUNCTIVE PROCEDURE,,,27 ,,NW,,,,,,$130.50,$0.00,1,0,1,1,1,1,20120101,E0100,HCPCS,CANE ADJUST/FIXED WITH TIP,,,28 ,,NW,,,,,,$42.50,$0.00,1,1,1,1,1,1,20120101,E0100,HCPCS,CANE ADJUST/FIXED WITH TIP,NU,,28 ,,NW,,,,,,$42.50,$0.00,1,1,1,1,1,1,20120101,E0100,HCPCS,CANE ADJUST/FIXED WITH TIP,RR,,28 ,,NW,,,,,,$16.15,$0.00,1,1,1,1,1,1,20120101,E0100,HCPCS,CANE ADJUST/FIXED WITH TIP,UE,,28 ,,NW,,,,,,$34.56,$0.00,1,1,1,1,1,1,20120101,E0105,HCPCS,CANE ADJUST/FIXED QUAD/3 PRO,,,28 ,,NW,,,,,,$95.97,$0.00,1,1,1,1,1,1,20120101,E0105,HCPCS,CANE ADJUST/FIXED QUAD/3 PRO,NU,,28 ,,NW,,,,,,$95.97,$0.00,1,1,1,1,1,1,20120101,E0105,HCPCS,CANE ADJUST/FIXED QUAD/3 PRO,RR,,28 ,,NW,,,,,,$21.08,$0.00,1,1,1,1,1,1,20120101,E0105,HCPCS,CANE ADJUST/FIXED QUAD/3 PRO,UE,,28 ,,NW,,,,,,$72.31,$0.00,1,1,1,1,1,1,20120101,E0110,HCPCS,CRUTCH FOREARM PAIR,,,28 ,,NW,,,,,,$159.04,$0.00,1,1,1,1,1,1,20120101,E0110,HCPCS,CRUTCH FOREARM PAIR,NU,,28 ,,NW,,,,,,$159.04,$0.00,1,1,1,1,1,1,20120101,E0110,HCPCS,CRUTCH FOREARM PAIR,RR,,28 ,,NW,,,,,,$33.18,$0.00,1,1,1,1,1,1,20120101,E0110,HCPCS,CRUTCH FOREARM PAIR,UE,,28 ,,NW,,,,,,$113.08,$0.00,1,1,1,1,1,1,20120101,E0111,HCPCS,CRUTCH FOREARM EACH,,,28 ,,NW,,,,,,$101.06,$0.00,1,1,1,1,1,1,20120101,E0111,HCPCS,CRUTCH FOREARM EACH,NU,,28 ,,NW,,,,,,$101.06,$0.00,1,1,1,1,1,1,20120101,E0111,HCPCS,CRUTCH FOREARM EACH,RR,,28 ,,NW,,,,,,$20.21,$0.00,1,1,1,1,1,1,20120101,E0111,HCPCS,CRUTCH FOREARM EACH,UE,,28 ,,NW,,,,,,$75.86,$0.00,1,1,1,1,1,1,20120101,E0112,HCPCS,CRUTCH UNDERARM PAIR WOOD,,,28 ,,NW,,,,,,$69.61,$0.00,1,1,1,1,1,1,20120101,E0112,HCPCS,CRUTCH UNDERARM PAIR WOOD,NU,,28 ,,NW,,,,,,$69.61,$0.00,1,1,1,1,1,1,20120101,E0112,HCPCS,CRUTCH UNDERARM PAIR WOOD,RR,,28 ,,NW,,,,,,$22.74,$0.00,1,1,1,1,1,1,20120101,E0112,HCPCS,CRUTCH UNDERARM PAIR WOOD,UE,,28 ,,NW,,,,,,$54.75,$0.00,1,1,1,1,1,1,20120101,E0113,HCPCS,CRUTCH UNDERARM EACH WOOD,,,28 ,,NW,,,,,,$42.00,$0.00,1,1,1,1,1,1,20120101,E0113,HCPCS,CRUTCH UNDERARM EACH WOOD,NU,,28 ,,NW,,,,,,$42.00,$0.00,1,1,1,1,1,1,20120101,E0113,HCPCS,CRUTCH UNDERARM EACH WOOD,RR,,28 ,,NW,,,,,,$14.70,$0.00,1,1,1,1,1,1,20120101,E0113,HCPCS,CRUTCH UNDERARM EACH WOOD,UE,,28 ,,NW,,,,,,$32.98,$0.00,1,1,1,1,1,1,20120101,E0114,HCPCS,CRUTCH UNDERARM PAIR NO WOOD,,,28 ,,NW,,,,,,$86.33,$0.00,1,1,1,1,1,1,20120101,E0114,HCPCS,CRUTCH UNDERARM PAIR NO WOOD,NU,,28 ,,NW,,,,,,$86.33,$0.00,1,1,1,1,1,1,20120101,E0114,HCPCS,CRUTCH UNDERARM PAIR NO WOOD,RR,,28 ,,NW,,,,,,$20.46,$0.00,1,1,1,1,1,1,20120101,E0114,HCPCS,CRUTCH UNDERARM PAIR NO WOOD,UE,,28 ,,NW,,,,,,$66.56,$0.00,1,1,1,1,1,1,20120101,E0116,HCPCS,CRUTCH UNDERARM EACH NO WOOD,,,28 ,,NW,,,,,,$51.41,$0.00,1,1,1,1,1,1,20120101,E0116,HCPCS,CRUTCH UNDERARM EACH NO WOOD,NU,,28 ,,NW,,,,,,$51.41,$0.00,1,1,1,1,1,1,20120101,E0116,HCPCS,CRUTCH UNDERARM EACH NO WOOD,RR,,28 ,,NW,,,,,,$14.93,$0.00,1,1,1,1,1,1,20120101,E0116,HCPCS,CRUTCH UNDERARM EACH NO WOOD,UE,,28 ,,NW,,,,,,$40.15,$0.00,1,1,1,1,1,1,20120101,E0117,HCPCS,UNDERARM SPRINGASSIST CRUTCH,,,28 ,,NW,,,,,,$457.02,$0.00,1,1,1,1,1,1,20120101,E0117,HCPCS,UNDERARM SPRINGASSIST CRUTCH,NU,,28 ,,NW,,,,,,$457.02,$0.00,1,1,1,1,1,1,20120101,E0117,HCPCS,UNDERARM SPRINGASSIST CRUTCH,RR,,28 ,,NW,,,,,,$40.84,$0.00,1,1,1,1,1,1,20120101,E0117,HCPCS,UNDERARM SPRINGASSIST CRUTCH,UE,,28 ,,NW,,,,,,$336.70,$0.00,1,1,1,1,1,1,20120101,E0118,HCPCS,CRUTCH SUBSTITUTE,,,28 ,,NW,,,,,,$360.43,$0.00,1,1,1,1,1,1,20120101,E0118,HCPCS,CRUTCH SUBSTITUTE,RR,,28 ,,NW,,,,,,$37.67,$0.00,1,1,1,1,1,1,20120101,E0130,HCPCS,WALKER RIGID ADJUST/FIXED HT,,,28 ,,NW,,,,,,$121.30,$0.00,1,1,1,1,1,1,20120101,E0130,HCPCS,WALKER RIGID ADJUST/FIXED HT,NU,,28 ,,NW,,,,,,$121.30,$0.00,1,1,1,1,1,1,20120101,E0130,HCPCS,WALKER RIGID ADJUST/FIXED HT,RR,,28 ,,NW,,,,,,$30.89,$0.00,1,1,1,1,1,1,20120101,E0130,HCPCS,WALKER RIGID ADJUST/FIXED HT,UE,,28 ,,NW,,,,,,$89.47,$0.00,1,1,1,1,1,1,20120101,E0135,HCPCS,WALKER FOLDING ADJUST/FIXED,,,28 ,,NW,,,,,,$151.17,$0.00,1,1,1,1,1,1,20120101,E0135,HCPCS,WALKER FOLDING ADJUST/FIXED,NU,,28 ,,NW,,,,,,$151.17,$0.00,1,1,1,1,1,1,20120101,E0135,HCPCS,WALKER FOLDING ADJUST/FIXED,RR,,28 ,,NW,,,,,,$31.91,$0.00,1,1,1,1,1,1,20120101,E0135,HCPCS,WALKER FOLDING ADJUST/FIXED,UE,,28 ,,NW,,,,,,$108.31,$0.00,1,1,1,1,1,1,20120101,E0140,HCPCS,WALKER W TRUNK SUPPORT,,,28 ,,NW,,,,,,$752.22,$0.00,1,1,1,1,1,1,20120101,E0140,HCPCS,WALKER W TRUNK SUPPORT,NU,,28 ,,NW,,,,,,$752.22,$0.00,1,1,1,1,1,1,20120101,E0140,HCPCS,WALKER W TRUNK SUPPORT,RR,,28 ,,NW,,,,,,$62.33,$0.00,1,1,1,1,1,1,20120101,E0140,HCPCS,WALKER W TRUNK SUPPORT,UE,,28 ,,NW,,,,,,$558.11,$0.00,1,1,1,1,1,1,20120101,E0141,HCPCS,RIGID WHEELED WALKER ADJ/FIX,,,28 ,,NW,,,,,,$216.31,$0.00,1,1,1,1,1,1,20120101,E0141,HCPCS,RIGID WHEELED WALKER ADJ/FIX,NU,,28 ,,NW,,,,,,$216.31,$0.00,1,1,1,1,1,1,20120101,E0141,HCPCS,RIGID WHEELED WALKER ADJ/FIX,RR,,28 ,,NW,,,,,,$38.71,$0.00,1,1,1,1,1,1,20120101,E0141,HCPCS,RIGID WHEELED WALKER ADJ/FIX,UE,,28 ,,NW,,,,,,$154.34,$0.00,1,1,1,1,1,1,20120101,E0143,HCPCS,WALKER FOLDING WHEELED W/O S,,,28 ,,NW,,,,,,$224.21,$0.00,1,1,1,1,1,1,20120101,E0143,HCPCS,WALKER FOLDING WHEELED W/O S,NU,,28 ,,NW,,,,,,$224.21,$0.00,1,1,1,1,1,1,20120101,E0143,HCPCS,WALKER FOLDING WHEELED W/O S,RR,,28 ,,NW,,,,,,$38.09,$0.00,1,1,1,1,1,1,20120101,E0143,HCPCS,WALKER FOLDING WHEELED W/O S,UE,,28 ,,NW,,,,,,$158.74,$0.00,1,1,1,1,1,1,20120101,E0144,HCPCS,ENCLOSED WALKER W REAR SEAT,,,28 ,,NW,,,,,,$661.25,$0.00,1,1,1,1,1,1,20120101,E0144,HCPCS,ENCLOSED WALKER W REAR SEAT,NU,,28 ,,NW,,,,,,$661.25,$0.00,1,1,1,1,1,1,20120101,E0144,HCPCS,ENCLOSED WALKER W REAR SEAT,RR,,28 ,,NW,,,,,,$54.36,$0.00,1,1,1,1,1,1,20120101,E0144,HCPCS,ENCLOSED WALKER W REAR SEAT,UE,,28 ,,NW,,,,,,$475.71,$0.00,1,1,1,1,1,1,20120101,E0147,HCPCS,WALKER VARIABLE WHEEL RESIST,,,28 ,,NW,,,,,,"$1,213.20",$0.00,1,1,1,1,1,1,20120101,E0147,HCPCS,WALKER VARIABLE WHEEL RESIST,NU,,28 ,,NW,,,,,,"$1,213.20",$0.00,1,1,1,1,1,1,20120101,E0147,HCPCS,WALKER VARIABLE WHEEL RESIST,RR,,28 ,,NW,,,,,,$99.37,$0.00,1,1,1,1,1,1,20120101,E0147,HCPCS,WALKER VARIABLE WHEEL RESIST,UE,,28 ,,NW,,,,,,$903.85,$0.00,1,1,1,1,1,1,20120101,E0148,HCPCS,HEAVYDUTY WALKER NO WHEELS,,,28 ,,NW,,,,,,$249.16,$0.00,1,1,1,1,1,1,20120101,E0148,HCPCS,HEAVYDUTY WALKER NO WHEELS,NU,,28 ,,NW,,,,,,$249.16,$0.00,1,1,1,1,1,1,20120101,E0148,HCPCS,HEAVYDUTY WALKER NO WHEELS,RR,,28 ,,NW,,,,,,$25.79,$0.00,1,1,1,1,1,1,20120101,E0148,HCPCS,HEAVYDUTY WALKER NO WHEELS,UE,,28 ,,NW,,,,,,$180.74,$0.00,1,1,1,1,1,1,20120101,E0149,HCPCS,HEAVY DUTY WHEELED WALKER,,,28 ,,NW,,,,,,$456.18,$0.00,1,1,1,1,1,1,20120101,E0149,HCPCS,HEAVY DUTY WHEELED WALKER,NU,,28 ,,NW,,,,,,$456.18,$0.00,1,1,1,1,1,1,20120101,E0149,HCPCS,HEAVY DUTY WHEELED WALKER,RR,,28 ,,NW,,,,,,$40.81,$0.00,1,1,1,1,1,1,20120101,E0149,HCPCS,HEAVY DUTY WHEELED WALKER,UE,,28 ,,NW,,,,,,$336.01,$0.00,1,1,1,1,1,1,20120101,E0153,HCPCS,FOREARM CRUTCH PLATFORM ATTA,,,28 ,,NW,,,,,,$139.95,$0.00,1,1,1,1,1,1,20120101,E0153,HCPCS,FOREARM CRUTCH PLATFORM ATTA,NU,,28 ,,NW,,,,,,$139.95,$0.00,1,1,1,1,1,1,20120101,E0153,HCPCS,FOREARM CRUTCH PLATFORM ATTA,RR,,28 ,,NW,,,,,,$19.58,$0.00,1,1,1,1,1,1,20120101,E0153,HCPCS,FOREARM CRUTCH PLATFORM ATTA,UE,,28 ,,NW,,,,,,$98.85,$0.00,1,1,1,1,1,1,20120101,E0154,HCPCS,WALKER PLATFORM ATTACHMENT,,,28 ,,NW,,,,,,$120.55,$0.00,1,1,1,1,1,1,20120101,E0154,HCPCS,WALKER PLATFORM ATTACHMENT,NU,,28 ,,NW,,,,,,$120.55,$0.00,1,1,1,1,1,1,20120101,E0154,HCPCS,WALKER PLATFORM ATTACHMENT,RR,,28 ,,NW,,,,,,$18.64,$0.00,1,1,1,1,1,1,20120101,E0154,HCPCS,WALKER PLATFORM ATTACHMENT,UE,,28 ,,NW,,,,,,$85.68,$0.00,1,1,1,1,1,1,20120101,E0155,HCPCS,"WALKER WHEEL ATTACHMENT,PAIR",,,28 ,,NW,,,,,,$52.57,$0.00,1,1,1,1,1,1,20120101,E0155,HCPCS,"WALKER WHEEL ATTACHMENT,PAIR",NU,,28 ,,NW,,,,,,$52.57,$0.00,1,1,1,1,1,1,20120101,E0155,HCPCS,"WALKER WHEEL ATTACHMENT,PAIR",RR,,28 ,,NW,,,,,,$9.59,$0.00,1,1,1,1,1,1,20120101,E0155,HCPCS,"WALKER WHEEL ATTACHMENT,PAIR",UE,,28 ,,NW,,,,,,$41.40,$0.00,1,1,1,1,1,1,20120101,E0156,HCPCS,WALKER SEAT ATTACHMENT,,,28 ,,NW,,,,,,$44.97,$0.00,1,1,1,1,1,1,20120101,E0156,HCPCS,WALKER SEAT ATTACHMENT,NU,,28 ,,NW,,,,,,$44.97,$0.00,1,1,1,1,1,1,20120101,E0156,HCPCS,WALKER SEAT ATTACHMENT,RR,,28 ,,NW,,,,,,$8.16,$0.00,1,1,1,1,1,1,20120101,E0156,HCPCS,WALKER SEAT ATTACHMENT,UE,,28 ,,NW,,,,,,$35.22,$0.00,1,1,1,1,1,1,20120101,E0157,HCPCS,WALKER CRUTCH ATTACHMENT,,,28 ,,NW,,,,,,$136.04,$0.00,1,1,1,1,1,1,20120101,E0157,HCPCS,WALKER CRUTCH ATTACHMENT,NU,,28 ,,NW,,,,,,$136.04,$0.00,1,1,1,1,1,1,20120101,E0157,HCPCS,WALKER CRUTCH ATTACHMENT,RR,,28 ,,NW,,,,,,$18.75,$0.00,1,1,1,1,1,1,20120101,E0157,HCPCS,WALKER CRUTCH ATTACHMENT,UE,,28 ,,NW,,,,,,$95.93,$0.00,1,1,1,1,1,1,20120101,E0158,HCPCS,WALKER LEG EXTENDERS SET OF4,,,28 ,,NW,,,,,,$53.28,$0.00,1,1,1,1,1,1,20120101,E0158,HCPCS,WALKER LEG EXTENDERS SET OF4,NU,,28 ,,NW,,,,,,$53.28,$0.00,1,1,1,1,1,1,20120101,E0158,HCPCS,WALKER LEG EXTENDERS SET OF4,RR,,28 ,,NW,,,,,,$8.76,$0.00,1,1,1,1,1,1,20120101,E0158,HCPCS,WALKER LEG EXTENDERS SET OF4,UE,,28 ,,NW,,,,,,$41.65,$0.00,1,1,1,1,1,1,20120101,E0159,HCPCS,BRAKE FOR WHEELED WALKER,,,28 ,,NW,,,,,,$33.83,$0.00,1,1,1,1,1,1,20120101,E0159,HCPCS,BRAKE FOR WHEELED WALKER,NU,,28 ,,NW,,,,,,$33.83,$0.00,1,1,1,1,1,1,20120101,E0159,HCPCS,BRAKE FOR WHEELED WALKER,RR,,28 ,,NW,,,,,,$4.80,$0.00,1,1,1,1,1,1,20120101,E0159,HCPCS,BRAKE FOR WHEELED WALKER,UE,,28 ,,NW,,,,,,$26.87,$0.00,1,1,1,1,1,1,20120101,E0160,HCPCS,SITZ TYPE BATH OR EQUIPMENT,,,28 ,,NW,,,,,,$61.76,$0.00,1,1,1,1,1,1,20120101,E0160,HCPCS,SITZ TYPE BATH OR EQUIPMENT,NU,,28 ,,NW,,,,,,$61.76,$0.00,1,1,1,1,1,1,20120101,E0160,HCPCS,SITZ TYPE BATH OR EQUIPMENT,RR,,28 ,,NW,,,,,,$12.63,$0.00,1,1,1,1,1,1,20120101,E0160,HCPCS,SITZ TYPE BATH OR EQUIPMENT,UE,,28 ,,NW,,,,,,$48.16,$0.00,1,1,1,1,1,1,20120101,E0161,HCPCS,SITZ BATH/EQUIPMENT W/FAUCET,,,28 ,,NW,,,,,,$50.53,$0.00,1,1,1,1,1,1,20120101,E0161,HCPCS,SITZ BATH/EQUIPMENT W/FAUCET,NU,,28 ,,NW,,,,,,$50.53,$0.00,1,1,1,1,1,1,20120101,E0161,HCPCS,SITZ BATH/EQUIPMENT W/FAUCET,RR,,28 ,,NW,,,,,,$10.00,$0.00,1,1,1,1,1,1,20120101,E0161,HCPCS,SITZ BATH/EQUIPMENT W/FAUCET,UE,,28 ,,NW,,,,,,$39.30,$0.00,1,1,1,1,1,1,20120101,E0162,HCPCS,SITZ BATH CHAIR,,,28 ,,NW,,,,,,$309.88,$0.00,1,1,1,1,1,1,20120101,E0162,HCPCS,SITZ BATH CHAIR,NU,,28 ,,NW,,,,,,$309.88,$0.00,1,1,1,1,1,1,20120101,E0162,HCPCS,SITZ BATH CHAIR,RR,,28 ,,NW,,,,,,$31.35,$0.00,1,1,1,1,1,1,20120101,E0162,HCPCS,SITZ BATH CHAIR,UE,,28 ,,NW,,,,,,$233.52,$0.00,1,1,1,1,1,1,20120101,E0163,HCPCS,COMMODE CHAIR WITH FIXED ARM,,,28 ,,NW,,,,,,$244.34,$0.00,1,1,1,1,1,1,20120101,E0163,HCPCS,COMMODE CHAIR WITH FIXED ARM,NU,,28 ,,NW,,,,,,$244.34,$0.00,1,1,1,1,1,1,20120101,E0163,HCPCS,COMMODE CHAIR WITH FIXED ARM,RR,,28 ,,NW,,,,,,$48.45,$0.00,1,1,1,1,1,1,20120101,E0163,HCPCS,COMMODE CHAIR WITH FIXED ARM,UE,,28 ,,NW,,,,,,$178.26,$0.00,1,1,1,1,1,1,20120101,E0165,HCPCS,COMMODE CHAIR WITH DETACHARM,,,28 ,,NW,,,,,,$361.63,$0.00,1,1,1,1,1,1,20120101,E0165,HCPCS,COMMODE CHAIR WITH DETACHARM,RR,,28 ,,NW,,,,,,$37.79,$0.00,1,1,1,1,1,1,20120101,E0167,HCPCS,COMMODE CHAIR PAIL OR PAN,,,28 ,,NW,,,,,,$26.78,$0.00,1,1,1,1,1,1,20120101,E0167,HCPCS,COMMODE CHAIR PAIL OR PAN,NU,,28 ,,NW,,,,,,$26.78,$0.00,1,1,1,1,1,1,20120101,E0167,HCPCS,COMMODE CHAIR PAIL OR PAN,RR,,28 ,,NW,,,,,,$3.65,$0.00,1,1,1,1,1,1,20120101,E0167,HCPCS,COMMODE CHAIR PAIL OR PAN,UE,,28 ,,NW,,,,,,$21.79,$0.00,1,1,1,1,1,1,20120101,E0168,HCPCS,HEAVYDUTY/WIDE COMMODE CHAIR,,,28 ,,NW,,,,,,$352.61,$0.00,1,1,1,1,1,1,20120101,E0168,HCPCS,HEAVYDUTY/WIDE COMMODE CHAIR,NU,,28 ,,NW,,,,,,$352.61,$0.00,1,1,1,1,1,1,20120101,E0168,HCPCS,HEAVYDUTY/WIDE COMMODE CHAIR,RR,,28 ,,NW,,,,,,$33.35,$0.00,1,1,1,1,1,1,20120101,E0168,HCPCS,HEAVYDUTY/WIDE COMMODE CHAIR,UE,,28 ,,NW,,,,,,$258.33,$0.00,1,1,1,1,1,1,20120101,E0170,HCPCS,COMMODE CHAIR ELECTRIC,,,28 ,,NW,,,,,,"$3,608.49",$0.00,1,1,1,1,1,1,20120101,E0170,HCPCS,COMMODE CHAIR ELECTRIC,RR,,28 ,,NW,,,,,,$377.09,$0.00,1,1,1,1,1,1,20120101,E0171,HCPCS,COMMODE CHAIR NON-ELECTRIC,,,28 ,,NW,,,,,,$558.69,$0.00,1,1,1,1,1,1,20120101,E0171,HCPCS,COMMODE CHAIR NON-ELECTRIC,RR,,28 ,,NW,,,,,,$58.38,$0.00,1,1,1,1,1,1,20120101,E0172,HCPCS,SEAT LIFT MECHANISM TOILET,,,28 ,,NW,,,,,,$309.76,$0.00,1,1,1,1,1,1,20120101,E0175,HCPCS,COMMODE CHAIR FOOT REST,,,28 ,,NW,,,,,,$130.60,$0.00,1,1,1,1,1,1,20120101,E0175,HCPCS,COMMODE CHAIR FOOT REST,NU,,28 ,,NW,,,,,,$130.60,$0.00,1,1,1,1,1,1,20120101,E0175,HCPCS,COMMODE CHAIR FOOT REST,RR,,28 ,,NW,,,,,,$17.11,$0.00,1,1,1,1,1,1,20120101,E0175,HCPCS,COMMODE CHAIR FOOT REST,UE,,28 ,,NW,,,,,,$89.59,$0.00,1,1,1,1,1,1,20120101,E0181,HCPCS,PRESS PAD ALTERNATING W/ PUM,,,28 ,,NW,,,,,,$508.72,$0.00,1,1,1,1,1,1,20120101,E0181,HCPCS,PRESS PAD ALTERNATING W/ PUM,RR,,28 ,,NW,,,,,,$53.16,$0.00,1,1,1,1,1,1,20120101,E0182,HCPCS,"REPLACE PUMP, ALT PRESS PAD",,,28 ,,NW,,,,,,$477.59,$0.00,1,1,1,1,1,1,20120101,E0182,HCPCS,"REPLACE PUMP, ALT PRESS PAD",RR,,28 ,,NW,,,,,,$49.91,$0.00,1,1,1,1,1,1,20120101,E0184,HCPCS,DRY PRESSURE MATTRESS,,,28 ,,NW,,,,,,$424.01,$0.00,1,1,1,1,1,1,20120101,E0184,HCPCS,DRY PRESSURE MATTRESS,NU,,28 ,,NW,,,,,,$424.01,$0.00,1,1,1,1,1,1,20120101,E0184,HCPCS,DRY PRESSURE MATTRESS,RR,,28 ,,NW,,,,,,$49.13,$0.00,1,1,1,1,1,1,20120101,E0184,HCPCS,DRY PRESSURE MATTRESS,UE,,28 ,,NW,,,,,,$319.44,$0.00,1,1,1,1,1,1,20120101,E0185,HCPCS,GEL PRESSURE MATTRESS PAD,,,28 ,,NW,,,,,,$724.19,$0.00,1,1,1,1,1,1,20120101,E0185,HCPCS,GEL PRESSURE MATTRESS PAD,NU,,28 ,,NW,,,,,,$724.19,$0.00,1,1,1,1,1,1,20120101,E0185,HCPCS,GEL PRESSURE MATTRESS PAD,RR,,28 ,,NW,,,,,,$84.19,$0.00,1,1,1,1,1,1,20120101,E0185,HCPCS,GEL PRESSURE MATTRESS PAD,UE,,28 ,,NW,,,,,,$553.41,$0.00,1,1,1,1,1,1,20120101,E0186,HCPCS,AIR PRESSURE MATTRESS,,,28 ,,NW,,,,,,$394.37,$0.00,1,1,1,1,1,1,20120101,E0186,HCPCS,AIR PRESSURE MATTRESS,RR,,28 ,,NW,,,,,,$41.21,$0.00,1,1,1,1,1,1,20120101,E0187,HCPCS,WATER PRESSURE MATTRESS,,,28 ,,NW,,,,,,$440.26,$0.00,1,1,1,1,1,1,20120101,E0187,HCPCS,WATER PRESSURE MATTRESS,RR,,28 ,,NW,,,,,,$46.01,$0.00,1,1,1,1,1,1,20120101,E0188,HCPCS,SYNTHETIC SHEEPSKIN PAD,,,28 ,,NW,,,,,,$51.52,$0.00,1,1,1,1,1,1,20120101,E0188,HCPCS,SYNTHETIC SHEEPSKIN PAD,NU,,28 ,,NW,,,,,,$51.52,$0.00,1,1,1,1,1,1,20120101,E0188,HCPCS,SYNTHETIC SHEEPSKIN PAD,RR,,28 ,,NW,,,,,,$8.95,$0.00,1,1,1,1,1,1,20120101,E0188,HCPCS,SYNTHETIC SHEEPSKIN PAD,UE,,28 ,,NW,,,,,,$40.11,$0.00,1,1,1,1,1,1,20120101,E0189,HCPCS,LAMBSWOOL SHEEPSKIN PAD,,,28 ,,NW,,,,,,$99.45,$0.00,1,1,1,1,1,1,20120101,E0189,HCPCS,LAMBSWOOL SHEEPSKIN PAD,NU,,28 ,,NW,,,,,,$99.45,$0.00,1,1,1,1,1,1,20120101,E0189,HCPCS,LAMBSWOOL SHEEPSKIN PAD,RR,,28 ,,NW,,,,,,$15.75,$0.00,1,1,1,1,1,1,20120101,E0189,HCPCS,LAMBSWOOL SHEEPSKIN PAD,UE,,28 ,,NW,,,,,,$73.39,$0.00,1,1,1,1,1,1,20120101,E0190,HCPCS,POSITIONING CUSHION,,,28 ,,NW,,,,,,$46.60,$0.00,1,1,1,1,1,1,20120101,E0191,HCPCS,PROTECTOR HEEL OR ELBOW,,,28 ,,NW,,,,,,$22.71,$0.00,1,1,1,1,1,1,20120101,E0191,HCPCS,PROTECTOR HEEL OR ELBOW,NU,,28 ,,NW,,,,,,$22.71,$0.00,1,1,1,1,1,1,20120101,E0191,HCPCS,PROTECTOR HEEL OR ELBOW,RR,,28 ,,NW,,,,,,$2.86,$0.00,1,1,1,1,1,1,20120101,E0191,HCPCS,PROTECTOR HEEL OR ELBOW,UE,,28 ,,NW,,,,,,$18.47,$0.00,1,1,1,1,1,1,20120101,E0193,HCPCS,POWERED AIR FLOTATION BED,,,28 ,,NW,,,,,,"$12,230.04",$0.00,1,1,1,1,1,1,20120101,E0193,HCPCS,POWERED AIR FLOTATION BED,RR,,28 ,,NW,,,,,,"$1,278.06",$0.00,1,1,1,1,1,1,20120101,E0194,HCPCS,AIR FLUIDIZED BED,,,28 ,,NW,,,,,,"$47,646.30",$0.00,1,1,1,1,1,1,20120101,E0194,HCPCS,AIR FLUIDIZED BED,RR,,28 ,,NW,,,,,,"$4,979.14",$0.00,1,1,1,1,1,1,20120101,E0194,HCPCS,AIR FLUIDIZED BED,UE,,28 ,,NW,,,,,,"$37,888.66",$0.00,1,1,1,1,1,1,20120101,E0196,HCPCS,GEL PRESSURE MATTRESS,,,28 ,,NW,,,,,,$603.77,$0.00,1,1,1,1,1,1,20120101,E0196,HCPCS,GEL PRESSURE MATTRESS,RR,,28 ,,NW,,,,,,$63.09,$0.00,1,1,1,1,1,1,20120101,E0196,HCPCS,GEL PRESSURE MATTRESS,UE,,28 ,,NW,,,,,,$418.74,$0.00,1,1,1,1,1,1,20120101,E0197,HCPCS,AIR PRESSURE PAD FOR MATTRES,,,28 ,,NW,,,,,,$491.79,$0.00,1,1,1,1,1,1,20120101,E0197,HCPCS,AIR PRESSURE PAD FOR MATTRES,NU,,28 ,,NW,,,,,,$491.79,$0.00,1,1,1,1,1,1,20120101,E0197,HCPCS,AIR PRESSURE PAD FOR MATTRES,RR,,28 ,,NW,,,,,,$57.65,$0.00,1,1,1,1,1,1,20120101,E0197,HCPCS,AIR PRESSURE PAD FOR MATTRES,UE,,28 ,,NW,,,,,,$425.53,$0.00,1,1,1,1,1,1,20120101,E0198,HCPCS,WATER PRESSURE PAD FOR MATTR,,,28 ,,NW,,,,,,$496.95,$0.00,1,1,1,1,1,1,20120101,E0198,HCPCS,WATER PRESSURE PAD FOR MATTR,NU,,28 ,,NW,,,,,,$496.95,$0.00,1,1,1,1,1,1,20120101,E0198,HCPCS,WATER PRESSURE PAD FOR MATTR,RR,,28 ,,NW,,,,,,$45.66,$0.00,1,1,1,1,1,1,20120101,E0198,HCPCS,WATER PRESSURE PAD FOR MATTR,UE,,28 ,,NW,,,,,,$372.29,$0.00,1,1,1,1,1,1,20120101,E0199,HCPCS,DRY PRESSURE PAD FOR MATTRES,,,28 ,,NW,,,,,,$62.00,$0.00,1,1,1,1,1,1,20120101,E0199,HCPCS,DRY PRESSURE PAD FOR MATTRES,NU,,28 ,,NW,,,,,,$62.00,$0.00,1,1,1,1,1,1,20120101,E0199,HCPCS,DRY PRESSURE PAD FOR MATTRES,RR,,28 ,,NW,,,,,,$10.11,$0.00,1,1,1,1,1,1,20120101,E0199,HCPCS,DRY PRESSURE PAD FOR MATTRES,UE,,28 ,,NW,,,,,,$49.12,$0.00,1,1,1,1,1,1,20120101,E0200,HCPCS,HEAT LAMP WITHOUT STAND,,,28 ,,NW,,,,,,$165.99,$0.00,1,1,1,1,1,1,20120101,E0200,HCPCS,HEAT LAMP WITHOUT STAND,NU,,28 ,,NW,,,,,,$165.99,$0.00,1,1,1,1,1,1,20120101,E0200,HCPCS,HEAT LAMP WITHOUT STAND,RR,,28 ,,NW,,,,,,$24.88,$0.00,1,1,1,1,1,1,20120101,E0200,HCPCS,HEAT LAMP WITHOUT STAND,UE,,28 ,,NW,,,,,,$118.47,$0.00,1,1,1,1,1,1,20120101,E0202,HCPCS,PHOTOTHERAPY LIGHT W/ PHOTOM,,,28 ,,NW,,,,,,"$1,174.86",$0.00,1,1,1,1,1,1,20120101,E0202,HCPCS,PHOTOTHERAPY LIGHT W/ PHOTOM,RR,,28 ,,NW,,,,,,$122.77,$0.00,1,1,1,1,1,1,20120101,E0203,HCPCS,THERAPEUTIC LIGHTBOX TABLETP,,,28 ,,NW,,,,,,$368.84,$0.00,1,1,1,1,1,1,20120101,E0205,HCPCS,HEAT LAMP WITH STAND,,,28 ,,NW,,,,,,$425.83,$0.00,1,1,1,1,1,1,20120101,E0205,HCPCS,HEAT LAMP WITH STAND,NU,,28 ,,NW,,,,,,$425.83,$0.00,1,1,1,1,1,1,20120101,E0205,HCPCS,HEAT LAMP WITH STAND,RR,,28 ,,NW,,,,,,$43.50,$0.00,1,1,1,1,1,1,20120101,E0205,HCPCS,HEAT LAMP WITH STAND,UE,,28 ,,NW,,,,,,$313.27,$0.00,1,1,1,1,1,1,20120101,E0210,HCPCS,ELECTRIC HEAT PAD STANDARD,,,28 ,,NW,,,,,,$61.55,$0.00,1,1,1,1,1,1,20120101,E0210,HCPCS,ELECTRIC HEAT PAD STANDARD,NU,,28 ,,NW,,,,,,$61.55,$0.00,1,1,1,1,1,1,20120101,E0210,HCPCS,ELECTRIC HEAT PAD STANDARD,RR,,28 ,,NW,,,,,,$9.78,$0.00,1,1,1,1,1,1,20120101,E0210,HCPCS,ELECTRIC HEAT PAD STANDARD,UE,,28 ,,NW,,,,,,$47.60,$0.00,1,1,1,1,1,1,20120101,E0215,HCPCS,ELECTRIC HEAT PAD MOIST,,,28 ,,NW,,,,,,$140.94,$0.00,1,1,1,1,1,1,20120101,E0215,HCPCS,ELECTRIC HEAT PAD MOIST,NU,,28 ,,NW,,,,,,$140.94,$0.00,1,1,1,1,1,1,20120101,E0215,HCPCS,ELECTRIC HEAT PAD MOIST,RR,,28 ,,NW,,,,,,$19.09,$0.00,1,1,1,1,1,1,20120101,E0215,HCPCS,ELECTRIC HEAT PAD MOIST,UE,,28 ,,NW,,,,,,$99.82,$0.00,1,1,1,1,1,1,20120101,E0217,HCPCS,WATER CIRC HEAT PAD W PUMP,,,28 ,,NW,,,,,,"$1,134.72",$0.00,1,1,1,1,1,1,20120101,E0217,HCPCS,WATER CIRC HEAT PAD W PUMP,NU,,28 ,,NW,,,,,,"$1,134.72",$0.00,1,1,1,1,1,1,20120101,E0217,HCPCS,WATER CIRC HEAT PAD W PUMP,RR,,28 ,,NW,,,,,,$104.35,$0.00,1,1,1,1,1,1,20120101,E0217,HCPCS,WATER CIRC HEAT PAD W PUMP,UE,,28 ,,NW,,,,,,$844.89,$0.00,1,1,1,1,1,1,20120101,E0218,HCPCS,WATER CIRC COLD PAD W PUMP,,,28 ,,NW,,,,,,"$1,134.72",$0.00,1,1,1,1,1,1,20120101,E0221,HCPCS,INFRARED HEATING PAD SYSTEM,,,28 ,,NW,,,,,,$511.78,$0.00,1,1,1,1,1,1,20120101,E0225,HCPCS,HYDROCOLLATOR UNIT,,,28 ,,NW,,,,,,$881.31,$0.00,1,1,1,1,1,1,20120101,E0225,HCPCS,HYDROCOLLATOR UNIT,NU,,28 ,,NW,,,,,,$881.31,$0.00,1,1,1,1,1,1,20120101,E0225,HCPCS,HYDROCOLLATOR UNIT,RR,,28 ,,NW,,,,,,$70.64,$0.00,1,1,1,1,1,1,20120101,E0225,HCPCS,HYDROCOLLATOR UNIT,UE,,28 ,,NW,,,,,,$654.27,$0.00,1,1,1,1,1,1,20120101,E0231,HCPCS,WOUND WARMING DEVICE,,,28 ,,NW,,,,,,$435.41,$0.00,1,1,1,1,1,1,20120101,E0231,HCPCS,WOUND WARMING DEVICE,RR,,28 ,,NW,,,,,,$47.65,$0.00,1,1,1,1,1,1,20120101,E0232,HCPCS,WARMING CARD FOR NWT,,,28 ,,NW,,,,,,$137.34,$0.00,1,1,1,1,1,1,20120101,E0235,HCPCS,PARAFFIN BATH UNIT PORTABLE,,,28 ,,NW,,,,,,$349.67,$0.00,1,1,1,1,1,1,20120101,E0235,HCPCS,PARAFFIN BATH UNIT PORTABLE,RR,,28 ,,NW,,,,,,$36.54,$0.00,1,1,1,1,1,1,20120101,E0235,HCPCS,PARAFFIN BATH UNIT PORTABLE,UE,,28 ,,NW,,,,,,$298.38,$0.00,1,1,1,1,1,1,20120101,E0236,HCPCS,PUMP FOR WATER CIRCULATING P,,,28 ,,NW,,,,,,$779.81,$0.00,1,1,1,1,1,1,20120101,E0236,HCPCS,PUMP FOR WATER CIRCULATING P,RR,,28 ,,NW,,,,,,$81.49,$0.00,1,1,1,1,1,1,20120101,E0236,HCPCS,PUMP FOR WATER CIRCULATING P,UE,,28 ,,NW,,,,,,$585.81,$0.00,1,1,1,1,1,1,20120101,E0239,HCPCS,HYDROCOLLATOR UNIT PORTABLE,,,28 ,,NW,,,,,,"$1,050.73",$0.00,1,1,1,1,1,1,20120101,E0239,HCPCS,HYDROCOLLATOR UNIT PORTABLE,NU,,28 ,,NW,,,,,,"$1,050.73",$0.00,1,1,1,1,1,1,20120101,E0239,HCPCS,HYDROCOLLATOR UNIT PORTABLE,RR,,28 ,,NW,,,,,,$84.15,$0.00,1,1,1,1,1,1,20120101,E0239,HCPCS,HYDROCOLLATOR UNIT PORTABLE,UE,,28 ,,NW,,,,,,$781.99,$0.00,1,1,1,1,1,1,20120101,E0240,HCPCS,BATH/SHOWER CHAIR,,,28 ,,NW,,,,,,$90.16,$0.00,1,1,1,1,1,1,20120101,E0241,HCPCS,BATH TUB WALL RAIL,,,28 ,,NW,,,,,,$53.77,$0.00,1,1,1,1,1,1,20120101,E0242,HCPCS,BATH TUB RAIL FLOOR,,,28 ,,NW,,,,,,$124.15,$0.00,1,1,1,1,1,1,20120101,E0243,HCPCS,TOILET RAIL,,,28 ,,NW,,,,,,$93.99,$0.00,1,1,1,1,1,1,20120101,E0244,HCPCS,TOILET SEAT RAISED,,,28 ,,NW,,,,,,$70.80,$0.00,1,1,1,1,1,1,20120101,E0245,HCPCS,TUB STOOL OR BENCH,,,28 ,,NW,,,,,,$123.03,$0.00,1,1,1,1,1,1,20120101,E0246,HCPCS,TRANSFER TUB RAIL ATTACHMENT,,,28 ,,NW,,,,,,$176.64,$0.00,1,1,1,1,1,1,20120101,E0247,HCPCS,TRANS BENCH W/WO COMM OPEN,,,28 ,,NW,,,,,,$98.65,$0.00,1,1,1,1,1,1,20120101,E0248,HCPCS,HDTRANS BENCH W/WO COMM OPEN,,,28 ,,NW,,,,,,$197.73,$0.00,1,1,1,1,1,1,20120101,E0249,HCPCS,PAD WATER CIRCULATING HEAT U,,,28 ,,NW,,,,,,$209.09,$0.00,1,1,1,1,1,1,20120101,E0249,HCPCS,PAD WATER CIRCULATING HEAT U,NU,,28 ,,NW,,,,,,$209.09,$0.00,1,1,1,1,1,1,20120101,E0249,HCPCS,PAD WATER CIRCULATING HEAT U,RR,,28 ,,NW,,,,,,$24.52,$0.00,1,1,1,1,1,1,20120101,E0249,HCPCS,PAD WATER CIRCULATING HEAT U,UE,,28 ,,NW,,,,,,$150.73,$0.00,1,1,1,1,1,1,20120101,E0250,HCPCS,HOSP BED FIXED HT W/ MATTRES,,,28 ,,NW,,,,,,"$1,547.32",$0.00,1,1,1,1,1,1,20120101,E0250,HCPCS,HOSP BED FIXED HT W/ MATTRES,RR,,28 ,,NW,,,,,,$161.70,$0.00,1,1,1,1,1,1,20120101,E0250,HCPCS,HOSP BED FIXED HT W/ MATTRES,UE,,28 ,,NW,,,,,,"$1,020.59",$0.00,1,1,1,1,1,1,20120101,E0251,HCPCS,HOSP BED FIXD HT W/O MATTRES,,,28 ,,NW,,,,,,"$1,185.80",$0.00,1,1,1,1,1,1,20120101,E0251,HCPCS,HOSP BED FIXD HT W/O MATTRES,RR,,28 ,,NW,,,,,,$123.92,$0.00,1,1,1,1,1,1,20120101,E0251,HCPCS,HOSP BED FIXD HT W/O MATTRES,UE,,28 ,,NW,,,,,,$782.91,$0.00,1,1,1,1,1,1,20120101,E0255,HCPCS,HOSPITAL BED VAR HT W/ MATTR,,,28 ,,NW,,,,,,"$1,859.61",$0.00,1,1,1,1,1,1,20120101,E0255,HCPCS,HOSPITAL BED VAR HT W/ MATTR,RR,,28 ,,NW,,,,,,$194.33,$0.00,1,1,1,1,1,1,20120101,E0255,HCPCS,HOSPITAL BED VAR HT W/ MATTR,UE,,28 ,,NW,,,,,,"$1,217.97",$0.00,1,1,1,1,1,1,20120101,E0256,HCPCS,HOSPITAL BED VAR HT W/O MATT,,,28 ,,NW,,,,,,"$1,299.30",$0.00,1,1,1,1,1,1,20120101,E0256,HCPCS,HOSPITAL BED VAR HT W/O MATT,RR,,28 ,,NW,,,,,,$135.78,$0.00,1,1,1,1,1,1,20120101,E0256,HCPCS,HOSPITAL BED VAR HT W/O MATT,UE,,28 ,,NW,,,,,,$876.04,$0.00,1,1,1,1,1,1,20120101,E0260,HCPCS,HOSP BED SEMI-ELECTR W/ MATT,,,28 ,,NW,,,,,,"$2,273.80",$0.00,1,1,1,1,1,1,20120101,E0260,HCPCS,HOSP BED SEMI-ELECTR W/ MATT,RR,,28 ,,NW,,,,,,$237.62,$0.00,1,1,1,1,1,1,20120101,E0260,HCPCS,HOSP BED SEMI-ELECTR W/ MATT,UE,,28 ,,NW,,,,,,"$1,708.14",$0.00,1,1,1,1,1,1,20120101,E0261,HCPCS,HOSP BED SEMI-ELECTR W/O MAT,,,28 ,,NW,,,,,,"$2,108.65",$0.00,1,1,1,1,1,1,20120101,E0261,HCPCS,HOSP BED SEMI-ELECTR W/O MAT,RR,,28 ,,NW,,,,,,$220.36,$0.00,1,1,1,1,1,1,20120101,E0261,HCPCS,HOSP BED SEMI-ELECTR W/O MAT,UE,,28 ,,NW,,,,,,"$1,413.26",$0.00,1,1,1,1,1,1,20120101,E0265,HCPCS,HOSP BED TOTAL ELECTR W/ MAT,,,28 ,,NW,,,,,,"$2,972.04",$0.00,1,1,1,1,1,1,20120101,E0265,HCPCS,HOSP BED TOTAL ELECTR W/ MAT,RR,,28 ,,NW,,,,,,$310.58,$0.00,1,1,1,1,1,1,20120101,E0265,HCPCS,HOSP BED TOTAL ELECTR W/ MAT,UE,,28 ,,NW,,,,,,"$2,044.30",$0.00,1,1,1,1,1,1,20120101,E0266,HCPCS,HOSP BED TOTAL ELEC W/O MATT,,,28 ,,NW,,,,,,"$2,690.63",$0.00,1,1,1,1,1,1,20120101,E0266,HCPCS,HOSP BED TOTAL ELEC W/O MATT,RR,,28 ,,NW,,,,,,$281.18,$0.00,1,1,1,1,1,1,20120101,E0266,HCPCS,HOSP BED TOTAL ELEC W/O MATT,UE,,28 ,,NW,,,,,,"$1,820.52",$0.00,1,1,1,1,1,1,20120101,E0270,HCPCS,HOSPITAL BED INSTITUTIONAL T,,,28 ,,NW,,,,,,$429.05,$0.00,1,1,1,1,1,1,20120101,E0270,HCPCS,HOSPITAL BED INSTITUTIONAL T,RR,,28 ,,NW,,,,,,$45.20,$0.00,1,1,1,1,1,1,20120101,E0270,HCPCS,HOSPITAL BED INSTITUTIONAL T,UE,,28 ,,NW,,,,,,$322.49,$0.00,1,1,1,1,1,1,20120101,E0271,HCPCS,MATTRESS INNERSPRING,,,28 ,,NW,,,,,,$329.17,$0.00,1,1,1,1,1,1,20120101,E0271,HCPCS,MATTRESS INNERSPRING,NU,,28 ,,NW,,,,,,$329.17,$0.00,1,1,1,1,1,1,20120101,E0271,HCPCS,MATTRESS INNERSPRING,RR,,28 ,,NW,,,,,,$37.66,$0.00,1,1,1,1,1,1,20120101,E0271,HCPCS,MATTRESS INNERSPRING,UE,,28 ,,NW,,,,,,$263.75,$0.00,1,1,1,1,1,1,20120101,E0272,HCPCS,MATTRESS FOAM RUBBER,,,28 ,,NW,,,,,,$311.55,$0.00,1,1,1,1,1,1,20120101,E0272,HCPCS,MATTRESS FOAM RUBBER,NU,,28 ,,NW,,,,,,$311.55,$0.00,1,1,1,1,1,1,20120101,E0272,HCPCS,MATTRESS FOAM RUBBER,RR,,28 ,,NW,,,,,,$34.54,$0.00,1,1,1,1,1,1,20120101,E0272,HCPCS,MATTRESS FOAM RUBBER,UE,,28 ,,NW,,,,,,$238.63,$0.00,1,1,1,1,1,1,20120101,E0273,HCPCS,BED BOARD,,,28 ,,NW,,,,,,$54.65,$0.00,1,1,1,1,1,1,20120101,E0273,HCPCS,BED BOARD,RR,,28 ,,NW,,,,,,$21.43,$0.00,1,1,1,1,1,1,20120101,E0273,HCPCS,BED BOARD,UE,,28 ,,NW,,,,,,$43.02,$0.00,1,1,1,1,1,1,20120101,E0274,HCPCS,OVER-BED TABLE,,,28 ,,NW,,,,,,$120.07,$0.00,1,1,1,1,1,1,20120101,E0274,HCPCS,OVER-BED TABLE,RR,,28 ,,NW,,,,,,$38.70,$0.00,1,1,1,1,1,1,20120101,E0274,HCPCS,OVER-BED TABLE,UE,,28 ,,NW,,,,,,$71.52,$0.00,1,1,1,1,1,1,20120101,E0275,HCPCS,BED PAN STANDARD,,,28 ,,NW,,,,,,$32.28,$0.00,1,1,1,1,1,1,20120101,E0275,HCPCS,BED PAN STANDARD,NU,,28 ,,NW,,,,,,$32.28,$0.00,1,1,1,1,1,1,20120101,E0275,HCPCS,BED PAN STANDARD,RR,,28 ,,NW,,,,,,$4.62,$0.00,1,1,1,1,1,1,20120101,E0275,HCPCS,BED PAN STANDARD,UE,,28 ,,NW,,,,,,$25.68,$0.00,1,1,1,1,1,1,20120101,E0276,HCPCS,BED PAN FRACTURE,,,28 ,,NW,,,,,,$28.87,$0.00,1,1,1,1,1,1,20120101,E0276,HCPCS,BED PAN FRACTURE,NU,,28 ,,NW,,,,,,$28.87,$0.00,1,1,1,1,1,1,20120101,E0276,HCPCS,BED PAN FRACTURE,RR,,28 ,,NW,,,,,,$4.55,$0.00,1,1,1,1,1,1,20120101,E0276,HCPCS,BED PAN FRACTURE,UE,,28 ,,NW,,,,,,$24.03,$0.00,1,1,1,1,1,1,20120101,E0277,HCPCS,POWERED PRES-REDU AIR MATTRS,,,28 ,,NW,,,,,,"$9,705.93",$0.00,1,1,1,1,1,1,20120101,E0277,HCPCS,POWERED PRES-REDU AIR MATTRS,RR,,28 ,,NW,,,,,,"$1,014.29",$0.00,1,1,1,1,1,1,20120101,E0277,HCPCS,POWERED PRES-REDU AIR MATTRS,UE,,28 ,,NW,,,,,,"$7,291.37",$0.00,1,1,1,1,1,1,20120101,E0280,HCPCS,BED CRADLE,,,28 ,,NW,,,,,,$63.86,$0.00,1,1,1,1,1,1,20120101,E0280,HCPCS,BED CRADLE,NU,,28 ,,NW,,,,,,$63.86,$0.00,1,1,1,1,1,1,20120101,E0280,HCPCS,BED CRADLE,RR,,28 ,,NW,,,,,,$6.74,$0.00,1,1,1,1,1,1,20120101,E0280,HCPCS,BED CRADLE,UE,,28 ,,NW,,,,,,$47.85,$0.00,1,1,1,1,1,1,20120101,E0290,HCPCS,HOSP BED FX HT W/O RAILS W/M,,,28 ,,NW,,,,,,"$1,159.69",$0.00,1,1,1,1,1,1,20120101,E0290,HCPCS,HOSP BED FX HT W/O RAILS W/M,RR,,28 ,,NW,,,,,,$121.19,$0.00,1,1,1,1,1,1,20120101,E0290,HCPCS,HOSP BED FX HT W/O RAILS W/M,UE,,28 ,,NW,,,,,,$789.86,$0.00,1,1,1,1,1,1,20120101,E0291,HCPCS,HOSP BED FX HT W/O RAIL W/O,,,28 ,,NW,,,,,,$834.30,$0.00,1,1,1,1,1,1,20120101,E0291,HCPCS,HOSP BED FX HT W/O RAIL W/O,RR,,28 ,,NW,,,,,,$87.19,$0.00,1,1,1,1,1,1,20120101,E0291,HCPCS,HOSP BED FX HT W/O RAIL W/O,UE,,28 ,,NW,,,,,,$584.84,$0.00,1,1,1,1,1,1,20120101,E0292,HCPCS,HOSP BED VAR HT W/O RAIL W/O,,,28 ,,NW,,,,,,"$1,306.66",$0.00,1,1,1,1,1,1,20120101,E0292,HCPCS,HOSP BED VAR HT W/O RAIL W/O,RR,,28 ,,NW,,,,,,$136.55,$0.00,1,1,1,1,1,1,20120101,E0292,HCPCS,HOSP BED VAR HT W/O RAIL W/O,UE,,28 ,,NW,,,,,,$882.99,$0.00,1,1,1,1,1,1,20120101,E0293,HCPCS,HOSP BED VAR HT W/O RAIL W/,,,28 ,,NW,,,,,,"$1,114.90",$0.00,1,1,1,1,1,1,20120101,E0293,HCPCS,HOSP BED VAR HT W/O RAIL W/,RR,,28 ,,NW,,,,,,$116.51,$0.00,1,1,1,1,1,1,20120101,E0293,HCPCS,HOSP BED VAR HT W/O RAIL W/,UE,,28 ,,NW,,,,,,$757.19,$0.00,1,1,1,1,1,1,20120101,E0294,HCPCS,HOSP BED SEMI-ELECT W/ MATTR,,,28 ,,NW,,,,,,"$2,048.54",$0.00,1,1,1,1,1,1,20120101,E0294,HCPCS,HOSP BED SEMI-ELECT W/ MATTR,RR,,28 ,,NW,,,,,,$214.08,$0.00,1,1,1,1,1,1,20120101,E0294,HCPCS,HOSP BED SEMI-ELECT W/ MATTR,UE,,28 ,,NW,,,,,,"$1,350.01",$0.00,1,1,1,1,1,1,20120101,E0295,HCPCS,HOSP BED SEMI-ELECT W/O MATT,,,28 ,,NW,,,,,,"$1,999.43",$0.00,1,1,1,1,1,1,20120101,E0295,HCPCS,HOSP BED SEMI-ELECT W/O MATT,RR,,28 ,,NW,,,,,,$208.94,$0.00,1,1,1,1,1,1,20120101,E0295,HCPCS,HOSP BED SEMI-ELECT W/O MATT,UE,,28 ,,NW,,,,,,"$1,317.35",$0.00,1,1,1,1,1,1,20120101,E0296,HCPCS,HOSP BED TOTAL ELECT W/ MATT,,,28 ,,NW,,,,,,"$2,431.06",$0.00,1,1,1,1,1,1,20120101,E0296,HCPCS,HOSP BED TOTAL ELECT W/ MATT,RR,,28 ,,NW,,,,,,$254.05,$0.00,1,1,1,1,1,1,20120101,E0296,HCPCS,HOSP BED TOTAL ELECT W/ MATT,UE,,28 ,,NW,,,,,,"$1,686.38",$0.00,1,1,1,1,1,1,20120101,E0297,HCPCS,HOSP BED TOTAL ELECT W/O MAT,,,28 ,,NW,,,,,,"$2,188.42",$0.00,1,1,1,1,1,1,20120101,E0297,HCPCS,HOSP BED TOTAL ELECT W/O MAT,RR,,28 ,,NW,,,,,,$228.69,$0.00,1,1,1,1,1,1,20120101,E0297,HCPCS,HOSP BED TOTAL ELECT W/O MAT,UE,,28 ,,NW,,,,,,"$1,450.79",$0.00,1,1,1,1,1,1,20120101,E0300,HCPCS,ENCLOSED PED CRIB HOSP GRADE,,,28 ,,NW,,,,,,"$4,020.82",$0.00,1,1,1,1,1,1,20120101,E0300,HCPCS,ENCLOSED PED CRIB HOSP GRADE,NU,,28 ,,NW,,,,,,"$4,020.82",$0.00,1,1,1,1,1,1,20120101,E0300,HCPCS,ENCLOSED PED CRIB HOSP GRADE,RR,,28 ,,NW,,,,,,$438.67,$0.00,1,1,1,1,1,1,20120101,E0300,HCPCS,ENCLOSED PED CRIB HOSP GRADE,UE,,28 ,,NW,,,,,,"$3,025.78",$0.00,1,1,1,1,1,1,20120101,E0301,HCPCS,"HD HOSP BED, 350-600 LBS",,,28 ,,NW,,,,,,"$3,916.85",$0.00,1,1,1,1,1,1,20120101,E0301,HCPCS,"HD HOSP BED, 350-600 LBS",RR,,28 ,,NW,,,,,,$409.32,$0.00,1,1,1,1,1,1,20120101,E0302,HCPCS,EX HD HOSP BED > 600 LBS,,,28 ,,NW,,,,,,"$9,975.27",$0.00,1,1,1,1,1,1,20120101,E0302,HCPCS,EX HD HOSP BED > 600 LBS,RR,,28 ,,NW,,,,,,"$1,042.44",$0.00,1,1,1,1,1,1,20120101,E0303,HCPCS,HOSP BED HVY DTY XTRA WIDE,,,28 ,,NW,,,,,,"$4,362.59",$0.00,1,1,1,1,1,1,20120101,E0303,HCPCS,HOSP BED HVY DTY XTRA WIDE,RR,,28 ,,NW,,,,,,$455.90,$0.00,1,1,1,1,1,1,20120101,E0304,HCPCS,HOSP BED XTRA HVY DTY X WIDE,,,28 ,,NW,,,,,,"$10,715.40",$0.00,1,1,1,1,1,1,20120101,E0304,HCPCS,HOSP BED XTRA HVY DTY X WIDE,RR,,28 ,,NW,,,,,,"$1,119.78",$0.00,1,1,1,1,1,1,20120101,E0305,HCPCS,RAILS BED SIDE HALF LENGTH,,,28 ,,NW,,,,,,$277.37,$0.00,1,1,1,1,1,1,20120101,E0305,HCPCS,RAILS BED SIDE HALF LENGTH,RR,,28 ,,NW,,,,,,$28.99,$0.00,1,1,1,1,1,1,20120101,E0305,HCPCS,RAILS BED SIDE HALF LENGTH,UE,,28 ,,NW,,,,,,$219.28,$0.00,1,1,1,1,1,1,20120101,E0310,HCPCS,RAILS BED SIDE FULL LENGTH,,,28 ,,NW,,,,,,$299.60,$0.00,1,1,1,1,1,1,20120101,E0310,HCPCS,RAILS BED SIDE FULL LENGTH,NU,,28 ,,NW,,,,,,$299.60,$0.00,1,1,1,1,1,1,20120101,E0310,HCPCS,RAILS BED SIDE FULL LENGTH,RR,,28 ,,NW,,,,,,$37.54,$0.00,1,1,1,1,1,1,20120101,E0310,HCPCS,RAILS BED SIDE FULL LENGTH,UE,,28 ,,NW,,,,,,$238.78,$0.00,1,1,1,1,1,1,20120101,E0315,HCPCS,BED ACCESSORY BRD/TBL/SUPPRT,,,28 ,,NW,,,,,,$107.33,$0.00,1,1,1,1,1,1,20120101,E0316,HCPCS,BED SAFETY ENCLOSURE,,,28 ,,NW,,,,,,"$3,131.67",$0.00,1,1,1,1,1,1,20120101,E0316,HCPCS,BED SAFETY ENCLOSURE,RR,,28 ,,NW,,,,,,$327.27,$0.00,1,1,1,1,1,1,20120101,E0325,HCPCS,URINAL MALE JUG-TYPE,,,28 ,,NW,,,,,,$22.61,$0.00,1,1,1,1,1,1,20120101,E0325,HCPCS,URINAL MALE JUG-TYPE,NU,,28 ,,NW,,,,,,$22.61,$0.00,1,1,1,1,1,1,20120101,E0325,HCPCS,URINAL MALE JUG-TYPE,RR,,28 ,,NW,,,,,,$4.39,$0.00,1,1,1,1,1,1,20120101,E0325,HCPCS,URINAL MALE JUG-TYPE,UE,,28 ,,NW,,,,,,$17.14,$0.00,1,1,1,1,1,1,20120101,E0326,HCPCS,URINAL FEMALE JUG-TYPE,,,28 ,,NW,,,,,,$24.05,$0.00,1,1,1,1,1,1,20120101,E0326,HCPCS,URINAL FEMALE JUG-TYPE,NU,,28 ,,NW,,,,,,$24.05,$0.00,1,1,1,1,1,1,20120101,E0326,HCPCS,URINAL FEMALE JUG-TYPE,RR,,28 ,,NW,,,,,,$3.53,$0.00,1,1,1,1,1,1,20120101,E0326,HCPCS,URINAL FEMALE JUG-TYPE,UE,,28 ,,NW,,,,,,$19.50,$0.00,1,1,1,1,1,1,20120101,E0328,HCPCS,"PED HOSPITAL BED, MANUAL",,,28 ,,NW,,,,,,$99.73,$0.00,1,1,1,1,1,1,20120101,E0329,HCPCS,PED HOSPITAL BED SEMI/ELECT,,,28 ,,NW,,,,,,$563.68,$0.00,1,1,1,1,1,1,20120101,E0352,HCPCS,DISPOSABLE PACK W/BOWEL SYST,,,28 ,,NW,,,,,,$46.13,$0.00,1,1,1,1,1,1,20120101,E0370,HCPCS,AIR ELEVATOR FOR HEEL,,,28 ,,NW,,,,,,$69.62,$0.00,1,1,1,1,1,1,20120101,E0371,HCPCS,NONPOWER MATTRESS OVERLAY,,,28 ,,NW,,,,,,"$8,665.81",$0.00,1,1,1,1,1,1,20120101,E0371,HCPCS,NONPOWER MATTRESS OVERLAY,RR,,28 ,,NW,,,,,,$905.59,$0.00,1,1,1,1,1,1,20120101,E0372,HCPCS,POWERED AIR MATTRESS OVERLAY,,,28 ,,NW,,,,,,"$10,565.01",$0.00,1,1,1,1,1,1,20120101,E0372,HCPCS,POWERED AIR MATTRESS OVERLAY,RR,,28 ,,NW,,,,,,"$1,104.07",$0.00,1,1,1,1,1,1,20120101,E0373,HCPCS,NONPOWERED PRESSURE MATTRESS,,,28 ,,NW,,,,,,"$12,101.87",$0.00,1,1,1,1,1,1,20120101,E0373,HCPCS,NONPOWERED PRESSURE MATTRESS,RR,,28 ,,NW,,,,,,"$1,264.67",$0.00,1,1,1,1,1,1,20120101,E0424,HCPCS,STATIONARY COMPRESSED GAS 02,,,28 ,,NW,,,,,,"$5,401.96",$0.00,1,1,1,1,1,1,20120101,E0424,HCPCS,STATIONARY COMPRESSED GAS 02,RR,,28 ,,NW,,,,,,$564.52,$0.00,1,1,1,1,1,1,20120101,E0425,HCPCS,GAS SYSTEM STATIONARY COMPRE,,,28 ,,NW,,,,,,"$11,340.87",$0.00,1,1,1,1,1,1,20120101,E0425,HCPCS,GAS SYSTEM STATIONARY COMPRE,NU,,28 ,,NW,,,,,,"$11,340.87",$0.00,1,1,1,1,1,1,20120101,E0430,HCPCS,OXYGEN SYSTEM GAS PORTABLE,,,28 ,,NW,,,,,,"$5,115.15",$0.00,1,1,1,1,1,1,20120101,E0430,HCPCS,OXYGEN SYSTEM GAS PORTABLE,NU,,28 ,,NW,,,,,,"$5,115.15",$0.00,1,1,1,1,1,1,20120101,E0430,HCPCS,OXYGEN SYSTEM GAS PORTABLE,UE,,28 ,,NW,,,,,,"$3,827.07",$0.00,1,1,1,1,1,1,20120101,E0431,HCPCS,PORTABLE GASEOUS 02,,,28 ,,NW,,,,,,$599.11,$0.00,1,1,1,1,1,1,20120101,E0431,HCPCS,PORTABLE GASEOUS 02,RR,,28 ,,NW,,,,,,$62.61,$0.00,1,1,1,1,1,1,20120101,E0433,HCPCS,PORTABLE LIQUID OXYGEN SYS,,,28 ,,NW,,,,,,"$1,359.55",$0.00,1,1,1,1,1,1,20120101,E0433,HCPCS,PORTABLE LIQUID OXYGEN SYS,RR,,28 ,,NW,,,,,,$142.08,$0.00,1,1,1,1,1,1,20120101,E0434,HCPCS,PORTABLE LIQUID 02,,,28 ,,NW,,,,,,$599.11,$0.00,1,1,1,1,1,1,20120101,E0434,HCPCS,PORTABLE LIQUID 02,RR,,28 ,,NW,,,,,,$62.61,$0.00,1,1,1,1,1,1,20120101,E0435,HCPCS,OXYGEN SYSTEM LIQUID PORTABL,,,28 ,,NW,,,,,,"$3,505.05",$0.00,1,1,1,1,1,1,20120101,E0435,HCPCS,OXYGEN SYSTEM LIQUID PORTABL,NU,,28 ,,NW,,,,,,"$3,505.05",$0.00,1,1,1,1,1,1,20120101,E0435,HCPCS,OXYGEN SYSTEM LIQUID PORTABL,UE,,28 ,,NW,,,,,,"$2,619.14",$0.00,1,1,1,1,1,1,20120101,E0439,HCPCS,STATIONARY LIQUID 02,,,28 ,,NW,,,,,,"$5,401.96",$0.00,1,1,1,1,1,1,20120101,E0439,HCPCS,STATIONARY LIQUID 02,RR,,28 ,,NW,,,,,,$564.52,$0.00,1,1,1,1,1,1,20120101,E0440,HCPCS,OXYGEN SYSTEM LIQUID STATION,,,28 ,,NW,,,,,,"$7,154.61",$0.00,1,1,1,1,1,1,20120101,E0440,HCPCS,OXYGEN SYSTEM LIQUID STATION,NU,,28 ,,NW,,,,,,"$7,154.61",$0.00,1,1,1,1,1,1,20120101,E0440,HCPCS,OXYGEN SYSTEM LIQUID STATION,UE,,28 ,,NW,,,,,,"$5,357.02",$0.00,1,1,1,1,1,1,20120101,E0441,HCPCS,"STATIONARY O2 CONTENTS, GAS",,,28 ,,NW,,,,,,$231.72,$0.00,1,1,1,1,1,1,20120101,E0442,HCPCS,"STATIONARY O2 CONTENTS, LIQ",,,28 ,,NW,,,,,,$231.72,$0.00,1,1,1,1,1,1,20120101,E0443,HCPCS,"PORTABLE 02 CONTENTS, GAS",,,28 ,,NW,,,,,,$231.72,$0.00,1,1,1,1,1,1,20120101,E0444,HCPCS,"PORTABLE 02 CONTENTS, LIQUID",,,28 ,,NW,,,,,,$231.72,$0.00,1,1,1,1,1,1,20120101,E0445,HCPCS,OXIMETER NON-INVASIVE,,,28 ,,NW,,,,,,$388.30,$0.00,1,1,1,1,1,1,20120101,E0446,HCPCS,"TOPICAL OX DELIVER SYS, NOS",,,28 ,,NW,,,,,,$793.43,$0.00,1,1,1,1,1,1,20120101,E0450,HCPCS,VOL CONTROL VENT INVASIV INT,,,28 ,,NW,,,,,,"$15,851.48",$0.00,1,1,1,1,1,1,20120101,E0450,HCPCS,VOL CONTROL VENT INVASIV INT,NU,,28 ,,NW,,,,,,"$15,851.48",$0.00,1,1,1,1,1,1,20120101,E0450,HCPCS,VOL CONTROL VENT INVASIV INT,RR,,28 ,,NW,,,,,,"$2,246.94",$0.00,1,1,1,1,1,1,20120101,E0450,HCPCS,VOL CONTROL VENT INVASIV INT,UE,,28 ,,NW,,,,,,"$11,886.38",$0.00,1,1,1,1,1,1,20120101,E0455,HCPCS,OXYGEN TENT EXCL CROUP/PED T,,,28 ,,NW,,,,,,$38.47,$0.00,1,1,1,1,1,1,20120101,E0457,HCPCS,CHEST SHELL,,,28 ,,NW,,,,,,"$1,510.67",$0.00,1,1,1,1,1,1,20120101,E0457,HCPCS,CHEST SHELL,NU,,28 ,,NW,,,,,,"$1,510.67",$0.00,1,1,1,1,1,1,20120101,E0457,HCPCS,CHEST SHELL,RR,,28 ,,NW,,,,,,$129.11,$0.00,1,1,1,1,1,1,20120101,E0457,HCPCS,CHEST SHELL,UE,,28 ,,NW,,,,,,"$1,126.82",$0.00,1,1,1,1,1,1,20120101,E0459,HCPCS,CHEST WRAP,,,28 ,,NW,,,,,,"$1,244.37",$0.00,1,1,1,1,1,1,20120101,E0459,HCPCS,CHEST WRAP,NU,,28 ,,NW,,,,,,"$1,244.37",$0.00,1,1,1,1,1,1,20120101,E0459,HCPCS,CHEST WRAP,RR,,28 ,,NW,,,,,,$97.88,$0.00,1,1,1,1,1,1,20120101,E0459,HCPCS,CHEST WRAP,UE,,28 ,,NW,,,,,,$927.18,$0.00,1,1,1,1,1,1,20120101,E0460,HCPCS,NEG PRESS VENT PORTABL/STATN,,,28 ,,NW,,,,,,"$18,256.64",$0.00,1,1,1,1,1,1,20120101,E0460,HCPCS,NEG PRESS VENT PORTABL/STATN,NU,,28 ,,NW,,,,,,"$18,256.64",$0.00,1,1,1,1,1,1,20120101,E0460,HCPCS,NEG PRESS VENT PORTABL/STATN,RR,,28 ,,NW,,,,,,"$1,687.12",$0.00,1,1,1,1,1,1,20120101,E0460,HCPCS,NEG PRESS VENT PORTABL/STATN,UE,,28 ,,NW,,,,,,"$13,686.38",$0.00,1,1,1,1,1,1,20120101,E0461,HCPCS,VOL CONTROL VENT NONINV INT,,,28 ,,NW,,,,,,"$21,501.40",$0.00,1,1,1,1,1,1,20120101,E0461,HCPCS,VOL CONTROL VENT NONINV INT,RR,,28 ,,NW,,,,,,"$2,246.94",$0.00,1,1,1,1,1,1,20120101,E0462,HCPCS,ROCKING BED W/ OR W/O SIDE R,,,28 ,,NW,,,,,,"$4,559.44",$0.00,1,1,1,1,1,1,20120101,E0462,HCPCS,ROCKING BED W/ OR W/O SIDE R,NU,,28 ,,NW,,,,,,"$4,559.44",$0.00,1,1,1,1,1,1,20120101,E0462,HCPCS,ROCKING BED W/ OR W/O SIDE R,RR,,28 ,,NW,,,,,,$495.15,$0.00,1,1,1,1,1,1,20120101,E0462,HCPCS,ROCKING BED W/ OR W/O SIDE R,UE,,28 ,,NW,,,,,,"$3,429.40",$0.00,1,1,1,1,1,1,20120101,E0463,HCPCS,PRESS SUPP VENT INVASIVE INT,,,28 ,,NW,,,,,,"$33,384.77",$0.00,1,1,1,1,1,1,20120101,E0463,HCPCS,PRESS SUPP VENT INVASIVE INT,RR,,28 ,,NW,,,,,,"$3,488.78",$0.00,1,1,1,1,1,1,20120101,E0464,HCPCS,PRESS SUPP VENT NONINV INT,,,28 ,,NW,,,,,,"$33,384.77",$0.00,1,1,1,1,1,1,20120101,E0464,HCPCS,PRESS SUPP VENT NONINV INT,RR,,28 ,,NW,,,,,,"$3,488.78",$0.00,1,1,1,1,1,1,20120101,E0470,HCPCS,RAD W/O BACKUP NON-INV INTFC,,,28 ,,NW,,,,,,"$4,822.85",$0.00,1,1,1,1,1,1,20120101,E0470,HCPCS,RAD W/O BACKUP NON-INV INTFC,RR,,28 ,,NW,,,,,,$504.00,$0.00,1,1,1,1,1,1,20120101,E0471,HCPCS,RAD W/BACKUP NON INV INTRFC,,,28 ,,NW,,,,,,"$12,214.43",$0.00,1,1,1,1,1,1,20120101,E0471,HCPCS,RAD W/BACKUP NON INV INTRFC,RR,,28 ,,NW,,,,,,"$1,276.43",$0.00,1,1,1,1,1,1,20120101,E0472,HCPCS,RAD W BACKUP INVASIVE INTRFC,,,28 ,,NW,,,,,,"$12,214.43",$0.00,1,1,1,1,1,1,20120101,E0472,HCPCS,RAD W BACKUP INVASIVE INTRFC,RR,,28 ,,NW,,,,,,"$1,276.43",$0.00,1,1,1,1,1,1,20120101,E0480,HCPCS,PERCUSSOR ELECT/PNEUM HOME M,,,28 ,,NW,,,,,,"$1,071.26",$0.00,1,1,1,1,1,1,20120101,E0480,HCPCS,PERCUSSOR ELECT/PNEUM HOME M,NU,,28 ,,NW,,,,,,"$1,071.26",$0.00,1,1,1,1,1,1,20120101,E0480,HCPCS,PERCUSSOR ELECT/PNEUM HOME M,RR,,28 ,,NW,,,,,,$81.14,$0.00,1,1,1,1,1,1,20120101,E0480,HCPCS,PERCUSSOR ELECT/PNEUM HOME M,UE,,28 ,,NW,,,,,,$796.51,$0.00,1,1,1,1,1,1,20120101,E0481,HCPCS,INTRPULMNRY PERCUSS VENT SYS,,,28 ,,NW,,,,,,$583.13,$0.00,1,1,1,1,1,1,20120101,E0482,HCPCS,COUGH STIMULATING DEVICE,,,28 ,,NW,,,,,,"$9,752.38",$0.00,1,1,1,1,1,1,20120101,E0482,HCPCS,COUGH STIMULATING DEVICE,RR,,28 ,,NW,,,,,,"$1,019.14",$0.00,1,1,1,1,1,1,20120101,E0483,HCPCS,CHEST COMPRESSION GEN SYSTEM,,,28 ,,NW,,,,,,"$25,179.74",$0.00,1,1,1,1,1,1,20120101,E0483,HCPCS,CHEST COMPRESSION GEN SYSTEM,RR,,28 ,,NW,,,,,,"$2,631.33",$0.00,1,1,1,1,1,1,20120101,E0484,HCPCS,NON-ELEC OSCILLATORY PEP DVC,,,28 ,,NW,,,,,,$72.90,$0.00,1,1,1,1,1,1,20120101,E0484,HCPCS,NON-ELEC OSCILLATORY PEP DVC,NU,,28 ,,NW,,,,,,$72.90,$0.00,1,1,1,1,1,1,20120101,E0484,HCPCS,NON-ELEC OSCILLATORY PEP DVC,RR,,28 ,,NW,,,,,,$11.26,$0.00,1,1,1,1,1,1,20120101,E0484,HCPCS,NON-ELEC OSCILLATORY PEP DVC,UE,,28 ,,NW,,,,,,$56.17,$0.00,1,1,1,1,1,1,20120101,E0485,HCPCS,ORAL DEVICE/APPLIANCE PREFAB,,,28 ,,NW,,,,,,"$2,976.07",$0.00,1,1,1,1,1,1,20120101,E0485,HCPCS,ORAL DEVICE/APPLIANCE PREFAB,NU,,28 ,,NW,,,,,,"$2,976.07",$0.00,1,1,1,1,1,1,20120101,E0485,HCPCS,ORAL DEVICE/APPLIANCE PREFAB,RR,,28 ,,NW,,,,,,$325.70,$0.00,1,1,1,1,1,1,20120101,E0485,HCPCS,ORAL DEVICE/APPLIANCE PREFAB,UE,,28 ,,NW,,,,,,"$2,241.17",$0.00,1,1,1,1,1,1,20120101,E0486,HCPCS,ORAL DEVICE/APPLIANCE CUSFAB,,,28 ,,NW,,,,,,"$2,782.81",$0.00,1,1,1,1,1,1,20120101,E0486,HCPCS,ORAL DEVICE/APPLIANCE CUSFAB,NU,,28 ,,NW,,,,,,"$2,782.81",$0.00,1,1,1,1,1,1,20120101,E0486,HCPCS,ORAL DEVICE/APPLIANCE CUSFAB,RR,,28 ,,NW,,,,,,$341.44,$0.00,1,1,1,1,1,1,20120101,E0486,HCPCS,ORAL DEVICE/APPLIANCE CUSFAB,UE,,28 ,,NW,,,,,,"$2,349.47",$0.00,1,1,1,1,1,1,20120101,E0487,HCPCS,ELECTRONIC SPIROMETER,,,28 ,,NW,,,,,,$266.56,$0.00,1,1,1,1,1,1,20120101,E0500,HCPCS,IPPB ALL TYPES,,,28 ,,NW,,,,,,"$2,710.83",$0.00,1,1,1,1,1,1,20120101,E0500,HCPCS,IPPB ALL TYPES,NU,,28 ,,NW,,,,,,"$2,710.83",$0.00,1,1,1,1,1,1,20120101,E0500,HCPCS,IPPB ALL TYPES,RR,,28 ,,NW,,,,,,$241.44,$0.00,1,1,1,1,1,1,20120101,E0500,HCPCS,IPPB ALL TYPES,UE,,28 ,,NW,,,,,,"$2,027.30",$0.00,1,1,1,1,1,1,20120101,E0550,HCPCS,HUMIDIF EXTENS SUPPLE W IPPB,,,28 ,,NW,,,,,,"$1,225.39",$0.00,1,1,1,1,1,1,20120101,E0550,HCPCS,HUMIDIF EXTENS SUPPLE W IPPB,NU,,28 ,,NW,,,,,,"$1,225.39",$0.00,1,1,1,1,1,1,20120101,E0550,HCPCS,HUMIDIF EXTENS SUPPLE W IPPB,RR,,28 ,,NW,,,,,,$94.66,$0.00,1,1,1,1,1,1,20120101,E0550,HCPCS,HUMIDIF EXTENS SUPPLE W IPPB,UE,,28 ,,NW,,,,,,$912.66,$0.00,1,1,1,1,1,1,20120101,E0555,HCPCS,HUMIDIFIER FOR USE W/ REGULA,,,28 ,,NW,,,,,,$6.76,$0.00,1,1,1,1,1,1,20120101,E0555,HCPCS,HUMIDIFIER FOR USE W/ REGULA,NU,,28 ,,NW,,,,,,$6.76,$0.00,1,1,1,1,1,1,20120101,E0555,HCPCS,HUMIDIFIER FOR USE W/ REGULA,RR,,28 ,,NW,,,,,,$0.67,$0.00,1,1,1,1,1,1,20120101,E0555,HCPCS,HUMIDIFIER FOR USE W/ REGULA,UE,,28 ,,NW,,,,,,$2.76,$0.00,1,1,1,1,1,1,20120101,E0560,HCPCS,HUMIDIFIER SUPPLEMENTAL W/ I,,,28 ,,NW,,,,,,$318.87,$0.00,1,1,1,1,1,1,20120101,E0560,HCPCS,HUMIDIFIER SUPPLEMENTAL W/ I,NU,,28 ,,NW,,,,,,$318.87,$0.00,1,1,1,1,1,1,20120101,E0560,HCPCS,HUMIDIFIER SUPPLEMENTAL W/ I,RR,,28 ,,NW,,,,,,$35.83,$0.00,1,1,1,1,1,1,20120101,E0560,HCPCS,HUMIDIFIER SUPPLEMENTAL W/ I,UE,,28 ,,NW,,,,,,$233.05,$0.00,1,1,1,1,1,1,20120101,E0561,HCPCS,HUMIDIFIER NONHEATED W PAP,,,28 ,,NW,,,,,,$206.07,$0.00,1,1,1,1,1,1,20120101,E0561,HCPCS,HUMIDIFIER NONHEATED W PAP,NU,,28 ,,NW,,,,,,$206.07,$0.00,1,1,1,1,1,1,20120101,E0561,HCPCS,HUMIDIFIER NONHEATED W PAP,RR,,28 ,,NW,,,,,,$22.62,$0.00,1,1,1,1,1,1,20120101,E0561,HCPCS,HUMIDIFIER NONHEATED W PAP,UE,,28 ,,NW,,,,,,$148.46,$0.00,1,1,1,1,1,1,20120101,E0562,HCPCS,HUMIDIFIER HEATED USED W PAP,,,28 ,,NW,,,,,,$624.15,$0.00,1,1,1,1,1,1,20120101,E0562,HCPCS,HUMIDIFIER HEATED USED W PAP,NU,,28 ,,NW,,,,,,$624.15,$0.00,1,1,1,1,1,1,20120101,E0562,HCPCS,HUMIDIFIER HEATED USED W PAP,RR,,28 ,,NW,,,,,,$52.99,$0.00,1,1,1,1,1,1,20120101,E0562,HCPCS,HUMIDIFIER HEATED USED W PAP,UE,,28 ,,NW,,,,,,$462.02,$0.00,1,1,1,1,1,1,20120101,E0565,HCPCS,COMPRESSOR AIR POWER SOURCE,,,28 ,,NW,,,,,,"$1,495.67",$0.00,1,1,1,1,1,1,20120101,E0565,HCPCS,COMPRESSOR AIR POWER SOURCE,NU,,28 ,,NW,,,,,,"$1,495.67",$0.00,1,1,1,1,1,1,20120101,E0565,HCPCS,COMPRESSOR AIR POWER SOURCE,RR,,28 ,,NW,,,,,,$120.20,$0.00,1,1,1,1,1,1,20120101,E0565,HCPCS,COMPRESSOR AIR POWER SOURCE,UE,,28 ,,NW,,,,,,"$1,115.93",$0.00,1,1,1,1,1,1,20120101,E0570,HCPCS,NEBULIZER WITH COMPRESSION,,,28 ,,NW,,,,,,$336.09,$0.00,1,1,1,1,1,1,20120101,E0570,HCPCS,NEBULIZER WITH COMPRESSION,NU,,28 ,,NW,,,,,,$336.09,$0.00,1,1,1,1,1,1,20120101,E0570,HCPCS,NEBULIZER WITH COMPRESSION,RR,,28 ,,NW,,,,,,$35.12,$0.00,1,1,1,1,1,1,20120101,E0570,HCPCS,NEBULIZER WITH COMPRESSION,UE,,28 ,,NW,,,,,,$252.48,$0.00,1,1,1,1,1,1,20120101,E0572,HCPCS,AEROSOL COMPRESSOR ADJUST PR,,,28 ,,NW,,,,,,$937.67,$0.00,1,1,1,1,1,1,20120101,E0572,HCPCS,AEROSOL COMPRESSOR ADJUST PR,RR,,28 ,,NW,,,,,,$97.99,$0.00,1,1,1,1,1,1,20120101,E0574,HCPCS,ULTRASONIC GENERATOR W SVNEB,,,28 ,,NW,,,,,,"$1,011.42",$0.00,1,1,1,1,1,1,20120101,E0574,HCPCS,ULTRASONIC GENERATOR W SVNEB,RR,,28 ,,NW,,,,,,$105.70,$0.00,1,1,1,1,1,1,20120101,E0575,HCPCS,NEBULIZER ULTRASONIC,,,28 ,,NW,,,,,,"$2,536.60",$0.00,1,1,1,1,1,1,20120101,E0575,HCPCS,NEBULIZER ULTRASONIC,NU,,28 ,,NW,,,,,,"$2,536.60",$0.00,1,1,1,1,1,1,20120101,E0575,HCPCS,NEBULIZER ULTRASONIC,RR,,28 ,,NW,,,,,,$223.06,$0.00,1,1,1,1,1,1,20120101,E0575,HCPCS,NEBULIZER ULTRASONIC,UE,,28 ,,NW,,,,,,"$1,896.63",$0.00,1,1,1,1,1,1,20120101,E0580,HCPCS,NEBULIZER FOR USE W/ REGULAT,,,28 ,,NW,,,,,,$264.21,$0.00,1,1,1,1,1,1,20120101,E0580,HCPCS,NEBULIZER FOR USE W/ REGULAT,NU,,28 ,,NW,,,,,,$264.21,$0.00,1,1,1,1,1,1,20120101,E0580,HCPCS,NEBULIZER FOR USE W/ REGULAT,RR,,28 ,,NW,,,,,,$26.87,$0.00,1,1,1,1,1,1,20120101,E0580,HCPCS,NEBULIZER FOR USE W/ REGULAT,UE,,28 ,,NW,,,,,,$192.03,$0.00,1,1,1,1,1,1,20120101,E0585,HCPCS,NEBULIZER W/ COMPRESSOR & HE,,,28 ,,NW,,,,,,$850.12,$0.00,1,1,1,1,1,1,20120101,E0585,HCPCS,NEBULIZER W/ COMPRESSOR & HE,NU,,28 ,,NW,,,,,,$850.12,$0.00,1,1,1,1,1,1,20120101,E0585,HCPCS,NEBULIZER W/ COMPRESSOR & HE,RR,,28 ,,NW,,,,,,$66.62,$0.00,1,1,1,1,1,1,20120101,E0585,HCPCS,NEBULIZER W/ COMPRESSOR & HE,UE,,28 ,,NW,,,,,,$631.21,$0.00,1,1,1,1,1,1,20120101,E0600,HCPCS,SUCTION PUMP PORTAB HOM MODL,,,28 ,,NW,,,,,,"$1,117.05",$0.00,1,1,1,1,1,1,20120101,E0600,HCPCS,SUCTION PUMP PORTAB HOM MODL,NU,,28 ,,NW,,,,,,"$1,117.05",$0.00,1,1,1,1,1,1,20120101,E0600,HCPCS,SUCTION PUMP PORTAB HOM MODL,RR,,28 ,,NW,,,,,,$85.35,$0.00,1,1,1,1,1,1,20120101,E0600,HCPCS,SUCTION PUMP PORTAB HOM MODL,UE,,28 ,,NW,,,,,,$831.13,$0.00,1,1,1,1,1,1,20120101,E0601,HCPCS,CONT AIRWAY PRESSURE DEVICE,,,28 ,,NW,,,,,,"$2,375.77",$0.00,1,1,1,1,1,1,20120101,E0601,HCPCS,CONT AIRWAY PRESSURE DEVICE,NU,,28 ,,NW,,,,,,"$2,375.77",$0.00,1,1,1,1,1,1,20120101,E0601,HCPCS,CONT AIRWAY PRESSURE DEVICE,RR,,28 ,,NW,,,,,,$204.07,$0.00,1,1,1,1,1,1,20120101,E0601,HCPCS,CONT AIRWAY PRESSURE DEVICE,UE,,28 ,,NW,,,,,,"$1,774.89",$0.00,1,1,1,1,1,1,20120101,E0602,HCPCS,MANUAL BREAST PUMP,,,28 ,,NW,,,,,,$59.47,$0.00,1,1,1,1,1,1,20120101,E0602,HCPCS,MANUAL BREAST PUMP,NU,,28 ,,NW,,,,,,$59.47,$0.00,1,1,1,1,1,1,20120101,E0602,HCPCS,MANUAL BREAST PUMP,RR,,28 ,,NW,,,,,,$9.05,$0.00,1,1,1,1,1,1,20120101,E0602,HCPCS,MANUAL BREAST PUMP,UE,,28 ,,NW,,,,,,$46.09,$0.00,1,1,1,1,1,1,20120101,E0603,HCPCS,ELECTRIC BREAST PUMP,,,28 ,,NW,,,,,,$185.57,$0.00,1,1,1,1,1,1,20120101,E0603,HCPCS,ELECTRIC BREAST PUMP,NU,,28 ,,NW,,,,,,$185.57,$0.00,1,1,1,1,1,1,20120101,E0603,HCPCS,ELECTRIC BREAST PUMP,RR,,28 ,,NW,,,,,,$57.01,$0.00,1,1,1,1,1,1,20120101,E0603,HCPCS,ELECTRIC BREAST PUMP,UE,,28 ,,NW,,,,,,$143.13,$0.00,1,1,1,1,1,1,20120101,E0604,HCPCS,HOSP GRADE ELEC BREAST PUMP,,,28 ,,NW,,,,,,$578.71,$0.00,1,1,1,1,1,1,20120101,E0604,HCPCS,HOSP GRADE ELEC BREAST PUMP,NU,,28 ,,NW,,,,,,$578.71,$0.00,1,1,1,1,1,1,20120101,E0604,HCPCS,HOSP GRADE ELEC BREAST PUMP,RR,,28 ,,NW,,,,,,$207.91,$0.00,1,1,1,1,1,1,20120101,E0604,HCPCS,HOSP GRADE ELEC BREAST PUMP,UE,,28 ,,NW,,,,,,$427.94,$0.00,1,1,1,1,1,1,20120101,E0605,HCPCS,VAPORIZER ROOM TYPE,,,28 ,,NW,,,,,,$53.32,$0.00,1,1,1,1,1,1,20120101,E0605,HCPCS,VAPORIZER ROOM TYPE,NU,,28 ,,NW,,,,,,$53.32,$0.00,1,1,1,1,1,1,20120101,E0605,HCPCS,VAPORIZER ROOM TYPE,RR,,28 ,,NW,,,,,,$9.76,$0.00,1,1,1,1,1,1,20120101,E0605,HCPCS,VAPORIZER ROOM TYPE,UE,,28 ,,NW,,,,,,$44.02,$0.00,1,1,1,1,1,1,20120101,E0606,HCPCS,DRAINAGE BOARD POSTURAL,,,28 ,,NW,,,,,,$547.44,$0.00,1,1,1,1,1,1,20120101,E0606,HCPCS,DRAINAGE BOARD POSTURAL,NU,,28 ,,NW,,,,,,$547.44,$0.00,1,1,1,1,1,1,20120101,E0606,HCPCS,DRAINAGE BOARD POSTURAL,RR,,28 ,,NW,,,,,,$44.97,$0.00,1,1,1,1,1,1,20120101,E0606,HCPCS,DRAINAGE BOARD POSTURAL,UE,,28 ,,NW,,,,,,$404.48,$0.00,1,1,1,1,1,1,20120101,E0607,HCPCS,BLOOD GLUCOSE MONITOR HOME,,,28 ,,NW,,,,,,$142.68,$0.00,1,1,1,1,1,1,20120101,E0607,HCPCS,BLOOD GLUCOSE MONITOR HOME,NU,,28 ,,NW,,,,,,$142.68,$0.00,1,1,1,1,1,1,20120101,E0607,HCPCS,BLOOD GLUCOSE MONITOR HOME,RR,,28 ,,NW,,,,,,$18.02,$0.00,1,1,1,1,1,1,20120101,E0607,HCPCS,BLOOD GLUCOSE MONITOR HOME,UE,,28 ,,NW,,,,,,$100.89,$0.00,1,1,1,1,1,1,20120101,E0610,HCPCS,PACEMAKER MONITR AUDIBLE/VIS,,,28 ,,NW,,,,,,$554.11,$0.00,1,1,1,1,1,1,20120101,E0610,HCPCS,PACEMAKER MONITR AUDIBLE/VIS,NU,,28 ,,NW,,,,,,$554.11,$0.00,1,1,1,1,1,1,20120101,E0610,HCPCS,PACEMAKER MONITR AUDIBLE/VIS,RR,,28 ,,NW,,,,,,$50.08,$0.00,1,1,1,1,1,1,20120101,E0610,HCPCS,PACEMAKER MONITR AUDIBLE/VIS,UE,,28 ,,NW,,,,,,$409.38,$0.00,1,1,1,1,1,1,20120101,E0615,HCPCS,PACEMAKER MONITR DIGITAL/VIS,,,28 ,,NW,,,,,,"$1,114.93",$0.00,1,1,1,1,1,1,20120101,E0615,HCPCS,PACEMAKER MONITR DIGITAL/VIS,NU,,28 ,,NW,,,,,,"$1,114.93",$0.00,1,1,1,1,1,1,20120101,E0615,HCPCS,PACEMAKER MONITR DIGITAL/VIS,RR,,28 ,,NW,,,,,,$113.01,$0.00,1,1,1,1,1,1,20120101,E0615,HCPCS,PACEMAKER MONITR DIGITAL/VIS,UE,,28 ,,NW,,,,,,$828.46,$0.00,1,1,1,1,1,1,20120101,E0616,HCPCS,CARDIAC EVENT RECORDER,,,28 ,,NW,,,,,,"$8,202.30",$0.00,1,1,1,1,1,1,20120101,E0617,HCPCS,AUTOMATIC EXT DEFIBRILLATOR,,,28 ,,NW,,,,,,"$15,103.98",$0.00,1,1,1,1,1,1,20120101,E0617,HCPCS,AUTOMATIC EXT DEFIBRILLATOR,RR,,28 ,,NW,,,,,,"$1,578.40",$0.00,1,1,1,1,1,1,20120101,E0618,HCPCS,APNEA MONITOR,,,28 ,,NW,,,,,,"$6,067.33",$0.00,1,1,1,1,1,1,20120101,E0618,HCPCS,APNEA MONITOR,RR,,28 ,,NW,,,,,,$634.05,$0.00,1,1,1,1,1,1,20120101,E0619,HCPCS,APNEA MONITOR W RECORDER,,,28 ,,NW,,,,,,"$6,067.33",$0.00,1,1,1,1,1,1,20120101,E0619,HCPCS,APNEA MONITOR W RECORDER,RR,,28 ,,NW,,,,,,$634.05,$0.00,1,1,1,1,1,1,20120101,E0620,HCPCS,CAP BLD SKIN PIERCING LASER,,,28 ,,NW,,,,,,"$2,159.85",$0.00,1,1,1,1,1,1,20120101,E0620,HCPCS,CAP BLD SKIN PIERCING LASER,NU,,28 ,,NW,,,,,,"$2,159.85",$0.00,1,1,1,1,1,1,20120101,E0620,HCPCS,CAP BLD SKIN PIERCING LASER,RR,,28 ,,NW,,,,,,$194.01,$0.00,1,1,1,1,1,1,20120101,E0620,HCPCS,CAP BLD SKIN PIERCING LASER,UE,,28 ,,NW,,,,,,"$1,613.79",$0.00,1,1,1,1,1,1,20120101,E0621,HCPCS,PATIENT LIFT SLING OR SEAT,,,28 ,,NW,,,,,,$198.51,$0.00,1,1,1,1,1,1,20120101,E0621,HCPCS,PATIENT LIFT SLING OR SEAT,NU,,28 ,,NW,,,,,,$198.51,$0.00,1,1,1,1,1,1,20120101,E0621,HCPCS,PATIENT LIFT SLING OR SEAT,RR,,28 ,,NW,,,,,,$21.77,$0.00,1,1,1,1,1,1,20120101,E0621,HCPCS,PATIENT LIFT SLING OR SEAT,UE,,28 ,,NW,,,,,,$143.59,$0.00,1,1,1,1,1,1,20120101,E0625,HCPCS,PATIENT LIFT BATHROOM OR TOI,,,28 ,,NW,,,,,,"$2,065.32",$0.00,1,1,1,1,1,1,20120101,E0625,HCPCS,PATIENT LIFT BATHROOM OR TOI,NU,,28 ,,NW,,,,,,"$2,065.32",$0.00,1,1,1,1,1,1,20120101,E0625,HCPCS,PATIENT LIFT BATHROOM OR TOI,RR,,28 ,,NW,,,,,,$215.83,$0.00,1,1,1,1,1,1,20120101,E0625,HCPCS,PATIENT LIFT BATHROOM OR TOI,UE,,28 ,,NW,,,,,,"$1,551.53",$0.00,1,1,1,1,1,1,20120101,E0627,HCPCS,SEAT LIFT INCORP LIFT-CHAIR,,,28 ,,NW,,,,,,$807.51,$0.00,1,1,1,1,1,1,20120101,E0627,HCPCS,SEAT LIFT INCORP LIFT-CHAIR,NU,,28 ,,NW,,,,,,$807.51,$0.00,1,1,1,1,1,1,20120101,E0627,HCPCS,SEAT LIFT INCORP LIFT-CHAIR,RR,,28 ,,NW,,,,,,$66.33,$0.00,1,1,1,1,1,1,20120101,E0627,HCPCS,SEAT LIFT INCORP LIFT-CHAIR,UE,,28 ,,NW,,,,,,$599.50,$0.00,1,1,1,1,1,1,20120101,E0628,HCPCS,SEAT LIFT FOR PT FURN-ELECTR,,,28 ,,NW,,,,,,$807.51,$0.00,1,1,1,1,1,1,20120101,E0628,HCPCS,SEAT LIFT FOR PT FURN-ELECTR,NU,,28 ,,NW,,,,,,$807.51,$0.00,1,1,1,1,1,1,20120101,E0628,HCPCS,SEAT LIFT FOR PT FURN-ELECTR,RR,,28 ,,NW,,,,,,$66.33,$0.00,1,1,1,1,1,1,20120101,E0628,HCPCS,SEAT LIFT FOR PT FURN-ELECTR,UE,,28 ,,NW,,,,,,$599.50,$0.00,1,1,1,1,1,1,20120101,E0629,HCPCS,SEAT LIFT FOR PT FURN-NON-EL,,,28 ,,NW,,,,,,$793.43,$0.00,1,1,1,1,1,1,20120101,E0629,HCPCS,SEAT LIFT FOR PT FURN-NON-EL,NU,,28 ,,NW,,,,,,$793.43,$0.00,1,1,1,1,1,1,20120101,E0629,HCPCS,SEAT LIFT FOR PT FURN-NON-EL,RR,,28 ,,NW,,,,,,$65.32,$0.00,1,1,1,1,1,1,20120101,E0629,HCPCS,SEAT LIFT FOR PT FURN-NON-EL,UE,,28 ,,NW,,,,,,$588.91,$0.00,1,1,1,1,1,1,20120101,E0630,HCPCS,PATIENT LIFT HYDRAULIC,,,28 ,,NW,,,,,,"$2,514.26",$0.00,1,1,1,1,1,1,20120101,E0630,HCPCS,PATIENT LIFT HYDRAULIC,NU,,28 ,,NW,,,,,,"$2,514.26",$0.00,1,1,1,1,1,1,20120101,E0630,HCPCS,PATIENT LIFT HYDRAULIC,RR,,28 ,,NW,,,,,,$218.20,$0.00,1,1,1,1,1,1,20120101,E0630,HCPCS,PATIENT LIFT HYDRAULIC,UE,,28 ,,NW,,,,,,"$1,879.88",$0.00,1,1,1,1,1,1,20120101,E0635,HCPCS,PATIENT LIFT ELECTRIC,,,28 ,,NW,,,,,,"$3,024.67",$0.00,1,1,1,1,1,1,20120101,E0635,HCPCS,PATIENT LIFT ELECTRIC,NU,,28 ,,NW,,,,,,"$3,024.67",$0.00,1,1,1,1,1,1,20120101,E0635,HCPCS,PATIENT LIFT ELECTRIC,RR,,28 ,,NW,,,,,,$263.00,$0.00,1,1,1,1,1,1,20120101,E0635,HCPCS,PATIENT LIFT ELECTRIC,UE,,28 ,,NW,,,,,,"$2,262.96",$0.00,1,1,1,1,1,1,20120101,E0636,HCPCS,PT SUPPORT & POSITIONING SYS,,,28 ,,NW,,,,,,"$24,974.87",$0.00,1,1,1,1,1,1,20120101,E0636,HCPCS,PT SUPPORT & POSITIONING SYS,RR,,28 ,,NW,,,,,,"$2,609.92",$0.00,1,1,1,1,1,1,20120101,E0637,HCPCS,COMBINATION SIT TO STAND SYS,,,28 ,,NW,,,,,,"$1,448.88",$0.00,1,1,1,1,1,1,20120101,E0638,HCPCS,STANDING FRAME SYS,,,28 ,,NW,,,,,,"$2,087.90",$0.00,1,1,1,1,1,1,20120101,E0640,HCPCS,FIXED PATIENT LIFT SYSTEM,,,28 ,,NW,,,,,,"$1,445.69",$0.00,1,1,1,1,1,1,20120101,E0641,HCPCS,MULTI-POSITION STND FRAM SYS,,,28 ,,NW,,,,,,"$1,221.17",$0.00,1,1,1,1,1,1,20120101,E0642,HCPCS,DYNAMIC STANDING FRAME,,,28 ,,NW,,,,,,"$2,909.29",$0.00,1,1,1,1,1,1,20120101,E0650,HCPCS,PNEUMA COMPRESOR NON-SEGMENT,,,28 ,,NW,,,,,,"$1,689.51",$0.00,1,1,1,1,1,1,20120101,E0650,HCPCS,PNEUMA COMPRESOR NON-SEGMENT,NU,,28 ,,NW,,,,,,"$1,689.51",$0.00,1,1,1,1,1,1,20120101,E0650,HCPCS,PNEUMA COMPRESOR NON-SEGMENT,RR,,28 ,,NW,,,,,,$187.37,$0.00,1,1,1,1,1,1,20120101,E0650,HCPCS,PNEUMA COMPRESOR NON-SEGMENT,UE,,28 ,,NW,,,,,,"$1,254.43",$0.00,1,1,1,1,1,1,20120101,E0651,HCPCS,PNEUM COMPRESSOR SEGMENTAL,,,28 ,,NW,,,,,,"$2,140.64",$0.00,1,1,1,1,1,1,20120101,E0651,HCPCS,PNEUM COMPRESSOR SEGMENTAL,NU,,28 ,,NW,,,,,,"$2,140.64",$0.00,1,1,1,1,1,1,20120101,E0651,HCPCS,PNEUM COMPRESSOR SEGMENTAL,RR,,28 ,,NW,,,,,,$198.97,$0.00,1,1,1,1,1,1,20120101,E0651,HCPCS,PNEUM COMPRESSOR SEGMENTAL,UE,,28 ,,NW,,,,,,"$1,599.39",$0.00,1,1,1,1,1,1,20120101,E0652,HCPCS,PNEUM COMPRES W/CAL PRESSURE,,,28 ,,NW,,,,,,"$12,849.87",$0.00,1,1,1,1,1,1,20120101,E0652,HCPCS,PNEUM COMPRES W/CAL PRESSURE,NU,,28 ,,NW,,,,,,"$12,849.87",$0.00,1,1,1,1,1,1,20120101,E0652,HCPCS,PNEUM COMPRES W/CAL PRESSURE,RR,,28 ,,NW,,,,,,"$1,232.54",$0.00,1,1,1,1,1,1,20120101,E0652,HCPCS,PNEUM COMPRES W/CAL PRESSURE,UE,,28 ,,NW,,,,,,"$9,528.53",$0.00,1,1,1,1,1,1,20120101,E0655,HCPCS,PNEUMATIC APPLIANCE HALF ARM,,,28 ,,NW,,,,,,$233.54,$0.00,1,1,1,1,1,1,20120101,E0655,HCPCS,PNEUMATIC APPLIANCE HALF ARM,NU,,28 ,,NW,,,,,,$233.54,$0.00,1,1,1,1,1,1,20120101,E0655,HCPCS,PNEUMATIC APPLIANCE HALF ARM,RR,,28 ,,NW,,,,,,$26.98,$0.00,1,1,1,1,1,1,20120101,E0655,HCPCS,PNEUMATIC APPLIANCE HALF ARM,UE,,28 ,,NW,,,,,,$170.21,$0.00,1,1,1,1,1,1,20120101,E0656,HCPCS,SEGMENTAL PNEUMATIC TRUNK,,,28 ,,NW,,,,,,"$1,418.74",$0.00,1,1,1,1,1,1,20120101,E0656,HCPCS,SEGMENTAL PNEUMATIC TRUNK,NU,,28 ,,NW,,,,,,"$1,418.74",$0.00,1,1,1,1,1,1,20120101,E0656,HCPCS,SEGMENTAL PNEUMATIC TRUNK,RR,,28 ,,NW,,,,,,$119.75,$0.00,1,1,1,1,1,1,20120101,E0656,HCPCS,SEGMENTAL PNEUMATIC TRUNK,UE,,28 ,,NW,,,,,,"$1,058.10",$0.00,1,1,1,1,1,1,20120101,E0657,HCPCS,SEGMENTAL PNEUMATIC CHEST,,,28 ,,NW,,,,,,"$1,331.39",$0.00,1,1,1,1,1,1,20120101,E0657,HCPCS,SEGMENTAL PNEUMATIC CHEST,NU,,28 ,,NW,,,,,,"$1,331.39",$0.00,1,1,1,1,1,1,20120101,E0657,HCPCS,SEGMENTAL PNEUMATIC CHEST,RR,,28 ,,NW,,,,,,$110.94,$0.00,1,1,1,1,1,1,20120101,E0657,HCPCS,SEGMENTAL PNEUMATIC CHEST,UE,,28 ,,NW,,,,,,$992.51,$0.00,1,1,1,1,1,1,20120101,E0660,HCPCS,PNEUMATIC APPLIANCE FULL LEG,,,28 ,,NW,,,,,,$352.89,$0.00,1,1,1,1,1,1,20120101,E0660,HCPCS,PNEUMATIC APPLIANCE FULL LEG,NU,,28 ,,NW,,,,,,$352.89,$0.00,1,1,1,1,1,1,20120101,E0660,HCPCS,PNEUMATIC APPLIANCE FULL LEG,RR,,28 ,,NW,,,,,,$34.21,$0.00,1,1,1,1,1,1,20120101,E0660,HCPCS,PNEUMATIC APPLIANCE FULL LEG,UE,,28 ,,NW,,,,,,$257.95,$0.00,1,1,1,1,1,1,20120101,E0665,HCPCS,PNEUMATIC APPLIANCE FULL ARM,,,28 ,,NW,,,,,,$298.22,$0.00,1,1,1,1,1,1,20120101,E0665,HCPCS,PNEUMATIC APPLIANCE FULL ARM,NU,,28 ,,NW,,,,,,$298.22,$0.00,1,1,1,1,1,1,20120101,E0665,HCPCS,PNEUMATIC APPLIANCE FULL ARM,RR,,28 ,,NW,,,,,,$30.07,$0.00,1,1,1,1,1,1,20120101,E0665,HCPCS,PNEUMATIC APPLIANCE FULL ARM,UE,,28 ,,NW,,,,,,$215.90,$0.00,1,1,1,1,1,1,20120101,E0666,HCPCS,PNEUMATIC APPLIANCE HALF LEG,,,28 ,,NW,,,,,,$302.31,$0.00,1,1,1,1,1,1,20120101,E0666,HCPCS,PNEUMATIC APPLIANCE HALF LEG,NU,,28 ,,NW,,,,,,$302.31,$0.00,1,1,1,1,1,1,20120101,E0666,HCPCS,PNEUMATIC APPLIANCE HALF LEG,RR,,28 ,,NW,,,,,,$30.40,$0.00,1,1,1,1,1,1,20120101,E0666,HCPCS,PNEUMATIC APPLIANCE HALF LEG,UE,,28 ,,NW,,,,,,$221.21,$0.00,1,1,1,1,1,1,20120101,E0667,HCPCS,SEG PNEUMATIC APPL FULL LEG,,,28 ,,NW,,,,,,$769.01,$0.00,1,1,1,1,1,1,20120101,E0667,HCPCS,SEG PNEUMATIC APPL FULL LEG,NU,,28 ,,NW,,,,,,$769.01,$0.00,1,1,1,1,1,1,20120101,E0667,HCPCS,SEG PNEUMATIC APPL FULL LEG,RR,,28 ,,NW,,,,,,$69.97,$0.00,1,1,1,1,1,1,20120101,E0667,HCPCS,SEG PNEUMATIC APPL FULL LEG,UE,,28 ,,NW,,,,,,$570.67,$0.00,1,1,1,1,1,1,20120101,E0668,HCPCS,SEG PNEUMATIC APPL FULL ARM,,,28 ,,NW,,,,,,"$1,019.75",$0.00,1,1,1,1,1,1,20120101,E0668,HCPCS,SEG PNEUMATIC APPL FULL ARM,NU,,28 ,,NW,,,,,,"$1,019.75",$0.00,1,1,1,1,1,1,20120101,E0668,HCPCS,SEG PNEUMATIC APPL FULL ARM,RR,,28 ,,NW,,,,,,$80.76,$0.00,1,1,1,1,1,1,20120101,E0668,HCPCS,SEG PNEUMATIC APPL FULL ARM,UE,,28 ,,NW,,,,,,$758.73,$0.00,1,1,1,1,1,1,20120101,E0669,HCPCS,SEG PNEUMATIC APPLI HALF LEG,,,28 ,,NW,,,,,,$424.08,$0.00,1,1,1,1,1,1,20120101,E0669,HCPCS,SEG PNEUMATIC APPLI HALF LEG,NU,,28 ,,NW,,,,,,$424.08,$0.00,1,1,1,1,1,1,20120101,E0669,HCPCS,SEG PNEUMATIC APPLI HALF LEG,RR,,28 ,,NW,,,,,,$38.48,$0.00,1,1,1,1,1,1,20120101,E0669,HCPCS,SEG PNEUMATIC APPLI HALF LEG,UE,,28 ,,NW,,,,,,$312.00,$0.00,1,1,1,1,1,1,20120101,E0671,HCPCS,PRESSURE PNEUM APPL FULL LEG,,,28 ,,NW,,,,,,"$1,013.53",$0.00,1,1,1,1,1,1,20120101,E0671,HCPCS,PRESSURE PNEUM APPL FULL LEG,NU,,28 ,,NW,,,,,,"$1,013.53",$0.00,1,1,1,1,1,1,20120101,E0671,HCPCS,PRESSURE PNEUM APPL FULL LEG,RR,,28 ,,NW,,,,,,$81.32,$0.00,1,1,1,1,1,1,20120101,E0671,HCPCS,PRESSURE PNEUM APPL FULL LEG,UE,,28 ,,NW,,,,,,$754.03,$0.00,1,1,1,1,1,1,20120101,E0672,HCPCS,PRESSURE PNEUM APPL FULL ARM,,,28 ,,NW,,,,,,$782.09,$0.00,1,1,1,1,1,1,20120101,E0672,HCPCS,PRESSURE PNEUM APPL FULL ARM,NU,,28 ,,NW,,,,,,$782.09,$0.00,1,1,1,1,1,1,20120101,E0672,HCPCS,PRESSURE PNEUM APPL FULL ARM,RR,,28 ,,NW,,,,,,$64.49,$0.00,1,1,1,1,1,1,20120101,E0672,HCPCS,PRESSURE PNEUM APPL FULL ARM,UE,,28 ,,NW,,,,,,$580.50,$0.00,1,1,1,1,1,1,20120101,E0673,HCPCS,PRESSURE PNEUM APPL HALF LEG,,,28 ,,NW,,,,,,$645.75,$0.00,1,1,1,1,1,1,20120101,E0673,HCPCS,PRESSURE PNEUM APPL HALF LEG,NU,,28 ,,NW,,,,,,$645.75,$0.00,1,1,1,1,1,1,20120101,E0673,HCPCS,PRESSURE PNEUM APPL HALF LEG,RR,,28 ,,NW,,,,,,$54.58,$0.00,1,1,1,1,1,1,20120101,E0673,HCPCS,PRESSURE PNEUM APPL HALF LEG,UE,,28 ,,NW,,,,,,$478.27,$0.00,1,1,1,1,1,1,20120101,E0675,HCPCS,PNEUMATIC COMPRESSION DEVICE,,,28 ,,NW,,,,,,"$8,959.03",$0.00,1,1,1,1,1,1,20120101,E0675,HCPCS,PNEUMATIC COMPRESSION DEVICE,RR,,28 ,,NW,,,,,,$936.24,$0.00,1,1,1,1,1,1,20120101,E0676,HCPCS,INTER LIMB COMPRESS DEV NOS,,,28 ,,NW,,,,,,$484.93,$0.00,1,1,1,1,1,1,20120101,E0691,HCPCS,UVL PNL 2 SQ FT OR LESS,,,28 ,,NW,,,,,,"$2,220.32",$0.00,1,1,1,1,1,1,20120101,E0691,HCPCS,UVL PNL 2 SQ FT OR LESS,NU,,28 ,,NW,,,,,,"$2,220.32",$0.00,1,1,1,1,1,1,20120101,E0691,HCPCS,UVL PNL 2 SQ FT OR LESS,RR,,28 ,,NW,,,,,,$200.08,$0.00,1,1,1,1,1,1,20120101,E0691,HCPCS,UVL PNL 2 SQ FT OR LESS,UE,,28 ,,NW,,,,,,"$1,659.13",$0.00,1,1,1,1,1,1,20120101,E0692,HCPCS,UVL SYS PANEL 4 FT,,,28 ,,NW,,,,,,"$2,794.32",$0.00,1,1,1,1,1,1,20120101,E0692,HCPCS,UVL SYS PANEL 4 FT,NU,,28 ,,NW,,,,,,"$2,794.32",$0.00,1,1,1,1,1,1,20120101,E0692,HCPCS,UVL SYS PANEL 4 FT,RR,,28 ,,NW,,,,,,$257.39,$0.00,1,1,1,1,1,1,20120101,E0692,HCPCS,UVL SYS PANEL 4 FT,UE,,28 ,,NW,,,,,,"$2,089.65",$0.00,1,1,1,1,1,1,20120101,E0693,HCPCS,UVL SYS PANEL 6 FT,,,28 ,,NW,,,,,,"$3,450.32",$0.00,1,1,1,1,1,1,20120101,E0693,HCPCS,UVL SYS PANEL 6 FT,NU,,28 ,,NW,,,,,,"$3,450.32",$0.00,1,1,1,1,1,1,20120101,E0693,HCPCS,UVL SYS PANEL 6 FT,RR,,28 ,,NW,,,,,,$323.08,$0.00,1,1,1,1,1,1,20120101,E0693,HCPCS,UVL SYS PANEL 6 FT,UE,,28 ,,NW,,,,,,"$2,581.63",$0.00,1,1,1,1,1,1,20120101,E0694,HCPCS,UVL MD CABINET SYS 6 FT,,,28 ,,NW,,,,,,"$11,035.23",$0.00,1,1,1,1,1,1,20120101,E0694,HCPCS,UVL MD CABINET SYS 6 FT,NU,,28 ,,NW,,,,,,"$11,035.23",$0.00,1,1,1,1,1,1,20120101,E0694,HCPCS,UVL MD CABINET SYS 6 FT,RR,,28 ,,NW,,,,,,"$1,081.58",$0.00,1,1,1,1,1,1,20120101,E0694,HCPCS,UVL MD CABINET SYS 6 FT,UE,,28 ,,NW,,,,,,"$8,270.39",$0.00,1,1,1,1,1,1,20120101,E0700,HCPCS,SAFETY EQUIPMENT,,,28 ,,NW,,,,,,$71.64,$0.00,1,1,1,1,1,1,20120101,E0705,HCPCS,TRANSFER DEVICE,,,28 ,,NW,,,,,,$103.88,$0.00,1,1,1,1,1,1,20120101,E0705,HCPCS,TRANSFER DEVICE,NU,,28 ,,NW,,,,,,$103.88,$0.00,1,1,1,1,1,1,20120101,E0705,HCPCS,TRANSFER DEVICE,RR,,28 ,,NW,,,,,,$15.36,$0.00,1,1,1,1,1,1,20120101,E0705,HCPCS,TRANSFER DEVICE,UE,,28 ,,NW,,,,,,$74.50,$0.00,1,1,1,1,1,1,20120101,E0710,HCPCS,RESTRAINTS ANY TYPE,,,28 ,,NW,,,,,,$32.21,$0.00,1,1,1,1,1,1,20120101,E0720,HCPCS,TENS TWO LEAD,,,28 ,,NW,,,,,,$842.25,$0.00,1,1,1,1,1,1,20120101,E0720,HCPCS,TENS TWO LEAD,NU,,28 ,,NW,,,,,,$842.25,$0.00,1,1,1,1,1,1,20120101,E0720,HCPCS,TENS TWO LEAD,RR,,28 ,,NW,,,,,,$72.43,$0.00,1,1,1,1,1,1,20120101,E0720,HCPCS,TENS TWO LEAD,UE,,28 ,,NW,,,,,,$662.48,$0.00,1,1,1,1,1,1,20120101,E0730,HCPCS,TENS FOUR LEAD,,,28 ,,NW,,,,,,$857.87,$0.00,1,1,1,1,1,1,20120101,E0730,HCPCS,TENS FOUR LEAD,NU,,28 ,,NW,,,,,,$857.87,$0.00,1,1,1,1,1,1,20120101,E0730,HCPCS,TENS FOUR LEAD,RR,,28 ,,NW,,,,,,$73.24,$0.00,1,1,1,1,1,1,20120101,E0730,HCPCS,TENS FOUR LEAD,UE,,28 ,,NW,,,,,,$668.06,$0.00,1,1,1,1,1,1,20120101,E0731,HCPCS,CONDUCTIVE GARMENT FOR TENS/,,,28 ,,NW,,,,,,$813.19,$0.00,1,1,1,1,1,1,20120101,E0731,HCPCS,CONDUCTIVE GARMENT FOR TENS/,NU,,28 ,,NW,,,,,,$813.19,$0.00,1,1,1,1,1,1,20120101,E0731,HCPCS,CONDUCTIVE GARMENT FOR TENS/,RR,,28 ,,NW,,,,,,$84.98,$0.00,1,1,1,1,1,1,20120101,E0740,HCPCS,INCONTINENCE TREATMENT SYSTM,,,28 ,,NW,,,,,,"$1,281.74",$0.00,1,1,1,1,1,1,20120101,E0740,HCPCS,INCONTINENCE TREATMENT SYSTM,NU,,28 ,,NW,,,,,,"$1,281.74",$0.00,1,1,1,1,1,1,20120101,E0740,HCPCS,INCONTINENCE TREATMENT SYSTM,RR,,28 ,,NW,,,,,,$106.23,$0.00,1,1,1,1,1,1,20120101,E0740,HCPCS,INCONTINENCE TREATMENT SYSTM,UE,,28 ,,NW,,,,,,$955.29,$0.00,1,1,1,1,1,1,20120101,E0744,HCPCS,NEUROMUSCULAR STIM FOR SCOLI,,,28 ,,NW,,,,,,"$2,257.38",$0.00,1,1,1,1,1,1,20120101,E0744,HCPCS,NEUROMUSCULAR STIM FOR SCOLI,NU,,28 ,,NW,,,,,,"$2,257.38",$0.00,1,1,1,1,1,1,20120101,E0744,HCPCS,NEUROMUSCULAR STIM FOR SCOLI,RR,,28 ,,NW,,,,,,$190.71,$0.00,1,1,1,1,1,1,20120101,E0744,HCPCS,NEUROMUSCULAR STIM FOR SCOLI,UE,,28 ,,NW,,,,,,"$1,686.66",$0.00,1,1,1,1,1,1,20120101,E0745,HCPCS,NEUROMUSCULAR STIM FOR SHOCK,,,28 ,,NW,,,,,,"$2,206.00",$0.00,1,1,1,1,1,1,20120101,E0745,HCPCS,NEUROMUSCULAR STIM FOR SHOCK,NU,,28 ,,NW,,,,,,"$2,206.00",$0.00,1,1,1,1,1,1,20120101,E0745,HCPCS,NEUROMUSCULAR STIM FOR SHOCK,RR,,28 ,,NW,,,,,,$187.77,$0.00,1,1,1,1,1,1,20120101,E0745,HCPCS,NEUROMUSCULAR STIM FOR SHOCK,UE,,28 ,,NW,,,,,,"$1,648.68",$0.00,1,1,1,1,1,1,20120101,E0746,HCPCS,ELECTROMYOGRAPH BIOFEEDBACK,,,28 ,,NW,,,,,,$204.42,$0.00,1,1,1,1,1,1,20120101,E0746,HCPCS,ELECTROMYOGRAPH BIOFEEDBACK,NU,,28 ,,NW,,,,,,$204.42,$0.00,1,1,1,1,1,1,20120101,E0746,HCPCS,ELECTROMYOGRAPH BIOFEEDBACK,RR,,28 ,,NW,,,,,,$22.37,$0.00,1,1,1,1,1,1,20120101,E0746,HCPCS,ELECTROMYOGRAPH BIOFEEDBACK,UE,,28 ,,NW,,,,,,$153.94,$0.00,1,1,1,1,1,1,20120101,E0747,HCPCS,ELEC OSTEOGEN STIM NOT SPINE,,,28 ,,NW,,,,,,"$9,285.69",$0.00,1,1,1,1,1,1,20120101,E0747,HCPCS,ELEC OSTEOGEN STIM NOT SPINE,NU,,28 ,,NW,,,,,,"$9,285.69",$0.00,1,1,1,1,1,1,20120101,E0747,HCPCS,ELEC OSTEOGEN STIM NOT SPINE,RR,,28 ,,NW,,,,,,$903.99,$0.00,1,1,1,1,1,1,20120101,E0747,HCPCS,ELEC OSTEOGEN STIM NOT SPINE,UE,,28 ,,NW,,,,,,"$6,906.87",$0.00,1,1,1,1,1,1,20120101,E0748,HCPCS,ELEC OSTEOGEN STIM SPINAL,,,28 ,,NW,,,,,,"$9,698.21",$0.00,1,1,1,1,1,1,20120101,E0748,HCPCS,ELEC OSTEOGEN STIM SPINAL,NU,,28 ,,NW,,,,,,"$9,698.21",$0.00,1,1,1,1,1,1,20120101,E0748,HCPCS,ELEC OSTEOGEN STIM SPINAL,RR,,28 ,,NW,,,,,,$947.85,$0.00,1,1,1,1,1,1,20120101,E0748,HCPCS,ELEC OSTEOGEN STIM SPINAL,UE,,28 ,,NW,,,,,,"$7,267.60",$0.00,1,1,1,1,1,1,20120101,E0749,HCPCS,ELEC OSTEOGEN STIM IMPLANTED,,,28 ,,NW,,,,,,"$6,173.54",$0.00,1,1,1,1,1,1,20120101,E0749,HCPCS,ELEC OSTEOGEN STIM IMPLANTED,RR,,28 ,,NW,,,,,,$645.15,$0.00,1,1,1,1,1,1,20120101,E0760,HCPCS,OSTEOGEN ULTRASOUND STIMLTOR,,,28 ,,NW,,,,,,"$8,052.01",$0.00,1,1,1,1,1,1,20120101,E0760,HCPCS,OSTEOGEN ULTRASOUND STIMLTOR,NU,,28 ,,NW,,,,,,"$8,052.01",$0.00,1,1,1,1,1,1,20120101,E0760,HCPCS,OSTEOGEN ULTRASOUND STIMLTOR,RR,,28 ,,NW,,,,,,$783.28,$0.00,1,1,1,1,1,1,20120101,E0760,HCPCS,OSTEOGEN ULTRASOUND STIMLTOR,UE,,28 ,,NW,,,,,,"$6,032.89",$0.00,1,1,1,1,1,1,20120101,E0762,HCPCS,TRANS ELEC JT STIM DEV SYS,,,28 ,,NW,,,,,,"$2,548.66",$0.00,1,1,1,1,1,1,20120101,E0762,HCPCS,TRANS ELEC JT STIM DEV SYS,NU,,28 ,,NW,,,,,,"$2,548.66",$0.00,1,1,1,1,1,1,20120101,E0762,HCPCS,TRANS ELEC JT STIM DEV SYS,RR,,28 ,,NW,,,,,,$232.91,$0.00,1,1,1,1,1,1,20120101,E0762,HCPCS,TRANS ELEC JT STIM DEV SYS,UE,,28 ,,NW,,,,,,"$1,905.33",$0.00,1,1,1,1,1,1,20120101,E0764,HCPCS,FUNCTIONAL NEUROMUSCULARSTIM,,,28 ,,NW,,,,,,"$27,620.85",$0.00,1,1,1,1,1,1,20120101,E0764,HCPCS,FUNCTIONAL NEUROMUSCULARSTIM,NU,,28 ,,NW,,,,,,"$27,620.85",$0.00,1,1,1,1,1,1,20120101,E0764,HCPCS,FUNCTIONAL NEUROMUSCULARSTIM,RR,,28 ,,NW,,,,,,"$2,740.10",$0.00,1,1,1,1,1,1,20120101,E0764,HCPCS,FUNCTIONAL NEUROMUSCULARSTIM,UE,,28 ,,NW,,,,,,"$20,709.55",$0.00,1,1,1,1,1,1,20120101,E0765,HCPCS,NERVE STIMULATOR FOR TX N&V,,,28 ,,NW,,,,,,$185.77,$0.00,1,1,1,1,1,1,20120101,E0765,HCPCS,NERVE STIMULATOR FOR TX N&V,NU,,28 ,,NW,,,,,,$185.77,$0.00,1,1,1,1,1,1,20120101,E0765,HCPCS,NERVE STIMULATOR FOR TX N&V,RR,,28 ,,NW,,,,,,$21.19,$0.00,1,1,1,1,1,1,20120101,E0765,HCPCS,NERVE STIMULATOR FOR TX N&V,UE,,28 ,,NW,,,,,,$133.28,$0.00,1,1,1,1,1,1,20120101,E0769,HCPCS,ELECTRIC WOUND TREATMENT DEV,,,28 ,,NW,,,,,,$73.24,$0.00,1,1,1,1,1,1,20120101,E0770,HCPCS,FUNCTIONAL ELECTRIC STIM NOS,,,28 ,,NW,,,,,,$73.24,$0.00,1,1,1,1,1,1,20120101,E0776,HCPCS,IV POLE,,,28 ,,NW,,,,,,$309.39,$0.00,1,1,1,1,1,1,20120101,E0776,HCPCS,IV POLE,NU,,28 ,,NW,,,,,,$309.39,$0.00,1,1,1,1,1,1,20120101,E0776,HCPCS,IV POLE,RR,,28 ,,NW,,,,,,$37.62,$0.00,1,1,1,1,1,1,20120101,E0776,HCPCS,IV POLE,UE,,28 ,,NW,,,,,,$221.76,$0.00,1,1,1,1,1,1,20120101,E0779,HCPCS,AMB INFUSION PUMP MECHANICAL,,,28 ,,NW,,,,,,$340.39,$0.00,1,1,1,1,1,1,20120101,E0779,HCPCS,AMB INFUSION PUMP MECHANICAL,RR,,28 ,,NW,,,,,,$35.57,$0.00,1,1,1,1,1,1,20120101,E0780,HCPCS,MECH AMB INFUSION PUMP <8HRS,,,28 ,,NW,,,,,,$24.73,$0.00,1,1,1,1,1,1,20120101,E0780,HCPCS,MECH AMB INFUSION PUMP <8HRS,NU,,28 ,,NW,,,,,,$24.73,$0.00,1,1,1,1,1,1,20120101,E0781,HCPCS,EXTERNAL AMBULATORY INFUS PU,,,28 ,,NW,,,,,,"$5,848.11",$0.00,1,1,1,1,1,1,20120101,E0781,HCPCS,EXTERNAL AMBULATORY INFUS PU,RR,,28 ,,NW,,,,,,$611.14,$0.00,1,1,1,1,1,1,20120101,E0782,HCPCS,NON-PROGRAMBLE INFUSION PUMP,,,28 ,,NW,,,,,,"$10,102.49",$0.00,1,1,1,1,1,1,20120101,E0782,HCPCS,NON-PROGRAMBLE INFUSION PUMP,NU,,28 ,,NW,,,,,,"$10,102.49",$0.00,1,1,1,1,1,1,20120101,E0782,HCPCS,NON-PROGRAMBLE INFUSION PUMP,RR,,28 ,,NW,,,,,,$988.33,$0.00,1,1,1,1,1,1,20120101,E0782,HCPCS,NON-PROGRAMBLE INFUSION PUMP,UE,,28 ,,NW,,,,,,"$7,570.79",$0.00,1,1,1,1,1,1,20120101,E0783,HCPCS,PROGRAMMABLE INFUSION PUMP,,,28 ,,NW,,,,,,"$19,932.52",$0.00,1,1,1,1,1,1,20120101,E0783,HCPCS,PROGRAMMABLE INFUSION PUMP,NU,,28 ,,NW,,,,,,"$19,932.52",$0.00,1,1,1,1,1,1,20120101,E0783,HCPCS,PROGRAMMABLE INFUSION PUMP,RR,,28 ,,NW,,,,,,"$1,971.33",$0.00,1,1,1,1,1,1,20120101,E0783,HCPCS,PROGRAMMABLE INFUSION PUMP,UE,,28 ,,NW,,,,,,"$14,943.31",$0.00,1,1,1,1,1,1,20120101,E0784,HCPCS,EXT AMB INFUSN PUMP INSULIN,,,28 ,,NW,,,,,,"$9,747.16",$0.00,1,1,1,1,1,1,20120101,E0784,HCPCS,EXT AMB INFUSN PUMP INSULIN,RR,,28 ,,NW,,,,,,"$1,018.60",$0.00,1,1,1,1,1,1,20120101,E0785,HCPCS,REPLACEMENT IMPL PUMP CATHET,,,28 ,,NW,,,,,,"$1,103.87",$0.00,1,1,1,1,1,1,20120101,E0785,HCPCS,REPLACEMENT IMPL PUMP CATHET,KF,,28 ,,NW,,,,,,"$1,103.87",$0.00,1,1,1,1,1,1,20120101,E0786,HCPCS,IMPLANTABLE PUMP REPLACEMENT,,,28 ,,NW,,,,,,"$19,415.24",$0.00,1,1,1,1,1,1,20120101,E0786,HCPCS,IMPLANTABLE PUMP REPLACEMENT,NU,,28 ,,NW,,,,,,"$19,415.24",$0.00,1,1,1,1,1,1,20120101,E0786,HCPCS,IMPLANTABLE PUMP REPLACEMENT,RR,,28 ,,NW,,,,,,"$1,919.55",$0.00,1,1,1,1,1,1,20120101,E0786,HCPCS,IMPLANTABLE PUMP REPLACEMENT,UE,,28 ,,NW,,,,,,"$14,555.35",$0.00,1,1,1,1,1,1,20120101,E0791,HCPCS,PARENTERAL INFUSION PUMP STA,,,28 ,,NW,,,,,,"$6,554.83",$0.00,1,1,1,1,1,1,20120101,E0791,HCPCS,PARENTERAL INFUSION PUMP STA,RR,,28 ,,NW,,,,,,$684.99,$0.00,1,1,1,1,1,1,20120101,E0791,HCPCS,PARENTERAL INFUSION PUMP STA,UE,,28 ,,NW,,,,,,"$5,169.65",$0.00,1,1,1,1,1,1,20120101,E0830,HCPCS,AMBULATORY TRACTION DEVICE,,,28 ,,NW,,,,,,"$3,168.50",$0.00,1,1,1,1,1,1,20120101,E0840,HCPCS,TRACT FRAME ATTACH HEADBOARD,,,28 ,,NW,,,,,,$139.83,$0.00,1,1,1,1,1,1,20120101,E0840,HCPCS,TRACT FRAME ATTACH HEADBOARD,NU,,28 ,,NW,,,,,,$139.83,$0.00,1,1,1,1,1,1,20120101,E0840,HCPCS,TRACT FRAME ATTACH HEADBOARD,RR,,28 ,,NW,,,,,,$31.78,$0.00,1,1,1,1,1,1,20120101,E0840,HCPCS,TRACT FRAME ATTACH HEADBOARD,UE,,28 ,,NW,,,,,,$104.47,$0.00,1,1,1,1,1,1,20120101,E0849,HCPCS,CERVICAL PNEUM TRAC EQUIP,,,28 ,,NW,,,,,,"$1,262.88",$0.00,1,1,1,1,1,1,20120101,E0849,HCPCS,CERVICAL PNEUM TRAC EQUIP,NU,,28 ,,NW,,,,,,"$1,262.88",$0.00,1,1,1,1,1,1,20120101,E0849,HCPCS,CERVICAL PNEUM TRAC EQUIP,RR,,28 ,,NW,,,,,,$104.34,$0.00,1,1,1,1,1,1,20120101,E0849,HCPCS,CERVICAL PNEUM TRAC EQUIP,UE,,28 ,,NW,,,,,,$940.98,$0.00,1,1,1,1,1,1,20120101,E0850,HCPCS,TRACTION STAND FREE STANDING,,,28 ,,NW,,,,,,$200.15,$0.00,1,1,1,1,1,1,20120101,E0850,HCPCS,TRACTION STAND FREE STANDING,NU,,28 ,,NW,,,,,,$200.15,$0.00,1,1,1,1,1,1,20120101,E0850,HCPCS,TRACTION STAND FREE STANDING,RR,,28 ,,NW,,,,,,$27.65,$0.00,1,1,1,1,1,1,20120101,E0850,HCPCS,TRACTION STAND FREE STANDING,UE,,28 ,,NW,,,,,,$150.85,$0.00,1,1,1,1,1,1,20120101,E0855,HCPCS,CERVICAL TRACTION EQUIPMENT,,,28 ,,NW,,,,,,"$1,221.46",$0.00,1,1,1,1,1,1,20120101,E0855,HCPCS,CERVICAL TRACTION EQUIPMENT,NU,,28 ,,NW,,,,,,"$1,221.46",$0.00,1,1,1,1,1,1,20120101,E0855,HCPCS,CERVICAL TRACTION EQUIPMENT,RR,,28 ,,NW,,,,,,$100.21,$0.00,1,1,1,1,1,1,20120101,E0855,HCPCS,CERVICAL TRACTION EQUIPMENT,UE,,28 ,,NW,,,,,,$909.96,$0.00,1,1,1,1,1,1,20120101,E0856,HCPCS,CERVIC COLLAR W AIR BLADDER,,,28 ,,NW,,,,,,$360.38,$0.00,1,1,1,1,1,1,20120101,E0856,HCPCS,CERVIC COLLAR W AIR BLADDER,NU,,28 ,,NW,,,,,,$360.38,$0.00,1,1,1,1,1,1,20120101,E0856,HCPCS,CERVIC COLLAR W AIR BLADDER,RR,,28 ,,NW,,,,,,$33.85,$0.00,1,1,1,1,1,1,20120101,E0856,HCPCS,CERVIC COLLAR W AIR BLADDER,UE,,28 ,,NW,,,,,,$264.21,$0.00,1,1,1,1,1,1,20120101,E0860,HCPCS,TRACT EQUIP CERVICAL TRACT,,,28 ,,NW,,,,,,$72.73,$0.00,1,1,1,1,1,1,20120101,E0860,HCPCS,TRACT EQUIP CERVICAL TRACT,NU,,28 ,,NW,,,,,,$72.73,$0.00,1,1,1,1,1,1,20120101,E0860,HCPCS,TRACT EQUIP CERVICAL TRACT,RR,,28 ,,NW,,,,,,$12.35,$0.00,1,1,1,1,1,1,20120101,E0860,HCPCS,TRACT EQUIP CERVICAL TRACT,UE,,28 ,,NW,,,,,,$56.03,$0.00,1,1,1,1,1,1,20120101,E0870,HCPCS,TRACT FRAME ATTACH FOOTBOARD,,,28 ,,NW,,,,,,$216.51,$0.00,1,1,1,1,1,1,20120101,E0870,HCPCS,TRACT FRAME ATTACH FOOTBOARD,NU,,28 ,,NW,,,,,,$216.51,$0.00,1,1,1,1,1,1,20120101,E0870,HCPCS,TRACT FRAME ATTACH FOOTBOARD,RR,,28 ,,NW,,,,,,$26.43,$0.00,1,1,1,1,1,1,20120101,E0870,HCPCS,TRACT FRAME ATTACH FOOTBOARD,UE,,28 ,,NW,,,,,,$164.44,$0.00,1,1,1,1,1,1,20120101,E0880,HCPCS,TRAC STAND FREE STAND EXTREM,,,28 ,,NW,,,,,,$228.13,$0.00,1,1,1,1,1,1,20120101,E0880,HCPCS,TRAC STAND FREE STAND EXTREM,NU,,28 ,,NW,,,,,,$228.13,$0.00,1,1,1,1,1,1,20120101,E0880,HCPCS,TRAC STAND FREE STAND EXTREM,RR,,28 ,,NW,,,,,,$37.45,$0.00,1,1,1,1,1,1,20120101,E0880,HCPCS,TRAC STAND FREE STAND EXTREM,UE,,28 ,,NW,,,,,,$176.34,$0.00,1,1,1,1,1,1,20120101,E0890,HCPCS,TRACTION FRAME ATTACH PELVIC,,,28 ,,NW,,,,,,$221.85,$0.00,1,1,1,1,1,1,20120101,E0890,HCPCS,TRACTION FRAME ATTACH PELVIC,NU,,28 ,,NW,,,,,,$221.85,$0.00,1,1,1,1,1,1,20120101,E0890,HCPCS,TRACTION FRAME ATTACH PELVIC,RR,,28 ,,NW,,,,,,$63.29,$0.00,1,1,1,1,1,1,20120101,E0890,HCPCS,TRACTION FRAME ATTACH PELVIC,UE,,28 ,,NW,,,,,,$179.85,$0.00,1,1,1,1,1,1,20120101,E0900,HCPCS,TRAC STAND FREE STAND PELVIC,,,28 ,,NW,,,,,,$235.42,$0.00,1,1,1,1,1,1,20120101,E0900,HCPCS,TRAC STAND FREE STAND PELVIC,NU,,28 ,,NW,,,,,,$235.42,$0.00,1,1,1,1,1,1,20120101,E0900,HCPCS,TRAC STAND FREE STAND PELVIC,RR,,28 ,,NW,,,,,,$52.23,$0.00,1,1,1,1,1,1,20120101,E0900,HCPCS,TRAC STAND FREE STAND PELVIC,UE,,28 ,,NW,,,,,,$182.33,$0.00,1,1,1,1,1,1,20120101,E0910,HCPCS,TRAPEZE BAR ATTACHED TO BED,,,28 ,,NW,,,,,,$317.77,$0.00,1,1,1,1,1,1,20120101,E0910,HCPCS,TRAPEZE BAR ATTACHED TO BED,RR,,28 ,,NW,,,,,,$33.21,$0.00,1,1,1,1,1,1,20120101,E0910,HCPCS,TRAPEZE BAR ATTACHED TO BED,UE,,28 ,,NW,,,,,,$241.52,$0.00,1,1,1,1,1,1,20120101,E0911,HCPCS,HD TRAPEZE BAR ATTACH TO BED,,,28 ,,NW,,,,,,$829.42,$0.00,1,1,1,1,1,1,20120101,E0911,HCPCS,HD TRAPEZE BAR ATTACH TO BED,RR,,28 ,,NW,,,,,,$86.68,$0.00,1,1,1,1,1,1,20120101,E0912,HCPCS,HD TRAPEZE BAR FREE STANDING,,,28 ,,NW,,,,,,"$1,907.18",$0.00,1,1,1,1,1,1,20120101,E0912,HCPCS,HD TRAPEZE BAR FREE STANDING,RR,,28 ,,NW,,,,,,$199.30,$0.00,1,1,1,1,1,1,20120101,E0920,HCPCS,FRACTURE FRAME ATTACHED TO B,,,28 ,,NW,,,,,,$838.07,$0.00,1,1,1,1,1,1,20120101,E0920,HCPCS,FRACTURE FRAME ATTACHED TO B,RR,,28 ,,NW,,,,,,$87.58,$0.00,1,1,1,1,1,1,20120101,E0920,HCPCS,FRACTURE FRAME ATTACHED TO B,UE,,28 ,,NW,,,,,,$577.19,$0.00,1,1,1,1,1,1,20120101,E0930,HCPCS,FRACTURE FRAME FREE STANDING,,,28 ,,NW,,,,,,$832.73,$0.00,1,1,1,1,1,1,20120101,E0930,HCPCS,FRACTURE FRAME FREE STANDING,RR,,28 ,,NW,,,,,,$87.02,$0.00,1,1,1,1,1,1,20120101,E0930,HCPCS,FRACTURE FRAME FREE STANDING,UE,,28 ,,NW,,,,,,$625.57,$0.00,1,1,1,1,1,1,20120101,E0935,HCPCS,CONT PAS MOTION EXERCISE DEV,,,28 ,,NW,,,,,,$426.95,$0.00,1,1,1,1,1,1,20120101,E0935,HCPCS,CONT PAS MOTION EXERCISE DEV,RR,,28 ,,NW,,,,,,$44.62,$0.00,1,1,1,1,1,1,20120101,E0936,HCPCS,"CPM DEVICE, OTHER THAN KNEE",,,28 ,,NW,,,,,,$112.18,$0.00,1,1,1,1,1,1,20120101,E0936,HCPCS,"CPM DEVICE, OTHER THAN KNEE",RR,,28 ,,NW,,,,,,$11.72,$0.00,1,1,1,1,1,1,20120101,E0940,HCPCS,TRAPEZE BAR FREE STANDING,,,28 ,,NW,,,,,,$549.04,$0.00,1,1,1,1,1,1,20120101,E0940,HCPCS,TRAPEZE BAR FREE STANDING,RR,,28 ,,NW,,,,,,$57.38,$0.00,1,1,1,1,1,1,20120101,E0940,HCPCS,TRAPEZE BAR FREE STANDING,UE,,28 ,,NW,,,,,,$389.55,$0.00,1,1,1,1,1,1,20120101,E0941,HCPCS,GRAVITY ASSISTED TRACTION DE,,,28 ,,NW,,,,,,$811.47,$0.00,1,1,1,1,1,1,20120101,E0941,HCPCS,GRAVITY ASSISTED TRACTION DE,NU,,28 ,,NW,,,,,,$811.47,$0.00,1,1,1,1,1,1,20120101,E0941,HCPCS,GRAVITY ASSISTED TRACTION DE,RR,,28 ,,NW,,,,,,$84.80,$0.00,1,1,1,1,1,1,20120101,E0941,HCPCS,GRAVITY ASSISTED TRACTION DE,UE,,28 ,,NW,,,,,,$609.60,$0.00,1,1,1,1,1,1,20120101,E0942,HCPCS,CERVICAL HEAD HARNESS/HALTER,,,28 ,,NW,,,,,,$38.19,$0.00,1,1,1,1,1,1,20120101,E0942,HCPCS,CERVICAL HEAD HARNESS/HALTER,NU,,28 ,,NW,,,,,,$38.19,$0.00,1,1,1,1,1,1,20120101,E0942,HCPCS,CERVICAL HEAD HARNESS/HALTER,RR,,28 ,,NW,,,,,,$4.32,$0.00,1,1,1,1,1,1,20120101,E0942,HCPCS,CERVICAL HEAD HARNESS/HALTER,UE,,28 ,,NW,,,,,,$28.58,$0.00,1,1,1,1,1,1,20120101,E0944,HCPCS,PELVIC BELT/HARNESS/BOOT,,,28 ,,NW,,,,,,$86.10,$0.00,1,1,1,1,1,1,20120101,E0944,HCPCS,PELVIC BELT/HARNESS/BOOT,NU,,28 ,,NW,,,,,,$86.10,$0.00,1,1,1,1,1,1,20120101,E0944,HCPCS,PELVIC BELT/HARNESS/BOOT,RR,,28 ,,NW,,,,,,$8.54,$0.00,1,1,1,1,1,1,20120101,E0944,HCPCS,PELVIC BELT/HARNESS/BOOT,UE,,28 ,,NW,,,,,,$64.67,$0.00,1,1,1,1,1,1,20120101,E0945,HCPCS,BELT/HARNESS EXTREMITY,,,28 ,,NW,,,,,,$85.18,$0.00,1,1,1,1,1,1,20120101,E0945,HCPCS,BELT/HARNESS EXTREMITY,NU,,28 ,,NW,,,,,,$85.18,$0.00,1,1,1,1,1,1,20120101,E0945,HCPCS,BELT/HARNESS EXTREMITY,RR,,28 ,,NW,,,,,,$8.41,$0.00,1,1,1,1,1,1,20120101,E0945,HCPCS,BELT/HARNESS EXTREMITY,UE,,28 ,,NW,,,,,,$65.57,$0.00,1,1,1,1,1,1,20120101,E0946,HCPCS,FRACTURE FRAME DUAL W CROSS,,,28 ,,NW,,,,,,"$1,055.03",$0.00,1,1,1,1,1,1,20120101,E0946,HCPCS,FRACTURE FRAME DUAL W CROSS,NU,,28 ,,NW,,,,,,"$1,055.03",$0.00,1,1,1,1,1,1,20120101,E0946,HCPCS,FRACTURE FRAME DUAL W CROSS,RR,,28 ,,NW,,,,,,$110.25,$0.00,1,1,1,1,1,1,20120101,E0946,HCPCS,FRACTURE FRAME DUAL W CROSS,UE,,28 ,,NW,,,,,,$792.57,$0.00,1,1,1,1,1,1,20120101,E0947,HCPCS,FRACTURE FRAME ATTACHMNTS PE,,,28 ,,NW,,,,,,$947.32,$0.00,1,1,1,1,1,1,20120101,E0947,HCPCS,FRACTURE FRAME ATTACHMNTS PE,NU,,28 ,,NW,,,,,,$947.32,$0.00,1,1,1,1,1,1,20120101,E0947,HCPCS,FRACTURE FRAME ATTACHMNTS PE,RR,,28 ,,NW,,,,,,$117.70,$0.00,1,1,1,1,1,1,20120101,E0947,HCPCS,FRACTURE FRAME ATTACHMNTS PE,UE,,28 ,,NW,,,,,,$720.66,$0.00,1,1,1,1,1,1,20120101,E0948,HCPCS,FRACTURE FRAME ATTACHMNTS CE,,,28 ,,NW,,,,,,$928.81,$0.00,1,1,1,1,1,1,20120101,E0948,HCPCS,FRACTURE FRAME ATTACHMNTS CE,NU,,28 ,,NW,,,,,,$928.81,$0.00,1,1,1,1,1,1,20120101,E0948,HCPCS,FRACTURE FRAME ATTACHMNTS CE,RR,,28 ,,NW,,,,,,$110.06,$0.00,1,1,1,1,1,1,20120101,E0948,HCPCS,FRACTURE FRAME ATTACHMNTS CE,UE,,28 ,,NW,,,,,,$672.84,$0.00,1,1,1,1,1,1,20120101,E0950,HCPCS,TRAY,,,28 ,,NW,,,,,,$341.64,$0.00,1,1,1,1,1,1,20120101,E0950,HCPCS,TRAY,NU,,28 ,,NW,,,,,,$341.64,$0.00,1,1,1,1,1,1,20120101,E0950,HCPCS,TRAY,RR,,28 ,,NW,,,,,,$37.32,$0.00,1,1,1,1,1,1,20120101,E0950,HCPCS,TRAY,UE,,28 ,,NW,,,,,,$266.53,$0.00,1,1,1,1,1,1,20120101,E0951,HCPCS,LOOP HEEL,,,28 ,,NW,,,,,,$70.00,$0.00,1,1,1,1,1,1,20120101,E0951,HCPCS,LOOP HEEL,NU,,28 ,,NW,,,,,,$70.00,$0.00,1,1,1,1,1,1,20120101,E0951,HCPCS,LOOP HEEL,RR,,28 ,,NW,,,,,,$7.05,$0.00,1,1,1,1,1,1,20120101,E0951,HCPCS,LOOP HEEL,UE,,28 ,,NW,,,,,,$52.43,$0.00,1,1,1,1,1,1,20120101,E0952,HCPCS,"TOE LOOP/HOLDER, EACH",,,28 ,,NW,,,,,,$67.63,$0.00,1,1,1,1,1,1,20120101,E0952,HCPCS,"TOE LOOP/HOLDER, EACH",NU,,28 ,,NW,,,,,,$67.63,$0.00,1,1,1,1,1,1,20120101,E0952,HCPCS,"TOE LOOP/HOLDER, EACH",RR,,28 ,,NW,,,,,,$6.86,$0.00,1,1,1,1,1,1,20120101,E0952,HCPCS,"TOE LOOP/HOLDER, EACH",UE,,28 ,,NW,,,,,,$50.81,$0.00,1,1,1,1,1,1,20120101,E0955,HCPCS,CUSHIONED HEADREST,,,28 ,,NW,,,,,,$666.61,$0.00,1,1,1,1,1,1,20120101,E0955,HCPCS,CUSHIONED HEADREST,NU,,28 ,,NW,,,,,,$666.61,$0.00,1,1,1,1,1,1,20120101,E0955,HCPCS,CUSHIONED HEADREST,RR,,28 ,,NW,,,,,,$77.56,$0.00,1,1,1,1,1,1,20120101,E0955,HCPCS,CUSHIONED HEADREST,UE,,28 ,,NW,,,,,,$510.32,$0.00,1,1,1,1,1,1,20120101,E0956,HCPCS,W/C LATERAL TRUNK/HIP SUPPOR,,,28 ,,NW,,,,,,$346.30,$0.00,1,1,1,1,1,1,20120101,E0956,HCPCS,W/C LATERAL TRUNK/HIP SUPPOR,NU,,28 ,,NW,,,,,,$346.30,$0.00,1,1,1,1,1,1,20120101,E0956,HCPCS,W/C LATERAL TRUNK/HIP SUPPOR,RR,,28 ,,NW,,,,,,$37.74,$0.00,1,1,1,1,1,1,20120101,E0956,HCPCS,W/C LATERAL TRUNK/HIP SUPPOR,UE,,28 ,,NW,,,,,,$270.09,$0.00,1,1,1,1,1,1,20120101,E0957,HCPCS,W/C MEDIAL THIGH SUPPORT,,,28 ,,NW,,,,,,$467.99,$0.00,1,1,1,1,1,1,20120101,E0957,HCPCS,W/C MEDIAL THIGH SUPPORT,NU,,28 ,,NW,,,,,,$467.99,$0.00,1,1,1,1,1,1,20120101,E0957,HCPCS,W/C MEDIAL THIGH SUPPORT,RR,,28 ,,NW,,,,,,$52.83,$0.00,1,1,1,1,1,1,20120101,E0957,HCPCS,W/C MEDIAL THIGH SUPPORT,UE,,28 ,,NW,,,,,,$361.35,$0.00,1,1,1,1,1,1,20120101,E0958,HCPCS,WHLCHR ATT- CONV 1 ARM DRIVE,,,28 ,,NW,,,,,,$732.46,$0.00,1,1,1,1,1,1,20120101,E0958,HCPCS,WHLCHR ATT- CONV 1 ARM DRIVE,NU,,28 ,,NW,,,,,,$732.46,$0.00,1,1,1,1,1,1,20120101,E0958,HCPCS,WHLCHR ATT- CONV 1 ARM DRIVE,RR,,28 ,,NW,,,,,,$85.49,$0.00,1,1,1,1,1,1,20120101,E0958,HCPCS,WHLCHR ATT- CONV 1 ARM DRIVE,UE,,28 ,,NW,,,,,,$559.37,$0.00,1,1,1,1,1,1,20120101,E0959,HCPCS,AMPUTEE ADAPTER,,,28 ,,NW,,,,,,$86.37,$0.00,1,1,1,1,1,1,20120101,E0959,HCPCS,AMPUTEE ADAPTER,NU,,28 ,,NW,,,,,,$86.37,$0.00,1,1,1,1,1,1,20120101,E0959,HCPCS,AMPUTEE ADAPTER,RR,,28 ,,NW,,,,,,$8.55,$0.00,1,1,1,1,1,1,20120101,E0959,HCPCS,AMPUTEE ADAPTER,UE,,28 ,,NW,,,,,,$65.30,$0.00,1,1,1,1,1,1,20120101,E0960,HCPCS,W/C SHOULDER HARNESS/STRAPS,,,28 ,,NW,,,,,,$322.80,$0.00,1,1,1,1,1,1,20120101,E0960,HCPCS,W/C SHOULDER HARNESS/STRAPS,NU,,28 ,,NW,,,,,,$322.80,$0.00,1,1,1,1,1,1,20120101,E0960,HCPCS,W/C SHOULDER HARNESS/STRAPS,RR,,28 ,,NW,,,,,,$34.81,$0.00,1,1,1,1,1,1,20120101,E0960,HCPCS,W/C SHOULDER HARNESS/STRAPS,UE,,28 ,,NW,,,,,,$252.50,$0.00,1,1,1,1,1,1,20120101,E0961,HCPCS,WHEELCHAIR BRAKE EXTENSION,,,28 ,,NW,,,,,,$56.27,$0.00,1,1,1,1,1,1,20120101,E0961,HCPCS,WHEELCHAIR BRAKE EXTENSION,NU,,28 ,,NW,,,,,,$56.27,$0.00,1,1,1,1,1,1,20120101,E0961,HCPCS,WHEELCHAIR BRAKE EXTENSION,RR,,28 ,,NW,,,,,,$5.80,$0.00,1,1,1,1,1,1,20120101,E0961,HCPCS,WHEELCHAIR BRAKE EXTENSION,UE,,28 ,,NW,,,,,,$28.34,$0.00,1,1,1,1,1,1,20120101,E0966,HCPCS,WHEELCHAIR HEAD REST EXTENSI,,,28 ,,NW,,,,,,$142.23,$0.00,1,1,1,1,1,1,20120101,E0966,HCPCS,WHEELCHAIR HEAD REST EXTENSI,NU,,28 ,,NW,,,,,,$142.23,$0.00,1,1,1,1,1,1,20120101,E0966,HCPCS,WHEELCHAIR HEAD REST EXTENSI,RR,,28 ,,NW,,,,,,$13.96,$0.00,1,1,1,1,1,1,20120101,E0966,HCPCS,WHEELCHAIR HEAD REST EXTENSI,UE,,28 ,,NW,,,,,,$106.62,$0.00,1,1,1,1,1,1,20120101,E0967,HCPCS,MANUAL WC HAND RIM W PROJECT,,,28 ,,NW,,,,,,$134.87,$0.00,1,1,1,1,1,1,20120101,E0967,HCPCS,MANUAL WC HAND RIM W PROJECT,NU,,28 ,,NW,,,,,,$134.87,$0.00,1,1,1,1,1,1,20120101,E0967,HCPCS,MANUAL WC HAND RIM W PROJECT,RR,,28 ,,NW,,,,,,$13.33,$0.00,1,1,1,1,1,1,20120101,E0967,HCPCS,MANUAL WC HAND RIM W PROJECT,UE,,28 ,,NW,,,,,,$101.10,$0.00,1,1,1,1,1,1,20120101,E0968,HCPCS,WHEELCHAIR COMMODE SEAT,,,28 ,,NW,,,,,,$325.27,$0.00,1,1,1,1,1,1,20120101,E0968,HCPCS,WHEELCHAIR COMMODE SEAT,NU,,28 ,,NW,,,,,,$325.27,$0.00,1,1,1,1,1,1,20120101,E0968,HCPCS,WHEELCHAIR COMMODE SEAT,RR,,28 ,,NW,,,,,,$35.64,$0.00,1,1,1,1,1,1,20120101,E0968,HCPCS,WHEELCHAIR COMMODE SEAT,UE,,28 ,,NW,,,,,,$254.33,$0.00,1,1,1,1,1,1,20120101,E0969,HCPCS,WHEELCHAIR NARROWING DEVICE,,,28 ,,NW,,,,,,$291.74,$0.00,1,1,1,1,1,1,20120101,E0969,HCPCS,WHEELCHAIR NARROWING DEVICE,NU,,28 ,,NW,,,,,,$291.74,$0.00,1,1,1,1,1,1,20120101,E0969,HCPCS,WHEELCHAIR NARROWING DEVICE,RR,,28 ,,NW,,,,,,$30.68,$0.00,1,1,1,1,1,1,20120101,E0969,HCPCS,WHEELCHAIR NARROWING DEVICE,UE,,28 ,,NW,,,,,,$230.26,$0.00,1,1,1,1,1,1,20120101,E0970,HCPCS,WHEELCHAIR NO. 2 FOOTPLATES,,,28 ,,NW,,,,,,$110.91,$0.00,1,1,1,1,1,1,20120101,E0970,HCPCS,WHEELCHAIR NO. 2 FOOTPLATES,NU,,28 ,,NW,,,,,,$110.91,$0.00,1,1,1,1,1,1,20120101,E0970,HCPCS,WHEELCHAIR NO. 2 FOOTPLATES,RR,,28 ,,NW,,,,,,$9.53,$0.00,1,1,1,1,1,1,20120101,E0970,HCPCS,WHEELCHAIR NO. 2 FOOTPLATES,UE,,28 ,,NW,,,,,,$83.58,$0.00,1,1,1,1,1,1,20120101,E0971,HCPCS,WHEELCHAIR ANTI-TIPPING DEVI,,,28 ,,NW,,,,,,$89.36,$0.00,1,1,1,1,1,1,20120101,E0971,HCPCS,WHEELCHAIR ANTI-TIPPING DEVI,NU,,28 ,,NW,,,,,,$89.36,$0.00,1,1,1,1,1,1,20120101,E0971,HCPCS,WHEELCHAIR ANTI-TIPPING DEVI,RR,,28 ,,NW,,,,,,$8.80,$0.00,1,1,1,1,1,1,20120101,E0971,HCPCS,WHEELCHAIR ANTI-TIPPING DEVI,UE,,28 ,,NW,,,,,,$67.03,$0.00,1,1,1,1,1,1,20120101,E0973,HCPCS,W/CH ACCESS DET ADJ ARMREST,,,28 ,,NW,,,,,,$366.21,$0.00,1,1,1,1,1,1,20120101,E0973,HCPCS,W/CH ACCESS DET ADJ ARMREST,NU,,28 ,,NW,,,,,,$366.21,$0.00,1,1,1,1,1,1,20120101,E0973,HCPCS,W/CH ACCESS DET ADJ ARMREST,RR,,28 ,,NW,,,,,,$38.60,$0.00,1,1,1,1,1,1,20120101,E0973,HCPCS,W/CH ACCESS DET ADJ ARMREST,UE,,28 ,,NW,,,,,,$286.58,$0.00,1,1,1,1,1,1,20120101,E0974,HCPCS,W/CH ACCESS ANTI-ROLLBACK,,,28 ,,NW,,,,,,$153.29,$0.00,1,1,1,1,1,1,20120101,E0974,HCPCS,W/CH ACCESS ANTI-ROLLBACK,NU,,28 ,,NW,,,,,,$153.29,$0.00,1,1,1,1,1,1,20120101,E0974,HCPCS,W/CH ACCESS ANTI-ROLLBACK,RR,,28 ,,NW,,,,,,$16.11,$0.00,1,1,1,1,1,1,20120101,E0974,HCPCS,W/CH ACCESS ANTI-ROLLBACK,UE,,28 ,,NW,,,,,,$116.67,$0.00,1,1,1,1,1,1,20120101,E0978,HCPCS,"W/C ACC,SAF BELT PELV STRAP",,,28 ,,NW,,,,,,$154.75,$0.00,1,1,1,1,1,1,20120101,E0978,HCPCS,"W/C ACC,SAF BELT PELV STRAP",NU,,28 ,,NW,,,,,,$154.75,$0.00,1,1,1,1,1,1,20120101,E0978,HCPCS,"W/C ACC,SAF BELT PELV STRAP",RR,,28 ,,NW,,,,,,$15.26,$0.00,1,1,1,1,1,1,20120101,E0978,HCPCS,"W/C ACC,SAF BELT PELV STRAP",UE,,28 ,,NW,,,,,,$115.20,$0.00,1,1,1,1,1,1,20120101,E0980,HCPCS,WHEELCHAIR SAFETY VEST,,,28 ,,NW,,,,,,$62.90,$0.00,1,1,1,1,1,1,20120101,E0980,HCPCS,WHEELCHAIR SAFETY VEST,NU,,28 ,,NW,,,,,,$62.90,$0.00,1,1,1,1,1,1,20120101,E0980,HCPCS,WHEELCHAIR SAFETY VEST,RR,,28 ,,NW,,,,,,$6.13,$0.00,1,1,1,1,1,1,20120101,E0980,HCPCS,WHEELCHAIR SAFETY VEST,UE,,28 ,,NW,,,,,,$46.95,$0.00,1,1,1,1,1,1,20120101,E0981,HCPCS,"SEAT UPHOLSTERY, REPLACEMENT",,,28 ,,NW,,,,,,$173.55,$0.00,1,1,1,1,1,1,20120101,E0981,HCPCS,"SEAT UPHOLSTERY, REPLACEMENT",NU,,28 ,,NW,,,,,,$173.55,$0.00,1,1,1,1,1,1,20120101,E0981,HCPCS,"SEAT UPHOLSTERY, REPLACEMENT",RR,,28 ,,NW,,,,,,$17.35,$0.00,1,1,1,1,1,1,20120101,E0981,HCPCS,"SEAT UPHOLSTERY, REPLACEMENT",UE,,28 ,,NW,,,,,,$131.04,$0.00,1,1,1,1,1,1,20120101,E0982,HCPCS,"BACK UPHOLSTERY, REPLACEMENT",,,28 ,,NW,,,,,,$183.70,$0.00,1,1,1,1,1,1,20120101,E0982,HCPCS,"BACK UPHOLSTERY, REPLACEMENT",NU,,28 ,,NW,,,,,,$183.70,$0.00,1,1,1,1,1,1,20120101,E0982,HCPCS,"BACK UPHOLSTERY, REPLACEMENT",RR,,28 ,,NW,,,,,,$18.24,$0.00,1,1,1,1,1,1,20120101,E0982,HCPCS,"BACK UPHOLSTERY, REPLACEMENT",UE,,28 ,,NW,,,,,,$137.96,$0.00,1,1,1,1,1,1,20120101,E0983,HCPCS,ADD PWR JOYSTICK,,,28 ,,NW,,,,,,"$4,266.36",$0.00,1,1,1,1,1,1,20120101,E0983,HCPCS,ADD PWR JOYSTICK,RR,,28 ,,NW,,,,,,$445.84,$0.00,1,1,1,1,1,1,20120101,E0984,HCPCS,ADD PWR TILLER,,,28 ,,NW,,,,,,"$2,983.72",$0.00,1,1,1,1,1,1,20120101,E0984,HCPCS,ADD PWR TILLER,NU,,28 ,,NW,,,,,,"$2,983.72",$0.00,1,1,1,1,1,1,20120101,E0984,HCPCS,ADD PWR TILLER,RR,,28 ,,NW,,,,,,$313.39,$0.00,1,1,1,1,1,1,20120101,E0984,HCPCS,ADD PWR TILLER,UE,,28 ,,NW,,,,,,"$2,305.59",$0.00,1,1,1,1,1,1,20120101,E0985,HCPCS,W/C SEAT LIFT MECHANISM,,,28 ,,NW,,,,,,$378.35,$0.00,1,1,1,1,1,1,20120101,E0985,HCPCS,W/C SEAT LIFT MECHANISM,NU,,28 ,,NW,,,,,,$378.35,$0.00,1,1,1,1,1,1,20120101,E0985,HCPCS,W/C SEAT LIFT MECHANISM,RR,,28 ,,NW,,,,,,$41.73,$0.00,1,1,1,1,1,1,20120101,E0985,HCPCS,W/C SEAT LIFT MECHANISM,UE,,28 ,,NW,,,,,,$294.12,$0.00,1,1,1,1,1,1,20120101,E0986,HCPCS,MAN W/C PUSH-RIM POW ASSIST,,,28 ,,NW,,,,,,"$8,118.75",$0.00,1,1,1,1,1,1,20120101,E0986,HCPCS,MAN W/C PUSH-RIM POW ASSIST,NU,,28 ,,NW,,,,,,"$8,118.75",$0.00,1,1,1,1,1,1,20120101,E0986,HCPCS,MAN W/C PUSH-RIM POW ASSIST,RR,,28 ,,NW,,,,,,$849.25,$0.00,1,1,1,1,1,1,20120101,E0986,HCPCS,MAN W/C PUSH-RIM POW ASSIST,UE,,28 ,,NW,,,,,,"$6,099.48",$0.00,1,1,1,1,1,1,20120101,E0990,HCPCS,WHEELCHAIR ELEVATING LEG RES,,,28 ,,NW,,,,,,$384.57,$0.00,1,1,1,1,1,1,20120101,E0990,HCPCS,WHEELCHAIR ELEVATING LEG RES,NU,,28 ,,NW,,,,,,$384.57,$0.00,1,1,1,1,1,1,20120101,E0990,HCPCS,WHEELCHAIR ELEVATING LEG RES,RR,,28 ,,NW,,,,,,$47.87,$0.00,1,1,1,1,1,1,20120101,E0990,HCPCS,WHEELCHAIR ELEVATING LEG RES,UE,,28 ,,NW,,,,,,$304.47,$0.00,1,1,1,1,1,1,20120101,E0992,HCPCS,WHEELCHAIR SOLID SEAT INSERT,,,28 ,,NW,,,,,,$184.15,$0.00,1,1,1,1,1,1,20120101,E0992,HCPCS,WHEELCHAIR SOLID SEAT INSERT,NU,,28 ,,NW,,,,,,$184.15,$0.00,1,1,1,1,1,1,20120101,E0992,HCPCS,WHEELCHAIR SOLID SEAT INSERT,RR,,28 ,,NW,,,,,,$17.78,$0.00,1,1,1,1,1,1,20120101,E0992,HCPCS,WHEELCHAIR SOLID SEAT INSERT,UE,,28 ,,NW,,,,,,$138.10,$0.00,1,1,1,1,1,1,20120101,E0994,HCPCS,WHEELCHAIR ARM REST,,,28 ,,NW,,,,,,$34.39,$0.00,1,1,1,1,1,1,20120101,E0994,HCPCS,WHEELCHAIR ARM REST,NU,,28 ,,NW,,,,,,$34.39,$0.00,1,1,1,1,1,1,20120101,E0994,HCPCS,WHEELCHAIR ARM REST,RR,,28 ,,NW,,,,,,$3.32,$0.00,1,1,1,1,1,1,20120101,E0994,HCPCS,WHEELCHAIR ARM REST,UE,,28 ,,NW,,,,,,$25.81,$0.00,1,1,1,1,1,1,20120101,E0995,HCPCS,WHEELCHAIR CALF REST,,,28 ,,NW,,,,,,$109.15,$0.00,1,1,1,1,1,1,20120101,E0995,HCPCS,WHEELCHAIR CALF REST,NU,,28 ,,NW,,,,,,$109.15,$0.00,1,1,1,1,1,1,20120101,E0995,HCPCS,WHEELCHAIR CALF REST,RR,,28 ,,NW,,,,,,$10.82,$0.00,1,1,1,1,1,1,20120101,E0995,HCPCS,WHEELCHAIR CALF REST,UE,,28 ,,NW,,,,,,$81.79,$0.00,1,1,1,1,1,1,20120101,E1002,HCPCS,PWR SEAT TILT,,,28 ,,NW,,,,,,"$12,573.06",$0.00,1,1,1,1,1,1,20120101,E1002,HCPCS,PWR SEAT TILT,NU,,28 ,,NW,,,,,,"$12,573.06",$0.00,1,1,1,1,1,1,20120101,E1002,HCPCS,PWR SEAT TILT,RR,,28 ,,NW,,,,,,"$1,294.65",$0.00,1,1,1,1,1,1,20120101,E1002,HCPCS,PWR SEAT TILT,UE,,28 ,,NW,,,,,,"$9,440.17",$0.00,1,1,1,1,1,1,20120101,E1003,HCPCS,PWR SEAT RECLINE,,,28 ,,NW,,,,,,"$13,618.38",$0.00,1,1,1,1,1,1,20120101,E1003,HCPCS,PWR SEAT RECLINE,NU,,28 ,,NW,,,,,,"$13,618.38",$0.00,1,1,1,1,1,1,20120101,E1003,HCPCS,PWR SEAT RECLINE,RR,,28 ,,NW,,,,,,"$1,399.23",$0.00,1,1,1,1,1,1,20120101,E1003,HCPCS,PWR SEAT RECLINE,UE,,28 ,,NW,,,,,,"$10,224.16",$0.00,1,1,1,1,1,1,20120101,E1004,HCPCS,PWR SEAT RECLINE MECH,,,28 ,,NW,,,,,,"$15,095.44",$0.00,1,1,1,1,1,1,20120101,E1004,HCPCS,PWR SEAT RECLINE MECH,NU,,28 ,,NW,,,,,,"$15,095.44",$0.00,1,1,1,1,1,1,20120101,E1004,HCPCS,PWR SEAT RECLINE MECH,RR,,28 ,,NW,,,,,,"$1,546.89",$0.00,1,1,1,1,1,1,20120101,E1004,HCPCS,PWR SEAT RECLINE MECH,UE,,28 ,,NW,,,,,,"$11,331.92",$0.00,1,1,1,1,1,1,20120101,E1005,HCPCS,PWR SEAT RECLINE PWR,,,28 ,,NW,,,,,,"$16,336.22",$0.00,1,1,1,1,1,1,20120101,E1005,HCPCS,PWR SEAT RECLINE PWR,NU,,28 ,,NW,,,,,,"$16,336.22",$0.00,1,1,1,1,1,1,20120101,E1005,HCPCS,PWR SEAT RECLINE PWR,RR,,28 ,,NW,,,,,,"$1,670.96",$0.00,1,1,1,1,1,1,20120101,E1005,HCPCS,PWR SEAT RECLINE PWR,UE,,28 ,,NW,,,,,,"$12,262.56",$0.00,1,1,1,1,1,1,20120101,E1006,HCPCS,PWR SEAT COMBO W/O SHEAR,,,28 ,,NW,,,,,,"$20,001.00",$0.00,1,1,1,1,1,1,20120101,E1006,HCPCS,PWR SEAT COMBO W/O SHEAR,NU,,28 ,,NW,,,,,,"$20,001.00",$0.00,1,1,1,1,1,1,20120101,E1006,HCPCS,PWR SEAT COMBO W/O SHEAR,RR,,28 ,,NW,,,,,,"$2,037.40",$0.00,1,1,1,1,1,1,20120101,E1006,HCPCS,PWR SEAT COMBO W/O SHEAR,UE,,28 ,,NW,,,,,,"$15,011.14",$0.00,1,1,1,1,1,1,20120101,E1007,HCPCS,PWR SEAT COMBO W/SHEAR,,,28 ,,NW,,,,,,"$27,067.42",$0.00,1,1,1,1,1,1,20120101,E1007,HCPCS,PWR SEAT COMBO W/SHEAR,NU,,28 ,,NW,,,,,,"$27,067.42",$0.00,1,1,1,1,1,1,20120101,E1007,HCPCS,PWR SEAT COMBO W/SHEAR,RR,,28 ,,NW,,,,,,"$2,744.12",$0.00,1,1,1,1,1,1,20120101,E1007,HCPCS,PWR SEAT COMBO W/SHEAR,UE,,28 ,,NW,,,,,,"$20,310.93",$0.00,1,1,1,1,1,1,20120101,E1008,HCPCS,PWR SEAT COMBO PWR SHEAR,,,28 ,,NW,,,,,,"$27,069.84",$0.00,1,1,1,1,1,1,20120101,E1008,HCPCS,PWR SEAT COMBO PWR SHEAR,NU,,28 ,,NW,,,,,,"$27,069.84",$0.00,1,1,1,1,1,1,20120101,E1008,HCPCS,PWR SEAT COMBO PWR SHEAR,RR,,28 ,,NW,,,,,,"$2,744.33",$0.00,1,1,1,1,1,1,20120101,E1008,HCPCS,PWR SEAT COMBO PWR SHEAR,UE,,28 ,,NW,,,,,,"$20,312.81",$0.00,1,1,1,1,1,1,20120101,E1009,HCPCS,ADD MECH LEG ELEVATION,,,28 ,,NW,,,,,,"$2,549.15",$0.00,1,1,1,1,1,1,20120101,E1009,HCPCS,ADD MECH LEG ELEVATION,NU,,28 ,,NW,,,,,,"$2,549.15",$0.00,1,1,1,1,1,1,20120101,E1009,HCPCS,ADD MECH LEG ELEVATION,RR,,28 ,,NW,,,,,,$277.09,$0.00,1,1,1,1,1,1,20120101,E1009,HCPCS,ADD MECH LEG ELEVATION,UE,,28 ,,NW,,,,,,"$1,919.01",$0.00,1,1,1,1,1,1,20120101,E1010,HCPCS,ADD PWR LEG ELEVATION,,,28 ,,NW,,,,,,"$3,577.83",$0.00,1,1,1,1,1,1,20120101,E1010,HCPCS,ADD PWR LEG ELEVATION,NU,,28 ,,NW,,,,,,"$3,577.83",$0.00,1,1,1,1,1,1,20120101,E1010,HCPCS,ADD PWR LEG ELEVATION,RR,,28 ,,NW,,,,,,$395.15,$0.00,1,1,1,1,1,1,20120101,E1010,HCPCS,ADD PWR LEG ELEVATION,UE,,28 ,,NW,,,,,,"$2,693.80",$0.00,1,1,1,1,1,1,20120101,E1014,HCPCS,RECLINING BACK ADD PED W/C,,,28 ,,NW,,,,,,$647.85,$0.00,1,1,1,1,1,1,20120101,E1014,HCPCS,RECLINING BACK ADD PED W/C,NU,,28 ,,NW,,,,,,$647.85,$0.00,1,1,1,1,1,1,20120101,E1014,HCPCS,RECLINING BACK ADD PED W/C,RR,,28 ,,NW,,,,,,$75.19,$0.00,1,1,1,1,1,1,20120101,E1014,HCPCS,RECLINING BACK ADD PED W/C,UE,,28 ,,NW,,,,,,$496.24,$0.00,1,1,1,1,1,1,20120101,E1015,HCPCS,SHOCK ABSORBER FOR MAN W/C,,,28 ,,NW,,,,,,$231.98,$0.00,1,1,1,1,1,1,20120101,E1015,HCPCS,SHOCK ABSORBER FOR MAN W/C,NU,,28 ,,NW,,,,,,$231.98,$0.00,1,1,1,1,1,1,20120101,E1015,HCPCS,SHOCK ABSORBER FOR MAN W/C,RR,,28 ,,NW,,,,,,$23.48,$0.00,1,1,1,1,1,1,20120101,E1015,HCPCS,SHOCK ABSORBER FOR MAN W/C,UE,,28 ,,NW,,,,,,$177.33,$0.00,1,1,1,1,1,1,20120101,E1016,HCPCS,SHOCK ABSORBER FOR POWER W/C,,,28 ,,NW,,,,,,$447.50,$0.00,1,1,1,1,1,1,20120101,E1016,HCPCS,SHOCK ABSORBER FOR POWER W/C,NU,,28 ,,NW,,,,,,$447.50,$0.00,1,1,1,1,1,1,20120101,E1016,HCPCS,SHOCK ABSORBER FOR POWER W/C,RR,,28 ,,NW,,,,,,$50.33,$0.00,1,1,1,1,1,1,20120101,E1016,HCPCS,SHOCK ABSORBER FOR POWER W/C,UE,,28 ,,NW,,,,,,$345.98,$0.00,1,1,1,1,1,1,20120101,E1017,HCPCS,HD SHCK ABSRBR FOR HD MAN WC,,,28 ,,NW,,,,,,$716.33,$0.00,1,1,1,1,1,1,20120101,E1017,HCPCS,HD SHCK ABSRBR FOR HD MAN WC,NU,,28 ,,NW,,,,,,$716.33,$0.00,1,1,1,1,1,1,20120101,E1017,HCPCS,HD SHCK ABSRBR FOR HD MAN WC,RR,,28 ,,NW,,,,,,$77.58,$0.00,1,1,1,1,1,1,20120101,E1017,HCPCS,HD SHCK ABSRBR FOR HD MAN WC,UE,,28 ,,NW,,,,,,$539.15,$0.00,1,1,1,1,1,1,20120101,E1018,HCPCS,HD SHCK ABSRBER FOR HD POWWC,,,28 ,,NW,,,,,,$411.70,$0.00,1,1,1,1,1,1,20120101,E1018,HCPCS,HD SHCK ABSRBER FOR HD POWWC,NU,,28 ,,NW,,,,,,$411.70,$0.00,1,1,1,1,1,1,20120101,E1018,HCPCS,HD SHCK ABSRBER FOR HD POWWC,RR,,28 ,,NW,,,,,,$43.02,$0.00,1,1,1,1,1,1,20120101,E1018,HCPCS,HD SHCK ABSRBER FOR HD POWWC,UE,,28 ,,NW,,,,,,$309.28,$0.00,1,1,1,1,1,1,20120101,E1020,HCPCS,RESIDUAL LIMB SUPPORT SYSTEM,,,28 ,,NW,,,,,,$794.08,$0.00,1,1,1,1,1,1,20120101,E1020,HCPCS,RESIDUAL LIMB SUPPORT SYSTEM,NU,,28 ,,NW,,,,,,$794.08,$0.00,1,1,1,1,1,1,20120101,E1020,HCPCS,RESIDUAL LIMB SUPPORT SYSTEM,RR,,28 ,,NW,,,,,,$93.27,$0.00,1,1,1,1,1,1,20120101,E1020,HCPCS,RESIDUAL LIMB SUPPORT SYSTEM,UE,,28 ,,NW,,,,,,$605.92,$0.00,1,1,1,1,1,1,20120101,E1028,HCPCS,W/C MANUAL SWINGAWAY,,,28 ,,NW,,,,,,$680.08,$0.00,1,1,1,1,1,1,20120101,E1028,HCPCS,W/C MANUAL SWINGAWAY,NU,,28 ,,NW,,,,,,$680.08,$0.00,1,1,1,1,1,1,20120101,E1028,HCPCS,W/C MANUAL SWINGAWAY,RR,,28 ,,NW,,,,,,$79.17,$0.00,1,1,1,1,1,1,20120101,E1028,HCPCS,W/C MANUAL SWINGAWAY,UE,,28 ,,NW,,,,,,$520.40,$0.00,1,1,1,1,1,1,20120101,E1029,HCPCS,W/C VENT TRAY FIXED,,,28 ,,NW,,,,,,"$1,184.04",$0.00,1,1,1,1,1,1,20120101,E1029,HCPCS,W/C VENT TRAY FIXED,NU,,28 ,,NW,,,,,,"$1,184.04",$0.00,1,1,1,1,1,1,20120101,E1029,HCPCS,W/C VENT TRAY FIXED,RR,,28 ,,NW,,,,,,$141.80,$0.00,1,1,1,1,1,1,20120101,E1029,HCPCS,W/C VENT TRAY FIXED,UE,,28 ,,NW,,,,,,$898.40,$0.00,1,1,1,1,1,1,20120101,E1030,HCPCS,W/C VENT TRAY GIMBALED,,,28 ,,NW,,,,,,"$3,644.26",$0.00,1,1,1,1,1,1,20120101,E1030,HCPCS,W/C VENT TRAY GIMBALED,NU,,28 ,,NW,,,,,,"$3,644.26",$0.00,1,1,1,1,1,1,20120101,E1030,HCPCS,W/C VENT TRAY GIMBALED,RR,,28 ,,NW,,,,,,$401.80,$0.00,1,1,1,1,1,1,20120101,E1030,HCPCS,W/C VENT TRAY GIMBALED,UE,,28 ,,NW,,,,,,"$2,743.58",$0.00,1,1,1,1,1,1,20120101,E1031,HCPCS,ROLLABOUT CHAIR WITH CASTERS,,,28 ,,NW,,,,,,$841.00,$0.00,1,1,1,1,1,1,20120101,E1031,HCPCS,ROLLABOUT CHAIR WITH CASTERS,NU,,28 ,,NW,,,,,,$841.00,$0.00,1,1,1,1,1,1,20120101,E1031,HCPCS,ROLLABOUT CHAIR WITH CASTERS,RR,,28 ,,NW,,,,,,$98.72,$0.00,1,1,1,1,1,1,20120101,E1031,HCPCS,ROLLABOUT CHAIR WITH CASTERS,UE,,28 ,,NW,,,,,,$640.95,$0.00,1,1,1,1,1,1,20120101,E1035,HCPCS,PATIENT TRANSFER SYSTEM <300,,,28 ,,NW,,,,,,"$10,141.04",$0.00,1,1,1,1,1,1,20120101,E1035,HCPCS,PATIENT TRANSFER SYSTEM <300,RR,,28 ,,NW,,,,,,"$1,059.76",$0.00,1,1,1,1,1,1,20120101,E1036,HCPCS,PATIENT TRANSFER SYSTEM >300,,,28 ,,NW,,,,,,"$14,057.07",$0.00,1,1,1,1,1,1,20120101,E1036,HCPCS,PATIENT TRANSFER SYSTEM >300,RR,,28 ,,NW,,,,,,"$1,468.99",$0.00,1,1,1,1,1,1,20120101,E1037,HCPCS,"TRANSPORT CHAIR, PED SIZE",,,28 ,,NW,,,,,,"$2,121.14",$0.00,1,1,1,1,1,1,20120101,E1037,HCPCS,"TRANSPORT CHAIR, PED SIZE",RR,,28 ,,NW,,,,,,$221.66,$0.00,1,1,1,1,1,1,20120101,E1038,HCPCS,TRANSPORT CHAIR PT WT<=300LB,,,28 ,,NW,,,,,,$354.35,$0.00,1,1,1,1,1,1,20120101,E1038,HCPCS,TRANSPORT CHAIR PT WT<=300LB,RR,,28 ,,NW,,,,,,$37.03,$0.00,1,1,1,1,1,1,20120101,E1039,HCPCS,TRANSPORT CHAIR PT WT >300LB,,,28 ,,NW,,,,,,$673.62,$0.00,1,1,1,1,1,1,20120101,E1039,HCPCS,TRANSPORT CHAIR PT WT >300LB,RR,,28 ,,NW,,,,,,$70.39,$0.00,1,1,1,1,1,1,20120101,E1050,HCPCS,WHELCHR FXD FULL LENGTH ARMS,,,28 ,,NW,,,,,,"$1,653.26",$0.00,1,1,1,1,1,1,20120101,E1050,HCPCS,WHELCHR FXD FULL LENGTH ARMS,NU,,28 ,,NW,,,,,,"$1,653.26",$0.00,1,1,1,1,1,1,20120101,E1050,HCPCS,WHELCHR FXD FULL LENGTH ARMS,RR,,28 ,,NW,,,,,,$201.56,$0.00,1,1,1,1,1,1,20120101,E1050,HCPCS,WHELCHR FXD FULL LENGTH ARMS,UE,,28 ,,NW,,,,,,"$1,250.32",$0.00,1,1,1,1,1,1,20120101,E1060,HCPCS,WHEELCHAIR DETACHABLE ARMS,,,28 ,,NW,,,,,,"$2,269.75",$0.00,1,1,1,1,1,1,20120101,E1060,HCPCS,WHEELCHAIR DETACHABLE ARMS,NU,,28 ,,NW,,,,,,"$2,037.04",$0.00,1,1,1,1,1,1,20120101,E1060,HCPCS,WHEELCHAIR DETACHABLE ARMS,RR,,28 ,,NW,,,,,,$237.19,$0.00,1,1,1,1,1,1,20120101,E1060,HCPCS,WHEELCHAIR DETACHABLE ARMS,UE,,28 ,,NW,,,,,,"$1,538.33",$0.00,1,1,1,1,1,1,20120101,E1070,HCPCS,WHEELCHAIR DETACHABLE FOOT R,,,28 ,,NW,,,,,,"$1,775.27",$0.00,1,1,1,1,1,1,20120101,E1070,HCPCS,WHEELCHAIR DETACHABLE FOOT R,NU,,28 ,,NW,,,,,,"$1,775.27",$0.00,1,1,1,1,1,1,20120101,E1070,HCPCS,WHEELCHAIR DETACHABLE FOOT R,RR,,28 ,,NW,,,,,,$214.97,$0.00,1,1,1,1,1,1,20120101,E1070,HCPCS,WHEELCHAIR DETACHABLE FOOT R,UE,,28 ,,NW,,,,,,"$1,341.83",$0.00,1,1,1,1,1,1,20120101,E1083,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,,,28 ,,NW,,,,,,"$1,287.92",$0.00,1,1,1,1,1,1,20120101,E1083,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,NU,,28 ,,NW,,,,,,"$1,287.92",$0.00,1,1,1,1,1,1,20120101,E1083,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,RR,,28 ,,NW,,,,,,$150.35,$0.00,1,1,1,1,1,1,20120101,E1083,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,UE,,28 ,,NW,,,,,,$976.49,$0.00,1,1,1,1,1,1,20120101,E1084,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,,,28 ,,NW,,,,,,"$1,594.38",$0.00,1,1,1,1,1,1,20120101,E1084,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,NU,,28 ,,NW,,,,,,"$1,594.38",$0.00,1,1,1,1,1,1,20120101,E1084,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,RR,,28 ,,NW,,,,,,$194.29,$0.00,1,1,1,1,1,1,20120101,E1084,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,UE,,28 ,,NW,,,,,,"$1,206.34",$0.00,1,1,1,1,1,1,20120101,E1085,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,,,28 ,,NW,,,,,,"$1,424.83",$0.00,1,1,1,1,1,1,20120101,E1085,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,NU,,28 ,,NW,,,,,,"$1,424.83",$0.00,1,1,1,1,1,1,20120101,E1085,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,RR,,28 ,,NW,,,,,,$171.73,$0.00,1,1,1,1,1,1,20120101,E1085,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,UE,,28 ,,NW,,,,,,"$1,034.66",$0.00,1,1,1,1,1,1,20120101,E1086,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,,,28 ,,NW,,,,,,"$1,726.32",$0.00,1,1,1,1,1,1,20120101,E1086,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,NU,,28 ,,NW,,,,,,"$1,726.32",$0.00,1,1,1,1,1,1,20120101,E1086,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,RR,,28 ,,NW,,,,,,$190.24,$0.00,1,1,1,1,1,1,20120101,E1086,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,UE,,28 ,,NW,,,,,,"$1,265.22",$0.00,1,1,1,1,1,1,20120101,E1087,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,,,28 ,,NW,,,,,,"$2,044.13",$0.00,1,1,1,1,1,1,20120101,E1087,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,NU,,28 ,,NW,,,,,,"$2,044.13",$0.00,1,1,1,1,1,1,20120101,E1087,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,RR,,28 ,,NW,,,,,,$241.88,$0.00,1,1,1,1,1,1,20120101,E1087,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,UE,,28 ,,NW,,,,,,"$1,543.30",$0.00,1,1,1,1,1,1,20120101,E1088,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,,,28 ,,NW,,,,,,"$2,427.91",$0.00,1,1,1,1,1,1,20120101,E1088,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,NU,,28 ,,NW,,,,,,"$2,427.91",$0.00,1,1,1,1,1,1,20120101,E1088,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,RR,,28 ,,NW,,,,,,$274.93,$0.00,1,1,1,1,1,1,20120101,E1088,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,UE,,28 ,,NW,,,,,,"$1,831.31",$0.00,1,1,1,1,1,1,20120101,E1089,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,,,28 ,,NW,,,,,,"$2,278.23",$0.00,1,1,1,1,1,1,20120101,E1089,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,NU,,28 ,,NW,,,,,,"$2,278.23",$0.00,1,1,1,1,1,1,20120101,E1089,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,RR,,28 ,,NW,,,,,,$264.97,$0.00,1,1,1,1,1,1,20120101,E1089,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,UE,,28 ,,NW,,,,,,"$1,718.52",$0.00,1,1,1,1,1,1,20120101,E1090,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,,,28 ,,NW,,,,,,"$2,347.04",$0.00,1,1,1,1,1,1,20120101,E1090,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,NU,,28 ,,NW,,,,,,"$2,347.04",$0.00,1,1,1,1,1,1,20120101,E1090,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,RR,,28 ,,NW,,,,,,$264.97,$0.00,1,1,1,1,1,1,20120101,E1090,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,UE,,28 ,,NW,,,,,,"$1,726.32",$0.00,1,1,1,1,1,1,20120101,E1092,HCPCS,WHEELCHAIR WIDE W/ LEG RESTS,,,28 ,,NW,,,,,,"$2,076.06",$0.00,1,1,1,1,1,1,20120101,E1092,HCPCS,WHEELCHAIR WIDE W/ LEG RESTS,NU,,28 ,,NW,,,,,,"$2,076.06",$0.00,1,1,1,1,1,1,20120101,E1092,HCPCS,WHEELCHAIR WIDE W/ LEG RESTS,RR,,28 ,,NW,,,,,,$242.19,$0.00,1,1,1,1,1,1,20120101,E1092,HCPCS,WHEELCHAIR WIDE W/ LEG RESTS,UE,,28 ,,NW,,,,,,"$1,567.42",$0.00,1,1,1,1,1,1,20120101,E1093,HCPCS,WHEELCHAIR WIDE W/ FOOT REST,,,28 ,,NW,,,,,,"$1,790.88",$0.00,1,1,1,1,1,1,20120101,E1093,HCPCS,WHEELCHAIR WIDE W/ FOOT REST,NU,,28 ,,NW,,,,,,"$1,790.88",$0.00,1,1,1,1,1,1,20120101,E1093,HCPCS,WHEELCHAIR WIDE W/ FOOT REST,RR,,28 ,,NW,,,,,,$215.32,$0.00,1,1,1,1,1,1,20120101,E1093,HCPCS,WHEELCHAIR WIDE W/ FOOT REST,UE,,28 ,,NW,,,,,,"$1,353.89",$0.00,1,1,1,1,1,1,20120101,E1100,HCPCS,WHCHR S-RECL FXD ARM LEG RES,,,28 ,,NW,,,,,,"$1,684.47",$0.00,1,1,1,1,1,1,20120101,E1100,HCPCS,WHCHR S-RECL FXD ARM LEG RES,NU,,28 ,,NW,,,,,,"$1,684.47",$0.00,1,1,1,1,1,1,20120101,E1100,HCPCS,WHCHR S-RECL FXD ARM LEG RES,RR,,28 ,,NW,,,,,,$202.41,$0.00,1,1,1,1,1,1,20120101,E1100,HCPCS,WHCHR S-RECL FXD ARM LEG RES,UE,,28 ,,NW,,,,,,"$1,273.73",$0.00,1,1,1,1,1,1,20120101,E1110,HCPCS,WHEELCHAIR SEMI-RECL DETACH,,,28 ,,NW,,,,,,"$1,650.42",$0.00,1,1,1,1,1,1,20120101,E1110,HCPCS,WHEELCHAIR SEMI-RECL DETACH,NU,,28 ,,NW,,,,,,"$1,650.42",$0.00,1,1,1,1,1,1,20120101,E1110,HCPCS,WHEELCHAIR SEMI-RECL DETACH,RR,,28 ,,NW,,,,,,$196.62,$0.00,1,1,1,1,1,1,20120101,E1110,HCPCS,WHEELCHAIR SEMI-RECL DETACH,UE,,28 ,,NW,,,,,,"$1,248.19",$0.00,1,1,1,1,1,1,20120101,E1130,HCPCS,WHLCHR STAND FXD ARM FT REST,,,28 ,,NW,,,,,,$928.26,$0.00,1,1,1,1,1,1,20120101,E1130,HCPCS,WHLCHR STAND FXD ARM FT REST,NU,,28 ,,NW,,,,,,$928.26,$0.00,1,1,1,1,1,1,20120101,E1130,HCPCS,WHLCHR STAND FXD ARM FT REST,RR,,28 ,,NW,,,,,,$110.02,$0.00,1,1,1,1,1,1,20120101,E1130,HCPCS,WHLCHR STAND FXD ARM FT REST,UE,,28 ,,NW,,,,,,$715.44,$0.00,1,1,1,1,1,1,20120101,E1140,HCPCS,WHEELCHAIR STANDARD DETACH A,,,28 ,,NW,,,,,,"$1,318.42",$0.00,1,1,1,1,1,1,20120101,E1140,HCPCS,WHEELCHAIR STANDARD DETACH A,NU,,28 ,,NW,,,,,,"$1,318.42",$0.00,1,1,1,1,1,1,20120101,E1140,HCPCS,WHEELCHAIR STANDARD DETACH A,RR,,28 ,,NW,,,,,,$158.51,$0.00,1,1,1,1,1,1,20120101,E1140,HCPCS,WHEELCHAIR STANDARD DETACH A,UE,,28 ,,NW,,,,,,$945.99,$0.00,1,1,1,1,1,1,20120101,E1150,HCPCS,WHEELCHAIR STANDARD W/ LEG R,,,28 ,,NW,,,,,,"$1,332.61",$0.00,1,1,1,1,1,1,20120101,E1150,HCPCS,WHEELCHAIR STANDARD W/ LEG R,NU,,28 ,,NW,,,,,,"$1,332.61",$0.00,1,1,1,1,1,1,20120101,E1150,HCPCS,WHEELCHAIR STANDARD W/ LEG R,RR,,28 ,,NW,,,,,,$159.64,$0.00,1,1,1,1,1,1,20120101,E1150,HCPCS,WHEELCHAIR STANDARD W/ LEG R,UE,,28 ,,NW,,,,,,"$1,009.84",$0.00,1,1,1,1,1,1,20120101,E1160,HCPCS,WHEELCHAIR FIXED ARMS,,,28 ,,NW,,,,,,"$1,031.12",$0.00,1,1,1,1,1,1,20120101,E1160,HCPCS,WHEELCHAIR FIXED ARMS,NU,,28 ,,NW,,,,,,"$1,031.12",$0.00,1,1,1,1,1,1,20120101,E1160,HCPCS,WHEELCHAIR FIXED ARMS,RR,,28 ,,NW,,,,,,$123.83,$0.00,1,1,1,1,1,1,20120101,E1160,HCPCS,WHEELCHAIR FIXED ARMS,UE,,28 ,,NW,,,,,,$783.54,$0.00,1,1,1,1,1,1,20120101,E1161,HCPCS,MANUAL ADULT WC W TILTINSPAC,,,28 ,,NW,,,,,,"$3,970.49",$0.00,1,1,1,1,1,1,20120101,E1161,HCPCS,MANUAL ADULT WC W TILTINSPAC,NU,,28 ,,NW,,,,,,"$3,970.49",$0.00,1,1,1,1,1,1,20120101,E1161,HCPCS,MANUAL ADULT WC W TILTINSPAC,RR,,28 ,,NW,,,,,,$434.41,$0.00,1,1,1,1,1,1,20120101,E1161,HCPCS,MANUAL ADULT WC W TILTINSPAC,UE,,28 ,,NW,,,,,,"$2,988.28",$0.00,1,1,1,1,1,1,20120101,E1170,HCPCS,WHLCHR AMPU FXD ARM LEG REST,,,28 ,,NW,,,,,,"$1,455.34",$0.00,1,1,1,1,1,1,20120101,E1170,HCPCS,WHLCHR AMPU FXD ARM LEG REST,NU,,28 ,,NW,,,,,,"$1,455.34",$0.00,1,1,1,1,1,1,20120101,E1170,HCPCS,WHLCHR AMPU FXD ARM LEG REST,RR,,28 ,,NW,,,,,,$169.00,$0.00,1,1,1,1,1,1,20120101,E1170,HCPCS,WHLCHR AMPU FXD ARM LEG REST,UE,,28 ,,NW,,,,,,"$1,102.06",$0.00,1,1,1,1,1,1,20120101,E1171,HCPCS,WHEELCHAIR AMPUTEE W/O LEG R,,,28 ,,NW,,,,,,"$1,310.62",$0.00,1,1,1,1,1,1,20120101,E1171,HCPCS,WHEELCHAIR AMPUTEE W/O LEG R,NU,,28 ,,NW,,,,,,"$1,310.62",$0.00,1,1,1,1,1,1,20120101,E1171,HCPCS,WHEELCHAIR AMPUTEE W/O LEG R,RR,,28 ,,NW,,,,,,$155.78,$0.00,1,1,1,1,1,1,20120101,E1171,HCPCS,WHEELCHAIR AMPUTEE W/O LEG R,UE,,28 ,,NW,,,,,,$992.81,$0.00,1,1,1,1,1,1,20120101,E1172,HCPCS,WHEELCHAIR AMPUTEE DETACH AR,,,28 ,,NW,,,,,,"$1,592.25",$0.00,1,1,1,1,1,1,20120101,E1172,HCPCS,WHEELCHAIR AMPUTEE DETACH AR,NU,,28 ,,NW,,,,,,"$1,592.25",$0.00,1,1,1,1,1,1,20120101,E1172,HCPCS,WHEELCHAIR AMPUTEE DETACH AR,RR,,28 ,,NW,,,,,,$192.63,$0.00,1,1,1,1,1,1,20120101,E1172,HCPCS,WHEELCHAIR AMPUTEE DETACH AR,UE,,28 ,,NW,,,,,,"$1,204.21",$0.00,1,1,1,1,1,1,20120101,E1180,HCPCS,WHEELCHAIR AMPUTEE W/ FOOT R,,,28 ,,NW,,,,,,"$1,645.45",$0.00,1,1,1,1,1,1,20120101,E1180,HCPCS,WHEELCHAIR AMPUTEE W/ FOOT R,NU,,28 ,,NW,,,,,,"$1,645.45",$0.00,1,1,1,1,1,1,20120101,E1180,HCPCS,WHEELCHAIR AMPUTEE W/ FOOT R,RR,,28 ,,NW,,,,,,$197.68,$0.00,1,1,1,1,1,1,20120101,E1180,HCPCS,WHEELCHAIR AMPUTEE W/ FOOT R,UE,,28 ,,NW,,,,,,"$1,244.65",$0.00,1,1,1,1,1,1,20120101,E1190,HCPCS,WHEELCHAIR AMPUTEE W/ LEG RE,,,28 ,,NW,,,,,,"$1,894.45",$0.00,1,1,1,1,1,1,20120101,E1190,HCPCS,WHEELCHAIR AMPUTEE W/ LEG RE,NU,,28 ,,NW,,,,,,"$1,894.45",$0.00,1,1,1,1,1,1,20120101,E1190,HCPCS,WHEELCHAIR AMPUTEE W/ LEG RE,RR,,28 ,,NW,,,,,,$222.86,$0.00,1,1,1,1,1,1,20120101,E1190,HCPCS,WHEELCHAIR AMPUTEE W/ LEG RE,UE,,28 ,,NW,,,,,,"$1,431.22",$0.00,1,1,1,1,1,1,20120101,E1195,HCPCS,WHEELCHAIR AMPUTEE HEAVY DUT,,,28 ,,NW,,,,,,"$2,029.94",$0.00,1,1,1,1,1,1,20120101,E1195,HCPCS,WHEELCHAIR AMPUTEE HEAVY DUT,NU,,28 ,,NW,,,,,,"$2,029.94",$0.00,1,1,1,1,1,1,20120101,E1195,HCPCS,WHEELCHAIR AMPUTEE HEAVY DUT,RR,,28 ,,NW,,,,,,$236.21,$0.00,1,1,1,1,1,1,20120101,E1195,HCPCS,WHEELCHAIR AMPUTEE HEAVY DUT,UE,,28 ,,NW,,,,,,"$1,532.66",$0.00,1,1,1,1,1,1,20120101,E1200,HCPCS,WHEELCHAIR AMPUTEE FIXED ARM,,,28 ,,NW,,,,,,"$1,419.16",$0.00,1,1,1,1,1,1,20120101,E1200,HCPCS,WHEELCHAIR AMPUTEE FIXED ARM,NU,,28 ,,NW,,,,,,"$1,419.16",$0.00,1,1,1,1,1,1,20120101,E1200,HCPCS,WHEELCHAIR AMPUTEE FIXED ARM,RR,,28 ,,NW,,,,,,$170.86,$0.00,1,1,1,1,1,1,20120101,E1200,HCPCS,WHEELCHAIR AMPUTEE FIXED ARM,UE,,28 ,,NW,,,,,,"$1,074.39",$0.00,1,1,1,1,1,1,20120101,E1220,HCPCS,WHLCHR SPECIAL SIZE/CONSTRC,,,28 ,,NW,,,,,,"$4,662.75",$0.00,1,1,1,1,1,1,20120101,E1221,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,,,28 ,,NW,,,,,,$793.47,$0.00,1,1,1,1,1,1,20120101,E1221,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,NU,,28 ,,NW,,,,,,$793.47,$0.00,1,1,1,1,1,1,20120101,E1221,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,RR,,28 ,,NW,,,,,,$92.67,$0.00,1,1,1,1,1,1,20120101,E1221,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,UE,,28 ,,NW,,,,,,$605.48,$0.00,1,1,1,1,1,1,20120101,E1222,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,,,28 ,,NW,,,,,,"$1,114.83",$0.00,1,1,1,1,1,1,20120101,E1222,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,NU,,28 ,,NW,,,,,,"$1,114.83",$0.00,1,1,1,1,1,1,20120101,E1222,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,RR,,28 ,,NW,,,,,,$134.91,$0.00,1,1,1,1,1,1,20120101,E1222,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,UE,,28 ,,NW,,,,,,$845.97,$0.00,1,1,1,1,1,1,20120101,E1223,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,,,28 ,,NW,,,,,,"$1,213.43",$0.00,1,1,1,1,1,1,20120101,E1223,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,NU,,28 ,,NW,,,,,,"$1,213.43",$0.00,1,1,1,1,1,1,20120101,E1223,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,RR,,28 ,,NW,,,,,,$143.41,$0.00,1,1,1,1,1,1,20120101,E1223,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,UE,,28 ,,NW,,,,,,$920.45,$0.00,1,1,1,1,1,1,20120101,E1224,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,,,28 ,,NW,,,,,,"$1,326.23",$0.00,1,1,1,1,1,1,20120101,E1224,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,NU,,28 ,,NW,,,,,,"$1,326.23",$0.00,1,1,1,1,1,1,20120101,E1224,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,RR,,28 ,,NW,,,,,,$156.86,$0.00,1,1,1,1,1,1,20120101,E1224,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,UE,,28 ,,NW,,,,,,"$1,004.87",$0.00,1,1,1,1,1,1,20120101,E1225,HCPCS,MANUAL SEMI-RECLINING BACK,,,28 ,,NW,,,,,,$757.29,$0.00,1,1,1,1,1,1,20120101,E1225,HCPCS,MANUAL SEMI-RECLINING BACK,NU,,28 ,,NW,,,,,,$757.29,$0.00,1,1,1,1,1,1,20120101,E1225,HCPCS,MANUAL SEMI-RECLINING BACK,RR,,28 ,,NW,,,,,,$86.47,$0.00,1,1,1,1,1,1,20120101,E1225,HCPCS,MANUAL SEMI-RECLINING BACK,UE,,28 ,,NW,,,,,,$577.81,$0.00,1,1,1,1,1,1,20120101,E1226,HCPCS,MANUAL FULLY RECLINING BACK,,,28 ,,NW,,,,,,$879.49,$0.00,1,1,1,1,1,1,20120101,E1226,HCPCS,MANUAL FULLY RECLINING BACK,NU,,28 ,,NW,,,,,,$879.49,$0.00,1,1,1,1,1,1,20120101,E1226,HCPCS,MANUAL FULLY RECLINING BACK,RR,,28 ,,NW,,,,,,$107.24,$0.00,1,1,1,1,1,1,20120101,E1226,HCPCS,MANUAL FULLY RECLINING BACK,UE,,28 ,,NW,,,,,,$670.20,$0.00,1,1,1,1,1,1,20120101,E1227,HCPCS,WHEELCHAIR SPEC SZ SPEC HT A,,,28 ,,NW,,,,,,$473.58,$0.00,1,1,1,1,1,1,20120101,E1227,HCPCS,WHEELCHAIR SPEC SZ SPEC HT A,NU,,28 ,,NW,,,,,,$473.58,$0.00,1,1,1,1,1,1,20120101,E1227,HCPCS,WHEELCHAIR SPEC SZ SPEC HT A,RR,,28 ,,NW,,,,,,$53.52,$0.00,1,1,1,1,1,1,20120101,E1227,HCPCS,WHEELCHAIR SPEC SZ SPEC HT A,UE,,28 ,,NW,,,,,,$365.70,$0.00,1,1,1,1,1,1,20120101,E1228,HCPCS,WHEELCHAIR SPEC SZ SPEC HT B,,,28 ,,NW,,,,,,$484.88,$0.00,1,1,1,1,1,1,20120101,E1228,HCPCS,WHEELCHAIR SPEC SZ SPEC HT B,NU,,28 ,,NW,,,,,,$484.88,$0.00,1,1,1,1,1,1,20120101,E1228,HCPCS,WHEELCHAIR SPEC SZ SPEC HT B,RR,,28 ,,NW,,,,,,$52.72,$0.00,1,1,1,1,1,1,20120101,E1228,HCPCS,WHEELCHAIR SPEC SZ SPEC HT B,UE,,28 ,,NW,,,,,,$374.22,$0.00,1,1,1,1,1,1,20120101,E1229,HCPCS,PEDIATRIC WHEELCHAIR NOS,,,28 ,,NW,,,,,,"$1,504.36",$0.00,1,1,1,1,1,1,20120101,E1230,HCPCS,POWER OPERATED VEHICLE,,,28 ,,NW,,,,,,"$3,513.24",$0.00,1,1,1,1,1,1,20120101,E1230,HCPCS,POWER OPERATED VEHICLE,NU,,28 ,,NW,,,,,,"$3,513.24",$0.00,1,1,1,1,1,1,20120101,E1230,HCPCS,POWER OPERATED VEHICLE,RR,,28 ,,NW,,,,,,$385.83,$0.00,1,1,1,1,1,1,20120101,E1230,HCPCS,POWER OPERATED VEHICLE,UE,,28 ,,NW,,,,,,"$2,744.14",$0.00,1,1,1,1,1,1,20120101,E1231,HCPCS,RIGID PED W/C TILT-IN-SPACE,,,28 ,,NW,,,,,,"$2,882.69",$0.00,1,1,1,1,1,1,20120101,E1231,HCPCS,RIGID PED W/C TILT-IN-SPACE,NU,,28 ,,NW,,,,,,"$2,882.69",$0.00,1,1,1,1,1,1,20120101,E1231,HCPCS,RIGID PED W/C TILT-IN-SPACE,RR,,28 ,,NW,,,,,,$315.49,$0.00,1,1,1,1,1,1,20120101,E1231,HCPCS,RIGID PED W/C TILT-IN-SPACE,UE,,28 ,,NW,,,,,,"$2,170.84",$0.00,1,1,1,1,1,1,20120101,E1232,HCPCS,FOLDING PED WC TILT-IN-SPACE,,,28 ,,NW,,,,,,"$3,592.41",$0.00,1,1,1,1,1,1,20120101,E1232,HCPCS,FOLDING PED WC TILT-IN-SPACE,NU,,28 ,,NW,,,,,,"$3,592.41",$0.00,1,1,1,1,1,1,20120101,E1232,HCPCS,FOLDING PED WC TILT-IN-SPACE,RR,,28 ,,NW,,,,,,$396.62,$0.00,1,1,1,1,1,1,20120101,E1232,HCPCS,FOLDING PED WC TILT-IN-SPACE,UE,,28 ,,NW,,,,,,"$2,704.72",$0.00,1,1,1,1,1,1,20120101,E1233,HCPCS,RIG PED WC TLTNSPC W/O SEAT,,,28 ,,NW,,,,,,"$3,720.81",$0.00,1,1,1,1,1,1,20120101,E1233,HCPCS,RIG PED WC TLTNSPC W/O SEAT,NU,,28 ,,NW,,,,,,"$3,720.81",$0.00,1,1,1,1,1,1,20120101,E1233,HCPCS,RIG PED WC TLTNSPC W/O SEAT,RR,,28 ,,NW,,,,,,$409.44,$0.00,1,1,1,1,1,1,20120101,E1233,HCPCS,RIG PED WC TLTNSPC W/O SEAT,UE,,28 ,,NW,,,,,,"$2,800.98",$0.00,1,1,1,1,1,1,20120101,E1234,HCPCS,FLD PED WC TLTNSPC W/O SEAT,,,28 ,,NW,,,,,,"$3,244.60",$0.00,1,1,1,1,1,1,20120101,E1234,HCPCS,FLD PED WC TLTNSPC W/O SEAT,NU,,28 ,,NW,,,,,,"$3,244.60",$0.00,1,1,1,1,1,1,20120101,E1234,HCPCS,FLD PED WC TLTNSPC W/O SEAT,RR,,28 ,,NW,,,,,,$361.86,$0.00,1,1,1,1,1,1,20120101,E1234,HCPCS,FLD PED WC TLTNSPC W/O SEAT,UE,,28 ,,NW,,,,,,"$2,443.82",$0.00,1,1,1,1,1,1,20120101,E1235,HCPCS,RIGID PED WC ADJUSTABLE,,,28 ,,NW,,,,,,"$3,125.84",$0.00,1,1,1,1,1,1,20120101,E1235,HCPCS,RIGID PED WC ADJUSTABLE,NU,,28 ,,NW,,,,,,"$3,125.84",$0.00,1,1,1,1,1,1,20120101,E1235,HCPCS,RIGID PED WC ADJUSTABLE,RR,,28 ,,NW,,,,,,$349.95,$0.00,1,1,1,1,1,1,20120101,E1235,HCPCS,RIGID PED WC ADJUSTABLE,UE,,28 ,,NW,,,,,,"$2,354.75",$0.00,1,1,1,1,1,1,20120101,E1236,HCPCS,FOLDING PED WC ADJUSTABLE,,,28 ,,NW,,,,,,"$2,762.69",$0.00,1,1,1,1,1,1,20120101,E1236,HCPCS,FOLDING PED WC ADJUSTABLE,NU,,28 ,,NW,,,,,,"$2,762.69",$0.00,1,1,1,1,1,1,20120101,E1236,HCPCS,FOLDING PED WC ADJUSTABLE,RR,,28 ,,NW,,,,,,$313.62,$0.00,1,1,1,1,1,1,20120101,E1236,HCPCS,FOLDING PED WC ADJUSTABLE,UE,,28 ,,NW,,,,,,"$2,082.39",$0.00,1,1,1,1,1,1,20120101,E1237,HCPCS,RGD PED WC ADJSTABL W/O SEAT,,,28 ,,NW,,,,,,"$2,786.45",$0.00,1,1,1,1,1,1,20120101,E1237,HCPCS,RGD PED WC ADJSTABL W/O SEAT,NU,,28 ,,NW,,,,,,"$2,786.45",$0.00,1,1,1,1,1,1,20120101,E1237,HCPCS,RGD PED WC ADJSTABL W/O SEAT,RR,,28 ,,NW,,,,,,$316.01,$0.00,1,1,1,1,1,1,20120101,E1237,HCPCS,RGD PED WC ADJSTABL W/O SEAT,UE,,28 ,,NW,,,,,,"$2,100.25",$0.00,1,1,1,1,1,1,20120101,E1238,HCPCS,FLD PED WC ADJSTABL W/O SEAT,,,28 ,,NW,,,,,,"$2,762.69",$0.00,1,1,1,1,1,1,20120101,E1238,HCPCS,FLD PED WC ADJSTABL W/O SEAT,NU,,28 ,,NW,,,,,,"$2,762.69",$0.00,1,1,1,1,1,1,20120101,E1238,HCPCS,FLD PED WC ADJSTABL W/O SEAT,RR,,28 ,,NW,,,,,,$313.62,$0.00,1,1,1,1,1,1,20120101,E1238,HCPCS,FLD PED WC ADJSTABL W/O SEAT,UE,,28 ,,NW,,,,,,"$2,082.39",$0.00,1,1,1,1,1,1,20120101,E1239,HCPCS,PED POWER WHEELCHAIR NOS,,,28 ,,NW,,,,,,"$1,504.36",$0.00,1,1,1,1,1,1,20120101,E1240,HCPCS,WHCHR LITWT DET ARM LEG REST,,,28 ,,NW,,,,,,"$1,672.41",$0.00,1,1,1,1,1,1,20120101,E1240,HCPCS,WHCHR LITWT DET ARM LEG REST,NU,,28 ,,NW,,,,,,"$1,672.41",$0.00,1,1,1,1,1,1,20120101,E1240,HCPCS,WHCHR LITWT DET ARM LEG REST,RR,,28 ,,NW,,,,,,$198.80,$0.00,1,1,1,1,1,1,20120101,E1240,HCPCS,WHCHR LITWT DET ARM LEG REST,UE,,28 ,,NW,,,,,,"$1,264.51",$0.00,1,1,1,1,1,1,20120101,E1250,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,,,28 ,,NW,,,,,,"$1,407.10",$0.00,1,1,1,1,1,1,20120101,E1250,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,NU,,28 ,,NW,,,,,,"$1,407.10",$0.00,1,1,1,1,1,1,20120101,E1250,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,RR,,28 ,,NW,,,,,,$154.10,$0.00,1,1,1,1,1,1,20120101,E1250,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,UE,,28 ,,NW,,,,,,"$1,123.34",$0.00,1,1,1,1,1,1,20120101,E1260,HCPCS,WHEELCHAIR LIGHTWT FOOT REST,,,28 ,,NW,,,,,,"$1,637.65",$0.00,1,1,1,1,1,1,20120101,E1260,HCPCS,WHEELCHAIR LIGHTWT FOOT REST,NU,,28 ,,NW,,,,,,"$1,637.65",$0.00,1,1,1,1,1,1,20120101,E1260,HCPCS,WHEELCHAIR LIGHTWT FOOT REST,RR,,28 ,,NW,,,,,,$198.18,$0.00,1,1,1,1,1,1,20120101,E1260,HCPCS,WHEELCHAIR LIGHTWT FOOT REST,UE,,28 ,,NW,,,,,,"$1,300.69",$0.00,1,1,1,1,1,1,20120101,E1270,HCPCS,WHEELCHAIR LIGHTWEIGHT LEG R,,,28 ,,NW,,,,,,"$1,291.47",$0.00,1,1,1,1,1,1,20120101,E1270,HCPCS,WHEELCHAIR LIGHTWEIGHT LEG R,NU,,28 ,,NW,,,,,,"$1,291.47",$0.00,1,1,1,1,1,1,20120101,E1270,HCPCS,WHEELCHAIR LIGHTWEIGHT LEG R,RR,,28 ,,NW,,,,,,$152.22,$0.00,1,1,1,1,1,1,20120101,E1270,HCPCS,WHEELCHAIR LIGHTWEIGHT LEG R,UE,,28 ,,NW,,,,,,$978.62,$0.00,1,1,1,1,1,1,20120101,E1280,HCPCS,WHCHR H-DUTY DET ARM LEG RES,,,28 ,,NW,,,,,,"$1,544.73",$0.00,1,1,1,1,1,1,20120101,E1280,HCPCS,WHCHR H-DUTY DET ARM LEG RES,NU,,28 ,,NW,,,,,,"$2,119.33",$0.00,1,1,1,1,1,1,20120101,E1280,HCPCS,WHCHR H-DUTY DET ARM LEG RES,RR,,28 ,,NW,,,,,,$245.38,$0.00,1,1,1,1,1,1,20120101,E1280,HCPCS,WHCHR H-DUTY DET ARM LEG RES,UE,,28 ,,NW,,,,,,"$1,600.05",$0.00,1,1,1,1,1,1,20120101,E1285,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,,,28 ,,NW,,,,,,"$2,098.76",$0.00,1,1,1,1,1,1,20120101,E1285,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,NU,,28 ,,NW,,,,,,"$2,098.76",$0.00,1,1,1,1,1,1,20120101,E1285,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,RR,,28 ,,NW,,,,,,$247.24,$0.00,1,1,1,1,1,1,20120101,E1285,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,UE,,28 ,,NW,,,,,,"$1,548.98",$0.00,1,1,1,1,1,1,20120101,E1290,HCPCS,WHEELCHAIR HVY DUTY DETACH A,,,28 ,,NW,,,,,,"$2,169.70",$0.00,1,1,1,1,1,1,20120101,E1290,HCPCS,WHEELCHAIR HVY DUTY DETACH A,NU,,28 ,,NW,,,,,,"$2,169.70",$0.00,1,1,1,1,1,1,20120101,E1290,HCPCS,WHEELCHAIR HVY DUTY DETACH A,RR,,28 ,,NW,,,,,,$254.33,$0.00,1,1,1,1,1,1,20120101,E1290,HCPCS,WHEELCHAIR HVY DUTY DETACH A,UE,,28 ,,NW,,,,,,"$1,593.67",$0.00,1,1,1,1,1,1,20120101,E1295,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,,,28 ,,NW,,,,,,"$1,963.97",$0.00,1,1,1,1,1,1,20120101,E1295,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,NU,,28 ,,NW,,,,,,"$1,963.97",$0.00,1,1,1,1,1,1,20120101,E1295,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,RR,,28 ,,NW,,,,,,$234.51,$0.00,1,1,1,1,1,1,20120101,E1295,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,UE,,28 ,,NW,,,,,,"$1,483.71",$0.00,1,1,1,1,1,1,20120101,E1296,HCPCS,WHEELCHAIR SPECIAL SEAT HEIG,,,28 ,,NW,,,,,,$790.34,$0.00,1,1,1,1,1,1,20120101,E1296,HCPCS,WHEELCHAIR SPECIAL SEAT HEIG,NU,,28 ,,NW,,,,,,$790.34,$0.00,1,1,1,1,1,1,20120101,E1296,HCPCS,WHEELCHAIR SPECIAL SEAT HEIG,RR,,28 ,,NW,,,,,,$94.65,$0.00,1,1,1,1,1,1,20120101,E1296,HCPCS,WHEELCHAIR SPECIAL SEAT HEIG,UE,,28 ,,NW,,,,,,$603.11,$0.00,1,1,1,1,1,1,20120101,E1297,HCPCS,WHEELCHAIR SPECIAL SEAT DEPT,,,28 ,,NW,,,,,,$197.82,$0.00,1,1,1,1,1,1,20120101,E1297,HCPCS,WHEELCHAIR SPECIAL SEAT DEPT,NU,,28 ,,NW,,,,,,$197.82,$0.00,1,1,1,1,1,1,20120101,E1297,HCPCS,WHEELCHAIR SPECIAL SEAT DEPT,RR,,28 ,,NW,,,,,,$22.48,$0.00,1,1,1,1,1,1,20120101,E1297,HCPCS,WHEELCHAIR SPECIAL SEAT DEPT,UE,,28 ,,NW,,,,,,$148.32,$0.00,1,1,1,1,1,1,20120101,E1298,HCPCS,WHEELCHAIR SPEC SEAT DEPTH/W,,,28 ,,NW,,,,,,$698.12,$0.00,1,1,1,1,1,1,20120101,E1298,HCPCS,WHEELCHAIR SPEC SEAT DEPTH/W,NU,,28 ,,NW,,,,,,$698.12,$0.00,1,1,1,1,1,1,20120101,E1298,HCPCS,WHEELCHAIR SPEC SEAT DEPTH/W,RR,,28 ,,NW,,,,,,$82.73,$0.00,1,1,1,1,1,1,20120101,E1298,HCPCS,WHEELCHAIR SPEC SEAT DEPTH/W,UE,,28 ,,NW,,,,,,$533.96,$0.00,1,1,1,1,1,1,20120101,E1300,HCPCS,WHIRLPOOL PORTABLE,,,28 ,,NW,,,,,,$152.92,$0.00,1,1,1,1,1,1,20120101,E1300,HCPCS,WHIRLPOOL PORTABLE,NU,,28 ,,NW,,,,,,$152.92,$0.00,1,1,1,1,1,1,20120101,E1300,HCPCS,WHIRLPOOL PORTABLE,RR,,28 ,,NW,,,,,,$15.98,$0.00,1,1,1,1,1,1,20120101,E1300,HCPCS,WHIRLPOOL PORTABLE,UE,,28 ,,NW,,,,,,$114.88,$0.00,1,1,1,1,1,1,20120101,E1310,HCPCS,WHIRLPOOL NON-PORTABLE,,,28 ,,NW,,,,,,"$4,996.53",$0.00,1,1,1,1,1,1,20120101,E1310,HCPCS,WHIRLPOOL NON-PORTABLE,NU,,28 ,,NW,,,,,,"$4,996.53",$0.00,1,1,1,1,1,1,20120101,E1310,HCPCS,WHIRLPOOL NON-PORTABLE,RR,,28 ,,NW,,,,,,$408.11,$0.00,1,1,1,1,1,1,20120101,E1310,HCPCS,WHIRLPOOL NON-PORTABLE,UE,,28 ,,NW,,,,,,"$3,741.30",$0.00,1,1,1,1,1,1,20120101,E1353,HCPCS,OXYGEN SUPPLIES REGULATOR,,,28 ,,NW,,,,,,$59.46,$0.00,1,1,1,1,1,1,20120101,E1353,HCPCS,OXYGEN SUPPLIES REGULATOR,NU,,28 ,,NW,,,,,,$59.46,$0.00,1,1,1,1,1,1,20120101,E1353,HCPCS,OXYGEN SUPPLIES REGULATOR,RR,,28 ,,NW,,,,,,$8.26,$0.00,1,1,1,1,1,1,20120101,E1353,HCPCS,OXYGEN SUPPLIES REGULATOR,UE,,28 ,,NW,,,,,,$44.60,$0.00,1,1,1,1,1,1,20120101,E1354,HCPCS,"WHEELED CART, PORT CYL/CONC",,,28 ,,NW,,,,,,$108.42,$0.00,1,1,1,1,1,1,20120101,E1355,HCPCS,OXYGEN SUPPLIES STAND/RACK,,,28 ,,NW,,,,,,$44.77,$0.00,1,1,1,1,1,1,20120101,E1355,HCPCS,OXYGEN SUPPLIES STAND/RACK,NU,,28 ,,NW,,,,,,$44.77,$0.00,1,1,1,1,1,1,20120101,E1355,HCPCS,OXYGEN SUPPLIES STAND/RACK,RR,,28 ,,NW,,,,,,$5.39,$0.00,1,1,1,1,1,1,20120101,E1355,HCPCS,OXYGEN SUPPLIES STAND/RACK,UE,,28 ,,NW,,,,,,$33.58,$0.00,1,1,1,1,1,1,20120101,E1356,HCPCS,"BATT PACK/CART, PORT CONC",,,28 ,,NW,,,,,,$169.45,$0.00,1,1,1,1,1,1,20120101,E1357,HCPCS,"BATTERY CHARGER, PORT CONC",,,28 ,,NW,,,,,,$283.95,$0.00,1,1,1,1,1,1,20120101,E1358,HCPCS,"DC POWER ADAPTER, PORT CONC",,,28 ,,NW,,,,,,$178.84,$0.00,1,1,1,1,1,1,20120101,E1372,HCPCS,OXY SUPPL HEATER FOR NEBULIZ,,,28 ,,NW,,,,,,$356.55,$0.00,1,1,1,1,1,1,20120101,E1372,HCPCS,OXY SUPPL HEATER FOR NEBULIZ,NU,,28 ,,NW,,,,,,$356.55,$0.00,1,1,1,1,1,1,20120101,E1372,HCPCS,OXY SUPPL HEATER FOR NEBULIZ,RR,,28 ,,NW,,,,,,$46.37,$0.00,1,1,1,1,1,1,20120101,E1372,HCPCS,OXY SUPPL HEATER FOR NEBULIZ,UE,,28 ,,NW,,,,,,$256.92,$0.00,1,1,1,1,1,1,20120101,E1390,HCPCS,OXYGEN CONCENTRATOR,,,28 ,,NW,,,,,,"$5,401.96",$0.00,1,1,1,1,1,1,20120101,E1390,HCPCS,OXYGEN CONCENTRATOR,NU,,28 ,,NW,,,,,,"$5,401.96",$0.00,1,1,1,1,1,1,20120101,E1390,HCPCS,OXYGEN CONCENTRATOR,RR,,28 ,,NW,,,,,,$564.52,$0.00,1,1,1,1,1,1,20120101,E1391,HCPCS,"OXYGEN CONCENTRATOR, DUAL",,,28 ,,NW,,,,,,"$5,401.96",$0.00,1,1,1,1,1,1,20120101,E1391,HCPCS,"OXYGEN CONCENTRATOR, DUAL",RR,,28 ,,NW,,,,,,$564.52,$0.00,1,1,1,1,1,1,20120101,E1392,HCPCS,PORTABLE OXYGEN CONCENTRATOR,,,28 ,,NW,,,,,,"$1,359.55",$0.00,1,1,1,1,1,1,20120101,E1392,HCPCS,PORTABLE OXYGEN CONCENTRATOR,RR,,28 ,,NW,,,,,,$142.08,$0.00,1,1,1,1,1,1,20120101,E1399,HCPCS,DURABLE MEDICAL EQUIPMENT MI,,,28 ,,NW,,,,,,$157.70,$0.00,1,1,1,1,1,1,20120101,E1405,HCPCS,O2/WATER VAPOR ENRICH W/HEAT,,,28 ,,NW,,,,,,"$6,568.11",$0.00,1,1,1,1,1,1,20120101,E1405,HCPCS,O2/WATER VAPOR ENRICH W/HEAT,NU,,28 ,,NW,,,,,,"$6,568.11",$0.00,1,1,1,1,1,1,20120101,E1405,HCPCS,O2/WATER VAPOR ENRICH W/HEAT,RR,,28 ,,NW,,,,,,$686.38,$0.00,1,1,1,1,1,1,20120101,E1405,HCPCS,O2/WATER VAPOR ENRICH W/HEAT,UE,,28 ,,NW,,,,,,"$4,934.15",$0.00,1,1,1,1,1,1,20120101,E1406,HCPCS,O2/WATER VAPOR ENRICH W/O HE,,,28 ,,NW,,,,,,"$5,963.15",$0.00,1,1,1,1,1,1,20120101,E1406,HCPCS,O2/WATER VAPOR ENRICH W/O HE,NU,,28 ,,NW,,,,,,"$5,963.15",$0.00,1,1,1,1,1,1,20120101,E1406,HCPCS,O2/WATER VAPOR ENRICH W/O HE,RR,,28 ,,NW,,,,,,$623.16,$0.00,1,1,1,1,1,1,20120101,E1406,HCPCS,O2/WATER VAPOR ENRICH W/O HE,UE,,28 ,,NW,,,,,,"$4,479.69",$0.00,1,1,1,1,1,1,20120101,E1500,HCPCS,CENTRIFUGE,,,28 ,,NW,,,,,,$269.40,$0.00,1,1,1,1,1,1,20120101,E1510,HCPCS,KIDNEY DIALYSATE DELIVRY SYS,,,28 ,,NW,,,,,,"$2,401.55",$0.00,1,1,1,1,1,1,20120101,E1510,HCPCS,KIDNEY DIALYSATE DELIVRY SYS,NU,,28 ,,NW,,,,,,"$2,401.55",$0.00,1,1,1,1,1,1,20120101,E1510,HCPCS,KIDNEY DIALYSATE DELIVRY SYS,RR,,28 ,,NW,,,,,,$252.98,$0.00,1,1,1,1,1,1,20120101,E1510,HCPCS,KIDNEY DIALYSATE DELIVRY SYS,UE,,28 ,,NW,,,,,,"$1,808.52",$0.00,1,1,1,1,1,1,20120101,E1520,HCPCS,HEPARIN INFUSION PUMP,,,28 ,,NW,,,,,,"$1,237.42",$0.00,1,1,1,1,1,1,20120101,E1520,HCPCS,HEPARIN INFUSION PUMP,NU,,28 ,,NW,,,,,,"$1,237.42",$0.00,1,1,1,1,1,1,20120101,E1520,HCPCS,HEPARIN INFUSION PUMP,RR,,28 ,,NW,,,,,,$127.59,$0.00,1,1,1,1,1,1,20120101,E1520,HCPCS,HEPARIN INFUSION PUMP,UE,,28 ,,NW,,,,,,$915.68,$0.00,1,1,1,1,1,1,20120101,E1530,HCPCS,REPLACEMENT AIR BUBBLE DETEC,,,28 ,,NW,,,,,,"$1,759.88",$0.00,1,1,1,1,1,1,20120101,E1530,HCPCS,REPLACEMENT AIR BUBBLE DETEC,NU,,28 ,,NW,,,,,,"$1,759.88",$0.00,1,1,1,1,1,1,20120101,E1530,HCPCS,REPLACEMENT AIR BUBBLE DETEC,RR,,28 ,,NW,,,,,,$181.48,$0.00,1,1,1,1,1,1,20120101,E1530,HCPCS,REPLACEMENT AIR BUBBLE DETEC,UE,,28 ,,NW,,,,,,"$1,320.28",$0.00,1,1,1,1,1,1,20120101,E1540,HCPCS,REPLACEMENT PRESSURE ALARM,,,28 ,,NW,,,,,,$362.00,$0.00,1,1,1,1,1,1,20120101,E1540,HCPCS,REPLACEMENT PRESSURE ALARM,NU,,28 ,,NW,,,,,,$362.00,$0.00,1,1,1,1,1,1,20120101,E1540,HCPCS,REPLACEMENT PRESSURE ALARM,RR,,28 ,,NW,,,,,,$38.90,$0.00,1,1,1,1,1,1,20120101,E1540,HCPCS,REPLACEMENT PRESSURE ALARM,UE,,28 ,,NW,,,,,,$272.35,$0.00,1,1,1,1,1,1,20120101,E1550,HCPCS,BATH CONDUCTIVITY METER,,,28 ,,NW,,,,,,$388.54,$0.00,1,1,1,1,1,1,20120101,E1550,HCPCS,BATH CONDUCTIVITY METER,NU,,28 ,,NW,,,,,,$388.54,$0.00,1,1,1,1,1,1,20120101,E1550,HCPCS,BATH CONDUCTIVITY METER,RR,,28 ,,NW,,,,,,$40.60,$0.00,1,1,1,1,1,1,20120101,E1550,HCPCS,BATH CONDUCTIVITY METER,UE,,28 ,,NW,,,,,,$291.88,$0.00,1,1,1,1,1,1,20120101,E1560,HCPCS,REPLACE BLOOD LEAK DETECTOR,,,28 ,,NW,,,,,,"$2,036.45",$0.00,1,1,1,1,1,1,20120101,E1560,HCPCS,REPLACE BLOOD LEAK DETECTOR,NU,,28 ,,NW,,,,,,"$2,036.45",$0.00,1,1,1,1,1,1,20120101,E1560,HCPCS,REPLACE BLOOD LEAK DETECTOR,RR,,28 ,,NW,,,,,,$209.98,$0.00,1,1,1,1,1,1,20120101,E1560,HCPCS,REPLACE BLOOD LEAK DETECTOR,UE,,28 ,,NW,,,,,,"$1,506.97",$0.00,1,1,1,1,1,1,20120101,E1570,HCPCS,ADJUSTABLE CHAIR FOR ESRD PT,,,28 ,,NW,,,,,,"$1,429.00",$0.00,1,1,1,1,1,1,20120101,E1570,HCPCS,ADJUSTABLE CHAIR FOR ESRD PT,NU,,28 ,,NW,,,,,,"$1,429.00",$0.00,1,1,1,1,1,1,20120101,E1570,HCPCS,ADJUSTABLE CHAIR FOR ESRD PT,RR,,28 ,,NW,,,,,,$149.33,$0.00,1,1,1,1,1,1,20120101,E1570,HCPCS,ADJUSTABLE CHAIR FOR ESRD PT,UE,,28 ,,NW,,,,,,"$1,073.51",$0.00,1,1,1,1,1,1,20120101,E1575,HCPCS,TRANSDUCER PROTECT/FLD BAR,,,28 ,,NW,,,,,,$106.82,$0.00,1,1,1,1,1,1,20120101,E1575,HCPCS,TRANSDUCER PROTECT/FLD BAR,NU,,28 ,,NW,,,,,,$106.82,$0.00,1,1,1,1,1,1,20120101,E1575,HCPCS,TRANSDUCER PROTECT/FLD BAR,RR,,28 ,,NW,,,,,,$11.02,$0.00,1,1,1,1,1,1,20120101,E1575,HCPCS,TRANSDUCER PROTECT/FLD BAR,UE,,28 ,,NW,,,,,,$79.05,$0.00,1,1,1,1,1,1,20120101,E1590,HCPCS,HEMODIALYSIS MACHINE,,,28 ,,NW,,,,,,"$2,716.70",$0.00,1,1,1,1,1,1,20120101,E1590,HCPCS,HEMODIALYSIS MACHINE,NU,,28 ,,NW,,,,,,"$2,716.70",$0.00,1,1,1,1,1,1,20120101,E1590,HCPCS,HEMODIALYSIS MACHINE,RR,,28 ,,NW,,,,,,$297.31,$0.00,1,1,1,1,1,1,20120101,E1590,HCPCS,HEMODIALYSIS MACHINE,UE,,28 ,,NW,,,,,,"$2,045.84",$0.00,1,1,1,1,1,1,20120101,E1592,HCPCS,AUTO INTERM PERITONEAL DIALY,,,28 ,,NW,,,,,,$8.66,$0.00,1,1,1,1,1,1,20120101,E1594,HCPCS,CYCLER DIALYSIS MACHINE,,,28 ,,NW,,,,,,"$7,171.25",$0.00,1,1,1,1,1,1,20120101,E1594,HCPCS,CYCLER DIALYSIS MACHINE,NU,,28 ,,NW,,,,,,"$7,171.25",$0.00,1,1,1,1,1,1,20120101,E1594,HCPCS,CYCLER DIALYSIS MACHINE,RR,,28 ,,NW,,,,,,$784.82,$0.00,1,1,1,1,1,1,20120101,E1594,HCPCS,CYCLER DIALYSIS MACHINE,UE,,28 ,,NW,,,,,,"$5,400.41",$0.00,1,1,1,1,1,1,20120101,E1600,HCPCS,DELI/INSTALL CHRG HEMO EQUIP,,,28 ,,NW,,,,,,$200.31,$0.00,1,1,1,1,1,1,20120101,E1610,HCPCS,REVERSE OSMOSIS H2O PURI SYS,,,28 ,,NW,,,,,,"$4,766.38",$0.00,1,1,1,1,1,1,20120101,E1610,HCPCS,REVERSE OSMOSIS H2O PURI SYS,NU,,28 ,,NW,,,,,,"$4,766.38",$0.00,1,1,1,1,1,1,20120101,E1610,HCPCS,REVERSE OSMOSIS H2O PURI SYS,RR,,28 ,,NW,,,,,,$498.10,$0.00,1,1,1,1,1,1,20120101,E1610,HCPCS,REVERSE OSMOSIS H2O PURI SYS,UE,,28 ,,NW,,,,,,"$3,580.64",$0.00,1,1,1,1,1,1,20120101,E1615,HCPCS,DEIONIZER H2O PURI SYSTEM,,,28 ,,NW,,,,,,$749.27,$0.00,1,1,1,1,1,1,20120101,E1620,HCPCS,REPLACEMENT BLOOD PUMP,,,28 ,,NW,,,,,,$598.44,$0.00,1,1,1,1,1,1,20120101,E1625,HCPCS,WATER SOFTENING SYSTEM,,,28 ,,NW,,,,,,"$2,426.10",$0.00,1,1,1,1,1,1,20120101,E1630,HCPCS,RECIPROCATING PERITONEAL DIA,,,28 ,,NW,,,,,,$189.21,$0.00,1,1,1,1,1,1,20120101,E1634,HCPCS,PERITONEAL DIALYSIS CLAMP,,,28 ,,NW,,,,,,$12.12,$0.00,1,1,1,1,1,1,20120101,E1635,HCPCS,COMPACT TRAVEL HEMODIALYZER,,,28 ,,NW,,,,,,$450.57,$0.00,1,1,1,1,1,1,20120101,E1636,HCPCS,SORBENT CARTRIDGES PER 10,,,28 ,,NW,,,,,,$52.12,$0.00,1,1,1,1,1,1,20120101,E1637,HCPCS,"HEMOSTATS FOR DIALYSIS, EACH",,,28 ,,NW,,,,,,$44.45,$0.00,1,1,1,1,1,1,20120101,E1639,HCPCS,DIALYSIS SCALE,,,28 ,,NW,,,,,,$204.73,$0.00,1,1,1,1,1,1,20120101,E1699,HCPCS,DIALYSIS EQUIPMENT NOC,,,28 ,,NW,,,,,,$211.45,$0.00,1,1,1,1,1,1,20120101,E1700,HCPCS,JAW MOTION REHAB SYSTEM,,,28 ,,NW,,,,,,$787.74,$0.00,1,1,1,1,1,1,20120101,E1700,HCPCS,JAW MOTION REHAB SYSTEM,NU,,28 ,,NW,,,,,,$787.74,$0.00,1,1,1,1,1,1,20120101,E1700,HCPCS,JAW MOTION REHAB SYSTEM,RR,,28 ,,NW,,,,,,$63.69,$0.00,1,1,1,1,1,1,20120101,E1700,HCPCS,JAW MOTION REHAB SYSTEM,UE,,28 ,,NW,,,,,,$583.65,$0.00,1,1,1,1,1,1,20120101,E1701,HCPCS,REPL CUSHIONS FOR JAW MOTION,,,28 ,,NW,,,,,,$24.58,$0.00,1,1,1,1,1,1,20120101,E1702,HCPCS,REPL MEASR SCALES JAW MOTION,,,28 ,,NW,,,,,,$44.50,$0.00,1,1,1,1,1,1,20120101,E1800,HCPCS,ADJUST ELBOW EXT/FLEX DEVICE,,,28 ,,NW,,,,,,"$2,476.76",$0.00,1,1,1,1,1,1,20120101,E1800,HCPCS,ADJUST ELBOW EXT/FLEX DEVICE,RR,,28 ,,NW,,,,,,$258.83,$0.00,1,1,1,1,1,1,20120101,E1801,HCPCS,SPS ELBOW DEVICE,,,28 ,,NW,,,,,,"$2,762.32",$0.00,1,1,1,1,1,1,20120101,E1801,HCPCS,SPS ELBOW DEVICE,RR,,28 ,,NW,,,,,,$288.67,$0.00,1,1,1,1,1,1,20120101,E1802,HCPCS,ADJST FOREARM PRO/SUP DEVICE,,,28 ,,NW,,,,,,"$7,578.49",$0.00,1,1,1,1,1,1,20120101,E1802,HCPCS,ADJST FOREARM PRO/SUP DEVICE,RR,,28 ,,NW,,,,,,$791.97,$0.00,1,1,1,1,1,1,20120101,E1805,HCPCS,ADJUST WRIST EXT/FLEX DEVICE,,,28 ,,NW,,,,,,"$2,600.30",$0.00,1,1,1,1,1,1,20120101,E1805,HCPCS,ADJUST WRIST EXT/FLEX DEVICE,RR,,28 ,,NW,,,,,,$271.74,$0.00,1,1,1,1,1,1,20120101,E1806,HCPCS,SPS WRIST DEVICE,,,28 ,,NW,,,,,,"$2,225.87",$0.00,1,1,1,1,1,1,20120101,E1806,HCPCS,SPS WRIST DEVICE,RR,,28 ,,NW,,,,,,$232.61,$0.00,1,1,1,1,1,1,20120101,E1810,HCPCS,ADJUST KNEE EXT/FLEX DEVICE,,,28 ,,NW,,,,,,"$2,553.71",$0.00,1,1,1,1,1,1,20120101,E1810,HCPCS,ADJUST KNEE EXT/FLEX DEVICE,RR,,28 ,,NW,,,,,,$266.87,$0.00,1,1,1,1,1,1,20120101,E1811,HCPCS,SPS KNEE DEVICE,,,28 ,,NW,,,,,,"$2,881.34",$0.00,1,1,1,1,1,1,20120101,E1811,HCPCS,SPS KNEE DEVICE,RR,,28 ,,NW,,,,,,$301.11,$0.00,1,1,1,1,1,1,20120101,E1812,HCPCS,KNEE EXT/FLEX W ACT RES CTRL,,,28 ,,NW,,,,,,"$1,822.09",$0.00,1,1,1,1,1,1,20120101,E1812,HCPCS,KNEE EXT/FLEX W ACT RES CTRL,RR,,28 ,,NW,,,,,,$190.41,$0.00,1,1,1,1,1,1,20120101,E1815,HCPCS,ADJUST ANKLE EXT/FLEX DEVICE,,,28 ,,NW,,,,,,"$2,600.91",$0.00,1,1,1,1,1,1,20120101,E1815,HCPCS,ADJUST ANKLE EXT/FLEX DEVICE,RR,,28 ,,NW,,,,,,$271.80,$0.00,1,1,1,1,1,1,20120101,E1816,HCPCS,SPS ANKLE DEVICE,,,28 ,,NW,,,,,,"$2,930.23",$0.00,1,1,1,1,1,1,20120101,E1816,HCPCS,SPS ANKLE DEVICE,RR,,28 ,,NW,,,,,,$306.22,$0.00,1,1,1,1,1,1,20120101,E1818,HCPCS,SPS FOREARM DEVICE,,,28 ,,NW,,,,,,"$2,996.27",$0.00,1,1,1,1,1,1,20120101,E1818,HCPCS,SPS FOREARM DEVICE,RR,,28 ,,NW,,,,,,$313.12,$0.00,1,1,1,1,1,1,20120101,E1820,HCPCS,SOFT INTERFACE MATERIAL,,,28 ,,NW,,,,,,$175.32,$0.00,1,1,1,1,1,1,20120101,E1820,HCPCS,SOFT INTERFACE MATERIAL,NU,,28 ,,NW,,,,,,$175.32,$0.00,1,1,1,1,1,1,20120101,E1820,HCPCS,SOFT INTERFACE MATERIAL,RR,,28 ,,NW,,,,,,$20.41,$0.00,1,1,1,1,1,1,20120101,E1820,HCPCS,SOFT INTERFACE MATERIAL,UE,,28 ,,NW,,,,,,$125.40,$0.00,1,1,1,1,1,1,20120101,E1821,HCPCS,REPLACEMENT INTERFACE SPSD,,,28 ,,NW,,,,,,$238.52,$0.00,1,1,1,1,1,1,20120101,E1821,HCPCS,REPLACEMENT INTERFACE SPSD,NU,,28 ,,NW,,,,,,$238.52,$0.00,1,1,1,1,1,1,20120101,E1821,HCPCS,REPLACEMENT INTERFACE SPSD,RR,,28 ,,NW,,,,,,$24.98,$0.00,1,1,1,1,1,1,20120101,E1821,HCPCS,REPLACEMENT INTERFACE SPSD,UE,,28 ,,NW,,,,,,$172.84,$0.00,1,1,1,1,1,1,20120101,E1825,HCPCS,ADJUST FINGER EXT/FLEX DEVC,,,28 ,,NW,,,,,,"$2,600.30",$0.00,1,1,1,1,1,1,20120101,E1825,HCPCS,ADJUST FINGER EXT/FLEX DEVC,RR,,28 ,,NW,,,,,,$271.74,$0.00,1,1,1,1,1,1,20120101,E1830,HCPCS,ADJUST TOE EXT/FLEX DEVICE,,,28 ,,NW,,,,,,"$2,600.30",$0.00,1,1,1,1,1,1,20120101,E1830,HCPCS,ADJUST TOE EXT/FLEX DEVICE,RR,,28 ,,NW,,,,,,$271.74,$0.00,1,1,1,1,1,1,20120101,E1831,HCPCS,STATIC STR TOE DEV EXT/FLEX,,,28 ,,NW,,,,,,"$1,319.33",$0.00,1,1,1,1,1,1,20120101,E1831,HCPCS,STATIC STR TOE DEV EXT/FLEX,RR,,28 ,,NW,,,,,,$137.87,$0.00,1,1,1,1,1,1,20120101,E1840,HCPCS,ADJ SHOULDER EXT/FLEX DEVICE,,,28 ,,NW,,,,,,"$8,741.92",$0.00,1,1,1,1,1,1,20120101,E1840,HCPCS,ADJ SHOULDER EXT/FLEX DEVICE,RR,,28 ,,NW,,,,,,$913.55,$0.00,1,1,1,1,1,1,20120101,E1841,HCPCS,STATIC STR SHLDR DEV ROM ADJ,,,28 ,,NW,,,,,,"$10,595.02",$0.00,1,1,1,1,1,1,20120101,E1841,HCPCS,STATIC STR SHLDR DEV ROM ADJ,RR,,28 ,,NW,,,,,,"$1,107.20",$0.00,1,1,1,1,1,1,20120101,E1902,HCPCS,AAC NON-ELECTRONIC BOARD,,,28 ,,NW,,,,,,"$2,719.67",$0.00,1,1,1,1,1,1,20120101,E2000,HCPCS,GASTRIC SUCTION PUMP HME MDL,,,28 ,,NW,,,,,,$969.98,$0.00,1,1,1,1,1,1,20120101,E2000,HCPCS,GASTRIC SUCTION PUMP HME MDL,RR,,28 ,,NW,,,,,,$101.36,$0.00,1,1,1,1,1,1,20120101,E2100,HCPCS,BLD GLUCOSE MONITOR W VOICE,,,28 ,,NW,,,,,,"$1,445.62",$0.00,1,1,1,1,1,1,20120101,E2100,HCPCS,BLD GLUCOSE MONITOR W VOICE,NU,,28 ,,NW,,,,,,"$1,445.62",$0.00,1,1,1,1,1,1,20120101,E2100,HCPCS,BLD GLUCOSE MONITOR W VOICE,RR,,28 ,,NW,,,,,,$123.98,$0.00,1,1,1,1,1,1,20120101,E2100,HCPCS,BLD GLUCOSE MONITOR W VOICE,UE,,28 ,,NW,,,,,,"$1,081.80",$0.00,1,1,1,1,1,1,20120101,E2101,HCPCS,BLD GLUCOSE MONITOR W LANCE,,,28 ,,NW,,,,,,$446.63,$0.00,1,1,1,1,1,1,20120101,E2101,HCPCS,BLD GLUCOSE MONITOR W LANCE,NU,,28 ,,NW,,,,,,$446.63,$0.00,1,1,1,1,1,1,20120101,E2101,HCPCS,BLD GLUCOSE MONITOR W LANCE,RR,,28 ,,NW,,,,,,$40.12,$0.00,1,1,1,1,1,1,20120101,E2101,HCPCS,BLD GLUCOSE MONITOR W LANCE,UE,,28 ,,NW,,,,,,$328.87,$0.00,1,1,1,1,1,1,20120101,E2120,HCPCS,PULSE GEN SYS TX ENDOLYMP FL,,,28 ,,NW,,,,,,"$6,543.89",$0.00,1,1,1,1,1,1,20120101,E2120,HCPCS,PULSE GEN SYS TX ENDOLYMP FL,RR,,28 ,,NW,,,,,,$683.85,$0.00,1,1,1,1,1,1,20120101,E2201,HCPCS,"MAN W/CH ACC SEAT W>=20""<24""",,,28 ,,NW,,,,,,$661.07,$0.00,1,1,1,1,1,1,20120101,E2201,HCPCS,"MAN W/CH ACC SEAT W>=20""<24""",NU,,28 ,,NW,,,,,,$661.07,$0.00,1,1,1,1,1,1,20120101,E2201,HCPCS,"MAN W/CH ACC SEAT W>=20""<24""",RR,,28 ,,NW,,,,,,$76.83,$0.00,1,1,1,1,1,1,20120101,E2201,HCPCS,"MAN W/CH ACC SEAT W>=20""<24""",UE,,28 ,,NW,,,,,,$506.18,$0.00,1,1,1,1,1,1,20120101,E2202,HCPCS,SEAT WIDTH 24-27 IN,,,28 ,,NW,,,,,,$828.57,$0.00,1,1,1,1,1,1,20120101,E2202,HCPCS,SEAT WIDTH 24-27 IN,NU,,28 ,,NW,,,,,,$828.57,$0.00,1,1,1,1,1,1,20120101,E2202,HCPCS,SEAT WIDTH 24-27 IN,RR,,28 ,,NW,,,,,,$97.64,$0.00,1,1,1,1,1,1,20120101,E2202,HCPCS,SEAT WIDTH 24-27 IN,UE,,28 ,,NW,,,,,,$631.85,$0.00,1,1,1,1,1,1,20120101,E2203,HCPCS,FRAME DEPTH LESS THAN 22 IN,,,28 ,,NW,,,,,,$836.99,$0.00,1,1,1,1,1,1,20120101,E2203,HCPCS,FRAME DEPTH LESS THAN 22 IN,NU,,28 ,,NW,,,,,,$836.99,$0.00,1,1,1,1,1,1,20120101,E2203,HCPCS,FRAME DEPTH LESS THAN 22 IN,RR,,28 ,,NW,,,,,,$98.64,$0.00,1,1,1,1,1,1,20120101,E2203,HCPCS,FRAME DEPTH LESS THAN 22 IN,UE,,28 ,,NW,,,,,,$638.10,$0.00,1,1,1,1,1,1,20120101,E2204,HCPCS,FRAME DEPTH 22 TO 25 IN,,,28 ,,NW,,,,,,"$1,392.20",$0.00,1,1,1,1,1,1,20120101,E2204,HCPCS,FRAME DEPTH 22 TO 25 IN,NU,,28 ,,NW,,,,,,"$1,392.20",$0.00,1,1,1,1,1,1,20120101,E2204,HCPCS,FRAME DEPTH 22 TO 25 IN,RR,,28 ,,NW,,,,,,$167.69,$0.00,1,1,1,1,1,1,20120101,E2204,HCPCS,FRAME DEPTH 22 TO 25 IN,UE,,28 ,,NW,,,,,,"$1,054.52",$0.00,1,1,1,1,1,1,20120101,E2205,HCPCS,"MANUAL WC ACCESSORY, HANDRIM",,,28 ,,NW,,,,,,$67.00,$0.00,1,1,1,1,1,1,20120101,E2205,HCPCS,"MANUAL WC ACCESSORY, HANDRIM",NU,,28 ,,NW,,,,,,$67.00,$0.00,1,1,1,1,1,1,20120101,E2205,HCPCS,"MANUAL WC ACCESSORY, HANDRIM",RR,,28 ,,NW,,,,,,$6.51,$0.00,1,1,1,1,1,1,20120101,E2205,HCPCS,"MANUAL WC ACCESSORY, HANDRIM",UE,,28 ,,NW,,,,,,$50.24,$0.00,1,1,1,1,1,1,20120101,E2206,HCPCS,COMPLETE WHEEL LOCK ASSEMBLY,,,28 ,,NW,,,,,,$83.48,$0.00,1,1,1,1,1,1,20120101,E2206,HCPCS,COMPLETE WHEEL LOCK ASSEMBLY,NU,,28 ,,NW,,,,,,$83.48,$0.00,1,1,1,1,1,1,20120101,E2206,HCPCS,COMPLETE WHEEL LOCK ASSEMBLY,RR,,28 ,,NW,,,,,,$8.18,$0.00,1,1,1,1,1,1,20120101,E2206,HCPCS,COMPLETE WHEEL LOCK ASSEMBLY,UE,,28 ,,NW,,,,,,$62.56,$0.00,1,1,1,1,1,1,20120101,E2207,HCPCS,CRUTCH AND CANE HOLDER,,,28 ,,NW,,,,,,$88.96,$0.00,1,1,1,1,1,1,20120101,E2207,HCPCS,CRUTCH AND CANE HOLDER,NU,,28 ,,NW,,,,,,$88.96,$0.00,1,1,1,1,1,1,20120101,E2207,HCPCS,CRUTCH AND CANE HOLDER,RR,,28 ,,NW,,,,,,$8.77,$0.00,1,1,1,1,1,1,20120101,E2207,HCPCS,CRUTCH AND CANE HOLDER,UE,,28 ,,NW,,,,,,$66.69,$0.00,1,1,1,1,1,1,20120101,E2208,HCPCS,CYLINDER TANK CARRIER,,,28 ,,NW,,,,,,$407.44,$0.00,1,1,1,1,1,1,20120101,E2208,HCPCS,CYLINDER TANK CARRIER,NU,,28 ,,NW,,,,,,$407.44,$0.00,1,1,1,1,1,1,20120101,E2208,HCPCS,CYLINDER TANK CARRIER,RR,,28 ,,NW,,,,,,$45.28,$0.00,1,1,1,1,1,1,20120101,E2208,HCPCS,CYLINDER TANK CARRIER,UE,,28 ,,NW,,,,,,$315.98,$0.00,1,1,1,1,1,1,20120101,E2209,HCPCS,ARM TROUGH EACH,,,28 ,,NW,,,,,,$371.66,$0.00,1,1,1,1,1,1,20120101,E2209,HCPCS,ARM TROUGH EACH,NU,,28 ,,NW,,,,,,$371.66,$0.00,1,1,1,1,1,1,20120101,E2209,HCPCS,ARM TROUGH EACH,RR,,28 ,,NW,,,,,,$40.92,$0.00,1,1,1,1,1,1,20120101,E2209,HCPCS,ARM TROUGH EACH,UE,,28 ,,NW,,,,,,$289.15,$0.00,1,1,1,1,1,1,20120101,E2210,HCPCS,WHEELCHAIR BEARINGS,,,28 ,,NW,,,,,,$25.00,$0.00,1,1,1,1,1,1,20120101,E2210,HCPCS,WHEELCHAIR BEARINGS,NU,,28 ,,NW,,,,,,$25.00,$0.00,1,1,1,1,1,1,20120101,E2210,HCPCS,WHEELCHAIR BEARINGS,RR,,28 ,,NW,,,,,,$2.30,$0.00,1,1,1,1,1,1,20120101,E2210,HCPCS,WHEELCHAIR BEARINGS,UE,,28 ,,NW,,,,,,$18.74,$0.00,1,1,1,1,1,1,20120101,E2211,HCPCS,PNEUMATIC PROPULSION TIRE,,,28 ,,NW,,,,,,$79.66,$0.00,1,1,1,1,1,1,20120101,E2211,HCPCS,PNEUMATIC PROPULSION TIRE,NU,,28 ,,NW,,,,,,$79.66,$0.00,1,1,1,1,1,1,20120101,E2211,HCPCS,PNEUMATIC PROPULSION TIRE,RR,,28 ,,NW,,,,,,$7.74,$0.00,1,1,1,1,1,1,20120101,E2211,HCPCS,PNEUMATIC PROPULSION TIRE,UE,,28 ,,NW,,,,,,$57.32,$0.00,1,1,1,1,1,1,20120101,E2212,HCPCS,PNEUMATIC PROP TIRE TUBE,,,28 ,,NW,,,,,,$11.91,$0.00,1,1,1,1,1,1,20120101,E2212,HCPCS,PNEUMATIC PROP TIRE TUBE,NU,,28 ,,NW,,,,,,$11.91,$0.00,1,1,1,1,1,1,20120101,E2212,HCPCS,PNEUMATIC PROP TIRE TUBE,RR,,28 ,,NW,,,,,,$1.09,$0.00,1,1,1,1,1,1,20120101,E2212,HCPCS,PNEUMATIC PROP TIRE TUBE,UE,,28 ,,NW,,,,,,$8.93,$0.00,1,1,1,1,1,1,20120101,E2213,HCPCS,PNEUMATIC PROP TIRE INSERT,,,28 ,,NW,,,,,,$62.36,$0.00,1,1,1,1,1,1,20120101,E2213,HCPCS,PNEUMATIC PROP TIRE INSERT,NU,,28 ,,NW,,,,,,$62.36,$0.00,1,1,1,1,1,1,20120101,E2213,HCPCS,PNEUMATIC PROP TIRE INSERT,RR,,28 ,,NW,,,,,,$6.11,$0.00,1,1,1,1,1,1,20120101,E2213,HCPCS,PNEUMATIC PROP TIRE INSERT,UE,,28 ,,NW,,,,,,$46.69,$0.00,1,1,1,1,1,1,20120101,E2214,HCPCS,PNEUMATIC CASTER TIRE EACH,,,28 ,,NW,,,,,,$68.25,$0.00,1,1,1,1,1,1,20120101,E2214,HCPCS,PNEUMATIC CASTER TIRE EACH,NU,,28 ,,NW,,,,,,$68.25,$0.00,1,1,1,1,1,1,20120101,E2214,HCPCS,PNEUMATIC CASTER TIRE EACH,RR,,28 ,,NW,,,,,,$7.37,$0.00,1,1,1,1,1,1,20120101,E2214,HCPCS,PNEUMATIC CASTER TIRE EACH,UE,,28 ,,NW,,,,,,$51.17,$0.00,1,1,1,1,1,1,20120101,E2215,HCPCS,PNEUMATIC CASTER TIRE TUBE,,,28 ,,NW,,,,,,$19.57,$0.00,1,1,1,1,1,1,20120101,E2215,HCPCS,PNEUMATIC CASTER TIRE TUBE,NU,,28 ,,NW,,,,,,$19.57,$0.00,1,1,1,1,1,1,20120101,E2215,HCPCS,PNEUMATIC CASTER TIRE TUBE,RR,,28 ,,NW,,,,,,$1.79,$0.00,1,1,1,1,1,1,20120101,E2215,HCPCS,PNEUMATIC CASTER TIRE TUBE,UE,,28 ,,NW,,,,,,$14.59,$0.00,1,1,1,1,1,1,20120101,E2216,HCPCS,FOAM FILLED PROPULSION TIRE,,,28 ,,NW,,,,,,$101.53,$0.00,1,1,1,1,1,1,20120101,E2216,HCPCS,FOAM FILLED PROPULSION TIRE,NU,,28 ,,NW,,,,,,$101.53,$0.00,1,1,1,1,1,1,20120101,E2216,HCPCS,FOAM FILLED PROPULSION TIRE,RR,,28 ,,NW,,,,,,$10.68,$0.00,1,1,1,1,1,1,20120101,E2216,HCPCS,FOAM FILLED PROPULSION TIRE,UE,,28 ,,NW,,,,,,$76.30,$0.00,1,1,1,1,1,1,20120101,E2217,HCPCS,FOAM FILLED CASTER TIRE EACH,,,28 ,,NW,,,,,,$87.05,$0.00,1,1,1,1,1,1,20120101,E2217,HCPCS,FOAM FILLED CASTER TIRE EACH,NU,,28 ,,NW,,,,,,$87.05,$0.00,1,1,1,1,1,1,20120101,E2217,HCPCS,FOAM FILLED CASTER TIRE EACH,RR,,28 ,,NW,,,,,,$9.10,$0.00,1,1,1,1,1,1,20120101,E2217,HCPCS,FOAM FILLED CASTER TIRE EACH,UE,,28 ,,NW,,,,,,$65.40,$0.00,1,1,1,1,1,1,20120101,E2218,HCPCS,FOAM PROPULSION TIRE EACH,,,28 ,,NW,,,,,,$176.47,$0.00,1,1,1,1,1,1,20120101,E2218,HCPCS,FOAM PROPULSION TIRE EACH,NU,,28 ,,NW,,,,,,$176.47,$0.00,1,1,1,1,1,1,20120101,E2218,HCPCS,FOAM PROPULSION TIRE EACH,RR,,28 ,,NW,,,,,,$18.99,$0.00,1,1,1,1,1,1,20120101,E2218,HCPCS,FOAM PROPULSION TIRE EACH,UE,,28 ,,NW,,,,,,$132.77,$0.00,1,1,1,1,1,1,20120101,E2219,HCPCS,FOAM CASTER TIRE ANY SIZE EA,,,28 ,,NW,,,,,,$82.04,$0.00,1,1,1,1,1,1,20120101,E2219,HCPCS,FOAM CASTER TIRE ANY SIZE EA,NU,,28 ,,NW,,,,,,$82.04,$0.00,1,1,1,1,1,1,20120101,E2219,HCPCS,FOAM CASTER TIRE ANY SIZE EA,RR,,28 ,,NW,,,,,,$9.05,$0.00,1,1,1,1,1,1,20120101,E2219,HCPCS,FOAM CASTER TIRE ANY SIZE EA,UE,,28 ,,NW,,,,,,$61.50,$0.00,1,1,1,1,1,1,20120101,E2220,HCPCS,SOLID PROPULSION TIRE EACH,,,28 ,,NW,,,,,,$55.39,$0.00,1,1,1,1,1,1,20120101,E2220,HCPCS,SOLID PROPULSION TIRE EACH,NU,,28 ,,NW,,,,,,$55.39,$0.00,1,1,1,1,1,1,20120101,E2220,HCPCS,SOLID PROPULSION TIRE EACH,RR,,28 ,,NW,,,,,,$5.23,$0.00,1,1,1,1,1,1,20120101,E2220,HCPCS,SOLID PROPULSION TIRE EACH,UE,,28 ,,NW,,,,,,$42.38,$0.00,1,1,1,1,1,1,20120101,E2221,HCPCS,SOLID CASTER TIRE EACH,,,28 ,,NW,,,,,,$52.36,$0.00,1,1,1,1,1,1,20120101,E2221,HCPCS,SOLID CASTER TIRE EACH,NU,,28 ,,NW,,,,,,$52.36,$0.00,1,1,1,1,1,1,20120101,E2221,HCPCS,SOLID CASTER TIRE EACH,RR,,28 ,,NW,,,,,,$5.12,$0.00,1,1,1,1,1,1,20120101,E2221,HCPCS,SOLID CASTER TIRE EACH,UE,,28 ,,NW,,,,,,$39.25,$0.00,1,1,1,1,1,1,20120101,E2222,HCPCS,SOLID CASTER INTEGRATED WHL,,,28 ,,NW,,,,,,$43.29,$0.00,1,1,1,1,1,1,20120101,E2222,HCPCS,SOLID CASTER INTEGRATED WHL,NU,,28 ,,NW,,,,,,$43.29,$0.00,1,1,1,1,1,1,20120101,E2222,HCPCS,SOLID CASTER INTEGRATED WHL,RR,,28 ,,NW,,,,,,$4.14,$0.00,1,1,1,1,1,1,20120101,E2222,HCPCS,SOLID CASTER INTEGRATED WHL,UE,,28 ,,NW,,,,,,$32.45,$0.00,1,1,1,1,1,1,20120101,E2224,HCPCS,PROPULSION WHL EXCLUDES TIRE,,,28 ,,NW,,,,,,$183.21,$0.00,1,1,1,1,1,1,20120101,E2224,HCPCS,PROPULSION WHL EXCLUDES TIRE,NU,,28 ,,NW,,,,,,$183.21,$0.00,1,1,1,1,1,1,20120101,E2224,HCPCS,PROPULSION WHL EXCLUDES TIRE,RR,,28 ,,NW,,,,,,$19.07,$0.00,1,1,1,1,1,1,20120101,E2224,HCPCS,PROPULSION WHL EXCLUDES TIRE,UE,,28 ,,NW,,,,,,$137.15,$0.00,1,1,1,1,1,1,20120101,E2225,HCPCS,CASTER WHEEL EXCLUDES TIRE,,,28 ,,NW,,,,,,$35.73,$0.00,1,1,1,1,1,1,20120101,E2225,HCPCS,CASTER WHEEL EXCLUDES TIRE,NU,,28 ,,NW,,,,,,$35.73,$0.00,1,1,1,1,1,1,20120101,E2225,HCPCS,CASTER WHEEL EXCLUDES TIRE,RR,,28 ,,NW,,,,,,$3.43,$0.00,1,1,1,1,1,1,20120101,E2225,HCPCS,CASTER WHEEL EXCLUDES TIRE,UE,,28 ,,NW,,,,,,$26.74,$0.00,1,1,1,1,1,1,20120101,E2226,HCPCS,CASTER FORK REPLACEMENT ONLY,,,28 ,,NW,,,,,,$78.13,$0.00,1,1,1,1,1,1,20120101,E2226,HCPCS,CASTER FORK REPLACEMENT ONLY,NU,,28 ,,NW,,,,,,$78.13,$0.00,1,1,1,1,1,1,20120101,E2226,HCPCS,CASTER FORK REPLACEMENT ONLY,RR,,28 ,,NW,,,,,,$7.66,$0.00,1,1,1,1,1,1,20120101,E2226,HCPCS,CASTER FORK REPLACEMENT ONLY,UE,,28 ,,NW,,,,,,$58.55,$0.00,1,1,1,1,1,1,20120101,E2227,HCPCS,GEAR REDUCTION DRIVE WHEEL,,,28 ,,NW,,,,,,"$3,095.20",$0.00,1,1,1,1,1,1,20120101,E2227,HCPCS,GEAR REDUCTION DRIVE WHEEL,NU,,28 ,,NW,,,,,,"$3,095.20",$0.00,1,1,1,1,1,1,20120101,E2227,HCPCS,GEAR REDUCTION DRIVE WHEEL,RR,,28 ,,NW,,,,,,$346.88,$0.00,1,1,1,1,1,1,20120101,E2227,HCPCS,GEAR REDUCTION DRIVE WHEEL,UE,,28 ,,NW,,,,,,"$2,331.79",$0.00,1,1,1,1,1,1,20120101,E2228,HCPCS,"MWC ACC, WHEELCHAIR BRAKE",,,28 ,,NW,,,,,,"$1,596.21",$0.00,1,1,1,1,1,1,20120101,E2228,HCPCS,"MWC ACC, WHEELCHAIR BRAKE",NU,,28 ,,NW,,,,,,"$1,596.21",$0.00,1,1,1,1,1,1,20120101,E2228,HCPCS,"MWC ACC, WHEELCHAIR BRAKE",RR,,28 ,,NW,,,,,,$193.01,$0.00,1,1,1,1,1,1,20120101,E2228,HCPCS,"MWC ACC, WHEELCHAIR BRAKE",UE,,28 ,,NW,,,,,,"$1,207.57",$0.00,1,1,1,1,1,1,20120101,E2230,HCPCS,MANUAL STANDING SYSTEM,,,28 ,,NW,,,,,,"$1,789.22",$0.00,1,1,1,1,1,1,20120101,E2231,HCPCS,SOLID SEAT SUPPORT BASE,,,28 ,,NW,,,,,,$296.70,$0.00,1,1,1,1,1,1,20120101,E2231,HCPCS,SOLID SEAT SUPPORT BASE,NU,,28 ,,NW,,,,,,$296.70,$0.00,1,1,1,1,1,1,20120101,E2231,HCPCS,SOLID SEAT SUPPORT BASE,RR,,28 ,,NW,,,,,,$31.54,$0.00,1,1,1,1,1,1,20120101,E2231,HCPCS,SOLID SEAT SUPPORT BASE,UE,,28 ,,NW,,,,,,$232.89,$0.00,1,1,1,1,1,1,20120101,E2295,HCPCS,PED DYNAMIC SEATING FRAME,,,28 ,,NW,,,,,,$115.04,$0.00,1,1,1,1,1,1,20120101,E2300,HCPCS,PWR SEAT ELEVATION SYS,,,28 ,,NW,,,,,,"$1,556.29",$0.00,1,1,1,1,1,1,20120101,E2301,HCPCS,PWR STANDING,,,28 ,,NW,,,,,,"$3,004.21",$0.00,1,1,1,1,1,1,20120101,E2310,HCPCS,ELECTRO CONNECT BTW CONTROL,,,28 ,,NW,,,,,,"$3,659.61",$0.00,1,1,1,1,1,1,20120101,E2310,HCPCS,ELECTRO CONNECT BTW CONTROL,NU,,28 ,,NW,,,,,,"$3,659.61",$0.00,1,1,1,1,1,1,20120101,E2310,HCPCS,ELECTRO CONNECT BTW CONTROL,RR,,28 ,,NW,,,,,,$403.30,$0.00,1,1,1,1,1,1,20120101,E2310,HCPCS,ELECTRO CONNECT BTW CONTROL,UE,,28 ,,NW,,,,,,"$2,755.09",$0.00,1,1,1,1,1,1,20120101,E2311,HCPCS,ELECTRO CONNECT BTW 2 SYS,,,28 ,,NW,,,,,,"$7,366.52",$0.00,1,1,1,1,1,1,20120101,E2311,HCPCS,ELECTRO CONNECT BTW 2 SYS,NU,,28 ,,NW,,,,,,"$7,366.52",$0.00,1,1,1,1,1,1,20120101,E2311,HCPCS,ELECTRO CONNECT BTW 2 SYS,RR,,28 ,,NW,,,,,,$774.05,$0.00,1,1,1,1,1,1,20120101,E2311,HCPCS,ELECTRO CONNECT BTW 2 SYS,UE,,28 ,,NW,,,,,,"$5,535.25",$0.00,1,1,1,1,1,1,20120101,E2312,HCPCS,MINI-PROP REMOTE JOYSTICK,,,28 ,,NW,,,,,,"$7,532.40",$0.00,1,1,1,1,1,1,20120101,E2312,HCPCS,MINI-PROP REMOTE JOYSTICK,NU,,28 ,,NW,,,,,,"$7,532.40",$0.00,1,1,1,1,1,1,20120101,E2312,HCPCS,MINI-PROP REMOTE JOYSTICK,RR,,28 ,,NW,,,,,,$790.60,$0.00,1,1,1,1,1,1,20120101,E2312,HCPCS,MINI-PROP REMOTE JOYSTICK,UE,,28 ,,NW,,,,,,"$5,659.67",$0.00,1,1,1,1,1,1,20120101,E2313,HCPCS,"PWC HARNESS, EXPAND CONTROL",,,28 ,,NW,,,,,,$564.30,$0.00,1,1,1,1,1,1,20120101,E2313,HCPCS,"PWC HARNESS, EXPAND CONTROL",NU,,28 ,,NW,,,,,,$564.30,$0.00,1,1,1,1,1,1,20120101,E2313,HCPCS,"PWC HARNESS, EXPAND CONTROL",RR,,28 ,,NW,,,,,,$64.82,$0.00,1,1,1,1,1,1,20120101,E2313,HCPCS,"PWC HARNESS, EXPAND CONTROL",UE,,28 ,,NW,,,,,,$433.61,$0.00,1,1,1,1,1,1,20120101,E2321,HCPCS,HAND INTERFACE JOYSTICK,,,28 ,,NW,,,,,,"$8,659.30",$0.00,1,1,1,1,1,1,20120101,E2321,HCPCS,HAND INTERFACE JOYSTICK,NU,,28 ,,NW,,,,,,"$8,659.30",$0.00,1,1,1,1,1,1,20120101,E2321,HCPCS,HAND INTERFACE JOYSTICK,RR,,28 ,,NW,,,,,,$903.34,$0.00,1,1,1,1,1,1,20120101,E2321,HCPCS,HAND INTERFACE JOYSTICK,UE,,28 ,,NW,,,,,,"$6,504.88",$0.00,1,1,1,1,1,1,20120101,E2322,HCPCS,MULT MECH SWITCHES,,,28 ,,NW,,,,,,"$8,325.18",$0.00,1,1,1,1,1,1,20120101,E2322,HCPCS,MULT MECH SWITCHES,NU,,28 ,,NW,,,,,,"$8,325.18",$0.00,1,1,1,1,1,1,20120101,E2322,HCPCS,MULT MECH SWITCHES,RR,,28 ,,NW,,,,,,$869.84,$0.00,1,1,1,1,1,1,20120101,E2322,HCPCS,MULT MECH SWITCHES,UE,,28 ,,NW,,,,,,"$6,254.29",$0.00,1,1,1,1,1,1,20120101,E2323,HCPCS,SPECIAL JOYSTICK HANDLE,,,28 ,,NW,,,,,,$255.35,$0.00,1,1,1,1,1,1,20120101,E2323,HCPCS,SPECIAL JOYSTICK HANDLE,NU,,28 ,,NW,,,,,,$255.35,$0.00,1,1,1,1,1,1,20120101,E2323,HCPCS,SPECIAL JOYSTICK HANDLE,RR,,28 ,,NW,,,,,,$26.41,$0.00,1,1,1,1,1,1,20120101,E2323,HCPCS,SPECIAL JOYSTICK HANDLE,UE,,28 ,,NW,,,,,,$199.11,$0.00,1,1,1,1,1,1,20120101,E2324,HCPCS,CHIN CUP INTERFACE,,,28 ,,NW,,,,,,$168.18,$0.00,1,1,1,1,1,1,20120101,E2324,HCPCS,CHIN CUP INTERFACE,NU,,28 ,,NW,,,,,,$168.18,$0.00,1,1,1,1,1,1,20120101,E2324,HCPCS,CHIN CUP INTERFACE,RR,,28 ,,NW,,,,,,$16.63,$0.00,1,1,1,1,1,1,20120101,E2324,HCPCS,CHIN CUP INTERFACE,UE,,28 ,,NW,,,,,,$126.13,$0.00,1,1,1,1,1,1,20120101,E2325,HCPCS,SIP AND PUFF INTERFACE,,,28 ,,NW,,,,,,"$4,205.59",$0.00,1,1,1,1,1,1,20120101,E2325,HCPCS,SIP AND PUFF INTERFACE,NU,,28 ,,NW,,,,,,"$4,205.59",$0.00,1,1,1,1,1,1,20120101,E2325,HCPCS,SIP AND PUFF INTERFACE,RR,,28 ,,NW,,,,,,$457.98,$0.00,1,1,1,1,1,1,20120101,E2325,HCPCS,SIP AND PUFF INTERFACE,UE,,28 ,,NW,,,,,,"$3,164.61",$0.00,1,1,1,1,1,1,20120101,E2326,HCPCS,BREATH TUBE KIT,,,28 ,,NW,,,,,,"$1,114.80",$0.00,1,1,1,1,1,1,20120101,E2326,HCPCS,BREATH TUBE KIT,NU,,28 ,,NW,,,,,,"$1,114.80",$0.00,1,1,1,1,1,1,20120101,E2326,HCPCS,BREATH TUBE KIT,RR,,28 ,,NW,,,,,,$133.27,$0.00,1,1,1,1,1,1,20120101,E2326,HCPCS,BREATH TUBE KIT,UE,,28 ,,NW,,,,,,$846.43,$0.00,1,1,1,1,1,1,20120101,E2327,HCPCS,HEAD CONTROL INTERFACE MECH,,,28 ,,NW,,,,,,"$13,798.69",$0.00,1,1,1,1,1,1,20120101,E2327,HCPCS,HEAD CONTROL INTERFACE MECH,NU,,28 ,,NW,,,,,,"$13,798.69",$0.00,1,1,1,1,1,1,20120101,E2327,HCPCS,HEAD CONTROL INTERFACE MECH,RR,,28 ,,NW,,,,,,"$1,417.23",$0.00,1,1,1,1,1,1,20120101,E2327,HCPCS,HEAD CONTROL INTERFACE MECH,UE,,28 ,,NW,,,,,,"$10,359.36",$0.00,1,1,1,1,1,1,20120101,E2328,HCPCS,HEAD/EXTREMITY CONTROL INTER,,,28 ,,NW,,,,,,"$15,362.18",$0.00,1,1,1,1,1,1,20120101,E2328,HCPCS,HEAD/EXTREMITY CONTROL INTER,NU,,28 ,,NW,,,,,,"$15,362.18",$0.00,1,1,1,1,1,1,20120101,E2328,HCPCS,HEAD/EXTREMITY CONTROL INTER,RR,,28 ,,NW,,,,,,"$1,573.55",$0.00,1,1,1,1,1,1,20120101,E2328,HCPCS,HEAD/EXTREMITY CONTROL INTER,UE,,28 ,,NW,,,,,,"$11,532.05",$0.00,1,1,1,1,1,1,20120101,E2329,HCPCS,HEAD CONTROL NONPROPORTIONAL,,,28 ,,NW,,,,,,"$5,501.98",$0.00,1,1,1,1,1,1,20120101,E2329,HCPCS,HEAD CONTROL NONPROPORTIONAL,NU,,28 ,,NW,,,,,,"$5,501.98",$0.00,1,1,1,1,1,1,20120101,E2329,HCPCS,HEAD CONTROL NONPROPORTIONAL,RR,,28 ,,NW,,,,,,$587.54,$0.00,1,1,1,1,1,1,20120101,E2329,HCPCS,HEAD CONTROL NONPROPORTIONAL,UE,,28 ,,NW,,,,,,"$4,136.85",$0.00,1,1,1,1,1,1,20120101,E2330,HCPCS,HEAD CONTROL PROXIMITY SWITC,,,28 ,,NW,,,,,,"$10,621.78",$0.00,1,1,1,1,1,1,20120101,E2330,HCPCS,HEAD CONTROL PROXIMITY SWITC,NU,,28 ,,NW,,,,,,"$10,621.78",$0.00,1,1,1,1,1,1,20120101,E2330,HCPCS,HEAD CONTROL PROXIMITY SWITC,RR,,28 ,,NW,,,,,,"$1,099.51",$0.00,1,1,1,1,1,1,20120101,E2330,HCPCS,HEAD CONTROL PROXIMITY SWITC,UE,,28 ,,NW,,,,,,"$7,976.77",$0.00,1,1,1,1,1,1,20120101,E2331,HCPCS,ATTENDANT CONTROL,,,28 ,,NW,,,,,,$727.51,$0.00,1,1,1,1,1,1,20120101,E2340,HCPCS,W/C WDTH 20-23 IN SEAT FRAME,,,28 ,,NW,,,,,,$636.58,$0.00,1,1,1,1,1,1,20120101,E2340,HCPCS,W/C WDTH 20-23 IN SEAT FRAME,NU,,28 ,,NW,,,,,,$636.58,$0.00,1,1,1,1,1,1,20120101,E2340,HCPCS,W/C WDTH 20-23 IN SEAT FRAME,RR,,28 ,,NW,,,,,,$73.80,$0.00,1,1,1,1,1,1,20120101,E2340,HCPCS,W/C WDTH 20-23 IN SEAT FRAME,UE,,28 ,,NW,,,,,,$487.85,$0.00,1,1,1,1,1,1,20120101,E2341,HCPCS,W/C WDTH 24-27 IN SEAT FRAME,,,28 ,,NW,,,,,,$934.19,$0.00,1,1,1,1,1,1,20120101,E2341,HCPCS,W/C WDTH 24-27 IN SEAT FRAME,NU,,28 ,,NW,,,,,,$934.19,$0.00,1,1,1,1,1,1,20120101,E2341,HCPCS,W/C WDTH 24-27 IN SEAT FRAME,RR,,28 ,,NW,,,,,,$110.76,$0.00,1,1,1,1,1,1,20120101,E2341,HCPCS,W/C WDTH 24-27 IN SEAT FRAME,UE,,28 ,,NW,,,,,,$711.03,$0.00,1,1,1,1,1,1,20120101,E2342,HCPCS,W/C DPTH 20-21 IN SEAT FRAME,,,28 ,,NW,,,,,,$785.40,$0.00,1,1,1,1,1,1,20120101,E2342,HCPCS,W/C DPTH 20-21 IN SEAT FRAME,NU,,28 ,,NW,,,,,,$785.40,$0.00,1,1,1,1,1,1,20120101,E2342,HCPCS,W/C DPTH 20-21 IN SEAT FRAME,RR,,28 ,,NW,,,,,,$92.27,$0.00,1,1,1,1,1,1,20120101,E2342,HCPCS,W/C DPTH 20-21 IN SEAT FRAME,UE,,28 ,,NW,,,,,,$599.44,$0.00,1,1,1,1,1,1,20120101,E2343,HCPCS,W/C DPTH 22-25 IN SEAT FRAME,,,28 ,,NW,,,,,,"$1,231.76",$0.00,1,1,1,1,1,1,20120101,E2343,HCPCS,W/C DPTH 22-25 IN SEAT FRAME,NU,,28 ,,NW,,,,,,"$1,231.76",$0.00,1,1,1,1,1,1,20120101,E2343,HCPCS,W/C DPTH 22-25 IN SEAT FRAME,RR,,28 ,,NW,,,,,,$147.71,$0.00,1,1,1,1,1,1,20120101,E2343,HCPCS,W/C DPTH 22-25 IN SEAT FRAME,UE,,28 ,,NW,,,,,,$934.19,$0.00,1,1,1,1,1,1,20120101,E2351,HCPCS,ELECTRONIC SGD INTERFACE,,,28 ,,NW,,,,,,"$2,201.52",$0.00,1,1,1,1,1,1,20120101,E2351,HCPCS,ELECTRONIC SGD INTERFACE,NU,,28 ,,NW,,,,,,"$2,201.52",$0.00,1,1,1,1,1,1,20120101,E2351,HCPCS,ELECTRONIC SGD INTERFACE,RR,,28 ,,NW,,,,,,$257.57,$0.00,1,1,1,1,1,1,20120101,E2351,HCPCS,ELECTRONIC SGD INTERFACE,UE,,28 ,,NW,,,,,,"$1,661.48",$0.00,1,1,1,1,1,1,20120101,E2360,HCPCS,22NF NONSEALED LEADACID,,,28 ,,NW,,,,,,$216.77,$0.00,1,1,1,1,1,1,20120101,E2360,HCPCS,22NF NONSEALED LEADACID,NU,,28 ,,NW,,,,,,$216.77,$0.00,1,1,1,1,1,1,20120101,E2360,HCPCS,22NF NONSEALED LEADACID,RR,,28 ,,NW,,,,,,$21.71,$0.00,1,1,1,1,1,1,20120101,E2360,HCPCS,22NF NONSEALED LEADACID,UE,,28 ,,NW,,,,,,$163.21,$0.00,1,1,1,1,1,1,20120101,E2361,HCPCS,22NF SEALED LEADACID BATTERY,,,28 ,,NW,,,,,,$471.12,$0.00,1,1,1,1,1,1,20120101,E2361,HCPCS,22NF SEALED LEADACID BATTERY,NU,,28 ,,NW,,,,,,$471.12,$0.00,1,1,1,1,1,1,20120101,E2361,HCPCS,22NF SEALED LEADACID BATTERY,RR,,28 ,,NW,,,,,,$53.25,$0.00,1,1,1,1,1,1,20120101,E2361,HCPCS,22NF SEALED LEADACID BATTERY,UE,,28 ,,NW,,,,,,$363.77,$0.00,1,1,1,1,1,1,20120101,E2362,HCPCS,GR24 NONSEALED LEADACID,,,28 ,,NW,,,,,,$188.95,$0.00,1,1,1,1,1,1,20120101,E2362,HCPCS,GR24 NONSEALED LEADACID,NU,,28 ,,NW,,,,,,$188.95,$0.00,1,1,1,1,1,1,20120101,E2362,HCPCS,GR24 NONSEALED LEADACID,RR,,28 ,,NW,,,,,,$18.74,$0.00,1,1,1,1,1,1,20120101,E2362,HCPCS,GR24 NONSEALED LEADACID,UE,,28 ,,NW,,,,,,$141.67,$0.00,1,1,1,1,1,1,20120101,E2363,HCPCS,GR24 SEALED LEADACID BATTERY,,,28 ,,NW,,,,,,$614.53,$0.00,1,1,1,1,1,1,20120101,E2363,HCPCS,GR24 SEALED LEADACID BATTERY,NU,,28 ,,NW,,,,,,$614.53,$0.00,1,1,1,1,1,1,20120101,E2363,HCPCS,GR24 SEALED LEADACID BATTERY,RR,,28 ,,NW,,,,,,$71.07,$0.00,1,1,1,1,1,1,20120101,E2363,HCPCS,GR24 SEALED LEADACID BATTERY,UE,,28 ,,NW,,,,,,$471.29,$0.00,1,1,1,1,1,1,20120101,E2364,HCPCS,U1NONSEALED LEADACID BATTERY,,,28 ,,NW,,,,,,$216.77,$0.00,1,1,1,1,1,1,20120101,E2364,HCPCS,U1NONSEALED LEADACID BATTERY,NU,,28 ,,NW,,,,,,$216.77,$0.00,1,1,1,1,1,1,20120101,E2364,HCPCS,U1NONSEALED LEADACID BATTERY,RR,,28 ,,NW,,,,,,$21.71,$0.00,1,1,1,1,1,1,20120101,E2364,HCPCS,U1NONSEALED LEADACID BATTERY,UE,,28 ,,NW,,,,,,$163.20,$0.00,1,1,1,1,1,1,20120101,E2365,HCPCS,U1 SEALED LEADACID BATTERY,,,28 ,,NW,,,,,,$387.09,$0.00,1,1,1,1,1,1,20120101,E2365,HCPCS,U1 SEALED LEADACID BATTERY,NU,,28 ,,NW,,,,,,$387.09,$0.00,1,1,1,1,1,1,20120101,E2365,HCPCS,U1 SEALED LEADACID BATTERY,RR,,28 ,,NW,,,,,,$42.78,$0.00,1,1,1,1,1,1,20120101,E2365,HCPCS,U1 SEALED LEADACID BATTERY,UE,,28 ,,NW,,,,,,$300.85,$0.00,1,1,1,1,1,1,20120101,E2366,HCPCS,"BATTERY CHARGER, SINGLE MODE",,,28 ,,NW,,,,,,$807.01,$0.00,1,1,1,1,1,1,20120101,E2366,HCPCS,"BATTERY CHARGER, SINGLE MODE",NU,,28 ,,NW,,,,,,$807.01,$0.00,1,1,1,1,1,1,20120101,E2366,HCPCS,"BATTERY CHARGER, SINGLE MODE",RR,,28 ,,NW,,,,,,$95.23,$0.00,1,1,1,1,1,1,20120101,E2366,HCPCS,"BATTERY CHARGER, SINGLE MODE",UE,,28 ,,NW,,,,,,$616.09,$0.00,1,1,1,1,1,1,20120101,E2367,HCPCS,"BATTERY CHARGER, DUAL MODE",,,28 ,,NW,,,,,,"$1,337.20",$0.00,1,1,1,1,1,1,20120101,E2367,HCPCS,"BATTERY CHARGER, DUAL MODE",NU,,28 ,,NW,,,,,,"$1,337.20",$0.00,1,1,1,1,1,1,20120101,E2367,HCPCS,"BATTERY CHARGER, DUAL MODE",RR,,28 ,,NW,,,,,,$160.87,$0.00,1,1,1,1,1,1,20120101,E2367,HCPCS,"BATTERY CHARGER, DUAL MODE",UE,,28 ,,NW,,,,,,"$1,013.30",$0.00,1,1,1,1,1,1,20120101,E2368,HCPCS,POWER WC MOTOR REPLACEMENT,,,28 ,,NW,,,,,,"$1,638.63",$0.00,1,1,1,1,1,1,20120101,E2368,HCPCS,POWER WC MOTOR REPLACEMENT,NU,,28 ,,NW,,,,,,"$1,638.63",$0.00,1,1,1,1,1,1,20120101,E2368,HCPCS,POWER WC MOTOR REPLACEMENT,RR,,28 ,,NW,,,,,,$198.34,$0.00,1,1,1,1,1,1,20120101,E2368,HCPCS,POWER WC MOTOR REPLACEMENT,UE,,28 ,,NW,,,,,,"$1,239.37",$0.00,1,1,1,1,1,1,20120101,E2369,HCPCS,PWR WC GEAR BOX REPLACEMENT,,,28 ,,NW,,,,,,"$1,432.63",$0.00,1,1,1,1,1,1,20120101,E2369,HCPCS,PWR WC GEAR BOX REPLACEMENT,NU,,28 ,,NW,,,,,,"$1,432.63",$0.00,1,1,1,1,1,1,20120101,E2369,HCPCS,PWR WC GEAR BOX REPLACEMENT,RR,,28 ,,NW,,,,,,$172.73,$0.00,1,1,1,1,1,1,20120101,E2369,HCPCS,PWR WC GEAR BOX REPLACEMENT,UE,,28 ,,NW,,,,,,"$1,084.82",$0.00,1,1,1,1,1,1,20120101,E2370,HCPCS,PWR WC MOTOR/GEAR BOX COMBO,,,28 ,,NW,,,,,,"$2,523.70",$0.00,1,1,1,1,1,1,20120101,E2370,HCPCS,PWR WC MOTOR/GEAR BOX COMBO,NU,,28 ,,NW,,,,,,"$2,523.70",$0.00,1,1,1,1,1,1,20120101,E2370,HCPCS,PWR WC MOTOR/GEAR BOX COMBO,RR,,28 ,,NW,,,,,,$289.75,$0.00,1,1,1,1,1,1,20120101,E2370,HCPCS,PWR WC MOTOR/GEAR BOX COMBO,UE,,28 ,,NW,,,,,,"$1,903.14",$0.00,1,1,1,1,1,1,20120101,E2371,HCPCS,GR27 SEALED LEADACID BATTERY,,,28 ,,NW,,,,,,$507.56,$0.00,1,1,1,1,1,1,20120101,E2371,HCPCS,GR27 SEALED LEADACID BATTERY,NU,,28 ,,NW,,,,,,$507.56,$0.00,1,1,1,1,1,1,20120101,E2371,HCPCS,GR27 SEALED LEADACID BATTERY,RR,,28 ,,NW,,,,,,$57.77,$0.00,1,1,1,1,1,1,20120101,E2371,HCPCS,GR27 SEALED LEADACID BATTERY,UE,,28 ,,NW,,,,,,$391.06,$0.00,1,1,1,1,1,1,20120101,E2372,HCPCS,GR27 NON-SEALED LEADACID,,,28 ,,NW,,,,,,$709.89,$0.00,1,1,1,1,1,1,20120101,E2372,HCPCS,GR27 NON-SEALED LEADACID,NU,,28 ,,NW,,,,,,$709.89,$0.00,1,1,1,1,1,1,20120101,E2372,HCPCS,GR27 NON-SEALED LEADACID,RR,,28 ,,NW,,,,,,$76.26,$0.00,1,1,1,1,1,1,20120101,E2372,HCPCS,GR27 NON-SEALED LEADACID,UE,,28 ,,NW,,,,,,$534.08,$0.00,1,1,1,1,1,1,20120101,E2373,HCPCS,HAND/CHIN CTRL SPEC JOYSTICK,,,28 ,,NW,,,,,,"$4,107.07",$0.00,1,1,1,1,1,1,20120101,E2373,HCPCS,HAND/CHIN CTRL SPEC JOYSTICK,NU,,28 ,,NW,,,,,,"$4,107.07",$0.00,1,1,1,1,1,1,20120101,E2373,HCPCS,HAND/CHIN CTRL SPEC JOYSTICK,RR,,28 ,,NW,,,,,,$448.09,$0.00,1,1,1,1,1,1,20120101,E2373,HCPCS,HAND/CHIN CTRL SPEC JOYSTICK,UE,,28 ,,NW,,,,,,"$3,090.75",$0.00,1,1,1,1,1,1,20120101,E2374,HCPCS,HAND/CHIN CTRL STD JOYSTICK,,,28 ,,NW,,,,,,"$1,692.58",$0.00,1,1,1,1,1,1,20120101,E2374,HCPCS,HAND/CHIN CTRL STD JOYSTICK,NU,,28 ,,NW,,,,,,"$1,692.58",$0.00,1,1,1,1,1,1,20120101,E2374,HCPCS,HAND/CHIN CTRL STD JOYSTICK,RR,,28 ,,NW,,,,,,$204.99,$0.00,1,1,1,1,1,1,20120101,E2374,HCPCS,HAND/CHIN CTRL STD JOYSTICK,UE,,28 ,,NW,,,,,,"$1,279.87",$0.00,1,1,1,1,1,1,20120101,E2375,HCPCS,NON-EXPANDABLE CONTROLLER,,,28 ,,NW,,,,,,"$2,689.79",$0.00,1,1,1,1,1,1,20120101,E2375,HCPCS,NON-EXPANDABLE CONTROLLER,NU,,28 ,,NW,,,,,,"$2,689.79",$0.00,1,1,1,1,1,1,20120101,E2375,HCPCS,NON-EXPANDABLE CONTROLLER,RR,,28 ,,NW,,,,,,$306.31,$0.00,1,1,1,1,1,1,20120101,E2375,HCPCS,NON-EXPANDABLE CONTROLLER,UE,,28 ,,NW,,,,,,"$2,027.67",$0.00,1,1,1,1,1,1,20120101,E2376,HCPCS,"EXPANDABLE CONTROLLER, REPL",,,28 ,,NW,,,,,,"$4,191.48",$0.00,1,1,1,1,1,1,20120101,E2376,HCPCS,"EXPANDABLE CONTROLLER, REPL",NU,,28 ,,NW,,,,,,"$4,191.48",$0.00,1,1,1,1,1,1,20120101,E2376,HCPCS,"EXPANDABLE CONTROLLER, REPL",RR,,28 ,,NW,,,,,,$456.52,$0.00,1,1,1,1,1,1,20120101,E2376,HCPCS,"EXPANDABLE CONTROLLER, REPL",UE,,28 ,,NW,,,,,,"$3,154.05",$0.00,1,1,1,1,1,1,20120101,E2377,HCPCS,"EXPANDABLE CONTROLLER, INITL",,,28 ,,NW,,,,,,"$1,543.22",$0.00,1,1,1,1,1,1,20120101,E2377,HCPCS,"EXPANDABLE CONTROLLER, INITL",NU,,28 ,,NW,,,,,,"$1,543.22",$0.00,1,1,1,1,1,1,20120101,E2377,HCPCS,"EXPANDABLE CONTROLLER, INITL",RR,,28 ,,NW,,,,,,$186.42,$0.00,1,1,1,1,1,1,20120101,E2377,HCPCS,"EXPANDABLE CONTROLLER, INITL",UE,,28 ,,NW,,,,,,"$1,167.85",$0.00,1,1,1,1,1,1,20120101,E2381,HCPCS,PNEUM DRIVE WHEEL TIRE,,,28 ,,NW,,,,,,$276.11,$0.00,1,1,1,1,1,1,20120101,E2381,HCPCS,PNEUM DRIVE WHEEL TIRE,NU,,28 ,,NW,,,,,,$276.11,$0.00,1,1,1,1,1,1,20120101,E2381,HCPCS,PNEUM DRIVE WHEEL TIRE,RR,,28 ,,NW,,,,,,$28.99,$0.00,1,1,1,1,1,1,20120101,E2381,HCPCS,PNEUM DRIVE WHEEL TIRE,UE,,28 ,,NW,,,,,,$217.48,$0.00,1,1,1,1,1,1,20120101,E2382,HCPCS,"TUBE, PNEUM WHEEL DRIVE TIRE",,,28 ,,NW,,,,,,$79.34,$0.00,1,1,1,1,1,1,20120101,E2382,HCPCS,"TUBE, PNEUM WHEEL DRIVE TIRE",NU,,28 ,,NW,,,,,,$79.34,$0.00,1,1,1,1,1,1,20120101,E2382,HCPCS,"TUBE, PNEUM WHEEL DRIVE TIRE",RR,,28 ,,NW,,,,,,$7.74,$0.00,1,1,1,1,1,1,20120101,E2382,HCPCS,"TUBE, PNEUM WHEEL DRIVE TIRE",UE,,28 ,,NW,,,,,,$59.45,$0.00,1,1,1,1,1,1,20120101,E2383,HCPCS,"INSERT, PNEUM WHEEL DRIVE",,,28 ,,NW,,,,,,$509.41,$0.00,1,1,1,1,1,1,20120101,E2383,HCPCS,"INSERT, PNEUM WHEEL DRIVE",NU,,28 ,,NW,,,,,,$509.41,$0.00,1,1,1,1,1,1,20120101,E2383,HCPCS,"INSERT, PNEUM WHEEL DRIVE",RR,,28 ,,NW,,,,,,$57.98,$0.00,1,1,1,1,1,1,20120101,E2383,HCPCS,"INSERT, PNEUM WHEEL DRIVE",UE,,28 ,,NW,,,,,,$392.46,$0.00,1,1,1,1,1,1,20120101,E2384,HCPCS,PNEUMATIC CASTER TIRE,,,28 ,,NW,,,,,,$290.80,$0.00,1,1,1,1,1,1,20120101,E2384,HCPCS,PNEUMATIC CASTER TIRE,NU,,28 ,,NW,,,,,,$290.80,$0.00,1,1,1,1,1,1,20120101,E2384,HCPCS,PNEUMATIC CASTER TIRE,RR,,28 ,,NW,,,,,,$30.85,$0.00,1,1,1,1,1,1,20120101,E2384,HCPCS,PNEUMATIC CASTER TIRE,UE,,28 ,,NW,,,,,,$228.47,$0.00,1,1,1,1,1,1,20120101,E2385,HCPCS,"TUBE, PNEUMATIC CASTER TIRE",,,28 ,,NW,,,,,,$189.68,$0.00,1,1,1,1,1,1,20120101,E2385,HCPCS,"TUBE, PNEUMATIC CASTER TIRE",NU,,28 ,,NW,,,,,,$189.68,$0.00,1,1,1,1,1,1,20120101,E2385,HCPCS,"TUBE, PNEUMATIC CASTER TIRE",RR,,28 ,,NW,,,,,,$18.80,$0.00,1,1,1,1,1,1,20120101,E2385,HCPCS,"TUBE, PNEUMATIC CASTER TIRE",UE,,28 ,,NW,,,,,,$141.92,$0.00,1,1,1,1,1,1,20120101,E2386,HCPCS,FOAM FILLED DRIVE WHEEL TIRE,,,28 ,,NW,,,,,,$505.19,$0.00,1,1,1,1,1,1,20120101,E2386,HCPCS,FOAM FILLED DRIVE WHEEL TIRE,NU,,28 ,,NW,,,,,,$505.19,$0.00,1,1,1,1,1,1,20120101,E2386,HCPCS,FOAM FILLED DRIVE WHEEL TIRE,RR,,28 ,,NW,,,,,,$57.44,$0.00,1,1,1,1,1,1,20120101,E2386,HCPCS,FOAM FILLED DRIVE WHEEL TIRE,UE,,28 ,,NW,,,,,,$389.25,$0.00,1,1,1,1,1,1,20120101,E2387,HCPCS,FOAM FILLED CASTER TIRE,,,28 ,,NW,,,,,,$245.51,$0.00,1,1,1,1,1,1,20120101,E2387,HCPCS,FOAM FILLED CASTER TIRE,NU,,28 ,,NW,,,,,,$245.51,$0.00,1,1,1,1,1,1,20120101,E2387,HCPCS,FOAM FILLED CASTER TIRE,RR,,28 ,,NW,,,,,,$25.18,$0.00,1,1,1,1,1,1,20120101,E2387,HCPCS,FOAM FILLED CASTER TIRE,UE,,28 ,,NW,,,,,,$190.03,$0.00,1,1,1,1,1,1,20120101,E2388,HCPCS,FOAM DRIVE WHEEL TIRE,,,28 ,,NW,,,,,,$193.42,$0.00,1,1,1,1,1,1,20120101,E2388,HCPCS,FOAM DRIVE WHEEL TIRE,NU,,28 ,,NW,,,,,,$193.42,$0.00,1,1,1,1,1,1,20120101,E2388,HCPCS,FOAM DRIVE WHEEL TIRE,RR,,28 ,,NW,,,,,,$19.19,$0.00,1,1,1,1,1,1,20120101,E2388,HCPCS,FOAM DRIVE WHEEL TIRE,UE,,28 ,,NW,,,,,,$145.07,$0.00,1,1,1,1,1,1,20120101,E2389,HCPCS,FOAM CASTER TIRE,,,28 ,,NW,,,,,,$104.96,$0.00,1,1,1,1,1,1,20120101,E2389,HCPCS,FOAM CASTER TIRE,NU,,28 ,,NW,,,,,,$104.96,$0.00,1,1,1,1,1,1,20120101,E2389,HCPCS,FOAM CASTER TIRE,RR,,28 ,,NW,,,,,,$10.38,$0.00,1,1,1,1,1,1,20120101,E2389,HCPCS,FOAM CASTER TIRE,UE,,28 ,,NW,,,,,,$78.64,$0.00,1,1,1,1,1,1,20120101,E2390,HCPCS,SOLID DRIVE WHEEL TIRE,,,28 ,,NW,,,,,,$164.23,$0.00,1,1,1,1,1,1,20120101,E2390,HCPCS,SOLID DRIVE WHEEL TIRE,NU,,28 ,,NW,,,,,,$164.23,$0.00,1,1,1,1,1,1,20120101,E2390,HCPCS,SOLID DRIVE WHEEL TIRE,RR,,28 ,,NW,,,,,,$16.28,$0.00,1,1,1,1,1,1,20120101,E2390,HCPCS,SOLID DRIVE WHEEL TIRE,UE,,28 ,,NW,,,,,,$123.04,$0.00,1,1,1,1,1,1,20120101,E2391,HCPCS,SOLID CASTER TIRE,,,28 ,,NW,,,,,,$78.60,$0.00,1,1,1,1,1,1,20120101,E2391,HCPCS,SOLID CASTER TIRE,NU,,28 ,,NW,,,,,,$78.60,$0.00,1,1,1,1,1,1,20120101,E2391,HCPCS,SOLID CASTER TIRE,RR,,28 ,,NW,,,,,,$7.72,$0.00,1,1,1,1,1,1,20120101,E2391,HCPCS,SOLID CASTER TIRE,UE,,28 ,,NW,,,,,,$58.93,$0.00,1,1,1,1,1,1,20120101,E2392,HCPCS,"SOLID CASTER TIRE, INTEGRATE",,,28 ,,NW,,,,,,$206.82,$0.00,1,1,1,1,1,1,20120101,E2392,HCPCS,"SOLID CASTER TIRE, INTEGRATE",NU,,28 ,,NW,,,,,,$206.82,$0.00,1,1,1,1,1,1,20120101,E2392,HCPCS,"SOLID CASTER TIRE, INTEGRATE",RR,,28 ,,NW,,,,,,$20.58,$0.00,1,1,1,1,1,1,20120101,E2392,HCPCS,"SOLID CASTER TIRE, INTEGRATE",UE,,28 ,,NW,,,,,,$155.08,$0.00,1,1,1,1,1,1,20120101,E2394,HCPCS,DRIVE WHEEL EXCLUDES TIRE,,,28 ,,NW,,,,,,$278.81,$0.00,1,1,1,1,1,1,20120101,E2394,HCPCS,DRIVE WHEEL EXCLUDES TIRE,NU,,28 ,,NW,,,,,,$278.81,$0.00,1,1,1,1,1,1,20120101,E2394,HCPCS,DRIVE WHEEL EXCLUDES TIRE,RR,,28 ,,NW,,,,,,$29.36,$0.00,1,1,1,1,1,1,20120101,E2394,HCPCS,DRIVE WHEEL EXCLUDES TIRE,UE,,28 ,,NW,,,,,,$219.51,$0.00,1,1,1,1,1,1,20120101,E2395,HCPCS,CASTER WHEEL EXCLUDES TIRE,,,28 ,,NW,,,,,,$209.42,$0.00,1,1,1,1,1,1,20120101,E2395,HCPCS,CASTER WHEEL EXCLUDES TIRE,NU,,28 ,,NW,,,,,,$209.42,$0.00,1,1,1,1,1,1,20120101,E2395,HCPCS,CASTER WHEEL EXCLUDES TIRE,RR,,28 ,,NW,,,,,,$20.80,$0.00,1,1,1,1,1,1,20120101,E2395,HCPCS,CASTER WHEEL EXCLUDES TIRE,UE,,28 ,,NW,,,,,,$157.09,$0.00,1,1,1,1,1,1,20120101,E2396,HCPCS,CASTER FORK,,,28 ,,NW,,,,,,$236.21,$0.00,1,1,1,1,1,1,20120101,E2396,HCPCS,CASTER FORK,NU,,28 ,,NW,,,,,,$236.21,$0.00,1,1,1,1,1,1,20120101,E2396,HCPCS,CASTER FORK,RR,,28 ,,NW,,,,,,$25.62,$0.00,1,1,1,1,1,1,20120101,E2396,HCPCS,CASTER FORK,UE,,28 ,,NW,,,,,,$181.31,$0.00,1,1,1,1,1,1,20120101,E2397,HCPCS,"PWC ACC, LITH-BASED BATTERY",,,28 ,,NW,,,,,,$729.20,$0.00,1,1,1,1,1,1,20120101,E2397,HCPCS,"PWC ACC, LITH-BASED BATTERY",NU,,28 ,,NW,,,,,,$729.20,$0.00,1,1,1,1,1,1,20120101,E2397,HCPCS,"PWC ACC, LITH-BASED BATTERY",RR,,28 ,,NW,,,,,,$85.29,$0.00,1,1,1,1,1,1,20120101,E2397,HCPCS,"PWC ACC, LITH-BASED BATTERY",UE,,28 ,,NW,,,,,,$557.25,$0.00,1,1,1,1,1,1,20120101,E2402,HCPCS,NEG PRESS WOUND THERAPY PUMP,,,28 ,,NW,,,,,,"$35,131.07",$0.00,1,1,1,1,1,1,20120101,E2402,HCPCS,NEG PRESS WOUND THERAPY PUMP,RR,,28 ,,NW,,,,,,"$3,671.27",$0.00,1,1,1,1,1,1,20120101,E2500,HCPCS,SGD DIGITIZED PRE-REC <=8MIN,,,28 ,,NW,,,,,,$952.48,$0.00,1,1,1,1,1,1,20120101,E2500,HCPCS,SGD DIGITIZED PRE-REC <=8MIN,NU,,28 ,,NW,,,,,,$952.48,$0.00,1,1,1,1,1,1,20120101,E2500,HCPCS,SGD DIGITIZED PRE-REC <=8MIN,RR,,28 ,,NW,,,,,,$76.88,$0.00,1,1,1,1,1,1,20120101,E2500,HCPCS,SGD DIGITIZED PRE-REC <=8MIN,UE,,28 ,,NW,,,,,,$708.24,$0.00,1,1,1,1,1,1,20120101,E2502,HCPCS,SGD PREREC MSG >8MIN <=20MIN,,,28 ,,NW,,,,,,"$2,962.74",$0.00,1,1,1,1,1,1,20120101,E2502,HCPCS,SGD PREREC MSG >8MIN <=20MIN,NU,,28 ,,NW,,,,,,"$2,962.74",$0.00,1,1,1,1,1,1,20120101,E2502,HCPCS,SGD PREREC MSG >8MIN <=20MIN,RR,,28 ,,NW,,,,,,$274.33,$0.00,1,1,1,1,1,1,20120101,E2502,HCPCS,SGD PREREC MSG >8MIN <=20MIN,UE,,28 ,,NW,,,,,,"$2,215.98",$0.00,1,1,1,1,1,1,20120101,E2504,HCPCS,SGD PREREC MSG>20MIN <=40MIN,,,28 ,,NW,,,,,,"$3,916.03",$0.00,1,1,1,1,1,1,20120101,E2504,HCPCS,SGD PREREC MSG>20MIN <=40MIN,NU,,28 ,,NW,,,,,,"$3,916.03",$0.00,1,1,1,1,1,1,20120101,E2504,HCPCS,SGD PREREC MSG>20MIN <=40MIN,RR,,28 ,,NW,,,,,,$369.69,$0.00,1,1,1,1,1,1,20120101,E2504,HCPCS,SGD PREREC MSG>20MIN <=40MIN,UE,,28 ,,NW,,,,,,"$2,930.90",$0.00,1,1,1,1,1,1,20120101,E2506,HCPCS,SGD PREREC MSG > 40 MIN,,,28 ,,NW,,,,,,"$5,753.45",$0.00,1,1,1,1,1,1,20120101,E2506,HCPCS,SGD PREREC MSG > 40 MIN,NU,,28 ,,NW,,,,,,"$5,753.45",$0.00,1,1,1,1,1,1,20120101,E2506,HCPCS,SGD PREREC MSG > 40 MIN,RR,,28 ,,NW,,,,,,$553.37,$0.00,1,1,1,1,1,1,20120101,E2506,HCPCS,SGD PREREC MSG > 40 MIN,UE,,28 ,,NW,,,,,,"$4,308.90",$0.00,1,1,1,1,1,1,20120101,E2508,HCPCS,SGD SPELLING PHYS CONTACT,,,28 ,,NW,,,,,,"$8,910.07",$0.00,1,1,1,1,1,1,20120101,E2508,HCPCS,SGD SPELLING PHYS CONTACT,NU,,28 ,,NW,,,,,,"$8,910.07",$0.00,1,1,1,1,1,1,20120101,E2508,HCPCS,SGD SPELLING PHYS CONTACT,RR,,28 ,,NW,,,,,,$869.06,$0.00,1,1,1,1,1,1,20120101,E2508,HCPCS,SGD SPELLING PHYS CONTACT,UE,,28 ,,NW,,,,,,"$6,676.48",$0.00,1,1,1,1,1,1,20120101,E2510,HCPCS,SGD W MULTI METHODS MSG/ACCS,,,28 ,,NW,,,,,,"$16,882.88",$0.00,1,1,1,1,1,1,20120101,E2510,HCPCS,SGD W MULTI METHODS MSG/ACCS,NU,,28 ,,NW,,,,,,"$16,882.88",$0.00,1,1,1,1,1,1,20120101,E2510,HCPCS,SGD W MULTI METHODS MSG/ACCS,RR,,28 ,,NW,,,,,,"$1,666.32",$0.00,1,1,1,1,1,1,20120101,E2510,HCPCS,SGD W MULTI METHODS MSG/ACCS,UE,,28 ,,NW,,,,,,"$12,656.05",$0.00,1,1,1,1,1,1,20120101,E2511,HCPCS,SGD SFTWRE PRGRM FOR PC/PDA,,,28 ,,NW,,,,,,$781.10,$0.00,1,1,1,1,1,1,20120101,E2511,HCPCS,SGD SFTWRE PRGRM FOR PC/PDA,NU,,28 ,,NW,,,,,,$781.10,$0.00,1,1,1,1,1,1,20120101,E2511,HCPCS,SGD SFTWRE PRGRM FOR PC/PDA,RR,,28 ,,NW,,,,,,$81.88,$0.00,1,1,1,1,1,1,20120101,E2511,HCPCS,SGD SFTWRE PRGRM FOR PC/PDA,UE,,28 ,,NW,,,,,,$586.91,$0.00,1,1,1,1,1,1,20120101,E2512,HCPCS,"SGD ACCESSORY, MOUNTING SYS",,,28 ,,NW,,,,,,"$1,637.33",$0.00,1,1,1,1,1,1,20120101,E2512,HCPCS,"SGD ACCESSORY, MOUNTING SYS",NU,,28 ,,NW,,,,,,"$1,637.33",$0.00,1,1,1,1,1,1,20120101,E2512,HCPCS,"SGD ACCESSORY, MOUNTING SYS",RR,,28 ,,NW,,,,,,$171.10,$0.00,1,1,1,1,1,1,20120101,E2512,HCPCS,"SGD ACCESSORY, MOUNTING SYS",UE,,28 ,,NW,,,,,,"$1,230.01",$0.00,1,1,1,1,1,1,20120101,E2599,HCPCS,SGD ACCESSORY NOC,,,28 ,,NW,,,,,,$387.09,$0.00,1,1,1,1,1,1,20120101,E2601,HCPCS,GEN W/C CUSHION WDTH < 22 IN,,,28 ,,NW,,,,,,$230.61,$0.00,1,1,1,1,1,1,20120101,E2601,HCPCS,GEN W/C CUSHION WDTH < 22 IN,NU,,28 ,,NW,,,,,,$230.61,$0.00,1,1,1,1,1,1,20120101,E2601,HCPCS,GEN W/C CUSHION WDTH < 22 IN,RR,,28 ,,NW,,,,,,$23.38,$0.00,1,1,1,1,1,1,20120101,E2601,HCPCS,GEN W/C CUSHION WDTH < 22 IN,UE,,28 ,,NW,,,,,,$176.05,$0.00,1,1,1,1,1,1,20120101,E2602,HCPCS,GEN W/C CUSHION WDTH >=22 IN,,,28 ,,NW,,,,,,$410.66,$0.00,1,1,1,1,1,1,20120101,E2602,HCPCS,GEN W/C CUSHION WDTH >=22 IN,NU,,28 ,,NW,,,,,,$410.66,$0.00,1,1,1,1,1,1,20120101,E2602,HCPCS,GEN W/C CUSHION WDTH >=22 IN,RR,,28 ,,NW,,,,,,$45.73,$0.00,1,1,1,1,1,1,20120101,E2602,HCPCS,GEN W/C CUSHION WDTH >=22 IN,UE,,28 ,,NW,,,,,,$318.39,$0.00,1,1,1,1,1,1,20120101,E2603,HCPCS,SKIN PROTECT WC CUS WD <22IN,,,28 ,,NW,,,,,,$510.19,$0.00,1,1,1,1,1,1,20120101,E2603,HCPCS,SKIN PROTECT WC CUS WD <22IN,NU,,28 ,,NW,,,,,,$510.19,$0.00,1,1,1,1,1,1,20120101,E2603,HCPCS,SKIN PROTECT WC CUS WD <22IN,RR,,28 ,,NW,,,,,,$58.12,$0.00,1,1,1,1,1,1,20120101,E2603,HCPCS,SKIN PROTECT WC CUS WD <22IN,UE,,28 ,,NW,,,,,,$393.01,$0.00,1,1,1,1,1,1,20120101,E2604,HCPCS,SKIN PROTECT WC CUS WD>=22IN,,,28 ,,NW,,,,,,$624.03,$0.00,1,1,1,1,1,1,20120101,E2604,HCPCS,SKIN PROTECT WC CUS WD>=22IN,NU,,28 ,,NW,,,,,,$624.03,$0.00,1,1,1,1,1,1,20120101,E2604,HCPCS,SKIN PROTECT WC CUS WD>=22IN,RR,,28 ,,NW,,,,,,$72.17,$0.00,1,1,1,1,1,1,20120101,E2604,HCPCS,SKIN PROTECT WC CUS WD>=22IN,UE,,28 ,,NW,,,,,,$478.46,$0.00,1,1,1,1,1,1,20120101,E2605,HCPCS,POSITION WC CUSH WDTH <22 IN,,,28 ,,NW,,,,,,$873.74,$0.00,1,1,1,1,1,1,20120101,E2605,HCPCS,POSITION WC CUSH WDTH <22 IN,NU,,28 ,,NW,,,,,,$873.74,$0.00,1,1,1,1,1,1,20120101,E2605,HCPCS,POSITION WC CUSH WDTH <22 IN,RR,,28 ,,NW,,,,,,$103.31,$0.00,1,1,1,1,1,1,20120101,E2605,HCPCS,POSITION WC CUSH WDTH <22 IN,UE,,28 ,,NW,,,,,,$665.79,$0.00,1,1,1,1,1,1,20120101,E2606,HCPCS,POSITION WC CUSH WDTH>=22 IN,,,28 ,,NW,,,,,,"$1,339.85",$0.00,1,1,1,1,1,1,20120101,E2606,HCPCS,POSITION WC CUSH WDTH>=22 IN,NU,,28 ,,NW,,,,,,"$1,339.85",$0.00,1,1,1,1,1,1,20120101,E2606,HCPCS,POSITION WC CUSH WDTH>=22 IN,RR,,28 ,,NW,,,,,,$161.24,$0.00,1,1,1,1,1,1,20120101,E2606,HCPCS,POSITION WC CUSH WDTH>=22 IN,UE,,28 ,,NW,,,,,,"$1,015.23",$0.00,1,1,1,1,1,1,20120101,E2607,HCPCS,SKIN PRO/POS WC CUS WD <22IN,,,28 ,,NW,,,,,,$937.66,$0.00,1,1,1,1,1,1,20120101,E2607,HCPCS,SKIN PRO/POS WC CUS WD <22IN,NU,,28 ,,NW,,,,,,$937.66,$0.00,1,1,1,1,1,1,20120101,E2607,HCPCS,SKIN PRO/POS WC CUS WD <22IN,RR,,28 ,,NW,,,,,,$111.21,$0.00,1,1,1,1,1,1,20120101,E2607,HCPCS,SKIN PRO/POS WC CUS WD <22IN,UE,,28 ,,NW,,,,,,$713.63,$0.00,1,1,1,1,1,1,20120101,E2608,HCPCS,SKIN PRO/POS WC CUS WD>=22IN,,,28 ,,NW,,,,,,"$1,117.70",$0.00,1,1,1,1,1,1,20120101,E2608,HCPCS,SKIN PRO/POS WC CUS WD>=22IN,NU,,28 ,,NW,,,,,,"$1,117.70",$0.00,1,1,1,1,1,1,20120101,E2608,HCPCS,SKIN PRO/POS WC CUS WD>=22IN,RR,,28 ,,NW,,,,,,$133.52,$0.00,1,1,1,1,1,1,20120101,E2608,HCPCS,SKIN PRO/POS WC CUS WD>=22IN,UE,,28 ,,NW,,,,,,$848.68,$0.00,1,1,1,1,1,1,20120101,E2609,HCPCS,CUSTOM FABRICATE W/C CUSHION,,,28 ,,NW,,,,,,$455.80,$0.00,1,1,1,1,1,1,20120101,E2610,HCPCS,POWERED W/C CUSHION,,,28 ,,NW,,,,,,$447.73,$0.00,1,1,1,1,1,1,20120101,E2611,HCPCS,GEN USE BACK CUSH WDTH <22IN,,,28 ,,NW,,,,,,"$1,007.23",$0.00,1,1,1,1,1,1,20120101,E2611,HCPCS,GEN USE BACK CUSH WDTH <22IN,NU,,28 ,,NW,,,,,,"$1,007.23",$0.00,1,1,1,1,1,1,20120101,E2611,HCPCS,GEN USE BACK CUSH WDTH <22IN,RR,,28 ,,NW,,,,,,$119.81,$0.00,1,1,1,1,1,1,20120101,E2611,HCPCS,GEN USE BACK CUSH WDTH <22IN,UE,,28 ,,NW,,,,,,$765.87,$0.00,1,1,1,1,1,1,20120101,E2612,HCPCS,GEN USE BACK CUSH WDTH>=22IN,,,28 ,,NW,,,,,,"$1,347.92",$0.00,1,1,1,1,1,1,20120101,E2612,HCPCS,GEN USE BACK CUSH WDTH>=22IN,NU,,28 ,,NW,,,,,,"$1,347.92",$0.00,1,1,1,1,1,1,20120101,E2612,HCPCS,GEN USE BACK CUSH WDTH>=22IN,RR,,28 ,,NW,,,,,,$162.16,$0.00,1,1,1,1,1,1,20120101,E2612,HCPCS,GEN USE BACK CUSH WDTH>=22IN,UE,,28 ,,NW,,,,,,"$1,021.26",$0.00,1,1,1,1,1,1,20120101,E2613,HCPCS,POSITION BACK CUSH WD <22IN,,,28 ,,NW,,,,,,"$1,256.69",$0.00,1,1,1,1,1,1,20120101,E2613,HCPCS,POSITION BACK CUSH WD <22IN,NU,,28 ,,NW,,,,,,"$1,256.69",$0.00,1,1,1,1,1,1,20120101,E2613,HCPCS,POSITION BACK CUSH WD <22IN,RR,,28 ,,NW,,,,,,$150.87,$0.00,1,1,1,1,1,1,20120101,E2613,HCPCS,POSITION BACK CUSH WD <22IN,UE,,28 ,,NW,,,,,,$952.90,$0.00,1,1,1,1,1,1,20120101,E2614,HCPCS,POSITION BACK CUSH WD>=22IN,,,28 ,,NW,,,,,,"$1,723.23",$0.00,1,1,1,1,1,1,20120101,E2614,HCPCS,POSITION BACK CUSH WD>=22IN,NU,,28 ,,NW,,,,,,"$1,723.23",$0.00,1,1,1,1,1,1,20120101,E2614,HCPCS,POSITION BACK CUSH WD>=22IN,RR,,28 ,,NW,,,,,,$208.83,$0.00,1,1,1,1,1,1,20120101,E2614,HCPCS,POSITION BACK CUSH WD>=22IN,UE,,28 ,,NW,,,,,,"$1,302.85",$0.00,1,1,1,1,1,1,20120101,E2615,HCPCS,POS BACK POST/LAT WDTH <22IN,,,28 ,,NW,,,,,,"$1,439.99",$0.00,1,1,1,1,1,1,20120101,E2615,HCPCS,POS BACK POST/LAT WDTH <22IN,NU,,28 ,,NW,,,,,,"$1,439.99",$0.00,1,1,1,1,1,1,20120101,E2615,HCPCS,POS BACK POST/LAT WDTH <22IN,RR,,28 ,,NW,,,,,,$173.63,$0.00,1,1,1,1,1,1,20120101,E2615,HCPCS,POS BACK POST/LAT WDTH <22IN,UE,,28 ,,NW,,,,,,"$1,090.31",$0.00,1,1,1,1,1,1,20120101,E2616,HCPCS,POS BACK POST/LAT WDTH>=22IN,,,28 ,,NW,,,,,,"$1,923.09",$0.00,1,1,1,1,1,1,20120101,E2616,HCPCS,POS BACK POST/LAT WDTH>=22IN,NU,,28 ,,NW,,,,,,"$1,923.09",$0.00,1,1,1,1,1,1,20120101,E2616,HCPCS,POS BACK POST/LAT WDTH>=22IN,RR,,28 ,,NW,,,,,,$229.67,$0.00,1,1,1,1,1,1,20120101,E2616,HCPCS,POS BACK POST/LAT WDTH>=22IN,UE,,28 ,,NW,,,,,,"$1,452.75",$0.00,1,1,1,1,1,1,20120101,E2617,HCPCS,CUSTOM FAB W/C BACK CUSHION,,,28 ,,NW,,,,,,$796.59,$0.00,1,1,1,1,1,1,20120101,E2619,HCPCS,REPLACE COVER W/C SEAT CUSH,,,28 ,,NW,,,,,,$197.00,$0.00,1,1,1,1,1,1,20120101,E2619,HCPCS,REPLACE COVER W/C SEAT CUSH,NU,,28 ,,NW,,,,,,$197.00,$0.00,1,1,1,1,1,1,20120101,E2619,HCPCS,REPLACE COVER W/C SEAT CUSH,RR,,28 ,,NW,,,,,,$19.54,$0.00,1,1,1,1,1,1,20120101,E2619,HCPCS,REPLACE COVER W/C SEAT CUSH,UE,,28 ,,NW,,,,,,$147.80,$0.00,1,1,1,1,1,1,20120101,E2620,HCPCS,WC PLANAR BACK CUSH WD <22IN,,,28 ,,NW,,,,,,"$1,734.87",$0.00,1,1,1,1,1,1,20120101,E2620,HCPCS,WC PLANAR BACK CUSH WD <22IN,NU,,28 ,,NW,,,,,,"$1,734.87",$0.00,1,1,1,1,1,1,20120101,E2620,HCPCS,WC PLANAR BACK CUSH WD <22IN,RR,,28 ,,NW,,,,,,$210.26,$0.00,1,1,1,1,1,1,20120101,E2620,HCPCS,WC PLANAR BACK CUSH WD <22IN,UE,,28 ,,NW,,,,,,"$1,311.57",$0.00,1,1,1,1,1,1,20120101,E2621,HCPCS,WC PLANAR BACK CUSH WD>=22IN,,,28 ,,NW,,,,,,"$1,818.55",$0.00,1,1,1,1,1,1,20120101,E2621,HCPCS,WC PLANAR BACK CUSH WD>=22IN,NU,,28 ,,NW,,,,,,"$1,818.55",$0.00,1,1,1,1,1,1,20120101,E2621,HCPCS,WC PLANAR BACK CUSH WD>=22IN,RR,,28 ,,NW,,,,,,$219.19,$0.00,1,1,1,1,1,1,20120101,E2621,HCPCS,WC PLANAR BACK CUSH WD>=22IN,UE,,28 ,,NW,,,,,,"$1,374.31",$0.00,1,1,1,1,1,1,20120101,E2622,HCPCS,ADJ SKIN PRO W/C CUS WD<22IN,,,28 ,,NW,,,,,,"$1,066.33",$0.00,1,1,1,1,1,1,20120101,E2622,HCPCS,ADJ SKIN PRO W/C CUS WD<22IN,NU,,28 ,,NW,,,,,,"$1,066.33",$0.00,1,1,1,1,1,1,20120101,E2622,HCPCS,ADJ SKIN PRO W/C CUS WD<22IN,RR,,28 ,,NW,,,,,,$127.21,$0.00,1,1,1,1,1,1,20120101,E2622,HCPCS,ADJ SKIN PRO W/C CUS WD<22IN,UE,,28 ,,NW,,,,,,$810.13,$0.00,1,1,1,1,1,1,20120101,E2623,HCPCS,ADJ SKIN PRO WC CUS WD>=22IN,,,28 ,,NW,,,,,,"$1,345.56",$0.00,1,1,1,1,1,1,20120101,E2623,HCPCS,ADJ SKIN PRO WC CUS WD>=22IN,NU,,28 ,,NW,,,,,,"$1,345.56",$0.00,1,1,1,1,1,1,20120101,E2623,HCPCS,ADJ SKIN PRO WC CUS WD>=22IN,RR,,28 ,,NW,,,,,,$161.93,$0.00,1,1,1,1,1,1,20120101,E2623,HCPCS,ADJ SKIN PRO WC CUS WD>=22IN,UE,,28 ,,NW,,,,,,"$1,019.53",$0.00,1,1,1,1,1,1,20120101,E2624,HCPCS,ADJ SKIN PRO/POS CUS<22IN,,,28 ,,NW,,,,,,"$1,074.75",$0.00,1,1,1,1,1,1,20120101,E2624,HCPCS,ADJ SKIN PRO/POS CUS<22IN,NU,,28 ,,NW,,,,,,"$1,074.75",$0.00,1,1,1,1,1,1,20120101,E2624,HCPCS,ADJ SKIN PRO/POS CUS<22IN,RR,,28 ,,NW,,,,,,$128.23,$0.00,1,1,1,1,1,1,20120101,E2624,HCPCS,ADJ SKIN PRO/POS CUS<22IN,UE,,28 ,,NW,,,,,,$816.49,$0.00,1,1,1,1,1,1,20120101,E2625,HCPCS,ADJ SKIN PRO/POS WC CUS>=22,,,28 ,,NW,,,,,,"$1,349.52",$0.00,1,1,1,1,1,1,20120101,E2625,HCPCS,ADJ SKIN PRO/POS WC CUS>=22,NU,,28 ,,NW,,,,,,"$1,349.52",$0.00,1,1,1,1,1,1,20120101,E2625,HCPCS,ADJ SKIN PRO/POS WC CUS>=22,RR,,28 ,,NW,,,,,,$162.36,$0.00,1,1,1,1,1,1,20120101,E2625,HCPCS,ADJ SKIN PRO/POS WC CUS>=22,UE,,28 ,,NW,,,,,,"$1,022.49",$0.00,1,1,1,1,1,1,20120101,G0008,HCPCS,ADMIN INFLUENZA VIRUS VAC,,,9 ,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0009,HCPCS,ADMIN PNEUMOCOCCAL VACCINE,,,9 ,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0010,HCPCS,ADMIN HEPATITIS B VACCINE,,,9 ,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0027,HCPCS,SEMEN ANALYSIS,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0101,HCPCS,CA SCREEN;PELVIC/BREAST EXAM,,,18 ,,RBRVS,0.45 ,0.32 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0102,HCPCS,PROSTATE CA SCREENING; DRE,,,18 ,,RBRVS,0.17 ,0.08 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0103,HCPCS,PSA SCREENING,,,17 ,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0104,HCPCS,CA SCREEN;FLEXI SIGMOIDSCOPE,,,21 ,,RBRVS,0.96 ,0.76 ,2.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0105,HCPCS,COLORECTAL SCRN; HI RISK IND,,,21 ,,RBRVS,3.69 ,2.22 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0106,HCPCS,COLON CA SCREEN;BARIUM ENEMA,,,20 ,,RBRVS,0.99 ,5.23 ,5.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0106,HCPCS,COLON CA SCREEN;BARIUM ENEMA,26,,20 ,,RBRVS,0.99 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0106,HCPCS,COLON CA SCREEN;BARIUM ENEMA,TC,,20 ,,RBRVS,,4.82 ,4.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0108,HCPCS,DIAB MANAGE TRN PER INDIV,,,14 ,,RBRVS,0.90 ,0.66 ,0.66 ,,,$0.00,$0.00,1,1,1,1,1,1,20120101,G0109,HCPCS,DIAB MANAGE TRN IND/GROUP,,,14 ,,RBRVS,0.25 ,0.29 ,0.29 ,,,$0.00,$0.00,1,1,1,1,1,1,20120101,G0117,HCPCS,GLAUCOMA SCRN HGH RISK DIREC,,,14 ,,RBRVS,0.45 ,0.97 ,0.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0118,HCPCS,GLAUCOMA SCRN HGH RISK DIREC,,,14 ,,RBRVS,0.17 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0120,HCPCS,COLON CA SCRN; BARIUM ENEMA,,,20 ,,RBRVS,0.99 ,5.23 ,5.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0120,HCPCS,COLON CA SCRN; BARIUM ENEMA,26,,20 ,,RBRVS,0.99 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0120,HCPCS,COLON CA SCRN; BARIUM ENEMA,TC,,20 ,,RBRVS,,4.82 ,4.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0121,HCPCS,COLON CA SCRN NOT HI RSK IND,,,21 ,,RBRVS,3.69 ,2.22 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0122,HCPCS,COLON CA SCRN; BARIUM ENEMA,,,20 ,,RBRVS,0.99 ,6.87 ,6.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0122,HCPCS,COLON CA SCRN; BARIUM ENEMA,26,,20 ,,RBRVS,0.99 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0122,HCPCS,COLON CA SCRN; BARIUM ENEMA,TC,,20 ,,RBRVS,,6.44 ,6.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0123,HCPCS,SCREEN CERV/VAG THIN LAYER,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0124,HCPCS,SCREEN C/V THIN LAYER BY MD,,,17 ,,RBRVS,0.42 ,0.40 ,0.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0127,HCPCS,TRIM NAIL(S),,,21 ,,RBRVS,0.17 ,0.06 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0128,HCPCS,CORF SKILLED NURSING SERVICE,,,14 ,,RBRVS,0.08 ,0.19 ,0.19 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,G0130,HCPCS,SINGLE ENERGY X-RAY STUDY,,,20 ,,RBRVS,0.22 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0130,HCPCS,SINGLE ENERGY X-RAY STUDY,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0130,HCPCS,SINGLE ENERGY X-RAY STUDY,TC,,20 ,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0141,HCPCS,"SCR C/V CYTO,AUTOSYS AND MD",,,17 ,,RBRVS,0.42 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0143,HCPCS,"SCR C/V CYTO,THINLAYER,RESCR",,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0144,HCPCS,"SCR C/V CYTO,THINLAYER,RESCR",,,17 ,,TotalUnits,,,,0.88 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0145,HCPCS,"SCR C/V CYTO,THINLAYER,RESCR",,,17 ,,TotalUnits,,,,1.10 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0147,HCPCS,"SCR C/V CYTO, AUTOMATED SYS",,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0148,HCPCS,"SCR C/V CYTO, AUTOSYS, RESCR",,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0151,HCPCS,"HHCP-SERV OF PT,EA 15 MIN",,,14 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,G0152,HCPCS,"HHCP-SERV OF OT,EA 15 MIN",,,14 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,G0153,HCPCS,"HHCP-SVS OF S/L PATH,EA 15MN",,,14 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,G0154,HCPCS,"HHCP-SVS OF RN,EA 15 MIN",,,14 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,G0155,HCPCS,"HHCP-SVS OF CSW,EA 15 MIN",,,14 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,G0156,HCPCS,"HHCP-SVS OF AIDE,EA 15 MIN",,,14 ,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,G0157,HCPCS,HHC PT ASSISTANT EA 15,,,14 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,G0158,HCPCS,HHC OT ASSISTANT EA 15,,,14 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,G0159,HCPCS,HHC PT MAINT EA 15 MIN,,,14 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,G0160,HCPCS,HHC OCCUP THERAPY EA 15,,,14 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,G0161,HCPCS,HHC SLP EA 15 MIN,,,14 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,G0162,HCPCS,"HHC RN E&M PLAN SVS, 15 MIN",,,14 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,G0163,HCPCS,HHC LPN/RN OBS/ASSES EA 15,,,14 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,G0164,HCPCS,HHC LIS NURSE TRAIN EA 15,,,14 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,G0166,HCPCS,"EXTRNL COUNTERPULSE, PER TX",,,14 ,,RBRVS,0.07 ,4.41 ,4.41 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,G0168,HCPCS,WOUND CLOSURE BY ADHESIVE,,,21 ,,RBRVS,0.45 ,0.28 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0175,HCPCS,"OPPS SERVICE,SCHED TEAM CONF",,,14 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0176,HCPCS,OPPS/PHP;ACTIVITY THERAPY,,,16 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0177,HCPCS,OPPS/PHP; TRAIN & EDUC SERV,,,16 ,,TotalUnits,,,,2.04 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0179,HCPCS,MD RECERTIFICATION HHA PT,,,15 ,,RBRVS,0.45 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0180,HCPCS,MD CERTIFICATION HHA PATIENT,,,15 ,,RBRVS,0.67 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0181,HCPCS,HOME HEALTH CARE SUPERVISION,,,15 ,,RBRVS,1.73 ,1.24 ,1.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0182,HCPCS,HOSPICE CARE SUPERVISION,,,15 ,,RBRVS,1.73 ,1.28 ,1.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0186,HCPCS,"DSTRY EYE LESN,FDR VSSL TECH",,,14 ,,TotalUnits,,,,9.21 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0202,HCPCS,SCREENINGMAMMOGRAPHYDIGITAL,,,20 ,,RBRVS,0.70 ,3.38 ,3.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0202,HCPCS,SCREENINGMAMMOGRAPHYDIGITAL,26,,20 ,,RBRVS,0.70 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0202,HCPCS,SCREENINGMAMMOGRAPHYDIGITAL,TC,,20 ,,RBRVS,,3.09 ,3.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0204,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,,,20 ,,RBRVS,0.87 ,4.01 ,4.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0204,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,26,,20 ,,RBRVS,0.87 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0204,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,TC,,20 ,,RBRVS,,3.66 ,3.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0206,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,,,20 ,,RBRVS,0.70 ,3.16 ,3.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0206,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,26,,20 ,,RBRVS,0.70 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0206,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,TC,,20 ,,RBRVS,,2.87 ,2.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0219,HCPCS,PET IMG WHOLBOD MELANO NONCO,,,20 ,,TotalUnits,,,,28.08 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0219,HCPCS,PET IMG WHOLBOD MELANO NONCO,26,,20 ,,TotalUnits,,,,1.96 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0219,HCPCS,PET IMG WHOLBOD MELANO NONCO,TC,,20 ,,TotalUnits,,,,26.12 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0235,HCPCS,PET NOT OTHERWISE SPECIFIED,,,20 ,,TotalUnits,,,,26.72 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0235,HCPCS,PET NOT OTHERWISE SPECIFIED,26,,20 ,,TotalUnits,,,,1.87 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0235,HCPCS,PET NOT OTHERWISE SPECIFIED,TC,,20 ,,TotalUnits,,,,24.85 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0237,HCPCS,THERAPEUTIC PROCD STRG ENDUR,,,14 ,,RBRVS,,0.29 ,0.29 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,G0238,HCPCS,"OTH RESP PROC, INDIV",,,14 ,,RBRVS,,0.31 ,0.31 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,G0239,HCPCS,"OTH RESP PROC, GROUP",,,14 ,,RBRVS,,0.34 ,0.34 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,G0245,HCPCS,INITIAL FOOT EXAM PT LOPS,,,15 ,,RBRVS,0.88 ,0.44 ,1.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0246,HCPCS,FOLLOWUP EVAL OF FOOT PT LOP,,,15 ,,RBRVS,0.45 ,0.22 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0247,HCPCS,ROUTINE FOOTCARE PT W LOPS,,,15 ,,RBRVS,0.50 ,0.18 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0248,HCPCS,DEMONSTRATE USE HOME INR MON,,TC,14 ,,RBRVS,,4.11 ,4.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0249,HCPCS,PROVIDE INR TEST MATER/EQUIP,,TC,14 ,,RBRVS,,3.63 ,3.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0250,HCPCS,MD INR TEST REVIE INTER MGMT,,PC,4 ,,RBRVS,0.18 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0252,HCPCS,PET IMAGING INITIAL DX,,,20 ,,RBRVS,1.50 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0252,HCPCS,PET IMAGING INITIAL DX,26,,20 ,,RBRVS,1.50 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0255,HCPCS,CURRENT PERCEP THRESHOLD TST,,,14 ,,TotalUnits,,,,1.14 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0255,HCPCS,CURRENT PERCEP THRESHOLD TST,26,,14 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0255,HCPCS,CURRENT PERCEP THRESHOLD TST,TC,,14 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0257,HCPCS,UNSCHED DIALYSIS ESRD PT HOS,,,14 ,,TotalUnits,,,,7.20 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0259,HCPCS,INJECT FOR SACROILIAC JOINT,,,21 ,,TotalUnits,,,,4.77 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0260,HCPCS,INJ FOR SACROILIAC JT ANESTH,,,21 ,,TotalUnits,,,,16.58 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0268,HCPCS,REMOVAL OF IMPACTED WAX MD,,,14 ,,RBRVS,0.61 ,0.31 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0269,HCPCS,OCCLUSIVE DEVICE IN VEIN ART,,,21 ,,TotalUnits,,,,3.78 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0270,HCPCS,MNT SUBS TX FOR CHANGE DX,,,14 ,,RBRVS,0.45 ,0.28 ,0.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0271,HCPCS,GROUP MNT 2 OR MORE 30 MINS,,,14 ,,RBRVS,0.25 ,0.15 ,0.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0275,HCPCS,"RENAL ANGIO, CARDIAC CATH",,,20 ,,RBRVS,0.25 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0278,HCPCS,"ILIAC ART ANGIO,CARDIAC CATH",,,20 ,,RBRVS,0.25 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0281,HCPCS,ELEC STIM UNATTEND FOR PRESS,,,19 ,,RBRVS,0.18 ,0.18 ,0.18 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,G0282,HCPCS,ELECT STIM WOUND CARE NOT PD,,,19 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,G0283,HCPCS,ELEC STIM OTHER THAN WOUND,,,19 ,,RBRVS,0.18 ,0.18 ,0.18 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,G0288,HCPCS,"RECON, CTA FOR SURG PLAN",,TC,20 ,,RBRVS,,2.55 ,2.55 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,G0289,HCPCS,"ARTHRO, LOOSE BODY + CHONDRO",,,21 ,,RBRVS,1.48 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0290,HCPCS,"DRUG-ELUTING STENTS, SINGLE",,,21 ,,TotalUnits,,,,90.75 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0293,HCPCS,"NON-COV SURG PROC,CLIN TRIAL",,,14 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0295,HCPCS,ELECTROMAGNETIC THERAPY ONC,,,19 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,G0306,HCPCS,CBC/DIFFWBC W/O PLATELET,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0307,HCPCS,CBC WITHOUT PLATELET,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0328,HCPCS,FECAL BLOOD SCRN IMMUNOASSAY,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0329,HCPCS,ELECTROMAGNTIC TX FOR ULCERS,,,19 ,,RBRVS,0.06 ,0.20 ,0.20 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,G0333,HCPCS,DISPENSE FEE INITIAL 30 DAY,,,28 ,,NW,,,,,,$73.78,$0.00,1,1,1,0,0,1,20120101,G0337,HCPCS,HOSPICE EVALUATION PREELECTI,,,15 ,,RBRVS,1.42 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0339,HCPCS,"ROBOT LIN-RADSURG COM, FIRST",,,21 ,,TotalUnits,,,,198.48 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0340,HCPCS,ROBT LIN-RADSURG FRACTX 2-5,,,21 ,,TotalUnits,,,,144.16 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0341,HCPCS,PERCUTANEOUS ISLET CELLTRANS,,,21 ,,RBRVS,6.98 ,3.83 ,29.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0342,HCPCS,LAPAROSCOPY ISLET CELL TRANS,,,21 ,,RBRVS,11.92 ,7.14 ,7.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0343,HCPCS,LAPAROTOMY ISLET CELL TRANSP,,,21 ,,RBRVS,19.85 ,12.09 ,12.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0364,HCPCS,BONE MARROW ASPIRATE &BIOPSY,,,21 ,,RBRVS,0.16 ,0.09 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0365,HCPCS,VESSEL MAPPING HEMO ACCESS,,,14 ,,RBRVS,0.25 ,5.90 ,5.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0365,HCPCS,VESSEL MAPPING HEMO ACCESS,26,,14 ,,RBRVS,0.25 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0365,HCPCS,VESSEL MAPPING HEMO ACCESS,TC,,14 ,,RBRVS,,5.81 ,5.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0372,HCPCS,MD SERVICE REQUIRED FOR PMD,,,14 ,,RBRVS,0.17 ,0.07 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0378,HCPCS,HOSPITAL OBSERVATION PER HR,,,10 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0382,HCPCS,LEV 3 HOSP TYPE B ED VISIT,,,7 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0389,HCPCS,ULTRASOUND EXAM AAA SCREEN,,,20 ,,RBRVS,0.58 ,2.68 ,2.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0389,HCPCS,ULTRASOUND EXAM AAA SCREEN,26,,20 ,,RBRVS,0.58 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0389,HCPCS,ULTRASOUND EXAM AAA SCREEN,TC,,20 ,,RBRVS,,2.43 ,2.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0396,HCPCS,ALCOHOL/SUBS INTERV 15-30MN,,,16 ,,RBRVS,0.65 ,0.23 ,0.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0397,HCPCS,ALCOHOL/SUBS INTERV >30 MIN,,,16 ,,RBRVS,1.30 ,0.56 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0399,HCPCS,HOME SLEEP TEST/TYPE 3 PORTA,,,14 ,,TotalUnits,,,,2.37 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0399,HCPCS,HOME SLEEP TEST/TYPE 3 PORTA,,PC,14 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,0,1,1,1,0,20120101,G0399,HCPCS,HOME SLEEP TEST/TYPE 3 PORTA,,TC,14 ,,TotalUnits,,,,1.66 ,,$0.00,$0.00,1,1,1,0,1,0,20120101,G0400,HCPCS,HOME SLEEP TEST/TYPE 4 PORTA,,,14 ,,TotalUnits,,,,5.24 ,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0400,HCPCS,HOME SLEEP TEST/TYPE 4 PORTA,26,,14 ,,TotalUnits,,,,1.55 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0400,HCPCS,HOME SLEEP TEST/TYPE 4 PORTA,TC,,14 ,,TotalUnits,,,,3.69 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0402,HCPCS,INITIAL PREVENTIVE EXAM,,,18 ,,RBRVS,2.43 ,1.15 ,1.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0403,HCPCS,EKG FOR INITIAL PREVENT EXAM,,,18 ,,RBRVS,0.17 ,0.37 ,0.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0404,HCPCS,EKG TRACING FOR INITIAL PREV,,TC,18 ,,RBRVS,,0.31 ,0.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0405,HCPCS,EKG INTERPRET & REPORT PREVE,,PC,18 ,,RBRVS,0.17 ,0.06 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0406,HCPCS,TELHEALTH INPT CONSULT 15MIN,,,6 ,,RBRVS,0.76 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0407,HCPCS,TELHEATH INPT CONSULT 25MIN,,,6 ,,RBRVS,1.39 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0408,HCPCS,TELHEALTH INPT CONSULT 35MIN,,,6 ,,RBRVS,2.00 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0409,HCPCS,CORF RELATED SERV 15 MINS EA,,,16 ,,RBRVS,,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0410,HCPCS,GRP PSYCH PARTIAL HOSP 45-50,,,16 ,,TotalUnits,,,,1.35 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0412,HCPCS,OPEN TX ILIAC SPINE UNI/BIL,,,21 ,,RBRVS,10.45 ,8.73 ,8.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0413,HCPCS,PELVIC RING FRACTURE UNI/BIL,,,21 ,,RBRVS,15.73 ,12.22 ,12.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0414,HCPCS,PELVIC RING FX TREAT INT FIX,,,21 ,,RBRVS,14.65 ,12.00 ,12.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0415,HCPCS,OPEN TX POST PELVIC FXCTURE,,,21 ,,RBRVS,20.93 ,15.34 ,15.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0416,HCPCS,SAT BIOPSY PROSTATE 1-20 SPC,,,17 ,,RBRVS,3.09 ,13.96 ,13.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0416,HCPCS,SAT BIOPSY PROSTATE 1-20 SPC,,PC,17 ,,RBRVS,3.09 ,1.82 ,1.82 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,G0416,HCPCS,SAT BIOPSY PROSTATE 1-20 SPC,,TC,17 ,,RBRVS,,12.14 ,12.14 ,,,$0.00,$0.00,1,1,1,0,1,0,20120101,G0417,HCPCS,SAT BIOPSY PROSTATE 21-40,,,17 ,,RBRVS,5.86 ,27.26 ,27.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0417,HCPCS,SAT BIOPSY PROSTATE 21-40,,PC,17 ,,RBRVS,5.86 ,3.55 ,3.55 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,G0417,HCPCS,SAT BIOPSY PROSTATE 21-40,,TC,17 ,,RBRVS,,23.71 ,23.71 ,,,$0.00,$0.00,1,1,1,0,1,0,20120101,G0418,HCPCS,SAT BIOPSY PROSTATE 41-60,,,17 ,,RBRVS,10.30 ,46.56 ,46.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0418,HCPCS,SAT BIOPSY PROSTATE 41-60,,PC,17 ,,RBRVS,10.30 ,6.06 ,6.06 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,G0418,HCPCS,SAT BIOPSY PROSTATE 41-60,,TC,17 ,,RBRVS,,40.50 ,40.50 ,,,$0.00,$0.00,1,1,1,0,1,0,20120101,G0419,HCPCS,SAT BIOPSY PROSTATE: >60,,,17 ,,RBRVS,11.61 ,55.86 ,55.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,G0419,HCPCS,SAT BIOPSY PROSTATE: >60,,PC,17 ,,RBRVS,11.61 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,0,20120101,G0419,HCPCS,SAT BIOPSY PROSTATE: >60,,TC,17 ,,RBRVS,,48.60 ,48.60 ,,,$0.00,$0.00,1,1,1,0,1,0,20120101,G0420,HCPCS,ED SVC CKD IND PER SESSION,,,14 ,,RBRVS,2.12 ,1.02 ,1.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0421,HCPCS,ED SVC CKD GRP PER SESSION,,,14 ,,RBRVS,0.50 ,0.24 ,0.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0422,HCPCS,INTENS CARDIAC REHAB W/EXERC,,,4 ,,RBRVS,1.06 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0423,HCPCS,INTENS CARDIAC REHAB NO EXER,,,4 ,,RBRVS,1.06 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0424,HCPCS,PULMONARY REHAB W EXER,,,14 ,,RBRVS,0.28 ,0.12 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0425,HCPCS,INPT TELEHEALTH CONSULT 30M,,,6 ,,RBRVS,1.92 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0426,HCPCS,INPT TELEHEALTH CONSULT 50M,,,6 ,,RBRVS,2.61 ,1.20 ,1.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0427,HCPCS,INPT TELEHEALTH CON 70/>M,,,6 ,,RBRVS,3.86 ,1.77 ,1.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0429,HCPCS,DERMAL FILLER INJECTION(S),,,14 ,,RBRVS,1.19 ,0.56 ,1.19 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,G0431,HCPCS,DRUG SCREEN MULTIP CLASS,,,17 ,,TotalUnits,,,,3.01 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0432,HCPCS,EIA HIV-1/HIV-2 SCREEN,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0433,HCPCS,ELISA HIV-1/HIV-2 SCREEN,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0434,HCPCS,DRUG SCREEN MULTI DRUG CLASS,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0435,HCPCS,ORAL HIV-1/HIV-2 SCREEN,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0436,HCPCS,TOBACCO-USE COUNSEL 3-10 MIN,,,14 ,,RBRVS,0.24 ,0.10 ,0.16 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,G0437,HCPCS,TOBACCO-USE COUNSEL>10MIN,,,14 ,,RBRVS,0.50 ,0.24 ,0.30 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,G0438,HCPCS,"PPPS, INITIAL VISIT",,,15 ,,RBRVS,2.43 ,2.19 ,2.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0439,HCPCS,"PPPS, SUBSEQ VISIT",,,15 ,,RBRVS,1.50 ,1.63 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0442,HCPCS,ANNUAL ALCOHOL SCREEN 15 MIN,,,16 ,,RBRVS,0.18 ,0.08 ,0.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0443,HCPCS,BRIEF ALCOHOL MISUSE COUNSEL,,,16 ,,RBRVS,0.45 ,0.20 ,0.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,G0444,HCPCS,DEPRESSION SCREEN ANNUAL,,,16 ,,RBRVS,0.18 ,0.08 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0445,HCPCS,HIGH INTEN BEH COUNS STD 30M,,,16 ,,RBRVS,0.45 ,0.20 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0446,HCPCS,INTENS BEHAVE THER CARDIO DX,,,16 ,,RBRVS,0.45 ,0.20 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0447,HCPCS,BEHAVIOR COUNSEL OBESITY 15M,,,16 ,,RBRVS,0.45 ,0.20 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G0451,HCPCS,DEVLOPMENT TEST INTERPT&REP,,,17 ,,RBRVS,,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,G9017,HCPCS,AMANTADINE HCL 100MG ORAL,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120102,G9018,HCPCS,"ZANAMIVIR,INHALATION PWD 10M",,,29 ,,NW,,,,,,$15.31,$0.00,1,1,1,0,0,1,20120103,G9019,HCPCS,OSELTAMIVIR PHOSPHATE 75MG,,,29 ,,NW,,,,,,$16.11,$0.00,1,1,1,0,0,1,20120104,G9020,HCPCS,RIMANTADINE HCL 100MG ORAL,,,29 ,,NW,,,,,,$5.13,$0.00,1,1,1,0,0,1,20120105,G9033,HCPCS,AMANTADINE HCL ORAL BRAND,,,29 ,,NW,,,,,,$62.51,$0.00,1,1,1,0,0,1,20120106,G9034,HCPCS,"ZANAMIVIR, INH PWDR, BRAND",,,29 ,,NW,,,,,,$49.89,$0.00,1,1,1,0,0,1,20120107,G9036,HCPCS,"RIMANTADINE HCL, BRAND",,,29 ,,NW,,,,,,$193.49,$0.00,1,1,1,0,0,1,20120108,G9141,HCPCS,"INFLUENZA A H1N1,ADMIN W COU",,,9 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G9142,HCPCS,"INFLUENZA A H1N1, VACCINE",,,9 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,G9143,HCPCS,WARFARIN RESPON GENETIC TEST,,,17 ,,TotalUnits,,,,5.00 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0001,HCPCS,ALCOHOL AND/OR DRUG ASSESS,,,16 ,,TotalUnits,,,,1.14 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0002,HCPCS,ALCOHOL AND/OR DRUG SCREENIN,,,16 ,,TotalUnits,,,,3.32 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0003,HCPCS,ALCOHOL AND/OR DRUG SCREENIN,,,16 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0004,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0005,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0006,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0010,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,2.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0011,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,7.96 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0014,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,5.32 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0015,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,2.26 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0016,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,1.88 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0017,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,3.07 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0018,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,4.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0019,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,2.07 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0020,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0022,HCPCS,ALCOHOL AND/OR DRUG INTERVEN,,,16 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0024,HCPCS,ALCOHOL AND/OR DRUG PREVENTI,,,16 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0025,HCPCS,ALCOHOL AND/OR DRUG PREVENTI,,,16 ,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0031,HCPCS,MH HEALTH ASSESS BY NON-MD,,,16 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0032,HCPCS,MH SVC PLAN DEV BY NON-MD,,,16 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0033,HCPCS,ORAL MED ADM DIRECT OBSERVE,,,16 ,,TotalUnits,,,,2.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0034,HCPCS,MED TRNG & SUPPORT PER 15MIN,,,16 ,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0035,HCPCS,MH PARTIAL HOSP TX UNDER 24H,,,16 ,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0036,HCPCS,COMM PSY FACE-FACE PER 15MIN,,,16 ,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0037,HCPCS,COMM PSY SUP TX PGM PER DIEM,,,16 ,,TotalUnits,,,,2.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0038,HCPCS,SELF-HELP/PEER SVC PER 15MIN,,,16 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0039,HCPCS,ASSER COM TX FACE-FACE/15MIN,,,16 ,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0040,HCPCS,ASSERT COMM TX PGM PER DIEM,,,16 ,,TotalUnits,,,,1.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0041,HCPCS,FOS C CHLD NON-THER PER DIEM,,,16 ,,TotalUnits,,,,1.54 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0043,HCPCS,"SUPPORTED HOUSING, PER DIEM",,,16 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0044,HCPCS,"SUPPORTED HOUSING, PER MONTH",,,16 ,,TotalUnits,,,,9.57 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0045,HCPCS,RESPITE NOT-IN-HOME PER DIEM,,,16 ,,TotalUnits,,,,2.29 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0048,HCPCS,SPEC COLL NON-BLOOD:A/D TEST,,,16 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H0050,HCPCS,ALCOHOL/DRUG SERVICE 15 MIN,,,16 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H1000,HCPCS,PRENATAL CARE ATRISK ASSESSM,,,16 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H1001,HCPCS,ANTEPARTUM MANAGEMENT,,,16 ,,TotalUnits,,,,2.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H1002,HCPCS,CARECOORDINATION PRENATAL,,,16 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H1003,HCPCS,PRENATAL AT RISK EDUCATION,,,16 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H1004,HCPCS,FOLLOW UP HOME VISIT/PRENTAL,,,16 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H1005,HCPCS,PRENATALCARE ENHANCED SRV PK,,,16 ,,TotalUnits,,,,1.96 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2000,HCPCS,COMP MULTIDISIPLN EVALUATION,,,16 ,,TotalUnits,,,,1.94 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2010,HCPCS,COMPREHENSIVE MED SVC 15 MIN,,,16 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2011,HCPCS,"CRISIS INTERVEN SVC, 15 MIN",,,16 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2012,HCPCS,"BEHAV HLTH DAY TREAT, PER HR",,,16 ,,TotalUnits,,,,1.00 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2013,HCPCS,"PSYCH HLTH FAC SVC, PER DIEM",,,16 ,,TotalUnits,,,,2.33 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2014,HCPCS,"SKILLS TRAIN AND DEV, 15 MIN",,,16 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2017,HCPCS,"PSYSOC REHAB SVC, PER 15 MIN",,,16 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2018,HCPCS,"PSYSOC REHAB SVC, PER DIEM",,,16 ,,TotalUnits,,,,1.76 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2019,HCPCS,"THER BEHAV SVC, PER 15 MIN",,,16 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2020,HCPCS,"THER BEHAV SVC, PER DIEM",,,16 ,,TotalUnits,,,,1.56 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2021,HCPCS,"COM WRAP-AROUND SV, 15 MIN",,,16 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2022,HCPCS,"COM WRAP-AROUND SV, PER DIEM",,,16 ,,TotalUnits,,,,3.13 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2023,HCPCS,"SUPPORTED EMPLOY, PER 15 MIN",,,16 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2024,HCPCS,"SUPPORTED EMPLOY, PER DIEM",,,16 ,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2026,HCPCS,"SUPP MAINT EMPLOY, PER DIEM",,,16 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2029,HCPCS,"SEX OFFEND TX SVC, PER DIEM",,,16 ,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2032,HCPCS,"ACTIVITY THERAPY, PER 15 MIN",,,16 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2033,HCPCS,MULTISYS THER/JUVENILE 15MIN,,,16 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2035,HCPCS,"A/D TX PROGRAM, PER HOUR",,,16 ,,TotalUnits,,,,1.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,H2036,HCPCS,"A/D TX PROGRAM, PER DIEM",,,16 ,,TotalUnits,,,,1.01 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,J0120,HCPCS,TETRACYCLIN INJECTION,,,29 ,,NW,,,,,,$62.87,$0.00,1,1,1,0,0,1,20120101,J0129,HCPCS,ABATACEPT INJECTION,,,29 ,,NW,,,,,,$52.35,$0.00,1,1,1,0,0,1,20120101,J0130,HCPCS,ABCIXIMAB INJECTION,,,29 ,,NW,,,,,,"$1,255.40",$0.00,1,1,1,0,0,1,20120101,J0132,HCPCS,ACETYLCYSTEINE INJECTION,,,29 ,,NW,,,,,,$8.21,$0.00,1,1,1,0,0,1,20120101,J0133,HCPCS,ACYCLOVIR INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J0135,HCPCS,ADALIMUMAB INJECTION,,,29 ,,NW,,,,,,$969.54,$0.00,1,1,1,0,0,1,20120101,J0150,HCPCS,INJECTION ADENOSINE 6 MG,,,29 ,,NW,,,,,,$23.36,$0.00,1,1,1,0,0,1,20120101,J0152,HCPCS,ADENOSINE INJECTION,,,29 ,,NW,,,,,,$228.70,$0.00,1,1,1,0,0,1,20120101,J0171,HCPCS,ADRENALIN EPINEPHRINE INJECT,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J0180,HCPCS,AGALSIDASE BETA INJECTION,,,29 ,,NW,,,,,,$337.41,$0.00,1,1,1,0,0,1,20120101,J0190,HCPCS,INJ BIPERIDEN LACTATE/5 MG,,,29 ,,NW,,,,,,$3.98,$0.00,1,1,1,0,0,1,20120101,J0200,HCPCS,ALATROFLOXACIN MESYLATE,,,29 ,,NW,,,,,,$32.91,$0.00,1,1,1,0,0,1,20120101,J0205,HCPCS,ALGLUCERASE INJECTION,,,29 ,,NW,,,,,,$102.28,$0.00,1,1,1,0,0,1,20120101,J0207,HCPCS,AMIFOSTINE,,,29 ,,NW,,,,,,"$1,005.09",$0.00,1,1,1,0,0,1,20120101,J0210,HCPCS,METHYLDOPATE HCL INJECTION,,,29 ,,NW,,,,,,$97.45,$0.00,1,1,1,0,0,1,20120101,J0215,HCPCS,ALEFACEPT,,,29 ,,NW,,,,,,$88.59,$0.00,1,1,1,0,0,1,20120101,J0220,HCPCS,ALGLUCOSIDASE ALFA INJECTION,,,29 ,,NW,,,,,,$378.48,$0.00,1,1,1,0,0,1,20120101,J0256,HCPCS,ALPHA 1 PROTEINASE INHIBITOR,,,29 ,,NW,,,,,,$11.11,$0.00,1,1,1,0,0,1,20120101,J0270,HCPCS,ALPROSTADIL FOR INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J0275,HCPCS,ALPROSTADIL URETHRAL SUPPOS,,,29 ,,NW,,,,,,$56.49,$0.00,1,1,1,0,0,1,20120101,J0278,HCPCS,AMIKACIN SULFATE INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J0280,HCPCS,AMINOPHYLLIN 250 MG INJ,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J0282,HCPCS,AMIODARONE HCL,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J0285,HCPCS,AMPHOTERICIN B,,,29 ,,NW,,,,,,$33.83,$0.00,1,1,1,0,0,1,20120101,J0287,HCPCS,AMPHOTERICIN B LIPID COMPLEX,,,29 ,,NW,,,,,,$22.56,$0.00,1,1,1,0,0,1,20120101,J0288,HCPCS,AMPHO B CHOLESTERYL SULFATE,,,29 ,,NW,,,,,,$35.44,$0.00,1,1,1,0,0,1,20120101,J0289,HCPCS,AMPHOTERICIN B LIPOSOME INJ,,,29 ,,NW,,,,,,$38.66,$0.00,1,1,1,0,0,1,20120101,J0290,HCPCS,AMPICILLIN 500 MG INJ,,,29 ,,NW,,,,,,$10.27,$0.00,1,1,1,0,0,1,20120101,J0295,HCPCS,AMPICILLIN SODIUM PER 1.5 GM,,,29 ,,NW,,,,,,$7.19,$0.00,1,1,1,0,0,1,20120101,J0300,HCPCS,AMOBARBITAL 125 MG INJ,,,29 ,,NW,,,,,,$29.80,$0.00,1,1,1,0,0,1,20120101,J0330,HCPCS,SUCCINYCHOLINE CHLORIDE INJ,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J0348,HCPCS,ANIDULAFUNGIN INJECTION,,,29 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20120101,J0350,HCPCS,INJECTION ANISTREPLASE 30 U,,,29 ,,NW,,,,,,$243.65,$0.00,1,1,1,0,0,1,20120101,J0360,HCPCS,HYDRALAZINE HCL INJECTION,,,29 ,,NW,,,,,,$11.96,$0.00,1,1,1,0,0,1,20120101,J0364,HCPCS,APOMORPHINE HYDROCHLORIDE,,,29 ,,NW,,,,,,$14.50,$0.00,1,1,1,0,0,1,20120101,J0365,HCPCS,"APROTONIN, 10,000 KIU",,,29 ,,NW,,,,,,$8.21,$0.00,1,1,1,0,0,1,20120101,J0380,HCPCS,INJ METARAMINOL BITARTRATE,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J0390,HCPCS,CHLOROQUINE INJECTION,,,29 ,,NW,,,,,,$206.48,$0.00,1,1,1,0,0,1,20120101,J0395,HCPCS,ARBUTAMINE HCL INJECTION,,,29 ,,NW,,,,,,$27.53,$0.00,1,1,1,0,0,1,20120101,J0400,HCPCS,ARIPIPRAZOLE INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J0456,HCPCS,AZITHROMYCIN,,,29 ,,NW,,,,,,$13.66,$0.00,1,1,1,0,0,1,20120101,J0461,HCPCS,ATROPINE SULFATE INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J0470,HCPCS,DIMECAPROL INJECTION,,,29 ,,NW,,,,,,$71.68,$0.00,1,1,1,0,0,1,20120101,J0475,HCPCS,BACLOFEN 10 MG INJECTION,,,29 ,,NW,,,,,,$470.28,$0.00,1,1,1,0,0,1,20120101,J0476,HCPCS,BACLOFEN INTRATHECAL TRIAL,,,29 ,,NW,,,,,,$180.39,$0.00,1,1,1,0,0,1,20120101,J0480,HCPCS,BASILIXIMAB,,,29 ,,NW,,,,,,"$5,239.01",$0.00,1,1,1,0,0,1,20120101,J0500,HCPCS,DICYCLOMINE INJECTION,,,29 ,,NW,,,,,,$53.16,$0.00,1,1,1,0,0,1,20120101,J0515,HCPCS,INJ BENZTROPINE MESYLATE,,,29 ,,NW,,,,,,$69.26,$0.00,1,1,1,0,0,1,20120101,J0520,HCPCS,BETHANECHOL CHLORIDE INJECT,,,29 ,,NW,,,,,,$7.70,$0.00,1,1,1,0,0,1,20120101,J0558,HCPCS,PENG BENZATHINE/PROCAINE INJ,,,29 ,,NW,,,,,,$10.27,$0.00,1,1,1,0,0,1,20120101,J0561,HCPCS,PENICILLIN G BENZATHINE INJ,,,29 ,,NW,,,,,,$12.81,$0.00,1,1,1,0,0,1,20120101,J0583,HCPCS,BIVALIRUDIN,,,29 ,,NW,,,,,,$8.21,$0.00,1,1,1,0,0,1,20120101,J0585,HCPCS,"INJECTION,ONABOTULINUMTOXINA",,,29 ,,NW,,,,,,$15.31,$0.00,1,1,1,0,0,1,20120101,J0586,HCPCS,ABOBOTULINUMTOXINA,,,29 ,,NW,,,,,,$20.14,$0.00,1,1,1,0,0,1,20120101,J0587,HCPCS,"INJ, RIMABOTULINUMTOXINB",,,29 ,,NW,,,,,,$28.19,$0.00,1,1,1,0,0,1,20120101,J0588,HCPCS,INCOBOTULINUMTOXIN A,,,29 ,,NW,,,,,,$15.31,$0.00,1,1,1,0,0,1,20120101,J0592,HCPCS,BUPRENORPHINE HYDROCHLORIDE,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J0594,HCPCS,BUSULFAN INJECTION,,,29 ,,NW,,,,,,$47.52,$0.00,1,1,1,0,0,1,20120101,J0595,HCPCS,BUTORPHANOL TARTRATE 1 MG,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J0597,HCPCS,"C-1 ESTERASE, BERINERT",,,29 ,,NW,,,,,,$74.09,$0.00,1,1,1,0,0,1,20120101,J0598,HCPCS,"C-1 ESTERASE, CINRYZE",,,29 ,,NW,,,,,,$107.11,$0.00,1,1,1,0,0,1,20120101,J0600,HCPCS,EDETATE CALCIUM DISODIUM INJ,,,29 ,,NW,,,,,,$462.23,$0.00,1,1,1,0,0,1,20120101,J0610,HCPCS,CALCIUM GLUCONATE INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J0620,HCPCS,CALCIUM GLYCER & LACT/10 ML,,,29 ,,NW,,,,,,$29.00,$0.00,1,1,1,0,0,1,20120101,J0630,HCPCS,CALCITONIN SALMON INJECTION,,,29 ,,NW,,,,,,$136.90,$0.00,1,1,1,0,0,1,20120101,J0636,HCPCS,INJ CALCITRIOL PER 0.1 MCG,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J0637,HCPCS,CASPOFUNGIN ACETATE,,,29 ,,NW,,,,,,$31.41,$0.00,1,1,1,0,0,1,20120101,J0638,HCPCS,CANAKINUMAB INJECTION,,,29 ,,NW,,,,,,$213.40,$0.00,1,1,1,0,0,1,20120101,J0640,HCPCS,LEUCOVORIN CALCIUM INJECTION,,,29 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20120101,J0641,HCPCS,LEVOLEUCOVORIN INJECTION,,,29 ,,NW,,,,,,$5.13,$0.00,1,1,1,0,0,1,20120101,J0670,HCPCS,INJ MEPIVACAINE HCL/10 ML,,,29 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20120101,J0690,HCPCS,CEFAZOLIN SODIUM INJECTION,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J0692,HCPCS,CEFEPIME HCL FOR INJECTION,,,29 ,,NW,,,,,,$10.27,$0.00,1,1,1,0,0,1,20120101,J0694,HCPCS,CEFOXITIN SODIUM INJECTION,,,29 ,,NW,,,,,,$15.31,$0.00,1,1,1,0,0,1,20120101,J0696,HCPCS,CEFTRIAXONE SODIUM INJECTION,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J0697,HCPCS,STERILE CEFUROXIME INJECTION,,,29 ,,NW,,,,,,$6.16,$0.00,1,1,1,0,0,1,20120101,J0698,HCPCS,CEFOTAXIME SODIUM INJECTION,,,29 ,,NW,,,,,,$5.13,$0.00,1,1,1,0,0,1,20120101,J0702,HCPCS,BETAMETHASONE ACET&SOD PHOSP,,,29 ,,NW,,,,,,$15.31,$0.00,1,1,1,0,0,1,20120101,J0706,HCPCS,CAFFEINE CITRATE INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J0710,HCPCS,CEPHAPIRIN SODIUM INJECTION,,,29 ,,NW,,,,,,$14.57,$0.00,1,1,1,0,0,1,20120101,J0713,HCPCS,INJ CEFTAZIDIME PER 500 MG,,,29 ,,NW,,,,,,$6.16,$0.00,1,1,1,0,0,1,20120101,J0715,HCPCS,CEFTIZOXIME SODIUM / 500 MG,,,29 ,,NW,,,,,,$15.93,$0.00,1,1,1,0,0,1,20120101,J0718,HCPCS,CERTOLIZUMAB PEGOL INJ,,,29 ,,NW,,,,,,$11.96,$0.00,1,1,1,0,0,1,20120101,J0720,HCPCS,CHLORAMPHENICOL SODIUM INJEC,,,29 ,,NW,,,,,,$49.13,$0.00,1,1,1,0,0,1,20120101,J0725,HCPCS,CHORIONIC GONADOTROPIN/1000U,,,29 ,,NW,,,,,,$29.00,$0.00,1,1,1,0,0,1,20120101,J0735,HCPCS,CLONIDINE HYDROCHLORIDE,,,29 ,,NW,,,,,,$58.79,$0.00,1,1,1,0,0,1,20120101,J0740,HCPCS,CIDOFOVIR INJECTION,,,29 ,,NW,,,,,,"$1,794.12",$0.00,1,1,1,0,0,1,20120101,J0743,HCPCS,CILASTATIN SODIUM INJECTION,,,29 ,,NW,,,,,,$31.41,$0.00,1,1,1,0,0,1,20120101,J0744,HCPCS,CIPROFLOXACIN IV,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J0745,HCPCS,INJ CODEINE PHOSPHATE /30 MG,,,29 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20120101,J0760,HCPCS,COLCHICINE INJECTION,,,29 ,,NW,,,,,,$17.72,$0.00,1,1,1,0,0,1,20120101,J0770,HCPCS,COLISTIMETHATE SODIUM INJ,,,29 ,,NW,,,,,,$35.44,$0.00,1,1,1,0,0,1,20120101,J0775,HCPCS,"COLLAGENASE, CLOST HIST INJ",,,29 ,,NW,,,,,,$91.00,$0.00,1,1,1,0,0,1,20120101,J0780,HCPCS,PROCHLORPERAZINE INJECTION,,,29 ,,NW,,,,,,$6.16,$0.00,1,1,1,0,0,1,20120101,J0795,HCPCS,CORTICORELIN OVINE TRIFLUTAL,,,29 ,,NW,,,,,,$14.50,$0.00,1,1,1,0,0,1,20120101,J0800,HCPCS,CORTICOTROPIN INJECTION,,,29 ,,NW,,,,,,"$6,080.51",$0.00,1,1,1,0,0,1,20120101,J0833,HCPCS,COSYNTROPIN INJECTION NOS,,,29 ,,NW,,,,,,$222.26,$0.00,1,1,1,0,0,1,20120101,J0834,HCPCS,COSYNTROPIN CORTROSYN INJ,,,29 ,,NW,,,,,,$167.50,$0.00,1,1,1,0,0,1,20120101,J0850,HCPCS,CYTOMEGALOVIRUS IMM IV /VIAL,,,29 ,,NW,,,,,,"$2,290.97",$0.00,1,1,1,0,0,1,20120101,J0878,HCPCS,DAPTOMYCIN INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J0881,HCPCS,"DARBEPOETIN ALFA, NON-ESRD",,,29 ,,NW,,,,,,$9.24,$0.00,1,1,1,0,0,1,20120101,J0882,HCPCS,"DARBEPOETIN ALFA, ESRD USE",,,29 ,,NW,,,,,,$9.24,$0.00,1,1,1,0,0,1,20120101,J0885,HCPCS,"EPOETIN ALFA, NON-ESRD",,,29 ,,NW,,,,,,$25.78,$0.00,1,1,1,0,0,1,20120101,J0886,HCPCS,EPOETIN ALFA 1000 UNITS ESRD,,,29 ,,NW,,,,,,$25.78,$0.00,1,1,1,0,0,1,20120101,J0894,HCPCS,DECITABINE INJECTION,,,29 ,,NW,,,,,,$79.73,$0.00,1,1,1,0,0,1,20120101,J0895,HCPCS,DEFEROXAMINE MESYLATE INJ,,,29 ,,NW,,,,,,$25.78,$0.00,1,1,1,0,0,1,20120101,J0900,HCPCS,TESTOSTERONE ENANTHATE INJ,,,29 ,,NW,,,,,,$19.41,$0.00,1,1,1,0,0,1,20120101,J0945,HCPCS,BROMPHENIRAMINE MALEATE INJ,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J1000,HCPCS,DEPO-ESTRADIOL CYPIONATE INJ,,,29 ,,NW,,,,,,$18.53,$0.00,1,1,1,0,0,1,20120101,J1020,HCPCS,METHYLPREDNISOLONE 20 MG INJ,,,29 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20120101,J1030,HCPCS,METHYLPREDNISOLONE 40 MG INJ,,,29 ,,NW,,,,,,$7.19,$0.00,1,1,1,0,0,1,20120101,J1040,HCPCS,METHYLPREDNISOLONE 80 MG INJ,,,29 ,,NW,,,,,,$18.53,$0.00,1,1,1,0,0,1,20120101,J1051,HCPCS,MEDROXYPROGESTERONE INJ,,,29 ,,NW,,,,,,$21.75,$0.00,1,1,1,0,0,1,20120101,J1055,HCPCS,MEDRXYPROGESTER ACETATE INJ,,,29 ,,NW,,,,,,$124.82,$0.00,1,1,1,0,0,1,20120101,J1056,HCPCS,MA/EC CONTRACEPTIVEINJECTION,,,29 ,,NW,,,,,,$61.21,$0.00,1,1,1,0,0,1,20120101,J1060,HCPCS,TESTOSTERONE CYPIONATE 1 ML,,,29 ,,NW,,,,,,$15.86,$0.00,1,1,1,0,0,1,20120101,J1070,HCPCS,TESTOSTERONE CYPIONAT 100 MG,,,29 ,,NW,,,,,,$10.27,$0.00,1,1,1,0,0,1,20120101,J1080,HCPCS,TESTOSTERONE CYPIONAT 200 MG,,,29 ,,NW,,,,,,$16.92,$0.00,1,1,1,0,0,1,20120101,J1094,HCPCS,INJ DEXAMETHASONE ACETATE,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J1100,HCPCS,DEXAMETHASONE SODIUM PHOS,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J1110,HCPCS,INJ DIHYDROERGOTAMINE MESYLT,,,29 ,,NW,,,,,,$64.43,$0.00,1,1,1,0,0,1,20120101,J1120,HCPCS,ACETAZOLAMID SODIUM INJECTIO,,,29 ,,NW,,,,,,$78.92,$0.00,1,1,1,0,0,1,20120101,J1160,HCPCS,DIGOXIN INJECTION,,,29 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20120101,J1162,HCPCS,DIGOXIN IMMUNE FAB (OVINE),,,29 ,,NW,,,,,,"$1,471.21",$0.00,1,1,1,0,0,1,20120101,J1165,HCPCS,PHENYTOIN SODIUM INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J1170,HCPCS,HYDROMORPHONE INJECTION,,,29 ,,NW,,,,,,$5.13,$0.00,1,1,1,0,0,1,20120101,J1180,HCPCS,DYPHYLLINE INJECTION,,,29 ,,NW,,,,,,$17.48,$0.00,1,1,1,0,0,1,20120101,J1190,HCPCS,DEXRAZOXANE HCL INJECTION,,,29 ,,NW,,,,,,$591.87,$0.00,1,1,1,0,0,1,20120101,J1200,HCPCS,DIPHENHYDRAMINE HCL INJECTIO,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J1205,HCPCS,CHLOROTHIAZIDE SODIUM INJ,,,29 ,,NW,,,,,,$661.93,$0.00,1,1,1,0,0,1,20120101,J1212,HCPCS,DIMETHYL SULFOXIDE 50% 50 ML,,,29 ,,NW,,,,,,$230.31,$0.00,1,1,1,0,0,1,20120101,J1230,HCPCS,METHADONE INJECTION,,,29 ,,NW,,,,,,$17.72,$0.00,1,1,1,0,0,1,20120101,J1240,HCPCS,DIMENHYDRINATE INJECTION,,,29 ,,NW,,,,,,$10.27,$0.00,1,1,1,0,0,1,20120101,J1245,HCPCS,DIPYRIDAMOLE INJECTION,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J1250,HCPCS,INJ DOBUTAMINE HCL/250 MG,,,29 ,,NW,,,,,,$14.50,$0.00,1,1,1,0,0,1,20120101,J1260,HCPCS,DOLASETRON MESYLATE,,,29 ,,NW,,,,,,$20.70,$0.00,1,1,1,0,0,1,20120101,J1265,HCPCS,DOPAMINE INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J1267,HCPCS,DORIPENEM INJECTION,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J1270,HCPCS,"INJECTION, DOXERCALCIFEROL",,,29 ,,NW,,,,,,$9.24,$0.00,1,1,1,0,0,1,20120101,J1290,HCPCS,ECALLANTIDE INJECTION,,,29 ,,NW,,,,,,$654.68,$0.00,1,1,1,0,0,1,20120101,J1300,HCPCS,ECULIZUMAB INJECTION,,,29 ,,NW,,,,,,$452.56,$0.00,1,1,1,0,0,1,20120101,J1320,HCPCS,AMITRIPTYLINE INJECTION,,,29 ,,NW,,,,,,$79.63,$0.00,1,1,1,0,0,1,20120101,J1324,HCPCS,ENFUVIRTIDE INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J1325,HCPCS,EPOPROSTENOL INJECTION,,,29 ,,NW,,,,,,$37.05,$0.00,1,1,1,0,0,1,20120101,J1327,HCPCS,EPTIFIBATIDE INJECTION,,,29 ,,NW,,,,,,$55.57,$0.00,1,1,1,0,0,1,20120101,J1330,HCPCS,ERGONOVINE MALEATE INJECTION,,,29 ,,NW,,,,,,$7.18,$0.00,1,1,1,0,0,1,20120101,J1335,HCPCS,ERTAPENEM INJECTION,,,29 ,,NW,,,,,,$70.87,$0.00,1,1,1,0,0,1,20120101,J1364,HCPCS,ERYTHRO LACTOBIONATE /500 MG,,,29 ,,NW,,,,,,$19.34,$0.00,1,1,1,0,0,1,20120101,J1380,HCPCS,ESTRADIOL VALERATE 10 MG INJ,,,29 ,,NW,,,,,,$20.14,$0.00,1,1,1,0,0,1,20120101,J1410,HCPCS,INJ ESTROGEN CONJUGATE 25 MG,,,29 ,,NW,,,,,,$252.05,$0.00,1,1,1,0,0,1,20120101,J1430,HCPCS,ETHANOLAMINE OLEATE 100 MG,,,29 ,,NW,,,,,,$693.34,$0.00,1,1,1,0,0,1,20120101,J1435,HCPCS,INJECTION ESTRONE PER 1 MG,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J1436,HCPCS,ETIDRONATE DISODIUM INJ,,,29 ,,NW,,,,,,$196.66,$0.00,1,1,1,0,0,1,20120101,J1438,HCPCS,ETANERCEPT INJECTION,,,29 ,,NW,,,,,,$496.05,$0.00,1,1,1,0,0,1,20120101,J1440,HCPCS,FILGRASTIM 300 MCG INJECTION,,,29 ,,NW,,,,,,$593.48,$0.00,1,1,1,0,0,1,20120101,J1441,HCPCS,FILGRASTIM 480 MCG INJECTION,,,29 ,,NW,,,,,,$934.11,$0.00,1,1,1,0,0,1,20120101,J1450,HCPCS,FLUCONAZOLE,,,29 ,,NW,,,,,,$13.66,$0.00,1,1,1,0,0,1,20120101,J1451,HCPCS,"FOMEPIZOLE, 15 MG",,,29 ,,NW,,,,,,$20.95,$0.00,1,1,1,0,0,1,20120101,J1452,HCPCS,INTRAOCULAR FOMIVIRSEN NA,,,29 ,,NW,,,,,,"$2,195.88",$0.00,1,1,1,0,0,1,20120101,J1453,HCPCS,FOSAPREPITANT INJECTION,,,29 ,,NW,,,,,,$5.13,$0.00,1,1,1,0,0,1,20120101,J1455,HCPCS,FOSCARNET SODIUM INJECTION,,,29 ,,NW,,,,,,$37.05,$0.00,1,1,1,0,0,1,20120101,J1457,HCPCS,GALLIUM NITRATE INJECTION,,,29 ,,NW,,,,,,$6.16,$0.00,1,1,1,0,0,1,20120101,J1458,HCPCS,GALSULFASE INJECTION,,,29 ,,NW,,,,,,$828.62,$0.00,1,1,1,0,0,1,20120101,J1459,HCPCS,INJ IVIG PRIVIGEN 500 MG,,,29 ,,NW,,,,,,$85.37,$0.00,1,1,1,0,0,1,20120101,J1460,HCPCS,GAMMA GLOBULIN 1 CC INJ,,,29 ,,NW,,,,,,$49.13,$0.00,1,1,1,0,0,1,20120101,J1559,HCPCS,HIZENTRA INJECTION,,,29 ,,NW,,,,,,$19.34,$0.00,1,1,1,0,0,1,20120101,J1560,HCPCS,GAMMA GLOBULIN > 10 CC INJ,,,29 ,,NW,,,,,,$471.08,$0.00,1,1,1,0,0,1,20120101,J1561,HCPCS,GAMUNEX INJECTION,,,29 ,,NW,,,,,,$91.81,$0.00,1,1,1,0,0,1,20120101,J1562,HCPCS,"VIVAGLOBIN, INJ",,,29 ,,NW,,,,,,$19.34,$0.00,1,1,1,0,0,1,20120101,J1566,HCPCS,"IMMUNE GLOBULIN, POWDER",,,29 ,,NW,,,,,,$75.70,$0.00,1,1,1,0,0,1,20120101,J1568,HCPCS,OCTAGAM INJECTION,,,29 ,,NW,,,,,,$136.90,$0.00,1,1,1,0,0,1,20120101,J1569,HCPCS,GAMMAGARD LIQUID INJECTION,,,29 ,,NW,,,,,,$92.61,$0.00,1,1,1,0,0,1,20120101,J1570,HCPCS,GANCICLOVIR SODIUM INJECTION,,,29 ,,NW,,,,,,$163.48,$0.00,1,1,1,0,0,1,20120101,J1571,HCPCS,HEPAGAM B IM INJECTION,,,29 ,,NW,,,,,,$132.88,$0.00,1,1,1,0,0,1,20120101,J1572,HCPCS,FLEBOGAMMA INJECTION,,,29 ,,NW,,,,,,$86.17,$0.00,1,1,1,0,0,1,20120101,J1573,HCPCS,"HEPAGAM B INTRAVENOUS, INJ",,,29 ,,NW,,,,,,$132.88,$0.00,1,1,1,0,0,1,20120101,J1580,HCPCS,GARAMYCIN GENTAMICIN INJ,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J1590,HCPCS,GATIFLOXACIN INJECTION,,,29 ,,NW,,,,,,$2.65,$0.00,1,1,1,0,0,1,20120101,J1595,HCPCS,INJECTION GLATIRAMER ACETATE,,,29 ,,NW,,,,,,"$3,752.51",$0.00,1,1,1,0,0,1,20120101,J1599,HCPCS,"IVIG NON-LYOPHILIZED, NOS",,,29 ,,NW,,,,,,$198.01,$0.00,1,1,1,0,0,1,20120101,J1600,HCPCS,GOLD SODIUM THIOMALEATE INJ,,,29 ,,NW,,,,,,$34.64,$0.00,1,1,1,0,0,1,20120101,J1610,HCPCS,GLUCAGON HYDROCHLORIDE/1 MG,,,29 ,,NW,,,,,,$225.48,$0.00,1,1,1,0,0,1,20120101,J1620,HCPCS,GONADORELIN HYDROCH/ 100 MCG,,,29 ,,NW,,,,,,$620.82,$0.00,1,1,1,0,0,1,20120101,J1626,HCPCS,GRANISETRON HCL INJECTION,,,29 ,,NW,,,,,,$5.13,$0.00,1,1,1,0,0,1,20120101,J1630,HCPCS,HALOPERIDOL INJECTION,,,29 ,,NW,,,,,,$5.13,$0.00,1,1,1,0,0,1,20120101,J1631,HCPCS,HALOPERIDOL DECANOATE INJ,,,29 ,,NW,,,,,,$38.66,$0.00,1,1,1,0,0,1,20120101,J1640,HCPCS,"HEMIN, 1 MG",,,29 ,,NW,,,,,,$27.39,$0.00,1,1,1,0,0,1,20120101,J1642,HCPCS,INJ HEPARIN SODIUM PER 10 U,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J1644,HCPCS,INJ HEPARIN SODIUM PER 1000U,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J1645,HCPCS,DALTEPARIN SODIUM,,,29 ,,NW,,,,,,$29.80,$0.00,1,1,1,0,0,1,20120101,J1650,HCPCS,INJ ENOXAPARIN SODIUM,,,29 ,,NW,,,,,,$17.72,$0.00,1,1,1,0,0,1,20120101,J1652,HCPCS,FONDAPARINUX SODIUM,,,29 ,,NW,,,,,,$16.92,$0.00,1,1,1,0,0,1,20120101,J1655,HCPCS,TINZAPARIN SODIUM INJECTION,,,29 ,,NW,,,,,,$10.27,$0.00,1,1,1,0,0,1,20120101,J1670,HCPCS,TETANUS IMMUNE GLOBULIN INJ,,,29 ,,NW,,,,,,$612.81,$0.00,1,1,1,0,0,1,20120101,J1675,HCPCS,HISTRELIN ACETATE,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J1680,HCPCS,HUMAN FIBRINOGEN CONC INJ,,,29 ,,NW,,,,,,$1.66,$0.00,1,1,1,0,0,1,20120101,J1700,HCPCS,HYDROCORTISONE ACETATE INJ,,,29 ,,NW,,,,,,$1.13,$0.00,1,1,1,0,0,1,20120101,J1710,HCPCS,HYDROCORTISONE SODIUM PH INJ,,,29 ,,NW,,,,,,$16.24,$0.00,1,1,1,0,0,1,20120101,J1720,HCPCS,HYDROCORTISONE SODIUM SUCC I,,,29 ,,NW,,,,,,$11.11,$0.00,1,1,1,0,0,1,20120101,J1730,HCPCS,DIAZOXIDE INJECTION,,,29 ,,NW,,,,,,$239.98,$0.00,1,1,1,0,0,1,20120101,J1740,HCPCS,IBANDRONATE SODIUM INJECTION,,,29 ,,NW,,,,,,$360.76,$0.00,1,1,1,0,0,1,20120101,J1742,HCPCS,IBUTILIDE FUMARATE INJECTION,,,29 ,,NW,,,,,,$298.76,$0.00,1,1,1,0,0,1,20120101,J1743,HCPCS,IDURSULFASE INJECTION,,,29 ,,NW,,,,,,"$1,080.66",$0.00,1,1,1,0,0,1,20120101,J1745,HCPCS,INFLIXIMAB INJECTION,,,29 ,,NW,,,,,,$146.57,$0.00,1,1,1,0,0,1,20120101,J1750,HCPCS,INJ IRON DEXTRAN,,,29 ,,NW,,,,,,$30.61,$0.00,1,1,1,0,0,1,20120101,J1756,HCPCS,IRON SUCROSE INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J1786,HCPCS,IMUGLUCERASE INJECTION,,,29 ,,NW,,,,,,$102.28,$0.00,1,1,1,0,0,1,20120101,J1790,HCPCS,DROPERIDOL INJECTION,,,29 ,,NW,,,,,,$7.19,$0.00,1,1,1,0,0,1,20120101,J1800,HCPCS,PROPRANOLOL INJECTION,,,29 ,,NW,,,,,,$8.21,$0.00,1,1,1,0,0,1,20120101,J1810,HCPCS,DROPERIDOL/FENTANYL INJ,,,29 ,,NW,,,,,,$22.36,$0.00,1,1,1,0,0,1,20120101,J1815,HCPCS,INSULIN INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J1817,HCPCS,INSULIN FOR INSULIN PUMP USE,,,29 ,,NW,,,,,,$7.19,$0.00,1,1,1,0,0,1,20120101,J1826,HCPCS,INTERFERON BETA-1A INJ,,,29 ,,NW,,,,,,"$1,362.50",$0.00,1,1,1,0,0,1,20120101,J1830,HCPCS,INTERFERON BETA-1B / .25 MG,,,29 ,,NW,,,,,,$377.89,$0.00,1,1,1,0,0,1,20120101,J1835,HCPCS,ITRACONAZOLE INJECTION,,,29 ,,NW,,,,,,"$2,199.17",$0.00,1,1,1,0,0,1,20120101,J1840,HCPCS,KANAMYCIN SULFATE 500 MG INJ,,,29 ,,NW,,,,,,$20.95,$0.00,1,1,1,0,0,1,20120101,J1850,HCPCS,KANAMYCIN SULFATE 75 MG INJ,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J1885,HCPCS,KETOROLAC TROMETHAMINE INJ,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J1890,HCPCS,CEPHALOTHIN SODIUM INJECTION,,,29 ,,NW,,,,,,$25.78,$0.00,1,1,1,0,0,1,20120101,J1930,HCPCS,LANREOTIDE INJECTION,,,29 ,,NW,,,,,,$76.51,$0.00,1,1,1,0,0,1,20120101,J1931,HCPCS,LARONIDASE INJECTION,,,29 ,,NW,,,,,,$66.04,$0.00,1,1,1,0,0,1,20120101,J1940,HCPCS,FUROSEMIDE INJECTION,,,29 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20120101,J1945,HCPCS,LEPIRUDIN,,,29 ,,NW,,,,,,$725.55,$0.00,1,1,1,0,0,1,20120101,J1950,HCPCS,LEUPROLIDE ACETATE /3.75 MG,,,29 ,,NW,,,,,,"$1,422.09",$0.00,1,1,1,0,0,1,20120101,J1953,HCPCS,LEVETIRACETAM INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J1955,HCPCS,INJ LEVOCARNITINE PER 1 GM,,,29 ,,NW,,,,,,$18.53,$0.00,1,1,1,0,0,1,20120101,J1956,HCPCS,LEVOFLOXACIN INJECTION,,,29 ,,NW,,,,,,$15.31,$0.00,1,1,1,0,0,1,20120101,J1960,HCPCS,LEVORPHANOL TARTRATE INJ,,,29 ,,NW,,,,,,$9.24,$0.00,1,1,1,0,0,1,20120101,J1980,HCPCS,HYOSCYAMINE SULFATE INJ,,,29 ,,NW,,,,,,$33.83,$0.00,1,1,1,0,0,1,20120101,J1990,HCPCS,CHLORDIAZEPOXIDE INJECTION,,,29 ,,NW,,,,,,$50.74,$0.00,1,1,1,0,0,1,20120101,J2001,HCPCS,LIDOCAINE INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J2010,HCPCS,LINCOMYCIN INJECTION,,,29 ,,NW,,,,,,$16.92,$0.00,1,1,1,0,0,1,20120101,J2020,HCPCS,LINEZOLID INJECTION,,,29 ,,NW,,,,,,$85.37,$0.00,1,1,1,0,0,1,20120101,J2060,HCPCS,LORAZEPAM INJECTION,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J2150,HCPCS,MANNITOL INJECTION,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J2170,HCPCS,MECASERMIN INJECTION,,,29 ,,NW,,,,,,$19.34,$0.00,1,1,1,0,0,1,20120101,J2175,HCPCS,MEPERIDINE HYDROCHL /100 MG,,,29 ,,NW,,,,,,$6.16,$0.00,1,1,1,0,0,1,20120101,J2180,HCPCS,MEPERIDINE/PROMETHAZINE INJ,,,29 ,,NW,,,,,,$20.95,$0.00,1,1,1,0,0,1,20120101,J2185,HCPCS,MEROPENEM,,,29 ,,NW,,,,,,$10.27,$0.00,1,1,1,0,0,1,20120101,J2210,HCPCS,METHYLERGONOVIN MALEATE INJ,,,29 ,,NW,,,,,,$16.11,$0.00,1,1,1,0,0,1,20120101,J2248,HCPCS,MICAFUNGIN SODIUM INJECTION,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J2250,HCPCS,INJ MIDAZOLAM HYDROCHLORIDE,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J2260,HCPCS,INJ MILRINONE LACTATE / 5 MG,,,29 ,,NW,,,,,,$11.11,$0.00,1,1,1,0,0,1,20120101,J2270,HCPCS,MORPHINE SULFATE INJECTION,,,29 ,,NW,,,,,,$8.21,$0.00,1,1,1,0,0,1,20120101,J2271,HCPCS,MORPHINE SO4 INJECTION 100MG,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J2275,HCPCS,MORPHINE SULFATE INJECTION,,,29 ,,NW,,,,,,$8.21,$0.00,1,1,1,0,0,1,20120101,J2278,HCPCS,ZICONOTIDE INJECTION,,,29 ,,NW,,,,,,$17.72,$0.00,1,1,1,0,0,1,20120101,J2280,HCPCS,"INJ, MOXIFLOXACIN 100 MG",,,29 ,,NW,,,,,,$10.27,$0.00,1,1,1,0,0,1,20120101,J2300,HCPCS,INJ NALBUPHINE HYDROCHLORIDE,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J2310,HCPCS,INJ NALOXONE HYDROCHLORIDE,,,29 ,,NW,,,,,,$20.95,$0.00,1,1,1,0,0,1,20120101,J2315,HCPCS,"NALTREXONE, DEPOT FORM",,,29 ,,NW,,,,,,$8.21,$0.00,1,1,1,0,0,1,20120101,J2320,HCPCS,NANDROLONE DECANOATE 50 MG,,,29 ,,NW,,,,,,$11.11,$0.00,1,1,1,0,0,1,20120101,J2323,HCPCS,NATALIZUMAB INJECTION,,,29 ,,NW,,,,,,$27.39,$0.00,1,1,1,0,0,1,20120101,J2325,HCPCS,NESIRITIDE INJECTION,,,29 ,,NW,,,,,,$113.55,$0.00,1,1,1,0,0,1,20120101,J2353,HCPCS,"OCTREOTIDE INJECTION, DEPOT",,,29 ,,NW,,,,,,$282.65,$0.00,1,1,1,0,0,1,20120101,J2354,HCPCS,"OCTREOTIDE INJ, NON-DEPOT",,,29 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20120101,J2355,HCPCS,OPRELVEKIN INJECTION,,,29 ,,NW,,,,,,$582.21,$0.00,1,1,1,0,0,1,20120101,J2357,HCPCS,OMALIZUMAB INJECTION,,,29 ,,NW,,,,,,$52.35,$0.00,1,1,1,0,0,1,20120101,J2358,HCPCS,OLANZAPINE LONG-ACTING INJ,,,29 ,,NW,,,,,,$8.21,$0.00,1,1,1,0,0,1,20120101,J2360,HCPCS,ORPHENADRINE INJECTION,,,29 ,,NW,,,,,,$16.11,$0.00,1,1,1,0,0,1,20120101,J2370,HCPCS,PHENYLEPHRINE HCL INJECTION,,,29 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20120101,J2400,HCPCS,CHLOROPROCAINE HCL INJECTION,,,29 ,,NW,,,,,,$35.44,$0.00,1,1,1,0,0,1,20120101,J2405,HCPCS,ONDANSETRON HCL INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J2410,HCPCS,OXYMORPHONE HCL INJECTION,,,29 ,,NW,,,,,,$7.19,$0.00,1,1,1,0,0,1,20120101,J2425,HCPCS,PALIFERMIN INJECTION,,,29 ,,NW,,,,,,$29.80,$0.00,1,1,1,0,0,1,20120101,J2426,HCPCS,PALIPERIDONE PALMITATE INJ,,,29 ,,NW,,,,,,$18.53,$0.00,1,1,1,0,0,1,20120101,J2430,HCPCS,PAMIDRONATE DISODIUM /30 MG,,,29 ,,NW,,,,,,$37.05,$0.00,1,1,1,0,0,1,20120101,J2440,HCPCS,PAPAVERIN HCL INJECTION,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J2460,HCPCS,OXYTETRACYCLINE INJECTION,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J2469,HCPCS,PALONOSETRON HCL,,,29 ,,NW,,,,,,$45.10,$0.00,1,1,1,0,0,1,20120101,J2501,HCPCS,PARICALCITOL,,,29 ,,NW,,,,,,$8.21,$0.00,1,1,1,0,0,1,20120101,J2503,HCPCS,PEGAPTANIB SODIUM INJECTION,,,29 ,,NW,,,,,,"$2,447.99",$0.00,1,1,1,0,0,1,20120101,J2504,HCPCS,"PEGADEMASE BOVINE, 25 IU",,,29 ,,NW,,,,,,$588.65,$0.00,1,1,1,0,0,1,20120101,J2505,HCPCS,"INJECTION, PEGFILGRASTIM 6MG",,,29 ,,NW,,,,,,"$6,290.68",$0.00,1,1,1,0,0,1,20120101,J2510,HCPCS,PENICILLIN G PROCAINE INJ,,,29 ,,NW,,,,,,$31.41,$0.00,1,1,1,0,0,1,20120101,J2513,HCPCS,PENTASTARCH 10% SOLUTION,,,29 ,,NW,,,,,,$8.89,$0.00,1,1,1,0,0,1,20120101,J2515,HCPCS,PENTOBARBITAL SODIUM INJ,,,29 ,,NW,,,,,,$53.16,$0.00,1,1,1,0,0,1,20120101,J2540,HCPCS,PENICILLIN G POTASSIUM INJ,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J2543,HCPCS,PIPERACILLIN/TAZOBACTAM,,,29 ,,NW,,,,,,$12.81,$0.00,1,1,1,0,0,1,20120101,J2545,HCPCS,PENTAMIDINE NON-COMP UNIT,,,29 ,,NW,,,,,,$126.43,$0.00,1,1,1,0,0,1,20120101,J2550,HCPCS,PROMETHAZINE HCL INJECTION,,,29 ,,NW,,,,,,$5.13,$0.00,1,1,1,0,0,1,20120101,J2560,HCPCS,PHENOBARBITAL SODIUM INJ,,,29 ,,NW,,,,,,$9.24,$0.00,1,1,1,0,0,1,20120101,J2562,HCPCS,PLERIXAFOR INJECTION,,,29 ,,NW,,,,,,$658.71,$0.00,1,1,1,0,0,1,20120101,J2590,HCPCS,OXYTOCIN INJECTION,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J2597,HCPCS,INJ DESMOPRESSIN ACETATE,,,29 ,,NW,,,,,,$8.21,$0.00,1,1,1,0,0,1,20120101,J2650,HCPCS,PREDNISOLONE ACETATE INJ,,,29 ,,NW,,,,,,$4.45,$0.00,1,1,1,0,0,1,20120101,J2670,HCPCS,TOTAZOLINE HCL INJECTION,,,29 ,,NW,,,,,,$11.33,$0.00,1,1,1,0,0,1,20120101,J2675,HCPCS,INJ PROGESTERONE PER 50 MG,,,29 ,,NW,,,,,,$5.13,$0.00,1,1,1,0,0,1,20120101,J2680,HCPCS,FLUPHENAZINE DECANOATE 25 MG,,,29 ,,NW,,,,,,$28.19,$0.00,1,1,1,0,0,1,20120101,J2690,HCPCS,PROCAINAMIDE HCL INJECTION,,,29 ,,NW,,,,,,$20.95,$0.00,1,1,1,0,0,1,20120101,J2700,HCPCS,OXACILLIN SODIUM INJECITON,,,29 ,,NW,,,,,,$8.21,$0.00,1,1,1,0,0,1,20120101,J2710,HCPCS,NEOSTIGMINE METHYLSLFTE INJ,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J2720,HCPCS,INJ PROTAMINE SULFATE/10 MG,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J2724,HCPCS,PROTEIN C CONCENTRATE,,,29 ,,NW,,,,,,$33.02,$0.00,1,1,1,0,0,1,20120101,J2725,HCPCS,INJ PROTIRELIN PER 250 MCG,,,29 ,,NW,,,,,,$80.77,$0.00,1,1,1,0,0,1,20120101,J2730,HCPCS,PRALIDOXIME CHLORIDE INJ,,,29 ,,NW,,,,,,$216.62,$0.00,1,1,1,0,0,1,20120101,J2760,HCPCS,PHENTOLAINE MESYLATE INJ,,,29 ,,NW,,,,,,$137.71,$0.00,1,1,1,0,0,1,20120101,J2765,HCPCS,METOCLOPRAMIDE HCL INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J2770,HCPCS,QUINUPRISTIN/DALFOPRISTIN,,,29 ,,NW,,,,,,$412.30,$0.00,1,1,1,0,0,1,20120101,J2778,HCPCS,RANIBIZUMAB INJECTION,,,29 ,,NW,,,,,,$960.68,$0.00,1,1,1,0,0,1,20120101,J2780,HCPCS,RANITIDINE HYDROCHLORIDE INJ,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J2783,HCPCS,RASBURICASE,,,29 ,,NW,,,,,,$450.15,$0.00,1,1,1,0,0,1,20120101,J2785,HCPCS,REGADENOSON INJECTION,,,29 ,,NW,,,,,,$126.43,$0.00,1,1,1,0,0,1,20120101,J2788,HCPCS,RHO D IMMUNE GLOBULIN 50 MCG,,,29 ,,NW,,,,,,$74.09,$0.00,1,1,1,0,0,1,20120101,J2790,HCPCS,RHO D IMMUNE GLOBULIN INJ,,,29 ,,NW,,,,,,$206.96,$0.00,1,1,1,0,0,1,20120101,J2791,HCPCS,RHOPHYLAC INJECTION,,,29 ,,NW,,,,,,$14.50,$0.00,1,1,1,0,0,1,20120101,J2792,HCPCS,"RHO(D) IMMUNE GLOBULIN H, SD",,,29 ,,NW,,,,,,$45.91,$0.00,1,1,1,0,0,1,20120101,J2793,HCPCS,RILONACEPT INJECTION,,,29 ,,NW,,,,,,$52.35,$0.00,1,1,1,0,0,1,20120101,J2794,HCPCS,"RISPERIDONE, LONG ACTING",,,29 ,,NW,,,,,,$14.50,$0.00,1,1,1,0,0,1,20120101,J2795,HCPCS,ROPIVACAINE HCL INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J2796,HCPCS,ROMIPLOSTIM INJECTION,,,29 ,,NW,,,,,,$111.94,$0.00,1,1,1,0,0,1,20120101,J2800,HCPCS,METHOCARBAMOL INJECTION,,,29 ,,NW,,,,,,$70.07,$0.00,1,1,1,0,0,1,20120101,J2805,HCPCS,SINCALIDE INJECTION,,,29 ,,NW,,,,,,$182.80,$0.00,1,1,1,0,0,1,20120101,J2810,HCPCS,INJ THEOPHYLLINE PER 40 MG,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J2820,HCPCS,SARGRAMOSTIM INJECTION,,,29 ,,NW,,,,,,$61.21,$0.00,1,1,1,0,0,1,20120101,J2850,HCPCS,INJ SECRETIN SYNTHETIC HUMAN,,,29 ,,NW,,,,,,$67.65,$0.00,1,1,1,0,0,1,20120101,J2910,HCPCS,AUROTHIOGLUCOSE INJECITON,,,29 ,,NW,,,,,,$75.76,$0.00,1,1,1,0,0,1,20120101,J2916,HCPCS,NA FERRIC GLUCONATE COMPLEX,,,29 ,,NW,,,,,,$13.66,$0.00,1,1,1,0,0,1,20120101,J2920,HCPCS,METHYLPREDNISOLONE INJECTION,,,29 ,,NW,,,,,,$6.16,$0.00,1,1,1,0,0,1,20120101,J2930,HCPCS,METHYLPREDNISOLONE INJECTION,,,29 ,,NW,,,,,,$8.21,$0.00,1,1,1,0,0,1,20120101,J2940,HCPCS,SOMATREM INJECTION,,,29 ,,NW,,,,,,$123.35,$0.00,1,1,1,0,0,1,20120101,J2941,HCPCS,SOMATROPIN INJECTION,,,29 ,,NW,,,,,,$107.11,$0.00,1,1,1,0,0,1,20120101,J2950,HCPCS,PROMAZINE HCL INJECTION,,,29 ,,NW,,,,,,$32.40,$0.00,1,1,1,0,0,1,20120101,J2993,HCPCS,RETEPLASE INJECTION,,,29 ,,NW,,,,,,"$3,279.82",$0.00,1,1,1,0,0,1,20120101,J2995,HCPCS,INJ STREPTOKINASE /250000 IU,,,29 ,,NW,,,,,,$174.75,$0.00,1,1,1,0,0,1,20120101,J2997,HCPCS,ALTEPLASE RECOMBINANT,,,29 ,,NW,,,,,,$102.28,$0.00,1,1,1,0,0,1,20120101,J3000,HCPCS,STREPTOMYCIN INJECTION,,,29 ,,NW,,,,,,$25.78,$0.00,1,1,1,0,0,1,20120101,J3010,HCPCS,FENTANYL CITRATE INJECITON,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J3030,HCPCS,SUMATRIPTAN SUCCINATE / 6 MG,,,29 ,,NW,,,,,,$186.02,$0.00,1,1,1,0,0,1,20120101,J3070,HCPCS,PENTAZOCINE INJECTION,,,29 ,,NW,,,,,,$27.39,$0.00,1,1,1,0,0,1,20120101,J3095,HCPCS,TELEVANCIN INJECTION,,,29 ,,NW,,,,,,$6.16,$0.00,1,1,1,0,0,1,20120101,J3101,HCPCS,TENECTEPLASE INJECTION,,,29 ,,NW,,,,,,$136.10,$0.00,1,1,1,0,0,1,20120101,J3105,HCPCS,TERBUTALINE SULFATE INJ,,,29 ,,NW,,,,,,$5.13,$0.00,1,1,1,0,0,1,20120101,J3110,HCPCS,TERIPARATIDE INJECTION,,,29 ,,NW,,,,,,$20.95,$0.00,1,1,1,0,0,1,20120101,J3120,HCPCS,TESTOSTERONE ENANTHATE INJ,,,29 ,,NW,,,,,,$12.81,$0.00,1,1,1,0,0,1,20120101,J3130,HCPCS,TESTOSTERONE ENANTHATE INJ,,,29 ,,NW,,,,,,$26.58,$0.00,1,1,1,0,0,1,20120101,J3140,HCPCS,TESTOSTERONE SUSPENSION INJ,,,29 ,,NW,,,,,,$25.89,$0.00,1,1,1,0,0,1,20120101,J3150,HCPCS,TESTOSTERON PROPIONATE INJ,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J3230,HCPCS,CHLORPROMAZINE HCL INJECTION,,,29 ,,NW,,,,,,$24.17,$0.00,1,1,1,0,0,1,20120101,J3240,HCPCS,THYROTROPIN INJECTION,,,29 ,,NW,,,,,,"$2,499.53",$0.00,1,1,1,0,0,1,20120101,J3243,HCPCS,TIGECYCLINE INJECTION,,,29 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20120101,J3246,HCPCS,TIROFIBAN HCL,,,29 ,,NW,,,,,,$25.78,$0.00,1,1,1,0,0,1,20120101,J3250,HCPCS,TRIMETHOBENZAMIDE HCL INJ,,,29 ,,NW,,,,,,$16.11,$0.00,1,1,1,0,0,1,20120101,J3260,HCPCS,TOBRAMYCIN SULFATE INJECTION,,,29 ,,NW,,,,,,$7.19,$0.00,1,1,1,0,0,1,20120101,J3262,HCPCS,TOCILIZUMAB INJECTION,,,29 ,,NW,,,,,,$10.27,$0.00,1,1,1,0,0,1,20120101,J3265,HCPCS,INJECTION TORSEMIDE 10 MG/ML,,,29 ,,NW,,,,,,$6.85,$0.00,1,1,1,0,0,1,20120101,J3280,HCPCS,THIETHYLPERAZINE MALEATE INJ,,,29 ,,NW,,,,,,$13.66,$0.00,1,1,1,0,0,1,20120101,J3285,HCPCS,TREPROSTINIL INJECTION,,,29 ,,NW,,,,,,$147.37,$0.00,1,1,1,0,0,1,20120101,J3300,HCPCS,TRIAMCINOLONE A INJ PRS-FREE,,,29 ,,NW,,,,,,$10.27,$0.00,1,1,1,0,0,1,20120101,J3301,HCPCS,TRIAMCINOLONE ACET INJ NOS,,,29 ,,NW,,,,,,$5.13,$0.00,1,1,1,0,0,1,20120101,J3302,HCPCS,TRIAMCINOLONE DIACETATE INJ,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J3303,HCPCS,TRIAMCINOLONE HEXACETONL INJ,,,29 ,,NW,,,,,,$5.13,$0.00,1,1,1,0,0,1,20120101,J3305,HCPCS,INJ TRIMETREXATE GLUCORONATE,,,29 ,,NW,,,,,,$103.23,$0.00,1,1,1,0,0,1,20120101,J3310,HCPCS,PERPHENAZINE INJECITON,,,29 ,,NW,,,,,,$45.61,$0.00,1,1,1,0,0,1,20120101,J3315,HCPCS,TRIPTORELIN PAMOATE,,,29 ,,NW,,,,,,$502.49,$0.00,1,1,1,0,0,1,20120101,J3320,HCPCS,SPECTINOMYCN DI-HCL INJ,,,29 ,,NW,,,,,,$83.25,$0.00,1,1,1,0,0,1,20120101,J3350,HCPCS,UREA INJECTION,,,29 ,,NW,,,,,,$28.91,$0.00,1,1,1,0,0,1,20120101,J3355,HCPCS,"UROFOLLITROPIN, 75 IU",,,29 ,,NW,,,,,,$158.64,$0.00,1,1,1,0,0,1,20120101,J3357,HCPCS,USTEKINUMAB INJECTION,,,29 ,,NW,,,,,,$280.24,$0.00,1,1,1,0,0,1,20120101,J3360,HCPCS,DIAZEPAM INJECTION,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J3364,HCPCS,UROKINASE 5000 IU INJECTION,,,29 ,,NW,,,,,,$22.85,$0.00,1,1,1,0,0,1,20120101,J3365,HCPCS,"UROKINASE 250,000 IU INJ",,,29 ,,NW,,,,,,"$1,087.11",$0.00,1,1,1,0,0,1,20120101,J3370,HCPCS,VANCOMYCIN HCL INJECTION,,,29 ,,NW,,,,,,$9.24,$0.00,1,1,1,0,0,1,20120101,J3385,HCPCS,VELAGLUCERASE ALFA,,,29 ,,NW,,,,,,$831.84,$0.00,1,1,1,0,0,1,20120101,J3396,HCPCS,VERTEPORFIN INJECTION,,,29 ,,NW,,,,,,$25.78,$0.00,1,1,1,0,0,1,20120101,J3400,HCPCS,TRIFLUPROMAZINE HCL INJ,,,29 ,,NW,,,,,,$37.38,$0.00,1,1,1,0,0,1,20120101,J3410,HCPCS,HYDROXYZINE HCL INJECTION,,,29 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20120101,J3411,HCPCS,THIAMINE HCL 100 MG,,,29 ,,NW,,,,,,$9.24,$0.00,1,1,1,0,0,1,20120101,J3415,HCPCS,PYRIDOXINE HCL 100 MG,,,29 ,,NW,,,,,,$17.72,$0.00,1,1,1,0,0,1,20120101,J3420,HCPCS,VITAMIN B12 INJECTION,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J3430,HCPCS,VITAMIN K PHYTONADIONE INJ,,,29 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20120101,J3465,HCPCS,"INJECTION, VORICONAZOLE",,,29 ,,NW,,,,,,$16.92,$0.00,1,1,1,0,0,1,20120101,J3470,HCPCS,HYALURONIDASE INJECTION,,,29 ,,NW,,,,,,$52.35,$0.00,1,1,1,0,0,1,20120101,J3471,HCPCS,"OVINE, UP TO 999 USP UNITS",,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J3472,HCPCS,"OVINE, 1000 USP UNITS",,,29 ,,NW,,,,,,$329.36,$0.00,1,1,1,0,0,1,20120101,J3473,HCPCS,HYALURONIDASE RECOMBINANT,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J3475,HCPCS,INJ MAGNESIUM SULFATE,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J3480,HCPCS,INJ POTASSIUM CHLORIDE,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J3485,HCPCS,ZIDOVUDINE,,,29 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20120101,J3486,HCPCS,ZIPRASIDONE MESYLATE,,,29 ,,NW,,,,,,$19.34,$0.00,1,1,1,0,0,1,20120101,J3487,HCPCS,ZOLEDRONIC ACID,,,29 ,,NW,,,,,,$535.51,$0.00,1,1,1,0,0,1,20120101,J3488,HCPCS,RECLAST INJECTION,,,29 ,,NW,,,,,,$529.87,$0.00,1,1,1,0,0,1,20120101,J3490,HCPCS,DRUGS UNCLASSIFIED INJECTION,,,29 ,,NW,,,,,,$6.28,$0.00,1,1,1,0,0,1,20120101,J3520,HCPCS,EDETATE DISODIUM PER 150 MG,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J3530,HCPCS,NASAL VACCINE INHALATION,,,29 ,,NW,,,,,,$50.11,$0.00,1,1,1,0,1,1,20120101,J3535,HCPCS,METERED DOSE INHALER DRUG,,,29 ,,NW,,,,,,$17.07,$0.00,1,1,1,0,0,1,20120101,J3570,HCPCS,LAETRILE AMYGDALIN VIT B17,,,29 ,,NW,,,,,,$53.21,$0.00,1,1,1,0,0,1,20120101,J3590,HCPCS,UNCLASSIFIED BIOLOGICS,,,29 ,,NW,,,,,,$42.32,$0.00,1,1,1,0,0,1,20120101,J7030,HCPCS,NORMAL SALINE SOLUTION INFUS,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7040,HCPCS,NORMAL SALINE SOLUTION INFUS,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J7042,HCPCS,5% DEXTROSE/NORMAL SALINE,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7050,HCPCS,NORMAL SALINE SOLUTION INFUS,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7060,HCPCS,5% DEXTROSE/WATER,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J7070,HCPCS,D5W INFUSION,,,29 ,,NW,,,,,,$6.16,$0.00,1,1,1,0,0,1,20120101,J7100,HCPCS,DEXTRAN 40 INFUSION,,,29 ,,NW,,,,,,$52.35,$0.00,1,1,1,0,0,1,20120101,J7110,HCPCS,DEXTRAN 75 INFUSION,,,29 ,,NW,,,,,,$32.22,$0.00,1,1,1,0,0,1,20120101,J7120,HCPCS,RINGERS LACTATE INFUSION,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J7131,HCPCS,HYPERTONIC SALINE SOL,,,29 ,,NW,,,,,,$8.21,$0.00,1,1,1,0,0,1,20120101,J7185,HCPCS,XYNTHA INJ,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J7186,HCPCS,ANTIHEMOPHILIC VIII/VWF COMP,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J7187,HCPCS,"HUMATE-P, INJ",,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J7189,HCPCS,FACTOR VIIA,,,29 ,,NW,,,,,,$5.13,$0.00,1,1,1,0,0,1,20120101,J7190,HCPCS,FACTOR VIII,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J7191,HCPCS,FACTOR VIII (PORCINE),,,29 ,,NW,,,,,,$6.03,$0.00,1,1,1,0,0,1,20120101,J7192,HCPCS,FACTOR VIII RECOMBINANT NOS,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J7193,HCPCS,FACTOR IX NON-RECOMBINANT,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J7194,HCPCS,FACTOR IX COMPLEX,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J7195,HCPCS,FACTOR IX RECOMBINANT,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J7196,HCPCS,ANTITHROMBIN RECOMBINANT,,,29 ,,NW,,,,,,$7.97,$0.00,1,1,1,0,0,1,20120101,J7197,HCPCS,ANTITHROMBIN III INJECTION,,,29 ,,NW,,,,,,$8.21,$0.00,1,1,1,0,0,1,20120101,J7198,HCPCS,ANTI-INHIBITOR,,,29 ,,NW,,,,,,$5.13,$0.00,1,1,1,0,0,1,20120101,J7199,HCPCS,HEMOPHILIA CLOT FACTOR NOC,,,29 ,,NW,,,,,,$1.32,$0.00,1,1,1,0,0,1,20120101,J7300,HCPCS,INTRAUT COPPER CONTRACEPTIVE,,,29 ,,NW,,,,,,$874.52,$0.00,1,1,1,1,1,1,20120101,J7302,HCPCS,LEVONORGESTREL IU CONTRACEPT,,,29 ,,NW,,,,,,$910.75,$0.00,1,1,1,1,1,1,20120101,J7303,HCPCS,CONTRACEPTIVE VAGINAL RING,,,29 ,,NW,,,,,,$86.98,$0.00,1,1,1,1,1,1,20120101,J7304,HCPCS,CONTRACEPTIVE HORMONE PATCH,,,29 ,,NW,,,,,,$48.24,$0.00,1,1,1,1,1,1,20120101,J7306,HCPCS,LEVONORGESTREL IMPLANT SYS,,,29 ,,NW,,,,,,$910.75,$0.00,1,1,1,1,1,1,20120101,J7307,HCPCS,ETONOGESTREL IMPLANT SYSTEM,,,29 ,,NW,,,,,,"$1,075.00",$0.00,1,1,1,1,1,1,20120101,J7308,HCPCS,AMINOLEVULINIC ACID HCL TOP,,,29 ,,NW,,,,,,$360.76,$0.00,1,1,1,0,0,1,20120101,J7310,HCPCS,GANCICLOVIR LONG ACT IMPLANT,,,29 ,,NW,,,,,,"$40,198.45",$0.00,1,1,1,0,0,1,20120101,J7311,HCPCS,FLUOCINOLONE ACETONIDE IMPLT,,,29 ,,NW,,,,,,"$45,851.35",$0.00,1,1,1,0,0,1,20120101,J7312,HCPCS,DEXAMETHASONE INTRA IMPLANT,,,29 ,,NW,,,,,,$467.06,$0.00,1,1,1,0,0,1,20120101,J7321,HCPCS,HYALGAN/SUPARTZ INJ PER DOSE,,,29 ,,NW,,,,,,$214.21,$0.00,1,1,1,0,0,1,20120101,J7323,HCPCS,EUFLEXXA INJ PER DOSE,,,29 ,,NW,,,,,,$327.75,$0.00,1,1,1,0,0,1,20120101,J7324,HCPCS,ORTHOVISC INJ PER DOSE,,,29 ,,NW,,,,,,$402.64,$0.00,1,1,1,0,0,1,20120101,J7325,HCPCS,SYNVISC OR SYNVISC-ONE,,,29 ,,NW,,,,,,$31.41,$0.00,1,1,1,0,0,1,20120101,J7330,HCPCS,CULTURED CHONDROCYTES IMPLNT,,,29 ,,NW,,,,,,"$65,274.96",$0.00,1,1,1,0,0,1,20120101,J7335,HCPCS,CAPSAICIN 8% PATCH,,,29 ,,NW,,,,,,$62.82,$0.00,1,1,1,0,0,1,20120101,J7500,HCPCS,AZATHIOPRINE ORAL 50MG,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7501,HCPCS,AZATHIOPRINE PARENTERAL,,,29 ,,NW,,,,,,$259.30,$0.00,1,1,1,0,0,1,20120101,J7502,HCPCS,CYCLOSPORINE ORAL 100 MG,,,29 ,,NW,,,,,,$10.27,$0.00,1,1,1,0,0,1,20120101,J7504,HCPCS,LYMPHOCYTE IMMUNE GLOBULIN,,,29 ,,NW,,,,,,"$1,356.06",$0.00,1,1,1,0,0,1,20120101,J7505,HCPCS,MONOCLONAL ANTIBODIES,,,29 ,,NW,,,,,,"$2,689.57",$0.00,1,1,1,0,0,1,20120101,J7506,HCPCS,PREDNISONE ORAL,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7507,HCPCS,TACROLIMUS ORAL PER 1 MG,,,29 ,,NW,,,,,,$8.21,$0.00,1,1,1,0,0,1,20120101,J7509,HCPCS,METHYLPREDNISOLONE ORAL,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7510,HCPCS,PREDNISOLONE ORAL PER 5 MG,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7511,HCPCS,ANTITHYMOCYTE GLOBULN RABBIT,,,29 ,,NW,,,,,,"$1,050.87",$0.00,1,1,1,0,0,1,20120101,J7513,HCPCS,"DACLIZUMAB, PARENTERAL",,,29 ,,NW,,,,,,"$1,249.77",$0.00,1,1,1,0,0,1,20120101,J7515,HCPCS,CYCLOSPORINE ORAL 25 MG,,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,J7516,HCPCS,CYCLOSPORIN PARENTERAL 250MG,,,29 ,,NW,,,,,,$56.38,$0.00,1,1,1,0,0,1,20120101,J7517,HCPCS,MYCOPHENOLATE MOFETIL ORAL,,,29 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20120101,J7518,HCPCS,MYCOPHENOLIC ACID,,,29 ,,NW,,,,,,$10.27,$0.00,1,1,1,0,0,1,20120101,J7520,HCPCS,"SIROLIMUS, ORAL",,,29 ,,NW,,,,,,$28.19,$0.00,1,1,1,0,0,1,20120101,J7525,HCPCS,TACROLIMUS INJECTION,,,29 ,,NW,,,,,,$333.39,$0.00,1,1,1,0,0,1,20120101,J7599,HCPCS,IMMUNOSUPPRESSIVE DRUG NOC,,,29 ,,NW,,,,,,$5.97,$0.00,1,1,1,0,0,1,20120101,J7604,HCPCS,ACETYLCYSTEINE COMP UNIT,,,29 ,,NW,,,,,,$15.20,$0.00,1,1,1,0,0,1,20120101,J7605,HCPCS,ARFORMOTEROL NON-COMP UNIT,,,29 ,,NW,,,,,,$15.31,$0.00,1,1,1,0,0,1,20120101,J7606,HCPCS,"FORMOTEROL FUMARATE, INH",,,29 ,,NW,,,,,,$13.66,$0.00,1,1,1,0,0,1,20120101,J7607,HCPCS,LEVALBUTEROL COMP CON,,,29 ,,NW,,,,,,$10.03,$0.00,1,1,1,0,0,1,20120101,J7608,HCPCS,ACETYLCYSTEINE NON-COMP UNIT,,,29 ,,NW,,,,,,$6.16,$0.00,1,1,1,0,0,1,20120101,J7609,HCPCS,ALBUTEROL COMP UNIT,,,29 ,,NW,,,,,,$12.16,$0.00,1,1,1,0,0,1,20120101,J7610,HCPCS,ALBUTEROL COMP CON,,,29 ,,NW,,,,,,$10.55,$0.00,1,1,1,0,0,1,20120101,J7611,HCPCS,ALBUTEROL NON-COMP CON,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7612,HCPCS,LEVALBUTEROL NON-COMP CON,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7613,HCPCS,ALBUTEROL NON-COMP UNIT,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7614,HCPCS,LEVALBUTEROL NON-COMP UNIT,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7615,HCPCS,LEVALBUTEROL COMP UNIT,,,29 ,,NW,,,,,,$6.16,$0.00,1,1,1,0,0,1,20120101,J7620,HCPCS,ALBUTEROL IPRATROP NON-COMP,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7622,HCPCS,BECLOMETHASONE COMP UNIT,,,29 ,,NW,,,,,,$13.76,$0.00,1,1,1,0,0,1,20120101,J7624,HCPCS,BETAMETHASONE COMP UNIT,,,29 ,,NW,,,,,,$3.98,$0.00,1,1,1,0,0,1,20120101,J7626,HCPCS,BUDESONIDE NON-COMP UNIT,,,29 ,,NW,,,,,,$12.81,$0.00,1,1,1,0,0,1,20120101,J7627,HCPCS,BUDESONIDE COMP UNIT,,,29 ,,NW,,,,,,$13.66,$0.00,1,1,1,0,0,1,20120101,J7628,HCPCS,BITOLTEROL MESYLATE COMP CON,,,29 ,,NW,,,,,,$5.60,$0.00,1,1,1,0,0,1,20120101,J7629,HCPCS,BITOLTEROL MESYLATE COMP UNT,,,29 ,,NW,,,,,,$5.60,$0.00,1,1,1,0,0,1,20120101,J7631,HCPCS,CROMOLYN SODIUM NONCOMP UNIT,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7632,HCPCS,CROMOLYN SODIUM COMP UNIT,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7633,HCPCS,BUDESONIDE NON-COMP CON,,,29 ,,NW,,,,,,$25.75,$0.00,1,1,1,0,0,1,20120101,J7634,HCPCS,BUDESONIDE COMP CON,,,29 ,,NW,,,,,,$46.46,$0.00,1,1,1,0,0,1,20120101,J7635,HCPCS,ATROPINE COMP CON,,,29 ,,NW,,,,,,$34.79,$0.00,1,1,1,0,0,1,20120101,J7636,HCPCS,ATROPINE COMP UNIT,,,29 ,,NW,,,,,,$12.87,$0.00,1,1,1,0,0,1,20120101,J7637,HCPCS,DEXAMETHASONE COMP CON,,,29 ,,NW,,,,,,$0.98,$0.00,1,1,1,0,0,1,20120101,J7638,HCPCS,DEXAMETHASONE COMP UNIT,,,29 ,,NW,,,,,,$0.98,$0.00,1,1,1,0,0,1,20120101,J7639,HCPCS,DORNASE ALFA NON-COMP UNIT,,,29 ,,NW,,,,,,$68.46,$0.00,1,1,1,0,0,1,20120101,J7640,HCPCS,FORMOTEROL COMP UNIT,,,29 ,,NW,,,,,,$19.18,$0.00,1,1,1,0,0,1,20120101,J7641,HCPCS,FLUNISOLIDE COMP UNIT,,,29 ,,NW,,,,,,$26.58,$0.00,1,1,1,0,0,1,20120101,J7642,HCPCS,GLYCOPYRROLATE COMP CON,,,29 ,,NW,,,,,,$0.72,$0.00,1,1,1,0,0,1,20120101,J7643,HCPCS,GLYCOPYRROLATE COMP UNIT,,,29 ,,NW,,,,,,$0.72,$0.00,1,1,1,0,0,1,20120101,J7644,HCPCS,IPRATROPIUM BROMIDE NON-COMP,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7645,HCPCS,IPRATROPIUM BROMIDE COMP,,,29 ,,NW,,,,,,$8.75,$0.00,1,1,1,0,0,1,20120101,J7648,HCPCS,ISOETHARINE NON-COMP CON,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J7649,HCPCS,ISOETHARINE NON-COMP UNIT,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,J7650,HCPCS,ISOETHARINE COMP UNIT,,,29 ,,NW,,,,,,$6.07,$0.00,1,1,1,0,0,1,20120101,J7657,HCPCS,ISOPROTERENOL COMP CON,,,29 ,,NW,,,,,,$8.26,$0.00,1,1,1,0,0,1,20120101,J7658,HCPCS,ISOPROTERENOL NON-COMP CON,,,29 ,,NW,,,,,,$11.33,$0.00,1,1,1,0,0,1,20120101,J7659,HCPCS,ISOPROTERENOL NON-COMP UNIT,,,29 ,,NW,,,,,,$11.33,$0.00,1,1,1,0,0,1,20120101,J7660,HCPCS,ISOPROTERENOL COMP UNIT,,,29 ,,NW,,,,,,$1.37,$0.00,1,1,1,0,0,1,20120101,J7667,HCPCS,METAPROTERENOL COMP CON,,,29 ,,NW,,,,,,$11.01,$0.00,1,1,1,0,0,1,20120101,J7668,HCPCS,METAPROTERENOL NON-COMP CON,,,29 ,,NW,,,,,,$0.23,$0.00,1,1,1,0,0,1,20120101,J7669,HCPCS,METAPROTERENOL NON-COMP UNIT,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7674,HCPCS,"METHACHOLINE CHLORIDE, NEB",,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J7676,HCPCS,PENTAMIDINE COMP UNIT DOSE,,,29 ,,NW,,,,,,$499.05,$0.00,1,1,1,0,0,1,20120101,J7680,HCPCS,TERBUTALINE SULF COMP CON,,,29 ,,NW,,,,,,$32.22,$0.00,1,1,1,0,0,1,20120101,J7681,HCPCS,TERBUTALINE SULF COMP UNIT,,,29 ,,NW,,,,,,$32.22,$0.00,1,1,1,0,0,1,20120101,J7682,HCPCS,TOBRAMYCIN NON-COMP UNIT,,,29 ,,NW,,,,,,$190.05,$0.00,1,1,1,0,0,1,20120101,J7683,HCPCS,TRIAMCINOLONE COMP CON,,,29 ,,NW,,,,,,$12.81,$0.00,1,1,1,0,0,1,20120101,J7684,HCPCS,TRIAMCINOLONE COMP UNIT,,,29 ,,NW,,,,,,$10.37,$0.00,1,1,1,0,0,1,20120101,J7685,HCPCS,TOBRAMYCIN COMP UNIT,,,29 ,,NW,,,,,,$141.73,$0.00,1,1,1,0,0,1,20120101,J7686,HCPCS,"TREPROSTINIL, NON-COMP UNIT",,,29 ,,NW,,,,,,$993.70,$0.00,1,1,1,0,0,1,20120101,J7699,HCPCS,INHALATION SOLUTION FOR DME,,,29 ,,NW,,,,,,$6.47,$0.00,1,1,1,0,0,1,20120101,J7799,HCPCS,NON-INHALATION DRUG FOR DME,,,29 ,,NW,,,,,,$15.00,$0.00,1,1,1,0,0,1,20120101,J8498,HCPCS,ANTIEMETIC RECTAL/SUPP NOS,,,29 ,,NW,,,,,,$1.32,$0.00,1,1,1,0,0,1,20120101,J8499,HCPCS,ORAL PRESCRIP DRUG NON CHEMO,,,29 ,,NW,,,,,,$1.15,$0.00,1,1,1,0,0,1,20120101,J8501,HCPCS,ORAL APREPITANT,,,29 ,,NW,,,,,,$16.92,$0.00,1,1,1,0,0,1,20120101,J8510,HCPCS,ORAL BUSULFAN,,,29 ,,NW,,,,,,$15.18,$0.00,1,1,1,0,0,1,20120101,J8515,HCPCS,"CABERGOLINE, ORAL 0.25MG",,,29 ,,NW,,,,,,$35.44,$0.00,1,1,1,0,0,1,20120101,J8520,HCPCS,"CAPECITABINE, ORAL, 150 MG",,,29 ,,NW,,,,,,$30.36,$0.00,1,1,1,0,0,1,20120101,J8521,HCPCS,"CAPECITABINE, ORAL, 500 MG",,,29 ,,NW,,,,,,$92.53,$0.00,1,1,1,0,0,1,20120101,J8530,HCPCS,CYCLOPHOSPHAMIDE ORAL 25 MG,,,29 ,,NW,,,,,,$2.76,$0.00,1,1,1,0,0,1,20120101,J8540,HCPCS,ORAL DEXAMETHASONE,,,29 ,,NW,,,,,,$1.03,$0.00,1,1,1,0,0,1,20120101,J8560,HCPCS,ETOPOSIDE ORAL 50 MG,,,29 ,,NW,,,,,,$128.90,$0.00,1,1,1,0,0,1,20120101,J8562,HCPCS,ORAL FLUDARABINE PHOSPHATE,,,29 ,,NW,,,,,,$265.84,$0.00,1,1,1,0,0,1,20120101,J8565,HCPCS,GEFITINIB ORAL,,,29 ,,NW,,,,,,$127.24,$0.00,1,1,1,0,0,1,20120101,J8597,HCPCS,ANTIEMETIC DRUG ORAL NOS,,,29 ,,NW,,,,,,$830.06,$0.00,1,1,1,0,0,1,20120101,J8600,HCPCS,MELPHALAN ORAL 2 MG,,,29 ,,NW,,,,,,$27.60,$0.00,1,1,1,0,0,1,20120101,J8610,HCPCS,METHOTREXATE ORAL 2.5 MG,,,29 ,,NW,,,,,,$1.38,$0.00,1,1,1,0,0,1,20120101,J8650,HCPCS,NABILONE ORAL,,,29 ,,NW,,,,,,$39.47,$0.00,1,1,1,0,0,1,20120101,J8700,HCPCS,TEMOZOLOMIDE,,,29 ,,NW,,,,,,$38.63,$0.00,1,1,1,0,0,1,20120101,J8705,HCPCS,TOPOTECAN ORAL,,,29 ,,NW,,,,,,$258.35,$0.00,1,1,1,0,0,1,20120101,J8999,HCPCS,ORAL PRESCRIPTION DRUG CHEMO,,,29 ,,NW,,,,,,$8.87,$0.00,1,1,1,0,0,1,20120101,J9000,HCPCS,DOXORUBICIN HCL INJECTION,,,29 ,,NW,,,,,,$12.42,$0.00,1,1,1,0,0,1,20120101,J9001,HCPCS,DOXORUBICIN HCL LIPOSOME INJ,,,29 ,,NW,,,,,,"$1,284.39",$0.00,1,1,1,0,0,1,20120101,J9010,HCPCS,ALEMTUZUMAB INJECTION,,,29 ,,NW,,,,,,"$1,400.35",$0.00,1,1,1,0,0,1,20120101,J9015,HCPCS,ALDESLEUKIN INJECTION,,,29 ,,NW,,,,,,"$1,764.64",$0.00,1,1,1,0,0,1,20120101,J9017,HCPCS,ARSENIC TRIOXIDE INJECTION,,,29 ,,NW,,,,,,$143.88,$0.00,1,1,1,0,0,1,20120101,J9020,HCPCS,ASPARAGINASE INJECTION,,,29 ,,NW,,,,,,$214.49,$0.00,1,1,1,0,0,1,20120101,J9025,HCPCS,AZACITIDINE INJECTION,,,29 ,,NW,,,,,,$20.70,$0.00,1,1,1,0,0,1,20120101,J9027,HCPCS,CLOFARABINE INJECTION,,,29 ,,NW,,,,,,$292.32,$0.00,1,1,1,0,0,1,20120101,J9031,HCPCS,BCG LIVE INTRAVESICAL VAC,,,29 ,,NW,,,,,,$378.17,$0.00,1,1,1,0,0,1,20120101,J9033,HCPCS,BENDAMUSTINE INJECTION,,,29 ,,NW,,,,,,$74.34,$0.00,1,1,1,0,0,1,20120101,J9035,HCPCS,BEVACIZUMAB INJECTION,,,29 ,,NW,,,,,,$147.37,$0.00,1,1,1,0,0,1,20120101,J9040,HCPCS,BLEOMYCIN SULFATE INJECTION,,,29 ,,NW,,,,,,$92.53,$0.00,1,1,1,0,0,1,20120101,J9041,HCPCS,BORTEZOMIB INJECTION,,,29 ,,NW,,,,,,$100.67,$0.00,1,1,1,0,0,1,20120101,J9045,HCPCS,CARBOPLATIN INJECTION,,,29 ,,NW,,,,,,$20.70,$0.00,1,1,1,0,0,1,20120101,J9050,HCPCS,CARMUSTINE INJECTION,,,29 ,,NW,,,,,,$569.67,$0.00,1,1,1,0,0,1,20120101,J9055,HCPCS,CETUXIMAB INJECTION,,,29 ,,NW,,,,,,$122.41,$0.00,1,1,1,0,0,1,20120101,J9060,HCPCS,CISPLATIN 10 MG INJECTION,,,29 ,,NW,,,,,,$9.66,$0.00,1,1,1,0,0,1,20120101,J9065,HCPCS,INJ CLADRIBINE PER 1 MG,,,29 ,,NW,,,,,,$92.53,$0.00,1,1,1,0,0,1,20120101,J9070,HCPCS,CYCLOPHOSPHAMIDE 100 MG INJ,,,29 ,,NW,,,,,,$45.53,$0.00,1,1,1,0,0,1,20120101,J9098,HCPCS,CYTARABINE LIPOSOME INJ,,,29 ,,NW,,,,,,"$1,164.41",$0.00,1,1,1,0,0,1,20120101,J9100,HCPCS,CYTARABINE HCL 100 MG INJ,,,29 ,,NW,,,,,,$4.14,$0.00,1,1,1,0,0,1,20120101,J9120,HCPCS,DACTINOMYCIN INJECTION,,,29 ,,NW,,,,,,"$1,328.19",$0.00,1,1,1,0,0,1,20120101,J9130,HCPCS,DACARBAZINE 100 MG INJ,,,29 ,,NW,,,,,,$15.18,$0.00,1,1,1,0,0,1,20120101,J9150,HCPCS,DAUNORUBICIN INJECTION,,,29 ,,NW,,,,,,$56.57,$0.00,1,1,1,0,0,1,20120101,J9151,HCPCS,DAUNORUBICIN CITRATE INJ,,,29 ,,NW,,,,,,$197.37,$0.00,1,1,1,0,0,1,20120101,J9155,HCPCS,DEGARELIX INJECTION,,,29 ,,NW,,,,,,$8.21,$0.00,1,1,1,0,0,1,20120101,J9160,HCPCS,DENILEUKIN DIFTITOX INJ,,,29 ,,NW,,,,,,"$3,833.03",$0.00,1,1,1,0,0,1,20120101,J9165,HCPCS,DIETHYLSTILBESTROL INJECTION,,,29 ,,NW,,,,,,$56.45,$0.00,1,1,1,0,0,1,20120101,J9171,HCPCS,DOCETAXEL INJECTION,,,29 ,,NW,,,,,,$49.13,$0.00,1,1,1,0,0,1,20120101,J9175,HCPCS,ELLIOTTS B SOLUTION PER ML,,,29 ,,NW,,,,,,$11.96,$0.00,1,1,1,0,0,1,20120101,J9178,HCPCS,"INJ, EPIRUBICIN HCL, 2 MG",,,29 ,,NW,,,,,,$6.16,$0.00,1,1,1,0,0,1,20120101,J9181,HCPCS,ETOPOSIDE INJECTION,,,29 ,,NW,,,,,,$4.14,$0.00,1,1,1,0,0,1,20120101,J9185,HCPCS,FLUDARABINE PHOSPHATE INJ,,,29 ,,NW,,,,,,$349.28,$0.00,1,1,1,0,0,1,20120101,J9190,HCPCS,FLUOROURACIL INJECTION,,,29 ,,NW,,,,,,$5.52,$0.00,1,1,1,0,0,1,20120101,J9200,HCPCS,FLOXURIDINE INJECTION,,,29 ,,NW,,,,,,$207.00,$0.00,1,1,1,0,0,1,20120101,J9201,HCPCS,GEMCITABINE HCL INJECTION,,,29 ,,NW,,,,,,$317.19,$0.00,1,1,1,0,0,1,20120101,J9202,HCPCS,GOSERELIN ACETATE IMPLANT,,,29 ,,NW,,,,,,$680.93,$0.00,1,1,1,0,0,1,20120101,J9206,HCPCS,IRINOTECAN INJECTION,,,29 ,,NW,,,,,,$35.87,$0.00,1,1,1,0,0,1,20120101,J9207,HCPCS,IXABEPILONE INJECTION,,,29 ,,NW,,,,,,$217.70,$0.00,1,1,1,0,0,1,20120101,J9208,HCPCS,IFOSFOMIDE INJECTION,,,29 ,,NW,,,,,,$120.34,$0.00,1,1,1,0,0,1,20120101,J9209,HCPCS,MESNA INJECTION,,,29 ,,NW,,,,,,$9.66,$0.00,1,1,1,0,0,1,20120101,J9211,HCPCS,IDARUBICIN HCL INJECTION,,,29 ,,NW,,,,,,$179.18,$0.00,1,1,1,0,0,1,20120101,J9212,HCPCS,INTERFERON ALFACON-1 INJ,,,29 ,,NW,,,,,,$17.72,$0.00,1,1,1,0,0,1,20120101,J9213,HCPCS,INTERFERON ALFA-2A INJ,,,29 ,,NW,,,,,,$123.55,$0.00,1,1,1,0,0,1,20120101,J9214,HCPCS,INTERFERON ALFA-2B INJ,,,29 ,,NW,,,,,,$68.99,$0.00,1,1,1,0,0,1,20120101,J9215,HCPCS,INTERFERON ALFA-N3 INJ,,,29 ,,NW,,,,,,$67.61,$0.00,1,1,1,0,0,1,20120101,J9216,HCPCS,INTERFERON GAMMA 1-B INJ,,,29 ,,NW,,,,,,$945.18,$0.00,1,1,1,0,0,1,20120101,J9217,HCPCS,LEUPROLIDE ACETATE SUSPNSION,,,29 ,,NW,,,,,,$650.97,$0.00,1,1,1,0,0,1,20120101,J9218,HCPCS,LEUPROLIDE ACETATE INJECITON,,,29 ,,NW,,,,,,$15.18,$0.00,1,1,1,0,0,1,20120101,J9219,HCPCS,LEUPROLIDE ACETATE IMPLANT,,,29 ,,NW,,,,,,"$5,760.42",$0.00,1,1,1,0,0,1,20120101,J9225,HCPCS,VANTAS IMPLANT,,,29 ,,NW,,,,,,"$4,737.54",$0.00,1,1,1,0,0,1,20120101,J9226,HCPCS,SUPPRELIN LA IMPLANT,,,29 ,,NW,,,,,,"$16,890.09",$0.00,1,1,1,0,0,1,20120101,J9230,HCPCS,MECHLORETHAMINE HCL INJ,,,29 ,,NW,,,,,,$512.97,$0.00,1,1,1,0,0,1,20120101,J9245,HCPCS,INJ MELPHALAN HYDROCHL 50 MG,,,29 ,,NW,,,,,,"$2,195.77",$0.00,1,1,1,0,0,1,20120101,J9250,HCPCS,METHOTREXATE SODIUM INJ,,,29 ,,NW,,,,,,$1.38,$0.00,1,1,1,0,0,1,20120101,J9260,HCPCS,METHOTREXATE SODIUM INJ,,,29 ,,NW,,,,,,$8.28,$0.00,1,1,1,0,0,1,20120101,J9261,HCPCS,NELARABINE INJECTION,,,29 ,,NW,,,,,,$269.77,$0.00,1,1,1,0,0,1,20120101,J9263,HCPCS,OXALIPLATIN,,,29 ,,NW,,,,,,$40.01,$0.00,1,1,1,0,0,1,20120101,J9264,HCPCS,PACLITAXEL PROTEIN BOUND,,,29 ,,NW,,,,,,$24.97,$0.00,1,1,1,0,0,1,20120101,J9265,HCPCS,PACLITAXEL INJECTION,,,29 ,,NW,,,,,,$22.08,$0.00,1,1,1,0,0,1,20120101,J9266,HCPCS,PEGASPARGASE INJECTION,,,29 ,,NW,,,,,,"$3,576.39",$0.00,1,1,1,0,0,1,20120101,J9268,HCPCS,PENTOSTATIN INJECTION,,,29 ,,NW,,,,,,"$1,895.47",$0.00,1,1,1,0,0,1,20120101,J9270,HCPCS,PLICAMYCIN (MITHRAMYCIN) INJ,,,29 ,,NW,,,,,,$303.02,$0.00,1,1,1,0,0,1,20120101,J9280,HCPCS,MITOMYCIN 5 MG INJ,,,29 ,,NW,,,,,,$78.62,$0.00,1,1,1,0,0,1,20120101,J9293,HCPCS,MITOXANTRONE HYDROCHL / 5 MG,,,29 ,,NW,,,,,,$147.09,$0.00,1,1,1,0,0,1,20120101,J9300,HCPCS,GEMTUZUMAB OZOGAMICIN INJ,,,29 ,,NW,,,,,,"$3,592.70",$0.00,1,1,1,0,0,1,20120101,J9302,HCPCS,OFATUMUMAB INJECTION,,,29 ,,NW,,,,,,$158.86,$0.00,1,1,1,0,0,1,20120101,J9303,HCPCS,PANITUMUMAB INJECTION,,,29 ,,NW,,,,,,$290.44,$0.00,1,1,1,0,0,1,20120101,J9305,HCPCS,PEMETREXED INJECTION,,,29 ,,NW,,,,,,$128.85,$0.00,1,1,1,0,0,1,20120101,J9307,HCPCS,PRALATREXATE INJECTION,,,29 ,,NW,,,,,,$536.50,$0.00,1,1,1,0,0,1,20120101,J9310,HCPCS,RITUXIMAB INJECTION,,,29 ,,NW,,,,,,"$1,368.25",$0.00,1,1,1,0,0,1,20120101,J9315,HCPCS,ROMIDEPSIN INJECTION,,,29 ,,NW,,,,,,$723.72,$0.00,1,1,1,0,0,1,20120101,J9320,HCPCS,STREPTOZOCIN INJECTION,,,29 ,,NW,,,,,,$862.80,$0.00,1,1,1,0,0,1,20120101,J9328,HCPCS,TEMOZOLOMIDE INJECTION,,,29 ,,NW,,,,,,$19.32,$0.00,1,1,1,0,0,1,20120101,J9330,HCPCS,TEMSIROLIMUS INJECTION,,,29 ,,NW,,,,,,$178.11,$0.00,1,1,1,0,0,1,20120101,J9340,HCPCS,THIOTEPA INJECTION,,,29 ,,NW,,,,,,$382.45,$0.00,1,1,1,0,0,1,20120101,J9351,HCPCS,TOPOTECAN INJECTION,,,29 ,,NW,,,,,,$38.63,$0.00,1,1,1,0,0,1,20120101,J9355,HCPCS,TRASTUZUMAB INJECTION,,,29 ,,NW,,,,,,$169.11,$0.00,1,1,1,0,0,1,20120101,J9357,HCPCS,VALRUBICIN INJECTION,,,29 ,,NW,,,,,,"$2,307.07",$0.00,1,1,1,0,0,1,20120101,J9360,HCPCS,VINBLASTINE SULFATE INJ,,,29 ,,NW,,,,,,$4.14,$0.00,1,1,1,0,0,1,20120101,J9370,HCPCS,VINCRISTINE SULFATE 1 MG INJ,,,29 ,,NW,,,,,,$16.56,$0.00,1,1,1,0,0,1,20120101,J9390,HCPCS,VINORELBINE TARTRATE INJ,,,29 ,,NW,,,,,,$79.69,$0.00,1,1,1,0,0,1,20120101,J9395,HCPCS,"INJECTION, FULVESTRANT",,,29 ,,NW,,,,,,$204.54,$0.00,1,1,1,0,0,1,20120101,J9600,HCPCS,PORFIMER SODIUM INJECTION,,,29 ,,NW,,,,,,"$3,866.41",$0.00,1,1,1,0,0,1,20120101,J9999,HCPCS,CHEMOTHERAPY DRUG,,,29 ,,NW,,,,,,$40.78,$0.00,1,1,1,0,0,1,20120101,K0001,HCPCS,STANDARD WHEELCHAIR,,,28 ,,NW,,,,,,"$1,019.59",$0.00,1,1,1,1,1,1,20120101,K0001,HCPCS,STANDARD WHEELCHAIR,NU,,28 ,,NW,,,,,,"$1,019.59",$0.00,1,1,1,1,1,1,20120101,K0001,HCPCS,STANDARD WHEELCHAIR,RR,,28 ,,NW,,,,,,$106.55,$0.00,1,1,1,1,1,1,20120101,K0001,HCPCS,STANDARD WHEELCHAIR,UE,,28 ,,NW,,,,,,$765.95,$0.00,1,1,1,1,1,1,20120101,K0002,HCPCS,STND HEMI (LOW SEAT) WHLCHR,,,28 ,,NW,,,,,,$968.69,$0.00,1,1,1,1,1,1,20120101,K0002,HCPCS,STND HEMI (LOW SEAT) WHLCHR,NU,,28 ,,NW,,,,,,$968.69,$0.00,1,1,1,1,1,1,20120101,K0002,HCPCS,STND HEMI (LOW SEAT) WHLCHR,RR,,28 ,,NW,,,,,,$160.00,$0.00,1,1,1,1,1,1,20120101,K0002,HCPCS,STND HEMI (LOW SEAT) WHLCHR,UE,,28 ,,NW,,,,,,$736.72,$0.00,1,1,1,1,1,1,20120101,K0003,HCPCS,LIGHTWEIGHT WHEELCHAIR,,,28 ,,NW,,,,,,"$1,056.66",$0.00,1,1,1,1,1,1,20120101,K0003,HCPCS,LIGHTWEIGHT WHEELCHAIR,NU,,28 ,,NW,,,,,,"$1,056.66",$0.00,1,1,1,1,1,1,20120101,K0003,HCPCS,LIGHTWEIGHT WHEELCHAIR,RR,,28 ,,NW,,,,,,$174.67,$0.00,1,1,1,1,1,1,20120101,K0003,HCPCS,LIGHTWEIGHT WHEELCHAIR,UE,,28 ,,NW,,,,,,$802.69,$0.00,1,1,1,1,1,1,20120101,K0004,HCPCS,HIGH STRENGTH LTWT WHLCHR,,,28 ,,NW,,,,,,"$1,556.07",$0.00,1,1,1,1,1,1,20120101,K0004,HCPCS,HIGH STRENGTH LTWT WHLCHR,NU,,28 ,,NW,,,,,,"$1,556.07",$0.00,1,1,1,1,1,1,20120101,K0004,HCPCS,HIGH STRENGTH LTWT WHLCHR,RR,,28 ,,NW,,,,,,$247.91,$0.00,1,1,1,1,1,1,20120101,K0004,HCPCS,HIGH STRENGTH LTWT WHLCHR,UE,,28 ,,NW,,,,,,"$1,177.25",$0.00,1,1,1,1,1,1,20120101,K0005,HCPCS,ULTRALIGHTWEIGHT WHEELCHAIR,,,28 ,,NW,,,,,,"$3,101.63",$0.00,1,1,1,1,1,1,20120101,K0005,HCPCS,ULTRALIGHTWEIGHT WHEELCHAIR,NU,,28 ,,NW,,,,,,"$3,101.63",$0.00,1,1,1,1,1,1,20120101,K0005,HCPCS,ULTRALIGHTWEIGHT WHEELCHAIR,RR,,28 ,,NW,,,,,,$347.39,$0.00,1,1,1,1,1,1,20120101,K0005,HCPCS,ULTRALIGHTWEIGHT WHEELCHAIR,UE,,28 ,,NW,,,,,,"$2,336.57",$0.00,1,1,1,1,1,1,20120101,K0006,HCPCS,HEAVY DUTY WHEELCHAIR,,,28 ,,NW,,,,,,"$1,463.14",$0.00,1,1,1,1,1,1,20120101,K0006,HCPCS,HEAVY DUTY WHEELCHAIR,NU,,28 ,,NW,,,,,,"$1,463.14",$0.00,1,1,1,1,1,1,20120101,K0006,HCPCS,HEAVY DUTY WHEELCHAIR,RR,,28 ,,NW,,,,,,$235.83,$0.00,1,1,1,1,1,1,20120101,K0006,HCPCS,HEAVY DUTY WHEELCHAIR,UE,,28 ,,NW,,,,,,"$1,107.73",$0.00,1,1,1,1,1,1,20120101,K0007,HCPCS,EXTRA HEAVY DUTY WHEELCHAIR,,,28 ,,NW,,,,,,"$2,064.71",$0.00,1,1,1,1,1,1,20120101,K0007,HCPCS,EXTRA HEAVY DUTY WHEELCHAIR,NU,,28 ,,NW,,,,,,"$2,064.71",$0.00,1,1,1,1,1,1,20120101,K0007,HCPCS,EXTRA HEAVY DUTY WHEELCHAIR,RR,,28 ,,NW,,,,,,$331.09,$0.00,1,1,1,1,1,1,20120101,K0007,HCPCS,EXTRA HEAVY DUTY WHEELCHAIR,UE,,28 ,,NW,,,,,,"$1,558.91",$0.00,1,1,1,1,1,1,20120101,K0009,HCPCS,OTHER MANUAL WHEELCHAIR/BASE,,,28 ,,NW,,,,,,$953.16,$0.00,1,1,1,1,1,1,20120101,K0010,HCPCS,STND WT FRAME POWER WHLCHR,,,28 ,,NW,,,,,,"$4,869.65",$0.00,1,1,1,1,1,1,20120101,K0010,HCPCS,STND WT FRAME POWER WHLCHR,NU,,28 ,,NW,,,,,,"$4,869.65",$0.00,1,1,1,1,1,1,20120101,K0010,HCPCS,STND WT FRAME POWER WHLCHR,RR,,28 ,,NW,,,,,,$696.10,$0.00,1,1,1,1,1,1,20120101,K0010,HCPCS,STND WT FRAME POWER WHLCHR,UE,,28 ,,NW,,,,,,"$3,662.26",$0.00,1,1,1,1,1,1,20120101,K0011,HCPCS,STND WT PWR WHLCHR W CONTROL,,,28 ,,NW,,,,,,"$17,378.93",$0.00,1,1,1,1,1,1,20120101,K0011,HCPCS,STND WT PWR WHLCHR W CONTROL,NU,,28 ,,NW,,,,,,"$17,378.93",$0.00,1,1,1,1,1,1,20120101,K0011,HCPCS,STND WT PWR WHLCHR W CONTROL,RR,,28 ,,NW,,,,,,"$1,816.13",$0.00,1,1,1,1,1,1,20120101,K0012,HCPCS,LTWT PORTBL POWER WHLCHR,,,28 ,,NW,,,,,,"$5,414.54",$0.00,1,1,1,1,1,1,20120101,K0012,HCPCS,LTWT PORTBL POWER WHLCHR,RR,,28 ,,NW,,,,,,$565.83,$0.00,1,1,1,1,1,1,20120101,K0014,HCPCS,OTHER POWER WHLCHR BASE,,,28 ,,NW,,,,,,"$2,744.39",$0.00,1,1,1,1,1,1,20120101,K0015,HCPCS,DETACH NON-ADJUS HGHT ARMRST,,,28 ,,NW,,,,,,$601.11,$0.00,1,1,1,1,1,1,20120101,K0015,HCPCS,DETACH NON-ADJUS HGHT ARMRST,NU,,28 ,,NW,,,,,,$601.11,$0.00,1,1,1,1,1,1,20120101,K0015,HCPCS,DETACH NON-ADJUS HGHT ARMRST,RR,,28 ,,NW,,,,,,$69.34,$0.00,1,1,1,1,1,1,20120101,K0015,HCPCS,DETACH NON-ADJUS HGHT ARMRST,UE,,28 ,,NW,,,,,,$461.19,$0.00,1,1,1,1,1,1,20120101,K0017,HCPCS,DETACH ADJUST ARMREST BASE,,,28 ,,NW,,,,,,$195.50,$0.00,1,1,1,1,1,1,20120101,K0017,HCPCS,DETACH ADJUST ARMREST BASE,NU,,28 ,,NW,,,,,,$195.50,$0.00,1,1,1,1,1,1,20120101,K0017,HCPCS,DETACH ADJUST ARMREST BASE,RR,,28 ,,NW,,,,,,$19.40,$0.00,1,1,1,1,1,1,20120101,K0017,HCPCS,DETACH ADJUST ARMREST BASE,UE,,28 ,,NW,,,,,,$146.58,$0.00,1,1,1,1,1,1,20120101,K0018,HCPCS,DETACH ADJUST ARMRST UPPER,,,28 ,,NW,,,,,,$109.14,$0.00,1,1,1,1,1,1,20120101,K0018,HCPCS,DETACH ADJUST ARMRST UPPER,NU,,28 ,,NW,,,,,,$109.14,$0.00,1,1,1,1,1,1,20120101,K0018,HCPCS,DETACH ADJUST ARMRST UPPER,RR,,28 ,,NW,,,,,,$10.72,$0.00,1,1,1,1,1,1,20120101,K0018,HCPCS,DETACH ADJUST ARMRST UPPER,UE,,28 ,,NW,,,,,,$81.85,$0.00,1,1,1,1,1,1,20120101,K0019,HCPCS,ARM PAD EACH,,,28 ,,NW,,,,,,$64.73,$0.00,1,1,1,1,1,1,20120101,K0019,HCPCS,ARM PAD EACH,NU,,28 ,,NW,,,,,,$64.73,$0.00,1,1,1,1,1,1,20120101,K0019,HCPCS,ARM PAD EACH,RR,,28 ,,NW,,,,,,$6.33,$0.00,1,1,1,1,1,1,20120101,K0019,HCPCS,ARM PAD EACH,UE,,28 ,,NW,,,,,,$48.50,$0.00,1,1,1,1,1,1,20120101,K0020,HCPCS,FIXED ADJUST ARMREST PAIR,,,28 ,,NW,,,,,,$177.69,$0.00,1,1,1,1,1,1,20120101,K0020,HCPCS,FIXED ADJUST ARMREST PAIR,NU,,28 ,,NW,,,,,,$177.69,$0.00,1,1,1,1,1,1,20120101,K0020,HCPCS,FIXED ADJUST ARMREST PAIR,RR,,28 ,,NW,,,,,,$17.64,$0.00,1,1,1,1,1,1,20120101,K0020,HCPCS,FIXED ADJUST ARMREST PAIR,UE,,28 ,,NW,,,,,,$133.18,$0.00,1,1,1,1,1,1,20120101,K0037,HCPCS,HIGH MOUNT FLIP-UP FOOTREST,,,28 ,,NW,,,,,,$178.38,$0.00,1,1,1,1,1,1,20120101,K0037,HCPCS,HIGH MOUNT FLIP-UP FOOTREST,NU,,28 ,,NW,,,,,,$178.38,$0.00,1,1,1,1,1,1,20120101,K0037,HCPCS,HIGH MOUNT FLIP-UP FOOTREST,RR,,28 ,,NW,,,,,,$15.89,$0.00,1,1,1,1,1,1,20120101,K0037,HCPCS,HIGH MOUNT FLIP-UP FOOTREST,UE,,28 ,,NW,,,,,,$133.79,$0.00,1,1,1,1,1,1,20120101,K0038,HCPCS,LEG STRAP EACH,,,28 ,,NW,,,,,,$92.69,$0.00,1,1,1,1,1,1,20120101,K0038,HCPCS,LEG STRAP EACH,NU,,28 ,,NW,,,,,,$92.69,$0.00,1,1,1,1,1,1,20120101,K0038,HCPCS,LEG STRAP EACH,RR,,28 ,,NW,,,,,,$9.13,$0.00,1,1,1,1,1,1,20120101,K0038,HCPCS,LEG STRAP EACH,UE,,28 ,,NW,,,,,,$69.48,$0.00,1,1,1,1,1,1,20120101,K0039,HCPCS,LEG STRAP H STYLE EACH,,,28 ,,NW,,,,,,$206.10,$0.00,1,1,1,1,1,1,20120101,K0039,HCPCS,LEG STRAP H STYLE EACH,NU,,28 ,,NW,,,,,,$206.10,$0.00,1,1,1,1,1,1,20120101,K0039,HCPCS,LEG STRAP H STYLE EACH,RR,,28 ,,NW,,,,,,$20.52,$0.00,1,1,1,1,1,1,20120101,K0039,HCPCS,LEG STRAP H STYLE EACH,UE,,28 ,,NW,,,,,,$154.53,$0.00,1,1,1,1,1,1,20120101,K0040,HCPCS,ADJUSTABLE ANGLE FOOTPLATE,,,28 ,,NW,,,,,,$271.54,$0.00,1,1,1,1,1,1,20120101,K0040,HCPCS,ADJUSTABLE ANGLE FOOTPLATE,NU,,28 ,,NW,,,,,,$271.54,$0.00,1,1,1,1,1,1,20120101,K0040,HCPCS,ADJUSTABLE ANGLE FOOTPLATE,RR,,28 ,,NW,,,,,,$28.35,$0.00,1,1,1,1,1,1,20120101,K0040,HCPCS,ADJUSTABLE ANGLE FOOTPLATE,UE,,28 ,,NW,,,,,,$214.01,$0.00,1,1,1,1,1,1,20120101,K0041,HCPCS,LARGE SIZE FOOTPLATE EACH,,,28 ,,NW,,,,,,$202.44,$0.00,1,1,1,1,1,1,20120101,K0041,HCPCS,LARGE SIZE FOOTPLATE EACH,NU,,28 ,,NW,,,,,,$202.44,$0.00,1,1,1,1,1,1,20120101,K0041,HCPCS,LARGE SIZE FOOTPLATE EACH,RR,,28 ,,NW,,,,,,$20.15,$0.00,1,1,1,1,1,1,20120101,K0041,HCPCS,LARGE SIZE FOOTPLATE EACH,UE,,28 ,,NW,,,,,,$151.76,$0.00,1,1,1,1,1,1,20120101,K0042,HCPCS,STANDARD SIZE FOOTPLATE EACH,,,28 ,,NW,,,,,,$131.93,$0.00,1,1,1,1,1,1,20120101,K0042,HCPCS,STANDARD SIZE FOOTPLATE EACH,NU,,28 ,,NW,,,,,,$131.93,$0.00,1,1,1,1,1,1,20120101,K0042,HCPCS,STANDARD SIZE FOOTPLATE EACH,RR,,28 ,,NW,,,,,,$13.02,$0.00,1,1,1,1,1,1,20120101,K0042,HCPCS,STANDARD SIZE FOOTPLATE EACH,UE,,28 ,,NW,,,,,,$98.91,$0.00,1,1,1,1,1,1,20120101,K0043,HCPCS,FTRST LOWER EXTENSION TUBE,,,28 ,,NW,,,,,,$74.59,$0.00,1,1,1,1,1,1,20120101,K0043,HCPCS,FTRST LOWER EXTENSION TUBE,NU,,28 ,,NW,,,,,,$74.59,$0.00,1,1,1,1,1,1,20120101,K0043,HCPCS,FTRST LOWER EXTENSION TUBE,RR,,28 ,,NW,,,,,,$7.30,$0.00,1,1,1,1,1,1,20120101,K0043,HCPCS,FTRST LOWER EXTENSION TUBE,UE,,28 ,,NW,,,,,,$55.94,$0.00,1,1,1,1,1,1,20120101,K0044,HCPCS,FTRST UPPER HANGER BRACKET,,,28 ,,NW,,,,,,$63.53,$0.00,1,1,1,1,1,1,20120101,K0044,HCPCS,FTRST UPPER HANGER BRACKET,NU,,28 ,,NW,,,,,,$63.53,$0.00,1,1,1,1,1,1,20120101,K0044,HCPCS,FTRST UPPER HANGER BRACKET,RR,,28 ,,NW,,,,,,$6.22,$0.00,1,1,1,1,1,1,20120101,K0044,HCPCS,FTRST UPPER HANGER BRACKET,UE,,28 ,,NW,,,,,,$47.59,$0.00,1,1,1,1,1,1,20120101,K0045,HCPCS,FOOTREST COMPLETE ASSEMBLY,,,28 ,,NW,,,,,,$216.57,$0.00,1,1,1,1,1,1,20120101,K0045,HCPCS,FOOTREST COMPLETE ASSEMBLY,NU,,28 ,,NW,,,,,,$216.57,$0.00,1,1,1,1,1,1,20120101,K0045,HCPCS,FOOTREST COMPLETE ASSEMBLY,RR,,28 ,,NW,,,,,,$22.02,$0.00,1,1,1,1,1,1,20120101,K0045,HCPCS,FOOTREST COMPLETE ASSEMBLY,UE,,28 ,,NW,,,,,,$163.01,$0.00,1,1,1,1,1,1,20120101,K0046,HCPCS,ELEVAT LEGRST LOW EXTENSION,,,28 ,,NW,,,,,,$74.59,$0.00,1,1,1,1,1,1,20120101,K0046,HCPCS,ELEVAT LEGRST LOW EXTENSION,NU,,28 ,,NW,,,,,,$74.59,$0.00,1,1,1,1,1,1,20120101,K0046,HCPCS,ELEVAT LEGRST LOW EXTENSION,RR,,28 ,,NW,,,,,,$7.30,$0.00,1,1,1,1,1,1,20120101,K0046,HCPCS,ELEVAT LEGRST LOW EXTENSION,UE,,28 ,,NW,,,,,,$55.95,$0.00,1,1,1,1,1,1,20120101,K0047,HCPCS,ELEVAT LEGRST UP HANGR BRACK,,,28 ,,NW,,,,,,$277.10,$0.00,1,1,1,1,1,1,20120101,K0047,HCPCS,ELEVAT LEGRST UP HANGR BRACK,NU,,28 ,,NW,,,,,,$277.10,$0.00,1,1,1,1,1,1,20120101,K0047,HCPCS,ELEVAT LEGRST UP HANGR BRACK,RR,,28 ,,NW,,,,,,$29.16,$0.00,1,1,1,1,1,1,20120101,K0047,HCPCS,ELEVAT LEGRST UP HANGR BRACK,UE,,28 ,,NW,,,,,,$218.18,$0.00,1,1,1,1,1,1,20120101,K0050,HCPCS,RATCHET ASSEMBLY,,,28 ,,NW,,,,,,$124.27,$0.00,1,1,1,1,1,1,20120101,K0050,HCPCS,RATCHET ASSEMBLY,NU,,28 ,,NW,,,,,,$124.27,$0.00,1,1,1,1,1,1,20120101,K0050,HCPCS,RATCHET ASSEMBLY,RR,,28 ,,NW,,,,,,$12.24,$0.00,1,1,1,1,1,1,20120101,K0050,HCPCS,RATCHET ASSEMBLY,UE,,28 ,,NW,,,,,,$93.19,$0.00,1,1,1,1,1,1,20120101,K0051,HCPCS,CAM RELESE ASSEM FTRST/LGRST,,,28 ,,NW,,,,,,$201.22,$0.00,1,1,1,1,1,1,20120101,K0051,HCPCS,CAM RELESE ASSEM FTRST/LGRST,NU,,28 ,,NW,,,,,,$201.22,$0.00,1,1,1,1,1,1,20120101,K0051,HCPCS,CAM RELESE ASSEM FTRST/LGRST,RR,,28 ,,NW,,,,,,$20.05,$0.00,1,1,1,1,1,1,20120101,K0051,HCPCS,CAM RELESE ASSEM FTRST/LGRST,UE,,28 ,,NW,,,,,,$150.81,$0.00,1,1,1,1,1,1,20120101,K0052,HCPCS,SWINGAWAY DETACH FOOTREST,,,28 ,,NW,,,,,,$326.30,$0.00,1,1,1,1,1,1,20120101,K0052,HCPCS,SWINGAWAY DETACH FOOTREST,NU,,28 ,,NW,,,,,,$326.30,$0.00,1,1,1,1,1,1,20120101,K0052,HCPCS,SWINGAWAY DETACH FOOTREST,RR,,28 ,,NW,,,,,,$35.21,$0.00,1,1,1,1,1,1,20120101,K0052,HCPCS,SWINGAWAY DETACH FOOTREST,UE,,28 ,,NW,,,,,,$255.08,$0.00,1,1,1,1,1,1,20120101,K0053,HCPCS,ELEVATE FOOTREST ARTICULATE,,,28 ,,NW,,,,,,$355.79,$0.00,1,1,1,1,1,1,20120101,K0053,HCPCS,ELEVATE FOOTREST ARTICULATE,NU,,28 ,,NW,,,,,,$355.79,$0.00,1,1,1,1,1,1,20120101,K0053,HCPCS,ELEVATE FOOTREST ARTICULATE,RR,,28 ,,NW,,,,,,$38.86,$0.00,1,1,1,1,1,1,20120101,K0053,HCPCS,ELEVATE FOOTREST ARTICULATE,UE,,28 ,,NW,,,,,,$277.22,$0.00,1,1,1,1,1,1,20120101,K0056,HCPCS,SEAT HT <17 OR >=21 LTWT WC,,,28 ,,NW,,,,,,$195.31,$0.00,1,1,1,1,1,1,20120101,K0056,HCPCS,SEAT HT <17 OR >=21 LTWT WC,NU,,28 ,,NW,,,,,,$195.31,$0.00,1,1,1,1,1,1,20120101,K0056,HCPCS,SEAT HT <17 OR >=21 LTWT WC,RR,,28 ,,NW,,,,,,$19.39,$0.00,1,1,1,1,1,1,20120101,K0056,HCPCS,SEAT HT <17 OR >=21 LTWT WC,UE,,28 ,,NW,,,,,,$146.48,$0.00,1,1,1,1,1,1,20120101,K0065,HCPCS,SPOKE PROTECTORS,,,28 ,,NW,,,,,,$91.24,$0.00,1,1,1,1,1,1,20120101,K0065,HCPCS,SPOKE PROTECTORS,NU,,28 ,,NW,,,,,,$91.24,$0.00,1,1,1,1,1,1,20120101,K0065,HCPCS,SPOKE PROTECTORS,RR,,28 ,,NW,,,,,,$8.98,$0.00,1,1,1,1,1,1,20120101,K0065,HCPCS,SPOKE PROTECTORS,UE,,28 ,,NW,,,,,,$68.39,$0.00,1,1,1,1,1,1,20120101,K0069,HCPCS,REAR WHL COMPLETE SOLID TIRE,,,28 ,,NW,,,,,,$205.21,$0.00,1,1,1,1,1,1,20120101,K0069,HCPCS,REAR WHL COMPLETE SOLID TIRE,NU,,28 ,,NW,,,,,,$205.21,$0.00,1,1,1,1,1,1,20120101,K0069,HCPCS,REAR WHL COMPLETE SOLID TIRE,RR,,28 ,,NW,,,,,,$20.78,$0.00,1,1,1,1,1,1,20120101,K0069,HCPCS,REAR WHL COMPLETE SOLID TIRE,UE,,28 ,,NW,,,,,,$153.86,$0.00,1,1,1,1,1,1,20120101,K0070,HCPCS,REAR WHL COMPL PNEUM TIRE,,,28 ,,NW,,,,,,$344.48,$0.00,1,1,1,1,1,1,20120101,K0070,HCPCS,REAR WHL COMPL PNEUM TIRE,NU,,28 ,,NW,,,,,,$344.48,$0.00,1,1,1,1,1,1,20120101,K0070,HCPCS,REAR WHL COMPL PNEUM TIRE,RR,,28 ,,NW,,,,,,$37.50,$0.00,1,1,1,1,1,1,20120101,K0070,HCPCS,REAR WHL COMPL PNEUM TIRE,UE,,28 ,,NW,,,,,,$268.66,$0.00,1,1,1,1,1,1,20120101,K0071,HCPCS,FRONT CASTR COMPL PNEUM TIRE,,,28 ,,NW,,,,,,$222.28,$0.00,1,1,1,1,1,1,20120101,K0071,HCPCS,FRONT CASTR COMPL PNEUM TIRE,NU,,28 ,,NW,,,,,,$222.28,$0.00,1,1,1,1,1,1,20120101,K0071,HCPCS,FRONT CASTR COMPL PNEUM TIRE,RR,,28 ,,NW,,,,,,$22.32,$0.00,1,1,1,1,1,1,20120101,K0071,HCPCS,FRONT CASTR COMPL PNEUM TIRE,UE,,28 ,,NW,,,,,,$168.28,$0.00,1,1,1,1,1,1,20120101,K0072,HCPCS,FRNT CSTR CMPL SEM-PNEUM TIR,,,28 ,,NW,,,,,,$134.35,$0.00,1,1,1,1,1,1,20120101,K0072,HCPCS,FRNT CSTR CMPL SEM-PNEUM TIR,NU,,28 ,,NW,,,,,,$134.35,$0.00,1,1,1,1,1,1,20120101,K0072,HCPCS,FRNT CSTR CMPL SEM-PNEUM TIR,RR,,28 ,,NW,,,,,,$13.27,$0.00,1,1,1,1,1,1,20120101,K0072,HCPCS,FRNT CSTR CMPL SEM-PNEUM TIR,UE,,28 ,,NW,,,,,,$100.73,$0.00,1,1,1,1,1,1,20120101,K0073,HCPCS,CASTER PIN LOCK EACH,,,28 ,,NW,,,,,,$70.02,$0.00,1,1,1,1,1,1,20120101,K0073,HCPCS,CASTER PIN LOCK EACH,NU,,28 ,,NW,,,,,,$70.02,$0.00,1,1,1,1,1,1,20120101,K0073,HCPCS,CASTER PIN LOCK EACH,RR,,28 ,,NW,,,,,,$6.87,$0.00,1,1,1,1,1,1,20120101,K0073,HCPCS,CASTER PIN LOCK EACH,UE,,28 ,,NW,,,,,,$52.46,$0.00,1,1,1,1,1,1,20120101,K0077,HCPCS,FRONT CASTER ASSEM COMPLETE,,,28 ,,NW,,,,,,$120.82,$0.00,1,1,1,1,1,1,20120101,K0077,HCPCS,FRONT CASTER ASSEM COMPLETE,NU,,28 ,,NW,,,,,,$120.82,$0.00,1,1,1,1,1,1,20120101,K0077,HCPCS,FRONT CASTER ASSEM COMPLETE,RR,,28 ,,NW,,,,,,$11.91,$0.00,1,1,1,1,1,1,20120101,K0077,HCPCS,FRONT CASTER ASSEM COMPLETE,UE,,28 ,,NW,,,,,,$90.56,$0.00,1,1,1,1,1,1,20120101,K0098,HCPCS,DRIVE BELT POWER WHEELCHAIR,,,28 ,,NW,,,,,,$102.46,$0.00,1,1,1,1,1,1,20120101,K0098,HCPCS,DRIVE BELT POWER WHEELCHAIR,NU,,28 ,,NW,,,,,,$102.46,$0.00,1,1,1,1,1,1,20120101,K0098,HCPCS,DRIVE BELT POWER WHEELCHAIR,RR,,28 ,,NW,,,,,,$10.13,$0.00,1,1,1,1,1,1,20120101,K0098,HCPCS,DRIVE BELT POWER WHEELCHAIR,UE,,28 ,,NW,,,,,,$76.78,$0.00,1,1,1,1,1,1,20120101,K0105,HCPCS,IV HANGER,,,28 ,,NW,,,,,,$204.28,$0.00,1,1,1,1,1,1,20120101,K0105,HCPCS,IV HANGER,NU,,28 ,,NW,,,,,,$204.28,$0.00,1,1,1,1,1,1,20120101,K0105,HCPCS,IV HANGER,RR,,28 ,,NW,,,,,,$20.25,$0.00,1,1,1,1,1,1,20120101,K0105,HCPCS,IV HANGER,UE,,28 ,,NW,,,,,,$153.17,$0.00,1,1,1,1,1,1,20120101,K0108,HCPCS,W/C COMPONENT-ACCESSORY NOS,,,28 ,,NW,,,,,,$156.19,$0.00,1,1,1,1,1,1,20120101,K0195,HCPCS,ELEVATING WHLCHAIR LEG RESTS,,,28 ,,NW,,,,,,$744.43,$0.00,1,1,1,1,1,1,20120101,K0195,HCPCS,ELEVATING WHLCHAIR LEG RESTS,RR,,28 ,,NW,,,,,,$77.79,$0.00,1,1,1,1,1,1,20120101,K0455,HCPCS,PUMP UNINTERRUPTED INFUSION,,,28 ,,NW,,,,,,"$5,848.11",$0.00,1,1,1,1,1,1,20120101,K0455,HCPCS,PUMP UNINTERRUPTED INFUSION,RR,,28 ,,NW,,,,,,$611.14,$0.00,1,1,1,1,1,1,20120101,K0462,HCPCS,TEMPORARY REPLACEMENT EQPMNT,,,28 ,,NW,,,,,,$520.80,$0.00,1,1,1,1,1,1,20120101,K0552,HCPCS,SUPPLY/EXT INF PUMP SYR TYPE,,,28 ,,NW,,,,,,$8.03,$0.00,1,1,1,1,1,1,20120101,K0601,HCPCS,REPL BATT SILVER OXIDE 1.5 V,,,28 ,,NW,,,,,,$3.38,$0.00,1,1,1,1,1,1,20120101,K0601,HCPCS,REPL BATT SILVER OXIDE 1.5 V,NU,,28 ,,NW,,,,,,$3.38,$0.00,1,1,1,1,1,1,20120101,K0602,HCPCS,REPL BATT SILVER OXIDE 3 V,,,28 ,,NW,,,,,,$17.44,$0.00,1,1,1,1,1,1,20120101,K0602,HCPCS,REPL BATT SILVER OXIDE 3 V,NU,,28 ,,NW,,,,,,$17.44,$0.00,1,1,1,1,1,1,20120101,K0603,HCPCS,REPL BATT ALKALINE 1.5 V,,,28 ,,NW,,,,,,$1.75,$0.00,1,1,1,1,1,1,20120101,K0603,HCPCS,REPL BATT ALKALINE 1.5 V,NU,,28 ,,NW,,,,,,$1.75,$0.00,1,1,1,1,1,1,20120101,K0604,HCPCS,REPL BATT LITHIUM 3.6 V,,,28 ,,NW,,,,,,$16.94,$0.00,1,1,1,1,1,1,20120101,K0604,HCPCS,REPL BATT LITHIUM 3.6 V,NU,,28 ,,NW,,,,,,$16.94,$0.00,1,1,1,1,1,1,20120101,K0605,HCPCS,REPL BATT LITHIUM 4.5 V,,,28 ,,NW,,,,,,$32.39,$0.00,1,1,1,1,1,1,20120101,K0605,HCPCS,REPL BATT LITHIUM 4.5 V,NU,,28 ,,NW,,,,,,$32.39,$0.00,1,1,1,1,1,1,20120101,K0606,HCPCS,AED GARMENT W ELEC ANALYSIS,,,28 ,,NW,,,,,,"$59,963.60",$0.00,1,1,1,1,1,1,20120101,K0606,HCPCS,AED GARMENT W ELEC ANALYSIS,KF,,28 ,,NW,,,,,,"$59,963.60",$0.00,1,1,1,1,1,1,20120101,K0606,HCPCS,AED GARMENT W ELEC ANALYSIS,RR,,28 ,,NW,,,,,,"$6,266.32",$0.00,1,1,1,1,1,1,20120101,K0607,HCPCS,REPL BATT FOR AED,,,28 ,,NW,,,,,,$999.46,$0.00,1,1,1,1,1,1,20120101,K0607,HCPCS,REPL BATT FOR AED,NU,,28 ,,NW,,,,,,$999.46,$0.00,1,1,1,1,1,1,20120101,K0607,HCPCS,REPL BATT FOR AED,RR,,28 ,,NW,,,,,,$80.30,$0.00,1,1,1,1,1,1,20120101,K0607,HCPCS,REPL BATT FOR AED,UE,,28 ,,NW,,,,,,$743.51,$0.00,1,1,1,1,1,1,20120101,K0608,HCPCS,REPL GARMENT FOR AED,,,28 ,,NW,,,,,,$614.57,$0.00,1,1,1,1,1,1,20120101,K0608,HCPCS,REPL GARMENT FOR AED,NU,,28 ,,NW,,,,,,$614.57,$0.00,1,1,1,1,1,1,20120101,K0608,HCPCS,REPL GARMENT FOR AED,RR,,28 ,,NW,,,,,,$52.38,$0.00,1,1,1,1,1,1,20120101,K0608,HCPCS,REPL GARMENT FOR AED,UE,,28 ,,NW,,,,,,$454.82,$0.00,1,1,1,1,1,1,20120101,K0609,HCPCS,REPL ELECTRODE FOR AED,,,28 ,,NW,,,,,,"$2,211.25",$0.00,1,1,1,1,1,1,20120101,K0609,HCPCS,REPL ELECTRODE FOR AED,KF,,28 ,,NW,,,,,,"$2,211.25",$0.00,1,1,1,1,1,1,20120101,K0669,HCPCS,SEAT/BACK CUS NO DMEPDAC VER,,,28 ,,NW,,,,,,$644.90,$0.00,1,1,1,1,1,1,20120101,K0669,HCPCS,SEAT/BACK CUS NO DMEPDAC VER,NU,,28 ,,NW,,,,,,$644.90,$0.00,1,1,1,1,1,1,20120101,K0672,HCPCS,REMOVABLE SOFT INTERFACE LE,,,28 ,,NW,,,,,,$156.96,$0.00,1,1,1,1,1,1,20120101,K0730,HCPCS,CTRL DOSE INH DRUG DELIV SYS,,,28 ,,NW,,,,,,"$4,282.26",$0.00,1,1,1,1,1,1,20120101,K0730,HCPCS,CTRL DOSE INH DRUG DELIV SYS,NU,,28 ,,NW,,,,,,"$4,282.26",$0.00,1,1,1,1,1,1,20120101,K0730,HCPCS,CTRL DOSE INH DRUG DELIV SYS,RR,,28 ,,NW,,,,,,$406.27,$0.00,1,1,1,1,1,1,20120101,K0730,HCPCS,CTRL DOSE INH DRUG DELIV SYS,UE,,28 ,,NW,,,,,,"$3,205.57",$0.00,1,1,1,1,1,1,20120101,K0733,HCPCS,12-24HR SEALED LEAD ACID,,,28 ,,NW,,,,,,$115.90,$0.00,1,1,1,1,1,1,20120101,K0733,HCPCS,12-24HR SEALED LEAD ACID,NU,,28 ,,NW,,,,,,$115.90,$0.00,1,1,1,1,1,1,20120101,K0733,HCPCS,12-24HR SEALED LEAD ACID,RR,,28 ,,NW,,,,,,$11.52,$0.00,1,1,1,1,1,1,20120101,K0733,HCPCS,12-24HR SEALED LEAD ACID,UE,,28 ,,NW,,,,,,$86.94,$0.00,1,1,1,1,1,1,20120101,K0738,HCPCS,PORTABLE GAS OXYGEN SYSTEM,,,28 ,,NW,,,,,,"$1,359.55",$0.00,1,1,1,1,1,1,20120101,K0738,HCPCS,PORTABLE GAS OXYGEN SYSTEM,RR,,28 ,,NW,,,,,,$142.08,$0.00,1,1,1,1,1,1,20120101,K0739,HCPCS,REPAIR/SVC DME NON-OXYGEN EQ,,,28 ,,NW,,,,,,$28.54,$0.00,1,1,1,1,1,1,20120101,K0740,HCPCS,REPAIR/SVC OXYGEN EQUIPMENT,,,28 ,,NW,,,,,,$65.06,$0.00,1,1,1,1,1,1,20120101,K0741,HCPCS,PORTABLE GASEOUS OXYGEN SYS,,,28 ,,NW,,,,,,$714.75,$0.00,1,1,1,1,1,1,20120101,K0742,HCPCS,PORTABLE GASEOUS OXYGEN,,,28 ,,NW,,,,,,$229.59,$0.00,1,1,1,1,1,1,20120101,K0743,HCPCS,PORTABLE HOME SUCTION PUMP,,,28 ,,NW,,,,,,$157.70,$0.00,1,1,1,1,1,1,20120101,K0744,HCPCS,ABSORP DRG <= 16 SUC PUMP,,,28 ,,NW,,,,,,$3.42,$0.00,1,1,1,1,1,1,20120101,K0745,HCPCS,ABSORP DRG >16 <=48 SUC PUMP,,,28 ,,NW,,,,,,$5.58,$0.00,1,1,1,1,1,1,20120101,K0746,HCPCS,ABSORP DRG >48 SUC PUMP,,,28 ,,NW,,,,,,$10.86,$0.00,1,1,1,1,1,1,20120101,K0800,HCPCS,POV GROUP 1 STD UP TO 300LBS,,,28 ,,NW,,,,,,"$1,891.76",$0.00,1,1,1,1,1,1,20120101,K0800,HCPCS,POV GROUP 1 STD UP TO 300LBS,NU,,28 ,,NW,,,,,,"$1,891.76",$0.00,1,1,1,1,1,1,20120101,K0800,HCPCS,POV GROUP 1 STD UP TO 300LBS,RR,,28 ,,NW,,,,,,$226.54,$0.00,1,1,1,1,1,1,20120101,K0800,HCPCS,POV GROUP 1 STD UP TO 300LBS,UE,,28 ,,NW,,,,,,"$1,429.19",$0.00,1,1,1,1,1,1,20120101,K0801,HCPCS,POV GROUP 1 HD 301-450 LBS,,,28 ,,NW,,,,,,"$3,024.49",$0.00,1,1,1,1,1,1,20120101,K0801,HCPCS,POV GROUP 1 HD 301-450 LBS,NU,,28 ,,NW,,,,,,"$3,024.49",$0.00,1,1,1,1,1,1,20120101,K0801,HCPCS,POV GROUP 1 HD 301-450 LBS,RR,,28 ,,NW,,,,,,$339.77,$0.00,1,1,1,1,1,1,20120101,K0801,HCPCS,POV GROUP 1 HD 301-450 LBS,UE,,28 ,,NW,,,,,,"$2,278.74",$0.00,1,1,1,1,1,1,20120101,K0802,HCPCS,POV GROUP 1 VHD 451-600 LBS,,,28 ,,NW,,,,,,"$3,417.29",$0.00,1,1,1,1,1,1,20120101,K0802,HCPCS,POV GROUP 1 VHD 451-600 LBS,NU,,28 ,,NW,,,,,,"$3,417.29",$0.00,1,1,1,1,1,1,20120101,K0802,HCPCS,POV GROUP 1 VHD 451-600 LBS,RR,,28 ,,NW,,,,,,$379.08,$0.00,1,1,1,1,1,1,20120101,K0802,HCPCS,POV GROUP 1 VHD 451-600 LBS,UE,,28 ,,NW,,,,,,"$2,573.36",$0.00,1,1,1,1,1,1,20120101,K0806,HCPCS,POV GROUP 2 STD UP TO 300LBS,,,28 ,,NW,,,,,,"$2,279.81",$0.00,1,1,1,1,1,1,20120101,K0806,HCPCS,POV GROUP 2 STD UP TO 300LBS,NU,,28 ,,NW,,,,,,"$2,279.81",$0.00,1,1,1,1,1,1,20120101,K0806,HCPCS,POV GROUP 2 STD UP TO 300LBS,RR,,28 ,,NW,,,,,,$265.34,$0.00,1,1,1,1,1,1,20120101,K0806,HCPCS,POV GROUP 2 STD UP TO 300LBS,UE,,28 ,,NW,,,,,,"$1,720.24",$0.00,1,1,1,1,1,1,20120101,K0807,HCPCS,POV GROUP 2 HD 301-450 LBS,,,28 ,,NW,,,,,,"$3,437.87",$0.00,1,1,1,1,1,1,20120101,K0807,HCPCS,POV GROUP 2 HD 301-450 LBS,NU,,28 ,,NW,,,,,,"$3,437.87",$0.00,1,1,1,1,1,1,20120101,K0807,HCPCS,POV GROUP 2 HD 301-450 LBS,RR,,28 ,,NW,,,,,,$381.16,$0.00,1,1,1,1,1,1,20120101,K0807,HCPCS,POV GROUP 2 HD 301-450 LBS,UE,,28 ,,NW,,,,,,"$2,588.81",$0.00,1,1,1,1,1,1,20120101,K0808,HCPCS,POV GROUP 2 VHD 451-600 LBS,,,28 ,,NW,,,,,,"$5,296.40",$0.00,1,1,1,1,1,1,20120101,K0808,HCPCS,POV GROUP 2 VHD 451-600 LBS,NU,,28 ,,NW,,,,,,"$5,296.40",$0.00,1,1,1,1,1,1,20120101,K0808,HCPCS,POV GROUP 2 VHD 451-600 LBS,RR,,28 ,,NW,,,,,,$566.99,$0.00,1,1,1,1,1,1,20120101,K0808,HCPCS,POV GROUP 2 VHD 451-600 LBS,UE,,28 ,,NW,,,,,,"$3,982.66",$0.00,1,1,1,1,1,1,20120101,K0812,HCPCS,POWER OPERATED VEHICLE NOC,,,28 ,,NW,,,,,,"$1,553.93",$0.00,1,1,1,1,1,1,20120101,K0813,HCPCS,PWC GP 1 STD PORT SEAT/BACK,,,28 ,,NW,,,,,,"$4,198.45",$0.00,1,1,1,1,1,1,20120101,K0813,HCPCS,PWC GP 1 STD PORT SEAT/BACK,RR,,28 ,,NW,,,,,,$442.38,$0.00,1,1,1,1,1,1,20120101,K0814,HCPCS,PWC GP 1 STD PORT CAP CHAIR,,,28 ,,NW,,,,,,"$5,241.05",$0.00,1,1,1,1,1,1,20120101,K0814,HCPCS,PWC GP 1 STD PORT CAP CHAIR,RR,,28 ,,NW,,,,,,$552.11,$0.00,1,1,1,1,1,1,20120101,K0815,HCPCS,PWC GP 1 STD SEAT/BACK,,,28 ,,NW,,,,,,"$5,901.81",$0.00,1,1,1,1,1,1,20120101,K0815,HCPCS,PWC GP 1 STD SEAT/BACK,RR,,28 ,,NW,,,,,,$621.65,$0.00,1,1,1,1,1,1,20120101,K0816,HCPCS,PWC GP 1 STD CAP CHAIR,,,28 ,,NW,,,,,,"$5,672.27",$0.00,1,1,1,1,1,1,20120101,K0816,HCPCS,PWC GP 1 STD CAP CHAIR,RR,,28 ,,NW,,,,,,$597.50,$0.00,1,1,1,1,1,1,20120101,K0820,HCPCS,PWC GP 2 STD PORT SEAT/BACK,,,28 ,,NW,,,,,,"$4,451.99",$0.00,1,1,1,1,1,1,20120101,K0820,HCPCS,PWC GP 2 STD PORT SEAT/BACK,RR,,28 ,,NW,,,,,,$469.07,$0.00,1,1,1,1,1,1,20120101,K0821,HCPCS,PWC GP 2 STD PORT CAP CHAIR,,,28 ,,NW,,,,,,"$5,580.06",$0.00,1,1,1,1,1,1,20120101,K0821,HCPCS,PWC GP 2 STD PORT CAP CHAIR,RR,,28 ,,NW,,,,,,$587.79,$0.00,1,1,1,1,1,1,20120101,K0822,HCPCS,PWC GP 2 STD SEAT/BACK,,,28 ,,NW,,,,,,"$6,644.47",$0.00,1,1,1,1,1,1,20120101,K0822,HCPCS,PWC GP 2 STD SEAT/BACK,RR,,28 ,,NW,,,,,,$699.81,$0.00,1,1,1,1,1,1,20120101,K0823,HCPCS,PWC GP 2 STD CAP CHAIR,,,28 ,,NW,,,,,,"$6,685.03",$0.00,1,1,1,1,1,1,20120101,K0823,HCPCS,PWC GP 2 STD CAP CHAIR,RR,,28 ,,NW,,,,,,$704.08,$0.00,1,1,1,1,1,1,20120101,K0824,HCPCS,PWC GP 2 HD SEAT/BACK,,,28 ,,NW,,,,,,"$7,948.61",$0.00,1,1,1,1,1,1,20120101,K0824,HCPCS,PWC GP 2 HD SEAT/BACK,RR,,28 ,,NW,,,,,,$837.07,$0.00,1,1,1,1,1,1,20120101,K0825,HCPCS,PWC GP 2 HD CAP CHAIR,,,28 ,,NW,,,,,,"$7,316.97",$0.00,1,1,1,1,1,1,20120101,K0825,HCPCS,PWC GP 2 HD CAP CHAIR,RR,,28 ,,NW,,,,,,$770.59,$0.00,1,1,1,1,1,1,20120101,K0826,HCPCS,PWC GP 2 VHD SEAT/BACK,,,28 ,,NW,,,,,,"$10,150.19",$0.00,1,1,1,1,1,1,20120101,K0826,HCPCS,PWC GP 2 VHD SEAT/BACK,RR,,28 ,,NW,,,,,,"$1,068.77",$0.00,1,1,1,1,1,1,20120101,K0827,HCPCS,PWC GP VHD CAP CHAIR,,,28 ,,NW,,,,,,"$8,702.02",$0.00,1,1,1,1,1,1,20120101,K0827,HCPCS,PWC GP VHD CAP CHAIR,RR,,28 ,,NW,,,,,,$916.36,$0.00,1,1,1,1,1,1,20120101,K0828,HCPCS,PWC GP 2 XTRA HD SEAT/BACK,,,28 ,,NW,,,,,,"$11,136.04",$0.00,1,1,1,1,1,1,20120101,K0828,HCPCS,PWC GP 2 XTRA HD SEAT/BACK,RR,,28 ,,NW,,,,,,"$1,172.52",$0.00,1,1,1,1,1,1,20120101,K0829,HCPCS,PWC GP 2 XTRA HD CAP CHAIR,,,28 ,,NW,,,,,,"$10,264.98",$0.00,1,1,1,1,1,1,20120101,K0829,HCPCS,PWC GP 2 XTRA HD CAP CHAIR,RR,,28 ,,NW,,,,,,"$1,080.85",$0.00,1,1,1,1,1,1,20120101,K0830,HCPCS,PWC GP2 STD SEAT ELEVATE S/B,,,28 ,,NW,,,,,,"$1,360.44",$0.00,1,1,1,1,1,1,20120101,K0831,HCPCS,PWC GP2 STD SEAT ELEVATE CAP,,,28 ,,NW,,,,,,"$1,686.14",$0.00,1,1,1,1,1,1,20120101,K0835,HCPCS,PWC GP2 STD SING POW OPT S/B,,,28 ,,NW,,,,,,"$6,736.87",$0.00,1,1,1,1,1,1,20120101,K0835,HCPCS,PWC GP2 STD SING POW OPT S/B,RR,,28 ,,NW,,,,,,$709.54,$0.00,1,1,1,1,1,1,20120101,K0836,HCPCS,PWC GP2 STD SING POW OPT CAP,,,28 ,,NW,,,,,,"$6,968.78",$0.00,1,1,1,1,1,1,20120101,K0836,HCPCS,PWC GP2 STD SING POW OPT CAP,RR,,28 ,,NW,,,,,,$733.95,$0.00,1,1,1,1,1,1,20120101,K0837,HCPCS,PWC GP 2 HD SING POW OPT S/B,,,28 ,,NW,,,,,,"$7,948.61",$0.00,1,1,1,1,1,1,20120101,K0837,HCPCS,PWC GP 2 HD SING POW OPT S/B,RR,,28 ,,NW,,,,,,$837.07,$0.00,1,1,1,1,1,1,20120101,K0838,HCPCS,PWC GP 2 HD SING POW OPT CAP,,,28 ,,NW,,,,,,"$7,161.00",$0.00,1,1,1,1,1,1,20120101,K0838,HCPCS,PWC GP 2 HD SING POW OPT CAP,RR,,28 ,,NW,,,,,,$754.17,$0.00,1,1,1,1,1,1,20120101,K0839,HCPCS,PWC GP2 VHD SING POW OPT S/B,,,28 ,,NW,,,,,,"$10,150.19",$0.00,1,1,1,1,1,1,20120101,K0839,HCPCS,PWC GP2 VHD SING POW OPT S/B,RR,,28 ,,NW,,,,,,"$1,068.77",$0.00,1,1,1,1,1,1,20120101,K0840,HCPCS,PWC GP2 XHD SING POW OPT S/B,,,28 ,,NW,,,,,,"$15,132.60",$0.00,1,1,1,1,1,1,20120101,K0840,HCPCS,PWC GP2 XHD SING POW OPT S/B,RR,,28 ,,NW,,,,,,"$1,593.13",$0.00,1,1,1,1,1,1,20120101,K0841,HCPCS,PWC GP2 STD MULT POW OPT S/B,,,28 ,,NW,,,,,,"$7,140.00",$0.00,1,1,1,1,1,1,20120101,K0841,HCPCS,PWC GP2 STD MULT POW OPT S/B,RR,,28 ,,NW,,,,,,$751.96,$0.00,1,1,1,1,1,1,20120101,K0842,HCPCS,PWC GP2 STD MULT POW OPT CAP,,,28 ,,NW,,,,,,"$7,140.00",$0.00,1,1,1,1,1,1,20120101,K0842,HCPCS,PWC GP2 STD MULT POW OPT CAP,RR,,28 ,,NW,,,,,,$751.96,$0.00,1,1,1,1,1,1,20120101,K0843,HCPCS,PWC GP2 HD MULT POW OPT S/B,,,28 ,,NW,,,,,,"$8,499.42",$0.00,1,1,1,1,1,1,20120101,K0843,HCPCS,PWC GP2 HD MULT POW OPT S/B,RR,,28 ,,NW,,,,,,$895.04,$0.00,1,1,1,1,1,1,20120101,K0848,HCPCS,PWC GP 3 STD SEAT/BACK,,,28 ,,NW,,,,,,"$8,630.23",$0.00,1,1,1,1,1,1,20120101,K0848,HCPCS,PWC GP 3 STD SEAT/BACK,RR,,28 ,,NW,,,,,,$908.80,$0.00,1,1,1,1,1,1,20120101,K0849,HCPCS,PWC GP 3 STD CAP CHAIR,,,28 ,,NW,,,,,,"$8,315.98",$0.00,1,1,1,1,1,1,20120101,K0849,HCPCS,PWC GP 3 STD CAP CHAIR,RR,,28 ,,NW,,,,,,$875.73,$0.00,1,1,1,1,1,1,20120101,K0850,HCPCS,PWC GP 3 HD SEAT/BACK,,,28 ,,NW,,,,,,"$9,934.79",$0.00,1,1,1,1,1,1,20120101,K0850,HCPCS,PWC GP 3 HD SEAT/BACK,RR,,28 ,,NW,,,,,,"$1,046.10",$0.00,1,1,1,1,1,1,20120101,K0851,HCPCS,PWC GP 3 HD CAP CHAIR,,,28 ,,NW,,,,,,"$9,570.51",$0.00,1,1,1,1,1,1,20120101,K0851,HCPCS,PWC GP 3 HD CAP CHAIR,RR,,28 ,,NW,,,,,,"$1,007.76",$0.00,1,1,1,1,1,1,20120101,K0852,HCPCS,PWC GP 3 VHD SEAT/BACK,,,28 ,,NW,,,,,,"$11,405.04",$0.00,1,1,1,1,1,1,20120101,K0852,HCPCS,PWC GP 3 VHD SEAT/BACK,RR,,28 ,,NW,,,,,,"$1,200.83",$0.00,1,1,1,1,1,1,20120101,K0853,HCPCS,PWC GP 3 VHD CAP CHAIR,,,28 ,,NW,,,,,,"$11,702.87",$0.00,1,1,1,1,1,1,20120101,K0853,HCPCS,PWC GP 3 VHD CAP CHAIR,RR,,28 ,,NW,,,,,,"$1,232.18",$0.00,1,1,1,1,1,1,20120101,K0854,HCPCS,PWC GP 3 XHD SEAT/BACK,,,28 ,,NW,,,,,,"$15,349.08",$0.00,1,1,1,1,1,1,20120101,K0854,HCPCS,PWC GP 3 XHD SEAT/BACK,RR,,28 ,,NW,,,,,,"$1,615.92",$0.00,1,1,1,1,1,1,20120101,K0855,HCPCS,PWC GP 3 XHD CAP CHAIR,,,28 ,,NW,,,,,,"$14,525.85",$0.00,1,1,1,1,1,1,20120101,K0855,HCPCS,PWC GP 3 XHD CAP CHAIR,RR,,28 ,,NW,,,,,,"$1,529.28",$0.00,1,1,1,1,1,1,20120101,K0856,HCPCS,PWC GP3 STD SING POW OPT S/B,,,28 ,,NW,,,,,,"$9,228.81",$0.00,1,1,1,1,1,1,20120101,K0856,HCPCS,PWC GP3 STD SING POW OPT S/B,RR,,28 ,,NW,,,,,,$971.80,$0.00,1,1,1,1,1,1,20120101,K0857,HCPCS,PWC GP3 STD SING POW OPT CAP,,,28 ,,NW,,,,,,"$9,404.19",$0.00,1,1,1,1,1,1,20120101,K0857,HCPCS,PWC GP3 STD SING POW OPT CAP,RR,,28 ,,NW,,,,,,$990.26,$0.00,1,1,1,1,1,1,20120101,K0858,HCPCS,PWC GP3 HD SING POW OPT S/B,,,28 ,,NW,,,,,,"$11,335.65",$0.00,1,1,1,1,1,1,20120101,K0858,HCPCS,PWC GP3 HD SING POW OPT S/B,RR,,28 ,,NW,,,,,,"$1,193.53",$0.00,1,1,1,1,1,1,20120101,K0859,HCPCS,PWC GP3 HD SING POW OPT CAP,,,28 ,,NW,,,,,,"$10,832.75",$0.00,1,1,1,1,1,1,20120101,K0859,HCPCS,PWC GP3 HD SING POW OPT CAP,RR,,28 ,,NW,,,,,,"$1,140.60",$0.00,1,1,1,1,1,1,20120101,K0860,HCPCS,PWC GP3 VHD SING POW OPT S/B,,,28 ,,NW,,,,,,"$15,990.45",$0.00,1,1,1,1,1,1,20120101,K0860,HCPCS,PWC GP3 VHD SING POW OPT S/B,RR,,28 ,,NW,,,,,,"$1,683.42",$0.00,1,1,1,1,1,1,20120101,K0861,HCPCS,PWC GP3 STD MULT POW OPT S/B,,,28 ,,NW,,,,,,"$20,535.78",$0.00,1,1,1,1,1,1,20120101,K0861,HCPCS,PWC GP3 STD MULT POW OPT S/B,RR,,28 ,,NW,,,,,,"$2,161.79",$0.00,1,1,1,1,1,1,20120101,K0862,HCPCS,PWC GP3 HD MULT POW OPT S/B,,,28 ,,NW,,,,,,"$11,335.65",$0.00,1,1,1,1,1,1,20120101,K0862,HCPCS,PWC GP3 HD MULT POW OPT S/B,RR,,28 ,,NW,,,,,,"$1,193.53",$0.00,1,1,1,1,1,1,20120101,K0863,HCPCS,PWC GP3 VHD MULT POW OPT S/B,,,28 ,,NW,,,,,,"$15,990.45",$0.00,1,1,1,1,1,1,20120101,K0863,HCPCS,PWC GP3 VHD MULT POW OPT S/B,RR,,28 ,,NW,,,,,,"$1,683.42",$0.00,1,1,1,1,1,1,20120101,K0864,HCPCS,PWC GP3 XHD MULT POW OPT S/B,,,28 ,,NW,,,,,,"$18,938.32",$0.00,1,1,1,1,1,1,20120101,K0864,HCPCS,PWC GP3 XHD MULT POW OPT S/B,RR,,28 ,,NW,,,,,,"$1,993.67",$0.00,1,1,1,1,1,1,20120101,K0868,HCPCS,PWC GP 4 STD SEAT/BACK,,,28 ,,NW,,,,,,"$5,280.46",$0.00,1,1,1,1,1,1,20120101,K0869,HCPCS,PWC GP 4 STD CAP CHAIR,,,28 ,,NW,,,,,,"$2,800.04",$0.00,1,1,1,1,1,1,20120101,K0870,HCPCS,PWC GP 4 HD SEAT/BACK,,,28 ,,NW,,,,,,"$6,543.54",$0.00,1,1,1,1,1,1,20120101,K0871,HCPCS,PWC GP 4 VHD SEAT/BACK,,,28 ,,NW,,,,,,"$9,273.27",$0.00,1,1,1,1,1,1,20120101,K0877,HCPCS,PWC GP4 STD SING POW OPT S/B,,,28 ,,NW,,,,,,"$3,940.56",$0.00,1,1,1,1,1,1,20120101,K0878,HCPCS,PWC GP4 STD SING POW OPT CAP,,,28 ,,NW,,,,,,"$3,574.45",$0.00,1,1,1,1,1,1,20120101,K0879,HCPCS,PWC GP4 HD SING POW OPT S/B,,,28 ,,NW,,,,,,"$4,840.15",$0.00,1,1,1,1,1,1,20120101,K0880,HCPCS,PWC GP4 VHD SING POW OPT S/B,,,28 ,,NW,,,,,,"$6,859.28",$0.00,1,1,1,1,1,1,20120101,K0884,HCPCS,PWC GP4 STD MULT POW OPT S/B,,,28 ,,NW,,,,,,"$5,460.90",$0.00,1,1,1,1,1,1,20120101,K0885,HCPCS,PWC GP4 STD MULT POW OPT CAP,,,28 ,,NW,,,,,,"$5,257.52",$0.00,1,1,1,1,1,1,20120101,K0886,HCPCS,PWC GP4 HD MULT POW S/B,,,28 ,,NW,,,,,,"$5,540.13",$0.00,1,1,1,1,1,1,20120101,K0890,HCPCS,PWC GP5 PED SING POW OPT S/B,,,28 ,,NW,,,,,,"$2,629.24",$0.00,1,1,1,1,1,1,20120101,K0891,HCPCS,PWC GP5 PED MULT POW OPT S/B,,,28 ,,NW,,,,,,"$3,221.28",$0.00,1,1,1,1,1,1,20120101,K0898,HCPCS,POWER WHEELCHAIR NOC,,,28 ,,NW,,,,,,"$3,101.63",$0.00,1,1,1,1,1,1,20120101,K0899,HCPCS,POW MOBIL DEV NO DMEPDAC,,,28 ,,NW,,,,,,"$2,561.70",$0.00,1,1,1,1,1,1,20120101,L0112,HCPCS,CRANIAL CERVICAL ORTHOSIS,,,28 ,,NW,,,,,,"$2,004.87",$0.00,1,1,1,1,1,1,20120101,L0113,HCPCS,CRANIAL CERVICAL TORTICOLLIS,,,28 ,,NW,,,,,,$381.66,$0.00,1,1,1,1,1,1,20120101,L0120,HCPCS,CERV FLEXIBLE NON-ADJUSTABLE,,,28 ,,NW,,,,,,$38.01,$0.00,1,1,1,1,1,1,20120101,L0130,HCPCS,FLEX THERMOPLASTIC COLLAR MO,,,28 ,,NW,,,,,,$225.08,$0.00,1,1,1,1,1,1,20120101,L0140,HCPCS,CERVICAL SEMI-RIGID ADJUSTAB,,,28 ,,NW,,,,,,$85.28,$0.00,1,1,1,1,1,1,20120101,L0150,HCPCS,CERV SEMI-RIG ADJ MOLDED CHN,,,28 ,,NW,,,,,,$150.08,$0.00,1,1,1,1,1,1,20120101,L0160,HCPCS,CERV SEMI-RIG WIRE OCC/MAND,,,28 ,,NW,,,,,,$213.85,$0.00,1,1,1,1,1,1,20120101,L0170,HCPCS,CERVICAL COLLAR MOLDED TO PT,,,28 ,,NW,,,,,,"$1,002.54",$0.00,1,1,1,1,1,1,20120101,L0172,HCPCS,CERV COL THERMPLAS FOAM 2 PI,,,28 ,,NW,,,,,,$178.19,$0.00,1,1,1,1,1,1,20120101,L0174,HCPCS,CERV COL FOAM 2 PIECE W THOR,,,28 ,,NW,,,,,,$379.39,$0.00,1,1,1,1,1,1,20120101,L0180,HCPCS,CER POST COL OCC/MAN SUP ADJ,,,28 ,,NW,,,,,,$548.75,$0.00,1,1,1,1,1,1,20120101,L0190,HCPCS,CERV COLLAR SUPP ADJ CERV BA,,,28 ,,NW,,,,,,$745.65,$0.00,1,1,1,1,1,1,20120101,L0200,HCPCS,CERV COL SUPP ADJ BAR & THOR,,,28 ,,NW,,,,,,$782.40,$0.00,1,1,1,1,1,1,20120101,L0220,HCPCS,THOR RIB BELT CUSTOM FABRICA,,,28 ,,NW,,,,,,$165.38,$0.00,1,1,1,1,1,1,20120101,L0430,HCPCS,DEWALL POSTURE PROTECTOR,,,28 ,,NW,,,,,,"$2,074.49",$0.00,1,1,1,1,1,1,20120101,L0450,HCPCS,TLSO FLEX PREFAB THORACIC,,,28 ,,NW,,,,,,$239.25,$0.00,1,1,1,1,1,1,20120101,L0452,HCPCS,TLSO FLEX CUSTOM FAB THORACI,,,28 ,,NW,,,,,,$354.18,$0.00,1,1,1,1,1,1,20120101,L0454,HCPCS,TLSO FLEX PREFAB SACROCOC-T9,,,28 ,,NW,,,,,,$470.85,$0.00,1,1,1,1,1,1,20120101,L0456,HCPCS,TLSO FLEX PREFAB,,,28 ,,NW,,,,,,"$1,414.70",$0.00,1,1,1,1,1,1,20120101,L0458,HCPCS,TLSO 2MOD SYMPHIS-XIPHO PRE,,,28 ,,NW,,,,,,"$1,264.99",$0.00,1,1,1,1,1,1,20120101,L0460,HCPCS,TLSO2MOD SYMPHYSIS-STERN PRE,,,28 ,,NW,,,,,,"$1,428.16",$0.00,1,1,1,1,1,1,20120101,L0462,HCPCS,TLSO 3MOD SACRO-SCAP PRE,,,28 ,,NW,,,,,,"$1,784.81",$0.00,1,1,1,1,1,1,20120101,L0464,HCPCS,TLSO 4MOD SACRO-SCAP PRE,,,28 ,,NW,,,,,,"$2,131.36",$0.00,1,1,1,1,1,1,20120101,L0466,HCPCS,TLSO RIGID FRAME PRE SOFT AP,,,28 ,,NW,,,,,,$544.63,$0.00,1,1,1,1,1,1,20120101,L0468,HCPCS,TLSO RIGID FRAME PREFAB PELV,,,28 ,,NW,,,,,,$680.55,$0.00,1,1,1,1,1,1,20120101,L0470,HCPCS,TLSO RIGID FRAME PRE SUBCLAV,,,28 ,,NW,,,,,,$960.83,$0.00,1,1,1,1,1,1,20120101,L0472,HCPCS,TLSO RIGID FRAME HYPEREX PRE,,,28 ,,NW,,,,,,$601.05,$0.00,1,1,1,1,1,1,20120101,L0480,HCPCS,TLSO RIGID PLASTIC CUSTOM FA,,,28 ,,NW,,,,,,"$2,137.33",$0.00,1,1,1,1,1,1,20120101,L0482,HCPCS,TLSO RIGID LINED CUSTOM FAB,,,28 ,,NW,,,,,,"$2,354.29",$0.00,1,1,1,1,1,1,20120101,L0484,HCPCS,TLSO RIGID PLASTIC CUST FAB,,,28 ,,NW,,,,,,"$2,621.10",$0.00,1,1,1,1,1,1,20120101,L0486,HCPCS,TLSO RIGIDLINED CUST FAB TWO,,,28 ,,NW,,,,,,"$2,786.82",$0.00,1,1,1,1,1,1,20120101,L0488,HCPCS,TLSO RIGID LINED PRE ONE PIE,,,28 ,,NW,,,,,,"$1,428.16",$0.00,1,1,1,1,1,1,20120101,L0490,HCPCS,TLSO RIGID PLASTIC PRE ONE,,,28 ,,NW,,,,,,$377.69,$0.00,1,1,1,1,1,1,20120101,L0491,HCPCS,TLSO 2 PIECE RIGID SHELL,,,28 ,,NW,,,,,,"$1,084.55",$0.00,1,1,1,1,1,1,20120101,L0492,HCPCS,TLSO 3 PIECE RIGID SHELL,,,28 ,,NW,,,,,,$699.23,$0.00,1,1,1,1,1,1,20120101,L0621,HCPCS,SIO FLEX PELVISACRAL PREFAB,,,28 ,,NW,,,,,,$125.78,$0.00,1,1,1,1,1,1,20120101,L0622,HCPCS,SIO FLEX PELVISACRAL CUSTOM,,,28 ,,NW,,,,,,$364.84,$0.00,1,1,1,1,1,1,20120101,L0623,HCPCS,SIO PANEL PREFAB,,,28 ,,NW,,,,,,$60.08,$0.00,1,1,1,1,1,1,20120101,L0624,HCPCS,SIO PANEL CUSTOM,,,28 ,,NW,,,,,,$104.34,$0.00,1,1,1,1,1,1,20120101,L0625,HCPCS,LO FLEXIBL L1-BELOW L5 PRE,,,28 ,,NW,,,,,,$72.19,$0.00,1,1,1,1,1,1,20120101,L0626,HCPCS,LO SAG STAYS/PANELS PRE-FAB,,,28 ,,NW,,,,,,$101.26,$0.00,1,1,1,1,1,1,20120101,L0627,HCPCS,LO SAGITT RIGID PANEL PREFAB,,,28 ,,NW,,,,,,$564.49,$0.00,1,1,1,1,1,1,20120101,L0628,HCPCS,LO FLEX W/O RIGID STAYS PRE,,,28 ,,NW,,,,,,$108.82,$0.00,1,1,1,1,1,1,20120101,L0629,HCPCS,LSO FLEX W/RIGID STAYS CUST,,,28 ,,NW,,,,,,$137.59,$0.00,1,1,1,1,1,1,20120101,L0630,HCPCS,LSO POST RIGID PANEL PRE,,,28 ,,NW,,,,,,$208.11,$0.00,1,1,1,1,1,1,20120101,L0631,HCPCS,LSO SAG-CORO RIGID FRAME PRE,,,28 ,,NW,,,,,,"$1,461.42",$0.00,1,1,1,1,1,1,20120101,L0632,HCPCS,LSO SAG RIGID FRAME CUST,,,28 ,,NW,,,,,,"$2,142.46",$0.00,1,1,1,1,1,1,20120101,L0633,HCPCS,LSO FLEXION CONTROL PREFAB,,,28 ,,NW,,,,,,$383.36,$0.00,1,1,1,1,1,1,20120101,L0634,HCPCS,LSO FLEXION CONTROL CUSTOM,,,28 ,,NW,,,,,,$562.02,$0.00,1,1,1,1,1,1,20120101,L0635,HCPCS,LSO SAGIT RIGID PANEL PREFAB,,,28 ,,NW,,,,,,"$1,473.73",$0.00,1,1,1,1,1,1,20120101,L0636,HCPCS,LSO SAGITTAL RIGID PANEL CUS,,,28 ,,NW,,,,,,"$2,160.51",$0.00,1,1,1,1,1,1,20120101,L0637,HCPCS,LSO SAG-CORONAL PANEL PREFAB,,,28 ,,NW,,,,,,"$1,740.69",$0.00,1,1,1,1,1,1,20120101,L0638,HCPCS,LSO SAG-CORONAL PANEL CUSTOM,,,28 ,,NW,,,,,,"$1,887.26",$0.00,1,1,1,1,1,1,20120101,L0639,HCPCS,LSO S/C SHELL/PANEL PREFAB,,,28 ,,NW,,,,,,"$1,740.69",$0.00,1,1,1,1,1,1,20120101,L0640,HCPCS,LSO S/C SHELL/PANEL CUSTOM,,,28 ,,NW,,,,,,"$1,490.19",$0.00,1,1,1,1,1,1,20120101,L0700,HCPCS,CTLSO A-P-L CONTROL MOLDED,,,28 ,,NW,,,,,,"$3,062.41",$0.00,1,1,1,1,1,1,20120101,L0710,HCPCS,CTLSO A-P-L CONTROL W/ INTER,,,28 ,,NW,,,,,,"$3,243.88",$0.00,1,1,1,1,1,1,20120101,L0810,HCPCS,HALO CERVICAL INTO JCKT VEST,,,28 ,,NW,,,,,,"$3,912.28",$0.00,1,1,1,1,1,1,20120101,L0820,HCPCS,HALO CERVICAL INTO BODY JACK,,,28 ,,NW,,,,,,"$3,215.70",$0.00,1,1,1,1,1,1,20120101,L0830,HCPCS,HALO CERV INTO MILWAUKEE TYP,,,28 ,,NW,,,,,,"$4,791.47",$0.00,1,1,1,1,1,1,20120101,L0859,HCPCS,MRI COMPATIBLE SYSTEM,,,28 ,,NW,,,,,,"$1,752.13",$0.00,1,1,1,1,1,1,20120101,L0861,HCPCS,HALO REPL LINER/INTERFACE,,,28 ,,NW,,,,,,$279.56,$0.00,1,1,1,1,1,1,20120101,L0970,HCPCS,TLSO CORSET FRONT,,,28 ,,NW,,,,,,$155.77,$0.00,1,1,1,1,1,1,20120101,L0972,HCPCS,LSO CORSET FRONT,,,28 ,,NW,,,,,,$144.00,$0.00,1,1,1,1,1,1,20120101,L0974,HCPCS,TLSO FULL CORSET,,,28 ,,NW,,,,,,$249.17,$0.00,1,1,1,1,1,1,20120101,L0976,HCPCS,LSO FULL CORSET,,,28 ,,NW,,,,,,$216.01,$0.00,1,1,1,1,1,1,20120101,L0978,HCPCS,AXILLARY CRUTCH EXTENSION,,,28 ,,NW,,,,,,$257.96,$0.00,1,1,1,1,1,1,20120101,L0980,HCPCS,PERONEAL STRAPS PAIR,,,28 ,,NW,,,,,,$25.09,$0.00,1,1,1,1,1,1,20120101,L0982,HCPCS,STOCKING SUPP GRIPS SET OF F,,,28 ,,NW,,,,,,$23.86,$0.00,1,1,1,1,1,1,20120101,L0984,HCPCS,PROTECTIVE BODY SOCK EACH,,,28 ,,NW,,,,,,$81.73,$0.00,1,1,1,1,1,1,20120101,L0999,HCPCS,ADD TO SPINAL ORTHOSIS NOS,,,28 ,,NW,,,,,,$125.78,$0.00,1,1,1,1,1,1,20120101,L1000,HCPCS,CTLSO MILWAUKE INITIAL MODEL,,,28 ,,NW,,,,,,"$3,054.47",$0.00,1,1,1,1,1,1,20120101,L1001,HCPCS,CTLSO INFANT IMMOBILIZER,,,28 ,,NW,,,,,,$59.28,$0.00,1,1,1,1,1,1,20120101,L1005,HCPCS,TENSION BASED SCOLIOSIS ORTH,,,28 ,,NW,,,,,,"$4,629.10",$0.00,1,1,1,1,1,1,20120101,L1010,HCPCS,CTLSO AXILLA SLING,,,28 ,,NW,,,,,,$94.99,$0.00,1,1,1,1,1,1,20120101,L1020,HCPCS,KYPHOSIS PAD,,,28 ,,NW,,,,,,$127.58,$0.00,1,1,1,1,1,1,20120101,L1025,HCPCS,KYPHOSIS PAD FLOATING,,,28 ,,NW,,,,,,$176.47,$0.00,1,1,1,1,1,1,20120101,L1030,HCPCS,LUMBAR BOLSTER PAD,,,28 ,,NW,,,,,,$91.27,$0.00,1,1,1,1,1,1,20120101,L1040,HCPCS,LUMBAR OR LUMBAR RIB PAD,,,28 ,,NW,,,,,,$113.11,$0.00,1,1,1,1,1,1,20120101,L1050,HCPCS,STERNAL PAD,,,28 ,,NW,,,,,,$119.94,$0.00,1,1,1,1,1,1,20120101,L1060,HCPCS,THORACIC PAD,,,28 ,,NW,,,,,,$133.48,$0.00,1,1,1,1,1,1,20120101,L1070,HCPCS,TRAPEZIUS SLING,,,28 ,,NW,,,,,,$130.26,$0.00,1,1,1,1,1,1,20120101,L1080,HCPCS,OUTRIGGER,,,28 ,,NW,,,,,,$76.59,$0.00,1,1,1,1,1,1,20120101,L1085,HCPCS,OUTRIGGER BIL W/ VERT EXTENS,,,28 ,,NW,,,,,,$219.88,$0.00,1,1,1,1,1,1,20120101,L1090,HCPCS,LUMBAR SLING,,,28 ,,NW,,,,,,$127.78,$0.00,1,1,1,1,1,1,20120101,L1100,HCPCS,RING FLANGE PLASTIC/LEATHER,,,28 ,,NW,,,,,,$223.21,$0.00,1,1,1,1,1,1,20120101,L1110,HCPCS,RING FLANGE PLAS/LEATHER MOL,,,28 ,,NW,,,,,,$370.94,$0.00,1,1,1,1,1,1,20120101,L1120,HCPCS,COVERS FOR UPRIGHT EACH,,,28 ,,NW,,,,,,$55.77,$0.00,1,1,1,1,1,1,20120101,L1200,HCPCS,FURNSH INITIAL ORTHOSIS ONLY,,,28 ,,NW,,,,,,"$2,484.80",$0.00,1,1,1,1,1,1,20120101,L1210,HCPCS,LATERAL THORACIC EXTENSION,,,28 ,,NW,,,,,,$360.19,$0.00,1,1,1,1,1,1,20120101,L1220,HCPCS,ANTERIOR THORACIC EXTENSION,,,28 ,,NW,,,,,,$316.68,$0.00,1,1,1,1,1,1,20120101,L1230,HCPCS,MILWAUKEE TYPE SUPERSTRUCTUR,,,28 ,,NW,,,,,,$833.51,$0.00,1,1,1,1,1,1,20120101,L1240,HCPCS,LUMBAR DEROTATION PAD,,,28 ,,NW,,,,,,$111.78,$0.00,1,1,1,1,1,1,20120101,L1250,HCPCS,ANTERIOR ASIS PAD,,,28 ,,NW,,,,,,$102.72,$0.00,1,1,1,1,1,1,20120101,L1260,HCPCS,ANTERIOR THORACIC DEROTATION,,,28 ,,NW,,,,,,$109.37,$0.00,1,1,1,1,1,1,20120101,L1270,HCPCS,ABDOMINAL PAD,,,28 ,,NW,,,,,,$109.58,$0.00,1,1,1,1,1,1,20120101,L1280,HCPCS,RIB GUSSET (ELASTIC) EACH,,,28 ,,NW,,,,,,$117.73,$0.00,1,1,1,1,1,1,20120101,L1290,HCPCS,LATERAL TROCHANTERIC PAD,,,28 ,,NW,,,,,,$108.85,$0.00,1,1,1,1,1,1,20120101,L1300,HCPCS,BODY JACKET MOLD TO PATIENT,,,28 ,,NW,,,,,,"$2,599.44",$0.00,1,1,1,1,1,1,20120101,L1310,HCPCS,POST-OPERATIVE BODY JACKET,,,28 ,,NW,,,,,,"$2,624.91",$0.00,1,1,1,1,1,1,20120101,L1499,HCPCS,SPINAL ORTHOSIS NOS,,,28 ,,NW,,,,,,"$2,679.07",$0.00,1,1,1,1,1,1,20120101,L1600,HCPCS,ABDUCT HIP FLEX FREJKA W CVR,,,28 ,,NW,,,,,,$173.23,$0.00,1,1,1,1,1,1,20120101,L1610,HCPCS,ABDUCT HIP FLEX FREJKA COVR,,,28 ,,NW,,,,,,$63.45,$0.00,1,1,1,1,1,1,20120101,L1620,HCPCS,ABDUCT HIP FLEX PAVLIK HARNE,,,28 ,,NW,,,,,,$185.15,$0.00,1,1,1,1,1,1,20120101,L1630,HCPCS,ABDUCT CONTROL HIP SEMI-FLEX,,,28 ,,NW,,,,,,$225.29,$0.00,1,1,1,1,1,1,20120101,L1640,HCPCS,PELV BAND/SPREAD BAR THIGH C,,,28 ,,NW,,,,,,$658.16,$0.00,1,1,1,1,1,1,20120101,L1650,HCPCS,HO ABDUCTION HIP ADJUSTABLE,,,28 ,,NW,,,,,,$316.25,$0.00,1,1,1,1,1,1,20120101,L1652,HCPCS,HO BI THIGHCUFFS W SPRDR BAR,,,28 ,,NW,,,,,,$484.91,$0.00,1,1,1,1,1,1,20120101,L1660,HCPCS,HO ABDUCTION STATIC PLASTIC,,,28 ,,NW,,,,,,$223.14,$0.00,1,1,1,1,1,1,20120101,L1680,HCPCS,PELVIC & HIP CONTROL THIGH C,,,28 ,,NW,,,,,,"$1,864.84",$0.00,1,1,1,1,1,1,20120101,L1685,HCPCS,POST-OP HIP ABDUCT CUSTOM FA,,,28 ,,NW,,,,,,"$1,805.59",$0.00,1,1,1,1,1,1,20120101,L1686,HCPCS,HO POST-OP HIP ABDUCTION,,,28 ,,NW,,,,,,"$1,414.15",$0.00,1,1,1,1,1,1,20120101,L1690,HCPCS,COMBINATION BILATERAL HO,,,28 ,,NW,,,,,,"$2,783.13",$0.00,1,1,1,1,1,1,20120101,L1700,HCPCS,LEG PERTHES ORTH TORONTO TYP,,,28 ,,NW,,,,,,"$2,343.33",$0.00,1,1,1,1,1,1,20120101,L1710,HCPCS,LEGG PERTHES ORTH NEWINGTON,,,28 ,,NW,,,,,,"$2,823.51",$0.00,1,1,1,1,1,1,20120101,L1720,HCPCS,LEGG PERTHES ORTHOSIS TRILAT,,,28 ,,NW,,,,,,"$2,065.98",$0.00,1,1,1,1,1,1,20120101,L1730,HCPCS,LEGG PERTHES ORTH SCOTTISH R,,,28 ,,NW,,,,,,"$1,716.15",$0.00,1,1,1,1,1,1,20120101,L1755,HCPCS,LEGG PERTHES PATTEN BOTTOM T,,,28 ,,NW,,,,,,"$2,422.69",$0.00,1,1,1,1,1,1,20120101,L1810,HCPCS,KO ELASTIC WITH JOINTS,,,28 ,,NW,,,,,,$139.57,$0.00,1,1,1,1,1,1,20120101,L1820,HCPCS,KO ELAS W/ CONDYLE PADS & JO,,,28 ,,NW,,,,,,$177.09,$0.00,1,1,1,1,1,1,20120101,L1830,HCPCS,KO IMMOBILIZER CANVAS LONGIT,,,28 ,,NW,,,,,,$122.36,$0.00,1,1,1,1,1,1,20120101,L1831,HCPCS,KNEE ORTH POS LOCKING JOINT,,,28 ,,NW,,,,,,$394.35,$0.00,1,1,1,1,1,1,20120101,L1832,HCPCS,KO ADJ JNT POS RIGID SUPPORT,,,28 ,,NW,,,,,,$962.13,$0.00,1,1,1,1,1,1,20120101,L1834,HCPCS,KO W/0 JOINT RIGID MOLDED TO,,,28 ,,NW,,,,,,"$1,160.25",$0.00,1,1,1,1,1,1,20120101,L1836,HCPCS,RIGID KO WO JOINTS,,,28 ,,NW,,,,,,$171.81,$0.00,1,1,1,1,1,1,20120101,L1840,HCPCS,KO DEROT ANT CRUCIATE CUSTOM,,,28 ,,NW,,,,,,"$1,418.30",$0.00,1,1,1,1,1,1,20120101,L1843,HCPCS,KO SINGLE UPRIGHT CUSTOM FIT,,,28 ,,NW,,,,,,"$1,272.89",$0.00,1,1,1,1,1,1,20120101,L1844,HCPCS,KO W/ADJ JT ROT CNTRL MOLDED,,,28 ,,NW,,,,,,"$2,390.10",$0.00,1,1,1,1,1,1,20120101,L1845,HCPCS,KO W/ ADJ FLEX/EXT ROTAT CUS,,,28 ,,NW,,,,,,"$1,231.52",$0.00,1,1,1,1,1,1,20120101,L1846,HCPCS,KO W ADJ FLEX/EXT ROTAT MOLD,,,28 ,,NW,,,,,,"$1,728.14",$0.00,1,1,1,1,1,1,20120101,L1847,HCPCS,KO ADJUSTABLE W AIR CHAMBERS,,,28 ,,NW,,,,,,$803.58,$0.00,1,1,1,1,1,1,20120101,L1850,HCPCS,KO SWEDISH TYPE,,,28 ,,NW,,,,,,$409.04,$0.00,1,1,1,1,1,1,20120101,L1860,HCPCS,KO SUPRACONDYLAR SOCKET MOLD,,,28 ,,NW,,,,,,"$1,662.04",$0.00,1,1,1,1,1,1,20120101,L1900,HCPCS,AFO SPRNG WIR DRSFLX CALF BD,,,28 ,,NW,,,,,,$380.41,$0.00,1,1,1,1,1,1,20120101,L1902,HCPCS,AFO ANKLE GAUNTLET,,,28 ,,NW,,,,,,$110.66,$0.00,1,1,1,1,1,1,20120101,L1904,HCPCS,AFO MOLDED ANKLE GAUNTLET,,,28 ,,NW,,,,,,$675.55,$0.00,1,1,1,1,1,1,20120101,L1906,HCPCS,AFO MULTILIGAMENTUS ANKLE SU,,,28 ,,NW,,,,,,$161.57,$0.00,1,1,1,1,1,1,20120101,L1907,HCPCS,AFO SUPRAMALLEOLAR CUSTOM,,,28 ,,NW,,,,,,$785.39,$0.00,1,1,1,1,1,1,20120101,L1910,HCPCS,AFO SING BAR CLASP ATTACH SH,,,28 ,,NW,,,,,,$383.10,$0.00,1,1,1,1,1,1,20120101,L1920,HCPCS,AFO SING UPRIGHT W/ ADJUST S,,,28 ,,NW,,,,,,$492.25,$0.00,1,1,1,1,1,1,20120101,L1930,HCPCS,AFO PLASTIC,,,28 ,,NW,,,,,,$337.65,$0.00,1,1,1,1,1,1,20120101,L1932,HCPCS,AFO RIG ANT TIB PREFAB TCF/=,,,28 ,,NW,,,,,,"$1,265.74",$0.00,1,1,1,1,1,1,20120101,L1940,HCPCS,AFO MOLDED TO PATIENT PLASTI,,,28 ,,NW,,,,,,$733.43,$0.00,1,1,1,1,1,1,20120101,L1945,HCPCS,AFO MOLDED PLAS RIG ANT TIB,,,28 ,,NW,,,,,,"$1,447.78",$0.00,1,1,1,1,1,1,20120101,L1950,HCPCS,AFO SPIRAL MOLDED TO PT PLAS,,,28 ,,NW,,,,,,"$1,132.45",$0.00,1,1,1,1,1,1,20120101,L1951,HCPCS,AFO SPIRAL PREFABRICATED,,,28 ,,NW,,,,,,"$1,189.21",$0.00,1,1,1,1,1,1,20120101,L1960,HCPCS,AFO POS SOLID ANK PLASTIC MO,,,28 ,,NW,,,,,,$834.91,$0.00,1,1,1,1,1,1,20120101,L1970,HCPCS,AFO PLASTIC MOLDED W/ANKLE J,,,28 ,,NW,,,,,,"$1,048.94",$0.00,1,1,1,1,1,1,20120101,L1971,HCPCS,"AFO W/ANKLE JOINT, PREFAB",,,28 ,,NW,,,,,,$648.48,$0.00,1,1,1,1,1,1,20120101,L1980,HCPCS,AFO SING SOLID STIRRUP CALF,,,28 ,,NW,,,,,,$538.62,$0.00,1,1,1,1,1,1,20120101,L1990,HCPCS,AFO DOUB SOLID STIRRUP CALF,,,28 ,,NW,,,,,,$661.60,$0.00,1,1,1,1,1,1,20120101,L2000,HCPCS,KAFO SING FRE STIRR THI/CALF,,,28 ,,NW,,,,,,"$1,535.29",$0.00,1,1,1,1,1,1,20120101,L2005,HCPCS,KAFO SNG/DBL MECHANICAL ACT,,,28 ,,NW,,,,,,"$5,936.64",$0.00,1,1,1,1,1,1,20120101,L2010,HCPCS,KAFO SNG SOLID STIRRUP W/O J,,,28 ,,NW,,,,,,"$1,402.33",$0.00,1,1,1,1,1,1,20120101,L2020,HCPCS,KAFO DBL SOLID STIRRUP BAND/,,,28 ,,NW,,,,,,"$1,733.21",$0.00,1,1,1,1,1,1,20120101,L2030,HCPCS,KAFO DBL SOLID STIRRUP W/O J,,,28 ,,NW,,,,,,"$1,556.62",$0.00,1,1,1,1,1,1,20120101,L2034,HCPCS,KAFO PLA SIN UP W/WO K/A CUS,,,28 ,,NW,,,,,,"$2,949.55",$0.00,1,1,1,1,1,1,20120101,L2035,HCPCS,KAFO PLASTIC PEDIATRIC SIZE,,,28 ,,NW,,,,,,$223.57,$0.00,1,1,1,1,1,1,20120101,L2036,HCPCS,KAFO PLAS DOUB FREE KNEE MOL,,,28 ,,NW,,,,,,"$2,807.45",$0.00,1,1,1,1,1,1,20120101,L2037,HCPCS,KAFO PLAS SING FREE KNEE MOL,,,28 ,,NW,,,,,,"$2,551.99",$0.00,1,1,1,1,1,1,20120101,L2038,HCPCS,KAFO W/O JOINT MULTI-AXIS AN,,,28 ,,NW,,,,,,"$2,127.17",$0.00,1,1,1,1,1,1,20120101,L2040,HCPCS,HKAFO TORSION BIL ROT STRAPS,,,28 ,,NW,,,,,,$236.49,$0.00,1,1,1,1,1,1,20120101,L2050,HCPCS,HKAFO TORSION CABLE HIP PELV,,,28 ,,NW,,,,,,$700.11,$0.00,1,1,1,1,1,1,20120101,L2060,HCPCS,HKAFO TORSION BALL BEARING J,,,28 ,,NW,,,,,,$865.43,$0.00,1,1,1,1,1,1,20120101,L2070,HCPCS,HKAFO TORSION UNILAT ROT STR,,,28 ,,NW,,,,,,$186.40,$0.00,1,1,1,1,1,1,20120101,L2080,HCPCS,HKAFO UNILAT TORSION CABLE,,,28 ,,NW,,,,,,$521.90,$0.00,1,1,1,1,1,1,20120101,L2090,HCPCS,HKAFO UNILAT TORSION BALL BR,,,28 ,,NW,,,,,,$651.66,$0.00,1,1,1,1,1,1,20120101,L2106,HCPCS,AFO TIB FX CAST PLASTER MOLD,,,28 ,,NW,,,,,,"$1,058.22",$0.00,1,1,1,1,1,1,20120101,L2108,HCPCS,AFO TIB FX CAST MOLDED TO PT,,,28 ,,NW,,,,,,"$1,621.69",$0.00,1,1,1,1,1,1,20120101,L2112,HCPCS,AFO TIBIAL FRACTURE SOFT,,,28 ,,NW,,,,,,$709.07,$0.00,1,1,1,1,1,1,20120101,L2114,HCPCS,AFO TIB FX SEMI-RIGID,,,28 ,,NW,,,,,,$890.38,$0.00,1,1,1,1,1,1,20120101,L2116,HCPCS,AFO TIBIAL FRACTURE RIGID,,,28 ,,NW,,,,,,"$1,092.03",$0.00,1,1,1,1,1,1,20120101,L2126,HCPCS,KAFO FEM FX CAST THERMOPLAS,,,28 ,,NW,,,,,,"$1,822.39",$0.00,1,1,1,1,1,1,20120101,L2128,HCPCS,KAFO FEM FX CAST MOLDED TO P,,,28 ,,NW,,,,,,"$2,552.11",$0.00,1,1,1,1,1,1,20120101,L2132,HCPCS,KAFO FEMORAL FX CAST SOFT,,,28 ,,NW,,,,,,"$1,227.19",$0.00,1,1,1,1,1,1,20120101,L2134,HCPCS,KAFO FEM FX CAST SEMI-RIGID,,,28 ,,NW,,,,,,"$1,530.62",$0.00,1,1,1,1,1,1,20120101,L2136,HCPCS,KAFO FEMORAL FX CAST RIGID,,,28 ,,NW,,,,,,"$1,818.92",$0.00,1,1,1,1,1,1,20120101,L2180,HCPCS,PLAS SHOE INSERT W ANK JOINT,,,28 ,,NW,,,,,,$164.21,$0.00,1,1,1,1,1,1,20120101,L2182,HCPCS,DROP LOCK KNEE,,,28 ,,NW,,,,,,$129.26,$0.00,1,1,1,1,1,1,20120101,L2184,HCPCS,LIMITED MOTION KNEE JOINT,,,28 ,,NW,,,,,,$165.86,$0.00,1,1,1,1,1,1,20120101,L2186,HCPCS,ADJ MOTION KNEE JNT LERMAN T,,,28 ,,NW,,,,,,$201.98,$0.00,1,1,1,1,1,1,20120101,L2188,HCPCS,QUADRILATERAL BRIM,,,28 ,,NW,,,,,,$437.27,$0.00,1,1,1,1,1,1,20120101,L2190,HCPCS,WAIST BELT,,,28 ,,NW,,,,,,$116.64,$0.00,1,1,1,1,1,1,20120101,L2192,HCPCS,PELVIC BAND & BELT THIGH FLA,,,28 ,,NW,,,,,,$519.61,$0.00,1,1,1,1,1,1,20120101,L2200,HCPCS,LIMITED ANKLE MOTION EA JNT,,,28 ,,NW,,,,,,$67.79,$0.00,1,1,1,1,1,1,20120101,L2210,HCPCS,DORSIFLEXION ASSIST EACH JOI,,,28 ,,NW,,,,,,$91.73,$0.00,1,1,1,1,1,1,20120101,L2220,HCPCS,DORSI & PLANTAR FLEX ASS/RES,,,28 ,,NW,,,,,,$112.43,$0.00,1,1,1,1,1,1,20120101,L2230,HCPCS,SPLIT FLAT CALIPER STIRR & P,,,28 ,,NW,,,,,,$106.85,$0.00,1,1,1,1,1,1,20120101,L2232,HCPCS,"ROCKER BOTTOM, CONTACT AFO",,,28 ,,NW,,,,,,$126.72,$0.00,1,1,1,1,1,1,20120101,L2240,HCPCS,ROUND CALIPER AND PLATE ATTA,,,28 ,,NW,,,,,,$114.81,$0.00,1,1,1,1,1,1,20120101,L2250,HCPCS,FOOT PLATE MOLDED STIRRUP AT,,,28 ,,NW,,,,,,$500.83,$0.00,1,1,1,1,1,1,20120101,L2260,HCPCS,REINFORCED SOLID STIRRUP,,,28 ,,NW,,,,,,$270.82,$0.00,1,1,1,1,1,1,20120101,L2265,HCPCS,LONG TONGUE STIRRUP,,,28 ,,NW,,,,,,$165.54,$0.00,1,1,1,1,1,1,20120101,L2270,HCPCS,VARUS/VALGUS STRAP PADDED/LI,,,28 ,,NW,,,,,,$74.69,$0.00,1,1,1,1,1,1,20120101,L2275,HCPCS,PLASTIC MOD LOW EXT PAD/LINE,,,28 ,,NW,,,,,,$168.81,$0.00,1,1,1,1,1,1,20120101,L2280,HCPCS,MOLDED INNER BOOT,,,28 ,,NW,,,,,,$678.81,$0.00,1,1,1,1,1,1,20120101,L2300,HCPCS,ABDUCTION BAR JOINTED ADJUST,,,28 ,,NW,,,,,,$391.19,$0.00,1,1,1,1,1,1,20120101,L2310,HCPCS,ABDUCTION BAR-STRAIGHT,,,28 ,,NW,,,,,,$169.25,$0.00,1,1,1,1,1,1,20120101,L2320,HCPCS,NON-MOLDED LACER,,,28 ,,NW,,,,,,$281.50,$0.00,1,1,1,1,1,1,20120101,L2330,HCPCS,LACER MOLDED TO PATIENT MODE,,,28 ,,NW,,,,,,$572.15,$0.00,1,1,1,1,1,1,20120101,L2335,HCPCS,ANTERIOR SWING BAND,,,28 ,,NW,,,,,,$329.65,$0.00,1,1,1,1,1,1,20120101,L2340,HCPCS,PRE-TIBIAL SHELL MOLDED TO P,,,28 ,,NW,,,,,,$684.87,$0.00,1,1,1,1,1,1,20120101,L2350,HCPCS,PROSTHETIC TYPE SOCKET MOLDE,,,28 ,,NW,,,,,,"$1,343.61",$0.00,1,1,1,1,1,1,20120101,L2360,HCPCS,EXTENDED STEEL SHANK,,,28 ,,NW,,,,,,$73.78,$0.00,1,1,1,1,1,1,20120101,L2370,HCPCS,PATTEN BOTTOM,,,28 ,,NW,,,,,,$393.35,$0.00,1,1,1,1,1,1,20120101,L2375,HCPCS,TORSION ANK & HALF SOLID STI,,,28 ,,NW,,,,,,$158.68,$0.00,1,1,1,1,1,1,20120101,L2380,HCPCS,TORSION STRAIGHT KNEE JOINT,,,28 ,,NW,,,,,,$170.30,$0.00,1,1,1,1,1,1,20120101,L2385,HCPCS,STRAIGHT KNEE JOINT HEAVY DU,,,28 ,,NW,,,,,,$186.05,$0.00,1,1,1,1,1,1,20120101,L2387,HCPCS,ADD LE POLY KNEE CUSTOM KAFO,,,28 ,,NW,,,,,,$231.23,$0.00,1,1,1,1,1,1,20120101,L2390,HCPCS,OFFSET KNEE JOINT EACH,,,28 ,,NW,,,,,,$145.54,$0.00,1,1,1,1,1,1,20120101,L2395,HCPCS,OFFSET KNEE JOINT HEAVY DUTY,,,28 ,,NW,,,,,,$211.39,$0.00,1,1,1,1,1,1,20120101,L2397,HCPCS,SUSPENSION SLEEVE LOWER EXT,,,28 ,,NW,,,,,,$151.36,$0.00,1,1,1,1,1,1,20120101,L2405,HCPCS,KNEE JOINT DROP LOCK EA JNT,,,28 ,,NW,,,,,,$113.01,$0.00,1,1,1,1,1,1,20120101,L2415,HCPCS,KNEE JOINT CAM LOCK EACH JOI,,,28 ,,NW,,,,,,$156.61,$0.00,1,1,1,1,1,1,20120101,L2425,HCPCS,KNEE DISC/DIAL LOCK/ADJ FLEX,,,28 ,,NW,,,,,,$184.42,$0.00,1,1,1,1,1,1,20120101,L2430,HCPCS,KNEE JNT RATCHET LOCK EA JNT,,,28 ,,NW,,,,,,$184.42,$0.00,1,1,1,1,1,1,20120101,L2492,HCPCS,KNEE LIFT LOOP DROP LOCK RIN,,,28 ,,NW,,,,,,$141.85,$0.00,1,1,1,1,1,1,20120101,L2500,HCPCS,THI/GLUT/ISCHIA WGT BEARING,,,28 ,,NW,,,,,,$445.51,$0.00,1,1,1,1,1,1,20120101,L2510,HCPCS,TH/WGHT BEAR QUAD-LAT BRIM M,,,28 ,,NW,,,,,,"$1,129.22",$0.00,1,1,1,1,1,1,20120101,L2520,HCPCS,TH/WGHT BEAR QUAD-LAT BRIM C,,,28 ,,NW,,,,,,$698.85,$0.00,1,1,1,1,1,1,20120101,L2525,HCPCS,TH/WGHT BEAR NAR M-L BRIM MO,,,28 ,,NW,,,,,,"$1,881.76",$0.00,1,1,1,1,1,1,20120101,L2526,HCPCS,TH/WGHT BEAR NAR M-L BRIM CU,,,28 ,,NW,,,,,,"$1,029.00",$0.00,1,1,1,1,1,1,20120101,L2530,HCPCS,THIGH/WGHT BEAR LACER NON-MO,,,28 ,,NW,,,,,,$329.34,$0.00,1,1,1,1,1,1,20120101,L2540,HCPCS,THIGH/WGHT BEAR LACER MOLDED,,,28 ,,NW,,,,,,$617.65,$0.00,1,1,1,1,1,1,20120101,L2550,HCPCS,THIGH/WGHT BEAR HIGH ROLL CU,,,28 ,,NW,,,,,,$414.48,$0.00,1,1,1,1,1,1,20120101,L2570,HCPCS,HIP CLEVIS TYPE 2 POSIT JNT,,,28 ,,NW,,,,,,$732.64,$0.00,1,1,1,1,1,1,20120101,L2580,HCPCS,PELVIC CONTROL PELVIC SLING,,,28 ,,NW,,,,,,$698.94,$0.00,1,1,1,1,1,1,20120101,L2600,HCPCS,HIP CLEVIS/THRUST BEARING FR,,,28 ,,NW,,,,,,$290.33,$0.00,1,1,1,1,1,1,20120101,L2610,HCPCS,HIP CLEVIS/THRUST BEARING LO,,,28 ,,NW,,,,,,$346.05,$0.00,1,1,1,1,1,1,20120101,L2620,HCPCS,PELVIC CONTROL HIP HEAVY DUT,,,28 ,,NW,,,,,,$389.92,$0.00,1,1,1,1,1,1,20120101,L2622,HCPCS,HIP JOINT ADJUSTABLE FLEXION,,,28 ,,NW,,,,,,$448.69,$0.00,1,1,1,1,1,1,20120101,L2624,HCPCS,HIP ADJ FLEX EXT ABDUCT CONT,,,28 ,,NW,,,,,,$501.47,$0.00,1,1,1,1,1,1,20120101,L2627,HCPCS,PLASTIC MOLD RECIPRO HIP & C,,,28 ,,NW,,,,,,"$2,576.85",$0.00,1,1,1,1,1,1,20120101,L2628,HCPCS,METAL FRAME RECIPRO HIP & CA,,,28 ,,NW,,,,,,"$2,508.20",$0.00,1,1,1,1,1,1,20120101,L2630,HCPCS,PELVIC CONTROL BAND & BELT U,,,28 ,,NW,,,,,,$347.61,$0.00,1,1,1,1,1,1,20120101,L2640,HCPCS,PELVIC CONTROL BAND & BELT B,,,28 ,,NW,,,,,,$488.51,$0.00,1,1,1,1,1,1,20120101,L2650,HCPCS,PELV & THOR CONTROL GLUTEAL,,,28 ,,NW,,,,,,$164.54,$0.00,1,1,1,1,1,1,20120101,L2660,HCPCS,THORACIC CONTROL THORACIC BA,,,28 ,,NW,,,,,,$250.61,$0.00,1,1,1,1,1,1,20120101,L2670,HCPCS,THORAC CONT PARASPINAL UPRIG,,,28 ,,NW,,,,,,$230.07,$0.00,1,1,1,1,1,1,20120101,L2680,HCPCS,THORAC CONT LAT SUPPORT UPRI,,,28 ,,NW,,,,,,$212.67,$0.00,1,1,1,1,1,1,20120101,L2750,HCPCS,PLATING CHROME/NICKEL PR BAR,,,28 ,,NW,,,,,,$110.57,$0.00,1,1,1,1,1,1,20120101,L2755,HCPCS,CARBON GRAPHITE LAMINATION,,,28 ,,NW,,,,,,$168.36,$0.00,1,1,1,1,1,1,20120101,L2760,HCPCS,EXTENSION PER EXTENSION PER,,,28 ,,NW,,,,,,$84.77,$0.00,1,1,1,1,1,1,20120101,L2768,HCPCS,ORTHO SIDEBAR DISCONNECT,,,28 ,,NW,,,,,,$167.83,$0.00,1,1,1,1,1,1,20120101,L2780,HCPCS,NON-CORROSIVE FINISH,,,28 ,,NW,,,,,,$92.61,$0.00,1,1,1,1,1,1,20120101,L2785,HCPCS,DROP LOCK RETAINER EACH,,,28 ,,NW,,,,,,$45.83,$0.00,1,1,1,1,1,1,20120101,L2795,HCPCS,KNEE CONTROL FULL KNEECAP,,,28 ,,NW,,,,,,$116.13,$0.00,1,1,1,1,1,1,20120101,L2800,HCPCS,KNEE CAP MEDIAL OR LATERAL P,,,28 ,,NW,,,,,,$143.62,$0.00,1,1,1,1,1,1,20120101,L2810,HCPCS,KNEE CONTROL CONDYLAR PAD,,,28 ,,NW,,,,,,$108.84,$0.00,1,1,1,1,1,1,20120101,L2820,HCPCS,SOFT INTERFACE BELOW KNEE SE,,,28 ,,NW,,,,,,$116.96,$0.00,1,1,1,1,1,1,20120101,L2830,HCPCS,SOFT INTERFACE ABOVE KNEE SE,,,28 ,,NW,,,,,,$127.69,$0.00,1,1,1,1,1,1,20120101,L2840,HCPCS,TIBIAL LENGTH SOCK FX OR EQU,,,28 ,,NW,,,,,,$62.02,$0.00,1,1,1,1,1,1,20120101,L2850,HCPCS,FEMORAL LGTH SOCK FX OR EQUA,,,28 ,,NW,,,,,,$83.48,$0.00,1,1,1,1,1,1,20120101,L2861,HCPCS,TORSION MECHANISM KNEE/ANKLE,,,28 ,,NW,,,,,,$493.45,$0.00,1,1,1,1,1,1,20120101,L2999,HCPCS,LOWER EXTREMITY ORTHOSIS NOS,,,28 ,,NW,,,,,,$151.36,$0.00,1,1,1,1,1,1,20120101,L3000,HCPCS,FT INSERT UCB BERKELEY SHELL,,,28 ,,NW,,,,,,$423.22,$0.00,1,1,1,1,1,1,20120101,L3001,HCPCS,FOOT INSERT REMOV MOLDED SPE,,,28 ,,NW,,,,,,$170.33,$0.00,1,1,1,1,1,1,20120101,L3002,HCPCS,FOOT INSERT PLASTAZOTE OR EQ,,,28 ,,NW,,,,,,$207.52,$0.00,1,1,1,1,1,1,20120101,L3003,HCPCS,FOOT INSERT SILICONE GEL EAC,,,28 ,,NW,,,,,,$223.73,$0.00,1,1,1,1,1,1,20120101,L3010,HCPCS,FOOT LONGITUDINAL ARCH SUPPO,,,28 ,,NW,,,,,,$223.73,$0.00,1,1,1,1,1,1,20120101,L3020,HCPCS,FOOT LONGITUD/METATARSAL SUP,,,28 ,,NW,,,,,,$254.60,$0.00,1,1,1,1,1,1,20120101,L3030,HCPCS,FOOT ARCH SUPPORT REMOV PREM,,,28 ,,NW,,,,,,$99.17,$0.00,1,1,1,1,1,1,20120101,L3031,HCPCS,FOOT LAMIN/PREPREG COMPOSITE,,,28 ,,NW,,,,,,$144.98,$0.00,1,1,1,1,1,1,20120101,L3040,HCPCS,FT ARCH SUPRT PREMOLD LONGIT,,,28 ,,NW,,,,,,$61.97,$0.00,1,1,1,1,1,1,20120101,L3050,HCPCS,FOOT ARCH SUPP PREMOLD METAT,,,28 ,,NW,,,,,,$61.97,$0.00,1,1,1,1,1,1,20120101,L3060,HCPCS,FOOT ARCH SUPP LONGITUD/META,,,28 ,,NW,,,,,,$95.93,$0.00,1,1,1,1,1,1,20120101,L3070,HCPCS,ARCH SUPRT ATT TO SHO LONGIT,,,28 ,,NW,,,,,,$42.54,$0.00,1,1,1,1,1,1,20120101,L3080,HCPCS,ARCH SUPP ATT TO SHOE METATA,,,28 ,,NW,,,,,,$42.54,$0.00,1,1,1,1,1,1,20120101,L3090,HCPCS,ARCH SUPP ATT TO SHOE LONG/M,,,28 ,,NW,,,,,,$53.90,$0.00,1,1,1,1,1,1,20120101,L3100,HCPCS,HALLUS-VALGUS NGHT DYNAMIC S,,,28 ,,NW,,,,,,$57.11,$0.00,1,1,1,1,1,1,20120101,L3140,HCPCS,ABDUCTION ROTATION BAR SHOE,,,28 ,,NW,,,,,,$115.36,$0.00,1,1,1,1,1,1,20120101,L3150,HCPCS,ABDUCT ROTATION BAR W/O SHOE,,,28 ,,NW,,,,,,$105.65,$0.00,1,1,1,1,1,1,20120101,L3160,HCPCS,SHOE STYLED POSITIONING DEV,,,28 ,,NW,,,,,,$25.64,$0.00,1,1,1,1,1,1,20120101,L3170,HCPCS,FOOT PLASTIC HEEL STABILIZER,,,28 ,,NW,,,,,,$66.84,$0.00,1,1,1,1,1,1,20120101,L3201,HCPCS,OXFORD W SUPINAT/PRONAT INF,,,28 ,,NW,,,,,,$91.81,$0.00,1,1,1,1,1,1,20120101,L3202,HCPCS,OXFORD W/ SUPINAT/PRONATOR C,,,28 ,,NW,,,,,,$90.07,$0.00,1,1,1,1,1,1,20120101,L3203,HCPCS,OXFORD W/ SUPINATOR/PRONATOR,,,28 ,,NW,,,,,,$87.46,$0.00,1,1,1,1,1,1,20120101,L3204,HCPCS,HIGHTOP W/ SUPP/PRONATOR INF,,,28 ,,NW,,,,,,$87.46,$0.00,1,1,1,1,1,1,20120101,L3206,HCPCS,HIGHTOP W/ SUPP/PRONATOR CHI,,,28 ,,NW,,,,,,$90.94,$0.00,1,1,1,1,1,1,20120101,L3207,HCPCS,HIGHTOP W/ SUPP/PRONATOR JUN,,,28 ,,NW,,,,,,$92.69,$0.00,1,1,1,1,1,1,20120101,L3208,HCPCS,SURGICAL BOOT EACH INFANT,,,28 ,,NW,,,,,,$50.02,$0.00,1,1,1,1,1,1,20120101,L3209,HCPCS,SURGICAL BOOT EACH CHILD,,,28 ,,NW,,,,,,$69.17,$0.00,1,1,1,1,1,1,20120101,L3211,HCPCS,SURGICAL BOOT EACH JUNIOR,,,28 ,,NW,,,,,,$73.53,$0.00,1,1,1,1,1,1,20120101,L3212,HCPCS,BENESCH BOOT PAIR INFANT,,,28 ,,NW,,,,,,$102.26,$0.00,1,1,1,1,1,1,20120101,L3213,HCPCS,BENESCH BOOT PAIR CHILD,,,28 ,,NW,,,,,,$123.16,$0.00,1,1,1,1,1,1,20120101,L3214,HCPCS,BENESCH BOOT PAIR JUNIOR,,,28 ,,NW,,,,,,$131.00,$0.00,1,1,1,1,1,1,20120101,L3215,HCPCS,ORTHOPEDIC FTWEAR LADIES OXF,,,28 ,,NW,,,,,,$165.83,$0.00,1,1,1,1,1,1,20120101,L3216,HCPCS,ORTHOPED LADIES SHOES DPTH I,,,28 ,,NW,,,,,,$199.79,$0.00,1,1,1,1,1,1,20120101,L3217,HCPCS,LADIES SHOES HIGHTOP DEPTH I,,,28 ,,NW,,,,,,$217.21,$0.00,1,1,1,1,1,1,20120101,L3219,HCPCS,ORTHOPEDIC MENS SHOES OXFORD,,,28 ,,NW,,,,,,$185.86,$0.00,1,1,1,1,1,1,20120101,L3221,HCPCS,ORTHOPEDIC MENS SHOES DPTH I,,,28 ,,NW,,,,,,$222.43,$0.00,1,1,1,1,1,1,20120101,L3222,HCPCS,MENS SHOES HIGHTOP DEPTH INL,,,28 ,,NW,,,,,,$245.94,$0.00,1,1,1,1,1,1,20120101,L3224,HCPCS,WOMAN'S SHOE OXFORD BRACE,,,28 ,,NW,,,,,,$82.64,$0.00,1,1,1,1,1,1,20120101,L3225,HCPCS,MAN'S SHOE OXFORD BRACE,,,28 ,,NW,,,,,,$93.69,$0.00,1,1,1,1,1,1,20120101,L3230,HCPCS,CUSTOM SHOES DEPTH INLAY,,,28 ,,NW,,,,,,$293.73,$0.00,1,1,1,1,1,1,20120101,L3250,HCPCS,CUSTOM MOLD SHOE REMOV PROST,,,28 ,,NW,,,,,,$605.00,$0.00,1,1,1,1,1,1,20120101,L3251,HCPCS,SHOE MOLDED TO PT SILICONE S,,,28 ,,NW,,,,,,$78.75,$0.00,1,1,1,1,1,1,20120101,L3252,HCPCS,SHOE MOLDED PLASTAZOTE CUST,,,28 ,,NW,,,,,,$315.68,$0.00,1,1,1,1,1,1,20120101,L3253,HCPCS,SHOE MOLDED PLASTAZOTE CUST,,,28 ,,NW,,,,,,$78.75,$0.00,1,1,1,1,1,1,20120101,L3254,HCPCS,ORTH FOOT NON-STNDARD SIZE/W,,,28 ,,NW,,,,,,$89.52,$0.00,1,1,1,1,1,1,20120101,L3255,HCPCS,ORTH FOOT NON-STANDARD SIZE/,,,28 ,,NW,,,,,,$381.00,$0.00,1,1,1,1,1,1,20120101,L3257,HCPCS,ORTH FOOT ADD CHARGE SPLIT S,,,28 ,,NW,,,,,,$57.85,$0.00,1,1,1,1,1,1,20120101,L3260,HCPCS,AMBULATORY SURGICAL BOOT EAC,,,28 ,,NW,,,,,,$33.47,$0.00,1,1,1,1,1,1,20120101,L3265,HCPCS,PLASTAZOTE SANDAL EACH,,,28 ,,NW,,,,,,$36.08,$0.00,1,1,1,1,1,1,20120101,L3300,HCPCS,SHO LIFT TAPER TO METATARSAL,,,28 ,,NW,,,,,,$68.43,$0.00,1,1,1,1,1,1,20120101,L3310,HCPCS,SHOE LIFT ELEV HEEL/SOLE NEO,,,28 ,,NW,,,,,,$105.65,$0.00,1,1,1,1,1,1,20120101,L3320,HCPCS,SHOE LIFT ELEV HEEL/SOLE COR,,,28 ,,NW,,,,,,$208.50,$0.00,1,1,1,1,1,1,20120101,L3330,HCPCS,LIFTS ELEVATION METAL EXTENS,,,28 ,,NW,,,,,,$790.13,$0.00,1,1,1,1,1,1,20120101,L3332,HCPCS,SHOE LIFTS TAPERED TO ONE-HA,,,28 ,,NW,,,,,,$95.93,$0.00,1,1,1,1,1,1,20120101,L3334,HCPCS,SHOE LIFTS ELEVATION HEEL /I,,,28 ,,NW,,,,,,$50.65,$0.00,1,1,1,1,1,1,20120101,L3340,HCPCS,SHOE WEDGE SACH,,,28 ,,NW,,,,,,$110.51,$0.00,1,1,1,1,1,1,20120101,L3350,HCPCS,SHOE HEEL WEDGE,,,28 ,,NW,,,,,,$31.23,$0.00,1,1,1,1,1,1,20120101,L3360,HCPCS,SHOE SOLE WEDGE OUTSIDE SOLE,,,28 ,,NW,,,,,,$47.41,$0.00,1,1,1,1,1,1,20120101,L3370,HCPCS,SHOE SOLE WEDGE BETWEEN SOLE,,,28 ,,NW,,,,,,$65.19,$0.00,1,1,1,1,1,1,20120101,L3380,HCPCS,SHOE CLUBFOOT WEDGE,,,28 ,,NW,,,,,,$65.19,$0.00,1,1,1,1,1,1,20120101,L3390,HCPCS,SHOE OUTFLARE WEDGE,,,28 ,,NW,,,,,,$65.19,$0.00,1,1,1,1,1,1,20120101,L3400,HCPCS,SHOE METATARSAL BAR WEDGE RO,,,28 ,,NW,,,,,,$53.90,$0.00,1,1,1,1,1,1,20120101,L3410,HCPCS,SHOE METATARSAL BAR BETWEEN,,,28 ,,NW,,,,,,$120.21,$0.00,1,1,1,1,1,1,20120101,L3420,HCPCS,FULL SOLE/HEEL WEDGE BTWEEN,,,28 ,,NW,,,,,,$71.67,$0.00,1,1,1,1,1,1,20120101,L3430,HCPCS,SHO HEEL COUNT PLAST REINFOR,,,28 ,,NW,,,,,,$205.93,$0.00,1,1,1,1,1,1,20120101,L3440,HCPCS,HEEL LEATHER REINFORCED,,,28 ,,NW,,,,,,$99.17,$0.00,1,1,1,1,1,1,20120101,L3450,HCPCS,SHOE HEEL SACH CUSHION TYPE,,,28 ,,NW,,,,,,$136.36,$0.00,1,1,1,1,1,1,20120101,L3455,HCPCS,SHOE HEEL NEW LEATHER STANDA,,,28 ,,NW,,,,,,$53.90,$0.00,1,1,1,1,1,1,20120101,L3460,HCPCS,SHOE HEEL NEW RUBBER STANDAR,,,28 ,,NW,,,,,,$45.78,$0.00,1,1,1,1,1,1,20120101,L3465,HCPCS,SHOE HEEL THOMAS WITH WEDGE,,,28 ,,NW,,,,,,$76.54,$0.00,1,1,1,1,1,1,20120101,L3470,HCPCS,SHOE HEEL THOMAS EXTEND TO B,,,28 ,,NW,,,,,,$81.37,$0.00,1,1,1,1,1,1,20120101,L3480,HCPCS,SHOE HEEL PAD & DEPRESS FOR,,,28 ,,NW,,,,,,$81.37,$0.00,1,1,1,1,1,1,20120101,L3485,HCPCS,SHOE HEEL PAD REMOVABLE FOR,,,28 ,,NW,,,,,,$33.47,$0.00,1,1,1,1,1,1,20120101,L3500,HCPCS,ORTHO SHOE ADD LEATHER INSOL,,,28 ,,NW,,,,,,$39.33,$0.00,1,1,1,1,1,1,20120101,L3510,HCPCS,ORTHOPEDIC SHOE ADD RUB INSL,,,28 ,,NW,,,,,,$39.33,$0.00,1,1,1,1,1,1,20120101,L3520,HCPCS,O SHOE ADD FELT W LEATH INSL,,,28 ,,NW,,,,,,$42.54,$0.00,1,1,1,1,1,1,20120101,L3530,HCPCS,ORTHO SHOE ADD HALF SOLE,,,28 ,,NW,,,,,,$42.54,$0.00,1,1,1,1,1,1,20120101,L3540,HCPCS,ORTHO SHOE ADD FULL SOLE,,,28 ,,NW,,,,,,$66.84,$0.00,1,1,1,1,1,1,20120101,L3550,HCPCS,O SHOE ADD STANDARD TOE TAP,,,28 ,,NW,,,,,,$13.45,$0.00,1,1,1,1,1,1,20120101,L3560,HCPCS,O SHOE ADD HORSESHOE TOE TAP,,,28 ,,NW,,,,,,$31.23,$0.00,1,1,1,1,1,1,20120101,L3570,HCPCS,O SHOE ADD INSTEP EXTENSION,,,28 ,,NW,,,,,,$110.51,$0.00,1,1,1,1,1,1,20120101,L3580,HCPCS,O SHOE ADD INSTEP VELCRO CLO,,,28 ,,NW,,,,,,$84.61,$0.00,1,1,1,1,1,1,20120101,L3590,HCPCS,O SHOE CONVERT TO SOF COUNTE,,,28 ,,NW,,,,,,$70.05,$0.00,1,1,1,1,1,1,20120101,L3595,HCPCS,ORTHO SHOE ADD MARCH BAR,,,28 ,,NW,,,,,,$55.49,$0.00,1,1,1,1,1,1,20120101,L3600,HCPCS,TRANS SHOE CALIP PLATE EXIST,,,28 ,,NW,,,,,,$99.17,$0.00,1,1,1,1,1,1,20120101,L3610,HCPCS,TRANS SHOE CALIPER PLATE NEW,,,28 ,,NW,,,,,,$129.90,$0.00,1,1,1,1,1,1,20120101,L3620,HCPCS,TRANS SHOE SOLID STIRRUP EXI,,,28 ,,NW,,,,,,$99.17,$0.00,1,1,1,1,1,1,20120101,L3630,HCPCS,TRANS SHOE SOLID STIRRUP NEW,,,28 ,,NW,,,,,,$129.90,$0.00,1,1,1,1,1,1,20120101,L3640,HCPCS,SHOE DENNIS BROWNE SPLINT BO,,,28 ,,NW,,,,,,$57.11,$0.00,1,1,1,1,1,1,20120101,L3649,HCPCS,ORTHOPEDIC SHOE MODIFICA NOS,,,28 ,,NW,,,,,,$76.05,$0.00,1,1,1,1,1,1,20120101,L3650,HCPCS,SHLDER FIG 8 ABDUCT RESTRAIN,,,28 ,,NW,,,,,,$82.46,$0.00,1,1,1,1,1,1,20120101,L3671,HCPCS,SO CAP DESIGN W/O JNTS CF,,,28 ,,NW,,,,,,"$1,160.39",$0.00,1,1,1,1,1,1,20120101,L3674,HCPCS,SO AIRPLANE W/WO JOINT CF,,,28 ,,NW,,,,,,"$1,532.99",$0.00,1,1,1,1,1,1,20120101,L3677,HCPCS,SO HARD PLASTIC STABILIZER,,,28 ,,NW,,,,,,$228.53,$0.00,1,1,1,1,1,1,20120101,L3702,HCPCS,EO W/O JOINTS CF,,,28 ,,NW,,,,,,$348.41,$0.00,1,1,1,1,1,1,20120101,L3710,HCPCS,ELBOW ELASTIC WITH METAL JOI,,,28 ,,NW,,,,,,$168.21,$0.00,1,1,1,1,1,1,20120101,L3720,HCPCS,FOREARM/ARM CUFFS FREE MOTIO,,,28 ,,NW,,,,,,$978.65,$0.00,1,1,1,1,1,1,20120101,L3730,HCPCS,FOREARM/ARM CUFFS EXT/FLEX A,,,28 ,,NW,,,,,,"$1,363.50",$0.00,1,1,1,1,1,1,20120101,L3740,HCPCS,CUFFS ADJ LOCK W/ ACTIVE CON,,,28 ,,NW,,,,,,"$1,603.18",$0.00,1,1,1,1,1,1,20120101,L3760,HCPCS,"EO WITHJOINT, PREFABRICATED",,,28 ,,NW,,,,,,$628.67,$0.00,1,1,1,1,1,1,20120101,L3762,HCPCS,RIGID EO WO JOINTS,,,28 ,,NW,,,,,,$126.59,$0.00,1,1,1,1,1,1,20120101,L3763,HCPCS,EWHO RIGID W/O JNTS CF,,,28 ,,NW,,,,,,$971.37,$0.00,1,1,1,1,1,1,20120101,L3764,HCPCS,EWHO W/JOINT(S) CF,,,28 ,,NW,,,,,,"$1,091.18",$0.00,1,1,1,1,1,1,20120101,L3765,HCPCS,EWHFO RIGID W/O JNTS CF,,,28 ,,NW,,,,,,"$1,665.86",$0.00,1,1,1,1,1,1,20120101,L3766,HCPCS,EWHFO W/JOINT(S) CF,,,28 ,,NW,,,,,,"$1,766.06",$0.00,1,1,1,1,1,1,20120101,L3806,HCPCS,WHFO W/JOINT(S) CUSTOM FAB,,,28 ,,NW,,,,,,$567.86,$0.00,1,1,1,1,1,1,20120101,L3807,HCPCS,"WHFO,NO JOINT, PREFABRICATED",,,28 ,,NW,,,,,,$297.09,$0.00,1,1,1,1,1,1,20120101,L3808,HCPCS,"WHFO, RIGID W/O JOINTS",,,28 ,,NW,,,,,,$462.27,$0.00,1,1,1,1,1,1,20120101,L3900,HCPCS,HINGE EXTENSION/FLEX WRIST/F,,,28 ,,NW,,,,,,"$1,957.88",$0.00,1,1,1,1,1,1,20120101,L3901,HCPCS,HINGE EXT/FLEX WRIST FINGER,,,28 ,,NW,,,,,,"$2,424.06",$0.00,1,1,1,1,1,1,20120101,L3904,HCPCS,WHFO ELECTRIC CUSTOM FITTED,,,28 ,,NW,,,,,,"$4,448.73",$0.00,1,1,1,1,1,1,20120101,L3905,HCPCS,WHO W/NONTORSION JNT(S) CF,,,28 ,,NW,,,,,,"$1,280.58",$0.00,1,1,1,1,1,1,20120101,L3906,HCPCS,WHO W/O JOINTS CF,,,28 ,,NW,,,,,,$570.17,$0.00,1,1,1,1,1,1,20120101,L3908,HCPCS,WRIST COCK-UP NON-MOLDED,,,28 ,,NW,,,,,,$84.14,$0.00,1,1,1,1,1,1,20120101,L3912,HCPCS,FLEX GLOVE W/ELASTIC FINGER,,,28 ,,NW,,,,,,$131.20,$0.00,1,1,1,1,1,1,20120101,L3913,HCPCS,HFO W/O JOINTS CF,,,28 ,,NW,,,,,,$324.66,$0.00,1,1,1,1,1,1,20120101,L3915,HCPCS,WHO W NONTOR JNT(S) PREFAB,,,28 ,,NW,,,,,,$670.41,$0.00,1,1,1,1,1,1,20120101,L3917,HCPCS,PREFAB METACARPL FX ORTHOSIS,,,28 ,,NW,,,,,,$124.38,$0.00,1,1,1,1,1,1,20120101,L3919,HCPCS,HO W/O JOINTS CF,,,28 ,,NW,,,,,,$324.66,$0.00,1,1,1,1,1,1,20120101,L3921,HCPCS,HFO W/JOINT(S) CF,,,28 ,,NW,,,,,,$391.45,$0.00,1,1,1,1,1,1,20120101,L3923,HCPCS,HFO W/O JOINTS PF,,,28 ,,NW,,,,,,$108.84,$0.00,1,1,1,1,1,1,20120101,L3925,HCPCS,FO PIP/DIP WITH JOINT/SPRING,,,28 ,,NW,,,,,,$68.99,$0.00,1,1,1,1,1,1,20120101,L3927,HCPCS,FO PIP/DIP W/O JOINT/SPRING,,,28 ,,NW,,,,,,$42.61,$0.00,1,1,1,1,1,1,20120101,L3929,HCPCS,"HFO NONTORSION JOINT, PREFAB",,,28 ,,NW,,,,,,$107.90,$0.00,1,1,1,1,1,1,20120101,L3931,HCPCS,WHFO NONTORSION JOINT PREFAB,,,28 ,,NW,,,,,,$244.00,$0.00,1,1,1,1,1,1,20120101,L3933,HCPCS,FO W/O JOINTS CF,,,28 ,,NW,,,,,,$249.09,$0.00,1,1,1,1,1,1,20120101,L3935,HCPCS,FO NONTORSION JOINT CF,,,28 ,,NW,,,,,,$258.47,$0.00,1,1,1,1,1,1,20120101,L3956,HCPCS,ADD JOINT UPPER EXT ORTHOSIS,,,28 ,,NW,,,,,,$94.72,$0.00,1,1,1,1,1,1,20120101,L3960,HCPCS,SEWHO AIRPLAN DESIG ABDU POS,,,28 ,,NW,,,,,,"$1,091.32",$0.00,1,1,1,1,1,1,20120101,L3961,HCPCS,SEWHO CAP DESIGN W/O JNTS CF,,,28 ,,NW,,,,,,"$2,193.47",$0.00,1,1,1,1,1,1,20120101,L3962,HCPCS,SEWHO ERBS PALSEY DESIGN ABD,,,28 ,,NW,,,,,,"$1,050.53",$0.00,1,1,1,1,1,1,20120101,L3967,HCPCS,SEWHO AIRPLANE W/O JNTS CF,,,28 ,,NW,,,,,,"$2,595.98",$0.00,1,1,1,1,1,1,20120101,L3971,HCPCS,SEWHO CAP DESIGN W/JNT(S) CF,,,28 ,,NW,,,,,,"$2,462.42",$0.00,1,1,1,1,1,1,20120101,L3973,HCPCS,SEWHO AIRPLANE W/JNT(S) CF,,,28 ,,NW,,,,,,"$2,595.98",$0.00,1,1,1,1,1,1,20120101,L3975,HCPCS,SEWHFO CAP DESIGN W/O JNT CF,,,28 ,,NW,,,,,,"$2,193.47",$0.00,1,1,1,1,1,1,20120101,L3976,HCPCS,SEWHFO AIRPLANE W/O JNTS CF,,,28 ,,NW,,,,,,"$2,193.47",$0.00,1,1,1,1,1,1,20120101,L3977,HCPCS,SEWHFO CAP DESGN W/JNT(S) CF,,,28 ,,NW,,,,,,"$2,462.42",$0.00,1,1,1,1,1,1,20120101,L3978,HCPCS,SEWHFO AIRPLANE W/JNT(S) CF,,,28 ,,NW,,,,,,"$2,595.98",$0.00,1,1,1,1,1,1,20120101,L3980,HCPCS,UPP EXT FX ORTHOSIS HUMERAL,,,28 ,,NW,,,,,,$448.55,$0.00,1,1,1,1,1,1,20120101,L3982,HCPCS,UPPER EXT FX ORTHOSIS RAD/UL,,,28 ,,NW,,,,,,$531.03,$0.00,1,1,1,1,1,1,20120101,L3984,HCPCS,UPPER EXT FX ORTHOSIS WRIST,,,28 ,,NW,,,,,,$488.83,$0.00,1,1,1,1,1,1,20120101,L3995,HCPCS,SOCK FRACTURE OR EQUAL EACH,,,28 ,,NW,,,,,,$47.24,$0.00,1,1,1,1,1,1,20120101,L3999,HCPCS,UPPER LIMB ORTHOSIS NOS,,,28 ,,NW,,,,,,$47.99,$0.00,1,1,1,1,1,1,20120101,L4000,HCPCS,REPL GIRDLE MILWAUKEE ORTH,,,28 ,,NW,,,,,,"$1,921.62",$0.00,1,1,1,1,1,1,20120101,L4002,HCPCS,"REPLACE STRAP, ANY ORTHOSIS",,,28 ,,NW,,,,,,$59.25,$0.00,1,1,1,1,1,1,20120101,L4010,HCPCS,REPLACE TRILATERAL SOCKET BR,,,28 ,,NW,,,,,,"$1,032.79",$0.00,1,1,1,1,1,1,20120101,L4020,HCPCS,REPLACE QUADLAT SOCKET BRIM,,,28 ,,NW,,,,,,"$1,345.38",$0.00,1,1,1,1,1,1,20120101,L4030,HCPCS,REPLACE SOCKET BRIM CUST FIT,,,28 ,,NW,,,,,,$789.68,$0.00,1,1,1,1,1,1,20120101,L4040,HCPCS,REPLACE MOLDED THIGH LACER,,,28 ,,NW,,,,,,$592.02,$0.00,1,1,1,1,1,1,20120101,L4045,HCPCS,REPLACE NON-MOLDED THIGH LAC,,,28 ,,NW,,,,,,$454.15,$0.00,1,1,1,1,1,1,20120101,L4050,HCPCS,REPLACE MOLDED CALF LACER,,,28 ,,NW,,,,,,$604.10,$0.00,1,1,1,1,1,1,20120101,L4055,HCPCS,REPLACE NON-MOLDED CALF LACE,,,28 ,,NW,,,,,,$362.60,$0.00,1,1,1,1,1,1,20120101,L4060,HCPCS,REPLACE HIGH ROLL CUFF,,,28 ,,NW,,,,,,$445.32,$0.00,1,1,1,1,1,1,20120101,L4070,HCPCS,REPLACE PROX & DIST UPRIGHT,,,28 ,,NW,,,,,,$402.22,$0.00,1,1,1,1,1,1,20120101,L4080,HCPCS,REPL MET BAND KAFO-AFO PROX,,,28 ,,NW,,,,,,$134.39,$0.00,1,1,1,1,1,1,20120101,L4090,HCPCS,REPL MET BAND KAFO-AFO CALF/,,,28 ,,NW,,,,,,$124.36,$0.00,1,1,1,1,1,1,20120101,L4100,HCPCS,REPL LEATH CUFF KAFO PROX TH,,,28 ,,NW,,,,,,$144.61,$0.00,1,1,1,1,1,1,20120101,L4110,HCPCS,REPL LEATH CUFF KAFO-AFO CAL,,,28 ,,NW,,,,,,$117.06,$0.00,1,1,1,1,1,1,20120101,L4130,HCPCS,REPLACE PRETIBIAL SHELL,,,28 ,,NW,,,,,,$741.67,$0.00,1,1,1,1,1,1,20120101,L4205,HCPCS,ORTHO DVC REPAIR PER 15 MIN,,,28 ,,NW,,,,,,$36.09,$0.00,1,1,1,1,1,1,20120101,L4210,HCPCS,ORTH DEV REPAIR/REPL MINOR P,,,28 ,,NW,,,,,,$60.26,$0.00,1,1,1,1,1,1,20120101,L4350,HCPCS,ANKLE CONTROL ORTHOSI PREFAB,,,28 ,,NW,,,,,,$124.94,$0.00,1,1,1,1,1,1,20120101,L4360,HCPCS,PNEUMATI WALKING BOOT PREFAB,,,28 ,,NW,,,,,,$378.25,$0.00,1,1,1,1,1,1,20120101,L4370,HCPCS,PNEUMATIC FULL LEG SPLINT,,,28 ,,NW,,,,,,$250.36,$0.00,1,1,1,1,1,1,20120101,L4386,HCPCS,NON-PNEUM WALK BOOT PREFAB,,,28 ,,NW,,,,,,$203.77,$0.00,1,1,1,1,1,1,20120101,L4392,HCPCS,REPLACE AFO SOFT INTERFACE,,,28 ,,NW,,,,,,$31.96,$0.00,1,1,1,1,1,1,20120101,L4394,HCPCS,REPLACE FOOT DROP SPINT,,,28 ,,NW,,,,,,$23.89,$0.00,1,1,1,1,1,1,20120101,L4396,HCPCS,STATIC AFO,,,28 ,,NW,,,,,,$214.83,$0.00,1,1,1,1,1,1,20120101,L4398,HCPCS,FOOT DROP SPLINT RECUMBENT,,,28 ,,NW,,,,,,$100.04,$0.00,1,1,1,1,1,1,20120101,L4631,HCPCS,"AFO, WALK BOOT TYPE, CUS FAB",,,28 ,,NW,,,,,,"$2,282.94",$0.00,1,1,1,1,1,1,20120101,L5000,HCPCS,SHO INSERT W ARCH TOE FILLER,,,28 ,,NW,,,,,,$791.46,$0.00,1,1,1,1,1,1,20120101,L5010,HCPCS,MOLD SOCKET ANK HGT W/ TOE F,,,28 ,,NW,,,,,,"$2,014.35",$0.00,1,1,1,1,1,1,20120101,L5020,HCPCS,TIBIAL TUBERCLE HGT W/ TOE F,,,28 ,,NW,,,,,,"$3,311.93",$0.00,1,1,1,1,1,1,20120101,L5050,HCPCS,ANK SYMES MOLD SCKT SACH FT,,,28 ,,NW,,,,,,"$3,749.62",$0.00,1,1,1,1,1,1,20120101,L5060,HCPCS,SYMES MET FR LEATH SOCKET AR,,,28 ,,NW,,,,,,"$4,698.28",$0.00,1,1,1,1,1,1,20120101,L5100,HCPCS,MOLDED SOCKET SHIN SACH FOOT,,,28 ,,NW,,,,,,"$3,792.46",$0.00,1,1,1,1,1,1,20120101,L5105,HCPCS,PLAST SOCKET JTS/THGH LACER,,,28 ,,NW,,,,,,"$5,693.54",$0.00,1,1,1,1,1,1,20120101,L5150,HCPCS,MOLD SCKT EXT KNEE SHIN SACH,,,28 ,,NW,,,,,,"$5,847.81",$0.00,1,1,1,1,1,1,20120101,L5160,HCPCS,MOLD SOCKET BENT KNEE SHIN S,,,28 ,,NW,,,,,,"$6,340.68",$0.00,1,1,1,1,1,1,20120101,L5200,HCPCS,KNE SING AXIS FRIC SHIN SACH,,,28 ,,NW,,,,,,"$5,367.61",$0.00,1,1,1,1,1,1,20120101,L5210,HCPCS,NO KNEE/ANKLE JOINTS W/ FT B,,,28 ,,NW,,,,,,"$4,024.47",$0.00,1,1,1,1,1,1,20120101,L5220,HCPCS,NO KNEE JOINT WITH ARTIC ALI,,,28 ,,NW,,,,,,"$4,589.49",$0.00,1,1,1,1,1,1,20120101,L5230,HCPCS,FEM FOCAL DEFIC CONSTANT FRI,,,28 ,,NW,,,,,,"$6,310.16",$0.00,1,1,1,1,1,1,20120101,L5250,HCPCS,HIP CANAD SING AXI CONS FRIC,,,28 ,,NW,,,,,,"$8,432.51",$0.00,1,1,1,1,1,1,20120101,L5270,HCPCS,TILT TABLE LOCKING HIP SING,,,28 ,,NW,,,,,,"$8,507.23",$0.00,1,1,1,1,1,1,20120101,L5280,HCPCS,HEMIPELVECT CANAD SING AXIS,,,28 ,,NW,,,,,,"$8,548.18",$0.00,1,1,1,1,1,1,20120101,L5301,HCPCS,BK MOLD SOCKET SACH FT ENDO,,,28 ,,NW,,,,,,"$3,879.31",$0.00,1,1,1,1,1,1,20120101,L5312,HCPCS,"KNEE DISART, SACH FT, ENDO",,,28 ,,NW,,,,,,"$5,561.97",$0.00,1,1,1,1,1,1,20120101,L5321,HCPCS,AK OPEN END SACH,,,28 ,,NW,,,,,,"$5,491.21",$0.00,1,1,1,1,1,1,20120101,L5331,HCPCS,HIP DISART CANADIAN SACH FT,,,28 ,,NW,,,,,,"$7,756.02",$0.00,1,1,1,1,1,1,20120101,L5341,HCPCS,HEMIPELVECTOMY CANADIAN SACH,,,28 ,,NW,,,,,,"$8,349.31",$0.00,1,1,1,1,1,1,20120101,L5400,HCPCS,POSTOP DRESS & 1 CAST CHG BK,,,28 ,,NW,,,,,,"$2,022.81",$0.00,1,1,1,1,1,1,20120101,L5410,HCPCS,POSTOP DSG BK EA ADD CAST CH,,,28 ,,NW,,,,,,$636.93,$0.00,1,1,1,1,1,1,20120101,L5420,HCPCS,POSTOP DSG & 1 CAST CHG AK/D,,,28 ,,NW,,,,,,"$2,570.07",$0.00,1,1,1,1,1,1,20120101,L5430,HCPCS,POSTOP DSG AK EA ADD CAST CH,,,28 ,,NW,,,,,,$812.99,$0.00,1,1,1,1,1,1,20120101,L5450,HCPCS,POSTOP APP NON-WGT BEAR DSG,,,28 ,,NW,,,,,,$624.09,$0.00,1,1,1,1,1,1,20120101,L5460,HCPCS,POSTOP APP NON-WGT BEAR DSG,,,28 ,,NW,,,,,,$840.59,$0.00,1,1,1,1,1,1,20120101,L5500,HCPCS,INIT BK PTB PLASTER DIRECT,,,28 ,,NW,,,,,,"$2,081.40",$0.00,1,1,1,1,1,1,20120101,L5505,HCPCS,INIT AK ISCHAL PLSTR DIRECT,,,28 ,,NW,,,,,,"$2,898.53",$0.00,1,1,1,1,1,1,20120101,L5510,HCPCS,PREP BK PTB PLASTER MOLDED,,,28 ,,NW,,,,,,"$2,354.51",$0.00,1,1,1,1,1,1,20120101,L5520,HCPCS,PERP BK PTB THERMOPLS DIRECT,,,28 ,,NW,,,,,,"$2,403.59",$0.00,1,1,1,1,1,1,20120101,L5530,HCPCS,PREP BK PTB THERMOPLS MOLDED,,,28 ,,NW,,,,,,"$2,837.51",$0.00,1,1,1,1,1,1,20120101,L5535,HCPCS,PREP BK PTB OPEN END SOCKET,,,28 ,,NW,,,,,,"$2,818.73",$0.00,1,1,1,1,1,1,20120101,L5540,HCPCS,PREP BK PTB LAMINATED SOCKET,,,28 ,,NW,,,,,,"$2,970.28",$0.00,1,1,1,1,1,1,20120101,L5560,HCPCS,PREP AK ISCHIAL PLAST MOLDED,,,28 ,,NW,,,,,,"$3,214.88",$0.00,1,1,1,1,1,1,20120101,L5570,HCPCS,PREP AK ISCHIAL DIRECT FORM,,,28 ,,NW,,,,,,"$3,339.29",$0.00,1,1,1,1,1,1,20120101,L5580,HCPCS,PREP AK ISCHIAL THERMO MOLD,,,28 ,,NW,,,,,,"$3,898.38",$0.00,1,1,1,1,1,1,20120101,L5585,HCPCS,PREP AK ISCHIAL OPEN END,,,28 ,,NW,,,,,,"$4,161.25",$0.00,1,1,1,1,1,1,20120101,L5590,HCPCS,PREP AK ISCHIAL LAMINATED,,,28 ,,NW,,,,,,"$4,007.23",$0.00,1,1,1,1,1,1,20120101,L5595,HCPCS,HIP DISARTIC SACH THERMOPLS,,,28 ,,NW,,,,,,"$6,595.57",$0.00,1,1,1,1,1,1,20120101,L5600,HCPCS,HIP DISART SACH LAMINAT MOLD,,,28 ,,NW,,,,,,"$7,335.55",$0.00,1,1,1,1,1,1,20120101,L5610,HCPCS,ABOVE KNEE HYDRACADENCE,,,28 ,,NW,,,,,,"$3,398.03",$0.00,1,1,1,1,1,1,20120101,L5611,HCPCS,AK 4 BAR LINK W/FRIC SWING,,,28 ,,NW,,,,,,"$2,501.74",$0.00,1,1,1,1,1,1,20120101,L5613,HCPCS,AK 4 BAR LING W/HYDRAUL SWIG,,,28 ,,NW,,,,,,"$3,896.61",$0.00,1,1,1,1,1,1,20120101,L5614,HCPCS,4-BAR LINK ABOVE KNEE W/SWNG,,,28 ,,NW,,,,,,"$2,429.94",$0.00,1,1,1,1,1,1,20120101,L5616,HCPCS,AK UNIV MULTIPLEX SYS FRICT,,,28 ,,NW,,,,,,"$2,127.42",$0.00,1,1,1,1,1,1,20120101,L5617,HCPCS,AK/BK SELF-ALIGNING UNIT EA,,,28 ,,NW,,,,,,$785.91,$0.00,1,1,1,1,1,1,20120101,L5618,HCPCS,TEST SOCKET SYMES,,,28 ,,NW,,,,,,$417.92,$0.00,1,1,1,1,1,1,20120101,L5620,HCPCS,TEST SOCKET BELOW KNEE,,,28 ,,NW,,,,,,$412.39,$0.00,1,1,1,1,1,1,20120101,L5622,HCPCS,TEST SOCKET KNEE DISARTICULA,,,28 ,,NW,,,,,,$566.36,$0.00,1,1,1,1,1,1,20120101,L5624,HCPCS,TEST SOCKET ABOVE KNEE,,,28 ,,NW,,,,,,$564.25,$0.00,1,1,1,1,1,1,20120101,L5626,HCPCS,TEST SOCKET HIP DISARTICULAT,,,28 ,,NW,,,,,,$754.50,$0.00,1,1,1,1,1,1,20120101,L5628,HCPCS,TEST SOCKET HEMIPELVECTOMY,,,28 ,,NW,,,,,,$759.72,$0.00,1,1,1,1,1,1,20120101,L5629,HCPCS,BELOW KNEE ACRYLIC SOCKET,,,28 ,,NW,,,,,,$483.96,$0.00,1,1,1,1,1,1,20120101,L5630,HCPCS,SYME TYP EXPANDABL WALL SCKT,,,28 ,,NW,,,,,,$703.69,$0.00,1,1,1,1,1,1,20120101,L5631,HCPCS,AK/KNEE DISARTIC ACRYLIC SOC,,,28 ,,NW,,,,,,$678.75,$0.00,1,1,1,1,1,1,20120101,L5632,HCPCS,SYMES TYPE PTB BRIM DESIGN S,,,28 ,,NW,,,,,,$326.41,$0.00,1,1,1,1,1,1,20120101,L5634,HCPCS,SYMES TYPE POSTER OPENING SO,,,28 ,,NW,,,,,,$467.44,$0.00,1,1,1,1,1,1,20120101,L5636,HCPCS,SYMES TYPE MEDIAL OPENING SO,,,28 ,,NW,,,,,,$364.91,$0.00,1,1,1,1,1,1,20120101,L5637,HCPCS,BELOW KNEE TOTAL CONTACT,,,28 ,,NW,,,,,,$473.83,$0.00,1,1,1,1,1,1,20120101,L5638,HCPCS,BELOW KNEE LEATHER SOCKET,,,28 ,,NW,,,,,,$791.18,$0.00,1,1,1,1,1,1,20120101,L5639,HCPCS,BELOW KNEE WOOD SOCKET,,,28 ,,NW,,,,,,"$1,797.36",$0.00,1,1,1,1,1,1,20120101,L5640,HCPCS,KNEE DISARTICULAT LEATHER SO,,,28 ,,NW,,,,,,"$1,019.49",$0.00,1,1,1,1,1,1,20120101,L5642,HCPCS,ABOVE KNEE LEATHER SOCKET,,,28 ,,NW,,,,,,$930.80,$0.00,1,1,1,1,1,1,20120101,L5643,HCPCS,HIP FLEX INNER SOCKET EXT FR,,,28 ,,NW,,,,,,"$2,455.60",$0.00,1,1,1,1,1,1,20120101,L5644,HCPCS,ABOVE KNEE WOOD SOCKET,,,28 ,,NW,,,,,,$880.42,$0.00,1,1,1,1,1,1,20120101,L5645,HCPCS,BK FLEX INNER SOCKET EXT FRA,,,28 ,,NW,,,,,,"$1,225.03",$0.00,1,1,1,1,1,1,20120101,L5646,HCPCS,BELOW KNEE CUSHION SOCKET,,,28 ,,NW,,,,,,$841.66,$0.00,1,1,1,1,1,1,20120101,L5647,HCPCS,BELOW KNEE SUCTION SOCKET,,,28 ,,NW,,,,,,"$1,243.93",$0.00,1,1,1,1,1,1,20120101,L5648,HCPCS,ABOVE KNEE CUSHION SOCKET,,,28 ,,NW,,,,,,$992.17,$0.00,1,1,1,1,1,1,20120101,L5649,HCPCS,ISCH CONTAINMT/NARROW M-L SO,,,28 ,,NW,,,,,,"$3,158.03",$0.00,1,1,1,1,1,1,20120101,L5650,HCPCS,TOT CONTACT AK/KNEE DISART S,,,28 ,,NW,,,,,,$769.50,$0.00,1,1,1,1,1,1,20120101,L5651,HCPCS,AK FLEX INNER SOCKET EXT FRA,,,28 ,,NW,,,,,,"$1,899.63",$0.00,1,1,1,1,1,1,20120101,L5652,HCPCS,SUCTION SUSP AK/KNEE DISART,,,28 ,,NW,,,,,,$629.14,$0.00,1,1,1,1,1,1,20120101,L5653,HCPCS,KNEE DISART EXPAND WALL SOCK,,,28 ,,NW,,,,,,$886.38,$0.00,1,1,1,1,1,1,20120101,L5654,HCPCS,SOCKET INSERT SYMES,,,28 ,,NW,,,,,,$510.96,$0.00,1,1,1,1,1,1,20120101,L5655,HCPCS,SOCKET INSERT BELOW KNEE,,,28 ,,NW,,,,,,$412.23,$0.00,1,1,1,1,1,1,20120101,L5656,HCPCS,SOCKET INSERT KNEE ARTICULAT,,,28 ,,NW,,,,,,$586.91,$0.00,1,1,1,1,1,1,20120101,L5658,HCPCS,SOCKET INSERT ABOVE KNEE,,,28 ,,NW,,,,,,$549.36,$0.00,1,1,1,1,1,1,20120101,L5661,HCPCS,MULTI-DUROMETER SYMES,,,28 ,,NW,,,,,,$930.04,$0.00,1,1,1,1,1,1,20120101,L5665,HCPCS,MULTI-DUROMETER BELOW KNEE,,,28 ,,NW,,,,,,$803.07,$0.00,1,1,1,1,1,1,20120101,L5666,HCPCS,BELOW KNEE CUFF SUSPENSION,,,28 ,,NW,,,,,,$104.70,$0.00,1,1,1,1,1,1,20120101,L5668,HCPCS,SOCKET INSERT W/O LOCK LOWER,,,28 ,,NW,,,,,,$152.04,$0.00,1,1,1,1,1,1,20120101,L5670,HCPCS,BK MOLDED SUPRACONDYLAR SUSP,,,28 ,,NW,,,,,,$414.38,$0.00,1,1,1,1,1,1,20120101,L5671,HCPCS,BK/AK LOCKING MECHANISM,,,28 ,,NW,,,,,,$798.68,$0.00,1,1,1,1,1,1,20120101,L5672,HCPCS,BK REMOVABLE MEDIAL BRIM SUS,,,28 ,,NW,,,,,,$443.17,$0.00,1,1,1,1,1,1,20120101,L5673,HCPCS,SOCKET INSERT W LOCK MECH,,,28 ,,NW,,,,,,"$1,052.26",$0.00,1,1,1,1,1,1,20120101,L5676,HCPCS,BK KNEE JOINTS SINGLE AXIS P,,,28 ,,NW,,,,,,$560.03,$0.00,1,1,1,1,1,1,20120101,L5677,HCPCS,BK KNEE JOINTS POLYCENTRIC P,,,28 ,,NW,,,,,,$789.36,$0.00,1,1,1,1,1,1,20120101,L5678,HCPCS,BK JOINT COVERS PAIR,,,28 ,,NW,,,,,,$59.12,$0.00,1,1,1,1,1,1,20120101,L5679,HCPCS,SOCKET INSERT W/O LOCK MECH,,,28 ,,NW,,,,,,$871.12,$0.00,1,1,1,1,1,1,20120101,L5680,HCPCS,BK THIGH LACER NON-MOLDED,,,28 ,,NW,,,,,,$454.54,$0.00,1,1,1,1,1,1,20120101,L5681,HCPCS,INTL CUSTM CONG/LATYP INSERT,,,28 ,,NW,,,,,,"$1,886.02",$0.00,1,1,1,1,1,1,20120101,L5682,HCPCS,BK THIGH LACER GLUT/ISCHIA M,,,28 ,,NW,,,,,,$955.54,$0.00,1,1,1,1,1,1,20120101,L5683,HCPCS,INITIAL CUSTOM SOCKET INSERT,,,28 ,,NW,,,,,,"$1,886.02",$0.00,1,1,1,1,1,1,20120101,L5684,HCPCS,BK FORK STRAP,,,28 ,,NW,,,,,,$70.24,$0.00,1,1,1,1,1,1,20120101,L5685,HCPCS,BELOW KNEE SUS/SEAL SLEEVE,,,28 ,,NW,,,,,,$165.33,$0.00,1,1,1,1,1,1,20120101,L5686,HCPCS,BK BACK CHECK,,,28 ,,NW,,,,,,$77.16,$0.00,1,1,1,1,1,1,20120101,L5688,HCPCS,BK WAIST BELT WEBBING,,,28 ,,NW,,,,,,$91.19,$0.00,1,1,1,1,1,1,20120101,L5690,HCPCS,BK WAIST BELT PADDED AND LIN,,,28 ,,NW,,,,,,$147.22,$0.00,1,1,1,1,1,1,20120101,L5692,HCPCS,AK PELVIC CONTROL BELT LIGHT,,,28 ,,NW,,,,,,$193.29,$0.00,1,1,1,1,1,1,20120101,L5694,HCPCS,AK PELVIC CONTROL BELT PAD/L,,,28 ,,NW,,,,,,$265.35,$0.00,1,1,1,1,1,1,20120101,L5695,HCPCS,AK SLEEVE SUSP NEOPRENE/EQUA,,,28 ,,NW,,,,,,$240.61,$0.00,1,1,1,1,1,1,20120101,L5696,HCPCS,AK/KNEE DISARTIC PELVIC JOIN,,,28 ,,NW,,,,,,$274.25,$0.00,1,1,1,1,1,1,20120101,L5697,HCPCS,AK/KNEE DISARTIC PELVIC BAND,,,28 ,,NW,,,,,,$117.06,$0.00,1,1,1,1,1,1,20120101,L5698,HCPCS,AK/KNEE DISARTIC SILESIAN BA,,,28 ,,NW,,,,,,$160.61,$0.00,1,1,1,1,1,1,20120101,L5699,HCPCS,SHOULDER HARNESS,,,28 ,,NW,,,,,,$280.46,$0.00,1,1,1,1,1,1,20120101,L5700,HCPCS,REPLACE SOCKET BELOW KNEE,,,28 ,,NW,,,,,,"$4,467.08",$0.00,1,1,1,1,1,1,20120101,L5701,HCPCS,REPLACE SOCKET ABOVE KNEE,,,28 ,,NW,,,,,,"$5,496.32",$0.00,1,1,1,1,1,1,20120101,L5702,HCPCS,REPLACE SOCKET HIP,,,28 ,,NW,,,,,,"$7,029.53",$0.00,1,1,1,1,1,1,20120101,L5703,HCPCS,SYMES ANKLE W/O (SACH) FOOT,,,28 ,,NW,,,,,,"$3,443.36",$0.00,1,1,1,1,1,1,20120101,L5704,HCPCS,CUSTOM SHAPE COVER BK,,,28 ,,NW,,,,,,$819.52,$0.00,1,1,1,1,1,1,20120101,L5705,HCPCS,CUSTOM SHAPE COVER AK,,,28 ,,NW,,,,,,"$1,473.44",$0.00,1,1,1,1,1,1,20120101,L5706,HCPCS,CUSTOM SHAPE CVR KNEE DISART,,,28 ,,NW,,,,,,"$1,444.68",$0.00,1,1,1,1,1,1,20120101,L5707,HCPCS,CUSTOM SHAPE CVR HIP DISART,,,28 ,,NW,,,,,,"$1,970.62",$0.00,1,1,1,1,1,1,20120101,L5710,HCPCS,KNE-SHIN EXO SNG AXI MNL LOC,,,28 ,,NW,,,,,,$555.99,$0.00,1,1,1,1,1,1,20120101,L5711,HCPCS,KNEE-SHIN EXO MNL LOCK ULTRA,,,28 ,,NW,,,,,,$825.13,$0.00,1,1,1,1,1,1,20120101,L5712,HCPCS,KNEE-SHIN EXO FRICT SWG & ST,,,28 ,,NW,,,,,,$681.90,$0.00,1,1,1,1,1,1,20120101,L5714,HCPCS,KNEE-SHIN EXO VARIABLE FRICT,,,28 ,,NW,,,,,,$640.82,$0.00,1,1,1,1,1,1,20120101,L5716,HCPCS,KNEE-SHIN EXO MECH STANCE PH,,,28 ,,NW,,,,,,"$1,176.46",$0.00,1,1,1,1,1,1,20120101,L5718,HCPCS,KNEE-SHIN EXO FRCT SWG & STA,,,28 ,,NW,,,,,,"$1,424.96",$0.00,1,1,1,1,1,1,20120101,L5722,HCPCS,KNEE-SHIN PNEUM SWG FRCT EXO,,,28 ,,NW,,,,,,"$1,443.09",$0.00,1,1,1,1,1,1,20120101,L5724,HCPCS,KNEE-SHIN EXO FLUID SWING PH,,,28 ,,NW,,,,,,"$2,523.47",$0.00,1,1,1,1,1,1,20120101,L5726,HCPCS,KNEE-SHIN EXT JNTS FLD SWG E,,,28 ,,NW,,,,,,"$2,853.82",$0.00,1,1,1,1,1,1,20120101,L5728,HCPCS,KNEE-SHIN FLUID SWG & STANCE,,,28 ,,NW,,,,,,"$3,820.54",$0.00,1,1,1,1,1,1,20120101,L5780,HCPCS,KNEE-SHIN PNEUM/HYDRA PNEUM,,,28 ,,NW,,,,,,"$1,850.29",$0.00,1,1,1,1,1,1,20120101,L5781,HCPCS,LOWER LIMB PROS VACUUM PUMP,,,28 ,,NW,,,,,,"$5,806.92",$0.00,1,1,1,1,1,1,20120101,L5782,HCPCS,HD LOW LIMB PROS VACUUM PUMP,,,28 ,,NW,,,,,,"$6,123.68",$0.00,1,1,1,1,1,1,20120101,L5785,HCPCS,EXOSKELETAL BK ULTRALT MATER,,,28 ,,NW,,,,,,$796.77,$0.00,1,1,1,1,1,1,20120101,L5790,HCPCS,EXOSKELETAL AK ULTRA-LIGHT M,,,28 ,,NW,,,,,,"$1,127.67",$0.00,1,1,1,1,1,1,20120101,L5795,HCPCS,EXOSKEL HIP ULTRA-LIGHT MATE,,,28 ,,NW,,,,,,"$1,737.90",$0.00,1,1,1,1,1,1,20120101,L5810,HCPCS,ENDOSKEL KNEE-SHIN MNL LOCK,,,28 ,,NW,,,,,,$771.24,$0.00,1,1,1,1,1,1,20120101,L5811,HCPCS,ENDO KNEE-SHIN MNL LCK ULTRA,,,28 ,,NW,,,,,,"$1,151.06",$0.00,1,1,1,1,1,1,20120101,L5812,HCPCS,ENDO KNEE-SHIN FRCT SWG & ST,,,28 ,,NW,,,,,,$878.63,$0.00,1,1,1,1,1,1,20120101,L5814,HCPCS,ENDO KNEE-SHIN HYDRAL SWG PH,,,28 ,,NW,,,,,,"$5,389.42",$0.00,1,1,1,1,1,1,20120101,L5816,HCPCS,ENDO KNEE-SHIN POLYC MCH STA,,,28 ,,NW,,,,,,"$1,323.80",$0.00,1,1,1,1,1,1,20120101,L5818,HCPCS,ENDO KNEE-SHIN FRCT SWG & ST,,,28 ,,NW,,,,,,"$1,511.12",$0.00,1,1,1,1,1,1,20120101,L5822,HCPCS,ENDO KNEE-SHIN PNEUM SWG FRC,,,28 ,,NW,,,,,,"$2,598.48",$0.00,1,1,1,1,1,1,20120101,L5824,HCPCS,ENDO KNEE-SHIN FLUID SWING P,,,28 ,,NW,,,,,,"$2,520.59",$0.00,1,1,1,1,1,1,20120101,L5826,HCPCS,MINIATURE KNEE JOINT,,,28 ,,NW,,,,,,"$4,548.03",$0.00,1,1,1,1,1,1,20120101,L5828,HCPCS,ENDO KNEE-SHIN FLUID SWG/STA,,,28 ,,NW,,,,,,"$4,536.48",$0.00,1,1,1,1,1,1,20120101,L5830,HCPCS,ENDO KNEE-SHIN PNEUM/SWG PHA,,,28 ,,NW,,,,,,"$3,090.35",$0.00,1,1,1,1,1,1,20120101,L5840,HCPCS,MULTI-AXIAL KNEE/SHIN SYSTEM,,,28 ,,NW,,,,,,"$5,458.48",$0.00,1,1,1,1,1,1,20120101,L5845,HCPCS,KNEE-SHIN SYS STANCE FLEXION,,,28 ,,NW,,,,,,"$2,582.24",$0.00,1,1,1,1,1,1,20120101,L5848,HCPCS,KNEE-SHIN SYS HYDRAUL STANCE,,,28 ,,NW,,,,,,"$1,535.40",$0.00,1,1,1,1,1,1,20120101,L5850,HCPCS,ENDO AK/HIP KNEE EXTENS ASSI,,,28 ,,NW,,,,,,$175.43,$0.00,1,1,1,1,1,1,20120101,L5855,HCPCS,MECH HIP EXTENSION ASSIST,,,28 ,,NW,,,,,,$475.26,$0.00,1,1,1,1,1,1,20120101,L5856,HCPCS,ELEC KNEE-SHIN SWING/STANCE,,,28 ,,NW,,,,,,"$35,046.84",$0.00,1,1,1,1,1,1,20120101,L5857,HCPCS,ELEC KNEE-SHIN SWING ONLY,,,28 ,,NW,,,,,,"$12,435.99",$0.00,1,1,1,1,1,1,20120101,L5858,HCPCS,STANCE PHASE ONLY,,,28 ,,NW,,,,,,"$27,098.52",$0.00,1,1,1,1,1,1,20120101,L5910,HCPCS,ENDO BELOW KNEE ALIGNABLE SY,,,28 ,,NW,,,,,,$536.36,$0.00,1,1,1,1,1,1,20120101,L5920,HCPCS,ENDO AK/HIP ALIGNABLE SYSTEM,,,28 ,,NW,,,,,,$794.73,$0.00,1,1,1,1,1,1,20120101,L5925,HCPCS,ABOVE KNEE MANUAL LOCK,,,28 ,,NW,,,,,,$551.28,$0.00,1,1,1,1,1,1,20120101,L5930,HCPCS,HIGH ACTIVITY KNEE FRAME,,,28 ,,NW,,,,,,"$4,900.95",$0.00,1,1,1,1,1,1,20120101,L5940,HCPCS,ENDO BK ULTRA-LIGHT MATERIAL,,,28 ,,NW,,,,,,$769.27,$0.00,1,1,1,1,1,1,20120101,L5950,HCPCS,ENDO AK ULTRA-LIGHT MATERIAL,,,28 ,,NW,,,,,,"$1,202.64",$0.00,1,1,1,1,1,1,20120101,L5960,HCPCS,ENDO HIP ULTRA-LIGHT MATERIA,,,28 ,,NW,,,,,,"$1,552.25",$0.00,1,1,1,1,1,1,20120101,L5961,HCPCS,"ENDO POLY HIP, PNEU/HYD/ROT",,,28 ,,NW,,,,,,"$6,919.34",$0.00,1,1,1,1,1,1,20120101,L5962,HCPCS,BELOW KNEE FLEX COVER SYSTEM,,,28 ,,NW,,,,,,$925.13,$0.00,1,1,1,1,1,1,20120101,L5964,HCPCS,ABOVE KNEE FLEX COVER SYSTEM,,,28 ,,NW,,,,,,"$1,497.06",$0.00,1,1,1,1,1,1,20120101,L5966,HCPCS,HIP FLEXIBLE COVER SYSTEM,,,28 ,,NW,,,,,,"$1,934.73",$0.00,1,1,1,1,1,1,20120101,L5968,HCPCS,MULTIAXIAL ANKLE W DORSIFLEX,,,28 ,,NW,,,,,,"$5,270.76",$0.00,1,1,1,1,1,1,20120101,L5970,HCPCS,FOOT EXTERNAL KEEL SACH FOOT,,,28 ,,NW,,,,,,$294.66,$0.00,1,1,1,1,1,1,20120101,L5971,HCPCS,"SACH FOOT, REPLACEMENT",,,28 ,,NW,,,,,,$294.66,$0.00,1,1,1,1,1,1,20120101,L5972,HCPCS,FLEXIBLE KEEL FOOT,,,28 ,,NW,,,,,,$556.08,$0.00,1,1,1,1,1,1,20120101,L5973,HCPCS,ANK-FOOT SYS DORS-PLANT FLEX,,,28 ,,NW,,,,,,"$25,431.45",$0.00,1,1,1,1,1,1,20120101,L5974,HCPCS,FOOT SINGLE AXIS ANKLE/FOOT,,,28 ,,NW,,,,,,$351.60,$0.00,1,1,1,1,1,1,20120101,L5975,HCPCS,COMBO ANKLE/FOOT PROSTHESIS,,,28 ,,NW,,,,,,$642.33,$0.00,1,1,1,1,1,1,20120101,L5976,HCPCS,ENERGY STORING FOOT,,,28 ,,NW,,,,,,$886.97,$0.00,1,1,1,1,1,1,20120101,L5978,HCPCS,FT PROSTH MULTIAXIAL ANKL/FT,,,28 ,,NW,,,,,,$446.29,$0.00,1,1,1,1,1,1,20120101,L5979,HCPCS,MULTI-AXIAL ANKLE/FT PROSTH,,,28 ,,NW,,,,,,"$3,662.25",$0.00,1,1,1,1,1,1,20120101,L5980,HCPCS,FLEX FOOT SYSTEM,,,28 ,,NW,,,,,,"$5,896.57",$0.00,1,1,1,1,1,1,20120101,L5981,HCPCS,FLEX-WALK SYS LOW EXT PROSTH,,,28 ,,NW,,,,,,"$4,637.03",$0.00,1,1,1,1,1,1,20120101,L5982,HCPCS,EXOSKELETAL AXIAL ROTATION U,,,28 ,,NW,,,,,,$922.91,$0.00,1,1,1,1,1,1,20120101,L5984,HCPCS,ENDOSKELETAL AXIAL ROTATION,,,28 ,,NW,,,,,,$909.31,$0.00,1,1,1,1,1,1,20120101,L5985,HCPCS,LWR EXT DYNAMIC PROSTH PYLON,,,28 ,,NW,,,,,,$379.56,$0.00,1,1,1,1,1,1,20120101,L5986,HCPCS,MULTI-AXIAL ROTATION UNIT,,,28 ,,NW,,,,,,"$1,013.37",$0.00,1,1,1,1,1,1,20120101,L5987,HCPCS,SHANK FT W VERT LOAD PYLON,,,28 ,,NW,,,,,,"$10,471.59",$0.00,1,1,1,1,1,1,20120101,L5988,HCPCS,VERTICAL SHOCK REDUCING PYLO,,,28 ,,NW,,,,,,"$2,882.00",$0.00,1,1,1,1,1,1,20120101,L5990,HCPCS,USER ADJUSTABLE HEEL HEIGHT,,,28 ,,NW,,,,,,"$2,614.10",$0.00,1,1,1,1,1,1,20120101,L5999,HCPCS,LOWR EXTREMITY PROSTHES NOS,,,28 ,,NW,,,,,,"$1,695.70",$0.00,1,1,1,1,1,1,20120101,L6000,HCPCS,PAR HAND ROBIN-AIDS THUM REM,,,28 ,,NW,,,,,,"$2,216.56",$0.00,1,1,1,1,1,1,20120101,L6010,HCPCS,HAND ROBIN-AIDS LITTLE/RING,,,28 ,,NW,,,,,,"$2,453.13",$0.00,1,1,1,1,1,1,20120101,L6020,HCPCS,PART HAND ROBIN-AIDS NO FING,,,28 ,,NW,,,,,,"$2,291.37",$0.00,1,1,1,1,1,1,20120101,L6025,HCPCS,PART HAND DISART MYOELECTRIC,,,28 ,,NW,,,,,,"$11,648.38",$0.00,1,1,1,1,1,1,20120101,L6050,HCPCS,WRST MLD SCK FLX HNG TRI PAD,,,28 ,,NW,,,,,,"$3,222.78",$0.00,1,1,1,1,1,1,20120101,L6055,HCPCS,WRST MOLD SOCK W/EXP INTERFA,,,28 ,,NW,,,,,,"$4,336.44",$0.00,1,1,1,1,1,1,20120101,L6100,HCPCS,ELB MOLD SOCK FLEX HINGE PAD,,,28 ,,NW,,,,,,"$3,212.40",$0.00,1,1,1,1,1,1,20120101,L6110,HCPCS,ELBOW MOLD SOCK SUSPENSION T,,,28 ,,NW,,,,,,"$3,511.61",$0.00,1,1,1,1,1,1,20120101,L6120,HCPCS,ELBOW MOLD DOUB SPLT SOC STE,,,28 ,,NW,,,,,,"$4,036.69",$0.00,1,1,1,1,1,1,20120101,L6130,HCPCS,ELBOW STUMP ACTIVATED LOCK H,,,28 ,,NW,,,,,,"$4,315.98",$0.00,1,1,1,1,1,1,20120101,L6200,HCPCS,ELBOW MOLD OUTSID LOCK HINGE,,,28 ,,NW,,,,,,"$4,538.10",$0.00,1,1,1,1,1,1,20120101,L6205,HCPCS,ELBOW MOLDED W/ EXPAND INTER,,,28 ,,NW,,,,,,"$6,024.87",$0.00,1,1,1,1,1,1,20120101,L6250,HCPCS,ELBOW INTER LOC ELBOW FORARM,,,28 ,,NW,,,,,,"$4,504.06",$0.00,1,1,1,1,1,1,20120101,L6300,HCPCS,SHLDER DISART INT LOCK ELBOW,,,28 ,,NW,,,,,,"$6,237.57",$0.00,1,1,1,1,1,1,20120101,L6310,HCPCS,SHOULDER PASSIVE RESTOR COMP,,,28 ,,NW,,,,,,"$5,104.53",$0.00,1,1,1,1,1,1,20120101,L6320,HCPCS,SHOULDER PASSIVE RESTOR CAP,,,28 ,,NW,,,,,,"$2,802.38",$0.00,1,1,1,1,1,1,20120101,L6350,HCPCS,THORACIC INTERN LOCK ELBOW,,,28 ,,NW,,,,,,"$6,582.91",$0.00,1,1,1,1,1,1,20120101,L6360,HCPCS,THORACIC PASSIVE RESTOR COMP,,,28 ,,NW,,,,,,"$5,323.57",$0.00,1,1,1,1,1,1,20120101,L6370,HCPCS,THORACIC PASSIVE RESTOR CAP,,,28 ,,NW,,,,,,"$3,432.23",$0.00,1,1,1,1,1,1,20120101,L6380,HCPCS,POSTOP DSG CAST CHG WRST/ELB,,,28 ,,NW,,,,,,"$1,879.33",$0.00,1,1,1,1,1,1,20120101,L6382,HCPCS,POSTOP DSG CAST CHG ELB DIS/,,,28 ,,NW,,,,,,"$2,433.88",$0.00,1,1,1,1,1,1,20120101,L6384,HCPCS,POSTOP DSG CAST CHG SHLDER/T,,,28 ,,NW,,,,,,"$3,159.18",$0.00,1,1,1,1,1,1,20120101,L6386,HCPCS,POSTOP EA CAST CHG & REALIGN,,,28 ,,NW,,,,,,$647.18,$0.00,1,1,1,1,1,1,20120101,L6388,HCPCS,POSTOP APPLICAT RIGID DSG ON,,,28 ,,NW,,,,,,$684.34,$0.00,1,1,1,1,1,1,20120101,L6400,HCPCS,BELOW ELBOW PROSTH TISS SHAP,,,28 ,,NW,,,,,,"$3,805.37",$0.00,1,1,1,1,1,1,20120101,L6450,HCPCS,ELB DISART PROSTH TISS SHAP,,,28 ,,NW,,,,,,"$4,942.56",$0.00,1,1,1,1,1,1,20120101,L6500,HCPCS,ABOVE ELBOW PROSTH TISS SHAP,,,28 ,,NW,,,,,,"$4,882.22",$0.00,1,1,1,1,1,1,20120101,L6550,HCPCS,SHLDR DISAR PROSTH TISS SHAP,,,28 ,,NW,,,,,,"$6,219.19",$0.00,1,1,1,1,1,1,20120101,L6570,HCPCS,SCAP THORAC PROSTH TISS SHAP,,,28 ,,NW,,,,,,"$7,161.61",$0.00,1,1,1,1,1,1,20120101,L6580,HCPCS,WRIST/ELBOW BOWDEN CABLE MOL,,,28 ,,NW,,,,,,"$2,519.29",$0.00,1,1,1,1,1,1,20120101,L6582,HCPCS,WRIST/ELBOW BOWDEN CBL DIR F,,,28 ,,NW,,,,,,"$2,163.94",$0.00,1,1,1,1,1,1,20120101,L6584,HCPCS,ELBOW FAIR LEAD CABLE MOLDED,,,28 ,,NW,,,,,,"$3,331.16",$0.00,1,1,1,1,1,1,20120101,L6586,HCPCS,ELBOW FAIR LEAD CABLE DIR FO,,,28 ,,NW,,,,,,"$3,018.62",$0.00,1,1,1,1,1,1,20120101,L6588,HCPCS,SHDR FAIR LEAD CABLE MOLDED,,,28 ,,NW,,,,,,"$4,612.86",$0.00,1,1,1,1,1,1,20120101,L6590,HCPCS,SHDR FAIR LEAD CABLE DIRECT,,,28 ,,NW,,,,,,"$4,221.20",$0.00,1,1,1,1,1,1,20120101,L6600,HCPCS,POLYCENTRIC HINGE PAIR,,,28 ,,NW,,,,,,$288.02,$0.00,1,1,1,1,1,1,20120101,L6605,HCPCS,SINGLE PIVOT HINGE PAIR,,,28 ,,NW,,,,,,$284.43,$0.00,1,1,1,1,1,1,20120101,L6610,HCPCS,FLEXIBLE METAL HINGE PAIR,,,28 ,,NW,,,,,,$248.96,$0.00,1,1,1,1,1,1,20120101,L6611,HCPCS,"ADDITIONAL SWITCH, EXT POWER",,,28 ,,NW,,,,,,$566.59,$0.00,1,1,1,1,1,1,20120101,L6615,HCPCS,DISCONNECT LOCKING WRIST UNI,,,28 ,,NW,,,,,,$251.78,$0.00,1,1,1,1,1,1,20120101,L6616,HCPCS,DISCONNECT INSERT LOCKING WR,,,28 ,,NW,,,,,,$94.27,$0.00,1,1,1,1,1,1,20120101,L6620,HCPCS,FLEXION/EXTENSION WRIST UNIT,,,28 ,,NW,,,,,,$466.02,$0.00,1,1,1,1,1,1,20120101,L6621,HCPCS,FLEX/EXT WRIST W/WO FRICTION,,,28 ,,NW,,,,,,"$3,304.80",$0.00,1,1,1,1,1,1,20120101,L6623,HCPCS,SPRING-ASS ROT WRST W/ LATCH,,,28 ,,NW,,,,,,"$1,016.97",$0.00,1,1,1,1,1,1,20120101,L6624,HCPCS,FLEX/EXT/ROTATION WRIST UNIT,,,28 ,,NW,,,,,,"$5,463.72",$0.00,1,1,1,1,1,1,20120101,L6625,HCPCS,ROTATION WRST W/ CABLE LOCK,,,28 ,,NW,,,,,,$859.09,$0.00,1,1,1,1,1,1,20120101,L6628,HCPCS,QUICK DISCONN HOOK ADAPTER O,,,28 ,,NW,,,,,,$732.74,$0.00,1,1,1,1,1,1,20120101,L6629,HCPCS,LAMINATION COLLAR W/ COUPLIN,,,28 ,,NW,,,,,,$216.27,$0.00,1,1,1,1,1,1,20120101,L6630,HCPCS,STAINLESS STEEL ANY WRIST,,,28 ,,NW,,,,,,$316.74,$0.00,1,1,1,1,1,1,20120101,L6632,HCPCS,LATEX SUSPENSION SLEEVE EACH,,,28 ,,NW,,,,,,$89.99,$0.00,1,1,1,1,1,1,20120101,L6635,HCPCS,LIFT ASSIST FOR ELBOW,,,28 ,,NW,,,,,,$264.27,$0.00,1,1,1,1,1,1,20120101,L6637,HCPCS,NUDGE CONTROL ELBOW LOCK,,,28 ,,NW,,,,,,$561.85,$0.00,1,1,1,1,1,1,20120101,L6638,HCPCS,ELEC LOCK ON MANUAL PW ELBOW,,,28 ,,NW,,,,,,"$3,616.40",$0.00,1,1,1,1,1,1,20120101,L6640,HCPCS,SHOULDER ABDUCTION JOINT PAI,,,28 ,,NW,,,,,,$437.77,$0.00,1,1,1,1,1,1,20120101,L6641,HCPCS,EXCURSION AMPLIFIER PULLEY T,,,28 ,,NW,,,,,,$243.07,$0.00,1,1,1,1,1,1,20120101,L6642,HCPCS,EXCURSION AMPLIFIER LEVER TY,,,28 ,,NW,,,,,,$339.24,$0.00,1,1,1,1,1,1,20120101,L6645,HCPCS,SHOULDER FLEXION-ABDUCTION J,,,28 ,,NW,,,,,,$515.28,$0.00,1,1,1,1,1,1,20120101,L6646,HCPCS,MULTIPO LOCKING SHOULDER JNT,,,28 ,,NW,,,,,,"$4,570.10",$0.00,1,1,1,1,1,1,20120101,L6647,HCPCS,SHOULDER LOCK ACTUATOR,,,28 ,,NW,,,,,,$723.56,$0.00,1,1,1,1,1,1,20120101,L6648,HCPCS,EXT PWRD SHLDER LOCK/UNLOCK,,,28 ,,NW,,,,,,"$4,714.49",$0.00,1,1,1,1,1,1,20120101,L6650,HCPCS,SHOULDER UNIVERSAL JOINT,,,28 ,,NW,,,,,,$549.05,$0.00,1,1,1,1,1,1,20120101,L6655,HCPCS,STANDARD CONTROL CABLE EXTRA,,,28 ,,NW,,,,,,$111.37,$0.00,1,1,1,1,1,1,20120101,L6660,HCPCS,HEAVY DUTY CONTROL CABLE,,,28 ,,NW,,,,,,$133.90,$0.00,1,1,1,1,1,1,20120101,L6665,HCPCS,TEFLON OR EQUAL CABLE LINING,,,28 ,,NW,,,,,,$66.53,$0.00,1,1,1,1,1,1,20120101,L6670,HCPCS,HOOK TO HAND CABLE ADAPTER,,,28 ,,NW,,,,,,$72.64,$0.00,1,1,1,1,1,1,20120101,L6672,HCPCS,HARNESS CHEST/SHLDER SADDLE,,,28 ,,NW,,,,,,$258.09,$0.00,1,1,1,1,1,1,20120101,L6675,HCPCS,HARNESS FIGURE OF 8 SING CON,,,28 ,,NW,,,,,,$167.39,$0.00,1,1,1,1,1,1,20120101,L6676,HCPCS,HARNESS FIGURE OF 8 DUAL CON,,,28 ,,NW,,,,,,$178.51,$0.00,1,1,1,1,1,1,20120101,L6677,HCPCS,UE TRIPLE CONTROL HARNESS,,,28 ,,NW,,,,,,$398.60,$0.00,1,1,1,1,1,1,20120101,L6680,HCPCS,TEST SOCK WRIST DISART/BEL E,,,28 ,,NW,,,,,,$367.26,$0.00,1,1,1,1,1,1,20120101,L6682,HCPCS,TEST SOCK ELBW DISART/ABOVE,,,28 ,,NW,,,,,,$396.94,$0.00,1,1,1,1,1,1,20120101,L6684,HCPCS,TEST SOCKET SHLDR DISART/THO,,,28 ,,NW,,,,,,$560.66,$0.00,1,1,1,1,1,1,20120101,L6686,HCPCS,SUCTION SOCKET,,,28 ,,NW,,,,,,$994.74,$0.00,1,1,1,1,1,1,20120101,L6687,HCPCS,FRAME TYP SOCKET BEL ELBOW/W,,,28 ,,NW,,,,,,$823.01,$0.00,1,1,1,1,1,1,20120101,L6688,HCPCS,FRAME TYP SOCK ABOVE ELB/DIS,,,28 ,,NW,,,,,,$852.33,$0.00,1,1,1,1,1,1,20120101,L6689,HCPCS,FRAME TYP SOCKET SHOULDER DI,,,28 ,,NW,,,,,,"$1,051.13",$0.00,1,1,1,1,1,1,20120101,L6690,HCPCS,FRAME TYP SOCK INTERSCAP-THO,,,28 ,,NW,,,,,,"$1,127.84",$0.00,1,1,1,1,1,1,20120101,L6691,HCPCS,REMOVABLE INSERT EACH,,,28 ,,NW,,,,,,$531.59,$0.00,1,1,1,1,1,1,20120101,L6692,HCPCS,SILICONE GEL INSERT OR EQUAL,,,28 ,,NW,,,,,,$890.59,$0.00,1,1,1,1,1,1,20120101,L6693,HCPCS,LOCKINGELBOW FOREARM CNTRBAL,,,28 ,,NW,,,,,,"$4,110.24",$0.00,1,1,1,1,1,1,20120101,L6694,HCPCS,ELBOW SOCKET INS USE W/LOCK,,,28 ,,NW,,,,,,"$1,052.26",$0.00,1,1,1,1,1,1,20120101,L6695,HCPCS,ELBOW SOCKET INS USE W/O LCK,,,28 ,,NW,,,,,,$871.12,$0.00,1,1,1,1,1,1,20120101,L6696,HCPCS,CUS ELBO SKT IN FOR CON/ATYP,,,28 ,,NW,,,,,,"$1,886.02",$0.00,1,1,1,1,1,1,20120101,L6697,HCPCS,CUS ELBO SKT IN NOT CON/ATYP,,,28 ,,NW,,,,,,"$1,886.02",$0.00,1,1,1,1,1,1,20120101,L6698,HCPCS,BELOW/ABOVE ELBOW LOCK MECH,,,28 ,,NW,,,,,,$798.68,$0.00,1,1,1,1,1,1,20120101,L6703,HCPCS,"TERM DEV, PASSIVE HAND MITT",,,28 ,,NW,,,,,,$494.77,$0.00,1,1,1,1,1,1,20120101,L6704,HCPCS,"TERM DEV, SPORT/REC/WORK ATT",,,28 ,,NW,,,,,,$941.98,$0.00,1,1,1,1,1,1,20120101,L6706,HCPCS,TERM DEV MECH HOOK VOL OPEN,,,28 ,,NW,,,,,,$539.71,$0.00,1,1,1,1,1,1,20120101,L6707,HCPCS,TERM DEV MECH HOOK VOL CLOSE,,,28 ,,NW,,,,,,"$2,086.26",$0.00,1,1,1,1,1,1,20120101,L6708,HCPCS,TERM DEV MECH HAND VOL OPEN,,,28 ,,NW,,,,,,"$1,357.35",$0.00,1,1,1,1,1,1,20120101,L6709,HCPCS,TERM DEV MECH HAND VOL CLOSE,,,28 ,,NW,,,,,,"$1,981.35",$0.00,1,1,1,1,1,1,20120101,L6711,HCPCS,"PED TERM DEV, HOOK, VOL OPEN",,,28 ,,NW,,,,,,$947.03,$0.00,1,1,1,1,1,1,20120101,L6712,HCPCS,"PED TERM DEV, HOOK, VOL CLOS",,,28 ,,NW,,,,,,"$1,772.70",$0.00,1,1,1,1,1,1,20120101,L6713,HCPCS,"PED TERM DEV, HAND, VOL OPEN",,,28 ,,NW,,,,,,"$2,246.35",$0.00,1,1,1,1,1,1,20120101,L6714,HCPCS,"PED TERM DEV, HAND, VOL CLOS",,,28 ,,NW,,,,,,"$1,897.38",$0.00,1,1,1,1,1,1,20120101,L6721,HCPCS,"HOOK/HAND, HVY DTY, VOL OPEN",,,28 ,,NW,,,,,,"$3,399.21",$0.00,1,1,1,1,1,1,20120101,L6722,HCPCS,"HOOK/HAND, HVY DTY, VOL CLOS",,,28 ,,NW,,,,,,"$2,925.60",$0.00,1,1,1,1,1,1,20120101,L6805,HCPCS,TERM DEV MODIFIER WRIST UNIT,,,28 ,,NW,,,,,,$534.01,$0.00,1,1,1,1,1,1,20120101,L6810,HCPCS,TERM DEV PRECISION PINCH DEV,,,28 ,,NW,,,,,,$268.53,$0.00,1,1,1,1,1,1,20120101,L6881,HCPCS,TERM DEV AUTO GRASP FEATURE,,,28 ,,NW,,,,,,"$5,934.04",$0.00,1,1,1,1,1,1,20120101,L6882,HCPCS,MICROPROCESSOR CONTROL UPLMB,,,28 ,,NW,,,,,,"$4,492.92",$0.00,1,1,1,1,1,1,20120101,L6883,HCPCS,REPLC SOCKT BELOW E/W DISA,,,28 ,,NW,,,,,,"$2,609.09",$0.00,1,1,1,1,1,1,20120101,L6884,HCPCS,REPLC SOCKT ABOVE ELBOW DISA,,,28 ,,NW,,,,,,"$3,752.72",$0.00,1,1,1,1,1,1,20120101,L6885,HCPCS,REPLC SOCKT SHLDR DIS/INTERC,,,28 ,,NW,,,,,,"$5,323.57",$0.00,1,1,1,1,1,1,20120101,L6890,HCPCS,PREFAB GLOVE FOR TERM DEVICE,,,28 ,,NW,,,,,,$252.48,$0.00,1,1,1,1,1,1,20120101,L6895,HCPCS,CUSTOM GLOVE FOR TERM DEVICE,,,28 ,,NW,,,,,,$860.99,$0.00,1,1,1,1,1,1,20120101,L6900,HCPCS,HAND RESTORAT THUMB/1 FINGER,,,28 ,,NW,,,,,,"$2,593.37",$0.00,1,1,1,1,1,1,20120101,L6905,HCPCS,HAND RESTORATION MULTIPLE FI,,,28 ,,NW,,,,,,"$2,524.79",$0.00,1,1,1,1,1,1,20120101,L6910,HCPCS,HAND RESTORATION NO FINGERS,,,28 ,,NW,,,,,,"$2,439.07",$0.00,1,1,1,1,1,1,20120101,L6915,HCPCS,HAND RESTORATION REPLACMNT G,,,28 ,,NW,,,,,,"$1,034.15",$0.00,1,1,1,1,1,1,20120101,L6920,HCPCS,WRIST DISARTICUL SWITCH CTRL,,,28 ,,NW,,,,,,"$10,880.45",$0.00,1,1,1,1,1,1,20120101,L6925,HCPCS,WRIST DISART MYOELECTRONIC C,,,28 ,,NW,,,,,,"$12,450.31",$0.00,1,1,1,1,1,1,20120101,L6930,HCPCS,BELOW ELBOW SWITCH CONTROL,,,28 ,,NW,,,,,,"$10,776.82",$0.00,1,1,1,1,1,1,20120101,L6935,HCPCS,BELOW ELBOW MYOELECTRONIC CT,,,28 ,,NW,,,,,,"$12,620.36",$0.00,1,1,1,1,1,1,20120101,L6940,HCPCS,ELBOW DISARTICULATION SWITCH,,,28 ,,NW,,,,,,"$13,882.63",$0.00,1,1,1,1,1,1,20120101,L6945,HCPCS,ELBOW DISART MYOELECTRONIC C,,,28 ,,NW,,,,,,"$15,952.86",$0.00,1,1,1,1,1,1,20120101,L6950,HCPCS,ABOVE ELBOW SWITCH CONTROL,,,28 ,,NW,,,,,,"$14,993.18",$0.00,1,1,1,1,1,1,20120101,L6955,HCPCS,ABOVE ELBOW MYOELECTRONIC CT,,,28 ,,NW,,,,,,"$17,966.00",$0.00,1,1,1,1,1,1,20120101,L6960,HCPCS,SHLDR DISARTIC SWITCH CONTRO,,,28 ,,NW,,,,,,"$19,039.61",$0.00,1,1,1,1,1,1,20120101,L6965,HCPCS,SHLDR DISARTIC MYOELECTRONIC,,,28 ,,NW,,,,,,"$22,440.49",$0.00,1,1,1,1,1,1,20120101,L6970,HCPCS,INTERSCAPULAR-THOR SWITCH CT,,,28 ,,NW,,,,,,"$23,481.29",$0.00,1,1,1,1,1,1,20120101,L6975,HCPCS,INTERSCAP-THOR MYOELECTRONIC,,,28 ,,NW,,,,,,"$25,824.46",$0.00,1,1,1,1,1,1,20120101,L7007,HCPCS,ADULT ELECTRIC HAND,,,28 ,,NW,,,,,,"$5,373.39",$0.00,1,1,1,1,1,1,20120101,L7008,HCPCS,PEDIATRIC ELECTRIC HAND,,,28 ,,NW,,,,,,"$8,687.89",$0.00,1,1,1,1,1,1,20120101,L7009,HCPCS,ADULT ELECTRIC HOOK,,,28 ,,NW,,,,,,"$5,472.26",$0.00,1,1,1,1,1,1,20120101,L7040,HCPCS,PREHENSILE ACTUATOR,,,28 ,,NW,,,,,,"$4,388.86",$0.00,1,1,1,1,1,1,20120101,L7045,HCPCS,PEDIATRIC ELECTRIC HOOK,,,28 ,,NW,,,,,,"$2,426.50",$0.00,1,1,1,1,1,1,20120101,L7170,HCPCS,ELECTRONIC ELBOW HOSMER SWIT,,,28 ,,NW,,,,,,"$9,425.95",$0.00,1,1,1,1,1,1,20120101,L7180,HCPCS,ELECTRONIC ELBOW SEQUENTIAL,,,28 ,,NW,,,,,,"$53,444.15",$0.00,1,1,1,1,1,1,20120101,L7181,HCPCS,ELECTRONIC ELBO SIMULTANEOUS,,,28 ,,NW,,,,,,"$58,461.91",$0.00,1,1,1,1,1,1,20120101,L7185,HCPCS,ELECTRON ELBOW ADOLESCENT SW,,,28 ,,NW,,,,,,"$9,773.94",$0.00,1,1,1,1,1,1,20120101,L7186,HCPCS,ELECTRON ELBOW CHILD SWITCH,,,28 ,,NW,,,,,,"$14,499.04",$0.00,1,1,1,1,1,1,20120101,L7190,HCPCS,ELBOW ADOLESCENT MYOELECTRON,,,28 ,,NW,,,,,,"$12,298.98",$0.00,1,1,1,1,1,1,20120101,L7191,HCPCS,ELBOW CHILD MYOELECTRONIC CT,,,28 ,,NW,,,,,,"$15,170.47",$0.00,1,1,1,1,1,1,20120101,L7260,HCPCS,ELECTRON WRIST ROTATOR OTTO,,,28 ,,NW,,,,,,"$3,322.51",$0.00,1,1,1,1,1,1,20120101,L7261,HCPCS,ELECTRON WRIST ROTATOR UTAH,,,28 ,,NW,,,,,,"$6,200.37",$0.00,1,1,1,1,1,1,20120101,L7360,HCPCS,SIX VOLT BAT OTTO BOCK/EQ EA,,,28 ,,NW,,,,,,$342.91,$0.00,1,1,1,1,1,1,20120101,L7362,HCPCS,BATTERY CHRGR SIX VOLT OTTO,,,28 ,,NW,,,,,,$365.36,$0.00,1,1,1,1,1,1,20120101,L7364,HCPCS,TWELVE VOLT BATTERY UTAH/EQU,,,28 ,,NW,,,,,,$670.12,$0.00,1,1,1,1,1,1,20120101,L7366,HCPCS,BATTERY CHRGR 12 VOLT UTAH/E,,,28 ,,NW,,,,,,$909.12,$0.00,1,1,1,1,1,1,20120101,L7367,HCPCS,REPLACEMNT LITHIUM IONBATTER,,,28 ,,NW,,,,,,$533.89,$0.00,1,1,1,1,1,1,20120101,L7368,HCPCS,LITHIUM ION BATTERY CHARGER,,,28 ,,NW,,,,,,$702.32,$0.00,1,1,1,1,1,1,20120101,L7400,HCPCS,"ADD UE PROST BE/WD, ULTLITE",,,28 ,,NW,,,,,,$412.96,$0.00,1,1,1,1,1,1,20120101,L7401,HCPCS,ADD UE PROST A/E ULTLITE MAT,,,28 ,,NW,,,,,,$466.42,$0.00,1,1,1,1,1,1,20120101,L7402,HCPCS,ADD UE PROST S/D ULTLITE MAT,,,28 ,,NW,,,,,,$506.45,$0.00,1,1,1,1,1,1,20120101,L7403,HCPCS,ADD UE PROST B/E ACRYLIC,,,28 ,,NW,,,,,,$503.15,$0.00,1,1,1,1,1,1,20120101,L7404,HCPCS,ADD UE PROST A/E ACRYLIC,,,28 ,,NW,,,,,,$776.95,$0.00,1,1,1,1,1,1,20120101,L7405,HCPCS,ADD UE PROST S/D ACRYLIC,,,28 ,,NW,,,,,,"$1,026.75",$0.00,1,1,1,1,1,1,20120101,L7499,HCPCS,UPPER EXTREMITY PROSTHES NOS,,,28 ,,NW,,,,,,$860.99,$0.00,1,1,1,1,1,1,20120101,L7510,HCPCS,PROSTHETIC DEVICE REPAIR REP,,,28 ,,NW,,,,,,$42.00,$0.00,1,1,1,1,1,1,20120101,L7520,HCPCS,REPAIR PROSTHESIS PER 15 MIN,,,28 ,,NW,,,,,,$42.00,$0.00,1,1,1,1,1,1,20120101,L7600,HCPCS,PROSTHETIC DONNING SLEEVE,,,28 ,,NW,,,,,,$83.26,$0.00,1,1,1,1,1,1,20120101,L7900,HCPCS,MALE VACUUM ERECTION SYSTEM,,,28 ,,NW,,,,,,$747.09,$0.00,1,1,1,1,1,1,20120101,L8000,HCPCS,MASTECTOMY BRA,,,28 ,,NW,,,,,,$55.32,$0.00,1,1,1,1,1,1,20120101,L8001,HCPCS,BREAST PROSTHESIS BRA & FORM,,,28 ,,NW,,,,,,$161.96,$0.00,1,1,1,1,1,1,20120101,L8002,HCPCS,BRST PRSTH BRA & BILAT FORM,,,28 ,,NW,,,,,,$212.36,$0.00,1,1,1,1,1,1,20120101,L8010,HCPCS,MASTECTOMY SLEEVE,,,28 ,,NW,,,,,,$72.66,$0.00,1,1,1,1,1,1,20120101,L8015,HCPCS,EXT BREASTPROSTHESIS GARMENT,,,28 ,,NW,,,,,,$78.62,$0.00,1,1,1,1,1,1,20120101,L8020,HCPCS,MASTECTOMY FORM,,,28 ,,NW,,,,,,$297.43,$0.00,1,1,1,1,1,1,20120101,L8030,HCPCS,BREAST PROSTHES W/O ADHESIVE,,,28 ,,NW,,,,,,$473.78,$0.00,1,1,1,1,1,1,20120101,L8031,HCPCS,BREAST PROSTHESIS W ADHESIVE,,,28 ,,NW,,,,,,$473.78,$0.00,1,1,1,1,1,1,20120101,L8032,HCPCS,REUSABLE NIPPLE PROSTHESIS,,,28 ,,NW,,,,,,$52.11,$0.00,1,1,1,1,1,1,20120101,L8035,HCPCS,CUSTOM BREAST PROSTHESIS,,,28 ,,NW,,,,,,"$5,314.13",$0.00,1,1,1,1,1,1,20120101,L8039,HCPCS,BREAST PROSTHESIS NOS,,,28 ,,NW,,,,,,$42.00,$0.00,1,1,1,1,1,1,20120101,L8040,HCPCS,NASAL PROSTHESIS,,,28 ,,NW,,,,,,"$3,627.11",$0.00,1,1,1,1,1,1,20120101,L8040,HCPCS,NASAL PROSTHESIS,KM,,28 ,,NW,,,,,,"$3,444.03",$0.00,1,1,1,1,1,1,20120101,L8040,HCPCS,NASAL PROSTHESIS,KN,,28 ,,NW,,,,,,"$1,430.14",$0.00,1,1,1,1,1,1,20120101,L8041,HCPCS,MIDFACIAL PROSTHESIS,,,28 ,,NW,,,,,,"$4,378.93",$0.00,1,1,1,1,1,1,20120101,L8041,HCPCS,MIDFACIAL PROSTHESIS,KM,,28 ,,NW,,,,,,"$4,158.25",$0.00,1,1,1,1,1,1,20120101,L8041,HCPCS,MIDFACIAL PROSTHESIS,KN,,28 ,,NW,,,,,,"$1,730.89",$0.00,1,1,1,1,1,1,20120101,L8042,HCPCS,ORBITAL PROSTHESIS,,,28 ,,NW,,,,,,"$4,924.40",$0.00,1,1,1,1,1,1,20120101,L8042,HCPCS,ORBITAL PROSTHESIS,KM,,28 ,,NW,,,,,,"$4,676.46",$0.00,1,1,1,1,1,1,20120101,L8042,HCPCS,ORBITAL PROSTHESIS,KN,,28 ,,NW,,,,,,"$1,949.07",$0.00,1,1,1,1,1,1,20120101,L8043,HCPCS,UPPER FACIAL PROSTHESIS,,,28 ,,NW,,,,,,"$5,519.49",$0.00,1,1,1,1,1,1,20120101,L8043,HCPCS,UPPER FACIAL PROSTHESIS,KM,,28 ,,NW,,,,,,"$5,241.77",$0.00,1,1,1,1,1,1,20120101,L8043,HCPCS,UPPER FACIAL PROSTHESIS,KN,,28 ,,NW,,,,,,"$2,187.09",$0.00,1,1,1,1,1,1,20120101,L8044,HCPCS,HEMI-FACIAL PROSTHESIS,,,28 ,,NW,,,,,,"$6,114.54",$0.00,1,1,1,1,1,1,20120101,L8044,HCPCS,HEMI-FACIAL PROSTHESIS,KM,,28 ,,NW,,,,,,"$5,807.09",$0.00,1,1,1,1,1,1,20120101,L8044,HCPCS,HEMI-FACIAL PROSTHESIS,KN,,28 ,,NW,,,,,,"$2,425.13",$0.00,1,1,1,1,1,1,20120101,L8045,HCPCS,AURICULAR PROSTHESIS,,,28 ,,NW,,,,,,"$4,030.73",$0.00,1,1,1,1,1,1,20120101,L8045,HCPCS,AURICULAR PROSTHESIS,KM,,28 ,,NW,,,,,,"$3,827.48",$0.00,1,1,1,1,1,1,20120101,L8045,HCPCS,AURICULAR PROSTHESIS,KN,,28 ,,NW,,,,,,"$1,591.60",$0.00,1,1,1,1,1,1,20120101,L8046,HCPCS,PARTIAL FACIAL PROSTHESIS,,,28 ,,NW,,,,,,"$3,932.62",$0.00,1,1,1,1,1,1,20120101,L8046,HCPCS,PARTIAL FACIAL PROSTHESIS,KM,,28 ,,NW,,,,,,"$3,734.28",$0.00,1,1,1,1,1,1,20120101,L8046,HCPCS,PARTIAL FACIAL PROSTHESIS,KN,,28 ,,NW,,,,,,"$1,552.34",$0.00,1,1,1,1,1,1,20120101,L8047,HCPCS,NASAL SEPTAL PROSTHESIS,,,28 ,,NW,,,,,,"$1,998.65",$0.00,1,1,1,1,1,1,20120101,L8047,HCPCS,NASAL SEPTAL PROSTHESIS,KM,,28 ,,NW,,,,,,"$1,897.00",$0.00,1,1,1,1,1,1,20120101,L8047,HCPCS,NASAL SEPTAL PROSTHESIS,KN,,28 ,,NW,,,,,,$778.77,$0.00,1,1,1,1,1,1,20120101,L8048,HCPCS,UNSPEC MAXILLOFACIAL PROSTH,,,28 ,,NW,,,,,,$756.90,$0.00,1,1,1,1,1,1,20120101,L8049,HCPCS,REPAIR MAXILLOFACIAL PROSTH,,,28 ,,NW,,,,,,$57.62,$0.00,1,1,1,1,1,1,20120101,L8300,HCPCS,TRUSS SINGLE W/ STANDARD PAD,,,28 ,,NW,,,,,,$122.84,$0.00,1,1,1,1,1,1,20120101,L8310,HCPCS,TRUSS DOUBLE W/ STANDARD PAD,,,28 ,,NW,,,,,,$198.38,$0.00,1,1,1,1,1,1,20120101,L8320,HCPCS,TRUSS ADDITION TO STD PAD WA,,,28 ,,NW,,,,,,$82.22,$0.00,1,1,1,1,1,1,20120101,L8330,HCPCS,TRUSS ADD TO STD PAD SCROTAL,,,28 ,,NW,,,,,,$76.09,$0.00,1,1,1,1,1,1,20120101,L8400,HCPCS,SHEATH BELOW KNEE,,,28 ,,NW,,,,,,$25.38,$0.00,1,1,1,1,1,1,20120101,L8410,HCPCS,SHEATH ABOVE KNEE,,,28 ,,NW,,,,,,$32.13,$0.00,1,1,1,1,1,1,20120101,L8415,HCPCS,SHEATH UPPER LIMB,,,28 ,,NW,,,,,,$31.80,$0.00,1,1,1,1,1,1,20120101,L8417,HCPCS,PROS SHEATH/SOCK W GEL CUSHN,,,28 ,,NW,,,,,,$97.95,$0.00,1,1,1,1,1,1,20120101,L8420,HCPCS,PROSTHETIC SOCK MULTI PLY BK,,,28 ,,NW,,,,,,$30.98,$0.00,1,1,1,1,1,1,20120101,L8430,HCPCS,PROSTHETIC SOCK MULTI PLY AK,,,28 ,,NW,,,,,,$34.27,$0.00,1,1,1,1,1,1,20120101,L8435,HCPCS,PROS SOCK MULTI PLY UPPER LM,,,28 ,,NW,,,,,,$32.69,$0.00,1,1,1,1,1,1,20120101,L8440,HCPCS,SHRINKER BELOW KNEE,,,28 ,,NW,,,,,,$64.50,$0.00,1,1,1,1,1,1,20120101,L8460,HCPCS,SHRINKER ABOVE KNEE,,,28 ,,NW,,,,,,$97.13,$0.00,1,1,1,1,1,1,20120101,L8465,HCPCS,SHRINKER UPPER LIMB,,,28 ,,NW,,,,,,$73.57,$0.00,1,1,1,1,1,1,20120101,L8470,HCPCS,PROS SOCK SINGLE PLY BK,,,28 ,,NW,,,,,,$11.04,$0.00,1,1,1,1,1,1,20120101,L8480,HCPCS,PROS SOCK SINGLE PLY AK,,,28 ,,NW,,,,,,$14.82,$0.00,1,1,1,1,1,1,20120101,L8485,HCPCS,PROS SOCK SINGLE PLY UPPER L,,,28 ,,NW,,,,,,$17.84,$0.00,1,1,1,1,1,1,20120101,L8499,HCPCS,UNLISTED MISC PROSTHETIC SER,,,28 ,,NW,,,,,,$30.25,$0.00,1,1,1,1,1,1,20120101,L8500,HCPCS,ARTIFICIAL LARYNX,,,28 ,,NW,,,,,,"$1,015.42",$0.00,1,1,1,1,1,1,20120101,L8501,HCPCS,TRACHEOSTOMY SPEAKING VALVE,,,28 ,,NW,,,,,,$165.01,$0.00,1,1,1,1,1,1,20120101,L8505,HCPCS,"ARTIFICIAL LARYNX, ACCESSORY",,,28 ,,NW,,,,,,$28.80,$0.00,1,1,1,1,1,1,20120101,L8507,HCPCS,TRACH-ESOPH VOICE PROS PT IN,,,28 ,,NW,,,,,,$55.50,$0.00,1,1,1,1,1,1,20120101,L8509,HCPCS,TRACH-ESOPH VOICE PROS MD IN,,,28 ,,NW,,,,,,$141.29,$0.00,1,1,1,1,1,1,20120101,L8510,HCPCS,VOICE AMPLIFIER,,,28 ,,NW,,,,,,$334.42,$0.00,1,1,1,1,1,1,20120101,L8511,HCPCS,INDWELLING TRACH INSERT,,,28 ,,NW,,,,,,$94.80,$0.00,1,1,1,1,1,1,20120101,L8512,HCPCS,GEL CAP FOR TRACH VOICE PROS,,,28 ,,NW,,,,,,$3.29,$0.00,1,1,1,1,1,1,20120101,L8513,HCPCS,TRACH PROS CLEANING DEVICE,,,28 ,,NW,,,,,,$7.87,$0.00,1,1,1,1,1,1,20120101,L8514,HCPCS,REPL TRACH PUNCTURE DILATOR,,,28 ,,NW,,,,,,$122.30,$0.00,1,1,1,1,1,1,20120101,L8515,HCPCS,GEL CAP APP DEVICE FOR TRACH,,,28 ,,NW,,,,,,$82.55,$0.00,1,1,1,1,1,1,20120101,L8600,HCPCS,IMPLANT BREAST SILICONE/EQ,,,28 ,,NW,,,,,,$955.59,$0.00,1,1,1,1,1,1,20120101,L8603,HCPCS,COLLAGEN IMP URINARY 2.5 ML,,,28 ,,NW,,,,,,$602.67,$0.00,1,1,1,1,1,1,20120101,L8606,HCPCS,SYNTHETIC IMPLNT URINARY 1ML,,,28 ,,NW,,,,,,$285.65,$0.00,1,1,1,1,1,1,20120101,L8609,HCPCS,ARTIFICIAL CORNEA,,,28 ,,NW,,,,,,"$9,416.35",$0.00,1,1,1,1,1,1,20120101,L8610,HCPCS,OCULAR IMPLANT,,,28 ,,NW,,,,,,$900.35,$0.00,1,1,1,1,1,1,20120101,L8612,HCPCS,AQUEOUS SHUNT PROSTHESIS,,,28 ,,NW,,,,,,$990.48,$0.00,1,1,1,1,1,1,20120101,L8613,HCPCS,OSSICULAR IMPLANT,,,28 ,,NW,,,,,,$414.67,$0.00,1,1,1,1,1,1,20120101,L8614,HCPCS,COCHLEAR DEVICE,,,28 ,,NW,,,,,,"$28,150.58",$0.00,1,1,1,1,1,1,20120101,L8615,HCPCS,COCH IMPLANT HEADSET REPLACE,,,28 ,,NW,,,,,,$619.71,$0.00,1,1,1,1,1,1,20120101,L8616,HCPCS,COCH IMPLANT MICROPHONE REPL,,,28 ,,NW,,,,,,$135.12,$0.00,1,1,1,1,1,1,20120101,L8617,HCPCS,COCH IMPLANT TRANS COIL REPL,,,28 ,,NW,,,,,,$118.29,$0.00,1,1,1,1,1,1,20120101,L8618,HCPCS,COCH IMPLANT TRAN CABLE REPL,,,28 ,,NW,,,,,,$35.32,$0.00,1,1,1,1,1,1,20120101,L8619,HCPCS,COCH IMP EXT PROC/CONTR RPLC,,,28 ,,NW,,,,,,"$12,063.36",$0.00,1,1,1,1,1,1,20120101,L8621,HCPCS,REPL ZINC AIR BATTERY,,,28 ,,NW,,,,,,$0.93,$0.00,1,1,1,1,1,1,20120101,L8622,HCPCS,REPL ALKALINE BATTERY,,,28 ,,NW,,,,,,$0.49,$0.00,1,1,1,1,1,1,20120101,L8623,HCPCS,"LITH ION BATT CID,NON-EARLVL",,,28 ,,NW,,,,,,$84.02,$0.00,1,1,1,1,1,1,20120101,L8624,HCPCS,"LITH ION BATT CID, EAR LEVEL",,,28 ,,NW,,,,,,$206.28,$0.00,1,1,1,1,1,1,20120101,L8627,HCPCS,CID EXT SPEECH PROCESS REPL,,,28 ,,NW,,,,,,"$10,307.73",$0.00,1,1,1,1,1,1,20120101,L8628,HCPCS,CID EXT CONTROLLER REPL,,,28 ,,NW,,,,,,"$1,799.17",$0.00,1,1,1,1,1,1,20120101,L8629,HCPCS,CID TRANSMIT COIL AND CABLE,,,28 ,,NW,,,,,,$230.31,$0.00,1,1,1,1,1,1,20120101,L8630,HCPCS,METACARPOPHALANGEAL IMPLANT,,,28 ,,NW,,,,,,$496.70,$0.00,1,1,1,1,1,1,20120101,L8631,HCPCS,MCP JOINT REPL 2 PC OR MORE,,,28 ,,NW,,,,,,"$3,173.63",$0.00,1,1,1,1,1,1,20120101,L8641,HCPCS,METATARSAL JOINT IMPLANT,,,28 ,,NW,,,,,,$500.42,$0.00,1,1,1,1,1,1,20120101,L8642,HCPCS,HALLUX IMPLANT,,,28 ,,NW,,,,,,$423.36,$0.00,1,1,1,1,1,1,20120101,L8658,HCPCS,INTERPHALANGEAL JOINT SPACER,,,28 ,,NW,,,,,,$433.04,$0.00,1,1,1,1,1,1,20120101,L8659,HCPCS,INTERPHALANGEAL JOINT REPL,,,28 ,,NW,,,,,,"$2,764.58",$0.00,1,1,1,1,1,1,20120101,L8670,HCPCS,"VASCULAR GRAFT, SYNTHETIC",,,28 ,,NW,,,,,,$775.09,$0.00,1,1,1,1,1,1,20120101,L8680,HCPCS,IMPLT NEUROSTIM ELCTR EACH,,,28 ,,NW,,,,,,$641.83,$0.00,1,1,1,1,1,1,20120101,L8681,HCPCS,PT PRGRM FOR IMPLT NEUROSTIM,,,28 ,,NW,,,,,,"$1,641.52",$0.00,1,1,1,1,1,1,20120101,L8682,HCPCS,IMPLT NEUROSTIM RADIOFQ REC,,,28 ,,NW,,,,,,"$8,743.19",$0.00,1,1,1,1,1,1,20120101,L8683,HCPCS,RADIOFQ TRSMTR FOR IMPLT NEU,,,28 ,,NW,,,,,,"$7,691.87",$0.00,1,1,1,1,1,1,20120101,L8684,HCPCS,RADIOF TRSMTR IMPLT SCRL NEU,,,28 ,,NW,,,,,,"$1,083.85",$0.00,1,1,1,1,1,1,20120101,L8685,HCPCS,IMPLT NROSTM PLS GEN SNG REC,,,28 ,,NW,,,,,,"$19,219.19",$0.00,1,1,1,1,1,1,20120101,L8686,HCPCS,IMPLT NROSTM PLS GEN SNG NON,,,28 ,,NW,,,,,,"$12,250.90",$0.00,1,1,1,1,1,1,20120101,L8687,HCPCS,IMPLT NROSTM PLS GEN DUA REC,,,28 ,,NW,,,,,,"$25,022.24",$0.00,1,1,1,1,1,1,20120101,L8688,HCPCS,IMPLT NROSTM PLS GEN DUA NON,,,28 ,,NW,,,,,,"$15,953.72",$0.00,1,1,1,1,1,1,20120101,L8689,HCPCS,EXTERNAL RECHARG SYS INTERN,,,28 ,,NW,,,,,,"$2,483.98",$0.00,1,1,1,1,1,1,20120101,L8690,HCPCS,"AUD OSSEO DEV, INT/EXT COMP",,,28 ,,NW,,,,,,"$6,911.10",$0.00,1,1,1,1,1,1,20120101,L8691,HCPCS,OSSEOINTEGRATED SND PROC RPL,,,28 ,,NW,,,,,,"$3,858.74",$0.00,1,1,1,1,1,1,20120101,L8692,HCPCS,NON-OSSEOINTEGRATED SND PROC,,,28 ,,NW,,,,,,$202.75,$0.00,1,1,1,1,1,1,20120101,L8693,HCPCS,"AUD OSSEO DEV, ABUTMENT",,,28 ,,NW,,,,,,"$2,164.99",$0.00,1,1,1,1,1,1,20120101,L8695,HCPCS,EXTERNAL RECHARG SYS EXTERN,,,28 ,,NW,,,,,,$23.22,$0.00,1,1,1,1,1,1,20120101,L8699,HCPCS,PROSTHETIC IMPLANT NOS,,,28 ,,NW,,,,,,$334.42,$0.00,1,1,1,1,1,1,20120101,L9900,HCPCS,O&P SUPPLY/ACCESSORY/SERVICE,,,28 ,,NW,,,,,,$156.79,$0.00,1,1,1,1,1,1,20120101,M0064,HCPCS,VISIT FOR DRUG MONITORING,,,16 ,,RBRVS,0.37 ,0.09 ,0.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,M0076,HCPCS,PROLOTHERAPY,,,14 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,M0300,HCPCS,IV CHELATIONTHERAPY,,,4 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P2031,HCPCS,HAIR ANALYSIS,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P2038,HCPCS,BLOOD MUCOPROTEIN,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P3000,HCPCS,SCREEN PAP BY TECH W MD SUPV,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P3001,HCPCS,SCREENING PAP SMEAR BY PHYS,,,17 ,,RBRVS,0.42 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,P7001,HCPCS,CULTURE BACTERIAL URINE,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9010,HCPCS,WHOLE BLOOD FOR TRANSFUSION,,,14 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9011,HCPCS,BLOOD SPLIT UNIT,,,14 ,,TotalUnits,,,,1.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9012,HCPCS,CRYOPRECIPITATE EACH UNIT,,,14 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9016,HCPCS,RBC LEUKOCYTES REDUCED,,,14 ,,TotalUnits,,,,3.98 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9017,HCPCS,PLASMA 1 DONOR FRZ W/IN 8 HR,,,14 ,,TotalUnits,,,,1.08 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9019,HCPCS,"PLATELETS, EACH UNIT",,,14 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9020,HCPCS,PLAELET RICH PLASMA UNIT,,,14 ,,TotalUnits,,,,4.15 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9021,HCPCS,RED BLOOD CELLS UNIT,,,14 ,,TotalUnits,,,,2.50 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9022,HCPCS,WASHED RED BLOOD CELLS UNIT,,,14 ,,TotalUnits,,,,1.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9031,HCPCS,PLATELETS LEUKOCYTES REDUCED,,,14 ,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9032,HCPCS,"PLATELETS, IRRADIATED",,,14 ,,TotalUnits,,,,1.38 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9034,HCPCS,"PLATELETS, PHERESIS",,,14 ,,TotalUnits,,,,6.94 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9035,HCPCS,PLATELET PHERES LEUKOREDUCED,,,14 ,,TotalUnits,,,,7.76 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9037,HCPCS,PLATE PHERES LEUKOREDU IRRAD,,,14 ,,TotalUnits,,,,13.34 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9040,HCPCS,RBC LEUKOREDUCED IRRADIATED,,,14 ,,TotalUnits,,,,5.97 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9041,HCPCS,"ALBUMIN (HUMAN),5%, 50ML",,,14 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9043,HCPCS,"PLASMA PROTEIN FRACT,5%,50ML",,,14 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9045,HCPCS,"ALBUMIN (HUMAN), 5%, 250 ML",,,14 ,,TotalUnits,,,,1.51 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9046,HCPCS,"ALBUMIN (HUMAN), 25%, 20 ML",,,14 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9047,HCPCS,"ALBUMIN (HUMAN), 25%, 50ML",,,14 ,,TotalUnits,,,,1.23 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9048,HCPCS,"PLASMAPROTEIN FRACT,5%,250ML",,,14 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9053,HCPCS,"PLT, PHER, L/R CMV-NEG, IRR",,,14 ,,TotalUnits,,,,15.12 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9058,HCPCS,"RBC, L/R, CMV-NEG, IRRAD",,,14 ,,TotalUnits,,,,7.51 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9059,HCPCS,"PLASMA, FRZ BETWEEN 8-24HOUR",,,14 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9603,HCPCS,ONE-WAY ALLOW PRORATED MILES,,,17 ,,TotalUnits,,,,0.01 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9604,HCPCS,ONE-WAY ALLOW PRORATED TRIP,,,17 ,,TotalUnits,,,,0.05 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9612,HCPCS,CATHETERIZE FOR URINE SPEC,,,17 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,P9615,HCPCS,URINE SPECIMEN COLLECT MULT,,,17 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,Q0035,HCPCS,CARDIOKYMOGRAPHY,,,4 ,,RBRVS,0.17 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,Q0035,HCPCS,CARDIOKYMOGRAPHY,26,,4 ,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,Q0035,HCPCS,CARDIOKYMOGRAPHY,TC,,4 ,,RBRVS,,0.29 ,0.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,Q0081,HCPCS,INFUSION THER OTHER THAN CHE,,,22 ,,TotalUnits,,,,1.93 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,Q0083,HCPCS,CHEMO BY OTHER THAN INFUSION,,,14 ,,TotalUnits,,,,0.91 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,Q0084,HCPCS,CHEMOTHERAPY BY INFUSION,,,14 ,,TotalUnits,,,,1.99 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,Q0085,HCPCS,CHEMO BY BOTH INFUSION AND O,,,14 ,,TotalUnits,,,,6.14 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,Q0091,HCPCS,OBTAINING SCREEN PAP SMEAR,,,17 ,,RBRVS,0.37 ,0.15 ,0.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20120101,Q0092,HCPCS,SET UP PORT XRAY EQUIPMENT,,TC,20 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,0,1,1,20120101,Q0111,HCPCS,WET MOUNTS/ W PREPARATIONS,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,Q0112,HCPCS,POTASSIUM HYDROXIDE PREPS,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,Q0113,HCPCS,PINWORM EXAMINATIONS,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,Q0114,HCPCS,FERN TEST,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,Q0115,HCPCS,POST-COITAL MUCOUS EXAM,,,17 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,Q0138,HCPCS,"FERUMOXYTOL, NON-ESRD",,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,Q0139,HCPCS,"FERUMOXYTOL, ESRD USE",,,28 ,,NW,,,,,,$52.69,$0.00,1,1,1,0,0,1,20120101,Q0144,HCPCS,"AZITHROMYCIN DIHYDRATE, ORAL",,,29 ,,NW,,,,,,$33.02,$0.00,1,1,1,0,0,1,20120101,Q0163,HCPCS,DIPHENHYDRAMINE HCL 50MG,,,29 ,,NW,,,,,,$1.38,$0.00,1,1,1,0,0,1,20120101,Q0164,HCPCS,PROCHLORPERAZINE MALEATE 5MG,,,29 ,,NW,,,,,,$1.38,$0.00,1,1,1,0,0,1,20120101,Q0165,HCPCS,PROCHLORPERAZINE MALEATE10MG,,,29 ,,NW,,,,,,$1.38,$0.00,1,1,1,0,0,1,20120101,Q0166,HCPCS,GRANISETRON HCL 1 MG ORAL,,,29 ,,NW,,,,,,$2.76,$0.00,1,1,1,0,0,1,20120101,Q0167,HCPCS,DRONABINOL 2.5MG ORAL,,,29 ,,NW,,,,,,$22.08,$0.00,1,1,1,0,0,1,20120101,Q0168,HCPCS,DRONABINOL 5MG ORAL,,,29 ,,NW,,,,,,$57.95,$0.00,1,1,1,0,0,1,20120101,Q0169,HCPCS,PROMETHAZINE HCL 12.5MG ORAL,,,29 ,,NW,,,,,,$1.38,$0.00,1,1,1,0,0,1,20120101,Q0170,HCPCS,PROMETHAZINE HCL 25 MG ORAL,,,29 ,,NW,,,,,,$1.38,$0.00,1,1,1,0,0,1,20120101,Q0171,HCPCS,CHLORPROMAZINE HCL 10MG ORAL,,,29 ,,NW,,,,,,$1.38,$0.00,1,1,1,0,0,1,20120101,Q0172,HCPCS,CHLORPROMAZINE HCL 25MG ORAL,,,29 ,,NW,,,,,,$1.38,$0.00,1,1,1,0,0,1,20120101,Q0173,HCPCS,TRIMETHOBENZAMIDE HCL 250MG,,,29 ,,NW,,,,,,$2.76,$0.00,1,1,1,0,0,1,20120101,Q0174,HCPCS,THIETHYLPERAZINE MALEATE10MG,,,29 ,,NW,,,,,,$2.76,$0.00,1,1,1,0,0,1,20120101,Q0175,HCPCS,PERPHENAZINE 4MG ORAL,,,29 ,,NW,,,,,,$2.76,$0.00,1,1,1,0,0,1,20120101,Q0176,HCPCS,PERPHENAZINE 8MG ORAL,,,29 ,,NW,,,,,,$2.76,$0.00,1,1,1,0,0,1,20120101,Q0177,HCPCS,HYDROXYZINE PAMOATE 25MG,,,29 ,,NW,,,,,,$2.76,$0.00,1,1,1,0,0,1,20120101,Q0178,HCPCS,HYDROXYZINE PAMOATE 50MG,,,29 ,,NW,,,,,,$2.76,$0.00,1,1,1,0,0,1,20120101,Q0180,HCPCS,DOLASETRON MESYLATE ORAL,,,29 ,,NW,,,,,,$225.18,$0.00,1,1,1,0,0,1,20120101,Q0181,HCPCS,UNSPECIFIED ORAL ANTI-EMETIC,,,29 ,,NW,,,,,,$45.81,$0.00,1,1,1,0,0,1,20120101,Q0478,HCPCS,"POWER ADAPTER, COMBO VAD",,,28 ,,NW,,,,,,$234.78,$0.00,1,1,1,1,1,1,20120101,Q0479,HCPCS,"POWER MODULE COMBO VAD, REP",,,28 ,,NW,,,,,,"$17,484.58",$0.00,1,1,1,1,1,1,20120101,Q0480,HCPCS,"DRIVER PNEUMATIC VAD, REP",,,28 ,,NW,,,,,,"$131,462.30",$0.00,1,1,1,1,1,1,20120101,Q0481,HCPCS,"MICROPRCSR CU ELEC VAD, REP",,,28 ,,NW,,,,,,"$21,180.99",$0.00,1,1,1,1,1,1,20120101,Q0482,HCPCS,"MICROPRCSR CU COMBO VAD, REP",,,28 ,,NW,,,,,,"$6,610.59",$0.00,1,1,1,1,1,1,20120101,Q0483,HCPCS,"MONITOR ELEC VAD, REP",,,28 ,,NW,,,,,,"$27,340.28",$0.00,1,1,1,1,1,1,20120101,Q0484,HCPCS,MONITOR ELEC OR COMB VAD REP,,,28 ,,NW,,,,,,"$5,281.60",$0.00,1,1,1,1,1,1,20120101,Q0485,HCPCS,"MONITOR CABLE ELEC VAD, REP",,,28 ,,NW,,,,,,$478.78,$0.00,1,1,1,1,1,1,20120101,Q0486,HCPCS,MON CABLE ELEC/PNEUM VAD REP,,,28 ,,NW,,,,,,$392.69,$0.00,1,1,1,1,1,1,20120101,Q0487,HCPCS,"LEADS ANY TYPE VAD, REP ONLY",,,28 ,,NW,,,,,,$463.89,$0.00,1,1,1,1,1,1,20120101,Q0488,HCPCS,"PWR PACK BASE ELEC VAD, REP",,,28 ,,NW,,,,,,"$21,188.60",$0.00,1,1,1,1,1,1,20120101,Q0489,HCPCS,"PWR PCK BASE COMBO VAD, REP",,,28 ,,NW,,,,,,"$23,697.96",$0.00,1,1,1,1,1,1,20120101,Q0490,HCPCS,"EMR PWR SOURCE ELEC VAD, REP",,,28 ,,NW,,,,,,$992.06,$0.00,1,1,1,1,1,1,20120101,Q0491,HCPCS,EMR PWR SOURCE COMBO VAD REP,,,28 ,,NW,,,,,,"$1,579.35",$0.00,1,1,1,1,1,1,20120101,Q0492,HCPCS,"EMR PWR CBL ELEC VAD, REP",,,28 ,,NW,,,,,,$115.61,$0.00,1,1,1,1,1,1,20120101,Q0493,HCPCS,"EMR PWR CBL COMBO VAD, REP",,,28 ,,NW,,,,,,$335.71,$0.00,1,1,1,1,1,1,20120101,Q0494,HCPCS,"EMR HD PMP ELEC/COMBO, REP",,,28 ,,NW,,,,,,$278.77,$0.00,1,1,1,1,1,1,20120101,Q0495,HCPCS,"CHARGER ELEC/COMBO VAD, REP",,,28 ,,NW,,,,,,"$6,064.15",$0.00,1,1,1,1,1,1,20120101,Q0496,HCPCS,"BATTERY ELEC/COMBO VAD, REP",,,28 ,,NW,,,,,,"$2,154.41",$0.00,1,1,1,1,1,1,20120101,Q0497,HCPCS,"BAT CLPS ELEC/COMB VAD, REP",,,28 ,,NW,,,,,,$649.01,$0.00,1,1,1,1,1,1,20120101,Q0498,HCPCS,"HOLSTER ELEC/COMBO VAD, REP",,,28 ,,NW,,,,,,$715.46,$0.00,1,1,1,1,1,1,20120101,Q0499,HCPCS,BELT/VEST ELEC/COMBO VAD REP,,,28 ,,NW,,,,,,$214.80,$0.00,1,1,1,1,1,1,20120101,Q0500,HCPCS,"FILTERS ELEC/COMBO VAD, REP",,,28 ,,NW,,,,,,$41.03,$0.00,1,1,1,1,1,1,20120101,Q0501,HCPCS,"SHWR COV ELEC/COMBO VAD, REP",,,28 ,,NW,,,,,,$711.14,$0.00,1,1,1,1,1,1,20120101,Q0502,HCPCS,"MOBILITY CART PNEUM VAD, REP",,,28 ,,NW,,,,,,$914.79,$0.00,1,1,1,1,1,1,20120101,Q0503,HCPCS,BATTERY PNEUM VAD REPLACEMNT,,,28 ,,NW,,,,,,"$1,864.09",$0.00,1,1,1,1,1,1,20120101,Q0504,HCPCS,"PWR ADPT PNEUM VAD, REP VEH",,,28 ,,NW,,,,,,$967.34,$0.00,1,1,1,1,1,1,20120101,Q0505,HCPCS,MISCL SUPPLY/ACCESSORY VAD,,,28 ,,NW,,,,,,$15.38,$0.00,1,1,1,1,1,1,20120101,Q0506,HCPCS,LITH-ION BATT ELEC/PNEUM VAD,,,28 ,,NW,,,,,,"$1,212.55",$0.00,1,1,1,1,1,1,20120101,Q0510,HCPCS,DISPENS FEE IMMUNOSUPRESSIVE,,,29 ,,NW,,,,,,$64.71,$0.00,1,1,1,0,0,1,20120101,Q0511,HCPCS,"SUP FEE ANTIEM,ANTICA,IMMUNO",,,29 ,,NW,,,,,,$31.06,$0.00,1,1,1,0,0,1,20120101,Q0512,HCPCS,PX SUP FEE ANTI-CAN SUB PRES,,,29 ,,NW,,,,,,$20.71,$0.00,1,1,1,0,0,1,20120101,Q0513,HCPCS,DISP FEE INHAL DRUGS/30 DAYS,,,29 ,,NW,,,,,,$64.71,$0.00,1,1,1,0,0,1,20120101,Q0514,HCPCS,DISP FEE INHAL DRUGS/90 DAYS,,,29 ,,NW,,,,,,$85.42,$0.00,1,1,1,0,0,1,20120101,Q0515,HCPCS,SERMORELIN ACETATE INJECTION,,,29 ,,NW,,,,,,$5.13,$0.00,1,1,1,0,0,1,20120101,Q2004,HCPCS,BLADDER CALCULI IRRIG SOL,,,29 ,,NW,,,,,,$36.25,$0.00,1,1,1,0,0,1,20120101,Q2009,HCPCS,FOSPHENYTOIN INJ PE,,,29 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,Q2017,HCPCS,"TENIPOSIDE, 50 MG",,,29 ,,NW,,,,,,"$1,032.90",$0.00,1,1,1,0,0,1,20120101,Q2026,HCPCS,RADIESSE INJECTION,,,14 ,,TotalUnits,,,,8.54 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,Q2027,HCPCS,SCULPTRA INJECTION,,,14 ,,TotalUnits,,,,8.54 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,Q2035,HCPCS,"AFLURIA VACC, 3 YRS & >, IM",,,9 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,Q2036,HCPCS,"FLULAVAL VACC, 3 YRS & >, IM",,,9 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,Q2037,HCPCS,"FLUVIRIN VACC, 3 YRS & >, IM",,,9 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,Q2038,HCPCS,"FLUZONE VACC, 3 YRS & >, IM",,,9 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,Q2039,HCPCS,"NOS FLU VACC, 3 YRS & >, IM",,,9 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,Q2043,HCPCS,SIPULEUCEL-T AUTO CD54+,,,29 ,,NW,,,,,,"$77,882.07",$0.00,1,1,1,0,0,1,20120101,Q3001,HCPCS,BRACHYTHERAPY RADIOELEMENTS,,,28 ,,NW,,,,,,$95.06,$0.00,1,1,1,0,0,1,20120101,Q3014,HCPCS,TELEHEALTH FACILITY FEE,,,14 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,Q3025,HCPCS,IM INJ INTERFERON BETA 1-A,,,29 ,,NW,,,,,,$566.10,$0.00,1,1,1,0,0,1,20120101,Q3026,HCPCS,SUBC INJ INTERFERON BETA-1A,,,29 ,,NW,,,,,,$165.53,$0.00,1,1,1,0,0,1,20120101,Q4001,HCPCS,CAST SUP BODY CAST PLASTER,,,28 ,,NW,,,,,,$147.72,$0.00,1,1,1,0,0,1,20120101,Q4002,HCPCS,CAST SUP BODY CAST FIBERGLAS,,,28 ,,NW,,,,,,$306.61,$0.00,1,1,1,0,0,1,20120101,Q4003,HCPCS,CAST SUP SHOULDER CAST PLSTR,,,28 ,,NW,,,,,,$83.01,$0.00,1,1,1,0,0,1,20120101,Q4004,HCPCS,CAST SUP SHOULDER CAST FBRGL,,,28 ,,NW,,,,,,$169.29,$0.00,1,1,1,0,0,1,20120101,Q4005,HCPCS,CAST SUP LONG ARM ADULT PLST,,,28 ,,NW,,,,,,$48.81,$0.00,1,1,1,0,0,1,20120101,Q4006,HCPCS,CAST SUP LONG ARM ADULT FBRG,,,28 ,,NW,,,,,,$96.16,$0.00,1,1,1,0,0,1,20120101,Q4007,HCPCS,CAST SUP LONG ARM PED PLSTER,,,28 ,,NW,,,,,,$27.76,$0.00,1,1,1,0,0,1,20120101,Q4008,HCPCS,CAST SUP LONG ARM PED FBRGLS,,,28 ,,NW,,,,,,$51.44,$0.00,1,1,1,0,0,1,20120101,Q4009,HCPCS,CAST SUP SHT ARM ADULT PLSTR,,,28 ,,NW,,,,,,$38.81,$0.00,1,1,1,0,0,1,20120101,Q4010,HCPCS,CAST SUP SHT ARM ADULT FBRGL,,,28 ,,NW,,,,,,$76.17,$0.00,1,1,1,0,0,1,20120101,Q4011,HCPCS,CAST SUP SHT ARM PED PLASTER,,,28 ,,NW,,,,,,$23.03,$0.00,1,1,1,0,0,1,20120101,Q4012,HCPCS,CAST SUP SHT ARM PED FBRGLAS,,,28 ,,NW,,,,,,$41.44,$0.00,1,1,1,0,0,1,20120101,Q4013,HCPCS,CAST SUP GAUNTLET PLASTER,,,28 ,,NW,,,,,,$37.23,$0.00,1,1,1,0,0,1,20120101,Q4014,HCPCS,CAST SUP GAUNTLET FIBERGLASS,,,28 ,,NW,,,,,,$71.96,$0.00,1,1,1,0,0,1,20120101,Q4015,HCPCS,CAST SUP GAUNTLET PED PLSTER,,,28 ,,NW,,,,,,$21.98,$0.00,1,1,1,0,0,1,20120101,Q4016,HCPCS,CAST SUP GAUNTLET PED FBRGLS,,,28 ,,NW,,,,,,$39.34,$0.00,1,1,1,0,0,1,20120101,Q4017,HCPCS,CAST SUP LNG ARM SPLINT PLST,,,28 ,,NW,,,,,,$33.55,$0.00,1,1,1,0,0,1,20120101,Q4018,HCPCS,CAST SUP LNG ARM SPLINT FBRG,,,28 ,,NW,,,,,,$63.54,$0.00,1,1,1,0,0,1,20120101,Q4019,HCPCS,CAST SUP LNG ARM SPLNT PED P,,,28 ,,NW,,,,,,$19.87,$0.00,1,1,1,0,0,1,20120101,Q4020,HCPCS,CAST SUP LNG ARM SPLNT PED F,,,28 ,,NW,,,,,,$35.13,$0.00,1,1,1,0,0,1,20120101,Q4021,HCPCS,CAST SUP SHT ARM SPLINT PLST,,,28 ,,NW,,,,,,$33.55,$0.00,1,1,1,0,0,1,20120101,Q4022,HCPCS,CAST SUP SHT ARM SPLINT FBRG,,,28 ,,NW,,,,,,$63.54,$0.00,1,1,1,0,0,1,20120101,Q4023,HCPCS,CAST SUP SHT ARM SPLNT PED P,,,28 ,,NW,,,,,,$19.87,$0.00,1,1,1,0,0,1,20120101,Q4024,HCPCS,CAST SUP SHT ARM SPLNT PED F,,,28 ,,NW,,,,,,$35.13,$0.00,1,1,1,0,0,1,20120101,Q4025,HCPCS,CAST SUP HIP SPICA PLASTER,,,28 ,,NW,,,,,,$125.10,$0.00,1,1,1,0,0,1,20120101,Q4026,HCPCS,CAST SUP HIP SPICA FIBERGLAS,,,28 ,,NW,,,,,,$258.74,$0.00,1,1,1,0,0,1,20120101,Q4027,HCPCS,CAST SUP HIP SPICA PED PLSTR,,,28 ,,NW,,,,,,$66.17,$0.00,1,1,1,0,0,1,20120101,Q4028,HCPCS,CAST SUP HIP SPICA PED FBRGL,,,28 ,,NW,,,,,,$132.99,$0.00,1,1,1,0,0,1,20120101,Q4029,HCPCS,CAST SUP LONG LEG PLASTER,,,28 ,,NW,,,,,,$65.12,$0.00,1,1,1,0,0,1,20120101,Q4030,HCPCS,CAST SUP LONG LEG FIBERGLASS,,,28 ,,NW,,,,,,$130.89,$0.00,1,1,1,0,0,1,20120101,Q4031,HCPCS,CAST SUP LNG LEG PED PLASTER,,,28 ,,NW,,,,,,$36.18,$0.00,1,1,1,0,0,1,20120101,Q4032,HCPCS,CAST SUP LNG LEG PED FBRGLS,,,28 ,,NW,,,,,,$68.80,$0.00,1,1,1,0,0,1,20120101,Q4033,HCPCS,CAST SUP LNG LEG CYLINDER PL,,,28 ,,NW,,,,,,$56.70,$0.00,1,1,1,0,0,1,20120101,Q4034,HCPCS,CAST SUP LNG LEG CYLINDER FB,,,28 ,,NW,,,,,,$112.47,$0.00,1,1,1,0,0,1,20120101,Q4035,HCPCS,CAST SUP LNGLEG CYLNDR PED P,,,28 ,,NW,,,,,,$31.45,$0.00,1,1,1,0,0,1,20120101,Q4036,HCPCS,CAST SUP LNGLEG CYLNDR PED F,,,28 ,,NW,,,,,,$59.33,$0.00,1,1,1,0,0,1,20120101,Q4037,HCPCS,CAST SUP SHRT LEG PLASTER,,,28 ,,NW,,,,,,$73.54,$0.00,1,1,1,0,0,1,20120101,Q4038,HCPCS,CAST SUP SHRT LEG FIBERGLASS,,,28 ,,NW,,,,,,$149.30,$0.00,1,1,1,0,0,1,20120101,Q4039,HCPCS,CAST SUP SHRT LEG PED PLSTER,,,28 ,,NW,,,,,,$39.87,$0.00,1,1,1,0,0,1,20120101,Q4040,HCPCS,CAST SUP SHRT LEG PED FBRGLS,,,28 ,,NW,,,,,,$78.27,$0.00,1,1,1,0,0,1,20120101,Q4041,HCPCS,CAST SUP LNG LEG SPLNT PLSTR,,,28 ,,NW,,,,,,$45.13,$0.00,1,1,1,0,0,1,20120101,Q4042,HCPCS,CAST SUP LNG LEG SPLNT FBRGL,,,28 ,,NW,,,,,,$88.27,$0.00,1,1,1,0,0,1,20120101,Q4043,HCPCS,CAST SUP LNG LEG SPLNT PED P,,,28 ,,NW,,,,,,$26.19,$0.00,1,1,1,0,0,1,20120101,Q4044,HCPCS,CAST SUP LNG LEG SPLNT PED F,,,28 ,,NW,,,,,,$47.76,$0.00,1,1,1,0,0,1,20120101,Q4045,HCPCS,CAST SUP SHT LEG SPLNT PLSTR,,,28 ,,NW,,,,,,$31.45,$0.00,1,1,1,0,0,1,20120101,Q4046,HCPCS,CAST SUP SHT LEG SPLNT FBRGL,,,28 ,,NW,,,,,,$59.33,$0.00,1,1,1,0,0,1,20120101,Q4047,HCPCS,CAST SUP SHT LEG SPLNT PED P,,,28 ,,NW,,,,,,$18.82,$0.00,1,1,1,0,0,1,20120101,Q4048,HCPCS,CAST SUP SHT LEG SPLNT PED F,,,28 ,,NW,,,,,,$33.03,$0.00,1,1,1,0,0,1,20120101,Q4049,HCPCS,"FINGER SPLINT, STATIC",,,28 ,,NW,,,,,,$16.22,$0.00,1,1,1,0,0,1,20120101,Q4050,HCPCS,CAST SUPPLIES UNLISTED,,,28 ,,NW,,,,,,$48.58,$0.00,1,1,1,0,0,1,20120101,Q4051,HCPCS,SPLINT SUPPLIES MISC,,,28 ,,NW,,,,,,$32.79,$0.00,1,1,1,0,0,1,20120101,Q4074,HCPCS,ILOPROST NON-COMP UNIT DOSE,,,29 ,,NW,,,,,,$164.28,$0.00,1,1,1,0,0,1,20120101,Q4081,HCPCS,"EPOETIN ALFA, 100 UNITS ESRD",,,29 ,,NW,,,,,,$3.08,$0.00,1,1,1,0,0,1,20120101,Q4082,HCPCS,DRUG/BIO NOC PART B DRUG CAP,,,29 ,,NW,,,,,,"$2,715.96",$0.00,1,1,1,0,0,1,20120101,Q4100,HCPCS,"SKIN SUBSTITUTE, NOS",,,29 ,,NW,,,,,,$15.38,$0.00,1,1,1,0,0,1,20120101,Q4101,HCPCS,APLIGRAF,,,29 ,,NW,,,,,,$89.39,$0.00,1,1,1,0,0,1,20120101,Q4102,HCPCS,OASIS WOUND MATRIX,,,29 ,,NW,,,,,,$13.66,$0.00,1,1,1,0,0,1,20120101,Q4103,HCPCS,OASIS BURN MATRIX,,,29 ,,NW,,,,,,$13.66,$0.00,1,1,1,0,0,1,20120101,Q4104,HCPCS,INTEGRA BMWD,,,29 ,,NW,,,,,,$43.49,$0.00,1,1,1,0,0,1,20120101,Q4105,HCPCS,INTEGRA DRT,,,29 ,,NW,,,,,,$27.39,$0.00,1,1,1,0,0,1,20120101,Q4106,HCPCS,DERMAGRAFT,,,29 ,,NW,,,,,,$99.86,$0.00,1,1,1,0,0,1,20120101,Q4107,HCPCS,GRAFTJACKET,,,29 ,,NW,,,,,,$230.31,$0.00,1,1,1,0,0,1,20120101,Q4108,HCPCS,INTEGRA MATRIX,,,29 ,,NW,,,,,,$49.94,$0.00,1,1,1,0,0,1,20120101,Q4110,HCPCS,PRIMATRIX,,,29 ,,NW,,,,,,$76.51,$0.00,1,1,1,0,0,1,20120101,Q4111,HCPCS,GAMMAGRAFT,,,29 ,,NW,,,,,,$19.34,$0.00,1,1,1,0,0,1,20120101,Q4112,HCPCS,CYMETRA INJECTABLE,,,29 ,,NW,,,,,,$843.11,$0.00,1,1,1,0,0,1,20120101,Q4113,HCPCS,GRAFTJACKET XPRESS,,,29 ,,NW,,,,,,$843.11,$0.00,1,1,1,0,0,1,20120101,Q4114,HCPCS,INTEGRA FLOWABLE WOUND MATRI,,,29 ,,NW,,,,,,"$2,453.63",$0.00,1,1,1,0,0,1,20120101,Q4115,HCPCS,ALLOSKIN,,,29 ,,NW,,,,,,$19.02,$0.00,1,1,1,0,0,1,20120101,Q4116,HCPCS,ALLODERM,,,29 ,,NW,,,,,,$79.73,$0.00,1,1,1,0,0,1,20120101,Q4119,HCPCS,MATRISTEM WOUND MATRIX,,,29 ,,NW,,,,,,$37.60,$0.00,1,1,1,0,0,1,20120101,Q4123,HCPCS,ALLOSKIN,,,29 ,,NW,,,,,,$19.02,$0.00,1,1,1,0,0,1,20120101,Q5001,HCPCS,HOSPICE IN PATIENT HOME,,,14 ,,TotalUnits,,,,1.35 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,Q5002,HCPCS,HOSPICE IN ASSISTED LIVING,,,14 ,,TotalUnits,,,,1.61 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,Q5003,HCPCS,HOSPICE IN LT/NON-SKILLED NF,,,14 ,,TotalUnits,,,,0.06 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,Q5004,HCPCS,HOSPICE IN SNF,,,14 ,,TotalUnits,,,,1.52 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,Q5005,HCPCS,"HOSPICE, INPATIENT HOSPITAL",,,14 ,,TotalUnits,,,,5.03 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,Q5006,HCPCS,HOSPICE IN HOSPICE FACILITY,,,14 ,,TotalUnits,,,,6.27 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,Q5010,HCPCS,HOSPICE HOME CARE IN HOSPICE,,,14 ,,TotalUnits,,,,6.27 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,Q9951,HCPCS,"LOCM >= 400 MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$2.26,$0.00,1,1,1,0,0,1,20120101,Q9953,HCPCS,"INJ FE-BASED MR CONTRAST,1ML",,,28 ,,NW,,,,,,$9.57,$0.00,1,1,1,0,0,1,20120101,Q9954,HCPCS,"ORAL MR CONTRAST, 100 ML",,,28 ,,NW,,,,,,$58.59,$0.00,1,1,1,0,0,1,20120101,Q9955,HCPCS,"INJ PERFLEXANE LIP MICROS,ML",,,28 ,,NW,,,,,,$3.98,$0.00,1,1,1,0,0,1,20120101,Q9956,HCPCS,"INJ OCTAFLUOROPROPANE MIC,ML",,,28 ,,NW,,,,,,$55.80,$0.00,1,1,1,0,0,1,20120101,Q9957,HCPCS,"INJ PERFLUTREN LIP MICROS,ML",,,28 ,,NW,,,,,,$156.30,$0.00,1,1,1,0,0,1,20120101,Q9958,HCPCS,"HOCM <=149 MG/ML IODINE, 1ML",,,28 ,,NW,,,,,,$0.08,$0.00,1,1,1,0,0,1,20120101,Q9959,HCPCS,"HOCM 150-199MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$0.52,$0.00,1,1,1,0,0,1,20120101,Q9960,HCPCS,"HOCM 200-249MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$1.05,$0.00,1,1,1,0,0,1,20120101,Q9961,HCPCS,"HOCM 250-299MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$1.57,$0.00,1,1,1,0,0,1,20120101,Q9962,HCPCS,"HOCM 300-349MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$1.62,$0.00,1,1,1,0,0,1,20120101,Q9963,HCPCS,"HOCM 350-399MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$2.05,$0.00,1,1,1,0,0,1,20120101,Q9964,HCPCS,"HOCM>= 400MG/ML IODINE, 1ML",,,28 ,,NW,,,,,,$2.47,$0.00,1,1,1,0,0,1,20120101,Q9965,HCPCS,"LOCM 100-199MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$2.55,$0.00,1,1,1,0,0,1,20120101,Q9966,HCPCS,"LOCM 200-299MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$3.70,$0.00,1,1,1,0,0,1,20120101,Q9967,HCPCS,"LOCM 300-399MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$5.37,$0.00,1,1,1,0,0,1,20120101,R0070,HCPCS,TRANSPORT PORTABLE X-RAY,,TC,20 ,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,R0075,HCPCS,TRANSPORT PORT X-RAY MULTIPL,,TC,20 ,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,R0076,HCPCS,TRANSPORT PORTABLE EKG,,,20 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,S0012,HCPCS,"BUTORPHANOL TARTRATE, NASAL",,,28 ,,NW,,,,,,$144.82,$0.00,1,1,1,0,0,1,20120101,S0014,HCPCS,"TACRINE HYDROCHLORIDE, 10 MG",,,28 ,,NW,,,,,,$4.96,$0.00,1,1,1,0,0,1,20120101,S0017,HCPCS,"INJECTION, AMINOCAPROIC ACID",,,28 ,,NW,,,,,,$12.14,$0.00,1,1,1,0,0,1,20120101,S0020,HCPCS,"INJECTION, BUPIVICAINE HYDRO",,,28 ,,NW,,,,,,$8.37,$0.00,1,1,1,0,0,1,20120101,S0021,HCPCS,"INJECTION, CEFOPERAZONE SOD",,,28 ,,NW,,,,,,$6.68,$0.00,1,1,1,0,0,1,20120101,S0023,HCPCS,"INJECTION, CIMETIDINE HYDROC",,,28 ,,NW,,,,,,$5.79,$0.00,1,1,1,0,0,1,20120101,S0028,HCPCS,"INJECTION, FAMOTIDINE, 20 MG",,,28 ,,NW,,,,,,$3.96,$0.00,1,1,1,0,0,1,20120101,S0030,HCPCS,"INJECTION, METRONIDAZOLE",,,28 ,,NW,,,,,,$19.08,$0.00,1,1,1,0,0,1,20120101,S0032,HCPCS,"INJECTION, NAFCILLIN SODIUM",,,28 ,,NW,,,,,,$41.13,$0.00,1,1,1,0,0,1,20120101,S0034,HCPCS,"INJECTION, OFLOXACIN, 400 MG",,,28 ,,NW,,,,,,$29.98,$0.00,1,1,1,0,0,1,20120101,S0039,HCPCS,"INJECTION, SULFAMETHOXAZOLE",,,28 ,,NW,,,,,,$21.77,$0.00,1,1,1,0,0,1,20120101,S0040,HCPCS,"INJECTION, TICARCILLIN DISOD",,,28 ,,NW,,,,,,$27.43,$0.00,1,1,1,0,0,1,20120101,S0073,HCPCS,"INJECTION, AZTREONAM, 500 MG",,,28 ,,NW,,,,,,$33.88,$0.00,1,1,1,0,0,1,20120101,S0074,HCPCS,"INJECTION, CEFOTETAN DISODIU",,,28 ,,NW,,,,,,$52.04,$0.00,1,1,1,0,0,1,20120101,S0077,HCPCS,"INJECTION, CLINDAMYCIN PHOSP",,,28 ,,NW,,,,,,$6.98,$0.00,1,1,1,0,0,1,20120101,S0078,HCPCS,"INJECTION, FOSPHENYTOIN SODI",,,28 ,,NW,,,,,,$332.29,$0.00,1,1,1,0,0,1,20120101,S0080,HCPCS,"INJECTION, PENTAMIDINE ISETH",,,28 ,,NW,,,,,,$129.17,$0.00,1,1,1,0,0,1,20120101,S0081,HCPCS,"INJECTION, PIPERACILLIN SODI",,,28 ,,NW,,,,,,$3.55,$0.00,1,1,1,0,0,1,20120101,S0088,HCPCS,IMATINIB 100 MG,,,28 ,,NW,,,,,,$98.79,$0.00,1,1,1,0,0,1,20120101,S0090,HCPCS,"SILDENAFIL CITRATE, 25 MG",,,28 ,,NW,,,,,,$32.06,$0.00,1,1,1,0,0,1,20120101,S0091,HCPCS,GRANISETRON 1MG,,,28 ,,NW,,,,,,$153.41,$0.00,1,1,1,0,0,1,20120101,S0092,HCPCS,HYDROMORPHONE 250 MG,,,28 ,,NW,,,,,,$194.86,$0.00,1,1,1,0,0,1,20120101,S0093,HCPCS,MORPHINE 500 MG,,,28 ,,NW,,,,,,$31.32,$0.00,1,1,1,0,0,1,20120101,S0104,HCPCS,"ZIDOVUDINE, ORAL, 100 MG",,,28 ,,NW,,,,,,$3.43,$0.00,1,1,1,0,0,1,20120101,S0106,HCPCS,BUPROPION HCL SR 60 TABLETS,,,28 ,,NW,,,,,,$206.14,$0.00,1,1,1,0,0,1,20120101,S0108,HCPCS,MERCAPTOPURINE 50 MG,,,28 ,,NW,,,,,,$7.11,$0.00,1,1,1,0,0,1,20120101,S0109,HCPCS,METHADONE ORAL 5MG,,,28 ,,NW,,,,,,$0.53,$0.00,1,1,1,0,0,1,20120101,S0119,HCPCS,ONDANSETRON 4 MG,,,28 ,,NW,,,,,,$42.16,$0.00,1,1,1,0,0,1,20120101,S0122,HCPCS,INJ MENOTROPINS 75 IU,,,28 ,,NW,,,,,,$132.40,$0.00,1,1,1,0,0,1,20120101,S0126,HCPCS,INJ FOLLITROPIN ALFA 75 IU,,,28 ,,NW,,,,,,$151.14,$0.00,1,1,1,0,0,1,20120101,S0128,HCPCS,INJ FOLLITROPIN BETA 75 IU,,,28 ,,NW,,,,,,$143.81,$0.00,1,1,1,0,0,1,20120101,S0132,HCPCS,INJ GANIRELIX ACETAT 250 MCG,,,28 ,,NW,,,,,,$199.13,$0.00,1,1,1,0,0,1,20120101,S0136,HCPCS,"CLOZAPINE, 25 MG",,,28 ,,NW,,,,,,$2.44,$0.00,1,1,1,0,0,1,20120101,S0137,HCPCS,"DIDANOSINE, 25 MG",,,28 ,,NW,,,,,,$15.00,$0.00,1,1,1,0,0,1,20120101,S0138,HCPCS,"FINASTERIDE, 5 MG",,,28 ,,NW,,,,,,$5.31,$0.00,1,1,1,0,0,1,20120101,S0139,HCPCS,"MINOXIDIL, 10 MG",,,28 ,,NW,,,,,,$2.10,$0.00,1,1,1,0,0,1,20120101,S0140,HCPCS,"SAQUINAVIR, 200 MG",,,28 ,,NW,,,,,,$3.55,$0.00,1,1,1,0,0,1,20120101,S0142,HCPCS,COLISTIMETHATE INH SOL MG,,,28 ,,NW,,,,,,$20.01,$0.00,1,1,1,0,0,1,20120101,S0145,HCPCS,PEG INTERFERON ALFA-2A/180,,,28 ,,NW,,,,,,$50.23,$0.00,1,1,1,0,0,1,20120101,S0155,HCPCS,EPOPROSTENOL DILUTANT,,,28 ,,NW,,,,,,$29.28,$0.00,1,1,1,0,0,1,20120101,S0156,HCPCS,"EXEMESTANE, 25 MG",,,28 ,,NW,,,,,,$15.85,$0.00,1,1,1,0,0,1,20120101,S0157,HCPCS,"BECAPLERMIN GEL 1%, 0.5 GM",,,28 ,,NW,,,,,,$33.15,$0.00,1,1,1,0,0,1,20120101,S0160,HCPCS,DEXTROAMPHETAMINE,,,28 ,,NW,,,,,,$0.75,$0.00,1,1,1,0,0,1,20120101,S0164,HCPCS,INJECTION PANTROPRAZOLE,,,28 ,,NW,,,,,,$24.44,$0.00,1,1,1,0,0,1,20120101,S0166,HCPCS,INJ OLANZAPINE 2.5MG,,,28 ,,NW,,,,,,$11.10,$0.00,1,1,1,0,0,1,20120101,S0170,HCPCS,ANASTROZOLE 1 MG,,,28 ,,NW,,,,,,$15.24,$0.00,1,1,1,0,0,1,20120101,S0171,HCPCS,BUMETANIDE 0.5 MG,,,28 ,,NW,,,,,,$2.24,$0.00,1,1,1,0,0,1,20120101,S0172,HCPCS,CHLORAMBUCIL 2 MG,,,28 ,,NW,,,,,,$4.18,$0.00,1,1,1,0,0,1,20120101,S0174,HCPCS,DOLASETRON 50 MG,,,28 ,,NW,,,,,,$97.64,$0.00,1,1,1,0,0,1,20120101,S0175,HCPCS,FLUTAMIDE 125 MG,,,28 ,,NW,,,,,,$4.04,$0.00,1,1,1,0,0,1,20120101,S0176,HCPCS,HYDROXYUREA 500 MG,,,28 ,,NW,,,,,,$2.16,$0.00,1,1,1,0,0,1,20120101,S0177,HCPCS,LEVAMISOLE 50 MG,,,28 ,,NW,,,,,,$9.39,$0.00,1,1,1,0,0,1,20120101,S0178,HCPCS,LOMUSTINE 10 MG,,,28 ,,NW,,,,,,$48.38,$0.00,1,1,1,0,0,1,20120101,S0179,HCPCS,MEGESTROL 20 MG,,,28 ,,NW,,,,,,$1.09,$0.00,1,1,1,0,0,1,20120101,S0182,HCPCS,PROCARBAZINE 5 MG,,,28 ,,NW,,,,,,$97.35,$0.00,1,1,1,0,0,1,20120101,S0183,HCPCS,PROCHLORPERAZINE 5 MG,,,28 ,,NW,,,,,,$1.24,$0.00,1,1,1,0,0,1,20120101,S0187,HCPCS,TAMOXIFEN 10 MG,,,28 ,,NW,,,,,,$4.04,$0.00,1,1,1,0,0,1,20120101,S0189,HCPCS,TESTOSTERONE PELLET 75 MG,,,28 ,,NW,,,,,,$118.58,$0.00,1,1,1,0,0,1,20120101,S0190,HCPCS,"MIFEPRISTONE, ORAL, 200 MG",,,28 ,,NW,,,,,,$152.77,$0.00,1,1,1,0,0,1,20120101,S0191,HCPCS,"MISOPROSTOL, ORAL, 200 MCG",,,28 ,,NW,,,,,,$3.97,$0.00,1,1,1,0,0,1,20120101,S0195,HCPCS,PNEUMO VACCINE 5-9 YRS,,,28 ,,NW,,,,,,$65.82,$0.00,1,1,1,0,1,1,20120101,S0199,HCPCS,MED ABORTION INC ALL EX DRUG,,,12 ,,TotalUnits,,,,4.65 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0201,HCPCS,PARTIAL HOSPITALIZATION SERV,,,14 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S0207,HCPCS,PARAMEDICINTERCEP NONHOSPALS,,,14 ,,TotalUnits,,,,7.09 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S0208,HCPCS,PARAMED INTRCEPT NONVOL,,,14 ,,TotalUnits,,,,4.56 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S0220,HCPCS,MEDICAL CONFERENCE BY PHYSIC,,,15 ,,TotalUnits,,,,2.81 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0221,HCPCS,"MEDICAL CONFERENCE, 60 MIN",,,15 ,,RBRVS,1.42 ,0.44 ,1.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0255,HCPCS,HOSPICE REFER VISIT NONMD,,,15 ,,RBRVS,0.48 ,0.11 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0257,HCPCS,END OF LIFE COUNSELING,,,15 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0260,HCPCS,H&P FOR SURGERY,,,15 ,,TotalUnits,,,,1.44 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0265,HCPCS,GENETIC COUNSEL 15 MINS,,,14 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0302,HCPCS,COMPLETED EPSDT,,,18 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0315,HCPCS,DISEASE MANAGEMENT PROGRAM,,,14 ,,TotalUnits,,,,1.12 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0316,HCPCS,FOLLOW-UP/REASSESSMENT,,,14 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0317,HCPCS,DISEASE MGMT PER DIEM,,,14 ,,TotalUnits,,,,1.47 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0390,HCPCS,ROUT FOOT CARE PER VISIT,,,14 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0395,HCPCS,IMPRESSION CASTING FT,,,28 ,,NW,,,,,,$96.42,$0.00,1,1,1,0,1,1,20120101,S0400,HCPCS,GLOBAL ESWL KIDNEY,,,21 ,,RBRVS,9.64 ,6.13 ,17.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20120101,S0500,HCPCS,DISPOS CONT LENS,,,28 ,,NW,,,,,,$61.40,$0.00,1,1,1,1,1,1,20120101,S0504,HCPCS,SINGL PRSCRP LENS,,,28 ,,NW,,,,,,$111.27,$0.00,1,1,1,1,1,1,20120101,S0506,HCPCS,BIFOC PRSCP LENS,,,28 ,,NW,,,,,,$157.90,$0.00,1,1,1,1,1,1,20120101,S0508,HCPCS,TRIFOC PRSCRP LENS,,,28 ,,NW,,,,,,$99.44,$0.00,1,1,1,1,1,1,20120101,S0510,HCPCS,NON-PRSCRP LENS,,,28 ,,NW,,,,,,$39.00,$0.00,1,1,1,1,1,1,20120101,S0512,HCPCS,DAILY CONT LENS,,,28 ,,NW,,,,,,$92.02,$0.00,1,1,1,1,1,1,20120101,S0514,HCPCS,COLOR CONT LENS,,,28 ,,NW,,,,,,$170.46,$0.00,1,1,1,1,1,1,20120101,S0515,HCPCS,SCLERAL LENS LIQUID BANDAGE,,,28 ,,NW,,,,,,$365.74,$0.00,1,1,1,1,1,1,20120101,S0516,HCPCS,SAFETY FRAMES,,,28 ,,NW,,,,,,$105.66,$0.00,1,1,1,1,1,1,20120101,S0518,HCPCS,SUNGLASS FRAMES,,,28 ,,NW,,,,,,$51.73,$0.00,1,1,1,1,1,1,20120101,S0580,HCPCS,POLYCARB LENS,,,28 ,,NW,,,,,,$39.50,$0.00,1,1,1,1,1,1,20120101,S0581,HCPCS,NONSTND LENS,,,28 ,,NW,,,,,,$244.78,$0.00,1,1,1,1,1,1,20120101,S0592,HCPCS,COMP CONT LENS EVAL,,,23 ,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0595,HCPCS,NEW LENSES IN PTS OLD FRAME,,,28 ,,NW,,,,,,$7.06,$0.00,1,1,1,1,1,1,20120101,S0601,HCPCS,SCREENING PROCTOSCOPY,,,21 ,,RBRVS,0.55 ,0.38 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0610,HCPCS,ANNUAL GYNECOLOGICAL EXAMINA,,,18 ,,TotalUnits,,,,2.79 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0612,HCPCS,ANNUAL GYNECOLOGICAL EXAMINA,,,18 ,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0613,HCPCS,ANN BREAST EXAM,,,18 ,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0618,HCPCS,AUDIOMETRY FOR HEARING AID,,,8 ,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S0620,HCPCS,ROUTINE OPHTHALMOLOGICAL EXA,,,23 ,,TotalUnits,,,,1.25 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0621,HCPCS,ROUTINE OPHTHALMOLOGICAL EXA,,,23 ,,TotalUnits,,,,1.40 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0622,HCPCS,PHYS EXAM FOR COLLEGE,,,14 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0630,HCPCS,REMOVAL OF SUTURES,,,14 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0800,HCPCS,LASER IN SITU KERATOMILEUSIS,,,14 ,,TotalUnits,,,,15.46 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0810,HCPCS,PHOTOREFRACTIVE KERATECTOMY,,,14 ,,TotalUnits,,,,16.09 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S0812,HCPCS,PHOTOTHERAP KERATECT,,,14 ,,RBRVS,0.92 ,0.64 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S1001,HCPCS,DELUXE ITEM,,,28 ,,NW,,,,,,$22.19,$0.00,1,1,1,1,1,1,20120101,S1002,HCPCS,CUSTOM ITEM,,,28 ,,NW,,,,,,$22.51,$0.00,1,1,1,1,1,1,20120101,S1015,HCPCS,IV TUBING EXTENSION SET,,,28 ,,NW,,,,,,$35.93,$0.00,1,1,1,0,0,1,20120101,S1016,HCPCS,NON-PVC INTRAVENOUS ADMINIST,,,28 ,,NW,,,,,,$50.45,$0.00,1,1,1,0,0,1,20120101,S1040,HCPCS,CRANIAL REMOLDING ORTHOSIS,,,28 ,,NW,,,,,,$513.97,$0.00,1,1,1,1,1,1,20120101,S2053,HCPCS,TRANSPLANTATION OF SMALL INT,,,21 ,,RBRVS,83.29 ,27.76 ,27.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2054,HCPCS,TRANSPLANTATION OF MULTIVISC,,,21 ,,RBRVS,61.68 ,22.96 ,22.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2055,HCPCS,HARVESTING OF DONOR MULTIVIS,,,21 ,,RBRVS,61.68 ,22.96 ,22.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2060,HCPCS,LOBAR LUNG TRANSPLANTATION,,,21 ,,RBRVS,40.94 ,20.19 ,20.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2065,HCPCS,SIMULT PANC KIDN TRANS,,,21 ,,RBRVS,61.68 ,22.96 ,22.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2068,HCPCS,BREAST DIEP OR SIEA FLAP,,,21 ,,TotalUnits,,,,211.74 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2070,HCPCS,CYSTO LASER TX URETERAL CALC,,,21 ,,RBRVS,6.87 ,3.46 ,3.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2080,HCPCS,LAUP,,,21 ,,RBRVS,9.63 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2083,HCPCS,ADJUSTMENT GASTRIC BAND,,,21 ,,TotalUnits,,,,1.56 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2095,HCPCS,TRANSCATH EMBOLIZ MICROSPHER,,,21 ,,RBRVS,18.11 ,6.24 ,6.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2102,HCPCS,ISLET CELL TISSUE TRANSPLANT,,,21 ,,TotalUnits,,,,48.84 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2115,HCPCS,PERIACETABULAR OSTEOTOMY,,,21 ,,RBRVS,21.87 ,12.02 ,12.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2120,HCPCS,LOW DENSITY LIPOPROTEIN(LDL),,,17 ,,TotalUnits,,,,41.06 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2140,HCPCS,CORD BLOOD HARVESTING,,,21 ,,TotalUnits,,,,1.86 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2142,HCPCS,CORD BLOOD-DERIVED STEM-CELL,,,21 ,,TotalUnits,,,,1.62 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2150,HCPCS,BMT HARV/TRANSPL 28D PKG,,,21 ,,RBRVS,2.24 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2202,HCPCS,ECHOSCLEROTHERAPY,,,14 ,,RBRVS,1.09 ,0.64 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2205,HCPCS,MINIMALLY INVASIVE DIRECT CO,,,21 ,,RBRVS,33.64 ,12.57 ,12.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2206,HCPCS,MINIMALLY INVASIVE DIRECT CO,,,21 ,,RBRVS,39.77 ,14.75 ,14.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2207,HCPCS,MINIMALLY INVASIVE DIRECT CO,,,21 ,,RBRVS,34.87 ,12.92 ,12.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2225,HCPCS,MYRINGOTOMY LASER-ASSIST,,,21 ,,RBRVS,1.35 ,1.56 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2230,HCPCS,IMPLANT SEMI-IMP HEAR,,,21 ,,TotalUnits,,,,15.48 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2235,HCPCS,IMPLANT AUDITORY BRAIN IMP,,,21 ,,RBRVS,0.73 ,8.52 ,8.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2260,HCPCS,INDUCED ABORTION 17-24 WEEKS,,,12 ,,RBRVS,5.90 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2265,HCPCS,INDUCED ABORTION 25-28 WKS,,,12 ,,RBRVS,5.90 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2266,HCPCS,INDUCED ABORTION 29-31 WKS,,,12 ,,RBRVS,5.90 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2267,HCPCS,INDUCED ABORTION 32 OR MORE,,,12 ,,RBRVS,5.90 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2300,HCPCS,"ARTHROSCOPY, SHOULDER, SURGI",,,21 ,,TotalUnits,,,,12.49 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2340,HCPCS,CHEMODENERVATION OF ABDUCTOR,,,21 ,,RBRVS,3.86 ,1.65 ,4.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2341,HCPCS,CHEMODENERV ADDUCT VOCAL,,,21 ,,RBRVS,3.86 ,1.65 ,4.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2342,HCPCS,NASAL ENDOSCOP PO DEBRID,,,21 ,,RBRVS,2.98 ,1.39 ,4.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2348,HCPCS,DECOMPRESS DISC RF LUMBAR,,,21 ,,RBRVS,8.88 ,4.30 ,4.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2350,HCPCS,"DISKECTOMY, ANTERIOR, WITH D",,,21 ,,RBRVS,22.75 ,11.08 ,11.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2351,HCPCS,"DISKECTOMY, ANTERIOR, WITH D",,,21 ,,RBRVS,3.28 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2361,HCPCS,VERTEBROPLAST CERV ADDL,,,21 ,,RBRVS,4.30 ,1.51 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S2900,HCPCS,ROBOTIC SURGICAL SYSTEM,,,21 ,,TotalUnits,,,,13.28 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3005,HCPCS,EVAL SELF-ASSESS DEPRESSION,,,16 ,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3600,HCPCS,STAT LAB,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3601,HCPCS,STAT LAB HOME/NF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3620,HCPCS,NEWBORN METABOLIC SCREENING,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,S3625,HCPCS,MATERNAL TRIPLE SCREEN TEST,,,17 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3630,HCPCS,EOSINOPHIL BLOOD COUNT,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3645,HCPCS,HIV-1 ANTIBODY TESTING OF OR,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3650,HCPCS,"SALIVA TEST, HORMONE LEVEL;",,,17 ,,TotalUnits,,,,3.09 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3652,HCPCS,"SALIVA TEST, HORMONE LEVEL;",,,17 ,,TotalUnits,,,,2.51 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3655,HCPCS,ANTISPERM ANTIBODIES TEST,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3820,HCPCS,COMP BRCA1/BRCA2,,,17 ,,TotalUnits,,,,20.18 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3822,HCPCS,SING MUTATION BRST/OVAR,,,17 ,,TotalUnits,,,,2.85 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3823,HCPCS,3 MUTATION BRST/OVAR,,,17 ,,TotalUnits,,,,3.46 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3830,HCPCS,GENE TEST HNPCC COMP,,,17 ,,TotalUnits,,,,13.26 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3833,HCPCS,COMP APC SEQUENCE,,,17 ,,TotalUnits,,,,13.04 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3835,HCPCS,GENE TEST CYSTIC FIBROSIS,,,17 ,,TotalUnits,,,,1.57 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3854,HCPCS,GENE PROFILE PANEL BREAST,,,17 ,,TotalUnits,,,,26.43 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S3900,HCPCS,SURFACE EMG,,,17 ,,TotalUnits,,,,1.27 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S4005,HCPCS,INTERIM LABOR FACILITY GLOBA,,,12 ,,TotalUnits,,,,13.24 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S4011,HCPCS,IVF PACKAGE,,,14 ,,TotalUnits,,,,66.38 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S4015,HCPCS,COMPLETE IVF NOS CASE RATE,,,14 ,,TotalUnits,,,,71.73 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S4016,HCPCS,FROZEN IVF CASE RATE,,,14 ,,TotalUnits,,,,20.87 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S4022,HCPCS,ASST OOCYTE FERT CASE RATE,,,14 ,,TotalUnits,,,,14.68 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S4035,HCPCS,STIMULATED IUI CASE RATE,,,14 ,,TotalUnits,,,,17.70 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S4040,HCPCS,MONIT STORE CRYO EMBRYO 30 D,,,14 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S4042,HCPCS,OVULATION MGMT PER CYCLE,,,14 ,,TotalUnits,,,,3.70 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S4981,HCPCS,INSERT LEVONORGESTREL IUS,,,14 ,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S4989,HCPCS,CONTRACEPT IUD,,,28 ,,NW,,,,,,$516.65,$0.00,1,1,1,1,1,1,20120101,S4990,HCPCS,NICOTINE PATCH LEGEND,,,28 ,,NW,,,,,,$28.76,$0.00,1,1,1,0,0,1,20120101,S4993,HCPCS,CONTRACEPTIVE PILLS FOR BC,,,28 ,,NW,,,,,,$31.20,$0.00,1,1,1,1,1,1,20120101,S4995,HCPCS,SMOKING CESSATION GUM,,,28 ,,NW,,,,,,$61.27,$0.00,1,1,1,0,0,1,20120101,S5000,HCPCS,"PRESCRIPTION DRUG, GENERIC",,,28 ,,NW,,,,,,$21.42,$0.00,1,1,1,0,0,1,20120101,S5001,HCPCS,"PRESCRIPTION DRUG,BRAND NAME",,,28 ,,NW,,,,,,$91.53,$0.00,1,1,1,0,0,1,20120101,S5010,HCPCS,5% DEXTROSE AND 0.45% SALINE,,,28 ,,NW,,,,,,$21.94,$0.00,1,1,1,0,0,1,20120101,S5011,HCPCS,5% DEXTROSE IN LACTATED RING,,,28 ,,NW,,,,,,$23.60,$0.00,1,1,1,0,0,1,20120101,S5012,HCPCS,5% DEXTROSE WITH POTASSIUM,,,28 ,,NW,,,,,,$76.25,$0.00,1,1,1,0,0,1,20120101,S5013,HCPCS,5%DEXTROSE/0.45%SALINE1000ML,,,28 ,,NW,,,,,,$21.26,$0.00,1,1,1,0,0,1,20120101,S5014,HCPCS,D5W/0.45NS W KCL AND MGS04,,,28 ,,NW,,,,,,$12.83,$0.00,1,1,1,0,0,1,20120101,S5035,HCPCS,HIT ROUTINE DEVICE MAINT,,,14 ,,RBRVS,0.18 ,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5102,HCPCS,ADULT DAY CARE PER DIEM,,,14 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5105,HCPCS,CENTERBASED DAY CARE PERDIEM,,,14 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5108,HCPCS,HOMECARE TRAIN PT 15 MIN,,,14 ,,RBRVS,0.45 ,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5109,HCPCS,HOMECARE TRAIN PT SESSION,,,14 ,,TotalUnits,,,,1.08 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5110,HCPCS,FAMILY HOMECARE TRAINING 15M,,,14 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5111,HCPCS,FAMILY HOMECARE TRAIN/SESSIO,,,14 ,,TotalUnits,,,,1.68 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5115,HCPCS,NONFAMILY HOMECARE TRAIN/15M,,,14 ,,TotalUnits,,,,1.68 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5116,HCPCS,NONFAMILY HC TRAIN/SESSION,,,14 ,,TotalUnits,,,,1.68 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5126,HCPCS,ATTENDANT CARE SERVICE /DIEM,,,14 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5136,HCPCS,ADULT COMPANIONCARE PER DIEM,,,14 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5140,HCPCS,ADULT FOSTER CARE PER DIEM,,,14 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5145,HCPCS,CHILD FOSTERCARE TH PER DIEM,,,14 ,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5151,HCPCS,UNSKILLED RESPITECARE /DIEM,,,14 ,,TotalUnits,,,,1.59 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5161,HCPCS,EMER RSPNS SYS SERV PERMONTH,,,14 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5180,HCPCS,HH RESPIRATORY THRPY IN EVAL,,,14 ,,TotalUnits,,,,1.47 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5181,HCPCS,HH RESPIRATORY THRPY NOS/DAY,,,14 ,,TotalUnits,,,,1.47 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5190,HCPCS,WELLNESS ASSESSMENT BY NONPH,,,14 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S5199,HCPCS,PERSONAL CARE ITEM NOS EACH,,,28 ,,NW,,,,,,$61.59,$0.00,1,1,1,0,0,1,20120101,S5497,HCPCS,HIT CATH CARE NOC,,,28 ,,NW,,,,,,$61.59,$0.00,1,1,1,1,1,1,20120101,S5498,HCPCS,HIT SIMPLE CATH CARE,,,28 ,,NW,,,,,,$37.13,$0.00,1,1,1,1,1,1,20120101,S5501,HCPCS,HIT COMPLEX CATH CARE,,,28 ,,NW,,,,,,$40.04,$0.00,1,1,1,1,1,1,20120101,S5502,HCPCS,HIT INTERIM CATH CARE,,,28 ,,NW,,,,,,$70.52,$0.00,1,1,1,1,1,1,20120101,S5517,HCPCS,HIT DECLOTTING KIT,,,28 ,,NW,,,,,,$81.54,$0.00,1,1,1,1,1,1,20120101,S5520,HCPCS,HIT PICC INSERT KIT,,,28 ,,NW,,,,,,$98.70,$0.00,1,1,1,1,1,1,20120101,S5521,HCPCS,HIT MIDLINE CATH INSERT KIT,,,28 ,,NW,,,,,,$145.98,$0.00,1,1,1,1,1,1,20120101,S5522,HCPCS,HIT PICC INSERT NO SUPP,,,14 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5523,HCPCS,HIP MIDLINE CATH INSERT KIT,,,14 ,,TotalUnits,,,,1.53 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S5550,HCPCS,INSULIN RAPID 5 U,,,28 ,,NW,,,,,,$0.14,$0.00,1,1,1,0,0,1,20120101,S5551,HCPCS,INSULIN MOST RAPID 5 U,,,28 ,,NW,,,,,,$0.14,$0.00,1,1,1,0,0,1,20120101,S5552,HCPCS,INSULIN INTERMED 5 U,,,28 ,,NW,,,,,,$0.14,$0.00,1,1,1,0,0,1,20120101,S5553,HCPCS,INSULIN LONG ACTING 5 U,,,28 ,,NW,,,,,,$0.14,$0.00,1,1,1,0,0,1,20120101,S5560,HCPCS,INSULIN REUSE PEN 1.5 ML,,,28 ,,NW,,,,,,$3.54,$0.00,1,1,1,1,1,1,20120101,S8030,HCPCS,TANTALUM RING APPLICATION,,,20 ,,RBRVS,9.46 ,7.66 ,7.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S8037,HCPCS,MRCP,,,20 ,,TotalUnits,,,,7.77 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S8040,HCPCS,TOPOGRAPHIC BRAIN MAPPING,,,14 ,,RBRVS,2.97 ,3.05 ,3.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S8049,HCPCS,INTRAOPERATIVE RADIATION THE,,,20 ,,RBRVS,,4.35 ,4.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20120101,S8080,HCPCS,SCINTIMAMMOGRAPHY,,,20 ,,TotalUnits,,,,3.57 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S8085,HCPCS,FLUORINE-18 FLUORODEOXYGLUCO,,,20 ,,TotalUnits,,,,2.91 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,S8092,HCPCS,ELECTRON BEAM COMPUTED TOMOG,,,20 ,,TotalUnits,,,,2.28 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,S8096,HCPCS,PORTABLE PEAK FLOW METER,,,28 ,,NW,,,,,,$44.55,$0.00,1,1,1,1,1,1,20120101,S8097,HCPCS,ASTHMA KIT,,,28 ,,NW,,,,,,$55.38,$0.00,1,1,1,1,1,1,20120101,S8100,HCPCS,SPACER WITHOUT MASK,,,28 ,,NW,,,,,,$24.34,$0.00,1,1,1,1,1,1,20120101,S8101,HCPCS,SPACER WITH MASK,,,28 ,,NW,,,,,,$40.54,$0.00,1,1,1,1,1,1,20120101,S8110,HCPCS,PEAK EXPIRATORY FLOW RATE (P,,,14 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S8185,HCPCS,FLUTTER DEVICE,,,28 ,,NW,,,,,,$98.80,$0.00,1,1,1,1,1,1,20120101,S8186,HCPCS,SWIVEL ADAPTOR,,,28 ,,NW,,,,,,$15.23,$0.00,1,1,1,1,1,1,20120101,S8189,HCPCS,TRACH SUPPLY NOC,,,28 ,,NW,,,,,,$61.59,$0.00,1,1,1,1,1,1,20120101,S8210,HCPCS,MUCUS TRAP,,,28 ,,NW,,,,,,$1.25,$0.00,1,1,1,1,1,1,20120101,S8262,HCPCS,MANDIB ORTHO REPOS DEVICE,,,28 ,,NW,,,,,,"$2,163.57",$0.00,1,1,1,1,1,1,20120101,S8265,HCPCS,HABERMAN FEEDER,,,28 ,,NW,,,,,,$65.23,$0.00,1,1,1,1,1,1,20120101,S8301,HCPCS,INFECT CONTROL SUPPLIES NOS,,,28 ,,NW,,,,,,$61.59,$0.00,1,1,1,1,1,1,20120101,S8415,HCPCS,SUPPLIES FOR HOME DELIVERY,,,28 ,,NW,,,,,,$153.72,$0.00,1,1,1,1,1,1,20120101,S8420,HCPCS,CUSTOM GRADIENT SLEEV/GLOV,,,28 ,,NW,,,,,,$114.31,$0.00,1,1,1,1,1,1,20120101,S8421,HCPCS,READY GRADIENT SLEEV/GLOV,,,28 ,,NW,,,,,,$137.56,$0.00,1,1,1,1,1,1,20120101,S8422,HCPCS,CUSTOM GRAD SLEEVE MED,,,28 ,,NW,,,,,,$279.59,$0.00,1,1,1,1,1,1,20120101,S8423,HCPCS,CUSTOM GRAD SLEEVE HEAVY,,,28 ,,NW,,,,,,$150.58,$0.00,1,1,1,1,1,1,20120101,S8424,HCPCS,READY GRADIENT SLEEVE,,,28 ,,NW,,,,,,$127.23,$0.00,1,1,1,1,1,1,20120101,S8425,HCPCS,CUSTOM GRAD GLOVE MED,,,28 ,,NW,,,,,,$276.93,$0.00,1,1,1,1,1,1,20120101,S8426,HCPCS,CUSTOM GRAD GLOVE HEAVY,,,28 ,,NW,,,,,,$243.94,$0.00,1,1,1,1,1,1,20120101,S8427,HCPCS,READY GRADIENT GLOVE,,,28 ,,NW,,,,,,$157.56,$0.00,1,1,1,1,1,1,20120101,S8428,HCPCS,READY GRADIENT GAUNTLET,,,28 ,,NW,,,,,,$54.40,$0.00,1,1,1,1,1,1,20120101,S8429,HCPCS,GRADIENT PRESSURE WRAP,,,28 ,,NW,,,,,,$196.48,$0.00,1,1,1,1,1,1,20120101,S8430,HCPCS,PADDING FOR COMPRSSN BDG,,,28 ,,NW,,,,,,$22.33,$0.00,1,1,1,1,1,1,20120101,S8431,HCPCS,COMPRESSION BANDAGE,,,28 ,,NW,,,,,,$15.83,$0.00,1,1,1,1,1,1,20120101,S8450,HCPCS,SPLINT DIGIT,,,28 ,,NW,,,,,,$27.32,$0.00,1,1,1,1,1,1,20120101,S8451,HCPCS,SPLINT WRIST OR ANKLE,,,28 ,,NW,,,,,,$50.68,$0.00,1,1,1,1,1,1,20120101,S8452,HCPCS,SPLINT ELBOW,,,28 ,,NW,,,,,,$18.36,$0.00,1,1,1,1,1,1,20120101,S8460,HCPCS,CAMISOLE POST-MAST,,,28 ,,NW,,,,,,$95.32,$0.00,1,1,1,1,1,1,20120101,S8490,HCPCS,100 INSULIN SYRINGES,,,28 ,,NW,,,,,,$1.25,$0.00,1,1,1,1,1,1,20120101,S8940,HCPCS,HIPPOTHERAPY PER SESSION,,,19 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S8948,HCPCS,LOW-LEVEL LASER TRMT 15 MIN,,,14 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S8950,HCPCS,"COMPLEX LYMPHEDEMA THERAPY,",,,14 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S8990,HCPCS,PT OR MANIP FOR MAINT,,,19 ,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S8999,HCPCS,RESUSCITATION BAG,,,28 ,,NW,,,,,,$225.74,$0.00,1,1,1,1,1,1,20120101,S9001,HCPCS,HOME UTERINE MONITOR WITH OR,,,28 ,,NW,,,,,,$114.87,$0.00,1,1,1,1,1,1,20120101,S9024,HCPCS,PARANASAL SINUS ULTRASOUND,,,20 ,,TotalUnits,,,,2.17 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9034,HCPCS,ESWL FOR GALLSTONES,,,21 ,,RBRVS,9.64 ,6.13 ,17.10 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9061,HCPCS,MEDICAL SUPPLIES AND EQUIPME,,,28 ,,NW,,,,,,$66.79,$0.00,1,1,1,1,1,1,20120101,S9083,HCPCS,URGENT CARE CENTER GLOBAL,,,15 ,,TotalUnits,,,,1.90 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9088,HCPCS,SERVICES PROVIDED IN URGENT,,,15 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9090,HCPCS,VERTEBRAL AXIAL DECOMPRESSIO,,,14 ,,TotalUnits,,,,1.75 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9097,HCPCS,HOME VISIT WOUND CARE,,,14 ,,TotalUnits,,,,1.15 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S9098,HCPCS,HOME PHOTOTHERAPY VISIT,,,14 ,,TotalUnits,,,,1.89 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S9109,HCPCS,CHF TELEMONITORING MONTH,,,4 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S9117,HCPCS,BACK SCHOOL VISIT,,,14 ,,RBRVS,0.17 ,0.06 ,0.32 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9122,HCPCS,HOME HEALTH AIDE OR CERTIFIE,,,14 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S9123,HCPCS,NURSING CARE IN HOME RN,,,14 ,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S9124,HCPCS,"NURSING CARE, IN THE HOME; B",,,14 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S9125,HCPCS,"RESPITE CARE, IN THE HOME, P",,,14 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S9126,HCPCS,"HOSPICE CARE, IN THE HOME, P",,,14 ,,TotalUnits,,,,1.38 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S9127,HCPCS,"SOCIAL WORK VISIT, IN THE HO",,,14 ,,TotalUnits,,,,1.64 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9128,HCPCS,"SPEECH THERAPY, IN THE HOME,",,,14 ,,TotalUnits,,,,1.21 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9129,HCPCS,"OCCUPATIONAL THERAPY, IN THE",,,14 ,,TotalUnits,,,,1.19 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9131,HCPCS,PT IN THE HOME PER DIEM,,,14 ,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9140,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,,14 ,,TotalUnits,,,,1.36 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S9141,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,,14 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,1,1,1,20120101,S9145,HCPCS,INSULIN PUMP INITIATION,,,14 ,,TotalUnits,,,,3.81 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S9152,HCPCS,"SPEECH THERAPY, RE-EVAL",,,8 ,,TotalUnits,,,,2.94 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9208,HCPCS,HOME MGMT PRETERM LABOR,,,28 ,,NW,,,,,,$249.64,$0.00,1,1,1,1,1,1,20120101,S9211,HCPCS,HOME MGMT GEST HYPERTENSION,,,28 ,,NW,,,,,,$105.80,$0.00,1,1,1,1,1,1,20120101,S9212,HCPCS,HM POSTPAR HYPER PER DIEM,,,28 ,,NW,,,,,,$125.05,$0.00,1,1,1,1,1,1,20120101,S9213,HCPCS,HM PREECLAMP PER DIEM,,,28 ,,NW,,,,,,$246.84,$0.00,1,1,1,1,1,1,20120101,S9214,HCPCS,HM GEST DM PER DIEM,,,28 ,,NW,,,,,,$228.58,$0.00,1,1,1,1,1,1,20120101,S9325,HCPCS,HIT PAIN MGMT PER DIEM,,,28 ,,NW,,,,,,$127.50,$0.00,1,1,1,1,1,1,20120101,S9326,HCPCS,HIT CONT PAIN PER DIEM,,,28 ,,NW,,,,,,$181.04,$0.00,1,1,1,1,1,1,20120101,S9327,HCPCS,HIT INT PAIN PER DIEM,,,28 ,,NW,,,,,,$179.63,$0.00,1,1,1,1,1,1,20120101,S9328,HCPCS,HIT PAIN IMP PUMP DIEM,,,28 ,,NW,,,,,,$130.45,$0.00,1,1,1,1,1,1,20120101,S9329,HCPCS,HIT CHEMO PER DIEM,,,28 ,,NW,,,,,,$194.68,$0.00,1,1,1,1,1,1,20120101,S9330,HCPCS,HIT CONT CHEM DIEM,,,28 ,,NW,,,,,,$191.46,$0.00,1,1,1,1,1,1,20120101,S9331,HCPCS,HIT INTERMIT CHEMO DIEM,,,28 ,,NW,,,,,,$213.20,$0.00,1,1,1,1,1,1,20120101,S9335,HCPCS,HT HEMODIALYSIS DIEM,,,28 ,,NW,,,,,,$584.60,$0.00,1,1,1,1,1,1,20120101,S9336,HCPCS,HIT CONT ANTICOAG DIEM,,,28 ,,NW,,,,,,$183.11,$0.00,1,1,1,1,1,1,20120101,S9338,HCPCS,HIT IMMUNOTHERAPY DIEM,,,28 ,,NW,,,,,,$226.86,$0.00,1,1,1,1,1,1,20120101,S9339,HCPCS,HIT PERITON DIALYSIS DIEM,,,28 ,,NW,,,,,,$471.17,$0.00,1,1,1,1,1,1,20120101,S9340,HCPCS,HIT ENTERAL PER DIEM,,,28 ,,NW,,,,,,$75.67,$0.00,1,1,1,1,1,1,20120101,S9341,HCPCS,HIT ENTERAL GRAV DIEM,,,28 ,,NW,,,,,,$51.95,$0.00,1,1,1,1,1,1,20120101,S9342,HCPCS,HIT ENTERAL PUMP DIEM,,,28 ,,NW,,,,,,$55.79,$0.00,1,1,1,1,1,1,20120101,S9343,HCPCS,HIT ENTERAL BOLUS NURS,,,28 ,,NW,,,,,,$34.61,$0.00,1,1,1,1,1,1,20120101,S9345,HCPCS,HIT ANTI-HEMOPHIL DIEM,,,28 ,,NW,,,,,,$115.48,$0.00,1,1,1,1,1,1,20120101,S9346,HCPCS,HIT ALPHA-1-PROTEINAS DIEM,,,28 ,,NW,,,,,,$80.81,$0.00,1,1,1,1,1,1,20120101,S9347,HCPCS,HIT LONGTERM INFUSION DIEM,,,28 ,,NW,,,,,,$90.11,$0.00,1,1,1,1,1,1,20120101,S9348,HCPCS,HIT SYMPATHOMIM DIEM,,,28 ,,NW,,,,,,$199.87,$0.00,1,1,1,1,1,1,20120101,S9349,HCPCS,HIT TOCOLYSIS DIEM,,,28 ,,NW,,,,,,$288.31,$0.00,1,1,1,1,1,1,20120101,S9351,HCPCS,HIT CONT ANTIEMETIC DIEM,,,28 ,,NW,,,,,,$366.77,$0.00,1,1,1,1,1,1,20120101,S9353,HCPCS,HIT CONT INSULIN DIEM,,,28 ,,NW,,,,,,$501.50,$0.00,1,1,1,1,1,1,20120101,S9355,HCPCS,HIT CHELATION DIEM,,,28 ,,NW,,,,,,$149.76,$0.00,1,1,1,1,1,1,20120101,S9357,HCPCS,HIT ENZYME REPLACE DIEM,,,28 ,,NW,,,,,,$162.73,$0.00,1,1,1,1,1,1,20120101,S9359,HCPCS,HIT ANTI-TNF PER DIEM,,,28 ,,NW,,,,,,$297.82,$0.00,1,1,1,1,1,1,20120101,S9361,HCPCS,HIT DIURETIC INFUS DIEM,,,28 ,,NW,,,,,,$108.42,$0.00,1,1,1,1,1,1,20120101,S9363,HCPCS,HIT ANTI-SPASMOTIC DIEM,,,28 ,,NW,,,,,,$218.64,$0.00,1,1,1,1,1,1,20120101,S9364,HCPCS,HIT TPN TOTAL DIEM,,,28 ,,NW,,,,,,$340.90,$0.00,1,1,1,1,1,1,20120101,S9365,HCPCS,HIT TPN 1 LITER DIEM,,,28 ,,NW,,,,,,$392.88,$0.00,1,1,1,1,1,1,20120101,S9366,HCPCS,HIT TPN 2 LITER DIEM,,,28 ,,NW,,,,,,$479.44,$0.00,1,1,1,1,1,1,20120101,S9367,HCPCS,HIT TPN 3 LITER DIEM,,,28 ,,NW,,,,,,$533.84,$0.00,1,1,1,1,1,1,20120101,S9368,HCPCS,HIT TPN OVER 3L DIEM,,,28 ,,NW,,,,,,$683.91,$0.00,1,1,1,1,1,1,20120101,S9370,HCPCS,HT INJ ANTIEMETIC DIEM,,,28 ,,NW,,,,,,$138.54,$0.00,1,1,1,1,1,1,20120101,S9372,HCPCS,HT INJ ANTICOAG DIEM,,,28 ,,NW,,,,,,$93.94,$0.00,1,1,1,1,1,1,20120101,S9373,HCPCS,HIT HYDRA TOTAL DIEM,,,28 ,,NW,,,,,,$105.19,$0.00,1,1,1,1,1,1,20120101,S9374,HCPCS,HIT HYDRA 1 LITER DIEM,,,28 ,,NW,,,,,,$152.02,$0.00,1,1,1,1,1,1,20120101,S9375,HCPCS,HIT HYDRA 2 LITER DIEM,,,28 ,,NW,,,,,,$194.76,$0.00,1,1,1,1,1,1,20120101,S9376,HCPCS,HIT HYDRA 3 LITER DIEM,,,28 ,,NW,,,,,,$212.28,$0.00,1,1,1,1,1,1,20120101,S9377,HCPCS,HIT HYDRA OVER 3L DIEM,,,28 ,,NW,,,,,,$229.80,$0.00,1,1,1,1,1,1,20120101,S9379,HCPCS,HIT NOC PER DIEM,,,28 ,,NW,,,,,,$61.59,$0.00,1,1,1,1,1,1,20120101,S9401,HCPCS,ANTICOAG CLINIC PER SESSION,,,14 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9430,HCPCS,PHARMACY COMP/DISP SERV,,,14 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9433,HCPCS,MEDICAL FOOD ORAL 100% NUTR,,,28 ,,NW,,,,,,$32.51,$0.00,1,1,1,0,1,1,20120101,S9434,HCPCS,MOD SOLID FOOD SUPPL,,,28 ,,NW,,,,,,$49.75,$0.00,1,1,1,0,1,1,20120101,S9435,HCPCS,MEDICAL FOODS FOR INBORN ERR,,,28 ,,NW,,,,,,$31.33,$0.00,1,1,1,0,1,1,20120101,S9436,HCPCS,LAMAZE CLASS,,,14 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9441,HCPCS,ASTHMA EDUCATION,,,14 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9442,HCPCS,BIRTHING CLASS,,,14 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9443,HCPCS,LACTATION CLASS,,,14 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9449,HCPCS,WEIGHT MGMT CLASS,,,14 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9451,HCPCS,EXERCISE CLASS,,,14 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9452,HCPCS,NUTRITION CLASS,,,14 ,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9453,HCPCS,SMOKING CESSATION CLASS,,,14 ,,TotalUnits,,,,1.53 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9455,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,,14 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S9460,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,,14 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S9465,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,,14 ,,TotalUnits,,,,1.26 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,S9470,HCPCS,"NUTRITIONAL COUNSELING, DIET",,,14 ,,TotalUnits,,,,0.96 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,S9474,HCPCS,ENTEROSTOMAL THERAPY BY A RE,,,14 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,S9475,HCPCS,AMBULATORY SETTING SUBSTANCE,,,16 ,,TotalUnits,,,,1.79 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,S9480,HCPCS,INTENSIVE OUTPATIENT PSYCHIA,,,16 ,,TotalUnits,,,,2.66 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S9484,HCPCS,CRISIS INTERVENTION PER HOUR,,,16 ,,TotalUnits,,,,0.91 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S9485,HCPCS,CRISIS INTERVENTION MENTAL H,,,16 ,,TotalUnits,,,,4.63 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,S9490,HCPCS,HIT CORTICOSTEROID/DIEM,,,28 ,,NW,,,,,,$235.68,$0.00,1,1,1,1,1,1,20120101,S9494,HCPCS,HIT ANTIBIOTIC TOTAL DIEM,,,28 ,,NW,,,,,,$188.08,$0.00,1,1,1,1,1,1,20120101,S9497,HCPCS,HIT ANTIBIOTIC Q3H DIEM,,,28 ,,NW,,,,,,$234.53,$0.00,1,1,1,1,1,1,20120101,S9500,HCPCS,HIT ANTIBIOTIC Q24H DIEM,,,28 ,,NW,,,,,,$269.21,$0.00,1,1,1,1,1,1,20120101,S9501,HCPCS,HIT ANTIBIOTIC Q12H DIEM,,,28 ,,NW,,,,,,$263.11,$0.00,1,1,1,1,1,1,20120101,S9502,HCPCS,HIT ANTIBIOTIC Q8H DIEM,,,28 ,,NW,,,,,,$328.36,$0.00,1,1,1,1,1,1,20120101,S9503,HCPCS,HIT ANTIBIOTIC Q6H DIEM,,,28 ,,NW,,,,,,$302.76,$0.00,1,1,1,1,1,1,20120101,S9504,HCPCS,HIT ANTIBIOTIC Q4H DIEM,,,28 ,,NW,,,,,,$279.16,$0.00,1,1,1,1,1,1,20120101,S9529,HCPCS,VENIPUNCTURE HOME/SNF,,,28 ,,NW,,,,,,$93.79,$0.00,1,1,1,0,1,1,20120101,S9537,HCPCS,HT HEM HORM INJ DIEM,,,28 ,,NW,,,,,,$78.08,$0.00,1,1,1,1,1,1,20120101,S9538,HCPCS,HIT BLOOD PRODUCTS DIEM,,,28 ,,NW,,,,,,$253.25,$0.00,1,1,1,1,1,1,20120101,S9542,HCPCS,HT INJ NOC PER DIEM,,,28 ,,NW,,,,,,$61.59,$0.00,1,1,1,1,1,1,20120101,S9558,HCPCS,HT INJ GROWTH HORM DIEM,,,28 ,,NW,,,,,,$33.93,$0.00,1,1,1,1,1,1,20120101,S9559,HCPCS,HIT INJ INTERFERON DIEM,,,28 ,,NW,,,,,,$318.90,$0.00,1,1,1,1,1,1,20120101,S9560,HCPCS,HT INJ HORMONE DIEM,,,28 ,,NW,,,,,,$86.84,$0.00,1,1,1,1,1,1,20120101,S9562,HCPCS,HT INJ PALIVIZUMAB DIEM,,,28 ,,NW,,,,,,$86.84,$0.00,1,1,1,1,1,1,20120101,S9590,HCPCS,HT IRRIGATION DIEM,,,28 ,,NW,,,,,,$124.64,$0.00,1,1,1,1,1,1,20120101,S9810,HCPCS,HT PHARM PER HOUR,,,28 ,,NW,,,,,,$61.59,$0.00,1,1,1,0,0,1,20120101,S9900,HCPCS,CHRISTIAN SCI PRACT VISIT,,,14 ,,TotalUnits,,,,0.08 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9970,HCPCS,HEALTH CLUB MEMBERSHIP YR,,,14 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9981,HCPCS,MED RECORD COPY ADMIN,,,14 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9986,HCPCS,NOT MEDICALLY NECESSARY SVC,,,14 ,,TotalUnits,,,,4.46 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9988,HCPCS,SERV PART OF PHASE I TRIAL,,,14 ,,TotalUnits,,,,0.06 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,S9990,HCPCS,SERVICES PROVIDED AS PART OF,,,14 ,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,T1000,HCPCS,PRIVATE DUTY/INDEPENDENT NSG,,,15 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T1001,HCPCS,NURSING ASSESSMENT/EVALUATN,,,15 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T1002,HCPCS,RN SERVICES UP TO 15 MINUTES,,,15 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T1003,HCPCS,LPN/LVN SERVICES UP TO 15MIN,,,15 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T1004,HCPCS,NSG AIDE SERVICE UP TO 15MIN,,,15 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T1005,HCPCS,RESPITE CARE SERVICE 15 MIN,,,15 ,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T1006,HCPCS,FAMILY/COUPLE COUNSELING,,,16 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,T1007,HCPCS,TREATMENT PLAN DEVELOPMENT,,,16 ,,TotalUnits,,,,3.02 ,,$0.00,$0.00,1,1,1,0,1,1,20120101,T1009,HCPCS,CHILD SITTING SERVICES,,,14 ,,TotalUnits,,,,0.06 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,T1012,HCPCS,ALCOHOL/SUBSTANCE ABUSE SKIL,,,16 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,T1013,HCPCS,SIGN LANG/ORAL INTERPRETER,,,14 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,T1015,HCPCS,CLINIC SERVICE,,,15 ,,TotalUnits,,,,1.36 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,T1016,HCPCS,CASE MANAGEMENT,,,15 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,T1019,HCPCS,PERSONAL CARE SER PER 15 MIN,,,15 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T1020,HCPCS,PERSONAL CARE SER PER DIEM,,,15 ,,TotalUnits,,,,1.88 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T1021,HCPCS,HH AIDE OR CN AIDE PER VISIT,,,15 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T1023,HCPCS,PROGRAM INTAKE ASSESSMENT,,,15 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,T1024,HCPCS,TEAM EVALUATION & MANAGEMENT,,,15 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,T1026,HCPCS,"PED COMPR CARE PKG, PER HOUR",,,15 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,T1027,HCPCS,FAMILY TRAINING & COUNSELING,,,16 ,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,T1028,HCPCS,HOME ENVIRONMENT ASSESSMENT,,,16 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T1030,HCPCS,RN HOME CARE PER DIEM,,,15 ,,TotalUnits,,,,1.99 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,T1031,HCPCS,LPN HOME CARE PER DIEM,,,15 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,T1502,HCPCS,MEDICATION ADMIN VISIT,,,15 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,T2001,HCPCS,N-ET; PATIENT ATTEND/ESCORT,,,14 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T2003,HCPCS,N-ET; ENCOUNTER/TRIP,,,14 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T2004,HCPCS,N-ET; COMMERC CARRIER PASS,,,14 ,,TotalUnits,,,,0.07 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T2005,HCPCS,N-ET; STRETCHER VAN,,,14 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T2007,HCPCS,NON-EMER TRANSPORT WAIT TIME,,,14 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T2013,HCPCS,HABIL ED WAIVER PER HOUR,,,14 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,T2014,HCPCS,"HABIL PREVOC WAIVER, PER D",,,14 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,T2016,HCPCS,HABIL RES WAIVER PER DIEM,,,14 ,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,T2017,HCPCS,HABIL RES WAIVER 15 MIN,,,14 ,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,T2018,HCPCS,HABIL SUP EMPL WAIVER/DIEM,,,14 ,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,T2020,HCPCS,DAY HABIL WAIVER PER DIEM,,,14 ,,TotalUnits,,,,1.05 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,T2022,HCPCS,"CASE MANAGEMENT, PER MONTH",,,14 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,T2023,HCPCS,TARGETED CASE MGMT PER MONTH,,,14 ,,TotalUnits,,,,1.51 ,,$0.00,$0.00,1,0,1,1,1,1,20120101,T2025,HCPCS,"WAIVER SERVICE, NOS",,,14 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,T2031,HCPCS,ASSIST LIVING WAIVER/DIEM,,,14 ,,TotalUnits,,,,2.47 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T2032,HCPCS,"RES CARE, NOS WAIVER/MONTH",,,14 ,,TotalUnits,,,,2.48 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T2033,HCPCS,"RES, NOS WAIVER PER DIEM",,,14 ,,TotalUnits,,,,1.65 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T2040,HCPCS,FINANCIAL MGT WAIVER/15MIN,,,14 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T2042,HCPCS,HOSPICE ROUTINE HOME CARE,,,14 ,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T2043,HCPCS,HOSPICE CONTINUOUS HOME CARE,,,14 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T2045,HCPCS,HOSPICE GENERAL CARE,,,14 ,,TotalUnits,,,,5.70 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T2046,HCPCS,"HOSPICE LONG TERM CARE, R&B",,,14 ,,TotalUnits,,,,1.37 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T2048,HCPCS,"BH LTC RES R&B, PER DIEM",,,14 ,,TotalUnits,,,,1.67 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T2049,HCPCS,"N-ET; STRETCHER VAN, MILEAGE",,,14 ,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,1,1,1,20120101,T4521,HCPCS,ADULT SIZE BRIEF/DIAPER SM,,,28 ,,NW,,,,,,$1.32,$0.00,1,1,1,1,1,1,20120101,T4522,HCPCS,ADULT SIZE BRIEF/DIAPER MED,,,28 ,,NW,,,,,,$1.35,$0.00,1,1,1,1,1,1,20120101,T4523,HCPCS,ADULT SIZE BRIEF/DIAPER LG,,,28 ,,NW,,,,,,$1.44,$0.00,1,1,1,1,1,1,20120101,T4524,HCPCS,ADULT SIZE BRIEF/DIAPER XL,,,28 ,,NW,,,,,,$1.77,$0.00,1,1,1,1,1,1,20120101,T4525,HCPCS,ADULT SIZE PULL-ON SM,,,28 ,,NW,,,,,,$1.61,$0.00,1,1,1,1,1,1,20120101,T4526,HCPCS,ADULT SIZE PULL-ON MED,,,28 ,,NW,,,,,,$1.62,$0.00,1,1,1,1,1,1,20120101,T4527,HCPCS,ADULT SIZE PULL-ON LG,,,28 ,,NW,,,,,,$1.64,$0.00,1,1,1,1,1,1,20120101,T4528,HCPCS,ADULT SIZE PULL-ON XL,,,28 ,,NW,,,,,,$1.76,$0.00,1,1,1,1,1,1,20120101,T4529,HCPCS,PED SIZE BRIEF/DIAPER SM/MED,,,28 ,,NW,,,,,,$1.31,$0.00,1,1,1,1,1,1,20120101,T4530,HCPCS,PED SIZE BRIEF/DIAPER LG,,,28 ,,NW,,,,,,$1.49,$0.00,1,1,1,1,1,1,20120101,T4531,HCPCS,PED SIZE PULL-ON SM/MED,,,28 ,,NW,,,,,,$1.71,$0.00,1,1,1,1,1,1,20120101,T4532,HCPCS,PED SIZE PULL-ON LG,,,28 ,,NW,,,,,,$1.95,$0.00,1,1,1,1,1,1,20120101,T4533,HCPCS,YOUTH SIZE BRIEF/DIAPER,,,28 ,,NW,,,,,,$1.39,$0.00,1,1,1,1,1,1,20120101,T4534,HCPCS,YOUTH SIZE PULL-ON,,,28 ,,NW,,,,,,$1.73,$0.00,1,1,1,1,1,1,20120101,T4535,HCPCS,DISPOSABLE LINER/SHIELD/PAD,,,28 ,,NW,,,,,,$1.20,$0.00,1,1,1,1,1,1,20120101,T4536,HCPCS,REUSABLE PULL-ON ANY SIZE,,,28 ,,NW,,,,,,$1.37,$0.00,1,1,1,1,1,1,20120101,T4537,HCPCS,REUSABLE UNDERPAD BED SIZE,,,28 ,,NW,,,,,,$22.76,$0.00,1,1,1,1,1,1,20120101,T4539,HCPCS,REUSE DIAPER/BRIEF ANY SIZE,,,28 ,,NW,,,,,,$9.63,$0.00,1,1,1,1,1,1,20120101,T4540,HCPCS,REUSABLE UNDERPAD CHAIR SIZE,,,28 ,,NW,,,,,,$8.78,$0.00,1,1,1,1,1,1,20120101,T4541,HCPCS,LARGE DISPOSABLE UNDERPAD,,,28 ,,NW,,,,,,$1.14,$0.00,1,1,1,1,1,1,20120101,T4542,HCPCS,SMALL DISPOSABLE UNDERPAD,,,28 ,,NW,,,,,,$1.31,$0.00,1,1,1,1,1,1,20120101,T4543,HCPCS,DISP BARIATRIC BRIEF/DIAPER,,,28 ,,NW,,,,,,$2.03,$0.00,1,1,1,1,1,1,20120101,T5001,HCPCS,POSITION SEAT SPEC ORTH NEED,,,28 ,,NW,,,,,,$671.95,$0.00,1,1,1,1,1,1,20120101,T5999,HCPCS,"SUPPLY, NOS",,,28 ,,NW,,,,,,$22.23,$0.00,1,1,1,1,1,1,20120101,V2020,HCPCS,VISION SVCS FRAMES PURCHASES,,,28 ,,NW,,,,,,$93.44,$0.00,1,1,1,1,1,1,20120101,V2025,HCPCS,EYEGLASSES DELUX FRAMES,,,28 ,,NW,,,,,,$133.71,$0.00,1,1,1,1,1,1,20120101,V2100,HCPCS,LENS SPHER SINGLE PLANO 4.00,,,28 ,,NW,,,,,,$71.77,$0.00,1,1,1,1,1,1,20120101,V2101,HCPCS,SINGLE VISN SPHERE 4.12-7.00,,,28 ,,NW,,,,,,$75.20,$0.00,1,1,1,1,1,1,20120101,V2102,HCPCS,SINGL VISN SPHERE 7.12-20.00,,,28 ,,NW,,,,,,$90.23,$0.00,1,1,1,1,1,1,20120101,V2103,HCPCS,SPHEROCYLINDR 4.00D/12-2.00D,,,28 ,,NW,,,,,,$66.78,$0.00,1,1,1,1,1,1,20120101,V2104,HCPCS,SPHEROCYLINDR 4.00D/2.12-4D,,,28 ,,NW,,,,,,$69.78,$0.00,1,1,1,1,1,1,20120101,V2105,HCPCS,SPHEROCYLINDER 4.00D/4.25-6D,,,28 ,,NW,,,,,,$73.83,$0.00,1,1,1,1,1,1,20120101,V2106,HCPCS,SPHEROCYLINDER 4.00D/>6.00D,,,28 ,,NW,,,,,,$78.50,$0.00,1,1,1,1,1,1,20120101,V2107,HCPCS,SPHEROCYLINDER 4.25D/12-2D,,,28 ,,NW,,,,,,$77.92,$0.00,1,1,1,1,1,1,20120101,V2108,HCPCS,SPHEROCYLINDER 4.25D/2.12-4D,,,28 ,,NW,,,,,,$77.84,$0.00,1,1,1,1,1,1,20120101,V2109,HCPCS,SPHEROCYLINDER 4.25D/4.25-6D,,,28 ,,NW,,,,,,$84.05,$0.00,1,1,1,1,1,1,20120101,V2110,HCPCS,SPHEROCYLINDER 4.25D/OVER 6D,,,28 ,,NW,,,,,,$82.07,$0.00,1,1,1,1,1,1,20120101,V2111,HCPCS,SPHEROCYLINDR 7.25D/.25-2.25,,,28 ,,NW,,,,,,$85.28,$0.00,1,1,1,1,1,1,20120101,V2112,HCPCS,SPHEROCYLINDR 7.25D/2.25-4D,,,28 ,,NW,,,,,,$90.40,$0.00,1,1,1,1,1,1,20120101,V2113,HCPCS,SPHEROCYLINDR 7.25D/4.25-6D,,,28 ,,NW,,,,,,$96.57,$0.00,1,1,1,1,1,1,20120101,V2114,HCPCS,SPHEROCYLINDER OVER 12.00D,,,28 ,,NW,,,,,,$101.98,$0.00,1,1,1,1,1,1,20120101,V2115,HCPCS,LENS LENTICULAR BIFOCAL,,,28 ,,NW,,,,,,$106.88,$0.00,1,1,1,1,1,1,20120101,V2118,HCPCS,LENS ANISEIKONIC SINGLE,,,28 ,,NW,,,,,,$107.62,$0.00,1,1,1,1,1,1,20120101,V2121,HCPCS,"LENTICULAR LENS, SINGLE",,,28 ,,NW,,,,,,$109.13,$0.00,1,1,1,1,1,1,20120101,V2199,HCPCS,LENS SINGLE VISION NOT OTH C,,,28 ,,NW,,,,,,$100.83,$0.00,1,1,1,1,1,1,20120101,V2200,HCPCS,LENS SPHER BIFOC PLANO 4.00D,,,28 ,,NW,,,,,,$83.28,$0.00,1,1,1,1,1,1,20120101,V2201,HCPCS,LENS SPHERE BIFOCAL 4.12-7.0,,,28 ,,NW,,,,,,$88.36,$0.00,1,1,1,1,1,1,20120101,V2202,HCPCS,LENS SPHERE BIFOCAL 7.12-20.,,,28 ,,NW,,,,,,$95.61,$0.00,1,1,1,1,1,1,20120101,V2203,HCPCS,LENS SPHCYL BIFOCAL 4.00D/.1,,,28 ,,NW,,,,,,$84.34,$0.00,1,1,1,1,1,1,20120101,V2204,HCPCS,LENS SPHCY BIFOCAL 4.00D/2.1,,,28 ,,NW,,,,,,$86.29,$0.00,1,1,1,1,1,1,20120101,V2205,HCPCS,LENS SPHCY BIFOCAL 4.00D/4.2,,,28 ,,NW,,,,,,$89.90,$0.00,1,1,1,1,1,1,20120101,V2206,HCPCS,LENS SPHCY BIFOCAL 4.00D/OVE,,,28 ,,NW,,,,,,$95.68,$0.00,1,1,1,1,1,1,20120101,V2207,HCPCS,LENS SPHCY BIFOCAL 4.25-7D/.,,,28 ,,NW,,,,,,$89.52,$0.00,1,1,1,1,1,1,20120101,V2208,HCPCS,LENS SPHCY BIFOCAL 4.25-7/2.,,,28 ,,NW,,,,,,$92.16,$0.00,1,1,1,1,1,1,20120101,V2209,HCPCS,LENS SPHCY BIFOCAL 4.25-7/4.,,,28 ,,NW,,,,,,$95.64,$0.00,1,1,1,1,1,1,20120101,V2210,HCPCS,LENS SPHCY BIFOCAL 4.25-7/OV,,,28 ,,NW,,,,,,$103.09,$0.00,1,1,1,1,1,1,20120101,V2211,HCPCS,LENS SPHCY BIFO 7.25-12/.25-,,,28 ,,NW,,,,,,$104.00,$0.00,1,1,1,1,1,1,20120101,V2212,HCPCS,LENS SPHCYL BIFO 7.25-12/2.2,,,28 ,,NW,,,,,,$106.01,$0.00,1,1,1,1,1,1,20120101,V2213,HCPCS,LENS SPHCYL BIFO 7.25-12/4.2,,,28 ,,NW,,,,,,$106.32,$0.00,1,1,1,1,1,1,20120101,V2214,HCPCS,LENS SPHCYL BIFOCAL OVER 12.,,,28 ,,NW,,,,,,$113.57,$0.00,1,1,1,1,1,1,20120101,V2215,HCPCS,LENS LENTICULAR BIFOCAL,,,28 ,,NW,,,,,,$120.64,$0.00,1,1,1,1,1,1,20120101,V2218,HCPCS,LENS ANISEIKONIC BIFOCAL,,,28 ,,NW,,,,,,$130.12,$0.00,1,1,1,1,1,1,20120101,V2219,HCPCS,LENS BIFOCAL SEG WIDTH OVER,,,28 ,,NW,,,,,,$76.27,$0.00,1,1,1,1,1,1,20120101,V2220,HCPCS,LENS BIFOCAL ADD OVER 3.25D,,,28 ,,NW,,,,,,$70.40,$0.00,1,1,1,1,1,1,20120101,V2221,HCPCS,"LENTICULAR LENS, BIFOCAL",,,28 ,,NW,,,,,,$119.45,$0.00,1,1,1,1,1,1,20120101,V2299,HCPCS,LENS BIFOCAL SPECIALITY,,,28 ,,NW,,,,,,$63.72,$0.00,1,1,1,1,1,1,20120101,V2300,HCPCS,LENS SPHERE TRIFOCAL 4.00D,,,28 ,,NW,,,,,,$97.00,$0.00,1,1,1,1,1,1,20120101,V2301,HCPCS,LENS SPHERE TRIFOCAL 4.12-7.,,,28 ,,NW,,,,,,$108.75,$0.00,1,1,1,1,1,1,20120101,V2302,HCPCS,LENS SPHERE TRIFOCAL 7.12-20,,,28 ,,NW,,,,,,$110.40,$0.00,1,1,1,1,1,1,20120101,V2303,HCPCS,LENS SPHCY TRIFOCAL 4.0/.12-,,,28 ,,NW,,,,,,$96.59,$0.00,1,1,1,1,1,1,20120101,V2304,HCPCS,LENS SPHCY TRIFOCAL 4.0/2.25,,,28 ,,NW,,,,,,$99.16,$0.00,1,1,1,1,1,1,20120101,V2305,HCPCS,LENS SPHCY TRIFOCAL 4.0/4.25,,,28 ,,NW,,,,,,$108.06,$0.00,1,1,1,1,1,1,20120101,V2306,HCPCS,LENS SPHCYL TRIFOCAL 4.00/>6,,,28 ,,NW,,,,,,$110.40,$0.00,1,1,1,1,1,1,20120101,V2307,HCPCS,LENS SPHCY TRIFOCAL 4.25-7/.,,,28 ,,NW,,,,,,$106.57,$0.00,1,1,1,1,1,1,20120101,V2308,HCPCS,LENS SPHC TRIFOCAL 4.25-7/2.,,,28 ,,NW,,,,,,$109.56,$0.00,1,1,1,1,1,1,20120101,V2309,HCPCS,LENS SPHC TRIFOCAL 4.25-7/4.,,,28 ,,NW,,,,,,$117.93,$0.00,1,1,1,1,1,1,20120101,V2310,HCPCS,LENS SPHC TRIFOCAL 4.25-7/>6,,,28 ,,NW,,,,,,$116.84,$0.00,1,1,1,1,1,1,20120101,V2311,HCPCS,LENS SPHC TRIFO 7.25-12/.25-,,,28 ,,NW,,,,,,$122.74,$0.00,1,1,1,1,1,1,20120101,V2312,HCPCS,LENS SPHC TRIFO 7.25-12/2.25,,,28 ,,NW,,,,,,$121.02,$0.00,1,1,1,1,1,1,20120101,V2313,HCPCS,LENS SPHC TRIFO 7.25-12/4.25,,,28 ,,NW,,,,,,$133.32,$0.00,1,1,1,1,1,1,20120101,V2314,HCPCS,LENS SPHCYL TRIFOCAL OVER 12,,,28 ,,NW,,,,,,$137.87,$0.00,1,1,1,1,1,1,20120101,V2315,HCPCS,LENS LENTICULAR TRIFOCAL,,,28 ,,NW,,,,,,$152.16,$0.00,1,1,1,1,1,1,20120101,V2318,HCPCS,LENS ANISEIKONIC TRIFOCAL,,,28 ,,NW,,,,,,$178.06,$0.00,1,1,1,1,1,1,20120101,V2319,HCPCS,LENS TRIFOCAL SEG WIDTH > 28,,,28 ,,NW,,,,,,$81.56,$0.00,1,1,1,1,1,1,20120101,V2320,HCPCS,LENS TRIFOCAL ADD OVER 3.25D,,,28 ,,NW,,,,,,$86.83,$0.00,1,1,1,1,1,1,20120101,V2321,HCPCS,"LENTICULAR LENS, TRIFOCAL",,,28 ,,NW,,,,,,$149.75,$0.00,1,1,1,1,1,1,20120101,V2399,HCPCS,LENS TRIFOCAL SPECIALITY,,,28 ,,NW,,,,,,$155.23,$0.00,1,1,1,1,1,1,20120101,V2410,HCPCS,LENS VARIAB ASPHERICITY SING,,,28 ,,NW,,,,,,$123.44,$0.00,1,1,1,1,1,1,20120101,V2430,HCPCS,LENS VARIABLE ASPHERICITY BI,,,28 ,,NW,,,,,,$139.80,$0.00,1,1,1,1,1,1,20120101,V2499,HCPCS,VARIABLE ASPHERICITY LENS,,,28 ,,NW,,,,,,$114.57,$0.00,1,1,1,1,1,1,20120101,V2500,HCPCS,CONTACT LENS PMMA SPHERICAL,,,28 ,,NW,,,,,,$114.35,$0.00,1,1,1,1,1,1,20120101,V2501,HCPCS,CNTCT LENS PMMA-TORIC/PRISM,,,28 ,,NW,,,,,,$153.33,$0.00,1,1,1,1,1,1,20120101,V2502,HCPCS,CONTACT LENS PMMA BIFOCAL,,,28 ,,NW,,,,,,$187.50,$0.00,1,1,1,1,1,1,20120101,V2503,HCPCS,CNTCT LENS PMMA COLOR VISION,,,28 ,,NW,,,,,,$170.54,$0.00,1,1,1,1,1,1,20120101,V2510,HCPCS,CNTCT GAS PERMEABLE SPHERICL,,,28 ,,NW,,,,,,$142.78,$0.00,1,1,1,1,1,1,20120101,V2511,HCPCS,CNTCT TORIC PRISM BALLAST,,,28 ,,NW,,,,,,$193.14,$0.00,1,1,1,1,1,1,20120101,V2512,HCPCS,CNTCT LENS GAS PERMBL BIFOCL,,,28 ,,NW,,,,,,$223.19,$0.00,1,1,1,1,1,1,20120101,V2513,HCPCS,CONTACT LENS EXTENDED WEAR,,,28 ,,NW,,,,,,$198.77,$0.00,1,1,1,1,1,1,20120101,V2520,HCPCS,CONTACT LENS HYDROPHILIC,,,28 ,,NW,,,,,,$136.12,$0.00,1,1,1,1,1,1,20120101,V2521,HCPCS,CNTCT LENS HYDROPHILIC TORIC,,,28 ,,NW,,,,,,$210.85,$0.00,1,1,1,1,1,1,20120101,V2522,HCPCS,CNTCT LENS HYDROPHIL BIFOCL,,,28 ,,NW,,,,,,$212.11,$0.00,1,1,1,1,1,1,20120101,V2523,HCPCS,CNTCT LENS HYDROPHIL EXTEND,,,28 ,,NW,,,,,,$180.96,$0.00,1,1,1,1,1,1,20120101,V2530,HCPCS,CONTACT LENS GAS IMPERMEABLE,,,28 ,,NW,,,,,,$250.10,$0.00,1,1,1,1,1,1,20120101,V2531,HCPCS,CONTACT LENS GAS PERMEABLE,,,28 ,,NW,,,,,,$503.74,$0.00,1,1,1,1,1,1,20120101,V2599,HCPCS,CONTACT LENS/ES OTHER TYPE,,,28 ,,NW,,,,,,$100.91,$0.00,1,1,1,1,1,1,20120101,V2600,HCPCS,HAND HELD LOW VISION AIDS,,,28 ,,NW,,,,,,$141.53,$0.00,1,1,1,1,1,1,20120101,V2610,HCPCS,SINGLE LENS SPECTACLE MOUNT,,,28 ,,NW,,,,,,$105.86,$0.00,1,1,1,1,1,1,20120101,V2615,HCPCS,TELESCOP/OTHR COMPOUND LENS,,,28 ,,NW,,,,,,$414.02,$0.00,1,1,1,1,1,1,20120101,V2623,HCPCS,PLASTIC EYE PROSTH CUSTOM,,,28 ,,NW,,,,,,"$2,723.10",$0.00,1,1,1,1,1,1,20120101,V2624,HCPCS,POLISHING ARTIFICAL EYE,,,28 ,,NW,,,,,,$77.49,$0.00,1,1,1,1,1,1,20120101,V2625,HCPCS,ENLARGEMNT OF EYE PROSTHESIS,,,28 ,,NW,,,,,,$926.76,$0.00,1,1,1,1,1,1,20120101,V2626,HCPCS,REDUCTION OF EYE PROSTHESIS,,,28 ,,NW,,,,,,$448.92,$0.00,1,1,1,1,1,1,20120101,V2627,HCPCS,SCLERAL COVER SHELL,,,28 ,,NW,,,,,,"$3,858.83",$0.00,1,1,1,1,1,1,20120101,V2628,HCPCS,FABRICATION & FITTING,,,28 ,,NW,,,,,,$662.19,$0.00,1,1,1,1,1,1,20120101,V2629,HCPCS,PROSTHETIC EYE OTHER TYPE,,,28 ,,NW,,,,,,$139.29,$0.00,1,1,1,1,1,1,20120101,V2630,HCPCS,ANTER CHAMBER INTRAOCUL LENS,,,28 ,,NW,,,,,,$328.96,$0.00,1,1,1,0,1,1,20120101,V2631,HCPCS,IRIS SUPPORT INTRAOCLR LENS,,,28 ,,NW,,,,,,$484.49,$0.00,1,1,1,0,1,1,20120101,V2632,HCPCS,POST CHMBR INTRAOCULAR LENS,,,28 ,,NW,,,,,,$482.43,$0.00,1,1,1,0,1,1,20120101,V2700,HCPCS,BALANCE LENS,,,28 ,,NW,,,,,,$76.47,$0.00,1,1,1,1,1,1,20120101,V2702,HCPCS,DELUXE LENS FEATURE,,,28 ,,NW,,,,,,$15.86,$0.00,1,1,1,1,1,1,20120101,V2710,HCPCS,GLASS/PLASTIC SLAB OFF PRISM,,,28 ,,NW,,,,,,$97.93,$0.00,1,1,1,1,1,1,20120101,V2715,HCPCS,PRISM LENS/ES,,,28 ,,NW,,,,,,$19.83,$0.00,1,1,1,1,1,1,20120101,V2718,HCPCS,FRESNELL PRISM PRESS-ON LENS,,,28 ,,NW,,,,,,$61.50,$0.00,1,1,1,1,1,1,20120101,V2730,HCPCS,SPECIAL BASE CURVE,,,28 ,,NW,,,,,,$54.08,$0.00,1,1,1,1,1,1,20120101,V2744,HCPCS,TINT PHOTOCHROMATIC LENS/ES,,,28 ,,NW,,,,,,$37.90,$0.00,1,1,1,1,1,1,20120101,V2745,HCPCS,"TINT, ANY COLOR/SOLID/GRAD",,,28 ,,NW,,,,,,$12.70,$0.00,1,1,1,1,1,1,20120101,V2750,HCPCS,ANTI-REFLECTIVE COATING,,,28 ,,NW,,,,,,$52.90,$0.00,1,1,1,1,1,1,20120101,V2755,HCPCS,UV LENS/ES,,,28 ,,NW,,,,,,$36.55,$0.00,1,1,1,1,1,1,20120101,V2756,HCPCS,EYE GLASS CASE,,,28 ,,NW,,,,,,$6.54,$0.00,1,1,1,1,1,1,20120101,V2760,HCPCS,SCRATCH RESISTANT COATING,,,28 ,,NW,,,,,,$36.57,$0.00,1,1,1,1,1,1,20120101,V2761,HCPCS,MIRROR COATING,,,28 ,,NW,,,,,,$30.98,$0.00,1,1,1,1,1,1,20120101,V2762,HCPCS,"POLARIZATION, ANY LENS",,,28 ,,NW,,,,,,$84.95,$0.00,1,1,1,1,1,1,20120101,V2770,HCPCS,OCCLUDER LENS/ES,,,28 ,,NW,,,,,,$52.35,$0.00,1,1,1,1,1,1,20120101,V2780,HCPCS,OVERSIZE LENS/ES,,,28 ,,NW,,,,,,$21.79,$0.00,1,1,1,1,1,1,20120101,V2781,HCPCS,PROGRESSIVE LENS PER LENS,,,28 ,,NW,,,,,,$96.96,$0.00,1,1,1,1,1,1,20120101,V2782,HCPCS,"LENS, 1.54-1.65 P/1.60-1.79G",,,28 ,,NW,,,,,,$89.07,$0.00,1,1,1,1,1,1,20120101,V2783,HCPCS,"LENS, >= 1.66 P/>=1.80 G",,,28 ,,NW,,,,,,$96.17,$0.00,1,1,1,1,1,1,20120101,V2784,HCPCS,LENS POLYCARB OR EQUAL,,,28 ,,NW,,,,,,$74.22,$0.00,1,1,1,1,1,1,20120101,V2785,HCPCS,CORNEAL TISSUE PROCESSING,,,28 ,,NW,,,,,,"$4,144.40",$0.00,1,1,1,1,1,1,20120101,V2786,HCPCS,OCCUPATIONAL MULTIFOCAL LENS,,,28 ,,NW,,,,,,$116.67,$0.00,1,1,1,1,1,1,20120101,V2787,HCPCS,ASTIGMATISM-CORRECT FUNCTION,,,28 ,,NW,,,,,,$713.60,$0.00,1,1,1,1,1,1,20120101,V2788,HCPCS,PRESBYOPIA-CORRECT FUNCTION,,,28 ,,NW,,,,,,"$1,405.58",$0.00,1,1,1,1,1,1,20120101,V2790,HCPCS,AMNIOTIC MEMBRANE,,,28 ,,NW,,,,,,"$1,165.61",$0.00,1,1,1,0,1,1,20120101,V2797,HCPCS,VIS ITEM/SVC IN OTHER CODE,,,28 ,,NW,,,,,,$428.88,$0.00,1,1,1,1,1,1,20120101,V2799,HCPCS,MISCELLANEOUS VISION SERVICE,,,28 ,,NW,,,,,,$100.91,$0.00,1,1,1,0,1,1,20120101,V5008,HCPCS,HEARING SCREENING,,,8 ,,TotalUnits,,,,1.24 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,V5010,HCPCS,ASSESSMENT FOR HEARING AID,,,8 ,,TotalUnits,,,,1.62 ,,$0.00,$0.00,1,1,1,0,0,1,20120101,V5011,HCPCS,HEARING AID FITTING/CHECKING,,,28 ,,NW,,,,,,$162.45,$0.00,1,1,1,1,1,1,20120101,V5014,HCPCS,HEARING AID REPAIR/MODIFYING,,,28 ,,NW,,,,,,$95.35,$0.00,1,1,1,1,1,1,20120101,V5020,HCPCS,CONFORMITY EVALUATION,,,28 ,,NW,,,,,,$91.38,$0.00,1,1,1,1,1,1,20120101,V5030,HCPCS,BODY-WORN HEARING AID AIR,,,28 ,,NW,,,,,,"$2,555.86",$0.00,1,1,1,1,1,1,20120101,V5040,HCPCS,BODY-WORN HEARING AID BONE,,,28 ,,NW,,,,,,"$1,785.98",$0.00,1,1,1,1,1,1,20120101,V5050,HCPCS,HEARING AID MONAURAL IN EAR,,,28 ,,NW,,,,,,"$2,167.69",$0.00,1,1,1,1,1,1,20120101,V5060,HCPCS,BEHIND EAR HEARING AID,,,28 ,,NW,,,,,,"$1,703.49",$0.00,1,1,1,1,1,1,20120101,V5070,HCPCS,GLASSES AIR CONDUCTION,,,28 ,,NW,,,,,,$655.42,$0.00,1,1,1,1,1,1,20120101,V5080,HCPCS,GLASSES BONE CONDUCTION,,,28 ,,NW,,,,,,"$2,638.35",$0.00,1,1,1,1,1,1,20120101,V5090,HCPCS,HEARING AID DISPENSING FEE,,,28 ,,NW,,,,,,$521.77,$0.00,1,1,1,1,1,1,20120101,V5100,HCPCS,BODY-WORN BILAT HEARING AID,,,28 ,,NW,,,,,,"$4,629.36",$0.00,1,1,1,1,1,1,20120101,V5110,HCPCS,HEARING AID DISPENSING FEE,,,28 ,,NW,,,,,,$535.74,$0.00,1,1,1,1,1,1,20120101,V5120,HCPCS,BODY-WORN BINAUR HEARING AID,,,28 ,,NW,,,,,,"$3,962.99",$0.00,1,1,1,1,1,1,20120101,V5130,HCPCS,IN EAR BINAURAL HEARING AID,,,28 ,,NW,,,,,,"$3,722.21",$0.00,1,1,1,1,1,1,20120101,V5140,HCPCS,BEHIND EAR BINAUR HEARING AI,,,28 ,,NW,,,,,,"$4,454.68",$0.00,1,1,1,1,1,1,20120101,V5150,HCPCS,GLASSES BINAURAL HEARING AID,,,28 ,,NW,,,,,,"$4,800.80",$0.00,1,1,1,1,1,1,20120101,V5160,HCPCS,DISPENSING FEE BINAURAL,,,28 ,,NW,,,,,,$770.26,$0.00,1,1,1,1,1,1,20120101,V5170,HCPCS,WITHIN EAR CROS HEARING AID,,,28 ,,NW,,,,,,"$3,139.74",$0.00,1,1,1,1,1,1,20120101,V5180,HCPCS,BEHIND EAR CROS HEARING AID,,,28 ,,NW,,,,,,"$2,555.86",$0.00,1,1,1,1,1,1,20120101,V5190,HCPCS,GLASSES CROS HEARING AID,,,28 ,,NW,,,,,,"$3,099.30",$0.00,1,1,1,1,1,1,20120101,V5200,HCPCS,CROS HEARING AID DISPENS FEE,,,28 ,,NW,,,,,,$526.03,$0.00,1,1,1,1,1,1,20120101,V5210,HCPCS,IN EAR BICROS HEARING AID,,,28 ,,NW,,,,,,"$3,468.07",$0.00,1,1,1,1,1,1,20120101,V5220,HCPCS,BEHIND EAR BICROS HEARING AI,,,28 ,,NW,,,,,,"$3,306.33",$0.00,1,1,1,1,1,1,20120101,V5230,HCPCS,GLASSES BICROS HEARING AID,,,28 ,,NW,,,,,,"$3,440.57",$0.00,1,1,1,1,1,1,20120101,V5240,HCPCS,DISPENSING FEE BICROS,,,28 ,,NW,,,,,,$568.08,$0.00,1,1,1,1,1,1,20120101,V5241,HCPCS,"DISPENSING FEE, MONAURAL",,,28 ,,NW,,,,,,$157.28,$0.00,1,1,1,1,1,1,20120101,V5242,HCPCS,"HEARING AID, MONAURAL, CIC",,,28 ,,NW,,,,,,"$1,782.45",$0.00,1,1,1,1,1,1,20120101,V5243,HCPCS,"HEARING AID, MONAURAL, ITC",,,28 ,,NW,,,,,,"$1,877.44",$0.00,1,1,1,1,1,1,20120101,V5244,HCPCS,"HEARING AID, PROG, MON, CIC",,,28 ,,NW,,,,,,"$2,469.14",$0.00,1,1,1,1,1,1,20120101,V5245,HCPCS,"HEARING AID, PROG, MON, ITC",,,28 ,,NW,,,,,,"$2,260.31",$0.00,1,1,1,1,1,1,20120101,V5246,HCPCS,"HEARING AID, PROG, MON, ITE",,,28 ,,NW,,,,,,"$2,085.21",$0.00,1,1,1,1,1,1,20120101,V5247,HCPCS,"HEARING AID, PROG, MON, BTE",,,28 ,,NW,,,,,,"$2,483.97",$0.00,1,1,1,1,1,1,20120101,V5248,HCPCS,"HEARING AID, BINAURAL, CIC",,,28 ,,NW,,,,,,"$2,294.88",$0.00,1,1,1,1,1,1,20120101,V5249,HCPCS,"HEARING AID, BINAURAL, ITC",,,28 ,,NW,,,,,,"$1,840.01",$0.00,1,1,1,1,1,1,20120101,V5250,HCPCS,"HEARING AID, PROG, BIN, CIC",,,28 ,,NW,,,,,,"$5,963.87",$0.00,1,1,1,1,1,1,20120101,V5251,HCPCS,"HEARING AID, PROG, BIN, ITC",,,28 ,,NW,,,,,,"$5,333.72",$0.00,1,1,1,1,1,1,20120101,V5252,HCPCS,"HEARING AID, PROG, BIN, ITE",,,28 ,,NW,,,,,,"$7,619.80",$0.00,1,1,1,1,1,1,20120101,V5253,HCPCS,"HEARING AID, PROG, BIN, BTE",,,28 ,,NW,,,,,,"$3,540.55",$0.00,1,1,1,1,1,1,20120101,V5254,HCPCS,"HEARING ID, DIGIT, MON, CIC",,,28 ,,NW,,,,,,"$3,887.65",$0.00,1,1,1,1,1,1,20120101,V5255,HCPCS,"HEARING AID, DIGIT, MON, ITC",,,28 ,,NW,,,,,,"$3,049.14",$0.00,1,1,1,1,1,1,20120101,V5256,HCPCS,"HEARING AID, DIGIT, MON, ITE",,,28 ,,NW,,,,,,"$2,286.85",$0.00,1,1,1,1,1,1,20120101,V5257,HCPCS,"HEARING AID, DIGIT, MON, BTE",,,28 ,,NW,,,,,,"$2,744.22",$0.00,1,1,1,1,1,1,20120101,V5258,HCPCS,"HEARING AID, DIGIT, BIN, CIC",,,28 ,,NW,,,,,,"$4,366.36",$0.00,1,1,1,1,1,1,20120101,V5259,HCPCS,"HEARING AID, DIGIT, BIN, ITC",,,28 ,,NW,,,,,,"$3,811.42",$0.00,1,1,1,1,1,1,20120101,V5260,HCPCS,"HEARING AID, DIGIT, BIN, ITE",,,28 ,,NW,,,,,,"$3,811.42",$0.00,1,1,1,1,1,1,20120101,V5261,HCPCS,"HEARING AID, DIGIT, BIN, BTE",,,28 ,,NW,,,,,,"$4,421.25",$0.00,1,1,1,1,1,1,20120101,V5262,HCPCS,"HEARING AID, DISP, MONAURAL",,,28 ,,NW,,,,,,$186.93,$0.00,1,1,1,1,1,1,20120101,V5263,HCPCS,"HEARING AID, DISP, BINAURAL",,,28 ,,NW,,,,,,$169.44,$0.00,1,1,1,1,1,1,20120101,V5264,HCPCS,EAR MOLD/INSERT,,,28 ,,NW,,,,,,$102.91,$0.00,1,1,1,1,1,1,20120101,V5265,HCPCS,"EAR MOLD/INSERT, DISP",,,28 ,,NW,,,,,,$74.65,$0.00,1,1,1,1,1,1,20120101,V5266,HCPCS,BATTERY FOR HEARING DEVICE,,,28 ,,NW,,,,,,$1.91,$0.00,1,1,1,1,1,1,20120101,V5267,HCPCS,HEARING AID SUPPLY/ACCESSORY,,,28 ,,NW,,,,,,$29.74,$0.00,1,1,1,1,1,1,20120101,V5268,HCPCS,ALD TELEPHONE AMPLIFIER,,,28 ,,NW,,,,,,$137.49,$0.00,1,1,1,1,1,1,20120101,V5269,HCPCS,"ALERTING DEVICE, ANY TYPE",,,28 ,,NW,,,,,,$156.26,$0.00,1,1,1,1,1,1,20120101,V5270,HCPCS,"ALD, TV AMPLIFIER, ANY TYPE",,,28 ,,NW,,,,,,$224.01,$0.00,1,1,1,1,1,1,20120101,V5271,HCPCS,"ALD, TV CAPTION DECODER",,,28 ,,NW,,,,,,$395.96,$0.00,1,1,1,1,1,1,20120101,V5272,HCPCS,TDD,,,28 ,,NW,,,,,,$267.37,$0.00,1,1,1,1,1,1,20120101,V5273,HCPCS,ALD FOR COCHLEAR IMPLANT,,,28 ,,NW,,,,,,$525.96,$0.00,1,1,1,1,1,1,20120101,V5274,HCPCS,ALD UNSPECIFIED,,,28 ,,NW,,,,,,$152.83,$0.00,1,1,1,1,1,1,20120101,V5275,HCPCS,EAR IMPRESSION,,,28 ,,NW,,,,,,$68.61,$0.00,1,1,1,1,1,1,20120101,V5298,HCPCS,HEARING AID NOC,,,28 ,,NW,,,,,,"$3,415.46",$0.00,1,1,1,1,1,1,20120101,V5299,HCPCS,HEARING SERVICE,,,28 ,,NW,,,,,,$67.79,$0.00,1,1,1,0,0,1,20120101,V5362,HCPCS,SPEECH SCREENING,,,8 ,,RBRVS,0.86 ,0.28 ,3.50 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,V5363,HCPCS,LANGUAGE SCREENING,,,8 ,,RBRVS,0.86 ,0.28 ,3.50 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,V5364,HCPCS,DYSPHAGIA SCREENING,,,8 ,,RBRVS,,1.70 ,1.70 ,,,$0.00,$0.00,1,1,1,0,0,1,20120101,